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Generic Name: albuterol Brand name: Classification: adrenergics; B2 adranergic SABAWhy is patient/client receiving this? Bronchodilator to control bronchospasm and reversible airway obstruction r/t COPD; agonist of Beta 2 receptors which causes SNS response: relaxation of airways and bronchodilation FIRST LINE RESCUE MEDDosage/Route: PO initially 2 mg tid or qid (can be increased up to 32 mg/day) Inhaln 2 inhalations q4-6 hrs; 4-8 puffs q 20 min for up to 4 hrs and then q1-4 hr PRN Rate of administration with IV meds: IV diluents compatible with IV medication: Major Side effects: less side effects -CNS: nervousness, restlessness, tremor, HA -RESP: paradoxical bronchospasm w/ excessive use -CV: palpations, chest pain, arryhtmias, hypertension -GI: N/V-FandE: hypokalemia Data used to indicate medication is effective: resolution of wheezing, decreased difficulty breathing, increased O2 saturationMedication administration concerns: Use proper MDI technique: -remove cap-shake-tilt head back slightly and breathe out -position inhaler ideally away from mouth but in mouth acceptable -breathe in slowly (3-5 s)-hold breath for 10 s to allow it to permeate lungs -wait 1 minute between sprays; wash mouth between sprays; SHOULD USE SPACER -If used too long in too high of doses can result in lost selectivity -hyperglycemia in patients with DMPatient/client teaching points: Encourage pt to wash mouth after each spray Stress to patient importance of adhering to physician’s orders and why dose can’t be exceeded (risk of paradoxical bronchospasm) Encourage pt to wash mouth after each spray Stress to patient importance of adhering to physician’s orders and why dose can’t be exceeded (risk of paradoxical bronchospasm)Generic Name: salmeterol Brand name: Classification: adrenergics; B2 adranergic LABA Why is patient/client receiving this? Therapy for asthma/prevention of bronchospasm in pts who currently take, but are inadequately controlled on long term asthma control medication; prevention of exercise-induced bronchospasm; maintaince/prevention of bronchospasm in COPD Dosage/Route: -Inhalin: 50 mcg (1 inhalation) bid -Prevention of exercise induced bronchospasm: 50 mcg (1 inhalation) at least 30 min before exercise (add. Doses shouldn’t be used for at least 12 hrs) -COPD: 50 mcg bid Rate of administration with IV meds: IV diluents compatible with IV medication: Major Side effects: less side effects -CNS: HA, nervousness –CV: palpations, tachycardia, -GI: abd pain, diarrhea, nausea –MS: muscle cramps/soreness –RESP: asthma related death, paradoxical bronchospasm Data used to indicate medication is effective: prevention of exercised induced asthma, bronchospasm Medication administration concerns: -should be used with glucocorticoid NOT alone -beta blockers may decrease effectiveness, -use with caffeine increases stimulant effects, -use with MAOI’s and tricyclic antidepressants potentiate cardiovascular effects -assess lung sounds, pulse, BP before admin, monitor pulmonary function tests, observe for paradoxical bronchospasm Patient/client teaching points: -to be used for maintanence, NOT rescue –do not exceeded doses –notify if breathing does not improve after using salmeterol Generic Name: fluticasone Brand name: Flovent Classification: corticosteroid 1ST LINE FOR MAINTANENCE Why is patient/client receiving this? Maintanece/prophylactic treatment of asthma; may decrease requirement for or avoid use of systemic corticosteroids and delay pulmonary damage from chronic asthma Dosage/Route: -Inhalin: for pts w/ previous asthma therapy incl bronchodialators alone: 88 mcg bid, (up to 440 mcg bid)pts w/ other corticosteroids: 88-220 bid (up to 440 mcg bid) pts w/ hx of oral corticosteroids 440 mcg bid (up to 880 mcg bid) Powder: previous asthma therapy w/ bronchodialators only 100 mcg twice daily (up to 500 mcg bid) hx of other inhaled corticosteroids: 100-250 mcg bid (up to 500 mcg bid) previous therapy including oral corticosteroids: 500-1000 mcg bid Major Side effects: less side effects -CNS: HA, nervousness –EENT: dysphonia, hoarsness, oropharyngeal fungal infections, nasal stuffiness, rinorhea, sinusitis -GI: diarrhea–MS: muscle cramps/soreness –RESP: bronchospasm, cough, upper resp. infection, weezing -Endo: adrenal suppression (high dose long term therapy), decrease bone density, growth suppression, cushing’s syndrome –hypersentitivity incl. anaphylaxis, laryngeal edema, urticarial, bronchospasm chrug-strauss syndromeData used to indicate medication is effective: management of symptoms of chronic asthma Medication administration concerns: -assess lung sounds, pulse, BP before admin, monitor pulmonary function tests, observe for paradoxical bronchospasm –assess for signs of adrenal insufficiency during initial therapy AND times of stress –monitor for withdrawl (join pain/ depression) -monitor growth in children –monitor bone density and bone health in at risk pts –monitor for signs of hypersensitivity –use proper MDI technique (spacer for inhalin; 1 min between puffs) Patient/client teaching points: -don’t discontinue, gradual decrease required; -advise pts taking w/ bronchodialator to take bronchodilator, wait 5 min, administer corticosteroid –maitanence NOT rescue –stop if hypersensitivity rxn occurs Generic Name: beclomethasone Brand name: Qvar Classification: corticosteroid 1ST LINE FOR MAINTANENCE Why is patient/client receiving this? Maintanece/prophylactic treatment of asthma; may decrease requirement for or avoid use of systemic corticosteroidsDosage/Route: -Inhalin: for pts w/ previous asthma therapy incl bronchodialators alone: 40-80 mcg bid, (up to 320 mcg bid)pts w/ hx of inhaled corticosteroids 40-160 mcg bid (up to 320 mcg bid) Major Side effects: less side effects -CNS: HA–EENT: cataracts dysphonia, oropharyngeal fungal infections, pharyngitis, rinorhea, sinusitis –MS: back pain –RESP: bronchospasm, cough, weezing -Endo: adrenal suppression (high dose long term therapy), growth suppression, Data used to indicate medication is effective: management of symptoms of chronic asthma Medication administration concerns: -no known drug rxns -assess lung sounds, pulse, BP before admin, monitor pulmonary function tests, –assess for signs of adrenal insufficiency during initial therapy AND times of stress –monitor for withdrawl (join pain/ depression) -monitor growth in children–use proper MDI technique (spacer for inhalin; 1 min between puffs) Patient/client teaching points: -don’t discontinue, gradual decrease required; -advise pts taking w/ bronchodialator to take bronchodilator, wait 5 min, administer corticosteroid –maitanence NOT rescue Generic Name: zafirlukastBrand name: Classification: leukotriene antagonist Why is patient/client receiving this? Long term control agent in management of asthma Dosage/Route: -PO: 20 mg twice daily Major Side effects: less side effects -CNS: suicidal thoughts, HA, agitation, aggression, anxiety, dream abnormality, hallucinations, insomnia, irritability GI: hepatotoxicity, abd pain, dyspepsia, n/v –MS: arthralgia, myalgia –churg-strauss syndrome, fever, infection (geriatrics) Data used to indicate medication is effective: prevention of and reduction in symptoms of asthma Medication administration concerns: -levels increased by aspirin, decreased by erthryomycin and theophylline, increased risk of bleeding with warfarin -food decreases absorbption -assess lungs sounds/resp function –monitor closesly for changes in behabior that indicate depression or suicidal thoughts –monitor liver function Patient/client teaching points: -take on an empty stomach as directed –do not discontinue – not for acute asthma attacks, for management –look for suicidality Generic Name: zafirlukastBrand name: Accolate Classification: leukotriene antagonist Why is patient/client receiving this? Long term control agent in management of asthma Dosage/Route: -PO: 20 mg twice daily Major Side effects: less side effects -CNS: suicidal thoughts, HA, agitation, aggression, anxiety, dream abnormality, hallucinations, insomnia, irritability GI: hepatotoxicity, abd pain, dyspepsia, n/v –MS: arthralgia, myalgia –churg-strauss syndrome, fever, infection (geriatrics) Data used to indicate medication is effective: prevention of and reduction in symptoms of asthma Medication administration concerns: -levels increased by aspirin, decreased by erthryomycin and theophylline, increased risk of bleeding with warfarin -food decreases absorbption -assess lungs sounds/resp function –monitor closesly for changes in behabior that indicate depression or suicidal thoughts –monitor liver function Patient/client teaching points: -take on an empty stomach as directed –do not discontinue – not for acute asthma attacks, for management –look for suicidality Generic Name: cromolynBrand name: Nasal Crom Classification: mast cell stabalizer Why is patient/client receiving this? Inhalan: prophylaxis of bronchial asthma, prevention of exercise induced bronchospasm; intranasal: prevention and treatment of seasonal and perennial allergic rhinitis PO: mastocytosis ; prevents degranulation and release of histamine Dosage/Route: -Inhalin: nebulized one ampule (20 mg) qid; for prevention of bronchospasm use one nebulized ampule 10-15 min before exposure to known precipitating situation -Intranasal: 1 spray (5.2 mg/spray) into each nostril 3-4 times daily (up to six times daily) -PO: 200 mg 4 times a day Major Side effects: less side effects -CNS: dizziness, HA –DERM: rash, urticarial, angioedema –EENT: intranasal: nasal irritation, nasal congestion, sneezing; -RESP: inhalation: irritation of resp tract, cough wheezing, bronchospasm GI: nausea, unpleasant taste –Allergic rxns including anaphylaxis or worsening of condition Data used to indicate medication is effective: 2-4 wk after therapy: reduction in symptoms of asthma, prevention of exercise induced bronchospasm, decrease in symptoms of allergic rhinitis Medication administration concerns: -PO broken into glass of water –Inhalin: monitor lung sounds and pulmonary function –Intranasal: assess for symptoms of rhinitis -clear nasal passages before use –nasal use 1 wk before contact with allergen Patient/client teaching points: -minimal systemic effects, considered very safe but need to monitor for signs of hypersensitivity rxn – if prescribed for exercise or allergies, take 15 min before exposure NO SOONER than 60 min for effectiveness –notify if symptoms do not improve or get worseGeneric Name: theophyllineBrand name: Classification: xanthines Why is patient/client receiving this? Long term control of reversible airway obstruction caused by asthma or COPD; increases cAMP which results in bronchodilation, cns stimulation, positive inotropic and chronotropic effects, diuresis, gastric acid secretion Dosage/Route: Serum doses should be determined, loading dose decreased if theophylline prep used in preceeding 24 hrs -PO: healthy adults, non smokers: loading dose-5 mg/kg followed by 10 mg/kg/day divided q8-12 hrs (not to exceed 900 mg/day) Adults with HF, Cor Pulmonale, or liver dysfunction: ld 5 mg/kg followed by 5 mg/kg/day divided q8-12 hrs (not to exceed 400 mg/day) Adolescent and adult smokers under 50: ld 5 mg/kg, followed by 16 mg/kg divided q8-12 hrs IV: -ld 4.7 mg/kg given over 20-30 min followed by .56 mg/kg/hr for non smokers via continuous infusion(use infusion pump); smokers: .72 mg/kg/hr-Geriatric patients: ld 4.7 mg/kg given over 20-30 min followed by .47 mg/kg/hr via continuous infusion - Adults w/ HF or Liver failure: ld 4.7 mg/kg given over 20-30 min, followed by .39 mg/kg/hr via continuous infusion Major Side effects: less side effects -CNS: seizures, anxiety, HA, insomnia, irritability; -CV: arrhythmias, tachycardia, angina, palpitations –GI: n/v, anorexia –neuro: tremor Data used to indicate medication is effective: clearing of lung fields on auscultation Medication administration concerns: -additive CV and CNS -side effects with adrenergics, may decrease therapeutic effect of lithium and phenytoin, erythromycin, beta blockers, calcium channel blockers, hormonal contraceptives, INH, protease inhibitors may decrease metabolism and lead to toxicity –assess BP, pulse, resp. status, before and throughout therapy –monitor Is and Os –cardiac history should be monitored for chest pain and ECG changes –pulmonary function tests –administer PO with food or water to minimize GI irritation, do not crush Patient/client teaching points: -drink adequate liquid (2000 mL/day) to decrease viscocity of airway secretions –encourage not to smoke –don’t change brands –emphasize importance of follow up testing Generic Name: ipratropium Brand name: atrovent Classification: anticholinergic Why is patient/client receiving this? Inhalan: Maintenance therapy of reversible airway obstruction due to COPD incl. chronic bronchitis and emphysema, intranasal: rinnorhea assoc with allergic and nonallergic perennial rhinitis; unlabeled use for treatment of bronchospasm casued by asthma; blocks muscarinic (subtype of cholinergic) receptors which results in decrease of cGMP and bronchodialation Dosage/Route: -Inhalin; (MDI, non acute): 2 inhalation 4 times daily; acute exacerbations: 4-8 puffs using spacer as needed via nebulizer (non acute): 500 mcg 3-4 times daily; (acute): 500 mcg q 30 min for 3 doses and then q2-4 hr prn -Intranasal: .03% solution 2 sprays in each nostril 2-3 times daily (21 mcg/spray) -Inhalin: .06% solution 2 sprays in each nostril 3-4 times daily (42 mcg/spray) Major Side effects: less side effects -CNS: dizziness, HA, nervousness; EENT: blurred vision, sore throat, epistaxis, nasal dryness (last 2 nasal only) –RESP: bronchospasm, cough –CV: hypotension, palpiations –GI: irritation, nausea DERM: rash –allergic reactions Data used to indicate medication is effective: decreased dyspnea, improved breath sounds, decrease in rhinorrhea from perennial rinorrhitis or common cold Medication administration concerns: -additive anticholinergic effects with other anticholonergic drugs , assessment of atropine and belladonna alkaloid allergies, Inhalin: assess resp status (rate breath sounds, degree of dyspnea, pulse) before administration of medication, Patient/client teaching points: -instruct pt to rinse mouth after using inhaler, good oral hygiene and sugarless gum or candy can minimize dry mouth, -explain importance of pulmonary function tests –caution pt not to spray in eyes –do not inhale in nose during administration (so it stays in nasal passages) Generic Name: diphenhydramine Brand name: Benadryl Classification: 1st generation antihistamine (Best antihistamine) Why is patient/client receiving this? Relief of allergic symptoms caused by histamine release including: anaphylaxis, seasonal/perennial allergic rhinitis, allergic dermatoses; parkinson’s disease and dystonic reactions for medications; mild nighttime sedation, prevention of motion sickness, antitussive (syrup); Antagonizes effects of histamine at H1 receptor sites, anticholinergic properties Dosage/Route PO: antihistaminic: 25-50 mg q 4-6 hr not to exceed 300 mg/day, anti-tussive: 25 mg q 4 hr as needed, not to exceed 150 mg/day anti-dyskinetic: 25-50 mg q 4 hr (not to exceed 400 mg/day) sedative hypnotic: 50 mg 20-30 min before sleepIM/IV: 1.25 mg/kg (37/5mg/m2) 4 times daily (not to exceed 300 mg/day); IV can be diluted in NS, 1/2NS, D5W, D10W, dextrose saline, LR and Dextrose/ringers, Concentration 25 mg/mL, infuse at rate no greater than 25mg/ min Topical: apply to affected area 3-4 times dailyMajor Side effects: less side effects -CNS: drowsiness, dizziness, HA, paradoxical excitation –EENT: blurred vision, tinnitus –CV: hypotension, palpitations, GI: anorexia, drymouth GU: dysuria, frequency, urinary retention DERM: photosensitivity RESP: chest tightness, thickened bronchial secretions, wheezing –pain at IM site Data used to indicate medication is effective: -allergies: assess for urticarial and patency -rhinitis: assess degree of stuffiness, rhinorrhea and sneezing, -motion sickness: assess n/v, bowel sounds, abd pain, -cough suppressant: assess frequency and nature of cough, unless contraindicated intake fluid to decrease viscocity Medication administration concerns: -additive anticholinergic effects with other anticholonergic drugs,-MAOI intensify and prolong cholinergic effects –risk of CNS depression with other antihistamines, alcohol, opioid analgesics, sedatives/hypnotics Patient/client teaching points: -instruct pt of fall risk and interventions –caution use of alcohol or other CNS depressants use of protective clothing or sunscreen if photosensitivity occursGeneric Name: loratadine Brand name: Claritin Classification: 2nd generation antihistamine (non sedative) Why is patient/client receiving this? Relief of seasonal allergies and hives; Antagonizes effects of histamine at H1 receptor sites, anticholinergic properties Dosage/Route PO: 10 mg once daily Renal impairment: Ccr <30 mL/miin-10 mg every other day Major Side effects: less side effects -CNS: confusion, drowsiness (rare), paradoxical excitation –EENT: blurred vision –GI: dry mouth, GI upset –DERM: photosensitivity, rash –Metab: weight gain Data used to indicate medication is effective: -assess allergy symptoms, assess lung sounds before and after and character of bronchial secretions, maintain fluid intake of 1500-2000 mL/day to decrease viscocity Medication administration concerns: while these interactions may occur, less likely with this antihistamine -additive anticholinergic effects with other anticholonergic drugs,-MAOI intensify and prolong cholinergic effects –risk of CNS depression with other antihistamines, alcohol, opioid analgesics, sedatives/hypnotics Patient/client teaching points: -instruct pt of fall risk and interventions –caution use of alcohol or other CNS depressants –good oral health to minimize dry mouth –use of protective clothing or sunscreen if photosensitivity occursGeneric Name: pseudoephedrineBrand name: Sudafed Classification: sympathomimetic (Schedule III) Why is patient/client receiving this? Relief of cough and/or nasal congestion assoc with common cold or upper respiratory allergies; decongestant action on nasal mucosa Dosage/Route PO: 5mL (one teaspoonful) ever four to six hours as needed, not to exceed four doses (20mL)/24 hr Major Side effects: less side effects -CNS: Seizures, anxiety, nervousness, dizziness, drowsiness, excitability, fear, hallucinations, headache, insomnia, restlessness, weakness –RESP: respiratory difficulty CV: cardiovascular collapse, palpiations, hypertension, tachycardia –GI: anorexia, drymouth GU: dysuria –diaphoresis Data used to indicate medication is effective: -assess cough and nasal congestion periodically during therapy, relief of cough and nasal congestion Medication administration concerns: -concurrent use with MAOIS may cause hypertensive crisis; addative effects with other adrenergics, concurrent use with beta blockers may result in hypertension or bradycardia; drugs that acidify urine may decrease effectiveness (alakaline can intensify) -USE CAUTIOUSLY WITH HX OF HTN, USE CAN RESULT IN REBOUND CONGESTION AFTER 2-3 DAYS Patient/client teaching points: -take as directed, using accurate measuring device and NOT household teaspoon –may cause drowsiness or dizziness –fall risk interventions Generic Name: acetylcysteine Brand name: Mucomyst Classification: mucolytic agent Why is patient/client receiving this? PO antidote for management of potentially hepatotoxic overdose of acetaminophen, inhalin: mucolytic in management of conditions associated with thick viscid mucuous secretions (chronic bronchitis, emphysema, cystic fibrosis); degrades mucus by altering molecular compostion Dosage/Route (for mucolytic action)Nhalin: nebulization via face mask 3-5 ml of 20% solution or 6-10 mL of 10% solution 3-4 times dailyvia tent or croupette: volume of 10-20% solution required to maintain heavy mistdirect installation: 1-2 mL of 10-20% q1-4 hrstracheotomy: -2 mL of 10-20% solution q 1-4 hr (up to 2-5 mL of 20% solution via tracheal catheter into particular segments) Major Side effects: less side effects -CNS: drowsiness –CV: vasodilation, tachycardia, hypotension –EENT:rhinorrhea –RESP: bronchospasm, bronchial tracheal iriation, chest tightness, increased secretions, GI: n/v, stomatitis DERM: rash, clamminess, pruritus, urtacria –Allergica reactions (angioedema and anaphylaxis with IV) Data used to indicate medication is effective: -assess resp function (lung sounds, dyspnea); color, amount, and consistency of secretions before and immediately following treatment to determine effectiveness Medication administration concerns: -effect within 1 min, peaks 5-10 min; unpleasant odor-use with NG tube if there – if orally put in juice or on ice (tell to drink fast), have something on hand to rinse mouth ot kill taste -rotten egg smell can induce emesis Patient/client teaching points: -encourage fluid –clear airway by forcefully coughing before taking aerosol treatment Generic Name: guaifenesinBrand name:OTC medications, Mucinex Classification: expectorant Why is patient/client receiving this? Coughs associated with viral upper respiratory tract infections; increases resp tract fluid to reduce viscocity of secretions changes nonproductive cough into productive Dosage/Route PO: 200-400 mg q 4hr or 600-1200 mg q 12 hr as extended release product (not to exceed 2400 mg/day) Major Side effects: less side effects -CNS: dizziness, HA –GI: n/v, diharrhea, stomach pain –DERM: rash, hives Data used to indicate medication is effective: -assess lung sounds, frequency and type of cough and character of secretions periodically before during and after use – results in productive coughMedication administration concerns: -follow dose with full glass of water to decrease viscocity of fluids –DO NOT CRUSH xr tablets Patient/client teaching points: - cough effectively –may cause dizziness, fall risk interventions –limit talking, stop smoking, maintain moisture in environmental air, take some sugarless gum or hard candy to relieve discomfort caused by chronic nonproductive cough Generic Name: dextromethorphan Brand name: Classification: antitussive Why is patient/client receiving this? Symptomatic relief of cough caused by minor viral upper respiratory tract infections or inhaled irritants, effective for non productive cough, common ingredient in non prescription cough and cold preparations; acts at the cough center in the medulla, structurally similar to opioids but have no analgesic effects Dosage/Route (PO: 10-20 mg q 4 hr or 30 mg q 6-8 hr or 60 mg of extended release prescription bid (not to exceed 120 mg/day) Major Side effects: less side effects -CNS: dizziness, sedation (high dose) –GI :nausea Data used to indicate medication is effective: -assess lung sounds, frequency and type of cough and character of secretions periodically before during and after use – decrease in cough frequency and intensity Medication administration concerns: -use with MAOI’s results in serotonin syndrome (nausea, confusion, changes in BP) –increased CNS depression with antihystamines, antidespressants, sedative/hypnotics, alcohol –well absorbed over 15-30 min –drug of increasing abuse –effectiveness questionable in adults NONEXISTANT in children Patient/client teaching points: - cough effectively (sit up, take several deep breaths) –minimize cough by avoiding irritants (cigarette smoke, fumes, dust) –humidification of air, sips of water, sugarless hard candy may decrease frequency of dry irritating cough –avoid taking more than recommended dose or taking with CNS depressants –may cause dizziness Generic Name: benzonatate Brand name: tessalon Classification: antitussive Why is patient/client receiving this? Relief of nonproductive cough due to minor throat or bronchial irritation from inhaled irritants or colds; anesthetizes cough or stretch receptors in vagal nerve afferent fibers found in lungs, pleura, and respiratory passages Dosage/Route PO: 100 mg tid (up to 600 mg/day) Major Side effects: less side effects -CNS: HA, mild dizziness, sedation –EENT: burning sensation in eyes, nasal congestion –GI: constipation, GI upset, nausea -DERM: pruritis, skin erruptions –MISC: chest numbness, chilly sensation, hypersensitivity reactions Data used to indicate medication is effective: -assess lung sounds, frequency and type of cough and character of secretions periodically before during and after use – decrease in cough frequency and intensity Medication administration concerns: -use with MAOI’s results in serotonin syndrome (nausea, confusion, changes in BP) –increased CNS depression with antihystamines, antidespressants, sedative/hypnotics, alcohol –well absorbed over 15-30 min –drug of increasing abuse –effectiveness questionable in adults NONEXISTANT in children Patient/client teaching points: -do not chew capsules –keep out of reach of children cough effectively (sit up, take several deep breaths) –minimize cough by avoiding irritants (cigarette smoke, fumes, dust) –humidification of air, sips of water, sugarless hard candy may decrease frequency of dry irritating cough –avoid taking more than recommended dose or taking with CNS depressants Generic Name: isoniazid (INH)Brand name: Classification: antitubercularsWhy is patient/client receiving this? First line therapy of active TB in combo with other agents, prevention of TB in exposure to active disease ; inhibits mycobacterial cell wall synthesis and metabolism Dosage/Route (for TB)PO, IM: 300 mg/day (5mg/kg) or 15 mg/kg (up to 900 mg) 2-3 times weekly Major Side effects: less side effects -CNS: psychosis, seizures, -EENT: visual disturbances –GI: DRUG INDUCED HEPATITIS, n/v –DERM: rashes, Endo: gynecomastia –Hemat: blood dyscrasis –Neuro: peripheral neuropathy -feverData used to indicate medication is effective: -mycobacterial studies and sensitivities, monitor hepatic lab values; resolution of symptoms or prevention of advancement Medication administration concerns: -additive CNS toxicity with other antituberculars –increased risk of hepatotoxicity with other hepatotoxic agents –severe reactions occur with foods with high concentration of tyramine Patient/client teaching points: -notify us for signs of hepatitis or peripheral neuropathy –avoid swiss and cheschire cheese, tuna, sardines, and other tyramine containing foods –importance of follow up exams Generic Name: rifampin Brand name: Classification: antituberculars, rifamycins Why is patient/client receiving this? Active tuberculosis w/ other agents, elimination of meningococcal carriers, inhibits RNA synthesis Dosage/Route (for TB)PO, IV: 600 mg/day or 10 mg/kg/day (up to 600 mg/day) single dose, may also be given twice weekly IV: intermittent: reconstitute 600 mg vial with 10mL sterile water for injection for concentration of 60mg/mL Dilute further in 100 or 500 mL of D5W or NS not to exceed 6mg/mL Administer 100 mL diluted over 30 min and diluted in 500 over 3 hrs Major Side effects: less side effects -CNS: ataxia, confusion, drowsiness, fatigue, HA, weakness –DERM: rash, puritis –EENT: red discoloration of tears –GI: abd pain, diharrhea, flatulence, heartburn, n/v, increase liver enzymes discoloration of saliva –GU: red discoloration of urine –HEMAT: hemolytic anemia, thrombocytopenia –MS: muscle weakenss, myalgia –flu like symptoms Data used to indicate medication is effective: - mycobacterial studies and sensitivities, monitor hepatic lab values; resolution of symptoms or prevention of advancement assess lung sounds, frequency and type of cough and character of secretions periodically before during and after useMedication administration concerns: -risk of hepatotoxicity with other hepatotoxic agents –change in liver enzymes may increase or decrease metabolism of other drugs incl opioid agonists, oral hypoglycemic agents, warfarin, estrogens, phenytoin, phenobarbital, hormonal contraceptives -administer on empty stomach 1hr before or 2 hr after meals w/ full glass of waterPatient/client teaching points: -notify us for signs of hepatitis or flu like symptoms, -may cause drowsiness –inform change in color of saliva, sputum, sweat, and tears is normal (soft conact lenses may be permanently discolored) –importance of follow up exams Generic Name: pyrazinamide Brand name: Classification: antituberculars Why is patient/client receiving this? Used with other agents for treatment of active tuberculosis; lowers pH of environment around mycobacteria Dosage/Route PO: 15-30 mg/kg/day as single dose. Up to 60 mg/kg/day has been used in isoniazid resistant TB, may also be given 50-70 mg/kg 2-3 times weekly Pts with HIV: 20-40 mg/kg/day for first two months of therapy (max 2g/day)Major Side effects: less side effects -GI: hepatotoxicity, anorexia, diharrhea, n/v –GU: dysuria –DERM: acne, itching, photosensitiy, skin rash –HEMAT: anemia, thrombocytopenia –METAB: hyperuricemia –MS: gouty arthritis Data used to indicate medication is effective: -evaluate hepatic function every 2-4 weeks –mycobacterial studies and sensitivity Medication administration concerns: -use with rifampin may result in LIFE THREATENING hepatotoxicity -decrease effectiveness of antigout medications -Oto and Nephrotoxicity Patient/client teaching points: -take missed doses as soon as possible without doubling dose –important to continue dose –may interfere with ketone measurements in diabetic pts –sunscreen/protective clothing if photosensitive Generic Name: ethambutol Brand name: tessalon Classification: antitussive Why is patient/client receiving this? Active TB or other mycobacterial with at least one other drug; effective only against active dividing mycobacteria by inhibiting growth Dosage/Route PO: 15-25 mg/kg/day (maximum 2.5/day) or 50 mg/kg (up to 2.5 g) twice weekly or 25-30 mg/kg (up to 2.5 g) 3 times weekly Major Side effects: less side effects -CNS: confusion, dizziness, hallucinations, headache, malaise –EENT: optic neuritis –GI: HEPATITIS –abd pain, anorexia, n/v –METAB: hyperuricemia –MS: joint pain, -NEURO: peripheral neuritis –RESP: pulmonary infiltrates –anyphalactoid rxns, fever Data used to indicate medication is effective: - mycobacterial studies and sensitivities –lung sounds and character/amount of sputum –assess visual function, monitor renal and hepatic functions, uric acid –administer PO with food or milk to minimize GI irritation Medication administration concerns: -neurotoxicity increased with other neurotoxic agents Patient/client teaching points: -report changes in vision immediately –importance of routine exams ................
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