Ampicillin Sulbactam (Unasyn)Drug class antibacterial Pregnancy Category: BTherapeutic effects Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall, causing cell death.Indications Treatment of skin and skin structure, intra-abdominal, and gynecologic infections caused by susceptible microorganisms.Contraindications Hypersensitivity to penicillins.Side effects Dermatologic: Rash (less than 2%); erythema multiforme, exfoliative dermatitis, urticaria. GI: Diarrhea (3%); black, hairy tongue; Clostridium difficile associated diarrhea; enterocolitis; gastritis; pseudomembranous colitis; stomatitis. Genitourinary: Increased BUN and creatinine; presence of RBCs and hyaline casts in urine. Hematologic: Agranulocytosis; decreased Hct, Hgb, lymphocytes, neutrophils, RBC, platelets, and WBC; increased basophils, eosinophils, lymphocytes, monocytes, and platelets; positive direct Coombs tests. Hypersensitivity: Hypersensitivity (anaphylactic) reactions (sometimes fatal). Local: Pain at IM injection site (16%); pain at IV injection site, thrombophlebitis at injection site (3%). Metabolic: Elevated serum alkaline phosphatase, ALT, AST, and LDH; reduced serum albumin and total proteins.

Nursing implications Assessment History: Allergies to penicillins, cephalosporins, or other allergens; renal disorders; lactation Physical: Culture infected area; skin color, lesion; R, adventitious sounds; bowel sounds; CBC, LFTs, renal function tests, serum electrolytes, Hct, urinalysisTeaching points Take this drug around-the-clock. Take the full course of therapy; do not stop taking the drug if you feel better. This antibiotic is specific to your problem and should not be used to self-treat other infections. You may experience these side effects: Nausea, vomiting, GI upset (eat frequent small meals), diarrhea. Report pain or discomfort at sites, unusual bleeding or bruising, mouth sores, rash, hives, fever, itching, severe diarrhea, difficulty breathing.

Simvastatin (Zocor)Drug class Antihyperlipidemic HMG-CoA reductase inhibitor Pregnancy Category: XTherapeutic effects It reduces total cholesterol, LDL-cholesterol and triglycerides and increases HDL-cholesterol levels.Indications To reduce the risk of coronary disease, mortality, and CV events, including CVA, TIA, MI and reduction in need for bypass surgery and angioplasty in patients with coronary heart disease and hypercholesterolemia Adjunct to diet in the treatment of elevated total cholestrol and LDL cholesterol with primary hypercholesterolemia (types IIa and IIb) in those unresponsive to dietary restriction of saturated fat and cholesterol and other nonpharmacologic measuresContraindications Acute liver disease or unexplained persistent elevations of serum transaminases..Side effects Headache, nausea, flatulence, heartburn, abdominal pain, diarrhea/constipation, dysgeusia; myopathy features like myalgia and muscle weakness; serum transaminases and CPK elevations; hypersensitivity; lens opacities; blurring of vision; dizziness; sexual dysfunction; insomnia; depression and upper respiratory symptoms.

Nursing implications Assessment History: Allergy to simvastatin, fungal byproducts; impaired hepatic function; pregnancy; lactation Physical: Orientation, affect; liver evaluation, abdominal examinationTeaching points Give in the evening; highest rates of cholesterol synthesis are between midnight and 5 AM You may experience these side effects: Nausea (eat frequent small meals); headache, muscle and joint aches and pains (may lessen); sensitivity to light (use a suncreen and wear protective clothing). Report severe GI upset, changes in vision, unusual bleeding or bruising, dark urine or light-colored stools, fever, muscle pain, or soreness.Losartan (Cozaar)Drug class Anti-hypertensive (angiotensin II receptor blocker (ARB)) Pregnancy Category: C

Therapeutic effects Inhibits vasoconstrictive and aldosterone-secreting action of angiotensin II by blocking angiotensin II receptor on the surface of vascular smooth muscle and other tissue cells..Indications Hypetension, Nephepatically in type 2 daibetic patients, to reduce risk of CVA in patients with hypertension and left ventricular hypertrophyContraindications Patients hypersensitive to drug, breast-feeding is not recommended,causes fetal and neonatal morbidity and death when administered in the 2nd and 3rd trimester of pregnancy. Special Precaution: Impaired renal or hepatic functionSide effects CNS-dizziness, asthenia, fatigue, headache, insomia. CV-edema,chest pain. EENT-nasal congestion, sinusitis, pharyngitis, sinus disorder. GI-Abdominal pain, nausea, diarrhea, dyspepsia. Musculoskeletal-muscle cramps, myalgia, back or leg pain. Respiratory-cough, upper respiratory infection.

Nursing implications Monitor patients BP. Monitor patients who are also taking diuretics for symptomatic hypotension. Assessmpatients renal function Tell patient to avoid salt substitutes

Lactulose (Cephulac)

Drug class Gastrointestinal agent, hyperosmotic laxative Pregnancy Category: CTherapeutic effects The drug passes unchanged into the colon where bacteria break it down to organic acids that increase the osmotic pressure in the colon and slightly acidify the colonic contents, resulting in an increase in stool water content, stool softening, laxative action. This also results in migration of blood ammonia into the colon contents with subsequent trapping and expulsion of feces.Indications Treatment of constipation.Contraindications Contraindicated with allergy to lactulose, low-galactose diet Use cautiously with diabetes, pregnancy, and lactation.

Side effects Abdominal fullness, flatulence, belching. (excessive dose); nausea, vomiting, colon accumulation of hydrogen gas; hypernatremia.Nursing implications Assessment History: Allergy to lactulose, low-galactose diet. diabetes, pregnancy, and lactation. Physical: Abdominal examination, bowel sounds, serum electrolytes, serum ammonia levels.Teaching points Do not freeze laxative form. Ask patient to report diarrhea, severe belching, abdominal fullness. Do not administer other laxatives with lactulose. May be taken with fruit juice or milk to increase palatability. Notify physician if diarrhea (i.e., more than 2 or 3 soft stools/d) persists more than 2448 h. Diarrhea is a sign of overdosage. Dose adjustment may be indicated.

Aspirin (Salicylate)

Drug class Anticoagulants,Antiplatelets&Fibrinolytics(Thrombolytics) AntipyreticAnalgesic(nonopioid) Antirheumatic NSAID Pregnancy Category: DTherapeutic effects Exhibits antipyretic, anti-inflammatory and analgesic effects. The antipyreticeffect is due to an action on the hypothalamus,resulting in heat loss by vasodilation of peripheral blood vessels. Anti-inflammatory effects are mediated by a decrease in prostaglandin synthesis. It also decreases platelet aggregation.Indications Mild to moderate pain Fever Inflammatory conditionsrheumatic fever, rheumatoid arthritis, osteoarthritis Reduction of risk of recurrent stroke Reduction of risk of death or nonfatal MI in patients with history of infarction or unstable angina pectoris MI prophylaxisContraindications Hypersensitivity tosalicylates, severeanemia, history of blood coagulationdefects, vitamin K deficiency, 1 weekbefore and aftersurgery,pregnancy in thelast trimester

Side effects GI:dyspepsia, heartburn,anorexia, nausea,epigastric discomfort,potentiation of pepticulcer Allergic:Bronchospasm,asthma-like symptoms,anaphylaxis, skin rashes,urticaria Hematologic:prolongation of bleedingtime, thrombocytopenia,leucopenia, Other:Thirst, fever,dimness of visionNursing implications Assessment History: Allergy to salicylates or NSAIDs; allergy to tartrazine; hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency; impaired hepatic function; impaired renal function Physical: Skin color, lesions; T; eighth cranial nerve function, orientation, reflexes, affect; P, BP, perfusion; R, adventitious sounds; liver evaluation, bowel sounds; CBC, clotting times, urinalysis, stool guaiac, LFTs, renal function testsTeaching points Use the drug only as suggested; avoid overdose. Avoid the use of other over-the-counter drugs while taking this drug. Many of these drugs contain aspirin, and serious overdose can occur. Take the drug with food or after meals if GI upset occurs. may experience these side effects: Nausea, GI upset, heartburn (take drug with food); easy bruising, gum bleeding (related to aspirins effects on blood clotting) Report ringing in the ears; dizziness, confusion; abdominal pain; rapid or difficult breathing; nausea, vomiting, bloody stools.

Azithromycin (Zithromax)Drug class Macrolide (typically antibiotics) Pregnancy Category: BTherapeutic effects The mechanism of action of azithromycin is inhibition of protein synthesis in bacteria by binding to the 50S ribosomal subunit and preventing translocation of peptides.Macrolides are protein synthesis inhibitors. The mechanism of action of macrolides is inhibition of bacterial proteinbiosynthesis, and they are thought to do this by preventing peptidyltransferase from adding the peptidyl attachedto tRNA to the next amino acid (similarily to chloramphenicol) as well as inhibiting ribosomaltranslocation.Another potential mechanism is premature dissociation of the peptidyl-tRNA from the ribosome Indications Upper & lower resp tract infections, skin & soft tissue infectionsContraindications Hypersensitivity to macrolidesSide effects nausea and vomiting, headache, dizziness, fatigue, diarrhea, dyspepsia, abdominal pain, anorexiaNursing implications Monitor patient for super infection (Drug may cause overgrowth of none susceptible bacteria or fungi) Take the full course prescribed. Do not take with antacids Report severe or watery diarrhea, severe nausea or vomiting, rash or itching, mouth sores,vaginal sores

sodium chlorideDrug class Electrolyte Pregnancy Category: CTherapeutic effects replaces and maintains sodium and chloride levels which are essential ions necessary in normal cellular metabolism Sodium is the major cation of the bodys extracellular fluid. It plays a crucial role in maintaining the fluid and electrolyte balance. Excess retention of sodium results in overhydration(edema, hypervolemia), which is often treated with diuretics. Abnormally low levels of sodium result in dehydration.Indications prophylaxis of heat prostration or muscle cramps; chloride deficiency due to dieresis or salt restrictions H yponatremiaContraindications congestive heart failure, severely impaired renal function, hypernatremia, fluid retentionSide effects Hypernatremia, hypopotassemia, acidosis. Fluid and solute overload leading to dilution of serum electrolyte level, CHF, overhydration, acute pulmonary edemaNursing implications Monitor electrolytes, ECG, liver and renal function studiesb. Note level of consciousness. Assess the heart and lung sounds. Observe S&S of hypernatremia, flushed skin, elevated temperature, rough dry tongue, and edema. Monitor VS and I&O. Assess patients fluid status Assess urine specific gravity and serum sodium levels

Potassium Chloride (Kalium Durules)Drug class Electrolyte and water balance agent Pregnancy Category: ATherapeutic effects replaces and maintains sodium and chloride levels which are essential ions necessary in normal cellular metabolism Sodium is the major cation of the bodys extracellular fluid. It plays a crucial role in maintaining the fluid and electrolyte balance. Excess retention of sodium results in overhydration(edema, hypervolemia), which is often treated with diuretics. Abnormally low levels of sodium result in dehydration.Indications prophylaxis of heat prostration or muscle cramps; chloride deficiency due to dieresis or salt restrictions H yponatremiaContraindications congestive heart failure, severely impaired renal function, hypernatremia, fluid retentionSide effects Hypernatremia, hypopotassemia, acidosis. Fluid and solute overload leading to dilution of serum electrolyte level, CHF, overhydration, acute pulmonary edemaNursing implications Monitor electrolytes, ECG, liver and renal function studiesb. Note level of consciousness. Assess the heart and lung sounds. Observe S&S of hypernatremia, flushed skin, elevated temperature, rough dry tongue, and edema. Monitor VS and I&O. Assess patients fluid status Assess urine specific gravity and serum sodium levels

Therapeutic effects ASA Analgesic and antirheumatic effects are attributable to aspirins ability to inhibit the synthesis of prostaglandins, important mediators of inflammation. Antipyretic effects are not fully understood, but aspirin probably acts in the thermoregulatory center of the hypothalamus to block effects of endogenous pyrogen by inhibiting synthesis of the prostaglandin intermediary. Inhibition of platelet aggregation is attributable to the inhibition of platelet synthesis of thromboxane A2, a potent vasoconstrictor and inducer of platelet aggregation. This effect occurs at low doses and lasts for the life of the platelet (8 days). Higher doses inhibit the synthesis of prostacyclin, a potent vasodilator and inhibitor of platelet aggregation