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PAIN MED. MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction Mild Pain
Tylenol (Acetaminophen) NSAIDS:
Motrin (Ibuprofen)
Toridol (Ketorolac)
Adults: Oral 325-650
mg every 4-6 hours. (maximum daily dose is 4 grams)Suppository 650mg every 4-6 hours.
Children: Oral 40-650 mg every 4 hoursSuppository 80-325 mg every 4-6 hours depending on age.
Children (general): 10
to 15 mg per kg of body weight, every 4 to 6 hours, to a maximum of 65 mg/kg in 24 hours.
Adults: 325 mg to 650 mg every 4 to 6 hours to a maximum of 4,000 mg in 24 hours.
10-40 mg every 4-6
hours
Relief of signs and symptoms of rheumatoid arthritis and osteoarthritis
Relief of mild to moderate pain
Treatment of primary dysmenorrhea
Fever reduction Unlabeled uses:
Prophylactic for migraine; abortive treatment for migraine
Headache Chest pain, Hepatic toxicity and
failure, jaundice Acute kidney failure,
renal tubular necrosis Rash fever
Assess pain Assessmusculoskeletal
status: ROMbefore dose and 1 hr. after
Monitor liver function studies
Monitor renal function studies
Monitor bloodstudies: CBC,Hgb, Hct,proteome if patient is on long-term therapy
Check I&O ratio Assesshepatotoxicity- Assess
forallergicreactions, visualchanges andototoxicity
Identify prior drug history
Identify fever:length of time inevidence andrelatedsymptoms
Administer in the morning with a full glass of water at least 60 min before the first beverage, food, and medication of the day.
Patient must stay up right for 60min after taking the tablet to avoid potentially serious esophageal erosion
Do not exceed recommended dose; do not take for longer than 10 days.
Take the drug only for complaints indicated; it is not an anti-inflammatory agent.
Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclooxygenase, which results in decreased formation prostaglandin precursors.
Therefore drugs that increase the action of liver enzymes that metabolize acetaminophen [for example, carbamazepine (Tegretol), isoniazid (INH, Nydrazid, and Laniazid), rifampin (Rifamate, Rifadin, and Rimactane)] reduce the levels of acetaminophen and may decrease the action of acetaminophen. Doses of acetaminophen greater than the recommended doses are toxic to the liver and may result in severe liver damage. The potential for acetaminophen to harm the liver is increased when it is combined with alcohol or drugs that also harm the liver.
Moderate Pain OPIOID ANALGESICS
Norco (Hydrocodone)
Vicodine (Hydrocodone)
Oxycontin (Oxycodone HCl)
Percocet (Oxycodone)
7.5-10mg (oral) every
4-6 hours Intramuscular Dose
Regular 30-120mg Low 15-60mg
Intravenous Dose Regular 30mg Low 15mg
Oral Dose Maximum 40mg Regular 10-20mg Low 10mg
10-80mg (oral)
2.5-10mg (oral)
4-6 pain Analgesia for moderate
to severe acute pain Alternative to Narcotic
Analgesic
Lightheadedness Dizziness Drowsiness Nausea Vomiting Constipation
BP ____ HR ____ Postural Hypotension N/V Pain ___ /10 (PQRST)
Dizzy >no standing N/V > call nurse Inform patient that
hydrocodone and acetaminophen may cause dizziness and drowsiness.
Advise patient to avoid hazardous activities until drugs CN effects are known.
Advise patient to change position slowly to minimize effects of orthostatic hypotension
Management of moderate to severe pain.
Binds to opiate receptors in the CNS
Alters the perception of ad response to painful stimuli, while producing generalized CNS depression
Anticholinergic: Increased risk of ileus, sever constipation and urine retention.
Antidiarrheal: Increased risk of CNS depression and severe constipation.
Barbiturate anesthetics: Possibly increased respiratory and CNS depression.
Severe Pain OPIOID ANALGESICS
Dilaudid (Hydromorphone)
1mg IV Q 4-6 hours prn Peak 15-30min Onset 10-15min Duration 2-3 hour
7-10 pain PCA pump Symptomatic relief of
sever, acute and chronic pain after non-narcotic analgesics have failed and preanasthetic
Constipation Dizziness Hypotension Blurred vision Nausea and vomiting Urine Retention
BP ____ HR ____ Postural Hypotension N/V Pain ___ /10 (PQRST) Morphine Allergy to Sulfa Drugs
Avoid alcohol and other CNS depressants while receiving morphine.
Do not use OTC drug unless approved by physician
Do not smoke or
Binds to opiate receptors in the CNS
Alters the perception of and response to painful stimuli while producing generalized CNS depression
High risk of CNS depression with alcohol, antidepressant, antihistamines, and sedative/hypnotics including benzodiazepines and
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(Morphine)
(Fentanyl)
(Demerol)
Adult: (PO) 10-30mg q4h (IV) 2.5-15mg q4h (IM/SC) 5-20mg (PR) 10-20mg
0.5-1mcg/kg/dose, may
repeat after 30-60min.
100 mg/ 2mL
medication Used to relieve dyspnea
of acute left ventricular failure and pulmonary edema and pain of MI.
ambulate without assistance after receiving drug. Bedside rails are advised
Use caution or avoid tasks requiring alertness (e.g. Driving a car) until response to drug is known since drug may cause drowsiness, dizziness, or blurred vision
Do not breast feed while taking this drug
Suppresses the cough reflex via a direct central action.
Pain Control
phenothiazines.
Anti-Anxiety >Benzodiazepines<
Ativan (Lorazopam) > Barbiturates<
Phenobarbitol
adult: PO 2–6 mg/d in
divided doses (max: 10 mg/d)
geriatric: PO 0.5–1 mg/d (max: 2 mg/d)
child: PO/IV 0.05 mg/kg q4–8h (max: 2 mg/dose)
15-120 mg/day PO
divided BID/TID
Management of anxiety disorders and for short-term relief of symptoms of anxiety. Also used for preanesthetic medication to produce sedation and to reduce anxiety and recall of events related to day of surgery; for management of status epilepticus.
Sedative (oral or
parenteral) Hypnotic, short-term (up
to 2 wk.) treatment of insomnia (oral or parenteral)
Long-term treatment of generalized tonic-conic and cortical focal seizures (oral)
Drowsiness Headache Hyper/hypotension Nausea and vomiting Vertigo CNS Depression Nausea and vomiting Constipation / diarrhea
Be aware that SL administration has more rapid absorption than PO, and bioavailability compares to IM use.
Do not administer intra-arterially; arteriospasm, gangrene may result.
Give IM injections of undiluted drug deep into muscle mass, monitor injection sites.
Do not use solutions that are discolored or contain a precipitate. Protect drug from light, and refrigerate oral solution.
Keep equipment to maintain a patent airway on standby when drug is given IV.
Monitor patient
responses, blood levels (as appropriate) if any of the above interacting drugs are given with phenobarbital; suggest alternative means of contraception to women using hormonal contraceptives.
Do not administer intra-arterially; may produce arteriospasm, thrombosis, gangrene.
Administer IV doses
Do not drive or engage in other hazardous activities for a least 24–48 h after receiving IM injection of lorazepam.
Do not drink large-volumes of coffee. Anxiolytic effects of lorazepam can significantly be altered by caffeine.
Do not consume alcoholic beverages for at least 24–48 h after an injection and avoid when taking an oral regimen.
Notify physician if daytime psychomotor function is impaired; a change in regimen or drug may be needed.
Terminate regimen gradually over a period of several days. Do not stop long-term therapy abruptly; withdrawal may be induced with feelings of panic, tonic–clonic seizures, tremors, abdominal and muscle cramps, sweating, vomiting.
This drug will make you drowsy and less anxious; do not try to get up after youhave received this drug (request assistance to sit up or move around).
Take this drug exactly as prescribed; this drug is habit forming; its effectiveness infacilitating sleep disappears after a short time.
Do not take this drug
Most potent of the available benzodiazepines. Effects (anxiolytic, sedative, hypnotic, and skeletal muscle relaxant) are mediated by the inhibitory neurotransmitter GABA. Action sites: thalamic, hypothalamic, and limbic levels of CNS.
General CNS depressant;
barbiturates inhibit impulse conduction in the ascending RAS, depress the cerebral cortex, alter cerebellar function, depress motor output, and can produce excitation, sedation, hypnosis, anesthesia, and deep coma; at sub hypnotic doses, has anticonvulsant activity, making it suitable for long-term use as an
Increased CNS depression with alcohol and other sedating medications, such as barbiturates and opioids
Decreased effectiveness with theophylline’s
Increased serum levels
and therapeutic and toxic effects with valproic acid
Increased CNS depression with alcohol
Increased risk of nephrotoxicity with methoxyflurane
Increased risk of neuromuscular excitation and hypotension with barbiturate anesthetics
PAIN MED.
MED Name/Class Safedose/Rout Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
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slowly. Administer IM doses
deep in a large muscle mass (gluteus maximus, vastus laterals) or other areas where there is little risk of encountering a nerve trunk or major artery.
longer than 2 wk. (for insomnia), and do not increase thedosage without consulting the prescriber.
antiepileptic.
GI : SBO, GERD, Ulcers, Gastritis MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt Teaching Action Drug 2 Drug Interaction PPI (proton pump inhibitor) “Prazole”
Protonix (pantoprazole)
Prilosec (omeprazole)
Adult 20-80mg 20mg PO Q12
Stress Ulcers GERD Gastritis Absence of epigastric pain Fullness Pain
Headache Diarrhea Abdominal pain Nausea Vomiting Insomnia Hyperglycemia
Assess for epigastric or abdominal pain and occult blood in stool emesis or gastric aspirate
Known hypersensitivity, hypocalcaemia or if taking any meds that interact with this drug.
Report severe diarrhea If patientsdiabetic may
cause hyperglycemia Avoid hazardous
activities as dizziness may occur
Avoid salicylates, ibuprofen
ETOH- may cause GI irritation
Blocks final step of acid production
Inhibits H+/K+ ATPas in gastric parietal cell suppressing gastric secretion.
Binds to an enzyme on gastric parietal cells in the presence of acidic gastric PH.
Preventing the final transportation of hydrogen ions into the gastric lumen.
Contraindicated in hypersensitivity, metabolic alkalosis and hypocalcaemia.
↑ Pantoprazole serum levels w/ meds: diazepam, flurezepam, triazolam, clarithromycin, phenytoin
↓ Absorption w/meds: calcium carbonate, vit B12, sucralfate.
↑ Blding w/ warfarin
H2 Blockers“tidine” Treatment and prevention of heartburn, acid indigestion, and sour stomach.
Dizziness Arrhythmias Drowsiness Headache Nausea
Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.
Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid.
Inform patient that it may cause drowsiness or dizziness.
Inform patient that increased fluid and fiber intake may minimize constipation.
Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health care professional promptly.
Blocks HCl production Turns down Volume of
Stomach Acid production
Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance.
Anti-Acids (Tums)
2-4 teaspoons (10-20 mL)
4 times a day taken 20min to 1 hr. after meals and at bedtime or as directed by the physician.
Relieve heartburn Major symptom of gastro
esophageal reflux disease or acids indigestion.
Treatment of ulcers
Upset stomach Vomiting Stomach pain Belching constipation
Observe ’10 rights’ in
drug administration to avoid medication errors.
Monitor and record pain scales to serve as
Instruct patient to avoid
caffeine, alcohol, harsh spices, and black pepper because it may aggravate the underlying
Neutralizes Stomach Acids 20-30min.
Aluminum hydroxide may form
complexes withcertain drugs e.g., tetracycline’s,digoxin andvitamins, resulting in decreased absorption. Thisshould
PAIN MED. MED Name/Class Safedose/Rout Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
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(Suspension) resulting from excessive acidity.
baseline data and to determinethe effectiveness of the drug.
Give drug 20 min- 1 hour after meal to counteract the hydrochloric acid production by neutralizing the acidity.
Administer with at least 8 ounces of water to enhance absorption
Monitor stool consistency to prevent diarrhea and constipation. `
GIcondition. Instruct patient to
increase fiber and fluid intake and regular physical activity to help ease constipation.
Instruct patient to eat banana if diarrhea occurred.
be borne in mind when concomitantadministration is considered.
Stool Softeners Colace (docusate
sodium)
Bisacodyl (Dulcolax)
100mg PO BID 5-15 mg tablets 10 mg suppository
Prevention of
constipation. Used as enema to soften
fecal impaction Promotes incorporation
of water into stool, resulting in softer fecal mass.
May also promote electrolyte and water secretion.
Abdominal Pain Nausea Vomiting
Assess for abdominal
distention, presence of bowel sounds, and usual pattern of bowel function.
Asses color, consistency and amount of stool produced.
Advice patients that
laxatives should be used only for short-term therapy.
Encourage patient to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid intake and increasing mobility.
Advice patient not to use laxative when abdominal pain, nausea, vomiting or fever is present.
Advice patient not to take docusate within 2 hour of other laxatives.
Promotes incorporation
of water into stool, resulting in softer fecal mass, may also promote electrolyte and water secretion into the colon.
Electrolyte imbalance
Anti-Emetic Zofran (Ondansetron)
Compazine (Prochlorperazine)
Reglan (metoclopramide)
0.12 mg/kg or 32mg
single dose PO: 2.5mg-10mg max
40mg/day IM: 0.1-10mg max
40mg/day IV: 2.5-10mg max
40mg/day Rectal: 25mg bid IV not recommended for
children 10mg q6-8hour
Treatment for nausea and
vomiting Prevent symptoms of
gastric static and esophageal reflux.
Headache Dizziness Diarrhea Constipation Abdominal Pain Restlessness Anxiety Depression Irritability Hyper/hypotension
Assess for nausea,
vomiting, abdominal distention and bowel sounds prior to and following administration.
Assess patient for extrapyramidal effect periodically
Assess patient BP
Advice patient to notify
health care professional immediately if involuntary movement of eyes, face or limbs occur.
Blocks the effects of
serotonin at 5ht receptor sites located in vagal nerve terminals and the chemoreceptor trigger zone in the CNS.
Decreases incidence and severity of nausea and vomiting.
May be affected by drugs
altteringthe activity of liver enzymes.
May cause transient increase in serum bilirubin, AST and ALT levels.
Canbeusedastranquilizerfornon-
psychoticanxiety,butotherdrugsmay have more favorable side effect profile (e.g., benzodiazepines)
GI : SBO, GERD, Ulcers, Gastritis
MED Name/Class Safedose/Rout Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
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CARDIAC: CHF, MI, HTN, ^cholesterol MED Name/class dose/Route/Freq MAX Daily Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction ACE Inhibitor “PRIL”
Prinivil, Zestril (Lisinopril)
Capoten (Captopril)
2.5-40mg 0.3-25mg PO
40mg/day
Hypertension Management of
congestive heart failure (CHF)
Reduces the risk of death or development of CHF after myocardial infarction (MI)
Slows the progression of left ventricular dysfunction into overt heart failure
Used to decreased the progression of diabetic neuropathy
Insomnia Vertigo Weakness Cough Hypotension Chest pain Tachycardia
H/O Angio-
Edema Mod-severe
aortic stenosis Systolic BP <90,
Cr>3.0 K+ >5.5 BP_____
HR_____ Assess Vital Signs
before giving Rx. Monitor BP and
pulse frequently during initial dose adjustment
Monitor weight and assess lungs for rales/crackles
Assess for peripheral edema, jugular venous distention
Advice patient take
the med same time daily.
Change position slowly
Stops Angiotensin 1 to
converting to Angiotensin 2 in the R.A.A.S
Decrease B/P Excretion of sodium and
water and retention of potassium
Decreased
antihypertensive effects if taken with indomethacin
Exacerbation of cough if combined with capsaicin
ARB angiotensin block Valsartan
Candesartan
Losartan
1 tab daily; 25-100mg/d
16mg once daily
50mg OD
360mg/day
2-32
mg/day as a single dose or divided into 2 daily doses
Treatment of
hypertension, alone or in combination with other antihypertensive.
Treatment of heart failure in patients who are intolerant of angiotensin-converting enzyme (ACE_ inhibitors.
Headache Dizziness Hypotension Diarrhea URI Symptoms
BP_____
HR_____ Administer
without regard to meals.
Ensure that patients is not pregnant before beginning therapy
Take drug without
regard to means Report fever chills,
dizziness and pregnancy.
Selectively blocks the
binding of angiotensin II to specific tissue receptors found in thevascular smooth muscle and adrenal gland; this action blocks the vasoconstriction effect of the renin\u2013angiotensin system as well as the release of aldosterone, leading to decreasedBP; may prevent the vessel remodeling associated with the development of Atherosclerosis.
Contraindicated with
hypersensitivity to valsartan, pregnancy (use during second
Or third trimester can cause injury or even death to fetus), lactation.
Use cautiously with hepatic or renal dysfunction, hypovolemic
Aldosterone Antagonist Aldactone(Spironolactone)
Inspra (Eplerenone)
100-200
mg/dayPO for edema;100-400mg/day PO for hyperaldosteronism; 50-100 mg/day PO for hypertension
Pediatric :3.3 mg/kg/day PO 100mg/day PO BID
25-50mg/day
Decrease BP Take Pressure Off L Ventricle of heart Treat high blood
pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. It is also used to treat swelling (edema)
Headache diarrhea, cramps, drowsiness, rash, nausea, vomiting, impotence, irregular menstrual
periods, irregular hair growth
Check blood pressure before initiation of therapy and at regular intervals throughout therapy.
Lab tests: Monitor serum electrolytes (sodium and potassium) especially during early therapy; monitor digoxin level when used
Be aware that the maximal diuretic effect may not occur until third day of therapy and that diuresis may continue for 2–3 d after drug is withdrawn.
Report signs of hypernatremia or hyperkalemia (see Appendix F), most likely to occur in patients with severe cirrhosis.
Block Altosterone in R.A.A.S decrease total body fluid
BP Mild diuretic that acts
on the distal tubule to inhibit sodium exchange for potassium, resulting inincreased secretion of sodium andwater conservation of potassium. Analdosterone antagonist
Manifests a slightantihypertensiveef
Increased hyperkalemia with potassium supplements, ACE inhibitors, diets rich in potassium.
Decreased diuretic effect with salicylates
Decreased hypoprothrombinemic effect of anticoagulants
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for 4 weeks
concurrently. Assess for signs
of fluid and electrolyte imbalance, and signs of digoxin toxicity.
Monitor daily I&O and check for edema. Report lack of diuretic response or development of edema; both may indicate tolerance to drug.
Weigh patient under standard conditions before therapy begins and daily throughout therapy. Weight is a useful index of need for dosage adjustment. For patients with ascites, physician may want measurements of abdominal girth.
Avoid replacing fluid losses with large amounts of free water
fect. Interferes with synthesis of testosterone and mayincrease formation of estradiol from estrogenthus leading to endocrine abnormalities
Loop Diuretics Lasix (Furosemide)
Bumex(Bumetanide)
Demadex (Torsemide)
20mg/tab
0.5-1mg/day
5-20mg/day
10mg/day
Treatment of edema
associated with CHF, hepatic cirrhosis, and renal disease. Hypertension.
orthostatic
hypertension thrombophlebitis chronic aortitis vertigo headache
BP_____ HR_____ Weights
(trending) 1___2 ___3 ___4
___ K+ ____ Assess patient's
underlying condition.
Monitor for renal, cardiac, neurologic, GI, pulmonary manifestation of hypokalemia.
Assess fluid volume.
s/s Hypo K+ Posteral Syncope advise patient
totake drug with food toprevent GI upsetinform patient of possibleneed for potassium ormagnesium supplements
Inhabits sodium and
chloride reabsorption at the proximal tubules, distal tubules and ascending loop of Henley leading to excretion of water together with sodium, chloride and potassium. Diuretic antihypertensive.
Cross-sensitivity with
thiazides and sulfonamides may occur
Thiazide Diuretics Hydrochlorothiazide
(Metolazone)
5-20mg/day
80mg/day
For pain on
integumentary structures, myalgia, neuralgia, headache, dysmenorrhea, gout.
heartburn Thirst fever dimness of vision
BP_____ HR_____ Assess for pain:
type, location and pattern
Note for asthma
Record intermittent
therapy on a calendar, or use prepared dated envelopes. Take drug
Inhibits reabsorption of
sodium and chloride in distal renal tubule, increasing the
Excretion of sodium,
Taking insulin with
Hydrochlorothiazide may cause high blood sugar (hyperglycemia.
CARDIAC: CHF, MI, HTN, ^cholesterol MED Name/Class Safedose/Rout MAX daily Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
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Arthritis, SLE, acute rheumatic fever
osteoporosis
asthma like symptoms
Monitor renal,LFTs and CBC
Determine history of peptic ulcers or bleeding tendencies.
early so increased urination will not disturb sleep. Drug may be taken with food or meals if GI upset occurs.
Weigh yourself on a regular basis, at the same time and in the same clothing;
Record weight on your calendar.
chloride, and water by the kidney.
Ca+ Channel Block “PINES”
Norvasc (Amlodipine)
5mg/tab OD
CHR Angina hypertension
Dizziness headache Peripheral edema Flushing rush Nausea Abdominal discomfort
Monitor patients
BP, cardiac rhythm, and output.
Take with meals if
upset stomach occurs.
Block Ca+ channels of cell inhabits the movement of
calcium ions across the membranes of cardiac and arterial muscle cells
inhabits trans membranecalcium flow, which results in the depression of impulse formation in specialized cardiac pacemaker cells
The body breaks down
(metabolizes) amlodipine using liver enzymes known as CYP 3A4 enzymes. Drugs known as CYP 3A4 inducers speed up the activity of these enzymes, causing the body to metabolize amlodipine too quickly. This may make amlodipine less effective.
Beta Block CHF Tachycardia Management of
hypertension, used alone or with other antihypertensive agents
Pharyngitis Dizziness Vertigo Bardycardia CHF Cardiac Arrhythmias Rush
Baseline weight, skin condition, neurologic status, P, BP, ECG, R,kidney and liver function tests, blood and urine glucose
Do not stop taking this drug unless instructed to do so by a health care provider.
Avoid over-the-counter medications.
Avoid driving or dangerous activities if dizziness, weakness occur.
These side effects may occur: Dizziness, light-headedness, loss of appetite, nightmares, depression, and sexual impotence.
Report difficulty breathing, night cough, swelling of extremities, slow pulse,
Confusion, depression, rash, fever, sore throat.
Blocks beta-adrenergic receptors of the sympathetic nervous system in the heart and juxtaglomerular apparatus (kidney), thus decreasing the excitability of the heart, decreasing cardiac output and oxygen consumption, decreasing the release of renin fromthe kidney, and lowering blood pressure.
Increased effects with verapamil, anticholinergic
Increased risk of orthostatic hypotension with prazosin
Possible increased BP-lowering effects with aspirin, bismuth subsalicylate,
magnesium salicylate, sulfinpyrazone, hormonal contraceptives
Decreased antihypertensive effects with NSAIDs
Possible increased hypoglycemic effect of insulin
Zabeta (Bisoprolol) 1.25mg 10mg Coreg (Carvedilol) 3.125mg x 2 25 -
50mg x 2
If >85kg Lopressor Metroprolol 12.5 – 25mg 200mg x
1
CARDIAC: CHF, MI, HTN, ^cholesterol MED Name/Class Safedose/Rout MAX daily Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
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Inotropic
Cardiac Glycosides Lanoxin (Digoxin)
0.125mg x 1
0.125
mg – 0.25mg x 1
Heart failure- Supraventricular arrhythmias- Emergency heart failure
Headache Weakness Drowsiness visual disturbances mental status change Arrhythmias GI upset, anorexia
Dig Toxic0.8-2.0ng/ml
Low K+ levels (^dig toxic)
BP_____ HR_____ EKG
Monitor apical pulse for 1 minute before administering.
Administer as indicated.
Check dosage and preparation carefully.- Avoid giving with meals; this will delay absorption
Instruct patient not to stop taking drug without notifying physician.
Instruct to report slow or irregular pulse, rapid weight gain, loss of appetite, nausea, diarrhea, vomiting, blurred or yellow vision, unusual tiredness or weakness, swelling of the ankles, legs or fingers, difficulty breathing.
Weigh patient every other day.
Instruct to have regular medical check-ups, which may include blood tests, to evaluate effects of drug.
Do proper documentation.
Digoxin is a cardiac glycoside which has positive inotropic activity characterized by an increase in the force of myocardial contraction. It also reduces the conductivity of the heart through the atrioventricular (AV) node. Digoxin also exerts direct action on vascular smooth muscle and indirect effects mediated primarily by the autonomic nervous system and an increase in vagal activity
effectiveness reduced by phenytoin, neomycin,sulphasalazine, kaolin, pectin, antacids and inpatients receiving radiotherapy- Metoclopramide may alter the absorption of solid dosage forms of digoxin- Blood levels increased by calcium channel blockers, spironolactone, quinidine and calcium salts.- Electrolyte imbalances such as hypokalemiaand hypomagnesaemia(e.g. admin of potassium-losing diuretics, corticosteroids) can increase the risk of cardiac toxicity
Nitrates VASODILATOR Nitro (Nitroglycerin)
0.2-0.6 mg SL q
5 minutes
3doses
in 15 minutes
MI, /CAD Treatment of angina
pectoris
Headache Restlessness Nausea Vomiting Hypotension Tachycardia
Viagra BP_____ HR_____ Monitor blood
pressure and heart rate on a regular basis
NO Viagra (Vascular Collapse)
Instruct patient to take medication while sitting down and to change positionsslowly.
Instruct patient to allow tablets to dissolve under tongue, and not to chewer swallow sublingual tablets.
Instruct patient to seek emergency help promptly if chest pain is unresolved after 15 minutes.
Instruct patient not to change brands without consultingprescriber. Instruct patient to keep tablets in original, air-tight container
Reduces cardiac oxygen demand by decreasing leftventricularpressure and systemicvascular resistance; dilates coronaryarteries andimproves collateral flow to ischemic regions
Viagra
Blood Thinners (anti-coagulants)
Dizziness Headache
Observe patients receiving
Protect from injury and notify Dr of
ASA: Prevent bleeding by
Use of heparin, ASA, Tylenol,
CARDIAC: CHF, MI, HTN, ^cholesterol MED Name/Class Safedose/Rout MAX daily Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
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ASPRIN (anti-platelet)
81mg Q Day 325mg CP
Anticoagulation for purposes of stroke, PE, deep venous thrombosis, prophylaxis for venous thrombosis, acute MI
Insomnia Constipation N/V Urinary Retention Bleeding Anemia Thrombocytopenia
parenteral drug carefully; closely monitor BP and vital signs.
Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician.
Monitor for S&S of hypokalemia.
Monitor I&O ratio and pattern. Report decrease or unusual increase in output.
pink, red, dark brown or cloudy urine, red or dark brown vomitus; red or black stools, bleeding gums or oral mucosa; ecchymosis, hematoma, epistaxis, bloody sputum; chest pain; abdominal or lumbar pain or swelling; unusual increase in menstrual flow; pelvic pain; severe or continuous headache, faintness, or dizziness
Menstruation may be somewhat increased and prolonged;
Learn correct technique for SC admin if discharged from hospital on heparin
Engage in normal activities such as shaving with a safety razor in the absence of a low platelet count.
Alcohol and smoking may alter the response to heparin and are not advised
Do not take aspirin or any other OTC meds without the Dr approval
inactivation of thrombin formation, inhibition of formation of fibrin
Heparin:
exerts direct effect on blood coagulation (clotting) by enhancing the inhibitory actions of antithrombin III on several factors essential to normal blood clotting, thereby blocking the conversion of prothrombin tothrombin and fibrinogen to fibrin.
Coumadin:
Warfarin is used to treat blood clots (such as in deep vein thrombosis-DVT or pulmonary embolus-PE) and/or to prevent new clots from forming in your body. Preventing harmful blood clots helps to reduce the risk of a stroke or heart attack
glucocorticoids,
sulfonamides, cephalosporin’sincrease effects of warfarin. Phenobarbital, tegrtol, Dilantin, oral contraceptives decreases anticoagulation effects.
Heparin (Heparin Sodium) 150=10,000 U/kg IV
Prophylaxis and Tx of venous thrombosis and pulmonary embolism and to prevent thromboembolic complications arising from cardiac and vascular surgery, frostbite, and during acute stage of MI. Also used in Tx of disseminated intravascular coagulation (DIC), atrial fibrillation with embolization, and as anticoagulant in blood transfusions, estracorporealcirculation, and dialysis procedures
Lovenox (enoxaparin) 40mg SQ daily Prevention o thrombus formation
Systemic anticoagulation for prevention of ischemic or thrombotic events
Coumadin (Warfarin)
2.5 mg/1 tab OD
Prevents further extension of formed existing clot, prevention of new clot formation, and secondary thromboembolic complications. And for treatment of hyperkalemia.
CARDIAC: CHF, MI, HTN, ^cholesterol MED Name/Class Safedose/Rout MAX daily Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
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Insulin & Diabetic MED Name/class ONSET/ Peak/ Duration Uses (Goals) RN Consider Pt. Teaching Action Drug 2 Drug Interaction Insulin
Diabetes Mellitus Regulate sugar in your bloodstream
Assess patient periodically for symptoms of hypoglycemia (anxiety; restlessness; mood changes; tingling in hands, feet, lips or tongue; chills; cold sweats; confusion; cool pale skin; difficulty in concentration; drowsiness; excessive hunger; headache
Monitor body weight
Hypoglycemia H.A.N.D.W.A.S.H Headache Altered Nervousness Disoriented W Anxiety Shaky
Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat and inhibiting hepatic glucose production.
Insulin also inhabits lipolysis and proteolysis and enhances protein synthesis.
A rapid-acting insulin with more rapid onset and shorter duration than human regular insulin; should be used with intermediate or long acting insulin.
Lantus/Lefemir NO MIXING!!!! With
other insulin’s Beta blockers may block
some of the signs and symptoms of hypoglycemia and delay recovery from hypoglycemia (Lopressor)
Alcohol may decrease insulin requirements.
Rapid Acting “LOG” Apidra (Glusine) Aspart (Novolog) Lispro (Humalog)
15min ONSET 30 - 90 min PEAK 4-6 hour DURATION
Short Acting “LIN” Humalin/Novolin R
30 – 60 min ONSET 2-4 hr. PEAK DURATION
Intermediate (cloudy) NPH
1-2HR ONSET 6-10 hr. PEAK DURATION
Roll NPH to mix
Long Act Glargine (Lantus) Detremir (Levemir)
4 Hr. ONSET NO PEAK 18 – 24 Hr. DURATION
Asses for symptoms of hypoglycemia.
Monitor body weight. MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction Anti-Diabetic (Metformin) Glucophage 500-1000mg
Max. 2000mg/day (child) 2500mg/day (adult)
improve glycemiccontrolling clients with type 2diabetes
Extended-Release form
used to treat type2 diabetes as initial therapy
Diarrhea Nausea Unpleasant metallic taste.
Assess for patients history of diabetes
Monitor patients’ blood glucose before and after giving medications.
Assess for hypersensitivity to Metformin
Assess Patients renal function
Monitor sign and symptoms of hypoglycemic reaction.
Inform the patient of potential risks/advantages of therapy and of alternative modes of therapy
Do not discontinue this medication without consulting your health care provider.
Monitor urine or blood for glucose and ketones as prescribed.
Do not use this drug during pregnancy; if you become pregnant, consult with your
Health care provider for appropriate therapy.
Decreases heptic glucose production
Decreases intestinal glucose absorption.
Increases sensitivity to insulin.
decongestants can make metformin less effective, increasing your chance of high blood sugar (hyperglycemia)
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RESPIRATORY: COPD (Asthma, Emphysema, Chronic Bronchitis) Restrictive Airway Disease MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction Bronchodilators
PO (Adults and Children more than 12 years): 2-4 mg 3-4 times a day or 4-8 mgof extended dose tablets twice a day.
To control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder (COPD)
Quick relief for bronchospasm
For the prevention of exercise-induced bronchospasm4. Long-term control agent for patients with chronic or persistent bronchospasm
Restlessness cardiac arrhythmias palpitation sweating nausea & vomiting
Relief and prevention of bronchospasm in patients with reversible obstructive
airway disease Inhalation: Treatment
of acute attacks of bronchospasm
Prevention of exercise-induced bronchospasm
Unlabeled use: Adjunct in treating serious hyperkalemia in dialysis patients;
seems to lower potassium concentrations when inhaled by patients on
hemodialysis
Do not exceed recommended dosage; adverse effects or loss of effectiveness may
Result. Read the instructions that come with respiratory inhalant.
These side effects may occur: Dizziness, drowsiness, fatigue, headache (use
caution if driving or performing tasks that require alertness); nausea, vomiting,
change in taste (eat small, frequent meals); rapid heart rate, anxiety, sweating,
Flushing, insomnia. Report chest pain,
dizziness, insomnia, weakness, tremors or irregular heartbeat,
difficulty breathing, productive cough, failure to respond to usual dosage
in low doses, acts relatively selectively at beta2-adrenergic receptors to cause
bronchodilator and vasodilation; at higher doses, beta2 selectivity is lost, and the drug
Acts at beta2 receptors to cause typical sympathomimetic cardiac effects.
Increased sympathomimetic effects with other sympathomimetic drugs
Increased risk of toxicity, especially cardiac, when used with theophylline,
aminophylline, oxtriphylline
Decreased bronchodilating effects with beta-adrenergic blockers (eg, propranolol)
Decreased effectiveness of insulin, oral hypoglycemic drugs
Decreased serum levels and therapeutic effects of digoxin
Beta 2 Agonist Proventil (Albuterol)
Methylaxthine Theophylline
(Elixophyllin)
1.4 mg poq12h Maintenance 3mg/kg q
8hr.
Bronchospasm of COPD Bronchial asthma Chronic bronchitis
Nausea Vomiting Palpitation Hyperglycemia Anxiety Insomnia
Monitor theophylline blood levels
Monitor I&O Assess for signs of
toxicity: irritability, insomnia, restlessness, tremors
Monitor respiratory rate, rhythm and dept.
Assess for allergic reaction.
Take this drug exactly as prescribed
Avoid excessive intake of coffee, tea, cocoa, cola, and chocolates.
Have frequent blood test to monitor drug effects and ensure safe and effective dosage.
Relaxes bronchial smooth muscle, causing bronchodilator and increasing vital capacity
that has been impaired by bronchospasm and air trapping; actions may be mediated by
inhibition of phosphodiesterase, which increases the concentration of cyclic adenosine
monophosphate; in concentrations that may be higher than those reached clinically, it also
Inhibits the release of slow-reacting substance of anaphylaxis and histamine.
Drinking alcohol can increase the level of theophylline in your blood, which can cause dangerous side effects. It is best to avoid alcohol while taking theophylline.
Anti - Cholinergic Ipratropium Inhaler
(Atrovent,Apovent,Aerovent)
2 inhalations (36 mcg)
qid.
Bronchodilator for maintenance treatment of bronchospasm associated with COPD (solution, aerosol), chronic bronchitis, and emphysema
Nasal spray: Symptomatic relief of rhinorrhea associated with perennial rhinitis,
Nausea GI distress Dry mouth Dyspnea bronchitis Back pain Chest pain.
Asses History of hypersensitivity to atropine
Asses skin color lesion texture
BP, P, R adventitious sounds
Bowel sounds
Use as an inhalation product
Side effect may occur Report rash, eye pain,
difficulty voiding, palpitation, vision changes
STOPS(inhibits) secretion from serous and seromucous glands lining the nasal mucosa.
Anticholinergic, chemically related to atropine, which blocks vagally mediated reflexes
By antagonizing the action of acetylcholine.
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common cold
Causes bronchodilator
Anti-Inflam Agents 10mg/5ml OD on full
stomach
Replacement therapy in adrenal cortical insufficiency
Hyperkalemia associated with cancer
Short-term management of various inflammatory and allergic disorders, such as
rheumatoid arthritis, collagen diseases (e.g., SLE), dermatologic diseases (e.g., pemphigus), status asthmatics, and autoimmune disorders
Hematologic disorders: thrombocytopenia purpura, erythroblastopenia
Ulcerative colitis, acute exacerbations of multiple sclerosis and palliation in some leukemia’s and lymphomas
Trichinosis with neurologic or myocardial involvement
^Blood sugar & Infection ^ Edema (retain Na+) Wt gain bloating moon face
Assess physical weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral perfusion, prominence of superficial veins, R, Adventitious sounds, serum electrolytes, blood glucose.
Do not immediately stop taking the corticosteroid, need to be tapered OFF, ADRENAL crisis may occur
Avoid exposure to infections.
Report unusual weight gain, swelling of the extremities, muscle weakness, black or tarry stools, fever, prolonged sore throat, colds or other infections, worsening of the disorder for which the drug is being taken
Inhabitations of leukocyte infiltration at the site of inflammation
Interference in the faction of mediators of inflammatory response, and suppression of humeral immune responses.
Increased therapeutic and toxic effects with troleandomycin, ketoconazole
Increased therapeutic and toxic effects of estrogens, including hormonal
contraceptives Risk of severe
deterioration of muscle strength in myasthenia gravis patients who
also are receiving ambenonium, edrophonium, neostigmine, pyridostigmine
Decreased steroid blood levels with barbiturates, phenytoin, rifampin
Decreased effectiveness of salicylates
Corticosteroids Prednisone
(Deltasone/Flovent)
Mast Cell Stabilizer CromolynSodium
(Intal Rynacrom)
Inhalers or Nasal spray involvement Treats asthma, COPD, Hay Fever or Chronic inflammation of the major pathways of the respiratory tract (bronchioles/’ bronchi)
H/A Trouble Swollowing Skin itchy Muscle pain
Ensure proper use of inhailer (exhale completely before inhailing drug with admin of inhailor) Respiratory assessment Lung Sounds
Educate MEDS WORK SLOWLY 2-6 weeks to become effective DO NOT USE for immediate allergy relief or acute asthma attack SE: Runny Nose, Throat irritation, HA CALL DR. if white sores in throat OR swelling tough
Prevents allergy and inflammation Reaction from releasing histamines that cause allergic inflammation
Leukotrine Rec. Antagonist zafirlukast (Astra,
Accolate) (Singulair)
ADULTS AND CHILDREN
> 12 YR 20 mg PO bid on an
empty stomach. PEDIATRIC PATIENTS
5\u201311 YR 10 mg PO bid on an
empty stomach
Leukotriene modifiers reduce inflammation in the lung tissue treatment of bronchial asthma
Headache Dizziness Nausea diarrhea abdominal pain Vomiting
Ensure that drug is taken continually for optimal effect.
Do not administer for acute asthma attack or acute bronchospasm.
Take this drug on an empty stomach, 1 hr. before or 2 hr. after meals.
Take this drug regularly as prescribed; do not stop taking it during symptom-free periods; do not stop taking it without consulting your health care provider.
Do not take this drug for acute asthma attack or
Selectively and competitively blocks receptor for leukotriene D4 and E4, components of SRS-A, thus blocking airway edema, smooth muscle constriction, and cellular activity associated with inflammatory process that contribute to signs and symptoms of asthma.
Increased risk of bleeding with warfarin
Potentially for increased effects and toxicity of calcium channel-blockers, cyclosporine.
Decreased effective with erythromycin, theophylline.
RESPIRATORY: COPD (Asthma, Emphysema, Chronic Bronchitis) Restrictive Airway Disease
MED Name/Class Safedose/Rout Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
Page 14 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed
acute bronchospasm; Anti-Allergic
Xolair (Omalizumab) 150 to 375 mg is
administered SC every 2 or 4 weeks
moderate to sever persistent asthma who have a positive skin test otinvitro reactivity to a perennial aeroallergen and whose symptoms are inadequately controlled with inhaled corticosteroids.
Wheezing tightness in your cheat skin rash feeling anxious Swelling face, lips,
tongue
Assess lung sounds and RR, assess for allergic reactions within 2 hr of first injection, monitor for injection site reactions.Solution is viscous and maytake 5-10 sec. to administer
Take daily Use flow meter to every
AM to track lung copasity from day to day
Inhibits binding of IgE toreceptors on mast cells andeosinophils, preventing of mediators of theallergic response. Alsodecreases amount of IgEreceptors on basophils.
CI in hypersensitivity and acute bronchospasm
POST OP (Blood & Bones) MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction
Blood 1-2 units over 2-4 hours (faster admin will neg. affect kidneys)
Anemia Blood loss S/P Sx
Allergic Rx Lysed cells Death
H/H _____ RBC____ BP____ HR____ TEMP____ VS before VS 15 min into VS Q 30 min VS After
Benadryl Cortisone Back pain, Diff breathing, Rapid HR s/s RX
O (Universal Donor) AB (universal Reciever) Rh + (receives everyone +/- Rh – (ONLY receives Neg.)
A-A B-B O – O & GIVE TO ALL, AB-Recieves ALL
Fe+ (iron) PO: ADULTS, ELDERLY: 2-3
mg/kg/day or 50-100mg elemental iron 2 time/day up to 100mg 4time/day. CHILDREN: 3 mg/kg/day elemental iron in 1-3 divided doses
prevention or treatment of iron deficiency anemia due to inadequate diet, malabsorption pregnancy, and blood loss
Mild, transient nausea Heartburn Anorexia Constipation Diarrhea
Assess for clinical improvement, record of relief of symptoms (fatigue, irritability, pallor, paresthesia, and headache).
Expect stools to darken in color.
If gastrointestinal discomfort occurs, take after meals or with food.
Do not take within 2 hours of antacids because it prevents absorption
essential component in the formation of hemoglobin, myoglobin andenzymes. It is necessary for effective erythropoiesis and transport or utilization of oxygen
Doxycycline, mycophenolate, penicillamine, or thyroid hormones (eg,levothyroxine)
Blood Thinners (anti-coagulants)
Easy Bruising Increased r/f bleeding Fever Rhinitis Hyperkalemia Irritation Mild Pain
Check: H/H: ___ Plt, ___ INR ___ (2.0-3.0 Therp. Warforin) PTT: ___ NO Give: GI Bleed, Ulcers APTT
- Black Stool (call PMD) - Easy Bruising & Bleeding - Brush teeth slowly to
prevent bleeding gums - NO shaving with Razors - Safety!
exerts direct effect on blood coagulation (clotting) by enhancing the inhibitory actions of antithrombin III on several factors essential to normal blood clotting, thereby blocking the conversion of prothrombintothrombin and fibrinogen to fibrin
Antihistamines Digoxin Tetracycline ASA 81mg Q Day
325mg CP Clot Prevention, ^CMS Boost Circulation
Heparin (Heparin Sodium) SQ 5,000 – 10,000 UNITS Adults: Initially, 5,000
units by I.V. bolus; then 20,000 to 40,000 units/day by I.V. infusion with pump. Titrate hourly rate based on PTT results (every 4 to 6 hours in the early stages of treatment).
Children: Initially, 50 units/kg I.V.; then 25 units/kg/hour or 20,000 units/m
2 daily by I.V. infusion pump.
prophylaxis and Tx of venous thrombosis and pulmonary embolism and to prevent thromboembolic complications arising from cardiac and vascular surgery, frostbite, and during acute stage of MI. Also used in Tx of disseminated intravascular coagulation (DIC), atrial fibrillation with embolization, and as anticoagulant in blood transfusions, estracorporealcirculation, and dialysis procedures
Lovenox (Enoxaparin) 40 mg once daily SQ Prevention of DVT/Pulmonary Embolism
RESPIRATORY: COPD (Asthma, Emphysema, Chronic Bronchitis) Restrictive Airway Disease
MED Name/Class Safedose/Rout Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
Page 15 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed
Coumadin (Warfarin)
2.5-10mg per day for 2-4 days then adjust daily dose by results of prothrombin time or INR
Management of Myocardial infarction: decreases risk of death, decreases risk of subsequent MI
POST OP (Blood & Bones)
MED Name/Class Safedose/Rout Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
Page 16 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed
ANTI-INFECTIVES `MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction Penicillin
Amoxil (Amoxicillin)
Polycillin (Ampicillin)
Geocillin (Carbenicillin Indanyl Sodium)
Zosyn
(Piperacillin/Tazobactam)
Bicillin (Penicillin G Sodium)
Bactocil (Oxacillin
Sodium)
Adult: 250-500mg every
8hours Children: 20-
40/mg/kg/day divided dosage given every 8 hours
20-500mg
382 to 764 mg
3.375-4.5g every 6 hours 1-4mL
Infections of the resp.
tract, skin and skin
structures, Para nasal sinuses, genitourinary tract, otitis media, sinusitis Meningitis. UTI
Dizziness Nausea and vomiting Diarrhea Abdominal pain
Obtain pt.’shas of
allergy. Assess pt. for any s/s
of infection Asses for pt.’s
sensitivity to penicillin or other cephalosporin’s
Assess for allergic reaction during therapy.
Assess for bowel pattern
Teach patient to
report adverse reactions.
Notify prescriber if infection worsens or doesn’t improve after 72 hours
Prevents bacterial cell wall
synthesis during replication
Allopurinol: increased
risk of rash chlothromycins, sulfon-amides
tetracycline’s: Reduced bactericidal effect of amoxicillin
Methotrexate: Increased risk of methotrexate
NO AMINOGLYCO IV TUBING
Cephalosporin’s >1st Gen<
Staphylococcus Infections
-Lower Lungs - Bones Infections - Blood Infections Respiratory tract
infections Skin and skin structure
infections Bone and joints
infections
Loss of appetite Mild diarrhea Nausea Stomach cramps Vomiting
Be alert of adverse reactions and drug interaction.
This drug should be used extremely carefully because of its potent vasoconstrictor action. IV use may induce sudden hypertension and cerebrovascular accidents. As a last resort, give IV slowly over several minutes and monitor blood pressure closely.
Tell patient to take entireamount of drug exactly asprescribed, even after he feelsbetter.
Advise patient to notify prescriber if rash develops or signs and symptoms of super infection appear.
Inform patient not to crush, cut,or chew extended-releasetablets.
Bind to bacterial cell wall membrane,causing cell death.
** ALLERGY: PENICILLIN*
NO PENECILLIN IV TUBING
Ancef (cefazolin) IV/IM 0.5-1 g 6-12 hrly. Max: 6 g/day, up to 12 g/day in severe infections.
Keflex (Cefalexin) 500mg 1cap q6hrs Duricef, Ultracef
(cefadroxil) 1 g/day P.O. or 500 mg
P.O. q 12 hours >2nd Gen< Mandol(Cefamandole)
Cefzil(Cefprozil) 250 to 500 mg, every 8 hours, PO
Zinacef, Ceftin (Cefuroxime) 125-500mg >3rd Gen<
Cefizox (Ceftizoxime)
IM/IV 1-2g max of 3-4g Rocephin (Ceftriaxone) 1-2 g IV/IM qDay or
divided BID for 4-14 days depending on type and severity of infection
Claforan (cefotaxime) 1 to 2 g IV/IM q8hr Tetracycline’s
Doryx (Doxycycline) Achromycin
(Tetracycline) Terramycin
(Oxytetracline)
200mg once daily PO Adult: 500mg PO bid Child: 25-50mg/kg PO
qid PO: Onset-Rapid, Peak
2-3hours; Duration 6-12 hours
10-50mg/kg
Acne H. Pylori Gonorrhea Certain types of
pneumonia Lyme disease
Dizziness Vestibular reaction Diarrhea Nausea and vomiting Photosensitivity
Assess patient for infection (vital signs, appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy
Sun screen d/t making skin sensitive to sunlight
Yellow Teeth NO dairy NO Iron NO antiacids Not with food
Inhibits bacterial protein synthesis at the level of the 30s bacterial ribosome.
No DAIRY NO IRON NO Anti-acids
`MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction Macrolides
Zithromax (Azithromycin)
500mg/daily for 3 days.
URI GU Mild moderate nausea,
Nausea Vomiting abdominal pain
Assess skin color, GI output Bowel sounds
Take the full course prescribed.
Do not take with
Azithromycinblockstranspeptidation by binding to50s ribosomal subunit of susceptible organismsand
Coumadin Theophylline Prednisone
POST OP (Blood & Bones)
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Biaxin (Clarithromycin) (E-Mycin) Erythromycin
500mg 1tac Bid PO 250mg every 8 hours PO
vomiting, abdominal pain, dyspepsia, flatulence, diarrhea, cramping; angioedema, cholestasis jaundice; dizziness, headache, vertigo, somnolence; transient elevations of liver enzyme values
dyspepsia Diahhrea
antacids. May exp. side effects Report severe or watery
diarrhea, nausea/vomiting0
disrupting RNA-dependent protein synthesis at the chain elongation step
Dopamine Contraindicated with
hypersensitivity to azithromycin, erythromycin, or any macrolide antibiotic
Aminoglycosides Garamycin (Gentamicin) Kantrex (kanamycin) Mycifradin (Neomycin)
Adult: IV/IM 1.5–2
mg/kg loading dose followed by 3–5 mg/kg/d in 2–3 divided doses Intrathecal 4–8 mg preservative free q.d. Topical 1–2 drops of solution in eye q4h up to 2 drops q1h or small amount of ointment b.i.d. or t.i.d.
Child: IV/IM 6–7.5 mg/kg/d in 3–4 divided doses Intrathecal >3 mo, 1–2 mg preservative free q.d.
Neonate: IV/IM 2.5 mg/kg q12–24h
Parenteral use
restricted to treatment of serious infections of GI, respiratory, and urinary tracts, CNS, bone, skin, and soft tissue (including burns) when other less toxic antimicrobial agents are ineffective or are contraindicated. Has been used in combination with other antibiotics. Also used topically for primary and secondary skin infections and for superficial infections of external eye and its adnexa.
NEPHRO TOXICITY Tennatus (ringing in
ears) Skeletal muscle
weakness Apnea Nausea Vomiting
Perform C&S and
RENAL function (BUN/ Creat) prior to first dose and periodically during therapy; therapy may begin pending test results. Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, and patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity.
Weekly Blood Draws To check Peak & trough levels (TOXICITY LEVELS &Theraputic range) Report: - Tennatus (ringing in ears) may indicate Kidney toxicity
Broad-spectrum aminoglycoside
antibiotic derived from Micromonospora purpose. Action is usually bactericidal.
History of
hypersensitivity to or toxic reaction with any aminoglycoside antibiotic. Safe use during pregnancy (category C) or lactation is not established
NO PENECILLIN IV TUBING
Fluroquinolones Cipro (ciprofloxacin) Levaquin (lomefloxacin) (Floxin)
500mg BID Per Orem 250-750mg Q 24 hr.
Oral Adults 600-1800
mg/day in 2-4 equal doses. Childn>1 mth 8-25 mg/kg/day in 3-4 equal doses
IM/IV AdultSeriousinfections 2400-2700 mg in 2-4 equal doses. Less complicated infections 1200-1800 mg/day in 3-4 equal doses. Childn>1mth 20-40 mg/kg in 3-4 equal doses. Neonates <1 mth 15-20 mg/kg in 3-4 equal doses.
Resp: GU Bone Skin Infections
Diarrhea Difficulty sleeping headache nausea, vomiting stomach upset, gas unusual taste vaginal irritation
Assess for level of pain relief and administer prn dose as needed but not to exceed the recommended total daily dose.
Monitor vital signs and assess for orthostatic hypotension or signs of CNS depression.
Discontinue drug and notify physician if S&S of hypersensitivity occur.
Assess bowel and bladder function; report urinary frequency or retention.
Use seizure precautions for patients who have a history of seizures or who are concurrently using drugs that lower the seizure threshold.
Monitor ambulation and take appropriate safety precautions.
Exercise caution with potentially hazardous activities until response to drug is known.
Understand potential adverse effects and report problems with bowel and bladder function, CNS impairment, and any other bothersome adverse effects to physician.
Do not breast feed while taking this drug.
NOT WITH FOOD NO MILK NO IRON
Inhibition of topoisomerase(DNA gyrase) enzymes, which inhibits relaxation of super coiled DNA and promotes breakage of double stranded DNA
Do not take with Cisapride, droperidol, some medicines for irregular heart rhythm.
NOT WITH FOOD NO MILK NO IRON
POST OP (Blood & Bones)
MED Name/Class Safedose/Rout Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
Page 18 SimpleNursing.com 82% or higher on your next nursing Test Guaranteed
`MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction Sulfanamides
Bactrim, Septra (Trimethoprim- Sulfamethoxazole)
Tab 2 tab Forer tab. 1 tab infant & children TM 6 mg &SMZ 30 mg/kg body wt daily. To be given in bid. Gonorrhea 5 tab bid or 2 ½ forte tab bid for 1 day.
Resp tract, renal GIT, GUT. Osteomyelitis,
pneumocystis carinii pneumonia,
toxoplasmosis, actinomycetoma,
acute brucellosis, nocardiosis
Fatigue Nausea Vomiting diarrhea Crystalluria Toxic epidermal
Assess for infection (vital signs; appearance of wound, sputum, urine, and stool;WBC) at beginning and during therapy.
Obtain specimens for culture and sensitivity before initiating therapy.
Inspect IV site frequently. Phlebitis is common.
Monitor CBC and urinalysis periodically during therapy
Instruct patient to notify health care professional if rash, or fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise patient not to treat diarrhea without consulting health care professional.
Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.
Interferes with bacterial growth by inhibiting bacterial folic acid synthesisthrough competitive antagonism of PABA.
Oral Anticoag./ Diuretics
no work K+ Supplements Anta-Acids & Ca+ Block
The Others: Vancocin (vancomycin)
Flagyl(Metronidazole)
Zyvox (Linezolid)
Clindamycin(Cleocin)
2 g/day IV divided q6-
12hr; may increase based on body weight or to achieve higher trough values, increase toxicity >4 g/day
Capsules: 375 mg Injection: 5mg/mLOral suspension:200mg/5ml Tablets:200mg, 250mg,
400mg, 500mg Topical gel: 0.75 %, 1% 600mg every 12 hour for
14-28 days
Oral 150-300mg q6hr.
IV 600mg/day in 2-4equal
doses up to 4.8g/day UV ir IM
Treat a severe
intestinal condition known as Clostridium difficile-associated diarrhea.
Treats only bacterial infections of the intestines.
Chills Drug fever Rash Eosinophilia Reversible neutropenia
Assess patient for
infection Vital signs appearance of wound,
sputum, urine, and stool
WBC Beginning of and
throughout therapy. Allergy to medication
monitor I/O
Instructed patient on
range of Vancomycin toxicity (toxicity is reported at levels sustained above 80 to 100 mcg/ml). Patient verbalized understanding of instructions given.
Instructed patient on Vancomycin adverse effects such as: erythroderrma, thrombocytopenia, neutropenia, ototoxicity, and nephrotoxicity. Patient verbalized understanding of instructions given.
VANCOMYCIN>>>>>>> RED MANS
SYNDROME: (NOT A ALLERGY RX)infusing too rapidly may cause REDDING of skin, NOT a adverse RX, only a Side Effect
hypotensive symptoms. Patient verbalized understanding of instructions given.
Treatment of potentially life-
threatening infections when less toxic anti-infective are contraindicated. Particularly useful in staphylococcal infections, including:endocarditis, meningitis, osteomyelitis, and pneumonia septicemia, soft-tissue infections in patients who have allergies to penicillin or its derivatives or when sensitivity testing demonstrates resistance to methicillin.
Ototoxic and
nephrotoxic drugs (aspirin, aminoglycosides, cyclosporine cisplatin, loop diuretics): no depolarizing neuromuscular blocking agents: general anesthetics.
POST OP (Blood & Bones)