Levaquin (lomefloxacin)

NURS 1566 Clinical Form 3: Clinical Medications Worksheets (You will need to make additional copies of these forms) Generic Name Trade Name Classification Dose Route Time/frequency lomefloxacin Levaquin Anti-infectives 500 g PO daily Peak Onset Duration Normal dosage range Unknown Rapid 24 hrs 400 mg once daily Why is your patient getting this medication For IV meds, compatibility with IV drips and/or Pyelonephritis solutions N/A Mechanism of action and indications Nursing Implications (what to focus on) (Why med ordered) Contraindications/warnings/interactions Inhibit bacterial DNA synthesis by inhibiting DNA Hypersensitivity. Cross-sensitivity among agents may gyrase. Broad spectrum anti-infective. occur (including cinoxacin and nalidixic acid). Use cautiously in: Underlying CNS pathology, Renal impairment (dosage reduction if CCr <40 ml/min for gatifloxacin, gemifloxacin or lomefloxacin). Cirrhosis, Geriatric patients, dialysis patients (increased risk of adverse reactions). Common side effects dizziness, drowsiness, headache, insomnia, abdominal pain, diarrhea, nausea, SEIZURES, ARRHYTHMIAS, PSEUDOMEMBRANOUS COLITIS, HYPERSENSITIVITY REACTIONS INCLUDING ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically) Concurrent use with glyburide and other antidiabetics may result in hypoglycemia (Glucotrol XL).

Lab value alterations caused by medicine Fluoroquinolones may cause ↑ serum AST, ALT, LDH, bilirubin, and alkaline phosphatase, May also cause ↓ WBC; ↑ or ↓ serum glucose; and glucosuria, hematuria, proteinuria, and albuminuria, Be sure to teach the patient the following about this medication Instruct patient to take medication as directed at evenly spaced times and to finish drug completely, even if feeling better. Take missed doses as soon as possible, unless almost time for next dose. Do not double doses. Advise patient that sharing of this medication may be dangerous. Caution patients that fluoroquinolones should only be used to treat bacterial infections; they are not effective against viral infections, such as the common cold. Encourage patient to maintain a fluid intake of at least 1500-2000 ml/day to prevent crystalluria. Advise patients to notify health care professional immediately if they are taking theophylline. Advise patient that antacids or medications containing iron or zinc will decrease absorption and should not be taken within 6 hr before lomefloxacin and 2 hr after taking this medication. May cause dizziness and drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known. Advise patient to notify health care professional of any personal or family history of QTc prolongation or proarrhythmic conditions such as recent hypokalemia, significant bradycardia, or recent myocardial ischemia. Patients with this history should not receive fluoroquinolones. Caution patient to use sunscreen and protective clothing to prevent phototoxicity reactions during and for 5 days after therapy. Notify health care professional if a sunburn-like reaction or skin eruption occurs. Instruct patient to consult health care professional before taking any other Rx, OTC, or herbal products. Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal itching or discharge, loose or foul-smelling stools). Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. Instruct patient to notify health care professional immediately if rash or tendon pain or inflammation occur. Therapy should be discontinued.

Nursing Process- Assessment (Pre-administration assessment) Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC; urinalysis; frequency and urgency of urination; cloudy or foulsmelling urine) prior to and during therapy.

Assessment Why would you hold or not give this med? Signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify physician or other health care professional immediately if these problems occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in case of an anaphylactic reaction. Patients taking gemifloxacin who are at greater risk for rash are those receiving gemifloxacin for >7 days, <40 yrs of age, females, and postmenopausal females receiving hormone replacement therapy. Instruct patient to notify health care professional immediately if rash or tendon pain or inflammation occur. Therapy should be discontinued.

Evaluation Check after giving Resolution of the signs and symptoms of infection. Time for complete resolution depends on organism and site of infection. Resolution of the signs and symptoms of urinary tract infection (negative urine culture). Post exposure treatment of inhalational anthrax or cutaneous anthrax.