Drug Study Clindamycin, Ipatropium Bromide

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Generic name of Drug: Ciprofloxacin Dosage: Route: Frequency: Pharmacologic action: Ciprofloxacin inhibits an enzyme called DNA gyrase that is an essential component of the mechanism that passes genetic information onto daighter cells when a cell divides. Broad spectrum antibiotic effective against Gram-positive and Gram-negative bacteria. Often used when other antibiotics fail. Indications: Recommended for use against against a wide variety of infections when susceptibility is demonstrated. Contraindications: Any previous adverse reaction to Ciprofloxacin. Avoid giving to adolescents, pregnant or lactating women, those with known neurological problems. Adverse Effects of the Drug: Neurological side effects ranging from dizziness to tremors, hallucinations, psychosis and convulsions have been seen in small numbers of patients. As with many other antibiotics it can kill the healthy bacteria of the gut and give rise to a disorder called pseudomembranous colitis. It can also make users sunburn easily and can cause muscle or tendon inflammation or damage. Desired Action on the Client:

Nursing Responsibilities/ Precautions: Assessment and Drug Effects: 1. for patients with renal impairment, oral and IV doses are lowered according to creatinine clearance. 2. Oral: do not give an antacid within 4 h of the oral ciprofloxacin dose. 3. IV: dilute in NS or D5W to a final concentration of 0.5-2 mg/ mL. Typical dilution are 200 mg in 100-250 mL and 400 mg in 250-500 mL Give slowly over 60 min. Avoid rapid infusion and use of a small vein. Discontinue other IV infusion while infusing ciprofloxacin or infuse through another site. Reconstituted IV solution is stable for 14 d refrigerated. 4. report tendon inflammation or pain. Drug should be discontinued. 5. patient should be well hydrated. Monitor I&O 6. Assess for S&S of GI irritation in clients receiving high dosages and in older adults. 7. monitor INR and PT in patients receiving coumarin therapy 8. assess for S&S of superinfection Patient and Family Education: 1. immediately report tendon inflammation or pain. Drug should be discontinued. 2. fluid intake of 2-3 L/d is advised, if not contraindicated. 3. report sudden, unexplained joint pain. 4. restrict caffeine due to the following effects (e.g. nervousness, insomnia, anxiety, tachycardia) 5. report possible toxicity, esp. if taking theophylline derivatives.

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Generic name of Drug: Clindamycin Dosage: Route: Frequency: Pharmacologic action: semi-synthetic derivative of lincomycin with a greater degree of antibacterial activity in vitro, better absorption, and lower incidence of GI adverse effects than lincomycin. Suppresses protein synthesis by binding to 50 s subunits of bacterial ribosomes, and therefore, inhibits other antibiotics (e.g., erythromycin) that act at this site. Indications: serious infections when less toxic alternatives are inappropriate. Topical applications are used in treatment of acne vulgaris. Vaginal applications are used in treatment of bacterial vaginosis in nonpregnant women. Anaerobic infections (empyema, lung abscesses, intra-abdominal infections and absecesses, peritonitis, endometriosis) Streptococci and Staphylococci infections (serious respiratory and skin infections, septicemia, osteomyelitis) Pneumococci infections (respiratory infections) Adjunctive therapy to surgical treatment of bone and joint infections Dental procedure prophylaxis Unlabeled uses: CNS toxoplasmosis in AIDS patients Pneumocystis carinii Pelvic Inflammatory Disease: Chlamydia trachomatis Bacterial vaginitis: Gardnerella vaginalis Contraindications: May cause a fatal colitis, characterized by severe diarrhea, cramping, and passage of blood and mucous ; Not for treatment of minor bacterial or viral infections Adverse Effects of the Drug: Hypotension; CNS: Headache, mild depression, confusion; Gastrointestinal: diarrhea (2-20%), pseudomembranous colitis (>10% with oral tx), nausea, vomiting, abdominal pain, esophagitis ;

Jaundice; Local injection site pain, thrombophlebitis ; Hypersensitivity reactions: urticaria, erythema multiforme, generalized morbilliform-like rash Desired Action on the Client: Nursing Responsibilities/ Precautions: Assessment and Drug Effects: 1. Take each dose with a full glass of water (decreases esophageal iritiation) 2. May be taken without regard for meals 3. For IM: deep IM injection is recommended. Rotate injection sites and observe daily foe evidence of inflammatory reaction. Single IM doses should not exceed 600 mg. 4. report S&S of severe diarrhea and colitis 5. monitor BP and pulse after administration. Advise patient to remain recumbent following administration of IM injection until BP stabilizes. 6. be alert for signs of superinfection and anaphylactoid reactions that require immediate attention. Patient and Family Education: 1. complete full course of therapy 2. report loose stool or diarrhea (more than 5 loose stools daily) promptly and do not self-medicate with antidiarrheal preparations.

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Generic name of Drug: Ipratropium Bromide- Salbutamol Sulfate (Combivent) Dosage: Route: Frequency: Pharmacologic action: Combivent Inhalation Solution is a combination of the anticholinergic bronchodilator, ipratropium bromide, and the beta2-adrenergic bronchodilator, salbutamol sulfate. Ipratropium bromide is a quaternary ammonium derivative of atropine and is an anticholinergic drug which has bronchodilator properties. Salbutamol produces bronchodilation through stimulation of beta2-adrenergic receptors in bronchial smooth muscle, thereby causing relaxation of muscle fibres. This action is manifested by an increase in pulmonary function as demonstrated by spirometric measurements. Indications: For the management of bronchospasm in patients suffering from chronic obstructive pulmonary disease (COPD) who requires regular treatment with both ipratropium and salbutamol. Contraindications: Patients with cardiac tachyarrhythmias, hypertrophic obstructive cardiomyopathy and patients with a history of hypersensitivity to any of its components or to atropine or its derivatives. Adverse Effects of the Drug: fatigue, abdominal pain, hypertension, dyspepsia, tachycardia, sinusitis, dysuria, and urinary retention blurred vision, taste perversion, dry mouth, paradoxical bronchospasm, bronchitis, angina, arrhythmia, lightheadedness, drowsiness, insomnia, dizziness, vertigo, CNS stimulation, weakness, itching, rash, flushing, alopecia, hypotension, increased blood pressure, gastrointestinal distress, vomiting, diarrhea, edema, constipation and urinary difficulty Desired Action on the Client:

Nursing Responsibilities/ Precautions: Assessment and Drug Effects: 1. monitor respiratory status; auscultate lungs before and after inhalation 2. report treatment failure (exacerbation of respiratory symptoms) to physician 3. Patient and Family Education: 1. do not allow the solution/ mist to enter the eyes 2. consult a doctor immediately in the event of acute, rapidly worsening dyspnea. In addition, the patient should be warned to seek medical advice should a reduced response become apparent. 3. The concomitant use of Combivent with other sympathomimetic agents is not recommended since such combined use may lead to deleterious cardiovascular effects. 4. Eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival and corneal congestion may be signs of acute narrow-angle glaucoma. Should any combination of these symptoms develop, treatment with miotic drops should be initiated and specialist advice sought immediately. 5. allow 30-60 sec between puffs for optimum results. 6. wait 5 min between this and other inhaled medications. 7. rinse mouth after medication puffs to reduce bitter taste

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Diagnosis/ Clinical Impression: Ward: Bed no. Generic name of Drug: Nifedipine Dosage: Route: Frequency: Pharmacologic action: Nifedipine inhibits the movement of calcium ions across cell membranes. By blocking the entry of calcium into cells, smooth muscle contraction is depressed. Nifedipine dilates coronary arteries and arterioles in normal and ischemic tissue, prevents coronary artery spasm, dilates peripheral vessels, and decreases total peripheral resistance (lessening myocardial oxygen demand). When arterial pressure is reduced, a reflex is stimulated, causing a small increase in heart rate, and a mild elevation in the force of myocardial contraction. Nifedipine does not slow SA nodal activity or prolong AV nodal conduction. Indications: Angina pectoris; Hypertensive Crisis Contraindications: Hypersensitivity; Compensatory hypertension; Hypotension Adverse Effects of the Drug: Dizziness; Lighteadedness; Flushing; Heat sensation; Hypotension Desired Action on the Client:

Nursing Responsibilities/ Precautions: Assessment and Drug Effects: 1. do not give within the first 1-2 wk following an MI 2. use only the SR form to treat chronic HPN. Ensure that SR form is not chewed or crushed. It must be swallowed whole. 3. monitor BP carefully during titration period. 4. monitor blood sugar in diabetic patients. Nifedipine has diabetogenic properties. Patient and Family Education: 1. be aware that withdrawal symptoms may occur with abrupt discontinuation of the drug 2. inspect gums regularly. Report gingival hyperplasia 3. encourage patient to stop smoking while taking the nifedipine. It decreases the efficacy of nifedipine and has direct and adverse effects on the heart in the patient on nifedipine treatment.