ivtt meds

8/13/2019 ivtt meds

1/14

Omeprazole

LoSec (CAN), Prilosec

Drug Classes

Antisecretory agent; Proton pump inhibitorTherapeutic actionsGastric acid-pump inhibitor: suppresses gastric acid secretion by specific inhibition of the hydrogen/potass

ATPase enzyme system at the secretory surface of the gastric parietal cells; blocks the final step of acid

production.

Indications

Short-term treatment of active duodenal ulcer; First-line therapy in treatment of heartburn orsymptoms of gastroesophageal reflux disease (GERD); Short-term treatment of active benign gastr

ulcer; GERD, severe erosive esophagitis, poorly responsive symptomatic GERD; Treatment of patho

hypersecretory conditions ( Zollinger-Ellison syndrome, multiple adenomas, systemic mastocytosis(long-term therapy); Eradication of H. pylori with amoxicillin; Unlabeled use: posterior laryngitis;

enhance efficacy of pancreatin for the treatment of steatorrhea in cystic fibrosis

Contraindications/cautions

Contraindications: hypersensitivity to omeprazole or its components. Use cautiously with pregnancy, lactation.

Dosage

Available Forms: DR capsules--10, 20, 40 mg Adult : Active duodenal ulcer:20 mg PO qd for 4---8 wk. Shou

8/13/2019 ivtt meds

2/14

be used for maintenance therapy. ; Active gastric ulcer: 40 mg PO qd for 4---8 wk. ; Severe erosive esopha

or poorly responsive GERD: 20 mg PO daily for 4---8 wk. Do not use as maintenance therapy. Do not use >8

Pathologic hypersecretory conditions: Individualize dosage. Initial dose is 60 mg PO qd. Doses up to 120 m

have been used. Administer daily doses of > 80 mg in divided doses.

Adverse Effects CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream

abnormalities; GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue

atrophy; Respiratory: URI symptoms, cough, epistaxis; Dermatologic: Rash, inflammation, urticaria,

pruritus, alopecia, dry skin; Other: Cancer in preclinical studies, back pain, fever

Clinically important drug-drug interactions

Increased serum levels and potential increase in toxicity of benzodiazepinesNursing Considerations

Assessment History: Hypersensitivity to omeprazole or any of its components, pregnancy, lactation

Physical: Skin lesions; T; reflexes, affect; urinary output, abdominal exam; respiratory auscultation

Implementation

Administer before meals. Caution patient to swallow capsules whole, not to open, chew, or crush. Arrange for further evaluation of patient after 8 wk of therapy for gastroreflux disorders; not inten

for maintenance therapy. Symptomatic improvement does not rule out gastric cancer, which did o

in preclinical studies.

Administer antacids with omeprazole, if needed.

8/13/2019 ivtt meds

3/14

Dexamethasone Drug Classes

Corticosteroid; Glucocorticoid; HormoneTherapeutic actions

Enters target cells and binds to specific receptors, initiating many complex reactions that are responsible foantiinflammatory and immunosuppressive effects.

Indications

Hypercalcemia associated with cancer; Short-term management of various inflammatory and allergdisorders, such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus

status asthmaticus, and autoimmune disorders; Hematologic disorders: thrombocytopenic purpura

erythroblastopenia; Trichinosis with neurologic or myocardial involvement; Ulcerative colitis, acute

exacerbations of multiple sclerosis, and palliation in some leukemias and lymphomas

Contraindications/cautions Contraindications: infections, especially tuberculosis, fungal infections, amebiasis, vaccinia and var

and antibioticresistant infections.

Use cautiously with renal or hepatic disease; hypothyroidism, ulcerative colitis with impendingperforation; diverticulitis; active or latent peptic ulcer; inflammatory bowel disease; CHF, hyperten

thromboembolic disorders; osteoporosis; convulsive disorders; diabetes mellitus; lactation.

Dosage

Available Forms: Tablets--0.25, 0.5, 0.75, 1, 1.5, 2, 4, 6 mg; elixir--0.5 mg/5ml; oral solution--0.5 mg/5ml;

8/13/2019 ivtt meds

4/14

injection--8 mg/ml, 16 mg/ml, 4 mg/ml, 10 mg/ml, 20 mg/ml, 24 mg/ml; aerosol--84 µg/actuation; ophtha

solution--0.1%; ophthalmic suspension--0.1%; ophthalmic ointment--0.05%;

Adverse Effects

CNS: Convulsions, vertigo, headaches, pseudotumor cerebri, euphoria, insomnia, mood swings,depression, psychosis, intracerebral hemorrhage, reversible cerebral atrophy in infants, cataracts,increased intraocular pressure, glaucoma ; GI: Peptic or esophageal ulcer, pancreatitis, abdominal

distention ; CV: Hypertension, CHF, necrotizing angiitis ; Hematologic: Fluid and electrolyte disturba

negative nitrogen balance, increased blood sugar, glycosuria, increased serum cholesterol, decreas

serum T3 and T4 levels ; GU: Amenorrhea, irregular menses ; MS: Muscle weakness, steroid myopat

loss of muscle mass, osteoporosis, spontaneous fractures ; Endocrine: Growth retardation, decreas

carbohydrate tolerance, diabetes mellitus, cushingoid state, secondary adrenocortical and pituitary

unresponsiveness; Hypersensitivity: Anaphylactoid or hypersensitivity reactions; Other: Impaired w

healing; petechiae; ecchymoses; increased sweating; thin and fragile skin; acne; immunosuppressiomasking of signs of infection; activation of latent infections, including tuberculosis, fungal, and vira

infections; pneumonia; abscess; septic infection; GI and GU infections


Increased therapeutic and toxic effects of cortisone with troleandomycin Decreased effects of anticholinesterases with corticotropin; profound muscular depression is poss Decreased steroid blood levels with phenytoin, phenobarbital, rifampin Decreased serum levels of salicylates with cortisone.

8/13/2019 ivtt meds

5/14

Nursing Considerations

For systemic administration: Do not give drug to nursing mothers; drug is secreted in breast milk. Give daily doses before 9 am to mimic normal peak corticosteroid blood levels. Increase dosage when patient is subject to stress.

Taper doses when discontinuing high-dose or long-term therapy. Do not give live virus vaccines with immunosuppressive doses of corticosteroids. For respiratory inhalant, intranasal preparation: Do not use respiratory inhalant during an acute

asthmatic attack or to manage status asthmaticus.

Do not use intranasal product with untreated local nasal infections, epistaxis, nasal trauma, septalulcers, or recent nasal surgery.

Taper systemic steroids carefully during transfer to inhalational steroids; adrenal insufficiency deathave occurred.

For topical dermatologic preparations: Use caution when occlusive dressings, tight diapers; coveraffected area; these can increase systemic absorption.

Avoid prolonged use near the eyes, in genital and rectal areas, and in skin creases.

8/13/2019 ivtt meds

6/14

Furosemide

Apo-Furosemide (CAN), Furoside (CAN), Lasix, Myrosemide (CAN)

Drug Classes

Loop diureticTherapeutic actions

Inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of

Henle, leading to a sodium-rich diuresis.

Indications

Edema associated with CHF, cirrhosis, renal disease (oral, IV); Acute pulmonary edema (IV);Hypertension (oral)


Contraindications: allergy to furosemide, sulfonamides; allergy to tartrazine (in oral solution); electdepletion; anuria, severe renal failure; hepatic coma; pregnancy; lactation.; Use cautiously with SLEgout, diabetes mellitus.

Dosage

Available Forms: Tablets--20, 40, 80 mg; oral solution--10 mg/ml, 40 mg/5 ml; injection--10 mg/ml

IV Facts

Preparation: Store at room temperature; exposure to light may slightly discolor solution. Infusion: Inject directly or into tubing of actively running IV; inject slowly over 1---2 min.

8/13/2019 ivtt meds

7/14

Incompatibilites: Do not mix with acidic solutions. Isotonic saline, Lactated Ringer's Injection, and 5Dextrose Injection may be used after pH has been adjusted (if necessary); precipitates form with

gentamicin, netilimicin, milrinone in 5% Dextrose, 0.9% Sodium Chloride.

Adverse Effects

CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue, blurredvision, tinnitus, irreversible hearing loss; GI: Nausea, anorexia, vomiting, oral and gastric irritation,

constipation; diarrhea, acute pancreatitis, jaundice ; CV: Orthostatic hypotension, volume depletion

cardiac arrhythmias, thrombophlebitis ; Hematologic: Leukopenia, anemia, thrombocytopenia, fluid

electrolyte imbalances; GU: Polyuria, nocturia, glycosuria, urinary bladder spasm ; Dermatologic:

Photosensitivity, rash, pruritus, urticaria, purpura, exfoliative dermatitis, erythema multiforme ;Oth

Muscle cramps and muscle spasms


Increased risk of cardiac arrhythmias with digitalis glycosides (due to electrolyte imbalance) Increased risk of ototoxicity with aminoglycoside antibiotics, cisplatin Decreased absorption of furosemide with phenytoin Decreased natriuretic and antihypertensive effects with indomethacin, ibuprofen, other NSAIDs Decreased GI absorption with charcoal


Assessment

History: Allergy to furosemide, sulfonamides, tartrazine; electrolyte depletion anuria, severe renal failure;

hepatic coma; SLE; gout; diabetes mellitus; lactation

8/13/2019 ivtt meds

8/14

Physical: Skin color, lesions, edema; orientation, reflexes, hearing; pulses, baseline ECG, BP, orthostatic BP,

perfusion; R, pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns; CBC, se

electrolytes (including calcium), blood sugar, liver and renal function tests, uric acid, urinalysis

Implementation

Administer with food or milk to prevent GI upset. Reduce dosage if given with other antihypertensives; readjust dosages gradually as BP responds. Give early in the day so that increased urination will not disturb sleep. Avoid IV use if oral use is at all possible. Do not mix parenteral solution with highly acidic solutions with pH below 3.5. Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions. Discard diluted solution after 24 h. Refrigerate oral solution. Measure and record weight to monitor fluid changes. Arrange to monitor serum electrolytes, hydration, liver function. Arrange for potassium-rich diet or supplemental potassium as needed.

8/13/2019 ivtt meds

9/14

Metronidazole

Apo-Metronidazole (CAN), Flagyl, MetroCream (CAN), MetroGel, Metro I.V., Neo-Tric (CAN)

Drug Classes

Antibiotic ; Antibacterial; Amebicide; AntiprotozoalTherapeutic actions

Bactericidal: inhibits DNA synthesis in specific (obligate) anaerobes, causing cell death; antiprotozoal-

trichomonacidal, amebicidal: biochemical mechanism of action is not known.

Indications

Acute infection with susceptible anaerobic bacteria; Acute intestinal amebiasis; Amebic liver absceTrichomoniasis (acute and partners of patients with acute infection); Preoperative, intraoperative,

postoperative prophylaxis for patients undergoing colorectal surgery; Topical application in the

treatment of inflammatory papules, pustules, and erythema of rosacea; Unlabeled uses: prophylax

patients undergoing gynecologic, abdominal surgery; hepatic encephalopathy; Crohn's disease;antibiotic-associated pseudomembranous colitis; treatment of Gardnerella vaginalis, giardiasis (us

recommended by the CDC)


Contraindications: hypersensitivity to metronidazole; pregnancy (do not use for trichomoniasis in ftrimester).

Use cautiously with CNS diseases, hepatic disease, candidiasis (moniliasis), blood dyscrasias, lactatDosage

Available Forms: Tablets--250, 500 mg; powder for injection--500 mg; injection--500 mg/100 ml

8/13/2019 ivtt meds

10/14

IV Facts

Preparation: Reconstitute by adding 4.4 ml of Sterile Water for Injection, Bacteriostatic Water forInjection, 0.9% Sodium Chloride Injection, Bacteriostatic 0.9% Sodium Chloride Injection to the vial

mix thoroughly.

Adverse Effects

CNS: Headache, dizziness, ataxia, vertigo, incoordination, insomnia, seizures, peripheral neuropathfatigue; GI: Unpleasant metallic taste, anorexia, nausea, vomiting, diarrhea, GI upset, cramps; GU:

Dysuria, incontinence, darkening of the urine; Local: Thrombophlebitis (IV); redness, burning, dryne

and skin irritation (topical); Other: Severe disulfiramlike interaction with alcohol, candidiasis

(superinfection)


Decreased effectiveness with barbiturates Disulfiram-like reaction (flushing, tachycardia, nausea, vomiting) with alcohol Psychosis if taken with disulfiram Increased bleeding tendencies with oral anticoagulants


Avoid use unless necessary. Metronidazole is carcinogenic in some rodents. Administer oral doses with food. Apply topically (MetroGel, MetroCream) after cleansing the area. Advise patient that cosmetics ma

used over the area after application.

Reduce dosage in hepatic disease.

8/13/2019 ivtt meds

11/14

Piperacillin sodium

Pipracil

Drug Classes

Antibiotic; Penicillin with extended spectrumTherapeutic actions

Bactericidal: inhibits synthesis of cell wall of sensitive organisms, causing cell death.

Indications

Treatment of mixed infections and presumptive therapy prior to identification of organisms Lower respiratory tract infections caused by Haemophilus influenzae, Klebsiella, Pseudomonas

aeruginosa, Serratia, E. coli, Bacteroides, Enterobacter

Intra-abdominal infections caused by E. coli, P. aeruginosa, Clostridium, Bacteroides species, includBacteroides fragilis

UTIs caused by E. coli, Proteus species, including Proteus mirabilis, Klebsiella, P. aeruginosa, entero Gynecologic infections caused by Neisseria gonorrhoeae, Bacteroides, enterococci, anaerobic cocci Skin and skin-structure infections caused by E. coli, P. mirabilis, indole-positive Proteus, P. aerugino

Klebsiella, Enterobacter, Bacteroides, Serratia, Acinetobacter

Bone and joint infections caused by P. aeruginosa, Bacteroides, enterococci, anaerobic cocci Septicemia caused by E. coli, Klebsiella, Enterobacter, Serratia, P. mirabilis, Streptococcus pneumon

P. aeruginosa, Bacteroides, enterococci, anaerobic cocci

Infections caused by Streptococcus (narrower spectrum antibiotic usually used) Prophylaxis in abdominal surgery

8/13/2019 ivtt meds

12/14


Contraindications: allergies to penicillins, cephalosporins, procaine, or other allergens. Use cautiously with pregnancy, lactation (may cause diarrhea or candidiasis in the infant).

Dosage

Available Forms: Powder for injection--2, 3, 4 g

Adverse Effects

CNS: Lethargy, hallucinations, seizures; GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue,“hairy” tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis,

pseudomembranous colitis, nonspecific hepatitis; Hematologic: Anemia, thrombocytopenia, leuko

neutropenia, prolonged bleeding time; GU: Nephritis; Hypersensitivity reactions: Rash, fever, whee

anaphylaxis; Other: Superinfections, sodium overload--CHF;Local: Pain, phlebitis, thrombosis at inje

site

Nursing Considerations Culture infection before beginning treatment; reculture if response is not as expected. Continue therapy for at least 2 d after signs of infection have disappeared, usually 7---10 d. Administer by IM or IV routes only. Carefully check IV site for signs of thrombosis or drug reaction. Do not give IM injections repeatedly in the same site, atrophy can occur; monitor injection sites. Maintain epinephrine, IV fluids, vasopressors, bronchodilators, oxygen, and emergency equipment

standby in case of serious hypersensitivity reaction.

8/13/2019 ivtt meds

13/14

Generic Name: Ciprofloxacin hydrochloride

Brand Name: Ziprocap

Dosage: 500 mg/cap, BID

Drug Classes: * Antibacterial

Therapeutic actions: Bactericidal; interferes with DNA replication in susceptible gram-negative bacteria

preventing cell reproduction.

Indications:

* For the treatment of infections caused by susceptible gram-negative bacteria, including E. coli, P. mirabi

pneumoniae, Enterobacter cloacae, P. vulgaris, P. rettgeri, M. morganii, P. aeruginosa, Citrobacter freundii

aureus, S. epidermidis, group D streptococci

* Treatment of acute otitis externa (otic)

* Treatment of chronic bacterial prostatitis

* Unlabeled use: effective in patients with cystic fibrosis who have pulmonary exacerbationsContraindications/cautions: * Contraindications: allergy to ciprofloxacin, norfloxacin, pregnancy, lactatio

* Use cautiously with renal dysfunction, seizures.

Adverse Effects:

* CNS: Headache, dizziness, insomnia, fatigue, somnolence, depression, blurred vision

* GI: Nausea, vomiting, dry mouth, diarrhea, abdominal pain

* Hematologic: Elevated BUN, SGOT, SGPT, serum creatinine and alkaline phosphatase; decreased WBC,

neutrophil count, Hct

* Other: Fever, rash

8/13/2019 ivtt meds

14/14

Nursing Responsibilities

* Arrange for culture and sensitivity tests before beginning therapy.

* Continue therapy for 2 d after signs and symptoms of infection are gone.

* Give oral drug 1 h before or 2 h after meals with a glass of water.

* Ensure that patient is well hydrated.

* Give antacids at least 2 h after dosing.

* Monitor clinical response; if no improvement is seen or a relapse occurs, repeat culture and sensitivity

* Encourage patient to complete full course of therapy.

Drug-specific teaching points:

* Take oral drug on an empty stomach--1 h before or 2 h after meals. If an antacid is needed take it at le

before or after dose.* Drink plenty of fluids while you are on this drug.

* Know that the following side effects may occur: nausea, vomiting, abdominal pain (small, frequent mea

may help); diarrhea or constipation; drowsiness, blurring of vision, dizziness (observe caution if driving or u

dangerous equipment).

* Report rash, visual changes, severe GI problems, weakness, tremors.

ivtt meds

Documents

Transcript of ivtt meds