GENERIC NAME: furosemide BRAND NAME: Lasix

DRUG CLASS AND MECHANISM: Furosemide is a potent diuretic (water pill) that is used to eliminate water and salt from the body. In the kidneys, salt (composed of sodium and chloride), water, and other small molecules normally are filtered out of the blood and into the tubules of the kidney. The filtered fluid ultimately becomes urine. Most of the sodium, chloride and water that is filtered out of the blood is reabsorbed into the blood before the filtered fluid becomes urine and is eliminated from the body. Furosemide works by blocking the absorption of sodium, chloride, and water from the filtered fluid in the kidney tubules, causing a profound increase in the output of urine (diuresis). The onset of action after oral administration is within one hour, and the diuresis lasts about 6-8 hours. The onset of action after injection is five minutes and the duration of diuresis is two hours. The diuretic effect of furosemide can cause depletion of sodium, chloride, body water and other minerals. Therefore, careful medical supervision is necessary during treatment. The FDA approved furosemide in July 1982. PRESCRIPTION: Yes GENERIC AVAILABLE: Yes PREPARATIONS: Tablets: 20, 40, and 80mg. Oral solution: 10 mg/ml, 40 mg/5 ml. Injection: 10 mg/ml STORAGE: Furosemide should be stored at room temperature in a light resistant container. PRESCRIBED FOR: Furosemide is a powerful diuretic that is used to treat excessive accumulation of fluid and/or swelling (edema) of the body caused by heart failure, cirrhosis, chronic kidney failure, and the nephrotic syndrome. It is sometimes used alone or in conjunction with other blood pressure pills to treat high blood pressure. DOSING: The usual starting oral dose for treatment of edema in adults is 20-80 mg as a single dose. The same dose or an increased dose may be administered 6-8 hours later. Doses may be increased 20-40 mg every 6-8 hours until the desired effect occurs. The effective dose may be administered once or twice daily. Some patients may require 600 mg daily. The starting oral dose for children is 2 mg/kg. The starting dose may be increased by 1-2 mg/kg every 6 hours until the desired effect is achieved. Doses greater than 6 mg/kg are not recommended. The recommended dose for treating hypertension is 40 mg twice daily. DRUG INTERACTIONS: Administration of furosemide with aminoglycoside antibiotics (for example, gentamicin) or [ethacrynic acid (Edecrin) - another diuretic] may cause hearing damage. Furosemide competes with aspirin for elimination in the urine by the kidneys. Concomitant use of furosemide and aspirin may, therefore, lead to high blood levels of aspirin and aspirin toxicity. Furosemide also may reduce excretion of lithium (Eskalith, Lithobid) by the kidneys, causing increased blood levels of lithium and possible side effects from lithium. Sucralfate (Carafate) reduces the action of furosemide by binding furosemide in the intestine and preventing its absorption into the body. Ingestion of furosemide and sucralfate should be separated by two hours. PREGNANCY: There are no adequate studies of furosemide in pregnant women. NURSING MOTHERS: Furosemide is secreted in breast milk. Nursing mothers should avoid breastfeeding while taking furosemide. SIDE EFFECTS: Common side effects of furosemide include low blood pressure, dehydration and electrolyte depletion (for example, sodium, potassium). Less common side effects include jaundice,

ringing in the ears (tinnitus), sensitivity to light (photophobia), rash, pancreatitis, nausea, diarrhea, abdominal pain, and dizziness. Increased blood sugar and uric acid levels also may occur.
Reference: FDA Prescribing Information

Pantoloc

Common Name
pantoprazole

In this drug factsheet:

How does Pantoloc work? What will it do for me? How should I use Pantoloc? What form(s) does Pantoloc come in? Who should NOT take Pantoloc? What side effects are possible with Pantoloc? Are there any other precautions or warnings for Pantoloc? What other drugs could interact with Pantoloc?

DIN (Drug Identification Number)

02241804 02229453 PANTOLOC 20MG TABLET PANTOLOC 40MG TABLET

How does this medication work? What will it do for me?

Pantoprazole belongs to the family of medications called proton pump inhibitors (PPIs). Proton pump inhibitors are used to treat conditions such as stomach ulcers, intestinal ulcers, and gastroesophageal reflux disease (GERD, reflux esophagitis) by reducing the amount of acid the stomach produces. Pantoprazole is also sometimes used along with antibiotics to treat stomach ulcers that are caused by bacteria known as H. pylori. Pantoprazole can also be used to treat or reduce the risk of stomach ulcers due to medications known as nonsteroidal anti-inflammatory drugs (NSAIDs), which irritate the stomach. Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. As well, some forms of this medication may not be used for all of the conditions discussed here. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
How should I use this medication?

The recommended dose of pantoprazole to treat reflux esophagitis is 40 mg once daily in the morning for 4 to 8 weeks. Treatment may be maintained at a dose of 20 mg to 40 mg once daily. To treat GERD or heartburn, the recommended dose is 40 mg once daily for up to 4 weeks. To prevent stomach ulcers associated with NSAID use, the dose is 20 mg once daily in the morning. To treat duodenal (intestinal) ulcers, the recommended dose is 40 mg once daily in the morning for 2 to 4 weeks. To treat gastric (stomach) ulcers, the recommended dose is 40 mg once daily in the morning for 4 to 8 weeks. To treat duodenal (intestinal) ulcers caused by H. pylori in adults, the dose of pantoprazole is 40 mg twice daily taken with amoxicillin 1,000 mg twice daily and clarithromycin 500 mg twice daily, or pantoprazole 40 mg twice daily taken with metronidazole 500 mg twice daily and clarithromycin 500 mg twice daily. The usual duration of this treatment is 7 days. Do not chew or crush the tablets, and take them with a glass of water in the morning either before, during, or after breakfast. Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor. It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice. Store this medication at room temperature and keep it out of the reach of children. Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

What form(s) does this medication come in?

20 mg Each enteric-coated, yellow, oval, biconvex tablet, marked "P20" on one side, contains pantoprazole 20 mg (pantoprazole sodium sesquihydrate 22.6 mg). Nonmedicinal ingredients: anhydrous sodium carbonate, calcium stearate, crospovidone, ferric oxide, mannitol, methylhydroxypropyl cellulose, poly (ethylacrylate, methacrylic acid), polysorbate 80, polyvidone, propylene glycol, sodium lauryl sulfate, titanium dioxide, and triethyl citrate. 40 mg Each enteric-coated, yellow, oval, biconvex tablet, marked "P40" on one side, contains pantoprazole 40 mg (pantoprazole sodium sesquihydrate 45.1 mg). Nonmedicinal ingredients: anhydrous sodium carbonate, calcium stearate, crospovidone, ferric oxide, mannitol, methylhydroxypropyl cellulose, poly (ethylacrylate, methacrylic acid), polysorbate 80, polyvidone, propylene glycol, sodium lauryl sulfate, titanium dioxide, and triethyl citrate. Some medications may have other generic brands available. Always ask your doctor or pharmacist about the safety of switching between brands of the same medication.
Who should NOT take this medication?

Pantoprazole should not be taken by anyone who:

is allergic to pantoprazole or to any of the ingredients of the medication is also using the medication atazanavir

MUCOSTA

Manufacturer Distributor Contents Indications

Otsuka East Malaysia: Zuellig Pharma / West Malaysia: Zuellig Pharma Rebamipide Gastric ulcers. Treatment of gastric mucosal lesions (erosion, bleeding, redness and edema) in the following conditions: Acute gastritis and acute exacerbation of chronic gastritis.

Dosage

Adults: Gastric Ulcers: Usual Dose: 1 tab orally 3 times daily (in the morning, in the evening and before bedtime). Treatment of Gastric Mucosal Lesions (Erosion, Bleeding, Redness and Edema) in Acute Gastritis and Acute Exacerbation of Chronic Gastritis: Usual Dose: 1 tab orally 3 times daily.

Overdosage

In an efficacy study of gastric ulcer, 1 case of abdominal pain was reported among 81 patients who received rebamipide 900 mg/day (maximum dosage of the study). In postmarketing experience, there is limited information on overdosage. Treatment of overdosage should be symptomatic. Close medical supervision and monitoring should continue until the patient is recovering.

Administration Contraindications Special Precautions

May be taken with or without food Patients with a history of hypersensitivity to any ingredient of Mucosta. Use in pregnancy & lactation: Mucosta should be administered to pregnant or possibly pregnant women only if the anticipated therapeutic benefit is thought to outweigh any potential risk. (The safety of rebamipide in pregnant women has not been established.) Nursing should be interrupted when Mucosta is administered. (Rat studies have shown that rebamipide is excreted in the breast milk.) Use in children: The safety of Mucosta in low birth weight infants, newborns, suckling infants and children has not been established. (Clinical experience is insufficient.) Use in the elderly: Special care is required in elderly patients to minimize the risk of gastrointestinal disorders because these patients may be physiologically more sensitive to Mucosta than younger patients.

Adverse Drug Reactions

Of 10,047 patients treated, adverse reactions including abnormal laboratory findings were reported in 54 patients (0.54%). Of 3035 patients >65 years, adverse reactions were noted in 18 patients (0.59%). The nature and incidence of adverse reactions were not different between the elderly and younger patients. The summary of data as follows includes adverse reactions voluntarily reported after marketing (figures are total cases reported at the time of approval and at the completion of re-examination of Mucosta). Clinically Significant Adverse Reactions: Shock, Anaphylactoid Reactions (Incidence Unknown*): Shock or anaphylactoid reactions may occur. Patients should therefore be closely monitored. If abnormal findings are observed, Mucosta should be discontinued and appropriate measures taken. Leukopenia (Incidence <0.1%) and Thrombocytopenia (Incidence Unknown*): Leukopenia and thrombocytopenia may occur. Patients should therefore be closely monitored. If

abnormal findings are observed, Mucosta should be discontinued and appropriate measures taken. Hepatic Dysfunction (Incidence <0.1%) and Jaundice (Incidence Unknown*): Hepatic dysfunction and jaundice, as indicated by increases in AST (GOT), ALT (GPT), -GTP and alkaline phosphatase levels have been reported in patients receiving Mucosta. If abnormal laboratory findings are observed, Mucosta should be discontinued and appropriate measures taken. Other Adverse Reactions: Hypersensitivity: Incidence <0.1%: Rash, pruritus, drug eruptionlike eczema, other symptoms of hypersensitivity. Incidence Unknown*: Urticaria. If symptoms of hypersensitivity occur, Mucosta should be discontinued. Neuropsychiatric: Incidence Unknown*: Numbness, dizziness, sleepiness. Gastrointestinal: Incidence <0.1%: Constipation, feeling of enlarged abdomen, diarrhea, nausea, vomiting, heartburn, abdominal pain, belching, taste abnormality, etc. Incidence Unknown*: Dry mouth. Hepatic: Incidence <0.1%: Increased AST (GOT), ALT (GPT), -GTP, alkaline phosphatase levels. If transaminase levels are markedly increased or fever and rash develop, Mucosta should be discontinued and appropriate measures should be taken. Hematologic: Incidence <0.1%: Leukopenia, granulocytopenia, etc. Incidence Unknown*: Thrombocytopenia. Others: Incidence <0.1%: Menstrual disorders, increased BUN levels, edema, feeling of a foreign body in the pharynx. Incidence Unknown*: Breast swelling and pain, gynecomastia induction of lactation, palpitations, fever, facial flushing, numbness of tongue, cough, respiratory distress, alopecia. *The incidence rates of voluntarily reported adverse reactions are not known. Click to view ADR Monitoring Website Drug Interactions Rebamipide had little inhibitory effect on cytochrome P-450 enzymes in vitro. Rebamipide is hardly metabolized in the liver and excreted in urine as an unchanged compound; thus, the drug has not much influence on metabolism of other drugs. Regarding the concomitant administration with other drugs with higher protein-binding rate (H2-blocker and warfarin), although Mucosta has a high protein-binding rate (95%), its blood concentration is as low as up to 200 ng/mL; therefore, rebamipide is considered less likely to increase the blood concentration in competition with other drugs. In addition, there have been reports that Mucosta has not been influenced by plasma salicylic acid concentration (human) at the time of aspirin administration, serum indomethacin concentration (human) at the time of indomethacin administration, and plasma and tumor tissue 5-FU concentration (rat) at the time of UFT administration. No drug interactions between rebamipide and other drugs are reported.

View more drug interactions with Mucosta Storage Store below 25C. Shelf-Life: 3 years. Description Each tablet also contains the following inactive ingredients: Microcrystalline cellulose, lowsubstituted hydroxypropyl cellulose, hydroxypropyl cellulose, magnesium stearate, hydroxypropyl methyl cellulose 2910, polyethylene glycol 6000 and titanium oxide. Rebamipide is ()-2-(4-chlorobenzoylamino)-3-[2(1H)-quinolinon-4-yl] propionic acid. Its molecular formula is C19H15ClN2O4 and has a molecular weight of 370.79. Melting Point: 292.5C (decomposition). Rebamipide occurs as a white crystalline powder. It is odorless and has a bitter taste. It is very slightly soluble in methanol and ethanol (95%), and practically insoluble in water. Its N,N-dimethylformamide solution (1 in 20) shows no optical rotation. Mechanism of Action Pharmacology: Experiments Using Animal Models: Preventive or Healing Effects in Gastric Ulcer Models: Rebamipide inhibited gastric mucosal injury in various experimental rat models of ulcers, including ulcers induced by water-immersion restraint stress, aspirin, indomethacin, histamine, serotonin and pyloric ligation. It also protected the mucosa from injury caused by other ulcerogenic conditions that presumably yield reactive oxygen species, including mucosal ischemia-reperfusion, administration of platelet activating factor (PAF) or diethyldithiocarbamate (DDC) and administration of indomethacin under stressed conditions. In a rat acetic acid-induced ulcer model, Mucosta promoted healing of gastric ulcers and was seen to suppress the recurrence and relapse of ulcers 120-140 days after ulcer induction. Preventive or Healing Effects in Gastritis Models: Rebamipide inhibited the development of taurocholic acid-induced gastritis and promoted healing of mucosal inflammation associated with gastritis in rat experiments. Prostaglandin-Increasing Effect: Rebamipide increased the generation of prostaglandin E2 (PGE2) in the gastric mucosa in rats. It also increased the contents of PGE 2, 15-keto-13,14dihydro-PGE2 (a metabolite of PGE2) and PGI2 in the gastric juice. In healthy male subjects, the drug again revealed the increasing effect on the PGE2 content in the gastric mucosa and protected the gastric mucosa from injury caused by ethanol loading. Cytoprotective Effect: Rebamipide exhibited a gastric cytoprotective effect by inhibiting mucosal damage induced by ethanol, strong acid or strong base in rats. The drug also protected gastric epithelial cells in vitro against aspirin- or taurocholic acid-induced injury in cultured cells obtained from rabbit fetuses. In healthy male subjects, the drug inhibited gastric mucosal injury induced by aspirin, ethanol and HCl-ethanol loading.

Mucus-Increasing Effect: Rebamipide promoted gastric enzyme activity to synthesize high molecular weight glycoproteins, thickened the superficial mucous layer of gastric mucosa and increased the amount of gastric-soluble mucus in rats. Endogenous PGs were not involved in the increase in soluble mucus. Mucosal Blood Flow-Increasing Effect: Rebamipide increased gastric mucosal blood flow and improved impaired hemodynamics after blood loss in rats. Effect on Mucosal Barrier: Rebamipide did not ordinarily affect the gastric transmucosal potential difference in rats, but did inhibit lowering of the potential difference by ethanol. Effect on Gastric Alkaline Secretion: Rebamipide promoted gastric alkaline secretion in rats. Effect on Mucosal Cell Turnover: Rebamipide activated gastric mucosal cell proliferation and increased the number of covering epithelial cells in rats. Effect on Gastric Mucosal Repair: Rebamipide restored the bile acid- or hydrogen peroxideinduced retardation of artificial wound repair in cultured rabbit gastric epithelial cells. Effect on Gastric Secretion: Rebamipide did not alter either basal secretion of gastric juice or secretagogue-stimulated acid secretion. Effects on Reactive Oxygen Species: Rebamipide scavenged hydroxyl radicals directly and suppressed superoxide production by polymorphonuclear leukocytes. It inhibited the gastric mucosal cell injury caused by reactive oxygen species released from neutrophils stimulated by Helicobacter pylori in vitro. Rebamipide reduced the content of lipid peroxide in the gastric mucosa of rats treated with indomethacin under stressed conditions and inhibited the mucosal injury. Effect on Inflammatory Cellular Infiltration in the Gastric Mucosa: Rebamipide prevented inflammatory cell infiltration in rat models of taurocholic acid-induced gastritis, NSAID- or ischemia reperfusion-induced gastric mucosal damage. Effect on Inflammatory Cytokine Release (Interleukin-8) in the Gastric Mucosa: Rebamipide, taken by the oral route, suppressed the increased production of interleukin-8 in the mucosa of patients with Helicobacter pylori. It also inhibited the activation of NF-B, the expression of interleukin-8 mRNA and the production of interleukin-8 in epithelial cells co-cultured with Helicobacter pylori. Clinical Studies: Clinical Efficacy in Gastric Ulcer: Mucosta was studied in patients with gastric ulcer using endoscopy for objective drug evaluation. In the final endoscopic assessment, rebamipide achieved complete healing in 60% (200/335) of the patients studied and near-complete healing in 67% (224/335). The clinical usefulness of Mucosta based on efficacy and safety was demonstrated in a double-blind study. A 6-month follow-up of 67 patients who showed healing at a daily dose of 300 mg revealed that recurrence occurred in only 4 patients (~6%).

Clinical Efficacy in Acute Gastritis and Acute Exacerbation of Chronic Gastritis: Mucosta was studied in patients with acute gastritis or acute exacerbation of chronic gastritis. The drug achieved an 80% (370/461) global efficacy rate in patients evaluated, with 76% (351/461) showing moderate or marked improvement. The drug's clinical usefulness was found to be reproducible in a double-blind study. Pharmacokinetics: Plasma Concentrations: Following single oral administration of Mucosta 100 mg to 27 healthy male subjects in a fasted state, t max is 2.41.2 hrs, Cmax is 21679 ng/mL with t of 1.90.7 hrs (calculated from values up to 12 hrs) and AUC24 hrs of 874209 nghr/mL. The absorption of rebamipide following single oral administration at 150 mg to 6 healthy subjects in a fed state tended to be slower than in a fasted state. However, food did not affect bioavailability of the drug in humans. Pharmacokinetic parameters obtained from patients with renal impairment after single oral administration of rebamipide at 100 mg revealed higher plasma concentrations and a longer elimination half-life compared with those in healthy subjects. At steady state, rebamipide plasma concentrations observed in dialyzed renal patients following repeated administration were very close to the values simulated from single administration. Therefore, the drug was not considered to accumulate. Metabolism: Rebamipide was primarily excreted as the unchanged compound in the urine after single oral administration to healthy adult males at a dose of 600 mg. A metabolite with a hydroxyl group at the 8th position was identified in the urine. However, the excretion of this metabolite was only 0.03% of the administered dose. The enzyme involved in the formation of the metabolite was CYP3A4. (Note: The usual dosage in adults is 100 mg 3 times daily.) Excretion: Approximately 10% of the administered dose was excreted in the urine when rebamipide was administered as a single oral dose to healthy adult males at 100 mg. Protein-Binding: Rebamipide at 0.05-5 mcg/mL was added to human plasma in vitro and 98.4-98.6% of the drug was bound to plasma proteins.

Vastarel MR
Trimetazidine

Name of the medicinal product Vastarel MR, modified release film-coated tablets in 10's and 60's / box. Qualitative and quantitative composition Trimetazidine dihydrochloride 35 mg Excipients q.s. for one modified release film-coated tablet

Pharmacological properties Pharmacodynamic properties Other cardiovascular antianginal drug Code ATC: C01EB15 (C: cardiovascular system) By preserving energy metabolism in cells exposed to hypoxia or ischaemia, trimetazidine prevents a decrease in intracellular ATP levels, thereby ensuring the proper functioning of ionic pumps and transmembrane sodium-potassium flow whilst maintaining cellular homeostasis. In animals Trimetazidine: - helps maintain energy metabolism in the heart and neurosensory organs during episodes of ischaemia and hypoxia, - reduces intracellular acidosis and alterations in transmembrane ion flow caused by ischaemia, - decreases the migration and infiltration of polynuclear neutrophils in ischaemic and reperfused cardiac tissue. It also reduces the size of experimental infarctions, - exerts this action in the absence of any direct haemodynamic effect. In man Controlled studies in angina patients have shown that trimetazidine: - increases coronary flow reserve, thereby delaying the onset of exercise-induced ischaemia, starting from the 15th day of treatment, - limits rapid swings in blood pressure without any significant variations in heart rate, - significantly decreases the frequency of angina attacks, - leads to a significant decrease in the use of trinitroglycerin. In a two-month study in patients receiving 50 mg atenolol, adding one 35 mg trimetazidine modified release tablet produced a significant increase in the time to 1-mm ST-segment depression in exercise tests, when compared to a placebo, 12 hours after taking the drug. Pharmacokinetic properties - After oral administration, maximum concentration is found, on average, 5 hours after taking the tablet. Over 24 hours the plasma concentration remains at levels above or equal to 75% of the maximum concentration for 11 hours. Steady state is reached by the 60th hour, at the latest. - The pharmacokinetic characteristics of Vastarel MR are not influenced by meals. - The apparent distribution volume is 4.8 I/kg; protein binding is low: in vitro measurements give value of 16%. - Trimetazidine is eliminated primarily in the urine, mainly in the unchanged form. The elimination half-life of Vastarel MR is an average of 7 hours in healthy young volunteers and 12 hours in subjects aged more than 65 years. Total clearance of trimetazidine is the result of major renal clearance which is directly correlated to creatinine clearance and, to a lesser extent, to liver clearance which is reduced with age. - A specific clinical study carried out in an elderly population using a dosage of 2 tablets per

day taken in 2 doses, analysed by a kinetic population method, showed an increase in plasma exposure which does not justify a dosage alteration. Therapeutic indications - Prophylactic treatment of episodes of angina pectoris. - Adjuvant symptomatic treatment of vertigo and tinnitus. - Adjuvant treatment of the decline in visual acuity and visual field disturbances presumably of vascular origin. Contraindications Hypersensitivity to the active substance or to any of the excipients. The use of this medicinal product is not recommended during pregnancy and breast-feeding (see section Pregnancy and lactation) Special warnings and precautions for use This drug is not a curative treatment for angina attacks, nor is it indicated as an initial treatment for unstable angina, or myocardial infarction. In the event of an angina attack, the coronaropathy should be reevaluated and an adaptation of the treatment considered (drug treatment and possibly revascularisation). Pregnancy & breast-feeding Pregnancy: No teratogenic effect was seen in animal studies; in the absence of clinical data, a risk of birth defect induction cannot be excluded; consequently, as a precaution, it is best not to prescribe the drug during pregnancy. Lactation: In the absence of data on excretion of the drug in milk, breast-feeding is not recommended during treatment. Side effects Rare cases of gastrointestinal disorders (nausea and vomiting). Interaction with other medicinal products and other forms of interaction No drug interaction has been reported; in particular, trimetazidine can be prescribed in combination with heparin, calciparin, vitamin K antagonist, oral hypolipidaemia agents, aspirin, beta-blockers, calcium inhibitors, digitalis (Trimetazidine has no effect on the plasma levels of digoxin). Dosage and method of administration One tablet at mealtimes in the morning and evening. Overdosage The experience of overdosage is very limited. Patients should be monitored in terms of cardiovascular and hemodynamic parameters.

Storage conditions No special storage condition required. Store below 30C.

Brand Name: UNASYN CLASSIFICATIONS Therapeutic: Anti-infectives Pharmacologic: Aminopenicillins/ beta lactamase inhibitors ACTIONS Physiologic Mechanism Bactericidal action. Active against: Streptococci, Penumococci, Enterococci, Haemophilus influenzae, Use should be reserved for infections caused by beta-lactamase-producing strains. Pharmacologic Mechanism Binds to bacteria cell wall, resulting in cell death, spectrum is broader than that of penicillin. Addition of sulbactam increases resistance to beta-lactamase, enzymes produced by bacteria that may inactivate ampicillin. INDICATION Treatment of respiratory infections NURSING CONSIDERATIONS Assess patient for infection (vital signs, wound appearance, sputum, urine, stool, and WBCs) at beginning and throughout therapy. Obtain a history before initiating therapy to determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Obtain specimens for culture and sensitivity before therapy. First dose may be given before receiving results. Observe patients for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify the physician immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction. Caution patient to notify physician if fever and diarrhea occur, especially if stool contains

blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication. Instruct patient to notify physician if symptoms do not improve.