Ampicillin

(am pi sill in) ampicillin sodium Oral: Ampicin (CAN), Apo-Ampi (CAN), Novo-Ampicillin (CAN), Nu-Ampi (CAN), Penbritin (CAN), Principen Pregnancy Category B Drug classes Antibiotic Penicillin Therapeutic actions Bactericidal action against sensitive organisms; inhibits synthesis of bacterial cell wall, causing cell death. Indications Treatment of infections caused by susceptible strains of Shigella, Salmonella, Escherichia coli, Haemophilus influenzae, Proteus mirabilis, Neisseria gonorrhoeae, enterococci, gram-positive organisms (penicillin Gsensitive staphylococci, streptococci, pneumococci) Meningitis caused by Neisseria meningitidis Unlabeled use: Prophylaxis in cesarean section in certain high-risk patients Dosage & route Maximum recommended dosage, 814 g/day (reserve 14 g for serious infections, such as meningitis, septicemia); may be given IV, IM, or PO. Use parenteral routes for severe infections; switch to oral route as soon as possible.

ADULTS Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 2 g ampicillin IM or IV with gentamicin 1.5 mg/kg IM or IV within 30 minutes of starting procedure. Six hours later, give 1 g ampicillin IM or IV or 1 g amoxicillin PO. Prevention of bacterial endocarditis for dental, oral, or upper respiratory procedures: 2 g ampicillin IM or IV within 30 minutes of procedure. STDs in pregnant women and patients allergic to tetracycline: 3.5 g ampicillin PO with 1 g probenecid. Prophylaxis in cesarean section: Single IV or IM dose of 25100 mg/kg immediately after cord is clamped. ADULTS AND PEDIATRIC PATIENTS Respiratory and soft-tissue infections: > 40 kg: 250500 mg IV or IM q 6 hr. < 40 kg: 2550 mg/kg/day IM or IV in equally divided doses at 68 hr intervals. > 20 kg: 250 mg PO q 6 hr. < 20 kg: 50 mg/kg/day PO in equally divided doses q 68 hr. GI and GU infections, including women with N. gonorrhoeae: > 40 kg: 500 mg IM or IV q 6 hr. < 40 kg: 50100 mg/kg/day IM or IV in equally divided doses q 68 hr. > 20 kg: 500 mg PO q 6 hr. < 20 kg: 100 mg/kg/day PO in equally divided doses q 68 hr. Gonococcal infections: 500 mg q 6 hr for penicillin-sensitive organism or for patients > 45 kg, single dose of 3.5 g PO with 1 g probenecid.

Bacterial meningitis: 150200 mg/kg/day by continuous IV drip and then IM injections in equally divided doses q 34 hr. Septicemia: 150200 mg/kg/day IV for at least 3 days, then IM q 34 hr. PEDIATRIC PATIENTS Prevention of bacterial endocarditis for GI or GU surgery or instrumentation: 50 mg/kg ampicillin IM or IV with 1.5 mg/kg gentamicin IM or IV within 30 minutes of procedure. Six hours later give 25 mg/kg ampicillin IM or IV or 25 mg/kg amoxicillin PO. Prevention of bacterial endocarditis for dental, oral, or upper respiratory procedures: 50 mg/kg ampicillin IM or IV within 30 minutes of procedure. Adverse effects CNS: Lethargy, hallucinations, seizures CV: CHF GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black hairy tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, nonspecific hepatitis GU: Nephritis Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time Hypersensitivity: Rash, fever, wheezing, anaphylaxis Local: Pain, phlebitis, thrombosis at injection site (parenteral) Other: Superinfectionsoral and rectal moniliasis, vaginitis Contraindications and cautions Contraindicated with allergies to penicillins, cephalosporins, or other allergens. Use cautiously with renal disorders.

Nursing considerations 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, urinalysis Interventions Culture infected area before treatment; reculture area if response is not as expected. Check IV site carefully for signs of thrombosis or drug reaction. Do not give IM injections in the same site; atrophy can occur. Monitor injection sites. Administer oral drug on an empty stomach, 1 hr before or 2 hr after meals with a full glass of water; do not give with fruit juice or soft drinks. Teaching points Take this drug around-the-clock. Take the full course of therapy; do not stop taking the drug if you feel better. Take the oral drug on an empty stomach, 1 hour before or 2 hours after meals; do not take with fruit juice or soft drinks; the oral solution is stable for 7 days at room temperature or 14 days refrigerated. 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.

Gentamicin sulfate

Brand Name: Garamycin, G-myticin Pregnancy Category C Drug class: Aminoglycoside Therapeutic actions Bactericidal: inhibits protein synthesis in susceptible strains of gram-negative bacteria; appears to disrupt functional integrity of bacterial cell membrane, causing cell death. Indications: Parenteral Serious infections caused by susceptible strains of Pseudomonas aeruginosa, Proteus sp., Escherichia coli, Klebsiella-Enterobacter-Serratia species, Citrobacter, Staphylococcus sp. In serious infections when causative organisms are not known (often in

conjunction with a penicillin or cephalosporin) Unlabeled use: with clindamycin as alternative regimen in PID

Intrathecal For serious CNS infections caused by susceptible Pseudomonas species

Ophthalmic preparations Treatment of superficial ocular infections due to strains of microorganisms

susceptible to gentamicin

Topical dermatologic preparation Infection prophylaxis in minor skin abrasions and treatment of superficial

infections of the skin due to susceptible organisms amenable to local treatment Gentamicin-impregnated PMAA beads on surgical wire Orphan drug use: treatment of chronic osteomyelitis of post-traumatic,

postoperative, or hematogenous origin Gentamicin liposome injection Orphan drug use: treatment of disseminated Myobacterium avium-intracellulare

infection

Contraindications Contraindicated with allergy to any aminoglycosides; renal or hepatic disease;

preexisting hearing loss; active infection with herpes, vaccinia, varicella, fungal infections, myobacterial infections (ophthalmic preparations); myasthenia gravis; parkinsonism; infant botulism; lactation. Adverse effects Ototoxicity--tinnitus, dizziness, vertigo, deafness (partially reversible to irreversible), vestibular paralysis, confusion, disorientation, depression, lethargy, nystagmus, visual disturbances, headache, numbness, tingling, tremor, paresthesias, muscle twitching, convulsions, muscular weakness, neuromuscular blockade, Palpitations, hypotension, hypertension,Hepatic toxicity, nausea, vomiting, anorexia, weight loss, stomatitis, increased salivation,Nephrotoxicity,Leukemoid reaction, agranulocytosis, granulocytosis, leukopenia, leukocytosis, thrombocytopenia,

eosinophilia, pancytopenia, anemia, hemolytic anemia, increased or decreased reticulocyte count, electrolyte disturbances,Purpura, rash, urticaria, exfoliative dermatitis, itching,Pain, irritation, arachnoiditis at IM injection sites,Fever, apnea, splenomegaly, joint pain, superinfections Drug Interactions: Increased ototoxic, nephrotoxic, neurotoxic effects with other aminoglycosides,

cephalothin, potent diuretics Increased neuromuscular blockade and muscular paralysis with anesthetics,

nondepolarizing neuromuscular blocking drugs, succinylcholine, citrateanticoagulated blood Potential inactivation of both drugs if mixed with beta-lactamtype antibiotics

(space doses with concomitant therapy) Increased bactericidal effect with penicillins, cephalosporins (to treat some

gram-negative organisms and enterococci), carbenicillin, ticarcillin (to treat Pseudomonas infections) Nursing considerations Give by IM route if at all possible; give by deep IM injection. Culture infected area before therapy. Use 2 mg/mL intrathecal preparation without preservatives, for intrathecal use. Cleanse area before application of dermatologic preparations. Ensure adequate hydration of patient before and during therapy. Monitor renal function tests, complete blood counts, serum drug levels during

long-term therapy. Consult with prescriber to adjust dosage.

Ranitidine
BRAND NAME: Zantac CLASSIFICATION Therapeutic: Anti-ulcer agents Pharmacologic: Histamine H2 antagonists DOSAGE 20 mg IV q8h MECHANISM OF ACTION Inhibits the action of histamine at the H2 receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. In addition, ranitidine bismuth citrate has some antibacterial action against H. pylori. INDICATION Treatment and prevention of heartburn, acid indigestion, and sour stomach. CONTRA INDICATIONS Contraindicated in: Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance.

Use Cautiously in: Renal impair- ment Geriatric patients (more susceptible to adverse CNS reactions) Pregnancy or Lactation SIDE EFFECTS/ ADVERSE EFFECTS CNS: Confusion, dizziness, drowsiness, hallucinations, headache CV: Arrhythmias GI: Altered taste, black tongue, constipation, dark stools, diarrhea, drug-induced hepatitis, nausea GU: Decreased sperm count, impotence ENDO: Gynecomastia HEMAT: Agranulocytosis, Aplastic Anemia, neutropenia, thrombocytopenia LOCAL: Pain at IM site MISC: Hypersensitivity reactions, vasculitis

NURSING IMPLICATIONS/RESPONSIBILITIES Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid. Inform patient that it may cause drowsiness or dizziness. Inform patient that increased fluid and fiber intake may minimize constipation. Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health car professional promptly. Inform patient that medication may temporarily cause stools and tongue to appear gray black.