Pharmacology

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PANCREATIN

2009-10-04T08:22:00.001-07:00

BRAND NAMES:
Hi-Vegi-Lip® [OTC]; Kutrase®; Ku-Zyme®; Pan-2400™ [OTC]; Pancreatin 4X [OTC]; Pancreatin 8X [OTC]; Veg-Pancreatin 4X [OTC]

AVAILABLE FORMS:
Capsule:
Kutrase®: Lipase 2400 units, protease 30,000 units, amylase 30,000 units
Ku-Zyme®: Lipase 1200 units, protease 15,000 units, amylase 15,000 units
Pan-2400™: Lipase 9816 units, protease 60,214 units, amylase 75,900 units [pancreatin 2400 mg]
Tablet:
Hi-Vegi-Lip®: Lipase 4800 units, amylase 60,000 units, protease 60,000 units [pancreatin 2400 mg; vegetable source]
Pancreatin 4X: Lipase 12,000 units, amylase 60,000 units, protease 60,000 units [pancreatin 2400 mg]
Pancreatin 8X: Lipase 22,500 units, amylase 180,000 units, protease 180,000 units [pancreatin 7200 mg]
Veg-Pancreatin 4X: Lipase 12,000 units, amylase 60,000 units, protease 60,000 units [pancreatin 2400 mg; vegetable source]

INDICATIONS:
Exocrine pancreatic secretion insufficiency; digestive aid in diseases related to deficiency of pancreatic enzymes, such as cystic fibrosis.

ADVERSE REACTIONS:
GI: nausea, diarrhea with high doses
Skin: perianal irritation
Other: allergic reactions

MECHANISM OF ACTION:
It is a mixture of several digestive enzymes produced by the exocrine cells of the pancreas. It is composed of amylase, lipase and protease. The supplement form of pancreatin may be derived from pork or beef sources. An enzyme supplement, not a replacement, which contains a combination of lipase, amylase and protease. Replaces endogenous pancreatic enzymes and enhances the digestion of proteins, starch and fat in the stomach and intestines.

CONTRAINDICATIONS:
Hypersensitivity to pork protein or any component of the formulation; acute pancreatitis or acute exacerbations of chronic pancreatic disease.

EFFECTS ON LAB TEST RESULT:
May increase uric acid levels.

NURSING CONSIDERATIONS:
1. Store at controlled room temperature of 15°C to 30°C (59°F to 86°F); protect from humidity.
2. Should be taken with a meal or snack. Capsules may be opened and sprinkled on soft food.
3. Retention in the mouth before swallowing may cause mucosal irritation and stomatitis; do not crush or chew, swallow whole.
4. Use with caution in pregnant or beast feeding mothers.
5. Drug isn’t effective in GI disorders unrelated to pancreatic enzyme deficiency.
6. Warn patient not to inhale powder form or powder from capsules; it may irritate skin or mucous membranes.

SODIUM PHOSPHATES

2009-10-04T08:21:00.001-07:00

BRAND NAMES:
Fleet® Enema [OTC]; Fleet® Phospho®-Soda [OTC]; Fleet® Phospho-Soda® Accu-Prep™ [OTC]; Visicol™

AVAILABLE FORMS:
Enema: Monobasic sodium phosphate 19 g and dibasic sodium phosphate 7 g per 118 mL delivered dose (135 mL)
Fleet® Enema: Monobasic sodium phosphate 19 g and dibasic sodium phosphate 7 g per 118 mL delivered dose (135 mL)
Fleet® Enema for Children: Monobasic sodium phosphate 9.5 g and dibasic sodium phosphate 3.5 g per 59 mL delivered dose (68 mL)
Injection, solution [preservative free]: Phosphate 3 mmol and sodium 4 mEq per mL (5 mL, 15 mL, 50 mL)
Fleet® Phospho®-Soda: Monobasic sodium phosphate monohydrate 2.4 g and dibasic sodium phosphate heptahydrate 0.9 g per 5 mL (45 mL, 90 mL) [contains sodium benzoate; unflavored or ginger-lemon flavor]
Fleet® Phospho-Soda® Accu-Prep™ [kit]: Monobasic sodium phosphate monohydrate 2.4 g and dibasic sodium phosphate heptahydrate 0.9 g per 5 mL (15 mL) [solution contains sodium benzoate; kit contains solution in six 15 mL unit-dose containers (equal to two 45 mL doses) plus 4 anorectal pads containing pramoxine hydrochloride 1% and glycerin 12%]
Tablet, oral (Visicol™): Sodium phosphate monobasic monohydrate 1.102 g and sodium phosphate dibasic anhydrous 0.398 g [1.5 g total sodium phosphate per tablet]

INDICATIONS:
Short-term treatment of constipation and to evacuate the colon for rectal and bowel exams
I.V.: Source of phosphate in large volume I.V. fluids and parenteral nutrition; treatment and prevention of hypophosphatemia

ADVERSE REACTIONS:
Cardiovascular: Edema, hypotension
Central nervous system: Dizziness, headache
Endocrine & metabolic: Hypocalcemia, hypernatremia, hyperphosphatemia, calcium phosphate precipitation
Gastrointestinal: Nausea, vomiting, diarrhea, abdominal bloating, abdominal pain, abdominal cramping, mucosal bleeding, superficial mucosal ulcerations
Renal: Acute renal failure

MECHANISM OF ACTION:
Sodium Phosphates Injection, USP, 3 mM P/mL (millimoles/mL), is a sterile, nonpyrogenic, concentrated solution containing a mixture of monobasic sodium phosphate and dibasic sodium phosphate in water for injection. Sodium is the principal cation of extracellular fluid. It comprises more than 90% of the total cations at its normal plasma concentration of approximately 142 mEq/liter. While the sodium ion can diffuse across cell membranes, intracellular sodium is maintained at a much lower concentration than extracellular sodium through the expenditure of energy by the cell (so called “sodium cation pump”). Loss of intracellular potassium ion is usually accompanied by an increase in intracellular sodium ion.
Phosphorus in the form of organic and inorganic phosphate has a variety of important biochemical functions in the body and is involved in many significant metabolic and enzyme reactions in almost all organs and tissues. It exerts a modifying influence on the steady state of calcium levels, a buffering effect on acid-base equilibrium and a primary role in the renal excretion of hydrogen ion.
As a laxative, exerts osmotic effect in the small intestine by drawing water into the lumen of the gut, producing distention and promoting peristalsis and evacuation of the bowel; phosphorous participates in bone deposition, calcium metabolism, utilization of B complex vitamins, and as a buffer in acid-base equilibrium

CONTRAINDICATIONS:
Hypersensitivity to sodium phosphate salts or any component of the formulation; congenital megacolon, toxic megacolon, bowel obstruction, bowel perforation, imperforate anus (enema), congestive heart failure, ascites.
Sodium phosphate is contraindicated in diseases where high phosphorus or low calcium levels may be encountered, and in patients with hypernatremia.
Oral: Should not be used in patients with kidney disease, unstable angina pectoris, gastric retention, ileus, acute obstruction or pseudo-obstruction, severe chronic constipation, acute colitis, or hypomotility syndrome.

EFFECTS ON LAB TEST RESULT:
May increase sodium and phosphate levels. May decrease electrolyte level, with prolonged use.

NURSING CONSIDERATIONS:
1. This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired.
2. Store at 20 to 25°C (68 to 77°F).
3. Intravenous preparation: Must be diluted before use; infuse slowly.
4. Should be taken on an empty stomach with water; a clear liquid diet should be used for 12 hours prior to tablet administration.
5. Do not use recommended dose more than once in 24 hours.
6. Maintain adequate fluid intake.
7. Teach patient about dietary sources of bulk, including bran and other cereals, fresh fruits and vegetables.
8. Use cautiously in clients with large hemorrhoids or anal excoriations.
9. Dosages are expressed as sennosides.
10. before giving drug for constipation, determine whether patient has adequate fluid intake, exercise and diet.

METFORMIN Hydrochloride

2009-10-04T08:20:00.000-07:00

BRAND NAMES:
Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet

AVAILABLE FORMS:
Tablets: 500mg; 850mg; 1000mg
Tablets ( extended-release): 500mg

INDICATIONS:
Adjunct to diet to lower glucose level in patients with type 2 (non-insulin dependent) diabetes mellitus

ADVERSE REACTIONS:
GI: diarrhea, nausea, vomiting, abdominal bloating, flatulence, anorexia, unpleasant or metallic taste
Hematologic: megaloblastic anemia
Metabolic: lactic acidosis

MECHANISM OF ACTION:
Decreases hepatic glucose production and intestinal absorption of glucose and improves insulin sensitivity (increases peripheral glucose uptake and utilization).

CONTRAINDICATIONS:
Contraindicated with hypersensitivity to drug and in those with renal disease or metabolic acidosis.

EFFECTS ON LAB TEST RESULT:
May decrease hemoglobin levels.

NURSING CONSIDERATION:
1. FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.
2. Take metformin with a meal, unless your doctor tells you otherwise. Some forms of metformin are taken only once daily with the evening meal. Follow your doctor's instructions.
3. Stop drug immediately and notify prescriber if patient develops a condition related to hypoxemia or dehydration.
4. Avoid drinking alcohol.

PHENOBARBITAL

2009-10-04T08:19:00.003-07:00

BRAND NAMES:
Luminal® Sodium; Barbita; Solfoton

AVAILABLE FORMS:
Capsule: 16 mg
Elixir*: 15 mg/5 ml, 20 mg/5 ml
Injection: 30 mg/ml, 60 mg/ml, 65 mg/ml, 130 mg/ml
Tablets: 15 mg, 16 mg, 30 mg, 60 mg, 100 mg

INDICATIONS:
 All forms of epilepsy, febrile seizure
 Status epilepticus
 Sedation
 Insomia
 Perioperative sedation

ADVERSE REACTION:
CNS: drowsiness, lethargy, hangover, paradoxical excitement in elderly patients, somnolence, changes in EEG pattern
CV: bradycardia, hypotension
GI: nausea, vomiting
Hematologic: exacerbation of porphyria
Respiratory: respiratory depression
Skin: rash, erythema multiforme, Steven’s Johnson syndrome, urticaria, pain, swelling, necrosis
Other: angioedema

MECAHANISM OF ACTION:
It is a barbiturate, nonselective central nervous system depressant which is primarily used as a sedative hypnotic and also as an anticonvulsant in subhypnotic doses. is in a group of drugs called barbiturates (bar-BIT-chur-ates). Phenobarbital slows the activity of your brain and nervous system. It depresses monosynaptic and polysunaptic transmission in CNS and increases threshold for seizure activity in motor cortex. As sedative, drug probably interferes with transmission of impulses from thalamus to cortex of brain.

CONTRAINDICATIONS:
Do not use this medication without telling your doctor if you are pregnant. It could cause harm to the unborn baby. Use an effective form of birth control, and tell your doctor if you become pregnant during treatment.Contraindicated in patients hypersensitive to barbiturates and I those with the history of manifest or latent porphyria; in clients with hepatic dysfunction, respiratory disease with dyspnea or obstruction or nephritis.

EFFECTS ON LAB TEST RESULT:
May decrease bilirubin levels.

NURSING CONSIDERATTION:
1. Do not stop using phenobarbital without first talking to your doctor, even if you feel better. You may have increased seizures if you stop using phenobarbital suddenly.
2. Take phenobarbital only when you are getting ready for several hours of sleep. You may fall asleep very quickly after taking the medicine.
3. Phenobarbital can make birth control pills less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking phenobarbital.
4. Phenobarbital can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.
5. Phenobarbital can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
6. Avoid drinking alcohol. It can increase some of the side effects of phenobarbital.
7. Do not use injectable solution if it contains a precipitate.
8. Give I.M. injection deeply. Superficial injection may cause pain, abscess and tissue sloughing.
9. Elderly patients are more sensitive to drug’s effect.
10. Inform client that full therapeutic effects aren’t seen for 2 to 3 weeks, except when loading dose is used.

ASPIRIN

2009-10-04T08:18:00.000-07:00

BRAND NAMES:
Arthritis Pain, Aspergum, Aspir-Low, Aspirin Lite Coat, Bayer Aspirin, Bufferin, Easprin, Ecotrin, Empirin, Fasprin, Genacote, Halfprin, Norwich Aspirin, St. Joseph Aspirin, Stanback Analgesic, Tri-Buffered Aspirin, YSP Aspirin, Zorprin

AVAILABLE FORMS:
Chewable tablets: 81mg;
Caplets and tablets: 325mg, 500mg;
Enteric coated (safety coated) caplets and tablets: 325mg, 500mg
Suppositories: 120mg, 200mg, 300mg, 600mg

INDICATIONS:
 Angiotensin Converting Enzyme (ACE) Inhibitors: The hyponatremic and hypotensive effects of ACE inhibitors may be diminished by the concomitant administration of aspirin due to its direct effect on the ennin-angiotensin conversion pathway.
 Acetazolamide: Concurrent use of aspirin and acetazolamide can lead to high serum concentrations of acetazolamide (and toxicity) due to competition at the renal tubule for secretion.
 Anticoagulant Therapy (Heparin and Warfarin): Patients on anticoagulation therapy are at increased risk for bleeding because of drug-drug interactions and the effect on platelets. Aspirin can displace warfarin from protein binding sites, leading to prolongation of both the prothrombin time and the bleeding time. Aspirin can increase the anticoagulant activity of heparin, increasing bleeding risk.
 Anticonvulsants: Salicylate can displace protein-bound phenytoin and valproic acid, leading to a decrease in the total concentration of phenytoin and an increase in serum valproic acid levels.
 Beta Blockers: The hypotensive effects of beta blockers may be diminished by the concomitant administration of aspirin due to inhibition of renal prostaglandins, leading to decreased renal blood flow, and salt and fluid retention.
 Diuretics: The effectiveness of diuretics in patients with underlying renal or cardiovascular disease may be diminished by the concomitant administration of aspirin due to inhibition of renal prostaglandins, leading to decreased renal blood flow and salt and fluid retention.
 Methotrexate: Salicylate can inhibit renal clearance of methotrexate, leading to bone marrow toxicity, especially in the elderly or renal impaired.
 Nonsteroidal Anti-inflammatory Drugs (NSAID’s): The concurrent use of aspirin with other NSAID’s should be avoided because this may increase bleeding or lead to decreased renal function.
 Oral Hypoglycemics: Moderate doses of aspirin may increase the effectiveness of oral hypoglycemic drugs, leading to hypoglycemia.
 Uricosuric Agents (Probenecid and Sulfinpyrazone): Salicylates antagonize the uricosuric action of uricosuric agents.
 Carcinogenesis, Mutagenesis, Impairment of Fertility: Administration of aspirin for 68 weeks at 0.5 percent in the feed of rats was not carcinogenic. In the Ames Salmonella assay, aspirin was not mutagenic; however, aspirin did induce chromosome aberrations in cultured human fibroblasts. Aspirin inhibits ovulation in rats. (See Pregnancy.)
 Pregnancy: Pregnant women should only take aspirin if clearly needed. Because of the known effects of NSAID’s on the fetal cardiovascular system (closure of the ductus arteriosus), use during the third trimester of pregnancy should be avoided. Salicylate products have also been associated with alterations in maternal and neonatal hemostasis mechanisms, decreased birth weight, and with perinatal mortality.
 Labor and Delivery: Aspirin should be avoided 1 week prior to and during labor and delivery because it can result in excessive blood loss at delivery. Prolonged gestation and prolonged labor due to prostaglandin inhibition have been reported.
 Nursing Mothers: Nursing mothers should avoid using aspirin because salicylate is excreted in breast milk. Use of high doses may lead to rashes, platelet abnormalities, and bleeding in nursing infants.
 Pediatric Use: Pediatric dosing recommendations for juvenile rheumatoid arthritis are based on well-controlled clinical studies. An initial dose of 90-130 mg/kg/day in divided doses, with an increase as needed for anti-inflammatory efficacy (target plasma salicylate levels of 150-300 mcg/mL) are effective. At high doses (i.e., plasma levels of greater than 200 mg/mL), the incidence of toxicity increases.

ADVERSE REACTION:
EENT: tinnitus, hearing loss.
GI: nausea, GI distress, occult bleeding, dyspepsia, GI bleeding
Hematologic: leucopenia, thrombocytopenia, prolonged bleeding time
Hepatic: hepatitis
Skin: rash, bruising, urticaria.
Other: angioedema, hypersensitivity reactions, Reye’s syndrome

MECHANISM OF ACTION:
Aspirin is in a group of drugs called salicylates. It works by reducing substances in the body that cause pain, fever, and inflammation. Aspirin's ability to suppress the production of prostaglandins and thromboxanes is due to its irreversible inactivation of the cyclooxygenase (COX) enzyme. Cyclooxygenase is required for prostaglandin and thromboxane synthesis. Aspirin acts as an acetylating agent where an acetyl group is covalently attached to a serine residue in the active site of the COX enzyme. This makes aspirin different from other NSAIDs (such as diclofenac and ibuprofen), which are reversible inhibitors. It is thought to produce analgesia by blocking generation of pain impulses and relieve fever by central action in the hypothalamic heat-regulating center.

CONTRAINDICATION:
Allergy: Aspirin is contraindicated in patients with known allergy to nonsteroidal anti-inflammatory drug products and in patients with the syndrome of asthma, rhinitis, and nasal polyps. Aspirin may cause severe urticaria, angioedema, or bronchospasm (asthma).
Reye's Syndrome: Aspirin should not be used in children or teenagers for viral infections, with or without fever, because of the risk of Reye's syndrome with concomitant use of aspirin in certain viral illnesses.

EFFECTS ON LAB TEST RESULT:
May increase liver function test values. May decrease WBC and platelet count.

NURSING CONSIDERATIONS:
1. Aspirin should not be given to a child or teenager who has a fever, especially if the child also has flu symptoms or chicken pox. Aspirin can cause a serious and sometimes fatal condition called Reye's syndrome in children.
2. Stop using this medication and call your doctor at once if you have any symptoms of bleeding in your stomach or intestines. Symptoms include black, bloody, or tarry stools, and coughing up blood or vomit that looks like coffee grounds.
3. Take this medication with a full glass of water. Taking aspirin with food or milk can lessen stomach upset.
4. The enteric-coated pill has a special coating to protect your stomach. Breaking the pill could damage this coating. The extended-release tablet is specially made to release medicine slowly in the body. Breaking this pill would cause too much of the drug to be released at one time.
5. Avoid drinking alcohol while you are taking this medication. Alcohol may increase your risk of stomach bleeding.
6. Store aspirin at room temperature away from moisture and heat.
7. Tell patient who is allergic to tartrazine dye to avoid aspirin.
8. Advise client on a sodium-restricted diet that 1 tablet of buffered aspirin contains 553mg of sodium.

NITROGLYCERIN

2009-10-04T08:16:00.001-07:00

BRAND NAMES:
Nitrostat, Nitroquick, Nitrolingual, Nitro-Dur, Minitran, Nitro-Bid

AVAILABLE FORMS:
Tablets: 0.3, 0.4, 0.6 mg;
Capsules: 2.5, 6.5, 9 mg; Spray: 0.4 mg/spray;
Transdermal Patch: 0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hour;
Ointment: 2%;
Injection: 100, 200, 400 mcg/ml;
Injection solution: 5 mg/ml.

INDICATIONS:
Treatment of angina pectoris; I.V. for congestive heart failure; pulmonary hypertension; hypertensive emergencies occurring perioperatively (especially during cardiovascular surgery).

ADVERSE REACTION:
Cardiovascular: Hypotension (infrequent), postural hypotension, crescendo angina (uncommon), rebound hypertension (uncommon), pallor, cardiovascular collapse, tachycardia, shock, flushing, peripheral edema
Central nervous system: Headache (most common), lightheadedness (related to blood pressure changes), syncope (uncommon), dizziness, restlessness
Gastrointestinal: Nausea, vomiting, bowel incontinence, xerostomia
Genitourinary: Urinary incontinence
Hematologic: Methemoglobinemia (rare, overdose)
Neuromuscular & skeletal: Weakness
Ocular: Blurred vision
Miscellaneous: Cold sweat

MECHANISM OF ACTION:
Nitroglycerin belongs to a class of drugs called nitrates. Nitroglycerin is used for the treatment and prevention of angina caused by coronary artery disease. A nitrate that reduces cardiac oxygen demand by decreasing left ventricular end-diastolic pressure (preload) and, to a lesser extent, systematic vascular resistant (after load). Nitroglycerin relaxes blood vessels allowing more blood to flow through and improves blood flow to the heart.

CONTRAINDICATIONS:
Hypersensitivity to organic nitrates; hypersensitivity to isosorbide, nitroglycerin, or any component of the formulation; concurrent use with phosphodiesterase-5 (PDE-5) inhibitors (sildenafil, tadalafil, or vardenafil); angle-closure glaucoma (intraocular pressure may be increased); head trauma or cerebral hemorrhage (increase intracranial pressure); severe anemia; allergy to adhesive (transdermal product)
Additional contraindications for I.V. product: Hypotension; uncorrected hypovolemia; inadequate cerebral circulation; constrictive pericarditis; pericardial tamponade

NURSING RESPONSIBILITY:
1.All formulations should be kept at room temperature, 15-30 C (59-86 F).
2.The sublingual tablets are especially susceptible to moisture. They should NOT be kept in bathrooms or kitchens because of the greater moisture in these rooms. Care should be taken to replace the sublingual tablets every six months.
3.Severe hypotension can occur. Use with caution in volume depletion, hypotension, and right ventricular infarctions.
4.Check or monitor vital signs and intensity or duration of drug response.
5.Advise patient who complains of a tingling sensation with SL drug to try holding tablet in buccal pouch.
6.Tell client to take oral tablet on an empty stomach either 30 minutes before or 1 to 2 hours after meals, to swallow oral tablets whole and not to chew tablets.
7.Advise client to avoid drinking alcohol.
8.To minimize orthostatic hypotension, tell patient to change to upright position slowly.

Lidocaine Hydrochloride

2009-10-03T02:29:00.000-07:00

Brand Names:
Anestacon®; Band-Aid® Hurt-Free™ Antiseptic Wash [OTC]; Burnamycin [OTC]; Burn Jel [OTC]; Burn-O-Jel [OTC]; LidaMantle®; Lidoderm®; L-M-X™ 4 [OTC]; L-M-X™ 5 [OTC]; Premjact® [OTC]; Solarcaine® Aloe Extra Burn Relief [OTC]; Topicaine® [OTC]; Xylocaine®; Xylocaine® MPF; Xylocaine® Viscous; Zilactin-L® [OTC]

AVAILABLE FORMS:
Infusion (premixed): 0.2% (2 mg/ml), 0.4% (4 mg/ml), 0.8% (8 mg/ml)
Injection (for direct I.V use): 1% (10 mg/ml), 2% (20 mg/ml)
Injection (for I.M. use): 300 mg/3 ml automatic injection device

INDICATIONS:
Ventricular arrhythmias caused by MI, cardiac manipulation, or cardiac glycosides.

ACTION:
A class IB antiarrhythmic that decreases the depolarization, automaticity and excitability in the ventricles during the diastolic phase by direct action on the tissues, especially the Purkinje network.

ADVERSE REACTIONS:

Cardiovascular: Bradycardia, hypotension, heart block, arrhythmia, cardiovascular collapse, sinus node supression, increase defibrillator threshold, vascular insufficiency (periarticular injections), arterial spasms
Central nervous system: Drowsiness after administration is usually a sign of a high blood level. Other effects may include lightheadedness, dizziness, tinnitus, blurred vision, vomiting, twitching, tremor, lethargy, coma, agitation, slurred speech, seizure, anxiety, euphoria, hallucinations, paresthesia, psychosis.
Dermatologic: Itching, rash, edema of the skin, contact dermatitis
Gastrointestinal: Nausea, vomiting, taste disorder
Local: Thrombophlebitis
Neuromuscular & skeletal: Transient radicular pain (subarachnoid administration; up to 1.9%)
Ocular: Blurred vision, diplopia
Respiratory: Dyspnea, respiratory depression or arrest, bronchospasm
Miscellaneous: Allergic reactions, urticaria, edema, anaphylactoid reaction

CONTRAINDICATIONS:

Hypersensitivity to lidocaine or any component of the formulation; hypersensitivity to another local anesthetic of the amide type; Adam-Stokes syndrome; severe degrees of SA, AV, or intraventricular heart block (except in patients with a functioning artificial pacemaker); premixed injection may contain corn-derived dextrose and its use is contraindicated in patients with allergy to corn-related products

NURSING CONSIDERATIONS:

Give I.M. injections in the deltoid muscle only.
Monitor levels. Therapeutic levels are 2 to 5 mcg/ml.
Monitor patient's response, especially blood pressure and electrolytes, BUN and creatinine levels. Notify prescriber promptly if abnormalities develop.
Stop infusion and notify prescriber if arrhythmias worsen or ECG changes, such as widening QRS complex or substantially prolonged PR interval, are evident.

Digoxin

2009-09-29T00:45:00.000-07:00

Brand:
Digitek
Lanoxicaps
Lanoxin
Cardoxin

AVAILABLE FORMS:
Capsule: 0.05mg; 0.1mg; 0.2mg
Elixir: 0.05mg/ml
Tablet: 0.125mg; 0.25mg

INDICATION:

Heart failure, paroxysmal supraventricular tachycardia, atrial fibrillation and flutter

MECHANISM OF ACTION:
Inhibits soddium potassium-activated adenosine triphosphatase, promoting movement of calcium from extracellular to intracellular cytoplasm and strengthening myocardial contraction. Digoxin increases the force of contraction of the muscle of the heart by inhibiting the activity of an enzyme (ATPase) that controls movement of calcium, sodium and potassium into heart muscle. Calcium controls the force of contraction. Inhibiting ATPase increases calcium in heart muscle and therefore increases the force of heart contractions. Digoxin also slows electrical conduction between the atria and the ventricles of the heart and is useful in treating abnormally rapid atrial rhythms such as atrial fibrillation, atrial flutter, and atrial tachycardia.

ADVERSE REACTION:
CNS: fatigue, generalized muscle weakness, agitation, headache, malaise, dizziness, vertigo, stupor, paresthesia.
CV: arrhytmias
EENT: blurred vision, light flashes, photophobia, diplopia
GI: anorexia, nausea, vomiting, diarrhea

CONTRAINDICATIONS:
You should not use this medication if you are allergic to digoxin, or if you have ventricular fibrillation (a heart rhythm disorder of the ventricles, or lower chambers of the heart that allow blood to flow out of the heart). FDA pregnancy category C. Digoxin may be harmful to an unborn baby.

NURSING CONSIDERATIONS:

Digoxin should be stored at room temperature, 59-86 F (15-30 C) and protected from light.
Caution should be exercised by nursing mothers who are taking digoxin.
Do not stop taking digoxin without first talking to your doctor. Stopping suddenly may make your condition worse.
Avoid becoming overheated or dehydrated during exercise, in hot weather, or by not drinking enough fluids. Digoxin overdose can occur more easily if you are dehydrated.
Take digoxin with a full glass of water.

Co-Trimoxazole

2009-09-29T00:24:00.000-07:00

INDICATIONS & DOSAGES

Shigellosis
Otitis media
Chronic bronchitis, upper respiratory tract infections
Traveler's diarrhea
P.carinii pneumonia

ACTION

Sulfamethoxazole inhibits formation of dihydrofolic acid from PABA; trimethprim inhibits dihydrofolate reductase formation. Both decrease bacterial folic acid synthesis; bactericidal.

ADVERSE REACTIONS

CNS: headache, mental depression, aseptic meningitis, tinnitus, apathy, seizures, hallucinations, ataxia, nervousness, fatigue, vertigo, insomnia.

CV:thrombophlebitis

GI:nausea, vomiting, diarrhea, abdominal pain

GU:crystalluria, hematuria, interstitial nephritis.

Hematologic:agranulocytosis, aplasticanemia, megaloblastic anemia, thrombocytopenia, leukopenia, hemolytic anemia.

Hepatic:jaundice, hepatic necrosis.

Musculoskeletal:arthralgia, myalgia, muscle weakness.

Respiratory:pulmonary infiltrates

Skin:erithema multiforme, Stevens-Johnson syndrome, generalized skin eruption,

epidermal necrolysis, exfoliative dermatitis, photosensitivity, urticaria, pruritus.

CLOZAPINE

2009-09-28T18:27:00.000-07:00

Brand Name:
Clozaril

AVAILABLE FORMS:
25mg; 100mg

INDICATIONS:
Schizophrenia

MECHANIS OF ACTION:
Clozapine is an anti-psychotic medication that works by blocking receptors in the brain for several neurotransmitters (chemicals that nerves use to communicate with each other) including dopamine type 4 receptors, serotonin type 2 receptors, norepinephrine receptors, acetylcholine receptors, and histamine receptors. Unlike traditional anti-psychotic agents, such as chlorpromazine (Thorazine) and haloperidol (Haldol) as well as the newer anti-psychotics, risperidone (Risperdal) and olanzapine (Zyprexa), clozapine only weakly blocks dopamine type 2 receptors.

ADVERSE REACTIONS:
CNS: extrapyramidal reactions, tardive dyskinesia, sedation, pseudoparkinsonism, EEG changes, drowsiness, seizures, dizziness, neuroleptic malignant syndrome.
CV: orthostatic hypotension, tachycardia, ECG changes.
EENT: ocular changes, blurred vision, nasal congestion.
GI: dry mouth, constipation, increased appetite.
GU: urine retention, dark urine, menstrual irregularities, inhibited ejaculation.
Hematologic: leukopenia, agranulocytosis, eosinophilia, hemolytic anemia, aplastic anemia, thrombocytopenia.
Hepatic: cholestatic jaundice.
Metabolic: weight pain.
Skin: mild photosensitivity reactions, allergic reactions.
Other: gynecomatia.

EFFECTS ON LAB TEST RESULTS

May increase liver function test values and eosinophil count. May decrease hemoglobin and WBC, granulocyte and platelet counts.

CONTRAINDICATIONS:
You should not take this medication if you are allergic to clozapine. Clozapine is not for use in psychotic conditions related to dementia. Clozapine may cause heart failure, sudden death, or pneumonia in older adults with dementia-related conditions. You should not take clozapine if you have uncontrolled epilepsy, paralytic ileus or intestinal blockage, an infection caused by clozapine, or if you are also using drugs that weaken your immune system (such as cancer medicine or steroids). Clozapine can pass into breast milk and may harm a nursing baby. You should not use this medication if you are breast-feeding a baby.

NURSING RESPONSIBILITIES:

Tell patient that smoking may decrease the effectivity of the drug.
Take the regular oral tablet (Clozaril) with a full glass of water. Clozapine can be taken with or without food.
Store clozapine at room temperature away from moisture and heat.
Clozapine may cause seizures, dizziness, or fainting. Be careful if you drive or do anything that requires you to be awake and alert.
Call your doctor at once if you have any serious side effects

Dobutamine hydrochloride

2009-09-27T19:12:00.000-07:00

AVAILABLE FORMS
Injection:12.5 mg/ml in 20-ml vials (parenteral)

INDICATIONS & DOSAGES

Increased cardiac output in short term treatment of cardiac decompensation caused by depressed contractility, such as during refractory heart failure; adjunct in cardiac surgery.

ACTION
Directly stimulates beta receptors of heart to increase myocardial contractility and stroke volume. At therapeutic dosages, drug decreases peripheral vascular resistance (afterload), reduces ventricular filling pressure (preload), and may facilitate AV node conduction.Net result is increased cardiac output.

ADVERSE REACTIONS
CNS:headache
CV:increased heart rate, hypertention, PVCs, angina, nonspecific chest pain, palpitations, hypotention.
GI:nausea, vomiting
Respiratory:shortness of breath, asthmatic episodes.
Other:phlebitis, hypersensitivity reactions,anaphylaxis.

CONTRAINDICATIONS
Contraindicated in patients hypersensitive to drug or its ingredients and in those with idiopathic hypertrophic subaortic stenosis.

NURSING CONSIDERATIONS

Use cautiously in patients with history of hypertension. Drug may cause exaggerated pressor response. Also, use cautiously in patients with history of sulfite sensitivity.
Before starting theraphy with dobutamine, correct hypovolemia with plasma volume expanders.
Give a cardiac glycoside before dobutamine. Because drug increases AV node conduction, patients with artial fibrillation may develop a rapid ventricular rate.
Continuously monitor ECG, blood pressure, pulmonary artery wedge pressure, cardiac output and urine output.
Monitor electrolytes.Drug may lower potassium levels.
Alert: Don't confuse dobutamnine with dopamine.

PATIENT TEACHING

Tell patient to report adverse reactions promptly, especially dyspnea and druginduced headache.
Instruct patient to report discomport at I.V. insection site.

Captopril

2009-09-15T18:13:00.001-07:00

Brand:
Acenorm; Capoten; Enzace; Novo-Captopril

AVAILABLE FORMS:
Tablets: 12.5mg; 25mg; 50mg; 100mg

INDICATIONS:

Hypertension
Heart failure
Diabetic neuropathy

MECHANISM OF ACTION:
Captopril is in a group of drugs called ACE inhibitors. ACE stands for angiotensin converting enzyme. Thought to inhibit ACE, preventing conversion of angiotensin I to angiotensin II, a potent vasoconstrictor. Reduced formation of angiotensin II decreases peipheral arterial resistance, decreasing aldosterone secretion, which reduces sodium and water retension and lowers blood pressure.

ADVERSE REACTION:
CNS: dizziness, fainting, headache, malaise, fatigue
CV: tachycardia, hypotension, angina pectoris
GI: abdominal pain, anorexia, constipation, diarrhea, dry mouth, dysgeusia, nausea, vomiting
Metabolic: hyperkalemia
Hematologic: leukopenia, anemia, pancytopenia
Respiratory: dyspnea, dry, persistent, nonproductive cough
Skin: urticarial rash, alopecia, pruritus

CONTRAINDICATIONS:
ACE inhibitors, including captopril, can be harmful to the fetus and should not be taken by pregnant women. Captopril is secreted in breast milk. Therefore it should be avoided by nursing mothers.

NURSING RESPONSIBILITY:

Take captopril exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.
Take each dose with a full glass of water.
Instruct patient to take drug 1 hour before meals; food in the GI tract may reduce absorbtion.
Vomiting, diarrhea, or heavy sweating can cause you to become dehydrated. This can lead to very low blood pressure, electrolyte disorders, or kidney failure while you are taking captopril. Drink plenty of water each day while you are taking this medication.
Captopril should be stored at room temperature, 15 to 30 C (59 to 86 F) and away from moisture.
Use cautiously in patients with renal impaired.
Monitor patient's blood pressure and pulse rate frequently.
Assists patients for sign of edema.
Instruct patient to report signs and symptoms of infection, such as fever and sore throat.

Mannitol - Osmitrol

2009-09-12T04:32:00.000-07:00

AVAILABLE FORMS:
Injections: 5%; 10%; 15%; 20%; 25%

INDICATIONS:

Oliguria
Reduction of Intraocular or ontracranial pressure
Diuresis
Irrigating solution (transurethral resection of prostate gland

MECHANISM OF ACTION:
Mannitol elevates blood plasma osmolality, resulting in enhanced flow of water from tissues, including the brain and cerebrospinal fluid, into interstitial fluid and plasma.Induces diuresis because mannitol is not reabsorbed in the renal tubule, thereby increasing the osmolality of the glomerular filtrate, facilitating excretion of water, and inhibiting the renal tubular reabsorption of sodium, chloride, and other solutes .

ADVERSE REACTIONS
CNS: dizziness, headache, fatigue, vertigo, paresthesia, weakness, restlessness, drowsiness, anxiety, depression, nervousness, blurred vision.
CV: orthostatic hypotension, palpitations, vasculitis
GI: anorexia, nausea, epigastric distress, vomiting, diarrhea, constipation, dry mouth
GU: nocturia, polyuria, impotence,
Hematologic: agranulocytosis, purpura
Hepatic: jaundice, hepatitis
Metabolic: hyperglycemia, fluid and electrolytes imbalances, volume deplation and dehydration
Musculoskeletal: muscle cramps
Skin: dermatitis, photosensitivity reations, rash, pruritus, urticaria

CONTRAINDICATIONS:
Contraindicated in patients hypersensitive to drug and in those with anuria, severe pulmonary congestion, frank pulmonary edema, severe heart failure, severe dehydration, metabolic edema progressive renal disease or dysfunctoin, or active intracranial beeding except during craniotomy.

ONSET OF ACTION:

Diuresis—1 to 3 hours.
Reduction in cerebrospinal and intraocular fluid pressure—Within 15 minutes after start of infusion.

FACEBOOK

2009-09-12T04:01:00.000-07:00

Do you have Facebook Account?

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You can tell your emotions and share opinions and post it. Telling the world that you are happy, sad, lonely, angry, etc...

There are also games that will make you enjoy your day and while playing still connect and share moments with friends or even strangers who you want to be your friend.

Some games are farmville, zyngapoker, mafia wars, barn buddy, vampire wars, pirates, and yoville.

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Metoprolol Tartrate; Succinate

2009-09-02T08:23:00.000-07:00

Metoprolol (Lopressor, Metoprolol Succinate ER, Toprol-XL, betaloc)

AVAILABLE FORMS:
Metoprolol Succinate
Tablets: (extended release) 25mg; 50mg; 100mg; 200mg
Metoprolol Tartrate
Injection: img/ml in 5ml ampules
Tablets: 50mg; 100mg; 200mg

INDICATIONS:

Hypertension
Angina Pectoris

MECHANISM OF ACTION:
Metoprolol is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins). A selective beta blocker that selectively blocks beta-adrenergenic receptor.

ADVERSE REACTIONS:
CNS: Fatigue; dizziness, depression; anxiety, nervousness
CV: slow or uneven heartbeats; hypotension; heart failure
GI: vomiting; diarrhea
Respiratory: Dyspnea; feeling short of breath, even with mild exertion
Skin: rash
Others: decreased sex drive, impotence, or difficulty having an orgasm

EFFECTS ON LAB TEST RESULTS:
May increase transaminase, alkaline phosphatase, LDH, and uric acid level.

CONTRAINDICATIONS:
FDA pregnancy category C. This medication may be harmful to an unborn baby. It is contraindicated also to breast-feeding mothers. Do not use this medication if you are allergic to metoprolol. Avoid using metoprolol if you have a heart problem such as heart block, sick sinus syndrome, or slow heart rate; and problems with circulation (such as Raynaud's syndrome). pheochromocytoma; or

NURSING CONSIDERATIONS:

Metoprolol can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.
Avoid drinking alcohol, which could increase drowsiness and dizziness while you are taking metoprolol.
Store metoprolol at room temperature away from moisture and heat.
Hypertension often has no symptoms, so you may not even feel that you have high blood pressure. Continue using this medicine as directed, even if you feel well. You may need to use blood pressure medication for the rest of your life.
Metoprolol should be taken with food or just after a meal.Take this medication with a full glass of water.
Metoprolol can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Paracetamol

2009-09-02T08:04:00.000-07:00

Acetaminophen (Aceta, Atasol, Aminofen, Banesin, Dapa, Neopap, Tempra, Tylenol, Tapanol, Valorin)

AVAILABLE FORMS:
Capsules: 325mg; 500mg
Gelcaps: 500mg
Oral Liquid: 160mg/5ml; 500mg/15ml
Oral suspension: 80mg/ml; 120mg/5ml; 160mg/15ml

INDICATIONS:

Mild pain
Fever

MECHANISM OF ACTION:
It has been assumed that paracetamol acts by reducing production of prostaglandins, which are involved in the pain and fever processes, by inhibiting the cyclooxygenase (COX) enzyme. Thought to produce analgesia by blocking generation of pain impulses, probably by inhibiting prostaglandin synthesis.

ADVERSE REACTION:
Hematologic: hemolytic anemia, neutropenia, leukopenia, pancytopenia
Hepatic: Liver damage, jaundice
Metabolic: hypoglycemia
Skin: rash, urticaria

NURSING CONSIDERATIONS:

Use cautiously in patients with history of chronic alcohol use.
Smoking cigarettes may interfere with the effectiveness of acetaminophen.
It interferes with the results of some medical tests.
People should check with a physician or pharmacist before combining acetaminophen with any other prescription or nonprescription (over-the-counter) medicine.
Overdoses of acetaminophen may cause nausea, vomiting, sweating, and exhaustion. Very large overdoses can cause liver damage. In case of an overdose, a person is advised to get immediate medical attention.
Tell breast feeding mothers that acetaminophen appears in breast milk in low levels.

Diphenhydramine hydrochloride

2009-08-31T17:59:00.001-07:00

Diphenhydramine hydrochloride ( Allerdryl, Allermed, Benadryl, Diphenadryl, Hydramine, Tusstat)

AVAILABLE FORMS:
Capsules: 25mg; 50mg
Injection: 10mg/ml; 50 mg/ml
Elixir: 12.5 mg/5ml

INDICATIONS:

Rhinitis,allergic symptoms, motion sickness
Parkinson's Disease
Extrapyramidal Symptoms
Nighttime sleep aid / sedation

MECHANISM OF ACTION:
Competes with histamine for H1-receptor sites on effector cells. Diphenhydramine blocks the effects of H1 receptor stimulation (bronchoconstriction, visceral contractions) and that of H2 receptor stimulation (peripheral vasodilation and secretion of gastric acids). It provides local anesthesia by preventing transmission of nerve impulses.

ADVERSE REACTIONS:
CNS: drowsiness, dizziness, headache, fatigue, sedation, sleepiness, incoordination, confusion, restlessness, insomia, nervousness, tremor, seizures.
CV: hypotension, palpitations, tachycardia.
GI: nausea, vomiting, epigastric distress, dry mouth, diarrhea, constipation.
GU: urine retention, urinary frequency.
Hematologic: hemolytic anemia, leukopenia, agranulocytosis, thrombocytopenia.
Metabolic: weight gain.
Skin: rash, urticaria, photosensitivity.
Other: anaphylactic shock.

CONTRAINDICATIONS:
Topically to treat chickenpox, poison ivy, or sunburn. Topically on large areas of the body or on blistered or oozing skin. Contraindicated in patients hypersensitive to drug or other drugs of similar chemical structure and in those with acute asthma, angle-closure glaucoma, stenosing peptic ulcer, symptomatic prostatic hyperplasia, bladder-neck obstruction, or pyloroduodenal obstruction. Alsso contraindicated in those taking MAO inhibitors, in neonates or premature infants, in elderly or debilitated patients, and in breast-feeding women.

NURSING CONSIDERATIONS

Use cautiously in patients with increased intraocular pressure, hyperthyroidism, CV disease, hypertension or bronchial asthma.
Children younger than age 14 should use drug only as directed by prescriber.
Discontinue drug 4 days before patient undergoes diagnostic skin test.Antihistamines can prevent, reduce, or mask positive skin test response.
Alert: Don't confuse cyproheptadine with cyclobenzaprine.

CHLOPROMAZINE Hcl ( Zycloran)

2009-08-31T08:19:00.000-07:00

INDICATIONS:
For the management of psychotic disorders including management of Schizophrenia and manic depressive illness.

CONTRAINDICATIONS:
Comatose or depressed states due to CNS depressants; blood dyscrasias; bone marrow depression; and liver damage. Hypersensitivity to chlorpromazine. Should be avoided in children or adolescents with symptoms suggestive of Reye’s Syndrome.

ADVERSE EFFECTS:
CNS: Extrapyramidal reactions, dizziness, Tardive Dyskinesia
ANS: Blurred vision, dry mouth, constipation, ileus, nasal stuffiness, photophobia
Cardiovascular: Hypotension, ventricular arrhythmia
Dermatologic: Itching, skin rash, erythema, allergic purpura
GI: Nausea, vomiting, increase or decrease appetite, gastric irritation

WARNING:
The drug may impair the mental and physical ability for operating a motor vehicle or complex hazardous machinery.

Sertraline Hydrochloride (Lustral, Zoloft)

2009-08-27T03:31:00.000-07:00

AVAILABLE FORMS:
Capsule: 25mg, 50mg, 100mg
Oral concentrate: 20mg/ml
Tablets: 50mg, 100mg

INDICATIONS:

Depression
Obsessive-Compulsive Disorder
Panic Disorder
Post-traumatic Stress Disorder

MECHANISM OF ACTION:

Unknown. Thought to be linked to drug's inhibition of CNS neuronal uptake of serotonin.

ADVERSE REACTION:

CNS: Headache, Tremor, Dizziness, Insomia, Somnolence, Paresthesia, Hyperthesia, Fatigue, Nervousness, Anxiety, Agitation, Hypertonia, Twitching, Confusion.

CV: Palpitaions, Chest pain, Hot Flushes.

GI: Dry mouth, Nausea, Diarrhea, Loose Stools, Dyspepsia, Vomiting, Constipation, Thirst, Flatulence, Anorexia, Abdominal pain, Increased appetite.

GU: Male sexual dysfunction

Musculoskeletal: Myalgia

Skin: Rash, Pruritus, Diaphoresis

EFFECTS ON LAB TEST RESULT:

May increase ALT, and AST levels.

CONTRAINDICATIONS:

Contraindicated in patients taking MAO inhibitors or within 14days of discontinuing MAO inhibitor therapy.

NURSING CONSIDERATIONS:

Use cautiously in patients at risk for suicide and with seizure disorders, major affective disorder or disease or conditions that affects metabolism or hemodynamic responses.
Administer sertraline once daily either in morning or evening. May be given with or without food.
Record mood changes.
Tell patient to avoid alcohol and consult prescriber before taking OTC drugs.
Instruct patient to avoid stopping the medication abruptly.

Nifedipine

2009-08-27T00:15:00.000-07:00

AVAILABLE FORMS:
capsul:10 mg, 20mg tablets (extended-released):30 mg, 60mg, 90mg

INDICATIONS & DOSAGES:

Vasospastic angina (prinzmental's or variant angina), classic chronic stable angina pectoris.
Hypertension

MECHANISM OF ACTION:

Unknown. Thought to inhibit calcium ion influx across cardiac and smooth-muscle cells, decreasing contractility and oxygen demand. Also may dilate coronary arteries and arterioles.

ADVERSE REACTION:

CNS: dizziness, light-headedness, headache, weakness, syncope, nervousness.

CV: peripheral edema, hypotension, palpitation, heart failure, MI, pulmonary edema, flushing.

EENT: nasal congestion

GI: nausea, diarrhea, constipation, abdominal discomfort

Metabolic: hypokalemia

Musculoskeletal: Muscle cramps

Respiratory: dyspnea, cough

Skin: Rash, pruritus

EFFECTS ON LAB TEST RESULTS:

May increase ALT, AST, alkaline phosphatase and LDH levels. May decrease potassium level.

CONTRAINDICATIONS:

Contraindicated in patients hypersensitive to drug.

NURSING CONSIDERATIONS:

Use cautiously in patients with heart failure or hypotension and in elderly patients.
Don't give immediate-release form within 1 week of acute MI or in acute coronary syndrome.
Watch for symptoms of heart failure.
Tell patient that angina may worsen briefly when beginning drug oor when dosage is increased.
Advise patient to avoid taking drug with grapefruit juice.
Tell patient to protect capsules from direct light and moisture and to store at room temperature.

metronidazole (apo-metronidazole, flagyl, flagyl 375, flagyl ER, metric 21, metrogyl, novonidazol, protostat, trikacide)

2009-08-26T19:09:00.000-07:00

AVAILABLE FORMS:

Capsules: 375 mg

Injections: 500 mg/100 ml ready to use

Oral suspension (benzoyl metronidazole): 200 mg/5 ml

Powder for injections: 500-mg single-dose vials

Tablets:200 mg, 250 mg, 400 mg, 500 mg

Tablets (extended-release): 750 mg

INDICATIONS & DOSAGES:

Amebic liver abscess

Intestinal amebiasis

Trichomoniasis

Refractory trichomoniasis

Bacterial infections caused by anaerobic microorganisms

Prevention of postoperative infection in contaminated or potentially contaminated colorectal surgery

Bacterial vaginosis

MECHANISM OF ACTION:

A direct-acting trichomonacide and amebicide that works at both intestinal and extraintestinal sites.It's thought to enter the cells of microorganisms that contain nitroreductase.Unstable compounds are then formed that bind to DNA and inhibit synthesis, causing cell death.

ADVERSE REACTIONS

CNS:vertigo, headache, ataxia, dizziness, syncope, incoordination,confusion, irritability, depression, weakness, insomia, seizures, peripheral neuropathy.

CV: Flattenned T wave, edema, blushing, thrombophebitis, after IV infusion

EENT: Rhinitis, Sinusitis, Pharyngitis

GI: Abdominal cramping or pain, Stomatitis, Epigastric distress, Nausea, Vomiting, Anorexia, Diarrhea, Constipation, Proctitis, dry mouth, metalic taste.

GU: darkened urine, polyuria, dysuria, cystitis, dyspareunia, dry ness of vagina and vulva, vaginal candidiasis, vaginitis, genital pruritus.

Hematologic: transient leukopenia, neutropenia

Musculoskeletal: fleeting joint pain

Respiratory: Upper Respiratory Tract Infection

Skin: Rash

EFFECTS ON LAB TEST RESULTS:

May decrease WBC and neutrophil count.

CONTRAINDICATIONS:

First Trimester of Pregnancy.

NURSING CONSIDERATIONS:

It may interfere with the chemical analyses of aminotransferases and triglycerides, leading to falsely decreased values.
Use cautiously in patients with history of blood dyscrasia or CNS disorders.
Monitor liver function test carefully in elderly patients.
Give oral form with meals.
Record the amount and characteristics of the stools.
Tell patient that metallic taste and dark or red-brown urine may occur.