: مجموعة متنوعه من الأدوية بشرح كامل لها

[آية بسمله]

Cefazolin


Trade name: Ancef, Kefzol
Class: Antibiotic "cephalosporines" FIRST GENERATION
Pregnancy: (Category B)

Action: Bind to bacterial cell ll membrane, causing cell death

Uses
Treatment of:
Skin and skin stcture infections (including burn wounds)
Pneumonia
Otitis media
Urinary tract infections
Bone and joint infections
Septicemia (including endocarditic) caused by susceptible organisms
Perioperative prophylaxis

Dose
By intramuscular injection or intravenous injection or infusion, 05–1 g every 6–12 hours; CHILD, 25–50 mg/kg daily (in divided doses), increased to 100 mg/kg daily in severe infections

Contraindications
Hypersensitivity to cephalosporin or Penicillin, renal failure, Pregnancy, Lactation


Side effects
Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, skin rashes super-infection, heartburn, sore mouth, bone marrow depression: (Decrease WBC, decreased platelets, decreased Hct Nephrotoxicity, (pain, abscess at injection site, phlebitis and inflammation at IV site

Nursing considerations
Infuse over 30 minutes unless otherwise indicated
Therapy should be continued for at least 2-3 days after symptoms of infection have disappeared
Assess client with a history of hypersensitivity reaction “for penicillin or cephalosporin”
Assess client financial status These dgs are usually expensive
If GI upset occurs administer Dgs with meals “Should be administered on empty stomach”
Obtain liver & renal studies








Cefotaxime


Trade name: claforan
Class: Antibiotic "cephalosporines "(third generation)
Pregnancy: Category B

Action: Bind to bacterial cell ll membrane, causing cell death

Uses
Pneumonia – GU tract infections - meningitis, Peritonitis, septicemia, pelvic cellulitis - endometritis


Dose
by intramuscular or intravenous injection or by intravenous infusion, 1 g every 12 hours increased in severe infections (eg meningitis) to 8 g daily in 4 divided doses; higher doses (up to 12 g daily in 3–4 divided doses) may be required; NEONATE 50 mg/kg daily in 2–4 divided doses increased to 150–200 mg/kg daily in severe infections; CHILD 100–150 mg/kg daily in 2–4 divided doses increased up to 200 mg/kg daily in very severe infections
Gonorrhea, 500 mg as a single dose

Contraindications
Hypersensitivity to cephalosporin or Penicillin

Side effects
CNS: seizures high doses
GI: pseudomembraneous colitis, diarrhea, nausea, vomiting, cramps, pseudolithiasis (ceftriaxone)
Derm: rashes, urticaria
Hemat: bleeding (increased with cefoperazone), blood dyscrasias, hemolytic anemia
Local: pain at IM site, phlebitis at IV site
Misc: allergic reactions including anaphylaxis and sem sickness, super infection

Nursing considerations
Should not be mixed with amino glycosides ( each should be given separately)
For IV use, should be mixed with 10 ml sterile ter & administer over 3-5 minutes

[آية بسمله]

Ceftazidime

Trade name: Ceptaz, Fortum, Tazicef, Tazidime
Class: Antibiotic "cephalosporines" third-generation
Pregnancy: Category B

Action : Bind to bacterial cell ll membrane, causing cell death

Uses
Ceftazidime eliminates bacteria that cause many kinds of infections, including lung, skin, bone, joint, stomach, blood, gynecological, and urinary tract infections

Dose
by deep intramuscular injection or intravenous injection or infusion, 1 g every 8 hours or 2 g every 12 hours; 2 g every 8–12 hours or 3 g every 12 hours in severe infections; single doses over 1 g intravenous route only; elderly usual max 3 g daily; child up to 2 months 25–60 mg/kg daily in 2 divided doses, over 2 months 30–100 mg/kg daily in 2–3 divided doses; up to 150 mg/kg daily (max 6 g daily) in 3 divided doses if immuno- compromised or meningitis; intravenous route recommended for children

Urinary-tract and less serious infections, 05–1 g every 12 hours
Pseudomonal lung infection in cystic fibrosis, adult 100–150 mg/kg daily in 3 divided doses; child up to 150 mg/kg daily (max 6 g daily) in 3divided doses; intravenous route recommended for children
Surgical prophylaxis, prostatic surgery, 1 g at induction of anesthesia repeated if necessary when catheter removed

Contraindications
Hypersensitivity to cephalosporin

Side effects
Diarrhea, stomach pain, upset stomach, vomiting

Nursing considerations
Infuse over 30 minutes unless otherwise indicated
Therapy should be continued for at least 2-3 days after symptoms of infection have disappeared
Assess client with a history of hypersensitivity reaction “for penicillin or cephalosporin”
Assess client financial status These dgs are usually expensive
Obtain liver & renal studies

[آية بسمله]

Ceftriaxone


Trade name: Rocephin
Class: Antibiotic "cephalosporines" third-generation
Pregnancy: Category B

Action: Bind to bacterial cell ll membrane, causing cell death

Uses
Pneumonia, UTI, infections of skin, bone & abdomen Meningitis, bacterial septicemia, pre-op prophylaxis

Dose
by deep intramuscular injection, or by intravenous injection over at least 2–4 minutes, or by intravenous infusion, 1 g daily; 2–4 g daily in severe infections; intramuscular doses over 1 g divided between more than one site

Neonate by intravenous infusion over 60 minutes, 20–50 mg/kg daily - max 50 mg/kg daily

Infant and child under 50 kg, by deep intramuscular injection, or by intravenous injection over 2–4 minutes, or by intravenous infusion, 20–50 mg/kg daily; up to 80 mg/kg daily in severe infections; doses of 50 mg/kg and over by intravenous infusion only; 50 kg and over, adult dose

Uncomplicated gonorrhea, by deep intramuscular injection, 250 mg as a single dose

Surgical prophylaxis, by deep intramuscular injection or byintravenous injection over at least 2–4 minutes, 1 g at induction; colorectal surgery, by deep intramuscular injection or by intravenous injection over at least 2–4 minutes or by intravenous infusion, 2 g at induction; intramuscular doses over 1 g divided between more than one site

Contraindications

Hypersensitivity to cephalosporin or Penicillin ,renal failure

Side effects
Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, skin rashes super-infection, heartburn, sore mouth, bone marrow depression

Nursing considerations
IM injection should be deep into the body of large muscle
IV injection should be diluted
For stability of solution the package insert should be checked carefully
Dosage should be maintained for at least 2 days after symptoms of infection have disappeared (usual course is 4-14 days

[آية بسمله]

Cefuroxime


Trade name: Zinacef
Class: Antibiotic "cephalosporines" (second generation)
Pregnancy: Category B

Action: Bind to bacterial cell ll membrane, causing cell death

Uses
Pharyngitis, tonsillitis , Otitis media ,Lower respiratory tract infections, UTIs Dermatologic infections, Treatment of early Lyme disease ,Lower respiratory tract infections, influenza, Septicemia, Meningitis Bone and joint infections, Perioperative prophylaxis

Dose : by mouth (as cefuroxime axetil), 250 mg twice daily in most infections including mild to moderate lower respiratory-tract infections (eg bronchitis); doubled for more severe lower respiratory-tract infections or if pneumonia suspected

Urinary-tract infection, 125 mg twice daily, doubled in pyelonephritis
Gonorrhea, 1 g as a single dose
Child over 3 months, 125 mg twice daily, if necessary doubled inchild over 2 years with otitis media


ContraindicationsAllergy to cephalosporin or penicillins, renal failure, lactation, pregnancy

Side effects
CNS: Headache, dizziness, lethargy, paresthesias
GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudo membranous colitis, liver toxicity
Hematologic: Bone marrow depression: decreased WBC, decreased platelets, decreased Hct
GU: Nephrotoxicity
Hypersensitivity: Ranging from rash to fever to anaphylaxis, sem sickness reaction

Nursing considerations
Culture infection, arrange for sensitivity tests before and during therapy if expected response is not seen
Give oral dg with food to decrease GI upset and enhance absorption
Give oral dg to children who can sllow tablets; cshing the dg results in a bitter, unpleasant taste
Have vitamin K available in case hypoprothrombinemia occurs
Discontinue if hypersensitivity reaction occurs

[آية بسمله]

Chloramphenicol

Trade name: Chloromycetin
Class: antibiotic
Pregnancy: Category C

Action: it inhibits protein synthesis in bacteria by binding to ribosome

Uses
Not to be used for trivial infections as prophylaxis of infection
Cold, throat infections or flu
Treatment of choice for typhoid fever not for carrier state
Meningitis due to hemophilus influenza, pneumocoeoi or
Miningococei
Skin infections (topically)
Brain abscesses

Dose : by mouth or by intravenous injection or infusion, 50 mg/kg daily in 4 divided doses (exceptionally, can be doubled for severe infections such as septicemia and meningitis, providing high doses reduced as soon as clinically indicated); Child, haemophilus epiglottitis and pyogenic meningitis, 50–100 mg/kg daily in divided doses (high dosages decreased as soon as clinically indicated); Infants under 2 weeks 25 mg/kg daily in 4 divided doses
2 weeks–1 year 50 mg/kg daily in 4 divided dose

Contraindications
Hypersensitivity to chloramphenicol
Pregnancy
Nursing mothers
Renal and hepatic failure

Side effectsA plastic anemia, pancytopnea, nausea, vomiting abdominal distention, “progressive pallid cyanoses, ashen gray color, tachypnea , vasomotor collapse & death”, Gray syndrome in infants, super infections

Nursing considerations

Administer IV as 10% solution over at least 1 min
Note any history of hypersensitivity & other contraindications, & if
Client takes antidiabetic or other medications that cause bone marrow depression
Neonates should be observed closely (greater hazards of toxicity)
Arrange for further hematologic studies to be conducted every 2 days to detect early signs of bone marrow depression
The dg should be taken at regular intervals to be most effective
The dg should be taken 1 hr before or 2 hr after meals - if GI upset Occurs it could be taken with the food

[آية بسمله]

Chlorpromazine

Trade name: Largactil
Class: Antipsychotic, phenothiazine
Pregnancy: Category C

Action: Act by blocking dopamine receptors It has significant antiemetic effect, hypoteinsive, sedative & anticholenergic effect

Uses
Acute & chronic psychosis (such as schizophrenia, mania & manic
Depression
Preanasthetic
Intractable hiccoughs
Nausea & vomiting

Dose : by mouth psychomotor agitation, excitement, and violent or dangerously impulsive behavior initially 25 mg 3 times daily (or 75 mg at night), adjusted according to response, to usual maintenance dose of 75–300 mg daily

Intractable hiccup, oral 25–50 mg 3–4 times daily
By deep intramuscular injection, (for relief of acute symptoms, 25–50 mg every 6–8 hours; Child, 1–5 years 05 mg/kg every 6–8 hours (max 40 mg daily); 6–12 years 05 mg/kg every 6–8 hours (max 75 mg daily)

Induction of hypothermia (to prevent shivering), by deep intramuscular injection, 25–50 mg every 6–8 hours; Child 1–12 years, initially 05–1 mg/kg, followed by maintenance 05 mg/kg every 4–6 hours

Contraindications
Sever depression, coma
Bone marrow depression
Patients with history of seizures & on anticonvulsant therapy
Hepatic & renal diseases
Prostatic hypertrophy
Dehydration - glaucoma, measles

Side effects
Depression, dizziness, seizures, gynecomastia Orthostatic hypotension, bronchospasm, larlynyospasm tardive dyskinesia, photosensitivity, leukopnea, aplastic anemia, and dry mouth


Nursing considerations
Shouldn’t be used to treat nausea & vomiting in children less than 6 months of age
Should avoid getting solution on hands or clothing - it will cause dermatitis
Solutions with marked discoloration should be discarded
Note any history of seizures
Take liver & kidney function test periodically
******** & rotate injection sites
Report side effects immediately
Determine age of male patients & assess for prostatic hypertrophy

[آية بسمله]

Ciprofloxacin Hydrochloride

Trade name: ciproxin
Class: Antibacterial, quinolone derivative
Pregnancy: Category C

Action: is a synthetic quinolone with broad- spectm bactericidal activity, inhibits the synthesis of bacterial DNA by inhibiting the enzyme DNA gyrase

Uses
UIT, infectious diarrhea
Infection of lower respiratory tract, bone, joints & skin

Dose : by mouth, respiratory-tract infections, 250–750 mg
Twice daily, Urinary-tract infections, 250–500 mg twice
Daily (100 mg twice daily for 3 days in acute uncomplicated cystitis in women

Chronic prostatitis, 500 mg twice daily for 28 days
Gonorrhea, 500 mg as a single dose

Pseudomonal lower respiratory-tract infection in cystic fibrosis, 750 mg twice daily; CHILD 5–17 years, up to 20 mg/kg twice daily

Most other infections, 500–750 mg twice daily
Surgical prophylaxis, 750 mg 60–90 minutes before procedure

Prophylaxis of meningococcal meningitis, [not licensed for this indication] 500 mg as a single dose; Child 5–12 years 250 mg

By intravenous infusion (over 30–60 minutes; 400 mg over 60 minutes), 200–400 mg twice daily, Child 20 mg/kg daily in 2 divided doses

Pseudomonal lower respiratory-tract infection in cystic fibrosis, 400 mg twice daily; CHILD 5–17 years, up to 10 mg/kg 3 times daily (max 12 g daily)
Child not recommended but where benefit outweighs risk, by mouth, 10–30 mg/kg daily in 2 divided doses or by intravenous infusion, 8–16 mg/kg daily in 2 divided doses
Anthrax (treatment and post-exposure prophylaxis, see notes above), by mouth, 500 mg twice daily; child 30 mg/kg daily in 2 divided doses

Contraindications
Hypersensitivity - children - lactation

Side effects
Nausea vomiting Dysphasia, crystalluria,
Hematuria, Rashes, bad taste, GI bleeding,
Headache, insomnia

Nursing considerations
Give medication 2 hr after meals
Stress importance of drinking increased amounts of fluids to keep urine acidic & to minimize the risk of crystalluria

[آية بسمله]

Clindamycin phosphate

Trade name: Dalacin
Class: antibiotic, clindamycin
Pregnancy: Category B

Action: suppress protein synthesis by microorganisms by binding to ribosomes It is both bacteriostatic & bactericidal

Uses
Serious respiratory tract infections (lung abscess, pneumonia)
Serious skin infections
Septicemia
Osteomyelitis caused by staphylococci
Used topically for inflammatory acne vulgaris

Dose : by mouth, 150–300 mg every 6 hours; up to 450 mg every 6 hours in severe infections; CHILD, 3–6 mg/kg every 6 hours
NB
Patients should discontinue immediately and contact doctor if diarrhea develops; capsules should be sllowed with a glass of ter
By deep intramuscular injection or by intravenous infusion, 06–27 g daily (in 2–4 divided doses); life-threatening infection, up to 48 g daily; single doses above 600 mg by intravenous infusion only; single doses by intravenous infusion not to exceed 12 g
CHILD over 1 month, 15–40 mg/kg daily in 3–4 divided doses; severe infections, at least 300 mg daily regardless of weight

Contraindications
Hypersensitivity
Minor bacterial infections
Pregnancy

Side effects
Nausea, vomiting, diarrhea, abdominal pain, tenesmus
Loss of weight, pseudo membranous colitis, skin rashes
Hypotension
Thrombophlebitis following IV use

Nursing considerations
Give parenteral dg to hospitalized client only
Dilute IV injections If IM, inject medication deeply
Don’t refrigerate solution because it becomes thick
Before use, take full history & not signs of allergy
Be prepared to manage colitis which can occur 2-9 days or several weeks after initiation of therapy Which includes: fluids, electrolytes, Protein supplement, corticosteroids, and Vancomycin as ordered
During IV administration, observe for signs of hypotension
Administer only on an empty stomach With a full glass of ter to prevent esophageal ulceration

[آية بسمله]

Cloxacillin

Trade name: Orbenin
Class: antibiotic - penicillinase-resistant penicillins
Pregnancy: Category B

Action: Inhibit bacterial cell ll synthesis

Uses
Infections caused by penicillinase- producing staphylococci, streptococci, pneumococci
Osteomylitis
pneumonia
infected wounds & burns
Septic arthritis

Dose : by mouth, 250–500 mg every 6 hours, at least 30 minutes before food; Child under 2 years quarter adult dose; 2–10 years half adult dose
By intramuscular injection, 250–500 mg every 6 hours; Child under 2 years quarter adult dose; 2–10 years half adult dose

By slow intravenous injection or by intravenous infusion, 025–2 g every 6 hours; Child under 2 years quarter adult dose; 2–10 years half adult dose
Endocarditis 12 g daily in 6 divided doses for 4 weeks
Osteomyelitis up to 8 g daily in 3–4 divided doses

Contraindications
Hypersensitivity to penicillins & cephalosporin

Side effects
Allergic: skin rashes, pritis, wheezing, fever…
Diarrhea, abdominal cramps pain, nausea, vomiting
Psendomembranous colitis, thrombocytopenia, leucopenia
Thrombophlebitis + Electrolytes imbalance following IV use
Hepatotoxicity

Nursing considerations
Administer on an empty stomach
Refrigerate reconstituted solution & discard remaining amount after 14 days
NB: To prepare oral suspension, add amount of ter stated on label and shake well
Shake the bottle well before each use

[آية بسمله]

Dexamethasone

Trade name: dexacort
Class: adrenocorticosteroid –synthetic, glucocorticoid type
Pregnancy: Category C/D if used in 1st trimester

Action• They are a group of natural hormones produced by the adrenal cortex
They are used for a variety of therapeutic purposes
Many slightly modified synthetic variants are available today
Some patients respond better to one substance than to another
These hormones influence many ****bolic pathys & all organ systems & are essential for survival
The release of corticosteroids is controlled by hormones such as corticotropin- releasing factor produced by the hypothalamus & ACTH produced by the anterior pituitary


Uses


Replacement therapy: adrenal insufficiency (Addison’s disease)
Rheumatic disorders: rheumatoid arthritis & osteoarthritis
Collagen diseases: systemic lapus erythematosus, rheumatic cardiac
• Allergic diseases: dg hypersensitivity, urticarial transfusion reaction
Respiratory diseases: bronchial asthma, rhinitis
Ocular diseases : allergic & inflammatory conjunctivitis, keratitis
Dermatological diseases: psoriasis, contact dermatitis, urticaria
Diseases of the GIT: ulcerative colitis
Nervous system: Myasthenia gravis
Malignancies: leukemia, lymphoma
Nephrotic syndrome• Hematologic diseases: hemolytic anemia, thrombocytopenic purpura
Miscellaneous: septic shock, liver cirrhosis, stimulation of surfactant
Production, prevention of organ rejection


Dose

By mouth, usual range 05–10 mg daily;
by intramuscular injection or slow intravenous injection or infusion (as dexamethasone phosphate), initially 05–20 mg; CHILD
200–500 micrograms/kg daily

Cerebral edema (as dexamethasone phosphate), by intravenous injection, 10 mg initially, then 4 mg by intramuscular injection every 6 hours as required for 2–10 days
Shock (as dexamethasone phosphate), by intravenous injection or infusion, 2–6 mg/kg, repeated if necessary after 2–6 hours
Note Dexamethasone 1 mg = dexamethasone phosphate 12 mg = dexamethasone sodium phosphate 13 mg


Contraindications

If infection is suspected (Mask signs & symptoms)
Peptic ulcer
Acute glomelonephritis
Cushing’s syndrome
Congestive heart failure
Hypertension
Hyperlipidemia


Side effects

Edema, alkalosis, hypokalemia, hypertension, CHF muscle sting, weakness, osteoporosis, nausea & vomiting
Headache, hypercholesterolemia, hirsutism, amenorrhea, depression
Redistribution of body fats: thin extremities and fat tnk, moon-like face, buffalo hump

Nursing considerations

 Administer oral forms with food to minimize ulcerogenic effect
 For chronic use, give the smallest dose possible
 Corticosteroids should be discontinued gradually if used chronically
 ******** baseline weight, BP, Pulse & temperature
 Frequently take BP, monitor body weight - signs of Na+ & H2O retention
 Periodic sem electrolytes, blood sugar monitoring
 Report signs & symptoms of side effects - Cushing-like syndrome
 Discuss with female client potentials of menstal difficulties
 Instct the client to take diet high in protein & potassium
 Instct the client to avoid falls & accidents - osteoporosis causes Pathological fracture
 Remind the client to carry a card identifying the dg being used
 Stress the need for regular medical supervision
 Advice the client to delay any vaccination while taking these medications Weakened immunity
 Explain the need to maintain general hygiene & cleanliness to prevent Infection

[آية بسمله]

Digoxin

Trade name: Lanoxicaps, Lanoxin, Novo-Digoxin (CAN)

Dg classes
Cardiac glycoside
Cardiotonic agent
Pregnancy: (Category C)

Therapeutic actions
Increases intracellular calcium and allows more calcium to enter the myocardial cell during depolarization via a sodium---potassium pump mechanism; this increases force of contraction (positive inotropic effect), increases renal perfusion (seen as diuretic effect in patients with CHF),decreases heart rate (negative chronotropic effect), and decreases AV node conduction velocity

Indications
CHF
Atrial fibrillation
Atrial flutter
Paroxysmal atrial tachycardia

Dose

by mouth, rapid digitalization, 1–15 mg in divided doses over 24 hours; less urgent digitalization, 250–500 micrograms daily (higher dose may be divided), Maintenance, 625–500 micrograms daily (higher dose may be divided) according to renal function and, in atrial fibrillation, on heart-rate response; usual range, 125–250 micrograms daily (lower dose may be appropriate in elderly)
Emergency loading dose by intravenous infusion, 075–1 mg over at least 2 hours then maintenance dose by mouth on the following day

Contraindications
Contraindications: allergy to digitalis preparations, ventricular tachycardia, ventricular fibrillation, heart block, sick sinus syndrome, IHSS, acute MI, renal insufficiency and electrolyte abnormalities (decreased K+, decreased Mg++, increased Ca++)
Use cautiously with pregnancy and lactation

Side effects
CNS: Headache, weakness, drowsiness, visual disturbances
GI: GI upset, anorexia
CV: Arrhythmias

Nursing Considerations
Monitor apical pulse for 1 min before administering; hold dose if pulse <60 in adult or <90 in infant, retake pulse in 1 h If adult pulse remains <60 or infant <90, hold dg and notify prescriber Note any change from baseline rhythm or rate
Check dosage and preparation carefully
Avoid IM injections, which may be very painful
Follow diluting instctions carefully, and use diluted solution promptly
Avoid giving with meals; this will delay absorption
Have emergency equipment ready; have K+ salts, lidocaine, phenytoin, atropine, and cardiac monitor on standby in case toxicity develops
Monitor for therapeutic dg levels: 05---2 ng/mL

[آية بسمله]

Dobutamine hydrochloride

Trade name: Dobutrex
Dg classes:
• Sympathomimetic
• β1-selective adrenergic agonist
Pregnancy: Category B

Therapeutic actions
Positive inotropic effects are mediated by β1- adrenergic receptors in the heart; increases the force of myocardial contraction with relatively minor effects on heart rate, arrhythmogenesis; has minor effects on blood vessels

Indications
For inotropic support in the short-term treatment of adults with cardiac decompensation due to depressed contractility, resulting from either organic heart disease or from cardiac surgical procedures
Investigational use in children with congenital heart disease undergoing diagnostic cardiac catheterization, to augment CV function

Dosage
Available Forms: Injection 125 mg/mL
Administer only by IV infusion
Titrate on the basis of the patient's homodynamic/renal response
Close monitoring is necessary

Adult
25---15 µg/kg/min IV is usual rate to increase cardiac output; rarely, rates up to 40 µg/kg per minute are needed

IV facts
Preparation: Reconstitute by adding 10 mL Sterile Water for Injection or 5% Dextrose Injection to 250-mg vial If material is not completely dissolved, add 10 mL of diluent Further dilute to at least 50 mL with 5% Dextrose Injection, 09% Sodium Chloride Injection, or Sodium Lactate Injection Store reconstituted solution under refrigeration for 48 h or at room temperature for 6 h Store final diluted solution in glass or via flex container at room temperature Stable for 24 h Do not freeze (Note: dg solutions may exhibit a color that increases with time; this indicates oxidation of the dg, not a loss of potency

Infusion: May be administered through common IV tubing with dopamine, lidocaine, tobramycin, nitropsside, potassium chloride, or protamine sulfate Titrate rate based on patient response--P, BP, rhythm; use of an infusion pump is suggested
Incompatibilities: Do not mix dg with alkaline solutions, such as 5% Sodium Bicarbonate Injection; do not mix with hydrocortisone sodium succinate, cefazolin, cefamandole, neutral cephalothin, penicillin, sodium ethacrynate; sodium heparin
Y-site Incompatibilities: Do not mix with acyclovir, alteplase, aminophylline, foscarnet

Adverse effects

CNS: Headache
GI: Nausea
CV: Increase in heart rate, increase in systolic blood pressure, increase in ventricular ectopic beats (PVCs), anginal pain, palpitations, shortness of breath

Clinically important interactions
Dg-dg
Increased effects with TCAs (eg, imipramine), furazolidone, methyldopa
Risk of severe hypertension with β-blockers
Decreased effects of guanethidine with dobutamine

Nursing Considerations
Arrange to digitalize patients who have atrial fibrillation with a rapid ventricular rate before giving dobutamine--dobutamine facilitates AV conduction
Monitor urine flow, cardiac output, pulmonary wedge pressure, ECG, and BP closely during infusion; adjust dose/rate accordingly

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