omeprazole treating steatorrhea in cystic fibrosis

Heartburn Relief , Losec_ , patients

Mepradec , Prilosec, Prilosec OTC, Contraindications
Ratio-Omeprazole_, Sandoz ● Hypersensitivity to drug or its
Omeprazole_, Zanprol , Zegerid components
Pharmacologic class: Proton pump Precautions
inhibitor Use cautiously in:
Therapeutic class: Antiulcer drug ● hepatic disease
Pregnancy risk category C ● pregnant or breastfeeding patients
Action ● children (safety not established).
Reduces gastric acid secretion and increases Administration
gastric mucus and bicarbonate ● Give 30 to 60 minutes before a meal,
production, creating protective coating preferably in morning.
on gastric mucosa and easing discomfort ● If desired, give concurrently with
from excess gastric acid antacids.
Availability ● Know that if patient has ulcer at start
Capsules (delayed-release): 10 mg, of therapy, treatment may be extended.
20 mg, 40 mg ● When giving through nasogastric
Powder for oral suspension: 20 mg tube, use powder for oral suspension,
Tablets (delayed-release): 20 mg or separate capsule and mix pellets
1Indications and dosages with water. Agitate syringe while
➣Gastroesophageal reflux disease injecting. After administration, flush
Adults: 20 mg P.O. (capsules, powder) with 30 to 60 ml of water.
daily for 4 weeks ● Don’t crush capsules.
➣Erosive esophagitis ● Be aware that symptomatic response
Adults: 20 mg P.O. (capsules, powder) doesn’t rule out gastric cancer.
daily for 4 to 8 weeks Route Onset Peak Duration
➣Short-term treatment of active P.O. Within 1 hr Within 2 hr 72-96 hr
duodenal ulcer P.O. Unknown 10-90 min Unknown
Adults: 20 mg P.O. (capsules, powder) (delayed)
daily for 4 weeks. Some patients may
need 4 additional weeks of therapy. Adverse reactions
➣To reduce risk of duodenal ulcers CNS: dizziness, headache, asthenia
caused by Helicobacter pylori GI: nausea, vomiting, diarrhea, constipation,
Adults: 40 mg P.O. (capsules) daily in abdominal pain
morning, given with clarithromycin t.i.d. Musculoskeletal: back pain
for 2 weeks; then 20 mg daily for 2 weeks Respiratory: cough, upper respiratory
➣Gastric ulcers tract infection
Adults: 40 mg P.O. (capsules) daily for Skin: rash
4 to 8 weeks Interactions
➣Pathologic hypersecretory conditions, Drug-drug. Ampicillin, cyanocobalamin,
including Zollinger-Ellison iron salts, ketoconazole: reduced
syndrome absorption of these drugs
Adults: Initially, 60 mg P.O. (capsules) Clarithromycin: increased omeprazole
daily; may increase up to 120 mg t.i.d. blood level
Divide daily dosages above 80 mg. Diazepam, phenytoin, warfarin: prolonged
➣Frequent heartburn (two or more elimination and increased effects
episodes a week) of these drugs
Adults ages 18 and older: 20 mg P.O. Digoxin: increased digoxin absorption
(OTC tablets) daily for 14 days and blood level, possible digoxin
Off-label uses toxicity
● Posterior laryngitis Drugs metabolized by CYP450 system:
● To enhance pancreatin efficacy in competitive metabolism
Drug-diagnostic tests. Alanine phosphatase,
alkaline aminotransferase, aspartate Combivent is used to prevent bronchospasm in
aminotransferase, bilirubin: increased people with chronic obstructive pulmonary
levels disease (COPD) who are also using other
Gastrin: increased level during first medicines to control their condition.Combivent
1 to 2 weeks of therapy may also be used for other purposes not listed in
Patient monitoring this medication guide. 
● Assess vital signs.
● Check for abdominal pain, emesis, What is the important information about
diarrhea, or constipation. Combivent
● Evaluate fluid intake and output. Do not use Combivent if you are allergic to it, or
● Watch for elevated liver function test to atropine (Atreza, Sal-Tropine), soybeans,
results (rare). peanuts, or other food products that contain soya
Patient teaching lecithin. Call your doctor right away if you feel
● Tell patient to take 30 to 60 minutes that this medicine is not working as well as usual,
before a meal, preferably in morning. or if it makes your condition worse. If it seems like
● Instruct patient to swallow capsules you need to use more of any of your medications
or tablets whole and not to chew or in a 24-hour period, talk with your doctor. 
crush them. If he can’t swallow capsule,
tell him he may open it, carefully Extreme heat can cause the medicine canister to
sprinkle and mix entire contents into 1 burst. Do not store your inhaler in your car on hot
tbsp of cool applesauce, and swallow days. Do not throw an empty canister into open
immediately with glass of water. flame. 
● Inform patient taking OTC delayedrelease
tablets for heartburn that full Do not use Combivent if you are allergic to it, or
effect may take 1 to 4 days. Advise him to atropine (Atreza, Sal-Tropine), soybeans,
not to take tablets for more than 14 peanuts, or other food products that contain soya
days without consulting healthcare lecithin. If you have any of these other conditions,
professional. you may need a dose adjustment or special tests
● Caution patient to avoid driving and to safely use Combivent: 
other hazardous activities until he  heart disease, high blood pressure, or
knows how drug affects concentration congestive heart failure
and alertness.  diabetes
● As appropriate, review all other significant  a seizure disorder such as epilepsy
adverse reactions and interactions,  glaucoma
especially those related to the  overactive thyroid
drugs and tests mentioned above  enlarged prostate, problems with urination
 liver or kidney disease. FDA pregnancy category
C. It is not known whether Combivent is harmful
to an unborn baby. Tell your doctor if you are
Combivent Nebules pregnant or plan to become pregnant during
Combivent Nebules contain two active treatment. It is not known whether albuterol or
ingrediants, Albuterol and Ipratropium. ipratropium pass into breast milk or if it could
Combivent Nebules contain 2.5mg of Albuterol harm a nursing baby. Do not use Combivent
and 0.5mg of Ipratropium in each 2.5ml size without telling your doctor if you are breast-
nebule. Each nebule contain 2.5ml volume. Each feeding a baby. 
box contains 20 Nebules. The total volume of one
box is thus 20 nebules x 2.5ml/nebule, or 50ml. Where can I get more information on Combivent
Thus, the concentration of drug per nebule is: Nebules? 
Albuterol 1mg/ml and Ipratropium 0.2mg/ml (or For more information on Combivent Nebules,
2.5mg Albuterol and 0.5mg Ipratropium per 2.5ml Combivent Nebules prescribed Patients, who are
nebule). Nebules are also sometimes called trying place an order for Combivent Nebules from
Respules. an online pharmacy store can place their
 prescription order at CanadaDrugsOnline.com Adults and children: 20 to 240 mg/day
which is an online Canadian pharmacy store. P.O.
hydrocortisone acetate (suspension)—
Adults and children: 5 to 75 mg by
intra-articular injection (depending on
joint size) q 2 to 3 weeks
hydrocortisone hydrocortisone acetate (intrarectal
Ala-Cort, Ala-Scalp, Cetacort, foam)—
Colocort, Cortef, Cortenema, Hi-Cor, Adults and children: One applicatorful
Hycort_, Hytone, Stie-Cort, Synacort, of intrarectal foam daily or b.i.d. for
Texacort 2 to 3 weeks; then one applicatorful
hydrocortisone acetate every other day
Cortifoam, Hydrocortistab hydrocortisone sodium phosphate—
hydrocortisone butyrate Adults and children: 15 to 240 mg/day
Locoid subcutaneously, I.M., or I.V., adjusted
hydrocortisone sodium according to response
succinate hydrocortisone sodium succinate—
A-hydroCort, Solu-Cortef Adults and children: 100 to 500 mg
hydrocortisone valerate I.M. or I.V.; may repeat at 2-, 4-, or
Westcort 6-hour intervals, depending on response
Pharmacologic class: Short-acting and condition
corticosteroid hydrocortisone retention enema—
Therapeutic class: Anti-inflammatory Adults and children: 100 mg P.R. at
(steroidal) bedtime for 21 nights or until desired
Pregnancy risk category C response; patient should retain enema
Action for at least 1 hour.
Suppresses inflammatory and immune ➣Itching and inflammation caused
responses, mainly by inhibiting by skin conditions
migration of leukocytes and phagocytes Adults and children: Thin film of topical
and decreasing inflammatory preparation applied to affected
mediators area one to four times daily, depending
Availability on drug form and severity of condition
Cream, gel, lotion, ointment, solution: Off-label uses
various strengths ● Phlebitis
● Stomatitis
vial, 250 mg/vial, 500 mg/vial, 1,000 Contraindications
mg/vial ● Hypersensitivity to drug, alcohol,
Intrarectal aerosol foam: 90 mg bisulfites, or tartrazine (with some
Oral suspension: 10 mg/5 ml products)
Retention enema: 100 mg/60 ml ● Systemic fungal infections
Spray (topical): 1% ● Concurrent use of other immunosuppressant
Tablets: 5 mg, 10 mg, 20 mg corticosteroids
1Indications and dosages ● Concurrent administration of livevirus
➣Replacement therapy in adrenocortical vaccines
insufficiency; hypercalcemia due Precautions
to cancer; arthritis; collagen diseases; Use cautiously in:
dermatologic diseases; autoimmune ● hypertension, osteoporosis, glaucoma,
and hematologic disorders; trichinosis; renal or GI disease, hypothyroidism,
ulcerative colitis; multiple sclerosis; cirrhosis, thromboembolic disorders,
proctitis; nephrotic syndrome; myasthenia gravis, heart failure
aspiration pneumonia ● pregnant or breastfeeding patients
hydrocortisone, hydrocortisone ● children ages 6 and younger (safety
cypionate— not established).
Administration pancreatitis
● Give oral form with food or milk to Hematologic: purpura
avoid GI upset. Metabolic: sodium and fluid retention,
● Give I.V. injection of sodium succinate hypokalemia, hypocalcemia,
form over 30 seconds to a few hyperglycemia, hypercholesterolemia,
minutes. amenorrhea, growth retardation, diabetes
● Know that drug may be given as intermittent mellitus, cushingoid appearance,
or continuous I.V. infusion. hypothalamic-pituitary-adrenal suppression
Dilute in normal saline solution, dextrose with secondary adrenal insufficiency
5% in water, or dextrose 5% in (with abrupt withdrawal or
normal saline solution. high-dose, prolonged use)
● Inject I.M. deep into gluteal muscle. Musculoskeletal: osteoporosis, aseptic
Rotate injection sites to prevent muscle joint necrosis,muscle pain or weakness,
atrophy. steroid myopathy, loss of muscle mass,
● Be aware that subcutaneous administration tendon rupture, spontaneous fractures
may cause muscle atrophy or Respiratory: cough, wheezing, rebound
sterile abscess. congestion, bronchospasm
2Never abruptly discontinue highdose Skin: rash, pruritus, urticaria, contact
or long-term systemic therapy. dermatitis, acne, bruising, hirsutism,
● Know that systemic forms typically petechiae, striae, acneiform lesions,
are used for adrenal replacement skin fragility and thinness, angioedema
rather than inflammation. Other: altered taste; anosmia; appetite
changes; weight gain; facial edema; increased
heat, hydration, inflammation, denuding, susceptibility to infection;
and thinning of skin increase topical masking or aggravation of infection;
drug absorption. adhesive arachnoiditis; injection site
Route Onset Peak Duration pain, burning, or atrophy; immunosuppression;
P.O. 1-2 hr 1-2 hr 1-1.5 days hypersensitivity reactions
I.V. Immediate Unknown 1-1.5 days including anaphylaxis
I.M. Rapid 4-8 hr 1-1.5 days Interactions
P.R. Slow 3-5 days 4-6 days Drug-drug. Amphotericin B, loop and
Spray Unknown Unknown Unknown thiazide diuretics, mezlocillin, piperacillin,
(topical), ticarcillin: additive hypokalemia
subcut. Fluoroquinolones: increased risk of tendon
Adverse reactions rupture
CNS: headache, nervousness, depression, Hormonal contraceptives: prolonged
euphoria, personality changes, half-life and increased effects of hydrocortisone
psychoses, vertigo, paresthesia, insomnia, Insulin, oral hypoglycemics: increased
restlessness, conus medullaris syndrome, requirements for these drugs
meningitis, increased intracranial Live-virus vaccines: decreased antibody
pressure, seizures response to vaccine, increased risk of
CV: hypotension, hypertension, thrombophlebitis, adverse reactions
heart failure, shock, fat Nonsteroidal anti-inflammatory drugs:
embolism, thromboembolism, increased risk of adverse GI reactions
arrhythmias Phenobarbital, phenytoin, rifampin: decreased
EENT: cataracts, glaucoma, increased hydrocortisone efficacy
intraocular pressure, epistaxis, nasal Somatrem: inhibition of growthpromoting
congestion, perforated nasal septum, effect
dysphonia, hoarseness, nasopharyngeal Drug-diagnostic tests. Calcium,
or oropharyngeal fungal infections potassium, thyroxine, triiodothyronine:
GI: nausea, vomiting, esophageal candidiasis decreased levels
or ulcer, abdominal distention, Cholesterol, glucose: increased levels
dry mouth, rectal bleeding, peptic ulceration, Digoxin assays: false elevation (with
some test methods) those related to the drugs, tests, herbs,
Nitroblue tetrazolium test: falsenegative and behaviors mentioned above.
result
Drug-herbs. Echinacea: increased
immunostimulation
Ginseng: potentiation of immunomodulation Endostatin is a naturally-occurring 20-kDa C-terminal
Drug-behaviors. Alcohol use: increased
risk of gastric irritation and GI ulcers fragment derived from type XVIII collagen. It is
reported to serve as an anti-angiogenic agent,
Patient monitoring
2In high-dose therapy (which similar toangiostatin and thrombospondin.
should not exceed 48 hours), watch
closely for signs and symptoms of depression Endostatin is a broad spectrum angiogenesis
or psychotic episodes. inhibitor and may interfere with the pro-angiogenic
● Monitor blood pressure, weight, and
electrolyte levels regularly. action of growth factors such as basic fibroblast
● Assess blood glucose levels in diabetic growth factor(bFGF/FGF-2) and vascular endothelial
patients. Expect to increase insulin or
oral hypoglycemic dosage. growth factor (VEGF).[1]
2Monitor patient’s response during
weaning from drug.Watch for adrenal
crisis, which may occur if drug is discontinued moxifloxacin hydrochloride
too quickly. Avelox, Vigamox
Patient teaching Pharmacologic class: Fluoroquinolone
● Instruct patient to take daily P.O. Therapeutic class: Anti-infective
dose with food by 8 A.M. Pregnancy risk category C
2Urge patient to immediately report FDA BOXED WARNING
unusual weight gain, face or leg ● Fluoroquinolones for systemic use
swelling, epigastric burning, vomiting are associated with an increased risk of
of blood, black tarry stools, irregular tendinitis and tendon rupture in all
menstrual cycles, fever, prolonged sore ages. This risk is further increased in
throat, cold or other infection, or patients usually over age 60, with concomitant
worsening of symptoms. use of corticosteroids, and in
● Tell patient using topical form not to kidney, heart, and lung transplant
apply occlusive dressing unless instructed recipients.
by prescriber.
● Advise patient to discontinue topical Action
drug and notify prescriber if local irritation Selectively inhibits DNA synthesis by
occurs. disrupting DNA replication and transcription
● Instruct patient to eat small, frequent and suppressing protein synthesis,
meals and to take antacids as needed to causing bacterial cell death
minimize GI upset. Availability
● Tell patient that response to drug will Injection (premixed): 400 mg/250-ml
be monitored regularly. bag
2Caution patient not to stop taking Ophthalmic solution: 5% (3 ml in 6-ml
drug abruptly. bottle)
● In long-term use, instruct patient to Tablets: 400 mg
have regular eye exams. 1Indications and dosages
● Instruct patient to wear medical identification ➣Acute bacterial sinusitis
stating that he’s taking this drug. Adults: 400 mg P.O. or I.V. q 24 hours
● As appropriate, review all other significant for 10 days
and life-threatening adverse ➣Acute bacterial exacerbation of
reactions and interactions, especially
chronic bronchitis arrhythmias
Adults: 400 mg P.O. or I.V. q 24 hours EENT: conjunctivitis; decreased visual
for 5 days acuity; keratitis; eye dryness, discomfort,
➣Community-acquired pneumonia pain, pruritus, and hyperemia;
Adults: 400 mg P.O. or I.V. q 24 hours subconjunctival hemorrhage; tearing;
for 7 to 14 days otitis media; pharyngitis; rhinitis (all
➣Uncomplicated skin and skinstructure with ophthalmic solution)
infections GI: nausea, diarrhea, abdominal pain,
Adults: 400 mg P.O. or I.V. q 24 hours pseudomembranous colitis
for 7 days GU: vaginitis
➣Bacterial conjunctivitis Hematologic: eosinophilia, thrombocytopenia,
Adults: Instill one drop of ophthalmic leukopenia
solution into affected eye t.i.d. for 7 Musculoskeletal: joint pain, tendinitis,
days. tendon rupture
Contraindications Respiratory: increased cough (with
● Hypersensitivity to drug, its components, ophthalmic solution)
or other fluoroquinolones Skin: rash, photosensitivity, phototoxicity,
Precautions Stevens-Johnson syndrome
Use cautiously in: Other: altered taste, fever (with ophthalmic
● underlying CNS diseases or disorders, solution), phlebitis at I.V. site,
renal impairment, cirrhosis, bradycardia, superinfection, hypersensitivity reactions
acute myocardial ischemia, including anaphylaxis
prolonged QTc interval, uncorrected
hypokalemia, dialysis Interactions
● elderly patients Drug-drug. Amiodarone, bepridil,
● pregnant or breastfeeding patients disopyramide, erythromycin, pentamidine,
(safety not established except in postexposure phenothiazines, pimozide, procainamide,
inhalation anthrax) quinidine, sotalol, tricyclic
● children younger than age 18 (except antidepressants: increased risk of serious
in postexposure inhalation anthrax) adverse cardiovascular reactions
● children younger than age 1 (ophthalmic Antacids, bismuth subsalicylate, iron
use). salts, sucralfate, zinc salts: decreased
Administration moxifloxacin absorption
● Give premixed I.V. dose over 60 minutes. Theophylline: increased theophylline
Avoid bolus or rapid infusion. blood level and possible toxicity
● Don’t mix with other drugs in same Drug-diagnostic tests. Alanine aminotransferase,
I.V. line. alkaline phosphatase, aspartate
● Know that although milk or yogurt aminotransferase, bilirubin, lactate
may impair absorption of P.O. moxifloxacin, dehydrogenase, platelets: increased
drug may be given with other levels
calcium products. Drug-food. Concurrent tube feedings,
Route Onset Peak Duration milk, yogurt: impaired absorption of
P.O. Within 1 hr 1-3 hr 24 hr P.O. moxifloxacin
I.V. Rapid End of 24 hr Drug-herbs. Dong quai, St. John’s wort:
infusion phototoxicity
Ophthalmic Unknown Unknown Unknown Fennel: decreased moxifloxacin absorption
Adverse reactions Drug-behaviors. Sun exposure: phototoxicity
CNS: dizziness, drowsiness, headache, Patient monitoring
confusion, light-headedness, insomnia, 2Watch for hypersensitivity reaction
agitation, hallucinations, acute psychoses, (such as anaphylaxis) and other
tremor, seizures allergic reactions, which may occur after
CV: hypertension, vasodilation, tachycardia, initial dose.
prolonged QT interval, ● Monitor cardiovascular and neurologic
status closely. Impedes extracellular calcium ion movement
2Stay alert for tendinitis and across membranes of myocardial
Achilles tendon rupture. muscle cells, depressing myocardial contractility
● Monitor CBC and liver function and impulse formation; slows
tests. impulse conduction velocity and dilates
● Assess GI status. Report signs or coronary arteries and peripheral arterioles.
symptoms of pseudomembranous Net effect is reduced cardiac workload
colitis. and lower blood pressure.
● Watch closely for superinfection. Availability
Patient teaching Tablets (extended-release): 2.5 mg,
● Advise patient to take tablets once a 5 mg, 10 mg
day with or without food, 4 hours before 1Indications and dosages
or 8 hours after antacids,multivitamins, ➣Hypertension
sucralfate, or preparations containing Adults: Initially, 5 mg P.O. daily. Depending
aluminum, magnesium, iron, on response, may decrease to
or zinc. 2.5 mg or increase to a maximum of
2Tell patient drug may cause serious 10 mg P.O. daily at 2-week intervals.
allergic reactions even several days Dosage adjustment
after therapy begins. Advise him to ● Hepatic impairment
stop taking drug and report these reactions ● Elderly patients
immediately. Off-label uses
2Urge patient to stop taking drug ● Heart failure
and promptly report tendon pain, diarrhea ● Angina pectoris or vasospastic
with blood or pus, and signs (Prinzmetal’s) angina
and symptoms of superinfection. Contraindications
● Teach patient how to use eye drops. ● Hypersensitivity to drug
Caution him to avoid touching applicator Precautions
tip to eye, finger, or other Use cautiously in:
object. ● cardiac disease, arrhythmias, severe
● Instruct patient being treated for hepatic or renal impairment
bacterial conjunctivitis not to wear ● elderly patients
contact lenses. ● pregnant or breastfeeding patients
● Caution patient to avoid driving and ● children (safety not established).
other hazardous activities until he Administration
knows how drug affects concentration ● Give without regard to meals.
and alertness. ● Make sure patient swallows tablet
● As appropriate, review all other significant whole without crushing or chewing.
and life-threatening adverse Route Onset Peak Duration
reactions and interactions, especially P.O. 1 hr 2-4 hr Up to 24 hr
those related to the drugs, tests, foods, Adverse reactions
herbs, and behaviors mentioned CNS: headache, drowsiness, dizziness,
above. syncope, nervousness, anxiety, psychiatric
disturbances, paresthesia,
felodipine insomnia, asthenia, confusion, irritability
Cardioplen , Felotens , Keloc , CV: chest pain, peripheral edema, hypotension,
Neofel ,Plendil, Renedil_, palpitations, tachycardia,
Vascalpha angina, arrhythmias,myocardial infarction,
Pharmacologic class: Calcium channel atrioventricular block
blocker EENT: rhinorrhea, sneezing, pharyngitis
Therapeutic class: Antihypertensive,
antianginal GI: nausea, vomiting, diarrhea, constipation,
Pregnancy risk category C abdominal discomfort, dyspepsia,
Action abdominal cramps, flatulence, dry
mouth ● Explain that exercise and hot weather
Hematologic: anemia may increase drug’s hypotensive effects.
Musculoskeletal: back pain ● Tell patient to report peripheral edema,
Respiratory: bronchitis persistent headache, or flushing.
Skin: dermatitis, rash, pruritus, urticaria, ● Advise patient to use hard candy or
erythema gum if dry mouth or thirst occurs.
Other: dysgeusia, gingival hyperplasia, ● Tell female patient to inform
facial edema, thirst, warm sensation prescriber if she is pregnant or breastfeeding.
Interactions ● As appropriate, review all other significant
Drug-drug. Antifungals, cimetidine, and life-threatening adverse
erythromycin, propranolol, ranitidine: reactions and interactions, especially
increased felodipine blood level, those related to the drugs, foods, and
increased risk of toxicity behaviors mentioned above.
Barbiturates, hydantoins: decreased
felodipine blood level
Beta-adrenergic blockers, digoxin,
disopyramide, phenytoin: bradycardia,
conduction defects, heart failure
Fentanyl, nitrates, other antihypertensives,
quinidine: additive hypotension
Nonsteroidal anti-inflammatory drugs:
decreased antihypertensive effects
Drug-food. Grapefruit juice: increased
felodipine blood level and effects
Drug-behaviors. Acute alcohol ingestion:
additive hypotension
Patient monitoring
2Don’t give to patient with heart
block unless he has a pacemaker.
2Use extreme caution when administering
to patients with pulmonary
hypertension, renal insufficiency,
heart failure, or compromised
ventricular function (especially those
receiving beta-adrenergic blockers
concurrently).
● Monitor fluid intake and output, and
weigh patient daily.
● Monitor ECG and vital signs. Assess
for signs and symptoms of heart block.
● Assess for reflex tachycardia, angina,
and sustained hypotension.
● Check hepatic profile and alkaline
phosphatase level in patients with
hepatic impairment.
Patient teaching
● Tell patient drug controls but doesn’t
cure high blood pressure, so he should
keep taking it even if he feels well.
● Instruct patient to move slowly when
rising, to avoid light-headedness or
dizziness from sudden blood pressure
decrease.