NAME OF DRUG

ROUTE/DOSE

Carvedilol
-antihypertensives
-beta blockers

25 g 1 tab tab BID

Aspirin
-Therapeutic:
antipyretics, nonopioid
analgesics
Pharmacologic:
salicylates

100 g 1 tab

P. Chan 2017

MECHANISM OF
ACTION
Blocks stimulation of
beta1 (myocardial) and
beta2
(pulmonary,vascular
and uterine)-adrenergic
receptor sites. Also has
alpha1 blocking activity
which may result in
orthostatic hypotension.

INDICATION

Produce analgesia and

reduce inammation
and fever by inhibiting
the production of
prostaglandins.
Aspirin Only:
Decreases platelet
aggregation.

Inammatory disorders
including: Rheumatoid
arthritis, Osteoarthritis.
Mild to moderate pain.
Fever.
Aspirin: Prophylaxis of
transient ischemic
attacks

Hypertension

Side Effects/Adverse
Reactions

Nursing
Responsibilities
-Monitor BP and pulse
frequently during dose
adjustment period and
periodically during
therapy.
Assess for orthostatic
hypotension when
assisting patient up
from supine position.
-Monitor intake and
output ratios and daily
weight.
-Assess patient
routinely for evidence
of uid overload
(peripheral edema,
dyspnea, rales/
crackles, fatigue,
weight gain, jugular
venous distention).
Patients may
experience worsening
of symptoms during
initiation of therapy for
HF.
-Hypertension: Check
frequency of rells to
determine adherence.
-Patients who have
asthma, allergies, and
nasal
polyps or who are
allergic to tartrazine are
at an increased risk for
developing
hypersensitivity

Therapeutic Effects:
Analgesia. Reduction
of inammation.
Reduction of fever.
Aspirin: Decreased
incidence of transient
ischemic attacks and
MI.

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and MI.

reactions.
-Assess for rash
periodically during
therapy. May cause
Stevens-Johnson
syndrome or toxic
epidermal necrolysis.
Discontinue therapy if
severe or if
accompanied with
fever, general malaise,
fatigue, muscle or joint
aches, blisters, oral
lesions, conjunctivitis,
hepatitis and/or
eosinophilia.
-Pain: Assess pain and
limitation of
movement; note
type, location, and
intensity before and at
the peak
(see Time/Action
Prole) after
administration.
-Fever: Assess fever
and note associated
signs (diaphoresis,
tachycardia, malaise,
chills).
Aspirin: Prolongs
bleeding time for 47
days and, in large
doses, may cause
prolonged prothrombin
time. Monitor
hematocrit periodically
in prolonged high-dose
therapy to assess for GI
blood loss.

Atorvastatin (Lipitor)
-Therapeutic: lipidlowering agents
Pharmacologic: HMGCoA reductase
inhibitors

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80 mg 1 tab

Inhibit an enzyme, 3hydroxy-3methylglutarylcoenzyme A (HMGCoA) reductase, which

is responsible for
catalyzing an early step
in the synthesis of
cholesterol.
Therapeutic Effects:
Lowers total and LDL
cholesterol and
triglycerides. Slightly
increase HDL.
Slows of the
progression of coronary
atherosclerosis
with resultant decrease
in CHD-related events
(all agents except
rosuvastatin have
indication for
decreasing events).

Atorvastatin: Primary
prevention of
cardiovascular disease
(risk of
MI or stroke) in
patients with multiple
risk factors
for coronary heart
disease CHD or type 2
diabetes
mellitus (also risk of
angina or
revascsularization
procedures in patients
with multiple risk
factors for
CHD).

-Toxicity and Overdose:

Monitor patient for the
onset of tinnitus,
headache,
hyperventilation,
agitation, mental
confusion, lethargy,
diarrhea, and sweating.
If these symptoms
appear, withhold
medication and notify
health care professional
immediately.
-Obtain a dietary
history, especially with
regard to fat
consumption.
-Monitor liver function
tests, including AST,
before, at 12 wk after
initiation of therapy or
after dose elevation,
and then q 6 mo. If AST
levels increase to 3
times normal, HMGCoA reductase inhibitor
therapy should be
reduced or
discontinued. May also
cause increased alkaline
phosphatase and
bilirubin levels.
-If patient develops
muscle tenderness
during therapy, monitor
CK levels. If CK levels
are >10 times the upper
limit of normal or
myopathy occurs,
therapy should be

Lactulose

30 ml OD

Increases water content

and softens the stool.
Lowers the pH of the
colon, which inhibits
the diffusion
of ammonia from the
colon into the blood,
thereby reducing blood
ammonia levels.

Treatment of chronic
constipation. Adjunct in
the management of
portal-systemic
(hepatic) encephalopathy (PSE).

GI: belching, cramps,

distention, atulence,
diarrhea.
Endo: hyperglycemia
(diabetic patients).

Omeprazole

40 mg/cap

Binds to an enzyme on
gastric parietal cells in
the presence of acidic
gastric pH, preventing
the nal transport of
hydrogen ions into the
gastric lumen.

Reduction of risk of GI
bleeding in critically ill
patients.

CNS: dizziness,
drowsiness, fatigue,
headache, weakness.
CV: chest pain. GI:
abdominal pain, acid
regurgitation,
constipation, diarrhea,
atulence,
nausea, vomiting.

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discontinued.
Assess patient for
abdominal distention,
presence
of bowel sounds, and
normal pattern of bowel
function.
-Assess color,
consistency, and
amount of stool
produced.
-Lab Test
Considerations: dec.
blood ammonia
concentrations by 25
50%.
-May cause inc blood
glucose levels in
diabetic patients.
-Monitor serum
electrolytes periodically
when used chronically.
May cause diarrhea
with resulting
hypokalemia and
hypernatremia.
Assess patient routinely
for epigastric or
abdominal pain and frank or
occult blood in the
stool,
emesis, or gastric
aspirate.
Lab Test
Considerations:
Monitor CBC with
differential periodically
during therapy.
May cause increased

AST, ALT, alkaline

phosphatase, and
bilirubin.
May cause serum
gastrin concentrations
to increase during rst
12 wk of therapy.
Levels return to normal
after discontinuation of
omeprazole.
Monitor INR and
prothrombin time in
patients
taking warfarin.
May cause
hypomagnesemia.
Monitor serum
magnesium prior to and
periodically during
therFolanerve

1 um/tab

Folic Acid with B6 and

B12
Piperacillin Tazobactam

4.5 g IV

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Piperacillin: Binds to
bacterial cell wall
membrane, causing cell
death. Spectrum is
extended compared
with other penicillins.
Tazobactam: Inhibits beta-lactamase,
an enzyme that can
destroy
penicillins.

Appendicitis and
peritonitis. Skin and
skin structure
infections. Gynecologic
infections. Communityacquired and
nosocomial pneumonia
caused by piperacillinresistant, betalactamase producing
bacteria.

CNS: SEIZURES
(higher doses),
confusion, dizziness,
headache, insomnia,
lethargy. GI:
PSEUDOMEMBRANOUS COLITIS,
diarrhea, constipation,
drug-induced
hepatitis, nausea,
vomiting. GU:
interstitial nephritis.
Derm: rashes ( incr. in
cystic brosis patients),
urticaria.

Assess patient for

infection (vital signs;
appearance of wound, sputum,
urine, and stool; WBC)
at
beginning of and during
therapy.
Obtain a history
before initiating therapy
to determine previous use of
and reactions to
penicillins
or cephalosporins.
Persons with a negative

Vancomycin

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1 g IV Q12

Binds to bacterial cell

wall, resulting in cell
death.

Treatment of potentially
life threatening infections when less toxic
anti-infectives are
contraindicated.
Particularly useful in
staphylococcal
infections, including:
Endocarditis,
Meningitis,
Osteomyelitis,

EENT: ototoxicity. CV:

hypotension. GI:
nausea,
vomiting. GU:
nephrotoxicity. Derm:
rashes. Hemat: eosinophilia,
leukopenia. Local:
phlebitis.
MS: back and neck
pain. Misc:

history of penicillin
sensitivity may still
have an allergic
response.
Obtain specimens for
culture and sensitivity
prior
to initiating therapy.
First dose may be given
before receiving results.
Observe patient for
signs and symptoms of
anaphylaxis (rash, pruritus,
laryngeal edema,
wheezing). Discontinue the
drug and notify health
care
professional
immediately if these
occur. Keep epinephrine, an
antihistamine, and
resuscitation
equipment close by in
the event of an
anaphylactic reaction.
Assess patient for
infection (vital signs;
appearance of wound, sputum,
urine, and stool; WBC)
at
beginning of and
throughout therapy.
Obtain specimens for
culture and sensitivity
prior to initiating

Pneumonia,
Septicemia, Soft-tissue
infections in patients
who have allergies to
penicillin
or its derivatives or
when sensitivity testing
demonstrates resistance to
methicillin.
Levofloxacin
-anti-infectives

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750 mg IV

Inhibit bacterial DNA

synthesis by inhibiting
DNA gyrase.

Skin and skin

structure infections

hypersensitivity reactions including

ANAPHYLAXIS,
chills, fever, red
man syndrome (with
rapid infusion),
superinfection.

therapy. First dose may

be given before
receiving results.
Monitor IV site
closely. Vancomycin is
irritating to
tissues and causes
necrosis and severe
pain with
extravasation. Rotate
infusion site.
- Assess for infection
(vital signs; appearance
of
wound, sputum, urine,
and stool; WBC;
urinalysis; frequency
and urgency of
urination; cloudy or
foul-smelling urine)
prior to and during
therapy.
-Obtain specimens for
culture and sensitivity
before initiating
therapy. First dose may
be given before
receiving results.
-Expect to obtain
culture and sensitivity
tests before
levofloxacin treatment
begins.
-Avoid giving drug
within 2 hours of
antacids.
-Stop levofloxacin at
first sign of
hypersensitivity,
including rash and

jaundice, because drug

may lead to
anaphylaxis. Reaction
may occur after first
dose. Expect to give
epinephrine and
provide supportive care.
-Notify prescriber if
patient has symptoms
of peripheral
neuropathy (pain;
burning; tingling;
numbness; weakness;
altered sensations of
light touch, pain,
temperature, position
sense, or vibration
sense), which could be
permanent; or CNS
abnormalities (seizures,
psychosis, increased
ICP or CNS
stimulation), which
may lead to more
serious adverse
reactions, such as
suicidal ideation. In
each case, expect to
discontinue
levofloxacin.
-Monitor patients
bowel elimination. If
diarrhea develops,
obtain stool culture to
check for
pseudomembranous
colitis. If confirmed,
expect to stop drug and
give fluid, electrolytes,
and antibiotics effective

P. Chan 2017

against Clostridium
difficile.
-Advise patient to
increase fluid intake
during therapy to
prevent crystalluria.
-Tell patient to
complete the drug as
prescribed, even if
symptoms subside.
-Urge patient to avoid
excessive sun exposure
and to wear sunscreen
because of increased
risk of photosensitivity.
Tell patient to notify
prescriber at first sign.
-Advise patient to
notify prescriber about
heart palpitations or
loss of consciousness.
An ECG may be
needed to detect
adverse drug effects on
the patients heart.

P. Chan 2017