Drugs Study

Meropenem trihydrate (Mepenem) - Carbapenem Antibiotic

Indication: Treatment of susceptible infections including intra-abdominal infections,

meningitis, resp tract infections (including cystic fibrosis patients), septicemia, skin
infections, UTI & infections in immunocompromised patients.

Contraindications: Hypersensitvity

Adverse Reactions: Skin rashes, urticaria, eosinophilia, fever; nausea, vomiting,

diarrhea, tooth or tongue discoloration & altered taste; superinfection w/ nonsusceptible
organisms eg Enterococcus faecium, Pseudomonas aeruginosa w/ acquired resistance
& Candida.

Nursing responsibilities

Assessment & Drug Effects

 Lab tests: Perform C&S tests prior to therapy. Monitor periodically liver and
kidney function.
 Determine history of hypersensitivity reactions to other beta-lactams,
cephalosporins, penicillins, or other drugs.
 Discontinue drug and immediately report S&S of hypersensitivity (see Appendix
F).
 Report S&S of superinfection or pseudomembranous colitis (see Appendix F).
 Monitor for seizures especially in older adults and those with renal insufficiency.

Patient & Family Education

 Learn S&S of hypersensitivity, superinfection, and pseudomembranous colitis;

report any of these to physician promptly.
 Do not breast feed while using this drug.

Gentamycin (Garamycin) - Antiinfective; Aminoglycoside antibiotic

Action: Broad-spectrum aminoglycoside antibiotic derived from Micromonospora

purpurea. Action is usually bacteriocidal.

Indication: Parenteral use restricted to treatment of serious infections of GI, respiratory,

and urinary tracts, CNS, bone, skin, and soft tissue (including burns) when other less
toxic antimicrobial agents are ineffective or are contraindicated.

Adverse Reaction: Ototoxicity & nephrotoxicity. Rash, urticaria, itching, drug fever,
anaphylactoid reactions.
Contraindication: History of hypersensitivity to or toxic reaction with any aminoglycoside
antibiotic. Safe use during pregnancy (category C) or lactation is not established

Nursing Responsibilities:

 Lab tests: Perform C&S and renal function prior to first dose and periodically
during therapy; therapy may begin pending test results. Determine creatinine
clearance and serum drug concentrations at frequent intervals, particularly for
patients with impaired renal function, infants (renal immaturity), older adults,
patients receiving high doses or therapy beyond 10 d, patients with fever or
extensive burns, edema, obesity.
 Repeat C&S if improvement does not occur in 3–5 d; reevaluate therapy.

Salbutamol (Ventolin) - Adrenergic Inhalants, Selective beta-2-adrenoreceptor

agonists

Indication: To relieve bronchospasm associated with acute or chronic asthma,

bronchitis, or other reversible obstructive airway diseases. Also used to prevent
exercise-induced bronchospasm.

Contraindications: Eclampsia andsevere pre-eclampsia; intra-uterine infection,intra-

uterine foetal death, antepartum haemorrhage, placenta praevia and cord
compression,threatened miscarriage,cardiac disease

Adverse Reaction: Fine skeletal muscle tremor especially hands, tachycardia,

palpitations,musclecramps, headache, paradoxical bronchospasm, angioedema,
urticaria, hypotension and collapse. Potentially serious hypokalaemia after large
doses.

Nursing Responsibilities

 Use cautiously in patients with cardiovascular disorders.

 Syrup is available for children as young as age 2.
 Inhaler may be used 15 minutes before exercise to prevent exercise-induced
bronchospasm.
 Patient may use tablets and inhaler at the same time. Monitor for toxicity.
 Warn the patient about the risk of paradoxical bronchospasm and if it occurs,
stop drug immediately.
 Teach patient to use the inhaler correctly: Shake it, clear the throat, expel as
much air as possible from the lungs, inhale deeply while releasing the drug from
the inhaler, hold breath for several seconds.
 Use of a spacer may improve delivery.
 Wait for 2 minutes between puffs of inhaler.
  If the patient is also using a steroid inhaler, use the bronchodilator first, then wait
5 minutes before using the steroid.
 Wash the canister with warm water and soap at least once a week.

Dopamine (Docard) - Adrenergic and Dopaminergic cardiac stimulants excluding

glycosides

Indications: Treatment of Heart failure. Hemodynamic imbalances in shock due to MI,

trauma, endotoxic septicemia, open-heart surgery, renal failure & chronic cardiac
decompensations as in congestive failure.

Contraindications: Pheochromocytoma; uncorrected tachyarrhythmias; ventricular

fibrillation.

Adverse reaction: Ectopic beats; nausea, vomiting; tachycardia, anginal pain,

palpitation, dyspnea, headache; hypotension, vasoconstriction. Infrequent, aberrant
conduction, bradycardia; piloerection, widened QRS complex, azotemia, elevated BP.

Nursing Responsibilities

 Be familiar with patient’s baseline data (e.g., quality of peripheral pulses, blood
pressure, clinical symptoms, serum electrolytes, creatinine clearance) as a
foundation for making assessments.
 Take apical pulse for 1 full min noting rate, rhythm, and quality before
administering. If changes are noted, withhold digoxin, take rhythm strip if patient
is on ECG monitor, notify physician promptly.
 Monitor for S&S of drug toxicity: In children, cardiac arrhythmias are usually
reliable signs of early toxicity. Early indicators in adults (anorexia, nausea,
vomiting, diarrhea, visual disturbances) are rarely initial signs in children.
 Monitor I&O ratio during digitalization, particularly in patients with impaired renal
function. Also monitor for edema daily and auscultate chest for rales.
 Monitor serum digoxin levels closely during concurrent antibiotic–digoxin therapy,
which can precipitate toxicity because of altered intestinal flora.

Patient & Family Education

 Report to physician if pulse falls below 60 or rises above 110 or if you detect
skipped beats or other changes in rhythm, when digoxin is prescribed for atrial
fibrillation.
 Suspect toxicity and report to physician if any of the following occur: Anorexia,
nausea, vomiting, diarrhea, or visual disturbances.
 Weigh each day under standard conditions. Report weight gain >1 kg (2 lb)/d.
  Take digoxin PRECISELY as prescribed, do not skip or double a dose or change
dose intervals, and take it at same time each day.
 Continue with brand originally prescribed unless otherwise directed by physician.
 Do not breast feed while taking this drug without consulting physician.

Captopril (Captor) – ACE Inhibitors

Indications: Treatment of CHF in patients unresponsive to conventional therapy; used

with diuretics and digitalis. Treatment of diabetic nephropathy. Treatment of left
ventricular dysfunction after MI

Contraindication: allergy to captopril, history of angiodema.

Adverse effects : angina pectoris, MI, Raynaud's syndrome, CHF, hypotension in

salt- or volume-depleted patients Rash, pruritus, pemphigoid-like reaction, scalded
mouth sensation, exfoliative dermatitis, photosensitivity, alopecia Gastric irritation,
aphthous ulcers, peptic ulcers, dysgeusia,cholestatic jaundice, hepatocellular injury.

Nursing considerations

- Hypertension should be managed according to appropriate guidelines.

- Treatment with an ACE inhibitor can be started in the community in the majority of
people with heart failure.
- In patients taking diuretics, close supervision is needed when commencing treatment.
- The initial dose of ACE has a risk of first-dose hypotension, therefore patients should
be advised to sit or lie down for 2-4 hours after this.
- Evaluate therapeutic response.

- Advise patients to avoid driving and other hazardous work until they are confident that
they have no dizziness or fainting from possible hypotensive side-effects.
- Avoid excess intake of alcohol since this can enhance hypotensive effect.
- This medication should not be stopped without medical consultation.
- Advise patients to rise slowly in order to avoid postural hypotension.
Nurses should refer to manufacturer's summary of product characteristics and to
appropriate local guidelines

Digoxin (Elixir) – Digitalis Glycoside – Anti Arrhytmics, Inotropics

Indications: treatment of CHF, Atrial Fibrilation

Adverse Reactions: fatigue, arrhythmias, bradycardia, anorexia, nausea, vomiting

Contraindications and cautions

 • Contraindicated with allergy to digitalis preparations, ventricular tachycardia,
ventricular fibrillation, heart block, sick sinus syndrome, IHSS, acute MI, renal
insufficiency and electrolyte abnormalities (decreased K+, decreased Mg++,
increased Ca++).

• Use cautiously with pregnancy and lactation

Nursing Responsibilities

• Take apical pulse for 1 full min noting rate, rhythm, and quality before
administering. If changes are noted, withhold digoxin.
• Withhold med if pulse falls below ordered parameters
• Monitor for S&S of drug toxicity
• Monitor I&O ratio during digitalization, particularly in pts with impaired renal
function. Monitor for edema daily and auscultate chest for rales
• Monitor serum digoxin levels closely during concurrent antibiotic-digoxin
therapy, which can precipitate toxicity because of altered intestinal flora
• Report to Dr if pulse falls below 60 or rises above 110 or if you detect skipped
beats or other changes in rhythm
• Report to Dr if there is anorexia, N/V, diarrhea, or visual disturbances
• Weigh each day, report weight gain >1kg d
• Take precisely as prescribed, do not skip or double a dose or change dose
intervals, and take at same time each day
• Continue with brand originally prescribed unless directed by physician