Unit 7 Drug Flash Cards

Front 1

Aspirin (ZORprin)

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Aspirin (ZORprin)
CLASSIFICATION: T: antipyretics, nonopioid analgesics. P: Salicylates.
ACTIONS: Analgesic, ↓ inflammation and fever by inhibiting production of prostaglandins. ↓ platelet aggregation.
USES: Analgesia, ↓ inflammation, ↓ fever, ↓ chances of TIA or MI.
ROUTE/DOSES: PO, Rect: for pain/fever (325-500 Q3hr, 325-650 Q4hr, <4g/day). For inflammation (2.4g/day initially, then 3.6-5.4g/day maintenance divided doses). Prevention of TIAs (1-1.3g/day). Prevention of MI’s (300-325mg/day, or 80mg/day).
SIDE EFFECTS: GI BLEEDING, EXFOLIATIVE DERMITITIS, STEVEN-JOHNSON SYDROME, TOXIC EPIDERMAL NECROLYSIS, dyspepsia, heartburn, nausea.
DRUG/DRUG: May ↑ risk of bleeding w/: warfarin, heparin and heparin-like drugs, thrombolytic agents, ticlopidine, clopidogrel, tirofiban, cefoperazone, cefotetan. May blunt effects to diuretics, antiHTN drugs, some NAIDS (↑ risk of GI irritation. ↑ risk of ototoxicity w/ vancomycin. All salicylates ↑ activity of PCN’s, phenytoin, methotrexate, valproic acid, oral hypoglycemics, sulfa’s.
DRUG/FOOD: may ↑ serum salicylates levels: Foods that can acidify urine(append M)- cheese, cranberries, corn, eggs, fish, grains, lentils, meats, plums, poultry…
DRUG/NATURAL PRODUCTS: ↑ anticoag effect and bleeding w/: arnica, chamomile, clove, feverfew, garlic, ginger, gingko, ginseng.
NURSING IMPLICATIONS: ↑ risk for hypersensitivity to ASA: allergies, asthma, nasal polyps or allergy to tartrazine.

Front 2

Naproxen (Aleve)

Back 2

Naproxen (Aleve)
CLASSIFICATION: T: nonopioid analgesics, NSAIDs, antipyretics.
ACTIONS: inhibits prostaglandin synthesis.
USES: ↓ pain, ↓ fever, ↓ inflammation.
ROUTE/DOSES: PO: 250-500mg, up to 1.5g/day.
SIDE EFFECTS: DRUG INDUCED HEPATITIS, GI BLEEDING, ANAPHYLAXIS, STEVEN-JOHNSON SYNDROME, dizziness, drowsiness, headache, constipation, dyspepsia, nausea.
DRUG/DRUG: ↑ risk of bleeding: anticoagulants, thrombolytics, eptifibatide, tirofiban, cefotetan, , cefoperazone, valproic acid, clopidogrel, ticlopidine. GI side effects: aspirin, corticosteroids, other NSAIDs. May ↓ response to ACE inhibitors, angiotensin II antagonists, furosemide. ↑ risk of hypoglycemia w/ insulin or oral hypoglycemic agents.
DRUG/NATURAL: ↑ anticoagulant effect, and bleeding risk w/ anise, arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, gingko, ginseng, licorice…
NURSING IMPLICATIONS: ↑ risk for hypersensitivity: allergies to ASA, asthma, nasal polyps. Assess for rhinitis, asthma, urticaria. Passes into breast milk, not for nursing mothers, and avoid during third trimester.

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Ibuprofen (Motrin)

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Ibuprofen (Motrin)
CLASSIFICATION: T: antipyretic, antirheumatic, nonopioid analgesic, NSAIDs. P: nonopioid analgesics.
ACTIONS: Inhibits prostaglandin synthesis.
USES: ↓ pain, inflammation and fever.
ROUTE/DOSES: PO: anti inflammatory (400-800mg Q6-8hrs; <3600mg/day), analgesic/anti-inflammatory/antidysmenorrheal (200-400mg Q4-6hrs, <1200/day).
SIDE EFFECTS: GI BLEEDING, HEPATITIS, EXFOLIATIVE DERMITIS, STEVEN-JOHNSON SYNDROME, TENs, ANAPHYLAXIS, headache, constipation, dyspepsia, N/V.
DRUG/DRUG: ↑ risk of bleeding: anticoagulants, thrombolytics, eptifibatide, tirofiban, cefotetan, , cefoperazone, valproic acid, clopidogrel, ticlopidine. GI side effects: aspirin, corticosteroids, other NSAIDs, and alcohol. May ↓ effectivness of diuretics and antiHTN drugs. ↑ level of digoxin, lithium, methotrexate. ↑ risk of hypoglycemia w/ insulin or oral hypoglycemic agents.
DRUG/NATURAL PRODUCTS: ↑ anticoagulant effect, and bleeding risk w/ anise, arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, gingko, ginseng, licorice…
NURSING IMPLICATIONS: ↑ risk for hypersensitivity: allergies to ASA, asthma, nasal polyps. Assess for rhinitis, asthma, urticaria.

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Ketorolac (Toradol)

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Ketorolac (Toradol)
CLASSIFICATION:T: NSAIDs, nonopioid analgesic. P: pyrroziline carboxylic acid.
ACTIONS: Inhibits prostaglandin synthesis, antipyretic, anti-inflammatory.
USES: ↓ pain, antipyretic, anti-inflammatory.
ROUTE/DOSES: PO: (20mg initially, then 10mg Q4-6hr, <40mg/day). IM, (single 60mg, 30mg Q6hr, <120mg/day). IV (same as IM except single dose is 30mg).
SIDE EFFECTS: BLEEDING, HEPATITIS, EXFOLIATIVE DERMITIS, STEVEN-JOHNSON SYNDROME, TENs, ANAPHYLAXIS, drowsiness.
DRUG/DRUG: ↑ GI w/ ASA, NSAIDs, K+ , corticosteroids, alcohol. ↑ renal issues w/ chronic acetaminophen use. May ↓ effectivness of diuretics and antiHTN drugs. ↑ lithium levels. ↑ risk of bleeding: anticoagulants, thrombolytics, eptifibatide, tirofiban, cefotetan, , cefoperazone, valproic acid, clopidogrel, ticlopidine.
DRUG/NATURAL PRODUCTS: ↑ anticoagulant effect, and bleeding risk w/ anise, arnica, chamomile, clove, dong quai, feverfew, garlic, ginger, gingko, ginseng, licorice…
NURSING IMPLICATIONS: ↑ risk for hypersensitivity: allergies to ASA, asthma, nasal polyps. Assess for rhinitis, asthma, urticaria.

Front 5

Hydrocortisone (Cortef, Solu-Cortef

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Hydrocortisone (Cortef, Solu-Cortef), Davis 323
Classification: T: antiasthmatics, corticosteroids; P: corticosteroids (systemic) (short-acting)
Actions/Uses: management of adrenocortical insufficiency, suppress inflammation and normal immune response. Intense metabolic effects. Suppress adrenal function at chronic doses. Has potent sodium-retaining activity.
Routes/Doses: PO adults: 20-240 mg/day in 1-4 divided doses. *Also IM, IV routes/doses for adults*.
Side Effects: depression, euphoria, HTN, anorexia, N/V, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, decreased wound healing, muscle-wasting, osteoporosis, cushingoid appearance
Contraindications: Active untreated infections. Lactation. Alcohol, bisulfate or tartrazine hypersensitivity or intolerance. Administration of live virus vaccines. Increased risk of hypokalemia with piperacillin or ticarcillin. Hypokalemia may increase risk of digoxin toxicity. May increase req for insult. Increased risk of adverse GI effects with NSAIDs.
Nursing Implications: Assess pt for signs of adrenal insufficiency. Monitor I&O and wt daily. Monitor serum electrolytes and glucose. May cause hyperglycemia, hypokalemia. May decrease WBCs, serum K+ and Ca2+. Guiac-test stools. May increase serum Na+, cholesterol, and lipid values. Periodic adrenal function tests. Capsules should be swallowed whole. Do NOT crush, break or chew. IM, subcut: shake suspension well. Avoid grapefruit juice during therapy. With QDaily doses, administer in morning to coince with body’s normal secretion of cortisol.

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Methylprednisolone
(Solu-Medro)

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Methylprednisolone (Solu-Medrol), Davis 323
Classification: T: antiasthmatics, corticosteroids; P: corticosteroids (systemic) (intermediate-acting)
Actions/Uses: suppress inflammation and normal immune response. Intense metabolic effects. Suppress adrenal function at chronic doses.
Routes/Doses: PO adults – (for MS) 160 mg/day for 7 days then 64mg EOD for 1mo. Other uses – 4-48mg/day as single dose or divided doses. Asthma exacerbations – 120-189mg/day in divided doses 3-4 times/day for 48hr then 60-80mg/day divided twice daily. *There are also rectal, IM, and IV routes.*
Side Effects: depression, euphoria, HTN, anorexia, N/V, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, decreased wound healing, muscle-wasting, osteoporosis, cushingoid appearance
Contraindications: Active untreated infections. Lactation. Alcohol, bisulfate or tartrazine hypersensitivity or inteolerance. Administration of live virus vaccines. Increased risk of hypokalemia with piperacillin or ticarcillin. Hypokalemia may increase risk of digoxin toxicity. May increase req for insult. Increased risk of adverse GI effects with NSAIDs. Grapefruit juice increases serum levels.
Nursing Implications: Assess pt for signs of adrenal insufficiency. Monitor I&O and wt daily. Monitor serum electrolytes and glucose. May cause hyperglycemia, hypokalemia. May decrease WBCs, serum K+ and Ca2+. Guiac-test stools. May increase serum Na+, cholesterol, and lipid values. Periodic adrenal function tests. Capsules should be swallowed whole. Do NOT crush, break or chew. IM, subcut: shake suspension well. Avoid grapefruit juice during therapy. With QDaily doses, administer in morning to coince with body’s normal secretion of cortisol.

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Prednisone (Deltasone)

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Prednisone (Deltasone), Davis 323
Classification: T: antiasthmatics, corticosteroids; P: corticosteroids (systemic) (intermediate-acting)
Actions/Uses: suppress inflammation and normal immune response. Intense metabolic effects. Suppress adrenal function at chronic doses.
Routes/Doses: PO adults – most uses – 5-60mg/day single or divided doses. MS – 200 mg/day for 7 days then 80mg EOD for 1mo. Asthma exacerbations – 120-180mg/day in divided doses 3-4 times/day for 48hrs then 60-80 mg/day in divided twice daily. *there are also IM, IV routes/doses*
Side Effects: depression, euphoria, HTN, anorexia, N/V, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, decreased wound healing, muscle-wasting, osteoporosis, cushingoid appearance
Contraindications: Active untreated infections. Lactation. Alcohol, bisulfate or tartrazine hypersensitivity or inteolerance. Administration of live virus vaccines. Increased risk of hypokalemia with piperacillin or ticarcillin. Hypokalemia may increase risk of digoxin toxicity. May increase req for insult. Increased risk of adverse GI effects with NSAIDs.
Nursing Implications: Assess pt for signs of adrenal insufficiency. Monitor I&O and wt daily. Monitor serum electrolytes and glucose. May cause hyperglycemia, hypokalemia. May decrease WBCs, serum K+ and Ca2+. Guiac-test stools. May increase serum Na+, cholesterol, and lipid values. Periodic adrenal function tests. Capsules should be swallowed whole. Do NOT crush, break or chew. IM, subcut: shake suspension well. Avoid grapefruit juice during therapy. With QDaily doses, administer in morning to coince with body’s normal secretion of cortisol.

Front 8

Triamcinolone
(Kenalog, Triamolone)

Back 8

Triamcinolone (Kenalog, Triamolone), Davis 323
Classification: T: antiasthmatics, corticosteroids; P: corticosteroids (systemic) (intermediate-acting)
Actions/Uses: suppress inflammation and normal immune response. Intense metabolic effects. Suppress adrenal function at chronic doses.
Routes/Doses: PO adults – adrenocortical insufficiency – 4-12mg/day as single or divided doses. Other uses – 4-48mg/day (up to 60mg/day) as single/divided doses. *Also IM routes/doses*
Side Effects: depression, euphoria, HTN, anorexia, N/V, ecchymoses, fragility, hirsutism, petechiae, adrenal suppression, decreased wound healing, muscle-wasting, osteoporosis, cushingoid appearance
Contraindications: Active untreated infections. Lactation. Alcohol, bisulfate or tartrazine hypersensitivity or inteolerance. Administration of live virus vaccines. Increased risk of hypokalemia with piperacillin or ticarcillin. Hypokalemia may increase risk of digoxin toxicity. May increase req for insult. Increased risk of adverse GI effects with NSAIDs.
Nursing Implications: Assess pt for signs of adrenal insufficiency. Monitor I&O and wt daily. Monitor serum electrolytes and glucose. May cause hyperglycemia, hypokalemia. May decrease WBCs, serum K+ and Ca2+. Guiac-test stools. May increase serum Na+, cholesterol, and lipid values. Periodic adrenal function tests. Capsules should be swallowed whole. Do NOT crush, break or chew. IM, subcut: shake suspension well. Avoid grapefruit juice during therapy. With QDaily doses, administer in morning to coince with body’s normal secretion of cortisol.

Front 9

Alcohol
(Ethanol)

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Alcohol(ethanol), Lehne/405, 1117
Classification:
Actions/Uses: Skin disinfectant (topical), aid to digestion in bedridden pts, preserve cognitive function in older people (oral), provide calories and fluid replacement, treat poisoning by methanol and ethylene glycol (IV), nerve block (local injection)
Routes/Doses:
• Topical – Most effective at 70% concentration. Skin must be kept moist w/ ethanol for 2 min for killing 90% of surface bacteria. Solution or foam.
• IV – 5~10% alcohol in 5% dextrose
Side Effects: sleep disturbance, heart failure, liver damage, kidney failure, pancreatitis, cancer, physical dependence…
Contraindications: (Include Drug/Drug and Drug/Food Interactions): CNS depressants (intensify), NSAIDs (injure GI mucousa), acetaminophen (liver injury), disulfiram, antihypertensives (counteract)
Nursing Implications: Should not be consumed by pts with peptic ulcer disease, liver disease, pregnant women. Used with caution by pts w/epilepsy. CNS is depressed w/alcohol. Rebound excitation (seizure) can result. Increase the risk of breast cancer and colorectal cancer.

Front 10

Povidone-iodine
(Betadine)

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Povidone-iodine (Betadine), Lehne/ 1117
Classification: disinfectants (?)
Actions/Uses: prophylaxis (observance of rules necessary to prevent disease, oral – removal of bacterial plaque) of post-op infection, hand washing, surgical scrubbing, skin preparation for procedures
Routes/Doses: Ointments, solutions, aerosols, gels, swabs, sponges, wipes
Side Effects: Burning sensation of mouth/throat, irritation, swelling of eyelid…
Contraindications: Some individuals are allergic to iodine.

Front 11

Iodine

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Iodine , Davis/ 663
Classification:T: antithyroid agents, P: iodine containing agents
Actions/Uses: Inhibits the release and synthesis of thyroid hormones.  vascularity of the thyroid gland, thyroidal uptake of radioactive iodine and thyroid cancer following radiation emergencies. bleeding during thyroid surgery.
Routes/Doses:
SSKI (Saturated solution of potassium iodide): 1gK+/ml
For hyperthyroidism, PO: strong iodine solution 1ml in water x3/day, K+ iodide saturated solution 5drops (250mg) x3/day
Supplement, IV: 1-2mcg elemental iodide/kg/day
Side Effects: diarrhea, GI irritation, hypothyroidism, hypersensitivity.
Contraindications: Hypersensitivity, lithium (hypothyroidism
Nursing Implications: Do not confuse with Lodine (etodolac)

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Chlorhexidine
(Hibiclens)

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Chlorhexidine (Hibiclens), Lehne / 1118
Classification:antiseptic
Actions/Uses: surgical antiseptic (pre-op skin preparation, surgical scrub, hand washing, wound cleanser), lethal to most gram + and – bacteria.
Routes/Doses: IV – chlorhexidine gluconate (0.5%, 2%, 4%) with isopropanol (4% or 70%)
Side Effects: Adverse effects are rare. 2 inadvertent report.
Contraindications: not available
Nursing Implications: not available

Front 13

Hydrogen peroxide

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Hydrogen peroxide, Lehne / 1118
Classification: disinfectant
Actions/Uses: germicidal until contact with tissue, application of hydrogen peroxide to wounds derives from liberation of O2 = loosen debris and facilitate cleansing. Used for disinfection and sterilization of instruments.
Routes/Doses: 3%~6% solution
Side Effects: not available
Contraindications: not avilable
Nursing Implications: not available

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Ampicillin
(Omnipen)

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Ampicillin (Omnipen) Davis’s p.140, Lehne p.968
Classification:Th.: anti-infectives; Ph.: aminopenicillins
Actions/Uses: Binds to bacterial cell wall, causing cell death. Used to treat infections of skin & skin structure, of soft tissue; otitis media; sinusitis; respiratory infections, genitourinary infections, meningitis, septicemia. Endocarditis prophylaxis. Prevention of infection in certain high-risk patients undergoing cesarean section.
Routes/Doses: (Vary) (Adult max) PO: 2 – 4 g/day; dose q 6 -8 hours. IV: 2 – 12 g/day; dose q 6 -8 hours.
Side Effects: Rash and diarrhea most common; seizures, pseudomembranous colitis, anaphylaxis and serum sickness most serious.
CI: hypersensitivity to penicillins; use cautiously in renal insufficiency & sensitivity to cephalosporins. Drug/drug interactions: Probenecid decreases renal excretion and increases blood levels of ampicillin – therapy may be combined for this purpose. Large doses my increase risk of bleeding with warfarin. Incidence of rash increases with concurrent allopurinol therapy. May ↓ effectiveness of oral hormonal contraceptives.
Nursing Implications: Do not confuse with imipenem. Double-check allergies; obtain specimens for C & C before therapy; assess for infection before & throughout therapy. After administration: watch for signs and symptoms of anaphylaxis - keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of a reaction.

Front 15

Dicloxacillin
(Dycill)

Back 15

Dicloxacillin (Dycill) Davis’s p.932
Classification:Th.: anti-infectives; Ph.: penicillinase-resistant penicillins
Actions/Uses: Binds to bacterial cell wall, causing cell death. Treatment of the following infections due to penicillinase-producing staphylococci: Respiratory tract infections, Sinusitis, skin and skin structure infections. Notable for activity against penicillinase-producing strains of S. aureus, S. epidermis. NOT active against MeRSA
Routes/Doses: Oral only. Up to 2g/day, doses every 6h.
Side Effects: Nausea, rash and diarrhea most common; seizures, pseudomembranous colitis, anaphylaxis and serum sickness most serious.
Contraindications: Hypersensitivity to penicillins; use cautiously in renal insufficiency & sensitivity to cephalosporins. Probenecid decreases renal excretion and increases blood levels. May alter the effect of warfarin. Food and acidic juices decrease absorption.
Nursing Implications: Double-check allergies; obtain specimens for C & C before therapy; assess for infection before & throughout therapy. After administration: watch for signs and symptoms of anaphylaxis; keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of a reaction. May cause elevated AST, ALT, LDH, and serum alkaline phosphatase concentrations.

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Cephalexin
(Keflex)

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Cephalexin (Keflex) Davis’s p.253
Classification:Th.: anti-infectives; Ph.: first-generation cephalosporins
Actions/Uses: Binds to bacterial cell wall membrane, causing cell death. Active against many gram-positive cocci inc. Strep. pneumoniae & penicillinase-producing staph. NOT active against MeRSA or enterococcus, limited activity against some E. coli. Used to treat infections of skin & skin structure (including burns); pneumonia; otitis media; sinusitis; urinary infections, bone and joint infections, meningitis, septicemia (including endocarditis) caused by susceptible organisms.
Routes/Doses: Oral only : 1 – 2g/day, doses every 6h. Less for renal impairment!
Side Effects: Nausea, vomiting, rashes, and diarrhea most common; seizures, pseudomembranous colitis, anaphylaxis and serum sickness most serious.
Contraindications: Hypersensitivity to cephalosporins, serious hypersensitivity to penicillins. Probenecid decreases renal excretion and increases blood levels. Concurrent use of loop diuretics or aminoglycerides may increase risk of renal toxicity.
Nursing Implications: Double-check allergies; obtain specimens for C & C before therapy; assess for infection before & throughout therapy. After administration: watch for signs and symptoms of anaphylaxis; keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of a reaction. May cause elevated serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN and creatinine.

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Cefuroxime
(Ceftin)

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Cefuroxime (Ceftin) Davis’s p.256
Classification:Th.: anti-infectives; Ph.: second-generation cephalosporins
Actions/Uses: See first-generation cephalosporins: plus, ↑ activity against several other gram-negative pathogens including E. coli. Treatment of respiratory tract infections, skin & skin structure infections, bone & joint infections, urinary tract and gynecologic infections, septicemia, meningitis, otitis media, perioperative prophylaxis.
Routes/Doses: Oral: up to1g/day, 12-hourly. IM, IV: Up to 6g/day, 8-hourly. Less for renal impairment!
Side Effects: Diarrhea, nausea, vomiting, rashes, pain at IM site, phlebitis at IV site most common: seizures, pseudomembranous colitis, anaphylaxis and serum sickness most serious.
Contraindications: Hypersensitivity to cephalosporins, serious hypersensitivity to penicillins. Use cautiously in renal impairment.
Nursing Implications: Double-check allergies; obtain specimens for C & C before therapy; assess for infection before & throughout therapy. After administration: watch for signs and symptoms of anaphylaxis; keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of a reaction. May cause false-negative blood glucose results with ferricyanide tests. May cause elevated serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN and creatinine.

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Ceftriaxone
(Rocephin)

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Ceftriaxone (Rocephin) Davis’s p.260
Classification:Th.: anti-infectives; Ph.: third-generation cephalosporins
Actions/Uses: See second-generation cephalosporins: plus, even greater activity against several other gram-negative pathogens, but less for staphylococci. Used for treatment of respiratory tract infections, skin & skin structure infections, bone & joint infections, urinary tract and gynecologic infections including gonorrhea, intra-abdominal infections, septicemia, meningitis, otitis media, perioperative prophylaxis.
Routes/Doses: IM, IV: 1 – 2g/day
Side Effects: Diarrhea, nausea, vomiting, rashes, pain at IM site, phlebitis at IV site most common: seizures, pseudomembranous colitis, anaphylaxis and serum sickness most serious.
Contraindications: Hypersensitivity to cephalosporins, serious hypersensitivity to penicillins. Use cautiously in renal impairment. Concurrent use of loop diuretics or nephrotoxic agents including aminoglycides may increase risk of toxicity.
Nursing Implications: Double-check allergies; obtain specimens for C & C before therapy; assess for infection before & throughout therapy. After administration: watch for signs and symptoms of anaphylaxis; keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of a reaction. May cause elevated serum AST, ALT, alkaline phosphatase, bilirubin, LDH, BUN and creatinine.

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Tetracycline HCL
(Achromycin)

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Tetracycline HCL (Achromycin), [D p. 1122]
CLASSIFICATION: Anti-infectives
ACTION/USES: Inhibits bacterial protein synthesis at level of 30S bacterial ribosome. Treatment for variety of infections caused by unusual organisms (Bacteria) such as Mycoplasma, Chlamydia, Rickettsia, Borellia burgdorferi.
*Treats gonorrhea & syphilis in penicillin-allergic pts. *Treats chronic acne, periodontitis
ROUTES/DOSES: PO
SIDE EFFECTS: diarrhea, nausea, vomiting
CONTRAINDICATIONS: may  effect of warfarin. May  effectiveness of oral contraceptives. Calcium in foods/dairy  effect of absorption (minimal w/doxycycline)
NURSING IMPLICATIONS: Assess for infection (vs; look at wound, sputum, urine, stool; WBC) at beginning & throughout therapy. Obtain specimens for culture & sensitivity before initiating therapy. Can give 1st dose before getting results. *** May cause yellow-brown discoloration & softening of teeth/bones if administered prenatally or early childhood.

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Doxcycline
(Vibramycin)

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Doxcycline (Vibramycin) [D p. 1122]
CLASSIFICATION: Anti-infectives
ACTION/USES: **Treatment of Anthrax!
ROUTES/DOSES: PO, IV
SIDE EFFECTS: SAME AS ABOVE
CONTRAINDICATIONS: SAME AS ABOVE & Barbituates can  effect of Doxycyc.
NURSING IMPLICATIONS: SAME AS ABOVE

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Erythromycin
(E-Mycin)

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Erythromycin (E-Mycin) [D p. 473]
CLASSIFICATION: T= Anti-infectives; P= Macrolides
ACTION/USES: Inhibits bacterial protein synthesis at level of 50S bacterial ribosome. Used for infections caused by susceptible organisms including: Upper & Lower Resp Tract Infections, skin & skin structure infections, Pertussis, Diptheria, Pelvic Inflamm dz, Rheumatic fever. Used in place of penicillin due to hypersensitivity. Spectrum – Activity against many gram-postive cocci (e.g. Strep, Staph) & gram-neg bacilli (e.g. Clostridium, Corynebacterium)
ROUTES/DOSES: IV, PO, Topical (for acne)
SIDE EFFECTS: Ventricular arrhythmias (life threatening) nausea, vomiting, diarrhea, phlebitis (inflamm of the vein)
CONTRAINDICATIONS: Lots! Concurrent use w/pimozide (couldn’t find)  risk of serious arrhythmias. Similar affects w/many HTN meds (e.g. verapamil, diltiazem)
NURSING IMPLICATIONS: Assess for infection (vs; look at wound, sputum, urine, stool; WBC) at beginning & throughout therapy. Obtain specimens for culture & sensitivity before initiating therapy. Can give 1st dose before getting results. **Monitor liver functions periodically for those on high-dose/long-term therapy

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Azithromycin
(Zithromax)

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Azithromycin(Zithromax) [D p. 182]
CLASSIFICATION: T= Anti-infectives, agents for atypical mycobacterium; P= Macrolides
ACTION/USES: Inhibits bacterial protein synthesis at level of 50S bacterial ribosome. Treatment for the following infections: Upper Resp Tract including strep pharyngitis, acute bacterial exacerbations of chronic bronchitis & tonsillitis. Lower Resp Tract including bronchitis, pneumonia. Prevention of myogacterium avium complex (MAC) infection in pts w/advanced HIV infection. Skin & skin structure infections. Spectrum – Active against specific gram-postive aerobic bacteria (e.g. Staph aureus, Strep pneumoniae,pyogenes [group A strep) & specific gram-neg aerobic bacteria (e.g.Haemophilus influenzae, Neisseria gonorrhoeae) ***NOT ACTIVE against MRSA (methicillin-resistant S.aureus).
ROUTES/DOSES: primarily PO; IV or PO for P.I. dz & Community-Aquired Pneumonia
SIDE EFFECTS: nausea, diarrhea, abdominal pain, pseudomembranous colitis (life threatening)
CONTRAINDICATIONS: aluminum & magnes-containing antacids  peak serum levels. Can  serum levels of various drugs (e.g. digoxin), so carefully monitor w/concurrent use.
NURSING IMPLICATIONS: Assess for infection (vs; look at wound, sputum, urine, stool; WBC) at beginning & throughout therapy. Obtain specimens for culture & sensitivity before initiating therapy. Can give 1st dose before getting results. ***Observe for S & S of anaphylaxis (rash, laryngeal edema, wheezing) & notify physician immediately.

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Gentamicin
(Garamycin)

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Gentamicin (Garamycin) [D p.117]
CLASSIFICATION: T= Anti-infectives, P= Aminoglycosides
ACTION/USES: Inhibits bacterial protein synthesis at level of 30S bacterial ribosome. Treatment of serious gram-neg (enterococcal?) bacillary infections & infections caused by staphylococci when penicillins or other less toxic drugs are contraindicated. Used to treat endocarditis prophylaxis Spectrum – Most aminoglycosides used against P.aeruginosa, Klebsiella pneumoniae, E. coli, S. aureus. For treating enterococcal infections, need to use w/a penicillin.
ROUTES/DOSES: IM, IV ***Peak level should not exceed 10 mcg/ml; trough level shouldn’t exceed 2 mcg/ml.
SIDE EFFECTS: ototoxicity (vestibular & cochlear), nephrotoxicity, muscle paralysis(w.high doses)
CONTRAINDICATIONS: Inactivated by penicillins & cephalosporins when co-admin to pts w/renal dysfunction. Possible respiratory paralysis after inhalation anesthetics or neuromusc blking agents.  incid of ototoxicity w/loop diuretics.  incid of neprotoxicity w/ other nephrotoxic drugs.
NURSING IMPLICATIONS: Assess for infection (vs; look at wound, sputum, urine, stool; WBC) at beginning & throughout therapy. Obtain specimens for culture & sensitivity before initiating therapy. Can give 1st dose before getting results. ***Dosage adjusted on basis of bl level monitoring & assess of renal function. Caution w/pts w/renal dysfunction. Eval 8th cranial nerve by audiometry before & throughout therapy (hearing loss usually in high freq range). Also monitor for vestibular dysfunction (vertigo, ataxia, nausea, vomiting).

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Sulfamethoxazole (SMZ) with Trimethoprim (Bactrim) – DS or SS

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Sulfamethoxazole (SMZ) with Trimethoprim (Bactrim) – DS or SS
(Davis 1175, Lehne 1005) Note: SMZ may also been seen written as SMX.
CLASSIFICATION: T: anti-infectives, antiprotozoals, P: folate antagonists, sulfonamides
ACTION/USES: To treat bacterial infections. For treatment of primarily UTIs. Also bronchitis, Shigella enteritis, Otitis media, Pneumocystis carinii pneumonia, Traveler’s diarrhea. Many off label uses.
ROUTES/DOSES: PO, IV. For oral, single strength (SS) is 80 mg TMP/400 mg SMZ. Double strength (DS) is 160 mg TMP/400 mg SMZ.
SIDE EFFECTS: nausea, vomiting, rashes, HEPATIC NECROSIS, TOXIC EPIDERMAL NECROLYSIS, AGRANULOCYTOSIS, APLASTIC ANEMIA, ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME.
CONTRAINDICATIONS: Hypersensitivity reactions. Megaloblastic anemia secondary to folate deficiency. Severe renal impairment. Pregnancy, lactation, or children less than 2 mo. May increase effects of digoxin, thiopental and warfarin. May increase toxicity of methotrexate.
NURSING IMPLICATIONS: Assess for UTI. Specimen with C&S. Monitor I/O. Monitor CBC and UA throughout therapy. Administer on empty stomach unless GI irritation. Be sure not to confuse single strength and double strength. Instruct pt to finish all medication even if feeling better.

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Silver sulfadiazine (Silvadene)

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Silver sulfadiazine (Silvadene) [Lehne 1004-1005]
CLASSIFICATION: antibacterial (?)
ACTION/USES: To suppress bacterial colonization in patients with 2nd and 3rd degree burns.
ROUTES/DOSES: topical
SIDE EFFECTS: high incidence of hypersensitivity, so not used routinely
CONTRAINDICATIONS: not listed in Lehne
NURSING IMPLICATIONS: not listed in Lehne

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Ciprofloxacin
(Cipro)

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Ciprofloxacin(Cipro) [Davis 531, Lehne 1029-1030]
CLASSIFICATION: T: anti-infective
ACTION/USES: broad spectrum bactericide; many uses (UTI, gyn infections, gonorrhea, RTI including sinusitis, GI tract infection, etc.)
ROUTES/DOSES: Oral 500-750 mg q12h. IV also.
SIDE EFFECTS: GI reactions (nausea, vomiting, diarrhea, abdominal pain), dizziness, headache, restlessness and confusion. SEIZURES, PSEUDOMEMBRANOUS COLITIS, ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME.
CONTRAINDICATIONS: Hypersensitivity. Increased risk of serious adverse CV reactions with concurrent use of other “–oxacins” and other meds (see Davis 532).
NURSING IMPLICATIONS: Assess for infection. Obtain specimens with C&S. Observe for sxs of anaphylaxis. Try to administer on empty stomach. If GI irritation occurs may be administered with meals. Do not administer with milk or yogurt.

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Levofloxacin
(Levaquin)

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Levofloxacin (Levaquin) [Davis 531, Lehne]
CLASSIFICATION: T: anti-infective
ACTION/USES: Treatment of bacterial infections (UTI, gonorrhea, prostatitis, skin, inhalation anthrax).
ROUTES/DOSES: PO, IV
SIDE EFFECTS: SIEZURES, ARRYTHMIAS, COLITIS, ANAPHYLAXIS
CONTRAINDICATIONS: SEIZURES, PSEUDOMEMBRANOUS COLITIS, ANAPHYLAXIS, STEVENS-JOHNSON SYNDROME.
NURSING IMPLICATIONS: Maintain fluid intake of 1500-2000 mL/day to prevent crystalluria. Observe for anaphylaxis.

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Vancomycin
(Vancocin)

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Vancomycin(Vancocin) , pg. 1185
CLASSIFICATION: Therapeutic: anti-infectives
ACTION/USES: Binds to bacterial cell walls. Used in treatment of potentially life-threatening infections when less toxic anti-infectives are contraindicated.
ROUTES/DOSES: PO-125-500mg q6hr; IV-500mg q6hr or 1g q12hr
SIDE EFFECTS: Anaphylaxis, hypotension, nephrotoxicity, phlebitis, “red man” syndrome
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions): May cause additive ototoxicity and nephrotoxicity with other ototoxic and nephrotoxic drugs (aspirin, aminoglycosides, cyclosporine, cisplatin, loop diuretics). May enhance neuromuscular blockade from nondepolarizing neuromuscular blocking agents.
NURSING IMPLICATIONS: -Assess the pt for infection. -Monitor IV site closely. Vancomycin is irritating to tissues and causes necrosis and severe pain with extravasation. Rotate infusion site and monitor BP throughout IV infusion. –Monitor I&O and daily wt. Cloudy or pink urine may be a sign of nephrotoxicity. –Assess pt for signs of superinfection (black, furry overgrowth on tongue; vaginal itching or discharge; loose or foul smelling stools).

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Metronidazole
(Flagyl)

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Metronidazole (Flagyl) , pg. 788
CLASSIFICATION: Therapeutic: anti-infectives, antiprotozoals, antiulcer agents
ACTION/USES: Disrupts DNA and protein synthesis in susceptible organisms. Used to treat anaerobic infections, trichomoniasis, amebiasis, H. pylori, bacterial vaginoses, and antibiotic assoc. pseudomembranous colitis.
ROUTES/DOSES: doses vary depending on cause of infection, so only listed doses of anaerobic infections. PO-7.5mg/kg q6hr; IV-initial dose 15mg/kg, then 7.5mg/kg q6-8hr or 500mg q6-8hrs
SIDE EFFECTS: seizures, dizziness, headache, abdominal pain, anorexia, nausea
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions):
Cimetidine: ↓ metabolism of metronidazole
Phenobarbital & rifampin: ↑ metabolism & may ↓ effectiveness
Phenytoin, lithium, & warafin: ↑ effects
Alcohol ingestion: disulfiram-like reaction may occur
NURSING IMPLICATIONS: -Assess the pt for infection. –Monitor I&O and daily wt.
–Monitor neurological status (numbness, weakness, ataxia, or seizures can occur).

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Bacitracin

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Bacitracin
( I had a hard time finding this one in Davis, so I looked at several websites to find the info, which is still not complete; http://medical-dictionary.thefreedictionary.com/Bacitracin+zinc , http://www.healthsquare.com/drugs/146083.htm?ic=4030
CLASSIFICATION: therapeutic: anti-infectives
ACTION/USES: acts by interfering with bacterial cell wall synthesis; it is effective against a wide range of gram-positive and a few gram-negative bacteria. It is used topically to treat open infections such as infected eczema and infected dermal ulcers. To prevent skin infections in minor skin injuries (e.g., scrapes, cuts, small burns). Ophthalmic solution is used to treat eye infections.
ROUTES/DOSES: topical, ophthalmic ointment/solution
SIDE EFFECTS: Irritation, redness, and itching
CONTRAINDICATIONS: ?
NURSING IMPLICATIONS: Clean and dry the affected area, removing any dried crust. Apply a thin film of medication to the affected area.

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Neosporin

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Neosporin
(combination drug; in fact there are several combinations), pg.1282. Cream: polymyxin B 10,000 units (not found in drug book) + Neomycin 3.5mg otc (pg.117)…I may need help on this one. I am not sure which form they want us to know really well.
CLASSIFICATION: therapeutic: anti-infectives, pharmacologic: aminoglycosides
ACTION/USES: Neomycin inhibits protein synthesis in bacteria at level of 30s ribosome. Used orally to prepare GI tract for surgery and to treat some forms of diarrhea.
ROUTES/DOSES: topical: 0.5% Rx, OTC, ointment: 0.5% Rx, OTC, irrigant: 125mg/5ml (?), ophthalmic ointment/solution
SIDE EFFECTS: ototoxicity, nephrotoxicity
CONTRAINDICATIONS (Include Drug/Drug and Drug/Food Interactions):
NURSING IMPLICATIONS: -Assess the pt for infxn/superinfxn. –Monitor I & O, daily wt. –Keep pt well hydrated.

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Rifampin
(Rifadin)

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Rifampin (Rifadin) , pg. 1037
CLASSIFICATION: Therapeutic: antituberculars; Pharmacologic: rifamycins
ACTION/USES: Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms. Used in active tuberculosis and in the elimination of meningococcal carriers.
ROUTES/DOSES: PO & IV for tuberculosis-600mg/day or 10mg/kg/day single dose; may also be given 2-3x/week. PO & IV for asymptomatic carriers of meningococcus-600mg q12hr for 2 days.
SIDE EFFECTS: red discoloration of tears/urine/all body fluids, abdominal pain, diarrhea, flatulence, heartburn, nausea, vomiting
CI: Other hepatotoxic agents (alcohol): ↑ risk of hepatotoxicity
Warfarin, opioid analgesics, corticosteroids, hormonal contraceptive agents, etc: since rifampin stimulates liver enzymes, ↑ metabolism & ↓ effectiveness may occur in these drugs.
NURSING IMPLICATIONS: PO-administer on an empty stomach at least 1hr before or 2hr after meals with a full glass of water, unless GI irritation becomes a problem. –Perform mycobacterial studies & susceptibility tests prior to and periodically during therapy. –Assess lung sounds and amt of sputum periodically.

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Linezolid
(Zyvox)

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Linezolid (Zyvox) [D p721]
Classification: T- anti infectives, P-oxazolidinones
Action/uses: bacteriostatic inhibitor of protein synthesis- interferes w/ ribosomal formation inhibiting protein synthesis
Use: Activity against multidrug resistant G+ pathogens like: vancomycin resistant enterococci (VRE), MRSA- used on(multi drug resistant): Staph aureous, E. faecium, S. epidermis in pneumonia
Routes/doses: PO, IV
S/E: PSEUDOMEMBRANE COLITIS, D/N, HA, reversible myelosuppression
Drug-drug: MAOI properties so avoid: indirect acting sympathomimetics, vasopressors, SSRIs, dopaminergic agens
Drug-food: MAOI properties so avoid nitrates- cold cuts, aged cheeses, etc.D p1359
CI: Hypersensitivity, phenylketonuria, pts on myelosuppressive therapy
Nursing implications: Assess for infxn at beginning & during therapy. Monitor for pseudomembranous colitis (assess GI fxn). Monitor labs for: ↓blood cells (RBCS & WBCs), ↑liver & kid fxn lab.

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Telithromycin
(Ketek)

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Telithromycin (Ketek) [D p1108]
Classification:T- anti infectives, P- ketolides
Action/uses: bacteriostatic inhibitor of protein synthesis- interferes w/ ribosomal formation inhibiting protein synthesis
Use: significant action against S.pneumonia that are multidrug resistant strains including pencillin & macrolide resistant; treats acute bacterial infxns of chronic bronchitis, sinusitis, community acquired pneumonia
Routes/doses: PO
S/E: PSEUDOMEMBRANE COLITIS, diarrhea, prolonged QT interval , exacerbate myasthenia gravis
CI: Hypersensitivity esp to macrolides
Drug-drug: hi potential for many drug-drug interactions d/t its ability to be a substrate & inhibitor for CYP3A4 receptor in the liver-these drugs are:ketoconazole, itraconazole, simvastatin, lovastatin, atorvastatin, midazolam, triazolam, ergot derivatives (ergotamine, dihydroergotamine), carbamazepine, cyclosporine, tacrolimus, sirolimus, hexobarbital, phenytoin, and rifampin.
Nursing implications: Assess for infxn at beginning & during therapy. If pt has fever, diarrhea & stool w/ blood, pus, or mucus, notify health professional d/t pseudomembrane colitis.

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Daptomycin
(Cubicin)

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Daptomycin (Cubicin) [D p.350]
Classification:T- anti infectives, P-cyclic lipopeptide antibacterial agents
Action/uses: inserts into bacterial cell membrane forms channel intracellular K loss & inhibiting DNA/RNA synthesis cell death
Use: kills only gram positive bacteria- treats MRSA, Strep pygones, algalactiae, dysgalactiae and E.faecalis (vancomycin-resistent); approved for complicated skin and skin structure infxns
Routes/doses: IV
S/E: PSEUDOMEMBRANE COLITIS, constipation, N/D, injection site rxns, HA, insomnia, rash
CI: Hypersensitivity
Drug-drug: interacts w/ Tobramycin, HMG-CoA reductase inhibitors (statin drugs)
Nursing implications: Assess for infxn at beginning & during therapy. If pt has fever, diarrhea & stool w/ blood, pus, or mucus, notify health professional d/t pseudomembrane colitis.

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Imipenem-cilastatin sodium (Primaxin)

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Imipenem-cilastatin sodium (Primaxin)
CLASSIFICATION: T: anti-infective. P: carbapenems.
ACTIONS: Imipenem: binds to bacteria cell wall-killing it. Combo w/ cilastatin: prevents renal inactivation of Imipenem.
USES: Bactericidal, broad spectrum. Most Gram + aerobic cocci; many Gram – bacillary; also against salmonella, shigella, Neissia gonorrheae; many anaerobes.
ROUTE/DOSES: IV (250-500mg Q6hr to 500mgQ6hr-1gQ6-8hr). IM (500-750mgQ12hr)
SIDE EFFECTS: SEIZURES, PSEUDOMEMBRANE COLITIS, ANAPHYLAXIS, diarrhea, N/V, rash.
DRUG/DRUG: Do not admix w/ amino glycosides (inactivation may occur). Probenecid ↓ renal excretion, ↑ blood levels. Ganciclovir or cyclosporine (↑ risk for seizures).
NURSING IMPLICATIONS: DON’T CONFUSE Imipenem w/ omnipen. Watch for S/S of anaphylaxis, have equip ready just in case.

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Piperacillin with Tazobactam (Zosyn)

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Piperacillin with Tazobactam (Zosyn), Davis 961
Classification: T: anti-infectives, P: extended spectrum penicillins
Actions/Uses: Piperacillin – Tx of serious infections d/t susceptible organisms, including: skin/bone/joint infections, septicemia, resp tract infections, intra-abdominal infections, gynecologic and UTIs. Binds to bacterial cell wall membrane, causing cell death. Tazobactam – appendicitis, skin and skin structure infections, gynecologic infections, pneumonia. Inhibitis beta-lactamase, an enzyme that can destroy penicillins. *Death of susceptible bacteria.
Routes/Doses: IV adults – 3.375-4.5g q6hr
Side Effects: rashes (incr in pt w cystic fibrosis), hypokalemia, seizures, pain, anaphylaxis, phlebitis
Contraindications: hypersensitivity to penicillins, betalactams, cephalosporins, or tazobactam. Probenecid decreases renal excretions and increases blood levels. Corticosteroids and potassium-losing diuretics may increase risk of hypokalemia. Increased risk of hepatotoxicity with hepatotoxic agents.
Nursing Implications: Asses pt for infection at beginning/during therapy. Obtain hx to determine use of/rxns to penicillins/cephalosporins. Obtain speciemsn for C&S prior to therapy. Observe pt for s/sx of anaphylaxis (discontinue if present) – keep epinephrine and resuscitation equipment nearby. Evaluate renal/hepatic function, CBC, serum K+, and bleeding times prior to/during therapy. Advise pt to reports signs of superinfection and allergy.

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Quinupristin with Dalfopristin
(Synercid)

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Quinupristin with Dalfopristin (Synercid) Lehne / 989
CLASSIFICATION: streptogramins
ACTION/USES: inhibit bacterial protein synthesis, bactericidal, safe for pts who are allergic to PCN and cephalosporins. MRSA, methicillin-resistant Staph. Epidermidis, drug-resistant Strep. pneumoniae.
ROUTES/DOSES: IV, 7.5mg/kg over 1hr x2-3/day
Fixed dose combination (70parts dalfopristin/30parts quinupristin)
SIDE EFFECTS: hepatotoxicity (blood test x2 during 1st wk and weekly thereafter) 50% develop infusion-related thrombophlebitis, joint/muscle pain, rash, pruritus, vomiting, diarrhea
CONTRAINDICATIONS: because dalfopristin and quinupristin inhibit hepatic drug metabolizing enzymes, the combination is likely to inhibit the metabolism of many other drugs, including cyclosporine, tacrolimus, and cisapride

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Ampicillin Na & Sulbactam Na
(Unasyn)

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Ampicillin sodium/sulbactam sodium (Unasyn)(Davis 143)
CLASSIFICATION: T: anti-infective, P: aminopenicillin/beta lactamase inhibitor
ACTION/USES: Treatment of the following infections: skin and skin structure, soft tissue, Otitis media, sinusitis, respiratory infections, GU infections, meningitis, septicemia.
ROUTES/DOSES: IM, IV
SIDE EFFECTS: SEIZURES, ANAPHYLAXIS, SERUM SICKNESS, COLITIS.
CONTRAINDICATIONS:
NURSING IMPLICATIONS: Check for allergy to penicillins, cephalosporins. Observe for anaphylaxis

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Ticarcillin disodium & Clavulanate K
(Timentin)

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Ticarcillin disodium & Clavulanate potassium (Timentin) [D p. 1142]
Classification:T- anti infectives, P-extended spectrum pencillins
Action/uses: pencillin + β lactamase inhibitorweakens cell membrane wall +inhibiting bacterial β lactamases extended antimicrobial spectrum pencillin
Uses: txmt of skin & skin structures infxns, bone & jt infxns, septicemia, resp tract infxns, intra abd infxns, gynecologic & UTIs
Routes/doses: IV
S/E: SEIZURES, CHF, PSEUDOMEMBRANE COLITIS, ANAPHYLAXIS, diarrhea, rashes, hypokalemia, phlebitis
CI: drug-drug: interacts w/ probenecid, lithium, K losing diuretics, amphotericin B, corticosteroids, digoxin
Nursing implications: Assess for infxn at beginning & during therapy. If pt has fever, diarrhea & stool w/ blood, pus, or mucus, notify health professional d/t pseudomembrane colitis. Observe for s/sx of anaphylaxis: rash, pruritus, wheezing, laryngeal edema)- use antihistamine, epinephrine, or rescucitation equip. in case of emergency.

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Collagenase
(Santyl)

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Collagenase (Santyl)
(not in Davis or Lehne – had to piece together from various sources)
Classification: enzymatic debridement agents
Action/Uses: enzymatic debriding ointment. Enzyme collagenase has ability to digest collagen in necrotic tissue. Used to debride chronic dermal ulcers and severely burned areas.
Routes/Doses: topical application
Side Effects: no allergic sensitivity or toxic reactions have been noted in clinical use when used as directed. Debriding enzymes may increase risk of bacteriaemia.
Contraindications: enzyme activity is adversely affect by certain detergents, mercury and silver.
Nursing implications: Wound should be cleansed of debris and digested material prior to application. Use should be terminated when debridement of necrotic tissue is complete and granulation tissue is well established.

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Papain-urea
(Accuzyme)

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Papain-urea (Accuzyme)
(not in Davis or Lehne – pieced together from various sources)
Classification: Enzymatic debridement agents
Action/Uses: Papain and urea both break down certain proteins. Used to break down dead skin or tissues (debridement) in wounds such as pressure ulcer, burns, surgical wounds and cysts.
Routes/Doses: topical
Side Effects: mild stinging/burning where applied. Irritation of skin.
Contraindications: Skin products containing metals (silver nitrate, silver sulfadizine). Pts allergic to papaya.
Nursing implications: Wound should be cleansed of debris and digested material prior to application. Use should be terminated when debridement of necrotic tissue is complete and granulation tissue is well established. Check for allergy to papaya (Papain is made from papaya).

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Becaplermin
(Regranex)

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Becaplermin (Regranex) (Davis, 1310)
Classification: T – wound/ulcer/decubiti healing agent, P – platelet-derived growth factors
Action/Uses: Used to treat ulcers of the foot, ankle, or leg – especially in pts w/ diabetes. It is a human-platelet derived growth factor, a substance naturally produced by the body that helps in wound healing. It works by bringing the cells that the body uses to repair wounds to the site of the ulcer.
Routes/Doses: topical
Side Effects: erythematous rash at application site.
Contraindications: known hypersensitivity to becaplermin or parabens. Known neoplasm at sit of application. Wounds that close by primary intention.
Nursing implications: assess healing of wound.