DRUG Imipenem Classification: Anti-infectives

ACTION *Binds to the bacterial cell wall, resulting in cell death, combination with cilastatin prevents renal inactivation of impipenem resists the actions of many enzymes that degenerate most other penicillins & penicillin leike anti-infectives

INDICATION *Treatment of : lower respiratory infection, urinary tract infection, abdominal infection, gynecologic infection, skin & skin structute infection, bone & joint infection, bacteremia, endocarditis, polymicrobic infection

CONTRAINDICATION *Hypersensitivity: Cross-sensitivity may occur w/ penicillin & cephalosporins

ADVERSE / SIDE EFFECTS CNS: seizures, dizziness CV: hypotension GI: pseudomembranous, colitis, diarrhea, nausea & vomiting DERM: rash, pruritus, sweating, urticaria HEMAT: eosinophilia LOCAL: phlebitis at IV site MISC: allergic reaction including anaphylaxis, fever, superinfection

NURSING RESPONSIBILITIES Observe patients receiving parenteral drug carefully; closely monitor BP and vital signs. Sudden death from cardiac arrest has been reported. Monitor BP during periods of diuresis and through period of dosage adjustment. Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician.

DRUG Enalpril

ACTION Angiotensinconverting enzyme inhibitors reduce the activity of the reninangiotensinaldosterone system.

INDICATION Treatment of hypertension alone or in combination with other antihypertensives, especially thiazide-type diuretics Treatment of acute and chronic CHF Treatment of asymptomatic left ventricular dysfunction (LVD) Unlabeled use: Diabetic nephropathy

CONTRAINDICATION Contraindicated with allergy to enalapril. Use cautiously with impaired renal function; salt or volume depletion(hypotension may occur); lactation, pregnancy

Classification: Antihypertensive, ACE inhibitor

ADVERSE / SIDE EFFECTS CNS: Headache, dizziness, fatigue, insomnia, paresthesias CV: Syncope, chest pain, palpitations, hypotension in salt- or volumedepleted patients GI: Gastric irritation, nausea, vomiting, diarrhea,

NURSING RESPONSIBILITIES *Alert surgeon, and mark patient's chart with notice that enalapril is being taken; the angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion. *Monitor patients on diuretic therapy for excessive hypotension after

abdominal pain, dyspepsia,elevated liver enzymes GU: Proteinuria, renal insufficiency, renal failure, polyuria, oliguria, urinaryfrequency, impotence Hematologic: Decreased hematocrit and hemoglobin Other: Cough, muscle cramps, hyperhidrosis

the first few doses of enalapril. *Monitor patient closely in any situation that may lead to a drop in BPsecondary to reduced fluid volume (excessive perspiration and dehydration,vomiting, diarrhea) because excessive hypotension may occur. *Arrange for reduced dosage in patients with impaired renal function. *Monitor patient carefully because peak effect may not be seen for 4 hr. Do not administer second dose until BP has been checked.