Drug Information Worksheet: Hypertension - 40 Twice Daily

Drug Information Worksheet
Medication and Dose Uses / Purpose Mode of Action Time Labs / VS

Side Effects / Adverse Reactions
Contraindications / Nursing Implications
Lasix- Furosemide •Edema due to •Inhibits the reabsorption F and E: dehydration, hypocalcemia, Onset: Monitor electrolytes,
diuretics heart failure, of sodium and chloride hypochloremia, hypokalemia, PO: 30-60 mins renal and hepatic
loop diuretics hepatic from the loop of Henle and hypomagnesemia, hyponatremia, IM: 10-30 mins function, serum
Edema: impairment or distal renal tubule. hypovolemia, metabolic alkalosis IV: 5 mins glucose, and uric
PO: (Adults) 20–80 mg/day as renal disease. •Increases renal excretion Hemat: APLASTIC ANEMIA, acid levels before
a single dose initially, may •Hypertension. of water, Na, Cl, Mg, K,. AGRANULOCYTOSIS, hemolytic Peak: and periodically
repeat in 6–8 hr; may ↑ dose •Effectiveness persists in anemia, leukopenia, thrombocytopenia PO: 1-2hr throughout therapy.
by 20–40 mg q 6–8 hr until impaired renal function. MS: muscle cramps IM: U/K Commonly ↓ serum
desired response. Maintenance Therapeutic effects: Derm: ERYTHEMA MULTIFORME, IV: 30 mins K. May cause ↓
doses may be given once or 2x •Diuresis and subsequent STEVENS-JOHNSON SYNDROME, serum Na, Ca, and
daily (doses up to 2.5 g/day mobilization of excess fluid TOXIC EPIDERMAL NECROLYSIS Duration: Mg concentrations.
have been used in patients (edema, pleural effusions). Nursing Implications: PO: 6-8 hrs May also cause ↑
with HF or renal disease). •Decreased BP. Assess fluid status. Monitor daily weight, IM: 4-8 hrs BUN, serum
Hypertension– 40 twice daily intake and output ratios, amount and IV: 2 hrs glucose, creatinine,
initially (when added to location of edema, lung sounds, skin and uric acid levels.
regimen, ↓ dose of other turgor, and mucous membranes. Notify
antihypertensives by 50%); health care professional if thirst, dry
adjust further dosing based on mouth, lethargy, weakness, hypotension,
response; Hypercalcemia– 120 or oliguria occurs.
mg/day in 1–3 doses.
IM: IV: (Adults) 20–40 mg, Assess patient for skin rash frequently
may repeat in 1–2 hr and ↑ by during therapy. Discontinue furosemide
20 mg every 1–2 hr until at first sign of rash; may be life-
response is obtained, threatening. Stevens-Johnson syndrome,
maintenance dose may be toxic epidermal necrolysis, or erythema
given q 6–12 hr; Continuous multiforme may develop.
infusion– Bolus 0.1 mg/kg
followed by 0.1 mg/kg/hr, Monitor BP and pulse before and during
double q 2 hr to a maximum of administration. Monitor frequency of
0.4 mg/kg/hr. prescription refills to determine
compliance in patients treated for
hypertension.
contraindications: hypersensitivity, cross

sensitivity with thiazides and
sulfonamides may occur; hepatic coma,
or anuria; avoid in patients with alcohol
intolerance.
Aldactone –Spironolactone •Management of Causes loss of sodium F and E: hyperkalemia, hyponatremia, Onset: Evaluate serum
diuretics, potassium sparing primary bicarbonate and Ca while hyperchloremic metabolic acidosis PO: U/K potassium levels
diuretics hyperaldosteroni saving K and H ions by CNS: dizziness, clumsiness, headache, prior to and routinely
sm. antagonizing aldosterone. sedation; CV: Arrhythmias; GI: Irritation; Peak: during therapy.
PO: (Adults) 25–400 mg/day •Management of GU: Erectile dysfunction PO: 1-3 hrs Withhold drug and
as a single dose or 2 divided edema Therapeutic effects: Derm: DRUG RASH WITH notify health care
doses.HF– 25–50 mg/day associated with •Increased survival in EOSINOPHILIA AND SYSTEMIC Duration: professional if
HF, cirrhosis and patients with severe heart SYMPTOMS (DRESS), STEVENS- PO: 2-3 days patient becomes
nephrotic failure (New York Heart JOHNSON SYNDROME, TOXIC hyperkalemic
syndrome. Association class II-IV). EPIDERMAL NECROLYSIS Monitor BUN, serum
•Management of •Weak diuretic and Endo: amenorrhea, gynecomastia (in creatinine, and
essential antihypertensive response males), breast tenderness,, deepening of electrolytes prior to
hypertension. when compared with other voice, ↑ hair growth (in females), sexual and periodically
•Treatment of diuretics. dysfunction during therapy. May
hypokalemia •Conservation of K Nursing interventions: cause ↑ serum Mg,
(counteracts K •Monitor intake and output ratios and uric acid, BUN,
loss caused by daily weight during therapy. creatinine, K,
other diuretics). •If medication is given as an adjunct to plasma renin
antihypertensive therapy, BP should be activity, and urinary
evaluated before administering. calcium excretion
Assess patient for skin rash frequently levels. May also
during therapy. Discontinue diuretic at cause ↓ Na levels.
first sign of rash; may be life-threatening.
Stevens-Johnson syndrome or toxic
epidermal necrolysis may develop. Treat
symptomatically; may recur once
treatment is stopped
•Monitor response of signs and
symptoms of hypokalemia (weakness,
fatigue, U wave on ECG, arrhythmias,
polyuria, polydipsia). Assess patient
frequently for development of
hyperkalemia (fatigue, muscle
weakness, paresthesia, confusion,
dyspnea, cardiac arrhythmias). Patients
who have diabetes mellitus or kidney
disease and elderly patients are at
increased risk of developing these
symptoms.
Contraindicated in: Hypersensitivity,

Anuria, Acute renal insufficiency,
Significant renal impairment (CCr <30

mL/min); SCr >2.5 mg/dL (for patients
with heart failure), Hyperkalemia,
Addison's disease, Concurrent use of
eplerenone.
Tenormin – Atenolol •Management of Blocks stimulation of beta1 CV: BRADYCARDIA, HF, PULMONARY Onset: May cause ↑ BUN,
antianginals, antihypertensives hypertension. (myocardial)-adrenergic EDEMA, hypotension, peripheral PO: 1 hr serum lipoprotein,
beta blockers •Management of receptors. Does not usually vasoconstriction potassium,
angina pectoris. affect beta2 (pulmonary, CNS: fatigue, weakness, anxiety, Peak: triglyceride, and uric
PO: (Adults) Antianginal– 50 •Prevention of vascular, uterine)-receptor depression, dizziness, drowsiness, PO: 2-4 hrs acid levels.
mg once daily; may be ↑ after 1 MI. sites. insomnia, memory loss, mental status May cause ↑ in
wk to 100 mg/day (up to 200 Therapeutic Effects: changes, nervousness, nightmares Duration: blood glucose levels
mg/day). Antihypertensive– •Decreased BP and heart Resp: bronchospasm, wheezing PO: 24 hrs
25–50 mg once daily; may be ↑ rate. EENT: blurred vision, stuffy nose
after 2 wk to 50–100 mg once •Decreased frequency of GU: erectile dysfunction, ↓ libido, urinary
daily. MI– 50 mg, then 50 mg attacks of angina pectoris. frequency
12 hr later, then 100 mg/day as •Prevention of MI. Endo: hypoglycemia, hyperglycemia
a single dose or in 2 divided MS: arthralgia, back pain, joint pain
doses for 6–9 days or until Nursing interventions:
hospital discharge. PO: Take apical pulse before
administering drug. If <50 bpm or if
Renal Impairment arrhythmia occurs, withhold
PO: (Adults) CCr 15–35 medication and notify physician or
mL/min– dosage should not other health care professional
exceed 50 mg/day; CCr <15 Monitor BP, ECG, and pulse frequently
mL/min– dosage should not during dosage adjustment period and
exceed 50 mg every other day periodically throughout therapy.
• Monitor intake and output ratios and
daily weights. Assess routinely for HF
(dyspnea, rales/crackles, weight gain,
peripheral edema, jugular venous
distention).
Angina: Assess frequency and
characteristics of angina periodically
throughout therapy
Monitor patients receiving beta blockers
for signs of overdose (bradycardia,
severe dizziness or fainting, severe
drowsiness, dyspnea, bluish fingernails
or palms, seizures). Notify physician
immediately if these signs occur.
•Instruct patient to take atenolol as

directed at the same time each day,
even if feeling well; do not skip or double
up on missed doses. Take missed doses
as soon as possible up to 8 hr before
next dose. Abrupt withdrawal may cause
life-threatening arrhythmias,
hypertension, or myocardial ischemia.
•Teach patient and family how to check
pulse and BP. Instruct them to check
pulse daily and BP weekly and to report
significant changes
Contraindicated in: Uncompensated

HF; Pulmonary edema; Cardiogenic
shock; Bradycardia or heart block.
Lopresor – •Hypertension. Blocks stimulation of CNS: fatigue, weakness, anxiety, Onset: May cause ↑ BUN,
Metoprolol •Angina pectoris. beta1(myocardial)- depression, dizziness, drowsiness, PO: 15 mins serum lipoprotein,
antianginals, antihypertensives •Prevention of MI adrenergic receptors. Does insomnia, memory loss, mental status PO-ER: u/k potassium,
and decreased not usually affect changes, nervousness, nightmares IV: immediate triglyceride, and uric
Beta blockers mortality in beta2(pulmonary, vascular, EENT: blurred vision, dry eyes, nasal acid levels.
patients with uterine)-adrenergic stuffiness Peak: •May cause ↑ in
recent MI. receptor sites. CV: BRADYCARDIA, HF, PULMONARY PO: u/k blood glucose levels.
PO: (Adults) •Management of EDEMA, hypotension, peripheral PO-ER: 6-12 hr •May cause ↑ serum
Antihypertensive/antianginal– stable, Therapeutic Effects: vasoconstriction IV: 20 mins alkaline
25–100 mg/day as a single symptomatic •Decreased BP and heart GI: constipation, diarrhea, drug-induced phosphatase, LDH,
dose initially or 2 divided (class II or III) rate. hepatitis, dry mouth, flatulence, gastric Duration: AST, and ALT
doses; may be ↑ q 7 days as heart failure due •Decreased frequency of pain, heartburn PO: 6-12 hrs levels.
needed up to 450 mg/day to ischemic, attacks of angina pectoris. GU: erectile dysfunction, ↓ libido, urinary PO-ER: 24 hrs
hypertensive or •Decreased rate of frequency IV: 5-8 hrs
(immediate-release) or 400
cardiomyopathc cardiovascular mortality Nursing interventions:
mg/day (extended-release) (for origin (may be and hospitalization in Monitor BP, ECG, and pulse frequently
angina, give in divided doses). used with ACE patients with heart failure during dose adjustment and periodically
Extended-release products are inhibitors, during therapy.
given once daily. MI– 25–50 diuretics and/or •Monitor frequency of prescription refills
mg (starting 15 min after last IV digoxin; Toprol to determine compliance.
dose) q 6 hr for 48 hr, then 100 XL only • Monitor vital signs and ECG every 5–15
mg twice daily. Heart failure– min during and for several hours after
12.5–25 mg once daily (of parenteral administration. If heart rate
extended-release), can be <40 bpm, especially if cardiac output is
doubled every 2 wk up to 200
mg/day. Migraine prevention– also decreased, administer atropine

50–100 mg 2–4 times daily 0.25–0.5 mg IV.
(unlabeled). • Monitor intake and output ratios and
daily weights. Assess routinely for signs
IV: (Adults) MI– 5 mg q 2 min and symptoms of HF (dyspnea,
for 3 doses, followed by oral rales/crackles, weight gain, peripheral
dosing. edema, jugular venous distention).
High Alert: IV vasoactive medications are
inherently dangerous. Before
administering intravenously, have
second practitioner independently check
original order and dose calculations.
Toprol-XL- PO: Take apical pulse before
Metoprolol administering. If <50 bpm or if arrhythmia
occurs, withhold medication and notify
health care professional.
•Instruct patient to take medication as
directed, at the same time each day,
up on missed doses; Abrupt withdrawal
may precipitate life-threatening
arrhythmias, hypertension, or myocardial
ischemia.
Contraindicated in: Uncompensated

HF; Pulmonary edema; Cardiogenic
shock; Bradycardia, heart block, or sick
sinus syndrome (in absence of a
pacemaker).
Betapace- •Management of Blocks stimulation of beta1 CNS: fatigue, weakness, anxiety, Onset: Calculate creatinine
Sotalol life-threatening (myocardial) and beta2 dizziness, drowsiness, insomnia, PO: hr clearance prior to
antiarrhythmics (class III) ventricular (pulmonary, vascular, and memory loss, mental depression, mental dosing.
arrhythmias. uterine) -adrenergic status changes, nervousness, Peak: •May cause ↑ BUN,
•Betapace AF: receptor sites. nightmares DERM: Rashes. PO: 2-3 days serum lipoprotein,
Ventricular Arrhythmias Maintenance of CV: ARRHYTHMIAS, BRADYCARDIA, potassium,
normal sinus Therapeutic Effecs: HF, PULMONARY EDEMA, orthostatic Duration: triglyceride, and uric
PO: (Adults) 80 mg twice rhythm in Suppression of hypotension, peripheral vasoconstriction PO: 8-12 hrs acid levels.
daily; may be gradually ↑ patients with arrhythmias EENT: blurred vision, dry eyes, nasal •May cause
(usual maintenance dose is highly stuffiness increased ANA
160–320 mg/day in 2–3 divided symptomatic GI: constipation, diarrhea, nausea titers.
atrial GU: erectile dysfunction, ↓ libido
doses; some patients may fibrillation/atrial Nursing interventions: •May cause increase
require up to 480–640 mg/day). flutter (AF/AFL) Monitor ECG prior to and periodically in blood glucose
who are currently during therapy. May cause life- levels
Renal Impairment in sinus rhythm. threatening ventricular tachycardia
PO: (Adults) CCr 30–59 associated with QT interval prolongation.
mL/min– initial dose of 80 mg, Do not initiate sotalol therapy if baseline
with subsequent doses given q QTc is longer than 450 ms. If QT interval
becomes ≥500 ms, reduce dose, prolong
24 hr; CCr 10 –29 mL/min–
duration of infusion, or discontinue
initial dose of 80 mg, with therapy.
subsequent doses given q 36– •Monitor BP and pulse frequently during
48 hr. dose adjustment period and periodically
during therapy. Assess for orthostatic
Atrial Fibrillation/Atrial hypotension when assisting patient up
Flutter from supine position
Monitor intake and output ratios and
PO: (Adults) 80 mg twice daily weight. Assess patient routinely for
daily, may be ↑ during careful evidence of fluid overload (peripheral
monitoring to 120 mg twice edema, dyspnea, rales/crackles, fatigue,
daily if necessary. weight gain, jugular venous distention).
Monitor patients receiving beta blockers
Renal Impairment for signs of overdose (bradycardia,
PO: (Adults) CCr 40–60 severe dizziness or fainting, severe
mL/min– Administer q 24 hr. drowsiness, dyspnea, bluish fingernails
or palms, seizures). Notify health care
professional immediately if these signs
occur.
•Glucagon has been used to treat
bradycardia and hypotension.
PO: Take apical pulse prior to
administering. If <50 bpm or if arrhythmia
occurs, withhold medication and notify
health care professional.
◦Administer on an empty stomach, 1 hr
before or 2 hr after meals. Administration
with food, especially milk or milk
products, reduces absorption by
approximately 20%.
•Instruct patient to take medication as
directed, at the same time each day,
up on missed doses. Abrupt withdrawal
may precipitate life-threatening

arrhythmias, hypertension, or myocardial
ischemia
Contraindicated in: Hypersensitivity;

Uncompensated HF; Pulmonary edema;
Asthma; Cardiogenic shock; Congenital
or acquired long QT syndromes; Sinus
bradycardia, 2nd- and 3rd-degree AV
block (unless a functioning pacemaker is
present); CCr <40 mL/min in patients
who are being treated with Betapace AF
Norvasc Management of Inhibits the transport of CV: peripheral edema, angina, Onset: Total serum calcium
Amlodipine hypertension, calcium into myocardial bradycardia, hypotension, palpitations PO: u/k concentrations are
antihypertensives angina pectoris, and vascular smooth CNS: dizziness, fatigue not affected by
calcium channel blockers and vasospastic muscle cells, resulting in GI: nausea, gingival hyperplasia Peak: calcium channel
(Prinzmetal's) inhibition of excitation- Derm: flushing PO: 6-9 hrs blockers.
PO: (Adults) 5–10 mg once angina. contraction coupling and Nursing interventions:
daily; antihypertensive in fragile subsequent contraction. •Monitor BP and pulse before therapy, Duration: Check for liver
or small patients or patients Therapeutic Effects: during dose titration, and periodically PO: 24 hrs function before
already receiving other •Systemic vasodilation during therapy administering med.
antihypertensives– initiate at resulting in decreased BP. Angina: Assess location, duration,
2.5 mg/day, ↑ as •Coronary vasodilation intensity, and precipitating factors of
required/tolerated (up to 10 resulting in decreased patient's anginal pain.
mg/day) as an antihypertensive frequency and severity of •Advise patient to take medication as
therapy with 2.5 mg/day in attacks of angina. directed, even if feeling well.
patients with hepatic ◦May cause drowsiness or dizziness.
insufficiency. Advise patient to avoid driving or other
activities requiring alertness until
Hepatic Impairment response to the medication is known
PO: (Adults)
Antihypertensive– Initiate Contraindicated in: Hypersensitivity;
therapy at 2.5 mg/day, ↑ as Systolic BP <90 mm Hg.
required/tolerated (up to 10
mg/day); antianginal– initiate
therapy at 5 mg/day, ↑ as
required/tolerated (up to 10
mg/day).
Cardizem CD •Hypertension. Inhibits transport of Onset: Total serum calcium

diltiazem •Angina pectoris calcium into myocardial CNS: abnormal dreams, anxiety, PO:30 mins concentrations are
antianginals; antiarrhythmics and vasospastic and vascular smooth confusion, dizziness, drowsiness, PO-SR:u/k not affected by
calcium channels blockers (Prinzmetal's) muscle cells, resulting in headache, nervousness, psychiatric PO-CD, XR, calcium channel
angina. inhibition of excitation- disturbances, weakness LA: u/k blockers.
DO NOT CRUSH •Supraventricular contraction coupling and EENT: blurred vision, disturbed IV: 2-5 mins •Monitor serum
tachyarrhythmias subsequent contraction. equilibrium, epistaxis, tinnitus potassium
and rapid Peak: periodically.
Resp: cough, dyspnea
PO: (Adults) 30–120 mg 3–4 ventricular rates Therapeutic Effects: PO: 2-3 hrs Hypokalemia ↑ the
times daily or 60–120 mg twice in atrial flutter or •Systemic vasodilation CV: ARRHYTHMIAS, HF, peripheral PO-SR: u/k risk of arrhythmias
daily as SR capsules or 180– fibrillation resulting in decreased BP. edema, bradycardia, chest pain, PO-CD, XR, and should be
240 mg once daily as CD or •Coronary vasodilation hypotension, palpitations, syncope, LA: 14 days corrected.
XR capsules or LA tablets (up resulting in decreased tachyiacard IV: 2-4 hrs •Monitor renal and
frequency and severity of Derm: STEVENS-JOHNSON hepatic functions
to 360 mg/day); Concurrent
attacks of angina. SYNDROME, dermatitis, erythema periodically during
simvastatin therapy– Diltiazem
•Reduction of ventricular multiforme, flushing, sweating, Duration: long-term therapy.
dose should not exceed 240 rate in atrial fibrillation or photosensitivity, pruritus/urticaria, rash. PO: 6-8 hrs May cause ↑ in
mg/day and simvastatin dose flutter Assess for rash periodically during PO-SR: 12 hrs hepatic enzymes
should not exceed 10 mg/day. therapy. PO-CD, XR, after several days of
Endo: gynecomastia, hyperglycemia LA: up to 24 therapy
IV: (Adults) 0.25 mg/kg; may Hemat: anemia, leukopenia, hrs
repeat in 15 min with a dose of thrombocytopenia IV: u/k
0.35 mg/kg. May follow with Metabolic: weight gain
continuous infusion at 10 mg/hr MS: joint stiffness, muscle cramps
(range 5–15 mg/hr) for up to 24 GU: dysuria, nocturia, polyuria, sexual
hr. dysfunction, urinary frequency
Nursing interventions:
•Monitor BP and pulse prior to therapy,
during dose titration, and periodically
during therapy.
daily weight. Assess for signs of HF
(peripheral edema, rales/crackles,
dyspnea, weight gain, jugular venous
distention
Arrhythmias: Monitor ECG continuously
during administration. Report
bradycardia or prolonged hypotension
promptly. Emergency equipment and
medication should be available. Monitor
BP and pulse before and frequently

during administration
◦Advise patient to contact health care
professional if chest pain does not
improve, worsens after therapy, or
occurs with diaphoresis; if shortness of
breath occurs; or if severe, persistent
headache occurs.
Cardene Management of: I bits the transport of Onset: Total serum Ca

Nicardipine •Hypertension, calcium into myocardial CNS: abnormal dreams, anxiety, PO: 20 mins concentrations are
•Angina pectoris, and vascular smooth confusion, dizziness, drowsiness, PO-ER: u/k not affected by
antianginals, antihypertensives •Vasospastic muscle cells, resulting in headache, jitteriness, nervousness, IV: u/k calcium channel
(Prinzmetal's) inhibition of excitation- psychiatric disturbances, weakness blockers.
Calcium channel blockers angina contraction coupling and EENT: blurred vision, disturbed Peak: •Monitor serum K
subsequent contraction. equilibrium, epistaxis, tinnitus PO:0.5- 2 periodically.
hours Hypokalemia ↑ risk
PO: (Adults) 20 mg 3 times Resp: cough, dyspnea, shortness of
Therapeutic Effects: PO-ER: u/k of arrhythmias;
daily, may ↑ q 3 days (range •Systemic vasodilation breath IV: 45 mins •Monitor renal and
resulting in decreased BP. CV: ARRHYTHMIAS, HF, peripheral hepatic functions
20–40 mg 3 times daily); or 30
nhi•Coronary vasodilation edema, bradycardia, chest pain, Duration: periodically during
mg twice daily as sustained- hypotension, palpitations, syncope,
release form (up to 60 mg resulting in decreased PO: 8 hrs long-term therapy.
frequency and severity of tachycardia PO-ER: 12 hrs Several days of
twice daily). Derm: dermatitis, erythema multiforme,
attacks of angina IV: 50 hrs therapy may cause ↑
flushing, ↑ sweating, photosensitivity, hepatic enzymes,
IV: (Adults) Substitute for PO pruritus/urticaria, rash which return to
nicardipine– if PO dose is 20 STEVENS-JOHNSON SYNDROME, normal upon
mg q 8 hr, then infusion rate is gingival hyperplasia discontinuation of
0.5 mg/hr; if PO dose is 30 mg Nursing interventions: therapy.
q 8 hr, then infusion rate is 1.2 Monitor BP and pulse prior to therapy,
mg/hr; if PO dose is 40 mg q 8 during dose titration, and periodically
hr, then infusion rate is 2.2 throughout
mg/hr. Patients not receiving Assess for rash periodically during
therapy. May cause Stevens-Johnson
PO nicardipine– initiate therapy
syndrome
at 5 mg/hr, may be increased PO: May be administered without regard
by 2.5 mg q 5–15 min as to meals. May be administered with
needed (up to 15 mg/hr). meals if GI irritation becomes a problem.
•Advise patient to take medication
exactly as directed, even if feeling well.
Take missed doses as soon as possible
unless almost time for next dose; do not
double doses. May need to be

discontinued gradually.
◦Instruct patient and family in proper
technique for monitoring BP
◦Advise patient to contact health care
professional if chest pain does not
improve, worsens after therapy, or
occurs with diaphoresis; if shortness of
breath; or if persistent headache occurs.

Sick sinus syndrome; 2nd- or 3rd-degree
AV block (unless an artificial pacemaker
is in place); SBP <90 mm Hg; Advanced
aortic stenosis.
Procardia XL Management of: Inhibits calcium transport Onset: Total serum Ca

nifedipine •Hypertension into myocardial and GI: ↑ liver enzymes, anorexia, PO: 20 mins concentrations are
(extended- vascular smooth muscle constipation, diarrhea, dry mouth, PO-PA: u//k not affected by
antianginals, release only), cells, resulting in inhibition dysgeusia, dyspepsia, GI obstruction, PO-CC, PA, calcium channel
Antihypertensive •Angina pectoris, of excitation-contraction nausea, ulcer, vomiting XL: u/k blockers.
•Vasospastic coupling and subsequent GU: dysuria, nocturia, polyuria, sexual •Monitor serum K
Calcium channel blockers (Prinzmetal's) contraction. dysfunction, urinary frequency Peak: periodically.
angina Therapeutic Effects: PO: u/k Hypokalemia
Derm: flushing, dermatitis, erythema
PO: (Adults) 10–30 mg 3 Unlabeled •Systemic vasodilation, PO-PA: 4 hrs increases risk of
times daily (not to exceed 180 Use(s): resulting in decreased BP. multiforme, ↑ sweating, photosensitivity, PO-CC, PA, arrhythmias
mg/day), or 10–20 mg twice •Prevention of •Coronary vasodilation, pruritus/urticaria, rash XL: 6 hrs •Monitor renal and
daily as immediate-release migraine resulting in decreased CV: ARRHYTHMIAS, HF, peripheral hepatic functions
form, or 30–90 mg once daily headache. frequency and severity of edema, bradycardia, chest pain, periodically during
as sustained-release (CC, XL) •Management of attacks of angina. hypotension, palpitations, syncope, long-term therapy
form (not to exceed 90–120 HF or tachycardia Duration:
mg/day). cardiomyopathy Hemat: anemia, leukopenia, PO: 6-8 hrs
thrombocytopenia PO-PA: 12 hrs
CNS: headache, abnormal dreams, PO-CC, PA,
anxiety, confusion, dizziness, XL: 24 hrs
drowsiness, jitteriness, nervousness
Resp: cough, dyspnea, shortness of
breath
STEVENS-JOHNSON SYNDROME,
gingival hyperplasia
Nursing interventions:
•Monitor BP and pulse before therapy,

during dose titration, and periodically
during therapy. Monitor ECG
periodically during prolonged therapy.◦
daily weight. Assess for signs of HF
(peripheral edema, rales/crackles,
dyspnea, weight gain, jugular venous
distention
Assess for rash periodically during
therapy. May cause Stevens-Johnson
syndrome.

is in place); Systolic BP <90 mm Hg;
Coadministration with grapefruit juice,
rifampin, rifabutin, phenobarbital,
phenytoin, carbamazepine, or St. John's
wort.
Calan SR •Management of •Inhibits the transport of CNS: abnormal dreams, anxiety, Onset: Total serum Ca
verapamil hypertension, calcium into myocardial confusion, dizziness/lightheadedness, PO: 1-2 hrs concentrations are
angina pectoris, and vascular smooth drowsiness, extrapyramidal reactions PO-ER: u/k not affected by
Antianginals, antiarrhythmics, and/or muscle cells, resulting in CV: ARRHYTHMIAS, HF, bradycardia, IV: 1-5 mins calcium channel
antihypertenesives, cvascular vasospastic inhibition of excitation- chest pain, hypotension, palpitations, blockers.
headache suppressant (Prinzmetal's) contraction coupling and peripheral edema, syncope, tachycardia Peak: •Monitor serum K
angina. subsequent contraction. Derm: STEVENS-JOHNSON PO: 30-90 mins periodically.
Calcium channel blockers •Management of •Decreases SA and AV SYNDROME, dermatitis, erythema PO-ER: 5-7 hrs Hypokalemia ↑ risk
supraventricular conduction and prolongs multiforme, flushing, photosensitivity, IV: 3-5 mins of arrhythmias
arrhythmias and AV node refractory period pruritus/urticaria, rash, sweating •Monitor renal and
PO: (Adults) 80–120 mg 3 rapid ventricular in conduction tissue. Resp: cough, dyspnea, shortness of Duration: hepatic functions
times daily, ↑ as needed. rates in atrial Therapeutic Effect(s): breath PO: 3-7 hrs periodically during
Patients with hepatic flutter or •Systemic vasodilation EENT: blurred vision, disturbed PO-ER: 24hrs long-term therapy.
impairment or geriatric fibrillation. resulting in decreased BP. equilibrium, epistaxis, tinnitus IV: 2 hrs May cause ↑ hepatic
patients– 40 mg 3 times daily •Coronary vasodilation GI: ↑ liver enzymes, anorexia, enzymes after
initially. Extended-release resulting in decreased constipation, diarrhea, dry mouth, several days of
preparations– 120–240 mg/day frequency and severity of dysgeusia, dyspepsia, nausea, vomiting therapy, which
as a single dose; may be ↑ as attacks of angina. GU: dysuria, nocturia, polyuria, sexual return to normal on
needed (range 240–480 dysfunction, urinary frequency discontinuation of
mg/day). therapy.
Nursing interventions
IV: (Adults) 5–10 mg (75–150 •Monitor BP and pulse before therapy,
mcg/kg); may repeat with 10 during dosage titration, and periodically
mg (150 mcg/kg) after 15–30 throughout therapy.
min. Monitor ECG periodically during
prolonged therapy. Verapamil may cause
prolonged PR interval.
Assess for rash periodically during
therapy
Arrhythmias: Monitor ECG continuously
during administration. Notify health care
professional promptly if bradycardia or
prolonged hypotension occurs.
Emergency equipment and medication
should be available. Monitor BP and
pulse before and frequently during
administration.

is in place); Systolic BP <90 mm Hg; HF,
severe ventricular dysfunction, or
cardiogenic shock, unless associated
with supraventricular tachyarrhythmias;
Concurrent IV beta blocker therapy
Captopril (Capoten) •Alone or with Angiotensin-converting Derm: ANGIOEDEMA, rash, pruritis Onset: Monitor renal
other agents in enzyme (ACE) inhibitors Hemat: AGRANULOCYTOSIS, PO: 15-60 mins function. May cause
antihypertensives the management block the conversion of neutropenia ↑ BUN and serum
of hypertension. angiotensin I to the Resp: cough Peak: creatinine.
ace inhibitors • Management of vasoconstrictor angiotensin CV: hypotension, chest pain, PO: 60-90 mins •May cause
heart failure. II. ACE inhibitors also palpitations, tachycardia hyperkalemia
Hypertension •Reduction of risk prevent the degradation of GI: taste disturbances, abdominal pain, Duration: •May cause positive
PO: (Adults and of death, heart bradykinin and other anorexia, constipation, diarrhea, nausea, PO: 6- 12hrs antinuclear antibody
Adolescents): 12.5–25 mg 2– failure-related vasodilatory vomiting (ANA) titer.
3 times daily, may be ↑ at 1–2 hospitalizations, prostaglandins. ACE GU: proteinuria, impaired renal function • Monitor CBC with
wk intervals up to 150 mg 3 and development inhibitors also ↑ plasma Derm: ANGIOEDEMA, rash, pruritis differential prior to
times daily (initiate therapy with of overt heart renin levels and ↓ Hemat: AGRANULOCYTOSIS, initiation of therapy,
failure following aldosterone levels. Net neutropenia every 2 wk for the
6.25–12.5 mg 2–3 times daily
myocardial result is systemic Nursing implications: first 3 mo, and
in patients receiving diuretics). infarction. vasodilation. periodically for up to
•Treatment of Therapeutic Effects: Monitor BP and pulse frequently during 1 yr in patients at

Heart Failure diabetic •Lowering of BP in patients initial dose adjustment and periodically risk for neutropenia
PO: (Adults) 25 mg 3 times nephropathy in with hypertension. during therapy (patients with renal
daily (6.25–12.5 mg 3 times patients with •Improved survival and Assess patient for signs of angioedema impairment, or
daily in patients who have been Type 1 diabetes reduced symptoms in (dyspnea, facial swelling) collagen-vascular
vigorously diuresed); titrated up mellitus and patients with heart failure. Persistent dry cough may occur and may disease) or at first
to target dose of 50 mg 3 times retinopathy. •Improved survival and not subside until medication is sign of infection.
reduced development of discontinued. Consult health care Discontinue therapy
daily (max dose = 450 mg/day).
overt heart failure after professional if cough becomes if neutrophil count is
Left Ventricular Dysfunction myocardial infarction. bothersome. Also notify health care <1000/mm3 .
•Decreased progression of professional if nausea, vomiting, or
Post-MI
diabetic nephropathy with diarrhea occurs and continues.
PO: (Adults) 6.25-mg test decreased need for
dose, followed by 12.5 mg 3 transplantation or dialysis. Contraindicated in: Hypersensitivity;
times daily, may be ↑ up to 50 History of angioedema with previous use
mg 3 times daily. of ACE inhibitors; Concurrent use with
aliskiren in patients with diabetes or
Diabetic NephropathyPO:
moderate-to-severe renal impairment
(Adults) 25 mg 3 times daily.
(CCr <60 mL/min); OB: Can cause injury
Renal Impairment or death of fetus – if pregnancy occurs,
PO: (Adults) ClCr 10–50 discontinue immediately; Lactation:
mL/min: Administer 75% of Discontinue drug or use formula.
dose; ClCr <10 mL/min:
Administer 50% of dose.
Lisinopril •Alone or with Angiotensin-converting CNS: dizziness, fatigue, headache, Onset: Monitor renal
Prinvil other agents in enzyme (ACE) inhibitors weakness PO: 1 hr function. May cause
the management block the conversion of CV: hypotension, chest pain increase in BUN and
antihypertensives of hypertension. angiotensin I to the GI: abdominal pain, diarrhea, nausea, Peak: serum creatinine.
• Management of vasoconstrictor angiotensin vomiting PO: 6 hrs •May cause
ace inhibitors heart failure. II. ACE inhibitors also GU: erectile dysfunction, impaired renal hyperkalemia.
•Reduction of risk prevent the degradation of function Duration: •Monitor CBC
of death or bradykinin and other Derm: rashes PO: 24 hrs periodically during
Hypertension development of vasodilatory F and E: hyperkalemia therapy in patients
PO: (Adults) 10 mg once daily, heart failure after prostaglandins. ACE Misc: ANGIOEDEMA with collagen
can be ↑ up to 20–40 mg/day myocardial inhibitors also ↑ plasma Nursing interventions: vascular disease
infarction renin levels and ↓ and/or renal
(initiate therapy at 5 mg/day in aldosterone levels. Net Hypertension: Monitor BP and pulse disease. May rarely
patients receiving diuretics). result is systemic frequently during initial dose adjustment cause slight ↓ in
vasodilation. and periodically during therapy. hemoglobin and
Renal Impairment Therapeutic Effects: Assess patient for signs of angioedema hematocrit and
PO: (Adults) CCr 10–30 •Increased survival and (dyspnea, facial swelling). agranulocytosis.
mL/min– Initiate therapy at 5 decreased symptoms in Heart Failure: Monitor weight and assess •May cause ↑ AST,
mg daily; may be slowly titrated patients with heart failure. patient routinely for resolution of fluid ALT, alkaline
•Increased survival after overload (peripheral edema, phosphatase, and
up to 40 mg/day.CCr < 10
myocardial infarction. rales/crackles, dyspnea, weight gain, serum bilirubin.
mL/min– Initiate therapy at 2.5 jugular venous distention
mg once daily; may be slowly
titrated up to 40 mg/day. Contraindicated in: Hypersensitivity;
History of angioedema with previous use
Heart Failure of ACE inhibitors; Concurrent use with
PO: (Adults) 5 mg once daily, aliskiren in patients with diabetes or
may be titrated every 2 wk up moderate-to-severe renal impairment
to 40 mg/day; initiate therapy at (CCr <60 mL/min); OB: Can cause injury
2.5 mg once daily in patients or death of fetus – if pregnancy occurs,
with hyponatremia (serum discontinue immediately; Lactation:
sodium <130 mEq/L). Discontinue drug or use formula.
Renal Impairment
(Adults) CCr ≤30 mL/min–
Initiate therapy at 2.5 mg once
daily.
Acute Myocardial Infarction

PO: (Adults) 5 mg once daily
for 2 days, then 10 mg daily.
Renal Impairment
PO: (Adults) Initiate with
caution in patients with serum
creatinine >2 mg/dL.
Vasotec •Alone or with Angiotensin-converting CNS: dizziness, fatigue, headache, Onset: Monitor renal
enalapril other agents in enzyme (ACE) inhibitors vertigo, weakness Enalapril PO: 1 function. May cause
block the conversion of Resp: cough, dyspnea hr
antihypertensives the management angiotensin I to the CV: hypotension, chest pain Enalaprilat IV: ↑ in BUN and serum
ace inhibitors of hypertension. vasoconstrictor angiotensin GI: abdominal pain, diarrhea, nausea, 15 mins creatinine.
•Management of II. ACE inhibitors also vomiting •May cause
Hypertension symptomatic prevent the degradation of GU: proteinuria, impaired renal function Peak: hyperkalemia.
PO: (Adults) 2.5–5 mg once heart failure. bradykinin and other Derm: rashes Enalapril PO: •Monitor CBC
daily, ↑ as required up to 40 •Slowed vasodilatory F and E: hyperkalemia 4-8 hr periodically during
mg/day in 1–2 divided doses progression of prostaglandins. ACE Misc: ANGIOEDEMA Enalaprilat IV: therapy in patients
(initiate therapy at 2.5 mg once asymptomatic left inhibitors also ↑ plasma Nursing implications 1-4 hr with collagen
daily in patients receiving ventricular renin levels and ↓ Monitor BP and pulse frequently during vascular disease
dysfunction to aldosterone levels. Net initial dose adjustment and periodically Duration: and/or renal
diuretics).
overt heart result is systemic during therapy. Notify health care Enalapril PO: disease. May rarely
IV: (Adults) 0.625–1.25 mg failure. vasodilation. professional of significant changes 12-24 hr cause slight ↓
(0.625 mg if receiving diuretics) Therapeutic Effects: Assess patient for signs of angioedema Enalaprilat IV: hemoglobin and
every 6 hr; can be titrated up to •Lowering of BP in patients (swelling of face, extremities, eyes, lips, 4-6 hr hematocrit and
5 mg every 6 hr. with hypertension. or tongue, or difficulty in swallowing or agranulocytosis.
•Increased survival and breathing). •May cause ↑ AST,
Renal Impairment reduction of symptoms in Monitor weight and assess patient ALT, alkaline
PO: IV: (Adults) CCr 10–50 patients with symptomatic routinely for resolution of fluid overload phosphatase, and
mL/min– 75% of dose; CCr <10 heart failure. (peripheral edema, rales/crackles, serum bilirubin
mL/min– 50% of dose. •Decreased development dyspnea, weight gain, jugular venous
of overt heart failure. distention).
Heart Failure Instruct patient to notify health care
PO: (Adults) 2.5 mg 1–2 times professional if rash; mouth sores; sore
daily, titrated up to target dose throat; fever; swelling of hands or feet;
of 10 mg twice daily; initiate irregular heart beat; chest pain; dry
cough; hoarseness; swelling of face,
therapy at 2.5 mg once daily in
eyes, lips, or tongue; or if difficulty
patients with hyponatremia
swallowing or breathing occurs.
(serum sodium <130 mEq/L). Persistent dry cough may occur and may
not subside until medication is
Asymptomatic Left
discontinued.
Ventricular Dysfunction
PO: (Adults) 2.5 mg twice Contraindicated in: Hypersensitivity;
daily, titrated upward to a History of angioedema (either idiopathic
target dose of 10 mg twice or with previous use of ACE inhibitors);
daily. Concurrent use with aliskiren in patients
with diabetes or moderate-to-severe
renal impairment (CCr <60 mL/min); OB:
Can cause injury or death of fetus – if
pregnancy occurs, discontinue
immediately; Lactation: Discontinue

drug or use formula
Plavix Reduction of Inhibits platelet Onset: Monitor bleeding

clopidogrel atherosclerotic aggregation by irreversibly CNS: depression, dizziness, fatigue, PO: within 24 time during therapy.
events (MI, inhibiting the binding of headache EENT: epistaxis Resp: cough, hrs Prolonged bleeding
antiplatelet agent stroke, vascular ATP to platelet receptors. dyspnea, eosinophilic pneumonia CV: time, which is time-
death) in patients chest pain, edema, hypertension Peak: and dose-
Platelet aggregation inhibitors at risk for such Therapeutic Effects: GI: GI BLEEDING, abdominal pain, PO: 3-7 days dependent, is
events including diarrhea, dyspepsia, gastritis expected.
recent MI, acute Decreased occurrence of Derm: DRUG RASH WITH Duration: Monitor CBC with
Recent MI, Stroke, or coronary atherosclerotic events in EOSINOPHILIA AND SYSTEMIC PO: 5 days differential and
Peripheral Vascular Disease syndrome patients at risk. SYMPTOMS, pruritus, purpura, rash platelet count
(unstable Hemat: BLEEDING, NEUTROPENIA, periodically during
PO: (Adults) 75 mg once daily. angina/non–Q- THROMBOTIC THROMBOCYTOPENIC therapy.
wave MI), stroke, PURPURA Neutropenia and
Acute Coronary Syndrome or peripheral thrombocytopenia
vascular disease. Nursing interventions: may rarely occur
PO: (Adults) 300 mg initially,
Monitor patient for signs of thrombotic
then 75 mg once daily; aspirin thrombocytic purpura (thrombocytopenia,
75–325 mg once daily should be microangiopathic hemolytic anemia,
given concurrently. neurologic findings, renal dysfunction,
fever)

Pathologic bleeding (peptic ulcer,
intracranial hemorrhage); Concurrent
use of omeprazole or esomeprazole;
Impaired CYP2C19 function due to
genetic variation; Lactation: Lactation.
Coumadin •Prophylaxis and Interferes with hepatic GI: cramps, nausea Onset: Monitor PT, INR
warfarin treatment synthesis of vitamin K- Derm: dermal necrosis PO, IV: 36-72
High Alert Medication: of:◦Venous dependent clotting factors Hemat: BLEEDING hr Monitor stool and
significant patient harm when it thrombosis, (II, VII, IX, and X). Ingestion of large quantities of foods high urine for occult blood
is used in error ◦Pulmonary in vitamin K content (see list in food Peak: before and
embolism, sources for specific nutrients) may PO, IV: 5-7 periodically during
Anticoagulant antagonize the anticoagulant effect of days therapy
warfarin. Toxicity Overdose:
coumarins ◦Atrial fibrillation Nursing interventions: Duration: antidote is vitamin K

with Assess for signs of bleeding and PO, IV: 2-5
PO: IV: (Adults) 2–5 mg/day for embolization. hemorrhage (bleeding gums; nosebleed; days
2–4 days; then adjust daily dose •Management of unusual bruising; tarry, black stools;
by results of INR. Initiate therapy myocardial hematuria; fall in hematocrit or BP;
with lower doses in geriatric or infarction:◦Decre guaiac-positive stools, urine, or
debilitated patients or in Asian ases risk of nasogastric aspirate).
patients or those with CYP2C9*2 death, High Alert: Medication errors involving
and/or CYP2C9*3 alleles or ◦Decreases risk anticoagulants have resulted in serious
VKORC1 AA genotype. of subsequent harm or death from internal or
MI, intracranial bleeding. Before
◦Decreases risk administering, evaluate recent INR or PT
of future results and have second practitioner
thromboembolic independently check original order
events. Advise patient to report any symptoms of
•Prevention of unusual bleeding or bruising (bleeding
thrombus gums; nosebleed; black, tarry stools;
formation and hematuria; excessive menstrual flow)
embolization and pain, color, or temperature change
after prosthetic to any area of your body to health care
valve placement. professional immediately
Instruct patient not to drink alcohol or
take other Rx, OTC, or herbal products,
especially those containing aspirin or
NSAIDs, or to start or stop any new
medications during warfarin therapy
without advice of health care
professional.
Contraindicated in: Uncontrolled

bleeding; Open wounds; Active ulcer
disease; Recent brain, eye, or spinal cord
injury or surgery; Severe liver or kidney
disease; Uncontrolled hypertension; OB:
Crosses placenta and may cause fatal
hemorrhage in the fetus. May also cause
congenital malformation.
Lovenox •Prevention of Potentiates the inhibitory Side effects/Adverse reactions: Onset: Monitor CBC,
Enoxaparin venous effect of antithrombin on dizziness, headache, insomnia, edema, Subcut: u/k platelet count, and
thromboembolis factor Xa and thrombin. constipation, ↑ liver enzymes, nausea, stools for occult
m (VTE) (deep vomiting, urinary retention, ecchymoses, Peak:
High Alert Medication: vein thrombosis Therapeutic Effect: pruritus, rash, urticarial, hyperkalemia, Subcut: 3-5 hrs blood periodically
significant patient harm when it (DVT) and/or Prevention of thrombus BLEEDING, anemia, eosinophilia, during therapy.
is used in error pulmonary formation thrombocytopenia, erythema at injection Duration: •May cause ↑ in AST
embolism (PE)) site, hematoma, irritation, pain Subcut: 12 hr and ALT levels.
Anticoagulant in surgical or •May cause
medical patients. Nursing Implications: hyperkalemia
Antithrombotics, low molecular •Treatment of Assess for signs of bleeding and
weight heparins DVT with or hemorrhage (bleeding gums; nosebleed;
without PE (with unusual bruising; black, tarry stools;
VTE Prophylaxis warfarin). hematuria; fall in hematocrit or BP;
SC: (Adults) Knee replacement •Prevention of guaiac-positive stools); bleeding from
surgery– 30 mg q 12 hr starting 12– ischemic surgical site. Notify health care
24 hr after surgery for 7–10 days; Hip complications professional if these occur.
replacement– 30 mg q 12 hr starting (with aspirin) SC: Observe injection sites for
12–24 hr postop or 40 mg once daily
from unstable hematomas, ecchymosis, or
angina and non- inflammation.
starting 12 hr before surgery (either
ST-segment- High alert; Unintended concomitant use
dose may be continued for 7–14
elevation MI. of two heparin products (unfractionated
days; continued prophylaxis with 40 •Treatment of heparin and low molecular weight
mg once daily may be continued for acute ST- heparins) has resulted in serious harm
up to 3 wk); Abdominal surgery– 40 segment- and death. Review patients’ recent and
mg once daily starting 2 hr before elevation MI (with current medication administration
surgery and then continued for 7–12 thrombolytics or records before administering any heparin
days or until ambulatory (up to 14 percutaneous product.
days); Medical patients with acute coronary •Advise patient to report any symptoms
illness– 40 mg once daily for 6–14
intervention of unusual bleeding or bruising,
Desired dizziness, itching, rash, fever, swelling,
days.
outcomes; or difficulty breathing to health care
Treatment of DVT/PE
•Prevention of professional immediately.
deep vein •Instruct patient not to take aspirin,
SC: (Adults) Outpatient– 1 mg/kg
thrombosis and naproxen, or ibuprofen without
every 12 hr. Warfarin should be pulmonary consulting health care professional while
started within 72 hr; enoxaparin may embolism. on enoxaparin therapy.
be continued for a minimum of 5 •Resolution of For overdose, protamine sulfate 1 mg for
days and until therapeutic acute deep vein each mg of enoxaparin should be
anticoagulation with warfarin is thrombosis. administered by slow IV injection
achieved (INR >2 for 2 consecutive •Prevention of
days); Inpatient– 1 mg/kg every 12 hr ischemic Contraindicated in: Hypersensitivity;
or 1.5 mg/kg every 24 hr. Warfarin complications Hypersensitivity to benzyl alcohol
should be started within 72 hr;
(with aspirin) in (multidose vial); Positive in vitro test for
patients with antiplatelet antibody in the presence of
enoxaparin may be continued for a
unstable angina enoxaparin; Active, major bleeding.
minimum of 5 days or until
therapeutic anticoagulation with or non-Q-wave

warfarin is achieved (INR >2 for two MI
consecutive days).
Unstable Angina/Non–ST-
Segment-Elevation MI
SC: (Adults) 1 mg/kg q 12 hr for 2–8
days (with aspirin).
ST-Segment-Elevation MI
IV: SC: (Adults <75 yr): Administer
single IV bolus of 30 mg plus 1
mg/kg subcut dose (maximum of 100
mg for first 2 doses only), followed by
1 mg/kg subcut q 12 hr. The usual
duration of treatment is 2–8 days. In
patients undergoing percutaneous
coronary intervention, if last subcut
dose was <8 hr before balloon
inflation, no additional dosing
needed; if last subcut dose was ≥8 hr
before balloon inflation, administer
single IV bolus of 0.3 mg/kg.
SC: (Adults ≥75 yr): 0.75 mg/kg

every 12 hr (no IV bolus needed)
(maximum of 75 mg for first 2 doses
only; no initial bolus). The usual
duration of treatment is 2–8 days.
Renal Impairment
SC: (Adults CCr <30 mL/min): VTE
prophylaxis for abdominal or
knee/hip replacement surgery– 30
mg once daily. Treatment of
DVT/PE– 1 mg/kg once daily.
Unstable angina/non-ST-segment-
elevation MI– 1 mg/kg once daily.
Acute ST-segment-elevation MI
(patients <75 yr)– Single IV bolus of

30 mg plus 1 mg/kg subcut dose,
followed by 1 mg/kg subcut once
daily. Acute ST-segment-elevation MI
(patients ≥75 yr)– 1 mg/kg once daily
(no initial bolus).
Pradaxa To reduce the Acts as a direct inhibitor of GI: abdominal pain, diarrhea, dyspepsia, Onset: Use aPTT or ECT,
dabigatran risk of thrombin. gastritis, nausea PO: within hrs not INR, to assess
ther class: anticoagulants stroke/systemic Hemat: BLEEDING, thrombocytopenia anticoagulant
Pharm class: thrombin embolization Misc: ANGIOEDEMA, Peak: activity, if needed.
inhibiyors associated with HYPERSENSITIVITY REACTIONS PO: u/k •Monitor renal
nonvalvular atrial INCLUDING ANAPHYLAXIS function prior to and
fibrillation Nursing interventions Duration: periodically during
PO: (Adults) 150 mg twice daily. •Assess for symptoms of stroke or PO:2 days therapy. Patients
peripheral vascular disease periodically with renal
Renal Impairment during therapy. impairment may
PO: (Adults) CCr 30–50 mL/min • Assess for symptoms of bleeding and require dose
and taking dronedarone or blood loss; may be fatal. reduction or
systemic ketoconazole– 75 mg Inform patient that they may bleed more discontinuation.
twice daily; CCr 15–30 mL/min– easily or longer than usual. Advise
75 mg twice daily; CCr 15–30 patient to notify health care professional
immediately if signs of bleeding (unusual
mL/min and taking P-gp
bruising; pink or brown urine; red or
inhibitor– Avoid concomitant use;
black, tarry stools; coughing up blood;
CCr <15 mL/min– Not vomiting blood; pain or swelling in a joint;
recommended. headache; dizziness; weakness.

Active pathological bleeding; Concurrent
use of P-glycoprotein (P-gp) inducers;
Prosthetic heart valves (mechanical or
bioprosthetic)
Ancef •Treatment of the Binds to bacterial cell wall CNS: SEIZURES (HIGH DOSES) Onset: •May cause ↑ serum
cafazolin following membrane, causing cell GI: PSEUDOMEMBRANOUS COLITIS, IM: rapid AST, ALT, alkaline
infections due to death. diarrhea, nausea, vomiting, cramps IV: rapid phosphatase,
anti-infectives susceptible Therapeutic Effect(s): Derm: STEVENS-JOHNSON bilirubin, LDH, BUN,
organisms: ◦Skin Bactericidal action against SYNDROME, rash, pruritis, urticaria Peak: and creatinine.
first generation cephalosporins and skin susceptible bacteria. IM: 0.5-2 hrs
structure Spectrum: •Active against Hemat: leukopenia, neutropenia, IV: 5 mins •May rarely cause
IM: IV: (Adults) Moderate-to- infections many gram-positive cocci thrombocytopenia leukopenia,
severe infections– 500 mg-2 g (including burn including: ◦Streptococcus Local: pain at IM site, phlebitis at IV site Duration: neutropenia,
every 6–8 hr; maximum 12 wounds), pneumoniae, Misc: allergic reactions including IM: 6-12 hrs thrombocytopenia,
g/day. Mild infections with Gram- ◦Pneumonia, ◦Group A beta-hemolytic anaphylaxis and serum sickness, IV: 6-12 hrs and eosinophilia.
positive cocci– 250–500 mg ◦Urinary tract streptococci, superinfection
every 8 hr.Uncomplicated urinary
infections, ◦Penicillinase-producing Nursing implications:
◦Biliary tract staphylococci. Observe patient for signs and symptoms
tract infection– 1 g every 12
infections, •Not active against: of anaphylaxis (rash, pruritus, laryngeal
hr.Pneumococcal pneumonia– ◦Genital ◦Methicillin-resistant edema, wheezing). Discontinue drug and
500 mg every 12 hr.Infective infections, staphylococci, notify health care professional
endocarditis or septicemia– 1– ◦Bone and joint ◦Bacteroides fragilis, immediately if these problems occur.
1.5 g every 6 hr.Perioperative infections, ◦Enterococcus. Keep epinephrine, an antihistamine, and
prophylaxis– 1 g within 30–60 ◦Septicemia, • Active against some resuscitation equipment close by in case
min prior to incision (an ◦Bacterial gram-negative rods of an anaphylactic reaction.
additional 500 mg–1 g should be endocarditis including: ◦Proteus Monitor bowel function. Diarrhea,
given for surgeries ≥ 2 hr). 500 prophylaxis for mirabilis, abdominal cramping, fever, and bloody
mg-1 g should then be given for dental and upper ◦Escherichia coli. stools should be reported to health care
respiratory professional promptly as a sign of
all surgeries every 6–8 hr for 24
procedures. pseudomembranous colitis
hr following the surgery. •Perioperative Assess patient for skin rash frequently
prophylaxis. during therapy. Discontinue at first sign
Renal Impairment
•Not suitable for of rash; may be life-threatening.
IM: IV: (Adults) CCr 10–30 the treatment of Stevens-Johnson syndrome may
mL/min– Administer dose every meningitis. develop
12 hr; CCr ≤10 mL/min–
Administer every 24 hr. Contraindicated in: Hypersensitivity to
cephalosporins; Serious hypersensitivity to
penicillins.
Zosyn •Appendicitis and Piperacillin: Binds to CNS: SEIZURES (HIGHER DOSES), Onset: Evaluate renal and
piperacillin-tazobactam peritonitis. bacterial cell wall confusion, dizziness, headache, IV: rapid hepatic function,
•Skin and skin membrane, causing cell insomnia, lethargy CBC, serum
anti-infectives structure death. Spectrum is GI: PSEUDOMEMBRANOUS COLITIS, Peak: potassium, and
infections. extended compared with diarrhea, constipation, drug-induced IV: end of bleeding times prior
extended spectrum penicillins •Gynecologic other penicillins. hepatitis, nausea, vomiting infusion to and routinely
infections. •Tazobactam: Inhibits GU: interstitial nephritis during therapy
•Community- beta-lactamase, an Derm: STEVENS-JOHNSON Duration: •May cause ↑ BUN,
Contains 2.79 mEq (64 mg) acquired and enzyme that can destroy SYNDROME, TOXIC EPIDERMAL IV: 4-6 hrs creatinine, AST,
sodium/g of piperacillin; adult nosocomial penicillins. NECROLYSIS, rashes (↑ in cystic ALT, serum bilirubin,
doses below expressed as pneumonia fibrosis patients), urticaria alkaline
caused by Therapeutic Effects:
combined piperacillin- Death of susceptible Hemat: bleeding, leukopenia, phosphatase LDH.,

piperacillin/tazobactam content resistant, beta- bacteria. neutropenia, thrombocytopenia and
lactamase– Spectrum: Active against Local: pain, phlebitis at IV site •May cause
IV: (Adults) Most infections– producing piperacillin-resistant, beta- Misc: HYPERSENSITIVITY leukopenia and
3.375 g q 6 hr. Nosocomial bacteria. lactamase– REACTIONS, INCLUDING neutropenia,
pneumonia– 4.5 g q 6 hr. producing:•Bacteroides ANAPHYLAXIS AND SERUM especially with
fragilis, SICKNESS, fever (↑ in cystic fibrosis prolonged therapy
IV: (Adults) Nosocomial •E. coli, patients), superinfection •May cause
pneumonia– 4.5 g q 6 hr. •Acinetobacter baumanii, Nursing implications: prolonged
•Klebsiella pneumoniae, •Obtain a history before initiating therapy prothrombin and
IV: (Adults and Children >40 •Pseudomonas to determine previous use of and partial
kg): Appendicitis and/or aeruginosa, reactions to penicillins or cephalosporins. thromboplastin time.
•Staphylococcus aureus, Persons with a negative history of •May cause ↓ H/H
peritonitis– 3.375 g q 6 hr.
•Haemophilus influenzae. penicillin sensitivity may still have an and
Renal Impairment allergic response. thrombocytopenia,
Observe patient for signs and symptoms eosinophilia,
IV: (Adults) CCr 20–40 mL/min–
of anaphylaxis (rash, pruritus, laryngeal leukopenia, and
2.25 g q 6 hr (3.375 g q 6 hr for
edema, wheezing). Discontinue the drug neutropenia.proteinu
nosocomial pneumonia); CCr and notify health care professional ria; hematuria;
<20 mL/min– 2.25 g q 8 hr (2.25 immediately if these occur. pyuria;
g q 6 hr for nosocomial Monitor bowel function. Diarrhea, hyperglycemia; ↓
pneumonia); Hemodialysis– 2.25 abdominal cramping, fever, and bloody total protein or
g q 12 h (2.25 g q 8 hr for stools should be reported to health care albumin; and
nosocomial pneumonia). professional promptly as a sign of abnormalities in Na,
pseudomembranous colitis K, Ca sodium, K, Ca
Assess for skin reactions (rash, fever, levels
edema, mucosal erosions or ulcerations,
red or inflamed eyes). Monitor patient
with mild to moderate rash for
progression
Caution patient to notify health care
professional if fever and diarrhea occur,
especially if stool contains blood, pus, or
mucus. Advise patient not to treat
diarrhea without consulting health care
professional.
Contraindicated in: Hypersensitivity to

penicillins, beta-lactams, cephalosporins,
or tazobactam (cross-sensitivity may
occur).
Zithromax •Treatment of the Inhibits protein synthesis at CNS: dizziness, seizures, drowsiness, Onset: May cause ↑ serum
azithromycin following the level of the 50S fatigue, headache PO: rapid bilirubin, AST, ALT,
infections due to bacterial ribosome. CV: TORSADES DE POINTES, chest IV: rapid LDH, and alkaline
agents for atypical susceptible pain, hypotension, palpitations, QT phosphatase
mycobacterium; organisms:◦Uppe Therapeutic Effects: interval prolongation Peak: concentrations.
anti-infectives r respiratory tract GI: HEPATOTOXICITY, PO: 2.5-3.2hr •May cause ↑
Macrolide infections, Bacteriostatic action PSEUDOMEMBRANOUS COLITIS, IV: end of creatine
including against susceptible abdominal pain, diarrhea, nausea, infusion phosphokinase,
streptococcal bacteria. cholestatic jaundice, ↑ liver enzymes, potassium,
Most Respiratory and Skin pharyngitis, acute Spectrum: •Active against dyspepsia, flatulence, melena, oral Duration: prothrombin time,
Infections bacterial the following gram-positive candidiasis, pyloric stenosis PO: 24 hr BUN, serum
PO: (Adults) 500 mg on 1st day, exacerbations of aerobic GU: nephritis, vaginitis IV: 24hr creatinine, and
then 250 mg/day for 4 more days chronic bronchitis bacteria:◦Staphylococcus Hemat: anemia, leukopenia, blood glucose
(total dose of 1.5 g); Acute and tonsillitis, aureus, thrombocytopenia concentrations.
bacterial sinusitis– 500 mg once ◦Lower ◦Streptococcus Derm: STEVENS-JOHNSON •May occasionally
respiratory tract pneumoniae, SYNDROME, TOXIC EPIDERMAL cause ↓ WBC and
daily for 3 days or single 2-g
infections, ◦S. pyogenes (group A NECROLYSIS, photosensitivity, rash platelet count.
dose of extended-release including strep). EENT: ototoxicity
suspension (Zmax). bronchitis and •Active against these F and E: hyperkalemia
pneumonia, gram-negative aerobic Misc: ANGIOEDEMA
Acute bacterial exacerbations ◦Acute otitis bacteria:◦Haemophilus Nursing implications
of chronic bronchitis media, influenzae, •Assess patient for infection (vital signs;
◦Skin and skin ◦Moraxella catarrhalis, appearance of wound, sputum, urine,
PO: (Adults) 500 mg on 1st day, structure ◦Neisseria gonorrhoeae. and stool; WBC) at beginning of and
then 250 mg/day for 4 more days infections, •Also active throughout therapy.
(total dose of 1.5 g) or 500 mg ◦Nongonococcal against:◦Bordetella Observe for signs and symptoms of
daily for 3 days. urethritis, pertussis anaphylaxis (rash, pruritus, laryngeal
cervicitis, ◦Mycoplasma, edema, wheezing). Notify health care
Community-Acquired gonorrhea, and ◦Legionella, professional immediately if these occur.
Pneumonia chancroid. ◦ Chlamydia pneumoniae, • Assess patient for skin rash frequently
IV: PO: (Adults) More severe– •Prevention of ◦ Ureaplasma urealyticum, during therapy. Discontinue azithromycin
500 mg IV q 24 hr for at least 2 disseminated ◦ Borrelia burgdorferi, at first sign of rash; may be life-
doses, then 500 mg PO q 24 hr Mycobacterium ◦ M. avium. threatening. Stevens-Johnson syndrome
for a total of 7–10 days; less avium complex or toxic epidermal necrolysis may
(MAC) infection •Not active against develop.
severe– 500 mg PO, then 250
in patients with methicillin-resistant S. Y-Site Incompatibility ◦amiodarone
mg/day PO for 4 more days or 2
advanced HIV aureus. ◦amphotericin B colloidal
g single dose as extended- infection. ◦chlorpromazine
release suspension (Zmax). •Extended- ◦diazepam
release ◦doxorubicin
Pelvic Inflammatory Disease suspension ◦epirubicin
(ZMax) Acute ◦midazolam
bacterial sinusitis ◦mitoxantrone

IV: PO: (Adults) 500 mg IV q 24 and community- ◦/dalfopristin
hr for 1–2 days, then 250 mg PO acquired ◦thiopental mycophenolate
q 24 hr for a total of 7 days. pneumonia in ◦nicardipine
adults. ◦pentamidine
Endocarditis Prophylaxis Unlabeled ◦piperacillin-tazobactam
PO: (Adults) 500 mg 1 hr before Use(s): ◦potassium chloride
procedure. •Prevention of ◦quinupristin
bacterial
Urethritis, Cervicitis, endocarditis. Contraindicated in: Hypersensitivity to
Chancroid, Chlamydia •Treatment of azithromycin, erythromycin, or other
PO: (Adults) Single 1-g dose. cystic fibrosis macrolide anti-infectives; History of
lung disease. cholestatic jaundice or hepatic dysfunction
Gonorrhea •Treatment and with prior use of azithromycin; QT interval
PO: (Adults) Single 2-g dose. post-exposure prolongation, hypokalemia,
prophylaxis of
hypomagnesemia, or bradycardia;
Prevention of Disseminated pertussis in
infants. Concurrent use of quinidine, procainamide,
MAC Infection dofetilide, amiodarone, or sotalol.
PO: (Adults) 1.2 g once weekly
(alone or with rifabutin).
vancomycin IV: Treatment of Binds to bacterial cell wall, EENT: ototoxicity Onset:
Vancocin potentially life- resulting in cell death. CV: hypotension IV: rapid
Ther class: ami-infectives threatening GI: nausea, vomiting
infections when Therapeutic Effect(s): GU: nephrotoxicity Peak:
less toxic anti- Derm: rashes IV: end of
Serious Systemic Infections infectives are Bactericidal action against Hemat: eosinophilia, leukopenia infusion
contraindicated. susceptible organisms. Local: phlebitis
IV: (Adults) 500 mg q 6 hr or 1 g Particularly MS: back and neck pain Duration:
q 12 hr (up to 4 g/day). useful in Spectrum: Active against Misc: HYPERSENSITIVITY IV: 12-24 hrs
staphylococcal gram-positive pathogens, REACTIONS INCLUDING
IT: (Adults) 20 mg/day. infections, including:•Staphylococci ANAPHYLAXIS, chills, fever, "red man"
including:◦Endoc (including methicillin- syndrome (with rapid infusion),
Endocarditis Prophylaxis in arditis, resistant strains of superinfection
Penicillin-Allergic Patients meningitis, Staphylococcus aureus), Nursing implications:
osteomyelitis, •Group A beta-hemolytic Observe patient for signs and symptoms
IV: (Adults and Adolescents): pneumonia, streptococci, of anaphylaxis (rash, pruritus, laryngeal
1-g single dose 1-hr septicemia, soft- •Streptococcus edema, wheezing). Discontinue drug and
preprocedure. tissue infections pneumoniae, notify health care professional
in patients who •Corynebacterium, immediately if these problems occur.
Diarrhea Due to C. difficile have allergies to •Clostridium difficile,
penicillin or its •Enterococcus faecalis, •Monitor IV site closely. Vancomycin is

PO: (Adults) 125 mg q 6 hr for derivatives or •Enterococcus faecium irritating to tissues and causes necrosis
10 days. when sensitivity and severe pain with extravasation.
testing Rotate infusion site.
Staphylococcal Enterocolitis demonstrates •Monitor BP throughout IV infusion.
resistance to •Monitor intake and output ratios and
PO: (Adults) 500–2000 mg/day methicillin. daily weight. Cloudy or pink urine may be
in 3–4 divided doses for 7–10 •PO: Treatment a sign of nephrotoxicity.
days. of staphylococcal Y incompatibility: albumun, diazepam,
enterocolitis or furosemide, hepatin, ibuprofen,
Renal Impairment diarrhea due to
IV: (Adults) An initial loading Clostridium
dose of 750 mg–1 g (not less difficile.
than 15 mg/kg); serum level •IV: Part of
monitoring is optimal for endocarditis
prophylaxis in
choosing maintenance dose in
high-risk patients
patients with renal impairment;
who are allergic
these guidelines may be helpful. to penicillin.
CCr 50–80 mL/min– 1 g q 1–3
days; CCr 10–50 mL/min– 1 g q
3–7 days; CCr <10 mL/min– 1 g
q 7–14 days.
Gentamicin •Treatment of Inhibits protein synthesis in CNS: ataxia, vertigo Onset: Monitor renal
serious gram- bacteria at level of 30S EENT: ototoxicity (vestibular and IM: rapid function by
anti-infectives negative bacterial ribosome. cochlear) IV: rapid urinalysis, specific
infections and Therapeutic Effects: GU: nephrotoxicity gravity, BUN,
aminoglycosides infections caused Bactericidal action. MS: muscle paralysis (high parenteral Peak: creatinine, and CCr
by staphylococci Spectrum: •Notable for doses) IM: 30-90 mins before and
when penicillins activity against: Misc: hypersensitivity reactions IV: 15-30 mins throughout therapy.
IM: IV: (Adults) 1–2 mg/kg q 8 or other less toxic ◦Pseudomonas Nursing implications: •May cause ↑ BUN,
hr (up to 6 mg/kg/day in 3 drugs are aeruginosa, •Assess for infection (vital signs, wound Duration: AST, ALT, serum
divided doses); Once-daily contraindicated. ◦Klebsiella pneumoniae, appearance, sputum, urine, stool, WBC) IM: 8-24hrs alkaline
dosing (unlabeled)– 4–7 mg/kg q •In combination ◦Escherichia coli, at beginning of and throughout therapy. IV: 8-24hrs phosphatase,
24 hr. with other agents ◦Proteus, •Obtain specimens for culture and bilirubin, creatinine,
in the ◦Serratia, sensitivity before initiating therapy. and LDH
IT: (Adults) 4–8 mg/day. management of ◦Acinetobacter, monitor for vestibular dysfunction concentrations.
serious ◦Staphylococcus aureus. (vertigo, ataxia, nausea, vomiting).
Topical: (Adults and Children enterococcal •In treatment of •Monitor intake and output and daily
> 1 mo): Apply cream or infections. enterococcal infections, weight to assess hydration status and
ointment 3–4 times daily. •Prevention of synergy with a penicillin is renal function
infective required. •Instruct patient to report signs of
Renal Impairment endocarditis. •Not active against: : hypersensitivity, tinnitus, vertigo, hearing
IM: IV: (Adults) Initial dose of 2 •Topical: Ophth: ◦Streptococci , loss, rash, dizziness, or difficulty
Treatment of ◦Anaerobes. urinating.
mg/kg. Subsequent
localized
doses/intervals dependent on
infections due to
blood level monitoring and renal susceptible Contraindicated in: Hypersensitivity to
function assessment. organisms. gentamicin or other aminoglycosides; Most
parenteral products contain bisulfites and
should be avoided in patients with known
intolerance; Pedi: Products containing
benzyl alcohol should be avoided in
neonates.
Flagyl PO: IV: Disrupts DNA and protein CNS: SEIZURES, dizziness, headache, Onset: May alter results of
metronidazole Treatment of the synthesis in susceptible aseptic meningitis (IV), encephalopathy PO: rapid serum AST, ALT,
inti-infectives, anyiprotozoals following organisms. (IV) PO-ER: rapid and LDH tests.
anaerobic EENT: optic neuropathy, tearing (topical IV: rapid
PO: (Adults) Anaerobic infections:◦Intra- Therapeutic Effects: only) Topical: 3 wk
infections– 7.5 mg/kg q 6 hr (not abdominal GI: abdominal pain, anorexia, nausea, Vaginal: u/k
to exceed 4 g/day). infections (may Bactericidal, diarrhea, dry mouth, furry tongue,
Trichomoniasis– 250 mg q 8 hr be used with a trichomonacidal, or glossitis, unpleasant taste, vomiting Peak:
for 7 days or single 2-g dose or 1 cephalosporin), amebicidal action. Derm: STEVENS-JOHNSON PO: 1-3 hr
g twice daily for 1 day. SYNDROME, rash, urticariatopical only: PO-ER: u/k
Amebiasis– 500–750 mg q 8 hr ◦Gynecologic Spectrum: •Most notable burning, mild dryness, skin irritation, IV: end of
for 5–10 days. H. pylori– 250 mg infections, for activity against transient redness infusion
4 times daily or 500 mg twice ◦Skin and skin anaerobic bacteria, Hemat: leukopenia Topical: 9 wk
daily for 1–2 wk (with other structure including:◦Bacteroides, Local: phlebitis at IV site Vaginal: 6-12
agents). Bacterial vaginoses– infections, ◦Clostridium. Nursing implications hr
750 mg once daily as ER tablets ◦Lower Assess for rash periodically during
for 7 days. Antibiotic associated respiratory tract •In addition, is active therapy. May cause Stevens-Johnson
pseudomembranous colitis–
infections, against:◦Trichomonas syndrome. Discontinue therapy if severe Duration:
250–500 mg 3–4 times/day for
◦Bone and joint vaginalis, or if accompanied with fever, general PO: 8 hr
10–14 days.
IV: (Adults) Anaerobic
infections, ◦Entamoeba histolytica, malaise, fatigue, muscle or joint aches, PO-ER: up to
infections– Initial dose 15 mg/kg, ◦CNS infections, ◦Giardia lamblia, blisters, oral lesions, conjunctivitis, 24hr
then 7.5 mg/kg q 6–8 hr or 500 ◦Septicemia, ◦H. pylori, hepatitis and/or eosinophilia. IV: 6-8 hr
mg q 6–8 hr (not to exceed 4 ◦Endocarditis. ◦Clostridium difficile. •Assess for infection (vital signs; Topical: 12hr
g/day). Perioperative •IV: Perioperative appearance of wound, sputum, urine, Vaginal: 12hr
prophylaxis– Initial dose 15 prophylactic and stool; WBC) at beginning of and
mg/kg 1 hr before surgery, then agent in throughout therapy.
7.5 mg/kg 6 and 12 hr later. colorectal •May cause dizziness or light-
Amebiasis– 500–750 mg q 8 hr surgery. headedness. Caution patient to avoid
for 5–10 days. •PO: Amebicide driving or other activities requiring
in the alertness until response to medication is
Topical: (Adults) Acne management of known.
rosacea– Apply thin film to amebic •Inform patient that medication may
affected area bid. dysentery, cause an unpleasant metallic taste.
amebic liver
Vag: (Adults) Bacterial abscess, and Contraindicated in: Hypersensitivity;
vaginosis– One applicatorful (5 trichomoniasis:◦T Hypersensitivity to parabens (topical only);
g) 2 times daily for 5 days. reatment of OB: First trimester of pregnancy.
peptic ulcer
disease caused
by Helicobacter
pylori.
•Topical:
Treatment of
acne rosacea.
Levaquin PO: IV: Inhibits bacterial DNA CNS: ELEVATED INTRACRANIAL Onset: May cause ↑ serum
levofloxacin Treatment of the synthesis by inhibiting DNA PRESSURE (INCLUDING PO: rapid AST, ALT, LDH,
following gyrase enzyme. PSEUDOTUMOR CEREBRI), IV: rapid bilirubin, and
anti-infectives bacterial Therapeutic Effect(s): SEIZURES, agitation, anxiety, confusion, alkaline
fluoroquinolones infections: Death of susceptible depression, dizziness, drowsiness, Peak: phosphatase.
◦Urinary tract bacteria. hallucinations, headache, insomnia, PO: 1-2hr May also cause ↑ or
PO: IV: (Adults) Most infections, Spectrum: •Active against nightmares, paranoia, tremor. CV: IV: end of ↓ serum glucose.
infections– 250–750 mg q 24 hr; including cystitis, gram-positive pathogens, TORSADE DE POINTES, QT interval infusion
Inhalational anthrax (post- pyelonephritis, including: ◦Staphylococcus prolongation. GI: HEPATOTOXICITY,

exposure)– 500 mg daily for 60 and prostatitis, aureus, PSEUDOMEMBRANOUS COLITIS, Duration:
days. ◦Respiratory tract ◦Staphylococcus nausea, abdominal pain, diarrhea, PO: 24 hr
Renal Impairment infections, epidermidis, vomiting. Derm: STEVENS-JOHNSON IV: 24hr
PO: IV: (Adults) Normal renal including acute ◦Staphylococcus SYNDROME, photosensitivity, rash
function dosing of 750 mg/day: sinusitis, acute saprophyticus, Endo: hyperglycemia, hypoglycemia
CCr 20–49 mL/min– 750 mg q exacerbations of ◦Streptococcus pyogenes, Local: phlebitis at IV site
48 hr; CCr 10–19 mL/min– 750
chronic ◦Streptococcus Misc: HYPERSENSITIVITY
mg initially, then 500 mg q 48 hr;
bronchitis, pneumoniae, REACTIONS INCLUDING
Normal renal function dosing of
500 mg/day: CCr 20–49 mL/min–
community- ◦Enterococcus faecalis, ANAPHYLAXIS
500 mg initially then 250 mg q 24 acquired ◦Bacillus anthracis. Nursing implications:
hr; CCr 10–19 mL/min– 500 mg pneumonia, and •Gram-negative spectrum Observe patient for signs and symptoms
initially then 250 mg q 48 hr. nosocomial notable for activity against: of anaphylaxis (rash, pruritus, laryngeal
Normal renal function dosing of pneumonia, ◦Escherichia coli, edema, wheezing). Monitor bowel
250 mg/day: CCr 10–19 mL/min– ◦Uncomplicated ◦Klebsiella pneumoniae, function. Diarrhea, abdominal cramping,
250 mg q 48 hr. and complicated ◦Enterobacter cloacae, fever, and bloody stools should be
skin and skin ◦Proteus mirabilis, reported to health care professional
structure ◦Pseudomonas promptly as a sign of
infections. aeruginosa, pseudomembranous colitis
◦Serratia marcescens, Assess for rash periodically during
•Post-exposure ◦Haemophilus influenzae, therapy. Instruct patient to notify health
treatment of ◦Moraxella catarrhalis. care professional if fever and diarrhea
inhalational •Additional spectrum develop, especially if stool contains
anthrax. includes: ◦Chlamydophylia blood, pus, or mucus. Advise patient not
•Treatment and pneumoniae, to treat diarrhea without consulting
prophylaxis of ◦Legionella pneumoniae, health care professional
plague ◦Mycoplasma pneumoniae,
and Yersinia pestis Contraindicated in: Hypersensitivity
(cross-sensitivity within class may exist);
QTc interval prolongation; Uncorrected
hypokalemia or hypomagnesemia;
Concurrent use of Class IA antiarrhythmics
(disopyramide, quinidine, procainamide) or
Class III antiarrhythmics (amiodarone,
sotalol) (↑risk of QTc interval prolongation
and torsade de pointes); History of
myasthenia gravis (may worsen symptoms
including muscle weakness and breathing
problems); OB: Pregnancy; Lactation: Not
recommended.
Rocephin •Treatment of: Binds to the bacterial cell CNS: SEIZURES (HIGH DOSES) Onset: •May cause
ceftriaxone ◦Skin and skin wall membrane, causing GI: PSEUDOMEMBRANOUS COLITIS, IM: rapid increased serum
structure cell death. diarrhea, cholelithiasis, gallbladder IV: rapid AST, ALT, alkaline
anti-infectives infections, Therapeutic Effects: sludging phosphatase,
◦Bone and joint Bactericidal action against Derm: rashes, urticaria Peak: bilirubin, LDH, BUN,
third generation cephalosporins infections, susceptible bacteria. Hemat: bleeding, eosinophilia, hemolytic IM: 1-2hr and creatinine.
◦Complicated and Increased action against: anemia, leukopenia, thrombocytosis IV: end of •May rarely cause
IM: IV: (Adults) Most infections– uncomplicated ◦Acinetobacter, Local: pain at IM site, phlebitis at IV site infusion leukopenia,
1–2 g every 12–24 hr urinary tract ◦Enterobacter, Misc: ALLERGIC REACTIONS neutropenia,
Gonorrhea– 250 mg IM (single infections, ◦Haemophilus influenzae INCLUDING ANAPHYLAXIS, Duration: agranulocytosis,
dose). Meningitis– 2 g every 12 ◦Uncomplicated (including β-lactamase- superinfection IM: 12-24hr thrombocytopenia,
hr.Perioperative prophylaxis– 1 g gynecological producing strains), Nursing implications IV: 12-24hr eosinophilia,
0.5–2 hr before surgery (single infections ◦Haemophilus Observe patient for signs and symptoms lymphocytosis, and
dose). including parainfluenzae, of anaphylaxis (rash, pruritus, laryngeal thrombocytosis.
gonorrhea, ◦Escherichia coli, edema, wheezing). Discontinue the drug
◦Lower ◦Klebsiella pneumoniae, and notify health care professional
respiratory tract ◦Morganella morganii, immediately if these symptoms occur.
infections, ◦Neisseria, Monitor bowel function. Diarrhea,
◦Intra-abdominal ◦Proteus, abdominal cramping, fever, and bloody
infections, ◦Providencia, stools should be reported to health care
◦Septicemia, ◦Serratia, professional promptly as a sign of
◦Meningitis, ◦Moraxella catarrhalis. pseudomembranous colitis.
◦Otitis media. Instruct patient to notify health care
•Perioperative professional if fever and diarrhea
prophylaxis develop, especially if diarrhea contains
blood, mucus, or pus. Advise patient not
to treat diarrhea without consulting
health care professional
Contraindicated in: Hypersensitivity to

cephalosporins; Serious hypersensitivity to
penicillins
Dilaudid •Moderate to •Binds to opiate receptors CNS: confusion, sedation, dizziness, Onset: May ↑ plasma
Hydromorphone severe pain in the CNS. dysphoria, euphoria, floating feeling, PO-IR: 30 mins amylase and lipase
High Alert (alone and in •Alters the perception of hallucinations, headache, unusual PO-ER: u/k concentrations.
combination with and response to painful dreams Subcut: 15 If an opioid
allergy, cold and cough nonopioid stimuli while producing EENT: blurred vision, diplopia, miosis mins antagonist is
remedies (antitussives) analgesics); generalized CNS Resp: respiratory depression IM: 15 mins required to reverse
opioid analgesics extended release depression. CV: hypotension, bradycardia IV: 10-15mins respiratory
product for GI: constipation, dry mouth, nausea, Rect: 15- depression or coma,
opioid agonists opioid-tolerant vomiting 30mins
patients requiring •Suppresses the cough GU: urinary retention. naloxone (Narcan) is
Analgesic around-the-clock reflex via a direct central Derm: flushing, sweating Peak: the antidote.
PO: (Adults ≥50 kg): management of action. Misc: physical dependence, PO-IR: 30-
Immediate-release –4–8 mg q 3– persistent psychological dependence, tolerance 90mins
4 hr initially (some patients may moderate-to- Therapeutic Effect(s): Nursing implications PO-ER: u/k
respond to doses as small as 2 severe pain. •Decrease in moderate to Assess BP, pulse, and respirations Subcut: 30-
mg initially); or once 24-hr opioid
•Antitussive severe pain. before and periodically during 90mins
(lower doses). •Suppression of cough. administration. If respiratory rate is IM: 30-60mins
requirement is determined,
<10/min, assess level of sedation. Dose IV: 15-30mins
convert to extended-release by may need to be decreased by 25–50%. Rect: 30-
administering total daily oral Initial drowsiness will diminish with 90mins
dose once daily. continued use.
PO: (Adults and Children <50 Pain: Assess type, location, and Duration:
kg): 0.06 mg/kg q 3–4 hr initially, intensity of pain prior to and 1 hr PO-IR: 4-5hrs
younger children may require following IM or PO and 5 min (peak) PO-ER: u/k
smaller initial doses of 0.03 following IV administration Subcut: 4-5hrs
mg/kg. Maximum dose 5 mg. Prolonged use may lead to physical and IM: 4-5hrs
IV: IM: SC: (Adults ≥50 kg): 1.5 psychological dependence and IV: 2-3hrs
tolerance. This should not prevent Rect: 4-5hrs
mg q 3–4 hr as needed initially;
patient from receiving adequate
may be ↑. analgesia
IV: IM: SC: (Adults and Rate: Administer slowly, at a rate not to
Children <50 kg): 0.015 mg/kg exceed 2 mg over 3–5 min. High Alert:
mg q 3–4 hr as needed initially; Rapid administration may lead to
may be ↑. increased respiratory depression,
IV: (Adults) Continuous infusion hypotension, and circulatory collapse.
(unlabeled)– 0.2–30 mg/hr
depending on previous opioid Contraindicated in: Hypersensitivity;
use. An initial bolus of twice the Some products contain bisulfites and
should be avoided in patients with known
hourly rate in mg may be given
hypersensitivity; Severe respiratory
with subsequent breakthrough depression (in absence of resuscitative
boluses of 50–100% of the equipment) (E-R only); Acute or severe
hourly rate in mg. bronchial asthma (extended-release
Rect: (Adults) 3 mg q 6–8 hr only); Paralytic ileus (extended-release
initially as needed. only); Acute, mild, intermittent, or
postoperative pain (extended-release
Antitussive only); Prior GI surgery or narrowing of GI
tract (extended-release only); Opioid
PO: (Adults and Children >12 non-tolerant patients (extended-release
yr): 1 mg q 3–4 hr. only); Avoid chronic use during
pregnancy or lactation.
Morphine •Severe pain (the Binds to opiate receptors in CNS:confusion, sedation, dizziness, Onset: May ↑ plasma
20 mg/mL oral the CNS. Alters the dysphoria, euphoria, floating feeling, PO: u/k amylase and lipase
High Alert Medication solution perception of and response hallucinations, headache, unusual PO-ER: u/k levels.
opioid analgesics concentration to painful stimuli while dreams, blurred vision, miosis, IM: 10-30mins If an opioid
opioid agonists should only be producing generalized RESPIRATORY DEPRESSION, Subc: 20mins antagonist is
used in opioid- CNS depression. hypotension, bradycardia, constipation, Rect: u/k required to reverse
PO: Rect: (Adults ≥50 kg): tolerant patients). Therapeutic Effects: nausea, vomiting, urinary retention, IV: rapid respiratory
Usual starting dose for moderate •Management of Decrease in severity of itching, sweating, physical dependence, Epidural: 6- depression or coma,
to severe pain in opioid-naive moderate to pain. Addition of naltrexone psychological dependence, tolerance 30mins naloxone is the
patients– 30 mg q 3–4 hr initially severe chronic in Embeda product is IT: rapid (min) antidote.
or once 24-hr opioid requirement pain in patients designed to prevent abuse Nursing Implementations:
is determined, convert to requiring use of a or misuse by altering the High Alert: Assess level of Peak:
controlled-, extended-, or continuous formulation. Naltrexone consciousness, BP, pulse, and PO: 60mins
sustained-release morphine by around-the-clock has no effect unless the respirations before and periodically PO-ER: 3-4hrs
administering total daily oral opioid analgesic capsule is crushed or during administration. If respiratory rate IM: 30-60mins
morphine dose every 24 hr (as for an extended chewed. is <10/min, assess level of sedation. Subc: 50-
Kadian or Avinza ), 50% of the period of time Physical stimulation may be sufficient to 90mins
total daily oral morphine dose (extended/sustai prevent significant hypoventilation. Rect: 20-
every 12 hr (as Kadian, MS ned-release). Subsequent doses may need to be 60mins
Contin ), or 33% of the total daily •Pulmonary decreased by 25–50%. Initial drowsiness IV: 20mins
oral morphine dose every 8 hr edema. will diminish with continued use. Epidural: 1hr
(as MS Contin ). See •Pain associated Assess geriatric patients frequently; IT: u/k
equianalgesic chart, with MI. older adults are more sensitive to the
equianalgesic dosing guidelines. effects of opioid analgesics and may Duration:
Avinza dose should not exceed experience side effects and respiratory PO: 4-5hrs
1600 mg/day because of fumaric
complications more frequently. PO-ER: 8-
acid in formulation.
High Alert: Do not confuse morphine with 24hrs
PO: Rect: (Adults and Children hydromorphone–errors have resulted in IM: 4-5hrs
death. Have second practitioner Subc: 4-5hrs
<50 kg): Usual starting dose for
independently check original order, dose Rect: 3-7hrs
moderate to severe pain in calculations, and infusion pump settings IV: 4-5hrs
opioid-naive patients– 0.3 mg/kg Home Care Issues: High Alert: Explain to Epidural: up to
q 3–4 hr initially. patient and family how and when to 24 hrs
administer morphine and how to care for IT: up to 24hrs
IM: IV: SC: (Adults ≥50 kg): infusion equipment properly
Usual starting dose for moderate
to severe pain in opioid-naive Contraindicated in: Hypersensitivity;
patients– 4–10 mg q 3–4 hr. MI– Some products contain tartrazine,
8–15 mg, for very severe pain bisulfites, or alcohol and should be avoided
additional smaller doses may be in patients with known hypersensitivity.
given every 3–4 hr. Acute, mild, intermittent, or postoperative
pain (extended/sustained-release);
IM: IV: SC: (Adults and Significant respiratory depression
Children <50 kg): Usual starting (extended/sustained-release); Acute or
dose for moderate to severe pain severe bronchial asthma (extended/
in opioid-naive patients– 0.05– sustained-release); Paralytic ileus
0.2 mg/kg q 3–4 hr, maximum: (extended/sustained-release);
15 mg/dose.
IV: SC: (Adults) Continuous

infusion– 0.8–10 mg/hr; may be
preceded by a bolus of 15 mg
(infusion rates vary greatly; up to
400 mg/hr have been used).
Epidural: (Adults) Intermittent

injection– 5 mg/day (initially); if
relief is not obtained at 60 min,
1–2 mg increments may be
made (total dose not to exceed
10 mg/day. Continuous infusion–
2–4 mg/24 hr; may ↑ by 1–2
mg/day (up to 30 mg/day).
IT: (Adults) 0.2–1 mg. Use

preservative-free formulation.
Percocet –combination Oxycodone PO

oxycodone & acetaminophen Onset: 10-15
High Alert Medication:
significant patient harm when it min
is used in error. Peak: 60-90
Oxycodone min
Ther. Class. Duration: 3-6
hr
opioid analgesics Oxycodone: Acetaminophe

7.5-10 mg oxycodone n oral, rectal,
Moderate to •Binds to opiate receptors
Acetaminophen: 325-650 mg severe pain; in the CNS. IV. May ↑ plasma
Contraindicated in:
extended release •Alters the perception of Hypersensitivity;
Onset: 0.5 hr amylase and lipase
product should and response to painful Peak: 1-3 hr levels.
be used for stimuli, while producing  Some products contain alcohol or bisulfites
Class. Duration: 3-8
patients requiring generalized CNS and should be avoided in patients with
opioid agonists around-the-clock depression.
hr
nonopioid analgesic known intolerance or hypersensitivity;
management of Therapeutic Effect(s):
combinations chronic pain. Decreased pain.  Significant respiratory depression;
 Paralytic ileus;
 Acute or severe bronchial asthma.
 Acute, mild, intermittent, or postoperative
pain (extended-release)
Acetaminiphen Adverse reactions/side affects:

Class. CNS: confusion, sedation, dizziness,
antipyretics dysphoria, euphoria, floating feeling,
nonopioid analgesics hallucinations, headache, unusual
•Inhibits the synthesis of dreams
PO: Rect: prostaglandins that may
Treatment serve as mediators of pain EENT: blurred vision, diplopia, miosis
of:◦Mild pain, and fever, primarily in the Resp: RESPIRATORY DEPRESSION Increased serum
◦Fever. CNS. CV: orthostatic hypotension bilirubin, LDH, AST,
•Has no significant anti- GI: constipation, dry mouth, choking, GI ALT, and
•IV: Treatment inflammatory properties or obstruction, nausea, vomiting prothrombin time
of:◦Mild to GI toxicity. GU: urinary retention may indicate
moderate pain, Misc: physical dependence, hepatotoxicity.
◦Moderate to Therapeutic Effect(s): psychological dependence, tolerance Evaluate hepatic,
severe pain with •Analgesia. Nursing implications hematologic, and
opioid •Antipyresis. Assess type, location, and intensity of renal function
analgesics, pain prior to and 1 hr (peak) after periodically during
◦Fever. administration prolonged, high-
Assess BP, pulse, and respirations dose therapy.
before and periodically during
administration. If respiratory rate is
<10/min, assess level of sedation.
Toxicity overdose:
If an opioid antagonist is required to

reverse respiratory depression or coma,
naloxone is the antidote
Side effects/ adverse reactions for

acetaminophen:
CV: hypertension (IV), hypotension (IV)
GI: HEPATOTOXICITY (↑ DOSES),
constipation (↑ in children) (IV), ↑ liver
enzymes, nausea (IV), vomiting (IV)
F and E: hypokalemia (IV)
Derm: ACUTE GENERALIZED
EXANTHEMATOUS PUSTULOSIS,
STEVENS-JOHNSON SYNDROME,
TOXIC EPIDERMAL NECROLYSIS,
rash, urticaria
Contraindicated in:
 Previous hypersensitivity;
 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;
 Severe hepatic impairment/active liver
disease.
Nursing implications
Assess overall health status and alcohol
usage before administering
acetaminophen. Patients who are
malnourished or chronically abuse
alcohol are at higher risk of developing
hepatotoxicity with chronic use of usual
doses of this drug.
Toxicity Overdose:
If overdose occurs, acetylcysteine
(Acetadote) is the antidote.
Vicodine Extended-release Bind to opiate receptors in CNS: confusion, dizziness, sedation, Po: May cause ↑ plasma
hydrocodone product: the CNS. Alter the euphoria, hallucinations, headache, Onset: 10-30 amylase and lipase
High Alert Medication: Management of perception of and response unusual dreams min concentrations.
significant patient harm when it pain that is to painful stimuli while EENT: blurred vision, diplopia, miosis Peak:30-60
is used in error severe enough to producing generalized Resp: respiratory depression min
Class. warrant daily, CNS CV: hypotension, bradycardia Duration: 4-6 hr
allergy, cold and cough around-the-clock, depression:•Suppress the GI: constipation, dyspepsia, nausea,
remedies (antitussive) long-term opioid cough reflex via a direct vomiting Po and ER:
opioid analgesics treatment where central action. Contraindicated in: unknown
Pharm. Class. alternative
opioid agonists nonopioid treatment options Therapeutic Effects:  Hypersensitivity to hydrocodone (cross-
analgesic are inadequate. •Decrease in severity of sensitivity may exist to other opioids);
combinations •Combination moderate pain.
products: •Suppression of the cough
 Significant respiratory depression
Management of reflex.  Paralytic ileus
moderate to  Acute or severe bronchial asthma or
Route/Dosage severe pain.
•Antitussive hypercarbia
PO: (Adults) Analgesic– 2.5–10 (usually in  Hypersensitivity to
mg q 3–6 hr as needed; if using combination
combination products, products with acetaminophen/ibuprofen (for combination
acetaminophen dosage should decongestants). products);
not exceed 4 g/day and should
 Ibuprofen-containing products should be
not exceed 5 tablets/day of
ibuprofen-containing avoided in patients with bleeding disorders
products; Antitussive– 5 mg q 4–6 or thrombocytopenia;
hr as needed; Extended  Acetaminophen-containing products should
release– 10 mg q 12 hr; may ↑ as
be avoided in patients with severe hepatic
needed in increments of 10 mg q
12 hr q 3–7 days. or renal disease;
PO: Children Analgesic (1–13  Ibuprofen-containing products should be
yr)– 0.1–0.2 mg/kg q 3–4
avoided in patients undergoing coronary
hr. Antitussive – 0.6 mg/kg/day
divided q 6–8 hr; (maximum artery bypass graft surgery;
doses <2 yr: 1.25 mg/dose; 2–12  OB: Lactation: Avoid chronic use;
yr: 5 mg/dose; >12 yr: 10
 Products containing alcohol, aspartame,
mg/dose) .
saccharin, sugar, or tartrazine (FDC yellow
dye #5) should be avoided in patients who
have hypersensitivity or intolerance to these

compound
Nursing implications
Pain: Assess type, location, and intensity
of pain prior to and 1 hr (peak) following
administration
•Assess BP, pulse, and respirations
before and periodically during
administration. If respiratory rate is
<10/min, assess level of sedation
Cough: Assess cough and lung sounds
during antitussive use.
Toxicity Overdose:
If an opioid antagonist is required to
reverse respiratory depression or coma,
naloxone is the antidote.
Lidocaine IV: Ventricular Local: Produces local CNS: SEIZURES, confusion, IV: Serum electrolyte
High Alert Medication: arrhythmias. anesthesia by inhibiting drowsiness, blurred vision, dizziness, O: immediate levels should be
significant patient harm when it •IM: Self-injected transport of ions across nervousness, slurred speech, tremor P: immediate monitored
is used in error. or when IV neuronal membranes, CV: CARDIAC ARREST, arrhythmias, D: 10-20 min periodically during
Class. unavailable thereby preventing bradycardia IM: prolonged therapy.
anesthetics (topical/local) (during transport initiation and conduction of Local: stinging, burning, contact O:5-15 MIN
antiarrhythmics (class IB) to hospital normal nerve impulses. dermatitis, erythema P:20-30 MIN
facilities). Misc: ALLERGIC REACTIONS, D:60-90 MIN
Patch: (Adults) Up to 3 patches •Local: INCLUDING ANAPHYLAXIS Local:
may be applied once for up to Infiltration/mucos Nursing implications O: rapid
12 hr in any 24-hr period; al/topical Anesthetic: Assess degree of P:unknown
consider smaller areas of anesthetic. numbness of affected part. D:1-3 hr
application in geriatric or •Patch: Pain due Transdermal: Monitor for pain intensity
debilitated patients to post-herpetic in affected area periodically during
neuralgia. therapyIf irritation or burning sensation
occurs during application, remove patch

until irritation subsides. Wash hands
after application; avoid contact with eyes
Contraindicated in:
Hypersensitivity; cross-sensitivity may
occur;
Third-degree heart block
ASA •Inflammatory •Produce analgesia and EENT: tinnitus PO: Monitor hepatic
Aspirin disorders reduce inflammation and GI: GI BLEEDING, dyspepsia, epigastric O: 5-30 MIN function before
Class. including: fever by inhibiting the distress, nausea, abdominal pain, P:1-3 HR antirheumatic
antipyretics ◦Rheumatoid production of anorexia, hepatotoxicity, vomiting D:3-6 HR therapy
nonopioid analgesics arthritis, prostaglandins. Hemat: anemia, hemolysis May cause ↑ serum
◦Osteoarthritis. •Decreases platelet Derm: rash, urticaria AST, ALT, and
Pharm. Class. aggregation. Misc: ALLERGIC REACTIONS alkaline
salicylates Route/Dosage •Mild to moderate Therapeutic Effects: INCLUDING ANAPHYLAXIS AND phosphatase
Pain/Fever pain. •Analgesia. LARYNGEAL EDEMA •Prolongs bleeding
•Fever. •Reduction of Nursing implications time and, in large
PO: Rect: (Adults) 325–1000 •Prophylaxis of inflammation. Patients who have asthma, allergies, and doses, may cause
mg q 4–6 hr (not to exceed 4 transient •Reduction of fever. nasal polyps are at an increased risk for prolonged
g/day). Extended-release ischemic attacks •Decreased incidence of developing hypersensitivity reactions. prothrombin time.
tablets– 650 mg q 8 hr or 800 and MI. transient ischemic attacks Pain: Assess pain and limitation of Monitor hematocrit
mg q 12 hr. and MI. movement; note type, location, and periodically in
PO: Rect: (Children 2–11 yr): intensity before and at the peak (see prolonged high-dose
10–15 mg/kg/dose q 4–6 hr; Time/Action Profile) after administration. therapy to assess for
maximum dose: 4 g/day. •Fever: Assess fever and note GI blood loss.
Inflammation associated signs (diaphoresis,
PO: (Adults) 2.4 g/day initially; tachycardia, malaise, chills).
increased to maintenance dose Caution patient to avoid concurrent use
of 3.6–5.4 g/day in divided of alcohol with this medication to
doses (up to 7.8 g/day for minimize possible gastric irritation;
acute rheumatic fever). Toxicity Overdose:
PO: Children 60–100 Monitor for the onset of headache,
mg/kg/day in divided doses (up hyperventilation, agitation, mental
to 130 mg/kg/day for acute confusion, lethargy, diarrhea, and
rheumatic fever). sweating. If these symptoms appear,
Prevention of Transient withhold medication and notify health
Ischemic Attacks care professional immediately.
PO: (Adults) 50–325 mg once
daily. Contraindicated in:
Prevention of Myocardial
Hypersensitivity to aspirin or other
Infarction/Antiplatelet effects
salicylates
PO: (Adults) 80–325 mgonce Cross-sensitivity with other NSAIDs may

dailySuspected acute MI -160 exist (less with nonaspirin salicylates)
mg as soon as MI is Bleeding disorders or thrombocytopenia
suspected. Pedi: May increase risk of Reye's
PO: Children 3–10 mg/kg/day syndrome in children or adolescents with
given once daily (round dose to viral infections.
a convenient amount). Use Cautiously in:
Kawasaki Disease History of GI bleeding or ulcer disease
PO: Children 80–100 Chronic alcohol use/abuse
mg/kg/day in 4 divided doses Severe hepatic or renal disease
until fever resolves; may be OB: Salicylates may have adverse
followed by maintenance dose effects on fetus and mother and should
of 3–5 mg/kg/day as a single be avoided during pregnancy, especially
dose for up to 8 wk. during the 3rd trimester
Lactation: Safety not established
Geri: ↑ risk of adverse reactions
especially GI bleeding; more sensitive to
toxic levels
Celebrex •Relief of signs •Inhibits the enzyme COX- CNS: dizziness, headache, insomnia PO: May cause ↑ AST
celecoxib and symptoms of 2. This enzyme is required CV: MYOCARDIAL INFARCTION, O: 24-48 HR and ALT levels.
Class. osteoarthritis, for the synthesis of STROKE, THROMBOSIS, edema P:UNKNOWN •May cause
antirheumatic rheumatoid prostaglandins. GI: GI BLEEDING, abdominal pain, D:12-24 HR hypophosphatemia
nonsteroidal anti inflammatory arthritis, •Has analgesic, anti- diarrhea, dyspepsia, flatulence, nausea and ↑ BUN.
agents ankylosing inflammatory, and Derm: EXFOLIATIVE DERMATITIS,
Pharm. Class. spondylitis, and antipyretic properties. STEVENS-JOHNSON SYNDROME,
cox 2 inhibitors juvenile Therapeutic Effect(s): TOXIC EPIDERMAL NECROLYSIS,
rheumatoid •Decreased pain and rash
Route/Dosage arthritis. inflammation caused by Nursing implications
PO: (Adults) Osteoarthritis– •Management of arthritis or spondylitis. Assess patient for skin rash frequently
200 mg once daily or 100 mg acute pain •Decreased pain. during therapy. Discontinue at first sign
twice daily. Rheumatoid including primary of rash; may be life-threatening.
arthritis– 100–200 mg twice dysmenorrhea. Stevens-Johnson syndrome may
daily. Ankylosing spondylitis– develop
200 mg once daily or 100 mg •Assess patient for allergy to
twice daily; dose may be ↑ after sulfonamides, aspirin, or NSAIDs.
6 wk to 400 mg daily. Acute Patients with these allergies should not
pain, including dysmenorrhea– receive celecoxib.
400 mg initially, then a 200-mg Contraindicated in:
dose if needed on the first day; Hypersensitivity;
then 200 mg twice daily as Cross-sensitivity may exist with other

needed. NSAIDs, including aspirin;
Hepatic Impairment History of allergic-type reactions to
PO: (Adults) Moderate hepatic sulfonamides;
impairment (Child-Pugh Class History of asthma, urticaria, or allergic-
B)– ↓ dose by 50%. type reactions to aspirin or other
PO: (Children ≥2 yr, ≥10 kg– NSAIDs, including the aspirin triad
≤25 kg): Juvenile rheumatoid (asthma, nasal polyps, and severe
arthritis– 50 mg twice daily. hypersensitivity reactions to aspirin);
PO: (Children ≥2 yr, ≥25 kg): Advanced renal disease;
Juvenile rheumatoid arthritis– Severe hepatic dysfunction;
100 mg twice daily Peri-operative pain from coronary artery
bypass graft (CABG) surgery;
OB: Should not be used in late
pregnancy (may cause premature
closure of the ductus arteriosus
Motrin PO: IV: Inhibits prostaglandin CNS: headache, dizziness, drowsiness, PO: antipyretic BUN, serum
ibuprofen Treatment synthesis. intraventricular hemorrhage (ibuprofen O: 0,5-2,5 HR creatinine, CBC, and
Class. of:◦Mild to lysine), psychic disturbances P:2-4 HR liver function tests
antipyretics moderate pain, Therapeutic Effect(s): EENT: amblyopia, blurred vision, tinnitus D:6-8 HR should be evaluated
antirheumatics ◦Fever. •Decreased pain and CV: arrhythmias, edema, hypertension periodically in
nonopioid analgesics •PO: Treatment inflammation. GI: GI BLEEDING, HEPATITIS, PO analgesic: patients receiving
nonsteroidal anti inflammatory of:◦Inflammatory •Reduction of fever. constipation, dyspepsia, nausea, O: 30 MIN prolonged therapy.
agents disorders necrotizing enterocolitis (ibuprofen P:1-2 HR •Serum potassium,
Pharm. Class. including lysine), vomiting, abdominal discomfort D:4-6 HR BUN, serum
nonopioid analgesics Analgesia rheumatoid Derm: EXFOLIATIVE DERMATITIS, creatinine, alkaline
arthritis (including STEVENS-JOHNSON SYNDROME, PO phosphatase, LDH,
PO: (Adults) Anti- juvenile) and TOXIC EPIDERMAL NECROLYSIS, inflammatory: AST, and ALT may
inflammatory– 400–800 mg 3– osteoarthritis, rashes, injection site reaction O: < 7 DAYS show ↑ levels.
4 times daily (not to exceed ◦Dysmenorrhea Misc: ALLERGIC REACTIONS P:1-2 WEEKS •May cause
3200 mg/day). IV: Moderate to INCLUDING ANAPHYLAXIS D:unknown prolonged bleeding
Analgesic/antidysmenorrheal/a severe pain with Nursing implications time
ntipyretic– 200–400 mg q 4–6 opioid analgesics Patients who have asthma, aspirin- IV analgesic:
hr (not to exceed 1200 induced allergy, and nasal polyps are at O:unknown
mg/day). increased risk for developing P:unknown
PO: (Children 6 mo–12 yr): hypersensitivity reactions D:6 hr
Anti-inflammatory– 30–50 •Assess for signs and symptoms of GI
mg/kg/day in 3–4 divided bleeding (tarry stools, lightheadedness, IV antipyretic:
doses (maximum dose: 2.4 hypotension), renal dysfunction (elevated O:within 2 hr
g/day). Antipyretic– 5 mg/kg for BUN and creatinine levels, decreased P:10-12 HR
temperature <102.5°F urine output) D:4-6 HR
(39.17°C) or 10 mg/kg for
higher temperatures (not to Assess patient for skin rash frequently

exceed 40 mg/kg/day); may be during therapy
repeated q 4–6 hr. Cystic
fibrosis (unlabeled)– 20–30 Contraindicated in:
mg/kg/day divided twice daily. Hypersensitivity (cross-sensitivity may
PO: (Infants and Children): exist with other NSAIDs, including
Analgesic– 4–10 mg/kg/dose q aspirin);
6–8 hr. Active GI bleeding or ulcer disease;
IV: (Adults) Analgesic– 400– Chewable tablets contain aspartame and
800 mg q 6 hr as needed (not should not be used in patients with
to exceed 3200 mg/day); phenylketonuria;
Antipyretic– 400 mg initially, Peri-operative pain from coronary artery
then 400 mg q 4–6 hr or 100– bypass graft (CABG) surgery;
200 mg q 4 hr as needed (not OB: Avoid after 30 wk gestation (may
to exceed 3200 mg/day). cause premature closure of fetal ductus
Pediatric OTC Dosing arteriosus);
PO: (Children 11 yr/72–95 lb): Pedi: Ibuprofen lysine: Preterm neonates
300 mg q 6–8 hr. with untreated infection, congenital heart
PO: (Children 9–10 yr/60–71 disease where patency of PDA is
lb): 250 mg q 6–8 hr. necessary for pulmonary or systemic
PO: (Children 6–8 yr/48–59 lb): blood flow, bleeding, thrombocytopenia,
200 mg q 6–8 hr. coagulation defects, necrotizing
PO: (Children 4–5 yr/36–47 lb): enterocolitis, significant renal dysfunction
150 mg q 6–8 hr.
PO: (Children 2–3 yr/24–35 lb):
100 mg q 6–8 hr.
PO: (Children 12–23 mo/18–23
lb): 75 mg q 6–8 hr.
PO: (Infants 6–11 mo/12–17
lb): 50 mg q 6–8 hr.
PDA Closure
IV: (Neonates Gestational age
≤32 weeks, 500–1500 g): 10
mg/kg followed by two doses of
5 mg/kg at 24 and 48 hr after
initial dose
Solumedrol ◦Inflammatory, •Suppresses inflammation CNS: depression, euphoria, headache, PO: Monitor serum
methylprednisolone ◦Allergic, and the normal immune restlessness O: unknown electrolytes and
Class. ◦Hematologic, response. CV: hypertension P:1-2 HR glucose. May cause
anti-inflammatories (steroidal) ◦Neoplastic, •Has numerous intense GI: PEPTIC ULCERATION, anorexia, D:1,25-1,5 hyperglycemia,
immunosuppressants ◦Autoimmune metabolic effects (see nausea, vomiting DAYS especially in persons
disorders,
Pharm. Class. ◦Immunosuppres Adverse Reactions and Derm: acne, ↓ wound healing, IM acetate: with diabetes. May
corticosteroids ant.•May be Side Effects. ecchymoses, fragility, hirsutism, O:6-48 HR cause hypokalemia
suitable for •Suppresses adrenal petechiae P:4-8 DAYS Guaiac test stools.
alternate-day function at chronic doses Endo: adrenal suppression, D:1-4 WEEKS
dosing in the of 4 mg/day. hyperglycemia
PO: (Adults) Multiple sclerosis– management of •Has negligible F and E: fluid retention (long-term high
160 mg/day for 7 days, then 64 chronic illness. mineralocorticoid activity. doses), hypokalemia, hypokalemic IM/IV
mg every other day for 1 mo. •Replacement alkalosis succinate:
Other uses– 2–60 mg/day as a therapy in Hemat: THROMBOEMBOLISM, O; rapid
single dose or in 2–4 divided adrenal thrombophlebitis P:unknown
doses. Asthma exacerbations– insufficiency MS: muscle wasting, osteoporosis, D: unknown
120–180 mg/day in divided Misc: cushingoid appearance (moon
doses 3–4 times/day for 48 hr, face, buffalo hump)
then 60–80 mg/day divided Nursing implications
twice daily. •Monitor intake and output ratios and
PO: Children Anti- daily weights. Observe patient for
inflammatory/Immunosuppressi peripheral edema, steady weight gain,
ve– 0.5–1.7 mg/kg/day or 5–25 rales/crackles, or dyspnea
mg/m2/day in divided doses q . Advise patient to take medication as
6–12 hr. Asthma directed.S topping the medication
exacerbations– 1 mg/kg q 6 hr suddenly may result in adrenal
for 48 hr, then 1–2 mg/kg/day insufficiency (anorexia, nausea,
(maximum: 60 mg/day) divided weakness, fatigue, dyspnea,
twice daily. hypotension, hypoglycemia
IM: IV: (Adults) Most uses:
methylprednisolone sodium Contraindicated in:
succinate– 40–250 mg q 4–6 Active untreated infections (may be used
hr. High-dose "pulse" therapy: in patients being treated for tuberculous
methylprednisolone sodium meningitis)
succinate– 30 mg/kg IV q 4–6 Lactation: Avoid chronic use
hr for up to 72 hr. Multiple Known alcohol, bisulfite, or tartrazine
sclerosis: methylprednisolone hypersensitivity or intolerance (some
sodium succinate– 160 mg/day products contain these and should be
for 7 days, then 64 mg every avoided in susceptible patients)
other day for 1 mo. Adjunctive Administration of live virus vaccines.
therapy ofPneumocystis
jirovecii pneumonia in AIDS
patients: methylprednisolone
sodium succinate– 30 mg twice
daily for 5 days, then 30 mg
once daily for 5 days, 15 mg
once daily for 10 days. Acute
spinal cord injury:

methylprednisolone sodium
succinate– 30 mg/kg over 15
min initially, followed 45 min
later with 5.4 mg/kg/hr for 23 hr
(unlabeled).
IM: IV: Children Anti-
inflammatory/Immunosuppressi
ve– 0.5–1.7 mg/kg/day or 5–25
mg/m2/day in divided doses q
6–12 hr Acute spinal cord
injury: methylprednisolone
sodium succinate– 30 mg/kg
over 15 min initially, then 45
min later initiate continuous
infusion of 5.4 mg/kg/hr for 23
hr (unlabeled). Staus
asthmaticus– 2 mg/kg/dose,
then 0.5–1 mg/kg/dose q 6 hr.
Lupus nephritis– 30 mg/kg IV
every other day for 6 doses.
IM: (Adults)
Methylprednisolone acetate–
40–120 mg daily, weekly, or
every 2 wk
digoxin •Heart failure. •Increases the force of CNS: fatigue, headache, weakness PO: Evaluate serum
Lanoxin •Atrial fibrillation myocardial contraction. EENT: blurred vision, yellow or green O:30-120 MIN electrolyte levels
Ther. Class. and atrial flutter •Prolongs refractory period vision P:2-8 HR (especially
antiarrhythmics (slows ventricular of the AV node. CV: ARRHYTHMIAS, bradycardia, ECG D:2-4 DAYS potassium,
inotropics rate). •Decreases conduction changes, AV block, SA block magnesium, and
•Paroxysmal through the SA and AV GI: anorexia, nausea, vomiting, diarrhea IM: calcium) and renal
Class. atrial tachycardia. nodes. Nursing implications O:30 MIN and hepatic
digitalis glycosides Monitor ECG throughout IV P:4-6 HR functions
High Alert Medication administration and 6 hr after each dose. D:2-4 DAYS
risk of causing significant Notify health care professional if
patient harm when it is used in bradycardia or new arrhythmias occur. IV
error. •Observe IV site for redness or O:5-30 MIN
infiltration; extravasation can lead to P:1-4 HR
IV: (Adults) Digitalizing dose– tissue irritation and sloughing. D:2-4 DAYS
0.5–1 mg given as 50% of the High Alert: Digoxin has a narrow
dose initially and one quarter of therapeutic range. Have second
the initial dose in each of 2 practitioner independently check original

subsequent doses at 6–12 hr order and dose calculations
intervals. Teach patient to take pulse and to
IV: (Children >10 yr): contact health care professional before
Digitalizing dose– 8–12 mcg/kg taking medication if pulse rate is <60 or
given as 50% of the dose >100.
initially and one quarter of the Toxicity Overdose: abdominal pain,
initial dose in each of 2 anorexia, nausea, vomiting, visual
subsequent doses at 6–12 hr disturbances, bradycardia, and other
intervals. arrhythmias.
IV: (Children 5–10 yr):
Digitalizing dose– 15–30 Contraindicated in:
mcg/kg given as 50% of the Hypersensitivity;
dose initially and one quarter of Uncontrolled ventricular arrhythmias;
the initial dose in each of 2 AV block (in absence of pacemaker);
subsequent doses at 6–12 hr Idiopathic hypertrophic subaortic
intervals. stenosis;
IV: (Children 2–5 yr): Constrictive pericarditis;
Digitalizing dose– 25–35 Known alcohol intolerance (elixir only)
mcg/kg given as 50% of the
dose initially and one quarter of
the initial dose in each of 2
subsequent doses at 6–12 hr
intervals.
IV: (Children 1–24 mo):
Digitalizing dose– 30–50
intervals.
IV: (Infants –full term): 20–30
intervals.
IV: (Infants –premature):

intervals.
PO: (Adults) Digitalizing dose–
0.75–1.5 mg given as 50% of
the dose initially and one
quarter of the initial dose in
each of 2 subsequent doses at
6–12 hr intervals. Maintenance
dose– 0.125–0.5 mg/day
depending on patient's lean
body weight, renal function,
and serum level.
PO: Geriatric Patients Initial
daily dosage should not
exceed 0.125 mg.
PO: (Children >10 yr):
intervals. Maintenance dose–
2.5–5 mcg/kg given daily as a
single dose.
PO: (Children 5–10 yr):
5–10 mcg/kg given daily in 2
divided doses. PO: (Children
>10 yr): Digitalizing dose– 10–
15 mcg/kg given as 50% of the
2.5–5 mcg/kg given daily as a
single dose.

divided doses.
7.5–10 mcg/kg given daily in 2
divided doses.
PO: (Children 1–24 mo):
divided doses.
PO: (Infants –full term):
divided doses.
PO: (Infants –premature):

5–7.5 mcg/kg given daily in 2
divided doses
Colace PO: Prevention •Promotes incorporation of EENT: throat irritation PO:

docusate of constipation (in water into stool, resulting in GI: mild cramps, diarrhea O:12-72 HR
Class. patients who softer fecal mass. Derm: rashes P:unknown
laxatives should avoid •May also promote Nursing implications D:unknown
Pharm. Class. straining, such as electrolyte and water •Assess for abdominal distention,
stool softeners Docusate after MI or rectal secretion into the colon. presence of bowel sounds, and usual Rectal:
Calcium surgery). pattern of bowel function. O: 2-15 MIN
•Rect: Used as •Advise patients that laxatives should be P:unknown
PO: (Adults) 240 mg once enema to soften used only for short-term therapy. Long- D:unknown
daily. fecal impaction term therapy may cause electrolyte
Docusate Sodium imbalance and dependence.
PO: (Adults and Children >12
yr): 50–400 mg in 1–4 divided Contraindicated in:
doses. Hypersensitivity;
PO: (Children 6–12 yr): 40–150 Abdominal pain, nausea, or vomiting,
mg in 1–4 divided doses. especially when associated with fever or
PO: (Children 3–6 yr): 20–60 other signs of an acute abdomen.
mg in 1–4 divided doses.
PO: (Children <3 yr): 10–40 mg
in 1–4 divided doses.
PO: Infants 5 mg/kg/day in 1–4
divided doses.
Rect: (Adults) 50–100 mg or 1
unit containing 283 mg
docusate sodium, soft soap,
and glycerin
Dulcolax •Treatment of •Stimulates peristalsis. GI: abdominal cramps, nausea, diarrhea, PO:
bisacodyl constipation. •Alters fluid and electrolyte rectal burning O:6-12 hr
Class. •Evacuation of transport, producing fluid F and E: hypokalemia (with chronic use) P:unknown
laxatives the bowel before accumulation in the colon. MS: muscle weakness (with chronic use) D:unknown
Pharm. Class. radiologic studies Therapeutic effects: Nursing implications:
stimulant laxatives or surgery. evacuation of the colon •Assess patient for abdominal distention, Rectal:
•Part of a bowel presence of bowel sounds, and usual O: 15-60 min
regimen in spinal pattern of bowel function P:unknown
D:unknown
PO: (Adults and Children ≥12 cord injury •Advise patient to increase fluid intake to
yr): 5–15 mg/day (up to 30 patients at least 1500–2000 mL/day during
mg/day) as a single dose. therapy to prevent dehydration.
PO: (Children 3–11 yr): 5–10
mg/day (0.3 mg/kg) as a single Contraindicated in:
dose. Hypersensitivity;
Rect: (Adults and Children ≥12 Abdominal pain;
yr): 10 mg/day single dose. Obstruction;
Rect: (Children 2–11 yr): 5–10 Nausea or vomiting (especially with fever
mg/day single dose. or other signs of an acute abdomen).
Rect: (Children <2 yr): 5
mg/day single dose.
Lipitor •Adjunctive Inhibits 3-hydroxy-3- GI: abdominal cramps, constipation, PO: •Monitor liver
atorvastatin Class. management of methylglutaryl-coenzyme A diarrhea, flatus, heartburn, altered taste, O:unknown function tests prior to
lipid-lowering agents primary (HMG-CoA) reductase, an drug-induced hepatitis, dyspepsia, ↑ liver P:unknown initiation of therapy
Pharm. Class. hypercholesterol enzyme which is enzymes, nausea, pancreatitis D:20-30 hr May cause ↑ alkaline
hmg coa reductase inhibitors emia and mixed responsible for catalyzing Endo: hyperglycemia phosphatase and
dyslipidemia. an early step in the GU: erectile dysfunction bilirubin levels
•Primary synthesis of cholesterol. Derm: rashes, pruritus
prevention of Therapeutic Effects: MS: RHABDOMYOLYSIS, arthralgia,
PO: (Adults) 10–20 mg once coronary heart •Lowering of total and LDL arthritis, myalgia, myositis
daily initially; (may start with 40 disease cholesterol and Misc: HYPERSENSITIVITY
mg/day if LDL-C needs to be ↓ (myocardial triglycerides. Slightly REACTIONS INCLUDING
by >45%); may be ↑ every 2–4 infarction, stroke, increases HDL cholesterol. ANGIONEUROTIC EDEMA
wk up to 80 mg/day; angina, and •Reduction of Nursing implications
Concurrent nelfinavir therapy– coronary lipids/cholesterol reduces •Obtain a diet history, especially with
Dose should not exceed 40 revascularization) the risk of myocardial regard to fat consumption
mg/day; Concurrent in asymptomatic infarction and stroke Evaluate serum cholesterol and
clarithromycin, itraconazole, patients with sequelae. triglyceride levels before initiating, after
saquinavir/ritonavir, increased total •Slows the progression of 2–4 wk of therapy, and periodically
darunavir/ritonavir, and low-density coronary atherosclerosis thereafter
fosamprenavir, or lipoprotein (LDL) with resultant decrease in Instruct patient to notify health care
fosamprenavir/ritonavir cholesterol and coronary heart disease– professional if unexplained muscle pain,
therapy– Dose should not decreased high- related events. tenderness, or weakness occurs,
exceed 20 mg/day. density especially if accompanied by fever or
PO: (Children 10–17 yr): 10 lipoprotein (HDL) malaise
mg/day initially, may be ↑ every cholesterol. Advise patient to avoid drinking more
4 wk up to 20 mg/day; than one quart of grapefruit juice per day
Concurrent nelfinavir therapy– during therapy (risk of rhabdomyolysis)
Dose should not exceed 40 Medication helps control but does not
mg/day; Concurrent cure elevated serum cholesterol levels.
clarithromycin, itraconazole, Contraindicated in:
saquinavir/ritonavir, Hypersensitivity
darunavir/ritonavir, Active liver disease or unexplained
fosamprenavir, or persistent elevations in AST and ALT
fosamprenavir/ritonavir OB: Potential for fetal anomalies
therapy– Dose should not Lactation: May appear in breast milk.
exceed 20 mg/day
Zocor •Adjunctive •Lowering of total and LDL GI: abdominal cramps, constipation, PO: liver function tests
simvastatin management of cholesterol and diarrhea, flatus, heartburn, altered taste, O: days ;hiperbilirubinemia ;
Class. primary triglycerides. Slightly drug-induced hepatitis, dyspepsia, ↑ liver P:2-4 weeks jaundice; ↑ alkaline
lipid-lowering agents hypercholesterol increases HDL cholesterol. enzymes, nausea, pancreatitis D:unknown phosphatase
Class. emia and mixed •Slows the progression of GU: erectile dysfunction
hmg coa reductase inhibitors dyslipidemias. coronary atherosclerosis Derm: rashes, pruritus
(statin) •Secondary with resultant decrease in MS: RHABDOMYOLYSIS, arthralgia,
prevention of coronary heart disease- immune-mediated necrotizing myopathy,
The 80 mg dose should be myocardial related events. myopathy (↑ risk with 80 mg dose)
restricted to patients who have infarction, Nursing implications:
been taking this dose for ≥12 coronary •Obtain a diet history, especially with
mo without evidence of muscle revascularization, regard to fat consumption
toxicity stroke, and Evaluate serum cholesterol and
PO: (Adults) 5–40 mg once cardiovascular triglyceride levels before initiating, after
daily in the evening; if LDL goal mortality in 4–6 wk of therapy, and periodically
cannot be achieved with 40 patients with thereafter
mg/day dose, add another clinically evident •Monitor liver function tests prior to
lipid-lowering therapy (do not ↑ coronary heart initiation of therapy and as clinically
simvastatin dose to 80 disease indicated.
mg/day). Concurrent
verapamil, diltiazem, or Contraindicated in:
dronedarone therapy– Dose Hypersensitivity
should not exceed 10 mg/day. Concurrent use of strong CYP3A4
Concurrent amiodarone, inhibitors (protease inhibitors, azole
amlodipine or ranolazine antifungals, erythromycin, clarithromycin,
therapy– Dose should not telithromycin, nefazodone, boceprevir,
exceed 20 mg/day; Concurrent telaprevir, or grapefruit juice),
lomitapide therapy– ↓ dose by gemfibrozil, cyclosporine or danazol (↑
50% (dose should not exceed risk of myopathy/rhabdomyolysis)
20 mg/day or 40 mg/day for Active liver disease or unexplained
patients who previously persistant elevations in AST/ALT
received 80 mg/day chronically OB: Lactation: Pregnancy or lactation
[for ≥12 mo] without evidence
of myopathy).
PO: (Children 10–17 yr): 10

mg/day initially, may be ↑ at 4
wk intervals up to 40 mg/day.
Concurrent amiodarone,
amlodipine or ranolazine
therapy– Dose should not
exceed 20 mg/day Concurrent
verapamil or diltiazem therapy–
Dose should not exceed 10
mg/day.
Renal Impairment
PO: (Adults) CCr <10 mL/min–
5 mg/day initially, titrate
carefully.
Zofran •Prevention of Blocks the effects of CNS: headache, dizziness, drowsiness, PO,IV: May cause transient
ondansetron nausea and serotonin at 5-HT3– fatigue, weakness O: rapid ↑ in serum bilirubin,
Class. vomiting receptor sites (selective CV: TORSADE DE POINTES, QT P:15-30 min AST, and ALT levels
antiemetics associated with antagonist) located in interval prolongation D:4-8 hr
highly or vagal nerve terminals and GI: constipation, diarrhea, abdominal
Pharm. Class. moderately the chemoreceptor trigger pain, dry mouth, ↑ liver enzymes IM:
five ht3 antagonists emetogenic zone in the CNS. Neuro: extrapyramidal reactions O:rapid
chemotherapy. Nursing implications P:40 min
PO: (Adults) Prevention of •PO: Prevention Therapeutic Effects: Monitor ECG in patients with D:unknown
nausea/vomiting associated of nausea and Decreased incidence and hypokalemia, hypomagnesemia, HF,
with highly-emetogenic vomiting severity of nausea and bradyarrhythmias, or patients taking
chemotherapy– 24 mg 30 min associated with vomiting following concomitant medications that prolong the
prior to chemotherapy. radiation therapy. chemotherapy or surgery. QT interval
PO: (Adults and Children >11 •Prevention and •Assess patient for nausea, vomiting,
yr): Prevention of treatment of abdominal distention, and bowel sounds
nausea/vomiting associated postoperative prior to and following administration.
with moderately emetogenic nausea and •Assess patient for extrapyramidal
chemotherapy– 8 mg 30 min vomiting. effects (involuntary movements, facial
prior to chemotherapy and grimacing, rigidity, shuffling walk,
repeated 8 hr later; 8 mg q 12 trembling of hands) periodically during
hr may be given for 1–2 days therapy
following chemotherapy.
Prevention of radiation-induced Contraindicated in:
nausea/vomiting– 8 mg 1–2 hr Hypersensitivity;
prior to radiation; may be Orally disintegrating tablets contain

repeated q 8 hr, depending on aspartame and should not be used in
type, location, and extent of patients with phenylketonuria;
radiation. Prevention of Congenital long QT syndrome;
postoperative Concurrent use of apomorphine.
nausea/vomiting– 16 mg 1 hr Use Cautiously in:
before induction of anesthesia. Hepatic impairment (daily dose not to
PO: (Children 4–11 yr): exceed 8 mg);
Prevention of nausea/vomiting Abdominal surgery (may mask ileus);
associated with moderately OB: Lactation: Pedi: Pregnancy,
emetogenic chemotherapy– 4 lactation, or children ≤3 yr (PO) or <1 mo
mg 30 min prior to (parenteral) (safety not established).
chemotherapy and repeated 4
and 8 hr later; 4 mg q 8 hr may
be given for 1–2 days following
chemotherapy.
IV: (Adults) Prevention of
chemotherapy-induced
nausea/vomiting– 0.15 mg/kg
(max dose = 16 mg) 30 min
prior to chemotherapy,
repeated 4 and 8 hr later.
IM: IV: (Adults) Prevention of
postoperative
nausea/vomiting– 4 mg before
induction of anesthesia or
postoperatively.
IV: (Children 6 mo–18 yr):
Prevention of chemotherapy-
induced nausea/vomiting– 0.15
mg/kg (max dose = 16 mg) 30
min prior to chemotherapy,
repeated 4 and 8 hr later.
IV: (Children 1 mo–12 yr and
>40 k g): Prevention of
postoperative
nausea/vomiting– 4 mg.
IV: (Children 1 mo–12 yr and
≤40 kg): Prevention of
postoperative
nausea/vomiting– 0.1 mg/kg.
Hepatic Impairment
PO: IM: IV: (Adults) Severe

hepatic impairment– Not to
exceed 8 mg/day
Reglan •Prevention of •Blocks dopamine CNS: drowsiness, extrapyramidal PO: May alter hepatic
metoclopramide chemotherapy- receptors in reactions, restlessness, NEUROLEPTIC O: 30-60 min function test results.
Class. induced emesis. chemoreceptor trigger MALIGNANT SYNDROME, anxiety, P:unknown •May cause ↑ serum
antiemetics •Treatment of zone of the CNS. depression, irritability, tardive dyskinesia D: 1-2 hr prolactin and
postsurgical and •Stimulates motility of the CV: arrhythmias (supraventricular IM: aldosterone
Prevention of Chemotherapy- diabetic gastric upper GI tract and tachycardia, bradycardia), hypertension, O: 10-15 min concentrations.
Induced Vomiting stasis. accelerates gastric hypotension P:unknown
PO: IV: (Adults and Children) •Facilitation of emptying. GI: constipation, diarrhea, dry mouth, D:1-2 hr
1–2 mg/kg 30 min before small bowel nausea IV:
chemotherapy. Additional intubation in Therapeutic Effects: Nursing implications O:1-3 min
doses of 1–2 mg/kg may be radiographic •Decreased nausea and •Assess for nausea, vomiting, abdominal P:immediate
given q 2–4 hr, pretreatment procedures. vomiting. distention, and bowel sounds before and D:unknown
with diphenhydramine will ↓ the •Management of •Decreased symptoms of after administration.
risk of extrapyramidal reactions gastroesophagea gastric stasis. •Assess for extrapyramidal side effects
to this dose. l reflux. •Easier passage of (parkinsonian– difficulty speaking or
Facilitation of Small Bowel •Treatment and nasogastric tube into small swallowing, loss of balance control, pill
Intubation prevention of bowel rolling, mask-like face, shuffling gait,
IV: (Adults and Children > 14 postoperative rigidity, tremors; and dystonic– muscle
yr): 10 mg over 1–2 min. nausea and spasms, twisting motions, twitching,
IV: (Children 6–14 yr): 2.5–5 vomiting when inability to move eyes, weakness of arms
mg (dose should not exceed nasogastric or legs) periodically throughout course of
0.5 mg/kg) over 1–2 min. suctioning is therapy.
IV: (Children <6 yr): 0.1 mg/kg undesirable. Monitor for neuroleptic malignant
over 1–2 min. syndrome (hyperthermia, muscle rigidity,
Diabetic Gastroparesis altered consciousness, irregular pulse or
PO: IV: (Adults) 10 mg 30 min BP, tachycardia, and diaphoresis).
before meals and at bedtime Contraindicated in:
for 2–8 weeks. Hypersensitivity;
Gastroesophageal Reflux Possible GI obstruction or hemorrhage;
PO: IM: IV: (Adults) 10–15 mg History of seizure disorders;
30 min before meals and at Pheochromocytoma;
bedtime (not to exceed 0.5 Parkinson's disease.
mg/kg/day). A single dose of
20 mg may be given
preventively. Some patients
may respond to doses as small

as 5 mg.
PO: IM: IV: (Neonates, Infants,
and Children): 0.4–0.8
mg/kg/day in 4 divided doses.
Postoperative
Nausea/Vomiting
IM: IV: (Adults and Children >
14 yr): 10 mg at the end of
surgical procedure, repeat in
6–8 hr if needed.
IM: IV: (Children <14 yr): 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 (unlabeled)
Pepcid •Short-term Inhibits the action of CNS: confusion, dizziness, drowsiness, PO: Monitor CBC with
famotidine treatment of histamine at the H2- hallucinations, headache O:within 60 min differential
Class. active duodenal receptor site located CV: ARRHYTHMIAS P: 1-4 hr periodically during
antiulcer agents ulcers and primarily in gastric parietal GI: constipation, diarrhea, nausea D: 6-12 hr therapy
benign gastric cells, resulting in inhibition GU: ↓ sperm count, erectile dysfunction •May cause an ↑ in
Pharm. Class. ulcers. of gastric acid secretion. Endo: gynecomastia IV: serum
histamine h2 antagonists •Maintenance Hemat: AGRANULOCYTOSIS, O: within 60 transaminases and
therapy for Therapeutic Effect(s): APLASTIC ANEMIA, anemia, min serum creatinine.
PO: (Adults) Short-term duodenal ulcers •Healing and prevention of neutropenia, thrombocytopenia P:0.5-3 hr •Antagonize effects
treatment of active ulcers– 40 after healing of ulcers. Local: pain at IM site D:8-15 hr of pentagastrin and
mg/day at bedtime or 20 mg active ulcer(s). •Decreased symptoms of Nursing Implications: histamine during
twice daily for up to 8 •Management of gastroesophageal reflux. •Assess for epigastric or abdominal pain gastric acid
wk.Duodenal ulcer gastroesophagea •Decreased secretion of and frank or occult blood in the stool, secretion testing.
prophylaxis– 20 mg once daily l reflux disease gastric acid. emesis, or gastric aspirate. Avoid administration
at bedtime. GERD– 20 mg (GERD). •Geri: Assess elderly and debilitated for 24 hr preceding
twice daily for up to 6 wk; up to •Treatment of patients routinely for confusion. the test.
40 mg twice daily for up to 12 heartburn, acid
wk for esophagitis with indigestion, and Contraindicated in:
erosions, ulcerations, and Hypersensitivity
continuing symptoms. Gastric sour stomach Phenylketonuria (chewable tablets only)

hypersecretory conditions– 20 (OTC use). OB: Crosses placenta; no adequate
mg q 6 hr initially, up to 160 mg •Management of human studies
q 6 hr. OTC use– 10 mg for gastric Lactation: Discontinue breastfeeding to
relief of symptoms; for hypersecretory avoid exposure of infant to serious side
prevention–10 mg 60 min states (Zollinger- effects.
before eating or take 10 mg as Ellison Use Cautiously in:
chewable tablet 15 minutes syndrome). Renal impairment (more susceptible to
before heartburn-inducing •Prevention and adverse CNS reactions; ↑ dosage
foods or beverages (not to treatment of interval recommended if CCr <10
exceed 20 mg/24 hr for up to 2 stress-induced mL/min)
wk). upper GI Pedi: Injection contains benzyl alcohol
PO: IV: (Children 1–12 yr): bleeding in which has been associated with gasping
Peptic ulcer– 0.5 mg/kg/day as critically ill syndrome in neonates
a single bedtime dose or in patients. Geri: More susceptible to adverse CNS
divided doses twice daily reactions; dose ↓ recommended
(maximum: 40 mg daily);
GERD– 1 mg/kg/day in divided
doses twice daily (maximum:
80 mg daily).
PO: (Infants > 3 mo–1 yr):
GERD– 0.5 mg/kg/dose twice
daily.
PO: (Infants and neonates < 3
mo): GERD– 0.5 mg/kg/dose
once daily.
IV: (Adults) 20 mg q 12 hr.
Renal Impairment
PO: (Adults) CCr 10–50
mL/min- administer normal
dose q 24 hr or 50% dose at
normal dosing intervalCCr <10
mL/min– 20 mg at bedtime;
interval may need to be ↑ to
every 36–48 hr
Protonix •Erosive Binds to an enzyme in the CNS: headache PO: May cause abnormal
pantoprazole esophagitis presence of acidic gastric GI: PSEUDOMEMBRANOUS COLITIS, O: 2.5 hr liver function tests,
Class. associated with pH, preventing the final abdominal pain, diarrhea, eructation, P:unknown including ↑ AST,
antiulcer agents GERD. transport of hydrogen ions flatulence D: 1 week ALT, alkaline
into the gastric lumen. Endo: hyperglycemia
Pharm. Class. •Decrease Therapeutic Effects: F and E: hypomagnesemia (especially if IV: phosphatase, and
proton pump inhibitors relapse rates of •Diminished accumulation treatment duration ≥3 mo) O:15-30 min bilirubin.
daytime and of acid in the gastric Nursing implications P:2 hr •May cause
GERD nighttime lumen, with lessened acid •Assess patient routinely for epigastric or D: unknown hypomagnesemia.
PO: (Adults) 40 mg once daily. heartburn reflux. abdominal pain and for frank or occult Monitor serum
PO: (Children ≥5 yr): 15–39 kg symptoms on •Healing of duodenal blood in stool, emesis, or gastric magnesium prior to
–20 mg once daily for up to 8 patients with ulcers and esophagitis. aspirate. and periodically
wk; ≥40 kg –40 mg once daily GERD. •Decreased acid secretion during therapy.
for up to 8 wk. •Pathologic in hypersecretory Contraindicated in:
IV: (Adults) 40 mg once daily gastric conditions. Hypersensitivity;
for 7–10 days. hypersecretory OB: Should be used during pregnancy
Gastric Hypersecretory conditions. only if clearly needed;
Conditions Lactation: Discontinue breast feeding
PO: (Adults) 40 mg twice daily, due to potential for serious adverse
up to 120 mg twice daily. reactions in infants
IV: (Adults) 80 mg q 12 hr (up
to 240 mg/day
Insulin, regular •Control of •Lowers blood glucose Endo: HYPOGLYCEMIA IV: Monitor blood
Humulin, R hyperglycemia in by:◦stimulating glucose Local: lipodystrophy, pruritus, erythema, O: 10-30 min glucose every 6 hr
Novolin R patients with uptake in skeletal muscle swelling P:15-30 min during therapy
Class. diabetes mellitus. and fat, Misc: ALLERGIC REACTIONS D:30-60 min
antidiabetics •Concentrated ◦inhibiting hepatic glucose INCLUDING ANAPHYLAXIS
hormones regular insulin U- production. Nursing implications Subq:
High Alert: Medication errors 500: Only for use Assess patient periodically for symptoms
involving insulins have resulted in patients with •Other actions of of hypoglycemia (anxiety; restlessness; O:30-60 min
in serious patient harm and insulin insulin:◦inhibition of tingling in hands, feet, lips, or tongue; P:2-4 hr
death requirements lipolysis and proteolysis, chills; cold sweats; confusion; cool, pale D:5-7 hr
>200 units/day. ◦enhanced protein skin; difficulty in concentration;
Dose depends on blood Unlabeled synthesis. drowsiness; nightmares or trouble
glucose, response, and many Use(s): sleeping; excessive hunger; headache;
other factors irritability; nausea; nervousness;
Ketoacidosis–Regular (100 Treatment of tachycardia; tremor; weakness; unsteady
units/mL) Insulin Only hyperkalemia gait) and hyperglycemia (confusion,
IV: (Adults) 0.1 unit/kg/hr as a drowsiness; flushed, dry skin; fruit-like
continuous infusion. breath odor; rapid, deep breathing,
IV: Children Loading dose-0.1 polyuria; loss of appetite; unusual thirst)
unit/kg, then maintenance during therapy.
continuous infusion 0.05–0.2 Overdose is manifested by symptoms of
unit/kg/hr, titrate to optimal rate hypoglycemia. Mild hypoglycemia may
of decrease of serum glucose be treated by ingestion of oral glucose.

of 80–100 mg/dL/hr. Severe hypoglycemia is a life-
Maintenance Therapy threatening emergency; treatment
SC: (Adults and Children) 0.5– consists of IV glucose, glucagon, or
1 unit/kg/day in divided doses. epinephrine.
Adolescents during rapid
growth– 0.8–1.2 unit/kg/day in Contraindicated in:
divided doses. Hypoglycemia;
Treatment of Hyperkalemia Allergy or hypersensitivity to a particular
SC: IV: (Adults and Children) type of insulin, preservatives, or other
dextrose 0.5–1 g/kg combined additives.
with insulin 1 unit for every 4–5 Use Cautiously in:
g dextrose given. Stress or infection–may temporarily ↑
insulin requirements;
Renal/hepatic impairment–may ↓ insulin
requirements;
Concomitant use with pioglitazone or
rosiglitazone (↑ risk of fluid retention and
worsening HF)
OB: Pregnancy may temporarily ↑ insulin
requirements
Insulin 70/30 Ther. Class. Action Contraindicated in: NPH Lab Test
Regular insulin In antidiabetics Lower blood glucose by: Hypoglycemia; subcutaneous: Considerations: May
combination with: NPH hormones stimulating glucose uptake Allergy or hypersensitivity to a particular onset 2- cause ↓ serum
insulins (Humulin 70/Regular Pharm. Class. in skeletal muscle and fat, type of insulin, preservatives, or other 4h;peak 4- inorganic
insulin30, Novolin 70/Regular Pancreatics inhibiting hepatic glucose additives. 10h;duration phosphate,
insulin30). production. Use Cautiously in: 10-16h magnesium, and
Control of Other actions: Stress and infection (may temporarily ↑ 70%NPH- potassium levels.
hyperglycemia in inhibition of lipolysis and insulin requirements); 30%Regular Monitor blood
Dose depends on blood patients with type proteolysis, Renal/hepatic impairment (may ↓ insulin insulin mixture: glucose every 6 hr
glucose, response, and 1 or type 2 enhanced protein requirements); onset 30 min; during therapy, more
many other factors diabetes mellitus. synthesis. Concomitant use with pioglitazone or peak 2- frequently in
SC: (Adults and Children) rosiglitazone (↑ risk of fluid retention and 12h;duration ketoacidosis and
0.5–1 unit/kg/day. worsening HF) 24h times of stress.
Adolescents during rapid OB: Pregnancy may temporarily ↑ insulin Hemoglobin A1C
growth– 0.8–1.2 units/kg/day requirements; may also be
Pedi: Safety of Humalog not established monitored every 3–6
mo to determine
Adverse Reactions/Side Effects effectiveness.
Endo: HYPOGLYCEMIA
Local: erythema, lipodystrophy, pruritis,
swelling
Misc: ALLERGIC REACTIONS

INCLUDING ANAPHYLAXIS
*
Assess for symptoms of hypoglycemia
(anxiety; restlessness; tingling in hands,
feet, lips, or tongue; chills; cold sweats;
confusion; cool, pale skin; difficulty in
concentration; drowsiness; excessive
hunger; headache; irritability; nightmares
or trouble sleeping; nausea;
nervousness; tachycardia; tremor;
weakness; unsteady gait) and
hyperglycemia (confusion, drowsiness;
flushed, dry skin; fruit-like breath odor;
rapid, deep breathing, polyuria; loss of
appetite; nausea; vomiting; unusual
thirst) periodically during therapy.
Monitor body weight periodically.
Changes in weight may necessitate
changes in insulin dos
Lantus Control of •Lowers blood glucose by : Endo: HYPOGLYCEMIA Subq: •Monitor blood
Insulin glargine hyperglycemia in ◦stimulating glucose Local: lipodystrophy, pruritus, erythema, O:3-4 hr glucose every 6 hr
Class. patients with type uptake in skeletal muscle swelling P:none during therapy
hormones 1 and type 2 and fat, Misc: ALLERGIC REACTIONS D:24 hr
diabetes mellitus. ◦inhibiting hepatic glucose INCLUDING ANAPHYLAXIS
High Alert: Medication errors production. Nursing implications
involving insulins have resulted Assess for symptoms of hypoglycemia
in serious patient harm and •Other actions of insulin: (anxiety; restlessness; tingling in hands,
death ◦inhibition of lipolysis and feet, lips, or tongue; chills; cold sweats;
proteolysis, confusion; cool, pale skin; difficulty in
SC: (Adults and Children ≥6 ◦enhanced protein concentration; drowsiness; nightmares or
yr): Initiation in patients with synthesis. trouble sleeping; excessive hunger;
type 2 diabetes already being headache; irritability; nausea;
treated with oral antidiabetic nervousness; tachycardia; tremor;
agents– 10 units once daily; weakness)and hyperglycemia
then adjusted on the basis of (confusion, drowsiness; flushed, dry skin;
patient's needs (range 2–100 fruit-like breath odor; rapid, deep
units/day), Conversion from breathing, polyuria; loss of appetite;
other intermediate- or long- unusual thirst) periodically during
acting insulin Use 80% of the therapy.
total daily NPH or dose once
daily, then adjust on the basis •Instruct patient on proper technique for
of patient's needs administration. Include type of insulin,
equipment (syringe, cartridge pens,
alcohol swabs), storage, and place to
discard syringes. Discuss the importance
of selection and rotation of injection
sites, and compliance with therapeutic
regimen.
Toxicity Overdose:
Overdose is manifested by symptoms of
hypoglycemia. Mild hypoglycemia may
be treated by ingestion of oral glucose.
Severe hypoglycemia is a life-
threatening emergency; treatment
consists of IV glucose, glucagon, or
epinephrine. Recovery from
hypoglycemia may be delayed due to the
prolonged effect of subcut insulin
glargine.
Contraindicated in:
Hypoglycemia
Allergy or hypersensitivity to insulin
glargine

Drug Information Worksheet: Hypertension - 40 Twice Daily

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Drug Information Worksheet: Hypertension - 40 Twice Daily

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Medication and Dose Uses / Purpose Mode of Action Time Labs / VS

contraindications: hypersensitivity, cross

Contraindicated in: Hypersensitivity,

Significant renal impairment (CCr <30

•Instruct patient to take atenolol as

Contraindicated in: Uncompensated

mg/day. Migraine prevention– also decreased, administer atropine

Contraindicated in: Uncompensated

may precipitate life-threatening

Contraindicated in: Hypersensitivity;

Cardizem CD •Hypertension. Inhibits transport of Onset: Total serum calcium

BP and pulse before and frequently

Cardene Management of: I bits the transport of Onset: Total serum Ca

double doses. May need to be

Contraindicated in: Hypersensitivity;

Procardia XL Management of: Inhibits calcium transport Onset: Total serum Ca

•Monitor BP and pulse before therapy,

Contraindicated in: Hypersensitivity;

Contraindicated in: Hypersensitivity;

•Treatment of Therapeutic Effects: Monitor BP and pulse frequently during 1 yr in patients at

Acute Myocardial Infarction

immediately; Lactation: Discontinue

Plavix Reduction of Inhibits platelet Onset: Monitor bleeding

Contraindicated in: Hypersensitivity;

coumarins ◦Atrial fibrillation Nursing interventions: Duration: antidote is vitamin K

Contraindicated in: Uncontrolled

therapeutic anticoagulation with or non-Q-wave

SC: (Adults ≥75 yr): 0.75 mg/kg

(patients <75 yr)– Single IV bolus of

Contraindicated in: Hypersensitivity;

combined piperacillin- Death of susceptible Hemat: bleeding, leukopenia, phosphatase LDH.,

Contraindicated in: Hypersensitivity to

bacterial sinusitis ◦mitoxantrone

penicillin or its •Enterococcus faecalis, •Monitor IV site closely. Vancomycin is

Inhalational anthrax (post- pyelonephritis, including: ◦Staphylococcus prolongation. GI: HEPATOTOXICITY,

Contraindicated in: Hypersensitivity to

IV: SC: (Adults) Continuous

Epidural: (Adults) Intermittent

IT: (Adults) 0.2–1 mg. Use

Percocet –combination Oxycodone PO

opioid analgesics Oxycodone: Acetaminophe

Acetaminiphen Adverse reactions/side affects:

If an opioid antagonist is required to

Side effects/ adverse reactions for

have hypersensitivity or intolerance to these

occurs during application, remove patch

PO: (Adults) 80–325 mgonce Cross-sensitivity with other NSAIDs may

then 200 mg twice daily as Cross-sensitivity may exist with other

higher temperatures (not to Assess patient for skin rash frequently

spinal cord injury:

the initial dose in each of 2 practitioner independently check original

subsequent doses at 6–12 hr

PO: (Children 5–10 yr):

intervals. Maintenance dose–

Colace PO: Prevention •Promotes incorporation of EENT: throat irritation PO:

PO: (Children 10–17 yr): 10

prior to radiation; may be Orally disintegrating tablets contain

PO: IM: IV: (Adults) Severe

may respond to doses as small

continuing symptoms. Gastric sour stomach Phenylketonuria (chewable tablets only)

of decrease of serum glucose be treated by ingestion of oral glucose.

Misc: ALLERGIC REACTIONS