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•Discuss the actions, side effects, contraindications and nursing considerations of the following medications: •Ceftriaxone oVancomycin hydrochloride...

•Discuss the actions, side effects, contraindications and nursing considerations of the following medications:

•Ceftriaxone

oVancomycin hydrochloride

oFentanylcitrate

oMidazolam hydrochloride

oDiazepam

oLidocaine/Prilocaine topical cream

Solutions

Expert Solution

1) CEFTRIAXONE

ACTIONS :-
Ceftriaxone selectively and irreversibly inhibits bacterial cell wall synthesis by binding to transpeptidases, also called transamidases, which are penicillin binding proteins (PBPs) that catalyze the cross linking of the peptidoglycan polymers forming the bacterial cell wall.
SIDE EFFECTS :- Rashes, bloody, or watery stools, stomach cramps, or fever during treatment or for up to two or more months after stopping treatment.Stomach tenderness, pain or bloating, nausea and vomiting, heart burn and chest pain.
CONTRAINDICATIONS :-
diarrhea from an infection with Clostridium difficile bacteria.
a type of blood disorder where the red blood cells burst called hemolytic anemia.
liver problems.
disease of the gallbladder.
severe renal impairment.
yellowing of the skin in a newborn child.
NURSING CONSIDERATIONS :-
Watch for seizures; notify physician immediately if patient develops or increases seizure activity.
Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn).
2) VANCOMYCIN HYDROCHLORIDE

ACTIONS :- When taken by mouth it fights bacteria in the intestines. Vancomycin is used to treat an infection of the intestines caused by Clostridium difficile, which can cause watery or bloody diarrhea. It is also used to treat staph infections that can cause inflammation of the colon and small intestines.
SIDE EFFECTS :- Serious allergic reactions (anaphylactoid reactions), including low blood pressure, wheezing, indigestion, hives, or itching. Rapid infusion of Vancomycin may also cause flushing of the upper body (called "red neck" or "red man syndrome"),dizziness,
CONTRAINDICATIONS :-
Vancomycin is contraindicated in patients with known hypersensitivity to this antibiotic. Solutions containing dextrose may be contraindicated in patients with known allergy to corn or corn products.
NURSING CONSIDERATIONS :-Advise patient to report signs of nephrotoxicity (blood or pus in urine, decreased urine output, weight gain from fluid retention, fatigue). Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged fever, chills, skin rashes, or GI problems (nausea, vomiting).

3) FENTANYL CITRATE :-

ACTIONS :- Fentanyl is a strong agonist at mu- and kappa-opiate receptors, which have been reclassified by an International Union of Pharmacology subcommittee as OP2 (kappa) and OP3 (mu). These receptors are coupled with G-protein (guanine-nucleotide-binding protein) receptors and function as modulators, both positive and negative, of synaptic transmission via G-proteins that activate effector proteins. Opioid-G-protein systems include adenylyl cyclase-cyclic adenosine monophosphate (cAMP) and phospholipase3 C (PLC)-intositol 1,4,5 triphosphate.
SIDE EFFECTS :- Addiction, Abuse, and Misuse , life-threatening Respiratory depression,interactions with benzodiazepines or other CNS depressants,serotonin syndrome,severe cardiovascular epression,gastrointestinal adverse Reactions,seizures.
CONTRAINDICATIONS :-
Respiratory depression, apnea, skeletal muscle rigidity, bradycardia (may be severe); severe hypotension, syncope.
NURSING CONSIDERATIONS :-
Assess IV site closely for signs of extravasation.

Assess for signs of adverse reactions.

Continuous cardiorespiratory and blood pressure monitoring.

Monitor oxygen saturations.

Monitor respiratory status carefully. Effect on respiration is longer acting that analgesic effect.

Ensure naloxone and resuscitation equipment is readily available.

Monitor urinary and bladder function.

Drug documentation.

Record balance discarded out of the narcotic register.Two nurses must witness the discarding of the unused drug, syringes and ampoules into the sharps container.Two nurses must sign FBC when discarding any unused drugs from a continuous IV infusion.

4) Midazolam hydrochloride binds to the GABA receptor but does not displace GABA; rather, it enhances the affinity of GABA for its receptor site on the same receptor complex. The pharmacodynamic consequences of benzodiazepine agonist actions include antianxiety effects, sedation, and reduction of seizure activity.
Side effects-Nausea, vomiting,dizziness, or drowsinessmay occur. If any of these effects persist or worsen, notify the doctor or pharmacist promptly.
Contraindications-
closed angle glaucoma.
chronic heart failure.
constriction of blood vessels of the extremities.
obstructive pulmonary disease.
hardening of the liver.
acute kidney failure.
coma.
a condition where the body is unable to maintain adequate blood flow called shock.
Nursing Implications
Assessment & Drug Effects

Inspect insertion site for redness, pain, swelling, and other signs of extravasation during IV infusion.
Monitor for hypotension, especially if the patient is premedicated with a narcotic agonist analgesic.
Monitor vital signs for entire recovery period. In obese patient, half-life is prolonged during IV infusion; therefore, duration of effects is prolonged (i.e., amnesia, postoperative recovery).
Be aware that overdose symptoms include somnolence, confusion, sedation, diminished reflexes, coma, and untoward effects on vital signs.
Patient & Family Education

Do not drive or engage in potentially hazardous activities until response to drug is known. You may feel drowsy, weak, or tired for 1–2 d after drug has been given.
Be prepared for amnesia to prevent an upsetting postoperative period.
Review written instructions to assure future understanding and compliance. Patient teaching during amnestic period may not be remembered. Even if dose is small and depth of amnesia is unclear, relearn information.
5)Diazepam is used to treat anxiety, alcohol withdrawal, and seizures. It is also used to relieve muscle spasms and to provide sedation before medical procedures. This medication works by calming the brain and nerves.Diazepam belongs to a class of drugs known as benzodiazepines.

Side effects-
drowsiness,
tired feeling,
dizziness,
spinning sensation,
fatigue
constipation,
ataxia (loss of balance),
memory problems,
restlessness,
irritability,
muscle weakness,
nausea,
drooling,
dry mouth,
slurred speech,
blurred or double vision,
skin rash,
itching, or
loss of interest in sex.
Contraindications:-Contraindications to diazepam include patients with severe respiratory insufficiency, myasthenia gravis, sleep apnea syndrome, and severe hepatic insufficiency. It is permissible in patients with open-angle glaucomawho are receiving appropriate therapy but is contraindicated in acute narrow-angle glaucoma.
NURSING CONSIDERATIONS
- Assess blood pressure, pulse and respiration if IV administration. - Provide frequent sips of water for dry mouth. - Provide fluids and fibre for constipation. - Evaluate therapeutic response, mental state and physical dependency after long-term use.
6)Lidocaine is a local anesthetic (numbing medication). It works by blocking nerve signals in your body.Lidocaine topical (for use on the skin) is used to reduce pain or discomfort caused by skin irritations such as sunburn, insect bites, poison ivy, poison oak, poison sumac, and minor cuts, scratches, or burns.
Lidocaine is an antiarrhythmic medication of the class Ib type. This means it works by blocking sodium channels and thus decreasing the rate of contractions of the heart. When it is used locally as a numbing agent, local neurons cannot signal the brain.

Side effects:-Common Side effects of Lidocaine include:
Low blood pressure(hypotension)
Swelling (edema)
Redness at injection site
Small red or purple spots on skin
Skin irritation
Constipation
Nausea
Vomiting
Confusion
Dizziness
Headache
Numbness and tingling
Drowsiness
Tremor
Irritation symptoms (topicalproducts); i.e., redness, swelling
Serious side effects of lidocaine include:

Cardiac arrest
Abnormal heartbeat
Methemoglobinemia
Seizures
Severe allergic reactions (anaphylaxis)
Malignant hyperthermia
This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

Contraindications-

-Heart block, second or third degree (without pacemaker)
-Severe sinoatrial block (without pacemaker)
-Serious adverse drug reaction to lidocaine or amide local anesthetics.
Nursing consideration-Reduce dosage with hepatic or renal failure. Continuously monitor response when used as antiarrhythmic or injected as local anesthetic. WARNING: Keep life-support equipment and vasopressors readily available in case severe adverse reaction (CNS, CV, or respiratory) occurs when lidocaine is injected.


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