Generic: Acetazolamide

Brand: Diamox

Classification: Carbonic Anhydrase Inhibitor, Diuretic

Usual Dosage: PO 250 mg 1–4 times/d, 500 mg sustained release b.i.d., up to 1 g/d IM/IV 500 mg, may repeat in 2–4 h

Drug Interactions / Contraindications: Renal excretion of amphetamines, ephedrine, flecainide, quinidine, procainamide, tricyclic antidepressents may be
decreased, thereby enhancing or prolonging their effects. Renal excretion of lithium is increased. Excretion of phenobarbital may be increased. Amphotericin B
and corticosteroids may accelerate potassium loss. Digitalis glycosides may predispose persons with hypokalemia to digitalis toxicity; puts patients on high
doses of salicylates at high risk for salicylate toxicity.

Side Effects / Adverse Effects: Paresthesias, sedation, malaise, disorientation, depression, fatigue, muscle weakness, and flaccid paralysis.

Nursing Implications: Establish baseline weight before initial therapy and weigh daily thereafter when used to treat edema. Monitor for S&S of: mild to severe
metabolic acidosis; potassium loss which is greatest early in therapy. Monitor I&O especially when used with other diuretics.

Labs: Blood pH, blood gases, urinalysis, CBC, and serum electrolytes (initially and periodically during prolonged therapy or concomitant therapy with other
diuretics or digitalis).

Generic: Acetylcysteine

Brand: Mucomyst

Classification: Mucolytic Agent, Antidote

Usual Dosage: Inhalation, 1-10 mL of 20% solution every 4-6 hours or 2-20 mL of 10% solution every 4-6 hours. Direct instillation, 1-2 mL of 10-20%
solution every 1-4 hours.

Side Effects / Adverse Effects: Vomiting, Dizziness, Bronchospasm

Drug Interactions / Contraindications: Patients at risk for gastric hemorrhage

Nursing Implications: Watch for fluid overload, monitor for signs and symptoms of aspiration of excess secretions.

Labs: Pulmonary function, pulse oximetry, baseline serum acetaminophen levels, BUN, plasma glucose, serum electrolytes, bilirubin, LFT’s.
Generic: Acyclovir

Brand: Zovirax

Classification: Antiviral

Usual Dosage: 400mg TID for 7-10 d cycle

Contraindications: Valacyclovir hypersensitivity.

Precautions: Renal impairment. Maintain adequate hydration. Pregnancy. Nursing mothers.

Adverse Effects: Nausea, vomiting, headache, CNS disturbances, diarrhea, vertigo, myalgia, rash malaise, viral resistance, renal failure,

Nursing Implications: Observe infusion sight if IV for signs of tissue damage, monitor I & O and hydrations status.

Labs: Baseline and periodic renal function studies, BUN, Creatinine, and electrolytes.

Generic: Adenosine

Brand: Adenocard, Adenoscan

Classification: Antiarrhythmic

Usual Dosage: IV 6 mg bolus initially; after 1–2 min may give two additional 12 mg bolus doses for a total of 3 doses. Do not exceed 12 mg in any one dose.

Side Effects / Adverse Effects: Transient facial flushing, transient dyspnea, and tingling.

Drug Interactions / Contraindications: Dipyridamole can potentiate the effects of adenosine; theophylline will block the electrophysiologic effects of adenosine;
carbamazepine may increase risk of heart block.

Nursing Implications: Monitor for S&S of bronchospasm in asthma patients. Notify physician immediately. Use a hemodynamic monitoring system
during administration; monitor BP and heart rate and rhythm continuously for several minutes after administration.

Labs: N/A
Generic: Aminophylline (Theophylline Ethylenediamide)
Brand: Truphylline, Corophyllin, Paladrom
Classification: Bronchodilator; Xanthine
Usual Dosage: IV loading dose 6 mg/kg over 30 minutes. IV maintenance dose for a nonsmoker is 0.5 mg/kg/h; smoker 0.8 mg/kg/h; CHF or cirrhosis 0.1 – 2.0
mg/kg/h.
Contraindications / Drug Interactions: Increases lithium excretions; cimetidine, high dose allopurinal, ciprofloxacin, erythromycin, troleandomycin can
significantly increase theophyline levels. St. John’s wart may decrease effect.
Adverse Effects: Nervousness, cardiac arrhythmias, anorexia.
Nursing Implications: High incidence of toxicity, monitor for hypotension, arrhythmias, and convulsions.
Blood Test: Serum theophylline levels
Teaching / Nursing Implications: Institute measures to prevent falls, monitor BP and respiration rates, monitor I & O and bowel elimination pattern.
Labs: Baseline and periodic leukocyte and differential counts, renal and hepatic function.

Generic: Amitriptyline Hydrochloride

Brand: Amitril, Elavil, Enovil

Classification: Psychotherapeutic, Tricyclic Antidepressant

Usual Dosage: PO 25-75 mg per day, may gradually increase to 150-300 mg per day

Side Effects / Adverse Effects: Sedation, orthostatic hypotension, constipation

Drug Interactions / Contraindications: CNS depressants, alcohol, antihypertensives, barbiturates, anticoagulants

Generic: Amphotericin B

Brand: Amphocin, Fungizone

Classification: Antifungal

Usual Dosage: 0.25-0.30mg/kg/day unfused over 4-6 h

Contraindications: Hypersensitivity to amphotericin; lactation.

Side Effects / Adverse Effects: Fever, chills, headache, sedation, muscle pain, nausea, vomiting diarrhea, anemia, thrombocytopenia, hypokalemia,
hypomagnesemia.

Nursing Implications: Monitor cardiovascular and respiratory status, and I&O.

Labs: Monitor BUN serum and Creatinine

Generic: Atorvastatin calcium

Brand: Lipitor

Classification: Antilipemic Agent, Reductase Inhibiitor (statin)

Usual Dosage: PO Start with 10–40 mg q.d., may increase up to 80 mg/d

Drug Interactions / Contraindications: May increase digoxin levels 20%, increases levels of norethindrone and ethinyl estradiol oral contraceptives;
erythromycin may increase atorvastatin levels 40%; MACROLIDE ANTIBIOTICS, cyclosporine, delavirdine, gemfibrozil, niacin, clofibrate, may increase
atorvastatin levels.

Side Effects / Adverse Effects: Abdominal pain, constipation, diarrhea, dyspepsia, and flatulence.

Nursing Implications: Assess for muscle pain, tenderness, or weakness; and, if present, monitor CPK level (discontinue drug with marked elevations of CPK or
if myopathy is suspected). Monitor carefully for digoxin toxicity with concurrent digoxin use.

Labs: Monitor lipid levels within 2–4 wk after initiation of therapy or upon change in dosage; monitor liver functions at 6 and 12 wk after initiation or elevation
of dose, and periodically thereafter.
Generic: Atropine Sulfate

Brand: Atropine, Atropair

Classification: Anticholinergic, Antimuscarinic, Antiarrhythmic

Usual Dosage: Pre-op IV/IM/Sub-Q 0.4-0.6 mg 30-60 minutes before surgery

Side Effects / Adverse Effects: Headache, Ataxia, Hypertension or Hypotension, Palpitations and Tachycardia

Drug Interactions / Contraindications: Patients with severe Ulcerative Colitis, acute MI, Antihistamines

Nursing Implications: Monitor vital signs, palpate lower abdomen for distention; Patient should maintain adequate hydration

Blood Test Needed: Upper GI series

Generic: Calcitonin (salmon)

Brand: Calcimar, Miacalcin

Classification: Bone Metabolism Regulator

Usual Dosage: SC/IM 4 IU/kg q12h, may increase to 8 IU/kg q6h if needed

Drug Interactions / Contraindications: May decrease serum lithium levels.

Side Effects / Adverse Effects: Transient nausea, Headache, eye pain, feverish sensation, hypersensitivity reactions, and anaphylaxis.

Nursing Implications: Have on hand epinephrine 1:1000, antihistamines, and oxygen in the event of a reaction. Also have readily available parenteral calcium,
particularly during early therapy. Hypocalcemic tetany is a theoretical possibility. Examine urine specimens periodically for sediment with long-term therapy.

Labs: Monitor for hypocalcemia (see Signs & Symptoms, Appendix F). Theoretically, calcitonin can lead to hypocalcemic tetany. Latent tetany may be
demonstrated by Chvostek's or Trousseau's signs and by serum calcium values: 7–8 mg/dL (latent tetany); below 7 mg/dL (manifest tetany).
Generic: Ciprofloxacin hydrochloride

Brand: Cipro, Cipro IV, Cipro XR, Proquin XR

Classification: Quinolone, Antibiotic

Usual Dosage: Uncomplicated UTI 250 mg by mouth every 12 hours or 500 mg XR 3 times per day. IV 200 mg every 12 hours for 7-14 days. Complicated
UTI 1000 mg by mouth XR every day for 7-14 days. IV 400 mg every 12 hours for 7-14 days.

Side Effects / Adverse Effects: Pseudomembranous colitis, peripheral neuropathy, phlebitis

Drug Interaction / Contraindications: antacids reduce absorption, may increase PT for patients on Warfarin

Nursing Implications: Increased fall risk, watch for tendon inflammation, explain to client to avoid calcium because it decreases the levels

Labs: Liver enzymes

Generic: Clonazepam

Brand: Klonopin, Klonopin Wafers, Rivotril

Classification: Anticonvulsant, Benzodiazepine

Usual Amount / Adult: Seizure, by mouth 1.5 mg per day in 3 divided doses, increased by 0.5-1 mg three times per day until seizures are controlled or until
intolerable adverse effects. Max recommended dose is 20 mg per day. Panic Disorder, by mouth 1-2 mg per day in divided doses.
Max 4 mg per day.

Side Effects / Adverse Effects: Palpitations, Leukopenia, Drowsiness

Drug Interactions / Contraindications: Use cautiously if patient suffers from renal or hepatic disease, addiction prone individuals, or individuals with glaucoma
or COPD.

Nursing Implications: Advise patient not to drink alcohol or use other CNS depressants as this will intensify drowsiness, assess for signs of over dosage, check
for physical and psychological dependence. Patient should refrain from alcohol.

Labs: Periodic liver function, platelet counts, blood counts, and renal function
Generic: Clozapine

Brand: Clozaril, Fazaclo

Classification: Psychotherapeutic agent, antipsychotic, atypical

Usual Dosage: PO initiate at 12.5 mg once or twice a day, then increase by 25-50 mg per day and titrate to a target dose of 350-450 mg per day in 3 divided
doses. Further increases (not more then twice weekly) can be made if necessary, max of 900 mg per day.

Side Effects / Adverse Effects: Tachycardia, transient fever, agranulocytosis

Drug Interactions / Contraindications: Alcohol and other CNS depressants, antocholinergics and antihypertensives

Teaching / Nursing Implications: Monitor diabetics for loss of glycemic control, monitor cardiovascular and respiratory status, monitor temp.

Labs: Baseline WBC count

Generic: Colchicine

Brand: Novocolchine

Classification: Antigout Agent

Usual Dosage: PO 0.5 or 0.6 mg every night or every other night as needed (up to 1.8 mg/day may be needed for severe cases)

Side Effects / Adverse Effects: Bone marrow depression, abdominal pain, agranulocytosis, Aplastic anemia.

Drug Interactions / Contraindications: Do not use in patients with severe GI, renal, hepatic, or cardiac disease.

Teach / Nursing Implications: teach patient to avoid fermented beverages such as beer and wine as they may precipitate gouty attack.

Labs: Baseline and periodic determinations of serum uric acid and Creatinine are advised, as well as CBC, including Hgb, platelet count, serum electrolytes,
and urinalysis.
Generic: Collagenase

Brand: Santyl

Classification: Topical debriding agent

Usual Dosage: Ointment 250 units/g

Adverse Effects / Side Effects: N/A

Nursing Implications: Wound must be free of antiseptic and antibacterial agents.

Labs: N/A

Generic: Cyanocobalamin, Vitamin B12

Brand: Anacobin, Bedoz, Nascobal, Rubion

Classification: Vitamin B12

Usual Dosage: IM or deep Sub-q 30 mcg per day for 5-10 days, then 100-200 mcg per month

Side Effects / Adverse Effects: Swelling, anaphylactic shock, pulmonary edema

Drug Interactions / Contraindications: Leber’s Disease

Teaching / Nursing Implications: Obtain a complete diet and drug history and inquire into alcohol drinking patterns for all patients receiving Cyanocobalamin
to identify and correct poor habits.

Labs: Reticulocyte and erythrocyte counts prior to starting therapy, Hgb, Hct, vitamin B12, and serum folate levels.
Generic: Desmopressin acetate

Brand: DDAVP, Stimate

Classification: Posterior Pituitary Hormone (ADH)

Usual Dosage: Intranasal 0.1–0.4 mL (10–40 mcg) in 1–3 divided doses IV/SC 2–4 mcg in 2 divided doses PO 0.2–0.4 mg/d

Drug Interactions / Contraindications: Demeclocycline, lithium, other vasopressors may decrease antidiuretic response; carbamazepine, chlorpropamide,
clofibrate may prolong antidiuretic response.

Side Effects / Adverse Effects: Transient headache, drowsiness, listlessness.

Nursing Implications: Monitor I&O ratio and pattern (intervals). Fluid intake must be carefully controlled, particularly in older adults and the very young to
avoid water retention and sodium depletion. Weigh patient daily and observe for edema. Severe water retention may require reduction in dosage and use of a
diuretic. Monitor BP during dosage-regulating period and whenever drug is administered parenterally. Monitor urine and plasma osmolality. An increase in
urine osmolality and a decrease in plasma osmolality indicate effectiveness of treatment in diabetes insipidus.

Labs: N/A

Generic: Dexamethasone Sodium Phosphate

Brand: Decadron Phosphate, Maxidex Opthalmic

Classification: Hormone, Adrenal Corticosteroid, Glucocorticoid

Usual Amount / Adult: For allergies, inflammation, and neoplasias by mouth 0.25 – 4 mg twice a day to four times a day. IM 8-16 mg every 1-3 weeks or 0.8-
1.6 mg intralesional every 1-3 weeks. For cerebral edema IV 10 mg followed by 4 mg every 6 hours, reduce dose after 2-4 days then taper over 5-7 days.

Side Effects / Adverse Effects: Euphoria, Hyperglycemia, Impaired Wound Healing, Immun-Compromised Patients, Cushingoid state

Drug Interactions / Contraindications: Barbituates, Potassium Loss, May inhibit antibody response to vaccines and toxoids.

Nursing Implications: Monitor and report signs and symptoms of Cushing’s syndrome, monitor for hypersensitivity reaction, Monitor weight, growth, fluid,
and electrolyte balance. Patient should avoid foods high in sugar or salt and should take potassium and Vitamin C supplements.

Blood Test Needed: Monitor Potassium and Calcium levels

Generic: Diphenoxylate Hydrochloride with Atropine Sulfate

Brand: Lomotil, Diphenatol, Lofene, Lonox, Lo-Trol,

Classification: Anti-diarrheal

Usual Dosage: By mouth 1-2 tablets or 1-2 teaspoons full (5 mL) 3-4 times per day

Side Effects / Adverse Effects: Pruritis, dizziness, abdominal pain

Drug Interactions / Contraindications: Alcohol will enhance CNS depressant effect, severe dehydration or electrolyte imbalance

Nursing Implications: Assess GI and report abdominal distention, monitor for dehydration, monitor frequency and consistency of stools

Blood Test Needed: N/A

Generic: Dipyridamole

Brand: Persantine

Classification: Antiplatelet Agent, Platelet Aggregate Inhibitor

Usual Dosage: PO 75–100 mg q.i.d.

Drug Interactions / Contraindications: Other anticoagulants can increase bleeding risk.

Side Effects / Adverse Effects: Headache, dizziness, faintness, syncope, weakness, and flushing.

Nursing Implications: Monitor therapeutic effectiveness. Clinical response may not be evident before second or third month of continuous therapy. Effects
include reduced frequency or elimination of anginal episodes, improved exercise tolerance, reduced requirement for nitrates.

Labs: N/A
Generic: Doxycycline Hyclate

Brand: Vibramycin, Novodoxylin, Monodox, Apo-Doxy, Doryx, Doxy, Doxycin

Classification: Antibiotic; Tetracycline

Usual Amount / Adult: By mouth or IV give 100 mg every 12 hours on the first day, then 100 mg per day as a single dose

Side Effects / Adverse Effects: Interference with color vision, enterocolitis, photosensitivity

Drug Interaction / Contraindications: Check expiration dates because this medication is toxic if expired; antacids can significantly decrease absorption; can
increase effect of certain diuretics.

Nursing Implications: Should be taken with entire glass of water and, if possible with food, to minimize nausea and avoid esophageal ulceration.

Blood Test Needed: BUN and Creatinine

Generic: Ferrous Sulfate

Brand: Feosol, Fer-In-Sol, Fer-Iron, Ferospace, Ferralyn, Ferra-TD, Fesofor, Hematinic

Classification: Blood former, Iron preparation

Usual Dosage: PO 750-1500 mg per day on 1-3 divided doses

Side Effects / Adverse Effects: Constipation, discoloration of eyes and teeth, black stools

Drug Interactions / Contraindications: Antacids decrease iron absorption, iron decreases absorption of tetracyclines. Food decreases absorption of iron, ascorbic
acid may increase iron absorption.

Nursing Implications: Monitor bowel movements as constipation is a common adverse effect.

Labs: Monitor Hgb and reticulocyte values during therapy.

Generic: Fluconazole

Brand: Diflucan

Classification: Antibiotic, Azole Antifungal

Usual Dosage: 200mg day 1, then 100mg/d x 14d

Drug Interactions / Contraindications: Concomitant cisapride. Proarrhytmic conditions. Discontinue if liver disease or progressively worsening rash develops.
Elderly. Pregnancy.

Adverse Effects / Side Effects: Nausea, headache, rash , vomiting, abdominal pain, diarrhea, hepatotoxicity, exfoliative dermatitis.

Nursing Implications: Monitor for allergic reaction.

Labs: Monitor liver function, BUN, and Creatinine.

Generic: Folic Acid, Vitamin B9

Brand: Apo-Folic, Folacin, Novofolacid

Classification: Vitamin B9

Usual Dosage: PO/IM/SC/IV ≤1 mg per day

Side Effects / Adverse Effects: Slight flushing and feeling of warmth following IV administration

Drug Interactions / Contraindications: Chloramphenicol may antagonize effects of folate therapy

Nursing Implications: Obtain careful history of dietary intake and drug and alcohol usage prior to start of therapy. Drugs reported to cause folate deficiency
include oral contraceptives, alcohol, barbiturates, methotrexate, phenytoin, primidone, and thrimethoprim. Folate deficiency may also result from renal
dialysis.

Labs: N/A
Generic: Guaifenesin

Brand: Mucinex

Classification: Expectorant

Usual Dosage: 600mg; 1-2tabs every 12hrs.

Drug Interactions / Contraindications: Asthma. Lower respiratory disorders. Pregnancy. Nursing mothers.

Adverse Effects / Side Effects: GI upset, drowsiness, headache, rash.

Nursing Implications: Monitor for therapeutic effectiveness, notify physician if high fever, rash, or headache develops.

Labs: N/A

Generic: Hydrochlorothiazide

Brand: HCTZ, Oretic, Esidrix

Classification: Electrolytic and water balance agent, Diuretic

Usual Dosage: PO 25–200 mg/d in 1–3 divided doses

Drug Interactions / Contraindications: Amphotericin B, CORTICOSTEROIDS increase hypokalemic effects; SULFONYLUREAS, insulin may antagonize
hypoglycemic effects; cholestyramine, colestipol decrease THIAZIDE absorption; diazoxide intensifies hypoglycemic and hypotensive effects; increased
potassium and magnesium loss may cause digoxin toxicity; decreases lithium excretion and increases toxicity; increases risk of NSAID-induced renal failure
and may attenuate diuresis.

Side Effects / Adverse Effects: Mood changes, unusual tiredness or weakness, dizziness, light-headedness, paresthesias

Nursing Implications: Check BP before initiation of therapy and at regular intervals. Monitor closely for hypokalemia; it increases the risk of digoxin toxicity.
Monitor I&O and check for edema. Drug may cause hyperglycemia and loss of glycemic control in diabetics. Drug may cause orthostatic hypotension,
dizziness.

Labs: Baseline and periodic determinations of serum electrolytes, blood counts, BUN, blood glucose, uric acid, CO 2, are recommended.
Generic: Hydroxyzine Hydrochloride / Hydroxyzine Pamoate

Brand: Atarax syrup, Vistaril Intramuscular, Vistaril Oral

Classification: Antihistamine, Antianxiety, Antiemetic

Usual Dosage: For anxiety by mouth 25-100 mg three times per day or four times per day. IM 25-100 mg every 4-6 hours.

Side Effects / Adverse Effects: Drowsiness, Hypotension, Dyspnea

Drug Interactions / Contraindications: Alcohol and CNS depressants add to CNS depression, do not use during lactation or pregnancy, do not use as sole
treatment for psychoses or depression.

Nursing Implications: Monitor I & O, patients with marked renal dysfunction may rapidly develop visual and auditory hallucinations and hematologic toxicity.

Blood Test Needed: Determine status of kidney, liver, and bone marrow function before and periodically during treatment. Monitor hemoglobin, WBC, and
platelet counts at least once a week.

Generic: Indomethacin

Brand: Indocin, Indocin SR, Indocid

Classification: Analgesic, NSAID

Usual Dosage: For RA by mouth 25-50 mg twice a day or three times a day, max 200 mg per day or 75 mg sustained release 1-2 times per day.

Side Effects / Adverse Effects: Hypersensitivity, Vertigo, Elevated BP, Tachycardia

Drug Interactions / Contraindications: Allergy to aspirin, history of GI lesions, do not use if patient is taking oral anticoagulants, heparin, and alcohol may
prolong bleeding time.

Nursing Implications: Monitor for therapeutic effectiveness, monitor weight and observe for edema

Blood Test: Monitor renal function, hepatic function, CBC with differential.
Generic: Interferon Alfa-2a

Brand: Roferon-A Injection

Classification: Antineoplastic, Immunomodulator, Interferon

Usual Dosage: SC/IM 3 million U/d for 16-24 weeks, may be reduced to 3 times per week for maintenance therapy

Side Effects / Adverse Effects: Flu-like syndrome, anorexia, psychosis

Drug Interactions / Contraindications: May increase theophylline levels.

Nursing Implications: Monitor I & O, ecchymoses, vital signs, gait difficulty, and for oral superinfections with Candida albicans.

Labs: Establish baseline data for CBC and platelet count, peripheral and bone marrow hairy cells, and liver and renal function.

Generic: Ipecac Syrup

Brand: Ipecac Syrup

Classification: Emetic

Usual Dosage: 30mL followed by 1-2 240mL glasses of H2O.

Drug Interactions / Contraindications: Comatose, semi-comatose, inebriated, deeply sedated patients, patients in shock, seizures, strychnine.

Adverse Effects / Side Effects: Achy, stiff muscles, severe myopathy, convulsions, coma, diarrhea, tachycardia, chest pain, dyspnea.

Nursing Implications: Can be cardiotoxic if not vomited, report to physician if vomiting persists for longer than 2-3 hours.

Labs:N/A
Generic: Isorbide Dinitrate

Brand: Isordil, Iso-Bid

Classification: Nitrate vasodilator

Usual Dosage: PO Regular tablets 2.5–30 mg q.i.d. a.c. and h.s.; Sublingual tablet 2.5–10 mg q4–6h; Chewable tablet 5–30 mg chewed q2–3h; Sustained
release tablets 40 mg q6–12h

Drug Interactions / Contraindications: Alcohol may enhance hypotensive effects and lead to cardiovascular collapse; Antihypertensive agent, Phenotizines add
to hypotensive effects.

Adverse Effects / Side Effects: Hypersensitivity reaction, paradoxical increase in anginal pain, lightheadedness, and flushing.

Nursing Implications: Monitor effectiveness of drug in relieving angina. Headaches tend to decrease in intensity and frequency with continued therapy but may
require administration of analgesic and reduction in dosage. Chronic administration of large doses may produce tolerance and thus decrease effectiveness of
nitrate preparations.

Labs: N/A

Generic: Sodium Polystyrene Sulfonate

Brand: Kayexalate, SPS Suspension

Classification: Electrolyte and water balance, Cation exchange

Usual Dosage: By mouth, 15 g suspended in 70% sorbitol or 20-100 mL of other fluid 1-4 times per day. Per rectum, 30-50 g/100 mL 70% sorbitol
every 6 hours as warm emulsion high into sigmoid colon.

Side Effects / Adverse Effects: May cause constipation, sodium retention, and should not be given to patients with bowel opbstructions.

Drug Interactions / Contraindications: Antacids and laxatives containing calcium or magnesium

Nursing Implications: Talk to doctor about restricting the patient’s sodium intake since this medication already contains 100 mg of sodium per gram.
Explain to patient that they should keep track of bowel movements and that a mild laxative may be used to avoid constipation.

Labs: Serum potassium levels daily, monitor acid-base balance, electrolytes, and minerals.
Generic: Lactulose

Brand: Cephulac, Chronulac

Classification: Hyperosmotic laxative

Usual Doasge: 30-45mL TID o rQID adjusted to produce 2-3 soft stools

Drug Interactions / Contraindications: Low galactose diet; pregnancy.

Adverse Effects / Side Effects: Flatulence, belching, abdominal cramps, pain, and distention; diarrhea, nausea, vomiting, colon accumulation of hydrogen gas;
hypernatremia.

Nursing Implications: Promote fluid intake.

Labs: N/A

Generic: Levothyroxine sodium

Brand: Synthroid

Classification: Thyroid Hormone Replacement

Usual Dosage: PO 25–50 mcg/d, gradually increased by 50–100 mcg q1–4wk to usual dose of 100–400 mcg/d IV/IM ½ established oral dose (usually 50–100
mcg daily)

Drug Interactions / Contraindications: Cholestyramine, colestipol decrease absorption of levothyroxine; epinephrine, norepinephrine increase risk of cardiac
insufficiency; oral anticoagulants may potentiate hypoprothrombinemia.

Side Effects / Adverse Effects: Irritability, nervousness, insomnia, and headache.

Nursing Implications: Monitor pulse before each dose during dose adjustment. If rate is >100, consult physician. Levothyroxine may aggravate severity of
previously obscured symptoms of diabetes mellitus, Addison's disease, or diabetes insipidus. Therapy for these disorders may require adjustment.

Labs: Baseline and periodic tests of thyroid function. Closely monitor PT/INR and assess for evidence of bleeding if patient is receiving concurrent
anticoagulant therapy. A decrease in anticoagulant dosage may be needed 1–4 wk after concurrent levothyroxine is started.
Generic: Lithium Carbonate

Brand: Eskalith, Lithane, Lithobid, Lithonate, Lithotabs

Classification: Psychotherapeutic agent, Mood stabilizer

Usual Dose: Loading dose PO 600 mg three times per day or 900 mg sustained release twice a day or 30 mL solution three times per day. Maintenance dose PO
300 mg three times per day or four times per day or 15-20 mL solution in 2-4 divided doses.

Side Effects / Adverse Effects: Lethargy, peripheral circulatory collapse, diabetes insipidus

Drug Interactions / Contraindications: Carbamazepine, haloperidol, phenothiazines increase risk for neurotoxicity, extrapyramidal effects

Nursing Implications: Monitor for signs and symptoms of lithium toxicity, monitor I & O, watch for edema.

Labs: Periodic lithium levels and periodic thyroid function.

Generic: Losartan Potassium

Brand: Cozaar

Classification: Angiotensin II Receptor Antagonist; Antihypertensive

Usual Dose: PO 25-50 mg in 1-2 divided doses (max 100 mg/day); start with 25 mg/day if volume depleted (ex: diuretics)

Drug Interactions / Contraindications: Not to be used in children younger then 6 and lactating women. Phenobarbital decreases serum levels of losartan and its
metabolite.

Side Effects / Adverse Effects: Myalgia, dyspepsia, and headache.

Nursing Implications: Monitor BP, inadequate response may be improved by splitting the daily dose into twice daily dose.

Labs: CBC, electrolytes, liver and kidney function with long term therapy.
Generic: Mannitol

Brand: Osmitrol

Classification: Osmotic Diuretic

Usual Dosage: IV 100 g as a 10–20% solution over 2–6 h

Drug Interactions / Contraindications: Increases urinary excretion of lithium, salycylates, barbiturates, imipramine, and potassium.

Side Effects / Adverse Effects: Hyponatremia, dehydration, and acidosis.

Nursing Implications: Measure I&O accurately and record to achieve proper fluid balance. Monitor vital signs closely. Report significant changes in BP and
signs of CHF. Monitor for possible indications of fluid and electrolyte imbalance (e.g., thirst, muscle cramps or weakness, paresthesias, and signs of CHF). Be
alert to the possibility that a rebound increase in ICP sometimes occurs about 12 h after drug administration. Patient may complain of headache or confusion.
Take accurate daily weight.

Labs: Monitor closely serum and urine electrolytes and kidney function during therapy.

Generic: Meclizine

Brand: Anitvert

Classification: Antihistamine

Usual Dosage: 25-50mg 1 hour prior to departure

Drug Interactions / Contraindications: Asthma. Glaucoma. GI or urinary obstruction. Pregnancy. Nursing mothers.

Adverse Effects / Side Effects: Drowsiness, sedation, dry mouth, blurred vision.

Nursing Implications: Supervise patient’s ambulation, assess effectiveness of drug.

Labs: N/A
Generic: Metformin

Brand: Glucophage

Classification: Hormone, Anti-diabetic Agent

Usual Dosage: PO Start with 500 mg q.d. to t.i.d. or 850 mg q.d. to b.i.d. with meals, may increase by 500–850 mg/d every 1–3 wk (max: 2550 mg/d); or start
with 500 mg sustained release with p.m. meal, may increase by 500 mg/d at p.m. meal qwk (max: 2000 mg/d)

Drug Interactions / Contraindications: Captopril, furosemide, nifedipine may increase risk of hypoglycemia. Cimetidine reduces clearance of metformin.
Concomitant therapy with Azole antifungal agents (fluconazole, ketoconazole, itraconazole) and oral hypoglycemic drugs has been reported in severe
hypoglycemia. Iodinated radiocontrast dyes can cause lactic acidosis and acute kidney failure. Amiloride, cimetidine digoxin, dofetilide, midodrine, morphine,
procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, or vancomycin may decrease metformin elimination by competing for common renal
tubular transport systems. Acarbose may decrease metformin levels. Iodinated contrast dyes may cause lactic acidosis or acute kidney failure.

Side Effects / Adverse Effects: Headache, dizziness, agitation, and fatigue.

Nursing Implications: Monitor known or suspected alcoholics carefully for decreased liver function. Monitor cardiopulmonary status throughout course of
therapy; cardiopulmonary insufficiency may predispose to lactic acidosis.

Labs: Obtain baseline and periodic kidney and liver function tests; drug contraindicated in the presence of renal or hepatic insufficiency. Monitor blood glucose
and HbA1C, and lipid profile periodically.

Generic: Midazolam Hydrochloride

Brand: Versed

Classification: Benzodiazepine Anxiolytic, Sedative-Hypnotic

Usual Dosage: IM 0.07-0.08 mg/kg 30-60 minutes before procedure. IV 1-2.5 mg, may repeat in 2 minutes prn.

Side Effects / Adverse Effects: Retrograde Amnesia, Hypotension, Respiratory Arrest

Drug Interactions: Alcohol, CNS Depressants, Anticonvulsants

Nursing Implications: Monitor for impending respiratory arrest, monitor for hypotension.

Labs: N/A
Generic: Montelukast
Brand: Singulair
Classifications: Bronchodilator; Leukotriene Receptor Antangonist
Usual Dosage: PO 10 mg every day in the evening
Side Effects / Adverse Effects: Asthenia, fever, and dizziness.
Drug Interactions / Contraindications: Acute asthma attack
Nursing Implications: Monitor effectiveness
Labs: Liver function

Generic: Naloxone Hydrochloride

Brand: Narcan
Classification: Narcotic (opiate) antagonist
Usual Dosage: IV for opiate overdose 0.4 – 2 mg, may repeat every 2-3 minutes up to 10 mg if necessary. Postop opiate depression IV 0.1 – 0.2 mg, may repeat
every 2-3 minutes for up to 3 doses if necessary.
Side Effects / Adverse Effects: Tachycardia, tremors, nausea and vomiting
Drug Interaction: Decreases effects of opiate narcotics.
Nursing Implications: This may induce withdrawals in patients addicted to opiates, monitor for bleeding, and monitor respirations and vital signs.
Labs: N/A
Generic: Naproxen Sodium

Brand: Aleve, Anaprox, Anaprox DS

Classification: Analgesic, NSAID, Antipyretic

Usual Dosage: By mouth, 250-500 mg twice per day, max of 1100 mg per day

Side Effects / Adverse Effects: Heartburn, Palpitation, Dyspnea

Drug Interactions / Contraindications: Bleeding time effects of oral anticoagulants, Heparin may be prolonged.

Nursing Implications: Take detailed drug history prior to administration, monitor therapeutic effects.

Labs: Obtain baseline and periodic evaluations of Hgb and kidney and liver functions in patients receiving prolonged or high dose therapy.

Generic: Nitroprusside Sodium

Brand: Nitropress

Classification: Non-nitrate Vasodilator, Antihypertensive

Usual Dosage: IV 0.3–0.5 mcg/kg/min (average 3 mcg/kg/min)

Side Effects / Adverse Effects: Thiocyanate toxicity, profound hypotension, and diaphoresis.

Drug Interactions / Contraindications: Contraindicated in patients with compensatory hypertension, as in atriovenous shunt or coarctation of aorta, and for
control of hypotension in patients with inadequate cerebral circulation.

Nursing Implications: Monitor constantly to titrate IV infusion rate to BP response. Relieve adverse effects by slowing IV rate or by stopping drug; minimize
them by keeping patient supine. Notify physician immediately if BP begins to rise after drug infusion rate is decreased or infusion is discontinued. Monitor
I&O.

Labs: Monitor blood thiocyanate level in patients receiving prolonged treatment or in patients with severe kidney dysfunction (levels usually arenot allowed to
exceed 10 mg/dL). Determine plasma cyanogen level following 1 or 2 d of therapy in patients with impaired liver function.
Generic: Ondansetron hydrochloride
Brand: Zofran
Classification: 5-HT3, Antagonist, Antiemetic
Usual Dosage: 8-24mg 30 min before chemotherapy
Drug Interactions / Contraindications: Hypersensitivity to ondansetron; children <4 y. Rifampin may decrease ondansetron levels.
Adverse Effect / Side Effects: Dizziness and light-headedness, headache, sedation. Diarrhea, constipation, dry mouth, transient increases in aminotranseferases
and bilirubin.
Nursing Implications: Monitor fluid and electrolyte status. Monitor cardiovascular status. Monitor I & O.
Labs:N/A

Generic: Pancuronium Bromide

Brand: Pavulon

Classification: Skeletal Muscle Relaxant

Usual Dosage: IV 0.04-0.1 mg/kg initial dose, may give additional doses of 0.01 mg/kg at 30-60 minute intervals.

Side Effects / Adverse Effects: Increased pulse rate and BP, Respiratory depression, muscle weakness

Drug Interaction / Contraindications: General anesthetics increase neuromuscular blocking and duration of action

Nursing Implications: Assess cardiovascular and respiratory status continuously.

Labs: N/A

Generic: Pancrelipase
Brand: Viokase, Ultrase, Cotazym

Classification: Enzyme Replacement Therapy

Usual Dosage: PO 1-3 capsules or tablets or 1-2 packets of powder 1-2 hours before, during, or 1 hour after meals, with an extra dose taken with any food eaten
between meals.

Side Effects / Adverse Effects: Anorexia, hyperuricosuria, nausea

Drug Interactions / Contraindications: Iron absorption may be decreased. Esophageal strictures, pancreatitis, and pregnancy.

Nursing Implications: Monitor I & O and weights.

Labs: N/A

Generic: Permethrin

Brand: Nix, Eliminate, Acticin

Classification: Scabicide, Pediculide

Usual Dosage: Topically apply sufficient volume to clean wet hair to saturate the hair and scalp, leave on for 10 minutes, then rinse hair thoroughly

Side Effects / Adverse Effects: Pruritis, tingling, numbness

Drug Interaction / Contraindications: Lactation, hypersensitivity to pyrethrines, chrysanthemums, sulfites, and other preservatives or dyes.

Nursing Implications: Inspect hair shafts daily for at least one week to determine if drug was effective.

Labs: N/A

Generic: Phytonadione, Vitamin K

Brand: Aquamephyton, Mephyton

Classification: Vitamin K, Antidote

Usual Dosage: PO/SC/IM 2-5-10 mg, rarely up to 50 mg per day, may repeat parenteral dose after 6-8 hours if needed, or PO dose after 12-24 hours. IV
emergency only: 10-15 mg at a rate of ≤1 mg per minute, may be repeated in 4 hours if bleeding continues.

Side Effects / Adverse Effects: Facial flush, bronchospasm, chills

Drug Interactions / Contraindications: Benzyl alcohol or castor oil

Nursing Implications: Monitor patient constantly because of possible anaphylactic reaction

Labs: Baseline and frequent PT/INR

Generic: Prochlorperazine

Brand: Compazine, Compro

Classification: Psychotherapeutic, Antpsychotic, Phenothiazine, Antiemetic

Usual Dosage: 5-10mg 3-4times/d.

Drug Interactions / Contraindications: Hypersensitivity to phenothiazines; bone marrow depression; blood dyscrasias, jaundice; comatose or severely depressed
states.

Adverse Effects / Side Effects: Drowsiness, dizziness, extrapyramidal reactions, persistent tardive dyskinesia, colestatic jaundice.

Nursing Implications: Position patient carefully to avoid aspiration if they vomit, watch for fever.

Labs: Periodic CBC with differential in long-term therapy

Generic: Promethazine Hydrochloride

Brand: Phenergan

Classification: Anti-emetic, Anti-vertigo agent

Usual Dosage: For motion sickenss by mouth or rectally 25 mg every 12 hours as needed. For nausea by mouth, rectally, intramuscular, IV 12.5 – 25 mg every
4 to 6 hours as needed. For allergies by mouth or rectally 12.5 mg three times per day or 25 mg at hour of sleep, repeat in 2 hours if necessary, switch to orally.
For sedation PO/PR/IM/IV 25-50 mg per dose.

Side Effects / Adverse Effects: Deep sleep, irregular respirations, hypotension or hypertension

Drug Interaction / Contraindications: Children with Reye’s syndrome, angina, acute MI

Nursing Implications: Supervise ambulation and assess breathing; Give with food, milk, or a full glass of water to minimize GI upset. May be crushed and
mixed with food or water.

Blood Test Needed: N/A

Generic: Propranolol Hydrochloride

Brand: Inderal, Inderal LA, InnoPran XL

Classification: Beta-Adrenergic Receptor Antagonist, Antihypertensive, Antiarrhythmic

Usual Dosage: PO 40 mg b.i.d., usually need 160–480 mg/d in divided doses

Side Effects / Adverse Effects: Agranulocytosis, dyspnea, laryngospasm, and bronchospasms.

Drug Interactions / Contraindications: Phenothizines have additive hypotensive effects. Beta-adrenergic agonists (e.g., albuterol) antagonize effects. Atropine
and Tricyclic antidepressents block bradycardia. Diuretics and other hypotensive agents increase hypotension. High doses of tubocurarine may potentiate
neuromuscular blockade. Cimetidine decreases clearance, increases effects. ANTACIDS, ascorbic acid may decrease absorption.

Nursing Implications: Monitor apical pulse, respiration, BP, and circulation to extremities closely throughout period of dosage adjustment. Consult physician
for acceptable parameters.

Labs: Obtain periodic hematologic, kidney, liver, and cardiac functions when propranolol is given for prolonged periods.
Generic: Propofol

Brand: Diprivan

Classification: General Anesthesia, Sedative-Hypnotic

Usual Dosage: IV 2-2.5 mg/kg every 10 seconds until induction onset

Side Effects / Adverse Effects: Headache, Dizziness, Hypotension

Drug Interactions / Contraindications: CNS depressants cause addictive CNS depression

Nursing Implications: Take seizure precautions, monitor for hypotension.

Labs: N/A

Generic: Simethicone

Brand: Gas-X, Mylicon, Phazyme

Classification: Anti-flatulence

Usual Dose: Liquid drops: 40 mg per 0.6 ml. Chewable tablets: 40mg, 80mg, 125mg. Tablets: 60mg, 95mg. Capsules: 125mg

Side Effects / Adverse Effects: None reported

Drug Interactions / Contraindications: None reported

Nursing Implications: N/A

Labs: N/A

Generic: Sodium Polystyrene Sulfonate

Brand: Kayexalate, SPS Suspension

Classification: Electrolyte and water balance, Cation exchange

Usual Dosage: By mouth, 15 g suspended in 70% sorbitol or 20-100 mL of other fluid 1-4 times per day. Per rectum, 30-50 g/100 mL 70% sorbitol every 6
hours as warm emulsion high into sigmoid colon.

Side Effects / Adverse Effects: May cause constipation, sodium retention, and should not be given to patients with bowel opbstructions.

Drug Interactions / Contraindications: Antacids and laxatives containing calcium or magnesium

Nursing Implications: Talk to doctor about restricting the patient’s sodium intake since this medication already contains 100 mg of sodium per gram. Explain to
patient that they should keep track of bowel movements and that a mild laxative may be used to avoid constipation.

Labs: Serum potassium levels daily, monitor acid-base balance, electrolytes, and minerals.

Generic: Spironolactone

Brand: Aldactone, Novospiroton

Classification: Electrolyte and water balance, Potassium sparing diuretic

Usual Dosage: PO 25-200 mg per day in divided doses, continued for at least 5 days

Side Effects / Adverse Effects: Lethargy, ataxia, gynecomastia

Drug Interactions / Contraindications: Anuria, severe renal insufficiency, diuretic effect may be antagonized by aspirin.

Nursing Implications: Check blood pressure before start of therapy, assess for signs of fluid and electrolyte imbalance, monitor daily I & O and for edema.
Inform patient that salt substitutes may increase risk of hyperkalemia

Labs: Serum electrolytes, monitor Digoxin levels

Generic: Sucralfate

Brand: Carafate, Sulcrate

Classification: Antiulcer; Gastro-adhesive

Usual Dosage: PO 1 gram 4 times per day and at bedtime. For maintenance, PO 1 gram 2 times per day.

Side Effects / Adverse Effects: Constipation, nausea, and diarrhea.

Drug Interactions / Contraindications: May decrease absorption of Quinolones. Not recommended for pregnant women and children.

Nursing Implications: Be aware of drug interactions and schedule other medications accordingly.

Labs: N/A

Generic: Sulfamethoxazole-Trimethoprim

Brand: Bactrim, Bactrim DS, Septra, Septra DS, SMZ-TMP DS

Classification: Urinary tract agent, Sulfonamide

Usual Dosage: By mouth, 160 mg of Trimethoprine and 800 mg Sulfamethoxazole every 12 hours. IV 8-10 mg/kg every day, with the Trimethoprine divided
every 6-12 hours.

Side Effects / Adverse Effects: Pseudomembranous enterocolitis, Aplastic anemia, rashes

Drug Interactions / Contraindications: Alcohol may cause disulfiram reaction, may enhance hypoprothrombinemic effects of oral anticoagulants

Nursing Implications: Assess for rashes, itching, or hives sense this could indicate allergy, older patients are especially at risk for adverse reactions. Advise
patient to avoid consumption of alcohol.

Labs: Baseline and follow up urinalysis, CBC with differential, platelet count, BUN and Creatinine.

Generic: Topiramate
Brand: Topamax

Classification: Migraine Prophylaxis, Anti-Convulsant, Gamma-Aminobutyrate Enhancer

Usual Dosage: PO initiate with 25 mg twice a day, increase by 25 mg per week to 200 mg per day dose or max tolerated dose.

Side Effects / Adverse Effects: Fatigue, Speech problems, Dizziness

Drug Interactions / Contraindications: Increased CNS depression with alcohol and other CNS depressants, may decrease efficacy of oral contraceptives.

Teaching / Nursing Implications: Monitor mental status and report significant cognitive impairment.

Labs: Periodically monitor CBC with Hgb and Hct.

Generic: Valproic Acid

Brand: Depakote, Depacon, Depakene

Classification: Anticonvulsant, GABA inhibitor

Usual Dosage: Po/IV 10-15 mg/kg/per day in divided doses when total daily dose ›250 mg, increase at 1 week intervals by 5-10 mg/kg/per day with max at 60
mg/kg/per day.

Side Effects / Adverse Effects: Bone marrow depression, indigestion, liver failure

Drug Interactions / Contraindications: alcohol and other CNS depressants, aspirin and Warfarin increase risk for spontaneous bleeding

Nursing Implications: Monitor for therapeutic effect, monitor patient alertness

Labs: Perform baseline platelet count, bleeding time, and serum ammonia

Generic: Vancomycin Hydrochloride

Brand: Vancocin

Classification: Antibiotic, Glycopeptide

Usual Dosage: Systemic infection, IV 500 mg every 6 hours or 1 g every 12 hours or 15 mg/kg every 12 hours. C. diff, by mouth 125-500 mg every 6 hours.
Surgical prophylaxis, IV 10-15 mg/kg starting one hour prior to surgery

Side Effects / Adverse Effects: ototoxicity, nephrotoxicity, leukopenia

Drug Interactions / Contraindications: IM administration, allergy to corn or corn products, use of other ototoxic and nephrotoxic products.

Nursing Implications: monitor BP and heart rate, assess hearing, and monitor urine coloration for signs of nephrotoxicity.

Labs: Urinalysis, kidney and liver functions, peak and trough levels.

Generic: Vasopressin injection

Brand: Pitressin

Classification: Pituitary Hormone (ADH)

Usual Dosage: IM/SC 5–10 U aqueous solution 2–4 times/d (5–60 U/d) or 1.25–2.5 U in oil q2–3d Intranasal Apply to cotton pledget or intranasal spray.

Drug Interactions / Contraindications: Alcohol, demeclocycline, epinephrine, heparin, lithium, phenytoin may decrease antidiuretic effects of vasopressin;
guanethidine, neostigmine increase vasopressor actions; chlorpropamide, clofibrate, carbamazepine, Thiazide diuretics may increase antidiuretic activity.

Side Effects / Adverse Effects: Anaphylaxis; tremor, sweating, bronchoconstriction, circumoral and facial pallor, and post nasal drip.

Nursing Implications: Establish baseline data of BP, weight, I&O pattern and ratio. Monitor BP and weight throughout therapy. (Dose used to stimulate diuresis
has little effect on BP.) Report sudden changes in pattern to physician. Be alert to the fact that even small doses of vasopressin may precipitate MI or coronary
insufficiency, especially in older adult patients. Keep emergency equipment and drugs (antiarrhythmics) readily available. Check patient's alertness and
orientation frequently during therapy. Lethargy and confusion associated with headache may signal onset of water intoxication, which, although insidious in
rate of development, can lead to convulsions and terminal coma. Monitor urine output, specific gravity, and serum osmolality while patient is hospitalized.
Withhold vasopressin, restrict fluid intake, and notify physician if urine-specific gravity is <1.015.

Labs: N/A

Generic: Verapamil Hydrochloride

Brand: Calan, Verelan, Isoptin

Classification: Calcium channel blocker, Antihypertensive, Antiarrhythmic

Usual Dosage: PO 80 mg q6–8h, may increase up to 320–480 mg/d in divided doses

Side Effects / Adverse Effects: Hypotension, AV Block, and flushing.

Drug Interactions / Contraindications: Beta blockers increase risk of CHF, bradycardia, or heart block; significantly increased levels of digoxin and
carbamazepine and toxicity; potentiates hypotensive effects of hypotensive agents; levels of lithium and cyclosporine may be increased, increasing their
toxicity; calcium salts (IV) may antagonize verapamil effects. Contraindicated in patients with cardiogenic shock, cardiomegaly, digitalis toxicity, second- or
third-degree AV block; Wolff-Parkinson-White syndrome including atrial flutter and fibrillation; accessory AV pathway, left ventricular dysfunction, severe
CHF, sinus node disease, sick sinus syndrome.

Nursing Implications: Monitor therapeutic effectiveness. Drug should decrease angina frequency, nitroglycerin consumption, and episodes of ST segment
deviation. Establish baseline data and periodically monitor BP and pulse. Monitor ECG continuously during IV administration.

Labs: Baseline and periodic liver and kidney functions.

Generic: Warfarin Sodium

Brand: Coumadin Sodium, Warfilone

Classification: Anticoagulant

Usual Dosage: 2-10 mg daily

Side Effects / Adverse Effects: Hemorrhage, Abdominal pain, Jaundice

Drug Interactions / Contraindications: Vitamin C or K deficiency, hemophilia, severe hepatic or renal disease, ASPIRIN

Nursing Implications: Obtain a careful medication history prior to the start of therapy; explain to patients that they are at greater risk for bleeding and bruising.
Advise patient to avoid citrus and citrus products.

Labs: PT/INT, urinalysis, liver function.