Medication Table

Include ALL SCHEDULED MEDICATIONS; Include ONLY PRN MEDICATIONS given for pain, nausea, and any PRN medication given
in the last 24 hours. Table must be typed, neat, and easy to read.
DRUG
(3 points)

DOSE/ROUTE
(3 points)

CLASSIFICATION
(3 points

WHY IS PATIENT
TAKING MED?
(disease/diagnosis)
(3 points)

DATA NEEDED
BEFORE/AFTER
ADMINISTERING
MED- I.E.: B/P, P, RESP,
LABS, ETC.
(3 points)

PERTINENT SIDE
EFFECTS
(3 points)

Aspirin

81 mg PO

Anti-inflammatory,
anticoagulant

Revascularization
(to prevent heart
attack or stroke)

Monitor urinary
pH, may result in
toxicity.

Cefuroxime

250 mg PO q12hr

Antibiotic

Knee joint infection

Dicyclomine

10 mg PO bid

GI antispasmodic,
anticholinergic

Irritable bowel
syndrome

Enoxaparin

40 mg
subcutaneous

Anticoagulant

Prevention of DVT

Obtain CBC, assess

for thrush, monitor
I&O.
Monitor daily
bowel activity &
consistency,
monitor I&O,
assess for urinary
retention, monitor
changes in BP &
temperature
Obtain CBC, note
platelet count,
assess for bleeding.

GI distress
(abdominal
distention,
cramping,
heartburn), high
doses may produce
GI bleeding,
tinnitus (low grade
toxicity),
hyperthermia
(marked toxicity)
Oral candidiasis,
vaginal candidiasis,
mild diarrhea
Dry mouth,
constipation,
blurred vision,
urinary hesitancy,
hot/dry/flushed
skin, hyperthermia

Injection site
hematoma, nausea,
peripheral edema,
ecchymosis,

Lisinopril

40 mg PO

Antihypertensive

HTN

Obtain BP, hold for

SBP <100, obtain
apical pulse;
monitor for edema,
monitor I&O

Metoprolol

50 mg PO

Antihypertensive

HTN

Omeprazole

40 mg PO

Proton Pump
Inhibitor

Symptomatic
GERD

Assess baseline
renal function,
obtain BP and
apical pulse; hold
for SBP <100 and
HR <60; assess for
dyspnea, monitor
I&O
Monitor for GI
discomfort, nausea,
diarrhea

Narcotic analgesic

Pain

Hydrocodone

5 mg PO q6hr
PRN

4 mg PO q6hr
PRN

Antiemetic

Nausea & Vomiting

Ondansetron

2 points for correct spelling and neatness. Total points possible: 20

Obtain vitals. Hold

for HR <55, SBP
<90, respirations
<12, assess pain
scale, palpate
bladder for urinary
retention, monitor
bowel movements
Assess for
dehydration,
monitor EKG in pts
with electrolyte
abnormalities,
assess mental status

Total points earned: _____

hemorrhage
Dizziness, postural
hypotension, chest
discomfort,
palpitations,
peripheral edema,
angioedema
Insomnia, anxiety,
diarrhea,
constipation,
altered taste, dry
eyes

Headache,
dizziness, asthenia,
vomiting,
pancreatitis
Lethargy,
hypotension, facial
flushing,
drowsiness, urinary
retention, blurred
vision, constipation,
dry mouth
Anxiety, dizziness,
drowsiness,
hypoxia, urinary
retention,
abdominal pain,
asthenia, blurred
vision