PARENTERAL MEDS

Generic/Brand Name: Citicoline Sodium /

Classification: CNS Stimulants
Zynapse
Dosage/Route: 1g q8
Indication: Citicoline is indicated in CVD in acute recovery phase in severe s/sx of
cerebrovascular insufficiency and in-cranial traumatism and their sequallae. Citicoline in CVA,
stimulates brain function.
Mechanism of Action: Citicoline increases blood flow and O2 consumption in the brain. It is
also involved in the biosynthesis action.
Side Effects/Adverse Reactions: Fleeting and discrete hypotension effect, increased
parasympathetic effects, low blood pressure, itching or hives, swelling in face or hands, chest
tightness, tingling in mouth and throat.
Nursing Consideration: - Monitor for adverse effect.
- Monitor patients neurologic status.
- Note if there are signs of slurring in speech.
Patient Teaching: - Instruct patient to take the medication as prescribed.
- Teach the patient that citicoline may be taken with or without food.
- Instruct patient to report immediate feelings of chest tightness, tingling in
mouth and throat, headache, diarrhea and blurring of vision.
Generic/Brand Name: Ampicilin Sodium and Classification: Antibiotic Aminopenicillin
Sulbactam Sodium / Unasyn
and beta-lactamase inhibitor
Dosage/Route: 750mg ANST (-) q8 IVTT
Indication: Indicated for the treatment of intra-abdominal infections, pneumonia, soft tissue
infections, sinusitis, septicemia.
Mechanism of Action: Interferes with cell wall replication of susceptible organisms. Destroys
bacteria by inhibiting bacterial cell-wall synthesis during microbial multiplication. Addition of
sulbactam enhances drugs resistance to beta-lactamase, an enzyme that can inactivate
ampicillin.
Side Effects/Adverse Reactions: CNS: Lethargy, hallucinations, anxiety, confusion, agitation,
depression, fatigue, dizziness, seizure. EENT: blurred vision, itchy eyes. GI: nausea, vomiting,
diarrhea, abdominal pain, gastritis, stomatitis. GU: hematuria, hyaline cast in urine, vaginitis,
nephropathy, interstitial nephritis. RESPIRATORY: wheezing, dyspnea, hypoxia, apnea. SKIN:
rash, urticarial, diaphoresis.
Nursing Consideration: - Assess patient of previous sensitivity reaction to penicillin or
cephalosporins.
- Assess patient for signs and symptoms of infections.
- Complete C&S before beginning of product therapy to identify if
correct treatment has been initiated.
- Assess for allergic reactions.
- Monitor blood studies.

- Monitor electrolytes.
- Assess bowel pattern daily.
- Monitor for bleeding.
- Assess for superinfection.
Patient Teaching: - Instruct patient to report rash, fever, or chills. A rash is the most common
allergic reaction.
ORAL MEDS
Generic/Brand Name: Atorvastatin Calcium / Classification: Antihyperlipidemic HMGLipitor
CoA reductase inhibitor
Dosage/Route: 40mg/tab ODHS P.O.
Indication: Prevention of CV disease in adults without clinically evident coronary disease but
with multiple risk factors for CAD such as age >55 yr, smoking, hypertension, low HDL-C,
family history of early CAD; to reduce the risk of MI and risk for revascularization procedures
and angina.
Mechanism of Action: Inhibits HMG-CoA reductase, the enzyme that catalyzes the first step in
the cholesterol synthesis pathway, resulting in a decrease in serum cholesterol, serum LDLs
(associated with increased risk of CAD), and increases serum HDLs (associated with decreased
risk of CAD); increases hepatic LDL recapture sites, enhances reuptake and catabolism of LDL;
low triglyceride levels.
Side Effects/Adverse Reactions: CNS: Headache, asthenia
GI: flatulence, abdominal pain, cramps, constipation, nausea,
dyspepsia, heartburn, liver failure
RESPIRATORY: sinusitis, pharyngitis
Other: rhabdomyolysis with acute renal failure, arthralgia,
myalgia
Nursing Consideration: Assessment
- History: Allergy to atorvastatin, fungal byproducts; active hepatic
disease; acute serious illness; pregnancy, lactation
- Physical: Orientation, affect, muscle strength; liver evaluation,
abdominal examination; lipid studies, LFTs, renal function tests
Intervention
- Obtain LFTs as a baseline and periodically during therapy;
discontinue drug if AST and ALT levels increases to 3 times normal
levels
- Withhold atorvastatin in any acute, serious condition (severe
infection, hypotension, major surgery, trauma, severe metabolic or
endocrine disorder, seizures) that may suggest myopathy or serve as
risk factor for development of renal failure.
Patient Teaching: - Inform patient about side effects of drug such as nausea (eat frequent small
meals); headache, muscle and joint aches and pains (may lessen over time)

Advise patient to report presence or feelings of muscle pain, weakness,

tenderness; malaise; fever, changes in color of urine or stool; swelling.

Generic/Brand Name: Glimiperide / Amaryl

Classification: Antidiabetic - Sulfonylurea
Dosage/Route: 2mg/tab OD P.O.
Indication: Glimiperide is indicated to treat DM type 2 in patients with uncontrolled blood sugar
levels.
Mechanism of Action: Lowers glucose levels by stimulating pancreas to release insulin.
Side Effects/Adverse Reactions: CNS: dizziness, asthenia, headache
EENT: changes in accommodation
GI: nausea
Hematologic: leukopenia, haemolytic anemia,
agranulocytosis, thrombocytopenia, aplastic anemia,
pancytopenia
Metabolic: hypoglycaemia, dilutional hyponatremia
Nursing Consideration: - Glimiperide and insulin may be given together in patients who lose
glucose control after first responding to therapy.
- Monitor fasting glucose level periodically to determine therapeutic response. Also
monitor glycosylated haemoglobin level, usually every 3 to 6 months, to precisely assess
long-term glycemic control.
Patient Teaching: - Make sure that the patient understands that therapy relieves symptoms but
doesnt cure the disease. Patient should also understand potential risks and
advantages of taking drug and of other treatment methods.
- Stress importance of adhering to diet, weight reduction, exercise, and
personal hygiene programs. Explain to patient and family how and when to
monitor glucose level, and teach recognition of and intervention for signs
and symptoms of high and low glucose levels.
- Educate patient to carry candy or other simple sugars to treat mild episodes
of low glucose level.
Generic/Brand Name:
Classification: Calcium Antagonists /
Losartan+Amlodipine / Tozam
Angiotensin II Antagonists
Dosage/Route: 500mg/5mg 1tab BID (Hold for BP <130mmHg) P.O.
Indication: Indicated to treat mild to moderate hypertension.
Mechanism of Action: Amlodipine inhibits the movement of Ca ions across the cell membrane
into vascular smooth muscles and myocytes. Losartan is an angiotensin II receptor (type AT1)
antagonists antihypertensive which acts by blocking the actions of angiotensin II of reninangiotensin-aldosterone system.
Side Effects/Adverse Reactions: Headache, dizziness, back pain, myalgia, respiratory tract
disorders, asthenia/fatigue; first-dose hypotension, rash, cough, angioedema; neutropaenial GI

disturbances; transient elevation of liver enzymes; taste disturbances and hyperkalemia,

hypotension, bradycardia, conductive system delay, CCF.
Nursing Consideration: - Monitor blood pressure frequently during initiation of therapy.
Because drug-induced vasodilation has a gradual onset, acute
hypotension is rare.
- Notify prescriber if signs of heart failure occur, such as swelling of
hands and feet or shortness of breath
- Monitor patient closely if also taking diuretics for symptomatic
hypotension
- Regularly assess the patients renal function
Patient Teaching: - Advise patient to avoid salt substitutes; these products may contain
potassium, which can cause high potassium level
- Advise patient to immediately report swelling of face, eyes, lips, or tongue
or any breathing difficulty
Generic/Brand Name: Acetylcysteine /
Classification: Mucolytic L-cysteine
Exflem
derivative
Dosage/Route: 600mg 1tab BID 500cc H2O P.O.
Indication: Adjunct therapy for abnormal viscid thickened mucous secretions in patients with
pneumonia, bronchitis, bronchiectasis, primary amyloidosis of the lung, tuberculosis, cystic
fibrosis, emphysema, atelectasis, pulmonary complications of thoracic surgery, or CV surgery.
Mechanism of Action: Reduces the viscosity of pulmonary secretions by splitting disulphide
linakages between mucoprotein molecular complexes. Also, restores liver stores of glutathione to
treat acetaminophen toxicity.
Side Effects/Adverse Reactions: CNS: abnormal thinking, fever, drowsiness, gait disturbances
CV: chest tightness, flushing, hypertension, hypotension,
tachycardia
EENT: rhinorrhea, ear pain, eye pain, pharyngitis, throat
tightness
GI: nausea, stomatitis, vomiting
Respiratory: bronchospasm, cough, dyspnea, rhonchi
Skin: clamminess, diaphoresis, pruritus, rash, urticarial
Other: anaphylactoid reaction, angioedema, chills
Nursing Consideration: - Monitor cough type and frequency
- Monitor patient for bronchospasm
- Ingestion of more than 150mg/kg of acetaminophen may cause liver
toxicity. Measure acetaminophen level 4 hours after ingestion to
determine risk of liver toxicity.
Patient Teaching: - Warn patient that drug may have a foul taste or smell that may be distressing

Generic/Brand Name: Lactulose / Lilac

Classification: Laxative Dissacharide
Dosage/Route: 30cc BID P.O.
Indication: Lactulose is indicated to prevent or treat constipation
Mechanism of Action: Produces an osmotic effect in colon; resulting distention promotes
peristalsis. Also decreases ammonia, probably as a result of bacterial degeneration, which lowers
the pH of colon contents.
Side Effects/Adverse Reactions: GI: abdominal cramps, belching, diarrhea, flatulence, gaseous
distention, nausea, vomiting
Nursing Consideration: - Monitor sodium level for hypernatremia, especially when giving in
higher doses
- Monitor mental status and potassium levels
- Replace fluid loss
Patient Teaching: - Inform patient about adverse reactions and tell him to notify prescriber if
reactions become bothersome or if diarrhea occurs
- Instruct patient not to take other laxatives during lactulose therapy
Generic/Brand Name: Pregabalin / Funxion
Classification: Anticonvulsant CNS drug
Dosage/Route: 500mg/cap 1cap ODHS P.O.
Indication: Pregabalin is indicated to treat diabetic peripheral neuropathy
Mechanism of Action: May contribute to analgesic and anticonvulsant effects by binding sites
in CNS.
Side Effects/Adverse Reactions: CNS: ataxia, somnolence, tremor, abnormal gait, asthenia,
vertigo, nystagmus, euphoria
CV: edema, PR interval prolongation
EENT: blurred or abnormal vision, eye disorder
GI: dry mouth, abdominal pain, gastroenteritis
GU: anorgasmia, impotence, urinary incontinence
Metabolic: hypoglycaemia, weight gain
Musculoskeletal: arthralgia, myalgia, myasthenia
Respiratory: bronchitis, dyspnea
Skin: ecchymosis, pruritus
Nursing Consideration: - Monitor patient for signs and symptoms of angioedema which may
compromise breathing
- Monitor patients weight and fluid status
- Check for changes in vision
- Watch for signs of rhabdomyolysis, such as dark, red, or colacolored urine; muscle tenderness; generalized weakness; or muscle
stiffness or aching
Patient Teaching: - Caution patient to avoid hazardous activities until drugs effects are known.
- Instruct patient to watch for weight changes and water retention.
- Advise patient to report vision changes and malaise or fever accompanied
by muscle pain, tenderness, or weakness

If patient has diabetes, urge him to inspect his skin closely for ulcer
formation

Generic/Brand Name: Clipidogrel bisulfate / Classification: Antiplatelet Platelet

Platexan
aggregation inhibitor
Dosage/Route: 75mg/tab OD P.O.
Indication: Indicated to reduce thrombotic events in patients with atherosclerosis documented
by recent stroke, MI, or peripheral arterial disease
Mechanism of Action: Inhibits the binding of adenosine diphosphate (ADP) to its platelet
receptor, impending ADP-mediated activation and subsequent platelet aggregation, and
irreversibly modifies the platelet ADP receptor.
Side Effects/Adverse Reactions: CNS: confusion, fatal intracranial bleeding, hallucinations
CV: hypotension
EENT: epistaxis, rhinitis, taste disorder
GI: haemorrhage, abdominal pain, constipation, diarrhea,
dyspepsia, gastritis, ulcers
GU: UTI, hematuria
Hematologic: purpura
Musculoskeletal: arthralgia, myalgia, arthritis
Respiratory: bronchospasm, respiratory tract bleeding
Skin: rash, pruritus, eczema, Stevens-Johnson syndrome
Nursing Consideration: - Drug may cause fatal thrombotic thrombocytopenic purpura that
requires urgent treatment, including plasmapheresis
Patient Teaching: - Advise patient it may take longer than usual to stop bleeding. Advise him to
refrain from activities in which trauma and bleeding may occur, and
encourage him to wear a seat belt when in a car.
- Instruct patient to notify prescriber if unusual bleeding or bruising occurs.
- Tell patient to inform all health care providers, including dentists, before
undergoing procedures or starting new drug therapy, that he is taking drug.
Generic/Brand Name: Piracetam / Nootropil
Classification: Neuromuscular agent
Dosage/Route: 1.2g/tab BID PO
Indication: Piracetam
Mechanism of Action: Piracetam acts selectively upon telencephalon by improving its
associative function. It increases the energy output of the brain cell and activates its
neurophysiological potentialities, especially in deficit conditions. Nootropil is virtually nontoxic
and has a stimulating, sedative or neurovegetative activities.
Side Effects/Adverse Reactions: Hyperkinesia, weight gain, asthenia, nervousness, agitation,
irritability, anxiety and sleep disturbance, fatigue or drowsiness, GI disturbances
Nursing Consideration: - Monitor heart rate, ECG and BP periodically throughout the therapy
- Drug has strong taste. Mixing oral form with orange juice mask the

taste
- Assess patient to clear airway
- Provide support ventilation, if needed
- Assess and support cardiac function
Patient Teaching: - Advise patient to report any unusualities
Generic/Brand Name: Potassium Chloride
Classification: Potassium supplement
Dosage/Route: 20mL TID x 6 doses P.O.
Indication: Potassium chloride is indicated to prevent and treat hypokalemia
Mechanism of Action: Replaces potassium and maintain potassium level
Side Effects/Adverse Reactions: CNS: paresthesia of limbs, confusion, flaccid paralysis
CV: arrhythmias, heart block, cardiac arrest, hypotension
GI: nausea, vomiting, abdominal pain, diarrhea
Metabolic: hyperkalemia
Respiratory: respiratory paralysis
Nursing Consideration: - Patients at an increased risk of GI lesions include those with
scleroderma, diabetes, mitral valve replacement, cardiomegaly, or
esophageal strictures, and elderly or immobile patients
- Drug is commonly used orally with potassium-wasting diuretics to
maintain potassium levels
- Monitor ECG and electrolyte levels during therapy
- Monitor renal function
- Many adverse reactions may reflect hyperkalemia
Patient Teaching: - Teach patient how to prepare powders and how to take drug. Tell patient to
take with or after meals with full glass of water or fruit juice to lessen GI
lesions
- Educate patient of the signs and symptoms of hyperkalemia, and instruct
patient to notify prescriber if they occur
- Warn patient not to use salt substitutes concurrently, except with
prescribers permission
Generic/Brand Name: Amlodipine besylate
Classification: Antihypertensive Calcium
(Provasc)
Channel Blocker
Dosage/Route: 10 mg/tab tab OD P.O.
Indication: Indicated to treat hypertension and prevent chronic stable angina or vasospastic
angina
Mechanism of Action: Inhibits the movement of calcium ions across the membrane of cardiac
and arterial muscle cells, slowing the conduction of the cardiac impulse, and decrease cardiac
work, decrease cardiac oxygen consumption and increases on to cardiac cells.
Side Effects/Adverse Reactions: CNS: fatigue, dizziness, light-headedness, asthenia
CV: edema, flushing, palpitations

GI: dyspepsia, nausea, abdominal pain

GU: sexual difficulties
Musculoskeletal: muscle cramps
Respiratory: dyspnea
Skin: rash, pruritus
Nursing Consideration: - Monitor blood pressure frequently during initiation of therapy.
Because drug-induced vasodilation has a gradual onset, acute
hypotension is rare.
- Notify prescriber if signs of heart failure occur, such as swelling of
hands and feet or shortness of breath
- Abrupt withdrawal of drug may increase frequency and duration of
chest pain. Taper dose gradually under medical supervision
Patient Teaching: - Caution patient to continue taking drug, even when he feels better
- Educate patient that nitroglycerin may be taken as needed when angina
symptoms are acute. If patient continues nitrate therapy during adjustment
of amlodipine dosage, urge continued compliance

TREATMENT MEDS
Generic/Brand Name: Nitroglycerine (NTG
Classification: Vasodilator - Nitrate
Patch)
Dosage/Route: 5mg OD ACW
Indication: Nitroglycerine is indicated in preventing chronic angina attacks and hypertension
Mechanism of Action: Relaxes (widens) blood vessels to allow blood to flow more easily. This
reduces the heart's workload and the amount of oxygen needed by the heart.
Side Effects/Adverse Reactions: CNS: dizziness, syncope, weakness
CV: orthostatic hypotension, tachycardia, palpitations
EENT: S.L. burning
GI: nausea, vomiting
Skin: cutaneous vasodilation, contact dermatitis, rash
Nursing Consideration: - Administer nitroglycerin patch with extreme caution to patients with
hypotension or hypovolemia since the drug may precipitate a severe
hypotensive state.
- Closely monitor vital signs, particularly blood pressure. Excessive
hypotension can worsen ischemia
Patient Teaching: - Urge patient using skin patches to dispose of them carefully because enough

medication remains after normal use to be hazardous to children and pets

Advise patient to avoid alcohol while on therapy
To minimize dizziness when standing up, tell patient to rise slowly. Advise
patient to go up and down stair carefully and to lie down at the first sign of
dizziness

STAT MEDS
Generic/Brand Name: Insulin (Humulin R)

Classification: Antidiabetic Pancreatic

hormone

Dosage/Route: 5 units/mL Subq

Indication: Treatment of type 1 (insulin-dependent) diabetes and type 2 (non- insulindependent) diabetes
Mechanism of Action: Insulin is a hormone secreted by the beta cells of the pancreas that, by
receptor-mediated effects, promotes the storage of the body's fuels, facilitating the transport
of metabolites and ions (potassium)through cell membranes and stimulating the synthesis
of glycogen from glucose, of fats from lipids, and proteins from amino acids.
Side Effects/Adverse Reactions: EENT: blurred vision
GI: dry mouth
Metabolic: hypoglycaemia, hyperglycemia, hypomagnesemia,
hypokalemia
Skin: rash, urticaria, pruritus, swelling, redness, stinging,
warmth at injection site
Respiratory: increased cough, respiratory tract infection,
dyspnea, reduced pulmonary function
Other: lipoatrophy, lipohypertrophy, anaphylaxis,
hyspersensitivity reactions
Nursing Consideration: - Monitor patient for hyperglycemia (rebound, or Somogyi, effect)
Patient Teaching: - Make sure that the patient knows that drug relieves symptoms but doesnt
cure the disease
- Educate patient about the disease and importance of following therapeutic
regimen, adhering to specific diet, losing weight, getting exercise,
following personal hygiene program, and avoiding infection. Emphasize
importance of timing injections with eating and of not skipping meals
- Advise patient not to smoke within 30 minutes after insulin injection
because smoking decreases amount of insulin absorbed subcutaneously
- Advise patient to avoid vigorous exercise immediately after insulin
injection, especially of the area where injection was given, because it
increases absorption and risk of low glucose episodes.
- Advise patient to avoid alcohol because it lowers glucose levels.