Final Drug Study

Rose Pearl V.
Jimenez
BSN III-2
Chronic Bronchitis and Emphysema
Anti-inflammatory: Corticosteroids
Brand Generic Indications Dosage Side Effects Adverse Contraindications Nursing

Name Name Effects Considerations
Prednisone Prednisone Prednisone is an anti- Adult dosage (ages  nausea CNS: euphoria,  Contraindicated in  Determine if
inflammatory drug 18–64 years)  vomiting insomnia, psychotic patients patient is
Intensol, and thus deals with  loss of behavior, pseudotumor hypersensitive to sensitive to
Rayos inflammation of the Typical starting appetite cerebri, vertigo, drug or its other
conducting air dosage: This may  heartburn headache, paresthesia, components; in corticosteroids.
passages in the lung. vary from 5 mg to  trouble seizures. those with systemic  Immediate-
Inflammation may be 60 mg per day, sleeping, CV: HF, HTN, edema, fungal infections release drug
present in both depending on the  increased arrhythmias, (immediate-release may be used
asthma and COPD. condition being sweating or thrombophlebitis, only), cerebral for alternate-
The strategic use of treated. acne may thromboembolism. malaria, or active day therapy.
prednisone can occur. EENT: cataracts, ocular herpes  Always adjust
soothe and thus heal For immediate- If any of these effects glaucoma. simplex; and in to lowest
the delicate lining release tablets only: persist or worsen, tell GI: peptic ulceration, those receiving effective dose.
layer of these To reduce side your doctor or pancreatitis, Gl immunosuppressive  Most adverse
passageways, making effects, twice the pharmacist promptly. irritation, increased doses together with reactions to
them more resistant usual dose of this appetite, nausea, live-virus vaccines. corticosteroids
to bronchospasm. drug may be taken vomiting, abdominal  Use cautiously in are dose or
every other distention. patients with recent duration-
morning. This is GU: menstrual MI, GI ulcer, renal dependent.
called alternate day irregularities, increased disease, HTN,  For better
therapy. Do not use urine calcium level. osteoporosis, results and less
alternate day Metabolic: diabetes mellitus, toxicity, give 3
therapy unless hypokalemia, seizures, once-daily dose
prescribed by your hyperglycemia, hypothyroidism, in the morning.
doctor. carbohydrate cirrhosis, active  Drug may be
intolerance, hepatitis, used in
Child dosage (ages hypercholes. terolemia, diverticulitis, non-
Rose Pearl V. Jimenez
BSN III-2
0–17 years) Aypocalcemia, weight specific ulcerative conjunction

gain. colitis, recent with
Dosage for children Musculoskeletal: intestinal mineralocortico
is usually based on growth suppression in . anastomoses, ids when
weight. Your doctor children, muscle thromboembolic needed.
will determine the weakness, disorders,  Monitor
best dosage for your osteoporosis. myasthenia gravis, patient's BP,
child. Skin: hirsutism, HF, TB, ocular sleep patterns,
delayed wound herpes simplex, and and potassium
Senior dosage (ages healing, acne, various psychiatric level.
65 years and older) skin eruptions. disturbances.  If therapy lasts
Other: cushingoid Alert: Patients are more 6 weeks,
Older adults may state, susceptibility to susceptible to infections monitor IOP.
process drugs more infections, acute (from mild to fatal) during  Weigh patient
slowly. A normal adrenal insufficiency therapy. Drug can also mask daily; report
adult dose may after increased stress signs and symptoms of sudden weight
cause levels of the or abrupt withdrawal infection. gain to
drug to be higher after long-term  Drug can cause prescriber.
than normal. If therapy. cataracts or  Drug can cause
you’re a senior, you After abrupt glaucoma. HPA axis
may need a lower withdrawal: rebound Alert: High-dose therapy is suppression
dose or a different inflammation, fatigue, associated with acute and result in
schedule. weakness, arthralgia, myopathy that most often corticosteroid
fever, dizziness, occurs in patients receiving insufficiency if
lethargy, depression, neuromuscular drugs or in withdrawn.
fainting, orthostatic those with diseases such as Reduce dosage
hypotension, dyspnea, myasthenia gravis. gradually and
anorexia,hypoglycemia. reinstitute
After prolonged use, corticosteroid
sudden withdrawal therapy if
may be fatal. needed.
 Monitor
patient for HPA
axis
suppression
and cushingoid
BSN III-2
effects,
including moon
face, buffalo
hump, central
obesity,
thinning hair,
HTN, and
increased
susceptibility to
infection.
 Watch for
depression or
psychotic
episodes,
especially
during high-
dose
 Patient with
diabetes may
need increased
insulin; monitor
glucose level.
 Elderly patients
may be more
susceptible to
osteoporosis
with long-term
use.
 Patients with
thyroid status
changes may
need dosage
adjustment.
 Drug can cause
osteoporosis at
any age.
BSN III-2
Monitor bone
density in
patients on
longterm
therapy and
bone growth in
children.
Institute bone-
loss prevention
measures if
therapy is
expected to
last 3 months
or more.
 Monitor
patient for
signs and
symptoms of
infection. Drug
may mask or
worsen
infections,
including latent
amebiasis.
 Unless
contraindicated
, give low-
sodium diet
that’s high in
potassium and
protein. Give
potassium
supplements as
needed.
Gradually reduce
dosage after long-term
BSN III-2
therapy.
Bronchodilators: Beta- adrenergic agonist
Brand Name Generic Indication Dosage Side Effects Adverse Contraindications Nursing
Name Effects Considerations
Proventil Albutarol Albutarol (also The usual dose of  Nervousness CNS: tremor,  Contraindicated in  Drug may
known as Proventil is 2  shaking (tremor) nervousness, patients decrease
salbutamol) is used inhalations every 4  mouth/throat headache, hypersensitive to sensitivity of
to prevent and treat to 6 hours. To dryness or hyperactivity, drug or its spirometry
wheezing and prevent exercise- irritation insomnia, dizziness, ingredients. used for
shortness of breath induced  cough weakness, CNS  Use cautiously in diagnosis of
caused by breathing bronchospasm, use  dizziness stimulation, malaise. patients with CV asthma.
problems (e.g., 2 inhalations 15 to  headache CV: tachycardia, disorders (including  Syrup contains
asthma, chronic 30 minutes before  trouble sleeping palpitations, HTN, coronary no alcohol or
obstructive you exercise. The nausea may chest pain, insufficiency and sugar and may
pulmonary disease). effects of Proventil occur. lymphadenopathy, HTN), be taken by
It is also used to should last about 4 edema. hyperthyroidism, or children as
prevent asthma to 6 hours. You sent diabetes mellitus young as age 2.
brought on by 2 minutes ago and in those who  In children,
exercise. Albuterol When using the EENT: conjunctivitis, are unusually syrup may
belongs to a class of Proventil inhaler otitis media, dry and responsive to rarely cause
drugs known as device for the first irritated nose and adrenergics. erythema
bronchodilators. It time, prime it by throat (with inhaled  Use extended- multiforme or
works in the airways spraying 4 test form), nasal release tablets Stevens-
by opening breathing sprays into the air, congestion, epistaxis, cautiously in Johnson
passages and away from your face. hoarseness, patients with GI syndrome.
relaxing muscles. Shake well before pharyngitis, rhinitis. narrowing.  Monitor
priming. Also prime GI: nausea, vomiting, Dialyzable drug: Unknown. patient for
the inhaler if you heartburn, anorexia, Overdose S&S: Exaggeration effectiveness.
have not used it for altered taste, of adverse reactions, Using drug
2 weeks or longer, or increased appetite. seizures, angina, alone may not
BSN III-2
if you have dropped GU: UTI. hypotension, HTN, be adequate to

the inhaler. Metabolic: tachycardia, arrhythmias, control asthma
hypokalemia. nervousness, headache, in some
Musculoskeletal: tremor, dry mouth, patients. Long-
muscle cramps, back palpitations, nausea, term control
pain. dizziness, fatigue, malaise, medications
Respiratory: sleeplessness, hypokalemia, may be
bronchospasm, cardiac arrest. needed.
cough, wheezing, Alert: Drug may cause
dyspnea, bronchitis, paradoxical
increased sputum. bronchospasm.
Other: Monitor patient closely;
hypersensitivity discontinue drug
reactions, flulike immediately and use
syndrome, cold alternative therapy if
symptoms. paradoxical
bronchospasm occurs.
Bronchospasm with
inhaled formulations
frequently occurs with
first use of new canister
or vial.
Alert: Patient may use
tablets and aerosol
together. Monitor
these patients closely
for signs and symptoms
of toxicity.
Look alike-sound alike:
Don't confuse albuterol
with atenolol or
Albutein.
BSN III-2
Brand Name Generic Indication Dosage Side Effects Adverse Contraindication Nursing
Bronchodilators: Methylxanthines
Bronchodilators: Anticholinergics
Brand Name Generic Name Indication Dosage Side Effects Adverse Contraindication Nursing
Effects Considerations
Mucolytics: Mucomyst
BSN III-2
Expectorants: Guaifensin
Brand Name Generic Indication Dosage Side Effects Adverse Contraindicatio Nursing
Name Effects n Consideration
Antihistamines: non-drying
Effects Consideration
BSN III-2
ASTHMA
Cortecosteroids
Vanceril, Beclomethasone Beclomethasone is Adults and children  Headache NS: headache.  Contraindicated in  Check mucous
beclovent,qvar used to prevent age 12 and older:  sore throat EENT: hoarseness, patients membranes
difficulty breathing, Starting dose, 40 to  runny or throat irritation, hypersensitive to frequently for
chest tightness, 80 mcg b.i.d. when stuffy nose fungal infection of drug or its signs and
wheezing, and patient previously  back pain throat, pharyngitis, ingredients and in symptoms of
coughing caused by used bronchodilators  nausea rhinitis, sinusitis. those with status fungal
asthma in adults and alone, or 40 to 320  cough difficult GI: fungal infection of asthmaticus, infection.
children 5 years of mcg b.i.d. when or painful mouth, dry mouth. nonasthmatic  During times of
age and older. It patient previously speech Musculoskeletal: bronchial diseases, stress (trauma,
belongs to a class of used inhaled back pain. or asthma surgery, or
medications called corticosteroids. Respiratory: cough, controlled by infection),
corticosteroids. It Maximum, 320 mcg URI, exacerbation of bronchodilators or systemic
works by decreasing b.i.d. asthma, wheezing. other corticosteroids
swelling and Other: angioedema, noncorticosteroids may be needed
irritation in the Children ages 5 to facial edema, alone. to prevent
airways to allow for 11: 40 mcg b.i.4., up hypersensitivity  Use cautiously, if at adrenal
easier breathing. to 80 mcg b.i.d. reactions, adrenal all, in patients with insufficiency in
insufficiency, TB, ocular HSV, or previously
suppression of HPA untreated systemic corticosteroid-
function. fungal, bacterial, dependent .
parasitic, or viral patients.
infections.  Periodic
 Use cautiously in measurement
patients receiving of growth and
systemic development
corticosteroid may be needed
therapy. during high-
dose or
BSN III-2
prolonged
therapy in
children.
 Cataracts and
decreases in
bone mineral
density can
occur. Closely
monitor
patients for
vision changes
and for
decreased
bone mineral
content,
especially
patients with
major risk
factors.
Alert: Taper oral
corticosteroid therapy
slowly. Acute adrenal
insufficiency and death
may occur in patients
with asthma who
change abruptly from
oral corticosteroids to
beclomethasone.
Alert: Bronchospasm
may occur after dosing;
discontinue drug and
treat immediately with
a short-acting inhaled
bronchodilator.
BSN III-2
Cromolyn and Nedocromil
Intal Cromolyn Aerosol Intal inhaler is a Intal inhaler delivers  throat  severe INTAL is contraindicated  Withhold drug
prophylactic agent about 800 mcg per irritation or wheezing or in those patients who and notify
indicated in the inhalation. For dryness chest have shown physician if any
management of management of  unusual or tightness just hypersensitivity to of the
patients with bronchial asthma in unpleasant after inhaling cromolyn sodium. following
bronchial asthma. adults and pediatric taste in your the occur;
patients (5 years of mouth medication angioedema or
age and over), the  cough  skin rash, bronchospasm
usual starting dosage  wheezing bruising,  Monitor for
is two metered  nausea severe exacerbation
inhalations four times  heartburn tingling, of asthmatic
daily at regular  stomach pain numbness, symptoms
intervals. This dose  sneezing pain, muscle including
should not be  stuffy or itchy weakness breathlessness
exceeded. Effective nose fever, swollen and cough that
Intal Inhaler therapy  watery eyes glands, rash may occur in
is dependent upon its  burning or or itching, patients
administration at bleeding of joint pain, receiving
regular intervals, as your nose and a general cromolyn
directed. Intal may  urinating more ill feeling. during
interact with other or less than corticosteroid
medicines in a usual withdrawal.
nebulizer.  dizziness  For patients
 drowsiness with asthma,
headache therapeutic
effects may be
noted within a
few days but
generally not
until after 1–2
wk of therapy.
BSN III-2
 Throat
irritation,
cough, and
hoarseness can
be minimized
by gargling
with water,
drinking a few
swallows of
water, or by
sucking on a
lozenge after
each
treatment.
 Talk to your
physician
about what to
do in the event
of an acute
asthmatic
attack.
Cromolyn is of
no value in
acute asthma.
 Cromolyn does
not eliminate
the continued
need for
therapy with
bronchodilator
s,
expectorants,
antibiotics, or
corticosteroids,
but the
amount and
BSN III-2
frequency of
use of these
medications
may be
appreciably
reduced.
 Report any
unusual signs
or symptoms.
Hypersensitivit
y reactions can
be severe and
life-
threatening.
Drug should be
discontinued if
an allergic
reaction
occurs.
 Treatment
with cromolyn
15 min before
doing
protracted
exercises
reportedly
blunts the
effects of
vigorous
exercise as well
as cold air.
Ophthalmic use: Do
not wear soft contact
lenses during therapy
with ophthalmic drug.
They may be worn
BSN III-2
within a few hours after

therapy is discontinued.
 Learn the
proper
technique for
instillation of
ophthalmic
drops.
Do not breast feed
while taking this drug.
Tilade Nedocromil Tilade (nedocromil The recommended  dry mouth Gastrointestinal: Tilade Inhaler is  Tilade
inhalation aerosol) dosage for adult and  unpleasant unpleasant taste contraindicated in (nedocromil
Inhaler is indicated pediatric patients 6 taste which was reported in patients who have shown inhalation
for maintenance years of age and older  itchy skin approximately 13% of hypersensitivity to aerosol) must
therapy in the is two inhalations four  mild nausea patients receiving nedocromil sodium or be taken
management of adult times a day at regular  cough nedocromil (the active other ingredients in this regularly to
and pediatric patients intervals, which  nausea ingredient contained preparation. achieve
6 years and older with provides a dose of 14  headache in Tilade) and resulted benefit, even
mild to moderate mg per day. In  sinus pain in drug withdrawal in during
asthma. Tilade patients whose  sore throat up to 3%. Less symptom-free
(nedocromil asthma is well commonly, periods.
inhalation aerosol) is controlled on this nedocromil has  Tilade
not indicated for the dosage (e.g., patients caused nausea and (nedocromil
reversal of acute who only need vomiting (2% to 4%). inhalation
bronchospasm. occasional inhaled or aerosol) is not
oral beta2-agonists Respiratory: meant to
and who are not throat irritation may relieve acute
experiencing serious be relieved by asthma
exacerbations), less drinking water before symptoms. If
frequent and after inhalation of symptoms do
administration may nedocromil (the active not improve or
be effective. ingredient contained the patient's
in Tilade) Use of a condition
beta-2 agonist prior to worsens, the
nedocromil inhalation patient should
may relieve cough and not increase
BSN III-2
bronchospasm. the dosage but

Cough and throat should notify
irritation in 6% to 7% the physician
of patients treated immediately.
with nedocromil.  They should
Bronchospasm has not decrease
been induced in 5% of the dose
patients. without the
physician's
Nervous system: knowledge.
headache in up to 6% The
of patients treated. recommended
Less commonly dose should
dizziness has been not be
reported.[Ref] exceeded.
 The full
Hepatic: elevations of therapeutic
liver function tests effect of Tilade
(SGPT) in (nedocromil
approximately 3% of inhalation
patients treated with aerosol) may
nedocromil (the active not be
ingredient contained obtained for 1
in Tilade) week or longer
after initiating
treatment.
 Because the
therapeutic
effect depends
upon local
delivery to the
lungs, it is
essential that
patients be
properly
instructed in
BSN III-2
the correct
method of use
(see Patient
Instructions for
Use).
 An illustrated
leaflet for the
patient is
included in
each Tilade
(nedocromil
inhalation
aerosol)
Inhaler pack.
Leukotine modifiers
Brand Generic Indication Dosage Side Effects Adverse Contraindication Nursing

Name Name Effects Consideration
Accolate Zafrikulast Prevention and long- Adults and children  Headache CNS: headache,  Contraindicated in Alert: Reducing oral
term treatment of age 12 and older: 20  sore throat asthenia, dizziness, patients corticosteroid dose has
asthma mg P.O. b.i.d  cold pain, fever. hypersensitive to been followed in rare
Children ages 5 to 11: symptoms drug and in those cases by eosinophilia,
10 mg P.O. b.i.d  trouble GI: abdominal pain, with hepatic vasculitic rash,
sleeping diarrhea, dyspepsia, impairment, worsening pulmonary
 malaise gastritis, nausea, including hepatic symptoms, cardiac
 nausea vomiting. cirrhosis. complications, or
 stomach pain Musculoskeletal:  Use cautiously in neuropathy, sometimes
 diarrhea back pain, myalgia. elderly patients. known as Churg-Strauss
weakness Other: accidental Dialyzable drug: Unknown. syndrome.
dizziness injury, infection. Overdose S&S: Rash, upset  Drug isn’t
muscle pain. stomach. indicated to
BSN III-2
reverse
bronchospasm
in acute asthma
attacks,
including status
asthmaticus.
Alert: Drug may cause
behavior and mood
changes, including
agitation, depression,
insomnia, and suicidal
thinking and behavior.
Monitor patient and
consider discontinuing
drug if neuropsychiatric
symptoms develop.
Alert: Life-threatening
hepatic failure has been
noted in postmarketing
reports. If liver
dysfunction is suspected
(right upper quadrant
abdominal pain, nausea,
fatigue, lethargy,
pruritus, jaundice,
flulike symptoms,
anorexia, enlarged
liver), discontinue drug
immediately,
Don’t confuse Accolate
with Accupril or
Accutane
Singuilair Montelukast  Asthma, Asthma, seosanal  upper NS: headache,  Contraindicated in  Assess
seosanal allergic rhinitis, respiratory asthenia, dizziness, patients patient's
allergic rhinitis, perennial allergic infection fatigue, fever, hypersensitive to underlying
BSN III-2
perennial rhinitis  fever somnolence, drug or its condition;

allergic rhinitis Adults and children  headache weakness. ingredients. monitor
 Prevention of age 15 and older: 10  sore throat EENT: conjunctivitis,  Avoid use with patient for
exercise- mg P.O. once daily in  cough otitis media, nasal aspirin and other effectiveness.
induced evening. Children  stomach pain congestion, NSAIDs in patients Alert: Don’t abruptly
bronchoconstri ages 6 to 14: § mg  diarrhea nosebleed, laryngitis, with known aspirin substitute drug for
ction chewable tablet PO.  earache or ear sinusitis, pharyngitis, sensitivity because inhaled or oral
once daily in evening. infection rhinitis, tonsillitis, drug hasn't been corticosteroids. Dose
Children ages 2 to 5:  flu dental pain. GI: shown to affect the
of inhaled
4 mg chewable tablet  runny nose abdominal pain, bronchoconstrictor
corticosteroids may be
or packet of 4-mg oral  sinus dyspepsia, infectious. response to aspirin
reduced gradually.
granules P.O, once infection. gastroenteritis, and other NSAIDs in
daily in the evening. nausea, diarrhea. aspirin-sensitive
Alert: Drug isn't
Children ages 12 to GU: pyuria. asthmatic patients.
indicated for use in
23 months (asthma Hematologic:  Patients with
patients with acute
only): packet of 4-mg systemic asthma may
asthmatic attacks,
oral granules P.O. eosinophilia. present with
status asthmaticus, or
once daily in the Respiratory: URI, systemic
as monotherapy for
evening. cough, wheezing, eosinophilia that
management of
Children ages 6 to 23 pneumonia. may manifest as
exercise-induced
months (perennial Skin: rash, dermatitis, clinical features of
bronchospasm.
allergic rhinitis only): urticaria, eczema. vasculitis consistent
Continue appropriate
packet of 4-mg oral ~ Other: flulike with , Churg-Strauss
rescue drug for acute
granules P.O. once symptoms, trauma, syndrome. Churg-
worsening.
daily in the evening. varicella, viral Strauss syndrome is
 Drug may cause
infection. often treated with
behaviour and
Prevention of systemic
moos changes.
exercise-induced corticosteroid
Monitor patient
broachoconstriction. therapy. These
and consider
Adults and children reactions have
discontinuing
age 15 and older: 10 sometimes been
drug if
mg PO. at least 2 associated with
neoropsychiatri
hours before exercise. reduction ‘ of oral
c symptoms
Patients already corticosteroid
develop.
taking a daily dose dosage, Be alert to
shouldn't take an development of
BSN III-2
additional dose. Also, eosinophilia,

an additional dose vasculitic rash,
shouldn’t be taken worsening
within 24 hours of a pulmonary
previous dose. symptoms, cardiac
Children ages 6 to 14: complications, or
§ mg PO. at least 2 neuropathy.
hours before exercise  Use cautiously and
(1 chewable tablet). with appropriate
An additional dose monitoring in
shouldn't be taken patients whose
within 24 hours of a dosages of systemic
previous dose. corticosteroids are
reduced.
Alert: Neuropsychiatric
events have been reported
in adults, adolescents, and
children taking montelukast.
Postmarketing reports
include agitation, aggressive
behavior or hostility,
anxiousness, depression,
disonentation, disturbance
in attention, dream
abnormalities,
hallucinations, insomnia,
irritability, memory
impairment, restlessness,
somnambulism, suicidal
thinking and behavior
(including suicide), and
tremor.
 Use caution when
using drug in
patients with
hepatic disease,
BSN III-2
jaundice, or
hepatitis.
Dialyzable drug: Unknown.
Overdose S&S: Headache,
vomiting, psychomotor
hyperactivity, thirst,
somnolence, hyperkinesia,
abdominal pain.
Zyflo Zileuton Indicated for the For the prophylaxis  Nausea Body as a Whole:  Zileuton is  Assess
prophylaxis and chronic and chronic  upset Pain, asthenia, contraindicated in respiratory
treatment of asthma in maintenance stomach myalgia, arthralgia, patients with status and
adults and children 12 treatment of asthma.  diarrhea fever, malaise, neck hypersensitivity to airway function
years of age and older. Oral dosage  trouble pain/rigidity. zileuton or any of regularly.
Zileuton is not indicated (extended-release sleeping CNS: Headache, its inactive  Lab tests:
for use in the reversal of tablets)  cold dizziness, insomnia, ingredients. Periodic CBC
bronchospasm in acute Adults symptoms nervousness,  Alcoholism, and routine
asthma attacks. Therapy 1,200 mg PO twice (stuffy nose, somnolence. geriatric, hepatic blood
with zileuton can be daily, within one hour sinus pain, CV: Chest pain. disease, hepatitis, chemistry;
continued during acute after morning and sneezing, sore GI: Abdominal pain, hepatotoxicity, monthly liver
exacerbations of evening meals. throat) dyspepsia, nausea, jaundice function tests
asthma. Children and  headache constipation,  Acute for 3 mo, then
Adolescents 12 years  weakness, or flatulence, vomiting, bronchospasm, every 2–3 mo
and older muscle pain. elevated liver status asthmaticus for rest of first
1,200 mg PO twice function tests,  Behavioral changes, year, then
daily, within one hour asymptomatic psychiatric event, periodically.
after morning and hepatitis. suicidal ideation  Instructions for
evening meals. Skin: Pruritus.  Children, infants, CONCURRENT
Other: Conjunctivitis, neonates THERAPIES:
hypertonia,  Pregnancy Reduce
lymphadenopathy,  Breast-feeding theophylline
vaginitis, UTI, dose and
leukopenia. closely monitor
theophylline
levels; closely
monitor PT and
INR with
BSN III-2
warfarin
therapy; closely
monitor
phenytoin level
with phenytoin
therapy; closely
monitor HR and
BP for excessive
beta blockade
with
propranolol
therapy.
 Take
medication
regularly even
during
symptom-free
periods.
 Drug is not
intended to
treat acute
episodes of
asthma.
 Report to
physician
promptly S&S
of hepatic
toxicity (see
Appendix F) or
flu-like
symptoms.
Follow-up lab
work is very
important.
 Notify physician
if condition
BSN III-2
worsens while
using
prescribed
doses of all
antiasthmatic
medications.
 Do not breast
feed while
taking this
drug.
B2- adrenergic agonist: Short acting
Brand Generic Indication Dosage Side Effects Adverse Contraindication Nursing

Name Name Effects Considerations
Proventil Albuterol Albuterol (also the usual dose of  Nervousness CNS: tremor,  Contraindicated in  Drug may
known as Proventil is 2  shaking (tremor) nervousness, patients decrease
salbutamol) is used inhalations every 4  mouth/throat headache, hypersensitive to sensitivity of
to prevent and treat to 6 hours. To dryness or irritation hyperactivity, drug or its spirometry
wheezing and prevent exercise-  cough insomnia, dizziness, ingredients. used for
shortness of breath induced  dizziness weakness, CNS  Use cautiously in diagnosis of
caused by breathing bronchospasm, use  headache trouble stimulation, malaise. patients with CV asthma.
problems (e.g., 2 inhalations 15 to sleeping nausea CV: tachycardia, disorders (including  Syrup contains
asthma, chronic 30 minutes before may occur. palpitations, HTN, coronary no alcohol or
obstructive you exercise. The chest pain, insufficiency and sugar and may
pulmonary disease). effects of Proventil lymphadenopathy, HTN), be taken by
It is also used to should last about 4 edema. hyperthyroidism, or children as
prevent asthma to 6 hours. You sent diabetes mellitus young as age 2.
brought on by 2 minutes ago and in those who  In children,
exercise. Albuterol When using the EENT: conjunctivitis, are unusually syrup may
belongs to a class of Proventil inhaler otitis media, dry and responsive to rarely cause
drugs known as device for the first irritated nose and adrenergics. erythema
BSN III-2
bronchodilators. It time, prime it by throat (with inhaled  Use extended- multiforme or

works in the airways spraying 4 test form), nasal release tablets Stevens-
by opening sprays into the air, congestion, epistaxis, cautiously in Johnson
breathing passages away from your hoarseness, patients with GI syndrome.
and relaxing face. Shake well pharyngitis, rhinitis. narrowing.  Monitor
muscles. before priming. GI: nausea, vomiting, Dialyzable drug: Unknown. patient for
Also prime the heartburn, anorexia, Overdose S&S: Exaggeration effectiveness.
inhaler if you have altered taste, of adverse reactions, Using drug
not used it for 2 increased appetite. seizures, angina, alone may not
weeks or longer, or GU: UTI. hypotension, HTN, be adequate to
if you have dropped Metabolic: tachycardia, arrhythmias, control asthma
the inhaler. hypokalemia. nervousness, headache, in some
Musculoskeletal: tremor, dry mouth, patients. Long-
muscle cramps, back palpitations, nausea, term control
pain. dizziness, fatigue, malaise, medications
Respiratory: sleeplessness, hypokalemia, may be
bronchospasm, cardiac arrest. needed.
cough, wheezing, Alert: Drug may cause
dyspnea, bronchitis, paradoxical
increased sputum. bronchospasm.
Other: Monitor patient
hypersensitivity closely; discontinue
reactions, flulike drug immediately and
syndrome, cold use alternative therapy
symptoms. if paradoxical
bronchospasm occurs.
Bronchospasm with
inhaled formulations
frequently occurs with
first use of new canister
or vial.
Alert: Patient may use
tablets and aerosol
together. Monitor
these patients closely
for signs and symptoms
BSN III-2
of toxicity.
Don't confuse albuterol
with atenolol or
Albutein.
Alupent Metaproterenol Alupent Adult:  headache NS: Nervousness, Conditions:  Monitor
(metaproterenol tablet  dizziness weakness,  overactive thyroid respiratory
sulfate) Aerosol is a 10mg  lightheadedness drowsiness, tremor gland status.
bronchodilator used 20mg  insomnia (particularly after PO  diabetes Auscultate
to treat conditions syrup  tremor administration),  high blood pressure lungs before
such as asthma, 10mg/5mL  nervousness headache, fatigue.  coronary artery and after
bronchitis, and Asthma, Reversible  sweating CV: Tachycardia, disease inhalation to
emphysema. Bronchospasm  nausea hypertension, cardiac  a low supply of determine
20 mg PO  vomiting arrest, palpitation. oxygen rich blood efficacy of drug
three/four times  diarrhea, or dry GI: Nausea, vomiting, to the heart in decreasing
daily mouth. bad taste.  chronic heart airway
Urogenital: failure resistance.
Pediatric: Occasional difficulty  abnormal EKG with  Monitor
tablet in micturition and QT changes from cardiac status.
10mg muscle cramps. birth Report
20mg Respiratory: Throat  seizures tachycardia
syrup irritation, cough,  an abnormally fast and
10mg/5mL exacerbation of heartbeat hypotension.
Asthma asthma. Allergies:  Report failure
PO  Beta-Adrenergic to respond to
<2 years old: 0.4 Agents usual dose.
mg/kg PO q8-12hr Drug may have
2-6 years old: 1-3.5 shorter
mg/kg/day divided duration of
q6-8hr PO; not to action after
exceed 10 mg/dose long-term use.
6-9 years old: 10 mg  Do not
PO three/four times increase dose
daily or frequency
>12 years old: 20 unless ordered
mg PO three times by physician;
BSN III-2
daily there is the

possibility of
serious
adverse
effects.
 Anticipate
tremor as a
possible
adverse effect.
 Do not breast
feed while
taking this drug
without
consulting
physician.
Tornalate Bitolterol Bitolterol mesylate Adults and children  nervousness CNS: tremor,  Contraindicated in • Avoid excessive or
(Tornalate) is a older than age 12:  tremor nervousness, patients prolonged use because
short-acting β2 For intermittent  headache headache, dizziness, hypersensitive to it can lead to tolerance.
adrenergic receptor flow, 1 mg t.i.d. For  palpitations light-headedness. drug. • Repeated use may
agonist used for the continuous flow,  fast heart rate CV: palpitations,  Use cautiously in result in paradoxical
relief of 2.5 mg t.i.d.  elevated blood chest discomfort, patients with bronchospasm.
bronchospasm in However, because pressure tachycardia. ischemic heart Discontinue drug
conditions such as deposition of  nausea EENT: throat disease, immediately if this
asthma and COPD. inhaled medications  dizziness irritation. hypertension, occurs.
is variable, higher  heartburn GI: nausea, vomiting. hyperthyroidism, • May reduce the
doses are GU: proteinuria. diabetes mellitus, sensitivity of
occasionally used, Hematologic: arrhythmias, spirometry for
especially in leukopenia, seizure disorders, diagnosing asthma.
patients with acute thrombocytopenia. or a history of • Monitor patient for
bronchospasm. In Hepatic: liver unusual decreased
some patients, impairment. responsiveness to effectiveness. Don’t
higher doses (1.5 Respiratory: cough, beta-adrenergic increase frequency or
mg for intermittent dyspnea. agonists. dose; fatal reactions
flow and 3.5 mg for Other: have resulted from
continuous flow hypersensitivity excessive oral
nebulizer) or reactions. inhalation of
BSN III-2
increased frequency sympathomimetic

may be required. amines.
The interval • Store at 59° to 86° F
between (15° to 30° C).
treatments should Nebulizer solution
be at least 4 hours. shouldn’t be mixed
The maximum dose with other drugs (such
is 8 mg for as cromolyn sodium
intermittent flow and acetylcysteine) in
and 14 mg for the the nebulizer because
continuous flow of incompatibilities.
nebulizer system. Pregnant patients
• There are no
adequate controlled
studies of use in
pregnant women.
Breast-feeding patients
• Administer cautiously
to breast-feeding
women. It’s unknown if
drug appears in breast
milk.
Pediatric patients
• Drug isn’t
recommended for
children younger than
age 12.
Geriatric patients
• Lower doses are
indicated in elderly
patients, who may be
more sensitive to the
effects of the drug.
Maxair Pirbuterol indicated for the The usual dose for  Tremor CNS: depression,  Risk of Before using, the
prevention and adults and children  Nervousness anxiety, confusion, hypokalemia, inhaler must be shaken
reversal of 12 years and older  Dizziness insomnia, weakness, usually transient well; assess lung
BSN III-2
bronchospasm in is two inhalations  Weakness hyperkinesia,  Use caution in sounds, pulse, and
patients 12 years of (400 mcg) repeated  Headache syncope. cardiovascular blood pressure before
age and older with every 4-6 hours.  upset stomach Cardiovascular: disease, glaucoma, administration and
reversible One inhalation (200  diarrhea hypotension, skipped hyperthyroidism, during peak of
bronchospasm mcg) repeated  cough beats, chest pain. hypokalemia, and medication; observe
including asthma. It every 4-6 hours  dry mouth Gastrointestinal: dry seizure disorders. patient for wheezing
may be used with or may be sufficient  throat irritation mouth, glossitis,  May increase serum after administration, if
without concurrent for some patients. abdominal glucose; use this occurs, call
theophylline and/or pain/cramps, caution in diabetes physician
corticosteroid A total daily dose of anorexia, diarrhea, mellitus
therapy. 12 inhalations stomatitis, nausea  Fatal outcomes
should not be and vomiting. reported with
exceeded. Ear, Nose and excessive use of
Throat: smell/taste therapy
If a previously changes, sore throat.  Not for use in
effective dosage Dermatological: rash, chronic asthma
regimen fails to pruritus. therapy unless anti-
provide the usual Other:numbness in inflammatory agent
relief, medical extremities, alopecia, use concomitantly
advice should bruising, fatigue,
besought edema, weight gain,
immediately as this flushing.
is often a sign of
seriously worsening
asthma which
would require
reassessment of
therapy.
BSN III-2
B2- adrenergic agonist
Name Effects Consideration
Serevent Salmeterol  Long term  Long term  Hoarseness NS: anxiety,  Contraindicated in  Drug may
maintenance maintenance  Throat headache, dizziness, patients increase the
to prevent to prevent  Irritation tremor, nervousness, hypersensitive to risk of
bronchospas bronchospas  Headache paresthesia, sleep drug or its asthma-
m in patients m in patients  rapid heartbeat disturbance, fever. ingredients. related death.
with with  nervousness CV: tachycardia,  Contraindicated for Only use
nocturnal nocturnal  cough palpitations, HTN. treatment of salmeterol as
asthma or asthma or  dry EENT: conjunctivitis, asthma without a additional
reversible reversible mouth/throat keratitis, concomitant long- therapy for
obstructive obstructive  upset stomach nasopharyngitis, term asthma patients
airway airway may occur. pharyngitis, control medication whose
disease as disease as hoarseness, nasal such as an inhaled condition is
concomitant concomitant cavity or sinus corticosteroid. not
therapy with therapy with disorder, candidiasis Using without a adequately
a long-term a long-term of mouth/throat, long-term asthma controlled on
asthma asthma hyposalivation, control medication other
control control sinusitis. may increase the medications
medication medication Gl: nausea, vomiting, risk of asthma- or patients
such as an such as an diarrhea, heartburn. related death. whose disease
inhaled inhaled Musculoskeletal: Alert: Don’t use drug with severity
corticosteroi corticosteroi joint and back pain, other medications warrants
d d myalgia. containing long-acting betaz initiation of
 To prevent Adults and children Respiratory: URI, agonists. treatment
exercise- age 4 and older: cough, lower Alert: Don’t use as the with two
induced inhalation (50 mcg) respiratory tract primary treatment for acute maintenance
bronchospas b.i.d. in the morning infection. episodes of asthma or therapies.
m and evening, about 12 Other: COPD.  Once asthma
 COPD, hours apart. hypersensitivity  Use cautiously in control is
emphysema,  To prevent reactions, rash, ur. patients unusually achieved and
or chronic exercise- ticaria, flulike responsive to maintained,
bronchitis induced symptoms, sympathomimetics assess patient
BSN III-2
bronchospas photodermatitis. and those with at regular

m coronary intervals; step
Adults.and children insufficiency, down therapy
age 4 and older: 1 arrhythmias, HTN, (e.g.,
inhalation (SO mcg) at other CV disorders, discontinue
least 30 minutes thyrotoxicosis, salmeterol) if
before exercise. hepatic possible
Additional doses impairment, without loss
shouldn’t be taken for diabetes, or seizure of asthma
at least 12 hours. disorders. control and
 COPD, Dialyzable drug: Unknown. maintain
emphysema, Overdose S&S: Exaggeration patient on a
or chronic of adverse reactions, long-term
bronchitis hypokalemia, seizures, asthma
Adults: inhalation (50 angina, HTN, hypotension, control
mcg) b.i.d. in the dry mouth, muscle cramps, medication
morning and evening, dizziness, fatigue, insomnia, such as an
about 12 hours apart. tachycardia, ventricular inhaled
arrhythmias, cardiac arrest, corticosteroid.
sudden death. Don’t use
salmeterol for
patients
whose asthma
ts adequately
controlled on
lowor
medium-dose
inhaled
corticosteroid
s.
 Long-acting
beta2 agonists
may increase
risk of
asthma-
related
BSN III-2
hospitalizatio
n in children
and
adolescents.
For children
and
adolescents
with asthma
who require
addition of a
long-acting
beta agonist
to an inhaled
corticosteroid,
a fixeddose
combination
product
containing
both an
inhaled
corticosteroid
and a long-
acting beta2
agonist should
ordinarily be
used to
ensure
adherence
with both
drugs. In cases
in which use
of a separate
long-term
asthmacontrol
medication
(such as an
BSN III-2
inhaled
corticosteroid
) and a long-
acting beta2
agonist is
clinically
indicated,
appropriate
steps must be
taken to
ensure
adherence
with both
treatment
components,
If adherence
can't be
ensured, a
fixed-dose
combination
product
containing
both an
inhaled
corticosteroid
and a long-
acting beta2
agonist is
recommende
d.
 Drug isn’t
indicated for
acute
bronchospas
m.
BSN III-2
Alert: Monitor patient

for rash and urticana,
which may signal a
hypersensitivity
reaction. |
 Rarely,
potentially
life-
threatening
paradoxical
bronchospas
m can occur.
Distinguish
this symptom
from
inadequate
response.
Methylxanthines
Uniphyl, Theophylline Theophylline is Adult dosage (ages  Headache Nausea, vomiting,  Contraindicated in  Caution patient
Theochron indicated for the 18–59 years)  Irritability abdominal pain, individuals who not to chew or
treatment of the The usual starting  Nervousness diarrhea, headache, have shown crush enteric-
symptoms and dose is 300–400 mg  fast, pounding, or insomnia, dizziness, hypersensitivity to coated timed-
reversible airflow per day. After 3 irregular heart beat anxiety, its components. release
obstruction days, your dose  restlessness preparations.
associated with may be increased  insomnia
restlessness,  Contraindicated in
 Give
tremor, patients with active
chronic asthma and to 400–600 mg per  tremors palpitations. immediate
other chronic lung day if you don’t peptic ulcer, and in
 light-headedness Potentially Fatal: release, liquid
diseases, e.g., have any side underlying seizures
BSN III-2
emphysema and effects. After 3  seizures Convulsions, cardiac disorders. dosage forms
chronic bronchitis. more days, if your  nausea arrhythmias, with food if GI
dose is tolerated  stomach ache hypotension and effects occur.
and more  diarrhea sudden death after  Do not give
medication is  loss of appetite too rapid IV injection timed-release
needed, your dose preparations
may be adjusted with food;
based on the level these should
of theophylline in be given on an
your blood. empty
Child dosage (ages stomach, 1 hr
16–17 years) before or 2 hr
The usual starting after meals.
dose is 300–400 mg  Advise patients
per day. After 3 that this drug
days, your dose should not be
may be increased used during
to 400–600 mg per pregnancy;
day if you don’t using barrier
have any side contraceptives
effects. After 3 is
more days, if your recommended.
dose is tolerated  WARNING:
and more Monitor results
medication is of serum
needed, your dose theophylline
may be adjusted level
based on the level determinations
of theophylline in carefully, and
your blood. reduce dosage
Child dosage (ages if serum levels
1–15 years who exceed
weigh more than therapeutic
45 kg) range of 10–15
The starting dose is mcg/mL.
300–400 mg per  Monitor
BSN III-2
day. After 3 days, carefully for

your doctor may clinical signs of
increase your dose adverse
to 400–600 mg per effects,
day. After 3 more particularly if
days, your dose serum
may be adjusted as theophylline
needed based on levels are not
the level of available.
theophylline in  WARNING:
your blood. Keep diazepam
Child dosage (ages readily
1–15 years who available to
weigh less than 45 treat seizures.
kg)
The starting dose is
12–14 mg/kg per
day up to 300 mg
per day. After 3
days, your doctor
may increase your
dose to 16 mg/kg
daily up to a
maximum of 400
mg per day if you
don’t have any side
effects. After 3
more days, if the
dose is tolerated, it
may be increased
to 20 mg/kg daily
up to a maximum
of 600 mg per day.
This drug is given

in divided doses
BSN III-2
every 4–6 hours.

Your dose will be
adjusted based on
the amount of
theophylline in the
blood.
Norphyl, Aminophylline Aminophylline is a Individualize  Nausea CNS: Irritability  Hypersensitivity to  Administer to
Phyllocontin, complex of dosage: Base  Vomiting (especially children); the pregnant
Truphylline. theophylline and adjustments on  Headache restlessness, ethylenediamine or patients only
ethylenediamine clinical responses;  Insomnia dizziness, muscle those allergic to the when clearly
and is given for its monitor serum  Irritability twitching, seizures, theophyllines, needed—
theophylline activity theophylline levels;  restlessness severe depression, caffeine or neonatal
to relax smooth maintain  increase in urine stammering speech; theobromine tachycardia,
muscle and to therapeutic range volume abnormal behavior  Aminophylline jitteriness, and
relieve bronchial of 10–20 mcg/mL;  shakiness characterized by should not be withdrawal
spasm. base dosage on  increased gastric acid withdrawal, mutism, administered apnea
lean body mass; secretion and concomitantly with observed when
127 mg  gastroesophageal unresponsiveness other xanthine mothers
aminophylline reflex alternating with drugs. When received
dihydrate = 100 mg hyperactive periods therapeutic doses xanthines up
theophylline CV: Palpitations, of Aminophylline until delivery.
anhydrous. sinus tachycardia, and/or theophylline  Caution patient
ventricular are administered not to chew or
tachycardia, life- simultaneously by crush enteric-
threatening more than one coated timed-
ventricular route or in more release forms.
arrhythmias, than one  Give
circulatory failure preparation, the immediate-
GI: Loss of appetite, hazard of serious release, liquid
hematemesis, toxicity is increased. dosage forms
epigastric pain,  The use of with food if GI
gastroesophageal Aminophylline IV in effects occur.
reflux during sleep, children under 6  Do not give
increased AST months of age is timed-release
GU: Proteinuria, not generally forms with
increased excretion recommended. food; these
BSN III-2
of renal tubular cells  The use of should be

and RBCs; diuresis Aminophylline is given on an
(dehydration), contra-indicated in empty
urinary retention in patients with acute stomach 1 hr
men with prostate porphyria. before or 2 hr
enlargement after meals.
Respiratory:  Maintain
Tachypnea, adequate
respiratory arrest hydration.
Other: Fever,  Monitor results
flushing, of serum
hyperglycemia, theophylline
SIADH, rash. levels carefully,
and arrange for
reduced
dosage if
serum levels
exceed
therapeutic
range of 10–20
mcg/mL.
 Take serum
samples to
determine
peak
theophylline
concentration
drawn 15–30
min after an IV
loading dose.
 Monitor for
clinical signs of
adverse
effects,
particularly if
serum
BSN III-2
theophylline
levels are not
Anticholinergics
Atrovent Ipratropium  Ipratropium Adults  a common Cardiovascular: Conditions:  Protect
bromide is Acute Asthma cold Hypotension,  closed angle solution for
indicated for Exacerbation (Off-  bronchitis palpitations, glaucoma inhalation
the treatment label)  flu-Like tachycardia  blockage of the from light.
of reversible Inhaler: 8 actuations symptoms General: Dry throat, urinary bladder Store unused
bronchospasm (136 mcg) q20min  headache throat irritation  enlarged prostate vials in foil
associated with PRN for 3 hr  throat dryness Gastrointestinal (GI):  an inability to pouch.
chronic Nebulizer: 500 mcg  trouble Constipation, completely empty  Use nebulizer
obstructive q20min for 3 doses, breathing stomatitis, mouth the bladder mouthpiece
pulmonary then PRN edema Allergies: instead of
disease (COPD). Administration Sensory: Narrow-  Anticholinergics – face mask to
 Ipratropium Prime before initial angle glaucoma, Quaternary avoid blurred
bromide is use by releasing 2 glaucoma, halo  Ipratropium vision or
indicated, when test sprays into air; vision, conjunctival Analogues aggravation of
used repeat priming if hyperemia, corneal narrow-angle
concomitantly unused for ≥3 days edema, mydriasis, glaucoma.
with inhaled Dosing acute eye pain, blurry  Can mix
beta2-agonists, Considerations vision albuterol in
for treatment In treatment of acute Respiratory: nebulizer for
of reversible asthma exacerbation Bronchospasm, up to 1 hr.
airways with inhaler, short- including paradoxical  Ensure
obstruction as acting beta agonist bronchospasm adequate
in acute and (SABA) must be Renal: Urinary hydration,
chronic asthma. coadministered. retention control
BSN III-2
environmenta
Pediatric l temperature
Acute Asthma to prevent
Exacerbation (Off- hyperpyrexia.
label)  Have patient
<5 years (inhaler): 2 void before
inhalations q20min taking
for 1 hr if necessary medication to
5-12 years (inhaler): avoid urinary
4-8 actuations q20 retention.
min PRN for up to 3  Teach patient
hr proper use of
≥12 years (inhaler): 8 inhaler.
actuations q20 min
PRN for up to 3 hr
<5 years (nebulizer):
0.25 mg (250 mcg)
q20min for 1 hr if
necessary
5-12 years
(nebulizer): 250-500
mcg q20 min for 3
doses, then PRN
≥12 years
(nebulizer): 500 mcg
q20 min for 3 doses,
then PRN
BSN III-2
TUBERCOLOSIS
First-line drugs
Second-line drugs
BSN III-2
BSN III-2
PNEUMONIA
VACCINES
Brand Name Generic Indication Dosage Side Effects Adverse Effects Contraindication Nursing
Name Consideration
PCV7; Prevnar Pneumococcal Prevnar® is indicated The dose is 0.5 mL to  Redness Central nervous system: The only contraindication Federal law requires
Conjugate Vaccine for active be given  Pain or Drowsiness, fever, to PCV-7 immunization is a that the date of
immunization of intramuscularly. swelling at the irritability, restlessness severe administration, the
infants and toddlers site of the shot hypersensitivity reaction to vaccine manufacturer,
against invasive  mild fever Dermatologic: Erythema, a previous dose of the lot number of vaccine,
disease caused by S.  chills rash vaccine. and the administering
pneumoniae due to  headache person's name, title
capsular serotypes  drowsiness or Gastrointestinal: Appetite and address be
included in the tiredness decreased, diarrhea, entered into the
vaccine (4, 6B, 9V,  decreased vomiting patient's permanent
14, 18C, 19F, and appetite medical record
23F). The routine  irritability Local: Induration,
schedule is 2, 4, 6, nodules, tenderness
and 12-15 months of
age.
PPV23; Pneumococcal PNEUMOVAX® 23 is Single 0.5-mL dose of Reactions where the injection-site Do not administer  Inform the
Pneumovax Polusaccharide a vaccine indicated PNEUMOVAX 23 shot was given: pain/soreness/tendernes PNEUMOVAX 23 to patient,
vaccine for active administered  redness s (60.0%), injection-site individuals with a history of parent or
immunization for the intramuscularly  pain swelling/induration anaphylactic/anaphylactoid guardian of
prevention of or subcutaneously  fever (20.3%), headache or severe allergic reaction the benefits
pneumococcal only.  muscle aches (17.6%), injection-site to any component of the and risks
disease caused by erythema vaccine. associated
the 23 serotypes (16.4%), asthenia and with
contained in the fatigue (13.2%), and vaccination.
vaccine (1, 2, 3, 4, 5, myalgia (11.9%).  Tell the
6B, 7F, 8, 9N, 9V, patient,
10A, 11A, parent or
2 guardian that
BSN III-2
12F, 14, 15B, 17F, vaccination

18C, 19F, 19A, 20, with
22F, 23F, and 33F). PNEUMOVAX
PNEUMOVAX 23 is 23 may not
approved for use in offer 100%
persons 50 years of protection
age or older and from
persons aged 2 years pneumococcal
who are at increased infection.
risk for  Provide the
pneumococcal patient,
disease. parent or
guardian with
the vaccine
information
statements
required by
the National
Childhood
Vaccine Injury
Act of 1986,
with each
immunization.
 Instruct the
patient,
parent or
guardian to
report any
serious
adverse
reactions to
their health
care provider
who in turn
should report
such events to
BSN III-2
the vaccine
manufacturer
Antibiotics
Brand Name Generic Indication Dosage Side Effects Adverse Effects Contraindication Nursing
Name Consideration
Pfizerpen Penicillin G Serious streptococcal Children: 150,000 NS: seizures,  Contraindicated in patients  Before starting
pottasium infections, such as to 300,000 agitation, anxiety, hypersensitive to drug or drug, obtain
pneumonia and units/kg/day in confusion, other penicillins. culture and
endocarditis equal doses I.M. or depression,  Use cautiously in patients susceptibility tests
(Streptococcus I. V. every 4 to 6 dizziness, fatigue, with other drug allergies, to identify
pneumoniae), and hours. Duration of hallucinations, especially to organisms causing
meningococcal therapy depends lethargy, cephalosporins, because of infection.
infections. on infecting hyperreflexia, possible cross-sensitivity.  Monitor renal
organism and type myoclonic twitches,  Use cautiously in patients function closely.
of infection. neuropathy. with renal impairment or Patients with poor
CV: asthma. renal function may
thrombophlebitis,  Drug may cause CDAD have increased
cardiac arrest, ranging in seventy from levels of penicillin
arrhythmias. mild diarrhea to fatal and are at
GI: colitis. If CDAD is suspected increased risk
pseudomembranous or confirmed, drug may
colitis, enterocolitis, need te be discontinued for adverse effects.
nausea, vomiting. and treatment initiated.
GU: interstitial Dialyzable drug: Yes.
nephritis, Overdose S&S: Agitation,
nephropathy. confusion, asterixis, hallucinations,
Hematologic: stupor, coma, multifocal
agranulocytosis, myoclonus, seizures,
leukopenia, encephalopathy,
thrombocytopenia,
anemia, hyperkalemia.
BSN III-2
eosinophilia,
hemolytic anemia.
Metabolic: Severe
potassium
poisoning.
Skin: exfoliative
dermatitis,
maculopapular
eruptions, pain at
injection site.
Other: anaphylaxis,
hypersensitivity
reactions,
overgrowth of
nonsusceptible
organisms.
Augmentin, Amoxicilin Community-acquired Adults and  diarrhea CNS: agitation,  Contraindicated in patients Alert: Ratios of amoxicillin
Augmentin ES- pneumonia or acute children weighing  stomach anxiety, behavioral hypersensitive to drug or and clavulanic acid aren’t
600, Augmentin bacterial sinusitis 40 kg or more: upset changes, confusion, other penicillins and in consistent from product to
caused by H. 2,000 mg/125 mg  headache dizziness, insomnia, those with a history of product. Therefore,
XR, Calvulin influenzae, M. Augmentin XR  abnormal headache, seizures. amoxicillin-related formulations aren’t
catarrhalis, H. tablets every 12 taste sense GI: nausea, vomiting, cholestatic jaundice or equivalent, For example,
parainfluenzae, hours for 7 to 10  skin rash diarrhea, hepatic dysfunction. don’t, substitute two 250-
Klebsiella days for  vaginal yeast indigestion, gastritis,  Use cautiously in patients mg tablets for one 500-mg
pneumoniae, pneumonia; 10 infection stomatitis, glossitis, with other drug allergies tablet or substitute one
methicillinsusceptible days for sinusitis. black hairy tongue, (especially to 250-mg film-coated tablet
Staphylococcus enterocolitis, cephalosporins) because of for one 250-mg chewable
aureus, or S. Adjust-a-dose: In pseudomembranous possible cross-sensitivity. tablet.
pneumoniae with patients with CrCl colitis,  Augmentin XR is  Each Augmentin
reduced susceptibility less than 30 mucocutaneous contraindicated in patients XR tablet contains
to penicillin. mL/minute and candidiasis, receiving hemodialysis and 29.3 mg (1.27
patients receiving abdominal pain. those with CrCl of less than mEq) of sodium
hemodialysis, don’t GU: vaginal 30 mL/minute. Use and 13 mg of
use Augmentin XR. candidiasis, vaginitis. cautiously in patients with potassium (0.33
Hematologic: hepatic dysfunction. mEq).
anemia,  Drug may increase risk of  Augmentin XR
BSN III-2
thrombocytopenia, hepatic dysfunction isn’t indicated for

thrombocytopenic (hepatitis, cholestatic treating infections
purpura, jaundice), especially in caused by S.
eosinophilia, elderly patients, males, pneumoniae with
leukopenia, and patients on prolonged penicillin
agranulocytosis. treatment. minimum
Other:  Don’t give ampicillin-class inhibitory
hypersensitivity antibiotics to patients with concentration, or
reactions, mononucleosis due to high MIC, of 4 mcg/mL
anaphylaxis, incidence of erythematous or greater.
pruritus, rash, rash.  If large doses are
urticaria, Dialyzable drug: Yes. given or therapy is
angioedema, Overdose S&S: Crystalluria, oliguric prolonged,
overgrowth of renal failure, GI symptoms, rash, bacterial or fungal
nonsusceptible hyperactivity or drowsiness. superinfection
organisms, serum may occur,
sickness-like especially in
reaction. elderly,
debilitated, or
immunosuppresse
d patients.
 CDAD, ranging
from mild diarrhea
to fatal colitis, has
been reported
with nearly all
antibacterial
agents, including
amoxicillinclavulan
ate. Evaluate
patient if diarrhea
occurs,
 Chewable tablets
and powder for
oral solution
contain
BSN III-2
phenylalanine.
 Monitor LFTs
periodically in
patients with
hepatic
impairment.
Discontinue drug if
signs of hepatitis
occur.
Alert: Don’t interchange
the oral suspensions
because of varying
clavulanic acid contents.
 600 mg
amoxicillin/42.9
mg clavulanic
acid/5 mL is
intended only for
children ages 3
months to 12
years with
persistent or
recurrent acute
otitis media.
Alert: Both 250and 500-mg
film coated tablets contain
the same amount of
clavulanic acid (125 mg).
Therefore, two 250-mg
tablets aren’t equivalent to
one 500-mg tablet, Regular
Augmentin XR.
 This drug
combination is
particularly useful
BSN III-2
in clinical settings
with a high
prevalence of
amoxicillin-
resistant
organisms.
 Look alike-sound
alike: Don’t
confuse amoxicillin
with amoxapine or
Azulfidine.
Augmentin, Clavulanic acid The combination of Adults  diarrhea GI: Diarrhea, nausea,  The drug combination is  Determine
augmentin XR amoxicillin and The usual adult  upset vomiting. primarily excreted renally, previous
clavulanic acid is used dose is one 500-mg stomach Skin: Rash, urticaria. hypersensitivity
so caution is necessary
to treat certain tablet of  vomiting Other: Candidal
when a patient has renal
reactions to
infections caused by AUGMENTIN every  mild skin rash vaginitis; moderate
impairment or is on
penicillins,
bacteria, including 12 hours or one increases in serum cephalosporins,
infections of the ears, 250-mg tablet of ALT, AST;
hemodialysis.
and other
lungs, sinus, skin, and AUGMENTIN every glomerulonephritis;  Patients who have renal allergens prior to
urinary tract. 8 hours. agranulocytosis disease may need to have therapy.
Amoxicillin is in a their dosages adjusted  Lab tests: Baseline
class of medications Pediatric and monitored closely. C&S tests prior to
called penicillin-like Neonates And The liver primarily initiation of
antibiotics. It works Infants Aged <12 metabolizes the drug therapy; start drug
by stopping the Weeks (<3 combination and pending results.
growth of bacteria. Months) therefore, caution is  Monitor for S&S of
Clavulanic acid is in a The recommended necessary when given to an urticarial rash
class of medications dose of patients who have liver (usually occurring
called beta-lactamase AUGMENTIN is 30 within a few days
damage or disease.
inhibitors. It works by mg/kg/day divided after start of drug)
 Amoxicillin/clavulanate
preventing bacteria every 12 hours, suggestive of a
should never be given to
from destroying based on the hypersensitivity
patients who have had an
amoxicillin. amoxicillin reaction. If it
idiosyncratic drug-induced
component. occurs, look for
injury from clavulanic acid
Antibiotics will not other signs of
or amoxicillin, although
work for colds, flu, or hypersensitivity
BSN III-2
other viral infections. there is no evidence that (fever, wheezing,

Using antibiotics clavulanic acid itself is generalized
when they are not hepatotoxic. Because itching, dyspnea),
needed increases clavulanic acid is only and report to
your risk of getting an administered in physician
infection later that conjunction with immediately.
resists antibiotic amoxicillin, it is important  Note: Generalized,
treatment. to consider the adverse erythematous,
effects of amoxicillin, maculopapular
which is penicillin-derived rash (ampicillin
antibiotic so caution is rash) is not due to
necessary in patients who hypersensitivity. It
have a known history of is usually mild, but
penicillin allergy. can be severe.
Report onset of
rash to physician,
since
hypersensitivity
should be ruled
out.
Macrolide antibiotics
BSN III-2
Eryc, Ery-Tab, Erythromycin Erythromycin is used to Applies to the Blistering, peeling, or CNS: fever. CV: vein  Contraindicated in  Monitor
PCE treat certain infections following strengths: loosening of the skin irritation or patients patient for
caused by bacteria, such 250 mg; 333 mg; chills thrombophlebitis hypersensitive to superinfection
as infections of the stearate 500 mg; cough after LV injection, drug or other and diarrhea.
respiratory tract, ethylsuccinate 400 diarrhea ventricular macrolides. Q Alert: Drug may
including bronchitis, mg; lactobionate 1 difficulty with arrhythmias. Drug has been cause
pneumonia, g; lactobionate 500 swallowing GI: associated with overgrowth of
Legionnaires' disease (a mg; 500 mg; dizziness pseudomembranous prolonged QT nonsusceptibl
type of lung infection), ethylsuccinate 200 fast heartbeat colitis, abdominal interval and e bacteria or
and pertussis (whooping mg/5 mL; hives or welts, skin rash pain and cramping, infrequent cases of fungi.
cough; a serious ethylsuccinate 400 joint or muscle pain diarthea, nausea, arrhythmia,  Monitor
infection that can cause mg/5 mL; puffiness or swelling of vomitmg. including torsades hepatic
severe coughing); ethylsuccinate 100 the eyelids or around Hepatic: hepatic de pointes. Avoid function. Drug
diphtheria (a serious mg/2.5 mL; the eyes, face, lips, or dysfunction. drug in patients may cause
infection in the throat). ethylsuccinate 200 tongue with known hepatotoxicity
mg; stearate 250 red, irritated eyes Skin: eczema, rash, prolonged QT .
mg; estolate 125 red skin lesions, often urticaria. interval,  Elderly
mg/5 mL; estolate with a purple center Other: anaphylaxis, proarrhythmic patients may
250 mg/5 mL; redness of the skin overgrowth of conditions, or be more at
estolate 250 mg; sore throat nonsusceptible clinically significant risk for
gluceptate 1 g; sores, ulcers, or white bacteria or fungi. bradycardia, and in developing
estolate 500 mg; spots in the mouth or on those receiving drug-induced
ethylsuccinate; the lips class LA (quinidine) hearing loss.
stearate tightness in the chest or class II Monitor
unusual tiredness or (dofetilide, patient for
weakness amiodarone, new hearing
sotalol) loss.
antiarrhythmics.
 Use erythromycin
salts cautiously m
patients with
impaired hepatic
function. ¢ May
BSN III-2
cause infantile
hypertrophic pyloric
stenosis (HPS)
requiring surgery.
Benefit of therapy
needs to be
weighed agaist risk
of developing HPS.
 Prolonged or
repeated use may
result m
superinfection. If
superinfection
occurs, discontinue
drug.
 Drug may cause
CDAD, ranging in
severity from mild
to life-threatening
colitis, during
treatment and for
up to 2 months
after treatment.
 Drug may need to
be discontinued if
CDAD is suspected
or confirmed.
 Don’t use drug to
treat neurosyphilis.
Dialyzable drug: No.
Zithromax, Zmax Azithromycin  Community- Community-  diarrhea or CNS: fatigue,  Contraindicated in  Monitor
acquired acquired loose stools headache, patients patient for
pneumonia pneumonia caused  nausea somnolence, hypersensitive to superinfection
caused by by Chlamydophila  abdominal pain dizziness. azithromycin, . Drug may
Chlamydophila pneumoniae, H.  stomach upset CV: chest pain, erythromycin, or cause
pneumoniae, H. influenzae,  vomiting palpitations. other macrolide or overgrowth of
BSN III-2
influenzae, Mycoplasma  constipation EENT: eye irritation ketolide antibiotics nonsusceptibl

Mycoplasma pneumoniae, S.  dizziness, (ophthalmic). and in those with e bacteria or
pneumoniae, S. pneumoniae,  tiredness, GI: abdominal pain, history of fungi.
pneumoniae, Legionella  headache, anorexia, diarrhea, cholestatic jaundice  If patient
Legionella pneumophila, M.  vaginal itching nansea, vomiting, or hepatic vomits within
pneumophila, catarrhalis, or S. or discharge pseudomembranous dysfunction from 60 minutes of
M. catarrhalis, aureus  nervousness colitis, dyspepsia, prior use of taking Zmax,
or S. aureus  sleep problems flatulence, melena. azithromycin. notify
 Community- Adults and (insomnia) GU: candidiasis,  Serious cases of prescriber;
acquired adolescents age 16  skin rash or nephritis, vaginitis. allergic reactions, additional or
pneumonia and older: For mild itching Hepatic: cholestatic mcluding different
caused by C. infections, give 500  ringing in the jaundice. angioedema, therapy may
pneumoniae, H. mg PO. as a single ears Skin: photosensitivity anaphylaxis, be needed.
influenzae, M. dose on day 1; then  hearing reactions, rash, pain StevensJohnson Alert: Monitor patient
pneumoniae, or 250 mg PO. daily on problems at injection site, syndrome, toxic for CDAD, which may
§. pneumoniae days 2 through 5. or decreased pruritus. epidermal range in severity from
Total dose is 1.5 g. sense of taste or Other: angioedema. necrolysis, and mild diarrhea to fatal
For more severe smell. DRESS syndrome colitis.
infections or those have been Alert: Consider full risk
caused by S. aureus, reported, some profile when choosing
give 500 mg I.V. as a with fatalities. appropriate antibiotic
single daily dose for Prolonged therapy. Alternative
2 days; then 500 mg observation and macrolide or
PO, as a single daily symptomatic fluoroquinolone class
dose to complete a treatment may be drugs also have the
7to 10-day course necessary. potential to cause
 Infantile QTinterval
Community- hypertrophic pyloric prolongation and
acquired stenosis has been other significant
pneumonia caused reported after the adverse effects.
by C. pneumoniae, use of azithromycin  Monitor
H. influenzae, M. in neonates patient for
pneumoniae, or §. (treatment up to 42 allergic and
pneumoniae days of life). skin reactions.
 Don’t use oral drug Discontinue
Children age 6 in patients with pn drug if
BSN III-2
months and older: pneumonia or in reactions

10 mg/kg oral those with occur. Be
suspension P.O, moderate to severe aware that
(maximum of 500 illness or risk allergic
mg) as a single dose factors (such as symptoms
on day 1, followed cystic fibrosis, may recur
by 5 mg/kg nosocomially when
(maximum of 250 acquired infections, symptomatic
mg) daily on days 2 known or aus ted therapy is
through 5. Or, a bacteremia; discontinued;
single dose of Zmax hospitalized, patient may
60 mg/kg. Children elderty, bilitated require
weighing 34 kg or patients, or patients prolonged
more should receive with monitormg
the adult dose (2 g). immunodeficiency and
or functional treatment.
asplenia).  Monitor
 Use cautiously in patient for
patients with jaundice,
impaired hepatic hepatotoxicit
function or y, and
myasthenia gravis. hepatitis.
Alert: Drug is not indicated Discontinue
for prophylaxis of drug
bronchiolitis obliterans immediately
syndrome in patients if signs and
undergoing hematopoietic symptoms
stem cell transplantation (yellowing of
(HSCT). Long-term skin or sclera,
exposure may increase the abdominal
risk of hematological pain, nausea,
malignancy relapse and vomiting,
death. dark urine)
Alert: Use cautiously in occur.
patients at increased risk Alert: Exacerbation
BSN III-2
for torsades de pointes and new onset of

and fatal arrhythmias, myasthenia gravis
including those with have occurred with
known prolonged QT azithromycin use.
interval, history of
torsades de pointes,
congenital long QT
syndrome,
bradyarrhythmias,
uncompensated HF,
uncorrected hypokalemia
or hypomagnesemia,
clinically significant
bradycardia, or concomitant
use of drugs known to
prolong the QT interval or
class IA ainamide, quinidine)
or class III (amiodarone,
dofetilide, sotalol)
antiarrhythmics.
Alert: Elderly patients may
be at increased risk for
drug-associated QT-interval
effects.
 Drug may cause
CDAD ranging in
severity from mild
diarrhea to fatal
colitis, which may
occur over 2
months after
administration. If
CDAD is suspected
or confirmed, drug
may need to be
BSN III-2
discontinued and
appropriate
treatment begun.
 Prolonged use of
ophthalmic solution
may result in
overgrowth of
nonsusceptible
organisms,
including fungi. If
superinfection
occurs, discontinue
drug and institute
alternative therapy.
Biaxin Clarithromycin Clarithromycin is a Adult  diarrhea NS: headache, Alert: Use in patients with Alert: Be sure to use
macrolide antimicrobial Dosage Forms &  nausea insomnia. CAD has shown an extended-release form
indicated for mild to Strengths  vomiting GI: increased risk of all-cause to only treat infections
moderate infections  stomach pain pseudomembranous mortality | year or more for which i It is
caused by designated, oral suspension  heartburn colitis, abdominal after the end of treatment. approved.
susceptible bacteria in 125mg/5mL  change in taste pain or discomfort, Consider potential risk  Monitor
the following: 250mg/5mL  headache diarrhea, nausea, versus benefits before using patient for
tablet taste perversion, in patients with suspected superinfection
 Acute Bacterial 250mg dyspepsia, flatulence, or confirmed heart disease.  Drug may
Exacerbation of 500mg vomiting (in children). Use of an alternative cause
Chronic tablet, extended Hematologic: antibiotic is recommended. overgrowth of
Bronchitis in release coagulation  Severe acute nonsusceptibl
Adults 500mg abnormalities. hypersensitivity e bacteria or
 Acute Maxillary Skin: rash (in reactions, mcluding fungi.
Sinusitis Pediatric children). anaphylaxis,
 Community- Dosage Forms & Stevens-Johnson
Acquired Strengths syndrome, toxic
Pneumonia oral suspension epidermal
125mg/5mL necrolysis, drug
250mg/5mL rash with
tablet eosinophilia, and
BSN III-2
250mg Henoch-Schönlein
500mg purpura, have been
reported.
Discontinue drug
and begin
immediate
treatment if these
occur.
 Contraindicated in
patients
hypersensitive to
clarithromycin,
erythromycin, or
other macrolides
and in those
receiving pimozide
or other drugs that
prolong QT interval
or cause cardiac
arrhythmias.
patients with a
history of
cholestatic jaundice
or hepatic
impairment
associated with
prior use of
clarithromycin.
 Avoid use in
patients with
ongoing
proarrhythmic
conditions, such as
uncorrected
hypokalemia or
BSN III-2
hypomagnesemia
or clinically
significant
bradycardia, and in
patients receiving
Class IA or Class III
antiarrhythmics.
Elderly patients
may be more
susceptible to drug-
associated effects
on the QT interval.
 Use cautiously in
patients with
hepatic or or renal
impairment.
 May cause
exacerbation of or
new signs and
symptoms in
patients with
myasthenia gravis.
Use cautiously in
these patients.
 Drug may cause
CDAD and
pseudomembranou
s colitis, which can
occur more than 2
months after
therapy ends.
 Safety and
effectiveness in
children younger
than age 6 months
haven't been
BSN III-2
established.
Hemophilus influenza Antibiotics (second and third generations)
BSN III-2
Fungal infection: Antibiotics
Low risk CAP
Brand Generic Indication Dosage Side Effects Adverse Effects Contraindication Nursing
Name Name Consideration
Augmentin, Amoxicillin Community-acquired 500 mg cap BID  diarrhea CNS: agitation, anxiety,  Contraindicated in Alert: Ratios of amoxicillin
Augmentin ES- pneumonia or acute PO  stomach upset behavioral changes, patients and clavulanic acid aren’t
600, bacterial sinusitis caused  headache confusion, dizziness, hypersensitive to consistent from product to
by H. influenzae, M.  abnormal taste insomnia, headache, drug or other product. Therefore,
Augmentin XR, catarrhalis, H. seizures. GI: nausea, formulations aren’t
sense penicillins and in
Calvulin parainfluenzae,  skin rash vaginal vomiting, diarrhea, those with a history equivalent, For example,
Klebsiella pneumoniae, yeast infection indigestion, gastritis, of amoxicillin- don’t, substitute two 250-
methicillinsusceptible stomatitis, glossitis, related cholestatic mg tablets for one 500-mg
Staphylococcus aureus, black hairy tongue, jaundice or hepatic tablet or substitute one
or S. pneumoniae with enterocolitis, dysfunction. 250-mg film-coated tablet
reduced susceptibility to pseudomembranous  Use cautiously in for one 250-mg chewable
penicillin. colitis, mucocutaneous patients with other tablet.
candidiasis, abdominal drug allergies  Each Augmentin XR
pain. (especially to tablet contains 29.3
GU: vaginal candidiasis, cephalosporins) mg (1.27 mEq) of
vaginitis. Hematologic: because of possible sodium and 13 mg
anemia, cross-sensitivity. of potassium (0.33
thrombocytopenia,  Augmentin XR is mEq).
thrombocytopenic contraindicated in  Augmentin XR isn’t
BSN III-2
purpura, eosinophilia, patients receiving indicated for

leukopenia, hemodialysis and treating infections
agranulocytosis. Other: those with CrCl of caused by S.
hypersensitivity less than 30 pneumoniae with
reactions, anaphylaxis, mL/minute. Use penicillin minimum
pruritus, rash, urticaria, cautiously in inhibitory
angioedema, patients with concentration, or
overgrowth of hepatic MIC, of 4 mcg/mL
nonsusceptible dysfunction. or greater.
organisms, serum  Drug may increase  If large doses are
sickness-like reaction. risk of hepatic given or therapy is
dysfunction prolonged,
(hepatitis, bacterial or fungal
cholestatic superinfection may
jaundice), especially occur, especially in
in elderly patients, elderly, debilitated,
males, and patients or
on prolonged immunosuppressed
treatment. patients.
 Don’t give  CDAD, ranging from
ampicillin-class mild diarrhea to
antibiotics to fatal colitis, has
patients with been reported with
mononucleosis due nearly all
to high incidence of antibacterial
erythematous rash. agents, including
Dialyzable drug: Yes. amoxicillinclavulan
Overdose S&S: Crystalluria, ate. Evaluate
oliguric renal failure, GI patient if diarrhea
symptoms, rash, occurs,
hyperactivity or drowsiness.  Chewable tablets
and powder for oral
solution contain
phenylalanine.
 Monitor LFTs
periodically in
BSN III-2
patients with
hepatic
impairment.
Discontinue drug if
signs of hepatitis
occur.
Alert: Don’t interchange the
oral suspensions because of
varying clavulanic acid
contents.
 600 mg
amoxicillin/42.9 mg
clavulanic acid/5
mL is intended only
for children ages 3
months to 12 years
with persistent or
recurrent acute
otitis media.
Alert: Both 250and 500-mg
film coated tablets contain
the same amount of
clavulanic acid (125 mg).
Therefore, two 250-mg
one 500-mg tablet, Regular
Augmentin XR.
 This drug
combination is
particularly useful
in clinical settings
with a high
prevalence of
amoxicillin-
resistant
BSN III-2
organisms.
Don’t confuse amoxicillin
with amoxapine or
Azulfidine.
Globaxole forte Co-trimoxazole Co-Trimoxazole Forte 500  nausea Metablic: Hyperkalemia  Hypersensitivity to  Try to drink several
forte tablets are indicated in cap BID  vomiting GI: Nausea, diarrhea the active glasses of water
children (>12 to <18 PO NS: Headache substance(s) each day while you
years old) and adults  loss of appetite Skin: Rash sulphonamides, are on co-
(>18 years old) for the Cardiovascular: trimethoprim, co- trimoxazole. It is
treatment of the Thrombophlebitis, trimoxazole. important that you
following infections allergic myocarditis,  Contra-indicated in do not become
when owing to sensitive polyarteritis/periarteritis patients with lacking in fluid in
organisms (see section nodosa severe hepatic the body
5.1). Other: Fungal/monilial parenchymal (dehydrated).
overgrowth damage.  Most people
• Treatment and
 Contra-indicated in improve within a
prevention of
patients with few days of starting
Pneumocystis jirovecii
severe renal treatment. If your
pneumonitis or “PJP”.
insufficiency where symptoms do not
• Treatment and repeated improve despite
prophylaxis of measurements of taking co-
toxoplasmosis. the plasma trimoxazole, go
concentration back to see your
• Treatment of cannot be doctor, as you may
nocardiosis. performed. need an alternative
The following infections  Co-Trimoxazole antibiotic. This is
may be treated with Co- should not be given because some
Trimoxazole where to infants during bacteria are
there is bacterial the first 6 weeks of resistant to some
evidence of sensitivity to life. types of antibiotics.
Co-Trimoxazole and  Co-Trimoxazole  Even if you feel
good reason to prefer should not be given your infection has
the combination of to patients with a cleared up, keep
antibiotics in Co- history of drug- taking the antibiotic
Trimoxazole to a single induced immune until the course is
BSN III-2
antibiotic: thrombocytopenia finished (unless

with use of your doctor tells
• Acute uncomplicated
trimethoprim you otherwise).
urinary tract infection.
and/or This is to prevent
• Acute otitis media. sulphonamides. the infection from
 Co-Trimoxazole coming back and
• Acute exacerbation of should not be given being more difficult
chronic bronchitis. to patients with to treat. A typical
acute porphyria. course of
treatment will last
for 5-7 days,
although the
treatment of some
of the more serious
infections can take
longer than this.
 Some people
develop thrush (a
yeast infection
which causes
redness and
itchiness in the
mouth or vagina)
after taking a
course of
antibiotics. If you
think you have
thrush speak to
your doctor or
pharmacist for
advice.
 If you are having an
operation or dental
treatment, tell the
person carrying out
the treatment
BSN III-2
which medicines
you are taking.
 If you buy any
medicines, check
with a pharmacist
that they are
suitable to take
with co-
trimoxazole.
 This medicine may
stop the oral
typhoid vaccine
from working. If
you are due to have
any vaccinations,
make sure the
person treating you
knows that you are
taking it.
 If you still feel
unwell after
completing your
course of the
antibiotic, make
another
appointment to see
your doctor.
Macrol, rulid Roxithromycin Adults 150 mg tab BID  Diarrhea Gastrointestinal: Roxithromycin is  Roxithromycin is
Roxithromycin is PO x7 days  Nausea Nausea, vomiting, contraindicated in the best taken on an
indicated for the  abdominal pain epigastric pain, following conditions: empty stomach,
treatment of the and vomiting diarrhoea (very rarely  known about 15 minutes
following types of mild  headaches containing blood), hypersensitivity to before food or 3
anorexia, flatulence, macrolides, hours after food. If
to moderately severe  dizziness
pseudomembranous including it makes you feel
infections caused by or  vertigo, and
likely to be caused by colitis. In clinical studies, erythromycin sick, then take it
also the rarely
the incidence of  severely impaired with food.
BSN III-2
susceptible micro- seen rashes gastrointestinal events hepatic function  Take roxithromycin
organisms: was higher with  concomitant at the same time
• upper respiratory the 300 mg once daily therapy with each day.
tract infection - acute dosage regimen than vasoconstrictive  Tablets: swallow
pharyngitis, tonsillitis with 150 mg twice daily. ergot alkaloids the tablets whole
and sinusitis Symptoms of with a glass of
• dental infections pancreatitis have water.
• lower respiratory been observed; most  Dispersible tablets:
patients have received remove the correct
tract infection - acute
other drugs for which number of tablets
bronchitis; acute
pancreatitis is a known from the foil. If
exacerbations of
adverse your child is only
chronic bronchitis and effect. taking half a tablet
community acquired Hypersensitivity: at a time, place the
pneumonia Urticaria, rash, pruritus, remaining half of
• skin and skin angioedema. Rarely, the tablet back in
structure infections serious allergic reactions the foil and cover
• non-gonococcal may occur, e.g. asthma, it up. Add the
urethritis. bronchospasm, tablets to a small
anaphylactic like amount of water
reactions, purpura, (about 1
glottic oedema, tablespoon) and
generalised oedema, wait about 30 or
erythema 40 seconds for the
multiforme, exfoliative tablet to break
dermatitis, Stevens- down into fine
Johnson syndrome and granules. (The
Toxic Epidermal tablets will not
Necrosis (TEN) completely
Hepatic: dissolve). Stir if
Moderate increases in necessary. After
serum transaminases taking, rinse the
(AST and ALT) and/or container with
alkaline phosphatase water and drink
levels have this to ensure all
been observed and are roxithromycin dose
BSN III-2
somewhat more likely to is swallowed

occur in the elderly (> 65  If you forget to
years). Acute cholestatic take your dose,
hepatitis and acute take it as soon as
hepatocellular injury are you remember.
rarely reported. But, if it is nearly
Other: time for your next
Eosinophilia, dose, just take the
bronchospasm, next dose at the
hallucination, confusion, right time. Do not
headache, dizziness, take double the
paraesthesia, tinnitus, dose.
malaise, moniliasis  It is best to take
(candidiasis), the antibiotic for
pancreatitis, QT the number of
prolongation, disorders days your doctor
of taste and/or smell, has told you to. Do
temporary deafness, not stop taking it,
hypoacusis and vertigo. even if you feel
your infection has
cleared up. Talk to
your doctor first.
Klaricid Clarithromycin Clarithromycin is a Adult  diarrhea NS: headache, insomnia. Alert: Use in patients with Alert: Be sure to use
macrolide antimicrobial Dosage Forms &  nausea GI: pseudomembranous CAD has shown an extended-release form to
indicated for mild to Strengths  vomiting colitis, abdominal pain increased risk of all-cause only treat infections for
moderate infections  stomach pain or discomfort, diarrhea, mortality | year or more which i It is approved.
caused by designated, oral suspension  heartburn nausea, taste after the end of treatment.  Monitor patient for
susceptible bacteria in 125mg/5mL  change in taste perversion, dyspepsia, Consider potential risk superinfection.
the following: 250mg/5mL headache flatulence, vomiting (in versus benefits before using
tablet children). in patients with suspected  Drug may cause
 Acute Bacterial 250mg Hematologic: or confirmed heart disease. overgrowth of
Exacerbation of 500mg coagulation Use of an alternative nonsusceptible
Chronic tablet, extended abnormalities. antibiotic is recommended. bacteria or fungi.
Bronchitis in release Skin: rash (in children).  Severe acute
Adults 500mg hypersensitivity
 Acute Maxillary reactions, mcluding
BSN III-2
Sinusitis Pediatric anaphylaxis,

 Community- Dosage Forms & Stevens-Johnson
Acquired Strengths syndrome, toxic
Pneumonia oral suspension epidermal
125mg/5mL necrolysis, drug
250mg/5mL rash with
tablet eosinophilia, and
250mg Henoch-Schönlein
500mg purpura, have been
reported.
Discontinue drug
and begin
immediate
treatment if these
occur.
patients
hypersensitive to
clarithromycin,
erythromycin, or
other macrolides
and in those
receiving pimozide
or other drugs that
prolong QT interval
or cause cardiac
arrhythmias.
patients with a
history of
cholestatic jaundice
or hepatic
impairment
associated with
prior use of
clarithromycin.
BSN III-2
 Avoid use in
patients with
ongoing
proarrhythmic
conditions, such as
uncorrected
hypokalemia or
hypomagnesemia
or clinically
significant
bradycardia, and in
patients receiving
Class IA or Class III
antiarrhythmics.
Elderly patients
may be more
susceptible to drug-
associated effects
on the QT interval.
 Use cautiously in
patients with
hepatic or or renal
impairment.
 May cause
exacerbation of or
new signs and
symptoms in
patients with
myasthenia gravis.
Use cautiously in
these patients.
 Drug may cause
CDAD and
pseudomembranou
s colitis, which can
occur more than 2
BSN III-2
months after
therapy ends.
 Safety and
effectiveness in
children younger
than age 6 months
haven't been
established.
Zithromax, Azithromycin  Community- 500 mg tab OD x  diarrhea or CNS: fatigue, headache,  Contraindicated in  Monitor patient for
Zmax acquired 3 days or 2 grams loose stools somnolence, dizziness. patients superinfection.
pneumonia single dose  nausea CV: chest pain, hypersensitive to Drug may cause
caused by  abdominal pain palpitations. azithromycin, overgrowth of
Chlamydophila  stomach upset EENT: eye irritation erythromycin, or nonsusceptible
pneumoniae, H.  vomiting (ophthalmic). other macrolide or bacteria or fungi.
influenzae,  constipation GI: abdominal pain, ketolide antibiotics  If patient vomits
Mycoplasma  dizziness, anorexia, diarrhea, and in those with within 60 minutes
pneumoniae, S.  tiredness, nansea, vomiting, history of of taking Zmax,
pneumoniae,  headache, pseudomembranous cholestatic jaundice notify prescriber;
Legionella  vaginal itching colitis, dyspepsia, or hepatic additional or
pneumophila, or discharge flatulence, melena. dysfunction from different therapy
M. catarrhalis,  nervousness GU: candidiasis, prior use of may be needed.
or S. aureus  sleep problems nephritis, vaginitis. azithromycin. Alert: Monitor patient for
 Community- (insomnia) Hepatic: cholestatic  Serious cases of CDAD, which may range in
acquired  skin rash or jaundice. allergic reactions, severity from mild diarrhea
pneumonia itching Skin: photosensitivity mcluding to fatal colitis.
caused by C.  ringing in the reactions, rash, pain at angioedema, Alert: Consider full risk
pneumoniae, H. ears injection site, pruritus. anaphylaxis, profile when choosing
influenzae, M.  hearing Other: angioedema. StevensJohnson appropriate antibiotic
pneumoniae, or problems syndrome, toxic therapy. Alternative
§. pneumoniae or decreased epidermal macrolide or
sense of taste or necrolysis, and fluoroquinolone class drugs
smell. DRESS syndrome also have the potential to
have been cause QTinterval
reported, some prolongation and other
with fatalities. significant adverse effects.
Prolonged  Monitor patient for
BSN III-2
observation and allergic and skin

symptomatic reactions.
treatment may be Discontinue drug if
necessary. reactions occur. Be
 Infantile aware that allergic
hypertrophic pyloric symptoms may
stenosis has been recur when
reported after the symptomatic
use of azithromycin therapy is
in neonates discontinued;
(treatment up to 42 patient may require
days of life). prolonged
 Don’t use oral drug monitormg and
in patients with pn treatment.
pneumonia or in  Monitor patient
those with for jaundice,
moderate to severe hepatotoxicity,
illness or risk and hepatitis.
factors (such as Discontinue drug
cystic fibrosis, immediately if
nosocomially signs and
acquired infections, symptoms
known or aus ted
(yellowing of skin
bacteremia;
or sclera,
hospitalized,
abdominal pain,
elderty, bilitated
nausea, vomiting,
patients, or patients
with dark urine) occur.
immunodeficiency Alert: Exacerbation and
or functional new onset of myasthenia
asplenia). gravis have occurred with
 Use cautiously in azithromycin use.
patients with
impaired hepatic
function or
myasthenia gravis.
BSN III-2
Alert: Drug is not indicated

for prophylaxis of
bronchiolitis obliterans
syndrome in patients
undergoing hematopoietic
stem cell transplantation
(HSCT). Long-term
exposure may increase the
risk of hematological
malignancy relapse and
death.
Alert: Use cautiously in
patients at increased risk
for torsades de pointes
and fatal arrhythmias,
including those with
known prolonged QT
interval, history of
torsades de pointes,
congenital long QT
syndrome,
bradyarrhythmias,
uncompensated HF,
uncorrected hypokalemia
or hypomagnesemia,
clinically significant
bradycardia, or concomitant
use of drugs known to
prolong the QT interval or
class IA ainamide, quinidine)
or class III (amiodarone,
dofetilide, sotalol)
antiarrhythmics.
Alert: Elderly patients may
be at increased risk for
BSN III-2
drug-associated QT-interval
effects.
 Drug may cause
CDAD ranging in
severity from mild
diarrhea to fatal
colitis, which may
occur over 2
months after
administration. If
CDAD is suspected
or confirmed, drug
may need to be
discontinued and
appropriate
treatment begun.
 Prolonged use of
ophthalmic solution
may result in
overgrowth of
nonsusceptible
organisms,
including fungi. If
superinfection
occurs, discontinue
drug and institute
alternative therapy.
Stable co-morbid illness

BSN III-2
Name Effect Consideration
Amoclav, Co-amoxiclav Is a combination 375-625 mg tab  Diarrhea GI: diarrhea, nausea,  in patients with a  Determine
augmentin penicillin-class TID  itching, redness and vomiting history of previous
antibacterial and beta- discomfort in or Skin: rash,urticaria hypersensitivity hypersensitivit
lactamase inhibitor around your mouth, Other: candidal to beta-lactams, y reactions to
indicated in the armpits, vagina, penis vaginitis, moderate e.g. penicillins penicillins,
treatment of or groin area – these increases in serum and cephalosporin
infections due to are symptoms of ALT, AST; cephalosporins s, and other
susceptible isolates of thrush (a yeast glomerulonephritis;  in patients with a allergens prior
the designated infection) agranulocytosis previous history to therapy.
bacteria.  feeling or being sick (rare). of amoxicillin-  Lab tests:
(nausea or vomiting), clavulanate- Baseline C&S
especially when taking associated tests prior to
high doses of co- jaundice/hepatic initiation of
amoxiclav dysfunction. therapy; start
drug pending
results.
 Monitor for
S&S of an
urticarial rash
(usually
occurring
within a few
days after
start of drug)
suggestive of a
hypersensitivit
y reaction. If it
occurs, look
for other signs
of
hypersensitivit
y (fever,
wheezing,
BSN III-2
generalized
itching,
dyspnea), and
report to
physician
immediately.
 Note:
Generalized,
erythematous,
maculopapula
r rash
(ampicillin
rash) is not
due to
hypersensitivit
y. It is usually
mild, but can
be severe.
Report onset
of rash to
physician,
since
hypersensitivit
y should be
ruled out.
Zegen Cefuroxime Susceptible mild to 250-500 mg tab  Diarrhea Gastrointestinal: Cefuroxime is  Monitor renal,
moderate infections BID PO  Nausea Diarrhea, nausea and contraindicated in hepatic, and
including  Vomiting vomiting patients with hematologic
pharyngitis/tonsillitis,  Jarisch/Herxheimer Cardiovascular: Local cephalosporin function
acute maxillary reaction. This is a thrombophlebitis hypersensitivity or periodically
sinusitis, chronic short-term reaction Endocrine & cephamycin with
bronchitis, acute seen after antibiotic metabolic: Increased hypersensitivity. prolonged
otitis media, treatment for certain lactate Cefuroxime should be therapy.
BSN III-2
uncomplicated skin diseases. Symptoms dehydrogenase used cautiously in  Monitor

and skin structure, can include fever, Hematologic & patients with prothrombin
UTIs, gonorrhea, chills, or muscle pain. oncologic: Decreased hypersensitivity to time in
early Lyme disease. haematocrit, penicillin. patients at risk
decreased of
hemoglobin prolongation
Hepatic: Increased during
serum transaminases, cephalosporin
increased serum therapy
alkaline phosphatase (nutritionally-
Immunologic: Jarisch- deficient,
Herxheimer reaction prolonged
treatment,
renal or
hepatic
disease).
 Observe for
signs and
symptoms of
anaphylaxis
during first
dose.
BSN III-2
Moderate risk CAP
Zegen,Zinacef Cefuroxime Susceptible mild to 750 mg q 8 hour  Diarrhea Gastrointestinal: Cefuroxime is  Monitor renal,
moderate infections IV  Nausea Diarrhea, nausea contraindicated in patients hepatic, and
including  Vomiting and vomiting with cephalosporin hematologic
pharyngitis/tonsillitis,  Jarisch/Herxheimer Cardiovascular: hypersensitivity or function
acute maxillary reaction. This is a Local cephamycin periodically with
sinusitis, chronic short-term reaction thrombophlebitis hypersensitivity. prolonged
bronchitis, acute seen after antibiotic Endocrine & Cefuroxime should be used therapy.
otitis media, treatment for certain metabolic: cautiously in patients with  Monitor
diseases. Symptoms Increased lactate hypersensitivity to prothrombin
uncomplicated skin
can include fever, dehydrogenase penicillin. time in patients
and skin structure,
chills, or muscle pain. Hematologic & at risk of
UTIs, gonorrhea,
oncologic: prolongation
early Lyme disease. Decreased during
haematocrit, cephalosporin
decreased therapy
hemoglobin (nutritionally-
Hepatic: Increased deficient,
serum prolonged
transaminases, treatment, renal
increased serum or hepatic
alkaline disease).
phosphatase  Observe for
Immunologic: signs and
Jarisch-Herxheimer symptoms of
reaction anaphylaxis
during first
dose.
Unasyn Ampicillin- The combination of 750 mg- 1.5 q 8  swollen, black, or Hepatic: Increased  The use of  Determine
Sulbactam ampicillin and hour IV "hairy" tongue; AST (SGOT), ALT UNASYN is previous
sulbactam injection is  mild or occasional (SGPT), alkaline contraindicated in hypersensitivity
used to treat certain diarrhea; phosphatase, and individuals with a reactions to
BSN III-2
infections caused by  vaginal itching or LDH. history of serious penicillins,

bacteria, including discharge; Hematologic: hypersensitivity cephalosporins,
infections of the skin,  mild skin rash; or Decreased reactions (e.g., and other
female reproductive  pain, swelling, bruising, hemoglobin, anaphylaxis or allergens prior
organs, and abdomen or irritation around the hematocrit, RBC, Stevens-Johnson to therapy.
(stomach area). IV needle. WBC, neutrophils, syndrome) to  Lab tests:
Ampicillin is in a class lymphocytes, ampicillin, Baseline C&S
of medications called platelets and sulbactam or to tests prior to
penicillin-like increased other beta-lactam initiation of
antibiotics. It works by lymphocytes, antibacterial drugs therapy; start
stopping the growth monocytes, (e.g., penicillins drug pending
of bacteria. Sulbactam basophils, and results.
is in a class of eosinophils, and cephalosporins).  Report
medications called platelets.  UNASYN is promptly
beta-lactamase Blood Chemistry: contraindicated in unexplained
inhibitors. It works by Decreased serum patients with a bleeding (e.g.,
preventing bacteria albumin and total previous history of epistaxis,
from destroying proteins. cholestatic purpura,
ampicillin. Renal: Increased jaundice/hepatic ecchymoses).
BUN and creatinine. dysfunction  Monitor patient
Urinalysis: Presence associated with carefully during
of RBC’s and hyaline UNASYN. the first 30 min
casts in urine. after initiation
of IV therapy for
signs of
hypersensitivity
and
anaphylactoid
reaction (see
Appendix F).
Serious
anaphylactoid
reactions
require
immediate use
of emergency
BSN III-2
drugs and
airway
management.
 Observe for and
report
symptoms of
superinfections
(see Appendix
F). Withhold
drug and notify
physician.
 Monitor I&O
ratio and
pattern. Report
dysuria, urine
retention, and
hematuria.
Amoclav, Co-amoxiclav Co-amoxiclav is a 600 mg- 1.2 gm q  diarrhea Immune system:  contra-indicated in  Assess bowel
augmentin combination antibiotic 8 hour IV  itching, redness and Angioneurotic patients with a patternbefore
used for bacterial discomfort in or oedema, history of and
infections. It contains around your mouth, anaphylaxis, serum hypersensitivity to duringtreatmen
amoxicillin (an armpits, vagina, penis sickness-like beta-lactams, e.g. t as
antibiotic from the or groin area – these syndrome, penicillins and pseudomembra
penicillin group of are symptoms of hypersensitivity cephalosporins. nous colitis
medicines) mixed with thrush (a yeast vasculitis  contra-indicated in mayoccur.
clavulanic acid. The infection) Nervous system: patients with a  Report
clavulanic acid stops  feeling or being sick previous history of hematuria
Dizziness,
bacteria from (nausea or vomiting), Co-amoxiclav oroliguria as
headache
breaking down especially when taking (Augmentin®) high doses
amoxicillin, allowing reversible
high doses of co- associated canbe
the antibiotic to work hyperactivity and jaundice/hepatic nephrotoxic.
amoxiclav
better. convulsions. dysfunction.  Assess
Convulsions may respiratorystatu
It is used in adults and occur in patients s.
children to treat: with impaired renal  Observe for
function or in those anaphylaxis.
BSN III-2
 middle ear receiving high  Ensure that the

and sinus doses. patienthas
infections Gastrointestinal: adequate fluid
 throat or lung Diarrhea, nausea, intakeduring
respiratory vomiting any
tract Skin: Erythema diarrheaattack.
infections multiforme
 urinary tract
infections
 skin and soft
tissue
infections
 dental
infections
 joint and
bone
infections
The medicine is only

available on
prescription. It comes
as tablets or as a
liquid that you drink.
It's also given by

injection, but this is
usually only done in a
hospital.
Levox Levofloxacin 500 mg tab OD x
5-7 days
BSN III-2
Higher risk CAP (Intensive care)
Brand Name Generic Name Indication Dosage Side Effects Adverse Contraindicatio Nursing
Effects n Considerattion
Risk for Pseudomonas
Aspiration Pneumonia
BSN III-2
Typical presentation
BSN III-2

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Rose Pearl V.

Chronic Bronchitis and Emphysema

Brand Generic Indications Dosage Side Effects Adverse Contraindications Nursing

0–17 years) Aypocalcemia, weight specific ulcerative conjunction

Bronchodilators: Beta- adrenergic agonist

if you have dropped GU: UTI. hypotension, HTN, be adequate to

Cromolyn and Nedocromil

within a few hours after

bronchospasm. the dosage but

Brand Generic Indication Dosage Side Effects Adverse Contraindication Nursing

perennial rhinitis  fever somnolence, drug or its condition;

additional dose. Also, eosinophilia,

B2- adrenergic agonist: Short acting

Brand Generic Indication Dosage Side Effects Adverse Contraindication Nursing

bronchodilators. It time, prime it by throat (with inhaled  Use extended- multiforme or

daily there is the

increased frequency sympathomimetic

B2- adrenergic agonist

bronchospas photodermatitis. and those with at regular

Alert: Monitor patient

day. After 3 days, carefully for

This drug is given

every 4–6 hours.

of renal tubular cells  The use of should be

12F, 14, 15B, 17F, vaccination

thrombocytopenia, hepatic dysfunction isn’t indicated for

other viral infections. there is no evidence that (fever, wheezing,

influenzae, Mycoplasma  constipation EENT: eye irritation ketolide antibiotics nonsusceptibl

months and older: pneumonia or in reactions

for torsades de pointes and new onset of

Hemophilus influenza Antibiotics (second and third generations)

Fungal infection: Antibiotics

Low risk CAP

purpura, eosinophilia, patients receiving indicated for

antibiotic: thrombocytopenia finished (unless

somewhat more likely to is swallowed

Sinusitis Pediatric anaphylaxis,

observation and allergic and skin

Alert: Drug is not indicated

Stable co-morbid illness

uncomplicated skin diseases. Symptoms dehydrogenase used cautiously in  Monitor

Moderate risk CAP

infections caused by  vaginal itching or LDH. history of serious penicillins,

 middle ear receiving high  Ensure that the

The medicine is only

It's also given by

Higher risk CAP (Intensive care)

Risk for Pseudomonas

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