Exam 4 Drugs

N30163 Examination # 4 Medication List
NSAIDS/Opioids Aspirin
Acetaminophen
Ibuprofen
Meperidine
Morphine
Codiene
Naloxone
Fentanyl
Respiratory Agents: Oxygen

Theophylline
Albuterol
Ipratropium
Triamcinolone
Cromolyn
Diphenhydramine
Beclomethasone dipropionate
Promethazine
Codiene
Dextromethorphan
Loratadine
Corticosteroids: Dexamethasone
Prednisone
Cortisone
GI Drugs: Omperazole
Misoprostol
Amphogel----Maalox
Psyllium
Ondansetron
Sulcarafate
Calcium carbonate
Bisacodyl
Docusate sodium
Cimetidine
Metoclopramide
Milk of Magnesia
Magnesium citrate
Diphenoxylate/atropine
Ranitidine
CNS Drugs
Levodopa/carbidopa
Entacapone
Donepezil
Memantine
Interferon-beta
Mitoxantone
Mental Health Drugs Amitriptyline

Zolpidem
Fluoxetine
Diazepam,
Flumazenil
Haloperidol
Lithium carbonate,
Valproic acid
Clozapine,
Olanzapine
Venlaxfaxine
Phenelzine
Reproductive Health Drugs Conjugated estrogens
Norethindrone
Ibuprofen
Fluoxetine
Ethinyl estradiol/norethindrone
Sildenafil
Finasteride
Tamsulosin
04-04-2017 djc
Generic Name Trade Name Classification
Aspirin (acetylsalicylic acid/ASA) First-generation NSAIDs (COX-1 and
COX-2 Inhibitors)
Nonopiod analgesic, anti-
inflammatory, antipyretic, analgesic
Mechanism of Action Indication/Therapeutic Use Administration
Nonselective inhibition of  Inflammation suppression, such as • Make sure patients swallow
cyclooxygenase: inhibition of COX-1 with osteoarthritis and rheumatoid enteric-coated or sustained release
can result in decreased platelet arthritis forms whole and do not
aggregation, kidney damage, MI and  Analgesia for mild to moderate pain crush or chew them.
ischemic stroke while inhibition of  Fever reduction • Discontinue 1 week before
COX-2 results in decreased  Dysmenorrhea scheduled surgery.
inflammation, fever, and pain and  Inhibition of platelet aggregation, • Monitor for initial and continued
does not decrease platelet which protects against ischemic therapeutic effects.
aggregation. stroke and myocardial infarction
Side Effects/ Adverse Effects Interventions Patient Teaching
Gastric upset, heartburn, nausea, • Monitor for signs of • Take with food, milk, or 8
gastric ulceration gastrointestinal bleeding oz of water to minimize
(black or dark-colored stools, gastrointestinal effects.
abdominal pain, nausea, • Avoid alcohol.
hematemesis). • Report persistent gastric
• Test for and treat Helicobacter irritation and signs of bleeding.
pylori infection prior to long term
therapy.
• For patients at high risk for
gastric bleeding, recommend a
proton pump inhibitor, such as
omeprazole, or an H2 receptor
antagonist, such as ranitidine, to
decrease the risk of ulcer formation.
 Risk is increased in older adults,
clients who smoke or have alcohol
use disorder, and those who have a
history of peptic ulcers or previous
inability to tolerate NSAIDs.
Bleeding – promotes bleeding by • Monitor for signs of bleeding • Report any unusual or
inhibiting platelet aggregation (easy bruising, petechiae, prolonged bleeding.
excessive bleeding from minor
injuries).
Kidney dysfunction/renal impairment • Monitor intake and output; • Report changes in urine output,
watch for low urine output and weight gain, or signs of fluid
fluid retention. retention such as edema or
• Monitor for rapid rises in BUN bloating.
and creatinine.
Salicylism • Monitor for tinnitus, diaphoresis, • Report ringing or buzzing in the
headache, dizziness, and ears, sweating, headache, and
respiratory alkalosis. dizziness.
• Stop aspirin therapy for patients • Stop taking aspirin if these
reporting these symptoms symptoms develop.
Reye’s syndrome • Recommend acetaminophen • Do not give aspirin or NSAIDs
(Tylenol) and not aspirin or to children under age 19 who
NSAIDs for children and have viral infections, particularly
adolescents under age 19 who chickenpox and influenza; use
have viral infections, particularly acetaminophen instead.
chickenpox and influenza.
Contraindications Precaution Interactions
• Pregnancy risk category D • Older adults • Anticoagulants, glucocorticoids,
• Hypersensitivity to aspirin and • Cigarette smoking and alcohol increase the risk of
other NSAIDs • Alcohol use disorder bleeding.
• Peptic ulcer disease • Helicobacter pylori infection • Ibuprofen decreases the
• Bleeding disorders (hemophilia, • Heart failure antiplatelet effects of low-dose
vitamin K deficiency) • Hypertension aspirin by blocking access of ASA to
• Children or adolescents • Hypovolemia COX1 in platelets.
with chickenpox or influenza • Asthma • ACE inhibitors and angiotensin
(especially aspirin) • Chronic urticaria receptor blockers increase the
• Within 1 week of any elective • Advanced kidney dysfunction risk of kidney failure.
surgery (aspirin) • Antihypertensive effects of ACE
inhibitors decrease.
• The risk of lithium carbonate
(Lithobid) and methotrexate
toxicity increases
Ibuprofen Advil, Motrin, Caldolor First-generation NSAIDs (COX-1 and
COX-2 Inhibitors)
Nonopiod analgesic, anti-
inflammatory, antipyretic, analgesic
Nonselective inhibition of  Inflammation suppression, such as • Make sure patients swallow
cyclooxygenase: inhibition of COX-1 with osteoarthritis and rheumatoid enteric-coated or sustained release
can result in decreased platelet arthritis forms whole and do not
aggregation, kidney damage, MI and  Analgesia for mild to moderate pain crush or chew them.
ischemic stroke while inhibition of  Fever reduction • Discontinue 1 week before
COX-2 results in decreased  Dysmenorrhea (more so than ASA) scheduled surgery.
inflammation, fever, and pain and  Inhibition of platelet aggregation, • Monitor for initial and continued
does not decrease platelet which protects against ischemic therapeutic effects.
aggregation. stroke and myocardial infarction
 Premenstrual disorder (PMD) –
reduce headache, dysmenorrhea,
cramps, and muscle and joint pain
Gastric upset, heartburn, nausea, • Monitor for signs of • Take with food, milk, or 8
gastric ulceration gastrointestinal bleeding oz of water to minimize
(Less than ASA) (black or dark-colored stools, gastrointestinal effects.
abdominal pain, nausea, • Avoid alcohol.
hematemesis). • Report persistent gastric
• Test for and treat Helicobacter irritation and signs of bleeding.
pylori infection prior to long term
therapy.
• For patients at high risk for
gastric bleeding, recommend a
proton pump inhibitor, such as
omeprazole, or an H2 receptor
antagonist, such as ranitidine, to
decrease the risk of ulcer formation.
 Risk is increased in older adults,
clients who smoke or have alcohol
use disorder, and those who have a
history of peptic ulcers or previous
inability to tolerate NSAIDs.
Bleeding – promotes bleeding by • Monitor for signs of bleeding • Report any unusual or
inhibiting platelet aggregation (less (easy bruising, petechiae, prolonged bleeding.
than ASA) excessive bleeding from minor
injuries).
Kidney dysfunction/renal impairment • Monitor intake and output; • Report changes in urine output,
watch for low urine output and weight gain, or signs of fluid
fluid retention. retention such as edema or
• Monitor for rapid rises in BUN bloating.
and creatinine.
Salicylism – ASA only • Monitor for tinnitus, diaphoresis, • Report ringing or buzzing in the
headache, dizziness, and ears, sweating, headache, and
respiratory alkalosis. dizziness.
• Stop aspirin therapy for patients • Stop taking aspirin if these
reporting these symptoms symptoms develop.
Reye’s syndrome • Recommend acetaminophen • Do not give aspirin or NSAIDs
(Tylenol) and not aspirin or to children under age 19 who
NSAIDs for children and have viral infections, particularly
adolescents under age 19 who chickenpox and influenza; use
have viral infections, particularly acetaminophen instead.
chickenpox and influenza.
Thromboembolic events • Recommend non-aspirin • Report chest pain or heaviness,
Risk of MI and stroke NSAIDs for short periods and in shortness of breath, sudden
low doses only. and severe headache,
• Recommend low-dose aspirin numbness, weakness, visual
to prevent these events if disturbances, or confusion.
prescribed by provider. • Take low-dose aspirin once
• Monitor for signs of myocardial daily to reduce the risk of heart
infarction and cerebrovascular attack and stroke if prescribed.
accident.
• Pregnancy risk category D • Older adults • Anticoagulants, glucocorticoids,
• Hypersensitivity to aspirin and • Cigarette smoking and alcohol increase the risk of
other NSAIDs • Alcohol use disorder bleeding.
• Peptic ulcer disease • Helicobacter pylori infection • Ibuprofen decreases the
• Bleeding disorders (hemophilia, • Heart failure antiplatelet effects of low-dose
vitamin K deficiency) • Hypertension aspirin.
• Children or adolescents • Hypovolemia • ACE inhibitors and angiotensin
with chickenpox or influenza • Asthma receptor blockers increase the
(especially aspirin) • Chronic urticaria risk of kidney failure.
• Within 1 week of any elective • Advanced kidney dysfunction • Antihypertensive effects of ACE
surgery (aspirin) inhibitors decrease.
• Perioperative use prior to • The risk of lithium carbonate
coronary artery bypass grafting (Lithobid) and methotrexate
(non-aspirin NSAIDs) toxicity increases
Acetaminophen Tylenol Antipyretic
Analgesic
Selective inhibition of cyclooxygenase  Analgesia for mild to moderate pain • Administer orally or rectally.
in the CNS  Fever reduction • Caution patients that the drug is
available in many combination
products as well as many
formulations; patients must
read labels carefully to avoid
overdose.
• Do not administer more than 4
g/day (adults).
• Infants and children should
be given the manufacturer’s
recommended dose based on
their age.
Liver damage (overdose) • Monitor for early symptoms of • Do not exceed 4 g/day (adults).
overdose/poisoning (abdominal • Report any abdominal
discomfort, nausea, vomiting, discomfort, nausea, vomiting,
sweating, diarrhea); liver sweating, or diarrhea
damage results in 48 to 72 hr immediately.
following overdose.  Undernourished clients should limit
• Prepare to administer acetaminophen to 3g/day
acetylcysteine (Mucomyst,  Advise clients who consume more
Acetadote) orally or IV to than 3 alcoholic drinks per day to
counteract overdose and reduce liver limit acetaminophen to 2g/day
injury.
• Alcohol use disorder • Anemia • Alcohol increases the risk of
• Immunosuppression liver injury (with high doses of
• Hepatic or kidney disease acetaminophen).
• Warfarin (Coumadin) increases
the risk of bleeding.
• Cholestyramine (Questran)
reduces absorption.
Morphine Pure Opioid Agonists

Acts on the mu receptors, and to a  Analgesia for moderate to severe • Measure baseline vital signs
lesser degree on kappa receptors. pain (postoperative MI, following (respiratory rate, BP, and pulse rate)
Activation of mu receptors produces childbirth, cancer) before administration and
analgesia, respiratory depression,  Sedation monitor throughout therapy.
euphoria, and sedation. Whereas  Reduction of bowel motility • Administer orally, IM, IV, SC,
kappa receptor activation produces (constipation) for diarrhea rectally, or epidurally.
analgesia, sedation, and decreased GI  Cough suppression • Make sure patients swallow
motility. sustained-release forms whole
and do not crush or chew them.
• Administer IV opioids slowly
and with recommended dilution
over 4 to 5 min; have naloxone
and resuscitation equipment
available.
• Monitor PCA use and pump
settings carefully.
• Administer to patients with
cancer on a fixed, around-the clock
dosing schedule, not
PRN.
Respiratory depression • Monitor vital signs, pulse • Take the drug only when needed
Elevation of intracranial pressure oximetry, lung sounds and short-term.
secondary to respiratory depression • For respiratory rates below  Avoid use of opioids with CNS
12/min, withhold the drug and depressant medications
stimulate breathing. (barbiturates, benzodiazepines,
• Administer an opioid antagonist consumption of alcohol)
such as naloxone to restore
respiratory rate.
Constipation • Monitor bowel function. • Increase fluid and fiber intake.
Activates mu receptors in the GI • Administer fiber supplement • Increase activity/exercise.
and/or stool softeners.
Orthostatic hypotension Monitor blood pressure Instruct patients to get up slowly.

Blunting the baroreceptor reflex and
by dilating peripheral arterioles and
veins
Urinary retention • Monitor intake and output, • Report any inability to urinate or
watching for signs of urinary difficulty urinating.
retention, such as bladder
distention.
• Encourage patients to urinate
every 4 hr.
• Prepare to insert a urinary
catheter to drain the bladder.
Cough suppression • Auscultate lung sounds regularly for • Cough regularly to clear
crackles. secretions from the throat and
• Encourage patients (especially chest.
postoperatively) to cough
frequently to prevent a build-up
of respiratory secretions.
• Have suction equipment
available.
Biliary colic  Avoid giving morphine to clients
who have a history of biliary colic.
Use meperidine as an alternative.
Emesis/vomiting, nausea • Administer an antiemetic. • Take the drug with food or milk
• For vomiting, ensure adequate (oral forms).
hydration.  Remain still. Emesis occurs more
often in ambulating patients.
Sedation • Monitor patients when • Do not take prior to driving
ambulating. or activities requiring mental
alertness.
• Sit or lie down if feeling
lightheaded.
• Change positions gradually.
 Elevation of intracranial pressure
By suppressing respiration, morphine
increases the CO2 content of blood,
which dilates the cerebral
vasculature, causing ICP to rise
 Euphoria/dysphoria
 Miosis (pinpoint pupils)
 Adverse effects from prolonged
used: hormonal changes and alter
immune function
• Pregnancy risk category D • Schedule II controlled • CNS depressants
(long-term use, high doses, substance (barbiturates, phenobarbital,
near term; otherwise C) • Older adults, infants benzodiazepines, alcohol)
• Kidney failure • Reduced respiratory reserve: increase CNS depression.
• Increased intracranial pressure asthma, emphysema, kyphoscoliosis, • Anticholinergic agents,
• Biliary colic chronic cor pulmonale, extreme such as antihistamines, and
• Preterm labor obesity. tricyclic antidepressants
• Head injury increase anticholinergic effects
• Inflammatory bowel disease (constipation, urinary retention).
• Prostatic enlargement • MAOIs can cause hyperpyrexic
• Hypotension coma (excitation, seizures,
• Hepatic or kidney disease respiratory depression) with
 Clients in labor meperidine (Demerol).
• Antihypertensives increase
hypotensive effects.
• St. John’s wort can increase
sedation.
 Additional medications such as
amphetamines, clonidine, and
dextromethorphan can increase
opioid-induced analgesia.
Fentanyl Sublimaze, Duragesic, Abstral, Actiq, Pure Opioid Agonists
Fentora, Onsolis, Lazanda, Subsys
Acts on the mu receptors, and to a • Supplement to general • Available in multiple forms
lesser degree on kappa receptors. Anesthesia for surgical premedication,
Activation of mu receptors produces  IM or IV – surgical anesthesia including IV and stick lozenges
analgesia, respiratory depression, • Used with droperidol, • Place a stick lozenge between
euphoria, and sedation. Whereas and nitrous oxide for cheek and gum of child or adult;
kappa receptor activation produces neuroleptanesthesia patient should suck (not chew)
analgesia, sedation, and decreased GI • Used with skeletal muscle on lozenge longer than 15 min
motility. relaxant as anesthesia for  Available parenteral, transdermal,
high risk patients in selected transmucosal ,and intranasal
situations
 Transmucosal – Breakthrough
cancer pain
oximetry, lung sounds and short-term.
• For respiratory rates below  Avoid use of opioids with CNS
respiratory rate.
distention.
every 4 hr.
available.
hydration.

alertness.
lightheaded.
immune function
• Kidney failure • Reduced respiratory reserve increase CNS depression.
• Increased intracranial pressure • Head injury • Anticholinergic agents,
• Biliary colic • Inflammatory bowel disease such as antihistamines, and
• Preterm labor • Prostatic enlargement tricyclic antidepressants
• Substance abuse • Hypotension increase anticholinergic effects
• Obstetric delivery • Hepatic or kidney disease (constipation, urinary retention).
• Myasthenia gravis  Clients in labor • MAOIs can cause hyperpyrexic
coma (excitation, seizures,
respiratory depression) with
meperidine (Demerol).
sedation.
Meperidine Demerol Pure Opioid Agonists
Strong opioid agonist
Acts on the mu receptors, and to a  Analgesia for moderate to severe  Available PO and parenteral
lesser degree on kappa receptors. pain (postoperative MI, following
Activation of mu receptors produces childbirth, cancer)
analgesia, respiratory depression,  Sedation
euphoria, and sedation. Whereas  Reduction of bowel motility
kappa receptor activation produces (constipation) for diarrhea
analgesia, sedation, and decreased GI  Cough suppression
motility.  Pts who can’t take other opioids,
and for pts with drug-induced rigors
Decline in use because of short half- or postanesthesia shivering
life, interacts adversely with a
number of drugs, risk of harm from
accumulation
Toxicity  Treatment should not exceed 48
Accumulation of normeperidine hours, and the dosage should not
Dysphoria, irritability, tremors, and exceed 600 mg/24 hr
seizures
respiratory rate.
distention.
every 4 hr.
available.
hydration.

alertness.
lightheaded.
immune function
sedation.
Codeine Pure Opioid Agonists
Moderate to Strong Opioid Agonist
Acts on the mu receptors, and to a  Analgesia for mild to moderate pain  Available orally and parenterally
lesser degree on kappa receptors.  Cough suppression  Given alone or in combination with
Activation of mu receptors produces nonopioid analgesics
analgesia, respiratory depression,
euphoria, and sedation. Whereas
kappa receptor activation produces
analgesia, sedation, and decreased GI
motility.
Produce less analgesia and

respiratory depression than
morphine. Undergoes conversion to
morphine by the CYP2D6 enzyme
Lactation  Be alert for signs of infant
High levels in breast milk owing to intoxication – excessive sleepiness,
ultrarapid codeine metabolism breathing difficulties, lethargy, poor
feeding
respiratory rate.
distention.
every 4 hr.
Extremely effective crackles. secretions from the throat and
available.
hydration.

alertness.
lightheaded.
immune function
sedation.
Naloxone Narcan Opioid antagonist

A structural analog of morphine that  Reversal of opioid effects • Administer IM, IV, or SC because
acts as a competitive antagonist at (analgesia, sedation, euphoria, and rapid first-pass inactivation
opioid receptors, thereby blocking respiratory depression) • Titrate doses carefully to achieve
opioid actions.  Opioid overdose reversal of respiratory depression
 Relief of opioid-induced without full reversal of pain
constipation management effects
 Management of opioid addiction • Monitor vital signs.
 Reversal of neonatal respiratory • Be aware that the drug might
depression (from maternal analgesia) increase pain by reducing
opioid effects and precipitate
acute withdrawal for patients
who are opioid-dependent.
• Prepare to administer every
2 to 3 min until reversal of
undesirable effects.
• Prepare to begin administration
again as the effects of opioids
might persist beyond the effects
of the reversal agent.
• Observe for nausea, vomiting,
tachycardia, and diaphoresis
(indications of opioid reversal).
Tachycardia and tachypnea • Monitor vital signs for these
expected indications of opioid
reversal, in particular blood
pressure to elevation.
• Monitor heart rhythm for signs
of tachycardia.
• Have oxygen and resuscitation
equipment ready.
Abstinence syndrome • Expect these symptoms in
Cramping, hypertension, vomiting, opioid-dependent patients.
and reversal of analgesia

• Opioid dependence • Cardiac irritability • Opioid effects decrease.
 Respiratory depression due to • Head injury, increased
nonpioid drugs intracranial pressure
• Brain tumor
• Seizure disorders
Beclomethasone dipropionate – QVAR Glucocorticoids
Inhalation Antinflammatory drugs
Prednisone – oral Asthma drugs
Beclomethasone – intranasal
Suppress inflammation  Long-term prophylaxis of asthma Inhaled:
 Decreased synthesis and release of  Short-term oral therapy is used to • Use on a regular schedule
inflammatory mediators treat manifestations following an rather than PRN.
(leukotrienes, histamine, acute asthma episode • Do not use these drugs for an
prostaglandins)  Long-term oral therapy is used to acute attack.
 Decreased infiltration and activity treat chronic, severe asthma. • When using concurrently with
of inflammatory cells (eosinophils, a beta2-adrenergic agonist
leukocytes) inhaler, use the beta2 agonist
 Decreased edema of the airway first to dilate the airway before
mucosa using the glucocorticoid.
 Prevent inflammation, suppress Oral:
airway mucus production, and • Use oral therapy twice daily for
promote responsiveness of beta2 3 to 10 days.
receptors in the bronchial tree • For long-term use (10 days or
more), take once daily using
alternate-day dosing.
• Taper the dose slowly when
symptoms are controlled to
establish the lowest possible
oral dose.
• Take supplemental doses
as needed in times of stress
(illness, surgery).
Inhaled: Oral candidiasis, hoarseness, • Provide/prescribe a spacer. • Use a spacer (on most
difficulty speaking • Initiate antifungal therapy as glucocorticoid MDIs) to deposit
From local deposition of inhaled needed. less drug in the oropharynx.
glucocorticoids • Rinse the mouth and/or gargle
after using the glucocorticoid
inhaler to prevent candidiasis.
Oral: Suppression of adrenal gland • Observe for suppression of • Explain the schedule of
function adrenal function alternate-day therapy.
• Monitor plasma drug levels. • Taper the dose before
• Recommend alternate day discontinuing it - NEVER stop
dosing abruptly
Bone loss • Monitor for signs of bone • Take the drug on alternate
demineralization, muscle days.
wasting • Perform weight-bearing
• Recommend the lowest exercise daily.
possible effective dose and • Consume adequate calcium
alternate-day dosing. and vitamin D.
Hyperglycemia – oral • Monitor blood glucose levels, • Report polyphagia, polydipsia,
especially for patients who have and polyuria.
diabetes mellitus.
• Recommend adjust of dosages
of insulin/ hypoglycemic drugs
accordingly.
Peptic ulcer disease – oral • Observe for gastrointestinal • Avoid taking NSAIDs.
bleeding (bloody vomitus as • Take the drug with food or
well as black, tarry stools) meals.
• Implement gastric protective • Report or indigestion or bloody
measures vomitus as well as black, tarry
◦◦Give drug with food or meals stools
◦◦Recommend analgesic
substitute if NSAID is
prescribed
Infection • Observe for signs of infection • Report signs of infection, such
that may not include fever as a sore throat, that may not
or inflammation (sore throat, be accompanied by fever or
fatigue, tachycardia, and inflammation
discharge from a wound) • Report painful mucous
• Recommend initiation of membranes with white patches
appropriate antimicrobial
therapy.
Fluid and electrolyte imbalances  Monitor for weight gain or • Report weight gain or edema
edema (hypernatremia) • Report weakness
• Monitor for generalized
weakness (hypokalemia)
• Recommend initiation of
appropriate fluid and electrolyte
replacement therapy.
Intranasal: drying of the nasal
mucosa, burning or itching sensation,
sore throat, epistaxis, headache

• Recent live virus immunization • Peptic ulcer disease • Potassium-depleting diuretics,
(oral) • Diabetes mellitus such as furosemide (Lasix)
• Systemic fungal infection (oral) • Hypertension increase risk of hypokalemia.
• Oral candidiasis (inhaled) • Renal dysfunction • NSAIDs increase risk of
• Use of NSAIDs gastrointestinal bleeding.
• Effects of insulin and oral
hypoglycemics are decreased.
Cromolyn Mast cell stabilizers
Antiasthma
Suppress inflammation; does not  Prophylaxis for mild to moderate • Use with a nebulizer or a
cause bronchodilation asthma metered-dose inhaler.
Stabilizes the cytoplasmic membrane  Long-term treatment of allergy • Clear mucus from airways prior
of mast cells, preventing release of related asthma to inhalation.
histamine and other mediations. Also • Prophylaxis for exercise • Expect several weeks of use for
inhibits eosinophils, macrophages, Induced bronchospasm full effects to become apparent
and other inflammatory cells • Prophylaxis for seasonal allergy • Administer two to four times
symptoms daily on a fixed schedule.
• Management of allergic rhinitis • Use the inhaler 15 min prior to
(intranasally) exercising to prevent exercise
induced
bronchospasm.
• Do not use to relieve an acute
asthma exacerbation.
Safest of all antiasthma drugs • Administer epinephrine and/ • Seek medical care immediately
Allergic reaction or antihistamines to reverse for sudden rash, swelling of the
anaphylaxis. mouth or throat, or wheezing
after use.
Dry mouth • Encourage patient to drink sips • Suck on hard candy.

of water • Sip water.
• Give patient hard candy to suck
on
Headache • Administer mild analgesic as • Use over-the-counter

needed analgesics as needed.
Bitter aftertaste Encourage patient to suck on • Suck on hard candy.

hard candy after inhalations • Sip water.
Cough, tingling, or burning of the • Encourage patient to gargle, • Gargle with or drink water after
throat and trachea after inhalation drink water, or suck on throat use.
lozenge after use. • Suck on throat lozenges after
use.

• Allergy to cromolyn • Liver disease • None known
• Coronary artery disease • Kidney disease
• Cardiac dysrhythmias
• Status asthmaticus
Albuterol Proventil, Ventolin Beta2-Adrenergic Agonists
Inhaled; short-acting Bronchodilators
Activates beta2 receptors in the  Inhaled, short-acting used for • Follow manufacturer’s
smooth muscle of the lung, resulting prevention of asthma instructions for using delivery
in bronchodilation, and thus relieve • Long-term management of devices.
bronchospasm. Limited role in asthma • Use short-acting preparations
suppressing histamine release in the • Prevention of exercise-induced for acute exacerbations.
lung and increasing ciliary motility. asthma • Use long-acting preparations
 Bronchospasm is relieved • Treatment of ongoing asthma for long-term control.
 Histamine release is inhibited Exacerbations • Inhale beta2-adrenergic
 Ciliary motility is increased agonists before inhaling
glucocorticoids.
• Follow dosage limits and
schedules.
• Watch for signs and triggers
of impending exacerbations of
asthma.
• Keep a log of the frequency
and intensity of exacerbations.
• Notify the provider of changes
in patterns of exacerbations.
Tachycardia, angina • Monitor and report tachycardia, • Report chest pain and heart
heart palpitations, and chest palpitations.
pain • Report increase in pulse rate.
• Avoid caffeine.
Tremors • Monitor and report tremors. • Notify provider if tremors

Caused by activation of beta2 interfere with ADLs.
receptors in skeletal muscles

• Allergy to albuterol or • Diabetes mellitus • Beta-adrenergic blockers
Levalbuterol • Hyperthyroidism reduce the effectiveness of
• Cardiovascular disease beta2-adrenergic agonists.
• Hypertension • Monoamine oxidase inhibitors
• Angina pectoris (MAOIs) and tricyclic
antidepressants increase
the risks of hypertension,
tachycardia, and angina.
Theophylline Theo-24, Theochron, Elixophyllin Methlyxanthines
Antiasthma
 Relaxation of bronchial smooth  Oral use for long-term control of • If a dose is missed, do not
muscle, resulting in bronchodilation chronic asthma or COPD double the dose.
• Chew chewable tablets
thoroughly.
• Do not crush or chew
sustained-release or enteric coated
preparations.
• Maintain scheduled interval
between doses.
 Rare at therapeutic levels Monitor plasma drug levels • Reduce or eliminate caffeine
 When therapeutic levels are intake.
exceeded: restlessness, insomnia, • Have periodic laboratory testing
nausea, vomiting, diarrhea of drug levels.
Toxicity: seizures, dysrhythmias • Monitor plasma drug levels. • Stop taking the drug and notify
• Discontinue drug therapy. provider if begin experiencing
• Give activated charcoal to dysrhythmias or seizures
decrease absorption.
• Prepare to initiate
anticonvulsant therapy and
institute seizure precautions.
• Monitor heart rate and rhythm.
• Give antidysrhythmics to
restore heart rate and rhythm.
• Initiate anticonvulsant
therapy and institute seizure
precautions.
• Cardiac disorders that • Heart disease  Caffeine – intensifies the AE and
cannot withstand myocardial • Liver dysfunction increase theophylline levels
stimulation • Acute pulmonary edema  Tobacco and marijuana smoke –
• Severe liver or renal impairment • Hyperthyroidism induce theophylline metabolism
• Diabetes mellitus • Cimetidine (Tagamet), some
• Peptic ulcer disease fluoroquinolones, and caffeine
increase the risk of toxicity.
• Phenobarbital, phenytoin
(Dilantin), and nicotine increase
metabolism of theophylline.
Ipratropium Atrovent HFA Anticholinergic
Antiasthma
Block muscarinic cholinergic  Relief bronchospasm associated  Inhalation
receptors of the bronchi, resulting in with COPD • Follow manufacturer’s
bronchodilation (by preventing  Allergen-induced and exercise- instructions for using delivery
bronchoconstriction) induced bronchospasm devices.
• Follow dosage limits and
schedules.
• Allow the prescribed time
between puffs.
• Delay use of other inhalants for
5 minutes.
• Do not use as an emergency
rescue medication.
• Rinse the mouth after use to
reduce unpleasant taste.
Dry mouth, hoarseness Provide patient water and hard • Suck on hard candy.
candy • Sip water frequently
Increased intraocular pressure • Schedule routine testing for • Have regular eye examinations
glaucoma. to test for glaucoma.

• Allergy to soya lecithin, • Glaucoma • Beta2-adrenergic agonists
soybean, peanuts • Prostatic hypertrophy enhance bronchodilation.
• Bladder neck obstruction
Triamcinolone Nasacort AQA Nasal glucocorticoids
Allergic rhinitis drug
Nasal glucocorticoids decrease  Reduce the effects of allergic  Advise client that a metered-dose
inflammation associated with allergic rhinitis including sneezing, itching, spray device is used to administer the
rhinitis. They are the first line of runny nose medication
treatment for nasal congestion.  Advise client to administer dose
daily, not just when manifestations
occur
 Advise clients who have seasonal
allergic rhinitis it can take 7 days or
more to get the maximum relief
 Advise clients who have perennial
allergic rhinitis it can take as long as
21 days to get the maximum relief
 Advise clients to clear blocked nasal
passages with a topical decongestant
prior to glucocorticoid administration
Sore throat, nosebleed, headache, Contact provider if adverse effects
burning in the nose occur

• Pregnancy Risk Category C • Beta2-adrenergic agonists
enhance bronchodilation.
Diphenhydramine Benadryl Antihistamines for allergic rhinitis
1st generation H1 antagonists
Antihistamine action is on the H1 • Mild allergic reactions • Do not crush or chew entericcoated
receptors, which results in the (seasonal allergic rhinitis, formulations.
blocking of histamine release in the cough, urticaria, mild • Do not take with alcohol or
small blood vessels, capillaries, and transfusion reaction) other CNS depressants.
nerves during allergic reaction. These • Anaphylaxis (hypotension, • Take 30 min prior to activity for
medications relieve itching, sneezing, acute laryngeal edema, motion sickness.
and rhinorrhea, but do not relieve bronchospasm)
nasal congestion. First generation • Motion sickness
antihistamines produce cholinergic • Insomnia – Short-term use:
effects and drowsiness no longer than 2 consecutive
weeks (first-generation H1
antagonists)
Sedation, drowsiness, dizziness • Monitor the patient when • Take the drug prior to or at
ambulating. bedtime.
• Recommend switching patient • Avoid driving and activities that
to a nonsedating antihistamine require mental alertness.
if sedation is excessive
Anticholinergic effects: dry mouth, • Encourage sips of water or • Suck on hard candy.
constipation sucking on hard candy
GI discomfort: nausea, vomiting, • Give with food • Take the drug with food.
constipation • Encourage high intake of fluids • Increase fluid and fiber intake.
• Recommend selecting high • Take laxative as needed
fiber foods on menu and
provide fiber supplement or
laxative as needed
Acute toxicity: flushed face, high • Monitor for urinary retention • Report difficulty urinating
fever, tachycardia, dry mouth, • Administer activated charcoal • If symptoms of toxicity develop,
urinary retention, pupil dilation in and cathartics. stop taking the drug.
adults; excitation, hallucinations, • Administer acetaminophen • Seek medical care.
seizures in children (Tylenol) and apply ice packs or
give sponge baths for fever.
• Prepare to administer phenytoin
(Dilantin) IV for seizures
• Newborns and children under 2 • Children • Alcohol and other CNS
years • Older adults depressants increase
• Breastfeeding women • History of asthma depressant effects of
• Narrow-angle glaucoma • Urinary retention antihistamines.
• Prostatic hypertrophy • Open-angle glaucoma
• Acute asthma exacerbation • Hypertension
• Impaired kidney or liver function
Loratadine Claritin Antihistamines for allergic rhinitis
(nonsedating)
2nd generation H1 antagonists
Antihistamine action is on the H1 Allergic rhinitis May take with or without food.
receptors, which results in the Chronic idiopathic urticaria • Do not take with other over-
blocking of histamine release in the thecounter
small blood vessels, capillaries, and antihistamines.
nerves during allergic reaction. These • Expect dose to be lower
medications relieve itching, sneezing, in patients who have
and rhinorrhea, but do not relieve compromised renal or liver
nasal congestion. First generation function.
antihistamines produce cholinergic
effects and drowsiness
Drowsiness and fatigue (less • Monitor the patient when • Take the drug prior to or at
than first-generation sedating ambulating. bedtime.
antihistamines, but still a • Avoid driving and activities that
possible effect) require mental alertness.
Anticholinergic effects - dry • Provide water and encourage • Take frequent sips of water.
mouth, nose, and throat (less frequent sips. • Suck on hard candy.
than first-generation sedating • Provide hard candy to suck on.
antihistamines, but still a
possible effect)
• Infants under 6 months • Impaired kidney or liver function • Theophylline (Theo-24) can
• Breastfeeding women reduce clearance and lead to
• Allergy to H1-receptor toxicity.
antihistamines or hydroxyzine • Atropine may cause
anticholinergic effects.
Codeine Opioid antitussive

Codeine suppresses cough through Chronic nonproductive cough to • Use only on a short-term basis.
its action on the central nervous decrease the frequency and intensity • Use the lowest effective dose.
system to increase cough threshold • Use only when needed.
CNS effects: dizziness,  Obtain baseline vital signs  Change position slowly and to lie
lightheadedness, drowsiness,  Monitor clients when ambulating down if feeling lightheaded
respiratory depression  Observe for manifestations of  Avoid activities that require
respiratory depression, such as alertness, such as driving, while
respirations less than 12/min. taking codeine
Stimulate the client to breath if
respiratory depression occurs.
GI distress: nausea, vomiting,  Take with food 

constipation  Increase fluids and dietary fiber
Opioid use disorder  Advise clients of the potential for 

abuse
 Use for a short duration

 Pregnancy Risk Category C  Children • CNS depressants
 Codeine used alone is in the  Older adults (barbiturates, phenobarbital,
Schedule II class of the Controlled  Substance use disorder benzodiazepines, alcohol)
Substances Act. Codeine that is increase CNS depression.
mixed with other antitussives is • Anticholinergic agents,
classified as Schedule V such as antihistamines, and
 Respiratory depression, acute tricyclic antidepressants
asthma, head trauma, liver and renal increase anticholinergic effects
dysfunction, and acute alcohol use (constipation, urinary retention).
disorder • MAOIs can cause hyperpyrexic
sedation.
Additional medications such as
Dextromethorphan Delsym Nonopioid antitussive

Dextromethorphan suppresses cough  Cough suppression  Some formulations contain alcohol
through its action on the CNS.  Can reduce pain when combined and/or sucrose
Although not an opioid, it is derived with an opioid  Available forms include capsules,
from opioids. lozenges, liquids, and syrups.
 Few adverse effects
 Some mild nausea, dizziness, and
sedation can occur
 There is still some potential for
abuse as the medication can instill
euphoria in high doses
 Pregnancy Risk Category C  Can cause high fever when used
within 2 weeks of MAOI
antidepressants
Dexamethasone, Prednisone, Cortef Glucocorticoid
Cortisone (high minceralcorticoid
potency)
Mimic effect of natural steroid  Low doses: adrenocortical • Give orally, IV, IM, SC, topically,
hormones. insufficiency intranasally, or by inhalation,
 High doses: Nonendocrine depending on the indication.
application • For long-term use (10 days
• Symptomatic relief of pain and or more), take in the morning
inflammation for a wide variety using alternate-day dosing.
of disorders • Taper the dose slowly when
• Management of many skin symptoms are controlled to
disorders establish the lowest possible
• Delay progression of some oral dose.
disorders, such as rheumatoid • For short-term oral use, the
arthritis largest dose is given on the 1st
• Prevention of organ rejection day with progressively smaller
• Adjunctive therapy for some doses for each of the next 8
Cancers days.
 Inflammatory bowel disease • Give supplemental doses as
 Allergic conditions: allergic rhinitis, needed in times of stress.
bee stings, drug-induced allergies
 Asthma
 Prevention of respiratory distress
syndrome in preterm infants
 Dexamethasone: CINV
Suppression of adrenal function • Recommend larger dosage Take the drug on an alternateday
during times of illness and schedule.
stress. • Report increased stress, as
higher dosages are required at
such times.
• Taper the dose before
discontinuing it.
Bone loss/osteoporosis Recommend the lowest • Take the drug on alternate days
Suppresses bone formation by possible effective dose and for long-term therapy.
osteoblasts, accelerate bone alternate-day dosing. • Perform weight-bearing
resorption by osteoclasts, reduce exercise daily.
intestinal absorption of calcium. • Consume adequate calcium
and vitamin D.
Infection • Observe for signs of infection • Report signs of infection, such
 Suppressing host defenses that may not include fever as a sore throat.
or inflammation (sore throat,
fatigue, tachycardia, and
discharge from a wound).
• Recommend initiation of
appropriate antimicrobial
therapy.
Glucose intolerance/hyperglycemia Monitor blood glucose levels, • Report polyphagia, polydipsia,
especially for patients who have and polyuria.
diabetes mellitus.
• Adjust dosages of insulin/
hypoglycemic drugs
accordingly
Myopathy (muscle injury) • Recommend the lowest • Report muscle pain or
possible effective dose and weakness.
alternate-day dosing.
Fluid and electrolyte imbalance • Monitor intake and output; • Report weight gain or edema
 Sodium and water retention and watch for edema, crackles in (hypernatremia).
potassium loss the lungs, and unexplained • Report weakness
weight gain (hypernatremia). (hypokalemia).
• Monitor for generalized
weakness (hypokalemia).
Growth delay in children Recommend alternate day therapy
Psychologic disturbances
Mild reaction: insomnia, anxiety,
agitation, or irritability
Severe reaction: delirium,
hallucinations, depression, euphoria,
or mania.
Cataracts and glaucoma (long-term) • Determine schedule for regular • Report blurred vision and loss
ophthalmologic examinations. of color acuity.
• Minimize exposure of eyes to
sunlight.
• Obtain periodic eye examinations.
Peptic ulcer disease, GI discomfort • Observe for gastrointestinal • Avoid taking NSAIDs.
 By inhibiting prostaglandin bleeding (bloody vomitus as • Take the drug with food or
synthesis, glucocorticoids can well as black, tarry stools) meals.
augment secretion of gastric acid and • Implement gastric protective • Report or indigestion or bloody
pepsin, inhibit production of measures vomitus as well as black, tarry
cytoprotective mucus, and reduce • Give drug with food or meals stools.
gastric mucosal blood flow • Recommend analgesic
substitute if NSAID is
prescribed.
Fat redistribution (long-term therapy) • Monitor for Cushing-like effects: • Understand that long-term
abdominal fat, buffalo hump, therapy may cause some
and moon face. changes in fat distribution
throughout the body.

• Pregnancy Risk Category C • Heart failure • Potassium-depleting diuretics,
• Recent live virus immunization • Peptic ulcer disease, gastritis, such as furosemide (Lasix)
• Systemic fungal infection esophagitis increase risk of hypokalemia.
• Cataracts • Diabetes mellitus • The risk of digoxin-induced
• Hypertension dysrhythmias increases with
• Kidney dysfunction digoxin.
• Myasthenia gravis • NSAIDs increase risk of
• Osteoporosis gastrointestinal bleeding and
 Open-angle glaucoma ulceration.
 Infections that are resistant to • Effects of insulin and oral
treatment hypoglycemics decrease in
patients who have diabetes.
• Prednisone prevents the body
from responding to vaccines
• Live vaccine administration
increases risk for developing
that viral disease.
Cimetidine Tagamet Histamine2 Receptor Antagonist
Ranitidine hydrochloride (more Zantac
potent, less AE, less drug
interactions)
Block H2 receptors, which reduces  Used in conjunction with antibiotics • Give orally, IM, or IV.
the volume of gastric acid and lower to treat ulcers caused by H. pylori. • Give with or without food (no
the concentration of hydrogen ions in • Gastric and duodenal ulcers difference in absorption for
the stomach • Heartburn, dyspepsia Ranitidine).
• Erosive esophagitis • Administer IV preparation
• Gastrointestinal reflux disease slowly to avoid bradycardia.
(GERD) • Do not give antacids within 1 hr
• Aspiration pneumonitis of administration.
• Hypersecretory disorders such • Make sure patients dissolve
as Zollinger-Ellison syndrome effervescent tablets in water
(gastrin), systemic mastocytosis and do not chew them, swallow
(histamine) them whole, or allow them to
dissolve on the tongue.
• Antiandrogenic effects: • For patients who develop • Report any changes in sexual
gynecomastia, impotence, reduced impotence or reduced libido, desire or function.
libido recommend switching to
with cimetidine (Tagamet), not ranitidine.
ranitidine
• CNS effects (lethargy, • For patients who develop CNS • Report lethargy, depression,
depression, restlessness, effects, recommend switching restlessness, or seizures.
seizures) with cimetidine, not to ranitidine.
ranitidine
Older adults with renal or hepatic
impairment
Pneumonia

• Children younger than 12 yr • Kidney or liver dysfunction • Absorption of ketoconazole,
(over-the-counter formulations) • Phenylketonuria itraconazole (Sporanox), some
• Acute porphyria • Older adults cephalosporins, and delavirdine
• COPD (Rescriptor) decreases.
• Patients at high risk for infection • Antacids can reduce
absorption.
• Cimetidine (not ranitidine)
increases levels of warfarin
(Coumadin), phenytoin
(Dilantin), lidocaine (Xylocaine),
and theophylline (Theolair).
Omeprazole Prilosec, Prilosec OTC Proton Pump Inhibitor

Block basal and stimulated acid Short term therapy of • Administer orally once daily
production, and reduce gastric acid  Gastric and duodenal ulcers before the first meal of the day.
secretion by irreversibly inhibiting  Erosive esophagitis • Make sure patients do
the enzyme that produces gastric  GERD not crush, chew, or break
acid, H+,K+, -ATPase. Long term therapy of delayed-release capsules of
 Hypersecretory disorders such as omeprazole.
Zollinger-Ellison syndrome  Active ulcers should be treated for
4 to 6 weeks
Minor short term therapy: headache, Monitor for severe vomiting or • Report vomiting or diarrhea.
diarrhea, nausea, and vomiting diarrhea • Try antacids to help minimize
symptoms.
• Drink plenty of clear fluids.
• Tell patients to report any
signs of obvious or occult
gastrointestinal bleeding, such
as coffee-ground emesis.
Pneumonia Inform clients of these possible
Due to alteration of upper GI flora effects and to monitor and report
and impairment of WBC function manifestations of respiratory
infection
Fracutres/bone loss/osteoporosis • Limit drug therapy to the lowest • Perform weight-bearing

Due to reduced acid secretion, which dose and shortest duration exercise daily.
may decrease absorption of calcium possible. • Consume adequate calcium
• For longer-term therapy, and vitamin D.
monitor for bone loss via
bone density scanning at
recommended intervals.
Rebound acid hypersecretion  Take low dose if possible
 Taper slowly to discontinue
Hypomagnesemia  Reports manifestations of

hypomagnesemia: tremors, muscle
cramps, seizures, and dysrhythmias

Pregnancy Risk Category C • Liver dysfunction • Absorption of atazanavir
• Children younger than 18 yr • Metabolic or respiratory (Reyataz), ketoconazole
(over-the-counter formulations) Alkalosis (Nizoral), and itraconazole
• Hypersensitivity to the drug  COPD cuz high risk for pneumonia decreases.
 Dysphagia • Food can reduce absorption.
• Levels of warfarin (Coumadin),
phenytoin (Dilantin), and
diazepam (Valium) increase.
• Ginkgo biloba and St. John’s
wort decrease drug levels.
 Beneficial effects of clopidogrel can
decrease with concurrent use
Sucralfate Carafate, Sulcrate Mucosal protectant

The acidic environment of the  Acute duodenal ulcers • Administer orally on an empty
stomach and duodenum changes  Acute duodenal ulcers and stomach.
sucralfate into a protective barrier maintenance therapy • Give four times a day, 1
that adheres to an ulcer. This  Sucralfate is not absorbed, hr before the usual three
protects the ulcer from further injury therefore, it has no systemic effects mealtimes and again at
from acid and pepsin. This viscous bedtime.
substance can stick to the ulcer for • Do not give antacids within 30
up to 6 hr. to 60 min of administration.
• Do not give within 2 hr of
administering fluoroquinolone
antibiotics, warfarin
(Dilantin), theophylline
(Theolair), digoxin (Lanoxin),
tetracycline, or diazepam
(Valium).
• Administer stool softeners. Drink at least 1500mL/day
• Increase activity and exercise.

• Children • Chronic renal failure, dialysis • Absorption of fluoroquinolone
• Hypersensitivity to the drug • Renal dysfunction antibiotics, warfarin
(Dilantin), theophylline
(Theolair), digoxin (Lanoxin),
tetracycline, and diazepam
(Valium) decreases.
• Antacids reduce therapeutic effects
by raising gastric pH above 4
Misoprostol Cytotec Prostaglandin E analog

Acts as an endogenous prostaglandin  Prevention of gastric ulcers from • Administer orally four times a
in the GI tract that decreases acid long-term NSAID use day, with meals and again at
secretion, increases the secretion of  Unlabeled use: used in clients who bedtime.
bicarbonate and protective mucus, are pregnant only to induce labor by • Confirm nonpregnant state
and promotes vasodilation to causing cervical ripening before initiating drug therapy,
maintain submucosal blood flow. as this drug can cause
spontaneous abortion.
• Make sure women of
childbearing age use effective
contraception during drug
therapy.
Diarrhea, abdominal pain • Monitor for severe diarrhea and • Report worsening diarrhea or
abdominal pain. abdominal pain.
• Expect diarrhea to resolve after
the first week of drug therapy.
• Drink plenty of clear fluids.
• Take the drug with food to
minimize gastrointestinal
effects.
Dysmenorrhea, spotting • Monitor for excessive menstrual • Report menstrual changes.
pain or midcycle bleeding.

• Pregnancy risk category X • Inflammatory bowel disease • Antacids that contain
• Hypersensitivity to the drug • Renal dysfunction magnesium worsen diarrhea.
• Children younger than 18 yr
Aluminum hydroxide Amphogel Antacids
Magnesium hydroxide Milk of Magnesia
Calcium carbonate
Antacids neutralize gastric acid by  Peptic ulcer disease • Administer orally up to four
producing neutral salts, and  GERD times a day.
inactivating pepsin • Make sure patients chew
Mucosal protection can occur from tablets thoroughly and then
stimulation of the production of drink 4 oz of water or milk and
prostaglandins drink water after taking liquid
preparations.
• Do not give within 2 hr of
administering drugs that
interact with antacids.
Constipation (aluminum and calcium • Monitor bowel function. • Increase fluid and fiber intake.
antacids) • Administer stool softeners. • Increase activity and exercise.
• Report abdominal pain.
Diarrhea (magnesium antacid) • Monitor for severe diarrhea. • Report severe diarrhea.
Recommend combination to
minimize bowel effects
 Aluminum hydroxide:  Monitor electrolyte levels

Hypophosphatemia,  Caution with patients with
hypomagnesemia hypertension or heart failure
Aluminum hydroxide binds to
phosphate
 Fluid retention
Magnesium hydroxide : Toxicity,  Avoid clients with impaired kidney Monitor for CNS depression
hypermagnesemia function
Calcium carbonate: constipation, acid

rebound, belching, and flatulence

• Gastrointestinal perforation, • Abdominal pain  Absorption of warfarin
obstruction • Renal dysfunction (Coumadin), digoxin (Lanoxin),
• Hypophosphatemia (aluminum • Dehydration, fluid restriction cimetidine (Tagamet), NSAIDs,
based • Reduced bowel motility ciprofloxacin (Cipro), phenytoin
antacids) (Dilantin), isoniazid (INH),
tetracycline, and many other
drugs decreases.
 Take 1 hr from sucralfate and
cimetidine/ranitidine
Psyllium Metamucil Bulk-Forming Laxative

Bulk-forming laxatives soften fecal  Constipation • Give orally one to three times a
mass and increase bulk, which is  Diverticulosis day with at least 8 oz of fluid.
identical to the action of dietary  Irritable bowel syndrome • Mix powdered forms with 8 oz
fiber.  Stool regulation for diarrhea and of fluid.
with fecal ostomies • Expect soft, formed stools 1 to
3 days after initiating therapy.
• Tell patients that taking it before
meals might reduce appetite.
Esophageal obstruction or intestinal • Emphasize the importance of • Take with at least 8 oz of water
obstruction taking at least 8 oz of fluid with or juice.
When taken with little fluid each dose. • Report difficulty swallowing,
• Monitor intake and output and chest pain, or absence of bowel
bowel function. movements.
• Monitor for retrosternal pain.
Diarrhea (with excessive use) • Monitor for severe diarrhea and • Report persistent diarrhea.
dehydration. • Drink plenty of fluids.
• Advise patients to increase

exercise and fluid intake
(at least 2 to 3 L/day) and
consume high-fiber foods (bran,
fresh fruits/vegetables).
• Esophageal or gastrointestinal • Diabetes mellitus • Absorption of antibiotics,
obstruction salicylates, digoxin (Lanoxin),
• Narrowing of intestinal lumen nitrofurantoin (Furadantin),
• Fecal impaction and warfarin (Coumadin)
 Acute surgical abdomen decreases.
• Dysphagia
• Nausea, vomiting
• Appendicitis
• Undiagnosed abdominal pain
Docusate sodium Colace Surfactant laxative

Surfactant laxatives lower surface  Constipation • Give orally with at least 8 oz of
tension of the stool to allow  Prevention of fecal impaction, fluid.
penetration of water. Also inhibits straining during defecation, painful • Expect soft stools several days
fluid absorption and stimulates elimination of hard stools after initiating therapy.
secretion of water and electrolytes
into the intestinal lumen
Diarrhea, mild abdominal cramps Monitor for severe diarrhea and • Report persistent diarrhea.
dehydration • Drink plenty of fluids.

• Gastrointestinal obstruction, • Diabetes mellitus • Systemic absorption of mineral
perforation • Heart failure oil increases.
• Concurrent use of mineral oil • Edema
• Fecal impaction
Bisacodyl Correctol, Dulcolax, Fleet Laxative Stimulant laxative

Stimulant laxatives result in  Constipation from opioid use or • Give orally or by rectal
stimulation of intestinal peristalsis. from slow intestinal transit suppository.
They also increase the amount of  Colon evacuation prior to elective • Expect semi-fluid stools within 6
water and electrolytes within the procedures to 12 hr with oral dosing and in
intestinal lumen. 15 to 60 min with suppositories.
• Tell patients to take the oral
form at least 1 hr after drinking
milk or taking antacids and not
to crush or chew the entericcoated
or delayed-release
tablets
Burning sensation (suppositories) • Tell patients to expect rectal or • Expect a burning sensation with
anal burning. suppository use.
Proctitis (prolonged use of • Monitor for rectal discomfort, • Report rectal discomfort,
suppositories) bleeding, or discharge of mucus bleeding, or discharge.
or pus. • Stop taking the drug.
Laxative abuse • Discourage long-term use. • Do not use repeatedly or for

• Monitor intake and output. extended periods.
• Monitor bowel elimination
pattern.

• Pregnancy Risk Category C • Eating disorders or other • Antacids dissolve the enteric
 Children younger than 1 yr factors that increase the risk of coating, causing abdominal
• Gastrointestinal obstruction, abuse cramping.
perforation • Excessive use decreases
• Anal or rectal fissures vitamin K absorption.
• Ulcerated hemorrhoids
• Fecal impaction, ileus
• Proctitis
Magnesium hydroxide Phillips’ Milk of Magnesia Osmotic laxative
Milk of Magnesia
Magnesium citrate
Osmotic laxatives draw water into  Low dose: prevent painful  Give orally in liquid form
the intestine to increase the mass of elimination (clients who have  Expect soft or semifluid stool in 6 to
stool, stretching musculature, which episiotomy or hemorrhoids) 12 hours for low doses and in 2 to 6
results in peristalsis  High dose: client preparation prior hours for high doses.
to surgery or diagnostic tests, such as
a colonoscopy.
 Rapid evacuation of the bowel after
ingestion of poisons or following
anthelmintic therapy to rid the body
of dead parasites.
Toxic magnesium levels Advise clients who have impaired

kidney function to read labels
carefully and to avoid laxatives that
contain magnesium
Dehydration  Monitor I&O  Increase water intake to at least 8

 Monitor/assess for manifestations to 10 glasses of water per day.
of dehydration, such as poor skin
turgor
Laxative abuse • Discourage long-term use. • Do not use repeatedly or for

• Monitor intake and output. extended periods.
• Monitor bowel elimination
pattern.

 Fecal impaction • Eating disorders or other
 Bowel obstruction factors that increase the risk of
 Acute surgical abdomen abuse
 Nausea, cramping, and abdominal
pain
 Ulcerative colitis
 Diverticulitis
Ondansetron Zofran Antiemetic
Serotonin Receptor Antagonist
Prevents emesis by blocking the  Prevents emesis related to • Give orally, IM, or IV
serotonin receptors in the chemotherapy, radiation therapy, • When treating chemotherapy
chemoreceptor trigger zone (CTZ), and postoperative recovery induced
and antagonizing the serotonin  Off label use: treat nausea and nausea and vomiting,
receptors on the afferent vagal vomiting from childhood viral give the drug IV slowly (over
neurons that travel from the upper GI gastritis and morning sickness 15 min) starting 30 min before
tract to the CTZ. chemotherapy administration,
and then 4 and 8 hr later.
• When treating anesthesia induced
nausea and vomiting,
give the drug 1 hr before
anesthesia induction.
• When treating radiationinduced
nausea and vomiting,
give the drug 1 to 2 hrs before
therapy, and then every 8 hrs
as needed.
Headache, diarrhea, dizziness • Monitor for persistent • Report headache.
headache. • Take over-the-counter
• Administer analgesics for pain analgesics to relieve headache
relief. if taking the drug at home.
• Monitor for dizziness. • Report dizziness.
• Monitor for severe diarrhea and • Do not engage in dangerous
dehydration. activities if dizziness occurs or
tends to recur.
• Lie down and change positions
slowly when feeling dizzy.
• Report persistent diarrhea.
• Drink plenty of fluids.
Prolonged QT interval can lead to a Monitor ECG in clients who have
serious dysrhythmia (torsades de cardiac disorders
pointes)

 Children younger than 4 yr  Liver dysfunction  Rifampin decreases drug levels
 QT prolongation  Phenylketonuria
 Electrolyte abnormalities, heart
failure, bradydysrhythmias
Promethazine Phenergan Antiemetic
Dopamine antagonist
Antiemetic effects result from  Prevents emesis related to • Give orally, IM, or IV
blockade of dopamine receptors in chemotherapy, opioids, toxins, and
the CTZ postoperative recovery

Extrapyramidal symptoms (EPS):  Administer an anticholinergic • Report restlessness, anxiety, or
dystonia (continuous spasms and medication, such as spasms of the face and neck,
muscle contractions, akathisia (motor diphenhydramine or benztropine, to lip smacking, writhing motions,
restlessness), parkinsonism, treat EPSs and involuntary movements
bradykinesia, tremor, tardive • Recommend the lowest
dyskinesia (irregular jerky possible dose for the shortest
movements) duration of time.
• Monitor for restlessness,
anxiety, spasms of the face and
neck, lip smacking, writhing
motions, and involuntary
movements.
• Discontinue the drug for
extrapyramidal symptoms.
Hypotension  Monitor clients receiving  Rise slowly from lying to standing
antihypertensive medications for low to prevent dizziness and falls
blood pressure

alertness.
• Sit or lie down if feeling drowsy.
Anticholinergic effects: dry mouth, • Monitor for dry mouth. • Suck on hard candy or chew
urinary retention, constipation  Administer a stimulant laxative gum.
such as senna to counteract a • Sip water.
decrease in bowel motility, or stool  Increase fluid intake
softeners such as docusate sodium to  Increase physical activity by
prevent constipation engaging in regular exercise
 Void every 4 hr. Monitor I&O, and
palpate the lower abdomen area
every 4 to 6 hr to assess the bladder
 Children younger than 2 yr because  Children older than 2 yr  CNS depressants, such as opioids
of respiratory depression and local and alcohol, can intensify CNS
tissue injury depression of antiemetics
 Concurrent use of
antihypertensives can intensify
hypotensive effects
 Concurrent use of anticholinergic
medications (antihistamines) can
intensify anticholinergic effects
Metoclopramide Reglan Antiemetic
Prokinetic agent
Controls nausea and vomiting by • Nausea and vomiting from • Give orally or IV.
blocking dopamine and serotonin chemotherapy, opioids, • When treating chemotherapy
receptors in the CTZ. radiation therapy, toxins induced
Augments the action of acetylcholine, Oral: nausea and vomiting,
which causes an increase in upper GI • Gastroesophageal reflux give the drug IV slowly (over
motility, increasing peristalsis disease (GERD) 15 min) starting 30 min before
• Diabetic gastroparesis chemotherapy administration,
and then 2, 4, 7, 10, and 13 hr
later.
• Administer doses of 10 mg or
less intravenously over 1 to 2
min
• Give oral forms 30 min before
meals and at bedtime.
Extrapyramidal symptoms (EPS):  Administer an anticholinergic • Report restlessness, anxiety, or
dystonia (continuous spasms and medication, such as spasms of the face and neck,
muscle contractions, akathisia (motor diphenhydramine or benztropine, to lip smacking, writhing motions,
restlessness), parkinsonism, treat EPSs and involuntary movements
bradykinesia, tremor, tardive • Recommend the lowest
dyskinesia (irregular jerky possible dose for the shortest
movements) duration of time.
• Monitor for restlessness,
anxiety, spasms of the face and
neck, lip smacking, writhing
motions, and involuntary
movements.
• Discontinue the drug for
extrapyramidal symptoms.
alertness.
• Sit or lie down if feeling drowsy.
Diarrhea • Monitor for severe diarrhea and • Report diarrhea.
dehydration. • Drink plenty of clear fluids.

• Gastrointestinal obstruction, • Heart failure • Other CNS depressants
hemorrhage, perforation • Hypertension increase sedative effects and
• Uncontrolled seizure disorders • Asthma the risk for seizures.
• Pheochromocytoma • Parkinson’s disease • Opioids and anticholinergics
• Breast cancer • Hypokalemia decrease therapeutic effects.
• Porphyria • Phenothiazines worsen
• Seizure disorders extrapyramidal symptoms.
• Liver or kidney dysfunction • Absorption of many drugs
• Older adults decreases, including
acetaminophen (Tylenol),
aspirin, diazepam (Valium),
tetracycline, digoxin (Lanoxin),
 and lithium (Lithobid).
Diphenoxylate + atropine Lomotil Antidiarrheals

Antidiarrheals activate opioids  Diarrhea • Diphenoxylate/atropine
receptors in the GI tract to decrease  Symptomatic treatment of diarrhea ◦◦Give orally.
intestinal motility and to increase the ◦◦Give 20 mg /day in 5 mg
absorption of fluid and sodium in the doses.
intestine ◦◦Continue for 24 to 36 hr to
determine its efficacy.
◦◦Be aware that excessive
doses of diphenoxylate can
cause CNS effects similar to
morphine, but atropine in high
doses causes unpleasant
effects that discourage abuse;
treat overdoses with naloxone.
At recommended doses for diarrhea, • Tell patients with diarrhea to
diphenoxylate does not effect the avoid fluid and electrolyte
CNS system imbalances by drinking clear
liquids or a commercial oral
electrolyte solution, and to
avoid caffeine because it
increases gastrointestinal
motility.
Sedation, dizziness, lightheadedness, • Monitor patients when • Do not take prior to driving
drowsiness ambulating. or activities requiring mental
AE of diphenoxylate • Recommend the lowest alertness.
effective dose for the shortest • Sit or lie down if feeling
period of time lightheaded.
Anticholinergic effects (dry • Monitor for anticholinergic • Suck on hard candy or chew
mouth, urinary retention effects. gum.
AE of atropine • Monitor urinary elimination • Sip water.
patterns, especially in older • Urinate every 4 hr and report
adults. any undesirable changes in
urinary elimination.
• Children younger than 2 yr • Ulcerative colitis Other CNS depressants
• Inflammatory bowel disease • Renal or liver dysfunction increase CNS depression
• Advanced hepatic disease • History of chemical abuse (diphenoxylate/atropine).
• Glaucoma • Prostatic hypertrophy • Monoamine oxidase
• Severe fluid and electrolyte inhibitors increase the
imbalance risk for hypertensive crisis
• Pseudomembranous (diphenoxylate/atropine).
enterocolitis
• Diarrhea due to poisoning
• Ileus
• Gastrointestinal bleeding
Levodopa/carbidopa Sinemet Anti-Parkinson’s
Dopamine-replacement
 Levodopa crosses the blood-brain  Relieves symptoms of Parkinson’s • Begin administration with low
barrier, whereas dopamine alone disease doses to reduce side effects
cannot cross this barrier and has a  Addition of carbidopa allows for of levodopa (daily doses of
very short half-life. Levodopa is taken reduced dose of levodopa and levodopa greater than 1,000
up by dopaminergic nerve terminals prevents some adverse effects mg have increased side effects)
and covered to dopamine. This newly  Most effective PD treatment, but • Advise patient that it can take
synthesized DA is released into the the beneficial effects diminish by the up to 6 months for full response
synaptic space and causes end of year 5 to levodopa/carbidopa to occur
stimulation of DA receptors  “Wearing off” times occur at the • Monitor for loss of drug effect
 Carbidopa is used to augment end of the dose cycle or can occur at and “on-off” episodes and
levodopa by decreasing the amount any time even at high dose levels, report these to provider
of levodopa that is converted to DA lasting minutes to several hours. • Immediate-release tablets
in the intestine and periphery. This begin working within 30 min,
results in larger amounts of levodopa then begin to wear off
reaching the CNS • Extended-release tablets work
over 4 to 6 hr but can take up
to 2 hr to begin working in the
morning
Nausea and vomiting • Addition of carbidopa (at • Advise patient to take drug
least 75 mg/day) relieves GI with food if necessary but to
symptoms avoid high-protein foods, which
decrease absorption
 Avoid vitamin preparations and
foods containing pyridoxine (B6)
which reduce the therapeutic effects
Dyskinesias: tremors, twitching, head • Administer amantadine • Instruct patient to inform
bobbing, ticks, grimacing, (Symmetrel) as ordered to provider if dyskinesias develop
decrease dyskinesias • Avoid high-protein foods, which
• Lower dose of levodopa for decrease absorption
dyskinesia
• Increase bedtime dose of
levodopa for dystonia in
morning
• Give dose four times (instead of
three times) daily if symptoms
present a couple hours before
next dose
Orthostatic/postural hypotension • Monitor patient for this effect • Instruct patient to move slowly
and prevent falling to sitting/standing position
Cardiovascular effects from beta1  Monitor vital signs and ECG  Notify the provider if
stimulation: tachycardia, palpitations,  Use cautiously in clients who have manifestations occur
irregular heartbeat cardiovascular disorders
Psychosis: visual hallucinations, • Decrease levodopa/carbidopa • Instruct patient to notify
nightmares, paranoid ideation dosage provider if these symptoms
• Administer 2nd generation occur
antipsychotics, such as
quetiapine (Seroquel) or clozapine to
relieve
symptoms
 2nd generation antipsychotic
medications do not block dopamine
receptors in the striatum
Darkening of urine and sweat • Observe patient's urine and • Warn patient that darkening of
Activation of malignant melanoma sweat for a change in color urine and sweat can occur
On-off episodes (random • Use controlled release Sinemet • Instruct patient to notify
times throughout day where (if previously using immediaterelease provider if these symptoms
Parkinson’s disease symptoms tablets) occur
potentiate ) • Administer dopamine agonist • Avoid high protein foods which
(e.g., pramipexole [Mirapex]) decrease absorption
• Administer COMT inhibitor
(e.g., entacapone [Comtan])
• Administer MAO-B inhibitor
(e.g., selegiline [Eldepryl])
• Narrow-angle glaucoma • Older adults • Traditional (1st generation)
• History of melanoma • Existing renal, hepatic, antipsychotics and preparations
• Psychosis, suicidal thoughts respiratory, or endocrine with vitamin B6 decrease
disorders levodopa/carbidopa action
• Wide angle glaucoma • MAOI antidepressants within 2
• Peptic ulcer disease weeks can cause hypertensive
• Depression, bipolar disorder crisis
• High protein meals decrease
levodopa/carbidopa action
• Anticholinergic drugs increase
response to levodopa/
carbidopa
Entacapone Comtan Anti-Parkinson’s
COMT inhibitor
COMT inhibitor enhances the effect  Beneficial in combination with Available in 200 mg tablets and fixed
of levodopa by blocking its levodopa/carbidopa to inhibit the dose combinations with
breakdown. It blocks the metabolism metabolism of levodopa in the levodopa/carbidopa
of levodopa in the intestine and intestines and peripheral tissues
peripheral tissues. It prolongs the
plasma half-life of levodopa.
Increases levodopa AE: dyskinesias, 
orthostatic hypotension, nausea,
hallucinations, sleep disturbances,
and impulse control disorders
GI: vomiting, diarrhea, constipation
Discoloration of urine to yellow- Assure the client that the urine color
orange is harmless

• Narrow-angle glaucoma • Older adults • Traditional (1st generation)
• History of melanoma • Existing renal, hepatic, antipsychotics and preparations
• Psychosis, suicidal thoughts respiratory, or endocrine with vitamin B6 decrease
disorders levodopa/carbidopa action
• Wide angle glaucoma • MAOI antidepressants within 2
• Peptic ulcer disease weeks can cause hypertensive
• Depression, bipolar disorder crisis
• High protein meals decrease
levodopa/carbidopa action
• Anticholinergic drugs increase
response to levodopa/
carbidopa
Donepezil Aricept, Aricept ODT Drugs for Alzheimer’s disease
Cholinesterase inhibitor
Cholinesterase inhibitors prevent the  Mild to severe Alzheimer’s disease  Give at bedtime daily with or
enzyme cholinesterase from without food
inactivating acetylcholine, thereby  Also available as a syrup and in
increasing the amount of ACh orally disintegrating tablets
available at receptor sites.
Transmission of nerve impulses is
increased at all sites responding to
ACH as a transmitter.
GI effects: nausea, vomiting,  Give with food to decrease these  Instruct patient (caregiver) to take
dyspepsia, diarrhea effects with food at bedtime to minimize GI
 Monitor patient’s weight effects
 Monitor for signs of GI bleeding,  Report vomiting, severe diarrhea,
such as dark stools or coffee-ground weight loss, GI bleeding
emesis
CNS effects: insomnia, dizziness,  Monitor for these effects  Instruct patient to report CNS
headache  Keep patient safe from falls if symptoms to provider
dizziness occurs
Bradycardia  Monitor heart rate Report temporary loss of

 Provide respiratory support consciousness
through mechanical ventilation and
oxygen, and administer atropine to
reverse muscarinic stimulation
 Have resuscitation equipment
available
 Pregnancy Risk Category C  Liver, renal, cardiac, GI, or  Atropine counteracts the effects of
 Obstruction of GI and renal system pulmonary disorders Donepezil
 GI bleeding  Hyperthyroidism  NSAIDs increases risk for GI
 Allergy to donepezil  Seizures bleeding
 Jaundice  Peptic ulcer disease  Anticholinergic drugs, such as
 Children  Asthma antihistamines, TCAs, antipsychotics,
 Bradycardia decrease effect
 Hypotension
Memantine Namenda Drugs for Alzheimer’s disease
NMDA Receptor Antagonist
Memantine blocks calcium entry at  Slows decrease in functioning for • Available orally in tablets or
NMDA receptors, which are believed moderate to severe Alzheimer’s liquid solution
to play a critical role in learning and disease • Give with or without food
memory, when extracellular
glutamate is low, and thereby stops
further calcium entry, which allows
intracellular calcium levels to
normalize. It permits calcium influx
when extracellular glutamate is high.
CNS effects: dizziness, headache,  Monitor for these effects  Instruct patient to report CNS
increased confusion  Keep patient safe from falls if symptoms to provider
dizziness occurs
Constipation  Monitor for constipation • Instruct patient/caregiver to

increase fluids and fiber in diet
• Advise to report constipation to
provider

• Renal failure • Liver disorders Over-the-counter antacids
• Previous allergy to memantine • Renal disorders (reduced dose (sodium bicarbonate) and
may be necessary) other drugs that increase pH of
• Seizure disorders urine cause increased levels of
• Older adults memantine and possible toxicity
• Memantine with levodopa/
carbidopa can enhance the
adverse effects of levodopa/
carbidopa
• Other NMDA antagonists, such
as amantadine (Symmetrel)
or ketamine (Ketalar) may
increase memantine levels
Interferon beta-1a (Avonex, Rebif) Drugs for Multiple Sclerosis
Beta-1b (Betaseron) Immunomodulators
Inhibits the migration of  Beta-1a: multiple sclerosis • Beta-1a (Avonex): Give IM
proinflammatory leukocytes across (relapsing-remitting type) weekly
the blood-brain barrier, preventing  Beta-1b: multiple sclerosis • Beta-1a (Rebif): Give SC daily
these cells from reaching neurons of (relapsing and secondary progressive for 3 days each week
the CNS. It also suppresses T-helper MS) ◦◦Administer late in day
cell activity. ◦◦Allow 48 hours between
injections
• Beta-1b: (Betaseron): Give SC
every other day
• Beta-1b: Use within hours after
Reconstituting
Flu-like symptoms • Begin with low dose and titrate • Instruct patient to pre-medicate
These decrease with prolonged to higher doses to prevent with prescribed NSAID if flu-like
treatment adverse effects symptoms occur
• Medicate with acetaminophen
or other prescribed NSAID if
symptoms are expected
Hepatotoxicity • Monitor liver function tests • Instruct patient to report
before treatment begins and abdominal tenderness,
periodically thereafter anorexia, jaundice to provider
Myelosuppression • Monitor CBC before treatment • Instruct patient to notify

begins and periodically provider for easy bruising,
thereafter bleeding, fatigue
Injection-site reactions: pain, redness • Monitor for injection site • Instruct patient to rotate
at subcutaneous injection site Reactions injection sites, use cool
compress prior to injection and
warm, moist compress following
injection
• Instruct patient to report skin
ulceration to provider
Depression
Neutralizing antibodies

• Previous allergy to interferon • Suicidal tendencies • Any drug which suppresses
beta, human albumin or • Pre-existing or history of liver the immune system (e.g.
mannitol disorder prednisone) may increase risk
• Alcohol abuse for myelosuppression
• Children younger than 18 years
• Seizures
• Mental health disorders
• Thyroid disorders
Mitoxantrone Novantrone Drugs for Multiple Sclerosis
Immunosuppressants
Mitoxantrone is a cytotoxic drug that  Worsening relapsing-remitting MS  IV
binds with DNA and inhibits  Secondary progressive MS  Perform CBCs at baseline, before
topoisomerase II. Mitoxantrone  Progressive-relapsing MS each dose, and 10 to 14 days after
suppresses production of immune each dose
system cells, and thereby decreases  Perform LFTs at baseline and before
autoimmune destruction of myelin. each dose
 Perform a pregnancy test before
each dose
 Determine LVEF before each dose
and whenever signs of heart failure
develop
Myelosuppression • Monitor CBC before treatment  Avoid contact with people who
Loss of neutrophils increases risk of begins and periodically have infections
severe infection thereafter  Report signs of infection: fever,
chills, cough, hoarseness
 Avoid live virus vaccine
Cardiotoxicity • Monitor LVEF and heart failure  Report signs of peripheral edema,
fatigue, shortness of breath
Toxic to tissues with a high

percentage of actively dividing cells.
Reversible hair loss
Injury to the GI mucosa: stomatitis
and GI distress
Nausea, vomiting, menstrual
irregularities, symptoms of allergy
Blue-green tint to the skin, sclera,
and urine
• Liver disease • Any drug which suppresses
 Cardiac impairment/heart failure the immune system (e.g.
 Pregnancy Risk Category D prednisone) may increase risk
for myelosuppression
Haloperidol Haldol First Generation Antipsychotics
High potency
 Block dopamine (D2), acetylcholine,  Suppresses symptoms of • Give oral dose with food and/or
histamine, and norepinephrine schizophrenia full glass of water to prevent GI
receptors in the brain and periphery.  Acute manic phase of bipolar effects
 Inhibition of psychotic disorder • Have patient swallow sustained
manifestations, believed to be a  Relieves nausea/vomiting through release form whole
result of D2 blockade in the brain blocking of dopamine in the CTZ • Give IM injection in large
 Intractable hiccups muscle; rotate sites
 Tourette syndrome • Keep patient recumbent for
30 minutes after IM or IV dose
due to possible hypotension
EPS: Acute dystonia • Be prepared to administer IM • Instruct patient to notify
 Spasm of tongue, face, neck, and or IV anticholinergic, such as provider for severe spasms of
back diphenhydramine, if this occurs the neck and body
 Occurs hours to days following the
first dose
EPS: Parkinsonism • Treat on short-term basis with • Instruct patient to notify
 Bradykinesia, rigidity, shuffling gait, anti-Parkinson drugs (benztropine, provider if muscle rigidity,
drooling, and tremors diphenhydramine, or amantadine) tremors, and sluggish
 First month of therapy • Possibly switch to an atypical movements, drooling, and
antipsychotic shuffling gait occur
EPS: Akathisia • Treat with beta blocker or • Instruct patient to notify
 Patient unable to stand still or sit, Benzodiazepine or anticholinergic provider for feelings of inner
and is continually pacing and agitated drugs restlessness, inability to sit still
 Occurs within first 2 months of • Possibly switch to an atypical
therapy antipsychotic
EPS: Tardive dyskinesia • Monitor for these irreversible • Instruct patient to notify
 Involuntary twisting movements of symptoms provider if involuntary
the tongue and face, such as lip- • Switch patient to an atypical movements of tongue, face,
smacking, which cause speech and/or antipsychotic limbs, trunk begin to occur
eating disturbances
 Months to years after therapy
begins
Neuroleptic malignant syndrome  Stop antipsychotic medication • Instruct patient to report sudden
 High fever, rigidity, VS instability,  Monitor vital signs fever immediately to provider
loss of consciousness, blood pressure  Apply cooling blankets
fluctuations, dysrhythmias,  Administer antipyretics (aspirin,
diaphoresis, drooling. acetaminophen)
 (more common with haloperidol  Increase fluid intake
and other high-potency drugs than  Administer diazepam to control
chlorpromazine) anxiety
 Administer dantrolene and
bromocriptine to induce muscle
relaxation
 Wait 2 weeks before resuming
therapy. Consider switching to an
atypical agent
Anticholinergic effects: dry mouth, • Monitor patient for dry mouth, • Chew gum or suck hard candy
constipation, urinary retention, constipation, and urinary to treat dry mouth
blurred vision, tachycardia retention • Increase fluids/fiber to prevent
constipation
• Urinate just before taking drug
dose
Orthostatic hypotension  Clients should develop tolerance in  Sit or lie down if lightheaded or
From alpha1-adrenergic receptor 2 to 3 months dizzy
blockade on blood vessels  In the hospital setting, monitor BP  Slowly get up or change positions
and heart rate for orthostaic changes.
If a significant decrease in BP or
increase in HR is noted, do not
administer the medication, and notify
the provider
Sedation  Give the mediation at bedtime to  Effects should diminish within a few
From blockade of histamine1 avoid daytime sleepiness weeks
receptor in the CNS  Do not drive until sedation has
subsided
Neuroendocrine effects:  Observe for manifestations and
gynecomastia, galactorrhea, and notify the provider if they occur
menstrual irregularities
Seizures  An increase in antiseizure  Report seizure activity to the

medication can be necessary provider
Sexual dysfunction: suppressed • Counsel patient about sexual • Encourage patient to report
sexual drive, erectile dysfunction dysfunction these symptoms
• Change to different
Antipsychotic (high potency)
Agranulocytosis  If indications of infection appear,  Observe for indications of

obtain a baseline WBC infection(fever, sore throat), and to
 Medication should be discontinued notify the provider of these occur.
if laboratory tests indicate the
presence of infection
Severe dysrhythmias • Monitor vital signs, periodic • Instruct patient to report
Prolongation of the QT interval ECG and serum potassium palpitations, fainting spells,
levels other cardiac symptoms
Skin effects: photosensitivity, • Wear gloves when handling • Instruct patients to wear gloves
dermatitis phenothiazines to prevent when handling phenothiazines
(phenothiazine drugs) personal dermatitis • Instruct patients to avoid sun
exposure, use sunscreen,
protective clothing, sun glasses
• Allergy to phenothiazine • COPD  Anticholinergic drugs increase
antipsychotic drugs • Glaucoma anticholinergic effects
• Alcohol withdrawal • Diabetes mellitus
• Bone marrow suppression • Hypertension
• CNS depression • Prostatic hypertrophy  CNS depressants (alcohol, opioids,
• Reye’s syndrome • History of breast cancer and antihistamines) have additive
• Children younger than 6 • Thyroid, cardiac, liver disorders CNS depressant effects
months  Levodopa counteracts the effects of
antipsychotic agents
Clozapine Clozaril, FazaClo, Versacloz Second generation antipsychotic
Olanzapine Zyprexa
 Works mainly by blocking  Schizophrenia – most effective  Clozapine- Tablets, orally
serotonin, and to a lesser degree, agent disintegrating tablets
dopamine receptors.  Psychotic episodes induced by  Olanzapine- tablets, orally
 Also blocks receptors for levodopa therapy disintegrating tablets, short-acting
norepinephrine, histamine, and  Bipolar disorders injectable, extended-release injection
acetylcholine  Olanzapine- treatment-resistant
 More effective with fewer adverse major depression (in combination
effects with fluoxetine)
Agranulocytosis  If indications of infection appear,  Observe for indications of
No risk with Olanzapine obtain a baseline WBC and ANC infection(fever, sore throat), and to
Olanzapine- leukopenia/neutropenia (absolute neutrophil count) notify the provider of these occur.
 Medication should be discontinued
if laboratory tests indicate the
presence of infection
Metabolic effects: weight gain, • Monitor weight, blood glucose, • Instruct patient to increase
diabetes, and dyslipidemia and cholesterol/triglyceride exercise, eat a diet low in
High risk with Clozapine and levels periodically sugar, fat, and calories
olanzapine • Instruct patient to report
polyuria, polydipsia (possible
symptoms of diabetes)
• Instruct diabetic patients to
monitor blood glucose more
closely
Seizures  An increase in antiseizure  Report seizure activity to the
medication can be necessary provider
EPS: Acute dystonia LOW RISK • Be prepared to administer IM • Instruct patient to notify
 Spasm of tongue, face, neck, and or IV anticholinergic, such as provider for severe spasms of
back diphenhydramine, if this occurs the neck and body
 Occurs hours to days following the
first dose
EPS: Parkinsonism LOW RISK • Treat on short-term basis with • Instruct patient to notify
 Bradykinesia, rigidity, shuffling gait, anti-Parkinson drugs (benztropine, provider if muscle rigidity,
drooling, and tremors diphenhydramine, or amantadine) tremors, and sluggish
 First month of therapy • Possibly switch to an atypical movements, drooling, and
antipsychotic shuffling gait occur
EPS: Akathisia LOW RISK • Treat with beta blocker or • Instruct patient to notify
 Patient unable to stand still or sit, Benzodiazepine or anticholinergic provider for feelings of inner
and is continually pacing and agitated drugs restlessness, inability to sit still
 Occurs within first 2 months of • Possibly switch to an atypical
therapy antipsychotic
EPS: Tardive dyskinesia LOW RISK • Monitor for these irreversible • Instruct patient to notify
 Involuntary twisting movements of symptoms provider if involuntary
the tongue and face, such as lip- • Switch patient to an atypical movements of tongue, face,
antipsychotic limbs, trunk begin to occur
smacking, which cause speech and/or
eating disturbances
 Months to years after therapy
begins
Anticholinergic effects: dry mouth, • Monitor patient for dry mouth, • Chew gum or suck hard candy
constipation, urinary retention, constipation, and urinary to treat dry mouth
blurred vision, tachycardia retention • Increase fluids/fiber to prevent
constipation
• Urinate just before taking drug
dose
Orthostatic hypotension  Clients should develop tolerance in  Sit or lie down if lightheaded or
From alpha1-adrenergic receptor 2 to 3 months dizzy
blockade on blood vessels  In the hospital setting, monitor BP  Slowly get up or change positions
and heart rate for orthostaic changes.
If a significant decrease in BP or
increase in HR is noted, do not
administer the medication, and notify
the provider
Sedation  Give the mediation at bedtime to  Effects should diminish within a few
From blockade of histamine1 avoid daytime sleepiness weeks
receptor in the CNS  Do not drive until sedation has
subsided
Neuroendocrine effects:  Observe for manifestations and
gynecomastia, galactorrhea, and notify the provider if they occur
menstrual irregularities
Sexual dysfunction: suppressed • Counsel patient about sexual • Encourage patient to report
sexual drive, erectile dysfunction dysfunction these symptoms
• Change to different
Antipsychotic (high potency)
Myocarditis  Report unexplained fatigue,

dyspnea, tachypnea, chest pain,
palpitations

• Severe CNS depression • Older adults  Immunosuppressive medications
• Prolonged QT on ECG • Parkinson’s disease can further suppress immune
• Psychosis related to dementia • Liver or renal disorders function
in older adults (increase risk of • Heart failure, cardiac  CNS depressants (alcohol, opioids,
stroke) dysrhythmias, or MI and antihistamines) have additive
• Exposure to sunlight • Hypotension CNS depressant effects
• Lactation • Seizure disorders  Levodopa counteracts the effects of
• Children (<5 for autism; <10 for • Fluid or electrolyte disturbances antipsychotic agents
BPD; <13 for schizophrenia) • Diabetes mellitus  Cytochrome P450 inducers
• CNS depression (phenytoin, rifampin) lower clozapine
levels
 Cytochrome P450 inhibitors
(ketoconazole, erythromycin) raise
clozapine levels
Fluoxetine Prozac Antidepressant
Selective serotonin reuptake inhibitor
 SSRIs selectively block reuptake of  Major depression • Give orally in tablets, capsules,
the monoamine neutrotransmitter  Bipolar disorder solution, or sustained-release
serotonin in the synaptic space,  Obsessive-compulsive disorders weekly capsules (fluoxetine).
thereby intensifying the effects of  Panic disorder • Recognize that it may take 4
serotonin.  Bulimia nervosa to 6 weeks to reach clinical
 SSRIs are considered first-line  Premenstrual dysphoric disorder effectiveness.
treatment for depression. Can take 1- (PMD) – reduce depression, anger, • Administer with food if
3 weeks or longer before irritability, tension, dysphoria, gastrointestinal upset occurs.
pharmacological benefits take effect. fatigue, and confusion • Give in the morning to prevent
 Unlabeled uses: PTSD, social sleep disruption.
phobia, alcoholism, ADHD, migraine,  For PMD – every day throughout
Tourette’s syndrome the menstrual cycle or just during the
luteal phase
Sexual dysfunction: anorgasmia, • Monitor for this effect. • Report impotence and
impotence, decreased libido • Reducing dosage or changing decreased libido.
antidepressant drugs may
relieve this effect.
 Discontinuing medication
temporarily (medication holiday), and
using adjunct medications to improve
sexual dysfunction (Viagra)
 Inform clients that an atypical
antidepressant such as bupropion has
fewer sexual dysfunction adverse
effects.
Weight gain (long term therapy) • Monitor weight weekly • Eat a healthful diet and
Weight loss (in early therapy) throughout therapy. increase exercise.
Serotonin syndrome: • Monitor for mental confusion, • Report increased anxiety, fever,
mental confusion, delirium, difficulty concentrating, excessive sweating, tremors,
tachycardia, elevated blood pressure, fever, agitation, anxiety, and hallucinations.
abdominal pain, diarrhea, irritability, hallucinations, incoordination, • Stop taking the drug.
mood swings, agitation, anxiety, hyperreflexia, diaphoresis, and
restlessness, incoordination, tremors.
hyperreflexia, diaphoresis, tremors, • Discontinue the drug.
muscle spasms, cardiovascular shock,
seizures, death
Withdrawal syndrome  Taper dose gradually. Do not
Headache, nausea, visual abruptly discontinue.
disturbances, anxiety, dizziness,
tremor, dysphoria
CNS stimulation: insomnia, agitation, • Monitor for these effects; • Report these effects.
anxiety, nervousness decreased dosage may relieve • Take the drug in the morning to
symptoms. avoid interference with sleep.
 Avoid caffeinated beverages
 Teach relaxation techniques to
promote sleep
Increased risk for suicidal ideation • Monitor for increased • Understand that this is a risk.
(especially children, adolescents, and depression/suicidal ideation • Report any worsening of
young adults) depression or thoughts of
suicide.
Bruxism: clenching and grinding of  Changing to a different  Report to provider

teeth classification of antidepressants or  Use a mouth guard
adding a low dose of buspirone can
decrease this adverse effect
GI bleeding  Use caution in clients who have a  Report sxs of bleeding
Because platelets need serotonin for history of GI bleed and ulcers, and
aggregation those taking other medications that
affect blood coagulation
Hyponatremia • Monitor serum sodium • Report lethargy, abdominal
Serum sodium below 135 mEq/L periodically. cramps, diarrhea, and nausea.
Especially in older adults and those • Observe for signs of
taking diuretics hyponatremia, such as lethargy,
abdominal cramps, diarrhea,
and nausea
Other A/E:
 Rash
 Dizziness, fatigue, faintness
 EPS
Pregnancy Risk category C • Liver disease • Taking an SSRI within 2 weeks
• Allergy to any SSRI drug • Older adults of MAOIs or another SSRI
• Children younger than 7 to • Peptic ulcer disease/history of GI increases the risk of serotonin
8 years (fluoxetine). bleeding syndrome.
• Use with MAOIs or TCA • Diabetes mellitus (may • Fluoxetine increases levels of
decrease glucose control) tricyclic antidepressants and
• Hyponatremia lithium.
• Cardiac disease • NSAIDs increase the risk of
• Suicidal tendencies gastrointestinal bleeding.
Venlafaxine Effexor XR Antidepressant
Serotonin-norepinephrine reuptake
inhibitors
 SNRIs block reuptake of  Major depression • Start with low doses and titrate
norepinephrine as well as serotonin  Generalized anxiety disorder upward every 4 days until
with effects similar to the SSRIs  Social anxiety disorder optimal dosage is reached
 Panic disorder (venlafaxine).
• Give with food to minimize
gastrointestinal symptoms.
• Make sure patients swallow
sustained-release capsules
whole.
Nausea, vomiting, anorexia, weight • Monitor for these common • Take the drug with food.
loss, headache, insomnia, effects. • Report headache.
nervousness, sweating • Monitor for weight loss related • Take over-the-counter
to anorexia. analgesics as needed.
• Monitor for these effects; Take the drug in the morning to
decreased dosage may relieve avoid interference with sleep.
symptoms.
Hypertension • Monitor blood pressure. • Have blood pressure checked
regularly.
Sexual dysfunction: anorgasmia, • Monitor for this effect. • Report impotence and
impotence, decreased libido • Reducing dosage or changing decreased libido.
antidepressant drugs may
relieve this effect.
 Discontinuing medication
temporarily (medication holiday), and
using adjunct medications to improve
sexual dysfunction (Viagra)
 Inform clients that an atypical
antidepressant such as bupropion has
fewer sexual dysfunction adverse
effects.
Dizziness, blurred vision, mydriasis Avoid driving, use of machinery until
(dilation of pupils) effects are known
Serotonin syndrome: • Monitor for mental confusion, • Report increased anxiety, fever,
mental confusion, delirium, difficulty concentrating, excessive sweating, tremors,
tachycardia, elevated blood pressure, fever, agitation, anxiety, and hallucinations.
abdominal pain, diarrhea, irritability, hallucinations, incoordination, • Stop taking the drug.
mood swings, agitation, anxiety, hyperreflexia, diaphoresis, and
restlessness, incoordination, tremors.
hyperreflexia, diaphoresis, tremors, • Discontinue the drug.
muscle spasms, cardiovascular shock,
seizures, death
Withdrawal syndrome  Taper dose gradually. Do not
Headache, nausea, visual abruptly discontinue.
disturbances, anxiety, dizziness,
tremor, dysphoria
suicide.
Hyponatremia • Monitor serum sodium • Report lethargy, abdominal

Serum sodium below 135 mEq/L periodically. cramps, diarrhea, and nausea.
Especially in older adults and those • Observe for signs of
taking diuretics hyponatremia, such as lethargy,
abdominal cramps, diarrhea,
and nausea
 Pregnancy category risk C. avoid • Liver and kidney disease • Taking SNRIs within 14 days
during the third trimester and avoid • Glaucoma of MAOIs increase the risk of
breasfeeding while taking an SNRI • Cardiac disorders, hypertension serotonin syndrome.
• Allergy to venlafaxine or other • Cimetidine (Tagamet),
SNRIs desipramine (Norpramin), and
• Suicidal ideation haloperidol (Haldol) increase
• Concurrent administration with blood levels of venlafaxine.
MAOIs or within 14 days of last • Trazodone (Desyrel), St.
dose John’s wort, and sour date nut
increase the risk of serotonin
syndrome.
Amitriptyline Antidepressant
Tricyclic antidepressants
 TCAs block reuptake of  Major depression • Give orally at bedtime.
norepinephrine and serotonin in the  Depressive episodes of bipolar • Monitor for therapeutic effects
synaptic space, thereby intensifying disorders after 1 to 3 weeks.
the effects of these  Fibromyalgia syndrome • Expect long-term use to control
neurotransmitters  Other uses: neuropathic pain, depression.
 It can take 10 to 14 days or longer chronic insomnia, ADHD, panic
before TCAs begin to work, and disorder, OCD
maximum effects might be not seen
until 4 to 8 weeks.
Orthostatic hypotension • Monitor orthostatic vital signs • Do not drive or perform
Blockade of alpha1-adrenergic hazardous activities if drowsy.
receptors on blood vessels, causing • Move slowly from lying to sitting
no vasoconstriction when getting up or standing.
Anticholinergic effects • Monitor for these effects. • Urinate before taking the daily
 By blocking muscarinic cholinergic dose.
receptors • Increase fiber and fluids to
 Dry mouth, constipation, urinary prevent constipation.
retention, blurred vision, • Chew gum, suck on hard
photophobia, tachycardia candy, or sip water to prevent
dry mouth.
Drowsiness, sedation • Monitor for sedation and, if • Take at bedtime to prevent
 By blockade of histamine receptors it occurs, take measures to daytime drowsiness.
in the CNS prevent falls. • Do not drive or perform
 Sweating hazardous activities if drowsy.
Cardiac toxicity • Assure that patients have no • Take the drug exactly as
 Resulting in cholinergic blockade more than a 1-week supply of prescribed.
and cardiac toxicity evidenced by the drug.
dysrhythmias, mental confusion, and • For overdose, prepare for
agitation, followed by seizures, coma, gastric lavage and administer
and possible death physostigmine to treat
anticholinergic effects and
lidocaine to treat ventricular
dysrhythmias.
 Obtain baseline ECG
 Monitor VS frequently
Decreased seizure threshold Monitor clients who have seizure
disorder
Hypomania: mild mania  If hypomania develops, the patient

should be evaluated to determine
whether elation is drug induced or
the result of bipolar disorder
suicide.

 Pregnancy category risk C. • Angle closure glaucoma • CNS depressants increase
• Allergy to TCAs • Prostatic hypertrophy sedation.
• Children younger than 12 years • History of urinary retention • Levodopa/carbidopa and
• Recent acute myocardial • Liver or renal disorders sympathomimetic drugs
infarction • Suicidal ideation may cause increased effects
• Cardiac dysrhythmias • History of electroconvulsive of those drugs, such as
• Seizure disorder history therapy hypertension.
• Concurrent use with MAOIs • Schizophrenia  Increased effects of epinephrine,
• Hematologic or respiratory dopamine (direct-acting
disorders sympathomimetics) occur because
• Diabetes mellitus uptake into the nerve terminals is
• Alcohol use disorder blocked by TCAs.
• Administration within 2
weeks of MAOIs may cause
hypertensive crisis.
• Cimetidine (Tagamet) and
methylphenidate (Ritalin)
increase amitriptyline levels.
• Anticholinergic drugs (such
as antihistamines) increase
anticholinergic effects.
• Ginkgo biloba increases the risk
of seizures; St. John’s wort may
cause serotonin syndrome
Phenelzine Nardil Antidepressant
Monoamine Oxidase Inhibitor
 MAOIs block MAO, which coverts  Depression which has not • Begin with lowest dose and
monoamine neurotransmitters into responded to other classes of titrate upward
inactive products, in the brain, antidepressants • When discontinuing, titrate
thereby increasing the amount of  Atypical depression dose downward to prevent
norepinephrine, dopamine,  Bulimia nervosa rebound effect (headache,
serotonin, and tyramine available for  Panic disorder restlessness, sometimes
transmission of impulses. An  Social anxiety disorder increased depression)
increased amount of these  Generalized anxiety disorder
neurotransmitters at nerve endings  Obsessive-compulsive disorder
intensifies responses and relieves  AHDH
depression.  Agoraphobia
CNS stimulation: anxiety, agitation, • Monitor for anxiety, insomnia, • Report extreme anxiety,
mania, or hypomania, insomnia Agitation insomnia, agitation to the
provider
Orthostatic hypotension • Monitor orthostatic vital signs • Do not drive or perform

hazardous activities if drowsy.
• Move slowly from lying to sitting
or standing.
Hypertensive crisis from dietary • Monitor BP carefully throughout • Provide patient, caregiver or
tyramine treatment significant other a list of foods
 Severe hypertension, headache, • Give patient a list of food to may contain tyramine
nausea, tachycardia, confusion, avoid
diaphoresis • Assess patient to determine
willingness and ability to follow
special diet
• If hypertensive crisis occurs,
prepare to administer IV
phentolamine or sublingual
nifedipine
• Allergy to MAOIs • Epilepsy • Foods containing tyramine,
• Patients unable to adhere to • Diabetes mellitus tricyclic antidepressants, and
tyramine-free diet • Schizophrenia or mania sympathomimetic drugs cause
• Suicidal ideation hypertensive crisis
• Renal failure • Chocolate and caffeine can
• Liver disorders also cause hypertension
• Pheochromocytoma • Antihypertensive drugs may
• Cardiac disease cause hypotension
• Patients older than 60 years • Meperidine (Demerol) causes
• Children younger than 6 years fever
• Patients taking SSRIs • SSRI antidepressants may
• Glaucoma cause serotonin syndrome
• Alcohol or drug addiction
Lithium Lithobid Drugs for bipolar disorder
Mood stabilizer
 Lithium produces neurochemical  Acute mania • Give with milk or meals to
changes in the brain, including  Controls acute manic episodes in prevent GI effects
serotonin receptor blockade bipolar disorder (BPD) • Assure that sustained release
 There is evidence that the use of  Long-term prophylaxis against tablets are swallowed whole
lithium can slow a decrease in recurrent of mania or depression
neuronal atrophy and/or an increase
in neuronal growth
 GI effects: nausea, diarrhea, • Monitor for early, transient • Instruct patient to take lithium
abdominal pain effects with food
 Transient fatigue, muscle • Differentiate transient from toxic • Advise patient to inform
weakness, headache, confusion, effects by monitoring lithium provider if these effects do not
memory impairment levels subside or become worse
• Instruct patient not to drive
or perform hazardous tasks if
drowsiness occurs
Tremor: fine hand tremors • Give prescribed beta blocker, like • Advise patient to avoid caffeine,
propranolol, to stressors, which can increase
decrease tremor tremors
• Monitor for increasing tremor • Instruct patient to notify
 Adjust to the lowest possible provider for worsening tremor
dosage, give in divided doses, or use
long-acting formulations
Polyuria, mild thirst • Monitor fluid intake and output • Instruct patient to drink 8 to 12
• Monitor for electrolyte glasses of fluid/day to prevent
Imbalance dehydration
 Use a potassium-sparing diuretic,
such as spironolactone
Renal toxicity  Adjust dosage and keep dose low  Avoid long-term lithium therapy
 Assess baseline kidney function,
and monitor kidney function
periodically
Goiter and hypothyroidism • Monitor thyroid function tests • Instruct patient to report signs
 Lithium reduces incorporation of yearly of hypothyroidism (cold, dry skin;
iodine into thyroid hormone • Monitor for signs of decreased heart rate; weight gain) or
Hypothyroidism neck
 Administer levothyroxine to swelling
manage hypothyroid effects
Lithium toxicity • Monitor serum lithium levels; • Instruct patient to recognize
 Early indications <1.5 mEq/L  should be below 1.5 mEq/L signs of toxicity and notify
diarrhea, nausea, vomiting, thirst, initially and below 1.0 mEq/L provider
polyuria, muscle weakness, fine hand long term • Instruct patient to consume
tremor, slurred speech, lethargy • Monitor sodium levels (low adequate amounts of food
 Advanced indication 1.5-2.0 mEq/L sodium can cause toxicity) containing sodium
 GI distress, mental confusion, poor • Recognize symptoms of toxicity
coordination, coarse tremors, to prevent severe effects
sedation • Monitor kidney function during
 Severe toxicity 2.0-2.5 mEq/L  treatment
extreme polyuria of dilute urine,
tinnitus, involuntary extremity
movements, blurred vision, ataxia,
seizures, severe hypotension leading
to coma and possibly death from
respiratory complications
• Pregnancy Category D, • Thyroid disorders  Diuretics increase the risk of lithium
lactation • Older adults toxicity
• Severe renal insufficiency • Seizure disorders  NSAIDs (except aspirin) increase
• Moderate to severe cardiac • Suicidal ideation renal reabsorption of lithium leading
disorders • Diabetes mellitus to toxicity
• Dehydration, decreased serum • Urinary retention Anticholinergics (antihistamine and
sodium or low salt diet TCAs) can induce urinary retention
• History of angioedema caused and polyuria, leading to abdominal
by ACE inhibitors discomfort
Valproic acid/Valproate Depakote, Depacon, Depakene Drugs for bipolar disorder
Mood-stabilizing antiepileptic drugs
 Slowing the entrance of sodium and  Controls mania in bipolar disorder • Available orally or IV
calcium back into the neuron and,  Treatment and prevention of • Give enteric-coated form and
thus, extending the time it takes for relapse of mania and depressive administer with food to prevent
the nerve to return to its active state episodes GI symptoms
 Potentiating the inhibitory effects  Treats all seizure types • Dilute IV form in at least 50 mL
of gamma butyric acid (GABA) of diluents and do not mix with
 Inhibiting glutamic acid other drugs in solution
(glutamate), which in turn suppresses • Depakote sprinkles may be
CNS excitation opened and sprinkled on food
(e.g., applesauce) before
consuming
 GI effects: nausea, vomiting, Give with food  Advise patients that manifestations
indigestion • Use ER form are usually self-limiting
• Add H2 antagonist, such as  Advise patients to take medication
Famotidine with food or switch to enteric-coated
pills
Hepatotoxicity • Monitor liver function tests • Instruct patient to report
Anorexia, nausea, vomiting, fatigue, before treatment and abdominal pain, jaundice,
abdominal pain, jaundice periodically during therapy nausea, anorexia to provider
• Assure that patient takes lowest
effective dose
Pancreatitis • Monitor serum amylase if • Instruct patient to report
Nausea, vomiting, abdominal pain symptoms occur nausea, vomiting, abdominal
pain to provider
Thrombocytopenia • Monitor bleeding time, platelet • Instruct patient to report

Bruising, bleeding, prolonged count bruising or bleeding to provider
bleeding time, decreased platelets • Assess for bruising, bleeding
Weight gain  Advise patients to follow a healthy

low-calorie diet, engage in regular
exercise, and monitor weight

• Pregnancy Risk Category D, • Kidney disease • Increases blood levels of
lactation • Older adults phenytoin and phenobarbital
• Liver disorders • Children under the age of 10 • Use with topiramate increases
• Taking other anticonvulsants risk for hyperammonemia
• Thrombocytopenia
• Hyperammonemia
Diazepam Valium Sedative-hypnotic drugs
Benzodiazepines
 Benzodiazepines enhance the  Anxiety and anxiety disorders • Take oral benzodiazepines
inhibitor effects of gamma-  Insomnia with food if gastrointestinal
aminobutyric acid (GABA) in the CNS.  Panic disorders symptoms develop.
Relief from anxiety occurs rapidly  Skeletal muscle spasm and • Give diazepam orally, rectally,
following administration spasticity IM, or IV.
 When GABA binds to its receptor,  Seizure disorders – treats status • Administer IV diazepam
the chloride channel opens and epilepticus slowly and have emergency
hyperpolarizes the neuron, thereby  Acute alcohol withdrawal resuscitation equipment nearby.
decrease its ability to fire. symptoms • Take care to avoid intra-arterial
 Induction of anesthesia IV diazepam administration or
extravasation into tissue.
• Be aware that IV diazepam
precipitates in solution with
some diluents and drugs.
• Do not give the emulsion form
IM (IV only).
• Avoid IM diazepam due to
inconsistent absorption; if
necessary, inject slowly into a
large muscle.
CNS depressant: sedation, • Monitor patients to prevent • Instruct patients to use care
lightheadedness, ataxia, decreased falls and other injury following with ambulation and when
cognitive function administration. driving or using hazardous
Sleep driving, preparing and eating equipment.
meals, making phone calls
Anterograde amnesia (impaired recall • Assess patient’s memory • Advise patients that amnesia
of events after dosing) following administration. may occur.
Respiratory depression • Monitor vital signs, especially • Instruct patients to avoid

Only with IV with IV administration. increasing the prescribed dose.
• Instruct patients to change
positions slowly to prevent falls.
Paradoxical reaction: insomnia, • Monitor patients, especially • Instruct patients to stop

excitation, euphoria, anxiety, rage older adults, for a paradoxical taking the drug and inform
reaction. the provider if a paradoxical
reaction occurs.
Withdrawal symptoms: anxiety, • Taper over 1 to 2 weeks to • Instruct patients to taper

insomnia, diaphoresis, tremors, prevent or minimize withdrawal. the drug slowly to prevent
lightheadedness, delirium, • Monitor for signs of withdrawal withdrawal symptoms.
hypertension, muscle twitching,
seizures
Toxicity • Reverse sedation with IV • Instruct patients to take the
Oral- drowsiness, lethargy, confusion flumazenil. drug as prescribed and avoid
IV – respiratory depression, severe • Manage oral overdose with the use of other depressants.
hypotension, or cardiac/respiratory gastric lavage, activated
arrest charcoal, saline cathartics, and
dialysis.
• Provide airway and blood
pressure support as needed for
parenteral overdose.
• Pregnancy Category D, • Older adults, children under 18 • The risk of severe sedation and
lactation (alprazolam); respiratory depression increase
• Schedule IV controlled • Renal or hepatic impairment when taken concurrently
substances • Mental health disorders, with other CNS depressants
• Glaucoma suicidal ideation, addiction risk (alcohol, opioids, other
• Coma, shock, neonates, labor/ • Chronic respiratory disorders benzodiazepines).
delivery (IV diazepam) • Neuromuscular disorders • Cimetidine (Tagamet) increases
Sleep apnea benzodiazepine levels.
• Smoking decreases the effects
of benzodiazepines.
• Kava kava and valerian
increase the risk for sedation.
• Disulfiram (Antabuse) and
fluoxetine (Prozac) increase
alprazolam levels.
Zolpidem Ambien Sedative-hypnotic drugs
Non-Benzodiazepines
 Enhance the action of GABA in the  Short term treatment of insomnia  Available in immediate-release
CNS. This results in prolonged sleep tablet, extended-release tablets, oral
duration and decreased awakenings. spray, sublingual tablets
These medications do not function as  All formulations have rapid onset
antianxiety, muscle relaxant, or and hence should be taken just
antiepileptic agents. before bedtime
 Binds to the benzodiazepine1
receptor site on the GABA receptor-
chloride channel complex
 There is low risk of tolerance,
substance use disorder, and
dependence
Daytime sleepiness and  Administer medication at bedtime  Advise patients to take medication
lightheadedness, headache allowing for at least 8 hr of sleep
Sleep driving and other sleep-related  Advise patients that more rapid
complex behaviors absorption occurs when the
medication is taken when the
stomach is empty
• Pregnancy Category C,  Older adult CNS depressants such as alcohol,
lactation  Impaired kidney, liver, or barbiturates, opioids cause additive
• Schedule IV controlled respiratory function CNS depression
substances
Conjugated estrogens Premarin Estrogens

 Estrogens are hormones needed for  Relief of severe menopausal Oral:
growth and maturation of the female symptoms (vasomotor) and vulvar • Take according to the precise
reproductive tract, development of and vaginal atrophy – hot flashes, dosing schedule, typically
secondary sex characteristics, and are mood changes continuously to avoid monthly
active in the follicular phase of the  Prevention of postmenopausal bleeding.
menstrual cycle. osteoporosis • Take pills at the same time
 Estrogens block bone resorption each day.
and reduce low-density lipoprotein Transdermal estradiol patches:
(LDL) levels. At high levels, estrogens • Apply patches at the
suppress the release of a follicle- recommended interval, typically
stimulating hormone (FSH) needed once or twice per week.
for conception. • Apply to clean, dry, intact skin
 Estrogens also can promote or on the abdomen or trunk (not
suppress blood coagulation breasts or waistline) and press
firmly for 10 seconds.
• Do not use the same site more
than once per week.
Intravaginal estradiol hemihydrates
tablets (Vagifem) or
vaginal cream (Estrace vaginal
cream):
• Use according to the precise
dosing schedule, typically
tablets are inserted once daily
for 2 weeks, then twice per
week
• Insert tablet using provided
applicator at bedtime.
• Vaginal cream is applied
using a reusable applicator
to measure the precise dose;
insert into vagina at bedtime.
Nausea • Inform patients that this effect • Take oral forms with food.
diminishes with time. • Take, apply, or instill at bedtime.
Endometrial and ovarian cancers • Monitor for vaginal bleeding. • Report persistent or recurrent
When estrogen is used alone for • Advise a yearly pelvic vaginal bleeding.
postmenopausal therapy Examination and endometrial biopsy
every 2 years
• Check that patients who have
an intact uterus are prescribed
progesterone with their
estrogen.
Potential risk for estrogen-dependent  Rule out estrogen-dependent • Perform self-breast examination
breast cancer breast cancer prior to starting every month.
Most often in postmenopausal therapy • Obtain a mammogram and
women who use estrogen with  Encourage clients to examine their breast examination at the
progestin breasts regularly. Obtain yearly recommended intervals.
breast exams by a provider, and
periodic mammograms
Embolic events • Monitor for and report any • Report leg or chest pain, leg
 MI, pulmonary embolism, DVT, indications of deep-vein edema, sudden change in
stroke thrombosis, pulmonary vision, severe headache, or
 Women older than 60 have embolism, myocardial shortness of breath.
increased risk of myocardial infarction, and cerebrovascular • Do not smoke.
infarction and coronary heart disease accident. • Stop taking at least 4
• Encourage patients who smoke weeks before any surgery
to quit smoking. that increases the risk of
• Use HRT for no more than 3 thromboembolic events.
to 4 years to treat vasomotor • Exercise regularly and follow a
or genital symptoms of healthy, low-fat diet.
menopause.
• Pregnancy Category X • Hypertension Rifampin, ritonavir (Norvir),
• History of or other risk for • Gall bladder disease phenobarbital, carbamazepine
thromboembolic events • Diabetes mellitus (Tegretol), primidone
• Suspected or confirmed breast, • Heart disease (Mysoline), phenytoin (Dilantin),
vaginal, cervical, or endometrial • Migraines and St. John’s wort can reduce
cancer • Kidney dysfunction the effectiveness of estrogens.
• Liver disease  Breastfeeding • Estrogens can reduce the
• Undiagnosed vaginal bleeding  Prepubescent girls effects of warfarin (Coumadin)
and hypoglycemic drugs.
• Estrogens can increase
levels of theophylline (Theo-
24), diazepam (Valium),
chlordiazepoxide (Librium), and
tricyclic antidepressants.
Norethindrone Progesterone

 Progesterone induce favorable  Contraception “minipill” • Give orally daily or cyclically or
conditions for fetal growth and  Progestins counter adverse effects via IM injection.
development and maintain of estrogen in menopausal hormone • Expect amenorrhea and other
pregnancy. A drop in progesterone therapy menstrual irregularities.
levels results in menstruation  Treatment of endometriosis
 Contraceptive effects: altering  Treatment of dysfunctional uterine
cervical secretions. Cervical glands bleeding
produce a thick, sticky mucus that  Treatment of endometrial
acts as a barrier to penetration by carcinoma
sperm  Treatment of amenorrhea
 Modify the endometrium, making it  Can be used in women who are
less favorable for implantation undergoing IVF, and in some clients
to prevent preterm birth
Breast cancer  Rule out estrogen-dependent • Perform self-breast examination
In postmenopausal women in breast cancer prior to starting every month.
combination with estrogen therapy • Obtain a mammogram and
 Encourage clients to examine their breast examination at the
breasts regularly. Obtain yearly recommended intervals.
breast exams by a provider, and
periodic mammograms
Embolic events • Monitor for and report any • Report leg or chest pain, leg
 Women older than 60 have embolism, myocardial shortness of breath.
increased risk of myocardial infarction, and cerebrovascular • Do not smoke.
infarction and coronary heart disease accident. • Stop taking at least 4
 Unlikely with minipill progestin only • Encourage patients who smoke weeks before any surgery
OC to quit smoking. that increases the risk of
menopause.
Breakthrough bleeding, amenorrhea,  Obtain baseline breast exam and • Report any unusual
breast tenderness Pap smear breakthrough bleeding
• Monitor the pattern and amount or spotting or changes in
of any reported bleeding. menstrual patterns.
Edema • Monitor weight, BP, I&O • Report unusual weight gain.

• Pregnancy (risk category X) • Asthma Rifampin (Rifadin), ritonavir
• History of or high risk for • Seizures (Norvir), phenobarbital
thromboembolic events • Cerebrovascular accident (Luminal), carbamazepine
• Undiagnosed vaginal bleeding • Migraines (Tegretol), primidone
• Liver disease • Cardiac or kidney dysfunction (Mysoline), phenytoin (Dilantin),
• Cervical, uterine, vaginal, or St. John’s wort, and others can
breast cancer reduce the effectiveness of
progesterones.
• Progesterones may require
adjustments in the dosage of
hypoglycemic drugs.
 Concurrent use with corticosteroids
and anticoagulants can cause
decreased bone density
Ethinyl estradiol/norethindrone Yasmin Combination oral contraceptives

 Oral contraceptives stop  Prevention of pregnancy • Confirm negative pregnancy
conception by preventing ovulation.  Reduction in fluid retention status before starting therapy.
 Estrogen suppresses release of FSH associated with premenstrual • Use an additional method of
from the pituitary syndrome contraception during the first
 Progestin suppresses LH surge  Other benefits include decreased cycle.
 Thicken the cervical mucus and risk for: • Take pills at the same time
alter the endometrial lining to reduce  Uterine and ovarian cancers each day.
the chance of fertilization  Pelvic inflammatory disease • Take according to the precise
 Benign breast disease dosing schedule, typically 21
 Ovarian cysts days of a drug-containing pill
and 7 days of an inactive pill.
• Follow the manufacturer’s
instructions for missed pills,
typically taking one missed
pill with the next pill, two pills
for 2 consecutive days after
2 missed days, and after 3
missed days starting a new
cycle 7 days later with alterative
contraception in the interim.
Breast cancer • Recommend mammograms • Perform self-breast examination
 Can increase the growth of a pre- and breast examinations at every month.
existing breast cancer appropriate intervals. • Obtain a mammogram and
• Discontinue the drug for any breast examination at the
indications of breast cancer. recommended intervals.
Thromboembolism • Monitor for and report any • Report leg or chest pain, leg
 Unlikely with progestin-only OCs embolism, myocardial shortness of breath.
infarction, and cerebrovascular • Do not smoke.
accident. • Stop taking at least 4
• Encourage patients who smoke weeks before any surgery
to quit smoking. that increases the risk of
menopause.
Breakthrough bleeding or irregular  Evaluate for possible pregnancy if  Instruct patients to record duration
uterine bleeding – Progestin two or more menstrual periods are and frequency of breakthrough
missed bleeding
Hypertension • Monitor blood pressure. • Obtain regular blood pressure

 Less likely with ethynyl estradiol checks.
and drospirenone than with other
combination contraceptives
Hyperglycemia  Monitor glucose in patients who
have diabetes mellitus
 Adjust antihyperglycemics as
needed
Hyperkalemia  Monitor potassium levels and ECG
Due to the drospirenone in the drug periodically
 Do not use combination OC with
drospirenone in clients at risk for
hyperkalemia, such as renal
insufficiency or adrenal insufficiency
• Pregnancy (risk category X) • Hypertension • ACE inhibitors and other
• History or other risk for • Diabetes mellitus drugs that can elevate
thromboembolic events • Heart disease serum potassium can
• Suspected or confirmed breast • Migraines cause hyperkalemia (due to
cancer  Gallbladder disease drospirenone).
• Altered liver function • Rifampin (Rifadin), ritonavir
• Altered renal or adrenal (Norvir), phenobarbital
function (estradiol and (Luminal), carbamazepine
drospirenone) (Tegretol), primidone
• Smokers above age 35 (Mysoline), phenytoin (Dilantin),
and St. John’s wort can reduce
the effectiveness of oral
contraceptives.
• Oral contraceptives can
reduce the effects of warfarin
(Coumadin) and hypoglycemic
drugs.
• Oral contraceptives can
increase levels of theophylline
(Theo-24), diazepam (Valium),
chlordiazepoxide (Librium), and
tricyclic antidepressants.
Sildenafil Viagra Drugs for erectile dysfunction
PDE5 Inhibitor
 Augments the effects of nitric oxide  Erectile dysfunction • Take orally 1 hr before sexual
released during sexual stimulation by activity.
inhibiting PDE5 thereby increases and • Take with or without food (but
preserves cGMP levels in the penis. high-fat foods delay effects and
Resulting in enhanced blood flow to reduce peak effects: sildenafil
the corpus cavernosum and penile and vardenafil [Levitra], not
erection. tadalafil [Cialis]).
• Expect effects to last up to 4 hr.
• Do not take within 24 hr of
using nitrates.
• Do not take more than one
dose in a 24-hr period.
Hypotension • Monitor blood pressure. • Report dizziness or fainting.
 Especially in men taking nitrates or • Have blood pressure checked
alpha blockers regularly.
Priapism (persistent erection) • Tell patients about the risk of • Seek medical care immediately
impotence following priapism. for an erection lasting more
• Explain that treatment involves than 4 hr.
aspirating blood from the
corpus cavernosum and
irrigating with a vasoconstrictor.
Nonarteritic ischemic optic • Monitor for vision changes. • Seek medical care immediately
neuropathy for changes in vision.
Irreversible loss of vision
Sudden hearing loss • Monitor for hearing loss. • Stop taking the drug.
• If hearing loss is suspected,
further evaluation should be
done by provider.
Other A/E: headache, flushing,

dyspepsia, nasal congestion,
diarrhea, rash, and dizziness

• Concurrent use of nitroglycerin • Myocardial infarction, • Nitrates (nitroglycerin) increase
or other nitrates cerebrovascular accident, or the risk of life-threatening
• Children potentially fatal dysrhythmias hypotension.
within the past 6 months • CYP3A4 inhibitors (grapefruit
• Unstable angina juice, ketoconazole,
• Heart failure erythromycin, itraconazole
• Hepatic or renal disease [Sporanox], cimetidine
[Tagamet], and others) increase
plasma levels and the risk of
adverse effects.
• Alpha-adrenergic antagonists
such as doxazosin (Cardura)
and drugs used to treat benign
prostatic hypertrophy can cause
orthostatic hypotension.
Finasteride Proscar Drugs for benign prostatic
hyperplasia
5-Alpha-reductase inhibitor
 Decreases usable testosterone,  Benign prostatic hyperplasia • Take orally, with or without food.
dihydrotestosterone, by inhibiting  Male pattern baldness (Propecia) • Crush the tablets if needed.
the converting enzyme, 5-alpha • Expect drug therapy to be
reductase, causing a reduction of the lifelong.
prostate size and increased hair • Ensure that women do not
growth handle the drug, especially if
crushed, due to the possibility
of transdermal absorption.
• Expect therapeutic effects to
take 6 to 12 months.
Reduced libido and ejaculate volume • Tell patients about the • Expect decreases in libido and
possibility of reductions in libido ejaculate volume.
and ejaculate volume.
Reduced prostate-specific antigen • Obtain a baseline PSA level • Undergo regular prostate
(PSA) levels and monitor periodically. cancer screenings.
• Expect PSA levels to decline
with therapy.
• Evaluate any increases
in PSA level, as they may
indicate prostate cancer or
nonadherence to therapy.
Gynecomastia • Monitor for breast enlargement. • Report breast enlargement.
• Evaluate if there is concern for
body image.

• Pregnancy (risk category X) • Liver impairment • Saw palmetto may potentiate
• Female, children • Obstructive uropathy effects.
Tamsulosin Flomax Drugs for benign prostatic
hyperplasia
Alpha1-Adrenergic antagonist
 Decrease dynamic obstruction of  Benign prostatic hyperplasia • Take orally once a day.
the urethra by relaxing smooth • Take at the same time each
muscles of the bladder neck and day, 30 min after the same
prostate meal (such as breakfast).
 Nonselective agents also cause • Swallow the capsules whole; do
vasodilation and can lower blood not crush or chew them.
pressure. These agents are used fro
clients who have BPH and
hypertension
Reduced ejaculate volume, • Tell patients about the • Expect decreases in ejaculate
ejaculation failure, retrograde possibility of altered ejaculation. volume and ejaculation failure.
ejaculation
Floppy iris syndrome following Hold the medication before cataract

cataract surgery surgery
Hypotension, dizziness, nasal • Monitor blood pressure. • Have blood pressure checked
congestion, sleepiness, faintness • Report a drop of 20 mm Hg regularly.
(nonselective alpha blockers, NOT (systolic) or more or a heart • Rise slowly from a reclining or
TAMSULOSIN) rate increase of 15 beats/min or sitting position.
more when rising from lying or • Report dizziness or fainting.
sitting. • Do not engage in dangerous
activities if dizziness occurs or
tends to recur.
• Advise patient this drug will like
need to be taken lifelong.
• Concurrent use of erectile • Renal impairment • Drugs that lower blood pressure
dysfunction drugs such as • History of syncope (antihypertensives, PDE5 inhibitors,
sildenafil (Viagra) • Hypotension and nitroglycerin)
• Females, children can increase hypotensive
effects of nonselective alpha
blockers.
• Erythromycin, itraconazole
(Sporanox), nefazodone
(Serzone), and HIV protease
inhibitors increase levels of
nonselective alpha blockers.
• Cimetidine (Tagamet) may
worsen orthostatic hypotension.

Exam 4 Drugs

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N30163 Examination # 4 Medication List

Respiratory Agents: Oxygen

Mental Health Drugs Amitriptyline

Reproductive Health Drugs Conjugated estrogens

Mechanism of Action Indication/Therapeutic Use Administration

Orthostatic hypotension Monitor blood pressure Instruct patients to get up slowly.

Sedation • Monitor patients when • Do not take prior to driving

Sedation • Monitor patients when • Do not take prior to driving

Produce less analgesia and

Sedation • Monitor patients when • Do not take prior to driving

Mechanism of Action Indication/Therapeutic Use Administration

Contraindications Precaution Interactions

Contraindications Precaution Interactions

Dry mouth • Encourage patient to drink sips • Suck on hard candy.

Headache • Administer mild analgesic as • Use over-the-counter

Bitter aftertaste Encourage patient to suck on • Suck on hard candy.

Contraindications Precaution Interactions

Tremors • Monitor and report tremors. • Notify provider if tremors

Contraindications Precaution Interactions

Contraindications Precaution Interactions

Contraindications Precaution Interactions

Mechanism of Action Indication/Therapeutic Use Administration

GI distress: nausea, vomiting,  Take with food 

Opioid use disorder  Advise clients of the potential for 

Contraindications Precaution Interactions

Mechanism of Action Indication/Therapeutic Use Administration

Contraindications Precaution Interactions

Contraindications Precaution Interactions

Mechanism of Action Indication/Therapeutic Use Administration

Fracutres/bone loss/osteoporosis • Limit drug therapy to the lowest • Perform weight-bearing

Hypomagnesemia  Reports manifestations of

Contraindications Precaution Interactions

Mechanism of Action Indication/Therapeutic Use Administration

Contraindications Precaution Interactions

Mechanism of Action Indication/Therapeutic Use Administration

Contraindications Precaution Interactions

 Aluminum hydroxide:  Monitor electrolyte levels

Calcium carbonate: constipation, acid

Contraindications Precaution Interactions

Mechanism of Action Indication/Therapeutic Use Administration

• Advise patients to increase

Mechanism of Action Indication/Therapeutic Use Administration

• Advise patients to increase

Mechanism of Action Indication/Therapeutic Use Administration

Laxative abuse • Discourage long-term use. • Do not use repeatedly or for

• Advise patients to increase

Toxic magnesium levels Advise clients who have impaired

Dehydration  Monitor I&O  Increase water intake to at least 8

Laxative abuse • Discourage long-term use. • Do not use repeatedly or for

• Advise patients to increase

Contraindications Precaution Interactions

Side Effects/ Adverse Effects Interventions Patient Teaching

Sedation • Monitor patients when • Do not take prior to driving

Contraindications Precaution Interactions

Mechanism of Action Indication/Therapeutic Use Administration

GI: vomiting, diarrhea, constipation

Contraindications Precaution Interactions

Bradycardia  Monitor heart rate Report temporary loss of

Constipation  Monitor for constipation • Instruct patient/caregiver to

Contraindications Precaution Interactions

Myelosuppression • Monitor CBC before treatment • Instruct patient to notify

Contraindications Precaution Interactions

Toxic to tissues with a high