MULTIVITAMINS

PATIENT:
ACTION

DOSE:

INDICATIONS AND CONTRAINDICATIONS

Supplies
the
needed
vitamins
and
minerals, which
are needed for
the
optimal
functioning of
the
body
systems.

ADVERSE EFFECTS NURSING RESPONSIBILITIES /PRECAUTIONS

OF THE DRUG
Indications:
GI:
Discomfort, Advise patients to take drug after eating to avoid GI

Vitamin and mineral deficiencies associated with

vomiting
and
upset because of iron.
restricted diets, inadequate food intake, decreased
diarrhea
may Explain to client the effects to be expected from
absorption or utilization, pregnancy, lactation and
occur related to
taking this medication
during convalescence after surgical procedures or
amount
of
Whenever anemia is present, its nature must be
medical diseases.
elemental
iron
established and underlying causes determined.
taken
Folic acid in doses more than 100mcg daily may

Disturbances of growth and development,

Renal:
occasional
mask pernicious anemia
metabolism and lack of appetite, exposure to acute
yellow discoloration of
and chronic infectious diseases
urine may occur

Exhaustion after extraordinary physical or mental

strains
Contraindications:

Those containing high doses of calcium are not for

patients with hypercalcemia or hypercalciuria
Intolerance or inability to absorb iron, hemochromatosis,
pernicious anemia.

PARACETAMOL
PATIENT:
ACTION
Commonly used
for the relief of
headaches,
minor aches and
pains,
Paracetamol
exerts
its
analgesic
and
antipyretic effect
by decreasing
the synthesis of
prostaglandins in
the CNS through
COX2 inhibition.
It serves to
decrease
the
amount
of
circulating
prostaglandins
that may serve
as mediators of
pain and fever.

DOSE:

INDICATIONS AND
CONTRAINDICATIO
NS
Indications:
Mild pain
Fever

ADVERSE
EFFECTS
OF
THE DRUG
GI: hepatotoxicity
(overdose),
hepatic failure

Contraindications:
It is contraindicated
for patients with
hypersensitivity
reactions
to
paracetamol.

GU: renal failure

(high
doses/chronic
use)

Products containing
alcohol, aspartame,
saccharin, sugar, or
tartrazine
(FDC
yellow
dye
#5)
should be avoided in
patients who have
hypersensitivity
or
intolerance to these
compounds.

NURSING RESPONSIBILITIES /PRECAUTIONS

Chronic high-dose acetaminophen (>2 g/day) may increase the risk of bleeding with
warfarin (PT should be monitored regularly and INR should not exceed 4)

Hepatotoxicity is additive with other hepatotoxic substances, including alcohol

Concurrent use of sulfinpyrazone, isoniazid, rifampin, rifabutin, phenytoin,

barbiturates, and carbamazepine may increase the risk of acetaminophen-induced liver
damage (limit self-medication); these agents will also decrease therapeutic effects of
acetaminophen

Combined use with salicylates or NSAIDs increases the risk of adverse renal effects.

Propranolol decreases metabolism and may increase effects.

May decrease effects of lamotrigine, zidovudine, and loop diuretics

General Info: Assess overall health status and alcohol usage before administering
acetaminophen. Malnourished patients or chronic alcohol abusers are at higher risk of
developing hepatotoxicity with chronic use of usual doses of this drug.

Integumentary
System:
rash,
urticaria.

Assess amount, frequency, and type of drugs taken in patients selfmedicating, especially with OTC drugs. Prolonged use of acetaminophen alone or
combined with salicylates or NSAIDs increases the risk of adverse renal effects.
For short-term use, combined doses of acetaminophen and salicylates should not
exceed the recommended dose of either drug given alone.

Pain: Assess type, location, and intensity prior to and 3060 min following administration.

OMEPRAZOLE
PATIENT:
ACTION

Fever: Assess fever; note presence of associated signs (diaphoresis, tachycardia, and
malaise).

Lab Test Considerations: Hepatic, hematologic, and renal function should be evaluated
periodically throughout prolonged, high-dose therapy.
o

May alter results of blood glucose monitoring. May cause falsely

decreased values when measured with glucose oxidase/peroxidase method, but
probably not with hexokinase/glucose-6-phosphate dehydrogenase (G6PD)
method. May also cause falsely increased values with certain instruments; see
manufacturer's instruction manual.

Increased serum bilirubin, LDH, AST, ALT, and prothrombin time may
indicate hepatotoxicity.

Toxicity and Overdose: If overdose occurs, acetylcysteine (Mucomyst) is the antidote

Advise patient to take medication exactly as directed and not to take more than the
recommended amount. Chronic excessive use of >4 g/day (2 g in patients with chronic
alcoholism) may lead to hepatotoxicity, renal, or cardiac damage. Adults should not take
acetaminophen longer than 10 days and children not longer than 5 days unless directed
by health care professional. Short-term doses of acetaminophen with salicylates or
NSAIDs should not exceed the recommended daily dose of either drug alone.

Advise patient to avoid alcohol (3 or more glasses per day increase the risk of liver
damage) if taking more than an occasional 12 doses and to avoid taking concurrently
with salicylates or NSAIDs for more than a few days, unless directed by health care
professional.

Advise parents or caregivers to check concentrations of liquid preparations.

DOSE:

INDICATIONS
AND
CONTRAINDICATIONS
Indications:

Bleeding peptic ulcers, after

endoscopic treatment of
bleeding

(unlicensed)

Continuation of PPI therapy

when the PO/NG route is
unavailable.

Helicobacter
pylori
eradication.

Omeprazole is a
proton
pump
inhibitor
(PPI)
which
inhibits
gastric

acid production by
the gastric parietal
cells.
Following
endoscopic treat-
ment of bleeding
peptic
ulcers,
omeprazole given Contraindications:
intravenous for 72 Hypersensitivity
hours has been
shown to reduce
the
risk
of
rebleeding

ADVERSE EFFECTS OF THE DRUG

NURSING RESPONSIBILITIES /PRECAUTIONS

GI disturbances (nausea, vomiting, Assessment:

abdominal pain, diarrhoea and
Assess patient routinely for epigastric or abdominal pain and frank
constipation)
or occult blood in the stool, emesis, or gastric aspirate.
Paraesthesia
Agitation
Lab Test Considerations:
Liver dysfunction
CBC with differential should be monitored periodically throughout
Hyponatraemia
therapy.
Leukopenia and thrombocytopenia May cause elevated AST, ALT, alkaline phosphatase, and
rarely
bilirubin.
May cause serum gastrin concentrations to increase during first
Cautions
12 wk of therapy. Levels return to normal after
Severe hepatic disease (risk of
discontinuation of omeprazole
encephalopathy)
Pregnancy (toxic in animal studies)
Administration
May mask symptoms of gastric cancer Bleeding peptic ulcers, after endoscopic treatment of bleeding
Omeprazole
may
enhance IV: Initial 80 mg IV loading dose given over 1 hour, followed by 8
anticoagulant effect of warfarin
mg/h
monitor INR
IV infusion for 72 hours
and may increase phenytoin levels
Reconstitute with either sodium chloride 0.9% or glucose 5%
Omeprazole
may
reduce
the Continuation of PPI therapy when the PO/NG route is unavailable
effectiveness of clopidogrel
IV bolus: 40 mg daily. Reconstitute 40 mg vial with the solvent

Organ failure

Hepatic: reduce dose

FLUCONAZOLE
PATIENT:
ACTION

Fungistatic; may also

be
fungicidal
depending
on
concentration.
Interferes
with
formation
of
ergosterol,
the
principal sterol in the
fungal cell membrane
that, when depleted,
interrupts membrane
function.

pro-vided and administer over 5 min

PO: Administer doses before meals, preferably in the morning.
Capsules should be swallowed whole; do not crush, open, or
chew

DOSE:

INDICATIONS
AND
CONTRAINDICATIONS
Uses
Cryptococcal meningitis
and oropharyngeal and
systemic
candidiasis,
both commonly found in
AIDS
and
other
immunocompromised
patients;
vaginal
candidiasis.
Contraindications
Hypersensitivity
to
fluconazole or other
azole
antifungals;
coadministration
with
cisapride;
pregnancy
(category C), lactation.
Cautious Use
AIDS or malignancy;
hepatic impairment.

ADVERSE
EFFECTS OF THE
DRUG
CNS: Headache. GI:
Nausea, vomiting,
abdominal
pain,
diarrhea, increase in
AST in patients with
cryptococcal
meningitis
and
AIDS. Skin: Rash.
Drug: Increased PT
in
patients
on warfarin; may
increase alosetron,b
exarotene,phenytoi
n,cevimeline,cilosta
zol,cyclosporine,do
fetilide,haloperidol,l
evobupivicaine,mo
dafinil,zonisamide l
evels and toxicity;
hypoglycemic
reactions with ORAL
SULFONYLUREAS;
decreased
fluconazole
levels
with rifampin,cimeti
dine; may prolong
the
effects
of fentanyl,alfentani
l,methadone;
increased
ergotamine toxicity
with dihydroergota
mine,ergotamine.

NURSING RESPONSIBILITIES /PRECAUTIONS

PREPARE Continuous: Packaged ready for use as a 2 mg/mL solution. Remove
wrapper just prior to use.
ADMINISTER Continuous: Give at a maximum rate of approximately 200 mg/h.
Give after hemodialysis is completed.
Do not use IV admixtures of fluconazole and other medications.
INCOMPATIBILITIES Solution/additive: Trimethoprim-sulfamethoxazole. Y-site: Amp
hotericin
B,amphotericin
B
cholesteryl,ampicillin,calcium
gluconate,ceftazidime,ceftriaxone,cefuroxime,chloramphenicol,clindamycin,diazepa
m,digoxin,erythromycin,furosemide,haloperidol,hydroxyzine,imipenemcilastatin,pentamidine,piperacillin,ticarcillin,trimethoprim-sulfamethoxazole.
Assessment & Drug Effects
Monitor for allergic response. Patients allergic to other azole antifungals may be
allergic to fluconazole.
Lab tests: Monitor BUN, serum creatinine, and liver function.
Note: Drug may cause elevations of the following laboratory serum values: ALT,
AST, alkaline phosphatase, bilirubin.
Monitor for S&S of hepatotoxicity.
Patient & Family Education
Monitor carefully for loss of glycemic control if diabetic.
Inform physician of all medications being taken.

TRAMADOL
PATIENT:

DOSE:

ACTION

INDICATIONS
AND ADVERSE EFFECTS OF THE
CONTRAINDICATIONS
DRUG
Centrally acting Indications:
CNS: seizures, dizziness,
opiate receptor Management of moderate
headache,
somnolence,
agonist
that
to moderately severe
anxiety, CNS stimulation,
inhibits
the
pain.
confusion,
coordination
uptake
of
disturbance,
euphoria,
norepinephrine
Contraindications:
malaise, nervousness, sleep
and serotonin, Hypersensitivity to tramadol
disorder, weakness.
suggesting both
or
other
opioid EENT: visual disturbances.
opioid
and
analgesics
CV: vasodilation.
nonopioid
Patients acutely intoxicated GI: constipation, nausea,
mechanisms of
with alcohol, hypnotics,
abdominal pain, anorexia,
pain relief. May
centrally
acting
diarrhea,
dry
mouth,
produce opioidanalgesics, opioids, or
dyspepsia,
flatulence,
like effects, but
psychotropic drugs
vomiting.
causes
less Patients
on
obstetric GU: menopausal symptoms,
respiratory
preoperative medication
urinary retention/frequency.
depression than Patients who are physically Derm: pruritus, sweating.
morphine.
dependent on opioids Neuro: hypertonia.
(may
precipitate
Misc: physical dependence,
withdrawal)
psychological dependence,
tolerance.

NURSING RESPONSIBILITIES /PRECAUTIONS

POTASSIUM CHLORIDE
PATIENT:
ACTION
Maintain acid-base
balance, isotonicity,
and
electrophysiologic
balance of the cell

Increased risk of CNS depression when used concurrently with other CNS
depressants, including alcohol, antihistamines, sedative/hypnotics ,
opioid analgesics, anesthetics, or psychotropic agents

Increased risk of seizures with high doses of penicillins or cephalosporins

phenothiazines opioid analgesics or antidepressants,

Carbamazepine increases the metabolism and decreases the effectiveness

of tramadol (increased doses may be required)

Use cautiously in patients who are receiving MAO inhibitors (increased risk
of adverse reactions)

Effectiveness may be altered by concurrent quinidine

Assess type, location, and intensity of pain before and 23 hr (peak) after
administration
Assess blood pressure and respiratory rate before and periodically during
administration. Respiratory depression has not occurred with recommended
doses.
Assess bowel function routinely.
Assess previous analgesic history. Tramadol is not recommended for patients
dependent on opioids or who have previously received opioids for more than 1
wk; may cause opioid withdrawal symptoms.
Monitor patient for seizures. May occur within recommended dose range. Risk is
increased with higher doses and in patients taking antidepressants, opioid
analgesics, or other drugs that decrease the seizure threshold.
Instruct patient on how and when to ask for pain medication.
Caution patient to avoid concurrent use of alcohol or other CNS depressants with
this medication.

DOSE:

INDICATIONS
AND
CONTRAINDICATIONS
Indications:

> PO, IV: Treatment or

prevention of potassium
depletion
Contraindications:

ADVERSE EFFECTS OF NURSING RESPONSIBILITIES /PRECAUTIONS

THE DRUG
CNS: confusion, restlessness, Assess patient for signs and symptoms of hypokalemia (weakness,
weakness.
fatigue, U wave on ECG, arrhythmias, polyuria, polydipsia) and
hyperkalemia
CV: ARRHYTHMIAS, ECG
Monitor pulse, blood pressure, and ECG periodically throughout IV
changes.
therapy.
GI: abdominal pain, diarrhea,

Activator in many
enzymatic reactions;
essential
to
transmission
of
nerve
impulses;
contraction
of
cardiac,
skeletal,
and smooth muscle;
gastric
secretion;
renal function; tissue
synthesis;
and
carbohydrate
metabolism

flatulence,
nausea, Monitor serum potassium before and periodically throughout therapy.
Hyperkalemia
vomiting; tablets, capsules
Monitor renal function, serum bicarbonate, and pH. Determine serum
Severe renal impairment
onlyGI
ulceration,
magnesium level if patient has refractory hypokalemia;
Hyperkalemic
familial
stenotic
lesions.
hypomagnesemia should be corrected to facilitate effectiveness of
periodical paralysis
potassium replacement. Monitor serum chloride because
Hyperkalemic
familial Local: irritation at IV site.

Neuro:
paralysis,
paresthesia.
hypochloremia may occur if replacing potassium without concurrent
periodic paralysis
chloride
Toxicity and Overdose: Symptoms of toxicity are those of hyperkalemia
(slow, irregular heartbeat; fatigue; muscle weakness; paresthesia;
confusion; dyspnea; peaked T waves; depressed ST segments;
prolonged QT segments; widened QRS complexes; loss of P waves;
and cardiac arrhythmias).
Avoid extravasation; severe pain and tissue necrosis may occur

MORPHINE SULFATE
PATIENT:

DOSE:

ACTION

INDICATIONS
AND
CONTRAINDICATIONS

Principal opium alkaloid;

acts as agonist at specific
opioid receptors in the
CNS to produce analgesia,
euphoria, sedation; the
receptors mediating these
effects are thought to be
the same as those
mediating the effects of
endogenous
opioids
(enkephalins, endorphins).

Indications:
(1) Relief of moderate to
severe pain (immediaterelease tablets/solution).
(2) Relief of moderate to
severe pain in those
requiring
narcotic
analgesia for more than a
few
days
(controlled/extended/sustai
ned-release tablets). IV:
(1) Relief of severe pain.
Pain from
MI.
(2)
Preoperatively for sedation
and
to
reduce
apprehension.
(3)
Facilitate induction of
anesthesia and reduce
anesthetic
dose.
(4)
Control postoperative pain.
(5) Relieve anxiety and
reduce left ventricular work
by
reducing
preload
pressure.
(6)
Treat
dyspnea associated with
acute left ventricular failure
and pulmonary edema. (7)
Anesthesia for open-heart
surgery
Contraindications:
Epidural or intrathecal
morphine: If infection is
present at injection site;
with anticoagulant therapy;
bleeding diathesis; if client
has received parenteral
corticosteroids within the
past 2 weeks. Morphine
injection: Heart failure
secondary to chronic lung
disease,
cardiac

ADVERSE
EFFECTS OF THE
DRUG

NURSING RESPONSIBILITIES /PRECAUTIONS

CNS: Lightheadedness,
dizziness,
sedation, euphoria, d
ysphoria, delirium,
insomnia, agitation,
anxiety,
fear,
hallucinations,
disorientation,
drowsiness, lethargy,
impaired mental and
physical
performance, coma,
mood
changes,
weakness,
headache, tremor,
seizures, miosis,
visual disturbances,
suppression
of
cough reflex

Assessment:

CV: Facial flushing,

peripheral circulatory
collapse,
tachycardia, bradyca
rdia,
arrhythmia,
palpitations, chest
wall
rigidity,
hypertension,
hypotension,
orthostatic
hypotension,
syncope
Dermatologic: Prurit
us, urticaria, laryngo
spasm,
bronchospasm, ede
ma

1.

Document location and characteristics of pain.

Rate utilizing a pain-rating scale.

2.

List other agents prescribed and the outcome.

3.

Note any seizure disorder or head trauma.

Monitor VS and assess respiratory status.

Client/Family Teaching:
1.

May be administered with food to diminish GI

upset. Do not crush or chew controlled- or
extended-release capsules or tablets.

2.

Immediate-release capsules may be swallowed

intact or the contents of the capsule may be
sprinkled on food or stirred in juice to avoid the
bitter taste.

3.

Drug may cause dizziness and drowsiness;

avoid activities that require mental alertness.

4.

Practice cough and deep-breathing exercises

and incentive spirometry to decrease risk of
atelectasis.

5.

Record drug use for breakthrough pain when

SR therapy prescribed, to ensure adequate
dosage.

6.

Avoid alcohol/CNS depressants and OTC

agents. Keep out of reach of children and away

arrhythmias, brain tumor,

acute alcoholism, delirium
tremens, convulsive states.

GI: Nausea,
vomiting, dry mouth,
anorexia,
constipation, biliary tr
act
spasm;
increased
colonic
motility in patients
with
chronic
ulcerative colitis
GU: Ureteral spasm,
spasm
of vesical sphincters,
urinary retention or
hesitancy, oliguria, a
ntidiuretic effect,
reduced libido or
potency
Local: Tissue
irritation
and induration (SC
injection)
Major
hazards:
Respiratory
depression, apnea,
circulatory
depression,
respiratory arrest,
shock,
cardiac
arrest
Other: Sweating, ph
ysical tolerance and
dependence,
psychological
dependence

from bedside.