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cefixime • Tablets shouldn’t be substituted for oral

suspension to treat otitis media because

cefixime suspension produces a higher
Class and Category peak blood level than do tablets when
Chemical class: Third-generation cephalosporin,
administered at the same dose.
7-aminocephalosporanic acid
•Monitor BUN and serum creatinine for
Therapeutic class: Antibiotic
early signs of nephrotoxicity. Also monitor
Pregnancy category: B
fluid intake and output; decreasing urine
Indications and Dosages output may indicate nephrotoxicity.
To treat uncomplicated UTI caused by • Be aware that an allergic reaction may
Escherichia coli and Proteus mirabilis; otitis media occur a few days after therapy starts.
caused by Haemophilus • Assess bowel pattern daily; severe diarrhea
influenzae,Moraxella catarrhalis, or may indicate pseudomembranous colitis.
Streptococcus pyogenes; pharyngitis • Assess for signs of superinfection, such as
and tonsillitis caused by S. pyogenes; perineal itching, fever, malaise, redness,
acute bronchitis and acute exacerbations pain, swelling, drainage, rash, diarrhea,
of chronic bronchitis caused by H. and cough or sputum changes.
influenzae and Streptococcus pneumonia • Assess for pharyngitis, ecchymosis, bleeding,
and arthralgia; they may indicate a
Mechanism of Action blood dyscrasia.
Interferes with bacterial cell wall synthesis
• Instruct patient to complete the prescribed
by inhibiting the final step in the crosslinking
course of therapy.
of peptidoglycan strands. Peptidoglycan
• Advise patient to shake oral suspension
makes cell membranes rigid and
well before pouring dose and to use a calibrated
protective.Without it, bacterial cells rupture
device to obtain an accurate dose.
and die.
• Instruct patient to store oral suspension at
room temperature and to discard unused
Hypersensitivity to cephalosporins or their
portion after 14 days.
• Tell patient to immediately report severe
diarrhea to prescriber.
Adverse Reactions • Inform patient that yogurt and buttermilk
CNS: Chills, fever, headache, seizures can help maintain intestinal flora and
CV: Edema decrease diarrhea.
EENT: Hearing loss
GI: Abdominal cramps, diarrhea, elevated • Teach patient to recognize and report
liver function test results, hepatic failure, signs of superinfection, such as furry
hepatitis, hepatomegaly, jaundice, nausea, tongue, perineal itching, and loose, foulsmelling
oral candidiasis, pseudomembranous colitis, stools.
GU: Elevated BUN level, nephrotoxicity,
renal failure, vaginal candidiasis azithromycin
Zithromax, Zmax
HEME: Eosinophilia, hemolytic anemia, Class and Category
hypoprothrombinemia, neutropenia, Chemical class: Azalide (subclass of
thrombocytopenia, unusual bleeding macrolide)
MS: Arthralgia Therapeutic class: Antibiotic
RESP: Dyspnea Pregnancy category: B
SKIN: Ecchymosis, erythema, erythema
multiforme, pruritus, rash, Stevens-Johnson Indications and Dosages
syndrome, toxic epidermal necrolysis To treat mild community-acquired
Other: Anaphylaxis, angioedema, facial pneumonia, otitis media, pharyngitis,
edema, superinfection tonsillitis, and uncomplicated skin and
Nursing Considerations soft-tissue infections
• Use cefixime cautiously in patients with
impaired renal function or a history of GI
To treat community-acquired pneumonia
disease, especially colitis. Also use cautiously
caused by Chlamydophila pneumoniae,
in patients hypersensitive to penicillin
because cross-sensitivity has
Haemophilus influenzae,
occurred in about 10% of such patients. Mycoplasma pneumoniae, or
• If possible, obtain culture and sensitivity Streptococcus pneumonia
test results, as ordered, before giving drug.
Mechanism of Action
Binds to a ribosomal subunit of susceptible colitis, vomiting
bacteria, blocking peptide translocation and GU: Acute renal failure, elevated BUN and
inhibiting RNA-dependent protein synthesis. serum creatinine levels, nephritis, vaginal
Drug concentrates in phagocytes, candidiasis
macrophages, and fibroblasts, which release HEME: Leukopenia, neutropenia, thrombocytopenia
it slowly and may help move it to infection MS: Arthralgia
sites. SKIN: Erythema multiforme, photosensitivity,
Incompatibilities pruritus, rash, Stevens-Johnson syndrome,
Don’t add I.V. substances, additives, or toxic epidermal necrolysis, urticaria
drugs to azithromycin I.V. solution, and Other: Allergic reaction, anaphylaxis,
don’t infuse through the same I.V. line. angioedema, elevated serum phosphorus
Contraindications level, hyperkalemia, infusion site reaction
Hypersensitivity to azithromycin, erythromycin, (such as pain and redness), new or worsening
ketolide antibiotics, or other myasthenia syndrome, superinfection
macrolide antibiotics Nursing Considerations
Interactions •Obtain culture and sensitivity test results,
DRUGS if possible, before starting therapy.
antacids that contain aluminum or magnesium: • Use azithromycin cautiously in patients
Possibly decreased peak blood with hepatic dysfunction (drug is metabolized
azithromycin level, but extent of absorption in the liver) or renal dysfunction
is unchanged (effects are unknown in this group).
carbamazepine, cyclosporine, phenytoin, terfenadine • Give azithromycin capsules 1 hour before
(drugs metabolized by P-450 cytochrome or 2 to 3 hours after food. Give tablets or
system): Possibly increased blood suspension without regard to food.
levels of these drugs
digoxin: Possibly increased blood digoxin liver function studies because drug is eliminated
level mainly by the liver.
dihydroergotamine, ergotamine: Possibly • Assess patient for bacterial or fungal
severe peripheral vasospasm and abnormal superinfection, which may occur with prolonged
sensations (acute ergot toxicity) or repeated therapy. If it occurs,expect to give another
HMG-CoA reductase inhibitors: Increased antibiotic or antifungal.
risk of severe myopathy or rhabdomyolysis
pimozide: Possibly sudden death
•Monitor bowel elimination; if needed,
oral anticoagulants: Possibly potentiated
obtain stool culture to rule out pseudomembranous
effects of oral anticiagulants
colitis. If it occurs, expect to
theophylline: Possibly increased blood theophylline
stop azithromycin and give fluid, electrolytes,
and antibiotics effective with
triazolam: Possibly decreased excretion and
Clostridium difficile.
increased therapeutic effects of triazolam PATIENT TEACHING
warfarin: Possibly increased anticoagulation • Tell patient to take azithromycin capsules
1 hour before or 2 to 3 hours after food.
food: Dramatically increased absorption
Instruct patient to take tablets or suspension
rate of azithromycin
without regard to food.
Adverse Reactions
CNS: Aggressiveness, agitation, anxiety,
• Tell patient to immediately report signs
and symptoms of allergic reaction (such as
asthenia, dizziness, fatigue, headache, hyperactivity, rash, itching, hives, chest tightness, and
malaise, nervousness, paresthesia, trouble breathing).
seizures, somnolence, syncope, vertigo •Warn patient that abdominal pain and
CV: Chest pain, edema, elevated serum CK loose, watery stools may occur. If diarrhea
level, hypotension, palpitations, prolonged persists or becomes severe, urge him to
QT interval, torsades de pointes, ventricular contact prescriber and replace fluids.
tachycardia • Because azithromycin may destroy normal
EENT: Hearing loss, mucocutaneous candidiasis, flora, teach patient to watch for and
perversion or loss of taste or smell, immediately report signs of superinfection,
tinnitus such as white patches in the mouth.
ENDO: Hyperglycemia
GI: Abdominal pain, anorexia, cholestatic
jaundice, constipation, diarrhea, dyspepsia, carvedilol
elevated liver function test results, flatulence, Coreg, Coreg CR
hepatic necrosis or failure, hepatitis, Class and Category
nausea, pancreatitis, pseudomembranous Chemical class: Nonselective beta-adrenergic
blocker with alpha1-adrenergic blocking GI: Abdominal pain, diarrhea, elevated liver
activity function test results, melena, nausea, vomiting
Therapeutic class: Antihypertensive, heart GU: Albuminuria, hematuria, elevated
failure treatment adjunct BUN and creatinine levels, impotence, renal
Pregnancy category: C insufficiency, UTI
Indications and Dosages HEME: Aplastic anemia, decreased PT,
To control hypertension thrombocytopenia, unusual bleeding or
Mechanism of Action MS: Arthralgia, arthritis, back pain, muscle
Reduces cardiac output and tachycardia, cramps
causes vasodilation, and decreases peripheral RESP: Dyspnea, increased cough
vascular resistance, which reduces blood SKIN: Jaundice, pruritus, purpura, urticaria
pressure and cardiac workload.When given Other: Anaphylaxis, angioedema, fluid
for at least 4 weeks, carvedilol reduces plasma overload, gout, hyperkalemia, hyperuricemia,
renin activity. hyponatremia, hypovolemia, viral
Contraindications infection, weight gain or loss
Asthma or related bronchospastic conditions; Nursing Considerations
cardiogenic shock; decompensated • Use carvedilol cautiously in patients with
heart failure that requires I.V. inotropics; peripheral vascular disease because it may
history of serious hypersensitivity reactions, aggravate symptoms of arterial insufficiency.
such as anaphylaxis, angioedema, or In patients with diabetes mellitus it
Stevens-Johnson syndrome; hypersensitivity may mask signs of hypoglycemia, such as
to carvedilol or its components; second- or tachycardia, and may delay recovery.
third-degree AV block, severe bradycardia •Monitor patient’s blood glucose level, as
or hepatic impairment, or sick sinus syndrome ordered, during carvedilol therapy because
unless pacemaker is in place drug may alter blood glucose level.
DRUGS • If patient has heart failure, expect to also
amiodarone; other CYP2C9 drugs, such as give digoxin, a diuretic, and an ACE
fluconazole: Increased risk of bradycardia or inhibitor.
beta blockers, digoxin: Increased risk of • Instruct patient prescribed extendedrelease
bradycardia capsules to swallow them whole. If
calcium channel blockers (especially diltiazem swallowing capsules is difficult, tell patient
and verapamil): Abnormal cardiac he may open capsule and sprinkle beads
conduction and, possibly, increased adverse on a spoonful of cold applesauce and then
effects of calcium channel blockers eat the applesauce immediately without
catecholamine-depleting drugs (such as reserpine, •Warn patient that drug may cause orthostatic
MAO inhibitors): Additive effects, hypotension, light-headedness, and
increased risk of hypotension and bradycardia dizziness; advise him to take precautions.
cimetidine: Increased blood carvedilol level • Tell patient with heart failure to notify
clonidine: Risk of tachycardia and hypertension prescriber if he gains 5 lb or more in
when clonidine is discontinued 2 days or if shortness of breath increases,
cyclosporine, digoxin: Increased blood levels which may signal worsening heart failure.
of these drugs • Alert patient with diabetes to monitor his
digoxin: Possibly increased digoxin level glycemic control closely because drug may
oral antidiabetics: Increased risk of hypoglycemia increase blood glucose level or mask
rifampin: Decreased blood carvedilol level symptoms of hypoglycemia.
Adverse Reactions • Stress the need to seek emergency care if
CNS: Asthenia, depression, dizziness, patient develops hives or swelling of the
fatigue, fever, headache, hypesthesia, hypotonia, face, lips, tongue, or throat that causes
insomnia, light-headedness, malaise, trouble swallowing or breathing.
paresthesia, somnolence, stroke, syncope,
CV: Angina, AV block, bradycardia, edema,
heart failure, hypertension, hypertriglyceridemia,
orthostatic hypotension, palpitations,
peripheral vascular disorder
EENT: Blurred vision, dry eyes, periodontitis,
pharyngitis, rhinitis
ENDO: Hyperglycemia, hypoglycemia