Indication for Cefuroxime

Cefuroxime is used to treat otitis media, respiratory tract, genitourniary tract, gynecologic, skin, and bone infections. It is also used in the treatment of speticemia, bacterial meningitis, gonorrhea, and other gonococcal infections.

Cefuroxime can also be used for ampicillin-resistant influenza, perioperative prophylaxis, impetigo, acute bacterial maxillary sinusitis, and early Lyme disease.

Routes and Dosage of Cefuroxime

IM/IV: ADULTS, ELDERLY: 750 mg to 1.5 g every 8 hours. CHILDREN: 75-100 mg/kg/day divided every 8 hours. Maximum: 8 g/day. NEONATES: 50-100 mg/kg/day divided every 12 hours.

PO: ADULTS, ELDERLY: 125-500 mg 2 times a day depending on the infection.

Pharyngitis, Tonsillitis

PO: CHILDREN 3 MONTHS-12 YEARS: Tablet: 125 mg every 12 hours. Suspension: 20 mg/kg/day in 2 divided doses.

Acute Otitis Media, Acute Bacterial Maxillary Sinusitis, Impetigo

PO: CHILDREN 3 MONTHS-12 YEARS: Tablet: 250 mg every 12 hours. Suspension: 30 mg/kg/day in 2 divided doses.

Bacterial Meningitis

IV: CHILDREN 3 MONTHS-12 YEARS: 200-240 mg/kg/day in divided doses every 6-8 hours

Perioperative Prophylaxis

IV: ADULTS, ELDERLY: 1.5 g 30-60 minutes before surgery and 750 mg every 8 hours post operative.

IM/IV: NEONATES: 20-100 mg/kg/day in divided doses every 12 hours.

Dosage in Renal Impairment

Adult dosage is modified based on creatinine clearance and/or severity of infection.

Action of Cefuroxime

Cefuroxime binds to bacterial membranes. It inhibits synthesis of bacterial cell wall.

Side Effects and Adverse Reactions of Cefuroxime

Side Effects of Cefuroxime

• Discomfort with IM administration
• Oral candidiasis (mouth and/or tongue sores)
• Mild diarrhea
• Mild abdominal cramping
• Vaginal candidiasis
• Nausea
• Serum sickness reaction (joint pain, fever)
• Allergic reactions
• Thrombophlebitis

Adverse Reactions of Cefuroxime

• Antibiotic-associated colitis
• Superinfection
• Nephrotoxicity
• Severe hypersensitivity reactions

Nursing Considerations for Clients Taking Cefuroxime

• Question for history of allergies, particularly cephalosporins and penicillins.
• Give without regards to meals. If GI upset occurs give with food or milk.
• Avoid crushing tablets due to bitter taste.
• Suspension must be given with food.
• Intramuscular injections must be administered deep IM to minimize discomfort.
• Assess mouth for white patches on mucous membranes and tongue.
• Monitor bowel activity and stool consistency carefully.
• Mild GI effects may be tolerable but increasing severity may indicate onset of antibiotic-associated colitis.
• Monitor input and output and renal function reports for nephrotoxicity.
• Be alert for superinfection: severe genital or anal pruritus, abdominal pain, severe mouth soreness, moderate to severe diarrhea.

Patient Teachings for Clients Taking

• Discomfort may occur with IM injection.
• Doses should be evenly spaced.
• Continue antibiotic therapy for full length of treatment.
• May cause GI upset (may take with food or milk).

Indication for Clonidine

Clonidine is used for the treatment of hypertension alone or in combination with other anti-hypertensive agents. It is also used in the treatment of severe pain.

Clonidine may also be used in the diagnosis of pheochromocytoma, prevention of migraine headaches, treatment of dysmenorrhea or menopausal flushing, opioid withdrawal, and attention deficit hyperactivity disorder (ADHD).

Routes and Dosage of Clonidine

Hypertension

PO: ADULTS: Initially, 0.1 mg two times a day. Increase by 0.1-0.2 mg every 2 to 4 days. MAINTENANCE: 0.2-1.2 mg per day in two to four divided doses up to a maximum of 2.4 mg/day. CHILDREN: 5-25 mcg/kg/day in divided doses every 6 hours; increase at 5- to 7-day intervals. Maximum: 0.9 mg/day.

TRANSDERMAL: ADULTS, ELDERLY: System delivering 0.1 mg/24 hours up to 0.6 mg/24 hours every 7 days.

Usual Elderly Dosage

PO: Initially, 0.1 mg at bedtime. may increase gradually.

ADHD

PO: CHILDREN: Initially 0.05 mg per day. May increase by 0.05 mg per day every 3-7 days. Maximum: 0.3-0.4 mg per day.

Severe Pain

Epidural: ADULTS, ELDERLY: 30-40 mcg per hour. CHILDREN: Initially 0.5 mcg/kg/hour not to exceed adult dose.

Action of Clonidine

Clonidine reduces peripheral resistance; decreases blood pressure and heart rate. Epidurally administered clonidine prevents pain signal transmission to the brain and produces analgesia at pre- and post-alpha-adrenergic receptors in the spinal cord.

Side Effects and Adverse Reactions of Clonidine

Side Effects of Clonidine

• Dry mouth
• Drowsiness
• Dizziness
• Sedation
• Constipation
• Depression
• Swelling of feet
• Loss of appetite
• Decreased sexual ability
• Itching of the eyes
• Dizziness
• Nausea
• Vomiting
• Nervousness
• Itching
• Red skin
• Darkening of skin
• Nightmares
• Vivid dreams
• Cold feeling in the fingers or toes

Adverse Reactions of Clonidine

• Profound hypotension
• Irritability
• Bradycardia
• Respiratory depression
• Hypothermia
• Miosis
• Arrhythmias
• Apnea
• Abrupt withdrawal may result in: rebound hypertension, nervousness, agitation, anxiety, insomnia, hand tingling, tremor, flushing, and sweating.

Nursing Considerations for Clients Taking Clonidine

• Obtain blood pressure immediately before each dose is administered in addition to regular monitoring (be alert on blood pressure fluctuations).
• Give without regard to food.
• Tablets may be crushed.
• Monitor pattern of daily bowel activity and stool consistency.
• If clonidine is to be withdrawn, discontinue concurrent beta-blocker therapy several days before discontinuing clonidine. This prevents clonidine withdrawal hypertensive crisis.
• Slowly reduce clonidine dosage over 2-4 days.

Patient Teachings for Clients Taking Clonidine

• Sugarless gum or sips of tepid water may relieve dry mouth.
• Rise slowly from lying to sitting position, permit legs to dangle momentarily before standing.
• Skipping doses or voluntarily discontinuing drug use may produce severe, rebound hypertension.
• Side effects diminish during therapy.

Indication for Vitamin C

Vitamin C is used for prevention and treatment of scurvy, acidification of urine, dietary supplement, prevention of and reduction in the severity of colds.

Routes and Dosage of Vitamin C

Dietary Supplement

PO: ADULTS, ELDERLY: 45-60 mg/day. CHILDREN >4 years: 30-40 mg/day.

Deficiency

PO: ADULTS, ELDERLY: 75-150 mg/day.

Scurvy

PO: ADULTS, ELDERLY: 300mg – 1g per day.

Burns

PO: ADULTS, ELDERLY: Up to 2g per day.

Enhance Wound Healing

PO: ADULTS, ELDERLY: 300-500 mg/day for 7-10 days.

Action of Vitamin C

Assists in collagen formation, tissue repair; involved in oxidation reduction reactions, other metabolic reactions.

Vitamin C is involved in metabolism; carbohydrate utilization; synthesis of lipids, proteins, carnitine. It also preserves blood vessel integrity.

Side Effects and Adverse Reactions of Vitamin C

Side Effects of Vitamin C

• Abdominal cramps
• Nausea
• Vomiting
• Diarrhea
• Increased urination with doses exceeding 1 gram
• Flushing
• Headache
• Dizziness
• Sleepiness or insomnia

Adverse Reactions of Vitamin C

• Urine acidification that may lead to crystalluria

Nursing Considerations for Clients Taking Vitamin C

• May give without regard to food.
• Assess for clinical improvement (improved sense of well-being and sleep patterns).
• Observe for reversal of deficiency symptoms (gingivitis, bleeding gums, poor wound healing, digestive difficulties, joint pain).

Patient Teachings for Clients Taking Vitamin C

• Abrupt vitamin C withdrawal may produce rebound deficiency.

Indication for Amoxicillin

Amoxicillin is used for the treatment of skin or skin structure infections; respiratory tract, GI tract, and GU tract infections; otitis media; gonorrhea.

It is also used in the treatment of H. pylori associated with peptic ulcer. It can also be used in the treatment of Lyme disease and typhoid fever.

Routes and Dosage of Amoxicillin

Ear, Nose, Throat, GU, Skin, or Skin structure infections

PO: ADULTS, ELDERLY, CHILDREN >20 KG: 250-500 mg ever 8 hours (or 500-875 mg tablets for 2 times a day). CHILDREN <20 KG: 20-40 mg/kg/day in divided doses every 8-12 hours.

Lower Respiratory Tract Infections

PO: ADULTS, ELDERLY, CHILDREN >20 KG: 500 mg every 8 hours (or 875 mg tablets 2 times/day). CHILDREN <20 KG: 40 mg/kg/day in divided doses every 812 hours.

Acute Uncomplicated Gonorrhea

PO:ADULTS: 3 g one time with 1 g probenecid. Follow with tetracycline or erythromycin therapy. CHILDREN >2 YEARS: 50 mg/kg plus probenacid 25 mg/kg as a single dose.

Acute Otitis Media

PO: CHILDREN: 80-90 mg/kg/day in divided dose every 12 hours.

H. Pylori

PO: ADULTS, ELDERLY (in combination): 1 g two times/day. for 10 days. NEONATES, CHILDREN < 3 MOS: 20-30 mg/g/day in divided doses.

Endocarditis Prophylaxis

PO: ADULTS, ELDERLY: 2 g 1 hour prior to procedure. CHILDREN: 50 mg/kg as above.

Renal Function Impairment

Creatinine clearance 10-30 ml/min: Administer every 12 hours. Creatinine clearance <10 ml/min: Administer every 24 hours.

Action of Amoxicillin

Amoxicillin is bactericidal to susceptible microorganisms. It inhibits cell wall synthesis.

Side Effects and Adverse Reactions of Amoxicillin

Side Effects of Amoxicillin

• GI disturbances (mild diarrhea, nausea, or vomiting)
• Headache
• Oral and Vaginal Candidiasis
• Generalized Rash
• Urticaria

Adverse Reactions of Amoxicillin

• Superinfections
• Severe hypersensitivity reactions (anaphylaxis, acute interstitial nephritis)
• Potentially fatal antibiotic colitis ( abdominal cramps, watery svere diarrhea, fever)

Nursing Considerations for Clients Taking Amoxicillin

• Question history of allergies, especially penicillin and cephalosporin.
• Store capsules, tablets at room temperature.
• After reconstitution, oral solution is stable for 14 days at eiter room temperature or refrigerated.
• Give without regards to meals.
• Hold medication and promptly report rash or diarrhea (with fever abdominal pain, mucus, and blood in stool may indicate antibiotic-associated colitis).
• Be alert for superinfection: increased fever, sore throat, vomiting, diarrhea, black/hairy tongue, ulceration, or changes of oral mucosa, anal/genital pruritus

Patient Teachings for Clients Taking Amoxicillin

• Continue antibiotic for full length of treatment.
• Space doses evenly.
• Take with meals if GI upset occurs.
• Notify physician in event of rash, diarrhea, or other new symptom.

Indication for Calcium Carbonate

Calcium carbonate may be used for Acute hypocalcemia, electrolyte depletion, cardiac arrest, hyperkalemia, and hypermagnesemia.

It can also be used in Chronic hypocalcemia, calcium deficiency, and as an antacid. It is also used in the treatment of hyperphosphatemia.

Routes and Dosage of Calcium Carbonate

Hypocalcemia

PO: ADULTS, ELDERLY: 1-2 g/day in 3-4 divided doses. CHILDREN: 45-65 mg/kg/day in 3-4 divided doses.

Antacid

PO: ADULTS, ELDERLY: 1-2 tabs (5-10 ml) every 2 hours as needed.

Osteoporosis

PO: ADULTS, ELDERLY: 1,200 mg/day.

Action of Calcium Carbonate

Calcium is essential for function, integrity of nervous, muscular, and skeletal systems. It plays an important role in normal cardiac and renal functions, respiration, blood coagulation, cell membrane, and capillary permeability. It assists in regulating the release and storage of neurotransmitters and hormones. Calcium neutralizes or reduces gastric acid production.

Side Effects and Adverse Reactions of Calcium Carbonate

Side Effects of Calcium Carbonate

• Hypotension
• Flushing
• Warmth
• Nausea
• Vomiting
• Pain
• Rash
• Redness
• Burning at the injection site
• Sweating
• Decreased blood pressure
• Chalky taste
• Mild constipation
• Fecal impaction
• Swelling of the hands or feet
• Metabolic alkalosis
• Milk-alkali syndrome (headache, decreased appetite, nausea, vomiting, unusual tiredness)
• Difficult or painful urination

Adverse Reactions of Calcium Carbonate

• Hypercalcemia (Early Signs: Constipation, headache, dry mouth, increased thirst, irritability, decreased appetite, metallic taste, fatigue, weakness, depression.)
• Hypercalcemia (Late signs: Confusion, drowsiness, increased blood pressure, light sensitivity, urination, irregular heartbeat, nausea, vomiting)

Nursing Considerations for Clients Taking Calcium Carbonate

• Assess blood pressure, ECG readings, renal function, magnesium, phosphate, and potassium concentrations.
• Take tablets with full glass of water 30 minutes to 1 hour after meals.
• Give syrup diluted in juice or water.
• Chew chewable tablets well before swallowing.
• Monitor blood pressure, ECG, renal function, magnesium, phosphate, potassium, serum, and urine calcium concentrations.
• Monitor for signs of hypercalcemia.

Patient Teachings for Clients Taking Calcium Carbonate

• Stress importance of diet.
• Take tablets with full glass of water, 30 minutes to 1 hour after meals.
• Give liquid before meals.
• Do not take within 1-2 hours of other oral medications, fiber-containing foods.
• Avoid excessive alcohol, tobacco, and caffeine.

Indication for Azithromycin

Azithromycin is used for the treatment of mild to moderate infections of upper respiratory tract and lower respiratory tract infections, uncomplicated skin or skin structure infections, and sexually transmitted diseases. It prevents disseminated Mycobacterium avium complex.

Routes and Dosage of Azithromycin

Respiratory Tract Infections

PO: ADULTS, ELDERLY: 500 mg once, them 250 mg daily for 4 days. CHILDREN >6 MONTHS: 10 mg/kg once (maximum 500 mg) then 5 mg/kg/day for 4 days (maximum 250 mg).

Acute Bacterial Exacerbations of COPD

PO: ADULTS: 500 mg/day for 3 days.

Skin, Skin Structure Infections

PO: ADULTS, ELDERLY: 500 mg once, then 250 mg daily for 4 days.

Otitis Media

CHILDREN >6 MONTHS: 10 mg/kg once 9maximum 500 mg) the 5 mg/kg/day for 4 days (maximum 250 mg).

Pharyngitis, Tonsillitis

PO: CHILDREN: >2 YEARS: 12 mg/kg/day (maximum: 500 mg) for 5 days.

Treatment of MAC

PO: ADULTS, ELDERLY: 500 mg/day in combination. CHILDREN: 5 mg/kg/day (maximum 250 mg) in combination.

MAC Prevention

PO: ADULTS, ELDERLY: 1,200 mg/week alone or with rifabutin. CHILDREN: 5 mg/kg/day (maximum 250 mg) or 20 mg/kg.wk (maximum 1,200 mg) alone or with rifabutin.

Non-gonococcal Urethitis, Cervicitis due to C. Trachomatis

PO: ADULTS: 1 g as a single dose.

Usual Parenteral Dosage

IV: ADULTS: 500 mg/day followed by oral therapy.

Action of Azithromycin

Azithromycin binds to ribosomal receptor sites of susceptible organisms. It inhibits protein synthesis.

Side Effects and Adverse Reactions of Azithromycin

Side Effects of Azithromycin

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Headache
• Dizziness
• Allergic Reaction

Adverse Reactions of Azithromycin

• Superinfections
• Acute intestinal nephritis

Nursing Considerations for Clients Taking Azithromycin

• Question for history of hepatitis, allergies to azithromycin or erythromycin.
• May give tablets without regard to food.
• Check for GI discomfort, nausea, and vomiting.
• Determine pattern of bowel activity ans stool consistency.
• Monitor hepatic function tests, assess for hepatotoxicity: malaise, fever, abdominal pain, and GI disturbances.
• Evaluate for superinfection: genital/anal pruritus, sore mouth or tongue, moderate to severe diarrhea.

Patient Teachings for Clients Taking Azithromycin

• Continue therapy for full length of treatment.
• Doses should be evenly spaced.
• Take oral medication with 8 oz water at least 1 hour before or 2 hours after food or beverage.

Indication for Digoxin

Digoxin is used as a prophylactic management and treatment of CHF, control of ventricular rate in patients with atrial fibrillation. It is also used in the treatment and prevention of recurrent paroxysmal atrial tachycardia.

Routes and Dosage of Digoxin

Dosage should be adjusted in elderly patients with renal dysfunction. Larger doses often required for adequate control of ventricular rate in patients with atrial fibrillation or flutter. Administer loading dosage in several doses at 4 to 8 hour intervals.

Usual Dosage for Adults (Rapid Loading Dosage)

IV: ADULTS, ELDERLY: 0.6-1 mg

PO: ADULTS, ELDERLY: Initially 0.5-0.75 mg, additional doses of 0.125-0.375 mg at 6 to 8 hour intervals. RANGE: 0.75-1.25 mg

Usual Dosage for Adults (Maintenance Dosage)

PO/IV: ADULTS, ELDERLY: 0.125-0.375 mg/day

Usual Dosage for Children (Rapid Loading Dosage)

IV: Children >10 years: 8-12 mcg/kg; 5-10 years: 15-30 mcg/kg; 2-5 years: 25-35 mcg/kg; 1-24 mos: 30-50 mcg/kg; FULL-Term: 20-30 mcg/kg; PREMATURE: 15-25 mcg/kg

PO: Children >10 years: 10-15 mcg/kg; 5-10 years: 20-35 mcg/kg; 2-5 years: 30-40 mcg/kg; 1-24 mos: 30-50 mcg/kg; FULL-TERM: 25-35 mcg/kg; PREMATURE: 20-30 mcg/kg

Usual Dosage for Children (Maintenance Dosage)

PO/IV: CHILDREN: 25%-35% loading dose (20%-30% for premature).

Dosage in Renal Impairment

Total digitalizing dose should decrease by 50% in end-stage renal disease. If creatinine clearance is 10-50 mg/min, dosage should be 25%-75% normal. If creatinine clearance is <10ml/min, dosage should be 10%-25% normal.

Action of Digoxin

Digoxin increases the influx of calcium from extracellular to intracellular cytoplasm. It potentiates the activity of the contractile heart muscle fibers and increases the force of myocardial contraction. Decreases conduction through the SA and AV nodes.

Side Effects and Adverse Reactions of Digoxin

Side Effects of Digoxin

• None known; however, there is a very narrow margin of safety between a therapeutic and toxic result.

Adverse Reactions of Digoxin

• GI disturbances (anorexia, nausea, vomiting)
• Neurologic abnormalities (fatigue, headache, depression, weakness, drowsiness, confusion, nightmares)
• Facial pain
• Personality changes
• Ocular disturbances (photo phobia, light flashes, halos around bright objects, yellow or green color perception) may be noted

Nursing Considerations for Clients Taking Digoxin

• Assess apical pulse for 60 secs (30 secs if on maintenance therapy). If pulse is <60/min (<70min for children), withhold drug, contact physician.
• Blood samples are best taken 6-8 hours after dose or just before next dose.
• May be given without regard to meals.
• Tablets may be crushed.
• Monitor pulse for bradycardia, EKG for arrhythmias for 1-2 hours after administration (excessive slowing of pulse may be a first clinical sign of toxicity).
• Assess for GI disturbances, neurologic abnormalities (signs of toxicity) every 2-4 hours during digitalization (daily during maintenance).
• Monitor serum potassium, magnesium levels.

Patient Teachings for Clients Taking Digoxin

• Stress importance of follow-up visits and tests.
• Teach patient to take apical pulse correctly and to report pulse <60/min (or as indicated by physician).
• Ensure patient understands signs of toxicity and need to notify physician if any occur. Wear/carry identification of digoxin therapy and inform dentist and other physicians of taking digoxin.
• Do not increase or skip doses.
• Do not take OTC medications without consulting your physician.
• Inform physician of decreased appetite, nausea or vomiting, diarrhea, and visual changes.

Indication for Tramadol

Tramadol is used to treat moderate to moderately sever pain.

Routes and Dosage of Tramadol

Moderate to Moderately Severe Pain

PO: ADULTS, ELDERLY: 50-100mg every 4-6 hours. Maximum <75 years old: 400mg per day. Maximum >75 years old: 300mg per day.

Renal Function Impairment (Creatinine clearance <30mL per minute)

Alert: Dialysis patients can receive their regular dose on day of dialysis.

PO: ADULTS, ELDERLY: Increase dosing interval to 12 hours. Maximum daily dose: 200mg.

Hepatic Function Impairment

PO: ADULTS, ELDERLY: 50mg every 12 hours.

Action of Tramadol

Tramadol binds to µ-opiate receptors and inhibits reuptake of norepinephrine and serotonin. It reduces intensity of pain stimuli incoming from sensory nerve endings, altering pain perception and emotional response to pain.

Side Effects and Adverse Reactions of Tramadol

Side Effects of Tramadol

• Dizziness or vertigo
• Nausea and Vomiting
• Constipation
• Headache
• Somnolence
• Pruritus
• CNS Stimulation
• Asthenia
• Diaphoresis
• Dyspepsia
• Dry mouth
• Diarrhea
• Malaise
• Vasodilation
• Anorexia
• Flatulence
• Rash
• Visual disturbance
• Urinary retention or frequency
• Menopausal symptoms

Adverse Reactions of Tramadol

• Respiratory depression
• Seizures
• Prolonged duration of action and cumulative effect may occur in patients with impaired hepatic or renal function.

Nursing Considerations for Clients Taking Tramadol

• Assess onset, type, location, and duration of pain.
• Effect of medication is reduced if full pain recurs before next dose.
• Assess drug history especially carbamazepine, CNS depressant medication, MAOIs.
• Review past medical history, especially epilepsy or seizures.
• Assess renal or hepatic function laboratory values.
• Give without regards to meals
• Monitor pulse and blood pressure.
• Assist with ambulation if dizziness or vertigo occurs.
• Dry crackers or cola may relieve nausea.
• Palpate bladder for urinary retention.
• Monitor pattern of daily bowel activity and stool consistency.
• Sips of tepid water may relieve dry mouth.
• Assess for clinical improvement and record onset of relief from pain.

Patient Teachings for Clients Taking Tramadol

• May cause dependence.
• Avoid alcohol and over-the-counter medications.
• May cause drowsiness, dizziness, and blurred vision.
• Avoid tasks requiring alertness and motor skills until response to drug is established.
• Inform physician if severe constipation, difficulty in breathing, excessive sedation, seizures, muscle weakness, tremors, chest pain, and palpitations occur.

Indication for Ciprofloxacin

Ciprofloxacin is used in the treatment of chronic bacterial prostatitis. It is also used in the treatment of skin or skin structure, GI tract, bone or joint, lower respiratory tract, and urinary tract infections. Ciprofloxacin is also used in the treatment of chancroid.

Ciprofloxacin is also used in the treatment of infectious diarrhea, uncomplicated gonorrhea, empiric treatment of febrile neutropenia, and acute sinusitis. It can also be used for conjunctival keratitis, keratoconjunctivitis, corneal ulcers, blepharitis, dacrocystitis, blepharoconjunctivitis, and acute meibomianitis.

Routes and Dosage of Ciprofloxacin

Mild to Moderate Urinary Tract Infections

PO: ADULTS, ELDERLY: 250mg every 12 hours.

IV: ADULTS, ELDERLY: 200mg every 12 hours.

Complicated Urinary Tract, Mild to Moderate Respiratory Tract, Skin or Skin Structure, Bones, Joint Infections, Infectious Diarrhea

PO: ADULTS, ELDERLY: 500mg every 12 hours.

IV: ADULTS, ELDERLY: 400mg every 12 hours.

Severe, Complicated Infections

PO: ADULTS, ELDERLY: 750 mg every 12 hours.

PO: ADULTS, ELDERLY: 400mg every 12 hours.

Prostatitis

PO: ADULTS, ELDERLY: 500mg every 12 hours for 28 days.

Uncomplicated Bladder Infections

PO: ADULTS: 100mg 2 times a day for 3 days.

Acute Sinusitis

PO: ADULTS, 500mg every 12 hours.

Uncomplicated Gonorrhea

PO: ADULTS: 250mg as single dose.

Usual Dosage for Children

PO: 20-30 mg/kg/day in 2 divided doses. Maximum: 1.5 g per day.

IV: 20-30 mg/kg/day in 2 divided doses every 12 hours. Maximum: 800mg per day.

Dosage in Renal Impairment

Dose and frequency is modified in patients based on severity of infection, degree of renal impairment. Hemodialysis and peritoneal dialysis, 250-500mg every 24 hours after dialysis.

Usual Opthalmic Dose

Corneal Ulcer: ADULTS, ELDERLY: 2 drops every 15 minutes for 6 hours, then 2 drops ever 30 minutes for remainder of first day; 2 drops every 1 hour for second day; then 2 drops every 4 hours in days 3-14.

Conjuctivitis: ADULTS, ELDERLY: 1-2 drops every 2 hours for 2 days, then 2 drops every 4 hours in the next 5 days.

Action of Ciprofloxacin

Ciprofloxacin inhibits DNA enzyme in susceptible microorganisms. It interferes with bacterial DNA replication. Ciprofloxacin is also bactericidal.

Side Effects and Adverse Reactions of Ciprofloxacin

Side Effects of Ciprofloxacin

• Nausea
• Diarrhea
• Dyspepsia
• Vomiting
• Constipation
• Flatulence
• Confusion
• Crystalluria
• Burning
• Crusting in the corner of eye
• Abdominal pain or discomfort
• Headache
• Rash
• Bad taste
• Redness of the eyelid
• Confusion
• Hallucination
• Hypersensitivity reaction
• Insomnia
• Dry mouth
• Paresthesia

Adverse Reactions of Ciprofloxacin

• Superinfection (especially enterococcal and fungal)
• Nephropathy
• Cardiopulmonary arrest
• Cerebral thrombosis may occur
• Arthropathy may occur if given to children <18 years.
• Sensitization may contraindicate later systemic use of Ciprofloxacin

Nursing Considerations for Clients Taking Ciprofloxacin

• Question for history of hypersensitivity to Ciprofloxacin or Quinolones.
• May be given without regards to meals. Preferred dosing time 2 hours after meals.
• Do not administer antacids within 2 hours of Ciprofloxacin.
• Encourage cranberry juice or citrus fruits.
• Evaluate food tolerance.
• Determine pattern of bowel activity.
• Check for dizziness, headache, visual difficulties, and tremors.
• Observe therapeutic response.

Patient Teachings for Clients Taking Ciprofloxacin

• Do not skip doses, take full course of therapy.
• Take with 8 oz water, drink several glasses of water between meals.
• Eat or drink high sources of ascorbic acid, like cranberry juice or citrus fruits, to prevent crystalluria.
• Do not take antacids.
• Shake suspension well before using.
• Do not chew microcapsules in suspension.
• Sugarless gum or hard candy may relieve bad taste.
• Opthalmic: A crystal precipitate may form but usually resolves in 1-7 days.

Indication for Nifedipine

Nifedipine is used in the treatment of angina due to coronary artery spasm (Prinzmetal’s variant angina), chronic stable angina (Effort-associated angina). It is also used in the treatment of essential hypertension. Nifedipine can also be used in the treatment of Raynaud’s phenomena.

Routes and Dosage of Nifedipine

Alert: May give 10-20mg sublingual as needed for acute attacks of angina.

Prinzmetal’s Variant Angina, Chronic Stable Angina

PO: ADULTS, ELDERLY: Initially, 10mg three times a day. Increase at 7 to 14 day intervals. MAINTENANCE: 10mg three times a day up to 30mg four times a day.

Extended-release: ADULTS, ELDERLY: Initially, 30-60mg per day. MAINTENANCE: up to 120mg per day.

Hypertension

Extended-release:ADULTS, ELDERLY: Initially, 30-60mg per day. MAINTENANCE: up to 120mg per day.

Action of Nifedipine

Nifedipine inhibits calcium ion movement across cell membrane, depressing contraction of cardiac or vascular smooth muscle. It also increases heart rate and cardiac output. Nifedipine decreases systemic vascular resistance and blood pressure.

Side Effects and Adverse Reactions of Nifedipine

Side Effects of Nifedipine

• Peripheral edema
• Headache
• Flushed skin
• Dizziness
• Nausea
• Shakiness
• Muscle cramps or pain
• Drowsiness
• Palpitations
• Nasal congestion
• Cough
• Dyspnea
• Wheezing
• Hypotension
• Rash
• Pruritus
• Urticaria
• Constipation
• Abdominal discomfort
• Flatulence
• Sexual dysfunction

Adverse Reactions of Nifedipine

• May precipitate Congestive Heart Failure and Myocardial Infarction in patients with cardiac disease and peripheral ischemia.
• Nausea
• Drowsiness
• Confusion
• Slurred speech

Nursing Considerations for Clients Taking Nifedipine

• Do not crush or break film-coated tablets and sustained-release capsules.
• Give without regards to meals
• Grapefruit juice may alter absorption.
• Concurrent therapy of sublingual nitroglycerin may be used for relief of anginal pain.
• Record onset, type, radiation, location, intensity, and duration of anginal pain or precipitating factors.
• Check blood pressure for hypotension immediately prior to giving medication.
• Assist with ambulation if client is lightheaded or dizziness occurs.
• Assess for peripheral edema behind medial malleolus.
• Assess skin for flushing.
• Monitor liver enzyme tests.

Patient Teachings for Clients Taking Nifedipine

• Rise slowly from lying to sitting position, dangle legs from bed before standing to reduce hypotensive effect.
• Contact physician or nurse if irregular heartbeat, shortness of breath, pronounced dizziness, or nausea occurs.
• Avoid alcohol and grapefruit juice use.