1. Ropivicaine 33.

Toradol
2. Robinul 34. Coumadin
3. Prevacid 35.Lovenox
4. Zofran
5. Phenegran
6. Morphine
7. Dilaudid
8. Fentanyl
9. Benadryl
10. Reglan
11. Versed
12. Cipro
13. Levaquin
14. Clindamycin
15. Ancef
16. Apresoline
17. Labetalol
18. Afrin
19. Solu- Cortef
20. Invanz
21. Mefoxin
22. Colace /Dulcolax
23. Vicodin
24. Norco
25. Narcan
26. Romazicon
27. Ativan
28. Vistaril;
29. Demerol
30. Vancomycin
31. Percodan
32. Percocet
Trade Name: Naropin Generic Name: ropivacaine HCl

Patient Dose: 2 mg/mL, 5 mg/mL, 7.5 mg/mL, 10 mg/mL injection

Route: intrathecal injection

Dose Range:
● Surgical Anesthesia
o Epidural 25-200 mg (0.5-1% solution)
o Nerve Block 5-250 mg (0.5%, 0.75% solution)
● Labor Pain
o Epidural 20-40 mg (0.2% solution)
● Postoperative Pain Management
o Epidural 12-20 mg/h (0.2% solution)
o Infiltration 2-200 mg (0.2-0.5% solution)

Classification: Central Nervous System Agent, Local anesthetic (Ester-type)

Action: Blocks the generation and conduction of nerve impulses by increasing the threshold for electrical
excitability

Use Pre/Post-op: Local and regional post-operative anesthesia & post-operative pain management for
obstetrics procedures

Nursing Responsibilities:
● Avoid rapid injection of large volume doses
● Do not use disinfecting agents containing heavy metal ions (Hg, Cu, Zn, etc.) on skin insertion site or to
clean top of vial
● Discard continuous infusion solutions after 24 h
● Store unopened at 20-25 degrees Celsius Monitor carefully cardiovascular & respiratory status
throughout treatment
● Assess for hypotension and bradycardia
● Report immediately S&S of CNS stimulation or CNS depression
● Encourage patient not to breastfeed without consulting physician

Side Effects: Pain, fever, rigors, hypoesthesia, paresthesia, headache, dizziness, anxiety, hypotension,
bradycardia, hypertension, tachycardia, chest pain, fetal bradycardia, nausea, pruritus, urinary retention,
oliguria, anemia

Incompatibility: Additive adverse effects with other local anesthetics. Contraindicated in hypersensitivity to
ropivacaine and other local anesthetics of the amide type, generalized septicemia, inflammation or sepsis at the
proposed injection site, cerebral spinal diseases (meningitis, etc.), heart block, hypotension, GI hemorrhage.
Caution use in pregnancy (B), lactation, debilitated, older adult, acutely ill patients, arrhythmias, shock.
Trade Name: Robinul, Robinul Forte Generic Name: glycopyrrolate

Patient Dose: 1 mg, 2 mg tablets; 0.2 mg/mL injection

Route: PO, IM, IV injection

Dose Range:
● Peptic Ulcer
o PO 1 mg TID or 2 mg BID. or TID. in equally divided intervals (max: 8 mg/d), then decrease to
1 mg BID. 
o IM/IV 0.1–0.2 mg as single dose TID. or QID.
● Reversal of Neuromuscular Blockade
o IV 0.2 mg glycopyrrolate administered with 1 mg of neostigmine or 5 mg pyridostigmine
● Control of Secretions
o PO 40–100 mcg/kg TID–QID. IM/IV 4–10 mcg/kg TID–QID.
o PO 1–2 mg/dose BID. or TID. IM/IV 0.1–0.2 mg/dose given q4–8h

Classification: AUTONOMIC NERVOUS SYSTEM AGENT; ANTICHOLINERGIC

(PARASYMPATHOLYTIC); ANTIMUSCARINIC; ANTISPASMODIC

Action: Synthetic anticholinergic (antimuscarinic) compound with pharmacologic effects similar to those of
atropine. Inhibits muscarinic action of acetylcholine or autonomic neuroeffector sites innervated by
postganglionic cholinergic nerves.

Use Pre/Post-op: Used parenterally as preanesthetic and intraoperative medication and to reverse
neuromuscular blockade.

Nursing Responsibilities:
● Incidence and severity of adverse effects are generally dose related.
● Monitor I&O ratio and pattern particularly in older adults. Watch for urinary hesitancy and retention.
● Monitor vital signs, especially when drug is given parenterally. Report any changes in heart rate or
rhythm.
● Promote good oral hygiene and consider a saliva substitute as dry mouth is a common side effect of this
medication.
● Educate patient on dangers of breastfeeding while taking this medication.
● Educate client on dangers of high-heat environments as this medication can cause reduced sweating.

Side Effects: Decreased sweating, weakness, dizziness, drowsiness, overdosage leading to possible paralysis,
palpitation, tachycardia, constipation, urinary retention, blurred vision.

Incompatibility: Amantadine, ANTIHISTAMINES, TRICYCLIC ANTIDEPRESSANTS, quinidine,

disopyramide, procainamide compound anticholinergic effects; decreases levodopa effects; methotrimeptrazine
may precipitate extrapyramidal effects; decreases antipsychotic effects (decreased absorption) of
PHENOTHIAZINES. Solution/additive: Methylprednisolone, chloramphenicol, dexamethasone, diazepam,
dimenhydrinate, methohexital, pentazocine, phenobarbital, secobarbital, sodium bicarbonate, thiopental. Y-site:
Diazepam, dimenhydrinate, methohexital, pentazocine, phenobarbital, secobarbital, thiopental.
Trade Name: Zofran, Zofran ODT Generic Name: ondansetron HCl

Patient Dose: 4 mg, 8 mg, 24 mg tablets; 4 mg, 8 mg orally disintegrating tablets; 4 mg/5 mL oral solution; 2
mg/mL, 32 mg/5 mL injection

Route: PO, IV injection

Dose Range:
● Nausea and Vomiting
o PO 8 mg 30 min before chemotherapy, then q8h times 2 more doses
o IV 6 mo–18 y, 0.15 mg/kg or 32 mg infused over 15 min beginning 30 min before start of
chemotherapy, followed by 0.15 mg/kg 4 and 8 h after first dose of ondansetron, may also give 8
mg bolus, then 1 mg/h by continuous infusion (max: 32 mg/d), or 32 mg as single dose
● Nausea and Vomiting with Highly Emetogenic Chemotherapy
o PO Single 24-mg dose 30 min before administration of single-day highly emetogenic
chemotherapy
● Postoperative Nausea and Vomiting
o PO 8–16 mg 1 h preoperatively 
o IM 4 mg injected immediately prior to anesthesia induction or once postoperatively if patient
experiences nausea/vomiting shortly after surgery 
o IV 4 mg by slow IV push, may repeat q8h as needed
● Hyperemesis Gravidarum
o PO/IV 4–8 mg 2–3 times per day

Classification: GASTROINTESTINAL AGENT; ANTIEMETIC; 5-HT3 ANTAGONIST

Action: Selective serotonin (5-HT3) receptor antagonist. Serotonin receptors are located centrally in the
chemoreceptor trigger zone (CTZ) and peripherally on the vagal nerve terminals. Serotonin is released from the
wall of the small intestine and stimulates the vagal efferents through the serotonin receptors and initiates the
vomiting reflex.

Use Pre/Post-op: Prevents nausea and vomiting associated with cancer chemotherapy and anesthesia.
postoperative nausea and vomiting.

Nursing Responsibilities:
● Monitor cardiovascular status, especially in patients with a history of coronary artery disease. Rare cases
of tachycardia and angina have been reported.
● Monitor fluid and electrolyte status. Diarrhea, which may cause fluid and electrolyte imbalance, is a
potential adverse effect of the drug.
● Inform patients and their family that headache is a common side effect of this medication. Ensure that
they know to ask for an analgesic in the event that they are in need of one.

Side Effects: CNS: Dizziness and light-headedness, headache, sedation. GI: Diarrhea, constipation, dry
mouth, transient increases in liver aminotransferases and bilirubin.   Hypersensitivity reactions.

Incompatibility: Solution/additive: Meropenem. Y-site: Acyclovir, allopurinol, aminophylline, amphotericin

B, ampicillin, ampicillin/sulbactam, amsacrine, cefepime, cefoperazone, fluorouracil, furosemide, ganciclovir,
lorazepam, meropenem, methylprednisolone, piperacillin, sargramostim, sodium bicarbonate, TPN. Should be
avoided in patients with a hypersensitivity to Ondansetron.
Trade Name: Phenergan, Pentazine, Prometh, Prothazine Generic Name: promethazine HCl

Patient Dose: 12.5 mg, 25 mg, 50 mg tablets; 6.25 mg/5 mL syrup; 12.5 mg, 25 mg, 50 mg suppositories; 25
mg/mL, 50 mg/mL injection

Route: PO, PR, IM, IV

Dose Range:
● Motion Sickness
o PO/PR/IM/IV 25 mg BID.
● Nausea
o PO/PR/IM/IV 12.5–25 mg q4–6h prn
● Allergies
o PO/PR/IM/IV 12.5 mg QID. or 25 mg hs
● Sedation
o PO/PR/IM/IV 25–50 mg preoperatively or hs

Classification: GASTROINTESTINAL AGENT; ANTIEMETIC; ANTIVERTIGO AGENT;

PHENOTHIAZINE

Action: Long-acting derivative of phenothiazine with marked antihistamine activity and prominent sedative,
amnesic, antiemetic, and anti-motion-sickness actions. Unlike other phenothiazine derivatives, relatively free of
extrapyramidal adverse effects; however, in high doses it carries same potential for toxicity.

Use Pre/Post-op: Preoperative, postoperative, and obstetric sedation and as adjunct to analgesics for control of
pain.

Nursing Responsibilities:
• Supervise ambulation. Promethazine sometimes produces marked sedation and dizziness.
• Be aware that antiemetic action may mask symptoms of unrecognized disease and signs of drug
overdosage as well as dizziness, vertigo, or tinnitus associated with toxic doses of aspirin or other
ototoxic drugs.
• Patients in pain may develop involuntary (athetoid) movements of upper extremities following
parenteral administration. These symptoms usually disappear after pain is controlled.
• Monitor respiratory function in patients with respiratory problems, particularly children. Drug may
suppress cough reflex and cause thickening of bronchial secretions.
• Education patient on importance of avoiding prolonged exposure to sunlight while taking this drug.

Side Effects: Deep sleep, coma, convulsions, cardiorespiratory symptoms, extrapyramidal reactions,
nightmares (in children), CNS stimulation, abnormal movements. Irregular respirations, respiratory depression,
apnea. Sedation drowsiness, confusion, dizziness, disturbed coordination, restlessness, tremors. Transient mild
hypotension or hypertension. Anorexia, nausea, vomiting, constipation. Leukopenia, agranulocytosis. Blurred
vision, dry mouth, nose, or throat. Photosensitivity. Urinary retention.

Incompatibility: Solution/additive: Aminophylline, carbenicillin, cefotetan, chloramphenicol, chlorothiazide,

heparin, hydrocortisone, methicillin, methohexital, penicillin G sodium, pentobarbital, phenobarbital,
thiopental, diatrizoate, dimenhydrinate, iodipamide, iothalamate, nalbuphine. Y-site: Aldesleukin, allopurinol,
amphotericin B cholesteryl complex, cefepime, cefoperazone, cefotetan, doxorubicin liposome, foscarnet,
heparin, methotrexate.
Trade Name: Prevacid Generic Name: lansoprazole

Patient Dose/Route: capsule/tablet/oral-disintegrating tab: 15 mg, 30 mg; oral suspension 3 mg/mL; PO

Dose Range:
● Duodenal Ulcer
o Active: 15 mg PO QD for 4 weeks
o Maintenance: 15 mg PO QD
● Gastric Ulcer
o 30 mg PO QD for 8 weeks
● NSAID-associated GU
o Treatment: 30 mg PO QD for 8 weeks
o Prevention: 15 mg PO QD for 12 weeks
● GERD
o 15 mg PO QD for 8 weeks
● Erosive Esophagitis
o 30 mg PO QD for 8-16 weeks
o Maintenance: 15 mg PO QD
● Hypersecretory Condition (Zollinger-Ellison Syndrome)
o 60 mg PO QD initially, up to 180mq q12h used
▪ if dose > 120 mg/d PO, administer in divided doses q12h
● Helicobacter Pylori Infection
o Triple therapy: Lansoprazole 30 mg + amoxicillin 1 g + clarithromycin 500 mg PO q12h for 10-
14 days
o Dual therapy (clarithromycin resistant): lansoprazole 30 mg + amoxicillin 1 g PO q8h for 14
days
o Penicillin allergy: lansoprazole 30 mg + clarithromycin 500 mg + metronidazole 500 mg q12h
for 10-14 days
● Heartburn
o OTC product: 15 mg PO QD for 14 days
▪ May repeat q4months

Classification: Proton Pump Inhibitor (PPI)

Action: Binds to H+/K+-exchanging ATPase (proton pump) in gastric parietal cells, resulting in suppression of
basal and stimulated acid secretion

Use Pre/Post-op: Short-term treatment of duodenal ulcer (up to 4 wk) and erosive esophagitis (up to 8 wk),
pathologic hypersecretory disorders, gastric ulcers; in combination with clarithromycin and amoxicillin
for Helicobacter pylori. Gastroesophageal reflux disease.

Nursing Responsibilities:
● Administer before meals
● Lab tests: Monitor CBC, kidney & liver function tests, and serum gastric levels periodically.
● Monitor for therapeutic effectiveness of concurrently used drugs that require an acid medium for
absorption (digoxin, ampicillin, ketoconazole)

Side Effects: Headache, diarrhea, constipation, nausea, abdominal pain

Incompatibility: Solution/additive, Y-site: Do not administer with other drugs or diluents.
Trade Name: Dilaudid, Dilaudid-HP Generic Name: hydromorphone hydrochloride

Patient Dose: 1 mg, 2 mg, 3 mg, 4 mg, 8 mg tablets; 12 mg, 16 mg, 24 mg, 32 mg extended-release capsules; 5
mg/5 mL oral liquid; 1 mg/mL, 2 mg/mL, 4 mg/mL, 10 mg/mL injection; 3 mg suppositories

Route: PO, PR, SubQ, IM, IV

Dose Range:
● Moderate to Severe Pain
o PO/SC/IM/IV 1–4 mg q4–6h prn. 
o Extended release 12–32 mg q24h (see prescribing information for conversion from other opioid
analgesics) 
o Rectal 3 mg q4–6h
● Antitussive
o PO 1 mg q3–4h prn

Classification: CENTRAL NERVOUS SYSTEM (CNS) AGENT; ANALGESIC; NARCOTIC (OPIATE)

AGONIST.

Action: Semisynthetic derivative structurally similar to morphine but with 8–10 times more potent analgesic
effect. Has more rapid onset and shorter duration of action than morphine and is reported to have less hypnotic
action and less tendency to produce nausea and vomiting.

Use Pre/Post-op: Relief of moderate to severe post-operative pain.

Nursing Responsibilities:
● Note baseline respiratory rate, rhythm, and depth and size of pupils before administration. Respirations
of 12/min or less and mitosis are signs of toxicity. Withhold drug and promptly notify physician.
● Monitor vital signs at regular intervals. Drug-induced respiratory depression may occur even with small
doses and increases progressively with higher doses.
● Assess effectiveness of pain relief 30 min after medication administration.
● Monitor drug effects carefully in older adult or debilitated patients and those with impaired renal and
hepatic function.
● Assess effectiveness of cough. Drug depresses cough and sigh reflexes and may induce atelectasis,
especially in postoperative patients and those with pulmonary disease.
● Monitor bowel pattern; drug-induced constipation may require treatment.
● It is important to inform the client that a routine schedule of administration is more effective than one
that is PRN. Teach patients to request medication at the onset of pain and do not wait until pain is
severe.

Side Effects: GI: Nausea, vomiting, constipation. CNS: Euphoria, dizziness, sedation, drowsiness. CV:
Hypotension, bradycardia or tachycardia. Respiratory: Respiratory depression. Special Senses: Blurred vision.

Incompatibility: Solution/additive: Prochlorperazine, sodium bicarbonate, thiopental. Y-site: Minocycline,

prochlorperazine, tetracycline. Abrupt discontinuation, alcoholism; angina; biliary tract disease; older adults;
epidural administration; GI disease, GI obstruction; head trauma; heart failure; hepatic disease; hypotension,
hypovolemia, oliguria, prostatic hypertrophy; pulmonary disease; renal disease, renal impairment; paralytic
ileus; increased intracranial pressure; inflammatory bowel disease; labor; latex hypersensitivity; obstetric
delivery; bladder obstruction; cardiac arrhythmias, cardiac disease; respiratory depression; seizure disorder,
seizures; substance abuse; surgery; ulcerative colitis; urethral stricture, urinary retention; lactation, neonates,
and infants <6 mo.
Trade Name: Astramorph PF, Avinza, Duramorph Generic Name: morphine sulfate

Patient Dose: tablets: 10, 15, 30mg; XR capsules: 15, 20, 30, 60, 100, 120, 200mg; oral solution: 10mg/2.5mL,
10mg/5ml, 20mg/mL, 20mg/5mL, 30mg/1.5mL, 100mg/5mL; injection: 0.5 mg/mL, 1mg/mL, 2mg/mL,
4mg/mL, 5mg/mL, 8mg/mL, 10mg/mL, 15mg/mL, 25mg/mL, 50mg/mL; PR: 5, 10, 20, 30mg

Route: PO, PR, Epidural, SubQ, IM, IV

Dose Range:
● Pain Relief
o PO 10–30 mg q4h prn or 15–30 mg sustained release q8–12h; (Kadian) dose q12–24h, increase
dose prn for pain relief; (Avinza) dose q24h 
o IV 2.5–15 mg q4h or 0.8–10 mg/h by continuous infusion, may increase prn to control pain or 5–
10 mg epidural q24h 
o Epidural (DepoDur only) 10–15 mg as single dose 30 min before surgery (max: 20 mg) 
o IM/SC 5–20 mg q4h 
o PR 10–20 mg q4h prn

Classification: CENTRAL NERVOUS SYSTEM (CNS) AGENT; ANALGESIC; NARCOTIC (OPIATE)

AGONIST

Action: Natural opium alkaloid with agonist activity. Binds with same receptors as endogenous opioid peptides

Use Pre/Post-op: Controls severe pain; also used as an adjunct to anesthesia. Used for relief of severe acute and
chronic pain after nonnarcotic analgesics have failed and as preanesthetic medication. Also used to relieve
dyspnea of acute left ventricular failure and pulmonary edema and pain of MI.

Nursing Responsibilities:
● Obtain baseline respiratory rate, depth, and rhythm and size of pupils before administering the drug.
● Observe patient closely to be certain pain relief is achieved.
● Record relief of pain and duration of analgesia.
● Be alert to elevated pulse or respiratory rate, restlessness, anorexia, or drawn facial expressions
● Monitor for respiratory depression; it can be severe for as long as 24 h after administration
● Assess vital signs at regular intervals.
● Monitor I&O ratio and pattern; report oliguria or urinary retention.

Side Effects: Hypersensitivity, sweating, skeletal muscle flaccidity; cold, clammy skin, hypothermia.
Euphoria, insomnia, disorientation, visual disturbances, dysphoria, paradoxic CNS stimulation (restlessness,
tremor, delirium, insomnia), convulsions (infants and children); decreased cough reflex, drowsiness, dizziness,
deep sleep, coma, continuous intrathecal infusion may cause granulomas leading to paralysis. Miosis.
Bradycardia, palpitations, syncope; flushing of face, neck, and upper thorax; orthostatic hypotension, cardiac
arrest. Constipation, anorexia, dry mouth, biliary colic, nausea, vomiting, elevated transaminase levels. Urinary
retention or urgency, dysuria, oliguria, reduced libido or potency (prolonged use). Prolonged labor and
respiratory depression of newborn. Precipitation of porphyria. Severe respiratory depression (as low as 2–
4/min) or arrest; pulmonary edema.

Incompatibility: Solution/additive: aminophylline, amobarbital, chlorothiazide, floxacillin, fluorouracil,

haloperidol, heparin, meperidine, pentobarbital, phenobarbital, phenytoin, sodium bicarbonate, thiopental. Y-
site: Amphotericin B cholesteryl complex, azithromycin, cefepime, doxorubicin liposome, minocycline,
sargramostim, tetracycline.
Trade Name: Duragesic, Actiq Oralet, Sublimaze Generic Name: fentanyl citrate

Patient Dose: 0.05 mg/mL injection; 100 mcg, 200 mcg, 300 mcg, 400 mcg lozenges; 200 mcg, 400 mcg, 600
mcg, 800 mcg, 1200 mcg, 1600 mcg lozenges on a stick; 12 mcg/h, 25 mcg/h, 50 mcg/h, 75 mcg/h, 100 mcg/h
transdermal patch

Route: PO, IM, IV, transdermal patch

Dose Range:
● Premedication
o IM 50-100 mcg 30-60 min before surgery
o PO stuck on 400 mcg lozenge until sedated
● Adjunct for Regional Anesthesia
o IM 50-100 mcg
o IV 2-20 mcg/kg over 1-2 min up to 50 mcg/kg
● General Anesthesia
o IV up to 150 mcg/kg as required
● Postoperative Pain
o IM 5-100 mcg q1-2h PRN
● Chronic Pain
o Initial dose of 25 mcg/h patch q3d
o Suck on stick lozenge over 15 minutes

Classification: CENTRAL NERVOUS SYSTEM AGENT; ANALGESIC; NARCOTIC (OPIATE) AGONIST

Action: Synthetic, potent narcotic agonist analgesic with pharmacologic actions qualitatively similar to those of
morphine and meperidine, but more prompt and less prolonged. Principal actions: analgesia and sedation.

Use Pre/Post-op: Provides analgesia and sedation. Short-acting analgesic during operative and perioperative
periods, as a narcotic analgesic supplement in general and regional anesthesia, and with droperidol or with
diazepam to produce neuroleptoanalgesia.

Nursing Responsibilities:
● Give parenteral doses undiluted or diluted in 5 mL sterile water or NS.

● Monitor vital signs and observe patient for signs of skeletal and thoracic muscle (depressed respirations)
rigidity and weakness.
● Watch carefully for respiratory depression and for movements of various groups of skeletal muscle in
extremities, external eye, and neck during postoperative period. These movements may present patient
management problems; report promptly.
● Duration of respiratory depressant effect may be considerably longer than narcotic analgesic effect.
● Have immediately available oxygen, resuscitative and intubation equipment, and an opioid antagonist
such as naloxone.

Side Effects: Sedation, euphoria, dizziness, diaphoresis, delirium, convulsions with high doses. Hypotension,
bradycardia, circulatory depression, cardiac arrest. Miosis, blurred vision. Nausea, vomiting, constipation,
ileus. Laryngospasm, bronchoconstriction, respiratory depression or arrest. Muscle rigidity, especially muscles
of respiration after rapid IV infusion, urinary retention. Rash, contact dermatitis from patch.

Incompatibility: Solution/additive: Fluorouracil, pentobarbital, thiopental. Y-site: Azithromycin. Alcohol and

other CNS DEPRESSANTS potentiate effects; MAO INHIBITORS may precipitate hypertensive crisis.
Trade Name: Benadryl Generic Name: diphenhydramine HCl

Patient Dose: 25 mg, 50 mg capsules/tablets; 6.25 mg/5 mL, 12.5 mg/5 mL syrup; 50 mg/mL injection

Route: PO, IM, IV

Dose Range:
● Allergy Symptoms, Antiparkinsonism, Motion Sickness, Nighttime Sedation
o PO 25-50 mg TID or QID (max: 300mg/d)
o IV/IM 10-50 mg q4-6h (max: 400 mg/d)
● Nonproductive Cough
o PO 25 mg q4-6h (max: 100 mg/d)

Classification: ANTIHISTAMINE; H1-RECEPTOR ANTAGONIST

Action: H1-receptor antagonist and antihistamine with significant anticholinergic activity. Competes for H1-
receptor sites on effector cells, thus blocking histamine release.
Use Pre/Post-op: Temporary symptomatic relief of various allergic conditions and to treat or prevent motion
sickness, vertigo, and reactions to blood or plasma in susceptible patients. Also indicated as a sedative-hypnotic.

Nursing Responsibilities:
● Give PO dose with food or milk to lessen GI adverse effects.
● For motion sickness: Give first dose PO 30 min before exposure to motion; give remaining doses before
meals and at bedtime.
● Give IM injection deep into large muscle mass; alternate injection sites. Avoid perivascular or SC
injections because of its irritating effects.
● Hypersensitivity reactions (including anaphylactic shock) are more likely to occur with parenteral than
PO administration.
● Give IV dose undiluted at a rate of 25 mg or a fraction thereof over 1 min

● Monitor cardiovascular status especially with pre-existing cardiovascular disease.

● Monitor for adverse effects especially in children and the older adult.
● Supervise ambulation and use side-rails as necessary. Drowsiness is most prominent during the first few
days of therapy and often disappears with continued therapy.

● Do not use alcohol or other CNS depressants

● Do not drive or engage in other potentially hazardous activities until drug response is known
● Increase fluid intake if not contraindicated
● Do not breast feed while taking this drug

Side Effects: High incidence of drowsiness, but GI side effects are minor. Tachycardia, Dry mouth,
cardiovascular collapse, anaphylactic shock.

Incompatibility: Y-Site: Furosemide. Drug: Alcohol and other CNS DEPRESSANTS, MAO

INHIBITORS compound CNS depression. IV: Furosemide. Adverse effects Contraindicated: lower respiratory
tract symptoms (including acute asthma); narrow-angle glaucoma; prostatic hypertrophy, bladder neck
obstruction; GI obstruction or stenosis; pregnancy (category C). Caution use: History of asthma; convulsive
disorders; increased IOP; hyperthyroidism; hypertension, cardiovascular disease; diabetes mellitus; older adults,
infants, and young children.
Trade Name: Reglan, Clopra, Maxolon Generic Name: metoclopramide HCl
Patient Dose: 5 mg, 10 mg tablets; 5 mg/5 mL solution; 5 mg/mL injection
Route: PO, IM, IV

Dose Range:
● GERD
o PO 10-15 mg QID ac & hs
● Diabetic Gastroparesis
o PO 10 mg QID ac and hs for 2-8 weeks
● Small-bowel intubation, radiologic examination
o IM/IV 10 mg over 1-2 min
● Chemotherapy-induced emesis
o PO 2 mg/kg 1 h before antineoplastic administration
▪ May repeat q2h for 3 more doses if needed
o IM/IV 2 mg/kg 30 min before antineoplastic administration
▪ May repeat q2h for 2 doses, then q3h for 3 doses if needed

Classification: GASTROINTESTINAL AGENT; PROKINETIC AGENT (GI STIMULANT)

Action: Potent central dopamine receptor antagonist. Increases resting tone of esophageal sphincter, and tone
and amplitude of upper GI contractions. As a result, gastric emptying and intestinal transit are accelerated with
little effect, if any, on gastric, biliary, or pancreatic secretions

Use Pre/Post-op: Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy; to
facilitate intubation of small bowel; symptomatic treatment of GERD

Nursing Responsibilities:
● Give oral doses 30 min before meals and at bedtime
● IV doses of 10 mg or less may be given undiluted.  
● IV doses >10 mg IV should be diluted in at least 50 mL of D5W, NS, D5/.45% NaCl, RL or other
compatible solution.  

● Immediately report onset of restlessness, involuntary movements, facial grimacing, rigidity, or tremors.
● Be aware that during early treatment period, serum aldosterone may be elevated; after prolonged
administration periods, it returns to pretreatment level.
● Lab tests: Periodic serum electrolyte.
● Monitor for possible hypernatremia, hypokalemia, especially if patient has CHF or cirrhosis

Side Effects: Mild sedation, fatigue, restlessness, extrapyramidal symptoms, nausea, diarrhea, dry mouth,
hypertensive crisis (rare)

Incompatibility: Solution/additive: Ampicillin, calcium gluconate, cephalothin, chloramphenicol, cisplatin,

erythromycin, floxacillin, fluorouracil, furosemide, methotrexate, penicillin G potassium, sodium bicarbonate,
TETRACYCLINES. Y-site: Allopurinol, amphotericin B cholesteryl complex, amsacrine, cefepime,
doxorubicin liposome, furosemide, propofol. Contraindicated: Sensitivity or intolerance to metoclopramide;
allergy to sulfiting agents; history of seizure disorders; concurrent use of drugs that can cause extrapyramidal
symptoms; pheochromocytoma; mechanical GI obstruction or perforation; ileus; history of breast cancer.
Caution use: CHF, cardiac disease, asthma, hypokalemia, HTN, hepatic disease, infertility, Parkinson’s disease,
kidney dysfunction, GI hemorrhage, seizures, tardive dyskinesia
Trade Name: Versed, Lorazepam Generic Name: midazolam

Patient Dose: Oral syrup: 2mg/mL; injectable solution: 1mg/mL, 5mg/mL

Route: PO, IM, IV

Dose Range:
● Preoperative sedation/anxiolysis with anterograde amnesia
o IM 70-80mcg/kg (dose range ~5mg) 30-60 minutes pre-op
▪ Reduce 50% for chronically ill/geriatric patients
o IV initial 0.5-1mg given over 2 minutes (not to exceed 2.5 mg/dose)
● Anesthesia
o Induction: 300-350mcg/kg IV injection over 20-30 seconds
▪ Use increments of 25% of initial dose PRN to complete induction
▪ May use up to 0.6mg/kg in resistant cases, but may prolong recovery
▪ Use 300 mcg in patient > 55 yo
o Maintenance: Administer increments of 25% of induction dose PRN with signs of lightening
anesthetic effect
● Sedation of intubated/ventilated patients
o IV Load: 10-50mcg /kg (dose range 0.5-4mg)
▪ Slow IV injection or infusion over several minutes
▪ Repeat q5-15 min PRN
o Maintenance: initial, 20-100mcg/kg/h infusion
▪ Titrate up or down 25-50% PRN

Classification: Antianxiety agents, Anxiolytics, Benzodiazepines

Action: Short-acting parenteral benzodiazepine. Mechanism of action unclear. 

Use Pre/Post-op: Preoperative sedation/anxiolysis with anterograde amnesia, anesthesia, sedation of

intubated/ventilated patients,

Nursing Responsibilities:
● Wait 2-3 minutes to evaluate sedative effect after each IV dose adjustment
o Total dose >5mg usually not required to reach sedative effect.
● Because it is water soluble, takes ~2-3x longer than diazepam to peak EEG effects
o Wait 2-3 minutes to fully evaluate sedative effects before initiating procedure/repeat dosing
● Has twice the affinity for benzodiazepine receptors that diazepam has
● May be administered IM if unable to obtain vascular access
● Typical adult induction and maintenance doses may need to be decreased in elderly patients by 20-50%
o Elderly patients are more susceptible to CNS depressants than general population

Side Effects: Decreased respiratory rate, apnea, drowsiness, seizure-like activity, nausea/vomiting, cough, pain
at injection site.

Incompatibility: Solution/additive: Lactated Ringer's, dimenhydrinate, pentobarbital, perphenazine,

prochlorperazine, ranitidine. Y-site: Albumin, amoxicillin, amoxicillin/clavulanate, amphotericin B cholesteryl
complex, ampicillin, bumetanide, butorphanol, ceftazidime, cefuroxime, clonidine, dexamethasone,
dimenhydrinate, floxacillin, foscarnet, fosphenytoin, furosemide, hydrocortisone, imipenem/cilastatin,
methotrexate, nafcillin, omeprazole, pentobarbital, perphenazine, prochlorperazine, sodium bicarbonate,
thiopental, TPN.
Trade Name: Cipro, Cipro XR, ProQuin XR Generic Name: ciprofloxacin

Patient Dose: infusion solution: 200mg/100mL, 200mg/20mL, 400mg/40mL, 400mg/200mL; oral suspension:
250mg/5mL, 500mg/5mL; tablet: 100mg, 250mg, 500mg, 750mg; XR tablet: 500mg, 1000mg

Route: PO, IV

Dose Range:
● Acute Sinusitis, Bone & Joint Infections, Intra-abdominal Infections, Skin/Skin Structure Infections
o PO 500mg q12h; IV 400 mg q12h
● Infectious Diarrhea
o PO 500mg q12h
● LRTIs
o Mild/moderate: PO 500mg q12h or 400mg; IV q12h for 7-14 days
o Severe/complicated: PO 750mg q12h or 400mg; IV q12h for 7-14 days
● Nosocomial Pneumonia
o IV 400mg q8h for 10-14 days
● UTIs
o Acute uncomplicated: immediate release 250mg PO q12h for 3 d; XR 500mg PO q24h for 3 d
o Mild/moderate: 250 mg PO q12h or 200mg IV q12h for 7-14 days
o Severe/complicated: 500mg PO q12h for 7-14 days
● Urethral & Cervical Gonococcal Infections
o Uncomplicated: 250mg-500mg PO once

Classification: Fluroquinolones

Action: Inhibits relaxation of DNA and DNA gyrase in susceptible organisms; promotes breakage of DNA

Use Pre/Post-op: Prevention/Tx of infection related to surgical procedures, surgical site, surgical wound.

Nursing Responsibilities:
● Report tendon inflammation or pain. Drug should be discontinued.
● Lab tests: Culture and sensitivity tests should be done prior to initial dose. Treatment may be
implemented pending results.
● Monitor urine pH; it should be less than 6.8, especially in the older adult and patients receiving high
dosages of ciprofloxacin, to reduce the risk of crystalluria.
● Monitor I&O ratio and patterns: Patients should be well hydrated; assess for S&S of crystalluria.
● Monitor plasma theophylline concentrations, since drug may interfere with half-life.
● Assess for S&S of GI irritation

● Fluid intake of 2–3 L/d is advised, if not contraindicated.

Side Effects: Nausea, abdominal pain, diarrhea, increased aminotransferase levels, vomiting, headache,
increased serum creatinine, rash, restlessness.

Incompatibility: Adverse effects: tendonitis, tendon rupture, peripheral neuropathy, CNS effects. Arthralgia,
myalgia. Contraindicated: Hx of myasthenia gravis, concurrent tizanidine administration. Caution use in
pregnancy, oral suspension through nasal gastric tub. No longer recommended for gonorrhea d/t wide spread
resistance. Solution/additive: aminophylline, clindamycin, heparin. Y-Site: aminophylline, ampicillin,
ampicillin/sulbactam, azithromycin, cefepime, dexamethasone, furosemide, heparin, hydrocortisone, phenytoin,
propofol, sodium bicarbonate, theophylline, warfarin
Trade Name: Levaquin Generic Name: levofloxacin

Patient Dose: tablets: 250 mg, 500 mg, 750 mg; solution: 25 mg/mL; injection: 250 mg, 500 mg, 750 mg;
ophthalmic solution: 0.5%

Route: PO, IV, Ointment, Ophthalmic

Dose Range:
● Infections
o PO 500 mg q24h x 10 days 
o IV 500 mg infused over 60 min q24h x 7–14 d
● Community-Acquired Pneumonia
o PO/IV 750 mg q24h x 5 days
● Uncomplicated UTI
o PO 250 mg q24h x 14 days
● Complicated UTI, Pyelonephritis
o PO 250 mg q24h x 10 days
o IV 250 mg infused over 60 min q24h x 10 days
● Acute Bacterial Sinusitis
o PO 750 mg tablet QD x 5 days
● Chronic Bacterial Prostatitis
o PO 500 mg q24h x 28 days
● Skin & Skin Structure Infections
o PO 750 mg q24h x 14 days
● Bacterial Conjunctivitis
o Ophthalmic 1–2 drops in affected eye(s) q2h while awake (max: 8 times)

Classification: Anti-infective; Fluoroquinolone Antibiotic

Action: Inhibits bacterial DNA synthesis by inhibiting a DNA enzyme. This is effective against gram-positive
and gram-negative bacteria.

Use Pre/Postop: Infections, CAP, UTI, Pyelonephritis, Sinusitis, Prostatitis, Conjunctivitis

Nursing Responsibilities:
● Do C&S test prior to beginning therapy and periodically
● Avoid NSAIDs while taking levofloxacin
● Allow a minimum of 2 h between drug dosage aluminum or magnesium antacids, iron supplements,
multivitamins with zinc, or sucralfate.

Side Effects: Headache, insomnia, dizziness, Nausea, abdominal pain, dyspepsia, rash, pruritus, decreased
vision, foreign body sensation, transient ocular burning, ocular pain, photophobia, vaginitis, chest or back pain,
fever, pharyngitis

Incompatibility: Magnesium or aluminum-containing antacids, sucralfate, iron, zinc may decrease levofloxacin
absorption; NSAIDs may increase risk of CNS
Trade Name: Cleocin Generic Name: clindamycin HCl

Patient Dose: capsules: 75 mg, 150 mg, 300 mg; oral suspension: 75 mg/5 mL; injection: 150 mg/mL; vaginal
cream: 2%; suppositories: 100 mg; gel, lotion:10 mg; foam: 1%

Route: PO, IV, Ointment

Dose Range:
● Moderate to Severe Infections
o PO 150–450 mg q6h 
o IM/IV 300–900 mg q6–8h
● Acne Vulgaris
o Topical: Apply to affected areas BID.; 1% foam QD application
● Bacterial Vaginosis
o Topical: insert 1 suppository intravaginally at bedtime times 3 d, or
▪ insert 1 applicator full of cream intravaginally at bedtime times 7 d

Classification: Antibiotic

Action: Suppresses protein synthesis by binding subunits of bacterial ribosomes, and inhibiting other antibiotics
that act at this site.

Use Pre/Postop: Particularly effective against susceptible strains of anaerobic streptococci, including
Staphylococcus aureus, Staphylococcus epidermidis, Streptococci, and Pneumococci.

Nursing Responsibilities:
● Culture and susceptibility testing should be performed
● Severe diarrhea and colitis, including pseudomembranous colitis, have been associated with oral,
parenteral, and topical clindamycin.
● Take drug for the full course of therapy as prescribed.

Side Effects: Fever, sensitization, swelling of face (following topical use), jaundice, generalized myalgia,
proctitis, vaginitis, pain, induration, agranulocytosis sterile abscess, thrombophlebitis, hypotension cardiac
arrest (rapid IV), diarrhea, abdominal pain, flatulence, bloating, nausea, vomiting

Incompatibility: Aminophylline, ceftriaxone, ciprofloxacin, fluconazole, ranitidine, tobramycin, allopurinol,

azithromycin, doxapram, filgrastim, fluconazole, idarubicin. History of hypersensitivity to clindamycin or
lincomycin; history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis; pregnancy (category
B), lactation.
Trade Name: Ancef Generic Name: cefazolin sodium

Patient Dose: 250 mg, 500 mg, 1 g injection

Route: IV, IM

Dose Range:
● Moderate to Severe Infections
o IM 250 mg–2 g q8h, up to 2 g q4h (max: 12 g/d)
● Surgical Prophylaxis
o IV/IM 1–2 g 30–60 min before surgery, then q8h for 24 h

Classification: Antibiotic, Cephalosporin

Action: First-generation derivative of cephalosporins. Activity against gram-negative organisms is limited.

Bactericidal action: preferentially binds to one or more of the penicillin-binding proteins. This inhibits the final
stage of bacterial synthesis, killing the bacterium.

Use Pre/Postop: Effective treatment for bone and joint infections, biliary tract infections, enocarditis
prophylaxis and treatment, respiratory tract and genital tract infections, septicemia and skin infections, and
surgical prophylaxis.

Nursing Responsibilities:
● Monitor I&O: Be alert to changes in BUN, serum creatinine
● If patient has had a reaction to penicillin, be alert to signs of hypersensitivity with use of cefazolin.
● Perform culture and sensitivity testing prior to and during therapy.

Side Effects: Anaphylaxis, fever, eosinophilia, superinfections, seizure (high doses in patients with renal
insufficiency), diarrhea, anorexia, abdominal cramps, maculopapular rash, urticaria.

Incompatibility: Solution/additive: AMINOGLYCOSIDES, ascorbic acid, atracurium, bleomycin, cimetidine,

hydromorphone, lidocaine, ranididine, vitamin B complex with C. Y-site: Amiodarone,
AMINOGLYCOSIDES, amphotericin B cholesteryl complex, idarubicin, pentamidine, vinorelbine.
Trade Name: Apresoline Generic Name: hydralazine hydrochloride

Patient Dose: 10 mg, 25 mg, 50 mg, 100 mg tablets; 20 mg/mL vial

Route: PO, IV, IM

Dose Range:
● Hypertension
o PO 10–50 mg QID. 
o IM 10–50 mg q4–6h IV 10–20 mg q4–6h

Classification: Antihypertensive

Action: Reduces BP by direct effect on vascular smooth muscles of arterial-resistance vessels, resulting in
vasodilation. Hypotensive effect may be limited by sympathetic reflexes, which increase HR, SV, and CO

Use Pre/Postop: Vasodilation reduces peripheral resistance and substantially improves cardiac output, and
renal and cerebral blood flow.

Nursing Responsibilities:
● Make baseline and periodic determinations of BUN, creatinine clearance uric acid, serum potassium,
blood glucose, and ECG.
● Monitor BP and HR closely
● Monitor weight, check for edema, and report weight gain

Side Effects: Hypersensitivity, headache, dizziness, tremors, palpitation, angina, tachycardia, flushing,
arrhythmia, shock, paralytic ileus, anemia, agranulocytosis, congestion, muscle cramps

Incompatibility: Solution/additive: Aminophylline, ampicillin, chlorothiazide, edetate calcium

disodium, hydrocortisone, mephentermine, methohexital, nitroglycerin, phenobarbital, verapamil.
Trade Name: Trandate Generic Name: labetalol hydrochloride

Patient Dose: 100 mg, 200 mg, 300 mg tablet; 5 mg/mL injection

Route: PO, IV

Dose Range:
● Hypertension
o PO 100 mg BID., may gradually increase to 200–400 mg BID
o IV 20 mg slowly over 2 min, with 40–80 mg q10min if needed
▪ Up to 300 mg total or 2 mg/min continuous infusion

Classification: Antihypertensive, alpha- and beta-adrenergic antagonist

Action: The alpha block results in vasodilation, decreased peripheral resistance, and orthostatic hypotension
and only slightly affects cardiac output and coronary artery blood flow. It has beta-blocking effects on the sinus
node, AV node, and ventricular muscle, which lead to bradycardia, delay in AV conduction, and depression of
cardiac contractility.

Use Pre/Postop: Acts as an adrenergic receptor blocking agent that combines selective alpha activity and
nonselective beta-adrenergic blocking actions. Both actions contribute to blood pressure reduction

Nursing Responsibilities:
● Monitor BP and pulse during dosage adjustment period
● Monitor diabetic patients closely; drug may mask usual cardiovascular to acute hypoglycemia
● Monitor BP at 5 min intervals for 30 min after IV administration
● Postural hypotension is most likely to occur during peak plasma levels

Side Effects: Dizziness, fatigue/malaise, headache, tremors, transient paresthesia, Postural hypotension, angina
pectoris, palpitation, bradycardia, syncope, pedal or peripheral edema, pulmonary edema, CHF, flushing, cold
extremities, arrhythmias, dry eyes, vision disturbances, nasal stuffiness, rhinorrhea, acute urinary retention,
difficult micturition, impotence, ejaculation failure, loss of libido, bronchospasm, myalgia, muscle cramps

Incompatibility: Solution/additive: Sodium bicarbonate.  Y-site: Furosemide, heparin, nafcillin, thiopental, 

warfarin
Trade Name: Afrin Generic Name: oxymetazoline HCl

Patient Dose: 0.025%, 0.05% solution

Route: Intranasal

Dose Range:
● Nasal Congestion
o Intranasal 2–3 sprays of 0.05% solution into each nostril BID.

Classification: Vasoconstrictor, decongestant

Action: Sympathomimetic agent that acts directly on alpha receptors of sympathetic nervous system. No effect
on beta receptors

Use Pre/Postop: Constricts smaller arterioles in nasal passages and has prolonged decongestant effect

Nursing Responsibilities:
● Monitor for S&S of excess use. If noted, discuss possibility of rebound congestion
● Systemic effects can result from swallowing excessive medication
● Wash hands carefully after handling oxymetazoline, Anisocoria develop if eyes are rubbed with
contaminated fingers.

Side Effects: Burning, stinging, dryness of nasal mucosa, sneezing, headache, light-headedness, drowsiness,
insomnia, palpitations, rebound congestion

Incompatibility: No clinically significant interactions established

Trade Name: Solu-Coref Generic Name: hydrocortisone sodium succinate

Patient Dose: 100 mg/2 mL, 250 mg/2 mL, 500 mg/4 mL, 1000 mg/8 mL vials

Route: PO, IM, IV, PR

Dose Range:
● Adrenal Insufficiency, Anti-inflammatory
o PO 10–320 mg/d in 3–4 divided doses 
o IV/IM 15–800 mg/d in 3–4 divided doses (max: 2 g/d)
● Intraarticular, Intralesional (Acetate Salt)
o IM 5–50 mg q3–5d for bursae; 5–50 mg once q1–4 wk for joints
● Anti-inflammatory Agent
o Topical apply a small amount to the affected area 1–4 times
o PR insert 1% cream, 10% foam, 10–25 mg suppository, or 100 mg enema nightly

Classification: Anti-inflammatory, Adrenal Corticosteroids

Action: Short-acting synthetic steroid with both glucocorticoid and mineralocorticoid properties that affect
nearly all systems of the body

Use Pre/Postop: Hydrocortisone has anti-inflammatory, immunosuppressive, and metabolic functions

Nursing Responsibilities:
● Establish baseline and continuing data on BP, weight, fluid and electrolyte balance, and blood glucose.
● Periodic serum electrolytes blood glucose, Hct and Hgb, platelet count, and WBC with differential
● Be alert to signs of hypocalcemia and slight weight gain with improved appetite.

Side Effects: Aggravation or masking of infections, sodium and fluid retention, nausea, increased appetite,
ulcerative esophagitis, acne, impaired wound healing, petechiae, ecchymosis, easy bruising

Incompatibility: Solution/additive: Amobarbital, ampicillin, bleomycin, colistimethate, dimenhydrinate,

doxapram, doxorubicin, ephedrine, heparin, hydralazine, metaraminol, methicillin, nafcillin, pentobarbital,
phenobarbital, prochlorperazine, promethazine, secobarbital, tetracyclines. Y-site: Ergotamine, phenytoin
Trade Name: Invanz Generic Name: ertapenem sodium

Patient Dose: 1 g vial

Route: IV, IM

Dose Range:
● Community Acquired Pneumonia; Complicated UTI
o IV/IM 1 g QD x 10–14 days
● Intraabdominal Infection
o IV/IM 1 g QD x 5–14 d
● Skin and Skin Structure Infections
o IV/IM 1 g QD x 7–14 d
● Acute Pelvic Infections
o IV/IM 1 g QD x 3–10 d

Classification: Anti-infective; beta-lactam antibiotic

Action: Broad-spectrum carbapenem antibiotic that inhibits the cell wall synthesis of gram-positive and gram-
negative bacteria by its strong affinity for penicillin-binding proteins of the bacterial cell wall.

Use Pre/Postop: Complicated intraabdominal infections, complicated skin and skin structure infections,
community-acquired pneumonia, complicated UTI, and acute pelvic infections due to susceptible bacteria.

Nursing Responsibilities:
● Perform C&S tests prior to therapy. Monitor periodically liver and kidney function
● Monitor AST, ALT, alkaline phosphatase, CBC, platelet count, and routine blood chemistry during
prolonged therapy
● Use caution with CNS disorders

Side Effects: Phlebitis or thrombosis at injection site, asthenia, fatigue, death, fever, leg pain, anxiety, altered
mental status, dizziness, headache, insomnia cough, dyspnea, pharyngitis, rash

Incompatibility: Solution/additive: Dextrose. Y-site: Do not mix or infuse with any other drugs.

Trade Name: Mefoxin Generic Name: cefoxitin sodium

Patient Dose: 1 g, 2 g injection

Route: IV, IM

Dose Range:
● Moderate to Severe Infections
o IV/IM 1–2 g q6–8h, up to 12 g/day
● Surgical Prophylaxis
o IV/IM 2 g 30–60 min before surgery, then 2 g q6h for 24 h
● Uncomplicated Gonorrhea
o IV/IM 2 g given concurrently with 1 g probenecid PO

Classification: Antibiotic; Second-Generation Cephalosporin

Action: Broad-spectrum beta-lactam antibiotic derivative. Classified as second generation cephalosporin;

structurally and pharmacologically related to cephalosporins and penicillins. Considerably less active than most
cephalosporins against Staphylococci.

Use Pre/Postop: It shows enhanced activity against a wide variety of gram-negative organisms, gonorrhea, skin
and urinary tract infections, and is used for surgical prophylaxis, reducing or eliminating infection. Effective for
mixed aerobic-anaerobic infections. Effectively treats gynecologic, bone and joint and intra-abdominal
infections, gonorrhea, skin and urinary tract infections, and is used for surgical prophylaxis, reducing or
eliminating infection.

Nursing Responsibilities:
● Inspect injection sites regularly. Report evidence of inflammation and patient's complaint of pain.
● Monitor I&O rates and pattern
● Report watery or bloody loose stools or severe diarrhea.

Side Effects: Drug fever, eosinophilia, superinfections, local reaction, thrombophlebitis, diarrhea,
pseudomembranous colitis. rash, exfoliative dermatitis, pruritus, urticaria, nephrotoxicity, interstitial nephritis.

Incompatibility: Solution/additive: AMINOGLYCOSIDES, ranitidine. Y-site: AMINOGLYCOSIDES,

filgrastim, hetastarch, pentamidine, vancomycin.
Trade Name: Colace Generic Name: docusate sodium

Patient Dose: 100 mg tablets; 50 mg, 100 mg, 240 mg, 250 mg capsules; 50 mg/15 mL, 60 mg/15 mL, 150
mg/15 mL syrup

Route: PO, PR

Dose Range:
● Stool Softener
o PO 50–500 mg/d 
o PR 50–100 mg added to enema fluid

Classification: Gastrointestinal agent; stool softener

Action: Anionic surface-active agent with emulsifying and wetting properties.

Use Pre/Postop: Prophylactically in patients who should avoid straining during defecation and for treatment of
constipation associated with hard, dry stools

Nursing Responsibilities:
● Withhold drug if diarrhea develops and notify physician.
● Do not take concomitantly with mineral oil.
● Take sufficient liquid with each dose and increase fluid intake during the day, if allowed.
● Do not take for prolonged periods in lieu of proper dietary management

Side Effects: Occasional mild abdominal cramps, diarrhea, nausea, bitter taste.

Incompatibility: Drug: Docusate will increase systemic absorption of mineral oil.

Trade Name: Dulcolax Generic Name: bisacodyl

Patient Dose: 5 mg tablets; 10 mg suppository

Route: PO, PR

Dose Range:
● Laxative
o PO 5–15 mg prn (max: 30 mg for special procedures)
o PR 10 mg prn

Classification: Gastrointestinal agent; stimulant laxative

Action: Expands intestinal fluid volume by increasing epithelial permeability.

Use Pre/Postop: Temporary relief of acute constipation and for evacuation of colon before in patients with
spinal cord damage. Surgery, proctoscopic, sigmoidoscopic, and radiologic examinations. Also used to cleanse
colon before delivery and to relieve constipation

Nursing Responsibilities:
● Evaluate periodically patient's need for continued use of drug
● Add high-fiber foods slowly to regular diet to avoid gas and diarrhea.
● Adequate fluid intake includes at least 6–8 glasses/day

Side Effects: Systemic effects not reported. Mild cramping, nausea, diarrhea, fluid and electrolyte disturbances

Incompatibility: Drug: ANTACIDS will cause early dissolution of enteric coated tablets, resulting

in abdominal cramping.
Trade Name: Vicodin Generic Name: hydrocodone bitartrate

Patient Dose: 5 mg hydrocodone usually with 500 mg or more acetaminophen

Route: PO

Dose Range:
● Mild to Moderate Pain, Cough
o PO 5–10 mg q4–6h prn (max: 15 mg/dose)

Classification: Narcotic (opiate) agonist analgesic; antitussive

Action: Morphine derivative similar to codeine but more addicting and with slightly greater antitussive activity,
and analgesic effect. CNS depressant with moderate to severe relief of pain. Available in the United States only
in combination with other drugs.

Use Pre/Postop: Symptomatic relief of hyperactive or nonproductive cough and for relief of moderate to
moderately severe pain.

Nursing Responsibilities:
● Monitor for nausea and vomiting, especially in ambulatory patients.
● Monitor respiratory status and bowel elimination
● Alcohol and other CNS depressants compound sedation and CNS depression

Side Effects: Dry mouth, constipation, nausea, vomiting, light-headedness, sedation, dizziness, drowsiness,
euphoria, dysphoria, respiratory depression, urticaria, rash, pruritus

Incompatibility: Drug: Alcohol and other CNS DEPRESSANTS compound sedation and CNS

depression. Herbal: St. John's wort increases sedation. 
Trade Name: Norco Generic Name: acetaminophen + hydrocodone

Patient Dose: 5mg/325mg, 7.5mg/325mg, 10mg/325mg tablets

Route: PO

Dose Range:
● PO 1-2 tablets q4-6h PRN for pain

Classification: opioid analgesic

Action: Works by blocking certain nerve cell receptors in the brain

Use Pre/Post-op: Used to treat moderate to severe pain.

Nursing Responsibilities:
● Assess bowel function routinely
● Prevent constipation by increasing fluids and bulk laxatives
● Assess BP, HR, RR before and periodically during administration.
o If RR is <10 min, assess level of sedation.
● Assess cough and lung sounds during antitussive use
● If an opioid antagonist is required to reverse respiratory depression or coma, naloxone is the antidote.

Side Effects: lightheadedness, dizziness, sedation, nausea, constipation, vomiting. These effects seem to be
more prominent in ambulatory than in nonambulatory patients, and some of these adverse reactions may be
alleviated if the patient lies down. Skin rash, pruritus, decreased frequency in urination, fever, black, tarry,
stool.

Incompatibility: Narcotics, acetaminophen, butorphanol, nalburhine, Benzodiazepines, butorphanol.

Trade Name: Narcan Generic Name: naloxone HCl

Patient Dose: 0.4-2 mg IV/IM/SubQ injection

● IV onset 1-2 minutes, duration 45 minutes
● IM, SubQ Onset 2-5 minutes, duration > 45 minutes

Route: IM, SubQ, IV

Dose Range:
● Opiate Overdose
o IV 0.4-2 mg
o May be repeated q2-3 min up to 10 mg if necessary
● Post-Operative Opiate Depression
o IV 0.02-0.2 q 2-3 min until response is obtained
● IV: Dilute 2 mg in 500 ml solution of D5W or NS to yield 4 mcg/ml (0.004 mg/ml)

Classification: Therapeutic antidotes for Opioids, Opioid antagonists

Action: Produces Complete or Partial Reversal of Opioid Depression. NARCAN (naloxone) prevents or
reverses the effects of opioids including respiratory depression, without producing any agonist effects, sedation
and hypotension.

Use Pre/Post-op: Excessive doses of naloxone hydrochloride in post-operative patients have resulted in
significant reversal of analgesia, and have caused agitation.

Nursing Responsibilities:
● Observe patient closely; duration of some narcotics may exceed that of naloxone. Keep physician
informed; repeat naloxone dose may be necessary.
● Narcotic abstinence symptoms induced by naloxone generally start to diminish 20-40 min after
administration.
● Monitor RR, rhythm, and depth, pulse, ECG, BP, and LOC q 3-4 h after expected peak of blood
concentration.
● Monitor surgical and obstetric patients closely for bleeding.
● Monitor patient for abnormal coagulation test results, also observe for reversal of analgesia which may
be nausea, vomiting, sweating, tachycardia.

Side Effects: Hypotension, hypertension, Ventricular Arrhythmias, ventricular tachycardia and fibrillation,
dyspnea, pulmonary edema, and cardiac arrest. Death, coma, and encephalopathy have been reported as
sequelae of these events.

Incompatibility: Fentora, methadone, Dilaudid, Opana, Actiq, drugs that contain topiramate, like Topamax or
Qsymia. Y-site: Amphotericin B cholesteryl complex.
Trade Name: Romazicon Generic Name: flumazenil

Patient Dose/Route: 0.2 mg, 0.3mg, 0.5mg IV injection

● Ordered doses repeated over 20-minute interval

Dose Range:
● Initial dose of 0.2mg over 15 seconds
● Second dose of 0.3mg give over 30 seconds
● Third dose of 0.5mg IV may be given every minute until the desired clinical response is achieved

Classification: Central Nervous System Agent, Benzodiazepine antagonist

Action: Antagonizes the effects of benzodiazepine on the CNS.

Use Pre/Post-op: It is the reversal agent for respiratory depressant and sedative effects of benzodiazepine
medications.

Nursing Responsibilities:
● Include careful assessment of respiratory rate and effort, BP, and mental status.
● If the benzodiazepine is reversed too rapidly, patients may have emergence reactions in which they
become agitated and confused and experience perceptual distortions, it is the nurse’s responsibility to
watch for any signs of emergent reactions.

Side Effects: Emotional lability, headache, dizziness, agitations, seizures, vomiting, hiccups, shivering, pain at
injection site.

Incompatibility: May antagonize effects of zaleplon, zolpidem, may cause convulsions or arrhythmias with
tricyclic antidepressants. Caution Use: Xanax, librium, ProSom, Dalmane
Trade Name: Ativan Generic Name: lorazepam

Patient Dose: 0.5 mg, 1 mg, 2 mg tablets; 2 mg/mL oral solution; 2 mg/mL, 4 mg/mL IV/IM injection

Route: PO, IM, IV

Dose Range:
● Anti-anxiety
o PO 2–6 mg/d in divided doses (max: 10 mg/d)
● Insomnia
o PO 2–4 mg at bedtime
● Premedication
o IM 2–4 mg (0.05 mg/kg) at least 2 h before surgery IV 0.044 mg/kg up to 2 mg 15–20 min
before surgery
● Status Epilepticus
o IV 4 mg injected slowly at 2 mg/min, may repeat dose once if inadequate response after 10 min

Classification: central nervous system agent; anxiolytic; sedative-hypnotic; benzodiazepine

Action: Most potent of the available benzodiazepines. Effects (anxiolytic, sedative, hypnotic, and skeletal
muscle relaxant) are mediated by the inhibitory neurotransmitter GABA. Action sites: thalamic, hypothalamic,
and limbic levels of CNS

Use Pre/Post-op: Used often in an emergency room to stop a seizure, particularly status epilepticus. Also used
for pre-anesthetic medication to produce sedation and to reduce anxiety and recall of events related to day of
surgery; for management of status epilepticus.

Nursing Responsibilities:
● Have equipment for maintaining patent airway immediately available before starting IV administration.
● IM or IV lorazepam injection of 2–4 mg is usually followed by a depth of drowsiness or sleepiness that
permits patient to respond to simple instructions whether patient appears to be asleep or awake.
● Supervise ambulation of older adult patients for at least 8 h after lorazepam injection to prevent falling and
injury.
● Lab tests: Assess CBC and liver function tests periodically for patients on long-term therapy.
● Supervise patient who exhibits depression with anxiety closely; the possibility of suicide exists, particularly
when there is apparent improvement in mood.

Side Effects: Anterograde amnesia, drowsiness, sedation, dizziness, weakness, unsteadiness, disorientation,
depression, sleep disturbance, restlessness, confusion, hallucinations. CV: Hypertension or hypotension. Special
Senses: Blurred vision, diplopia; depressed hearing. GI: Nausea, vomiting, abdominal discomfort, anorexia.

Incompatibility: Drug: Alcohol, CNS DEPRESSANTS, ANTICONVULSANTS potentiate CNS depression;

cimetidine increases lorazepam plasma levels, increases toxicity; lorazepam may decrease anti-parkinsonism
effects of levodopa; may increase phenytoin levels; smoking decreases sedative and antianxiety effects. Herbal:
Kava-kava, valerian may potentiate sedation. Y-site: Idarubicin, omeprazole, ondansetron, sargramostim,
sufentanil, TPN with albumin.
Trade Name: Vistaril Generic Name: hydroxyzine HCl

Patient Dose: 10 mg, 25 mg, 50 mg, 100 mg tablets; 10 mg/5 mL syrup; 25 mg/5 mL oral suspension; 25
mg/mL, 50 mg/mL IM injection. Hydroxyzine Pamoate: 25 mg, 50 mg, 100 mg capsules

Route: PO, IM

Dose Range:
● Anxiety
o PO 25–100 mg TID. or QID. IM 25–100 mg q4–6h
● Pruritus
o PO 25 mg TID. or QID. IM 25 mg q4–6h
o Geriatric: PO 10 mg 3–4 times daily
● Nausea
o IM 25–100 mg q4–6h

Classification: ANTIHISTAMINE

Action: Piperazine derivative structurally and pharmacologically related to other cyclizines (e.g., buclizine,
chlorcyclizine). In common with such agents, it causes CNS depression.

Use Pre/Post-op: Post op nausea and vomiting. (With narcotic) to decrease pain of N,

Nursing Responsibilities:
● Evaluate alertness. Drowsiness may occur and usually disappears with continued therapy or following
reduction of dosage.
● Monitor condition of oral membranes daily when patient is on high dosage of hydroxyzine.
● Reevaluate usefulness of drug periodically.
● Reduce dosage of the depressant up to 50% when CNS depressants are prescribed concomitantly.

Side Effects: Urticaria, dyspnea, chest tightness, wheezing, involuntary motor activity (rare). Hematologic:
Phlebitis, hemolysis, thrombosis. Skin: Erythematous macular eruptions, erythema multiforme, digital gangrene
from inadvertent IV or intraarterial injection

Incompatibility: Solution/additive: Aminophylline, amobarbital, chloramphenicol, dimenhydrinate, penicillin

G, pentobarbital, phenobarbital.
Trade Name: Demerol Generic Name: meperidine HCl

Patient Dose: 50 mg, 100 mg tablets; 50 mg/5 mL syrup; 10 mg/mL, 25 mg/mL, 50 mg/mL, 75 mg/mL, 100
mg/mL IV/IM/SubQ injection

Route: PO, SubQ, IM, IV

Dose Range:
● Moderate to severe pain
o PO/SubQ/IM/IV 50–150 mg q3–4h prn
● Preoperative
o IM/SubQ 50–150 mg 30–90 min before surgery
● Obstetric Analgesia
o IM/SubQ 50–100 mg when pains become regular, may be repeated q1–3h

Classification: CNS agent, Narcotic (opioid) agonist analgesic

Action: Synthetic morphine-like compound. Chemically dissimilar to morphine, but in equianalgesic doses it is
qualitatively comparable. Usual doses produce either no pupillary change or slight miosis, but overdose results
in marked miosis or mydriasis. Also, unlike morphine, has little or no antidiarrheal or antitussive action.
Produces CNS stimulation in toxic doses.

Use Pre/Post-op: Relief of moderate to severe pain, for preoperative medication, for support of anesthesia, and
for obstetric analgesia

Nursing Responsibilities:
● Give narcotic analgesics in the smallest effective dose and for the least period of time compatible with
patient's needs.
● Assess patient's need for prn medication. Record time of onset, duration, and quality of pain.
● Note respiratory rate, depth, and rhythm and size of pupils in patients receiving repeated doses. If
respirations are 12/min or below and pupils are constricted or dilated (see ACTIONS AND USES) or
breathing is shallow, or if signs of CNS hyperactivity are present, consult physician before administering
drugs.
● Chart patient's response to drug and evaluate continued need.
● Repeated use can lead to tolerance as well as psychic and physical dependence of the morphine type.

Side Effects: Allergic (Pruritus, urticaria, skin rashes, wheal and flare over IV site), profuse perspiration. CNS:
Dizziness, weakness, euphoria, dysphoria, sedation, headache, uncoordinated muscle movements,
disorientation, decreased cough reflex, miosis, corneal anesthesia, respiratory depression. Toxic doses: muscle
twitching, tremors, hyperactive reflexes, excitement, hypersensitivity to external stimuli, agitation, confusion,
hallucinations, dilated pupils, convulsions. CV: Facial flushing, light-headedness, hypotension, syncope,
palpitation, bradycardia, tachycardia, cardiovascular collapse, cardiac arrest (toxic doses). GI: Dry mouth,
nausea, vomiting, constipation, biliary tract spasm. Urogenital: Oliguria, urinary retention. Respiratory:
Respiratory depression in newborn, bronchoconstriction (large doses). Skin: Phlebitis (following IV use), pain,
tissue irritation and induration, particularly following subcutaneous injection. Metabolic: Increased levels of
serum amylase, BSP retention, bilirubin, AST, ALT.

Incompatibility: Solution/additive: Aminophylline, BARBITURATES, floxacillin, furosemide, heparin,

methicillin, morphine, phenytoin, sodium bi-carbonate. Y-site: Allopurinol, amphotericin B cholesteryl
complex, cefepime, cefoperazone, doxorubicin liposome, furosemide, heparin, idarubicin, imipenemcilastatin,
mezlocillin, minocycline, tetracycline.
Trade Name: Vancocin Generic Name: vancomycin HCl

Patient Dose: 125 mg, 250 mg capsules; 1 g, 10 g oral powder; 500 mg, 1 g IV injection

Route: PO, IV

Dose Range:
● Systemic Infections
o IV 500 mg q6h or 1 g q12h, infuse over 60–90 min
● Clostridium difficile Colitis
o PO 125–500 mg q6h

Classification: Anti-infective, antibiotic

Action: Prepared from Streptomyces orientalis, with bactericidal and bacteriostatic actions. Acts by interfering
with cell membrane synthesis in multiplying organisms.

Use Pre/Post-op: Parenterally for potentially life-threatening infections in patients allergic, nonsensitive, or
resistant to other less toxic antimicrobial drugs. Used orally only in Clostridium difficile colitis (not effective by
oral route for treatment of systemic infections).

Nursing Responsibilities:
● Monitor BP and heart rate continuously through period of drug administration.
● Lab tests: Monitor urinalysis, kidney & liver functions, and hematologic studies periodically.
● Monitor serial tests of vancomycin blood levels (peak and trough) in patients with borderline kidney
function, in infants and neonates, and in patients >60 y.
● Assess hearing. Drug may cause damage to auditory branch (not vestibular branch) of eighth cranial
nerve, with consequent deafness, which may be permanent.
● Be aware that serum levels of 60–80 mcg/mL are associated with ototoxicity. Tinnitus and high-tone
hearing loss may precede deafness, which may progress even after drug is withdrawn. Older adults and
those on high doses are especially susceptible.
● Monitor I&O: Report changes in I&O ratio and pattern. Oliguria or cloudy or pink urine may be a sign
of nephrotoxicity (also manifested by transient elevations in BUN, albumin, and hyaline and granular
casts in urine

Side Effects: Hypersensitivity reactions (chills, fever, skin rash, urticaria, shock-like state), anaphylactoid
reaction with vascular collapse, superinfections, severe pain, thrombophlebitis at injection site, generalized
tingling following rapid IV infusion. Hematologic: Transient leukopenia, eosinophilia. GI: Nausea, warmth.

Incompatibility: Solution/Additive: Aminophylline, BARBITURATES, cefotaxime, chloramphenicol,

chlorothiazide, dexamethasone, heparin, sodium bicarbonate, warfarin. Y-site: Albumin, aztreonam, cefepime,
cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, foscarnet, heparin, idarubicin, nafcillin,
omeprazole, piperacillin/tazobactam, ticarcillin, ticarcillin/clavulanate, warfarin.
Trade Name: Percodan Generic Name: oxycodone hydrochloride

Patient Dose: 5 mg, 15 mg, 30 mg tablets

Route: PO

Dose Range:
● Moderate to severe pain
o PO 5–10 mg q6h prn; OxyContin can be dosed q8h

Classification: central nervous system agent; narcotic (opiate) agonist; analgesic

Action: Semisynthetic derivative of an opium alkaloid with actions qualitatively similar to those of morphine.
Most prominent actions involve CNS and organs composed of smooth muscle. Binds with stereo-specific
receptors in various sites of CNS to alter both perception of pain and emotional response to pain, but precise
mechanism of action not clear. As potent as morphine and 10–12 times more potent than codeine.

Use Pre/Post-op: Relief of moderate to moderately severe pain such as may occur with bursitis, dislocations,
simple fractures and other injuries, and neuralgia. Relieves postoperative, postextractional, postpartum pain.

Nursing Responsibilities:
● Monitor patient's response closely, especially to sustained-release preparations.
● Consult physician if nausea continues after first few days of therapy.
● Note: Light-headedness, dizziness, sedation, or fainting appear to be more prominent in ambulatory than
in nonambulatory patients and may be alleviated if patient lies down.
● Evaluate patient's continued need for oxycodone preparations. Psychic and physical dependence and
tolerance may develop with repeated use. The potential for drug abuse is high.
● Lab tests: Check hepatic function and hematologic status periodically in patients on high dosage.

Side Effects: Euphoria, dysphoria, light-headedness, dizziness, sedation. GI: Anorexia, nausea, vomiting,
constipation, jaundice, hepatotoxicity (combinations containing acetaminophen). Respiratory: Shortness of
breath, respiratory depression. Skin: Pruritus, skin rash. CV: Bradycardia. Body as a Whole: Unusual bleeding
or bruising. Urogenital: Dysuria, frequency of urination, urinary retention.

Incompatibility: Salicylates, or nonsteroidal anti-inflammatory drugs, ibuprofen, naproxen.

Trade Name: Percocet Generic Name: oxycodone + acetaminophen

Patient Dose: 2.5mg/325mg tablet

Route: PO

Dose Range:
● PO 5-10 mg q 3-4 hr initially as needed
o If using combination products, acetaminophen or aspirin dose should not exceed 4g/day
o If using ibuprofen-containing products, should not exceed 4 tablets/day

Classification: Opioid Analgesics

Action: Binds to opiate receptors in the CNS.

Use Pre/Post-op: Alter the perception of and response to painful stimuli, while producing generalized CNS
depression.

Nursing Responsibilities:
● ASSESSMENT: assess blood pressure, pulse and respirations before and periodically during
administration. If respiratory rate is <10/min, assess level of sedation. Assess bowel function routinely.
To minimize constipation increased fluid intake and laxatives should be instituted.
● LAB CONSIDERATIONS: may increase plasma amylase and lipase levels.
● TOXICITY AND OVERDOSE: if an opioid antagonist is required to reverse respiratory depression or
coma, naloxone (Narcan) is the antidote. dilute the 0,4-mg ampule of naloxone in 10ml of 0.9% NaCl
and administer 0.5 ml (0.02mg) by direct IV push every 2 min.
● Do not confuse oxycodone with OxyContin. PO: may be administered with food or milk to minimize GI
irritation. Controlled- release tablets should be swallowed whole, do not crush, break, or chew.
● Taking broken, chewed or crushed controlled- release tablets leads to rapid release and absorption of a
potentially fatal dose of oxycodone.

Side Effects: CNS: confusion, sedation, Resp: respiratory depression, GI: constipation GU: urinary retention
Misc: physical/psychological dependence, tolerance

Incompatibility: buprenorphine, fentanyl, oxycodone/slt moderate CYP3A4, butorphanol.

Trade Name: Toradol Generic Name: ketorolac tromethamine

Patient Dose: 10 mg tablets; 15 mg/mL, 30 mg/mL IM injection; 0.4%, 0.5% ophthalmic solution

Route: PO, IM, IV, ophthalmic

Dose Range:
● Pain
o IV Loading Dose 30 mg (15 mg <50 kg) 
o IM 30–60 mg loading dose, then 15–30 mg q6h
▪ max: 150 mg/d on first day, then 120 mg subsequent days
▪ 30 mg load, then 15 mg q6h if <50 kg
o PO 10 mg q6h prn (max: 40 mg/d) max duration all routes 5 d
● Pain after Refractive Surgery
o Ophthalmic Acular LS only 1 drop in operative eye QID. up to 4 d
● Allergic Conjunctivitis
o Ophthalmic 1 drop 0.5% solution QID.

Classification: central nervous system agent; NSAID, analgesic; antipyretic

Action: It inhibits synthesis of prostaglandins and is a peripherally acting analgesic. Ketorolac does not have
any known effects on opiate receptors.

Use Pre/Post-op: Short-term management of pain; ocular itching due to seasonal allergic conjunctivitis,
reduction of post-operative pain and photophobia after refractive surgery.

Nursing Responsibilities:
● Correct hypovolemia prior to administration of ketorolac.
● Lab tests: Periodic serum electrolytes and liver functions; urinalysis (for hematuria and proteinuria) with
long-term use.
● Monitor urine output in older adults and patients with a history of cardiac decompensation, renal
impairment, heart failure, or liver dysfunction as well as those taking diuretics. Discontinuation of drug
will return urine output to pretreatment level.
● Monitor for S&S of GI distress or bleeding including nausea, GI pain, diarrhea, melena, or hematemesis.
GI ulceration with perforation can occur anytime during treatment. Drug decreases platelet aggregation
and thus may prolong bleeding time.
● Monitor for fluid retention and edema in patients with a history of CHF.

Side Effects: CNS: Drowsiness, dizziness, headache. GI: Nausea, dyspepsia, GI pain, hemorrhage. Other:
Edema, sweating, pain at injection site.

Incompatibility: Probenecid, blood thinners such as warfarin(Coumadin), Aspirin, or other NSAIDS,

ibuprofen, naproxen, Medrol. Y-Site: Azithromycin
Trade Name: Coumadin Generic Name: warfarin sodium

Patient Dose: 1 mg, 2 mg, 2.5 mg, 3 mg, 4 mg, 5 mg, 6 mg, 7.5 mg, 10 mg tablets; 2 mg IV injection

Route: PO, IV

Dose Range:
● Anticoagulant
o PO/IV 10–15 mg/d for 2–5 d, then 2–10 mg once/d with dose adjusted to maintain a PT 1.2–2
times control or INR of 2–3

Classification: BLOOD FORMERS, COAGULATORS, AND ANTICOAGULANTS; ORAL

ANTICOAGULANT

Action: Indirectly interferes with blood clotting by depressing hepatic synthesis of vitamin K-dependent
coagulation factors: II, VII, IX, and X.

Use Pre/Post-op: Prophylaxis and treatment of deep vein thrombosis and its extension, pulmonary embolism;
treatment of atrial fibrillation with embolization. Also used as adjunct in treatment of coronary occlusion,
cerebral transient ischemic attacks (TIAs), and as a prophylactic in patients with prosthetic cardiac valves. Used
extensively as rodenticide.

Nursing Responsibilities:
● Obtain a CAREFUL medication history prior to start of therapy and whenever altered responses to
therapy require interpretation; extremely IMPORTANT since many drugs interfere with the activity of
anticoagulant drugs (see INTERACTIONS).
● Adjust dose to maintain PT at 1½–2½ times the control (12–15 sec), or 15–35% of normal prothrombin
activity, or an INR of 2–4 depending on diagnosis.
● Lab tests: For maintenance dosage, PT/INR determinations at 1–4-wk intervals depending on patient's
response; periodic urinalyses, stool guaiac, and liver function tests. Blood samples should be drawn at
12–18 h after last dose (optimum).
● Monitor closely older adult, psychotic, or alcoholic patients because they present serious noncompliance
problems.
● Note: Patients at greatest risk of hemorrhage include those whose PT/INR are difficult to regulate, who
have an aortic valve prosthesis, who are receiving long-term anticoagulant therapy, and older adult and
debilitated patients.

Side Effects: GI: Anorexia, nausea, vomiting, abdominal cramps, diarrhea, steatorrhea, stomatitis. Other:
Increased serum transaminase levels, hepatitis, jaundice, burning sensation of feet, transient hair loss.
Overdosage: Internal or external bleeding, paralytic ileus; skin necrosis of toes (purple toes syndrome), tip of
nose, buttocks, thighs, calves, female breast, abdomen, and other fat-rich areas.

Incompatibility: Solution/additive: Ammonium chloride, 5% dextrose, Ringer's lactate,

AMINOGLYCOSIDES, ascorbic acid, epinephrine, metaraminol, oxytocin, promazine, tetracycline,
vancomycin, vitamin B complex with C
Trade Name: Lovenox Generic Name: enoxaparin

Patient Dose: 30 mg/0.3 mL, 40 mg/0.4 mL, 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1 mL SubQ injection

Route: SubQ only

Dose Range:
● Prevention of DVT after Hip or Knee Surgery
o SC 30 mg BID. for 10–14 d starting 12–24 h post-surgery
● Prevention of DVT after Abdominal Surgery
o SC 40 mg QD starting 2 h before surgery and continuing for 7–10 d (max: 12 d)
● Treatment of DVT and Pulmonary Embolus
o SC 1 mg/kg q12h or 1.5 mg/kg/d; monitor anti-Xa activity to determine appropriate dose
● Acute Coronary Syndrome
o SC 1 mg/kg q12h for 2–8 d, give concurrently with aspirin 100–325 mg/d

Classification: blood formers, coagulators, and anticoagulants; low molecular weight heparin

Action: Low molecular weight heparin with antithrombotic properties. Does not affect PT. Does affect
thrombin time (TT) and activated thromboplastin time (aPTT) up to 1.8 times the control value.

Use Pre/Post-op: Prevention of deep vein thrombosis (DVT) after hip, knee, or abdominal surgery, treatment of
DVT and pulmonary embolism, management of acute coronary syndrome. Used after surgery to decrease DVT
and PE, may be given at home or in hospital, always SubQ

Nursing Responsibilities:
● Lab tests: Baseline coagulation studies; periodic CBC, platelet count, urine and stool for occult blood.
● Monitor platelet count closely. Withhold drug and notify physician if platelet count less than
100,000/mm3.
● Monitor closely patients with renal insufficiency and older adults who are at higher risk for
thrombocytopenia.
● Monitor for and report immediately any sign or symptom of unexplained bleeding.

Side Effects: Allergic reactions (rash, urticaria), fever, angioedema arthralgia, pain and inflammation at
injection site, peripheral edema, arthralgia, fever. Digestive: Abnormal liver function tests. Hematologic:
Hemorrhage, thrombocytopenia, ecchymosis, anemia. Respiratory: Dyspnea. Skin: Rash, pruritus.

Incompatibility: Drug: Aspirin, NSAIDS, warfarin can increase risk of hemorrhage. Herbal: Garlic, ginger,

ginkgo, feverfew, horse chestnut may increase risk of bleeding.