Generic Name: Nalbuphine Brand Name: Nalphine General Classifications: Analgesic Indications: Management of Pain Mode of Action: Nalbuphine

is a phenanthrene derivative opioid analgesic with mixed opioid agonist and antagonist activity. It inhibits the ascending pain pathways, altering the perception of and response to pain by binding to opiate receptors in the CNS. It also produces generalised CNS depression. Contraindications: May impair ability to drive or operate machinery. Emotionally unstable patients or patients with history of opiate abuse; closely monitor these patients during long-term therapy. Impaired respiration due to other drugs, uraemia, bronchial asthma, severe infection, cyanosis, respiratory obstruction. MI patients who exhibit nausea and vomiting and in those about to undergo biliary tract surgery. Head injury, intracranial lesions or preexisting increased intracranial pressure. Renal or hepatic impairment. Elderly and debilitated patients. Pregnancy and lactation. Side Effects: Sedation, dizziness, vertigo, miosis, headache; nausea, vomiting, dry mouth; itching, burning, urticaria. Respiratory depression, dyspnoea, asthma; speech difficulty, urinary urgency, blurred vision, flushing, warmth; clamminess. Interactions: Additive CNS depressant effects may occur with other CNS depressants e.g. alcohol, anaesthetics, anxiolytics, hypnotics, TCAs and antipsychotics Nursing Implications: Assess pain characteristics. Assess for signs of dizziness, headache, nausea and vomiting. Assess blood pressure, pulse, and
respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Dose may need to be decreased by 2550%. Nalbuphine produces respiratory depression, but this does not markedly increase with increased doses.

Generic Name: Ciprofloxacin Brand Name: Ciprobay General Classifications: Analgesic Indications: Infections due to sensitive organisms of the resp tract, middle ear, sinuses, eyes,
kidneys & urinary tract, genital organs (including gonorrhoea), abdomen (GIT, biliary tract, peritonitis), skin & soft tissues, bones & joints; septicaemia, infections in patients w/ reduced host defense & for selective gut decontamination.

Infections of the resp.tract, middleear,paranasal sinuses,eyes,kidneys,urinary tract

Mode of Action:

InhibitsbacterialDNAgyrasethuspreventingreplicationinsusceptiblebacteria
Pharmacology: Ciprofloxacin is a synthetic broad-spectrum antibacterial agent of the quinolone group for oral and IV administration. These substances are called gyrase inhibitors. Ciprobay has a strong antibacterial action against a broad spectrum of bacteria. It prevents transcription by the chromosome (genetic material) of the information needed for the normal metabolism of bacteria. This leads to a rapid decrease in the ability of the bacteria to reproduce. Ciprobay is also characterised by the fact that, as a result of its particular mode of action, it does not generally exhibit parallel resistance to any other antibiotic outside the gyrase-inhibitor group. Therefore, Ciprobay is highly effective against bacteria which are resistant eg, to aminoglycosides, penicillins, cephalosporins, tetracyclines and other antibiotics. Contraindications: Ciprobay should not be used where there is hypersensitivity to ciprofloxacin or to other chemotherapeutic agents of the quinolone group.

Ciprobay should not be prescribed to children, growing adolescents and pregnant or nursing women, as there is no evidence of its safety when used in these groups and, on the basis of results from animal experiments, injury to the articular cartilage of an organism which is not fully grown cannot be completely ruled out. Animal experiments have not shown any evidence of teratogenic effects (malformations).

Side Effects:
The following side effects have been observed: Gastrointestinal Tract: Nausea, diarrhoea, vomiting, digestive disorders, abdominal pain, flatulence, anorexia. The doctor should be advised of any severe or persistent diarrhoea occurring during or after treatment, since these symptoms could conceal a serious intestinal disorder (pseudomembranous colitis) requiring urgent treatment. In such cases, Ciprobay should be discontinued and replaced by another appropriate drug (eg, vancomycin orally, 4 x 250 mg/day). Preparations which inhibit peristalsis are contraindicated. Nervous Systems: Dizziness, headache, tiredness, insomnia, agitation, trembling. Very Rarely: Peripheral paralgesia, sweating, unsteady gait, convulsions, anxiety states, nightmares, confusion, depressions, hallucinations, impaired taste and smell, visual disturbances (eg, double vision, colour vision). In some instances, these reactions occurred after the 1st administration of Ciprobay already. In these cases, Ciprobay has to be discontinued and the doctor should be informed immediately. Hypersensitivity reactions. Skin reactions eg, rashes. Very Rarely: Pruritus, drug fever. Anaphylactic/anaphylactoid reactions (eg, facial, vascular and laryngeal oedema; dyspnoea progressing to life-threatening shock). In these cases, Ciprobay has to be discontinued and medical treatm ent (eg, treatment for shock) is required. Punctate skin haemorrhages (petechiae), blister formation with accompanying haemorrhages (haemorrhagic bullae) and small nodules (papules) with crust formation showing vascular involvement (vasculitis), StevensJohnson syndrome, interstitial nephritis, hepatitis; very rarely, major liver disorders, including hepatic necrosis. Cardiovascular System: Very Rarely: Tachycardia, hot flushes, migraine, fainting. Others: Very Rarely: Joint pains, general feeling of weakness, muscular pains, tendovaginitis, mild photosensitivity, transient impairment in kidney function, including transient kidney failure, tinnitus, transitory impairment of hearing, especially at high frequencies. Blood and Blood Constituents: Eosinophilia, leucocytopenia, leucocytosis, anaemia; very rarely, thrombocytopenia, thrombocytosis, altered prothrombin levels.

Interactions: Indication for Ciprofloxacin

Ciprofloxacin is used in the treatment of chronic bacterial prostatitis. It is also used in the treatment of skin or skin structure, GI tract, bone or joint, lower respiratory tract, and urinary tract infections. Ciprofloxacin is also used in the treatment of chancroid. Ciprofloxacin is also used in the treatment of infectious diarrhea, uncomplicated gonorrhea, empiric treatment of febrile neutropenia, and acute sinusitis. It can also be used for conjunctival keratitis, keratoconjunctivitis, corneal ulcers, blepharitis, dacrocystitis, blepharoconjunctivitis, and acute meibomianitis.

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

Side Effects and Adverse Reactions of Ciprofloxacin

Side Effects of Ciprofloxacin

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

Adverse Reactions of Ciprofloxacin

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

Nursing Considerations for Clients Taking Ciprofloxacin

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

Patient Teachings for Clients Taking Ciprofloxacin

Do not skip doses, take full course of therapy. Take with 8 oz water, drink several glasses of water between meals. Eat or drink high sources of ascorbic acid, like cranberry juice or citrus fruits, to prevent crystalluria. Do not take antacids. Shake suspension well before using. Do not chew microcapsules in suspension.

Sugarless gum or hard candy may relieve bad taste. Opthalmic: A crystal precipitate may form but usually resolves in 1-7 days.

Nursing Implications: Assess pain characteristics. Assess for signs of dizziness, headache, nausea and vomiting. Assess blood pressure, pulse, and
respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation. Dose may need to be decreased by 2550%. Nalbuphine produces respiratory depression, but this does not markedly increase with increased doses.