DRUG NAME Generic Name: cefuroxime

INDICATION/ DOSAGE For the treatment of many different types of bacterial infections such as bronchitis, sinusitis, tonsillitis, ear infections, skin infections, gonorrhea, and urinary tract infections 150 mg 1 tab BID

CONTRAINDICATIONS

ADVERSE REACTIONS CV: phlebitis, thrombophlebitis GI: diarrhea, anorexia, vomiting Hematologic: hemolytic anemia, thrombocytopenia, transient neutropenia, eosinophilia

SIDE EFFECTS

NURSING CONSIDERATIONS Before giving dug. ask patient if she is allegic to penicillin or cephalosporin. Obtain specimen for culture and sensitivity tests before giving first dose. absorption of oral drug is induced.

DRUG ACTION

Contraindicated in patients hypersensitive to drug or other cephalosporin. Use cautiously in patients hypersensitive to penicillin because of possibility of cross-sensitivity with other beta lactam antibiotics

Brand Name: Xorimix

*Serious Side Effects: diarrhea that is watery or bloody fever, chills, body aches, flu symptoms chest pain, fast or pounding heartbeats unusual bleeding blood in your urine seizure (convulsions) pale or yellowed skin, dark colored urine, fever, confusion or weakness jaundice (yellowing of the skin or eyes) fever, sore throat, and headache with a severe blistering, peeling, and red skin rash skin rash, bruising, severe tingling, numbness, pain, muscle weakness increased thirst, loss of appetite, swelling, weight gain, feeling short of breath; or painful or difficult urination, urinating less than usual or not at all. *Less serious side effects may include: nausea, vomiting, stomach pain, mild diarrhea, gas, upset stomach cough, stuffy nose stiff or tight muscles, muscle pain joint pain or swelling headache, drowsiness feeling restless, irritable, or hyperactive white patches or sores inside your mouth or on your lips

Inhibits cell wall synthesis promoting osmotic instability usually bactericidal

unusual or unpleasant taste in your mouth diaper rash in an infant taking liquid cefuroxime mild itching or skin rash; or vaginal itching or discharge

Brand name: Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin Classification: Anti-fibrinolytic, antihemorrhagic Indications: Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and clinical areas: Treating heavy menstrual bleeding Hemorrhage following dental and/or oral surgery in patients with hemophilia Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures. Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid, lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues.

       

Obstetrical and gynecological: abortion, post-partum hemorrhage and menometrorrahgia Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with hemorrhage Effective in promoting hemostasis in traumatic injuries. Preventing hemorrhage after orthopedic surgeries.

Mechanism of Action Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysinebinding sites on plasminogen molecules. Anti-fibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogen-plasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis. Contraindications 1. 2. 3. 1. 2. 3. 4. 5. Allergic reaction to the drug or hypersensitivity Presence of blood clots (eg, in the leg, lung, eye, brain), have a history of blood clots, or are at risk for blood clots Current administration of factor IX complex concentrates or anti-inhibitor coagulant concentrates Pregnancy. Tranexamic acid crosses the placenta. Lactation. Tranexamic acid is distributed into breast milk; concentrations reach approximately 1% of the maternal plasma concentration. Contraceptives, estrogen-containing, oral or Estrogens. Concurrent use with tranexamic acid may increase the potential for thrombus formation. Renal function impairment (medication may accumulate; dosage adjustment based on the degree of impairment is recommended)

Precautions

Hematuria of upper urinary tract origin (risk of intrarenal obstruction secondary to clot retention in the renal pelvis and ureters if hematuria is massive; also, if hematuria is associated with a disease of the renal parenchyma, intravascular precipitation of fibrin may occur and exacerbate the disease)

ADVERSE REACTIONS: Gastrointestinal disturbances (nausea, vomiting, diarrhea) may occur but disappear when the dosage is reduced. Giddiness and hypotension have been reported occasionally. Hypotension has been observed when intravenous injection is too rapid. To avoid this response, the solution should not be injected more rapidly than 1 mL per minute.

Nursing Responsibilities 1. Unusual change in bleeding pattern should be immediately reported to the physician.

2. 3.

For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period. Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed.

4. 5. 6.

The medication can be taken with or without meals. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing. If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once.

7.

Inform the client that he/she should inform the physician immediately if the following severe side effects occur: Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth, face, lips or tongue Calf pain, swelling or tenderness Chest pain Confusion Coughing up blood Decreased urination Severe or persistent headache Severe or persistent body malaise Shortness of breath Slurred speech Slurred speech Vision changes

           

Generic name: metronidazole Brand name: Flagyl Preparations: PO 7.5 mg/kg q6hr (not to exceed 4g/day) CLASSIFICATION: Anti-infectives, Anti-protozoals ACTION: Disrupts DNA and protein synthesis in susceptible organisms Bactericidal, or amebicidal action INDICATION / USES: Amebicide in the management of amebic dysentery SIDE EFFECTS: All medicines may cause side effects, but many people have no, or minor, side effects.Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Metronidazole: Appetite loss; constipation; diarrhea; dizziness; headache; metallic taste; nausea; pain, swelling, or redness at the injection site; stomach upset; vomiting. Seek medical attention right away if any of these SEVERE side effects occur when using Metronidazole: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; fever; flushing; stuffy nose; very dry mouth or vagina); bloody stools; decreased coordination; increased or decreased urination; numbness, tingling, or burning of the arms, hands, legs, or feet; red, swollen, blistered, or peeling skin; seizures; severe diarrhea; severe or persistent dizziness or

headache; sore throat, chills, or fever; speech problems; stiff neck; stomach pain or cramps; vaginal itching, odor, or discharge; vision loss or other vision changes; white patches in the mouth.

COMMON ADVERSE EFFECTS: CNS: seizures, dizziness, headache GI: abdominal pain, anorexia, nausea, diarrhea, dry mouth, furry tongue, glossitis, unpleasant taste, vomiting Hematologic: leukopenia Skin: rashes, urticaria CONTRA-INDICATIONS: hypersensitivity NURSING CONSIDERATIONS: Administer with food or milk to minimize GI irritation. Tablets may be crushed for patients with difficulty swallowing. Instruct patient to take medication exactly as directed evenly spaced times between dose, even if feeling better. Do not skip doses or double up on missed doses. If a dose is missed, take as soon as remembered if not almost time for next dose. May cause dizziness or light-headedness. Caution patient or other activities requiring alertness until response to medication is known. Inform patient that medication may cause an unpleasant metallic taste. Inform patient that medication may cause urine to turn dark. Advise patient to consult health care professional if no improvement in a few days or if signs and symptoms of superinfection (black furry overgrowth on tongue; loose or foul-smelling stools develop).

Brand Name: TRAMADOL

CLASSIFICATIONS Therapeutic: Analgesics (centrally acting) ACTIONS Physiologic Mechanism Decreased pain. SIDE EFFECTS All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Tramadol: Constipation; diarrhea; dizziness; drowsiness; dry mouth; headache; increased sweating; indigestion; mild itching; nausea; trouble sleeping; vomiting; weakness. Seek medical attention right away if any of these SEVERE side effects occur when using Tramadol: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); agitation; chest pain; confusion; difficult or painful urination; disorientation; excessive sweating; fainting; fast or irregular heartbeat; fever; hallucinations; loss of coordination; mood or mental changes (eg, depression); red, blistered, swollen, or peeling skin; seizures; severe dizziness or light-headedness; severe nausea, vomiting, or diarrhea; severe or persistent headache; slow or shallow breathing; suicidal thoughts or behaviors; tremor; vision problems.

Pharmacologic Mechanism

Binds to mu-opioid receptors. Inhibits reuptake of serotonin and norepinephrine in the CNS. INDICATION Moderate to moderately severe pain

NURSING CONSIDERATIONS Assess type, location, and intensity of pain before and 2-3 hr (peak) after administration. Assess BP & RR before and periodically during administration. Respiratory depression has not occurred with recommended doses. Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects. Assess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or who have previously received opioids for more than 1 wk; may cause opioid withdrawal symptoms. Prolonged use may lead to physical and psychological dependence and tolerance, although these may be milder than with opioids. This should not prevent patient from receiving adequate analgesia. Most patients who receive tramadol for pain d not develop psychological dependence. If tolerance develops, changing to an opioid agonist may be required to relieve pain. Tramadol is considered to provide more analgesia than codeine 60 mg but less than combined aspirin 650mg/codeine 60 mg for acute postoperative pain. Monitor patient for seizures. May occur within recommended dose range. Risk increased with higher doses and inpatients taking antidepressants (SSRIs, tricyclics, or Mao inhibitors), opioid analgesics, or other durgs that decrese the seizure threshold. Overdose may cause respiratory depression and seizures. Naloxone (Narcan) may reverse some, but not all, of the symptoms of overdose. Treatment should be symptomatic and supportive. Maintain adequate respiratory exchange. Encourage patient to cough and breathe deeply every 2 hr to prevent atelactasis and pneumonia.

GENERIC NAME: Ketorolac BRAND NAME: Toradol CLASSIFICATION: Nonsteroidal anti-inflammatory agents, nonopioid analagesics DOSAGE: 30mg/amp1 amp IM MECHANISM OF ACTION: - Inhibits prostaglandin synthesis, producing peripherally mediated analgesia - Also has antipyretic and anti-inflammatory properties. - Therapeutic effect:Decreased pain INDICATION: Short term management of pain (not to exceed 5 days total for all routes combined)

CONTRAINDICATIONS: - Hypersensitivity - Cross-sensitivity with other NSAIDs may existPre- or perioperative use - Known alcohol intoleranceUse cautiously in: 1) History of GI bleeding 2) Renal impair-ment (dosage reduction may be required) 3) Cardiovascular disease SIDE EFFECTS/ ADVERSE EFFECTS: - CNS: 1) drowsiness 2) abnormal thinking 3) dizziness 4) euphoria 5) headache- RESP: 1) asthma 2) dyspnea - CV: 1) edema 2) pallor 3) vasodilation - GI: 1) GI Bleeding 2) abnormal taste 3) diarrhea 4) dry mouth 5) dyspepsia 6) GI pain 7) nausea - GU: 1) oliguria 2) renal toxicity 3) urinary frequency - DERM: 1) pruritis 2) purpura 3) sweating 4) urticaria - HEMAT: 1) prolonged bleeding time - LOCAL:

1) injection site pain - NEURO: 1) paresthesia - MISC: 1) allergic reaction, anaphylaxis NURSING IMPLICATIONS/RESPONSIBILITIES: - Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. - Assess pain (note type, location, and intensity) prior to and 1-2 hr following administration. - Ketorolac therapy should always be given initially by the IM or IV route. Oral therapy should be used only as a continuation of parenteral therapy. - Caution patient to avoid concurrent use of alcohol, aspirin, NSAIDs, acetaminophen, or other OTC medications without consulting health care professional. - Advise patient to consult if rash, itching, visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or influenza-like syndromes (chills,fever,muscles aches, pain) occur. - Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may respond to another.