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GENERIC NAME: FERROUS SULFATE

TRADE NAME: Feosul, Fer-Gen-Sol, Fer-in-Sol, FeroSul


DRIED: Feosol, Feratab, Slow FE, Slow Release Iron
CLASSIFICATION: Antianemic, iron
ACTION: Normal daily intake males 12-20 mg; females 8-15 mg; only 10% absorbed;
Iron absorbed by from duodenum and upper jejunum by active mechanism thru mucosal
cells, combines with transferring; iron stored as hemosiderin or aggregated ferritin in
reticuloendothelial cells of liver, spleen, bone marrow; 2/3 of iron in circulating RBC’s
INDICATIONS: Prophylaxis, treatment of iron deficiency and iron-deficiency anemia’s;
dietary supplement for iron
ROUTES OF ADMINISTRATION: Drops, Elixir, Tablets, Slow-Release Tablets
USUAL DOSAGE: Anemia prophylaxis: Adults 300 mg/day; peds 5 mg/kg/day
Anemia: 300 mg twice a day increased to 4 times a day as needed/tolerated
Peds: 10 mg/kg/day
DRIED: Anemia Prophylaxis: Adults 200 mg/day; peds 5 mg/kg/day
Anemia: 200 mg 3 times a day up to 200 mg 4 times a day as needed/tolerated
10 mg/kg 3 times daily
Slow release tablets: Adults 160 mg 1-2 times per day: NOT for children
ADVERSE REACTIONS: Constipation, gastric irritation, nausea, abdominal cramps,
anorexia, diarrhea, dark-colored stools

INTERACTIONS: ↓ GI absorption of iron: oral antacids, calcium salts, cholestyramine,


cimetidine, histamine H-2 receptor antagonists, pancreatic extracts, proton pump
inhibitors, vitamin E, St. John’s wort; ↑ GI absorption of iron: ascorbic acid,
chloramphenicol; Thyroid hormone and trientine: DO NOT USE TOGETHER

CONTRAINDICATIONS: Hemosiderosis, Hemochromatosis, peptic ulcer, regional


enteritis, ulcerative colitis, hemolytic anemia, pyridoxine-responsive anemia, liver
cirrhosis

NURSING CONSIDERATIONS: Substitution of one iron salt for another without


proper adjustment may result in serious over or under dosing; Eggs, milk, coffee or tea
may significantly inhibit iron absorption; Ingestion of calcium and iron supplements can
decrease iron absorption by 1/3; Iron absorption is not decreased if calcium bicarbonate
used between meals
GENERIC NAME: AMOXICILLIN
TRADE NAME: Amoxil, DisperMox, Trimox, Wymox, Polymox
CLASSIFICATION: Antibiotic, penicillin
ACTION: Synthetic broad-spectrum penicillin closely related to ampicillin; Binds to
bacterial cell wall (PBP-1 and PBP-3; penicillin-binding sites), causing cell death by
inhibiting cell wall synthesis; bactericidal action; spectrum is larger than penicillin’s
INDICATIONS: Ear, nose, and throat infections due to Streptococcus species, S.
pneumoniae, Staphylococcus species or Haemophilus influenzae; GU infections due to E.
coli, P. mirailis, or E. faecalis; lower resp tract infections due to Streptococcus species,
S. pneumoniae, Staphylococcus species, or H. haemophilus; acute uncomplicated
gonococcal infections due to N. gonorrhoeae
ROUTES OF ADMINISTRATION: Capsules; Oral Suspension; Tablets; Chewable
Tablets
USUAL DOSAGE: Over 40 kg: 500 mg q 8 hr or 500 mg q 12 hr; under 40 kg: 20
mg/kg/day in divided doses q 8 hr or 25 mg/kg/day in divided doses q 12 hr
Less than 40 kg: 20 mg/kg/day in divided doses q 8 hr OR 25 mg/kg/day in divided doses
q 12 hr
ADVERSE REACTIONS: Hypersensitivity, nausea & vomiting, gastritis, stomatitis;
specific allergies

INTERACTIONS: Antacids ↓ effect of PCNs related to ↓ GI tract absorption, antibiotics


↓ effect of PCNs, aspirin ↑ effect of PCNs by ↓ plasma protein binding, chloramphenicol
and erythromycins either ↑ or ↓ effects, tetracyclines ↓ effect of PCNs

CONTRAINDICATIONS: Hypersensitivity to PCNs; PO use of PCNs during acute


stages of emphysema, bacteremia, pneumonia, meningitis, pericarditis, and purulent or
septic arthritis; lactation

NURSING CONSIDERATIONS: Inject slowly; causes local irritation via IV/IM; IM


injections deep into gluteal muscle; IV injections usually diluted with IV solution; Assess
for allergic reactions (if reaction occurs, stop drug immediately); monitor vitals, chem.
Results; assess for 20 min after administering to check for allergies; should be prescribed
cautiously to nursing mothers; take full dosage; report unusual symptoms i.e. ↑
bruising/bleeding, sore throat, rash, diarrhea, symptoms worsening, or lack of response
GENERIC NAME: DOXYCYCLINE
TRADE NAME: Vibramycin, Monodox, Periostat, Vibra-Tabs, Vibrox, Adoxa,
Doxyhexal, Atridox
CLASSIFICATION: Tetracycline antibiotics
ACTION: Inhibits protein synthesis by binding to the ribosomal 305 subunit. Block
binding of Aminoacyl transfer RNA to the messenger RNA complex. Cell wall synthesis
is not inhibited.
INDICATIONS: Chancroid, tularemia, plague, bartonellosis, cholera, Rocky Mountain
spotted fever, typhus group, Q fever, tick fevers, rickettsialpox, respiratory tract
infections, trachoma, inclusion conjunctivitis, uncomplicated urethral, endocervical, or
rectal infections, psittacosis, relapsing fever, nongonococal urethritis, chronic UTI’s, also
used for oral care for chronic adult periodonitis
ROUTES OF ADMINISTRATION: Capsules, Enteric-Coated Capsules, IV, Oral
Suspension, Syrup, Tablets, Delayed-Release Tablets
USUAL DOSAGE: Infection: 100mg q 12hr first day then 100mg/day
Chronic UTI’s: 100 mg q 12 hr
IV: 200 mg IV on day one given in 1 or 2 infusions, then 100-200 mg depending on
severity (200 mg given in 1 or 2 infusions)
Gel 10%: apply to affected area for periodontal disease; gel hardens releasing
doxycycline for about 7 days
ADVERSE REACTIONS: Anorexia, nausea & vomiting, diarrhea,
dizziness, headache, rashes

INTERACTIONS: ↓ effect of doxycycline by ↑ liver breakdown;


Methotrexzate: possible GI and hematologic toxicity after high doses of
methotrexate

CONTRAINDICATIONS: Prophylaxis of malaria in pregnant individuals


and in children less than 8 years old; use during pregnancy (may stunt fetal
growth) and children up to 8 years old (may cause permanent teeth
discoloration); lactation

NURSING CONSIDERATIONS: Do not confuse with Dicyclomine;


check for any allergic/hypersensitivity reactions; note expiration date
(expired Doxycycline is nephrotoxic; Malaria prophylaxis can start 1-2 days
prior to travel, during travel, and up to 4 weeks after leaving malarial area;
protect from light
GENERIC NAME: ACETAMINOPHEN
TRADE NAME: Tylenol, Panadol, MANY others
CLASSIFICATION: Coal tar, non-narcotic analgesic
ACTION: Decreases fever by 1) a hypothalamic effect leading to sweating and
vasodilation and 2) inhibits the effect of pyrogens on the hypothalamic heat-regulating
centers. May cause analgesia by inhibiting CNS prostaglandin synthesis; however, due to
minimal effects on peripheral prostaglandin synthesis, acetaminophen has no anti-
inflammatory or uricosuric effects. Does not cause any anticoagulant effect or ulceration
of the GI tract. Antipyretic and analgesic effects are comparable to those of aspirin.
INDICATIONS: 1) Control of pain due to headache, earache, dysmenorrheal, arthralgia,
mylagia, musculoskeletal pain, arthritis, immunizations, teething, tonsillectomy 2)
Reduces fever in bacterial or viral infections 3) Substitute for aspirin in upper GI disease,
aspirin allergy, bleeding disorders, anticoagulant therapy, gouty arthritis.
ROUTES OF ADMINISTRATION: Caplets, Capsules, Sprinkle Capsules, Elixir,
Gelcaps, Oral Liquid/Syrup, Oral Solution, Syrup, Tablets, Chewable Tablets,
Dispersible Tablets
USUAL DOSAGE: Adults: 325-650 mg q 4 hr, up to max of 1 g q 6 hr; Extended-relief
caplets; 2 caplets (1,300 mg) q 8 hr; most all other administration; 1,300 mg q 8 hr
Effervescent granules: 1 or 2 ¾ capfuls placed in empty glass, then filled with water; q 4
hr if needed
ADVERSE REACTIONS: Few when taken in usual therapeutic doses; GI upset in
some; Chronic and even acute toxicity can develop after long symptom-free usage

INTERACTIONS: Chronic EtOH ↑ toxicity of larger therapeutic doses; barbiturates,


carbamazepine, hydantoins, isoniazid, rifampin & sulfinpyrazone: ↑ hepatotoxicity
potential related to ↑ liver breakdown; activated charcoal ↓ absorption when given ASAP
after overdose; NSAIDs ↑ risk of hypertension in women; oral contraceptives ↑ liver
breakdown ; propranolol ↑ effect related to liver ↓ breakdown; smoking possible ↓ serum
levels related to↑ hepatic metabolism

CONTRAINDICATIONS: Renal insufficiency, anemia; clients with cardiac or


pulmonary disease are more susceptible to acetaminophen toxicity

NURSING CONSIDERATIONS: Do not exceed more than 4 grams/day in adults and


75 mg/kg/day in children; do not take for >5 days (children), >10 days (adults), and >3
days (adult or child fever) without consulting provider; monitor chem. studies with long-
term usage; take as directed with milk or water to decrease GI upset; report paleness,
weakness and heartbeat skip (hemolytic anemia)
GENERIC NAME: DIPYRIDAMOLE
TRADE NAME: Persantine
CLASSIFICATION: Anticoagulant, platelet adhesion inhibitor
ACTION: Lengthens abnormally shortened platelet survival time; in higher
doses may act by several mechanisms, including inhibition of red blood cell
uptake of adenosine, itself an inhibitor of platelet reactivity; inhibition of
platelet phosphodiesterase, which leads to accumulation of cAMP within
platelets; direct stimulation of release of prostacyclin or prostaglandin D2;
and/or inhibition of thromboxane A2 formation
INDICATIONS: As an adjunct to coumarin anticoagulants in preventing
post-operative thromboembolic complications of cardiac valve replacement
ROUTES OF ADMINISTRATION: Tablets
USUAL DOSAGE: 75 – 100 mg four times daily as adjunct to warfarin
therapy
ADVERSE REACTIONS: Dizziness, abdominal distress, headache, rash,
diarrhea, liver dysfunction (rare), Angina pectoris, flushing, pruritus

INTERACTIONS: ↑ Digoxin bioavailability

CONTRAINDICATIONS: Use with caution in hypotension (can cause


peripheral vasodilation); caution during lactation

NURSING CONSIDERATIONS: Monitor vital signs, EKG, chem. tests;


document mental status, skin color, cardiopulmonary findings; helps prevent
clots by inhibiting platelet stickiness; avoid alcohol and tobacco usage due
to hypotensive vasoconstrictive effects; avoid use of unprescribed drugs
without approval; avoid quick movements due to ↓ BP; try small meals
frequently if nausea or gastric distress experienced
GENERIC NAME: FUROSEMIDE
TRADE NAME: Lasix
CLASSIFICATION: Diuretic, loop
ACTION: Inhibits the reabsorption of Na+ and Cl- in the proximal, distal tubes and the
ascending Loop of Henle resulting in the excretion of Na, Cl, and, to a lesser degree, K
and bicarbonate ions; resulting urine is more acidic; diuretic action independent of
changes in clients’ acid-base balance; has slight antihypertensive effect
INDICATIONS: Edema associated with CHF, nephritic syndrome, hepatic cirrhosis, and
ascites; IV for acute pulmonary edema; PO to treat hypertension in conjunction with
spironolacetone, triamterene, and other diuretics except ethacrynic acid
ROUTES OF ADMINISTRATION: Oral Solution; Tablets; IV; IM
USUAL DOSAGE: Edema: Initially, 20 – 80 mg/day as single dose; can be increased by
20-40 mg q 6-8 hrs until desired diuretic response is obtained: Hypertension: 40 mg twice
daily: HTN: 2-2.5 grams/day
IM; IV: Initial 20-40 mg (if no improvement, after 2 hrs increase in 20 mg increments)
IV: 40 mg slowly over 1-2 min (if inadequate after 1 hr, give 80 mg slowly over 1-2 min)
ADVERSE REACTIONS: Jaundice, hearing impairment, hypotension, water/electrolyte
depletion, pancreatitis, abdominal pain, dizziness, anemia

INTERACTIONS: Charcoal - ↓ absorption from GI tract; Clofibrate enhances diuretic


effect, hydantoins ↓ diuretic effect, propranolol - ↑ plasma propranolol levels

CONTRAINDICATIONS: Never use with ethacrynic acid; anuria, hypersensitivity to


drug, severe renal disease associated with azotemia and oliguria, hepatic coma associated
with electrolyte depletion; lactation

NURSING CONSIDERATIONS: Is a potent diuretic; excess amounts can lead to


profound diuresis with water and electrolyte depletion; individualize dosage; do not
confuse Lasix with Lanoxin; food decreases bioavailability and ultimately the degree of
diuresis; give IV injections slowly over 1-2 min; with renal impairment or if receiving
other oxotoxic drugs, observe for oxotoxicity; assess closely for signs of vascular
thrombosis
GENERIC NAME: TEMAZEPAM
TRADE NAME: Restoril
CLASSIFICATION: Sedative-hypnotic, benzodiazepine
ACTION: Benzodiazepine derivative; believed to potentiate
GABA neuronal inhibition; hypnotic action involves GABA
receptors in the CNS; drug decreases sleep latency, the number of
awakenings, and time spent in awake stage
INDICATIONS: Insomnia in clients unable to fall asleep, with
frequent awakenings during the night, and/or early morning
awakenings
ROUTES OF ADMINISTRATION: Capsules
USUAL DOSAGE: 15-30 mg at bedtime (7.5 mg may be
sufficient for some to improve sleep latency); in elderly or
debilitated, initially 7.5-15 mg until response determined
ADVERSE REACTIONS: Drowsiness, dizziness, lightheadedness, incoordination,
tremors, falling, palpitations, suicide attempts, respiratory depression and sleep apnea

INTERACTIONS: Alcohol/anesthetics/antihistamines/barbiturates/CNS
depressants/narcotics/phenothiazines/nonbarbiturate sedative-hypnotics - potentiates or
adds to CNS depressant effects; concomitant use may lead to drowsiness, lethargy,
stupor, respiratory collapse, coma, or death;
cimetidine/disulfiram/erythromycin/flouxetine/isoniazid/ketoconazole/metoprolol/ oral
contraceptives/probenecid/propoxyphene/ranitidine/rifampin/valproic acid - ↑ effect of
Temazepam reacting to ↓ liver breakdown

CONTRAINDICATIONS: Pregnancy, hypersensitivity, acute narrow-angle glaucoma,


psychoses, primary depressive order, psychiatric disorders in which anxiety is not a
significant symptom

NURSING CONSIDERATIONS: Store from 15-25ºC(68-77ºF) in well-closed light-


resistant container; take only as directed; do not increase dose; assess sleep patterns, diet,
lifestyle, routines; determine any depression or addiction history; may cause daytime
drowsiness
GENERIC NAME: DIGOXIN
TRADE NAME: Digitek, Digoxin Injection Pediatric, Lanoxicaps, Lanoxin
CLASSIFICATION: Cardiac glycoside
ACTION: Increases force and velocity of myocardial contraction (positive inotropic
effect) by increasing refractory period of the AV node and increasing total peripheral
resistance; effect is due to inhibition of Na/K-ATPase in the sarcolemmal membrane,
which alters excitation-contraction coupling; inhibiting Na/K-ATPase results in increased
Ca influx and increased release of free Ca ions within the myocardial cells, which then
potentiate the contractility of cardiac muscle fibers
INDICATIONS: CHF, including that due to venous congestion, edema, dyspnea,
orthopnea, and cardiac arrhythmia; May be drug of choice for CHF due to rapid onset,
relatively short duration, and ability to be administered PO or IV; Control of rapid
ventricular contraction rate in clients with A-Fib or flutter; Slow HR in sinus tachycardia
due to CHF; SVT; Prophylaxis and treatment of recurrent paroxysmal atrial tachycardia
with paroxysmal AV junctional rhythm; Cardiogenic shock; Apical HR > 60
ROUTES OF ADMINISTRATION: Capsules, Elixir, Tablets
USUAL DOSAGE: Initial: 0.4-0.6 mg initially followed by 0.1-0.3 mg q 6-8 hr
Maintenance: 0.05mg-0.35mg once or twice daily
Tablets/Elixir: Initial: 0.75-1.25 mg divided into 2 or more doses given q 6-8 hrs
Maintenance: 0.125-0.5 mg/day IV: Same as tablets, then 0.125-0.5 mg/day
ADVERSE REACTIONS: Tachycardia, headache, dizziness, mental disturbances,
nausea & vomiting, diarrhea, anorexia, blurred or yellowed vision

INTERACTIONS: The following drugs increase serum digoxin levels, leading to


possible toxicity: Aminoglycosides, amiodarone, anticholinergics, atorvastatin,
benzodiazepines, captopril, diltiazem, dipyridamole, erythromycin, esmolol, flecainide,
hydroxychloroquine, ibuprofen, indomethacin, itraconazole, nifedipine, quinidine,
quinine, telmisartan, tetracyclines, tolbutamide, verapamil;
Ephedra/ephedrine/epinephrine - ↑ chance of cardiac arrhythmias

CONTRAINDICATIONS: V-Fib or tachycardia (unless congestive failure supervenes


after protracted episode not due to digitalis), in presence of digoxin toxicity,
hypersensitivity to cardiac glycosides, beriberi heart disease, certain cases of
hypersensitive carotid sinus syndrome

NURSING CONSIDERATIONS: Digoxin is not effectively removed by dialysis, by


exchange transfusion, or during cardiopulmonary bypass (most of drug is in tissues and
not blood); measure liquids precisely; protect from light; monitor closely; take after
meals to lessen gastric irritation; do not take with grapefruit juice; do not change brands
(different preparations differ in bioavailability/may cause toxicity or effect loss)
GENERIC NAME: DIAZEPAM
TRADE NAME: Diastat, Diazepam, Intensol, Calium, C-IV
CLASSIFICATION: Antianxiety drug, antimanic, benzodiazepine
ACTION: Reduces anxiety by increasing or facilitating the inhibitory neurotransmitter
activity of GABA; skeletal muscle relaxant effect may be due to enhancement of GABA-
mediated presynaptic inhibition at the spinal level as well as in the brain stem reticular
formation
INDICATIONS: Management of anxiety disorders or for short-term relief of symptoms
of anxiety; Adjunct therapy in convulsive disorders; Adjunct for relief of skeletal muscle
spasm caused by reflex spasm to local pathology; Athetosis, stiff-man syndrome; Relief
of anxiety and tension in those undergoing surgical procedures; Acute alcohol withdrawal
for symptomatic relief of acute agitation; Adjunct therapy in status epilepticus seizures
ROUTES OF ADMINISTRATION: Oral solution, Intensol Solution, Tablets, Rectal
Gel; IM; IV
USUAL DOSAGE: Anxiety: 2-10 mg 2-4 X daily: Acute alcohol withdrawal 10 mg 3-4
X the first day then 5 mg 3-4 X daily: IV/IM: 5-10 mg IM or IV, repeat in 3-4 hrs if
needed: Acute alcohol withdrawal: 10 mg IV or IM init; then 5-10 mg in 3-4 hr if needed:
Status epilepticus: initial: 5-10 mg IV (preferred), may be repeated at 10-15 min intervals
up to 30 mg; may repeat therapy in 2-4 hrs
ADVERSE REACTIONS: Transient drowsiness, ataxia, confusion
INTERACTIONS: Potentiates antihypertensive effects of thiazides and other diuretics;
potentiates muscle relaxant effect of d-tubocurarine and gallamine; fluoxetine/isoniazid -
↑ half-life of diazepam; ranitidine - ↓ GI absorption of diazepam; smoking – possible ↑
diazepam hepatic metabolism leading to ↓ response;
Alcohol/anesthetics/antihistamines/barbiturates/CNS
depressants/narcotics/phenothiazines/nonbarbiturate sedative-hypnotics - potentiates or
adds to CNS depressant effects; concomitant use may lead to drowsiness, lethargy,
stupor, respiratory collapse, coma, or death;
cimetidine/disulfiram/erythromycin/flouxetine/isoniazid/ketoconazole/metoprolol/ oral
contraceptives/probenecid/propoxyphene/ranitidine/rifampin/valproic acid - ↑ effect of
Diazepam reacting to ↓ liver breakdown
CONTRAINDICATIONS: Hypersensitivity, acute narrow-angle glaucoma, psychoses,
primary depressive order, psychiatric disorders in which anxiety is not a significant
symptom, children under 6 months, lactation, and parenterally in children under 12 years
NURSING CONSIDERATIONS: Except for deltoid muscle, absorption from IM sites
is slow, erratic and painful (not generally recommended); IV route preferred in
convulsing client; parenteral administration may cause bradycardia, respiratory/cardiac
arrest; have emergency equipment/drugs available; assess emotional status; note
depression or drug abuse; drug acts by slowing down nervous system; avoid alcohol
GENERIC NAME: WARFARIN SODIUM
TRADE NAME: Coumadin
CLASSIFICATION: Anticoagulant, coumarin derivative
ACTION: Interferes with synthesis of vitamin K-dependent clotting factors
resulting in depletion of clotting factors II, VII, IX, and X; Has no direct
effect on an established thrombus although therapy may prevent further
extension of a formed clot as well as secondary thomboembolic problems
INDICATIONS: Prophylaxis and treatment of venous thrombosis and its
extension; Prophylaxis and treatment of atrial fibrillation with embolization;
Prophylaxis and treatment of pulmonary embolism; Prophylaxis and
treatment of thromboembolic complications associated with atrial fibrillation
ROUTES OF ADMINISTRATION: IV, Tablets
USUAL DOSAGE: Init: 5-10 mg/day for 2-4 days; then adjust dose on
prothrombin or INR determinations (lower in geriatric or debilitated
patients): Maintenance: 2-10 mg/day based on prothrombin or INR
ADVERSE REACTIONS: Bleeding/hemorrhage is main side effect; may occur from
any organ or tissue

INTERACTIONS: Warfarin is responsible for more adverse drug interactions than any
other group; clients on anticoagulant therapy must be monitored carefully each time a
drug is added or withdrawn; since potentiation may mean hemorrhages, a lengthened
prothrombin time (PT) or International Normalized Ratio (INR) warrants reduction of the
dosage of the anticoagulant; MULTIPLE DRUG INTERACTIONS (too many to list)

CONTRAINDICATIONS: Lactation; IM use; use of large loading dose (30 mg) is not
recommended due to increased risk of hemorrhage and lack of more rapid protection

NURSING CONSIDERATIONS: Take oral warfarin as prescribed and at same time


each day; must be compliant with drug therapy; do not change brands (may alter
response); does not dissolve clots but decreases clotting ability of blood and helps to
prevent formation of blood clots in vessels and heart valves; avoid IM shots, activities
that may cause injury or cuts and bruises; protect from light (store at controlled room
temperature); dispense in tight light-resistant container; vial not for multiple uses; discard
unused solution; note any bleeding tendencies; determine if pregnant (may cause fetal
malformations and neonatal hemorrhage)
GENERIC NAME: OXYCODONE AND ACETOMINOPHEN
TRADE NAME: Percocet, Endocet, Roxicet, Roxilox, Tylox, C-11
CLASSIFICATION: Analgesic
ACTION: Semi synthetic opiate that combines with specific receptors
located in CNS to produce various effects; mechanism is believed to involve
decreased permeability of cell membrane to Na, which results in diminished
transmission of pain impulses and analgesia; causes mild sedation and no
antitussive effect; most effective in relieving acute pain; does not cause any
anticoagulant effect or ulceration of GI tract
INDICATIONS: Relief of moderate to moderately severe pain
ROUTES OF ADMINISTRATION: Caplets, Capsules, Oral Solution,
Tablets
USUAL DOSAGE: 5 mL of oral solution q 6 hr or 1 caplet, capsule or
tablet q 6 hr as needed for pain
ADVERSE REACTIONS: Dizziness, light-headedness, nausea & vomiting, sedation,
sweating, itching, dry mouth, constipation

INTERACTIONS: Anticholinergic drugs – production of paralytic ileus; tricyclic


antidepressants - ↑ effect of either TCAs or oxycodone; CNS depressants – additive CNS
depression; MAO inhibitors - ↑ effect of either the MAO inhibitor or oxycodone

CONTRAINDICATIONS: Hypersensitivity to either oxycodone or acetaminophen; can


produce drug dependence and has abuse potentials

NURSING CONSIDERATIONS: Combination drug; do not confuse Percocet and


Percodan; do not confuse oxycodone with oxyContin; assess for drug seeking behaviors;
take only as directed; may take with food to decrease GI upset; do not share drugs; keep
in safe place; drug may cause dizziness and drowsiness; may cause constipation, nausea
& vomiting, rash/itching, and physical dependence; avoid alcohol and any other CNS
depressants without provider approval; tolerance may occur
GENERIC NAME: DILTIAZEM HYDROCHLORIDE
TRADE NAME: Cardizem CD, CartiaXT, Dilacor XR, Dilt-XR, Diltia XT, Diltiazem
HCl extended-Release, Taztia XT, Tiazac, Cardizem LA (Extended-Release)
CLASSIFICATION: Calcium channel blocker
ACTION: Inhibits influx of Ca through cell membrane, resulting in depression of
automaticity and conduction velocity in cardiac muscle; Decreases SA and AV
conduction and prolongs AV node effective and functional refractory periods; Also
decreases myocardial contractility and peripheral vascular resistance; decrease in HR
INDICATIONS: Angina pectoris due to coronary artery spasm; Chronic stable angina;
Hypertension (extended- or sustained-release only); Temporary control of rapid
ventricular rate in A-Fib or flutter; Rapid conversion of paroxysmal SVT to sinus rhythm.
ROUTES OF ADMINISTRATION: Tablets (Immediate- and Extended-Release),
Extended-Release Capsules, IV Bolus, Continuous Infusion IV
USUAL DOSAGE: Angina: initial 30 mg 4X daily, then increase gradually to total dose
of 180-360 mg (3-4 doses), 180 mg Ext. Release initially, then increase to 360 mg; HTN:
180-240 mg Ext. Release once daily, may titrate up to 540 mg/day: A-Fib IV bolus: 0.25
mg/kg given over 2 min, then if inadequate, second dose (0.35 mg/kg) in 15 min;
Continuous Inf IV: Initial infusion rate is 10 mg/hr, may be increased in 5 mg increments
to 15 mg/hr
ADVERSE REACTIONS: AV block, bradycardia, edema, dizziness/lightheadedness,
headache, dyspnea, rhinitis, infection, pain
INTERACTIONS: Amiodarone – possible cardiotoxicity with bradycardia and ↓ cardiac
output; anesthetics - ↑ risk of depression of cardiac contractility, conductivity, and
automaticity as well as vascular dilation; Digoxin – possible ↑ serum digoxin levels;
Lithium - ↑ risk of neurotoxicity; Theophyllines – risk of pharmacologic and toxicologic
theophylline effects
CONTRAINDICATIONS: Hypotension or cardiogenic shock; second- or third-degree
AV block and sick sinus syndrome except in presence of a functioning ventricular
pacemaker; acute MI, pulmonary congestion; IV diltiazem with IV beta-blockers: A-Fib
or atrial flutter associated with an accessory bypass tract; ventricular tachycardia; use of
Cardizem LyoJect Syringe in newborns, lactation
NURSING CONSIDERATIONS: Do not confuse Cardizem with Cardene; sublingual
nitroglycerin may be taken concomitantly for acute angina; diltiazem may also be taken
together with long-acting nitrates; note edema or CHF; review ECG for AV block;
monitor vital signs, renal and liver function tests; take extended-release capsules on an
empty stomach; do not open, chew, or crush; swallow whole; may cause
drowsiness/dizziness; record blood pressure for review; rise slowly from lying to sitting
to standing position
GENERIC NAME: DOCUSATE SODIUM
TRADE NAME: Colace, Dioctyn Softgels, Docu, D.O.S., D-S-S, Dulcolax
Stool Softener, Ex-Lax Stool Softener, Gena Soft, Non-Habit Forming Stool
Softener, Phillips Liqui-Gels, Regulex SS, Silace Stool Softener
CLASSIFICATION: Laxative, Emollient
ACTION: Acts by lowering the surface tension of feces and promoting
penetration by water and fat (increases softness of fecal mass; not absorbed
systematically, does not seem to interfere with absorption of nutrients
INDICATIONS: Lessens strain of defecation in persons with hernia or CV
diseases or other diseases in which stool straining should be avoided;
megacolon or bedridden patients; Constipation associated with dry, hard
stools
ROUTES OF ADMINISTRATION: Capsules, Soft-Gel Capsules, Oral
Liquid, Syrup, Tablets
USUAL DOSAGE: Adults and persons above 12 y/o: 50-500 mg; Under 3
y/o: 10-40mg; 3-6 y/o: 20-60 mg; 6-12 y/o: 40-120 mg
ADVERSE REACTIONS: Diarrhea, nausea & vomiting, perianal irritation, flatulence,
cramps, dehydration, electrolyte balance disturbance due to dehydration

INTERACTIONS: May ↑ absorption of mineral oil from GI tract;

CONTRAINDICATIONS: Nausea, vomiting, abdominal pain, intestinal obstruction;


severe abdominal pain due to appendicitis, enteritis, ulcerative colitis, diverticulitis,
intestinal obstruction, fecal impaction, undiagnosed abdominal pain

NURSING CONSIDERATIONS: Drink glass of water with each dose; may take oral
solutions with milk or juice to help mask taste; may take 1-3 days to soften fecal matter
due to minimally absorbing docusate salts; assess activity levels, diet, water intake,
exercise routines; have client identify habits and BM activities; note length of time it
takes for laxative to take effect; with abdominal pain and discomfort, note location,
triggers, type of discomfort, rule out other intestinal disorders/obstruction where laxatives
should not be used
GENERIC NAME: METFORMIN HYDROCHLORIDE
TRADE NAME: Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet
CLASSIFICATION: Oral Antidiabetic, Biguanide
ACTION: Decreases hepatic glucose production, decreases intestinal absorption of
glucose, increases peripheral uptake and utilization of glucose; does not cause
hypoglycemia in either diabetic or nondiabetic clients, and does not cause
hyperinsulinemia; insulin secretion remains unchanged, while fasting insulin levels and
day-long plasma insulin response may decrease
INDICATIONS: As monotherapy, as adjunct to diet and exercise, to improve glycemic
control in clients with type 2 diabetes; Immediate-release tablets and PO solution can be
used in clients 10 yrs and older; Extended Release form used to treat type 2 diabetes as
initial therapy or in conjunction with a sulfonylurea or insulin in clients 17 y/o and older
ROUTES OF ADMINISTRATION: Oral Solution, Tablets, Extended-Release Tablets
USUAL DOSAGE: Oral Solution: Adult up to 2,550 mg/day; child up to 2,000 mg/day
Tablets: Start dose 500 mg twice daily with food; dosage increases may be made in 500
mg every week, divided doses, up to maximum of 2,500 mg; If 2,500 mg needed, may be
tolerable in 3 equal doses daily
ADVERSE REACTIONS: Lactic acidosis, hypoglycemia, diarrhea, nausea & vomiting,
asthenia, flatulence, headache, abdominal pain/discomfort

INTERACTIONS: Alcohol - ↑ metformin effect on lactate metabolism; Furosemide - ↑


metformin plasma blood levels and metformin ↓ lowers half-life of Furosemide;
Propantheline - ↑ absorption of metformin related to slowed GI motility

CONTRAINDICATIONS: Renal disease or dysfunction, or abnormal creatine clearance


(CCR) due to cardiovascular collapse, acute MI, or septicemia; in CHF requiring
pharmacologic intervention, acute or chronic metabolic acidosis, including diabetic
ketoacidosis, with or without coma; abnormal hepatic function

NURSING CONSIDERATIONS: Lactic acidosis is a rare, but serious, metabolic


complication that can occur due to metformin accumulation (50 % fatal); do not confuse
Glucophage with Glucovance; individualize dosage based on tolerance and effectiveness;
give with meals and start at a low dose with gradual escalation (will reduce GI side
effects); may safely switch from metformin to metformin extended-release; may cause a
metallic taste (will subside)
GENERIC NAME: GUAIFENESIN
TRADE NAME: Naldecon, Senior EX, Robitussin, Scot-Tussin
Expectorant, Siltussin SA, Alterussin, Guiatuss, Humabid Maximum
Strength, Mucinex
CLASSIFICATION: Diabetic Tussin, Organidin NR
ACTION: May increase output of fluid from respiratory tract by reducing
viscosity and surface tension of respiratory secretions, thereby removing
accumulate dsecretions from upper and lower airway
INDICATIONS: Dry, nonproductive cough due to colds and minor upper
respiratory tract infections where there is mucus in respiratory tract; to
loosen phlegm and thin bronchial secretions
ROUTES OF ADMINISTRATION: Oral Liquid, Syrup, Tablets,
Extended-Release Tablets
USUAL DOSAGE: Expectorant: Over 12 y/o 200-400 mg q 4 hr, not
exceeding 2,400 mg/day; 6-11 y/o 100-200 mg q 4 hr not exceeding 1,200
mg/day, 2-5 y/o 50-100 mg q 4 hr not exceeding 600 mg/day, 6 mos-2 yrs
25-50 mg q 4 hr not exceeding 300 mg/day
ADVERSE REACTIONS: Nausea & vomiting; GI discomfort

INTERACTIONS: Inhibition of platelet adhesiveness by guanfenesin may


result in bleeding tendencies

CONTRAINDICATIONS: Chronic cough (due to smoking, asthma, or


emphysema), cough accompanied by excess secretions; lactation

NURSING CONSIDERATIONS: Assess for tobacco use, fever/chills, loss


of appetite, or increased fatigue; if symptoms persist for more than one
week, recur, or are accompanied by a persistent headache, fever or rash,
notify provider; do not perform activities that require mental alertness (drug
may cause drowsiness); report any evidence of increased bruising/bleeding,
fever, change in secretions, or lack of response
GENERIC NAME: ALBUTEROL (SALBUTAMOL)
TRADE NAME: AccuNeb, Albuterol HFA, ProAir HFA, Proventil,
Proventil HFA, Ventolin, Ventolin HFA, VoSpire ER
CLASSIFICATION: Sympathomimetic
ACTION: Stimulates Beta-2 receptors of bronchi leading to
bronchodilation; causes less tachycardia and is longer-acting than
isoprotenerol; has minimal Beta-1 activity; Proventil HFA inhaler contains
no CFC’s
INDICATIONS: Prophylaxis and treatment of bronchospasm due to
reversible obstructive airway disease; inhalation solution for acute attacks of
bronchospasm; Prophylaxis of exercise-induced bronchospasm
ROUTES OF ADMINISTRATION: Inhalation Aerosol, Inhalation
Solution, AccuNeb, Tablets, Syrup
USUAL DOSAGE: Proventil: Over 12 y/o 180 mcg (2 puffs) q 4-6 hr (May
only need one puff or 90 mcg q 4 hr) 4 times daily; same dosage 15 mins
prior to exercise if needed
ADVERSE REACTIONS: Headache, nausea & vomiting, palpitations/tachycardia,
tremor, bronchospasm

INTERACTIONS: Anesthetics – halogenated anesthetics sensitize heart to adrenergics


(causes cardiac arrhythmias); Antidiabetics – hyperglycemic effect of epinephrine may
necessitate ↑ dosage of insulin or oral hypoglycemic agents; Digitalis glycosides –
combination may cause cardiac arrhythmias; Oxytocics - ↑ chance of severe hypertension

CONTRAINDICATIONS: Tachycardia due to arrhythmias; aerosol for prevention of


exercise-induced bronchospasm and tablets are not recommended for children under 12
y/o.

NURSING CONSIDERATIONS: Do not confuse albuterol with atenolol; when given


by nebulation, use face mask or mouthpiece with compressed air or O2 with flowrate of 6-
10 lpm and should last 5-15 min; contents of MDI are under pressure (do not store near
heat or open flame); Proventil HFA and Ventolin HFA contain hydroflouroalkane as
propellant; practice breathing techniques for administration; when using inhalers, do not
use other albuterol inhalation medication unless specifically prescribed
GENERIC NAME: NITROGLYCERIN TOPICAL OINTMENT
TRADE NAME: Nitro-Bid
CLASSIFICATION: Coronary Vasodilator
ACTION: Nitrates relax vascular smooth muscle by stimulating production
of intracellular cyclic guanosine monophosphate. Dilation of post capillary
vessels decreases venous return to the heart due to pooling of blood; thus left
ventricle end-diastolic pressure is reduced; Relaxation of arterioles results in
a decreased systemic vascular resistance and arterial pressure; Oxygen
requirements of the myocardium are reduced and there is more efficient
redistribution of blood flow through collateral channels in myocardial tissue
INDICATIONS: Prophylaxis and treatment of angina pectoris due to CAD;
onset of action not rapid enough to be used to abort an acute anginal attack
ROUTES OF ADMINISTRATION: 2% Ointment
USUAL DOSAGE: 2 daily ½ inch doses (7.5 mg); apply one on rising in
morning and one 6 hr later; can be doubled and then doubled again if no
response and if tolerable
ADVERSE REACTIONS: Headache (may be severe and persistant), flushing,
dizziness, weakness, hypotension, paresthesia

INTERACTIONS: Ethyl alcohol – hypotension and cardiovascular collapse related to


vasodilator effect of both agents; antihypertensive drugs – additive hypotension; aspirin -
↑ serum levels and effects of nitrates; heparin – possible ↓ effect; narcotics – additive
hypotensive effect

CONTRAINDICATIONS: Sensitivity of nitrates, which may result in severe


hypotensive reaqctions, MI, or tolerance to nitrates; severe anemia, cerebral hemorrhage,
recent head trauma, postural hypotension, closed angle glaucoma, impaired hepatic
function, hypertrophic cardiomyopathy, hypotension, recent MI

NURSING CONSIDERATIONS: Do not use Nitro-Bid with Nicobid; Store from 15-
30˚C (59-86˚F); squeeze ointment onto application papers and fold paper in half, rub
back and forth, apply onto non-hairy part of skin; rotate sites to prevent irritation; once
dose established, use same type of covering to ensure same amount administered each
time; remove at bedtime or as directed to prevent tolerance or loss of drug effect
GENERIC NAME: MULTIVITAMINS
TRADE NAME: Centrum, One-A-Day, Equate Complete
CLASSIFICATION: Essential, organic, non-caloric, required for normal metabolism
ACTION: Essential for promoting growth, health, vitality, life, general well being,
prevention and cure of many health problems and diseases; necessary for metabolic
processes responsible for transforming foods into energy or tissue; formation and
maintenance of red blood cells, chemicals supporting the nervous system, hormones and
genetic material
INDICATIONS: Fat-soluble – A, D, E, K; water-soluble – C, B-complex; do not
provide energy (non-caloric) but some convert calories in fats, carbohydrates, and
proteins into usable body energy; cannot be assimilated without ingesting food; should be
taken with a meal; regulate metabolism, help convert fat and carbohydrates into energy;
assist in forming bone and tissue
ROUTES OF ADMINISTRATION: Tablet
USUAL DOSAGE: A – 5,000 (males), 4000 (females) international units (IU); B1 – 0.3-
1.5mg; B2 – 0.4-2.0mg; B3 – 5-20mg; B6 – 1.3-1.7mg; Folacin – 400mcg; Pantothenic
acid – 4-7mg; B12 – 6mcg; B7 – 100-300mcg; C – 90mg (men), 75mg (women), extra
35mg (smokers); D – 100-1500 IU; E – 22-33 IU; K – 80mcg (men), 65mcg (women)
SEVERE DIFICIENCY DISEASES: Scurvy, Rickets, Pellagra, pernicious anemia,
xerophthalmia, beriberi, osteomalacia, infantile hemolytic anemia, hemorrhagic diseases
of newborn; moderate vitamin deficiencies may also produce symptoms of impaired
health
INTERACTIONS: No major interactions involved; water-soluble vitamins mix well in
blood, are excreted by kidneys, only small amounts accumulate in tissues; regular intake
essential; fat-soluble vitamins stored in body after binding to specific plasma globulins in
fat parts of body; may accumulate in body and cause adverse reactions
CONTRAINDICATIONS: No adverse effects; no contraindications; vitamin D
deficiency is often underdiagnosed and undertreated in older population; clients with
impaired liver function should not take large amounts of fat-soluble vitamins unless
specifically prescribed due to toxicity potential from cumulative effects; pregnant and
breast-feeding women require more of some vitamins than most adults; vitamin
deficiency usually involves multiple rather than single deficiencies and is rare in US; can
usually be attributed to poor lifestyle choices or poor dietary habits with inadequate
intake of many vitamins.
NURSING CONSIDERATIONS: Document indications for therapy; assess metabolic
panel and vitamin levels; monitor levels to ensure requirements met and levels are as
desired; well-balanced diet with foods from basic groups is best source; take with food
for best absorption; avoid self-medication greater than RDA amounts
GENERIC NAME: METOPROLOL TARTRATE
TRADE NAME: Lopressor
CLASSIFICATION: Beta-adrenergic Blocking Agent
ACTION: Combines reversibly mainly with beta1-adrenergic receptors to block the
response to sympathetic nerve impulses, circulating catecholamines, or adrenergic drugs;
Blockage of beta1-receptors decreases heart rate, myocardial contractility, and cardiac
output and slows AV conduction, all of which decreases blood pressure
INDICATIONS: Hypertension; Acute MI in hemodynamically stable patients; Angina
pectoris
ROUTES OF ADMINISTRATION: Injection, Tablets
USUAL DOSAGE: Hypertension: 100 mg/day in single or divided doses; may be
increased weekly to 100-450 mg/day; Angina pectoris; 100 mg/day in 2 divided doses,
can be increased weekly until response obtained or heart rate slows; effective dose is 100-
400 mg/day; Aggressive behavior: 200-300 mg/day; Ventricular arrhythmias: 200
mg/day: IV: Early MI treatment: Three IV bolus injections of 5 mg each at approx. 2 min
intervals; then give 50 mg q 6 hr PO starting 15 min after last IV dose; continue for 48
hrs then 100 mg twice a day, continue for 1-3 months
ADVERSE REACTIONS: Fatigue, dizziness, depression, shortness of breath,
bradycardia, diarrhea

INTERACTIONS: Oral contraceptives/quinidine – may ↑ metoprolol effects;


diphenhydramine - ↓ metoprolol clearance → prolonged negative chronotropic and
inotropic effects in extensive metabolizers; methimazole/propylthiouracil – may ↓
metoprolol effects; rifampin - ↓ metoprolol effect related to ↑ liver metabolism

CONTRAINDICATIONS: MI in clients with a heart rate of less than 45 bpm, in


second- or third-degree heartblock, or if SBP is less than 100 mm Hg; moderate to severe
cardiac failure

NURSING CONSIDERATIONS: Do not confuse metoprolol with metoclopramide,


metaproterenol, or misoprostol; if transcient worsening of heart failure occurs, treat with
increased doses of diuretics; may need to lower dose of metoprolol or temporarily
discontinue; for CHF, do not increase dose until symptoms of worsening CHF have been
stabilized; if CHF clients experience symptomatic bradycardia, reduce dose; take dose
each day at same time; do not stop suddenly
GENERIC NAME: TRIAMTERENE AND HYDROCHLOROTHIAZIDE

TRADE NAME: Dyazide, Maxzide, Maxzide-25 MG

CLASSIFICATION: Antihypertensive, combination drug


ACTION: Triamterence acts directly on the distal tubule to promote the excretion of
sodium, bicarbonate, chloride, and fluid; Increases urinary pH; Hydrochlorothiazide
promotes excretion of sodium and chloride and thus water by distal renal tubule; Also
increases excretion of potassium and smaller amounts of bicarbonate; Antihypertensive
effects due to direct dilation of arterioles as well as fluid volume loss

INDICATIONS: Hypertension or edema in clients who manifest hypokalemia on


hydrochlorothiazide alone; in clients requiring a diuretic and in whom hypokalemia can
not be risked; usually not first line of therapy except when avoiding hypokalemia
ROUTES OF ADMINISTRATION: Capsules, Tablets

USUAL DOSAGE: Capsules: 37.5mgT/25mgH – 1-2 capsules once daily;


50mgT/25mgH – 1-2 capsules (possibly just need one capsule)
Tablets: 37.5mgT/25mgH – 1-2 tablets daily or 75mgT/25mgH 1 tablet daily
ADVERSE REACTIONS: Nausea & vomiting, headache, anorexia, GI upset, diarrhea,
flatulence, dizziness, photosensitivity
INTERACTIONS: Anesthetics – Thiazides may ↑ effects of anesthetics; antidiabetic
agents – thiozides antagonize hypoglycemic drug effects; antihypertensive agents –
thiazides potentiate drug effects; corticosteroids – enhanced potassium loss related to
potassium-losing properties of both drugs; digoxin – thiazides produce ↑ K and Mg loss
with ↑ chance of digitalis-induced arrhythmias; furosemide – profound diuresis and
electrolyte loss; insulin - ↓ effect related to thyazide-induced hyperglycemia;
tetracyclines - ↑ risk of azotemia; vitamin D - ↑ effect of vitamin D related to thiazide-
induced hypercalcemia
CONTRAINDICATIONS: Clients receiving other potassium-sparing drugs (amiloride,
spironolactone); use in anuria, acute or chronic renal insufficiency, significant renal
impairment, preexisting elevated serum potassium
NURSING CONSIDERATIONS: Assess for alcoholism (megaloblastic anemia may
occur because triamterene is weak antagonist of folic acid; monitor vital signs and tests
(reduce dose with dysfunction; drug is taken to lower BP and reduce swelling of
extremities (take in AM with food to reduce GI upset); check for signs/symptoms of
blood dyscrasia (sore throat, rash, fever); check for signs of anemia; avoid alcohol, OTC
agents, potassium supplements, salt substitutes that contain potassium, foods high in
potassium (drug is potassium-sparing)
GENERIC NAME: POTASSIUM SALTS
TRADE NAME: K+ Care ET
CLASSIFICATION: Electrolyte Supplements
ACTION: Potassium is readily and rapidly absorbed from the GI tract. Potassium
chloride is used because hypochloremia frequently accompanies potassium deficiency;
Potassium deficiency can be prevented or corrected through dietary measures
INDICATIONS: Treat Hypokalemia due to digitalis intoxication, diabetic acidosis,
diarrhea and vomiting, familial periodic paralysis, certain cases of uremia,
hyperadrenalism, starvation and debilitation, and corticosteroid or diuretic therapy;
Hypokalemia with or without metabolic acidosis and following surgical conditions
accompanied by nitrogen loss, vomiting and diarrhea, suction drainage, and increased
urinary excretion of potassium; Prophylaxis of potassium depletion when dietary intake is
not adequate in certain patients (CHF) with diuretics, hepatic cirrhosis with ascites,
excess aldosterone
ROUTES OF ADMINISTRATION: Capsules, SLOW IV, Tablets
USUAL DOSAGE: HIGHLY individualized: IV infusion; serum less than 2.0 mEq/L –
400 mEq/day at rate not exceeding 40 mEq/hr; serum less than 2.5 mEq/L – 200 mEq/day
not exceeding 20 mEq/hr: Capsules/Tablets 16-24 mEq/day for hypokalemia prophylaxis
ADVERSE REACTIONS: Nausea & vomiting, diarrhea, flatulence, abdominal
discomfort

INTERACTIONS: ACE inhibitors – may cause potassium retention → hyperkalemia;


digitalis glycosides – cardiac arrhythmias; potassium-sparing diuretics – severe
hyperkalemia with possibility of cardiac arrhythmias or arrest

CONTRAINDICATIONS: Severe renal function impairment with azotemia or oliguria,


postoperatively before urine flow has been reestablished, crush syndrome, Addison’s
disease, hyperkalemia from any cause, anuria, heat cramps, acute dehydration, severe
hemolytic reactions, adynamia episodica hereditaria, clients receiving potassium-sparing
diuretics or aldosterone-inhibiting drugs

NURSING CONSIDERATIONS: Give PO 3-4 times/day; correct hypokalemia


gradually over 3-7 days to avoid hyperkalemia; administer dilute liquid solutions of
potassium with esophageal compression; check administration site frequently for pain
and redness (drug extremely irritating); note impaired renal function; assess adequate
urinary flow before administering potassium; withhold drug, report abdominal pain,
distention, GI bleeding; check for signs of hypokalemia (weakness, fatigue, cardiac
arrhythmias)
GENERIC NAME: HEPARIN SODIUM AND SODIUM CHLORIDE
TRADE NAME: Heparin sodium and 0.45% Sodium Chloride, Heparin Sodium and 0.9%
Sodium Chloride
CLASSIFICATION: Heparin, Anticoagulant
ACTION: Does not dissolve previously formed clots, but forestalls enlargement and prevents
new clots from forming; Potentiates inhibitory action of antithrombin III; Occurs due to
formation of a complex with antithrombin III and causing a conformational change in
antithrombin III molecule; Action of thrombin in coagulation is inhibited; Also prevents
formation of a stable fibrin clot by inhibiting the activation of fibrin-stabilizing factor by
thrombin
INDICATIONS: Pulmonary/peripheral arterial embolism; Prophylaxis and treatment of venous
thrombosis and extensions; Atrial fibrillation with embolization; Treatment and diagnosis of DIC;
in low doses to prevent DVT and PE in pregnant clients with thromboembolism history and
others; Prophylaxis of clotting in blood transfusions and others
ROUTES OF ADMINISTRATION: Deep Subcutaneous, Intermittent IV, Continuous IV,
Special Uses
USUAL DOSAGE: Deep SC: Initial loading dose 10,000-20,000 units; maintenance dose 8,000-
10,000 units q 8 hr or 15,000-20,000 units q 12 hr: IV Inter: ILD-10,000 units undiluted or in 50-
100mL saline, then 5,000-10,000 units q 4-6 hr undiluted or in 50-100mL saline: Cont IV: ILD-
20,000-40,000 units/day in 1,000mL saline after 5,000 units IV
ADVERSE REACTIONS: Hemorrhage ranging from minor local ecchymoses to major
hemorrhagic complications from any organ, chills, fever, urticaria, local irritation,
erythema, mild pain, hematoma
INTERACTIONS: Oral
anticoagulants/dipyridamole/hydroxychloroquine/ibuprofen/indomethacin/NSAIDs/ticlop
idine – additive ↑ prothrombin time;
Antihistamines/digitalis/nicotine/nitroglycerin/tetracyclines - ↓ effect of heparin
CONTRAINDICATIONS: Active bleeding, blood dyscrasias (or other bleeding
disorders as in hemophilia), clients with frail or weakened blood vessels, purpura,
thrombocytopenia, liver disease with hypoprothrombinemia, open wounds, extensive
denudation of skin, increased capillary permeability; do not administer during surgery of
eye, brain or spinal cord or during continuous tube drainage of stomach or small intestine
NURSING CONSIDERATIONS: Do not administer IM; administer by deep subQ
injection to minimize local irritation, hematoma, and tissue sloughing and to prolong drug
action; utilize Z-track method or ‘Bunch technique’ method; do not administer within 2
in of umbilicus (decreased vascularity); do not massage site, slight discoloration does not
affect potency; perform test dose (1,000 units subQ) on clients with allergies or asthma
history
GENERIC NAME: INSULIN INJECTION (REGULAR)
TRADE NAME: (Human insulin) Humulin R, Novolin R, Novolin R
PenFill, Novolin R Prefilled, Velosulin BR (Pork Insulin) Regular Iletin II
CLASSIFICATION: Rapid-Acting Insulin Product
ACTION: Regular insulin is only preparation suitable for IV administration;
ONLY comes in 100 units/mL; rarely used as sole agent due to short
duration of action; Injections should be clear: Any cloudy or colored
solutions should not be used.
INDICATIONS: Suitable for treatment of diabetic coma, diabetic acidosis,
other emergency situations; especially suitable for client suffering from
labile diabetes; during acute phase of diabetic acidosis or for client in
diabetic crisis, client is monitored by serum glucose and serum ketone levels
ROUTES OF ADMINISTRATION: Subcutaneous
USUAL DOSAGE: Diabetes: Adults 5-10 units given 15-30 min prior to
meals and at bedtime (Peds 2-4 units)
ADVERSE REACTIONS: Hypoglycemia, hypokalemia, injection site reaction,
lipodystrophy, pruritus, rash

INTERACTIONS: ACE inhibitors/anabolic steroids/oral


antidiabetics/calcium/chloroquine/clofibrate/clonidine - ↑ hypoglycemic effect of insulin;
Acetazolamide/AIDS antiviral
drugs/albuterol/asparaginase/calcitonin/chlorthalidone/clozapine - ↓ hypoglycemic effect
of insulin (ONLY PARTIAL LIST: TOO MANY DRUG INTERACTIONS TO
LIST)

CONTRAINDICATIONS: Hypersensitivity to insulin; during episodes of


hypoglycemia in clients sensitive to any component of the product

NURSING CONSIDERATIONS: Assess for S/S of hypoglycemia (drowsiness, chills,


confusion, anxiety, cold sweats, cool pale skin, excessive hunger, nausea, headache,
irritability, shakiness, rapid pulse, unusual tiredness or weakness); assess S/S for
hyperglycemia (thirst, polydipsia, polyuria, drowsiness, blurred vision, loss of appetite,
fruity odor to breath, flushed dry skin); weigh client to determine amount to be given;
monitor glucose levels carefully in elderly and with hepatic or renal impairment; assess
injection sites, monitor VS (many more considerations; too many to list)
GENERIC NAME: ISOPHANE INSULIN SUSPENSION (NPH)
TRADE NAME: (Human) Humulin N, Novolin N, Novolin N PenFill,
Novolin N Prefilled
CLASSIFICATION: Intermediate-Acting Insulin product
ACTION: Contains zinc insulin crystals modified by protamine, appearing
as cloudy or milky suspension; Not recommended for emergency use; not
suitable for IV administration or in presence of ketosis
INDICATIONS: Replacement therapy in Type 1 Diabetes; Type 2 diabetes
when other methods have failed, blood sugars are significantly elevated, or
with surgery, trauma, infection, fever, endocrine dysfunction, pregnancy,
gangrene, Raynoud’s disease, kidney or liver dysfunction
ROUTES OF ADMINISTRATION: Subcutaneous
USUAL DOSAGE: 7-26 units as single dose 30-60 min before breakfast:
second similar or smaller dose may be given prior to dinner or at bedtime;
can be increased in increments of 2-10 units at daily or weekly intervals
ADVERSE REACTIONS: Hypoglycemia, hypokalemia, injection site reaction,
lipodystrophy, pruritus, rash, allergic reactions

INTERACTIONS: ACE inhibitors/anabolic steroids/oral


antidiabetics/calcium/chloroquine/clofibrate/clonidine - ↑ hypoglycemic effect of insulin;
Acetazolamide/AIDS antiviral
drugs/albuterol/asparaginase/calcitonin/chlorthalidone/clozapine - ↓ hypoglycemic effect
of insulin (ONLY PARTIAL LIST: TOO MANY DRUG INTERACTIONS TO
LIST)

CONTRAINDICATIONS: Hypersensitivity to insulin; during episodes of


hypoglycemia in clients sensitive to any component of the product

NURSING CONSIDERATIONS: Assess for S/S of hypoglycemia (drowsiness, chills,


confusion, anxiety, cold sweats, cool pale skin, excessive hunger, nausea, headache,
irritability, shakiness, rapid pulse, unusual tiredness or weakness); assess S/S for
hyperglycemia (thirst, polydipsia, polyuria, drowsiness, blurred vision, loss of appetite,
fruity odor to breath, flushed dry skin); weigh client to determine amount to be given;
monitor glucose levels carefully in elderly and with hepatic or renal impairment; assess
injection sites, monitor VS (many more considerations; too many to list)
GENERIC NAME: METHYLPREDNISOLONE SODIUM SUCCINATE

TRADE NAME: A-methaPred, Solu-Medrol

CLASSIFICATION: Glucocorticoid

ACTION: Anti-inflammatory effect is due to inhibition of prostaglandin synthesis; drug


also inhibits accumulation of macrophages and leukocytes at sites of inflammation and
inhibits phagocytosis and lysosomal enzyme release; low incidence of increased appetite,
peptic ulcer, psychic stimulation, and sodium and water retention; may mask negative
nitrogen balance
INDICATIONS: Severe hepatitis due to alcoholism; within 8 hr or severe spinal cord
injury (to improve neurological function); septic shock; nephritic syndrome, including
that due to lupus erythematosus or of the idiopathic type; hematologic diseases, including
hemolytic anemia, RBC anemia, idiopathic and secondary thrombocytopenic purpura in
adults (IV only), congenital hypoplastic anemia
ROUTES OF ADMINISTRATION: Powder for injection
USUAL DOSAGE: Initial 10-40 mg, depending on disease, then adjust dose depending
on response with following doses either IM or IV: SEVERE conditions – 30 mg/kg
infused IV over 10-20 min, may be repeated q 4-6 hr for 2-3 days only
ADVERSE REACTIONS: Small physiologic doses given as replacement therapy or
short-term high-dosage therapy during emergencies rarely cause side effects.

INTERACTIONS: Erythromycin - ↑ methylprednisolone effect related to ↓ liver


metabolism; grapefruit juice - ↑ AUC (area under the curve), peak levels, and half-life of
methylprednisolone related to ↓ liver metabolism

CONTRAINDICATIONS: Suspected infection as drug may mask infection, peptic


ulcer, phychoses, acute glomerulonephritis, herpes simplex infections of the eye, vaccinia
or varicella, Cushing’s syndrome, active tuberculosis, myasthenia gravis, recent intestinal
anastomoses, CHF or other cardiac disease, hypertension, systemic fungal infections,
open angle glaucoma

NURSING CONSIDERATIONS: Do not confuse Solu-Medrol with Solu-Cortef;


dosage must be individualized; use within 48 hours of preparation; note any aspirin
allergies, monitor vital signs, weight, chemical results; take as directed, may take with
food or milk to diminish GI upset
GENERIC NAME: VANCOMYCIN HYDROCHLORIDE
TRADE NAME: Vancocin, Vancoled
CLASSIFICATION: Miscellaneous Antibiotic
ACTION: Appears to bind to bacterial cell wall, arresting its synthesis and lysing the
cytoplasmic membrane by a mechanism that is different from that of penicillins and
cephalosporins; may also change permeability of the cytoplasmic membranes of bacteria,
thus inhibiting RNA synthesis; bactericidal for most organisms and bacteriostatic for
enterococci
INDICATIONS: PO – Antibiotic-induced pseudomembranous colitis due to Clostridium
difficile; Staphylococcal enterocolitis; Severe or progressive antibiotic-induced diarrhea
caused by C. difficile that is not responsive to the causative antibiotic being discontinued;
also for debilitated clients IV – Severe Staphylococcal infections in clients who have not
responded to penicillins or cephalosporins, who cannot receive these drugs, or who have
resistant infections; prophylaxis of bacterial endocarditis in PCN-allergic patients
ROUTES OF ADMINISTRATION: Capsules, powder for injection or oral solution
USUAL DOSAGE: PO – 0.5-2 g/day in 3-4 divided doses for 7-10 days OR 125 mg 3-4
times per day for C.difficile may be as effective as 500 mg dosage: IV – 500 mg q 6 hr or
1 g q 12 hr
ADVERSE REACTIONS: Oxotoxicity (including tinnitus), chills, coughing,
drowsiness, anorexia, nausea & vomiting, weakness, sore throat, fever

INTERACTIONS: Anesthetics - ↑ risk of erythema and histamine-like flushing in


children; nondepolarizing muscle relaxants - ↑ neuromuscular blockage;
nephritic/neurotoxic drugs – carefully monitor with concurrent or sequential systemis or
topical use

CONTRAINDICATIONS: Hypersensitivity; minor infections; lactation

NURSING CONSIDERATIONS: Reduce dosage in renal disease; dilute each 500 mg


vial with 10 mL sterile water (may further be diluted in 200 mL of dextrose or saline
solution and infused over 60 min); intermittent infusion preferred but may also be
administered with continuous IV drip; avoid rapid IV administration (may result in
hypotension, nausea, warmth, generalized tingling); aqueous solution stable for 2 weeks;
assess renal and auditory functions; report adverse drug effects such as oxotoxicity and
nephrotoxicity; during IV administration, ensure peak and trough levels are performed at
prescribed dosing interval (30 min prior and 1 hr after dosage)
GENERIC NAME: AMLODIPINE

TRADE NAME: Amvaz, Norvasc

CLASSIFICATION: Calcium Channel Blocker

ACTION: Inhibits influx of calcium through the cell membrane, resulting in depression
of automaticity and conduction velocity in cardiac muscle; decreases SA and AV
conduction and prolongs AV node effective and functional refractory periods; slight
decrease in heartrate; possible slight decrease in myocardial contractility; cardiac output
is increased; moderate decrease in peripheral vascular resistance

INDICATIONS: Hypertension alone or in combination with other antihypertensives;


chronic stable angina alone or in combination with other antianginal drugs; vasospastic
angina alone or in combination with other antianginal drugs

ROUTES OF ADMINISTRATION: Tablets

USUAL DOSAGE: 5 mg/day, up to maximum of 10 mg/day; titrate dose over 7-14 days
ADVERSE REACTIONS: Edema, palpitations, dizziness/lightheadedness,
headache, fatigue/lethargy, flushing

INTERACTIONS: Diltiazem - ↑ plasma levels of amlodipine → further ↓


BP; grapefruit juice - ↑ plasma amlodipine levels; Ranitidine - ↑ effect of
CCBs related to ↓first-pass metabolism

CONTRAINDICATIONS: Use with grapefruit juice

NURSING CONSIDERATIONS: Do not confuse Norvasc with Navane;


food does not affect bioavailability; elderly clients, small/fragile clients, or
clients with hepatic insufficiency may be started on 2.5 mg/day; take as
directed once daily; may take with or without meals (food helps decrease
stomach upset); report signs/symptoms of chest pain, SOB, dizziness,
swelling of extremities, irregular pulse, altered vision immediately
GENERIC NAME: CLOTRIMAZOLE TOPICAL CREAM
TRADE NAME: Fungoid, Lotrimin
CLASSIFICATION: Antifungal
ACTION: Depending on concentration, may be fungicidal or fungistatic;
acts by inhibiting the biosynthesis of sterols, resulting in damage to cell wall
and subsequent loss of essential intracellular elements due to altered
permeability; may also inhibit oxidative and peroxidative enzyme activity
and inhibit the biosynthesis of triglycerides and phospholipids by fungi
INDICATIONS: Broad-spectrum antifungal; Tinea pedis, tinea cruris, tinea
corporis due to T. rubrum, T. mentagrophytes, E. floccosum, and M. canis;
candidiasis due to C. albicans, and tinea versicolor due to M. furfur.
ROUTES OF ADMINISTRATION: Topical cream
USUAL DOSAGE: Use daily for 2 weeks or 4 weeks depending on disease;
if symptoms persist, consult provider
ADVERSE REACTIONS: Irritation, rash, stinging, burning, pruritus

INTERACTIONS: Use with caution when lactating

CONTRAINDICATIONS: Hypersensitivity; first trimester of pregnancy;


in children under 2 y/o; around eyes

NURSING CONSIDERATIONS: Do not allow topical products in eyes;


wash hands before and after treatments; report adverse effects or lack of
response
GENERIC NAME: FLUCONAZOLE

TRADE NAME: Diflucan

CLASSIFICATION: Antifungal

ACTION: Is highly selective inhibitor of fungal cytochrome P450 and sterol C-14 alpha-
demethylation; loss of normal sterols correlates with accumulation of 14 alpha-methyl
sterols in fungi and may be responsible for the fungistatic activity; decrease in cell wall
integrity and extrusion of intracellularmaterial, leading to death

INDICATIONS: Oropharyngeal and esophageal candidiasis; serious systemic candidal


infection (including UTIs, peritonitis, candidemia, disseminated candidiasis, and
pneumonia); cryptococcal meningitis

ROUTES OF ADMINISTRATION: IV, oral suspension, tablets

USUAL DOSAGE: Candidal UTI and peritonitis – 50-200 mg/day: oropharyngeal or


esophageal candidiasis – 150 mg as single oral dose
ADVERSE REACTIONS: Following single doses: headache, nausea, abdominal pain,
diarrhea, angioedema; following multiple doses: Nausea, headache, skin rash, vomiting,
abdominal pain, serious hepatic reactions, seizures

INTERACTIONS: Benzodiazepines – ↑ and prolonged serum levels → CNS depression


and psychomotor impairment; Glyburide – ↑ plasma glyburide levels related to ↓ liver
breakdown; Glipizide – ↑ plasma glipizide levels related to ↓ liver breakdown; oral
contraceptives – possible ↑ or ↓ plasma levels of ethinyl estradiol and levonorgestrel;
protease inhibitors – possible ↑ protease inhibitor levels with possible ↑ toxicity; MANY
MORE

CONTRAINDICATIONS: Hypersensitivity to fluconazole, lactation

NURSING CONSIDERATIONS: Daily dose same for either IV or PO; store tablets
under 30ºC (86ºF); loading dose of twice daily dose is recommended for first day to
obtain plasma levels close to steady state by second day; due to long half-life, once daily
dosing (either IV or PO) is possible; do not use IV solution if cloudy, precipitated, or seal
broken; do not exceed continuous IV infusion rate of 200 mg/hr; check site frequently for
extravasation/necrosis; describe clinical presentation of fungal infection
GENERIC NAME: CEFTAZIDIME

TRADE NAME: Ceptaz, Fortaz, Tazicef, Tazidime


CLASSIFICATION: Cephalosporin, third generation
ACTION: Only for IV or IM usage; between 80 and 90% is excreted unused
in urine
INDICATIONS: Lower respiratory tract infections due to Pseudomonas
aeruginosa and other Pseudomonas species, Haemophilus influenzae,
Klebsiella species, Enterobacter species, Proteus mirabilis, Escherichia
coli, Serratia species, Citrobacter species, Streptococcus pneumoniae,
Staphylococcus aureus; Skin and skin structure infections; UTIs, both
complicated and uncomplicated; bacterial septicemia; bone and joint
infections; gynecologic infections; intra-abdominal infections; CNS
infections
ROUTES OF ADMINISTRATION: IM, IV
USUAL DOSAGE: Usual infections – IM, IV: 1 g q 8-12 hr; UTIs – IM, IV
– 0.25-0.5 g q 12 hr; pneumonia, mild skin infections – 0.5-1 g q 8 hr
ADVERSE REACTIONS: Nausea & vomiting, diarrhea, yeast infection of
mouth or vagina, abdominal pain, stomach cramps, colitis, thrombophlebitis

INTERACTIONS: Colistimethate/colistin/ethacrynic
acid/furosemide/polymyxin B/vancomycin - ↑ risk of renal toxicity;
probenecid - ↑ effect of cephalosporins by ↓ excretion by kidney

CONTRAINDICATIONS: Hypersensitivity to cephalosporins or related


antibiotics

NURSING CONSIDERATIONS: For IM, reconstitute in sterile or


bacteriostatic water or 0.5% or 1% lidocaine injection, use large muscle
mass and inject deeply; IV route is preferred with bacterial septicemia,
peritonitis, bacterial meningitis, or other severe/life threatening infections;
for direct IV, reconstitute 1 g in 10 mL sterile water for injection (give over
3-5 min); do not give ceftazidime to solutions containing aminoglycosides
GENERIC NAME: BRIMONIDINE TARTRATE

TRADE NAME: Alphagan P.

CLASSIFICATION: Sympathomimetic

ACTION: An alpha-2 adrenergic receptor antagonist that reduces aqueous


humor production and increases uveoscleral outflow

INDICATIONS: lower intraocular pressure in open-angle glaucoma or


ocular hypertension

ROUTES OF ADMINISTRATION: Solution for eye drops

USUAL DOSAGE: 1 gtt (drop) in the affected eye(s) three times a day,
with doses about 8 hr apart
ADVERSE REACTIONS: Hypertension, somnolence, headache, fatigue,
dizziness, asthenia, oral dryness, upper respiratory symptoms, GI symptoms,
burning/stinging, blurring, foreign body sensation, ocular pruritus

INTERACTIONS: Antihypertensives/Beta-adrenergic blockers/cardiac


glycosides – May ↓ pulse and BP; use caution if combined; CNS depressants
– Possible additive CNS depression; MAOIs – DO NOT USE TOGETHER

CONTRAINDICATIONS: Must use MAO inhibitor therapy; lactation;


Use in children less than 2 years old

NURSING CONSIDERATIONS: Give with other topical ophthalmic


drugs 5 min apart; store at or below 25ºC (77ºF); document findings, ensure
routine screenings; avoid alcohol and other CNS depressants; remove prior
and do not reinsert soft contact lenses until at least 15 min after instillation
GENERIC NAME: QUETIAPINE FUMARATE
TRADE NAME: Seroquel
CLASSIFICATION: Antipsychotic
ACTION: Mechanism unknown but may act as an antagonist at dopamine
D2 and serotonin SHT2 receptors; side effects may be due to antagonism of
other receptors (e.g. histamine H1, dopamine D1, adrenergic alpha1 and
alpha2, serotonin SHT1A)
INDICATIONS: Treatment of schizophrenia; short-term treatment of acute
manic episodes associated with bipolar 1 disorder either as monotherapy or
adjunct therapy with divalproex or lithium
ROUTES OF ADMINISTRATION: Tablet
USUAL DOSAGE: 25 mg 2 times daily, increases of 25 to 50 mg 2-3 times
daily on second and third day as tolerated; target dose range for fourth day is
300-400 mg divided into 2 or 3 doses; antipsychotic dose range is 150 to 750
mg/day; if adjustments are needed, lower or raise by increments of 25-50 mg
twice daily
ADVERSE REACTIONS: Headache, drowsiness/somnolence, dizziness,
hypotension, tachycardia, constipation, dry mouth, dyspepsia
INTERACTIONS:
Barbiturates/carbamazepine/glucocorticoids/phenytoin/rifampin - ↓
quetiapine effect related to ↑ liver breakdown; dopamine
antagonists/levodopa – quetiapine antagonizes effect; thioridazine - ↑
quetiapine clearance
CONTRAINDICATIONS: Lactation
NURSING CONSIDERATIONS: Continue clients who respond to
quetiapine using the lowest dose needed to maintain remission; periodically
reassess; consider slower rate of titration and lower target dose in elderly,
debilitated clients, or in those who have a predisposition to hypotensive
reactions; store at 15-30ºC (59-86F); list reasons for therapy, clinical
presentation, behavioral manifestations; avoid alcohol and other OTC agents
without approval; take with or without food
GENERIC NAME: CLOTRIMAZOLE
TRADE NAME: Cruex, Desenex, Fungoid, Lotrimin, Lotrimin AF,
Mycelex
CLASSIFICATION: Antifungal
ACTION: Depending on concentration, may be fungistatic or fungicidal;
acts by inhibiting the biosynthesis of sterols, resulting in damage to the cell
wall and subsequent loss of essential intracellular elements due to altered
permeability; may also inhibit oxidative and perioxidative enzyme activity
and inhibit biosynthesis of triglycerides and phospholipids by fungi
INDICATIONS: Broad-spectrum antifungal; candidiasis due to C. albicans
and tinea versicolor due to M. furfur; tinea pedis, tinea cruris, and tinea
corporis due to T. rubrum, T. mentagrophytes, E. floccosum and M. canis
ROUTES OF ADMINISTRATION: Topical and vaginal cream
USUAL DOSAGE: Massage into affected skin and surrounding areas twice
daily (morning and evening); reevaluate if no improvement in 4 weeks
ADVERSE REACTIONS: Skin irritation, rash, burning, stinging, pruritus

INTERACTIONS: None specific

CONTRAINDICATIONS: Hypersensitivity; first trimester of pregnancy;


use around eyes; topically in children under 2 years old

NURSING CONSIDERATIONS: Do not get products in eyes; wash hands


prior and after handling product; apply only after cleaning affected area; use
napkin to prevent staining of clothing; report lack of response
GENERIC NAME: ASPIRIN (ACETYLSALICYCLIC ACID, ASA)
TRADE NAME: Empirin, Genprin, Genuine Bayer Aspirin, Maximum Bayer Aspirin,
Extended release Bayer 8-hour caplets, ZORprin, Easprin, MANY MORE
CLASSIFICATION: Nonsteroidal, anti-inflammatory drug, analgesic, antipyretic
ACTION: Exhibits antipyretic, anti-inflammatory, and analgesic effects; Antipyretic due
to an action on the hypothalamus, resulting in heat loss by vasodilation of peripheral
blood vessels and promoting sweating; Anti-inflammatory mediated through inhibition of
cyclo-oxygenase, which results in a decrease in prostaglandin synthesis and other
mediators of pain response
INDICATIONS: Analgesic – Pain from integumentary structures, myalgias, neuralgias,
arthralgias, headache, dysmenorrheal, and similar types of pain; gout; Antipyretic, Anti-
inflammatory – arthritis, osteoarthritis, SLE, acute rheumatic fever, gout, and many other
conditions
ROUTES OF ADMINISTRATION: Caplets, gum, suppositories, tablets, chewable
tablets, coated tablets, delayed-release tablets, effervescent tablets, enteric-coated tablets
USUAL DOSAGE: 325-500 mg q 3 hr, 325-600 mg q 4 hr, or 650-1,000 mg q 6 hr
ADVERSE REACTIONS: Dyspepsia, nausea, epigastric, discomfort

INTERACTIONS: TOO MANY TO LIST

CONTRAINDICATIONS: Hypersensitivity to salicylates; clients with


asthma, hay fever, or nasal polyps have higher incidence of hypersensitivity;
severe anemia, history of blood coagulation defects, in conjunction with
anticoagulant therapy; vitamin K deficiency

NURSING CONSIDERATIONS: Enteric-coated or buffered tablets better


tolerated by some; take with full glass of water; use epinephrine to
counteract hypersensitivity; take temperature 1 hour after administering;
note if asthma, hay fever, ulcer disease or nasal polyps; take as directed;
administer with meals and glass of water
GENERIC NAME: FLUTICASONE PROPIONATE AND
SALMETEROL XINAFOATE
TRADE NAME: Advair diskus
CLASSIFICATION: Anti-asthmatic, combination drug
ACTION: Fluticasone is an anti-inflammatory corticosteroid; precise
mechanism unknown but corticosteroids inhibit multiple cell types and
mediator production or secretion involved in asthmatic response; Salmeterol
is a long-acting beta2-adrenergic agonist that catalyzes conversion of ATP to
cyclic-AMP; increased cyclic-AMP levels cause relaxation of bronchial
smooth muscle and inhibition of release of mediators of immediate
hypersensitivity
INDICATIONS: Long-term, twice-daily maintenance treatment of asthma
in clients 12 years and older; not for relief of acute bronchospasms
ROUTES OF ADMINISTRATION: Inhalation powder
USUAL DOSAGE: One inhalation twice daily about 12 hours apart
(morning and evening)
ADVERSE REACTIONS: URTI, pharyngitis, headache, upper respiratory
tract inflammation, hoarseness/dysphonia, bronchitis, cough, nausea &
vomiting
INTERACTIONS: Beta-adrenergic blockers – block pulmonary effects of
salmeterol; also may produce severe brochospasms; diuretics – EKG change
and/or hypokalemia may be worsened; MAO inhibitors/tricyclic
antidepressants – action of salmeterol may be potentiated; administer with
extreme caution or within 2 weeks of discontinuation of MAO inhibitors and
tricyclic antidepressants
CONTRAINDICATIONS: Hypersensitivity to any component of the
product; primary treatment of status epilepticus or other acute episodes of
asthma where intensive measures are needed
NURSING CONSIDERATIONS: Do not use Advair Diskus for
transferring clients from systemic corticosteroid therapy due to possibility of
deaths due to adrenal insufficiency
GENERIC NAME: TIOTROPIUM BROMIDE

TRADE NAME: Spiriva

CLASSIFICATION: Anticholinergic

ACTION: Long-acting antimuscarinic (anticholinergic); in airways, it


inhibits muscarinic M3 receptors at the smooth muscle, leading to
bronchodilation

INDICATIONS: Long-term once daily, maintenance treatment of


bronchospasm associated with COPD, including chronic bronchitis and
emphysema
ROUTES OF ADMINISTRATION: Capsules containing powder for
inhalation
USUAL DOSAGE: Inhale contents of one capsule once daily using
HandiHaler inhalation device
ADVERSE REACTIONS: URTI, dry mouth, accidents, sinusitis,
pharyngitis/rhinitis, abdominal pain, chest pain (non-specific), dependent
edema, UTI

INTERACTIONS: None specific

CONTRAINDICATIONS: History of hypersensitivity to atropine or its


derivatives; use for initial treatment of acute episodes of bronchospasm; use
with other anticholinergics

NURSING CONSIDERATIONS: Teach client how to use inhaling device;


store capsules from 15-30ºC (59-86ºF); not to be used for acute
bronchospasms; do not permit powder to enter eyes; may cause papillary
dilation and blurred vision; do not swallow capsules; report any eye
pain/discomfort, colored images, blurred vision, vision halos associated with
red eyes (may indicate glaucoma)
GENERIC NAME: IPRATROPIUM BROMIDE

TRADE NAME: Atrovent, Atrovent HFA

CLASSIFICATION: Cholinergic blocking drug

ACTION: Chemically related to atropine; antagonizes the action of acetylcholine;


prevents the increase in intracellular levels of cyclic guanosine monophosphate, which is
caused by the interaction of acetylcholine with muscarinic receptors in bronchial smooth
muscle (leads to bronchodilation which is primarily a local, site-specific effect)

INDICATIONS: Alone or with other bronchodilators, especially beta-adrenergics, as a


bronchodilator for maintenance treatment of brochospasm associated with COPD,
including chronic bronchitis and emphysema

ROUTES OF ADMINISTRATION: Inhalation aerosol, solution for inhalation

USUAL DOSAGE: 2 inhalations (34 mcg) 4 times daily; may take more but not to
exceed 12 inhalations/day
ADVERSE REACTIONS: Headache, dizziness, chest pain, URTI, nausea, bronchitis,
coughing, dyspnea, pharyngitis, pain

INTERACTIONS: Potential additive interaction when used concomitantly with other


anticholinergics

CONTRAINDICATIONS: Hypersensitivity to atropine, ipratropium, or derivatives;


hypersensitivity to soy lecithin or relat4ed food products, including soybean or peanut;
use for initial treatment of acute bronchospasms

NURSING CONSIDERATIONS: Do not confuse Atrovent with Alupent (a


sympathomimetic); use with nebulizer with mouthpiece rather than facemask may be
preferable to reduce chance of solution hitting eyes; store aerosol between 15-30ºC (59-
86ºF); take only as directed and shake well before each use; if using more than one
inhalation per dose, wait 3 min before administering second dose
GENERIC NAME: IBUPROFEN

TRADE NAME: Advil, Motrin, Midol, Menadol, PediaCare and all derivatives

CLASSIFICATION: Nonsteroidal anti-inflammatory drug


ACTION: Anti-inflammatory effect is likely due to inhibition of cyclo-oxygenase;
inhibition of cyclo-oxygenase results in decreased prostaglandin synthesis; effective in
reducing joint swelling, pain, and morning stiffness, as well as to increase mobility in
patients with inflammatory disease; antipyretic action occurs by decreasing prostaglandin
synthesis in hypothalamus resulting in increase in peripheral blood flow and heat loss

INDICATIONS: Analgesic for mild to moderate pain; primary dysmenorrheal; relief of


signs and symptoms of rheumatoid arthritis or osteoarthritis
ROUTES OF ADMINISTRATION: Capsules, oral drops, suspension, tablets,
chewable tablets
USUAL DOSAGE: Rheumatoid arthritis and osteoarthritis: either 300 mg 4 times daily
or 400, 600, or 800 mg 3-4 times daily; adjust dosage to patient response; mild to
moderate pain: 400 mg q 4-6 hr as needed (doses greater than 400 mg are no more
effective as the 400 mg dose)
ADVERSE REACTIONS: Dizziness, rash, nausea, epigastric/GI pain,
heartburn

INTERACTIONS: Furosemide/thiazide diuretics – ↓ diuretic effect related


to ↓ renal prostaglandin synthesis; lithium – ↑ plasma lithium levels

CONTRAINDICATIONS: Pregnancy, especially during last trimester; use


in clients with the aspirin triad (bronchial asthma, rhinitis, aspirin
intolerance); use to treat perioperative pain in the setting of coronary artery
bypass graft surgery

NURSING CONSIDERATIONS: Do not use ibuprofen OTC for more


than 3 days as antipyretic or as an analgesic for more than 10 days unless
medically prescribed; do not take more than 3.2 g of prescription products;
take with a snack, milk, meal, or antacid to decrease GI upset and report any
nausea and vomiting; report ringing in the ears, blurred vision and avoid
prolonged sun exposure
GENERIC NAME: CYANOCOBALAMIN
TRADE NAME: Big Shot B-12, Twelve Resin-K
CLASSIFICATION: Vitamin B12
ACTION: Required for hematopoiesis, cell reproduction, nucleoprotein and
myelin synthesis
INDICATIONS: Vitamin B12 deficiency due to malabsorption syndrome as
seen in pernicious anemia, GI pathology, dysfunction, or surgery; Fish
tapeworm infestation, malignancy of pancreas or bowel, gluten enteropathy,
small bowel overgrowth of bacteria, sprue, accompanying folic acid
deficiency
ROUTES OF ADMINISTRATION: Lozenges, tablets, injection
USUAL DOSAGE: Pernicious anemia: 100 mcg/day for 6-7 days, then if
no improvement is noted, give 100 mcg every other day fro seven doses and
then 100 mcg q 3-4 days for 2-3 weeks; Vitamin B12 deficiency: 30 mcg
daily for 5-10 days then 100-200 mcg/month
ADVERSE REACTIONS: Itching, diarrhea, pain at injection site, nausea
& vomiting, headache, rhinitis

INTERACTIONS: Alcohol/aminosalicyclic
acid/Cholestyramine/colchidine/ neomycin, para-aminosalicylic acid/timed-
release potassium - ↓ Vitamin B12 absorption; cimetidine - ↓ digestion and
release of vitamin B12; ↓ absorption of cyanocobalamin

CONTRAINDICATIONS: Hypersensitivity to cobalt; Leber’s disease

NURSING CONSIDERATIONS: Protect injection from light and do not


freeze; with pernicious anemia, cannot give PO; determine if allergic to
cobalt; monitor VS, CBC, potassium, folic acid, and B12 levels, must take
B12 supplements for life with pernicious anemia; if vitamin B12 deficiency
is due to dietary deficiency, identify foods high in B12 and review diet;
avoid alcohol
GENERIC NAME: FOLIC ACID

TRADE NAME: Folvite, Folate

CLASSIFICATION: Vitamin B complex

ACTION: Folic acid is necessary for normal production of RBCs and for
synthesis of nucleoproteins; is converted into tetrahydrofolic acid which is a
cofactor in the biosynthesis of purines and thymidylates of nucleic acids

INDICATIONS: Treatment of megaloblastic anemias due to folic acid


deficiency; diagnosis of folate deficiency

ROUTES OF ADMINISTRATION: Tablets, injection

USUAL DOSAGE: 250-1,000 mcg/day until hematologic response occurs


initially, then 400 mcg/day to maintain
ADVERSE REACTIONS: Relatively nontoxic in humans

INTERACTIONS: Aminosalicylic acid - ↓ serum folate levels;


trimethoprim/methotrexate – folic acid antagonist; phenytoin - ↑ seizure
frequency, ↓ serum folic acid levels; oral contraceptives - ↑ risk of folate
deficiency

CONTRAINDICATIONS: Use in aplastic, normocytic, or pernicious


anemias (ineffective); folic acid injection that contains benzyl alcohol should
not be used in neonates or immature infants

NURSING CONSIDERATIONS: Review other prescribed drugs; may


cause increased body loss of folic acid; give PO; if severe malabsorption,
give either IV or SC; dosage should never be less than 0.1 mg/day; when
given IV, have drugs and equipment on hand in case of anaphylactic
reactions; take only as directed and avoid alcohol
GENERIC NAME: OXYCODONE HYDROCHLORIDE
TRADE NAME: OxyIR, OxyFAST, Oxydose, Roxicodone Intensol, Roxicodone, M-
oxy, Oxy-Contin
CLASSIFICATION: Narcotic analgesic
ACTION: Semi synthetic opiate that combines with specific receptors located in the
CNS to produce various effects; the mechanism is believed to involve decreased
permeability of the cell membrane to sodium, which results in diminished transmission of
pain impulses and therefore analgesia; causes mild sedation and little or no antitussive
effect; most effective in relieving acute pain.
INDICATIONS: Management of moderate to severe pain when a continuous around-
the-clock analgesic is required for an extensive period of time; to be used postoperatively
if the client has received the drug prior to surgery or if the postoperative pain is expected
to be moderate to severe and last for an extended period of time; not intended for use as
an ‘as needed’ analgesic; not for pain in the immediate postoperative period
ROUTES OF ADMINISTRATION: Immediate-release capsules, oral solution,
concentrate solution, controlled-release tablets, immediate-release tablets
USUAL DOSAGE: Individualize dose depending on severity of pain, client response
and client size; 10-30 mg q 4 hr (5 mg q 6 hr for OxyIR, Oxycodone IR capsules,
Oxydose, and OxyFAST) as needed
ADVERSE REACTIONS: Constipation, dry mouth, nausea & vomiting, mild itching,
drowsiness, lightheadedness, anorexia, weakness

INTERACTIONS: Use with protease inhibitors - ↑ CNS and respiratory depression;


ethyl alcohol/general anesthetics/antianxiety drugs/antihistamines/barbiturates/CNS
depressants – potentiation or addition of CNS depressant effects; concomitant use may
lead to drowsiness, lethargy, stupor, respiratory collapse, coma, or death

CONTRAINDICATIONS: Use in hypercarbia, paralytic ileus, children, or during labor;


asthma, emphysema, kyphoscoliosis, severe obesity, convulsive states as in epilepsy,
delirium tremens, tetanus and strychnine poisoning, diabetic acidosis, myxedema,
Addison’s disease, hepatic cirrhosis, and children under 6 months

NURSING CONSIDERATIONS: Have orders rewritten at timed intervals; make sure


all narcotic doses are recorded; note reasons for therapy, type, onset, characteristics of
symptoms; differentiate acute and chronic syndromes and rate pain levels; obtain baseline
VS’s generally, if the respiratory rate < 12/min or the SBP <90mm Hg, a narcotic should
not be administered unless there is ventilatory support or specific guidelines with
parameters for ventilation; give round-the-clock dosing for chronic pain; for control of
severe chronic pain, give immediate-release products on a regularly scheduled basis
GENERIC NAME: CARVEDILOL
TRADE NAME: Coreg
CLASSIFICATION: Alpha-beta adrenergic blocking agent

ACTION: Has both alpha- and beta-adrenergic blocking activities; decreases cardiac
output, reduces exercise- or isoproterenol-induced tachycardia, reduces reflex orthostatic
hypotension, causes vasodilation, and reduces peripheral vascular resistance; BP is
lowered more in the standing than in the supine position; significantly lowers plasma
resin activity when given for at least 4 weeks

INDICATIONS: Essential hypertension used either alone or in combination with other


antihypertensive drugs, especially thiazide diuretics; mild to severe heart failure of
ischemic or cardiomyopathic origin, used with diuretics, ACE inhibitors, and digitalis to
increase survival and reduce risk of hospitalization; reduce CV mortality in clinically
stable clients who have survived an acute MI and have a left ventricular ejection fraction
of 40% or less

ROUTES OF ADMINISTRATION: Tablets

USUAL DOSAGE: 6.25-25 mg 2 times per day


ADVERSE REACTIONS: Dizziness, headache, nausea & vomiting, diarrhea, URTI,
fatigue, pain, bradycardia, hypotension

INTERACTIONS: Antidiabetic agents - ↑ hypoglycemic effects R/T beta blockage;


Clonidine – potentiation of BP and heart rate lowering effects; Cyclosporine - ↑
cyclosporine blood levels R/T ↓ liver breakdown; Digoxin - ↑ digoxin levels

CONTRAINDICATIONS: Clients with NYHA class IV decompensated cardiac failure,


bronchial asthma, or related bronchospastic conditions, second- or third-degree AV
block, SSS (unless pacemaker is in place), cargiogenic shock, severe bradycardia, drug
hypersensitivity; hepatic impairment; lactation

NURSING CONSIDERATIONS: Full antihypertensive effect seen within 7-14 days;


addition of diuretic can produce additive effects and exaggerate orthostatic effect; treat
fluid retention with increased dose of diuretics, whether or not heart failure symptoms
have worsened; reduce dosage if bradycardia (HR less than 55 bpm) occurs; take as
prescrivbed with food, slows absorption/decreases orthostatic effects; avoid OTC agents;
avoid activities that require mental acuity until drug effects realized; do not stop abruptly;
R/T beta-blocking activity (esp. with ischemic heart disease)
GENERIC NAME: ISOSORBIDE MONONITRATE
TRADE NAME: ISMO, Monoket, Imdur
CLASSIFICATION: Coronary vasodilator

ACTION: Isosorbide mononitrate is the major metabolite if isosorbide dinitrate;


mononitrate is not subject to first-pass metabolism; relaxes vascular smooth muscle by
stimulating production of intracellular cyclic guanosine monophosphate; dilation of
postcapillary vessels decreases venous return to the heart due to pooling of blood; thus,
LV end-diastolic pressure (preload) is reduced; relaxation of arterioles results in a
decreased systemic vascular resistance and arterial pressure (afterload)

INDICATIONS: Treatment of angina pectoris; prophylaxis of angina pectoris caused by


coronary artery disease; the onset of action of the mononitrate is not sufficiently rapid to
be used in aborting an acute angina attack

ROUTES OF ADMINISTRATION: Tablets, Extended-release Tablets

USUAL DOSAGE: 30 mg or 60 mg once daily initially, then after several days dosage
may be increased to 120 mg (given as single 120 mg tablet or as two-60 mg tablets);
suggested regimen to give dose in a.m. on arising
ADVERSE REACTIONS: Dizziness, headache, hypotension, nausea and
vomiting, increased cough, allergic reaction

INTERACTIONS: Ethanol – additive vasodilation; calcium channel


blockers/organic nitrates – severe orthostatic hypotension

CONTRAINDICATIONS: To abort acute anginal attacks; use in acute MI


or CHF

NURSING CONSIDERATIONS: Do not confuse Imdur with Imuran or


Inderal; treatment regimen minimizes development of refreactory tolerance;
store tablets from 15-30°C (59-86°F); keep tightly closed and protect from
excessive moisture; note reasons for therapy, cardiac history,
onset/frequency of angina, triggers; monitor EKG, VS, cardiac status, family
history, risk factors and electrolytes; consume 1-2 L/day of fluids to ensure
adequate hydration, and do not stop abruptly; avoid alcohol
GENERIC NAME: ZINC OXIDE CREAM
TRADE NAME: Desitin
CLASSIFICATION: Skin cream
ACTION: Used to treat or prevent minor skin irritations, such as diaper rash
INDICATIONS: To use if diaper rash or other minor irritations are present
(diaper rash, poison ivy, burns)
ROUTES OF ADMINISTRATION: Cream applied topically
USUAL DOSAGE: Apply generous amount to affected area as often as
needed or as directed by doctor
ADVERSE REACTIONS: No reported side effects
INTERACTIONS: Other skin products; other prescription or non-
prescription medications
CONTRAINDICATIONS: Tell doctor of medical history, especially of
other skin infections or problems; advise of allergies, lactation
NURSING CONSIDERATIONS: Do not share cream with multiple
individuals; store between 15-30°C (59-86°F)
GENERIC NAME: POTASSIUM SALTS
TRADE NAME: K-norm, Micro-K, Extencaps, K+ 10, K-Dur 10 and 20, K-Tab, Kaon-
Cl, Klor-Con, Klotrix, Ten-K, more
CLASSIFICATION: Electrolyte
ACTION: Potassium is readily and rapidly absorbed through the GI tract; though a
number of salts can be used to supply cation, potassium chloride is agent of choice since
hypochloremia frequently accompanies potassium deficiency; dietary measures can
usually prevent and correct potassium deficiencies (beef, chicken, ham, turkey, veal, fish,
beans, broccoli, Brussels’ sprouts, lentils, spinach, potatoes, milk, bananas, dates, prunes,
raisins, avocados, watermelon, cantaloupe, apricots, molasses)
INDICATIONS: Treat hypokalemia due to digitalis intoxication, diabetic acidosis,
diarrhea and vomiting, familial periodic paralysis, certain cases of uremia,
hyperadrenalism, starvation and debilitation, and corticosteroid or diuretic therapy;
Hypokalemia with or without metabolic acidosis and following surgical conditions
accompanied by nitrogen loss, vomiting and diarrhea, suction drainage, and increased
urinary excretion of potassium; prophylaxis of potassium depletion when dietary intake is
not adequate in certain conditions
ROUTES OF ADMINISTRATION: Extended-release capsules
USUAL DOSAGE: Highly individualized; 40-100 mEq/day for potassium depletion
(usual dietary intake is 40-250 mEq/day)
ADVERSE REACTIONS: N&V, diarrhea, flatulence, abdominal discomfort

INTERACTIONS: ACE inhibitors – may cause potassium retention → hyperkalemia;


Digitalis glycosides – cardiac arrhythmias; Potassium-sparing diuretics – severe
hyperkalemia with possibility of cardiac arrhythmias or arrest

CONTRAINDICATIONS: Severe renal function impairment with azotemia or oliguria,


postoperatively before urine flow has been reestablished; Crush syndrome, Addison’s
disease, hyperkalemia from any cause, anuria, heat cramps, acute dehydration, severe
hemolytic reactions, adynamia, episodica hereditaria, clients receiving potassium-sparing
diuretics or aldosterone-inhibiting drugs; solid dosage forms in clients in whom there is a
reason for the delay or arrest in passage of tablets through the GI tract

NURSING CONSIDERATIONS: Give PO doses 3-4 times daily; correct hypokalemia


slowly over a period of 3-7 days to minimize risk of hyperkalemia; identify reasons for
therapy; document electrolytes and ECG; list all drugs and OTC agents consumed; note
any impaired renal function; assess for adequate urinary flow before administering
potassium, dysfunction can lead to hyperkalemia; withhold and report: abdominal pain,
distention, or GI weakness; monitor I & O, withhold drug and report oliguria, anuria, or
azoturia
GENERIC NAME: LISINOPRIL
TRADE NAME: Prinivil, Zestril
CLASSIFICATION: Antihypertensive, ACE inhibitor
ACTION: Inhibits angiotensin-converting enzyme resulting in decreased plasma
angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone
secretion; both supine and standing BP’s are reduced, although the drug is less effective
in African Americans than in Caucasians.
INDICATIONS: Alone or in combination with a diuretic (usually a thiazide) to treat
hypertension; hypertension in children, aged 6-16 years old; in combination with digitalis
and a diuretic for treating CHF not responding to other therapy; use within 24 hours of
acute MI to improve survival in hemodynamically stable clients
ROUTES OF ADMINISTRATION: Tablets
USUAL DOSAGE: Essential hypertension in combination with a diuretic – 5 mg; the
BP-lowering effects of the combination are additive; reduce dosage in renal impairment
as follows: CCR 10-30 mL/min: give initial dose of 5 mg/day for HTN; CCR less than 10
mL/min: give initial dose of 2.5 mg/day and adjust dose depending on BP response
ADVERSE REACTIONS: Chest Pains, dizziness, headache, hypotension, fatigue,
diarrhea, URTI

INTERACTIONS: Diuretics – excess ↓ BP; Indomethacin – possible ↓ lisinopril effect;


Potassium-sparing diuretics – significant ↑ serum potassium

CONTRAINDICATIONS: Use in children under 6 years old or in children with a GFR


less than 30 mL/min/1.73 m2

NURSING CONSIDERATIONS: When considering use of Lisinopril in client taking


diuretics, discontinue diuretic if possible 2-3 days prior to beginning lisinopril therapy; if
diuretic cannot be discontinued, initial dose should be 5 mg and observe closely for 2
hours; maximum antihypertensive effects may not be observed for 2-4 weeks; give under
medical supervision for CHF especially if SBP is less than 100 mmHg; use of potassium
supplements, potassium-sparing diuretics, or potassium salt substitutes with Prinzide or
Zestoretic may lead to increases in serum potassium; must be taken as directed at least
once a day to control BP; avoid symptoms of low BP (avoid orthostatic hypotension)
GENERIC NAME: METOLAZONE

TRADE NAME: Mykrox, Zaroxolyn

CLASSIFICATION: Diuretic, thiazide

ACTION: Promote diuresis by decreasing the rate at which sodium and chloride are
reabsorbed by the distal renal tubules of the kidney; by increasing the excretion of
sodium and chloride, forces excretion of additional water; also increases the excretion of
potassium and, to a lesser extent, bicarbonate, as well as decreases the excretion of
calcium and uric acid; sodium and chloride are excreted in approximately equal amount

INDICATIONS: Edema accompanying CHF; edema accompanying renal diseases,


including nephritic syndrome and conditions of reduced renal function

ROUTES OF ADMINISTRATION: Tablets

USUAL DOSAGE: Edema due to renal disease: 5-20 mg once daily (for those who
experience paroxysmal nocturnal dyspnea, a larger dose may be required to ensure
prolonged diuresis and saluresis for a 24-hr period
ADVERSE REACTIONS: Dizziness, headache, muscle cramps, malaise, lethargy,
lassitude, joint pain/swelling, chest pain

INTERACTIONS: Alcohol/Barbiturates/Narcotics - ↑ hypotensive effect;


NSAIDs/Salicylates - ↓ hypotensive effects of metolazone

CONTRAINDICATIONS: Anuria, prehepatic and hepatic coma, allergy or


hypersensitivity to metolazone; routine use during pregnancy and lactation; increases
secretion of sodium and water by inhibiting sodium resorption in the distal tubule;
promotes excretion of chloride, potassium, magnesium and bicarbonate

NURSING CONSIDERATIONS: Do not confuse metolazone with methotrexate


(antineoplastic) or with metoclopramide (GI stimulant); store tablets at room temperature
in a tight, light-resistant container; formulations of slow availability tablets should not be
interchanged with formulations of rapid availability tablets as they are not therapeutically
equivalent; monitor weight, BP, ECG, CBC, electrolytes, uric acid, renal, LFT’s, and
assess for signs/symptoms of electrolyte imbalance; take with or without food exactly as
directed early in the day
GENERIC NAME: MYCOPHENOLATE MOFETIL
TRADE NAME: CellCept
CLASSIFICATION: Immunosuppressant
ACTION: Is hydrolyzed to the active mycophenolic acid (MPA); MPA has potent
cytostatic effects on lymphocytes; inhibits proliferative responses of T- and B-
lymphocytes to both mitogenic and allospecific stimulation; MPA also suppresses
antibody formation of B-lymphocytes; MPA may also inhibit recruitment of leukocytes
into sites of inflammation and graft rejection
INDICATIONS: With cyclosporine and corticosteroids to prevent organ rejection in
those receiving allogeneic renal, heart, or liver transplants; may be used in children with
renal transplants; IV product is alternative to PO forms for those who cannot take PO
medications; In combination with prednisolone to treat diffuse proliferative lupus
nephritis
ROUTES OF ADMINISTRATION: Capsules (250 mg), powder for injection,
lyophilized (500 mg), powder for oral suspension (200 mg/mL), tablets (500 mg)
USUAL DOSAGE: 1000 mg twice daily, IV can be started <24 hr after transplantation
and switched to PO as soon as possible; for renal impairment, glomerular filtration rate
(GFR) <25 ml/min, daily dose not to exceed 2000 mg
ADVERSE REACTIONS: Hypertension, constipation, diarrhea, N&V, UTI, anemia,
leucopenia, peripheral edema, infection, abdominal pain, fever, headache, infections
(viral, fungal), pain, asthenia, back/chest pain

INTERACTIONS: Antacids containing Al/Mg / Cholestyramine / Iron - ↓ absorption of


mycophenolate: do not use together; Cyclosporine - ↓mycophenolic acid levels;
Vaccines, life attenuated – vaccinations may be less effective

CONTRAINDICATIONS: Hypersensitivity to mycophenylate, mycophenolic acid, or


polysorbate 80; use in those with rare hereditary deficiency of hypoxanthine-guanine
phosphoribosyl transferase, such as Lesch-Nyhan and Kelley-Seegmiller syndrome,
lactation

NURSING CONSIDERATIONS: Take exactly as directed on an empty stomach twice


a day; take with cyclosporine and steroids; do not remove from manufacturer’s original
container; do not break/crush, chew or open capsules as powder may be teratogenic if
inhaled or contact with skin/mucus membranes
GENERIC NAME: PREDNISONE
TRADE NAME: Deltasone, Meticorten, Orasone, Panasol-S, Prednicen-M, Sterapred
DS
CLASSIFICATION: Glucocorticoid
ACTION: Anti-inflammatory effect is due to inhibition of prostaglandin synthesis; also
inhibits accumulation of maxcrophages and leukocytes at sites of inflammation and
inhibits phagocytosis and lysosomal enzyme release

INDICATIONS: When used for anti-inflammatory or immunosuppressant therapy,


should possess minimal mineralcortocoid activity; is not curative when used with
glucocorticoids; should be considered as not primary therapy, but as adjunctive therapy in
collagen diseases such as SLE, acute rheumatic carditis, polymyositis

ROUTES OF ADMINISTRATION: Tablets (1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50


mg); oral solution (5 mg/mL); Syrup (5 mg/mL)

USUAL DOSAGE: 5-60 mg/day in four equally divided doses after meals and at
bedtime; decrease gradually by 5-10 mg q 4-5 days to establish minimum maintenance
dosage (5-10 mg) or discontinue altogether until symptoms recur
ADVERSE REACTIONS: Insomnia, N&V, GI upset, fatigue, dizziness, muscle
weakness, increased hunger/thirst, joint pain, decreased diabetic control

INTERACTIONS: Acetaminophen - ↑ risk of hepatotoxicity related to ↑ rate of


formation of hepatotoxic acetaminophen metabolite; alcohol - ↑ risk of GI ulceration or
hemorrhage; Bumetanide/ Furosemide - ↑ potassium loss R/T potassium-losing properties
of both drugs;

CONTRAINDICATIONS: Suspected infections as it may mask infections; also peptic


ulcer, psychoses, acute glomerulonephritis, herpes simplex infections of the eye, vaccinia
or varicella, the examthematous diseases, Cushing’s syndrome, active tuberculosis,
myasthenia gravis; Also, recent intestinal anastomoses, CHF or other cardiac disease,
hypertension, systemic fungal infections, open-angle glaucoma, hyperlipidemia,
hyperthyroidism or hypothyroidism, osteoporosis

NURSING CONSIDERATIONS: Do not confuse prednisone with prednisolone; note


reasons for therapy, type, onset, characteristics of signs/symptoms, clinical presentation;
monitor CBC, ESR, electrolytes, BP, blood sugar, weights, and mental status; take in AM
to prevent insomnia and take with food to decrease GI upset; do not stop abruptly with
long-term therapy; avoid alcohol and OTC agents
GENERIC NAME: BUMETANIDE

TRADE NAME: Bumetanide, Bumex

CLASSIFICATION: Diuretic, loop

ACTION: Inhibits reabsorption of both sodium and chloride in the proximal tubule and
the ascending loop of Henle; possible activity in proximal tubule to promote phosphate
excretion

INDICATIONS: Edema associated with CHF, nephritic syndrome, hepatic disease;


adjunct to treat acute pulmonary edema; especially useful in clients refractory to other
diuretics

ROUTES OF ADMINISTRATION: Injection (0.25 mg/mL); tablets (0.5 mg, 1 mg, 2


mg)

USUAL DOSAGE: Tablets for edema – 0.5-2 mg once daily; if response is inadequate, a
second or third dose may be given at 4-5 hr intervals up to a maximum of 10 mg/day
ADVERSE REACTIONS: Dizziness, hypotension, headache, nausea,
muscle cramps, encephalopathy in those with preexisting liver disease

INTERACTIONS: Charcoal - ↓ absorption from GI tract; Clofibrate


enhances diuretic effect, hydantoins ↓ diuretic effect, propranolol - ↑ plasma
propranolol levels; thiazide diuretics – additive effects with loop diuretics –
profound diuresis and serious electrolyte abnormalities

CONTRAINDICATIONS: Anuria, hepatic coma or severe electrolyte


depletion until condition improved/corrected; hypersensitivity to drug

NURSING CONSIDERATIONS: Do not confuse Bumex with Buprenex


(narcotic analgesic); Document reasons for therapy; pretreatment findings;
note sulfonamide allergy; may be cross sensitivity; monitor electrolytes,
I&O, renal and LFT’s, assess for ↓ K+; Reserve IV or IM for those whom
PO use is not practical or absorption from the GI tract is impaired; NOTE: 1
mg of bumetanide is equivalent to 40 mg of furosemide
GENERIC NAME: HYDROMORPHONE HYDROCHLORIDE

TRADE NAME: Dilaudid, Dilaudid-HP, Hydromorphone HP, 10, 20, and 50

CLASSIFICATION: Narcotic analgesic

ACTION: Hydromorphone is 710 times more analgesic than morphine, with a shorter
duration of action; it manifests less sedation, less vomiting, and less nausea than
morphone, although it induces pronounced respiratory depression

INDICATIONS: Moderate to severe pain (e.g. surgery, cancer, biliary colic, burns, renal
colic, MI, bone and soft tissue trauma); dilaudid-HP is a concentrated solution intended
for those tolerant to narcotics

ROUTES OF ADMINISTRATION: Injection (1 mg/mL, 2 mg/mL, 4 mg/mL, 10


mg/mL); Liquid, oral (1 mg/mL); powder for injection, lyophilized (250 mg/vial – 10
mg/mL after reconstitution); suppositories (3 mg); tablets (2 mg, 4 mg, 8 mg)

USUAL DOSAGE: 1-2 mg IM or SC q 4-6 hr as needed; for severe pain, 3-4 mg q 4-6
hr; may be given by slow IV over 2-3 min
ADVERSE REACTIONS: Constipation, N&V, asthenia, headache,
sleepiness/sedation/somnolence, itching/pruritis

INTERACTIONS: ↑ CNS and respiratory depression when used with protease


inhibitors; Alcohol, ethyl / Anesthetics, general / Antianxiety drugs / Antihistamines /
Barbiturates / CNS depressants / Sedative-hypnotics, nonbarbiturate – potentiation or
addition of CNS depressant effects; concomitant use may lead to drowsiness, lethargy,
stupor, respiratory collapse, coma, or death; Cimetidine - ↑ CNS toxicity

CONTRAINDICATIONS: Migraine headaches, asthma, emphysema, kyphoscoliosis,


severe obesity, convulsive states as in epilepsy, delirium tremens, tetanus and strychnine
poisoning, diabetic acidosis, myxedema, Addison’s disease, hepatic cirrhosis, and
children under 6 months

NURSING CONSIDERATIONS: Do not confuse hydromorphone with morphine; most


clients given around-the-clock therapy with controlled-release opioids may require
immediate-release medication for worsening of pain or to treat or prevent pain that
occurs; refrigerate suppositories; may be given by slow IV injection; administer slowly to
minimize hypotensive effects and respiratory depression; administer at a rate of 2 mg
over 5 min; use rating scale to measure pain
GENERIC NAME: LEVOFLOXACIN
TRADE NAME: Levoquin, Quixin
CLASSIFICATION: Antibiotic, fluoroquinolone
ACTION: Interferes with DNA gyrase and topoisomerase IV; DNA gyrase
is an enzyme needed for replication, transcription, and repair of bacterial
DNA; topoisomerase IV plays a key role in the partitioning of chromosomal
DNA during bacterial cell division; Effective against both gram-positive and
gram-negative organisms
INDICATIONS: Mild to moderate complicated UTIs due to Enterococcus
faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, P.
mirabilis, or Pseudomonas aeruginosa; Uncomplicated UTIs (mild to
moderate) due to E. coli, K. pneumoniae, or Staphylococcus saprophyticus
ROUTES OF ADMINISTRATION: Injection concentrate (500 mg, 750
mg); injection (250 mg, 500 mg, 750 mg); ophthalmic solution (0.5%,
1.5%), Oral solution (25 mg/mL); tablets (250 mg, 500 mg, 750 mg)
USUAL DOSAGE: Complicated UTIs – 250 mg once daily for 10 days;
Uncomplicated UTIs – 250 mg once a day for 3 days
ADVERSE REACTIONS: Headache, dizziness, insomnia, N&V, diarrhea,
dyspepsia/heartburn, constipation

INTERACTIONS: Antacids/didanosine/Iron salts/sucralfate/zinc salts - ↓ serum


Levofloxacin R/T ↓ GI tract absorption; Anticoagulants - ↑ anticoagulant effects

CONTRAINDICATIONS: Lactation, IM, intrathecal, intraperitoneal, or SC


administration

NURSING CONSIDERATIONS: Administer doses of 250 or 500 mg by slow infusion


over 60 min q 24 hr or 750 mg given by slow infusion over 90 min q 24 hr; avoid rapid or
bolus IV infusion; Diluted solutions for IV are stable for 72 hr up to a concentration of 5
mg/mL when stored in IV containers at 25°C or less (77°F or less); solutions are stable
for 14 days when stored under refrigeration at 5°C (41°F); diluted solutions that are
frozen in glass bottles or plastic IV containers are stable for 6 months when stored at
-20°C (-4°F); tablets can be taken without regard for food; consume plenty of liquids to
prevent urinary crystallization; take oral solution 1 hr before or 2 hr after eating
GENERIC NAME: MAGNESIUM HYDROXIDE
TRADE NAME: (Phillips) Milk of Magnesia, Ex-Lax Milk of Magnesia
CLASSIFICATION: Laxative
ACTION: Important for many systems in the body, especially the muscles and nerves;
reduces stomach acid and increases water in the intestines (aides in defecation)
INDICATIONS: Used as a laxative to relieve occasional constipation (irregularity); as
an antacid to relieve indigestion, sour stomach, heartburn
ROUTES OF ADMINISTRATION: Tablets, capsules, tablets (chewable), suspension
USUAL DOSAGE: Adults - 2-4 tablespoons or 6-8 chewable tablets (Laxative); 1-3
teaspoons with a little water up to 4 times daily (Antacid)
ADVERSE REACTIONS: Symptoms of magnesium hydroxide overdose (nausea,
vomiting, flushing, low blood pressure, bradycardia, drowsiness, coma, death
INTERACTIONS: Tetracyclines, fluoroquinolone antibiotic, penicillamine, digoxine,
nitrofurantoin
CONTRAINDICATIONS: No restrictions on food, beverages, activity unless advised
by PMD; seek emergency attention if an allergic reaction occurs; Kidney disease
NURSING CONSIDERATIONS: Do not take magnesium hydroxide if abdominal pain,
nausea, vomiting is present unless prescribed; do not use for longer than one week; rectal
bleeding or failure to have bowel movement after l;axative may indicate a more serious
condition
GENERIC NAME: SIMVASTATIN
TRADE NAME: Zocor
CLASSIFICATION: Antihyperlipidemic, HMG-CoA reductase inhibitor
ACTION: Competitively inhibits HMG-CoA reductase; this enzyme catalyzes the early
rate-limiting step in the synthesis of cholesterol; thus, cholesterol synthesis is
inhibited/decreased; decreases cholesterol, triglycerides, VLDL, LDI and increases HDL;
does not reduce basal plasma cortisol or testosterone levels or impair renal reserve
INDICATIONS: Adjunct to diet to reduce elevated total and LDL cholesterol,
apoprotein B, and triglyceride levels in hypercholesterolemia and mixed dyslipidemia
(types IIa and IIb) when the response to diet and other approaches has been inadequate;
to increase HDL cholesterol in primary hypercholesterolemia and mixed dyslipidemias;
treatment of isolated hypertriglyceridemia and hyperlipoproteinemia
ROUTES OF ADMINISTRATION: Tablets (5 mg, 10 mg, 20 mg, 40 mg, 80 mg
USUAL DOSAGE: Initial – 20 mg once daily in evening; maintenance – 5-80 mg/day as
a single dose in evening (consider starting dose of 5 mg/day for clients on
immunosuppressants, and increasing maintenance for increases in LDL concentrations;
40 mg as an alternative for those requiring a reduction of more than 45% in their LDL
cholesterol (most often those with CAD)
ADVERSE REACTIONS: Headache, abdominal pain/cramps, constipation

INTERACTIONS: Amioderone – possibility of myopathy, muscle weakness, and


rhabdomyolysis; Bosentan - ↓ Simvastatin levels R/T ↑ metabolism; Carbamazepine - ↓
Simvastatin AUC, peak levels, and shortened t1/2 R/T ↑ metabolism by CYP3A4;
Clarithromycin - ↑ risk of severe myopathy and rhabdomyolysis; Diltiazem - ↑ risk of
myopathy R/T ↑ simvastatin plasma levels; Erythromycin - ↑ risk of severe myopathy
and rhabdomyolysis; Grapefruit juice – chronic use of grapefruit juice ↑ simvastatin
plasma levels due to ↓ liver metabolism

CONTRAINDICATIONS: Use if pregnant, planning on being pregnant, or while


breastfeeding

NURSING CONSIDERATIONS: Do not confuse Zocor with Cozaar or Zoloft; may


administer with no regard to meals; take as prescribed; more preferable in the evening;
monitor CBC, lipid profile, CPK, renal LFT’s; low-cholesterol diet must be followed
during drug therapy (should be started 3-6 months prior to initial drug therapy); consult
dietician for assistance in meal planning and food preparation; do not take with grapefruit
juice, but grapefruit juice can be given at other times during the day
GENERIC NAME: EZETIMIBE

TRADE NAME: Zetia

CLASSIFICATION: Antihyperlipidemic

ACTION: Acts by inhibiting the absorption of cholesterol from the small


intestine, leading to a decrease in the delivery of cholesterol to the liver; this
complements the mechanism of action of HMG-CoA reductase inhibitors;
reduces total cholesterol

INDICATIONS: Primary hypercholesterolemia, either as monotherapy or


combination therapy with HMG-CoA reductase inhibitors; with atorvastatin
or simvastatin for homozygous familial hypercholesterolemia; as adjunct
therapy to diet for homozygous sitosterolemia
ROUTES OF ADMINISTRATION: Tablets 10 mg
USUAL DOSAGE: 10 mg once daily with or without food
ADVERSE REACTIONS: Back pain, diarrhea, arthralgia, sinusitis, abdominal pain

INTERACTIONS: Antacids - ↓ Ezetimibe Cmax after both Mg- and Ca-containing


antacids (no effect on AUC); Cholestyramine - ↓ ezetimibe AUC probably R/T ↓
Absorption; Cyclosprine - ↑ total ezetimibe levels (monitor carefully);
Fenofibrate/Gemfibrozil - ↑ tatol ezetimibe level

CONTRAINDICATIONS: Use with HMG-CoA reductase inhibitors in pregnant and


nursing women and in active liver disease or unexplained persistant elevations in serum
transaminases; as monotherapy in moderate to severe hepatic insufficiency and during
lactation; use in children less than 10 y/o

NURSING CONSIDERATIONS: Place client on a standard cholesterol-lowering diet


before therapy and for duration of treatment; give at least 2 hr prior or 4 hr after giving a
bile acid sequestrant; store from 15-30°C (59-86°F) protected from moisture; monitor
CBC, lipid panel, renal and LFTs; schedule LFTs at the beginning of therapy; list all
medications preascribed to ensure none interact unfavorably; identify cardiac risk factors;
take daily as directed with or without food; avoid taking with antacids (reduces drug
effect); low-cholesterol diet must be followed during drug therapy; report any S&S of
infection
GENERIC NAME: BACITRACIN OINTMENT
TRADE NAME: Baciguent

CLASSIFICATION: Antibiotic

ACTION: Interferes with synthesis of cell wall, preventing incorporation of


amino acids and nucleotides; is bacteriocidal, bacteriostatic, and active
against protoplasts; not absorbed from the GI tract; when given parenterally,
drug is well distributed in pleural and ascetic fluids; high nephrotoxicity;
carefully evaluate renal function prior to, and daily, during use.

INDICATIONS: Aid to prevent infection in minor cuts, scrapes, burns, and


wounds
ROUTES OF ADMINISTRATION: Ointment – 500 units/gram
USUAL DOSAGE: Apply small amount equal to surface area of a fingertip
1-3 times per day after cleaning the affected area; do not use for more than
one week
ADVERSE REACTIONS: After topical use: skin rashes

INTERACTIONS: Aminoglycosides – additive nephrotoxicity and


neuromuscular blocking activity; Anesthetics - ↑ neuromuscular blockade →
possible muscle paralysis; neuromuscular blocking agents – additive
neuromuscular blockage → possible muscle paralysis

CONTRAINDICATIONS: Hypersensitivity or toxic reaction to bacitracin;


pregnancy; epithelial herpes simplex keratitis, vaccinia, varicella,
mycobacterial eye infections; fungal diseases of eye; concomitant use of
nephrotoxic drugs
NURSING CONSIDERATIONS: Do not confuse bacitracin with
Bactroban; may cover affected area with sterile dressing; cleanse area
thoroughly before applying bacitracin as wet dressing or ointment; do not
use topical ointment near eyes, nose, mouth, or mucous membranes; report
lack of response, rash, stinging, itching, changes in vision, or unusual side
effects; do not administer with topical or systemic nephrotoxic drug
GENERIC NAME: VERAPAMIL
TRADE NAME: Calan, Calan SR, Covera-HS, Isoptin SR, Verelan, Verelan PM
CLASSIFICATION: Calcium channel blocker
ACTION: Slows AV conduction and prolongs effective refractory period; ↓ HR and ↑
PR interval; IV doses slightly increase LV filling pressure; moderately decreases
myocardial contractility and peripheral vascular resistance; worsening of heart failure
may result if verapamil is given to clients with moderate to severe cardiac dysfunction
INDICATIONS: Angina pectoris due to coronary artery spasm (Prinzmetal’s variant),
chronic stable angina including angina due to increased effort, unstable angina
(preinfarction, crescendo); with digitalis to control rapid ventricular rate at rest and
during stress in chronic atrial flutter or atrial fibrillation
ROUTES OF ADMINISTRATION: Capsules (Extended release) – 100 mg, 120 mg,
180 mg, 200 mg, 240 mg, 300 mg; Capsules (Sustained release) – 120 mg, 180 mg, 240
mg, 360 mg; Injection – 2.5 mg/mL; Tablets (Extended-release) – 120 mg, 180 mg, 240
mg; Tablets (immediate-release) – 40 mg, 80 mg, 120 mg; Tablets (Sustained-release) –
120 mg, 180 mg, 240 mg
USUAL DOSAGE: Essential hypertension – Initial, when used alone – 80 mg 3 times
per day; doses up to 360-480 mg daily may be used; Effects are seen in the first week of
therapy
ADVERSE REACTIONS: Infection, flu-like symptoms, URTI, rhinitis, nausea,
dyspepsia, diarrhea, constipation, headache, fatigue/lethargy, dizziness, peripheral edema
INTERACTIONS: Amiodarone – possible cardiotoxicity with ↓ CO (monitor closely);
Antihypertensive agents – additive hypotensive effects; antineoplastics - ↓ verapamil
absorption by several antineoplastics; atorvastatin - ↑ atorvastatin plasma levels;
barbiturates - ↓ verapamil bioavailability; Buspirone - ↑ buspirone effects; cyclosporine -
↑ cyclosporine plasma levels → possible renal toxicity; Digoxin - ↑ risk of digoxin
toxicity R/T ↑ plasma levels; MANY MORE
CONTRAINDICATIONS: Severe hypotension, second- or third-degree AV block,
cardiogenic shock, severe CHF, sick sinus syndrome (unless client has artificial
pacemaker), severe LV dysfunction; cardiogenic shock and severe CHF unless secondary
to SVT that can be treated with verapamil; lactation; use of verapamil, IV, with beta-
adrenergic blocking agents; ventricular tachycardia
NURSING CONSIDERATIONS: Do not confuse Isoptin with Intropin; take SR tablets
with food; Store ampules at 15-30°C (59-86°F); protect from light; always individualize
dose; note reasons for therapy, onset, characteristics of S&S; make sure no prescribed
meds interact; take SR capsule in AM with food; do not crush, cut, or chew; swallow
capsule whole; may cause dizziness and sudden drop in BP; use caution until drug effects
realized
GENERIC NAME: ONDANSETRON HYDROCHLORIDE
TRADE NAME: Zofran, Zofran ODT
CLASSIFICATION: Antiemetic
ACTION: Cytotoxic chemotherapy is thought to release serotonin from
enterochromaffin cells of the small intestine; the released serotonin may stimulate the
vagal afferent nerves through the 5-HT3 receptors, thus stimulating the vomiting reflex;
Ondansetron, a 5-HT3 antagonist, blocks this effect of serotonin; whether the drug acts
centrally and/or peripherally to antagonize the effect of serotonin is not known
INDICATIONS: Prevent N&V resulting from initial and repeated courses of cancer
chemotherapy, including cisplatin, greater than 50 mg/m2; prevent N&V associated with
initial and repeat courses of moderately emetogenic cancer chemotherapy; Prevent N&V
associated with radiotherapy in clients receiving either total body irradiation, single high-
dose fraction to the abdomen, or daily fractions to the abdomen
ROUTES OF ADMINISTRATION: Injection, oral solution, tablets, orally-
disintegrating tablets
USUAL DOSAGE: 4 mg IV undiluted over 2-5 min immediately before induction of
anesthesia or postoperatively as needed; alternatively, 4 mg undiluted may be given IM
as a single injection
ADVERSE REACTIONS: Diarrhea, headache, dizziness, malaise/fatigue, constipation,
bradycardia, hypotension, drowsiness/ sedation, anxiety/agitation, gynecological
disorder, urinary retention, hypoxia, pruritus, pyrexia, shivers

INTERACTIONS: ↓ ondansetron plasma levels R/T ↑ liver metabolism

CONTRAINDICATIONS: None specified: special concerns with use during lactation;


safety and effectiveness in children 3 years of age and younger are not known

NURSING CONSIDERATIONS: Do not confuse Zofran with Zoloft, Zantac, or Zosyn;


do not exceed 8 mg PO or 8 mg IV daily with impaired hepatic function; 2 mg/mL
Ondansetron injection requires no dilution for administration for postop N&V; inspect
visually for particulate matter and discoloration before administering; drug is to prevent
N&V; to be given exactly as prescribed; may cause drowsiness or dizziness; do not
perform activities that require mental alertness until drug effects realized; report any rash,
diarrhea, constipation, altered respirations (brochospasms), or loss of response
GENERIC NAME: CALCIUM CARBONATE
TRADE NAME: Calci-Mix, Surpass, Surpass Extra Strength, Cal-Carb Forte, Calcium
600, Nephro-Calci, Os-Cal 500, Oysco 500, Oyst-Cal 500, Oyster Shell Calcium, Tums

CLASSIFICATION: Calcium salt

ACTION: Calcium is essential for maintaining normal function of nerves, muscles, the
skeletal system, and permeability of cell membranes and capillaries; normal serum
calcium level is 9-10.4 mg.dL (4.5-5.2 mEq/L). Hypocalcemia is characterized by
muscular fibrillation, twitching, skeletal muscle spasms, leg cramps, titanic spasms,
cardiac arrythmias, smooth muscle hyperexcitability, mental depression, and anxiety
states
INDICATIONS: Mild hypocalcemia; Antacid (including heartburn, sour stomach, and
acid indigestion); anithyperphosphatemic
ROUTES OF ADMINISTRATION: Capsules, gum, gum tablets, lozenges, powder,
suspension, tablets, chewable tablets
USUAL DOSAGE: Hypocalcemia/Nutritional supplement – 1.25-1.5 grams 1-3 times
daily with or without meals; antihyperphosphatemic – 5-13 grams daily in divided doses
with meals
ADVERSE REACTIONS: After PO use – GI irritation, constipation, headache, mild
hypercalcemia (anorexia, N&V)

INTERACTIONS: Omeprazole ↓ fractional calcium absorption in fasting elderly


women

CONTRAINDICATIONS: Digitalized clients, sarcoidosis, renal or cardiac disease,


ventricular fibrillation, cancer clients with bone metastases; renal calculi,
hypophosphatemia; hypercalcemia

NURSING CONSIDERATIONS: Perform thorough nursing history, noting clinical


presentation, indications for therapy, and any precipitating causes; list drugs prescribed,
especially if receiving digitalis products (may be contraindicated); monitor calcium levels
and renal function; assess for renal or parathyroid disease; note bone density findings;
supplements need vitamin D to facilitate absorption; report adverse side effects, lack of
desired response, and keep all follow-up appointments to evaluate drug response
GENERIC NAME: LEVOTHYROXINE
TRADE NAME: Synthroid, Levoxyl, Levothroid, others
CLASSIFICATION: Synthetic Thyroid Preparation
ACTION: At a cellular level, works to induce changes in the metabolic rate, including
protein, carbohydrate and lipid metabolism, increase oxygen consumption, body
temperature, blood volume and overall cellular growth and differentiation. Stimulate the
cardiovascular system by increasing the number of myocardial beta-adrenergic receptors
which increases the sensitivity of the heart to catecholamines and ultimately increases
cardiac output. Additionally, increases renal blood flow and the glomerular filtration rate
which results in a diuretic effect. Thyroid hormone T4.
INDICATIONS: preferred drug for treatment of hypothyroidism because its hormonal
content is standardized and its effect is predictable. Also used to treat goiters, as
replacement therapy in patients who have had thyroidectomys
ROUTES OF ADMINISTRATION: PO, IV
USUAL DOSAGE: 25-300 mcg/day (25-200 mcg/day most common) IM/IV: 50% of
oral dose; IV 200-500 mcg in a single dose; repeat next day 100-300 mcg if necessary.
Pediatric 0-12 yr, PO: 25-150 mcg/day
ADVERSE REACTIONS: usually a result of overdose. Cardiac dysrhythmia with the
risk for life-threatening or fatal irregularities, tachycardia, palpitations, angina,
hypertension, cardiac arrest, insomnia, tremors, headache, anxiety, nausea, diarrhea,
increased or decreased appetite, cramps, menstrual irregularities, weight loss, sweating,
heat intolerance, fever.

INTERACTIONS: : May enhance the activity of oral anticoagulants which may need
reduced doses. When taken concurrently with digitalis glycosides may decrease serum
digitalis levels. Cholestyramine binds to thyroid hormone in the GI tract, possibly
reducing the absorption of both drugs. Diabetic patiens may require increased doses of
their hypoglycemic drugs. With epinephrine in patients with coronary disease, may
induce coronary insufficiency.

CONTRAINDICATIONS: known drug allergy, recent MI, adrenal insufficiency or


hyperthyroidism.

NURSING CONSIDERATIONS: Half life long enough that it only needs to be


administered once a day. Pregnancy category A. Switching between courses of
treatments should be minimized. Thyroid function tests should be monitored
GENERIC NAME: METOCLOPRAMIDE
TRADE NAME: Reglan, Reclomide
CLASSIFICATION: Antiemetics
ACTION: Block dopamine receptors in chemoreceptor trigger zone of the CNS. Stimulates motility of the
upper GI tract and accelerates gastric emptying. Therapeutic Effects: Decreased nausea and vomiting.
Decreased symptoms of gastric stasis. Easier passage of NG tube into small bowel.
INDICATIONS: Prevention of chemotheraphy-induced emesis. Treatment of postsurgicial and diabetic
gastric stasis. Facilitation of small bowel intubation in radiographic procedures. Management of
esophageal reflux. Treatment and prevention of gastric suctioning is undesirable. Unlabeled uses:
treatment of hiccups. Adjunct management of migraine headaches.
ROUTES OF ADMINISTRATION: IV, PO, IM
USUAL DOSAGE: : Prevention of Chemotherapy-Induced Vomiting: PO:IV (Adults (Adults and
Children): 1-2 mg/kg 30 min before chemotherapy. Additional doses of 1-2 mg/kg may be given q2-4hr,
for 2 doses, then q3 hr for 3 additional doses. May also be given as 3 mg/kg before pretreatment with
diphenhydramine will decrease the risk of extra pyramidal reactions to this dosage chemotherapy, followed
by 0.5mg/kg/hr for 8 hrs. Facilitation of Small Bowel intubation: IV(Adults): 10 mg over 1-2 min
IV(Children 6-14 yr): 2.5-5 mg(dose should not exceed 0.5 mg/kg over 1-2 mins. IV(Children<6yr): 0.1
mg/kg over 1-2 mins. Diabetic Gastroparesis: PO:IV (Adults):10 mg 30 min before meals and at bedtime
Gastroesophageal Reflux: PO(Adults): 10-15 mg 30 mins before meals and at bedtime (not to exceed 0.5
mg/kg/day).PO (Neonates, Infants, Children): 0.4-0.8 mg/kg/day in 4 divided doses. Postoperative
Nausea/Vomiting: IM:IV (Adults (Adults and Children>14):10-20 mg at the end of surgical procedure
repeat in 6-8 hr if needed. IM, IV(Children):0.1-0.2 mg/kg/dose, repeat in 6-8 hr if needed. Treatment of
hiccups: PO, IM(Adults): 10-20 mg 4 times daily PO; may be preceded by a single 10 mg dose IM
ADVERSE REACTIONS: drowsiness, extrapyramidal reactions, restlessness,
NEUROLEPTIC MALGNANT SYNDROME, anxiety, depression, irritability, tardive
dyskinesia, arrhythmias, hypertension, hypotension, constipation, diarrhea, dry mouth,
nausea, gynecomastia, methemoglobinemia, neutropenia, leucopenia, agranulocytosis

INTERACTIONS: : Additive CNS depression with other CNS depressants. May


increase absorption and risk of toxicity from cyclosporine. May affect the GI absorption
of other orally administered drugs. May exaggerate hypotension during extrapyramidal
reactions with agents such as haloperidol or phenothiazines

CONTRAINDICATIONS: Hypersensitivity. Possible GI obstruction or hemorrhage.


Hx of seizure disorders.

NURSING CONSIDERATIONS: Instruct patient to take metoclopramide exactly as


directed. If dose is missed, take as soon as remembered if not almost time for next dose
GENERIC NAME: PROCHLORPERAZINE (MALEATE)

TRADE NAME: Compazine, Compro Suppositories

CLASSIFICATION: Antipsychotic, phenothiazine

ACTION: Causes a high incidence of extrapyramidal and antiemetic effects, moderate


sedative effects, and a low incidence of anticholinergic effects and orthostatic
hypotension
INDICATIONS: Schizophrenia; short term treatment of generalized non-psychotic
anxiety (not the drug of choice); severe N&V

ROUTES OF ADMINISTRATION: Suppositories, injection, syrup, sustained-release


capsules, tablets

USUAL DOSAGE: Adults & adolescents (PO) – 5-10 mg (repeat dose q 3-4 hr as
needed, not to exceed 40 mg/day; (rectal suppository) - 25 mg twice daily; maleate
sustained-release tablets (maleate tablets) – 5-10 mg 3-4 times daily (up to 40 mg/day);
for extended release capsules, the dose is 15-30 mg once daily in the morning (or 10 mg q
12 hr, up to 40 mg/day)
ADVERSE REACTIONS: Drowsiness, dizziness, amenorrhea, blurred vision, skin
reactions, hypotension, extrapyramidal reactions

INTERACTIONS: Ethyl alcohol/general anesthetics/antianxiety drugs/barbiturates/CNS


depressants/narcotics/sedative hypnotics – potentiation or addition of CNS depressant
effects (concomitant use may lead to drowsiness, lethargy, stupor, respiratory collapse,
coma or death; aluminum salts (antacids) - ↓ absorption from GI tract; MANY MORE

CONTRAINDICATIONS: Use in clients who weigh less than 44 kg or who are under 2
y/o

NURSING CONSIDERATIONS: For the elderly, use doses in lower range as they are
more susceptible to hypotension and neuromuscular reactions; store all forms of the drug
in tight-closing amber-colored bottles; store suppositories below 37°C (98.6°F); DO NOT
GIVE SC; Do not mix other agents in syringe if given IV; Do not mix with any agent
containing preservative parabens; parenteral prescribing limits are 20 mg/day for children
2-5 y/o, 25 mg/day for children 6-12 y/o; assess mental status; note behavioral
presentation/manifestations; moniotor CBC, LFT’s, ECG; do not exceed prescribed dose;
auscultate bowel sounds and assess function
GENERIC NAME: TAMULOSIN HYDROCHLORIDE

TRADE NAME: Flomax

CLASSIFICATION: Alpha-adrenergic blocking drug


ACTION: Blockade of alpha1-receptors (probably alpha1a) in the prostate
results in relaxation of smooth muscles in the bladder, neck and prostate;
thus, urine flow rate is improved and there is a decrease in symptoms of
BPH

INDICATIONS: Signs and asymptoms of BPH; rule-out prostatic


carcinoma before using tamsulosin

ROUTES OF ADMINISTRATION: Capsules


USUAL DOSAGE: Adult males – 0.4 mg once daily given about 30 min
after same meal each day; if after 2 to 4 weeks clients have not responded,
dose can be increased to 0.8 mg daily
ADVERSE REACTIONS: Headache, dizziness, pharyngitis/rhinitis, abnormal
ejaculation, shoulder/neck/back/extremity pain, asthenia, diarrhea, chest pain

INTERACTIONS: Cimetidine causes significant ↓ in clearance of tamsulosin

CONTRAINDICATIONS: Use to treat hypertension, with other alpha-adrenergic


blocking agents, or in women or children

NURSING CONSIDERATIONS: Do not confuse Flomax with Fosamax, Flonase, or


Volmax; if dose discontinued or interrupted for several days at either dose, start back up
at 0.4 mg dose; store at 20-25°C (68-77°F); identify drugs prescribed to ensure none of
the drugs interact, esp cimetidine or coumadin; monitor CBC, I&O, VS, weight,
urodynamic studies; note PSA levels, results of digital rectal exam; take as directed, do
not chew, crush, or open capsule; may take 30 min after same meal each day to decrease
GI upset; report any loss of effectiveness or increased nighttime voiding; do not perform
activities that require mental/physical alertness until drug effects realized; may cause
drowsiness, dizziness, and syncope; change positions slowly to prevent sudden drop in
BP; do not stop suddenly after prolonged use; avoid OTCs without getting provider
approval first
GENERIC NAME: CALCITRIOL

TRADE NAME: Rocaltrol

CLASSIFICATION: Synthetic vitamin D analog


ACTION: Active in the regulation of the absorption of calcium from the GI
tract and its utilization in the body
INDICATIONS: management of hypocalcemia and resultant metabolic
bone disease in patients undergoing chronic renal dialysis; indicated in
management of secondary hyperparathyroidism and resultant metabolic bone
disease in patients with mild/moderate/severe chronic renal failure not yet on
dialysis; management of hypocalcemia and clinical manifestations in
patients with postsurgical hypoparathyroidism, idiopathic
hypoparathyroidism, and pseudohypoparathyroidism
ROUTES OF ADMINISTRATION: Capsules (0.25 mcg or 0.5 mcg); oral
solution (1 mcg/mL)
USUAL DOSAGE: 0.25 mcg – 1.0 mcg daily
ADVERSE REACTIONS: Hypercalcemia syndrome or calcium intoxication; weakness,
headache, somnolence, N&V, dry mouth, constipation, muscle pain, bone pain, metallic
taste, anorexia, stomach pain, abdominal pain; polyuria, polydipsia, nocturia, calcific
conjunctivitis, pancreatitis, photophobia, rhinorrhea, pruritis, hyperthermia, decreased
libido, elevated BUN, albuminuria, hypercholesterolemia, elevated SGOT (AST) and
SGPT (ALT) and MANY MORE

INTERACTIONS: Cholestyramine, Phenytoin/Phenobarbital, Thiazides, Digitalis,


Ketoconazole, Corticosteroids, Phosphate-binding agents, Vitamin D, Calcium
supplements, Magnesium
CONTRAINDICATIONS: Should not be taken to patients with hypercalcemia or
evidence of Vit D toxicity; use in patients with known hypersensitivity to Rocaltrol (or
drugs of same class) or any of the inactive ingrediants is contraindicated

NURSING CONSIDERATIONS: Effectiveness is predicated on the assumption that


each patient is receiving an adequate daily intake of calcium; advise patients to have
dietary intake minimum of 600 mg daily; patients should be advised of compliance with
dosage instructions and adherence to instructions about diet and calcium
supplementation; advise avoidance of the use of unapproved nonprescription drugs;
carefully inform about S&S of hypercalcemia
GENERIC NAME: HYDROCODONE BITARTRATE AND
ACETAMINOPHEN
TRADE NAME: Anexia 10/660, Anexia 5/325, Anexia 5/500, Anexia
7.5/325, Bancap HC, Ceta-Plus, Co-Gesic, Dolacet, Duocet, HyPhen, Hycet,
Hydrocet, Vicodin, Vicodin ES, Vicodin HP
CLASSIFICATION: Analgesic
ACTION: Hydrocodone produces its analgesic activity by an action on the
CNS via opiate receptors; analgesic reaction of acetaminophen is produced
by both peripheral and central mechanisms
INDICATIONS: Relief of moderate to moderately severe pain
ROUTES OF ADMINISTRATION: Capsules, tablets, oral solution
USUAL DOSAGE: For 5/500 products, the dose is 1 or 2 q 4-6 hr, up to 8
per day; for 5/325, 7.5/325, 10/325, and 7.5/400, the dose is 1 q 4-6 hr, up to
6 a day; for 7.5/500 and 7.5/650, the dose is 1 q 4-6 hr; for 7.5/750, the dose
is 1 q 4-6 hr, up to 5 per day; for 10/325, 10/400, 10/500, and 10/650, the
dose is 1 q 4-6 hr, up to 6 per day; for 10/650, 10/660, and 10/750, the dose
is 1 q 4-6 hr
ADVERSE REACTIONS: Nausea and vomiting, urinary retention, lightheadedness,
dizziness, sedation, mental clouding

INTERACTIONS: Anticholinergics - ↑ risk of paralytic ileus; CNS depressants,


including other narcotic analgesics, antianxiety agents, antipsychotics, alcohol – additive
CNS depression; MAO inhibitors/tricyclic antidepressants - ↑ effect of either the narcotic
or the antidepressant

CONTRAINDICATIONS: Hypersensitivity to acetaminophen or hydrocodone

NURSING CONSIDERATIONS: Note onset, location, characteristics of S&S, other


agents, prescribed, outcome, if pain acute or chronic; rate pain increased; note history of
hypothyroidism, BPH, urethral stricture, Addison’s disease, severe pulmonary disease,
head injury; monitor renal and LFT’s; avoid with dysfunction; take as directed; may take
with food/milk to decrease GI upset; do not perform activities that require mental
alertness; causes dizziness, lethargy, and impaired physical and mental performance;
report evidence of abnormal bruising/bleeding, breathing problems, N&V, constipation,
urinary difficulty, excessive sedation or lack of pain control; avoid alcohol and OTC
agents or CNS depressants; for short term use only (VERY habit-forming)
GENERIC NAME: MEPERIDINE HYDROCHLORIDE
TRADE NAME: Demerol Hydrochloride, C-11
CLASSIFICATION: Narcotic analgesic
ACTION: One-tenth as potent an analgesic as morphine; analgesic effect is only one-
half when given PO rather than parenterally; has no antitussive effecrs and does not
produce miosis; less smooth muscle spasm, constipation, and antitussive effect than
equianalgesic doses of morphine; produces both psychologic and physical dependence;
overdosage causes severe respiratory depression
INDICATIONS: Analgesic for moderate to severe pain; preoperative medication;
adjunct to anesthesia; obstetrical analgesia
ROUTES OF ADMINISTRATION: Injection (25 mg/mL, 50 mg/mL, 75 mg/mL, 100
mg/mL), oral solution (50 mg/5 mL), syrup (50 mg/5mL), tablets (50 mg, 100 mg)
USUAL DOSAGE: Analgesic (adults) – 50-100 mg q 3-4 hr as needed; (pediatric) – 1.1-
1.75 mg/kg, up to adult dosage, q 3-4 hr as needed; initial PCA dosage – 10 mg with a
range of 1-5 mg per incremental dose (recommended lock-out interval is 6-10 min with a
minimum of 5 min); Preoperatively IM, IV (adults) – 50-100 mg 30-90 min before
anesthesia; (pediatric) – 1.1-2.2 mg/kg (up to adult dose) 30-90 min prior to anesthesia;
IV analgesic – 15-35 mg/hr by continuous IV; Support of anesthesia – IV infusion 1
mg/mL or slow IV injection 10 mg/mL until client needs met
ADVERSE REACTIONS: Constipation, dry mouth, N&V, anorexia, dizziness, fatigue,
lightheadedness, muscle twitches, sweating, itching, decreased urination, decreased libido
INTERACTIONS: Antidepressants, tricyclic – additive anticholinergic side effects;
Cimetidine - ↑ respiratory and CNS depression; Hydantoins - ↓ meperidine effect R/T ↑
liver breakdown; MAO inhibitors - ↑ risk of severe symptoms including hyperpyrexia,
restlessness, hyper- or hypotension, convulsions, or coma; Protease inhibitors – avoid
combination; Sibutramine – possibility of life-threatening serotonin syndrome; smoking -
↓ analgesia R/T ↑ hepatic metabolism (takes several weeks to occur)
CONTRAINDICATIONS: Hypersensitivity to drug, convulsive states as in epilepsy,
tetanus, and strychnine poisoning, children under 6 months, diabetic acidosis, head
injuries, shock, liver disease, respiratory depression, increased intracranial pressure, and
before labor during pregnancy; use with sibutramine
NURSING CONSIDERATIONS: IM preferred over SC use in repeated doses; more
effective when given parenterally than PO; take syrup with half glass of water to
minimize anesthetic effect on mucous membranes; take drug within ordered intervals to
prevent pain recurring; report pain levels and lack of effectiveness; drug causes dizziness
and drowsiness (do not engage in activities that require mental alertness); due to low BP
effects, rise slowly and do not change positions abruptly; increase fluid intake and bulk to
avoid constipation; avoid alcohol and other CNS depressants.
GENERIC NAME: PROMETHAZINE HYDROCHLORIDE/CODEINE
TRADE NAME: Phenadoz, Phenergen
CLASSIFICATION: Antihistamine, first generation, phenothiazine
ACTION: Antiemetic effects are likely due to inhibition of the CTZ; effective in vertigo
by its central anticholinergic effect which inhibits the vestibular apparatus and the
integrative vomiting center as well as the CTZ; may cause severe drowsiness; significant
anticholinergic and antiemetic effects
INDICATIONS: Prophylaxis and treatment of motion sickness; prophylaxis and control
of N&V due to anesthesia or surgery; preoperative, postoperative, or obstetric sedation;
relief of apprehension and production of light sleep; hypersensitivity reaction, including
perennial and seasonal allergic rhinitis, vasomotor rhinitis, allergic conjunctivitis caused
by inhalant allergens and foods, mild uncomplicated allergic skin manifestations of
urticaria and angioedema, allergic reactions to blood or plasma, dermographism, and
adjunctive anaphylactic therapy; adjunct to analgesics for postoperative pain.
ROUTES OF ADMINISTRATION: Injection (25 mg/mL, 50 mg/mL <IM only>);
suppositories (12.5 mg, 25 mg, 50 mg); syrup (6.25 mg/mL); tablets (12.5 mg, 25 mg, 50
mg)
USUAL DOSAGE: Sedation (adults) – 25-50 mg at bedtime, (>2 yr) – 12.5-25 mg at
bedtime; Antiemetic (Adults) – 25 mg (usual dose); doses of 12-5-25 mg may be repeated
q 4-6 hr; (>2 yr) – 25 mg or 0.5 mg/lb
ADVERSE REACTIONS: Drowsiness, dizziness, confusion, blurred vision, dry mouth,
tinnitus, N&V, photosensitivity
INTERACTIONS: Antidepressants, tricyclic – additive anticholinergic side effects; CNS
depressants, antianxiety agents, barbiturates, narcotics, phenothiazines, procarbazine,
sedative-hypnotics – potentiation or addition of CNS depressant effects (concomitant use
may lead to drowsiness, lethargy, stupor, respiratory depression, coma, and possibly
death); Heparin – antihistamines may ↓ the anticoagulant effects
CONTRAINDICATIONS: Lactation, comatose clients, CNS depression due to drugs
(including barbiturates, general anesthetics, tranquilizers, alcohol, narcotics); previous
phenothiazine idiosyncrasy or hypersensitivity, acutely ill or dehydrated children (due to
greater susceptibility to dyastonias); children under 2 y/o; treatment of uncomplicated
vomiting in children
NURSING CONSIDERATIONS: Do not confuse promethazine with chlorpromazine or
with prochlorperazine (both antipsychotics); take only as directed and do not exceed dose
(cardiac arrythmias may occur); may take with milk or food to decrease GI upset; avoid
activities that require mental alertness until drug side effects realized (may cause
sedation); do nto consume alcohol, CNS depressants, or OTC agents unless provider
approved; consume adequate fluids to prevent dehydration (use caution in hot weather to
prevent heat stroke); decrease dosage in dehydrated or oliguric clients
GENERIC NAME: PROPOXYPHENE NAPSYLATE AND ACETAMINOPHEN
TRADE NAME: Darvocet-N 100, Darvocet-N 50, Propacet 100

CLASSIFICATION: Narcotic and nonnarcotic analgesic combination

ACTION: Propoxyphene is a centrally-acting narcotic analgesic related to methadone;


potency of propoxyphene is from two-thirds to equal that of codeine; acetaminophen may
cause analgesia by inhibiting CNS prostaglandin synthesis; however, due to minimal
effects on peripheral prostaglandin synthesis, acetaminophen has no anti-inflammatory or
uricosuric effects; decreases fever by (1) a hypothalamic effect leading to sweating and
vasodilation and (2) inhibits the effect of pyrogens on the hypothalamic heat-regulating
centers.

INDICATIONS: Relief of mild to moderate pain, either when pain is present alone or
when accompanied by fever

ROUTES OF ADMINISTRATION: Tablets

USUAL DOSAGE: 100 mg propoxyphene napsylate and 650 mg acetaminophen q 4 hr,


not to exceed 600 mg propoxyphene per day
ADVERSE REACTIONS: Drowsiness, dizziness, N&V, sedation
INTERACTIONS: Anticonvulsants - ↑ anticonvulsant pharmacologic and toxic effects
R/T inhibition of metabolism; antidepressants - ↑ antidepressant pharmacologic and toxic
effects R/T inhibition of metabolism; CNS depressants (including alcohol,
antidepressants, muscle relaxants, sedatives, tranquilizers) – additive CNS depression;
warfarin - ↑ warfarin pharmacologic and toxic effects R/T inhibition of metabolism
CONTRAINDICATIONS: Hypersensitivity to propoxyphene or acetaminophen; use in
those who are suicidal or addiction-prone; use in pregnancy unless until potential benefits
outweigh the possible risks
NURSING CONSIDERATIONS: Consideration should be given to reducing the dose
of propoxythene in geriatric clients and in those with renal or hepatic impairment; store
from 15-30°C (59-86°F); list drugs prescribed to ensure none interact; note reasons for
therapy, location, characteristics of S&S, other agents trialed, outcome, and rate the pain
level; assess for depression, suicide ideations, excessive alcohol use, drug addiction
prone, precludes drug use; monitor ROM, VS, renal, LFT’s; reduce dose with
dysfunction; do not exceed prescribed dose; do not perform activities that require mental
alertness until drug effects realized (may cause dizziness or drowsiness); avoid alcohol
and other CNS depressants during therapy; may cause dizziness, N&V (lie down and rest
if these effects occur to relieve symptoms).
GENERIC NAME: LITHIUM CARBONATE
TRADE NAME: Eskalith CR, Lithobid, Lithonate, Lithotabs
CLASSIFICATION: Antimanic
ACTION: Mechanism for the antimanic effect of lithium is unknown; possibilities
include: (a) decrease in catecholamine neurotransmitter levels caused by lithium effect on
Na+-K+ ATPase to improve transneuronal membrane transport of sodium ion; (b)
decrease in cyclic AMP levels caused by lithium which decreases sensitivity of
hormonal-sensitive adenyl cyclase receptors: Affects the distribution of calcium, Mg, and
sodium ions and affects glucose metabolism
INDICATIONS: Control of mania in manic-depressive clients; Investigational: to
reverse neutropenia induced by cancer chemotherapy, in children with chronic
neutropenia, and in AIDS clients receiving ziduvudine; prophylaxis of cluster headaches
ROUTES OF ADMINISTRATION: Capsules: 150 mg, 300 mg, 600 mg; Tablets: 300
mg; Extended Release Tablets: 300 mg, 450 mg
USUAL DOSAGE: Individualized, according to lithium serum level (not to exceed 1.4
mEq/L) and clinical response; Usual initial dose – 300-600 mg 3 X daily, or 600-900 mg
2 X daily of slow release forms; Maintenance: 300 mg 3-4 X daily; Administration of
drug halted when serum level exceeds 1.2 mEq/L, started back up 24 hr later
ADVERSE REACTIONS: Fine hand tremor, polyuria, thirst, transient and mild nausea,
general discomfort

INTERACTIONS: Acetazolamide / urea / urinary alkanizers / mannitol- ↓ lithium effect


by ↑ renal excretion; Bumetanide / ethacrynic acid / furosemide - ↑ lithium toxicity R/T ↓
renal clearance; Carbamazepine / phenytoin / probenecid - ↑ risk of lithium toxicity;
Diazepam - ↑ risk of hypothermia; Haloperidol - ↑ risk of neurologic toxicity; NSAID’s -
↓ lithium clearance, possibly R/T inhibition of renal prostaglandin synthesis

CONTRAINDICATIONS: Cardiovascular or renal disease; brain damage; dehydration,


sodium depletion, clients receiving diuretics; lactation

NURSING CONSIDERATIONS: Toxicity is closely related to serum lithium levels


and can occer at therapeutic doses; facilities to monitor lithium are required: determine
blood levels 1-2 times weekly to prevent toxicity; full beneficial drug effects might not be
noted for 6-10 days; drink 10-12 glasses of water per day to avoid dehydration; take with
food or immediately after meals; avoid caffeinated drinks/foods (may aggravate mania);
report persistent diarrhea; may need supplemental fluids or salts
GENERIC NAME: OXYBUTYNIN

TRADE NAME: Ditropan, Ditropan XL, Urotrol

CLASSIFICATION: Antispasmodic in urinary tract

ACTION: Exerts direct antispasmodic effect on smooth muscle and inhibits action of
acetylcholine at postganglionic cholinergic sites, thus decreasing bladder capacity and
delaying the initial desire to void by reducing the number of motor impulses reaching the
detrusor muscle

INDICATIONS: Urologic disorders, irritative voiding, frequent urinating, urgency, urge


incontinence, nocturia, incontinence with neurogenic bladder contractions

ROUTES OF ADMINISTRATION: Syrup, Tablets

USUAL DOSAGE: Adult: Oral, 5 mg two or three times a day, dosage being adjusted as
needed and tolerated; oral prescribing limits – 5 mg 4 times a day or 20 mg daily
ADVERSE REACTIONS: Rapid increase in temperature due to suppretion of sweat
glands; allergic reaction; increased intraocular pressure; constipation, decreased sweating,
drowsiness; dryness of mouth, nose, and throat

INTERACTIONS: Anticholinergics/anticholinergic-like drugs / CNS depressants – may


increase sedative effect of either these medications or oxybutynin

CONTRAINDICATIONS: Urinary retention, gastric retention, other severe


gastrointestinal motility conditions; uncontrolled narrow-angle glaucoma;
hypersensitivity to drug

NURSING CONSIDERATIONS: Take medication on an empty stomach with water, or


with food and milk to reduce gastric irritation; do not take more medication than the
amount prescribed; take as soon as possible if almost time for next dose, do not double
dose of missed for extended amount of time; avoid use of alcohol or other CNS
depressants; possibly have an increased sensitivity to light; caution if blurred vision or
drowsiness occurs; caution during exercise and hot weather (may cause heatstroke)
GENERIC NAME: PYRIDOXINE HYDROCHLORIDE (VITAMIN B6)

TRADE NAME: Pyridoxine HCl injection, Aminoxin, Vitelle Nestrex

CLASSIFICATION: Vitamin B6
ACTION: A water-soluble heat-resistant vitamin that is destroyed by light; acts as a
coenzyme in the metabolism of protein, carbohydrates, and fat; as amount of protein
increases in diet, pyridoxine requirement increases; however, pyridoxine deficiency alone
is rare

INDICATIONS: Pyridoxine deficiency including poor diet, drug-induced (ex. Oral


contraceptives, isoniazid), and inborn errors of metabolism

ROUTES OF ADMINISTRATION: Injection 100 mg/mL; tablets 25 mg, 50 mg, 100


mg, 250 mg, 500 mg

USUAL DOSAGE: Dietary supplement: Adults: 10-20 mg/day for 2 weeks, then 2-5
mg/day as part of a multivitamin preparation for several weeks; High urine oxylate
levels: 25-300 mg/day; PMS: 40-500 mg/day; Tardive dyskinesia due to antipsychotic
drugs: 100 mg/day for 4 weeks
ADVERSE REACTIONS: Paresthesia, numbness of feet, perioral numbness, unstable
gait. Decreased sensation to touch, temperature, and vibration

INTERACTIONS: Chloramphenicol / oral contraceptives / Cycloserine / Ethionamide /


Hydralazine / immunosuppressant’s / isoniazid / penicillamine : ↑ Pyridoxine
requirements; Levadopa: doses exceeding the 5 mg/day pyridoxine antagonize
therapeutic effect of levadopa; Phenobarbital: ↓ serum phenobarbitol levels; Phenytoin: ↓
serum phenytoin levels

CONTRAINDICATIONS: None – special concerns with safety and effectiveness in


children for doses that exceed RDA (not been established)

NURSING CONSIDERATIONS: Monitor uric acid levels, renal, LFTs; assess for
dysfunction; best source of vitamins are with foods high in Vitamin B6, potatoes, broccoli,
lima beans, bananas, chicken breast, liver, yeast, wheat germ, whole-grain cereals; if
prescribing levadopa, avoid vitamin supplements containing vitamin B6, do not take OTC
vitamin supplements without provider approval
GENERIC NAME: METOPROLOL SUCCINATE

TRADE NAME: Toprol XL

CLASSIFICATION: Antihypertensive

ACTION: Beta 1 adrenoreceptor blocking agents. HCT provides diuretic actions.


Crosses the blood-brain barrier. Slows the sinus rate and decreases AV nodal
conduction. Blocks the action of certain chemicals in your body – like epinephrine – that
affect the heart and blood vessels. Results in lowering of heartrate, BP and strain on the
heart.

INDICATIONS: Late or early MI, hypertension, angina, heart failure, irregular heart
rate, migrane prevention

ROUTES OF ADMINISTRATION: PO: tablets, IV

USUAL DOSAGE: PO: 100-450 mg/day divided bid-tid IV/PO/ 3 bolus injections of 5
mg at 2 min intervals followed in 15 min by 50 mg PO every 6 hrs for 48 hrs, thereafter
100 mg PO bid
ADVERSE REACTIONS: Hypokalemia may develop is cases of brisk diuresis or
severe cirrhosis, dizziness, lightheadedness, drowsiness, diarrhea, unusual dreams,
trouble sleeping, vision problems, cold hands, feet, decreased pulse.

INTERACTIONS: General anesthesia, clonidine, insulin, thiazides, lithium, NSAIDs,


antidiabetics, CA channel blockers, Digoxin, epinephrine, anti-hypertensives, thyroid
medications and anti-depressants.

CONTRAINDICATIONS: Sinus bradycardia, heart block greater than first degree,


cardiogenic shock, overt cardiac failure. Hypersensitivity to related derivatives or to any
of the excipients; hypersensitivity to other beta-blockers, cross sensitivity between beta
blockers can occur, sick sinus syndrome, severe peripheral arterial circulatory disorders,
pheochromocytoma, patients with bronchospastic diseases, used with caution in
diabetic patients or patients with impaired hepatic function.

NURSING CONSIDERATIONS: Apical pulse rate should be taken for 1 minute,


supine and standing BP should be taken, daily weight measurements are important. Take
with or right after a meal. Use regularly at the same time each day. May take 1-2 weeks
to see results. Do not discontinue taking medication without consulting a physician.
Medication must be gradually decreased. Exercise must be limited while decreasing
GENERIC NAME: CHOLESTYRAMINE RESIN
TRADE NAME: Questran, Questran Light, Cholestyramine Light, Prevalite
CLASSIFICATION: Antihyperlipidemic, bile acid sequestrant
ACTION: Binds sodium cholate (bile salts) in the intestine; thus the principal precursor
of cholesterol is not absorbed due to the formation of an insoluble complex, which is
excreted in the feces; decreases cholesterol and LDL and either has no effect or increases
triglycerides VLDL and HDL; also, itching is relieved as a result of removing irritating
bile salts; antidiarrheal effect results from binding and removal of bile acids
INDICATIONS: Adjunct to reduce elevated serum cholesterol in primary
hypercholesterolemia in those who do not respond adequately to diet; Pruritus associated
with partial biliary obstruction; Diarrhea due to bile acids; Investigational: Antibiotic-
induced pseudomembranous colitis (ex due to toxin produced by Clostridium difficile),
digitalis toxicity, treatment of thyroid hormone overdose, treatment of chlordecone
poisoning
ROUTES OF ADMINISTRATION: Powder for suspension
USUAL DOSAGE: Adult: Initial: 4 grams 1-2 times per day; Maintenance: 2-4 packets
or scoopfuls per day mixed with 60-180 mL water or non-carbonated beverage;
recommended 2 times daily, but can be given in one to six doses; maximum daily dose 6
packets or scoopfuls
ADVERSE REACTIONS: Constipation (may be severe), aggravation of hemorrhoids,
abdominal pain, bloating, vomiting, diarrhea, weight loss, flatulence, infection

INTERACTIONS: Aspirin - ↓ aspirin absorption from the GI tract; Clindamycin - ↓


clindamycin absorption from GI tract; too many interactions to list separately NOTE:
Most drugs either have a lessened effect or are less absorbed in the GI tract due to
medication

CONTRAINDICATIONS: Complete obstruction or atresia of bile duct

NURSING CONSIDERATIONS: Always mix powder with 60-180 mL water or


noncarbonated beverage before administering; resin may cause esophageal irritation or
blockage; do not take in dry form; avoid inhaling powder; may be irritating to mucous
membranes; allow powder to sit on top of beverage approx 2 min occasionally twirling to
keep powder from sides and then stir slowly (prevents foaming); take other drugs 1 hour
before or 4-6 hrs after Cholestyramine administration; assess skin and eyes for evidence
of jaundice or bile deposits; report any tarry stools or abnormal bleeding as supplemental
vitamin K (10 mg/week) may be necessary; CBC, PT, and renal function tests should be
done routinely
GENERIC NAME: SODIUM BICARBONATE

TRADE NAME: Arm and Hammer Pure Baking Soda, Bell/ans, Citrocarbonate, Soda
Mint
CLASSIFICATION: Alkalinizing agent, antacid, electrolyte

ACTION: Antacid action due to neutralization of hydrochloric acid by forming sodium


chloride and carbon dioxide; provides temporary relief of peptic ulcer pain and of
discomfort associated with indigestion; systemic and urinary alkalinizer by increasing
plasma and urinary bicarbonate
INDICATIONS: Treatment of hyperacidity; severe diarrhea where there is loss of
bicarbonate; alkalization of the urine to treat drug toxicity; treatment of acute mild to
moderate metabolic acidosis due to shock, severe dehydration, anoxia, uncontrolled
diabetes, renal disease, cardiac arrest, extracorporeal circulation of blood, severe primary
lactic acidosis; prophylaxis of renal calculi in gout
ROUTES OF ADMINISTRATION: Injection – 4%, 4.2%, 5%, 7.5%, 8.4%: Tablets –
325 mg, 520 mg, 650 mg
USUAL DOSAGE: Antacid: 0.325-2 grams 1-4 times per day: Urinary alkalinizer:
0.325-2 grams up to 4 times a day initially, then maximum of 15 grams in those under
age 60 and 8 grams over age 60;
ADVERSE REACTIONS: Rebound hyperacidity, milk-alkali syndrome; use in caution
in impaired renal function, toxemia of pregnancy, with oligurea or anuria, during
lactation, in edema, CHF, liver cirrhosis and with low-salt diets

INTERACTIONS: Ephedrine - ↑ ephedrine effect by ↑ renal tubular reabsorption (many


other drugs affected this way); iron products - ↓ iron effects R/T ↑ urine alkalinity (many
drugs affected this way also)

CONTRAINDICATIONS: Chloride loss due to vomiting or from continuous GI


suction; with diureticsknown to produce a hypochloremic alkalosis; metabolic and
respiratory alkalosis; hypocalcemia in which alkalosis may cause tetany; hypertension,
convulsions, CHF and other situations where administration of sodium can be dangerous

NURSING CONSIDERATIONS: Hypertonic solutions must be administered by trained


personnel; avoid extravasation as tissue irritation or cellulitis may occur; assess for
edema; administer isotonic solutions slowly; too rapid may result in death due to cellular
acidity; in event of severe tetany or severe alkalosis, have sodium gluconate on hand;
note reasons for therapy and history of renal impairment; chew tablets thoroughly and
take only as prescribed, and follow with glass of water, NOT with milk/yogurt
GENERIC NAME: AMIODARONE HYDROCHLORIDE
TRADE NAME: Cordarone, Pacerone
CLASSIFICATION: Antiarrhythmic
ACTION: Blocks sodium channels at rapid pacing frequencies, causing an increase in
the duration of the myocardial cell action potential and refractory period, as well as
alpha- and beta-adrenergic blockade; the drug decreases sinus rate, increases PR and QT
intervals, results in development of U waves, and changes T-wave contour; after IV use,
amiodarone relaxes vascular resistance (afterload), and increases cardiac index slightly
INDICATIONS: Use should be reserved for life-threatening ventricular arrhythmias
unresponsive to other therapy, such as recurrent ventricular fibrillation and recurrent,
hemodynamically unstable ventricular tachycardia; reserve IV use for acute treatment
until arrhythmias are stabilized
ROUTES OF ADMINISTRATION: Injection: 50 mg/mL;tablets:100 mg,200 mg,400
mg
USUAL DOSAGE: Administer ONLY in the hospital due to side effects, unusual
properties, and difficult dosing schedule: Loading dose: 150 mg over first 10 minutes (15
mg/min), then slow loading dose 360 mg over next 6 hrs (1mg/min), then maintenance
dose 540 mg over remaining 18 hr (0.5 mg/min) and continue with monitoring for 2 to 3
weeks; then PO amiodarone 800-1600 mg/day (IV less than 1 week), 600-800 mg/day
(IV between 1-3 weeks), and 400 mg/day (IV longer than 3 weeks)
ADVERSE REACTIONS: After PO use, CHF, cardiac arrhythmias, malaise, fatigue,
tremor, involuntary movements, poor coordination, peripheral neuropathy, paresthesias,
photosensitivity, N&V, constipation, anorexia, pulmonary inflammation: After IV use,
hypotension, bradycardia, AV block, CHF, ventricular tachycardia, nausea, fever,
injection site reactions
INTERACTIONS: MULTIPLE INTERACTIONS TOO MANY TO LIST – SEE
BOOK
CONTRAINDICATIONS: Marked sinus bradycardia due to severe sinus node
dysfunction, second- or third-degree AV block unless a functioning pacemaker is
available, cardiogenic shock, and when bradycardia has caused syncope except when
used with a pacemaker; known hypersensitivity to the drug or any of its components,
including iodine; lactation; use in children is not recommended
NURSING CONSIDERATIONS: Drug is used to control heart beat irregularities, take
as directed; assess respiratory status and lung sounds; note cardiac status, EKG and CV
findings; monitor for hepatic and pulmonary toxicity; note baseline vitals and perfusion,
assess for circulatory impairment and hypotension; assess vision before therapy and
monitor; monitor thyroid studies; may require replacement therapy with prolonged use;
during administration, observe for increased PR and QRS intervals, increased
arrhythmias, and HR < 60 bpm
GENERIC NAME: ACIDOPHILUS
TRADE NAME: Acidophilus, Acidophilus Extra Strength, Bacid, Flora-Q, Flora-Q 2,
Superdophilus
CLASSIFICATION: Antidiarrheal, probiotic
ACTION: Bacteria that naturally exists in the human body, primarily in intestines and
vagina; helps maintain acidic environment in body which can prevent growth of harmful
bacteria; helps body maintain normal consistency of bacteria in the stomach, intestines,
vagina; helps maintain normal intestinal flora
INDICATIONS: Diarrhea, electrolyte loss due to diarrhea, fluid loss via diarrhea, treat
or pre4vent vaginal yeast infections, yeast infections of mouth, UTI’s
ROUTES OF ADMINISTRATION: Tablets
USUAL DOSAGE: 230 mg
ADVERSE REACTIONS: Hives, difficulty breathing, swelling of the face, lips, tongue,
throat, other minimal side effects
INTERACTIONS: Possible interactions; too new to know; contact doctor for meds and
interactions
CONTRAINDICATIONS: Pregnancy, lactation, children
NURSING CONSIDERATIONS: Not FDA approved; all potential risks and/or
advantages may not be known; should not be substituted for prescription medications
Generic name: ascorbic acid
Trade name: Vitamin C, Ascorbate, ascorbyl palmitate, calcium ascorbate, sodium
ascorbate, cevitamic acid
Classification: Vitamin Supplement
Action: Water-soluble vitamin, necessary to form collagen in bones, cartilage, muscle,
and blood vessels, aids in absorption of iron
Indications: Scurvy, common cold prevention, iron absorption enhancement, UTI during
pregnancy, asthma, bleeding treatment, cancer prevention, ischemic heart disease
Routes: Oral
Dosage: RDA 90 mg/day for males, 75 mg/day for females; upper limit should not
exceed 2,000 mg/day
Adverse reactions: High doses associated with kidney stones, severe diarrhea, nausea,
gastritis, rarely flushing, faintness, dizziness, fatigue
Interactions: aspirin, effects lowered by barbiturates, oral estrogens / tetracycline
antibiotics / nicotine products ↓ vit C effects
Contraindications: None
Nursing considerations: Watch when taking with other vitamins and medications; check
with doctor for possible interactions with other vitamins and drugs
GENERIC NAME: ESCITALOPRAM OXALATE

TRADE NAME: Lexapro

CLASSIFICATION: Antidepressant, selective serotonin reuptake inhibitor

ACTION: Inhibits CNS neuronal uptake of serotonin; minimal effects on norepinephrine


and dopamine reuptake

INDICATIONS: Major depressive disorder, including maintenance, as defined in the


DSM-IV-TR category; generalized anxiety disorder

ROUTES OF ADMINISTRATION: Oral solution 5 mg/5 mL; tablets 5 mg, 10 mg, 20


mg

USUAL DOSAGE: Initial: 10 mg once daily, including elderly or those with hepatic
impairment; increase dose to 20 mg, if necessary, after a minimum of a week;
maintenance: 10 or 20 mg/day for up to 36 weeks after initial 8 weeks of treatment
ADVERSE REACTIONS: Nausea, dry mouth, increased sweating, dizziness, diarrhea,
flu-like symptoms, fatigue, insomnia, somnolence, rhinitis, ejaculation disorder

INTERACTIONS: Cimetidine/Omeprazole - ↑ Escitopram AUC and t1/2 R/T possible


inhibition of metabolism; MAO inhibitors – serious (may be fatal) reactions, including
hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes;
Metoprolol - ↑ Metoprolol Cmax and AUC; Sumatriptan – potential for weakness,
hyperreflexia, incoordination

CONTRAINDICATIONS: Clients taking monoamine oxidase inhibitors or citalopram


(Celexa); hypersensitivity to the drug or any component; alcohol use

NURSING CONSIDERATIONS: Give once daily in morning or evening with or


without food; discontinuing escitalopram may cause symptoms, including dysphoric
mood, irritability, agitation, dizziness, sensory disturbances, anxiety, confusion,
headache, lethargy, emotional lability, hypomania, or insomnia; gradual reduction
preferred over complete stop; note other prescribed drugs, avoid use within 14 days of
MAOI use; take as directed; should not be taken with Celexa; use caution when operating
machinery or cars until drug effects known; avoid alcohol, OTC agents, or CNS
depressants; use reliable birth control
GENERIC NAME: LANSOPRAZOLE

TRADE NAME: Prevacid, Prevacid IV


CLASSIFICATION: Proton pump inhibitor
ACTION: Gastric acid (proton) pump inhibitor, blocks final step of acid production;
suppresses gastric acid secretion by inhibition of the (H+, K+)-ATPase system located at
the secretory surface of the parietal cells in the stomach
INDICATIONS: Short-term treatment (up to 4 weeks) for healing and symptomatic
relief of active duodenal ulcer (PO only); maintain healing with duodenal ulcer; short-
term treatment (up to 8 weeks) for healing and symptomatic relief of benign gastric ulcer

ROUTES OF ADMINISTRATION: Capsules, delayed-release: 15 mg, 30 mg; granules


for oral suspension, delayed release: 15 mg, 30 mg; tablets, orally disintegrating: 15 mg,
30 mg
USUAL DOSAGE: Treatment of duodenal ulcer (initial) – 15 mg once daily before
breakfast for 4 weeks (maintenance) – 15 mg once daily; treatment of gastric ulcer – 30
mg once daily up to 8 weeks; GERD – 30 mg once daily before meals up to 8 weeks and
if symptoms remain after 2 or more weeks, can up to 30 mg once daily; erosive
esophagitis – 30 mg once daily before meals up to 8 weeks; if symptoms persist, may
continue for another 8 weeks
ADVERSE REACTIONS: Diarrhea, headache, N&V, constipation, rash

INTERACTIONS: Ampicillin - ↓ ampicillin effect R/T ↓ absorption; clarithromycin - ↑


lansoprazole AUC and peak plasma levels R/T inhibition of metabolism by CYP2C19;
Digoxin - ↓ digoxin effect R/T absorption; Iron salts - ↓ effect of iron salts R/T
absorption; sucralfate – delayed absorption of lansoprazole

CONTRAINDICATIONS: Lactation; use with rabeprazole

NURSING CONSIDERATIONS: Do not crush or chew any lansoprazole products;


consider dosage reduction in those with severe liver disease; for those unable to swallow
pills, open capsule and sprinkle on a spoon of applesauce; to give capsules in NG tube,
open capsule and mix intact granules with 40 mL of apple juice and instill through NG
tube into the stomach, flushing with additional apple juice to clear tube; store in tight
container protected from moisture and store between 15-30°
GENERIC NAME: PAROXETINE HYDROCHLORIDE, PAROXETINE MESYLATE

TRADE NAME: Paxil, Paxil CR, Pexeva

CLASSIFICATION: Antidepressant, selective serotonin reuptake inhibitor (SSRI)


ACTION: Antidepressant effect likely due to inhibition of CNS neuronal uptake of
serotonin and to a lesser extent norepinephrine and dopamine; Results in increased levels
of serotonin in synapses
INDICATIONS: Treatment of major depressive episodes as defined in the DSM-III
(immediate-release) or DSM-IV (controlled-release); panic disorder with or without
agoraphobia; treatment of social anxiety disorder (social phobia) as defined in the DSM-
IV; generalized anxiety disorder; up to 24 weeks for maintenance therapy

ROUTES OF ADMINISTRATION: Oral suspension – 10mg/5mL; tablets – 10 mg, 20


mg, 30 mg, 40 mg; tablets, controlled-release – 12.5 mg, 25 mg, 37.5 mg
USUAL DOSAGE: Major depressive disorder, initial – 25 mg/day usually given as
single dose in AM; can increase dose by 12.5 mg/day up to 62.5 mg/day; maintenance -
mg/day average: Social Anxiety disorder – 12.5 mg/day with range 12.5-37.5 mg/day:
Diabetic neuropathy – 10-60 mg/day (oral suspension): Panic disorder – 12.5 mg/day;
increase dose by 12.5 mg/day at 1 week intervals up to 75 mg/day
ADVERSE REACTIONS: Insomnia, somnolence, nausea, dry mouth, asthenia,
headache, dizziness, tremor, excessive sweating, diarrhea/loose stools, constipation,
abnormal ejaculation
INTERACTIONS: Antiarrhythmics (type IC) – possible ↑ effect R/T ↓ liver breakdown;
Cimetidine - ↑ Paroxetine effect R/T ↓ liver breakdown; Digoxin – possible ↓ plasma
levels; Phenobarbital – possible ↓ paroxetine effect R/T ↑ liver breakdown; Phenytoin –
possible ↓ paroxetine effect R/T ↑ liver breakdown and also ↓ phenytoin levels
CONTRAINDICATIONS: Lactation, use of alcohol, use during the first trimester of
pregnancy; concomitant use of thioridazine, use in children and adolescents less than 18
years of age with major depressive disorder due to increased risk of suicidal thoughts and
attempts
NURSING CONSIDERATIONS: Even though beneficial effects may be seen in 1-4
weeks, continue therapy as prescribed; effectiveness is maintained for up to 1 year with
daily doses averaging 30 mg of immediate-release or 37.5 mg of controlled-release; if
decreasing dose, decrease incrementally (stopping suddenly can cause dizziness, sensory
disturbances, agitation, anxiety, nausea, and sweating); document mania, altered
metabolic or hemodynamic states, seizures; note reasons for therapy, type, onset,
characteristics of S&S, other therapy trialed, and outcomes; may be given with or without
food; monitor weight, vital signs, ECG, electrolytes, CBC, renal and LFT’s and note any
dysfunction
GENERIC NAME: HYDRALAZINE HYDROCHLORIDE

TRADE NAME: Apresoline

CLASSIFICATION: Oral hypertensive

ACTION: Major effects are on the cardiovascular system; hydralazine lowers blood
pressure by exerting a peripheral vasodilating effect thru direct relaxation of vascular
smooth muscle; alters cellular calcium metabolism, interferes with calcium movements
within vascular smooth muscle; decreased arterial blood pressure; decreased peripheral
vascular resistance

INDICATIONS: Essential hypertension, either alone or as an adjunct

ROUTES OF ADMINISTRATION: 10 mg, 25 mg, 50 mg, 100 mg all PO tablets

USUAL DOSAGE: Initially 10 mg four times daily for first 2-4 days, increase to 25 mg
four times daily for balance of first week; for second and subsequent weeks, increase
dosage to 50 mg four times daily
ADVERSE REACTIONS: Usually reversible when dosage reduced – common
reactions include headache, anorexia, nausea, vomiting, diarrhea, palpitations,
tachycardia, angina pectoris; less common – constipation, paralytic ileus, dyspnea,
peripheral neuritis, numbness, tingling, dizziness, tremors, muscle cramps, difficulty in
urination

INTERACTIONS: MAO inhibitors cannot be used with Hydralazine, higher plasma


levels results when taken with food

CONTRAINDICATIONS: Hypersensitivity to hydralazine; coronary artery disease;


mitral valvular rheumatic heart disease

NURSING CONSIDERATIONS: Watch for usage of hydralazine in patients with


advanced renal damage; be aware that in hypertensive patients with normal kidneys, there
is evidence of increased renal blood flow and maintenance of glomerular filtration rate;
watch Vital Signs. Check I and O, daily weights need to be checked; check for renal
output
GENERIC NAME: CLONIDINE HYDROCHLORIDE
TRADE NAME: Catapres, Catapres-TTS-1, -2, and -3, Duraclon
CLASSIFICATION: Antihypertensive, centrally-acting
ACTION: Stimulates alpha-adrenergic receptors of the CNS, resulting in
inhibition of the sympathetic vasomotor centers and decreased nerve
impulses; bradycardia and a fall in both SBP and DBP occur; plasma renin
levels are decreased while peripheral venous pressure remains unchanged
INDICATIONS: Alone or with a diuretic or other hypertensives to treat
mild to moderate hypertension; treat spasticity; Investigational – Alcohol
withdrawal, atrial fibrillation, attention deficit hyperactivity disorder;
Epidural – with opiates for severe pain in cancer clients not relieved by
opiate analgesics alone; most effective for neuropathic pain
ROUTES OF ADMINISTRATION: Tablets – 0.1 mg, 0.2 mg, 0.3 mg;
Injection – 0.1 mg/mL, 0.5 mg/mL
USUAL DOSAGE: 0.1 mg twice a day initially, then increase by 0.1 -0.2
mg/day until desired response is attained
ADVERSE REACTIONS: Dry mouth, drowsiness, dizziness, sedation, constipation

INTERACTIONS: Alcohol – ↑ depressant effect; Beta-adrenergic blocking agents –


paradoxical hypertension, also ↑ severity of rebound hypertension following clonidine
withdrawal; CNS depressants - ↑ CNS depressant effect; Levadopa - ↓ Levadopa effect;
Mirtazapine – Loss of BP control → antagonism of α-2 adrenergic receptors; prazosin - ↓
Clonidine antihypertensive effect; Narcotic analgesic – potentiation of clonidine
hypotensive effect; Tolazoline / tricyclic antidepressants – blocks antihypertensive effect;
Verapamil - ↑ risk of AV block and severe hypotension
CONTRAINDICATIONS: Epidurally, presence of an injection site infection, clients on
anticoagulant therapy, in bleeding diathesis, administration above the C4 dermatome; for
obstetrics, postpartum, or perioperative pain

NURSING CONSIDERATIONS: Do not confuse Catapres with Cataflam or


Combipres; do not confuse Clonidine with Klonopin; may take 2-3 days to achieve
effective blood levels; with severe hypertension, may require other antihypertensive drug
therapy in addition to transdermal clonidine; if discontinuing drug, do so gradually over a
period of 2-4 days; identify reasons for therapy, onset, type of symptoms, and previous
treatments; obtain CBC, liver and renal function studies; promote periodic eye exams;
note occupation – may interfere with ability to work
GENERIC NAME: EPOETIN ALFA RECOMBINANT
TRADE NAME: Epogen, Procrit
CLASSIFICATION: Erythropoietin, human recombinant
ACTION: Made by recombinant DNA technology; it has the identical amino acid
sequence and same biologic effects as endogenous erythropoietin (which is normally
synthesized in the kidney and stimulates RBC production); will stimulate RBC
production
INDICATIONS: Treatment of anemia associated with chronic renal failure in adults and
children, including clients on dialysis (end-stage renal disease) or adults not on dialysis;
treatment of anemia in clients with nonmyeloid malignancies
ROUTES OF ADMINISTRATION: Injection – 2000 units/mL, 3000 units/mL, 4000
units/mL, 10000 units/mL, 20000 units/mL, 40000 units/mL
USUAL DOSAGE: Different dosages for different reasons: IV or SC, initial – 50-100
units/kg three times per week (the rate of increase of hematocrit depends on both dosage
and client variation; Maintenance – Individualize – 25 units/kg three times a week, doses
of 75-150 units/kg/week have maintained hematocrit of 36-38% for up to 6 months in
non-dialysis clients NOTE: reduce dose if hemoglobin approaches 12 grams/dL or if
hemoglobin increases by more than 1 gram/dL in any 2 week period
ADVERSE REACTIONS: Hypertension, headache, fever, fatigue, N&V, diarrhea,
edema, asthenia, respiratory congestion, cough, pyrexia, rash, SOB, insomnia, pruritus,
DVT (in surgery clients)

INTERACTIONS: No major interactions


CONTRAINDICATIONS: Uncontrolled hypertension; hypersensitivity to mammalian
cell-derived products or to human albumin; use in chronic renal failure clients who need
severe anemia corrected; to treat anemia in HIV-infected or cancer clients due to factors
such as iron or folate deficiencies, hemodialysis, or GI bleeding; anemic clients willing to
donate autologous blood

NURSING CONSIDERATIONS: DO NOT give with any other drug solutions; at time
of SC administration, the drug may be admixed in a syringe with bacteriostatic 0.9%
NaCl injection with benzylalcohol,0.9% at 1:1 ratio (benzyl alcohol acts as anesthetic that
may reduce discomfort at the SC site; individualize dose for each client; IV usually given
as a bolus 3 times/week; during hemodialysis, may require increased anticoagulation with
heparin to prevent clotting of artificial kidney; determine hematocrit twice weekly; if
hematocrit approaches 36%, decrease dose to maintain suggested hematocrit target range;
Individualize hemoglobin target level; do not shake vial; do not use vials showing
particulate matter or discolorization
GENERIC NAME: GLYBURIDE
TRADE NAME: Diaßeta, Glynase, PresTab, Micronase
CLASSIFICATION: Antidiabetic, oral; second generation sulfonylurea
ACTION: Lowers blood glucose by stimulating the release of insulin from functioning
pancreatic beta cells and by increasing the sensitivity of peripheral tissues to insulin; has
a mild diuretic effect
INDICATIONS: Diabetes mellitus; may be used with metformin when diet and
glyburide or diet and metformin alone do not provide adequate control
ROUTES OF ADMINISTRATION: Tablets, micronized – 1.5 mg, 3 mg, 4.5 mg, 6 mg;
Tablets, nonmicronized – 1.25 mg, 2.5 mg, 5 mg
USUAL DOSAGE: Initial for adults (Nonmicronized) – 2.5 – 5 mg/day given with
breakfast (or first main meal), then increase by 2.5 mg at weekly intervals to achieve the
desired response; maintenance – 1.25 – 20 mg/day; clients sensitive to sulfonylureas
should start with 1.25 mg/day; initial for adults (Micronized) – 1.5 – 3 mg/day given with
breakfast (or first main meal); those sensitive to sulfonylureas should start with 0.75
mg/day; increase by no more than 1.5 mg at weekly intervals to achieve the desired
response
ADVERSE REACTIONS: Hypoglycemia, nausea, epigastric distress, heartburn,
allergic skin reactions, blurred visions

INTERACTIONS: Anticoagulants – either ↑ or ↓ anticoagulant effect; Ciprofloxacin –


potentiation of hypoglycemic effect

CONTRAINDICATIONS: Stress before and during surgery, ketosis, severe trauma,


fever, infections, pregnancy, diabetes complicated by recurrent episodes of ketoacidosis
or coma; use in diabetics who can be controlled by diet alone

NURSING CONSIDERATIONS: Do not confuse glyburide with glipizide or Glucatrol;


administer 30 minutes prior to meals; do not exceed 20 mg/day of nonmicrozized and 12
mg/day of micronized products; note reasons for therapy; explain that it works by causing
pancreas to release more insulin into the blood stream, helps insulin get into cells to
lower blood sugar and help restore the way you use food to make energy; take as directed
with food; record finger sticks at various times (fasting, 1 – 2 hr after meals, before
bedtime), continue regular daily exercise, lifestyle changes, BP control, weight loss, and
dietary restrictions to control cholesterol and glucose; avoid alcohol, OTC agents without
approval; practice reliable contraception
GENERIC NAME: ATORVASTATIN CALCIUM
TRADE NAME: Lipitor
CLASSIFICATION: Antihyperlipidemic, HMG-CoA reductase inhibitor
ACTION: Competitively inhibits HMG-CoA reductase; this enzyme catalyzes the early
rate-limiting step in the synthesis of cholesterol; cholesterol synthesis is
inhibited/decreased; decreases cholesterol, triglycerides, VLDL, and LDL, and increases
HDL
INDICATIONS: Adjunct to diet to decrease elevated total and LDL cholesterol, apo-B,
and triglyceride levels and to increase HDL cholesterol in primary hypercholesterolemia
(including heterozygous familial and nonfamilial) and mixed dyslipidemia; adjunct to
other lipid-lowering treatments to reduce total and LDL cholesterol in homozygous
familial hypercholesterolemia
ROUTES OF ADMINISTRATION: Tablets – 10 mg, 20 mg, 40 mg, 80 mg
USUAL DOSAGE: Hypercholesterolemia – initial – 10-20 mg once daily (40 mg/day
for those who require more than a 45% reduction in LD cholesterol); then a diose range
caof 10-80 mg once daily may be used (individualize therapy according to goal of
therapy and response)
ADVERSE REACTIONS: Headache, infection, diarrhea, sinusitis, myalgia

INTERACTIONS: Antacids/Colestipol - ↓ Atorvastatin levels; Clarythromycin - ↑


Atorvastatin plasma levels; possibility of severe myopathy or rhabdomylosis; Digoxin - ↑
Digoxin levels after 80 mg atorvastatin R/T ↑ Digoxin absorption; Diltiazem - ↑ Plasma
atorvastatin levels → ↑ risk of myopathy; Eryhtromycin - ↑ Atorvastatin levels;
possibility of severe myopathy or rhabdomyolysis; Nefazodone / Verapamil - ↑ risk of
myopathy

CONTRAINDICATIONS: Active liver disease or unexplained persistently high LFT’s;


use with grapefruit juice; pregnancy, lactation

NURSING CONSIDERATIONS: Give as single dose at any time of the day, with or
without food; determine lipid levels within 2-4 weeks, adjust dosage accordingly; for
additive effect, may be used with a bile acid binding resin; do not use atorvastatin with
fibrates; Helps to lower blood cholesterol and fat levels, which have been proven to
promote CAD; take at same time each day with or without food; continue dietary
restrictions of saturated fat and cholesterol, regular exercise, and weight loss in the
overall goal of lowering cholesterol levels
GENERIC NAME: CLOPIDOGREL BISULFATE
TRADE NAME: Plavix

CLASSIFICATION: Antiplatelet Drug

ACTION: Inhibits platelet aggregation by inhibiting binding of adenosine diphosphate


(ADP) to its platelet receptor and subsequent ADP-mediative activation of glycoprotein
GPIIb/IIIa complex; Effect on receptors is irreversible; thus platelets are affected for
remainder of their lifespan; also inhibits platelet aggregation caused by agonists other
than ADP by blocking amplification of platelet activation by released ADP

INDICATIONS: Reduction of MI, stroke, and vascular death in clients with


atherosclerosis documented by recent stroke, MI, or established peripheral arterial
disease; acute coronary syndrome (unstable angina and non-Q wave MI), including those
on medical management and clients receiving stents

ROUTES OF ADMINISTRATION: 75 mg tablets


USUAL DOSAGE: Recent MI, stroke, or established peripheral arterial disease – 75 mg
once daily with or without food; Acute Coronary Syndrome – single 300 mg loading
dose, then 75 mg once daily; initiate and continue aspirin
ADVERSE REACTIONS: skin/appendage disorders, headache, URTI, chest pains, flu-
like symptoms
INTERACTIONS: Aspirin - ↑ risk of life-threatening or major bleeding events in high-
risk clients with recent ischemic stroke or TIAs; Atorvastatin – Inhibition of clopidogrel
effects on platelet function R/T inhibition of metabolic conversion (by CYP3A4) of the
prodrug clopidogrel to the active drug; Bupropion - ↑ Bupropion AUC and peak plasma
levels R/T inhibition of metabolism by CYP2B6 hydroxylation of bupropion; NSAIDs - ↑
risk of occult blood loss; Warfarin – Clopidrogrel prolongs bleeding time; safety of use
with warfarin not established
CONTRAINDICATIONS: Lactation, active pathological bleeding such as peptic ulcer
or intracranial hemorrhage
NURSING CONSIDERATIONS: Do not confuse Plavix with Pletal; dosage adjustment
not necessary for elderly clients or with renal disease; document atherosclerotic event
(MI, stroke) or established peripheral arterial disease requiring therapy; assess for any
active bleeding as with ulcers or intracranial bleeding; list all drugs prescribed/consumed
especially OTC; take exactly as directed, may take with or without food (food will lessen
stomach upset); may cause dizziness or drowsiness; avoid OTC agents especially aspirin,
aspirin-containing products, or NSAIDs; report any unusual bruising or bleeding; advise
all providers of prescribed therapy
GENERIC NAME: METRONIDAZOLE
TRADE NAME: Flagyl IV, Flagyl, Flagyl 375, Flagyl ER, Metric 21, Protostat,
MetroCream, MetroGel, MetroLotion, Noritate
CLASSIFICATION: Trichomonacide, amebicide
ACTION: Effective against anaerobic bacteria and protozoa; specifically inhibits growth
of trichomonae and amoebae by binding to DNA, resulting in loss of helical structures,
strand breakage, inhibition of nucleic acid synthesis, and cell death; the mechanism for its
effectiveness in reducing the inflammatory lesions of acne rosacea is not known
INDICATIONS: Serious infections due to susceptible anaerobic bacteria, including
Bacteroides fragilis resistant to clinamycin, chloramphenicol, and penicillin; Peritonitis,
intra-abdominal abscess and liver abscess due to B. fragilis, B. distasonis, B. ovatus, B.
thetiaotaomicron, B. vulgatus, Clostridium species, Eubacterium species,
Peptostreptococcus species, and Peptococcus niger
ROUTES OF ADMINISTRATION: Capsules – 375 mg; Tablets – 250 mg, 500 mg;
Tablets (Extended release) – 750 mg
USUAL DOSAGE: (Amebiasis) 500-750 mg 3 times daily for 5-10 days; pediatric – 35-
50 mg/kg/day in three divided doses; (Helicobacter pylori) 500 mg twice daily, with
Clarithromycin 500 mg twice daily, and either lansoprazole, 30 mg twice daily or
omeprazole 20 mg twice daily take all meds with meals
ADVERSE REACTIONS: Following systemic use; headache, vaginitis, nausea,
metallic taste, genital pruritis, bacterial infection, flu-like symptoms
INTERACTIONS: Barbiturates – Possible therapeutic failure of metronidazole R/T ↑
elimination; Busulfan - ↑ busulfan trough plasma levels (↑ risk of toxicity); Cimetidine -
↑ serum metronidazole levels R/T ↓ clearance; Disulfiram – Concurrent use may cause
confusion or acute psychosis; do not give metronidazole to clients who have taken
disulfram within the past 2 weeks; Lithium - ↑ lithium levels and toxicity; ethanol –
possible disulfram-like reaction, including flushing, palpitations, tachycardia and N&V
CONTRAINDICATIONS: Blood dyscrasias, active organic disease of the CNS,
trichomoniasis during the first trimester of pregnancy, lactation; is carcinogenic in
rodents; avoid unnecessary use; consumption of alcohol during use; topical use if
hypersensitive to parabens or other ingredients of the formulation
NURSING CONSIDERATIONS: Reduce dose in those with hepatic disease; dosage
reduction possible in geriatric clients; drug has a high sodium content; take with food or
milk to reduce GI upset; take ER tablets at least 1 hr before or 2 hrs after meals; report
lack of response, any symptoms of CNS toxicity (uncoordinated movements/tremors,
numbness, seizures, any unusual bruising/bleeding); do not perform tasks that require
mental alertness until drug effects are realized
GENERIC NAME: TRAMADOL HYDROCHLORIDE
TRADE NAME: Ultram, Ultram ER
CLASSIFICATION: Analgesic, centrally-acting
ACTION: A centrally acting analgesic not related chemically to opiates; precise
mechanism is not known; may bind to mu-opioid receptors and inhibit reuptake of
norepinephrine and serotonin; analgesic effect only partially antagonized by antagonist
naloxone; causes significantly less respiratory depression than morphine
INDICATIONS: Management of moderate to moderately severe pain; extended release
product is intended to treat moderate to moderately severe pain in adults who require
around-the-clock pain therapy for an extended amount of time
ROUTES OF ADMINISTRATION: Tablets – 50 mg; Tablets, extended-release – 100
mg, 200 mg, 300 mg
USUAL DOSAGE: Management of pain – individualize dose based on lowest effective
dose – for those requiring rapid onset of analgesia, 50-100 mg q 4-6 hr, as needed but not
to exceed 400 mg/day; for moderate pain, 50 mg initially, may be adequate, and for
severe pain, 100 mg is often more effective; for moderate chronic pain, not requiring
rapid analgesic onset, use 25 mg/day to improve tolerability
ADVERSE REACTIONS: Dizziness, headache, CNS stimulation, ataxia,
sedation/somnolence, vertigo, itching/pruritis, constipation, nausea
INTERACTIONS: Alcohol / Anesthetics, general - ↑ respiratory depression; CNS
depressants – additive CNS depression; Digoxin - ↑ (rare) risk of dig toxicity;
Cyclobenzaprine / MAO inhibitors / Promethazine / Tricyclic antidepressants - ↑ risk of
seizures; Warfarin - ↑ PT and INR
CONTRAINDICATIONS: Hypersensitivity to tramadol; in acute intoxication with
alcohol, hypnotics, centrally acting analgesics, opiates, or psychotropic drugs; use in
clients with past or present addiction or opiate dependence or in those with prior history
of allergy to codeine or opiates
NURSING CONSIDERATIONS: Do not confuse Ultram with Ultrase (pancreatic
enzyme); Store from 15-30°C (59-86°F) in a tight container; take only as directed, may
be taken without regard to food or meals; do not exceed prescribed doses of Tramadol;
store safely out of reach of children; do not perform activities that require mental
alertness; drug may cause drowsiness and impair mental or physical performance; alcohol
may intensify drug effects; report lack of response; avoid CNS depressants
GENERIC NAME: ACETAMINOPHEN
TRADE NAME: Tylenol, Aspirin Free Anacin, Aspirin Free Pain Relief, Extra Strength
Tablets multiple other names
CLASSIFICATION: Non-narcotic analgesic
ACTION: Decreases fever by 1) a hypothalamic effect leading to sweating and
vasodilation and 2) inhibits the effect of pyrogens on the hypothalamic heat-regulating
centers; may cause analgesia by inhibiting CNS prostaglandin synthesis
INDICATIONS: Control of pain due to headache, earache, dysmenorrheal, arthralgia,
myalgia, musculoskeletal pain, arthritis, immunizations, teething, toncillectomy; to
reduce fever in bacterial or viral infections; as a substitute for aspirin in upper GI disease,
aspirin allergy, bleeding disorders, clients on anticoagulant therapy, and gouty arthritis
ROUTES OF ADMINISTRATION: Caplets, Capsules, Capsule (Sprinkle), Drops,
Elixir, Gelcaps, Geltabs, Liquid, Solution, Suppositories, Tablets, Tablets (chewable),
Tablets (Dispersible)
USUAL DOSAGE: Caplets - 160 mg, 500 mg, 650 mg; Capsules – 325 mg, 500 mg;
Sprinkle capsules – 80 mg, 160 mg; Drops – 80 mg/0.8 mL; Elixir – 80 mg/2.5mL, 80
mg/5mL; 120 mg/5mL, 160 mg/5mL; Gelcaps – 500 mg; Tablets – 325 mg, 500 mg, 650
mg; Chewable tablets – 80 mg, 160 mg; Dispersible tablets – 80 mg
ADVERSE REACTIONS: Few when taken in usual therapeutic doses; GI upset in some
INTERACTIONS: Alcohol, Ethyl – Chronic use →↑ toxicity of larger therapeutic doses
of acetaminophen; Barbiturates / Carbamazepine / Hydantoins / Isoniazid / Propanolol /
Sulfinpyrazone / Rifampin - ↑ potential of hepatotoxicity R/T ↑ liver breakdown of
acetaminophen; Diuretics, loop - ↓ effect R/T ↓ renal prostaglandin excretion and ↓
plasma renin; NSAIDs - ↑ risk of hypertension in women; Propanolol - ↑ effect R/T ↓
liver breakdown
CONTRAINDICATIONS: Renal insufficiency, anemia; clients with cardiac or
pulmonary disease are more susceptible to acetaminophen toxicity
NURSING CONSIDERATIONS: Do not combine products containing acetaminophen,
many of which are OTC; read labels on all OTC products; take as directed with food or
milk to decrease GI upset; report signs and symptoms of toxicity immediately (nausea,
vomiting, abdominal pain, bluish coloration of nailbeds/skin, complaints of shortness of
breath, weakness, headache, dizziness; report paleness, weakness, and heart beat skips
(signs and symptoms of hemolytic anemia); do not exceed 4 grams/24 hr period in adults
and 75 mg/kg/day for children; do not take for more than 5 days for pain in children, 10
days for pain in adults, or more than 3 days for fever in adults or children without seeking
a doctor; note reasons for therapy, prescribed dosage and expected outcomes
GENERIC NAME: DONEPEZIL HYDROCHLORIDE

TRADE NAME: Aricept, Aricept ODT

CLASSIFICATION: Treatment of Alzeihmer’s disease

ACTION: A decrease in cholinergic function may be the cause of Alzeihmer’s disease;


Donezepil, a cholinesterase inhibitor, exerts effect by enhancing cholinergic function by
increasing levels of acetylcholine; no evidence that the drug alters the course of the
underlying dementing process

INDICATIONS: Treatment o fmild to moderate dementia of the Alzeihmer’s type; is


combined with memantine (Namanda) to lower the decline of mental and physical
function in Alzeihmer’s disease

ROUTES OF ADMINISTRATION: Tablets, oral disintegrating tablets

USUAL DOSAGE: 5 mg, 10 mg


ADVERSE REACTIONS: Anorexia, diarrhea, fatigue, insomnia, and muscle cramps,
nausea, vomiting

INTERACTIONS: Anticholinergic drugs – the cholinesterase inhibitor activity of


donepezil interferes with the activity of anticholinergics; Bethanichol – Synergistic
effects; NSAID’s - ↑ gastric acid secretion→ ↑ risk of active or occult bleeding;
Succinylcholine - ↑ muscle relaxant effect

CONTRAINDICATIONS: Hypersensitivity to piperidine derivatives

NURSING CONSIDERATIONS: Do not confuse Aricept with Aciphex (a proton pump


inhibitor); Donepezil orally disintegrating tablets are bioequivalent to donepezil tablets;
take in the evening, just prior to bedtime; may take with or without food; drug does nto
cure disease, just alleviates symptoms or slow physical and mental progression of
disease, especially when used with memantine; report adverse effects immediately, like
irregular pulse, dizzy spells, lack of response, worsening of symptoms; document
onset/duration, other agents tried and their outcomes
GENERIC NAME: ESOMEPRAZOLE MAGNESIUM
TRADE NAME: Nexium, Nexium IV
CLASSIFICATION: Proton pump inhibitor
ACTION: Suppresses the final step in gastric production by inhibiting the H+/K+-ATPase
in the gastric parietal cells; this decreases gastric acid secretion
INDICATIONS: Short-term treatment (4-8 weeks) in the healing and symptomatic
resolution of diagnostically confirmed erosive esophagitis; an additional 4-8 week course
may be instituted for those who have not healed; to maintain symptom resolution and
healing of erosive esophagitis; Treatment of heartburn and other symptoms associated
with GERD in adults; reduce occurrence of gastric ulcers associated with continuous
NSAID therapy in those at risk for developing gastric ulcers
ROUTES OF ADMINISTRATION: Delayed-release capsules, freeze-dried powder for
injection
USUAL DOSAGE: Healing of erosive esophagitis – 20-40 mg once daily for 4-8 weeks
(might need an additional 4-8 weeks); Maintenance of healing of erosive esophagitis – 20
mg once daily; Symptomatic GERD – 20 mg once daily for 4 weeks (can go for another 4
weeks if needed)
ADVERSE REACTIONS: Headache, diarrhea, nausea, stomach pain, constipation, dry
mouth

INTERACTIONS: Esomeprazole may interfere with the absorption of drugs where


gastric pH is an important factor in bioavailability (EX digoxin, iron salts, ketoconazole)

CONTRAINDICATIONS: Known hypersensitivity to any component of the formulation


or to any macrolide antibiotic; lactation

NURSING CONSIDERATIONS: Do not exceed dose of 20 mg daily in clients with


severe hepatic dysfunction; take delayed-release capsules whole 1 hour before meals; if
unable to swallow whole, can empty capsule onto one tablespoon of applesauce in a cup
and mix pellets into applesauce and swallow immediately; do not chew pellets; may take
with antacids; avoid alcohol and OTC products unless approved; document reason and
indications for therapy, type, onset of symptoms, and characteristics of symptoms; list
other agents prescribed; if female, determine if pregnant
GENERIC NAME: INSULIN GLARGINE

TRADE NAME: Lantus


CLASSIFICATION: Insulin, rDNA origin

ACTION: Long-acting recombinant human insulin analog; differs from human insulin in
that the amino acid asparagine is replaced by glycine and two arginines are added to the
C-terminus of the B-chain; is designed to have low aqueous solubility at neutral pH; at
pH 4, it is completely soluble; allows a relatively constant concentration/time profile over
24 hr with no pronounced peak

INDICATIONS: Once daily at bedtime for treatment of adult and pediatric clients (6
years and older) with type 1 diabetes mellitus or adults with type 2 diabetes mellitus who
require long-acting insulin to control hyperglycemia

ROUTES OF ADMINISTRATION: Injection

USUAL DOSAGE: Dose is individualized; give once daily at bedtime; average of 10


units once daily at the same time each day, then adjust according to client need to a total
daily dose ranging from 2-100 units
ADVERSE REACTIONS: Hypoglycemia, hypokalemia, injection site reaction,
lipodystrophy, pruritus, rash
INTERACTIONS: (MULTIPLE drug interations); ACE inhibitors / Disopyramide /
Fluoxetine / MAO inhibitors / Octreotide / Propoxyphene / Salicylates / Sulfonamides - ↑
blood glucose lowering effect and susceptibility to hypoglycemia; Danazol / Diuretics /
Isoniazid / Niacin / Somatropin - ↓ blood glucose lowering effect; Clonidine / Lithium
salts – either potentiates or weakens blood-glucose lowering effect and susceptibility to
hypoglycemia
CONTRAINDICATIONS: IV use
NURSING CONSIDERATIONS: Do not confuse insulin glargine with insulin
glulisine; given once daily at night; rotate sites; do not dilute or mix with any other
insulin solution; carry oral glucose tablets in event of hypoglycemia; monitor / record
blood sugar and assess for hypo/hyperglycemia; report any systemic rash, cough, or
dizziness; continue lifestyle changes and diabetic diet necessary to control blood sugar
with diabetes; attend diabetes education classes with spouse and keep all follow up visits
to evaluate blood sugar and blood pressure control, eye and foot exams, lower LDL and
associated symptoms; use only if solution is clear and colorless with no visible particles;
syringes must not contain any other medicinal product or residue
GENERIC NAME: MEMANTINE HYDROCHLORIDE
TRADE NAME: Namenda
CLASSIFICATION: Drug for Alzheimer’s disease

ACTION: It is believed that the activation of N-methyl-D-aspartate (NMDA) receptors


in the brain by glutamate, an excitory amino acid, contributes to the symptomatology of
Alzheimer’s disease; Memantine is believed to have low to moderate affinity as an
antagonist for open-channel NMDA receptors, thus preventing activation by glutamate;
the drug does not prevent or slow neurodegeneration in Alzheimer’s disease

INDICATIONS: Moderate to severe dementia of the Alzheimer’s type; when combined


with donepezil (Aricept), the decline of mental and physical function may be less

ROUTES OF ADMINISTRATION: Oral solution, tablets

USUAL DOSAGE: Initial – 5 mg/day, dose should be increased in 5 mg increments to


10 mg/day (5 mg twice a day), then 15 mg/day (5 mg and 10 mg as separate doses, and
finally 20 mg (10 mg twice a day); minimum recommended interval between dose
increases is one week; reduce dose in clients with moderate renal impairment
ADVERSE REACTIONS: Fatigue, pain, increased blood pressure, dizziness, headache,
constipation, vomiting, back pain, confusion, somnolence, hallucinations, coughing,
dyspnea

INTERACTIONS: Amantadine / Ketamine / Dextromethorphan – use with


memantadine with caution as amantadine is also an NMDA antagonist; Cimetidine /
HCTZ / Nicotine / Quinidine / Rantidine / Triamterene– possible altered plasma levels of
both drugs

CONTRAINDICATIONS: Known hypersensitivity to memantine or any excipients in


the formulation, including lactose monohydrates; conditions that raise urine pH may
decrease the urinary elimination of memantine resulting in increased plasma levels;
severe renal impairment

NURSING CONSIDERATIONS: Note reasons for therapy, when diagnosed with


Alzheimer’s disease and when treatment began; may take with or without food; with food
if GI upset occurs; drug is used in Alzheimer’s disease to improve level of cognitive
functioning does not cure disease but assists with symptoms; avoid alcohol and any OTC
products or herbals without provider approval to prevent interactions; may cause
dizziness, constipation, headache, pain
GENERIC NAME:
TRADE NAME:
CLASSIFICATION:
ACTION:
INDICATIONS:
ROUTES OF ADMINISTRATION:
USUAL DOSAGE:
ADVERSE REACTIONS:
INTERACTIONS:
CONTRAINDICATIONS:
NURSING CONSIDERATIONS:

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