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Commonly !"# #$%! &n
'm"$%"n(y ) *C+
/-,
5 000000000000000423 0000000000000000001
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?;9:00000000
@$!&n% Ao(8o$
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A$% GH%" A$% GH%"
$. +cetamino!hen
?
). +cetylsalicylic +cid A
>. +cti"ated ,harcoal B
;. +drenaline
C
?. +llumag
$0
A. +llo!urinol
$$
D. +mikacin
$)
B. +mino!hylline
$>
C. +miodarone$;
$0.+m!icillin
$A
$$.+m!hotercin
$D
$).+tenolol
$B
$>.+tor"astatin
$C
$;.+tracrium
)0
$?.+tro!ine
)$
$A.5iso!rolol
))
$D.,alcium
)>
$B.,a!to!ril
)?
$C.,ar"edilol
)D
)0.,efa9olin)B
)$.,efota3ime E ,laforan F
)C
)).,efta9idime F 8ortum F
>0
)>.,eftria3one E 2oce!hin F
>$
>
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);.,efuro3ime E Ginacef E
>)
)?.,hloram!henicol
>;
)A.,hlor!roma9ine
>?
)D.,i!roflo3acin
>A
)B.,lindamycin
>D
)C.,lo3acilin
>C
>0.6e3amethasone
;0
>$.6ia9e!am F+ssi"al
;)
>).6iclofenac Sodium
;>
>>.6igo3in
;?
>;.6iltia9im
;A
>?.6obutamine
;B
>A.6o!amine?0
>D.6o3ycyclin
?)
>B.1nala!ril
??
>C. 1no3a!arin F,le3aneF
?D
;0.1!hdrine
?C
;$.1rythromycin
A)
;).1some!ra9ole
AD
;>.8entanyl
AC
;;.8luma9enil F +ne3ateF D$
;?.8urosemiade
D>
;A.%entamycin
D?
;D.%libenclamide E 6aonil E DA
;B.%lucagon
DD
;C.7alo!eridol
DB?0.7e!arin
B$
?$.7uman +lbumin B>
?).7ydrocortisone
B;
?>.7ydrala9ine
BD
?;.7yoscine 5utyl!romide
BB
??.I!rtro!ium 5romide BC
?A.Iso!roterenol
C$
?D.etamine
C>
;
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?B.Lidocaine
C;
?C.4agnesium Sul!hate CA
A0.4annitol
CD
A$.4e!eridine F Pethidine F CC
A).4etformin
$0$
A>.4ethyl!rednisolone
$0)
A;.4etoclo!ramide
$0;
A?.4etronida9ole
$0?
AA.4ida9olam
$0D
AD.4or!hine
$0BAB./acetylcystine
$$0
AC./alo3ane
$$$
D0./efidi!ine
$$)
D$./eostigmine$$;
D)./itrates
$$?
D>./itro!russide
$$A
D;./oradrenaline
$$B
D?.Ome!ra9ole
$)0
DA.Octreotide F SandostatinE $)$
DD. O3ytocin
$)>
DB.Pancuronium
$);
DC.Penicillin %
$)?
B0.Phenobar!itol
$)A
B$.Phenytoin
$)B
B).Potassium ,hloride
$)C
B>.Prednisolone
$>0
B;.Prometha9ine$>>
B?.Pro!ofol
$>;
BA.Pro!ranolol
$>A
BD.Protamine Sul!hate $>D
BB.Huinidine Sul!hate $>B
BC.2anitidine
$;0
C0.2egular Insulin $;$
C$.Salbutamol E
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C>.S!ironolactone
$;A
C;.Stre!tokinase
$;D
C?.Succinyl ,holine
$;B
CA.*hio!ental Sodium E
PentothalE$;C
CD.*hyro3ine E 1ltro3inE $?$
CB.*rane3amic acid E $?>
CC.
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Commonly !"# #$%! &n 'm"$%"n(y Hn# *C+
S. GH$H("8Hmol T , T L("8Hm&noK7"n
U$H#" nHm"!&acamol !anadol
ClH!!, anti!yretic non o!ioid analgesic Paraamino!henol ty!e.
G$"%nHn(y,',ategory 5(L(8&on,+cetamino!hen decrease fe"er by an effect on hy!othalamus
leading to sweating J "asodilatation.
It also inhibits the effect of !yrogens on the heatregulating
,enter on the hy!othalamus.
It may cause analgesia by inhibiting ,/S !rostaglandin syntheses
So it has no antiinflammatory effect.
It doesnKt manifest any anticoagulant effect or any ulceration of %I*.+!"!,
Pain due to 7eadache dysmenorrhea arthralgia myalgia muscluoskletal !ain
immuni9ation teething tonsillectomy.
*o reduce fe"er due to bacterial J "iral infection.
+s a substitute for as!irin when contraindicated.
Con8$H&n#&(H8&on!,
2enal insufficiency anemia.V" "II"(8!,
,hronic J e"en acute to3icity can occur after long sym!tomfree usage.
7emolytic anemia neutro!nea thrombocyto!enia
Skin rashes fe"er aundice and hy!oglycemia.
Sym!toms of o"er dosage&
7e!atic to3icity general malaise delirium de!ression sei9ures
,oma J death nausea "omiting fe"er and "ascular colla!se.
U$"H8m"n8 oI oQ"$#o!",
$ Induction of emesis.
) %astric la"age.
> +cti"ated charcoal.
; Oral /acetyleystine 'mucomyst( is said to reduce or !re"ent he!atic damage
by inacti"ating acetamino!hen metabolites which cause li"er effects.
Ao!",by mouth 0.?M$ g e"ery ;MA hours to a ma3. Of ; g daily-
D
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C7&l#,
) months A0 mg for !ostimmuni9ation !yre3ia-
Otherwise under > months 'on doctorEs ad"ice only( $0 mgNkg
'? mgNkg if aundiced(-
> monthsM$ year A0M$)0 mg
$M? years $)0M)?0 mg
AM$) years )?0M?00 mg-
*hese doses may be re!eated e"ery ;MA hours when necessary
'4a3. of ; doses in ); hours(
@$!&n% (on!"$H8&on!,$ Su!!ositories should be stored below )D,.
) Li"er function studies for long term thera!y.> /ote signs of methemoglobinemia& bluish discoloration of gum J fingernails.
; 7a"e mucomyst a"ailable for signs of to3icity.
? *each !atient signs of to3icity to be re!orted immediately.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
D. L("8yl!Hl&(yl&( L( W L!K&$&n W ,
U$H#" nHm",+s!irin
ClH!!&I&(H8&on,
/onnarcotic analgesic anti!yretic antiinflammatory antirhumatic ant !latelet
/S+I6.
G$"%nHn(y,',ategory ,(
L(8&on,
*he anti!yretic effect is due to an action on the hy!othalamus that results in heat
loss by "asodilatation of !eri!heral blood "essels J !romoting sweating.
*he antiinflammatory effects !robably by decreasing !rostaglandin synthesis J
other mediators of the !ain res!onse.
*he analgesic action is not fully known but may be due to im!ro"ement of the
inflammatory condition .
@.M.&+s!irin also !roduces inhibition of !latelet aggregation.
+!"!,
Pain 4yalgia
+rthralgia 7eadache
6ysmenorrhea +nti!yretic 'reduce fe"er(
B
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+na!hyla3is
Skin rashes.
Increase bleeding time.
VHl&(ylH8" 8oX&(&8y- Salicylism&nausea "omiting di99iness tinnitus difficulty hearing diarrhea
mental confusion.
- +cute as!irin !oisoning&2es!iratory alkalosis hy!er!nea tach!nea
hemorrhage confusion !ulmonary edema con"ulsion tetany metabolic
acidosis.
A$% &n8"$H(8&on!,
2isk for bleeding increase if taken with other anticoagulants.2isk of %I bleeding increase if taken with steroids alcohol or other /S+I/6s.
Increased risk for salicylate to3icity if taken with frusimide 'lasi3(
7y!otension may occur if taken with nitroglycerin.
@$!&n% (on!"$H8&on!,
$.*ake drug with or after food or with milk to decrease %I irritation.
).+ssess for history of asthma and history of hy!ersensiti"ity.
>.6o not use with other anticoagulants.
;./ote any history of !e!tic ulcer.
?.2e!ort signs of side effect e.g. gastric irritation if occurs.
A.+s!irin is not gi"en $ week before J after surgery to !re"ent bleeding.
D. If !atient is diabetic discuss the !ossibility of hy!oglycemia occurring Patients
should monitor their blood glucose le"el freuently.
B. *eaches !atient about the to3ic sym!toms
'ringing in the ears( di99iness mental confusionetc( and
ask himNher to re!ort it to !hysician.
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@
Y. L(8&QH8"# C7H$(oHl ,
U$H#" nHm",1ucarbon
L(8&on&adsorbents
G$"%nHn(y,',ategory ,(
+!"!&used as adsorbent in cases of organo!hos!hourous !oisoning
$0
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Ao!" ,the first dose of $00 g is gi"en with a la3ati"e
'1.g. magnesium sul!hate( followed by acti"ated
charcoal ?0 g e"ery ; hours 'or more freuently if
tolerated( until the charcoal is seen in the stool.
@$!&n% (on!"$H8&on!, 13!lain the !rocedure to !atient because it always gi"en "ia /%* es!ecially if the
!atient is conscious and you want to insert /%*
ear glo"es when dealing with this drug because the !owder form discolor e"ery
thing to black color when touching it
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Z. L#$"nHl&n" W 'K&n"K7$&n" T , VymKH87om&m"8&(!
U$H#" nHm",+drenalineClH!!&6irect actingadrenergic agent.
G$"%nHn(y,',ategory ,(L(8&on,
+ natural hormone !roduced from adrenal medulla- induce marked stimulation of al!ha $ )
rece!tors causing cardiac stimulation bronchodilation J decongestion.
+!"!,
$ 2elief of res!iratory distress due to bronchos!asm.
) 2a!id relief of hy!ersensiti"ity reactions.
> ,ardiac arrest.
; O!en angle glaucoma.
? *o !rolong the action of anesthesia.
A *o!ically to sto! bleeding.
Ao!",
+"ailable in am!oules of $ml containing $ mg adrenaline
,an be gi"en by I.4 inection. I.
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is doubt as to the adeuacy of the circulation by slow intra"enous inection of $ in $0 000
'$00 microgramsNmL( solution 'e3treme caution(
Ao!",
I
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[. Llm&n&m 7y#$oX" Hn# mH%n"!&m 7y#$oX" ,
U$H#" nHm",WW LllmH%T
ClH!!&+ntacids
G$"%nHn(y,',ategory 5(
L(8&on&neutrali9ing or reducing gastric acidity thus increasing the !7 of the stomach and relie"ing
hy!eracidity. If the !7 is increased to ; the acti"ity of !e!sin is inhibited.
+!"!,
a. *reatment of hy!eracidity. '7eart burns(.b. Pe!tic ulcerc. 6uodenal ulcer.d. %astroeso!haged reflu3.e. hiatus hernia
Ao!"&$0 mL > or ; times daily of liuid magnesiumMaluminum antacids. +ntacids are best gi"en
when sym!toms occur or are e3!ected usually between meals and at
bedtime ; or more times daily- additional doses may be reuired u! to
once an hour.
Con8$H&n#&(H8&on!, Pregnancy
,hildren less than A years of age.
,hronic use of aluminum containing antacids may contribute to de"elo!ment of
+l9heimerKs disease.V" "II"(8!,
,onsti!ation intestinal obstruction bone !ain muscle weakness.
@$!&n% (on!"$H8&on!, It is recommended that most antacids be taken at > hours after meals J at bed M time.
*ablets should be thoroughly chewed before swallowing J followed by a glass of milk orwater.
Shake liuid sus!ensions thoroughly before !ouring the medication .
,lientKs taking aluminum or calcium containing antacids should take )?00>000 cc of fluids
to !re"ent consti!ation. +d"ise clients to re!ort !ersistent diarrhea or consti!ation !hysician.
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\. LlloK$&nol , ]ylo$&(
U$H#" nHm",Gyloric
ClH!!&+ntigout +gents
G$"%nHn(y,',ategory ,(
L(8&on,Is a !otent 3anthine o3idase inhibitor which reduces both serum and urinary uric acid
le"els by inhibiting the formation of uric acid without disru!ting the biosynthesis of "ital !urines.
$>
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+!"!,
Is the drug of choice for chronic gouty arthritis 'not useful for treatment of acutegout(.
7y!eruricemia associated with blood diseases renal diseases.
Pro!hylasis in hy!eruricemia in !atients with neo!lastic conditions.
*reatment of !atients with recurrent uric stone formation.
Ao!"
initially $00 mg daily !referably after food then adusted according
to !lasma or urinary uric acid concentration- usual maintenance dose in mild conditions $00M
)00 mg daily in moderately se"ere conditions >00MA00 mg daily in se"ere conditions D00MC00 mg
daily- doses o"er >00 mg daily gi"en in di"ided doses- ,7IL6 under $?years 'in neo!lastic
conditions en9yme disorders( $0M)0 mgNkg daily 'ma3. ;00 mg daily(
Con8$H&n#&(H8&on!, 7y!ersensiti"ity. Lactation.
7emochromatosis.
,hildren e3ce!t for those with neo!lastie diseases.V" "II"(8!,
Skin rash alo!ecia fe"er leuko!nea arthralgia nausea "omiting.@$!&n% (on!"$H8&on!,
+dminister with food or immediately after meal to lessen gastric irritation.
+t least $0$) eight ounce glasses of fluid should be taken each day.
ee! urine alkaline to !re"ent the formation of uric acid stones. *ake com!lete drug history.
4onitor the ,5, li"er J renal function J serum uric acid on routine bases.
If skin rash a!!ear re!ort to !hysician.
+"oid e3cessi"e intake of "itamin , which lead to the !otential for theformation of kidney stones.
+d"ice clients not to take iron salts with allo!urinol since high ironconcentration may occur in the li"er.
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^. Lm&_H(&n VlIH8",
U$H#" nHm",amikin
ClH!!&+ntibiotic F+mino glycosidesF
G$"%nHn(y,',ategory ,(L(8&on,inhibit !rotein synthesis by binding irre"ersibly to ribosome which leads to !roduction of
nonfunctional !rotein. *hey are usually bactericidal as a result of disru!tion of bacterial
cyto!lasmic membrane.
+!"!, 5one and oint infections.
2es!iratory tract infections.
$;
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Se!ticemia 'including neonatal se!sis(.
Urinary tract infection 'UI*(.
Post o!erati"e infections.
Intra Mabdominal infections 'as !eritonitis( .
Skin infections 'including burns(
Ao!" & by intramuscular or by slow intra"enous inection or by infusion $? mgNkg daily
in ) di"ided doses increased to )).? mgNkg daily in > di"ided doses in se"ere infections-
ma3. $.? g daily for u! to $0 days 'ma3. cumulati"e dose $? g(- child $? mgNkg daily in )
di"ided doses- neonate loading dose of $0 mgNkg then $? mgNkg daily in ) di"ided doses.
Con8$H&n#&(H8&on!, 7y!ersensiti"ity to amino glycosides.
Long Mterm thera!y.
8or !atients with im!aired renal function or !ree3isting hearing im!airment.
V" "II"(8!,
Ototo3icity& tinnitus hearing im!airment ata3ia J di99iness.
2enal im!airment '/e!hroto3icity( hematuria !roteinuriaR
/euroto3icity& headache tremor lethargy numbness burning of face.
Others& nausea "omiting skin rash J su!er infection.
@$!&n% (on!"$H8&on!, I.4. admin. Inect dee! into muscle to minimi9e !ain.
+dmin. 8or only D$0 days. +ssess history of hy!ersensiti"ity.
Obtain lab. Studies for renal function.
,ontinue to monitor for ototo3icity.
6iscuss with the client N family the im!ortance of taking medications at thea!!ro!riate !rescribed time inter"als.
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F. Lm&noK7yll&n",
ClH!!&+ntiasthmatic bronchodilator
G$"%nHn(y,',ategory ,(L(8&on&2ela3es smooth muscles of bronchi causing bronchodilation and increasing "ital ca!acity
of the lungs
+!"!,
Pro!hyla3is and treatment of bronchial asthma.
2e"ersible bronchos!asm associated with ,.O.P.6.
Ao!" ,
5y mouth$00M>00 mg >M; times daily after food
$?
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slow intra"enous inection&o"er at least )0 minutesF not !re"iously treated with
theo!hyllineF 'with close monitoring( '? mgNkg(
Intra"enous infusion& 0.> M 0.D mgNkgNhour
Con8$H&n#&(H8&on!, 7y!ersensiti"ity
7y!otension
,oronary artery disease 'angina !ectoris(.
V" "II"(8!,
/ausea "omiting e!igastric !ain.
2ectal irritation following use of su!!ositories.
7eadache di99iness 7y!otension arrhythmias ' tachycardia(
+mino!hylline gi"en by ra!id I. of the
cardiac action !otential. It has numerous other effects howe"er including actions that are similar to
those of antiarrhythmic classes I II and I times daily for $ week reduced to )00 mg twice daily for a
further week- maintenance usually )00 mg daily or the minimum reuired to control the
arrhythmia
by intra"enous infusion&initially ? mgNkg o"er )0M$)0 minutes with 1,% monitoring-
$A
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subseuent infusion gi"en if necessary according to res!onse u! to ma3. $.) g in ); hours FC00 mg
o"er )> hours E.
Q(-
erythema multiform e3foliati"e dermatitis !ruritus skin cancer Ste"ens
ohnson syndrome to3ic e!idermal necrolysis "asculitis '!ostmarketing(.
11/*
Q(.
%I
/ausea "omiting '$0Q to >>Q(- anore3ia consti!ation ';Q to
CQ(- abdominal !ain abnormal sali"ation abnormal taste '$Q to
>Q(- !ancreatitis '!ostmarketing(.
@$!&n% (on!"$H8&on!,
6uring I< infusion carefully monitor blood !ressure and
Slow the infusion if significant hy!otension occurs.
$D
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5radycardia should be treated by slowing the infusion or discontinuing it if
necessary. Sustained monitoring is essential because drug has an unusually long
halflife.
2e!ort ad"erse reactions !rom!tly. 5ear in mind that long
1limination halflife means that drug effects will !ersist long
after dosage adustments are made or drug is discontinued.
5e alert to signs of !ulmonary to3icity& !rogressi"e dys!nea
fatigue cough !leuritic !ain fe"er.
+uscultate chest !eriodically or when !atient com!lains of
res!iratory sym!toms. ,heck for diminished breath sounds rales !leuritic friction
rub- obser"e breathing !attern. 6rug induced !ulmonary function !roblems must be
distinguished from ,78 or !neumonia. ee! your medical direction !hysician
informed.
4onitor heart rate and rhythm and 5P until drug res!onse
has stabili9ed. 2e!ort !rom!tly sym!tomatic bradycardia.
Patients already recei"ing antidysrhythmic thera!y when
+miodarone is started must be closely obser"ed for ad"erse
effects !articularly conduction disturbances and e3acerbation of dysrhythmias.
6osage of !re"ious agent should be
reduced by >0T?0Q se"eral days after amiodarone thera!y is started
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O
SE. LmK&(&ll&n,
U$H#" nHm",Penbritin
ClH!!& +ntibiotic F5roads!ectrum !enicillinE
G$"%nHn(y,',ategory 5(
L(8&on,Inhibit cell wall synthesis some act by binding to !enicillin binding !rotein in the
cyto!lasmic membrane of the bacteria.
+!"!,
2es!iratory urinary J %I tract infections J other infection due to
am!icillin sensiti"e organisms.
4eningitis caused by /eisseria meningitidis.
Ao!"
$B
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5y mouth0.)?M$ g e"ery A hours at least >0 minutes before food-
,7IL6 under $0 years half adult dose.
Urinarytract infections?00 mg e"ery B hours-
,7IL6 under $0 years half adult dose.
5y intramuscular inection or intra"enous inection or infusion ?00 mg e"ery ;MAhours- ,7IL6 under $0 years half adult dose
Listerial meningitis 'in combination with another antibiotic( by
intra"enous infusion ) g e"ery ; hours for $0M$; days- I/8+/* under $
month ?0 mgNkg e"ery A hours- $M> months ?0M$00 mgNkg e"ery A hours-
child > monthsM$) years $00 mgNkg e"ery A hours 'ma3. $) g daily(
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to !enicillins. Use cautiously with renal disorders.
V" "II"(8!,
+llergic& skin rashes !ruritis whee9ing fe"erR. .
6iarrhea abdominal cram! !ain nausea "omiting.
Psendomembranous colitis thrombocyto!enia leuko!nea
*hrombo!hlebitis 1lectrolytes imbalance following I.? minutes or by infusion.
I.4. inections are made dee!ly into the gluteal muscle.
+ssess regularly for allergic reactions. If reaction occurs the drug must be discontinued
immediately 1!ine!hrine O)K antihistamines corticosteroids must be immediately
a"ailable.
6etain client in an ambulatory care site for at least )0 min after administering Penicillin.
+fter inection because rate of absor!tion should not be increased.
,om!lete entire !rescribed course of thera!y.
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@
SS. LmK7o8"$(&n,
$C
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U$H#" nHm",+m!hocin 8ungi9one
ClH!!&+ntibiotic antifungal
G$"%nHn(y,',ategory 5(
L(8&on,am!hotericin associates with ergosterol a membrane chemical of fungi forming a !ore
that leads to leakage and fungal cell death
+!"!,
+ntifungal infection
Ao!" , by mouth intestinal candidiasis $00M)00 mg e"ery A hours- Infant and child $00 mg
; times daily
Pro!hyla3is /eonate $00 mg once daily
My &n8$HQ"no! &nI!&on systemic fungal infections initial test dose of $ mg o"er )0M>0
minutes then )?0 microgramsNkg daily gradually increased if tolerated to $ mgNkg daily- ma3.
'se"ere infection( $.? mgNkg daily or on alternate days
Con8$H&n#&(H8&on!,+llergic reaction to am!hotericin
V" "II"(8!,
5urning itching redness or other sign of irritation not !resent before use of
this medicine Skin rash 6ryness of skin.
/ausea "omiting diarrhea melena abd. ,ram!s.
8e"er headache thrombo!hlebitis bone marrow de!ression !ancyto!nea.
+na!hyla3is.
@$!&n% (on!"$H8&on!,
*he drug is to3ic and should be used only for !atients under close medical su!er"ision
with a relati"ely certain diagnosis of dee! mycotic infections.
I.
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+!"!,
7y!ertension.
+ngina !ectoris.
Ao!"&by mouth 7y!ertension ?0 mg daily 'higher doses rarely necessary(
+ngina$00 mg daily in $ or ) doses
+rrhythmias?0M$00 mg daily
5y intra"enous inectionarrhythmias ).? mg at a rate of
$ mgNminute re!eated at ?minute inter"als to a ma3. Of $0 mg
Con8$H&n#&(H8&on!,
5radycardia ,.7.8. cardiogenic shock diabetes thyroto3icosis chronic bronchitis
asthma bronchos!asm em!hysema.
V" "II"(8!,
5radycardia ,.7.8. hy!otension cold e3tremities 'due to !eri!heral "asoconstriction(
edema dys!nia shortness of breath nausea "omiting he!atomegaly and
bronchos!asm.
@$!&n% (on!"$H8&on!,
8or I< use the drug may be diluted in sodium chloride de3trose on de3trose saline.
Instruct !atientNfamily to take blood !ressure and !ulse.
Pro"ide written instructions as when to call !hysician 'e.g. 72 below ?0 beatNmin(.
Instruct !atient to dress warmly during cold weather.
6iabetic !atient should be "ery careful about sym!toms of hy!oglycemia.
2e!ort any asthmalike sym!toms.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOSY. L8o$QH!8H8&n,
U$H#" nHm",Li!itor
ClH!!&+ntihy!erli!idemic Statins
G$"%nHn(y,',ategory V(
L(8&on,lowers the le"el of cholesterol in the blood by reducing the !roduction of cholesterol
by the li"er.
+!"!,
Pre"enting and treating atherosclerosis.
Ao!"
)$
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Primary hy!ercholesterolemia and combined hy!erli!idaemia usually
$0 mg once daily
8amilial hy!ercholesterolemia initially $0 mg daily increased at
inter"als of at least ; weeks to ;0 mg once daily- if necessary further
increased to ma3. B0 mg once daily
Con8$H&n#&(H8&on!,
+llergy to ator"astatin fungal by!roducts acti"e li"er disease or une3!lained and
!ersistent ele"ations of transaminase le"els !regnancy lactation.
Use cautiously with im!aired endocrine function
V" "II"(8!, ,/S&7eadache asthenia
%I&8latulence abdominal !ain cram!s consti!ation nausea dys!e!sia
heartburn li"er failure
2es!iratory&Sinusitis !haryngitis.
Other&2habdomyolysis with acute renal failure arthralgia myalgia
@$!&n% (on!"$H8&on!,
Obtain li"er function tests as a baseline and !eriodically during thera!y.
ithhold ator"astatin in any acute serious condition 'se"ere infection hy!otension maor
surgery trauma se"ere metabolic or endocrine disorder sei9ures(
1nsure that !atient has tried cholesterollowering diet regimen for >A mo before
beginning thera!y.
+dminister drug without regard to food but at same time each day.
,onsult dietitian regarding lowcholesterol diets.
1nsure that !atient is not !regnant and has a!!ro!riate contrace!ti"es a"ailable during
thera!y- serious fetal damage has been associated with this drug.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
SZ. L8$H($&m,
U$H#" nHm",U$H($&m
G$"%nHn(y,',ategory ,(
L(8&on,muscle rela3ant
+!"!,
))
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It is used as an adunct to general anesthesia or sedation in the intensi"e care unit
'I,U( to rela3 skeletal muscles and to facilitate tracheal intubations and mechanical
"entilation.
Ao!" , intra"enous inection& 0.>M0.A mgNkg
4aintenanceF intra"enous infusionF '0.>M0.A mgNkg hour(
Con8$H&n#&(H8&on!,
7y!ersensiti"e to atracurium cisatracurium or ben9enesulfonic acid.
V" "II"(8!,
Skin flushing mild reduction in blood !ressure and difficulty in breathing.
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6uring anesthesia to control sali"ation J bronchial secretions.
Parkinsonism.
+ntiarrhythmic '!ro!hyla3is(.
Pro!hyla3is and treatment of to3icity due to cholinesterase inhibitor including
organo!hos!hate !esticides.
O!hthalmologic treatment of u"eitis.
Ao!"
5radydysrhythmia &+dult 0.?$ mg I< may re!eated at ? min inter"als
until desired rate achie"ed F ma3 0.0> 0.0; mg N kg F Pediatric 0.0) mgNkg F min dose 0.$
mg ma3 single dose 0.? mg for a child and $ mg for an
adolescent.
+systole J P1+&+dult $ mg I< may re!eated e"ery >? min Fma3
0.0> 0.0; mg N kg com!lete "agal blockF
Pediatric unknown efficacy.
1ndotracheal route&>0 micNkg diluted in ? ml /S
+nticholinesterase !oisoning& +dult$) mg !ush e"ery ?$?
minutes to dry secretions no ma3 dose
Pediatric 0.0? mgNkgNdose e"ery ?$? min
@M
Possible !arado3ical bradycardia when !ushed slowly or when used at
doses less than 0.? mg
Con8$H&n#&(H8&on!,
%laucoma tachycardia myocardial ischemia.
Prostate hy!ertro!hy myasthenia gra"is !aralytic ileus.
4ental im!airment lactation he!atic disease.
V" "II"(8!,
/ausea "omiting dry mouth consti!ation heartburn
di99iness drowsiness headache insomnia blurring of "ision
Photo!hobia flashing eu!horia hallucination flushing of the skin.
@$!&n% (on!"$H8&on!,
,heck dosage J measure the drug e3actly.
+ssess for history of asthma glaucoma ulcer... etc.
6etermine the age of the client.
);
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8reuent mouth care.
+ssess client for change in !ulse rate.
In case of blurring of "ision assist on ambulating J gi"e safety measures.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
S\. M&!oK$olol ImH$H8",
U$H#" nHm",Gebeta
ClH!!&5etaadrenoce!tor blocking drugs
G$"%nHn(y,',ategory ,(
L(8&on&
5locks adrenergic rece!tors of the sym!athetic ner"ous system in the heart and
u3taglomerular a!!aratus 'kidney( thus decreasing the e3citability of the heart. 6ecreasing cardiac out!ut and o3ygen consum!tion decreasing the release of rennin
from the kidney and lowering blood !ressure.
+!"!,
4anagement of hy!ertension
used alone or with otherantihy!ertensi"e agents
Ao!"
Hypertension and anginausually $0 mg once daily '? mg may beadeuate in some !atients(- ma3. )0 mg daily
Adjunct in stable moderate to severe heart failureinitially $.)? mg once
daily 'in the morning( for $ week then if well tolerated increased to
).? mg once daily for $ week then >.D? mg once daily for $ week then ? mg
once daily for ; weeks then D.? mg once daily for ; weeks then $0 mg
once daily- ma3. $0 mg daily
Con8$H&n#&(H8&on!,
Sinus bradycardia second or thirddegree heartblock cardiogenic shock ,78.
Use cautiously with renal failure diabetes or thyroto3icosis 'biso!rolol can mask the
usual cardiac signs of hy!oglycemia and thyroto3icosis( lactation.
V" "II"(8!,
,/S&6i99iness !aresthesias slee! disturbances hallucinations disorientation
memory loss slurred s!eech .
%I&%astric !ain flatulence consti!ation diarrhea nausea "omiting anore3iaischemic colitis retro!eritoneal fibrosis he!atomegaly acute !ancreatitis.
)?
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,
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2enal failure
7y!o!arathyroidism.
Premature infants.
*o treat de!letion of electrolytes.
6uring cardiac resuscitation.
@ I.4. or I.
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@$!&n% (on!"$H8&on!,
Oral&
administer $$.? hr after meals alkalis J large amounts of fat
decrease the absor!tion of calcium.
If the client has difficulty swallowing large tablets obtain a calcium in water
sus!ension by diluting the calcium in hot water then cooled by administration.
I.
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Heart failure'adunct( initially A.)?M$).? mg under close medical su!er"ision-
usual maintenance dose )? mg )M> times daily- usual ma3. $?0 mg daily
Prophylaxisafter infarctionin clinically stable !atients with asym!tomatic
or sym!tomatic left "entricular dysfunction initially A.)? mg starting as early as > days after
infarction then increased o"er se"eral weeks to $?0 mg daily 'if tolerated( in di"ided doses .Con8$H&n#&(H8&on!,
7y!ersensiti"ity 2eno "ascular disease and !regnancy.
V" "II"(8!,
Skin rash loss of taste neutro!nea nausea "omiting
7y!otension !roteinuria renal failure and hy!erkalemia.
@$!&n% (on!"$H8&on!,
In case of o"erdose gi"e normal saline to restore 5P.
Should not be discontinued without 6r. Instructions.
Obtain baseline hematological studies li"er J renal functions tests !rior to
beginning the treatment.
6etermine client understands of the thera!y and if heNshe takes other medications.
Obser"e client closely for hy!otension > hours after the initial dose.
In case of hy!otension !lace client in su!ine !osition and gi"e I< saline infusion.
ithhold !otassium s!aring diuretics and consult with !hysician 'hy!erkalemia
may occur(.
*ake ca!to!ril $ hour before meal or on an em!ty stomach.
2e!ort skin rash heartburn and chest !ain to !hysician.
13!lain to client that he may de"elo! loss of taste for )> months if it !ersists
notify the !hysician.
S`. CH$Q"#&lol,
U$H#" nHm",,orega 6ilatrend.
ClH!!&antihy!ertensi"e,beta blockers.
G$"%nHn(y,',ategory ,(
L(8&on,
)C
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5locks stimulation of beta$ 'myocardial( and beta) '!ulmonary "ascular and
uterine( adrenergic rece!tor sites
+lso has al!ha$ blocking acti"ity which may result in orthostatic hy!otension.
+!"!, 4anagement of hy!ertension.
4anagement of ,78 'due to ischemia or cardiomyo!athy( with digo3in
diuretics and +,1 inhibitors.
Ao!"
7y!ertensioninitially $).? mg once daily increased after ) days to usual dose of )? mg
once daily- if necessary may be further increased at inter"als of at least ) weeks to ma3.
?0 mg daily in single or di"ided doses; ELDEL!initial dose of $).? mg daily may !ro"idesatisfactory control +nginainitially $).? mg twice daily increased after ) days to )? mg
twice daily
+dunct in heart failureinitially >.$)? mg twice daily 'with food( dose increased at
inter"als of at least ) weeks to A.)? mg twice daily then to $).? mg twice daily then to
)? mg twice daily- increase to highest dose tolerated ma3. )? mg twice daily in !atients
with se"ere heart failureor bodyweight less than B? kg and ?0 mgtwice daily in !atients
o"er B? kg
Con8$H&n#&(H8&on!,
Uncom!ensated ,78.
Pulmonary edema.
,ardiogenic shock.
5radycardia or heart block.
Se"ere he!atic im!airment or bronchial asthmaNbronchos!asm.
V" "II"(8!, ,ar"edilol may cause hy!erglycemia tiredness weakness
lightheadedness di99iness headache
diarrhea nausea "omiting "ision changes oint !ain difficulty falling
aslee! or staying aslee!
,ough dry eyes numbness burning or tingling in the arms or legs
@$!&n% (on!"$H8&on!, *each !atient and family how to check !ulse and blood !ressure.
>0
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4ay cause drowsiness or di99iness. ,aution !atients to a"oid dri"ing or other
acti"ities that reuire alertness until res!onse to the drug is known.
Patients with diabetes should closely monitor blood sugar
+d"ise !atient to notify health care !rofessional if slow !ulse difficulty breathing
whee9ing cold hands and feet di99iness confusion de!ression rash fe"er sore
throat unusual bleeding or bruising occurs.
7y!ertension& 2einforce the need to continue additional thera!ies for hy!ertension
'weight loss sodium restriction stress reduction regular e3ercise moderation of
alcohol consum!tion and smoking cessation(.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
O
DE. C"IHbol&n,
U$H#" nHm",+ncef ef9ol.
ClH!!&+ntibiotic Fce!halos!orinesF8I2S* %1/12+*IO/
G$"%nHn(y,',ategory 5(
L(8&on,5ind to bacterial cell wall membrane causing cell death.
+!"!,*reatment of&
Skin and skin structure infections 'including burn wounds(
Pneumonia.
Otitis media.
Urinary tract infections.
5one and oint infections.
Se!ticemia 'including endocarditic( caused by susce!tible organisms.
Perio!erati"e !ro!hyla3is.
Ao!"
5y intramuscular inection or intra"enous inection or infusion 0.?M$ g e"ery AM$)
hours- ,7IL6 )?M?0 mgNkg daily 'in di"ided doses( increased to $00 mgNkg daily in se"ere
infections
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to ce!halos!orin or Penicillin renal failure Pregnancy Lactation.
>$
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Con8$H&n#&(H8&on!,
7y!ersensiti"ity to ce!halos!orin or Penicillin.
V" "II"(8!,
,/S&sei9ures 'high doses(.
%I&!seudomembraneous colitis diarrhea nausea "omiting cram!s
!seudolithiasis 'ceftria3one(.
6erm&rashes urticaria.
7emat&bleeding 'increased with cefo!era9one( blood dyscrasias hemolytic
anemia.
Local&!ain at I4 site !hlebitis at I< site.
4isc&allergic reactions including ana!hyla3is and serum sickness su!er infection.
@$!&n% (on!"$H8&on!, Should not be mi3ed with amino glycosides. ' each should be gi"en se!arately(
8or I.di"ided doses- intra"enousroute recommended for children
>>
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Surgical !ro!hyla3is !rostatic surgery $ g at induction of anesthesia re!eated if necessary
when catheter remo"ed
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to ce!halos!orin
V" "II"(8!,
6iarrhea stomach !ain u!set stomach "omiting.
@$!&n% (on!"$H8&on!,
Infuse o"er >0 minutes unless otherwise indicated.
*hera!y should be continued for at least )> days after sym!toms of infection ha"e
disa!!eared.
+ssess client with a history of hy!ersensiti"ity reaction. for !enicillin or
ce!halos!orin.#
+ssess client financial status. *hese drugs are usually e3!ensi"e.
Obtain li"er J renal studies.
DY. C"I8$&HXon",
U$H#" nHm",2oce!hin
ClH!!& +ntibiotic Fce!halos!orinesF third"generation
G$"%nHn(y,',ategory 5(
L(8&on,5ind to bacterial cell wall membrane causing cell death.
+!"!,
Pneumonia U*I infections of skin bone J abdomen. 4eningitis bacterial
se!ticemia !reo!. !ro!hyla3is.
Ao!"by dee! intramuscular inection or by intra"enous inection o"er at least )M; minutes or by
intra"enous infusion $ g daily- )M; g daily in se"ere infections- intramuscular doses o"er
$ g di"ided between more than one site /eonateby intra"enous infusion o"er A0 minutes
)0M?0 mgNkg daily 'ma3. ?0 mgNkg daily( Infant and childunder ?0 kg by dee!
intramuscular inection or by intra"enous inection o"er )M; minutes or by intra"enous
infusion )0M?0 mgNkg daily- u! to B0 mgNkg daily in se"ere infections- doses of ?0 mgNkg
and o"er by intra"enous infusion only- ?0 kg and o"er adult doseUncom!licated gonorrhea by dee! intramuscular inection )?0 mg as a single dose.
>;
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Surgical !ro!hyla3is by dee! intramuscular inection or by intra"enous
inection o"er at least )M; minutes $ g at induction- colorectal surgery by dee!
intramuscular inection or by intra"enous inection o"er at least )M; minutes or by
intra"enous infusion ) g at induction- intramuscular doses o"er $ g di"ided between morethan one site
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to ce!halos!orin or Penicillin renal failure
V" "II"(8!,
/ausea "omiting diarrhea anore3ia abdominal !ain flatulence skin rashes
su!erinfection heartburn sore mouth bone marrow de!ression.
@$!&n% (on!"$H8&on!, I.4. inection should be dee! into the body of large muscle.
I.
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D[. C7lo$HmK7"n&(ol ,
U$H#" nHm",,hloromycetin
ClH!!& antibiotic
G$"%nHn(y,',ategory ,(
L(8&on&it inhibits !rotein synthesis in bacteria by binding to ribosome.
+!"!,
/ot to be used for tri"ial infections as !ro!hyla3is of infection
,old throat infections or flu.
*reatment of choice for ty!hoid fe"er 'not for carrier state(.
4eningitis due to hemo!hilus influen9a !neumocoeoi or
4iningococei.
Skin infections 'to!ically(.
5rain abscesses.
Ao!" & by mouth or by intra"enous inection or infusion ?0 mgNkg daily in ; di"ided
doses 'e3ce!tionally can be doubled for se"ere infections such as se!ticemia and
meningitis !ro"iding high doses reduced as soon as clinically indicated(- ,hild
haemo!hilus e!iglottitis and !yogenic meningitis ?0M$00 mgNkg daily in di"ided doses
'high dosages decreased as soon as clinically indicated(- Infants under ) weeks)? mgNkg
daily 'in ; di"ided doses(
) weeksM$ year?0 mgNkg daily 'in ; di"ided doses(
Con8$H&n#&(H8&on!,
7y!ersensiti"ity to chloram!henicol.
Pregnancy
/ursing mothers.
2enal and he!atic failure.V" "II"(8!,
+ !lastic anemia !ancyto!nea nausea "omiting abdominal distention !rogressi"e !allid
cyanoses ashen gray color tachy!nea "asomotor colla!se J death# %ray syndrome in
infants su!er infections.
@$!&n% (on!"$H8&on!,
+dminister I.D
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Patients with history of sei9ures J on anticon"ulsant thera!y.
7e!atic J renal diseases.
Prostatic hy!ertro!hy.
6ehydration glaucoma measles.
V" "II"(8!,
6e!ression di99iness sei9ures gynecomastia. Orthostatic hy!otension bronchos!asm
larlynyos!asm tardi"e dyskinesia !hotosensiti"ity leuko!nea a!lastic anemia and dry
mouth.
@$!&n% (on!"$H8&on!,
ShouldnKt be used to treat nausea J "omiting in children less than A months of age.
Should a"oid getting solution on hands or clothing 'it will cause dermatitis(.
Solutions with marked discoloration should be discarded.
/ote any history of sei9ures.
*ake li"er J kidney function test !eriodically.
6ocument J rotate inection sites.
2e!ort side effects immediately.
6etermine age of male !atients J assess for !rostatic hy!ertro!hy.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
D^. C&K$oIloXH(&n cy#$o(7lo$",
U$H#" nHm",ci!ro3in
ClH!!&+ntibacterial uinolone deri"ati"e
G$"%nHn(y,',ategory ,(
L(8&on,is a synthetic uinolone with broad s!ectrum bactericidal acti"ity inhibits the
synthesis of bacterial 6/+ by inhibiting the en9yme 6/+ gyrase.
+!"!,
UI* infectious diarrhea
Infection of lower res!iratory tract bone oints J skin.
Ao!" , by mouth res!iratorytract infections )?0MD?0 mg
*wice daily Urinarytract infections )?0M?00 mg twice
6aily '$00 mg twice daily for > days in acute
>C
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uncom!licated cystitis in women(
,hronic !rostatitis ?00 mg twice daily for )B days
%onorrhea?00 mg as a single dose
Pseudomonal lower res!iratorytract infectionin cystic fibrosis D?0 mg twice
daily- ,7IL6 ?M$D years u! to )0 mgNkg twice daily 'ma3. $.? g daily(4ost other infections ?00MD?0 mg twice daily
Surgical !ro!hyla3is D?0 mg A0MC0 minutes before !rocedure
Pro!hyla3is of meningococcal meningitis Wnot licensed for this indicationX
?00 mg as a single dose- ,hild ?M$)years )?0 mg
5y intra"enous infusion 'o"er >0MA0 minutes- ;00 mg o"er A0 minutes( )00M
;00 mg twice daily ,hild )0 mgNkg daily in ) di"ided doses
Pseudomonal lower res!iratorytract infection in cystic fibrosis ;00 mg twicedaily- ,7IL6 ?M$D years u! to $0 mgNkg > times daily 'ma3. $.) g daily(
,hild not recommendedbut where benefit outweighs risk by mouth $0M>0 mgNkg
daily in ) di"ided doses or by intra"enous infusion BM$A mgNkg daily in ) di"ided
doses
+nthra3'treatment and !oste3!osure !ro!hyla3is see notes abo"e( by mouth
?00 mg twice daily- child >0 mgNkg daily in ) di"ided doses 'ma3. $g daily(
Con8$H&n#&(H8&on!,
7y!ersensiti"ity children lactation.
V" "II"(8!,
/ausea "omiting. 6ys!hasia crystalluria
7ematuria 2ashes bad taste %I bleeding
7eadache insomnia.
@$!&n% (on!"$H8&on!,
%i"e medication ) hr after meals.
Stress im!ortance of drinking increased amounts of fluids to kee! urine acidic J to
minimi9e the risk of crystalluria.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
DF. Cl&n#Hmy(&n K7o!K7H8",
U$H#" nHm",6alacin
ClH!!&antibiotic clindamycin
G$"%nHn(y,',ategory 5(
;0
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L(8&on,su!!ress !rotein synthesis by microorganisms by binding to ribosomes. It is both
bacteriostatic J bactericidal.
+!"!,
Serious res!iratory tract infections. 'lung abscess !neumonia(.
Serious skin infections.
Se!ticemia.
Osteomyelitis caused by sta!hylococci.
Used to!ically for inflammatory acne "ulgaris .
Ao!" & by mouth $?0M>00 mg e"ery A hours- u! to ;?0 mg e"ery A hours in se"ere infections-
,7IL6 >MA mgNkg e"ery A hours
/.5
Patients should discontinue immediately and contact doctor if diarrhea de"elo!s- ca!sules should
be swallowed with a glass of water.
5y dee! intramuscular inection or by intra"enous infusion 0.AM).D g daily 'in )M; di"ided
doses(- lifethreatening infection u! to ;.B g daily- single doses abo"e A00 mg by intra"enous
infusion only- single doses by intra"enous infusion not to e3ceed $.) g
,7IL6 o"er $ month $?M;0 mgNkg daily in >M; di"ided doses- se"ere infections at least
>00 mg daily regardless of weight.
Con8$H&n#&(H8&on!,
7y!ersensiti"ity
4inor bacterial infections.
Pregnancy.
V" "II"(8!,
/ausea "omiting diarrhea abdominal !ain tenesmus.
Loss of weight !seudo membranous colitis skin rashes.
7y!otension.
*hrombo!hlebitis following I.
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5e !re!ared to manage colitis which can occur )C days or se"eral weeks after initiation of
thera!y. hich includes& fluids electrolytes Protein su!!lement corticosteroids and
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+llergic& skin rashes !ruritis whee9ing fe"erR. .
6iarrhea abdominal cram!s !ain nausea "omiting.
Psendomembranous colitis thrombocyto!enia leuco!enia
*hrombo!hlebitis 1lectrolytes imbalance following I.
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4uscle rela3ant.
+nticon"ulsi"e.
Preo!erati"ely.
5efore gastresco!y or eso!hagosco!y.
*reatment of status e!ile!ticus.
2elief of facial muscle s!asm.
Ao!"
5y intra"enous inection $0M)0 mg at a rate of 0.? mL ').? mg( !er >0 seconds re!eated
if necessary after >0MA0 minutes- may be followedby intra"enous infusionto ma3.
> mgNkg o"er ); hours-
,hild0.)0.> mgNkg or $ mg !er year of age
by rectum as rectal solution +dult and ,hildo"er $0 kg 0.? mgNkg- 1lderly0.)?mgNkg
Con8$H&n#&(H8&on!,
7y!ersensiti"ity.
+cute narrow angle glaucoma.
Pregnancy.
Shock coma.
+lcoholic into3ication 'to a"oid res!iratory of de!ression(.
V" "II"(8!,
6rowsiness fatigue
ata3ia
hy!otension
"isual disturbances headache
Phlebitis at inection site.
@$!&n% (on!"$H8&on!,
Stress that drug may reduce !tKs ability to handle dangerous eui!ment.
+"oid alcohol ingestion.
6onKt sto! taking the medication suddenly withdraw drug gradually.
4onitor 5.P. before J after administration.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
YD. A&(loI"nH( Vo#&m,
U$H#" nHm"&6iclofenac sodium&
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',+/(
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) Lactation.
> 7y!ersensiti"ity 'asthma rashes rhinitis(.
; Uses with caution in !atients with a history of %I disease J reduced renal
functions.
V" "II"(8!, ,/S&7eadache di99iness somnolence insomnia fatigue tiredness
di99iness tinnitus o!hthalmologic effects
%I&/ausea dys!e!sia %I !ain diarrhea "omiting consti!ation flatulence
7ematologic&5leeding !latelet inhibition with higher doses
%U& 6ysuria renal im!airment
6ermatologic& 2ash !ruritus sweating dry mucous membranes stomatitis
Other&Peri!heral edema ana!hylactoid reactions to fatal ana!hylactic shock
@$!&n% (on!"$H8&on!,
%i"e on full stomach to a"oid %I* irritation.
hen gi"en I4 %i"e it dee! into a large muscle because drug is "ery irritant.
/ote any history of allergic res!onses to as!irin or nonsteroidal antiinflammatory
agents. Y/S.+I6.Z
/ote the age of the client.
6etermine if !atient is taking oral hy!oglycemic or insulin and document it.
*ake these agents with milk or meal or antacids as !rescribed.
1ncourage !atient to take drug regularly.
2e!ort signs of %I irritation sore throat fe"er rash itching weight gain swelling
in ankles or fingers changes in "ision- black tarry stools tinnitus and rashes M etc.
6i99iness drowsiness can occur 'a"oid dri"ing or using dangerous machinery while
on this drug(.
If the client has 6iabetes 4ellitus e3!lain the !ossible in increasing hy!oglycemic
effect of the drugs to test urine J blood for glucose. *o adust dose of these agents.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
YY. A&%oX&n ,
U$H#" nHm"& Lano3ica!s Lano3in /o"o6igo3in ',+/(
A$% (lH!!"!,
,ardiac glycoside
,ardiotonic agent
;B
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G$"%nHn(y,',ategory ,(
U7"$HK"8&( H(8&on!
Increases intracellular calcium and allows more calcium to enter the myocardial cell during
de!olari9ation "ia a sodium!otassium !um! mechanism- this increases force of contraction
'!ositi"e inotro!ic effect( increases renal !erfusion 'seen as diuretic effect in !atients with
,78( decreases heart rate 'negati"e chronotro!ic effect( and decreases +< node conduction
"elocity.
*n#&(H8&on!
,78
+trial fibrillation
+trial flutter
Paro3ysmal atrial tachycardia
Ao!"
by mouth ra!id digitali9ation $M$.? mg in di"ided doses o"er ); hours- less urgent
digitali9ation )?0M?00 micrograms daily 'higher dose may be di"ided( 4aintenance
A).?M?00 micrograms daily 'higher dose may be di"ided( according to renal function and
in atrial fibrillation on heartrate res!onse- usual range $)?M)?0 micrograms daily
'lower dose may be a!!ro!riate in elderly(
1mergency loading doseby intra"enous infusion 0.D?M$ mg o"er at least ) hours then
maintenance doseby mouthon the following day
Con8$H&n#&(H8&on!,
,ontraindications& allergy to digitalis !re!arations "entricular tachycardia "entricular
fibrillation heart block sick sinus syndrome I7SS acute 4I renal insufficiency and
electrolyte abnormalities 'decreased decreased 4g increased ,a(.
Use cautiously with !regnancy and lactation.
V" "II"(8!,
,/S& 7eadache weakness drowsiness "isual disturbances
%I& %I u!set anore3ia
,
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4onitor a!ical !ulse for $ min before administering- hold dose if !ulse [A0 in adult or [C0
in infant retake !ulse in $ h. If adult !ulse remains [A0 or infant [C0 hold drug and notify
!rescriber. /ote any change from baseline rhythm or rate.
,heck dosage and !re!aration carefully.
+"oid I4 inections which may be "ery !ainful.
8ollow diluting instructions carefully and use diluted solution !rom!tly.
+"oid gi"ing with meals- this will delay absor!tion.
7a"e emergency eui!ment ready- ha"e salts lidocaine !henytoin atro!ine and
cardiac monitor on standby in case to3icity de"elo!s.
4onitor for thera!eutic drug le"els& 0.?) ngNmL.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
YZ. AH&l8&Hb"m 7y#$o(7lo$" , U$H#" nHm"& +lti6iltia9em +!o6iltia9 ,ardi9em 6ilacor V2
%en6iltia9em /o"o6ilta9em /u6iltia9 *iamate *ia9ac
A$% (lH!!"!
,alcium channelblocker
+ntianginal agent
+ntihy!ertensi"e
G$"%nHn(y,',ategory ,(
L(8&on,,alciumchannel blockers Fanti anginal antihy!ertensi"eF
Inhibits the mo"ement of calcium ions across the membranes of cardiac and arterial muscle
cells resulting in the de!ression of im!ulse formation in s!eciali9ed cardiac !acemaker
cells slowing of the "elocity of conduction of the cardiac im!ulse de!ression of
myocardial contractility and dilation of coronary arteries and arterioles and !eri!heralarterioles- these effects lead to decreased cardiac work decreased cardiac energy
consum!tion and in !atients with "asos!astic 'Prin9metalEs( angina increased deli"ery of
o3ygen to myocardial cells.
*n#&(H8&on!
+ngina !ectoris due to coronary artery s!asm 'Prin9metalEs "ariant angina(
1ffortassociated angina- chronic stable angina in !atients not controlled by
adrenergic blockers nitrates
1ssential hy!ertension 'sustained release(
?0
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*reatment of hy!ertension 'sustained release *iamate(
Paro3ysmal su!ra"entricular tachycardia '!arenteral(
Ao!"
+"ailable 8orms& *ablets>0 A0 C0 $)0 mg- S2 ca!sulesA0 C0 $)0 $B0 );0 >00 mg-
inection)? ?0 mg as ? mgNmL
1"aluate !atient carefully to determine the a!!ro!riate dose of this drug.
+ngina A0 mg > times daily 'elderlyinitially twice daily(- increased if
necessary to >A0 mg daily
Pediatric& Safety and efficacy not established.
Con8$H&n#&(H8&on!e(H8&on!
+llergy to diltia9em
im!aired he!atic or renal function
sick sinus syndrome hy!otension
!ulmonary congestion and 4I
heart block 'second or third degree( and
lactation
V" "II"(8!
,/S&6i99iness lightheadedness headache asthenia fatigue %I&/ausea he!atic inury
,
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2e!ort irregular heart beat shortness of breath swelling of the hands or feet !ronounced
di99iness consti!ation.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
O
Y[. AoP8Hm&n" 7y#$o(7lo$",
U$H#" nHm"& 6obutre3
A$% (lH!!"!,
Sym!athomimetic
$selecti"e adrenergic agonist
G$"%nHn(y,',ategory 5(
U7"$HK"8&( H(8&on!,
Positi"e inotro!ic effects are mediated by $ adrenergic rece!tors in the heart- increases the force
of myocardial contraction with relati"ely minor effects on heart rate arrhythmogenesis- has minor
effects on blood "essels.
*n#&(H8&on!
8or inotro!ic su!!ort in the shortterm treatment of adults with cardiac decom!ensation
due to de!ressed contractility resulting from either organic heart disease or from
cardiac surgical !rocedures
In"estigational use in children with congenital heart disease undergoing diagnostic
cardiac catheteri9ation to augment ,< function
Ao!H%"
+"ailable 8orms& Inection $).? mgNmL.
+dminister only by I< infusion.
*itrate on the basis of the !atientEs homodynamicNrenal res!onse.
,lose monitoring is necessary.
L#l8,
).?$? \gNkgNmin I< is usual rate to increase cardiac out!ut- rarely rates u! to ;0 \gNkg
!er minute are needed.
*f IH(8!
G$"KH$H8&on,2econstitute by adding $0 mL Sterile ater for Inection or ?Q 6e3trose
Inection to )?0mg "ial. If material is not com!letely dissol"ed add $0 mL of diluent.
?)
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8urther dilute to at least ?0 mL with ?Q 6e3trose Inection 0.CQ Sodium ,hloride
Inection or Sodium Lactate Inection. Store reconstituted solution under refrigeration for
;B h or at room tem!erature for A h. Store final diluted solution in glass or "ia fle3 container
at room tem!erature. Stable for ); h. 6o not free9e. '/ote& drug solutions may e3hibit a
color that increases with time- this indicates o3idation of the drug not a loss of !otency.( *nI!&on,4ay be administered through common I< tubing with do!amine lidocaine
tobramycin nitro!russide !otassium chloride or !rotamine sulfate. *itrate rate based on
!atient res!onseP 5P rhythm- use of an infusion !um! is suggested.
*n(omKH8&P&l&8&"!,6onotmi3 drug with alkaline solutions such as ?Q Sodium
5icarbonate Inection- do notmi3 with hydrocortisone sodium succinate cefa9olin
cefamandole neutral ce!halothin !enicillin sodium ethacrynate- sodium he!arin.
gJ!&8" *n(omKH8&P&l&8&"!,6o not mi3 with acyclo"ir alte!lase amino!hylline foscarnet.
L#Q"$!" "II"(8!
,/S&7eadache
%I&/ausea
,
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Suggested dilution&
*ransfer contents of one am!oule '?ml containing )00 mg of do!amine( by ase!tic
techniue to either )?0 or ?00 ml bottle of sterile I.
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6o3ychel 7yclate 6o3ytec /o"o6o3ylin /u
6o3ycycline
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Uncom!licated genital ,hlamydia nongonococcal urethritis $00 mg twice daily
for D days '$; days in !el"ic inflammatory disease
+nthra3'treatment or !oste3!osure !ro!hyla3is $00 mg twice daily-
,hild'only if alternati"e antibacterial cannot be gi"en( Wunlicensed doseX ? mgNkg
daily in ) di"ided doses 'ma3. )00 mg daily(
%eriatric or 2enal 8ailure Patients&
I< doses of do3ycycline are not as to3ic as other tetracyclines in these !atients.
L#Q"$!" "II"(8!
%I&8atty li"er li"er failure anore3ia nausea "omiting diarrhea glossitis dys!hagia
enterocolitis eso!hageal ulcer
7ematologic&7emolytic anemia thrombocyto!enia neutro!enia eosino!hilia
leukocytosis leuko!enia
6ermatologic&Phototo3ic reactions rash e3foliati"e dermatitis 'more freuent and more
se"ere with this tetracycline than with any others(
6ental&6iscoloring and inadeuate calcification of !rimary teeth of fetus if used by
!regnant women discoloring and inadeuate calcification of !ermanent teeth if used during
!eriod of dental de"elo!ment
Local&Local irritation at inection site
Other&Su!er infections ne!hrogenic diabetes insi!idus syndrome
Cl&n&(Hlly &mKo$8Hn8 &n8"$H(8&on!
6rugdrug
6ecreased absor!tion with antacids iron alkali
6ecreased thera!eutic effects with barbiturates carbama9e!ine !henytoins
Increased digo3in to3icity with do3ycycline
Increased ne!hroto3icity with metho3yflurane
6ecreased acti"ity of !enicillins
6rugfood
6ecreased effecti"eness of do3ycycline if taken with food dairy !roducts
6ruglab test
?D
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Interference with culture studies for se"eral days following thera!y
@$!&n% (on!"$H8&on,
+dminister the oral medication without regard to food or meals- if %I u!set occurs
gi"e with meals. 6o not gi"e with antacid milk or any !roduct that contains ,alcium Gink
aluminum magnesium and ferrous salts because these !roducts decrease the
absor!tion of the drug.
Protect !atient from light and sun e3!osure.
2e!ort rash itching- difficulty breathing- dark urine or lightcolored stools- !ain at
inection site
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
YF. 'nHlHK$&l T ConQ"$8&n W ,
U$H#" nHm"!& 1nala!rilat ,on"ertin
A$% (lH!!"!
+ntihy!ertensi"e +,1 inhibitor
G$"%nHn(y,',ategory ,N 6 if used in the )nd or >rd trimesters.X
U7"$HK"8&( H(8&on!
2enin synthesi9ed by the kidneys is released into the circulation where it acts on a
!lasma !recursor to !roduce angiotensin I which is con"erted by angiotensin
con"erting en9yme to angiotensin II a !otent "asoconstrictor that also causes
release of aldosterone from the adrenals- both of these actions increase 5P. 1nala!ril
blocks the con"ersion of angiotensin I to angiotensin II decreasing 5P decreasing
aldosterone secretion slightly increasing serum le"els and causing /aand fluid
loss- increased !rostaglandin synthesis also may be in"ol"ed in the antihy!ertensi"e
action.
*n#&(H8&on!
*reatment of hy!ertension alone or in combination with thia9idety!e diuretics
*reatment of acute and chronic ,78
?B
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*reatment of asym!tomatic left "entricular dysfunction 'L
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release during surgery will be blocked- hy!otension may be re"ersed with "olume
e3!ansion.
4onitor !atients on diuretic thera!y for e3cessi"e hy!otension following the first few doses
of enala!ril.
4onitor !atient closely in any situation that may lead to a fall in 5P secondary to reduced
fluid "olume 'e3cessi"e !ers!iration and dehydration "omiting diarrhea( because
e3cessi"e hy!otension may occur.
+rrange for reduced dosage in !atients with im!aired renal function.
4onitor !atient carefully because !eak effect may not be seen for ; h. 6o not administer
second dose until checking 5P.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
Y`. 'noXHKH$&n TCl"XHn" W ,
U$H#" nHm",Lo"eno3
A$% (lH!!"!
Lowmolecularweight he!arin
+ntithrombotic agent
G$"%nHn(y,',ategory 5(
U7"$HK"8&( H(8&on!
Low molecular weight he!arin that inhibits thrombus and clot formation by blocking factor
Va factor IIa !re"enting the formation of clots.
*n#&(H8&on!
Pre"ention of dee! "ein thrombosis which may lead to !ulmonary embolism
following hi! re!lacement knee re!lacement surgery abdominal surgery
Pre"ention of ischemic com!lications of unstable angina and nonHwa"e 4I
*reatment of dee! "ein thrombosis '6
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Ao!"
Pro!hyla3is of dee!"ein thrombosisin medical !atients by subcutaneous inection ;0 mg
';000 units( e"ery ); hours for at least A days until !atient ambulant 'ma3. $; days(
*reatment of dee!"ein thrombosis or !ulmonary embolismby subcutaneous inection
$.? mgNkg '$?0 unitsNkg( e"ery ); hours usually for at least ? days 'and until adeuate oralanticoagulation established(
Unstable angina and nonS*segmentele"ation myocardial infarction by subcutaneous
inection $ mgNkg '$00 unitsNkg( e"ery $) hours usually for )MB days 'minimum ) days(
L#Q"$!" "II"(8!
7ematologic&7emorrhage- bruising- thrombocyto!enia- ele"ated +S* +L* le"els-
hy!erkalemia
7y!ersensiti"ity& ,hills fe"er urticaria asthma Other& 8e"er- !ain- local irritation hematoma erythema at site of inection
Cl&n&(Hlly &mKo$8Hn8 &n8"$H(8&on!
6rugdrug
Increased bleeding tendencies with oral anticoagulants salicylates !enicillins
ce!halos!orins
6ruglab test
Increased +S* +L* le"els
6rugalternati"e thera!y
Increased risk of bleeding if combined with chamomile garlic ginger gingko
and ginseng thera!y
@$!&n% Con!"$H8&on!
%i"e drug as soon as !ossible after hi! surgery.
%i"e dee! S, inections- do not gi"eeno3a!arin by I4 inection.
+dminister by dee! S, inection- !atient should be lying down. +lternate between the left
and right anterolateral and !osterolateral abdominal wall. Introduce the whole length of the
needle into a skin fold held between the thumb and forefinger- hold the skin fold throughout
the inection.
A$
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+!!ly !ressure to all inection sites after needle is withdrawn- ins!ect inection sites for
signs of hematoma- do not massage inection sites.
6o not mi3 with other inections or infusions.
Store at room tem!erature- fluid should be clear colorless to !ale yellow.
Pro"ide for safety measures 'electric ra9or soft toothbrush( to !re"ent inury to !atient who
is at risk for bleeding.
,heck !atient for signs of bleeding- monitor blood tests.
+lert all health care !ro"iders that !atient is on eno3a!arin.
6iscontinue and initiate a!!ro!riate thera!y if thromboembolic e!isode occurs des!ite
eno3a!arin thera!y.
7a"e !rotamine sulfate 'eno3a!arin antidote( on standby in case of o"erdose.
*reat o"erdose as follows& Protamine sulfate '$Q solution(. 1ach mg of !rotamineneutrali9es $ mg eno3a!arin. %i"e "ery slowly I< o"er $0 min.
OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
ZE. 'K7"#$&n" !lIH8"
U$H#" nHm",/asal decongestant& Pret96
A$% (lH!!"!
Sym!athomimetic drug
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*n#&(H8&on!
*reatment of hy!otensi"e states es!ecially those associated with s!inal anesthesia- Stokes
+dams syndrome with com!lete heart block- ,/S stimulant in narcole!sy and de!ressi"e
states- acute bronchos!asm '!arenteral(
Pressor agent in hy!otensi"e states following sym!athectomy o"er dosage with ganglionicblocking agents antiadrenergic agents or other drugs used for lowering 5P '!arenteral(
2elief of acute bronchos!asm '!arenteral- e!ine!hrine is the !referred drug(
*reatment of allergic disorders such as bronchial asthma and local treatment of nasal
congestion in acute cory9a "asomotor rhinitis acute sinusitis hay fe"er 'oral(
Sym!tomatic relief of nasal and naso!haryngeal mucosal congestion due to the common
cold hay fe"er or other res!iratory allergies 'to!ical(
+duncti"e thera!y of middle ear infections by decreasing congestion around the eustachian
ostia 'to!ical(
Con8$H&n#&(H8&on!e(H8&on!
,ontraindications& allergy to e!hedrine angleclosure glaucoma anesthesia with
cyclo!ro!ane or halothane thyroto3icosis diabetes hy!ertension ,< disorders women in
labor whose 5P [ $>0NB0.
Use cautiously with angina arrhythmias !rostatic hy!ertro!hy unstable "asomotor
syndrome lactation.
Ao!H%"
L#l8
Hypotensive episodes, allergic disorders, asthma:
)??0 mg I4 'fast absor!tion( S, 'slower absor!tion( or I< 'emergency administration(.
Labor:
*itrate !arenteral doses to maintain 5P at or below $>0NB0.
Acute asthma:
+dminister the smallest effecti"e dose '0.)?0.? mL or $).?)? mg(.
Maintenance dosage--allergic disorders, asthma:
)??0 mg PO >;h as necessary.
Topical nasal decongestant:
A>
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Instill solution in each nostril ;h. 6o not use longer than >; consecuti"e days.
G"#&H8$&(,
)?$00 mgNm)I4 or S, di"ided into ; to A doses- > mgNkg !er day or $00 mgNm)!er day di"ided
into ; to A doses PO S, or I< for bronchodilation.
Topical nasal decongestant (> 6 y:
Instill solution in each nostril ;h. 6o not use for longer than >; consecuti"e d. 6o not use in
children [A y unless directed by !hysician.
h"$&H8$&(,
4ore likely to e3!erience ad"erse reactions- use with caution.
L#Q"$!" "II"(8!
Systemic effects are less likely with to!ical administration but can take !lace and should be
considered.
,/S&$ear, anxiety, tenseness, restlessness, headache, light"headedness, di##iness
drowsiness tremor insomnia hallucinations !sychological disturbances con"ulsions ,/S
de!ression weakness blurred "ision ocular irritation tearing !hoto!hobia sym!toms of
!aranoid schi9o!hrenia
%I&%ausea "omiting anore3ia
,
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o 6ecreased hy!otensi"e action of guanethidine with e!hedrine
@$!&n% Con!"$H8&on!
Protect solution from light- gi"e only if clear- discard any unused !ortion.
4onitor urine out!ut with !arenteral administration- initially renal blood "essels may beconstricted and urine formation decreased.
6o not use nasal decongestant for longer than >? d.
+"oid !rolonged use of systemic e!hedrine 'a syndrome resembling an an3iety effect may
occur(- tem!orary cessation of the drug usually re"erses this syndrome.
4onitor ,< effects carefully- !atients with hy!ertension may e3!erience changes in 5P
because of the additional "asoconstriction. If a nasal decongestant is needed gi"e
!seudoe!hedrine.ZS. '$y87$omy(&n ,
U$H#" nHm"!,1ramycin 1rythrocin
A$% (lH!!, 4acrolide antibiotic
G$"%nHn(y,',ategory 5(
U7"$HK"8&( H(8&on!
Inhibits !rotein synthesis of microorganisms by binding to ribosome.
It is effecti"e only against ra!idly multi!lying organisms.
+bsorbed readily from the u!!er %I* 'small intestine(.
+re manufactured in enteric Mcoated or filmcoated forms to !re"ent destruction
by gastric acid diffuse !oorly to ,.S.8. J !rimarily e3creted in bile.
*n#&(H8&on!
!ystemic Administration
+cute infections caused by sensiti"e strains of &treptococcus pneumoniae, 'ycoplasma
pneumoniae, Listeria monocytogenes, Legionella pneumophila
U2Is L2Is skin and softtissue infections caused by grou! + hemolytic stre!tococci
when oral treatment is !referred to inectable ben9athine !enicillin
PI6 caused by%( gonorrhoeaein !atients allergic to !enicillin
In conunction with sulfonamides in U2Is caused byHaemophilus influen#ae
+s an adunct to antito3in in infections caused by )orynebacterium diphtheriaeand
)orynebacterium minutissimum
A?
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Pro!hyla3is against ^hemolytic stre!tococcal endocarditis before dental or other
!rocedures in !atients allergic to !enicillin who ha"e "al"ular heart disease
"ral #rythromycin
*reatment of intestinal amebiasis caused byEntamoeba histolytica- infections in thenewborn and in !regnancy that are caused by )hlamydia trachomatisand in adult
chlamydial infections when tetracycline cannot be used- !rimary sy!hilis '*reponema
pallidum( in !enicillinallergic !atients- eliminating+ordetella pertussisorganisms from
the naso!haryn3 of infected indi"iduals and as !ro!hyla3is in e3!osed and susce!tible
indi"iduals.
Unlabeled uses& erythromycin base is used with neomycin before colorectal surgery to
reduce wound infection- treatment of se"ere diarrhea associated with )ampylobacter
enteritis or enterocolitis- treatment of genital inguinal or anorectal lym!hogranuloma
"enereum infection- treatment ofHaemophilus ducreyi'chancroid(
"phthalmic "intment
*reatment of su!erficial ocular infections caused by susce!tible strains of microorganisms-
!ro!hyla3is of o!hthalmia neonatorum caused by%( gonorrhoeae or )( trachomatis
Topical $ermatologic !olutions %or Acne
*reatment of acne "ulgaris
Topical $ermatologic "intment
Pro!hyla3is against infection in minor skin abrasions
*reatment of skin infections caused by sensiti"e microorganisms
Con8$H&n#&(H8&on!e(H8&on!
!ystemic Administration
,ontraindication& allergy to erythromycin.
Use cautiously with he!atic dysfunction lactation 'secreted and may be concentrated in
breast milk- may modify bowel flora of nursing infant and interfere with fe"er worku!s(.
"phthalmic "intment
,ontraindications& allergy to erythromycin- "iral fungal mycobacterial infections of the
eye.
AA
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Ao!H%"
+"ailable 8orms& 5ase& *ablets)?0 >>> ?00 mg- 62 ca!sules)?0 mg- o!hthalmic ointment?
mgNg. 1stolate& *ablets?00 mg- ca!sules)?0 mg- sus!ension$)? )?0 mgN? mL. Stearate&
*ablets)00 ;00 mg- sus!ension)00 ;00 mgN? mL $00 mgN)? mL- !owder for sus!ension
)00 mgN? mL- granules for sus!ension;00 mgN? mL- to!ical solution$.?Q )Q- to!ical gelointment)Q.
Systemic administration&
Oral !re!arations of the different erythromycin salts differ in !harmacokinetics& ;00 mg
erythromycin ethylsuccinate !roduces the same free erythromycin serum le"els as )?0 mg of
erythromycin base sterate or estolate.
Adult:
$?)0 mgNkg !er day in continuous I< infusion or u! to ; gNd in di"ided doses Ah- )?0 mg ';00
mg of ethylsuccinate( Ah PO or ?00 mg $)h PO or >>> mg Bh PO u! to ; gNd de!ending on
the se"erity of the infection.
Stre!tococcal infections&
)0?0 mgNkg !er day PO in di"ided doses 'for grou! + hemolytic stre!tococcal infections
continue thera!y for at least $0 d(.
LegionnaireEs disease&
$; gNd PO or I< in di"ided doses 'ethylsuccinate $.A gNd- o!timal doses not established(.
6ysenteric amebiasis&
)?0 mg ';00 mg of ethylsuccinate( PO id or >>> mg Bh for $0$; d.
+cute !el"ic inflammatory disease '/. gonorrhoeae(&
?00 mg of lactobionate or gluce!tate I< Ah for > d and then )?0 mg stearate or base PO Ah or
>>> mg Bh for D d.
Pertussis&
;0?0 mgNkg !er day PO in di"ided doses for ?$; d 'o!timal dosage not established(.
Pro!hyla3is against bacterial endocarditis before dental or u!!er res!iratory !rocedures& $ g '$.A g
of ethylsuccinate( A h later.
,hlamydial infections&
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Urogenital infections during !regnancy& ?00 mg PO id or AAA mg Bh for at least D d $N) this
dose Bh for at least $; d if intolerant to first regimen. Urethritis in males& B00 mg of
ethylsuccinate PO tid for D d.
Primary sy!hilis&
>0;0 g ';BA; g of ethylsuccinate( in di"ided doses o"er $0$? d.
,6, recommendations for S*6s&
?00 mg PO id for D>0 d de!ending on the infection.
&ediatric:
>0?0 mgNkg !er day PO in di"ided doses. S!ecific dosage determined by se"erity of infection
age and weight.
6ysenteric amebiasis&
>0?0 mgNkg !er day in di"ided doses for $0$; d.
Pro!hyla3is against bacterial endocarditis&
)0 mgNkg before !rocedure and then $0 mgNkg A h later.
,hlamydial infections&?0 mgNkg !er day PO in di"ided doses for at least ) 'conuncti"itis of newborn( or > '!neumonia
of infancy( wk.
O!hthalmic ointment&
$N)in ribbon instilled into conuncti"al sac of affected eye two to si3 times !er day de!ending on
se"erity of infection.
*o!ical dermatologic solution for acne&
+!!ly to affected areas morning and e"ening.
*o!ical dermatologic ointment&
+!!ly to affected area $? _Nd.
L#Q"$!" "II"(8!
Systemic +dministration
,/S&2e"ersible hearing loss confusion uncontrollable emotions abnormal thinking
AB
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%I&+bdominal cram!ing anore3ia diarrhea "omiting !seudomembranous colitis
he!atoto3icity
7y!ersensiti"ity&+llergic reactions ranging from rash to ana!hyla3is
Other&Su!er infections
O!hthalmic Ointment
6ermatologic& 1dema utricaria dermatitis angioneurotic edema
Local& Irritation burning itching at site of a!!lication
*o!ical 6ermatologic Pre!arations
Local&Su!er infections !articularly with longterm use
Cl&n&(Hlly &mKo$8Hn8 &n8"$H(8&on!
Systemic +dministration
6rugdrug
Increased serum le"els of digo3in
Increased effects of oral anticoagulants theo!hyllines carbama9e!ine
Increased thera!eutic and to3ic effects of corticosteroids
Increased le"els of cyclos!orine and risk of renal to3icity
*o!ical 6ermatologic Solution for +cne
6rugdrug
Increased irritant effects with !eeling desuamating or abrasi"e agents
Systemic +dministration
6ruglab test
Interferes with fluorometric determination of urinary catecholamines
6ecreased urinary estriol le"els due to inhibition of hydrolysis of steroids in the
gut
@$!&n% Con!"$H8&on,
AC
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!ystemic Administration
,ulture site of infection before thera!y.
+dminister oral erythromycin base or stearate on an em!ty stomach $ h before or )> h
after meals with a full glass of water 'oral erythromycin estolate ethylsuccinate and
certain entericcoated tablets Wsee manufacturerEs instructionsX may be gi"en without regard
to meals(.
+dminister around the clock to ma3imi9e effect- adust schedule to minimi9e slee!
disru!tion.
4onitor li"er function in !atients on !rolonged thera!y.
%i"e some !re!arations 'see abo"e( with meals or substitute one of these !re!arations if
%I u!set occurs with oral thera!y.
Topical $ermatologic !olution %or Acne
ash affected area rinse well and dry before a!!lication.
"phthalmic and Topical $ermatologic &reparation
Use to!ical !roducts only when needed. Sensiti9ation !roduced by the to!ical use of an
antibiotic may !reclude its later systemic use in serious infections. *o!ical antibiotic
!re!arations not normally used systemically are best.
,ulture site before beginning thera!y.
,o"er the affected area with a sterile bandage if needed 'to!ical(.
ZD. '!om"K$Hbol",
U$H#" nHm"!,/e3ium
ClH!!,Proton !um! inhibitors antinuclear agents
G$"%nHn(y,',ategory 5(
L(8&on,
5inds to an en9yme on gastric !arietal cells in the !resence of acidic gastric !7 !re"enting
the final trans!ort of hydrogen ions into the gastric lumen.
U7"$HK"8&( 'II"(8!,
o 6iminished accumulation of acid in the gastric lumen with lessened
gastroeso!hageal reflu3
o 7ealing of duodenal ulcers.
D0
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+!"!,
*reatment of %126 including&
o 7ealing of erosi"e eso!hagitis
o 4aintenance of healing of erosi"e eso!hagitis
o *reatment of sym!tomatic %126
In combination with amo3icillin and clarithromycin for the eradication of 7elicobacter
!ylori in !atients with duodenal ulcer disease or a history of duodenal ulcer disease.
'Information on cucurrent use with amo3icillin and clarithromycin can be found in 6a"isEs
6rug %uide for /urses.
Ao!",
%astrooeso!hageal reflu3 disease ;0 mg once daily for ; weeks followed by a further ;
weeks if not fully healed or sym!toms !ersist- maintenance )0 mg daily-
sym!tomatic treatment in the absence of oeso!hagitis )0 mg daily for u! to ;
weeks followed by )0 mg daily when reuired
,7IL6 & not recommended
Con8$H&n#&(H8&on!,
7y!ersensiti"ity
Lactation 'not recommended(.
V" "II"(8!,
,/S& headache.
%I& abdominal !ain consti!ation diarrhea dry mouth flatulence nausea.
@$!&n% (on!"$H8&on!,
/1VIU4 should be taken at least one hour before meals.
8or !atients who ha"e a nasogastricor gastric tube in !lace /1VIU4 8or 6elayed2elease
Oral Sus!ension can be administered as follows&
+dd $? mL of water to a catheterti!!ed syringe and then add the contents of a $0 mg
)0 mg or ;0 mg /1VIU4 !acket. It is im!ortant to only use a catheter ti!!ed syringe
when administering /1VIU4 through a nasogastric tubeor gastric tube.
Immediately shake the syringe and lea"e ) to > minutes to thicken.
Shake the syringe and inect through the nasogastric or gastric tube 8rench si9e A or
larger into the stomach within >0 minutes. 2efill the syringe with $? mL of water.
D$
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Shake and flush any remaining contents from the nasogastric or gastric tube into the
stomach.
/1VIU4 8or 6elayed2elease Oral Sus!ension should be administered as follows&
1m!ty the contents of a $0 mg )0 mg or ;0 mg !acket into a container containing $
tables!oon '$? mL( of water.
Stir.
Lea"e ) to > minutes to thicken.
Stir and drink within >0 minutes.
If any material remains after drinking add more water stir and drink immediately.
@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@@
ZY. i"n8Hnyl,
U$H#" nHm"!,+cti 6uragesic 8entanyl Oralet 8entanyl
*ransdermal 8entanyl *ransmucosal Sublima9e
A$% (lH!!
/arcotic agonist analgesic
G$"%nHn(y,',ategory ,N 6 if used for !rolonged !eriods or in high doses at term(
U7"$HK"8&( H(8&on!
+cts at s!ecific o!ioid rece!tors causing analgesia res!iratory de!ression !hysical
de!ression eu!horia.
*n#&(H8&on!
+nalgesic action of short duration during anesthesia and immediate !osto! !eriod
+nalgesic su!!lement in general or regional anesthesia
+dministration with a neurole!tic as an anesthetic !remeditation for induction of
anesthesia and as an adunct in maintenance of general and regional anesthesia
8or use as an anesthetic agent with o3ygen in selected highrisk !atients
*ransdermal system& management of chronic !ain in !atients reuiring o!ioid analgesia
*reatment of breakthrough !ain in cancer !atients being treated with narcotics
Con8$H&n#&(H8&on!e(H8&on!
,ontraindications&hy!ersensiti"ity to narcotics diarrhea caused by !oisoning acute
bronchial asthma u!!er airway obstruction !regnancy.
Use cautiouslywith bradycardia history of sei9ures lactation.
D)
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Ao!"
by intravenous injection with s!ontaneous res!iration ?0M)00 micrograms then ?0 micrograms as
reuired- ,7IL6>M? microgramsNkg then $ microgramNkg as reuired
ith assisted "entilation 0.>M>.? mg then $00M)00 micrograms as reuired-
,hild&$? microgramsNkg then $M> microgramsNkg as reuired+y intravenous infusionn )-. /(0 1 2 microgramsNkg3 hour
L#Q"$!" "II"(8!
,/S&Sedation clamminess sweating headache "ertigo floating feeling di99iness
lethargy confusion lightheadedness ner"ousness unusual dreams agitation eu!horia
hallucinations delirium insomnia an3iety fear disorientation im!aired mental and
!hysical !erformance coma mood changes weakness headache tremor con"ulsions
%I&/ausea "omiting dry mouth anore3ia consti!ation biliary tract s!asm
,
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@$!&n% Con!"$H8&on!
+dminister to women who are nursing a baby ;A h before the ne3t scheduled
feeding to minimi9e the amount in milk.
Pro"ide narcotic antagonist facilities for assisted or controlled res!iration on
standby during !arenteral administration.
Pre!are site by cli!!ing 'not sha"ing( hair at site- do not use soa! oils lotions
alcohol- allow skin to dry com!letely before a!!lication. +!!ly immediately
after remo"al from the sealed !ackage- firmly !ress the transdermal system in
!lace with the !alm of the hand for $0)0 sec making sure the contact is
com!lete. 4ust be worn continually for D) h.
Use caution with +cti form to kee! this drug out of the reach of children 'looks
like a lolli!o!( and follow the distribution restrictions in !lace with this drug
"ery carefully.
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