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Drug/ dose/

time/ route

Class/Action

Side effects

Zovirax eq/
200mg/ OD/
PO

Antiinfective
(Antiviral)/An
antiviral agent
hydrolyzed in the
intestinal wall or
liver to acyclovir;
interferes with
viral DNA
synthesis.
Because of
increased GI
absorption, the
plasma level of
this drug is
substantially
higher than that
of acyclovir when
both are taken
orally

CNS: Headache, weak


ness, somnolence,
dizziness, fatigue,
lethargy,
confusion. GI: Nausea,
vomiting,
diarrhea, abdominal
pain, dyspepsia,
flatulence. Urogenital:
Glomerulonephritis,
renal tubular damage,
acute renal
failure. Skin: Rash,
urticaria, pruritus.

Nursing considerations

Pertinent
laboratory
values

Monitor kidney function in


patients with kidney
impairment or those
receiving potentially
nephrotoxic drugs.
Monitor for S&S of
hypersensitivity; if
present, withhold drug
and notify physician. Be
aware of potential
adverse effects and do
not discontinue drug until
full course is completed.
Post-herpes pain is likely
to be present for several
months after completion
of therapy.
Do not breast feed while
taking this drug.

Amiodarone
/ 200mg/
OD/ PO

Cardiovascular
agent;
Antiarrhythmic/
Structurally

CNS: Peripheral
neuropathy (muscle
weakness, wasting
numbness,

Monitor BP carefully during


infusion and slow the

Baseline
and periodic
assessment
s of liver,

Rationale for
taking these
medications
Patient has
gram (-)
infection

related to
thyroxine. Class
III
antiarrhythmic;
also has
antianginal and
antiadrenergic
properties.
Totally unrelated
to other
antiarrhythmics.
Acts directly on
all cardiac
tissues. Prolongs
duration of
action potential
and refractory
period without
significantly
affecting resting
membrane
potential.

tingling), fatigue, abno


rmal gait,
dyskinesias, dizziness,
paresthesia,
headache. CV: Bradyca
rdia, hypotension (IV),
sinus arrest,
cardiogenic shock,
CHF, arrhythmias; AV
block. Special
Senses: Corneal
microdeposits, blurred
vision, optic neuritis,
optic neuropathy,
permanent blindness,
corneal degeneration,
macular degeneration,
photosensitivity. GI: An
orexia, nausea,
vomiting,
constipation,hepatotox
icity. Metabolic: Hypert
hyroidism or
hypothyroidism; may
cause neonatal hypoor hyperthyroidism if
taken during
pregnancy. Respiratory
: (Pulmonary toxicity)
Alveolitis, pneumonitis
(fever, dry cough,
dyspnea), interstitial
pulmonary
fibrosis, fatal gasping

infusion if significant
hypotension occurs;
bradycardia should be treated
by slowing the infusion or
discontinuing if necessary.
Monitor heart rate and
rhythm and BP until drug
response has stabilized;
report promptly symptomatic
bradycardia. Sustained
monitoring is essential
because drug has an
unusually long half-life.
Monitor for S&S of: Adverse
effects, particularly
conduction disturbances and
exacerbation of arrhythmias,
in patients receiving
concomitant antiarrhythmic
therapy (reduce dosage of
previous agent by 3050%
several days after amiodarone
therapy is started); druginduced hypothyroidism or,
especially during early
treatment period; pulmonary
toxicity (progressive dyspnea,
fatigue, cough, pleuritic pain,
fever) throughout therapy.

lung,
thyroid,
neurologic,
and GI
function
Elevations
of AST and
ALT

Aspirin/
81mg/ OD/
PO

Analgesic,
antiplatelet/
Antiinflammato
ry
action: Inhibits
prostaglandin
synthesis. As an
antiinflammatory
agent, aspirin
appears to be
involved in
enhancing
antigen removal
and in reducing
the spread of
inflammation in
ground
substances.
These
antiinflammatory
actions also
contribute to
analgesic
effects. Analges
ic
action: Principall
y peripheral with

syndromewith IV in
children. Skin: Slateblue
pigmentation, photose
nsitivity, rash. Other: W
ith chronic use,
angioedema.
Body as a
Whole: Hypersensitivit
y
(urticaria, bronchospas
m, anaphylactic shock
(laryngeal
edema). CNS: Dizzines
s, confusion,
drowsiness. Special
Senses: Tinnitus,
hearing
loss. GI:Nausea,
vomiting, diarrhea,
anorexia, heartburn,
stomach
pains, ulceration,
occult bleeding, GI
bleeding. Hematologic:
Thrombocytopenia, he
molytic anemia,
prolonged bleeding
time. Skin:Petechiae,
easy bruising,
rash. Urogenital: Impair
ed renal
function. Other: Prolon
ged pregnancy and

Monitor for loss of tolerance


to aspirin. The reaction is
nonimmunologic; symptoms
usually occur 15 min to 3 h
after ingestion: profuse
rhinorrhea, erythema, nausea,
vomiting, intestinal cramps,
diarrhea.
Monitor the diabetic child
carefully for need to adjust
insulin dose. Children on
high doses of aspirin are
particularly prone to
hypoglycemia (see Appendix
F).
Monitor for salicylate
toxicity. In adults, a sensation
of fullness in the ears,
tinnitus, and decreased or
muffled hearing are the most
frequent symptoms
associated with chronic

frequent PT
and IRN
with
concurrent
anticoagula
nt therapy;
more
frequent
fasting
blood
glucose
levels with
diabetes

Antiinflamm
atory and
analgesic
properties to
soothe leg

limited action in
the CNS, possibly
on the
hypothalamus;
results in relief of
mild to moderate
pain. Antipyreti
c action: In
addition to
inhibiting
prostaglandin
synthesis, aspirin
lowers body
temperature in
fever by
indirectly
causing centrally
mediated
peripheral
vasodilation and
sweating. Antipl
atelet
action: Aspirin
(but not other
salicylates)
powerfully
inhibits platelet
aggregation.
High serum
salicylate
concentrations
can impair
hepatic synthesis
of blood

labor with increased


bleeding.

salicylate overdosage.

Aztreonam/
1G/IV/Q12H

coagulation
factors VII, IX,
and X, possibly
by inhibiting
action of vitamin
K.
Beta-Lactam
antibiotic/ Acts
by inhibiting
synthesis of
bacterial cell
wall, primarily in
aerobic, gramnegative bacteria

Body as a
Whole: Hypersensitivit
y (urticaria,
eosinophilia, anaphyla
xis). CNS: Headache,
dizziness, confusion,
paresthesias,
insomnia,
seizures. GI: Nausea, d
iarrhea, vomiting,
elevated liver function
tests. Hematologic: Eos
inophilia. Special
Senses: Tinnitus, nasal
congestion, sneezing,
diplopia. Skin: Rash,
purpura, erythema
multiforme, exfoliative
dermatitis,
diaphoresis; petechiae,
pruritus. Other: Local
reactions (phlebitis,
thrombophlebitis
(following IV), pain at
injection sites),
superinfections (grampositive cocci), vaginal
candidiasis.

Inspect IV injection sites


daily for signs of
inflammation. Pain and
phlebitis occur in a
significant number of
patients.

Obtain
baseline C&S
test prior to
initiation of
therapy. Start
drug pending
results.
Baseline and
periodic renal
function tests,
particularly in
older adults
and in those
with history
of renal
impairment.

Gram (-)
bacteria test
positive

Marinol EQ/
2.5mg/
OD/PO

Heparin/500
0unit/mL/
SubQ/ BiD

Antiemetic/
Mechanism
unclear: Inhibits
vomiting through
control
mechanism in
the medulla
oblongata,
producing potent
antiemetic
effect;
nontherapeutic
actions are
exactly like those
of marijuana.
Has complex
CNS effect that
necessitates
close supervision
of the patient
during drug use.

CNS: Drowsiness, psyc


hologic high, dizziness,
anxiety, confusion,
euphoria, sensory or
perceptual difficulties,
impaired coordination,
depression, irritability,
headache, ataxia,
memory lapse,
paresthesias,
paranoia,
depersonalization,
disorientation, tinnitus,
nightmares, speech
difficulty, facial flush,
diaphoresis. CV: Tachy
cardia, orthostatic
hypotension,
hypertension,
syncope. GI: Dry
mouth, diarrhea, fecal
incontinence. Other: M
uscular pains.

Coagulators and
anticoagulants/
Exerts direct
effect on the

Hematologic: Spontane
ous bleeding, transient
thrombocytopenia, hy
pofibrinogenemia,

To help
patient not
throw up

Monitor patients with


hypertension or heart disease
for BP and cardiac status.
Response to dronabinol is
varied, and previous
uneventful use does not
guarantee that adverse
reactions will not occur.
Effects of drug may persist an
unpredictably long time
(days). Extended use at
therapeutic dosage may cause
accumulation of toxic
amounts of dronabinol and its
metabolites.
Watch for disturbing
psychiatric symptoms if dose
is increased: Altered mental
state, loss of coordination,
evidence of a psychologic
high (easy laughing, elation
and heightened awareness),
or depression.

Draw blood for coagulation


test 30 min before each
scheduled SC or intermittent

Lab tests:
Baseline
blood

cascade of blood
coagulation
(clotting) by
enhancing the
inhibitory actions
of antithrombin
III (heparin
cofactor) on
several factors
essential to
normal blood
clotting, thereby
blocking the
conversion of
prothrombin to
thrombin and
fibrinogen to
fibrin.

"white clot
syndrome." Body as a
Whole: Fever, chills,
urticaria, pruritus, skin
rashes, itching and
burning sensations of
feet, numbness and
tingling of hands and
feet, elevated BP,
headache, nasal
congestion,
lacrimation,
conjunctivitis, chest
pains,
arthralgia, bronchospa
sm, anaphylactoid
reactions. Endocrine: O
steoporosis,
hypoaldosteronism,
suppressed renal
function,
hyperkalemia; rebound
hyperlipidemia
(following termination
of heparin
therapy). GI: increased
AST,
ALT. Urogenital: Priapis
m
(rare). Skin: Injection
site reactions: pain,
itching, ecchymoses,
tissue irritation and
sloughing; cyanosis

IV dose and approximately


q4h for patients receiving
continuous IV heparin during
dosage adjustment period.
After dosage is established,
tests may be done once daily.
Patients vary widely in their
reaction to heparin; risk of
hemorrhage appears greatest
in women, all patients >60 y,
and patients with liver
disease or renal insufficiency.
Monitor vital signs. Report
fever, drop in BP, rapid pulse,
and other S&S of
hemorrhage.
Observe all needle sites daily
for hematoma and signs of
inflammation (swelling, heat,
redness, pain).
Antidote: Have on hand
protamine sulfate (1%
solution), specific heparin
antagonist.

coagulation
tests, Hct,
Hgb, RBC,
and platelet
counts prior
to initiation
of therapy
and at regular
intervals
throughout
therapy.
Monitor
APTT levels
closely.
Note: In
general,
dosage is
adjusted to
keep APTT
between 1.5
2.5 times
normal
control level.

and pains in arms or


legs (vasospasm),
reversible transient
alopecia (usually
around temporal area).
Lactobacillu
s
Acidophilus/
1 capsule/
BiD/ PO
Lidocaine
patch 5%
Methimazol
e/ 5mg/ OD/
PO

Antithyroid
agent/ Thioamide
with actions and
uses similar to
those of
propylthiouracil
but 10 times as
potent. Actions
are less
consistent, but
effects appear
more promptly
than with
propylthiouracil.
Inhibits synthesis
of thyroid
hormones as the
drug
accumulates in
the thyroid
gland. Does not
affect existing

GI: hepatotoxicity
(rare). Endocrine: Hypo
thyroidism. Hematologi
c: Leukopenia,agranul
ocytosis,
granulocytopenia,
thrombocytopenia,
pancytopenia, and
aplastic
anemia.Musculoskeleta
l: Arthralgia. CNS: Peri
pheral neuropathy,
drowsiness, neuritis,
paresthesias,
vertigo. Skin: Rash,
alopecia, skin
hyperpigmentation,
urticaria, and
pruritus. Urogenital:Ne
phrotic syndrome.

Lab tests:
Periodic
blood work,
since
agranulocytos
is is a rare,
but possible
adverse
effect.
Closely
monitor PT
and INR in
patients on
oral
anticoagulant
s.
Anticoagulant
activity may

T3 or T4 levels.

be
potentiated.

Midodrine/5
mg/Q8H/PO

Alpha1agonist/
Vasopressor and
alpha1 agonist.
Activates the
alpha-adrenergic
receptors of the
arteries and
veins, resulting
in increased
vascular tone
and elevation in
blood pressure.

Body as a
Whole: Paresthesia, chi
lls, pain, facial
flushing. CNS: Confusi
on, nervousness,
anxiety. CV: Hypertens
ion. GI: Dry
mouth. Skin: Pruritus,
piloerection, rash. Uro
genital:Dysuria,
urinary retention,
urinary frequency.

Monitor regularly supine and


standing BP. Stop drug if
supine BP increases
excessively; determine
acceptable parameters.
Monitor carefully effect of
the drug in diabetics with
orthostatic hypotension and
those taking fludrocortisone
acetate, which may increase
intraocular pressure.

Evaluate
kidney and
liver
function
prior to
initiating
therapy.