Generic: metolazone Trade: Zaroxolyn

Pharmocologic: Thiazide diuretic Therapeutic: Antihypertensive/Diuretic

Dosage: PO (Adults): Hypertension—2.5– 5 mg/day; edema 5– 20 mg/day
ACTION: INDICATIONS:
Increases excretion of sodium and HTN, fluid retention (edema) in pt w/ CHF or
water by inhibiting sodium reabsorption nephrotic disorder
in the distal tubule. Promotes excretion CONTRAINDICATIONS:
of chloride, potassium, magnesium, and Severe liver disease, unable to pass urine, Using
bicarbonate. May produce arteriolar metolazone during pregnancy could cause side
dilation. effects in the newborn baby, such as blood cell
problems, or jaundice (yellowing of the skin or
SIDE EFFECTS: eyes). <18 years of age, sulfonamides allergy
Dizziness, drowsiness, depressed mood,
muscle or joint pain, numbness or tingly, NURSING CONSIDERATIONS:,
nausea, stomach pain, loss of appetite, Monitor for S/S of dehydration (thirst,
diarrhea, constipation, dehydration, weakness, muscle cramping, hypotension,
electrolyte imbalance, orthostatic tachycardia), Monitor BP, I&O, and daily
hypotension, digoxin toxicity, ED weight, and assess feet, legs, and sacral area
for edema daily. Instruct pt to change
positions slowly to avoid dizziness and falls,
LAB TEST CONSIDERATION: Instruct pt to take the last dose in the
Monitor electrolytes (especially potassium), afternoon to avoid nocturia, May cause ↑
blood glucose, BUN, and serum creatinine and serum cholesterol, LDL, and triglyceride
uric acid levels. concentrations.
 Generic: furosemide Brand: Lasix Pharmacologic: LOOP DIURETIC Therapeutic: Diuretics
PO (Adults): 20– 80 mg/day as a single dose initially, may repeat in 6– 8 hr dose by 20– 40 mg q 6– 8
hr until desired response.
MODE OF ACTION: INDICATIONS:
Inhibits NaCl reabsorption in the ascending Tx of edema due to CHF, hepatic or renal
loop of Henle, thereby ↑ the excretion of failure and HTN.
sodium & potassium. May have peripheral
vasodilatory effects. CONTRAINDICATIONS:
Allergy to sulfonamides/thiazides, anuria.
SIDE EFFECTS: Pregnancy Category C.
Electrolyte imbalances (primarily hypokalemia),
orthostatic hypotension, ototoxicity (usually NURSING CONSIDERATIONS:
reversible), dehydration, increased BUN, Instruct pt to change positions slowly, consume high
hyperglycemia, blood dyscrasias, BMS, K+ foods or prescribed K+ supplements ut dict, use
photosensitivity. Commonly ↓serum K+. May sunscreen. Watch EKG for arrhythmias, especially
↓serum NA, calcium, and magnesium with altered K+ levels. Instruct pt to take the last
concentrations. May also cause↑ BUN, serum dose in the afternoon to avoid nocturia. Monitor for
glucose, creatinine, and uric acid levels. S/S of dehydration (thirst, weakness, muscle
cramping, hypotension, tachycardia). Assess fluid
LAB TEST CONSIDERATIONS: status. Monitor daily weight, I&O, amount and
location of edema, lung sounds, skin turgor, and
Monitor electrolytes, renal/hepatic function, mucous membranes. Monitor BP and pulse before
glucose, and uric acid levels before and and during administration. Assess patient for tinnitus
periodically throughout therapy. and hearing loss. Assess patients receiving digoxin
for anorexia, nausea, vomiting, muscle cramps,
paresthesia, and confusion.
Generic: bumetanide Trade: Bumex Pharmacologic: Loop diuretics Therapeutic: Diuretics
Usual adult dosage: 0.2-5 mg/day Available: IM, PO, IV

MODE OF ACTION: INDICATIONS:

Inhibits NaCl reabsorption in the ascending Tx of edema due to CHF, hepatic or renal failure
loop of Henle, thereby increasing the & HTN. Unlabeled Use: Reversal of oliguria in
excretion of sodium and potassium. May preterm neonates.
have peripheral vasodilatory effects. CONTRAINDICATIONS:
Therapeutic Effects: Diuresis and Allergy to sulfonamides, anuria. Pregnancy
subsequent mobilization of excess fluid category C
(edema, pleural effusions).
NURSING CONSIDERATIONS:
SIDE EFFECTS: Instruct pt to change positions slowly, consume
Electrolyte imbalances (primarily hypokalemia), high K+ foods or prescribed K+ supplements ut
orthostatic hypotension, ototoxicity (usually dict, use sunscreen. Watch EKG for
reversible), dehydration, increased BUN, arrhythmias, especially with altered K+ levels.
hyperglycemia, blood dyscrasias, BMS, Instruct pt to take the last dose in the afternoon
photosensitivity, Steven Johnson syndrome to avoid nocturia. Monitor the blood pressure for
effectiveness, monitor I&O q shift and weight
daily. Monitor for S/S of dehydration (thirst,
LAB TEST CONSIDERATIONS: weakness, muscle cramping, hypotension,
Monitor electrolytes, renal and hepatic function, tachycardia). Advise pt w/ DM to monitor blood
glucose, and uric acid levels before and periodically glucose closely. Assess patient for tinnitus and
during therapy. May cause ↑NA, K+, calcium, and hearing loss. Assess patients receiving digoxin
magnesium concentrations. May also cause ↓BUN, for anorexia, nausea, vomiting, muscle cramps,
glucose, creatinine, and uric acid levels. paresthesia, and confusion.
Generic: amiloride Pharmacologic: Potassium-sparing diuretics Therapeutic: Diuretic
Usual dosage: 5-20 mg po/day

MODE OF ACTION: INDICATIONS:

Inhibition of sodium resorption in the kidney,
Primary hyperaldosteronism, mgmt. of edema
saving potassium and hydrogen ions.
associated w/ CHF, cirrhosis and nephrotic
Therapeutic Effects: Weak diuretic and syndrome. Mgmt of essential HTN. Tx hypokalemia
antihypertensive response (counteracts K+ loss caused by other diuretics).

SIDE EFFECTS: CONTRAINDICATIONS:

Hyperkalemia, agranulocytosis, muscle Kidney problems, unable to urinate, or
cramps dizziness, HA, gynecomastia hyperkalemia. Pregnancy category C.
(males), breast tenderness, deepening of
voice, increased hair growth (females),
NURSING CONSIDERATIONS:
hyponatremia. May cause ↑serum
magnesium, uric acid, BUN, creatinine, K+ Check BP before administration, Monitor for S/S
and urinary calcium excretion levels. May of dehydration (thirst, weakness, muscle
also cause ↓NA levels cramping, hypotension, tachycardia), Monitor
intake & output Q shift, Weigh pt QD, have the pt
LAB TEST CONSIDERATIONS: change positions slowly to avoid dizziness and
Evaluate K+ levels before and routinely falls, Instruct the pt to take the last dose in the
during therapy. Withhold drug and notify health afternoon to avoid nocturia, Monitor the BP for
care professional if patient becomes effectiveness, Monitor EKG for signs
hyperkalemic. Monitor BUN, serum creatinine, and hyperkalemia (tented T waves). Teach pt to avoid
electrolytes before and periodically during therapy. NACL substitutes and high K+ foods.
Generic: triamterene Brand: Dyrenium Pharmacologic: POTASSIUM-SPARING DIURETIC
Usual dose for Edema: 100 mg po Bid, Max. 300 mg/day HTN: 50-100 mg po daily

MODE OF ACTION: INDICATIONS:

Causes loss of NA bicarbonate and CA+ Primary hyperaldosteronism, mgmt. of edema
while saving K+ and hydrogen ions by associated w/ CHF, cirrhosis (ascites) and
antagonizing aldosterone. Blocks nephrotic syndrome. Mgmt of essential HTN
reabsorption of NA in the distal convoluted (off label use, including tx in peds). Tx
tubules and collecting ducts of the hypokalemia (counteracts K+ loss caused by
nephrons, while conserving K+. other diuretics).
CONTRAINDICATIONS:
SIDE EFFECTS: Kidney problems, anuria, severe hepatic disease.
Hyperkalemia, agranulocytosis, muscle US FDA pregnancy category: Not Assigned. This
cramps dizziness, HA, gynecomastia drug should be used during pregnancy only if the
(males), breast tenderness, deepening of benefit outweighs the risk.
voice, increased hair growth (females), NURSING CONSIDERATIONS:
hyponatremia Monitor for S/S of dehydration (thirst, weakness, muscle
LAB TEST CONSIDERATIONS: cramping, hypotension, tachycardia), Monitor intake &
output Q shift, Weigh pt QD, have the pt change
Evaluate K+ levels prior to and routinely positions slowly to avoid dizziness and falls, Instruct the
during therapy. Withhold drug and notify pt to take the last dose in the afternoon to avoid
health care professional if patient becomes nocturia, Monitor the BP for effectiveness, Monitor EKG
hyperkalemic. Monitor BUN, serum creatinine, for signs hyperkalemia (tented T waves). Teach pt to
and electrolytes prior to and periodically avoid NACL substitutes and high K+ foods. Monitor
during therapy. response of signs and symptoms of hypokalemia
(weakness, fatigue, ECG
changes, arrhythmias, polyuria, polydipsia).
Generic: enalapril Trade: Vasotec Pharmacologic: ACE I Therapeutic: Antihypertensive
Usual adult dose: 2.5-5 mg po daily, IV/0.625-1.25 mg q 6 hr

MODE OF ACTION: INDICATIONS:

Ace inhibitors block the conversion of HTN in adults and peds at least 1 month old, left
angiotensin I to the vasoconstrictor ventricular dysfunction, CHF, ↓ risk of MI, stroke,
angiotensin II diabetic neuropathy and new onset DM

SIDE EFFECTS: CONTRAINDICATIONS:

st
1 dose phenomena, hypotension, dry US FDA pregnancy category D
cough, HA, angina pectoris, insomnia,
tachycardia, taste disturbance, nausea, NURSING CONSIDERATIONS:
diarrhea, proteinuria, ED, Renal failure, Always ck BP prior to administration. Monitor
hyperkalemia, angioedema, drowsiness weight, I&O and assess patient routinely for
resolution of fluid overload (peripheral edema,
LAB TEST CONSIDERATIONS: rales/crackles, dyspnea, weight gain, jugular
Monitor renal function. May cause ↑ in venous distention).Advise pt to change position
BUN and creatinine. May cause slowly to minimize orthostatic hypertension.
hyperkalemia. Monitor CBC periodically Caution pt to avoid salt substitute or foods
during therapy in patients with collagen containing high levels of K+ or NA unless
vascular disease and/or renal disease. directed by HCP. Monitor BP, EKG, and pulse
May rarely cause slight↓ HGB/HCT and every 5-15 minutes for several hrs after
agranulocytosis. May cause ↑ AST, parenteral admin. Assess pt for signs of
ALT, alkaline phosphatase, and serum angioedema (swelling of face, extremities, eyes,
bilirubin. lips, tongue, difficulty in swallowing or breathing)
Generic: captopril Trade: Capoten Pharmacologic: ACE I Therapeutic: Antihypertensive
Dosage: 12.5-25 mg 2-3 times/day Max: 450 mg/day

MODE OF ACTION: INDICATIONS:

Ace inhibitors block the conversion of HTN, Left Ventricular Dysfunction after MI,
angiotensin I to the vasoconstrictor CHF, DM nephropathy
angiotensin II
CONTRAINDICATIONS:
SIDE EFFECTS: If pt has DM, do not use captopril together with any
1st dose phenomena, hypotension, dry medication. Do not administer captopril tablet within 36
cough, HA, angina pectoris, insomnia, hours of switching to or from sacubitril/valsartan, a
nepriltsin inhibitor that contains aliskiren (Amturnide,
tachycardia, taste disturbance, nausea, Tekturna, Tekamlo). Anuria, dialysis, severe liver
diarrhea, proteinuria, ED, hyperkalemia, disease. US FDA pregnancy category D.
angioedema, drowsiness, neutropenia
NURSING CONSIDERATIONS:
LAB TEST CONSIDERATIONS: Monitor weight, I&O and assess pt routinely for
Monitor renal function. May cause ↑ in BUN resolution of fluid overload (peripheral edema,
and serum creatinine. May cause rales/crackles, dyspnea, weight gain, jugular
hyperkalemia. Monitor CBC periodically
venous distention). Always ck BP prior to
during therapy in patients with collagen
administration. Monitor for signs angioedema.
vascular disease and/or renal disease. May
Advise pt to change position slowly to minimize
rarely cause slight ↓ hemoglobin and
hematocrit and agranulocytosis. May cause ↑
orthostatic hypertension. Caution pt to avoid
AST, ALT, alkaline phosphatase, and serum salt substitute or foods containing high levels of
bilirubin. K+ or NA unless directed by HCP. Advise
diabetic patients to monitor blood glucose
closely, especially during first month of therapy
Generic: valsartan Trade: Diovan Pharmacologic: ARB Therapeutic: ANTIHYPERTENSIVE
Usual adult Dose: 80-160 mg/day, Ped’s up to 2.7 mg/kg Max 160 mg

MODE OF ACTION: INDICATIONS:

Reduce vasoconstriction and lower peripheral HTN age 6 and older, heart failure, ↓ risk of
resistance. Prevents angiotensin II from binding death s/p MI
to angiotensin II receptors on the muscles
surrounding blood vessels. They also limit CONTRAINDICATIONS:
+DM, do not use valsartan together with any
aldosterone production and promote diuresis and medication that contains aliskiren (Amturnide,
↓ blood volume. Tekturna, Tekamlo, Valturna). US FDA pregnancy
SIDE EFFECTS: category D, High K+, CKD
HA, diarrhea, rash, fatigue, orthostatic
hypotension, drug induced hepatitis, NURSING CONSIDERATIONS:
hyperkalemia, renal failure, drowsiness, Give 1 hour before meals. Monitor BP
angioedema, rhabdomyolysis hourly after initial dose x 4 hours. For
subsequent doses, take BP before each
LAB CONSIDERATION’S: dose and Q 4 hours. Ck w/ HCP if SBP
<100. Instruct pt not to use salt substitutes.
Monitor renal function. May cause increase
Instruct pt to get up slowly to reduce risk of
in BUN/creatinine. May cause
falls. In prolonged use monitor EKG for
hyperkalemia. May cause ↑ AST/ALT. May
prolonged PR interval. Monitor I&O, daily
cause slight ↓ in HCT/HGB, or neutropenia.
weights. Assess signs CHF. Assess patients
May ↑level and may ↑the risk of lithium
for signs of angioedema (dyspnea, facial
toxicity.
swelling)
Generic: clonidine Trade: Catapres, Catapres-TTS Pharmacologic: Central Alpha Adrenergic
agonist Therapeutic: Antihypertensive Usual dose: PO 0.1-0.2 mg/day; TD 0.1-0.3/24 (Epidural avail)

MODE OF ACTION: INDICATIONS:

alpha2
. stimulation ↓ the sympathetic outflow Mild-moderate HTN >18 y/o, Mgmt opioid
from the brainstem to the heart and blood w/d (off label), Mgmt cancer pain
vessels. This results in a decrease in PVR unresponsive to opioids alone.
(peripheral vascular resistance) and a lower
BP (causing vasodilation) CONTRAINDICATIONS:
Risk of hypotension increased w/ epidural
injectable route. US FDA pregnancy category:
SIDE EFFECTS: C.
Dry mouth/eyes, sedation, ED, sleep NURSING CONSIDERATIONS:
disturbances, nightmares, fatigue, Caution pt to avoid hot baths and showers
bradycardia, hypotension, weight gain, Na because this worsens hypotension. Avoid
retention, dizziness, constipation excessive use of caffeinated beverages
(>4/day). Take the medication at HS to avoid
LAB TEST CONSIDERATIONS: daytime sleepiness. Caution pt that suddenly
May cause transient ↑in blood glucose D/C this medication will cause w/d sx’s.
levels. May cause ↓urinary catecholamine Suggest chewing gum or hard candies to
and vanillylmandelic acid (VMA) relieve mouth dryness. Caution pt that etoh
concentrations; these may ↑on abrupt will worsen sedation. Change TD patch Q7
withdrawal. days. Monitor I&O and daily weight. Assess
edema daily. Ck BP/Pulse prior to
administration. Regular monitoring RFT
Generic: diltiazem Brand: Cardizem, Cardizem LA, Cartia XT, Dilacor XR, Diltia XT, Tiazac
Pharmacological: CCB Therapeutic: Antihypertensive Usual dose: PO 30-120 mg 3-4 x’s /day
SR180-240 mg/day, LA up to 360 mg/day
MODE OF ACTION: INDICATIONS:
Inhibit the flow of extracellular calcium ions HTN, angina pectoris and Prinzmetals angina
across the cell membranes in cardiac and and arrythmia’s (SVT, RVR w/ afib/aflutter)
vascular tissue. This results in relaxation of
Helps increase esophageal motility.
arterial smooth muscle, vasodilatation, ↓
peripheral resistance, and a decreased heart
CONTRAINDICATIONS:
rate.
ADVERSE EFFECTS: Severe hypotension, SSS, AV block. Recent MI
Peripheral edema, flushed skin, HA, w/ fluid build up in lungs. US FDA pregnancy
dizziness, nausea, constipation, fatigue, category: Not assigned.
weakness, impotence, MI, hepatotoxicity, NURSING CONSIDERATIONS:
heart failure, confusion, bradycardia, Give before meals. Take BP/Pulse prior to
tachycardia, orthostatic hypotension administration. Delay the dose and notify HCP if:
*This med is also antianginal, antiarrhythmic heart rate <60, systolic BP <100. Monitor EKG, I&O,
agent (class IV)* and daily weight. Assess for signs of HF (peripheral
LAB TEST CONSIDERATIONS: edema, rales/crackles, dyspnea, weight gain,
Total serum CA concentrations are not affected by jugular venous distention). Monitor for s/s of digoxin
CCB. Monitor K+ periodically. Hypokalemia ↑the toxicity, if on. Instruct pt to “dangle” for a few
risk of arrhythmias and should be corrected. minutes before ambulating and to change positions
Monitor renal and hepatic functions periodically slowly. Advise pt to avoid activities requiring
during long-term therapy. May cause ↑in LFT after alertness until the effects of the drug are known.
several days of therapy, which return to normal Explain that stopping these drugs suddenly can
after stopping. ). Monitor RFT, CBC, serum result in serious reactions. Ck with HCP before
glucose, and Dig if on. taking any OTC cold or allergy meds. Avoid caffeine
 Generic: telmisartan Brand: Micardis Pharmacological: Angiotensin Receptor II Antagonist
(ARB) Therapeutic: Antihypertensive Usual dose: 40-80 mg/day
Usual dose: 40-80 mg / day
MODE OF ACTION: INDICATIONS:
HTN >18 year old, cardiovascular risk reduction
Keeps blood vessels from narrowing,
which lowers blood pressure and
CONTRAINDICATIONS:
improves blood flow. Blocks the
Bilateral renal artery stenosis, concurrent
vasoconstrictor and use with aliskiren in patients with diabetes or
aldosterone-secreting effects of moderate-to-severe renal impairment (CCr 60
angiotensin II at various receptor sites, mL/min), obstructive biliary disorders or hepatic
including vascular smooth muscle and impairment. Pregnancy category D
the adrenal glands.
SIDE EFFECTS:
Hypotension, dizziness, fatigue, NURSING CONSIDERATIONS:
angioedema, hyperkalemia Assess patients for signs of angioedema
(dyspnea, facial swelling). Caution pt to avoid
salt substitutes containing K+ or foods
containing ↑ levels of K+ or NA unless directed
LAB TEST CONSIDERATION'S: by HCP. Caution pt to avoid sudden changes in
Monitor renal function. May cause position to ↓ orthostatic hypotension. of etoh,
↑ BUN/creatinine. May cause standing for long periods, exercising, and hot
hyperkalemia. May ↑ digoxin weather may increase orthostatic hypotension.
Assess BP (lying, sitting, standing) and pulse
levels.
frequently during initial dose adjustment and
periodically during therapy.
Generic: clopidogrel Trade: Plavix Pharmacological: Platelet aggregation inhibitors
Therapeutic: Antiplatelet agent Usual Dose: 75 mg po daily ACS: Initially 200 mg po loading dose

MODE OF ACTION: INDICATIONS:

Reduction of atherosclerotic events (MI,
Inhibits platelet aggregation by stroke, vascular death) in patients at risk for
irreversibly inhibiting the binding of ATP such events including recent MI, acute
to platelet receptors. coronary syndrome (unstable
angina/non–Q-wave MI), stroke, or peripheral
vascular disease.
Therapeutic Effects: Decreased
occurrence of atherosclerotic events in CONTRAINDICATIONS:
Patients at risk for bleeding (trauma, surgery,
patients at risk. or other pathologic conditions); History of GI
SIDE EFFECTS: bleeding/ulcer disease

GI bleed, epitaxial, purpura, bleeding, NURSING CONSIDERATIONS:

abdominal pain Assess patient for symptoms of stroke,
peripheral vascular disease, or MI periodically
LAB TEST CONSIDERATIONS: during therapy. Monitor patient for signs of
Monitor bleeding time during therapy. thrombotic thrombolytic purpura
Prolonged bleeding time, which is time- and (thrombocytopenia, microangiopathic
hemolytic anemia, neurologic findings, renal
dose-dependent, is expected. Monitor CBC
dysfunction, fever). May rarely occur, even
with differential and platelet count periodically
after short exposure (<2 wk). Requires prompt
during therapy.
treatment.
Generic: quetiapine Trade: Seroquel Therapeutic: antipsychotics, mood stabilizers
Usual Dose: Max dose 750 mg in schizophrenia and 300 mg in depression

MODE OF ACTION: INDICATIONS:

Probably acts by serving as an antagonist of Schizophrenia, bipolar disorder (manic
dopamine and serotonin. Also antagonizes depressive), depression, agitation and
histamine H1 receptors and alpha1-adrenergic dementia.
receptors. CONTRAINDICATIONS:
Causes fetal toxicity, pregnancy
SIDE EFFECTS: category C
Neuroleptic malignant syndrome, hyperglycemia,
asthenia constipation, hypotension,
; drowsiness,
headache, increased serum cholesterol, increased NURSING CONSIDERATIONS:
serum triglycerides/LFT, xerostomia, Steven Monitor for tremors or other
Johnson syndrome. uncontrollable muscle movements.
Monitor for hypotension. Monitor mental
status (mood, orientation, behavior)
LAB TEST CONSIDERATIONS: before and periodically during therapy.
May cause ↑ in AST & ALT. May cause ↑ Assess for suicidal tendencies, especially
cholesterol/triglycerides. Obtain fasting blood during early therapy.
glucose and cholesterol levels initially and
throughout therapy. Monitor serum prolactin prior
to & periodically during therapy. May cause ↑
serum prolactin levels.
Generic: amlodipine Trade: Norvasc
Pharmacologic: CCB Therapeutic: Antihypertensive Usual dose: 2.5-10 mg PO tablet daily

MODE OF ACTION: INDICATIONS:

Inhibits the transport of calcium into myocardial Alone or with other agents in the mgmt. of
and vascular smooth muscle cells, resulting in hypertension, angina pectoris, and
inhibition of excitation-contraction coupling and vasospastic (Prinz metal's) angina.
subsequent contraction. Decreases myocardial
excitability
Therapeutic Effects: Systemic vasodilation
resulting in decreased BP. Coronary vasodilation
CONTRAINDICATIONS:
resulting in decreased frequency and severity of
attacks of angina. Pregnancy category: C Avoid large
amounts of grapefruit juice (6-8 glasses
SIDE EFFECTS:
daily)
Peripheral edema, HA, bradycardia, drowsiness, NURSING CONSIDERATIONS:
orthostatic hypotension. Dizziness, palpitations, Monitor BP/pulse during therapy, ck EKG
flushing, photosensitive to sunlight, BMS,
periodically with prolonged tx, Monitor I&O
antiarrhythmic agents can interfere with
electrolytes responsible for cardiac conduction, and daily wt. Assess for signs HF, serum
new arrythmias can occur and cause CHF. calcium concentrations are not affected by
CCB, instruct pt to call MD if heart rate <50,
LAB TEST CONSIDERATIONS: develop rash, joint pain/edema, change
CK CBC Q 2 weeks the 1st 3 months of therapy, positions slowly, maintain good dental
monitor ANA, LFT chemistries during prolonged
hygiene, caution to wear protective clothing &
therapy
sunscreen when outdoors
 Generic: Calcium Carbonate Therapeutic: Mineral and electrolyte replacement/supplements
Adult Dosage: 1– 2 g/day in 3– 4 divided doses Hypophosphatemia mgmt: 1 g with each meal,
increase to 4– 7 g
as needed MODE OF ACTION: INDICATIONS:
Essential for nervous, muscular, and skeletal
Tx & prevention of hypocalcemia. Adjunct in
systems. Maintain cell membrane and capillary
the prevention of postmenopausal
permeability. Act as an activator in the transmission
osteoporosis. Relief of acid indigestion or
of nerve impulses and contraction of cardiac,
heartburn. Treatment of hyperphosphatemia in
skeletal, and smooth muscle. Essential for bone
esrd.
formation and blood coagulation. CONTRAINDICATIONS:
Therapeutic Effects: Replacement of calcium in
deficiency states. Control of hyperphosphatemia in Hypercalcemia, renal calculi, ventricular
end-stage renal disease without promoting fibrillation
aluminum absorption.
NURSING CONSIDERATIONS:
SIDE EFFECTS: Monitor for n/v, thirst, severe constipation,
HA, Arrythmias, bradycardia, constipation, paralytic ileus (signs toxicity) Advise pt
renal calculi, toxicity that exercise has been found to reverse
bone loss. Encourage pt to maintain diet
DRUG TEST CONSIDERATIONS: high in vitamin D. Increase bulk in diet,
Monitor calcium or ionized calcium, chloride,
fluid intake and mobility to decrease risk
sodium, potassium, magnesium, albumin, and PTH
concentrations before and periodically during constipation
therapy for treatment of hypocalcemia. When used
to treat hyperphosphatemia in renal failure patients,
monitor phosphate levels.
Generic: Aldactone Brand: Spironolactone Pharmacologic: POTASSIUM SPARING
Therapeutic: DIURETIC/ANTIHYPERTENSIVES Usual dose: 25-400 mg po daily

MODE OF ACTION: INDICATIONS:

Causes excretion of sodium and reduce Mgmt of primary aldosteronism, mgmt. of
excretion of potassium. Loss of NA bicarb edema associated w/ CHF, cirrhosis and
and CA+ while saving K+ and hydrogen ions. nephrotic syndrome. Mgmt of essential HTN.
By antagonizing aldosterone. Blocks TX of hypokalemia (counteracts K+ loss
reabsorption NA is distal convoluted tubules caused by other diuretics).
and collecting ducts of the nephrons, while
conserving K+. CONTRAINDICATIONS:
Anuria, ARF, Pregnancy Category C
SIDE EFFECTS:
Hyperkalemia, hypotension, dizziness, NURSING CONSIDERATIONS:
hyponatremia, gynecomastia (men),
Always ck BP before administration, Monitor
increased hair growth, breast tenderness,
for S/S of dehydration (thirst, weakness,
agranulocytosis, muscle cramps,
muscle cramping, hypotension, tachycardia),
dehydration
Monitor intake & output Q shift, Weigh pt QD,
LAB TEST CONSIDERATIONS: have the pt change positions slowly to avoid
Monitor electrolytes, especially K+. dizziness and falls, Instruct the pt to take the
last dose in the afternoon to avoid nocturia,
Monitor the BP for effectiveness, Monitor
EKG for signs hyperkalemia (tented T waves)
Generic: hydrochlorothiazide Trade: Microzide, Oretic Pharmacologic: Thiazide diuretic
Therapeutic: Antihypertensive Usual dose: 12.5-100 mg DAILY

MODE OF ACTION: INDICATIONS:

Inhibits sodium reabsorption and increases Mgmt mild-moderate HTN, tx edema
potassium loss. Increase excretion NA and associated w/ CHF, renal dysfunction, cirrhosis,
H2O by inhabitation reabsorption NA is corticosteroid therapy and estrogen therapy.
distal tubule. Promotes excretion K+, Mg CONTRAINDICATIONS:
and HCO3. May produce arteriolar dilation.
Allergy to sulfonamides. Pregnancy
Category B
SIDE EFFECTS: NURSING CONSIDERATIONS:
Dehydration, Electrolyte imbalance Watch EKG for sign arrythmia, Monitor for S/S
(hypokalemia), Orthostatic hypotension, of dehydration (thirst, weakness, muscle
Digoxin toxicity, ED, fatigue, cramping, hypotension, tachycardia), Monitor
hyperglycemia, BMS intake & output every shift, Weigh pt QD,
Instruct the pt to change positions slowly to
LAB TEST CONSIDERATIONS: avoid dizziness/falls, Instruct the pt to take the
Monitor electrolytes, especially last dose in the afternoon to avoid nocturia,
potassium. Always ck K+ prior to Monitor the BP for effectiveness, teach pt to
administration, monitor CBC, monitor consume K+ foods, use sunscreen
dig level (low k+ causes digoxin toxicity),
monitor LFT, amylase, lipase
Generic: metoprolol succinate/tartrate Trade: Lopressor, Toprol XL Pharmacologic: BB
Therapeutic: Antianginal, Antihypertensive Usual Dose: 25-100 mg po / day

MODE OF ACTION: INDICATIONS:

Blocks response to beta-adrenergic
Early treatment of acute MI, HTN, Angina, CHF,
stimulation. Cardio selective for beta-1 at
migraine HA, AFIB, Aflutter, anxiety
low does with little or no effect on beta-2
CONTRAINDICATIONS:
receptor
Hx asthma, COPD, Bronchospasm, heart block,
SIDE EFFECTS:
SSS, US FDA pregnancy category: C
ED, bradycardia, decreased exercise NURSING CONSIDERATIONS:
tolerance, fatigue, may induce CHF, Assess BP and HR prior to administration,
hypotension, bronchospasm, adventitious Assess for orthostatic hypotension, teach pts to
BS, diarrhea, dizziness, can rebound HTN, change position slowly/dangle extremities,
sensitivity to cold, decreased libido, Steven Delay dose & notify the HCP if the systolic BP is
Johnson syndrome, anaphylaxis, can <90 or the apical rate is <60, Give w/ meals or
induce MI w/ abrupt w/d, palpitations directly after, assess BS for wheezing/crackles,
advise pt to avoid substances such as
LAB TEST CONSIDERATIONS: caffeine-containing beverages and OTC cold
remedies (interferes with this medication),
instruct pt to report weight gain of >3 lbs in a
day or 5 lbs in a wk, Warn against sudden
cessation of this medication because this can
cause rebound htn, S/S’s of rebound effect:
severe ha, palpitations, trembling, sweating &
chest pain
 Generic: lisinopril Trade: Zestril, Prinivil Pharmacologic: ACE I
Therapeutic: Antihypertensive Usual Adult Dose: 10 mg once daily, can be ↑up to 20– 40 mg/day

MODE OF ACTION: INDICATIONS:

Block the action of ACE. As a result, They are considered the “first drug of choice” for
angiotensin II can’t form, which prevents patients with HTN because they don’t increase the
systemic and renal vasoconstriction and the heart rate. Left Ventricular Dysfunction, Improves
release of aldosterone. sx’s CHF, protect renal in DM pt, ↓risk of MI/CVA
diabetic neuropathy and new onset DM
ADVERSE EFFECTS: CONTRAINDICATIONS:
dry, hacking cough, first-dose syncope – Pregnancy category D (Don’t use in pregnancy!)
severe hypotension and fainting within 1-4 Should not be used with potassium sparing diuretics
hrs after the initial dose or after a significant (hyperkalemia)
increase in dose, taste disturbances, NURSING CONSIDERATIONS:
electrolyte disturbances, ED, drowsiness, Give 1 hour before meals, monitor BP hourly after
fatigue, HA, rash, diarrhea initial dose x 4 hours, for subsequent doses, take
BP before each dose and every 4 hours, check with
LAB TEST CONSIDERATIONS:
Monitor BUN, creatinine, and electrolyte health care provider if SBP <100, Instruct the pt to
lie down for 3-4 hours after the first dose. Caution pt
levels periodically.
to avoid activities requiring alertness until his
reaction is known. Instruct the pt to avoid
substances that interfere with ACE-I – coffee, tea,
cola, OTC cold meds, Inform pt that the cough will
go away after the meds are discontinued, Caution pt
to avoid NACL substitute or foods containing high
levels of K+ or NA unless directed by HCP.
 Generic: bisoprolol Trade: Monocor, Zebeta Pharmocologic: BB
Therapeutic: Antihypertensive Usual adult dose: Start 5 mg, max daily dose 20 mg

MODE OF ACTION: INDICATIONS:

Block the action of the sympathetic nervous Management of hypertension
systems catecholamines (epinephrine and
norepinephrine) on cardiac receptors. This CONTRAINDICATIONS:
AV block, severe HF, bradycardia, do not give to
results in slower heart rate, reduced clients with COPD/Asthma/Bronchospasm. US
contractility of the heart muscle, and FDA pregnancy category: C
vasodilation of the arterioles, with reduction
of PVR and BP. NURSING CONSIDERATIONS:
Have call bell within reach and assist w/
SIDE EFFECTS: ambulation, monitor BG q6h, assess BP and
Fatigue, weakness, bradycardia, pulmonary edema,
heart rate prior to administration, assess for
ED, insomnia hypo/hyperglycemia, difficulty
orthostatic hypotension, teach pt to change
physical exertion, sensitivity to cold. Rebound HTN
if d/c suddenly (severe HA, palpitations, trembling,
position slowly, delay dose and notify the MD if
sweating and chest pn) hypotension, the systolic BP is <90 or the apical rate is <60,
bronchospasm, and may induce CHF in susceptible give with meals or directly after, assess breath
pt sounds for wheezing and crackles, teach the pt
LAB TEST CONSIDERATIONS: to avoid substances such as caffeine-containing
May cause increased BUN, serum beverages and OTC cold remedies (interferes
lipoprotein, potassium, with this medication), instruct the pt to report
weight gain of >3 lbs in a day or 5 lbs in a week
triglyceride, and uric acid levels. May cause
(edema), warn the pt against sudden cessation
increased ANA titers. May cause increase in
of this medication.
blood glucose levels
 Generic: olmesartan Brand: Benicar Pharmacologic: ARB Therapeutic: Antihypertensive
Usual Dose: 20-40 mg once daily

MODE OF ACTION: INDICATIONS:

Prevents angiotensin II from binding to HTN, TX of diabetic neuropathy in pts w/ DM
angiotensin II receptor site. Also limit type II, prevention CVA, renal Impairment,
aldosterone production and promote diuresis hepatic Impairment, may help prevent
and decreased blood volume. Reduces migraine headaches
vasoconstriction and decrease peripheral
CONTRAINDICATIONS:
resistance
Not as effective in African Americans unless
SIDE EFFECTS: taken with another drug. US FDA pregnancy
Orthostatic HTN, angioedema, category: D
HA, fatigue, insomnia, weakness, rash,
NURSING CONSIDERATIONS:
diarrhea
Ck pts BP before and 2 hrs after
LAB TEST CONSIDERATION: administration. Assess pt for signs of
Monitor renal function. May cause ↑ BUN and
Angioedema (dyspnea, facial swelling).
serum creatinine. May cause hyperkalemia.
Advise pt to change position slowly to
Monitor CBC periodically during therapy in
minimize orthostatic hypertension. Caution pt
patients with collagen vascular disease
and/or renal disease. May rarely cause slight ↓ to avoid salt substitute or foods containing
in hemoglobin as well as leukopenia high levels of K+ or NA unless directed by
and eosinophilia. May cause ↑AST, ALT, alkaline MD. Check with health care provider if
phosphatase, serum bilirubin, uric acid, and systolic BP < 100
glucose.
Generic: benazepril Trade: Lotensin Pharmacologic: ACE I Therapeutic: Antihypertensive
Usual Adult Dose: 10 mg PO /day. May increase to 20-40 mg daily

MODE OF ACTION: INDICATIONS:

Blocks the action of ACE. As a result,
Alone or with other agents in the mgmt of
angiotensin II can’t form, which prevents
hypertension.
systemic and renal vasoconstriction and
the release of aldosterone. CONTRAINDICATIONS:
Pregnancy category D (Don’t use in pregnancy!)
SIDE EFFECTS: Should not be used with potassium sparing
Dry, hacking cough, 1st dose syncope – diuretics (hyperkalemia)
severe hypotension and fainting w/i 1-4 NURSING CONSIDERATIONS:
hrs after the initial dose or after a Give 1 hour before meals, monitor BP hourly
significant ↑ in dose, hyperkalemia, up to 4hrs after initial dose. For subsequent
angioedema, impaired renal fxn doses, take BP before each dose and every 4
LAB TEST CONSIDERATIONS: hours. Instruct pt to lie down for 3-4 hours
after the first dose. Caution pt to avoid
Monitor renal function. May cause ↑ BUN activities requiring alertness until rxn is
and serum creatinine, monitor K+, known. Instruct pt to avoid substances that
periodically ck CBC in pt w/ dx collagen interfere with ACE inhibitors – coffee, tea,
vascular disease and/or renal disease. cola, OTC cold meds. Inform the client that
the cough will go away after the meds are
D/C.
 Generic: atenolol Trade: Tenormin Therapeutic: antianginals, antihypertensives
Pharmacologic: CARDIO SELECTIVE BB Usual Dose: 25-100 mg po /24 hr

MODE OF ACTION: INDICATIONS:

Blocks stimulation of beta1 HTN, Angina, ↓risk of death s/p MI
(myocardial)-adrenergic receptors. Does not CONTRAINDICATIONS:
usually affect beta2(pulmonary, vascular, AV block, bradycardia, caution in use w/ CCB.
uterine)-receptor sites. Therapeutic Asthma/COPD/Bronchospasm. Pregnancy
Effects: Decreased BP and heart rate. Category D.
Decreased frequency of attacks of angina NURSING CONSIDERATIONS:
pectoris. Prevention of MI. Assess frequency and characteristics of angina
ADVERSE EFFECTS: periodically throughout therapy. Monitor
ED, fatigue, bradycardia, worsening CHF, input/output. Assess breath sounds for wheezing
bronchospasm, hypotension, and crackles. CK VS prior to administration.
Contact MD if SBP <100 or pulse <60. Teach pt
hyper/hypoglycemia, drug induced lupus
to get OOB slowly, report weight gain of >3 lbs
syndrome, insomnia, confusion. Serious
in a day or 5 lbs in a week. Warn pt not to
side effect- MI with abrupt withdrawal
suddenly d/c medication (risk of rebound effect)
LAB TEST CONSIDERATIONS: Teach the client to avoid substances that
May cause ↑ BUN, serum lipoprotein, interfere with the BB’s such as
potassium, triglyceride, and uric acid levels. caffeine-containing beverages and OTC cold
May cause ↑ ANA titers and alter BG. remedies. Monitor patients receiving beta
blockers for signs of OD (bradycardia, severe
dizziness or fainting, severe drowsiness,
dyspnea, bluish fingernails or palms, seizures).
Generic: atorvastatin Brand: Lipitor Pharmacologic: HMG COA REDUCTASE
INHIBITOR/STATIN Therapeutic: Lipid lowering Usual Dose: 10 -80 mg po QHS

MODE OF ACTION: INDICATIONS:

Reduces levels of "bad" cholesterol
High cholesterol, and to lower the risk of
(low-density lipoprotein, or LDL) and
stroke, heart attack, or other heart
triglycerides in the blood, while increasing
complications in people with type DM, CAD,
levels of "good" cholesterol (high-density
or other risk factors.
lipoprotein, or HDL). Inhibits HMG coA
reductase, an enzyme responsible for
CONTRAINDICATIONS:
catalyzing an early step in the synthesis of Avoid in pregnancy or breast feeding:
cholesterol. Children 10 yr (safety not established).
SIDE EFFECTS:
PMR
Rhabdomyolysis (breakdown of skeletal NURSING CONSIDERATIONS:
muscle tissue, leading to kidney failure), Monitor for unexplained muscle pain,
liver damage, joint pain, myalgias, tenderness, or weakness especially if you
myositis, angioneurotic edema also have fever, unusual tiredness, and dark
colored urine check CPK if c/o myalgia. Limit
LAB TEST CONSIDERATIONS: ETOH to max 2 drinks per day. Avoid drinking
Evaluate serum cholesterol and triglyceride more than 1 quart of grapefruit juice per day
levels before initiating, after 2– 4 wk of during therapy.
therapy, and periodically thereafter. Monitor
LFT prior to initiation of therapy and as
clinically indicated. Ck CPK if +myalgias
Melissa Ingram
Generic: amiodarone Trade: Codarone, Pacerone Pharmocologic: ANTIARRTHYTHMICS III
Usual dose: 2oomg daily Maintenance dose: 200-400 mg daily IV availible

MODE OF ACTION: INDICATIONS:

Prolongs action potential and refractory period. SVT
Inhibits adrenergic stimulation.
Slows the sinus rate, increases PR and QT
intervals, and decreases peripheral vascular CONTRAINDICATIONS:
resistance (vasodilation) Pregnancy Category: D
Therapeutic Effects: Suppression of arrhythmias

ADVERSE EFFECTS: NURSING CONSIDERATIONS:

Hypotension, pulmonary toxicity, neurotoxicity, Asses for pulmonary toxicity (rales/crackles,
tachycardia, asymptomatic ↑ANA titer, thyroid ↓BS, friction rub. Fatigue, cough, pleuntic
dysfunction, decreased vision, blindness, diffuse pain etc.., assist pt with ambulation to avoid
interstitial changes or alveolar infiltrates, CHF, falls, need eye exam regularly and
worsening arrythmia, ARDS, pulmonary fibrosis, whenever visual changes. CXR/PFT prior
hepatomegaly, bluish discoloration of the face, to starting and CXR Q 3-6 months during
neck, and arms therapy. CK BP frequently. Teach client to
LAB TEST CONSIDERATIONS: report unrelieved chest pain. Instruct male
Monitor AST, ALT, alkaline phosphatase at patients to notify health care professional if
regular intervals during therapy. Monitor signs of epididymitis (pain and swelling in
potassium, calcium, and magnesium prior to scrotum) occur.
starting and periodically during therapy.
Melissa Ingram
Generic: propranolol Brand: Inderal Pharmacologic: B-BLOCKERS Usual dose:
40 mg twice daily initially , up to 1 G per day IV (Adults): Antiarrhythmic 1– 3 mg; may be repeated after 2 min and
again in 4 hr prn
MODE OF ACTION: INDICATIONS:
Mgmt of HTN, angina, arrhythmias, hypertrophic
Blocks stimulation of beta1(myocardial) and
cardiomyopathy, thyrotoxicosis, essential tremors,
beta2 (pulmonary, vascular, and
pheochromocytoma. Mgmt of MI, & t prevention of
uterine)-adrenergic receptor sites; it’s
vascular HA. Proliferating infantile hemangioma
mechanism for the treatment of infantile
requiring systemic therapy (Hemangeol only).
hemangiomasis unknown. Therapeutic
Unlabeled Use: Also used to manage ETOH W/D,
Effects: Decreased heart rate and BP.
aggressive behavior,antipsychotic-associated
Suppression of arrhythmias. Prevention of
akathisia, situational anxiety, and esophageal
MI. Hemangioma resolution.
varices. PTSD (ongoing clinical trials)
SIDE EFFECTS:
CONTRAINDICATIONS:
May alter the effectiveness of insulin or oral
Pregnancy Category C
hypoglycemics(dose adjustments may be
necessary). May ↓ effectiveness of
NURSING CONSIDERATIONS:
beta-adrenergic bronchodilators and Monitor patients receiving beta blockers for signs of
theophylline OD (bradycardia, severe dizziness or fainting,
severe drowsiness, dyspnea, bluish fingernails or
LAB TEST CONSIDERATIONS:
May cause ↑ BUN, serum lipoprotein, k+, palms, seizures). Notify HCP ASP if these signs
occur. PO: Take apical pulse prior to administering.
triglyceride, and uric acid levels. May cause ↑
If 50 bpm or if arrhythmia occurs, withhold
ANA titers. May cause ↑ or ↓in blood glucose
medication and notify physician or other health
levels. In labile diabetic patients,
care professional. Abrupt withdrawal.
hypoglycemia may be accompanied by
precipitous ↑ of BP
Generic: prazosin Trade: Minipress Pharmacological: Peripherally acting antiadrenergic
Usual Dosage HTN: Adult 1 mg 2-3/day x 3 d. Then max 6-15 mg 2-3x/d

MODE OF ACTION: INDICATIONS:

Mild to moderate hypertension (peds ok)
Action: Dilates both arteries and veins by
Unlabeled Use: Management of urinary outflow
blocking postsynaptic alpha1-adrenergic
obstruction in patients with benign prostatic
receptors.
hyperplasia.
Therapeutic Effects: Lowering of BP. CONTRAINDICATIONS:
Pregnancy Category C. Use cautiously in renal
SIDE EFFECTS: insufficiency, pt’s undergoing cataract sx(↑risk
st of intraoperative floppy iris syndrome)
1 dose orthostatic hypotension, sexual
dysfunction, palpitation, weakness, HA
NURSING CONSIDERATIONS:
LAB TEST CONSIDERATIONS: R/o prostatic ca before therapy; sx’s are similar.
Teach pt to dangle before standing & to change
position slowly to prevent low BP. S/e of
vasodilators and adrenergic inhibitors can be
reduced by taking the medications in the
evening. BP is lowest during the night & highest
shortly after awakening. Avoid hot baths, etoh,
and strenuous exercise within 3 hours of meds.
Monitor BP & pulse frequently during initial
dosage adjustment & periodically throughout
therapy.
 Generic: doxazosin Brand : Cardura, Cardura XL Pharmacologic: Peripherally acting
antiadrenergic Usual Dosage: PO (Adults): 1 mg QD, may be gradually ↑at 2-wk intervals to 2– 16
mg/day day; incidence of postural hypotension greatly ↑ at doses 4 mg/day.
MODE OF ACTION: INDICATIONS:
Action: Dilates both arteries and veins by HTN, symptomatic BPH
blocking postsynaptic alpha1-adrenergic CONTRAINDICATIONS:
receptors. Pregnancy Category C, On Beers list due to
Therapeutic Effects: Lowering of BP. increased risk hypotension, pt’s undergoing
cataract surgery (risk of intraoperative floppy iris
Increased urine flow and decreased sx’s of
syndrome) ↑ risk of hypotension with sildenafil,
BPH. Helps improve lipid profile
tadalafil, vardenafil, other antihypertensives,
SIDE EFFECTS: nitrates, or acute ingestion of etoh.
1st dose orthostatic hypotension, drowsiness, NURSING CONSIDERATIONS:
dizziness, HA, may cause syncopal episodes, Take at HS. Monitor BP & pulse 2– 6 hr after 1st
especially within first 24 hr of therapy, sexual dose, w/ q ↑ in dose, and periodically during
dysfunction therapy. Assess for 1st dose orthostatic
nocturia hypotension & syncope. Incidence may be dose
related. Observe pt closely during this period
and take precautions to prevent injury. Monitor
I&O and daily weight, and assess for edema
LAB TEST CONSIDERATIONS: daily, especially at beginning of therapy. Report
weight gain or edema.
BPH: Assess pt for sx’s of prostatic hyperplasia
(urinary hesitancy, feeling of incomplete bladder
emptying, interruption of urinary stream.
Generic: methyldopa Pharmacologic: Centrally acting adrengerics Therapeutic: Antihypertensive
Usual Dose: PO (Adults): 250– 500 mg 2– 3 x/dayPO (Children): 10 mg/kg/dayIV (Adults): 250– 500 mg q 6 hr
(up to 1 g q 6 hr)IV (Children): 5– 10 mg/kg
MODE OF ACTION: INDICATIONS:
Stimulates CNS alpha-adrenergic receptors, Management of moderate to severe HTN
producing a ↓in sympathetic outflow to heart, (with other agents).
kidneys & blood vessels. Result is ↓ BP & CONTRAINDICATIONS:
peripheral resistance, a slight ↓ in heart rate, Pregnancy category B, active liver disease
and no change in cardiac output.
NURSING CONSIDERATIONS:
SIDE EFFECTS:
Drug fever, hemolytic anemia (rare), Monitor hepatic function test if unexplained
drowsiness, urine may darken or turn fever occurs. Fluid retention & expanded
red-black when left standing, dry mouth, volume may cause tolerance to develop
orthostatic hypotension within 2-3 mo after initiation of therapy. Dose
↑ should be made w/ the evening dose. When
BLOOD TEST CONSIDERATIONS: changing from IV to oral forms, dose should
Monitor renal and hepatic function & CBC
before & periodically during therapy. Monitor remain consistent. Intermittent Infusion:
direct Coombs’ test before & after 6 and 12 Diluent: Dilute in 100 mL of D5W, 0.9% NaCl,
mo of therapy. May cause a + direct D5/0.9% NaCl, 5% sodium bicarbonate, or
Coombs’ test, rarely associated w/ hemolytic Ringer’s solution. Concentration: 10 mg/mL.
anemia. May cause ↑ BUN, creatinine, K+, Rate: Infuse slowly over 30-60 min. Monitor
NA, prolactin, uric acid, AST, ALT, alkaline BP & pulse frequently during initial dose
phosphatase & bilirubin concentrations. adjustment, prior to administration &
periodically during therapy.
Generic: ferrous gluconate Trade: Fergon, Simron, Ferralet Pharmacological: Antianemic
Therapeutic: Iron supplement Usual Dose: Adults 2– 3 mg/kg/day in 2– 4 divided doses

MODE OF ACTION: INDICATIONS:

An essential mineral found in hemoglobin,
Iron deficiency anemia
myoglobin, and many enzymes. Enters the
bloodstream and is transported to the organs of
the reticuloendothelial system (liver, CONTRAINDICATIONS:
spleen, bone marrow) where it becomes part of Use cautiously in PUD, severe renal or
iron stores. hepatic impairment
SIDE EFFECTS:
Constipation, Diarrhea, Toxicity OD
NURSING CONSIDERATIONS:
Advise patient this med may cause dark
LAB TEST CONSIDERATIONS: stools and false positive guaiac test
Stomach pn, fever, n/v and diarrhea may
Monitor hemoglobin, hematocrit, and reticulocyte be early signs toxicity.
values prior to and every 3 wk during the first 2 Antidote for OD is deferoxamine
mo of therapy and periodically
thereafter. Serum ferritin and iron levels may
also be monitored to assess effectiveness of
therapy.
Generic: nifedipine Trade: Adalat CC, Procardia XL Pharmacological: CCB Therapeutic:
antianginals, antihypertensives Usual Dose: 10– 30 mg 3 times daily (not to exceed 180 mg/day), or 10– 20
mgBID as immediate-release form, or 30– 90 mg once daily as sustained-release
(CC, XL) formMODE
(not toOF
exceed 90– 120 mg/day).
ACTION: INDICATIONS:
Inhibits calcium transport into myocardial and HTN, Angina pectoris, vasospastic
vascular smooth muscle cells, resulting in (Prinzmetal’s) angina. Unlabeled Use:
inhibition of excitation-contraction coupling Prevention of migraine headache.
and subsequent contraction. Therapeutic Management of HF or cardiomyopathy.
Effects: Systemic vasodilation, resulting in
decreased BP. Coronary vasodilation, CONTRAINDICATIONS:
resulting in decreased frequency and severity Grapefruit and grapefruit juice increase
of attacks of angina. serum levels and effect; avoid concurrent
SIDE EFFECTS: use. SSS. Pregnancy category C
Steven Johnson syndrome, HA, edema,
flushing NURSING CONSIDERATIONS:
LAB TEST CONSIDERATIONS: Monitor intake and output ratios and daily
Patients receiving digoxin concurrently with weight. Assess for signs of HF. Instruct
nifedipine should have routine tests of patient to contact HCP if heart rate is <50
serum digoxin levels and be monitored for bpm. Monitor BP and pulse before therapy,
signs and symptoms of digoxin toxicity. during dose titration, and periodically during
Monitor serum potassium periodically. therapy. Monitor ECG periodically during
Monitor renal and hepatic functions prolonged therapy
periodically during long-term therapy
Generic: Verapamil Trade: Calan, Calin SR Pharmacological: CCB Therapeutic:antianginals,
antiarrhythmics, antihypertensives, vascular HA suppressants Usual Dose: 80– 120 mg TID ↑PRN. Pt w/
hepatic impairment or geriatric pt 40 mg TID initially. Extended-release preparations 20– 240 mg/day mg/day).
MODE OF ACTION: INDICATIONS:
Inhibits the transport of calcium into myocardial & Mgmt of HTN, angina pectoris, and/or vasospastic
vascular smooth muscle cells, resulting in angina. Management of supraventricular
inhibition of excitation-contraction coupling and arrhythmias and RVR in atrial flutter or fibrillation.
subsequent contraction. ↓ SA & AV conduction Unlabeled Use: Prevention of migraine HA
and prolongs AV node refractory period in
conduction tissue. Therapeutic Effects: CONTRAINDICATIONS:
Systemic vasodilation resulting in ↓ BP. Coronary Pregnancy Category C, SSS, Systolic BP
vasodilation resulting in decreased frequency and <90 mm Hg
severity of attacks of angina. Reduction of
ventricular rate during atrial fibrillation or flutter. NURSING CONSIDERATIONS:
SIDE EFFECTS: Monitor BP and pulse before therapy, during
dosage titration, and periodically. Don’t administer
Hypotension, Steven Johnson
if pulse <50. Monitor ECG periodically during
syndrome, elevated LFT, edema, HA
prolonged therapy. Monitor I&O and daily weight.
Assess for signs of HF (peripheral edema,
LAB TEST CONSIDERATIONS:
rales/crackles, dyspnea, weight gain, jugular
Pt’s receiving digoxin concurrently w/ CCB
venous distention). Arrhythmias: Monitor ECG
should have routine serum digoxin levels.
continuously during administration. Advise patient
Monitor potassium periodically. Monitor to notify health care professional if irregular
renal & hepatic functions periodically heartbeats, rash, dyspnea, swelling of hands &
during long-term therapy feet, pronounced dizziness, nausea, constipation
or hypotension.
Generic: nadolol Trade: Cogard Pharmacological: BB Therapeutic:antianginals,
antihypertensives Usual Dose: 40 mg once daily initially; may ↑ by 40– 80 mg/day q 7 days as needed (up
to 320 mg/day).
MODE OF ACTION: INDICATIONS:
Mgmt of HTN. Mgmt of angina pectoris. Unlabeled
Blocks stimulation of beta1 (myocardial) Use: Arrhythmias, migraine prophylaxis, tremors
and beta2 (pulmonary, vascular, and (essential, lithium-induced, parkinsonian), aggressive
uterine) receptor sites. Therapeutic behavior, antipsychotic-associated akathisia,
Effects: Decreased heart rate and BP. situational anxiety, esophageal varices, reduction of
intraocular pressure
CONTRAINDICATIONS:
SIDE EFFECTS: Uncompensated HF, pulmonary edema,
cardiogenic shock, bradycardia or heart block.
OD, fatigue, weakness, ED, bradycardia,
Pregnancy category C
pulmonary edema, orthostatic hypotension,
dizziness NURSING CONSIDERATIONS:
Monitor BP & pulse frequently during dose
LAB TEST CONSIDERATIONS:
adjustment and periodically during therapy.
May cause increased BUN, serum Assess for orthostatic hypotension when
lipoprotein, potassium, triglyceride, and uric assisting pt up from supine position. Monitor I&O
acid levels. May cause increased ANA ratios & daily weight. Assess pt routinely for
titers. May cause increase in blood glucose evidence of fluid overload. Monitor pt’s receiving
levels. BB for signs of OD (bradycardia, severe
dizziness or fainting, severe drowsiness,
dyspnea, bluish fingernails or palms, seizures)
Take apical pulse before administering. If <50
bpm or if arrhythmia occurs, withhold medication
Generic: donpezil Trade: Aricept Pharmacological: cholinergic (cholinesterase inhibitors)
Therapeutic: anti-alzheimer’s agents Usual Dose: 5 mg once daily; after 4– 6 wk may ↑ to 10 mg once daily

MODE OF ACTION: INDICATIONS:

Inhibits acetylcholinesterase thus improving
Mild, moderate, or severe dementia w/
cholinergic function by making more
neurocognitive d/o associated w/ alzheimer’s
acetylcholine available. Therapeutic
disease.
Effects: May temporarily lessen some of CONTRAINDICATIONS:
the dementia associated w/ Alzheimer's
disease. Enhances cognition. Does not
Pregnancy category C
cure the disease.
SIDE EFFECTS:
Dizziness, HA, loose stools, nausea, NURSING CONSIDERATIONS:
bradycardia Assess cognitive function (memory,
attention, reasoning, language, ability to
perform simple tasks) periodically during
therapy. Monitor heart rate periodically
during therapy.

LAB TEST CONSIDERATIONS:

Generic: haloperidol Trade: Haldol Pharmacological: butyrophenones
Therapeutic: antipsychotics Usual Dose: Adult 0.5– 5 mg 2– 3 times daily. Patients with severe sx’s may
require 100 mg/day PO (Children 3– 12 yr or 15– 40 kg): 0.25– 0.5 mg/day given in 2– 3 divided. Also availible IM/IV
MODE
doses; increase by 0.25– OF ACTION:
0.5 mg every 5– 7 days; maximum dose: 0.15 mg/kg/day INDICATIONS:
Alters the effects of dopamine in the Acute & chronic severe behavioral problems in children
CNS. Also has anticholinergic and which may be accompanied by: unprovoked,
alpha-adrenergic blocking activity. combative, explosive hyperexcitability, hyperactivity
accompanied by conduct disorders Psychotic disorders
Therapeutic Effects: Diminished signs
including: schizophrenia, manic states, drug induced
and symptoms of psychoses. Improved
psychoses. Also useful in managing aggressive or
behavior in children w/ tourette’s
agitated pt’s.
syndrome or other behavioral problems CONTRAINDICATIONS:
Pregnancy category C. Angle-closure glaucoma,
bone marrow depression, CNS depression,
SIDE EFFECTS: parkinsonism, severe liver or cardiovascular disease.
Extrapyramidal symptoms, tardive NURSING CONSIDERATIONS:
dyskinesia, and neuroleptic malignant Assess mental status (orientation, mood, behavior)
syndrome prior to & periodically during therapy. Assess +
(hallucination, delusions) and - (social isolation)
symptoms of schizophrenia. Monitor BP (sitting,
standing, lying) & pulse prior to and frequently during
the period of dose adjustment. May cause QT interval
LAB TEST CONSIDERATIONS:
changes on ECG. Observe pt carefully when
administering medication, to ensure that med is
actually taken and not hoarded.
Generic: venlafaxine Trade: Effexor XR Pharmacological: selective serotonin/NE reuptake
inhibitors Therapeutic: antidepressants, antianxiety agents Usual Dose: DEPRESSION 75 mg/day in 2– 3
divided doses; may ↑ by up to 75 mg/day, up to 225 mg/day. ; XR capsules 75 mg once daily (some pt’s may be started at 37.5 mg once
daily) for 4– 7 days; may ↑ by up to 75 mg/day at interval of not< than 4 days (not to exceed 225 mg/day). SOCIAL ANXIETY 75 mg XR
QD
MODE OF ACTION: INDICATIONS:
Inhibits serotonin and norepinephrine Major depressive disorder. GAD(Effexor XR only), social
reuptake in the CNS. Therapeutic Effects: anxiety disorder (Effexor XR only). Panic d/o (Effexor XR
Decrease in depressive symptomatology, only). Unlabeled Use: PMDD
with fewer relapses/recurrences. CONTRAINDICATIONS:
Decreased anxiety. Decrease in panic Pregnancy Category C; Concurrent use of MAO
attacks inhibitors or MAO like drugs, reduce dose in
SIDE EFFECTS: hepatic/renal disease
Drowsiness, dizziness, serotonin NURSING CONSIDERATIONS:
syndrome, GI upset, sexual dysfunction, Assess mental status and mood changes. Inform HCP if
rhinitis, abnormal dreams, anemia, pt demonstrates significant ↑ in anxiety, nervousness, or
eosinophilia, leukocytosis, leukopenia, insomnia. Assess suicidal tendencies, especially in early
chills therapy. Restrict amount of drug available to pt. Monitor
BP before and periodically during therapy. Sustained HTN
LAB TEST CONSIDERATIONS: may be dose-related; ↓ dose or d/c therapy if this occurs.
Monitor CBC with differential and platelet Monitor appetite and nutritional intake. Weigh weekly.
count periodically during therapy. Report continued weight loss. Adjust diet as tolerated to
support nutritional status. Assess for serotonin syndrome
(mental changes [agitation, hallucinations, coma],
autonomic instability [tachycardia, labile BP,
hyperthermia], neuromuscular aberrations [hyper-reflexia,
incoordination], and/or GI sx’s.
 Generic: sertraline Trade: Zoloft Pharmacological: SSRI’S Therapeutic: antidepressants
Usual Dose: Adults 25-50 mg/day; may ↑ Week; max. 200 mg/day Peds: 13-17 y/o 50 mg QD, 6-12 y/o 25 mg QD

MODE OF ACTION: INDICATIONS:

Inhibits neuronal uptake of serotonin in the CNS, Major depressive disorder. Panic disorder. OCD,
thus potentiating the activity of serotonin. Has PTSD. Social anxiety disorder (social phobia).
little effect on norepinephrine or dopamine. Premenstrual dysphoric disorder (PMDD). Unlabeled
Therapeutic Effects: Antidepressant action. Use: Generalized anxiety disorder (GAD).
Decreased incidence of panic attacks.
Decreased obsessive and compulsive behavior. CONTRAINDICATIONS:
Decreased feelings of intense fear, helplessness, Pregnancy C -Use during third trimester may
or horror. Decreased social anxiety. Decrease in result in neonatal serotonin syndrome requiring
premenstrual dysphoria. prolonged hospitalization, respiratory and
SIDE EFFECTS: nutritional support. Use only if potential benefit
Drowsiness, dizziness, insomnia, fatigue, HA, justifies potential risk to fetus, concurrent use w/
sexual dysfunction, dry mouth, serotonin MAOI
syndrome
NURSING CONSIDERATIONS:
Assess for suicidal tendencies, especially during
early therapy. Restrict amount of drug available to
LAB TEST CONSIDERATIONS: patient. Risk may be increased in children. Advise
pt to avoid ETOH. Monitor appetite and nutritional
May cause false-positive urine screening
intake. Weigh weekly. Assess for serotonin
tests for benzodiazepines. May cause
syndrome (mental changes [agitation,
hyperglycemia and DM, monitor serum
hallucinations, coma], autonomic instability
glucose if clinical sx’s.
[tachycardia, labile BP, hyperthermia],
neuromuscular aberrations [hyper-reflexia,
incoordination],and/or GI symptoms
Generic: lorazepam Trade: Ativan Pharmacological: benzodiazepines Therapeutic: anesthetic
adjuncts, antianxiety agents, sedative/hypnotics Usual Dose: Adult Anxiety 1– 3 mg bid or tid (up to 10
mg/day). Insomnia 2-4 mg at bedtime PO (Children): Anxiety/sedation 0.02– 0.1 mg/kg/dose (not to exceed 2 mg) q
4-8 hr PO,IV, IM, SL 4– 8 hr. Preop sedation 0.02– 0.09 mg/kg/dose.
MODE OF ACTION: INDICATIONS:
Anxiety disorder (oral), preop sedation
Depresses the CNS, probably by (injection), ↓ preoperative anxiety and provides
potentiating GABA, an inhibitory amnesia. Unlabeled Use: IV: Antiemetic prior to
neurotransmitter. chemotherapy. Insomnia, panic disorder, as an
Therapeutic Effects: Sedation, ↓ anxiety, ↓ adjunct with acute mania or acute psychosis.
seizures.
CONTRAINDICATIONS:
SIDE EFFECTS:
Angle-closure glaucoma, severe hypotension, sleep
Dizziness, drowsiness, lethargy, toxicity/OD apnea. Adjust geriatric’s for peds, geriatrics.
NURSING CONSIDERATIONS:
Caution pt to avoid taking alcohol or other CNS
depressants concurrently w/ this med. Advise pt
LAB TEST CONSIDERATIONS: to ↓ lorazepam dose gradually to minimize w/d
Pt’s on high-dose therapy should receive sx’s; abrupt w/d may cause tremors, nausea,
routine evaluation of renal, hepatic, and vomiting, and abdominal and muscle cramps.
hematologic function. Pedi: Assess neonates for prolonged CNS
depression related to inability to metabolize
lorazepam. Geri: Assess geriatric patients
carefully for CNS reactions as they are more
sensitive to these effects. Assess falls risk.
Generic: latanoprost Trade: Xalatan Pharmacological: Selective prostanoid agonist
Usual Dose: One drop of a 0.005% solution (1.5 mcg) in the affected eye(s) once daily in the evening

MODE OF ACTION: INDICATIONS:

Appears to reduce IOP by increasing Reduction of elevated intraocular pressure
uveoscleral outflow of aqueous humor (IOP) in patients with open-angle glaucoma
or ocular hypertension

CONTRAINDICATIONS:
Known hypersensitivity to latanoprost,
benzalkonium chloride. Pregnancy category
C
NURSING CONSIDERATIONS:
SIDE EFFECTS:
Explain importance of delaying insertion of
Burning/stinging, foreign body sensation, contact lenses for at least 15 minutes after
itching, changes in eyelashes and latanoprost instillation, since benzalkonium
permanent darkening of iris, eyelashes, or chloride preservative may be absorbed by
skin around the eyes soft lenses. Explain importance of
administering different topical ophthalmic
preparations at least 5 minutes apart.
LAB TEST CONSIDERATIONS: Explain importance of learning and adhering
to proper administration techniques to avoid
contamination of the solution with common
bacteria that can cause ocular infections.
Generic: acetaminophen Trade: Tylenol Therapeutic: antipyretics, nonopioid analgesics
Usual Dose: Adults/children >12 y/o 325-650 mg q 6 hours or 1 G TID-QID or 1300 mg q 8 HR (not >3 G) or >2 G
with hepatic/renal impairment
MODE OF ACTION: INDICATIONS:
Inhibits synthesis of prostaglandins that PO, Rect: Tx of mild pain, fever.
may serve as mediators of pain and fever, IV: Treatment of mild to moderate pain,
primarily in the CNS. Has no significant moderate to severe pain with opioid analgesics,
anti-inflammatory properties or GI toxicity fever.
CONTRAINDICATIONS:
Pregnancy Category B (oral, rectal), C (IV),
severe hepatic impairment, acute liver disease
SIDE EFFECTS:
NURSING CONSIDERATIONS:
Toxicity/OD, Steven Johnson syndrome,
Assess overall health status and ETOH usage
elevated LFT, hypokalemia (long term IV
before administering acetaminophen. Pt’s who
use), toxic epidermal necrolysis
are malnourished or chronically abuse ETOH
are at higher risk of developing hepatotoxicity
w/ chronic use of usual doses of this drug.
Assess for rash/skin integrity periodically during
LAB TEST CONSIDERATIONS: therapy. Assess type, location & intensity prior
Evaluate hepatic, hematologic, and renal to and 30-60 min after administration. Advise pt
function periodically during prolonged, to avoid etoh(3 or more glasses / day ↑ the risk
high-dose therapy. Pt’s on warfarin and tx’d of liver damage) if taking more than an
long term or w/ high dose need INR occasional 1– 2 doses. Observe for jaundice,
checked more frequently. easy bruising, clay colored stools, dark urine
Generic: aspirin Trade: Bayer Aspirin Pharmacological: salicylates Therapeutic: antipyretics,
nonopioid analgesics Usual Dose: PO (Adults): 2.4 g/day initially; increased to maintenance dose of 3.6– 5.4 g/day in
divided doses PO (Children): 60– 100 mg/kg/day in divided doses Suspected acute MI—160 mg as soon as MI is suspected
divided doses
MODE OF ACTION: INDICATIONS:
Produce analgesia and reduce inflammation Inflammatory disorders including: RA, OA, mild
and fever by inhibiting the production of to moderate pain, fever, prophylaxis of TIA &
prostaglandins. ↓ platelet aggregation. MI. Unlabeled Use: Adjunctive treatment of
Therapeutic Effects: Analgesia, reduction KD.
CONTRAINDICATIONS:
of inflammation, reduction of fever, ↓ Pregnancy Category D. Pt w/ asthma, allergies, &
incidence of TIA & MI. nasal polyps or who are allergic to tartrazine are at
an ↑ risk for developing hypersensitivity reactions.
CDC warns against giving aspirin to children or
SIDE EFFECTS: adolescents with varicella or flu like or viral illnesses
GI bleed, GI upset, tinnitus, bruising because of a possible association w/ Reye’s
syndrome
LAB TEST CONSIDERATIONS: NURSING CONSIDERATIONS:
Monitor hepatic function before
Pain: Assess pain & limitation of movement; note
antirheumatic therapy and if sx’s of
type, location, and intensity before & at the peak (see
hepatotoxicity occur. Monitor salicylate
Time/Action Profile) after administration. Fever:
levels periodically w/ prolonged high-dose
Assess fever & note associated signs (diaphoresis,
therapy. Prolongs bleeding time for 4– 7
tachycardia, malaise, chills). Caution pt to avoid
days and, in large doses, may cause
concurrent use of etoh w/ this med to min possible
prolonged prothrombin time. Monitor
gastric irritation. Advise pt to report tinnitus; unusual
hematocrit periodically in prolonged
bleeding of gums; bruising; black, tarry stools; or
high-dose therapy.
fever lasting longer than 3 days.
Generic: ibuprofen Trade: Advil, Motrin Pharmacological: Non opioid analgesics Therapeutic:
antipyretic, antirheumatics, NSAID Usual Dose: Anti-inflammatory 400-800 mg TID-QID (not to
exceed 3200 mg/day) Anti-dysmenorrheal/Antipyretic 200-400 mg q 4-6 hours (not to exceed 1200 mg/day)
MODE OF ACTION: INDICATIONS:
Inhibits prostaglandin synthesis. PO, IV: Tx of Mild to moderate pain, Fever. PO: Tx of
Therapeutic Effects: Decreased pain and Inflammatory disorders including RA(including juvenile) and
OA, dysmenorrhea. IV: Moderate to severe pain w/ opioid
inflammation. Reduction of fever.
analgesics. Closure of a clinically significant PDA in neonates
weighing 500– 1500 g and 32 wks gestational age (ibuprofen
SIDE EFFECTS: lysine only) CONTRAINDICATIONS:
Nausea, vomiting, GI bleed, thrombotic Pregnancy Category C (up to 30 wk gestation), D
events (MI, CVA, renal toxicity), Steven (starting at 30 wk gestation). Active GI bleeding or
Johnson syndrome, toxic epidermal ulcer disease
necrolysis, tinnitus, hearing loss NURSING CONSIDERATIONS:
Pt should be well hydrated before administration to prevent
renal adverse reactions. Don’t give to neonates with urine
LAB TEST CONSIDERATIONS:
output < 0.6 mL/kg/hour. Use lowest effective dose for
BUN, serum creatinine, CBC, and LFT shortest period of time, especially in the elderly. Assess for
should be evaluated periodically in pt’s signs/sx’s of GI bleeding, renal dysfunction, and hepatic
receiving prolonged therapy. impairment. Geri: Higher risk for poor outcomes or death
from GI bleeding. Age-related renal impairment increases risk
of hepatic & renal toxicity. Assess patient for skin rash
frequently during therapy. Assess pain (note type, location,
and intensity) prior to & 1– 2 hr following administration.
Advise patients to take ibuprofen with a full glass of water and
to remain in an upright position for 15– 30 min after
administration
Generic: morphine Trade: MS Contin, Kadian Pharmacological: opioid agonists
Therapeutic: opioid analgesics
Usual Dose: availible rectal, IV, IM, PO, Oral solution, epidural

MODE OF ACTION: INDICATIONS:

Severe pain (the 20 mg/mL oral solution concentration should only be
Binds to opiate receptors in the CNS. Alters used in opioid-tolerant pt). Moderate to severe chronic pain in
the perception of and response to painful opioid-tolerant pt requiring use of daily, around-the-clock long-term opioid
tx & for which alternative treatment options are inadequate
stimuli while producing generalized CNS (extended-release). Pulmonary edema, pain associated with MI
depression. Therapeutic Effects: Decrease CONTRAINDICATIONS:
in severity of pain. Addition of naltrexone in Pregnancy Category C. Significant respiratory depression
Embeda product is designed to prevent (extended-release), acute or severe bronchial asthma
abuse or misuse by altering the formulation. (extended-release), paralytic ileus (extended-release).
Naltrexone has no effect unless the capsule NURSING CONSIDERATIONS:
is crushed or chewed. Assess level of consciousness, BP, pulse & respirations
before and periodically during administration. If
SIDE EFFECTS: respiratory rate is < 10/min, assess level of sedation.
Constipation, OD related to misuse, Assess type, location, and intensity of pain prior to and
confusion, sedation, dizziness, 1 hr following PO, subcut, IM, and 20 min (peak)
orthostatic hypotension, decreased following IV administration. Assess bowel function
respirations routinely. Institute prevention of constipation with ↑
intake of fluids, bulk & w/ laxatives to minimize
constipating effects. Administer stimulant laxatives
LAB TEST CONSIDERATIONS: routinely if opioid use > 2-3 days, unless
contraindicated. Assess risk for opioid addiction, abuse,
or misuse prior to administration. Caution pt to avoid
concurrent use of ETOH or other CNS depressants with
this med.
Generic: hydrocodone/APAP Trade: Norco Pharmacological: opioid agonists/nonopioid analgesic
combinations Therapeutic: opioid analgesics Usual Dose: PO (Adults): Analgesic—2.5– 10 mg q 3– 6 hr as
needed; acetaminophen dosage should not exceed 4 g/day PO (Children): Analgesic (1– 13 yr)—0.1– 0.2 mg/kg q 3– 4 hr
MODE OF ACTION: INDICATION:
Bind to opiate receptors in the CNS. Alter Management of moderate to severe pain
the perception of and response to painful CONTRAINDICATIONS:
Pregnancy category C, Significant respiratory depression,
stimuli while producing generalized CNS paralytic ileus, acute or severe
depression. Therapeutic Effects: bronchial asthma or hypercarbia, congenital long QT
Decrease in severity of moderate pain. syndrome. OB, Lactation: Avoid chronic use; Products
containing alcohol, aspartame, saccharin, sugar, or
tartrazine (FDC yellow dye #5) should be avoided in
SIDE EFFECTS: patients who have hypersensitivity or intolerance to these
Constipation, ↓ respirations, compounds.
NURSING CONSIDERATIONS:
dependency, drowsiness, dizziness,
Assess BP, pulse, and respirations before and
liver/renal damage, orthostatic periodically during administration. If respiratory rate is
hypotension <10/min, assess level of sedation. Assess bowel
function routinely. Prevention of constipation should be
instituted w/ increased intake of fluids and bulk, and
laxatives. Caution patient to avoid concurrent use of
alcohol or other CNS depressants with
LAB TEST CONSIDERATIONS: this medication. Assess type, location, and intensity of
pain prior to and 1 hr (peak) following administration.
Monitor LFT, renal function in long term
Assess risk for opioid addiction, abuse, or misuse prior
use
to administration.
Generic: hydrocodone/ibuprofen Trade: Vicoprofen Pharmacological: opioid agonists/nonopioid
analgesic combinations Therapeutic: opioid analgesics Usual Dose: PO (Adults): Analgesic—2.5– 10 mg q
3– 6 hr PRN max 5 / day of ibuprofen-containing products ; PO (Children): Analgesic (1– 13 yr)—0.1– 0.2 mg/kg q 3– 4 hr
MODE OF ACTION: INDICATION:
Mgmt of moderate to severe pain
Bind to opiate receptors in the CNS. Alter
CONTRAINDICATIONS:
the perception of and response to painful Pregnancy Category C (up to 30 wk gestation), D (starting
stimuli while producing generalized CNS at 30 wk gestation), significant respiratory depression,
depression. Therapeutic Effects: paralytic ileus, acute or severe bronchial asthma or
Decrease in severity of moderate pain. hypercarbia, congenital long QT syndrome, severe
hepatic/renal disease. OB: Avoid after 30 wk gestation (may
cause premature closure of fetal ductus arteriosus); Pedi:
SIDE EFFECTS: Ibuprofen lysine: Preterm neonates with untreated infection,
Constipation, decreased respirations, congenital heart disease where patency of PDA is
dependency, drowsiness, dizziness, necessary for pulmonary or systemic blood flow, bleeding,
thrombocytopenia, coagulation defects, necrotizing
liver/renal damage, orthostatic
enterocolitis, significant renal dysfunction
hypotension, GI bleed
NURSING CONSIDERATIONS:
Assess BP, pulse & respirations before & periodically during
administration. If respiratory rate is <10/min, assess level of
sedation. Assess bowel function routinely. Prevention of
constipation should be instituted w/ increased intake of fluids
and bulk, and laxatives. Caution pt to avoid concurrent use
LAB TEST CONSIDERATIONS: of etoh or other CNS depressants w/ this med. Assess type,
Monitor renal function in long term use location, and intensity of pn prior to and 1 hr (peak) after
admin. Assess risk for opioid addiction, abuse, or misuse
prior to administration. PO: May be administered w/ food or
milk to minimize GI irritation
Generic: fentanyl (transdermal) Trade: Duragesic Pharmacological: opioid agonists
Usual Dose: 25 mcg/hr is the initial dose. If >100 mcg/hr is required, use multiple transdermal systems
MODE OF ACTION: INDICATIONS:
Moderate to severe chronic pain in opioid-tolerant pt’s
Binds to opiate receptors in the CNS, requiring use of daily, around-the-clock long-term opioid
altering the response to and perception treatment and for which alternative treatment options are
of pain. inadequate (extended-release)
Therapeutic Effects: Decrease in CONTRAINDICATIONS:
Dose should be adjusted for hepatic/ renal impairment.
severity of chronic pain. Significant respiratory depression, acute or severe
bronchial asthma, paralytic ileus, severe hepatic or renal
SIDE EFFECTS: impairment, etoh intolerance. Pregnancy category C. OB:
Confusion, sedation, weakness, Not recommended during labor and delivery; Lactation:
May cause adverse affects in infant.
constipation, dry mouth, nausea,
vomiting, toxicity/OD NURSING CONSIDERATIONS:
Apply system to flat, non irritated, and
nonirradiated site such as chest, back, flank, or
upper arm. Assess type, location, and intensity of
pain before and 24 hr after application and
periodically during therapy. Assess BP, pulse, and
respirations before and periodically during
administration. If respiratory rate is 10/min, assess
LAB TEST CONSIDERATIONS:
level of sedation. Assess bowel function routinely.
Assess risk for opioid addiction, abuse, or misuse
prior to administration. Monitor for respiratory
depression
Generic: oxycodone and APAP Trade: Percocet
Pharmacological: Opioid agonist/non opioid analgesic combo Therapeutic: Opioid analgesic
Usual Dose: 2.5-10 mg po q 5-6 hours or 5-10 mg p0 q 6 hours prn. Total APAP should not exceed 4 grams
MODE OF ACTION: INDICATIONS:
Binds to opiate receptors in CNS, alters Relief of moderate to severe pain (nociceptive)
perception of pain and produces realized CONTRAINDICATIONS:
Pregnancy Category B. OB, Lactation: Avoid
CMS depression. chronic use; prolonged use of XR morphine during
pregnancy can result in neonatal opioid w/d
syndrome; Children 11 yr (safety and effectiveness
of XR products not established)
SIDE EFFECTS:
Dizziness, orthostatic hypotension, NURSING CONSIDERATIONS:
constipation, itching skin, bradycardia, Assess BP, pulse, respirations before &
life threatening respiratory depression, periodically during administration. If respiratory
euphoria, drug abuse/dependency, liver rate is <10/min, assess level of sedation. Assess
damage/failure, Steven Johnson bowel function routinely, check BS for decreased
syndrome, toxic epidermal necrolysis peristalsis. Prevention of constipation should be
instituted w/ ↑ intake of fluids and bulk, and
laxatives. Caution pt to avoid concurrent use of
etoh or other CNS depressants w/ this med.
Assess type, location, and intensity of pain prior to
LAB TEST CONSIDERATIONS: and 1 hr (peak) following administration. Assess
LFT/renal function risk for opioid addiction, abuse, or misuse prior to
administration. PO: May be administered with food
or milk to minimize GI irritation
Generic: trimethoprim/sulfamethoxazole Trade: Bactrim DS Pharmacological: folate
antagonists, sulfonamides Therapeutic: anti-infectives, anti-protozoals Usual Dose: mild infection 6–
12 mg TMP/kg/day divided q 12 hr; Serious infection/Pneumocystis—15– 20 mg TMP/kg /day/divided q 6– 8 hr . Availible PO, IV
kg /day/divided q 6– 8OF
MODE hrACTION: INDICATIONS:
Tx of Bronchitis, Shigella enteritis, OM, pneumocystis jirovecii,
Combination inhibits the metabolism of folic pneumonia (PCP), UTI, traveler’s diarrhea. Prevention of PCP in
acid in bacteria at two different points. HIV-positive pt’[Link] Use: Biliary tract infections,
osteomyelitis, burn & wound infections, chlamydial infections,
endocarditis, gonorrhea, intra-abdominal infections, nocardiosis,
rheumatic fever prophylaxis, sinusitis, eradication of
meningococcal carriers, prophylaxis of urinary tract infections,
and an alternative agentin the treatment of chancroid.
SIDE EFFECTS: Prevention of bacterial infections in immunosuppressed patients.

Phlebitis is common when given IV, CONTRAINDICATIONS:

Pregnancy category C, Hypersensitivity to
hyperkalemia, C diff, nausea, vomiting,
sulfonamides or trimethoprim, ; Severe hepatic or
rash, Steven Johnson syndrome , renal impairment
hypoglycemia
NURSING CONSIDERATIONS:
Assess for infection (vital signs; appearance of
wound, sputum, urine, and stool WBC) at beginning
of and during therapy. 1st dose may be given before
LAB TEST CONSIDERATIONS: receiving results. Inspect IV site frequently. Monitor
Monitor CBC and urinalysis i&O ratios. Fluid intake should be sufficient to
periodically during therapy. Obtain maintain a urine output of at least 1200– 1500 mL
specimens for culture and sensitivity daily to prevent crystalluria and stone formation.
before initiating therapy. Assess for rash periodically during therapy. Caution
patient to use sunscreen and protective clothing to
prevent photosensitivity reactions
Generic: phenazopyridine Trade: Pyridium
Pharmacological: urinary tract analgesics Therapeutic: nonopioid analgesics
Usual Dose: PO (Adults): 200 mg 3 times daily for 2 days, PO (Children): 4 mg/kg 3 times daily for 2 days
MODE OF ACTION: INDICATIONS:
Provides relief from the following urinary tract
Acts locally on the urinary tract mucosa to symptoms, which may occur in association with
produce analgesic or local anesthetic infection or following urologic procedures: Pain,
effects. Has no antimicrobial activity. itching, burning, urgency, frequency.
Therapeutic Effects: Diminished urinary
CONTRAINDICATIONS:
tract discomfort. Pregnancy Category B, Glomerulonephritis,
SIDE EFFECTS: Severe hepatitis, uremia, or renal failure,
Renal insufficiency, G6PD efficiency
Bright orange urine, HA, nausea
NURSING CONSIDERATIONS:
Assess patient for urgency, frequency,
and pain on urination prior to and
throughout therapy. Inform patient that
LAB TEST CONSIDERATIONS:
drug causes reddish-orange
Renal function should be monitored
periodically during course of therapy. discoloration of urine that may
Interferes with urine tests based on stain clothing or bedding. Sanitary
color reactions. napkin may be worn to avoid clothing
stains. May also cause staining of soft
contact lenses.
 Generic: nitrofurantoin Trade: Macrodantin Therapeutic: anti-infectives
Usual Dose: PO (Adults): Treatment of active infection 50– 100 mg q 6– 8 hr or 100 mg q 12 hr as extended-release. PO
(Children >1 mo): Treatment of active infection—5– 7 mg/kg/day divided q 6 hr; max dose: 400 mg/day.
INDICATIONS:
MODE OF ACTION: Prevention and treatment of urinary tract
Interferes with bacterial enzymes. Therapeutic
infections caused by susceptible organisms;
Effects: Bactericidal or bacteriostatic action
not effective in systemic bacterial infections
against susceptible organisms. Spectrum: Many
CONTRAINDICATIONS:
gram-negative and some gram + organisms,
I.E: Citrobacter, Corynebacterium, Hypersensitivity; Hypersensitivity to
Enterobacter, Escherichia coli, Klebsiella, parabens (suspension); oliguria, anuria, or
Neisseria, Salmonella, Shigella, significant renal impairment (CCr 60
Staphylococcus aureus, Staphylococcus mL/min)
epidermidis, Enterococcus NURSING CONSIDERATIONS:
SIDE EFFECTS: Monitor I&O ratios. Report significant
C diff, anorexia, nausea, vomiting,
hepatotoxicity, pneumonitis, dizziness, discrepancies in totals. Assess for signs and
drowsiness, rust-yellow to brown ss’s of pulmonary reactions periodically
discoloration of urine during therapy. Administer w/ food or milk to
LAB TEST CONSIDERATIONS: minimize GI irritation. Assess for signs and
Monitor CBC routinely with patients on prolonged sx’s of urinary tract infection before and
therapy. Monitor LFT periodically during therapy. periodically during therapy. Instruct pt to
May cause ↑ serum glucose, bilirubin, alkaline notify health care professional if fever and
phosphatase, BUN, and creatinine. If
diarrhea develop, especially if stool contains
hepatotoxicity occurs, D/C therapy. Monitor renal
function periodically during therapy. Obtain
blood, pus, or mucus.
specimens
Melissa Ingramfor C+S before and during drug given.
Generic: tamsulosin Trade: Flomax Pharmacological: peripherally acting antiadrenergics
Usual Dose: PO (Adults): 0.4 mg once daily after a meal; may be ↑ after 2– 4 wk to 0.8 mg/day

MODE OF ACTION: INDICATIONS:

Decreases contractions in smooth muscle Management of signs/symptoms of benign
of the prostatic capsule by preferentially prostatic hyperplasia (BPH).
binding to alpha1-adrenergic receptors.
Therapeutic Effects: Decreased CONTRAINDICATIONS:
symptoms of prostatic hyperplasia (urinary Pregnancy category B, Sulfa allergy,
urgency, hesitancy, nocturia).

NURSING CONSIDERATIONS:
SIDE EFFECTS:
Assess patient for symptoms of BPH before
Dizziness, HA, orthostatic hypotension and periodically during therapy. Assess patient
for first-dose orthostatic hypotension and
syncope. Incidence may be dose related.
Observe patient closely during this period and
take precautions to prevent injury. Monitor I&O
and daily weight, and assess for edema daily,
LAB TEST CONSIDERATIONS: especially at beginning of therapy. Rectal
exams prior to and periodically throughout
therapy to assess prostate size
are recommended
Generic: bisacodyl Trade: Dulcolax, Ex-Lax Ultra Pharmacological: stimulant laxatives
Therapeutic: Laxatives Usual Dose: PO (Adults and Children 12 yr): 5– 15 mg/day (up to 30 mg/day) as a single dose
PO (Children 3– 11 yr): 5– 10 mg day (0.3 mg/kg) as a single dose. Rect (Adults and Children 12 yr): 10 mg/day single dose
Rect (Children 2– 11 yr): 5– 10 mg/day single dose
MODE OF ACTION: INDICATIONS:
Treatment of constipation. Evacuation of the bowel
Stimulates peristalsis. Alters fluid and before radiologic studies or surgery. Part of a bowel
electrolyte transport, producing fluid regimen in spinal cord injury patients.
accumulation in the colon. CONTRAINDICATIONS:
Therapeutic Effects: Evacuation of the Pregnancy Category C, Abdominal pain,
colon. obstruction, nausea or vomiting (especially w/ fever
or other signs of an acute abdomen).
NURSING CONSIDERATIONS:
Advise pt to increase fluid intake to at least 1500–
SIDE EFFECTS: 2000 mL/day during therapy to prevent
Abdominal cramps, nausea, dehydration. Encourage pt to use other forms of
hypokalemia bowel regulation (increasing bulk in the diet, ↑ fluid
intake, or increasing mobility). Normal bowel habits
may vary from 3 times/day to 3 times/wk. Assess
patient for abdominal distention, presence of bowel
sounds, and usual pattern of bowel function.
Assess color, consistency, and amount of stool
LAB TEST CONSIDERATIONS: produced. Do not administer oral doses within 1 hr
of milk or antacids; this may lead to premature
dissolution of tablet and gastric or duodenal
irritation.
Generic: docusate sodium Trade: Dulcolax, Colace Pharmacological: stool softeners Therapeutic:
Laxatives Usual Dose: PO (Adults and Children 1 PO (Children 3 yr): 10– 40 mg in 1– 4 divided doses <2 yr): 50– 400
mg in 1– 4 divided doses. PO (Children 6– 12 yr): 40– 150 mg in 1– 4 divided doses. PO (Children 3– 6 yr): 20– 60 mg in 1– 4
divided doses. PO (Infants): 5 mg/kg/day in 1– 4 divided doses. Rectal (Adults): 50– 100 mg or 1 unit containing 283 mg
docusate sodium, soft soap,and glycerin.
MODE OF ACTION: INDICATIONS:
PO: Prevention of constipation (in patients who
Promotes incorporation of water into stool,
should avoid straining, such as after
resulting in softer fecal mass. May also
MI or rectal surgery). Rect: Used as enema to
promote electrolyte and water secretion into
soften fecal impaction
the colon. Therapeutic Effects:Softening
CONTRAINDICATIONS:
and passage of stool
Abdominal pain, nausea, or vomiting,
especially when associated with fever or other
SIDE EFFECTS: signs of an acute abdomen.
Stomach cramps, diarrhea, rash
NURSING CONSIDERATIONS:
PO: Administer with a full glass of water or
juice. May be administered on an empty
stomach for more rapid results. Do not
administer within 2 hr of other laxatives,
especially mineral oil. May cause
increased absorption. Rect: Administer as a
retention or flushing enema. Assess for
LAB TEST CONSIDERATIONS: abdominal distention, presence of bowel
sounds, and usual pattern of bowel function.
Assess color, consistency, and amount of stool
produced.
Generic: diphenoxylate/atropine Trade: Lomotil Pharmacological: anticholinergics Therapeutic:
antidiarrheals Usual Dose: PO (Adults): 5 mg 3– 4 times daily initially, then 5 mg once daily as needed (not
to >20 mg/day).PO (Children): use liquid only—0.3– 0.4 mg/kg/day in 4 divided doses.
MODE OF ACTION: INDICATIONS:
Inhibits excess GI motility. Structurally Adjunctive therapy in the treatment of
related to opioid analgesics but has no diarrhea
analgesic properties. Atropine added to CONTRAINDICATIONS:
discourage abuse. Severe liver disease, infectious diarrhea
Therapeutic Effects: Decreased GI (due to Escherichia coli, Salmonella, or
motility with subsequent decrease in Shigella), diarrhea associated w/ C diff,
diarrhea. dehydrated pt, angle-closure glaucoma;
Children< 2 yr. Pregnancy category C

SIDE EFFECTS: NURSING CONSIDERATIONS:

Dizziness, constipation, Assess the frequency and consistency of
stools and bowel sounds prior to and
drowsiness, dry mouth throughout therapy. Assess patient’s fluid
and electrolyte balance and skin turgor for
dehydration. May be administered with food
if GI irritation occurs. Tablets may be crushed
and administered with patient’s fluid of
LAB TEST CONSIDERATIONS: choice.
LFT should be evaluated periodically
during prolonged therapy
Generic: magnesium hydroxide Trade: Milk of Magnesia Pharmacological: salines
Therapeutic: mineral and electrolyte replacements/supplements, laxatives
Dose: 5– 15 mL/dose up to 4 times/day 1244 mg/dose (2– 4 tabs) up to 4 times/day.
MODE OF ACTION: INDICATIONS:
liquid or 2.5– 7.5 mL/dose up
Essential for the activity of manyto 4 times/day as liquid concentrate
Tx/prevention mg/dose
of or 622–
hypomagnesemia. Laxative:
1244 mg/dose (2– 4 tabs) up to
enzymes. Play an important role in 4 times/day. bowel evacuant in prep for sx/radiographic
neurotransmission and muscular procedures. MOM has also been used as an
excitability. Are osmotically active in GI antacid.
tract, drawing water into the lumen and CONTRAINDICATIONS:
Pregnancy category UK, Hypermagnesemia;
causing peristalsis. Therapeutic Effects:
Hypocalcemia; Anuria; Heart block; Active
Replacement in deficiency states.
labor or within 2 hr of delivery (unless used for
Evacuation of the colon.
preterm labor).
SIDE EFFECTS:
NURSING CONSIDERATIONS:
Diarrhea, flushing, sweating Shake solution well before administration.
Laxative: Assess patient for abdominal
distention, presence of bowel sounds, and
usual pattern of bowel function. Assess color,
consistency, and amount of stool produced.
Antacid: Assess for heartburn and indigestion
LAB TEST CONSIDERATIONS: as well as location, duration, character, and
precipitating factors of gastric pain.
Generic: polyethylene glycol Trade: Miralax Pharmacological: osmotics Therapeutic: laxatives
Usual Dose: PO: Dissolve powder in 8 oz of water prior to administration

MODE OF ACTION: INDICATIONS:

Polyethylene glycol (PEG) in Treatment of occasional constipation.
solution acts as an osmotic agent,
drawing water into the lumen of the CONTRAINDICATIONS:
GI tract. Therapeutic Effects: Pregnancy category C, GI obstruction,
Evacuation of the GI tract without Gastric retention, Toxic colitis,
water or electrolyte imbalance. Megacolon, Bowel perforation

NURSING CONSIDERATIONS:
SIDE EFFECTS: Assess patient for abdominal distention,
Abdominal pain, cramping,
presence of bowel sounds, and usual
bloating, flatuance, nausea
pattern of bowel function. Assess color,
consistency, and amount of stool
produced. Inform patient that 2– 4 days
may be required to produce a bowel
LAB TEST CONSIDERATIONS: movement. PEG should not be used for
more than 2 wk. Prolonged, frequent, or
excessive use may result in electrolyte
imbalance and laxative dependence.
 Generic: metronidazole Trade: Flagyl, Metro gel, Metro cream Therapeutic: anti-infectives,
anti-protozoals, antiulcer agents Usual Dose: PO (Adults): Anaerobic infections 7.5 mg/kg q 6 hr (max 4
g/day). Trichomoniasis 250 mg q 8 hr for 7 days or single 2-g dose or 1 g BID for 1day. Amebiasis 500– 750 mg q 8 hr for
5– 10 days. H. pylori 250 mg QID IV (Adults): Anaerobic infections Initial dose 15 mg/kg, then 7.5 mg/kg q 6– 8 hr or 500
mg q 6– 8 hr (not to exceed 4 g/day).
MODE OF ACTION: INDICATIONS:
PO, IV: Tx of the following anaerobic infections: Intra-abdominal
Disrupts DNA & protein synthesis in susceptible infections (may be used with a cephalosporin), gyn infections,
skin infections, lower respiratory tract infections, bone/joint
organisms. Therapeutic Effects: Bactericidal, infections, CNS infections, septicemia, endocarditis. IV
trichomonacidal, or amebicidal action. Spectrum: Perioperative prophylactic agent in colorectal sx. PO: Amebicide
Most notable for activity against anaerobic in the mgmt. of amebic dysentery, amebic liver abscess, and
bacteria, including: Bacteroides, clostridium. In trichomoniasis: Tx of PUD caused by H-pylori. Topical Tx of acne
addition, is active against: Trichomonas vaginalis, rosacea. Vag: Mgmt of bacterial vaginosis. Unlabeled Use: Tx of
giardiasis. Tx of anti-infective associated C difficile-associated
entamoeba histolytica, giardia lamblia, h. pylori, c diarrhea (CDAD).
difficile.
SIDE EFFECTS: CONTRAINDICATIONS:
Dizziness, HA, nausea, aseptic Pregnancy Category B, First trimester of pregnancy
meningitis (IV), abdominal pain, NURSING CONSIDERATIONS:
encephalopathy (IV), anorexia, dry Assess for infection (vital signs; appearance of wound,
sputum, urine, and stool; WBC at beginning of and
mouth, lightheadedness, Steven Johnson
throughout therapy Monitor neurologic status during &
syndrome, metallic taste, may cause after IV infusions. Inform HCP if numbness, paresthesia,
urine to be dark weakness, ataxia, or seizures occur. Monitor I&O & daily
weight, especially for pt on NA restriction. Each 500 mg
LAB TEST CONSIDERATIONS: of premixed injection for dilution contains 14 mEq of NA.
Obtain specimens for C+S before Caution pt to avoid intake of etoh beverages or
initiating therapy. preparations containing etoh during and for at least 3
days after tx. Assess for rash periodically during therapy.
Generic: enoxaparin Trade: Lovenox Pharmacological: antithrombotics, heparins (low molecular
weight) Therapeutic: anticogulants Usual Dose: DVT/PE Subcut (Adults): Outpatient 1 mg/kg q 12 hr Subcut
(Infants and Children 2 mo-18 yr): 1 mg/kg/dose q 12 hr. Subcut (Infants 1– 2 mo): 1.5 mg/kg/dose q 12 hr.
MODE OF ACTION: INDICATIONS:
Prevention of venous thromboembolism VTE, DVT and/or
Potentiates the inhibitory effect of PE. Tx of DVT w/ or w/o PE (with warfarin). Prevention of
antithrombin on factor Xa and thrombin. ischemic complications (w/ asa) from unstable angina and
Therapeutic Effects: Prevention of non-ST-segment-elevation MI. Tx of acute
thrombus formation ST-segment-elevation MI (with thrombolytics or
CONTRAINDICATIONS:
percutaneous coronary intervention).
Hypersensitivity to benzyl alcohol (multidose vial);
SIDE EFFECTS: Positive in vitro test for antiplatelet antibody in the
Hyperkalemia, bleeding, anemia, presence of enoxaparin; Active, major bleeding.
bruising, thrombocytopenia Pregnancy category B
NURSING CONSIDERATIONS:
Assess for signs of bleeding and hemorrhage,
bleeding from surgical site. Notify HCP if these
occur. Assess pt for evidence of additional or
LAB TEST CONSIDERATIONS: increased thrombosis. Sx’s depend on area of
Monitoring of the aPTT may be considered involvement. Advise pt to report any sx’s of
in certain pt populations (such as obese unusual bleeding or bruising, dizziness, itching,
patients or pt w/ renal insufficiency). rash, fever, swelling, or difficulty breathing to
Monitoring of Antifactor Xa levels may be HCP ASAP. Instruct pt not to take NSAIDS
necessary to titrate doses in pediatric pt without consulting HCP. Subcut: Administer
Therapeutic range 0.5– 1 unit/mL. deep into subcut tissue. Alternate injection sites
daily
Generic: Heparin Pharmacological: antithrombotics Therapeutic: anticoagulants Usual Dose: IV
(Adults): Intermittent bolus 10,000 units, followed by 5000– 10,000 units q4– 6 hr. Continuous infusion :5000 units (35– 70 units/kg),
followed by 20,000– 40,000 units infused over 24 hr . Subcut (Adults): 5000 units IV, followed by initial subcut dose of 10,000– 20,000
units, then 8000– 10,000 units q 8 hr or 15,000– 20,000 units q 12 hr Prophylaxis of Thromboembolism: Subcut (Adults): 5000 units q
8– 12 hr (may be started 2 hr prior to sx
MODE OF ACTION: INDICATIONS:
Potentiates the inhibitory effect of antithrombin Prophylaxis and tx of various thromboembolic disorders
on factor Xa and thrombin. In low doses, including: Venous thromboembolism, PE, atrial
prevents the conversion of prothrombin to fibrillation, acute/chronic consumptive coagulopathies,
thrombin by its effects on factor Xa. Higher peripheral arterial thromboembolism. Used in very low
doses (10– 100 units) to maintain patency of IV
doses neutralize thrombin, preventing the
catheters (heparin flush).
conversion of fibrinogen to fibrin. CONTRAINDICATIONS:
Therapeutic Effects: Prevention of thrombus Pregnancy category C
formation. Prevention of extension
of existing thrombi (full dose). NURSING CONSIDERATIONS:
Assess for signs of bleeding and hemorrhage
SIDE EFFECTS: (bleeding gums; nosebleed; unusual bruising;
Bleeding, hematoma formation, thrombocytopenia,
hyperkalemia, toxicity/OD, ↑LFT, anemia, black, tarry stools; hematuria; fall in hematocrit or
Osteoporosis (long term use) BP; guaiac-positive stools). Assess pt for evidence
LAB TEST CONSIDERATIONS: of additional or increased thrombosis. Sx’s will
Monitor aPTT and HCT prior to and periodically depend on area of involvement. Inform all caring for
during therapy. W/ intermittent IV therapy is used, pt of anticoagulant therapy. Venipunctures and
draw aPTT levels 30 min before q dose during initial injection sites require application of pressure. Avoid
therapy and then periodically. During continuous IM injections of other medications. Subcut:
administration, monitor aPTT levels Q 4 hr during
Administer deep into subcut tissue. Instruct pt not to
early therapy. For Subcut therapy, draw blood 4–6 hr
after injection. Ck platelet count every 2–3 days
take medications containing aspirin or NSAIDs
throughout therapy while on heparin therapy
Melissa Ingram
Generic: warfarin Trade: Coumadin Pharmacological: coumarins Therapeutic: anticoagulant
Usual Dose: Therapeutic PT ranges 1.3– 1.5 times greater than control; Normal INR(not on anticoagulants) is 0.8– 1.2.
An INR of 2.5– 3.5 is recommended for pt at ↑risk of embolization. Lower levels are acceptable when risk is low
lower. H MODE OF ACTION: INDICATIONS:
Interferes with hepatic synthesis of vitamin Prophylaxis and tx of: Venous thrombosis,
K-dependent clotting factors (II, VII, IX, pulmonary embolism, a fib. Mgmt of MI: ↓ risk of
and X). Therapeutic Effects: Prevention death, Decreases risk of subsequent MI, ↓ risk of
of thromboembolic events. future thromboembolic events. Prevention of
thrombus formation and embolization after
prosthetic valve placement.
SIDE EFFECTS: CONTRAINDICATIONS:
Bleeding, anemia, toxicity/OD, dermal Pregnancy category X, Uncontrolled bleeding; Open
necrosis, bruising wounds; Active ulcer disease, Recent brain, eye, or
spinal cord injury or surgery, Severe liver/kidney disease
NURSING CONSIDERATIONS:
Assess for signs of bleeding and hemorrhage. Assess for
evidence of additional or increased thrombosis. Advise
LAB TEST CONSIDERATIONS: Ingestion of large quantities of foods high in vitamin K
content may antagonize the anticoagulant effect of
Monitor hepatic function and CBC before warfarin. Instruct pt not to drink ETOH or take other Rx,
and periodically throughout therapy. OTC, or herbal products, especially those containing
Monitor stool and urine for occult blood aspirin or NSAIDs, or to start or stop any new meds during
before and periodically during therapy warfarin therapy without advice of HCP. Advise pt to report
any sx’s of unusual bleeding or bruising. Because of the
large number of meds capable of significantly altering
warfarin’s effects, careful monitoring is recommended
when new agents are started or other agents are d/c
Generic: gabapentin Trade: Neurontin Pharmacological: therapeutic: analgesic adjuncts,
anticonvulsants, mood stabilizers Usual Dose: PO (Adults): IR-300 mg once daily on first day,
then 300 mg bid on 2nd day then 300 mg tid on day 3, may then be ↑ as prn to 600 mg tid
MODE OF ACTION: INDICATIONS:
Mechanism of action is not known. May Partial seizures (adjunct treatment)
affect transport of amino acids across and (immediate-release only). Postherpetic neuralgia,
stabilize neuronal membranes. RLS
Therapeutic Effects: ↓ incidence of Unlabeled Use: Neuropathic pain, prevention of
seizures. ↓postherpetic pain. ↓ leg migraine HA, bipolar d/o, anxiety, diabetic
neuropathy CONTRAINDICATIONS:
restlessness.
Pregnancy Category C
NURSING CONSIDERATIONS:
SIDE EFFECTS: Advise pt not to take w/i 2 hr of an antacid. Monitor
closely for notable changes in behavior that could
Drowsiness, dizziness, behavior/mood
indicate worsening of suicidal thoughts or behavior or
changes, leukopenia
depression. Seizures: Assess location, duration, and
characteristics of seizure activity. Postherpetic
Neuralgia & Neuropathic Pain: Assess location,
characteristics, and intensity of pain periodically during
therapy. Migraine Prophylaxis: Monitor frequency and
LAB TEST CONSIDERATIONS: intensity of pain on pain scale. RLS: Assess frequency
and intensity of RLS prior to and periodically during
therapy. Gabapentin should be discontinued gradually
over at least 1 wk. If dose is 600 mg/day, may d/c w/o
tapering
 Generic: prednisone Therapeutic: anti-inflammatories (steroidal) (intermediate acting), immune
modifiers Usual Dose: PO (Adults): Most uses 5– 60 mg/day as a single dose or in divided doses (delayed-release
tablets should be administered once daily). MS 200 mg/day for 1 wk, then 80 mg QOD UT DICT
MODE OF ACTION: INDICATIONS:
In pharmacologic doses, suppresses Used systemically and locally in a wide variety of chronic
diseases including: Inflammatory, allergic, hematologic,
inflammation and the normal immune response.
neoplastic, autoimmune disorders. Suitable for
Has numerous intense metabolic effects. alternate-day dosing in the mgmt of chronic illness.
Suppresses adrenal function at chronic doses of Unlabeled Use: Adjunctive therapy of hypercalcemia.
5 mg/day. Replaces endogenous cortisol in Adjunctive mgmt of nausea and vomiting from
deficiency states. Has minimal mineralocorticoid chemotherapy.
activity. Therapeutic Effects: Suppression of CONTRAINDICATIONS:
Active untreated infections (may be used in patients being
inflammation and modification of the normal treated for tuberculous meningitis); Some products contain
immune response. alcohol and should be avoided in patients with known
intolerance. Pregnancy category C
SIDE EFFECTS: NURSING CONSIDERATIONS:
Hypokalemia, depression, euphoria, anorexia, Indicated for many conditions. Assess involved
nausea, decreased wound healing, systems before and periodically during therapy.
hyperglycemia, osteoporosis, fragility Assess pt for signs of adrenal insufficiency
LAB TEST CONSIDERATIONS: (hypotension, weight loss, weakness, nausea,
Pt on prolonged courses of therapy should vomiting, anorexia, lethargy, confusion, restlessness)
routinely have hematologic values, before and periodically during therapy. Monitor intake
serum electrolytes, and serum and urine and output ratios and daily weights. Observe pt for
glucose evaluated. May decrease WBC peripheral edema, steady weight gain,
counts. May ↓ K+, calcium & ↑serum sodium rales/crackles, or dyspnea. Monitor serum
concentrations. electrolytes and glucose. May cause hyperglycemia,
especially pt w/ DM.
 Generic: Adrenalin Trade: epinephrine Pharmacological: adrenergics
Therapeutic: anti-asthmatics, bronchodilators, vasopressors Usual Dose: Subcut, IM (Adults): Anaphylactic
reactions/asthma 0.1– 0.5 mg (single dose max 1 mg); may repeat q 10– 15 min for anaphylactic shock or q 20 min– 4 hr for asthma.
MODE OF ACTION: INDICATIONS:
Results in the accumulation of cyclic adenosine Subcut, IV, Inhale: Mgmt of reversible airway disease due
monophosphate (cAMP) at beta-adrenergic to asthma or COPD. Subcut, IM, IV: Management of severe
receptors. Affects both beta1(cardiac)-adrenergic allergic reactions. IV, Intracardiac, Intratracheal,
receptors and beta2(pulmonary)-adrenergic Intraosseous (part of ACLS and PALS guidelines): Mgmt of
receptor sites. Produces bronchodilation. Also has cardiac arrest (unlabeled). Inhaln: Management of upper
alpha-adrenergic agonist properties, which result in airway obstruction and croup (racemic epinephrine).
vasoconstriction. Inhibits the release of mediators Local/Spinal: Adjunct in the localization/prolongation of
of immediate hypersensitivity reactions from mast anesthesia.
cells. Therapeutic Effects: Bronchodilation. CONTRAINDICATIONS:
Maintenance of heart rate and BP. Pregnancy Category C
Localization/prolongation of local/spinal anesthetic
NURSING CONSIDERATIONS:
Bronchodilator: Assess lung sounds, respiratory pattern, pulse,
SIDE EFFECTS: and BP before administration and during peak of med. Note
amount, color, and character of sputum produced. Monitor PFT
IM may cause tissue necrolysis, hyper before and periodically during therapy. Observe pt for drug
glycemia, nervousness, restless, tremor, tolerance and rebound bronchospasm. Pt’s requiring more than 3
tachycardia, angina, HTN, hypoglycemia inhalation treatments in 24 hr should be under close supervision.
If minimal or no relief is seen after 3– 5 inhalation treatments
within 6– 12 hr, further tx w/ aerosol alone is not recommended.
Assess for hypersensitivity reaction. : Monitor BP, pulse, ECG,
LAB TEST CONSIDERATIONS: and respiratory rate frequently during IV administration.
Continuous ECG, hemodynamic parameters, and urine output
should be monitored continuously during IV administration.
Monitor for chest pain, arrhythmias, heart rate >110 bpm, and
hypertension. Shock: Assess volume status. Correct hypovolemia
prior to administering epinephrine IV
Generic: diphenyhydramine Trade: Benadryl Therapeutic: allergy, cold, and cough remedies,
antihistamines, antitussives Usual Dose: PO (Adults and Children 12 yr) : Antihistaminic, antiemetic,
antivertiginic 25– 50 mg q 4– 6 hr, max 300 mg/day. Antitussive 25 mg q 4 hr prn, max 150 mg/day. Antidyskinetic 25– 50
mg q 4 hr(max 400 mg/day). Sedative/hypnotic 50 mg 20– 30 min before bedtime.
MODE OF ACTION: INDICATIONS:
Antagonizes the effects of histamine at Relief of allergic sx’s caused by histamine release
H1-receptor sites; does not bind to or inactivate including: Anaphylaxis, Seasonal and perennial allergic
histamine. Significant CNS depressant and rhinitis, Allergic dermatoses. Parkinson’s disease and
anticholinergic properties. Therapeutic dystonic reactions from meds. Mild nighttime sedation.
Effects: Decreased symptoms of histamine Prevention of motion sickness. Antitussive (syrup only).
excess (sneezing, rhinorrhea, nasal and ocular CONTRAINDICATIONS:
pruritus, ocular tearing and redness, urticaria).
Relief of acute dystonic reactions. Prevention
Pregnancy category B, Acute attacks of
of motion sickness. Suppression of cough. asthma NURSING CONSIDERATIONS:
SIDE EFFECTS:
When used for insomnia, administer 20 min before
Sedation, confusion, delirium (especially bedtime and schedule activities to minimize
geri), drowsiness, anorexia , dry mouth. interruption of sleep. PO: Administer with meals or
Can cause excitation in peds. May ↓ skin milk to minimize GI irritation. Capsule may be
response to allergy tests. D/C 4 emptied and contents taken with water/food. Advise
days before skin testing. pt to use sunscreen and protective clothing to prevent
photosensitivity reactions. Caution pt to avoid use of
LAB TEST CONSIDERATIONS: etoh and other CNS depressants concurrently with
this med. Geri: Instruct older adults to avoid OTC
products that contain diphenhydramine due to ↑
sensitivity to anticholinergic effects and potential for
adverse reactions related to these effects.
Generic: pantoprazole Trade: Protonix Pharmacological: PPI Therapeutic: antiulcer agents
Usual Dose: GERD IV (Adults): 40 mg once daily for 7– 10 days, PO (Adults): Short-term treatment of erosive esophagitis associated with GERD
40 mg QD for up to 8 wk; Maintenance of healing of erosive esophagitis—40 mg once daily MAX: up to 120 mg BID

MODE OF ACTION: INDICATIONS:

Binds to an enzyme in the presence of acidic Erosive esophagitis associated with GERD.
gastric pH, preventing the final transport of Maintenance of healing of erosive esophagitis.
hydrogen ions into the gastric lumen. Therapeutic
Pathologic gastric hypersecretory conditions.
Effects: Diminished accumulation of acid in the
gastric lumen, with lessened acid reflux. Healing of Unlabeled Use: Adjunctive tx of duodenal
duodenal ulcers and esophagitis. Decreased acid ulcers associated with H pylori.
secretion in hypersecretory conditions.
CONTRAINDICATIONS:
Pregnancy category B; small % Pt will not
SIDE EFFECTS: respond to PPI
May cause ↑AST, ALT, alkaline NURSING CONSIDERATIONS:
phosphatase, and bilirubin. Hypo Pt’s receiving pantoprazole IV should be
magnesium, CDAD hyperglycemia, converted to PO dosing as soon as possible.
bone pain, abdominal pain, fx. Monitor bowel function. Diarrhea, abd
cramping, fever, and bloody stools should be
LAB TEST CONSIDERATIONS: reported to HCP promptly as a sign of CDAD.
Monitor serum magnesium prior to and Assess patient routinely for epigastric or abd
periodically during therapy. May ↑ on or frank or occult blood in stool, emesis, or
risk of bleeding with warfarin(monitor gastric aspirate. Advise patient to avoid
INR/PT) alcohol, products containing aspirin or
NSAIDs, and foods that may cause an
increase in GI irritation
Generic: trazodone Therapeutic: antidepressants Usual Dose: PO (Adults): 150 mg/day in 3
divided doses;↑by 50 mg/day q 3– 4 days until desired response (max 400 mg/day in outpatients or 600 mg/day in hospitalized
patients). PO (Geriatric Patients): 75 mg/day in divided doses initially; may be ↑ q 3– 4 days. Insomnia PO (Adults): 25– 100 mg at
bedtime
MODE OF ACTION: INDICATIONS:
Alters the effects of serotonin in the CNS. Major depression
Therapeutic Effects: Antidepressant Unlabeled Use: Insomnia, chronic pain syndromes,
action, which may develop only over including diabetic neuropathy, and anxiety.
several weeks. CONTRAINDICATIONS:
Pregnancy category C, Recovery period after MI,
SIDE EFFECTS:
Concurrent electroconvulsive therapy, Concurrent
Dry mouth, sexual dysfunction, serotonin
use of MAO inhibitors or or MAO-like drugs,
syndrome, suicidal thoughts, drowsiness,
Angle-closure glaucoma.
blurred vision, hypotension
NURSING CONSIDERATIONS:
Monitor BP/pulse rate before and during initial therapy.
Monitor ECGs in Pt w/ pre-existing cardiac disease before
and periodically during therapy to detect arrhythmias.
Assess for serotonin syndrome (mental changes [agitation,
hallucinations, coma], autonomic instability [tachycardia,
labile BP, hyperthermia], neuromuscular aberrations and/or
GI sx’s. Depression: Assess mental status frequently.
Assess for suicidal tendencies, especially during early
LAB TEST CONSIDERATIONS: therapy. Instruct patient to notify HCP if priapism, irregular
Assess CBC and renal and hepatic function heartbeat, fainting, confusion, rash, or tremors occur or if
before and periodically during therapy dry mouth, nausea and vomiting, dizziness, headache,
muscle aches, constipation, or diarrhea becomes
pronounced.
Generic: albuterol and ipratropium vials Pharmacological: bronchodilators,
Antimuscarinic Usual Dose: One 3 mL vial by nebulization 4 times a day with up to 2 additional 3 mL
doses allowed per day. Max recommended dose is 6 vials (18 mL)/day
MODE OF ACTION: INDICATIONS:
Maintenance therapy in COPD including chronic
A sterile inhalation solution containing a bronchitis and emphysema.
combination of albuterol and ipratropium.
Albuterol and ipratropium are anticholinergic CONTRAINDICATIONS:
bronchodilators that relax muscles in the Allergy to albuterol (Proventil, Ventolin), ipratropium
airways and increase air flow to the lungs or atropine. Pregnancy category B-TETATOGENIC
through two distinctly different mechanisms: EFFECTS. Not approved for use by anyone <18 y/o
sympathomimetic (albuterol sulfate) and
anticholinergic/parasympatholytic (ipratropium
bromide).
SIDE EFFECTS: NURSING CONSIDERATIONS:
Cold sx’s, HA, trouble breathing, Warn pt not to exceed prescribed dose as
fatalities have been reported in association
rash, angioedema, shock, nausea, with ↑ use of inhaled products containing
constipation, dry mouth sympathomimetic amines and with the home
use of nebulizers. Paradoxical bronchospasm
has occurred with nebulized solution, therefore
first dose should be used under medical
LAB TEST CONSIDERATIONS: supervision. Evaluate therapeutic response.
Assess pulse, respiratory rate and lung sound
before and after tx. Wait 5 min between this
and other inhaled medications.
 Generic: hydralazine Pharmacological: vasodilator Therapeutic: antihypertensives
Usual Dose: PO (Adults): HTN 10 mg QID initially. After 2-4 days may↑to 25 mg QID for the rest of the 1st week; ; may
then ↑ to 50 mg QID(max 300 mg/day). HF 25– 37.5 mg QID ; max 300 mg/day in 3– 4 divided doses. IM, IV (Adults): HTN
5-40 mg PRN. Eclampsia 5mg q 15– 20 min; if no response after a total of 20 mg, consider an alternative agent
MODE OF ACTION: INDICATIONS:
Direct-acting peripheral arteriolar Moderate to severe hypertension (with a diuretic).
Unlabeled Use: HF unresponsive to conventional
vasodilator. Therapeutic Effects:
therapy with digoxin and diuretics.
Lowering of BP in hypertensive
patients and decreased afterload CONTRAINDICATIONS:
in patients with HF. Pregnancy category C, Hypersensitivity, Some
products contain tartrazine & should be avoided in
pt with known intolerance.
SIDE EFFECTS:
Tachycardia, drug induced lupus NURSING CONSIDERATIONS:
syndrome, sodium retention, Monitor BP and pulse frequently during initial dose
orthostatic hypotension, drowsiness adjustment and periodically
during therapy. Patients should weigh themselves
2x’s weekly and assess feet and ankles for fluid
LAB TEST CONSIDERATIONS: retention. Pharmacist may prepare oral solution from
Monitor CBC, electrolytes, LE cell prep, hydralazine injection for pt with difficulty swallowing.
and ANA titer prior to and periodically PO: Administer with meals consistently to enhance
during prolonged therapy absorption. IM or IV route should be used only when
drug cannot be given orally.
Generic: ondansetron Trade: Zofran, Zofran ODT Pharmacological: 5-HT3 antagonists
Therapeutic: antiemetic Usual Dose: Post op nausea:>11 y/o 16 mg 1 hr before start of anesthesia. IM, IV
(Adults): Prevention of postop n/v 4 mg before anesthesia or postop IV (Children 1 mo–12 yr and >40 k g): Prevention of
postop n/v 4 mg. IV (Children 1 mo–12 yr and ≤40 kg): Prevention of postop n/v—0.1 mg/kg.

MODE OF ACTION: INDICATIONS:

Blocks the effects of serotonin at Prevention of nausea and vomiting associated with
5-HT3– receptor sites (selective highly or moderately emetogenic
antagonist) in vagal nerve terminals and chemotherapy. PO: Prevention of n/v associated w/
the chemoreceptor trigger zone in CNS. radiation therapy. Prevention/tx of post n/v.
Therapeutic Effects: Decreased CONTRAINDICATIONS:
incidence and severity of nausea and
Hypersensitivity, ODT contain aspartame & should
vomiting following chemotherapy or sx.
not be used in pt w/ phenylketonuria; Congenital
SIDE EFFECTS: long QT syndrome, concurrent use of apomorphine.
PO, IM, IV (Adults) w/ severe hepatic
HA, constipation, diarrhea, Steven impairment-MAX 8 mg/day. Pregnancy Cat B
Johnson syndrome, dry mouth, NURSING CONSIDERATIONS:
toxic epidermal necrolysis Assess pt for n/v, abdominal distention, and bowel sounds
prior to and following administration. Assess pt for
extrapyramidal effects (involuntary movements, facial
grimacing, rigidity, shuffling walk, trembling of hands)
LAB TEST CONSIDERATIONS: periodically during therapy. Monitor ECG in patients with
hypokalemia, hypomagnesemia, HF, bradyarrhythmias.
Advise pt to HCP ASAP if sx’s of irregular heart beat,
serotonin syndrome, or involuntary movement of eyes, face,
or limbs occur.
Generic: tramadol Trade: Ultram Therapeutic: analgesics (centrally acting)
Usual Dose: PO (Adults 18 yr): Rapid titration—50– 100 mg q 4– 6 hr (not to exceed 400 mg/day [300 mg in
patients 75 yr]
mg MODE OF ACTION: INDICATIONS:
Binds to u-opioid receptors. Inhibits Moderate to moderately severe pain
reuptake of serotonin and norepinephrine (extended-release formulations indicated for
in the CNS. patients who require around-the-clock pain
Therapeutic Effects: Decreased pain. management).
CONTRAINDICATIONS:
Hypersensitivity, cross-sensitivity w/ opioids may occur,
pt’s who are acutely intoxicated with etoh,
sedatives/hypnotics, centrally acting analgesics, opioid
SIDE EFFECTS:
analgesics, or psychotropic agents; Pt’s who are physically
Dizziness, drowsiness, HA, dependent on opioid analgesics. Pregnancy category C
insomnia, constipation, nausea, NURSING CONSIDERATIONS:
serotonin syndrome, physical Assess type, location, and intensity of pain before and
dependence, orthostatic 2– 3 hr (peak) after administration. Assess BP &
hypotension, decreased seizure respiratory rate before & periodically during
administration. Assess bowel function routinely.
threshold Prevention of constipation should be instituted w/ I ↑
intake of fluids & bulk & w/ laxatives. Prolonged use
may lead to physical/psychological
LAB TEST CONSIDERATIONS: dependence/tolerance. Monitor patient for seizures.
Tramadol should be d/c gradually after long-term use to
prevent w/d symptoms. Caution pt to avoid concurrent
use of etoh or other CNS depressants with this med
Generic: ferrous sulfate Trade: Feosol, Feratab Pharmacological: iron supplements
Therapeutic: anti-anemics Usual Dose: PO (Adults): Deficiency— 2– 3 mg/kg/day in 2– 4 divided doses or 60–
100 mg elemental iron BID. Prophylaxis—60– 100 mg elemental iron daily.
MODE OF ACTION: INDICATIONS:
An essential mineral found in hemoglobin, Tx & prevention iron deficiency anemia.
myoglobin, and many enzymes. Enters
the bloodstream and is transported to the
organs of the reticuloendothelial system CONTRAINDICATIONS:
(liver, spleen, bone marrow) where it Anemia not due to iron deficiency,
becomes part of iron stores. Therapeutic hemochromatosis, hemosiderosis.
Effects: Resolution or prevention of iron Hypersensitivity to iron products.
deficiency anemia. NURSING CONSIDERATIONS:
Assess bowel function for constipation or
SIDE EFFECTS: diarrhea. Occult blood in stools may be
Nausea, constipation, dark stools, obscured by black coloration of iron in stool.
epigastric pn, toxicity/OD Guaiac test results may be false +. Oral
preparations are most effectively absorbed if
administered 1 hr before or 2 hr after meals. If
LAB TEST CONSIDERATIONS:
Monitor H&H & reticulocyte values prior gastric irritation occurs, give w/ meals. Take
to & q 3 wk during the first 2 mo of tablets/capsules with a full glass of h2o or juice.
therapy and periodically thereafter. Liquid preparations may stain teeth. Dilute in
Serum ferritin and iron levels may also water or fruit juice, full glass (240 mL) for adults
be monitored to assess effectiveness of and glass (120 mL) for children, and administer
therapy. with a straw or place drops at back of throat.
Generic: clonazepam Trade: Klonopin Pharmacological: benzodiazepines Therapeutic:
anticonvulsants Usual Dose: PO (Adults): 0.5 mg 3 times daily; may ↑ by 0.5– 1 mg q 3 days. Total daily
maintenance dose not to exceed 20 mg. Panic disorder—0.125 mg twice daily;↑after 3 days toward target dose of 1
mg/day (some pts may require up to 4 mg/day).
MODE OF ACTION: INDICATIONS:
Prophylaxis of: Petit mal, Lennox-Gastaut, Akinetic,
Anticonvulsant effects may be due to Myoclonic seizures. Panic disorder w/ or w/o agoraphobia.
Unlabeled Use: Uncontrolled leg movements during sleep.
presynaptic inhibition. Produces sedative
Neuralgias. Infantile spasms. Sedation. Adjunct
effects in the CNS, probably by stimulating management of acute mania, acute psychosis, or insomnia
inhibitory GABA receptors. Therapeutic CONTRAINDICATIONS:
Effects: Prevention of seizures. ↓ Pregnancy category D, severe hepatic impairment.
manifestations of panic d/o. Geri: May experience excessive sedation at usual
doses;↓dosage recommended.
SIDE EFFECTS:
Drowsiness, behavioral changes, ataxia, NURSING CONSIDERATIONS:
Monitor closely for notable changes in behavior that could
suicidal thoughts, fatigue, drowsiness, indicate the emergence or worsening of suicidal thoughts
dizziness or behavior or depression. Institute seizure precautions for
patients on initial therapy or undergoing dose
manipulations. PO: Administer w/ food to ↓ gastric
LAB TEST CONSIDERATIONS: irritation. Observe/record intensity, duration, and location of
Pt’s on prolonged therapy should have seizure activity. Assess degree/manifestations of anxiety
CBC and LFT results evaluated and mental status (orientation, mood, behavior) prior to &
periodically. May cause an↑ in serum periodically during therapy. Instruct pt/family to notify HCP
bilirubin, AST/ALT. of unusual tiredness, bleeding, sore throat, fever,
clay-colored stools, yellowing of skin, or behavioral
changes. Advise pt and family to notify HCP if thoughts
about suicide or dying
Generic: famotidine Trade: Pepcid Pharmacological: histamine H2 antagonists Therapeutic:
antiulcer agents Usual Dose: GERD-20 mg BID for up to 6 wk; up to 40 mg BID for up to 12 wk for esophagitis
with erosions, ulcerations. PO, IV (Children 1– 12 yr): GERD-1 mg/kg/day PO (Infants 3 mo-1 yr): GERD-0.5 mg/kg/dose
BID in divided doses twice daily (max 80 mg daily).
MODE OF ACTION: INDICATIONS:
Short-term tx of active duodenal ulcers and benign gastric ulcers.
Maintenance therapy for duodenal ulcers after healing of active
Inhibits the action of histamine at the ulcer(s). Mgmt of GERD. Tx of heartburn, acid indigestion & sour
H2-receptor site located primarily in stomach (OTC use). Mgmt of gastric hypersecretory states
gastric parietal cells, resulting in (Zollinger-Ellison syndrome). Prevention & tx of stress-induced ↑ GI
bleeding in critically ill patients. Unlabeled Use: Management of GI
inhibition of gastric acid secretion. symptoms associated with the use of NSAIDs. Prevention of stress
Therapeutic Effects: Healing & ulceration or aspiration pneumonitis. Prevention of acid inactivation
prevention of ulcers. Decreased sx’s of of supplemental pancreatic enzymes in pt’s w/ pancreatic
insufficiency. Mgmt of urticaria.
gerd. Decreased secretion of gastric
acid. CONTRAINDICATIONS:
SIDE EFFECTS: Pregnancy category B, Phenylketonuria
(chewable tablets only)
Confusion, aplastic anemia, NURSING CONSIDERATIONS:
Assess for epigastric or abdominal pn and frank/occult blood in
dizziness, drowsiness, the stool, emesis, or gastric aspirate. Geri: Assess elderly &
constipation debilitated patients routinely for confusion. PO: Administer w/
meals or immediately afterward and at hs to prolong effect.
Doses administered once daily should be administered at hs to
LAB TEST CONSIDERATIONS: prolong effect. Inform pt that smoking interferes w/ the action
of histamine antagonists. Advise patient to avoid etoh,
Monitor CBC with differential products containing asa or NSAIDs, and foods that cause an ↑
periodically during therapy. in GI irritation. Inform pt that ↑ fluid & fiber intake and exercise
may minimize constipation. Advise pt to report onset of
black/tarry stools; fever; ST; diarrhea; dizziness; rash;
confusion; or hallucinations to HCP.
Generic: apixaban Trade: Eliquis Pharmacological: factor Xa inhibitors
Therapeutic: anticoagulants Usual Dose: 2.5, 5 or 10 mg po BID
MODE OF ACTION: INDICATIONS:
↓ risk of stroke/systemic embolism associated w/
Acts as a selective, reversible site inhibitor nonvalvular afib. Prevention of DVT that may lead to PE
of factor Xa, inhibiting both free & bound s/p knee or hip replacement sx. Tx of and reduction in risk
factor. Doesn’t affect platelet aggregation of recurrence DVT/PE.
directly, but does inhibit thrombin induced CONTRAINDICATIONS:
platelet aggregation. ↓ thrombin generation Pregnancy category B, active pathological bleeding, severe
and thrombus development. Therapeutic hepatic impairment, Not recommended for use in patients
w/ prosthetic heart valve
Effects: Tx & prevention of
NURSING CONSIDERATIONS:
thromboembolic events.
Assess pt for sx’s of stroke, DVT, PE, or PVD
SIDE EFFECTS: periodically during therapy. Inform pt that they may
Bleeding, anaphylaxis bruise/bleed more easily or longer than usual. Advise
LAB TEST CONSIDERATIONS: pt to notify HCP immediately if signs of bleeding
When converting from warfarin, d/c warfarin and occurs, especially head injury. When switching b/t
start apixaban when INR is 2.0. When apixaban & anticoagulants other than warfarin, d/c 1
converting from apixaban to warfarin, apixaban being taken and begin the other at the next
affects INR, so INR measurements may not be scheduled dose. For sx, d/c apixaban at least 48 hrs
useful for determining right dose of warfarin. If before invasive or sx procedures w/ a moderate/high
continuous anticoagulation is necessary, d/c risk significant bleeding or at least 24 hrs prior to
apixaban and begin both a parenteral procedures w/ a low risk. For pt’s who cannot swallow
anticoagulant and warfarin at time of next dose tablet, 5 mg and 2.5 mg tablets can be crushed,
of apixaban, d/c parenteral anticoagulant when suspended in 60 mL of D5W, and administered
INR reaches acceptable range immediately through a NG tube; do not administer
 Generic: ceftriaxone Trade: Rocephin Pharmacological: 3rd gen cephalosporins Therapeutic:
anti-infectives Usual Dose: IM, IV (Adults): Most infections 1– 2 g q12-24hr, Gonorrhea 250 mg IM (single dose).
Meningitis 2 g q12 hr. Perioperative prophylx8s 0.5– 2 hr before sx. IM, IV (Children): Most infections 50-75 mg/kg/day
(not to >2 g/day) divided every 12– 24 hr
MODE OF ACTION: INDICATIONS:
Binds to the bacterial cell wall membrane, causing Tx of skin/skin structure infections, bone & joint infections,
cell death. Therapeutic Effects: Bactericidal action UTI, Uncomplicated gynecological infections including
against susceptible bacteria. Spectrum: Similar to gonorrhea, lower respiratory tract infections, intra-abdominal
that of 2nd generation cephalosporins, but activity infections, septicemia, meningitis, OM. Perioperative
prophylaxis
against staphylococci is ↓, while CONTRAINDICATIONS:
activity against gram - pathogens is >, even for Pregnancy category B, hypersensitivity to cephalosporins, serious
organisms resistant to 1st & 2nd generation agents. hypersensitivity to pcn; Pedi: Premature neonates up to a
Notable is ↑action against: acinetobacter, postmenstrual age of 41 wk; Pedi: Hyperbilirubinemic neonates
enterobacter, haemophilus influenzae, haemophilus (may lead to bilirubin encephalopathy); Pedi: Neonates 28 days
requiring calcium-containing IV solutions
parainfluenzae, e coli, klebsiella pneumoniae,
Morganella morganii, neisseria, proteus, providencia, NURSING CONSIDERATIONS:
serratia, moraxella catarrhalis. Has some activity Assess for infection at beginning of and throughout therapy. Before
against anaerobes, including bacteroides fragilis. Notinitiating therapy, obtain a hx to determine previous use of and
reactions to pcn or cephalosporins. Pedi: Assess newborns for
active against MRSA or enterococci. jaundice & ↑ bilirubinemia and shouldn’t be given to jaundiced
SIDE EFFECTS: neonates, especially premature neonates. Observe pt for signs
Seizures, c diff, pain at IM site, phlebitis at IV site,
and sx’s of anaphylaxis. Keep epi & antihistamine, and
anaphylaxis reaction. May cause increased serum resuscitation equipment close by. Monitor bowel function. IV:
AST, ALT, alkaline phosphatase, bilirubin, LDH, Monitor injection site frequently for phlebitis. Change sites every
BUN, and creatinine. May rarely cause leukopenia, 48– 72 hr to prevent phlebitis. If aminoglycosides are administered
neutropenia, agranulocytosis, thrombocytopenia, concurrently, administer in separate sites, if possible, <1 hr apart. If
eosinophilia, lymphocytosis, and thrombocytosis. 2nd site is unavailable, flush lines b/t meds. IM: Reconstitute IM
doses with sterile water for injection, or 0.9% NaCl for injection.
LAB TEST CONSIDERATIONS: May be diluted with lidocaine to ↓ injection discomfort. Do not
Obtain specimens for c+s before initiating therapy. administer lidocaine-containing ceftriaxone IV. Inject deep into a
well-developed muscle mass; massage well.
Generic: metformin Trade: Glucophage, Glucophage XR Pharmacological: biguanides
Therapeutic: antidiabetics Usual Dose: PO (Adults and children 17 yr): 500 mg BID; may ↑ by 500 mg at
weekly intervals up to 2000 mg/day. If doses 2000 mg/day are required, give in 3 divided doses. Doses (not to
exceed 2500 mg/day) XR tabs 500– 1000 mg QD with evening meal. May ↑ by 500 mg at weekly intervals up to 2500
mg once daily. If 2000 mg once daily is inadequate, 1000 mg BID may be used.
INDICATIONS:
MODE OF ACTION: Mgmt of type 2 DM; may be used with diet,
insulin, or sulfonylurea oral hypoglycemics.
↓ hepatic glucose production. ↓ intestinal
glucose absorption. ↑ sensitivity to insulin. CONTRAINDICATIONS:
Pregnancy category B, metabolic acidosis, dehydration,
Therapeutic Effects: Maintenance of blood sepsis, hypoxemia, hepatic impairment, excessive etoh
glucose use, renal dysfunction (Cr 1.5 mg/dL in men or 1.4
mg/dL in women), radiographic studies requiring IV
ADVERSE EFFECTS:
iodinated contrast media (hold metformin), HF
Abdominal bloating, diarrhea, nausea, NURSING CONSIDERATIONS:
Pt’s who develop illness or lab abnormalities should be
vomiting, lactic acidosis, ↓ vitamin B12 assessed for ketoacidosis or lactic acidosis. When
level combined w/ oral sulfonylureas, observe for signs & sx of
LAB TEST CONSIDERATIONS: hypoglycemic reactions (abdominal pain, sweating,
Monitor serum glucose & glycosylated hunger, weakness, dizziness, HA, tremor, tachycardia,
hemoglobin during therapy to evaluate anxiety). Pts stabilized on a diabetic regimen who are
effectiveness of therapy. Assess renal function exposed to stress, fever, trauma, infection, or sx may
before initiating and at least annually during require administration of insulin. Hold metformin & resume
after acute episode. Metformin should be temporarily d/c
therapy. D/c metformin if renal impairment
in pt requiring sx involving restricted intake of food/fluids.
occurs. Monitor folic acid & vitamin B12 every 1– Resume metformin when oral intake has resumed and
2 yr in long-term therapy. renal function is normal. PO: Administer metformin with
meals to ↓GI effects. XR tablets must be swallowed
whole; do not crush, dissolve, or chew.
Generic: guaifenesin Therapeutic: allergy, cold, and cough remedies, expectorant
Usual Dose: PO (Adults): 200– 400 mg q 4 hr or 600–1200 mg q 12 hr as extended-release product (not to exceed
2400 mg/day). PO (Children 6– 12 yr): 100– 200 mg q 4 hr or 600 mg q 12 hr as extended-release product (max 1200
mg/day). PO (Children 4– 6 yr): 50– 100 mg q 4 hr (Max 600 mg/day).
MODE OF ACTION: INDICATIONS:
Reduces viscosity of tenacious secretions Coughs associated w/ viral upper respiratory
by ↑ respiratory tract fluid. Therapeutic tract infections.
Effects: Mobilization and subsequent CONTRAINDICATIONS:
expectoration of mucus Pregnancy category C. Some products contain
etoh; Avoid in pts with known intolerance; Some
products contain aspartame and should be
SIDE EFFECTS: avoided in pt w/ phenylketonuria.
Dizziness, HA, nausea, vomiting, rash,
urticaria NURSING CONSIDERATIONS:
Instruct pt to contact HCP if cough persists > than
1wk or is accompanied by fever, rash, or persistent
HA or ST. Assess lung sounds, frequency and type of
cough, and character of bronchial secretions
periodically during therapy. Maintain fluid intake of
1500– 2000 mL/day to ↓ viscosity of secretions. PO:
Administer each dose of guaifenesin followed by a
full glass of water to decrease viscosity of secretions.
Extended-release tablets should be swallowed
whole; do not open, break, crush, or chew. Instruct
patient to cough effectively. Pt should sit upright and
take several deep breaths before attempting to
 Generic: insulin glargine Trade: Lantus Pharmacological: pancreatics Therapeutic:
hormones Usual Dose: Subcut (Adults and Children 6 yr): Type 1 diabetes (insulin naıve) usual
starting total daily insulin dose 0.2– 0.4 units/kg Type 2 diabetes (insulin naıve)—0.2 units/kg or
up to 10 units once daily; then adjust on the basis of pt needs
MODE OF ACTION: INDICATIONS:
↓ blood glucose by: stimulating glucose Control of hyperglycemia in patients w/ type 1
uptake in skeletal muscle and fat, inhibiting and type 2 DM
hepatic glucose production. Other actions
of insulin: inhibition of lipolysis & CONTRAINDICATIONS:
proteolysis, enhanced protein synthesis. Pregnancy Category C, allergy or
Therapeutic Effects: Control of hypersensitivity to insulin glargine. Pedi: Safety
hyperglycemia in diabetic patients and effectiveness not established in children <
6 y/o
SIDE EFFECTS: NURSING CONSIDERATIONS:
Hypoglycemia, anaphylaxis, swelling, itching Assess for sx’s of
hypoglycemia/hyperglycemia. Monitor body
LAB TEST CONSIDERATIONS: weight periodically. Advise pt to notify HCP if
Monitor blood glucose every 6 hr during
nausea, vomiting, or fever develop, if unable
therapy, more frequently in ketoacidosis
to eat regular diet, or if blood sugar levels are
and times of stress. HbA1C may be ck q
not controlled. Instruct pt on signs/sx’s of
3– 6 mo to determine effectiveness.
hypoglycemia and hyperglycemia and what to
Monitor potassium in pt at risk for
do if they occur. Pt with DM should carry a
hypokalemia (those using
source of sugar (candy, glucose gel)
potassium-lowering agents, those receiving
And ID describing their disease and tx
IV insulin) periodically during therapy.
regimen at all times.
 Generic: insulin detemir Trade: Levemir Pharmacological: pancreatics Therapeutic: hormones
Usual Dose: Subcut (Adults and Children 2 yr): Type 2 DM pt’s who are insulin naïve-0.1-0.2 units/kg
once daily in the evening (or divided into a twice daily regimen) or 10 units once daily in the evening
(or divided into a twice daily regimen)
MODE OF ACTION: INDICATIONS:
Control of hyperglycemia in patients w/ type
Lower blood glucose by: stimulating glucose 1 and type 2 DM
uptake in skeletal muscle and fat, inhibiting
hepatic glucose production. Other actions of CONTRAINDICATIONS:
insulin: inhibition of lipolysis & proteolysis, Pregnancy Category B, Hypoglycemia;
enhanced protein synthesis. Therapeutic Allergy or hypersensitivity to a particular type
Effects: Control of hyperglycemia in diabetic of insulin, preservatives, or other additives.
patients.

SIDE EFFECTS: NURSING CONSIDERATIONS:

Hypoglycemia, anaphylaxis, hypokalemia Assess for sx’s of
LAB TEST CONSIDERATIONS: hypoglycemia/hyperglycemia. Monitor body
Monitor blood glucose every 6 hr during weight periodically. Advise pt to notify HCP if
therapy,more frequently in ketoacidosis and nausea, vomiting, or fever develop, if unable
times of stress. Hemoglobin A1C may be to eat regular diet, or if blood sugar levels are
monitored every 3– 6 mo to determine not controlled. Instruct pt on signs/sx’s of
effectiveness. Monitor serum potassium in hypoglycemia and hyperglycemia and what
patients at risk for hypokalemia (those using to do if they occur. Pt with DM should carry a
potassium-lowering agents, those receiving source of sugar (candy, glucose gel)
IV insulin) periodically during therapy And ID describing their disease and tx
regimen at all times.
Generic: (dextrose, sodium chloride, sodium lactate, potassium chloride, and calcium chloride)
injection, solution Trade: 5% Dextrose in Lactated Ringer's Injection
Usual Dose: Fluid administration should be based on calculated maintenance or replacement fluid
requirements for each patient.

MODE OF ACTION: INDICATIONS:

This solution is indicated for use in adults & peds pt as a
5% Dextrose in Lactated Ringer's Injection
source of electrolytes, calories and water for hydration.
provides electrolytes and calories, and is a
Fluid resuscitation for certain patients, such as those with
source of water for hydration. It is capable of
burn injuries. LR is used to replace GI tract fluid losses,
inducing diuresis depending on the clinical
fistula drainage, & fluid losses due to burns & trauma. It's
condition of the patient. This solution also
also given to pt’s experiencing acute blood loss or
contains lactate which produces a metabolic
hypovolemia.
alkalinizing effect.
CONTRAINDICATIONS:
SIDE EFFECTS: Lactic acidosis, severe metabolic acidosis or
Febrile response, hypernatremia infection at alkalosis, severe liver disease . Pregnancy
the site of injection, venous thrombosis or category C
phlebitis extending from the site of injection, NURSING CONSIDERATIONS:
extravasation and hypervolemia. HyperkalemiaCheck labs for electrolyte levels, monitor vital signs &
breath sounds. Assess for signs of hypervolemia &
hypovolemia. Monitor input and output. Don’t give if pH
LAB TEST CONSIDERATIONS: is > than 7.5. Educate pts & their families about signs &
Frequent monitoring of electrolyte levels ex's of volume overload & dehydration, & instruct pt’s to
is essential. Monitor PH, hemoglobin and notify their nurse if they have trouble breathing or notice
hematocrit. any swelling. Instruct pt’s & families to keep the HOB
elevated (unless contraindicated).
Generic: isosorbide mononitrate Trade: Imdur Pharmacological: nitrates
Therapeutic: antianginals Usual Dose: PO (Adults): ISMO, Monoket 5– 20 mg BID w/ the 2 doses given 7
hr apart. Imdur 30– 60 mg once daily; may↑to 120 mg once daily (max dose 240 mg/day).
MODE OF ACTION: INDICATIONS:
Produce vasodilation (venous > than arterial). Prophylactic mgmt of angina pectoris.
↓ left ventricular end-diastolic pressure and Unlabeled Use: Tx of CHF
left ventricular end-diastolic volume (preload).
Net effect is reduced myocardial oxygen CONTRAINDICATIONS:
consumption. Increase coronary blood flow Pregnancy Category C, concurrent use of
by dilating coronary arteries and improving PDE-5 inhibitor (sildenafil, tadalafil,
collateral flow to ischemic regions. vardenafil) or riociguat.
Therapeutic Effects: Prevention of anginal
attacks. NURSING CONSIDERATIONS:
SIDE EFFECTS:
Assess location, duration, intensity, and
Dizziness, HA, orthostatic hypotension, precipitating factors of anginal pn. Monitor
tachycardia BP & pulse routinely during period of dose
LAB TEST CONSIDERATIONS: adjustment. Advise pt to notify HCP if dry
mouth or blurred vision occurs.
Generic: oxybutynin Trade: Ditropan XL Pharmacological: anticholinergics Therapeutic: urinary
tract antispasmodics Usual Dose: PO (Adults): IR tabs 5 mg BID-TID (max 5mg QID) (may start w/ 2.5 mg
BID-TID in elderly) XR tab 5– 10 mg QD; may↑, prn (in 5-mg increments) up to max dose of 30 mg/day

MODE OF ACTION: INDICATIONS:

Inhibits the action of ach at postganglionic Urinary symptoms that may be associated w/
receptors. Has direct spasmolytic action on neurogenic bladder including: Frequent urination,
smooth muscle, including smooth muscle lining urgency, nocturia, urge incontinence. OAB w/ sx’s of
the GU tract, w/o affecting vascular smooth urge incontinence, urgency, and frequency.
muscle. Therapeutic Effects: ↑ bladder CONTRAINDICATIONS:
capacity. Delayed desire to void. ↓ urge Pregnancy category B, uncontrolled
incontinence, urinary urgency, & frequency and angle-closure glaucoma, intestinal obstruction,
↓ # of urinary accidents associated w/ OAB. urinary retention. Geri: Appears on Beers list.
SIDE EFFECTS: Poorly tolerated due to anticholinergic effects
Dizziness, drowsiness, constipation, dry mouth, NURSING CONSIDERATIONS:
Monitor voiding pattern & i&o ratios, & assess abdomen
nausea, urinary retention, angioedema, blurred
for bladder distention prior to & periodically during
vision therapy. Cath maybe used to assess postvoid residual.
Cystometry is usually performed to dx type of bladder
dysfunction prior to rx of oxybutynin. Geri: Assess
LAB TEST CONSIDERATIONS: geriatric patients for anticholinergic effects (sedation &
weakness). PO: IR tabs should be given on an empty
stomach; XL tablets w/ or w/o food. XL tablets should
be swallowed whole; don’t break, crush, or chew.
Inform patient that oxybutynin decreases the body’s
ability to perspire. Avoid strenuous activity in a warm
envio as overheating may occur
Generic: nitroglycerin sl tablets Trade: Nitrostat Pharmacological: nitrates
Therapeutic: antianginals Usual Dose: SL (Adults): 0.3– 0.6 mg; may repeat q 5 min for 2 additional
doses for acute attack.
MODE OF ACTION: INDICATIONS:
↑ coronary blood flow by dilating coronary Mgmt of angina pectoris, adjunct tx of HF
arteries and improving collateral flow to
ischemic regions. Produces vasodilation
(venous > than arterial). ↓ left ventricular CONTRAINDICATIONS:
end-diastolic pressure and left ventricular Pregnancy category B, severe anemia,
end-diastolic volume (preload). Reduces pericardial tamponade, constrictive pericarditis. ;
myocardial oxygen consumption. Concurrent use of PDE-5 inhibitor (sildenafil,
Therapeutic Effects: Relief or prevention of tadalafil, vardenafil) or riociguat.
anginal attacks. ↑ cardiac output. ↓BP NURSING CONSIDERATIONS:
SIDE EFFECTS: Assess location, duration, intensity, and
Dizziness, HA, orthostatic hypotension, precipitating factors of patient’s anginal pn. Monitor
BP/pulse before and after administration. SL: Tablet
tachycardia
should be held under tongue until dissolved. Avoid
eating, drinking, or smoking until tablet is dissolved.
Advise pt that tablets should be replaced 6 mo after
opening to maintain potency. Acute Anginal
Attacks: Advise pt to sit ↓and use med at 1st sign
LAB TEST CONSIDERATIONS: of attack. Relief usually occurs within 5 min. Dose
may be repeated if pn is not relieved in 5– 10 min.
Call HCP or go to nearest ER if anginal pain is not
relieved by 3 tabs in 15 min.
 Generic: umeclidinium/vilanterol Trade: Anoro Ellipta Pharmacological: anticholinergics,
adrenergics, long-acting beta2-adrenergic agonists (LABAs) Therapeutic: bronchodilators
Usual Dose: (Adults): One inhalation (umeclidinium 62.5 mcg/vilanterol 25 mcg) once daily.

MODE OF ACTION: INDICATIONS:

Umeclidinium acts as an anticholinergic by Maintenance mgmt of airflow obstruction in pt’s
inhibiting M3 muscarinic receptors w/ COPD.
in bronchial smooth muscle resulting in CONTRAINDICATIONS:
bronchodilation; vilanterol, a beta2-adrergic agonist Pregnancy category C, severe/acute sx’s of
stimulates adenyl cyclase, resulting in
airflow obstruction, severe hypersensitivity to
accumulation of cyclic adenosine monophosphate
milk proteins or other ingredients; Concurrent
at beta2— adrenergic receptors resulting in
use with other anticholinergics
bronchodilation.
Therapeutic Effects: Bronchodilation with ↓ airflow NURSING CONSIDERATIONS:
obstruction. Assess lung sounds, pulse, and BP before
SIDE EFFECTS: administration and periodically during
HA, cough, pharyngitis, chest on, sinusitis, therapy. Observe for paradoxical bronchospasm
cough, and pn. May cause hypokalemia and (wheezing, dyspnea, tightness in chest) &
hypersensitivity reaction. Assess for signs & sx's of
hyperglycemia, urinary retention.
acute narrow-angle glaucoma (eye pain or
LAB TEST CONSIDERATIONS: discomfort, blurred vision, visual halos or colored
images in association w/ red eyes from conjunctival
congestion & corneal edema). When Anoro is
administered w/ other inhalation
meds, administer short-acting adrenergic
bronchodilators first, then Anoro, then
corticosteroids. Wait 5 min b/t meds
 Generic: zolpidem Trade: Ambien Therapeutic: sedative/hypnotics
Usual Dose: 5 mg (for women) and 5– 10 mg (for men) at bedtime; may ↑ to 10 mg at bedtime if 5–mg dose not
effective
MODE OF ACTION: INDICATIONS:
Produces CNS depression by binding to Insomnia with difficulties in sleep initiation
GABA receptors. Has no analgesic
properties.
Therapeutic Effects: Sedation & induction CONTRAINDICATIONS:
of sleep. Pregnancy category C, sleep apnea, Geri:
Initial dose ↓ recommended

NURSING CONSIDERATIONS:
Before administering, reduce external stimuli
SIDE EFFECTS: and provide comfort measures to ↑
Daytime drowsiness, dizziness, effectiveness of med. Protect pt from injury.
anaphylaxis, complex sleep-related Raise bed side rails. Assist with ambulation.
Remove pt’s cigarettes. Use lowest effective
behaviors (sleep-driving) dose. Tablets should be swallowed whole
with full glass of water. For faster onset of
sleep, do not give w/ or immediately after a
LAB TEST CONSIDERATIONS: meal. Because of rapid onset, advise patient
to go to bed asap after taking zolpidem.
Caution pt to avoid concurrent use of etoh or
other CNS depressants.
Generic: duloxetine Trade: Cymbalta Pharmacological: selective serotonin/norepinephrine
reuptake inhibitors Therapeutic: antidepressants Usual Dose: 30-60 mg QD

MODE OF ACTION: INDICATIONS:

Inhibits serotonin and NE reuptake in the CNS. Major depressive disorder, diabetic peripheral
Both antidepressant and pain inhibition are neuropathic pain, GAD, fibromyalgia, chronic
centrally mediated. Therapeutic Effects: musculoskeletal pain (including chronic lower
back pain and chronic pain from oa). Unlabeled Use:
↓depressive sx’s, ↓ neuropathic pain, ↓ sx’s of
Stress urinary incontinence.
anxiety,↓ pain.
CONTRAINDICATIONS:
Pregnancy category C, concurrent use of MAO inhibitors
SIDE EFFECTS: or MAOlike drugs (linezolid or methylene blue), severe
renal impairment (CCr 30 mL/min), chronic hepatic
Neuroleptic malignant syndrome, fatigue, impairment or substantial etoh use (↑risk of hepatitis)
drowsiness, insomnia, ↓ appetite,
constipation, dry mouth, nausea, dysuria,↑ NURSING CONSIDERATIONS:
Advise pt to avoid taking etoh during therapy. Monitor
sweating, ED, sexual dysfunction, orthostatic appetite and nutritional intake. Weigh weekly. Report
hypotension, serotonin syndrome, Steven continued weight loss. Adjust diet as tolerated to support
Johnson syndrome. May cause↑ALT, AST, nutritional status. Monitor closely for notable changes in
bilirubin, CPK, and alkaline phosphatase. May behavior that could indicate the emergence or ↑ of
cause hyponatremia. suicidal thoughts or behavior or depression, especially
in early therapy or during dose changes. Assess for rash
periodically during therapy. Depression: Assess mental
LAB TEST CONSIDERATIONS: status (orientation, mood, and behavior). Inform HCP if
Monitor blood sugar and hemoglobin A1c. pt demonstrates significant ↑ in anxiety, nervousness, or
insomnia. Pain & Fibromyalgia: Assess intensity,
quality, and location of pain periodically during therapy.
May require several weeks for effects to be seen.
 Generic: pregabalin Trade: Lyrica Pharmacological: gamma aminobutyric acid (GABA)
analogues, nonopioid analgesics Therapeutic: analgesics, anticonvulsants
Usual Dose: Diabetic Neuropathic Pn 50 mg TID,↑ over 7 days Max 100 mg TID. Post herpetic 75 mg BID or 50 mg TID
initially, may be ↑ over 7 days to 300 mg/day in 2– 3 divided doses; after 2– 4 wk may be ↑to 600 mg/day in 2– 3 divided
doses. Also avail liquid!
MODE OF ACTION: INDICATIONS:
Binds to calcium channels in CNS tissues which Neuropathic pn associated w/ diabetic peripheral
regulate neurotransmitter release. Doesn’t bind neuropathy, postherpetic neuralgia, fibromyalgia.
to opioid receptors. Therapeutic Effects: ↓ Neuropathic pn associated with spinal cord injury.
neuropathic or post-herpetic pn. ↓ partial-onset Adjunctive therapy of partial-onset seizures in
adults.
seizures. CONTRAINDICATIONS:
Pregnancy Category C, myopathy, adjust dose for
SIDE EFFECTS: renal impairment
Dizziness, drowsiness, dry mouth, blurred vision,
edema, weight gain. May cause ↑ creatine NURSING CONSIDERATIONS:
kinase levels. May cause↓ platelet count. Pain: Assess location, characteristics, & intensity of pn
periodically during therapy. Seizures: Assess location,
duration, and characteristics of seizure activity. Monitor
LAB TEST CONSIDERATIONS: closely for notable changes in behavior that could
indicate the emergence or worsening of suicidal thoughts
or behavior or depression. Med should be d/c gradually
over at least 1 wk. Instruct pt to promptly report
unexplained muscle pain, tenderness, or weakness,
especially if accompanied by malaise or fever. D/c
therapy if myopathy is dx or suspected or if markedly ↑
creatine kinase levels occurred. Caution pt to avoid etoh
or other CNS depressants.
 Generic: hydroxyzine Trade: Atarax Therapeutic: antianxiety agents, antihistamines,
sedative/hypnotics Usual Dose: Route/Dosage PO (Adults): Antianxiety 25– 100 mg QID, max 600 mg/day.
Preop sedation 50– 100 mg single dose. Antipruritic 25 mg TID-QID PO (Children): 2 mg/kg/day divided q 6– 8 hr.
IM (Adults): Preop sedation 25-100 mg single dose. Antiemetic, adjunct to opioid analgesic 25-100 mg q 4– 6 hr
prn. IM (Children): 0.5– 1 mg/kg/dose q 4– 6 hr prn
MODE OF ACTION: INDICATIONS:
Acts as a CNS depressant at the subcortical Tx of anxiety, preop sedation, antiemetic, antipruritic.
level of the CNS. Has anticholinergic, May be combined with opioid analgesics
antihistaminic, and antiemetic properties. CONTRAINDICATIONS:
Blocks histamine 1 receptors. Therapeutic OB: Potential for congenital defects (oral clefts and
Effects: Sedation, relief of anxiety, ↓nausea & hypoplasia of cerebral hemisphere; Lactation:
vomiting, ↓ allergic symptoms associated with Safety not established. Pregnancy category C
release of histamine, including pruritus.
NURSING CONSIDERATIONS:
SIDE EFFECTS: Assess pt for profound sedation & provide safety
precautions as indicated (side rails up, bed in low position,
Drowsiness, pain at IM site, dry mouth,
call bell within reach, supervision of ambulation and
delirium, acute confusion, dizziness, blurred transfer). Anxiety: Assess mental status (orientation,
vision, urinary retention, constipation, mood, and behavior). Nausea and Vomiting: Assess
tachycardia, degree of nausea and frequency and amount of emesis.
Pruritus: Assess degree of itching and character of
involved skin PO: Tablets may be crushed and capsules
opened and administered with food or fluids for pt having
LAB TEST CONSIDERATIONS: difficulty swallowing. IM: Administer only IM deep into
well-developed muscle, preferably with Z-track
technique. Injection is extremely painful. Do not use deltoid
site. If must be administered to children, midlateral muscles
of the thigh are preferred.
 Generic: amoxicillin/clavulanate Trade: Augmentin Pharmacological: aminopenicillins/beta
lactamase inhibitors Therapeutic: anti-infectives Usual Dose: Most Infections (Dosing based on
amoxicillin component)PO (Adults and Children 40 kg): 250 mg q 8 hr or 500 mg q 12 hr
MODE OF ACTION: INDICATIONS:
Binds to bacterial cell wall, causing cell death; Tx of a variety of infections including: Skin & skin
spectrum of amoxicillin is broader than pcn. structure infections, OM, sinusitis, respiratory tract
Clavulanate resists action of beta-lactamase, an infections, genitourinary tract infections.
enzyme produced by bacteria that is capable of CONTRAINDICATIONS:
inactivating some pcn. Therapeutic Effects: Pregnancy category B, hypersensitivity to pcn or
Bactericidal action against susceptible bacteria. clavulanate; suspension & chewable tablets contain
Spectrum: Active against streptococci, aspartame and should be avoided in
pneumococci, enterococci, haemophilus influenzae,phenylketonurics; H/o
e coli, proteus mirabilis, neisseria meningitidis, N. amoxicillin/clavulanate-associated cholestatic
gonorrhoeae, Staph aureus, klebsiella pneumoniae,jaundice. NURSING CONSIDERATIONS:
shigella, salmonella, moraxella catarrhalis. Assess for infection (vital signs, appearance of
SIDE EFFECTS: wound, sputum, urine, and stool WBC) at beginning of
Diarrhea, c diff, anaphylaxis, rash, may and throughout therapy. Observe for signs and sx’s of
causes↑ alkaline phosphatase, LDH, AST, anaphylaxis. Monitor bowel function. PO: Administer
and ALT concentrations. Elderly men and pt’s around the clock. Administer at the start of a meal to ↑
receiving prolonged tx are at ↑ risk for hepatic absorption and to decrease GI s/e. Don’t administer
dysfunction w/ ↑ fat meal. Instruct pt to notify HCP if diarrhea,
abdominal cramping, fever, or bloody stools occur and
LAB TEST CONSIDERATIONS: not to tx w/ antidiarrheals. Instruct female patients
taking oral contraceptives to use an alternate or
additional method of contraception during therapy and
until next menstrual period.
 Generic: levofloxacin Trade: Levaquin Pharmacological: fluoroquinolones
Therapeutic: anti-infectives
Usual Dose: PO, IV (Adults): Most infections—250– 750 mg q 24 hr; adjust dose based on renal impairment
MODE OF ACTION: INDICATIONS:
Inhibits bacterial DNA synthesis by inhibiting DNA
PO, IV: Tx of the following bacterial infections: UTI,
gyrase enzyme. Therapeutic Effects: Death of including cystitis, pyelonephritis, & prostatitis,
susceptible bacteria. Spectrum: Active against gram respiratory tract infections, including acute sinusitis,
+ pathogens, including: staph aureus, staph acute exacerbations of chronic bronchitis,
epidermidis, staph saprophyticus, streppyogenes, community-acquired pneumonia, & nosocomial
strep pneumoniae, enterococcus faecalis, bacillus pneumonia, uncomplicated and complicated skin &
anthracis. Gram - spectrum notable for activity skin structure infections. Post-exposure treatment of
against: E coli, klebsiella pneumoniae, enterobacter
inhalational anthrax. Tx & prophylaxis of plague.
cloacae, proteus mirabilis, pseudomonas aeruginosa,
serratia marcescens,haemophilus influenzae, CONTRAINDICATIONS:
Moraxella catarrhalis. Additional spectrum includes: Pregnancy category C, QTc interval prolongation;
chlamydophylia pneumoniae, legionella pneumoniae, Uncorrected hypokalemia or hypomagnesemia;
mycoplasma pneumoniae, and yersinia pestis Concurrent use of Class IA antiarrhythmics
(disopyramide, quinidine, procainamide) or
SIDE EFFECTS: Class III antiarrhythmics (amiodarone, sotalol) (qrisk
↑ICP, nausea, c diff, abdominal pn, peripheral
of QTc interval prolongation & torsade de pointes),
neuropathy, hepatotoxicity. May cause ↑ AST,
Hx of myasthenia gravis
ALT, LDH, bilirubin & alkaline phosphatase.
May also ↑ or ↓ glucose. NURSING CONSIDERATIONS:
Assess for infection (vital signs; appearance of wound,
sputum, urine, and stool; WBC; urinalysis; frequency &
LAB TEST CONSIDERATIONS: urgency of urination; cloudy or foul-smelling urine) at
Obtain specimens for c+s before initiating beginning of and during therapy. Observe patient for signs
therapy. and sx’s of anaphylaxis. Monitor bowel function. Assess
for rash
 Generic: vancomycin Trade: Vanocin Therapeutic: anti-infectives Usual Dose: C diff PO (Adults):
125 mg q 6 hr for 10 days. Serious system is infections IV (Adults): 500 mg q 6 hr or 1 g q 12 hr (up to 4 g/day)

MODE OF ACTION: INDICATIONS:

Binds to bacterial cell wall, resulting in cell IV: Tx of potentially life-threatening infections when less toxic
death. Therapeutic Effects: Bactericidal action anti-infectives are contraindicated. Particularly useful in
against susceptible organisms. Spectrum: staphylococcal infections, including: endocarditis, meningitis,
Active against gram-positive pathogens, osteomyelitis, pneumonia, septicemia, soft-tissue infections in
including: Staph (including methicillin-resistant pt’s who have allergies to pcn or its derivatives or when
strains of Staph aureus), Group A sensitivity testing demonstrates resistance to methicillin. PO
beta-hemolytic streptococci, Strep pneumoniae, Tx of staph enterocolitis or diarrhea due to c diff. IV: Part of
Corynebacterium, c difficile, Enterococcus endocarditis prophylaxis in ↑ risk pt’s who are allergic to pcn
faecalis, Enterococcus faecium. CONTRAINDICATIONS:
Pregnancy category C
SIDE EFFECTS: NURSING CONSIDERATIONS:
Nephrotoxicity, phlebitis, leukopenia, Assess pt for infection at beginning of and throughout
anaphylaxis, “redman” syndrome (with therapy. Obtain specimens for c+s prior to initiating therapy.
rapid infusion) Monitor IV site closely. Vancomycin is irritating to tissues and
causes necrosis and severe pn w/ extravasation. Rotate
infusion site. Monitor BP throughout IV infusion. Evaluate 8th
LAB TEST CONSIDERATIONS: cranial nerve function by audiometry and vancomycin levels
Monitor for casts, albumin, or cells in the urine
prior to and throughout therapy in patients with borderline
or ↓ specific gravity, CBC, and renal function
renal function or those60 yr of age. Monitor I&O & daily
periodically during therapy. Trough
concentrations should not exceed 10 weight. Cloudy or pink urine may be a sign of nephrotoxicity.
mcg/mL(mild-moderate infections) or 15– 20 Assess pt for signs of superinfection (black, furry overgrowth
mcg/mL (for severe infections). on tongue; vaginal itching or discharge; loose or
foul-smelling stools)
 Generic: sucralfate Trade: Carafate Pharmacological: GI protectants Therapeutic: antiulcer
agents Usual Dose: Tx of ulcers PO (Adults): 1 g QID, given 1 hr before meals and at bedtime; or 2 g BID, on
waking and at bedtime. Prevention ulcer PO (Adults): 1 g BID, given 1 hr before a meal.

MODE OF ACTION: INDICATIONS:

Aluminum salt of sulfated sucrose reacts Short-term mgmt. duodenal ulcers. Maintenance
w/gastric acid to form a thick paste, which (preventive) therapy of duodenal ulcers. Unlabeled Use:
Mgmt of gastric ulcer or gerd. Prevention of gastric
selectively adheres to the ulcer surface.
mucosal injury caused by high-dose asa or other
Therapeutic Effects: Protection of ulcers, NSAIDs in pt w/ RA or in high-stress situations (e.g.,
with subsequent healing ICU). Suspension: Mucositis/stomatitis/rectal or oral
ulcerations from various etiologies
SIDE EFFECTS: CONTRAINDICATIONS:
Constipation, ↑risk of hyperglycemia Pregnancy category B
with suspension, dry mouth NURSING CONSIDERATIONS:
PO: Administer on an empty stomach, 1 hr before
meals and at hs. Tablet may be broken or dissolved
in water before ingestion. Shake suspension well
before administration. If NG or feeding tube
administration is required, consult pharmacist;
protein-binding properties of sucralfate have
resulted in formation of a bezoar when administered
LAB TEST CONSIDERATIONS: with enteral feedings and other medications. If
antacids are also required for pn, administer 30 min
before or after sucralfate dosage. Assess pt
routinely for abdominal pn and frank or occult blood
Generic: megestrol Trade: Megace Pharmacological: progestins Therapeutic: anti-neoplastics,
hormones Usual Dose: PO (Adults): Breast ca 160 mg/day single dose or divided doses; Endometrial/ovarian ca 40–
320 mg/day in divided doses; Anorexia associated w/ AIDS-Megace: 800 mg once daily; may ↑ to 400 mg/day after 1
month
MODE OF ACTION: INDICATIONS:
Antineoplastic effect may result from Palliative tx of endometrial and breast ca,
inhibition of pituitary function. Therapeutic either alone or with sx or radiation (tablets
Effects: Regression of tumor. ↑ appetite only). Treatment of anorexia, weight loss, and
and weight gain in patients with AIDS cachexia associated with AIDS (oral
suspension only)
CONTRAINDICATIONS:
Pregnancy Category D (tablets), X
(suspension). Undx vaginal bleeding, severe
SIDE EFFECTS: liver disease; Suspension contains etoh &
should be avoided in pt w/ known intolerance.
Asymptomatic adrenal suppression
(chronic therapy),thromboembolism, NURSING CONSIDERATIONS:
hair loss Assess for swelling, pn, or tenderness in legs.
Report these signs of deep vein
thrombophlebitis. Anorexia: Monitor weight,
appetite, and nutritional intake in patients with
LAB TEST CONSIDERATIONS:
AIDS. PO: May be administered w/ meals if GI
irritation becomes a problem.
 Generic: levothyroxine Trade: Synthroid Pharmacological: thyroid preparations Therapeutic:
hormones Usual Dose: PO (Adults): Hypothyroidism-50 mcg as a single dose initially; may be ↑q 2–3wk by
25 mcg/day; usual maintenance dose is 75– 125 mcg/day (1.5 mcg/kg/day). Can be given IVP
MODE OF ACTION: INDICATIONS:
Replacement of or supplementation to Thyroid supplementation in hypothyroidism. Tx
endogenous thyroid hormones. Principal effect is or suppression of euthyroid goiters. Adjunctive
↑ MR of body tissues: Promote gluconeogenesis, tx for thyrotropin-dependent thyroid cancer.
↑utilization and mobilization of glycogen stores,
Stimulate protein synthesis, promote cell growth CONTRAINDICATIONS:
& differentiation, aid in the development of the Pregnancy Category A, recent MI,
brain and CNS. Therapeutic Effects: hyperthyroidism
Replacement in hypothyroidism to restore normal
hormonal balance. Suppression of thyroid NURSING CONSIDERATIONS:
Assess apical pulse & BP prior to &
cancer.
periodically during therapy. Assess for
SIDE EFFECTS: tachyarrhythmias and chest pn. Children:
Monitor height, weight, and psychomotor
Usually only seen when excessive doses
development. PO: Administer with a full glass
cause iatrogenic hyperthyroidism.
of water, on an empty stomach, 30– 60 min
Toxicity/OD
before breakfast, to prevent insomnia. For
LAB TEST CONSIDERATIONS: pt’s w/ difficulty swallowing, tabs can be
Monitor thyroid function studies prior to and during crushed and placed in 5– 10mL of water and
therapy. Monitor TSH levels in adults 8– 12 wks administered immediately via dropper or
after changing from one brand to another. Monitor spoon; do not store suspension.
blood and urine glucose in diabetic patients. Insulin
or oral hypoglycemic dose may need to be ↑
 Generic: insulin lispro, rDNA origin Trade: Humalog Pharmacological: pancreatics
Therapeutic: antidiabetics, hormones Usual Dose: Subcut (Adults and Children): Initial dose range-
0.2– 0.6 units/kg/day.
Usual maintenance range OF
MODE 0.5–ACTION:
1.2 units/kg/day. Adolescents during rapid growth 1.5 units/kg/day.
INDICATIONS:
growth—1.5 units/kg/day
Lowers blood glucose by: stimulating glucose Control of hyperglycemia in patients with
uptake in skeletal muscle and fat, inhibiting type 1 and type 2 DM
hepatic glucose production. Other actions of
insulin: inhibition of lipolysis & proteolysis, CONTRAINDICATIONS:
enhanced protein synthesis. A rapid-acting Pregnancy Category B, hypoglycemia,
insulin with more rapid onset and shorter Allergy or hypersensitivity to insulin lispro
duration than human regular insulin; should be
used with an intermediate or long-acting insulin.
NURSING CONSIDERATIONS:
Therapeutic Effects: Control of hyperglycemia Assess for sx’s of hypoglycemia. When
in diabetic patients. mixing insulins, draw insulin lispro into
SIDE EFFECTS: syringe 1st to avoid contamination
Hypoglycemia, hypokalemia of regular insulin vial. Subcut: Administer
LAB TEST CONSIDERATIONS: insulin lispro within 15 min before a meal.
Monitor blood glucose every 6 hr during Continuous Infusion: Administer
therapy, more frequently in ketoacidosis Humalog-U-100 IV under medical supervision
and ↑ stress. A1C may be monitored q 3– 6 ONLY with close monitoring of glucose and
mo to determine effectiveness. Monitor K+ K+ levels. Concentration: 0.1 unit/mL to 1.0
in pt at risk for hypokalemia (those using unit/mL. Diluent: 0.9% NaCl. Solutions of
K+lowering agents, those receiving IV insulin lispro and 0.9% NaCl can be stored for
insulin) periodically during therapy 48 hrs in refrigerator, then used at room
temperature for another 48 hr.
 Generic: insulin aspart Trade: Novolog Pharmacological: pancreatics
Therapeutic: antidiabetics, hormones
Usual Dose: Subcut (Adults and Children): 0.5– 1 units/kg/day total growth—1.5 units/kg/day
MODE OF ACTION: INDICATIONS:
Lowers blood glucose by: stimulating glucose Control of hyperglycemia in patients with type
uptake in skeletal muscle and fat, inhibiting 1 and type 2 DM
hepatic glucose production. Other actions of
insulin: inhibition of lipolysis and proteolysis, CONTRAINDICATIONS:
enhanced protein synthesis. A rapid-acting Pregnancy Category B, hypoglycemia,
insulin with more rapid onset & shorter duration Allergy or hypersensitivity to insulin aspart.
than human regular insulin; should be used with
an intermediate- or long-acting insulin.
NURSING CONSIDERATIONS:
Therapeutic Effects: Control of hyperglycemia Assess for sx’s of hypoglycemia. Because of
in diabetic patients. the short duration of insulin aspart,
SIDE EFFECTS: supplementation with longer-acting insulin is
Hypoglycemia, hypokalemia usually necessary to control blood glucose
LAB TEST CONSIDERATIONS: levels. Subcut: Administer insulin aspart subcut
Monitor blood glucose every 6 hr during in the abdominal wall, thigh, or upper
therapy, more frequently in ketoacidosis arm within 5– 10 min before a meal.
and ↑ stress. A1C may be monitored q 3– 6 Demonstrate technique for mixing insulins by
mo to determine effectiveness. Monitor K+ drawing up insulin aspart 1st & rolling
in pt at risk for hypokalemia (those using intermediate-acting insulin vial between palms
K+lowering agents, those receiving IV to mix. Instruct pt in testing of glucose &
insulin) periodically during therapy ketones. These tests should be closely
monitored during periods of stress or illness.
Generic: magnesium citrate Trade: Citrate of Magnesia Therapeutic: laxatives
Usual Dose: PO (Adults): Magnesium citrate 240 mL, PO (Children 6– 12 yr): Magnesium citrate 100 mL

MODE OF ACTION: INDICATIONS:

Essential for the activity of many As a: Laxative, Bowel evacuant in preparation for
enzymes. Play an important role in surgical/radiographic procedures.
neurotransmission and muscular
excitability. Are osmotically active in GI CONTRAINDICATIONS:
tract, drawing water into the lumen and Hypermagnesemia, hypocalcemia, anuria, heart
causing peristalsis. Therapeutic Effects: block, active labor or w/i 2 hr of delivery (unless
Replacement in deficiency states. used for preterm labor)
Evacuation of the colon NURSING CONSIDERATIONS:
Laxative: Assess pt for abdominal distention, presence
SIDE EFFECTS: of bowel sounds & usual pattern of bowel function.
Long-term therapy may cause electrolyte Assess color, consistency, and amount of stool
imbalance and dependence. Diarrhea, produced. Administer on empty stomach for more rapid
sweating results. Follow all oral laxative doses w/ a full glass of
liquid to prevent dehydration and for faster effect. Do
not administer at hs or late in the day. Advise pt not to
LAB TEST CONSIDERATIONS: take this med w/i 2 hr of taking other meds, especially
fluoroquinolones, nitrofurantoin, and tetracyclines.
Advise pt that laxatives should be used only for
short-term therapy. Advise pt to notify HCP if unrelieved
constipation, rectal bleeding, or sx’s of electrolyte
imbalance (muscle cramps or pain, weakness,
Generic: simethicone Trade: Mylanta Gas,Mylicon Therapeutic: anti-flatulent
Usual Dose: PO (Adults): 40– 125 mg qid, after meals and at hs(up to 500 mg/day).PO (Children 2– 12 yr): 40
mg 4 times daily. PO (Children 2 yr): 20 mg 4 times daily (up to 240 mg/day).
MODE OF ACTION: INDICATIONS:
Causes the coalescence of gas bubbles. Relief of painful sx’s of excess gas in the GI tract
Does not prevent the formation of gas. that may occur postoperatively or as a
Therapeutic Effects: Passage of gas consequence of: Air swallowing, dyspepsia, PUD,
through the GI tract by belching or diverticulitis.
CONTRAINDICATIONS:
passing flatus
Pregnancy Category UK, infant colic

NURSING CONSIDERATIONS:
SIDE EFFECTS:
Assess patient for abdominal pain, distention, and
None significant
bowel sounds prior to and periodically throughout
course of therapy. Frequency of belching &
passage of flatus should also be assessed. PO:
Administer after meals and at hs for best results.
Shake liquid preparations well prior to
administration. Chewable tablets should be
LAB TEST CONSIDERATIONS: chewed thoroughly before swallowing for faster
and more complete results. Drops can be mixed
with 30 mL of cool water, infant formula, or other
liquid as directed. Shake well before using
Generic: lovastatin Trade: Mevacor Pharmacological: HMG-CoA reductase inhibitors (statin)
Therapeutic: lipid-lowering agents
Usual Dose: PO (Adults): 20 mg QHS. May be↑at 4-wk intervals to a max of 80 mg/day (IR) or 60 mg/day (XR)

MODE OF ACTION: INDICATIONS:

Inhibits 3-hydroxy-3-methylglutaryl-coenzyme A Adjunctive management of primary hypercholesterolemia
(HMG-CoA) reductase, an enzyme which is and mixed dyslipidemias. Primary prevention of coronary
responsible for catalyzing an early step in the heart disease (MI, unstable angina, and coronary
synthesis of cholesterol. Therapeutic Effects: revascularization) in asymptomatic patients with↑ total &
↓of total and LDL cholesterol and triglycerides. LDL cholesterol and ↓HDL cholesterol. Slows the
Slightly ↑ HDL cholesterol. Slows the progression progression of coronary atherosclerosis in pt’s
w/ CAD
of coronary atherosclerosis w/
resultant decrease in coronary heart
CONTRAINDICATIONS:
Pregnancy Category X, Active liver disease or unexplained
disease-related events.
persistent elevations in AST and ALT; Concurrent use with
SIDE EFFECTS: strong CYP3A4 inhibitors (e.g. itraconazole, ketoconazole,
abdominal cramps, constipation, diarrhea, posaconazole, voriconazole, protease inhibitors,
flatus, heartburn, myalgia, rashes, elevated boceprevir, erythromycin, clarithromycin, telithromycin,
LFT, rhabdomyolysis, photosensitivity rxn nefazodone, and cobicistat-containing products)
(rare) NURSING CONSIDERATIONS:
LAB TEST CONSIDERATIONS: Administer w/ food. Administration on an empty stomach ↓
Evaluate cholesterol and triglyceride levels absorption by approximately 30%. Initial once-daily dose is
before initiating, after 4–6 wk of therapy, and administered with the evening meal. Advise pt to wear
periodically thereafter. Monitor LFT prior to sunscreen and protective clothing. Advise patient that this
initiation of therapy and as clinically medication should be used in conjunction with diet
restrictions (fat, cholesterol, carbohydrates, alcohol),
indicated. If pt develops muscle tenderness
exercise, and cessation of smoking. Instruct pt to notify
during therapy, monitor CPK level. HCP if unexplained muscle pain, tenderness, or weakness
occurs, especially if accompanied by fever or malaise
Generic: ciprofloxacin Trade: Cipro, Cipro XR Pharmacological: fluoroquinolones
Therapeutic: anti-infectives Usual Dose: Most infections PO (Adults): 500– 750 mg q 12 hr.
IV (Adults): 400 mg q 12 hr *Adjust dose accordingly for renal impairment*
MODE OF ACTION: INDICATIONS:
Inhibits bacterial DNA synthesis by inhibiting PO, IV: Tx of the following bacterial infections: Urinary tract
DNA gyrase enzyme. Therapeutic Effects: and gynecologic infections, including cystitis, and prostatitis,
respiratory tract infections including acute sinusitis, acute
Death of susceptible bacteria. Spectrum: Active
exacerbations of chronic bronchitis, and pneumonia,
against gram + pathogens skin/skin structure infections , bone and joint infections ,
infectious diarrhea , complicated intraabdominal infections
SIDE EFFECTS: (with metronidazole), typhoid fever. Post-exposure
Elevated ICP, diarrhea, nausea, hepatotoxicity, prophylaxis of inhalational anthrax. Cutaneous anthrax. Tx
anaphylaxis, c diff , may cause↑ serum AST, ALT, and prophylaxis of plague. IV Febrile neutropenia.
LDH, bilirubin, and alkaline phosphatase. May also Unlabeled Use: Acute pulmonary
cause ↑ or ↓glucose. Cystalluria, dizziness, exacerbations in cystic fibrosis
drowsiness, prevent phototoxicity reactions CONTRAINDICATIONS:
H/o myasthenia gravis, use with tizanidine; OB: Do not use
LAB TEST CONSIDERATIONS: unless potential benefit outweighs potential fetal risk; Pedi:
Obtain specimens for c+s before initiating Use only if no alternatives in children 1– 17 yrs due to
therapy. possible arthropathy
NURSING CONSIDERATIONS:
Assess for infection. Observe for signs & sx's of anaphylaxis.
Monitor bowel function. PO: Administer w/o regard to food & w/ a
full glass of water, at the same time QD. Products or foods
containing calcium, magnesium, aluminum, iron, or zinc should not
be ingested for 6 hr before and 2 hr after administration. If gastric
irritation occurs, may be administered w/ meals. Encourage pt to
maintain a fluid intake of at least 1500– 2000 mL/day. Caution pt
to use sunscreen & protective clothing to during & for 5 days after
therapy.
Generic: labetalol Brand: Trandate Pharmacological: BB Therapeutic: antianginals,
antihypertensives Usual Dose: PO (Adults): 100 mg BID initially, may be ↑ by 100 mg BID q 2– 3 days prn (usual
range 400– 800 mg/day in 2– 3 divided doses; doses up to 1.2– 2.4. IV (Adults): 20 mg (0.25 mg/kg) initially, additional
doses of 40– 80 mg may be given q 10 min prn (Max 300 mg total dose) or 2 mg/min infusion (range 50– 300 mg total
dose required).
ACTIONS: INDICATIONS:
Blocks stimulation of beta1 (myocardial)- and beta2 Mgmt of HTN
(pulmonary, vascular, and uterine)-adrenergic CONTRAINDICATIONS:
Pregnancy Category C, uncompensated HF, pulmonary
receptor sites. Also has alpha1-adrenergic blocking edema, cardiogenic shock, bradycardia or heart block OB:
activity, which may result in more orthostatic May cause fetal/neonatal bradycardia, hypotension,
hypotension. Therapeutic Effects: Decreased BP hypoglycemia, or respiratory depression; Lactation:
Usually compatible with breast feeding Pedi: Limited data
SIDE EFFECTS: available. NURSING CONSIDERATIONS:
Monitor BP & pulse frequently during dose adjustment and
Fatigue, weakness, orthostatic hypotension,
periodically during therapy. Hold dose and call HCP if pulse
increase sensitivity to cold, ED, bronchospasm,
<50. Assess for orthostatic hypotension when assisting pt up
wheezing. May cause ↑ BUN, serum lipoprotein,
from supine position. Pt’s receiving labetalol IV must be
K+, triglyceride, and uric acid levels. May cause ↑
supine during and for 3 hr after administration. VS should be
ANA titers. May cause ↑ in blood glucose levels.
monitored q 5-15 min during and for several hours after
May cause ↑ serum alkaline phosphatase, LDH,
administration. Monitor I&O ratios and daily weight. Assess
AST, and ALT levels
patient routinely for evidence of fluid overload. D/c if jaundice
or lab signs of hepatic function impairment occur. Monitor
patients receiving BBfor signs of OD (bradycardia, severe
dizziness or fainting, severe drowsiness, dyspnea, bluish
LAB TEST CONSIDERATIONS: fingernails or palms, seizures). Glucagon has been used to
treat bradycardia and hypotension. D/c of concurrent
clonidine should take place gradually, w/ BB d/c 1st. Then,
after several days, d/c clonidine. Pt’s w/ DM should closely
monitor blood glucose.
Generic: benzonatate Trade: Tessalon perles
Therapeutic: allergy, cold, and cough remedies, antitussives (local anesthetic)
Usual Dose: PO (Adults and Children 10 yr): 100 mg TID (up to 600 mg/day).
MODE OF ACTION: INDICATIONS:
Anesthetizes cough or stretch receptors in vagal Relief of nonproductive cough due to minor throat
nerve afferent fibers found in lungs, pleura, & or bronchial irritation from inhaled irritants or
respiratory passages. May also ↓ transmission colds
of the cough reflex centrally. Therapeutic CONTRAINDICATIONS:
Effects: ↓ in cough. Pregnancy Category C, cross-sensitivity with
other ester-type local anesthetics (tetracaine,
SIDE EFFECTS: procaine, and others) may occur. Pedi: Safety
not established in children <10 yr
HA, mild dizziness, sedation/drowsiness
NURSING CONSIDERATIONS:
Assess frequency and nature of cough, lung
sounds, and amount and type of sputum produced.
Unless contraindicated, maintain fluid intake of
1500– 2000 mL to ↓ viscosity of bronchial
secretions. Capsules should be swallowed whole.
Do not chew, because release of med from capsules
may cause local anesthetic effect and choking.
LAB TEST CONSIDERATIONS: Caution pt to avoid taking etoh or other CNS
depressants concurrently w/ this med.
Generic: doxycycline Trade: Doxy, Doryx Pharmacological: tetracyclines Therapeutic:
anti-infectives Usual Dose: PO (Adults and Children 8 yr and 45 k g): Most infections-100 mg q 12 hr on
the 1st day, then 100– 200 mg QD or 50– 100 mg q 12 hr

MODE OF ACTION: INDICATIONS:

Inhibits bacterial protein synthesis at the level of Tx of various infections caused by unusual organisms,
the 30S bacterial ribosome. Low dose products including: Mycoplasma, Chlamydia, Rickettsia, Borellia
used in the mgmt of periodontitis inhibit burgdorferi. Tx of inhalational anthrax (postexposure) and
collagenase. Therapeutic Effects: Bacteriostatic cutaneous anthrax. Tx gonorrhea and syphilis in
action against susceptible bacteria. Spectrum: Pcn allergic pt’s. Prevention of exacerbations of chronic
Includes activity against some gram + pathogens bronchitis. Treatment of acne. Tx of inflammatory lesions
associated with rosacea (Oracea only). Malaria prophylaxis
SIDE EFFECTS: CONTRAINDICATIONS:
Diarrhea, nausea, vomiting, photosensitivity, Pregnancy Category D. Some products contain etoh or
phlebitis at IV site, CDAD, Steven Johnson bisulfites and should be avoided in pt’s w/ known
syndrome, thrombophlebitis, May ↑AST, ALT, hypersensitivity or intolerance; OB: Pregnancy, risk of
alkaline phosphatase, bilirubin, and amylaseMay permanent staining of teeth in infant if used during last half
cause yellow-brown discoloration and softening of of pregnancy (unless used for anthrax; doxycycline may be
teeth and bones if administered prenatally or used to treat anthrax in pregnant women due to the
during early childhood.. seriousness of the disease),

LAB TEST CONSIDERATIONS: NURSING CONSIDERATIONS:

Obtain specimens for c+s before initiating Assess for infection. Monitor bowel function. Assess for
therapy. 1st dose may be given before receiving rash during therapy. IV: Assess IV site frequently. PO:
results. Monitor renal and hepatic functions and Administer around the clock, at least 1 hr AC or 2 hr PC.
CBC periodically during long-term therapy. May be taken w/ food or milk if GI irritation occurs.
Administer with a full glass of liquid and at least 1 hr before
going to bed to avoid esophageal ulceration. Caution pt to
use sunscreen and protective clothing
Generic: montelukast Trade: Singulair Pharmacological: leukotriene antagonists
Therapeutic: allergy, cold, and cough remedies, bronchodilators
Usual Dose: PO (Adults and Children 14 yr): 10 mg once daily.
MODE OF ACTION: INDICATIONS:
Antagonizes the effects of leukotrienes, which Prevention and chronic tx of asthma. Mgmt of
mediate the following: Airway edema, smooth seasonal allergic rhinitis. Prevention of
exercise-induced bronchoconstriction in patients 6 yr
muscle constriction, altered cellular activity.
Result is ↓ inflammatory process, which is part of
and older CONTRAINDICATIONS:
asthma and allergic rhinitis. Therapeutic Pregnancy Category B
Effects:↓frequency and severity of acute asthma
attacks. ↓ severity of allergic rhinitis. ↓ attacks of NURSING CONSIDERATIONS:
exercise-induced bronchoconstriction. Assess lung sounds and respiratory function
prior to and periodically during therapy.
SIDE EFFECTS: Assess allergy symptoms (rhinitis,
conjunctivitis, hives) before and periodically
Suicidal thoughts, Steven Johnson syndrome, during therapy. Monitor closely for changes in
toxic epidermal necrolysis. May cause ↑ AST
behavior that could indicate the emergence or
and ALT concentrations.
worsening of depression or suicidal thoughts.
Assess for rash periodically during therapy.
PO: For asthma, administer once daily in the
evening. For allergic rhinitis, may be
LAB TEST CONSIDERATIONS:
administered at any time of day. Administer
granules directly into mouth or mixed in a
spoonful of cold or room temperature foods.
Generic: nystatin Therapeutic: antifungals (topical/local)
Usual Dose: PO (Adults and Children): 400,000– 600,000 units 4 times daily as oral suspension or
200,000– 400,000 units 4– 5 times daily as lozenges
MODE OF ACTION: INDICATIONS:
Binds to fungal cell membrane, allowing Lozenges, oral suspension: Local tx of
leakage of cellular contents. Therapeutic oropharyngeal candidiasis. Tx of intestinal
Effects: Fungistatic or fungicidal action. candidiasis.
Spectrum: Active against most pathogenic
CONTRAINDICATIONS:
Candida species, including C. albicans. Pregnancy Category B, Some products may
contain ethyl alcohol or benzyl alcohol-avoid
use in patients who may be hypersensitive
to or intolerant of these additives
SIDE EFFECTS:
Diarrhea, nausea, stomach pain (large NURSING CONSIDERATIONS:
Inspect oral mucous membranes before and
doses), vomiting, contact dermatitis,
frequently throughout therapy. ↑ irritation of
Stevens-Johnson syndrome. mucous membranes may indicate need to d/c
med. PO: Suspension should be administered by
placing of dose in each side of 1⁄2 mouth. Pt
should hold suspension in mouth or swish
LAB TEST CONSIDERATIONS: throughout mouth for several minutes before
swallowing, then gargle and swallow. Shake well
before administration. Pedi: For neonates and
infants, paint suspension into recesses of the
Generic: carvedilol Trade: Coreg, Coreg CR Pharmacological: BB Therapeutic:
antihypertensives Usual Dose: HTN-6.25 mg BID, may be ↑ q 7– 14 days up to 25mg BID or XR 20 mg once
daily, dose may be doubled q 7– 14 days up to 80 mg once daily

MODE OF ACTION: INDICATIONS:

Blocks stimulation of beta1(myocardial) & beta2 HTN, HF (ischemic or cardiomyopathic) w/
(pulmonary, vascular, and uterine)-adrenergic digoxin, diuretics, and ACE I. Left ventricular
receptor sites. Also has alpha1 blocking activity, dysfunction after myocardial infarction.
which may result in orthostatic hypotension.
Therapeutic Effects: Decreased heart rate and CONTRAINDICATIONS:
BP. Improved cardiac output, slowing of the Pregnancy category C. Hx of serious hypersensitivity
progression of HF and decreased risk of death. reaction (Stevens-Johnson syndrome, angioedema,
anaphylaxis), pulmonary edema, cardiogenic shock,
bradycardia, heart block or SSS (unless a
SIDE EFFECTS: pacemaker is in place), uncompensated HF requiring
IV inotropic agents (wean before starting carvedilol),
Orthostatic HTN, dizziness, fatigue, weakness, severe hepatic impairment, asthma or other
diarrhea, ED, hyperglycemia. May ↑BUN, serum bronchospastic disorders.
lipoprotein, K+, triglyceride, and uric acid levels.
NURSING CONSIDERATIONS:
Monitor BP/pulse frequently during dose adjustment
period and periodically during therapy. PO: Take
LAB TEST CONSIDERATIONS: apical pulse before administering. Hold if < 50 bpm
or if arrhythmia occurs. Monitor I&O and daily
weight. Assess pt routinely for evidence of fluid
overload. Administer w/ food to minimize orthostatic
hypotension. Administer XR capsules in the AM
Generic: insulin regular Trade: Humulin R, Novolin R Pharmacological: pancreatics
Therapeutic: antidiabetics, hormones Usual Dose: Maintenance Therapy Subcut (Adults and Children):
0.5– 1 unit/kg/day in divided doses. Adolescents during rapid growth—0.8– 1.2 unit/kg/day in divided doses.
MODE OF ACTION: INDICATIONS:
↓ blood glucose by: stimulating glucose uptake in Control of hyperglycemia in pt w/ DM. Concentrated
skeletal muscle and fat, inhibiting hepatic glucose regular insulin U-500: Only for use in patients with
production. Other actions of insulin: inhibition of insulin requirements 200 units/day. Unlabeled Use:
lipolysis & proteolysis, enhanced protein Tx of hyperkalemia
synthesis. Therapeutic Effects: Control of CONTRAINDICATIONS:
hyperglycemia in diabetic patients.
Pregnancy Category B. Hypoglycemia, allergy or
hypersensitivity to a particular type
SIDE EFFECTS: of insulin, preservatives, or other additives.
Hypoglycemia, hypokalemia
NURSING CONSIDERATIONS:
Assess pt periodically for symptoms of hypoglycemia.
When mixing insulins, draw regular insulin into
syringe first to avoid contamination of regular insulin
LAB TEST CONSIDERATIONS: vial. Subcut: Administer regular insulin within 15– 30
Monitor blood glucose every 6 hr during therapy, more min before a meal. IV Push: Diluent: May be
frequently in ketoacidosis and times of stress. A1C administered IV undiluted directly into vein or
may be monitored q 3-6 mo to determine through Y-site. Rate: Administer up to 50 units over 1
effectiveness. Monitor potassium in pt at risk for min. Continuous Infusion Diluent: May be diluted in
hypokalemia (those using potassium-lowering agents, 0.9% NaCl using polyvinyl chloride infusion bags.
those receiving IV insulin) periodically during therapy Advise pt to notify HCP if nausea, vomiting, or fever
develops, if unable to eat regular diet, or if blood
glucose levels are not controlled.
Generic: NPH insulin Trade: HumuLIN N, NovoLIN N
Pharmacological: pancreatics Therapeutic: antidiabetics, hormones
Usual Dose: Subcut (Adults and Children): 0.5– 1 unit total insulin/kg/day. Adolescents during rapid growth
0.8-1.2 units total insulin/kg/day.
MODE OF ACTION: INDICATIONS:
↓ blood glucose by: stimulating glucose Control of hyperglycemia in patients w/ DM
uptake in skeletal muscle and fat, inhibiting
hepatic glucose production. Other actions CONTRAINDICATIONS:
of insulin: inhibition of lipolysis & Pregnancy Category B. Hypoglycemia,
proteolysis, enhanced protein synthesis. allergy or hypersensitivity to a particular type
Therapeutic Effects: Control of of insulin, preservatives, or other additives.
hyperglycemia in diabetic pt.

NURSING CONSIDERATIONS:
SIDE EFFECTS:
Assess patient periodically for symptoms of
Hypoglycemia, hypokalemia hypoglycemia. Monitor body weight
periodically. Subcut: Administer NPH insulin
within 30-60 min before a meal.
LAB TEST CONSIDERATIONS:
Monitor blood glucose every 6 hr during
therapy, more frequently in ketoacidosis
and times of stress. A1C may be monitored
every 3-6 mo to determine effectiveness.
Monitor K+ in pt’s at risk for hypokalemia
Generic: regular insulin mixtures Trade: HumuLIN 70/30, NovoLIN 70/30
Pharmacological: pancreatics Therapeutic: antidiabetics, hormones
Usual Dose: Subcut (Adults and Children): 0.5– 1 unit/kg/day. Adolescents during rapid growth 0.8– 1.2
units/kg/day
MODE OF ACTION: INDICATIONS:
↓ blood glucose by: stimulating glucose Control of hyperglycemia in pt’s w/ type 1 or type 2
uptake in skeletal muscle and fat, DM.
CONTRAINDICATIONS:
inhibiting hepatic glucose production. Pregnancy Category B (insulin lispro protamine
Other actions: inhibition of lipolysis & suspension/insulin lispro injection mixtures), C (insulin
proteolysis, enhanced protein synthesis. aspart protamine suspension/insulin aspart injection
Therapeutic Effects: Control of mixtures, NPH/regular insulin mixtures), hypoglycemia,
hyperglycemia in DM pt. allergy or hypersensitivity to a particular type of insulin,
preservatives, or other additives.
SIDE EFFECTS:
NURSING CONSIDERATIONS:
Hypokalemia, hypoglycemia Assess pt periodically for sx’s of hypoglycemia.
Monitor body weight. Instruct pt in proper testing of
LAB TEST CONSIDERATIONS: serum glucose & ketones. These tests should
be closely monitored during periods of stress or
Monitor blood glucose every 6 hr during
illness
therapy, more frequently in ketoacidosis and
times of stress. Hemoglobin A1C may also
be monitored every 3– 6 mo to determine
effectiveness. Monitor K+ in pt at risk for
hypokalemia.
Generic: ketorolac Trade: Toradol
Pharmacological: pyrroziline carboxylic acid Therapeutic: Nsaid, nonopioid analgesics
Usual Dose: PO (Adults 65 yr): 20 mg initially, followed by 10 mg q 4– 6 hr (Max 40mg/day). IM (Adults
65 yr):Single dose—60 mg. Multiple dosing—30 mg q 6 hr (Max 120 mg/day)
MODE OF ACTION: INDICATIONS:
Inhibits prostaglandin synthesis, producing ST mgmt of pain (not to exceed 5 days total for
peripherally mediated analgesia. Also all routes combined).
has antipyretic and anti-inflammatory CONTRAINDICATIONS:
properties. Therapeutic Effects: ↓ pn Pregnancy Category C (oral, nasal spray (30 wk
gestation), D (nasal spray 30 wk gestation).
SIDE EFFECTS:
Drowsiness, anaphylaxis, dizziness, dry Hypersensitivity/cross-sensitivity w/ other NSAIDs
may exist, preoperative use, active/hx PUD or GI
mouth, Steven Johnson Syndrome, may
bleeding, known etoh intolerance (injection only);
cause prolonged bleeding time that may
Perioperative pn from CABG sx, cerebrovascular
persist for 24-48 hr following d/c of
bleeding, advanced renal impairment or risk for renal
therapy. May cause ↑ BUN, serum failure due to volume depletion, use of pentoxifylline
creatinine, or potassium concentrations. or probenecid.
NURSING CONSIDERATIONS:
PO: Ketorolac therapy should always be given initially by
LAB TEST CONSIDERATIONS: the IM or IV route. Use oral therapy only as a continuation
Evaluate LFT’S, especially AST and ALT, of parenteral therapy. IV Push: Administer undiluted.
periodically in patients receiving prolonged Concentration: 15– 30 mg/mL. Rate: Administer over at
therapy. May cause↑ levels. least 15 sec. Assess for rash periodically during therapy.
Pain: Assess pain (note type, location, and intensity) prior
to and 1– 2 hr following administration.
Generic: Pravastatin Trade: Pravachol
Pharmacological: HMG-CoA reductase inhibitors (statins) Therapeutic: lipid-lowering agents
Usual Dose:PO (Adults): 10– 20 mg once daily at bedtime, may be adjusted at 4-wk intervals as needed (usual
range 10-40 mg/day)
MODE OF ACTION: INDICATIONS:
Inhibits 3-hydroxy-3-methylglutaryl-coenzyme Adjunctive management of primary
A (HMG-CoA) reductase, an enzyme which is hypercholesterolemia and mixed dyslipidemias.
responsible for catalyzing an early step in the Primary prevention of coronary heart disease (MI,
synthesis of cholesterol. Therapeutic Effects: coronary revascularization, cardiovascular mortality)
↓ of total and LDL cholesterol and triglycerides. in asymptomatic pt’s w/ ↑ total & LDL cholesterol & ↓
Slightly ↑ HDL cholesterol. Slows the HDL cholesterol. Secondary prevention of MI,
progression of coronary atherosclerosis with coronary revascularization, stroke, and overall
resultant decrease in coronary heart mortality in patients w/ clinically evident coronary
disease-related events. heart disease.
CONTRAINDICATIONS:
SIDE EFFECTS: Pregnancy Category X, hypersensitivity, active
abdominal cramps, constipation, diarrhea,
liver disease or unexplained persistent↑ in AST
flatus, heartburn, myalgia, rhabdomyolysis,
& ALT.
rash, photosensitivity reaction (rare)
NURSING CONSIDERATIONS:
Obtain a diet history, especially with regard to fat
LAB TEST CONSIDERATIONS:
Evaluate cholesterol and triglyceride levels consumption. PO: Administer once daily in the evening.
May be administered without regard to food. Avoid
before initiating, after 4– 6 wk of therapy &
grapefruit/grapefruit juice during therapy. If administered
periodically thereafter. Monitor LFT prior to in conjunction w/ bile acid sequestrants (cholestyramine,
initiation of therapy and as clinically indicated. If colestipol), administer 1 hr before or 4 hr after bile acid
pt develops muscle tenderness during therapy, sequestrant. Advise patient to wear sunscreen and
CPK levels should be checked. protective clothing.
Generic: naloxone Trade: Narcan, Evzio
Pharmacological: opioid antagonists Therapeutic: antidotes (for opioids)
Usual Dose: IV, IM, Subcut (Adults): Patients not suspected of being opioid dependent(10 mcg/kg); may repeat q
2– 3 min
MODE OF ACTION: INDICATIONS:
Competitively blocks the effects of opioids, Reversal of CNS depression and respiratory
including CNS & respiratory depression, depression because of suspected opioid OD.
w/o producing any agonist (opioid-like) Unlabeled Use: Opioid-induced pruritus
effects. Therapeutic Effects: Reversal of (low-dose IV infusion). Mgmt of refractory
circulatory shock.
signs of opioid excess. CONTRAINDICATIONS:
Pregnancy Category B
SIDE EFFECTS:
NURSING CONSIDERATIONS:
Hypotension, ventricular arrhythmias, Monitor respiratory rate, rhythm, and depth;
hypertension, nausea, vomiting pulse, ECG, BP; and level of consciousness
frequently for 3-4 hr after the expected peak of
blood concentrations. Assess pt for level of pn
after administration when used to tx postop
LAB TEST CONSIDERATIONS: respiratory depression. Naloxone ↓ respiratory
depression but also reverses analgesia. Assess
patient for signs and sx’s of opioid w/d.
Generic: Ephedrine Pharmacological: alpha- and beta-Adrenergic Agonists
Therapeutic: decongestant and bronchodilator
Usual Dose: Bronchospasm 12.5–25 mg every 4 hours PRN Ephedrine sulfate: Parenteral doses of 12.5–25 mg have
been given.

MODE OF ACTION: INDICATIONS:

It works by ↓ swelling and constricting blood Used for temporary relief of SOB, chest tightness,
vessels in the nasal passages and widening and wheezing due to bronchial asthma.
the lung airways, allowing you to breathe Hypotension during anesthesia, narcolepsy,
more easily. Relaxes bronchial smooth obesity (previously used), myasthenia gravis
muscle, stimulates cardiac muscle (producing CONTRAINDICATIONS:
positive inotropic effects). Relaxes GI smooth Pregnancy and breast-feeding: unknown MAO
muscle. Contracts urinary bladder trigone inhibitor (eg, phenelzine) taken in the last 14
and sphincter and relaxes the detrusor days. HTN, heart disease, an irregular heartbeat,
muscle thyroid disease, diabetes, or BPH. Known
SIDE EFFECTS: hypersensitivity to ephedrine or sympathomimetic
Dizziness, difficulty sleeping, hyperglycemia drugs.
HA, nausea, nervousness, tremor, loss of NURSING CONSIDERATIONS:
appetite, restlessness, stomach irritation, Check Bp, pulse, lung sounds, respiratory
risk misuse/abuse, HTN, tachycardia rate prior to administration and after.

LAB TEST CONSIDERATIONS:

Generic: Codeine-Guaifenesin Trade: Robitussin A-C, Cheratussin AC
Pharmacological: expectorant, narcotic cough suppressant Usual Dose: Adults and
children 12 years> : 2 tsp q 4 hours, max 12 teaspoonfuls in a 24-hour period
MODE OF ACTION: INDICATIONS:
Guaifenesin is an expectorant that helps This combo med is used to temporarily tx
thin and loosen mucus in the lungs, coughing and chest congestion sx’s caused by
making it easier to cough up the mucus. the common cold, flu, or other breathing
Codeine is an opioid cough suppressant illnesses (e.g., sinusitis, bronchitis).
(antitussive) that affects a certain part of
the brain, reducing the urge to cough. CONTRAINDICATIONS:
Do not breast-feed. Codeine can pass into breast
milk and may cause drowsiness, breathing
problems, or death in a nursing baby. Pt’s w/
SIDE EFFECTS: asthma.
Risk misuse/addiction, drowsiness, dizziness, NURSING CONSIDERATIONS:
lightheadedness, facial flushing, nausea, Give this med by mouth w/ or w/o food w/ a
vomiting, or constipation. full glass of water. Drink plenty of fluids while
using this med unless otherwise directed. The
fluid will help loosen the mucus in lungs.

LAB TEST CONSIDERATIONS:

 Generic: magnesium sulfate (IV, parenteral)(9.9% Mg; 8.1 mEq Mg/g) Pharmacological:
minerals/electrolytes Therapeutic: mineral and electrolyte replacements/supplements Usual Dose:
Eclampsia/Pre-Eclampsia IV, IM (Adults): 4– 5 g by IV infusion, w/ up to 5 g IM in each buttock; then
4– 5 g IM q 4 hr or 4 g by IV infusion followed by 1– 2 g/hr continuous infusion (Max 40 g/day or 20
g/48 hr in the presence of severe renal insufficiency
MODE OF ACTION: INDICATIONS:
Essential for the activity of many enzymes. Tx/prevention of hypomagnesemia. Tx of HTN. Prevention of
Plays an important role in seizures associated w/ severe eclampsia, pre-eclampsia, or
neurotransmission and muscular acute nephritis. Unlabeled Use: Preterm labor.
excitability. “Neuro protector” CONTRAINDICATIONS:
Pregnancy Category D. Hypermagnesemia, hypocalcemia,
SIDE EFFECTS: anuria, heart block. OB: Avoid using for > than 5–7 days for
Drowsiness, ↓respiratory rate,
preterm labor (may↑risk of hypocalcemia & bone changes in
arrhythmias, bradycardia, hypotension, newborn); avoid continuous use during active labor or within 2
diarrhea, muscle weakness, flushing, hr of delivery due to potential for mag toxicity in newborn.
sweating, hypothermia, toxicity
NURSING CONSIDERATIONS:
Antidote is calcium gluconate. If Hypomagnesemia/Anticonvulsant: Monitor pulse, BP, RR& ECG
ordered, administer Calcium Gluconate frequently w/ admin of parenteral mag sulfate. Resp should be at
10%, IV Push, 10 ml over 3 minutes. least 16/min before q dose. Monitor neurologic status before &
throughout therapy. Institute seizure precautions. Patellar reflex
(knee jerk) should be tested before & parenteral dose of mag
LAB TEST CONSIDERATIONS:
sulfate. If response is absent, no additional doses should be
Monitor serum magnesium levels
administered until + response is obtained. Monitor newborn for
and renal function periodically hypotension, hyporeflexia, and respiratory depression if mom has
throughout administration of received magnesium sulfate. Monitor I&O ratios. Urine output
parenteral mag sulfate should be maintained at a level of at least 100 mL/4 hr
\
 Generic: dinoprostone Trade: Cervidil Vaginal Insert Pharmacological: oxytocics,
prostaglandins Therapeutic: cervical ripening agent Usual Dose: Vag (Adults, Cervical): Endocervical
gel-0.5 mg; if response is unfavorable, repeat in 6 hr (max 1.5 mg/24 hr). Vaginal insert—one 10-mg insert.
MODE OF ACTION: INDICATIONS:
Endocervical Gel, Vaginal Insert: Used to “ripen” the
Produces contractions similar to those occurring cervix in pregnancy at or near term when induction of
during labor at term by stimulating myometrium labor is indicated. Vaginal Suppository: Induction of mid
(oxytocic effect). Initiates softening, effacement, trimester abortion, Mgmt of missed abortion up to 28 wk,
and dilation of the cervix (“ripening”). Also Mgmt of nonmetastatic gestational trophoblastic disease
stimulates GI smooth muscle. Therapeutic (benign hydatidiform mole).
Effects: Initiation of labor. Expulsion of fetus. CONTRAINDICATIONS:
Hypersensitivity to prostaglandins or additives in the gel or
SIDE EFFECTS: suppository, concurrent oxytocic therapy (wait for 30 min
Uterine contractile abnormalities, warm after removing insert before using oxytocin).Previous
feeling in vagina. Back pn, fever, n/v, chills, c-section or uterine sx, cephalopelvic disproportion,
uterine rupture, vomiting, diarrhea, HA, traumatic delivery or difficult labor, >6 term pregnancies,
drowsiness, dizziness, hypotension herpes genital's, fetal distress, placenta previa, acute PID
NURSING CONSIDERATIONS:
CK BP prior to admin; if >140/90 call HCP). Monitor temp, pulse, and BP frequently throughout therapy.
Dinoprostone-induced fever : (↑2F) usually occurs w/i 15-45 min after insertion of supp. This returns to nl 2-6 hr
after d/c. Auscultate breath sounds. Assess for S/S egotism (cold/numb fingers/toes, N/V, HA, muscle
pn/weakness)Wheezing & sensation of chest tightness may indicate hypersensitivity rxn. Assess for n/v, &
diarrhea in pt’s receiving supp. Pt should be premedicated w/ antiemetic and antidiarrheal. Monitor amount & type
of vaginal d/c. Notify HCP ASAP if sx’s of hemorrhage (increased bleeding, hypotension, pallor, tachycardia) occur
Monitor uterine activity, fetal status, & dilation/effacement of cervix continuously. Assess for hypertonus, sustained
uterine contractility, & fetal distress. Insert should be removed at the onset of active labor. Pt should remain supine
for 10 min after insertion of supp. Vaginal Insert: Place vaginal insert transversely in the posterior vaginal fornix
immediately after removing from foil package. Use vaginal insert only with a retrieval system. Pt should remain
supine for 2 hr after insertion Pregnancy Category: C
Generic: misoprostol Trade: Cytotec Pharmacological: prostaglandins Therapeutic: antiulcer
agents, cytoprotective agents Usual Dose: Termination of pregnancy-400 mcg single dose 2 days
after mifepristone if abortion has not occurred. Intravaginally(Adults): 25 mcg (1/4 of 100– mcg
tablet); may repeat q 3-6 hr, prn (intravaginally, PO, SL)
MODE OF ACTION: INDICATIONS:
Prevention of gastric mucosal injury from NSAIDs.
Acts as a prostaglandin analogue, decreasing
W/ mifepristone for termination of pregnancy.
gastric acid secretion (antisecretory effect) &
Unlabeled Use: Cervical ripening and labor
increasing the production of protective mucus
induction.
(cytoprotective effect). Causes uterine
contractions. Therapeutic Effects: Prevention
of gastric ulceration from NSAIDs. With CONTRAINDICATIONS:
mifepristone terminates pregnancy of less than Hypersensitivity to prostaglandins. OB:
49 days. SIDE EFFECTS: Shouldn’t be used to prevent NSAID-induced
When used for cervical ripening (unlabeled use) gastric injury due to potential for fetal harm or
may cause uterine rupture (risk factors are late death. Lactation: May cause severe diarrhea
trimester pregnancy, previous c-section or in the nursing infant. Pregnancy category X
uterine surgery or >5 previous pregnancies).
HA, abd pn, miscarriage, diarrhea, HTN. NURSING CONSIDERATIONS:
Termination of pregnancy: Monitor uterine
cramping & bleeding during therapy. Cervical
Ripening: Assess dilation of cervix
LAB TEST CONSIDERATIONS: periodically during therapy. Assess pt
routinely for epigastric or abdominal pn & for
frank or occult blood in the stool, emesis, or
gastric aspirate.
Generic: Oxytocin Trade: Pitocin Pharmacological: oxytocics Therapeutic: hormones Usual
Dose: Induction/Stimulation of Labor IV (Adults): 0.5-1 milliunits/min; ↑ by 1-2 milliunits/min q 30– 60 min until
desired contraction; dose may be ↓ after desired frequency of contractions & labor has progressed to 5– 6 cm dilation.
Postpartum Hemorrhage IV (Adults): 10 units infused at 20-40 milliunits/min. IM (Adults): 10 units after delivery of
placenta. Incomplete/Inevitable Abortion IV (Adults): 10 u at a rate of 20– 40 milliunits/min
MODE OF ACTION: INDICATIONS:
IV: Induction of labor at term. IV: Facilitation of
Stimulates uterine smooth muscle, threatened abortion. IV, IM: Postpartum control of
producing uterine contractions similar to bleeding or hemorrhage after expulsion of the
those in spontaneous labor. Has placenta. CONTRAINDICATIONS:
vasopressor & antidiuretic effects. Severe HTN may occur if oxytocin follows admin of
Therapeutic Effects: Induction of labor. vasopressors. Pregnancy category X
Control of postpartum bleeding. NURSING CONSIDERATIONS:
SIDE EFFECTS: Fetal maturity, presentation, & pelvic adequacy
Increased uterine motility, hypotension, should be assessed prior to admin of oxytocin for
painful contractions, coma, seizure, induction of labor. Assess character, frequency, &
hyponatremia, hypochloremia due to h2o duration of contractions; resting uterine tone; & fetal
intoxication. Fetal heart rate frequently throughout admin. If
arrythmias/hypoxia/asphyxia, hypotension, contractions occur <2 min apart and are >50-65 mm
abruptio placentae, fetal intracranial Hg on monitor, & last 60-90 sec or >, or if a
hemorrhage significant ∆ in fetal HR develops, stop infusion &
LAB TEST CONSIDERATIONS: turn pt on left side to prevent fetal anoxia. Notify
Monitor maternal electrolytes. H2O retention HCP ASAP. Monitor maternal BP & pulse frequently
may result in hypochloremia or hyponatremia. and fetal HR continuously throughout admin. Monitor
pt for s/s H2O intoxication (drowsiness, listlessness,
confusion, HA, anuria) & notify HCP if they occur.
Generic: methylergonovine Trade: Methergine Pharmacological: ergot alkaloids Therapeutic:
oxytocic Usual Dose: PO (Adults): 200–400 mcg (0.2–0.4 mg) q 6– 12 hr for 2– 7 days.
IM, IV (Adults): 200 mcg (0.2 mg) q 2–4 hr for up to 5 doses.
MODE OF ACTION: INDICATIONS:
Prevention & tx of postpartum or post abortion
Directly stimulates uterine & vascular hemorrhage caused by uterine atony or
smooth muscle. Therapeutic Effects: subinvolution.
Uterine contraction. CONTRAINDICATIONS:
Hypersensitivity. OB: Shouldn’t be used to
induce labor. Lactation: Do not breast feed
SIDE EFFECTS: during treatment & for 12 hours after the last
N/V, cramps, CVA, dizziness, HA, tinnitus, dose. Concurrent use of potent CYP3A4
HTN, arrhythmia, palps inhibitors. Exercise Extreme Caution in: 3rd
stage of labor
NURSING CONSIDERATIONS:
LAB TEST CONSIDERATIONS: Monitor BP, HR, & uterine response frequently
during medication admin. Notify HCP promptly
If no response to methylergonovine,
if uterine relaxation becomes prolonged or if
calcium levels may need to be assessed.
character of vaginal bleeding changes. Assess
Effectiveness of medication is ↑ w/
for signs of ergotism (cold, numb fingers &
hypocalcemia. May cause ↑ prolactin
toes, chest pn, N/V, HA, muscle pn,
levels.
weakness). IV admin is used for emergencies
only. Oral & IM routes are preferred.
Generic: Lidocaine Trade: Xylocaine Therapeutic: anesthetics Usual Dose: Infiltrate affected area
as needed (increased amount and frequency of use increases likelihood of systemic absorption and
adverse reactions).
MODE OF ACTION: INDICATIONS:
Produces local anesthesia by inhibiting Need for local anesthesia for episiotomy
transport of ions across neuronal or infant circumcision.
membranes, thereby preventing initiation
and conduction of normal nerve impulses.
CONTRAINDICATIONS:
Hypersensitivity, heart block

NURSING CONSIDERATIONS:
Assess degree of numbness of affected
part. S/S of toxicity include confusion,
SIDE EFFECTS: excitation, blurred or double vision,
Confusion, drowsiness, seizures, stinging, nausea, vomiting, ringing in ears, tremors,
blurred vision, dizziness, hypotension, twitching, seizures, difficulty breathing,
bradycardia, arrhythmia, toxicity severe dizziness or fainting, & unusually
slow HR. If sx’s of OD occur, stop infusion
and monitor pt closely. Assessment of
LAB TEST CONSIDERATIONS: vulva/perineum is made daily while pt is in
the hospital and at 6 weeks postpartum by
the HCP
Generic: labetalol Brand: Trandate Pharmacological: BB Therapeutic:
antihypertensives Usual Dose: PO (Adults): 100 mg BID initially, may be ↑ by 100 mg BID q 2– 3 days prn (usual
range 400– 800 mg/day in 2– 3 divided doses; doses up to 1.2– 2.4. IV (Adults): 20 mg (0.25 mg/kg) initially, additional
doses of 40– 80 mg may be given q 10 min prn (Max 300 mg total dose) or 2 mg/min infusion (range 50– 300 mg total
dose required).
ACTIONS: INDICATIONS:
Blocks stimulation of beta1 (myocardial)- and beta2 Mgmt of HTN
(pulmonary, vascular, and uterine)-adrenergic CONTRAINDICATIONS:
Pregnancy Category C, uncompensated HF, pulmonary
receptor sites. Also has alpha1-adrenergic blocking edema, cardiogenic shock, bradycardia or heart block OB:
activity, which may result in more orthostatic May cause fetal/neonatal bradycardia, hypotension,
hypotension. Therapeutic Effects: Decreased BP hypoglycemia, or respiratory depression; Lactation:
Usually compatible with breast feeding Pedi: Limited data
SIDE EFFECTS: available. NURSING CONSIDERATIONS:
Fatigue, weakness, orthostatic hypotension, Monitor BP & pulse frequently during dose adjustment &
increase sensitivity to cold, ED, arrhythmias, periodically during therapy. Hold dose and call HCP if
bradycardia, pulmonary edema, bronchospasm, pulse <50. Assess for orthostatic hypotension when
wheezing. May cause ↑ BUN, serum lipoprotein, assisting pt up from supine position. Pt’s receiving
K+, triglyceride, and uric acid levels. May cause ↑ labetalol IV must be supine during and for 3 hr after
ANA titers. May cause ↑ in blood glucose levels. administration. VS should be monitored q 5-15 min during
May cause ↑ serum alkaline phosphatase, LDH, and for several hours after administration. Monitor I&O
AST, and ALT levels ratios and daily weight. Assess patient routinely for
evidence of fluid overload. D/c if jaundice or lab signs of
hepatic function impairment occur. Monitor patients
LAB TEST CONSIDERATIONS: receiving BB for signs of OD (bradycardia, severe
Monitor LFT dizziness or fainting, severe drowsiness, dyspnea, bluish
fingernails or palms, seizures). Glucagon has been used to
treat bradycardia and hypotension. Pt’s w/ DM should
closely monitor blood glucose.
Generic: docusate sodium/senna Trade: Peri Colace Pharmacological: stimulant laxatives, stool
softeners Therapeutic: laxative
Usual Dose: PO (Adults and Children 12 yr): 2 tablets QD at HS; max 4 tablets BID.

MODE OF ACTION: INDICATIONS:

Senna’s metabolite acts as a local irritant Tx of constipation associated w/ dry, hard
on the colon stimulating peristalsis. stools and decreased intestinal motility.
Docusate promotes incorporation of water Prevention of opioid-induced constipation.
into stool, resulting in softer fecal mass. CONTRAINDICATIONS:
Therapeutic Effects: Softening & passage Hypersensitivity, abdominal pain, nausea, or
of stool. vomiting, especially when associated w/
fever or other signs of an acute abdomen;
SIDE EFFECTS: Concomitant use of mineral oil.
Electrolyte imbalance, dehydration, NURSING CONSIDERATIONS:
stomach cramps, diarrhea , rash, Assess for abdominal distention, presence of
discolored urine, n/v BS, & usual pattern of bowel function. Assess
color, consistency, & amount of stool produced.
PO: Administer w/ a full glass of water or juice.
LAB TEST CONSIDERATIONS: Don’t administer w/i 2 hr of other laxatives,
Review labs for evidence of especially mineral oil. May cause ↑ absorption.
electrolyte/fluid imbalance, Encourage pt’s to use other forms of bowel
vitamin/mineral imbalance. regulation, such as ↑ bulk in the diet, ↑ fluid
intake (6– 8 full glasses/day), and increasing
mobility.
Generic: hydrocodone/APAP Trade: Norco Pharmacological: opioid agonists/nonopioid analgesic
combinations Therapeutic: opioid analgesics Usual Dose: PO (Adults): Analgesic-2.5– 10 mg q 3– 6 hr prn;
acetaminophen dosage max4 g/day PO (Children): Analgesic (1– 13 yr)—0.1– 0.2 mg/kg q 3– 4 hr
MODE OF ACTION: INDICATION:
Bind to opiate receptors in the CNS. Alter Management of moderate to severe pain
the perception of and response to painful CONTRAINDICATIONS:
Pregnancy category C, Significant respiratory depression,
stimuli while producing generalized CNS paralytic ileus, acute or severe bronchial asthma or
depression. Therapeutic Effects: hypercarbia, congenital long QT syndrome. OB,
Decrease in severity of moderate pain. Lactation: Avoid chronic use; Products containing alcohol
aspartame, saccharin, sugar, or tartrazine (FDC yellow
dye #5) should be avoided in patients who have
SIDE EFFECTS: hypersensitivity or intolerance to these compounds.
Constipation, ↓ respirations, NURSING CONSIDERATIONS:
dependency, drowsiness, dizziness,
Assess BP, pulse, and respirations before and
liver/renal damage, orthostatic periodically during administration. If respiratory rate is
hypotension <10/min, assess level of sedation. Assess bowel
function routinely. Prevention of constipation should be
instituted w/ increased intake of fluids, increased
mobility & bulk, and laxatives. Caution pt to avoid
concurrent use of alcohol or other CNS depressants w/
LAB TEST CONSIDERATIONS: this med. Assess type, location, and intensity of pn
prior to and 1 hr (peak) following administration.
Monitor LFT, renal function in long term
use
Generic: oxycodone and APAP Trade: Percocet
Pharmacological: Opioid agonist/non opioid analgesic combo Therapeutic: Opioid analgesic
Usual Dose: 2.5-10 mg po q 5-6 hours or 5-10 mg p0 q 6 hours prn. Total APAP should not exceed 4 grams
MODE OF ACTION: INDICATIONS:
Binds to opiate receptors in CNS, alters Relief of moderate to severe pain (nociceptive)
perception of pain and produces realized CONTRAINDICATIONS:
Pregnancy Category B. OB, Lactation: Avoid
CMS depression. Prolonged use of XR morphine during pregnancy
can result in neonatal opioid w/d syndrome;
Children 11 yr (safety and effectiveness of XR
products not established)
SIDE EFFECTS:
NURSING CONSIDERATIONS:
Dizziness, orthostatic hypotension, Assess BP, pulse, respirations before &
constipation, itching skin, bradycardia, periodically during administration. If respiratory
life threatening respiratory depression, rate is <10/min, assess level of sedation. Assess
euphoria, drug abuse/dependency, liver bowel function routinely, check BS for decreased
damage/failure, confusion, sedation, peristalsis. Prevention of constipation should be
Steven Johnson syndrome, toxic instituted w/ ↑ intake of fluids and bulk, and
epidermal necrolysis laxatives. Caution pt to avoid concurrent use of
etoh or other CNS depressants w/ this med.
Assess type, location, and intensity of pain prior to
LAB TEST CONSIDERATIONS: and 1 hr (peak) following administration. PO: May
LFT/renal function be administered with food or milk to minimize GI
irritation. Assess for risk of addiction.
Generic: fentanyl (transdermal) Trade: Duragesic Pharmacological: opioid agonists
Usual Dose: 25 mcg/hr is the initial dose. If >100 mcg/hr is required, use multiple transdermal systems
MODE OF ACTION: INDICATIONS:
Moderate to severe chronic pain in opioid-tolerant pt’s
Binds to opiate receptors in the CNS, requiring use of daily, around-the-clock long-term opioid
altering the response to and perception treatment and for which alternative treatment options are
of pain. inadequate (extended-release)
Therapeutic Effects: Decrease in CONTRAINDICATIONS:
Dose should be adjusted for hepatic/ renal impairment.
severity of chronic pain. Significant respiratory depression, acute or severe
bronchial asthma, paralytic ileus, severe hepatic or renal
SIDE EFFECTS: impairment, etoh intolerance. OB: Not recommended
Confusion, sedation, weakness, during labor and delivery; Lactation: May cause adverse
affects in infant.
constipation, dry mouth, nausea,
vomiting, toxicity/OD NURSING CONSIDERATIONS:
Apply system to flat, non irritated, and
nonirradiated site such as chest, back, flank, or
upper arm. Assess type, location, and intensity of
pain before and 24 hr after application and
periodically during therapy. Assess BP, pulse, and
respirations before and periodically during
administration. If respiratory rate is 10/min, assess
LAB TEST CONSIDERATIONS:
level of sedation. Assess bowel function routinely.
Assess risk for opioid addiction, abuse, or misuse
prior to administration. Monitor for respiratory
depression
Generic: fentaNYL (parenteral) Trade: Sublimaze Pharmacological: opioid agonists
Therapeutic: opioid analgesics Usual Dose: Initial dose: 0.5 -1 mcg/kg (max 100 mcg) slow IVP.
Wait 5 -10 minutes for effect. Repeat 0.5 – 1 mcg/kg q 5 - 10 min until adequate analgesia or max
dosage is reached. Max hourly dose: 2 mcg/kg or 200 mcg/hr (2 – 4 doses/hr).
MODE OF ACTION: INDICATIONS:
Binds to opiate receptors in the CNS, Analgesic supplement to general anesthesia; usually w/ other
altering the response to and perception agents (ultra– short acting barbiturates, neuromuscular
blocking agents, and inhalation anesthetics) to produce
of pain. Produces CNS depression. balanced anesthesia
Therapeutic Effects: Supplement in CONTRAINDICATIONS:
Hypersensitivity, cross-sensitivity among agents may occur,
anesthesia. Decreased pn.
known intolerance. Maternal RR< 8/minute, or O2 sat < 94%.
Significant respiratory compromise (e.g. severe asthma, cystic
SIDE EFFECTS: fibrosis, COPD, OSA, etc.) Uncorrected hypotension or
Maternal: N/V, dysphoria, delayed hypovolemia
gastric emptying, respiratory NURSING CONSIDERATIONS:
depression and desat, allergic or Monitor RR, SPO2, BP frequently throughout therapy.
Report significant changes ASAP. The resp depressant
hypersensitivity reaction including
effects of fentanyl may last longer than the analgesic effects
anaphylaxis Fetal: ↓ fetal HR and/or
Initial doses of other opioids should be reduced. Monitor
variability, resp depression, desat up to
closely. Atropine may be used to tx bradycardia. If resp
12 hours of age, possible interference depression persists after sx, prolonged mechanical vent ma
w/ cuing & feeding efforts be required. If an opioid antagonist is required to reverse
resp depression or coma, naloxone (Narcan) is the antidote
LAB TEST CONSIDERATIONS:
Initiate fall precautions. Administer using slow IVP method.
Check LFT, CR/GFR prior to admin Monitor & record fetal HR
Generic: Measles, Mumps, and Rubella Virus Vaccine Live Trade: M-M-R II
Pharmacological: Vaccine Combinations Usual Dose: 0.5 ml subcutaneous route
MODE OF ACTION: INDICATIONS:
The measles, mumps, and rubella vaccine GUARD AGAINIST DISEASE! Children should get 2
contains live attenuated (weakened) forms of doses of MMR vaccine, usually: 1st dose: 12-15 mos of
the measles, mumps, and rubella viruses. age 2nd dose: 4-6 yrs of age. A 3rd of MMR might be
The vaccine works by stimulating our recc in mumps outbreak situation. Measles, mumps,
immune system to produce antibodies and rubella are viral diseases that can have serious
(proteins which will fight and kill the viruses consequences. Before vaccines, these diseases were
against the measles, mumps, and rubella very common in the USA, especially among children.
viruses). Adults born before 1957 are considered immune.
CONTRAINDICATIONS:
Life-threatening allergic rxn after dose of MMR vaccine,
SIDE EFFECTS:
Discomfort, redness or rash at injection or has severe allergy to any part the vaccine, weakened
immune system, +TB, recent blood transfusion,
site, swelling of glands in the cheeks or
moderately-severely ill should post pone, pregnancy
neck, seizure, temporary joint pn/stiffness,
(can cause serious birth defects), thrombocytopenia
deafness, brain damage
NURSING CONSIDERATIONS:
Allow pt to sit or lay ↓ down for about 15 min to prevent fainting/fall. Assess for S/S severe allergic
rxn (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and
weakness) The preferred injection site in small children is the anterolateral aspect of the thigh. The
posterior triceps aspect of the upper arm is the preferred site for older children and adolescents. If
parents refuse vaccine, this information must be documented.
Generic: DTaP and Tdap Trade: Adacel, Boostrix, Daptacel, Infanrix
Pharmacological: Vaccine Combinations with a Tetanus Component

MODE
Usual Dose: 0.5 mL IMOF ACTION: INDICATIONS:
Bordetella pertussis has a variety of cellular Administration of Tdap as soon as feasible is
components that contribute to the pathogenesis of advised for all pregnant women (preferably during
whooping cough by mechanisms that are poorly the early part of gestational weeks 27-36), for all
understood. The various acellular vaccines postpartum women not vaccinated during
contains different pertussis antigens derived from pregnancy, close contacts of infants younger than
B. pertussis, which confer immunity by inducing the12 months of age, and HCP w/ direct pt contact.
production of antibodies against these cellular Prevent disease!
components. Clinical studies suggest it has an CONTRAINDICATIONS:
Guillain barre syndrome, latex hypersensitivity,
efficacy of 79—93% in protecting against clinical
coma, encephalopathy, neurological disease, seizur
pertussis after household exposure. In addition,
disorder, seizures, fever, shock, infection,
pertussis occurring in vaccinees is typically <
Anticoagulant therapy, bleeding, coagulopathy,
severe than pertussis in unimmunized pt’s.
hemophilia, thrombocytopenia, vitamin K deficiency
SIDE EFFECTS: immunosuppression, pregnancy, neonates.
injection site reaction, drowsiness, fever, chills,
rash, severe allergic rxn, hypotension, hypoxia, NURSING CONSIDERATIONS:
The preferred injection sites are the anterolateral
HA, body aches, N/V aspect of the thigh (particularly for infants) &
deltoid muscle(usually suitable for older children).
Lactation: Unknown Complete a Vaccine Adverse Event Reporting
System (VAERS) report form if adverse events
LAB TEST CONSIDERATIONS: have been identified. have immediate availability of
epinephrine 1 mg/mL injection and other agents
used in the tx of severe anaphylaxis
 Generic: 0.5% Erythromycin ophthalmic ointment Pharmacological: Ophthalmological
Anti-infectives, macrolide antibiotic Therapeutic: anti-infectives
Usual Dose: Newborn babies-Use in the eyes once at birth. (topically)
MODE OF ACTION: INDICATIONS:
Automatic prophylaxis with eye ointment for all
Suppresses protein synthesis at the level of newborns w/i 24 hours of birth is currently
the 50S bacterial ribosome. Therapeutic recommended by several health organizations in
Effects: Bacteriostatic action against the US, for prevention of neonatal conjunctivitis
susceptible bacteria Reduces risk gonorrheal and ophthalmia neonatorum (infection).
ON, thereby reducing the risk of blindness CONTRAINDICATIONS:
from the infection & possibly, chlamydial ON Parent refusal; Pregnancy category B
(ophthalmia neonatorum). Reduces overall NURSING CONSIDERATIONS:
bacteria in the eye and may help to prevent Tilt the head back &, pressing your finger gently
ON from non-sexually transmitted bacteria on the skin just beneath the lower eyelid, pull the
like staph. lower eyelid away from the eye to make a space.
SIDE EFFECTS: Squeeze a thin strip of ointment into this space. A
Chemical pink eye, minor ocular irritation, 1-cm (approximately 1/3-inch) strip of ointment is
blurred vision, burning sensation, allergic usually enough. Let go of the eyelid and gently
reaction close the eyes. Keep the eyes closed for 1 or 2
minutes. It is important to include access to care
LAB TEST CONSIDERATIONS:
in your discussion, since HCP can never be 100%
Was mother screened for gonorrhea and
sure of a mother’s risk status, and failure to
chlamydia during the current pregnancy?
respond quickly to pink eye from gonorrhea can
result in eye damage and blindness in as little as
24 hours. Advise parent to watch for signs of
pus-containing pink eye and bring the infant in for
 Generic: phytonadione Trade: Mephyton, vitamin K1 Pharmacological: fat-soluble vitamins
Therapeutic: antidotes, vitamins Usual Dose: IM (Neonates): 0.5- 1 mg, w/i 1 hr of birth, may repeat in
6– 8 hr prn. May be repeated in 2– 3 wk if mother received previous
anticonvulsant/anticoagulant/anti-infective/antitubercular therapy. 1– 5 mg may be given IM to mother
12-24 hrbefore delivery
MODE OF ACTION: INDICATIONS:
Required for hepatic synthesis of blood Prevention of hemorrhagic disease of the
coagulation factors II (prothrombin), VII,IX, & newborn. i.e. life-threatening bleeding problem
X. Therapeutic Effects: Prevention of known as vitamin k-deficiency bleeding.
bleeding due to hypoprothrombinemia
CONTRAINDICATIONS:
*Breast fed babies are at higher risk Hypersensitivity, hypersensitivity or intolerance
*Vitamin K is slowly released over time from to benzyl alcohol. Parent refusal
the injection site, which provides enough
Vitamin K1 until the baby’s Vitamin K levels NURSING CONSIDERATIONS:
reach adult levels naturally Recommended site is the thickest part of
SIDE EFFECTS: the vastus lateralis in the anterolateral
Redness and pain at injection site, rash allergic thigh. Report & document any
rxn, hyperbilirubinemia (large doses in very unexplained bleeding or bruising, and
premature infants), hematoma formation at keep parent/s informed.
injection site

LAB TEST CONSIDERATIONS:

Generic: Hepatitis B Vaccine Trade: Engerix-B
Usual Dose: 5 mcg (0.5 mL) given IM or subcutaneously if mother negative; repeat doses ideally at 1
and 6 months after initial dose; the final dose (3rd or 4th dose) should be administered no earlier
than age 24 wks
MODE OF ACTION: INDICATIONS:
Hepatitis B surface antigen (HBsAg) which Vaccinate all neonates within 24 hours of birth
stimulates active immunity. These products using Engerix-B and Recombivax HB
convey active immunity via stimulation of
production of endogenously produced CONTRAINDICATIONS:
antibodies Hypersensitivity to any of injection ingredients,
including latex. Post pone vaccine if cardiac
disease, fever, infection unless mother +Hep B
SIDE EFFECTS:
NURSING CONSIDERATIONS:
Pain, edema, redness at injection site, Check temp prior to administration.
itching, fatigue, fever, allergic reaction Neonates, infants, and young children: Inject
into the anterolateral aspect of the mid-thigh.
Observe for any S/S allergic rxn. Suspected
adverse events after admin of any vaccine
may be reported to Vaccine Adverse Events
LAB TEST CONSIDERATIONS: Reporting System (VAERS), 1-800-822-7967
Check Cr/GFR
Generic: simethicone Trade: Mylicon Therapeutic: anti-flatulent
Usual Dose: PO (Children 2– 12 yr): 40 mg 4 times daily. PO (Children< 2 yr): 20 mg 4 times daily (up to 240
mg/day).
MODE OF ACTION: INDICATIONS:
Causes the coalescence of gas bubbles. Relief of painful sx’s of excess gas in the GI tract
Does not prevent the formation of gas. that may occur postoperatively or as a
Therapeutic Effects: Passage of gas consequence of: Air swallowing, dyspepsia, PUD,
through the GI tract by belching or diverticulitis.
CONTRAINDICATIONS:
passing flatus
Pregnancy Category UK, infant colic

NURSING CONSIDERATIONS:
SIDE EFFECTS:
Assess patient for abdominal pain, distention, and
None significant
bowel sounds prior to and periodically throughout
course of therapy. Frequency of belching &
passage of flatus should also be assessed. PO:
Administer after meals and at hs for best results.
Shake liquid preparations well prior to
administration. Drops can be mixed with 30 mL of
LAB TEST CONSIDERATIONS: cool water, infant formula, or other liquid as
directed. Shake well before using
Generic: docusate sodium Trade: Colace Pharmacological: stool softeners Therapeutic: Laxatives
Usual Dose: PO (Adults and Children 1 PO (Children 3 yr): 10– 40 mg in 1– 4 divided doses <2 yr): 50– 400 mg in 1– 4
divided doses. PO (Children 6– 12 yr): 40– 150 mg in 1– 4 divided doses. PO (Children 3– 6 yr): 20– 60 mg in 1– 4 divided
doses. PO (Infants): 5 mg/kg/day in 1– 4 divided doses. Rectal (Adults): 50– 100 mg or 1 unit containing 283 mg docusate
sodium, soft soap,and glycerin. C Section: Give BID due to decreased mobility
MODE OF ACTION: INDICATIONS:
PO: Prevention of constipation in patients who
Promotes incorporation of water into stool,
should avoid straining, such as after
resulting in softer fecal mass. May also
caesarean section or episiotomy Rect: Used as
promote electrolyte and water secretion into
enema to soften fecal impaction
the colon. Therapeutic Effects: Softening
CONTRAINDICATIONS:
and passage of stool
Abdominal pain, nausea, or vomiting,
especially when associated with fever or other
SIDE EFFECTS: signs of an acute abdomen.
Mild cramps, diarrhea, rash, throat
NURSING CONSIDERATIONS:
irritation
PO: Administer with a full glass of water or
juice. May be administered on an empty
stomach for more rapid results. Do not
Safe w/ lactation administer within 2 hr of other laxatives,
especially mineral oil. May cause
increased absorption. Rect: Administer as a
retention or flushing enema. Assess for
LAB TEST CONSIDERATIONS: abdominal distention, presence of bowel
sounds, and usual pattern of bowel function.
Assess color, consistency, and amount of stool
produced.
Generic: ibuprofen Trade: Advil, Motrin Pharmacological: Non opioid analgesics Therapeutic:
antipyretic, NSAID Usual Dose: Anti-inflammatory 400-800 mg TID-QID (not to exceed 3200 mg/day)
Antipyretic 200-400 mg q 4-6 hours (not to exceed 1200 mg/day)
MODE OF ACTION: INDICATIONS:
Inhibits prostaglandin synthesis. PO, IV: Tx of Mild to moderate pain, Fever. PO: Tx of
Therapeutic Effects: Decreased pain and Inflammatory disorders IV: Moderate to severe pain w/ opioid
analgesics. Closure of a clinically significant PDA in neonates
inflammation. Reduction of fever.
weighing 500–1500 g and <32 wks gestational age (ibuprofen
lysine only)
SIDE EFFECTS: CONTRAINDICATIONS:
Nausea, vomiting, dyspepsia, GI bleed, Active GI bleeding or ulcer disease. Use cautiously with
thrombotic events (MI, CVA, renal lactation.
toxicity), Steven Johnson syndrome, NURSING CONSIDERATIONS:
Pt should be well hydrated before administration to
toxic epidermal necrolysis, tinnitus, prevent renal adverse reactions. Don’t give to neonates
hearing loss, HA, dizziness, HF with urine output < 0.6 mL/kg/hour. Use lowest effective
LAB TEST CONSIDERATIONS: dose for shortest period of time. Assess for signs/sx’s of
BUN, serum creatinine, CBC, and LFT GI bleeding, renal dysfunction, and hepatic impairment.
should be evaluated periodically in pt’s Assess pt for skin rash. Assess pn (note type, location,
receiving prolonged therapy. and intensity) prior to & 1-2 hr after admin. Advise pt to
take ibuprofen w/ a full glass of water and to remain in an
upright position for 15– 30 min after admin. Ask pt “Have
you eaten? Motrin can upset your stomach”. Monitor
Neonate for signs bleeding, infection and decreased
urine output
Generic: Naproxen Trade: Aleve, Anaprox, Anaprox DS Therapeutic: nonopioid analgesics,
nonsteroidal anti-inflammatory agents, antipyretics Usual Dose: PO (Adults): Naproxen 250–500
mg BID (up to 1.5 g/day). Delayed-release naproxen 375– 500 mg BID. Naproxen sodium 275– 550
mg
twice daily (upMODE
to 1.65OF ACTION:
g/day). INDICATIONS:
Used to tx mild to moderate pain
Inhibits prostaglandin synthesis.
CONTRAINDICATIONS:
Therapeutic Effects: Decreased pain. Lactation: Should not be used by nursing
Reduction of fever. Suppression of mother. Don’t use in pt with severe renal
inflammation. disease. Hypersensitivity, GI bleed,
cardiovascular disease. Pt’s who have asthma,
aspirin-induced allergy, and nasal polyps are at
increased risk for developing hypersensitivity
reactions.
SIDE EFFECTS:
NURSING CONSIDERATIONS:
Dizziness, drowsiness, drug induced Assess pn prior to and 1-2 hours post
hepatitis, GI bleed, constipation, administration. . Assess for rhinitis, asthma,
dyspepsia, nausea, heart failure, MI, CVA and urticaria. Analgesic is more effective if
given before pain becomes severe. Assess for
S/S bleeding

LAB TEST CONSIDERATIONS:

Evaluate BUN, serum creatinine, CBC, &
LFT periodically in pt’s receiving
prolonged therapy.
:
Generic: lactulose Pharmacological: osmotic Therapeutic: Laxatives Usual Dose: (Adults): 15– 30
mL/day up to 60 mL/day as liquid or 10– 20 g as powder for oral solution (up to 40 g /day has been used)

MODE OF ACTION: INDICATIONS:

Increases water content and softens Tx of chronic constipation. Adjunct in the
the stool. Lowers the pH of the colon, mgmt. of portal-systemic
(hepatic) encephalopathy (PSE)
which inhibits the diffusion of
ammonia from the colon into the CONTRAINDICATIONS:
blood, thereby reducing Patients on low-galactose diets
blood ammonia levels.
NURSING CONSIDERATIONS:
Assess pt for abdominal distention,
SIDE EFFECTS: presence of BS, & normal pattern of bowel
Belching, gas distention, loose stool function. Assess color, consistency, &
amount of stool produced. PSE: Assess
LAB TEST CONSIDERATIONS: mental status (orientation, LOC) before &
↓blood ammonia concentrations by 25– periodically throughout course of therapy.
50%. May cause ↑blood glucose levels in PO: Mix w/ fruit juice, h2o, milk, or
DM pt. Monitor serum electrolytes carbonated citrus beverage to improve
periodically when used chronically. May flavor. Administer w/ full glass (240 mL) of
cause diarrhea with resulting hypokalemia h20 or juice. May be administered on an
& hypernatremia. empty stomach for more rapid results.
Melissa Ingram
Generic: citalopram Trade: Celexa Pharmacological: SSRI Therapeutic: antidepressants Usual
Dose: PO (Adults): 20 mg once daily initially, may be ↑ in 1 wk to 40 mg/day (max dose)
MODE OF ACTION: INDICATIONS:
Selectively inhibits the reuptake of Depression. Unlabeled Use: PMDD, OCD, pan
d/o, GAD), PTSD, social anxiety disorder (socia
serotonin in the CNS.
phobia).
CONTRAINDICATIONS:
Pregnancy category C, w/ hepatic impairment
SIDE EFFECTS: don’t >20 mg/day, max dose of 20 mg/day in
Apathy, confusion, insomnia, patients>
weakness, abdominal pain, anorexia, 60 y/o
NURSING CONSIDERATIONS:
diarrhea, dry mouth, ↑ salivation, Assess for serotonin syndrome (mental ∆,
agitation, hallucinations, coma, ANS instability
tremor, sweating, sexual dysfunction,
[tachycardia, labile BP, hyperthermia], dec
drowsiness, dizziness, blurred vision reflexes, incoordination, or GI sx (n/v, diarrhea)
especially in pt taking other SSRIs, SNRIs,
triptans. Advise sunscreen & protective clothing
to prevent photosensitivity. Advise frequent
LAB TEST CONSIDERATIONS: mouth rinses, good oral hygiene, and sugarless
Monitor electrolytes (potassium and gum/candy may ↓ dry mouth. Instruct female
magnesium) in pt at risk for electrolyte patients to inform HCPif pregnancy is planned or
imbalances prior to & periodically during suspected, or if BF. If used during pregnancy
therapy. should be tapered during 3rd trimester to avoid
neonatal serotonin syndrome.
Melissa Ingram
 Generic: trazodone Therapeutic: antidepressant Usual Dose: PO (Adults): 150 mg/day in 3 divided
doses;↑by 50 mg/day q 3– 4 days until desired response (max 400 mg/day in outpatients or 600
mg/day in hospitalized pt)
MODE OF ACTION: INDICATIONS:
Alters the effects of serotonin in the Major depression Unlabeled Use: Insomnia,
CNS. Therapeutic Effects: chronic pn syndromes, DM neuropathy &
Antidepressant action, which may anxiety.
CONTRAINDICATIONS:
develop only over several weeks. Hypersensitivity, recovery period after MI, w/
electroconvulsive therapy, use of MAOI, angle
closure glaucoma. Pregnancy category C
SIDE EFFECTS:
NURSING CONSIDERATIONS:
Drowsiness, hypotension, dry mouth, Instruct pt to notify HCP if signs of serotonin
sexual dysfunction, drowsiness, syndrome (mental status ∆: agitation,
blurred vision, constipation hallucinations, coma, autonomic instability,
LAB TEST CONSIDERATIONS: tachycardia, labile BP, hyperthermia,
Assess CBC & renal & hepatic hyperreflexia, incoordination. Caution pt to ∆
function before & periodically during positions slowly to min. orthostatic hypotension.
therapy. Slight ↓ clinically insignificant Advise pt to avoid concurrent use of etoh or
other CNS depressant drugs. Inform pt that
in leukocyte & neutrophil counts may frequent rinses, good oral hygiene, and
occur sugarless candy or gum may diminish dry mouth.
An increase in fluid intake, fiber, and exercise
may prevent constipation
Melissa Ingram
 Generic: lactobacillus acidophilus & bulgaricus Trade: Lactinex Therapeutic: antidiarrheals,
Probiotics Usual Dose:
MODE OF ACTION: INDICATIONS:
Lactobacillus is a bacteria that exists Used as a probiotic to aid in digestion, to
naturally in the body, primarily in the prevent diarrhea, and to relieve sx’s of
intestines & the vagina. Lactobacillus IBS CONTRAINDICATIONS:
helps maintain an acidic environment If diabetic, pt should know that each
in the body, which can prevent the packet of lactobacillus acidophilus and
growth of harmful bacteria. bulgaricus granules contains 24
Lactobacillus has been used as a milligrams of sugar. Each tablet contains
probiotic, or "friendly bacteria. 12 mg of sugar.
NURSING CONSIDERATIONS:
SIDE EFFECTS:
Dizziness, increased thirst, The BD Lactinex chewable tablet must
muscle/bone pain, weight loss, be chewed before swallowing. Drink a
fatigue, increased urination. small amount of water, milk, or fruit juice
after chewing/swallowing the tablet.
LAB TEST CONSIDERATIONS:

This product has not been approved by the FDA to treat any disease, and it
should not be substituted for prescription medications.
Melissa Ingram
 Generic: budesonide and formoterol fumarate dihydrate Trade: Symbicort Pharmacological:
corticosteroid and selective beta2-agonist (LABA) Therapeutic: bronchodilator Usual Dose: 2
inhalations twice daily 160.4.5 or 80/4.5
MODE OF ACTION: INDICATIONS:
Budesonide is an anti-inflammatory Asthma, COPD, chronic bronchitis and/or
(↓inflammation in lungs) corticosteroid that emphysema not controlled w/ corticosteroid
exhibits potent glucocorticoid activity & weak alone
CONTRAINDICATIONS:
mineralocorticoid activity. Formoterol fumarate SYMBICORT is NOT indicated for the relief of
is a long-acting selective beta2-adrenergic acute bronchospasm. Primary treatment of
agonist (LABA) w/ rapid onset. Inhaled status asthmaticus or other acute episodes of
formoterol fumarate acts locally in the lung as asthma or COPD where intensive measures
a bronchodilator (helps muscles around the are required.
airways in lungs stay relaxed to prevent sx’s) NURSING CONSIDERATIONS:
Rinse mouth w/ water w/o swallowing. Prime
SIDE EFFECTS:
Candida albicans infection, SYMBICORT before using for the 1st time or
immunosuppression, growth effects in >7 days since last use, by releasing 2 test
PEDS, hypercorticism, adrenal suppression, sprays into the air away from the face, shaking
HA nasal congestion, tachycardia, well for 5 sec before Q spray. Ck BMD prior to
palpitations, dysphonia, decreased BMD (LT starting & periodically after. Closely follow the
use), URI, pneumonia. ↑risk growth of PEDS. Teach regular eye exams.
cataract/glaucoma Teach pt call HCP + S/S pneumonia/URI.
Teach pt that med is not for sudden sx’s & will
LAB TEST CONSIDERATIONS:
Pt w/ hepatic disease should be closely not replace rescue inhaler. Teach pt to call
monitored. Monitor for hypokalemia, HCP if using rescue inhaler more often.
hyperglycemia
Melissa Ingram
Generic: Trade: Pharmacological: Therapeutic: Usual Dose:

MODE OF ACTION: INDICATIONS:

CONTRAINDICATIONS:

NURSING CONSIDERATIONS:
SIDE EFFECTS:

LAB TEST CONSIDERATIONS:

Melissa Ingram