GENERIC NAME: FERROUS SULFATE

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

DRIED: Feosol, Feratab, Slow FE, Slow Release Iron
CLASSIFICATION: Antianemic, iron
ACTION: Normal daily intake males 12-20 mg; Iemales 8-15 mg; only 10 absorbed;
Iron absorbed by Irom duodenum and upper jejunum by active mechanism thru mucosal
cells, combines with transIerring; iron stored as hemosiderin or aggregated Ierritin in
reticuloendothelial cells oI liver, spleen, bone marrow; 2/3 oI iron in circulating RBC`s
INDICATIONS: Prophylaxis, treatment oI iron deIiciency and iron-deIiciency anemia`s;
dietary supplement Ior iron
ROUTES OF ADMINISTRATION: Drops, Elixir, Tablets, Slow-Release Tablets
USUAL DOSAGE: Anemia prophylaxis: Adults 300 mg/day; peds 5 mg/kg/day
Anemia: 300 mg twice a day increased to 4 times a day as needed/tolerated
Peds: 10 mg/kg/day
DRIED: Anemia Prophylaxis: Adults 200 mg/day; peds 5 mg/kg/day
Anemia: 200 mg 3 times a day up to 200 mg 4 times a day as needed/tolerated
10 mg/kg 3 times daily
Slow release tablets: Adults 160 mg 1-2 times per day: NOT Ior children
ADVERSE REACTIONS: Constipation, gastric irritation, nausea, abdominal cramps,
anorexia, diarrhea, dark-colored stools
INTERACTIONS: GI absorption oI iron: oral antacids, calcium salts, cholestyramine,
cimetidine, histamine H-2 receptor antagonists, pancreatic extracts, proton pump
inhibitors, vitamin E, St. John`s wort; GI absorption oI iron: ascorbic acid,
chloramphenicol; Thyroid hormone and trientine: DO NOT USE TOGETHER
CONTRAINDICATIONS: Hemosiderosis, Hemochromatosis, peptic ulcer, regional
enteritis, ulcerative colitis, hemolytic anemia, pyridoxine-responsive anemia, liver
cirrhosis
NURSING CONSIDERATIONS: Substitution oI one iron salt Ior another without
proper adjustment may result in serious over or under dosing; Eggs, milk, coIIee or tea
may signiIicantly inhibit iron absorption; Ingestion oI calcium and iron supplements can
decrease iron absorption by 1/3; Iron absorption is not decreased iI calcium bicarbonate
used between meals
GENERIC NAME: AMOXICILLIN
TRADE NAME: Amoxil, DisperMox, Trimox, Wymox, Polymox
CLASSIFICATION: Antibiotic, penicillin
ACTION: Synthetic broad-spectrum penicillin closely related to ampicillin; Binds to
bacterial cell wall (PBP-1 and PBP-3; penicillin-binding sites), causing cell death by
inhibiting cell wall synthesis; bactericidal action; spectrum is larger than penicillin`s
INDICATIONS: Ear, nose, and throat inIections due to Streptococcus species, S.
pneumoniae, Staphvlococcus species or Haemophilus influen:ae; GU inIections due to E.
coli, P. mirailis, or E. faecalis; lower resp tract inIections due to Streptococcus species,
S. pneumoniae, Staphvlococcus species, or H. haemophilus; acute uncomplicated
gonococcal inIections due to N. gonorrhoeae
ROUTES OF ADMINISTRATION: Capsules; Oral Suspension; Tablets; Chewable
Tablets
USUAL DOSAGE: Over 40 kg: 500 mg q 8 hr or 500 mg q 12 hr; under 40 kg: 20
mg/kg/day in divided doses q 8 hr or 25 mg/kg/day in divided doses q 12 hr
Less than 40 kg: 20 mg/kg/day in divided doses q 8 hr OR 25 mg/kg/day in divided doses
q 12 hr
ADVERSE REACTIONS: Hypersensitivity, nausea & vomiting, gastritis, stomatitis;
speciIic allergies
INTERACTIONS: Antacids eIIect oI PCNs related to GI tract absorption, antibiotics
eIIect oI PCNs, aspirin eIIect oI PCNs by plasma protein binding, chloramphenicol
and erythromycins either or eIIects, tetracyclines eIIect oI PCNs
CONTRAINDICATIONS: Hypersensitivity to PCNs; PO use oI PCNs during acute
stages oI emphysema, bacteremia, pneumonia, meningitis, pericarditis, and purulent or
septic arthritis; lactation
NURSING CONSIDERATIONS: Inject slowly; causes local irritation via IV/IM; IM
injections deep into gluteal muscle; IV injections usually diluted with IV solution; Assess
Ior allergic reactions (iI reaction occurs, stop drug immediately); monitor vitals, chem.
Results; assess Ior 20 min aIter administering to check Ior allergies; should be prescribed
cautiously to nursing mothers; take Iull dosage; report unusual symptoms i.e.
bruising/bleeding, sore throat, rash, diarrhea, symptoms worsening, or lack oI response
GENERIC NAME: DOXYCYCLINE
TRADE NAME: Vibramycin, Monodox, Periostat, Vibra-Tabs, Vibrox, Adoxa,
Doxyhexal, Atridox
CLASSIFICATION: Tetracycline antibiotics
ACTION: Inhibits protein synthesis by binding to the ribosomal 305 subunit. Block
binding oI Aminoacyl transIer RNA to the messenger RNA complex. Cell wall synthesis
is not inhibited.
INDICATIONS: Chancroid, tularemia, plague, bartonellosis, cholera, Rocky Mountain
spotted Iever, typhus group, Q Iever, tick Ievers, rickettsialpox, respiratory tract
inIections, trachoma, inclusion conjunctivitis, uncomplicated urethral, endocervical, or
rectal inIections, psittacosis, relapsing Iever, nongonococal urethritis, chronic UTI`s, also
used Ior oral care Ior chronic adult periodonitis
ROUTES OF ADMINISTRATION: Capsules, Enteric-Coated Capsules, IV, Oral
Suspension, Syrup, Tablets, Delayed-Release Tablets
USUAL DOSAGE: InIection: 100mg q 12hr Iirst day then 100mg/day
Chronic UTI`s: 100 mg q 12 hr
IV: 200 mg IV on day one given in 1 or 2 inIusions, then 100-200 mg depending on
severity (200 mg given in 1 or 2 inIusions)
Gel 10: apply to aIIected area Ior periodontal disease; gel hardens releasing
doxycycline Ior about 7 days
ADVERSE REACTIONS: Anorexia, nausea & vomiting, diarrhea,
dizziness, headache, rashes
INTERACTIONS: eIIect oI doxycycline by liver breakdown;
Methotrexzate: possible GI and hematologic toxicity aIter high doses oI
methotrexate
CONTRAINDICATIONS: Prophylaxis oI malaria in pregnant individuals
and in children less than 8 years old; use during pregnancy (may stunt Ietal
growth) and children up to 8 years old (may cause permanent teeth
discoloration); lactation
NURSING CONSIDERATIONS: Do not conIuse with Dicyclomine;
check Ior any allergic/hypersensitivity reactions; note expiration date
(expired Doxycycline is nephrotoxic; Malaria prophylaxis can start 1-2 days
prior to travel, during travel, and up to 4 weeks aIter leaving malarial area;
protect Irom light
GENERIC NAME: ACETAMINOPHEN
TRADE NAME: Tylenol, Panadol, MANY others
CLASSIFICATION: Coal tar, non-narcotic analgesic
ACTION: Decreases Iever by 1) a hypothalamic eIIect leading to sweating and
vasodilation and 2) inhibits the eIIect oI pyrogens on the hypothalamic heat-regulating
centers. May cause analgesia by inhibiting CNS prostaglandin synthesis; however, due to
minimal eIIects on peripheral prostaglandin synthesis, acetaminophen has no anti-
inIlammatory or uricosuric eIIects. Does not cause any anticoagulant eIIect or ulceration
oI the GI tract. Antipyretic and analgesic eIIects are comparable to those oI aspirin.
INDICATIONS: 1) Control oI pain due to headache, earache, dysmenorrheal, arthralgia,
mylagia, musculoskeletal pain, arthritis, immunizations, teething, tonsillectomy 2)
Reduces Iever in bacterial or viral inIections 3) Substitute Ior aspirin in upper GI disease,
aspirin allergy, bleeding disorders, anticoagulant therapy, gouty arthritis.
ROUTES OF ADMINISTRATION: Caplets, Capsules, Sprinkle Capsules, Elixir,
Gelcaps, Oral Liquid/Syrup, Oral Solution, Syrup, Tablets, Chewable Tablets,
Dispersible Tablets
USUAL DOSAGE: Adults: 325-650 mg q 4 hr, up to max oI 1 g q 6 hr; Extended-relieI
caplets; 2 caplets (1,300 mg) q 8 hr; most all other administration; 1,300 mg q 8 hr
EIIervescent granules: 1 or 2 / capIuls placed in empty glass, then Iilled with water; q 4
hr iI needed
ADVERSE REACTIONS: Few when taken in usual therapeutic doses; GI upset in
some; Chronic and even acute toxicity can develop aIter long symptom-Iree usage
INTERACTIONS: Chronic EtOH toxicity oI larger therapeutic doses; barbiturates,
carbamazepine, hydantoins, isoniazid, riIampin & sulIinpyrazone: hepatotoxicity
potential related to liver breakdown; activated charcoal absorption when given ASAP
aIter overdose; NSAIDs risk oI hypertension in women; oral contraceptives liver
breakdown ; propranolol eIIect related to liver breakdown; smoking possible serum
levels related to hepatic metabolism
CONTRAINDICATIONS: Renal insuIIiciency, anemia; clients with cardiac or
pulmonary disease are more susceptible to acetaminophen toxicity
NURSING CONSIDERATIONS: Do not exceed more than 4 grams/day in adults and
75 mg/kg/day in children; do not take Ior ~5 days (children), ~10 days (adults), and ~3
days (adult or child Iever) without consulting provider; monitor chem. studies with long-
term usage; take as directed with milk or water to decrease GI upset; report paleness,
weakness and heartbeat skip (hemolytic anemia)
GENERIC NAME: DIPYRIDAMOLE
TRADE NAME: Persantine
CLASSIFICATION: Anticoagulant, platelet adhesion inhibitor
ACTION: Lengthens abnormally shortened platelet survival time; in higher
doses may act by several mechanisms, including inhibition oI red blood cell
uptake oI adenosine, itselI an inhibitor oI platelet reactivity; inhibition oI
platelet phosphodiesterase, which leads to accumulation oI cAMP within
platelets; direct stimulation oI release oI prostacyclin or prostaglandin D
2
;
and/or inhibition oI thromboxane A
2
Iormation
INDICATIONS: As an adjunct to coumarin anticoagulants in preventing
post-operative thromboembolic complications oI cardiac valve replacement
ROUTES OF ADMINISTRATION: Tablets
USUAL DOSAGE: 75 100 mg Iour times daily as adjunct to warIarin
therapy
ADVERSE REACTIONS: Dizziness, abdominal distress, headache, rash,
diarrhea, liver dysIunction (rare), Angina pectoris, Ilushing, pruritus
INTERACTIONS: Digoxin bioavailability
CONTRAINDICATIONS: Use with caution in hypotension (can cause
peripheral vasodilation); caution during lactation
NURSING CONSIDERATIONS: Monitor vital signs, EKG, chem. tests;
document mental status, skin color, cardiopulmonary Iindings; helps prevent
clots by inhibiting platelet stickiness; avoid alcohol and tobacco usage due
to hypotensive vasoconstrictive eIIects; avoid use oI unprescribed drugs
without approval; avoid quick movements due to BP; try small meals
Irequently iI nausea or gastric distress experienced
GENERIC NAME: FUROSEMIDE
TRADE NAME: Lasix
CLASSIFICATION: Diuretic, loop
ACTION: Inhibits the reabsorption oI Na

and Cl
-
in the proximal, distal tubes and the
ascending Loop oI Henle resulting in the excretion oI Na, Cl, and, to a lesser degree, K
and bicarbonate ions; resulting urine is more acidic; diuretic action independent oI
changes in clients` acid-base balance; has slight antihypertensive eIIect
INDICATIONS: Edema associated with CHF, nephritic syndrome, hepatic cirrhosis, and
ascites; IV Ior acute pulmonary edema; PO to treat hypertension in conjunction with
spironolacetone, triamterene, and other diuretics except ethacrynic acid
ROUTES OF ADMINISTRATION: Oral Solution; Tablets; IV; IM
USUAL DOSAGE: Edema: Initially, 20 80 mg/day as single dose; can be increased by
20-40 mg q 6-8 hrs until desired diuretic response is obtained: Hypertension: 40 mg twice
daily: HTN: 2-2.5 grams/day
IM; IV: Initial 20-40 mg (iI no improvement, aIter 2 hrs increase in 20 mg increments)
IV: 40 mg slowly over 1-2 min (iI inadequate aIter 1 hr, give 80 mg slowly over 1-2 min)
ADVERSE REACTIONS: Jaundice, hearing impairment, hypotension, water/electrolyte
depletion, pancreatitis, abdominal pain, dizziness, anemia
INTERACTIONS: Charcoal - absorption Irom GI tract; CloIibrate enhances diuretic
eIIect, hydantoins diuretic eIIect, propranolol - plasma propranolol levels
CONTRAINDICATIONS: Never use with ethacrynic acid; anuria, hypersensitivity to
drug, severe renal disease associated with azotemia and oliguria, hepatic coma associated
with electrolyte depletion; lactation
NURSING CONSIDERATIONS: Is a potent diuretic; excess amounts can lead to
proIound diuresis with water and electrolyte depletion; individualize dosage; do not
conIuse Lasix with Lanoxin; Iood decreases bioavailability and ultimately the degree oI
diuresis; give IV injections slowly over 1-2 min; with renal impairment or iI receiving
other oxotoxic drugs, observe Ior oxotoxicity; assess closely Ior signs oI vascular
thrombosis
GENERIC NAME: TEMAZEPAM
TRADE NAME: Restoril
CLASSIFICATION: Sedative-hypnotic, benzodiazepine
ACTION: Benzodiazepine derivative; believed to potentiate
GABA neuronal inhibition; hypnotic action involves GABA
receptors in the CNS; drug decreases sleep latency, the number oI
awakenings, and time spent in awake stage
INDICATIONS: Insomnia in clients unable to Iall asleep, with
Irequent awakenings during the night, and/or early morning
awakenings
ROUTES OF ADMINISTRATION: Capsules
USUAL DOSAGE: 15-30 mg at bedtime (7.5 mg may be
suIIicient Ior some to improve sleep latency); in elderly or
debilitated, initially 7.5-15 mg until response determined
ADVERSE REACTIONS: Drowsiness, dizziness, lightheadedness, incoordination,
tremors, Ialling, palpitations, suicide attempts, respiratory depression and sleep apnea
INTERACTIONS: Alcohol/anesthetics/antihistamines/barbiturates/CNS
depressants/narcotics/phenothiazines/nonbarbiturate sedative-hypnotics - potentiates or
adds to CNS depressant eIIects; concomitant use may lead to drowsiness, lethargy,
stupor, respiratory collapse, coma, or death;
cimetidine/disulIiram/erythromycin/Ilouxetine/isoniazid/ketoconazole/metoprolol/ oral
contraceptives/probenecid/propoxyphene/ranitidine/riIampin/valproic acid - eIIect oI
Temazepam reacting to liver breakdown
CONTRAINDICATIONS: Pregnancy, hypersensitivity, acute narrow-angle glaucoma,
psychoses, primary depressive order, psychiatric disorders in which anxiety is not a
signiIicant symptom
NURSING CONSIDERATIONS: Store Irom 15-25C(68-77F) in well-closed light-
resistant container; take only as directed; do not increase dose; assess sleep patterns, diet,
liIestyle, routines; determine any depression or addiction history; may cause daytime
drowsiness
GENERIC NAME: DIGOXIN
TRADE NAME: Digitek, Digoxin Injection Pediatric, Lanoxicaps, Lanoxin
CLASSIFICATION: Cardiac glycoside
ACTION: Increases Iorce and velocity oI myocardial contraction (positive inotropic
eIIect) by increasing reIractory period oI the AV node and increasing total peripheral
resistance; eIIect is due to inhibition oI Na/K-ATPase in the sarcolemmal membrane,
which alters excitation-contraction coupling; inhibiting Na/K-ATPase results in increased
Ca inIlux and increased release oI Iree Ca ions within the myocardial cells, which then
potentiate the contractility oI cardiac muscle Iibers
INDICATIONS: CHF, including that due to venous congestion, edema, dyspnea,
orthopnea, and cardiac arrhythmia; May be drug oI choice Ior CHF due to rapid onset,
relatively short duration, and ability to be administered PO or IV; Control oI rapid
ventricular contraction rate in clients with A-Fib or Ilutter; Slow HR in sinus tachycardia
due to CHF; SVT; Prophylaxis and treatment oI recurrent paroxysmal atrial tachycardia
with paroxysmal AV junctional rhythm; Cardiogenic shock; Apical HR ~ 60
ROUTES OF ADMINISTRATION: Capsules, Elixir, Tablets
USUAL DOSAGE: Initial: 0.4-0.6 mg initially Iollowed by 0.1-0.3 mg q 6-8 hr
Maintenance: 0.05mg-0.35mg once or twice daily
Tablets/Elixir: Initial: 0.75-1.25 mg divided into 2 or more doses given q 6-8 hrs
Maintenance: 0.125-0.5 mg/day IV: Same as tablets, then 0.125-0.5 mg/day
ADVERSE REACTIONS: Tachycardia, headache, dizziness, mental disturbances,
nausea & vomiting, diarrhea, anorexia, blurred or yellowed vision
INTERACTIONS: The Iollowing drugs increase serum digoxin levels, leading to
possible toxicity: Aminoglycosides, amiodarone, anticholinergics, atorvastatin,
benzodiazepines, captopril, diltiazem, dipyridamole, erythromycin, esmolol, Ilecainide,
hydroxychloroquine, ibuproIen, indomethacin, itraconazole, niIedipine, quinidine,
quinine, telmisartan, tetracyclines, tolbutamide, verapamil;
Ephedra/ephedrine/epinephrine - chance oI cardiac arrhythmias
CONTRAINDICATIONS: V-Fib or tachycardia (unless congestive Iailure supervenes
aIter protracted episode not due to digitalis), in presence oI digoxin toxicity,
hypersensitivity to cardiac glycosides, beriberi heart disease, certain cases oI
hypersensitive carotid sinus syndrome
NURSING CONSIDERATIONS: Digoxin is not eIIectively removed by dialysis, by
exchange transIusion, or during cardiopulmonary bypass (most oI drug is in tissues and
not blood); measure liquids precisely; protect Irom light; monitor closely; take aIter
meals to lessen gastric irritation; do not take with grapeIruit juice; do not change brands
(diIIerent preparations diIIer in bioavailability/may cause toxicity or eIIect loss)
GENERIC NAME: DIAZEPAM
TRADE NAME: Diastat, Diazepam, Intensol, Calium, C-IV
CLASSIFICATION: Antianxiety drug, antimanic, benzodiazepine
ACTION: Reduces anxiety by increasing or Iacilitating the inhibitory neurotransmitter
activity oI GABA; skeletal muscle relaxant eIIect may be due to enhancement oI GABA-
mediated presynaptic inhibition at the spinal level as well as in the brain stem reticular
Iormation
INDICATIONS: Management oI anxiety disorders or Ior short-term relieI oI symptoms
oI anxiety; Adjunct therapy in convulsive disorders; Adjunct Ior relieI oI skeletal muscle
spasm caused by reIlex spasm to local pathology; Athetosis, stiII-man syndrome; RelieI
oI anxiety and tension in those undergoing surgical procedures; Acute alcohol withdrawal
Ior symptomatic relieI oI acute agitation; Adjunct therapy in status epilepticus seizures
ROUTES OF ADMINISTRATION: Oral solution, Intensol Solution, Tablets, Rectal
Gel; IM; IV
USUAL DOSAGE: Anxiety: 2-10 mg 2-4 X daily: Acute alcohol withdrawal 10 mg 3-4
X the Iirst day then 5 mg 3-4 X daily: IV/IM: 5-10 mg IM or IV, repeat in 3-4 hrs iI
needed: Acute alcohol withdrawal: 10 mg IV or IM init; then 5-10 mg in 3-4 hr iI needed:
Status epilepticus: initial: 5-10 mg IV (preIerred), may be repeated at 10-15 min intervals
up to 30 mg; may repeat therapy in 2-4 hrs
ADVERSE REACTIONS: Transient drowsiness, ataxia, conIusion
INTERACTIONS: Potentiates antihypertensive eIIects oI thiazides and other diuretics;
potentiates muscle relaxant eIIect oI d-tubocurarine and gallamine; Iluoxetine/isoniazid -
halI-liIe oI diazepam; ranitidine - GI absorption oI diazepam; smoking possible
diazepam hepatic metabolism leading to response;
Alcohol/anesthetics/antihistamines/barbiturates/CNS
depressants/narcotics/phenothiazines/nonbarbiturate sedative-hypnotics - potentiates or
adds to CNS depressant eIIects; concomitant use may lead to drowsiness, lethargy,
stupor, respiratory collapse, coma, or death;
cimetidine/disulIiram/erythromycin/Ilouxetine/isoniazid/ketoconazole/metoprolol/ oral
contraceptives/probenecid/propoxyphene/ranitidine/riIampin/valproic acid - eIIect oI
Diazepam reacting to liver breakdown
CONTRAINDICATIONS: Hypersensitivity, acute narrow-angle glaucoma, psychoses,
primary depressive order, psychiatric disorders in which anxiety is not a signiIicant
symptom, children under 6 months, lactation, and parenterally in children under 12 years
NURSING CONSIDERATIONS: Except Ior deltoid muscle, absorption Irom IM sites
is slow, erratic and painIul (not generally recommended); IV route preIerred in
convulsing client; parenteral administration may cause bradycardia, respiratory/cardiac
arrest; have emergency equipment/drugs available; assess emotional status; note
depression or drug abuse; drug acts by slowing down nervous system; avoid alcohol
GENERIC NAME: WARFARIN SODIUM
TRADE NAME: Coumadin
CLASSIFICATION: Anticoagulant, coumarin derivative
ACTION: InterIeres with synthesis oI vitamin K-dependent clotting Iactors
resulting in depletion oI clotting Iactors II, VII, IX, and X; Has no direct
eIIect on an established thrombus although therapy may prevent Iurther
extension oI a Iormed clot as well as secondary thomboembolic problems
INDICATIONS: Prophylaxis and treatment oI venous thrombosis and its
extension; Prophylaxis and treatment oI atrial Iibrillation with embolization;
Prophylaxis and treatment oI pulmonary embolism; Prophylaxis and
treatment oI thromboembolic complications associated with atrial Iibrillation
ROUTES OF ADMINISTRATION: IV, Tablets
USUAL DOSAGE: Init: 5-10 mg/day Ior 2-4 days; then adjust dose on
prothrombin or INR determinations (lower in geriatric or debilitated
patients): Maintenance: 2-10 mg/day based on prothrombin or INR
ADVERSE REACTIONS: Bleeding/hemorrhage is main side eIIect; may occur Irom
any organ or tissue
INTERACTIONS: WarIarin is responsible Ior more adverse drug interactions than any
other group; clients on anticoagulant therapy must be monitored careIully each time a
drug is added or withdrawn; since potentiation may mean hemorrhages, a lengthened
prothrombin time (PT) or International Normalized Ratio (INR) warrants reduction oI the
dosage oI the anticoagulant; MULTIPLE DRUG INTERACTIONS (too many to list)
CONTRAINDICATIONS: Lactation; IM use; use oI large loading dose (30 mg) is not
recommended due to increased risk oI hemorrhage and lack oI more rapid protection
NURSING CONSIDERATIONS: Take oral warIarin as prescribed and at same time
each day; must be compliant with drug therapy; do not change brands (may alter
response); does not dissolve clots but decreases clotting ability oI blood and helps to
prevent Iormation oI blood clots in vessels and heart valves; avoid IM shots, activities
that may cause injury or cuts and bruises; protect Irom light (store at controlled room
temperature); dispense in tight light-resistant container; vial not Ior multiple uses; discard
unused solution; note any bleeding tendencies; determine iI pregnant (may cause Ietal
malIormations and neonatal hemorrhage)
GENERIC NAME: OXYCODONE AND ACETOMINOPHEN
TRADE NAME: Percocet, Endocet, Roxicet, Roxilox, Tylox, C-11
CLASSIFICATION: Analgesic
ACTION: Semi synthetic opiate that combines with speciIic receptors
located in CNS to produce various eIIects; mechanism is believed to involve
decreased permeability oI cell membrane to Na, which results in diminished
transmission oI pain impulses and analgesia; causes mild sedation and no
antitussive eIIect; most eIIective in relieving acute pain; does not cause any
anticoagulant eIIect or ulceration oI GI tract
INDICATIONS: RelieI oI moderate to moderately severe pain
ROUTES OF ADMINISTRATION: Caplets, Capsules, Oral Solution,
Tablets
USUAL DOSAGE: 5 mL oI oral solution q 6 hr or 1 caplet, capsule or
tablet q 6 hr as needed Ior pain
ADVERSE REACTIONS: Dizziness, light-headedness, nausea & vomiting, sedation,
sweating, itching, dry mouth, constipation
INTERACTIONS: Anticholinergic drugs production oI paralytic ileus; tricyclic
antidepressants - eIIect oI either TCAs or oxycodone; CNS depressants additive CNS
depression; MAO inhibitors - eIIect oI either the MAO inhibitor or oxycodone
CONTRAINDICATIONS: Hypersensitivity to either oxycodone or acetaminophen; can
produce drug dependence and has abuse potentials
NURSING CONSIDERATIONS: Combination drug; do not conIuse Percocet and
Percodan; do not conIuse oxycodone with oxyContin; assess Ior drug seeking behaviors;
take only as directed; may take with Iood to decrease GI upset; do not share drugs; keep
in saIe place; drug may cause dizziness and drowsiness; may cause constipation, nausea
& vomiting, rash/itching, and physical dependence; avoid alcohol and any other CNS
depressants without provider approval; tolerance may occur
GENERIC NAME: DILTIAZEM HYDROCHLORIDE
TRADE NAME: Cardizem CD, CartiaXT, Dilacor XR, Dilt-XR, Diltia XT, Diltiazem
HCl extended-Release, Taztia XT, Tiazac, Cardizem LA (Extended-Release)
CLASSIFICATION: Calcium channel blocker
ACTION: Inhibits inIlux oI Ca through cell membrane, resulting in depression oI
automaticity and conduction velocity in cardiac muscle; Decreases SA and AV
conduction and prolongs AV node eIIective and Iunctional reIractory periods; Also
decreases myocardial contractility and peripheral vascular resistance; decrease in HR
INDICATIONS: Angina pectoris due to coronary artery spasm; Chronic stable angina;
Hypertension (extended- or sustained-release only); Temporary control oI rapid
ventricular rate in A-Fib or Ilutter; Rapid conversion oI paroxysmal SVT to sinus rhythm.
ROUTES OF ADMINISTRATION: Tablets (Immediate- and Extended-Release),
Extended-Release Capsules, IV Bolus, Continuous InIusion IV
USUAL DOSAGE: Angina: initial 30 mg 4X daily, then increase gradually to total dose
oI 180-360 mg (3-4 doses), 180 mg Ext. Release initially, then increase to 360 mg; HTN:
180-240 mg Ext. Release once daily, may titrate up to 540 mg/day: A-Fib IV bolus: 0.25
mg/kg given over 2 min, then iI inadequate, second dose (0.35 mg/kg) in 15 min;
Continuous InI IV: Initial inIusion rate is 10 mg/hr, may be increased in 5 mg increments
to 15 mg/hr
ADVERSE REACTIONS: AV block, bradycardia, edema, dizziness/lightheadedness,
headache, dyspnea, rhinitis, inIection, pain
INTERACTIONS: Amiodarone possible cardiotoxicity with bradycardia and cardiac
output; anesthetics - risk oI depression oI cardiac contractility, conductivity, and
automaticity as well as vascular dilation; Digoxin possible serum digoxin levels;
Lithium - risk oI neurotoxicity; Theophyllines risk oI pharmacologic and toxicologic
theophylline eIIects
CONTRAINDICATIONS: Hypotension or cardiogenic shock; second- or third-degree
AV block and sick sinus syndrome except in presence oI a Iunctioning ventricular
pacemaker; acute MI, pulmonary congestion; IV diltiazem with IV beta-blockers: A-Fib
or atrial Ilutter associated with an accessory bypass tract; ventricular tachycardia; use oI
Cardizem LyoJect Syringe in newborns, lactation
NURSING CONSIDERATIONS: Do not conIuse Cardizem with Cardene; sublingual
nitroglycerin may be taken concomitantly Ior acute angina; diltiazem may also be taken
together with long-acting nitrates; note edema or CHF; review ECG Ior AV block;
monitor vital signs, renal and liver Iunction tests; take extended-release capsules on an
empty stomach; do not open, chew, or crush; swallow whole; may cause
drowsiness/dizziness; record blood pressure Ior review; rise slowly Irom lying to sitting
to standing position
GENERIC NAME: DOCUSATE SODIUM
TRADE NAME: Colace, Dioctyn SoItgels, Docu, D.O.S., D-S-S, Dulcolax
Stool SoItener, Ex-Lax Stool SoItener, Gena SoIt, Non-Habit Forming Stool
SoItener, Phillips Liqui-Gels, Regulex SS, Silace Stool SoItener
CLASSIFICATION: Laxative, Emollient
ACTION: Acts by lowering the surIace tension oI Ieces and promoting
penetration by water and Iat (increases soItness oI Iecal mass; not absorbed
systematically, does not seem to interIere with absorption oI nutrients
INDICATIONS: Lessens strain oI deIecation in persons with hernia or CV
diseases or other diseases in which stool straining should be avoided;
megacolon or bedridden patients; Constipation associated with dry, hard
stools
ROUTES OF ADMINISTRATION: Capsules, SoIt-Gel Capsules, Oral
Liquid, Syrup, Tablets
USUAL DOSAGE: Adults and persons above 12 y/o: 50-500 mg; Under 3
y/o: 10-40mg; 3-6 y/o: 20-60 mg; 6-12 y/o: 40-120 mg
ADVERSE REACTIONS: Diarrhea, nausea & vomiting, perianal irritation, Ilatulence,
cramps, dehydration, electrolyte balance disturbance due to dehydration
INTERACTIONS: May absorption oI mineral oil Irom GI tract;
CONTRAINDICATIONS: Nausea, vomiting, abdominal pain, intestinal obstruction;
severe abdominal pain due to appendicitis, enteritis, ulcerative colitis, diverticulitis,
intestinal obstruction, Iecal impaction, undiagnosed abdominal pain
NURSING CONSIDERATIONS: Drink glass oI water with each dose; may take oral
solutions with milk or juice to help mask taste; may take 1-3 days to soIten Iecal matter
due to minimally absorbing docusate salts; assess activity levels, diet, water intake,
exercise routines; have client identiIy habits and BM activities; note length oI time it
takes Ior laxative to take eIIect; with abdominal pain and discomIort, note location,
triggers, type oI discomIort, rule out other intestinal disorders/obstruction where laxatives
should not be used
GENERIC NAME: METFORMIN HYDROCHLORIDE
TRADE NAME: Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet
CLASSIFICATION: Oral Antidiabetic, Biguanide
ACTION: Decreases hepatic glucose production, decreases intestinal absorption oI
glucose, increases peripheral uptake and utilization oI glucose; does not cause
hypoglycemia in either diabetic or nondiabetic clients, and does not cause
hyperinsulinemia; insulin secretion remains unchanged, while Iasting insulin levels and
day-long plasma insulin response may decrease
INDICATIONS: As monotherapy, as adjunct to diet and exercise, to improve glycemic
control in clients with type 2 diabetes; Immediate-release tablets and PO solution can be
used in clients 10 yrs and older; Extended Release Iorm used to treat type 2 diabetes as
initial therapy or in conjunction with a sulIonylurea or insulin in clients 17 y/o and older
ROUTES OF ADMINISTRATION: Oral Solution, Tablets, Extended-Release Tablets
USUAL DOSAGE: Oral Solution: Adult up to 2,550 mg/day; child up to 2,000 mg/day
Tablets: Start dose 500 mg twice daily with Iood; dosage increases may be made in 500
mg every week, divided doses, up to maximum oI 2,500 mg; II 2,500 mg needed, may be
tolerable in 3 equal doses daily
ADVERSE REACTIONS: Lactic acidosis, hypoglycemia, diarrhea, nausea & vomiting,
asthenia, Ilatulence, headache, abdominal pain/discomIort
INTERACTIONS: Alcohol - metIormin eIIect on lactate metabolism; Furosemide -
metIormin plasma blood levels and metIormin lowers halI-liIe oI Furosemide;
Propantheline - absorption oI metIormin related to slowed GI motility
CONTRAINDICATIONS: Renal disease or dysIunction, or abnormal creatine clearance
(C
CR
) due to cardiovascular collapse, acute MI, or septicemia; in CHF requiring
pharmacologic intervention, acute or chronic metabolic acidosis, including diabetic
ketoacidosis, with or without coma; abnormal hepatic Iunction
NURSING CONSIDERATIONS: Lactic acidosis is a rare, but serious, metabolic
complication that can occur due to metIormin accumulation (50 Iatal); do not conIuse
Glucophage with Glucovance; individualize dosage based on tolerance and eIIectiveness;
give with meals and start at a low dose with gradual escalation (will reduce GI side
eIIects); may saIely switch Irom metIormin to metIormin extended-release; may cause a
metallic taste (will subside)
GENERIC NAME: GUAIFENESIN
TRADE NAME: Naldecon, Senior EX, Robitussin, Scot-Tussin
Expectorant, Siltussin SA, Alterussin, Guiatuss, Humabid Maximum
Strength, Mucinex
CLASSIFICATION: Diabetic Tussin, Organidin NR
ACTION: May increase output oI Iluid Irom respiratory tract by reducing
viscosity and surIace tension oI respiratory secretions, thereby removing
accumulate dsecretions Irom upper and lower airway
INDICATIONS: Dry, nonproductive cough due to colds and minor upper
respiratory tract inIections where there is mucus in respiratory tract; to
loosen phlegm and thin bronchial secretions
ROUTES OF ADMINISTRATION: Oral Liquid, Syrup, Tablets,
Extended-Release Tablets
USUAL DOSAGE: Expectorant: Over 12 y/o 200-400 mg q 4 hr, not
exceeding 2,400 mg/day; 6-11 y/o 100-200 mg q 4 hr not exceeding 1,200
mg/day, 2-5 y/o 50-100 mg q 4 hr not exceeding 600 mg/day, 6 mos-2 yrs
25-50 mg q 4 hr not exceeding 300 mg/day
ADVERSE REACTIONS: Nausea & vomiting; GI discomIort
INTERACTIONS: Inhibition oI platelet adhesiveness by guanIenesin may
result in bleeding tendencies
CONTRAINDICATIONS: Chronic cough (due to smoking, asthma, or
emphysema), cough accompanied by excess secretions; lactation
NURSING CONSIDERATIONS: Assess Ior tobacco use, Iever/chills, loss
oI appetite, or increased Iatigue; iI symptoms persist Ior more than one
week, recur, or are accompanied by a persistent headache, Iever or rash,
notiIy provider; do not perIorm activities that require mental alertness (drug
may cause drowsiness); report any evidence oI increased bruising/bleeding,
Iever, change in secretions, or lack oI response
GENERIC NAME: ALBUTEROL (SALBUTAMOL)
TRADE NAME: AccuNeb, Albuterol HFA, ProAir HFA, Proventil,
Proventil HFA, Ventolin, Ventolin HFA, VoSpire ER
CLASSIFICATION: Sympathomimetic
ACTION: Stimulates Beta-2 receptors oI bronchi leading to
bronchodilation; causes less tachycardia and is longer-acting than
isoprotenerol; has minimal Beta-1 activity; Proventil HFA inhaler contains
no CFC`s
INDICATIONS: Prophylaxis and treatment oI bronchospasm due to
reversible obstructive airway disease; inhalation solution Ior acute attacks oI
bronchospasm; Prophylaxis oI exercise-induced bronchospasm
ROUTES OF ADMINISTRATION: Inhalation Aerosol, Inhalation
Solution, AccuNeb, Tablets, Syrup
USUAL DOSAGE: Proventil: Over 12 y/o 180 mcg (2 puIIs) q 4-6 hr (May
only need one puII or 90 mcg q 4 hr) 4 times daily; same dosage 15 mins
prior to exercise iI needed
ADVERSE REACTIONS: Headache, nausea & vomiting, palpitations/tachycardia,
tremor, bronchospasm
INTERACTIONS: Anesthetics halogenated anesthetics sensitize heart to adrenergics
(causes cardiac arrhythmias); Antidiabetics hyperglycemic eIIect oI epinephrine may
necessitate dosage oI insulin or oral hypoglycemic agents; Digitalis glycosides
combination may cause cardiac arrhythmias; Oxytocics - chance oI severe hypertension
CONTRAINDICATIONS: Tachycardia due to arrhythmias; aerosol Ior prevention oI
exercise-induced bronchospasm and tablets are not recommended Ior children under 12
y/o.
NURSING CONSIDERATIONS: Do not conIuse albuterol with atenolol; when given
by nebulation, use Iace mask or mouthpiece with compressed air or O
2
with Ilowrate oI 6-
10 lpm and should last 5-15 min; contents oI MDI are under pressure (do not store near
heat or open Ilame); Proventil HFA and Ventolin HFA contain hydroIlouroalkane as
propellant; practice breathing techniques Ior administration; when using inhalers, do not
use other albuterol inhalation medication unless speciIically prescribed
GENERIC NAME: NITROGLYCERIN TOPICAL OINTMENT
TRADE NAME: Nitro-Bid
CLASSIFICATION: Coronary Vasodilator
ACTION: Nitrates relax vascular smooth muscle by stimulating production
oI intracellular cyclic guanosine monophosphate. Dilation oI post capillary
vessels decreases venous return to the heart due to pooling oI blood; thus leIt
ventricle end-diastolic pressure is reduced; Relaxation oI arterioles results in
a decreased systemic vascular resistance and arterial pressure; Oxygen
requirements oI the myocardium are reduced and there is more eIIicient
redistribution oI blood Ilow through collateral channels in myocardial tissue
INDICATIONS: Prophylaxis and treatment oI angina pectoris due to CAD;
onset oI action not rapid enough to be used to abort an acute anginal attack
ROUTES OF ADMINISTRATION: 2 Ointment
USUAL DOSAGE: 2 daily inch doses (7.5 mg); apply one on rising in
morning and one 6 hr later; can be doubled and then doubled again iI no
response and iI tolerable
ADVERSE REACTIONS: Headache (may be severe and persistant), Ilushing,
dizziness, weakness, hypotension, paresthesia
INTERACTIONS: Ethyl alcohol hypotension and cardiovascular collapse related to
vasodilator eIIect oI both agents; antihypertensive drugs additive hypotension; aspirin -
serum levels and eIIects oI nitrates; heparin possible eIIect; narcotics additive
hypotensive eIIect
CONTRAINDICATIONS: Sensitivity oI nitrates, which may result in severe
hypotensive reaqctions, MI, or tolerance to nitrates; severe anemia, cerebral hemorrhage,
recent head trauma, postural hypotension, closed angle glaucoma, impaired hepatic
Iunction, hypertrophic cardiomyopathy, hypotension, recent MI
NURSING CONSIDERATIONS: Do not use Nitro-Bid with Nicobid; Store Irom 15-
30C (59-86F); squeeze ointment onto application papers and Iold paper in halI, rub
back and Iorth, apply onto non-hairy part oI skin; rotate sites to prevent irritation; once
dose established, use same type oI covering to ensure same amount administered each
time; remove at bedtime or as directed to prevent tolerance or loss oI drug eIIect
GENERIC NAME: MULTIVITAMINS
TRADE NAME: Centrum, One-A-Day, Equate Complete
CLASSIFICATION: Essential, organic, non-caloric, required Ior normal metabolism
ACTION: Essential Ior promoting growth, health, vitality, liIe, general well being,
prevention and cure oI many health problems and diseases; necessary Ior metabolic
processes responsible Ior transIorming Ioods into energy or tissue; Iormation and
maintenance oI red blood cells, chemicals supporting the nervous system, hormones and
genetic material
INDICATIONS: Fat-soluble A, D, E, K; water-soluble C, B-complex; do not
provide energy (non-caloric) but some convert calories in Iats, carbohydrates, and
proteins into usable body energy; cannot be assimilated without ingesting Iood; should be
taken with a meal; regulate metabolism, help convert Iat and carbohydrates into energy;
assist in Iorming bone and tissue
ROUTES OF ADMINISTRATION: Tablet
USUAL DOSAGE: A 5,000 (males), 4000 (Iemales) international units (IU); B
1
0.3-
1.5mg; B
2
0.4-2.0mg; B
3
5-20mg; B
6
1.3-1.7mg; Folacin 400mcg; Pantothenic
acid 4-7mg; B
12
6mcg; B
7
100-300mcg; C 90mg (men), 75mg (women), extra
35mg (smokers); D 100-1500 IU; E 22-33 IU; K 80mcg (men), 65mcg (women)
SEVERE DIFICIENCY DISEASES: Scurvy, Rickets, Pellagra, pernicious anemia,
xerophthalmia, beriberi, osteomalacia, inIantile hemolytic anemia, hemorrhagic diseases
oI newborn; moderate vitamin deIiciencies may also produce symptoms oI impaired
health
INTERACTIONS: No major interactions involved; water-soluble vitamins mix well in
blood, are excreted by kidneys, only small amounts accumulate in tissues; regular intake
essential; Iat-soluble vitamins stored in body aIter binding to speciIic plasma globulins in
Iat parts oI body; may accumulate in body and cause adverse reactions
CONTRAINDICATIONS: No adverse eIIects; no contraindications; vitamin D
deIiciency is oIten underdiagnosed and undertreated in older population; clients with
impaired liver Iunction should not take large amounts oI Iat-soluble vitamins unless
speciIically prescribed due to toxicity potential Irom cumulative eIIects; pregnant and
breast-Ieeding women require more oI some vitamins than most adults; vitamin
deIiciency usually involves multiple rather than single deIiciencies and is rare in US; can
usually be attributed to poor liIestyle choices or poor dietary habits with inadequate
intake oI many vitamins.
NURSING CONSIDERATIONS: Document indications Ior therapy; assess metabolic
panel and vitamin levels; monitor levels to ensure requirements met and levels are as
desired; well-balanced diet with Ioods Irom basic groups is best source; take with Iood
Ior best absorption; avoid selI-medication greater than RDA amounts
GENERIC NAME: METOPROLOL TARTRATE
TRADE NAME: Lopressor
CLASSIFICATION: Beta-adrenergic Blocking Agent
ACTION: Combines reversibly mainly with beta
1
-adrenergic receptors to block the
response to sympathetic nerve impulses, circulating catecholamines, or adrenergic drugs;
Blockage oI beta
1
-receptors decreases heart rate, myocardial contractility, and cardiac
output and slows AV conduction, all oI which decreases blood pressure
INDICATIONS: Hypertension; Acute MI in hemodynamically stable patients; Angina
pectoris
ROUTES OF ADMINISTRATION: Injection, Tablets
USUAL DOSAGE: Hypertension: 100 mg/day in single or divided doses; may be
increased weekly to 100-450 mg/day; Angina pectoris; 100 mg/day in 2 divided doses,
can be increased weekly until response obtained or heart rate slows; eIIective dose is 100-
400 mg/day; Aggressive behavior: 200-300 mg/day; Ventricular arrhythmias: 200
mg/day: IV: Early MI treatment: Three IV bolus injections oI 5 mg each at approx. 2 min
intervals; then give 50 mg q 6 hr PO starting 15 min aIter last IV dose; continue Ior 48
hrs then 100 mg twice a day, continue Ior 1-3 months
ADVERSE REACTIONS: Fatigue, dizziness, depression, shortness oI breath,
bradycardia, diarrhea
INTERACTIONS: Oral contraceptives/quinidine may metoprolol eIIects;
diphenhydramine - metoprolol clearance prolonged negative chronotropic and
inotropic eIIects in extensive metabolizers; methimazole/propylthiouracil may
metoprolol eIIects; riIampin - metoprolol eIIect related to liver metabolism
CONTRAINDICATIONS: MI in clients with a heart rate oI less than 45 bpm, in
second- or third-degree heartblock, or iI SBP is less than 100 mm Hg; moderate to severe
cardiac Iailure
NURSING CONSIDERATIONS: Do not conIuse metoprolol with metoclopramide,
metaproterenol, or misoprostol; iI transcient worsening oI heart Iailure occurs, treat with
increased doses oI diuretics; may need to lower dose oI metoprolol or temporarily
discontinue; Ior CHF, do not increase dose until symptoms oI worsening CHF have been
stabilized; iI CHF clients experience symptomatic bradycardia, reduce dose; take dose
each day at same time; do not stop suddenly
GENERIC NAME: TRIAMTERENE AND HYDROCHLOROTHIAZIDE
TRADE NAME: Dyazide, Maxzide, Maxzide-25 MG
CLASSIFICATION: Antihypertensive, combination drug
ACTION: Triamterence acts directly on the distal tubule to promote the excretion oI
sodium, bicarbonate, chloride, and Iluid; Increases urinary pH; Hydrochlorothiazide
promotes excretion oI sodium and chloride and thus water by distal renal tubule; Also
increases excretion oI potassium and smaller amounts oI bicarbonate; Antihypertensive
eIIects due to direct dilation oI arterioles as well as Iluid volume loss
INDICATIONS: Hypertension or edema in clients who maniIest hypokalemia on
hydrochlorothiazide alone; in clients requiring a diuretic and in whom hypokalemia can
not be risked; usually not Iirst line oI therapy except when avoiding hypokalemia
ROUTES OF ADMINISTRATION: Capsules, Tablets
USUAL DOSAGE: Capsules: 37.5mgT/25mgH 1-2 capsules once daily;
50mgT/25mgH 1-2 capsules (possibly just need one capsule)
Tablets: 37.5mgT/25mgH 1-2 tablets daily or 75mgT/25mgH 1 tablet daily
ADVERSE REACTIONS: Nausea & vomiting, headache, anorexia, GI upset, diarrhea,
Ilatulence, dizziness, photosensitivity
INTERACTIONS: Anesthetics Thiazides may eIIects oI anesthetics; antidiabetic
agents thiozides antagonize hypoglycemic drug eIIects; antihypertensive agents
thiazides potentiate drug eIIects; corticosteroids enhanced potassium loss related to
potassium-losing properties oI both drugs; digoxin thiazides produce K and Mg loss
with chance oI digitalis-induced arrhythmias; Iurosemide proIound diuresis and
electrolyte loss; insulin - eIIect related to thyazide-induced hyperglycemia;
tetracyclines - risk oI azotemia; vitamin D - eIIect oI vitamin D related to thiazide-
induced hypercalcemia
CONTRAINDICATIONS: Clients receiving other potassium-sparing drugs (amiloride,
spironolactone); use in anuria, acute or chronic renal insuIIiciency, signiIicant renal
impairment, preexisting elevated serum potassium
NURSING CONSIDERATIONS: Assess Ior alcoholism (megaloblastic anemia may
occur because triamterene is weak antagonist oI Iolic acid; monitor vital signs and tests
(reduce dose with dysIunction; drug is taken to lower BP and reduce swelling oI
extremities (take in AM with Iood to reduce GI upset); check Ior signs/symptoms oI
blood dyscrasia (sore throat, rash, Iever); check Ior signs oI anemia; avoid alcohol, OTC
agents, potassium supplements, salt substitutes that contain potassium, Ioods high in
potassium (drug is potassium-sparing)
GENERIC NAME: POTASSIUM SALTS
TRADE NAME: K Care ET
CLASSIFICATION: Electrolyte Supplements
ACTION: Potassium is readily and rapidly absorbed Irom the GI tract. Potassium
chloride is used because hypochloremia Irequently accompanies potassium deIiciency;
Potassium deIiciency can be prevented or corrected through dietary measures
INDICATIONS: Treat Hypokalemia due to digitalis intoxication, diabetic acidosis,
diarrhea and vomiting, Iamilial periodic paralysis, certain cases oI uremia,
hyperadrenalism, starvation and debilitation, and corticosteroid or diuretic therapy;
Hypokalemia with or without metabolic acidosis and Iollowing surgical conditions
accompanied by nitrogen loss, vomiting and diarrhea, suction drainage, and increased
urinary excretion oI potassium; Prophylaxis oI potassium depletion when dietary intake is
not adequate in certain patients (CHF) with diuretics, hepatic cirrhosis with ascites,
excess aldosterone
ROUTES OF ADMINISTRATION: Capsules, SLOW IV, Tablets
USUAL DOSAGE: HIGHLY individualized: IV inIusion; serum less than 2.0 mEq/L
400 mEq/day at rate not exceeding 40 mEq/hr; serum less than 2.5 mEq/L 200 mEq/day
not exceeding 20 mEq/hr: Capsules/Tablets 16-24 mEq/day Ior hypokalemia prophylaxis
ADVERSE REACTIONS: Nausea & vomiting, diarrhea, Ilatulence, abdominal
discomIort
INTERACTIONS: ACE inhibitors may cause potassium retention hyperkalemia;
digitalis glycosides cardiac arrhythmias; potassium-sparing diuretics severe
hyperkalemia with possibility oI cardiac arrhythmias or arrest
CONTRAINDICATIONS: Severe renal Iunction impairment with azotemia or oliguria,
postoperatively beIore urine Ilow has been reestablished, crush syndrome, Addison`s
disease, hyperkalemia Irom any cause, anuria, heat cramps, acute dehydration, severe
hemolytic reactions, adynamia episodica hereditaria, clients receiving potassium-sparing
diuretics or aldosterone-inhibiting drugs
NURSING CONSIDERATIONS: Give PO 3-4 times/day; correct hypokalemia
gradually over 3-7 days to avoid hyperkalemia; administer dilute liquid solutions oI
potassium with esophageal compression; check administration site Irequently Ior pain
and redness (drug extremely irritating); note impaired renal Iunction; assess adequate
urinary Ilow beIore administering potassium; withhold drug, report abdominal pain,
distention, GI bleeding; check Ior signs oI hypokalemia (weakness, Iatigue, cardiac
arrhythmias)
GENERIC NAME: HEPARIN SODIUM AND SODIUM CHLORIDE
TRADE NAME: Heparin sodium and 0.45 Sodium Chloride, Heparin Sodium and 0.9
Sodium Chloride
CLASSIFICATION: Heparin, Anticoagulant
ACTION: Does not dissolve previously Iormed clots, but Iorestalls enlargement and prevents
new clots Irom Iorming; Potentiates inhibitory action oI antithrombin III; Occurs due to
Iormation oI a complex with antithrombin III and causing a conIormational change in
antithrombin III molecule; Action oI thrombin in coagulation is inhibited; Also prevents
Iormation oI a stable Iibrin clot by inhibiting the activation oI Iibrin-stabilizing Iactor by
thrombin
INDICATIONS: Pulmonary/peripheral arterial embolism; Prophylaxis and treatment oI venous
thrombosis and extensions; Atrial Iibrillation with embolization; Treatment and diagnosis oI DIC;
in low doses to prevent DVT and PE in pregnant clients with thromboembolism history and
others; Prophylaxis oI clotting in blood transIusions and others
ROUTES OF ADMINISTRATION: Deep Subcutaneous, Intermittent IV, Continuous IV,
Special Uses
USUAL DOSAGE: Deep SC: Initial loading dose 10,000-20,000 units; maintenance dose 8,000-
10,000 units q 8 hr or 15,000-20,000 units q 12 hr: IV Inter: ILD-10,000 units undiluted or in 50-
100mL saline, then 5,000-10,000 units q 4-6 hr undiluted or in 50-100mL saline: Cont IV: ILD-
20,000-40,000 units/day in 1,000mL saline aIter 5,000 units IV
ADVERSE REACTIONS: Hemorrhage ranging Irom minor local ecchymoses to major
hemorrhagic complications Irom any organ, chills, Iever, urticaria, local irritation,
erythema, mild pain, hematoma
INTERACTIONS: Oral
anticoagulants/dipyridamole/hydroxychloroquine/ibuproIen/indomethacin/NSAIDs/ticlop
idine additive prothrombin time;
Antihistamines/digitalis/nicotine/nitroglycerin/tetracyclines - eIIect oI heparin
CONTRAINDICATIONS: Active bleeding, blood dyscrasias (or other bleeding
disorders as in hemophilia), clients with Irail or weakened blood vessels, purpura,
thrombocytopenia, liver disease with hypoprothrombinemia, open wounds, extensive
denudation oI skin, increased capillary permeability; do not administer during surgery oI
eye, brain or spinal cord or during continuous tube drainage oI stomach or small intestine
NURSING CONSIDERATIONS: Do not administer IM; administer by deep subQ
injection to minimize local irritation, hematoma, and tissue sloughing and to prolong drug
action; utilize Z-track method or Bunch technique` method; do not administer within 2
in oI umbilicus (decreased vascularity); do not massage site, slight discoloration does not
aIIect potency; perIorm test dose (1,000 units subQ) on clients with allergies or asthma
history
GENERIC NAME: INSULIN INJECTION (REGULAR)
TRADE NAME: (Human insulin) Humulin R, Novolin R, Novolin R
PenFill, Novolin R PreIilled, Velosulin BR (Pork Insulin) Regular Iletin II
CLASSIFICATION: Rapid-Acting Insulin Product
ACTION: Regular insulin is only preparation suitable Ior IV administration;
ONLY comes in 100 units/mL; rarely used as sole agent due to short
duration oI action; Injections should be clear: Any cloudy or colored
solutions should not be used.
INDICATIONS: Suitable Ior treatment oI diabetic coma, diabetic acidosis,
other emergency situations; especially suitable Ior client suIIering Irom
labile diabetes; during acute phase oI diabetic acidosis or Ior client in
diabetic crisis, client is monitored by serum glucose and serum ketone levels
ROUTES OF ADMINISTRATION: Subcutaneous
USUAL DOSAGE: Diabetes: Adults 5-10 units given 15-30 min prior to
meals and at bedtime (Peds 2-4 units)
ADVERSE REACTIONS: Hypoglycemia, hypokalemia, injection site reaction,
lipodystrophy, pruritus, rash
INTERACTIONS: ACE inhibitors/anabolic steroids/oral
antidiabetics/calcium/chloroquine/cloIibrate/clonidine - hypoglycemic eIIect oI insulin;
Acetazolamide/AIDS antiviral
drugs/albuterol/asparaginase/calcitonin/chlorthalidone/clozapine - hypoglycemic eIIect
oI insulin (ONLY PARTIAL LIST: TOO MANY DRUG INTERACTIONS TO
LIST)
CONTRAINDICATIONS: Hypersensitivity to insulin; during episodes oI
hypoglycemia in clients sensitive to any component oI the product
NURSING CONSIDERATIONS: Assess Ior S/S oI hypoglycemia (drowsiness, chills,
conIusion, anxiety, cold sweats, cool pale skin, excessive hunger, nausea, headache,
irritability, shakiness, rapid pulse, unusual tiredness or weakness); assess S/S Ior
hyperglycemia (thirst, polydipsia, polyuria, drowsiness, blurred vision, loss oI appetite,
Iruity odor to breath, Ilushed dry skin); weigh client to determine amount to be given;
monitor glucose levels careIully in elderly and with hepatic or renal impairment; assess
injection sites, monitor VS (many more considerations; too many to list)
GENERIC NAME: ISOPHANE INSULIN SUSPENSION (NPH)
TRADE NAME: (Human) Humulin N, Novolin N, Novolin N PenFill,
Novolin N PreIilled
CLASSIFICATION: Intermediate-Acting Insulin product
ACTION: Contains zinc insulin crystals modiIied by protamine, appearing
as cloudy or milky suspension; Not recommended Ior emergency use; not
suitable Ior IV administration or in presence oI ketosis
INDICATIONS: Replacement therapy in Type 1 Diabetes; Type 2 diabetes
when other methods have Iailed, blood sugars are signiIicantly elevated, or
with surgery, trauma, inIection, Iever, endocrine dysIunction, pregnancy,
gangrene, Raynoud`s disease, kidney or liver dysIunction
ROUTES OF ADMINISTRATION: Subcutaneous
USUAL DOSAGE: 7-26 units as single dose 30-60 min beIore breakIast:
second similar or smaller dose may be given prior to dinner or at bedtime;
can be increased in increments oI 2-10 units at daily or weekly intervals
ADVERSE REACTIONS: Hypoglycemia, hypokalemia, injection site reaction,
lipodystrophy, pruritus, rash, allergic reactions
INTERACTIONS: ACE inhibitors/anabolic steroids/oral
antidiabetics/calcium/chloroquine/cloIibrate/clonidine - hypoglycemic eIIect oI insulin;
Acetazolamide/AIDS antiviral
drugs/albuterol/asparaginase/calcitonin/chlorthalidone/clozapine - hypoglycemic eIIect
oI insulin (ONLY PARTIAL LIST: TOO MANY DRUG INTERACTIONS TO
LIST)
CONTRAINDICATIONS: Hypersensitivity to insulin; during episodes oI
hypoglycemia in clients sensitive to any component oI the product
NURSING CONSIDERATIONS: Assess Ior S/S oI hypoglycemia (drowsiness, chills,
conIusion, anxiety, cold sweats, cool pale skin, excessive hunger, nausea, headache,
irritability, shakiness, rapid pulse, unusual tiredness or weakness); assess S/S Ior
hyperglycemia (thirst, polydipsia, polyuria, drowsiness, blurred vision, loss oI appetite,
Iruity odor to breath, Ilushed dry skin); weigh client to determine amount to be given;
monitor glucose levels careIully in elderly and with hepatic or renal impairment; assess
injection sites, monitor VS (many more considerations; too many to list)
GENERIC NAME: METHYLPREDNISOLONE SODIUM SUCCINATE
TRADE NAME: A-methaPred, Solu-Medrol
CLASSIFICATION: Glucocorticoid
ACTION: Anti-inIlammatory eIIect is due to inhibition oI prostaglandin synthesis; drug
also inhibits accumulation oI macrophages and leukocytes at sites oI inIlammation and
inhibits phagocytosis and lysosomal enzyme release; low incidence oI increased appetite,
peptic ulcer, psychic stimulation, and sodium and water retention; may mask negative
nitrogen balance
INDICATIONS: Severe hepatitis due to alcoholism; within 8 hr or severe spinal cord
injury (to improve neurological Iunction); septic shock; nephritic syndrome, including
that due to lupus erythematosus or oI the idiopathic type; hematologic diseases, including
hemolytic anemia, RBC anemia, idiopathic and secondary thrombocytopenic purpura in
adults (IV only), congenital hypoplastic anemia
ROUTES OF ADMINISTRATION: Powder Ior injection
USUAL DOSAGE: Initial 10-40 mg, depending on disease, then adjust dose depending
on response with Iollowing doses either IM or IV: SEVERE conditions 30 mg/kg
inIused IV over 10-20 min, may be repeated q 4-6 hr Ior 2-3 days only
ADVERSE REACTIONS: Small physiologic doses given as replacement therapy or
short-term high-dosage therapy during emergencies rarely cause side eIIects.
INTERACTIONS: Erythromycin - methylprednisolone eIIect related to liver
metabolism; grapeIruit juice - AUC (area under the curve), peak levels, and halI-liIe oI
methylprednisolone related to liver metabolism
CONTRAINDICATIONS: Suspected inIection as drug may mask inIection, peptic
ulcer, phychoses, acute glomerulonephritis, herpes simplex inIections oI the eye, vaccinia
or varicella, Cushing`s syndrome, active tuberculosis, myasthenia gravis, recent intestinal
anastomoses, CHF or other cardiac disease, hypertension, systemic Iungal inIections,
open angle glaucoma
NURSING CONSIDERATIONS: Do not conIuse Solu-Medrol with Solu-CorteI;
dosage must be individualized; use within 48 hours oI preparation; note any aspirin
allergies, monitor vital signs, weight, chemical results; take as directed, may take with
Iood or milk to diminish GI upset
GENERIC NAME: VANCOMYCIN HYDROCHLORIDE
TRADE NAME: Vancocin, Vancoled
CLASSIFICATION: Miscellaneous Antibiotic
ACTION: Appears to bind to bacterial cell wall, arresting its synthesis and lysing the
cytoplasmic membrane by a mechanism that is diIIerent Irom that oI penicillins and
cephalosporins; may also change permeability oI the cytoplasmic membranes oI bacteria,
thus inhibiting RNA synthesis; bactericidal Ior most organisms and bacteriostatic Ior
enterococci
INDICATIONS: PO Antibiotic-induced pseudomembranous colitis due to Clostridium
difficile; Staphylococcal enterocolitis; Severe or progressive antibiotic-induced diarrhea
caused by C. difficile that is not responsive to the causative antibiotic being discontinued;
also Ior debilitated clients IV Severe Staphylococcal inIections in clients who have not
responded to penicillins or cephalosporins, who cannot receive these drugs, or who have
resistant inIections; prophylaxis oI bacterial endocarditis in PCN-allergic patients
ROUTES OF ADMINISTRATION: Capsules, powder Ior injection or oral solution
USUAL DOSAGE: PO 0.5-2 g/day in 3-4 divided doses Ior 7-10 days OR 125 mg 3-4
times per day Ior C.difficile may be as eIIective as 500 mg dosage: IV 500 mg q 6 hr or
1 g q 12 hr
ADVERSE REACTIONS: Oxotoxicity (including tinnitus), chills, coughing,
drowsiness, anorexia, nausea & vomiting, weakness, sore throat, Iever
INTERACTIONS: Anesthetics - risk oI erythema and histamine-like Ilushing in
children; nondepolarizing muscle relaxants - neuromuscular blockage;
nephritic/neurotoxic drugs careIully monitor with concurrent or sequential systemis or
topical use
CONTRAINDICATIONS: Hypersensitivity; minor inIections; lactation
NURSING CONSIDERATIONS: Reduce dosage in renal disease; dilute each 500 mg
vial with 10 mL sterile water (may Iurther be diluted in 200 mL oI dextrose or saline
solution and inIused over 60 min); intermittent inIusion preIerred but may also be
administered with continuous IV drip; avoid rapid IV administration (may result in
hypotension, nausea, warmth, generalized tingling); aqueous solution stable Ior 2 weeks;
assess renal and auditory Iunctions; report adverse drug eIIects such as oxotoxicity and
nephrotoxicity; during IV administration, ensure peak and trough levels are perIormed at
prescribed dosing interval (30 min prior and 1 hr aIter dosage)
GENERIC NAME: AMLODIPINE
TRADE NAME: Amvaz, Norvasc
CLASSIFICATION: Calcium Channel Blocker
ACTION: Inhibits inIlux oI calcium through the cell membrane, resulting in depression
oI automaticity and conduction velocity in cardiac muscle; decreases SA and AV
conduction and prolongs AV node eIIective and Iunctional reIractory periods; slight
decrease in heartrate; possible slight decrease in myocardial contractility; cardiac output
is increased; moderate decrease in peripheral vascular resistance
INDICATIONS: Hypertension alone or in combination with other antihypertensives;
chronic stable angina alone or in combination with other antianginal drugs; vasospastic
angina alone or in combination with other antianginal drugs
ROUTES OF ADMINISTRATION: Tablets
USUAL DOSAGE: 5 mg/day, up to maximum oI 10 mg/day; titrate dose over 7-14 days
ADVERSE REACTIONS: Edema, palpitations, dizziness/lightheadedness,
headache, Iatigue/lethargy, Ilushing
INTERACTIONS: Diltiazem - plasma levels oI amlodipine Iurther
BP; grapeIruit juice - plasma amlodipine levels; Ranitidine - eIIect oI
CCBs related to Iirst-pass metabolism
CONTRAINDICATIONS: Use with grapeIruit juice
NURSING CONSIDERATIONS: Do not conIuse Norvasc with Navane;
Iood does not aIIect bioavailability; elderly clients, small/Iragile clients, or
clients with hepatic insuIIiciency may be started on 2.5 mg/day; take as
directed once daily; may take with or without meals (Iood helps decrease
stomach upset); report signs/symptoms oI chest pain, SOB, dizziness,
swelling oI extremities, irregular pulse, altered vision immediately
GENERIC NAME: CLOTRIMAZOLE TOPICAL CREAM
TRADE NAME: Fungoid, Lotrimin
CLASSIFICATION: AntiIungal
ACTION: Depending on concentration, may be Iungicidal or Iungistatic;
acts by inhibiting the biosynthesis oI sterols, resulting in damage to cell wall
and subsequent loss oI essential intracellular elements due to altered
permeability; may also inhibit oxidative and peroxidative enzyme activity
and inhibit the biosynthesis oI triglycerides and phospholipids by Iungi
INDICATIONS: Broad-spectrum antiIungal; Tinea pedis, tinea cruris, tinea
corporis due to T. rubrum, T. mentagrophvtes, E. floccosum, and M. canis;
candidiasis due to C. albicans, and tinea versicolor due to M. furfur.
ROUTES OF ADMINISTRATION: Topical cream
USUAL DOSAGE: Use daily Ior 2 weeks or 4 weeks depending on disease;
iI symptoms persist, consult provider
ADVERSE REACTIONS: Irritation, rash, stinging, burning, pruritus
INTERACTIONS: Use with caution when lactating
CONTRAINDICATIONS: Hypersensitivity; Iirst trimester oI pregnancy;
in children under 2 y/o; around eyes
NURSING CONSIDERATIONS: Do not allow topical products in eyes;
wash hands beIore and aIter treatments; report adverse eIIects or lack oI
response
GENERIC NAME: FLUCONAZOLE
TRADE NAME: DiIlucan
CLASSIFICATION: AntiIungal
ACTION: Is highly selective inhibitor oI Iungal cytochrome P450 and sterol C-14 alpha-
demethylation; loss oI normal sterols correlates with accumulation oI 14 alpha-methyl
sterols in Iungi and may be responsible Ior the Iungistatic activity; decrease in cell wall
integrity and extrusion oI intracellularmaterial, leading to death
INDICATIONS: Oropharyngeal and esophageal candidiasis; serious systemic candidal
inIection (including UTIs, peritonitis, candidemia, disseminated candidiasis, and
pneumonia); cryptococcal meningitis
ROUTES OF ADMINISTRATION: IV, oral suspension, tablets
USUAL DOSAGE: Candidal UTI and peritonitis 50-200 mg/day: oropharyngeal or
esophageal candidiasis 150 mg as single oral dose
ADVERSE REACTIONS: Following single doses: headache, nausea, abdominal pain,
diarrhea, angioedema; Iollowing multiple doses: Nausea, headache, skin rash, vomiting,
abdominal pain, serious hepatic reactions, seizures
INTERACTIONS: Benzodiazepines and prolonged serum levels CNS depression
and psychomotor impairment; Glyburide plasma glyburide levels related to liver
breakdown; Glipizide plasma glipizide levels related to liver breakdown; oral
contraceptives possible or plasma levels oI ethinyl estradiol and levonorgestrel;
protease inhibitors possible protease inhibitor levels with possible toxicity; MANY
MORE
CONTRAINDICATIONS: Hypersensitivity to Iluconazole, lactation
NURSING CONSIDERATIONS: Daily dose same Ior either IV or PO; store tablets
under 30C (86F); loading dose oI twice daily dose is recommended Ior Iirst day to
obtain plasma levels close to steady state by second day; due to long halI-liIe, once daily
dosing (either IV or PO) is possible; do not use IV solution iI cloudy, precipitated, or seal
broken; do not exceed continuous IV inIusion rate oI 200 mg/hr; check site Irequently Ior
extravasation/necrosis; describe clinical presentation oI Iungal inIection
GENERIC NAME: CEFTAZIDIME
TRADE NAME: Ceptaz, Fortaz, TaziceI, Tazidime
CLASSIFICATION: Cephalosporin, third generation
ACTION: Only Ior IV or IM usage; between 80 and 90 is excreted unused
in urine
INDICATIONS: Lower respiratory tract inIections due to Pseudomonas
aeruginosa and other Pseudomonas species, Haemophilus influen:ae,
Klebsiella species, Enterobacter species, Proteus mirabilis, Escherichia
coli, Serratia species, Citrobacter species, Streptococcus pneumoniae,
Staphvlococcus aureus; Skin and skin structure inIections; UTIs, both
complicated and uncomplicated; bacterial septicemia; bone and joint
inIections; gynecologic inIections; intra-abdominal inIections; CNS
inIections
ROUTES OF ADMINISTRATION: IM, IV
USUAL DOSAGE: Usual inIections IM, IV: 1 g q 8-12 hr; UTIs IM, IV
0.25-0.5 g q 12 hr; pneumonia, mild skin inIections 0.5-1 g q 8 hr
ADVERSE REACTIONS: Nausea & vomiting, diarrhea, yeast inIection oI
mouth or vagina, abdominal pain, stomach cramps, colitis, thrombophlebitis
INTERACTIONS: Colistimethate/colistin/ethacrynic
acid/Iurosemide/polymyxin B/vancomycin - risk oI renal toxicity;
probenecid - eIIect oI cephalosporins by excretion by kidney
CONTRAINDICATIONS: Hypersensitivity to cephalosporins or related
antibiotics
NURSING CONSIDERATIONS: For IM, reconstitute in sterile or
bacteriostatic water or 0.5 or 1 lidocaine injection, use large muscle
mass and inject deeply; IV route is preIerred with bacterial septicemia,
peritonitis, bacterial meningitis, or other severe/liIe threatening inIections;
Ior direct IV, reconstitute 1 g in 10 mL sterile water Ior injection (give over
3-5 min); do not give ceItazidime to solutions containing aminoglycosides
GENERIC NAME: BRIMONIDINE TARTRATE
TRADE NAME: Alphagan P.
CLASSIFICATION: Sympathomimetic
ACTION: An alpha-2 adrenergic receptor antagonist that reduces aqueous
humor production and increases uveoscleral outIlow
INDICATIONS: lower intraocular pressure in open-angle glaucoma or
ocular hypertension
ROUTES OF ADMINISTRATION: Solution Ior eye drops
USUAL DOSAGE: 1 gtt (drop) in the aIIected eye(s) three times a day,
with doses about 8 hr apart
ADVERSE REACTIONS: Hypertension, somnolence, headache, Iatigue,
dizziness, asthenia, oral dryness, upper respiratory symptoms, GI symptoms,
burning/stinging, blurring, Ioreign body sensation, ocular pruritus
INTERACTIONS: Antihypertensives/Beta-adrenergic blockers/cardiac
glycosides May pulse and BP; use caution iI combined; CNS depressants
Possible additive CNS depression; MAOIs DO NOT USE TOGETHER
CONTRAINDICATIONS: Must use MAO inhibitor therapy; lactation;
Use in children less than 2 years old
NURSING CONSIDERATIONS: Give with other topical ophthalmic
drugs 5 min apart; store at or below 25C (77F); document Iindings, ensure
routine screenings; avoid alcohol and other CNS depressants; remove prior
and do not reinsert soIt contact lenses until at least 15 min aIter instillation
GENERIC NAME: QUETIAPINE FUMARATE
TRADE NAME: Seroquel
CLASSIFICATION: Antipsychotic
ACTION: Mechanism unknown but may act as an antagonist at dopamine
D
2
and serotonin SHT
2
receptors; side eIIects may be due to antagonism oI
other receptors (e.g. histamine H
1
, dopamine D
1
, adrenergic alpha
1
and
alpha
2
, serotonin SHT
1A
)
INDICATIONS: Treatment oI schizophrenia; short-term treatment oI acute
manic episodes associated with bipolar 1 disorder either as monotherapy or
adjunct therapy with divalproex or lithium
ROUTES OF ADMINISTRATION: Tablet
USUAL DOSAGE: 25 mg 2 times daily, increases oI 25 to 50 mg 2-3 times
daily on second and third day as tolerated; target dose range Ior Iourth day is
300-400 mg divided into 2 or 3 doses; antipsychotic dose range is 150 to 750
mg/day; iI adjustments are needed, lower or raise by increments oI 25-50 mg
twice daily
ADVERSE REACTIONS: Headache, drowsiness/somnolence, dizziness,
hypotension, tachycardia, constipation, dry mouth, dyspepsia
INTERACTIONS:
Barbiturates/carbamazepine/glucocorticoids/phenytoin/riIampin -
quetiapine eIIect related to liver breakdown; dopamine
antagonists/levodopa quetiapine antagonizes eIIect; thioridazine -
quetiapine clearance
CONTRAINDICATIONS: Lactation
NURSING CONSIDERATIONS: Continue clients who respond to
quetiapine using the lowest dose needed to maintain remission; periodically
reassess; consider slower rate oI titration and lower target dose in elderly,
debilitated clients, or in those who have a predisposition to hypotensive
reactions; store at 15-30C (59-86F); list reasons Ior therapy, clinical
presentation, behavioral maniIestations; avoid alcohol and other OTC agents
without approval; take with or without Iood
GENERIC NAME: CLOTRIMAZOLE
TRADE NAME: Cruex, Desenex, Fungoid, Lotrimin, Lotrimin AF,
Mycelex
CLASSIFICATION: AntiIungal
ACTION: Depending on concentration, may be Iungistatic or Iungicidal;
acts by inhibiting the biosynthesis oI sterols, resulting in damage to the cell
wall and subsequent loss oI essential intracellular elements due to altered
permeability; may also inhibit oxidative and perioxidative enzyme activity
and inhibit biosynthesis oI triglycerides and phospholipids by Iungi
INDICATIONS: Broad-spectrum antiIungal; candidiasis due to C. albicans
and tinea versicolor due to M. furfur; tinea pedis, tinea cruris, and tinea
corporis due to T. rubrum, T. mentagrophvtes, E. floccosum and M. canis
ROUTES OF ADMINISTRATION: Topical and vaginal cream
USUAL DOSAGE: Massage into aIIected skin and surrounding areas twice
daily (morning and evening); reevaluate iI no improvement in 4 weeks
ADVERSE REACTIONS: Skin irritation, rash, burning, stinging, pruritus
INTERACTIONS: None speciIic
CONTRAINDICATIONS: Hypersensitivity; Iirst trimester oI pregnancy;
use around eyes; topically in children under 2 years old
NURSING CONSIDERATIONS: Do not get products in eyes; wash hands
prior and aIter handling product; apply only aIter cleaning aIIected area; use
napkin to prevent staining oI clothing; report lack oI response
GENERIC NAME: ASPIRIN (ACETYLSALICYCLIC ACID, ASA)
TRADE NAME: Empirin, Genprin, Genuine Bayer Aspirin, Maximum Bayer Aspirin,
Extended release Bayer 8-hour caplets, ZORprin, Easprin, MANY MORE
CLASSIFICATION: Nonsteroidal, anti-inIlammatory drug, analgesic, antipyretic
ACTION: Exhibits antipyretic, anti-inIlammatory, and analgesic eIIects; Antipyretic due
to an action on the hypothalamus, resulting in heat loss by vasodilation oI peripheral
blood vessels and promoting sweating; Anti-inIlammatory mediated through inhibition oI
cyclo-oxygenase, which results in a decrease in prostaglandin synthesis and other
mediators oI pain response
INDICATIONS: Analgesic Pain Irom integumentary structures, myalgias, neuralgias,
arthralgias, headache, dysmenorrheal, and similar types oI pain; gout; Antipyretic, Anti-
inIlammatory arthritis, osteoarthritis, SLE, acute rheumatic Iever, gout, and many other
conditions
ROUTES OF ADMINISTRATION: Caplets, gum, suppositories, tablets, chewable
tablets, coated tablets, delayed-release tablets, eIIervescent tablets, enteric-coated tablets
USUAL DOSAGE: 325-500 mg q 3 hr, 325-600 mg q 4 hr, or 650-1,000 mg q 6 hr
ADVERSE REACTIONS: Dyspepsia, nausea, epigastric, discomIort
INTERACTIONS: TOO MANY TO LIST
CONTRAINDICATIONS: Hypersensitivity to salicylates; clients with
asthma, hay Iever, or nasal polyps have higher incidence oI hypersensitivity;
severe anemia, history oI blood coagulation deIects, in conjunction with
anticoagulant therapy; vitamin K deIiciency
NURSING CONSIDERATIONS: Enteric-coated or buIIered tablets better
tolerated by some; take with Iull glass oI water; use epinephrine to
counteract hypersensitivity; take temperature 1 hour aIter administering;
note iI asthma, hay Iever, ulcer disease or nasal polyps; take as directed;
administer with meals and glass oI water
GENERIC NAME: FLUTICASONE PROPIONATE AND
SALMETEROL XINAFOATE
TRADE NAME: Advair diskus
CLASSIFICATION: Anti-asthmatic, combination drug
ACTION: Fluticasone is an anti-inIlammatory corticosteroid; precise
mechanism unknown but corticosteroids inhibit multiple cell types and
mediator production or secretion involved in asthmatic response; Salmeterol
is a long-acting beta2-adrenergic agonist that catalyzes conversion oI ATP to
cyclic-AMP; increased cyclic-AMP levels cause relaxation oI bronchial
smooth muscle and inhibition oI release oI mediators oI immediate
hypersensitivity
INDICATIONS: Long-term, twice-daily maintenance treatment oI asthma
in clients 12 years and older; not Ior relieI oI acute bronchospasms
ROUTES OF ADMINISTRATION: Inhalation powder
USUAL DOSAGE: One inhalation twice daily about 12 hours apart
(morning and evening)
ADVERSE REACTIONS: URTI, pharyngitis, headache, upper respiratory
tract inIlammation, hoarseness/dysphonia, bronchitis, cough, nausea &
vomiting
INTERACTIONS: Beta-adrenergic blockers block pulmonary eIIects oI
salmeterol; also may produce severe brochospasms; diuretics EKG change
and/or hypokalemia may be worsened; MAO inhibitors/tricyclic
antidepressants action oI salmeterol may be potentiated; administer with
extreme caution or within 2 weeks oI discontinuation oI MAO inhibitors and
tricyclic antidepressants
CONTRAINDICATIONS: Hypersensitivity to any component oI the
product; primary treatment oI status epilepticus or other acute episodes oI
asthma where intensive measures are needed
NURSING CONSIDERATIONS: Do not use Advair Diskus Ior
transIerring clients Irom systemic corticosteroid therapy due to possibility oI
deaths due to adrenal insuIIiciency
GENERIC NAME: TIOTROPIUM BROMIDE
TRADE NAME: Spiriva
CLASSIFICATION: Anticholinergic
ACTION: Long-acting antimuscarinic (anticholinergic); in airways, it
inhibits muscarinic M
3
receptors at the smooth muscle, leading to
bronchodilation
INDICATIONS: Long-term once daily, maintenance treatment oI
bronchospasm associated with COPD, including chronic bronchitis and
emphysema
ROUTES OF ADMINISTRATION: Capsules containing powder Ior
inhalation
USUAL DOSAGE: Inhale contents oI one capsule once daily using
HandiHaler inhalation device
ADVERSE REACTIONS: URTI, dry mouth, accidents, sinusitis,
pharyngitis/rhinitis, abdominal pain, chest pain (non-speciIic), dependent
edema, UTI
INTERACTIONS: None speciIic
CONTRAINDICATIONS: History oI hypersensitivity to atropine or its
derivatives; use Ior initial treatment oI acute episodes oI bronchospasm; use
with other anticholinergics
NURSING CONSIDERATIONS: Teach client how to use inhaling device;
store capsules Irom 15-30C (59-86F); not to be used Ior acute
bronchospasms; do not permit powder to enter eyes; may cause papillary
dilation and blurred vision; do not swallow capsules; report any eye
pain/discomIort, colored images, blurred vision, vision halos associated with
red eyes (may indicate glaucoma)
GENERIC NAME: IPRATROPIUM BROMIDE
TRADE NAME: Atrovent, Atrovent HFA
CLASSIFICATION: Cholinergic blocking drug
ACTION: Chemically related to atropine; antagonizes the action oI acetylcholine;
prevents the increase in intracellular levels oI cyclic guanosine monophosphate, which is
caused by the interaction oI acetylcholine with muscarinic receptors in bronchial smooth
muscle (leads to bronchodilation which is primarily a local, site-speciIic eIIect)
INDICATIONS: Alone or with other bronchodilators, especially beta-adrenergics, as a
bronchodilator Ior maintenance treatment oI brochospasm associated with COPD,
including chronic bronchitis and emphysema
ROUTES OF ADMINISTRATION: Inhalation aerosol, solution Ior inhalation
USUAL DOSAGE: 2 inhalations (34 mcg) 4 times daily; may take more but not to
exceed 12 inhalations/day
ADVERSE REACTIONS: Headache, dizziness, chest pain, URTI, nausea, bronchitis,
coughing, dyspnea, pharyngitis, pain
INTERACTIONS: Potential additive interaction when used concomitantly with other
anticholinergics
CONTRAINDICATIONS: Hypersensitivity to atropine, ipratropium, or derivatives;
hypersensitivity to soy lecithin or relat4ed Iood products, including soybean or peanut;
use Ior initial treatment oI acute bronchospasms
NURSING CONSIDERATIONS: Do not conIuse Atrovent with Alupent (a
sympathomimetic); use with nebulizer with mouthpiece rather than Iacemask may be
preIerable to reduce chance oI solution hitting eyes; store aerosol between 15-30C (59-
86F); take only as directed and shake well beIore each use; iI using more than one
inhalation per dose, wait 3 min beIore administering second dose
GENERIC NAME: IBUPROFEN
TRADE NAME: Advil, Motrin, Midol, Menadol, PediaCare and all derivatives
CLASSIFICATION: Nonsteroidal anti-inIlammatory drug
ACTION: Anti-inIlammatory eIIect is likely due to inhibition oI cyclo-oxygenase;
inhibition oI cyclo-oxygenase results in decreased prostaglandin synthesis; eIIective in
reducing joint swelling, pain, and morning stiIIness, as well as to increase mobility in
patients with inIlammatory disease; antipyretic action occurs by decreasing prostaglandin
synthesis in hypothalamus resulting in increase in peripheral blood Ilow and heat loss
INDICATIONS: Analgesic Ior mild to moderate pain; primary dysmenorrheal; relieI oI
signs and symptoms oI rheumatoid arthritis or osteoarthritis
ROUTES OF ADMINISTRATION: Capsules, oral drops, suspension, tablets,
chewable tablets
USUAL DOSAGE: Rheumatoid arthritis and osteoarthritis: either 300 mg 4 times daily
or 400, 600, or 800 mg 3-4 times daily; adjust dosage to patient response; mild to
moderate pain: 400 mg q 4-6 hr as needed (doses greater than 400 mg are no more
eIIective as the 400 mg dose)
ADVERSE REACTIONS: Dizziness, rash, nausea, epigastric/GI pain,
heartburn
INTERACTIONS: Furosemide/thiazide diuretics diuretic eIIect related
to renal prostaglandin synthesis; lithium plasma lithium levels
CONTRAINDICATIONS: Pregnancy, especially during last trimester; use
in clients with the aspirin triad (bronchial asthma, rhinitis, aspirin
intolerance); use to treat perioperative pain in the setting oI coronary artery
bypass graIt surgery
NURSING CONSIDERATIONS: Do not use ibuproIen OTC Ior more
than 3 days as antipyretic or as an analgesic Ior more than 10 days unless
medically prescribed; do not take more than 3.2 g oI prescription products;
take with a snack, milk, meal, or antacid to decrease GI upset and report any
nausea and vomiting; report ringing in the ears, blurred vision and avoid
prolonged sun exposure
GENERIC NAME: CYANOCOBALAMIN
TRADE NAME: Big Shot B-12, Twelve Resin-K
CLASSIFICATION: Vitamin B
12
ACTION: Required Ior hematopoiesis, cell reproduction, nucleoprotein and
myelin synthesis
INDICATIONS: Vitamin B
12
deIiciency due to malabsorption syndrome as
seen in pernicious anemia, GI pathology, dysIunction, or surgery; Fish
tapeworm inIestation, malignancy oI pancreas or bowel, gluten enteropathy,
small bowel overgrowth oI bacteria, sprue, accompanying Iolic acid
deIiciency
ROUTES OF ADMINISTRATION: Lozenges, tablets, injection
USUAL DOSAGE: Pernicious anemia: 100 mcg/day Ior 6-7 days, then iI
no improvement is noted, give 100 mcg every other day Iro seven doses and
then 100 mcg q 3-4 days Ior 2-3 weeks; Vitamin B
12
deIiciency: 30 mcg
daily Ior 5-10 days then 100-200 mcg/month
ADVERSE REACTIONS: Itching, diarrhea, pain at injection site, nausea
& vomiting, headache, rhinitis
INTERACTIONS: Alcohol/aminosalicyclic
acid/Cholestyramine/colchidine/ neomycin, para-aminosalicylic acid/timed-
release potassium - Vitamin B12 absorption; cimetidine - digestion and
release oI vitamin B12; absorption oI cyanocobalamin
CONTRAINDICATIONS: Hypersensitivity to cobalt; Leber`s disease
NURSING CONSIDERATIONS: Protect injection Irom light and do not
Ireeze; with pernicious anemia, cannot give PO; determine iI allergic to
cobalt; monitor VS, CBC, potassium, Iolic acid, and B12 levels, must take
B12 supplements Ior liIe with pernicious anemia; iI vitamin B12 deIiciency
is due to dietary deIiciency, identiIy Ioods high in B12 and review diet;
avoid alcohol
GENERIC NAME: FOLIC ACID
TRADE NAME: Folvite, Folate
CLASSIFICATION: Vitamin B complex
ACTION: Folic acid is necessary Ior normal production oI RBCs and Ior
synthesis oI nucleoproteins; is converted into tetrahydroIolic acid which is a
coIactor in the biosynthesis oI purines and thymidylates oI nucleic acids
INDICATIONS: Treatment oI megaloblastic anemias due to Iolic acid
deIiciency; diagnosis oI Iolate deIiciency
ROUTES OF ADMINISTRATION: Tablets, injection
USUAL DOSAGE: 250-1,000 mcg/day until hematologic response occurs
initially, then 400 mcg/day to maintain
ADVERSE REACTIONS: Relatively nontoxic in humans
INTERACTIONS: Aminosalicylic acid - serum Iolate levels;
trimethoprim/methotrexate Iolic acid antagonist; phenytoin - seizure
Irequency, serum Iolic acid levels; oral contraceptives - risk oI Iolate
deIiciency
CONTRAINDICATIONS: Use in aplastic, normocytic, or pernicious
anemias (ineIIective); Iolic acid injection that contains benzyl alcohol should
not be used in neonates or immature inIants
NURSING CONSIDERATIONS: Review other prescribed drugs; may
cause increased body loss oI Iolic acid; give PO; iI severe malabsorption,
give either IV or SC; dosage should never be less than 0.1 mg/day; when
given IV, have drugs and equipment on hand in case oI anaphylactic
reactions; take only as directed and avoid alcohol
GENERIC NAME: OXYCODONE HYDROCHLORIDE
TRADE NAME: OxyIR, OxyFAST, Oxydose, Roxicodone Intensol, Roxicodone, M-
oxy, Oxy-Contin
CLASSIFICATION: Narcotic analgesic
ACTION: Semi synthetic opiate that combines with speciIic receptors located in the
CNS to produce various eIIects; the mechanism is believed to involve decreased
permeability oI the cell membrane to sodium, which results in diminished transmission oI
pain impulses and thereIore analgesia; causes mild sedation and little or no antitussive
eIIect; most eIIective in relieving acute pain.
INDICATIONS: Management oI moderate to severe pain when a continuous around-
the-clock analgesic is required Ior an extensive period oI time; to be used postoperatively
iI the client has received the drug prior to surgery or iI the postoperative pain is expected
to be moderate to severe and last Ior an extended period oI time; not intended Ior use as
an as needed` analgesic; not Ior pain in the immediate postoperative period
ROUTES OF ADMINISTRATION: Immediate-release capsules, oral solution,
concentrate solution, controlled-release tablets, immediate-release tablets
USUAL DOSAGE: Individualize dose depending on severity oI pain, client response
and client size; 10-30 mg q 4 hr (5 mg q 6 hr Ior OxyIR, Oxycodone IR capsules,
Oxydose, and OxyFAST) as needed
ADVERSE REACTIONS: Constipation, dry mouth, nausea & vomiting, mild itching,
drowsiness, lightheadedness, anorexia, weakness
INTERACTIONS: Use with protease inhibitors - CNS and respiratory depression;
ethyl alcohol/general anesthetics/antianxiety drugs/antihistamines/barbiturates/CNS
depressants potentiation or addition oI CNS depressant eIIects; concomitant use may
lead to drowsiness, lethargy, stupor, respiratory collapse, coma, or death
CONTRAINDICATIONS: Use in hypercarbia, paralytic ileus, children, or during labor;
asthma, emphysema, kyphoscoliosis, severe obesity, convulsive states as in epilepsy,
delirium tremens, tetanus and strychnine poisoning, diabetic acidosis, myxedema,
Addison`s disease, hepatic cirrhosis, and children under 6 months
NURSING CONSIDERATIONS: Have orders rewritten at timed intervals; make sure
all narcotic doses are recorded; note reasons Ior therapy, type, onset, characteristics oI
symptoms; diIIerentiate acute and chronic syndromes and rate pain levels; obtain baseline
VS`s generally, iI the respiratory rate 12/min or the SBP 90mm Hg, a narcotic should
not be administered unless there is ventilatory support or speciIic guidelines with
parameters Ior ventilation; give round-the-clock dosing Ior chronic pain; Ior control oI
severe chronic pain, give immediate-release products on a regularly scheduled basis
GENERIC NAME: CARVEDILOL
TRADE NAME: Coreg
CLASSIFICATION: Alpha-beta adrenergic blocking agent
ACTION: Has both alpha- and beta-adrenergic blocking activities; decreases cardiac
output, reduces exercise- or isoproterenol-induced tachycardia, reduces reIlex orthostatic
hypotension, causes vasodilation, and reduces peripheral vascular resistance; BP is
lowered more in the standing than in the supine position; signiIicantly lowers plasma
resin activity when given Ior at least 4 weeks
INDICATIONS: Essential hypertension used either alone or in combination with other
antihypertensive drugs, especially thiazide diuretics; mild to severe heart Iailure oI
ischemic or cardiomyopathic origin, used with diuretics, ACE inhibitors, and digitalis to
increase survival and reduce risk oI hospitalization; reduce CV mortality in clinically
stable clients who have survived an acute MI and have a leIt ventricular ejection Iraction
oI 40 or less
ROUTES OF ADMINISTRATION: Tablets
USUAL DOSAGE: 6.25-25 mg 2 times per day
ADVERSE REACTIONS: Dizziness, headache, nausea & vomiting, diarrhea, URTI,
Iatigue, pain, bradycardia, hypotension
INTERACTIONS: Antidiabetic agents - hypoglycemic eIIects R/T beta blockage;
Clonidine potentiation oI BP and heart rate lowering eIIects; Cyclosporine -
cyclosporine blood levels R/T liver breakdown; Digoxin - digoxin levels
CONTRAINDICATIONS: Clients with NYHA class IV decompensated cardiac Iailure,
bronchial asthma, or related bronchospastic conditions, second- or third-degree AV
block, SSS (unless pacemaker is in place), cargiogenic shock, severe bradycardia, drug
hypersensitivity; hepatic impairment; lactation
NURSING CONSIDERATIONS: Full antihypertensive eIIect seen within 7-14 days;
addition oI diuretic can produce additive eIIects and exaggerate orthostatic eIIect; treat
Iluid retention with increased dose oI diuretics, whether or not heart Iailure symptoms
have worsened; reduce dosage iI bradycardia (HR less than 55 bpm) occurs; take as
prescrivbed with Iood, slows absorption/decreases orthostatic eIIects; avoid OTC agents;
avoid activities that require mental acuity until drug eIIects realized; do not stop abruptly;
R/T beta-blocking activity (esp. with ischemic heart disease)
GENERIC NAME: ISOSORBIDE MONONITRATE
TRADE NAME: ISMO, Monoket, Imdur
CLASSIFICATION: Coronary vasodilator
ACTION: Isosorbide mononitrate is the major metabolite iI isosorbide dinitrate;
mononitrate is not subject to Iirst-pass metabolism; relaxes vascular smooth muscle by
stimulating production oI intracellular cyclic guanosine monophosphate; dilation oI
postcapillary vessels decreases venous return to the heart due to pooling oI blood; thus,
LV end-diastolic pressure (preload) is reduced; relaxation oI arterioles results in a
decreased systemic vascular resistance and arterial pressure (aIterload)
INDICATIONS: Treatment oI angina pectoris; prophylaxis oI angina pectoris caused by
coronary artery disease; the onset oI action oI the mononitrate is not suIIiciently rapid to
be used in aborting an acute angina attack
ROUTES OF ADMINISTRATION: Tablets, Extended-release Tablets
USUAL DOSAGE: 30 mg or 60 mg once daily initially, then aIter several days dosage
may be increased to 120 mg (given as single 120 mg tablet or as two-60 mg tablets);
suggested regimen to give dose in a.m. on arising
ADVERSE REACTIONS: Dizziness, headache, hypotension, nausea and
vomiting, increased cough, allergic reaction
INTERACTIONS: Ethanol additive vasodilation; calcium channel
blockers/organic nitrates severe orthostatic hypotension
CONTRAINDICATIONS: To abort acute anginal attacks; use in acute MI
or CHF
NURSING CONSIDERATIONS: Do not conIuse Imdur with Imuran or
Inderal; treatment regimen minimizes development oI reIreactory tolerance;
store tablets Irom 15-30C (59-86F); keep tightly closed and protect Irom
excessive moisture; note reasons Ior therapy, cardiac history,
onset/Irequency oI angina, triggers; monitor EKG, VS, cardiac status, Iamily
history, risk Iactors and electrolytes; consume 1-2 L/day oI Iluids to ensure
adequate hydration, and do not stop abruptly; avoid alcohol
GENERIC NAME: ZINC OXIDE CREAM
TRADE NAME: Desitin
CLASSIFICATION: Skin cream
ACTION: Used to treat or prevent minor skin irritations, such as diaper rash
INDICATIONS: To use iI diaper rash or other minor irritations are present
(diaper rash, poison ivy, burns)
ROUTES OF ADMINISTRATION: Cream applied topically
USUAL DOSAGE: Apply generous amount to aIIected area as oIten as
needed or as directed by doctor
ADVERSE REACTIONS: No reported side eIIects
INTERACTIONS: Other skin products; other prescription or non-
prescription medications
CONTRAINDICATIONS: Tell doctor oI medical history, especially oI
other skin inIections or problems; advise oI allergies, lactation
NURSING CONSIDERATIONS: Do not share cream with multiple
individuals; store between 15-30C (59-86F)
GENERIC NAME: POTASSIUM SALTS
TRADE NAME: K-norm, Micro-K, Extencaps, K 10, K-Dur 10 and 20, K-Tab, Kaon-
Cl, Klor-Con, Klotrix, Ten-K, more
CLASSIFICATION: Electrolyte
ACTION: Potassium is readily and rapidly absorbed through the GI tract; though a
number oI salts can be used to supply cation, potassium chloride is agent oI choice since
hypochloremia Irequently accompanies potassium deIiciency; dietary measures can
usually prevent and correct potassium deIiciencies (beeI, chicken, ham, turkey, veal, Iish,
beans, broccoli, Brussels` sprouts, lentils, spinach, potatoes, milk, bananas, dates, prunes,
raisins, avocados, watermelon, cantaloupe, apricots, molasses)
INDICATIONS: Treat hypokalemia due to digitalis intoxication, diabetic acidosis,
diarrhea and vomiting, Iamilial periodic paralysis, certain cases oI uremia,
hyperadrenalism, starvation and debilitation, and corticosteroid or diuretic therapy;
Hypokalemia with or without metabolic acidosis and Iollowing surgical conditions
accompanied by nitrogen loss, vomiting and diarrhea, suction drainage, and increased
urinary excretion oI potassium; prophylaxis oI potassium depletion when dietary intake is
not adequate in certain conditions
ROUTES OF ADMINISTRATION: Extended-release capsules
USUAL DOSAGE: Highly individualized; 40-100 mEq/day Ior potassium depletion
(usual dietary intake is 40-250 mEq/day)
ADVERSE REACTIONS: N&V, diarrhea, Ilatulence, abdominal discomIort
INTERACTIONS: ACE inhibitors may cause potassium retention hyperkalemia;
Digitalis glycosides cardiac arrhythmias; Potassium-sparing diuretics severe
hyperkalemia with possibility oI cardiac arrhythmias or arrest
CONTRAINDICATIONS: Severe renal Iunction impairment with azotemia or oliguria,
postoperatively beIore urine Ilow has been reestablished; Crush syndrome, Addison`s
disease, hyperkalemia Irom any cause, anuria, heat cramps, acute dehydration, severe
hemolytic reactions, adynamia, episodica hereditaria, clients receiving potassium-sparing
diuretics or aldosterone-inhibiting drugs; solid dosage Iorms in clients in whom there is a
reason Ior the delay or arrest in passage oI tablets through the GI tract
NURSING CONSIDERATIONS: Give PO doses 3-4 times daily; correct hypokalemia
slowly over a period oI 3-7 days to minimize risk oI hyperkalemia; identiIy reasons Ior
therapy; document electrolytes and ECG; list all drugs and OTC agents consumed; note
any impaired renal Iunction; assess Ior adequate urinary Ilow beIore administering
potassium, dysIunction can lead to hyperkalemia; withhold and report: abdominal pain,
distention, or GI weakness; monitor I & O, withhold drug and report oliguria, anuria, or
azoturia
GENERIC NAME: LISINOPRIL
TRADE NAME: Prinivil, Zestril
CLASSIFICATION: Antihypertensive, ACE inhibitor
ACTION: Inhibits angiotensin-converting enzyme resulting in decreased plasma
angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone
secretion; both supine and standing BP`s are reduced, although the drug is less eIIective
in AIrican Americans than in Caucasians.
INDICATIONS: Alone or in combination with a diuretic (usually a thiazide) to treat
hypertension; hypertension in children, aged 6-16 years old; in combination with digitalis
and a diuretic Ior treating CHF not responding to other therapy; use within 24 hours oI
acute MI to improve survival in hemodynamically stable clients
ROUTES OF ADMINISTRATION: Tablets
USUAL DOSAGE: Essential hypertension in combination with a diuretic 5 mg; the
BP-lowering eIIects oI the combination are additive; reduce dosage in renal impairment
as Iollows: CCR 10-30 mL/min: give initial dose oI 5 mg/day Ior HTN; CCR less than 10
mL/min: give initial dose oI 2.5 mg/day and adjust dose depending on BP response
ADVERSE REACTIONS: Chest Pains, dizziness, headache, hypotension, Iatigue,
diarrhea, URTI
INTERACTIONS: Diuretics excess BP; Indomethacin possible lisinopril eIIect;
Potassium-sparing diuretics signiIicant serum potassium
CONTRAINDICATIONS: Use in children under 6 years old or in children with a GFR
less than 30 mL/min/1.73 m
2
NURSING CONSIDERATIONS: When considering use oI Lisinopril in client taking
diuretics, discontinue diuretic iI possible 2-3 days prior to beginning lisinopril therapy; iI
diuretic cannot be discontinued, initial dose should be 5 mg and observe closely Ior 2
hours; maximum antihypertensive eIIects may not be observed Ior 2-4 weeks; give under
medical supervision Ior CHF especially iI SBP is less than 100 mmHg; use oI potassium
supplements, potassium-sparing diuretics, or potassium salt substitutes with Prinzide or
Zestoretic may lead to increases in serum potassium; must be taken as directed at least
once a day to control BP; avoid symptoms oI low BP (avoid orthostatic hypotension)
GENERIC NAME: METOLAZONE
TRADE NAME: Mykrox, Zaroxolyn
CLASSIFICATION: Diuretic, thiazide
ACTION: Promote diuresis by decreasing the rate at which sodium and chloride are
reabsorbed by the distal renal tubules oI the kidney; by increasing the excretion oI
sodium and chloride, Iorces excretion oI additional water; also increases the excretion oI
potassium and, to a lesser extent, bicarbonate, as well as decreases the excretion oI
calcium and uric acid; sodium and chloride are excreted in approximately equal amount
INDICATIONS: Edema accompanying CHF; edema accompanying renal diseases,
including nephritic syndrome and conditions oI reduced renal Iunction
ROUTES OF ADMINISTRATION: Tablets
USUAL DOSAGE: Edema due to renal disease: 5-20 mg once daily (Ior those who
experience paroxysmal nocturnal dyspnea, a larger dose may be required to ensure
prolonged diuresis and saluresis Ior a 24-hr period
ADVERSE REACTIONS: Dizziness, headache, muscle cramps, malaise, lethargy,
lassitude, joint pain/swelling, chest pain
INTERACTIONS: Alcohol/Barbiturates/Narcotics - hypotensive eIIect;
NSAIDs/Salicylates - hypotensive eIIects oI metolazone
CONTRAINDICATIONS: Anuria, prehepatic and hepatic coma, allergy or
hypersensitivity to metolazone; routine use during pregnancy and lactation; increases
secretion oI sodium and water by inhibiting sodium resorption in the distal tubule;
promotes excretion oI chloride, potassium, magnesium and bicarbonate
NURSING CONSIDERATIONS: Do not conIuse metolazone with methotrexate
(antineoplastic) or with metoclopramide (GI stimulant); store tablets at room temperature
in a tight, light-resistant container; Iormulations oI slow availability tablets should not be
interchanged with Iormulations oI rapid availability tablets as they are not therapeutically
equivalent; monitor weight, BP, ECG, CBC, electrolytes, uric acid, renal, LFT`s, and
assess Ior signs/symptoms oI electrolyte imbalance; take with or without Iood exactly as
directed early in the day
GENERIC NAME: MYCOPHENOLATE MOFETIL
TRADE NAME: CellCept
CLASSIFICATION: Immunosuppressant
ACTION: Is hydrolyzed to the active mycophenolic acid (MPA); MPA has potent
cytostatic eIIects on lymphocytes; inhibits proliIerative responses oI T- and B-
lymphocytes to both mitogenic and allospeciIic stimulation; MPA also suppresses
antibody Iormation oI B-lymphocytes; MPA may also inhibit recruitment oI leukocytes
into sites oI inIlammation and graIt rejection
INDICATIONS: With cyclosporine and corticosteroids to prevent organ rejection in
those receiving allogeneic renal, heart, or liver transplants; may be used in children with
renal transplants; IV product is alternative to PO Iorms Ior those who cannot take PO
medications; In combination with prednisolone to treat diIIuse proliIerative lupus
nephritis
ROUTES OF ADMINISTRATION: Capsules (250 mg), powder Ior injection,
lyophilized (500 mg), powder Ior oral suspension (200 mg/mL), tablets (500 mg)
USUAL DOSAGE: 1000 mg twice daily, IV can be started 24 hr aIter transplantation
and switched to PO as soon as possible; Ior renal impairment, glomerular Iiltration rate
(GFR) 25 ml/min, daily dose not to exceed 2000 mg
ADVERSE REACTIONS: Hypertension, constipation, diarrhea, N&V, UTI, anemia,
leucopenia, peripheral edema, inIection, abdominal pain, Iever, headache, inIections
(viral, Iungal), pain, asthenia, back/chest pain
INTERACTIONS: Antacids containing Al/Mg / Cholestyramine / Iron - absorption oI
mycophenolate: do not use together; Cyclosporine - mycophenolic acid levels;
Vaccines, liIe attenuated vaccinations may be less eIIective
CONTRAINDICATIONS: Hypersensitivity to mycophenylate, mycophenolic acid, or
polysorbate 80; use in those with rare hereditary deIiciency oI hypoxanthine-guanine
phosphoribosyl transIerase, such as Lesch-Nyhan and Kelley-Seegmiller syndrome,
lactation
NURSING CONSIDERATIONS: Take exactly as directed on an empty stomach twice
a day; take with cyclosporine and steroids; do not remove Irom manuIacturer`s original
container; do not break/crush, chew or open capsules as powder may be teratogenic iI
inhaled or contact with skin/mucus membranes
GENERIC NAME: PREDNISONE
TRADE NAME: Deltasone, Meticorten, Orasone, Panasol-S, Prednicen-M, Sterapred
DS
CLASSIFICATION: Glucocorticoid
ACTION: Anti-inIlammatory eIIect is due to inhibition oI prostaglandin synthesis; also
inhibits accumulation oI maxcrophages and leukocytes at sites oI inIlammation and
inhibits phagocytosis and lysosomal enzyme release
INDICATIONS: When used Ior anti-inIlammatory or immunosuppressant therapy,
should possess minimal mineralcortocoid activity; is not curative when used with
glucocorticoids; should be considered as not primary therapy, but as adjunctive therapy in
collagen diseases such as SLE, acute rheumatic carditis, polymyositis
ROUTES OF ADMINISTRATION: Tablets (1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50
mg); oral solution (5 mg/mL); Syrup (5 mg/mL)
USUAL DOSAGE: 5-60 mg/day in Iour equally divided doses aIter meals and at
bedtime; decrease gradually by 5-10 mg q 4-5 days to establish minimum maintenance
dosage (5-10 mg) or discontinue altogether until symptoms recur
ADVERSE REACTIONS: Insomnia, N&V, GI upset, Iatigue, dizziness, muscle
weakness, increased hunger/thirst, joint pain, decreased diabetic control
INTERACTIONS: Acetaminophen - risk oI hepatotoxicity related to rate oI
Iormation oI hepatotoxic acetaminophen metabolite; alcohol - risk oI GI ulceration or
hemorrhage; Bumetanide/ Furosemide - potassium loss R/T potassium-losing properties
oI both drugs;
CONTRAINDICATIONS: Suspected inIections as it may mask inIections; also peptic
ulcer, psychoses, acute glomerulonephritis, herpes simplex inIections oI the eye, vaccinia
or varicella, the examthematous diseases, Cushing`s syndrome, active tuberculosis,
myasthenia gravis; Also, recent intestinal anastomoses, CHF or other cardiac disease,
hypertension, systemic Iungal inIections, open-angle glaucoma, hyperlipidemia,
hyperthyroidism or hypothyroidism, osteoporosis
NURSING CONSIDERATIONS: Do not conIuse prednisone with prednisolone; note
reasons Ior therapy, type, onset, characteristics oI signs/symptoms, clinical presentation;
monitor CBC, ESR, electrolytes, BP, blood sugar, weights, and mental status; take in AM
to prevent insomnia and take with Iood to decrease GI upset; do not stop abruptly with
long-term therapy; avoid alcohol and OTC agents
GENERIC NAME: BUMETANIDE
TRADE NAME: Bumetanide, Bumex
CLASSIFICATION: Diuretic, loop
ACTION: Inhibits reabsorption oI both sodium and chloride in the proximal tubule and
the ascending loop oI Henle; possible activity in proximal tubule to promote phosphate
excretion
INDICATIONS: Edema associated with CHF, nephritic syndrome, hepatic disease;
adjunct to treat acute pulmonary edema; especially useIul in clients reIractory to other
diuretics
ROUTES OF ADMINISTRATION: Injection (0.25 mg/mL); tablets (0.5 mg, 1 mg, 2
mg)
USUAL DOSAGE: Tablets Ior edema 0.5-2 mg once daily; iI response is inadequate, a
second or third dose may be given at 4-5 hr intervals up to a maximum oI 10 mg/day
ADVERSE REACTIONS: Dizziness, hypotension, headache, nausea,
muscle cramps, encephalopathy in those with preexisting liver disease
INTERACTIONS: Charcoal - absorption Irom GI tract; CloIibrate
enhances diuretic eIIect, hydantoins diuretic eIIect, propranolol - plasma
propranolol levels; thiazide diuretics additive eIIects with loop diuretics
proIound diuresis and serious electrolyte abnormalities
CONTRAINDICATIONS: Anuria, hepatic coma or severe electrolyte
depletion until condition improved/corrected; hypersensitivity to drug
NURSING CONSIDERATIONS: Do not conIuse Bumex with Buprenex
(narcotic analgesic); Document reasons Ior therapy; pretreatment Iindings;
note sulIonamide allergy; may be cross sensitivity; monitor electrolytes,
I&O, renal and LFT`s, assess Ior K; Reserve IV or IM Ior those whom
PO use is not practical or absorption Irom the GI tract is impaired; NOTE: 1
mg oI bumetanide is equivalent to 40 mg oI Iurosemide
GENERIC NAME: HYDROMORPHONE HYDROCHLORIDE
TRADE NAME: Dilaudid, Dilaudid-HP, Hydromorphone HP, 10, 20, and 50
CLASSIFICATION: Narcotic analgesic
ACTION: Hydromorphone is 710 times more analgesic than morphine, with a shorter
duration oI action; it maniIests less sedation, less vomiting, and less nausea than
morphone, although it induces pronounced respiratory depression
INDICATIONS: Moderate to severe pain (e.g. surgery, cancer, biliary colic, burns, renal
colic, MI, bone and soIt tissue trauma); dilaudid-HP is a concentrated solution intended
Ior those tolerant to narcotics
ROUTES OF ADMINISTRATION: Injection (1 mg/mL, 2 mg/mL, 4 mg/mL, 10
mg/mL); Liquid, oral (1 mg/mL); powder Ior injection, lyophilized (250 mg/vial 10
mg/mL aIter reconstitution); suppositories (3 mg); tablets (2 mg, 4 mg, 8 mg)
USUAL DOSAGE: 1-2 mg IM or SC q 4-6 hr as needed; Ior severe pain, 3-4 mg q 4-6
hr; may be given by slow IV over 2-3 min
ADVERSE REACTIONS: Constipation, N&V, asthenia, headache,
sleepiness/sedation/somnolence, itching/pruritis
INTERACTIONS: CNS and respiratory depression when used with protease
inhibitors; Alcohol, ethyl / Anesthetics, general / Antianxiety drugs / Antihistamines /
Barbiturates / CNS depressants / Sedative-hypnotics, nonbarbiturate potentiation or
addition oI CNS depressant eIIects; concomitant use may lead to drowsiness, lethargy,
stupor, respiratory collapse, coma, or death; Cimetidine - CNS toxicity
CONTRAINDICATIONS: Migraine headaches, asthma, emphysema, kyphoscoliosis,
severe obesity, convulsive states as in epilepsy, delirium tremens, tetanus and strychnine
poisoning, diabetic acidosis, myxedema, Addison`s disease, hepatic cirrhosis, and
children under 6 months
NURSING CONSIDERATIONS: Do not conIuse hydromorphone with morphine; most
clients given around-the-clock therapy with controlled-release opioids may require
immediate-release medication Ior worsening oI pain or to treat or prevent pain that
occurs; reIrigerate suppositories; may be given by slow IV injection; administer slowly to
minimize hypotensive eIIects and respiratory depression; administer at a rate oI 2 mg
over 5 min; use rating scale to measure pain
GENERIC NAME: LEVOFLOXACIN
TRADE NAME: Levoquin, Quixin
CLASSIFICATION: Antibiotic, Iluoroquinolone
ACTION: InterIeres with DNA gyrase and topoisomerase IV; DNA gyrase
is an enzyme needed Ior replication, transcription, and repair oI bacterial
DNA; topoisomerase IV plays a key role in the partitioning oI chromosomal
DNA during bacterial cell division; EIIective against both gram-positive and
gram-negative organisms
INDICATIONS: Mild to moderate complicated UTIs due to Enterococcus
Iaecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, P.
mirabilis, or Pseudomonas aeruginosa; Uncomplicated UTIs (mild to
moderate) due to E. coli, K. pneumoniae, or Staphvlococcus saprophvticus
ROUTES OF ADMINISTRATION: Injection concentrate (500 mg, 750
mg); injection (250 mg, 500 mg, 750 mg); ophthalmic solution (0.5,
1.5), Oral solution (25 mg/mL); tablets (250 mg, 500 mg, 750 mg)
USUAL DOSAGE: Complicated UTIs 250 mg once daily Ior 10 days;
Uncomplicated UTIs 250 mg once a day Ior 3 days
ADVERSE REACTIONS: Headache, dizziness, insomnia, N&V, diarrhea,
dyspepsia/heartburn, constipation
INTERACTIONS: Antacids/didanosine/Iron salts/sucralIate/zinc salts - serum
LevoIloxacin R/T GI tract absorption; Anticoagulants - anticoagulant eIIects
CONTRAINDICATIONS: Lactation, IM, intrathecal, intraperitoneal, or SC
administration
NURSING CONSIDERATIONS: Administer doses oI 250 or 500 mg by slow inIusion
over 60 min q 24 hr or 750 mg given by slow inIusion over 90 min q 24 hr; avoid rapid or
bolus IV inIusion; Diluted solutions Ior IV are stable Ior 72 hr up to a concentration oI 5
mg/mL when stored in IV containers at 25C or less (77F or less); solutions are stable
Ior 14 days when stored under reIrigeration at 5C (41F); diluted solutions that are
Irozen in glass bottles or plastic IV containers are stable Ior 6 months when stored at
-20C (-4F); tablets can be taken without regard Ior Iood; consume plenty oI liquids to
prevent urinary crystallization; take oral solution 1 hr beIore or 2 hr aIter eating
GENERIC NAME: MAGNESIUM HYDROXIDE
TRADE NAME: (Phillips) Milk oI Magnesia, Ex-Lax Milk oI Magnesia
CLASSIFICATION: Laxative
ACTION: Important Ior many systems in the body, especially the muscles and nerves;
reduces stomach acid and increases water in the intestines (aides in deIecation)
INDICATIONS: Used as a laxative to relieve occasional constipation (irregularity); as
an antacid to relieve indigestion, sour stomach, heartburn
ROUTES OF ADMINISTRATION: Tablets, capsules, tablets (chewable), suspension
USUAL DOSAGE: Adults - 2-4 tablespoons or 6-8 chewable tablets (Laxative); 1-3
teaspoons with a little water up to 4 times daily (Antacid)
ADVERSE REACTIONS: Symptoms oI magnesium hydroxide overdose (nausea,
vomiting, Ilushing, low blood pressure, bradycardia, drowsiness, coma, death
INTERACTIONS: Tetracyclines, Iluoroquinolone antibiotic, penicillamine, digoxine,
nitroIurantoin
CONTRAINDICATIONS: No restrictions on Iood, beverages, activity unless advised
by PMD; seek emergency attention iI an allergic reaction occurs; Kidney disease
NURSING CONSIDERATIONS: Do not take magnesium hydroxide iI abdominal pain,
nausea, vomiting is present unless prescribed; do not use Ior longer than one week; rectal
bleeding or Iailure to have bowel movement aIter l;axative may indicate a more serious
condition
GENERIC NAME: SIMVASTATIN
TRADE NAME: Zocor
CLASSIFICATION: Antihyperlipidemic, HMG-CoA reductase inhibitor
ACTION: Competitively inhibits HMG-CoA reductase; this enzyme catalyzes the early
rate-limiting step in the synthesis oI cholesterol; thus, cholesterol synthesis is
inhibited/decreased; decreases cholesterol, triglycerides, VLDL, LDI and increases HDL;
does not reduce basal plasma cortisol or testosterone levels or impair renal reserve
INDICATIONS: Adjunct to diet to reduce elevated total and LDL cholesterol,
apoprotein B, and triglyceride levels in hypercholesterolemia and mixed dyslipidemia
(types IIa and IIb) when the response to diet and other approaches has been inadequate;
to increase HDL cholesterol in primary hypercholesterolemia and mixed dyslipidemias;
treatment oI isolated hypertriglyceridemia and hyperlipoproteinemia
ROUTES OF ADMINISTRATION: Tablets (5 mg, 10 mg, 20 mg, 40 mg, 80 mg
USUAL DOSAGE: Initial 20 mg once daily in evening; maintenance 5-80 mg/day as
a single dose in evening (consider starting dose oI 5 mg/day Ior clients on
immunosuppressants, and increasing maintenance Ior increases in LDL concentrations;
40 mg as an alternative Ior those requiring a reduction oI more than 45 in their LDL
cholesterol (most oIten those with CAD)
ADVERSE REACTIONS: Headache, abdominal pain/cramps, constipation
INTERACTIONS: Amioderone possibility oI myopathy, muscle weakness, and
rhabdomyolysis; Bosentan - Simvastatin levels R/T metabolism; Carbamazepine -
Simvastatin AUC, peak levels, and shortened t1/2 R/T metabolism by CYP3A4;
Clarithromycin - risk oI severe myopathy and rhabdomyolysis; Diltiazem - risk oI
myopathy R/T simvastatin plasma levels; Erythromycin - risk oI severe myopathy
and rhabdomyolysis; GrapeIruit juice chronic use oI grapeIruit juice simvastatin
plasma levels due to liver metabolism
CONTRAINDICATIONS: Use iI pregnant, planning on being pregnant, or while
breastIeeding
NURSING CONSIDERATIONS: Do not conIuse Zocor with Cozaar or ZoloIt; may
administer with no regard to meals; take as prescribed; more preIerable in the evening;
monitor CBC, lipid proIile, CPK, renal LFT`s; low-cholesterol diet must be Iollowed
during drug therapy (should be started 3-6 months prior to initial drug therapy); consult
dietician Ior assistance in meal planning and Iood preparation; do not take with grapeIruit
juice, but grapeIruit juice can be given at other times during the day
GENERIC NAME: EZETIMIBE
TRADE NAME: Zetia
CLASSIFICATION: Antihyperlipidemic
ACTION: Acts by inhibiting the absorption oI cholesterol Irom the small
intestine, leading to a decrease in the delivery oI cholesterol to the liver; this
complements the mechanism oI action oI HMG-CoA reductase inhibitors;
reduces total cholesterol
INDICATIONS: Primary hypercholesterolemia, either as monotherapy or
combination therapy with HMG-CoA reductase inhibitors; with atorvastatin
or simvastatin Ior homozygous Iamilial hypercholesterolemia; as adjunct
therapy to diet Ior homozygous sitosterolemia
ROUTES OF ADMINISTRATION: Tablets 10 mg
USUAL DOSAGE: 10 mg once daily with or without Iood
ADVERSE REACTIONS: Back pain, diarrhea, arthralgia, sinusitis, abdominal pain
INTERACTIONS: Antacids - Ezetimibe C
max
aIter both Mg- and Ca-containing
antacids (no eIIect on AUC); Cholestyramine - ezetimibe AUC probably R/T
Absorption; Cyclosprine - total ezetimibe levels (monitor careIully);
FenoIibrate/GemIibrozil - tatol ezetimibe level
CONTRAINDICATIONS: Use with HMG-CoA reductase inhibitors in pregnant and
nursing women and in active liver disease or unexplained persistant elevations in serum
transaminases; as monotherapy in moderate to severe hepatic insuIIiciency and during
lactation; use in children less than 10 y/o
NURSING CONSIDERATIONS: Place client on a standard cholesterol-lowering diet
beIore therapy and Ior duration oI treatment; give at least 2 hr prior or 4 hr aIter giving a
bile acid sequestrant; store Irom 15-30C (59-86F) protected Irom moisture; monitor
CBC, lipid panel, renal and LFTs; schedule LFTs at the beginning oI therapy; list all
medications preascribed to ensure none interact unIavorably; identiIy cardiac risk Iactors;
take daily as directed with or without Iood; avoid taking with antacids (reduces drug
eIIect); low-cholesterol diet must be Iollowed during drug therapy; report any S&S oI
inIection
GENERIC NAME: BACITRACIN OINTMENT
TRADE NAME: Baciguent
CLASSIFICATION: Antibiotic
ACTION: InterIeres with synthesis oI cell wall, preventing incorporation oI
amino acids and nucleotides; is bacteriocidal, bacteriostatic, and active
against protoplasts; not absorbed Irom the GI tract; when given parenterally,
drug is well distributed in pleural and ascetic Iluids; high nephrotoxicity;
careIully evaluate renal Iunction prior to, and daily, during use.
INDICATIONS: Aid to prevent inIection in minor cuts, scrapes, burns, and
wounds
ROUTES OF ADMINISTRATION: Ointment 500 units/gram
USUAL DOSAGE: Apply small amount equal to surIace area oI a Iingertip
1-3 times per day aIter cleaning the aIIected area; do not use Ior more than
one week
ADVERSE REACTIONS: AIter topical use: skin rashes
INTERACTIONS: Aminoglycosides additive nephrotoxicity and
neuromuscular blocking activity; Anesthetics - neuromuscular blockade
possible muscle paralysis; neuromuscular blocking agents additive
neuromuscular blockage possible muscle paralysis
CONTRAINDICATIONS: Hypersensitivity or toxic reaction to bacitracin;
pregnancy; epithelial herpes simplex keratitis, vaccinia, varicella,
mycobacterial eye inIections; Iungal diseases oI eye; concomitant use oI
nephrotoxic drugs
NURSING CONSIDERATIONS: Do not conIuse bacitracin with
Bactroban; may cover aIIected area with sterile dressing; cleanse area
thoroughly beIore applying bacitracin as wet dressing or ointment; do not
use topical ointment near eyes, nose, mouth, or mucous membranes; report
lack oI response, rash, stinging, itching, changes in vision, or unusual side
eIIects; do not administer with topical or systemic nephrotoxic drug
GENERIC NAME: VERAPAMIL
TRADE NAME: Calan, Calan SR, Covera-HS, Isoptin SR, Verelan, Verelan PM
CLASSIFICATION: Calcium channel blocker
ACTION: Slows AV conduction and prolongs eIIective reIractory period; HR and
PR interval; IV doses slightly increase LV Iilling pressure; moderately decreases
myocardial contractility and peripheral vascular resistance; worsening oI heart Iailure
may result iI verapamil is given to clients with moderate to severe cardiac dysIunction
INDICATIONS: Angina pectoris due to coronary artery spasm (Prinzmetal`s variant),
chronic stable angina including angina due to increased eIIort, unstable angina
(preinIarction, crescendo); with digitalis to control rapid ventricular rate at rest and
during stress in chronic atrial Ilutter or atrial Iibrillation
ROUTES OF ADMINISTRATION: Capsules (Extended release) 100 mg, 120 mg,
180 mg, 200 mg, 240 mg, 300 mg; Capsules (Sustained release) 120 mg, 180 mg, 240
mg, 360 mg; Injection 2.5 mg/mL; Tablets (Extended-release) 120 mg, 180 mg, 240
mg; Tablets (immediate-release) 40 mg, 80 mg, 120 mg; Tablets (Sustained-release)
120 mg, 180 mg, 240 mg
USUAL DOSAGE: Essential hypertension Initial, when used alone 80 mg 3 times
per day; doses up to 360-480 mg daily may be used; EIIects are seen in the Iirst week oI
therapy
ADVERSE REACTIONS: InIection, Ilu-like symptoms, URTI, rhinitis, nausea,
dyspepsia, diarrhea, constipation, headache, Iatigue/lethargy, dizziness, peripheral edema
INTERACTIONS: Amiodarone possible cardiotoxicity with CO (monitor closely);
Antihypertensive agents additive hypotensive eIIects; antineoplastics - verapamil
absorption by several antineoplastics; atorvastatin - atorvastatin plasma levels;
barbiturates - verapamil bioavailability; Buspirone - buspirone eIIects; cyclosporine -
cyclosporine plasma levels possible renal toxicity; Digoxin - risk oI digoxin
toxicity R/T plasma levels; MANY MORE
CONTRAINDICATIONS: Severe hypotension, second- or third-degree AV block,
cardiogenic shock, severe CHF, sick sinus syndrome (unless client has artiIicial
pacemaker), severe LV dysIunction; cardiogenic shock and severe CHF unless secondary
to SVT that can be treated with verapamil; lactation; use oI verapamil, IV, with beta-
adrenergic blocking agents; ventricular tachycardia
NURSING CONSIDERATIONS: Do not conIuse Isoptin with Intropin; take SR tablets
with Iood; Store ampules at 15-30C (59-86F); protect Irom light; always individualize
dose; note reasons Ior therapy, onset, characteristics oI S&S; make sure no prescribed
meds interact; take SR capsule in AM with Iood; do not crush, cut, or chew; swallow
capsule whole; may cause dizziness and sudden drop in BP; use caution until drug eIIects
realized
GENERIC NAME: ONDANSETRON HYDROCHLORIDE
TRADE NAME: ZoIran, ZoIran ODT
CLASSIFICATION: Antiemetic
ACTION: Cytotoxic chemotherapy is thought to release serotonin Irom
enterochromaIIin cells oI the small intestine; the released serotonin may stimulate the
vagal aIIerent nerves through the 5-HT
3
receptors, thus stimulating the vomiting reIlex;
Ondansetron, a 5-HT
3
antagonist, blocks this eIIect oI serotonin; whether the drug acts
centrally and/or peripherally to antagonize the eIIect oI serotonin is not known
INDICATIONS: Prevent N&V resulting Irom initial and repeated courses oI cancer
chemotherapy, including cisplatin, greater than 50 mg/m
2
; prevent N&V associated with
initial and repeat courses oI moderately emetogenic cancer chemotherapy; Prevent N&V
associated with radiotherapy in clients receiving either total body irradiation, single high-
dose Iraction to the abdomen, or daily Iractions to the abdomen
ROUTES OF ADMINISTRATION: Injection, oral solution, tablets, orally-
disintegrating tablets
USUAL DOSAGE: 4 mg IV undiluted over 2-5 min immediately beIore induction oI
anesthesia or postoperatively as needed; alternatively, 4 mg undiluted may be given IM
as a single injection
ADVERSE REACTIONS: Diarrhea, headache, dizziness, malaise/Iatigue, constipation,
bradycardia, hypotension, drowsiness/ sedation, anxiety/agitation, gynecological
disorder, urinary retention, hypoxia, pruritus, pyrexia, shivers
INTERACTIONS: ondansetron plasma levels R/T liver metabolism
CONTRAINDICATIONS: None speciIied: special concerns with use during lactation;
saIety and eIIectiveness in children 3 years oI age and younger are not known
NURSING CONSIDERATIONS: Do not conIuse ZoIran with ZoloIt, Zantac, or Zosyn;
do not exceed 8 mg PO or 8 mg IV daily with impaired hepatic Iunction; 2 mg/mL
Ondansetron injection requires no dilution Ior administration Ior postop N&V; inspect
visually Ior particulate matter and discoloration beIore administering; drug is to prevent
N&V; to be given exactly as prescribed; may cause drowsiness or dizziness; do not
perIorm activities that require mental alertness until drug eIIects realized; report any rash,
diarrhea, constipation, altered respirations (brochospasms), or loss oI response
GENERIC NAME: CALCIUM CARBONATE
TRADE NAME: Calci-Mix, Surpass, Surpass Extra Strength, Cal-Carb Forte, Calcium
600, Nephro-Calci, Os-Cal 500, Oysco 500, Oyst-Cal 500, Oyster Shell Calcium, Tums
CLASSIFICATION: Calcium salt
ACTION: Calcium is essential Ior maintaining normal Iunction oI nerves, muscles, the
skeletal system, and permeability oI cell membranes and capillaries; normal serum
calcium level is 9-10.4 mg.dL (4.5-5.2 mEq/L). Hypocalcemia is characterized by
muscular Iibrillation, twitching, skeletal muscle spasms, leg cramps, titanic spasms,
cardiac arrythmias, smooth muscle hyperexcitability, mental depression, and anxiety
states
INDICATIONS: Mild hypocalcemia; Antacid (including heartburn, sour stomach, and
acid indigestion); anithyperphosphatemic
ROUTES OF ADMINISTRATION: Capsules, gum, gum tablets, lozenges, powder,
suspension, tablets, chewable tablets
USUAL DOSAGE: Hypocalcemia/Nutritional supplement 1.25-1.5 grams 1-3 times
daily with or without meals; antihyperphosphatemic 5-13 grams daily in divided doses
with meals
ADVERSE REACTIONS: AIter PO use GI irritation, constipation, headache, mild
hypercalcemia (anorexia, N&V)
INTERACTIONS: Omeprazole Iractional calcium absorption in Iasting elderly
women
CONTRAINDICATIONS: Digitalized clients, sarcoidosis, renal or cardiac disease,
ventricular Iibrillation, cancer clients with bone metastases; renal calculi,
hypophosphatemia; hypercalcemia
NURSING CONSIDERATIONS: PerIorm thorough nursing history, noting clinical
presentation, indications Ior therapy, and any precipitating causes; list drugs prescribed,
especially iI receiving digitalis products (may be contraindicated); monitor calcium levels
and renal Iunction; assess Ior renal or parathyroid disease; note bone density Iindings;
supplements need vitamin D to Iacilitate absorption; report adverse side eIIects, lack oI
desired response, and keep all Iollow-up appointments to evaluate drug response
GENERIC NAME: LEVOTHYROXINE
TRADE NAME: Synthroid, Levoxyl, Levothroid, others
CLASSIFICATION: Synthetic Thyroid Preparation
ACTION: At a cellular level, works to induce changes in the metabolic rate, including
protein, carbohydrate and lipid metabolism, increase oxygen consumption, body
temperature, blood volume and overall cellular growth and diIIerentiation. Stimulate the
cardiovascular system by increasing the number oI myocardial beta-adrenergic receptors
which increases the sensitivity oI the heart to catecholamines and ultimately increases
cardiac output. Additionally, increases renal blood Ilow and the glomerular Iiltration rate
which results in a diuretic eIIect. Thyroid hormone T4.
INDICATIONS: preIerred drug Ior treatment oI hypothyroidism because its hormonal
content is standardized and its eIIect is predictable. Also used to treat goiters, as
replacement therapy in patients who have had thyroidectomys
ROUTES OF ADMINISTRATION: PO, IV
USUAL DOSAGE: 25-300 mcg/day (25-200 mcg/day most common) IM/IV: 50 oI
oral dose; IV 200-500 mcg in a single dose; repeat next day 100-300 mcg iI necessary.
Pediatric 0-12 yr, PO: 25-150 mcg/day
ADVERSE REACTIONS: usually a result oI overdose. Cardiac dysrhythmia with the
risk Ior liIe-threatening or Iatal irregularities, tachycardia, palpitations, angina,
hypertension, cardiac arrest, insomnia, tremors, headache, anxiety, nausea, diarrhea,
increased or decreased appetite, cramps, menstrual irregularities, weight loss, sweating,
heat intolerance, Iever.
INTERACTIONS: : May enhance the activity oI oral anticoagulants which may need
reduced doses. When taken concurrently with digitalis glycosides may decrease serum
digitalis levels. Cholestyramine binds to thyroid hormone in the GI tract, possibly
reducing the absorption oI both drugs. Diabetic patiens may require increased doses oI
their hypoglycemic drugs. With epinephrine in patients with coronary disease, may
induce coronary insuIIiciency.
CONTRAINDICATIONS: known drug allergy, recent MI, adrenal insuIIiciency or
hyperthyroidism.
NURSING CONSIDERATIONS: HalI liIe long enough that it only needs to be
administered once a day. Pregnancy category A. Switching between courses oI
treatments should be minimized. Thyroid Iunction tests should be monitored
GENERIC NAME: METOCLOPRAMIDE
TRADE NAME: Reglan, Reclomide
CLASSIFICATION: Antiemetics
ACTION: Block dopamine receptors in chemoreceptor trigger zone oI the CNS. Stimulates motility oI the
upper GI tract and accelerates gastric emptying. Therapeutic EIIects: Decreased nausea and vomiting.
Decreased symptoms oI gastric stasis. Easier passage oI NG tube into small bowel.
INDICATIONS: Prevention oI chemotheraphy-induced emesis. Treatment oI postsurgicial and diabetic
gastric stasis. Facilitation oI small bowel intubation in radiographic procedures. Management oI
esophageal reIlux. Treatment and prevention oI gastric suctioning is undesirable. Unlabeled uses:
treatment oI hiccups. Adjunct management oI migraine headaches.
ROUTES OF ADMINISTRATION: IV, PO, IM
USUAL DOSAGE: : Prevention of Chemotherapv-Induced Jomiting. PO:IV (Adults (Adults and
Children): 1-2 mg/kg 30 min beIore chemotherapy. Additional doses oI 1-2 mg/kg may be given q2-4hr,
Ior 2 doses, then q3 hr Ior 3 additional doses. May also be given as 3 mg/kg beIore pretreatment with
diphenhydramine will decrease the risk oI extra pyramidal reactions to this dosage chemotherapy, Iollowed
by 0.5mg/kg/hr Ior 8 hrs. Facilitation of Small Bowel intubation. IV(Adults): 10 mg over 1-2 min
IV(Children 6-14 yr): 2.5-5 mg(dose should not exceed 0.5 mg/kg over 1-2 mins. IV(Children6yr): 0.1
mg/kg over 1-2 mins. Diabetic Gastroparesis: PO:IV (Adults):10 mg 30 min beIore meals and at bedtime
Gastroesophageal Reflux: PO(Adults): 10-15 mg 30 mins beIore meals and at bedtime (not to exceed 0.5
mg/kg/day).PO (Neonates, InIants, Children): 0.4-0.8 mg/kg/day in 4 divided doses. Postoperative
Nausea/Jomiting: IM:IV (Adults (Adults and Children~14):10-20 mg at the end oI surgical procedure
repeat in 6-8 hr iI needed. IM, IV(Children):0.1-0.2 mg/kg/dose, repeat in 6-8 hr iI needed. Treatment of
hiccups: PO, IM(Adults): 10-20 mg 4 times daily PO; may be preceded by a single 10 mg dose IM
ADVERSE REACTIONS: drowsiness, extrapyramidal reactions, restlessness,
NEUROLEPTIC MALGNANT SYNDROME, anxiety, depression, irritability, tardive
dyskinesia, arrhythmias, hypertension, hypotension, constipation, diarrhea, dry mouth,
nausea, gynecomastia, methemoglobinemia, neutropenia, leucopenia, agranulocytosis
INTERACTIONS: : Additive CNS depression with other CNS depressants. May
increase absorption and risk oI toxicity Irom cyclosporine. May aIIect the GI absorption
oI other orally administered drugs. May exaggerate hypotension during extrapyramidal
reactions with agents such as haloperidol or phenothiazines
CONTRAINDICATIONS: Hypersensitivity. Possible GI obstruction or hemorrhage.
Hx oI seizure disorders.
NURSING CONSIDERATIONS: Instruct patient to take metoclopramide exactly as
directed. II dose is missed, take as soon as remembered iI not almost time Ior next dose
GENERIC NAME: PROCHLORPERAZINE (MALEATE)
TRADE NAME: Compazine, Compro Suppositories
CLASSIFICATION: Antipsychotic, phenothiazine
ACTION: Causes a high incidence oI extrapyramidal and antiemetic eIIects, moderate
sedative eIIects, and a low incidence oI anticholinergic eIIects and orthostatic
hypotension
INDICATIONS: Schizophrenia; short term treatment oI generalized non-psychotic
anxiety (not the drug oI choice); severe N&V
ROUTES OF ADMINISTRATION: Suppositories, injection, syrup, sustained-release
capsules, tablets
USUAL DOSAGE: Adults & adolescents (PO) 5-10 mg (repeat dose q 3-4 hr as
needed, not to exceed 40 mg/day; (rectal suppository) - 25 mg twice daily; maleate
sustained-release tablets (maleate tablets) 5-10 mg 3-4 times daily (up to 40 mg/day);
Ior extended release capsules, the dose is 15-30 mg once daily in the morning (or 10 mg q
12 hr, up to 40 mg/day)
ADVERSE REACTIONS: Drowsiness, dizziness, amenorrhea, blurred vision, skin
reactions, hypotension, extrapyramidal reactions
INTERACTIONS: Ethyl alcohol/general anesthetics/antianxiety drugs/barbiturates/CNS
depressants/narcotics/sedative hypnotics potentiation or addition oI CNS depressant
eIIects (concomitant use may lead to drowsiness, lethargy, stupor, respiratory collapse,
coma or death; aluminum salts (antacids) - absorption Irom GI tract; MANY MORE
CONTRAINDICATIONS: Use in clients who weigh less than 44 kg or who are under 2
y/o
NURSING CONSIDERATIONS: For the elderly, use doses in lower range as they are
more susceptible to hypotension and neuromuscular reactions; store all Iorms oI the drug
in tight-closing amber-colored bottles; store suppositories below 37C (98.6F); DO NOT
GIVE SC; Do not mix other agents in syringe iI given IV; Do not mix with any agent
containing preservative parabens; parenteral prescribing limits are 20 mg/day Ior children
2-5 y/o, 25 mg/day Ior children 6-12 y/o; assess mental status; note behavioral
presentation/maniIestations; moniotor CBC, LFT`s, ECG; do not exceed prescribed dose;
auscultate bowel sounds and assess Iunction
GENERIC NAME: TAMULOSIN HYDROCHLORIDE
TRADE NAME: Flomax
CLASSIFICATION: Alpha-adrenergic blocking drug
ACTION: Blockade oI alpha1-receptors (probably alpha1a) in the prostate
results in relaxation oI smooth muscles in the bladder, neck and prostate;
thus, urine Ilow rate is improved and there is a decrease in symptoms oI
BPH
INDICATIONS: Signs and asymptoms oI BPH; rule-out prostatic
carcinoma beIore using tamsulosin
ROUTES OF ADMINISTRATION: Capsules
USUAL DOSAGE: Adult males 0.4 mg once daily given about 30 min
aIter same meal each day; iI aIter 2 to 4 weeks clients have not responded,
dose can be increased to 0.8 mg daily
ADVERSE REACTIONS: Headache, dizziness, pharyngitis/rhinitis, abnormal
ejaculation, shoulder/neck/back/extremity pain, asthenia, diarrhea, chest pain
INTERACTIONS: Cimetidine causes signiIicant in clearance oI tamsulosin
CONTRAINDICATIONS: Use to treat hypertension, with other alpha-adrenergic
blocking agents, or in women or children
NURSING CONSIDERATIONS: Do not conIuse Flomax with Fosamax, Flonase, or
Volmax; iI dose discontinued or interrupted Ior several days at either dose, start back up
at 0.4 mg dose; store at 20-25C (68-77F); identiIy drugs prescribed to ensure none oI
the drugs interact, esp cimetidine or coumadin; monitor CBC, I&O, VS, weight,
urodynamic studies; note PSA levels, results oI digital rectal exam; take as directed, do
not chew, crush, or open capsule; may take 30 min aIter same meal each day to decrease
GI upset; report any loss oI eIIectiveness or increased nighttime voiding; do not perIorm
activities that require mental/physical alertness until drug eIIects realized; may cause
drowsiness, dizziness, and syncope; change positions slowly to prevent sudden drop in
BP; do not stop suddenly aIter prolonged use; avoid OTCs without getting provider
approval Iirst
GENERIC NAME: CALCITRIOL
TRADE NAME: Rocaltrol
CLASSIFICATION: Synthetic vitamin D analog
ACTION: Active in the regulation oI the absorption oI calcium Irom the GI
tract and its utilization in the body
INDICATIONS: management oI hypocalcemia and resultant metabolic
bone disease in patients undergoing chronic renal dialysis; indicated in
management oI secondary hyperparathyroidism and resultant metabolic bone
disease in patients with mild/moderate/severe chronic renal Iailure not yet on
dialysis; management oI hypocalcemia and clinical maniIestations in
patients with postsurgical hypoparathyroidism, idiopathic
hypoparathyroidism, and pseudohypoparathyroidism
ROUTES OF ADMINISTRATION: Capsules (0.25 mcg or 0.5 mcg); oral
solution (1 mcg/mL)
USUAL DOSAGE: 0.25 mcg 1.0 mcg daily
ADVERSE REACTIONS: Hypercalcemia syndrome or calcium intoxication; weakness,
headache, somnolence, N&V, dry mouth, constipation, muscle pain, bone pain, metallic
taste, anorexia, stomach pain, abdominal pain; polyuria, polydipsia, nocturia, calciIic
conjunctivitis, pancreatitis, photophobia, rhinorrhea, pruritis, hyperthermia, decreased
libido, elevated BUN, albuminuria, hypercholesterolemia, elevated SGOT (AST) and
SGPT (ALT) and MANY MORE
INTERACTIONS: Cholestyramine, Phenytoin/Phenobarbital, Thiazides, Digitalis,
Ketoconazole, Corticosteroids, Phosphate-binding agents, Vitamin D, Calcium
supplements, Magnesium
CONTRAINDICATIONS: Should not be taken to patients with hypercalcemia or
evidence oI Vit D toxicity; use in patients with known hypersensitivity to Rocaltrol (or
drugs oI same class) or any oI the inactive ingrediants is contraindicated
NURSING CONSIDERATIONS: EIIectiveness is predicated on the assumption that
each patient is receiving an adequate daily intake oI calcium; advise patients to have
dietary intake minimum oI 600 mg daily; patients should be advised oI compliance with
dosage instructions and adherence to instructions about diet and calcium
supplementation; advise avoidance oI the use oI unapproved nonprescription drugs;
careIully inIorm about S&S oI hypercalcemia
GENERIC NAME: HYDROCODONE BITARTRATE AND
ACETAMINOPHEN
TRADE NAME: Anexia 10/660, Anexia 5/325, Anexia 5/500, Anexia
7.5/325, Bancap HC, Ceta-Plus, Co-Gesic, Dolacet, Duocet, HyPhen, Hycet,
Hydrocet, Vicodin, Vicodin ES, Vicodin HP
CLASSIFICATION: Analgesic
ACTION: Hydrocodone produces its analgesic activity by an action on the
CNS via opiate receptors; analgesic reaction oI acetaminophen is produced
by both peripheral and central mechanisms
INDICATIONS: RelieI oI moderate to moderately severe pain
ROUTES OF ADMINISTRATION: Capsules, tablets, oral solution
USUAL DOSAGE: For 5/500 products, the dose is 1 or 2 q 4-6 hr, up to 8
per day; Ior 5/325, 7.5/325, 10/325, and 7.5/400, the dose is 1 q 4-6 hr, up to
6 a day; Ior 7.5/500 and 7.5/650, the dose is 1 q 4-6 hr; Ior 7.5/750, the dose
is 1 q 4-6 hr, up to 5 per day; Ior 10/325, 10/400, 10/500, and 10/650, the
dose is 1 q 4-6 hr, up to 6 per day; Ior 10/650, 10/660, and 10/750, the dose
is 1 q 4-6 hr
ADVERSE REACTIONS: Nausea and vomiting, urinary retention, lightheadedness,
dizziness, sedation, mental clouding
INTERACTIONS: Anticholinergics - risk oI paralytic ileus; CNS depressants,
including other narcotic analgesics, antianxiety agents, antipsychotics, alcohol additive
CNS depression; MAO inhibitors/tricyclic antidepressants - eIIect oI either the narcotic
or the antidepressant
CONTRAINDICATIONS: Hypersensitivity to acetaminophen or hydrocodone
NURSING CONSIDERATIONS: Note onset, location, characteristics oI S&S, other
agents, prescribed, outcome, iI pain acute or chronic; rate pain increased; note history oI
hypothyroidism, BPH, urethral stricture, Addison`s disease, severe pulmonary disease,
head injury; monitor renal and LFT`s; avoid with dysIunction; take as directed; may take
with Iood/milk to decrease GI upset; do not perIorm activities that require mental
alertness; causes dizziness, lethargy, and impaired physical and mental perIormance;
report evidence oI abnormal bruising/bleeding, breathing problems, N&V, constipation,
urinary diIIiculty, excessive sedation or lack oI pain control; avoid alcohol and OTC
agents or CNS depressants; Ior short term use only (VERY habit-Iorming)
GENERIC NAME: MEPERIDINE HYDROCHLORIDE
TRADE NAME: Demerol Hydrochloride, C-11
CLASSIFICATION: Narcotic analgesic
ACTION: One-tenth as potent an analgesic as morphine; analgesic eIIect is only one-
halI when given PO rather than parenterally; has no antitussive eIIecrs and does not
produce miosis; less smooth muscle spasm, constipation, and antitussive eIIect than
equianalgesic doses oI morphine; produces both psychologic and physical dependence;
overdosage causes severe respiratory depression
INDICATIONS: Analgesic Ior moderate to severe pain; preoperative medication;
adjunct to anesthesia; obstetrical analgesia
ROUTES OF ADMINISTRATION: Injection (25 mg/mL, 50 mg/mL, 75 mg/mL, 100
mg/mL), oral solution (50 mg/5 mL), syrup (50 mg/5mL), tablets (50 mg, 100 mg)
USUAL DOSAGE: Analgesic (adults) 50-100 mg q 3-4 hr as needed; (pediatric) 1.1-
1.75 mg/kg, up to adult dosage, q 3-4 hr as needed; initial PCA dosage 10 mg with a
range oI 1-5 mg per incremental dose (recommended lock-out interval is 6-10 min with a
minimum oI 5 min); Preoperatively IM, IV (adults) 50-100 mg 30-90 min beIore
anesthesia; (pediatric) 1.1-2.2 mg/kg (up to adult dose) 30-90 min prior to anesthesia;
IV analgesic 15-35 mg/hr by continuous IV; Support oI anesthesia IV inIusion 1
mg/mL or slow IV injection 10 mg/mL until client needs met
ADVERSE REACTIONS: Constipation, dry mouth, N&V, anorexia, dizziness, Iatigue,
lightheadedness, muscle twitches, sweating, itching, decreased urination, decreased libido
INTERACTIONS: Antidepressants, tricyclic additive anticholinergic side eIIects;
Cimetidine - respiratory and CNS depression; Hydantoins - meperidine eIIect R/T
liver breakdown; MAO inhibitors - risk oI severe symptoms including hyperpyrexia,
restlessness, hyper- or hypotension, convulsions, or coma; Protease inhibitors avoid
combination; Sibutramine possibility oI liIe-threatening serotonin syndrome; smoking -
analgesia R/T hepatic metabolism (takes several weeks to occur)
CONTRAINDICATIONS: Hypersensitivity to drug, convulsive states as in epilepsy,
tetanus, and strychnine poisoning, children under 6 months, diabetic acidosis, head
injuries, shock, liver disease, respiratory depression, increased intracranial pressure, and
beIore labor during pregnancy; use with sibutramine
NURSING CONSIDERATIONS: IM preIerred over SC use in repeated doses; more
eIIective when given parenterally than PO; take syrup with halI glass oI water to
minimize anesthetic eIIect on mucous membranes; take drug within ordered intervals to
prevent pain recurring; report pain levels and lack oI eIIectiveness; drug causes dizziness
and drowsiness (do not engage in activities that require mental alertness); due to low BP
eIIects, rise slowly and do not change positions abruptly; increase Iluid intake and bulk to
avoid constipation; avoid alcohol and other CNS depressants.
GENERIC NAME: PROMETHAZINE HYDROCHLORIDE/CODEINE
TRADE NAME: Phenadoz, Phenergen
CLASSIFICATION: Antihistamine, Iirst generation, phenothiazine
ACTION: Antiemetic eIIects are likely due to inhibition oI the CTZ; eIIective in vertigo
by its central anticholinergic eIIect which inhibits the vestibular apparatus and the
integrative vomiting center as well as the CTZ; may cause severe drowsiness; signiIicant
anticholinergic and antiemetic eIIects
INDICATIONS: Prophylaxis and treatment oI motion sickness; prophylaxis and control
oI N&V due to anesthesia or surgery; preoperative, postoperative, or obstetric sedation;
relieI oI apprehension and production oI light sleep; hypersensitivity reaction, including
perennial and seasonal allergic rhinitis, vasomotor rhinitis, allergic conjunctivitis caused
by inhalant allergens and Ioods, mild uncomplicated allergic skin maniIestations oI
urticaria and angioedema, allergic reactions to blood or plasma, dermographism, and
adjunctive anaphylactic therapy; adjunct to analgesics Ior postoperative pain.
ROUTES OF ADMINISTRATION: Injection (25 mg/mL, 50 mg/mL IM only~);
suppositories (12.5 mg, 25 mg, 50 mg); syrup (6.25 mg/mL); tablets (12.5 mg, 25 mg, 50
mg)
USUAL DOSAGE: Sedation (adults) 25-50 mg at bedtime, (~2 yr) 12.5-25 mg at
bedtime; Antiemetic (Adults) 25 mg (usual dose); doses oI 12-5-25 mg may be repeated
q 4-6 hr; (~2 yr) 25 mg or 0.5 mg/lb
ADVERSE REACTIONS: Drowsiness, dizziness, conIusion, blurred vision, dry mouth,
tinnitus, N&V, photosensitivity
INTERACTIONS: Antidepressants, tricyclic additive anticholinergic side eIIects; CNS
depressants, antianxiety agents, barbiturates, narcotics, phenothiazines, procarbazine,
sedative-hypnotics potentiation or addition oI CNS depressant eIIects (concomitant use
may lead to drowsiness, lethargy, stupor, respiratory depression, coma, and possibly
death); Heparin antihistamines may the anticoagulant eIIects
CONTRAINDICATIONS: Lactation, comatose clients, CNS depression due to drugs
(including barbiturates, general anesthetics, tranquilizers, alcohol, narcotics); previous
phenothiazine idiosyncrasy or hypersensitivity, acutely ill or dehydrated children (due to
greater susceptibility to dyastonias); children under 2 y/o; treatment oI uncomplicated
vomiting in children
NURSING CONSIDERATIONS: Do not conIuse promethazine with chlorpromazine or
with prochlorperazine (both antipsychotics); take only as directed and do not exceed dose
(cardiac arrythmias may occur); may take with milk or Iood to decrease GI upset; avoid
activities that require mental alertness until drug side eIIects realized (may cause
sedation); do nto consume alcohol, CNS depressants, or OTC agents unless provider
approved; consume adequate Iluids to prevent dehydration (use caution in hot weather to
prevent heat stroke); decrease dosage in dehydrated or oliguric clients
GENERIC NAME: PROPOXYPHENE NAPSYLATE AND ACETAMINOPHEN
TRADE NAME: Darvocet-N 100, Darvocet-N 50, Propacet 100
CLASSIFICATION: Narcotic and nonnarcotic analgesic combination
ACTION: Propoxyphene is a centrally-acting narcotic analgesic related to methadone;
potency oI propoxyphene is Irom two-thirds to equal that oI codeine; acetaminophen may
cause analgesia by inhibiting CNS prostaglandin synthesis; however, due to minimal
eIIects on peripheral prostaglandin synthesis, acetaminophen has no anti-inIlammatory or
uricosuric eIIects; decreases Iever by (1) a hypothalamic eIIect leading to sweating and
vasodilation and (2) inhibits the eIIect oI pyrogens on the hypothalamic heat-regulating
centers.
INDICATIONS: RelieI oI mild to moderate pain, either when pain is present alone or
when accompanied by Iever
ROUTES OF ADMINISTRATION: Tablets
USUAL DOSAGE: 100 mg propoxyphene napsylate and 650 mg acetaminophen q 4 hr,
not to exceed 600 mg propoxyphene per day
ADVERSE REACTIONS: Drowsiness, dizziness, N&V, sedation
INTERACTIONS: Anticonvulsants - anticonvulsant pharmacologic and toxic eIIects
R/T inhibition oI metabolism; antidepressants - antidepressant pharmacologic and toxic
eIIects R/T inhibition oI metabolism; CNS depressants (including alcohol,
antidepressants, muscle relaxants, sedatives, tranquilizers) additive CNS depression;
warIarin - warIarin pharmacologic and toxic eIIects R/T inhibition oI metabolism
CONTRAINDICATIONS: Hypersensitivity to propoxyphene or acetaminophen; use in
those who are suicidal or addiction-prone; use in pregnancy unless until potential beneIits
outweigh the possible risks
NURSING CONSIDERATIONS: Consideration should be given to reducing the dose
oI propoxythene in geriatric clients and in those with renal or hepatic impairment; store
Irom 15-30C (59-86F); list drugs prescribed to ensure none interact; note reasons Ior
therapy, location, characteristics oI S&S, other agents trialed, outcome, and rate the pain
level; assess Ior depression, suicide ideations, excessive alcohol use, drug addiction
prone, precludes drug use; monitor ROM, VS, renal, LFT`s; reduce dose with
dysIunction; do not exceed prescribed dose; do not perIorm activities that require mental
alertness until drug eIIects realized (may cause dizziness or drowsiness); avoid alcohol
and other CNS depressants during therapy; may cause dizziness, N&V (lie down and rest
iI these eIIects occur to relieve symptoms).
GENERIC NAME: LITHIUM CARBONATE
TRADE NAME: Eskalith CR, Lithobid, Lithonate, Lithotabs
CLASSIFICATION: Antimanic
ACTION: Mechanism Ior the antimanic eIIect oI lithium is unknown; possibilities
include: (a) decrease in catecholamine neurotransmitter levels caused by lithium eIIect on
Na

-K

ATPase to improve transneuronal membrane transport oI sodium ion; (b)

decrease in cyclic AMP levels caused by lithium which decreases sensitivity oI
hormonal-sensitive adenyl cyclase receptors: AIIects the distribution oI calcium, Mg, and
sodium ions and aIIects glucose metabolism
INDICATIONS: Control oI mania in manic-depressive clients; Investigational: to
reverse neutropenia induced by cancer chemotherapy, in children with chronic
neutropenia, and in AIDS clients receiving ziduvudine; prophylaxis oI cluster headaches
ROUTES OF ADMINISTRATION: Capsules: 150 mg, 300 mg, 600 mg; Tablets: 300
mg; Extended Release Tablets: 300 mg, 450 mg
USUAL DOSAGE: Individualized, according to lithium serum level (not to exceed 1.4
mEq/L) and clinical response; Usual initial dose 300-600 mg 3 X daily, or 600-900 mg
2 X daily oI slow release Iorms; Maintenance: 300 mg 3-4 X daily; Administration oI
drug halted when serum level exceeds 1.2 mEq/L, started back up 24 hr later
ADVERSE REACTIONS: Fine hand tremor, polyuria, thirst, transient and mild nausea,
general discomIort
INTERACTIONS: Acetazolamide / urea / urinary alkanizers / mannitol- lithium eIIect
by renal excretion; Bumetanide / ethacrynic acid / Iurosemide - lithium toxicity R/T
renal clearance; Carbamazepine / phenytoin / probenecid - risk oI lithium toxicity;
Diazepam - risk oI hypothermia; Haloperidol - risk oI neurologic toxicity; NSAID`s -
lithium clearance, possibly R/T inhibition oI renal prostaglandin synthesis
CONTRAINDICATIONS: Cardiovascular or renal disease; brain damage; dehydration,
sodium depletion, clients receiving diuretics; lactation
NURSING CONSIDERATIONS: Toxicity is closely related to serum lithium levels
and can occer at therapeutic doses; Iacilities to monitor lithium are required: determine
blood levels 1-2 times weekly to prevent toxicity; Iull beneIicial drug eIIects might not be
noted Ior 6-10 days; drink 10-12 glasses oI water per day to avoid dehydration; take with
Iood or immediately aIter meals; avoid caIIeinated drinks/Ioods (may aggravate mania);
report persistent diarrhea; may need supplemental Iluids or salts
GENERIC NAME: OXYBUTYNIN
TRADE NAME: Ditropan, Ditropan XL, Urotrol
CLASSIFICATION: Antispasmodic in urinary tract
ACTION: Exerts direct antispasmodic eIIect on smooth muscle and inhibits action oI
acetylcholine at postganglionic cholinergic sites, thus decreasing bladder capacity and
delaying the initial desire to void by reducing the number oI motor impulses reaching the
detrusor muscle
INDICATIONS: Urologic disorders, irritative voiding, Irequent urinating, urgency, urge
incontinence, nocturia, incontinence with neurogenic bladder contractions
ROUTES OF ADMINISTRATION: Syrup, Tablets
USUAL DOSAGE: Adult: Oral, 5 mg two or three times a day, dosage being adjusted as
needed and tolerated; oral prescribing limits 5 mg 4 times a day or 20 mg daily
ADVERSE REACTIONS: Rapid increase in temperature due to suppretion oI sweat
glands; allergic reaction; increased intraocular pressure; constipation, decreased sweating,
drowsiness; dryness oI mouth, nose, and throat
INTERACTIONS: Anticholinergics/anticholinergic-like drugs / CNS depressants may
increase sedative eIIect oI either these medications or oxybutynin
CONTRAINDICATIONS: Urinary retention, gastric retention, other severe
gastrointestinal motility conditions; uncontrolled narrow-angle glaucoma;
hypersensitivity to drug
NURSING CONSIDERATIONS: Take medication on an empty stomach with water, or
with Iood and milk to reduce gastric irritation; do not take more medication than the
amount prescribed; take as soon as possible iI almost time Ior next dose, do not double
dose oI missed Ior extended amount oI time; avoid use oI alcohol or other CNS
depressants; possibly have an increased sensitivity to light; caution iI blurred vision or
drowsiness occurs; caution during exercise and hot weather (may cause heatstroke)
GENERIC NAME: PYRIDOXINE HYDROCHLORIDE (VITAMIN B
6
)
TRADE NAME: Pyridoxine HCl injection, Aminoxin, Vitelle Nestrex
CLASSIFICATION: Vitamin B
6
ACTION: A water-soluble heat-resistant vitamin that is destroyed by light; acts as a
coenzyme in the metabolism oI protein, carbohydrates, and Iat; as amount oI protein
increases in diet, pyridoxine requirement increases; however, pyridoxine deIiciency alone
is rare
INDICATIONS: Pyridoxine deIiciency including poor diet, drug-induced (ex. Oral
contraceptives, isoniazid), and inborn errors oI metabolism
ROUTES OF ADMINISTRATION: Injection 100 mg/mL; tablets 25 mg, 50 mg, 100
mg, 250 mg, 500 mg
USUAL DOSAGE: Dietary supplement: Adults: 10-20 mg/day Ior 2 weeks, then 2-5
mg/day as part oI a multivitamin preparation Ior several weeks; High urine oxylate
levels: 25-300 mg/day; PMS: 40-500 mg/day; Tardive dyskinesia due to antipsychotic
drugs: 100 mg/day Ior 4 weeks
ADVERSE REACTIONS: Paresthesia, numbness oI Ieet, perioral numbness, unstable
gait. Decreased sensation to touch, temperature, and vibration
INTERACTIONS: Chloramphenicol / oral contraceptives / Cycloserine / Ethionamide /
Hydralazine / immunosuppressant`s / isoniazid / penicillamine : Pyridoxine
requirements; Levadopa: doses exceeding the 5 mg/day pyridoxine antagonize
therapeutic eIIect oI levadopa; Phenobarbital: serum phenobarbitol levels; Phenytoin:
serum phenytoin levels
CONTRAINDICATIONS: None special concerns with saIety and eIIectiveness in
children Ior doses that exceed RDA (not been established)
NURSING CONSIDERATIONS: Monitor uric acid levels, renal, LFTs; assess Ior
dysIunction; best source oI vitamins are with Ioods high in Vitamin B
6,
potatoes, broccoli,
lima beans, bananas, chicken breast, liver, yeast, wheat germ, whole-grain cereals; iI
prescribing levadopa, avoid vitamin supplements containing vitamin B
6,
do not take OTC
vitamin supplements

without provider approval
GENERIC NAME: METOPROLOL SUCCINATE
TRADE NAME: Toprol XL
CLASSIFICATION: Antihypertensive
ACTION: Beta 1 adrenoreceptor blocking agents. HCT provides diuretic actions.
Crosses the blood-brain barrier. Slows the sinus rate and decreases AV nodal
conduction. Blocks the action oI certain chemicals in your body like epinephrine that
aIIect the heart and blood vessels. Results in lowering oI heartrate, BP and strain on the
heart.
INDICATIONS: Late or early MI, hypertension, angina, heart Iailure, irregular heart
rate, migrane prevention
ROUTES OF ADMINISTRATION: PO: tablets, IV
USUAL DOSAGE: PO: 100-450 mg/day divided bid-tid IV/PO/ 3 bolus injections oI 5
mg at 2 min intervals Iollowed in 15 min by 50 mg PO every 6 hrs Ior 48 hrs, thereaIter
100 mg PO bid
ADVERSE REACTIONS: Hypokalemia may develop is cases oI brisk diuresis or
severe cirrhosis, dizziness, lightheadedness, drowsiness, diarrhea, unusual dreams,
trouble sleeping, vision problems, cold hands, Ieet, decreased pulse.
INTERACTIONS: General anesthesia, clonidine, insulin, thiazides, lithium, NSAIDs,
antidiabetics, CA channel blockers, Digoxin, epinephrine, anti-hypertensives, thyroid
medications and anti-depressants.
CONTRAINDICATIONS: Sinus bradycardia, heart block greater than Iirst degree,
cardiogenic shock, overt cardiac Iailure. Hypersensitivity to related derivatives or to any
oI the excipients; hypersensitivity to other beta-blockers, cross sensitivity between beta
blockers can occur, sick sinus syndrome, severe peripheral arterial circulatory disorders,
pheochromocytoma, patients with bronchospastic diseases, used with caution in
diabetic patients or patients with impaired hepatic Iunction.
NURSING CONSIDERATIONS: Apical pulse rate should be taken Ior 1 minute,
supine and standing BP should be taken, daily weight measurements are important. Take
with or right aIter a meal. Use regularly at the same time each day. May take 1-2 weeks
to see results. Do not discontinue taking medication without consulting a physician.
Medication must be gradually decreased. Exercise must be limited while decreasing
GENERIC NAME: CHOLESTYRAMINE RESIN
TRADE NAME: Questran, Questran Light, Cholestyramine Light, Prevalite
CLASSIFICATION: Antihyperlipidemic, bile acid sequestrant
ACTION: Binds sodium cholate (bile salts) in the intestine; thus the principal precursor
oI cholesterol is not absorbed due to the Iormation oI an insoluble complex, which is
excreted in the Ieces; decreases cholesterol and LDL and either has no eIIect or increases
triglycerides VLDL and HDL; also, itching is relieved as a result oI removing irritating
bile salts; antidiarrheal eIIect results Irom binding and removal oI bile acids
INDICATIONS: Adjunct to reduce elevated serum cholesterol in primary
hypercholesterolemia in those who do not respond adequately to diet; Pruritus associated
with partial biliary obstruction; Diarrhea due to bile acids; Investigational: Antibiotic-
induced pseudomembranous colitis (ex due to toxin produced by Clostridium difficile),
digitalis toxicity, treatment oI thyroid hormone overdose, treatment oI chlordecone
poisoning
ROUTES OF ADMINISTRATION: Powder Ior suspension
USUAL DOSAGE: Adult: Initial: 4 grams 1-2 times per day; Maintenance: 2-4 packets
or scoopIuls per day mixed with 60-180 mL water or non-carbonated beverage;
recommended 2 times daily, but can be given in one to six doses; maximum daily dose 6
packets or scoopIuls
ADVERSE REACTIONS: Constipation (may be severe), aggravation oI hemorrhoids,
abdominal pain, bloating, vomiting, diarrhea, weight loss, Ilatulence, inIection
INTERACTIONS: Aspirin - aspirin absorption Irom the GI tract; Clindamycin -
clindamycin absorption Irom GI tract; too many interactions to list separately NOTE:
Most drugs either have a lessened effect or are less absorbed in the GI tract due to
medication
CONTRAINDICATIONS: Complete obstruction or atresia oI bile duct
NURSING CONSIDERATIONS: Always mix powder with 60-180 mL water or
noncarbonated beverage beIore administering; resin may cause esophageal irritation or
blockage; do not take in dry Iorm; avoid inhaling powder; may be irritating to mucous
membranes; allow powder to sit on top oI beverage approx 2 min occasionally twirling to
keep powder Irom sides and then stir slowly (prevents Ioaming); take other drugs 1 hour
beIore or 4-6 hrs aIter Cholestyramine administration; assess skin and eyes Ior evidence
oI jaundice or bile deposits; report any tarry stools or abnormal bleeding as supplemental
vitamin K (10 mg/week) may be necessary; CBC, PT, and renal Iunction tests should be
done routinely
GENERIC NAME: SODIUM BICARBONATE
TRADE NAME: Arm and Hammer Pure Baking Soda, Bell/ans, Citrocarbonate, Soda
Mint
CLASSIFICATION: Alkalinizing agent, antacid, electrolyte
ACTION: Antacid action due to neutralization oI hydrochloric acid by Iorming sodium
chloride and carbon dioxide; provides temporary relieI oI peptic ulcer pain and oI
discomIort associated with indigestion; systemic and urinary alkalinizer by increasing
plasma and urinary bicarbonate
INDICATIONS: Treatment oI hyperacidity; severe diarrhea where there is loss oI
bicarbonate; alkalization oI the urine to treat drug toxicity; treatment oI acute mild to
moderate metabolic acidosis due to shock, severe dehydration, anoxia, uncontrolled
diabetes, renal disease, cardiac arrest, extracorporeal circulation oI blood, severe primary
lactic acidosis; prophylaxis oI renal calculi in gout
ROUTES OF ADMINISTRATION: Injection 4, 4.2, 5, 7.5, 8.4: Tablets
325 mg, 520 mg, 650 mg
USUAL DOSAGE: Antacid: 0.325-2 grams 1-4 times per day: Urinary alkalinizer:
0.325-2 grams up to 4 times a day initially, then maximum oI 15 grams in those under
age 60 and 8 grams over age 60;
ADVERSE REACTIONS: Rebound hyperacidity, milk-alkali syndrome; use in caution
in impaired renal Iunction, toxemia oI pregnancy, with oligurea or anuria, during
lactation, in edema, CHF, liver cirrhosis and with low-salt diets
INTERACTIONS: Ephedrine - ephedrine eIIect by renal tubular reabsorption (many
other drugs aIIected this way); iron products - iron eIIects R/T urine alkalinity (many
drugs aIIected this way also)
CONTRAINDICATIONS: Chloride loss due to vomiting or Irom continuous GI
suction; with diureticsknown to produce a hypochloremic alkalosis; metabolic and
respiratory alkalosis; hypocalcemia in which alkalosis may cause tetany; hypertension,
convulsions, CHF and other situations where administration oI sodium can be dangerous
NURSING CONSIDERATIONS: Hypertonic solutions must be administered by trained
personnel; avoid extravasation as tissue irritation or cellulitis may occur; assess Ior
edema; administer isotonic solutions slowly; too rapid may result in death due to cellular
acidity; in event oI severe tetany or severe alkalosis, have sodium gluconate on hand;
note reasons Ior therapy and history oI renal impairment; chew tablets thoroughly and
take only as prescribed, and Iollow with glass oI water, NOT with milk/yogurt
GENERIC NAME: AMIODARONE HYDROCHLORIDE
TRADE NAME: Cordarone, Pacerone
CLASSIFICATION: Antiarrhythmic
ACTION: Blocks sodium channels at rapid pacing Irequencies, causing an increase in
the duration oI the myocardial cell action potential and reIractory period, as well as
alpha- and beta-adrenergic blockade; the drug decreases sinus rate, increases PR and QT
intervals, results in development oI U waves, and changes T-wave contour; aIter IV use,
amiodarone relaxes vascular resistance (aIterload), and increases cardiac index slightly
INDICATIONS: Use should be reserved Ior liIe-threatening ventricular arrhythmias
unresponsive to other therapy, such as recurrent ventricular Iibrillation and recurrent,
hemodynamically unstable ventricular tachycardia; reserve IV use Ior acute treatment
until arrhythmias are stabilized
ROUTES OF ADMINISTRATION: Injection: 50 mg/mL;tablets:100 mg,200 mg,400
mg
USUAL DOSAGE: Administer ONLY in the hospital due to side eIIects, unusual
properties, and diIIicult dosing schedule: Loading dose: 150 mg over Iirst 10 minutes (15
mg/min), then slow loading dose 360 mg over next 6 hrs (1mg/min), then maintenance
dose 540 mg over remaining 18 hr (0.5 mg/min) and continue with monitoring Ior 2 to 3
weeks; then PO amiodarone 800-1600 mg/day (IV less than 1 week), 600-800 mg/day
(IV between 1-3 weeks), and 400 mg/day (IV longer than 3 weeks)
ADVERSE REACTIONS: AIter PO use, CHF, cardiac arrhythmias, malaise, Iatigue,
tremor, involuntary movements, poor coordination, peripheral neuropathy, paresthesias,
photosensitivity, N&V, constipation, anorexia, pulmonary inIlammation: AIter IV use,
hypotension, bradycardia, AV block, CHF, ventricular tachycardia, nausea, Iever,
injection site reactions
INTERACTIONS: MULTIPLE INTERACTIONS TOO MANY TO LIST - SEE
BOOK
CONTRAINDICATIONS: Marked sinus bradycardia due to severe sinus node
dysIunction, second- or third-degree AV block unless a Iunctioning pacemaker is
available, cardiogenic shock, and when bradycardia has caused syncope except when
used with a pacemaker; known hypersensitivity to the drug or any oI its components,
including iodine; lactation; use in children is not recommended
NURSING CONSIDERATIONS: Drug is used to control heart beat irregularities, take
as directed; assess respiratory status and lung sounds; note cardiac status, EKG and CV
Iindings; monitor Ior hepatic and pulmonary toxicity; note baseline vitals and perIusion,
assess Ior circulatory impairment and hypotension; assess vision beIore therapy and
monitor; monitor thyroid studies; may require replacement therapy with prolonged use;
during administration, observe Ior increased PR and QRS intervals, increased
arrhythmias, and HR < 60 bpm
GENERIC NAME: ACIDOPHILUS
TRADE NAME: Acidophilus, Acidophilus Extra Strength, Bacid, Flora-Q, Flora-Q 2,
Superdophilus
CLASSIFICATION: Antidiarrheal, probiotic
ACTION: Bacteria that naturally exists in the human body, primarily in intestines and
vagina; helps maintain acidic environment in body which can prevent growth oI harmIul
bacteria; helps body maintain normal consistency oI bacteria in the stomach, intestines,
vagina; helps maintain normal intestinal Ilora
INDICATIONS: Diarrhea, electrolyte loss due to diarrhea, Iluid loss via diarrhea, treat
or pre4vent vaginal yeast inIections, yeast inIections oI mouth, UTI`s
ROUTES OF ADMINISTRATION: Tablets
USUAL DOSAGE: 230 mg
ADVERSE REACTIONS: Hives, diIIiculty breathing, swelling oI the Iace, lips, tongue,
throat, other minimal side eIIects
INTERACTIONS: Possible interactions; too new to know; contact doctor Ior meds and
interactions
CONTRAINDICATIONS: Pregnancy, lactation, children
NURSING CONSIDERATIONS: Not FDA approved; all potential risks and/or
advantages may not be known; should not be substituted Ior prescription medications
Generic name: ascorbic acid
Trade name: Vitamin C, Ascorbate, ascorbyl palmitate, calcium ascorbate, sodium
ascorbate, cevitamic acid
Classification: Vitamin Supplement
Action: Water-soluble vitamin, necessary to Iorm collagen in bones, cartilage, muscle,
and blood vessels, aids in absorption oI iron
Indications: Scurvy, common cold prevention, iron absorption enhancement, UTI during
pregnancy, asthma, bleeding treatment, cancer prevention, ischemic heart disease
Routes: Oral
Dosage: RDA 90 mg/day Ior males, 75 mg/day Ior Iemales; upper limit should not
exceed 2,000 mg/day
Adverse reactions: High doses associated with kidney stones, severe diarrhea, nausea,
gastritis, rarely Ilushing, Iaintness, dizziness, Iatigue
Interactions: aspirin, eIIects lowered by barbiturates, oral estrogens / tetracycline
antibiotics / nicotine products vit C eIIects
Contraindications: None
Nursing considerations: Watch when taking with other vitamins and medications; check
with doctor Ior possible interactions with other vitamins and drugs
GENERIC NAME: ESCITALOPRAM OXALATE
TRADE NAME: Lexapro
CLASSIFICATION: Antidepressant, selective serotonin reuptake inhibitor
ACTION: Inhibits CNS neuronal uptake oI serotonin; minimal eIIects on norepinephrine
and dopamine reuptake
INDICATIONS: Major depressive disorder, including maintenance, as deIined in the
DSM-IV-TR category; generalized anxiety disorder
ROUTES OF ADMINISTRATION: Oral solution 5 mg/5 mL; tablets 5 mg, 10 mg, 20
mg
USUAL DOSAGE: Initial: 10 mg once daily, including elderly or those with hepatic
impairment; increase dose to 20 mg, iI necessary, aIter a minimum oI a week;
maintenance: 10 or 20 mg/day Ior up to 36 weeks aIter initial 8 weeks oI treatment
ADVERSE REACTIONS: Nausea, dry mouth, increased sweating, dizziness, diarrhea,
Ilu-like symptoms, Iatigue, insomnia, somnolence, rhinitis, ejaculation disorder
INTERACTIONS: Cimetidine/Omeprazole - Escitopram AUC and t1/2 R/T possible
inhibition oI metabolism; MAO inhibitors serious (may be Iatal) reactions, including
hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes;
Metoprolol - Metoprolol C
max
and AUC; Sumatriptan potential Ior weakness,
hyperreIlexia, incoordination
CONTRAINDICATIONS: Clients taking monoamine oxidase inhibitors or citalopram
(Celexa); hypersensitivity to the drug or any component; alcohol use
NURSING CONSIDERATIONS: Give once daily in morning or evening with or
without Iood; discontinuing escitalopram may cause symptoms, including dysphoric
mood, irritability, agitation, dizziness, sensory disturbances, anxiety, conIusion,
headache, lethargy, emotional lability, hypomania, or insomnia; gradual reduction
preIerred over complete stop; note other prescribed drugs, avoid use within 14 days oI
MAOI use; take as directed; should not be taken with Celexa; use caution when operating
machinery or cars until drug eIIects known; avoid alcohol, OTC agents, or CNS
depressants; use reliable birth control
GENERIC NAME: LANSOPRAZOLE
TRADE NAME: Prevacid, Prevacid IV
CLASSIFICATION: Proton pump inhibitor
ACTION: Gastric acid (proton) pump inhibitor, blocks Iinal step oI acid production;
suppresses gastric acid secretion by inhibition oI the (H

, K

)-ATPase system located at

the secretory surIace oI the parietal cells in the stomach
INDICATIONS: Short-term treatment (up to 4 weeks) Ior healing and symptomatic
relieI oI active duodenal ulcer (PO only); maintain healing with duodenal ulcer; short-
term treatment (up to 8 weeks) Ior healing and symptomatic relieI oI benign gastric ulcer
ROUTES OF ADMINISTRATION: Capsules, delayed-release: 15 mg, 30 mg; granules
Ior oral suspension, delayed release: 15 mg, 30 mg; tablets, orally disintegrating: 15 mg,
30 mg
USUAL DOSAGE: Treatment oI duodenal ulcer (initial) 15 mg once daily beIore
breakIast Ior 4 weeks (maintenance) 15 mg once daily; treatment oI gastric ulcer 30
mg once daily up to 8 weeks; GERD 30 mg once daily beIore meals up to 8 weeks and
iI symptoms remain aIter 2 or more weeks, can up to 30 mg once daily; erosive
esophagitis 30 mg once daily beIore meals up to 8 weeks; iI symptoms persist, may
continue Ior another 8 weeks
ADVERSE REACTIONS: Diarrhea, headache, N&V, constipation, rash
INTERACTIONS: Ampicillin - ampicillin eIIect R/T absorption; clarithromycin -
lansoprazole AUC and peak plasma levels R/T inhibition oI metabolism by CYP2C19;
Digoxin - digoxin eIIect R/T absorption; Iron salts - eIIect oI iron salts R/T
absorption; sucralIate delayed absorption oI lansoprazole
CONTRAINDICATIONS: Lactation; use with rabeprazole
NURSING CONSIDERATIONS: Do not crush or chew any lansoprazole products;
consider dosage reduction in those with severe liver disease; Ior those unable to swallow
pills, open capsule and sprinkle on a spoon oI applesauce; to give capsules in NG tube,
open capsule and mix intact granules with 40 mL oI apple juice and instill through NG
tube into the stomach, Ilushing with additional apple juice to clear tube; store in tight
container protected Irom moisture and store between 15-30
GENERIC NAME: PAROXETINE HYDROCHLORIDE, PAROXETINE MESYLATE
TRADE NAME: Paxil, Paxil CR, Pexeva
CLASSIFICATION: Antidepressant, selective serotonin reuptake inhibitor (SSRI)
ACTION: Antidepressant eIIect likely due to inhibition oI CNS neuronal uptake oI
serotonin and to a lesser extent norepinephrine and dopamine; Results in increased levels
oI serotonin in synapses
INDICATIONS: Treatment oI major depressive episodes as deIined in the DSM-III
(immediate-release) or DSM-IV (controlled-release); panic disorder with or without
agoraphobia; treatment oI social anxiety disorder (social phobia) as deIined in the DSM-
IV; generalized anxiety disorder; up to 24 weeks Ior maintenance therapy
ROUTES OF ADMINISTRATION: Oral suspension 10mg/5mL; tablets 10 mg, 20
mg, 30 mg, 40 mg; tablets, controlled-release 12.5 mg, 25 mg, 37.5 mg
USUAL DOSAGE: Major depressive disorder, initial 25 mg/day usually given as
single dose in AM; can increase dose by 12.5 mg/day up to 62.5 mg/day; maintenance -
mg/day average: Social Anxiety disorder 12.5 mg/day with range 12.5-37.5 mg/day:
Diabetic neuropathy 10-60 mg/day (oral suspension): Panic disorder 12.5 mg/day;
increase dose by 12.5 mg/day at 1 week intervals up to 75 mg/day
ADVERSE REACTIONS: Insomnia, somnolence, nausea, dry mouth, asthenia,
headache, dizziness, tremor, excessive sweating, diarrhea/loose stools, constipation,
abnormal ejaculation
INTERACTIONS: Antiarrhythmics (type IC) possible eIIect R/T liver breakdown;
Cimetidine - Paroxetine eIIect R/T liver breakdown; Digoxin possible plasma
levels; Phenobarbital possible paroxetine eIIect R/T liver breakdown; Phenytoin
possible paroxetine eIIect R/T liver breakdown and also phenytoin levels
CONTRAINDICATIONS: Lactation, use oI alcohol, use during the Iirst trimester oI
pregnancy; concomitant use oI thioridazine, use in children and adolescents less than 18
years oI age with major depressive disorder due to increased risk oI suicidal thoughts and
attempts
NURSING CONSIDERATIONS: Even though beneIicial eIIects may be seen in 1-4
weeks, continue therapy as prescribed; eIIectiveness is maintained Ior up to 1 year with
daily doses averaging 30 mg oI immediate-release or 37.5 mg oI controlled-release; iI
decreasing dose, decrease incrementally (stopping suddenly can cause dizziness, sensory
disturbances, agitation, anxiety, nausea, and sweating); document mania, altered
metabolic or hemodynamic states, seizures; note reasons Ior therapy, type, onset,
characteristics oI S&S, other therapy trialed, and outcomes; may be given with or without
Iood; monitor weight, vital signs, ECG, electrolytes, CBC, renal and LFT`s and note any
dysIunction
GENERIC NAME: HYDRALAZINE HYDROCHLORIDE
TRADE NAME: Apresoline
CLASSIFICATION: Oral hypertensive
ACTION: Major eIIects are on the cardiovascular system; hydralazine lowers blood
pressure by exerting a peripheral vasodilating eIIect thru direct relaxation oI vascular
smooth muscle; alters cellular calcium metabolism, interIeres with calcium movements
within vascular smooth muscle; decreased arterial blood pressure; decreased peripheral
vascular resistance
INDICATIONS: Essential hypertension, either alone or as an adjunct
ROUTES OF ADMINISTRATION: 10 mg, 25 mg, 50 mg, 100 mg all PO tablets
USUAL DOSAGE: Initially 10 mg Iour times daily Ior Iirst 2-4 days, increase to 25 mg
Iour times daily Ior balance oI Iirst week; Ior second and subsequent weeks, increase
dosage to 50 mg Iour times daily
ADVERSE REACTIONS: Usually reversible when dosage reduced common
reactions include headache, anorexia, nausea, vomiting, diarrhea, palpitations,
tachycardia, angina pectoris; less common constipation, paralytic ileus, dyspnea,
peripheral neuritis, numbness, tingling, dizziness, tremors, muscle cramps, diIIiculty in
urination
INTERACTIONS: MAO inhibitors cannot be used with Hydralazine, higher plasma
levels results when taken with Iood
CONTRAINDICATIONS: Hypersensitivity to hydralazine; coronary artery disease;
mitral valvular rheumatic heart disease
NURSING CONSIDERATIONS: Watch Ior usage oI hydralazine in patients with
advanced renal damage; be aware that in hypertensive patients with normal kidneys, there
is evidence oI increased renal blood Ilow and maintenance oI glomerular Iiltration rate;
watch Vital Signs. Check I and O, daily weights need to be checked; check Ior renal
output
GENERIC NAME: CLONIDINE HYDROCHLORIDE
TRADE NAME: Catapres, Catapres-TTS-1, -2, and -3, Duraclon
CLASSIFICATION: Antihypertensive, centrally-acting
ACTION: Stimulates alpha-adrenergic receptors oI the CNS, resulting in
inhibition oI the sympathetic vasomotor centers and decreased nerve
impulses; bradycardia and a Iall in both SBP and DBP occur; plasma renin
levels are decreased while peripheral venous pressure remains unchanged
INDICATIONS: Alone or with a diuretic or other hypertensives to treat
mild to moderate hypertension; treat spasticity; Investigational Alcohol
withdrawal, atrial Iibrillation, attention deIicit hyperactivity disorder;
Epidural with opiates Ior severe pain in cancer clients not relieved by
opiate analgesics alone; most eIIective Ior neuropathic pain
ROUTES OF ADMINISTRATION: Tablets 0.1 mg, 0.2 mg, 0.3 mg;
Injection 0.1 mg/mL, 0.5 mg/mL
USUAL DOSAGE: 0.1 mg twice a day initially, then increase by 0.1 -0.2
mg/day until desired response is attained
ADVERSE REACTIONS: Dry mouth, drowsiness, dizziness, sedation, constipation
INTERACTIONS: Alcohol depressant eIIect; Beta-adrenergic blocking agents
paradoxical hypertension, also severity oI rebound hypertension Iollowing clonidine
withdrawal; CNS depressants - CNS depressant eIIect; Levadopa - Levadopa eIIect;
Mirtazapine Loss oI BP control antagonism oI u-2 adrenergic receptors; prazosin -
Clonidine antihypertensive eIIect; Narcotic analgesic potentiation oI clonidine
hypotensive eIIect; Tolazoline / tricyclic antidepressants blocks antihypertensive eIIect;
Verapamil - risk oI AV block and severe hypotension
CONTRAINDICATIONS: Epidurally, presence oI an injection site inIection, clients on
anticoagulant therapy, in bleeding diathesis, administration above the C4 dermatome; Ior
obstetrics, postpartum, or perioperative pain
NURSING CONSIDERATIONS: Do not conIuse Catapres with CataIlam or
Combipres; do not conIuse Clonidine with Klonopin; may take 2-3 days to achieve
eIIective blood levels; with severe hypertension, may require other antihypertensive drug
therapy in addition to transdermal clonidine; iI discontinuing drug, do so gradually over a
period oI 2-4 days; identiIy reasons Ior therapy, onset, type oI symptoms, and previous
treatments; obtain CBC, liver and renal Iunction studies; promote periodic eye exams;
note occupation may interIere with ability to work
GENERIC NAME: EPOETIN ALFA RECOMBINANT
TRADE NAME: Epogen, Procrit
CLASSIFICATION: Erythropoietin, human recombinant
ACTION: Made by recombinant DNA technology; it has the identical amino acid
sequence and same biologic eIIects as endogenous erythropoietin (which is normally
synthesized in the kidney and stimulates RBC production); will stimulate RBC
production
INDICATIONS: Treatment oI anemia associated with chronic renal Iailure in adults and
children, including clients on dialysis (end-stage renal disease) or adults not on dialysis;
treatment oI anemia in clients with nonmyeloid malignancies
ROUTES OF ADMINISTRATION: Injection 2000 units/mL, 3000 units/mL, 4000
units/mL, 10000 units/mL, 20000 units/mL, 40000 units/mL
USUAL DOSAGE: DiIIerent dosages Ior diIIerent reasons: IV or SC, initial 50-100
units/kg three times per week (the rate oI increase oI hematocrit depends on both dosage
and client variation; Maintenance Individualize 25 units/kg three times a week, doses
oI 75-150 units/kg/week have maintained hematocrit oI 36-38 Ior up to 6 months in
non-dialysis clients NOTE: reduce dose iI hemoglobin approaches 12 grams/dL or iI
hemoglobin increases by more than 1 gram/dL in any 2 week period
ADVERSE REACTIONS: Hypertension, headache, Iever, Iatigue, N&V, diarrhea,
edema, asthenia, respiratory congestion, cough, pyrexia, rash, SOB, insomnia, pruritus,
DVT (in surgery clients)
INTERACTIONS: No major interactions
CONTRAINDICATIONS: Uncontrolled hypertension; hypersensitivity to mammalian
cell-derived products or to human albumin; use in chronic renal Iailure clients who need
severe anemia corrected; to treat anemia in HIV-inIected or cancer clients due to Iactors
such as iron or Iolate deIiciencies, hemodialysis, or GI bleeding; anemic clients willing to
donate autologous blood
NURSING CONSIDERATIONS: DO NOT give with any other drug solutions; at time
oI SC administration, the drug may be admixed in a syringe with bacteriostatic 0.9
NaCl injection with benzylalcohol,0.9 at 1:1 ratio (benzyl alcohol acts as anesthetic that
may reduce discomIort at the SC site; individualize dose Ior each client; IV usually given
as a bolus 3 times/week; during hemodialysis, may require increased anticoagulation with
heparin to prevent clotting oI artiIicial kidney; determine hematocrit twice weekly; iI
hematocrit approaches 36, decrease dose to maintain suggested hematocrit target range;
Individualize hemoglobin target level; do not shake vial; do not use vials showing
particulate matter or discolorization
GENERIC NAME: GLYBURIDE
TRADE NAME: Diaeta, Glynase, PresTab, Micronase
CLASSIFICATION: Antidiabetic, oral; second generation sulIonylurea
ACTION: Lowers blood glucose by stimulating the release oI insulin Irom Iunctioning
pancreatic beta cells and by increasing the sensitivity oI peripheral tissues to insulin; has
a mild diuretic eIIect
INDICATIONS: Diabetes mellitus; may be used with metIormin when diet and
glyburide or diet and metIormin alone do not provide adequate control
ROUTES OF ADMINISTRATION: Tablets, micronized 1.5 mg, 3 mg, 4.5 mg, 6 mg;
Tablets, nonmicronized 1.25 mg, 2.5 mg, 5 mg
USUAL DOSAGE: Initial Ior adults (Nonmicronized) 2.5 5 mg/day given with
breakIast (or Iirst main meal), then increase by 2.5 mg at weekly intervals to achieve the
desired response; maintenance 1.25 20 mg/day; clients sensitive to sulIonylureas
should start with 1.25 mg/day; initial Ior adults (Micronized) 1.5 3 mg/day given with
breakIast (or Iirst main meal); those sensitive to sulIonylureas should start with 0.75
mg/day; increase by no more than 1.5 mg at weekly intervals to achieve the desired
response
ADVERSE REACTIONS: Hypoglycemia, nausea, epigastric distress, heartburn,
allergic skin reactions, blurred visions
INTERACTIONS: Anticoagulants either or anticoagulant eIIect; CiproIloxacin
potentiation oI hypoglycemic eIIect
CONTRAINDICATIONS: Stress beIore and during surgery, ketosis, severe trauma,
Iever, inIections, pregnancy, diabetes complicated by recurrent episodes oI ketoacidosis
or coma; use in diabetics who can be controlled by diet alone
NURSING CONSIDERATIONS: Do not conIuse glyburide with glipizide or Glucatrol;
administer 30 minutes prior to meals; do not exceed 20 mg/day oI nonmicrozized and 12
mg/day oI micronized products; note reasons Ior therapy; explain that it works by causing
pancreas to release more insulin into the blood stream, helps insulin get into cells to
lower blood sugar and help restore the way you use Iood to make energy; take as directed
with Iood; record Iinger sticks at various times (Iasting, 1 2 hr aIter meals, beIore
bedtime), continue regular daily exercise, liIestyle changes, BP control, weight loss, and
dietary restrictions to control cholesterol and glucose; avoid alcohol, OTC agents without
approval; practice reliable contraception
GENERIC NAME: ATORVASTATIN CALCIUM
TRADE NAME: Lipitor
CLASSIFICATION: Antihyperlipidemic, HMG-CoA reductase inhibitor
ACTION: Competitively inhibits HMG-CoA reductase; this enzyme catalyzes the early
rate-limiting step in the synthesis oI cholesterol; cholesterol synthesis is
inhibited/decreased; decreases cholesterol, triglycerides, VLDL, and LDL, and increases
HDL
INDICATIONS: Adjunct to diet to decrease elevated total and LDL cholesterol, apo-B,
and triglyceride levels and to increase HDL cholesterol in primary hypercholesterolemia
(including heterozygous Iamilial and nonIamilial) and mixed dyslipidemia; adjunct to
other lipid-lowering treatments to reduce total and LDL cholesterol in homozygous
Iamilial hypercholesterolemia
ROUTES OF ADMINISTRATION: Tablets 10 mg, 20 mg, 40 mg, 80 mg
USUAL DOSAGE: Hypercholesterolemia initial 10-20 mg once daily (40 mg/day
Ior those who require more than a 45 reduction in LD cholesterol); then a diose range
caoI 10-80 mg once daily may be used (individualize therapy according to goal oI
therapy and response)
ADVERSE REACTIONS: Headache, inIection, diarrhea, sinusitis, myalgia
INTERACTIONS: Antacids/Colestipol - Atorvastatin levels; Clarythromycin -
Atorvastatin plasma levels; possibility oI severe myopathy or rhabdomylosis; Digoxin -
Digoxin levels aIter 80 mg atorvastatin R/T Digoxin absorption; Diltiazem - Plasma
atorvastatin levels risk oI myopathy; Eryhtromycin - Atorvastatin levels;
possibility oI severe myopathy or rhabdomyolysis; NeIazodone / Verapamil - risk oI
myopathy
CONTRAINDICATIONS: Active liver disease or unexplained persistently high LFT`s;
use with grapeIruit juice; pregnancy, lactation
NURSING CONSIDERATIONS: Give as single dose at any time oI the day, with or
without Iood; determine lipid levels within 2-4 weeks, adjust dosage accordingly; Ior
additive eIIect, may be used with a bile acid binding resin; do not use atorvastatin with
Iibrates; Helps to lower blood cholesterol and Iat levels, which have been proven to
promote CAD; take at same time each day with or without Iood; continue dietary
restrictions oI saturated Iat and cholesterol, regular exercise, and weight loss in the
overall goal oI lowering cholesterol levels
GENERIC NAME: CLOPIDOGREL BISULFATE
TRADE NAME: Plavix
CLASSIFICATION: Antiplatelet Drug
ACTION: Inhibits platelet aggregation by inhibiting binding oI adenosine diphosphate
(ADP) to its platelet receptor and subsequent ADP-mediative activation oI glycoprotein
GPIIb/IIIa complex; EIIect on receptors is irreversible; thus platelets are aIIected Ior
remainder oI their liIespan; also inhibits platelet aggregation caused by agonists other
than ADP by blocking ampliIication oI platelet activation by released ADP
INDICATIONS: Reduction oI MI, stroke, and vascular death in clients with
atherosclerosis documented by recent stroke, MI, or established peripheral arterial
disease; acute coronary syndrome (unstable angina and non-Q wave MI), including those
on medical management and clients receiving stents
ROUTES OF ADMINISTRATION: 75 mg tablets
USUAL DOSAGE: Recent MI, stroke, or established peripheral arterial disease 75 mg
once daily with or without Iood; Acute Coronary Syndrome single 300 mg loading
dose, then 75 mg once daily; initiate and continue aspirin
ADVERSE REACTIONS: skin/appendage disorders, headache, URTI, chest pains, Ilu-
like symptoms
INTERACTIONS: Aspirin - risk oI liIe-threatening or major bleeding events in high-
risk clients with recent ischemic stroke or TIAs; Atorvastatin Inhibition oI clopidogrel
eIIects on platelet Iunction R/T inhibition oI metabolic conversion (by CYP3A4) oI the
prodrug clopidogrel to the active drug; Bupropion - Bupropion AUC and peak plasma
levels R/T inhibition oI metabolism by CYP2B6 hydroxylation oI bupropion; NSAIDs -
risk oI occult blood loss; WarIarin Clopidrogrel prolongs bleeding time; saIety oI use
with warIarin not established
CONTRAINDICATIONS: Lactation, active pathological bleeding such as peptic ulcer
or intracranial hemorrhage
NURSING CONSIDERATIONS: Do not conIuse Plavix with Pletal; dosage adjustment
not necessary Ior elderly clients or with renal disease; document atherosclerotic event
(MI, stroke) or established peripheral arterial disease requiring therapy; assess Ior any
active bleeding as with ulcers or intracranial bleeding; list all drugs prescribed/consumed
especially OTC; take exactly as directed, may take with or without Iood (Iood will lessen
stomach upset); may cause dizziness or drowsiness; avoid OTC agents especially aspirin,
aspirin-containing products, or NSAIDs; report any unusual bruising or bleeding; advise
all providers oI prescribed therapy
GENERIC NAME: METRONIDAZOLE
TRADE NAME: Flagyl IV, Flagyl, Flagyl 375, Flagyl ER, Metric 21, Protostat,
MetroCream, MetroGel, MetroLotion, Noritate
CLASSIFICATION: Trichomonacide, amebicide
ACTION: EIIective against anaerobic bacteria and protozoa; speciIically inhibits growth
oI trichomonae and amoebae by binding to DNA, resulting in loss oI helical structures,
strand breakage, inhibition oI nucleic acid synthesis, and cell death; the mechanism Ior its
eIIectiveness in reducing the inIlammatory lesions oI acne rosacea is not known
INDICATIONS: Serious inIections due to susceptible anaerobic bacteria, including
Bacteroides fragilis resistant to clinamycin, chloramphenicol, and penicillin; Peritonitis,
intra-abdominal abscess and liver abscess due to B. fragilis, B. distasonis, B. ovatus, B.
thetiaotaomicron, B. vulgatus, Clostridium species, Eubacterium species,
Peptostreptococcus species, and Peptococcus niger
ROUTES OF ADMINISTRATION: Capsules 375 mg; Tablets 250 mg, 500 mg;
Tablets (Extended release) 750 mg
USUAL DOSAGE: (Amebiasis) 500-750 mg 3 times daily Ior 5-10 days; pediatric 35-
50 mg/kg/day in three divided doses; (Helicobacter pvlori) 500 mg twice daily, with
Clarithromycin 500 mg twice daily, and either lansoprazole, 30 mg twice daily or
omeprazole 20 mg twice daily take all meds with meals
ADVERSE REACTIONS: Following systemic use; headache, vaginitis, nausea,
metallic taste, genital pruritis, bacterial inIection, Ilu-like symptoms
INTERACTIONS: Barbiturates Possible therapeutic Iailure oI metronidazole R/T
elimination; BusulIan - busulIan trough plasma levels ( risk oI toxicity); Cimetidine -
serum metronidazole levels R/T clearance; DisulIiram Concurrent use may cause
conIusion or acute psychosis; do not give metronidazole to clients who have taken
disulIram within the past 2 weeks; Lithium - lithium levels and toxicity; ethanol
possible disulIram-like reaction, including Ilushing, palpitations, tachycardia and N&V
CONTRAINDICATIONS: Blood dyscrasias, active organic disease oI the CNS,
trichomoniasis during the Iirst trimester oI pregnancy, lactation; is carcinogenic in
rodents; avoid unnecessary use; consumption oI alcohol during use; topical use iI
hypersensitive to parabens or other ingredients oI the Iormulation
NURSING CONSIDERATIONS: Reduce dose in those with hepatic disease; dosage
reduction possible in geriatric clients; drug has a high sodium content; take with Iood or
milk to reduce GI upset; take ER tablets at least 1 hr beIore or 2 hrs aIter meals; report
lack oI response, any symptoms oI CNS toxicity (uncoordinated movements/tremors,
numbness, seizures, any unusual bruising/bleeding); do not perIorm tasks that require
mental alertness until drug eIIects are realized
GENERIC NAME: TRAMADOL HYDROCHLORIDE
TRADE NAME: Ultram, Ultram ER
CLASSIFICATION: Analgesic, centrally-acting
ACTION: A centrally acting analgesic not related chemically to opiates; precise
mechanism is not known; may bind to mu-opioid receptors and inhibit reuptake oI
norepinephrine and serotonin; analgesic eIIect only partially antagonized by antagonist
naloxone; causes signiIicantly less respiratory depression than morphine
INDICATIONS: Management oI moderate to moderately severe pain; extended release
product is intended to treat moderate to moderately severe pain in adults who require
around-the-clock pain therapy Ior an extended amount oI time
ROUTES OF ADMINISTRATION: Tablets 50 mg; Tablets, extended-release 100
mg, 200 mg, 300 mg
USUAL DOSAGE: Management oI pain individualize dose based on lowest eIIective
dose Ior those requiring rapid onset oI analgesia, 50-100 mg q 4-6 hr, as needed but not
to exceed 400 mg/day; Ior moderate pain, 50 mg initially, may be adequate, and Ior
severe pain, 100 mg is oIten more eIIective; Ior moderate chronic pain, not requiring
rapid analgesic onset, use 25 mg/day to improve tolerability
ADVERSE REACTIONS: Dizziness, headache, CNS stimulation, ataxia,
sedation/somnolence, vertigo, itching/pruritis, constipation, nausea
INTERACTIONS: Alcohol / Anesthetics, general - respiratory depression; CNS
depressants additive CNS depression; Digoxin - (rare) risk oI dig toxicity;
Cyclobenzaprine / MAO inhibitors / Promethazine / Tricyclic antidepressants - risk oI
seizures; WarIarin - PT and INR
CONTRAINDICATIONS: Hypersensitivity to tramadol; in acute intoxication with
alcohol, hypnotics, centrally acting analgesics, opiates, or psychotropic drugs; use in
clients with past or present addiction or opiate dependence or in those with prior history
oI allergy to codeine or opiates
NURSING CONSIDERATIONS: Do not conIuse Ultram with Ultrase (pancreatic
enzyme); Store Irom 15-30C (59-86F) in a tight container; take only as directed, may
be taken without regard to Iood or meals; do not exceed prescribed doses oI Tramadol;
store saIely out oI reach oI children; do not perIorm activities that require mental
alertness; drug may cause drowsiness and impair mental or physical perIormance; alcohol
may intensiIy drug eIIects; report lack oI response; avoid CNS depressants
GENERIC NAME: ACETAMINOPHEN
TRADE NAME: Tylenol, Aspirin Free Anacin, Aspirin Free Pain RelieI, Extra Strength
Tablets multiple other names
CLASSIFICATION: Non-narcotic analgesic
ACTION: Decreases Iever by 1) a hypothalamic eIIect leading to sweating and
vasodilation and 2) inhibits the eIIect oI pyrogens on the hypothalamic heat-regulating
centers; may cause analgesia by inhibiting CNS prostaglandin synthesis
INDICATIONS: Control oI pain due to headache, earache, dysmenorrheal, arthralgia,
myalgia, musculoskeletal pain, arthritis, immunizations, teething, toncillectomy; to
reduce Iever in bacterial or viral inIections; as a substitute Ior aspirin in upper GI disease,
aspirin allergy, bleeding disorders, clients on anticoagulant therapy, and gouty arthritis
ROUTES OF ADMINISTRATION: Caplets, Capsules, Capsule (Sprinkle), Drops,
Elixir, Gelcaps, Geltabs, Liquid, Solution, Suppositories, Tablets, Tablets (chewable),
Tablets (Dispersible)
USUAL DOSAGE: Caplets - 160 mg, 500 mg, 650 mg; Capsules 325 mg, 500 mg;
Sprinkle capsules 80 mg, 160 mg; Drops 80 mg/0.8 mL; Elixir 80 mg/2.5mL, 80
mg/5mL; 120 mg/5mL, 160 mg/5mL; Gelcaps 500 mg; Tablets 325 mg, 500 mg, 650
mg; Chewable tablets 80 mg, 160 mg; Dispersible tablets 80 mg
ADVERSE REACTIONS: Few when taken in usual therapeutic doses; GI upset in some
INTERACTIONS: Alcohol, Ethyl Chronic use toxicity oI larger therapeutic doses
oI acetaminophen; Barbiturates / Carbamazepine / Hydantoins / Isoniazid / Propanolol /
SulIinpyrazone / RiIampin - potential oI hepatotoxicity R/T liver breakdown oI
acetaminophen; Diuretics, loop - eIIect R/T renal prostaglandin excretion and
plasma renin; NSAIDs - risk oI hypertension in women; Propanolol - eIIect R/T
liver breakdown
CONTRAINDICATIONS: Renal insuIIiciency, anemia; clients with cardiac or
pulmonary disease are more susceptible to acetaminophen toxicity
NURSING CONSIDERATIONS: Do not combine products containing acetaminophen,
many oI which are OTC; read labels on all OTC products; take as directed with Iood or
milk to decrease GI upset; report signs and symptoms oI toxicity immediately (nausea,
vomiting, abdominal pain, bluish coloration oI nailbeds/skin, complaints oI shortness oI
breath, weakness, headache, dizziness; report paleness, weakness, and heart beat skips
(signs and symptoms oI hemolytic anemia); do not exceed 4 grams/24 hr period in adults
and 75 mg/kg/day Ior children; do not take Ior more than 5 days Ior pain in children, 10
days Ior pain in adults, or more than 3 days Ior Iever in adults or children without seeking
a doctor; note reasons Ior therapy, prescribed dosage and expected outcomes
GENERIC NAME: DONEPEZIL HYDROCHLORIDE
TRADE NAME: Aricept, Aricept ODT
CLASSIFICATION: Treatment oI Alzeihmer`s disease
ACTION: A decrease in cholinergic Iunction may be the cause oI Alzeihmer`s disease;
Donezepil, a cholinesterase inhibitor, exerts eIIect by enhancing cholinergic Iunction by
increasing levels oI acetylcholine; no evidence that the drug alters the course oI the
underlying dementing process
INDICATIONS: Treatment o Imild to moderate dementia oI the Alzeihmer`s type; is
combined with memantine (Namanda) to lower the decline oI mental and physical
Iunction in Alzeihmer`s disease
ROUTES OF ADMINISTRATION: Tablets, oral disintegrating tablets
USUAL DOSAGE: 5 mg, 10 mg
ADVERSE REACTIONS: Anorexia, diarrhea, Iatigue, insomnia, and muscle cramps,
nausea, vomiting
INTERACTIONS: Anticholinergic drugs the cholinesterase inhibitor activity oI
donepezil interIeres with the activity oI anticholinergics; Bethanichol Synergistic
eIIects; NSAID`s - gastric acid secretion risk oI active or occult bleeding;
Succinylcholine - muscle relaxant eIIect
CONTRAINDICATIONS: Hypersensitivity to piperidine derivatives
NURSING CONSIDERATIONS: Do not conIuse Aricept with Aciphex (a proton pump
inhibitor); Donepezil orally disintegrating tablets are bioequivalent to donepezil tablets;
take in the evening, just prior to bedtime; may take with or without Iood; drug does nto
cure disease, just alleviates symptoms or slow physical and mental progression oI
disease, especially when used with memantine; report adverse eIIects immediately, like
irregular pulse, dizzy spells, lack oI response, worsening oI symptoms; document
onset/duration, other agents tried and their outcomes
GENERIC NAME: ESOMEPRAZOLE MAGNESIUM
TRADE NAME: Nexium, Nexium IV
CLASSIFICATION: Proton pump inhibitor
ACTION: Suppresses the Iinal step in gastric production by inhibiting the H

/K

-ATPase
in the gastric parietal cells; this decreases gastric acid secretion
INDICATIONS: Short-term treatment (4-8 weeks) in the healing and symptomatic
resolution oI diagnostically conIirmed erosive esophagitis; an additional 4-8 week course
may be instituted Ior those who have not healed; to maintain symptom resolution and
healing oI erosive esophagitis; Treatment oI heartburn and other symptoms associated
with GERD in adults; reduce occurrence oI gastric ulcers associated with continuous
NSAID therapy in those at risk Ior developing gastric ulcers
ROUTES OF ADMINISTRATION: Delayed-release capsules, Ireeze-dried powder Ior
injection
USUAL DOSAGE: Healing oI erosive esophagitis 20-40 mg once daily Ior 4-8 weeks
(might need an additional 4-8 weeks); Maintenance oI healing oI erosive esophagitis 20
mg once daily; Symptomatic GERD 20 mg once daily Ior 4 weeks (can go Ior another 4
weeks iI needed)
ADVERSE REACTIONS: Headache, diarrhea, nausea, stomach pain, constipation, dry
mouth
INTERACTIONS: Esomeprazole may interIere with the absorption oI drugs where
gastric pH is an important Iactor in bioavailability (EX digoxin, iron salts, ketoconazole)
CONTRAINDICATIONS: Known hypersensitivity to any component oI the Iormulation
or to any macrolide antibiotic; lactation
NURSING CONSIDERATIONS: Do not exceed dose oI 20 mg daily in clients with
severe hepatic dysIunction; take delayed-release capsules whole 1 hour beIore meals; iI
unable to swallow whole, can empty capsule onto one tablespoon oI applesauce in a cup
and mix pellets into applesauce and swallow immediately; do not chew pellets; may take
with antacids; avoid alcohol and OTC products unless approved; document reason and
indications Ior therapy, type, onset oI symptoms, and characteristics oI symptoms; list
other agents prescribed; iI Iemale, determine iI pregnant
GENERIC NAME: INSULIN GLARGINE
TRADE NAME: Lantus
CLASSIFICATION: Insulin, rDNA origin
ACTION: Long-acting recombinant human insulin analog; diIIers Irom human insulin in
that the amino acid asparagine is replaced by glycine and two arginines are added to the
C-terminus oI the B-chain; is designed to have low aqueous solubility at neutral pH; at
pH 4, it is completely soluble; allows a relatively constant concentration/time proIile over
24 hr with no pronounced peak
INDICATIONS: Once daily at bedtime Ior treatment oI adult and pediatric clients (6
years and older) with type 1 diabetes mellitus or adults with type 2 diabetes mellitus who
require long-acting insulin to control hyperglycemia
ROUTES OF ADMINISTRATION: Injection
USUAL DOSAGE: Dose is individualized; give once daily at bedtime; average oI 10
units once daily at the same time each day, then adjust according to client need to a total
daily dose ranging Irom 2-100 units
ADVERSE REACTIONS: Hypoglycemia, hypokalemia, injection site reaction,
lipodystrophy, pruritus, rash
INTERACTIONS: (MULTIPLE drug interations); ACE inhibitors / Disopyramide /
Fluoxetine / MAO inhibitors / Octreotide / Propoxyphene / Salicylates / SulIonamides -
blood glucose lowering eIIect and susceptibility to hypoglycemia; Danazol / Diuretics /
Isoniazid / Niacin / Somatropin - blood glucose lowering eIIect; Clonidine / Lithium
salts either potentiates or weakens blood-glucose lowering eIIect and susceptibility to
hypoglycemia
CONTRAINDICATIONS: IV use
NURSING CONSIDERATIONS: Do not conIuse insulin glargine with insulin
glulisine; given once daily at night; rotate sites; do not dilute or mix with any other
insulin solution; carry oral glucose tablets in event oI hypoglycemia; monitor / record
blood sugar and assess Ior hypo/hyperglycemia; report any systemic rash, cough, or
dizziness; continue liIestyle changes and diabetic diet necessary to control blood sugar
with diabetes; attend diabetes education classes with spouse and keep all Iollow up visits
to evaluate blood sugar and blood pressure control, eye and Ioot exams, lower LDL and
associated symptoms; use only iI solution is clear and colorless with no visible particles;
syringes must not contain any other medicinal product or residue
GENERIC NAME: MEMANTINE HYDROCHLORIDE
TRADE NAME: Namenda
CLASSIFICATION: Drug Ior Alzheimer`s disease
ACTION: It is believed that the activation oI N-methyl-D-aspartate (NMDA) receptors
in the brain by glutamate, an excitory amino acid, contributes to the symptomatology oI
Alzheimer`s disease; Memantine is believed to have low to moderate aIIinity as an
antagonist Ior open-channel NMDA receptors, thus preventing activation by glutamate;
the drug does not prevent or slow neurodegeneration in Alzheimer`s disease
INDICATIONS: Moderate to severe dementia oI the Alzheimer`s type; when combined
with donepezil (Aricept), the decline oI mental and physical Iunction may be less
ROUTES OF ADMINISTRATION: Oral solution, tablets
USUAL DOSAGE: Initial 5 mg/day, dose should be increased in 5 mg increments to
10 mg/day (5 mg twice a day), then 15 mg/day (5 mg and 10 mg as separate doses, and
Iinally 20 mg (10 mg twice a day); minimum recommended interval between dose
increases is one week; reduce dose in clients with moderate renal impairment
ADVERSE REACTIONS: Fatigue, pain, increased blood pressure, dizziness, headache,
constipation, vomiting, back pain, conIusion, somnolence, hallucinations, coughing,
dyspnea
INTERACTIONS: Amantadine / Ketamine / Dextromethorphan use with
memantadine with caution as amantadine is also an NMDA antagonist; Cimetidine /
HCTZ / Nicotine / Quinidine / Rantidine / Triamterene possible altered plasma levels oI
both drugs
CONTRAINDICATIONS: Known hypersensitivity to memantine or any excipients in
the Iormulation, including lactose monohydrates; conditions that raise urine pH may
decrease the urinary elimination oI memantine resulting in increased plasma levels;
severe renal impairment
NURSING CONSIDERATIONS: Note reasons Ior therapy, when diagnosed with
Alzheimer`s disease and when treatment began; may take with or without Iood; with Iood
iI GI upset occurs; drug is used in Alzheimer`s disease to improve level oI cognitive
Iunctioning does not cure disease but assists with symptoms; avoid alcohol and any OTC
products or herbals without provider approval to prevent interactions; may cause
dizziness, constipation, headache, pain
GENERIC NAME:
TRADE NAME:
CLASSIFICATION:
ACTION:
INDICATIONS:
ROUTES OF ADMINISTRATION:
USUAL DOSAGE:
ADVERSE REACTIONS:
INTERACTIONS:
CONTRAINDICATIONS:
NURSING CONSIDERATIONS: