Name Of Drug

Name of drug PENICILLIN G

dose

route

frequency

action

indication

Septicemia, empyema, pneumonia, pericarditis, endocarditis, meningitis Anthrax Actinomycosis (cervico-facial disease and thoracic and abdominal disease) Botulism (adjunctive therapy to antitoxin), gas gangrene, and tetanus (adjunctive therapy to human tetanus immune globulin) Diphtheria (adjunctive therapy to antitoxin and

Adverse effect

contraindicat ion

Nursing consideratio n

prevention of the carrier state) Erysipelothrix endocarditis Fusospirochet osis (severe infections of the oropharynx [Vincent's], lower respiratory tract and genital area) Listeria infections including meningitis and endocarditis Pasteurella infections including bacteremia and meningitis Haverhill fever Rat bite fever Disseminated

gonococcal infections Syphilis (congenital and neurosyphilis) Meningococca l meningitis and/or septicemia

Name of drug Furose mide (fur oh' se mide) ApoFurosemi de (CAN), Furoside (CAN), Lasix, Myrosem ide (CAN) Pregnan cy Category C Drug class Loop diuretic

dose Dosages ADULTS · Edema: Initially, 20–80 mg/day PO as a single dose. If needed, a second dose may be given in 6– 8 hr. If response is unsatisfact ory, dose may be increased in 20- to 40-mg increments at 6- to 8hr intervals. Up to 600 mg/day may be given. Intermitten t dosage schedule (2–4 consecutiv

route

frequenc y

action

indication

Adverse effect

contraindicat ion

Nursing consideration

Inhibits the reabsorptio n of sodium and chloride from the proximal and distal renal

· Edema associated with CHF, cirrhosis, renal disease (oral, IV)

· CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness,

Furosemide is contraindicate d in patients with anuria and in patients with a history of hypersensitivit y to Furosemide.

CLINICAL ALERT!

tubules and the loop of Henle, leading to a sodiumrich diuresis

· Acute pulmonary edema (IV)

· Contraindication s and cautions

fatigue, blurred vision, tinnitus, irreversible hearing loss

· Contraindicated with allergy to furosemide, sulfonamides; allergy to tartrazine (in

· CV: Orthostatic hypotension, volume depletion, cardiac arrhythmias,

oral solution); electrolyte depletion; anuria, severe renal failure; hepatic coma;

thrombophle bitis

· Hypertension (oral)

pregnancy; lactation. · Use cautiously with SLE, gout, diabetes mellitus.

· Dermatologic : Photosensitiv ity, rash, pruritus, urticaria, purpura, exfoliative dermatitis, erythema multiforme

Do not mix with acidic solutions. Isotonic saline, lactated Ringer's injection, and 5% dextrose injection may be used after pH has been adjusted (if necessary); precipitates form with gentamicin, netilimicin, milrinone in 5% dextrose, 0.9% sodium chloride.

Name confusion has occurred between furosemide and torsemide; use extreme caution. Assessment · History: Allergy to furosemide, sulfonamides, tartrazine; electrolyte depletion anuria, severe renal failure; hepatic coma; SLE; gout; diabetes mellitus; lactation, pregnancy · Physical: Skin color, lesions, edema; orientation, reflexes, hearing; pulses, baseline ECG, BP, orthostatic BP, perfusion; R, pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns; CBC, serum electrolytes (including calcium), blood sugar, liver and renal function tests, uric acid, urinalysis Interventions · Administer with food or milk to prevent GI upset. · Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP responds.

e days/wk) is preferred for maintenan ce, or 20– 40 mg IM or IV (slow IV injection over 1–2 min). May increase dose in increments of 20 mg in 2 hr. Highdose therapy should be given as infusion at rate not exceeding 4 mg/min. · Acute pulmonary edema: 40 mg IV over 1–2 min. May be increased to 80 mg IV given over 1–2 min if response is unsatisfact

· GI: Nausea, anorexia, vomiting, oral and gastric irritation, constipation, diarrhea, acute pancreatitis, jaundice · GU: Polyuria, nocturia, glycosuria, urinary bladder spasm · Hematologic: Leukopenia, anemia, thrombocyto penia, fluid and electrolyte imbalances · Other: Muscle cramps and muscle spasms

· Give early in the day so that increased urination will not disturb sleep. · Avoid IV use if oral use is at all possible. · Do not mix parenteral solution with highly acidic solutions with pH below 3.5. · Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions. · Discard diluted solution after 24 hr. · Refrigerate oral solution. · Measure and record weight to monitor fluid changes. · Arrange to monitor serum electrolytes, hydration, liver function. · Arrange for potassium-rich diet or supplemental potassium as needed. Teaching points · Record intermittent therapy on a calendar or dated envelopes. When possible, take the drug early so increased urination will not disturb sleep. Take with food or meals to prevent GI upset. · Weigh yourself on a regular

ory after 1 hr.

basis, at the same time and in the same clothing, and

· Hypertensi on: 40 mg bid PO. If needed, additional antihyperte nsive agents may be

record the weight on your calendar.

added at 50% usual dosage. GERIATRI C PATIENTS OR PATIENTS WITH RENAL IMPAIRME NT Up to 2–2.5 g/day has been tolerated. IV bolus injection should not exceed 1 g/day given over 30 min.

· These side effects may occur: increased volume and frequency of urination; dizziness, feeling faint on arising, drowsiness (avoid rapid position changes; hazardous activities, like driving; and consumption of alcohol); sensitivity to sunlight (use sunglasses, wear protective clothing, or use a sunscreen); increased thirst (suck on sugarless lozenges; use frequent mouth care); loss of body potassium (a potassiumrich diet or potassium supplement will be necessary). · Report loss or gain of more than 3 lb in 1 day, swelling in your ankles or fingers, unusual bleeding or bruising, dizziness, trembling, numbness, fatigue, muscle weakness or cramps.