GENERIC NAME: FERROUS SULFATETRADE NAME: Feosul, Fer-Gen-Sol, Fer-in-Sol, FeroSul

DRIED: Feosol, Feratab, Slow FE, Slow Release IronCLASSIFICATION: Antianemic, iron

ACTION: Normal daily intake males 12-20 mg; females 8-15 mg; only 10% absorbed; Iron absorbed by from duodenum and upper jejunum by active mechanism thru mucosal

cells, combines with transferring; iron stored as hemosiderin or aggregated ferritin in reticuloendothelial cells of liver, spleen, bone marrow; 2/3 of iron in circulating RBC’s

INDICATIONS: Prophylaxis, treatment of iron deficiency and iron-deficiency anemia’s; dietary supplement for iron

ROUTES OF ADMINISTRATION: Drops, Elixir, Tablets, Slow-Release TabletsUSUAL 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/toleratedPeds: 10 mg/kg/day

DRIED: Anemia Prophylaxis: Adults 200 mg/day; peds 5 mg/kg/dayAnemia: 200 mg 3 times a day up to 200 mg 4 times a day as needed/tolerated

10 mg/kg 3 times dailySlow release tablets: Adults 160 mg 1-2 times per day: NOT for children

ADVERSE REACTIONS: Constipation, gastric irritation, nausea, abdominal cramps, anorexia, diarrhea, dark-colored stools

INTERACTIONS: ↓ GI absorption of 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 of 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 of one iron salt for another without proper adjustment may result in serious over or under dosing; Eggs, milk, coffee or tea

may significantly inhibit iron absorption; Ingestion of calcium and iron supplements can decrease iron absorption by 1/3; Iron absorption is not decreased if calcium bicarbonate

used between meals

GENERIC NAME: AMOXICILLINTRADE NAME: Amoxil, DisperMox, Trimox, Wymox, Polymox

CLASSIFICATION: Antibiotic, penicillinACTION: 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’sINDICATIONS: Ear, nose, and throat infections due to Streptococcus species, S.

pneumoniae, Staphylococcus species or Haemophilus influenzae; GU infections due to E. coli, P. mirailis, or E. faecalis; lower resp tract infections due to Streptococcus species,

S. pneumoniae, Staphylococcus species, or H. haemophilus; acute uncomplicated gonococcal infections 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; specific allergies

INTERACTIONS: Antacids ↓ effect of PCNs related to ↓ GI tract absorption, antibiotics ↓ effect of PCNs, aspirin ↑ effect of PCNs by ↓ plasma protein binding, chloramphenicol

and erythromycins either ↑ or ↓ effects, tetracyclines ↓ effect of PCNs

CONTRAINDICATIONS: Hypersensitivity to PCNs; PO use of PCNs during acute stages of 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

for allergic reactions (if reaction occurs, stop drug immediately); monitor vitals, chem. Results; assess for 20 min after administering to check for allergies; should be prescribed

cautiously to nursing mothers; take full dosage; report unusual symptoms i.e. ↑ bruising/bleeding, sore throat, rash, diarrhea, symptoms worsening, or lack of response

GENERIC NAME: DOXYCYCLINETRADE NAME: Vibramycin, Monodox, Periostat, Vibra-Tabs, Vibrox, Adoxa,

Doxyhexal, AtridoxCLASSIFICATION: Tetracycline antibiotics

ACTION: Inhibits protein synthesis by binding to the ribosomal 305 subunit. Block binding of Aminoacyl transfer RNA to the messenger RNA complex. Cell wall synthesis

is not inhibited.INDICATIONS: Chancroid, tularemia, plague, bartonellosis, cholera, Rocky Mountain

spotted fever, typhus group, Q fever, tick fevers, rickettsialpox, respiratory tract infections, trachoma, inclusion conjunctivitis, uncomplicated urethral, endocervical, or

rectal infections, psittacosis, relapsing fever, nongonococal urethritis, chronic UTI’s, also used for oral care for chronic adult periodonitis

ROUTES OF ADMINISTRATION: Capsules, Enteric-Coated Capsules, IV, Oral Suspension, Syrup, Tablets, Delayed-Release Tablets

USUAL DOSAGE: Infection: 100mg q 12hr first day then 100mg/day Chronic UTI’s: 100 mg q 12 hr

IV: 200 mg IV on day one given in 1 or 2 infusions, then 100-200 mg depending on severity (200 mg given in 1 or 2 infusions)

Gel 10%: apply to affected area for periodontal disease; gel hardens releasing doxycycline for about 7 days

ADVERSE REACTIONS: Anorexia, nausea & vomiting, diarrhea, dizziness, headache, rashes

INTERACTIONS: ↓ effect of doxycycline by ↑ liver breakdown; Methotrexzate: possible GI and hematologic toxicity after high doses of

methotrexate

CONTRAINDICATIONS: Prophylaxis of malaria in pregnant individuals and in children less than 8 years old; use during pregnancy (may stunt fetal

growth) and children up to 8 years old (may cause permanent teeth discoloration); lactation

NURSING CONSIDERATIONS: Do not confuse with Dicyclomine; check for 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 after leaving malarial area;

protect from light

GENERIC NAME: ACETAMINOPHENTRADE NAME: Tylenol, Panadol, MANY others

CLASSIFICATION: Coal tar, non-narcotic analgesicACTION: Decreases fever by 1) a hypothalamic effect leading to sweating and

vasodilation and 2) inhibits the effect of pyrogens on the hypothalamic heat-regulating centers. May cause analgesia by inhibiting CNS prostaglandin synthesis; however, due to

minimal effects on peripheral prostaglandin synthesis, acetaminophen has no anti-inflammatory or uricosuric effects. Does not cause any anticoagulant effect or ulceration

of the GI tract. Antipyretic and analgesic effects are comparable to those of aspirin.INDICATIONS: 1) Control of pain due to headache, earache, dysmenorrheal, arthralgia,

mylagia, musculoskeletal pain, arthritis, immunizations, teething, tonsillectomy 2) Reduces fever in bacterial or viral infections 3) Substitute for 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 of 1 g q 6 hr; Extended-relief caplets; 2 caplets (1,300 mg) q 8 hr; most all other administration; 1,300 mg q 8 hr

Effervescent granules: 1 or 2 ¾ capfuls placed in empty glass, then filled with water; q 4 hr if needed

ADVERSE REACTIONS: Few when taken in usual therapeutic doses; GI upset in some; Chronic and even acute toxicity can develop after long symptom-free usage

INTERACTIONS: Chronic EtOH ↑ toxicity of larger therapeutic doses; barbiturates, carbamazepine, hydantoins, isoniazid, rifampin & sulfinpyrazone: ↑ hepatotoxicity

potential related to ↑ liver breakdown; activated charcoal ↓ absorption when given ASAP after overdose; NSAIDs ↑ risk of hypertension in women; oral contraceptives ↑ liver

breakdown ; propranolol ↑ effect related to liver ↓ breakdown; smoking possible ↓ serum levels related to↑ hepatic metabolism

CONTRAINDICATIONS: Renal insufficiency, 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 for >5 days (children), >10 days (adults), and >3

days (adult or child fever) 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: DIPYRIDAMOLETRADE NAME: Persantine

CLASSIFICATION: Anticoagulant, platelet adhesion inhibitorACTION: Lengthens abnormally shortened platelet survival time; in higher doses may act by several mechanisms, including inhibition of red blood cell

uptake of adenosine, itself an inhibitor of platelet reactivity; inhibition of platelet phosphodiesterase, which leads to accumulation of cAMP within platelets; direct stimulation of release of prostacyclin or prostaglandin D2;

and/or inhibition of thromboxane A2 formationINDICATIONS: As an adjunct to coumarin anticoagulants in preventing

post-operative thromboembolic complications of cardiac valve replacementROUTES OF ADMINISTRATION: Tablets

USUAL DOSAGE: 75 – 100 mg four times daily as adjunct to warfarin therapy

ADVERSE REACTIONS: Dizziness, abdominal distress, headache, rash, diarrhea, liver dysfunction (rare), Angina pectoris, flushing, 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 findings; helps prevent clots by inhibiting platelet stickiness; avoid alcohol and tobacco usage due to hypotensive vasoconstrictive effects; avoid use of unprescribed drugs without approval; avoid quick movements due to ↓ BP; try small meals

frequently if nausea or gastric distress experienced

GENERIC NAME: FUROSEMIDETRADE NAME: Lasix

CLASSIFICATION: Diuretic, loopACTION: Inhibits the reabsorption of Na+ and Cl- in the proximal, distal tubes and the ascending Loop of Henle resulting in the excretion of Na, Cl, and, to a lesser degree, K

and bicarbonate ions; resulting urine is more acidic; diuretic action independent of changes in clients’ acid-base balance; has slight antihypertensive effect

INDICATIONS: Edema associated with CHF, nephritic syndrome, hepatic cirrhosis, and ascites; IV for acute pulmonary edema; PO to treat hypertension in conjunction with

spironolacetone, triamterene, and other diuretics except ethacrynic acidROUTES 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/dayIM; IV: Initial 20-40 mg (if no improvement, after 2 hrs increase in 20 mg increments)

IV: 40 mg slowly over 1-2 min (if inadequate after 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 from GI tract; Clofibrate enhances diuretic effect, hydantoins ↓ diuretic effect, 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 profound diuresis with water and electrolyte depletion; individualize dosage; do not

confuse Lasix with Lanoxin; food decreases bioavailability and ultimately the degree of diuresis; give IV injections slowly over 1-2 min; with renal impairment or if receiving

other oxotoxic drugs, observe for oxotoxicity; assess closely for signs of vascular thrombosis

GENERIC NAME: TEMAZEPAMTRADE NAME: Restoril

CLASSIFICATION: Sedative-hypnotic, benzodiazepineACTION: Benzodiazepine derivative; believed to potentiate GABA neuronal inhibition; hypnotic action involves GABA

receptors in the CNS; drug decreases sleep latency, the number of awakenings, and time spent in awake stage

INDICATIONS: Insomnia in clients unable to fall asleep, with frequent awakenings during the night, and/or early morning

awakeningsROUTES OF ADMINISTRATION: Capsules

USUAL DOSAGE: 15-30 mg at bedtime (7.5 mg may be sufficient for some to improve sleep latency); in elderly or debilitated, initially 7.5-15 mg until response determined

ADVERSE REACTIONS: Drowsiness, dizziness, lightheadedness, incoordination, tremors, falling, 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 effects; concomitant use may lead to drowsiness, lethargy, stupor, respiratory collapse, coma, or death;

cimetidine/disulfiram/erythromycin/flouxetine/isoniazid/ketoconazole/metoprolol/ oral contraceptives/probenecid/propoxyphene/ranitidine/rifampin/valproic acid - ↑ effect of

Temazepam reacting to ↓ liver breakdown

CONTRAINDICATIONS: Pregnancy, hypersensitivity, acute narrow-angle glaucoma, psychoses, primary depressive order, psychiatric disorders in which anxiety is not a

significant symptom

NURSING CONSIDERATIONS: Store from 15-25ºC(68-77ºF) in well-closed light-resistant container; take only as directed; do not increase dose; assess sleep patterns, diet,

lifestyle, routines; determine any depression or addiction history; may cause daytime drowsiness

GENERIC NAME: DIGOXINTRADE NAME: Digitek, Digoxin Injection Pediatric, Lanoxicaps, Lanoxin

CLASSIFICATION: Cardiac glycosideACTION: Increases force and velocity of myocardial contraction (positive inotropic effect) by increasing refractory period of the AV node and increasing total peripheral resistance; effect is due to inhibition of Na/K-ATPase in the sarcolemmal membrane,

which alters excitation-contraction coupling; inhibiting Na/K-ATPase results in increased Ca influx and increased release of free Ca ions within the myocardial cells, which then

potentiate the contractility of cardiac muscle fibersINDICATIONS: CHF, including that due to venous congestion, edema, dyspnea,

orthopnea, and cardiac arrhythmia; May be drug of choice for CHF due to rapid onset, relatively short duration, and ability to be administered PO or IV; Control of rapid

ventricular contraction rate in clients with A-Fib or flutter; Slow HR in sinus tachycardia due to CHF; SVT; Prophylaxis and treatment of recurrent paroxysmal atrial tachycardia

with paroxysmal AV junctional rhythm; Cardiogenic shock; Apical HR > 60ROUTES OF ADMINISTRATION: Capsules, Elixir, Tablets

USUAL DOSAGE: Initial: 0.4-0.6 mg initially followed by 0.1-0.3 mg q 6-8 hrMaintenance: 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 hrsMaintenance: 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 following drugs increase serum digoxin levels, leading to possible toxicity: Aminoglycosides, amiodarone, anticholinergics, atorvastatin,

benzodiazepines, captopril, diltiazem, dipyridamole, erythromycin, esmolol, flecainide, hydroxychloroquine, ibuprofen, indomethacin, itraconazole, nifedipine, quinidine,

quinine, telmisartan, tetracyclines, tolbutamide, verapamil; Ephedra/ephedrine/epinephrine - ↑ chance of cardiac arrhythmias

CONTRAINDICATIONS: V-Fib or tachycardia (unless congestive failure supervenes after protracted episode not due to digitalis), in presence of digoxin toxicity, hypersensitivity to cardiac glycosides, beriberi heart disease, certain cases of

hypersensitive carotid sinus syndrome

NURSING CONSIDERATIONS: Digoxin is not effectively removed by dialysis, by exchange transfusion, or during cardiopulmonary bypass (most of drug is in tissues and

not blood); measure liquids precisely; protect from light; monitor closely; take after meals to lessen gastric irritation; do not take with grapefruit juice; do not change brands

(different preparations differ in bioavailability/may cause toxicity or effect loss)

GENERIC NAME: DIAZEPAMTRADE NAME: Diastat, Diazepam, Intensol, Calium, C-IV

CLASSIFICATION: Antianxiety drug, antimanic, benzodiazepineACTION: Reduces anxiety by increasing or facilitating the inhibitory neurotransmitter

activity of GABA; skeletal muscle relaxant effect may be due to enhancement of GABA-mediated presynaptic inhibition at the spinal level as well as in the brain stem reticular

formationINDICATIONS: Management of anxiety disorders or for short-term relief of symptoms of anxiety; Adjunct therapy in convulsive disorders; Adjunct for relief of skeletal muscle spasm caused by reflex spasm to local pathology; Athetosis, stiff-man syndrome; Relief

of anxiety and tension in those undergoing surgical procedures; Acute alcohol withdrawal for symptomatic relief of acute agitation; Adjunct therapy in status epilepticus seizuresROUTES OF ADMINISTRATION: Oral solution, Intensol Solution, Tablets, Rectal

Gel; IM; IVUSUAL DOSAGE: Anxiety: 2-10 mg 2-4 X daily: Acute alcohol withdrawal 10 mg 3-4

X the first day then 5 mg 3-4 X daily: IV/IM: 5-10 mg IM or IV, repeat in 3-4 hrs if needed: Acute alcohol withdrawal: 10 mg IV or IM init; then 5-10 mg in 3-4 hr if needed:Status epilepticus: initial: 5-10 mg IV (preferred), may be repeated at 10-15 min intervals

up to 30 mg; may repeat therapy in 2-4 hrs

ADVERSE REACTIONS: Transient drowsiness, ataxia, confusionINTERACTIONS: Potentiates antihypertensive effects of thiazides and other diuretics; potentiates muscle relaxant effect of d-tubocurarine and gallamine; fluoxetine/isoniazid - ↑ half-life of diazepam; ranitidine - ↓ GI absorption of 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 effects; concomitant use may lead to drowsiness, lethargy,

stupor, respiratory collapse, coma, or death; cimetidine/disulfiram/erythromycin/flouxetine/isoniazid/ketoconazole/metoprolol/ oral contraceptives/probenecid/propoxyphene/ranitidine/rifampin/valproic acid - ↑ effect of

Diazepam reacting to ↓ liver breakdownCONTRAINDICATIONS: Hypersensitivity, acute narrow-angle glaucoma, psychoses,

primary depressive order, psychiatric disorders in which anxiety is not a significant symptom, children under 6 months, lactation, and parenterally in children under 12 yearsNURSING CONSIDERATIONS: Except for deltoid muscle, absorption from IM sites

is slow, erratic and painful (not generally recommended); IV route preferred 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 SODIUMTRADE NAME: Coumadin

CLASSIFICATION: Anticoagulant, coumarin derivativeACTION: Interferes with synthesis of vitamin K-dependent clotting factors

resulting in depletion of clotting factors II, VII, IX, and X; Has no direct effect on an established thrombus although therapy may prevent further

extension of a formed clot as well as secondary thomboembolic problemsINDICATIONS: Prophylaxis and treatment of venous thrombosis and its

extension; Prophylaxis and treatment of atrial fibrillation with embolization; Prophylaxis and treatment of pulmonary embolism; Prophylaxis and

treatment of thromboembolic complications associated with atrial fibrillationROUTES OF ADMINISTRATION: IV, Tablets

USUAL DOSAGE: Init: 5-10 mg/day for 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 effect; may occur from any organ or tissue

INTERACTIONS: Warfarin is responsible for more adverse drug interactions than any other group; clients on anticoagulant therapy must be monitored carefully 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 of the dosage of the anticoagulant; MULTIPLE DRUG INTERACTIONS (too many to list)

CONTRAINDICATIONS: Lactation; IM use; use of large loading dose (30 mg) is not recommended due to increased risk of hemorrhage and lack of more rapid protection

NURSING CONSIDERATIONS: Take oral warfarin 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 of blood and helps to prevent formation of blood clots in vessels and heart valves; avoid IM shots, activities that may cause injury or cuts and bruises; protect from light (store at controlled room

temperature); dispense in tight light-resistant container; vial not for multiple uses; discard unused solution; note any bleeding tendencies; determine if pregnant (may cause fetal

malformations and neonatal hemorrhage)

GENERIC NAME: OXYCODONE AND ACETOMINOPHENTRADE NAME: Percocet, Endocet, Roxicet, Roxilox, Tylox, C-11

CLASSIFICATION: AnalgesicACTION: Semi synthetic opiate that combines with specific receptors

located in CNS to produce various effects; mechanism is believed to involve decreased permeability of cell membrane to Na, which results in diminished

transmission of pain impulses and analgesia; causes mild sedation and no antitussive effect; most effective in relieving acute pain; does not cause any

anticoagulant effect or ulceration of GI tractINDICATIONS: Relief of moderate to moderately severe pain

ROUTES OF ADMINISTRATION: Caplets, Capsules, Oral Solution, Tablets

USUAL DOSAGE: 5 mL of oral solution q 6 hr or 1 caplet, capsule or tablet q 6 hr as needed for pain

ADVERSE REACTIONS: Dizziness, light-headedness, nausea & vomiting, sedation, sweating, itching, dry mouth, constipation

INTERACTIONS: Anticholinergic drugs – production of paralytic ileus; tricyclic antidepressants - ↑ effect of either TCAs or oxycodone; CNS depressants – additive CNS

depression; MAO inhibitors - ↑ effect of 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 confuse Percocet and Percodan; do not confuse oxycodone with oxyContin; assess for drug seeking behaviors; take only as directed; may take with food to decrease GI upset; do not share drugs; keep in safe 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 HYDROCHLORIDETRADE 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 influx of Ca through cell membrane, resulting in depression of automaticity and conduction velocity in cardiac muscle; Decreases SA and AV

conduction and prolongs AV node effective and functional refractory 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 of rapid

ventricular rate in A-Fib or flutter; Rapid conversion of paroxysmal SVT to sinus rhythm.ROUTES OF ADMINISTRATION: Tablets (Immediate- and Extended-Release),

Extended-Release Capsules, IV Bolus, Continuous Infusion IVUSUAL DOSAGE: Angina: initial 30 mg 4X daily, then increase gradually to total dose of 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 if inadequate, second dose (0.35 mg/kg) in 15 min; Continuous Inf IV: Initial infusion 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, infection, pain

INTERACTIONS: Amiodarone – possible cardiotoxicity with bradycardia and ↓ cardiac output; anesthetics - ↑ risk of depression of cardiac contractility, conductivity, and

automaticity as well as vascular dilation; Digoxin – possible ↑ serum digoxin levels; Lithium - ↑ risk of neurotoxicity; Theophyllines – risk of pharmacologic and toxicologic

theophylline effectsCONTRAINDICATIONS: Hypotension or cardiogenic shock; second- or third-degree

AV block and sick sinus syndrome except in presence of a functioning ventricular pacemaker; acute MI, pulmonary congestion; IV diltiazem with IV beta-blockers: A-Fib or atrial flutter associated with an accessory bypass tract; ventricular tachycardia; use of

Cardizem LyoJect Syringe in newborns, lactationNURSING CONSIDERATIONS: Do not confuse Cardizem with Cardene; sublingual nitroglycerin may be taken concomitantly for acute angina; diltiazem may also be taken

together with long-acting nitrates; note edema or CHF; review ECG for AV block; monitor vital signs, renal and liver function tests; take extended-release capsules on an

empty stomach; do not open, chew, or crush; swallow whole; may cause drowsiness/dizziness; record blood pressure for review; rise slowly from lying to sitting

to standing position

GENERIC NAME: DOCUSATE SODIUMTRADE NAME: Colace, Dioctyn Softgels, Docu, D.O.S., D-S-S, Dulcolax Stool Softener, Ex-Lax Stool Softener, Gena Soft, Non-Habit Forming Stool

Softener, Phillips Liqui-Gels, Regulex SS, Silace Stool SoftenerCLASSIFICATION: Laxative, Emollient

ACTION: Acts by lowering the surface tension of feces and promoting penetration by water and fat (increases softness of fecal mass; not absorbed

systematically, does not seem to interfere with absorption of nutrientsINDICATIONS: Lessens strain of defecation 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

stoolsROUTES OF ADMINISTRATION: Capsules, Soft-Gel Capsules, Oral

Liquid, Syrup, TabletsUSUAL 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, flatulence, cramps, dehydration, electrolyte balance disturbance due to dehydration

INTERACTIONS: May ↑ absorption of mineral oil from GI tract;

CONTRAINDICATIONS: Nausea, vomiting, abdominal pain, intestinal obstruction; severe abdominal pain due to appendicitis, enteritis, ulcerative colitis, diverticulitis,

intestinal obstruction, fecal impaction, undiagnosed abdominal pain

NURSING CONSIDERATIONS: Drink glass of water with each dose; may take oral solutions with milk or juice to help mask taste; may take 1-3 days to soften fecal matter

due to minimally absorbing docusate salts; assess activity levels, diet, water intake, exercise routines; have client identify habits and BM activities; note length of time it takes for laxative to take effect; with abdominal pain and discomfort, note location,

triggers, type of discomfort, rule out other intestinal disorders/obstruction where laxatives should not be used

GENERIC NAME: METFORMIN HYDROCHLORIDETRADE NAME: Fortamet, Glucophage, Glucophage XR, Glumetza, Riomet

CLASSIFICATION: Oral Antidiabetic, BiguanideACTION: Decreases hepatic glucose production, decreases intestinal absorption of

glucose, increases peripheral uptake and utilization of glucose; does not cause hypoglycemia in either diabetic or nondiabetic clients, and does not cause

hyperinsulinemia; insulin secretion remains unchanged, while fasting 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 form used to treat type 2 diabetes as

initial therapy or in conjunction with a sulfonylurea or insulin in clients 17 y/o and olderROUTES OF ADMINISTRATION: Oral Solution, Tablets, Extended-Release TabletsUSUAL 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 food; dosage increases may be made in 500

mg every week, divided doses, up to maximum of 2,500 mg; If 2,500 mg needed, may be tolerable in 3 equal doses daily

ADVERSE REACTIONS: Lactic acidosis, hypoglycemia, diarrhea, nausea & vomiting, asthenia, flatulence, headache, abdominal pain/discomfort

INTERACTIONS: Alcohol - ↑ metformin effect on lactate metabolism; Furosemide - ↑ metformin plasma blood levels and metformin ↓ lowers half-life of Furosemide;

Propantheline - ↑ absorption of metformin related to slowed GI motility

CONTRAINDICATIONS: Renal disease or dysfunction, or abnormal creatine clearance (CCR) 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 function

NURSING CONSIDERATIONS: Lactic acidosis is a rare, but serious, metabolic complication that can occur due to metformin accumulation (50 % fatal); do not confuse Glucophage with Glucovance; individualize dosage based on tolerance and effectiveness;

give with meals and start at a low dose with gradual escalation (will reduce GI side effects); may safely switch from metformin to metformin extended-release; may cause a

metallic taste (will subside)

GENERIC NAME: GUAIFENESINTRADE NAME: Naldecon, Senior EX, Robitussin, Scot-Tussin

Expectorant, Siltussin SA, Alterussin, Guiatuss, Humabid Maximum Strength, Mucinex

CLASSIFICATION: Diabetic Tussin, Organidin NRACTION: May increase output of fluid from respiratory tract by reducing viscosity and surface tension of respiratory secretions, thereby removing

accumulate dsecretions from upper and lower airwayINDICATIONS: Dry, nonproductive cough due to colds and minor upper

respiratory tract infections 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 discomfort

INTERACTIONS: Inhibition of platelet adhesiveness by guanfenesin may result in bleeding tendencies

CONTRAINDICATIONS: Chronic cough (due to smoking, asthma, or emphysema), cough accompanied by excess secretions; lactation

NURSING CONSIDERATIONS: Assess for tobacco use, fever/chills, loss of appetite, or increased fatigue; if symptoms persist for more than one week, recur, or are accompanied by a persistent headache, fever or rash,

notify provider; do not perform activities that require mental alertness (drug may cause drowsiness); report any evidence of increased bruising/bleeding,

fever, change in secretions, or lack of response

GENERIC NAME: ALBUTEROL (SALBUTAMOL)TRADE NAME: AccuNeb, Albuterol HFA, ProAir HFA, Proventil,

Proventil HFA, Ventolin, Ventolin HFA, VoSpire ERCLASSIFICATION: Sympathomimetic

ACTION: Stimulates Beta-2 receptors of 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 of bronchospasm due to reversible obstructive airway disease; inhalation solution for acute attacks of

bronchospasm; Prophylaxis of exercise-induced bronchospasmROUTES OF ADMINISTRATION: Inhalation Aerosol, Inhalation

Solution, AccuNeb, Tablets, SyrupUSUAL DOSAGE: Proventil: Over 12 y/o 180 mcg (2 puffs) q 4-6 hr (May

only need one puff or 90 mcg q 4 hr) 4 times daily; same dosage 15 mins prior to exercise if needed

ADVERSE REACTIONS: Headache, nausea & vomiting, palpitations/tachycardia, tremor, bronchospasm

INTERACTIONS: Anesthetics – halogenated anesthetics sensitize heart to adrenergics (causes cardiac arrhythmias); Antidiabetics – hyperglycemic effect of epinephrine may

necessitate ↑ dosage of insulin or oral hypoglycemic agents; Digitalis glycosides – combination may cause cardiac arrhythmias; Oxytocics - ↑ chance of severe hypertension

CONTRAINDICATIONS: Tachycardia due to arrhythmias; aerosol for prevention of exercise-induced bronchospasm and tablets are not recommended for children under 12

y/o.

NURSING CONSIDERATIONS: Do not confuse albuterol with atenolol; when given by nebulation, use face mask or mouthpiece with compressed air or O2 with flowrate of 6-10 lpm and should last 5-15 min; contents of MDI are under pressure (do not store near

heat or open flame); Proventil HFA and Ventolin HFA contain hydroflouroalkane as propellant; practice breathing techniques for administration; when using inhalers, do not

use other albuterol inhalation medication unless specifically prescribed

GENERIC NAME: NITROGLYCERIN TOPICAL OINTMENTTRADE NAME: Nitro-Bid

CLASSIFICATION: Coronary VasodilatorACTION: Nitrates relax vascular smooth muscle by stimulating production of intracellular cyclic guanosine monophosphate. Dilation of post capillary

vessels decreases venous return to the heart due to pooling of blood; thus left ventricle end-diastolic pressure is reduced; Relaxation of arterioles results in

a decreased systemic vascular resistance and arterial pressure; Oxygen requirements of the myocardium are reduced and there is more efficient

redistribution of blood flow through collateral channels in myocardial tissueINDICATIONS: Prophylaxis and treatment of angina pectoris due to CAD; onset of action not rapid enough to be used to abort an acute anginal attack

ROUTES OF ADMINISTRATION: 2% OintmentUSUAL DOSAGE: 2 daily ½ inch doses (7.5 mg); apply one on rising in morning and one 6 hr later; can be doubled and then doubled again if no

response and if tolerable

ADVERSE REACTIONS: Headache (may be severe and persistant), flushing, dizziness, weakness, hypotension, paresthesia

INTERACTIONS: Ethyl alcohol – hypotension and cardiovascular collapse related to vasodilator effect of both agents; antihypertensive drugs – additive hypotension; aspirin -

↑ serum levels and effects of nitrates; heparin – possible ↓ effect; narcotics – additive hypotensive effect

CONTRAINDICATIONS: Sensitivity of 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 function, hypertrophic cardiomyopathy, hypotension, recent MI

NURSING CONSIDERATIONS: Do not use Nitro-Bid with Nicobid; Store from 15-30˚C (59-86˚F); squeeze ointment onto application papers and fold paper in half, rub

back and forth, apply onto non-hairy part of skin; rotate sites to prevent irritation; once dose established, use same type of covering to ensure same amount administered each

time; remove at bedtime or as directed to prevent tolerance or loss of drug effect

GENERIC NAME: MULTIVITAMINSTRADE NAME: Centrum, One-A-Day, Equate Complete

CLASSIFICATION: Essential, organic, non-caloric, required for normal metabolismACTION: Essential for promoting growth, health, vitality, life, general well being, prevention and cure of many health problems and diseases; necessary for metabolic processes responsible for transforming foods into energy or tissue; formation and

maintenance of 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 fats, carbohydrates, and

proteins into usable body energy; cannot be assimilated without ingesting food; should be taken with a meal; regulate metabolism, help convert fat and carbohydrates into energy;

assist in forming bone and tissueROUTES OF ADMINISTRATION: Tablet

USUAL DOSAGE: A – 5,000 (males), 4000 (females) international units (IU); B1 – 0.3-1.5mg; B2 – 0.4-2.0mg; B3 – 5-20mg; B6 – 1.3-1.7mg; Folacin – 400mcg; Pantothenic acid – 4-7mg; B12 – 6mcg; B7 – 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, infantile hemolytic anemia, hemorrhagic diseases

of newborn; moderate vitamin deficiencies may also produce symptoms of 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; fat-soluble vitamins stored in body after binding to specific plasma globulins in

fat parts of body; may accumulate in body and cause adverse reactionsCONTRAINDICATIONS: No adverse effects; no contraindications; vitamin D

deficiency is often underdiagnosed and undertreated in older population; clients with impaired liver function should not take large amounts of fat-soluble vitamins unless

specifically prescribed due to toxicity potential from cumulative effects; pregnant and breast-feeding women require more of some vitamins than most adults; vitamin

deficiency usually involves multiple rather than single deficiencies and is rare in US; can usually be attributed to poor lifestyle choices or poor dietary habits with inadequate

intake of many vitamins.NURSING CONSIDERATIONS: Document indications for therapy; assess metabolic

panel and vitamin levels; monitor levels to ensure requirements met and levels are as desired; well-balanced diet with foods from basic groups is best source; take with food

for best absorption; avoid self-medication greater than RDA amounts

GENERIC NAME: METOPROLOL TARTRATETRADE NAME: Lopressor

CLASSIFICATION: Beta-adrenergic Blocking AgentACTION: Combines reversibly mainly with beta1-adrenergic receptors to block the

response to sympathetic nerve impulses, circulating catecholamines, or adrenergic drugs; Blockage of beta1-receptors decreases heart rate, myocardial contractility, and cardiac

output and slows AV conduction, all of which decreases blood pressureINDICATIONS: Hypertension; Acute MI in hemodynamically stable patients; Angina

pectorisROUTES 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; effective 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 of 5 mg each at approx. 2 min intervals; then give 50 mg q 6 hr PO starting 15 min after last IV dose; continue for 48

hrs then 100 mg twice a day, continue for 1-3 months

ADVERSE REACTIONS: Fatigue, dizziness, depression, shortness of breath, bradycardia, diarrhea

INTERACTIONS: Oral contraceptives/quinidine – may ↑ metoprolol effects; diphenhydramine - ↓ metoprolol clearance → prolonged negative chronotropic and inotropic effects in extensive metabolizers; methimazole/propylthiouracil – may ↓

metoprolol effects; rifampin - ↓ metoprolol effect related to ↑ liver metabolism

CONTRAINDICATIONS: MI in clients with a heart rate of less than 45 bpm, in second- or third-degree heartblock, or if SBP is less than 100 mm Hg; moderate to severe

cardiac failure

NURSING CONSIDERATIONS: Do not confuse metoprolol with metoclopramide, metaproterenol, or misoprostol; if transcient worsening of heart failure occurs, treat with

increased doses of diuretics; may need to lower dose of metoprolol or temporarily discontinue; for CHF, do not increase dose until symptoms of worsening CHF have been

stabilized; if 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 drugACTION: Triamterence acts directly on the distal tubule to promote the excretion of sodium, bicarbonate, chloride, and fluid; Increases urinary pH; Hydrochlorothiazide

promotes excretion of sodium and chloride and thus water by distal renal tubule; Also increases excretion of potassium and smaller amounts of bicarbonate; Antihypertensive

effects due to direct dilation of arterioles as well as fluid volume loss

INDICATIONS: Hypertension or edema in clients who manifest hypokalemia on hydrochlorothiazide alone; in clients requiring a diuretic and in whom hypokalemia can

not be risked; usually not first line of therapy except when avoiding hypokalemiaROUTES 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, flatulence, dizziness, photosensitivity

INTERACTIONS: Anesthetics – Thiazides may ↑ effects of anesthetics; antidiabetic agents – thiozides antagonize hypoglycemic drug effects; antihypertensive agents –

thiazides potentiate drug effects; corticosteroids – enhanced potassium loss related to potassium-losing properties of both drugs; digoxin – thiazides produce ↑ K and Mg loss

with ↑ chance of digitalis-induced arrhythmias; furosemide – profound diuresis and electrolyte loss; insulin - ↓ effect related to thyazide-induced hyperglycemia;

tetracyclines - ↑ risk of azotemia; vitamin D - ↑ effect of vitamin D related to thiazide-induced hypercalcemia

CONTRAINDICATIONS: Clients receiving other potassium-sparing drugs (amiloride, spironolactone); use in anuria, acute or chronic renal insufficiency, significant renal

impairment, preexisting elevated serum potassiumNURSING CONSIDERATIONS: Assess for alcoholism (megaloblastic anemia may occur because triamterene is weak antagonist of folic acid; monitor vital signs and tests

(reduce dose with dysfunction; drug is taken to lower BP and reduce swelling of extremities (take in AM with food to reduce GI upset); check for signs/symptoms of

blood dyscrasia (sore throat, rash, fever); check for signs of anemia; avoid alcohol, OTC agents, potassium supplements, salt substitutes that contain potassium, foods high in

potassium (drug is potassium-sparing)

GENERIC NAME: POTASSIUM SALTSTRADE NAME: K+ Care ET

CLASSIFICATION: Electrolyte SupplementsACTION: Potassium is readily and rapidly absorbed from the GI tract. Potassium

chloride is used because hypochloremia frequently accompanies potassium deficiency; Potassium deficiency can be prevented or corrected through dietary measures

INDICATIONS: Treat Hypokalemia due to digitalis intoxication, diabetic acidosis, diarrhea and vomiting, familial periodic paralysis, certain cases of uremia,

hyperadrenalism, starvation and debilitation, and corticosteroid or diuretic therapy; Hypokalemia with or without metabolic acidosis and following surgical conditions

accompanied by nitrogen loss, vomiting and diarrhea, suction drainage, and increased urinary excretion of potassium; Prophylaxis of 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, TabletsUSUAL DOSAGE: HIGHLY individualized: IV infusion; 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 for hypokalemia prophylaxis

ADVERSE REACTIONS: Nausea & vomiting, diarrhea, flatulence, abdominal discomfort

INTERACTIONS: ACE inhibitors – may cause potassium retention → hyperkalemia; digitalis glycosides – cardiac arrhythmias; potassium-sparing diuretics – severe

hyperkalemia with possibility of cardiac arrhythmias or arrest

CONTRAINDICATIONS: Severe renal function impairment with azotemia or oliguria, postoperatively before urine flow has been reestablished, crush syndrome, Addison’s disease, hyperkalemia from 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 of

potassium with esophageal compression; check administration site frequently for pain and redness (drug extremely irritating); note impaired renal function; assess adequate urinary flow before administering potassium; withhold drug, report abdominal pain, distention, GI bleeding; check for signs of hypokalemia (weakness, fatigue, cardiac

arrhythmias)

GENERIC NAME: HEPARIN SODIUM AND SODIUM CHLORIDETRADE NAME: Heparin sodium and 0.45% Sodium Chloride, Heparin Sodium and 0.9%

Sodium ChlorideCLASSIFICATION: Heparin, Anticoagulant

ACTION: Does not dissolve previously formed clots, but forestalls enlargement and prevents new clots from forming; Potentiates inhibitory action of antithrombin III; Occurs due to formation of a complex with antithrombin III and causing a conformational change in

antithrombin III molecule; Action of thrombin in coagulation is inhibited; Also prevents formation of a stable fibrin clot by inhibiting the activation of fibrin-stabilizing factor by

thrombinINDICATIONS: Pulmonary/peripheral arterial embolism; Prophylaxis and treatment of venous

thrombosis and extensions; Atrial fibrillation with embolization; Treatment and diagnosis of DIC; in low doses to prevent DVT and PE in pregnant clients with thromboembolism history and

others; Prophylaxis of clotting in blood transfusions and othersROUTES OF ADMINISTRATION: Deep Subcutaneous, Intermittent IV, Continuous IV,

Special UsesUSUAL 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 after 5,000 units IV

ADVERSE REACTIONS: Hemorrhage ranging from minor local ecchymoses to major hemorrhagic complications from any organ, chills, fever, urticaria, local irritation,

erythema, mild pain, hematomaINTERACTIONS: Oral

anticoagulants/dipyridamole/hydroxychloroquine/ibuprofen/indomethacin/NSAIDs/ticlopidine – additive ↑ prothrombin time;

Antihistamines/digitalis/nicotine/nitroglycerin/tetracyclines - ↓ effect of heparinCONTRAINDICATIONS: Active bleeding, blood dyscrasias (or other bleeding disorders as in hemophilia), clients with frail or weakened blood vessels, purpura,

thrombocytopenia, liver disease with hypoprothrombinemia, open wounds, extensive denudation of skin, increased capillary permeability; do not administer during surgery of eye, brain or spinal cord or during continuous tube drainage of 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 of umbilicus (decreased vascularity); do not massage site, slight discoloration does not affect potency; perform 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 Prefilled, Velosulin BR (Pork Insulin) Regular Iletin IICLASSIFICATION: Rapid-Acting Insulin Product

ACTION: Regular insulin is only preparation suitable for IV administration; ONLY comes in 100 units/mL; rarely used as sole agent due to short duration of action; Injections should be clear: Any cloudy or colored

solutions should not be used.INDICATIONS: Suitable for treatment of diabetic coma, diabetic acidosis,

other emergency situations; especially suitable for client suffering from labile diabetes; during acute phase of diabetic acidosis or for client in

diabetic crisis, client is monitored by serum glucose and serum ketone levelsROUTES 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/clofibrate/clonidine - ↑ hypoglycemic effect of insulin;

Acetazolamide/AIDS antiviral drugs/albuterol/asparaginase/calcitonin/chlorthalidone/clozapine - ↓ hypoglycemic effect

of insulin (ONLY PARTIAL LIST: TOO MANY DRUG INTERACTIONS TO LIST)

CONTRAINDICATIONS: Hypersensitivity to insulin; during episodes of hypoglycemia in clients sensitive to any component of the product

NURSING CONSIDERATIONS: Assess for S/S of hypoglycemia (drowsiness, chills, confusion, anxiety, cold sweats, cool pale skin, excessive hunger, nausea, headache,

irritability, shakiness, rapid pulse, unusual tiredness or weakness); assess S/S for hyperglycemia (thirst, polydipsia, polyuria, drowsiness, blurred vision, loss of appetite, fruity odor to breath, flushed dry skin); weigh client to determine amount to be given;

monitor glucose levels carefully 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 PrefilledCLASSIFICATION: Intermediate-Acting Insulin product

ACTION: Contains zinc insulin crystals modified by protamine, appearing as cloudy or milky suspension; Not recommended for emergency use; not

suitable for IV administration or in presence of ketosisINDICATIONS: Replacement therapy in Type 1 Diabetes; Type 2 diabetes when other methods have failed, blood sugars are significantly elevated, or with surgery, trauma, infection, fever, endocrine dysfunction, pregnancy,

gangrene, Raynoud’s disease, kidney or liver dysfunctionROUTES OF ADMINISTRATION: Subcutaneous

USUAL DOSAGE: 7-26 units as single dose 30-60 min before breakfast: second similar or smaller dose may be given prior to dinner or at bedtime; can be increased in increments of 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/clofibrate/clonidine - ↑ hypoglycemic effect of insulin;

Acetazolamide/AIDS antiviral drugs/albuterol/asparaginase/calcitonin/chlorthalidone/clozapine - ↓ hypoglycemic effect

of insulin (ONLY PARTIAL LIST: TOO MANY DRUG INTERACTIONS TO LIST)

CONTRAINDICATIONS: Hypersensitivity to insulin; during episodes of hypoglycemia in clients sensitive to any component of the product

NURSING CONSIDERATIONS: Assess for S/S of hypoglycemia (drowsiness, chills, confusion, anxiety, cold sweats, cool pale skin, excessive hunger, nausea, headache,

irritability, shakiness, rapid pulse, unusual tiredness or weakness); assess S/S for hyperglycemia (thirst, polydipsia, polyuria, drowsiness, blurred vision, loss of appetite, fruity odor to breath, flushed dry skin); weigh client to determine amount to be given;

monitor glucose levels carefully 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-inflammatory effect is due to inhibition of prostaglandin synthesis; drug also inhibits accumulation of macrophages and leukocytes at sites of inflammation and

inhibits phagocytosis and lysosomal enzyme release; low incidence of increased appetite, peptic ulcer, psychic stimulation, and sodium and water retention; may mask negative

nitrogen balanceINDICATIONS: Severe hepatitis due to alcoholism; within 8 hr or severe spinal cord injury (to improve neurological function); septic shock; nephritic syndrome, including

that due to lupus erythematosus or of the idiopathic type; hematologic diseases, including hemolytic anemia, RBC anemia, idiopathic and secondary thrombocytopenic purpura in

adults (IV only), congenital hypoplastic anemiaROUTES OF ADMINISTRATION: Powder for injection

USUAL DOSAGE: Initial 10-40 mg, depending on disease, then adjust dose depending on response with following doses either IM or IV: SEVERE conditions – 30 mg/kg

infused IV over 10-20 min, may be repeated q 4-6 hr for 2-3 days only

ADVERSE REACTIONS: Small physiologic doses given as replacement therapy or short-term high-dosage therapy during emergencies rarely cause side effects.

INTERACTIONS: Erythromycin - ↑ methylprednisolone effect related to ↓ liver metabolism; grapefruit juice - ↑ AUC (area under the curve), peak levels, and half-life of

methylprednisolone related to ↓ liver metabolism

CONTRAINDICATIONS: Suspected infection as drug may mask infection, peptic ulcer, phychoses, acute glomerulonephritis, herpes simplex infections of the eye, vaccinia or varicella, Cushing’s syndrome, active tuberculosis, myasthenia gravis, recent intestinal

anastomoses, CHF or other cardiac disease, hypertension, systemic fungal infections, open angle glaucoma

NURSING CONSIDERATIONS: Do not confuse Solu-Medrol with Solu-Cortef; dosage must be individualized; use within 48 hours of preparation; note any aspirin

allergies, monitor vital signs, weight, chemical results; take as directed, may take with food or milk to diminish GI upset

GENERIC NAME: VANCOMYCIN HYDROCHLORIDETRADE NAME: Vancocin, Vancoled

CLASSIFICATION: Miscellaneous AntibioticACTION: Appears to bind to bacterial cell wall, arresting its synthesis and lysing the cytoplasmic membrane by a mechanism that is different from that of penicillins and

cephalosporins; may also change permeability of the cytoplasmic membranes of bacteria, thus inhibiting RNA synthesis; bactericidal for most organisms and bacteriostatic for

enterococciINDICATIONS: 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 for debilitated clients IV – Severe Staphylococcal infections in clients who have not responded to penicillins or cephalosporins, who cannot receive these drugs, or who have

resistant infections; prophylaxis of bacterial endocarditis in PCN-allergic patientsROUTES OF ADMINISTRATION: Capsules, powder for injection or oral solution

USUAL DOSAGE: PO – 0.5-2 g/day in 3-4 divided doses for 7-10 days OR 125 mg 3-4 times per day for C.difficile may be as effective 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, fever

INTERACTIONS: Anesthetics - ↑ risk of erythema and histamine-like flushing in children; nondepolarizing muscle relaxants - ↑ neuromuscular blockage;

nephritic/neurotoxic drugs – carefully monitor with concurrent or sequential systemis or topical use

CONTRAINDICATIONS: Hypersensitivity; minor infections; lactation

NURSING CONSIDERATIONS: Reduce dosage in renal disease; dilute each 500 mg vial with 10 mL sterile water (may further be diluted in 200 mL of dextrose or saline

solution and infused over 60 min); intermittent infusion preferred but may also be administered with continuous IV drip; avoid rapid IV administration (may result in

hypotension, nausea, warmth, generalized tingling); aqueous solution stable for 2 weeks; assess renal and auditory functions; report adverse drug effects such as oxotoxicity and

nephrotoxicity; during IV administration, ensure peak and trough levels are performed at prescribed dosing interval (30 min prior and 1 hr after dosage)

GENERIC NAME: AMLODIPINE

TRADE NAME: Amvaz, Norvasc

CLASSIFICATION: Calcium Channel Blocker

ACTION: Inhibits influx of calcium through the cell membrane, resulting in depression of automaticity and conduction velocity in cardiac muscle; decreases SA and AV

conduction and prolongs AV node effective and functional refractory 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 of 10 mg/day; titrate dose over 7-14 days

ADVERSE REACTIONS: Edema, palpitations, dizziness/lightheadedness, headache, fatigue/lethargy, flushing

INTERACTIONS: Diltiazem - ↑ plasma levels of amlodipine → further ↓ BP; grapefruit juice - ↑ plasma amlodipine levels; Ranitidine - ↑ effect of

CCBs related to ↓first-pass metabolism

CONTRAINDICATIONS: Use with grapefruit juice

NURSING CONSIDERATIONS: Do not confuse Norvasc with Navane; food does not affect bioavailability; elderly clients, small/fragile clients, or

clients with hepatic insufficiency may be started on 2.5 mg/day; take as directed once daily; may take with or without meals (food helps decrease

stomach upset); report signs/symptoms of chest pain, SOB, dizziness, swelling of extremities, irregular pulse, altered vision immediately

GENERIC NAME: CLOTRIMAZOLE TOPICAL CREAMTRADE NAME: Fungoid, Lotrimin

CLASSIFICATION: AntifungalACTION: Depending on concentration, may be fungicidal or fungistatic;

acts by inhibiting the biosynthesis of sterols, resulting in damage to cell wall and subsequent loss of essential intracellular elements due to altered

permeability; may also inhibit oxidative and peroxidative enzyme activity and inhibit the biosynthesis of triglycerides and phospholipids by fungi

INDICATIONS: Broad-spectrum antifungal; Tinea pedis, tinea cruris, tinea corporis due to T. rubrum, T. mentagrophytes, 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 for 2 weeks or 4 weeks depending on disease; if symptoms persist, consult provider

ADVERSE REACTIONS: Irritation, rash, stinging, burning, pruritus

INTERACTIONS: Use with caution when lactating

CONTRAINDICATIONS: Hypersensitivity; first trimester of pregnancy; in children under 2 y/o; around eyes

NURSING CONSIDERATIONS: Do not allow topical products in eyes; wash hands before and after treatments; report adverse effects or lack of

response

GENERIC NAME: FLUCONAZOLE

TRADE NAME: Diflucan

CLASSIFICATION: Antifungal

ACTION: Is highly selective inhibitor of fungal cytochrome P450 and sterol C-14 alpha-demethylation; loss of normal sterols correlates with accumulation of 14 alpha-methyl sterols in fungi and may be responsible for the fungistatic activity; decrease in cell wall

integrity and extrusion of intracellularmaterial, leading to death

INDICATIONS: Oropharyngeal and esophageal candidiasis; serious systemic candidal infection (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; following 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 of ethinyl estradiol and levonorgestrel;

protease inhibitors – possible ↑ protease inhibitor levels with possible ↑ toxicity; MANY MORE

CONTRAINDICATIONS: Hypersensitivity to fluconazole, lactation

NURSING CONSIDERATIONS: Daily dose same for either IV or PO; store tablets under 30ºC (86ºF); loading dose of twice daily dose is recommended for first day to

obtain plasma levels close to steady state by second day; due to long half-life, once daily dosing (either IV or PO) is possible; do not use IV solution if cloudy, precipitated, or seal broken; do not exceed continuous IV infusion rate of 200 mg/hr; check site frequently for

extravasation/necrosis; describe clinical presentation of fungal infection

GENERIC NAME: CEFTAZIDIME

TRADE NAME: Ceptaz, Fortaz, Tazicef, TazidimeCLASSIFICATION: Cephalosporin, third generation

ACTION: Only for IV or IM usage; between 80 and 90% is excreted unused in urine

INDICATIONS: Lower respiratory tract infections due to Pseudomonas aeruginosa and other Pseudomonas species, Haemophilus influenzae,

Klebsiella species, Enterobacter species, Proteus mirabilis, Escherichia coli, Serratia species, Citrobacter species, Streptococcus pneumoniae, Staphylococcus aureus; Skin and skin structure infections; UTIs, both complicated and uncomplicated; bacterial septicemia; bone and joint infections; gynecologic infections; intra-abdominal infections; CNS

infectionsROUTES OF ADMINISTRATION: IM, IV

USUAL DOSAGE: Usual infections – IM, IV: 1 g q 8-12 hr; UTIs – IM, IV – 0.25-0.5 g q 12 hr; pneumonia, mild skin infections – 0.5-1 g q 8 hr

ADVERSE REACTIONS: Nausea & vomiting, diarrhea, yeast infection of mouth or vagina, abdominal pain, stomach cramps, colitis, thrombophlebitis

INTERACTIONS: Colistimethate/colistin/ethacrynic acid/furosemide/polymyxin B/vancomycin - ↑ risk of renal toxicity;

probenecid - ↑ effect of 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 preferred with bacterial septicemia,

peritonitis, bacterial meningitis, or other severe/life threatening infections; for direct IV, reconstitute 1 g in 10 mL sterile water for injection (give over 3-5 min); do not give ceftazidime 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 outflow

INDICATIONS: lower intraocular pressure in open-angle glaucoma or ocular hypertension

ROUTES OF ADMINISTRATION: Solution for eye drops

USUAL DOSAGE: 1 gtt (drop) in the affected eye(s) three times a day, with doses about 8 hr apart

ADVERSE REACTIONS: Hypertension, somnolence, headache, fatigue, dizziness, asthenia, oral dryness, upper respiratory symptoms, GI symptoms,

burning/stinging, blurring, foreign body sensation, ocular pruritus

INTERACTIONS: Antihypertensives/Beta-adrenergic blockers/cardiac glycosides – May ↓ pulse and BP; use caution if 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 25ºC (77ºF); document findings, ensure routine screenings; avoid alcohol and other CNS depressants; remove prior and do not reinsert soft contact lenses until at least 15 min after instillation

GENERIC NAME: QUETIAPINE FUMARATETRADE NAME: Seroquel

CLASSIFICATION: AntipsychoticACTION: Mechanism unknown but may act as an antagonist at dopamine D2 and serotonin SHT2 receptors; side effects may be due to antagonism of

other receptors (e.g. histamine H1, dopamine D1, adrenergic alpha1 and alpha2, serotonin SHT1A)

INDICATIONS: Treatment of schizophrenia; short-term treatment of acute manic episodes associated with bipolar 1 disorder either as monotherapy or

adjunct therapy with divalproex or lithiumROUTES OF ADMINISTRATION: Tablet

USUAL DOSAGE: 25 mg 2 times daily, increases of 25 to 50 mg 2-3 times daily on second and third day as tolerated; target dose range for fourth day is 300-400 mg divided into 2 or 3 doses; antipsychotic dose range is 150 to 750 mg/day; if adjustments are needed, lower or raise by increments of 25-50 mg

twice daily

ADVERSE REACTIONS: Headache, drowsiness/somnolence, dizziness, hypotension, tachycardia, constipation, dry mouth, dyspepsia

INTERACTIONS: Barbiturates/carbamazepine/glucocorticoids/phenytoin/rifampin - ↓

quetiapine effect related to ↑ liver breakdown; dopamine antagonists/levodopa – quetiapine antagonizes effect; thioridazine - ↑

quetiapine clearanceCONTRAINDICATIONS: Lactation

NURSING CONSIDERATIONS: Continue clients who respond to quetiapine using the lowest dose needed to maintain remission; periodically reassess; consider slower rate of titration and lower target dose in elderly, debilitated clients, or in those who have a predisposition to hypotensive

reactions; store at 15-30ºC (59-86F); list reasons for therapy, clinical presentation, behavioral manifestations; avoid alcohol and other OTC agents

without approval; take with or without food

GENERIC NAME: CLOTRIMAZOLETRADE NAME: Cruex, Desenex, Fungoid, Lotrimin, Lotrimin AF,

MycelexCLASSIFICATION: Antifungal

ACTION: Depending on concentration, may be fungistatic or fungicidal; acts by inhibiting the biosynthesis of sterols, resulting in damage to the cell wall and subsequent loss of essential intracellular elements due to altered

permeability; may also inhibit oxidative and perioxidative enzyme activity and inhibit biosynthesis of triglycerides and phospholipids by fungi

INDICATIONS: Broad-spectrum antifungal; candidiasis due to C. albicans and tinea versicolor due to M. furfur; tinea pedis, tinea cruris, and tinea

corporis due to T. rubrum, T. mentagrophytes, E. floccosum and M. canisROUTES OF ADMINISTRATION: Topical and vaginal cream

USUAL DOSAGE: Massage into affected skin and surrounding areas twice daily (morning and evening); reevaluate if no improvement in 4 weeks

ADVERSE REACTIONS: Skin irritation, rash, burning, stinging, pruritus

INTERACTIONS: None specific

CONTRAINDICATIONS: Hypersensitivity; first trimester of pregnancy; use around eyes; topically in children under 2 years old

NURSING CONSIDERATIONS: Do not get products in eyes; wash hands prior and after handling product; apply only after cleaning affected area; use

napkin to prevent staining of clothing; report lack of 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 MORECLASSIFICATION: Nonsteroidal, anti-inflammatory drug, analgesic, antipyretic

ACTION: Exhibits antipyretic, anti-inflammatory, and analgesic effects; Antipyretic due to an action on the hypothalamus, resulting in heat loss by vasodilation of peripheral

blood vessels and promoting sweating; Anti-inflammatory mediated through inhibition of cyclo-oxygenase, which results in a decrease in prostaglandin synthesis and other

mediators of pain responseINDICATIONS: Analgesic – Pain from integumentary structures, myalgias, neuralgias, arthralgias, headache, dysmenorrheal, and similar types of pain; gout; Antipyretic, Anti-inflammatory – arthritis, osteoarthritis, SLE, acute rheumatic fever, gout, and many other

conditionsROUTES OF ADMINISTRATION: Caplets, gum, suppositories, tablets, chewable

tablets, coated tablets, delayed-release tablets, effervescent tablets, enteric-coated tabletsUSUAL 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, discomfort

INTERACTIONS: TOO MANY TO LIST

CONTRAINDICATIONS: Hypersensitivity to salicylates; clients with asthma, hay fever, or nasal polyps have higher incidence of hypersensitivity;

severe anemia, history of blood coagulation defects, in conjunction with anticoagulant therapy; vitamin K deficiency

NURSING CONSIDERATIONS: Enteric-coated or buffered tablets better tolerated by some; take with full glass of water; use epinephrine to

counteract hypersensitivity; take temperature 1 hour after administering; note if asthma, hay fever, ulcer disease or nasal polyps; take as directed;

administer with meals and glass of water

GENERIC NAME: FLUTICASONE PROPIONATE AND SALMETEROL XINAFOATETRADE NAME: Advair diskus

CLASSIFICATION: Anti-asthmatic, combination drugACTION: Fluticasone is an anti-inflammatory 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 of ATP to

cyclic-AMP; increased cyclic-AMP levels cause relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate

hypersensitivityINDICATIONS: Long-term, twice-daily maintenance treatment of asthma

in clients 12 years and older; not for relief of 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 inflammation, hoarseness/dysphonia, bronchitis, cough, nausea &

vomitingINTERACTIONS: Beta-adrenergic blockers – block pulmonary effects of salmeterol; also may produce severe brochospasms; diuretics – EKG change

and/or hypokalemia may be worsened; MAO inhibitors/tricyclic antidepressants – action of salmeterol may be potentiated; administer with

extreme caution or within 2 weeks of discontinuation of MAO inhibitors and tricyclic antidepressants

CONTRAINDICATIONS: Hypersensitivity to any component of the product; primary treatment of status epilepticus or other acute episodes of

asthma where intensive measures are neededNURSING CONSIDERATIONS: Do not use Advair Diskus for

transferring clients from systemic corticosteroid therapy due to possibility of deaths due to adrenal insufficiency

GENERIC NAME: TIOTROPIUM BROMIDE

TRADE NAME: Spiriva

CLASSIFICATION: Anticholinergic

ACTION: Long-acting antimuscarinic (anticholinergic); in airways, it inhibits muscarinic M3 receptors at the smooth muscle, leading to

bronchodilation

INDICATIONS: Long-term once daily, maintenance treatment of bronchospasm associated with COPD, including chronic bronchitis and

emphysemaROUTES OF ADMINISTRATION: Capsules containing powder for

inhalationUSUAL DOSAGE: Inhale contents of one capsule once daily using

HandiHaler inhalation device

ADVERSE REACTIONS: URTI, dry mouth, accidents, sinusitis, pharyngitis/rhinitis, abdominal pain, chest pain (non-specific), dependent

edema, UTI

INTERACTIONS: None specific

CONTRAINDICATIONS: History of hypersensitivity to atropine or its derivatives; use for initial treatment of acute episodes of bronchospasm; use

with other anticholinergics

NURSING CONSIDERATIONS: Teach client how to use inhaling device; store capsules from 15-30ºC (59-86ºF); not to be used for acute

bronchospasms; do not permit powder to enter eyes; may cause papillary dilation and blurred vision; do not swallow capsules; report any eye

pain/discomfort, 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 of acetylcholine; prevents the increase in intracellular levels of cyclic guanosine monophosphate, which is caused by the interaction of acetylcholine with muscarinic receptors in bronchial smooth

muscle (leads to bronchodilation which is primarily a local, site-specific effect)

INDICATIONS: Alone or with other bronchodilators, especially beta-adrenergics, as a bronchodilator for maintenance treatment of brochospasm associated with COPD,

including chronic bronchitis and emphysema

ROUTES OF ADMINISTRATION: Inhalation aerosol, solution for 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 food products, including soybean or peanut;

use for initial treatment of acute bronchospasms

NURSING CONSIDERATIONS: Do not confuse Atrovent with Alupent (a sympathomimetic); use with nebulizer with mouthpiece rather than facemask may be

preferable to reduce chance of solution hitting eyes; store aerosol between 15-30ºC (59-86ºF); take only as directed and shake well before each use; if using more than one

inhalation per dose, wait 3 min before administering second dose

GENERIC NAME: IBUPROFEN

TRADE NAME: Advil, Motrin, Midol, Menadol, PediaCare and all derivatives

CLASSIFICATION: Nonsteroidal anti-inflammatory drugACTION: Anti-inflammatory effect is likely due to inhibition of cyclo-oxygenase;

inhibition of cyclo-oxygenase results in decreased prostaglandin synthesis; effective in reducing joint swelling, pain, and morning stiffness, as well as to increase mobility in

patients with inflammatory disease; antipyretic action occurs by decreasing prostaglandin synthesis in hypothalamus resulting in increase in peripheral blood flow and heat loss

INDICATIONS: Analgesic for mild to moderate pain; primary dysmenorrheal; relief of signs and symptoms of 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

effective as the 400 mg dose)

ADVERSE REACTIONS: Dizziness, rash, nausea, epigastric/GI pain, heartburn

INTERACTIONS: Furosemide/thiazide diuretics – ↓ diuretic effect 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 of coronary artery bypass graft surgery

NURSING CONSIDERATIONS: Do not use ibuprofen OTC for more than 3 days as antipyretic or as an analgesic for more than 10 days unless

medically prescribed; do not take more than 3.2 g of 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: CYANOCOBALAMINTRADE NAME: Big Shot B-12, Twelve Resin-K

CLASSIFICATION: Vitamin B12

ACTION: Required for hematopoiesis, cell reproduction, nucleoprotein and myelin synthesis

INDICATIONS: Vitamin B12 deficiency due to malabsorption syndrome as seen in pernicious anemia, GI pathology, dysfunction, or surgery; Fish

tapeworm infestation, malignancy of pancreas or bowel, gluten enteropathy, small bowel overgrowth of bacteria, sprue, accompanying folic acid

deficiencyROUTES OF ADMINISTRATION: Lozenges, tablets, injection

USUAL DOSAGE: Pernicious anemia: 100 mcg/day for 6-7 days, then if no improvement is noted, give 100 mcg every other day fro seven doses and

then 100 mcg q 3-4 days for 2-3 weeks; Vitamin B12 deficiency: 30 mcg daily for 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 of vitamin B12; ↓ absorption of cyanocobalamin

CONTRAINDICATIONS: Hypersensitivity to cobalt; Leber’s disease

NURSING CONSIDERATIONS: Protect injection from light and do not freeze; with pernicious anemia, cannot give PO; determine if allergic to

cobalt; monitor VS, CBC, potassium, folic acid, and B12 levels, must take B12 supplements for life with pernicious anemia; if vitamin B12 deficiency

is due to dietary deficiency, identify foods 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 for normal production of RBCs and for synthesis of nucleoproteins; is converted into tetrahydrofolic acid which is a

cofactor in the biosynthesis of purines and thymidylates of nucleic acids

INDICATIONS: Treatment of megaloblastic anemias due to folic acid deficiency; diagnosis of folate deficiency

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 folate levels; trimethoprim/methotrexate – folic acid antagonist; phenytoin - ↑ seizure frequency, ↓ serum folic acid levels; oral contraceptives - ↑ risk of folate

deficiency

CONTRAINDICATIONS: Use in aplastic, normocytic, or pernicious anemias (ineffective); folic acid injection that contains benzyl alcohol should

not be used in neonates or immature infants

NURSING CONSIDERATIONS: Review other prescribed drugs; may cause increased body loss of folic acid; give PO; if 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 of anaphylactic reactions; take only as directed and avoid alcohol

GENERIC NAME: OXYCODONE HYDROCHLORIDETRADE NAME: OxyIR, OxyFAST, Oxydose, Roxicodone Intensol, Roxicodone, M-

oxy, Oxy-ContinCLASSIFICATION: Narcotic analgesic

ACTION: Semi synthetic opiate that combines with specific receptors located in the CNS to produce various effects; the mechanism is believed to involve decreased

permeability of the cell membrane to sodium, which results in diminished transmission of pain impulses and therefore analgesia; causes mild sedation and little or no antitussive

effect; most effective in relieving acute pain.INDICATIONS: Management of moderate to severe pain when a continuous around-

the-clock analgesic is required for an extensive period of time; to be used postoperatively if the client has received the drug prior to surgery or if the postoperative pain is expected to be moderate to severe and last for an extended period of time; not intended for use as

an ‘as needed’ analgesic; not for pain in the immediate postoperative periodROUTES OF ADMINISTRATION: Immediate-release capsules, oral solution,

concentrate solution, controlled-release tablets, immediate-release tabletsUSUAL DOSAGE: Individualize dose depending on severity of pain, client response

and client size; 10-30 mg q 4 hr (5 mg q 6 hr for 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 of CNS depressant effects; 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 for therapy, type, onset, characteristics of

symptoms; differentiate acute and chronic syndromes and rate pain levels; obtain baseline VS’s generally, if the respiratory rate < 12/min or the SBP <90mm Hg, a narcotic should

not be administered unless there is ventilatory support or specific guidelines with parameters for ventilation; give round-the-clock dosing for chronic pain; for control of

severe chronic pain, give immediate-release products on a regularly scheduled basis

GENERIC NAME: CARVEDILOLTRADE 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 reflex orthostatic

hypotension, causes vasodilation, and reduces peripheral vascular resistance; BP is lowered more in the standing than in the supine position; significantly lowers plasma

resin activity when given for at least 4 weeks

INDICATIONS: Essential hypertension used either alone or in combination with other antihypertensive drugs, especially thiazide diuretics; mild to severe heart failure of

ischemic or cardiomyopathic origin, used with diuretics, ACE inhibitors, and digitalis to increase survival and reduce risk of hospitalization; reduce CV mortality in clinically

stable clients who have survived an acute MI and have a left ventricular ejection fraction of 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, fatigue, pain, bradycardia, hypotension

INTERACTIONS: Antidiabetic agents - ↑ hypoglycemic effects R/T beta blockage; Clonidine – potentiation of BP and heart rate lowering effects; Cyclosporine - ↑

cyclosporine blood levels R/T ↓ liver breakdown; Digoxin - ↑ digoxin levels

CONTRAINDICATIONS: Clients with NYHA class IV decompensated cardiac failure, 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 effect seen within 7-14 days; addition of diuretic can produce additive effects and exaggerate orthostatic effect; treat fluid retention with increased dose of diuretics, whether or not heart failure symptoms have worsened; reduce dosage if bradycardia (HR less than 55 bpm) occurs; take as

prescrivbed with food, slows absorption/decreases orthostatic effects; avoid OTC agents; avoid activities that require mental acuity until drug effects realized; do not stop abruptly;

R/T beta-blocking activity (esp. with ischemic heart disease)

GENERIC NAME: ISOSORBIDE MONONITRATETRADE NAME: ISMO, Monoket, Imdur

CLASSIFICATION: Coronary vasodilator

ACTION: Isosorbide mononitrate is the major metabolite if isosorbide dinitrate; mononitrate is not subject to first-pass metabolism; relaxes vascular smooth muscle by

stimulating production of intracellular cyclic guanosine monophosphate; dilation of postcapillary vessels decreases venous return to the heart due to pooling of blood; thus,

LV end-diastolic pressure (preload) is reduced; relaxation of arterioles results in a decreased systemic vascular resistance and arterial pressure (afterload)

INDICATIONS: Treatment of angina pectoris; prophylaxis of angina pectoris caused by coronary artery disease; the onset of action of the mononitrate is not sufficiently 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 after 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 confuse Imdur with Imuran or Inderal; treatment regimen minimizes development of refreactory tolerance; store tablets from 15-30°C (59-86°F); keep tightly closed and protect from

excessive moisture; note reasons for therapy, cardiac history, onset/frequency of angina, triggers; monitor EKG, VS, cardiac status, family history, risk factors and electrolytes; consume 1-2 L/day of fluids to ensure

adequate hydration, and do not stop abruptly; avoid alcohol

GENERIC NAME: ZINC OXIDE CREAMTRADE NAME: Desitin

CLASSIFICATION: Skin creamACTION: Used to treat or prevent minor skin irritations, such as diaper rashINDICATIONS: To use if 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 affected area as often as needed or as directed by doctor

ADVERSE REACTIONS: No reported side effectsINTERACTIONS: Other skin products; other prescription or non-

prescription medicationsCONTRAINDICATIONS: Tell doctor of medical history, especially of

other skin infections or problems; advise of allergies, lactationNURSING CONSIDERATIONS: Do not share cream with multiple

individuals; store between 15-30°C (59-86°F)

GENERIC NAME: POTASSIUM SALTSTRADE NAME: K-norm, Micro-K, Extencaps, K+ 10, K-Dur 10 and 20, K-Tab, Kaon-

Cl, Klor-Con, Klotrix, Ten-K, moreCLASSIFICATION: Electrolyte

ACTION: Potassium is readily and rapidly absorbed through the GI tract; though a number of salts can be used to supply cation, potassium chloride is agent of choice since

hypochloremia frequently accompanies potassium deficiency; dietary measures can usually prevent and correct potassium deficiencies (beef, chicken, ham, turkey, veal, fish, 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, familial periodic paralysis, certain cases of uremia, hyperadrenalism, starvation and debilitation, and corticosteroid or diuretic therapy; Hypokalemia with or without metabolic acidosis and following surgical conditions

accompanied by nitrogen loss, vomiting and diarrhea, suction drainage, and increased urinary excretion of potassium; prophylaxis of potassium depletion when dietary intake is

not adequate in certain conditionsROUTES OF ADMINISTRATION: Extended-release capsules

USUAL DOSAGE: Highly individualized; 40-100 mEq/day for potassium depletion (usual dietary intake is 40-250 mEq/day)

ADVERSE REACTIONS: N&V, diarrhea, flatulence, abdominal discomfort

INTERACTIONS: ACE inhibitors – may cause potassium retention → hyperkalemia; Digitalis glycosides – cardiac arrhythmias; Potassium-sparing diuretics – severe

hyperkalemia with possibility of cardiac arrhythmias or arrest

CONTRAINDICATIONS: Severe renal function impairment with azotemia or oliguria, postoperatively before urine flow has been reestablished; Crush syndrome, Addison’s disease, hyperkalemia from any cause, anuria, heat cramps, acute dehydration, severe

hemolytic reactions, adynamia, episodica hereditaria, clients receiving potassium-sparing diuretics or aldosterone-inhibiting drugs; solid dosage forms in clients in whom there is a

reason for the delay or arrest in passage of tablets through the GI tract

NURSING CONSIDERATIONS: Give PO doses 3-4 times daily; correct hypokalemia slowly over a period of 3-7 days to minimize risk of hyperkalemia; identify reasons for therapy; document electrolytes and ECG; list all drugs and OTC agents consumed; note

any impaired renal function; assess for adequate urinary flow before administering potassium, dysfunction 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: LISINOPRILTRADE NAME: Prinivil, Zestril

CLASSIFICATION: Antihypertensive, ACE inhibitorACTION: 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 effective

in African 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 for treating CHF not responding to other therapy; use within 24 hours of

acute MI to improve survival in hemodynamically stable clientsROUTES OF ADMINISTRATION: Tablets

USUAL DOSAGE: Essential hypertension in combination with a diuretic – 5 mg; the BP-lowering effects of the combination are additive; reduce dosage in renal impairment

as follows: CCR 10-30 mL/min: give initial dose of 5 mg/day for HTN; CCR less than 10 mL/min: give initial dose of 2.5 mg/day and adjust dose depending on BP response

ADVERSE REACTIONS: Chest Pains, dizziness, headache, hypotension, fatigue, diarrhea, URTI

INTERACTIONS: Diuretics – excess ↓ BP; Indomethacin – possible ↓ lisinopril effect; Potassium-sparing diuretics – significant ↑ serum potassium

CONTRAINDICATIONS: Use in children under 6 years old or in children with a GFR less than 30 mL/min/1.73 m2

NURSING CONSIDERATIONS: When considering use of Lisinopril in client taking diuretics, discontinue diuretic if possible 2-3 days prior to beginning lisinopril therapy; if

diuretic cannot be discontinued, initial dose should be 5 mg and observe closely for 2 hours; maximum antihypertensive effects may not be observed for 2-4 weeks; give under medical supervision for CHF especially if SBP is less than 100 mmHg; use of 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 of 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 of the kidney; by increasing the excretion of

sodium and chloride, forces excretion of additional water; also increases the excretion of potassium and, to a lesser extent, bicarbonate, as well as decreases the excretion of

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 of reduced renal function

ROUTES OF ADMINISTRATION: Tablets

USUAL DOSAGE: Edema due to renal disease: 5-20 mg once daily (for those who experience paroxysmal nocturnal dyspnea, a larger dose may be required to ensure

prolonged diuresis and saluresis for a 24-hr period

ADVERSE REACTIONS: Dizziness, headache, muscle cramps, malaise, lethargy, lassitude, joint pain/swelling, chest pain

INTERACTIONS: Alcohol/Barbiturates/Narcotics - ↑ hypotensive effect; NSAIDs/Salicylates - ↓ hypotensive effects of metolazone

CONTRAINDICATIONS: Anuria, prehepatic and hepatic coma, allergy or hypersensitivity to metolazone; routine use during pregnancy and lactation; increases

secretion of sodium and water by inhibiting sodium resorption in the distal tubule; promotes excretion of chloride, potassium, magnesium and bicarbonate

NURSING CONSIDERATIONS: Do not confuse metolazone with methotrexate (antineoplastic) or with metoclopramide (GI stimulant); store tablets at room temperature in a tight, light-resistant container; formulations of slow availability tablets should not be interchanged with formulations of rapid availability tablets as they are not therapeutically

equivalent; monitor weight, BP, ECG, CBC, electrolytes, uric acid, renal, LFT’s, and assess for signs/symptoms of electrolyte imbalance; take with or without food exactly as

directed early in the day

GENERIC NAME: MYCOPHENOLATE MOFETILTRADE NAME: CellCept

CLASSIFICATION: ImmunosuppressantACTION: Is hydrolyzed to the active mycophenolic acid (MPA); MPA has potent

cytostatic effects on lymphocytes; inhibits proliferative responses of T- and B-lymphocytes to both mitogenic and allospecific stimulation; MPA also suppresses

antibody formation of B-lymphocytes; MPA may also inhibit recruitment of leukocytes into sites of inflammation and graft 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 forms for those who cannot take PO medications; In combination with prednisolone to treat diffuse proliferative lupus

nephritisROUTES OF ADMINISTRATION: Capsules (250 mg), powder for injection, lyophilized (500 mg), powder for oral suspension (200 mg/mL), tablets (500 mg)

USUAL DOSAGE: 1000 mg twice daily, IV can be started <24 hr after transplantation and switched to PO as soon as possible; for renal impairment, glomerular filtration rate

(GFR) <25 ml/min, daily dose not to exceed 2000 mg

ADVERSE REACTIONS: Hypertension, constipation, diarrhea, N&V, UTI, anemia, leucopenia, peripheral edema, infection, abdominal pain, fever, headache, infections

(viral, fungal), pain, asthenia, back/chest pain

INTERACTIONS: Antacids containing Al/Mg / Cholestyramine / Iron - ↓ absorption of mycophenolate: do not use together; Cyclosporine - ↓mycophenolic acid levels;

Vaccines, life attenuated – vaccinations may be less effective

CONTRAINDICATIONS: Hypersensitivity to mycophenylate, mycophenolic acid, or polysorbate 80; use in those with rare hereditary deficiency of hypoxanthine-guanine phosphoribosyl transferase, 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 from manufacturer’s original container; do not break/crush, chew or open capsules as powder may be teratogenic if

inhaled or contact with skin/mucus membranes

GENERIC NAME: PREDNISONETRADE NAME: Deltasone, Meticorten, Orasone, Panasol-S, Prednicen-M, Sterapred

DSCLASSIFICATION: Glucocorticoid

ACTION: Anti-inflammatory effect is due to inhibition of prostaglandin synthesis; also inhibits accumulation of maxcrophages and leukocytes at sites of inflammation and

inhibits phagocytosis and lysosomal enzyme release

INDICATIONS: When used for anti-inflammatory 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 four equally divided doses after 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, fatigue, dizziness, muscle weakness, increased hunger/thirst, joint pain, decreased diabetic control

INTERACTIONS: Acetaminophen - ↑ risk of hepatotoxicity related to ↑ rate of formation of hepatotoxic acetaminophen metabolite; alcohol - ↑ risk of GI ulceration or

hemorrhage; Bumetanide/ Furosemide - ↑ potassium loss R/T potassium-losing properties of both drugs;

CONTRAINDICATIONS: Suspected infections as it may mask infections; also peptic ulcer, psychoses, acute glomerulonephritis, herpes simplex infections of 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 fungal infections, open-angle glaucoma, hyperlipidemia, hyperthyroidism or hypothyroidism, osteoporosis

NURSING CONSIDERATIONS: Do not confuse prednisone with prednisolone; note reasons for therapy, type, onset, characteristics of signs/symptoms, clinical presentation;

monitor CBC, ESR, electrolytes, BP, blood sugar, weights, and mental status; take in AM to prevent insomnia and take with food 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 of both sodium and chloride in the proximal tubule and the ascending loop of 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 useful in clients refractory to other

diuretics

ROUTES OF ADMINISTRATION: Injection (0.25 mg/mL); tablets (0.5 mg, 1 mg, 2 mg)

USUAL DOSAGE: Tablets for edema – 0.5-2 mg once daily; if response is inadequate, a second or third dose may be given at 4-5 hr intervals up to a maximum of 10 mg/day

ADVERSE REACTIONS: Dizziness, hypotension, headache, nausea, muscle cramps, encephalopathy in those with preexisting liver disease

INTERACTIONS: Charcoal - ↓ absorption from GI tract; Clofibrate enhances diuretic effect, hydantoins ↓ diuretic effect, propranolol - ↑ plasma propranolol levels; thiazide diuretics – additive effects with loop diuretics –

profound diuresis and serious electrolyte abnormalities

CONTRAINDICATIONS: Anuria, hepatic coma or severe electrolyte depletion until condition improved/corrected; hypersensitivity to drug

NURSING CONSIDERATIONS: Do not confuse Bumex with Buprenex (narcotic analgesic); Document reasons for therapy; pretreatment findings; note sulfonamide allergy; may be cross sensitivity; monitor electrolytes,

I&O, renal and LFT’s, assess for ↓ K+; Reserve IV or IM for those whom PO use is not practical or absorption from the GI tract is impaired; NOTE: 1

mg of bumetanide is equivalent to 40 mg of furosemide

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 of action; it manifests 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 soft tissue trauma); dilaudid-HP is a concentrated solution intended

for 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 for injection, lyophilized (250 mg/vial – 10

mg/mL after 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; for 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 of CNS depressant effects; 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 confuse hydromorphone with morphine; most clients given around-the-clock therapy with controlled-release opioids may require immediate-release medication for worsening of pain or to treat or prevent pain that

occurs; refrigerate suppositories; may be given by slow IV injection; administer slowly to minimize hypotensive effects and respiratory depression; administer at a rate of 2 mg

over 5 min; use rating scale to measure pain

GENERIC NAME: LEVOFLOXACINTRADE NAME: Levoquin, Quixin

CLASSIFICATION: Antibiotic, fluoroquinoloneACTION: Interferes with DNA gyrase and topoisomerase IV; DNA gyrase

is an enzyme needed for replication, transcription, and repair of bacterial DNA; topoisomerase IV plays a key role in the partitioning of chromosomal DNA during bacterial cell division; Effective against both gram-positive and

gram-negative organismsINDICATIONS: Mild to moderate complicated UTIs due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, P.

mirabilis, or Pseudomonas aeruginosa; Uncomplicated UTIs (mild to moderate) due to E. coli, K. pneumoniae, or Staphylococcus saprophyticusROUTES 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 for 10 days; Uncomplicated UTIs – 250 mg once a day for 3 days

ADVERSE REACTIONS: Headache, dizziness, insomnia, N&V, diarrhea, dyspepsia/heartburn, constipation

INTERACTIONS: Antacids/didanosine/Iron salts/sucralfate/zinc salts - ↓ serum Levofloxacin R/T ↓ GI tract absorption; Anticoagulants - ↑ anticoagulant effects

CONTRAINDICATIONS: Lactation, IM, intrathecal, intraperitoneal, or SC administration

NURSING CONSIDERATIONS: Administer doses of 250 or 500 mg by slow infusion over 60 min q 24 hr or 750 mg given by slow infusion over 90 min q 24 hr; avoid rapid or bolus IV infusion; Diluted solutions for IV are stable for 72 hr up to a concentration of 5 mg/mL when stored in IV containers at 25°C or less (77°F or less); solutions are stable

for 14 days when stored under refrigeration at 5°C (41°F); diluted solutions that are frozen in glass bottles or plastic IV containers are stable for 6 months when stored at

-20°C (-4°F); tablets can be taken without regard for food; consume plenty of liquids to prevent urinary crystallization; take oral solution 1 hr before or 2 hr after eating

GENERIC NAME: MAGNESIUM HYDROXIDETRADE NAME: (Phillips) Milk of Magnesia, Ex-Lax Milk of Magnesia

CLASSIFICATION: LaxativeACTION: Important for many systems in the body, especially the muscles and nerves;

reduces stomach acid and increases water in the intestines (aides in defecation)INDICATIONS: Used as a laxative to relieve occasional constipation (irregularity); as

an antacid to relieve indigestion, sour stomach, heartburnROUTES 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 of magnesium hydroxide overdose (nausea, vomiting, flushing, low blood pressure, bradycardia, drowsiness, coma, death

INTERACTIONS: Tetracyclines, fluoroquinolone antibiotic, penicillamine, digoxine, nitrofurantoin

CONTRAINDICATIONS: No restrictions on food, beverages, activity unless advised by PMD; seek emergency attention if an allergic reaction occurs; Kidney disease

NURSING CONSIDERATIONS: Do not take magnesium hydroxide if abdominal pain, nausea, vomiting is present unless prescribed; do not use for longer than one week; rectal bleeding or failure to have bowel movement after l;axative may indicate a more serious

condition

GENERIC NAME: SIMVASTATINTRADE NAME: Zocor

CLASSIFICATION: Antihyperlipidemic, HMG-CoA reductase inhibitorACTION: Competitively inhibits HMG-CoA reductase; this enzyme catalyzes the early

rate-limiting step in the synthesis of 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 reserveINDICATIONS: 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 of isolated hypertriglyceridemia and hyperlipoproteinemiaROUTES 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 of 5 mg/day for clients on

immunosuppressants, and increasing maintenance for increases in LDL concentrations; 40 mg as an alternative for those requiring a reduction of more than 45% in their LDL

cholesterol (most often those with CAD)

ADVERSE REACTIONS: Headache, abdominal pain/cramps, constipation

INTERACTIONS: Amioderone – possibility of 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 of severe myopathy and rhabdomyolysis; Diltiazem - ↑ risk of myopathy R/T ↑ simvastatin plasma levels; Erythromycin - ↑ risk of severe myopathy and rhabdomyolysis; Grapefruit juice – chronic use of grapefruit juice ↑ simvastatin

plasma levels due to ↓ liver metabolism

CONTRAINDICATIONS: Use if pregnant, planning on being pregnant, or while breastfeeding

NURSING CONSIDERATIONS: Do not confuse Zocor with Cozaar or Zoloft; may administer with no regard to meals; take as prescribed; more preferable in the evening; monitor CBC, lipid profile, CPK, renal LFT’s; low-cholesterol diet must be followed

during drug therapy (should be started 3-6 months prior to initial drug therapy); consult dietician for assistance in meal planning and food preparation; do not take with grapefruit

juice, but grapefruit juice can be given at other times during the day

GENERIC NAME: EZETIMIBE

TRADE NAME: Zetia

CLASSIFICATION: Antihyperlipidemic

ACTION: Acts by inhibiting the absorption of cholesterol from the small intestine, leading to a decrease in the delivery of cholesterol to the liver; this complements the mechanism of action of 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 for homozygous familial hypercholesterolemia; as adjunct therapy to diet for homozygous sitosterolemia

ROUTES OF ADMINISTRATION: Tablets 10 mgUSUAL DOSAGE: 10 mg once daily with or without food

ADVERSE REACTIONS: Back pain, diarrhea, arthralgia, sinusitis, abdominal pain

INTERACTIONS: Antacids - ↓ Ezetimibe Cmax after both Mg- and Ca-containing antacids (no effect on AUC); Cholestyramine - ↓ ezetimibe AUC probably R/T ↓

Absorption; Cyclosprine - ↑ total ezetimibe levels (monitor carefully); Fenofibrate/Gemfibrozil - ↑ 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 insufficiency and during

lactation; use in children less than 10 y/o

NURSING CONSIDERATIONS: Place client on a standard cholesterol-lowering diet before therapy and for duration of treatment; give at least 2 hr prior or 4 hr after giving a

bile acid sequestrant; store from 15-30°C (59-86°F) protected from moisture; monitor CBC, lipid panel, renal and LFTs; schedule LFTs at the beginning of therapy; list all

medications preascribed to ensure none interact unfavorably; identify cardiac risk factors; take daily as directed with or without food; avoid taking with antacids (reduces drug

effect); low-cholesterol diet must be followed during drug therapy; report any S&S of infection

GENERIC NAME: BACITRACIN OINTMENTTRADE NAME: Baciguent

CLASSIFICATION: Antibiotic

ACTION: Interferes with synthesis of cell wall, preventing incorporation of amino acids and nucleotides; is bacteriocidal, bacteriostatic, and active

against protoplasts; not absorbed from the GI tract; when given parenterally, drug is well distributed in pleural and ascetic fluids; high nephrotoxicity;

carefully evaluate renal function prior to, and daily, during use.

INDICATIONS: Aid to prevent infection in minor cuts, scrapes, burns, and wounds

ROUTES OF ADMINISTRATION: Ointment – 500 units/gramUSUAL DOSAGE: Apply small amount equal to surface area of a fingertip 1-3 times per day after cleaning the affected area; do not use for more than

one week

ADVERSE REACTIONS: After 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 infections; fungal diseases of eye; concomitant use of nephrotoxic drugs

NURSING CONSIDERATIONS: Do not confuse bacitracin with Bactroban; may cover affected area with sterile dressing; cleanse area

thoroughly before applying bacitracin as wet dressing or ointment; do not use topical ointment near eyes, nose, mouth, or mucous membranes; report lack of response, rash, stinging, itching, changes in vision, or unusual side

effects; do not administer with topical or systemic nephrotoxic drug

GENERIC NAME: VERAPAMILTRADE NAME: Calan, Calan SR, Covera-HS, Isoptin SR, Verelan, Verelan PM

CLASSIFICATION: Calcium channel blockerACTION: Slows AV conduction and prolongs effective refractory period; ↓ HR and ↑

PR interval; IV doses slightly increase LV filling pressure; moderately decreases myocardial contractility and peripheral vascular resistance; worsening of heart failure may result if verapamil is given to clients with moderate to severe cardiac dysfunctionINDICATIONS: Angina pectoris due to coronary artery spasm (Prinzmetal’s variant),

chronic stable angina including angina due to increased effort, unstable angina (preinfarction, crescendo); with digitalis to control rapid ventricular rate at rest and

during stress in chronic atrial flutter or atrial fibrillationROUTES 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 mgUSUAL DOSAGE: Essential hypertension – Initial, when used alone – 80 mg 3 times per day; doses up to 360-480 mg daily may be used; Effects are seen in the first week of

therapy

ADVERSE REACTIONS: Infection, flu-like symptoms, URTI, rhinitis, nausea, dyspepsia, diarrhea, constipation, headache, fatigue/lethargy, dizziness, peripheral edemaINTERACTIONS: Amiodarone – possible cardiotoxicity with ↓ CO (monitor closely);

Antihypertensive agents – additive hypotensive effects; antineoplastics - ↓ verapamil absorption by several antineoplastics; atorvastatin - ↑ atorvastatin plasma levels;

barbiturates - ↓ verapamil bioavailability; Buspirone - ↑ buspirone effects; cyclosporine - ↑ cyclosporine plasma levels → possible renal toxicity; Digoxin - ↑ risk of digoxin

toxicity R/T ↑ plasma levels; MANY MORECONTRAINDICATIONS: Severe hypotension, second- or third-degree AV block,

cardiogenic shock, severe CHF, sick sinus syndrome (unless client has artificial pacemaker), severe LV dysfunction; cardiogenic shock and severe CHF unless secondary

to SVT that can be treated with verapamil; lactation; use of verapamil, IV, with beta-adrenergic blocking agents; ventricular tachycardia

NURSING CONSIDERATIONS: Do not confuse Isoptin with Intropin; take SR tablets with food; Store ampules at 15-30°C (59-86°F); protect from light; always individualize dose; note reasons for therapy, onset, characteristics of S&S; make sure no prescribed meds interact; take SR capsule in AM with food; do not crush, cut, or chew; swallow

capsule whole; may cause dizziness and sudden drop in BP; use caution until drug effects realized

GENERIC NAME: ONDANSETRON HYDROCHLORIDETRADE NAME: Zofran, Zofran ODT

CLASSIFICATION: AntiemeticACTION: Cytotoxic chemotherapy is thought to release serotonin from

enterochromaffin cells of the small intestine; the released serotonin may stimulate the vagal afferent nerves through the 5-HT3 receptors, thus stimulating the vomiting reflex; Ondansetron, a 5-HT3 antagonist, blocks this effect of serotonin; whether the drug acts

centrally and/or peripherally to antagonize the effect of serotonin is not knownINDICATIONS: Prevent N&V resulting from initial and repeated courses of cancer

chemotherapy, including cisplatin, greater than 50 mg/m2; prevent N&V associated with initial and repeat courses of moderately emetogenic cancer chemotherapy; Prevent N&V associated with radiotherapy in clients receiving either total body irradiation, single high-

dose fraction to the abdomen, or daily fractions to the abdomenROUTES OF ADMINISTRATION: Injection, oral solution, tablets, orally-

disintegrating tabletsUSUAL DOSAGE: 4 mg IV undiluted over 2-5 min immediately before induction of

anesthesia or postoperatively as needed; alternatively, 4 mg undiluted may be given IM as a single injection

ADVERSE REACTIONS: Diarrhea, headache, dizziness, malaise/fatigue, 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 specified: special concerns with use during lactation; safety and effectiveness in children 3 years of age and younger are not known

NURSING CONSIDERATIONS: Do not confuse Zofran with Zoloft, Zantac, or Zosyn; do not exceed 8 mg PO or 8 mg IV daily with impaired hepatic function; 2 mg/mL

Ondansetron injection requires no dilution for administration for postop N&V; inspect visually for particulate matter and discoloration before administering; drug is to prevent

N&V; to be given exactly as prescribed; may cause drowsiness or dizziness; do not perform activities that require mental alertness until drug effects realized; report any rash,

diarrhea, constipation, altered respirations (brochospasms), or loss of response

GENERIC NAME: CALCIUM CARBONATETRADE 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 for maintaining normal function of nerves, muscles, the skeletal system, and permeability of 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 fibrillation, twitching, skeletal muscle spasms, leg cramps, titanic spasms, cardiac arrythmias, smooth muscle hyperexcitability, mental depression, and anxiety

statesINDICATIONS: Mild hypocalcemia; Antacid (including heartburn, sour stomach, and

acid indigestion); anithyperphosphatemicROUTES OF ADMINISTRATION: Capsules, gum, gum tablets, lozenges, powder,

suspension, tablets, chewable tabletsUSUAL 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: After PO use – GI irritation, constipation, headache, mild hypercalcemia (anorexia, N&V)

INTERACTIONS: Omeprazole ↓ fractional calcium absorption in fasting elderly women

CONTRAINDICATIONS: Digitalized clients, sarcoidosis, renal or cardiac disease, ventricular fibrillation, cancer clients with bone metastases; renal calculi,

hypophosphatemia; hypercalcemia

NURSING CONSIDERATIONS: Perform thorough nursing history, noting clinical presentation, indications for therapy, and any precipitating causes; list drugs prescribed,

especially if receiving digitalis products (may be contraindicated); monitor calcium levels and renal function; assess for renal or parathyroid disease; note bone density findings;

supplements need vitamin D to facilitate absorption; report adverse side effects, lack of desired response, and keep all follow-up appointments to evaluate drug response

GENERIC NAME: LEVOTHYROXINETRADE NAME: Synthroid, Levoxyl, Levothroid, others

CLASSIFICATION: Synthetic Thyroid PreparationACTION: 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 differentiation. Stimulate the cardiovascular system by increasing the number of myocardial beta-adrenergic receptors

which increases the sensitivity of the heart to catecholamines and ultimately increases cardiac output. Additionally, increases renal blood flow and the glomerular filtration rate

which results in a diuretic effect. Thyroid hormone T4.INDICATIONS: preferred drug for treatment of hypothyroidism because its hormonal

content is standardized and its effect is predictable. Also used to treat goiters, as replacement therapy in patients who have had thyroidectomys

ROUTES OF ADMINISTRATION: PO, IVUSUAL DOSAGE: 25-300 mcg/day (25-200 mcg/day most common) IM/IV: 50% of oral dose; IV 200-500 mcg in a single dose; repeat next day 100-300 mcg if necessary.

Pediatric 0-12 yr, PO: 25-150 mcg/day

ADVERSE REACTIONS: usually a result of overdose. Cardiac dysrhythmia with the risk for life-threatening or fatal 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, fever.

INTERACTIONS: : May enhance the activity of 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 of both drugs. Diabetic patiens may require increased doses of

their hypoglycemic drugs. With epinephrine in patients with coronary disease, may induce coronary insufficiency.

CONTRAINDICATIONS: known drug allergy, recent MI, adrenal insufficiency or hyperthyroidism.

NURSING CONSIDERATIONS: Half life long enough that it only needs to be administered once a day. Pregnancy category A. Switching between courses of

treatments should be minimized. Thyroid function tests should be monitored

GENERIC NAME: METOCLOPRAMIDETRADE NAME: Reglan, Reclomide

CLASSIFICATION: AntiemeticsACTION: Block dopamine receptors in chemoreceptor trigger zone of the CNS. Stimulates motility of the

upper GI tract and accelerates gastric emptying. Therapeutic Effects: Decreased nausea and vomiting. Decreased symptoms of gastric stasis. Easier passage of NG tube into small bowel.

INDICATIONS: Prevention of chemotheraphy-induced emesis. Treatment of postsurgicial and diabetic gastric stasis. Facilitation of small bowel intubation in radiographic procedures. Management of

esophageal reflux. Treatment and prevention of gastric suctioning is undesirable. Unlabeled uses: treatment of hiccups. Adjunct management of migraine headaches.

ROUTES OF ADMINISTRATION: IV, PO, IMUSUAL DOSAGE: : Prevention of Chemotherapy-Induced Vomiting: PO:IV (Adults (Adults and

Children): 1-2 mg/kg 30 min before chemotherapy. Additional doses of 1-2 mg/kg may be given q2-4hr, for 2 doses, then q3 hr for 3 additional doses. May also be given as 3 mg/kg before pretreatment with

diphenhydramine will decrease the risk of extra pyramidal reactions to this dosage chemotherapy, followed by 0.5mg/kg/hr for 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(Children<6yr): 0.1 mg/kg over 1-2 mins. Diabetic Gastroparesis: PO:IV (Adults):10 mg 30 min before meals and at bedtime Gastroesophageal Reflux: PO(Adults): 10-15 mg 30 mins before meals and at bedtime (not to exceed 0.5

mg/kg/day).PO (Neonates, Infants, Children): 0.4-0.8 mg/kg/day in 4 divided doses. Postoperative Nausea/Vomiting: IM:IV (Adults (Adults and Children>14):10-20 mg at the end of surgical procedure

repeat in 6-8 hr if needed. IM, IV(Children):0.1-0.2 mg/kg/dose, repeat in 6-8 hr if needed. Treatment of hiccups: PO, IM(Adults): 10-20 mg 4 times daily PO; may be preceded by a single 10 mg dose IM

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 of toxicity from cyclosporine. May affect the GI absorption of 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 of seizure disorders.

NURSING CONSIDERATIONS: Instruct patient to take metoclopramide exactly as directed. If dose is missed, take as soon as remembered if not almost time for next dose

GENERIC NAME: PROCHLORPERAZINE (MALEATE)

TRADE NAME: Compazine, Compro Suppositories

CLASSIFICATION: Antipsychotic, phenothiazine

ACTION: Causes a high incidence of extrapyramidal and antiemetic effects, moderate sedative effects, and a low incidence of anticholinergic effects and orthostatic

hypotensionINDICATIONS: Schizophrenia; short term treatment of generalized non-psychotic

anxiety (not the drug of 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); for 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 of CNS depressant effects (concomitant use may lead to drowsiness, lethargy, stupor, respiratory collapse, coma or death; aluminum salts (antacids) - ↓ absorption from 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 forms of the drug in tight-closing amber-colored bottles; store suppositories below 37°C (98.6°F); DO NOT

GIVE SC; Do not mix other agents in syringe if given IV; Do not mix with any agent containing preservative parabens; parenteral prescribing limits are 20 mg/day for children

2-5 y/o, 25 mg/day for children 6-12 y/o; assess mental status; note behavioral presentation/manifestations; moniotor CBC, LFT’s, ECG; do not exceed prescribed dose;

auscultate bowel sounds and assess function

GENERIC NAME: TAMULOSIN HYDROCHLORIDE

TRADE NAME: Flomax

CLASSIFICATION: Alpha-adrenergic blocking drugACTION: Blockade of alpha1-receptors (probably alpha1a) in the prostate results in relaxation of smooth muscles in the bladder, neck and prostate; thus, urine flow rate is improved and there is a decrease in symptoms of

BPH

INDICATIONS: Signs and asymptoms of BPH; rule-out prostatic carcinoma before using tamsulosin

ROUTES OF ADMINISTRATION: CapsulesUSUAL DOSAGE: Adult males – 0.4 mg once daily given about 30 min after same meal each day; if after 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 significant ↓ in clearance of tamsulosin

CONTRAINDICATIONS: Use to treat hypertension, with other alpha-adrenergic blocking agents, or in women or children

NURSING CONSIDERATIONS: Do not confuse Flomax with Fosamax, Flonase, or Volmax; if dose discontinued or interrupted for several days at either dose, start back up at 0.4 mg dose; store at 20-25°C (68-77°F); identify drugs prescribed to ensure none of

the drugs interact, esp cimetidine or coumadin; monitor CBC, I&O, VS, weight, urodynamic studies; note PSA levels, results of digital rectal exam; take as directed, do

not chew, crush, or open capsule; may take 30 min after same meal each day to decrease GI upset; report any loss of effectiveness or increased nighttime voiding; do not perform

activities that require mental/physical alertness until drug effects realized; may cause drowsiness, dizziness, and syncope; change positions slowly to prevent sudden drop in

BP; do not stop suddenly after prolonged use; avoid OTCs without getting provider approval first

GENERIC NAME: CALCITRIOL

TRADE NAME: Rocaltrol

CLASSIFICATION: Synthetic vitamin D analogACTION: Active in the regulation of the absorption of calcium from the GI

tract and its utilization in the bodyINDICATIONS: management of hypocalcemia and resultant metabolic bone disease in patients undergoing chronic renal dialysis; indicated in

management of secondary hyperparathyroidism and resultant metabolic bone disease in patients with mild/moderate/severe chronic renal failure not yet on

dialysis; management of hypocalcemia and clinical manifestations in patients with postsurgical hypoparathyroidism, idiopathic

hypoparathyroidism, and pseudohypoparathyroidismROUTES 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, calcific 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, MagnesiumCONTRAINDICATIONS: Should not be taken to patients with hypercalcemia or

evidence of Vit D toxicity; use in patients with known hypersensitivity to Rocaltrol (or drugs of same class) or any of the inactive ingrediants is contraindicated

NURSING CONSIDERATIONS: Effectiveness is predicated on the assumption that each patient is receiving an adequate daily intake of calcium; advise patients to have

dietary intake minimum of 600 mg daily; patients should be advised of compliance with dosage instructions and adherence to instructions about diet and calcium

supplementation; advise avoidance of the use of unapproved nonprescription drugs; carefully inform about S&S of 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 HPCLASSIFICATION: Analgesic

ACTION: Hydrocodone produces its analgesic activity by an action on the CNS via opiate receptors; analgesic reaction of acetaminophen is produced

by both peripheral and central mechanismsINDICATIONS: Relief of moderate to moderately severe pain

ROUTES OF ADMINISTRATION: Capsules, tablets, oral solutionUSUAL DOSAGE: For 5/500 products, the dose is 1 or 2 q 4-6 hr, up to 8

per day; for 5/325, 7.5/325, 10/325, and 7.5/400, the dose is 1 q 4-6 hr, up to 6 a day; for 7.5/500 and 7.5/650, the dose is 1 q 4-6 hr; for 7.5/750, the dose

is 1 q 4-6 hr, up to 5 per day; for 10/325, 10/400, 10/500, and 10/650, the dose is 1 q 4-6 hr, up to 6 per day; for 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 of paralytic ileus; CNS depressants, including other narcotic analgesics, antianxiety agents, antipsychotics, alcohol – additive CNS depression; MAO inhibitors/tricyclic antidepressants - ↑ effect of either the narcotic

or the antidepressant

CONTRAINDICATIONS: Hypersensitivity to acetaminophen or hydrocodone

NURSING CONSIDERATIONS: Note onset, location, characteristics of S&S, other agents, prescribed, outcome, if pain acute or chronic; rate pain increased; note history of hypothyroidism, BPH, urethral stricture, Addison’s disease, severe pulmonary disease,

head injury; monitor renal and LFT’s; avoid with dysfunction; take as directed; may take with food/milk to decrease GI upset; do not perform activities that require mental

alertness; causes dizziness, lethargy, and impaired physical and mental performance; report evidence of abnormal bruising/bleeding, breathing problems, N&V, constipation,

urinary difficulty, excessive sedation or lack of pain control; avoid alcohol and OTC agents or CNS depressants; for short term use only (VERY habit-forming)

GENERIC NAME: MEPERIDINE HYDROCHLORIDETRADE NAME: Demerol Hydrochloride, C-11

CLASSIFICATION: Narcotic analgesicACTION: One-tenth as potent an analgesic as morphine; analgesic effect is only one-

half when given PO rather than parenterally; has no antitussive effecrs and does not produce miosis; less smooth muscle spasm, constipation, and antitussive effect than

equianalgesic doses of morphine; produces both psychologic and physical dependence; overdosage causes severe respiratory depression

INDICATIONS: Analgesic for 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 of 1-5 mg per incremental dose (recommended lock-out interval is 6-10 min with a minimum of 5 min); Preoperatively IM, IV (adults) – 50-100 mg 30-90 min before

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 of anesthesia – IV infusion 1

mg/mL or slow IV injection 10 mg/mL until client needs met

ADVERSE REACTIONS: Constipation, dry mouth, N&V, anorexia, dizziness, fatigue, lightheadedness, muscle twitches, sweating, itching, decreased urination, decreased libido

INTERACTIONS: Antidepressants, tricyclic – additive anticholinergic side effects; Cimetidine - ↑ respiratory and CNS depression; Hydantoins - ↓ meperidine effect R/T ↑ liver breakdown; MAO inhibitors - ↑ risk of severe symptoms including hyperpyrexia, restlessness, hyper- or hypotension, convulsions, or coma; Protease inhibitors – avoid

combination; Sibutramine – possibility of life-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 before labor during pregnancy; use with sibutramine

NURSING CONSIDERATIONS: IM preferred over SC use in repeated doses; more effective when given parenterally than PO; take syrup with half glass of water to

minimize anesthetic effect on mucous membranes; take drug within ordered intervals to prevent pain recurring; report pain levels and lack of effectiveness; drug causes dizziness and drowsiness (do not engage in activities that require mental alertness); due to low BP

effects, rise slowly and do not change positions abruptly; increase fluid intake and bulk to avoid constipation; avoid alcohol and other CNS depressants.

GENERIC NAME: PROMETHAZINE HYDROCHLORIDE/CODEINETRADE NAME: Phenadoz, Phenergen

CLASSIFICATION: Antihistamine, first generation, phenothiazineACTION: Antiemetic effects are likely due to inhibition of the CTZ; effective in vertigo

by its central anticholinergic effect which inhibits the vestibular apparatus and the integrative vomiting center as well as the CTZ; may cause severe drowsiness; significant

anticholinergic and antiemetic effectsINDICATIONS: Prophylaxis and treatment of motion sickness; prophylaxis and control of N&V due to anesthesia or surgery; preoperative, postoperative, or obstetric sedation; relief of apprehension and production of light sleep; hypersensitivity reaction, including perennial and seasonal allergic rhinitis, vasomotor rhinitis, allergic conjunctivitis caused

by inhalant allergens and foods, mild uncomplicated allergic skin manifestations of urticaria and angioedema, allergic reactions to blood or plasma, dermographism, and

adjunctive anaphylactic therapy; adjunct to analgesics for 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 of 12-5-25 mg may be repeated

q 4-6 hr; (>2 yr) – 25 mg or 0.5 mg/lb

ADVERSE REACTIONS: Drowsiness, dizziness, confusion, blurred vision, dry mouth, tinnitus, N&V, photosensitivity

INTERACTIONS: Antidepressants, tricyclic – additive anticholinergic side effects; CNS depressants, antianxiety agents, barbiturates, narcotics, phenothiazines, procarbazine,

sedative-hypnotics – potentiation or addition of CNS depressant effects (concomitant use may lead to drowsiness, lethargy, stupor, respiratory depression, coma, and possibly

death); Heparin – antihistamines may ↓ the anticoagulant effectsCONTRAINDICATIONS: 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 of uncomplicated

vomiting in childrenNURSING CONSIDERATIONS: Do not confuse 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 food to decrease GI upset; avoid

activities that require mental alertness until drug side effects realized (may cause sedation); do nto consume alcohol, CNS depressants, or OTC agents unless provider

approved; consume adequate fluids to prevent dehydration (use caution in hot weather to prevent heat stroke); decrease dosage in dehydrated or oliguric clients

GENERIC NAME: PROPOXYPHENE NAPSYLATE AND ACETAMINOPHENTRADE 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 of propoxyphene is from two-thirds to equal that of codeine; acetaminophen may

cause analgesia by inhibiting CNS prostaglandin synthesis; however, due to minimal effects on peripheral prostaglandin synthesis, acetaminophen has no anti-inflammatory or uricosuric effects; decreases fever by (1) a hypothalamic effect leading to sweating and vasodilation and (2) inhibits the effect of pyrogens on the hypothalamic heat-regulating

centers.

INDICATIONS: Relief of mild to moderate pain, either when pain is present alone or when accompanied by fever

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, sedationINTERACTIONS: Anticonvulsants - ↑ anticonvulsant pharmacologic and toxic effects

R/T inhibition of metabolism; antidepressants - ↑ antidepressant pharmacologic and toxic effects R/T inhibition of metabolism; CNS depressants (including alcohol,

antidepressants, muscle relaxants, sedatives, tranquilizers) – additive CNS depression; warfarin - ↑ warfarin pharmacologic and toxic effects R/T inhibition of metabolism

CONTRAINDICATIONS: Hypersensitivity to propoxyphene or acetaminophen; use in those who are suicidal or addiction-prone; use in pregnancy unless until potential benefits

outweigh the possible risksNURSING CONSIDERATIONS: Consideration should be given to reducing the dose of propoxythene in geriatric clients and in those with renal or hepatic impairment; store from 15-30°C (59-86°F); list drugs prescribed to ensure none interact; note reasons for

therapy, location, characteristics of S&S, other agents trialed, outcome, and rate the pain level; assess for depression, suicide ideations, excessive alcohol use, drug addiction

prone, precludes drug use; monitor ROM, VS, renal, LFT’s; reduce dose with dysfunction; do not exceed prescribed dose; do not perform activities that require mental alertness until drug effects realized (may cause dizziness or drowsiness); avoid alcohol

and other CNS depressants during therapy; may cause dizziness, N&V (lie down and rest if these effects occur to relieve symptoms).

GENERIC NAME: LITHIUM CARBONATETRADE NAME: Eskalith CR, Lithobid, Lithonate, Lithotabs

CLASSIFICATION: AntimanicACTION: Mechanism for the antimanic effect of lithium is unknown; possibilities

include: (a) decrease in catecholamine neurotransmitter levels caused by lithium effect on Na+-K+ ATPase to improve transneuronal membrane transport of sodium ion; (b) decrease in cyclic AMP levels caused by lithium which decreases sensitivity of

hormonal-sensitive adenyl cyclase receptors: Affects the distribution of calcium, Mg, and sodium ions and affects glucose metabolism

INDICATIONS: Control of 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 of cluster headachesROUTES OF ADMINISTRATION: Capsules: 150 mg, 300 mg, 600 mg; Tablets: 300

mg; Extended Release Tablets: 300 mg, 450 mgUSUAL 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 of slow release forms; Maintenance: 300 mg 3-4 X daily; Administration of 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 discomfort

INTERACTIONS: Acetazolamide / urea / urinary alkanizers / mannitol- ↓ lithium effect by ↑ renal excretion; Bumetanide / ethacrynic acid / furosemide - ↑ lithium toxicity R/T ↓

renal clearance; Carbamazepine / phenytoin / probenecid - ↑ risk of lithium toxicity; Diazepam - ↑ risk of hypothermia; Haloperidol - ↑ risk of neurologic toxicity; NSAID’s -

↓ lithium clearance, possibly R/T inhibition of 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; facilities to monitor lithium are required: determine

blood levels 1-2 times weekly to prevent toxicity; full beneficial drug effects might not be noted for 6-10 days; drink 10-12 glasses of water per day to avoid dehydration; take with food or immediately after meals; avoid caffeinated drinks/foods (may aggravate mania);

report persistent diarrhea; may need supplemental fluids or salts

GENERIC NAME: OXYBUTYNIN

TRADE NAME: Ditropan, Ditropan XL, Urotrol

CLASSIFICATION: Antispasmodic in urinary tract

ACTION: Exerts direct antispasmodic effect on smooth muscle and inhibits action of acetylcholine at postganglionic cholinergic sites, thus decreasing bladder capacity and

delaying the initial desire to void by reducing the number of motor impulses reaching the detrusor muscle

INDICATIONS: Urologic disorders, irritative voiding, frequent 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 of sweat glands; allergic reaction; increased intraocular pressure; constipation, decreased sweating,

drowsiness; dryness of mouth, nose, and throat

INTERACTIONS: Anticholinergics/anticholinergic-like drugs / CNS depressants – may increase sedative effect of 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 food and milk to reduce gastric irritation; do not take more medication than the

amount prescribed; take as soon as possible if almost time for next dose, do not double dose of missed for extended amount of time; avoid use of alcohol or other CNS

depressants; possibly have an increased sensitivity to light; caution if blurred vision or drowsiness occurs; caution during exercise and hot weather (may cause heatstroke)

GENERIC NAME: PYRIDOXINE HYDROCHLORIDE (VITAMIN B6)

TRADE NAME: Pyridoxine HCl injection, Aminoxin, Vitelle Nestrex

CLASSIFICATION: Vitamin B6

ACTION: A water-soluble heat-resistant vitamin that is destroyed by light; acts as a coenzyme in the metabolism of protein, carbohydrates, and fat; as amount of protein

increases in diet, pyridoxine requirement increases; however, pyridoxine deficiency alone is rare

INDICATIONS: Pyridoxine deficiency including poor diet, drug-induced (ex. Oral contraceptives, isoniazid), and inborn errors of 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 for 2 weeks, then 2-5 mg/day as part of a multivitamin preparation for several weeks; High urine oxylate

levels: 25-300 mg/day; PMS: 40-500 mg/day; Tardive dyskinesia due to antipsychotic drugs: 100 mg/day for 4 weeks

ADVERSE REACTIONS: Paresthesia, numbness of feet, 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 effect of levadopa; Phenobarbital: ↓ serum phenobarbitol levels; Phenytoin: ↓ serum phenytoin levels

CONTRAINDICATIONS: None – special concerns with safety and effectiveness in children for doses that exceed RDA (not been established)

NURSING CONSIDERATIONS: Monitor uric acid levels, renal, LFTs; assess for dysfunction; best source of vitamins are with foods high in Vitamin B6, potatoes, broccoli,

lima beans, bananas, chicken breast, liver, yeast, wheat germ, whole-grain cereals; if prescribing levadopa, avoid vitamin supplements containing vitamin B6, 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 of certain chemicals in your body – like epinephrine – that affect the heart and blood vessels. Results in lowering of heartrate, BP and strain on the

heart.

INDICATIONS: Late or early MI, hypertension, angina, heart failure, 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 of 5 mg at 2 min intervals followed in 15 min by 50 mg PO every 6 hrs for 48 hrs, thereafter

100 mg PO bid

ADVERSE REACTIONS: Hypokalemia may develop is cases of brisk diuresis or severe cirrhosis, dizziness, lightheadedness, drowsiness, diarrhea, unusual dreams,

trouble sleeping, vision problems, cold hands, feet, 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 first degree, cardiogenic shock, overt cardiac failure. Hypersensitivity to related derivatives or to any of 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 function.

NURSING CONSIDERATIONS: Apical pulse rate should be taken for 1 minute, supine and standing BP should be taken, daily weight measurements are important. Take with or right after 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 RESINTRADE NAME: Questran, Questran Light, Cholestyramine Light, Prevalite

CLASSIFICATION: Antihyperlipidemic, bile acid sequestrantACTION: Binds sodium cholate (bile salts) in the intestine; thus the principal precursor

of cholesterol is not absorbed due to the formation of an insoluble complex, which is excreted in the feces; decreases cholesterol and LDL and either has no effect or increases triglycerides VLDL and HDL; also, itching is relieved as a result of removing irritating

bile salts; antidiarrheal effect results from binding and removal of bile acidsINDICATIONS: 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 of thyroid hormone overdose, treatment of chlordecone poisoning

ROUTES OF ADMINISTRATION: Powder for suspensionUSUAL DOSAGE: Adult: Initial: 4 grams 1-2 times per day; Maintenance: 2-4 packets

or scoopfuls 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 scoopfuls

ADVERSE REACTIONS: Constipation (may be severe), aggravation of hemorrhoids, abdominal pain, bloating, vomiting, diarrhea, weight loss, flatulence, infection

INTERACTIONS: Aspirin - ↓ aspirin absorption from the GI tract; Clindamycin - ↓ clindamycin absorption from 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 of bile duct

NURSING CONSIDERATIONS: Always mix powder with 60-180 mL water or noncarbonated beverage before administering; resin may cause esophageal irritation or blockage; do not take in dry form; avoid inhaling powder; may be irritating to mucous

membranes; allow powder to sit on top of beverage approx 2 min occasionally twirling to keep powder from sides and then stir slowly (prevents foaming); take other drugs 1 hour before or 4-6 hrs after Cholestyramine administration; assess skin and eyes for evidence of 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 function 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 of hydrochloric acid by forming sodium chloride and carbon dioxide; provides temporary relief of peptic ulcer pain and of

discomfort associated with indigestion; systemic and urinary alkalinizer by increasing plasma and urinary bicarbonate

INDICATIONS: Treatment of hyperacidity; severe diarrhea where there is loss of bicarbonate; alkalization of the urine to treat drug toxicity; treatment of acute mild to moderate metabolic acidosis due to shock, severe dehydration, anoxia, uncontrolled

diabetes, renal disease, cardiac arrest, extracorporeal circulation of blood, severe primary lactic acidosis; prophylaxis of 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 of 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 function, toxemia of pregnancy, with oligurea or anuria, during

lactation, in edema, CHF, liver cirrhosis and with low-salt diets

INTERACTIONS: Ephedrine - ↑ ephedrine effect by ↑ renal tubular reabsorption (many other drugs affected this way); iron products - ↓ iron effects R/T ↑ urine alkalinity (many

drugs affected this way also)

CONTRAINDICATIONS: Chloride loss due to vomiting or from 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 of sodium can be dangerous

NURSING CONSIDERATIONS: Hypertonic solutions must be administered by trained personnel; avoid extravasation as tissue irritation or cellulitis may occur; assess for

edema; administer isotonic solutions slowly; too rapid may result in death due to cellular acidity; in event of severe tetany or severe alkalosis, have sodium gluconate on hand; note reasons for therapy and history of renal impairment; chew tablets thoroughly and

take only as prescribed, and follow with glass of water, NOT with milk/yogurt

GENERIC NAME: AMIODARONE HYDROCHLORIDETRADE NAME: Cordarone, PaceroneCLASSIFICATION: Antiarrhythmic

ACTION: Blocks sodium channels at rapid pacing frequencies, causing an increase in the duration of the myocardial cell action potential and refractory period, as well as

alpha- and beta-adrenergic blockade; the drug decreases sinus rate, increases PR and QT intervals, results in development of U waves, and changes T-wave contour; after IV use, amiodarone relaxes vascular resistance (afterload), and increases cardiac index slightlyINDICATIONS: Use should be reserved for life-threatening ventricular arrhythmias unresponsive to other therapy, such as recurrent ventricular fibrillation and recurrent, hemodynamically unstable ventricular tachycardia; reserve IV use for acute treatment

until arrhythmias are stabilizedROUTES OF ADMINISTRATION: Injection: 50 mg/mL;tablets:100 mg,200 mg,400

mgUSUAL DOSAGE: Administer ONLY in the hospital due to side effects, unusual

properties, and difficult dosing schedule: Loading dose: 150 mg over first 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 for 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: After PO use, CHF, cardiac arrhythmias, malaise, fatigue, tremor, involuntary movements, poor coordination, peripheral neuropathy, paresthesias, photosensitivity, N&V, constipation, anorexia, pulmonary inflammation: After IV use,

hypotension, bradycardia, AV block, CHF, ventricular tachycardia, nausea, fever, injection site reactions

INTERACTIONS: MULTIPLE INTERACTIONS TOO MANY TO LIST – SEE BOOK

CONTRAINDICATIONS: Marked sinus bradycardia due to severe sinus node dysfunction, second- or third-degree AV block unless a functioning pacemaker is

available, cardiogenic shock, and when bradycardia has caused syncope except when used with a pacemaker; known hypersensitivity to the drug or any of its components,

including iodine; lactation; use in children is not recommendedNURSING CONSIDERATIONS: Drug is used to control heart beat irregularities, take as directed; assess respiratory status and lung sounds; note cardiac status, EKG and CV findings; monitor for hepatic and pulmonary toxicity; note baseline vitals and perfusion,

assess for circulatory impairment and hypotension; assess vision before therapy and monitor; monitor thyroid studies; may require replacement therapy with prolonged use;

during administration, observe for increased PR and QRS intervals, increased arrhythmias, and HR < 60 bpm

GENERIC NAME: ACIDOPHILUSTRADE NAME: Acidophilus, Acidophilus Extra Strength, Bacid, Flora-Q, Flora-Q 2,

SuperdophilusCLASSIFICATION: 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 of harmful bacteria; helps body maintain normal consistency of bacteria in the stomach, intestines,

vagina; helps maintain normal intestinal floraINDICATIONS: Diarrhea, electrolyte loss due to diarrhea, fluid loss via diarrhea, treat

or pre4vent vaginal yeast infections, yeast infections of mouth, UTI’sROUTES OF ADMINISTRATION: Tablets

USUAL DOSAGE: 230 mgADVERSE REACTIONS: Hives, difficulty breathing, swelling of the face, lips, tongue,

throat, other minimal side effectsINTERACTIONS: Possible interactions; too new to know; contact doctor for meds and

interactionsCONTRAINDICATIONS: Pregnancy, lactation, children

NURSING CONSIDERATIONS: Not FDA approved; all potential risks and/or advantages may not be known; should not be substituted for prescription medications

Generic name: ascorbic acidTrade name: Vitamin C, Ascorbate, ascorbyl palmitate, calcium ascorbate, sodium ascorbate, cevitamic acidClassification: Vitamin SupplementAction: Water-soluble vitamin, necessary to form collagen in bones, cartilage, muscle, and blood vessels, aids in absorption of ironIndications: Scurvy, common cold prevention, iron absorption enhancement, UTI during pregnancy, asthma, bleeding treatment, cancer prevention, ischemic heart diseaseRoutes: OralDosage: RDA 90 mg/day for males, 75 mg/day for females; upper limit should not exceed 2,000 mg/dayAdverse reactions: High doses associated with kidney stones, severe diarrhea, nausea, gastritis, rarely flushing, faintness, dizziness, fatigueInteractions: aspirin, effects lowered by barbiturates, oral estrogens / tetracycline antibiotics / nicotine products ↓ vit C effectsContraindications: NoneNursing considerations: Watch when taking with other vitamins and medications; check with doctor for 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 of serotonin; minimal effects on norepinephrine and dopamine reuptake

INDICATIONS: Major depressive disorder, including maintenance, as defined 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, if necessary, after a minimum of a week;

maintenance: 10 or 20 mg/day for up to 36 weeks after initial 8 weeks of treatment

ADVERSE REACTIONS: Nausea, dry mouth, increased sweating, dizziness, diarrhea, flu-like symptoms, fatigue, insomnia, somnolence, rhinitis, ejaculation disorder

INTERACTIONS: Cimetidine/Omeprazole - ↑ Escitopram AUC and t1/2 R/T possible inhibition of metabolism; MAO inhibitors – serious (may be fatal) reactions, including

hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes; Metoprolol - ↑ Metoprolol Cmax and AUC; Sumatriptan – potential for weakness,

hyperreflexia, 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 food; discontinuing escitalopram may cause symptoms, including dysphoric

mood, irritability, agitation, dizziness, sensory disturbances, anxiety, confusion, headache, lethargy, emotional lability, hypomania, or insomnia; gradual reduction

preferred over complete stop; note other prescribed drugs, avoid use within 14 days of MAOI use; take as directed; should not be taken with Celexa; use caution when operating

machinery or cars until drug effects known; avoid alcohol, OTC agents, or CNS depressants; use reliable birth control

GENERIC NAME: LANSOPRAZOLE

TRADE NAME: Prevacid, Prevacid IVCLASSIFICATION: Proton pump inhibitor

ACTION: Gastric acid (proton) pump inhibitor, blocks final step of acid production; suppresses gastric acid secretion by inhibition of the (H+, K+)-ATPase system located at

the secretory surface of the parietal cells in the stomachINDICATIONS: Short-term treatment (up to 4 weeks) for healing and symptomatic

relief of active duodenal ulcer (PO only); maintain healing with duodenal ulcer; short-term treatment (up to 8 weeks) for healing and symptomatic relief of benign gastric ulcer

ROUTES OF ADMINISTRATION: Capsules, delayed-release: 15 mg, 30 mg; granules for oral suspension, delayed release: 15 mg, 30 mg; tablets, orally disintegrating: 15 mg,

30 mgUSUAL DOSAGE: Treatment of duodenal ulcer (initial) – 15 mg once daily before

breakfast for 4 weeks (maintenance) – 15 mg once daily; treatment of gastric ulcer – 30 mg once daily up to 8 weeks; GERD – 30 mg once daily before meals up to 8 weeks and

if symptoms remain after 2 or more weeks, can up to 30 mg once daily; erosive esophagitis – 30 mg once daily before meals up to 8 weeks; if symptoms persist, may

continue for another 8 weeks

ADVERSE REACTIONS: Diarrhea, headache, N&V, constipation, rash

INTERACTIONS: Ampicillin - ↓ ampicillin effect R/T ↓ absorption; clarithromycin - ↑ lansoprazole AUC and peak plasma levels R/T inhibition of metabolism by CYP2C19;

Digoxin - ↓ digoxin effect R/T absorption; Iron salts - ↓ effect of iron salts R/T absorption; sucralfate – delayed absorption of 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; for those unable to swallow pills, open capsule and sprinkle on a spoon of applesauce; to give capsules in NG tube, open capsule and mix intact granules with 40 mL of apple juice and instill through NG tube into the stomach, flushing with additional apple juice to clear tube; store in tight

container protected from 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 effect likely due to inhibition of CNS neuronal uptake of

serotonin and to a lesser extent norepinephrine and dopamine; Results in increased levels of serotonin in synapses

INDICATIONS: Treatment of major depressive episodes as defined in the DSM-III (immediate-release) or DSM-IV (controlled-release); panic disorder with or without

agoraphobia; treatment of social anxiety disorder (social phobia) as defined in the DSM-IV; generalized anxiety disorder; up to 24 weeks for 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 ejaculationINTERACTIONS: Antiarrhythmics (type IC) – possible ↑ effect R/T ↓ liver breakdown;

Cimetidine - ↑ Paroxetine effect R/T ↓ liver breakdown; Digoxin – possible ↓ plasma levels; Phenobarbital – possible ↓ paroxetine effect R/T ↑ liver breakdown; Phenytoin –

possible ↓ paroxetine effect R/T ↑ liver breakdown and also ↓ phenytoin levelsCONTRAINDICATIONS: Lactation, use of alcohol, use during the first trimester of

pregnancy; concomitant use of thioridazine, use in children and adolescents less than 18 years of age with major depressive disorder due to increased risk of suicidal thoughts and

attemptsNURSING CONSIDERATIONS: Even though beneficial effects may be seen in 1-4 weeks, continue therapy as prescribed; effectiveness is maintained for up to 1 year with daily doses averaging 30 mg of immediate-release or 37.5 mg of controlled-release; if

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 for therapy, type, onset,

characteristics of S&S, other therapy trialed, and outcomes; may be given with or without food; monitor weight, vital signs, ECG, electrolytes, CBC, renal and LFT’s and note any

dysfunction

GENERIC NAME: HYDRALAZINE HYDROCHLORIDE

TRADE NAME: Apresoline

CLASSIFICATION: Oral hypertensive

ACTION: Major effects are on the cardiovascular system; hydralazine lowers blood pressure by exerting a peripheral vasodilating effect thru direct relaxation of vascular

smooth muscle; alters cellular calcium metabolism, interferes 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 four times daily for first 2-4 days, increase to 25 mg four times daily for balance of first week; for second and subsequent weeks, increase

dosage to 50 mg four 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, difficulty in

urination

INTERACTIONS: MAO inhibitors cannot be used with Hydralazine, higher plasma levels results when taken with food

CONTRAINDICATIONS: Hypersensitivity to hydralazine; coronary artery disease; mitral valvular rheumatic heart disease

NURSING CONSIDERATIONS: Watch for usage of hydralazine in patients with advanced renal damage; be aware that in hypertensive patients with normal kidneys, there

is evidence of increased renal blood flow and maintenance of glomerular filtration rate; watch Vital Signs. Check I and O, daily weights need to be checked; check for renal

output

GENERIC NAME: CLONIDINE HYDROCHLORIDETRADE NAME: Catapres, Catapres-TTS-1, -2, and -3, Duraclon

CLASSIFICATION: Antihypertensive, centrally-actingACTION: Stimulates alpha-adrenergic receptors of the CNS, resulting in

inhibition of the sympathetic vasomotor centers and decreased nerve impulses; bradycardia and a fall in both SBP and DBP occur; plasma renin levels are decreased while peripheral venous pressure remains unchangedINDICATIONS: Alone or with a diuretic or other hypertensives to treat mild to moderate hypertension; treat spasticity; Investigational – Alcohol

withdrawal, atrial fibrillation, attention deficit hyperactivity disorder; Epidural – with opiates for severe pain in cancer clients not relieved by

opiate analgesics alone; most effective for neuropathic painROUTES OF ADMINISTRATION: Tablets – 0.1 mg, 0.2 mg, 0.3 mg;

Injection – 0.1 mg/mL, 0.5 mg/mLUSUAL 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 effect; Beta-adrenergic blocking agents – paradoxical hypertension, also ↑ severity of rebound hypertension following clonidine

withdrawal; CNS depressants - ↑ CNS depressant effect; Levadopa - ↓ Levadopa effect; Mirtazapine – Loss of BP control → antagonism of α-2 adrenergic receptors; prazosin - ↓

Clonidine antihypertensive effect; Narcotic analgesic – potentiation of clonidine hypotensive effect; Tolazoline / tricyclic antidepressants – blocks antihypertensive effect;

Verapamil - ↑ risk of AV block and severe hypotensionCONTRAINDICATIONS: Epidurally, presence of an injection site infection, clients on anticoagulant therapy, in bleeding diathesis, administration above the C4 dermatome; for

obstetrics, postpartum, or perioperative pain

NURSING CONSIDERATIONS: Do not confuse Catapres with Cataflam or Combipres; do not confuse Clonidine with Klonopin; may take 2-3 days to achieve

effective blood levels; with severe hypertension, may require other antihypertensive drug therapy in addition to transdermal clonidine; if discontinuing drug, do so gradually over a

period of 2-4 days; identify reasons for therapy, onset, type of symptoms, and previous treatments; obtain CBC, liver and renal function studies; promote periodic eye exams;

note occupation – may interfere with ability to work

GENERIC NAME: EPOETIN ALFA RECOMBINANTTRADE NAME: Epogen, Procrit

CLASSIFICATION: Erythropoietin, human recombinantACTION: Made by recombinant DNA technology; it has the identical amino acid

sequence and same biologic effects as endogenous erythropoietin (which is normally synthesized in the kidney and stimulates RBC production); will stimulate RBC

productionINDICATIONS: Treatment of anemia associated with chronic renal failure in adults and children, including clients on dialysis (end-stage renal disease) or adults not on dialysis;

treatment of anemia in clients with nonmyeloid malignanciesROUTES OF ADMINISTRATION: Injection – 2000 units/mL, 3000 units/mL, 4000

units/mL, 10000 units/mL, 20000 units/mL, 40000 units/mLUSUAL DOSAGE: Different dosages for different reasons: IV or SC, initial – 50-100

units/kg three times per week (the rate of increase of hematocrit depends on both dosage and client variation; Maintenance – Individualize – 25 units/kg three times a week, doses

of 75-150 units/kg/week have maintained hematocrit of 36-38% for up to 6 months in non-dialysis clients NOTE: reduce dose if hemoglobin approaches 12 grams/dL or if

hemoglobin increases by more than 1 gram/dL in any 2 week period

ADVERSE REACTIONS: Hypertension, headache, fever, fatigue, N&V, diarrhea, edema, asthenia, respiratory congestion, cough, pyrexia, rash, SOB, insomnia, pruritus,

DVT (in surgery clients)

INTERACTIONS: No major interactionsCONTRAINDICATIONS: Uncontrolled hypertension; hypersensitivity to mammalian cell-derived products or to human albumin; use in chronic renal failure clients who need severe anemia corrected; to treat anemia in HIV-infected or cancer clients due to factors

such as iron or folate deficiencies, hemodialysis, or GI bleeding; anemic clients willing to donate autologous blood

NURSING CONSIDERATIONS: DO NOT give with any other drug solutions; at time of 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 discomfort at the SC site; individualize dose for each client; IV usually given as a bolus 3 times/week; during hemodialysis, may require increased anticoagulation with

heparin to prevent clotting of artificial kidney; determine hematocrit twice weekly; if 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: GLYBURIDETRADE NAME: Diaßeta, Glynase, PresTab, Micronase

CLASSIFICATION: Antidiabetic, oral; second generation sulfonylureaACTION: Lowers blood glucose by stimulating the release of insulin from functioning pancreatic beta cells and by increasing the sensitivity of peripheral tissues to insulin; has

a mild diuretic effectINDICATIONS: Diabetes mellitus; may be used with metformin when diet and

glyburide or diet and metformin alone do not provide adequate controlROUTES OF ADMINISTRATION: Tablets, micronized – 1.5 mg, 3 mg, 4.5 mg, 6 mg;

Tablets, nonmicronized – 1.25 mg, 2.5 mg, 5 mgUSUAL DOSAGE: Initial for adults (Nonmicronized) – 2.5 – 5 mg/day given with

breakfast (or first 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 sulfonylureas

should start with 1.25 mg/day; initial for adults (Micronized) – 1.5 – 3 mg/day given with breakfast (or first main meal); those sensitive to sulfonylureas 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 effect; Ciprofloxacin – potentiation of hypoglycemic effect

CONTRAINDICATIONS: Stress before and during surgery, ketosis, severe trauma, fever, infections, pregnancy, diabetes complicated by recurrent episodes of ketoacidosis

or coma; use in diabetics who can be controlled by diet alone

NURSING CONSIDERATIONS: Do not confuse glyburide with glipizide or Glucatrol; administer 30 minutes prior to meals; do not exceed 20 mg/day of nonmicrozized and 12 mg/day of micronized products; note reasons for 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 food to make energy; take as directed

with food; record finger sticks at various times (fasting, 1 – 2 hr after meals, before bedtime), continue regular daily exercise, lifestyle 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 CALCIUMTRADE NAME: Lipitor

CLASSIFICATION: Antihyperlipidemic, HMG-CoA reductase inhibitorACTION: Competitively inhibits HMG-CoA reductase; this enzyme catalyzes the early

rate-limiting step in the synthesis of cholesterol; cholesterol synthesis is inhibited/decreased; decreases cholesterol, triglycerides, VLDL, and LDL, and increases

HDLINDICATIONS: 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 familial and nonfamilial) and mixed dyslipidemia; adjunct to other lipid-lowering treatments to reduce total and LDL cholesterol in homozygous

familial hypercholesterolemiaROUTES OF ADMINISTRATION: Tablets – 10 mg, 20 mg, 40 mg, 80 mg

USUAL DOSAGE: Hypercholesterolemia – initial – 10-20 mg once daily (40 mg/day for those who require more than a 45% reduction in LD cholesterol); then a diose range

caof 10-80 mg once daily may be used (individualize therapy according to goal of therapy and response)

ADVERSE REACTIONS: Headache, infection, diarrhea, sinusitis, myalgia

INTERACTIONS: Antacids/Colestipol - ↓ Atorvastatin levels; Clarythromycin - ↑ Atorvastatin plasma levels; possibility of severe myopathy or rhabdomylosis; Digoxin - ↑ Digoxin levels after 80 mg atorvastatin R/T ↑ Digoxin absorption; Diltiazem - ↑ Plasma

atorvastatin levels → ↑ risk of myopathy; Eryhtromycin - ↑ Atorvastatin levels; possibility of severe myopathy or rhabdomyolysis; Nefazodone / Verapamil - ↑ risk of

myopathy

CONTRAINDICATIONS: Active liver disease or unexplained persistently high LFT’s; use with grapefruit juice; pregnancy, lactation

NURSING CONSIDERATIONS: Give as single dose at any time of the day, with or without food; determine lipid levels within 2-4 weeks, adjust dosage accordingly; for

additive effect, may be used with a bile acid binding resin; do not use atorvastatin with fibrates; Helps to lower blood cholesterol and fat levels, which have been proven to promote CAD; take at same time each day with or without food; continue dietary

restrictions of saturated fat and cholesterol, regular exercise, and weight loss in the overall goal of lowering cholesterol levels

GENERIC NAME: CLOPIDOGREL BISULFATETRADE NAME: Plavix

CLASSIFICATION: Antiplatelet Drug

ACTION: Inhibits platelet aggregation by inhibiting binding of adenosine diphosphate (ADP) to its platelet receptor and subsequent ADP-mediative activation of glycoprotein

GPIIb/IIIa complex; Effect on receptors is irreversible; thus platelets are affected for remainder of their lifespan; also inhibits platelet aggregation caused by agonists other

than ADP by blocking amplification of platelet activation by released ADP

INDICATIONS: Reduction of 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 tabletsUSUAL DOSAGE: Recent MI, stroke, or established peripheral arterial disease – 75 mg

once daily with or without food; 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, flu-like symptoms

INTERACTIONS: Aspirin - ↑ risk of life-threatening or major bleeding events in high-risk clients with recent ischemic stroke or TIAs; Atorvastatin – Inhibition of clopidogrel effects on platelet function R/T inhibition of metabolic conversion (by CYP3A4) of the prodrug clopidogrel to the active drug; Bupropion - ↑ Bupropion AUC and peak plasma

levels R/T inhibition of metabolism by CYP2B6 hydroxylation of bupropion; NSAIDs - ↑ risk of occult blood loss; Warfarin – Clopidrogrel prolongs bleeding time; safety of use

with warfarin not establishedCONTRAINDICATIONS: Lactation, active pathological bleeding such as peptic ulcer

or intracranial hemorrhageNURSING CONSIDERATIONS: Do not confuse Plavix with Pletal; dosage adjustment

not necessary for elderly clients or with renal disease; document atherosclerotic event (MI, stroke) or established peripheral arterial disease requiring therapy; assess for 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 food (food 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 of prescribed therapy

GENERIC NAME: METRONIDAZOLETRADE NAME: Flagyl IV, Flagyl, Flagyl 375, Flagyl ER, Metric 21, Protostat,

MetroCream, MetroGel, MetroLotion, NoritateCLASSIFICATION: Trichomonacide, amebicide

ACTION: Effective against anaerobic bacteria and protozoa; specifically inhibits growth of trichomonae and amoebae by binding to DNA, resulting in loss of helical structures, strand breakage, inhibition of nucleic acid synthesis, and cell death; the mechanism for its effectiveness in reducing the inflammatory lesions of acne rosacea is not known

INDICATIONS: Serious infections 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 for 5-10 days; pediatric – 35-50 mg/kg/day in three divided doses; (Helicobacter pylori) 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 infection, flu-like symptoms

INTERACTIONS: Barbiturates – Possible therapeutic failure of metronidazole R/T ↑ elimination; Busulfan - ↑ busulfan trough plasma levels (↑ risk of toxicity); Cimetidine - ↑ serum metronidazole levels R/T ↓ clearance; Disulfiram – Concurrent use may cause

confusion or acute psychosis; do not give metronidazole to clients who have taken disulfram within the past 2 weeks; Lithium - ↑ lithium levels and toxicity; ethanol –

possible disulfram-like reaction, including flushing, palpitations, tachycardia and N&VCONTRAINDICATIONS: Blood dyscrasias, active organic disease of the CNS, trichomoniasis during the first trimester of pregnancy, lactation; is carcinogenic in rodents; avoid unnecessary use; consumption of alcohol during use; topical use if

hypersensitive to parabens or other ingredients of the formulationNURSING CONSIDERATIONS: Reduce dose in those with hepatic disease; dosage

reduction possible in geriatric clients; drug has a high sodium content; take with food or milk to reduce GI upset; take ER tablets at least 1 hr before or 2 hrs after meals; report lack of response, any symptoms of CNS toxicity (uncoordinated movements/tremors, numbness, seizures, any unusual bruising/bleeding); do not perform tasks that require

mental alertness until drug effects are realized

GENERIC NAME: TRAMADOL HYDROCHLORIDETRADE NAME: Ultram, Ultram ER

CLASSIFICATION: Analgesic, centrally-actingACTION: A centrally acting analgesic not related chemically to opiates; precise

mechanism is not known; may bind to mu-opioid receptors and inhibit reuptake of norepinephrine and serotonin; analgesic effect only partially antagonized by antagonist

naloxone; causes significantly less respiratory depression than morphineINDICATIONS: Management of 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 for an extended amount of time

ROUTES OF ADMINISTRATION: Tablets – 50 mg; Tablets, extended-release – 100 mg, 200 mg, 300 mg

USUAL DOSAGE: Management of pain – individualize dose based on lowest effective dose – for those requiring rapid onset of analgesia, 50-100 mg q 4-6 hr, as needed but not

to exceed 400 mg/day; for moderate pain, 50 mg initially, may be adequate, and for severe pain, 100 mg is often more effective; for 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 of dig toxicity;

Cyclobenzaprine / MAO inhibitors / Promethazine / Tricyclic antidepressants - ↑ risk of seizures; Warfarin - ↑ 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 of allergy to codeine or opiates

NURSING CONSIDERATIONS: Do not confuse Ultram with Ultrase (pancreatic enzyme); Store from 15-30°C (59-86°F) in a tight container; take only as directed, may be taken without regard to food or meals; do not exceed prescribed doses of Tramadol;

store safely out of reach of children; do not perform activities that require mental alertness; drug may cause drowsiness and impair mental or physical performance; alcohol

may intensify drug effects; report lack of response; avoid CNS depressants

GENERIC NAME: ACETAMINOPHENTRADE NAME: Tylenol, Aspirin Free Anacin, Aspirin Free Pain Relief, Extra Strength

Tablets multiple other namesCLASSIFICATION: Non-narcotic analgesic

ACTION: Decreases fever by 1) a hypothalamic effect leading to sweating and vasodilation and 2) inhibits the effect of pyrogens on the hypothalamic heat-regulating

centers; may cause analgesia by inhibiting CNS prostaglandin synthesisINDICATIONS: Control of pain due to headache, earache, dysmenorrheal, arthralgia,

myalgia, musculoskeletal pain, arthritis, immunizations, teething, toncillectomy; to reduce fever in bacterial or viral infections; as a substitute for aspirin in upper GI disease,

aspirin allergy, bleeding disorders, clients on anticoagulant therapy, and gouty arthritisROUTES 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 someINTERACTIONS: Alcohol, Ethyl – Chronic use →↑ toxicity of larger therapeutic doses of acetaminophen; Barbiturates / Carbamazepine / Hydantoins / Isoniazid / Propanolol /

Sulfinpyrazone / Rifampin - ↑ potential of hepatotoxicity R/T ↑ liver breakdown of acetaminophen; Diuretics, loop - ↓ effect R/T ↓ renal prostaglandin excretion and ↓

plasma renin; NSAIDs - ↑ risk of hypertension in women; Propanolol - ↑ effect R/T ↓ liver breakdown

CONTRAINDICATIONS: Renal insufficiency, anemia; clients with cardiac or pulmonary disease are more susceptible to acetaminophen toxicity

NURSING CONSIDERATIONS: Do not combine products containing acetaminophen, many of which are OTC; read labels on all OTC products; take as directed with food or milk to decrease GI upset; report signs and symptoms of toxicity immediately (nausea, vomiting, abdominal pain, bluish coloration of nailbeds/skin, complaints of shortness of breath, weakness, headache, dizziness; report paleness, weakness, and heart beat skips

(signs and symptoms of hemolytic anemia); do not exceed 4 grams/24 hr period in adults and 75 mg/kg/day for children; do not take for more than 5 days for pain in children, 10

days for pain in adults, or more than 3 days for fever in adults or children without seeking a doctor; note reasons for therapy, prescribed dosage and expected outcomes

GENERIC NAME: DONEPEZIL HYDROCHLORIDE

TRADE NAME: Aricept, Aricept ODT

CLASSIFICATION: Treatment of Alzeihmer’s disease

ACTION: A decrease in cholinergic function may be the cause of Alzeihmer’s disease; Donezepil, a cholinesterase inhibitor, exerts effect by enhancing cholinergic function by

increasing levels of acetylcholine; no evidence that the drug alters the course of the underlying dementing process

INDICATIONS: Treatment o fmild to moderate dementia of the Alzeihmer’s type; is combined with memantine (Namanda) to lower the decline of mental and physical

function in Alzeihmer’s disease

ROUTES OF ADMINISTRATION: Tablets, oral disintegrating tablets

USUAL DOSAGE: 5 mg, 10 mg

ADVERSE REACTIONS: Anorexia, diarrhea, fatigue, insomnia, and muscle cramps, nausea, vomiting

INTERACTIONS: Anticholinergic drugs – the cholinesterase inhibitor activity of donepezil interferes with the activity of anticholinergics; Bethanichol – Synergistic

effects; NSAID’s - ↑ gastric acid secretion→ ↑ risk of active or occult bleeding; Succinylcholine - ↑ muscle relaxant effect

CONTRAINDICATIONS: Hypersensitivity to piperidine derivatives

NURSING CONSIDERATIONS: Do not confuse 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 food; drug does nto

cure disease, just alleviates symptoms or slow physical and mental progression of disease, especially when used with memantine; report adverse effects immediately, like

irregular pulse, dizzy spells, lack of response, worsening of symptoms; document onset/duration, other agents tried and their outcomes

GENERIC NAME: ESOMEPRAZOLE MAGNESIUMTRADE NAME: Nexium, Nexium IV

CLASSIFICATION: Proton pump inhibitorACTION: Suppresses the final step in gastric production by inhibiting the H+/K+-ATPase

in the gastric parietal cells; this decreases gastric acid secretionINDICATIONS: Short-term treatment (4-8 weeks) in the healing and symptomatic

resolution of diagnostically confirmed erosive esophagitis; an additional 4-8 week course may be instituted for those who have not healed; to maintain symptom resolution and healing of erosive esophagitis; Treatment of heartburn and other symptoms associated with GERD in adults; reduce occurrence of gastric ulcers associated with continuous

NSAID therapy in those at risk for developing gastric ulcersROUTES OF ADMINISTRATION: Delayed-release capsules, freeze-dried powder for

injectionUSUAL DOSAGE: Healing of erosive esophagitis – 20-40 mg once daily for 4-8 weeks

(might need an additional 4-8 weeks); Maintenance of healing of erosive esophagitis – 20 mg once daily; Symptomatic GERD – 20 mg once daily for 4 weeks (can go for another 4

weeks if needed)

ADVERSE REACTIONS: Headache, diarrhea, nausea, stomach pain, constipation, dry mouth

INTERACTIONS: Esomeprazole may interfere with the absorption of drugs where gastric pH is an important factor in bioavailability (EX digoxin, iron salts, ketoconazole)

CONTRAINDICATIONS: Known hypersensitivity to any component of the formulation or to any macrolide antibiotic; lactation

NURSING CONSIDERATIONS: Do not exceed dose of 20 mg daily in clients with severe hepatic dysfunction; take delayed-release capsules whole 1 hour before meals; if unable to swallow whole, can empty capsule onto one tablespoon of 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 for therapy, type, onset of symptoms, and characteristics of symptoms; list

other agents prescribed; if female, determine if pregnant

GENERIC NAME: INSULIN GLARGINE

TRADE NAME: LantusCLASSIFICATION: Insulin, rDNA origin

ACTION: Long-acting recombinant human insulin analog; differs from human insulin in that the amino acid asparagine is replaced by glycine and two arginines are added to the C-terminus of 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 profile over 24 hr with no pronounced peak

INDICATIONS: Once daily at bedtime for treatment of 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 of 10 units once daily at the same time each day, then adjust according to client need to a total

daily dose ranging from 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 / Sulfonamides - ↑ blood glucose lowering effect and susceptibility to hypoglycemia; Danazol / Diuretics / Isoniazid / Niacin / Somatropin - ↓ blood glucose lowering effect; Clonidine / Lithium salts – either potentiates or weakens blood-glucose lowering effect and susceptibility to

hypoglycemiaCONTRAINDICATIONS: IV use

NURSING CONSIDERATIONS: Do not confuse 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 of hypoglycemia; monitor / record blood sugar and assess for hypo/hyperglycemia; report any systemic rash, cough, or

dizziness; continue lifestyle changes and diabetic diet necessary to control blood sugar with diabetes; attend diabetes education classes with spouse and keep all follow up visits to evaluate blood sugar and blood pressure control, eye and foot exams, lower LDL and associated symptoms; use only if solution is clear and colorless with no visible particles;

syringes must not contain any other medicinal product or residue

GENERIC NAME: MEMANTINE HYDROCHLORIDETRADE NAME: Namenda

CLASSIFICATION: Drug for Alzheimer’s disease

ACTION: It is believed that the activation of N-methyl-D-aspartate (NMDA) receptors in the brain by glutamate, an excitory amino acid, contributes to the symptomatology of

Alzheimer’s disease; Memantine is believed to have low to moderate affinity as an antagonist for 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 of the Alzheimer’s type; when combined with donepezil (Aricept), the decline of mental and physical function 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

finally 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, confusion, 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 of both drugs

CONTRAINDICATIONS: Known hypersensitivity to memantine or any excipients in the formulation, including lactose monohydrates; conditions that raise urine pH may decrease the urinary elimination of memantine resulting in increased plasma levels;

severe renal impairment

NURSING CONSIDERATIONS: Note reasons for therapy, when diagnosed with Alzheimer’s disease and when treatment began; may take with or without food; with food

if GI upset occurs; drug is used in Alzheimer’s disease to improve level of cognitive functioning 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

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