Clinical Drug Base

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 105 Student ____________________________________ Clients Initials ______________
Clinical Week _____________ Class ________________

Drug (trade & generic name) Drug: Dose: Chemical class: Route (Give timing for IV push/IVPB meds): Nucleoside reverse transcriptase inhibitor (NRTI) Frequency: Rationale for client: Action: Synthetic nucleoside analog with inhibitory action against HIV-1;inhibits replication of the virus by incorporating into cellular DNA by viral reverse transcriptase, thereby terminating the cellular DNA chain. Abacavir / Ziagen Classification & Mechanism of Action Functional class: Antiretroviral Major Side Effects & Contraindications Side-Effects: CNS: fever,headache, malaise, insomnia,paresthesia HEMA: Granulocytopeniam anemia, lymphopenia INTEG: rash, urticaria, hypersensitivity reactions META: Lactic acidosis RESP: Dyspnea GI: N, V,& D, anorexia,cramps, abd pain ,hepatotoxicity MISC: increases CPK, fatal hypersensitivity reactions Contraindications: lactic acidosis ,severe renal or impaired hepatic function, hgb < 9.5 Nursing Considerations Assess: HIV symptoms, fever and infections For lactic acidosis, severe hepatomegaly with steatosis- discontinue treatment- do not restart. Renal/Hepatic blood studies before, and during therapy Blood counts q2wk. monitor viral load Teach: controls symptoms, is not cure, pt. still infective and may pass AIDS virus to others
Drug: Dose:
Abatacept / Orencia
Functional class: Antirheumatic agent(disease modifying) biologic response modifer
Route (Give timing for IV push/IVPB meds): Chemical class: Frequency: Rationale for client: Action: Selective co stimulation modulator, inhibits, T-lymphocytes, inhibits tumor necrosis factor interferon-y interleukin-2 which are involved in immune and inflammatory reactions :
Side-Effects: CNS: Headache, asthenia, dizziness CV: hypertension, hypotension INTEG: rash, injection site reaction, flushing, urticaria, pruritus GI: Abdominal pain, dyspepsia, nausea SYST: Anaphylaxis, malignancies, angioedema Contraindications: Hypersensitivity and TB: Do not use with TNF antagonist(adalimumab, etanercept, infliximab: anakinra
Assess: for latent TB before treatment Dilute to administer. Use non protein binding filter, give over 30 minutes Monitor injection site for pain swelling Monitor for pain, stiffness, ROM, swelling of joints during treatment Immunizations should be brought up to date before treatment. Do not give vaccines immunizations while on treatment. Do not use corticosteroids or immunosuppressives
Drug: Dose:
Abciximab / Reopro
Functional class: Platelet aggregation inhibitor Chemical class:
Side-Effects: Rarely used: High Alert Contraindications: Hypersensitivity to this product or murine protein; GI, GU bleeding, CVA within 2 yr, bleeding disorders, intracranial neoplasm,intracranial arteriovenous malformations, intracranial aneurysm, platelet count<100,00/mm3 recent surgery, aneurysm, uncontrolled severe HTN, vasculitis, coagulopathy
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Rarely used: Used with heparin and aspirin to prevent acute cardiac ischemia following percutaneous transluminal coronary angioplasty (PTCA) in patients at high risk for reclosure of affected arteries.
Drug: Dose:
Acarbose / Precose
Functional class: Oral antidiabetic
Side-Effects: GI: Abdominal pain, diarrhea, flatulence, increased serum transaminase level Contraindications: Hypersensitivity, diabetic ketoacidosis, cirrhosis, inflammatory bowel disease, ileus, colonic ulceration, partial intestinal obstruction, chronic intestinal disease, serum creatinine >2 mg/dk, breastfeeding Precautions: Pregnancy (B) children, renal/hepatic disease
Give with first bite of each meal. Assess: for hypoglycemia/hyperglycemia if pt is on sulfonylureas or insulin: treat with dextrose, IV glucose, or glucagon 1 hr postprandial glucose for establishing effectiveness Monitor: GI side effects for tolerability/ compliance
Chemical class: Route (Give timing for IV push/IVPB meds): a-Glucosidase inhibitor Frequency: Rationale for client: Action: Delays digestion/absorption of ingested carbohydrates y inhibiting a-glucosidase, results in smaller rise in postprandial blood glucose after meals; does not increase insulin production
Drug: Dose:
Acebutolol / Monitan / Sectral
Functional class: Antihypertensive, antidysrhythmic
Chemical class: Route (Give timing for IV push/IVPB meds): Beta 1 blocker Frequency: Rationale for client: Action: Competitively blocks stimulation of badrenergic receptors within vascular smooth muscle, decrease rate of SA node discharge, increase recovery time, slows conduction of AV node resulting in decreased heart rate(negative chronotropic effect), which decreases reninaldosterone-angiotensin system at high doses, inhibits b2 receptors in bronchial system (high doses)
Side-Effects: Assess: CNS: Insomnia, fatigue, dizziness, mental - B/P during beginning treatment, changes, strange dreams ,ha periodically thereafter, pulse q4hr, note CV: Profound hypotension, rate, rhythm, quality bradycardia, CHF, cold - Apical/radial pulse before extremities,postural hypotension,2nd-3rd administration, notify significant changes degree heart block or >50 bpm, signs of CHF( dyspnea, RESP: dyspnea, wheezing, cough, crackles, weight gain, jvd) Bronchospasm - baseline renal/hepatic before therapy HEMA: Agranulocytosis, - edema feet, legs daily, I & O thrombocytopenia, purpura - Skin tugor, dryness of glucose INTEG: Rash, flushing, pruritus, membranes for hydration status sweating, alopecia, dry skin GI: N,V, & D, Mesenteric arterial Teach: thrombosis, ischemic colitis, flatulence Drug may alter blood glucose GU: Impotence, decreased libido, dysuria, Do not discontinue abruptly, no OTC cold nocturia, polyuria preps unless ok by HPC EENT: Sore throat, dry, burning eyes ENDO: Increased hypoglycemic response Treatment of overdose: to insulin Lavage, IV atropine for bradycardia, IV MS: Joint pain, cramping theophylline for broncho spasm, digoxin, MISC: Facial swelling, weight gain, o2, diuretic for cardiac failure, IV glucose decreased exercise tolerance for hypoglycemia, IV diazepam (or phentoin) for seizures. Contraindications: Hypersensitivity to b- blockers, Precautions: cardiogenic shock, heart block(2nd 3rd Pregnancy (B), major surgery, degree) sinus bradycardia, CHF, cardiac breastfeeding, PAD, DM, thyroid disease, failure COPD, asthma, well compensated heart failure, renal/hepatic disease
Drug: Acetaminophen / Tylenol Dose:
Functional class: Nonopioid analgesic, antipyretic
Chemical class: Route (Give timing for IV push/IVPB meds): Nonsalicylate, paraaminophenol derivative Frequency: Rationale for client: Action: May block pain impulses peripherally that occur in response to inhibition of prostaglandin synthesis, does not possess anti-inflammatory properties, antipyretic action results from inhibition of prostaglandins in the CNS(hypothalamic heat-regulating center)
Side-Effects: - Hepatic / renal studies CNS: Stimulation, drowsiness - I & O ratio for renal function CV: Toxicity-cyanosism anemia, neutropenia, jaundice, pancytopenia, Assess: CNS stimulation, delirium followed by - for chronic poisoning: rapid, weak pulse, vascular collapse, dyspnea: cold clammy extremities HEMA: Leukopenia, neutropenia, - for hepatotoxicity: dark urine, clay hemolytic anemia (LTU) colored stools, itching, jaundice Thrombocytopenia, pancytopenia INTEG: rash , urticaria Do not exceed maximum daily dose. GI: NV , abdominal pain, hepatotoxicity, Hepatic seizure (OD) GU: Renal failure ( high prolonged dose) Contraindications: Hypersensitivity, intolerance to tartrazine (yellow dye #5), alcohol, table sugar, saccharin Precaution: in Renal/ hepatic diseases
Drug: Acetazolamide / Dazamide Dose:
Functional class: Diuretic, carbonic anhydrase inhibitor, antiglaucoma agent, antiepileptic
Route (Give timing for IV push/IVPB meds): Chemical class: Sulfonamide derivative Frequency: Rationale for client: Action: Inhibits carbonic anhydrase activity in proximal renal tubules to decrease reabsorption of h2o, na, k+, bicarb, resulting in increased urine volume and alkalinization of urine;decreases carbonic anhydrase in CNS, increasing seizure threshold;decreases secretion of aqueous humor in eye lowers intraocular pressure
Side-Effects: CNS: Convulsions, drowsiness, anxiety, confusion, paresthesia, headache, stimulation META: Aplastic anemia, hemolytic anemia, leukopenia, thrombocytopenia, purpura, pancytopenia INTEG: rash, pruritus urticaria, fever, Stevens-johnson syndrome, flushing META: Hypokalemia, hyperchloremic acidosis hyponatremia GI: NV&D, anorexia, melena, weight loss, Hepatic insufficiency, cholestatic jaundice, fulminant hepatic necrosis, taste alterations GU: Frequency, polyuria, uremia, glucosuria, hematuria, dysuria, crystalluria, renal calculi EENT: Myopia, tinnitus ENDO: Hyperglycemia Contraindications: Hypersensitivity to sulfonamides, severe renal/hepatic disease, electrolyte imbalances, Addisons , adrenalcortical insufficiency
- Weigh daily, I & O daily to determine fluid loss, dehydration - B/P lying, standing; postural hypotension may occur - Assess electrolytes - Increase fluids to 2-3 liters per day if not contraindicated
Drug: Acetycysteine / Acetadote / Mucomyst Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Mucolytic Chemical class: Amino acid t-cysteine Action: Decrease viscosity of secretions by breaking disulfide links of mucoproteins, serves as a substrate in place of glutathione, which is necessary to inactivate toxic metabolites in acetaminophen od
Side-Effects: CNS: dizziness, drowsiness, headache, fever, chills CV: hypotension RESP: Bronchospasm, hemoptysis, burning, chest tightness INTEG: Urticaria, rash, fever, clamminess pruritus GI: Nausea, stomatitis, constipation, vomiting, anorexia, Hepatotoxicity EENT: Rhinorrhea, tooth damage Contraindications: Hypersensitivity, increased intracranial pressure, status asthmaticus Contraindications:
Do not mix with antibiotics Assess: - Cough: type, frequency, character, including sputum - Rate: rhythm of respirations, - increased dyspnea; sputum: discontinue it - bronchospasm occurs: V/S- cardiac status - ABGs for increased CO2 retention in asthma patients - Nausea, vomiting, rash: notify prescriber antidote-acetaminophen
Drug: Dose:
Acyclovir / Zovirax
Functional class: Antiviral Chemical class: Acyclic purine nucleoside analog Action: Interferes with DNA synthesis ny conversion to acyclovir triphosphate, causing decreased viral replication, time of lesional healing
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Side-Effects: CNS: Tremors, confusions, lethargy, hallucination, seizures, dizziness, headache, encephalopathic changes HEMA: Thrombotic thrombocytopenia purpura, hemolytic uremic syndrome(immunocompromised patient) INTEG: Rash, urticaria, pruritus, pain or phlebitis at IV site, unusual sweating, alopecia MS: Joint pain, leg pain,muscle cramps GI: NV&D, increased ALT,AST, abdominal pain glossitis, colitis GU: Oliguria, proteinuria, hematuria, vaginitis, moniliasis, glomerulonephritis, acute renal failure,changes in menses, polydipia EENT: Gingival hyperplasia Contraindications: Hypersensitivity to this or famciclovir, ganciclovir
Any patient with compromised renal system- product excreted slowly in poor renal system function: toxicity can occur rapidly - C& S before therapy - Bowel pattern before and during - Assess Skin eruptions, rash, urticaria, itching - Assess and note all allergies
Drug: Dose:
Adalimumab / Humira
Functional class: Antirheumatic agent,(disease modifying), immunonodulator
Route (Give timing for IV push/IVPB meds): Chemical class: Recombinant human IgGI monoclonal Frequency: antibody, DMARDs Rationale for client: Action: form of human IgGI monoclonal antibody specific for human tumor necrosis factor(TNF)
Side-Effects: CNS: Headache CV: Hypertension INTEG: Rash, injection site reaction GI: Abdominal pain, nausea, hepatic damage GU: UTI EENT: Sinusitis MISC: flulike symptoms, back pain, lupuslike syndrome, risk of cancer, risk of infections, may be fatal Contraindications: active infections
- Pain, stiffness, ROM, swelling of joints during treatment - Injection site pain, swelling, after 2 injections (4-5days) - Infections- fever, flulike symptoms - Do not give live vaccines during treatment
Drug: Dose:
Adefovir / Hepsera
Functional class: Antiviral
Chemical class: Route (Give timing for IV push/IVPB meds): Adensine monophospkate analog Frequency: Rationale for client: Action: Inhibits hepatitis B virus DNA polymerase by competing wity natural substrates and by causing DNA termination after its incorporation into viral DNA, causes viral DNA death
Side-Effects: CNS: headache, fever INTEG: rash GI: dyspepsia, abdominal pain,nv&D, hepatomegaly, weight loss GU: Hematuria, glycosuria, Nephrotoxicity Contraindications: hypersensitivity
Assess: - For nephrotoxicity, increasing CCr, Bun - Lactic acidosis, severe hepatomegaly with stenosis
Drug: Dose:
Adenosine / Adenocard / Adenoscan Functional class: Antidysrhmic
Chemical class: Route (Give timing for IV push/IVPB meds): Endogenous nucleoside Frequency: Rationale for client: Action: Slows conduction through AV node, can interrupt reentry pathways through AV node, and can restore normal sinus rhythm in pt. with paroxysmal supraventricular tachycardia (PSVT)
Side-Effects: CNS: light headedness dizziness, arm tingling, numbness, apprehension, headache CV: Chest pain, pressure, atrial tachydysrhythmias, sweating, palpitations, hypotension, facial flushing GI: Nausea, metallic taste, throat tightness, groin pressure RESP: Dyspnea, chest pressure, hyperventilation EENT: blurred vision, Contraindications: 2nd or 3rd degrees heart block, AV Block, atrial flutter, a-fib
- Cardiopulmonary status: B/P, pulse, RR, ECG - RR Status, rate, rhythm,lung fields for crackles in CHF, watch for RR depression - CNS effects; dizziness, confusion convulsions- discontinue
Drug: Dose:
Albumin, normal serum, 5% / 25%
Functional class: Blood derivative
Chemical class: Route (Give timing for IV push/IVPB meds): Placental human plasma Frequency: Rationale for client: Action: Exerts oncotic pressure, which expands volume of circulating blood and maintains cardiac output
Side-Effects: CNS: Fever,chills,flushing, headache CV: Fluid overload, hypotension, erratic pulse, tachycardia INTEG: rash, urticaria RESP: Altered respirations, PULMONARY EDEMA GI: NV, increased salivation Contraindications: CHF, severe anemia, renal insufficiency, pulmonary edema
- B/P decreases, erratic pulse, respirations - I&O ratio, urinary output may decrease, pulmonary wedge pressure will increase if overload occurs - Allergic reactions: fever, rash,itching, cills, nausea, vomiting, hypotension- stop: if reinstated use new lot, premed w/diphenhydramine
Drug: Dose:
Albuterol / Proventil
Functional class: Adrenergic B 2-agonist, sympathomimetic, bronchodilator
Route (Give timing for IV push/IVPB meds): Chemical class: Frequency: Rationale for client: Action: bronchodilation by action on b2(pulmonary) receptors by increasing levels of cAMP which relaxes smooth muscle, produces Bronchodilation CNS, cardiac stimulation, as well as increased diuresis and gastric acid secretion, longer acting than isoproterenol
Side-Effects: CNS: Tremors, anxiety, insomnia, headache, dizziness, slimulation, restlessness, hallucinations, flushing, irritability CV: Palpitations, tachycardia, angina, hyper/hypotension, dysrhythmias INTEG: muscle cramps RESP: cough, wheezing, dyspnea, bronchospasm, dry throat GI: Heartburn, nausea, vomiting EENT: Dry nose, irritation of nose and throat MISC: Flushing, sweating, anorexia, bad taste/smell changes, hypokalemia Contraindications:
Assess: - Respiratory function - That pt. has not received theophylline therapy before giving dose - Evidence of allergic reactions - Paradoxical bronchospasm, hold medication, notify prescriber Teach: - Limit caffeine / give gum, sips of water for dry mouth Therapeutic response: Absence of wheezing after 1 hr, improved airway OD Treatment: b1 adrenergic blocker
Drug: Dose:
Aldesleukin, IL-2
Functional class: Antineoplastic-misc
Chemical class: Interleukin-2 , human Route (Give timing for IV push/IVPB meds): recombinant(cytokine) Frequency: Rationale for client: Action: Enchancement of lymphocyte mitogensis and stimulation of IL-2 dependent cell lines; enhancement of lymphocyte cytotoxicity, induction of killer cell activity, results in activation of cellular immunity
Side-Effects: CNS: CV: Hema: Integ: GI: GU: EENT: Contraindications:
** High Alert
Drug: Dose:
Alemtuzumab / Campath
Functional class: Antineoplastic-miscellaneous
Chemical class: Route (Give timing for IV push/IVPB meds): Monoclonal antibody Frequency: Rationale for client: Action: Composed of recombinant DNA, binds to CD52 antigen on surface of B and T lymphocytes, causes lysis of leukemic cells
Side-Effects: CNS: Dizziness, fatigue CV: hypotension, tachycardia, hypertension, edema, chest pain HEMA: Anemia, neutropenia, thrombocytopenia, pancytopenia, purpura epistaxis INTEG: Rash, local reaction, pruritus RESP: Bronchospasm GI: anorexia, diarrhea, constipation, nausea, stomatitis, vomiting, abdominal pain, dyspepsia Contraindications:
- CBC, platelets q wk Assess: - for symptoms of infection, chills fever - CNS reaction, LOC, mental status, dizziness, confusion - Cardiac status, lung sounds, ECG before and during treatment Monitor - B/P - Bone marrow depression, brusing, bleeding, blood in stools, urine,sputum, emesis
Drug: Dose:
Alendronate / Fosamax
Functional class: Bone-resorption inhibitor
Chemical class: Route (Give timing for IV push/IVPB meds): Bisphosphonate Frequency: Rationale for client: Action: Decreases rate of bone resorption and may directly block dissolution of hydroxyapatite crystals of bone inhibits normal and abnormal bone resorption, mineralization
Side-Effects: CNS: Headache HEMA: anemia, hypomagnesemia, hypophosphatemia, hypocalcemia INTEG: Angioedema, stevens-johnson sysdrome, toxic epidermal necrolysis MS: bone pain GI: Abdominal pain, anorexia, constipation, nausea, vomiting, esophageal ulceration, acid reflux, dyspepsia, perforation, diarrhea Contraindications: Hypersensitivity to bisphosphonates, delayed esophageal emptying, inability to sit or stand for 30 minutes, hypocalcemia
Assess - for serious reactions; angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis
Administer with 8 oz of water 30 minutes before 1st food, beverage, or medication of the day(empty stomach), Have pt. remain upright for 30 min to prevent esophageal irritation
Drug: Dose:
Alfuzosin / Uroxatral
Functional class: Urinary tract antispasmodic, a-1-agonist
Chemical class: Route (Give timing for IV push/IVPB meds): Quinazolone Frequency: Rationale for client: Action: Binds to a-1-andrenoceptor subtypelocated mainly in the prostate, relaxing smooth muscles
Side-Effects: CNS: Dizziness, headache, fatigue CV: Postural hypotension within a few hours of adm., chest pain, tachycardia INTEG: rash GI: Nausea, abd pain, dyspepsia GU: Impotence, priaprism MISC: body pain in general, serostomia RESP: Upper respiratiory infection, pharyngitis, bronchitis, sinusitis Contraindications: Hypersensitivity, moderate to severe hepatic impairment, not indicated for women or children, breastfeeding
Assess - for hesitancy, urgency - CBC with diff and LFTs; B/P and heart rate; monitor for orthostatic hypotension - Bun, uric acid, I & O ratios, daily weights, edema Teach - Rise slowly from sitting to standing
Drug: Dose:
Aliskirin / Tektma
Functional class: Antihypertensive
Chemical class: Route (Give timing for IV push/IVPB meds): Direct rennin inhibitor Frequency: Rationale for client: Action: Renin inhibitor that acts on the renin angiotensin system
Side-Effects: CNS: headache, dizziness CV: Orthostatic hypotension INTEG: rash GI: diarrhea GU: renal stones, increased risk for uric acid META: hyperkalemia MISC: angioedema Contraindications: Hypersensitivity
- BUN may be increased - HCT,HGB may decrease Assess - for allergic reaction-angioedema - monitor B/P, daily dependent edema in feet and legs, weight, orthostatic hypotension Administer: - If PO give with a full glass of water and not with high fat meal Do not discontinue abruptly
Drug: Dose:
Alitretinoin / Panretin
Functional class: Retinoid, 2nd generation, topical antineoplastic
Side-Effects: INTEG: rash, stinging, warmth, redness, erythema, blistering, crusting, peeling, contact dermatitis, pain Contraindications:
Route (Give timing for IV push/IVPB meds): Chemical class: Frequency: Rationale for client: Action: Controls cellular differentiation and proliferation of neoplastic and healthy cells by binding to retinoid receptors
Assess - area of body involvedlesions may worsen at beginning of treatment - Dermal toxicity that may start as erythema, then edema, may need to be discontinued and restarted
Drug: Dose:
Allopurinol / Aloprim
Functional class: Antigout drug, antihyperuricemic
Chemical class: Route (Give timing for IV push/IVPB meds): Xanthene oxidase inhibitor Frequency: Rationale for client: Action: Inhibits the enzyme xanthine oxidase, reducing uric acid synthesis
Side-Effects: - CBC, AST, BUN, cretinine before CNS: Headache, drowsiness, neuritis, starting treatment paresthesia - I&O ratio, increase fluids to 2 L/day to HEMA: Agranulocytosis, prevent stone formation and toxicity thrombocytopenia, aplastic anemia, pancytopenia, leukopenia, bone marrow suppression, eosinophilia INTEG: Fever, chills, dermatitis, pruritus, purpura, erythema, ecchymosis, alopecia, rash SJS MISC: myopathy, arthralgia, hepatomegaly, cholestatic jaundice, renal failure, exfoliative dermatitis GI: Nausea, vomiting, anorexia, malaise, metallic taste, cramps, peptic ulcer, diarrhea, stomatitis EENT: Retinopathy, cataracts, epistaxis Contraindications: Hypersensitivity
Drug: Dose:
Almotriptan
Functional class: Antimigraine agent abortive
Chemical class: Route (Give timing for IV push/IVPB meds): 5-HT 1 receptor agonist, triptan Frequency: Rationale for client: Action: Binds selectively to the vascular 5-HT 1b/1d- recptors, exerts antimigraine effect ***Use to relieve migraine attack does not prevent
Side-Effects: CV: flushing, palpitations, tachycardia, Coronary artery vasospasm, MI, ventricular fibrillation, ventricular tachycardia INTEG: sweating MS: weakness, neck stiffness, myalgia NEURO: tingling, hot sensation, burning, feeling of pressure, tightness, numbness, dizziness, sedation, headache RESP: chest tightness, pressure GI: nausea, xerostomia EENT: throat, mouth, nasal discomfort, vision changes Contraindications: Hypersensitivity, cluster headache, hemiplegia, vascular migraine, ischemic heart disease or risk for peripheral vascular syndrome, concurrent use of ergotamine-containing preparations, uncontrolled hypertension, basilar or hemiplegic migraine: concurrent MAO inhibitor therapy or within 2 wk
Assess: - migraine: pain location, aura, duration, intensity, nausea, vomiting - B/P: signs/symptoms of coronary vasospasms - Tingling, hot sensation, burining, feeling of pressure, numbness, flushing - Stress level, activity, recreation, coping mechanisms - LOC, blurring vision Provide: - quiet, calm environment with decreased stimulation from noise, bright light, excessive talking If one dose does not relieve give another after 2 hr.
Drug: Dose:
Alprazolam / Xanax
Functional class: Antianxiety
Chemical class: Route (Give timing for IV push/IVPB meds): Benzodiazepine Frequency: Rationale for client: Action: Depresses subcortical levels of CNS, including limbic system, reticular formation
Side-Effects: CNS: Dizziness, drowsiness, confusion, headache, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucinations, memory impairment, poor coordination CV: Orthostatic hypotension, ECG changes, tachycardia, hypotension INTEG: rash, dermatitis, itching GI: Constipation, dry mouth, nausea, vomiting, anorexia, diarrhea, weight gain/loss, increased appetite GU: Decreased libido EENT: Blurred vision, tinnituw, mydriasis Contraindications: Pregnancy D- hypersensitivity to benzodiazepines, angle closure glaucoma, psychosis, breastfeeding, addiction
Monitor: - B/P, CBC Blood studies, Hepatic studies, ast, alt, bilrubin, creatinine LDH, alkaline phosphatase- long term use Assess - mental status, mood, anxiety, affect, sleeping pattern, muscle pain, nausea or vomiting Administer - Give with food or milk for GI symptoms - Give sips of water, hard candy for dry mouth - Decrease by .05 mg q 3 days to discontinue Treatment of overdose: flumazenil
Drug: Dose:
Alteplase / Activase t-PA
Functional class: Throbolytic enzyme
Chemical class: Route (Give timing for IV push/IVPB meds): Tisse plasminogen activator Frequency: Rationale for client: Action: Produces fibrin conversion of plasminogen to plasmin: able to bind fibrin, convert plasminogen in thrombus to plasmin, which leads to local fibrinolysis, limited systemic proteolysis
Side-Effects: Administer CV: Sinus bradycardia, ventricular - Give after reconstituting with provided tachycardia, accerlerated idioventricular diluent, add sterile water for inj., use 18 ga rhythm, bradycardia, recurrent ischemic needle Flush line after adm. stroke, hypotension - Do not use 150mg or more total doseINTEG: rash, urticaria intracranial bleeding may occur SYST: GI,GU intracranial, retroperitoneal - Avoid invasive procedures, rectal temp, bleeding, surface bleeding, anaphylaxis, injections fever Monitor Contraindications: - v/s q15 min, Temp q 4hr hypersentivity, active internal bleeding, >104 F indicates internal bleeding recent cva, severe uncontrolled hypertension, intracranial/intraspinal surgery/trauma ( within 3 mo) aneurysm, brain tumor, platelets > 100,000
Drug: Dose:
Aluminum hydroxide
Functional class: Antacid, ypophosphatemic
Chemical class: Route (Give timing for IV push/IVPB meds): Aluminum product, phosphate binder Frequency: Rationale for client: Action: Neutralizes gastric acidity, binds phosphates in GI tract these phosphates are excreted
Side-Effects: GI: constipation, anorexia, obstruction, fecal impaction META: Hypophosphatemia, hypercalciuria Contraindications: Hypersensitivity to aluminum
Assess - pain symptoms, location, duration, intensity, monitor phosphate levels - constipation Administer - give 1 hr before or after other medications to prevent poor absorption
Drug: Dose:
Amantadine / Symmetrel
Functional class: Antiviral, antiparkinsonian agent
Chemical class: Route (Give timing for IV push/IVPB meds): Tricyclic amine Frequency: Rationale for client: Action: prevents uncoating of nucleic acid in viral cell, preventing penetration of virus to host: causes release of dopamine from neurons
Side-Effects: CNS: headache, dizziness, drowiness, fatigue, anxiety, psychosis, depression, hallucinations, tremors, seizures, confusion, insomnia CV: orthostatic hypotension, CHF HEMA: Leukopenia, agranulocytosis INTEG: dermatitis, livedo reticularis GI: NV, constipation, dry mouth, anorexia GU: frequency, retention EENT: blurred vision Contraindications: breastfeeding, child> 1 yr. eczematic rash
Monitor - I & O, report frequency, hesitancy, - serum BUM, creatinine baseline Assess - CHF, confusion, mottling of skin, - bowel pattern before and during treatment - skin eruptions Administer - Give at least 4 hr before bedtimeinsomnia - Give in divided doses to prevent cns disturbances Monitor - daily edema in feet,legs, weight, - B/P, blood tests Administer - Do not break crush tabs - Give daily with full glass of water without regard to food Teach Do not discontinue abruptly *Only facilities enrolled in the LEAP program may administer this product
Drug: Dose:
Ambrisentan / Letairis
Functional class: antihypertensive
Chemical class: Route (Give timing for IV push/IVPB meds): Vasodilator/endothelin receptor antagonist Frequency: Rationale for client: Action: endothelin -1 receptor antagonist, endothelin-1 is vasoconstrictor
Side-Effects: CNS: headache,fever, flushing CV: orthostatic hypotension, hypotension, peripheral edema HEMA: anemia INTEG: rash GI:abdominal pain, constipation GU: decreasednsperm counts EENT: sinusitis, rhinitis RESP: Pharyngitis, dyspnea Contraindications: Breastfeeding
Drug: Dose:
Amikacin / Amikin
Functional class: antibiotic
Chemical class: Route (Give timing for IV push/IVPB meds): Aminoglycoside Frequency: Rationale for client: Action: interferes with protein synthesis in bacterial cell by binding to ribosomal subunit, which causes misreading of genetic code, inaccurate peptide sequence forms in protein chain, causing bacterial death
Side-Effects: Black Box Warning: CNS: confusion, depression, numbness, Hearing impairment renal/neuromuscular termors, seizures, muscle twitching, disease neurotoxicity, neuromuscular blockade with respiratory paralysis - Obtain c& s before therapy CV: hypotension or hypertension, palpitations Assess HEMA: Agranulocytosis, - I &O, blood studies, thrombocytopenia, leukopenia, - monitor electolytes for long term, eosinophilia, anemia - monitor for bleeding, INTEG: rash, burning, urticaria, - iv site for thrombophlebitis dermatitis, alopecia - B/P during infusion GI: NV, anorexia, increased alt,ast, - hearing before , during, after treatment bilirubin, hepatomegaly, hepatic necrosis, splenomegaly * Serum peak drawn 30 min-60 min after GU: Oliguria, hematuria, renal damage, iv infusion or 60 min after im injection, azotemia, renal failure, nephrotoxicity trough level drawn just before next dose EENT: ototoxicity, deafness, visual disturbances Contraindications: mild to moderate infections, hypersensitivity to sulfities, aminoglycosides
Drug: Dose:
Amiloride / Midamor
Functional class: Potassium-sparing diuretic
Chemical class: Route (Give timing for IV push/IVPB meds): Pyrazine Frequency: Rationale for client: Action: Inhibits sodium, potassium ATPase in the distal tubule, cortical collecting duct resulting in inhibition of sodium reabsorption and decreasing potassium secretion
Side-Effects: CNS: headache, dizziness, fatigue, weakness, paresthesias, tremor, depression, anxiety, CV: orthostatic hypotension, dysrhythmias, angina HEMA: Aplastic anemia, neutropenia INTEG: rash, pruritus, alopecia, uriticaria MS: cramps RESP: cough, dyspnea, shortness of breath GI: Nausea, diarrhea, dry mouth, vomiting, anorexia, cramps, constipation, abdominal pain, jaundice GU: Polyuria, dysuria, frequency, impotence EENT: Blurred vision, increased intraocular pressure Contraindications: impaired renal function
Black box warning: Hyperkalemia Monitor - manifestations of hyperkalemia, fatigue, muscle weakness, CARDIAC, NEURO - hyponatremia increased b/p, cold, clammy skin Assess - fluid volume Administer - Give in am to avoid sleep disturbance - Give with food if nausea occurs
Drug: Dose:
Amino Acid
Functional class: Caloric Agent
Chemical class: Route (Give timing for IV push/IVPB meds): Nitrogen product Frequency: Rationale for client: Action: Needed for anabolism to maintain structure; decreases catabolism, promotes healing
Side-Effects: CNS: dizziness, headache, confusion, loss of consciousness CV: hypertension, CHF, pulmonary edema ENDO: Hyperglycemia, rebound hypoglycemia, electrolyte imbalances, hyperosmolar syndrome, hyperglycemic nonketotic syndrome, acidosis INTEG: chills, flushing, warm feeling, rash, urticaria, extravasation necrosis, phlebitis at inj site GI: nausea,vomiting, jaundice GU: Glycouria, osmotic diuresis Contraindications: severe liver damage, PKU< maple syrup urine disease
Assess - Electrolytes - Check injection site for extravasation: redness along vein - Monitor for impending hepatic coma - Monitor temp q 4 hr for increased fever indicating infection if infection is suspected infusion is discontinued and tubing bottle and catheter tip cultured.
Drug: Dose:
Amiodarone (Cordarone, Pacerone)
Functional class: Antidysrhythmic
Chemical class: Route (Give timing for IV push/IVPB meds): Iodinated benzofuran derivative Frequency: Rationale for client: Severe ventricular tachycardia Supraventricular tachycardia Ventricular fibrillation Action: Prolongs duration of action potential and effective refractory period, noncompetitive a and B-adrenergic inhibition sinus rate, decreases peripheral vascular resistance
SIde-Effects: CNS:HA, dizziness, involuntary movement, tremors CV: Hypotension, bradycardia, sinus arrest, CHF, dysrhythmias, SA node dysfunction INTEG: rash, toxic epidermal necrolysis GI:Nausea,V, hepatotoxicity EENT: blurred vision, corneal microdeposits, dry eyes Contraindications: Black box warning: 2nd-3rd degree AV block, bradycardia, Severe hepatic disease, cardiac arrhythmias, pneumonitis, and pulmonary fibrosis.
- B blockers and CCB can cause bradycardia - Toxicity with grapefruit juice. Assess - for pulmonary toxicity: dyspnea, fatigue, cough, and fever. - I&O, electrolytes, AST, ALT, alk phos, and bilirubin - Opthalmic exams Treatment of overdose: O2, artificial ventilation, administer dopamine for circulatory depression and diazepam or thiopental for seizures
Drug: Amitriptyline (amitriptyline HCL, Apo-Amitriptyline) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Major depression
Functional class: Antidepressant-tricyclic Chemical class: Tertiary amine Action: Blocks reuptake of norepinephrine, serotonin into nerve endings, increasing action of norepinephrine, serotonin in nerve cells.
Side-Effects: CNS: Dizziness, drowsiness, confusion CV: orthostatic hypotension, ECG changes, tachycardia, hypertension, dysrhythmias GI: Constipation, dry mouth, paralytic ileus GU: urinary retention EENT: Blurred vision, tinnnitus Contraindications: Recovery phase of myocardial infarction, hypersensitivity to tricyclics.
Assess BP lying and standing. CBC Cardiac enzymes AST,ALT, and Billirubin Administer - Give with milk or food for GI symptoms
Drug: Dose:
Amlodipine (Norvasc)
Functional class: Antianginal, Antihypertensive, Calcium Channel Blocker
Route (Give timing for IV push/IVPB meds): Chemical class: Dihydropyridine Frequency: Rationale for client: Angina pectoris, HTN, Action: Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle and peripheral vascular smooth muscle; dilates coronary vascular arteries; increases myocardial O2 delivery inpatients with vasospastic angina.
Side-Effects: CNS:faigue,depression,insomnia CV: peripheral edema, bradycardia,synscope INTEG: rash, puritis GI:Constipation, flatulence, nausea GU: Nocturia, polyuria Contraindications: Black Box Warning: Hypersensitivity to dihydropyridine
Assess: - BP,RR,HR - I&O, Daily weights - Angina: Intensity, location and duration Teach - to report SOB and irregular HR to doctor
Drug: Dose:
Amoxapine (Asendin)
Functional class: Antidepressant
Chemical class: Dibenzoxazepine derivative-secondary Route (Give timing for IV push/IVPB meds): amine Frequency: Rationale for client: Depression with anxiety or agitation Action: Blocks reuptake of norepinephrine, serotonin into nerve endings, increasing action of norepinephrine, serotonin in nerve cells.
Side-Effects: CNS: Dizziness, Drowsiness, confusion CV: Orthostatic Hypotension, ECG changes HEMA: Thrombocytopenia, leukopenia, Agranulocytosis, and eosinophilia INTEG: rash, urticarial GI: Dry mouth, constipation, paralytic ileus GU: urinary retention, acute renal failure EENT: Blurred vision, tinnitus Contraindications: Seizure disorders. Black Box Warning: Children, suicidal patients
Assess: - BP lying and standing. - Blood studies: CBC and Cardiac enzymes. - AST,ALT, and Bilirubin. - Mental status. - Increase fluids for constipation.
Drug: Amoxicillin (Amoxil, Trimox, Wymox) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Infection
Functional class: Antiinfective, antiulcer Chemical class: Aminopenicillin Action: Interferes with cell wall replication of susceptible organisms; the cell wall, rendered osmotically unstable, swells and bursts from osmotic pressure; bactericidal, lysis mediated by bacterial cell wall autolysis
Side-Effects: CNS:HA, seizures, confusion HEMA: bone marrow depression, hemolytic anemia, granulocytopenia INTEG: Urticaria, rash GI: Nausea, Vomiting, diarrhea, pseudomembranous colitis Contraindications: Penicillin allergy. Can cause Steven Johnson Syndrome -
Assess Hepatic studies: AST, ALT Blood Studies: WBC, RBC,Hgb and Hct Renal studies: BUN, Creatinine. RR Any signs of allergic reaction: rash, SOB
Drug: Dose:
Amphotericin B (Fungizone)
Functional class: Antifungal
Chemical class: Route (Give timing for IV push/IVPB meds): Amphoteric polyene Frequency: Rationale for client: Action: Increases cell membrane permeability in susceptible fungi by binding sterols; alters cell membrane, causing leakage of cell components and cell death.
Side-Effects: CNS: HA, fever, chills, seizures HEMA: Thrombocytopenia, leukopenia, agranulocytosis INTEG: burning, irritation GI: N/V, anorexia GU: Hypokalemia, renal tubular acidosis EENT: Tinnitus, deafness, Contraindications: Severe bone marrow depression. Black Box Warning: Fungal Infections
Assess for renal and hepatotoxicity. Allergic reactions. Weight weekly. VS every 15-3o minutes during first infusion. - Assess for ototoxicity. - Blood studies: CBC, K, Na, Ca, Mg every 2 weeks -
Drug: Dose:
Ampicillin (Omniphen, Principen)
Functional class: Antiinfective-broad spectrum
Chemical class: Route (Give timing for IV push/IVPB meds): Aminopenicillin Frequency: Rationale for client: Infection Action: Interferes with cell wall replication of susceptible organisms; the cell wall, rendered osmotically unstable, swells and bursts from osmotic pressure; bactericidal, lysis mediated by bacterial cell wall autolysis
Side-Effects: CNS: Coma, seizures, lethargy HEMA: Anemia, bone marrow depression, granulocytopenia GI: pseudomembranous colitis, N, V GU: Oliguria, monilias, glomerulonephritis Contraindications: Penicillin allergy Precautions: during pregnancy.
Assess - renal function it can cause toxicity. - AST,ALT,WBC,RBC, Hgb,Hct,BUN, and Creatinine. - Respiratory status. - I&O ratio. Teach - Report hematuria, oliguria.
Drug: Dose:
Anagrelide (Agrylin)
Functional class: Antiplatelet
Chemical class: Route (Give timing for IV push/IVPB meds): Imidazoquinazolinone Frequency: Rationale for client: Action: Reduces platelet count and prevents early platelet shape changes in response to aggregating agents thus inhibiting platelet aggregation.
Side-Effects: Assess CNS:CVA, seizures, parasthesia, fever - Platelet counts twice a day. CV: postural hypotension, CHF,MI, - BP lying and standing. cardiomegaly, complete heart block, atrial - Cardiac status: chest pain. fibrillation, chest pain. HEMA: Anemia, thrombocytopenia, Store at room temperature. lymphadeonoma. INTEG: rash, photosensitivity Teach GI: Abdominal pain, diarrhea, anorexia - to rise slowly from lying position. GU: dysuria EENT: amblyopia, diplopia Contraindications: Hypersensitivity and pregnancy
Drug: Dose:
Anakinra (Kineret)
Functional class: Antirheumatic, immunomodulator
Chemical class: Route (Give timing for IV push/IVPB meds): Recombinant form of human interleukin1-receptor antagonist. Frequency: Rationale for client: Action: A form of human interleukin-1receptor antagonist produced by DNA technology; blocks activity of IL-1 resulting in decreased cartilage degradation and decreased bone resorption.
Side-Effects: CNS: Headache HEMA: Neutropenia INTEG: rash, injection site reaction, allergic reaction GI: abdominal pain, nausea EENT: Sinusitis Contraindications: Hypersensitivity of E. Coli, Sepsis. Precautions: pregnancy.
Assess Pain, stiffness, ROM, swelling of joints. Pain or swelling at injection site. WBC,fever, and flulike symptoms. Neutrophil count prior to treatment and monthly times 3.
Administer - at the same time each day, - Do not use if cloudy or discolored.
Drug: Dose:
Anastrozole (Arimidex)
Functional class: Antineoplastic
Chemical class: Route (Give timing for IV push/IVPB meds): Aromatase inhibitor Frequency: Rationale for client: Breast Cancer Action: Highly selective non-steroidal aromatase inhibitor that lowers serum estradiol concentrations; many breast cancers have strong estrogen receptors.
Side-Effects: CNS:Hot flashes, headache, light headedness, depression. CV: chest pain, HTN, MI, CVA HEMA: Leukopenia INTEG: rash, steven Johnson syndrome GI:Nausea, vomiting, constipation GU: UTI, Vaginal bleeding. Contraindications: Pregnancy,breastfeeding
Assess - Lab test: GGT, AST, ALT, alk phosphate, LDL. Administer - with food. Teach - to report vaginal bleeding. - to take adequate calcium and vitamin D due to risk for bone loss.
Drug: Dose:
Anidulafungin (Eraxis)
Functional class: Antifungual,systemic
Chemical class: Route (Give timing for IV push/IVPB meds): Echinocandin Frequency: Rationale for client: Candiasis Action: Inhibits fungal enzyme synthesis; causes direct damage to fungal cell wall.
Side-Effects: CNS: seizures, headache, dizziness CV: DVT, atrial fibrillation, right bundle branch block, sinus arrhythmia HEMA: Neutropenia, thrombocytopenia, leukopenia, coagulopathy INTEG: rash GI:anorexia, vomiting, increased AST and ALT Contraindications: Hypersensitivity and pregnancy
Assess Infection CBC, RBC, Hct, Hgb Renal studies: BUN Bleeding, hematuria,.
Drug: Anisterplase (Anisoylated, Plasminogen, APSAC, Eminase) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Thrombolytic enzyme Chemical class: Plasminogen activator Action: Promotes thrombolysis by promoting conversion of plasminogen to plasmin.
Side-Effects: CNS: intracranial hemorrhage, stroke, vertigo CV: hypotension, dysrhythmias HEMA: decreased Hct; GI, GU, intracranial, retroperitoneal, thrombocytopenia INTEG: rash, urticaria GI: N/V Contraindications: Hypersensitivity to anistreplase and streptokinase. CVA, embolism, stroke.
Assess Bleeding during 1st hour of treatment. - VS - Fever, rash, chills. - Blood studies: Hct, PT, PTT, - Hypersensitivity: rash, itching, fever.
Drug: Antihemophilic factor VIII (Alphanate, Bioclate, Helixate, FS, Hemofil M, Humate-P, Hyate C, Koate-DVI, Kogenate, MonoclateP,Recombinate,ReFacto) Dose:
Functional class: Hemostatic Chemical class: Factor VIII
Side-Effects: CNS: HA, flushing, lethargy, chills CV: hypotension, tachycardia. HEMA: thrombosis, risk of hepatitis B, risk for HIV, hemolysis INTEG: rash, urticaria GI: viral hepatitis, anorexia, vomiting Contraindications: Hypersensitivity, mouse, hamster, bovine, porcine protein, lactation, HIV
Assess Blood studies I&O Hct,Coombs test Test for factor VIII Blood type of patient for donor. Discontinue infusion if pulse has significant increase.
Action: Route (Give timing for IV push/IVPB meds): Necessary for clotting: activates factor X in conjunction with activated factor IX; Frequency: transforms prothrombin to thrombin. Rationale for client: Hemophilia A
Teach - Alert if bleeding ankles, knees, elbows, and other joints.
Drug: Dose:
Argatroban
Functional class: Anticoagulant
Chemical class: Route (Give timing for IV push/IVPB meds): Thrombin Inhibitor Frequency: Rationale for client: Action: Direct inhibitor of thrombin, it reversibly binds to the thrombin active site
Side-Effects: CNS: Fever, intracranial bleeding, HA CV: A-fib, MI, chest pain, hypotension HEMA: Hemorrhage GI: N/V/D, GI bleed GU: Hematuria, UTI, Abnormal kidney function Contraindications: Overt major bleeding
Assess - for bleeding gums, Petechiae, Ecchymosis - Monitor aPTT - Increased risk of bleeding with antiplatelets NSAID, salicylates Teach - to use soft bristle toothbrush, avoid contact sports, and use an electric razor
Drug: Dose:
Aripiprazole (Vitamin C)
Functional class: Antipsychotic
Chemical class: Route (Give timing for IV push/IVPB meds): Quinolinone Frequency: Rationale for client: Action: Exact MOA unknown
Side-Effects: BBW: CNS: Drowsiness, agitation, stroke, children, dementia, suicidal ideation suicidal ideation, HA, anxiety CV: Orthostatic hypotension , tachycardia - Can cause death in geriatric patients with INTEG: Rash dementia GI: Constipation, N/V, Jaundice, weight gain Assess EENT: Blurred vision, rhinitis - BP standing and lying, report drops of 30 mm Hg Contraindications: - Mental status before initial breast feeding, seizure disorders administration - Supervise ambulation until patient is stabilized on medication
Drug: Ascorbic Acid (vitamin C) Dose:
Functional class: Water-soluble vitamin
Chemical class: Route (Give timing for IV push/IVPB meds): NA Frequency: Rationale for client: Action: Needed for wound healing, collagen synthesis, antioxidant, carbohydrate metabolism
Side-Effects: CNS: HA, insomnia, fatigue, flushing, HEMA: Hemolytic anemia in patients with G6PD INTEG: Inflammation at inj site GI: N/V/D, anorexia, heartburn, cramps GU: Polyuria, dysuria, urate renal stones Contraindications: G6PD deficiency, tartrazine
Assess - I&O ratio, - injection site inflammation, thrombophlebitis if on large dose Teach - the need for citrus fruits in diet -Smoking can decrease vitamin C levels
Drug: Asneapine (saphris) Dose:
Functional class: antipsychotic
Chemical class: Route (Give timing for IV push/IVPB meds): benzisoxazole derivative Frequency: Rationale for client: Action: maybe mediated through both dopamine type 2 and serotonin type 2 antagonism
Side-Effects: - Avoid use with CNS depressants CNS: EPS, insomnia, drowsiness, anxiety, seizures, neuroleptic malignant syndrome Provide CV: sinus tachycardia, heart failure, - supervise ambulation until patient is stroke, orthostatic hypertension stabilized on the medication HEMA: thrombocytopenia - increase fluids to avoid constipation GI: N/V, constipation, weight gain, increased appetite Teach GU: hyperglycemia, hyperprolactinemia, - patient to avoid hot tubs, showers, and hyponatremia hot baths to avoid hypotension Contraindications: breast feeding
Drug: Dose:
Aspirin (ASA)
Functional class: nonopioid, analgesic, nonsteroidal antiinflammatory, antipyretic, antiplatelet
Route (Give timing for IV push/IVPB meds): Chemical class: salicylate Frequency: Rationale for client: Action: blocks pain impulses in CNS, reduces inflammation by inhibition of prostaglandin synthesis; antipyretic action results from vasodilation of peripheral vessels; reduces platelet aggregation
Side-Effects: Assess CNS: stimulation, seizure, HA, coma, - for hepatotoxicity: dark urine, clay drowsiness, dizziness, confusion colored stool, yellowing of the skin, CV: rapid pulse, pulmonary edema abdominal pain, fever HEMA: thrombocytopenia, - for ototoxicity agranulocytosis , leukopenia, neutropenia, hemolytic anemia, increased PT, APTT, Teach bleeding time - to use soft bristle toothbrush, electric INTEG: rash, uticaria, bruising razor, and to report excessive bruising or GI: N/V/D, GI bleed, heartburn , anorexia, bleeding hepatitis EENT: tinnitus, hearing loss Contraindications: breast feeding, children under 12, children with flu like symptoms, GI bleed, bleeding disorder, vitamin k deficiency, peptic ulcer, acute bronchospasm, increased intracranial pressure, intracranial bleeding, nasal polyps
Drug: Dose:
Atazanavir (reyataz)
Functional class: antiretroviral Chemical class: protease inhibitor Action: inhibits HIV protease, prevents maturation of the infectious virus
Side-Effects: CNS: HA, depression, dizziness, insomnia, peripheral neurological symptoms INTEG: rash, Sevens-Johnson syndrome, photosensitivity GI: N/V/D, abdominal pain, hepatotoxicity MISC: fever, back pain, cough, gynecomastia Contraindications: use with caution with hepatic disease
Assess - hepatic studies: AST, ALT, Bilirubin Teach - to wear protective clothing to prevent sun exposure - this product interacts with many products and St. JohnsWort so be sure to question patient about all herbal products used INFORM FAMILY: this product does not cure HIV or prevent transmission, only controls symptoms
Drug: Dose:
Atenolol (Tenormin)
Functional class: antihypertensive, antianginal
Chemical class: Route (Give timing for IV push/IVPB meds): beta blocker Frequency: Rationale for client: Action: competitively blocks stimulation of Badrenergic receptor within vascular smooth muscle
Side-Effects: CNS: insomnia, fatigue, mental changes CV: profound hypotension, bradycardia, cold extremities, 2nd or 3rd degree heart block, CHF HEMA: agranulocytosis, thrombocytopenia purpura INTEG: rash, fever, alopecia GI: N/V/D, ischemic colitis GU: impotence, decreased libido EENT: soar throat, dry burning eyes, blurred vision, stuffy nose Contraindications: cardiogenic shock, 2nd or 3rd degree heart block, sinus bradycardia, cardiac failure, raynauds disease, pulmonary edema
BBW: abrupt discontinuation Assess - I/O, weigh daily, and watch signs of CHF (rales/crackles, JVD, weight gain, edema) - hold if heart rate is less than 60 Teach - not to discontinue abruptly
Drug: Dose:
Atomoxetine (Strattera)
Functional class: psychotherapeutic
Chemical class: Route (Give timing for IV push/IVPB meds): selective norepinephrine reuptake inhibitor Frequency: Rationale for client: Action: same as chemical class
Side-Effects: BBW: CNS: insomnia, dizziness, HA, irritability, children less than 6, suicidal ideation crying, mood swings CV: palpitations, hot flashes, tachycardia, Assess increased BP - vital signs, BP INTEG: exfoliative dermatitis, sweating, - mental status rash GI: N/V/D, weight loss, hepatic injury, Teach dry mouth - to avoid alcohol GU: urinary retention, dysmenorrhea, erectile disturbance Contraindications: angle-closure glaucoma, arteriosclerosis, cardiac disease, cardiomyopathy, heart failure, jaundice, MAOI therapy
Drug: Dose:
Atorvastatin (Lipitor)
Functional class: antilypidemic
Chemical class: Route (Give timing for IV push/IVPB meds): HMG-CoA reductase inhibitor Frequency: Rationale for client: Action: inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis
Side-Effects: CNS: HA, asthenia INTEG: rash, pruritus, alopecia GI: abdominal cramps, constipation, diarrhea, flatus, heartburn, liver dysfunction, nausea GU: impotence EENT: lens opacities Contraindications: pregnancy, active hepatic disease
- can cause rhabdomyolysis* Assess - diet and diet history - check triglyceride levels periodically during treatment - bowel status, increase fiber and water for constipation Teach - to report blurred vision, severe GI symptoms, and muscle pain
Drug: Dose:
Atovaquone (mepron)
Functional class: antiprotozoal
Chemical class: Route (Give timing for IV push/IVPB meds): aromatic diamide derivative Frequency: Rationale for client: Action: interferes with DNA/RNA synthesis in protozoa
Side-Effects: CNS:dizziness, HA, anxienty, insomnia CV: hypotension HEMA: anemia, neutropenia INTEG: pruritus, urticaria, rash GI: N/V/D, acute pancreatitis, increased AST/ALT,constipation, abdominal pain Contraindications: allergy to component
Assess - for signs of infection Administer - with high fat foods because of increased absorption of the product
Drug: Dose:
Atropine (Atreza, Sal-tropine)
Functional class: antidysrhythmic
Chemical class: Route (Give timing for IV push/IVPB meds): belladonna alkaliod Frequency: Rationale for client: Action: blocks acetylcholine at parasympathetic neuroeffector sites
Side-Effects: Assess CNS: HA, dizziness, involuntary - I/O movement, confusion, coma CV: tachycardia, hypo/hypertension, Teach angina, PVCs - to report blurred vision or chest pain INTEG: rash, urticaria, contact dermatitis, dry skin, flushing Provide GI: dry mouth, N/V, abdominal pain, - sugarless hard candy, gum, frequent anorexia, constipation, paralytic ileus mouth rinses for dryness GU: retention EENT: blurred vision, photophobia, glaucoma, eye pain, pupil dilation Contraindications: GI obstructions, asthma, acute hemorrhage
Drug: Dose:
Azacitidine (vidaza)
Functional class: antineoplastic-nucleoside analogue
Chemical class: Route (Give timing for IV push/IVPB meds): DNA demethylation agent Frequency: Rationale for client: Action: cytotoxic by producing damage to double strand DNA during DNA synthesis
Side-Effects: CNS: anxiety, depression, dizziness CV: cardiac murmur, hypotension, peripheral edema HEMA: anemia, thrombocytopenia, leuk/neutropenia INTEG: irritation at site, rash sweating GI: N/V/D, hepatotoxicity, hepatic coma, abdominal pain distention GU: renal failure, renal tubular acidosis, dysuria, UTI Contraindications: advance malignant hepatic tumor
- monitor for stomatitis, avoid citrus - increase fluid intake to decrease dehydration - increase diet with iron, low fiber, few dairy products Teach - to avoid crowds or people with unknown infections, do not receive immunizations
Drug: Dose:
Azathioprine (Azasan, Imuran)
Functional class: immunosuppressant
Chemical class: Route (Give timing for IV push/IVPB meds): purine antagonist Frequency: Rationale for client: Action: produces immune suppression by inhibiting purine synthesis in cells
Side-Effects: HEMA: Leukopenia, thrombocytopenia, anemia, bleeding INTEG: rash, alopecia GI: NV, stomatitis, pancreatitis, hepatotoxicity Contraindications: breast feeding
BBW: bone marrow suppression, neoplastic disease Assess - hepatotoxicity: dark urine, jaundice, light colored stools - arthritis - therapeutic response may take 3 to 4 months
Drug: Dose:
Azitromycin (Zithromax)
Functional class: anti-infective
Chemical class: Route (Give timing for IV push/IVPB meds): macrolide Frequency: Rationale for client: Action: binds to 5OS ribosomal subunits of susceptible bacteria and suppresses protein synthesis
Side-Effects: CNS: dizziness, headache, vertigo CV: palpitations, chest pain HEMA: anemia INTEG: rash, itching, photosensitivity GI: N/V/D, hepatotoxicity GU: vaginitis, nephritis EENT:hearing loss, tinnitus, loss of smell Contraindications: Allergy
Teach - report sore throat, fatigue, fever, may indicate superinfection - do not take antacids with this product
Drug: Dose:
Baclofen
Functional class: Skeletal muscle relaxant, central acting
Chemical class: Route (Give timing for IV push/IVPB meds): GABA chlorophenyl derivative Frequency: Rationale for client: Action: Inhibits synaptic responses in CNS by stimulating GABAb receptor subtype, which decreases neurotransmitter function, frequency, and severity of muscle spasms
Side-Effects: CNS: Seizures, life threatening CNS depression, coma, CNS infection, Dizziness, HA, fatigue, disorientation CV: Hypotension, palpitations, cardiovascular collapse (IT) RESP: Dyspnea, respiratory failure INTEG: Rash, pruritis GI: N/V, constipation, increased AST, alk phosphate, dry mouth, anorexia GU: Urinary freq. hematuria EENT: Nasal congestion, blurred vision, tinnitus Contraindications: Hypersensitivity. Precaution with renal/hepatic disease, seizure disorder, DM, PUD. BBW: Abrupt discontinuation
Assess - B/P, - weight, and hepatic function - Monitor for increase in seizure activity in seizure disorders - I and O, urinary frequency - EEG in epileptic pts - Severe weakness, numbness in extremities - Tolerance, increased need for med - Withdrawal symptoms: CNS depression, dizziness, drowsiness Tx of OD: - Induce emesis of conscious pt, activate charcoal, dialysis, physostigmine to reduce CNS side effects.
Drug: Dose:
Balsalazide
Functional class: GI antiinflammatory
Chemical class: Route (Give timing for IV push/IVPB meds): Salicylate derivative Frequency: Rationale for client: Action: Delivered intact to the colon, bioconverted to 5-ASA
Side-Effects: CNS: HA, insomnia, fever, fatigue SYST: Anaphylaxis GI: N/V, abdominal pain, diarrhea MS; Arthralgia, back pain EENT: Dry eyes, rhinitis, blurred vision Contraindications: Hypersensitivity to salicylates/5aminosalicylates
- Will increase the effect of Warfarin Assess - Renal studies, BUN, creatinine, urinalysis (long term therapy) - Allergic reaction - rash, urticaria, bronchospasm. - Myelosupression: CBC - Have resuscitative equipment available R/T severe allergic reaction Teach -Take with food
Drug: Dose:
Basiliximab
Functional class: Immunosuppressant
Chemical class: Route (Give timing for IV push/IVPB meds): Murine/human monoclonal antibody (interleukin-2) receptor antagonist Frequency: Rationale for client: Action: Binds to and blocks the IL-2 receptor, which is selectively expressed on the surface of activated T lymphocytes; impairs the immune system to antigenic challenges
Side-Effects: CNS: Pyrexia, chills, tremors, HA, insomnia CV: Chest pain, angina, cardiac failure, hypertension, edema MISC: anaphylaxis, infection, moniliasis RESP: Dyspnea, wheezing, pulmonary edema, cough GI: N/V, abdominal pain, GI bleed, gingival hyperplasia, stomatitis INTEG: Acne, pruritus META: Acidosis, hypercholesterolemia, hyperuricemia, hypo/hyperkalemia, hypocalcemia, hypophosphatemia Contraindications: Breastfeeding, hypersensitivity, exposure to viral infection BBW: Infections
Assess - Increased temp, WBC, sputum, Urine, - Blood studies: HGB, WBC, platelets. - Hepatic studies: alk phos, AST, ALT, bilirubin - Anaphylaxis, dyspnea, wheezing, tachycardia Teach - To use contraception during treatment.
Drug: Dose:
Beclomethasone
Functional class: Corticosteriod, synthetic
Chemical class: Route (Give timing for IV push/IVPB meds): Glucocorticoid Frequency: Rationale for client: Action: Prevents inflammation by suppression of migration of polymorphnuclear leukocytes, fibroblasts, reversal of increased capillary permeability and lysosmal stabilization; does not suppress hypothalamus and pituitary function
Side-Effects: Assess CNS: HA - For fungal infection in mucous MISC: Angioedema, adrenal membranes insufficiency, facial edema - Adrenal function RESP: Bronchospasm, wheezing, cough GI: Dry mouth, dyspepsia Provide EENT: Hoarseness, candidal infections of - Gum, rinsing of mouth for dry mouth oral cavity, sore throat Teach Contraindications: - To gargle/rinse mouth after each use Hypersensitivity, status asthmaticus - Do not discontinue abruptly (primary treatment), nonasthmatic - The symptoms of adrenal insufficiency: bronchial disease; bacterial, fungal, viral nausea, anorexia, fatigue, dizziness, infections of mouth, throat, lungs dyspnea, weakness, joint pain, depression
Drug: Dose:
Benazepril
Chemical class: Route (Give timing for IV push/IVPB meds): Angiotensin-converting enzyme (ACE) inhibitor Frequency: Rationale for client: Action: Selectively suppresses rennin-angiotensinaldosterone system; inhibits ACE, preventing conversion of angiotensin I to angiotensin II
Side-Effects: Assess CNS: anxiety, HA, dizziness - K and Na levels, hypotension, orthostatic CV: hypotension, palpitations, angina hypotension, edema in legs, daily weight MISC:Angioedema in CHF INTEG: Rash, flushing GI: N/V, melena, diarrhea Antidote: GU: Increased BUN, creatinine, decreased 0.9% NaCl IV INF, hemodialysis libido Contraindications: Breastfeeding, children, hypersensitivity to ACE inhibitors BBW: Pregnancy D
Drug: Dose:
Bendamustine
Functional class: Antineoplastic alkylating agent
Chemical class: Route (Give timing for IV push/IVPB meds): Nitrogen mustard Frequency: Rationale for client: Action: Cross-linking DNA that causes single strand and double strand breaks, inhibits several mitotic and antimetabolite properties
Side-Effects: CNS: Asthenia, fatigue CV: Hypertensive crisis HEMA: Thrombocytopenia, leucopenia, anemia, lymphocytopenia, neutropenia, secondary malignancy INTEG: bulbous rash, pruritis GI: N/V, stomatitis GU: Renal failure SYST: anaphylaxis, severe skin toxicities Contraindications: Hepatic disease, renal impairment, hypersensitivity to this product or mannitol
Assess - AST, ALT, bilirubin, BUN, uric acid - bleeding, bruising, petechiae, hematuria - cold, cough, fever, (may indicate infection) Teach - avoid use of aspirin, ibuprofen, razors, commercial mouthwash
Drug: Dose:
Benztropine
Functional class: Cholinergic blocker, antiparkinsons agent
Chemical class: Route (Give timing for IV push/IVPB meds): Tertiary amine Frequency: Rationale for client: Action: Blockade of central acetylcholine receptors
Side-Effects: CNS: Anxiety, restlessness, confusion CV: Palpitations, hypotension MISC: Hyperthermia, heat stroke INTEG: Rash, urticaria, dermatoses GI: Dry mouth, constipation, paralytic ileus GU: Retention, dysuria EENT: Blurred vision, dilated pupils, photophobia Contraindications: Closed angle glaucoma, myasthenia gravis, GI/GU obstruction, PUD, megacolon, prostate hypertrophy
Assess -I&0 - Parkinsonism, muscle rigidity - Constipation, increase fluids - Mental status Teach - use caution in hot weather, may cause stroke - take with food - avoid OTC medication - use good oral hygiene
Drug: Dose:
Betamethasone
Functional class: Corticosteroid synthetic long acting Chemical class:
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Decreases inflammation by suppressing migration of polymorphonuclear leukocytes, fibroblasts, reversal of increased capillary permeability and lysosomal stablization
Side-Effects: CNS: Depression, flushing CV: Hypertension, circulatory collapse, thrombophlebitis, embolism, CHF HEMA: Thrombocytopenia INTEG: Acne, poor wound healing, ecchymosis, bruising GI: Diarrhea, abdominal distention, GI hemorrhage, pancreatitis MS: Fractures, osteoporosis EENT: Fungal infections Contraindications: Hypersensitivity, idiopathic thrombocytopenia, acute glomerulonephritis, amebiasis, fungal infections, nonasthmatic bronchial disease, AIDS, TB, threadworm, high doses in traumatic brain injury
- Metabolized in liver, excreted in urine Assess - infection, increased temp, WBC - K levels, blood glucose levels, long term users may cause hypokalemia and hypergycemia - daily weights - B/P q4h - edema - plasma cortisol levels during long term therapy (normal level: 138-635 nmol/L SI units when drawn at 0800) Teach - Do NOT discontinue abruptly - Avoid OTC medication - Symptoms of adrenal insufficiency: nausea, fatigue, dizziness, dyspnea, joint pain
Drug: Dose:
Bethanechol
Functional class: Urinary tract stimulant cholinergic
Chemical class: Route (Give timing for IV push/IVPB meds): Synthetic choline ester Action: Frequency: Stimulates muscarinic ACH receptors directly; mimics effects of Rationale for client: parasympathetic nervous system stimulation; stimulates gastric motility, stimulates micturition; increases lower esophageal pressure
Side-Effects: CNS: Dizziness, HA, malaise CV: cardiac arrest, circulatory collapse RESP: Acute asthma, dyspnea, bronchoconstriction GI: nausea, bloody diarrhea, belching, vomiting, cramps, fecal incontinence GU: Urgency EENT: miosis, increased salivation, lacrimation, blurred vision Contraindications: Severe bradycardia, asthma, severe hypotension, hyperthyroidism, PUD, CAD,COPD, GI/GU obstruction
Assess: - B/P pulse -I&O - HR Teach: - take 1hr before meals or 2hr after meals Antidote: Atropine 0.6-1.2mg IV or IM
Drug: Dose:
Bicalutamide
Functional class: Antineoplastic hormone
Chemical class: Route (Give timing for IV push/IVPB meds): Nonsteroidal anti-androgen Frequency: Rationale for client: Action: Binds to cytosolic androgen in target tissue, which competitively inhibits the action of androgens
Side-Effects: Assess: CNS: dizziness, insomnia, anxiety, - for diarrhea, constipation, hot flashes headache CV:CHF, edema, hot flashes, HTN, CP Teach: HEMA: Neutropenia, Leukopenia - Report signs of anemia, hepatoxicity or INTEG:Rash, sweating, dry skin, pruritis renal toxicity. GI: Diarrhea, constipation, N/V, increased - Loss of hair can happen but is reversible hepatic enzymes, melena, abd, pain after treatment. GU:Nocturia, hematuria, dysuria, UTI, - Report severe diarrhea. impotence, retention, gynecomastia MISC: Infection, anemia, bone pain, headache, backpain, flu-like symptoms Contraindications: hypersensitivity
Drug: Dose:
Bisacodyl
Functional class: Laxative, stimulant
Chemical class: Route (Give timing for IV push/IVPB meds): Diphenylmethane Frequency: Rationale for client: Action: Acts directly on intestine by increasing motor activity; thought to irritate colonic intramural plexus
Side-Effects: CNS: Muscle weakness META: Tetany, protein-losing enteropathy, alkalosis, hypokalemia GI: Nausea, vomiting, anorexia, cramps Contraindications: Abdominal pain, nausea, vomiting, appendicitis, fecal impaction
Assess: - blood, urine electrolytes - I&O - cause of constipation - rectal bleeding Teach: - Do not use in presence of abdominal pain, nausea, vomiting - Do not use for long term therapy
Drug: Dose:
Bisoprolol
Chemical class: Route (Give timing for IV push/IVPB meds): B1-blocker Frequency: Rationale for client: Action: Preferentially and competitively blocks stimulation, of B1 adrenergic receptors within cardiac muscle, slows conduction of AV node, decreases HR, which decreases O2 consumption in myocardium; decreases renin aldosteroneangiotensin system
Side-Effects: CNS: Vertigo, HA, mental changes, depression, lethargy CV: Ventricular dysrhythmias, profound hypotension, bradycardia, CHF, 2nd or 3rd degree heart block HEMA: Agranulocytosis, thrombocytopenia, purpura INTEG: Rash, flushing, alopecia GI: N/V, mesenteric arterial thrombosis GU: Impotence EENT: sore throat, burning eyes RESP: bronchospasm, dyspnea, wheezing Contraindications: Diabetes mellitus, thyroid/renal/hepatic disease, COPD, asthma, aortic or mitral valve disease BBW: Abrupt discontinuation
Assess: - B/P, pulse noting rate, rhythm and quality - Apical/radial pulse before administer notify M.D. if <60bpm - Edema in feet and legs - I&O, watch for CHF, JVD Teach: - Do not discontinue abruptly - Do not use with nasal decongestants, OTC cold preparations. - take pulse at home - Report symptoms of CHF such as, difficulty breathing especially on exertion, night cough Antidote: Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm; digoxin, O2, diuretic for cardiac failure, hemodialysis, IV glucose for hypoglycemia; IV diazepam for seizures
Drug: Dose:
bivalirudin
Functional class: Anticoagulant
Chemical class: Route (Give timing for IV push/IVPB meds): Thrombin inhibitor Frequency: Rationale for client: Action: Direct inhibitor of thrombin that is highly specific; able to inhibit free and clot bound thrombin
Side-Effects: CNS: Headache, insomnia, anxiety, nervousness CV: Hypo/hypertension, bradycardia HEMA: Hemorrhage, thrombocytopenia GI: Nausea, vomiting, abdominal pain, dyspepsia Contraindications: Hypersensitivity, active bleeding, cerebral aneurysm, intracranial hemorrhage, recent surgery, CVA
Assess - aPtt, Pt, INR, platelets, Hgb, Hct - Monitor bleeding, fever, urticaria - Watch for neurological status changes, BP changes, bradycardia Teach - To report black tarry stools, blood in urine, difficulty breathing
Drug: Dose:
bleomycin
Functional class: antineoplastic, antibiotic
Chemical class: Route (Give timing for IV push/IVPB meds): glycopeptide Frequency: Rationale for client: Action: Inhibits synthesis of DNA, RNA, protein; derived from Streptomyces verticillus; phase specific in the G2 and M phases; a nonvesicant sclerosing agent
Side-Effects: CNS: pain at tumor site, headache, confusion INTEG: rash, hyperkeratosis, nail changes, alopecia GI: Nausea, vomiting, anorexia, stomatitis, weight loss RESP: fibrosis, pneumonitis, pulmonary toxicity Contraindications: hypersensitivity, prior idiosyncratic reaction
Assess - pulmonary function test: chest x-ray; temperature, serum creatinine, dyspnea, crackles, unproductive cough, chest pain, tachypnea, fatigue, increased pulse, pallor, lethargy, effects of alopecia, symptoms indicating anaphylaxis Teach - deep breathing exercises, rinse the mouth out, keep HOB elevated, report any changes in breathing, cough, fever and complaints to HCP; avoid voids with citric acid, report any bleeding, white spots, or ulcerations in the mouth; use contraceptives, do not receive vaccines during treatment
Drug: Dose:
Boric acid
Functional class: Chemical class:
Side-Effects: INTEG: rash, urticaria EENT: Itching, irritation in ear Contraindications: hypersensitivity, perforated eardrum
Assess - For redness, swelling, fever, pain in the ear Teach - the correct way to instill drops using aseptic technique; dizziness may occur after instillation
Route (Give timing for IV push/IVPB meds): otic Action: Inhibits protein synthesis in susceptible Frequency: microorganisms Rationale for client: ear infection
Drug: Dose:
Bortezomib
Functional class: antineoplastic; miscellaneous
Chemical class: Route (Give timing for IV push/IVPB meds): proteasome inhibitor Frequency: Rationale for client: Action: A reversible inhibitor of chymotrypsin like activity in mammalian cells. Causes a delay in tumor growth by disrupting normal homeostatic mechanisms
Side-Effects: CNS: peripheral neuropathy CV: hypotension, edema, CHF HEMA: anemia, neutropenia, thrombocytopenia GI: constipation, diarrhea, vomiting Contraindications: hypersensitivity to this product, boron, or mannitol
Assess - hematologic status: platelets, CBC; BP, fluid status, peripheral neuropathy symptoms Teach - to use contraception; monitor BG levels if diabetic; contact HCP if severe vomiting, diarrhea
Drug: Dose:
Bosentan
Functional class: vasodilator
Chemical class: Route (Give timing for IV push/IVPB meds): endothelin receptor antagonist Frequency: Rationale for client: Action: Peripheral vasodilation occurs via antagonism of the effect of endothelin on endothelium and vascular smooth muscle
Side-Effects: CNS: headache, flushing, fatigue, fever CV: hypo/hypertension, hypertensive crisis HEMA: anemia, leucopenia, neutropenia, lymphopenia, thrombocytopenia INTEG: anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis GI: hepatotoxicity Contraindications: hypersensitivity, CVA, CAD
Assess - BP, pulse, hepatic studies: AST, ALT, bilirubin; blood studies: Hct, Hgb; vomiting, jaundice Teach - to report jaundice, dark urine, joint pain, fatigue, malaise, bruising, easy bleeding, use non-hormonal contraceptives
Drug: Dose:
brimonidine
Functional class: Chemical class: Action: Reduce aqueous humor production and increasing uveoscleral outflow.
Side-Effects: CNS: headache CV: hypertension, tachycardia, dysrhythmias GI: bitter taste EENT: burning, stinging Contraindications: hypersensitivity
Assess - ophth exams and intraocular pressure; blood counts Teach - how to instill drops; the product may cause burning, itching, blurring, dryness of eye area
Drug: Dose:
brinzolamide
Functional class: Chemical class: Action: converted to epinephrine, which decreases aqueous production and increases outflow
Drug: Dose:
bromfenac
Functional class: Chemical class: Action: Inhibit prostaglandin synthesis by inhibiting cyclooxygenase 1 and 2.
Drug: Dose:
bromocriptine
Functional class: DOPamine receptor agonist, antiparkinson agent
Route (Give timing for IV push/IVPB meds): Chemical class: Ergot alkaloid derivative Frequency: Rationale for client: Action: Inhibits prolactin release by activating postsynaptic DOPamine receptors ; activation of striatal DOPamine receptors may be reason for improvement in Parkinsons disease Functional class: Antihistamine
Side-Effects: CNS: Headache, seizures, hallucinations CV: shock, MI INTEG: rash on face, arms GI: nausea, vomiting, anorexia GU: frequency, incontinence, diuresis EENT: blurred vision, burning eyes Contraindications: Severe ischemic disease, uncontrolled hypertension, severe peripheral vascular disease, hypersensitivity to ergot, bromocriptine, migraine, preeclampsia
Assess - BP, Parkinsons symptoms: pill rolling, shuffling gait, restlessness, tremors, postural instability Teach - to change positions slowly to prevent orthostatic hypotension; use contraceptives; therapeutic effect may take up to 2 months; report signs of MI immediately
Drug: Dose:
brompheniramine
Chemical class: Route (Give timing for IV push/IVPB meds): Alkylamine, H1-receptor antagonist Frequency: Rationale for client: Action: Acts on blood vessels, GI, respiratory system by competing with histamine for H1-receptor site; decreases allergic response by blocking histamine
Side-Effects: Assess CNS: dizziness, drowsiness - urinary retention, frequency, dysuria; CV: hypotension, palpitations, tachycardia CBC; blood dyscrasias; HEMA: thrombocytopenia, thrombocytopenia, angranulocytosis agranulocytosis, hemolytic anemia (rare); respiratory status INTEG: photosensitivity GI: nausea, vomiting, constipation, Provide diarrhea - hard candy, gum, frequent rinsing of GU: retention, dysuria, impotence mouth for dryness EENT: blurred vision, dilated pupils, tinnitus, nasal stiffness Teach - to notify HCP if Contraindications: confusion/sedation/hypotension occurs; hypersensitivity to H1-receptor avoid alcohol and other CNS depressants antagonists, acute asthma attack, lower respiratory tract disease
Drug: Dose:
budesonide
Functional class: Glucocorticoid
Chemical class: Route (Give timing for IV push/IVPB meds): Nonhalogenated Frequency: Rationale for client: Action: Prevents inflammation by depression of migration of polymorphonuclear leukocytes, fibroblasts, reversal of increased capillary permeability and lysosomal stabilization; does not suppress hypothalamus and pituitary function
Side-Effects: CNS: headache CV: chest pain, hypertension, palpitation GI: dry mouth, dyspepsia, nausea, vomiting, abdominal pain EENT: sinusitis, pharyngitis Contraindications: hypersensitivity, status asthmaticus
Assess - espiratory status: rate, rhythm, wheezing, chest tightness; increased intraocular pressure Teach - to notify HCP if pharyngitis, nasal bleeding, oral candidiasis occur; keep emergency ID on them at all times identifying steroid use; prevent exposure of viral infection; avoid taking with grapefruit juice; use good oral hygiene
Drug: Dose:
budesonide
Functional class: Chemical class:
Route (Give timing for IV push/IVPB meds): nasal spray Action: produces vasoconstriction of arterioles, Frequency: thereby decreasing fluid exudation, mucosal engorgement by stimulation of Rationale for client: nasal congestion alpha adrenergic receptors in vascular smooth muscle
Side-Effects: CNS: anxiety, tremors, restlessness INTEG: contact dermatitis GI: nausea, vomiting, anorexia EENT: irritation, burning, sneezing, dryness, rebound congestion Contraindications: hypersensitivity to sympathomimetic amines
Assess - for redness, swelling, pain in nasal passages; systemic absorption; hypertension, tachycardia Teach - that stinging may occur; drying of the mucosa may decrease from environmental humidification; notify HCP if irregular pulse, insomnia, dizziness, or tremors occur; rinse dropper with very hot water to prevent contamination; proper administration to avoid systemic absorption
Drug: Dose:
bumetanide
Functional class: loop diuretic, antihypertensive
Chemical class: Route (Give timing for IV push/IVPB meds): sulfonamide derivative Frequency: Rationale for client: Action: Acts of ascending loop of Henle by inhibiting reabsorption of chloride, sodium
Side-Effects: CNS: headache, fatigue, weakness, dizziness CV: chest pain, circulatory collapse HEMA: thrombocytopenia, leucopenia, granulocytopenia, hemoconcentration INTEG: rash, pruritus, stevens Johnson sysndrome GI: nausea, acute pancreatitis, jaundice GU: polyuria, renal failure EENT: loss of hearing Contraindications: hypersensitivity to sulfonamides, anuria, hepatic coma
Assess - for tinnitus; weight, I&O daily to determine fluid loss; BP: orthostatic hypotension; electrolytes: K, Na, Cl; BUN, BG, CBC, serum creatinine, ABGs, uric acid, Ca, Mg; improvement of edema; signs of metabolic alkalosis; signs of hypokalemia; rash, elevated temp, confusion, dig toxicity Teach - to increase fluids intake to 2-3L/day; rise slowly from lying position; take with food or milk; take early in the morning; use sunscreen Antidote: Lavage
Drug: Dose:
buprenorhine
Functional class: opioid analgesic, partial agonist
Chemical class: Route (Give timing for IV push/IVPB meds): thebaine derivative Frequency: Action: Rationale for client: moderate to severe pain Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
Side-Effects: CNS: drowsiness, confusion, headache, sedation, euphoria, increased intracranial pressure CV: palpitations, bradycardia INTEG: rash GI: Nausea GU: increased urinary output EENT: miosis, tinnitus, blurred vision RESP: respiratory depression Contraindications: hypersensitivity
Assess - I &O ratio; decreased output; bowel pattern; CNS changes: dizziness, drowsiness, hallucinations, euphoria. LOC, pupil reaction; allergic reaction; respiratory dysfunction; tolerance Teach - to report any CNS changes or symptoms; tolerance may result Antidote: Narcan
Drug: Dose:
buPROPion
Functional class: antidepressantmiscellaneous smoking deterrent
Route (Give timing for IV push/IVPB meds): Chemical class: aminoketone Frequency: Rationale for client: Action: Inhibits reuptake of DOPamine
Side-Effects: Assess CNS: Headache, agitation, dizziness, - hepatic/renal functions; increased risk of akinesia, bradykinesia, confusion, seizures; mental status seizures, insomnia, sedation, tremors, suicidal ideation Provide CV: dysrhythmias, hypertension, - assistance with ambulation during tachycardia, complete AV block; QRS beginning therapy; safety measures prolongation (overdose) INTEG: rash, sweating, Stevens Johnson Teach syndrome - that therapeutic effects may take 2-4 GI: nausea, vomiting, dry mouth, weeks; use caution in activities that constipation require alertness because sedation or GU: menstrual irregularities, impotence blurred vision may occur; avoid alcohol EENT: blurred vision, auditory ingestion and other CNS depressants to disturbance prevent an increase risk of seizures; do not use with nicotine patches; suicidal ideation Contraindications: may occur; notify HCP if pregnancy is hypersensitivity, eating disorders, seizure suspected disorders Antidote: lavage, activated charcoal
Drug: Dose:
busPIRone
Functional class: Antianxiety, sedative
Chemical class: Route (Give timing for IV push/IVPB meds): azaspirodecanedione Frequency: Rationale for client: Action: Acts by inhibiting the action of serotonin; has shown little potential for abuse, a good choice in substance abuse
Side-Effects: Assess CNS: dizziness, headache, depression, - BP, pulse; CNS reactions; mental status stimulation, insomnia, nervousness, light headedness, numbness, paresthesia, Provide incoordination, tremors - assistance with ambulation; safety CV: tachycardia, palpitations, CVA, CHF, measures if drowsiness occur MI INTEG: rash Administer GI: nausea, dry mouth, diarrhea, - with food or milk and avoid grapefruit constipation juice; give sugarless gum, hard candy, GU: frequency, hesitancy frequent sips of water for dry mouth EENT: sore throat, tinnitus, blurred vision, nasal congestion Teach - to avoid grapefruit juice; to rise slowly; Contraindications: therapeutic response may occur 1-2 wks hypersensitivity after treatment
Drug: Dose:
busulfan
Functional class: antineoplastic alkylating agent
Chemical class: Route (Give timing for IV push/IVPB meds): bifunctional alkylating agent Frequency: Rationale for client: Action: Changes essential cellular ions to covalent bonding with resultant alkylation; this interferes with normal biologic function of DNA; activity is not phase specific; action is due to myelosuppression
Side-Effects: Assess CNS: cerebral hemorrhage, coma, - CBC, platelet count; seizure history; seizures, anxiety, depression, dizziness, bone marrow status; pulmonary function headache, weakness test, chest x-ray; renal studies: BUN, CV: hypotension, thrombosis, chest pain, serum uric acid, ALT, alk phos, bilirubin, tachycardia, atrial fibrillation, heart block, uric acid, I&O ratio; pericardial effusion, cardiac tamponade HEMA: thrombocytopenia, leucopenia, Monitor pancytopenia, severe bone marrow - for fever, cold, sore throat, bleeding, depression dyspnea, crackles, nonproductive cough, INTEG: dermatitis chest pain, tachypnea GI: anorexia, constipation, diarrhea, dry mouth, nausea, vomiting, weight loss Provide GU: renal toxicity - oral hygiene, strict medical asepsis, EENT: pharyngitis, epistaxis increase fluid intake to 2-3L/day Contraindications: radiation, chemotherapy, blastic phase of chronic myelocytic leukemia, hypersensitivity Teach - about protective isolation; avoid use of products containing aspirin or ibuprofen, razors, commercial mouthwash; use contraceptives; report signs of anemia, infection, jaundice or bleeding; avoid vaccinations, crowds; impotence or amenorrhea may occur; report changes in breathing or coughing
Drug: Dose:
butoconazole
Functional class: benzene and derivatives
Chemical class: Route (Give timing for IV push/IVPB meds): halobenzenes Frequency: Rationale for client: Action: Interferes with fungal DNA replication; binds sterols in fungal cell membranes, which increases permeability, leaking of nutrients
Side-Effects: Assess INTEG: rash, urticaria, stinging, burning - for allergic reaction: burning, stinging, GU: vulvovaginal burning, itching, pelvic itching, discharge, soreness cramps Teach Contraindications: - about asepsis before application; apply hypersensitivity with applicator only; avoid using any other vaginal products; abstain from sexual intercourse; notify HCP if symptoms persist
Drug: Dose:
butorphanol
Functional class: opioid analgesic
Chemical class: Route (Give timing for IV push/IVPB meds): mixed opioid antagonist, partial agonist Frequency: Rationale for client: Action: Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
Side-Effects: CNS: drowsiness, dizziness, confusion, headache, sedation, euphoria, weakness, hallucinations CV: palpitations, bradycardia, INTEG: rash, urticaria GI: nausea, vomiting, anorexia, constipation, cramps GU: increased urinary output EENT: tinnitus, blurred vision, miosis Contraindications: hypersensitivity to this product or preservative, addiction, CHF, myocardial infarction
Assess - decreased urine output; withdrawal symptoms in opioid dependent patients: PE, vascular occlusion, abscesses, ulceration; CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction; allergic reaction; respiratory dysfunction; physical dependence Provide - assistance with ambulation; safety measures Teach - to report any symptoms of CNS changes, allergic reaction; physical dependency may result; withdrawal symptoms may occur Antidote: Narcan -Assess for GI upset, tetany in ears (have calcium on hand if Ca levels drop too low) -Labs: BUN, creatnine, uric acid, chloride, urine pH, urine Ca, Mg, Phos. -Urine for sediment -Nutritional status; diet for sources of vit. D (milk, some seafood), calcium (dairy, green leafy veg.)
Drug: Calcitonin (Fortical, Miacalcin, Osteocalcin) Dose: SQ/IM 50-100IU/day Intranasal 200IU/day (1 spray)
Functional class: Parathyroid Agent (calcium regulator) Chemical class: Polypeptide hormone
Side-Effects: CNS: HA, tetany,chills,weakness,dizzy,fever CV: Chest pressure HEMA: INTEG: rash, flushing, edema(feet), Pruritus(earlobes) GI: N/V, diarrhea, anorexia, abd. pain, salty taste, epigastic pain GU: EENT: nasal congestion, eye pain Contraindications: Hypersensitivity to this product or fish
Route (Give timing for IV push/IVPB meds): Action: decreases bone reabsorption, SQ/IM, Intranasal blood calcium levels; increases deposits of calcium in bones; opposes parathyroid Frequency: daily or BID hormone Rationale for client: Pagets disease, postmenopausal osteoporosis, hypercalcemia
Drug: Calcitrol ( Vit. D3, Calcijex, Rocaltrol) Functional class: Parathyroid agent (calcium regulator) Dose: Adult 0.25-2mcg/day Chemical class: Vit. D hormone Route (Give timing for IV push/IVPB meds): IV or PO Action: Increases intestinal absorption of Frequency: divided doses bid or tid Ca, provides Ca for bones, renal tubular reabsorption of phosphate Rationale for client: hypocalcemia in chronic renal disease, hyperparathyroidism pseudohypoparathyroidism
Side-Effects: CNS: Drowsy, A, vertigo, fever, lethargy, hallucinations CV: Hypertension, palpitations HEMA: INTEG: GI: N/V/D, jaundice, dry mouth, anorexia, constipation, metallic taste GU: Polyuria, hypercalciuria, thirst, hyperphosphatemia, hematuria EENT: Blurred vision, photophobia Contraindications: Hypersensitivity, Vit. D toxicity, hypercalcemia, hyperphoshatemia
-Labs: BUN, urinary calcium, AST, ALT, cholesterol, albumin, uric acid, chloride, Mg, electrolytes, urine pH, phosphate -Assess f increased product level (toxicity occurs rapidly) -Assess for SE, renal status -Nutritional status; diet for sources of vit. D (milk, some seafood), calcium (dairy, green leafy veg.) MUST BE AVOIDED
Drug: Calcium Carbonate (Tums, Maalox, Oyst-Cal) Calcium Acetate (Calphron, Phoslo) Dose: 1200 mg/day
Functional class: Antacid, calcium supp. Chemical class: Calcium product Action: Neutralizes gastric activity
Side-Effects: CNS: CV: HEMA: INTEG: GI: Constipation, N/V/D, flatulence, eructation, rebound hyperacidity GU: Calculai, hypercalciuria EENT: Contraindications:
Route (Give timing for IV push/IVPB meds): PO Frequency: once a day or bid Rationale for client: Antacid, osteoporosis prevention, Tx f hypocalcemia
-Assess Ca. (urine, serum) -Milk alkoli syndrome: N/V, HA, - May increase Dig Toxicity -Hypercalcemia (Chovosteks/Trousseaus signs) -For antacid use: assess abd. pain, heartburn indigestion before or after administration
Drug: CALCIUM SALTS Calcium Chloride, Calcium Gluceptate, Calcium Gluconate (Kalcinate) Calcium Lactate (Cal-Lac) Dose: IV 500mg-1g q1-3days PO 0.5-2g/day Route (Give timing for IV push/IVPB meds): PO or calcium chloride IV give <1ml/min calcium glucephate IV 5-20ml or IM 2-5ml calcium Gluconate IV 0.5-2g @0.5ml/min (10% solution) Frequency: daily depending on route Rationale for client: prev. and Tx of hypocalcemia, cardiac toxicity caused by hyperkalemia, Vit. D deficiency, calcium antagonist toxicity (CCB toxicity)
Functional class: Electrolyte replacement Chemical class: Calcium product Action: Cation needed for maintenance of nervous, muscular, skeletal function; enzyme reactions; normal cardiac contractility; coagulation of blood; affects secretory activity of endocrine, exocrine glands
Side-Effects: CNS: CV: Shortened QT, heart block, hypotension, bradycardia, DYSRHYTHMIAS, CARDIAC ARREST (IV) HEMA: INTEG: Pain, burning @ IV site, severe venous thrombosis, necrosis, extravasation GI: N/V/C, HYPERCALCEMIA; drowsy, HA, muscle weakness, COMA, N/V, thirst GU: EENT: Contraindications: Hypercalcemia, Digoxin toxicity, vent. Fib., renal calculi
-Assess ECG f QT and T wave inversion, hypercalcemia- decrease or d/c med -Continue cardiac monitoring (rate, rhythm, CVP) -Hypocalcemia: muscle twitching, paresthesia, dysrhythmias, laryngospasm -Monitor Digoxin Pt.s closely: increase calcium increases dig. tox. risk
Drug: Candesartan (Atacand) Dose: 2-32mg/day Route (Give timing for IV push/IVPB meds): PO Frequency: once daily or BID Rationale for client: Tx of hypertension; alone or in combination; CHF NYHA Class II-IV and ejection fraction =<40%
Functional class: Antihypertensive Chemical class: Angiotensin II receptor antagonist Action: Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II ; selectively blocks the binding of angiotensin II to the AT1 receptor found in tissues
Side-Effects: CNS: Dizzy, HA, fatigue CV: Chest pain, peripheral edema, hypotension HEMA: INTEG: GI: Diarrhea, N/V, abd. pain GU: Renal Failure EENT: Sinusitis, rhinitis, pharyngitis RESP:Cough, Upper resp. infection SYST: ANGIOEDEMA Contraindications: Hypersensitivity
-Assess f angioedema, pregnancy (fetal death), or adverse reactions in renal pt.s -Assess B/P, pulse q4hr; note rate ,rhythm, quality; electrolytes: K, Na, Cl; baselines in renal/hepatic studies before therapy begins
Drug: Capecitabine ( Xeloda) Dose: 2500 mg/m2/day
Functional class: Antineoplastic, Antimetabolite
Side-Effects: CNS: HA, paresthesia, fatigue, insomnia, dizzy CV: HEMA: NEUTROPENIA, LYMPHOPENIA, THROMBOCYTOPENIA, anemia INTEG: hand-foot syndrome, dermatitis, nail disorder GI: N/V/D/C, stomatitis, dyspepsia, INTESTINAL OBSTRUCTION, NECROTIZING ENTEROCOLITIS RESP; Cough, Dyspnea OTHER; Hyperbilirubinemia, EYE IRRITATION, EDEMA, Myalgia, limb pain, PYREXIA, dehydration Contraindications: Preg (D), hypersensitivity to 5-FU, severe renal impairment, DPD deficiency
Chemical class: Flouropyrimidine Route (Give timing for IV push/IVPB meds): carbamate PO Frequency: Bid before meals Action: Competes with physiologic substrate of DNA synthesis, thus Rationale for client: Tx for colorectal and/or interfering with cell replication in the S pancreatic cancer phase of cell cycle (before mitosis) , also interferes with RNA and protein synthesis; product is converted to 5-FU
-Labs; CBC, diff.platelet count ea. week -Withhold med if WBC <4000/mm3 or low RBC, Hgb,Hct, notify MD if low - INR for pt. taking warfarin -Asses GI, Buccal cavity q8hrs, for s/s hand-foot syndrome, toxicity, bleeding and hepatic studies -Monitor temp q4hrs (no rectal temps) _Monitor resp. status with high doses BBW-Increase bleeding riskanticoagulants
Drug: Captopril ( Capoten, Novo-Captopril) Dose: max 450mg/day Route (Give timing for IV push/IVPB meds): PO
Functional class: Antihypertensive Chemical class: Angiotensin-converting enzyme (ACE) inhibitor
Side-Effects: CNS: fever, chills CV: Hypotension, postural hypotension, tachycardia, angina HEMA: NEUTROPENIA, AGRANULOCYTOSIS, PANCYTOPENIA, THROMBOCYTOPENIA INTEG: rash, pruritus GI: loss of taste, increased LFTs GU: NEPHROTIC SYNDROME, ACUTE REVERSIBLE RENAL FAILURE, impotence, dysuria, nocturia, proteinuria, polyuria, oliguria, urinary frequency RESP: BRONCHOSPASM, dyspnea, cough MISC: ANGIOSPASM, hyperkalemia Contraindications: heart block, potassiumsparing diuretics, bilateral renal artery stenosis, angioedema, hypersensitivity, breast feeding
Action: Selectively suppresses reninangiotensin-aldosterone system; inhibits ACE; preventing conversion of Rationale for client: Hypertension, CHF, left angiotensin 1 to angiotensin 2 ventricular dysfunction after MI, diabetic nephropathy Frequency: BID-TID
-Monitor B/P, pulse, rate, baseline, frequently -Labs; blood studies, renal studies, hepatic function -Monitor resp. status,CHF- wet crackles, edema, dyspnea, B/P -Edema in feet, legs daily, daily weights -Allergic symptoms not relieved with antihistamines d/c med, notify MD
Drug: Carbamazepine ( Tegretol, Carbatrol, Epitol) Dose: max 1600mg/day
Functional class: Anticonvulsant Chemical class: Iminostilbene derivative
Side-Effects: CNS: Drowsy, dizzy, unsteadiness, fatigue, HA, PARALYSIS, hallucinations, WORSENING OF SEIZURES, speech disturbance, SUICIDAL THOUGHTS/BEHAVIORS CV: HYPERTENSION, CHF, DYSRHYTHMIAS, AV BLOCK, hypotension, aggravation of cardiac artery disease HEMA: THROMBOCYTOPENIA, LEUKOPENIA, AGRANULOCYTOSIS, LEUKOCYTOSIS, APLASTIC ANEMIA, EOSINOPHILIA, increased PT INTEG: S-J syndrome, Toxic epidermal necrolysis, urticaria, rash GI: N/D/C/V, HEPATITIS, HEPATIC PORPHYIA, stomatitis, glossitis GU: RENAL failure, freq., retention, impotence, increased BUN EENT: Tinnitus, dry mouth, blurred vision, diplopia, nystagmus, conjunctivitis Contraindications: Preg. (D), hypersensitivity to carbamazepine or tricyclics, AV or bundle branch block Side-Effects: CNS: involuntary choriform movments, hand tremors, fatigue, headache, anxiety, twitching, numbness, weakness, confusion, agitation, insomnia, nightmares CV: orthostatic hypotension, tachycardia Hema: : hemolytic anemia, leukopenia Integ: rash, sweating GU: urinary retention, incontinence EENT: blurred vision, diplopia, dilated pupils GI: N/V anorexia, dry mouth, abdominal upset, dysphagia Contraindications: hypersensitivity, malignant melanoma or hx of, closedangle glaucoma
Route (Give timing for IV push/IVPB meds): Action: Exact mechanism unknown; PO appears to decrease polysynaptic responses and block posttetanic Frequency: BID-TID potentiation Rationale for client: Tonic-clonic, complexpartial, mixed seizures; trigeminal neuralgia, bipolar disorder
-Monitor Blood Studies q4wks then q36mo -Monitor for mental status changes -Assess Asian pt.s for skin reactions -Assess any seizure activity: character, location, duration, intensity, freq., presence of aura -Assess for s/s of toxicity, eye problems, allergic reaction
Drug: Carbidopa-levodopa (Atamet, Sinemet) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: parkinsons disease, Parkinson like syndrome r/t carbon monoxide, restless leg syndrome
Functional class: Anti-parkinson agent Chemical class: Catecholamine Action: Decarboxylation of levodopa in periphery in inhibited by carbidopa; more levodopa is made available for transport to brain and conversion to DOPamine in the brain
Assess for tremors CNS changes: anxiety, numbness, weakness Fall risk precautions L/S bloodpressure q shift Educate to remain seated for moment before rising after lying down Skin assessment q shift I and O q shift Post-void residuals PRN CBC with differential as ordered
Drug: Carboplatin Functional class: Antineoplastic Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Platinum coordination compound Frequency: Rationale for client: initial treatment of advanced ovarian cancer, Action: produces interstrand DNA cross palliative care of advanced ovarian cancer links and, to a lesser extent, DNA-protein cross links; activity is not cell cycle phase specific
Side-Effects: Cns: seizures, central neural toxicity, peripheral neuropathy Cv: cardiac abnormalities Eent: tinnitus, hearing loss, visual changes Gi: severe nausea, vomiting, weight loss Hema: thrombocytopenia, leukopenia, neutropenia, anemia Integ: alopecia Meta: hypomagnesemia, hypocalcemia, hypokalemia, hyponatremia Syst: anaphylaxis Contraindications: pregnancy, breatfeeding, hypersensitivity to this product or mannitol, significant bleeding BLACK BOX WARNING: SEVERE BONE MARROW DEPRESSION ANEMIA, INFECTION Side effects: CNS: dizziness, weakness, drowsiness, seizures CV: orthostatic hypotension EENT: diplopia GI: nausea, vomiting HEMA: leukopenia INTEG: rash, pruritus RESP: asthmatic attacks SYST: angioedema, anaphylaxis Contraindications:Hypersensitivity, intermittent porphyria
Seizure precautions Fall risk precautions Monitor for changes in LOC Cardiac assessment q shift Hearing screens PRN Educate client to report any sudden changes in vision May be administerd with an antiemetic PRN as ordered Daily weight CBC with differential Monitor for signs of infection, reverse isolation may be needed Serum electrolyte levels PRN as ordered Educate client of possible hair loss and offer support and/or access to support system/social services if needed
Drug: Carisoprodol (Soma) Functional class: Central acting skeletal Dose: muscle relaxant Route (Give timing for IV push/IVPB meds): Chemical class: Meprobamate congener Frequency: Action: depresses CNS by blocking Rationale for client: relieving pain, muscle interneuronal activity in descending stiffness reticular formation, spinal cord, producing sedation
Drug: Carvedilol (coreg) Functional class: Antihypertensive Dose: Chemical class: Alpha/beta adrenergic Route (Give timing for IV push/IVPB meds): blocker Action: a mixter of nonselective alpha and Frequency: beta adrenergic blocking activity; Rationale for client: essential hypertension, decreases cardiac output, decreases CHF, LV dysfunction after MI, exercise induced tachycardia, reflex cardiomyopathy tachycardia, causes vasodilation, reduction in peripheral vascular resistance
Side effects: CNS: Dizziness, fatigue, weakness CV: bradycardia, postural hypotension, CHF, pulmonary edema GI: diarrhea, increased AST,ALT GU: decreased libido, impotenance INTEG: rash MISC: hyperglycemia Contraindications: asthma, class IV decompensated cardiac failure, 2nd or 3rd degree heart block, cardiogenic shock, severe brady cardia, pulmonary edema
Nursing interventions Assess for changes in LOC Seizure/fall risk precautions Educate to report changes in vision such as double vision I and O q shift Abdominal assessment q shift Electrolytes if severe vomiting occurs CBC with differential Monitor for signs of infection Skin assessment q shift Resp assessment, including O2sat, q 4 hours: note and report and flushing, shortness of breath, inability to speak Monitor extremities for edema Nursing interventions Assess changes in LOC Fall risk precautions Cardiopulmonary assessment q shift L/S blood pressure q shift Education and counseling if needed of sexual function disruptments Skin assessment q shift Monitor blood sugar levels qday unless abnormalities are noted: MD may order more frequent testing Educate client that abrupt discontinuation of medication may result is serious adverse reactions
Drug: Caspofungin (cancidas) Functional class: Systemic antifungal Dose: Chemical class: Echinocandin Route (Give timing for IV push/IVPB meds): Action: inhibits an essential component in fungal cell walls; causes direct damage to Frequency: fungal cell wall Rationale for client: treatment of multiple systemic fungal infections
Side effects: CNS: dizziness, headache CV: sinus tachycardia GI: nausea, anorexia, vomiting, diarrhea, increased AST, ALT, alk phosphate INTEG: rash, pruritus, injection site pain RESP: ARDS Contraindications: hypersensitivity to this product or other echinocandins, such as mannitol
Drug: Celecoxib (Celebrex) Functional class: NSAID, antirheumatic Dose: Chemical class: COX-2 inhibitor Route (Give timing for IV push/IVPB meds): Action: inhibits prostaglandin synthesis by selectively inhibiting COX-2, an enzyme Frequency: needed for biosynthesis Rationale for client: acute, chronic RA, FAP, acute pain, primary dismennorrhea, JRA
Side-Effects: CNS: fatigue, anxiety, depression, nervousness, paresthesia, CV: stroke, MI, tachycardia, CHF Hema: blood dyscrasias, platlet aggregation Integ: Steven-Johnsons syndrome, toxic epidermal necrolysis GI: GI bleeding, ulceration GU: : nephrotoxicity: dysuria, hematuria, oliguria, cystitis, UTI EENT: hearing loss, blurred vision Contraindications: Pregnancy 3rd trimester, hypersensitivity to salicylates or sulfonamides
Nursing interventions: Fall risk precautions Cardiac assessment q shift: monitor HR q2-4 hours/PRN Assess GI upset: electrolytes if persistant vomiting occurs, nutritional assessment, frequent weight assessments Liver function studies: AST, ALT, BILI, alkaline phosphate Skin assessment q shift and frequently during infusion: assess IV site q 2 hours on rounds Closely monitor resp function for signs/symptoms of distress Nursing interventions Monitor for CNS changes Fall risk precautions Cardiac assessment q shift: monitor for edema closely (CHF) Educate to report sudden difficulty hearing or visual disturbances Vision and hearing screens PRN Assess bowel and bladder activity: note and report immediately any signs of blood in urine/feces, difficulty voiding, pain when voiding, lower back pain Note and report persistent GI upset/pain Skin assessment q shift Black box warning: CABG, GI bleeding, perforation, PUD, MI, Stroke
Drug: Cephalosporins 1st generation: Cefadoxil (duricef), cefazolin (Ancef), Cephalexin (Keflex), cephradine (Velosef) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: bacterial infections
Functional class: Anti-infective Chemical class: Cephalosporin 1st generation Action:inhibits bacterial cell wall synthesis, rendering cell wall osmotically unstable, leading to cell death; lysis mediated by cell wall autolytic enzymes
Side-Effects: CNS: Head ache, dizziness, weakness, seizures (in high doses) Hema: Leukopenia, thrombocytopenia, agranulocytosis, neutropenia, lymphocytosis, eosinophilia, pancytopenia, hemolytic anemia Integ: Rash, urticaria, dermatitis GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, increased liver enzymes, pseudomembranous colitis GU: Proteinuria, vaginitis, increased BUN, nephrotoxicity, renal failure EENT: Dyspnea, Anaphylaxis, serum sickness, superinfection Contraindications: Hypersensitivity
Nursing Interventions - Fall risk precautions
Seizure precautions CBC with differential as ordered Monitor for worsening of or development of new infection May be administerd with antiemetic if ordered UA as ordered Monitor for difficulty voiding or darkening urine and report Assess respiratory and skin q shift Liver enzymes/renal studies: AST,ALT,BUN CREATININE, ALK PHOSPHATE
Drug: Cephalosporin 2nd generation: cefaclor (Ceclor), cefotetan (Cefotan), cefoxitin (Mefoxin), cefprozil (Cefzil), cefuroxime (Ceftin), loracarbef (Lorabid)
Functional class: anti-infective Chemical class: cephalosporin 2nd generation Action: inhibits bacterial cell wall synthesis, rendering cell wall osmotically unstable, leading to cell death; lysis mediated by cell wall autolytic enzymes
Side-Effects: CNS: Head ache, dizziness, weakness, seizures (in high doses) Hema: Leukopenia, thrombocytopenia, agranulocytosis, neutropenia, lymphocytosis, eosinophilia, pancytopenia, hemolytic anemia Integ: Rash, urticaria, dermatitis GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, increased liver enzymes, pseudomembranous colitis GU: Proteinuria, vaginitis, increased BUN, nephrotoxicity, renal failure EENT: Dyspnea, Anaphylaxis, serum sickness, superinfection Contraindications: Hypersensitivity
Seizure precautions CBC with differential as ordered Monitor for worsening of or development of new infection May be administerd with antiemetic if ordered UA as ordered Monitor for difficulty voiding or darkening urine and report Assess respiratory and skin q shift Liver enzymes/renal studies: AST,ALT,BUN CREATININE, ALK PHOSPHATE
Drug:Cephalosporin 3rd generation: cefdinir (Omnicef), cefditoren pivoxil (Spectracef), cefepime (Maxipime), cefotaxime (Claforan), cefpodoxime (Vantin), ceftazidime (fortaz), ceftibuten(Cedax), ceftizoxime (Cefizox), ceftriaxone (Rocephin) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: BIG BOY INFECTIONS
Functional class: anti-infective Chemical class: broad spectrum: cephalosporin 3rd generation Action: inhibits bacterial cell wall synthesis, rendering cell wall osmotically unstable, leading to cell death; lysis mediated by cell wall autolytic enzymes
Side-Effects: CNS: Head ache, dizziness, weakness, seizures (in high doses) CV: CHF Hema: Leukopenia, thrombocytopenia, agranulocytosis, neutropenia, lymphocytosis, eosinophilia, pancytopenia, hemolytic anemia Integ: Rash, urticaria, dermatitis GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, increased liver enzymes, pseudomembranous colitis GU: Proteinuria, vaginitis, increased BUN, nephrotoxicity, renal failure EENT: Dyspnea, Anaphylaxis, serum sickness, superinfection Contraindications: Hypersensitivity
Seizure precautions CBC with differential as ordered Monitor for worsening of or development of new infection May be administerd with antiemetic if ordered UA as ordered Monitor for difficulty voiding or darkening urine and report Assess respiratory, CARDIAC and skin q shift Monitor for edema and/or water retention (I and O) Liver enzymes/renal studies: AST,ALT,BUN CREATININE, ALK PHOSPHATE
Drug:cephradine/ cephlasporins 1st gen
Functional class: anti infective Chemical class:
Dose: Route (Give timing for IV push/IVPB meds): Action Frequency: Rationale for client: See cephlasporin 1st Gen:
Side-Effects: CNS: CV: Hema: Integ: GI: GU: EENT: Contraindications:
Drug: certolizumab / Cimzia
Functional class: Biological response modifier Dose: 400mg Chemical class: Anti-tissue necrosis Route (Give timing for IV push/IVPB meds): factor( anti- TNF ) agent SubCut weeks 0, 2, 4 after therapeutic response 400mg q4wk Action: Monoclonal antibody that neutralizes the activity of tumor necrosis Frequency: 2 inj factor for alpha (TNF-Alpha) found in Rationale for client: Crohns disease Crohns disease; decreased infiltration of rheumatoid arthritis inflammatory cells.
Functional class: Antihistamine ( 2nd Generation peripherally selective) Dose: 5-10mg/day Chemical class: Piperazine H1 histamine Route (Give timing for IV push/IVPB meds): antagonist PO Action: Acts on bllod vessels GI, respitory Frequency: Daily systems by competing with histamine for Rationale for client: Rhinitis, allergy H1 receptor sites decreases allergy symptoms, chronic idiopathic urticaria response by blocking pharmacologis effects of histamines; minimal anticholinergic selective action. Drug: cetrorelix / Cetrotide Functional class: Gonadotropin-releasing hormone antagonist Dose: 0.25-3mg Chemical class: Synthetic decapeptide Route (Give timing for IV push/IVPB meds): SubCut Action: Inhibitor of pituitary gonadotropin secretion; initially increases LH and FSH, Frequency: q-bid/q4wk induces a rapid suppression of Rationale for client: Inhibits of premature gonadotropin secretion. LH surges in women undergoing controlled ovarian hyperstimulation, BPH in men Drug: cetirizine / Zyrtec
Side-Effects: CNS: seizures, dysmyelinating disease of CNS CV: Heart failure, MI, cardiac dysrhythmias Hema: Anemia, aplastic anemia, pancytopenia, thrombocytopenia Integ: Angioedema GI: Hepatitis, bowel obstruction, rash, urticaria MISC: Anaphylaxis, malignancies, serum sickness, suicidal ideation. Contraindications: Influenza, IV administration, sepsis, hypersensitive Side-Effects: CNS: headache, drowsiness, fatigue CV: Hema: Resp: Thickening of bronchoil secretions GI: Dry mouth GU: EENT: Contraindications: Side-Effects: CNS: headache CV: Hema: Integ: edema GI: GU: Syst: Fetal death, anaphylaxis. Contraindications:
Asses anti-nuclear antibody test, hepatitis B serology, CBC Rhuematoid arthritis ROM pain. GI symptoms. Periodic CBC. CV status: B/P, pulse, angina. Anaphylaxis. Active infections in pt. Do Not Admin. Pre admin TB test.
Asses allergy symptoms, baseline, during treatment. Resp status. Provide hard candy to alleviate dry mouth. Avoid exposure to sunlight can cause photosensitivity.
Asses serum progesterone, LH ovarian ultrasound day 7-14. Do not use if pregnancy is suspect. Do not use if latex allergy exists. ALT, AST, alk phos
Drug: cetuximab / Erbitux
Functional class: Anti-neoplastic misc. monoclonal antibody Dose: 400mg/mm2 Chemical class: Epidermal growth factor Route (Give timing for IV push/IVPB meds): inhibitor IV inf over 2 hrs. MAX infusion rate 5ml/min Action: Not fully understood. Binds to epidermal growth factor receptors inhibits Frequency: Weekly phosphorylation and activation of Rationale for client: Non-small cell Ca. receptor-associated kinase, resulting in inhibition of cell growth.
Drug: chloral hydrate / Somnate
Dose: 25-500mg Max 2g/day Route (Give timing for IV push/IVPB meds): PO/Rectal Action: Reduction product trichloroethanol produces mild cerebral Frequency: 2 to 3 X day. depression, which causes sleep. Rationale for client: Sedation, short term treat of insomnia, anxiety, alcohol withdrawal. Drug: Chlorambucil / Leukeran Functional class: antineoplastic alkylating agent Chemical class: Nitrogen mustard
Functional class: Sedative/hypnotic, nonbarbiturate. Chemical class: Chloral derivative
Side-Effects: CNS: Headache, insomnia, depression. Hema: Leukopenia, anemia Integ: Epidermal necrolysis, angioedema, acute infusion reactions, other skin toxicities, blepharitis, cheilitis, cellulitis, cysts, alopecia, skin/nail disorders. GI: Nausea, diarrhea, vomiting, anorexia, mouth ulcerations, dehydration, constipation, abdominal pain. GU: Renal failure Resp: Interstitial lung disease, pulmonary embolus, cough, dyspnea, peripheral edema. Syst: Anaphylaxis, sepsis, infection. Contraindications: Hypersensitive to Murine proteins. Side-Effects: CNS: Downiness CV: dysrhythmias Hema: Eosinophilia, leukopenia. Integ: Angioedema, rash. GI: Gastrin necrosis, nausea, vomiting, pooting, diarrhea. Resp: Depression. Contraindications: Sensitivity to Triclofos, severe renal disease, hepatic disease, Oral GI disorders, gastritis. Side-Effects: CNS: seizures CV: Hema: Thrombocytopenia, leukopenia, pancytopenia, permanent bone marrow suppression. Integ: SJS GI: Hepatoxicity, nausea, vomiting, diarrhea, weight loss, jaundice. Resp: Fibrosis, pneumonitis. Contraindications: Radiation therapy within 1 month. Recent small pox vaccination.
Asses pulmonary status. Toxic epidermal necrosis, angioedema, anaphylaxis. GI symptoms. K-RAS codon 12-13 mutation do not administer. DO not push IV. Do not shake or dilute. Administer through filter. Flush after infusion with 0.9%NS
Ccr <50 avoid use. Asses Mental status, Physical dependency. Respiratory status, Hx substance abuse. Do not break crush or chew. Monitor for hoarding of drug. Empty stomach for best absorption. -1 hr before bedtime for insomnia.
Dose: 0.1-0.2mg/kg/day Route (Give timing for IV push/IVPB meds): PO/IM Action: Destroys DNA, RNA prohibiting cell reproduction. Frequency: 0.1-0.2mg/kg/day for 3-6wks then 4-10mg/day maintenance Rationale for client: Leukemias and lymphomas
Half-life 2 hours. Asses PT/PTT/INR. Guaiac stools. Asses HFTs. Monitor respiratory status (breath sounds). CBC/diff weekly. WBC < 2000 notify HCP PO if possible avoid IM when platelets <100,000. Renal BUN, Ccr I&O.
Drug: Chloramphenicol / Chloromycetin
Dose: 50-100mg/kg/day Route (Give timing for IV push/IVPB meds): PO/IV -1 hr 50-100ml D5W Action: Binds to RNA which interferes with or inhibits protein synthesis. Frequency: Every 6 to 24 hrs. day. Rationale for client: Infection.
Functional class: Antiinfective-misc. Chemical class: Dichloroacetic acid derivative.
Drug: chlorothiazide / Diuril
Dose: 500mg/day Route (Give timing for IV push/IVPB meds): PO/IV 250mg/q6-12/hr Action: Acts on distal tubule and thick ascending limb of the loop of Henle by Frequency: QD/BID increasing the excretion of water, sodium, Rationale for client: Edema chloride, potassium, magnesium.
Functional class: Diuretic Chemical class: thiazide, sulfonamide derivative
Drug: chlorpheniramine / Chlor-Trimeton Dose: PO2-4mg/T/Q/ID Route (Give timing for IV push/IVPB meds):IM/IV/SubCut. 5-40mg/day MAX 40mg/day Frequency: Rationale for client: Allergies
Functional class: Antihistamine (1st Generation, nonselective) Chemical class: Alkylamine, H1-receptor antagonist. Action: Acts on blood vessels, Gi, and respiratory systems. Competing with histamine for H1-receptor sites; decreases allergic response by blocking histamine.
Side-Effects: CNS: Depression. CV: Grays syndrome in infants, failure to feed, pallor, cyanosis, abdominal distention, irregular respirations. Hema: Anemia, thrombocytopenia, aplastic anemia, granulocytopenia, leukopenia, acute generalized exanthematous pustulosis. GI:N/V/D Contraindications: Severe renal/hepatic disease. Minor infections, labor, tympanic membrane perforation. Side-Effects: CNS: Dizziness, fatigue. CV: Anaphylaxis. Hema: Aplastic anemia, hemolytic anemia, leukopenia, agranulocytosis, thrombocytopenia, neutropenia. Integ: Rash GI: N/V anorexia. Hepatitis GU: Frequent Urination, Electrolytes: Hypokalemia Contraindications: Side-Effects: CNS: Dizziness, drowsiness. Hema: Thrombocytopenia, agranulocytosis, hemolytic anemia. Integ: GI: Nausea GU: Retention Contraindications: Respiratory DO.
Do not use if less toxic product can be used. Asses infections, anemia. Renal studies, UA, protein, blood, BUN creatinine. Hepatic ALT, AST. Asses biwel patterns before during and after. Do not crush, break, or chew oral form.
Daily weights. Asses respiratory status. Postural B/P/ Electrolytes, K, Na, Cl, Ca, Mg, include BUN, BG, serum creatinine, pH, ABGs. Asses signs metabolic alkalosis. Confusion. Risk for fall in elderly.
Asses urinary retention, product should be discontinued. Respiratory status. Avoid other CNS depressants. PO do break crush or chew. Undiluted IV 10mg>1 min. Only 10/mg/ml for IV use. Provide hard candy.
Drug: chlorpromazine / Thorazine
Dose: 10-100mg Route (Give timing for IV push/IVPB meds): PO/IM/Supp. Action: Depress cerebral cortex, hypothalamus, and limbic system which Frequency: Q1-4hr, BID controls activity aggression. Blocks Rationale for client: Psychotic DO, post-op neurotransmission of dopamine at nausea synapse. Mechanics for antipsychotic is unclear.
Functional class: Antipsychotic, antiemetic Chemical class: Phenothiazine aliphatic
Drug: chlorthalidone / Thalitone Dose: 25-100mg/day Route: PO Frequency: QD, or QOD Rationale for client: Edema, HTN, edema in CHF
Functional class: Diuretic Chemical class: Thiazide-like phthalimides derivative Action: Acts on distal tubes and by =blocking the reabsorption of sodium and chloride resulting in increasing excretion of water, bicarbonate, magnesium, Possible arteriolar dilation.
Drug: cholestyramine / Questran Dose: 4g/day or BID MAX 24g/Day Route : PO Frequency: QD or BID Rationale for client: Lipids.
Functional class: Antilipemic Chemical class: Bile acid Sequestrant Action: Absorbs, combines with bile acids to form insoluble complex that is excreted through feces, loss of bile acids lowers cholesterol levels.
Side-Effects: CNS: Seizures, neuroleptic malignant syndrome, EPS, pseudo parkinsonism, akathisia, dystonia, tardive dyskinesia, headache CV: Cardiac arrest. Tachycardia, Postural B/P, hypertension. ECG changes Hema: leukopenia, leukocytopenia, agranulocytosis. Integ: Rash GI: Dry mouth, N/V, anorexia, constipation. Resp: Laryngospasm, respiratory depression Syst: Death in geriatrics with dementia. Contraindications: Alcohol/Barbiturate withdrawal. Geriatrics Side-Effects: CNS: Dizziness, weakness CV: Hypotension Hema: Aplastic anemia, hemolytic anemia, leukopenia, agranulocytosis, thrombocytopenia, neutropenia. Integ: GI: N/V/D GU: Uremia Elect: Hypokalemia EENT: Blurred vision Contraindications: Anuria, renal decompensation, Hypokalemia. Side-Effects: CNS: Meta: Decreased Vit A, D, K, red cell folate content, hyperchloremic acidosis. Hema: Bleeding GI: Constipation, abdominal pain, nausea Contraindications: Biliary obstruction, hyperlipidemia III, IV, V
Asses mental status. Pt hoarding. Affect LOC, reflexs, gait, coordination. Bilirubin, CBC, LFT, ocular exam, UA, Orthostatic B/P, ECG monitoring periodically, skin turgor daily. Constipation.
Asses Daily weights, I&O. CBC, electrolytes, Orthostatic B/P. Confusion
Asses cardiac glycoside levels if both are taken. Hepatic studies. Renal studies. Blood studies, CBC, Hgb, PT. I&O ratio for declining output. Tinnitus. Dependent edema.
Drug: cidofovir / Vistide
Functional class: Antiviral Chemical class: Nucleotide analog
Dose: 5mg/kg/week X 2 wk then 3mg/kg/wk MUST be given with Probenecid per Action: suppresses CMV replication be directions. selectively inhibition of viral DNA Route (Give timing for IV push/IVPB meds): synthesis IV dilute 100ml/NS 2hr/ follow with 1L NS Frequency: Weekly Rationale for client: CMV retinitis in HIV pt.
Drug: Cilostazol / Pletal Dose: 100mg Route: PO
Functional class: Platelet aggregation inhibitor Chemical class: Quinolinone derivative
Action: Reversibly inhibits cellular Frequency: BID Before breakfast and Dinner. phosphodiesterase, inhibits platelet Rationale for client: Intermittent aggregation induced by thrombin, ADP, claudication. collagen, arachidonic acid, epinephrine stress.
Drug: cimetidine / Tagamet Dose: PO 300mg QID IV BOL 300mg/20ml NS IV inf 300mg/50ml/ 15-30min IM 300mg/q6hr MAX 2400mg/day Route : IV/PO/IM Frequency: QID Rationale for client: Short term Gastric and Duodenal ulcers. Management of GERD.
Functional class: H2 histamine receptor antagonist Chemical class: Imidazole derivative Action: Inhibits histamine at H2-receptor site in the gastric parietal cells, which inhibits gastric acid secretion
Side-Effects: CNS: Coma, seizures, , Fever, chills, dizziness, headache, amnesia anxiety, insomnia, CV: Hema: Granulocytopenia, thrombocytopenia, irreversible neutropenia, anemia, eosinophilia Integ: rash, alopecia, pruritus, acne GI: Hemorrhage, N/V/D, anorexia GU: Hematuria, nephrotoxicity EENT: Contraindications: Hypersensitivity to Probenecid or sulfa products. Side-Effects: CNS: Dizziness CV: Palpations, tachycardia Hema: Bleeding,( epistaxis, hematuria, retinal hemorrhage, GI bleed), thrombocytopenia, polycythemia, aplastic anemia. Integ: SJS, rash GI: N/V/D, poots, dyspepsia. GU: Vaginal hemorrhage EENT: blindness Contraindications: Acute MI, active bleeding, hemostatic conditions. Side-Effects: CNS: Seizures, confusion, headache CV: Dysrhythmias Hema: Agranulocytosis, thrombocytopenia, neutropenia, aplastic anemia, increased PT Integ: Exfoliative dermatitis GI: Paralytic ileus, jaundice, diarrhea Resp: Pneumonia Contraindications:
Culture before treatment. Renal studies, Hepatic studies. GI symptoms. Monitor electrolytes, and minerals, Ca, P, mg, K, Watch closely for tetany during first dose. CBC, WBC/diff
Asses for CV disease. Blood studies, CBC, q2wk, Hvt, hgb, PT. Give BID 1hr before or 2hr after meals. NO Grapefruit Juice. May take 6 weeks for therapeutic effect.
Asses gastric pH. I&O ratio. BUN, Creatinine, CBC/diff. Antacids 1hr before to 1hr after. Monitor for black tarry stools.
Drug: cinacalcet / Sensipar Dose: 30mg BID Route : PO Frequency: BID titrate to normal Ca. Rationale for client: Hypercalcemia in parathyroid Ca. secondary hyperparathyroidism in chronic kidney disease on dialysis, primary hyperparathyroidism. Drug: ciprofloxacin / Cipro Dose: 200mg-1g Route: PO-100-500mg IV-400mg/250ml/2hr/Q12hr Frequency: BID Rationale for client: Infection
Functional class: Calcium receptor agonist Chemical class: Polypeptide hormone Action: Directly lowers PTH levels by increasing sensitivity of Ca sensing receptors to extracellular Ca.
Side-Effects: CNS: Seizures CV: HTN Integ: GI:N/V/D Contraindications: Hypersensitivity
Asses Hypocalcemia. Ca, Phos. Within 1 wk IF Ca <8.4mg/dl do not start therapy. Swallow whole tablets. Do not chew, crush, or break. Maybe used with Vit D.
Functional class: Anti-infectivebroad spectrum Chemical class: Fluoroquinolone Action: Interferes with conversion of intermediate DNA to hhigh-molecularweight DNA in bacteria. DNA gyrase inhibitor
Side-Effects: CNS: Seizures, Headache, restlessness Hema: Bone Marrow Depression Integ: Toxic epidermal necrolysis, SJS GI: pseudomembranous colitis, N/V/D Misc.: Tendon rupture. Contraindications: Seizure DO
Infection, WBC. CNS status. Renal studies. Hepatic studies. I&O ratio. Anaphylaxis. Tendon pain.
Drug: citalopram Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antidepressant Chemical class: SSRI Action: inhibits cns neuron uptake of serotonin but not norepinephrine. Weak inhibitor of cyp450 enzyme system making it more appealing that other products
Side-Effects: CNS: HA, nervousness, insomnia, drowsiness, anxiety, dizziness, hallucinations, suicidal attempts CV: hot flashes, palpitations, hemorrhage, htn, tachycardia INTEG: sweating, rash, pruritus, alopecia, acne GI: n/v, diarrhea, anorexia, dyspepsia, constipations, cramps, flatulence, taste changes GU: dysmenorrhea, decreased libido, frequency, uti, cystitis, impotence, retention EENT: visual changes, ear/eye pain, photophobia, tinnitus RESP: infection, pharyngitis, nasal congestion, sinus HA, sinusitis, cough, dyspnea, pneumonia SYST: asthenia, viral infection, fever, allgery, chills, hyponatremia in geriatrics Contraindications: hypersensitivity
Do not give to children. Fatal when given with MAOIs. monitor drug interactions. Will cause increased serum bilirubin, BG, and alk phos. Assess mental status, BP, weight weekly, ECG, and for alcohol consumption. Administer with food or crushed and at bedtime. Assist with ambulation. Allow sugarless gum or hard candy for dry mouth. Evaluate for efficacy. Therapeutic effect may take 4-6 wks to take effect, and anxiety may increase in first week. Monitor for suicidal tendencies. Notify hcp if pregnant. Monitor for effects of serotonin syndrome.
Drug: clarithromycin Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antiinfective Chemical class: macrolide Action: binds to 5OS ribosomal subunits of susceptible bacteria and suppresses protein synthesis
Side-Effects: CV: ventricular dysrhythmias, QT prolongation HEMA: leucopenia, thrombocytopenia, increased inr INTEG: rash, urticaria, pruritisu, SJS, toxic epidermal necrolysis GI: n/v, diarrhea, hepatoxicity, abdominal pain, stomatitis, heartburn, anorexia, abnormal taste, pseudomembranous colitis. GU:vaginitis, moniliasis EENT: tinnitus Contraindications: hypersensitivity to the product or macrolide antibiotics
Monitor for drug/herb interactions. Assess for infectin, cardiac function, renal and hepatic function, bowel pattern before and during treatment, respiratory status, skin eruptions, and for allergies. Perform C&S prior to therapy. Do not break or crush. Maintain fluid intake of at least 2L. administer q12h to maintain serum levels. Evaluate for efficacy. Treatment of hypersensitivity: withdraw product, maintain airway, administer epinephrine, aminophylline, O2, and iv corticosteroids.
Drug: clevidipine Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: CCB Chemical class: dihydropyridine Action: L-type calcium channels mediate the influx of calcium during depolarization in arterial smooth muscle, reduces mean arterial BP by decreasing systemic vascular resistance
Side-Effects: CNS: HA CV: htn, mi, sinus tachycardia, syncope, relex tachycardia, a-fib GI: n/v GU: renal failure Contraindications: hypersensitivity to this product, eggs, or soya lecithin; defective lipid metabolism, severe aortic stenosis, pancreatitis
Assess cardiac status, i/o ratio, and weight daily. Monitor for edema, dyspnea, jvd, and crackles. Do not give through same line as other meds. Gently invert several times before use. Store in refrigerator. Evaluate for efficacy.
Drug: clindamycin, clindamycin palmitate, clindamycin phosphate Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antiinfective miscellaneous Chemical class: lincomycin derivative Action: binds to 5OS subunit of bacterial ribosomes, suppresses protein sythensis
Side-Effects: HEMA: leudopenia, eosinophilia, agranulocytosis, thrombocytopenia, polyarthritis INTEG: rash, urticaria, pruritus, erythema, pain, abscess at inj site, SJS, exfoliative dermatitis GI: n/v, abdominal pain, diarrhea, pseudomembranous colitis, anorexia, weight loss, increased ast, alt, bilirubin, alk phos; jaundice GU:: vaginitis, frequency Contraindications: hypersensitivity to this product or lincomycin, tartrazine dye, ulcerative colitis/enteritis
Monitor drug interactions. Assess renal studies, blood studies, BP, bowel pattern before and during treatment, for skin eruptions, respiratory status, for allergies. Perform C&S prior to therapy. Administer in equal intervals around the lcock to maintain blood levels. Do not break or crush. Rotate IM sites. Store at room temp. maintain adequate intake of fluids, at least 2L. evaluate for efficacy. For hypersensitivity: withdraw product, maintain airway, administer epinephrine, aminophylline, O2, iv corticosteroids
Drug: clomiphene Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: ovulation stimulant Chemical class: nonsteroidal antiestrogenic Action: increases lh, fsh release from the pituitary, which increases maturation of ovarian follicle , ovulation, development of corpus luteum
Side-Effects: CNS: HA, depression, restlessness, anxiety, nervousness, fatuigue, insomnia, dizziness, flushing CV: vasomotor flushing, phlebitis, dvt INTEG: rash, dermatitis, urticaria, alopecia GI: n/v, constipation, abdominal pain, bloating GU: polyuria, frequency, birth defects, spontaneous abortions, multiple ovulation, breast pain, oliguria, abnormal uterine bleeding, ovarian cyst, hypertrophy of ovary EENT: blurred vision, diplopia, photophobia Contraindications: pregnancy (X), hypersensitivity, hepatic disease, undiagnosed uterine bleeding, uncontrolled thyroid or adrenal dysfunction, intracranial lesion, ovaian cyst, endometrial carcinoma
Assess liver function prior to therapy. Assess serum progesterone, ovarian size, cervical condition, for endometrial carcinoma. Administer after d/c estrogen therapy, and at the same time each day to maintain serum level. Evaluate for efficacy.
Drug: clomipramine Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:antidepressant, tricyclic Chemical class: tertiary amine Action: potentiates serotonin and norepinephrine; also increases dopamine metabolism; moderate anticholinergic effect
Side-Effects: CNS: dizziness, tremors, mania, seizures, aggressiveness, EOS, drowsiness, HA, neuropleptic malignant sydrome CV: hypotension, tachycardia, cardiac arrest HEMA:agranulocytosis, neutropenia, pancytopenia INTEG: diaphoresis, photosensitivity GI: constipation, dry mouth, n/v, dyspepsia, weight gain, hepatic toxicity GU: delayed ejaculation, anorgasmia, retention, decreased libido EENT: blurred vision META: hyponatremia SYST: suicide in children/adolescents Contraindications: hypersensitivity, immediate post MI
Monitor for drug interactions. Assess BP, for neuroleptic malignant syndrome, ECG, blood studies, hepatic studies, mental status, for retention, withdrawal symptoms, and for alcohol consumption. If systolic BP drops 20mmHg, withhold product. Store in room temp. assist with ambulation. Provide hard candy for dry mouth. Evaluate for efficacy. Effects may take 4-6 wks. Do not d/c abruptly. Antidote: ECG monitoring, induce emesis, lavage, activated charcoal, anticonvulsant, diazepam iv
Drug: clonazepam Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: anticonvulsant Chemical class: benzodiazepine derivative Action: inhibits spike, wave formation in absence seizures (petit mal), decreases amplitude, frequency, duration, spread of discharge in minor motor seizures
Side-Effects: CNS: drowsiness, dizziness, confusion, behaviora changes, tremors, insomnia, HA, suicidal tendencies, slurred speech, aterograde amnesia CV: palpitation, bradycardia, tachycardia HEMA: thrombocytopenia, leukocytosis, eosinophilia, INTEG: rash, alopecia, hirsutism GI: n/v, constipation, polyphagia, anorexia, xerostomia, diarrhea, gastritis, sore gums GU: dysuria, enuresis, nocturia, retention, libido changes EENT: increased salivation, nystagmus, diplopia, abnormal eye movements RESP: respiratory depression, dyspnea Contraindications: pregnancy, hypersensitivity to benzos, acute closed angle glaucoma, psychosis, severe hepatic disease
Monitor drug interactions. Increases ast, alk phos. Assess renal studies, blood studies, hepatic studies, product levels during initial treatment, mental status, for signs of physical withdrawal, for eye problems, allergic reaction, and toxicity. Administer with food. Store at room temp. assist with ambulation. Evaluate for efficacy. Teach patient to carry emergency ID bracelet. Avoid alcohol. Do not d/c abruptly. Antidote: lavage, activated charcoal, flumazenil, monitor electrolytes, VS, administer vasopressors
Drug: clonidine Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antihypertensive Chemical class: central alpha adrenergic agonist Action: inhibits sympathetic vasomotor center in cns, which reduces impulses in sympathetic nervous system; blood pressure, pulse rate, cardiac output decrease, prevents pain signal transmission in cns by alpha adrenergic receptor stimulation of the spinal cord
Side-Effects: CNS: drowsiness, sedation, HA fatigue, nightmares, insomnia, mental changes, anxiety, depression, hallucination, delerium CV: orthostatic hypotension, palpitations, CHF, ECG abnormalities INTEG: rash, alopecia, facial pallor, pruritus, hives, edema, burning papules, excoriation GI: n/v, malaise, constipation, dry mouth GU: impotence, dysuria, nocturia, gynecomastia EENT: taste change, parotid pain Contraindications: hypersensitivity, epidural bleeding, disorder anticoagulants
Monitor for drug reactions. Can cause life threatening elevations of BP when used with tricyclics or beta blockers. Assess blood studies, renal studies, baselines in renal and hepatic studies, BP, pain, edema, allergic reaction, and for signs of CHF. Give last dose at bedtime. Transdermally, qweek, apply to site without hair. Rotate sites. Store in cool envt. evaluate for efficacy. Antidote: supportive care; administer tolazoline, atropine, dopamine prn
Drug: clopidogrel Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:platelet aggregation Chemical class: thienopyridine derivative Action:inhibits ADP induced platelet aggregation
Side-Effects: CNS: HA, dizziness, depression, syncope, hyesthesia, neuralgia CV: edema, htn, chest pain HEMA: epitaxis, purpura, bleeding, neutropenia, aplastic anemia INTEG: rash, pruritus, SJS GI: n/v, diarrhea, constipation, GI discomfort, GI bleeding, pancreatitis GU: glomerulonephritis RESP: upper respiratory tract infection, dyspnea, rhinitis, bronchitis, cough, brochospasm Contraindications: hypersensitivity, active bleeding
Avoid use with CYP2C19 inhibitors. Monitor drug interactions. Assess thrombotic purpura, for symptoms of stroke or Mi during treatment, hepatic studies, blood studies. Administer with food. Evaluate for efficacy.
Drug: clorazepate Dose:
Functional class: antianxiety, anticonvulsant, sedative/hypnotic
Side-Effects: CNS: dizziness, drowsiness, confusion, HA, anxiety, tremors, stimulation, fatigue, depression, insomnia, hallucination, lethargy CV: orthostatic hypotension, ECG changes, tachycardia, hypotension, chest pain INTEG: rash, dermatitis, itching GI: constipation, dry mouth, n/v, anorexia, diarrhea EENT:blurred vision, tinnitus, mydriasis Contraindications:pregnancy, breastfeeding, children <9yo, hypersensitivity to beenzos, closed angle glaucoma, psychosis
Chemical class: benzodiazepine, long Route (Give timing for IV push/IVPB meds): acting Frequency: Rationale for client: Action:potentiates the actions of GABA especially in limbic system, reticular formation
Monitor drug interactions. Assess BP, blood studies, hepatic studies, i/o, mental status, physical dependency, for seizures and suicidal tendencies. Administer with food. Do not break or crush ext rel. can crush tab if pt cannot swallow whole. Assist with ambulation. Provide hard candy for dry mouth. Evaluate for efficacy. Antidote: lavage, VS, supportive care, flumazenil.
Drug: clozapine Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antipsychotic Chemical class: tricyclic dibenzodiazepine derivative Action: interferes with dopamine receptors binding with lack of EPS; also acts as an adrenergic cholinergic, histaminergic, serotonergic antagonist
Side-Effects: CNS:neuroleptic malignant syndrome, sedation, salivation, dizziness, HA, tremors, sleep problems, akinesia, fever, seizures, sweating, akathisia, confusion, fatigue, insomnia, depression, slurred speech, anxiety, agitation, dystonia CV: tachycardia, hypo/htn, chest pain, ECG changes, orthostatic hypotension HEMA: leucopenia, agranulocytosis, eosinophilia RESP: dyspnea, nasal congestion GI: drooling or excessive salivation, constipation, n/v, abdominal discomfort, diarrhea, anorexia, weight gain, dry mouth, heartburn, dyspepsia, GERD GU: urinary abnormalities, incontinence, ejaculation dysfunction frequency, urgency retention, dysuria EENT: blurred vision MISC: death in geriatric patients Contraindications: hypersensitivity, severe granulocytopenia, coma
Monitor for drug interactions. Assess for myocarditis, seizures, i/o, BP, for SPS, neuroleptic malignant syndrome and Constipation. assess LFTs monthly. Perform UA before treatment. Assess affect, orientation, and LOC. Assist with ambulation. Evaluate for efficacy. Antidote: lavage, activated charcoal; provide an airway, do not induce vomiting
Drug: codeine Dose:
Functional class: opiate analgesic, antitussive
Side-Effects: CNS: drowsiness, sedation, dizziness, agitation, dependency, lethargy, restlessness, euphoria, seizures, hallucinations, HA, confusion CV:bradycardia, palpitations, orthostatic hypotension, tachycardia, circulatory collapse RESP: respiratory depression, respiratory paralysis, dyspnea INTEG: flushing, rash, urticaria, pruritus GI: n/v,anorexia, constipation, dry mouth GU:retention Contraindications:breastfeeding, hypersensitivity, respiratory depression, increased ICP, seizures, severe respiratory disorders
Chemical class: opiate, phenathrene Route (Give timing for IV push/IVPB meds): derivative Frequency: Rationale for client: Action: depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors, decreases cough reflex, GI motility
Monitor for drug interactions. Assess i/o, GI function, pain, cough, CNS changes, allergy, and respiratory dysfunction. When given IV, give slowly with antiemetic. Assist with ambulation. Evaluate for ifficacy. Antidote: narcan
Drug: colchicine Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antigout agent Chemical class: colchicum autumnale alkaloid Action: inhibits microtubule formation of lactic acid in leukocytes, which decreases phagocytosis and inflammation in joints
Side-Effects: HEMA: agranulocytosis, thrombocytopenia, aplastic anemia, pacytopenia INTEG: chills, dermatitis, pruritus, purpura, erythema GI: n/v, anorexia, malaise, metallic taste, cramps, peptic ulcer, diarrhea GU: hematuria, oliguria, renal damage Contraindications: pregnancy, serious GI, sever cardiac/renal/hepatic disorders, hypersensitivity
Monitor for drug interactions. Assess for pain relief, i/o, CBC, and for toxicity. Administer with food. Evaluate for efficacy. Avoid alcohol. Antidote: d/c meds, opioids to treat diarrhea
Drug: colesevelam Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antilipemic Chemical class: bile acid sequestrant Action: absorbs, combines with bile acids to form insoluble complex that is excreted through feces; loss of bile acids lowers cholesterol levels
Side-Effects: CNS: HA, dizziness, drowsiness, vertigo, tinnitus HEMA: decreased red cell folate content, bleeding, increased PT INTEG:rash, irritation, of perianal area, tongue, skin GI: n/v, constipation, abdominal pain, fecal impaction, hemorrhoids, flatulence, steatorrhea, peptic ulcer, GI obstruction META: decreased vit A,D,K; hyperchloremic acidosis Contraindications: hypersensitivity, biliary obstruction, dysphagia, bowel disease, primary biliary cirrhosis, triglycerides >300, fat soluble vitamin deficiency
Monitor for drug interactions. Assess cardiac glycosides level, for signs of vit deficiency, and bowel pattern daily. Administer whole with food. Evaluate for efficacy. Do not d/c suddenly.
Drug: colestipol Dose:
Functional class: antilipemmonitor drug interactiosic Chemical class: bile acid sequestrant
Side-Effects: HEMA: bleedin, increased PT INTEG: rash, irritation of perianal area, tongue, skin GI: n/v, constipation, abdominal pain, fecal impaction, hemorrhoids, flatulence, peptic ulcer META: decreased bit A,D,K; hyperchloremic acidosis Contraindications: hypersensitivity, biliary obstruction
Monitor drug interactions. Assess fat consumption in diet, cardiac glycoside levels, for signs of vit deficiency, and bowel patterns daily. Administer whole with food. Evaluate for efficacy.
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: absorbs, combines with bile acids to form insoluble complex excreted through feces; loss of bile acids lowers cholesterol levels
Drug: CONIVAPTAN (Vaprisol) Dose: 20mg-40mg/day for max 4 days
Functional class: Vasopressin receptor Antagonist Chemical class:
Side-Effects: CNS: HA, confusion, insomnia CV: ATRIAL FIB., hyper/hypotension, orthostatic hypotension, phlebitis HEMA: Anemia INTEG: Erythemia, inj site reaction GI: N/V/C, dry mouth GU: Hematuria, polyuria, UTI, pollakiuria EENT: Contraindications: Hypersensitivity, hypovolemia
Route (Give timing for IV push/IVPB meds): IV INF Frequency: Daily Rationale for client: Euvolemia hyponatremia in those hospitalized Action: Dual arginine vasopressin (AVP) antagonist with affinity for V(1a9) V(2) receptors; level of circulating AVP in circulating blood is critical for regulation of water, electrolyte balance and is usually elevated in euvolemic/hypervolemic hyponatremia Functional class: Chemical class:
-Assess renal, hepatic function -Assess sodium volume status; overly rapid correction may occur of sodium concentration may result in Osmotic Demyelination Syndrome -Assess for HA or confusion - CV status: atrial fib , hypo/hypertension, orthostatic HTN, monitor B/P, pulse -Monitor other electrolytes
Drug: CONTRACEPTIVES HORMONAL Dose:
Side-Effects: CNS: depression, fatigue, dizzy, anxiety, nervousness, HA CV: Increased B/P, cerebral hemorrhage, thrombosis, pulmonary embolism, fluid retention, edema HEMA: Increased fibrinogen, clotting factor INTEG: Chloasma, melasma, acne, rash, urticaria, erythema, pruritus, hirsutism, alopecia, photosensitivity GI:N/V/D, bloating, constipation, change in appetite, cholestatic jaundice GU: Breakthrough bleeding, amenorrhea, spotting, dysmenorrhea, galactorrhea, endocervical hyperplasia, vaginitis, breast changes, cystitislike syndrome EENT: Optic neuritis, retinal thrombosis, cataracts ENDO: decreased glucose tol., increased TBG, PBI, T4, T3 Contraindications:
Route (Give timing for IV push/IVPB meds): PO, IM,Intrauterine,Vaginal ring, TD patch, Action: Prevents ovulation by suppressing or subdermal implant FSH, LH Frequency: Rationale for client: To prevent pregnancy, regulation of menstrual cycle, treatment of acne in women over 14 that other treatment has failed, emergency contraception
-Assess glucose, thyroid function, LFTs -Assess reproductive changes, change in breasts, tumors, positive Pap smear; product should be d/c -Teach about formation of clots (positive Homans), use sunscreen, take at the same time each day, take another tablet as soon as possible if missed dose
Drug: CORTICOTROPIN(ACTH), ( H.P. Acthar gel) Dose: 80-120 units/day x 14-21 days
Functional class: Pituitary Hormone Chemical class:
Side-Effects: CNS: CV: HEMA: INTEG: GI: GU: EENT: Contraindications: Hypersensitivity, scleroderma, osteoporosis, CHF, peptic ulcer disease, hypertension, systemic fungal infections, smallpox vaccination, recent surgery, ocular herpes simplex, primary adrenocortical insufficiency/hyperfunction -Assess Potassium, BGS, daily weight, I&O ratio, B/P, Pulse - report S/S of chest pain to provider - Monitor plasma cortisol levels (normal 138-635 mmol/L SI units if drawn at 8am) -Monitor for s/s of infection -Assess for edema, mental confusion, s/s of potassium depletion -Administer with food or milk
Route (Give timing for IV push/IVPB meds): IM Action: Frequency: daily Rationale for client: Testing adrenocortical function, treatment of adrenal insufficiency caused by administration of corticosteroids (long-term), MS, myasthenia gravis
Drug: CORTISONE (Cortone, Cortone Acetate) Dose: 25-300 mg/day
Functional class: Corticosteroid, synthetic Chemical class: Glucocorticoid, shortacting
Side-Effects: CNS: depression, flushing, sweating, HA, mood changes CV: HTN, circulatory collapse, thrombophlebitis, embolism, tachycardia, necrotizing angitis, CHF, edema HEMA: Thrombocytopenia INTEG: Acne, poor wound healing, ecchymosis, bruising, petechiae, hirsutism GI: N/D, abd. pain, GI Hemorrhage, increased appetite, pancreatitis, ulcerative esophagitis GU: EENT: Fungal infections, increased IOP, blurred vision, cataracts, glaucoma Contraindications: Preg (D), children <2 yr., psychosis, hypersensitivity, idiopathic thrombocytopenia, acute glomerulonephritis, amebiasis, fungal infections, nonasthmatic bronchial disease, AIDS, TB, measles, varicella
Route (Give timing for IV push/IVPB meds): PO Action: Decreases inflammation by suppression of migration of Frequency: Daily or every other day polymorphonuclear leukocytes, fibroblasts, reversal of increased capillary Rationale for client: Inflammation, severe permeability and lysosomal stabilization allergy, adrenal insufficiency, collagen disorders, resp, dermatologic, rheumatic disorders
Drug: CROMOLYN (Gastrocrom Intal, Nasalcrom, Rynacrom) Dose: 1spray max 6doses, or neb 20mg QID, or 200mg QID
Functional class: Antiasthmatic Chemical class: Mast Cell Stabilizer
Side-Effects: CNS: HA, Dizzy, neuritis, confusion, drowsy MS: Joint pain/swelling HEMA: INTEG: Rash, urticaria, angioedema GI: N/V, anorexia, dry mouth, bitter taste GU: Urinary freq., dysuria EENT: Throat irritation, cough, nasal congestion, burning eyes, nasal stinging, sneezing Contraindications: Hypersensitivity to this product or lactose, status asthmaticus, acute asthma
-Assess eosinophil count during Tx, -Resp. status: rate, rhythm, characteristics, cough, wheezing, dyspnea - provide sips of water to decrease throat irritation (INH, Neb) -Evaluate Therapeutic response
Action: Stabilizes the membrane of the Route (Give timing for IV push/IVPB meds): sensitized mast cell, preventing the release PO, INH, NEB, Nasal Sol of chemical mediators after an antigen-IgE interaction Frequency: TID-QID Rationale for client: Severe perennial bronchial asthma, prevention of exerciseinduced bronchospasm, acute bronchospasm induced by environmental pollutants, mastocytosis, allergic rhinitis
Drug: CROTAMITON (Eurax) Dose:
Functional class: Scabicide Chemical class:
Side-Effects: CNS: CV: HEMA: INTEG: GI: GU: EENT: Contraindications: Hypersensitivity, skin inflammation, abrasions, breaks in skin, mucous membranes -Assess for B12 deficiency: beefy red tongue; psychosis; pallor; neuropathy -GI Function; diarrhea, constipation -Monitor for pulmonary edema, worsening of CHF in cardiac pt.s -Monitor nutritional status; good sources of B12; egg yolks, fish, clams, dairy products oysters and organ meats
Route (Give timing for IV push/IVPB meds): Cream Action: Frequency: Apply daily Rationale for client: Scabies, pruritus
Drug: CYANOCOBALAMIN Vit. B12 (Cobex, Chrystamine, Ener-B) Dose: up to 1000mg/day PO
Functional class: Vit B12, water soluble vitamin Chemical class:
Side-Effects: CNS: Flushing, optic nerve atrophy CV: CHF, Pulmonary Edema, peripheral vascular thrombosis META: Hypokalemia INTEG: Itching, rash, pain at inj. site GI: Diarrhea SYST: Anaphylactic shock EENT: Contraindications: Optic nerve atrophy, hypersensitivity
Route (Give timing for IV push/IVPB meds): PO, IM, Sub-Q, nasal Action: Needed for adequate nerve functioning, protein and carbohydrate Frequency: Daily metabolism, normal growth, RBC development, cell reproduction Rationale for client: Vit B12 Deficiency, pernicious anemia, Vit B12 malabsorption syndrome, renal/hepatic failure
Drug: CYCLOBENZAPRINE (Flexeril) Dose: max 30mg/day
Functional class: Skeletal Muscle Relaxant, central-acting Chemical class: Tricyclic Amine Salt
Side-Effects: CNS: Dizzy, weakness, drowsy, tremor, depression, insomnia, confusion, paresthesia, nervousness CV: Orthostatic HTN, tachycardia, DYSRHYTHMIAS HEMA: INTEG: Rash, pruritus, fever, facial flushing, sweating GI: N/V/C, hiccups, dry mouth, hepatitis GU: Urinary retention, frequency, change in libido EENT: Diplopia, temporary loss of vision Contraindications: Acute recovery phase of MI, dysrhythmias, heart block, CHF, hypersensitivity, intermittent porphyria, thyroid disease
-Assess pain: location, duration, mobility, stiffness, baseline and periodically - Assess for allergic reactions -Monitor for severe weakness, numbness in extremities
Route (Give timing for IV push/IVPB meds): PO Frequency: TID Rationale for client: Adjunct for relief of muscle spasm and pain in musculoskeletal conditions Action: Reduction of tonic muscle activity at the brain stem; may be related to antidepressant effects
Drug: CYCLOPHOSPHAMIDE (Cytoxan, Procytox) Dose: PO 1-5mg/kg over 2-5 days or IV 4050mg/kg in divided doses over 2-5days
Functional class: Antineoplastic alkylating agent Chemical class: Nitrogen mustard
Side-Effects: CNS: HA, dizzy CV: Cardiotoxicity (high doses), myocardial fibrosis HEMA: Thrombocytopenia, leukopenia, pancytopenia, myelosuppression INTEG: Alopecia, dermatitis GI: N/V/D, weight loss, colitis, hepatotoxicity GU: Hemorrhagic cystitis, hematuria, neoplasms, amenorrhea, azoospermia, sterility, ovarian fibrosis RESP: Pulmonary fibrosis, interstitial pneumonia Contraindications: Preg. (D), breastfeeding, severely depressed bone marrow function, hypersensitivity, prostatic hypertrophy, bladder neck obstruction
Route (Give timing for IV push/IVPB meds): Action: Alkylates DNA is responsible for PO, IV cross-linking DNA strands; activity is not cell cycle phase specific Frequency: Divided doses over 2-5 days Rationale for client: Hodgkins disease, lymphomas, leukemia; cancer of female reproductive tract, breast, lung, prostate; multiple myeloma; neuroblastoma; retinoblastoma; Ewings Sarcoma; disseminated neuroblastoma
-Assess labs: renal/hepatic studies, CBC; differential, platelet count baseline -Pulmonary function tests: chest x-rays -Monitor for infection, bleeding, bruising -Resp. status/ function -Effects of alopecia on body image -Assess jaundice of skin -Monitor Buccal status q8hrs for dryness, sores or ulceration, bleeding, oral pain, white patches Monitor for S/S of severe allergic reaction; rash, pruritus, urticaria, purpuric skin lesions, itching, flushing
Drug: CYCLOSPORINE (Gengraf, Neoral, Sandimmune, Pulminiq) Dose:
Functional class: Immunosuppressant Chemical class: Fungus-derived peptide
Side-Effects: CNS: Tremors, HA, seizures, confusion CV: HEMA: INTEG: Rash, acne, pruritus, hirsutism GI: N/V/D, oral candida, gum hyperplasia, pancreatitis, hepatotoxicity GU: Albuminuria, hematuria, proteinuria, renal failure EENT: Contraindications: Hypersensitivity to polyxyethylated castor oil, breastfeeding, psoriasis or RA in renal disease, methotrexate, coal tar; ocular infections
Route (Give timing for IV push/IVPB meds): Action: Produces immunosuppression by PO, IV inhibiting lymphocytes (T) Frequency: Rationale for client: organ transplants to prevent rejection, rheumatoid arthritis, psoriasis
-BBW; uncontrolled, malignant HTN, radiation in psoriasis, neoplastic disease, sunlight (UV) exposure, renal disease/ failure -Assess renal studies, product blood level, hepatic studies, serum lipids - Assess for nephrotoxicity; 6wk post-op, acute tubular necrosis - S/S of encephalopathy, lymphoma
Drug: CYPROHEPTADINE (Cyproheptadine HCL) Dose: max 0.5mg/kg/day
Functional class: Antihistamine, H1receptor antagonist Chemical class: Piperidine
Side-Effects: CNS: Dizzy, Drowsy, poor coordination, fatigue, anxiety, euphoria, confusion, paresthesia, neuritis CV: Hypotension, palpitations, tachycardia HEMA: Hemolytic anemia, leukopenia, thrombocytosis, agranulocytosis INTEG: Rash, urticaria, photosensitivity GI: Constipation, dry mouth, N/V, anorexia, diarrhea, weight gain, increased appetite GU: Retention, dysuria, frequency EENT: Blurred vision, dilated pupils, tinnitus; nasal stuffiness; dry nose, throat, mouth RESP: Increased thick secretions, wheezing, chest tightness SYST: Anaphylactic shock Contraindications: Hypersensitivity to H1 receptor antagonist, breastfeeding, closeangle glaucoma, neonates/infants, peptic ulcers, bladder-neck obstruction, prostatic hypertrophy
-Assess I&O, CBC, Resp. status, cardiac status -Teach to take with meals -Provide hard candy and teach to rinse mouth for dryness
Route (Give timing for IV push/IVPB meds): PO Action: Acts on blood vessels, GI, respiratory system by competing with Frequency: BID-TID histamine for H1-receptor site, decreases allergic response by blocking histamine Rationale for client: Allergy symptoms, rhinitis, pruritus, common cold, urticaria
Drug: CYTARABINE ( Ara-C, Cytosine arabinoside Dose: Route (Give timing for IV push/IVPB meds): IV INF, Subcut/IM, Intrathecal Frequency: Rationale for client: Acute myelocytic leukemia, acute nonlymphocytic leukemia, chronic myelocytic leukemia, lymphomatous meningitis (IT)
Functional class: Antineoplastic, antimetabolite Chemical class: Pyrimidine nucleoside analog Action: Competes with physiologic substrate of DNA synthesis, thus interfering with cell replication in the S phase of the cell cycle (before mitosis)
Side-Effects: CNS: Neuritis, dizzy, HA, cerebellar syndrome, personality changes, ataxia, mechanical dysphasia, coma; chemical arachnoiditis CV: Chest pain, cardiopathy HEMA: Thrombophlebitis, bleeding, thrombocytopenia, leukopenia, myelosuppression, anemia INTEG: Rash, fever, freckling, cellulitis GI: N/V/D, anorexia, stomatitis, abdominal pain, hematemesis, GI hemorrhage, hepatotoxicity GU: Urinary retention, renal failure, hyperuricemia EENT: Sore throat, conjunctivitis Contraindications:
-Assess Labs; CBC, differential weekly, renal studies,, hepatic studies, blood uric acid -GI symptoms, I&O ratio, -Monitor temp q4hrs for s/s of infection -Assess for anaphylaxis, chemical arachnoiditis -Monitor for bleeding, urine, buccal cavity q8hrs, local irritation
Drug: dacarbazine (DTIC-DOME) Dose: 2-4.5mg/kg/day
Functional class: Antineoplastic alkylating agent Chemical class: Cytotoxic triazine
Side-Effects: CNS: seizures, cerebral hemorrhage CV: HEMA: thrombocytopenia, leukopenia INTEG: alopecia GI: N/V, anorexia, hepatoxicity GU: EENT: Contraindications: Breastfeeding & hypersensitivity
Route (Give timing for IV push/IVPB meds): IV Frequency: q daily Rationale for client: Metastatic Malignant melanoma Action: Alkylates DNA, RNA: inhibits synthesis of DNA & RNA, also responsible for breakage of cross-linking DNA strands.
Black Box Warning* Pregnancy (C) 1st trimester, radiation therapy, hepatic disease, bone marrow suppression, secondary malignancy. Assess CBC, temp q4h, hepatic studies, bleeding, petechiae, and jaundice, inflammation, and hypersensitivity rxns.
Drug: dactinomycin (Cosmegen) Dose: 500mcg/m/day
Functional class: Antineoplastic, antibiotic Chemical class:
Side-Effects: CNS: fatigue, lethargy, fever CV: HEMA: thrombocytopenia, leukopenia INTEG: rash, extravasation GI: N/V, anorexia, stomatitis, hepatoxicity GU: EENT: Contraindications: Children <6 mo, hypersensitivity
Route (Give timing for IV push/IVPB meds): IV Action: Inhibits DNA, RNA, protein synthesis; derived from Streptomyces Frequency: q daily 5 days parvullus, replication is decreased by binding to DNA, causing strand splitting. Rationale for client: Sarcomas, trophoblastic tumors in women, testicular cancer, Wilms tumor.
Black Box Warning* Pregnancy (D), Accidental exposure, extravasation secondary malignancy. Assess CBC, Renal studies, I &O ratio, temp q4h, hepatic studies, bleeding, food preferences, alopecia, inflammation or breaks in skin, allergic reactions(rash, pruritus, itching, flushing), GI, signs of acidosis or dehydration.
Drug: dalfampridine (Ampyra) Dose: 10 mg Route (Give timing for IV push/IVPB meds): PO Frequency: q12h Rationale for client: improve walking in patients w MS.
Functional class: Neurological agent- MS Chemical class: Broad-spectrum potassium channel blocker. Action: MOA not fully understood, inhibits potassium channels and increased action potential conduction in demyelinated axions.
Side-Effects: CNS: seizures, HA, dizziness CV: HEMA: INTEG: GI: nausea, constipation. GU: EENT: Contraindications: Renal Failure, Seizures.
Assess for improved walking, including speed. Seizure activity Do not crush, break, or chew pill Give w/o regard to meals Do not give closer than q12h Do not dbl. dose If missed, skip it
Drug: dalteparin (Fragmin) Dose: 2,500-25,000 IU/ml Route (Give timing for IV push/IVPB meds): subq Frequency: 2h prior to surgery, then q daily 5-10 days Rationale for client: Unstable angina, MI, prevention of DVT.
Functional class: Anticoagulant Chemical class: Low molecular weight heparin. Action: Inhibits factor Xa/IIa (thrombin) Resulting in anticoagulation.
Side-Effects: CNS: Intracranial bleeding CV: HEMA: thrombocytopenia, hemorrhage INTEG: GI: GU: EENT: Contraindications: Hypersensitivity to this product, heparin, or pork products. Active major bleeding, leukemia, unstable angina, non- Q wave MI.
Black Box Warning * Epidural Anesthesia Assess blood studies, bleeding gums, petechiae, ecchymosis, and neurological impairment, and spinal epidural hematoma, hypersensitivity for fever, skin rash, & urticaria.
Drug: dantrolene (Dantrium) Dose: 25-100 mg
Functional class: Skeletal Muscle relaxant, direct acting Chemical class: Hydantoin
Side-Effects: CNS: Dizziness, weakness, fatigue, drowsiness, seizures. CV: HEMA: Eosinophilia, aplastic anemia, leukopenia. INTEG: GI: Hepatic Injury, nausea GU: EENT: Contraindications: Hypersensitivity compromised pulmonary function, impaired myocardial function.
Black Box Warning* Active Hepatic Disease, Females Assess for increased seizure activity, I&O ratio, hepatic function, CBC, allergic reactions (rash, fever, respiratory distress), severe weakness, and CNS depression.
Route (Give timing for IV push/IVPB meds): PO Action: Interferes with intracellular release of calcium from the sarcoplasmic reticulum necessary to initiate contraction: slows catabolism in malignant Rationale for client: Spasticity in MS, stroke, hyperthermia. spinal cord injury, cerebral palsy. Frequency: bid-qid, max dose 400mg/day
Drug: Daptomycin (Cubicin) Dose: 4-6 mg/kg
Functional class: Anti-infective Chemical class: Lipopeptides
Side-Effects: CNS: CV: Heart Failure HEMA: Leukocytosis, anemia, thrombocytopenia INTEG: GI: Pseudomembranous colitis GU: Nephrotoxicity EENT: Contraindications: Hypersensitivity
Route (Give timing for IV push/IVPB meds): IV Action: A new class anti-infective; binds to the bacterial membrane and results in a Frequency: q24h, 7-14 days rapid depolarization of the membrane potential, leading to inhibition of DNA, Rationale for client: skin infections caused by RNA, & protein synthesis. Staphylococcus aureaus, & Enterococcus faecalis. Bacteremia endocarditis, UTI, VRE.
Assess I&O ratio compromised renal system Blood studies Culture & Sensitivity BP, Respiratory status Allergies prior to treatment
Drug: darbepoetin (Aranesp) Dose: 0.45mcg/kg Route (Give timing for IV push/IVPB meds): subq/ IV Frequency: q weekly Rationale for client: anemia w chronic renal failure, and pts. on dialysis
Functional class: Hematopoietic agent Chemical class: Recombinant human erythropoietin Action: Stimulates erythropoietin by the same MOA as endogenous erythropoietin produced by the kidney and released into the bloodstream, interacting with progenitor stem cells to increase RBC production.
Side-Effects: CNS: seizures, stroke CV: hypo/hypertension, cardiac arrest, angina pectoris, thrombosis, CHF, acute MI, dysrhythmias. HEMA: INTEG: GI: N/V/D, pain, constipation. GU: Infection, fatigue, fever, death, FVO, sepsis. EENT: respiratory cough, URI, dyspnea, bronchitis. Contraindications: Hypersensitivity to mammalian cell-derived products or human albumin, uncontrolled HTN, red cell aplasia.
Black Box Warning* Hgb>12g/dl, surgery Assess for anemia, fatigue, dyspnea, pallor Serious allergic reactions (rash, urticaria, anaphylaxis) Renal Studies &Blood Studies Increased BP, rising Hgb levels. I&O ratio Dialysis pts. for thrill & bruits, indicating impaired circulation.
Drug: darunavir (Prezista) Dose: 75-600 mg
Functional class: Anti- retroviral Chemical class: Protease Inhibitor
Side-Effects: CNS: HA, insomnia, dizziness CV: ketoacidosis, insulin resistant hyperglycemia. HEMA: INTEG: GI: N/V/D, abdominal pain. GU: EENT: Contraindications: Hypersensitivity
Route (Give timing for IV push/IVPB meds): PO Action: Inhibits human immunodeficiency virus (HIV-1) protease, this prevents Frequency: q daily maturation of virus. Rationale for client: HIV-1
Assess for co lower back, flank pain Infection, anemia, STDs Hepatic Studies Bowel Patterns Skin eruptions(rash, urticaria, itching) Allergies before treatment
Drug: dasatinib (Sprycel) Dose: 20-100 mg Route (Give timing for IV push/IVPB meds): PO Frequency: q daily Rationale for client: acute lymphoblastic leukemia
Functional class: Antineoplastic Chemical class :Protein-tyrosine kinase Inhibitor Action: Inhibits PDGFR-B tyrosine kinase created in chronic myeloid leukemia (CMI).
Side-Effects: CNS: hemorrhage CV: HEMA: neutropenia, thrombocytopenia, bleeding. INTEG: rash, pruritus GI: N/V, anorexia, abdominal pain GU: EENT: pleural effusion Contraindications: Pregnancy (D), hypersensitivity.
Assess ANC and platelets Renal toxicity if bilirubin >3 Hepatoxicity, CBC Fluid retention, edema, weight monitoring, & lung sounds. Administer meds after a meal w a large glass of H2O. Do not crush, break, or chew tab.
Drug: Daunorubicin (Cerubidine) Dose: 45-60 mg/m^2/day
Functional class: Antineoplastic, antibiotic Chemical class: Anthracycline glycoside
Side-Effects: CNS: CV: Dysrhythmias, CHF, pericarditis, myocarditis. HEMA: thrombocytopenia, leukopenia, anemia. INTEG: rash, extravasation. GI: N/V, anorexia GU: EENT: Contraindications: Pregnancy (D), breastfeeding, hypersensitivity, systemic infections, cardiac disease, bone marrow depression.
Route (Give timing for IV push/IVPB meds): IV Action: Inhibits DNA synthesis, causing strand splitting, cell cycle specific of the S Frequency: q daily/3 days. phase, a vesicant. Max dose 400-600mg/m^2 total cumulative dose. Rationale for client: Acute lymphocytic leukemia, myelongenous leukemia, Kaposis sarcoma.
Black Box Warning* Bone marrow suppression, cardiac disease, extravasation, renal failure. Assess Black Box Warning** CBC, differential, weekly platelet count, leukocyte nadir within 2 wk. after administration, recovery within 3 wk., no admin dose if abs.granulocyte count is <750mm^3. Assess Black Box Warning*** Chest X ray, ECG, radio nucleotide angiography, Muga, EKG, ST- T wave changes, Low QRS and T, dysrhythmia ( Heart block, PVC), watch for CHF (JVD, edema, crackles), may occur 2-6 post treatment. Same as above Assess 3 black boxes Assess Renal & Hepatic studies. Monitor temp q4h Bleeding, hematuria, alopecia, effects of body image & changes Buccal cavity q8h for dryness, ulcerations, and white forming patches. Local irritations & GI disturbances, Acidosis, signs of dehydration (poor skin turgor, decreased urine output, restlessness, weakness).
Drug: Daunorubicin citrate liposomal (DaunoXome) Dose: 40 mg/m^2/day
Functional class: Antineoplastic, antibiotic Chemical class: Anthracycline glycoside
Side-Effects: CNS: Fatigue, HA, malaise, neuropathy CV: HEMA: allergic rxn, chest pain, fever. INTEG: alopecia, pruritus GI: N/V/D GU: EENT: Cough, dyspnea, rhinitis, and sinusitis. Contraindications: Pregnancy (D), breastfeeding, hypersensitivity, systemic infections, cardiac disease, bone marrow depression.
Route (Give timing for IV push/IVPB meds): Action: Inhibits DNA synthesis, causing IV strand splitting, cell cycle specific of the S phase, a vesicant. Frequency: q 2 weeks Rationale for client: Kaposis sarcoma.
Drug: decitabine (Dacogen) Dose: 15 mg/m^2
Functional class: DNA demethylation agent Chemical class: Cytosine analog
Route (Give timing for IV push/IVPB meds): IV Frequency: First, dose over 3h, then q8h x3 days. Rationale for client: treatment of nave and experienced myelodysplasic syndrome Action: Incorporated into DNA and inhibits DNA methylation, halting growth of rapid proliferation of blasts.
CNS: HA, anxiety, dizziness, hypoesthesia, insomnia CV: edema, murmur, hypotension HEMA: neutropenia, thrombocytopenia, leukopenia, anemia. INTEG: alopecia, ecchymosis, erythema, pallor, petechiae, pruritus, rash, swelling face, urticaria. GI: N/V/D, anorexia, constipation, stomatitis. GU: EENT: Cough, crackles, hypoxia, pharyngitis, pneumonia, pulmonary edema. Contraindications: Pregnancy (D), breastfeeding, children, hypersensitivity.
Assess CBC, differential, weekly platelet counts. Renal & Hepatic Studies, monitor temp q4h, Bleeding, hematuria, Dyspnea, crackles, unproductive cough, tachypnea, pallor, & lethargy. Monitor Buccal cavity for dryness and ulceration, oral pain, bleeding dysphagia GI symptoms, stools, and need for electrolyte replacements.
Drug: delavirdine (Rescriptor) Dose: 100-200 mg Route (Give timing for IV push/IVPB meds): PO Frequency: tid Max dose 1200 mg/day Rationale for client: HIV-I Used in combination w other antiretroviral.
Functional class: Anti-retroviral Chemical class: Nonnucleoside reverse transcriptase inhibitor (NNRTI) Action: Binds directly to reverse transcriptase and blocks RNA, DNA, polymerase, causing a disruption of the enzymes site.
Side-Effects: CNS: CV: HEMA: neutropenia, leukopenia, thrombocytopenia, anemia, granulocytopenia. INTEG: SJS GI: hepatoxicity GU: nephrotoxicity EENT: Contraindications: Hypersensitivity
Assess CBC, Blood Chemistry, plasma HIV RNA count, Anemia, signs of infection Hepatic studies Culture and Sensitivity Bowel patterns prior and during treatment Skin eruptions Allergies prior to treatment Plasma delavirdine concentrations and signs of toxicity (Severe N/V, maculopapular rash).
Drug: denileukin diftitox (Ontak) Dose: 9-18 mcg/kg/day
Functional class: Antineoplastic Chemical class: Fusion Protein
Side-Effects: CNS: Dizziness, parasthesia, nervousness, confusion, insomnia CV: Hypotension, vasodilation, tachycardia, thrombosis, hypertension, dysrhythmias. HEMA: Thrombocytopenia, leukopenia INTEG: rash, pruritus, sweating. GI: GU: EENT: dyspnea, cough, pharyngitis, rhinitis. Contraindications: Hypersentivity to denileukin, diphtheria toxin, IL-2.
Route (Give timing for IV push/IVPB meds): IV Action: A recombinant DNA-derived cytotoxic protein that interacts with high Frequency: 5 days, q21days affinity IL-2 receptors on the cell surface and inhibits cellular protein synthesis. Rationale for client: Cutaneous T cell lymphoma.
Black Box Warning* Capillary leak syndrome (after 2wks of treatment), infusion-related reactions (may be fatal), & visual disturbances (may be permanent, monitor for acuity, and color vision). Assess CBC, differential & weekly platelet count. monitor temp q4h Hepatic studies Bleeding, hematuria, bruising, or petechiae q8h. Jaundice of skin or sclera, dark urine, or clay colored stools.
Drug: denosumab (Prolia) Dose: 60 mg/ml
Functional class: Bone reabsorption inhibitor
Side-Effects: CNS: CV: atrial fibrillation HEMA: anemia, neutropenia INTEG: GI: N/V/D GU: EENT: osteonecrosis of the jaw, cough, dyspnea Contraindications: hypersensitivity, hypocalcaemia.
Chemical class: Monoclonal antibody, Route (Give timing for IV push/IVPB meds): bone resorption. Subq Frequency: q6mo Action: Neutralizes activity of receptor Rationale for client: osteoporosis in postactivator nuclear factor kappa-B ligand by menopausal women at high risk for fractures. binding to it and blocking its interaction with cell surface receptors, may reduce bone turn over and decrease tumor problem. Drug: desipramine (Norpramin) Dose: 10-150 mg Route (Give timing for IV push/IVPB meds): PO Frequency: q daily Rationale for client: Depression Action: Blocks reuptake of norepinephrine, serotonin into nerve ending Functional class: Anti-depressant Chemical class: Dibenzazepine, secondary amine
Assess for acute phase reaction (fever, myalgia, HA, flulike symptoms for 72 hr after inj. ) Blood studies Hypocalcemia (parasthesia, twitching, laryngospasm) Hypercalcemia (N/V, weakness, thirst. Dysrhythmias) Dental status Infection
Side-Effects: CNS: Dizziness, drowsiness CV: Orthostatic hypotension, ECG tachycardia, hypertension HEMA: Agranulocytosis, thrombocytopenia, eosinophilia, leukopenia INTEG: GI: N/V/D, dry mouth, paralytic ileus GU: Retention, acute renal failure EENT: Blurred vision, tinnitus Contraindications: Hypersensitivity to tricyclics, acute MI.
Black Box Warning* Children<18yr, suicidal patients. Assess BP (lying, standing), pulse q4h, BP drops 20mm hg hold dose. Hepatic studies, Weight q weekly ECG for flattening T wave Seizure activity Mental status (mood changes, depression, panic). Urinary retention Withdrawal symptoms Alcohol consumption hold product til morning
Drug: desloratadine (Clarinex) Dose: 1-5 mg
Functional class: Antihistamine, 2nd generation
Side-Effects: CNS: Sedation, HA, fatigue, seizures CV: HEMA: INTEG: GI: Hepatitis GU: EENT: Contraindications: Hypersensitivity infants/neonates.
Chemical class: Selective histamine Route (Give timing for IV push/IVPB meds): (H1)-receptor antagonist PO Frequency: q daily Action: Binds to peripheral histamine receptors, providing antihistamine action Rationale for client: seasonal allergic rhinitis, w/o sedation. pruritus.
Assess allergies (hives, rash, rhinitis) Monitor respiratory status Test interactions Antigen skin test Educate pt. to avoid driving Store in a tight container at room temperature.
Drug: desmopressin (DDAVP/ Minirin, Octostim) Dose: 0.2-0.4 mcg/kg
Functional class: Pituitary Hormone Chemical class: Synthetic antidiuretic hormone
Side-Effects: CNS: Drowsiness CV: Increased BP, palpitations, tachycardia HEMA: INTEG: GI: Nausea, heartburn, cramps GU: Vulva pain EENT: nasal irritation Contraindications: Hypersensitivity, severe renal disease.
Route (Give timing for IV push/IVPB meds): Action: Promotes reabsorption of water by Subq, IV, or nasal spray action on renal tubular epithelium, causing smooth muscle contraction, increase in Frequency: q daily plasma factor VIII levels, increasing platelet aggregation resulting in Rationale for client: Hemophilia A, DM vasopressin effects. type1, pituitary dysfunction.
Assess Pulse, BP, I&O ratio Water intoxication (lethargy, behavioral changes, disorientation) Intranasal use (Nausea, congestion, cramps, HA) Severe allergic reaction (anaphylaxis) Urine and plasma osmolality Factor VIII coagulation activity, bleeding times. Nocturnal enuresis.
Drug: dexamethasone ( Decadron) Dose: 0.75-9 mg/day Route (Give timing for IV push/IVPB meds): PO Frequency: q 6-12h Rationale for client: Inflammation, allergies, cerebral edema, septic shock, collagen disorders.
Functional class: Corticosteroid, synthetic Chemical class: Glucocorticoid, long acting. Action: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, firbroblasts, reversal of increased capillary permeability and lysosomal stabilization.
Side-Effects: CNS: Depression, flushing, sweating, HA, mood changes, seizures. CV: hypertension, circulatory collapse, thrombophlebitis, embolism HEMA: thrombocytopenia INTEG: GI: N/V/D, abdominal distention, GI hemorrhage, increased appetite, pancreatitis GU: EENT: Contraindications: Children<2yo, psychosis, hypersensitivity.
Assess Potassium, blood, urine glucose while on long-term therapy. Daily weights (>5lb week notify MD) BP, Pulse q4h I&O ratio Plasma cortisol levels Infection (fever, WBC count) Potassium depletion Edema, hypertension, cardiac symptoms Mental Status, mood changes
Drug: dexlansoprazole (Dexilant) Dose: 30mg
Functional class: Antiulcer, PPI Chemical class: Benzimidazole
Side-Effects: CNS: anxiety, seizures CV: CVA, MI HEMA: neutropenia, thrombocytopenia, pernicious anemia, thrombosis INTEG: GI: GU: EENT: pneumonia Contraindications: Hypersensitivity
Route (Give timing for IV push/IVPB meds): PO Action: Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase Frequency: q daily x4weeks enzyme system in gastric parietal cells, blocking the final step of acid production. Rationale for client: GERD
Assess GI system (bowel sounds q8h, abdominal pain, swelling, anorexia. Hepatic Studies (AST, ALT, alkaline phosphate during treatment). Swallow caps completely, do not crush. May sprinkle on food and consume immediately. Report severe diarrhea Educate pt. to avoid hazardous activities b/c drug may cause dizziness to occur. Do not mix w/ alcohol.
Drug: dexmedetomidine (Precedex) Dose: 0.2-0.7 mcg/kg/hr.
Functional class: Sedative, alpha 2adrenoceptor agonist. Chemical class:
Side-Effects: CNS: CV: Bradycardia, hypotension, atrial fibrillation, infarction, cardiac arrest. HEMA: INTEG: GI: Nausea, thirst GU: EENT: Pulmonary edema, pleural effusion, hypoxia. Contraindications: Hypersensitivity, Chronic HTN.
Route (Give timing for IV push/IVPB meds): IV Frequency: use within 24h, no longer. Rationale for client: Sedation in mechanically ventilated intubated patients in ICU. Action: Produces alpha 2 agonist activity seen at low moderate doses, also alpha 1 at high doses.
Assess injection site for phlebitis, burning, and stinging. Cardiac status (BP, heart rate, ECG for changes, atrial fibrillation). CNS changes (jerky movements, tremors, dizziness, LOC, pupil reaction) Respiratory dysfunction (depression, rate, rhythm, notify MD <10/min.)
Drug: dexmethl-phenidate ( Focalin) Dose: 2.5mg
Functional class: Central Nervous System (CNS) stimulant, psychostimulant. Chemical class:
Side-Effects: CNS: Toxic psychosis, neuroleptic malignant syndrome (rare). CV: Dysrhythmias, tachycardia, MI, stroke. HEMA: Leukopenia, anemia, thrombocytopenic purpura INTEG: Exfoliate dermatitis. GI: GU: EENT: Fever Contraindications: Breastfeeding, children<6yo, hypersensitivity.
Route (Give timing for IV push/IVPB meds): PO Action: Increases release of norepinephrine and dopamine into the Frequency: bid extra neuronal space and blocks reuptake of norepinephrine and dopamine in the Rationale for client: treatment for ADHD presynaptic neuron. MOA in ADHD is unknown.
Controlled Substance Schedule II Black Box Warning* Substance Abuse. Assess VS, BP, CBC, differential platelet count, Weight studies. Height, growth rate q3 mo. in children. Mental Status changes, mood changes, sensorium, aggressiveness, hostility. Withdrawal symptoms Appetite and Sleep patterns Attention Span
Drug: dextran 40 (Gentran 40) Dose: 500ml/day Route (Give timing for IV push/IVPB meds): IV, INF Frequency: X3 days Rationale for client: prophylaxis of embolism, thrombosis
Functional class: Plasma volume expander Chemical class: Low-molecular-weight polysaccharide Action: Similar to human albumin, which expands plasma volume by drawing fluid from interstitial space to intravascular space.
Side-Effects: CNS: Cardiac arrest, CHF CV: HEMA: increased bleeding/coagulation times, thrombocytopenia. INTEG: Angioedema GI: GU: Osmotic nephrosis, renal failure, stasis. EENT: Bronchospasm, pulmonary edema. Contraindications: Hypersensitivity
Assess VS q5min x30min, Hgb, Hct, urine output q1h monitor for increase, if no increase DC Infusion. I&O ratio, specific gravity, and urine osmolarity. Allergy (rash, urticaria, pruritus, wheezes, dyspnea, bronchospasms occur DC) Circulatory overload Dehydration after infusion (increased temp, poor skin turgor)
Drug: dextran 70/75 (Gentran 70) Functional class: Plasma volume expander Dose: 500-1000ml Chemical class: High-molecular-weight Route (Give timing for IV push/IVPB meds): polysaccharide IV, INF Frequency: Continuous (do not exceed 20-40ml/min) Max dose 10ml/kg/24hr if therapy is >24hr. Rationale for client: Hypovolemic shock, or impending shock. Action: Similar to human albumin, which expands plasma volume by drawing fluid from interstitial space to intravascular space.
Side-Effects: CNS: Cardiac arrest, CHF CV: HEMA: increased bleeding/coagulation times, thrombocytopenia. INTEG: Angioedema GI: GU: Osmotic nephrosis, renal failure, stasis. EENT: Bronchospasm, pulmonary edema. Contraindications: Hypersensitivity
Assess VS q5min x30min, Hgb, Hct, urine output q1h monitor for increase, if no increase DC Infusion. I&O ratio, specific gravity, and urine osmolarity. Allergy (rash, urticaria, pruritus, wheezes, dyspnea, bronchospasms occur DC) Circulatory overload Dehydration after infusion (increased temp, poor skin turgor)
Drug: dextroamphetamine (Dexedrine) Dose: 5-60 mg
Functional class: Cerebral Stimulant Chemical class: Amphetamine
Side-Effects: CNS: Hyperactivity, insomnia, restlessness, talkativeness CV: Palpitations, tachycardia, dysrhythmias HEMA: INTEG: GI: Anorexia, dry mouth GU: EENT: Contraindications: Hypersensitivity
Route (Give timing for IV push/IVPB meds): PO Action: Increases release of norepinephrine, dopamine in cerebral Frequency: q daily cortex to reticular activating system. Rationale for client: Narcolepsy, ADHD
Black Box Warning* Symptomatic CV disease, substance abuse, VS, BP, check patients w cardiac disease often Assess CBC, urinalysis, Height, weight, growth rate in children, Mental status for mood changes, tolerance or dependency, Overdose, pain, fever, and dehydration.
Drug: dextromethorphan (Robitussin) Dose: 10-20 mg
Functional class: Antitussive, nonopioid Chemical class: Levorphanol derivative
Side-Effects: CNS: Dizziness CV: HEMA: INTEG: GI: Nausea GU: EENT: Contraindications: Hypersensitivity
Route (Give timing for IV push/IVPB meds): PO Action: Depresses cough center in medulla by direct effect. Frequency: q4h Rationale for client: relieve cough
Assess cough, type, frequency, character, and sputum production Decrease dose in geriatric patients Increase fluid intake to liquefy secretions Humidification of patients room Educate pt. to avoid driving, and avoid smoking and inhalants that increase cough.
Drug: dextrose (D-glucose) Dose: 10-25mg
Functional class: Caloric, parenteral solution Chemical class:
Side-Effects: CNS :Loss of consciousness CV: CHF, pulmonary edema, intracranial hemorrhage HEMA: INTEG: GI: GU: EENT: Contraindications: Hyperglycemia, hemorrhage, CHF, anuria, allergy to corn products.
Route (Give timing for IV push/IVPB meds): PO/IV Frequency: depends of Individual Rationale for client: Increase caloric intake. Action: Needed for adequate utilization of amino acids; decreases protein, nitrogen loss; prevents ketosis.
Assess Electrolyte Studies Inj site for extravasation Monitor temp q 4h Serum glucose in patients receiving hypotonic glucose 50% Nutritional Status
Drug: diazepam (Valium) Dose: 2-10 mg
Functional class: Antianxiety, anticonvulsant, skeletal muscle relaxant, central acting
Side-Effects: CNS: Dizziness, drowsiness CV: Orthostatic Hypotension, ECG changes, tachycardia HEMA: Neutropenia INTEG: GI: GU: EENT: Blurred Vision, Respiratory depression Contraindications: Pregnancy (D), hypersensitivity to benzodiazepines, hepatic disease, sleep apnea.
Route (Give timing for IV push/IVPB meds): Chemical class: Benzodiazepine, long PO acting Frequency: bid-tid Rationale for client: Anxiety, acute alcohol withdrawal, prevention and treatment of seizures. Action: Potentiates the actions of GABA, especially in the limbic system, reticular formation, enhances presympahtetic inhibition, and inhibits spinal polysynaptic afferent pathways.
Assess BP (lying, standing), pulse, respirations Blood studies Degree of anxiety Alcohol withdrawal seizure control (intensity and duration) muscle spasms, pain relief IV site for thrombosis Mental status Physical Dependency
Drug: diazoxide (Proglycem) Dose: 3-8 mg/kg/day
Functional class: Antihypoglycemic agent Chemical class:
Side-Effects: CNS: HA CV: HEMA: Thrombocytopenia, leukopenia, neutropenia INTEG: GI: GU: EENT: Contraindications: Hypersensitivity to thiazides, sulfonamides, dissecting aortic aneurysm.
Assess serum glucose levels Shake suspension well Protect from light Do not use darkened solution
Route (Give timing for IV push/IVPB meds): Action: Vasodilates arteriolar smooth PO muscle by direct relaxation, reducing BP with concomitant increase in heart rate, Frequency: q8-12h cardiac output, and reduces release of insulin from the pancreas. Rationale for client: Increase BG levels in hyperinsulinism
Drug: diclofenac epolamine (Flector) Dose: 50 mg
Functional class: NSAID, nonopioid analgesic Chemical class: Phenylacetic acid
Side-Effects: CNS: Dizziness, HA CV: CHF, Dysrhythmias, MI, Stroke HEMA: Blood dsycrasias INTEG: GI: Jaundice, Cholestatic hepatitis GU: Nephrotoxicity, dysuria, hematuria, oliguria, azotemia, cystitis, UTI EENT: Laryngeal edema, Bronchospasm. Contraindications: Hypersensitivity to aspirin, iodides, NSAIDS, asthma, CV disease.
Route (Give timing for IV push/IVPB meds): PO Frequency: bid-tid Rationale for client: Osteoarthritis, Chronic RA, mild to moderate pain. Action: Inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis, analgesic, and antiinflammatory, antipyretic.
Black Box Warning* Treatment of perioperative pain (CABG) surgery, GI Bleeding, MI, Stroke. Assess for pain and location, ROM. Blood Counts during therapy Clients w asthma watch for nasal polyps and development of hypersensitivity. Blood Dyscrasias (thrombocytopenia), bruising, fatigue, and poor healing times.
Drug: diclofenac potassium (Cambia) Dose: 50 mg
Route (Give timing for IV push/IVPB meds): PO Action: Inhibits prostaglandin synthesis by decreasing enzyme needed for Frequency: bid-tid biosynthesis, analgesic, and antiinflammatory, antipyretic. Rationale for client: Osteoarthritis, Chronic RA, mild to moderate pain.
Drug: diclofenac sodium (Voltaren) Dose: 50 mg
Route (Give timing for IV push/IVPB meds): PO Frequency: bid-tid Rationale for client: Osteoarthritis, Chronic RA, mild to moderate pain. Action: Inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis, analgesic, and antiinflammatory, antipyretic.
Drug: didanosine (Videx EC) Dose: 125-400 mg/day Route (Give timing for IV push/IVPB meds): PO
Functional class: Antiretroviral Chemical class: Nucleoside reverse transcriptase inhibitor (NRTI)
Side-Effects: CNS: Peripheral neuropathy, seizures, anxiety, insomnia, CNS depression CV: CHF HEMA: Leukopenia, granulocytopenia, thrombocytopenia, anemia. INTEG: Rash, pruritus GI: Pancreatitis, N/V/D, abdominal pain, hepatic failure GU: EENT: Lactic acidosis, anaphylaxis. Contraindications: Hypersensitivity, lactic acidosis, pancreatitis, phenylketonuria.
Action: Nucleoside analog incorporating into cellular DNA by viral reverses transcriptase, thereby terminating the Rationale for client: HIV-1, HIV prophylaxis. cellular DNA chain. Frequency: q daily
Black Box Warning* Hepatic Studies, lactic acidosis, pancreatitis. Assess for peripheral neuropathy tingling or pain, Lactic acidosis with abdominal pain, N/V, anaphylaxis, CBC, differential, platelet count, Renal & Hepatic studies, Temp q4h, administer on empty stomach q30 min ac meals or 2h prior to last meal. Adjust dose in renal impairment.
Drug: diflunisal (Dolobid) Dose: 2250-1000 mg/day
Functional class: Nonsteroidal antiinflammatory/analgesic (nonopioid) Chemical class:
Side-Effects: CNS: Dizziness, HA CV: MI, Stroke HEMA: anemia, Blood dsycrasias INTEG: Reyes Syndrome GI: hepatitis GU: cystitis EENT: Dehydration Contraindications: Pregnancy (3rd trimester), children <12yo, hypersensitivity to salicylates, bleeding disorders, Vit K deficiency, Reyes Syndrome, anemia, dehydration. Side-Effects: CNS: HA, confusion, hallucinations CV: hypotension, bradycardia, Hema: Integ: GI: N/V/D, abdominal pain GU: EENT: Contraindications: Ventricular fibrillation, ventricular tachycardia, 2nd or 3rd degree Heart block
Black Box Warning* GI Bleeding, perioperative pain of CABG, MI, Stroke.
Route (Give timing for IV push/IVPB meds): PO Action: Inhibits prostaglandin synthesis. Frequency: 2 divided doses q daily Rationale for client: Mild to moderate pain. *Rarely Used b/c it is 3-4 x more potent than aspirin
Drug: Digoxin Dose: Route: Frequency: Rationale for client:
Functional class: Cardiac glycoside, inotropic, antidysrhythmic Chemical class: Digoxin preparation Action: increases force of contraction; decreases heart rate
-Antidote: Digibind 228mg -Assess Apical pulse for 1 minute before giving -Hold if HR is <60 bpm -Therapeutic level (0.5-2)
Drug: Diltiazem Dose: Route: Frequency: Rationale for client:
Functional class: Calcium channel blocker Chemical class: Benzothiazepine Action: Produces relaxation of coronary vascular smooth muscles, dilates coronary arteries, slows conduction time, dilates peripheral arteries
Drug: Dimenhydrinate Dose: Route: Frequency: Rationale for client:
Functional class: Antiemetic, antihistamine, anticholinergic Chemical class: H1- receptor antagonist Action: competes with histamine for H1 receptors in GI tract
Side-Effects: CNS: HA, fatigue, drowsiness CV: edema, dysrhythmias, CHF Hema: Integ: rash, flushing, photosensitivity GI: N/V/C, gastric upset GU: nocturia, polyuria, renal failure EENT: Contraindications: Heart block, Hypotension, pulmonary congestion Side-Effects: CNS: drowsiness, headache CV: hypo/ hypertension Hema: Integ: rash, flushing GI: N/V/C GU: EENT: dry mouth, blurred vision Contraindications: hypersensitivity Side-Effects: CNS: dizziness, drowsiness, CV: hypotension, palpitations HEMA: thrombocytopenia, anemia INTEG: photosensitivity GI: Nausea, diarrhea, anorexia GU: retention, dysuria, frequency EENT: dry mouth, blurred vision RESP: increased thick secretions, wheezing, chest tightness Contraindications: Acute asthma attacks, lower respiratory tract disease Side-Effects: CNS: anxiety, HA, dizziness CV: palpitations, tachycardia, GI: Heartburn, nausea, vomiting RESP: dyspnea Contraindications: hypersensitivity
-Antidote: Atropine -Hold if systolic BP is <90 or diastolic is < 50 - Avoid sunlight -Increase fiber intake
-Watch for signs toxicity of other products -Assist with ambulation -Avoid alcohol & other depressants
Drug: Diphenhydramine Dose: Route: Frequency: Rationale for client:
Functional class: Antihistamine Chemical class: H1- receptor antagonist Action: Competes with histamine for H1receptor site; decreases allergic response by blocking histamine
-Antidote: Diazepam, Vasopressors -Assess for urinary retention -Monitor CBC during long-term use -Assess respiratory status for secretions, wheezing, & tightness
Drug: Dobutamine Dose:
Functional class: Adrenergic direct acting B1-agonist, cardiac stimulant Chemical class: Catecholamine
-Antidote: Beta Blocker -Sulfite sensitivity -Assess for muscle cramps & numbness of extremities
Route: Frequency: Rationale for client: Action: increases contractility, increases cardiac output without increased HR
Drug: Docusate Sodium / Calcium Dose:
Functional class: Laxative, emollient; stool softener Chemical class: Anionic surfactant
Side-Effects: INTEG: rash GI: nausea, anorexia, cramps, diarrhea EENT: bitter taste, throat irritation Contraindications: Obstruction, fecal impaction, N/V
-Increase fiber & fluid intake -Assess for cramping or rectal bleeding
Route: Frequency: Rationale for client: Action: Increases water, fat penetration in intestine, allows for easier passage of stool
Drug: Dolasetron Dose: Route: Frequency: Rationale for client:
Functional class: Antiemetic Chemical class: 5-HT3 receptor antagonist Action: prevents nausea & vomiting by blocking serotonin
Side-Effects: CNS: headache, dizziness, fatigue CV: dysrhythmias, hyper/hypotension GI: Diarrhea, abdominal pain, anorexia GU: urinary retention, oliguria Contraindications: hypersensitivity
-Assess for rash & bronchospasms -Monitor HR & BP
Drug: Dopamine Dose: Route: Frequency: Rationale for client:
Functional class: Adrenergic Chemical class: Catecholamine Action: increases cardiac output, causes vasoconstriction in blood vessels
Side-Effects: CNS: headache, anxiety CV: palpitations, tachycardia, HTN, ectopic beats, angina INTEG: necrosis, tissue sloughing GI: N/V/D Contraindications: Ventricular fibrillation, hypovolemia
-Monitor I&O, if urine output decreases, without decrease in BP the product should be stopped. -Assess for paresthesia & coldness of extremities -
Drug: Doripenem Dose: Route: Frequency: Rationale for client:
Functional class: Antiinfective Chemical class: Carbapenem Action: Bactericidal, interferes with cell wall replication
Side-Effects: CNS: seizures, headache HEMA: neutropenia, leukopenia INTEG: rash, phlebitis, Steven-Johnson syndrome, pruritus GI: N/V/D Contraindications: Penicillin, beta-lactam; viral infection
-Antidote: Epinephrine, Antihistamines -Assess for diarrhea, may indicate pseudomembranous colitis
Drug: Doxazosin Dose:
Functional class: Peripheral A1adrenergic receptor blocker Chemical class: Quinazoline
Side-Effects: CNS: dizziness, HA, weakness, depression CV: orthostatic hypotension, tachycardia, edema, angina GI:N/V/D, abdominal pain GU: incontinence, polyuria EENT: epistaxis, tinnitus, dry mouth, red sclera Contraindications: hypersensitivity
-Antidote: Vasopressors -Monitor BP & pulse 2-6 hr after each dose -Assess for edema in legs daily - Take first does at HS (bedtime)
Route: Frequency: Rationale for client: Action: Dilates peripheral blood vessels, lowers peripheral resistance which decreases BP
Drug: Doxepin Dose: Route: Frequency: Rationale for client:
Functional class: Antidepressant, antihistamine Chemical class: Dibenzoxepin, tertiary amine Action: blocks reuptake of norepinephrine, serotonin into nerve ending, increasing action of norepinephrine, serotonin in nerve cells
Side-Effects: CNS: dizziness, drowsiness, confusion CV: orthostatic hypotension, tachycardia, HTN HEMA: thrombocytopenia INTEG: rash, sweating, photosensitivity GI: diarrhea, dry mouth, paralytic ileus GU: retention, acute renal failure EENT: blurred vision, tinnitus, glossitis Contraindications: urinary retention, glaucoma, prostatic hypertrophy
-Antidote: activated charcoal -Hold if systolic BP drops 20 mm Hg -Monitor CBC for long-term use -Weight weekly; appetite may increase with product
Drug: Doxycycline Dose: Route:
Functional class: Antiinfective Chemical class: Tetracycline Action: Inhibits protein synthesis
Side-Effects: CNS: fever CV: pericarditis HEMA: thrombocytopenia, anemia INTEG: rash, urticaria, photosensitivity, increased pigmentation GI: N/V/D, abdominal pain GU: increased BUN EENT: dysphagia, glossitis Contraindications: Esophageal ulceration
- Monitor IV site for phlebitis/thrombosis, product is highly irritating -Avoid use in children 8 yr old due to tooth discoloration -Avoid sun
Frequency: Rationale for client:
Drug: Dronedarone Dose: Route: Frequency: Rationale for client:
Functional class: Antidysrhythmic Chemical class: Iodinated benzofuran derivative Action: decreases peripheral vascular resistance
Side-Effects: CV: bradycardia, hyper/hypotension INTEG: rash, photosensitivity GI: N/V/D, abdominal pain Contraindications: 2nd or 3rd degree AV block, bradycardia, heart failure, hepatic disease
-Monitor creatinine, K+, Mg -Monitor for dehydration, hypovolemia -Monitor HR & BP
Drug: Droperidol Dose: Route: Frequency: Rationale for client:
Functional class: Sedative/ hypnotic Chemical class: Butyrophenone Action: Acts on the CNS to produce tranquilization & sleep effects
Side-Effects: CNS: dizziness, drowsiness, anxiety CV: tachycardia, hypotension INTEG: chills, facial sweating, shivering EENT: upward rotation of eyes RESP: laryngospasm, bronchospasm Contraindications: children <2 yr, hypersensitivity
-Monitor VS q10min during IV administration -Assess for increasing HR or decreasing BP -Teach pt to ambulate with assistance
Drug: Duloxetine Dose: Route: Frequency: Rationale for client:
Functional class: Antidepressant Chemical class: Serotonin- norepinephrine reuptake inhibitor Action: inhibits neuronal serotonin & norepinephrine reuptake
Side-Effects: CNS: insomnia, anxiety, dizziness, tremor CV: thrombophlebitis, peripheral edema, hypertension INTEG: photosensitivity, bruising, sweating GI: N/V/C, dry mouth, dysphagia GU: urinary hesitation/ retention/ frequency EENT: abnormal vision Contraindications: Alcoholism, glaucoma, jaundice
-Elevate legs if peripheral edema occurs -Advise pt to use sugarless gum, hard candy, or frequent sips of water for dry mouth -Black Box warning: suicidal tendencies -Assess mental status
Drug: Dyphylline Dose: Route: Frequency: Rationale for client:
Functional class: Bronchodilator Chemical class: Xanthine, Theophylline derivative Action: relaxes smooth muscles of respiratory system
Side-Effects: CNS: anxiety, restlessness, insomnia, dizziness CV: palpitations, sinus tachycardia, hypotension INTEG :flushing, urticaria GI: N/V/D, anorexia, rectal irritation Contraindications: hypersensitivity
-Monitor I&O, dehydration may occur -Take with 8oz of water -Monitor Theophylline levels
Drug: Efavirenz, Sustiva Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiretroviral Chemical class: Nonnucleoside reverse transcriptase inhibitor (NNRTI) Action: Binds directly to reverse transcriptase and blocks RNA, DNA, polymerase, causing disruption of the enzymes site.
Side-Effects: CNS: Fatigue, Impaired Cognition, Insomnia CV: N/A HEMA:N/A INTEG: Rash, Erythema, StevensJohnson Syndrome, Toxic epidermal necrolysis GI: Diarrhea, Nausea, Abdominal Pain GU: Hematuria, kidney stones EENT:N/A Contraindications: Pregnancy (D) Side-Effects: CNS: Dizziness, Headache, Anxiety CV: Chest Pain, Palpitations, HTN HEMA: N/A INTEG: N/A GI: Nausea, Dry Mouth GU: N/A EENT: N/A MS: Weakness, Back Pain Resp: Chest tightness, Pressure Contraindications: Coronary Artery Vasospasm, PVD, Ischemic Bowel, Heart Disease, Severe Renal/Hepatic Disease
-Hepatic studies: ALT, AST, Renal Studies -Bowel pattern before, during treatment; if severe abdominal cramping with bleeding occurs, d/c -Labs: CBC, Blood Chemistry, Plasma HIV RNA, absolute CD4+/CD8+ cell counts/%, Serum beta 2 microglobulin, Serum ICD+24antigen levels, Cholesterol, Hepatic Enzymes -Give on an empty stomach at bedtime -Do not breastfeed or become pregnant, serious birth defects have occured -Avoid ingestion of tyramine foods (pickled products, beer, wine, aged cheese), food additives, preservatives, Colorings, Artificial Sweetners, Chocolate, Caffine -Monitor Urine Output -Take at beginning of headache, repeat dose 2 hr after first if not effective -Provide dark, quiet environment -Assess for neurological status -Swallow tabs whole; do not break, crush, or chew
Drug: Electriptan,Relpax Dose:
Functional class: Antimigraine agent, abortive
Chemical class: 5-HT1-1B/1D receptor Route (Give timing for IV push/IVPB meds): agonist, triptan Frequency: Rationale for client: Action: Binds selectively to the vascular 5-HT1-receptor subtype; causes vasoconstriction in cranial arteries
Drug: Emtricitabine, Emtriva Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiretroviral Chemical class: Nucleoside reverse transcriptase inhibitor (NRTI) Action: Synthetic nucleoside analog of cytosine. Inhibits replication of HIV virus by competing with the natural substrate and then becoming incorporated into cellular DNA by viral transcriptase, thereby terminating cellular DNA chain.
Side-Effects: CNS: Headache, Depression, Insomnia, Asthenia CV: N/A HEMA: N/A INTEG: Rash, skin discolorization GI: N/V/D, Anorexia, Abdominal Pain GU: N/A EENT: N/A Resp: Cough Contraindications: N/A
-BBW: Lactic Acidosis -BBW: Hepatic insufficiency, chronic hepatitis B virus -Assess Renal/Hepatic Function Tests -Teach, GI complaints resolve after 3-4 weeks of treatment -Take at same time each day to maintain blood level -Controls symptoms of HIV but does not cure -Changes in body fat distribution may occur
Drug: Enalapril, Vasotec Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antihypertensive Chemical class: Angiotensin-Converting Enzyme (ACE) Inhibitor Action: Selectively suppresses renninangiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II, dilation of arterial, venous vessels
Side-Effects: CNS: Insomnia, Dizziness, Headache CV: Hypotension, Dysrhythmias, MI, Tachycardia HEMA: Agranulocytosis, Neutropenia INTEG: Rash, purpura, photosensitivity GI: N/V, Dry Mouth, Loss of Taste GU: Proteinuria, Renal Failure, Polyuria or Oliguria EENT: Tinnitus, Visual Changes Contraindications: History of angioedema Side-Effects: CNS: Anxiety, Gullain-BarreSyndrome, Insomnia, Depression CV: N/A HEMA: Thrombocytopenia, Neutropenia INTEG: Injection site reactions GI: Abdominal pain, Anorexia, Constipation, Pancreatitis GU: Glomerulonephritis, Renal Failure EENT: Influenza, Cough, Conjunctivitis Contraindications: Breastfeeding
Drug: Enfuvirtide, Fuzeon Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiretroviral Chemical class: Fusion Inhibitor Action: Inhibitor of the fusion of HIV-1 with CD4+ cells.
-BBW: Pregnancy (D) -Assess Blood Studies, if neutrophils <1000/mm3, d/c tx -Monitor electrolytes: K, Na, Cl -Dilute dose with <50 mL of compatible sol -Teach patient not to use OTC cough, cold or allergy products -Avoid sunlight or wear sunscreen -Notify HCP of mouth sores, sore throat, fever, swelling of hands or feet, irregular heartbeat, chest pain -Rise slowly to sitting or standing to minimize orthostatic hypotension -Labs: BUN, Creatinine, CBC, blood chemistry, plasma HIV RNA, absolute CD4+/CD8+ cell counts/%, serum beta 2 microglobulin, serum ICD +24 antigen levels, cholesterol -Monitor Bowel Patterns -Reconstitute vial with 1.1 mL of sterile water for inj; tap and roll to mix; allow to stand until completely dissolved -SUBCUT, BID, Rotate Sites -Pneumonia may occur, contact HCP if cough, fever occur -Does not cure HIV, controls symptoms
Drug: Enoxaparin, Lovenox Dose:
Functional class: Anticoagulant, Antithrombotic
Side-Effects: CNS: Fever, Confusion CV: N/A HEMA: Hemorrhage, Hypochromic Anemia, Thrombocytopenia, Bleeding INTEG: Ecchymosis, Inj. Site Hematoma GI: Nausea GU: N/A EENT: META: Hyperkalemia in renal failure SYST: Edema, Peripheral Edema Contraindications: Major Bleeding or Hypersensitivity to Pork
Chemical class: Low-Molecular Weight Route (Give timing for IV push/IVPB meds): Heparin (LMWH) Frequency: Rationale for client: Action: Binds to antithrombin II inactivating factors Xa/IIa resulting in higher ratio of anti-factor Xa to IIa
-BBW: Lumbar puncture, epidural anesthesia, spinal anesthesia -Assess Blood Studies (Hct, CBC, coagulation studies, platelets, occult blood in stools) -Administer at same time daily to maintain blood levels -Do not aspirate; do not expel bubble from syringe before administration -Insert whole needle into skin fold held with thumb and forefinger -Teach pt. to use soft-bristle toothbrush, use electric razor -Avoid OTC products containing aspirin -ANTIDOTE: Protamine SO4 1% sol; dose should equal dose of enoxaprin -BBW: Hepatic disease, hepatitis, HIV, lactic acidosis -Administer PO on empty stomach 2 hr before or after food -Notify HCP of decreased urinary output, blood in urine -Does not cure, but lowers the amount of HBV in body -Do not breastfeed -Monitor for s/s of lactic acidosis: muscle pain, severe tiredness, stomach pain with N/V, Coldness in arms/legs, fast/irregular heartbeat, dizziness -Monitor for s/s hepatotoxicity: eyes/skin turns yellow, dark urine, light bowel movements, no appetite for days, nausea, stomach pain
Drug: Entecavir, Baraclude Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiviral Chemical class: Guanosine Nucleoside Analog Action: Inhibits hepatitis B virus DNA polymerase by competing with natural substrates and by causing DNA termination after its incorporation into viral DNA; causes viral DNA death
Side-Effects: CNS: Headache, Fatigue, Dizziness CV: N/A HEMA: N/A INTEG: Alopecia, Rash GI: Dyspepsia, N/V/D GU: N/A EENT:N/A ENDO: Hyperglycemia SYST: Lactic Acidosis, Severe Hepatomegaly with Stenosis Contraindications: N/A
Drug: Entacapone, Comtan Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiparkinson Agent Chemical class: COMT Inhibitor Action: Inhibits COMT and alters the plasma pharmacokinetics of levodopa. Given with levodopa/carbidopa.
Side-Effects: CNS: Involuntary choreiform movements, hand tremors, fatigue, headache, anxiety, twitching, numbness, dyskinesia, hypokinesia, hyperkinesia, weakness, confusion, agitation, nightmares, psychosis, hallucination, neuroleptic malignant syndrome CV: Orthostatic Hypotension HEMA: N/A INTEG: Rash, Sweating, Alopecia GI: N/V, Anorexia, Abdominal Distress, Dry Mouth, Flatulence, Bitter Taste, Diarrhea, Constipation, Dyspepsia GU: N/A EENT: N/A Contraindications:N/A
-Assess for neuroleptic malignant syndrome: high temp, increased CPK, rigidity, change in LOC -Administer only after MAOIs have been discontinued for 2 weeks -Give with a dose of levodopa/carbidopa; this product has no effect on own -Assist with ambulation at beginning of therapy -Hallucinations, mental changes, nausea, dyskinesia can occur and may mean pt is overmedicated -Change positions slowly -Urine/Sweat may darken
Drug: Ephedrine, Ephedrine Sulfate, Pretz-D Functional class: Bronchodilator, (OTC) Nonselective adrenergic, mixed direct and indirect effects Dose: Chemical class: Phenylisopropylamine Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Causes increased contractility and heart rate by acting on beta-receptors in the heart; also acts on alpha-receptors, causing vasoconstriction in blood vessels
Side-Effects: CNS: Tremors, Anxiety, Seizures, CNS Depression, Cerebral Hemorrhage CV: Palpitations, Tachycardia, Dysrhythmias HEMA: N/A INTEG: N/A GI: Anorexia, Nausea, Vomiting GU: Dysuria, Urinary Retention EENT: N/A Contraindications: Closed angle glaucoma, nonanaphylactic shock during general anesthesia, hypertension Side-Effects: CNS: Tremors, Anxiety, Dizziness, Cerebral Hemorrhage CV: Palpitations, tachycardia, dysrhythmias HEMA: N/A INTEG: N/A GI: Anorexia, Nausea, Vomiting GU: N/A EENT: Dry Eyes, Dyspnea Contraindications: Closed-angle glaucoma, nonanaphylactic shock during general anesthesia.
-Monitor I&O, ECG during administration -Assess injection site: tissue sloughing; if this occurs, administer phentolamine mixed with 0.9% NaCl -Store reconstituted solution refrigerated no longer than 24 hr -Take precautions in patients: Pregnancy (C), Breastfeeding, Cardiac Disorders, Hyperthyroidism, Diabetes Mellitus, Prostatic Hypertrophy, Angina
Drug: Epinephrine, Adrenalin Ana-Guard Dose:
Functional class: Bronchodilator nonselective adrenergic agonist, vasopressor
Route (Give timing for IV push/IVPB meds): Chemical class: Catecholamine Frequency: Rationale for client: Action: Beta 1 and 2 Agonist causing increased levels of cAMP producing bronchodilation, cardiac, and CNS stimulation; high doses cause vasoconstriction via alpha receptors; low doses can cause vasodilation via beta 2 vascular receptors.
- Monitor I&O, ECG during administration -Assess injection site: tissue sloughing; if this occurs, administer phentolamine mixed with 0.9% NaCl -Sulfite sensitivity, may be life threatening -Administer increased dose of insulin in diabetic patients if glucose is elevated -Teach patient to rinse mouth after use to prevent dryness after inhalation -Precautions: Pregnancy (C), Breastfeeding, Cardiac Disorders, Hyperthyroidism, Diabetes Mellitus, HTN, Organic Brain Syndrome, Cardiac Dilation, Coronary Insufficiency
Drug: Epirubicin, Ellence Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic, antibiotic Chemical class: Anthracycline Action: Inhibits DNA synthesis primarily; replication is decreased by binding to DNA, which causes strand splitting; maximum cytotoxic effects at S and for G2 phases, a vesicant
Side-Effects: CNS: N/A CV: Sinus Tachycardia, PVCs, Bradycardia, Extrasystoles HEMA: Thrombocytopenia, Leukopenia Anemia, Neutropenia, Secondary AML INTEG: Rash, Necrosis, Pain at Inj. Site, Reversible Alopecia GI: Nausea, Vomiting, Anorexia, Mucositis, Diarrhea GU: Amenorrhea, Hot Flashes, Hyperuricemia EENT: N/A Contraindications: Breastfeeding, Anthracyclines, Anthracenediones, Severe Myocardial Insufficiency, Recent MI, Systemic infections Side-Effects: CNS: Headache, Dizziness, Fatigue CV: Angina, MI HEMA:N/A INTEG: N/A GI: Increased GGT diarrhea, abdominal pain, increased ALT GU: Increased BUN, creatinine EENT: N/A Contraindications: Breastfeeding, Increased Serum Creatinine, Type 2 Diabetes with microalbuminuria, Hepatic Disease Side-Effects: CNS: Seizures, Coldness, Sweating CV: Hypertension, Hypertensive Encephalopathy, CHF, DVT HEMA: N/A INTEG: Pruritus, Rash, Inj Site Reaction GI: N/A GU: N/A EENT: Cough MISC: Iron Deficiency, Bone Pain Contraindications: Uncontrolled Hypertension
Drug: Eplerenone, Inspra Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antihypertensive Chemical class: Selective Aldosterone Receptor Antagonist Action: Binds to mineralocorticoid receptor and blocks the binding of aldosterone, a component of the renninangiotensin aldosterone system (RAAS)
-BBW: Severe hepatic disease -BBW: Bone marrow depression (severe), heart failure, extravasation, secondary malignancy -Assess Bone Marrow Depression, infection: increased temp -Labs: BUN, Serum Uric Acid, Urine CCr, Electrolytes Before, Creatinine, AST, ALT, Alk Phos -Administer antiemetic 30-60 min before giving to prevent vomiting -Hair may be lost during treatment and wig or hairpiece may make patient feel better; tell patient that new hair may be different in color, texture -Avoid crowds and persons with infections when granulocyte count is low -Urine may appear red for 2 days -Contraceptive measures are rec. during therapy and 4 mo thereafter -Assess Renal Studies: Protein, BUN, Creatinine, Increased LFTs, Uric Acid -Hyperkalemia may occur -Teach patient not to d/c abruptly -Advise no use of OTC cold, cough, allergy medications -Important to comply with dosage, even if feeling better -Advise that product may cause dizziness, fainting, light-headedness; may occur during first few days of therapy
Drug: Epoetin, Procrit Dose:
Functional class: Antianemic, Biologic Modifier, Hormone Chemical class: Amino Acid polypeptide
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Erythropoietin is one factor controlling rate of red cell production; product is developed by recombinant DNA technology.
-BBW: Hgb >12 g/dL, Surgery -Labs: Urinalysis, Protein, Blood, BUN, Creatinine, Ferritin, Transferrin -Report drop in I&O <50mL/hr -Assess for pure cell aplasia (PRCA) in absence of other causes, evaluate by testing sera for recombinant erythropoietin antibodies; any loss of response to epoetin should be evaluated -Teach patient to avoid driving or hazardous activity during beginning of tx -Take iron supplements, Vit B12 as directed.
Drug: Eprosartan, Teveten Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antihypertensive Chemical class: Angiotensin II-receptor antagonist (Subtype AT1) Action: Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; selectively block the binding of angiotensin II to AT1 receptor found in tissues
Side-Effects: CNS: Dizziness, depression, fatigue CV: Chest Pain HEMA: N/A INTEG: N/A GI: Diarrhea, Dyspepsia, Abdominal Pain GU: UTI EENT: Sinusitis RESP: Cough, Upper Resp Infection, SYST: Anaphylaxis Contraindications: NA
-BBW: Pregnancy (D) 2nd/3rd Trimesters -Assess B/P with position changes, pulse q4h; note rate, rhythm, quality -Baselines in renal, hepatic studies before therapy begins -Monitor Electrolytes -Look for Edema in legs, feet daily -Teach to notify prescriber of fever, chest pain, swelling of hands, feet, face, lip or tongue -If dose missed take as soon as possible, unless within 1 hr of next dose -Therapeutic effect may take 2-3 weeks -Labs: Platelets, Hgb, Hct, Creatinine, PT/aPTT baseline INR within 6 hr of loading dose and daily thereafter, patients undergoing PCI should have ACT monitored, maintain aPTT 50-70 sec unless PCI is to be performed -Aspirin and Heparin may be given with this product, check for bleeding -D/C heparin before removing femoral artery sheath, after PCI -Teach patient to report bruising, bleeding, chest pain immediately
Drug: Eptifibatide, Integrilin Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiplatelet agent Chemical class: Glycoprotein IIb/IIIa inhibitor Action: Platelet glycoprotein antagonist; this agent reversibly prevents fibrinogen, von Willebrands factor from binding to the glycoprotein IIb/IIIa receptor, inhibiting platelet aggregation
Side-Effects: CNS: Stroke, Hypotension CV: N/A HEMA: Thrombocytopenia INTEG: N/A GI: N/A GU: Hematuria EENT: N/A SYST: Bleeding, Anaphylaxis Contraindications: Active internal bleeding, Stroke w/in 2 yr, major surgery with severe trauma, severe hypertension, hx of intracranial bleeding Side-Effects: CNS: Headache, Dizziness, Fainting CV: Hypertension, Chest Pain HEMA: N/A INTEG: Sweating GI: Nausea, Vomiting, Diarrhea GU: Cramping EENT: Tinnitus Contraindications: Spontaneous abortion, PID
Drug: Ergonovine, Ergotrate Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Oxytocic Chemical class: Ergot Alkaloid Action: Stimulates uterine contractions and vascular smooth muscle, decreases bleeding
-Precautions: Cardiac, renal, hepatic, disease, asthma, anemia, seizure disorders, hypertension, glaucoma, obliterative vascular disease -Administer IM injection deep in large muscle; rotate sites -Teach patient to report increased blood loss, increased temp or foul smelling lochia -Avoid nicotine -Treatment of Overdose: stop product, give vasodilators, heparin, dextran
Drug: Erlotinib, Tarceva Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic-misc Chemical class: Epidermal growth factor receptor inhibitor Action: Not fully understood; inhibits intracellular phosphorylation of cell surface receptors associated with epidermal growth factor receptors
Side-Effects: CNS: CVA, Anxiety, Depression CV: MI/Ischemia HEMA: DVT INTEG: Rash, Stevens-Johnson like reaction, Toxic epidermal necrolysis GI: N/V/D, Anorexia, mouth ulceration GU: Renal Impairment/Failure EENT: Ocular changes, Conjunctivitis, Eye Pain Contraindications: Pregnancy D, Breastfeeding Side-Effects: CNS: Insomnia, Seizures, Headache CV: Tachycardia HEMA: N/A INTEG: Rash, pruritus, infused vein complication, phlebitis/thrombophlebitis GI: N/D/V, Pseudomembranous colitis GU: Vaginitis EENT: N/A SYST: Anaphylaxis Contraindications: Anaphylactic reactions to Beta-lactams Side-Effects: CNS: Seizures CV: Dysrhythmias, QT Prolongation HEMA: N/A INTEG: Rash, Urticaria, Pruritus GI: N/V/D, Hepatotoxicity, Pseudomembranous Colitis GU: Vaginitis, Moniliasis EENT: Hearing Loss, Tinnitus Contraindications: Preexisting hepatic disease
-Assess for: MI/Ischemia, CVA in pancreatic cancer patients; Pulmonary Changes; Ocular Changes -Blood Studies INR, LFTs, PT -Administer 1 hr before or 2 hr after meals -Interrupt dosing if severe changes to liver function occur -Teach patient to report adverse reactions immediately: SOB, severe abdominal pain, persistent diarrhea or vomiting, ocular changes, skin eruptions -Use reliable contraception during treatment, avoid breastfeeding -With renal disease lower dose may be required -If diarrhea occurs, discontinue -Allergic Reactions, Anaphylaxis; rash, urticaria, pruritus -Overgrowth of Infection: perineal itching, fever, malaise, redness, pain, swelling, drainage, rash, diarrhea, change in cough or sputum -Administer after C&S taken -Treatment of overdose: Epinephrine, Antihistamines, Resuscitate if needed -Monitor I&O -Labs: AST, ALT, Urinalysis, Protein, Blood -C&S Before Therapy Begins -Assess Cardiac Status dysrhythmias, QT prolongation -Do not give by IM or IV Push -Oral product with full glass of water, do not take with fruit juice -Take at evenly spaced intervals; complete dosage regimen; take without food unless formulation -Treatment of Hypersensitivity: Withdraw product; maintain airway; administer epinephrine, aminophylline, O2, IV Corticosteroids
Drug: Ertapenem, Invanz Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiinfective-Misc Chemical class: Carbapenem Action: Interferes with cell wall replication of susceptible organisms; osmotically unstable cell wall swells, burst from osmotic pressure
Drug: Erythromycin Base, Eramycin Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiinfective Chemical class: Macrolide Action: Binds to 50S ribosomal subunits of susceptible bacteria and suppresses protein synthesis
Drug: Escitalopram, Lexapro Dose:
Functional class: Antidepressant, SSRI (selective serotonin reuptake inhibitor) Chemical class:
Side-Effects: CNS: Headache, Nervousness, Insomnia, Drowsiness, Anxiety, Tremor, Dizziness, Fatigue, Sedation, Poor Concentration, Abnormal Dreams, Agitation, Seizures, Malignant Neuroleptic-Like Syndrome Reactions CV: Hot Flashes, Palpitations, Hemorrhage, Tachycardia, Bradycardia, MI, Thrombophlebitis HEMA: N/A INTEG: Sweating, Rash, Pruritus GI: N/D, Dry Mouth, Anorexia, Dyspepsia, Constipation, Cramps, Vomiting, Taste Changes, Flatulence GU: Dysmenorrhea, UTI, Decreased Lib EENT: Visual Changes, Ear/Eye Pain Contraindications: N/A
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Inhibits CNS neuron uptake of serotonin but not of norepinephrine
-BBW: Children/Adolescents <12 yr, suicidal ideation -Labs: CBC, Leukocytes, Differential, Cardiac Enzymes, Platelets, AST, ALT, Bilirubin, Creatatinine, Thyroid Function -Hold dose if alcohol is consumed -Offer patient gum, hard candy, frequent sips of water for dry mouth -Therapeutic effect may take 1 -4 weeks -Advise patient to use caution in driving, other activities requiring alertness because drowsiness, dizziness, blurred vision -Use sunscreen to prevent photosensitivity -Advise patient to change positions slowly, orthostatic hypotension may occur
Drug: Esmolol, Brevibloc Dose:
Functional class: Beta Adrenergic Blocker (Antidysrhythmic II) Chemical class: N/A
Side-Effects: CNS: Confusion, Seizures CV: Hypotension, Bradycardia, CHF HEMA: N/A INTEG: Induration, inflammation at site, discoloration, Edema, Erythema GI: Nausea, Vomiting, Anorexia, Constipation, Heartburn, Bloating GU: Urinary retention, impotence, dysuria EENT: N/A RESP: Bronchospasm, dyspnea, cough, wheeziness, pulmonary edema Contraindications: 2nd or 3rd degree heart block, cardiogenic shock, CHF, Cardiac Failure, Hypersensitivity, Severe Bradycardia
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Competitively blocks stimulation of beta 1 adrenergic receptors in the myocardium; produces negative chronotropic, inotropic activity (decreases rate if SA node discharge, increases recovery), slow conduction of AV node, decreases HR, decreases O2 consumption in myocardium; also decrease renninaldosterone-angiotensin system at high doses; inhibits Beta 2 receptors in bronchial system at higher doses
-BBW: Abrupt discontinuation -Measure I&O ratio, daily weights, watch for signs of CHF -Take BP q4h, if <100 systolic or <60 Diastolic, notify HCP before administration -ECG Continuously during inf, hypotension common -Reduced dosage needed in cool environment -Teach patient to notify HCP is chest pain, SOB, wheezing, hypotension, bradycardia, pain, or swelling at IV site -Treatment of Overdose: Discontinue Product
Drug: Esomeprazole, Nexium Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiulcer Chemical class: Proton Pump Inhibitor, Benzimidazole Action: Suppresses gastric secretion by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cell; characterized as gastric acid pump inhibitor, because it blocks final step of acid production
Side-Effects: CNS: Headache, Dizziness CV: N/A HEMA: N/A INTEG: Rash, Dry Skin GI: Diarrhea, Flatulence, Hepatic Failure, Hepatitis GU: N/A EENT: Cough, Pneumonia MISC: Heart Failure Contraindications: N/A
-Assess bowel sounds q8h, abdomen for pain, swelling, anorexia -Labs: AST, ALT, Alk Phos -Swallow Caps Whole, Do Not Crush, Cap may be sprinkled over tbsp of applesauce -Administer same time daily, before or with meal -Report severe diarrhea, abdominal pain, black, tarry stools -Diabetic patient needs to know hypoglycemia may occur -Avoid alcohol, salicylates, NSAIDs, may cause GI irritation -BBW: Breast / Endometrial Cancer, Thromboembolic Disorders, MI, Stroke -BBW: Cardiac Disease, Dementia -If diabetic, hyperglycemia may occur -Daily Weights -Labs: AST, ALT, Bilirubin, Alk Phos -Use lowest effective dose -IM injection deep in large muscle mass -Teach patient to report breast lumps, vaginal bleeding, edema, jaundice, dark urine, clay colored stools, dyspnea, headache, blurred vision, abdominal pain, numbness or stiffness in legs, chest pain, tenderness, redness, and swelling in extremities; male to report impotence or gynecomastia; dermal rash with transdermal patch -BBW: Endometrial Cancer -BBW: Cardiac Disease, Dementia -Hyperglycemia may occur in diabetic pt -Daily weights -Labs: AST, ALT, Bilirubin, Alk Phos -Use lowest effective dose -Avoid breastfeeding, product excreted in milk -Teach patient to report breast lumps, vaginal bleeding, edema, jaundice, dark urine, clay colored stools, dyspnea, headache, blurred vision, abdominal pain, numbness or stiffness in legs, chest pain, tenderness, redness, and swelling in extremities; male to report impotence or gynecomastia
Drug: Estradiol, Estrace Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Estrogen, Progestin Chemical class: N/A Action: Needed for adequate functioning of female reproductive system; affects release of pituitary gonadotropins, inhibits ovulation, adequate calcium use in bone.
Side-Effects: CNS: Dizziness, Headache, Seizures CV: Hypotension, Thromboembolism, Stroke, Pulmonary Embolism, MI HEMA: N/A INTEG: Rash, Urticaria, Acne, Hirsutism GI: N/V/D, anorexia, pancreatitis, cholestatic jaundice, hepatic adenoma GU: Amenorrhea, Increased risk of breast cancer, endometrial cancer, toxic shock, vaginal wall ulceration EENT: Contact lenses intolerance Contraindications: Pregnancy (X), Breastfeeding, Reproductive Cancer, Genital Bleeding Side-Effects: CNS: Dizziness, Headache, Seizures CV: Thromboembolism, Stroke, Pulmonary Embolism, MI HEMA: N/A INTEG: Rash, Urticaria, Acne, Hirsutism GI: N/V/D, Cholestatic Jaundice, Hepatic Adenoma GU: Gynecomastia, Testicular Atrophy, Impotence EENT: Contact Lense Intolerance Contraindications: Pregnancy X, Breastfeeding, Thromboembolic Disorders, Reproductive Cancer, Genital Bleeding, Hypersensitivity
Drug: Estrogen, Conjugated; Cenestin Dose:
Functional class: Estrogen, Hormone Chemical class: N/A
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Needed for adequate functioning of female reproductive system; affects release of pituitary gonadotropins, inhibits ovulation, adequate calcium use in bone
Drug: Eszopiclone, Lunesta Dose:
Functional class: Sedative/Hypnotic, Nonbenzodiazepine Chemical class: Cyclopyrrolone
Side-Effects: CNS: Worsening Depression, Suicidal Thoughts/Actions, Hallucinations CV: Peripheral Edema, Chest Pain HEMA: N/A INTEG: Rash, Angioedema GI: Dry Mouth, Bitter Taste GU:Gynecomastia, Dysmenorrhea EENT: N/A Contraindications: Ethanol Intoxication
-Assess sleep patterns during therapy -Do not break, chew, or crush tab -Administer immediately before bedtime -Avoid use with a high fat meal -Daytime drowsiness may occur
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Interacts with GABA receptors
Drug: Etanercept, Enbrel Dose:
Functional class: Antirheumatic Agent (Disease Modifying) (DMARDs) Chemical class: Anti-TNF Agent
Side-Effects: CNS: Headache, asthenia, dizziness CV: N/A HEMA: Pancytopenia, anemia, thrombocytopenia, leukopenia, neutropenia INTEG: Rash, Inj Site Reaction GI: Abdominal Pain, Dyspepsia, Vomiting GU: N/A EENT: N/A SYST: Serious Infections, Sepsis, Death, Malignancies Contraindications: Sepsis, Active Infections
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Binds tumor necrosis factor (TNF), which is involved in immune and inflammatory reactions
-BBW: Hypersensitivity to this product, latex, benzyl alcohol -BBW: Infection -Do not give with vaccines, immunizations brought up to date before treatment -Avoid use with anakinra, cyclophosphamide -Administer after reconstituting 1mL of supplied diluents, slowly inject into vial, swirl contents, do not shake, sol should be clear/colorless, do not use if cloudy or discolored -Inject SUBCUT into upper arm, abdomen, or thigh, rotate sites -Tell patient not to receive live vaccinations during therapy -Labs: ALT, AST, Bilirubin, Hct, Hgb -C&S, including sputum before treatment -Administer with meals to decrease GI symptoms -Take antiemetic if vomiting occurs -Take 2 hr before antacids -Teach patient to avoid alcohol
Drug: Ethambutol, Myambutol Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antitubercular Chemical class: Diisopropylethylene Action: Inhibits RNA synthesis, decreases tubercle bacilli replication
Side-Effects: CNS: Headache, Confusion, Disorientation, fever CV: N/A HEMA: N/A INTEG: Toxic epidermal necrolysis GI: Abdominal Distress, Anorexia, Nausea, Vomiting GU: N/A EENT: Blurred vision, optic neuritis Contraindications: Children <13 yr, Optic Neuritis
Drug: Etidronate, Didronel Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Bone resorption inhibitor Chemical class: Bisphosphonate Action : Decreases bone resorption and new bone development (accretion)
Side-Effects: CNS: Headache CV: Atrial Fibrillation HEMA: N/A INTEG: N/A GI: Nausea, Constipation, Diarrhea GU: Nephrotoxicity EENT: N/A MISC: Stevens-Johnson Syndrome, Angioedema MS: Bone Pain, Hypocalcemia Contraindications: Clinically overt osteomalacia
-Assess I&O, dental health -Labs: BUN, Creatinine, Phosphate Calcium, Alk Phos -Diet should include sources for Vit D -PO route on empty stomach with water 2 hr before meals; avoid simultaneous vitamins/minerals/antacids with calcium, iron, magnesium, or aluminum -Therapeutic Response may take 1-3 months -Teach patient to report sudden onset of unexplained pain, restricted mobility, heat over bone; hypercalcemic relapse
Drug: Etoposide, Toposar Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic-misc Chemical class: Semisynthetic podophyllotoxin Action: Inhibits mitotic activity through metaphase to mitosis; also inhibits cells from entering mitosis, depresses DNA, RNA synthesis, cell cycle specific S and G2; binds to complex of DNA and topoisomerase II
Side-Effects: CNS: Headache, Fever, Confusion CV: Hypotension, MI, Dysrhythmias HEMA: Thrombocytopenia, Leukopenia, Myelosuppression, Anemia INTEG: Rash, Alopecia, Stevens-Johnson syndrome GI: N/V/D, anorexia, hepatotoxicity GU: Nephrotoxicity EENT: Brochospasm Contraindications: Pregnancy D, Breastfeeding, Severe Renal/Hepatic Disease Side-Effects: CNS: Headache, Insomnia, Seizures, Stroke, Amnesia, Anxiety CV: Atrial fibrillation, HTN, MI HEMA: Hemolytic anemia, neutropenia, thrombocytopenia, anemia INTEG: Rash, Angioedema, StevensJohnson Syndrome GI: N/V/D, Anorexia, hematemesis GU: Renal Failure EENT: Blurred Vision Contraindications: Breastfeeding
Drug: Etravirine, Intelence Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiretroviral Chemical class: Nonnucleoside reverse transcriptase inhibitor (NNRTI) Action: Binds directly to reverse transcriptase blocking the RNA- and DNA- dependent DNA polymerase action causing a disruption of the enzymes catalytic site
-BBW: Bone marrow depression, infection, bleeding -Labs: CBC, BUN, Serum Uric Acid, Urine CCr, Electrolytes -Monitor I&O, report fall in output <30mL -Monitor temp q4h -Take B/P q15min during infusion; if systolic <90 mm Hg, discontinue -Administer antiemetic 30 60 min before giving product and prn to prevent vomiting -Increase fluid intake to 2-3 L/day -Low pruine diet -Nutritious Diet with iron, vitamin supplements -Assess for fatal hypersensitivity reactions: fever, rash, nausea, vomiting, fatigue, cough, dyspnea, diarrhea, abdominal discomfort; treatment should be discontinued and not restarted -Labs: BUN, Serum Uric Acid, CCr, Bilirubin, AST, ALT, amylase, alk phos, creatinine phosphokinase, creatinine, Cholesterol and Lipid Profile -Administer in combo with other antiretroviral with food -Teach that product is not cure but will control symp, pt is still infective -Take medication following a meal -Use contraception during use
Drug: Everolimus, Afinitor Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic-Misc Chemical class: Immunosupressant, Macrolide Action: Proliferation signal inhibitor that inhibits mammalian target of rapamycin (mTOR). This pathway is dysregulated in cancer
Side-Effects: CNS: Headache, Insomnia, Paresthesia CV: HTN, CHF, Peripheral Edema HEMA: Anemia, Leukopenia, Thrombocytopenia INTEG: Rash, Acne GI: N/V/D GU: Renal Failure EENT: Blurred Vision, Photophobia Contraindications: Breastfeeding, Hypersensitivity to rapamine, torisel
Drug: Exemestane, Aromasin Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic Chemical class: Aromatase Inhibitor Action: Lowers serum estradiol concentrations; many breast cancers have estrogen receptors
Side-Effects: CNS: Headache, depression, insomnia, anxiety, fatigue, hot flashes CV: Hypertension HEMA: Lymphopenia INTEG: N/A GI: N/V/D, Constipation, abdominal pain GU: N/A EENT: N/A Contraindications: Pregnancy D, Breastfeeding, Premenopausal women
-Assess lipid profile, a lipid lowering agent may be needed -Blood studies: Hgb, WBC, Platelets during tx q mo; if leukocytes <3000 or platelets <100,000, product should be discontinued or reduced -Labs: Alk Phos, AST, ALT, Amylase, Bilirubin -Administer tabs whole with full glass of water -Administer at same time each day -Advise pt to avoid crowds, persons with unknown infection are risks -Do not use with grapefruit juice -Avoid vaccines -Product may decrease fertility -Administer with meals at same time each day -Provide nutritious diet iron, vitamin supplements; Liquid diet if needed -Teach patient hot flashes are reversible after treatment ends -Teach to use reliable contraception and not to breastfeed -Take Vitamin D, Calcium for bone loss
Drug: Exenatide, Byetta Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antidiabetic Chemical class: Incretin Mimetic Action: Binds and activates known human GLP-1 receptor, mimics natural physiology for self-regulating glycemic control
Side-Effects: CNS: Headache, Dizziness, Feeling jittery, restlessness, weakness CV:N/A HEMA: N/A INTEG: N/A GI: N/V/D, Dyspepsia, anorexia, GERD, weight loss GU:N/A EENT: N/A Contraindications: N/A
-Precautions in geriatric patients, severe renal/hepatic/GI disease -May increase the effect of acetaminophen -Do not use with erythromycin, metoclopramide -Assess fasting blood glucose A1c levels,postprandial glucose during tx to determine diabetes control -Administer SUBCUT only -Administer 1 hour prior to meals -Teach patients s/s of hypo/hyperglycemia and how to correct each.
Drug: Ezetimide, Zetia Dose:
Functional class: Antilipemic; Cholesterol Absorption Inhibitor Chemical class: N/A
Side-Effects: CNS: Fatigue, Dizziness, Headache CV:N/A HEMA: N/A INTEG: N/A GI: Diarrhea, Abdominal Pain GU: N/A EENT: N/A MS:Myalgias, Arthralgias, Back Pain Contraindications: Severe Hepatic Disease Side-Effects: CNS: HA, fatigue, dizziness, fever INTEG: Pruritus GI: N/V/C/D, abdominal pain GU: Decreased sperm count RESP: Pharyngitis, sinusitis Contraindications: hypersensitivity to penciclovir, acyclovir, ganciclovir, valacyclovir, valganciclovir Side-Effects: CNS: HA, dizziness, anxiety, insomnia, seizures in renal disease CV: Dysrhythmias HEMA: Thrombocytopenia, aplastic anemia INTEG: Rash, toxic epidermal necrolysis GI: N/V/C, anorexia, cramps EENT: Taste change, tinnitus, orbital edema Contraindications: hypersensitivity
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Inhibits absorption of cholesterol by the small intestine
-Precautions in Pregnancy C, breastfeeding, children, hepatic disease -Labs: Lipid levels, LFTs baseline and CPK if muscle pain present -Teach patient that risk factors should be decreased: high-fat diet, smoking, alcohol consumption, absence of exercise -Notify HCP if unexplained weakness or muscle pain is present
Drug: Famciclovir Dose:
Chemical class: Route (Give timing for IV push/IVPB meds): Guanosine nucleoside Frequency: Rationale for client: Action: Inhibits DNA polymerase and viral DNA synthesis by conversion of this guanosine nucleotide to penciclovir
Assess: - Renal studies before and during treatment - Bowel pattern Administer: - With or w/o meals
Drug: Famotidine Dose:
Functional class: H2 histamine receptor antagonist
Assess: - Blood counts during therapy - For occult blood in emesis or stools Administer: - Antacids 1 hr before or 2 hr after giving famotidine Teach pt: - Not to double dose - Avoid alcohol and smoking - Drowsiness may occur
Chemical Class: Route (Give timing for IV push/IVPB meds): N/A Frequency: Rationale for client: Action: Competitively inhibits histamine at histamine H2 receptor site, decreasing gastric secretion while pepsin remains at a stable level
Drug: fat emulsions Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Increase calorie intake, fatty acid deficiency, prevention
Functional class: Caloric Chemical class: Fatty acid, long chain; nutritional suplement Action: Needed for energy , heat production; consist of neutral triglycerides, primarily unsaturated fatty acids
Side-Effects: CNS: Dizziness, HA, drowsiness, focal seizures CV: Shock HEMA: hyperlipemia, hypercoagulation, thrombocytopenia, leukopenia, leukocytosis GI: nausea, vomiting, hepatomegaly Contraindications: hypersensitivity to this product, eggs, soybeans, legumes; hyperlipidemia, lipid necrosis, acute pancreatitis, renal insufficiency
Assess: -triglycerides, free fatty acid levels, platelet counts -Hepatic studies -nutritional studies -Change tubing after every infusion
Drug: febuxostat Dose:
Functional class: Antigout drug, antihyperuricemic
Side-Effects: CNS: weakness, flushing CV: MI, atrial fib, atrial flutter, AV block, bradycardia, palpitations, sinus tachycardia, stroke HEMA: thrombocytopenia, anemia, pancytopenia, leukopenia, bone marrow suppression INTEG: rash GI: nausea, vomiting, anorexia, constipation, dyspepsia, weight gain/loss, melena, cholecystitis GU: Renal failure, urinary urgency/ frequency/ incontinence, hemateria EENT: retinopathy, cataracts, epistaxis Contraindications: hypersensitivity
Chemical class: Xanthene oxidase Route (Give timing for IV push/IVPB meds): inhibitor Frequency: Rationale for client: chronic gout, hyperuricemia Action: Inhibits the enzyme xanthine oxidase, reducing uric acid synthesis, more selective for xanthine oxidase than allopurinol
Assess: -uric acid levels q2wk (uric acid levels should be 6 mg/dl or less) -CBC, AST, BUN and creat before starting treatment -I&O - may crush and add to food or fluid to prevent GI symptoms Teach pt: -if dose is missed take as soon as remembered, do not double dose -increase fluid intake unless contraindicated -avoid alcohol and caffeine
Drug: felodipine Dose:
Functional class: Antihypertensive, calcium channel blocker, antianginal Chemical class: Dihydropyridine
Side-Effects: CNS: HA, fatigue, drowsiness, dizziness, anxiety, nervousness, insomnia, tinnitus, somnolence, light-headedness CV: dysrhythmias, edema, CHF, hypotension, palpitations, MI, pulmonary edema, tachycardia, syncope, angina, AV block HEMA: Anemia INTEG: rash, pruritus GI: nausea, vomiting, diarrhea, gastric upset, constipation, dry mouth GU: nocturia, polyuria Contraindications: sick sinus syndrome, 2nd or 3rd degree heat block, hypotension <90 mm Hg systolic
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: essential HTN, angina pectoris, Action: Inhibits calcium ion influx across cell membrane, resulting in inhibition of excitation/ contraction
Assess: -I&O and weight daily -BP, pulse, respirations, ECG periodically -Administer once daily w/o regards to meals FOR OVERDOSE: atropine for AV block, vasopressor for hypotension Teach Pt: -avoid hazardous activities until stabilized on product -avoid alcohol and limit caffeine intake -to report dyspnea, palpitations, irregular heartbeat, swelling of extremities -to change positions slowly to prevent orthostatic hypotension
Drug: fenofibrate Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Hypercholesterolemia, hyperlipidemia that does not respond to other treatment
Functional class: Antilipemic Chemical class: Fibric acid derivative Action: Increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase, resulting in triglyceride change in size and composition of LDL leading to rapid breakdown of LDL
Side-Effects: CNS: fatigue, weakness, drowsiness, dizziness, insomnia, depression, vertigo CV: angina, dysrhythmias, HTN, HEMA: anemia, leukopenia, ecchymosis, thrombosis/pulmonary embolism INTEG: rash, urticaria, pruritus GI: Nausea, vomiting, dyspepsia, flatulence, hepatomegaly, gastritis GU: dysuria, proteinuria, oliguria, urinary frequency Contraindications: severe renal/hepatic disease, primary biliary cirrhosis, preexisting gallbladder disease
Assess: -lipid levels, CBC, Hct, Hgb -Administer w/ meals Teach pt: -to report GU symptoms -notify prescriber of muscle pain, weakness, fever, fatigue, epigastric pain -compliance is needed
Drug: fenofibric acid Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: hypertriglyceridemia
Functional class: Antilipemic Chemical class: Fibric acid derivative Action: an active metabolite of fenofibrate; increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase, resulting in triglyceride change in size and composition of LDL leading to rapid breakdown of LDL
Side-Effects: CNS: fatigue, weakness, drowsiness, dizziness, insomnia, depression, vertigo, HA CV: HTN HEMA: anemia, leukopenia, thrombosis/pulmonary embolism INTEG: Rash, urticaria, pruritus GI: nausea, vomiting, dyspepsia, abdominal pain, cholecystitis, constipation, hepatitis, jaundice, pancreatitis GU: impotence, decreased libido EENT: blurred vision Contraindications: severe renal/hepatic disease, pre existing gallbladder disease
Assess: -lipid levels, CBC, CPK, serum bilirubin -Administer w/ meals Teach pt: -compliance is needed
Drug: fentanyl Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: anesthesia as premed, conscious sedation
Functional class: opioid analgesic Chemical class: synthetic phenylpiperidine Action: inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception by binding to opiate receptors
Side-Effects: CNS: dizziness, delirium, euphoria, sedation CV: bradycardia, arrest, hypo/hyperTN INTEG: rash, diaphoresis GI: nausea, vomiting, constipation GU: urinary retention EENT: blurred vision, miosis Contraindications: hypersensitivity to opiates, myasthenia gravis
Drug: fesoterodine Dose:
Functional class: overactive bladder product
Side-Effects: CNS: CV: chest pain, QT prolongation HEMA: INTEG: Rash GI: nausea, vomiting, ab pain, constipation, dry mouth GU: dysuria, urinary retention EENT: Contraindications: GI obstruction, ileus, pyloric stenosis, urinary retention, gastric retention
Chemical class: Route (Give timing for IV push/IVPB meds): Muscarinic receptor antagonist Frequency: Rationale for client: Overactive bladder, urinary incontinence Action: relaxes smooth muscles in urinary tract by inhibiting acetylcholine at postganglionic sites
Assess: -VS -drug history -hepatic and renal function tests -allergic reactions -Respiratory dysfunction -Administer slowly to prevent rigidity -ensure safety (side rails, night-light, call bell in reach) Teach pt: -cough, turn and deep breath -safety measures (call for help) Black Box: children, accidental exposure, fever, ambient temp increase, fever, respiratory depression Assess: Urinary patterns Teach Pt: -Not to drink liquids before bedtime -Importance of bladder training
Drug: Flavocoxid Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: dietary management of osteoarthritis
Functional class: analgesic, nonopioid Chemical class: flavanoid Action: exhibits anti-inflammatory, analgesic properties, thought to be due to inhibition of prostaglandin synthesis via inhibition of cyclooxygenase
Side-Effects: CNS: CV: HEMA: INTEG: GI: GU: EENT: Contraindications: hypersensitivity
Assess: -pain -administer 1 hr before or after meals to increase absorption
Drug: fexofenadine Dose:
Functional class: Antihistamine 2nd generation
Side-Effects: CNS: HA, stimulation, drowsiness, fatigue, confusion, tinnitus, restlessness, tremors CV: Hypotension, palpitations, bradycardia, tachycardia, dysrhythmias HEMA: hemolytic anemia, thrombocytopenia, leukopenia, agranulocytosis, pancytopenia INTEG: rash, eczema, photosensitivity, urticaria GI: nausea, diarrhea, ab pain, vomiting, constipation GU: frequency, dysuria, urinary retention, impotence EENT: Contraindications: Breastfeeding, severe hepatic disease Side-Effects: CNS: HA CV: HEMA: INTEG: stevens-johnson syndrome GI: nausea, vomiting, diarrhea, cramping, flatus, increased AST, ALT, hepatotoxicity GU: EENT: Contraindications: hypersensitivity to this product or azoles
Chemical class: piperidine, peripherally Route (Give timing for IV push/IVPB meds): selective Frequency: Rationale for client: Rhinitis, allergy symptoms, chronic idiopathic urticaria Action: acts on blood vessels, GI, respiratory system by competing with histamine for H1 receptor site; decreases allergic response by blocking pharmacologic effects of histamine, less sedating
Assess: -I & O ratio -allergies -respiratory status -administer with food or milk to decrease GI symptoms Teach Pt: -avoid driving if drowsiness occurs -avoid alcohol -do not exceed recommended dose
Drug: Fluconazole Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: oral candidiasis, vaginal, urinary candidiasis
Functional class: antifungal, systemic Chemical class: triazole derivative Action: inhibits ergosterol biosynthesis, causes direct damage to fungal membrane phospholipids
Assess: -for infection -obtain C & S Teach pt: -long term therapy may be needed -may be taken w/ food to reduce GI effects -use alternative method of contraception while taking this product
Drug: Fludrocortisone / Dose: 50-100mcg/day Route : PO Frequency: Daily Rationale for client: Adrenal insufficiency, salt-losing adrenogenital syndrome, Addisons disease. Drug: flumazenil / Romazicon
Functional class: Corticosteroid synthetic Chemical class: mineralocorticoid Action: Promotes reabsorption sodium and loss of potassium, water, hydrogen from distal renal tubules.
Functional class: Antidote: Benzodiazepine receptor antagonist Dose: 0.2mg Chemical class: Imidazobenzodiazepine Route (Give timing for IV push/IVPB meds): derivative. IV over 15sec, repeat ever 45 sec. up to 1mg/5min Action: Antagonizes actions of benzodiazepines on CNS, competitively Frequency: PRN inhibits activity at benzodiazepine Rationale for client: Reversal of sedative reorganization site on effect. GABA/benzodiazepine receptor complex. Drug: fluorouracil / Carac Dose: MAX 1g/wk Route (Give timing for IV push/IVPB meds):Topical IV 12mg/kg/day not exceed 800mg/day Frequency: QD X 4D Rationale for client: Systemic Ca, Skin Ca Topically Drug: fluoxetine / Prozac Dose: 60mg MAX 80mg/day Route : PO Frequency: daily Rationale for client: Depression Functional class: antidepressant (SSRI) Chemical class: Action: Inhibits CNS neuron uptake of serotonin but not norepinephrine Functional class: Antineoplastic, antimetabolite Chemical class: Pyrimidine analog Action: Inhibits DNA, RNA synthesis
Side-Effects: CNS: Seizures, flushing, sweating, headache, dizziness CV: Circulatory collapse, thrombophlebitis, embolism, CHF, hypotension, edema Hema: Hypokalemia Misc.: Anaphylaxis Contraindications: Acute glomerulonephritis, amebiasis, psychosis, Cushings Disease, fungal infections Side-Effects: CNS: Seizures CV: Dysrhythmias, Integ: Pain inj site. GI: N/V Contraindications:
Asses Daily Weights. I&O ratio. VS: B/P, Pulse Q4HR. CBC, Electrolytes. Titrate dose for lowest possible dose.
Assess Cardiac status. Seizures, Side-lying to prevent aspiration in case of N/V. Allergic reaction. Check airway, IV access large bore needle.
Side-Effects: Hema: Thrombocytopenia, leukopenia, myleosuppression, anemia, agranulocytosis. Integ: Rash GI: Hemorrhage, anorexia, stomatitis, Contraindications: Poor nutritional status, serious infections, Pregnancy(X). Surgery within 1 month.
Assess CBC/diff. Platelet count, Renal studies, Hepatic studies. Bleeding. Administer antiemetic 30-60min before. Wear gloves when applying topical cover with loose dressing.
Side-Effects: CNS: Seizures, suicidal ideation, neuroleptic malignant syndrome like reactions, H/A, drowsiness, fatigue, tremors, agitation. CV: Hemorrhage, tachycardia, bradycardia, MI, thrombophlebitis Hema: Integ: Sweating, rash, pruritus GI: N/V/D GU: Urinary frequency UTI, decreased libido Resp: infection, sinus headache, sinusitis Contraindications:
Assess Mental status, appetite, Orthostatic B/P, Blood studies, CBC/diff, Hepatic studies, Renal studies, Weight Q/WK. ECG flattened T wave, bundle branch, AV blocks. Alcohol consumption wit hold dose.
Drug: fluphenazine / decanoate Dose: 12.5-100mg Route :IM./SubCut/PO Frequency: daily Rationale for client: Psychotic Do, schizophrenia.
Functional class: Antipsychotic Chemical class: Phenothiazine, piperazine Action: Depresses cerebral cortex, hypothalamus, limbic system, which control activity and aggression, blocks neurotransmission produced by DOPamine at synapse, exhibits strong alpha-adrenergic and anticholinergic blocking action, mechanism of antipsychotic is unclear.
Side-Effects: CNS: Seizures, neuroleptic malignant syndrome, dystonia, tardive dyskinesia, drowsiness CV: Cardiac arrest, tachycardia, Orthostatic Hypotension, Hema: Leukopenia, leukocytosis, agranulocytosis, aplastic anemia, thrombocytopenia. Integ: Rash GI: Paralytic Ileus, hepatitis, dry mouth, N/V/D constipation, anorexia. Resp: respiratory depression, laryngospasm Contraindications: Side-Effects: CNS:lethargy,drowsiness,daytime sedation,dizziness,confusion,lightheadedn ess,headache,anxiety,irritability CV:chest pain,pulse changes,palpitations HEMA: INTEG: GI:nausea,vomiting,diarrhea,heartburn,ab dominal pain,constipation GU: EENT: Contraindications:pregnancy(X),breastfee ding,intermittent porphyyria,uncontrolled pain,sleep apnea
Asses swallowing medication. I&O ratio, Bilirubin, CBC, LFT monthly. UA before and during. Affect LOC orientation, reflexes. Orthostatic B/P. Dizziness on rising. Use 21ga or larger due to viscosity. Over Dose: Lavage orally. Provide airway, Do not induce vomiting.
Drug:flurazepam Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:sedative/hypnotic Chemical class:benzodiazepine,longacting Action:produces CNS depression at the limbic,thalamic,hypothalamic levels of CNS;may be mediated by neurotransmitter aminobutyric acid(GABA);results are sedation,hypnosis,skeletal muscle relaxation,anticonvulsant activity,anxiolytic action
Use caution in children under age 15. And those with renal/hepatic disease or suicidal tendencies or a history of drug abuse. Monitor mental status and sleep patterns. May see withdrawl symptoms if abruptly stopped.
Drug:flutamide Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:antineoplastic,hormone Chemical class:antiandrogen Action:interferes with androgen uptake in the nucleus or androgen activity in target tissues;arrests tumor growth in androgensensitive tissue
Side-Effects: CNS:hot flashes,drowsiness,confusion,depression,a nxiety,paresthesia CV: HEMA:leucopenia,thrombocytopenia,hem olytic anemia INTEG:irritation at site,rash,photosensitivity GI:diarrhea,nausea,comiting,increased levels in hepatic studies,hepatits,anorexia,hepatotoxicity GU:decreased libido,impotence,gynecomastia EENT: Contraindications: Pregnancy(D),hypersensitivity
Monitor hepatic studies. And monitor size of tumor and the spread of the cancer. Teach to report clay colored stools and dark urine for signs of hepatotoxicity.
Drug:fluticasone(Flovent) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:corticosteriods,inhalation Chemical class:antiasthmatic Action:decreases inflammation by inhibiting mast cells,macrophages,and leukotrienes;anti-inflammatory,and vasoconstrictor properties
Side-Effects: CNS:fever,headache,nervousness,dizzines s,migranes,numbness in fingers CV: HEMA: INTEG:urticaria,dermatitis GI:diarrhea,abdominal pain,nausea,vomiting,oral candidiasis,gastroenteritis GU:UTI EENT:pharyngitis,sinusitis,rhinitis,largyn gitis,hoarseness,dry eyes,cataracts,nasal discharge,epistaxis Contraindications: Primary treatment in status asthmasticus
Use with caution in those with active infections. Monitor respiratory status. Teach to avoid smoking and rinse mouth after using inhaled product.Teach to use bronchodilator first and that this is not for acute attacks.
Drug:fluvastatin(Lescol) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:antilipidemic Chemical class:HMG-CoA reductase inhibitor Action:inhibits HMG-CoA reductase enzyme,which reduces cholesterol synthesis
Side-Effects: CNS:Headache,dizziness,insomnia,Lou Gehrigs disease CV: HEMA:thrombocytopenia,hemolytic anemia,leukopenia INTEG:rash,pruritus GI:abdominal pain,cramps,nausea,constipation,diarrhea, dyspepsia,flatus,hepatic dysfunction GU: EENT:Lens opacities Contraindications:Preganacy(X),active hepatic disease
Do not take with grapefruit juice. Teach to report muscle pain/tenderness. Pt. should be on low cholesterol diet and exercise program.
Drug:fluvoxamine(Luvox CR) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:antidepressant SSRI Chemical class: Action:inhibits CNS neuron uptake of serotonin but not of norepinephrine
Side-Effects: CNS:headache,drowsiness,dizziness,seizu res,sleep disorders,insomnia,sucidial ideation,neuroleptic malignant syndrome CV: HEMA: INTEG:rash,sweating GI:nausea,anorexia,constipation,hepatotox icity,vomiting,diarrhea,dry mouth GU:decreased libido,anorgasma EENT: Contraindications:hypersensitivity
Monitor children under age 8 for suicidal ideation! Use precaution in those who have seizures,hepatic/cardiac disease,and geriatric patients. Therapeutic effects may take 2 to 3 weeks to begin. Take with food to decrease Gi upset.
Drug:folic acid(folate) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:vitamin B complex group Chemical class:water soluble vitamin Action:Needed for erythropoiesis;increases RBC,WBC,platelet formation in megaloblastic anemias
Side-Effects: CNS: CV: HEMA: INTEG:flushing GI: GU: EENT: Contraindications:anemias other than megoblastic,macrocytic,vitamin B12 deficiency.
Monitor for signs of weakness and fatigue and increase bran,yeast,dried beans,nuts,fruits,fresh vegetables,asparagus in diet.Urine may turn bright yellow.
Drug:fondaparinux(arixtra) Dose:
Functional class:anticoagulant,antithrombotic
Side-Effects: CNS:fever,confusion,heasdache,dizziness, insomnia CV: HEMA:anemia,minor bleeding,purpura,hematoma,thrombocytop enia,major bleeding,postop hemorrhage INTEG:increased wound drainage,bullous eruption,local reaction-rash,pruritus GI:nausea,vomiting,diarrhea,dyspepsia,co nstipation,increased AST,ALT GU:UTI,urinary retention EENT: Contraindications:hypersensitivity,hemop hilia,leukemia,PUD,hemorrhagic stroke,surgery,bacterial endocarditis
Chemical class:synthetic,selective factor Route (Give timing for IV push/IVPB meds): Xa inhibitor Frequency: Rationale for client: Action:acts by antithrombin III mediated selective inhibition of factor Xa;neutralization of factor Xa interrupts blood coagulation and inhibits thrombin formation;does not inactivate thrombin or affect platelets
Do not use if having a lumbar puncture or spinal/epidural anesthesia. Monitor platelet levels discontinue if below 100,000. Monitor for bleeding gums,black tarry stools and ecchymosis.
Drug:formoterol(Foradil Aerolizer) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:Bronchodilator Chemical class:B-adrenergic agonist Action:Has B1 and B2 action;relaxes bronchial smooth muscle and dilates the trachea and main bronchi by increasing levels of CAMP,which relaxes smooth muscles;causes increased contractility and heart rate by acting on B-receptors in heart Functional class:antiretroviral Chemical class:protease inhibitor Action:A prodrug of amprenavir;inhibits human immunodeficiency virus protease,which prevents maturation of the infectious virus
Side-Effects: CNS:tremors,anxiety,insomnia,HA,dizzin ess,stimulation CV:palpitations,tachycardia,hypertension HEMA: INTEG: GI:nausea,vomiting,xerostomia: GU: EENT: Contraindications: Hypersensitivity,closed angle glaucoma Side-Effects: CNS:HA,fatigue,depression,oral paresthesia CV: HEMA: INTEG:rash,pruritus GI:nausea,diarrhea,vomiting,abdominal pain GU: EENT: Contraindications:hypersensitivity
Do not use if pt has respiratory insufficiency!Monitor cardiac status:HTN,paliptations and tachycardia. Teach to rinse mouth after each use and correct usage of inhaler.
Drug:fosamprenavir(Lexiva) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Monitor for sulfa allergy. Monitor bowel pattern for hydration levels. Administer without regard to food.
Drug:fosaprepitant(Emend) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:antiemetic Chemical class:miscellaneous Action:A selective antagonist of human substance P/neurokinin 1 receptors decreasing emetic reflex,prodrug of aprepitant
Side-Effects: CNS:HA,dizziness,insomnia,anxiety,depr ession,confusion,peripheral neuropathy CV:bradycardia,tachycardia,DVT,hypo/hy pertension HEMA:anemia,thrombocytopenia,neutrop enia INTEG:pruritus,rash,uriticaria,anaphylaxi s GI:diarrhea,constipation,abdominal pain,anorexia,gastritis,increased AST/ALT,nausea,vomiting,heartburn GU:Increased BUN,serum creatinine,protenuria,dysuria EENT: Contraindications:hypersensitivity
Should not be used for continuous control of nausea and vomiting. Give IV over 15 minute infusion. Do not take with grapefruit juice. Monitor hydration status.
Drug:foscarnet(Foscavir) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:antiviral Chemical class:inorganic pyrophosphate organic analog Action:antiviral activity is produced by selective inhibition at the pyrophosphate binding site on virus-specific DNA polymerases and reverse transcriptases at concentractions that do not affect cellular DNA polymerases
Side-Effects: CNS:fever,dizziness,headache,seizures,ne uropathy,tremor,ataxia,dementia CV:HTN,palpitations,ECG abnormalities,!st degree AV block HEMA:anemia,thrombocytopenia,leukope nia,thrombosis,coagulation disorders INTEG:rash,sweating,pruritus,skin ulceration,seborrhea,alopecia,acne GI:nausea,vomiting,diarrhea,anorexia,abd ominal pain,constipation,dysphagia GU:acute renal failure,glomerulonephritis,uremia,hematur ia,albuminuria EENT:visual field defects,vocal cord paralysis,speech disorders Contraindications:hypersensitivity Side-Effects: CNS: insomnia, paresthesia, headache, dizziness CV: hypotension Hema: eosinophilia, leukopenia, neutropenia Integ: angioedema GI: nausea, proteinuria RESP: bronchospasm Contraindications: breastfeeding, children, hypersensitivity to ACE inhibitors
Monitor renal and hepatic studies. Monitor culture before treatment begins. Increase fluids before therapy to decrease risk for renal toxicity.Monitor for infection.
Drug:Monopril (Fosinopril) Functional class: Antihypertensive Dose: 10mg Chemical class: Angiotensin-converting Route (Give timing for IV push/IVPB meds): enzyme inhibitor PO Action: selectively suppresses reninFrequency: once a day angiotensin-aldosterone system; inhibits Rationale for client: ACE; prevents conversion of angiotensin I Hypertension to angiotensin II; results in dilation of arterial, venous vessels
Orthostatic hypotension; can seriously affect renal system, need baseline labs; edema in feet and legs, daily weight in CHF.
Drug:fosphenytoin(Cerebyx) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:anticonvulsant Chemical class:hydantoin,phosphate phenytoin ester Action:inhibits spread of seizure activity in motor cortex by altering ion transport;increases AV conduction,prodrug of phenytoin
Side-Effects: CNS:drowsiness,dizziness,insomnia,parast heis,depression,suicidal tendencies CV:hypo/hypertension,ventricular fibrillation,CHF,shock HEMA:agarnulocytosis,leucopenia,aplasti c anemia,thrombocytopenia INTEG:rash,lupus erythematosus,stevenjohnson syndrome,hirustism GI:nausea,vomiting,diarrhea,constipation, anorexia,weight loss,hepatitis.jaundice GU: EENT:nystagmus,diplopia,blurred vision Contraindications:pregnancy(D),hypersen sitivity,psychiatric conditions,bradycardia,SA and AV block,absence seizures
Monitor mental and respiratory status. Monitor for bleeding and bruising and slurred speech.
Drug:frovatriptan(Frova) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:antimigraine agent Chemical class:5-HT1-receptor agonist Action:Binds selectively to the vascular 5 HT1b,5HT1D receptor subtypes,exerts antimigraine effect;binds to benzodiazepine receptor sites,causes vasoconstriction in cranium
Side-Effects: CNS:hot/cold sensation,paresthesia,dizziness,headache,f atigue,insomnia,anxiety,seizures CV:flushing,chest pain,paliptaion HEMA: INTEG: GI:dry mouth,dyspespsia,abdominal pain,diarrhea,vomiting,nausea GU: EENT: Contraindications:hypersensitivity,angina pectoris,hx of MI,silent ischemia,IBD,PVD,severe hepatic disease.
Use caution in post menopausal women and men over age 40. And those with hepatic disorders. Monitor diet for ingestion of tyraminecontaineing foods(beer,artificial sweetners). Provide a quiet,calm,environment with decreased stimulation.
Drug:fulvestrant(Faslodex) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class:antineoplastic Chemical class:estrogen-receptor antagonist Action:inhibits cell division by binding to cytoplasmic estrogen receptors,downregulates estrogen receptors
Side-Effects: CNS:HA,depression,dizziness,insomnia,p aresthesia,anxiety CV: HEMA:Anemia INTEG:rash,sweating,hot flashes,inj,site pain GI:nausea,vomiting,anorexia,constipation, diarrhea,abdominal pain GU: EENT: Contraindications:pregnancy(d),hypersens itivity,children Side-Effects: CNS:HA,fatigue,weakness,vertigo,paresth esias CV: chest pain,orthostatic hypotension Hema: thrombocytopenia,agranulocytosis,leukop enia,neutropenia,anemia Integ: rash, pruritis,purpura GI: nausea,diarrhea,vomiting,dry mouth,cramps,anorexia GU: polyuria, renal failure,glycosuria EENT: loss of hearing,ear pain,tinnitus,blurred vision Contraindications: hypersensitivity to sulfonamides, anuria, Hypovolemia, electrolyte depletion Side-Effects: CNS: Drowsiness, confusion, anxiety, unsteady gait, suicidal ideation, seizures CV: Vasodilatation, peripheral edema, hypotension HEMA: Leukopenia, decreased WBC INTEG: Pruritus, Steven Johnson syndrome GI: Constipation, increased appetite, dental abnormalities, N&V GU: Impotence, bleeding, UTI EENT: Dry mouth, blurred vision, diplopia, nystagmus Contraindications: Hypersensitivity
Liquid diet may be added if pt does not become nauseated. Increased diet with iron and vitamin supplements as needed. Teach to report vaginal bleeding and bone pain. Encourage use of oral contraceptives.
Drug: Furosemide, Lasix Dose:20mg Route:PO Frequency: daily Rationale for client: hypertension
Functional Class: Loop diuretic Chemical Class: Sulfonamide derivative Action: increases the urinary excretion of sodium, chloride, and water by inhibiting the reabsorption of sodium and chloride in the proximal and distal tubule and in the loop of Henle
Signs of metabolic alkalosis(drowsiness,restlessness) hypokalemia,assess for orthostatic hypotension Monitor for allergies to sulfonamides,thiazides
Drug: gabapentin Neurontin Dose:
Functional class: Anticonvulsant Chemical class:
-Assess LOC - Give hard candy for dry mouth - Give 2 hrs apart when giving antacid -Assistance when ambulating -Increase fluids in diet for constipation
Route (Give timing for IV push/IVPB meds): PO Action: Mechanism unknown; may increase seizure threshold; structurally Frequency: similar to GABA. Rationale for client: Seizures
Drug: galantamine Razadyne Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Anti-Alzheimer Agent Chemical class: Centrally acting Cholinesterase inhibitor Action: Enhances cholinergic functioning by increasing acetylcholine in cerebral cortex.
Side-Effects: CNS: Tremors, insomnia, depression, dizziness, HA, fatigue CV: Bradycardia, chest pain HEMA: Anemia INTEG: GI: N&V, anorexia, abdominal distress, flatulence, diarrhea GU: Urinary incontinence, bladder outflow obstruction, hematuria EENT: Contraindications: GI bleeding, jaundice, renal failure, breastfeeding, children
-Assess BP, HR,RR during initial treatment -Take with meals -Assistance with ambulation -Check LOC
Drug: gallium Ganite Dose:
Functional class: Electrolyte modifier Chemical class: Hypocalcemic product
Side-Effects: CNS: Confusion, hallucinations, vivid dreams, encephalopathy, lethargy CV: Tacycardia, hypotension HEMA: Anemia, leukopenia, thrombocytopenia INTEG: GI: N&V, diarrhea, constipation, mucositis, metallic taste GU: Nephrotoxicity, increased BUN, creatinine EENT: Blurred vision, hearing loss Contraindications: hypocalcemia
-Monitor electrolytes -I & O -Perform Chovstek or Trousseaus sign - Avoid calcium & vit D
Route (Give timing for IV push/IVPB meds): IV Action: Lowers serum calcium levels by inhibiting calcium resorption from bone. Frequency: Rationale for client: Cancer related hypocalcemia
Drug: ganciclovir Cytovene Dose:
Side-Effects: CNS: Fever, chills, coma, confusion, bizzare dreams, tremors, seizures, paresthesia, weakness, peripheral neuropathy, headache CV: Dysrhythmia, hypo/hypertension HEMA: Granulocytopenia, thrombocytopenia, neutropenia INTEG: Rash, alopecia, pruritus, phlebitis GI: Abnormal LFTs, N&V, anorexia, abdominal pain, hemorrhage, pancreatitis GU: Hematuria, Increased BUN, creatinine EENT: Ocular pain, cataracts Contraindications: hypersensitivity to acyclovir
Chemical class: Synthetic nucleoside Route (Give timing for IV push/IVPB meds): analog PO or IV Frequency: Rationale for client: Action: Inhibits replication of herpes viruses, competitively inhibits human CMV DNA polymerase and is incorporated resulting in termination of DNA elongation.
-Use contraception during treatment - Monitor for infection by checking temp -Have pt avoid people with respiratory infections
Drug: gefitinib Iressa Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic Chemical class: Epidermal growth factor receptor inhibitor Action: Not fully understood; inhibits intracellular phosphorylation of cell surface receptors associated with epidermal growth factor receptors.
Side-Effects: CNS: CV: HEMA: Cough, dyspnea, Interstitial lung disease INTEG: Rash, pruritus, acne, dry skin, angioedema GI: N&V, pancreatitis, mouth ulceration, diarrhea, anorexia GU: EENT: Amblyopia, conjunctivitis, eye pain Contraindications: Pregnancy D, breastfeeding, children
-Assess lung sounds -Use contraception during treatment -Assess ocular changes
Drug: gemcitabine Gemzar Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic Chemical class: Nucleoside analog Action: Exhibits antitumor activity by killing cells undergoing DNA synthesis and blocking G1/S-phase boundary.
Side-Effects: CNS: CV: HEMA: Leukopenia, anemia, neutropenia, thrombocytopenia INTEG: Rash, alopecia, irritation at site, stomatitis GI: Diarrhea, N&V, anorexia, constipation, stomatitis GU: Proteinuria, hematuria EENT: Contraindications: Pregnancy, breastfeeding
-I&O - Assess skin turgor -Increase fluid intake - Rinse mouth -Diet with iron, low fiber, and few dairy products -Avoid citric foods
Drug: gemfibrozil Lopid Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antilipemic Chemical class: Fibric acid derivative Action: Inhibits biosynthesis of VLDL, decreasing triglycerides, increases HDL
Side-Effects: CNS: fatigue, vertigo, HA, dizziness, somnolence, paresthesia CV: HEMA: Leukopenia, anemia, eosinophilia, thrombocytopenia INTEG: Rash, urticarial, pruritus GI: Dyspepsia, diarrhea, abdominal pain, N&V GU: EENT: Contraindications: Renal/hepatic disease, preexisting gallbladder disease, primary biliary cirrhosis
-Administer 30 min before morning and evening meal -Monitor bowl pattern
Drug: gemifloxacin Factive Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Anti-infective Chemical class: Fluroquinolone Action: Inhibits DNA gyrase, which is an enzyme involved in replication, transcription, and repair of bacterial DNA.
Side-Effects: CNS: Dizziness, HA, depression, insomnia, nervousness, confusion, agitation, seizures CV: QT prolongation, vasodilation HEMA: Thrombocytopenia, neutropenia INTEG: Rash, pruritus, urticaria, photosensitivity GI: Diarrhea, N&V, anorexia, flatulence, heartburn, dry mouth, oral thrush, glossitis, stomatitis, pseudomembranous colitis GU: EENT: Visual distrubances Contraindications: Hypersensitivity
-Assess for tendon pain, discontinue if present -Increase fluids -Avoid iron or antacids -Rinse mouth -Candy or gum for dry mouth
Drug: gemtuzumab Mylotarg Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic Chemical class: Monoclonal antibody Action: Composed of recombinant humanized IgG4 kappa antibody, binds to CD33 antigen that is released in myeloid cells.
Side-Effects: CNS: Dizziness, insomnia, depression CV: Hypo/hypertension, hemorrhage, tachycardia HEMA: Neutropenia, thrombocytopenia INTEG: Rash, herpes simplex, local reaction, petechiae, pruritus GI: Anorexia, diarrhea, constipation, nausea, stomatitis, fatal liver toxicity GU: Hematuria, vaginal hemorrhage EENT: Contraindications: Pregnancy, breastfeeding
-Assess temperature for infection - Assess lung and heart sounds -Teach pt to avoid crowds and immunizations
Drug: gentamicin Cidomycin Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Anti-infective Chemical class: Aminoglycoside Action: Interferes with protein synthesis in bacterial cell by binding to ribosomal subunit, causing misreading of genetic code; inaccurate peptide sequence forms in protein chain, causing bacterial death.
Side-Effects: CNS: Confusion, depression, numbness, tremors, seizures, neurotoxicity, dizziness, vertigo CV: Hypo/hypertension, palpitations, edema HEMA: Agranulocytosis, thrombocytopenia, leukopenia INTEG: Rash, burning, urticaria, dermatitis, alopecia, photosensitivity GI: N&V, anorexia, hepatic necrosis, splenomegaly GU: Oliguria, hematuria, renal damage, azotemia, renal failure EENT: Ototoxicity, deafness, visual disturbances, tinnitus Contraindications: Hypersensitivity to other aminoglycosides, fungal/viral infection
-Weigh before treatment -I&O -Monitor vital signs during infusion -Serum peak draw at 30-60 min after IV inf or 60 mins after IM inj, and trough level drawn just before next dose -Assess 8th cranial nerve for dysfunction by audiometric testing -Assess skin turgor -Assess site for erythema, edema, or abscesses
Drug: glatiramer Copaxone Dose:
Functional class: Multiple sclerosis agent Chemical class:
Side-Effects: CNS: Anxiety, hypertonia, tremor, vertigo, agitation, confusion CV: Migraine, palpitations, syncope, tachycardia, vasodilation, chest pain HEMA: Ecchymosis, lymphadenopathy INTEG: Pruritus, sweating, rash, erythema, site reaction GI: N&V, diarrhea, anorexia, gastroenteritis GU: Urinary urgency, dysmenorrhea, vaginal moniliasis EENT: Ear pain, blurred vision Contraindications: Hypersensitivity to this product or mannitol
-Assess cardiac status -Assess CNS for confusion and anxiety -Subcut route only, using 27 gauge needle, do not shake vial, administer into hip, thigh, or arm.
Route (Give timing for IV push/IVPB meds): Subcut Action: Unknown, may modify the immune responses responsible for Frequency: multiple sclerosis. Rationale for client:
Drug: glimepiride / glipiZIDE Glocotrol Dose: Route (Give timing for IV push/IVPB meds): PO Frequency: Rationale for client:
Functional class: Antidiabetic Chemical class: 2nd generation Sulfonylurea Action: Causes functioning B cells in pancreas to release insulin, leading to drop in blood glucose levels; may improve insulin binding to insulin receptors
Side-Effects: CNS: HA, weakness, drowsiness, tinnitus, vertigo, dizziness CV: HEMA: Leukopenia, thrombocytopenia, aplastic anemia INTEG: Rash, allergic reactions, eczema, photosensitivity, pruritus GI: Hepatotoxicity, jaundice, N&V, diarrhea, heartburn GU: EENT: Contraindications: Type 1 diabetes, diabetic ketoacidosis
-Administer 30 minutes before meals -Assess glucose levels before meals -Assess for hypo/hyperglycemia reaction that can occur after meals Overdose- Glucose 25g IV via dextrose 50% solution 50 ml
Drug: glycopyrrolate Robinul Dose:
Functional class: Cholinergic blocker, antispasmodic
Side-Effects: CNS: Confusion, anxiety, delusions, depressions, seizures, flushing, weakness, lethargy CV: Palpitations, tacycardia HEMA: INTEG: Urticaria, allergic response GI: Dry mouth, constipation, abdominal distress, altered taste perception, paralytic ileus GU: Urinary hesitancy, retention, impotence EENT: Blurred vision, dilated pupils, difficulty swallowing, intraocular pressure Contraindications: Children under 3, glaucoma, GI obstruction, tachycardia, hepatic disease, ulcerative colitis, myocardia ischemia
Chemical class: Quaternary ammonium Route (Give timing for IV push/IVPB meds): compound Frequency: Rationale for client: Action: Inhibits the action of acetylcholine at receptor sites in parasympathetic nervous system, which controls secretions, free acids in stomach.
-I&O -Increase fluids if constipated -Monitor mental status -Keep in bed for at least 1 hour after parenteral dose -Hard candy, frequent drinks, or sugarless gum for dry mouth
Drug: goserelin Zoladex Dose:
Functional class: Gonadotropin releasing hormone, antineoplastic
Side-Effects: CNS: HA, spinal cord compression, anxiety, depression, dizziness, insomnia, lethargy, hot flashes CV: Dysrhythmia, CVA, MI, CHF HEMA: INTEG: Rash, pain at site, diaphoresis GI: N&V, constipation, diarrhea GU: Spotting, decreased libido, UTI EENT: Contraindications: Pregnancy, breastfeeding, non-diagnosed vaginal bleeding
-Pregnancy test prior to treatment -I&O
Chemical class: Synthetic decapeptide Route (Give timing for IV push/IVPB meds): analog of LHRH Frequency: Rationale for client: Action: Inhibitor of pituitary gonadotropin secretion; initially increases LH and FSH, with increases in testosterone, reduction in sex steroid levels
Drug: granisetron Kytril Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiemetic Chemical class: 5-HT3 receptor antagonist Action: Prevents nausea, vomiting by blocking serotonin peripherally, centrally and in the small intestine.
Side-Effects: CNS: HA, asthenia, anxiety, dizziness CV: hypertension HEMA: Leukopenia, thrombocytopenia, anemia INTEG: GI: Diarrhea, constipation, increased AST, ALT GU: EENT: Contraindications: Hypersensitivity to benzyl alcohol
-Assess for absence of nausea, vomiting during chemotherapy -Assess for hypersensitive reaction such as bronchospasm
Drug: guaifenesin Robitussin Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Expectorant Chemical class: Action: Increases the volume and reduces viscosity of secretions in the trachea and bronchi to facilitate secretion removal.
Side-Effects: CNS: Drowsiness, HA, dizziness CV: HEMA: INTEG: GI: N&V, anorexia, diarrhea GU: EENT: Contraindications: Hypersensitivity; chronic, persistent cough
-Assess for cough -Increases fluids to 2L per day
Drug: haloperidol (Haldol) Dose: 0.5-5mg
Functional class: Antipsychotic, neuroleptic Chemical class: Butyrophenone
Route (Give timing for IV push/IVPB meds): PO/IM Frequency: bid-tid (max 100mg/day) Rationale for client: Psychotic disorders, tics, tourettes, schizo, delirium, agitation or hiccups (short term) Action: depresses cerebral cortex, hypothalamus, limbic system, which control activity and aggression; blocks neurotransmission produced by dopamine at synapse
Side-Effects: CNS: pseudoparkinsonism, dystonia, tardive dyskinesia, drowsiness, HA CV: orthostatic hypotension, hypertension RESP: resp depression INTEG: rash GI: dry mouth, N/V, anorexia, constipation GU: urinary retention, dysuria, frequency, enuresis, amenorrhea EENT: blurred vision, dry eye, glaucoma Contraindications: <3 YO, coma, brain damage, bone marrow depression, alcohol or barbs withdrawal, parkinsons, epilepsy, glaucoma or urinary retention Side-Effects: CNS: fever insomnia, dizziness CV: Afib, HTN HEMA: INTEG: rash GI: constipation, nausea, vomiting GU: EENT: META: hypomagnesemia, hypophosphatemia, hypocalcemia Contraindications:
Monitor I&O, affect, LOC and orientation. Monitor respirations q4h during initial treatment. Monitor for orthostatic by performing laying, sitting and standing BP before and after initial treatment.
Drug: ibandronate (Boniva) Dose: Route (Give timing for IV push/IVPB meds): Frequency: QMonth Rationale for client: osteoporosis and prophylaxis
Functional class: bone reabsorption inhibitor Chemical class: bisphoshonate Action: inhibits bone reabsorption without inhibiting bone formation and mineralization
Potential for esophagitis, dysphagia & esophageal ulcers Severe esophageal risk greater in patients who lie down after taking oral bisphosphonates and/or who fail to swallow it with the recommended full glass (6-8 oz) of water Do not continue to take oral bisphosphonates after developing symptoms suggestive of esophageal irritation Food decreases bioavailability Ensure adequate intake of calcium, vitamin D Risk of osteonecrosis of jaw Risk of severe bone, joint &/or muscle pain Possible increased risk for atypical subtrochanteric and diaphyseal femur fractures; consider periodic reevaluation of need for continued bisphosphonate therapy, particularly if treatment >5 years Not recommended in severe renal impairment (CrCl <30 mL/min) Avoid concomitant multivalent cationcontaining drugs or food
Drug: Ibuprofen Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: inflammation, prophlaxis for emboli, pain
Functional class: NSAID Chemical class: propionic acid derivitive Action: inhibits prostaglandin synthesis by decreasing enzyme needed for biosynthesis
Side-Effects: CNS: headache, dizziness CV: MI, stoke, bleeding, bruising HEMA: increased bleed time INTEG: purpura, rash, necrotizing fasciitis GI: NA, anorexia, GI bleed GU: nephrotoxicity EENT: tinnitus Contraindications: bleeding, PUD
Use caution with asthma (bronchial), cardiac disease, CHF, hepatic/renal impairment, HTN Junior Advil (100 mg): higher than recommended dose may cause stomach bleeding Children's and Junior Advil (50 mg and 100 mg) may cause severe and persistent sore throat Fever, rash, abdominal pain, nausea, liver dysfunction and meningitis have occurred in patients with collagen-vascular disease, especially SLE ANTICIPATE ARRHYTHMIAS, have all materials at hand to handle potential lethal arrhythmias for at least 4-6 hr A-Fib >2-3 d duration requires anticoagulation prior to therapy Bradycardia, CHF, electrolyte abnormalities, history of polymorphic VT after antiarrhythmic therapy, liver dz, proarrhythmic events, recent MI, Drugs that prolong the QT interval and other class I or class III antiarrhythmic agents should not be given concurrently with ibutilide (or within 4 hours after infusion), other antiarrhythmics should be withheld prior to conversion with ibutilide (eg, 5 half-lives) Vesicant-avoid extravasation Risk of myocardiac toxicity leading to potentially fatal CHF Prior radiation Tx to mediastinalpericardial area & prior anthracyclines incr cardiotoxic risk Cumulative doses >150 mg/sq.meter associated with decr ejection fraction Possibility of inj site rxns Hepatic/renal impairment Avoid pregnancy
Drug: ibutilide (Corvert) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: rapid conversion of Afib
Functional class: antidysrhythmic Chemical class: Action: prolongs duration of action potential and effective refractory period
Side-Effects: CNS: HA CV: hypotension, brady, sinus, arrest, CHF, dysrhythmias, QT prolongation HEMA: INTEG: GI: nausea GU: EENT: Contraindications: hypersensitivity
Drug: idarubicin (Idamycin) Dose: Route (Give timing for IV push/IVPB meds):
Functional class: antineoplastic Chemical class: anthracycline glycoside Action: non-cell specific
Side-Effects: CNS: seizures, fever, chills CV: CHF, dysrhythmias, MI HEMA: anemia, thrombocytopenia INTEG: rash, extravagation GI: N/V, abdominal pain GU: nephrotoxicity EENT: Contraindications :pregnancy, hypersensitivity
Frequency: Rationale for client: ALL, breast CA, nonhodgkins, CLL, AML
Drug: iloperidone (Fanapt) Dose: Route (Give timing for IV push/IVPB meds):
Functional class: antipsychotic Chemical class: benzisoxazole derivative Action: unknown
Side-Effects: CNS: EPS, tardive dyskinesia, drowsiness CV: heart failure, QT prolongation HEMA: leukopenia, neutrapenia INTEG: rash GI: N/V, anorexia, constipation, abd pain GU: retention, incontinence EENT: Contraindications: breastfeeding
Frequency: Rationale for client: Schizophrenia
Prolongs QT interval; caution with other drugs/conditions that increase QTc Not recommended in hepatic impairment Risk of neuroleptic malignant syndrome and extrapyramidal symptoms Metabolic changes Atypical antipsychotics have been associated with metabolic changes that may increase cardiovascular/cerebrovascular risk including hyperglycemia, dyslipidemia, and body weight gain Increased risk of hyperglycemia and diabetes; in some cases, hyperglycemia concomitant with use of atypical antipsychotics has been associated with ketoacidosis, hyperosmolar coma, or death Monitor blood glucose of high risk patients Possibility of weight gain ANC and platelets, Renal toxicity, Hepatoxicity, CBC/diff wkly, Fluid retention. Monitor breath sounds. Assess for edema. Administer with meals and large glass of water. Decrease GI symptoms 800mg to BID 400mg. Theraputic response. Teach SOB, swelling of extremities, bleding. Reaason for treatment.
Drug: imatinib / Gleevec Dose: 400-800mg
Functional class: AntineoplasticMisc. Chemical class: Protein-tyrosine kinase inhibitor.
Route (Give timing for IV push/IVPB meds): Action: Inhibits Bcr-Abl tyrosine kinase PO created in chronic myeloid leukemia (CML) Frequency: Daily Rationale for client: Cancer treatment Drug: imipenem / cilastatin/ Primaxin IM, Primaxin IV Dose: 250gm/1g Functional class: Anti infectiveMisc. Chemical class: Carapenem
Side-Effects: CNS: CNS hemorrhage CV: Hemorrhage, heart failure, cardiac tamponade, hypereosinophilia cardiac toxicity Hema: Neutropenia, thrombocytopenia, bleeding Integ: rash, pruritus, Contraindications: cardiac/renal/hepatic disease Side-Effects: CNS: Seizures, CV: Hema: Integ: SJS GI: Pseudomembranous colitis, hepatitis, glossitis N/V/D GU: Renal toxicity/Failure Syst: Anaphylaxis Contraindications: AV block, Shock
Action: Interferes with cell wall replication of susceptible organisms. Route (Give timing for IV push/IVPB meds): Gram Positive/Gram Negative IV 30 to 60 min. IM 250to750mg/dilute with 3ml lidocaine Frequency: 3 to 4 times Day Rationale for client: Infection
Monitor bowel patterns during. Allergic reactions. Monitor for infection, T, WBC increase Wound characteristics, Sensitivity to PCN. Renal disease. Anaphylactic precautions during treatment, subsequent doses. Overgrowth of fungal infections. Administer Post C&S. Evaluate therapeutic response. Teach report severe N/V/D Report sore throat.
Drug: Immune Globulin IM/IV/SC Dose: 0.02-600mg Max 800mg/Day
Functional class: immune serum Chemical class: IgG
Action: Provides passive immunity to Hep A, measles, varicella, rubella, immune Route (Give timing for IV push/IVPB meds): globulin deficiency. Contains IgG IV-See Mosby page 606-607 multiple dose antibodies. requirements. Frequency: q3-4wks. Rationale for client: Increase immunity.
Side-Effects: CNS: headache, fatigue, malaise CV: Anaphylaxis Integ: Pain injection site. rash GI: ABD pain. Misc: Arthralgia, chest pain Syst: lymphadenopathy: Contraindications: Coagulopathy, hemophilia, IgA deficiency, thrombocytopenia.
Contagious disease exposure(6 days) Monitor for anaphylaxis. Administer <=3ml in one site. Use large muscle. Only with 1:1000 epinephrine available, resuscitation equip on hand.
Drug: Inamrinone (Inocor) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Short-term management of CHF that has not responded to other medications.
Functional class: Inotropic Chemical class: Bipyrimidine derivative Action: Positive inotropic agent with vasodilator properties; reduces preload and afterload by direct relaxation of vascular smooth muscle, increases cardiac output
Side-Effects: CNS: N/A CV: Dysrhythmias, hypotension, CP HEMA: thrombocytopenia INTEG: Allergic reaction, irritation at site of injection GI: N/V, anorexia, ascites, jaundice, hiccups GU: N/A EENT: N/A Contraindications: Severs aortic disease, acute MI, severe pulmonic valvular disease
Drug: Indapamide (Lozide) Dose:
Functional class: Diuretic-thiazide-like, antihypertensive Chemical class: Iodoline
Side-Effects: CNS: HA, fatigue, weakness, nervousness, agitation CV: Orthostatic hypotension, volume depletion, palpitations, dysrhythmias HEMA: Hypochloremic (<98), hypomagnesium (<1.2), hyperuricemia (>7), hypercalcemia (>10.5), hyponatrium (<135), hypokalemia (<3.5), hyperglycemia (>120), Alkalosis INTEG: Rash, pruritus GI: N/V, diarrhea, dry mouth, anorexia, cramps, constipation, abd. pain GU: Polyuria, nocturia, urinary frequency EENT: Blurred vision, nasal congestion, Increased intraocular pressure. Contraindications: Hypersensitivity to this product or sulfonamides, anuria, hepatic coma.
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Edema of CHF, HTN, diuresis Action: Acots on proximal section of distal renal tubule by inhibiting reabsorption of sodium; may act by direct vasodilation caused by blocking of calcium channels.
Drug: Indinavir (Crixivan) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: HIV-1 in combination with other antiretrovirals
Functional class: Antiretroviral Chemical class: Protease inhibitor Action: Inhibits human immunodeficiency virus (HIV-1) protease; this prevents maturation of the virus.
Side-Effects: CNS: Headache, insomnia, dizziness CV: N/A HEMA: ketoacidosis, insulin-resistant hyperglycemia, hyperlipidemia, lipodystrophy INTEG: Rash GI: Diarrhea, abdominal pain, N/V, anorexia, dry mouth GU: Nephrolithiasis EENT: N/A Contraindications: Breastfeeding
Drug: Indomethacin (Indocin) Dose:
Functional class: Nonsteroidal antiinflammatory product (NSAID), antirheumatic
Side-Effects: CNS: Dizziness, drowsiness, fatigue, tremors, confusion, confusion, insomnia, anxiety, depression, headache CV: Tachycardia, peripheral edema, palpitations, dysrthymias, HTN, MI stroke HEMA: Blood dyscrasias, prolonged bleeding INTEG: Purpura, rash, pruritus, sweating GI: N/V, anorexia, diarrhea, jaundice, cholestatic hepatitis, constipation, flatulence, cramps, dry mouth, peptic ulcer, ulceration, perforation, GI bleeding GU: Nephrotoxicity, dysuria, hematuria, oliguria, azotemia EENT: Tinnitus, hearing loss, blurred vision Contraindications: PUD, preoperative pain in CABG, Stroke, GI bleeding, MI
Route (Give timing for IV push/IVPB meds): Chemical class: Pripionic acid derivative Frequency: Action: Inhibits prostaglandin synthesis Rationale for client: RA, ankylosing by decreasing enzyme needed for spondylitis, osteoarthritis, bursitis, tendinitis, biosynthesis; analgesic, antiacute gouty arthritis, closure of patent ductus inflammatory, antipyretic. arteriorsus in premature infants.
Drug: Infliximab (Ramicade) Dose:
Functional class: Biologic response modifiers
Side-Effects: CNS: Headache, dizziness, depression, vertigo, fatigue, anxiety, fever, seizures, chills, flulike symptoms, demyelinating disease. CV: Chest pain, hyper/hypotension, tachycardia, CHF, acute coronary syndrome HEMA: Anemia, leukopenia, thrombocytopenia, pancytopenia INTEG: Rash, dermatitis, urticarial, dry skin, sweating, flushing, hematoma, pruritus, keratoderma GI: N/V, abdominal pain, stomatitis, constipation, dyspepsia, flatulence GU: Dysuria, urinary frequency EENT: N/A Contraindications: Moderate to severe CHF.
Chemical class: Tumor necrosis factor Route (Give timing for IV push/IVPB meds): modifiers Frequency: Rationale for client: Crohns disease, fistulizing (moderate-severe), RA given with methotrexate, plaque psoriasis, ankylosing spondylitis, ulcerative colitis, psoriasis. Action: monoclonal antibody that neutralizes the activity of tumor necrosis factor alpha found in Crohns disease; decreased infiltration of inflammatory cells.
Drug: Insulin Glulisine (Apidra) Insulin Aspart (Novolog, Novolog Flexpen, Novolog Pen Fill) Insulin Lispro (Humalog) **Rapid Acting** Onset 15-30 minutes Peak 30-90 minutes Duration 3-4 hours Drug: Insulin Regular (Humulin R, Novolin R, Novolin R Prefilled) Insulin, Regular Concentrated (Regular) **Short Acting** Onset 30 minutes Peak 2.5-5 hours Duration Up to 6 hours Drug: Insulin, Isophane Suspension (NPH) (Humulin N, Novolin N, Novolin Prefilled) **Intermediate Acting** Onset 1.5-4 hour Peak 4-12 hours Onset Up to 24 hours Drug: Insulin Detemir (Levemir) Insulin Glargine (Lantus) **Long Acting** Detemir: onset 40 minutes-2 hours Peak unknown Duration Up to 24 hours Glargine: onset 1.5 hours Peak No peak identified Duration 24 hours Ins Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes, insulin lispro may be used in combination with sulfonylureas in children > 3 yr old.
Functional class: Antidiabetic, pancreatic hormone Chemical class: Modified structes of endogenous human insulin Action: Decreased blood glucose by transport of glucose into cells and the conversion of glucose to glycogen, indirectly increases blood pyruvate and lactate, decreases phosphate and potassium; insulin may be human (processed by recombinant DNA technologies) Overdose Treatment: 25 gram D50W IV, or 1mg Glucagon IM
Side-Effects: CNS: CV: HEMA: Hypoglycemia, rebound hyperglycemia INTEG: Flushing, rash, urticarial, warmth, lipodystrophy, swelling, redness GI: GU: EENT: Blurred vision, dry mouth Contraindications:
Mixtures Drug: Insulin, Isophane Suspension and Regular Insulin (Humulin 70/30, Humalin 30/70, Novolin 70/30, Novolin 70/30, Novolin ge 30/70 Onset 10-20 minutes Peak 2 hr 40 minutes Duration Up to 24 hours Drug:Isophane Insulin Suspension (NPH) and Insulin Mixtures (Humulin 50/50 Insulin Lispro Mixture (Humalog 75/25, Humalog Mix 50/50 Insulin Aspart Mixuture (Novolog 70/30) Onset 30-60 minutes Peak Dual Duration 10-16 hours Ins Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes, insulin lispro may be used in combination with sulfonylureas in children > 3 yr old.
Functional class: Antidiabetic, pancreatic hormone Chemical class: Modified structes of endogenous human insulin Action: Decreased blood glucose by transport of glucose into cells and the conversion of glucose to glycogen, indirectly increases blood pyruvate and lactate, decreases phosphate and potassium; insulin may be human (processed by recombinant DNA technologies) Overdose Treatment: 25 gram D50W IV, or 1mg Glucagon IM
Side-Effects: CNS: CV: HEMA: Hypoglycemia, rebound hyperglycemia INTEG: Flushing, rash, urticarial, warmth, lipodystrophy, swelling, redness GI: GU: EENT: Blurred vision, dry mouth Contraindications:
Drug: Interferon alfa-2a recombinant (Referon-A) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Hairy cell leukemia in person > 18 years old; condylomata acuminate; chronic hepatitis C; 2a only chronic myelogenous leukemia; 2b only hepatitis B, malignant melanoma
Functional class: Antieoplasticmiscellaneous Chemical class: Protein Product Action: Antiviral action inhibits viral replication by reprogramming virus; antitumor action suppresses cell proliferation; immunomodulating action phagocytizes target cells; may also inhibit virus replication in virus-infected cells.
Side-Effects: CNS: Dizziness, confusion, numbness, parethesias, hallucinations, seizures, coma, amnesia, anxiety, mood changes, depression, somnolence, paranoia, irritability, hostility CV: Edema, hypotension, hypertension, chest pain, palpitations, dysrhythmia, CHF, MI, CVA, tachycardia, syncope HEMA: Neutropenia, thrombocytopenia INTEG: Rash, dry skin, itching, alopecia, flushing, photosensitivity, serious skin infection GI: weight loss, taste changes, nausea, anorexia, diarrhea, xerostomia GU: Impotence EENT: Contraindications: Hypersensitivity Black Box Warning: Autoimmune disorders, cardiac disease, infection, depression Side-Effects: CNS: Depression, headache, fatigue, fever, rigors, insomnia, dizziness, agitation, nervousness, anxiety CV: Hypertension, palpitation, tachycardia HEMA: Granulocytopenia, thrombocytopenia, leucopenia, ecchymosis, aplastic anemia INTEG: Alopecia, pruritus, rash, erythema, dry skin GI: Abdominal pain, N/V, diarrhea, anorexia, dyspepsia, constipation, flatulence, hemorrhoids, decreased salivation GU: Dysmenorrhea, vaginitis, menstrual disorders EENT: Tinnitus, earache, conjunctivitis, eye pain Contraindications: Cardiac disease, autoimmune disorder, infection, depression
Drug:Interferon Alfacon-1 (Infergen) Dose:
Functional class: Recombinant type 1 interferon Chemical class:
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Chronic Hep C infections in those 18 yrs and older with compensated liver disease who have antiHCV antibodies of HCV RNA. Action: Induces biologic responses and has antiviral, antiproliferative, and immunomodulatory effects.
Drug: Interferon Alfa-n 3 (Alferon N) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Condylomata acuminate (cenereal/genital warts), papillomavirus
Functional class: Antieoplastic, antiviral Chemical class: Human interferon aprotein Action: Binds interferon to membrane receptors on cell surface with high specificity, inhibition of virus replication, suppression of cell proliferation, increased phagocytosis
Side-Effects: CNS: Fever, headache, sweating, vasovagal reaction, chills, fatigue, dizziness, insomnia, sleepiness, depression, suicidal ideations CV: Chest pain, hypotension HEMA: INTEG: Pain at injection site, pruritus, pyrosis GI: N/V, heartburn, diarrhea, constipation, anorexia, stomatitis, dry mouth, taste distrubance GU: EENT: Other: May cause flu-like symptoms Contraindications: Sensitivity to eggs, neomycin, murine protein
Drug: Interferon Beta-1a (Avonex, Ribif) Dose:
Functional class: Multiple sclerosis agent, immune modifier
Side-Effects: CNS: Headache, fever,migraine, pain, chills, mental changes, depresstion, hypertonia, suicide attempts, seizures CV: Palpitations, hypertension, tachycardia, peripheral vascular disorders HEMA: Decreased lymphocytes, ANC, WBC; lymphadenopathy, anemia INTEG: sweating, injection site reaction GI: Diarrhea, constipation, vomiting, abdominal pain. GU: Dysmenorrhea, irregular menses, metorrhagia, cystitis, breast pain EENT: conjunctivitis, blurred vision Contraindications: Hypersensitivity to interferon-b, human albumin, hamster protein, or rotovirus vaccine
Chemical class: Interferon, Escherichia Route (Give timing for IV push/IVPB meds): coli derivative Frequency: Rationale for client: Ambulatory patients with relapsing remitting MS Action: Antiviral, immunoregulatory; action not clearly understood; biologic response modifying properties mediated through specific receptors on cells, inducing expression of interferon-induces gene products.
Drug: Interferon gamma-1b (Actimmune) Dose:
Functional class: biologic response modifier
Side-Effects: CNS: Headache, fatigue, depression, fever, chills CV: HEMA: Leukopenia, thrombocytopenia, neutropenia INTEG: Rash, pain at injection site, Stevens-Johnsons syndrome GI: GU: EENT: Contraindications:
Chemical class: Lymphokine, interleukin Route (Give timing for IV push/IVPB meds): type Frequency: Rationale for client: Serious infection associated with chronic granulomatous disease, osterpetrosis. Action: Species-specific protein synthesized in response to viruses, effects; can mediate killing of Staphylcoccus aurerus, Toxoplasma gondii, Leishmania donovani, Listeria monocytogenes, Mycobacerium avium intracellulare; enhances oxidate metabolism of macrophages, enhances antibodydependent cellular cytotoxicity. Functional class: Anticholinergic, bronchodilator
Drug: Ipratropium (Atrovent HFA) Dose:
Side-Effects: CNS: Anxiety, dizziness, headache, nervousness CV: Palpitations HEMA: INTEG: Rash GI: N/V, cramps GU: EENT: Resp: Cough, worsening of symptoms, bronchospasms Contraindications: Hypersensitivity to this product, atropine, bromide, soybean or peanut products
Chemical class: Synthetic quaternary Route (Give timing for IV push/IVPB meds): ammonium compound Frequency: Rationale for client: COPD, rhinorrhea in children 6-11 yrs old (nasal spray) Action: Inhibits interaction of acetylcholine at receptors sites on the bronchial smooth muscle, resulting in decreased cGMP, and bronchodilation
Drug: Irinotecan (Camptosar) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Metastatic Carcinoma of the colon or rectum, or 1st-line treatment in combination with 5-FU and leucovorin for metastatic or rectal carcinomas
Functional class: Antineoplastic hormone Chemical class: Topoisomerase inhibitor Action: Cytotoxic by producing damage to singe-strand DNA during DNA synthesis, binds to topoisomerase I
Side-Effects: CNS: Fever, headache, chills, dizziness CV: Vasodilation, edema, thromboembolism HEMA: Leukopenia, anemia, neutropenia INTEG: Irritation at site, rash, sweating, alopecia GI: Severe diarrhea, N/V, anorexia, constipation, cramps, flatus, stomatitis, dyspepsia, hepatotoxicity GU: EENT: Resp: Dyspnea, increased cough, rhinitis Contraindications: Myelosuppression, diarrhea
Drug: Iron Dextran (DexFerrum, INFeD) Dose: Route (Give timing for IV push/IVPB meds): Frequency:
Functional class: Hematinic Chemical class: Ferric hydroxid complex with dextran
Side-Effects: CNS: Headache, parethesia, dizziness, shivering, weakness, seizures CV: Chest pain, shock, hypotension, tachycardia HEMA: Chest pain, shock, hypotension, tachycardia INTEG: Rash, pruritus, urticaria, fever, sweating, chills, brown skin discoloration, pain at inj site, necrosis, sterile abscesses, phlebitis GI: N/V, metallic taste, abdominal pain GU: EENT: Resp: Dyspnea Other: Anaphylaxis Contraindications: Hypersensitivity
Action: Iron is carrired by transferring to the bone marrow, where it is incorporated Rationale for client: Iron deficiency anemia. into hemoglobin.
Drug: Iron Sucrose (Venofer) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: iron deficiency anemia
Functional class: Hematinic Chemical class: Ferric hydroxide complex with dextran Action: Iron is carried by transferring to the bone marrow, where it is incorporated into hemoglobin. Unlabled uses: Dytrophic epidermolysis bullosa (DEB)
Side-Effects: CNS: Headache, dizziness CV: Chest pain, hypo/hypertension, hypervolemia HEMA: INTEG: Rash, pruritis, urticaria, fever, sweating, chills GI: N/V, abdominal pain GU: EENT: Resp: Dyspnea, pneumonia, cough Contraindications: Hypersensitivity , all anemias excluding iron deficiency anemia, iron overload
Drug: Isoniazid,( Nydrazid, Laniazid INH, Isotamine, Laniazid, PMS-Isoniazid) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Treatment, prevention of Tb
Functional class: Antitubercular Chemical class: Isonicotinic acid hydrazide Action: Bactericidal interference with lipid, nucleic acid biosynthesis.
Side-Effects: CNS: Peripheral neuropathy, dizziness, memory impairment, toxic encephalopathy, seizures, psychosis, slurred speech CV: HEMA: Agranulocytosis, hemolytic, aplastic anemia, thrombocytopenia, eosinophilia, methemoglobinemia INTEG: GI: N/V, epigastric distress, jaundice, fatal hepatitis GU: EENT: Contraindications: Acute hepatic disease, Alchoholism
Drug: Isosorbide Dinitrate (Apo-ISDN, Cedocard-SR, Coronex, Dilatrate-SR, Coronex, Dilatrate-SR, ISO-bid,sonate, Isorbid, Isordil, Isosorbide, Dinatrate, Isotrate, Novosorbide, Sorbidtrate) Dose:
Functional class: Antianginal, vasodilator Chemical class: Nitrate
Side-Effects: CNS: Vascular headache, flushing, dizziness, weakness, faintness CV: Postural hypotension, tachycardia HEMA: hemolytic anemia, methemoglobinemia INTEG: Pallor, sweating, rash GI: N/V, diarrhea GU: EENT: Contraindications: Sever anemia, increased intracranial pressure, cerebral hemorrhage, acute MI
Action: Relaxation of vascular smooth muscle, which leads to decreased proload, after-load, which is responsible for Route (Give timing for IV push/IVPB meds): decreasing left ventricular end-diastolic pressure, systemic vascular resistance and Frequency: reducing cardiac O2 demand. Rationale for client: Treatment, prevention of chronic stable angina pectoris, diffuse esophageal spasm
Drug: Isotretinoin (Amnesteem, Claravis, Sotret) Dose:
Functional class: Antiacne agent, retinoid Chemical class:
Side-Effects: CNS: CV: HEMA: INTEG: GI: GU: EENT: Contraindications: Hypersensitivity, inflamed Skin.Pregnancy X
Route (Give timing for IV push/IVPB meds): Action: Inhibits calcium ion influx across cell membrane during cardiac Frequency: depolarization, produces relaxation of coronary vascular smooth muscle, Rationale for client: Severe recalcitrant peripheral vascular smooth muscle, dilates nodulocystic acne. coronary vascular arteries.
Drug: Isradipine (DynaCirc CR) Dose:
Functional class: Antihypertensive, antianginal (CCB) Chemical class: Dihydropyridine
Side-Effects: CNS: Headache, fatigue, dizziness, fainting, sleep disturbances, weakness, depressin, drowsiness CV: Peripheral edema, tachycardia, hypotension, chest pian, dysrhythmias, syncope HEMA: Leukopenia INTEG: Rash, pruritus, urticaria GI: N/V, diarrhea, gastric upset, constipation, hepatits, abdominal distension, dry mouth GU: nocturia, urinary frequency EENT: Contraindications: Sick sinus syndrome, 2nd or 3rd degree HB, hypotension <90 systolic
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Essential HTN Action: Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle, peripheral vascular smooth muscle; dilates coronary vascular arteries.
Drug: Itraconazole (Sporanox) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Systemic candidiasis, chronic mucocandidiasis, oral thrush, condiduria, histoplasmosis, chromomycosis, paracoccidiomycosis, blastomycosis, (pulmonarhy and extrapulomary), aspergillosis onychomycosis
Functional class: Antifungal, systemic Chemical class: Triazole derivative Action: Alters cell membranes and inhibits several fungal enzymes
Side-Effects: CNS: Headache, dizziness, insomnia, somnolence, depression CV: HTN HEMA: INTEG: Pruritus, fever, rash, toxic epidermal necrolysis GI: bleeding, hepatotoxicity GU: gynecomastia, impotence, decreased libido EENT: Contraindications: Fungal meningitis, onychomycosis or dermatomycosis in cardiac dysfunction, Heart failure, ventricular dysfunction, coadministration with other products Side-Effects: CNS: HA, dizziness CV: NV, anorexia, hepatotoxicity Hema: Thrombocytopenia, leukopenia Integ: Pruritus, fever, chills GI: GU: EENT: Contraindications: Breast feeding, fungal meningitis C&S taken before administration Monitor for allergic reaction Monitor for hepatotoxicity (NV, fatigue, clay colored stools) Take at least 2hr before drugs that increase gastric pH (antacids, H2, PPI)
Drug: ketoconazole
Functional class: Antifungal Chemical class: Imidazole derivative
Dose: Route (Give timing for IV push/IVPB meds): Action: Alters cell membrane permeability and inhibits several fungal Frequency: enzymes resulting in cellular death Rationale for client:
Drug: ketoprofen (Po-Keto) Functional class: NSAIDs, antirheumatic Dose: Chemical class: Propionic acid derivative Route (Give timing for IV push/IVPB meds): Action: Inhibits prostaglandins synthesis Frequency: by decreasing enzyme needed for Rationale for client: biosynthesis; analgesic, antiinflammatory, antipyretic
Drug: ketorolac (Apo-Ketorolac, Toradol) Functional class: NSAID, nonopioid Dose: analgesic Route (Give timing for IV push/IVPB meds): Chemical class: acetic acid Frequency: Rationale for client: Action: Inhibits prostaglandins synthesis by decreasing enzyme needed for biosynthesis; analgesic, antiinflammatory, antipyretic
Drug: labetalol (Apo-Labetalol, Trandate) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: HTN, angina
Functional class: Antihypertensive, antianginal Chemical class: alpha 1/beta blocker Action: Produces decreased in BP without reflex tachycardia or significant reduction in heart rate through mixture of alpha blocking, beta blocking effects; elevated plasma renins are reduced
Drug: lacosamide (Vimpat) Functional class: Anticonvulsant Dose: Chemical class: Functionalized amino Route (Give timing for IV push/IVPB meds): acid Frequency: Rationale for client: Action: May act through action at sodium channels; exact action is unknown
Side-Effects: CNS: Dizziness, drowsiness, tremors, depression CV: Tachycardia, peripheral edema, MI, stroke Hema: Blood dysrasias Integ: Rash, pruritis GI: GI bleeding, hepatitis, peptic ulcers, constipation GU: Nephrotoxicity, hematuria EENT: Contraindications: Hypersensitivity to NSAIDs, salicylates, asthma, severe renal/hepatic disease, PUD Side-Effects: CNS: Dizziness, seizures CV: HTN, syncope, flushing, MI, stroke Hema: Blood dyscrasias, prolonged bleeding Integ: Rash, sweating GI: GI bleeding, perforation, hepatic failure GU: Nephrotoxicity, dysuria, hematuria EENT: Stevens-Johnson, angioedema Contraindications: Pregnancy 3rd trimester, asthma, hepatic disease, PUD Side-Effects: CNS: Dizziness, mental changes, depression CV: Orthostatic hypotension, CHF, bradycardia Hema: Thrombocytopenia Integ: Rash, alopecia, dermatitis GI: Dyspepsia, taste distortion GU: Impotence, dysuria EENT: *Bronchospasm, wheezing Contraindications: Hypersensitivity to beta blocker, cardiogenic shock, heart block, CHF, bronchial asthma Side-Effects: CNS: Dizziness, syncope, vertigo, depression, suicidal ideation, HA CV: Atrial fibrillation, bradycardia, QT prolonged Hema: Anemia, neutropenia Integ: Rash, erythema GI: NV, constipation, hepatitis GU: EENT: Contraindication: Hypersensitivity
Asses pain (location and intensity) Monitor renal and hepatic function Monitor for signs of GI bleeding Monitor for nephrotoxicity (ringing in ears, blurred vision, flulike symptoms)
Monitor for signs of nephrotoxicity Teach pt to report changes in urine pattern, weight gain, black tarry stools, hematuria Teach pt to avoid other salicylates, NSAIDs, and acetaminophen
Do not use within 2 weeks of Monoamine oxidase inhibitors (MAOIs) Assess for weight gain, fluid volume overload, crackles Monitor BP before and during tx Take apical and radial pulse before administration
Assess for seizures (type, intensity, duration) Monitor mental status Monitor renal function Monitor for orthostatic hypotension
Drug: lactulose (Acilac, Apo-Lactulose, Constulose, Enulose) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Laxative; ammonia detoxicant (Hyperosmotic) Chemical class: Lactose synthetic derivative Action: Prevents absorption of ammonia in colon by acidifying stool; increases water in stool
Drug: lamivudine (Epivir, Epivir HBV, Heptovir, 3TC)
Functional class: Antiretroviral Chemical class: Nucleoside reverse transcriptase inhibitor (NRTI)
Dose: Route (Give timing for IV push/IVPB meds): Action: Inhibits replication of HIV virus by incorporating into cellular DNA by Frequency: viral reverse transcriptase, thereby Rationale for client: terminating cellular DNA chain Drug: lamotrigine (Lamictal, ApoFunctional class: Anticonvulsant Lamotrigene) Chemical class: Phenyltriazine Dose: Route (Give timing for IV push/IVPB meds): Action: Unknown, may inhibit voltage sensitive sodium channels Frequency: Rationale for client:
Drug: lansoprazole (Prevacid) Functional class: Antiulcer, proton pump Dose: inhibitor Route (Give timing for IV push/IVPB meds): Chemical class: Benzimidazole Frequency: Rationale for client: Action: Suppresses gastric acid secretion by inhibit hydrogen/potassium ATPase enzyme system in gastric parietal cell; characterized as gastric acid pump inhibitor, since it blocks final step of acid production
Side-Effects: CNS: NV, abdominal cramps, diarrhea, flatulence, belching CV: Hema: Integ: GI: GU: EENT: *hypernatremia Contraindications: Hypersensitivity lowgalactose diet Side-Effects: CNS: Fever, HA, malaise, seizures CV: Hema: Neutropenia, anemia Integ: Rash GI: NV, pancreatitis, dyspepsia GU: EENT: Taste change, hearing loss *Myalgia, arthralgia Contraindications: Side-Effects: CNS: Dizziness, ataxia, suicidal ideation, fever CV: Hema: Anemia, thrombocytopenia Integ: GI: NV, hepatotoxicity GU: Dysmenorrhea EENT: Diplopia, blurred vision Contraindications: Side-Effects: CNS: HA, dizziness, confusion, amnesia CV: Chest pain, tachycardia, CVA, MI Hema: Anemia Integ: Rash, pruritus GI: Diarrhea, abdominal pain, vomiting, constipation GU: Hematuria EENT: Contraindications:
Monitor stool amount and consistency Assess blood ammonia levels (30-70 mg/100mL) Monitor I&O
Monitor CBC and hepatic function Evaluate blood dyscrasias Teach pt to report GI problems Teach pt that the drug is not a cure for HIV, but tx only
Assess for seizure activity, duration, type, and intensity Monitor mental status
Assess GI function Assess for abdominal pain Monitor hepatic studies Teach patient to report severe diarrhea Teach pt to avoid alcohol and NSAIDs
Drug: lapatinib (Tykerb) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic Chemical class: Biologic response modifier, signal transduction inhibitor Action: Reverses tyrosine kinase of both epidermal growth factor receptor type 2
Drug: leflunomide (Arava) Functional class: Antirheumatic Dose: (DMARDs) Route (Give timing for IV push/IVPB meds): Chemical class: Immune modulator, pyrimidine synthesis inhibitor Frequency: Rationale for client: Action: Inhibits an enzyme involved in pyrimidine synthesis and has antiproliferative, antiinflammatory effect
Drug: lenalidomide (Revlimid) Functional class: Antianemic, biologic Dose: response modifier, hormone Route (Give timing for IV push/IVPB meds): Chemical class: Thalidomide derivative/TNF modifier Frequency: Rationale for client: Action: Decreases secretion of inflammatory cytokines and increases secretion of antiinflammatory cytokines, also COX-2 inhibitor Drug: lepirudin (Refludan) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Functional class: Anticoagulant Chemical class: Thrombin inhibitor, hirudin Action: Direct inhibitor of thrombin that is highly specific
Side-Effects: CNS: Fatigue, hand/foot syndrome CV: HF, palpitations Hema: Anemia, neutropenia Integ: Rash GI: Anorexia, diarrhea, dyspepsia GU: EENT: *dyspnea, pneumonitis Contraindications: Pregnancy (D), breastfeeding Side-Effects: CNS: HA, dizziness, paresthesia CV: Palpitations, HTN, chest pain, peripheral edema Hema: Anemia, ecchymosis Integ: Rash, acne, hematoma GI: NV, hepatotoxicity GU: EENT: Pharyngitis, oral candiasis Contraindications: Breastfeeding, jaundice, lactase deficiency, hepatic disease Side-Effects: CNS: Depression, sweating, fever CV: Chest pain, hypotension Hema: Anemia, thrombocytopenia Integ: GI: Abdominal pain, anorexia GU: EENT: *Hypokalemia, arthralgia, angioedema Contraindications: Breastfeeding Side-Effects: CNS: Fever, intracranial bleeding CV: HF, pericardial effusion Hema: Hemorrhage, anemia Integ: GI: GI bleeding GU: Hematuria, abnormal kidney function EENT: *Bronchospasm, stridor, multiorgan failure Contraindications: Hypersensitivity to hirudins
Monitor cardiac and hepatic function Teach pt to take with 8oz glass of water 1hr before or after meal
Screen for latent TB before tx Monitor for arthritic symptoms prior to and during tx Monitor BP and weight Teach pt to avoid vaccinations during tx and notify provider of weight loss
Pregnancy (X) Monitor blood studies
Obtain baseline aPTT before tx, do not begin if aPTT > or equal 2.5 aPTT should be 1.5-2.5 Monitor for bleeding Monitor blood studies Avoid all IM injections Teach pt to use a soft-bristle toothbrush and to report any signs of bleeding
Drug: letrozole (Femara) Functional class: Antineoplastic, Dose: nonsteroidal aromatase inhibitor Route (Give timing for IV push/IVPB meds): Chemical class: Frequency: Rationale for client: Action: Binds to the heme group of aromatase; inhibits conversion of androgens to estrogens to reduce plasma estrogen levels
Drug: leucovorin Functional class: Vitamin, folic Dose: acid/methotrexate antagonist antidote Route (Give timing for IV push/IVPB meds): Chemical class: Tetrahydrofolic acid derivative Frequency: Rationale for client: Action: Needed for normal patterns; prevents toxicity during antineoplastic therapy by protecting normal cells
Drug: leuprolide (Eligard, Lupron Depot, Functional class: Antineoplastic hormone Viadur) Chemical class: Gonadotropin-releasing Dose: hormone Route (Give timing for IV push/IVPB meds): Action: Causes initial increase in Frequency: circulating levels of LH, FSH; continuous Rationale for client: administration results in decreased LH, FSH; in men, testosterone is reduced to castrate levels; in premenopausal women, estrogen is reduced to menopausal levels Drug: levalbuterol (Xopenex) Functional class: Bronchodilator, Dose: adrenergic Beta 2 agonist Route (Give timing for IV push/IVPB meds): Chemical class: Frequency: Rationale for client: Action: Causes brochodilation by action on beta 2 (pulmonary) receptors by increasing levels of cAMP, which relaxes smooth muscles; produces brochodilation, CNS, cardiac stimulation, as well as increased diuresis and gastric acid secretions
Side-Effects: CNS: HA, lethargy, depression CV: Angina, MI, CVA Hema: Integ: Rash, alopecia, pruritus GI: NV, anorexia, constipation GU: Endometrial cancer EENT: Contraindications: Pregnancy (D), premenopausal females Side-Effects: CNS: Thrombocytosis CV: Hema: Integ: Rash, erythema, GI: GU: EENT: *wheezing Contraindications: Hypersensitivty to product or folic acid, benzyl alcohol, anemia Side-Effects: CNS: Memory impairment, depression CV: MI, PE, dysrhythmias Hema: Integ: Alopecia GI: NV, GI bleeding, diarrhea GU: Edema, hot flashes, vaginal bleeding EENT: Contraindications: Pregnancy (X), breastfeeding, hypersensitivity to GnRH or analogs, thromboembolic disorders Side-Effects: CNS: Tremors, anxiety, irritability CV: Palpitations, tachycardia Hema: Integ: Rash GI: Heartburn, NV, diarrhea GU: EENT: *Cough, angioedema Contraindications: Hypersensitivity to sympathomimetics, or albuterol
Monitor hepatic studies Teach pt to report allergic reactions and bleeding
Assess creatinine clearance prior to tx and daily Monitor I&O and urine output Monitor mental status and calcium levels
Monitor for lower abdominal pain, pelvic pain and excessive bleeding Monitor hepatic studies Teach pt to report any complaints or side effects to nurse of HCP
Monitor respiratory and cardiac status Monitor for signs of allergic reaction Teach pt to wait at least 1 min between inhalation Teach pt to limit caffeine intake Tx for overdose: beta 1 adrenergic blocker
Drug: levetiracetam (Keppra) Functional class: Anticonvulsant Dose: Chemical class: Route (Give timing for IV push/IVPB meds): Action: Unknown, may inhibit nerve Frequency: impulses by limiting influx of sodium ions Rationale for client: across cell membrane in motor cortex
Drug: levocetirizine (Xyzal)
Functional class: Antihistamine, low sedating Dose: Chemical class: H1 histamine blocker, Route (Give timing for IV push/IVPB meds): low-sedating Frequency: Rationale for client: Action: Acts on blood vessels, GI, respiratory system by competing with histamine for H1 receptor site; decreases allergic response by blocking pharmacologic effects of histamine; minimal anticholinergic action
Drug: levofloxacin (Levaquin, NovoFunctional class: Antiinfective Levofloxacin) Chemical class: Fluoroquinolone Dose: Route (Give timing for IV push/IVPB meds): Action: Interferes with conversion of intermediate DNA in bacteria; DNA Frequency: gyrase inhibitor; inhibits topoisomerase Rationale for client: IV
Drug: levoleucovorin (Fusilev) Functional class: Chemotherapy protectant Dose: Chemical class: Tetrahydrofolic acid Route (Give timing for IV push/IVPB meds): Action: Acts as replacement to rescue Frequency: cells from the effects of folate antagonist Rationale for client:
Side-Effects: CNS: Dizziness, psychosis, suicidal ideation CV: Hema: Lowered HCT, Hgb, RBC Integ: GI: GU: EENT: Contraindications: Breastfeeding Side-Effects: CNS: Drowsiness, fatigue CV: Hema: Integ: Rash GI: Dry mouth, increase LFTs GU: EENT: Contraindications: Breastfeeding, children 6-11 with renal disease, end stage renal disease, dialysis, hypersensitivity to certirizine and hydroxyzine Side-Effects: CNS: HA, dizziness, seizures CV: Chest pain, palpitations Hema: Eosinophilia Integ: Photosensitivity GI: NV, hepatotoxicity GU: Vaginitis, crystalluria EENT: Tendon rupture Contraindications: Hypersensitivty to quinolones Side-Effects: CNS: Seizures, syncope CV: Hema: Integ: Rash, anaphylaxis GI: NV, stomatitis GU: Abnormal renal function EENT: Contraindications: Hypersensitivity to product or folic acid, Mannitol; intrathecal administration
Monitor seizure activity Monitor renal function and blood studies Assess mental status Do not abruptly dc medication
Monitor for allergic reaction Monitor respiratory status and liver function
Assess for allergic reaction Assess for SS of infection Obtain C&S prior to therapy Monitor bowel pattern Monitor for signs of superinfection Do not use theophylline with product Teach pt to avoid sun exposure
Monitor creatinine clearance prior to therapy Obtain CBC Monitor mental status Teach pt to eat bran, yeast, dried beans, nuts, green leafy vegetables for folic acid deficiency
Drug: Lidocaine/Xylocaine
Dose: IV Bolus 50-100mg over 2-3min repeat q3-5min. IV Inf 20-50mcg/kg/min, IM 200-300mg in deltoid muscle, repeat 1Action: Increases electrical stimulation 1.5hr as needed. SC local anesthetic action. threshold of ventricle. His-Purknjle Route (Give timing for IV push/IVPB meds): system, which stabilizes the cardiac membrane, decreases automaticity. Frequency: Rationale for client: V Tach, MI, Dig Tox, Cardiac Cath.
Functional class: Antidysrhythmic (class Ib) Chemical class: Aminoacyl amide
Drug: lindane/Kwell
Dose: 1-2oz Route (Give timing for IV push/IVPB meds): topical apply to skin leave 5 mins. Remove Action: Stimulates nervous system of with soap and water. arthropods resulting in seizures, death of organism Frequency: once repeat 1 week Rationale for client: treatment of scabies, lice(head/pubic/body), nits Drug: linezolid/Zyvox Functional class: Broad spectrum Antiinfective Chemical class: Oxazolidinone
Functional class: Scabicide, Pediculicide Chemical class: Chlorinated hydrocarbon(synthetic)
Dose: IV/PO 600mg Route (Give timing for IV push/IVPB meds): 0.5-1.5hrs Action: Inhibits protein synthesis by interacting with translation. Frequency: Q12Hrs for 14-48days; max 1200mg/day Rationale for client: VRE, Nosocomial pneumonia skin and skin structure infections, community-acquired pneumonia, Drug: Liothyronine (T3)/T3 Functional class: Thyroid hormone Chemical class: Synthetic T3
Side-Effects: CNS: Headache, dizziness, seizures CV: Hypotension, Bradycardia, heart block, CV collapse, arrest Hema: Methemoglobinemic Integ: GI: GU: EENT: RESP: Respiratory depression Contraindications: Hypersensitivity to amides. Severe heart block. Supraventricular dysthymias. AdamsStokes syndrome. Wolff-Parkinson-White syndrome. Side-Effects: CNS: Seizures, CNS toxicity CV: V Tach Hema: Aplastic anemia Integ: pruritus, rash, irritation, contact dermatitis GI: N/V/D GU: Kidney damage EENT: Contraindications: Hypersensitivity, Persons with known seizure disorders. Norwegian (crusted) scabies. Side-Effects: CNS: H/A CV: Hema: Myelosuppression Integ: GI: N/V/D, pseudomembranous colitis, GU: EENT: MISC: Lactic acidosis Contraindications: Hypersensity
Half- life 8mins IM onset 5-15mins Dur1-1.5hr IV onset 2min Duration 20min Asses ECG continuously to determine >PR or QRS segs. Decrease rate or discontinue. Monitor for >PVCs. Monitor BP. IV inf IV pump <4mg/min. Therapeutic levels 1.5-5mcg/ml I&O ratio electrolytes (K, NA, Cl), Malignant hyperthermia, Resp status rate rhythm. DOPamine for respiratory depression. CNS status.
Remove all hair oils before applying lindane. Asses for lice, nits before and after treatment; if scabies are present check all surface skin. ID scource of infestation. Fine tooth comb for removal of nits. Hot water wash all clothing, bedding. Apply with rubber/non-latex gloves. Monitor for CNS toxicity.
CBC weekly, CNS status, Hepatic; ALT, AST. Administer separate IV site.
Dose: 25-75mcg/day MAX100mcg/day Route (Give timing for IV push/IVPB meds): Action: >metabolic rate, cardiac rate, O2 PO consumption, body temperature, blood volume, growth development at cellular Frequency: Daily level. Rationale for client: Congenital hypothyroidism, nMyxedena, severe hypothyroidism, Mysedema coma/precoma, non-toxic goiter, Suppession test.
Side-Effects: CNS: Insomnia, tremors, thyroid storm CV: Tachy, palpations, angina dysrhythmias, cardiac aresst Hema: Integ: GI: GU: EENT: Contraindications: Adrenal insufficiency, MI, thryotoxicosis, untreated HTN.
Asses BP, pulse, during treatment periodically. Daily weights. T3, T4. PT. Excitability. Cardiac status. Administer in AM to reduce insomnia.
Drug: liotrix/ T3-T4
Functional class: Thyroid hormone Chemical class: Dose: 12.5/3.1-150/37.5mcg levothyroxine/liothyronine (synthetic Route (Give timing for IV push/IVPB meds): T3/T4) PO Action: Increases metabolism, exact Frequency: Daily mechanism unknown. Rationale for client: Hypothyroidism
Drug: lisdexamfetamine/Vyvanse
Functional class: CNS stimulant Chemical class: Amphetamine
Dose: 30-70mg/day titrated Route (Give timing for IV push/IVPB meds): Action: Increases release of PO norepinephrine, Dopamine in cerebral cortex to reticular activating system. Frequency: Daily Rationale for client: ADHD
Drug: lisinopril/Zestril
Functional class: Antihypertensive Chemical class: ACE inhibitor.
Dose: 10-80mg/day Route (Give timing for IV push/IVPB meds): Action: Selectively suppresses RAAS. PO Inhibits ACE, preventing conversion of angiotensin I to angiotensin II Frequency: Daily Rationale for client: Mild to moderate HTN, adjunctive therapy for systolic CHF. Acute MI. Drug: lithium/ Lithobid Functional class: Anti-manic, antipsychotic Chemical class: Alkali metal ion salt
Side-Effects: CNS: Insomnia, tremors, thyroid storm CV: Tachy, palpations, angina, dysrhythmias, cardiac arrest Hema: Integ: GI: N/V/D weight loss GU: EENT: Contraindications: Adrenal insufficiency, MI, cardiac disease, diabetes Side-Effects: CNS: Hyperactivity, insomnia, restlessness, talkativeness CV: Palpations, tachycardia, dysrhythmias, MI, cardiomyopathy. Hema: Integ: GI: Anorexia GU: EENT: INTEG: Angioedema, SJS, toxic epidermal necrosis Contraindications: HTN, Glaucoma, CV disease, severe arteriosclerosis Side-Effects: CNS: Vertige, stroke, fatigue CV: Hema: Integ: GI: GU: proteinuria, renal insufficiency EENT: SYST: Angioedema Contraindications: Hypersensitive, previous angioedema Side-Effects: CNS: H/A, drowsiness, dizziness, seizures CV: hypotension, dysrhythmias, circulatory collapse. Hema: Leukocytosis Integ: GI: Polyuria, glycosuria, proteinuria, albuminuria GU: EENT: Contraindications: Children<12yo. Hepatic disease. Brain injury schizophrenia, severe cardiac/renal disease. Severe dehydration.
Asses B/P, pulse periodically during treatment. Daily WTs. Monitor T3, T4. PT. Excitiability, Cardiac status. Administer at least 4 hours before or after calcium, Iron. Administer in AM to reduce insomnia. Same time each day. Maintain lowest dose possible.
Asses VS, B/P. CBC. Monitor BG and insulin reactions. Mental status. Treatment of overdose: Administer fluids, antihypertensives, ammonium chloride for increased excretion, chlorpromazine for antagonize CNS effect.
Asses Platelets, CBC/diff, B/P, pulse rate/rhythm, Electrolytes( K, Na, Cl), Apical/pedal pulse before administration. Baseline Hepatic and renal studies. Daily WTS. Symptoms of CHF. Monitor for severe hypotension after first dose. Treatment for OD: Lavage, atropine for bradycardia, IV theophylline for bronchospasms digoxin O2, diuretic for cardiac failure. Daily wts report distal edema. Monitor sodium intake. Skin turgor daily. Neuro status, LOC, Gait, motor reflexes. Serum levels.0.5-1.5meg/l Toxic>1.5meg/l Treatment for OD: Induce emesis or lavage. Maintain airway, Respiratory function. Dialysis for severe intoxication.
Dose: 300-600mg day Route (Give timing for IV push/IVPB meds): PO Action: may alter sodium, potassium transport across cell membrane in nerve Frequency: TID and muscle cells .may balance biogenic Rationale for client: Bi-polar, manic amines of norepinephrine, serotonin in depressive psychosis CNS areas involved in emotional responses
Drug: lomustine/ CCNU
Dose: 100-130mg/m2 Route (Give timing for IV push/IVPB meds): PO Action: Responsible for crosslinking DNA strands, which leads to cell death. Activity Frequency: daily is not cell cycle phase specific. Rationale for client: Hodgkins disease, malignant glioma.
Functional class: Antineoplastic alkylation agent Chemical class: Nitrosourea
Drug: loperamide/ Imodium
Functional class: Antidiarrheal Chemical class: Piperidine derivative
Dose: 4mg initially/2mg after each loose stool. Action: Direct action on intestinal Route (Give timing for IV push/IVPB meds): muscles to decrease GI peristalsis reduces PO volume, increases bulk, electrolytes not lost. Frequency: PRN Rationale for client: Diarrhea
Functional class: antihistamine, 2nd generation Dose: 10mg Chemical class: Selective Route (Give timing for IV push/IVPB meds): histamine(h1)receptor antagonist PO Action: Binds to peripheral histamine Frequency: Daily receptors providing antihistamine action Rationale for client: Seasonal rhinitis, without sedation. chronic idiopathic urticaria Drug: loratadine/ Claritin Drug: Lorazepam/ Ativan Functional class: Sedative, hypnotic, antianxiety Dose: 2-6mg/dose max 10mg/day Chemical class: Benzodiazepine, short Route (Give timing for IV push/IVPB meds): acting PO/IM Action: Potentiates the action of GABA, Frequency: 2-3 times a day especially in the limbic system and Rationale for client: Anxiety, irrability in reticular formation. psychiatric or organic disease. Preoperatively.
Side-Effects: CNS: CV: Hema: Thrombocytopenia, leukocytopenia, myleosuppression, anemia Integ: GI: N/V/D anorexia stomatitis. Hepatoxicity GU: Azotemia, renal failure EENT: RESP: Fibrosis, pulmonary infiltrate Contraindications: Blastic phase of CMI. Side-Effects: CNS: CV: Hema: Integ: GI: N/V dry mouth, constipation, toxic mega colon. GU: EENT: SYST: Anaphylaxis, angioedema, toxic epidermal necrosis. Contraindications: PMC, constipation, GI bleed, toxic colon. Side-Effects: Minimal expected CNS: CV: Hema: Integ: GI: GU: EENT: Contraindications: Acute asthma attacks, lower respiratory tract disease. Increased intraocular pressure Side-Effects: CNS: Dizziness, drowsiness CV: Orthostatic hypotention, ECG changes, tachycardia, apnea, cardiac arrest(IV, Rapid) Hema: Integ: GI: GU: EENT: Blurred vision, Contraindications: COPD, close-angle glaucoma, psycosis, Hx of drug abuse, sleep apnea.
Asses CBC/diff, withhold if WBC<4000/mm3 or platelet count <100,000/mm3 PFT, chest x-ray, Renal studies, BUN, Creatinine, serum uric acid, I&O for <30ml/hr, Monitor T. Monitor Bilirubin, ALT, AST, PT. Monitor for jaundice. Monitor injection site.
Asses stool, volume, color, character. Electrolytes (K, Na, Cl) Bowel patterns before for rebound constipation. Administer for no more than 48 hours without relief. CNS due to dehydration. Abdominal distention. Do not break chew or crush.
Asses allergies. Monitor respiratory status. LFTs, Creatinine, BUN Empty stomach daily. Dissolve in mouth before swallowing.
Asses B/P sitting /standing. Hold if systolic drops >20mm/hg. CBC, hepatic studies, ALT, AST. Bilirubin, Creatinine, IDH, Alk. Phos. Mental status, !Suicidal tendencies. Sugarless gum or candy for dry mouth symptoms.
Drug: Losartan/ Cozaar
Dose: 50mg/day w/o diuretics or 25mg/day with diuretic use Route (Give timing for IV push/IVPB meds): Action: Blocks the vasoconstrictor and PO aldosterone-secreting effects of angiotensin II; selectively blocks the Frequency: Daily binding of angiotensin II to the AT1 Rationale for client: Hypertension, receptor found in tissues. nephropathy in DM II, HTN with L ventricular hypertrophy. Drug: lovastatin/ Mevacor Functional class: Antilipemic Chemical class: HMG-CoA reductase inhibitor
Functional class: Antihypertensive Chemical class: Angiotensin II receptor(type AT1) antagonist
Side-Effects: CNS: Dizziness, Insomnia CV: CVA, MI, dysrhythmias Hema: Thrombocytopenia Integ: Angioedema GI: diarrhea, dyspepsia GU: Renal failure REST: Cough, URI Contraindications:
Postural B/P changes. Pulse, rate, rythym, quality. Electrolytes: K, Na, Cl. Baseline renal, hepatic studies. Edema feet daily. Hydration status. Evaluate therapeutic response <B/P. Avoid sunlight. Avoid salt substitutes. Grapefruit juice. Rise slowly. Use contraception while on this medication.
Dose: 20-80mg Route (Give timing for IV push/IVPB meds): PO Action: Inhibits HMG-CoA reductase enzyme, which reduces cholesterol Frequency: Daily evening meal. synthesis. Rationale for client: Hyperlipidemia
Drug: loxapine/ Loxitane
Dose: 10-100mg/daily divided bid/qid Route (Give timing for IV push/IVPB meds): PO/IM Action: Depresses central cortex, hypothalamus, limbic system, which Frequency: BID/QID 100mg max daily control activity and aggression. Blocks Rationale for client: Anti psychoticosis neurotransmission of Dopamine at synapse.
Functional class: Antipsychotic, neuroleptic Chemical class: Dibenzoxapine
Side-Effects: CNS: Dizziness, headache, tremors, Lou Gehrigs Disease. CV: Hema: Thrombocytopenia, hemolytic anemia, leukocytopenia Integ: Rash, pruritus GI: Fltus, N/V/D Constipation, dyspepsia, abdominal pain, heartburn, hepatic dysfunction. MS: Muscle cramps, myalgia, myositis, rhabdomyolysis. EENT: Blurred Vision Contraindications: Active hepatic disease. Side-Effects: CNS: EPS, akathisia, dystonia, tardive dyskinesia, drowsiness H/A, pseudo Parkinsons disease, seizures, malignant syndrome. CV: Cardiac arrest, Orthostatic hypotension. Hema: Anemia, leukopenia, leukocytopenia, agranulocytopenia Integ: Rash GI: Dry mouth, N/V/anorexia, constipation. REST: Laryngospasm, Respiratory depression. Contraindications: Coma, Brain Damage, Severe CNS depression, Bone marrow depression.
Asses diet for cholesterol. Hepatic studies. Renal studies. Obtain baseline CPK. ! Muscle pain! If these occur stop medication.
Asses Mental status before drug therapy. Beware of hoarding of medication. I&O ratio. Palpate bladder. Bilirubin, CBC, LFTs, every month. Asses mental status, LOC, reflexes gait sleep pattern. Postural B/P. Treatment for OD: Orally gastric Lavage. IM; Maintain Airway.
Drug: lubiprostone/ Amitiza
Dose: 24mcg Route (Give timing for IV push/IVPB meds): PO Action: Locally acting chloride channel activator, enhances a chloride-rich Frequency: BID intestinal fluid secretion without altering Rationale for client: Constipation other electrolytes, increases motility in the intestines, increasing softening and passage of stool. Drug: lymphocyte immune globulin Functional class: Immuno globulins-(antithymocyte)/ Atgam immunosuppressant Chemical class: Dose: 10-30mg/kg/day Route (Give timing for IV push/IVPB meds): Action: Inhibits function of lymphocyte T IV>4hrs cells Frequency: Daily Rationale for client: Reduce organ rejection, aplastic anemia Drug: Magaldrate (Riopan) Dose: Route: Frequency: Rationale for client: Functional class: Antacid Chemical class: Aluminum/Magnesium hydroxide Action:Neutralizes gastric acidity
Functional class: Gastrointestinal agentmiscellaneous Chemical class:
Side-Effects: CNS: Headache CV: Hema: Integ: GI: Nausea, abdominal pain, eructation, GU: EENT: Contraindications: GI obstruction. Side-Effects: CNS: Seizures CV: Hema: Aplastic anemia, Thrombocytopenia Integ: GI: GI Bleed GU: Syst: Anaphylaxis Contraindications: Sensitivity to equine/leporine protein, acute viral illness Side-Effects: CNS: N/A CV: N/A Hema: Hypermagnesemia, hypophosphatemia Integ: N/A GI: Constipation, diarrhea, anorexia GU: N/A EENT: N/A Contraindications: Hypersensitivity to produxt or benzy alcohol Side-Effects: CNS: Muscle weakness, flushing sweating, flaccid paralysis, sedation CV: Hypotension, heart block, circulatory collapse, vasodilatation Hema: Prolonged bleeding time Integ: N/A GI: Nausea, vomiting, anorexia, cramps, diarrhea GU: N/A EENT: N/A Contraindications: Hypersensitivity, abdominal pain, N/V, obstruction, rectal bleeding, heart block, Myocaridal damage.
Assess GI symptoms. Administer with food BID. Therapeutic response.
Assess for active infection, Renal studies, BUN, Creatinine. Hepatic studies, ALT, AST, bilirubin. CBC/diff. Maintain equipment for anaphylaxis readily available. Intradermal testing with 1:1000 dilution 0.1 injection if wheal of rash >10mm or both use extreme caution.
Drug: Magnesium Salts: Magnesium chloride, magnesium citrate, magnesium gluconate, magnesium oxide, magnesium hydroxide, magnesium sulfate. Dose: Route: Frequency: Rationale for client:
Functional class: Anticonvulsant, saline laxative, antacid Chemical class: Electrolyte Action: Increases osmotic pressure, draws fluid into colon, neutralizes HCL
- Assess GI status - Assess for constipation - Increase bulk in diet - Administer laxatives if constipation occurs. - Administer between meals and at bedtime - Teach pt to separate enteric coated products and antacid by 2 hrs. - Teach pt to notify provider if coffee ground emesis or black tarry stools are present. - Assess for magnesium toxicity: excessive thirst, confusion, and decrease in reflexes. -Teach not to use for long term laxative therapy - May administer citrus fruit after to counteract unpleasant taste.
Drug: Mannitol (Osmitrol, Resectisol) Dose: Route: Frequency: Rationale for client:
Functional class: Diuretic, osmotic Chemical class: Hexahydric alcohol Action: Acts by increasing osmolarity of glomerular filtrate, which inhibits reabsorption of water and electrolytes and increases urinary output.
Drug: Maraviroc Dose: (Seizentry) Route: Frequency: Rationale for client:
Functional class: Antiretroviral Chemical class: Fusion inhibitor Action: Interferes with entry into HIV-1 by inhibiting the fusion of the virus and cell membrane
Drug: Mechlorethamine (Mustargen, nitrogen Functional class: Antineoplastic alkylating mustard) agent Dose: Chemical class: Nitrogen mustard Route: Action: Responsible for cross-linking Frequency: DNA strands leading to cell death; rapidly Rationale for client: degraded, a vesicant; activity is not cell cycle phase specific
Side-Effects: CNS:Dizziness, headache, seizures, rebound increased ICP, confusion. CV: Edema, thrombophlebitis, hypo/hypertension, tachycardia, angina, fever, chills, CHF, circulatory overload. Hema: N/A Integ: N/A GI: Nausea, vomiting, dry mouth, diarrhea GU: Marked dieresis, urinary retention, thirst. EENT: loss of hearing, blurred vision, nasal congestion, decreased intraocular pressure. Contraindications: intracranial bleeding, anuria, renal failure, edema, hypersensitivity. Side-Effects: CNS: Dizziness, depression, viral meningitis, neuropathy, fever CV: Mi, cardic ischemia, orthostatic hypotension Hema: N/A Integ: Rash, urticaria, pruritis, folliculitis GI: Diarrhea, constipation, dyspepsia, hypatotoxicity GU: N/A EENT: Gingival hyperplasia Contraindications: Hypersensitivity Side-Effects: CNS: Headache, dizziness, drowsiness, coma CV: N/A Hema: Thrombocytopenia, leucopenia, anemia Integ: Alopecia, pruritis, herpes zoster extravasion. GI: N/V, diarrhea, weight loss, stomatitis, colitis, hepatotoxicity GU: N/A EENT: Tinnitus, hearing loss Contraindications: Breastfeeding, acute herpes zoster, infection
- Assess daily weight -Assess rate, rhythm and depth of respirations - Assess for signs of metabolic acidosis: drowsiness and restlessness. - Assess hydration including skin turgor, thirst and dry mucous membranes - Assess for rashes - Take temperature q/day
- Assess for signs of infection - Administer without regard for meals, with 8oz water. - Teach pt to report sore throat, fever, fatigue (may indicate super infection)
- Monitor temperature - Assess for bruising - Assess for symptoms indication severe allergy: rash, pruritis, urticaria, purpuric skin lesions, itching, flushing. -Increase pts fluid intake, -Rinse mouth qid with water, brush bid to prevent stomatitis - Diet low in prurines
Drug: Meclizine (Antivert, Bonamine, Bonine, Dramamine Less Drowsy Formula, meclizine HCL, Medivert, Travel Sickness, Wal-Dram II) Dose: Route: Frequency: Rationale for client:
Functional class: Antiemetic, antihistamine, anticholinergic Chemical class: H1-Receptor antagonist, piperazine derivative Action: Acts centrally by blocking chemoreceptor trigger zine, which in turn acts on vomiting center.
Drug: MedroxyPROGESTERone (Amen, Depo-Provera, Provera) Dose: Route: Frequency: Rationale for client:
Functional class: Antineoplastic, hormone, contraceptive Chemical class: Progesterone derivative Action: Inhibits secretion of pituitary gonadotropins, which prevents follicular maturation and ovulation; stimulates growth of mammary tissue, antineoplastic action against endometrial cancer.
Drug: Megestrol (Megace, megestrol) Dose: Route: Frequency: Rationale for client:
Functional class: Antineoplastic hormone Chemical class: Progestin Action: Affects endometrium by antiluteinizing effect, this is thought to bring about cell death.
Side-Effects: CNS: Drowsiness, fatigue, restlessness, headache, insomnia CV: Hypotension Hema N/A Integ: N/A GI: N/V, anorexia, constipation, increased appetite GU: Urinary retention EENT: Dry mouth, blurred vision Contraindications: Hypersensitivity to cyclines, shock Side-Effects: CNS: Dizziness, headache, migraines, depression, fatigue, nervousness CV: Hypotension, thrombphlebitis, edema, thromboembolism, stroke, PE, MI Hema: N/A Integ: Rash, acne, urticaria, hirsutism, alopecia, oily skin, seborrhea, purpura, melasma, photosensitivity GI: N/V, anorexia, cramps, increased weight, cholestatic jaundice, abdominal pain. GU: Amenorrhea, cervical erosion, break through bleeding, dysmennorhea, vaginal candidiasis, breast changes, spontaneous abortion EENT: Diplopia Contraindications: Pregnancy (X), breast cancer, hypersensitivity, thromboembolic disorders, reproductive cancer, genital bleeding, missed abortion, dementia, osteoporosis, heart disorders. Side-Effects: CNS: Mood Swings, insomnia CV: Thrombophlebitis, thormboembolism, hypertension Hema: N/A Integ: Alpecia, rash, pruritis, purpura, itching, sweating GI: N/V, cramps, diarrhea, weight gain, flatus, indigestion GU: Fluid retention, gynecomastia, hypercalcemia, vaginal bleeding, discharge, impotence, decreased libido EENT: N/A Contraindications: Pregnancy, hypersensitivity
- Assess for signs of toxicity: drowsiness, dizziness, decreased LOC, N/V after 1 hour. - Teach patients that these products should not be used for at least 4 days prior to allergy testing. -Teach patients to avoid alcohol while taking these products.
- Assess for symptoms indicating severe allergic reaction, angioedema, have epinephrine and rescusitative equipment available. - Daily weight - Administer with food or milk to reduce GI symptoms - Teach patient to avoid direct sunlight or use sunscreen - Teach pt to report breast lumps, vaginal bleeding, edema, jaundice, dark urine, clay colored stools, dyspnea, headache, blurred vision, abdominal pain, numbness in legs, and chest pain. -Long term use decreases bone density, exercise and calcium supplements can help lessen this.
- Assess for thrombophlebitis: homans sign, edema, pain in calf, thigh, notify provider. - Assess for allergic reactions - Teach patient to report vaginal bleeding. - Teach pt that nonhormonal contraceptive should be used during and 4 mo after treatment. - Teach pt to recognize signs of fluid retention, and thromboemboli and report immediately.
Drug: Melozicam (Mobic) Dose: Route: Frequency: Rationale for client:
Functional class:NSAID, nonopioid analgesic Chemical class: Oxicam Action:Inhibits prostaglandin synthesis by decreasing an enzyme needed for biosynthesis; analgesic, antiinflammatory, antipyretic effects.
Drug: Memantine (Namenda) Dose: Route: Frequency: Rationale for client:
Functional class: Anti-Alzheimer agent Chemical class: NMDA receptor antagonist Action: Antagonist action of CNS NMDA receptors that may contribute to the symptoms of Alzheimers disease
Drug: Meperidine (Demerol, meperidine, Meperitab) Dose: Route: Frequency: Rationale for client:
Functional class: Opioid Anaglesic Chemical class: Phenylpiperidine derivative Action: Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
Side-Effects: CNS: Dizziness, drowsiness, tremors, headache, nervousness, malaise, fatigue, depression, seizures CV: Hypertension, angina, cardiac failure, MI, hypotension, palpitations, dysrhythmias, tachycardia, stroke. Hema: Blood dyscrasias, anemia, prolonged bleeding Integ: Rash, urticaria, photosensitivity GI: Pancreatitis, nausea, colitis, GERD, vomiting, diarrhea, constipation, flatulence, cramps, dry mouth, peptic ulcer, GI bleeding, jaundice GU: Nephrotoxicity, dysuria, oliguria EENT: Tinnitus, hearing loss, blurred vision Contraindications: Pregnancy, breastfeeding, hypersensitivity. Side-Effects: CNS: Dizziness, confusion, somnolence, headache, hallucinations CV: Hypertension Hema: N/A Integ: Rash GI: Vomiting, constipation GU: N/A EENT: N/A Contraindications: Breastfeeding, children, hypersensitivity, renal failure Side-Effects: CNS: Drowsiness, dizziness, confusion, headache, sedation, euphoria, increased ICP, seizures CV: Palpitations, bradycardia Hema: N/A Integ: Rash, urticaria, bruising, flushing, pruritis GI: N/V, cramps, anorexia, constipation, paralytic ileus GU: Urinary retention. EENT: Tinnitus, blurred vision, miosis, diplopia Contraindications: hypersensitivity
- Assess for anaphylaxis after administration. - Assess for jaundice: yellow sclera, clay colored stool. May indicate hepatic dysfunction. - Take without regard to meals, if GI upset occurs take with meals - Teach patient to report signs of toxicity such as blurred vision or tinnitus. - Teach pt to avoid aspirin, acetaminophen, NSAIDs, and alcohol without consulting with a physician.
- Assess LOC -Monitor B/P for hypertension - Can be taken without regard to meals. -Assist with ambulation during beginning stages of therapy because dizziness may occur.
- Assess renal function prior to administering - Administer with prescribed antiemetic for nausea - Teach safety measure: night-light, call bell within reach. - Treatment of OD with Naloxone (Narcan) 0.2-0.8 mg IV, O2, IV fluids
Drug: Meropenem ( Merrem) Dose: Route: Frequency: Rationale for client:
Functional class: Anti-infective Chemical class: Carbapenem Action: Bactericidal, interferes with cell wall replication of susceptible organisms; osmotically unstable cell wall swells, bursts from osmotic pressure.
Drug: Mesalamine , 5-ASA (Apriso, Asacol, Canasa, Lialda, Pentasa, Rowasa, Salofalk) Dose: Route: Frequency: Rationale for client:
Functional class: GI anti-inflammatory Chemical class: 5-Aminosalicylic acid Action: May diminish inflammation by blocking cyclooxygenase, inhibiting prostaglandin production in colon; local action only
Drug: Metaproterenol Dose: Route: Frequency: Rationale for client:
Functional class: Bronchodilator Chemical class: Selective B2-agonist Action: Relaxes bronchial smooth muscle by direct action of B2 adrenergic receptors with increased levels of cAMP
Side-Effects: CNS: Fever, seizures, dizziness, weakness, myoclonia, headache, confusion CV: Hypotension, palpatations, tachycardia Hema: Eosinophilia, neutropenia, decreased Hgb, Hct, agranulocytosis Integ: Rash, urticaria, pruritis, phlebitis, erythema at inj site GI: Diarrhea, N?V, psudomembranous colitis, hepatitis, glossitis GU: N/A EENT: N/A Contraindications: Hypersensitivity, breastfeeding Side-Effects: CNS: headache, fever, dizziness, insomnia, weakness CV: Pericarditis, myocarditis, chest pain Hema: N/A Integ: Rash, itching, acne GI: Cramps, gas, nausea, diarrhea GU: N/A EENT: Sore throat, cough pharyngitis, rhinitis Contraindications: Hypersensitivity Side-Effects: CNS: Tremors, anxiety, insomnis, headache, dizziness, stimulation CV: palpitations, tachycardia, hypertension, cardiac arrest Hema: N/A Integ: N/A GI: N/V, dry mouth GU: N/A EENT: N/A Contraindications: hypersensitivity, cardiac dysrhythmias
- Assess for allergies to penicillins, cephalosporins, or carbapenems. - Assess for anaphylaxis when administering - Assess for infection: temp, sputum, characteristics of wounds - Teach pt to report diarrhea - Treatment of anaphylaxis with epinephrine, antihistamines, resuscitate if needed.
- Assess for allergies - Usual course of therapy is 3-6 weeks - Assess therapeutic response
- Assess cardiac status -Administer 2 hr before bedtime to avoid sleeplessness. - Provide spacer device for geriatric patients
Drug: Metformin (Fortamet, Glucophage, Glumetza, Novo-metformin) Dose: Route: Frequency: Rationale for client:
Functional class: Antidiabetic, oral Chemical class: Biguanide Action: Inhibits hepatic glucose production and increases sensitivity of peripheral tissue to insulin
Drug: Methadone (Dolophine, methadone, Methadose) Dose: Route: Frequency: Rationale for client:
Functional class: Opioid Analgesic Chemical class: Synthetic diphenylheptane derivative Action: Depresses pain impulses transmission at the spinal cord level by interacting with opioid receptors, produces CNS depression
Drug:Methimazole Dose: Route: Frequency: Rationale for client:
Functional class: Thyroid hormone antagonist (antithyroid) Chemical class: Thioamide Action: Inhibits synthesis of thyroid hormones by decreasing iodine use in manufacture of thyroglobin and iodothyronine
Drug:Methocarbamol (Relaxin) Dose: Route: Frequency: Rationale for client:
Functional class: Skeletal muscle relaxant Chemical class: Carbamate derivative Action: Depresses multisyaptic pathways in the spinal cord, causing skeletal muscle relaxation
Side-Effects: CNS: Headache, weakness, dizziness, drowsiness, fatigue, vertigo CV: Heart failure Hema: Thrombocytopenia, decreased vit B12 levels Integ: Rash GI: N/V, diarrhea, heartburn, anorexia, metallic taste GU: N/A EENT: N/A Contraindications: Hypersensitivity, hepatic disease Side-Effects: CNS: Drowsiness, dizziness, confusion, headache, sedation, euphoria, seizures CV: palpitations, bradycardia, cardiac arrest Hema: N/A Integ: Rash, bruising, flushing GI: N/V anorexia, constipation, cramps GU: Increased urinary output EENT: tinnitus, blurred vision diplopia Contraindications: Hypersensitivity Side-Effects: CNS: Drowsiness, headache, vertigo, fever CV: N/A Hema: Agranulocytosis, leucopenia, thrombocytopenia, vasculitis Integ: Rash, urticaria, pruritis, alopecia, hyperpigmentation GI: Nausea, diarrhea, vomiting, jaundice, hepatitis GU: nephritis EENT: N/A Contraindications: Pregnancy, breastfeeding, hypersensitivity Side-Effects: CNS: dizziness, weakness, drowsiness, depression CV: Postural hypotension, bradycardia Hema: Hemolysis, increased hemoglobin leukopenia Integ: Rash, pruritis, fever, flushing GI: N/V, hiccups, anorexia, metallic taste, dyspepsia GU: Brown, black, green urine EENT: Diplopia, temporary loss of vision, blurred vision Contraindications: hypersensitivity
- Assess for hypoglycemic reactions: sweating, dizziness, anxiety, tremors, hunger - Assess for lactic acidosis: malaise, myalgia, abdominal distress - Given with meals
- Withdrawal symptoms may occur: nausea, vomiting, cramps, fever, faintness, anorexia - Treatment of overdose with Naloxone (Narcan) - Provide safety measures: night light, call light within reach -Assess respiratory status
- Daily weight - Assess for allergic reaction - Assess for bone marrow depression
- Assess for allergic reactions - Teach patient that urine may turn green brown or black - Teach not to take with alcohol - Treatment of overdose with activated charcoal, dialysis, have epinephrine, antihistamines, and corticosteroids available - Do not give sub-q
Drug: Methotrexate (Rheumatrex, Trexall) Dose: Route: Frequency: Rationale for client:
Functional class: Antineoplasticantimetabolite Chemical class: Folic acid antagonist Action: Inhibits an enzyme that reduces folic acid, which is needed for nucleic acid synthesis in all cells
Drug: Methylcellulose (Citrucel) Dose: Route: Frequency: Rationale for client:
Functional class: Laxative, bulk-forming Chemical class: Hydrophilic semisynthetic cellulose derivative Action: Attracts water, expands in intestine to increase peristalsis; also absorbs excess water in stool; decreases diarrhea
Drug: Methyldopa/ Methyldopate (Dopamet, Functional class: Antihypertensive Novo-medopa) Chemical class: Centrally acting Dose: adrenergic inhibitor Route: Action: Stimulates central inhibitory aFrequency: adrenergic receptors or acts as false Rationale for client: transmitter, resulting in reduction of arterial pressure
Side-Effects: CNS: Dizziness, seizures, leukoencephalopathy, headache, confusion CV: N/A Hema: Leukopenia, thrombocytopenia, anemia Integ: Rash, urticaria, alopecia, dry skin, photosensitivity GI: N/V, anorexia, diarrhea, ulcerative stomatitis, hepatotoxicity, GI hemorrhage, acute toxicity GU: Urinary retention, renal failure, hematuria EENT: Blurred vision, optic neuropathy Contraindications: hypersensitivity, HIV Side-Effects: CNS: N/A CV: N/A Hema: N/A Integ:N/A GI: obstruction, abdominal distention GU: N/A EENT: N/A Contraindications: Hypersensitivity, GI obstruction, hepatitis Side-Effects: CNS: Drowsiness, dizziness, weakness, headache, sedation CV: myocarditis, bradycardia, orthostatic hypotension, CHF, angina, edema Hema: Leukopenia, anemia Integ: Rash, toxic epidermal necrolysis GI: N/V, diarrhea, constipation, hepatic dysfunction, sor or black tongue, pancreatitis GU: Imptoence, failure to ejaculate EENT: nasal congestion Contraindications: active hepatic disease, hypersensitivity
- Assess for symptoms indicating sever allergy: rash, urticaria, itching, flushing - Assess buccal cavity for sores or ulcerations - Assess for hepatotoxicity: jaundice, yellow sclera, dark urine, clay colored stools - Teach pt that hair may be lost during treatment - Teach pt to avoid foods with citric acid, hot or rough texture - Teach pt to consume 10-12 glasses of fluid/day
- Assess I&O - Teach to increase fluid intake - Assess for cramping, rectal bleeding, nausea, vomiting. Product should be discontinued
- Assess for allergic reaction: rash, fever, pruritis - Teach pt not to discontinue product abruptly - Teach that compliance is necessary: not to skip or stop product unless directed by a physician - Treatment of overdose: gastric evacuation, hemodialysis
Drug: Methylergonovine (Methergine) Dose: Route: Frequency: Rationale for client:
Functional class: Oxytocic Chemical class: Ergot alkaloid Action:Stimulates uterine, vascular, smooth muscle, causing contractions, decreases bleeding; arterial vasoconstriction
Drug: Methylnaltrexone (Relistor) Dose: Route: Frequency: Rationale for client:
Functional class: Opioid Antagonist Chemical class: Action: Peripheral mu-opioid receptor antagonist that reduces constipation associated with opiate agonists
Drug: methylphenidate Dose: Route: Frequency: Rationale for client:
Functional class: cerebral stimulant Chemical class: piperidine derivative Action: increases release of norepinephrine, dopamine in cerebral cortex to reticular activating system; exact action not known
Side-Effects: CNS: Headache, dizziness, seizures CV: Hypotension, dysrhythmias, CVA Hema: N/A Integ: Sweating, rash GI: Nausea, vomiting GU: Cramping EENT: Tinnitus Contraindications: Pregnancy, hypertension, repiratory, cardiac disease, CAD, eclampsia, MI, neonates, Raynauds disease, stroke,sepsis, stroke, Buergers disease, thrombophlebitis, seizure disorders Side-Effects: CNS: Dizziness, migraines, obsessive compulsive disorder CV: N/A Hema: N/A Integ: N/A GI: Nausea, vomiting, diarrhea, flatulence, abdominal pain GU: N/A EENT: N/A Contraindications: Hypersensitivity, GI obstruction, IV route Side-Effects: CNS: hyperactivity, insomnia, restlessness, talkativeness, dizziness, drowsiness, toxic psychosis, headache, akathisia, dyskinesia, masking or worsening or Gilles de la Tourettes syndrome, seizures, hallucinations, malignant neuroleptic syndrome CV: palpitations, tachycardia, BP changes, angina, dysrhythmias Endo: growth retardation Hema: leukopenia, anemia, thrombocytopenic purpura Integ: exfoliative dermatitis, urticaria, rash, erythema multiforme, hypersensitivity reactions GI: nausea, anorexia, dry mouth, weight loss abdominal pain Misc: fever, arthralgia, scalp hair loss Contraindications: children < 6 yr, hypersensitivity, anxiety, history if Gilles de la Tourettes syndrome, glaucoma, anorexia nervosa, tartrazine dye hypersensitivity
- Assess for ergot toxicity: tinnitus, hypertension, palpitations, chest pain, nausea, vomiting, weakness, cold/numb extremities - Administer only during 4th stage of labor; not to be used to augment labor - Teach pt to report increased blood loss, severe abdominal cramps or foul-smelling lochia - Teach pt not to breastfeed -Assess uterine height and firmness
- Administer sub-q only -Do not administer IV - Teach pt not to drive or operate machinery until effect is known
Drug: Methylprednisolone Dose: Route Frequency: Rationale for client:
Functional class: corticosteroid, synthetic Chemical class: Glucocorticoid, immediate acting Action: Decrease inflammation, increasing capillary permeability and lysomal stabilization.
Drug: metoclopramide Dose: Route: Frequency: Rationale for client:
Functional class: cholinergic, antiemetic Chemical class: central dopamine receptor antagonist Action: enhances response to acetylcholine of tissue in upper GI tract causing contraction of gastric muscle; relaxes pyloric, duodenal segments; increases peristalsis without stimulation secretions, blocks dopamine in chemoreceptor trigger zone of CNS
Side-Effects: CNS: Mood changes, depression, diaphoresis, flushing, sweating, headache CV: hypertension, thrombosis, tachycardia, circulatory collapse, thrombophlebitis, embolism Hema: thrombocytopenia Integ: petechaie, acne, poor wound healing, ecchymosis MS: fractures, osteoporosis, weakness GI: diarrhea, nausea, abdominal distention, GI hemorrhage, increase appetite, pancreatitis EENT: Fungal infections, blurred vision, increased intraocular pressure, cataracts Contraindications: hypersensitivity, Cushings syndrome, measles, varicella, fungal infections Side-Effects: CNS: sedation, fatigue, restlessness, headache, sleeplessness, dystonia, dizziness, drowsiness, suicide ideation, seizures, EPS, neuroleptic malignant syndrome, tardive dyskinesia CV: hypotension, supraventricular tachycardia Hema: neutropenia, leukopenia, agranulocytosis Integ: urticaria, rash GI: dry mouth, constipation, nausea, anorexia, vomiting, diarrhea GU: decreased libido, prolactin secretion, amenorrhea, galactorrhea Contraindications: hypersensitivity to procaine or procainamide, seizure disorder, pheochromocytoma, breast cancer, GI obstruction
Drug: metolazone Dose: Route: Frequency: Rationale for client:
Functional class: diuretic, antihypertensive Chemical class: thiazide-like quinazoline derivative Action: acts on distal tubule by increasing excretion of water, sodium, chloride, potassium, magnesium, and bicarbonate
Drug: metoprolol Dose: Route: Frequency: Rationale for client:
Functional class: antihypertensive, antianginal Chemical class: beta 1 blocker Action: lowers BP by beta blocking effects; reduces elevated renin plasma levels; blocks beta 2 adrenergic receptors in bronchial, vascular smooth muscle only at high doses, negative chronotropic effect
Side-Effects: CNS: anxiety, depression, headache, dizziness, fatigue, weakness CV: orthostatic hypotension, palpitations, volume depletion, hypotension, chest pain Hema: aplastic anemia, hemolytic anemia, leukopenia, agranulocytosis, neutropenia Integ: rash, urticaria, purpura, photosensitivity, fever, dry skin GI: nausea, vomiting, anorexia, constipation, diarrhea, cramps, pancreatitis, GI irritation, dry mouth, jaundice GU: urinary frequency, polyuria, uremia, glucosuria, nocturia, impotence EENT: blurred vision Elect: hypokalemia, hypercalcemia, hyperponatremia Meta: hyperglycemia, increased creatinine and BUN MS: muscle cramps, joint pain, swelling Contraindications: hypersensitivity to thiazides or sulfonamides, anuria Side-Effects: CNS: insomnia, dizziness, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confusion, fatigue CV: hypotension, bradycardia, CHF, palpitations, dysrhythmias, cardiac arrest, AV block, pulmonary/peripheral edema, chest pain Hema: agranulocytosis, eosinophilia, thrombocytopenia, purpura Integ: rash, purpura, alopecia, dry skin, urticaria, pruritus GI: nausea, vomiting, colitis, cramps, diarrhea, constipation, flatulence, dry mouth, hiccups GU: impotence Resp: bronchospasm, dyspnea, wheezing Contraindications: hypersensitivity to beta blockers, cardiogenic shock, heart block, sinus bradycardia, pheochromocytoma, sick sinus syndrome
Drug: metronidazole Dose: Route: Frequency: Rationale for client:
Functional class: antiinfective Chemical class: nitromidazole derivative Action: direct-acting amebicie/trichomonacide binds, disrupts DNA structure inhibiting bacterial nucleic acid synthesis
Side-Effects: CNS: headache, dizziness, confusion, irritability, restlessness, ataxia, depression, fatigue, drowsiness, insomnia, paresthesia, peripheral neuropathy, seizures, incoordination, depression, encephalopathy CV: flattening of T waves Hema: leukopenia, bone marrow depression, aplasia Integ: rash, pruritus, urticaria, flushing GI: nausea, vomiting, diarrhea, epigastric distress, anorexia, constipation, abdominal cramps, pseudomembranous colitis GU: darkened urine, vaginal dryness, polyuria, albuminuria, dysuria, cystitis, decreased libido, neurotoxicity, incontinence, dyspareunia, candidiasis EENT: blurred vision, sore throat, retinal edema, dry mouth, metallic taste, furry tongue, glossitis, stomatitis, photophobia Contraindications: pregnancy 1st trimester, breastfeeding, hypersensitivity, GI/renal/hepatic disease, contracted visual or color fields, blood dyscrasias, CNS disorders
Drug: mexiletine Dose: Route: Frequency: Rationale for client:
Functional class: antidysrhythmic; class IB Chemical class: lidocaine analog Action: increased electrical stimulation threshold of ventricle, His-Purkinje system, which stabilizes cardiac membrane
Drug: micafungin Dose: Route: Frequency: Rationale for client:
Functional class: antifungal, systemic Chemical class: echinocandin Action: inhibits and essential component in fugal cell walls; causes direct damage to fungal cell wall
Side-Effects: CNS: headache, dizziness, confusion, seizures, tremors, psychosis, nervousness, paresthesias, weakness, fatigue, coordination difficulties, change is sleep habits CV: hypotension, bradycardia, angina, PVCs, heart block, CV collapse or arrest, sinus node slowing, left ventricular failure, syncope, cardiogenic shock, AV conduction disturbances, CHF, atrial dysrhythmias, ventricular tachycardia, other ventricular arrhythmias in acute phase of MI Hema: thrombocytopenia, leukopenia, agranulocytosis Integ: rash, alopecia, dry skin GI: nausea, vomiting, anorexia, diarrhea, abdominal pain, hepatitis, dry mouth, peptic ulcer, altered taste, GI bleeding, constipation GU: urinary hesitancy, decreased libido EENT: blurred vision, tinnitus Misc: edema, arthralgia, fever, SLE syndrome Resp: dyspnea Contraindications: hypersensitivity, cardiogenic shock, severe heart block Side-Effects: CNS: seizures, dizziness, headache, somnolence CV: flushing, hypertension, phlebitis Hema: neutropenia, thrombocytopenia, leukopenia, coagulopathy, anemia, hemolytic anemia Integ: rash, pruritus, inj site pain GI: abdominal pain, nausea, anorexia, vomiting, diarrhea, increase AST, ALT, alk phos, blood dehydrogenase, hyperbilirubinemia Meta: hypokalemia, hypocalcemia, hypomagnesemia MS: rigors Contraindications: hypersensitivity
Drug: midazolam Dose: Route: Frequency: Rationale for client:
Functional class: sedative, hypnotic, antianxiety Chemical class: benzodiazepine, shortacting Action: depresses subcortical levels in CNS
Drug: midodrine Dose: Route: Frequency: Rationale for client:
Functional class: vasopressor Chemical class: alpha 1 agonist Action: activates alpha adrenergic receptors of arteriolar, venous vasculature by increasing vascular tone
Drug: miglitol Dose: Route: Frequency: Rationale for client:
Functional class: oral hypoglycemic Chemical class: alpha glucosidase inhibitor Action: delays digestion and absorption of ingested carbohydrates, resulting in smaller rise in BG after meals
Side-Effects: CNS: retrograde amnesia, euphoria, confusion, headache, anxiety, insomnia, slurred speech, paresthesia, tremors, weakness, chills, agitation, paradoxical reactions CV: hypotension, PVCs, tachycardia, bigeminy, nodal rhythm, cardiac arrest Integ: urticaria, pain at inj site, swelling at inj site, rash, pruritus at inj site GI: nausea, vomiting, increased salivation, hiccups EENT: blurred vision, nystagmus, diplopia, loss of balance Resp: coughing, apnea, bronchospasm, laryngospasm, dyspnea, respiratory depression Contraindications: pregnancy (D), hypersensitivity to benzos, acute closeangle glaucoma, status asthmaticus Side-Effects: CNS: drowsiness, restlessness, headache, paresthesia, pain, chills, confusion CV: supine hypertension, vasodilation, flushing face Integ: pruritus, piloerection, rash GI: nausea, anorexia GU: dysuria EENT: dry mouth, blurred vision Contraindications: hypersensitivity, acute renal disease, pheochromocytoma, thyrotoxicosis, urinary retention Side-Effects: Hema: low iron Integ: rash GI: abdominal pain, diarrhea, flatulence, hepatotoxicity Contraindications: hypersensitivity, DKA, cirrhosis, inflammatory bowel disease, colonic ulcerations, partial intestinal obstruction, chronic intestinal disease, ileus
Drug: milrinone Dose: Route: Frequency: Rationale for client:
Functional class: inotropic/vasodilator agent with phosphodiesterase activity Chemical class: bipyridine derivative Action: positive inotropic agent, increases contractility of cardiac muscle with vasodilator properties; reduces preload and afterload by direct relaxation on vascular smooth muscle Functional class: broad-spectrum antiinfective Chemical class: tetracycline Action: inhibits protein synthesis, phosphorylation in microorganisms by binding to 30S ribosomal subunits; bacteriostatic
Drug: minocycline Dose: Route: Frequency: Rationale for client:
Side-Effects: CV: dysrhythmias, hypotension, chest pain Hema: thrombocytopenia GI: nausea, vomiting, anorexia, abdominal pain, hepatotoxicity, jaundice Misc: headache, hypokalemia, tremor, inj site rations Contraindications: hypersensitivity, severe aortic disease, severe pulmonic valvular disease, acute MI Side-Effects: CNS: dizziness, fever, light-headedness, vertigo, seizures, increased intracranial pressure CV: pericarditis Hema: eosinophilia, neutropenia, thrombocytopenia, hemolytic anemia, pancytopenia Integ: rash, urticaria, photosensitivity, increased pigmentation, exfoliative dermatitis, pruritus, blue-gray color of skin/mucous membranes GI: nausea, abdominal pain, vomiting, diarrhea, anorexia, enterocolitis, hepatotoxicity, flatulence, abdominal cramps, epigastric burning, stomatitis GU: increased BUN, polyuria, polydipsia, renal failure, nephrotoxicity EENT: dysphagia, glossitis, decreased calcification of deciduous teeth, permanent discoloration of teeth, oral candidiasis MS: myalgia, arthritis, bone discoloration, joint stiffness Syst: angioedema, Stevens-Johnson syndrome Contraindications: pregnancy (D), children < 8 yrs, hypersensitivity
Drug: minoxidil Dose: Route: Frequency: Rationale for client:
Functional class: antihypertensive Chemical class: vasodilator, peripheral Action: directly relaxes arteriolar smooth muscle, causing vasodilation
Drug: mirtazapine Dose: Route: Frequency: Rationale for client:
Functional class: antidepressant Chemical class: tetracyclic Action: blocks reuptake of norepinephrine, serotonin into nerve endings, increasing action of norepinephrine, serotonin n nerve cells, antagonist of central alpha 2 receptors, blocks histamine receptors
Drug: misoprostol Dose: Route: Frequency: Rationale for client:
Functional class: gastric mucosa protectant, antiulcer Chemical class: prostaglandin E1 analog Action: inhibits gastric acid secretion; may protect gastric mucosa; can increase bicarbonate, mucus production
Side-Effects: CNS: headache, fatigue CV: severe rebound hypertension on withdrawal in children, tachycardia, angina, increased T wave, CHF, pulmonary edema, pericardial effusion, edema, Na and water retention Hema: Hct, Hgb, erythrocyte count my decrease initially Integ: pruritus, Stevens-Johnson syndrome, rash, hirsutism GI: nausea, vomiting GU: breast tenderness Contraindications: dissecting aortic aneurysm, hypersensitivity, pheochromocytoma Side-Effects: CNS: dizziness, drowsiness, confusion, headache, anxiety, tremors, stimulation, weakness, nightmares, EPS, increased psychiatric symptoms, seizures CV: orthostatic hypotension, ECG changes, tachycardia, hypertension, palpitations Hema: agranulocytosis, thrombocytopenia, eosinophilia, leukopenia Integ: rash, urticaria, sweating, pruritus, photosensitivity GI: diarrhea, dry mouth, nausea, vomiting, paralytic ileus, increased appetite, cramps, epigastric, distress, constipation, jaundice, hepatitis, stomatitis GU: urinary retention, acute renal failure EENT: blurred vision, tinnitus, mydriasis Syst: flulike symptoms, increased cholesterol levels Contraindications: hypersensitivity, recovery phase of MI, agranulocytosis, jaundice Side-Effects: GI: diarrhea, nausea, vomiting, flatulence, constipation, dyspepsia, abdominal pain GU: spotting, cramps, hypermenorrhea, menstrual disorders Contraindications: hypersensitivity
Drug: mitomycin Dose: Route: Frequency: Rationale for client:
Functional class: antineoplastic, antibiotic Action: inhibits DNA synthesis, primarily; derived from Streptomyces caespitosus; appears to cause cross-linking of DNA, a vesicant
Drug: mitoxantrone Dose: Route: Frequency: Rationale for client:
Functional class: antineoplastic, antiinfective, immunomodulator Chemical class: synthetic anthraquinone Action: DNA reactive agent, cytocidal effect of both proliferating and nonproliferating cells, topoisomerase II inhibitor (vesicant)
Side-Effects: CNS: fever, headache, confusion, drowsiness, syncope, fatigue Hema: thrombocytopenia, leukopenia, anemia Integ: rash, alopecia, extravasation, nail discoloration GI: nausea, vomiting, anorexia, stomatitis, hepatotoxicity, diarrhea GU: urinary retention, renal failure, edema EENT: blurred vision Misc: hemolytic uremic syndrome, CHF Resp: fibrosis, pulmonary infiltrate, dyspnea Contraindications: pregnancy (D) 1st trimester, breastfeeding, hypersensitivity, coagulation disorders Side-Effects: CNS: headache, seizures, fatigue CV: CHF, cardiopathy, dysrhythmias Hema: thrombocytopenia, leukopenia, myelosuppresion, anemia, secondary leukemia Integ: rash, necrosis at inj site, dermatitis, thrombophlebitis at inj site, alopecia GI: nausea, vomiting, diarrhea, anorexia, mucositis, hepatotoxicity GU: amenorrhea, menstrual disorders EENT: conjunctivitis, blue/green sclera, blurred vision Misc: fever Resp: cough, dyspnea Contraindications: pregnancy (D), hypersensitivity
Drug: modafinil Dose: Route: Frequency: Rationale for client:
Functional class: CNS stimulant Chemical class: racemic compound Action: similar action as sympathomimetics, doesnt alter release of dopamine, norepinephrine
Drug: moexipril Dose: Route: Frequency: Rationale for client:
Functional class: antihypertensive Chemical class: angiotensin-converting enzyme inhibitor Action: selectively suppresses reninangiotensin-aldosterone system; inhibits ACE; prevents conversion of angiotensin I to angiotensin II; results in dilation of arterial, venous vessels
Drug: montelukast Dose: Route: Frequency: Rationale for client:
Functional class: bronchodilator Chemical class: leukotriene antagonist, cysteinyl Action: inhibits leukotriene (LTD4) formation
Side effects: CNS: headache, anxiety, cataplexy, depression, dizziness, insomnia, amnesia, confusion, ataxia, tremors, paresthesia, dyskinesia, suicidal ideation CV: dysrhythmias, hyper/hypotension, chest pain, vasodilation EENT: change in vision, rhinitis, pharyngitis, epistaxis GI: nausea, vomiting, changes in LFTs, anorexia, diarrhea, thirst, mouth ulcers GU: ejaculation disorder, urinary retention, albuminuria HEMA: eosinophilia INTEG: rash, dry skin, herpes simples, Stevens-Johnson syndrome Misc: infection, hyperglycemia, neck pain Contraindications: hypersensitivity, ischemic heart disease, left ventricular hypertrophy, chest pain, dysrhythmias Side effects: CNS: fever, chills CV: hypotension, postural hypotension GI: loss of taste GU: impotence, dysuria, nocturia, proteinuria, nephrotic syndrome, acute reversible renal failure, polyuria, oliguria, frequency Hema: neutropenia Integ: rash Meta: hypokalemia Resp: bronchospasm, dyspnea, dry cough Syst: angioedema, anaphylaxis Contraindications: breastfeeding, children, hypersensitivity, heart block, bilateral renal stenosis, hx of angioedema Side effects: CNS: dizziness, fatigue, headache, behavior changes, suicidal ideation, suicide, hallucinations, seizures, agitation, anxiety, depression, fever GI: abdominal pain, dyspepsia, nausea, vomiting, diarrhea Integ: rash MS: asthenia Resp: influenza, cough, nasal congestion Syst: anaphylaxis, angioedema Contraindications: hypersensitivity
Drug: morphine Dose: Route: Frequency: Rationale for client:
Functional class: opioid analgesic Chemical class: alkaloid Action: depresses pain impulse transmission at the spinal cord level by inter-acting with opioid receptors
Drug: moxifloxacin Dose: Route: Frequency: Rationale for client:
Functional class: Antiinfective Chemical class: Fluoroquinolone Action: Interferes with DNA in bacteria, DNA inhibitor
Side effects: CNS: drowsiness, dizziness, confusion, headache, sedation, euphoria, insomnia, seizures CV: palpitations, bradycardia, change in BP, shock, cardiac arrest, chest pain, hypo/hypertension, edema, tachycardia EENT: tinnitus, blurred vision, miosis, diplopia GI: nausea, vomiting, anorexia, constipation, cramps, bilary tract pressure GU: urinary retention Hema: thrombocytopenia Integ: rash, urticaria, bruising, flushing, diaphoresis, pruritus Resp: respiratory depression, respiratory arrest, apnea Contraindications: hypersensitivity, opioid addiction, hemorrhage, bronchial asthma, increased intracranial pressure Side-Effects: CNS: Headache, seizures, intracranial pressure, peripheral neuropathy CV: Dysrhythmia, Prolonged QT intervals Integ: Pruritus, photosensitivity GI: oral candidiasis, n/v/d EENT: blurred vision, tinnitus Contraindications: Can cause tendon pain or rupture.
Drug: mycophenolate Dose: Route: Frequency: Rationale for client:
Functional class: immunosuppressant Action: inhibits inflammatory responses that are mediated by the immune system; prolongs the survival of allogenic transplants
Drug: Nabilone (Cesamet)
Functional class: Antiemetic
Dose: Chemical class: Cannabinoid- misc. Route (Give timing for IV push/IVPB meds): Action: Orally, active cannabinoid, Frequency: chemically related to marijuana; may Rationale for client: Decrease N/V decrease nausea by action on cannabinoid associated with chemotherapy receptors in the CNS.
Side effects: CNS: tremors, dizziness, insomnia, headache, fever, progressive multifocal leukoencephalopathy CV: hypertension, chest pain GI: diarrhea, constipation, nausea, vomiting, stomatitis, GI bleeding GU: UTI, hematuria, renal tubular necrosis Hema: leukopenia, thrombocytopenia, anemia, pancytopenia, pure red cell aplasia Integ: rash Meta: peripheral edema, hypercholesterolemia, hypophosphatemia, edema, hyperkalemia, hypomagnesemia, hypocalcemia MS: arthralgia, muscle wasting Resp: dyspnea, respiratory infection, increased cough, pharyngitis, bronchitis, pneumonia Syst: lymphoma, nonmelanoma skin carcinoma, sepsis Contraindications: hypersensitivity Side-Effects: CNS: HA, drowsiness, sleep disturbance, vertigo, depression, hallucinations CV: Chest discomfort, tachycardia, orthostatic hypotension Hema: Integ: Allergic reactions, rash, photosensitivity, pruritus GI: Dry mouth, nausea, anorexia, increased appetite GU: EENT: Contraindications: Hypersensitivity to cannabinoids
Preg. C. Assess for: Absence of N/V during chemotherapy; CNS symptoms (HA, depression, drowsiness, etc.); CV symptoms and cardiac status (tachycardia, orthostatic hypo/hypertension); Psychiatric symptoms (euphoria, depression, sleep disturbance) Mood and behavioral changes may occur; notify doctor if pregnancy is suspected and avoid breastfeeding; No alcohol or other CNS depressants to be used while talking. Not to be used on an as-needed basis
Drug: Nabumetone
Functional class: Non-steroidal Antiinflammatory
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Acetic acid derivative Frequency: Rationale for client: Decrease pain and stiffness in joints Action: Metabolite inhibits COX-1, COX2 by blocking arachidonate; analgesic, anti-inflammatory, antipyretic.
Side-Effects: CNS: Dizziness, HA, tremors, confusion, insomnia, anxiety, depression, nervousness CV: Tachycardia, peripheral edema, palpitations, dysrhythmias, CHF, MI, stroke Hema: Blood dyscrasias Integ: Purpura, rash, pruritis, sweating, photosensitivity GI:NVD, anorexia, jaundice, constipation, flatulence, cramps, dry mouth peptic ulcer, gastritis GU: Nephrotoxicity, dysuria, hematuria, oliguria EENT: Tinnitus Contraindications: Preg. D (3rd trimester) hypersensitivity to aspirin, iodides, NSAIDS Side-Effects: CNS: Depression, dizziness, fatigue, lethargy, HA, insomnia, memory loss, nightmares CV: Bradycardia, hypotension, CHF, palpitations, AV block, chest pain, flushing, edema, vasodilation Hema: Agranulocytosis, thrombocytopenia Integ: Rash, fever, alopecia GI: NVD, constipation, cramps, dry mouth, flatulence, pancreatitis, taste distortion GU: Impotence, decreased libido EENT: Blurred vision, dry eyes, nasal congestion Contraindications: Cardiac failure, cardiogenic shock, 2nd/3rd degree heart block, bronchospastic disease, sinus bradycardia, CHF, COPD
Drug: Nadolol
Functional class: Antihypertensive, antianginal
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Beta-Adrenergic receptor blocker Frequency: Rationale for client: Decrease BP, HR, and Action: Long-acting, nonselective Betasymptoms of angina adrenergic receptor blocking agent, blocks Beta1 in the heart and Beta2 in the lungs, uterus, and circulatory system; mechanism is similar to that of propranolol.
BBW: Perioperative pain in CABG surgery, MI, stroke, GI bleeding Preg. C; Assess: Cardiac status, GI status, Pain (frequency, intensity, characteristics, relief after med.); Asthma, aspirin sensitivity, or nasal polyps. Renal/Hepatic studies: BUN, creatinine, AST, ALT, Hgb, LDH, blood glucose, WBC, platelets. Avoid alcohol and aspirin, report blurred vision, ringing in ears, avoid driving, report a change in urine pattern, increased weight, edema. Take with full glass of water and sit upright for 30 minutes. Report dark stools; may indicate GI bleed. Use sunscreen and protective clothing. Give w/ food if GI symptoms occur. Therapeutic effects may take up to1 month. BBW: Abrupt discontinuation Assess: BP, pulse, RR during therapy. Ortho. Hypo. may occur; Weigh dailyreport gain of 5lb; I/O ratio; Pain. May mask S/S of hypoglycemia or alter BG in diabetics. **DO NOT discontinue abruptly, serious dsyrhythmias may occur. Administer w/ 8oz. of water. Avoid OTC products unless prescriber approves. Rise slowly to prevent Ortho/hypo Teach how and when to check BP and pulse. **Hold dose and contact prescriber if pulse < 50 bpm, systolic BP <90 mm HG.
Drug: Nafarelin (Synarel)
Functional class: Gonadotropin
Dose: Chemical class: Analog of gonadotropinRoute (Give timing for IV push/IVPB meds): releasing hormone Frequency: Rationale for client: To decrease symptoms of endometriosis; adequate resolution of central precocious puberty Action: Stimulates the release of LH and FSH, which increases ovarian steroid production; repeated dosing prevents stimulation of the pituitary gland
Side-Effects: CNS: HA, flushing, depression, insomnia, hot flashes, CV: Hema: Integ: Acne GI: GU: Decreased libido, vaginal dryness, breast tenderness, increased pubic hair, impaired fertility, reduction in breast size, absence of menses, impotence, irregular periods EENT: Contraindications: Pregnancy X, breastfeeding, ; undiagnosed vaginal bleeding
Drug: Nafcillin
Functional class: Anti-Infective, broad spectrum
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Penicillinase-resistant penicillin Frequency: Rationale for client: Used for absence of Action: Interferes with cell wall fever and draining wounds replication of susceptible organisms; cell lysis mediated by cell wall autolytic enzymes. **Effective on gram-positive cocci.
Side-Effects: CNS: Lethargy, hallucinations, anxiety, depression, coma, seizures CV: Hema: Anemia, increased bleeding time, bone marrow depression Integ: GI: NVD, increased AST, ALT, abdominal pain, glossitis GU: Oliguria, proteinuria, hematuria, vaginitis, glomerulonephritis EENT: Contraindications: Hypersensitivity to penicillin or corn.
Assess: Abdominal pain (endometriosis) during treatment; endocrine studies, bone age, sex steroids, RHCg, GnRH, baseline q8weeks. Test results: pituitary/hypothalamus dysfunction (decreased LH); postmenopausal (increased LH) Use a nonhormonal contraception. Teach correct nasal use: 1 spray in R. nostril in AM, 1 spray in L. nostril in PM for endometriosis. 2 sprays each nostril in AM & PM for central precocious puberty. Tilt head back slightly; wait 30 sec between sprays. Avoid nasal decongestants or separate by 12 hours. Teach that growth of facial hair, increased body odor, and vaginal discharge may occur in females. Preg. B. Assess: I/O ratio; report hematuria, oliguria since penicillin in high doses is nephrotoxic. Hepatic studies: AST, ALT Blood studies: WBC, RBC, Hct, Hgb, bleeding time. Renal Studies: urinalysis, protein, blood, BUN, creatinine C&S before therapy, Bowel pattern, and Respiratory status. *Monitor for allergic reactions AEB anaphylaxis, dyspnea, rash, laryngeal edema. Teach to report sore throat, fever, fatigue. Wear or carry emergency ID if allergic to penicillin **Anaphylaxis Treatment: Withdraw product; maintain airway; administer epinephrine, aminophylline, O2, IV corticosteroids.
Drug: Nalbuphine (Nalbuphine HCl)
Functional class: Opioid analgesic
Dose: Chemical class: Synthetic opioid agonist, Route (Give timing for IV push/IVPB meds): antagonist Frequency: Rationale for client: To decrease pain Action: Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors.
Side-Effects: CNS: Drowsiness, dizziness, confusion, HA, sedation, euphoria, dreaming, hallucinations, physical, psychological dependency CV: Palpitations, bradycardia, change in BP, Ortho/hypo, cardiac arrest Hema: Integ: Rash, uticaria, bruising, flushing, diaphoresis GI: NV, anorexia, constipation, cramps, abdominal pain, bitter taste GU: Increased urinary output, dysuria, urinary retention, urgency EENT: Tinnitus, blurred vision, miosis, diplopia Contraindications: Hypersensitivity, opioid addiction Side-Effects: CNS: Drowsiness, nervousness, seizures, tremors CV: Rapid pulse, increased systolic BP, Hypo/hypertension, cardiac arrest, sinus tachycardia Hema: Integ: GI: NV hepatotoxicity GU: EENT: Contraindications: hypersensitivity Side-Effects: CNS: Stimulation, drowsiness, dizziness, confusion, seizures, HA, flushing, hallucinations, nervousness, suicidal ideation, anxiety CV: Rapid pulse, pulmonary edema, HTN, DVT Hema: Integ: Rash, uticaria, bruising, oily skin, acne, pruritis, GI: NVD, heart burn, anorexia, hepatitis, constipation, abdominal pain GU: Delayed ejaculation, decreased potency EENT: Tinnitus, hearing loss, blurred vision Contraindications: Hypersensitivity, opioid dependence
Drug: Naloxone (Narcan)
Functional class: Opioid antagonist, antidote
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Thebaine derivative Frequency: Rationale for client: Reversal of Respiratory depression; LOC- alert Action: Competes with opioids at opiate receptor sites
Preg. C Assess: I/O ratio, bowel status: constipation is common. *Withdrawl reactions in opiate dependent individuals (PE, vascular occlusion, abscess, ulcerations, NV, seizures; however, low potential for dependence) CNS changes, Allergic reactions, Respiratory dysfunction (Notify prescriber if RR <10 bpm), Need for pain medication. Teach that physical dependency may result from long term use. Avoid CNS depressants, alcohol Avoid driving and operating heavy machinery. Administer w/ antiemetic if NV occur **Overdose Treatment: Naloxone (Narcan) 0.2-0.8 mg IV, O2, IV fluids, vasopressors Preg. C Assess: Withdrawl (cramping, HTN, anxiety, vomiting) VS q3-5min., ABGs including PO2, PCO2, Cardiac status, Respiratory dysfunction (RR <10 administer Naloxone), assess pain.
Drug: Naltrexone (ReVia, Vivitrol)
Functional class: Opioid antagonist
Dose: Chemical class: Thebaine derivative Route (Give timing for IV push/IVPB meds): Action: Competes with opioids at opiate Frequency: receptor sites Rationale for client: Block opiate ingestion; successful nicotine, alcohol withdrawl
BBW: Hepatic failure, hepatitis, hepatic disease Preg. C Assess: ABGs including PO2, PCO2, LFTs, VS q3-5min; Signs of withdrawl, cardiac status, respiratory dysfunction (<10bpm a stimulant should be given), Mental status. Teach that they must be drug free to start treatment. Using opioids while taking this product could be fatal. Carry an emergency ID stating med. being used. If surgery is needed, all involved should be made aware of this medication. Give w/ food, antacid to prevent NV Use caution while driving. Suicidal thoughts/behavior may occurreport immediately.
Drug: Nandrolone
Functional class: Androgenic anabolic steroid, antianemic
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Halogenated testosterone derivative Frequency: Rationale for client: To increase appetite and Action: May stimulate bone marrow stamina development, stimulates erythropoietin production, increased Hgb and RBCs
Drug: Naproxen
Functional class: NSAID, nonopioid analgesic
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Propionic acid derivative Frequency: Rationale for client: For decreased pain, stiffness, swelling in joints, ability to move more easily Action: Completely inhibits COX-1 and COX-2 by blocking arachidonate; analgesic, anti-inflammatory, antipyretic
Side-Effects: CNS: Dizziness, HA, fatigue, tremors, flushing, sweating, anxiety, insomnia, chills, depression CV: Increased BP, edema Hema: Integ: Rash, acneiform lesions, oily hair/skin, acne vulgaris, alopecia GI: NVD, weight gain, cholestatic jaundice, hepatic necrosis/failure, hepatitis GU: Hematuria, amenorrhea, vaginitis, decreased libido, decreased breast size, testicular atrophy, clitoral hypertrophy, voiding change, impotence EENT: Conjunctival edema, nasal congestion Contraindications: Pregnancy X, breastfeeding, severe cardiac disease, abnormal genital bleeding, males with breast cancer and prostate cancer, females Side-Effects: CNS: Dizziness, drowsiness, fatigue, tremors, confusion, insomnia, anxiety, depression CV: Tachycardia, peripheral edema, palpitations, dysrhythmias, stroke, MI Hema: Blood dyscrasias Integ: Purpura, rash, sweating, pruritus GI: NVD, jaundice, hepatitis, constipation, flatulence, GI ulceration, bleeding, perforation GU: Nephrotoxicity, dysuria, hematuria, oliguria EENT: Tinnitus, hearing loss, blurred vision Contraindications: Pregnancy D (2nd/3rd trimester), hypersensitivity to NSAIDs, salicylates; asthma, severe renal/hepatic disease, ulcer disease
BBW: Hepatic disease, hypercholesterolemia, hepatocellular cancer Assess: Anemia symptoms (dyspnea, fatigue, weakness, pallor) Daily weight (call MD if weekly weight gain is >5lb.) BP q4h. I/O ratio. Electrolytes: K, Na, Cl, Ca; cholesterol. Hepatic studies: AST, ALT, bilirubin. Blood studies: CBC, Hct, Hgb, lipid panel. Edema, HTN, cardiac symptoms, jaundice. Mental Status, signs of masculinization in females; S/S of hypercalcemia and hypoglycemia (in diabetics). Titrate dose; give lowest effective dose. **Do not discontinue abruptly Teach about changes in sex Characteristics. BBW: Perioperative pain in CABG surgery, MI, GI bleeding, stroke. Assess: Cardiac status, GI status, Characteristics of pain, Asthma, nasal polyps, or aspirin hypersensitivity. Renal/Hepatic studies: BUN, creatinine, AST, ALT, Hgb, LDH, blood glucose, Hct, WBC, platelets. For eye/ear problems (may indicate toxicity) Take w/ food to decrease GI symptoms; on empty stomach to facilitate absorption. OTC <10 days unless approved by MD. Use sunscreen to protect skin. Report blurred vision, ringing in ears. Report change in urine pattern. Therapeutic effects may take up to one month. Avoid ASA, alcohol, steroids, or other OTC meds. w/o MD approval. Report use to all HCP.
Drug: Naratriptan (Amerge)
Functional class: Anitmigraine agent, abortive
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: 5-HT1 receptor angonist, triptan Frequency: Rationale for client: To decrease the Action: Binds selectively to the vascular frequency and severity of migraine headaches 5-HT1 receptor subtype, exerts antimigraine effect; causes vasoconstriction in cranial arteries.
Side-Effects: CNS: Dizziness, sedation, fatigue CV: Increased BP, palpitations, tachydysrhythmias, ST/T wave changes, PVCs, coronary vasospasm Hema: Integ: GI: NV GU: EENT: EENT infections, photophobia Contraindications: Angina pectoris, history of MI, documented silent ischemia, heart disease, uncontrolled HTN, CV syndromes, hemiplegic/ basilar migraines, severe renal/ hepatic disease Side-Effects: CNS: HA, fatigue, rigors, depression, suicidal ideation, progressive multifocal leukoencephalopathy (PML), anxiety CV: Chest discomfort, hypo/HTN, tachycardia Hema: Integ: Rash, dermatitis, pruritus, skin melanoma GI: Abdominal discomfort, gastroenteritis, severe hepatic injury GU: Amenorrhea, UTI, irregular menses, vaginitis, urinary frequency EENT: Contraindications: HIV, AIDS, leukemia, lymphoma, transplants, PML, murine protein allergy
Drug: Natalizumab (Tysabri) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: To decrease symptoms of MS
Functional class: Biologic response modifier, immunoglobulins, monoclonal antibody Action: Action not clearly understood; biologic response modifying properties mediated through specific receptors on cells, may be secondary of blockade of the interaction by inflammatory cells on vascular endothelial cells.
Preg. C Assess: Migraine symptoms (aura duration, effect on lifestyle, aggravating/alleviating factors); Neurological status. Take w/ fluid as soon as symptoms appear. Report tightness in chest, neck, throat, jaw. Not to use with other 5-HT1 agonists or an ergot preparation has been used within last 24h. Avoid using >2/week. Rebound HA may occur. Give w/ fluids as soon as symptoms appear; may take another dose in 4hr Tell MD if pregnancy is planned or suspected. Avoid breastfeeding. BBW: Progressive Multifocal Leukoencephalopathy (PML) Preg. C Assess: Blood, renal, hepatic studies: CBC, differential, platelets, BUN, creatinine, ALT, urinalysis CNS symptoms, GI status, Mental status. **This medication should only be used for MS in patients who have not responded to other treatments. Teach that female patients may experience irregular menses or amenorrhea. Use sunscreen to protect the skin. Notify MD if pregnant or suspect pregnant. Avoid breastfeeding. Notify MD if an infection is present (sore throat, cough, increased temp.)
Drug: Nebivolol
Dose: Chemical class: Beta-1 Blocker Route (Give timing for IV push/IVPB meds): Action: Competitively blocks stimulation Frequency: of Beta-adrenergic receptors within Rationale for client: To decrease BP after 1-2 vascular smooth muscle; decreases rate of weeks, decrease dysrhythmias. SA node discharge, increases recovery time, slows conduction of AV node resulting in decreased HR, which decreases O2 consumption in myocardium due to Beta-1 receptor antagonism; also decreases rennin-aldosterone-angiotensin system at high doses, inhibits B-2 receptors in bronchial system (high doses)
Side-Effects: CNS: Insomnia, fatigue, dizziness, mental changes, HA CV: Bradycardia, MI, AV heart block, edema Hema: Thrombocytopenia Integ: Rash, pruritus, uticaria, angioedema GI: NVD, abdominal pain GU: Impotence EENT: Contraindications: Cardiogenic shock, heart failure, severe hepatic disease, severe bradycardia, sick sinus syndrome, AV heart block.
Drug: Nelarabine (Arranon)
Dose: Chemical class: Purine analog Route (Give timing for IV push/IVPB meds): Action: Leukemic blasts allow for Frequency: incorporation into DNA, thus interfering Rationale for client: To decrease the spread with cell replication leading to cell death. of malignancy.
Side-Effects: CNS: Dizziness, fatigue, insomnia, seizures, paralysis, HA, confusion, Guillain-Barre syndrome CV: Edema Hema: Neutropenia, thrombocytopenia, leukopenia Integ: GI:NVD, anorexia, constipation, stomatitis GU: EENT: Contraindications: Pregnancy D
Preg. C Assess: BP before and during treatment. Apical/radial pulse before giving med. (pulse <50 notify MD) Signs of CHF (crackles, weight gain, JVD). Baseline renal/hepatic function tests before and during treatment. Edema in feet/legs. I/O daily. Skin turgor, dry mucous membranes. **DO NOT discontinue this product abruptly; taper over 2 weeks. May mask S/S of hypoglycemia or alter BG levels. Dont use OTC products containing alphaadrenergic stimulants(cold preparations or nasal decongestants) Take pulse, BP at home. Comply with weight control, dietary adjustments, modified exercise program. W/o regards to meals; may be crushed or swallowed whole; give w/ food to prevent GI upset. **Overdose Treatment: Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, Digoxin, O2, diuretic for cardiac failure, IV glucose for hypoglycemia, IV diazepam for seizures, IV fluids, IV pressors BBW: Severe neurotoxicity, seizure disorder, IM administration, neurologic disease, peripheral neuropathy. Assess: CBC (RBC, Hct, Hgb), differential platelet count weekly; withhold product if WBC is <4,000/mm3, platelet count is <75,000/mm3, or RBC, Hct, Hgb low; call MD. Labs: BUN, creatinine, uric acid, urine, electrolytes, bilirubin, ALT, AST, alk phos. Watch for bleeding. Buccal cavity for dryness, GI symptoms. Use contraception while taking this. Avoid food with citric acid, hot or rough texture if stomatitis is present. Report signs of infection, anemia, bleeding, or numbness. Dont operate machinery; seizures may occur. Dont receive vaccinations while taking this product.
Drug: Nelfinavir (Viracept)
Functional class: Antiretroviral
Dose: Chemical class: HIV protease inhibitor Route (Give timing for IV push/IVPB meds): Action: Inhibits HIV-1 protease, which Frequency: prevents maturation of the infectious Rationale for client: virus.
Side-Effects: CNS: HA, poor concentration, seizures, suicidal ideation CV: Bleeding Hema: Anemia, leucopenia, thrombocytopenia Integ: Rash, dermatitis GI: ND, anorexia, dyspepsia, flatulence, hepatitis, pancreatitis GU: EENT: Contraindications: Hypersensitivity to protease inhibitors
Drug: Neostigmine
Functional class: Cholinergic stimulant; anti-cholinesterase
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Quaternary compound Frequency: Rationale for client: To increase muscle strength, hand grasp, improve gait, absence of labored breathing (if severe). Action: Inhibits destruction of acetylcholine, which increases concentration at sites where acetylcholine is released; this facilitates transmission of impulses across myoneural junction.
Drug: Nesiritide (Natrecor)
Functional class: Vasodilator
Dose: Chemical class: Human B-type natriuretic Route (Give timing for IV push/IVPB meds): peptide Frequency: Rationale for client: For improvement with CHF with improved: PCWP, RAP, MPAP Action: Uses DNA technology, human Btype natriuretic peptide binds to the receptor in vascular smooth muscle and endothelial cells, leading to smooth muscle relaxation.
Side-Effects: CNS: Dizziness, HA, sweating, weakness, seizures, paralysis, loss of consciousness CV: Tachycardia, dysrhythmias, bradycardia, hypotension, ECG changes, cardiac arrest, syncope Hema: Integ: Rash, uticaria, flushing GI: NVD, cramps, increased peristalsis, salivary and gastric secretions GU: Urinary frequency, incontinence, urgency EENT: Miosis, blurred vision, lacrimation, visual changes Contraindications: Obstruction in the intestine,, renal system, bromide sensitivity, peritonitis, urinary tract obstruction, ileus Side-Effects: CNS: HA, insomnia, dizziness, anxiety, confusion CV: Hypotension, tachycardia, bradycardia, dysrhythmias Hema: Integ: Rash, sweating, pruritus, GI: NV GU: EENT: Contraindications: Hypersensitivity to E. coli protein, cardiogenic shock, or BP <90 mm Hg as primary therapy.
Assess: resistance testing at initiation and failure of treatment. Signs of infection anemia; Hepatics studies: AST, ALT C&S before and after therapy. Bowel pattern changes, skin eruptions, Allergies before treatment. Blood studies: Serum lipid profile, plasma HIV, RNA, BG, viral load, CD4 cell counts baseline and throughout treatment. Avoid taking with other meds. Product does not cure, but manages symptoms. Use a non-hormonal form of birth control. Take w/ food. Report symptoms of hyperglycemia. Assess: VS, respirations q8h. I/O ratio; check for urinary retention or incontinence. Brady. hypotension, bronchospasm, HA, dizziness, seizures, respiratory depression discontinue if toxicity occurs. Product does not cure, but relieves symptoms. Avoid driving of operating machinery until effects are known. Report respiratory distress, cardiac dysrhythmias. Take on empty stomach for better absorption. **Overdose Treatment: Respiratory support, atropine 1-4 mg (IV), aggressive hydration. Assess: PCWP, RAP, cardiac index, MPAP. BP, pulse during treatment until stable. I/O, daily weight, serum creatinine, BUN. For CHF: weight gain, dyspnea, crackles. Explain purpose of medication and expected results. Report dizziness, blurred vision, lightheadedness, or sweating.
Drug: Nevirapine (Viramune)
Functional class: Antiretroviral
Dose: Chemical class: Nonnucleoside reverse Route (Give timing for IV push/IVPB meds): transcriptase inhibitor (NNRTI) Frequency: Rationale for client: For absence of AIDS defining symptoms; improvement in quality of life. Action: Binds directly to reverse transcriptase and blocks RNA, DNA, causing a disruption of the enzymes sites.
Side-Effects: CNS: Paresthesia, HA, fever, peripheral neuropathy CV: Hema: Neutropenia, anemia, thrombocytopenia Integ: Rash, toxic epidermal necrolysis GI: ND, abdominal pain, hepatotoxicity, hepatic failure GU: EENT: Contraindications:
Drug: Niacin, Nicotinic Acid, Niacinamide, Nicotinamide
Functional class: Vitamin B3, antihyperlipidemic
Dose: Chemical class: Water-soluble vitamin Route (Give timing for IV push/IVPB meds): Action: Needed for conversion of fats, Frequency: protein, carbohydrates, by oxidation Rationale for client: To decrease lipids, warm reduction; acts directly on vascular extremities, absence of numbness in smooth muscle, causing vasodilation; extremities. reduces total cholesterol, LDL, VLDL, triglycerides; increases HDL
Side-Effects: CNS: Paresthesia, HA, dizziness, anxiety CV: Postural hypotension, vasovagal attacks, vasodilation Hema: Integ: Flushing, dry skin, rash, pruritus, itching, tingling GI: NVD, peptic ulcer, jaundice, hepatotoxicity GU: Hyperuricemia, glycosuria, hypoalbuminemia EENT: Contraindications: Breast feeding, peptic ulcer, hepatic disease, hemorrhage, severe hypotension
BBW: Hypersensitivity, hepatic disease, females, hepatitis Assess: Resistance testing prior to starting and when therapy fails. Signs of infection, anemia, hepatotoxicity. ALT, AST, viral load, CD4, plasma HIV RNA, renal studies; if LFTs are elevated significantly, product should be withheld; glucose in diabetic pts. C&S before and after therapy. Bowel pattern, allergies. Report R. quadrant pain, jaundice, rash immediately. W/o regards to meals. Med. not a cure, does not prevent transmission, controls symptoms of HIV. Use a non hormonal contraceptive. Must be taken in equal intervals around the clock to maintain blood levels for duration of therapy. Assess: AST, ALT, bilirubin, uric acid, alk phos, BG before and during treatment; lipid and triglyceride, cholesterol level if for hyperlipidemia. Cardiac status, nutritional status, hepatic dysfunction, CNS symptoms, symptoms of niacin deficiency (NV, anemia, poor memory, confusion, dermatitis) Teach that flushing and warmth may occur several hours after taking med. for up to 2 weeks, but will diminish. Rise slowly to prevent ortho/hypo. Abstain from alcohol Avoid sunlight if skin lesions are present. W/ meals for GI symptoms. Report clay colored stools, anorexia, jaundice, dark urine (hepatotoxicity may occur)
Drug: Nicotine, Nicotine Chewing Gum, Functional class: Smoking deterrent Nicotine Inhaler, Nicotine Lozenge, Nicotine Nasal Spray, Nicotine Transdermal Chemical class: Ganglionic cholinergic agonist Dose: Route (Give timing for IV push/IVPB meds): Action: Agonist at nicotinic receptors in peripheral, CNS; acts at sympathetic Frequency: ganglia, on chemoreceptors of aorta, Rationale for client: To decrease the urge to carotid bodies; also affects adrenalinsmoke, decreased need for gum after 3-6 releasing catecholamines. months
Drug: NIFEdipine
Functional class: Calcium-channel blocker, antianginal, antihypertensive
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Dihydropyridine Frequency: Rationale for client: To decrease anginal pain, BP, activity tolerance Action: Inhibits calcium ion influx across cell membrane during cardiac depolarization; relaxes coronary vascular smooth muscle, dilates coronary arteries; increases myocardial oxygen delivery in pts. With vasospastic angina; dilates peripheral arteries.
Side-Effects: CNS: Dizziness, vertigo, insomnia, HA, confusion, seizures, depression, numbness, strange dreams CV: Dysrhythmias, tachycardia, palpitations, edema, flushing, HTN Hema: Integ: GI: NVD, anorexia, indigestion, abdominal pain, constipation, irritation GU: EENT: Jaw ache, irritation in buccal cavity Contraindications: Pregnancy X, immediate post MI recovery period, severe angina pectoris Side-Effects: CNS: HA, fatigue, drowsiness, dizziness, anxiety, depression, light-headedness, nervousness, flushing CV: Dysrhythmias, edema, hypotension, palpitations, tachycardia Hema: Bruising, bleeding, petechiae Integ: Rash, pruritus, hair loss GI: NVD, gastric upset, constipation, dry mouth, flatulence GU: Nocturia, polyuria EENT: Blurred vision Contraindications: Hypersensitivity to this product or dihydropyridine
Assess: Adverse reaction: irritation of buccal cavity, dislike of taste, jaw ache. Chew gum slowly for 30 minutes to fully absorb into buccal mucosa; but no longer than that. Nicotine products just as toxic as cigarettesonly use to deter smoking. DO NOT use during pregnancy. Keep out of reach of children.
Drug: Nilotinib (Tasigna)
Functional class: Antineoplasticmisc.
Dose: Chemical class: Protein-tyrosine kinase Route (Give timing for IV push/IVPB meds): inhibitor Frequency: Rationale for client: To decrease the progression of the disease Action: Inhibits BCR-ABL tyrosine kinase created in chronic myeloid leukemia (CML)
Side-Effects: CNS: HA, dizziness, fatigue, fever, flushing CV: QT prolongation, palpitations, torsade de pointes Hema: Neutropenia, thrombocytopenia, anemia Integ: Rash, alopecia, erythema GI: NVD, hepatotoxicity, dyspepsia, pancreatitis GU: EENT: Contraindications: Pregnancy D, breastfeeding
Assess: Anginal pain, cardiac status, potassium, renal/ hepatic studies, for bruising, bleeding, petechiae. Limit caffine consumption; take no alcohol. Avoid OTC products. Teach that ext. rel. nonabsorbable shell may appear in stools. Comply with all areas of medical regimen. Change position slowly. Increase fluids to prevent constipation. W/o regards to meals. DO NOT discontinue abruptly; gradually taper. **Overdose Treatment: Defibrillation, atropine for AV block, vasopressors for hypotension. BBW: Hypokalemia, hypomagnesemia, QT prolongation, Hepatic disease Assess: ANC and platelets, CV status, renal toxicity, hepatortoxicity, CBC, bleeding, electrolytes. Report adverse reactions immediately (SOB, bleeding) Explain reason for treatment and expected outcome. Take on an empty stomach; separate dose by 12h; No makeup doses! Avoid people w/ URI; immunesuppression is common. Watch S/S of low potassium and magnesium.
Drug: Nilutamide
Functional class: Antineoplastic- hormone
Dose: Chemical class: Antiandrogen Route (Give timing for IV push/IVPB meds): Action: Interferes with testosterone uptake Frequency: in the nucleus or testosterone activity in Rationale for client: To decrease size in target tissues; arrests tumor growth in prostatic tumor size, decrease the spread of androgen-sensitive tissue; prostatic cancer carcinoma is androgen sensitive, so tumor growth is arrested.
Side-Effects: CNS: Hot flashes, drowsiness, insomnia, dizziness, depression CV: Heart failure, HTN Hema: Anemia Integ: Rash, sweating, alopecia, dry skin GI: NVD, constipation, dyspepsia, hepatotoxicity GU: Decreased libido, impotence, testicular atrophy, UTI, hematuria EENT: Delay in adaptation to dark Contraindications: Women, severe hepatic impairment
Drug: Nisoldipine (Sular)
Functional class: Calcium channel blocker; antihypertensive
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Dihydropyridine Frequency: Rationale for client: To decrease BP Action: Inhibits calcium ion influx across cell membrane, resulting in dilation of peripheral arteries.
Side-Effects: CNS: HA, fatigue, drowsiness, dizziness, depression, nervousness, confusion, migraine CV: Dysrhythmias, edema, CHF, hypotension, MI, pulmonary edema, tachycardia, chest pain Hema: Anemia, leukopenia, petechiae Integ: Rash, pruritus GI: NVD, constipation, gastric upset, dry mouth, dyspepsia GU: Nocturia, hematuria, dysuria EENT: Contraindications: Sick sinus syndrome, 2nd/3rd degree heart block, aortic stenosis Side-Effects: CNS: Dizziness, fever, HA CV: Hypotension Hema: Anemia, leukopenia, neutropenia Integ: Pruritus, sweating GI: NVD, anorexia, flatulence, abdominal pain, GU: EENT: Contraindications: Hypersensitivity
Drug: Nitazoxanide (Alinia)
Functional class: Antiprotazoal
Dose: Chemical class: Route (Give timing for IV push/IVPB meds): Action: Interferes with DNA/ RNA Frequency: synthesis in protazoa Rationale for client: For C&S negative for organism, decreased diarrhea.
BBW: Severe respiratory disease Assess: AST, ALT, alk phos (may be elevated), CNS symptoms, Chest XRays, PSA. Hyperglycemia, increased BUN, creatinine, leucopenia. Take without regards to meals. Report signs of hepatotoxicity (dark urine, abdominal pain, clay-colored stools, jaundice) Wear tinted eyeglass lens Start product on day of or after surgery. W/o regards to meals. Avoid alcohol consumption. **Overdose Treatment: Induce vomiting, provide supportive care. Assess: Cardiac status (BP, pulse, RR, ECG). I/O ratio, daily weight. For CHF (weight gain, crackles, dyspnea) NO grapefruit juice! Report nausea, dizziness, edema, SOB, palpitations. Limit caffine consumption. Avoid OTC meds. Comply with all parts of medical regimen. Take once a day as whole tablet; avoid high fat foods and grapefruit juice. Rise slowly to prevent ortho/hypo. **Overdose Treatment: Defibrillation, atropine for AV block, vasopressors for hypotension. Assess: Signs of infection. Bowel pattern before and during therapy. Take with food; shake susp. well before each dose.
Drug: Nitrofurnatoin
Functional class: Urinary tract antiinfective
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Synthetic nitrofuran derivative Frequency: Rationale for client: To decrease dysuria, Action: Inhibits bacterial acetyl-CoA fever; negative C&S interfering with carbohydrate metabolism.
Drug: Nitroglycerin
Functional class: Coronary vasodilator, antianginal
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Nitrate Frequency: Action: Decreases preload, afterload, Rationale for client: To decrease and prevent which is responsible for decreasing left anginal pain. ventricular end-diastolic pressure, systemic vascular resistance, dilates coronar arteries, improves blood flow through coronary vasculature, dilates arterial, venous beds systemically.
Side-Effects: CNS: Dizziness, HA, drowsiness, chills, confusion, vertigo CV: Bundle branch block, chest pain Hema: Anemia, Agranulocytosis, hemolytic anemia, leukopenia, thrombocytopenia Integ: Pruritus, rash, uticaria, angioedema, alopecia, tooth staining GI: NVD, abdominal pain, cholestatic jaundice, loss of appetite GU: EENT: Contraindications: Infants <1 month, anuria, severe renal disease, CCr < 60 ml/min Side-Effects: CNS: HA, flushing, dizziness CV: Postural hypotension, tachycardia, collapse, syncope Hema: Integ: Pallor, sweating, rash GI: NV GU: EENT: Contraindications: Severe anemia, ICP, cerebral hemorrhage, closed-angle glaucoma, cardiac tamponade, cardiomyopathy, constrictive pericarditis
Assess: blood count, S/S UTI, I/O ratio, CNS symptoms, Allergies. Rinse mouth after liquid medicationmay stain teeth, Report diarrhea containing mucus or pus to MD (may be pseudomembranous colitis). Take with food or milk; avoid alcohol. Do not drive/operate machinery Diabetics should monitor BG level. May turn urine rust yellow to brown.
Drug: Nitroprusside (Nitropress)
Functional class: Antihypertensive, vasodilator
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Frequency: Rationale for client: For decreased BP and absence of bleeding. Action: Directly relaxes arteriolar, venous smooth muscle, resulting in reduction in cardiac preload, afterload.
Side-Effects: CNS: Dizziness, HA, agitation, twitching, decreased reflexes, restlessness CV: Bradycardia, ECG changes, tachycardia, hypotension Hema: Integ: Pain, sweating, irritation at inj. site GI: NV, abdominal pain GU: EENT: Contraindications: HTN due to coarctation or AV shunting, acute CHF associated with reduced peripheral vascular resistance, AV shunt, Lebers disease, toxic amblyopia.
Assess: Pain, Orthostatic BP, pulse prior to and after taking. Tolerance, if taken over a long time. HA, light-headedness, decreased BP; may need to decrease dosage. Replace medication q6mo, as effectiveness is lost. If 3SL tabs in 15 min dont relieve pain, seek medical attention immediately. Avoid alcohol. Product may be taken before stressful activity, exercise, sexual activity. SL tab may sting when coming into contact with mucous membranes. Change positions slowly. **NEVER use erectile dysfunction products; may cause serious hypotension or death. BBW: Cyanide toxicity, hypotension Assess: K, Na, Cl, CO2, CBC, serum glucose, catecholamines, BUN, creatinine, AST, ALT, alk phos, serum methemoglobin (if pulmonary O2 levels are decreased use IV 1-2 mg/kg methylene blue given over several minutes). I/O ratio, daily weight. NVD, edema in feet, legs daily, hydration status. Crackles, dyspnea, orthopnea q30min. For decrease in bicarb, PCO2, blood pH, acidosis. Teach to report HA, dizziness, loss of hearing, blurred vision, dyspnea, faintness. **Antidote: Sodium Thiosulfate
Drug: Nizatidine (Axid)
Functional class: H2-Receptor antagonist
Dose: Chemical class: Substituted thiazole Route (Give timing for IV push/IVPB meds): Action: Blocks H2-receptors, thereby Frequency: reducing gastric acid output. Rationale for client: for GI symptoms: NVD, cramps
Side-Effects: CNS: HA, somnolence, confusion, abnormal dreams, dizziness CV: Cardiac dysrhythmias, cardiac arrest Hema: Thrombocytopenia, Agranulocytosis, aplastic anemia Integ: Pruritus, sweating, uticaria, exfoliative dermatitis GI: Nausea, jaundice, elevated hepatic enzymes, hepatitis GU: EENT: Contraindications: Hypersensitivity
Drug: Norepinephrine (Levothed)
Functional class: Adrenergic
Dose: Chemical class: Catecholamine Route (Give timing for IV push/IVPB meds): Action: Causes increased contractility and Frequency: heart rate by acting on B-receptors in Rationale for client: Increased BP with heart; also acts on Alpha receptors, stabilization. causing vasoconstriction in blood vessels; BP is elevated, coronary blood flow improves, cardiac output increases.
Side-Effects: CNS: HA, anxiety, dizziness, insomnia, cerebral hemorrhage CV: Palpitations, tachycardia, HTN, ectopic beats, angina Hema: Integ: Necrosis, gangrene, tissue sloughing with extravasation GI: NV GU: decreased urine output EENT: Contraindications: Ventricular fibrillation, tachydysrhythmias, pheochromocytoma, hypotension, hypovolemia
Assess: CBC w/ differential if on long term therapy. Gastric pH (>5 should be maintained) Fluid balance, I/O. Give w/ meals for prolonged effect; antacids 1 hours before or 1 hr after product; at bedtime if taken daily. Gynocomastia and impotence may occur, but are reversible. Avoid black pepper, alcohol, caffine, harsh spices, extremes in temperature of food. Avoid OTC: aspirin, cough, cold preparations. **Overdose Treatment: Symptomatic and supportive therapy is recommended; activated charcoal, emesis, or Lavage may reduce absorption. BBW: Extravasation Assess: I/O ratio. Call MD if Output is <30 ml/hr. ECG during administration continuously. BP, pulse q2-3min after parental route. Paresthesia and coldness of extremities; peripheral blood flow may decrease. Solution should be clear. Store reconstituted solution in refrigerator no longer than 24 hours. Report dyspnea, dizziness, and chest pain. **Overdose Treatment: Administer fluids, electrolyte replacement.
Drug: Norethindrone
Functional class: Progestogen
Dose: Chemical class: Progesterone derivative Route (Give timing for IV push/IVPB meds): Action: Inhibits secretion of pituitary Frequency: gonadotropins, which prevents follicular Rationale for client: Decreased abnormal maturation, ovulation; stimulates growth uterine bleeding, absence of amenorrhea. of mammary tissue; Antineoplastic action against endometrial cancer.
Drug: Norfloxacin
Functional class: Urinary anti-infective
Dose: Chemical class: Fluoroquinolone Route (Give timing for IV push/IVPB meds): Action: Interferes with the conversion of Frequency: intermediate DNA fragments into highmolecular- weight DNA in bacteria, Rationale for client: inhibits DNA gyrase.
Side-Effects: CNS: Dizziness, HA, migraines, depression, fatigue CV: Hypotension, thrombophlebitis, edema, thromboembolism, CVA, stroke, PE, MI Hema: Integ: Rash, uticaria, acne, hirsutism, alopecia, oily skin GI: NV, anorexia, cramps, increased weight, cholestatic jaundice GU: Amenorrhea, cervical erosion, breakthrough bleeding, dysmenorrheal, vaginal candidiasis, breast changes, spontaneous abortion EENT: Diplopia Contraindications: Pregnancy X, breast cancer, thromboembolic disorders, reproductive cancer, genital bleeding, liver tumors Side-Effects: CNS: HA, dizziness, fatigue, depression, insomnia CV: QT prolongation, dysrhythmias, torsade de pointes Hema: Agranulocytosis, hemolytic anemia Integ: Rash, photosensitivity GI: NVD, constipation, hepatic necrosis, flatulence, dry mouth. GU: EENT: Visual disturbances Contraindications: Hypersensitivity
Assess: Weight daily, I/O; call MD if weight gain >5lb. a week. BP at beginning and throughout treatment. AST, ALT, bilirubin, edema, HTN, cardiac symptoms, jaundice, mental status, hypercalcemia. Take w/ food or milk to reduce GI symptoms. Teach about cushingoid symptoms. Take at the same time of day. Report suspected pregnancy immediately; wait >3mo after stopping treatment to become pregnant. Avoid smoking. Does not protect against HIV, STDs May mask onset of menopause.
Assess: BUN, creatinine, AST, ALT, I/O ratio, for tendon pain, CNS symptoms, Allergic reactions. Do a clean-catch urine for C&S. Complete entire course of product therapy; take at same time each day. Take 1 hr before or 2 hr after meals; dont take antacids within 2 hours of this product. Sip water and use hard candy for dry mouth.
Drug: Norgestrel (Ovrette)
Functional class: Progestogen
Dose: Chemical class: Progesterone derivative Route (Give timing for IV push/IVPB meds): Action: Inhibits secretion of pituitary Frequency: gonadotropins, which prevent follicular Rationale for client: For absence of maturation, ovulation, stimulates growth pregnancy. of mammary tissue, Antineoplastic action against endometrial cancer
Drug: Nortripyline (Pamelor)
Functional class: Antidepressant, tricyclic
Dose: Chemical class: Dibenzocycloheptene Route (Give timing for IV push/IVPB meds): secondary amine Frequency: Rationale for client: To decrease depression Action: Blocks reuptake of norepinephrine, serotonin into nerve endings, increasing action of norepinephrine, serotonin in nerve cells.
Side-Effects: CNS: Dizziness, HA, migraines, fatigue, depression CV: Hypotension, stroke, PE, MI, thrombophlebitis, thromboembolism Hema: Integ: Rash, uticaria, acne, alopecia, oily skin, purpura GI: NV, anorexia, cramps, increased weight, cholestatic jaundice GU: Amenorrhea, cervical erosion, breakthrough bleeding, vaginal candidiasis, gynocomastia, testicular atrophy impotence EENT: Diplopia Contraindications: Pregnancy X, breastfeeding, breast cancer, reproductive cancer, genital bleeding, cerebral hemorrhage Side-Effects: CNS: Dizziness, drowsiness, confusion, HA, anxiety, tremors, stimulation, weakness, insomnia, nightmares CV: Ortho/hypo, ECG changes, tachycardia, HTN, palpitations Hema: Agranulocytosis, thrombocytopenia, leukopenia Integ: Rash, uticaria, sweating, pruritus, photosensitivity GI: Constipation, dry mouth, NV, paralytic ileus, increased appetite GU: Urinary retention, acute renal failure EENT: Blurred vision, tinnitus, mydriasis Contraindications: Pregnancy D, recovery phase of MI, seizure disorder, prostatic hypertrophy
Assess: Weight daily I/O; call MD if weekly gain >5lb. BP at beginning and throughout . ALT, AST, bilirubin, edema, HTN, jaundice, cardiac symptoms, mental status. Take one dose in the AM. With food or milk to decrease GI symptoms. Avoid smoking. Teach about cushingoid symptoms. Report suspected pregnancy immediately and wait >3mo before getting pregnant. Monitor BG if diabetic. Product does not protect against HIV, STDs. Take at same time each day.
Drug: Nystatin
Functional class: Antifungal
Dose: Chemical class: Amphoteric polyene Route (Give timing for IV push/IVPB meds): Action: Interferes with the fungal DNA Frequency: replication; binds sterols in fungal cell Rationale for client: Culture negative for membrane, which increases permeability, Candida leaking of cell nutrients.
Side-Effects: CNS: CV: Hema: Integ: Rash, uticaria (rare) GI: NVD, anorexia, cramps GU: EENT: Contraindications:
BBW: Children, suicidal ideation Assess: Orthostatic BP, CBC, leukocytes, differential, cardiac enzymes, AST, ALT, bilirubin, weight q week. ECG for flattened T wave, bundle branch block, AV block, dysrhythmias. Mental status, urinary retention, withdrawl symptoms, and alcohol intake. Take w/ food, milk for GI symptoms. Gum/hard candy for dry mouth Therapeutic effects may take 2-3 weeks to work. Avoid alcohol and CNS depressants. DO NOT discontinue quickly after long term use. Wear sunscreen and large hat. Report immediately if having urinary retention, worsening depression, or suicidal thoughts/ behaviors. **Overdose Treatment: ECG monitoring; Lavage, activated charcoal; administer anticonvulsant. Assess: allergic reaction, predisposing factors (antibiotic therapy, pregnancy, DM, sexual partner infection [vaginal infections]). Long term therapy may be needed to clear infection. DO NOT use commercial mouthwash for mouth infections. Call MD if irritation occurs.
Drug: niCARdipine
Functional class: Calcium-channel blocker, antianginal, antihypertensive
Dose: Route (Give timing for IV push/IVPB meds): Chemical class: Dihydropyridine Frequency: Rationale for client: decreased anginal pain, decreased BP Action: Inhibits calcium ion influx across cell membrane during cardiac depolarization; relaxes coronary vascular smooth muscle, dilates coronary arteries; increases myocardial oxygen delivery in pts. With vasospastic angina; dilates peripheral arteries Functional class: Hormone, Antidiarrheal Chemical class: Octapeptide
Drug: octreotide Sandostatin, Sandostatin LAR Depot Dose:
Route (Give timing for IV push/IVPB meds): Action: A potent growth hormone similar SQ, IM, IV to somatostatin Frequency: Rationale for client: Use: Sandostatin- acromegaly, improves symptoms of carcinoid tumors, vasoactive peptide tumors (VIPomas) LAR Depot- long-term maintenance of acromegaly, carc. Tumors, VIPomas
Side-Effects: CNS: HA, fatigue, drowsiness, dizziness, anxiety, depression, light-headedness, nervousness, flushing CV: Dysrhythmias, edema, hypotension, palpitations, tachycardia Hema: Bruising, bleeding, petechiae Integ: Rash, pruritus, hair loss GI: NVD, gastric upset, constipation, dry mouth, flatulence GU: Nocturia, polyuria EENT: Blurred vision Contraindications: Hypersensitivity to this product or dihydropyridine CNS: HA, Dizz, Fatigue, weakness, depression, anxiety, tremors, seizures CV: sinus bradycardia, dysrhythmias, SOB, chest pain, thrombophlebitis, ischemia, CHF, HTN, palpitations,prolonged QT, ST-T wave change HEMA: hematoma/bruise at injection site INTEG: Rash, uticaria,pain, inflammation of injection site GI: N/V/D,ab pain, flatulence, distention, constipation, hepatitis, GI bleed, pancreatitis GU: UTI ENDO: hypo/hyperglycemia, ketosis, hypothyroidism, diabetes insipidus, galactorrhea Contraindications: hypersensitivity
Assess: Cardiac status, anginal pain, K, renal/hepatic studies, CHF. Take w/o regards to meals. Limit caffine consumption. Avoid OTC products. Comply with all areas of the medical regimen. **Overdose Treatment: Defibrillation, B-agonists, IV calcium, diuretics, atropine for AV block, vasopressors for hypotension
Assess: Growth hormone antibodiesIGF-1, 1-4 Hr intrvls for 8-12 hr post dose in acromegaly; 5-HIAA, plasma serotonin; BG, serotonin levels (carcinoid tumors), plasma substance P, plasma vasoactive intestinal peptide (VIP) (VIPoma) -Thyroid function tests: T3,T4,T7,TSHindentify hypothyroidism -Fecal fat, serum carotene -Allergy -Cardiac Status: Bradycard, dysrhyth,conduction, prolonged QT, low voltage,axis shifts, early repolariztion, R/S transition IM- reconstitute w/dilutent provided, give into gluteal SQ-allow to get to room temp IV-may give bolus over 3 min Teach: reg assessment required, change positions slowly-OHTN
Drug: ofloxacin Dose:
Functional class: Antiinfective Chemical class: Fluoroquinolone
Route (Give timing for IV push/IVPB meds): PO,IV Action: Interferes with conversion of Frequency: intermediate DNA fragments into highmolecular-weight DNA in bacteria, Rationale for client: inhibits DNA gyrase Uses: Treatment of lower respiratory tract infections (pneumonia, bronchitis), genitourinary infections (prostatitis, UTIs) caused be E.coli, Klebsiella pneumonia, Chlamydia trachomatis, skin and skin structure infections; conjunctivitis (ophthalmic) Drug: olanzapine Zyprexa Zydis, Zyprexa, Zyprexa IM Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Unknown, may mediate antipsychotic activity by both Dopamine and serotonin type 2 antagonist; also may antagonize muscarinic receptors, histamine (h1) and alpha adrenergic receptors Use: Shizophrenia, acute manic episodesbipolar disorder -Dementia-alzheimers, OCD Functional class: Antipsychotic, neuroleptic Chemical class: Thienbenzodiazepine
CNS: Dizz, HA, fatigue, somnolence, seizures, vertigo, insomnia, depress CV: QT prolonged, dysryth, chest pain HEMA: Blood dyscrasias INTEG: rash, pruritis, photosensitivity GI:N/V/D, anorexia, dry mouth, flatulence, HB, Increased AST/ALT, constipation, p.colitis, abnrml taste GU:NA EENT: Visual disturbances Contraindications: QT Prolongation, hypersensitivity to quinolones -May alter BG levels-antidiabetics -Possible Theophylline toxicity-do not use together -Increases seizures w/NSAID use -Separate antacid use by 2 hrs CNS: EPS, seizures, neuroleptic malignant syndrome, dizz, tremor, abnormal gait, insomnia, fever CV: HypoTN, HF, sudden death, tachycardia HEMA: neutropenia INTEG: rash GU: urinary retention/frequency, impotence, amenorrhea, gynecomastia, breast engorge, premenst. syndrome GI: dry mouth, N/V, dyspepsia, constipation, weight gain, hepatitis EENT:NA Contraindications: Hypersensitivity
Assess: Renal, hepatic studies: BUN, creatinine, AST, ALT -Cardiac Status: QT prolongation -CNS symptoms: insomnia, vertigo, HA, agitation, confusion -Allergy Administer: 2hrs before or after antacid, After clean-catch urine for C&S Teach: Perform activities with assistance if dizzy/lightheaded; complete full course, avoid iron/mineral containing supplements w/in 2 hr before or after dose; avoid sun exposure-photosensitivity
Assess: mental status-orientation, mood, behavior, hallucinations Swallowing of PO med- hoarding I&O ratio, palpate bladder-retention Bilirubin, CBC Urinalysis before and during prolonged therapy Affect,LOC, reflexes, gait B/P sitting, standing, lying; pulse/RR Q4H during initial treat-establish base Geriatrics for serious reactions Skin turgor daily Weight gain, hyperglycemia, metabolic changes in diabetes Administer: anticholinergic for EPS PO- w/ glass of water/milk/food-GI upset Provide: Decreased stimuli by dimming light, avoiding loud noises; supervised ambulation until stable; increased fluids/bulk; sips of water/hard candy-dry mouth Teach: Use good oral hygiene-frequent rinsing of mouth, gum/candy/ice-dry mouth; sit/rise slowly- OHTN; avoid hot tubs/showers,baths-hypotension Avoid abrupt withdrawal Heat stroke may occur in hot weather Avoid OTC meds unless prescribed Overdose: PO-lavage; provide airway; DO NOT induce vomit/ use epinephrine
Drug: olmesartan Benicar Dose:
Functional class: anithypertensive Chemical class: Angiotensin II receptor (type AT1) Route (Give timing for IV push/IVPB meds): antagonist PO Frequency: Action: Blocks the vasoconstrictor and aldosterone-secreting effects of Rationale for client: angiotensin II; selectively blocks the binding of angiotensin II to the AT1 receptor found in tissues Use: HTN, alone/in combo with other anithypertensives
CNS: Dizz, fatigue, HA. insomnia CV: Chest pain, periph edema, tachycardia HEMA:NA INTEG: NA GI: Diarrhea, abdominal pain GU:NA EENT: sinusitis, rhinitis, pharyngitis Resp: upper resp. infection, bronchitis Syst: angioedema Black Box- preg-2nd/3rd trimester Contraindications: Hypersensitivity Potassium supplements/potassium-sparing diuretics increase hyperkalemia
Assess: For pregnancy-can cause fetal death; response and adverse reactions especially in renal disease; B/P, pulse q4h;Electrolytes: K,Na,Cl; baseline renal/hepatic studies before therapy begins; skin turgor, dry mucous membranes, angioedema:facial swell, dyspnea Teach: comply w/dosage schedule, even in feeling better; notify prescriber of mouth sores, fever, swelling of hands or feet, irreg heart beat, chest pain; excessive perspiration, dehydration, vomiting, diarrhea may lead to fall in B/P-notify HCP; rise/stand slowly-OHTN; avoid OTC unless approved; notify HCP immediately if pregnant/breastfeeding Assess: Blood dyscrasis: skin rash, fever, sore throat, bruising, bleeding, fatigue, joint pain (rare) Allergic reaction Administer: med after C&S, repeat C&S after full course of med Total daily dose evenly spaced to minimize GI intolerance, with food Evaluate: absence of fever, mucus in stools Teach: report diarrhea, take even if feeling better
Drug: olsalazine Dipentum Dose:
Functional class: Antiinflammatory
Chemical class: Route (Give timing for IV push/IVPB meds): Salicylate derivative Po Frequency: Action: Bioconverted to 5-aminosalicylic acid, which decreases inflammation Rationale for client: Use: Maintenance of remission of ulcerative colitis in patients intolerant to sulfasalazine
CNS: HA, hallucinations, depression, vertigo, fatigue, dizziness CV:NA HEMA:Leukopenia, neutropenia, thrombocytopenia, agranulocytosis, anemia INTEG: rash, dermatitis, uticaria GI: N/V/D, ab pain, hepatitis, bloating, pancreatitis GU:NA EENT:NA Contraindications: Hypersensitivity to salicylates -Increases AST/ALT CNS:NA CV: HF, cardiomyopathy, hypoTN HEMA: serious systemic eosinophilia INTEG: pruritis, dermatitis, inj site reaction, rash GI:NA GU:NA EENT:NA Misc: malignancies, anaphylaxis, thrombocytopenia, earache Resp: bronchospasm, pulm HTN Contraindications: Hypersensitivity to hamster protein Use cautiously w/live virus vaccines
Drug: omalizumab Xolair Dose:
Functional class: Antiasthmatic
Chemical class: Route (Give timing for IV push/IVPB meds): Monoclonal antibody SQ Frequency: Action: Recombinant DNA-derived humanized IgG murine monoclonal Rationale for client: antibody that selectively binds to IgE to limit the release of mediators in the allergic response Use: moderate to severe persistent asthma
Assess: RR,ryth,depth; monitor pulmonary function tests; serum IgE;auscultate lung fields bilaterally *Anyphylaxis, allergic reactions, inability to breathe, edema of throat-product should be DCd, have emergency equip availableobserve for 2 H, reaction can occur up to 24 Hr Teach: improvement will not be immediate, not to stop/decrease current asthma meds unless instructed; avoid live virus vaccines, report signs of allergic reaction
Drug: Omeprazole Prilosec, Prilosec OTC Dose:
Functional class: Antiulcer, proton pump inhibitor Chemical class: Benzimidazole
Route (Give timing for IV push/IVPB meds): Po Action: Suppresses gastric secretion by Frequency: inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cell; Rationale for client: characterized as gastric acid pump inhibitor, since it blocks final step of acid production Use: GERD, severe erosive esophagitis, poorly responsive systemic GERD, pathologic hypersecretory conditions (Zollinger-Ellison syndrome), treatment of active duodenal ulcers with or w/out antiinfectives for H. pylori
Drug: odansetron Zofran, Zofran ODT Dose:
Functional class: Antiemetic
Chemical class: Route (Give timing for IV push/IVPB meds): 5-HT3 receptor antagonist PO,IV,IM Frequency: Action: Prevents nausea, vomiting by blocking serotonin peripherally, centrally, Rationale for client: and in small intestine Use: Prevent N&V associated w/ cancer chemotherapy, radiotherapy, and prevent post-op N&V Functional class: Weight control agent
Drug: orlistat Alli, Xenical Dose:
Chemical class: Route (Give timing for IV push/IVPB meds): Lipase inhibitor Po Frequency: Action: Inhibits absorption of dietary fats Rationale for client: Use: Obesity management
CNS: HA, dizz, asthenia CV: HF, periph edema, tachy/bradycardia, angina, palpitations HEMA: thrombocytopenia, neutropenia, leukocytosis, pancytopenia, anemia INTEG: rash, dry skin, uritcaria, pruritis, alopecia GI:ab pain, N/V/D, const, flatulence, acid regurgi, ab swell, anorexia, irritable colon, esoph candidiasis, hepatic fail GU:UTI, frequency, proteinuria, hematuria, glycosuria EENT:NA RESP: upper resp infection, epistaxis, pneumonia META: hypoglycemia, increased hepatic enzymes, weight gain SYST: angioedema, Stevens-Johnsons Contraindications: Hypersensitivity -Warfarin increases bleeding -Increases-alk phos, AST,ALT, bilirubin CNS: HA, dizziness, drowsiness, fagitgue, EPS CV: NA HEMA: NA INTEG: NA GI: Diarrhea, const, ab pain, dry mouth GU:NA EENT: NA MISC: rash, bronchospasm, wound problems, urinary retention, hypoxia Contraindications: Hypersensitivity; PKU hypersensitivity, torsade de pointes CNS: Insomnia, depression, anxiety, dizziness, HA, fatigue CV: NA HEMA:NA INTEG: Dry skin, rash GI: Oily spotting, flatus with discharge, fecal urgency, fatty/oily stool, oily evacuation, fecal incontinence, frequent defecation, hepatic failure, hepatitis, pancreatitis, N/V/D, tooth disorder GU: UTI, vaginitis, menstrual irregularity RESP: Flu, EENT symptoms Contraindications: breastfeeding, hypersensitivity,chronic malabsorption, cholestasis
Assess: GI system- bowel sounds q8h, ab for pain, swelling, anorexia; Hepatic enzymes- AST,ALT, alk phos during treatment; blood studies; CBC, differential during treatment Administer: before eating, usually in AM Teach: Report severe diarrhea, Diabetic pt should know hypoglycemia may occur; avoid haz activities-dizziness; avoid alcohol, salicylates, ibuprofen-GI irritation
Assess: absence of nausea, vomiting during chemotherapy; hypersensitivity reaction, EPS- shuffling gait,tremors, grimacing, rigidity -Store at room temp 48 hr after dilution Teach: report diarrhea, constipation, rash, changes in respiration, discomfort at insertion site Headache requiring analgesic is common Assess: weight weekly, diabetic pts may need reduction in oral hypoglycemic; misuse in certain populations (anorexia nervosa, bulimia); liver injury-jaundice, weakness, abdominal pain Administer: For obesity only-pt should be on diet with 30% of calories from fat, omit dose if meal contains no fat Teach: 60 mg cap can be obtained OTChighest dose Safety/effectiveness beyond 2 yrs have not been determined Take multivitamin containing fat soluble vitamins 2 hr before or after Discuss unpleasant GI effects Notify if pregnancy is planned/suspect
Drug: oseltamivir Tamiflu Dose:
Chemical class: Route (Give timing for IV push/IVPB meds): Neuramidase inhibitor PO Frequency: Action: Inhibits influenza virus neuraminidase with possible alteration of Rationale for client: virus particle aggregation and release Use: Prevention/treatment of influenza type A or B
CNS: HA, dizziness, fatigue, insomnia, delirium, self-injury (children) ENDO: hyperglycemia CV:NA HEMA: NA INTEG: Toxic epidermal necrolysis, Stevens-johnsons syndrome, erythema multiforme GI: N/V/D, ab pain GU: NA EENT: NA RESP: cough Contraindications: hypersensitivity - Avoid use with H1N1 virus vaccine, intranasal influenza vaccine CNS: Lethargy, hallucinations, anxiety, depression, twitch, coma, seizures CV:NA HEMA Anemia,increased bleeding time,bone marrow depression, granulocytopenia, eosinophilia INTEG: exfoliative dermatitis, rash GI: N/V/D, increased AST, ALT, ab pain, glossiits, colitis, hepatotoxicity, pseudomembranous colitis GU: oliguria, proteinuria, hematuria, glomerulonephritis, acute interstitial nephritis, vaginitis, moniliasis SYST:anaphylaxis, Stevens-Johnsons Contraindications: Hypersensitivity to penicillins, corn -Do not give w/amino glycosides
Assess; bowel pattern before, during treatment; signs of infection Administer: within 2 days of symptoms of influenza, continue for 5 days At least 4 hr before bedtime to prevent insomnia Teach: About aspects of product therapy; avoid hazardous activities if dizziness occurs; take missed dose as soon as remembered within 2 hr of next dose *stop immediately; report to prescriber skin rash, delirium (child) Assess: I&O ratio, report hematuria, oliguria, high doses=nephrotoxic *Any patient with compromised renal system, since product is excreted slowly in poor renal system function; toxicity could occur rapidly Hepatic studies: AST, ALT Blood Studies: WBC,RBC, Hct,Hgb, bleeding time Renal: urinalysis, protein C&S before therapy-may be taken after Bowel pattern before and after treatmnt Skin eruptions to one week aftr DC Respiratory status Allergy Provide: Adrenalin, suction, tracheostomy set, endotracheal intubation equipment at bedside Teach: Complete course of med, culture may be taken after complete Report sore throat, fever, fatigue (may indicate superinfection), persistent diarrhea; CNS toxicity Treatment of anyphylaxis: w/draw product, maintain airway, administer epinephrine, aminophylline, O2, IV coriticosteroids
Drug: oxacillin Oxacillin sodium Dose:
Functional class: Broad-spectrum antiinfective
Chemical class: Route (Give timing for IV push/IVPB meds): Penicillinase-resistant penicillin Im,IV Frequency: Action: Interferes with cell wall replication of susceptible organisms; Rationale for client: osmotically unstable cell wall swells, bursts from osmotic pressure Use: Effective for gram + cocci, infections causes by penicillinase producing staphylococcus
Drug: oxaliplatin Eloxatin Dose:
Chemical class: Route (Give timing for IV push/IVPB meds): 3rd generation platinum analog IV Frequency: Action: Forms crosslinks, inhibiting DNA replication and transcription, cell cycle Teach: Report signs of infection, anemia nonspecific Report bleeding-avoid use of razors, commercial mouthwash Use: Metastatic carcinoma of the colon or Avoid aspirin, ibuprofen, NSAIDS, alcohol- rectum in combination with 5GI bleed FU/leucovorin Report side effects to RN/HCP Report changes in breathing, coughing Hair may be lost Report numbness, tingling in face/extremities, poor hearing or joint pain/swelling Do not receive vaccines during treatmnt Use contraceptives during and 4 mo aftermay cause infertitlity Avoid contact with cold- acute dyesthesias
CNS: Peripheral neuropathy, fatigue, HA, dizziness, insomnia CV: cardiac abnormalities, thromboembolism HEMA: thrombocytopenia, leucopenia, pancytopenia, neutropenia, anemia, hemolytic uremic syndrome INTEG: Alopecia, rash, flushing, extravasation, redness, swelling at inj GI: Severe nausea/V/D, weight loss GU: hematuria, dysuria, creatinine EENT:Decreased visual activity, tinnitus Contraindications: Pregnancy, breastfeeding, radiation therapy or chemotherapy w/in 1 mo, thrombocytopenia, small pox vaccine -Increased bleeding with NSAID, aspirin, alcohol, anticoagulant use -Increased nephrotoxicity with aminoglycoside, loop diuretic use
Assess: Bone marrow depression- CBC, diff, platelets, w/hold if WBC is <4000 or platelet count is <100,000-notify HCP Renal: BUN, creatinine, serum uric acid, urine CCr before, electrolytes during therapy; dose should not be given if BUN >19mg/dL; creatinine <1.5mg/dL; I&Oreport urine output <30 mL/HR Anyphylaxis Pulmonary fibrosis: cough, crackles, dyspnea, pulm infiltrate-DC immediatelyDeath may occur Monitor temp Hepatic studies before each cycle, prn,or monthly Bleeding-hematuria,bruising-obtain Rx for viscous lidocaine (Xylocaine) Jaundice; Edema of feet, joint pain, stomach pain, shaking Do not reconst w/ NaCl, do not use aluminum equipment Hydrate w/ 0.9% NaCl over 8-12 hr b4 Antiemtic 30-60 min b4 Diuretic or mannitol after inf
Drug: oxaprozin Daypro Dose:
Functional class: Nonsteroidal anti-inflammatory, antirheumatics
Route (Give timing for IV push/IVPB meds): Chemical class: PO Propionic acid derivative Frequency: Action: Completely inhibits COX-1, Rationale for client: COX-2 by blocking arachidonate; analgesic, anti-inflammatory, antipyretic Use: Acute and long-term management of osteoarthritis, RA, juvenile RA
Drug: oxazepam oxazepam Dose:
Functional class: Sedative/hypnotic; antianxiety
Chemical class: Route (Give timing for IV push/IVPB meds): Benzodiazipine, short acting PO Frequency: Controlled substance sched IV Rationale for client: Action: Potentiates the actions of GABA, especially in limbic system and reticular formation Use: Anxiety, alcohol w/drawal, insomnia
CNS: Dizz, HA, drows, fatigue, tremors, confusion, anxiety, depression, insom CV: tachycardia, periph edema, palpitations, dysrhyth, MI, stroke HEMA:Increased bleeding time,pancycytopenia INTEG:Purpura, rash, pruritis, sweating,photosensitivity. GI: N/V/D, anorexia, jaundice, cholestatic hepatitis, const,GI bleed, perforation, ulceration, dyspepsia GU: Nephrotoxicity EENT: tinnitus, hearing loss, blurred vision Contraindications: Pregnancy, 3rd trimester, hypersensitivity, asthma, patients in whom aspirin and iodides have allergic reactions or asthma Black box: Perioperative pain in CABG surgery; GI bleed, MI, stroke -Increased toxicity with aspirin, cyclosporine, methotrexate, probenecid use -Bleeding risk-oral anitcoag, thrombolytics, -Increase GI side effects-aspirin, corticoster,NSAIDs,alcohol, K supplements CNS: Dizz, drows, confusion, HA, anxiety, tremors, fatigue, depression, insom, halluc, paradox excitement, transient amnesia CV: OHTN, ECG changes, tachycardia, hypoTN HEMA: Leukopenia INTEG: rash, dermatitis, itching GI: N/V, anorexia GU: NA EENT: Blurred vision, tinnitus, mydriasis SYST: Dependence Contraindications: pregnancy, breastfeeding, hypersens to benzos, closed angle glaucoma, psychosis
Assess:Pain; Cardiac status-CV thromb events, MI,stroke-may be fatal GI status: ulcer,bleed, perforation-may be fatal; Stevens-Johnsons syndrome, anaphylaxis; Asthma, aspirin hypersensitivity, Renal, hepatic, blood studies-BUN, creatinine, AST, ALT, Hgb b4 treat, periodically after Audiometric, opthal exam b4,during,aftr Administer: w/food, antacids-decrease GI symptoms Teach: *Report blurred vision, ringing, roaring in ears; may indicate toxicity Avoid driving, haz active-dizz/drows *Report change in urine pattern, increased weight, edema, increased joint pain, fever, blood in urine,-neph tox Therapeutic effects may take 1 month Take with full glass of water-enhance absorption; sit upright for hr Avoid prolonged sun xposre,use sunscreen, protective clothing Avoid ASA, alcohol, other OTC w/o app
Assess: B/P (lying,standing), pulse, if systolic drops 20 mm Hg-hold,notify HP Blood studies: CBC-long term therapy Hepatic: AST, ALT, bilirubin, creatinine, LDH, alk phos (long term) Mental status: mood, sensorium, affect, sleep pattern, drowsiness, dizz *Physical dependency, w/draw symptom Suicidal tendencies Administer: w/food/milk-GI symptoms Sugarless gum, hard candy, frequent sips of water for dry mouth Provide: assistance w/ambulation during initial therapy; safety measure-SR Teach: May be taken with food; med not to be used for QD stress/longer than 4 mos unless directed by HCP; avoid OTC meds; avoid driving, haz act-drows Avoid alcohol ingestion, other pychotropics unless directed Do not DC abruptly aftr long-term use Rise slowly-fainting may occur Overdose: lavage, VS, supportive care,flumazenil
Drug: oxcarbazepine Trileptal Dose:
Functional class: Anticonvulsant
Chemical class: Route (Give timing for IV push/IVPB meds): Carbamazepine analog PO Frequency: Action: May inhibit nerve impulses by limiting influx of sodium ions across cell Rationale for client: membrane in motor cortex Use: Partial seizure
CNS: HA, dizz, confusion, fatigue, worsening of seizures, suicidal ideation/behavior, abnrml gait, agitation CV:hypoTN, chest pain, edema HEMA:NA INTEG: purpura, rash, acne GI:N/V/D, const, anorexia, gastritis, dry mouth/thirst, rectal hemorrhage GU: Frequency, UTI, vaginitis EENT: blurred vision, diplopia, nystagmus, rhinitis, sinusitis SYST: angioedema, anyphylaxis,StevensJohnson syndrome, Contraindications: hypersensitivity, MAOIs, ranolazine, nisoldipine Increase CNS depression w/ alcohol use
Drug :oxybutynin Ditropan, Ditropan XL, Geinique, Oxytrol Transdermal Dose:
Functional class: Anticholinergic Chemical class: Synthetic tertiary amine
Route (Give timing for IV push/IVPB meds): PO, TD Action: Relaxes smooth muscle in urinary Frequency: tract by inhibiting acetylcholine at postganglionic sites Rationale for client: Use: Antispasmodic for neurogenic bladder, overactive bladder
CNS: Anxiety, restlessness, dizz, somnolence, insomnia, nervousness, seizures, HA, drows, confusion CV: palpitations, sinus tachycard, HTN, peripheral edema HEMA:NA INTEG:NA GI: N/V/D, anorexia, ab pain, const, dyspepsia, taste perversion, GERD GU: Dysuria, impotence, retention,hesit EENT:Blurred vision, dry eyes, increased intraocular tension, dry mouth/throat Contraindications: hypersensitivity, GI obstruction, glaucoma, severe colitis, unstable CV disease, dementia
Assess: Description of seizures; Hyponatremia-HA, nausea, confusion Electrolyte: sodium; T4; (when given together) *Serious reactions-angioedema, anaphylaxis, SJ syndrome, CNS/mental status Eye problems-need for opth exams before, during, after Administer: w/food/milk-decrease GI symptoms Provide: hard candy/gum, frequent rinsing for dry mouth; assistance with ambulation-early trtmnt-dizziness Teach: Carry ID, avoid driving, haz act Do not DC abruptly-long term use Inform if hypersens to carbamazepine Avoid alcohol Use alternative contraception if using hormonal method Overdose: Activated charcoal, give 0.9% NaCl (hypotensive state), atropine (bradycardia), use benzodiazepines, barbiturates for seizures Assess: urinary patterns: distention, nocturia, frequency,urgency,incontinenc Allergic response: rash, uticaria; DC if these occur CNS effects: confusion, anxiety; anticholinergic effects in geriatrics Topical/Transdermal- rotate sites Teach: Avoid haz activitiesdizziness/blurred vision may occur Avoid OTC w/alcohol, CNS depressents Prevent photophobia by wearing sunglasses Avoid hot weather, strenuous activity, product decreases perspiration Rotate site of patch w/each application
Drug: -oxycodone-: Oxy-Contin, Endocodone --oxycodone/aspirin: Percodan -oxycodone/aceta;minophen: Percocet, Tylox -oxycodone/ibuprofen: Combunox Dose:
Functional class: Opiate analgesic Chemical class: Semisynthetic derivative
Action: Inhibits ascending pain pathways in CNS, increases pain threshold, alters Route (Give timing for IV push/IVPB meds): pain perception PO Frequency: Use: moderate to severe pain Rationale for client:
CNS: Drows, Dizz, confusion, HA, sedation, euphoria, fatigue, hallucination CV:Palpitations, bradycardia, change in B/P HEMA: NA INTEG: Rash, urticaria, bruise, flush,diaphoresis, pruritis GI: N/V, anorexia, constipation, cramps, gastritis, dyspepsia, biliary spasms GU: Increased urinary output, dysuria, urinary retention EENT: Tinnitus, blurred vision, miosis, diplopia RESP: respiratory depression Contraindications: hypersensitivity, addiction (opiate), asthma, ileus Black Box- respiratory depression, opioidnave pts, substance abuse -Increased toxicity w/ cimetidine, MAOI use
Assess: I&O ratio- check for decreased output-may indicate retention CNS change- dizz, drows, hallucinations, euphoria, LOC, pupil reaction Allergy Respiratory dysfunction-depression, Pain Bowel status: constipation; stimulate laxative may be needed Administer: w/ antiemetic if nausea/vomiting occur Provide: assistance with ambulation, safety measures Teach: Report any symptoms of CNS changes, allergy; W/drawal symptoms may occur-nausea, vomiting, cramps, fever, faintness, anorexia Avoid CNS depressants, alcohol Avoid driving, operating machinery if drowsiness occurs Overdose: Naloxone (Narcan) 0.2-0.8 mg IV, O2, IV fluids, vasopressors Assess: Pain before and 1 hr after (IV 30 min); I&O ratio, Bowel status; CNS changes; allergy; respiratory dysfunction Administer: 1 hr before or 2 hr after food w/antiemetic for nausea/vomiting Provide: assistance with ambulation, safety measures Teach: Report any symptoms of CNS change, allergy Physical dependence may occur w/extended use W/drawal symptoms may occur Not to drive or operate machinery if drowsiness occurs Avoid CNS depressants, alcohol Overdose: Naloxone (Narcan) 0.2-0.8 mg IV, O2, IV fluids, vasopressors
Drug: oxymorphone Numorphan, Opana, Opana ER Dose:
Functional class: Opiate analgesic
Chemical class: Route (Give timing for IV push/IVPB meds): Semisynthetic phenanthrene derivative PO, IM, SQ, Rect Frequency: Controlled Substance Schedule II Rationale for client: Action: Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception Use: Moderate to severe pain
CNS: Drows, Dizz, confusion, HA, hallucinations, increased intracranial pressure, sedation, seizures, euphoria (geriatrics) CV: palp, bradycardia, change in B/P, hypotension HEMA:NA INTEG: rash, uticaria, bruise, flush, diaphoresis, pruritis GI: N/V, anorexia, const, cramps GU: dysuria, urinary retention EENT: tinnitus, blurred vision, miosis, diplopia Contraindications: hypersensitivity, addiction (opiate), asthama, hepatic disease, ileus, intrathecal use, surgery Black Box: respiratory depression, alcoholism, opioid nave pts, substance abuse -Unpredictable effects/reactions w/MAOI use
Drug: oxytocin Pitocin Dose:
Functional class: Hormone
Chemical class: Route (Give timing for IV push/IVPB meds): Oxytocic, uterine active agent IM, IV Frequency: Action: Acts directly on myofibrils, producing uterine contraction; stimulates Rationale for client: milk ejection by the breast; vasoactive antidiuretic effect Use: Stimulation, induction of labor, missed or incomplete abortion; postpartum bleeding
CNS: Seizures, tetanic contractions CV: hypo/HTN, dysrhythmias, increased pulse, bradycardia, tachycardia, PVC HEMA: Increased hyperbilirubinemia INTEG: Rash GI: Anorexia, N/V, constipation GU: Abruptio placentae, decreased uterine blood flow SYST: water intoxication of mother RESP: Asphyxia FETUS; Dysrhythmias, jaundice, hypoxia, intracranial hemorrhage Contraindications: hypersensitivity, serum toxemia, cephalopelvic disproportion, fetal distress, hypertonic uterus, prolapsed umbilical cord, active genital herpes Black Box: Elective induction of labor
Assess: I&O ratio, respiration, B/P, pulse; Respiratory rate; Length, intensity, duration of contractions- notify if last over 1 min or absence of, turn on left sideDC oxytocin FHTs, fetal distress; turn pt on left side if FHT change in rate, give O2 *For signs and symptoms of water intoxication: confusion, anuria, drowsiness, HA Teach: Report increased blood loss, ab cramps, fever, foul smelling lochia Contractions will be similar to menstrual cramps, gradually increasing in intensity
Drug: Paclitaxel (Onxol,Taxol) Dose:
Functional class: Antineoplastic-misc. Chemical class: Toxoid
Side-Effects: CNS: peripheral neuropathy CV: Bradycardia, hypotension HEMA: bleeding, infections INTEG: Alopecia, generalized urticaria GI: N/V, diarrhea, mucositis, increased bili, alk phos, AST RESP: dyspnea Contraindications: Preg (D), hypersensitivity to paclitaxel or other products w/ polyxyethylated castor oil, albumin
Route (Give timing for IV push/IVPB meds): Action: Inhibits reorganization of microtubule network needed for Frequency: interphase and mitotic cellular function; also causes abnormal bundles of Rationale for client: microtubules during cell cycle and multiple esters of microtubules during mitosis
Assess CBC and hepatic studies Assess vitals during 1st hour of infusion Assess for bleeding and effects of alopecia Give antiemetic 30-60 minutes prior to product and prn Teach to identify signs of infection, anemia, bleeding Avoid use of NSAIDS especially aspirin Muscle & Joint pain 2-5 days after given is common
Drug: Paliperidone (Invega) Dose:
Functional class: Antipsychotic Chemical class: Benzisoxazole derivative
Side-Effects: CNS: EPS: pseudoparkinsonism, akathisia, dystonia, drowsiness, insomnia, agitation, anxiety, HA, dizziness CV: orthostatic hypotension GI: N/V, anorexia, constipation, xerostomia, weight gain Endo: Insulin increase EENT: blurred vision Contraindications: Breastfeeding, geriatric pts, seizure disorders, AV block, QT prolongation, torsade de pointes, hypersensitivity to this product or risperidone
Route (Give timing for IV push/IVPB meds): Action: Mediated through both Dopamine type 2 (D2) and serotonin type 2 (5-HT2) Frequency: antagonism Rationale for client:
Assess mental status before initial administration Assess I&O Assess affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances Assess and monitor B/P and heart rates, pulses. Report drops of 30 mmHg. In case of overdose: Lavage, provide airway; Do not induce vomiting
Drug: Palivizumab (Synagis) Dose:
Functional class: Monoclonal antibody
Side-Effects: CNS: fever INTEG: Rash, inj. Site reaction GI: N/V, diarrhea, increased AST RESP: upper respiratory tract infection, cough EENT: otitis media, rhinitis, pharyngitis Contraindications: hypersensitivity, adults, cyanotic congenital heart disease
Action: A humanized monoclonal antibody that exhibits neutralizing and Route (Give timing for IV push/IVPB meds): fusion-inhibitory activity against RSV Frequency: Rationale for client:
Assess for presence of RSV. Teach pt. to report upper respiratory infections, earaches, rash, sore throat Assess and monitor vitals, especially respiratory
Drug: Palonosetron (Aloxi) Dose:
Functional class: Antiemetic Chemical class: 5-HT3 receptor antagonist
Side-Effects: CNS: HA, dizziness, drowsiness, fatigue, insomnia GI: diarrhea, constipation, ABD pain MISC: weakness, hyperkalemia, anxiety, rash, arthralgia, fever, urinary retention Contraindications: Hypersensitivity
Assess for absence of N/V Assess for hypersensitivity Teach pt to avoid alcohol and barbiturates & report diarrhea, constipation, rash, or changes in respirations
Route (Give timing for IV push/IVPB meds): Action: Prevents N/V by blocking serotonin peripherally, centrally, and in Frequency: the small intestine at 5-HT3 receptor Rationale for client:
Drug: Pamidronate (Aredia) Dose:
Functional class: Bone-resorption inhibitor, electrolyte modifier Chemical class: Biphosphonate
Side-Effects: CNS: Fever, fatigue CV: HTN INTEG: redness, swelling GI: ABD pain, anorexia, constipation, N/V, dyspepsia RESP: coughing, dyspnea, upper respiratory tract infection EENT: ocular pain, inflammation, vision impairment Contraindications: Preg (D), hypersensitivity Side-Effects: INTEG: rash GI: N/V, anorexia, diarrhea, glossitis, anal soreness, ABD discomfort GU: hyperurucuria, hyperuricemia, perianal pain EENT: Buccal soreness, cavities Contraindications: Hypersensitivity to pork
Assess dental health, electrolytes (Ca, PO4, Mg, K), and bone pain Assess and monitor I&O Teach to continue dietary recommendation including vitamin D and calcium
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Inhibits bone resorption, apparently w/out inhibiting bone formation and mineralization; adsorbs calcium phosphate crystals in bone and may directly block dissolution of hydroxyapatite crystals of bone
Drug: Pancreatin (Creon, Encron) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Digestant Chemical class: Pancreatic enzyme concentrate-bovine/porcine Action: Pancreatic enzyme needed for breakdown of substances released from pancreas
Assess I&O; watch for increasing urinary output; urinalysis, blood chemistries Assess for fecal fat, nitrogen, PT, calcium during treatment Assess for allergy to pork
Drug: Pancrelipase (Cotazym, Pancrease) Dose:
Functional class: Digestant
Side-Effects: GI: anorexia, N/V, diarrhea, cramping, bloating GU: hyperuricuria, hyperuricemia Contraindications: Allergy to pork
Chemical class: Pancreatic enzymeRoute (Give timing for IV push/IVPB meds): bovine/porcine Frequency: Rationale for client: Action: Pancreatic enzyme needed for breakdown of substances released from pancreas
Assess for appropriate height/weight development Assess I&O; watch for increased urinary output Assess for fecal fat, nitrogen, PT during treatment Assess for allergy to pork Take with 8 oz or more of water Teach pt. not to inhale powder if that is form used
Drug: Pancuronium (pancuronium bromide) Dose:
Functional class: Neuromuscular blocker (nondepolarizing) Chemical class: Synthetic curariform
Side-Effects: CV: bradycardia, tachycardia, increased/decreased B/P, edema, HTN RESP: dyspnea INTEG: rash, flushing, pruritus, sweating, salivation EENT: increased secretions Contraindications: hypersensitivity to bromide ion
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, antagonizing action of acetylcholine
Assess for electrolyte imbalances (K, Mg) Assess VS: B/P, pulse, respirations Assess I&O Overdose: Edrophonium or neostigmine, atropine, monitor VS; may require mechanical ventaliation
Drug: Panitumumab (Vectibix) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic- misc. Chemical class: Mulitikinase inhibitor, signal transduction inhibitor Action: Decreases growth and survival of cancer cells by competitive inhibition of EGF receptor
Side-Effects: CNS: Fatigue CV: peripheral edema HEMA: thrombophlebitis INTEG: rash, pruritis GI: N/V, diarrhea, anorexia, ABD pain, constipation EENT: Ocular irritation, ocular hyperemia Contraindications: Hypersensitivity
Assess electrolytes (especially calcium, Mg) Assess for signs of infection, infusion reactions, ocular toxicity Teach to avoid sun, use sunscreen while using product
Drug: Pantoprazole (Protonix) Dose:
Functional class: PPI Chemical class: Benzimidazole
Side-Effects: CNS: HA, insomnia Meta: Hyperglycemia INTEG: rash GI: Diarrhea, ABD pain, flatulence Contraindications: Hypersensitivity
Assess GI system: bowel sounds Q8 hrs, Assess for ABD pain Assess hepatic studies and check vitamin B12
Route (Give timing for IV push/IVPB meds): Action: Suppresses gastric secretions by inhibiting hydrogen/potassium ATPase Frequency: enzyme system in gastric parietal cell; characterized as gastric acid pump Rationale for client: inhibitor, since it blocks final step of acid production
Drug: Paricalcitol (Zemplar) Dose:
Functional class: Vit D analog Chemical class: Fat-Soluble vitamin
Side-Effects: CNS: Light-Headedness CV: palpitations GI: N/V, anorexia, dry mouth Other: edema, fever, chills Contraindications: Hypersensitivity, hypercalcemia
Route (Give timing for IV push/IVPB meds): Action: Reduces parathyroid hormone(PTH) levels; suppresses PTH Frequency: levels in pts. W/ chronic renal failure w/ absence of hypercalcemia/ Rationale for client: hyperphosphatatemia; serum PO4, calcium, CaXP may increase
Assess Ca, PO4 twice a week during treatment; after dose is established take calcium and phosphorus QMonth Teach pt to avoid excessive use of aluminum compounds, not to take mineral oil while taking vit D, and report weakness, HA, loss or weight, N/V.
Drug: Paroxetine (Paxil) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antidepressant, SSRI Chemical class: Phenylpiperidine derivative Action: Inhibits CNS neuron uptake of serotonin but not of norepinephrine or Dopamine
Side-Effects: CNS: HA, drowsiness, insomnia, tremor, anxiety, dizziness, fatigue, sedation CV: vasodilation, postural hypotension INTEG: sweating, rash GI: N/V, diarrhea, dry mouth, constipation, anorexia GU: decreased libido, urinary frequency EENT: visual changes Contraindications: hypersensitivity, Preg (D), MAOI use, alcohol use
Assess mental status, blood studies, hepatic studies Assess B/P, pulse Q4H, if systolic B/P drops 20mmHg then hold product. Assess ECG and weight q week Teach to increase fluids, bulk in diet for constipation Have sugarfree gum or hard candy or sips of water for dry mouth Overdose: activated charcoal, gastric lavage, airway, for seizures give diazepam
Drug: Pegaptanib (Macugen) Dose:
Functional class: Ophthalmic agent- misc
Side-Effects: EENT: Blurred vision, eye pain, corneal edema, photophobia, cataract, reduced visual acuity, increased intraocular pressure, eye discharge Contraindications: Hypersensitivity
Assess visual acuity periodically Assess treated eye for increased intraocular pressure, infection
Action: Binds to vascular endothelial growth factor (VEGF), thereby inhibiting Route (Give timing for IV push/IVPB meds): angiogensis Frequency: Rationale for client:
Drug: Pegaspargase (Oncaspar) Dose:
Functional class: Antineoplastic Chemical class: Escherichia coli enzyme
Side-Effects: CNS: Neuritis, HA, fatigue, depression, confusion CV: Chest pain INTEG: rash, fever, chills GI: N/V, anorexia, cramps, stomatitis GU: urinary retention, azotemia ENDO: Hyperglycemia Contraindications: Breastfeeding, infant, hypersensitivity, bleeding, hypotension, DIC, pancreatitis, acute bronchospasm
Route (Give timing for IV push/IVPB meds): Action: Indirectly inhibits protein synthesis intumor cells; w/out amino acid, Frequency: DNA, RNA synthesis is halted; asparagines, protein synthesis is halted; Rationale for client: G1 phase; cell cycle specific; a nonvesicant; a modified version of Lasparaginase
Assess for s/s of pancreatitis (N/V, severe ABD pain) Assess CBC, renal studies, and hepatic studies Assess I&O Assess serum glucose Assess respiratory system for dyspnea, crackles, chest pain. Assess VS (B/P) Treatment of anaphylaxis: administer epinephrine, diphenhydramine, IV corticosteriods
Drug: Pegfilgrastim (Neulasta) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Hematopoietic agent Chemical class: Granulocyte colonystimulating factor Action: Stimulates proliferation and differentiation of neutrophils
Side-Effects: CNS: fever, fatigue, HA, dizziness, insomnia, peripheral edema INTEG: Alopecia GI: N/V, diarrhea, anorexia, constipation, ABD pain MISC: chest pain, skeletal pain Contraindications: Hypersensitivity to proteins of Escherichia coli, filgrastim
Assess and monitor for allergic reaction Assess Blood studies twice weekly and before treatment Assess B/P, respirations, and pulse before and during therapy
Drug: Pemetrexed (alimta) Dose:
Functional class: Antineoplasticantimetabolite Chemical class: Folic acid antagonist
Side-Effects: CNS: fatigue, fever, mood alteration CV: chest pain INTEG: rash, desquamation GI: N/V, anorexia, diarrhea, constipation, dehydration, dysphagia, ulcerative stomatitis GU: creatinine elevation RESP: Dyspnea Contraindications: Preg (D), hypersensitivity
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Inhibits multiple enzymes that reduces folic acid, which is needed for cell replication
Assess CBC, blood studies, renal studies, and electrolytes, before and during therapy Assess I&O; report if urine output <30 mL/hr Monitor temp Q4H Assess bleeding times and inspect for bruising Inspect buccal cavity Q8H for dryness, sores, ulceration, bleeding and white patches Teach pt to avoid alcohol, salycilates, and to eat food high in folic acid and take supplements as prescribed
Drug: Penicillin G & V Dose:
Functional class: Broad-Spectrum antiinfective Chemical class: Natural Penicillin
Side-Effects: CNS: lethargy, anxiety, depression, twitching HEMA: Anemia, increased bleeding time META: Hypo/hyperkalemia, alkalosis, hypernatremia GI: N/V, diarrhea, ABD pain, colitis, increased AST, ALT GU: vaginitis, moniliasis Contraindications: hypersensitivity to penicillin, corn; neonates
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Interferes w/ cell wall replication of susceptible organisms; lysis is mediated by cell wall autolytic enzymes, results in cell death
Assess and monitor infection Assess I&O Assess hepatic studies, blood studies, renal tests, and C&S Assess and monitor for adverse reaction Teach pt about preventing dehydration from excessive diarrhea and watch for electrolyte imbalances Take all medications as prescribed Treatment of anaphylaxis: Maintain airway, administer epinephrine, aminophylline, O2, IV corticosteriods
Drug: Pentamidine (Nebupent) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiprotozoal Chemical class: Aromatic diamide derivative Action: Interferes with DNA/RNA synthesis in protozoa
Side-Effects: CNS: Disorientation, dizziness, confusion, drowisness CV: hypotension, ventricular tachycardia HEMA: anemia INTEG: sterile abscess, rash, pruritis GI: N/V, anorexia, increased AST,ALT GU: decreased urination RESP: Cough, SOB Contraindications: Hypersensitivity
Assess blood studies, blood glucose, electrolytes (Ca, Mg), hepatic studies, and renal studies. Assess bowels and assess for signs of infection Assess respiratory status and assess for allergies Assess I&O and B/P
Drug: Pentazocine (Talwin) Dose:
Functional class: Opiate analgesic, antagonist Chemical class: Synthetic benzomorphan
Side-Effects: CNS: drowsiness, dizziness, confusion, HA, sedation, insomnia, light-headedness CV: bradycardia, change in B/P, hypotension, tachycardia, flushing INTEG: rash, pruritus, flushing, bruising GI: N/V, dry mouth, anorexia, constipation, cramps GU: increased urinary output, urinary retention EENT: blurred vision, tinnitus, diplopia Contraindications: hypersensitivity to this product or sulfites, addiction
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception
Assess pain: intensity, duration, location. Check prior to and 1 hour after dose Assess I&O, bowel status, and respiratory. Assess for CNS changes and adverse reactions. Overdose includes respiratory depression. Watch for addiction/withdrawal s/s. Overdose: Narcan Implement safety; fall risk
Drug: Pentobarbital (Nembutal) Dose:
Functional class: Sedative/hypnotic barbiturate; anticonvulsant, anesthetic adjunct
Side-Effects: CNS: Lethargy, drowsiness, hangover, dizziness, dependence, mental depression, agitation CV: hypotension, bradycardia INTEG: rash, pain, urticaria GI: N/V, constipation, diarrhea Contraindications: Preg (D), hypersensitivity to barbiturates, respiratory depression, addiction to barbiturates; severe renal/hepatic impairment; porphyria, uncontrolled pain
Route (Give timing for IV push/IVPB meds): Chemical class: Barbitone, short acting Frequency: Rationale for client: Action: Depresses activity in brain cells, primarily in reticular activating system in brain stem; selectively depresses neurons in posterior hypothalamus, limbic structures
Assess VS frequently Assess blood studies, hepatic studies, and mental status Assess for physical dependency Assess for respiratory changes Implement safety; fall risk Overdose: Lavage, activated charcoal, warming blanket, vital signs, hemodialysis, I&O ratio
Drug: Pentostatin (Nipent) Dose:
Functional class: Antineoplastic, enzyme inhibitor
Side-Effects: CNS: HA, anxiety, confusion, depression, dizziness HEMA: ecchymosis, petechiae INTEG: rash, dry skin, pruritus, sweating GI: N/V, anorexia, diarrhea, constipation, flatulence GU: dysuria, increased BUN/creatinine RESP: cough, sinusitis, rhinitis, epistaxis, dyspnea Contraindications: Preg (D), hypersensitivity
Chemical class: Strepomyces antibioticus Route (Give timing for IV push/IVPB meds): derivative Frequency: Rationale for client: Action: Inhibits the enzyme adenosine deaminase (ADA), which is able to block DNA synthesis and some RNA synthesis
Assess CBC, blood studies, hepatics studies, and renal studies. Monitor temp Q4H, elevated could indicate infection Inspect skin and buccal cavities. Inspect Q8H for dryness, sores, ulceration, and white patches Administer antiemetic 30-60 minutes before giving product Teach pt. to avoid foods with citric acid, hot or rough texture
Drug: Pentoxifylline (Pentoxil) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Hemmorheologic agent Chemical class: Dimethylxanthine derivative Action: Decreases blood viscosity, stimulates prostacyclin formation, increases blood flow by increasing flexibility of RBCs; decreases RBC hyperaggregation, decreases fibrinogen concentration
Side-Effects: CNS: HA, anxiety, tremors, dizziness, confusion CV: Angina, hypotension, chest pain, dyspnea, edema INTEG: rash, pruritus, brittle fingernails GI: N/V, dyspepsia, anorexia, dry mouth, thirst, bad taste, constipation, belching EENT: blurred vision, earache, sore throat, increased salivation Contraindications: Hypersensitivity to this product or xanthines, retinal/cerebral hemorrhage
Assess B/P, respirations of pts. also taking antihypertensives; intermittent claudication baseline and throughout Assess PT, Hgb, Hct in pts at risk for hemorrhage Teach that therapeutic response may take 2-4 weeks, 8-12 wk to reach full benefit
Drug: Peridopril (Aceon) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antihypertensive Chemical class: Angiotension-converting enzyme inhibitor Action: Selectively suppresses reninangiotension-aldosterone system; inhibits ACE; prevents conversionof angiotension I to angiotension II, dilation of arterial, venous vessels
Side-Effects: CNS: Insomnia, dizziness, HA, fatigue, anxiety, depression CV: hypotension, chest pain, tachycardia, syncope INTEG: rash, alopecia, hyperhidrosis GI: N/V, diarrhea, constipation, cramps, dry mouth, loss of taste GU: increased frequency of polyuria or oliguria EENT: tinnitus, visual changes, sore throat RESP: dyspnea, dry cough, crackles Contraindications: hypersensitivity
Assess B/P, pulse Q4H Assess electrolytes: K, Na, Cl during 1st 2 weeks of therapy Assess baseline in blood, renal and hepatic studies Assess for edema in lower extremities Assess skin turgor & hydration status Implement safety for fall risk r/t hypotension Overdose: Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure
Drug: Perphenazine Dose:
Functional class: Antipsychotic, neuroleptic Chemical class: Phenothiazine piperidine
Side-Effects: CNS: EPS, HA, dizziness CV: orthostatic hypotension, ECG changes HEMA: anemia INTEG: rash, dermatitis GI: dry mouth, N/V, anorexia, constipation, diarrhea, jaundice, weight gain GU: urinary retention/frequency, enuresis EENT: blurred vision, glaucoma Contraindications: children <12yrs old, hypersensitivity, blood dyscrasis, coma, brain damage, CNS depression
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Depresses cerebral cortex, hypothalamus, limbic system, which control activity, aggression; blocks neurotransmission produced by dopamine at synapse; exhibits strong a-adrenergic, antiemetic inhibits medullary chemoreceptor trigger zone; receptor affinity dopamine D2, histamine H1, aadrengeric
Assess mental status, bilirubin, CBC, LFTs Q month Assess I&O Assess B/P and skin turgor Overdose: Lavage and airway, do not induce vomiting
Drug: phenazopyridine (Azo-100) Dose:
Functional class: Urinary analgesic Chemical class: Azodye
Side-Effects: CNS: HA INTEG: rash, pruritus GI: N/V, diarrhea, heartburn, anorexia GU: orange-red urine Contraindications: hypersensitivity, renal insufficiency, hepatic disease, uremia
Route (Give timing for IV push/IVPB meds): Action: Exerts analgesic, anesthetic action on the urinary tract mucosa Frequency: Rationale for client:
Assess urinary status Assess hepatic studies if on long term therapy Teach pt that urine may turn red-orange and may stain clothes Treatment of overdose: Methylene blue or vit C
Drug: Phenobarbital ( Luminal) Dose:
Functional class: Anticonvulsant Chemical class: Barbiturate
Side-Effects: CNS: drowsiness, Ha, flushing INTEG: rash, urticaria GI: N/V, diarrhea, constipation Contraindications: Preg (D), breastfeeding, geriatric pts, hypersensitivity to barbiturates, porphyria, hepatic/respiratory disease, nephritis, hyperthyroidism, DM
Route (Give timing for IV push/IVPB meds): Action: Decreases impulse transmission; increases seizure threshold at cerebral Frequency: cortex level Rationale for client:
Assess mental status Assess for respiratory depression. Assess convulsion activity and precipitating factors Assess blood studies Teach pt to take exactly as ordered, may take up to 2-3 weeks to see therapeutic effects. Overdose: Lavage, activated charcoal, warming blanket, vital signs, hemodialysis, I&O ratio Assess weight daily and I&O Assess and monitor B/P Teach about rising slowly and implement fall risk Teach that pt may sip on water, have mint or sugar free gum to relieve dry mouth. Overdose: norepinephrine
Drug: Phentolamine Dose:
Functional class: Antihypertensive Chemical class: a-adrenergic blocker
Side-Effects: CNS: dizziness, flushing, weakness CV: hypotension, tachycardia, angina, dysrhythmias GI: Dry mouth, N/V, diarrhea, ABD pain EENT: nasal congestion Contraindications: hypersensitivity, MI, coronary insufficiency, angina
Route (Give timing for IV push/IVPB meds): Action: a-Adrenergic blocker, binds to aadrenergic receptors, dilating peripheral Frequency: blood vessels, lowering peripheral resistances, lowering blood pressure Rationale for client:
Drug: Phenylephrine Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Adrenergic, direct-acting Chemical class: Substituted phenylethylamine Action: Powerful and selective (alpha 1) receptor agonist causing contraction of blood vessels
CNS:HA, anxiety, tremor, insomnia, dizziness CV: Palpations, tachycardia, HTN, ectopic beats, angina, dysrhythmias Integ: gangrene GI: Nausea, vomiting SYST: Anaphylaxis Contraindications: Hypersensitivity, V. fib, tachydysrhythmias, pheochromocytoma, closed-angle glaucoma, severe HTN Black box warning: Cardiac disease, extravasation
Assess: I&O, ECG during administration continuously, if BP increases, product is decreased. BP and pulse q5min after parenteral route, CVP or PWP during inf if possible. Assess for paresthesias and coldness of extremities. Use infusion pump. Teach to report pain at inf site or other adverse reactions. Treat overdose with alpha-blocker
Drug: Phenytoin Functional class: Anticonvulsant; Dose: antidysrhythmic (IB) Route (Give timing for IV push/IVPB meds): Chemical class: Hydantoin Frequency: Rationale for client: Action: Inhibits spread of seizure activity in motor cortex by altering ion transport; increases AV conduction.
Drug: Phytonadione Functional class: Vit K, fat-soluble Dose: vitamin Route (Give timing for IV push/IVPB meds): Chemical class: Frequency: Rationale for client: Action: Needed for adequate blood clotting (factors II,VII, IX, X)
CNS: Suicidal tendencies, drowsiness, confusion CV: v. fib., hypotension Hema: Agranulocytosis, leucopenia, aplastic anemia, thrombocytopenia, megaloblastic anemia Integ: lupus erythematosus, stevensjohnson syndrome, toxic epideral necrolysis GI: Hepatitis, N&V GU: Nephritis, urine discoloration EENT: nystagmus, diplopia SYST: purple glove syndrome (IV) Contraindications: Pregnancy, hypersensitivity, psychiatric condition, bradycardia, SA and AV block, StokesAdams syndrome, hepatic failure, acute intermittent prophyria Side-Effects: CNS: HA, brain damage (lg doses) Hema: Hemolytic anemia, hemoglobinuria, hyperbilirubinemia Integ: rash, urticaria GI: nausea, decreased LFTs RESP: bronchospasm, resp arrest Contraindications: hypersensitivity, severe hepatic disease, late preg. Black box warning: IV use
Assess: for phenytoin hypersensitivity syndrome 3-12 wk after start of treatment; for rash; for purple glove syndrome; for seizures; blood studies (CBC, platelets q2wk until stabilized then q mo x 12, then q3mo; discontinue product if neutorphils <1600/mm3); renal function (albumin conc); mental status; respiratory depression; blood dyscrasias; if diabetic monitor urinc glucose. Teach urine may turn pink, not to discontinue product abruptly, brush teeth properly using soft tooth brush and flossing and see dentist frequently, carry emergency ID stating product use, not to change brands of product, avoid use of heavy alcohol and OTCs Assess: for bleeding; bleeding time; nutritional status. Teach not to take other supplements unless directed by prescriber, necessary foods for diet, avoid IM inj, used soft toothbrush, do not floss, use electric razor until coagulation defect corrected, report symptoms of bleeding, importance of frequent lab test to monitor coagulation factors
Drug: (trade & generic name) Pindolol Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antihypertensive Chemical class: Nonselective beta-blocker Action: Competitively blocks stimulation of beta-adrenergic receptor within vascular smooth muscle; decreases rate of SA node discharge, increases recovery time slows conduction of AV node, decreases heart rate, which decreases O2 consumption in myocardium; also decreases rennin-aldosterone-angiotensin system, at high doses inhibits beta 2 receptors in bronchial system
CNS: Insomnia, dizziness CV: HTN, CHF, AV block, pulmonary edema, bradycardia, dysrhythmias Hema: Agranulocytosis, thrombocytopenia, purpura Integ: rash, alopecia, fever, pruritus GI: N&V, ischemic colitis, abdominal pain, mesenteric arterial thrombosis GU: Impotence, urinary frequency EENT: Visual changes, double vision Contraindications: Hypersensitivity to beta-blockers, cardiogenic shock; 2nd-/3rddegree heart block; sinus bradycardia; sick sinus syndrome; acute bronchospasm Black box warning; abrupt discontinuation
Drug: Pioglitazone Functional class: Antidiabetic, oral Dose: Chemical class: thiazolidinedione Route (Give timing for IV push/IVPB meds): Action:Specifically targets insulin Frequency: resistance, an insulin sensitizer; regulates Rationale for client: the transcription of a number of insulin responsive genes
CNS: HA CV: MI, heart failure, death (geriatric) ENDO: hypo/hyperglycemia MISC: Myalgia, sinusitis, upper respiratory tract infection, pharyngitis, hepatotoxicity MS: fractures (females), myalgia Contraindications: Breastfeeding, children, hypersensitivity to thiazolidinedione, DKA Black box warning: CHF
Assess: I&O, daily weight, BP during initial treatment, pulse q4hr, notify prescriber of any significant changes, baselines in renal, hepatic studies pre therapy, skin turgor, mucous menbranes, dependent edema. Administer AC HS. Teach not to discontinue abruptly, not to use OTC products containing alphaadrenergic stimulants (nasal decongestants, OTC cold preparations) unless directed by prescriber, report bradycardia, dizziness,confusion, depression, fever, sore throat, SOB, avoid alcohol, smoking, sodium, carry emergency ID, diabetic symptoms may be masked by product, report symptoms of CHF, take at bedtime to prevent orthostatic hypotension, wear support hose to minimize effects of orthostatic hypotension. Treat overdose with lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure, hemodialysis, hypotension, give vasopressor (norepinephrine) Assess: for hypo/hyperglycemic reactions, LFTs periodiacally AST, LDH; FBS, glycosylated Hgb, plasma lipids/lipoproteins, BP, body weight during treatment. Teach to self-monitor using a blood glucose meter, symptoms of hypo/hyperglycemia, what to do about each, product must be continued of daily basis, avoid unapproved OTCs or herbal preparations, notify HCP if oral contraceptives are used, not to use if breastfeeding, report symptoms of hepatic dysfunction, report weight gain, edema
Drug: Piperacillin Functional class: Broad-spectrum Dose: antiinfective Route (Give timing for IV push/IVPB meds): Chemical class: Extended-spectrum penicillin Frequency: Rationale for client: Action: Lysis mediated by cell wall autolytic enzymes
CNS: coma, seizures Hema: bone marrow depression GI: N, V, D, increased AST, ALT; pseudomembranous colitis GU: oliguria, proteinuria, hematuria, vaginitis, moniliasis, glomerulonephritis, acute renal failure SYST: serum sickness, anaphylaxis, stevens-johnsons syndrome, exfoliative dermatitis, toxic epidermal necrolysis Contraindications: neonates, hypersensitivity to penicillins
Drug: (trade & generic name) Piperacillin/tazobactam Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiinfective, broadspectrum Chemical class: Extended-spectrum penicillin, beta-lactamase inhibitor Action: Interferes with cell wall reqlication of susceptible organisms; osmotically unstable cell wall swells and bursts from osmitoc pressure; tazobactam is a b-lactamase inhibitor, protects piperacillin from enzymatic degradation
CNS: dizziness, seizures CV: cardiac toxicity Hema: bone marrow depression, agranulocytosis, hemolytic anemia Integ: exfoliative dermatitis GI: N, V, D; increased AST, ALT; pseudomembranous colitis GU: oliguria, proteinuria, hematuria, vaginitis, moniliasis, glomerulonephritis, renal failure SYST: serum sickness, anaphylaxis, stevens-johnson syndrome Contraindications: Hypersensitivity to penicillins; neonates; carbapenem allergy
Assess for infection, I&O ratio, for hematuria, hepatic studies (AST, ALT), blood studies ( WBC, RBC, Hct, Hgb, bleeding time prior to and periodically during treatment), renal studies (urinalysis, protein blood, BUN, creatinine prior to and periodically during treatment), C&S before product therapy, bowel pattern before and during treatment, skin eruptions, resp. status, allergies. Perform/provide: Epinephrine, suction, tracheostomy set, endotracheal intubation equipment on unit; adequate intake of fluids during diarrhea episodes, scratch test to assess allergy after securing order from HCP. Teach that culture may be taken after completed course of medication, report sore throat, fever, fatigue; may indicate super infection; report CNS effects; wear or carry emergency ID if allergic to penicillins, notify nurse of diarrhea. Treat anaphylaxis by withdrawing product, maintain airway, administer epinephrine, aminophyline, 02, IV corticosteroids Assess for infection, I&O ratio, for hematuria, hepatic studies (AST, ALT), blood studies ( WBC, RBC, Hct, Hgb, bleeding time prior to and periodically during treatment), renal studies (urinalysis, protein blood, BUN, creatinine prior to and periodically during treatment), C&S before product therapy, bowel pattern before and during treatment, skin eruptions, resp. status, allergies. Perform/provide: Epinephrine, suction, tracheostomy set, endotracheal intubation equipment on unit; adequate intake of fluids during diarrhea episodes, scratch test to assess allergy after securing order from HCP. Teach that culture may be taken after completed course of medication, report sore throat, fever, fatigue; may indicate super infection; report CNS effects; wear or carry emergency ID if allergic to penicillins, notify nurse of diarrhea. Treat anaphylaxis by withdrawing product, maintain airway, administer epinephrine, aminophyline, 02, IV corticosteroids
Drug: Pirbuterol Functional class: Bronchodilator Dose: Chemical class: Beta-adrenergic agonist Route (Give timing for IV push/IVPB meds): Action: Causes bronchodilation with little Frequency: effect on heart rate by action on BRationale for client: receptors, causing increased cAMP and relaxation of smooth muscle
CNS: Tremors, anxiety, insomnia CV: Palpitations, tchycardia MS: muscle cramps GI: Gastritis, N&V, anorexia EENT: dry nose and mouth, irritation of nose, throat RESP: paradoxical bronchospasm Contraindications: hypersensitivity to sympathomimetics, tachycardia
Drug: Piroxicam Functional class: Nonsteroidal Dose: antiinflammatory Route (Give timing for IV push/IVPB meds): Chemical class: Oxicam derivative Action: Inhibits prostaglandin synthesis Frequency: by decreasing an enzyme needed for Rationale for client: biosynthesis; has analgesic, antiinflammatory, antipyretic properties
CNS: drowsiness, fatigue, HA CV: MI, stroke, CHF Hema: blood dyscrasias Integ: rash, purpura, photosensitivity GI: N, V, D; anorexia, cholestatic hepatitis, bleeding, ulceration, perforation GU: Nephrotoxicity: dysuria, hematuria, oliguria, azotemia SYST: anaphylaxis Contraindications: Pregnancy (D, 3rd trimester), hypersensitivity to this product, NSAIDs, salicylates; asthma Black box warning: perioperatice pain in CABG surgery; GI bleeding, MI, stroke
Assess: respiratory function (vital capacity, forced expiratory volume, ABGs, BP, lung sounds, pulsem characteristics of sputum), Administration: after shaking exhale; place mouthpiece in mouth; inhale slowly; hold breath; remove; exhale slowly; use gum or sips of water for dry mouth. Teach not to use OTC medications, extra stimulation may occur; use of inhaler; review package insert with patient; avoid getting aerosol in eyes; avoid smoking, smoke-filled rooms, persons with respiratory infections, to keep fluid intake >2L/day to liquefy thick secreations. Treat overdose with administration of a beta-adrenergic blocker. Assess cardiac status; GI status; pain; renal, hepatic, blood studies (BUN, creatinine, AST, ALT, Hgb, before treatment, periodically thereafter); audiometric, ophthalmic exam before, during, after treatment; for eye/ear problems. Those with aspirin sensitivity, asthma, nasal polyps may develop allergic reactions. Teach to drink at least 6-8 glasses of water/day, report blurred vision or ringing, roaring in ears, report change in urine pattern, weight increase, edema, pain increase in joints, fever, blood in urine (indicates nephrotoxicity); therapeutic effects may take up to 1 mo; avoid ASA, other OTC meds, alcohol; report pregnancy; avoid breastfeeding; avoid prolonged sun exposure, wear sunscreen, protective clothing; report brusing, bleeding, black tarry stools; inform all HCPs about product use.
Drug: Pitavastatin Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antilipidemic Chemical class: HMG-CoA reductase inhibitor Action: Inhibits HMG-CoA reductase enzymes, which reduces cholesterol synthesis; high doses lead to plaque regression.
Side-Effects: CNS: Headache CV: HEMA: INTEG: Rash, pruritus, alopecia GI: Constipation, diarrhea GU: RESP: Pharyngitis Contraindications: Pregnancy (X) , breastfeeding, hypersensitivity, active hepatic disease, cholestasis
Assess:
Hepatic studies q1-2months Administer Total day dose anytime without regards to food Evaluate Therapeutic response decrease in cholesterol to desired levels after 6 wks
Diet Cholesterol triglyceride levels
Drug: Plasma Protein fraction Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Hematological agent Chemical class: Plasma volume expander Action: Exerts similar oncotic pressure as human plasma, expands blood volume.
Side-Effects: CNS: Fever, chills, headache, paresthsias, flushing CV: Fluid overload, hypotension, erratic pulse HEMA: INTEG: Rash, urticaria, cyanosis GI: nausea, vomiting, increased salivation GU: RESP: Altered respirations, dyspnea, PE Contraindications: Hypersensitivity to this product or albumin, CHF, severe anemia, renal insufficiency, hyponatremia, cardiopulmonary bypass
Assess:
For Allergy Administer IV access at distant site from infection or trauma; no dilution required, use inf pump, use large bore needle, infuse slowly to prevent hypotension Perform/Provide Adequate hydration before administration Evaluate Therapeutic response; increased B/P, decreased edema, increased serum albumin
Blood studies B/P, pulse, respirations I & O ratio
Drug: Plerxafor Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Biologic modifier Chemical class: Colony-stimulating factor Action: Competitively inhibits the binding of Stromal-derived factors, allowing hematopoietic stem cells to mobilize into peripheral blood.
Side-Effects: CNS: Syncope, dizziness, fatigue, headache, insomnia, malaise, paresthesias CV: HEMA: Thrombocytopenia, leukocytosis INTEG: Rash, skin irritation, pruritus, inj. site reaction GI: Nausea, vomiting, diarrhea, abd. pain, constipation GU: RESP: Dyspnea, hypoxia Contraindications: Hypersensitivity, breastfeeding
Assess: B/P, respirations, pulse before and during therapy Administer Give 11 hours before apheresis
Blood studies
Evaluate
Max 40 mg/day of 27 mg/ day in renal disease Therapeutic response; collection of stem cells
Assess: Drug: Porfimer Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Used in photodynamic treatment of tumors (PDT); antitumor and cytotoxic actions are light and O2 dependent; used with 630-nm laser light Functional class: Antineoplastic Chemical class: Photosensitizing agenthematoporphyrin derivative Side-Effects: CNS: Anxiety, confusion, insomnia CV: Hypo/Hypertension, atrial fib, cardiac failure, tachycardia, chest pain HEMA: INTEG: GI: Abd. pain, constipation, diarrhea, dyspepsia, dysphagia, eructation, esophageal edema/bleeding, hematemesis, melena, nausea, vomiting, anorexia MISC: Dehydration, weight decrease, UTI RESP: Pleural effusion, pneumonia, dyspnea Contraindications: Porphyria, porphyrin allergy (porfimer); tracheoesophageal, bronchoesophageal fistula; PDT Ocular sensitivity; pts should wear dark sunglasses For extravasation at inj. site; take care to protect from light Administer As a single slow IV inf over 3-5 min at 2mg/kg Laser light is initiated 630-nm wave length laser light, 40-50 hr after inj, second laser if indicated 96-120 hr Perform/Provide Wiping of spills with a damp cloth, avoid skin/eye contact, uses rubber gloves, eye protection, dispose material in polyethylene bag according to policy
Assess: Drug: Potassium actetate/ Potassium bicarbonate Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Needed for adequate transmission of nerve impulses and cardiac contraction, renal function, intracellular ion maintenance Functional class: Electrolyte, mineral replacement Chemical class: Potassium Side-Effects: CNS: Confusion CV: Bradycardia, cardiac depression, dysrhythmias, arrest, peaking T waves, lowered R and depressed RST, prolonged P-R interval, widened QRS complex HEMA: INTEG: Cold extremities, rash, GI: Nausea, vomiting, cramps, pain, diarrhea, ulceration of small bowel GU: Oliguria EENT: Contraindications: Renal disease (severe), severe hemolytic disease, Addisons disease, hyperkalemia, acute dehydration, extensive tissue breakdown
ECG Potassium level during treatment I & O ratio
Cardiac status Administer Do not break, crush, or chew ext rel taps/caps or enteric With or after meals
Teach
IV with large bore needle To add potassium rich foods to diet Therapeutic response; absence of fatigue, muscle weakness, decreased thirst and urinary output, cardiac changes
Evaluate
Assess: Drug: Potassium bicarbonate and potassium choloride Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Needed for adequate transmission of nerve impulses and cardiac contraction, renal function, intracellular ion maintenance Functional class: Electrolyte, mineral replacement Chemical class: Potassium Side-Effects: CNS: Confusion CV: Bradycardia, cardiac depression, dysrhythmias, arrest, peaking T waves, lowered R and depressed RST, prolonged P-R interval, widened QRS complex HEMA: INTEG: Cold extremities, rash, GI: Nausea, vomiting, cramps, pain, diarrhea, ulceration of small bowel GU: Oliguria EENT: Contraindications: Renal disease (severe), severe hemolytic disease, Addisons disease, hyperkalemia, acute dehydration, extensive tissue breakdown
Teach
Evaluate
Drug: Potassium bicarbonate and potassium citrate Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Electrolyte, mineral replacement Chemical class: Potassium Action: Needed for adequate transmission of nerve impulses and cardiac contraction, renal function, intracellular ion maintenance
Side-Effects: CNS: Confusion CV: Bradycardia, cardiac depression, dysrhythmias, arrest, peaking T waves, lowered R and depressed RST, prolonged P-R interval, widened QRS complex HEMA: INTEG: Cold extremities, rash, GI: Nausea, vomiting, cramps, pain, diarrhea, ulceration of small bowel GU: Oliguria EENT: Contraindications: Renal disease (severe), severe hemolytic disease, Addisons disease, hyperkalemia, acute dehydration, extensive tissue breakdown
Assess:
Teach
Evaluate
Drug: Potassium Chloride Dose:
Functional class: Electrolyte, mineral replacement Chemical class: Potassium
Assess:
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Needed for adequate transmission of nerve impulses and cardiac contraction, renal function, intracellular ion maintenance
Teach
Evaluate
Drug: Potassium chloride/Potassium bicarbonate/Potassium citrate Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Assess:
Teach
Evaluate
Drug: Potassium gluconate Dose:
Functional class: Electrolyte, mineral replacement Chemical class: Potassium
Assess:
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Needed for adequate transmission of nerve impulses and cardiac contraction, renal function, intracellular ion maintenance
Teach
Evaluate
Drug: Potassium gluconate/Potassium chloride Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Assess:
Teach
Evaluate
Drug: Potassium gluconate/ potassium citrate Functional class: Electrolyte, mineral replacement Dose: Chemical class: Potassium Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Needed for adequate transmission of nerve impulses and cardiac contraction, renal function, intracellular ion maintenance
Assess:
Teach
Evaluate
Drug: Potassium iodide Dose:
Functional class: Thyroid hormone antagonist Chemical class: Iodine product
Side-Effects: CNS: HA, confusion, paresthesias, CV: HEMA: INTEG: Rash, urticarial, angioneurotic edema, acne, mucosal hemorrhage, fever GI: Nausea, diarrhea, vomiting, small bowel lesions, upper gastric pain MS: Myalgia, arthralgia, weakness EENT: Metallic taste, stomatitis, salivation, periorbital edema, sore teeth and gums, cold symptoms Contraindications:
Assess:
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Inhibits secretion of thyroid hormone, fosters colloid accumulation in thyroid follicles, decreases vascularity of gland
Pulse, BP, temp, serum potassium I & O ratio Daily Weight
Clinical response in 3 weeks should be increased weight and pulse, decreased T4 Administer Strong iodine solution after diluting with water or juice to improve taste With meals Lowest dose to improve symptoms Perform/Provide Fluids 3-4 L/day, unless contraindicated
At same time each day
Drug: Pralatrexate Dose:
Functional class: Antineoplasticantimetabolite Chemical class: Folate analog
Side-Effects: CNS: Fatigue, fever, asthenia CV: Sinus tacycardia HEMA: Leukopenia, Thrombocytopenia, myelosuppression, anemia, epitaxis, neutropenia INTEG: Rash, pruritus GI: N/V, anorexia, diarrhea, stomatitis, constipation, abd. pain, mucositis META: hypokalemia SYS: Edema, infection, night sweats, Contraindications: Pregnancy (D), hypersensitivity, leukopenia, thrombocytopenia, anemia, bone marrow suppression
Assess:
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Inhibits an enzyme that reduces folic acid, which is needed for acid synthesis in all cells; S phase of cells specific; immunosuppressive
Hepatic studies before and during therapy Buccal cavity Administer Antiemetic 30-60 min before giving product Use cytotoxic handling precautions Perform/Provide Rinsing mouth tid-qidwith water, club soda Evaluate Therapeutic response; decreased tumor size, spread of malignancy
CBC, differential, platelet count weekly, withhold if WBC <3500 or platelet count is <100,000 Renal studies Monitor Temp
Drug: Pramipexole Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiparkinson agent Chemical class: DOPamine-receptor agonist, non-ergot Action: Selective agonist for D2 receptors (presynaptic/postsynaptic sites) binding at D3 receptor contributes to antiparkinson effects
Side-Effects: CNS: Agitation, insomnia, psychosis, hallucination, depression, dizziness, HA, confusion, amnesia, sudden sleep onset CV: Orthostatic hypotension, edema, syncope, tachycardia HEMA:Hemolytic anemia, leukopenia, agranulocytosis INTEG: GI: Nausea, anorexia, constipation, dysphagia, dry mouth GU:Impotence, urinary frequency EENT: Blurred vision Contraindications: Hypersensitivity
Assess: B/P, ECG, respirations during initial treatment; hypo/hypertension should be reported Mental status Administer Adjust dosage to patient response, titrate slowly With meals Do not crush, chew, or break ER product Perform/Provide Assist with ambulation during beginning therapy Evaluate Therapeutic response; mvmt disorder improves
Renal studies,
Drug: Pramlintide Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antidiabetic Chemical class: Synthetic human amylin analog Action: Modulates and slows stomach emptying, prevents postprandial rise in plasma glucagon, decreases appetite, leads to decreased caloric intake and weight loss
Side-Effects: CNS: HA, fatigue, dizziness META: Hypoglycemia RESP: Cough, pharyngitis INTEG: Inj. site reactions GI: N/V, anorexia, abd pain GU: EENT: Contraindications: Hypersensitivity to this product or cresol, gastroparesis
Assess:
For hyperglycemia Administer Pre-meal insulin should be decreased by 50% when starting and adjusted to therapeutic dose to prevent hypoglycemia Take immediately before meal time Dont use if meal is skipped
Fasting BG For hypoglycemia reaction

Drug: Prasugrel Dose: Chemical class: ADP receptor antagonist Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Inhibits ADP-induced platelet aggregation Functional class: Platelet aggregation inhibitor Side-Effects: CNS: HA, dizziness CV: Edema, atrial fib, bradycardia, chest pain, hyper/hypotension HEMA: Epistaxis, leukopenia, thrombocytopenia, neutropenia, anaphylaxis, angioedema, anemia INTEG: Rash, hypercholesterolemia GI: N/V, diarrhea GU: EENT: Contraindications: Hypersensitivity, stroke, TIA Assess:
Dont use if discolored Dont give in the arm
Blood studies Administer With food
Hepatic studies
Dont break tablets Dont discontinue therapy abruptly
Drug: Pravastatin Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antilipidemic Chemical class: HMG-COA reductase inhibitor Action: Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis
Side-Effects: CNS: HA, dizziness, fatigue, ALS CV: Chest Pain HEMA: INTEG: Rash, pruritus, photosensitivity, GI: Nausea, constipation, diarrhea, flatus, abd. pain, hepatic dysfunction, heartburn, hepatitis GU: EENT: Contraindications: Pregnancy (X), breastfeeding, hypersensitivity, active hepatic disease
Assess:
Renal studies Administer Without regards to meals, at bedtime Give1 hr before or 4 hrs after bile acid sequestrants Evaluate Therapeutic response; decrease in cholesterol after 8 wk
Fasting lipid profile Hepatic studies
Drug: Prazosin Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antihypertensive Chemical class: Adrenergic blocker Action: Blocks a-mediated vasoconstriction of adrenergic receptors, inducing peripheral vasodilation
Side-Effects: CNS: Dizziness, HA, drowsiness, anxiety, depression, vertigo, weakness, fatigue CV: Palpitations, orthostatic hypotension, tachycardia, edema, rebound hypertension, HEMA: INTEG: GI: N/V, diarrhea, constipation, abd pain GU: Urinary frequency, incontinence, impotence, priaprism, sodium retention EENT: Blurred vision, epistaxis, tinnitus, dry mouth, red sclera Contraindications: Hypersensitivity
Assess: BP (siting,standing) during intial treatment Weight daily, I&O ratio, edema in feet, legs daily Skin turgor, dryness of mucosal membranes Crackles, dyspnea Administer 1st dose at bedtime to avoid fainting
Drug: prednisoLONE Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Corticosteroid, synthetic Chemical class: Glucocorticoid, immediate acting Action: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts; reversal to increase capillary permeability and lysosomal stabilization
Side-Effects: CNS: Depression, flushing, HA CV: Hypertension, circulatory collapse, thrombophlebitis, embolism, tachycardia HEMA: Thrombocytopenia INTEG: Acne, poor wound healing, ecchymosis, petechaie GI: Diarrhea, nausea, abd. distention, GI hemorrhage, increased appetite, pancreatitis GU: EENT: Fungal infection, increased ICP, blurred vision Contraindications: hypersensitivity, idiopathic thrombocytopenia, acute glomerulonephritis, amebiasis, fungal infections, nonasthmatic bronchial disease, measles, varicella, Cushings syndrome
Assess:
Potassium, BG, urine glucose Weight daily; prescriber if weekly gain > 5lbs BP q4h I&O ratio
Administer Orally disintegrating tabs; allow to dissolve, swallow or swallow whole, dont cut, split Perform/Provide Assistance with ambulation of patient with bone tissue disease to prevent fracture
Drug: predniSONE Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Corticosteroid Chemical class: Intermediate-acting glucocorticoid Action: Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts, reversal to increase capillary permeability, and lysosomal stabilization, minimal mineralocorticoid activity
Side-Effects: CNS: Depression, flushing, sweating, HA, mood changes CV: Hypertension, circulatory collapse, thrombophlebitis, embolism, tachycardia HEMA: Thrombocytopenia INTEG: Acne, poor wound healing, ecchymosis, petechaie GI: Diarrhea, nausea, abd. distention, GI hemorrhage, increased appetite, pancreatitis GU: EENT: Fungal infection, increased ICP, blurred vision Contraindications: psychosis, hypersensitivity, idiopathic thrombocytopenia, acute glomerulonephritis, amebiasis, fungal infections, AIDS, TB, measles
Assess:
Mental status Administer Titrated dose, uses lowest effective dose With food or milk Perform/Provide Assistance with ambulation of patient with bone tissue disease to prevent fracture
Adrenal insufficiency Potassium, BG, urine glucose Weight daily BP q4h I&O ratio
Drug: Pregabalin Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Anticonvulsant Chemical class: Gamma aminobutyric acid (GABA) analog Action: Binds to high voltage-gated calcium channels in CNS tissues; this may lead to anticonvulsant action, similar to the inhibitory neurotransmitter GABA, anxiolytic, analgesics, and antiepileptic properties
Side-Effects: CNS: Dizziness, fatigue, confusion, euphoria, incoordination, nervousness, neuropathy, tremor, vertigo, somnolence, ataxia, amnesia, abnormal thinking CV: HEMA: Ecchymosis, thrombocytopenia INTEG: GI: Constipation, flatulence, abd. pain, weight pain MS: Back pain, rhabdomyolysis, myopathy EENT: Dry mouth, blurred vision, nystagmus, amblyobia, sinusitis OTHER: angioedema, suicidal ideation Contraindications: Hypersensitivity, abrupt discontinuation
Assess:
Metal Status Administer Dont crush or chew caps; cap may be opened and contents put in applesauce or dissolved in juice Give without regards to meals Gradually withdraw over 7 days; abrupt withdrawal may precipitate seizures Perform/Provide Hard candy; frequent rinsing of mouth , gum for dry mouth Seizures precautions
Seizures Pain Renal Studies
Increased fluids
Drug: Primaquine Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antimalarial Chemical quinolone class: Sythetic 8-amino-
Side-Effects: CNS: HA, dizziness CV: Hypertension, dysrhythmias HEMA: Agranulocytosis, granulocytopenia, leukopenia, hemolytic anemia, leukocytosis, mild anemia, methemoglobinemia INTEG: Pruritus, skin eruptions, pallor, weakness GI: N/V, anorexia, cramps GU: EENT: Blurred vision, difficulty focusing Contraindications: Lupus, rheumatoid arthritis, hypersensitivity,
Assess:
Action: Unknown, thought to destroy exoerythrocytic forms gametocidal action
Renal status Administer Before or after meals at same time each day to maintain product level Take with food
Hepatic studies q week Blood studies Allergic reaction
Drug: Primidone Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Anticonvulsant Chemical class: Barbiturate derivative Action: Raises seizure threshold by conversion of product to phenobarbital, decreases neuron firing.
Side-Effects: CNS: Stimulation, drowsiness, irritability, psychosis, ataxia, vertigo, fatigue, emotional disturbances, suicidal ideation CV: HEMA: Thrombocytopenia, leukopenia, neutropenia, eosinophilia, megaloblastic anemia INTEG: Rash, edema, alopecia, lupuslike syndrome GI: N/V, anorexia, hepatitis GU: Impotence EENT: Diplopia, nystagmus, edema of eyelids Contraindications: Pregnancy (D), breastfeeding, hypersensitivity, porphyria, hepatic encephalopathy
Assess:
For seizures Product level: Therapeutic level 5-15 mcg/ml Mental status
Respiratory depression, wheezing Blood dyscrasias Administer Shake well
Take with food Tablets crushed and mixed with food or fluid for swallowing difficulties Avoid use with CNS depressants
Drug: Probenecid Dose:
Functional class: Uricosuric, antigout agent Chemical class: Sulfonamide derivate
Side-Effects: CNS: Drowsiness, HA CV: Bradycardia HEMA: RESP: Apnea GI: Gastric irritation, N/V, anorexia, hepatic necrosis GU: Glycosuria, thirst, frequency, nephrotic syndrome META: Acidosis, hypokalemia, hypercholremia, hyperglycemia Contraindications: Hypersensitivity, severe renal/hepatic disease, history of uric acid calculus
Assess:
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Inhibits tubular reabsorption of urates, with increased excretion of uric acids
Urine pH Administer After meals or with milk
Uric acid levels (3-7mg/dl) Respiratory rate, rhythm, depth Electrolytes
Increase fluid intake to 2-3 L/day to prevent urinary calculi
Drug: Procainamide Dose:
Functional class: Antidysrhythmic (Class IA)
Side-Effects: CNS: Headache, dizziness, confusion, psychosis, restlessness, irritability, weakness, depression CV: Hypotension, Heart block, cardiovascular collapse, arrest HEMA: INTEG: Rash, urticaria, edema, angioedema, swelling, pruritus, flushing GI: N/V, anorexia, diarrhea, hepatomegaly, pain, bitter taste GU: EENT: Contraindications: Hypersensitivity, severe heart block, torsade de pointes
Assess:
Chemical class: Procaine HCI amide Route (Give timing for IV push/IVPB meds): analog Frequency: Rationale for client: Action: Decreases excitability of cardiac muscle to electrical stimulation and slowly conduction in atrium, bundle of His, and ventricle increases refractory period.
Cardiac rate, rhythm, character, B/P continuously Administer IM inj. in deltoid; aspirate
ECG continuously Blood levels CBC q2wk x 3 months I&O ratio Toxicity
Check IV site q8h for infiltration or extravasation
Drug: Procaine Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Local anesthetic Chemical class: Ester Action: Competes with calcium for sites in nerve membrane that control sodium transport across cell membrane; decreases rise of depolarization phase of action potential
Side-Effects: CNS: Anxiety, restlessness, seizures, LOC, drowsiness, disorientation, tremors, shivering CV: Myocardial depression, cardiac arrest, dysrhythmias, bradycardia, hypotension, hypertension RESP: Status asthmaticus, respiratory arrest, anaphylaxis INTEG: Rash, urticarial, allergic reaction, edema, burning, GI: N/V GU: EENT: Blurred vision, tinnitus, pupil constriction Contraindications: Hypersensitivity, sulfite allergy, myasthenia gravis, severe hepatic disease
Assess:
Cardiac status Administer Only products that are not cloudy Only with crash cart, resuscitative equipment nearby
B/P, respirations, pulse Allergic reaction
Drug: Procarbazine Dose:
Functional class: Antieoplastic, alkylating agent Chemical class: Hydrazine derivative
Side-Effects: CNS: HA, dizziness, insomnia, confusion, coma, pain , chills, fever, sweating, seizures CV: HEMA: Thrombocytopenia, anemia, leukopenia, myelosuppression, bleeding tendencies, purpura, petechaie, hemolysis INTEG: Rash, pruritus, alopecia, herpes GI: N/V, anorexia, diarrhea, constipation, dry mouth, stomatitis GU: Azoospermia, cessation of menses EENT: Retinal hemorrhage, nystagmus, diplopia, dry eyes Contraindications: Pregnancy (D), breastfeeding, hypersensitivity, thrombocytopenia
Assess:
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Inhibits DNA, RNA, protein synthesis; has multiple sites of action; a non-vesicant
Bleeding Administer In divided doses and at bedtime to minimize N/V Nonphenothiazine antiemetic 30-60 min before giving product
CBC Renal studies I&O ratio Monitor temp Hepatic studies CNS changes For tyramine foods in diet Toxicity
Drug: Prochlorperazine Dose:
Functional class: Anriemetic, antipsychotic
Side-Effects: CNS: Nueroleptic malignant syndrome, extrapyramidal reactions, tardive dyskinesia, euphoria, depression, drownsiness, restlessness, tremor, dizziness, headache CV: Circulatory failure, tachycardia, hypotension, ECG changes HEMA: Agranulocytosis INTEG: GI: N/V, anorexia, dry mouth, diarrhea, constipation, weight loss, metallic taste, cramps RESP: Respiratory depression EENT: Blurred vision Contraindications: Hypersensitivity, coma
Assess:
Chemical class: Phenothiazine, piperazine Route (Give timing for IV push/IVPB meds): derivative Frequency: Rationale for client: Action: Decreases DOPamine neurotransmission by increasing DOPamine turnover through blockade of the D2 somatodendeitic autoreceptor in the mesolimbic system
VS, B/P; check pts with cardiac disease more often CBC
Respiratory status before, after, and during treatment Administer Avoid other CNS depressants

Teach
IM inj in large muscle mass Keep pt recumbent for hour The urine may be pink to reddish brown
Drug: Progesterone Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Progestogen Chemical class: Progesterone derivative Action: Inhibits secretion of pituitary gonadotropins, which prevent follicular maturation, ovulation; stimulates growth of mammary tissue; antieoplastic action against endometrial cancer
Side-Effects: CNS: Dizziness, HA, depression, fatigue, mood swings CV: Hypotension, thrombophlebitis, edema, thromboembolism, stroke, pulmonary embolism, MI SYS: Angioedema, anaphylaxis INTEG: Rash, acne, oily skin, hirsutism, alopecia GI N/V, anorexia, cholestatic jaundice, constipation GU: Amenorrhea, cervical erosion, gynecomastia, testicular atrophy, impotence, spontaneous abortion EENT: Diplopia, retinal thrombosis Contraindications: Pregnancy (D), hypersensitivity to this product and peanut oil, thromboembolic disorders, reproductive cancer, gential bleeding, PID, STDs
Assess:
Hepatic studies Administer At least 6 hr after any vaginal treatment using vaginal gel In one dose at in am
Weight daily B/P I&O ratio
With food or mile
Drug: Promethazine Dose:
Functional class: Antihistamine , H1 receptor antagonist Chemical class: Phenothiazine derivative
Side-Effects: CNS: Dizziness, drowsiness, fatigue, neuroleptic malignant syndrome CV: Hypo/Hypertension, palpitations, tachycardia HEMA: Thrombocytopenia, agranulocytosis, hemolytic anemia INTEG: Rash, urticaria, photosensitivity GI: Constipation, N/V, dry mouth, diarrhea, anorexia GU: Urinary retention, dysuria, frequency EENT: Blurred vision, dilated pupils, tinnitus, Contraindications: Hypersensitivity, breastfeeding, agranulocytosis, hemolytic anemia
Assess:
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Acts on blood vessels, GI, respiratory system by competing with histamine for H1- receptor sites; decreases allergic response by blocking histamine
Cardiac status Administer Avoid use with other CNS depressants With meals
I&O ratio CBC Respiratory status

Provide
When used for motion sickness 30-1 hr before travel
Assess:
Hard candy, gum, frequent rinsing of mouth for dryness
Drug: Propafenone Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antidysrhythmic Chemical class: Action: Slows conduction velocity; reduces membrane responsiveness; inhibits automaticity; increases ratio of effective refractory period to action potential duration; B blocking acitvity
Side-Effects: CNS: HA, dizziness, abnormal dreams, seizures, anxiety, fatigue CV: Supraventricular dysrhythmia, ventricular dysrhythmia, bradycardia, AV block , hypotension, chest pain, HEMA: Leukopenia, agranulocytosis, granulocytopenia, thrombocytopenia, anemia, bruising INTEG: Rash GI: N/V, constipation, dyspepsia, diarrhea, anorexia, dry mouth GU: EENT: Blurred vision, altered taste, tinnitus Contraindications: 2nd/3rd degree heart block, right bundle branch block, cardiogenic shock, hypersensitivity, bradycardia, uncontrolled CHF, marked hypotension
GI status Cardiac status I&O ratio B/P Lung fields
Administer After hypo/hyperkalemia is corrected Dosage adjustment q3-4 days
With food
Drug: Propantheline Dose:
Functional class: GI anticholinergic, antiulcer agent
Side-Effects: CNS: Confusion, stimulation in geriatric patients, HA, insomnia, drowsiness, anxiety CV: Palpitations, tachycardia, orthostatic hypotension HEMA: INTEG: Rash, urticarial, fever, allergic reactions Dry mouth, constipation, paralytic ileus, Heartburn, N/V GU: Urinary hesitancy, retention, impotence EENT: Blurred vision Contraindications: Hypersensitivity, closed-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, GI atony, toxic megacolon, urinary tract obstruction
Assess:
Chemical class: Synthetic quaternary Route (Give timing for IV push/IVPB meds): annomium compound Frequency: Rationale for client: Action: Inhibits action of acetylcholine at postganglionic parasympathetic neuroeffector sites
GI complaints Administer -1 hour before meals for better absorption, if taking antacids give 1 hr before or after Decreased doses to geriatric patients Provide
VS, cardiac status I&O Ratio
Gum, hard candy, frequent moth rinsing for dry mouth
Drug: Propofol Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: General anesthetic Chemical class: Action: Produces dose-dependent CNS depression by activation of GABA receptor
Side-Effects: CNS: HA, fever, shivering, increased ICP, impaired cerebral flow, seizures CV: Bradycardia, hypotension, asystole, bradydysrhythmias RESP: Apnea, cough, hiccups INTEG: flushing, phlebitis, hives, burning/stinging at inj. site GI: N/V, abd. cramping, dry mouth, hypersalivation, pancreatits GU: Urinary retention, green urine, cloudy urine, oliguria EENT: Blurred vision, tinnitus, eye pain, strange taste Contraindications: Hypersensitivity to product or soy bean oil, egg, benzyl alcohol
Assess:
Respiratory status Administer Only by qualified persons trained in anesthesia
Inj. site ECG for changes CNS changes
Drug: Propoxyphene Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Opiate analgesic Chemical class: Synthetic opiate Action: Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors
Side-Effects: CNS: Drowsiness, dizziness, confusion, increases ICP, HA, sedation, seizures, hyperthermia CV: Palpitations, bradycardia, dysrhythmias RESP: Respiratory depression, pulmonary edema INTEG: Rash GI: N/V, cramps, anorexia, constipation GU: Urinary retention, dysuria EENT:Tinnitus, blurred vision, miosis, diplopia Contraindications: hypersensitivity to ASA products
Assess:
Respiratory status Administer May be given with food or milk for GI upset With antiemetic for N/V ANTIDOTE: NARCAN
For pain I&O ratio Bowel status CNS changes Allergic reaction
Drug: Propranolol Dose:
Functional class: Antihypertensive, antianginal, antidysrhythmic Chemical class: Beta Adrenergic Blocker
Side-Effects: CNS: Depression, dizziness, fatigue, lethargy, bizarre dreams CV: Bradycardia, hypotension, CHF, palpitations, Pulmonary edema, dysrhythmias HEMA: Agranuloytosis, thrombocytopenia INTEG: Rash, pruritus, fever GI: N/V, diarrhea, constipation, cramps, gastric pain, GU: Impotence, decreased libido, UTIs EENT: Sore throat, laryngospasm, blurred vision, dry eyes RESP: Dyspnea, bronchospasm, cough Contraindications: Hypersensitivity, cardiogenic shock, AV heart block; bronchospastic disease, sinus bradycardia, bronchospasm, asthma
Assess:
B/P, pulse, respirations Notify provider if pulse < 50 bpm, or systolic < 90 I&O ratio ECG continuously Hepatic enzymes
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Nonselective Beta Blocker with negative inotropic, chronotropic, dromotropic properties
Angina pain Administer With8 oz of water with food Teach Dont discontinue abruptly
Drug: Propylthiouracil Dose:
Functional class: Thyroid hormone antagonist (antithyroid) Chemical class: Thiamide
Side-Effects: CNS: Drowsiness, HA, vertigo, fever CV: HEMA: Agranulocytosis, leukopenia, thrombocytopenia, hypothrombinemia, lymphadenopathy, bleeding INTEG: Rash, urticaria, pruritus, alopecia, hyperpigmentation GI: Nausea, diarrhea, vomiting, jaundice, hepatitis, liver failure, death GU: Nephritis MS: myalgia, osteoporosis Contraindications: Pregnancy (D), breastfeeding, hypersensitivity, agranulocytosis, hepatitis, jaundice
Assess:
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Blocks synthesis peripherally of T3, T4, inhibits organification of iodine
Blood studies Administer With meals
Pulse, B/P, temp I&O ratio Daily weight T3, T4
At same time each day to maintain product level Fluids 3-4 L/day, unless contraindicated
Provide
Drug: Protamine Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Heparin antagonist Chemical class: Low molecular weight protein Action: Binds heparin, making it ineffective
Side-Effects: CNS: Lassitude, flushing CV: Hypotension, bradycardia, circulatory collapse, capillary leak HEMA: Bleeding INTEG: Rash, dermatitis, urticaria GI: N/V, anorexia RESP: Dyspnea, pulmonary edema, severe respiratory distress, bronchospasm SYS: anaphylaxis, angioedema Contraindications: Hypersensitivity
Assess:
VS, B/P, pulse after 30 minutes, plus 3 hr after dose Administer Dont take if allergic to fish
Blood studies Coagulation tests
Drug: Pseudoephedrine Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Adrenergic Chemical class: Substituted phenylethylamine Action: Primary activity through a-effects on respiratory mucosal membranes reducing congestion hyperemia, edema, minimal bronchodilation secondary to Beffects
Side-Effects: CNS: Tremors, anxiety, stimulation, HA, seizures CV: Palpitations, tachycardia, hypertension, chest pain, dysrhythmias, CV collapse HEMA: INTEG: GI: Anorexia, N/V, dry mouth GU: Dysuria EENT: Dry nose, irritation of nose and throat Contraindications: Hypersensitivity to sympathomimetics, closed-angle glaucoma
Assess:
For nasal congestion B/P, pulse throughout treatment
Administer Near bedtime, stimulation can occur
Drug: Psyllium Dose: Route (Give timing for IV push/IVPB meds):
Functional class: Bulk laxative Chemical class: Psyllium colloid Action: Bulk-forming laxative
Side-Effects: CNS: CV: HEMA: INTEG: GI: N/V, anorexia, diarrhea, cramps, intestinal esophageal blockage GU: EENT: Hypersensitivity, intestinal obstruction, abd. pain, n/v, fecal impaction
Assess: I&O ratio Cause of constipation Administer Alone for better absorption
Frequency: Rationale for client:
In morning or evening Immediately after mixing with water With 8oz of water or juice followed by another 8oz of fluid
Drug: Pyrantel Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antielmintic Chemical class: Pyrimidine derivative Action: Causes paralysis in worm by neuroblockade via stimulation of ganglionic receptors; worms expelled by normal peristalsis
Side-Effects: CNS: Dizziness, HA, drowsiness, fever, weakness CV: HEMA: INTEG: Rash GI: N/V, anorexia, diarrhea, distention, abd. cramps, GU: EENT: Contraindications: Hypersensitivity
Assess: Stools during entire treatment; specimens must be sent to lab while still warm For diarrhea Administer Without regard to food
Drug: Pyrazinamide Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antitubercular agent Chemical class: Pyrazinoic acid amine, nicoturimide analog Action: Bactericidal interference with lipid, nucleic acid biosynthesis
Side-Effects: CNS: HA CV: HEMA: hemolytic anemia INTEG: photosensitivity, urticaria GI: Hepatotoxicity, peptic ulcer, N/V, anorexia, cramps, diarrhea GU: Urinary difficulty, increased uric acid levels EENT: Contraindications: hypersensitivity, severe hepatic damage, acute gout
Assess:
Hepatic status before Administer With meals
Signs of anemia Hepatic studies Renal status before
After C & S is complete
Drug: quetiapine/ Seroquel
Functional class: Antipsychotic Chemical class: Benzodiazepine
Dose: 50mg to 800mg Route (Give timing for IV push/IVPB meds): Action: Functions as antagonist at PO multiple neurotransmitter receptors in the brain including 5HT1a, 5HT2, DOPamine, Frequency: BID D1, D2, H1, and adnergenic Alpha1, Alpha2, Rationale for client: Bipolar, depression, receptors. mania, schizophrenia
Drug: quinapril/ Accupril
Functional class: Anti HTN Chemical class: ACE Inhibitor
Dose: 10-80mg Day Route (Give timing for IV push/IVPB meds): Action: Selectively inhibits RAAS. PO Inhibit ACE prevents conversion of angiotensin I to angiotensin II results in Frequency: Daily or divided BID vasodilation of arterial and venous Rationale for client: HTN, systolic CHF. vessels.
Drug: quinidine/ Quinalan
Dose: PO 324-648mg Q8hr IM 600mg then 400mg Q2hr, IV 16mg/min Route (Give timing for IV push/IVPB meds): Action: Prolongs duration of action IV 16mg/min potential and effective refractory period, thus decreasing myocardial excitability, Frequency: anticholinergic properties. Rationale for client: PVCs, Atrial fib, PAT, VTach, Atrial Flutter, Malaria/IV quinidine gluconate Drug: quinine/ Quinine Sulfate Dose: 648mg Route ( Give timing for IV push/IVPB meds): PO Frequency: Q8HR X 3days Rationale for client: Destroy parasite. Functional class: Anti malaria Chemical class: Cinchona tree alkaloid
Functional class: Antidysrhythmic Class IA Chemical class: Quinine dextroisomer
Action: Inhibits parasite replication, transcription of RNA to DNA by forming complexes with DNA or parasites.
Side-Effects: CNS: Seizures, neuroleptic malignant syndrome, dizziness, drowsiness, headache CV: Tachycardia, QT prolongation Hema: Leukopenia, agranulocytosis Integ: GI: Nausea, anorexia, constipation, GU: MISC: Rhabdomyolysis SYST: SJS, anaphylaxis Contraindications: Hypersensitivity Side-Effects: CNS: Headache, dizziness, fatigue CV: Hypotension, MI, tachycardia Hema: Thrombocytopenia, agranulocytosis Integ: Angioedema GI: N/V/D, GI hemorrhage GU: Resp: Cough Contraindications: Sensitivity to ACE, Prior angioedema. Side-Effects: CNS: Headache, dizziness CV: Hypotension, heart block, CV collapse, arrest, VTach, bradycardia Hema: Thrombocytopenia, aganulocytosis Integ: Angioedema GI: diarrhea, hepatoxcity GU: RESP: Depression Contraindications: Idiosyncratic response, digoxin Toxicity, blood dyscrasias, myasthenia gravis. Side-Effects: CNS: Seizures CV: Acute circulatory failure Hema: Thrombocytopenia, purpura, hypothrombinemia, hemolysis Integ: GI: N/V/D, anorexia GU: anuria EENT: blurred vision, corneal changes, retinal changes, difficulty focusing. MISC: Hemolytic uremic syndrome Contraindications: G6PD deficiency, retinal field changes, myasthenia gravis
CV status QT prolongation. Tachycardia, orthostatic hypotension. Mental status..AIMS. Monitor for hoarding of drugs. Baseline BG. CNS status, LOC effect, gait coordination, sleep patterns Provide quite atmosphere..
Blood studies, CBC, Platelets, WBC/diff, B/P orthostatic hypotension. Renal studies. K levels. Daily wts. Monitor edema to extremeities. Treatment of OD: Infuse 0.9 NS
ECG continuously to monitor PR or GRS segments, QT intervals, discontinue or reduce dose. Theraputic blood levels, 27mcg/ml. CBC, LFT. B/P for fluctuations. IV pump for VI inf.
Assess B/P, pulse, for hypotension, tachycardia. Hepatic studies Q6WK. CBC With food to to decrease GI upset. Do not double missed dose. Monitor for therapeutic response decrease symptoms of malaria.
Drug: Rabeprazole (Aciphex) Dose: 20mg Route: PO Frequency: QD Rationale for client: Prophylactic Drug: Ramipril (Altace) Dose: 5mg Route: PO Frequency: BID Rationale for client: HTN
Functional class: Antiulcer, PPI Chemical class: Benzimidazole Action: Suppresses gastric secretion by inhibiting hydrogen/Pot. ATPase enzyme system in gastric parietal cell
Side-Effects: CNS: Headache CV: Angina, tachycardia Hema: Thrombocytopenia GI: Diarrhea, abdomen pain, constipation GU: hematuria EENT: Contraindications: Hypersensitivity Side-Effects: CNS: Dizziness, fatigue CV: Hypotension, syncope Misc: Angioedema Resp: Cough, dyspnea GI: N/V GU: Proteinuria Meta: Hyperkalemia Contraindications: Hypersensitivity Side-Effects: CNS: Fatigue, seizures, tremors CV: Edema Hema: Integ: Rash GI: N/V, dry mouth, anorexia EENT: Tinnitus Contraindications: Hypersensitivity to adamantine Side-Effects: CNS: warm/cold sensations, flushing CV: MI, V-Fib, V-tach, CA vasospasm Endo: Hot flashes GI: N/V, Dry mouth Resp: Chest tightness Contraindications: Angina pectoris, Hx MI, Basilar migraines Side-Effects: CNS: Fatigue CV: MI, CHF Syst: Stevens/Johnson syndrome Integ: GI: Wt gain, Hepatotoxicity Misc: Edema EENT: Contraindications: Side-Effects: CNS: ALS (lou gehrigs disease) Resp: Rhinitus, sinusitis, cough Hema: Thrombocytopenia Integ: GI: Kidney failure, Liver dysfunction, heartburn Contraindications: Preg X, hepatic disease
-Check for bowel sounds q 12hrs, assess for abdominal pains, swelling -Take after breakfast with a full glass of water - Teach pt. to report any stomach pains or diarrhea
Functional class: Antihypertensive Chemical class: ACE inhibitor Action: Suppresses rennin-angiotension aldosterone system, resulting in dilation of arterial, venous vessels
-Assess BP before giving med -Assess Renal studies, Potas. Levels, Protein in urine -Daily wt. with CHF pt. -Teach pt. to rise slowly when getting out of bed
Drug:Rimantadine (Flumadine) Dose: 100mg Route: PO
Functional class: Synthetic antiviral Chemical class: Tricyclic amine
Action: Prevents uncoating of nucleic acid Frequency: BID in viral cells, preventing penetration of Rationale for client: Viral infection, influenza virus to host A Drug: Rizaatriptan (Maxalt) Dose: 10mg Route: PO Functional class: Migraine agent Chemical class: 5-HT receptor agonist, abortive agent triptan
-Assess for seizures, discontinue if they occur -Assess skin for rash -Take med after meal for better absorption.
Frequency: 1 q 2 hrs, not to exceed 30mg day Action: Binds selectively to the vascular Rationale for client: Migraine 5-ht receptor subtype, exerts anti-migraine effect. Drug: Rosiglitazone, (Avandia) Dose: 4mg Route: PO Frequency: QD Rationale for client: Type 2 diabetic Functional class: Antidiabetic Chemical class: Thiazolidinedione Action: Improves insulin resistance by hepatic glucose metabolism.
-Assess for visual disturbances, aura -Neuro check, LOC, blurring vision, N/V, tingling in extremities -Assess for ingestion of tyramine foods(pickled foods, alcohol, aged cheese)
-Assess bloodsugar and A1C -CV status those with CV diseases must monitor close -Assess for systemic reaction
Drug: Rosuvastatin (Crestor) Dose: 10mg Route: PO Frequency:QD Rationale for client: Hypercholesterolemia
Functional class: Antilipemic Chemical class: HMG-CoA reductase inhibitor Action: Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis
-Assess kidney and liver functions before tx -Obtain diet history, review HDL. LDL, with pt.
Drug: Remeron - Mirtazapine Dose: Route: Frequency: Rationale for client:
Functional class: Antidepressant Chemical class: Tetracyclic Action: Blocks uptake of norepinephrine and serotonin into nerve endings
Drug: Risperadal (risperadone) Dose: Route: Frequency: Rationale for client:
Functional class: Antipsychotic Chemical class: Benzisoxazole derivative Action: unknown
Drug: Robitussin DM, Dextromethorphan Dose: Route: Frequency: Rationale for client:
Functional class: Antitussive Chemical class: Levorphanol derivative Action: Direct effect on the medulla by increasing the coughing threshold
Drug: Robitussin DM, Guaifenesin Dose: Route: Frequency: Rationale for client:
Functional class: Expectorant Chemical class: Theophylline Action: Decreases viscosity of mucus in the trachea
Drug: Salmeterol Dose:
Pharm. Class: B2-Adrenergic Agonist; Bronchodilator
Route (Give timing for IV push/IVPB meds): Chem. Class: Frequency: Rationale for client: Prevention of exercise-induced asthma; bronchospasm; COPD Treatment of O.D. B2-Adrenergic Blocker Action: causes bronchodilation by action on B2 receptors by increasing lvls of cAMP, which relaxes smooth muscle, maintains improvement in FEV from 312hr; prevents nocturnal asthma s/s
Side-Effects: CNS: Confusion CV: Hypertension Hema: Thrombocytopenia Integ: Rash GI: paralytic ileus GU: Renal failure EENT: tinnitus Contraindications: MI recovery Side-Effects: CNS: Anxiety CV: orthostatic hypotension Hema: N/A Integ: N/A GI: Constipation GU: N/A EENT: blurred vision Contraindications: Hypersensitivity Side-Effects: CNS: Sedation CV: N/A Hema: N/A Integ: N/A GI: Nausea GU: N/A EENT: N/A Contraindications: Hypersensitivity Side-Effects: CNS: Drowsiness CV: Tachycardia Hema: N/A Integ: N/A GI: Diarrhea GU: Increased Urination EENT: N/A Contraindications: Chronic cough Side-Effects: CNS: Tremors, Anxiety CV: Hema: Integ: GI: GU: EENT: RESP: Bronchospasm Contraindications: Tachydysrhythmias; Severe cardiac disease
1. Labs: CBC, Bun, creatinine 2. Monitor LOC 3. Monitor B/P 4. Monitor platelet levels 5. Treat allergic reaction 6. Increase dietary fiber 7. Antidote: None specified 1. Assess level of anxiety 2. Advise pt. to make position changes slowly 3. Increase dietary fiber intake 4. Advise pt. blurred vision may occur
1. Assess sedative effect 2. Provide nausea relief 3. Assess for hypersensitivity 4. Antidote: Naloxone
1. Monitor LOC 2. Assess for tachycardia 3. Provide skin care for diarrhea 4. Monitor I/O 5. Antidote: None known
Assess: Resp. Function Admin: Gum, sips of water for dry mouth Teach: Not to use OTC meds; to avoid getting powder in eyes; to avoid smoking, smokefilled rooms, ppl w/ resp infections; not for treatment of acute exacerbation
Drug: Salsalate Dose:
Pharm. Class: Nonopioid analgesic; NSAID
Chem. Class: Route (Give timing for IV push/IVPB meds): Salicylate Frequency: Rationale for client: Mild-Mod pain/fever Treatment of O.D. Lavage; Activated charcoal; monitor electrolytes; VS Drug: Dose: Chem. Class: Route (Give timing for IV push/IVPB meds): Protease Inhibitor Frequency: Rationale for client: HIV-1 Action: Inhibit HIV-1 protease, which prevents maturation of the infectious virus Saquinavir Pharm. Class: Antiretroviral Action: blocks formation of prostaglandins, which cause pain/inflammation
Side-Effects: CNS: seizures, coma CV: pulm edema Hema: thrombocytopenia, agranulocytosis, leukopenia, neutropenia, hemolytic anemia Integ: rash GI: n/v, GI bleeding, diarrhea, heartburn, hepatotoxicity GU: EENT: RESP: Contraindications: children<3yr; NSAIDS; GI bleed; Bleeding disorders; Vit K deficiency Side-Effects: CNS: Paresthesia, seizures CV: Hema: Integ: rash GI: diarrhea, abd pain, nausea GU: EENT: stevens-johnson syndrome RESP: Contraindications:
Assess: Pain; for asthma, ASA hypersensitivity, nasal polyps; hepatic studies; renal studies; blood studies; i/o ratio Admin: w/ food/milk to decrease gastric s/s Teach: Not to exceed recommended dose; that therapeutic response takes 2 wk; to avoid alcohol ingestion; Watch for s/s of bleeding
Assess: s/s of infection, anemia; BG, viral load, CD4+ T cell count, plasma HIV RNA, serum cholesterol/lipid profile; resistance testing at start of therapy and at treatment failure; hepatic studies; C&S before therapy; bowl pattern before, during treatment; skin eruptions Admin: w/in 2hr of meal Teach: To take as prescribed w/in 2hr of a full meal; if dose is missed, take as soon as remembered up to 1hr before next dose; dont double dose; that product must be taken in = intervals around the clock to maintain bld lvls for duration of therapy;
Drug: Dose:
Saxagliptin
Pharm. Class: Antidiabetic
Chem. Class: Route (Give timing for IV push/IVPB meds): DPP-4 Inhibitor Frequency: Rationale for client: In adults, DM type 2 Action: slows the inactivation of incretin hormones; improves glucose homeostasis, improves glucose-dependent insulin synthesis, lowers glucagon secretions, and slows gastric emptying time
Side-Effects: CNS: HA CV: Hema: Integ: angioedema GI: n/v GU: EENT: RESP: Contraindications: DKA; DM type 1
Assess: For hypoglycemic reactions; CBC, LFTs, AST, LDH; renal studies; A1c Admin: May be taken w/ or w/o meals Teach: s/s of hypo/hyperglycemic reaction; that product must be continued on daily basis; avoid OTC meds, alcohol, digoxin, exenatide, insulins, Nateglinide, Repaglinide;
Drug: Dose:
Scopolamine
Pharm. Class: Cholinergic blocker
Chem. Class: Route (Give timing for IV push/IVPB meds): Belladoma alkaloid Frequency: Rationale for client: Preop to produce amnesia, sedation, and to decrease secretions; motion sickness; parkinsonian s/s Action: inhibits acetylcholine at receptor sites in autonomic nervous system, which controls secretions, free acid in stomach; blocks central muscarinic receptors, which decreases involuntary movements
Side-Effects: CNS: CV: Hema: Integ: GI: dry mouth, constipation, paralytic ileus GU: EENT: RESP: Contraindications: closed-angle glaucoma; myasthenia gravis; GI/GU obstruction; hypersensitivity to Belladoma/barbiturates
Assess: VS periodically; I&O ratio; Parkinsons, EPS; urinary hesitancy, retention; constipation; for tolerance over long-term therapy; mental status Admin: Parenteral dose w/ pt recumbent, slowly. Keep in bed for atleast 1 hr after dose;w/ or after meals for GI upset; at HS to avoid daytime drowsiness Teach: To taper over 1wk; avoid driving/other hazardous activities; avoid OTC meds, alcohol, antihistamines Assess: Cardiac status; Mental status; for opioids Admin: w/ meals, limit protein intake; dosing bid in AM and afternoon, avoid PM/HS dosing; at doses <10mg/day Teach: To change positions slowly; to report twitching, eye spasms; to use exactly as prescribed; to avoid foods high in tyramine ASSESS: Stool, blood, urine; I&O ratio; Cramping, bleeding, n/v ADMIN: In morning/ evening w/ full glass of water; on empty stomach for best absorption TEACHING: That urine, feces may turn yellow-brown to red; that normal bowel movements dont always occur; not to use in presence of abdominal pain, n/v; notify prescriber of unrelieved constipation/ s/s of F/E imbalances
Drug: Dose:
Selegiline
Pharm. Class: Antiparkinson
Chem. Class: Route (Give timing for IV push/IVPB meds): MAOI, type B Frequency: Rationale for client: Adjunct management of parkinsons disease in pts being treated w/ levodopa/carbidopa who had poor response to therapy; Alzheimers disease; depression Drug: Senna, Sennosides Dose: Chemical class: anthraquinone Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Constipation; bowel prep for Sx/exam TREAT O.D: MOA: Stimulates peristalsis by action on Auerbachs plexus; softens feces by increasing water, electrolytes in large intestine Action: increase dopaminergic activity by inhibition of MAO type B activity Treatment of O.D. IV fluids (HTN) IV dilute pressure agent for B/P titration Functional class: Laxative-stimulate
Side-Effects: CNS: suicide in child/adolescent, suicidal ideation in adults CV: tachycardia, sinus bradycardia, HTN crisis (children) Hema: Integ: GI: GU: EENT: RESP: Contraindications: Breastfeeding Side-Effects: CNS: CV: HEMA: INTEG: GI: n/v, anorexia, cramps GU: RESP: SYST: tetany CI: Hypersensitivity, breastfeeding, GI bleed, obstruction, CHF, abdominal pain, n/v, appendicitis, acute surgical abdomen
Drug: Sertraline Dose:
Pharm. Class: antidepressant
Chem. Class: Route (Give timing for IV push/IVPB meds): SSRI Frequency: Rationale for client: Major depressive disorder; OCD; PTSD; panic disorder; social anxiety disorder; PMDD Action: inhibits serotonin reuptake in CNS; increases action of serotonin; doesnt affect DOPamine, NE
Side-Effects: CNS: insomnia, agitation, somnolence, dizziness, HA, tremor, fatigue, seizures, neuroleptic malignant syndrome-like reaction CV: Hema: Integ: GI: diarrhea, n/v, constipation, anorexia, dry mouth, flatulence GU: male sex. dysfunction EENT: RESP: Contraindications:
Assess: Mental status; B/P (lying, standing), pulse q4h; wt qwk; urinary retention, constipation; alcohol consumption; hold dose till morning Admin: Increase fluids, bulk in diet; w/ food/milk for GI s/s; sugarless gum, hard candy, freq sips of water for dry mouth; avoid use w/ other CNS depressants Teach: That therapeutic effect may take up to 1wk; use caution when driving; to taper, not d/c suddenly; avoid alcohol; to notify HCP if planning to become pregnant/pregnant at that time Assess: For any sev loss of vision; use of organic nitrates; cardiac status Admin: Approx 1hr before sex; dont use more than 1/day Teach: That product doesnt protect against STDs; that absorption is decreased w/ high-fat meal; that tabs may be split; to report erection lasting >4hrs Assess: Prostatic hyperplasia; CBC, LFTs; B/P+HR; BUN, uric acid, urodynamic studies; I&Os, wt daily Admin: Give w/ meal at same time of day Teach: Not to drive/operate machinery until effect is known; not to use w/ grapefruit juice
Drug: Dose:
Sildenafil
Pharm. Class: Erectile agent; antihypertensive; peripheral vasodilator
Route (Give timing for IV push/IVPB meds): Chem. Class: Selective inhibitor of cGMP-PDE5 Frequency: Rationale for client: Treatment of erectile dysfunction; improvement in exercise ability; pulm HTN Action: enhances the effect of NO by inhibiting phosphodiesterase type 5, which is necessary for degrading cGMP in the corpus cavernosum
Side-Effects: CNS: HA, flushing, dizziness CV: MI, sudden death, CV collapse Hema: Integ: rash GI: dyspepsia, nasal congestion, diarrhea GU: EENT: abnorm vision, non-arteritic ischemic optic neuropathy RESP: Contraindications: hypersensitivity to nitrates Side-Effects: CNS: dizziness, HA CV: Hema: Integ: GI: GU: EENT: RESP: Contraindications: Renal failure
Drug: Silodosin Dose:
Pharm. Class: Selective Alpha 1-adrenergic blocker
Chem. Class: Route (Give timing for IV push/IVPB meds): Sulfamoylphenethylamine derivative Frequency: Rationale for client: s/s of BPH Action: binds preferentially to alpha 1Aadrenoceptor subtype loc mainly in prostate
Drug: Simethicone Dose:
Pharm. Class: antiflatulent Chem. Class:
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Flatulence; heartburn Action: disperses, prevents mucus gas pockets in GI system, lowers surface tension of gas bubbles
Side-Effects: CNS: CV: Hema: Integ: GI: GU: EENT: RESP: Contraindications: GI obstruction/perforation
Assess: Reason for excess gas production; Admin: After meals, at HS; shake susp well before admin Teach: That tabs must be chewed; to shake susp well before admin
Drug: Dose:
simvastatin
Functional class: Anti-lipidemic
Chemical class: Route (Give timing for IV push/IVPB meds): HMG-CoA reductase inhibitor Frequency: Rationale for client: Hyperlipidemia; CAD TREAT O.D: MOA: Inhibits HMG-CoA reductase enzyme, which reduces cholesterol synthesis
Side-Effects: CNS: ALS (Lou Gehrigs disease) CV: HEMA: INTEG: GI: liver dysfunction GU: RESP: MUS: myositis, rhabdomylosis CI: Hypersensitivity, active hepatic disease, breastfeeding, preg (X)
ASSESS: 12-hr fasting lipid profile: LDL, HDL, TG, cholesterol at 6-8wks, and q6mo; hepatic studies q1-2months during 1st 1 of treatment; for rhabdomyolysis ADMIN: Total dose in evening TEACHING: That blood work and eye exam will be necessary during treatment; to report blurry vision, dizziness, HA, severe GI s/s
Drug: Sirolimus Dose:
Pharm. Class: Immunosuppressor
Chem. Class: Route (Give timing for IV push/IVPB meds): Macrolide Frequency: Rationale for client: Organ transplants to prevent rejection; recommended use w/ cyclosporine+ corticosteroids Action: produces immunosuppression by inhibiting T-lymphocyte activation+ proliferation
Side-Effects: CNS: tremors, ha, insomnia, paresthesia CV: A-FIB, CHF, hypotension, palpitation, tachycardia Hema: anemia, leukopenia, thrombocytopenia, purpura Integ: rash, acne, lymphoma, exfoliative dermatitis GI: hepatotoxicity GU: albuminuria, hematuria, proteinuria, renal failure, nephrotic syndrome EENT: hyperlipidemia, RESP: pleural effusion, atelectasis, dyspnea Contraindications: breastfeeding
Assess: Bld lvls that may have altered metab; lipid profile; for infection/development of lymphoma; bld studies; hepatic studies Admin: Prophylaxis for Pneumocystis jiroveci pneumonia for 1yr after transplantation; for 3 days before transplant Sx Teach: To avoid crowds, ppl w/ known infections; to use contraception before and 12 wk after use of product; use sunscreen, protective clothing; avoid grapefruit juice/vaccines
Drug: Sitagliptin Dose:
Pharm. Class: Antidiabetic
Chem. Class: Route (Give timing for IV push/IVPB meds): DPP-4 Inhibitor Frequency: Rationale for client: Type 2 DM Action: slows inactivation of incretin hormones; improves glucose homeostasis, improves glucose-dependent insulin secretion, lowers glucagon secretions, and slows gastric emptying time
Side-Effects: CNS: ha CV: Hema: Integ: stevens-johnson syndrome GI: n/v GU: EENT: anaphylaxis RESP: angioedema Contraindications: DKA
Assess: CBC (baseline, q3mo); LFTs, AST,LDH, renal studies periodically; monitor BG PRN Admin: May be taken w/ or w/o food Teach: That product must be continued on daily basis; avoid OTC meds, alcohol, digoxin, exenatide, insulins, Nateglinide, Repaglinide, and other products the lower BG; to carry emergency ID Assess: Resp status; pulse; fluid balance; electrolytes, blood pH, PO2, HCO3, during treatment; ABGs frequently; urine pH, output, during begin of treatment; extravasation w/ IV admin; wt daily; for GI perforation s/t CO2 in GI tract Admin: Chew antacid tabs and drink 8oz water; dont take w/milk Teach: Not to take w/ milk; not to use for more than 2 wk; to notify HCP if indigestion is accompanied by cx pain; about Narestricted diet; avoid use of baking soda for indigestion
Drug: Sodium Bicarbonate Dose:
Pharm. Class: Alkalinizer
Chem. Class: Route (Give timing for IV push/IVPB meds): NaCHO3 Frequency: Rationale for client: Metabolic acidosis; cardiac arrest; alkanization (systemic/urinary) antacid; salicylate poisoning Action: orally neutralizes gastric acid, which forms water, NaCl, Co2; increases plasma bicarbonate, which buffer H ion concentration; reverses acidosis IV
Side-Effects: CNS: twitching, hyperflexia, tetany, seizures CV: cardiac arrest Hema: Integ: GI: belching, distention, paralytic ileus GU: EENT: alkalosis RESP: apnea Contraindications: metab/resp alkalosis; Hypochloremia; hypocalcemia
Drug: Sodium Biphosphate/ Sodium Phosphate Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Constipation; bowel/rectal prep for Sx/exam
Pharm. Class: Laxative, saline Chem. Class: Action: increases water absorption in the S.I. by osmotic action, laxative effect occurs by increased peristalsis and water retention
Side-Effects: CNS: CV: dysrhythmias, cardiac arrest Hema: Integ: GI: nausea, cramps GU: EENT: RESP: Contraindications: rectal fissures; abd pain; n/v; appendicitis; acute sx abd; ulcerated hemorrhoids; sodium restricted diets; renal failure; hyperphosphatemia; hypocalcemia; hypokalemia; hypernatremia; Addisons disease; CHF; ascites; bowel perforation; megacolon; imperforate anus Side-Effects: CNS: CV: Hema: Integ: GI: GU: EENT: RESP: Contraindications: hypersensitivity to saccharin/parabens; ileus
Assess: Stools; bowl pattern, B.S., flatulence, fever dietary patterns; bld, urine electrolytes Admin: Alone for better absorption; dont take w.in 1-2hr of other products Teach: Not to use long-term; not to use in presence of abd pain, n/v; to maintain fluid consumption
Drug: Sodium Polystyrene Sulfonate Dose:
Pharm. Class: K-removing resin
Chem. Class: Route (Give timing for IV push/IVPB meds): Cation exchange resin Frequency: Rationale for client: Hyperkalemia in conjunction w/ other measures Action: removes K by exchanging Na for K in body prim in LI
Assess: Hyperkalemia; ECG for abnormalities; bowel function daily; hypotension; serum K, Ca, Mg, Na, acid-base balance; I&O/wts daily; for digoxin Admin: PO dose as susp mixed w/ water/syr (20100mL); retention enema after mixing w/ warm water; intro by gravity, flush w/ 100mL of fluid, clamp, leave in place Teach:
Drug: Solifenacin Dose:
Pharm. Class: anticholinergic
Chem. Class: Route (Give timing for IV push/IVPB meds): Muscarinic receptor antagonist Frequency: Rationale for client: Overactive bladder Action: relaxes smooth mus in urinary tract by inhibiting acetylcholine at postganglionic sites
Side-Effects: CNS: dizziness CV: QTc prolongation Hema: Integ: GI: n/v, anorexia, constipation, dry mouth GU: EENT: vision abnorm, xerophthalmia RESP: Contraindications: uncontrolled closedangle glaucoma; urinary retention; gastric retention
Assess: Urinary patterns; allergic reactions Admin: Teach: Avoid hazardous activities; constipation, blurry vision may occur; call hcp if sev abd pain lasts>3 days; heat prostration may occur if used in hot environment
Drug: Somatropin Dose:
Pharm. Class: Pituitary hormone
Chem. Class: Route (Give timing for IV push/IVPB meds): GH Frequency: Action: stimulates growth Rationale for client: Hypopituitarism; child w. GH defic/growth failure; AIDS wasting syndrome; cachexia; adults w/ SDS; short stature in Noonan syndrome; SHOX defic; Turners syndrome; Prader-Willi syndrome Drug: Dose: Chemical class: Route (Give timing for IV push/IVPB meds): Multikinase Inhibitor; Signal transduction inhibitor Frequency: Rationale for client: Adv/metastatic murine renal cell carcinoma; unresectable hepatocellular cancer; metastatic/malignant melanoma Treatment of O.D: Action: Multikinase inhibitor that decreases tumor cell proliferation Sorafenib Functional class: Antineoplastic-misc.
Side-Effects: CNS: CV: Hema: Integ: GI: GU: hypercalciuria EENT: hyperglycemia, ketosis, hypothyroidism; antibodies to GH RESP: Contraindications: closed epiphyses; intracranial lesions; prolonged treatment in adults; scoliosis; sleep apnea; chemo; diabetes; resp disease Side-Effects: CNS: fatigue, wt loss, ha ENDO: CV: htn, cardiac ischemia, infarction, htn crisis, cardiotoxicity, MI HEMA: hemorrhage, leukopenia, lymphopenia, anemia, neutropenia, thrombocytopenia, pancytopenia INTEG: rash, dry skin, hand-foot syndrome, Exfoliative dermatitis, alopecia GI: n/v, diarrhea, pancreatitis, abd pain, GI perforation GU: EENT: RESP: hoarseness SYST: MISC: hypophosphatemia; arthralgia, myalgia Contraindications:
Assess: For s/s of diabetes Admin: Teach:
ASSESS: Cbc w/ differ, LFTs; for skin toxicities; b/p wkly x 6wks; PT, INR
ADMINISTRATION: On empty stomach 1 hr before meal/2hr after
TEACH: To report adverse effects immed; use contraception during treatment; dont double dose; avoid OTC meds
Drug: Dose:
Sotalol
Functional class: Antidysrhythmic group III
Chemical class: Route (Give timing for IV push/IVPB meds): Non-selective B blocker Frequency: Action: Rationale for client: Blockade of B1/B2-receptors leads to Life-threatening vent Dysrhythmias; betapace antidysrhythmic effect, prolongs action AF; to maintain sinus rhythm in symptomatic potential in myocardial fibers w/o A-Fib/flutter affecting conduction, prolongs QT interval; no effect on QRS duration Treatment of O.D: Lavage, IV atropine for bradycardia; IV theophylline for bronchospasm; digoxin, O2, diuretic for cardiac failure; admin vasopressor for hypotension; isoproterenol for heart block Drug: Spironolactone Dose: Chemical class: Route (Give timing for IV push/IVPB meds): Aldosterone antagonist Frequency: Rationale for client: Edema in CHF, htn, diuretic-induced Hypokalemia; prim hyperaldosteronism; edema of nephritic syndrome; cirrhosis of liver w/ ascites Treatment of O.D: Lavage if taken PO; mon electrolytes; admin IV fluids; mon hydration, renal, CV status Action: Competes w/ Aldosterone at receptor sites in distal tubule= excretion of NaCl, water, retention of K, Phosphate Functional class: K-sparing diuretic
Side-Effects: CNS: ENDO: CV: prodysrhythmias, prolonged QT, CHF, betapace AF HEMA: Agranulocytosis, thrombocytopenic Purpura, thrombocytopenia, leukopenia INTEG: GI: GU: EENT: RESP: bronchospasm SYST: MISC: Contraindications: Cardiogenic shock; heart block; sinus bradycardia; CHF; bronchial asthma; CCr<40mL/min Side-Effects: CNS: ha ENDO: hyperkalemia CV: HEMA: agranulocytosis INTEG: rash, pruritis GI: diarrhea, bleeding, n/v, hepatocellular toxicity GU: EENT: RESP: SYST: MISC: Contraindications: Anuria; sev renal disease; hyperkalemia
ASSESS: I&O, wt daily; B/P, pulse q4h; K, Mg lvls; apical/radial pulse before admin; baselines in renal studies before therapy begins; skin turgor, dryness of muc membranes ADMINISTRATION: Before/at HS; give 1 hr before/2hr after meals; dont give w/in 2hr of antacids TEACH: Taper dose; not to use antacids/other OTCs; to take pulse at home; avoid alcohol, smoking, Na intake; avoid hazardous activities; wear support hose to min effects of orthostatic hypotension
ASSESS: Electrolytes; wt, I&O daily; s/s of metab acidosis; rashes, temp; confusion; hydration ADMINISTRATION: In AM to avoid interference w/ sleep; w/ food TEACH: Avoid foods w/ high K content; be cautious while driving
Drug: Stavudine Dose:
Functional class: antiretroviral
Route (Give timing for IV push/IVPB meds): Chemical class: Nucleoside reverse transcriptase inhibitor Frequency: Rationale for client: Treatment of HIV-1 Treatment of O.D: Action: Prevents replication of HIV by the inhibition of the enzyme reverse transcriptase, causes DNA chain termination
Side-Effects: CNS: periph neuropathy, ha ENDO: CV: HEMA: INTEG: rash GI: Hepatotoxicity, diarrhea, n/v GU: EENT: RESP: SYST: MISC: lactic acidosis Contraindications: Hypersensitivity to this product, zidovudine, didanosine, zalcitabine; sev periph neuropathy Side-Effects: CNS: Guillain-Barre syndrome ENDO: CV: PE HEMA: bleeding INTEG: GI: GU: EENT: RESP: bronchospasm SYST: GI, GU, intracranial, retroperitoneal bleeding, surface bleeding, anaphylaxis MISC: Contraindications: Breastfeeding; active internal bleed; recent CVA; intracranial/intrapleural sx; intraspinal sx; CNS neoplasms; uncontrolled sev HTN
ASSESS: Bld studies; renal tests; C&S before therapy; bowel pattern before, during treatment; viral load and CD4 counts, plasma HIV RNA, baseline and throughout treatment ADMINISTRATION: Admin w/ or w/o meals; q12hrs; shake susp well before use TEACH: That product shouldnt be given w/ antineoplastics; that even w/ treatment may pass AIDS virus; that follow-ups are necess; bld counts done q2wks; avoid other meds unless approved by HCP ASSESS: Allergy; for bleed during 1st hr of treatment; bld studies; for hypersensitive reactions; VS, neurologic signs q4hr; ECG continuously, cardiac enzymes, radionuclide myocardial scanning/coron angiography; for resp depression ADMINISTRATION: TEACH: Reason for treatment and expected results
Drug: Streptokinase Dose:
Functional class: Thrombolytic enzyme
Chemical class: Route (Give timing for IV push/IVPB meds): B-hemolytic streptococcus filtrate (purified) Frequency: Rationale for client: DVT; PE; arterial thrombosis; arterial embolism; lysis of coronary artery thrombi after acute MI; acute evolving transmural MI Treatment of O.D: Action: Activates conversion plasminogen to plasmin: plasmin breaks down clots, fibrinogen, factors V, VII; occlusion of venous access lines
Drug: Streptomycin Dose:
Functional class: Anti-infective/antitubercular
Route (Give timing for IV push/IVPB meds): Chemical class: Aminoglycoside Frequency: Rationale for client: Treatment of O.D: Hemodialysis; mon serum lvls Action: Interferes w/ prot synthesis in bact cell by binding to ribosomal 30 S, causing inaccurate peptide sequence to form in prot chain, causing bact death
Side-Effects: CNS: seizures, neurotoxicity ENDO: CV: HEMA: agranulocytosis, thrombocytopenia, leukopenia, Eosinophilia, anemia INTEG: rash GI: n/v, anorexia, hepatic necrosis GU: oliguria, hematuria, renal damage, azotemia, renal failure, nephrotoxicity EENT: ototoxicity RESP: SYST: MISC: Contraindications:
ASSESS: Wt before; I&O, urinalysis daily; serum pk lvls 30min after; renal studies; hearing by audiometric testing; dehydration; overgrowth of infect; C&S before starting treatment; vestibular dysfunct; inj sites ADMINISTRATION: IM inj in large mus mass; rotate inj sites; product in evenly spaced doses to maintain bld lvl; TEACH:
Drug: Succimer Dose:
Functional class: Heavy metal chelator antagonist
Chemical class: Route (Give timing for IV push/IVPB meds): Chelating agent Frequency: Rationale for client: Lead poisoning in child w/ lead lvls >45mcg/dL; mercury/arsenic poisoning Treatment of O.D: Action: Binds w/ ions of lead to form a watersoluble complex excreted by kidneys
Side-Effects: CNS: ENDO: CV: HEMA: increased platelets, INT Eosinophilia INTEG: GI: n/v, diarrhea, metallic taste, anorexia GU: proteinuria EENT: RESP: SYST: MISC: Contraindications:
ASSESS: Renal, hepatic studies; for lead sources in home/school; allergic reactions ADMINISTRATION: Can open cap and sprinkle on food or in spoon followed by drink; admin immed after prep TEACH: That therapeutic effect may take 1-3mo; report urticaria, rash; to increase fluid intake
Drug: Succinylcholine Dose:
Functional class: Neuromuscular blocker (depolar-ultrashort)
Route (Give timing for IV push/IVPB meds): Chemical class: Frequency: Rationale for client: Facilitation of ET intubation, skel mus relaxation during orthopedic manipulations Treatment of O.D: Edrophonium/neostigmine, atropine, mon VS; may require mechanical ventilation Action: Inhibits transmission of nerve impulses by binding w/ cholinergic receptor sites, blocking action of acetylcholine; cause histamine release
Side-Effects: CNS: ENDO: CV: sinus arrest, Dysrhythmias HEMA: myoglobulinemia INTEG: GI: GU: EENT: RESP: prolonged apnea, bronchospasm, cyanosis, resp depress SYST: anaphylaxis, angioedema MISC: rhabdomyolysis Contraindications: Malignant hyperthermia; trauma
ASSESS: For electrolytes imbalances; VS until fully recovered; I&O ratio; recovery; allergic reactions ADMINISTRATION: Deep IM inj, prefer deltoid
TEACH:
Drug: Sucralfate Dose:
Functional class: Protectant; anti-ulcer
Chemical class: Route (Give timing for IV push/IVPB meds): Aluminum Hydroxide; sulfated sucrose Frequency: Rationale for client: Duodenal ulcer; oral mucositis; stomatitis after radiation of head/neck; GERD Treatment of O.D: Action: Forms complex that adheres to ulcer site, absorbs pepsin
Side-Effects: CNS: ENDO: CV: HEMA: INTEG: GI: dry mouth, constipation GU: EENT: RESP: SYST: MISC: Contraindications:
ASSESS: Gastric pH; bld in stools ADMINISTRATION: Dont take antacids 30 min before/after this product; on empty stomach, 1 hr before or 2hr after meals TEACH: To take on empty stomach; not to use over 8wk period; avoid smoking/antacids
Drug: Sulfadiazine Dose:
Functional class: anti-infective
Route (Give timing for IV push/IVPB meds): Chemical class: sulfonamide Frequency: Rationale for client: Action: UTIs; rheumatic fever prophylaxis; malaria; Inhibits folic acid synthesis meningitis; inclusion conjunctivitis; meningococeal meningtitis; nocardosis; acute otitis media; trachoma Treatment of O.D:
Side-Effects: CNS: seizures ENDO: CV: allergic myocarditis HEMA: leukopenia, thrombocytopenia, agranulocytosis, hemolytic anemia, Aplastic anemia INTEG: stevens-johnson syndrome; photosensitivity GI: n/v, abd pain, hepatitis, enterocolitis GU: renal failure, toxic nephrosis EENT: RESP: SYST: anaphylaxis, serum sickness-like symptoms MISC: Contraindications: Breastfeeding; infants<2mo; porphyria; hypersensitivity to sulfonamides, sulfonylureas, salicylates, sunscreens w/ PABA; preg at term
ASSESS: I&O ratio; renal studies; bld dyscrasias; allergic reaction ADMINISTRATION: On empty stomach; w/ full glass of water; medication after C&S, repeat after full course of therapy TEACH: Take each dose w/ full glass of water; avoid sunlight, OTC meds
Drug: Sulfasalazine Dose:
Functional class: GI anti-inflammatory; DMARD
Route (Give timing for IV push/IVPB meds): Chemical class: Sulfonamide Frequency: Rationale for client: Ulcerative colitis; RA; juvenile RA; Crohns disease Treatment of O.D: Action: Prodrug to deliver sulfapyridine and 5aminosalicyclic acid to colon; antiinflamm in connective tissue also
Side-Effects: CNS: seizures ENDO: CV: allergic myocarditis HEMA: leukopenia, neutropenia, thrombocytopenia, agranulocytosis, hemolytic anemia INTEG: stevens-johnson syndrome GI: n/v, abd pain, hepatitis GU: renal failure, toxic nephrosis EENT: RESP: SYST: anaphylaxis MISC: Contraindications: Preg at term; child<2yr; hypersensitivity to sulfonamides/salicylates; intestinal/urinary obstruction; poryphoria Side-Effects: CNS: seizures, coma ENDO: CV: HEMA: agranulocytosis INTEG: GI: gastric irritation, n/v, anorexia, hepatic necrosis, GI bleed GU: EENT: RESP: apnea SYST: MISC: Contraindications: Hypersensitivity to pyrazolones/salicylates; bld dyscrasias; CCr <50mL/min; active peptic ulcer; GI inflamm; nephrolithiasis
ASSESS: Renal studies; bld dyscrasias; allergic reaction ADMINISTRATION: w/ full glass of water; totally daily dose in evenly spaced doses and after meals to help min GI intolerance TEACH: Take each dose w/ full glass of water; that contact lens, urine/skin may be yelloworange; avoid sunlight
Drug: Sulfinpyrazone Dose:
Functional class: uricosuric
Chemical class: Route (Give timing for IV push/IVPB meds): pyrazolone Frequency: Rationale for client: Gout; Gouty arthritis Treatment of O.D: Action: Inhibits tubular reabsorption of urates, w/ increased excretion of uric acid; inhibits prostaglandin synthesis, which decreases platelet aggregation
ASSESS: Uric acid lvls; resp status; renal function; bleed tendency, RBC, Hct; I&O; electrolytes, CO2 before, during treatment; urine pH, output, glucose during beginning treatment ADMINISTRATION: w/ glass of milk; w/ food for GI s/s; increased fluids to prevent calculi; alkalinization of urine may be required TEACH: To avoid ASA, NSAIDs, alcohol, high purine diet
Drug: Sulindac Dose:
Functional class: NSAIDs; Antirheumatic
Chemical class: Route (Give timing for IV push/IVPB meds): Indene acetic acid derivative Frequency: Rationale for client: OA; RA; Gouty arthritis; Ankylosing Spondylitis; Bursitis; Tendinitis Treatment of O.D: Action: Metabolite inhibits COX-1, COX-2 by blocking arachidonate; analgesic, antiinflamm, anti-pyretic
Side-Effects: CNS: ENDO: CV: MI, CVA, CHF HEMA: bld dyscrasias INTEG: rash, pruritus GI: n/v, anorexia, diarrhea, Cholestatic hepatitis, bleeding, ulceration, perforation GU: nephrotoxicity EENT: RESP: SYST: anaphylaxis, stevens-johnson syndrome, toxic epidermal necrolysis MISC: Contraindications: Asthma; sev renal/hepatic disease; active ulcers; 3 trim pregnancy (D)
ASSESS: Cardiac/GI status; pain; renal, hepatic studies; BP checked qmo; audiometric, ophthalmic exam before, during, after
ADMINISTRATION: w/ food to decrease GI s/s; w/ full glass of water
Drug: Sumatriptan Dose:
Functional class: Antimigraine agent
Chemical class: Route (Give timing for IV push/IVPB meds): 5-HT1p receptor agonist; abortive; triptan Frequency: Rationale for client: Acute treatment of migraine Treatment of O.D: Action: Binds selectively to the vascular 5-HT-1D receptor subtype, exerts Antimigraine effect; causes vasoconstriction in cranial arteries
Side-Effects: CNS: tingling, hot sensation, burning, feeling of pressure, tightness, numbness, dizziness, sedation ENDO: CV: flushing, MI HEMA: INTEG: GI: GU: EENT: RESP: SYST: MISC: mus weakness, neck stiffness Contraindications: Angina pectoris; hx of MI; silent ischemia; ischemic heart dz; IV use; concurrent ergotamine containing preps; uncontrolled HTN; hemiplegic/basilar migraine
TEACH: Avoid driving/other hazardous activities; that therapeutic effect may take up to 1mo; avoid alcohol, asa, nsaids; to use sunscreen; report to all HCP that your on product ASSESS: For migraine; BP; for stress lvl; neurologic status; ingestion of tyramine foods; renal funct/output ADMINISTRATION: Take tabs w/ fluids as soon as s/s appear; may take a 2nd dose >4hr; max 200 mg/24hr TEACH: To use contraception while taking product; to use nasal spray; to have dark, quiet environment; that product doesnt reduce number of migraines
Drug: Sunitinib Dose:
Functional class: Antineoplastic-misc
Chemical class: Route (Give timing for IV push/IVPB meds): Prot-tyrosine kinase inhibitor Frequency: Action: Rationale for client: Inhibits multiple receptor tyrosine kinases GIST after disease progression/intolerance to (RTKs), some responsible for tumor imatinib; adv renal carcinoma growth Treatment of O.D:
Side-Effects: CNS: CNS hemorrhage, seizures ENDO: CV: LV dyfunct, QT prolong, cardiotox, torsade de pointes, thrombotic microangiopathy HEMA: neutropenia, thrombocytopenia, hemolytic anemia, leukopenia INTEG: rash, skin discoloration GI: n/v, hepatotox, dyspepsia, anorexia, abd pain, constipation pancreatitis, GI bleed/perforation GU: nephrotic syndrome EENT: RESP: PE SYST: bleeding, serious infection MISC: Contraindications: breastfeeding
ASSESS: ANC and platelets; CV status; for renal tox; for hepatotox; for CHF; for bleed
ADMINISTRATION: w/ meal and large glass of water to decrease GI s/s
Drug: tacrolimus (Prograf) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: atopic dermatitis or organ transplant rejection prevention or ulcerative colitis
Functional class: immunosuppressant Chemical class: macrolide Action: produces immunosuppression by inhibiting T-lymphocytes
Side-Effects: CNS: seizures, tremors, HA, chills, fever, paresthesia, posterior reversible encephalopathy syndrome CV: prolonged QT, HTN, myocardial hypertrophy HEMA: anemia, leukocytosis, thrombocytopenia, purpura INTEG: alopecia, flushing, rash, itching GI: GI bleeding, NVD, constipation GU:albuminuria, hematuria, UTIs, proteinuria, renal failure EENT: blurred vision, photophobia Contraindications: children <2 (topical); hypersensitivity to castor oil
TEACH: To avoid ppl w/ upper resp infect; avoid grapefruit juice Do not use with grapefruit juice or alcohol. Avoid vaccines. Avoid crowds. Avoid exposure to natural or artificial sunlight. Report fever, rash, severe diarrhea, chills, sore throat, fatigue, clay colored stools. PO Route: give with meals to reduce GI upset; do not give IM Topical Route: do not use occlusive dressings Assess blood studies monthly, if platelets or leukocytes low then D/C or reduce.
Drug: tadalafil (Adcirca, Cialis) Dose: Route (Give timing for IV push/IVPB meds): Frequency:
Functional class: impotence agent Chemical class: phosphodiesterase type 5 inhibitor
Side-Effects: CNS: seizures, HA, flushing, dizziness, transient global amnesia CV: MI, sudden death, CV collapse, tachycardia, hypo/hypertension HEMA: INTEG: GI: diarrhea, dyspepsia GU: UTIs, priapism EENT: hearing loss, blurred vision, changes in color vision, nasal congestion Contraindications: patients taking organic nitrates or alpha adrenergic antagonist other than once daily tamsulosin; newborns, women, children
Action: inhibits phosphodiesterase type 5 (PDE5); enhances erectile function by Rationale for client: erectile dsysfunction or increasing the amount of cGMP, which pulmonary arterial hypertension or sexual causes smooth muscle relaxation and dysfunction in males receiving increased blood flow into the corpus antidepressants cavernosum
Assess for any severe loss of vision. Ensure patients is not on nitrates because can cause unsafe drop in B/P resulting in MI or stroke. Take prior to sexual activity and do not use more than once a day. For pulmonary HTN, can give without regard to meals. Tell patient to report any bleeding problem. Teach patient that product has no effect in the absence of sexual stimulation and to notify MD immediately if erection lasts more than 4 hours.
Drug: tamoxifen (Aplha-Tamoxifen, Med Tamoxifen, Novladex, Novladex-D, NovoTamoxifen, Soltamox, Tamofen, Tamone, Tamoplex) Dose:
Functional class: antineoplastic Chemical class: antiestrogen hormone
Side-Effects: CNS: hot flashes, mood changes, HA, lightheadedness CV: stroke, chest pain, fluid retention, flushing HEMA: thrombocytopenia, leukopenia, DVT INTEG: alopecia, rash GI: altered taste/anorexia, NV GU: uterine malignancies, altered menses, amenorrhea, vaginal bleeding, pruritus vulvae RESP: pulmonary embolism META: hypercalcemia Contraindications: pregnancy, breastfeeding. Black Box warning: thromboembolic disease, endometrial cancer, stroke
Action: inhibits cell division by binding to cytoplasmic estrogen receptors; Route (Give timing for IV push/IVPB meds): resembles normal cell complex but DNA synthesis and estrogen response of target Frequency: tissue. Rationale for client: breast carcinoma, prevention of breast cancer, mastalgia, reduce size/pain of gynecomastia, ovulation stimulation, osteoporosis
Increase bleeding,anticoagulants. Avoid use with St. Johns wort, dong qui, and black cohosh. Give antiemetic 30-60 minutes prior to avoid vomiting. Assess for bleeding q8 hrs. Assess CBC weekly, withhold if WBC < 3500 or platelet <100,000. Teach to immediately report any changes in visual acuity, cause may be irreversible. Increase fluids to 2 liters, avoid sunlight. Hair may be loss during treatment.
Drug: tamsulosin (Flomax) Dose:
Functional class: selective alpha1 peripheral adrenergic blocker
Side-Effects: CNS: HA, dizziness, asthenia, insomnia CV: chest pain RESP: rhinitis, pharyngitis, cough INTEG: rash, pruritus, urticaria GI: nausea, diarrhea, dysgeusia GU: priapism, abnormal ejaculation, decreased libidio EENT: amblyopia, floppy iris syndrome SYST: angioedema Contraindications: hypersensitivity
Chemical class: Route (Give timing for IV push/IVPB meds): sulfamoylphenethylamine derivative Frequency: Rationale for client: benign prostatic hypertrophy (BPH) Action: binds preferentially to alpha1A adrenoceptor subtype located mainly in the prostate
Admin 30 minutes after same meal each day. I & O, daily weight, report any weight gain or edema. Teach pt not to drive for 4 hrs after first dose or any increase in dosage. Do not take with beta blockers, prazosin, terazosin, doxazosin, vardenafil.
Drug: tapentadol (Nucynta) Dose: Route (Give timing for IV push/IVPB meds): Frequency:
Functional class: analgesic Chemical class: mu opioid receptor blocker
Side-Effects: CNS: seizures, drowsiness, dizziness, confusion, HA, euphoria CV: palpitations, bradycardia, orthostatic hypotension, sinus tachycardia, hypo/hypertension SYST: anaphylaxis, infection, serotonin syndrome RESP: respiratory depression INTEG: rash, diaphoresis, pruritus GI: N V, constipation, cramps, gastritis, dyspepsia, biliary spasms GU: urinary retention/frequency Contraindications: hypersensitivity, asthma, ileus, respiratory depression
Action: centrally acting synthetic analgesic, mu-opioid agonist activity is Rationale for client: moderate to severe pain thought to result in analgesia, inhibits norepinephrine uptake
MAOIs will increase toxicity. St. Johns wort, valerian, lavender, kava, mistletoe will increase sedative effect. Admin with antiemetic if nausea/vomiting occur. Assess for respiratory depression, if RR <10 d/c. Assess for CNS changes. I&O, check for urinary retention.
Decreases effect of digoxin. Drug: tegaserod (Zelnorm) Dose: Chemical class: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: irritable bowel syndrome where primary bowel symptom is constipation or chronic constipation not associated with IBS Action: a 5-HT4 receptor partial agonist that binds 5-HT4 receptors, stimulating peristalsis and intestinal secretion Functional class: 5-HT4 receptor partial agonist, GI agent, prokinetic Side-Effects: Admin 30 minutes prior to meal. CNS: HA, fatigue, vertigo, depression, dizziness, poor concentration, suicide attempt CV: dysrhythmias, bundle branch block, supraventricular tachycardia, hypotension, angina SYST: anaphylaxis MS: back pain, arthralgia GI: increased AST & ALT, irritable colon, flatulence, eructation, increased appetite, nausea, abdominal pain GU: polyuria, renal pain, ovarian cyst, miscarriage, albuminuria MISC: facial edema, pain, increased CPK, asthma, breast carcinoma Contraindications: severe renal disease, moderate to severe hepatic disease, history of bowel obstruction, gallbladder disease, abdominal adhesions, sphincter of ODDI dysfunction, hypotension Assess CV status Assess for GI symptoms: nausea, abdominal pain. Notify prescriber of GI symptoms occur.
Drug: telavancin (Vibativ) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: skin infections, MRSA, nosocomial pneumonia
Functional class: antiinfective Chemical class: lipoglycopeptide, a semisynthetic derivative of vancomycin Action: inhibits bacterial cell wall synthesis, blocks glycopeptides
Side-Effects: CNS: anxiety, chills, flushing, HA, insomnia CV: QT prolongation, irregular heartbeat HEMA: leukopenia, eosinophilia, anemia, thrombocytopenia SYST: anaphylaxis, superinfection GI: NVD, pseudomembranous colitis, abdominal pain, metallic taste GU: nephrotoxicity, increased BUN and creatinine, renal failure, foamy urine EENT: hearing loss INTEG: chills, fever, rash, necrosis (red man syndrome Contraindications: hypersensitivity BLACK BOX WARNING: Pregnancy
Increase otoxicity or nephrotoxicity aminoglycosides, cephalosporins, polymyxin, colistin, bacitracin, cisplatin, amphotericin B, cidofovir. Do not use acidophilus with antiinfectives, separate by several hours. If hearing loss, ringing, or roaring in years, d/c. Monitor B/P, sudden drop may indicate red man syndrome -admin antihistamine if suspect. I & O report hematuria, oliguria due to nephrotoxicity tendency and increase fluids to 2L/day to avoid.
Drug: telbivudine (Tyzeka) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Hepatitis B
Functional class: antiretroviral Chemical class: nucleoside reverse transcriptase inhibitor (NRTI) Action: inhibits replication of HBV DNA polymerase, which inhibits HBV replication
Side-Effects: CNS: weakness, dizziness, insomnia, malaise, fever, HA MS: myalgia, arthralgia, muscle cramps RESP: cough INTEG: rash GI: hepatomegaly, NVD, anorexia, abdominal pain MISC: lactic acidosis EENT: taste change, hearing loss, photophobia Contraindications: hypersensitivity, breasfeeding Black Box Warning: impaired hepatic function, lactic acidosis
Take with a full glass of water. Teach patient that GI complaints and insomnia should resolve after 3 to 4 weeks of treatment. Teach patient that med does not cure Hep B or stop spread to others. Increase myopathy risk HMG-CoA reductase inhibitiors, fibric acid derivatives, penicillamine, cyclosporine, erythromycin, corticosteroids, azole antifungals
Drug: telithromycin (Ketek) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: acute bacterial exacerbation of bronchitis or acute bacterial sinusitis or community-acquired pneumonia or acute tonsillitis/pharyngitis
Functional class: antiinfective Chemical class: ketolides Action: binds to 50S ribosomal subunits of susceptible bacteria and suppresses protein synthesis
Side-Effects: CNS: increased sweating, HA, dizziness, insomnia CV: atrial dysrhythmias, QT prolongation, torsade de points MS: muscle cramps SYST: anaphylaxis, superinfection INTEG: rash, urticaria GI: pseudomembranous colitis, pancreatitis, NVD, hepatitis, abdominal pain/distention, stomatitis, anorexia GU: vaginitis, moniliasis EENT: blurred vision, diplopia, difficulty focusing Contraindications: history of hepatitis, hypersensitivity to macrolide antibiotics Black ox Warning: myasthenia gravis
Increase serious dysrhythmias pimozide, antidysrhythmics; do not use together. Assess cardiac status, check ECG for QT prolongation. If increasing diarrhea, may be pseudomembranous colitis. Hepatic studies: AST, ALT if patient on long-tern therapy. Teach patient to report diarrhea, dark urine, pale stools, jaundice, and severe abdominal pain.
Drug: telmisartan (Micardis) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: HTN or heart failure
Functional class: antihypertensive Chemical class: angiotensin II receptor antagonist Action: blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT1 receptor found in tissues
Side-Effects: CNS: dizziness, insomnia, anxiety, HA, fatigue MS: myalgia, pain RESP: cough, upper respiratory infection, sinusitis, pharyngitis INTEG: GI: diarrhea, dyspepsia, anorexia, vomiting GU: EENT: Contraindications: hypersensitivity Black Box Warning: Pregnancy, 2nd and 3rd trimesters
Increase digoxin peak/trough concentrations digoxin. Increase antihypertensive action diuretics, other antihypertensives. Increase hyperkalemia potassium sparing diuretics, potassium salt substitutes. Assess B/P, pulse, q4hr. Assess electrolytes. Administer increased dose to African American patients. Take at same time daily, may take 2 to 4 weeks to take effect.
Drug: temazepam (Restoril) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: insomnia
Functional class: sedative-hypnotic Chemical class: benzodiazepine, shortintermediate acting Action: produces CNS depression at limbic, thalamic, hypothalamic levels of the CNS; may be mediated by neurotransmitter GABA; results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, anxiolytic action
Side-Effects: CNS: lethargy, drowsiness, daytime sedation, dizziness, confusion, anxiety CV: chest pain, pulse changes, hypotension HEMA: leukopenia, granulocytopenia INTEG: GI: NVD, heartburn, abdominal pain, constipation, anorexia SYST: severe allergic reactions EENT: blurred vision Contraindications: intermittent porphyria, pregnancy, breastfeeding, hypersensitivity to benzodiazepines OD: lavage, activated charcoal; monitor electrolytes, VS
Blood studies and hepatic studies necessary for long term therapy: Hct, Hgb, RBCs, AST, ALT, bilirubin. Take 30 minutes to 1 hour before bedtime. Avoid use with CNS depressants; serious CNS depression may result. Assistance with ambulation after dosing is necessary. Limit to 7-10 days of continuous use. Do not D/C rapidly, withdraw gradually. May take 2 nights to take effect
Drug: temozolomide (Temodar) Dose:
Functional class: antineoplastic-alkylating agent
Side-Effects: CNS: seizures, hemiparesis, dizziness, poor coordination, amnesia, insomnia, paresthesia, somnolence, anxiety, dysphagia, depression, confusion MISC: HA, fatigue, asthenia, fever, edema, back pain, weight increase, diplopia HEMA: thrombocytopenia, leukopenia, myelosuppression, neutropenia, anemia INTEG: rash, pruritus GI: NV, anorexia, abdominal pain, constipation GU: urinary incontinence, UTI, frequency SYST: anaphylaxis, secondary malignancy Contraindications: hypersensitivity to product, carbazine, or gelatin; pregnancy, breastfeeding
Chemical class: imidazotetrazine Route (Give timing for IV push/IVPB meds): derivative Frequency: Rationale for client: anaplastic astrocytoma with relapse or glioblastoma multiform or malignant glioma or metastatic melanoma Action: a prodrug that undergoes conversion to MTIC; MTIC action prevents DNA transcription
Do not use within 24 hr of sargramostim, filgrastim, G-CSF. Increase bleeding risk NSAIDs, anticoagulants, platelet inhibitors, thrombolytics. Decrease action of digoxin; decrease antibody reaction of vaccines, toxoids. CBC on day 22, CBC weekly until recovery if ANC is <1.5 x 109 /L and platelets <100 x 109/L, do not admin. Assess for seizures throughout treatment, mental status. Give antiemetic 30-60 min before admin, Take each capsule with 8 oz water, and give on empty stomach at bedtime. If caps accidentally damaged, do not allow contact with skin or inhale. Use proper procedures for handling/disposing of chemo products
Drug: temsirolimus (Torisel) Dose:
Functional class: biologic response modifier
Side-Effects: CNS: seizures, HA CV: thrombophlebitis, HTN HEMA: anemia, leukopenia, thrombocytopenia INTEG: rash, pruritus GI: bowel perforation, NVD, constipation GU: albuminuria, hematuria, proteinuria, renal failure, mucositis ENDO: hypertriglyceridemia, hyperlipidemia, hyperglycemia META: metabolic acidosis, hyperglycemia, hyperlipidemia RESP: interstitial lung disease SYST: lymphoma Contraindications: hypersensitivity to this product or sirolimus, polysorbate 80; pregnancy, breastfeeding
Chemical class: kinase inhibitor, mTOR Route (Give timing for IV push/IVPB meds): antagonist Frequency: Action: inhibits mammalian target of Rationale for client: renal cell carcinoma or rapamycin (mTOR), a protein kinase astrocytoma or mantle cell lymphoma
Teach patient to report fever, rash, severe diarrhea, chills, sore throat, fatigue, serious infections, clay-colored stools, cramping, excessive thirst, urinary retention, new or worsening breathing problems, blood in stool, abdominal pain. Protect from light during preparation, use only in glass. Dilute product with 1.8 ml of provided diluent, the result is 3 ml; invert to mix well, withdraw amount and inject rapidly into 250 ml of NS, do not use PVC inf bags/sets. Teach patient to use contraception before, during, and 12 weeks after treatment.
Drug: tenecteplase (TNKase) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: acute MI
Functional class: thrombolytic enzyme Chemical class: tissue plasminogen activator Action: activates conversion of plasminogen to plasmin (fibrinolysin): plasmin breaks down clots (fibrin), fibrinogen, factors V, VII; occlusion of venous access lines
Side-Effects: CNS: CV: PE, cardiogenic shock, cardiac arrest, HF, tamponade, myocardial reinfarction, myocardial rupture, pericarditis, pericardial effusion, thrombosis, CVA HEMA: bleeding, decreased Hct INTEG: rash, urticarial, itching, flushing, phlebitis at IV inf site SYST: GI, GU, intracranial, retroperitoneal bleeding, surface bleeding, anaphylaxis Contraindications: active bleeding, aneurysm, arteriovenous malformation, intracranial/intraspinal surgery or trauma within 2 mo; severe renal/hepatic disease, severe HTN, CNS neoplasms, history of CVA, increased ICP/stroke
Blood studies prior to therapy, PT or aPTT must be less than 2x control before starting therapy. Assess for bleeding during 1st hour of treatment and monitor closely for next 24 hrs. VS, B/P, pulse, respirations, neurologic signs at least q4hrs. Temp >104 indicates internal bleeding; systolic pressure >25 mm Hg should be reported. Bed rest during entire course of treatment. Avoidance of venous or arterial puncture, inj, rectal temp, any invasive procedure. Notify prescriber if sudden onset of severe HA.
Drug: tenofovir ( Viread) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: HIV-1 infection or hepatitis B
Functional class: antiretroviral Chemical class: nucleoside analog reverse transcriptase inhibitor Action: inhibits replication of HIV virus by competing with the natural substrate an then incorporating into cellular DNA by viral reverse transcriptase, thereby terminating cellular DNA chain
Side-Effects: CNS: HA, asthenia META: lactic acidosis, hypokalemia, hypophosphatemia HEMA: neutropenia, osteopenia SYST: lipodystrophy INTEG: angioedema, rash GI: pancreatitis, NVD, anorexia, flatulence, abdominal pain, flatulence GU: renal failure, renal tubular acidosis/necrosis, fanconi syndrome MS: rhabdomyolysis, myopathy Contraindications: hypersensitivity Black Box Warning: lactic acidosis, hepatic disease, hepatitis
Give with meals; teach patient that GI complaints resolve after 3 to 4 weeks. Follow up visits must be continued because serious toxicity may occur; blood counts must be done q2wk. Hepatic studies: AST, ALT, bilirubin, amylase, lipase, triglycerides periodically during treatment. Changes in body fat distribution may occur.
Drug: terazosin (Hytrin) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: HTN or BPH
Functional class: antihypertensive Chemical class: alpha-adrenergic blocker Action: decreases total vascular resistance, which is responsible for a decrease in B/P, this occurs by blockade of alpha1-adrenergic blocker
Side-Effects: CNS: dizziness, HA, drowsiness, anxiety, depression, vertigo, weakness, fatigue CV: palpitations, orthostatic hypotension, tachycardia, edema, rebound hypertension RESP; dyspnea, cough, pharyngitis GI: NVD, constipation, abdominal pain GU: urinary frequency, incontinence, impotence, priapism EENT: blurred vision, epistaxis, tinnitus, dry mouth, red sclera, nasal congestion Contraindications: hypersensitivity
Increase toxicity; death-aconite Increase hypotensive effects beta blockers, nitroglycerin, verapamil, other antihypertensives, alcohol. Orthostatic B/P, pulse, jugular venous distention q4hr. BUN, uric acid if on long-term therapy. Weight daily, I&O. Admin at bedtime; fainting may occur, especially after 1st dose. Rise slowly from sitting/lying.
Drug: terbinafine (Larnisil) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: (topical) tinea cruris, tinea corporis, tinea pedis; (oral) onychomycosis of the toenail or fingernail due to dermatophytes
Functional class: antifungal Chemical class: synthetic allylamine derivative Action: interferes with cell membrane permeability in fungi
Side-Effects: HEMA: neutropenia INTEG: Stevens-Johnson syndrome, rash, pruritus, urticaria GI: diarrhea, dyspepsia, abdominal pain, nausea, hepatitis MISC: HA, hepatic enzyme changes, taste, visual disturbance Contraindications: chronic/active hepatic disease, renal disease GFR less than or equal to 50ml/min, hypersensitivity
Hepatic studies prior to beginning treatment (ALT, AST); do not use in presence of hepatic disease. CBC in treatment > 6 wk Teach patient to notify prescriber of nausea, vomiting, fatigue, jaundice, dark urine, clay-colored stool, RUQ pain.
Drug: terbutaline (Brethine, Bricanye) Dose:
Functional class: selective beta2-agonist; bronchodilator Chemical class: catecholamine
Side-Effects: CNS: tremors, anxiety, insomnia, HA, dizziness, stimulation CV: cardiac arrest, palpitations, tachycardia, HTN, dysrhythmias HEMA: INTEG: GI: NV GU: EENT: Contraindications: closed-angle glaucoma, tachydysrhythmiashypersensitivity to sympathhomimetics
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: bronchospasm, hyperkalemia Action: relaxes bronchial smooth muscle by direct action on beta2-adrenergic receptors through accumulation of cAMP at beta-adrenergic receptor sites; bronchodilation, diuresis, CNS, cardiac stimulation occur; relaxes uterine smooth muscle
Hypertensive crisis can occur if used with MAOIs. Decreases action of beta blockers Green tea will increase effect. Tolerance over long-term therapy may cause need for dose to be changed. Monitor for rebound bronchospasm. Teach patient to take on time, if missed, do not make up after 1 hr, wait until next dose. Increase fluids to >2L/day.
Drug: teriparatide (Forteco) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: postmenopausal women with osteoporosis, men with primary or hypogonadal osteoporosis who are at high risk for fracture, glucocorticoid-induced osteoporosis
Functional class: parathyroid hormone Chemical class: Action: contains human recombinant parathyroid hormone, to stimulate new bone growth
Side-Effects: CNS: dizziness, HA, insomnia, depression, vertigo CV: HTN, angina, syncope MISC: pain, asthenia, hyperuricemia INTEG: rash, sweating GI: ND, dyspepsia, vomiting, constipation MS: arthralgia, leg cramps, back/leg pain, weakness, osteosarcoma (rare) RESP: rhinitis, cough, pharyngitis, pneumonia, dyspnea Contraindications: increased baseline risk of osteosarcoma ( Pagets disease, open epiphyses, previous bone radiation), bone metastases, hx of skeletal malignancies, metabolic bone diseases, preexisting hypercalcemia
Increases digoxin toxicity. Uric acid, magnesium, creatinine, BUN, urine pH, vit D, phosphate for normal serum levels; serum calcium may be transiently increased after dosing (max at 4-6 hr post-dose). Assess for bone pain, HA, fatigue, changes in LOC, leg cramps. Assess for signs of persistent hypercalcemia: NV, constipation, lethargy, muscle weakness. Encourage diet high in vit D and calcium. Give SQ using disposable pen only; inject in thigh or abd over 5 seconds; rotate inj site; store pen in frig. Have patient sit or lie down, orthostatic hypertension may occur.
Drug: tetracaine(Pontocaine) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: spinal anesthesia, epidural and peripheral nerve block, perineum , lower extremities
Functional class: local anesthetic Chemical class: ester Action: competes with calcium for binding sites in nerve membrane that control sodium transport across the cell membrane; decreases rise of depolarization phase of action potential
Side-Effects: CNS: seizures, loss of consciousness, anxiety, drowsiness, disorientation, tremors, shivering CV: myocardial depression, cardiac arrest, dysrhythmias, bradycardia, hypo/hypertension, fetal bradycardia RESP: status asthmaticus, respiratory arrest, anaphylaxis INTEG: rash, urticaria, allergic reaction, edema, burning, skin discoloration at inj site, tissue necrosis GI: NV EENT: blurred vision, tinnitus, pupil constriction Contraindications: thrombocytopenia, severe hepatic disease, heart block, hypersensitivity , sulfite allergy
OD: maintain adequate airway, O2, vasopressor, IV fluids, anticonvulsants for seizures. Assess B/P, pulse, respirations, during treatment. Assess cardiac status. Only admin if not cloudy and does not contain precipitate; and only with crash cart nearby.
Drug: tetracycline (Apo-Tetra, Emtet, NuTetra, tetracycline HCl) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: syphilis, chlamydia trachomatis, gonorrhea, lymphogranuloma venereum, rickettsial infections
Functional class: broad-spectrum antiinfective Chemical class: tetracycline Action: inhibits protein synthesis and phosphorylation in microorganisms; bacteriostatic
Side-Effects: CNS: fever, HA, paresthesia CV: pericarditis HEMA: eosinophilia, neutropenia, thrombocytopenia, leukocytosis, hemolytic anemia INTEG: exfolitative dermatitis, angioedema, SJS, photosensitivity, increased pigmentation, rash GI: hepatotoxicity, hepatitis, pseudomembranous colitis, flatulence, abdominal cramps, NVD, anorexia, stomatitis, epigastric burning GU: azotemia, acute renal failure, increased BUN EENT: dysphagia, glossitis, decreased calcification, discoloration of deciduous teeth, oral candidiasis, oral ulcers Contraindications: children < 8 yrs, hypersensitivity to tetracyclines, pregnancy, breastfeeding
Increases effect of warfarin, digoxin. Assess for anemia: Hct, Hgb, fatigue. I&O ratio Should be given on an empty stomach with a full glass of water. Avoid milk products. Take 2 hrs before or after any iron products ad 1 hr after antacid. Teach patient to avoid sun exposure.
Functional class: bronchodilator Drug: theophylline (Accurbron) Chemical class: methylxanthine Dose: Route (Give timing for IV push/IVPB meds): Action: relaxes smooth muscle of respiratory system by blocking Frequency: phosphodiesterase, which increases cAMP Rationale for client: bronchial asthma, bronchospasm of COPD, chronic bronchitis, emphysema CNS: seizures, anxiety, restlessness, insomnia, dizziness, HA, muscle twitching, tremors, light- headedness CV: palpitations, sinus tachycardia, dysrhythmias, fluid retention with tachycardia, hypotension ENDO: hyperglycemia INTEG: flushing, urticaria GI: NVD, anorexia, bitter taste, dyspepsia, gastric distress MISC: SIADH, urinary frequency RESP: increased rate, tachypnea Contraindications: tachydysrhythmias, hypersensitivity to xanthines Side-Effects:
Beta blockers can cause cardiotoxicity. Increase the effects of anticoagulants. Decreases theophylline level phenytoin, phenobarbital, carbamazepine, rifampin, smoking. Therapeutic level is 5-15 mcg/ml Toxicity can occur with small increase above 20 mcg/ml. Notify prescriber of toxicity: NV, anxiety, insomnia, seizures. Also notify prescriber if change in smoking habit, dosage change. Monitor I&O
Drug: thiamine (vit B1) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Vit B1 Chemical class: water soluble Action: needed for pyruvate metabolism, carbohydrate metabolism
Side-Effects: CNS: weakness, restlessness CV: collapse, pulmonary edema, hypotension EENT: tightness of throat INTEG: angioneurotic edema, cyanosis, sweating, warmth GI: hemorrhage, N, D SYST: anaphylaxis Contraindications: hypersensitivity
Admin by IM inj; rotate sites if pain and inflammation occur; do not mix with alkaline sols; Z-track method to minimize pain. Application of cold to reduce pain. Teach pt. necessary foods to include in diet: yeast, beef, liver, legumes, and whole grain.
Drug: thiethylperazine (Norzine, Torecan) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Nausea, vomiting
Functional class: antiemetic Chemical class: phenothiazine, piperazine derivative Action: acts centrally by blocking chemoreceptor trigger zone, which in turn acts on vomiting center; DOPamine blocker
Side-Effects: CNS: seizures, neuroleptic malignant syndrome, euphoria, depression, restlessness, tremor, EPS, drowsiness, confusion CV: circulatory failure, tachycardia, postural hypotension, ECG changes HEMA: agranulocytosis, leukopenia RESP: respiratory depression GI: NVD, anorexia, dry mouth, constipation, weight loss, metallic taste, cramps GU: urinary retention, dark urine Contraindications: coma, seizure, encephalopathy, bone marrow depression, hypersensitivity to phenothiazines, sulfites, tartazine, pregnancy (X)
Avoid use with phenothiazines, seizures may occur. Increases anticholinergic action and sedation agents. Decreases effect of thiethylperazine barbiturates, antacids. Assess VS, B/P, checking pts with cardiac disease more often. Assess for NMS: dyspnea, fever, seizures, diaphoresis, fatigue, loss of urinary control, tachycardia. Assess respiratory status throughout treatment.
Drug: thiopental (Pentothal, thiopental sodium) Dose:
Functional class: general anesthetic Chemical class: barbiturate
Side-Effects: CNS: retrograde amnesia, prolonged somnolence CV: myocardial depression, dysrhythmias, tachycardia, hypotension MISC: hemolytic anemia (rare) INTEG: chills, shivering, necrosis, pain at inj site MS: muscle irritability RESP: respiratory depression, bronchospasm EENT: sneezing, coughing Contraindications: status asthmaticus, porphyrias, hypersensitivity
Route (Give timing for IV push/IVPB meds): Action: increases membrane ion conduction to chloride, decreases Frequency: depolarization due to glutamate and increases in GABA Rationale for client: short, general anesthesia or status epilepticus or ICP
Do not use with voriconazole. Increase hypotension MAOIs. Increase action CNS depressants, probenecid. VS q3-5 min during IV admin, after dose, q4hr postoperatively. If extravasation occurs, apply moist heat and 1% procaine to affected area. Only admin with crash cart. Use of kava, St. Johns wort will increase CNS depression.
Drug: thioridazine (Apo-Thioridazine, Novo-Ridazine, PMS-thioridazine, thioridazine HCl) Dose:
Functional class: antipsychotic, neuroleptic Chemical class: phenothiazine piperidine
Side-Effects: CNS: NMS, seizures, EPS, pseudoparkinsonism, dystonia, akathisia, tardive dyskinesia, HA, confusion, D&D CV: orthostatic hypotension, cardiac arrest, ECG changes, tachycardia, QT prolongation, torsade de pointes HEMA: leukopenia, leukocytosis, agranulocytosis, anemia INTEG: rash, photosensitivity, dermatitis GI: dry mouth, constipation, NVD, anorexia, jaundice, weight gain GU: urinary retention/frequency, enuresis, impotence, amenorrhea, gynecomastia, priapism, ejaculation dysfunction EENT: blurred vision, glaucoma, dry eyes RESP: laryngospasm, respiratory depression, dyspnea Contraindications: coma, CNS depression, children <2yr Black Box Warning: QT prolongation, cardiac dysrhythmias, cardiac disease, dementia, AV block, bundle-branch block, torsade de pointes Side-Effects: CNS: insomnia, tremors, HA, thyroid storm CV: tachycardia, palpitations, angina, dysrhythmias, HTN, cardiac arrest MiSC: menstrual irregularities, weight loss, sweating, heat intolerance, fever GI: ND, increased or decreased appetite, cramps Contraindications: adrenal insufficiency, MI, thyrotoxicosis, porcine protein hypersensitivity
Route (Give timing for IV push/IVPB meds): Action: depresses cerebral cortex, hypothalamus, limbic system, which Frequency: control activity, aggression; blocks neurotransmission produced by Rationale for client: psychotic disorders, DOPamine at synapse; exhibits strong schizophrenia, anxiety, major depressive alpha-adrenergic and anticholinergic disorders, organic brain syndrome, blocking action behavioral problems in children, dementia behavioral problems in geriatric patients
OD: lavage if orally ingested, provide an airway, do not induce vomiting, CV monitoring, continuous ECG. Assess mental status before first dose. Pulse and RR q4hr during initial treatment. Ensure patient swallows med and does not hoard or give to others. I&O ratio, palpate bladder to check for retention. Bilirubin, CBC, LFTs q mo. Urinalysis is recommended before and during prolonged therapy. B/P standing and lying, if drops >30, report to provider. Increase water and bulk to avoid urinary retention and constipation. Decreased sensory stimulation, no strenuous exercise, do not stand still for long periods, assist in ambulation.
Drug: thyroid USP, dessicated (Armour Functional class: thyroid hormone Thyroid, Bio-Throid, Nature Throid, Thyroid Strong, Westhroid) Chemical class: active thyroid hormone in natural state and ratio Dose: Route (Give timing for IV push/IVPB meds): Action: Increases metabolic rates, increases cardiac output, O2 consumption, Frequency: body temp, blood volume, growth, development at the cellular level Rationale for client: hypothyroidism or cretinism (juvenile hypothyroidism) or myxedema
Increases effects of anticoagulants, sympathomimetics, tricyclics, catecholamines. B/P, pulse before each dose. I&O ratio. Daily weight. PT may require decreased anticoagulant; check for bleeding and bruising. Increased nervousness, excitability, irritability, may indicate too high dose of med; usually after 1-3 wks of treatment. Admin in the am at the same time each day; separated iron, calcium products by 4 hr. Teach to avoid iodine food, iodine salt, soybeans, tofu, turnips, some seafood, some bread.
Drug: tiagabine (Gabitril) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: adjunct treatment of partial seizures in adults and children 12 or older.
Functional class: anticonvulsant Chemical class: Action: inhibits reuptake and metabolism of GABA, may increase seizure threshold; structurally similar to GABA; tiagabine binding sites in neocortex, hippocampus
Side-Effects: CNS: suicidal ideation, dizziness, anxiety, somnolence, ataxia, confusion, asthenia, unsteady gait, depression CV: vasodilation INTEG: SJS, pruritus, rash GI: NVD, increased appetite RESP: pharyngitis, coughing Contraindications: hypersensitivity
Drug: ticarcillin (Ticar) Dose:
Functional class: broad-spectrum antiinfective
Side-Effects: CNS: coma, seizures, lethargy, hallucinations, anxiety, twitching, depression, confusion HEMA: bone marrow depression, granulocytopenia, anemia, increased bleeding time INTEG: rash, SJS GI: pseudomembranous colitis, hepatotoxicity, NVD, increased AST/ALT, abdominal pain, glossitis, colitis GU: glomerulonephritis, oliguria, proteinuria, hematuria, vaginitis, moniliasis META: hypokalemia SYST: anaphylaxis Contraindications: hypersensitivity to penicillins
Chemical class: extended-spectrum Route (Give timing for IV push/IVPB meds): penicillin Frequency: Rationale for client: respiratory, soft tissue, urinary tract infections, bacterial septicemia Action: cell wall lysis mediated by cell wall autolytic enzymes
Lower doses may be needed when used with valproate. Do not take with high fat meal, will decrease absorption. Renal studies: urinalysis, BUN, creatinine q3mo. Hepatic studies: ALT, AST, bilirubin. If mental status changes occur, notify prescriber. Assistance with ambulation during early part of treatment, dizziness may occur. Seizures precautions: padded side rails, remove objects that may harm pt. Teach pt to carry emergency ID and to avoid driving and not to d/c abruptly. OD: lavage, VS Decreases effect of oral contraceptives and erythromycins. Can cause false positive urine glucose and urine protein. Increases effect of neuromuscular blocker, anticoagulants, methotrexate. Increases ticarcillin concentrations aspirin, probenecid. I&O ratio, report hematuria, oliguria since penicillin in high doses is nephrotoxic. Caution with pts with renal disease, product secreted slowly so toxicity can occur rapidly. OD: withdraw product, maintain airway, admin epinephrine, aminophylline, O2, IV corticosteroids for anaphylaxis.
Drug: ticlopidine Dose:
Functional class: platelet aggregation inhibitor Chemical class: thienopyridine compound
Side-Effects: CNS: dizziness CV: HEMA: bleeding (epistaxis, hematuria), conjunctival hemorrhage, GI bleeding, agranulocytosis, neutropenia, thrombocytopenic purpura INTEG: rash, pruritus GI: NVD, GI discomfort, cholestatic jaundice, hepatitis, increased cholesterol, LDL, VLDL, triglycerides Contraindications: severe hepatic disease, active bleeding, coagulopathy, hypersensitivity
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: reducing the risk of stroke in high risk patients Action: irreversible inhibition of platelet aggregation through antagonism of ADP
Blood studies and hepatic studies prior to treatment and during long term therapy. Bleed time baseline and throughout, levels may be 2-5x normal limit. Take with food to decrease gastric symptoms. DC when absolute neutrophil count falls during treatment to <1200/mm3 or platelets <80,000/mm3. Product should be DC 10-14 days prior to surgery and never double a missed dose. Report any bleeding, skin rashes, jaundiced skin, dark urine, or light colored stools to prescriber.
Drug: tigecycline (Tygacil) Dose:
Functional class: broad-spectrum antiinfective Chemical class: glyclyclines
Side-Effects: CNS: HA, dizziness, insomnia CV: hypo/hypertension, phlebitis HEMA: anemia, leukocytosis, thrombocytopenia INTEG: rash, pruritus, sweating, photosensitivity GI: NVD, anorexia, constipation, dyspepsia, abdominal pain, hepatotoxicity, hepatic failure META: increased ALT, AST, BUN, lactic acid, alk phos, amylase, hyperglycemia, bilirubinemia EENT: tooth discoloration MISC: back pain, fever, abnormal healing, abdominal pain, abscess, asthenia, infection, pain, peripheral edema, local reactions RESP: cough, dyspnea SYST: anaphylaxis Contraindications: children under 18 years, hypersensitivity to tigecycline, pregnancy (D), breastfeeding.
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: complicated skin/skin structure infections or community acquired pneumonia Action: inhibits protein synthesis and phosphorylation in microorganisms; bacteriostatic structurally similar to the tetracyclines.
Increase effect of warfarin. Decrease effect of oral contraceptives. Assess for signs of anemia, pseudomembranous colitis, and allergic reactions. Admin antiemetics and antacids as ordered to reduce GI upset. Teach pt to avoid sun exposure, sunscreen does not reduce photosensitivity. Teach pt to avoid pregnancy bc fetal harm may occur. Report any fever or signs of infection. Blood studies to check hepatic function while on therapy.
Drug: tiludronate (Skelid) Dose:
Functional class: bone resorption inhibitor Chemical class: bisphosphonate
Side-Effects: CNS: HA, dizziness, paresthesia CV: chest pain, edema, peripheral edema, atrial fibrillation ENDO: hyperparathyroidism INTEG: rash, epidermal necrosis, pruritus, sweating GI: ND, dry mouth, vomiting, flatulence, gastric ulcers, gastritis, dyspepsia GU: nephrotoxicity EENT: cataracts, ocular hypertension, pain/inflammation, conjunctivitis, visual impairment, sinusitis MS: bone pain, osteonecrosis of the jaw RESP: rhinitis, sinusitis, upper respiratory tract infection SYST: SJS Contraindications: severe renal disease with creatinine <30 ml/min; hypersensitivity to bisphosphonates; breastfeeding
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Pagets disease Action: decreases bone resorption by inhibiting resorption of mineralized bone matrix, inhibits osteoclasts
Therapeutic calcium level should be 9-10 mg/dl. Admin on empty stomach with 8 oz water 2 hrs before meals. Don not take with juice, coffee, or mineral water. Take calcium or mineral supplements 2 hr before or after. Do not take NSAIDs or antacids within 2 hr. Assess for signs of hypercalcemia: GI symptoms, polyuria, flushing, head swelling, tingling, HA. Assess for signs of hypocalcemia: nervousness, irritability, twitching, seizures, spasm, and paresthesia. Teach pt to follow a low-calcium diet as prescribed. Teach pt to maintain good oral hygiene. Notify prescriber if hypercalcemic relapse: renal calculi, nausea, vomiting, thirst, lethargy, deep bone or flank pain.
Drug: timolol (Apo-Timol, Novo-Timol, timolol maleate) Dose:
Functional class: antihypertensive Chemical class: nonselective beta-blocker
Side-Effects: CNS: insomnia, dizziness, hallucinations, anxiety, fatigue, depression, HA CV: CHF, hypotension, bradycardia, edema, chest pain, claudication, angina, AV block, ventricular dysrhythmias HEMA: agranulocytosis, thrombockytopenia, purpura INTEG: rash, alopecia, pruritus, fever GI: ischemic colitis, NVD, mesenteric arterial thrombosis, flatulence, constipation GU: urinary frequency, impotence EENT: visual changes, sore throat, double vision, dry & burning eyes META: hypoglycemia MUSC: joint pain, muscle pain RESP: bronchospasm, dyspnea, cough, crackles, nasal stuffiness Contraindications: cardiogenic shock, heart block (2nd and 3rd degree), sinus bradycardia, CHF, cardiac failure, severe COPD, asthma, hypersensitivity
Route (Give timing for IV push/IVPB meds): Action: competitively blocks stimulation of beta-adrenergic receptor within Frequency: vascular smooth muscle (decreases rate of SA node discharge, increases recovery Rationale for client: mild to moderate HTN time), slows conduction of AV node, and migraine prophylaxis decreases heart rate, which decreases O2 consumption in myocardium; also decreases renin-aldosterone-angiotensin system, at high doses inhibits beta2receptors in bronchial system
Increase toxicity, death aconite. OD: lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure, hemodialysis; admin vasopressor (norepinephrine). Apical/radial pulse before admin. Baselines in renal and hepatic studies before therapy begins. Skin turgor, mucous membranes for hydration status. I&O and daily weight, check for edema. Therapeutic response takes 1-2 weeks. Teach pt not to use OTC products containing alpha-adrenergic stimulants, such as nasal decongestants and cold preparations unless directed by prescriber. Teach not to d/c abruptly, needs to be tapered over 2 wks.
BBW: secondary malignancy Drug: tinidazole (Tindamax) Dose: Functional class: Antiprotozoal Chemical class: Nitroimidazole derivative Side-Effects: CNS: dizziness, HA, seizures, peripheral neuropathy HEMA: leukopenia INTEG: rash GI: N / V SYST: angioedema Contraindications: pregnancy, breastfeeding, hypersensitivity to nitroimidazole derivatives Must be > 3 years old Amebic liver abscess: CBC, ESR, ultrasound, total & diff leukocyte count Bowel pattern before & during tx Take with food No alcohol during and 3 days after tx.
Route (Give timing for IV push/IVPB meds): Action: Interferes with DNA / RNA synthesis in protozoa Frequency: Rationale for client:
Drug: tinzaparin (Innohep) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Anticoagulant Chemical class: Unfractionated porcine heparin Action: Increases the inhibitory effect of antithrombin factor Xa, thrombin
Side-Effects: CNS: fever, HA CV: dysrhythmias HEMA: anemia, thrombocytopenia, bleeding GI: hepatitis GU: UTI, hematuria SYST: Stevens-Johnson Syndrome Contraindications: hypersensitivity to heparin, pork, benzyl alcohol, or sulfites, hemophilia, PUD, HIT
BBW: spinal / epidural anesthesia, lumbar puncture Hct, platelets, occult blood in stools, bleeding gums, petechiae, black tarry stools Subcut only, no IM; rotate sites; do not massage inj. Site Not interchangeable with heparin or LMWHs. Give at same time each day.
Drug: tiotropium (Spiriva) Dose:
Functional class: anticholinergic, bronchodilator
Side-Effects: CNS: depression CV: chest pain HEMA: INTEG: Angioedema GI: vomiting, constipation RESP: cough, upper resp. tract infection EENT: dry mouth Contraindications: hypersensitivity to atropine or its derivatives
Chemical class: synthetic quaternary Route (Give timing for IV push/IVPB meds): ammonium compound Action: inhibits interaction of Frequency: acetylcholine at receptor sites on the bronchial smooth muscle, resulting in Rationale for client: decreased cGMP & bronchodilation
Caps are for INH only, do not swallow Place cap in HandiHaler Rinse mouth after use Teach: used for long term tx, not for immediate relief Use hard candy or regular oral hygiene to reduce dry mouth
Side-Effects: Drug: tipranavir (Aptivus) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: inhibits human immunodeficiency virus (HIV) protease; this prevents the maturation of virus Functional class: Antiretroviral Chemical class: Protease inhibitor CNS: HA, insomnia, fever, intracranial bleeding Other: insulin-resistant hyperglycemia, hyperlipidemia, ketoacidosis INTEG: rash GI: diarrhea, N / V, hepatitis B or C, fatalities if given with ritonavir, pancreatitis Contraindications: hypersensitivity
BBW: hepatic disease, intracranial bleeding, hepatitis Lower back / flank pain= kidney stones ALT, AST, bilirubin, amylase may be elevated Plasma HIV RNA, cholesterol profile, triglycerides blood in stool-stop med Do NOT break, crush or chew
Drug: tirofiban (Aggrastat) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiplatelet Chemical class: Glycoprotein IIb / IIIa inhibitor Action: Antagonist of platelet glycoprotein (GP) IIb / IIIa receptor that prevents binding of fibrinogen & Von Willebrands factor which inhibits platelet aggregation
Side-Effects: CNS: dizziness CV: bradycardia, hypotension HEMA: bleeding, thrombocytopenia INTEG: rash GI: Nausea, vomiting SYST: anaphylaxis Contraindications: active internal bleeding, stroke, major surgery, intracranial neoplasm, aneurysm, hemorrhage, acute pericarditis Side-Effects: CNS: dizziness, hallucination CV: hypotension, bradycardia GI: dry mouth, vomiting, constipation EENT: blurred vision Contraindications: hypersensitivity
Platelet counts > 100,000, Hct, Hgb before tx, within 6 hr of loading dose then daily. Watch for bleeding from puncture sites, catheters or in stools, urine Discontinue if platelet < 100,000 / mm3
Drug: tizanidine (zanaflex) Dose:
Functional class: skeletal muscle relaxant, alpha2-adrenergic agonist Chemical class: Imidazoline
Assess for: hypotension, for increased sedation, dizziness, hallucination, psychosis, product may need to be discontinued Corneal opacities may occur Hepatic studies @ 1,3,6 months & periodically Avoid use with other CNS depressants Avoid alcohol
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: increases presynaptic inhibition of motor neurons & reduces spasticity by alpha2-adrenergic agonism
Drug: tobramycin (TOBI) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiinfective Chemical class: Aminoglycoside Action: Interferes with protein synthesis in bacterial cell by binding to ribosomal subunits, causing inaccurate peptide sequence to form in protein chain, causing bacterial death.
Side-Effects: CNS: seizures, neurotoxicity CV:hypo/hypertension HEMA: thrombocytopenia, leukopenia INTEG: rash GI: N / V, hepatic necrosis GU: hematuria, renal damage EENT: ototoxicity Contraindications: Hypersensitivity to aminoglycosides
BBW: pregnancy (D), severe renal disease, hearing deficits, neuromuscular disease. Weigh pt-dose may be based on weight. I&O, UA daily, VS during infusion-hypotension & change in pulse Check for thrombophlebitis Serum aminoglycosides drawn (Peak 3060 min after IV inf. Or 60 min after IM inj. 4-10mcg/mL) (trough just before next dose (0.5-2 mcg/ mL)
Drug: tocainide Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antidysrhythmic class I b) Chemical class: Lidocaine analog Action: produces dose-dependent decreases in sodium & potassium conduction, thereby decreasing the excitability of myocardial cells; does not affect heart rate or B/P
Side-Effects: CNS: HA, dizziness, seizures CV: hypotension, bradycardia, heart block, sinus arrest, CHF HEMA: leucopenia, thrombocytopenia INTEG: Stevens-Johnson syndrome GI: N / V / D RESP: resp depression, pulmonary fibrosis EENT:tinnitus Contraindications: hypersensitivity to amides, severe heart block
BBW: bone marrow suppression, cardiac arrhythmias, pulmonary fibrosis CXR, pulm function tests, hepatic enzymes, lung sounds, sputum, SOB after 3-18 wks. CBC with diff, platelet count @ beginning & Q 3 months of tx. I&Os. Therapeutic level 4-10 mcg/mL Toxicity-fine tremors, dizziness Give with meds Overdose: O2, artificial ventilation, ECG; administer dopamine for circulartory depression, diazepam or thiopental for seizures BBW: Hepatic disease AST, ALT, alk phos, LDH, Bilirubin, CBC AST, ALT Q 2 wk x 1 yr if elevateddiscontinue B/P respiration during initial tx Urine & sweat may change colors. Report clay colored stools, jaundice, fatigue, appetite loss, lethargy, N/V, anorexia
Drug: tolcapone (tasmar) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antiparkinson agent Chemical class: COMT inhibitor Action: inhibits COMT; used as adjunct to levodopa / carbindopa therapy
Side-Effects: CNS: fatigue, HA CV: orthostatic hypotension HEMA:hemolytic anemia, leukopenia INTEG: GI: N / V / D / C, anorexia, fatal hepatic failure GU:UTI MS: rhabdomyolysis Contraindications: hypersensitivity
Drug: tolterodine (detrol) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: overactive bladder product Chemical class: muscarinic receptor antagonist Action: relaxes smooth muscles in urinary tract by inhibiting acetylcholine at postganglionic sites
Side-Effects: CNS: dizziness, HA CV: QT prolongation SYST: angioedema, stevens-johnson syndrome INTEG: rash GI: N / V / C, anorexia GU: urinary retention EENT: vision abnormalities Contraindications: uncontrolled closedangle glaucoma, urinary retention, gastric retention
Assess: urinary patterns Rash discontinue Take whole with liquids Dont drink liquids before bedtime
BBW: alcoholism, malnutrition Drug: tolvaptan ( Samsca) Dose: Chemical class: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: arginine vasopressin (AVP) antagonist with affinity for v2 receptors, level of circulating AVP in circulating blood is critical for regulation of water and electrolyte balance & is usually elevated in euvolemic/hypervolic hyponatremia Functional class: anticonvulsant Chemical class: monosaccharide derivative Action: may prevent seizure spread as opposed to an elevation of seizure threshold, increases GABA activity Functional class: vasopressin receptor antagonist , V2 Side-Effects: CNS: fever CV: v-fib, stroke, thrombosis HEMA:bleeding INTEG: GI: N / V / C MS: rhabdomyolysis RESP: resp. depression, pulm. embolism Contraindications: hypovolemia, anuria Assess: renal, hepatic function, cardiovascular status: v-fib, HTN, B/P, pulse, Na & K Initiate in hospital setting
Drug: topiramate (topamax) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Side-Effects: CNS: dizziness, fatigue, anxiety, memory loss, suicidal ideation HEMA: leukopenia INTEG: rash GI: N / D, anorexia, pancreatitis GU: dysmenorrhea EENT: vision abnormality Contraindications: metabolic acidosis Side-Effects: CNS: HA, dizziness CV: circulatory collapse HEMA: INTEG: rash GI: N / D / C GU: polyuria, renal failure ELECT:hypokalemia, hypochloremic alkalosis, hyponatremia ENDO: hyperglycemia, hyperuricemia EENT: loss of hearing Contraindications: infants, hypersensitivity to sulfonamides, anuria, hypovolemia
U/A, BUN, creatinine Q 3mo. ALT, AST, CBC; bilirubin & bicarbonate (if long term tx) Description of seizures: location, type, duration , aura Mental status Do not break, crush, or chew tabs
Drug: torsemide (Demadex) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: loop diuretic Chemical class: sulfonamide derivative Action: acts on loop of henle, proximal, distal tubules by inhibiting absorption of chloride, sodium, water
Assess: hearing at high doses Weight, I&Os Rate, depth, rhythm of respiration, postural hypotension, Electrolytes: K, Na, Cl; BUN, BG, CBC, creatinine, pH, ABGs, uric acid, Ca, Mg Give in AM K replacement if K < 3.0 mg/dL Give with food or milk if nausea Overdose: lavage if taken orally; monitor electrolytes, administer dextrose in saline, monitor hydration, CV, renal status.
Drug: tramadol (Ultram) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: analgesic Chemical class: Action: not completely understood, binds to opioid receptors, inhibits reuptake of norepinephrine, serotonin; Does not cause histamine release or affect heart rate
Side-Effects: CNS: seizures CV: SYST: anaphylaxis, Stevens-Johnson syndrome INTEG: rash GI: N / V / D / C, GI Bleeding GU: EENT: visual disturbances Contraindications: acute intoxication with any CNS depressant Side-Effects: CNS: dizziness, syncope CV: hypotension, bradycardia, MI, stroke HEMA: neutropenia, leucopenia, anemia RESP: cough GI: pancreatitis, dyspepsia GU: proteinuria, renal failure MISC: myalgia, angioedema Contraindications: breastfeeding, history of angioedema
Need for product: dependency Assess: constipation, CNS changes Do not break, crush, or chew ER med Give with antiemetic for N / V Avoid OTC meds & alcohol unless provider approved
BBW: pregnancy (D) Drug: trandolapril (Mavik) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: selectively suppresses renninangiotensin-aldosterone system; inhibits ACE; prevents conversion of Angiotensin I to Angiotensin II Functional class: antihypertensive Chemical class: angiotensin-converting enzyme inhibitor Assess: B/P, pulse, Q4hr, K, Na, Cl, renal & hepatic studies before tx Edema feet / legs, skin turgor Edema, dyspnea, wet crackles Photosensitivity Dont stop med abruptly
Drug: trastuzumab (herceptin) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antineoplastic Chemical class: humanized monoclonal antibody Action: DNA-derived monoclonal antibody selectively binds to extracellular portion of human epidermal growth factor receptor 2; it inhibits proliferation of cancer cells
Side-Effects: SYST: anaphylaxis, angioedema CNS: dizziness, numbness, paresthesias CV: tachycardia, CHF HEMA:anemia, leukopenia MS: bone pain GI: anorexia, diarrhea, hepatotoxicity MISC: flu-like symptoms, fever, HA, chills RESP: cough, dyspnea, pneumonia Contraindications: pregnancy (D), hypersensitivity to Chinese hamster ovary cell protein
BBW: cardiac disease, respiratory distress, inf-related reactions Assess: CBC, CHF, coughing, mental status, anaphylaxis, CNS reactions, anaphylaxis Teach to report signs of infection, use contraception while taking, avoid breastfeeding
Drug: trazodone (trazodone HCl) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antidepressant Chemical class: triazolopyridine Action: selectively inhibits serotonin, norepinephrine uptake by brain, potentiates behavioral changes
Side-Effects: CNS: dizziness, drowsiness, suicide in children/adolescents CV: orthostatic hypotension, ECG changes, HTN, tachycardia HEMA:thrombocytopenia, leukopenia INTEG: photosensitivity GI: diarrhea, dry mouth, paralytic ileus, hepatitis GU:urine retention, acute renal failure EENT: blurred vision, tinnitus Contraindications: suicidal ideation in children/ adolescents Side-Effects: CNS: dizziness, HA CV: hypotension HEMA: INTEG: rash GI: N / D GU: EENT: Contraindications: hypersensitivity to prostacyclin analogs
BBW: suicidal ideation in children / adolescents B/P, CBC, leukocytes, cardiac enzymes, AST, ALT, bilirubin Assess: ECG for flattening of T wave, BBB, AV block, dysrhythmias, mental status changes Give at bedtime for oversedation during daytime.
Drug: treprostinil (remodulin, tyvaso) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: antiplatelet agent Chemical class: tricyclic benzidine prostacyclin analog Action: direct vasodilation of pulmonary, systemic, arterial vascular beds, inhibition of platelet aggregation
AST, ALT, CBC, Hct, Hgb, PT, bleeding time 2-5 times normal limit Teach to assess for signs and symptoms of bleeding: blood in urine, stools
Drug: tretinoin, vit A acid, retinoic acid (Retin-A) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: vit A acid, acne product Chemical class: tretinoin derivative Action: (topical)-decreases cohesiveness of follicular epithelium, decreases microcomodone formation; (PO) induces maturation of acute promyelocytic leukemia, exact action is unknown
Side-Effects: CNS: HA, fever, sweating CV: HEMA: INTEG: rash GI: N / V / D / C, hemorrhage, hepatitis GU: EENT: Contraindications: hypersensitive to retinoids or parabens
BBW: pregnancy (D) PO, rapid evolving leukocytosis, respiratory compromise, acute promyelocytic leukemia differentiation syndrome Topical-lesions may worsen at beginning of tx. Hematologic parameters, cholesterol, triglycerides Do not use shaving lotions over topical areas
Drug: triamcinolone (amcort, azmacort) Dose:
Functional class: corticosteroid, synthetic Chemical class: glucocorticoid, intermediate-acting
Side-Effects: CNS: depression, flushing, sweating CV: HTN,circulatory collapse, thrombophlebitis, embolism HEMA: thrombocytopenia INTEG: GI: N / D, GI hemorrhage, pancreatitis, increased appetite EENT: Contraindications: children < 2 yr, psychosis, fungal infections, AIDS, TB Side-Effects: CNS: HA CV: HEMA: INTEG: GI: N / V / D GU: azotemia, interstitial nephritis, nephrotoxicity Contraindications: breastfeeding, anuria, severe renal / hepatic disease
Route (Give timing for IV push/IVPB meds): Action: decreases inflammation by suppression of migration of Frequency: polymorphonuclear leukocytes, fibroblasts, reversal of increased capillary Rationale for client: permeability and lysosomal stabilization
Assess: K, BG, hypokalemia, hyperglycemia Notify provider > 5lb. weight gain per week, decreased urine, increased edema, plasma cortisol (normal 138-635 nmol/ L if drawn at 8 am) Infection, mental status Rinse mouth after INH
BBW: hyperkalemia Drug: triamterene (Dyrenium) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: acts on distal tubule to inhibit reabsorption of Na, Cl; increase potassium retention Functional class: potassium-sparing diurectic Chemical class: pteridine derivative Assess: K, Na, Cl, BUN, BG, CBC, serum creatinine, blood pH, ABGs, LFTs metabolic acidosis (drowsiness, restless), skin turgor, Teach: photosensitivity Avoid foods high in potassium
Drug: triazolam (halcion) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: sedative-hypnotic, antianxiety Chemical class: benzodiazepine Action: produces CNS depression at limbic, thalamic, hypothalamic levels of CNS; may be mediated by neurotransmitter gama amino butyric acid (GABA); results are sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, anxiolytic action
Side-Effects: CNS: HA, lethargy, drowsiness CV: HEMA:leukopenia INTEG: GI: N / V / D / C, hepatic injury SYST: severe allergic reactions EENT: Contraindications: pregnancy (X), breastfeeding, hypersensitivity to benzodiazipines, intermittent porphyria
Assess: Hct, Hgb, RBC, AST, ALT, bilirubin, mental status, sleep problems Avoid other CNS depressents Must use contraception Avoid alcohol Overdose: lavage, activated charcoal; monitor electrolytes, VS
Drug: trihexyphenidyl (Apo-Trinex) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: cholinergic blocker Chemical class: synthetic tertiary amine Action: directly inhibits the parasympathetic nervous system; result is relaxation of smooth muscle by direct action on the muscle itself and indirectly via the parasympathetic nervous system
Side-Effects: CNS: dizziness CV: HEMA: INTEG: GI: dryness of mouth, constipation, paralytic ileus GU: EENT: Contraindications: closed angle glaucoma, GI / GU obstruction
Assess: parkinsons & EPS baseline, I&O, BP, pulse, constipation, mental status Give at bedtime Hardy candy, frequent drinks, sugarless gum give to reduce dry mouth
Assess: VS, BP Drug: trimethobenzamide (Tigan) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: acts centrally by blocking chemoreceptor trigger zone, which in turn acts on vomiting center Functional class: antiemetic Chemical class: ethanolamine derivative Side-Effects: CNS: drowsiness, coma, seizures, vertigo CV: cardiac dysrhytjmias HEMA: INTEG: GI: GU: EENT: Contraindications: children, hypersensitivity to opioids, shock Side-Effects: CNS: seizures, product fever, aseptic meningitis CV: allergic myocarditis HEMA:leucopenia, thrombocytopenia INTEG:stevens-johnson syndrome, erythema multiform GI: N / V, hepatitis, pseudomembranous colitis GU: renal failure, toxic nephrosis Contraindications: breastfeeding, infants <2mos., pregnancy at term, hyperkalemia, porphyria, hypersensitivity to trimethoprim or sulfonamides Capsules may be swallowed whole, chewed or allowed to dissolve Avoid alcohol and hazardous activities
Assess: I&Os, BUN, creatinine, UA Take on empty stomach with full glass of water Increase fluids to 2 L / day to decrease crystallization in kidneys Photosensitive Decrease oral contraceptive effectiveness
Drug: trimethoprim-sulfamethoxazole (bactrim) Dose:
Functional class: antiinfective Chemical class: sulfonamide
Route (Give timing for IV push/IVPB meds): Action: sulfamethoxazole (SMZ) interferes with bacterial biosynthesis of Frequency: proteins by competitive antagonism of PABA when adequate levels are Rationale for client: maintained
Drug: triptorelin (trelstar LA) Dose:
Functional class: gonadotropin-releasing hormone
Side-Effects: CNS: CV: HTN HEMA: INTEG: GI: N / V / D GU: impotence MISC: anaphylaxis, angioedema Contraindications: pregnancy (X), breastfeeding, hypersensitivity to LHRH agonists or LHRH Side-Effects: CNS: HA CV: tachycardia HEMA: INTEG: GI: constipation, dry mouth GU: urinary retention EENT: Contraindications: uncontrolled closedangle glaucoma, urinary retention, myasthenia gravis Side-Effects: CNS: headache, fever CV: hypotension, dysrhythmias HEMA: decreased Hct, bleeding INTEG: rash, urticaria GI: nausea, vomiting GU: N/A EENT: N/A Contraindications: COPD, hypersensitivity to this or other thrombolytic enzymes.
I&O Assess: testosterone (<25ng/dL) and PSA Postmenopausal symptoms may occur but will decrease after tx is D/C
Chemical class: synthetic decapeptide Route (Give timing for IV push/IVPB meds): analog of LHRH Frequency: Rationale for client: Action: inhibitor of pituitary gonadotropin secretion; initially increases LH and FSH, with increases in testosterone, reduction in sex steroid levels
Assess: urinary patterns Drug: trospium (Sanctura) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: relaxes smooth muscles in bladder by inhibiting acetylcholine effect on muscarinic receptors Functional class: Anticholinergic Chemical class: Muscarinic receptor antagonist Give one hour before meals on empty stomach Avoid hazardous activities Alcohol may increase drowsiness Assess urinary patterns
Drug: Urokinase (kinlytic) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Thrombolytic enzyme Chemical class: Beta-hemolytic streptococcus filtrate (purified) Action: promotes thrombolysis by directly converting plasminogen to plasmin.
Assess VS, peripheral pulses, lung sounds, and respiratory function. Assess for neurologic changes that may indicate intracranial bleeding. Monitor ECG continuously.
Drug: Ursodiol (Actigall, Urso) Dose:
Functional class: Gallstone solubilizing agent Chemical class: Ursodeoxycholic acid
Side-Effects: CNS: headache, anxiety, depression CV: N/A HEMA: N/A INTEG: pruritus, rash, urticaria, dry skin, sweating, alopecia GI: diarrhea, N/V, abdominal pain GU: N/A EENT: N/A Contraindications: calcified cholesterol stones, radiopaque stones, radiolucent bile pigment stones
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: suppresses hepatic synthesis, secretion of cholesterol; inhibits intestinal absorption of cholesterol.
Assess GI status: diarrhea, abdominal pain, N/V. Assess skin for pruritus, rash, urticaria, dry skin. Assess musculoskeletal status for aches or stiffness in joints.
Drug: Ustekinumab (stelara) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antipsoriatic agent Chemical class: N/A Action: Interleukin (IL)-12, IL-23 Antagonist
Side-Effects: CNS: headache, leukoencephalopathy CV: N/A HEMA: bleeding INTEG: pruritus, skin irritation, erythema GI: N/A GU: N/A EENT: N/A Contraindications: hypersensitivity, sepsis, active infections
Assess for injection site pain, swelling. Teach not to receive live vaccinations during treatment.
Drug: valacyclovir (Valtrex) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiviral Chemical class: Acyclic purine nucleoside analog Action: interferes with DNA synthesis by conversion to acyclovir, causing decreased viral replication, time of lesional healing
Side-Effects: CNS: dizziness, headcahe CV: N/A HEMA: thrombocytopenic purpura, hemolytic uremic syndrome INTEG: rash GI: nausea, increased AST GU: N/A EENT: N/A Contraindications: hypersensitivity to this or acyclovir, valganciclovir
Assess signs of infection; characteristics of lesions; therapy should be started at first sign or symptom of herpes and is most effective within 72 hrs of outbreak. Assess for thrombocytopenic purpura, hemolytic uremic syndrome; may be fatal.
Drug: valganciclovir (Valcyte) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiviral Chemical class: Synthetic nucleoside analog Action: Valganciclovir is metabolized to ganciclovir; inhibits replication of human cytomegalovirus in vivo and in vitro by selective inhibition of viral DNA synthesis.
Side-Effects: CNS: fever, coma, confusion, headache, insomnia, paresthesia weakness, seizures CV: N/A HEMA: granulocytopenia, thrombocytopenia, irreversible neutropenia, anemia, eosinophilia INTEG: rash, pruritus, SJS GI: N/V, anorexia, diarrhea, abdominal pain GU: hematuria EENT: retinal detachment in CMV retinitis Contraindications: absolute neutrophil count <500/mm; platelet count <25,000/mm; hemodialysis
Assess for infection: sore throat, cough, fever, chills, back pain. Culture for CMV retinitis. Teach to take with food.
Drug: valproate (Depacon); valproic acid (Depakene, Stavzor); divalproex sodium (Depakote, Depakote ER, Epival) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Anticonvulsant, vascular headache suppressant Chemical class: Carboxylic acid derivative Action: increases levels of y-aminobutyric acid in brain, which decreased seizure activity.
Side-Effects: CNS: sedation, drowsiness, coma, suicidal ideation CV: N/A HEMA: thrombocytopenia, leaukopenia, lymphocytosis INTEG: rash, dry skin GI: N/V, constipation, diarrhea, dyspepsia GU: enuresis EENT: visual disturbances, taste perversion Contraindications: hypersensitivity, urea cycle disorders
Assess mental status: bipolar disorder: mood activity, sleeping/eating, behavior; suicidal thoughts/behaviors. Assess hepatic studies: AST, ALT, bilirubin. Assess for pancreatitis; may be fatal.
Drug: valsartan (Diovan) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antihypertensive Chemical class: Angiotensin II receptor antagonist (Type AT1) Action: Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II to the AT1 receptor found in tissues.
Side-Effects: CNS: dizziness, insomnia CV: CVA, MI, dysrhythmias HEMA: anemia INTEG: N/A GI: diarrhea, hepatotoxicity GU: nephrotoxicity EENT: conjunctivitis Contraindications: hypersensitivity, severe hepatic disease, bilateral renal artery stenosis.
Assess BP, pulse q4hrs; blood studies; BUN, creatinine; electrolytes:K, Na, Cl, total CO2. Assess for angioedema: facial swelling; SOB; edema in feet, legs daily.
Drug: vancomycin (Vancocin, vancomycin HCl) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antiinfective-miscellaneous Chemical class: Tricyclic glycopeptide Action: inhibits bacterial cell wall synthesis, blocks glycopeptides
Side-Effects: CNS: cardiac arrest, vascular collapse CV: N/A HEMA: leucopenia, eosinophilia, neutropenia INTEG: chills, fever, rash GI: nausea, pseudomembranous colitis GU: increased BUN, creatinine, albumin EENT:ototoxicity, permanent deafness Contraindications: hypersensitivity, previous hearing loss
Assess for infection: WBC, urine, stools, sputum, characteristics of wound throughout treatment. Assess I&O, BP during administration, respiratory status, and allergies before treatment.
Drug: vardenafil (Levitra) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Impotence agent Chemical class: Phosphodiesterase type 5 inhibitor Action: inhibits phosphodiesterase type 5, enhances erectile function by increasing the amount of cGMP, which in turn causes smooth muscle relaxation and increased blood flow into the corpus cavernosum.
Side-Effects: CNS: headache, flushing, dizziness, insomnia CV: MI, CV collapse HEMA: N/A INTEG: N/A GI: N/A GU: abnormal ejaculation, priapism EENT: tinnitus, conjunctivitis Contraindications: hypersensitivity, congenital or acquired QT prolongation
Assess for any severe loss of vision and for use of organic nitrates that should not be used with this product.
Drug: varenicline (Chantix) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Smokin cessation agent Chemical class: N/A Action: Partial agonist for nicotine receptors; partially activates receptors to help curb cravings; occupies receptors to prevent nicotine binding.
Side-Effects: CNS: headache, suicide CV: MI, hypo/hypertension HEMA: N/A INTEG: angioedema, SJS GI: N/V, dry mouth, constipation GU: urinary frequency EENT: blurred vision Contraindications: hypersensitivity, eating disorders
Assess for smoking cessation after 12 wk; if progress has not been made, product may be used for an additional 12 wk. Assess for neuropsychiatric symptoms: mood, sensorium, affect; behavior changes, agitation, depression, suicidal ideation.
Drug: Vasopressin (Pressyn, Pitressin) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Pituitary Hormone Chemical class: Lysine vasopressin Action: Promotes reabsorption of water by action on renal tubular epithelium; causes vasoconstriction
Side-Effects: CNS: drowsiness, headache, lethargy, flushing CV: Increased B/P, dysrhythmias, cardiac arrest, shock, MI, chest pain HEMA: INTEG: GI: Nausea, heartburn, cramps, vomiting, flatus GU: vulval pain, uterine cramping EENT: nasal irritation, congestion, rhinitis Contraindications: Hypersensitivity, chronic nephritis
Assess pulse, B/P, I&O, daily weight, check for edema, Monitor for H2O intoxication(lethargy, behavioral changes, disorientation, neuromuscular excitability).
Drug: vecuronium Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Neuromuscular blocker Chemical class: monoquaternary analog of pancuronium Action: Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, antagonizing action of acetylcholine
Side-Effects: CNS: skeletal muscle weakness or paralysis (rare) CV: tachycardia HEMA: INTEG: Urticaria, flushing GI: GU: EENT: RESP: prolonged apnea, possible respiratory paralysis, bronchospasm, dyspnea Contraindications: Hypersensitivity
BBW: Respiratory disease Assess VS, Resp. status, muscle reflexes and signs of paralysis, I&O; interacts with theophylline: Dysrhythmias
BBW: suicidal ideation in children Drug: Venlafaxine (Effexor) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Potent inhibitor of neuronal serotonin and norepinephrine uptake, weak inhibitor of DOPamine Functional class: Antidepressant Chemical class: Side-Effects: CNS: emotional lability, vertigo, apathy, euphoria, hypotonia, suicidal ideation in children/adolescents, neuroleptic malignant syndrome-like reaction CV:migraine, angina pectoris, hypertension, syncope, sustained hypertension, change in QTc interval HEMA: agranulocytosis, aplastic anemia, neutropenia, pancytopenia, abnormal bleeding INTEG: GI: dysphagia, rectal hemorrhage GU: anorgasmia, dysuria, hematuria, metorrhagia, vaginitis, impaired urination, uterine hemorrhage, vaginal hemorrhage EENT: abnormal vision, ear pain Contraindications: Assess: mental status, B/P lying and standing, electrolytes, blood studies, hepatic studies Monitor for suicidal thoughts in children
Drug: verapamil (Apo-Verap) Dose:
Functional class: CCB, antihypertensive, antianginal/antidysrhythmic Chemical class: Diphenylalkylamine
Side-Effects: CNS: Headache, drowsiness CV: Edema, bradycardia, hypotension,CHF,Dysrhythmias HEMA: bruising, petechia, bleeding INTEG: rash, bruising GI: nausea, constipation GU:Impotence, nocturia, polyuria EENT: Contraindications: sick sinus syndrome, 2nd/3rd degree heart block, systolic b/p <90,severe CHF
Assess cardiac status: notify HCP if HR <50 bpm and systolic B/P <90. I&O and hepatic studies during long term treatment.
Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client: Action: Inhibits calcium ion influx across cell membrane during cardiac depolarization;produces relaxation of coronary vascular smooth muscle, dilates coronary arteries
Drug: vinBLAStine (VLB) (Velbe) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic Chemical class: Vinca rosea alkaloid Action: Inhibits mitotic activity, arrests cell cycle at metaphase, inhibits RNS synthesis, blocks cellular use of glutamic acid needed for purine synthesis
Side-Effects: CNS: parasthesia, seizures CV: Tachycardia, orthostatic hypo/hypertension HEMA: thrombocytopenia,leukopenia INTEG: rash, alopecia GI: Nausea, vomiting, anorexia, stomatititus, constipation, GI/rectal bleeding, hepatotoxicity GU:urinary retention, renal failure EENT: Contraindications: pregnancy, breastfeeding, infants, hypersensitivity, leucopenia, granulocytopenia, bone marrow suppression, infection
Assess CBC: withhold product of WBC <2000 or platelet count <75,000 and notify HCP; pulmonary function tests, neurologic studies, renal studies, monitor temp, hepatic studies, monitor for bleeding, respiratory status, effects of alopecia, jaundiced skin, and sensitivity of the hands and feet, frequency of stools, and gout and joint pain.
Drug: vinCRIStine (VCR) (Oncovin) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic Chemical class: Vinca alkaloid Action: Inhibits mitotic activity, arrests cell cycle at metaphase, inhibits RNS synthesis, blocks cellular use of glutamic acid needed for purine synthesis
Side-Effects: CNS: decreased reflexes, numbness, weakness, motor difficulties, seizures CV: orthostatic hypotension HEMA: thrombocytopenia, leucopenia, myelosuppression, anemia INTEG: alopecia, extravasation GI:nausea, vomiting, anorexia, stomatitis, constipation, abdominal pain, paralytic ileus, hepatotoxicity GU: EENT: Contraindications: Pregnancy, breastfeeding, infants, hypersensitivity, radiation therapy
Assess : CBC, renal studies, monitor temp q4hrs, hepatic studies before use, deep tendon reflexes , effects of alopecia, bleeding, jaundices skin, sensitivity of hands and feet, frequency of stools. BBW: Intrathecal use and Extravasation
Drug: Vinorelbine (Navelbine) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Antineoplastic Chemical class:semisynthetic vinca alkaloid Action: Inhibits mitotic spindle activity, arrests cell cycle at metaphase, inhibits RNS synthesis, blocks cellular use of glutamic acid needed for purine synthesis
Side-Effects: CNS: parasthesias, headache, weakness, seizures CV: chest pain HEMA: Neutropenia, anemia INTEG: rash, alopecia GI: nausea, vominting, anorexia, stomatitis, diarrhea, hepatotoxicity, GI obstruction/perforation GU: EENT: Contraindications: pregnancy, breastfeeding, infants, hypersensitivity, granulocyte count <1000 cells pretreatment
Assess B/P baseline and q15min during administration, C withhold product of WBC <4,000 or platelet count <75,000 and notify HCP, respriratory status for crackles/dyspnea/chest pain/nonproductive cough, reanl studies, for bleeding, nutritional status, neurological status, and for gout.
Drug: Vitamin A Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class fat soluble vitamin: Chemical class: Retinol Action: needed for normal bone, tooth development, visual dark adaptation, skin disease, mucosa tissue repair, assists in production of adrenal steroids, cholesterol, RNA
Side-Effects: CNS: headache, increased intracranial pressure, intracranial hypertension CV: HEMA: INTEG: GI:nausea, vominting, anorexia, abdominal pain, jaundice GU: EENT: gingivitis, inflammation of the tongue and lips Contraindications: Pregnancy, hypersensitivity, malabsorption syndrome, hypervitaminosis A, parenteral,, IV administration
Assess nutritional status, Vitamin A deficiency(decreased growth, dry/brittle nails, hair loss, night blindness, increased infection, hyperkeratosis of the skin, drying of the cornea)
Drug:Vitamin E Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: Chemical class: fat soluble Action: needed for digestion and metabolism of polyunsaturated fats, decreases platelet aggregation, decreases blood clot formation, promotes normal growth and development of muscle tissue, prostaglandin synthesis
Side-Effects: CNS: headache, fatigue CV: increased risk of thrombophlebitis HEMA: INTEG: sterile abscess, contact dermatitis GI: nausea, cramps, diarrhea GU: gonadal dysfunction EENT: blurred vision Contraindications:IV use in infants
Assess: nutritional status, administer with or after meals, teach necessary foods in diet
Drug: voriconazole (Vfend) Dose: Route (Give timing for IV push/IVPB meds): Frequency: Rationale for client:
Functional class: systemic antifungal Chemical class: Triazole derivative Action: Inhibits fungal CYP 450mediation demethylation, needed for biosynthesis
Side-Effects: CNS: headache CV:tachycardia, atrial arrhythmias, afib, AV block, bradycardia, CHF, MI, QT prolongation, torsade de pointes, hypo/hypertension HEMA: anemia, eosinophilia, thrombocytopenia, leucopenia, pancytopenia: INTEG: burning, irritation GI: nausea, vomiting, anorexia, hemorrhagic gastroenteritis, acute hepatic failure, hepatitis, intestinal perforaton, pancreatitis GU: hypokalemia, renal tubular necrosis, permanent renal impairment, anuria, oliguria EENT: blurred vision, eye hemorrhage Contraindications: Pregnancy, breastfeeding, children, hypersensitivity, sever bone marrow depression, severe hepatic disease Side-Effects: CNS: Fever, Dizzy, Fatigue, HA CV: Angina, Hypotension, Edema Hema: Hemorrhage, Leukopenia, Anemia, Ecchymosis, Petechiae Integ: Rash, Dermatitis, Urticaria GI: N-V-D, Hepatitis, Stomatitis GU: Hematuria Misc: Epistaxis, Hemoptysis, Syst: Anaphylaxis, Exfoliative Dermatitis, Purple Toe Syndrome Contraindications: Pregnancy (X), Breastfeeding, Bleeding Disorders, PUD, Severe Hepatic Disease, Aneurysms, Traumatic Surgery with Large Open Surface, Malignant Hypertension, Acute Nephritis, Thrombocytopenia Purpua
Assess: vital signs q15-30min during initial administration, note changes in pulse and B/P; I&O ratio; Blood studies; weigh weekly, for renal toxicity(BUN<40 or serum creat. <3) and hepatotoxicity( increasing AST,ALT, alk phos, bilirubin)
Drug: (trade & generic name) Functional class: Anticoagulant Warfarin ( Coumadin) Chemical class: Dose: Route (Give timing for IV push/IVPB meds): Action: Interferes with blood clotting by indirect means of depressing hepatic Frequency: synth. of vit K Rationale for client: ( factors II, VII, IX, X ) Prophylaxis of DVT, MI, Stroke, Thrombosis; post MI BBW: Bleeding Precau: Geriatrics, alcoholism, CHF, debilitated pts, trauma, indwelling caths, severe hypertension, active infections, protein C deficiency, polycythemia vera, vasculitis, severe diabetes
Assess: *Blood Studies ( Hct, Platelets, Occult Stool ) *INR ( In hosp. daily after 2nd or 3rd dose; Outpatient monitor every few days until stable dose ) * For bleeding Gums, Petechiae, Black Tarry Stools, Hematuria, Fever, Skin rash Admin: *Same time each day *Avoid all IMs that would cause bleeding Eval: *For decrease of DVT Teach: *Avoid OTC meds that would cause serious interactions.
Drug: zarfirlukast ( Accolate ) Functional class: Bronchodilator Dose: Chemical class: Leukotriene Receptor Route (Give timing for IV push/IVPB meds): Antagonist Frequency: Rationale for client: Prophylaxis and chronic treatment of asthma in adults/kids <5yo *Unlabeled use for chronic urticaria Action: Antagonizes contractile action of leukotrienes in airway smooth muscle, Inhibits bronchoconstriction from antigens
Side-Effects: CNS:HA, Dizzy, Suicidal Ideation, Insomnia, Fever CV: Hema: Agranulocytosis, Integ: Urticaria, Rash GI: N-V-D, ABD Pain, Hepatitis, Hepatic Failure, Dyspepsia Other : Infections, Asthenia, Myalgia, Increased ALT, Angioedema Contraindications: Hypersensitivity Precau: Preg (B), Breastfeeding, Children, Geriatrics, Hepatic Disease
Assess: *Resp. Rate, Rhythm, Depth; Auscultate breath sounds bilaterally and notify MD of abnormalities Admin: *1hr before or 2hr after meals to prevent decreased absorption; with H2O if GI upset occurs Teach: *Notify MD of N-V-D, ABD pain, jaundice ( Hepatic Dysfunction ); Dont use if breastfeeding; Take even if symptom free
Drug: zaleplon ( Sonata ) Functional class:Sedative, Non-Barbituate Dose: Chemical class: Pyrazolopyrimidine Route (Give timing for IV push/IVPB meds): Action: Binds selectively to omega 1 Frequency: receptors of GABAa complex resulting in Rationale for client: sedation, hypnosis, skeletal muscle relax, Insomnia anticonvulsant activity
Drug: (trade & generic name) Functional class:Antiviral Zanamivir ( Relenza ) Chemical class: Neuramidase Inhibitor Dose: Route (Give timing for IV push/IVPB meds): Action: Inhibits neuramidase enzyme needed for influenza virus replication Frequency: Rationale for client: Treatment for FLU A/B in pt who have been *Unlabled use for swine flu symptomatic for no more than 2 days (H1N1)
Side-Effects: CNS: Lethargy, Drowsy, Daytime Sedation, Dizzy, Confusion, Amnesia, Hallucinations, Hyper/Paresthesia, Vertigo, Sleep Driving Misc: Asthenia, Fever, HA, Myalgia, Dysmenorrhea Integ: GI: N, ABD pain, Constipation, Anorexia, Colitis, Dry Mouth Syst: Severe allergic rxn EENT: Vision Change, Ear/Eye Pain, Hyperacusis, Parosmia Contraindications: Severe Hepatic Disease Precau: Preg ( C ), Breastfeeding, < 15yo kids, Resp/Renal/Hepatic Dys Side-Effects: CNS:HA, Dizzy, Seizures, Fatigue, Self Injury, Delirium (child) Resp: Nasal Symptoms, Cough, Sinusitis, Bronchitis, Bronchospasm Syst: Angioedema Integ: GI: N-V-D, GU: EENT: ErNT Infections Precau: Preg-c, Breastfeeding, < 7 peds pts, geriatrics, Resp. disease, Angioedema, Milk protein Hypersensitivity, Reye;s
Assess: *Mental Status ( mood, affect, memory, excessive sedation, impaired coordination ) *Type of sleep problem ( falling/staying asleep ) Admin: *Immediately before bed *Avoid use with other CNS depressants Teach: *Avoid driving, alcohol *Short Term only
Assess: *Bowel Pattern *Resp Status ( rate, character, Wheezes, Tight Chest ) *Skin eruptions, photosensitivity after admin Admin: *Within 2 days of symptoms, Continue for 5dys Teach: *Transmission risk is not reduced *Pt with asthma or COPD to carry fast acting inhaler since bronchospasm may occur
Drug: zinc ( Orazinc, zinc sulfate) Functional class: Trace Element, Dose: supplement Route (Give timing for IV push/IVPB meds): Chemical class: Frequency: Rationale for client: Prevent Zinc deficiency *Unlabeled= wound healing Action: Needed for adequate healing/bone and joint development **Decrease absorption of fluoroquinolones/tetracyclines
Drug: ziprasidone ( Geodon ) Functional class: Dose: Antipsychotic/Neuroleptic Route (Give timing for IV push/IVPB meds): Chemical class: Benzisoxazole Derivative Frequency: Rationale for client: Action: Unknown, May be mediated through both dopamine type 2 and serotonin type 2 antagonism BBW: Dementia *Unlabeled use= Tourettes Syndrome
Drug: (trade & generic name) Functional class: Bone-Reabsorption zoledronic acid ( Reclast ) Inhibitor Dose: Chemical class: Bisphosphonate Route (Give timing for IV push/IVPB meds): Action: Inhibits osteoclastic activity and Frequency: skeletal calcium release, decreases Rationale for client: Moderate to severe abnormal bone reabsorbtion, may directly hypercalcemia associated with malignancy; block dissolution of hydroxyapatite bone multiple myeloma; bone metastases crystals
Side-Effects: CNS: CV: Hema: Integ: GI:N-V, Cramps, Heartburn, Ulcers GU: EENT: Prec: Preg C parenteral, breastfeeding, neonates, renal disease Side-Effects: CNS:EPS, Pseodoparkinsonism, akathisia, dystonia, tardive dyskinesia, drowsy, insomnia, seizures, neuroleptic malignant syndrome CV: Ortho-Hypo, tachycardia, prolonged Q-T, sudden death, heart failure, torsade de pointes Resp: Dyspnea, infection, cough Integ: GI: N-V-D, constipation, jaundice, ABD pain GU: Enuresis, urinary incontinence, gynecomastia, impotence EENT: Blurred vision, Diploplia Contraindications: Breastfeeding, Acute MI, Heart Failure, QT prolongation Side-Effects: CNS:Dizzy, HA, anxiety, confusion, insomnia, agitation CV: hypotension, leg edema, atrial fib, chest pain Hema: anemia Meta: hypokalemia, hypophosphatemia, hypocalcemia, increased serum creatinine GI: ABD pain, anorexia, constipation, NV-D, taste change GU: UTI, possible decreased renal function, renal damage MS: Severe bone pain, arthralgias, myalgias, osteonecrosis of jaw Contraindications: Preg D, Breastfeeding, hypocalcemia
Assess: *Zinc levels during treatment Admin: *With Meals; avoid dairy Teach: *Must be taken for 2-3 months to be effective *Immediately report N-V, Rash, Tarry stools, Severe vomiting Assess: *Mental status before initial admin *Geriatric closely for heart failure and sudden death *I&O *Urinalysis before and during treatment *V/S Q 4 hrs during initial treatment ( report drops of 30mmHg and ECG changes ) *EPS s/s ( bizarre mvmts of tongue, mouth, extremities ) Teach: *To rise/stand slowly *Must Titrate med *Avoid OTC cough/cold meds *Report impaired vision, tremors, muscle twitching Assess: *Renal tests, Ca, Po4, Mg, K, BUN, creatinine ( if low hold dose ) *Hypocalcemia (paresthesia, Chvosteks, Trousseaus ) *For atrial fib Teach: *To report N-V, bone pain, thirst ( hypercalcemia) * To continue with dietary recommendations
Drug: zolmitriptan ( Zomig ) Functional class: Migrane Agent, abortive Dose: Chemical class: 5ht1b/5ht1d receptor Route (Give timing for IV push/IVPB meds): antagonist Frequency: Rationale for client: Acute treatment of migrane with or without aura Action: Binds selectively to vascular 5ht receptor subtypes, causes antimigrane effect/vasoconstriction in cranial arteries
Drug: zolpidem ( Ambien ) Functional class: Sedative/Hypnotic Dose: Chemical class: Nonbenzodiazepine from Route (Give timing for IV push/IVPB meds): imidazopyridine class Frequency: Rationale for client: Insomnia Action: Produces CNS depression at limbic, thalamic, hypothalamic levels, may be mediated GABA
Drug: (trade & generic name) Functional class: Anticonvulsant Zonisamide ( Zonegran ) Chemical class: Sulfonamide Dose: Route (Give timing for IV push/IVPB meds): Action: May act through action at sodium and calcium channels, exact mech is Frequency: unkown, seratonergic action Rationale for client: *Unlabeled use for Bipolar disorder
Side-Effects: CNS: Tingling, hot sensation, burning, pressure, tightness, numbness, sedation CV: Palpitations, chest pain MS: weakness, neck stiffness, myalgia Resp: chest tightness, pressure GI: ABD discomfort, N, dry mouth, dyspepsia, dysphagia Contraindications: Angina Pectoris, hx of MI, documented silent ischemia, ischemic heart disease, risk of cv events, uncontrolled hypertension, basal /hemiplegic migrane Side-Effects: CNS:HA, lethargy drowsy, daytime sedation, complex sleep related reactions(sleep driving), suicidal ideas, mentation changes CV: chest pain, palpitations Hema: leukopenia, granulocytopenia Integ: GI: N-V-D, ABD pain, heartburn, constipation Misc: Myalgia Syst: severe allergic reactions Contraindications: Hypersensitivity to Benzodiazepines Side-Effects: CNS: Dizzy, insomnia, paresthesia, depression, fatigue, confusion, suicidal ideas CV: Hema: Aplastic anemia, granulocytopenia Integ: Rash, SJS GI: N-D, constipation, anorexia, dyspepsia Syst: Metabolic acidosis EENT: diploplia, verbal difficulty, speech abnormalities Contraindications: Hypersensitivity to sulfonamides, psychiatric condition, hepatic failure
Assess: *For tingling, burning, numb feeling *LOC, blurring vision, N-V, tingling in extremities before HA *Assess for ingestion of pickled foods, beer, wine, aged cheese, foods with preservatives which may precipitate migranes Teach: *To use contraception
Assess: *Mental status; mood memory, impaired coordination *Blood dyscrasis; fever, sore throat, rash, jaundice, epistaxis *Type of sleep Problem Admin: *Dont break or chew, take .5 hours before bed Teach: *Dependence is possible *Sleep driving/eating may occur *Avoid alcohol Assess: *For seizures ( duration, type, intensity, precipitating fx) *Renal function (Bun,creat, serum HCO3) *Mental status Teach: *Not to discontinue abruptly *Carry emergency ID stating product issue *Repot rash, back pain, ABD pain, blood in urine immediately *Tell MD if Preg is planned *No grapefruit juice
Drug: zidovudine ( AZT ) Functional class: Antiretroviral Dose: Chemical class: Nucleoside reverse Route (Give timing for IV push/IVPB meds): transcriptase inhibitor Frequency: Rationale for client: Used in combination with other antiretrovirals for HIV-1 infection *Unlabeled use for Epstein Barr, Hep B, Tcell leukemia/lymphoma, thrombocytopenia Action: Inhibits replication of HIV-1 virus by incorporating into cellular DNA by viral transcriptase, terminating the cellular DNA chain BBW: Impaired hepatic function, anemia, lactic acidosis, myopathy, neutropenia *Consult MD before using aspirin, Tylenol, indomethacin
Side-Effects: CNS:Fever, HA, Insomnia, Paresthesia, Seizures, confusion, tremors, depression MS: Myalgia, arthralgia, muscle spasm Hema: Granulocytopenia, anemia Integ: Rash, acne, puritis, urticaria GI:N-V-D, anorexia, dyspepsia, constipation, dysphagia, rectal bleeding, heptomegaly GU: Dysuria, polyuria, urinary frequency, hesitancy EENT: Taste changes, hearing loss, photophobia Misc: Lactic acidosis, Dyspnea Precau: Preg ( C ), Breastfeeding, Granu < 1000/mm3 or Hgb < 9.5
Assess: *Blood studies Q2weeks (watch for decreased grans, hgb if low therapy may be discontinued ) *Serum creatnine/BUN throughout Eval: for blood dyscrasias( anemia, granulocytosis, brusing, poor healing ) Teach: GI issues resolve after 3-4 weeks; NOT CURE; Call MD if throat is sore/fever (infection); Must have follow up visits Q 2weeks

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Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 105 Student ____________________________________ Clients Initials ______________

Clinical Week _____________ Class ________________

Functional class: Antirheumatic agent(disease modifying) biologic response modifer

Functional class: Platelet aggregation inhibitor Chemical class:

Functional class: Oral antidiabetic

Acebutolol / Monitan / Sectral

Functional class: Antihypertensive, antidysrhythmic

Drug: Acetaminophen / Tylenol Dose:

Functional class: Nonopioid analgesic, antipyretic

Drug: Acetazolamide / Dazamide Dose:

Functional class: Diuretic, carbonic anhydrase inhibitor, antiglaucoma agent, antiepileptic

Functional class: Antirheumatic agent,(disease modifying), immunonodulator

Functional class: Antiviral

Adenosine / Adenocard / Adenoscan Functional class: Antidysrhmic

Albumin, normal serum, 5% / 25%

Functional class: Blood derivative

Functional class: Adrenergic B 2-agonist, sympathomimetic, bronchodilator

Functional class: Antineoplastic-misc

Side-Effects: CNS: CV: Hema: Integ: GI: GU: EENT: Contraindications:

Functional class: Antineoplastic-miscellaneous

Functional class: Bone-resorption inhibitor

Functional class: Urinary tract antispasmodic, a-1-agonist

Functional class: Antihypertensive

Functional class: Retinoid, 2nd generation, topical antineoplastic

Functional class: Antigout drug, antihyperuricemic

Functional class: Antimigraine agent abortive

Functional class: Antianxiety

Alteplase / Activase t-PA

Functional class: Throbolytic enzyme

Functional class: Antacid, ypophosphatemic

Functional class: Antiviral, antiparkinsonian agent

Functional class: antihypertensive

Functional class: antibiotic

Functional class: Potassium-sparing diuretic

Functional class: Caloric Agent

Amiodarone (Cordarone, Pacerone)

Functional class: Antidysrhythmic

Functional class: Antianginal, Antihypertensive, Calcium Channel Blocker

Functional class: Antidepressant

Functional class: Antifungal

Ampicillin (Omniphen, Principen)

Functional class: Antiinfective-broad spectrum

Functional class: Antiplatelet

Functional class: Antirheumatic, immunomodulator

Functional class: Antineoplastic

Functional class: Antifungual,systemic

Functional class: Hemostatic Chemical class: Factor VIII

Teach - Alert if bleeding ankles, knees, elbows, and other joints.

Functional class: Anticoagulant

Functional class: Antipsychotic

Drug: Ascorbic Acid (vitamin C) Dose:

Functional class: Water-soluble vitamin

Drug: Asneapine (saphris) Dose:

Functional class: antipsychotic

Functional class: nonopioid, analgesic, nonsteroidal antiinflammatory, antipyretic, antiplatelet

Functional class: antihypertensive, antianginal

Functional class: psychotherapeutic

Functional class: antilypidemic

Functional class: antiprotozoal

Atropine (Atreza, Sal-tropine)

Functional class: antidysrhythmic

Functional class: antineoplastic-nucleoside analogue

Azathioprine (Azasan, Imuran)

Faulkner State Community College/Division of Nursing Clinical Medication Sheet Nursing 105 Student ______________________ Clients Initials

Clinical Week _ Class ____