THERAPEUTIC INDICATION CONTRAINDICATIO DOSAGE ADVERSE NURSING

ACTION NS REACTION CONSIDERATION

1. LEADS
ATROPINE Inhibits ➣Bradyarrhyt ● Hypersensitivity to  Adults: 0.5 to 1 mg by Adverse effects CNS:  Instruct patient to
SULFATE acetylcholine at hmias,sympto drug or other I.V.push repeated q 3 headache,restlessness, immediately report
(a'troe-peen) parasympathetic matic belladonna alkaloids to 5 minutes as ataxia, allergic response.
neuroeffector bradycardia ● Acute narrow-angle needed,to a maximum disorientation,deliriu  Inform patient that
Atropair , junction of smooth glaucoma dosage of 2 mg m,insomnia, headache,eye pain,and
Atropisol,Isopto muscle and cardiac ● Adhesions between Children: 0.01 mg/kg dizziness,drowsiness,a blurred vision may
Atropine muscle, blocking iris and lens I.V.to a maximum gitation,nervousness,c signal glaucoma.Tell
sinoatrial (SA) and (ophthalmic form) dosage of 0.4 mg or 0.3 onfusion,excitement him to report these
Classifications: atrioventricular ● Obstructive GI tract mg/m2. May repeat CV: symptoms at once.
AUTONOMIC (AV) nodes.These disease I.V.dose q 4 to 6 hours palpitations,bradycar  Caution patient to
NERVOUSSYSTEM actions increase ● Unstable  Adults: 2 to 3 mg dia,tachycardia avoid driving and other
AGENT;ANTICHOLINE impulse conduction cardiovascular status ● I.V.repeated q 5 to 10 EENT: hazardous activities
RGIC(PARA- and raise heart Asthma minutes until photophobia,blurred until he knows how
SYMPATHOLYTIC);A rate.In ophthalmic ● Myasthenia gravis ● symptoms disappear vision, increased drug affects
NTIMUSCARINIC use,blocks Thyrotoxicosis or a toxic level is intraocular concentration,
cholinergic ● Infants ages 3 months reached.For severe pressure,mydriasis,cy alertness,and vision.
stimulation to iris ➣Antidote for and younger poisoning,6 mg q hour. cloplegia,nasal  Encourage patient to
and ciliary anticholinester Children:0.05 mg/kg congestion GI: establish an effective
bodies,causing ase insecticide (Schull, 2013) I.M.or I.V. repeated q nausea,vomiting,const bedtime routine to
pupillary dilation poisoning every 10 to 30 minutes ipation, minimize insomnia.
and accommodation until symptoms bloating,dyspepsia,ile  Tell patient to apply
paralysis. disappear or a toxic us,abdominal pressure to inside
level is reached distention (in corner of eye during
(Schull, 2013)  Adults and children infants),dysphagia,dr instillation of
weighing more than y mouth GU: urinary ophthalmic solution and
40.8 kg (90 lb): 0.4 to retention,urinary for 1 to 2 minutes
0.6 mg I.M.,I.V.,or hesitancy,impotence afterward.
subcutaneously 30 to Skin: decreased  As appropriate,review
60 minutes before sweating,flushing, all other significant and
anesthesia Children urticaria,dry skin life-threatening adverse
 weighing 29.5 to 40.8 Other:thirst,anaphyla reactions and
kg (65 to 90 lb):0.4 mg xis interactions,especially
I.M.,I.V.,or
subcutaneously 30 to
60 minutes before
anesthesia Children
weighing 18.1 to 29.5
kg (40 to 65 lb): 0.3 mg
➣Preoperative I.M.,I.V.,or
ly to diminish subcutaneously 30 to
secretions and 60 minutes before
block cardiac anesthesia Children
vagal reflexes weighing 10.9 to 18.1
kg (24 to 40 lb): 0.2 mg
I.M.,I.V.,or
subcutaneously 30 to
60 minutes before
anesthesia Children
weighing 7.3 to 10.9 kg
(16 to 24 lb): 0.15 mg
I.M.,I.V.,or
subcutaneously 30 to
60 minutes before
anesthesia Children
weighing 3.2 to 7.3 kg
(7 to 16 lb):0.1 mg
I.M.,I.V.,or
subcutaneously
 Adults:0.4 to 0.6 mg
P.O.q 4 to 6 hours
Children: 0.01 mg/kg
or 0.3/m2 P.O. q 4 to 6
hours
  Adults: 0.1 to 0.25 mg
P.O.q.i.d.
 Adults: 1 to 2 mg/hour
I.M.or I.V. until
respiratory function
improves
 Adults:Instill one or
two drops of 0.5% or
1% solution into eye(s)
up to q.i.d.
Children:Instill one or
two drops of 0.5%
solution into eye(s) up
to t.i.d.
 Adults: Instill one or
two drops of 1%
solution into eye(s) 1
hour before refraction.
Children:Instill one or
two drops of 0.5%
solution into eye(s)
b.i.d.for 1 to 3 days
before examination.

(Schull, 2013)

➣Peptic ulcer
disease,functio
nal GI
disorders (such
as
hypersecretory
states)
➣Parkinsonis
m

➣Antidote for
muscarine-
induced
mushroom
toxicity

➣Pupillary
dilation in
acute
inflammatory
conditions of
iris and uveal
tract

➣To produce
mydriasis and
 cycloplegia for
refraction

(Schull, 2013)
LIDOCAINE Suppresses ➣Ventricular ● Hypersensitivity to  Adults:Initially,50 to CNS:  Discuss reason for drug
HYDROCHLORIDE automaticity of arrhythmias drug,its components,or 100 mg I.V. bolus anxiety;confusion;diff therapy with patient
ventricular other amide local given at rate of 25 to iculty and family,when
LidoPen Auto- cells,decreasing anesthetics 50 mg/minute.If speaking;dizziness;hal appropriate.
Injector,Xylocaine, Xylocard diastolic ● Heart desired response lucinations;  Explain that patient
depolarization and failure,cardiogenic doesn’t occur after 5 lethargy;paresthesia;l will be monitored
Pharmacologic increasing shock, second- or third- minutes,give repeat ight-headedness; continuously during
class:Amide ventricular degree heart block, dose at 25 to 50 fatigue;drowsiness;he therapy.
Therapeutic fibrillation intraventricular block mg/minute;maximum adache;persistent  Instruct patient to
class:Antiarrhythmic threshold.Produces in absence of a dosage is 300 mg given sensory,motor,or promptly report
(class IB),local local anesthesia by pacemaker over 1 hour. autonomic deficit discomfort at I.V.site as
anesthetic reducing sodium ● Wolff-Parkinson- Maintenance dosage is oflower spinal well as adverse
permeability of White or AdamsStokes 1 to 4 mg/minute by segment;septic effects,especially
sensory syndrome continuous meningitis;seizures cardiovascular,respirat
nerves,which blocks ● Severe I.V.infusion for no CV: ory,or neurologic
impulse generation hemorrhage,shock,or more than 24 hours. bradycardia,hypotens problems or allergic
and conduction. heart block (lidocaine Children:Initially,1 ion,new or worsening reactions.
with dextrose) mg/kg I.V.bolus, then arrhythmias,cardiac  As appropriate,review
(Schull, 2013) ● Local infection at repeated based on arrest EENT: all other significant and
puncture site (lidocaine patient response;don’t diplopia,abnormal life-threatening adverse
with dextrose) exceed 5 vision GI: reactions and
 ● Septicemia (lidocaine mg/kg.Maintenance nausea,vomiting,dry interactions,especially
with dextrose) dosage is 30 mouth GU: urinary those related to the
mcg/kg/minute by retention drugs and tests
Precautions Use continuous Metabolic:methemogl mentioned above.
cautiously in: I.V.infusion. obinemia
● renal or hepatic  Adults: For obstetric Respiratory: (Schull, 2013)
disorders,inflammation analgesia,200 to 300 suppressed cough
or sepsis in injection mg caudally as 1% reflex, respiratory
area solution.For surgical depression,respirator
● labor or delivery anesthesia,225 to 300 y arrest Skin:
● breastfeeding mg as 1.5% rash;urticaria;pruritu
patients. solution.For s;erythema;contact
continuous caudal dermatitis;cutaneous
➣Caudal (Schull, 2013) anesthesia,don’t repeat lesions;tissue
anesthesia maximum dosage at irritation,sloughing,a
(without intervals of less than nd necrosis Other:
epinephrine) 90 minutes. fever;edema;infection,
 Adults: For lumbar burning,stinging,tend
analgesia,250 to 300 erness,and swelling at
mg epidurally as 1% injection
solution,225 to 300 mg site;anaphylaxis
as 1.5% solution,or 200
to 300 mg as 2% (Schull, 2013)
solution.For thoracic
anesthesia,200 to 300
mg as 1% solution.For
continuous epidural
anesthesia,don’t repeat
maximum dosage at
intervals of less than
90 minutes.
 Adults: 50 to 300 mg
I.V.as 0.5%
 solution.For
I.V.regional
anesthesia,maximum
➣Epidural dosage is 4 mg/kg.
anesthesia  Children: Up to 4.5
(without mg/kg I.V.as 0.25% to
epinephrine) 1% solution
 Adults: For obstetric
low-spinal or saddle-
block anesthesia
(normal vaginal
delivery),50 mg of 5%
XylocaineMPF with
glucose 7.5%,or 9 to 15
mg of 1.5% Xylocaine-
MPF with dextrose
7.5%.For cesarean
section,75 mg of 5%
Xylocaine-MPF with
glucose 7.5%.For
surgical anesthesia,75
to 100 mg of 5%
Xylocaine-MPF with
glucose 7.5%.
 Adults: For obstetric
➣I.V.regional analgesia,100 mg
infiltration paracervically as 1%
(without solution (each side).For
epinephrine) paracervical
block,maximum
dosage is 200 mg over
each 90-minute period
➣I.V.local (half administered on
infiltration each side).
(without  Adults: For brachial
epinephrine) nerve block,225 to 300
mg as 1.5%
solution.For dental
nerve block,20 to 100
mg as 2% solution
➣Spinal with epinephrine
anesthesia 1:100,000 or
(without 1:50,000.For
epinephrine) intercostal nerve block,
30 mg as 1%
solution.For pudendal
nerve block,100 mg as
1% solution. For
paravertebral nerve
block,30 mg to 50 mg
as 1% solution.
 Adults: For cervical
nerve block,50 mg as
1% solution.For
lumbar nerve block,50
to 100 mg as 1%
solution.
 Adults: 1 to 5 ml of
lidocaine 2% with
epinephrine 1:50,000
or 1:100,000.
Maximum dosage is
less than 500 mg (7
mg/kg). Children: 20
to 30 mg as 2%
 solution with
epinephrine 1:100,000
 Adults:Apply thin
layer of gel,jelly,or
➣Paracervical ointment to skin or
anesthesia mucous membranes as
(without needed before
epinephrine procedure;or apply
5% patch to most
painful areas and
intact skin (up to three
patches at a time for
up to 12 hours within a
24hour period).For
new denture fittings,
use 5-g ointment (250
mg) per single dose or
20 g/day.For
➣Peripheral oropharyngeal
nerve block use,apply to desired
area or to instrument
before insertion.
Children:Apply thin
layer of ointment to
skin or mucous
membranes p.r.n.
before
procedure.Maximum
dosage is 2.5 g
ointment per 6 hours
or 4.5 mg/kg.
 Adults:For female
urethral
 examination,apply 3 to
5 ml of 2% jelly
topically several
minutes before
exam.For male
sounding or
cystoscopy,apply 5 to
10 ml of 2% jelly
topically before
➣Sympathetic procedure,or apply 30
nerve block ml to fill or dilate
(without urethra in divided
epinephrine) doses using penile
clamp for several
minutes between
doses.For male
catheterization,apply 5
➣Dental to 10 ml of 2% jelly to
anesthesia anterior urethra
before procedure.
Don’t use more than
600 mg/12 hours.
 Adults: For oral cavity
disorders, 300 mg (15
ml) of viscous oral
topical solution
swished and then
expelled,or applied
with cotton swab q 3
hours p.r.n.For
pharyngeal
disorders,use same
dosage,but solution
➣Topical may be swallowed.
anesthesia for Children older than
skin or mucous age 3:Dosage
membranes individualized based
on age,weight, and
physical
condition.Maximum
dosage is 4.5 mg/kg q 3
hours. Children up to
age 3:1.25 ml applied
with swab q 3 hours
 Adults: 0.6 to 3 mg/kg
or 40 to 200 mg of 4%
topical solution,not to
exceed 4.5 mg/kg or
300 mg (7.5 ml)
(Schull, 2013)
➣Prevention
or treatment of
pain during
procedures
involving male
or female
urethra
 Oral
cavity
disorders;
pharyngea
l disorders
 ➣Local
anesthesia
(oral or nasal
mucosa

(Schull, 2013)
EPINEPHRINE Stimulates alpha- ➣Bronchodilat ● Hypersensitivity to  Adults:0.1 to 0.5 ml of CNS: Patient monitoring
CHLORIDE(Generic) and beta-adrenergic ion;anaphylaxi drug,its components,or 1:1,000 solution nervousness,anxiety,tr
receptors,causing s; sulfites subcutaneously or emor,  Monitor vital
Adrenalin Chloride relaxation of cardiac hypersensitivit ● Angle-closure I.M.,repeated q 10 to vertigo,headache,diso signs,ECG,and
(Trade name) and bronchial y reaction glaucoma 15 minutes p.r.n.Or rientation,agitation,dr cardiovascular and
smooth muscle and ● Cardiac 0.1 to 0.25 ml of owsiness,fear,dizzines respiratory status.
Pharmacologic class: dilation of skeletal dilatation,cardiac 1:10,000 solution s, asthenia,cerebral  Watch for ventricular
Sympathomimetic muscles.Also insufficiency I.V.slowly over 5 to 10 hemorrhage, fibrillation,
(direct acting) decreases aqueous ● Cerebral minutes;may repeat q cerebrovascular tachycardia,arrhythmia
Therapeutic class: humor production, arteriosclerosis,organic 5 to 15 minutes accident (CVA) s,and signs and
Bronchodilator, increases aqueous brain syndrome p.r.n.or follow with a CV:palpitations,wide symptoms of shock.
mydriatic outflow,and dilates ● Shock with use of continuous infusion of ned pulse pressure,  Ask patient about
pupils by general anesthetics and 1 hypertension,tachycar anginal pain.
(Schull, 2013) contracting dilator halogenated mcg/minute,increased dia,angina,ECG  Assess drug’s effect on
Page. 428 muscle. hydrocarbons or to 4 mcg/minute changes,ventricular underlying problem
cyclosporine p.r.n.For emergency fibrillation,shock GI: (such as anaphylaxis or
(Schull, 2013) ● MAO inhibitor use treatment,EpiPen nausea,vomiting GU: asthma attack),and
Page. 428 within past 14 days delivers 0.3 mg I.M. of decreased urinary repeat dose as needed.
● Labor 1:1,000 epinephrine. output,urinary 2Monitor neurologic
● Breastfeeding Children: For retention,dysuria status,particularly for
emergency treatment, Respiratory: decreased level of
 EpiPen Jr.delivers dyspnea,pulmonary consciousness and other
Precautions Use 0.15 mg I.M.of 1:2,000 edema Skin: signs and symptoms of
cautiously in: epinephrine. urticaria,pallor,diaph cerebral hemorrhage or
●  Adults and children oresis, necrosis Other: CVA.
hypertension,hyperthyr ages 4 and older: One hemorrhage at  Monitor fluid intake
oidism, to three deep injection site and output, watching
diabetes,prostatic inhalations of for urinary retention or
hypertrophy inhalation solution (Schull, 2013) decreased urinary
● elderly patients with hand-held Page 429 output.
● pregnant patients nebulizer,repeated q 3  Inspect injection site
● children. hours p.r.n. for hemorrhage or skin
 Adults:0.5 to 1 mg necrosis.
(Schull, 2013) I.V.,repeated q 3 to 5
Page. 429 minutes,if needed.If Patient teaching
no response, may give  Teach patient who uses
3 to 5 mg I.V.q 3 to 5 auto-injector how to use
minutes. syringe correctly,when
 Adults:Onedrop in to inject drug,and when
affected eye once or to repeat doses.
➣Acute twice daily.Adjust  Teach patient who uses
asthma attack dosage to meet hand-held nebulizer
patient’s needs. correct use of
 Adults and children: equipment and
1:200,000 drug.Explain
concentration with indications for both
local anesthetic initial dose and repeat
(Schull, 2013) doses. 2Inform patient
Page 428-429 that drug may cause
serious adverse
effects.Tell him which
symptoms to report.
➣To restore  If patient will self-
cardiac administer drug outside
 rhythm in of health care
cardiac arrest setting,explain need for
prompt evaluation by a
health care provider to
ensure that underlying
disorder has been
corrected.
 As appropriate,review
all other significant and
➣Chronic life-threatening adverse
simple reactions and
glaucoma interactions,especially
those related to the
drugs

(Schull, 2013)
Page. 430-431
➣To prolong
local anesthetic
effects

(Schull, 2013)
Page. 428-429
DOPAMINE Causes ➣Shock;hemo ● Hypersensitivity to Adults and children: 2 to 5 CNS: headache Patient monitoring
HYDROCHORIDE norepinephrine dynamic drug or bisulfites mcg/kg/ minute by CV:palpitations,hypot  Monitor blood
(Generic) release (mainly on imbalance; ● I.V.infusion.Titrate dosage ension,angina, ECG pressure,pulse,urinary
dopaminergic hypotension;he Tachyarrhythmias,vent to desired response;may changes,tachycardia,v output,and pulmonary
Doastat, Intropin, receptors),leading to art failure ricular fibrillation increase infusion by 1 to 4 asoconstriction,arrhyt artery wedge pressure
Revimine (trade name) vasodilation of renal ● Pheochromocytoma mcg/kg/minute at 10- to hmias EENT: during infusion.
and mesenteric Page. 389 30-minute mydriasis GI:  Inspect I.V.site
Pharmacologic class: arteries.Also exerts Use cautiously in: intervals.Maximum nausea,vomiting regularly for
Catecholamine, inotropic effects on ● dosage is 50 Metabolic: irritation.Avoid
adrenergic heart,which hypovolemia,myocardia mcg/kg/minute. azotemia,hyperglycem extravasation.
Therapeutic class: increases the heart l infarction, occlusive ia Respiratory:  Monitor color and
Inotropic, vasopressor rate, blood vascular Page.389 dyspnea,asthma temperature of
flow,myocardial disease,diabetic (Schull, 2013) attacks Skin: extremities.
Page. 389 contractility, and endarteritis,atrial piloerection Other:  Never stop infusion
(Schull, 2013) stroke volume. embolism irritation at injection abruptly, because this
● concurrent MAO site,gangrene may cause severe
Page 389 inhibitor use ofextremities (with hypotension.Instead,ta
(Schull, 2013) ● pregnant or high doses for per gradually.
breastfeeding patients ● prolonged periods or Patient teaching
children. in occlusive vascular  Explain the need for
disease) close observation
Page. 389 during infusion.
(Schull, 2013) Page. 390  Instruct patient to
(Schull, 2013) report adverse
reactions and I.V.site
discomfort.
 As
appropriate,review all
other significant and
life-threatening
adverse reactions and
interactions,especially
those related to the
drugs and tests
mentioned above.
 Dilute full-strength
injection before
administering.
 If extravasation
occurs,infiltrate area
promptly with 10 to
15 ml of saline
  solution containing 5
to 10 mg
phentolamine to
prevent sloughing and
necrosis.Use syringe
with fine hypodermic
needle,and infiltrate
solution liberally
throughout area.Give
phentolamine as soon
as possible;its
sympathetic blockade
causes immediate
local hyperemic
changes if area is
infiltrated within 12
hours.

(Schull, 2013)

Page. 390
SODIUM Restores body’s ➣Metabolic ● Hypocalcemia  Adults and children: 2 CNS: Patient monitoring
BICARBONAE buffering capacity; acidosis ● Metabolic or to 5 mEq/kg by headache,irritability,c  When giving
(generic) neutralizes excess respiratory alkalosis I.V.infusion over 4 to onfusion, I.V.,closely monitor
acid ● Hypernatremia 8 stimulation,tremors,t arterial blood gas
Arm and Hammer ● Hypokalemia hours.However,dosag witching,hyperreflexi results and
Baking soda, Page. 1153 ● Severe pulmonary e highly a,weakness,seizures electrolyte levels.
Citrocarbonate, Soda, (Schull, 2013) edema individualized based ofalkalosis,tetany CV:  Stay alert for signs
Neut, Soda mint ● Seizures on patient’s condition irregular and symptoms of
( trade name) ● Vomiting resulting in and blood pH and pulse,edema,cardiac metabolic alkalosis
chloride loss carbon dioxide arrest GI: gastric and electrolyte
content. distention,belching,fla imbalances.
Pharmacologic class: ● Diuretic use resulting  Adults:Initially,4 g tulence,acid  Monitor fluid intake
Fluid and electrolyte in hypochloremic P.O.;then 1 to 2 g reflux,paralytic ileus and output. Assess
agent alkalosis P.O.q 4 hours GU: renal calculi for fluid overload.
Therapeutic class: ➣Urinary ● Acute ingestion of Children: 1 to 10 Metabolic:  Avoid rapid
Alkalinizer,antacid alkalization mineral acids (with oral mEq/kg/day P.O.in hypokalemia,fluid infusion,which may
form) divided doses given q retention,hypernatre cause tetany.
Page. 1153 4 to 6 hours mia,hyperosmolarity  Watch for
(Schull, 2013)  2 mEq/kg P.O.daily in (with inflammation at
Precautions Use four to five equal overdose),metabolic I.V.site.
cautiously in: doses.For proximal alkalosis Respiratory: 
● renal tubular acidosis,4 to slow and shallow Patient teaching
insufficiency,heart 10 mEq/kg P.O.daily respirations,cyanosis,  Tell patient using
failure, in divided doses. apnea Other: weight drug as antacid that
hypertension,peptic  Adults: 300 mg to 2 g gain,pain and too much sodium
➣Renal ulcer,cirrhosis, toxemia P.O.up to q.i.d., given inflammation at bicarbonate can
tubular ● pregnant patients. with a glass of water I.V.site cause systemic
acidosis problems.Urge him
Page. 1153 Page. 1153 Page. 1154 to use only the
(Schull, 2013) (Schull, 2013) amount approved by
prescriber.
 Advise patient not
to take oral form
with milk.Caution
him to avoid the
herb oak bark.
 Tell patient sodium
➣Antacid
bicarbonate
interferes with
Page. 1153
action of many
(Schull, 2013)
common
drugs.Instruct him
to notify all
prescribers if he’s
 taking oral sodium
bicarbonate on a
regular basis.
 As
appropriate,review
all other significant
and life-threatening
adverse reactions
and
interactions,especial
ly those related to
the drugs,tests,and
herbs mentioned
above

Page. 1154
(Schull, 2013)

CARDIAC DRUGS
NIRTROGLYCERIN Inhibits calcium ➣Management ● Hypersensitivity to  Adults: For acute CNS: Patient monitoring
E (generic) transport into and drug,other organic angina attack,0.3 to 0.6 dizziness,headache
myocardial and prophylaxis of nitrates,nitrites,or mg S.L.,repeated q 5 CV:  With I.V.use,monitor
Minitran,Nitrek,Nitro- vascular smooth angina pectoris adhesives (transdermal minutes for 15 minutes hypotension,syncope blood pressure
Dur, muscle form) p.r.n.;or one to two Hematologic:methem frequently.Titrate
Nitroject,Nitrolingual, cells,suppressing ● Angle-closure translingual oglobinemia Skin: dosage to obtain
Nitromist, contractions.Dilates glaucoma sprays,repeated q 5 contact dermatitis desired results.
Nitronal ,Nitroquick,N main coronary ● Orthostatic minutes for 15 minutes (with transdermal or  With transdermal
itrostat ( trade name) arteries and hypotension p.r.n.For long-term or ointment use,check for rash or
arterioles,inhibits ● Hypotension or prophylactic use,1-mg use),rash,exfoliative skin irritation.
Pharmacologic class: coronary artery uncorrected extended-release dermatitis,flushing  Monitor patient for
Nitrate spasm,increases hypovolemia (I.V.form) buccal tablet q 5 angina relief.
Therapeutic class: oxygen delivery to ● Early MI (S.L.form) hours,with dosage and Page.884 
Antianginal heart,and reduces ● Increased frequency increased (Schull, 2013) Patient teaching
 frequency and intracranial pressure p.r.n.;or 2.5 to 9 mg  Instruct patient to
Page. 882 severity of angina (as from head trauma (extended- place S.L.tablet
(Schull, 2013) attacks. or cerebral releasetablets) P.O.q 8 directly under tongue
hemorrhage) to 12 hours;or 1.3 to and hold it there as it
Page. 882-883 ● Severe anemia 6.5 mg (extended- dissolves.Caution him
(Schull, 2013) ● Pericardial release capsules) P.O.q not to chew or swallow
tamponade or 8 to 12 hours. tablet.
constrictive pericarditis  Adults:5 mcg/minute  Tell patient to use drug
● Concurrent sildenafil I.V.,increased by 5 before physical
therapy mcg/minute q 3 to 5 activities that may
minutes up to 20 cause angina.
mcg/minute,then  Instruct patient to take
Precautions Use increased by 10 to 20 drug at pain onset and
cautiously in: mcg/minute q 3 to 5 repeat every 5 minutes
● severe renal or minutes (dosage based for three doses.If pain
➣Hypertensio hepatic impairment, on hemodynamic doesn’t subside, advise
n during glaucoma,hypertrophic parameters) him to seek medical
surgery; cardiomyopathy  Adults: 12.5 to 25 mcg attention.
adjunct in y I.V.,then a continuous  Tell patient not to
heart failure ● hypovolemia,normal infusion of 10 to 20 chew or crush
or decreased mcg/minute q 5 to 10 sustained-release
pulmonary capillary minutes; increase by 5 tablets.
wedge pressure (with to 10 mcg/minute q 5  Advise patient to
I.V.use) to 10 minutes as apply correct amount
● alcohol intolerance needed to a maximum of ointment using
(with large I.V. doses) ● of 200 mcg/minute. applicator. Caution
pregnant or him to avoid rubbing
breastfeeding patients ● Page. 883 site. Instruct him to
children (safety not (Schull, 2013) cover ointment with
established). plastic wrap and tape
it,to wash hands after
Page. 883 placement,and to
(Schull, 2013) rotate sites.
 ➣Heart failure  Advise patient to
associated with consult prescriber or
acute pharmacist before
myocardial changing brands of
infarction (MI) transdermal
system.Different
brands may have
different drug
concentrations.
 As appropriate,review
all significant and life-
threatening adverse
reactions and
Page. 883 interactions,especially
(Schull, 2013) those related to the
drugs,tests,and
behaviors mentioned
above.
Page. 884
(Schull, 2013)

MORPHINE Interacts with ➣Severe to Contraindications Oral use— Adults: 5 to 30 CNS: Patient monitoring
SULFATE (generic) opioid receptor moderate pain ● Hypersensitivity to mg confusion,sedation,diz  Monitor vital
sites, primarily in drug,tartrazine, P.O.(immediaterelease) q ziness, signs.Contact
Astramorph limbic Page. 828 bisulfites,or alcohol 4 hours p.r.n.Or 20 mg dysphoria,euphoria,fl prescriber if
PF,Avinza,Duramorph system,thalamus, ● Acute bronchial P.O. (controlled- oating feeling, respiratory rate is 10
, Filnarine ,Filnarine and spinal cord.This (Schull, 2013) asthma release,Kadian) once or hallucinations,headac breaths/ minute or
SR ,Infumorph,Kadian interaction alters ● Upper airway twice daily p.r.n.Or 200 he,nightmares CV: less.
,Morcap SR , neurotransmitter obstruction mg P.O.(MS Contin) in hypotension,bradycar  Assess pain
Morphogesic ,Morpho release,altering ● Respiratory opioid-tolerant patients dia EENT: blurred character,location,and
gesic SR , MS perception of and depression who require daily vision,diplopia,miosis intensity.
Contin,MST tolerance for pain morphineequivalent GI:
Continus ,MXL , dosages above 400 mg. nausea,vomiting,const
Novo- Page. 828 ● GI ipation,dry mouth  Monitor fluid intake
Morphine,Oramorph obstruction,paralytic I.M.or subcutaneous use— GU: urinary retention and output. Stay alert
SR, Oramorph (Schull, 2013) ileus Adults: 5 to 20 mg/70 kg Respiratory:apnea,res for urinary retention.
SR ,PMS Morphine I.M.or subcutaneously q 4 piratory  Monitor bowel
Sulfate SR,Ratio- Precautions Use hours p.r.n. depression,respirator elimination pattern. If
Morphine Sulfate cautiously in: y arrest Skin: constipation
SR,Rhotard ,Sevredol , ● head I.V.use— Adults: 2 to 10 flushing,itching,sweati occurs,intervene as
Statex, Sulfate trauma;increased mg/70 kg I.V.p.r.n. given ng Other: physical or appropriate.
SR,Zomorph intracranial slowly over 4 to 5 psychological drug  Assess neurologic
pressure;severe minutes.As a continuous dependence,drug status.Implement
Pharmacologic class: renal,hepatic,or I.V.infusion,0.1 to 1 mg/ tolerance safety measures as
Opioid agonist pulmonary ml in dextrose 5% in needed to prevent
Therapeutic class: disease;hypothyroidism water delivered by Page. 829 injury.
Opioid analgesic ;adrenal controlled-infusion device. (Schull, 2013)  Evaluate patient for
Controlled substance insufficiency;prostatic signs and symptoms of
schedule II hypertrophy Rectal use— Adults:10 to physical or
● elderly or debilitated 30 mg P.R.q 4 hours p.r.n. psychological
Page.827 patients Epidural use— Adults: dependence.Be
(Schull, 2013) ● pregnant or Initially 5 mg watchful for drug
breastfeeding patients. (Astramorph PF, hoarding.
Duramorph) injected in
Page 829 lumbar region (may  Tell patient he may
(Schull, 2013) relieve pain up to 24 crush
hours).If response isn’t immediaterelease
adequate within 1 hour, form and mix with
carefully give incremental food or fluids.
doses of 1 to 2 mg p.r.n.,up
to 10 mg/24 hours.For  Advise patient not to
continuous epidural crush or break
infusion,2 to 4 mg/24 extended-release
hours.For epidural form.Instruct him to
injection (DepoDur) swallow it whole.
before orthopedic leg
surgery,recommended
dosage is 15 mg; before
lower abdominal or pelvic
surgery,10 to 15 mg.For
cesarean section after
umbilical cord
clamping,recommended
dosage is 10 mg.
Intrathecal use—
Adults:Usual intrathecal
dosage is one-tenth of
epidural dosage;0.2 to 1
mg as a single injection in
lumbar area may relieve
pain up to 24 hours.
Dosage adjustment ●
Adults weighing less than
50 kg (110 lb)
● Elderly patients ●
Children
Page 828-829
(Schull, 2013)
 Tell patient he may
open sustainedrelease
capsule
(Kadian),sprinkle
entire contents of
capsule onto a small
amount of food (such
as applesauce), and
consume
immediately.Stress
importance of not
chewing,crushing, or
dissolving pellets.
 Advise patient to take
drug at the first sign
of pain,because
continuous dosing is
more effective than
p.r.n.dosing
 Tell patient and
caregiver that drug
may cause respiratory
depression. Instruct
them to immediately
report respiratory
rate of 10
breaths/minute or
less.
 Inform patient that
drug may cause
 constipation or
urinary retention.
Encourage high-fiber
diet and high fluid
intake.

 Stress importance of
taking drug only as
prescribed.Point out
that drug may cause
psychological or
physical dependence.

 Caution patient to
avoid driving and
other hazardous
activities until he
knows how drug
affects concentration,
vision,and alertness.

 Teach patient and

caregiver about
appropriate safety
measures to prevent
injury.

 Caution patient to
avoid alcohol and
other CNS
depressants during
and for 24 hours after
therapy.
  Advise patient to
avoid herbs,which
may worsen adverse
CNS effects.

 As
appropriate,review all
other significant and
life-threatening
adverse reactions and
interactions,especially
those related to the
drugs,tests,herbs, and
behaviors mentioned
above.
Page. 830
(Schull, 2013)

DIGOXIN (generic) Increases force and ➣Heart ● Hypersensitivity to  Adults: For rapid CNS:fatigue,headache Patient monitoring
velocity of failure;tachyar drug digitalizing,0.6 to 1 ,asthenia CV:  Assess apical pulse
Apo- myocardial rhythmias; ● Uncontrolled mg I.V.over 24 bradycardia,ECG regularly for 1 full
Digoxin,Digitek,Lanoxi contraction and atrial ventricular hours,with 50% of changes, arrhythmias minute.If rate is less
n, PMS Digoxin (trade prolongs refractory fibrillation and arrhythmias total dosage given EENT: blurred or than 60 beats/
name) period of flutter;paroxys ● AV block initially and yellow vision GI: minute,withhold dose
atrioventricular mal atrial ● Idiopathic additional fractions nausea,vomiting,diarr and notify prescriber.
Pharmacologic (AV) node by tachycardia hypertrophic subaortic given at 4- to 8-hour hea GU: 2Monitor for signs and
class:Cardiac glycoside increasing calcium stenosis intervals;or gynecomastia symptoms of drug
Therapeutic class: entry into Page. 39-370 ● Constrictive digitalizing dose of Hematologic:thrombo toxicity (such as
Inotropic,antiarrhyth myocardial (Schull, 2013) pericarditis 0.75 to 1.25 mg cytopenia nausea,vomiting,visual
mic cells.Slows P.O.over 24 Other:decreasedappet disturbances,arrhythm
conduction through Precautions Use hours,with 50% of ite ias, and altered mental
Page. 369 sinoatrial and AV cautiously in: total dosage given status).Be aware that
(Schull, 2013) nodes and produces ● renal or hepatic initially and Page. 371 therapeutic digoxin
antiarrhythmic impairment,electrolyte additional fractions (Schull, 2013) levels range from 0.5 to
effect. imbalances,myocardial given at 4- to 8-hour 2 ng/ml.
infarction,thyroid intervals.Maintenance  Monitor ECG and
Page 369-370 disorders dosage is 0.063 to 0.5 blood levels of
(Schull, 2013) ● obesity mg/day (tablets) or digoxin,potassium,mag
● elderly patients 0.35 to 0.5 mg/day nesium,calcium,and
● pregnant or (gelatin creatinine. Stay alert
breastfeeding patients. capsules),depending for
on lean body hypocalcemia.Know
Page. 371 weight,renal that this condition may
(Schull, 2013) function,and drug predispose patient to
blood level. digoxin toxicity and
 Children older than may decrease digoxin
age 10:For rapid efficacy. 2Watch
digitalizing,8 to 12 closely for
mcg/kg I.V.over 24 hypokalemia and
hours,with 50% of hypomagnesemia.Kno
total dosage given w that digoxin toxicity
initially and may occur with these
additional fractions conditions despite
given at 4- to 8-hour digoxin blood levels
intervals;or below 2 ng/ml.
digitalizing dose of 10
to 15 mcg/kg P.O.over Patient teaching
24 hours,with 50% of  Tell patient to take
total dosage given drug at same time
initially and every day.
additional fractions  Instruct patient not
given at 6- to 8-hour to stop drug
intervals.Maintenance abruptly.
dosage is 25% to 35%  Instruct patient not
of loading to take over-
 dosage,given daily as thecounter drugs
a single dose without prescriber’s
(determined by renal approval.
function).  Teach patient how
 Children ages 5 to to recognize and
10:For rapid report signs and
digitalizing,15 to 30 symptoms of digoxin
mcg/kg I.V.over 24 toxicity.
hours,with 50% of  Stress importance
total dosage given of follow-up testing
initially and as directed by
additional fractions prescriber.
given at 4- to 8-hour  As
intervals;or appropriate,review
digitalizing dose of 20 all other significant
to 35 mcg/kg P.O.over and life-threatening
24 hours,with 50% of adverse reactions
total dosage given and
initially and interactions,especial
additional fractions ly those related to
given at 6- to 8-hour the
intervals.Maintenance drugs,tests,foods,
dosage is 25% to 35% and herbs
of loading mentioned above.
dosage,given daily in Page. 372
two divided doses (Schull, 2013)
(determined by renal
function).
 Children ages 2 to
5:For rapid
digitalizing,25 to 35
mcg/kg I.V.over 24
hours,with 50% of
 total dosage given
initially and
additional fractions
given at 4- to 8-hour
intervals;or
digitalizing dose of 30
to 40 mcg/kg P.O.over
24 hours,with 50% of
total dosage given
initially and
additional fractions
given at 6- to 8-hour
intervals.Maintenance
dosage is 25% to 35%
of loading
dosage,given daily in
two divided doses
(determined by renal
function).
 Children ages 1 to 24
months:For rapid
digitalizing,30 to 50
mcg/kg I.V. over 24
hours,with 50% of
total dosage given
initially and
additional fractions
given at 4- to 8-hour
intervals;or
digitalizing dose of 35
to 60 mcg/kg P.O.over
24 hours,with 50% of
total dosage given
 initially and
additional fractions
given at 6- to 8-hour
intervals.Maintenance
dosage is 25% to 35%
of loading
dosage,given daily in
two divided doses
(determined by renal
function).
 Infants (full-term):
For rapid
digitalizing,20 to 30
mcg/kg I.V.over 24
hours, with 50% of
total dosage given
initially and
additional fractions
given at 4- to 8-hour
intervals;or
digitalizing dose of 25
to 35 mcg/kg P.O.over
24 hours, with 50% of
total dosage given
initially and
additional fractions
given at 6- to 8-hour
intervals.Maintenance
dosage is 25% to 35%
of loading
dosage,given daily in
two divided doses
 (determined by renal
function)
 . Infants (premature):
For rapid
digitalizing,15 to 25
mcg/kg I.V.over 24
hours,with 50% of
total dosage given
initially and
additional fractions
given at 4- to 8-hour
intervals;or
digitalizing dose of 20
to 30 mcg/kg P.O.over
24 hours,with 50% of
total dosage given
initially and
additional fractions
given at 6- to 8-hour
intervals.Maintenance
dosage is 20% to 30%
of loading
dosage,given daily in
two divided doses
(determined by renal
function).
Page 370-371
(Schull, 2013)

HYPERTENSIVE
CRISIS
MANNITOL (generic) Increases osmotic ➣Test dose for ● Active intracranial  Adults: 0.2 g/kg Adverse reactions Patient monitoring
pressure of plasma marked bleeding (except during I.V.infusion CNS:
Osmitrol,Polyfusor ,Re in glomerular oliguria or craniotomy) (approximately 50 ml dizziness,headache,sei  Monitor I.V.site
sectisol (trade name) filtrate,inhibiting suspected ● Anuria secondary to of 25% solution,75 ml zures CV:chest carefully to avoid
tubular inadequate severe renal disease of 20% solution,or pain,hypotension,hyp extravasation and tissue
Pharmacologic class: reabsorption of renal function ● Progressive heart 100 ml of 15% ertension,tachycardia, necrosis.
Osmotic diuretic water and failure,pulmonary solution) over 3 to 5 thrombophlebitis,  In comatose
Therapeutic class: electrolytes congestion,renal minutes.If urine flow heart failure,vascular patient,insert indwelling
Diuretic (including sodium damage,or renal doesn’t overload EENT: urinary catheter as
and potassium). dysfunction after increase,second dose blurred vision,rhinitis ordered to monitor
Page. 744 These actions mannitol therapy may be given;if GI: urine output
(Schull, 2013) enhance water flow begins response is nausea,vomiting,diarr  . Monitor renal function
from various tissues ● Severe pulmonary inadequate after hea,dry mouth tests,urinary
and ultimately congestion or second GU:polyuria,urinary output,fluid
decrease pulmonary edema dose,reevaluate retention, osmotic balance,central venous
intracranial and ● Severe dehydration patient. nephrosis Metabolic: pressure,and electrolyte
intraocular  Adults: 50 to 100 g dehydration,water levels (especially sodium
pressures; serum Precautions Use I.V.infusion as 5% to intoxication,hypernat and potassium).
sodium level rises cautiously in: 15% solution remia,hyponatremia,  Watch for excessive
while potassium and ● severe renal  Adults: Up to 100 g hypovolemia,hypokale fluid loss and signs and
blood urea levels disease,heart failure, I.V.infusion as 15% to mia,hyperkalemia,me symptoms of
fall.Also protects mild to moderate 25% solution tabolic acidosis hypovolemia and
kidneys by ➣To prevent dehydration Children: 0.25 to 2 Respiratory: dehydration.
preventing toxins oliguria during ● pregnant or g/kg I.V.or 60 mg/m2 pulmonary congestion  Assess for evidence of
from forming and cardiovascular breastfeeding patients. as 15% to 20% Skin: rash,urticaria circulatory
blocking tubules. and other solution over 2 to 6 Other: overload,including
surgeries Page. 745 hours chills,fever,thirst,ede pulmonary
Page. 745 (Schull, 2013)  Adults:0.5 to 2 g/kg ma, extravasation edema,water
(Schull, 2013) I.V.infusion as 15% to with edema and tissue intoxication,and heart
25% solution given necrosis failure.
➣Acute
over 30 to 60 minutes
oliguria
Children: 1 to 2 g/kg Page. 746 Patient teaching
I.V.or 30 to 60 g/m2 (Schull, 2013)
 over 30 to 60  Teach patient about
minutes.Small or importance of
debilitated patients monitoring exact
may require smaller urinary output.
dose of 500 mg/kg.  Advise patient to
 Adults: 0.5 to 2 g/kg report pain at infusion
I.V.infusion as 15% to site as well as adverse
25% solution given reactions,such as
➣To reduce over 30 to 60 increased shortness of
intracranial minutes.For breath or pain in
pressure and preoperative use,give back,legs,or chest.
brain mass 60 to 90 minutes  Tell patient drug may
before surgery. cause thirst or dry
Children: 1 to 2 g/kg mouth.Emphasize that
I.V.or 30 to 60 g/m2 fluid restrictions are
over 30 to 60 necessary,but that
minutes.Small or frequent mouth care
debilitated patients should ease these
may require smaller symptoms.
dose of 500 mg/kg.  As appropriate,review
 Adults:5% to 25% all other significant
solution by I.V. and life-threatening
infusion given adverse reactions and
continuously to interactions,especially
maintain high urine those related to the
output Children:2 drugs and tests
➣To reduce g/kg I.V.of 5% to mentioned above.
intraocular 10% solution given Page. 746
pressure continuously to (Schull, 2013)
maintain high urine
output
 Adults: 2.5% to 5%
solution instilled into
 bladder via indwelling
urethral catheter,as
needed
Page 745
(Schull, 2013)

➣To promote
diuresis in
drug toxicity

➣Irrigation
during
transurethral
 resection of
prostate

Page. 745
(Schull, 2013)

FUROSEMIDE Unclear.Thought to ➣Acute ● Hypersensitivity to  Adults: 40 mg Adverse reactions Patient monitoring

(generic) inhibit sodium and pulmonary drug or other I.V.given over 1 to 2 CNS:  Watch for signs and
chloride edema sulfonamides minutes.If adequate dizziness,headache,ve symptoms of
Apo-Furosemide,Bio- reabsorption from ● Anuria response doesn’t occur rtigo, ototoxicity.
Furosemide, Dom- ascending loop of within 1 hour,give 80 weakness,lethargy,par  Assess for other
Furosemide,Frusol ,La Henle and distal mg I.V. over 1 to 2 esthesia,drowsiness,re evidence of drug
six, Lasix renal Precautions Use minutes. stlessness,light- toxicity
Special,Novosemide, tubules.Increases cautiously in:  Adults: Initially,20 to headedness CV: (arrhythmias,renal
Nu-Furosemide,PMS- potassium excretion ● diabetes 80 mg/day P.O. as a hypotension,orthostati dysfunction,abdominal
Furosemide(trade and plasma mellitus,severe hepatic single dose; may c pain,sore throat,fever).
name) volume,promoting ➣Edema disease increase in 20- to 40- hypotension,tachycar  Monitor
renal excretion of caused by ● elderly patients mg increments P.O.q 6 dia,volume depletion, CBC,BUN,and
Pharmacologic class: water,sodium, heart failure, ● pregnant or to 8 hours until desired necrotizing electrolyte, uric
Sulfonamide loop chloride,magnesium hepatic breastfeeding patients ● response occurs. angiitis,thrombophleb acid,and CO2 levels.
diuretic ,hydrogen,and cirrhosis,or neonates. Thereafter,may give itis,arrhythmias  Monitor blood
Therapeutic class: calcium. renal disease once or twice daily.For EENT:blurred pressure,pulse,fluid
Diuretic,antihypertensi Page. 548 maintenance,dosage vision,xanthopsia, intake and output,and
ve Page. 547 (Schull, 2013) may be reduced in hearing loss,tinnitus weight.
(Schull, 2013) some patients or GI:  Assess blood glucose
Page. 547 carefully titrated nausea,vomiting,diarr levels in patients with
(Schull, 2013) upward to 600 mg P.O. hea,constipation,dysp diabetes mellitus.
daily in severe epsia,oral and gastric  Monitor dietary
edema.Usual I.M.or irritation,cramping,a potassium intake.
I.V.dosage is 20 to 40 norexia,dry Watch for signs and
mg as a single mouth,acute symptoms of
injection; if response pancreatitis hypokalemia.
 inadequate, second and GU: excessive and 
each succeeding dose frequent urination, Patient teaching
may be increased in nocturia,glycosuria,bl
20-mg increments and adder spasm,  Instruct patient to
given no more often oliguria,interstitial take in morning with
than q 2 hours until nephritis food (and second
desired response Hematologic: dose,if prescribed,in
occurs. Single dose anemia,purpura,leuko afternoon),to prevent
may then be given once penia,thrombocytope nocturia.
or twice daily. nia,hemolytic anemia  Tell patient that
 Infants and children: 2 Hepatic: jaundice drug may cause
mg/kg P.O. (oral Metabolic: serious interactions
solution) as a single hyperglycemia,hyperu with many common
dose.As ricemia,dehydration,h drugs.Instruct him to
necessary,increase in ypokalemia, tell all prescribers
increments of 1 or 2 hypomagnesemia,hyp he’s taking it.
mg/kg q 6 to 8 hours to ocalcemia,  Instruct patient to
a maximum of 6 hypochloremic report signs and
mg/kg/dose.For alkalosis symptoms of
maintenance,give Musculoskeletal: ototoxicity (hearing
minimum effective muscle pain,muscle loss, ringing in
dosage. cramps Skin: ears,vertigo) and
 Adults: 40 mg photosensitivity,rash, other drug toxicities.
P.O.b.i.d.If satisfactory diaphoresis,urticaria,  Caution patient to
response doesn’t pruritus,exfoliative avoid driving and
occur,other dermatitis,erythema other hazardous
antihypertensives may multiforme activities until he
be added before Other:fever,transient knows how drug
furosemide dosage is pain at I.M. injection affects concentration
increased.However,dos site and alertness.
age may be titrated  Instruct patient to
upward as needed and Page. 548 move slowly when
tolerated to a (Schull, 2013) rising,to avoid
 maximum of 240 mg dizziness from
P.O.daily in two or sudden blood
three divided doses. pressure decrease.
Page. 547  Encourage patient to
(Schull, 2013) discuss need for
potassium and
magnesium
supplements with
prescriber.
 Caution patient to
➣Hypertensio avoid alcohol and
n herbs while taking
this drug.
Page. 547  Inform patient that
(Schull, 2013) he’ll undergo regular
blood testing during
therapy. As
appropriate,review
all other significant
and life-threatening
adverse reactions and
interactions,especiall
y those related to the
drugs,tests,herbs,
and behaviors
mentioned above.
Page. 549
(Schull, 2013)
NITROPRUSSIDE Action Interferes ➣Hypertensiv ● Hypertension caused Adults and children: 0.3 to CV:ECG Patient monitoring
SODIUM (generic) with calcium influx e by aortic coarctation or 10 mcg/ kg/minute changes,bradycardia,t  Measure blood pressure
and intracellular emergencies;co atrioventricular I.V.,titrated to response achycardia,markedhy frequently (preferably
Nipride,Nitropress activation of ntrolled shunting potension GI: ileus with continuous arterial
calcium, causing hypotension Hematologic:
Pharmacologic class: peripheral during ● Acute heart failure Dosage adjustment ● decreased platelet line) to detect rapid
Vasodilator vasodilation and anesthesia caused by reduced Hepatic insufficiency aggregation,methemo drop.
Therapeutic class: direct blood peripheral vascular ● Renal impairment globinemia Metabolic:  Monitor injection site
Antihypertensive pressure Page. 885 resistance ● Elderly patients hypothyroidism Skin: closely to avoid
decreaseAction (Schull, 2013) ● Congenital (Leber’s) rash,flushing Other: extravasation.Use
Page. 885 Interferes with optic atrophy, tobacco Page. 885 pain,irritation,and central line whenever
(Schull, 2013) calcium influx and amblyopia (Schull, 2013) venous streaking at possible.Ensure that
intracellular ● Inadequate cerebral injection site;too- infusion rate is precisely
activation of circulation rapid blood pressure controlled to prevent
calcium, causing ● Moribund patients decrease (causing too-rapid infusion.
peripheral apprehension,restless  Obtain baseline ECG
vasodilation and ness,palpitations,retro and monitor for
direct blood Precautions Use sternal changes. 2Watch for
pressure decrease cautiously in: discomfort,nausea, signs and symptoms of
● hepatic or renal retching,abdominal cyanide toxicity (lactic
Page. 885 disease,fluid and pain,diaphoresis, acidosis,
(Schull, 2013) electrolyte headache,dizziness,m dyspnea,headache,vomi
imbalances,hypothyroid uscle twitching); ting,confusion,and loss
ism thiocynate or cyanide of consciousness).
● elderly patients toxicity  After reconstitution
● pregnant or (initially,tinnitus,mios with appropriate
breastfeeding patients ● is,and diluent,drug isn’t
children. hyperreflexia)at blood suitable for direct
level of 60 mg/L; injection.Dilute
Page.885 severe cyanide reconstituted solution
(Schull, 2013) toxicity (air hunger, further in sterile 5%
confusion,lactic dextrose injection
acidosis,death)at level before infusing.
of 200 mg/L  Drug may cause steep
blood pressure
Page. 886 decrease.In patients not
(Schull, 2013) properly monitored,this
decrease can lead to
 irreversible ischemic
injury or death. Give
drug only when
available equipment
and personnel allow
continuous blood
pressure monitoring.
 Except when used
briefly or at low
infusion rates,drug
gives rise to significant
amount of cyanide
ion,which can reach
toxic,potentially lethal
levels. Infusion at
maximum dosage rate
should never last more
than 10 minutes.
 If blood pressure isn’t
adequately controlled
after 10 minutes of
maximumrate
infusion,end infusion
immediately. Monitor
acid-base balance and
venous oxygen
concentration,but be
aware that, although
these tests may indicate
cyanide toxicity,they
provide imperfect
guidance.
 Tell patient he’ll be
closely monitored
during therapy.
Instruct patient to
immediately report
headache,nausea,or
pain at injection site.

As appropriate,review
all other significant
and life-threatening
adverse reactions and
interactions,especially
those related to the
drugs and tests
mentioned above.

Page. 886
(Schull, 2013)

POISONING
NALOXONE Displaces previously Known Patient known to be Adult : 0.4 -2mg IV q2 to Tachycardia  Monitor respiratory
HYDROCHLORIDE administered narcotic suspected hypersensitive to 3mins.p.r.n Hypertension depth and rate
(generic) analgesics from their narcotic naloxone hydrochloride Nausea  .Be prepared to
receptors. Has induced Vomiting provideO2, ventilation
Narcan, Evzio (trade nopharmacologic respiratory Tremor and resuscitative
name) activity of its own depression measures. Also been
including that shown toi mprove
Classifcation: cause by circulation in
Opioid antagonist pentazocine and `xrefractory shock
propaxyphene
EPECAC SYRUP The major alkaloids  Poisoning Pregnant Adult: PO 30 mL followed Stiff muscles, severe  Note: Emetic effect
of ipecac (emetine Breastfeeding by 1–2 240 mL (8 oz) myopathy, occurs in 15–30 min
 (Ipeca®, Ipecacuanha and cephaeline) are  It is also
tincture®, Ipecavom®, thought to be the
Ipetitrin®, pharmacologicallyact
ive agents and have
Classifications: both local and central
activity. Locally, they
Gastrointestinal agent,
emetic produce an irritant
effect on thegastric
mucosa, whilst  a severe
centrally
they stimulate the
chemoreceptor
trigger zone. The
medullaryregions
must be responsive
for vomiting to be  Ipecac is
elicited. When
vomiting occurs,
contents from boththe
stomach and small
intestine are
evacuated. Vomiting
usually occurs with
10
– 30 min
ofadministration in  Small
both dogs and cats
Digestive tract problems glasses of water, may repeat convulsions, coma. CV: C and continues for 20–
used to Comatose, once in 20 min if necessary ardiomyopathy, 25 min. If vomiting
treat bronc Patients in shock; patients Child: PO >1 y, 15 mL cardiotoxicity, cardiac does not occur in 20–
hitis associ with depressed gag reflex; followed by 1–2 240 mL (8 arrhythmias, atrial 30 min, repeat dose
ated seizures, active or oz) glasses of water, may fibrillation, tachycardia, once.
with croup impending; impaired repeat once in 20 min if chest pain, dyspnea,  Contact physician
cardiac function; hypotension, fatal
in necessary; <1 y, 5–10 mL immediately if
arteriosclerosis; treatment myocarditis. GI: Diarrhea
children of ingested strong alkali, followed by 120–240 mL vomiting does not
(4–8 oz) of water, may , mild GI upset. If drug is occur within 15–20
acids, or other corrosives,
kind repeat once in 20 min if not vomited but min after a second
strychnine, petroleum
of diarrhea necessary absorbed or if ipecac dose. Dosage should
distillates, volatile oils, or
(amoebic rapid-acting CNS overdosage: persistent be recovered by
dysentery), depressants. vomiting, gastroenteritis, gastric lavage and
and cancer bloody diarrhea, sensory activated charcoal if
disturbances, stomach
. necessary.
cramps, tremor.
 Note: Ipecac syrup
also used can be cardiotoxic if
as an not vomited and
expectoran allowed to be
t to thin absorbed.
mucous  Report immediately
and to physician if
make coug vomiting persists
hing easier longer than 2–3 h
. after ipecac syrup is
given.
doses are  all an emergency
used to room, poison control
improve center, or physician
appetite. before using ipecac
syrup.
 Do not breast feed
after using this drug
 without consulting
physician.


ACTIVATED Binds to ➣Poisoning ----------  Adults: 25 to 100 g GI: Patient monitoring

CHARCOAL poisons,toxins,irrita P.O.(or 1 g/kg,or nausea,vomiting,diarr  Monitor patient for
nts,and about 10 times the hea,constipation,black constipation.
Actidose,Actidose- drugs,forming a amount of poison stools,intestinal  If patient vomits
Aqua,Bragg’s barrier between Precautions Use ingested) as a obstruction soon after receiving
Medicinal particulate material cautiously in: patients suspension in 120 to dose,ask prescriber if
Charcoal ,Carbomix , and GI mucosa that who have aspirated 240 ml (4 to 8 oz) of Page. 25 dose should be
Charcadote,Char- inhibits absorption corrosives or water Children: repeated.
Caps, Charco of this material in hydrocarbons and are Initially,1 to 2 g/kg Patient teaching
Caps,EZ-Char GI tract.As an vomiting. P.O.(or 10 times the
antiflatulent,reduces amount of poison  Instruct patient to
Pharmacologic class: intestinal gas ingested) as a drink six to eight
Carbon residue volume and relieves Page. 25 suspension in 120 to glasses of fluid daily
Therapeutic related discomfort. 240 ml (4 to 8 oz) of to prevent
class:Antiflatulent, (Schull, 2013) water constipation.
antidote Page. 24  Adults:600 mg to 5 g  Tell patient that
P.O.as a single dose,or stools will be black as
Page. 24 (Schull, 2013) 975 mg to 3.9 g in charcoal is excreted
divided doses from body.
(Schull, 2013)  Page25  As
(Schull, 2013) appropriate,review
all other significant
and life-threatening
➣Flatulence adverse reactions and
interactions,especiall
(Schull, y those related to the
2013) drugs and foods
Page 25  mentioned above.
 Page. 25

(Schull, 2013)

SHOCK
DOPAMINE (generic) Causes ➣Shock;hemo ● Hypersensitivity to Adults and children: 2 to 5 CNS: headache Patient monitoring
norepinephrine dynamic drug or bisulfites mcg/kg/ minute by CV:palpitations,hypot  Monitor blood
Intrepid ( trade name) release (mainly on imbalance; ●Tachyarrhythmias,ve I.V.infusion.Titrate dosage ension,angina, ECG pressure,pulse,urinary
dopaminergic ntricular fibrillation to desired response;may changes,tachycardia,v output,and pulmonary
Pharmacologic class: receptors),leading to Page. 389 ●Pheochromocytoma increase infusion by 1 to 4 asoconstriction,arrhyt artery wedge pressure
Catecholamine, vasodilation of renal (Schull, mcg/kg/minute at 10- to hmias EENT: during infusion.
adrenergic and mesenteric 2013) Precautions Use 30-minute mydriasis GI:  Inspect I.V.site
Therapeutic class: arteries.Also exerts cautiously in: intervals.Maximum nausea,vomiting regularly for
Inotropic, vasopressor inotropic effects on ● dosage is 50 Metabolic: irritation.Avoid
heart,which hypovolemia,myocardia mcg/kg/minute. azotemia,hyperglycem extravasation.
Page. 389 increases the heart l infarction, occlusive ia Respiratory:  Monitor color and
(Schull, 2013) rate, blood vascular Page. 389 dyspnea,asthma temperature of
flow,myocardialcont disease,diabetic (Schull, 2013) attacks Skin: extremities.
ractility, and stroke endarteritis,atrial piloerection Other:  xNever stop infusion
volume. embolism irritation at injection abruptly, because this
● concurrent MAO site,gangrene may cause severe
Page. 389 inhibitor use ofextremities (with hypotension.Instead,ta
(Schull, 2013) ● pregnant or high doses for per gradually.
breastfeeding patients prolonged periods or
● children. in occlusive vascular Patient teaching
disease  Explain the need for
Page. 389 close observation
(Schull, 2013) Page. 390 during infusion.
(Schull, 2013)  Instruct patient to
report adverse
reactions and I.V.site
discomfort.
  As appropriate,review
all other significant
and life-threatening
adverse reactions and
interactions,especially
those related to the
drugs and tests
mentioned above
 Dilute full-strength
injection before
administering.
 If extravasation
occurs,infiltrate area
promptly with 10 to 15
ml of salinesolution
containing 5 to 10 mg
phentolamine to
prevent sloughing and
necrosis.Use syringe
with fine hypodermic
needle,and infiltrate
solution liberally
throughout area.Give
phentolamine as soon
as possible;its
sympathetic blockade
causes immediate local
hyperemic changes if
area is infiltrated
within 12 hours.
Page. 389-390

(Schull, 2013)
DOBUTAMINE Stimulates beta1- ➣Short-term ● Hypersensitivity to Adults: 2.5 to 10 Adverse reactions Patient monitoring
HYDROCHLORIDE adrenergic treatment of drug mcg/kg/minute I.V.as a CNS: headache CV:  Monitor ECG and
(generic) receptors of cardiac ● Idiopathic continuous hypertension,hypoten blood pressure
heart,causing a decompensatio hypertrophic subaortic infusion,adjusted to sion,tachycardia,prem continuously during
Dobutrex( trade name) positive inotropic n caused by stenosis hemodynamic response ature ventricular administration.
effect that increases depressed contractions,angina,p  Monitor cardiac
Pharmacologic class: myocardial contractility Dosage adjustment alpitations,nonspecific output,pulmonary
Sympathomimetic,adr contractility and (such as during Precautions Use Elderly patients chest pain,phlebitis capillary wedge
energic stroke volume.Also refractory cautiously in: GI: nausea,vomiting pressure,and central
Therapeutic class: reduces peripheral heart ● Page. 382 Metabolic:hypokalem venous pressure.
Inotropic vascular resistance, failure);adjunc hypertension,MI,atrial (Schull, 2013) ia  Monitor fluid intake
decreases t in cardiac fibrillation, Respiratory:dyspnea, and output and watch
Page. 381 ventricular filling surgery hypovolemia asthma attacks Skin: for signs and symptoms
(Schull, 2013) pressure, and ● pregnant or extravasation with of worsening heart
promotes Page. 382 breastfeeding patients tissue necrosis Other: failure.
atrioventricular ● children. hypersensitivity  Assess electrolyte
conduction. reactions including levels.Stay especially
Page. 382 anaphylaxis alert for hypokalemia.
Page. 381-382 (Schull, 2013)  Instruct patient to
(Schull, 2013) Page. 382 report anginal
(Schull, 2013) pain,headache,leg
cramps,and shortness of
breath.
 Explain need for close
observation and
monitoring.
 As appropriate,review
all other significant and
life-threatening adverse
reactions and
interactions,especially
those related to the
 drugs and herbs
mentioned above.
Page. 382-383
(Schull, 2013)

ALBUTEROL Relaxes smooth ➣To prevent Hypersensitivity to Adults and children ages Adverse reactions Patient monitoring
SULFATE (generic) muscles by and relieve drug 12 and older: Tablets—2 CNS:  Stay alert for
stimulating beta2- bronchospasm to 4 mg P.O.three or four dizziness,excitement,h hypersensitivity
Ventolin vilmax( trade receptors,thereby in patients times daily,not to exceed eadache, reactions and
name) causing with reversible Precautions Use 32 mg daily. Extended- hyperactivity,insomni paradoxical
bronchodilation and obstructive cautiously in: release tablets—4 to 8 mg a CV: bronchospasm.Stop
Pharmacologic class: vasodilation airway disease ● cardiac P.O. q 12 hours,not to hypertension,palpitati drug immediately if
Sympathomimetic disease,hypertension,di exceed 32 mg daily in ons,tachycardia,chest these occur.
(beta2-adrenergic Page. 35 abetes divided doses.Syrup—2 to pain EENT:  Monitor serum
agonist) Therapeutic (Schull, 2013) mellitus,glaucoma,seizu 4 mg (1 to 2 tsp or 5 to 10 conjunctivitis,dry and electrolyte levels.
class: Bronchodilator, (Schull, 2013) re ml) three or four times irritated
antiasthmatic disorder,hyperthyroidis daily,not to exceed 8 mg throat,pharyngitis GI: Patient teaching
m,exercise-induced q.i.d. Aerosol—one to two nausea,vomiting,anor
Page.35 bronchospasm,prostatic inhalations q 4 to 6 hours exia,heartburn,GI  Tell patient to swallow
(Schull, 2013) hypertrophy to relieve bronchospasm; distress,dry mouth extendedrelease tablets
● elderly patients two inhalations q.i.d.to Metabolic: whole and not to mix
● pregnant or prevent hypokalemia them with food.
breastfeeding patients bronchospasm.Solution Musculoskeletal:  Follow
● children. for inhalation—2.5 mg muscle cramps manufacturer’s
three to four times daily Respiratory:cough,dy directions supplied
Page 36 by nebulization,delivered spnea,wheezing,parad with inhalation drugs.
over 5 to 15 minutes. oxicalbronchospasm  Teach patient signs
(Schull, 2013) Skin: and symptoms of
Children ages 6 to pallor,urticaria,rash, hypersensitivity
12:Tablets—2 mg angioedema,flushing,s reaction and
P.O.three or four times weating Other: tooth paradoxical
daily;maximum daily discoloration,increase bronchospasm.Tell
dosage is 24 mg,given in d him to stop taking
divided doses.Extended-
release tablets—4 mg q 12
hours;maximum daily
dosage is 24 mg/kg given
in divided doses.Syrup—2
mg (1 tsp or 5 ml) three or
four times daily,not to
exceed 24 mg.
Adults and children age 4
and older (with ProAir
HFA): Two inhalations q 4
to 6 hours to treat acute
bronchospasm
Children ages 2 to 12
weighing more than 15 kg
(33 lb): Solution for
inhalation—2.5 mg three
to four times/day by
nebulization Children ages
2 to 6:Syrup—Initially, 0.1
mg/kg P.O.t.i.d.,not to
exceed 2 mg (1 tsp)
t.i.d.Maximum dosage is 4
mg (2 tsp) t.i.d.
 Adults and children
older than age 4
(older than age 12
with Proventil): Two
inhalations 15
minutes before
appetite,hypersensitiv drug immediately and
ity reaction contact prescriber if
these occur.
Page 37  Instruct patient to
(Schull, 2013) notify prescriber
immediately if
prescribed dosage fails
to provide usual relief,
because this may
indicate seriously
worsening asthma.
 Advise patient to limit
intake of caffeine-
containing foods and
beverages and to avoid
herbs unless prescriber
approves.
 Caution patient to
avoid driving and
other hazardous
activities until he
knows how drug
affects concentration
and alertness.
 Advise patient to
establish effective
bedtime routine and to
take drug well before
bedtime to minimize
insomnia.
 As appropriate,review
all other significant
and life-threatening
 exercise Adults and adverse reactions and
children age 4 and interactions,especially
older (with ProAir those related to the
HFA): Two drugs,foods,and herbs
inhalations q 15 to 30 mentioned above.
minutes before Page 37
exercise (Schull, 2013)
(Schull, 2013)
Page. 36

➣To prevent
exercise-
induced
bronchospasm

(Schull, 2013)s
DIPHENHYDRAMIN Interferes with ➣Allergy ● Hypersensitivity to  Adults and children CNS: Patient monitoring
E (generic) histamine effects at symptoms drug over age 12: 25 to 50 drowsiness,dizziness,h  Monitor
histamine1-receptor caused by ● Alcohol intolerance mg P.O.q 4 to 6 eadache, paradoxical cardiovascular
Benadryl ( trade sites;prevents but histamine ● Acute asthma attacks hours,or 10 to 50 mg stimulation (especially status,especially in
name) doesn’t reverse release ● MAO inhibitor use I.V.or I.M.q 2 to 3 in children) CV: patients with
histamine-mediated (including within past 14 days hours p.r.n. (Some hypotension,palpitatio cardiovascular disease.
Pharmacologic class: response.Also anaphylaxis, ● Breastfeeding patients may need up ns, tachycardia  Supervise patient
Ethanolamine possesses CNS seasonal and ●Neonates,premature to 100 mg.) Don’t EENT: blurred during ambulation.Use
derivative,nonselective depressant and perennial infants exceed 400 mg/day. vision,tinnitus GI: side rails as necessary.
histamine1receptor anticholinergic allergic Children ages 6 to diarrhea,constipation Patient teaching
antagonist properties. rhinitis, and Precautions Use 12:12.5 to 25 mg P.O.q Other: decreased  Advise patient to
allergic cautiously in: 4 to 6 hours,or 1.25 appetite,pain at I.M. avoid alcohol and
Therapeutic Page. 377 dermatoses);na ● severe hepatic mg/kg (37.5 mg/m2) injection site other depressants
class:Antihistamine,an (Schull, 2013) usea; vertigo disease,angle-closure I.M.or I.V.q.i.d.Don’t such as sedatives
titussive,antiemetic,ant glaucoma,seizure exceed 150 mg/day. Page. 378 while taking drug.
ivertigo agent, disorders,prostatic Children ages 2 to (Schull, 2013)  Caution patient to
antidyskinetic hypertrophy,cardiovasc 5:6.25 mg P.O.q 4 to 6 avoid driving and
ular disease, hours.Don’t exceed other hazardous
Page. 377 hyperthyroidism  Adults: 25 mg P.O.q 4 activities until he
(Schull, 2013) ● elderly patients hours p.r.n. Don’t knows how drug
● pregnant patients exceed 150 mg/day. affects concentration
(safety not established) Children ages 6 to and alertness.
● children younger 12:12.5 mg P.O.q 4  As
than age 2 (safety not hours.Don’t exceed 75 appropriate,review all
established). mg/day. Children ages other significant
2 to 5:6.25 mg P.O.q 4 adverse reactions and
Page 378 hours.Don’t exceed interactions,especially
(Schull, 2013) 37.5 mg/24 hours. those related to the
 drugs,tests,herbs,and
 Adults: Initially,25 mg behaviors mentioned
P.O.t.i.d.;may be above.
increased to a Page. 379
maximum of 50 mg (Schull, 2013)
q.i.d.
➣Cough
  Adults: 50 mg P.O.20
to 30 minutes before
bedtime
Page 378
(Schull, 2013)

➣Dyskinesia;P
arkinson’s
disease

➣Mild
nighttime
sedation

Page. 378
(Schull, 2013)
HYDROCORTISONE Suppresses ➣Replacement ● Hypersensitivity to hydrocortisone,hydrocorti CNS: Patient monitoring
inflammatory and therapy in drug,alcohol, sone cypionate— Adults headache,nervousness
Ala-Cort,Ala- immune adrenocortical bisulfites,or tartrazine and children:20 to 240 ,depression,euphoria,  In high-dose therapy
Scalp,Cetacort, responses,mainly by insufficiency;h (with some products) mg/day P.O. personality changes, (which should not
Colocort,Cortef,Corte inhibiting migration ypercalcemia psychoses,vertigo,par exceed 48 hours),watch
nema,Hi-Cor, of leukocytes and due to ● Systemic fungal hydrocortisone acetate esthesia,insomnia,rest closely for signs and
Hycort,Hytone,Stie- phagocytes and cancer;arthriti infections (suspension)— Adults and lessness,conus symptoms of
Cort,Synacort, decreasing s;collagen ● Concurrent use of children: 5 to 75 mg by medullaris depression or psychotic
Texacort inflammatory diseases; other intra-articular injection syndrome,meningitis,i episodes.
mediators dermatologic immunosuppressant (depending on joint size) q ncreased intracranial  Monitor blood
Pharmacologic class: diseases;autoi corticosteroids 2 to 3 weeks pressure,seizures pressure,weight,and
Short-acting Page. 593 mmune and ● Concurrent CV:hypotension,hype electrolyte levels
corticosteroid (Schull, 2013) hematologic administration of hydrocortisone acetate rtension,thrombophle regularly.
Therapeutic class: disorders;trich livevirus vaccines (intrarectal foam)— bitis,heart  Assess blood glucose
Anti-inflammatory inosis; Adults and children: One failure,shock,fat levels in diabetic
(steroidal) ulcerative Precautions Use applicatorful of intrarectal embolism,thromboem patients.Expect to
colitis;multiple cautiously in: foam daily or b.i.d.for 2 to bolism, arrhythmias increase insulin or oral
Page. 593\ sclerosis; 3 weeks;then one EENT: hypoglycemic dosage.
(Schull, 2013) proctitis;nephr ●hypertension,osteopor applicatorful every other cataracts,glaucoma,in  Monitor patient’s
otic syndrome; osis,glaucoma,renal or day creased intraocular response during
aspiration GI disease, pressure,epistaxis,nas weaning from drug.
pneumonia hypothyroidism,cirrhos hydrocortisone sodium al  Watch for adrenal
is,thromboembolic phosphate— Adults and congestion,perforated crisis,which may occur
disorders,myasthenia children: 15 to 240 mg/day nasal septum, if drug is discontinued
(Schull, 2013) gravis,heart failure ● subcutaneously,I.M.,or dysphonia,hoarseness, too quickly.
pregnant or I.V.,adjusted according to nasopharyngeal or Patient teaching
breastfeeding patients response oropharyngeal fungal
● children ages 6 and infections GI:  Instruct patient to
younger (safety not hydrocortisone sodium nausea,vomiting,esop take daily P.O. dose
established) succinate— Adults and hageal candidiasis or with food by 8 A.M.
children: 100 to 500 mg ulcer,abdominal  Urge patient to
Page. 594 I.M.or I.V.;may repeat at distention, dry immediately report
(Schull, 2013) 2-,4-,or 6-hour mouth,rectal unusual weight
intervals,depending on bleeding,peptic gain,face or leg
response and condition ulceration,pancreatiti swelling,epigastric
s burning,vomiting of
hydrocortisone retention Hematologic: blood,black tarry
enema— Adults and purpura Metabolic: stools,irregular
children: 100 mg P.R.at
bedtime for 21 nights or
until desired
response;patient should
retain enema for at least 1
hour.
 Adults and children:
Thin film of topical
preparation applied to
affected area one to
four times
daily,depending on
drug form and severity
of condition
Off-label uses
● Phlebitis
● Stomatitis
Page. 594
(Schull, 2013)
sodium and fluid menstrual
retention,hypokalemi cycles,fever,prolonged
a,hypocalcemia, sore throat,cold or
hyperglycemia,hyperc other infection,or
holesterolemia, worsening of
amenorrhea,growth symptoms.
retardation,diabetes  Tell patient using
mellitus,cushingoid topical form not to
appearance, apply occlusive
hypothalamic- dressing unless
pituitary-adrenal instructed by
Suppression prescriber.
suppression with  Advise patient to
secondary adrenal discontinue topical
insufficiency (with drug and notify
abrupt withdrawal or prescriber if local
high-dose,prolonged irritation occurs.
use)  Instruct patient to eat
Musculoskeletal:osteo small,frequent meals
porosis,aseptic joint and to take antacids
necrosis,muscle pain as needed to minimize
or weakness, steroid GI upset.
myopathy,loss of  Tell patient that
muscle mass, tendon response to drug will
rupture,spontaneous be monitored
fractures regularly. 2Caution
patient not to stop
Respiratory: taking drug abruptly.
cough,wheezing,  In long-term
rebound use,instruct patient to
congestion,bronchosp have regular eye
asm exams.
➣Itching and Skin:  Instruct patient to
inflammation rash,pruritus,urticari wear medical
caused by skin a,contact identification stating
conditions dermatitis,acne,bruisi that he’s taking this
ng,hirsutism, drug.
Page. 594 petechiae,striae,acneif Page. 596
orm lesions, skin (Schull, 2013)
fragility and
thinness,angioedema

Other: altered
taste;anosmia;appetit
e changes;weight
gain;facial edema;
increased
susceptibility to
infection; masking or
aggravation of
infection; adhesive
arachnoiditis;injectio
n site pain,burning,or
atrophy;immunosupp
ression;hypersensitivi
ty reactions including
anaphylaxis

Page. 595