MEDICATION ADMINISTRATION WORKSHEET

Home Medication Why Taking? Date/Time Safe Dose Nursing

Med? (Include dose, route, (Per patient of Original Patient Implications
frequency) history, progress Order dose/Usual (VS, labs, drug-
notes, or consults) dose drug/drug-
food/drug-herb
interactions)
metformin Func Class: oral Adult: PO 500 Do not give
anti-diabetic mg bid w/radiologic
(Glucophage, initially, then contrast media;
Fortamet, Novo- Chem Class: increase to may cause renal
Metformin) biguanide desired failure.
response 1-2 Drug/drug
g; dosage increase
adjustment q metformin level:
2-3wk or 850 digoxin, morphine,
mg/day with vancomycin.
morning meal Drug/drug
with dosage interaction:
increased increase
every other hypoglycemia:
wk, max 2,550 corticosteroids,
mg/day. calcium channel
blockers, oral
Geriatric: PO contraceptives,
Use lowest and diuretics.
effective Assess: for
dose. hypoglycemic
reactions, CBC,
renal studies,
BUN, glucose,
etc.
glipiZIDE Func class: anti- Adult: PO 5 Drug/drug
diabetic mg initially interaction:
(Glucotrol, Glucotrol before Increase: action
XL) Chem class: breakfast, of digoxin,
Sulfonylurea then increase glycosides.
to desired Increase:
resonse; max hypoglycemic
40 mg/day in effects – insulin,
divided doses MAOIs, NSAIDs,
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or 15 anticoagulants,
mg/dose. PO sulfonamides, etc.
(XL) 5 mg/day Decrease:
with hypoglycemic
breakfast may effects – thiazide
increase to 10 diuretics,
mg/day max rifampin,
20 mg/day. cholestyrmine,
etc. Drug/herb
Geriatric: PO interaction:
2.5 mg/day; Increase anti-
may increase diabetic effect –
if needed. alfalfa, aloe,
basil, bay, etc.
Increase or
decrease:
hypoglycemic
effect –
chromium,
ginseng, etc.
Assess:
Hypo/Hyperglyce
mic reaction that
can occur soon
after meals, CBC
baseline and
throughout
treatment.
Func class: Adult: PO Increase:
hydrochlorothiazide Thiazide 12.5-100 hyperglycemia,
diuretic, anti- mg/day hyperuricemia,
hypertensive increased
(HCTZ, Esidrix, Geriatric: PO antihypertensives
Hydro-Chlor) Chem class: 12.5 mg/day, – diazoxide.
Sulfonamide initially Increase:
derivative hypokalemia –
glucocorticoids.
Increase: toxicity
– lithium, cardiac
glycosides.
Increase: renal
failure risk –
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NSAIDs.
Increases:
effects – loop
diuretics.
Drug/Herb:
severe
photosensitivity:
St John’s Wart.
Drugs/Lab Test:
Increase: BSP
retention,
amylase,
parathyroid test.
Decrease: PBI,
PSP.
Assess: Weight,
I&O daily to
determine fluid
loss; effect of
product may be
decreased if used
daily. Rate, depth,
rhythm of
respiration,
effect of
exertion. BP lying,
standing; postural
hypotension may
occur.
Func class: non- Adult and Hypoprothrombin
acetaminophen opioid analgesic, child >12 yr: ema: warfarin.
anti-pyretic PO/RECT 325 Renal adverse
– 650 mg q4- reactions:
Chem class: 6hr prn, max NSAIDs,
Nonsalicylate, 4 g/day. salicylates.
paraaminophenol Decrease: effect,
derivative increase
hepatotoxicity –
barbiturates,
alcohol,
carbamazepine,
etc. Decrease:
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absorption –
cholestyramine.
Drug/Herb-
Decrease:
acetaminophen
effect – St
John’s Wart.
Assess: Hepatic
studies: AST,
ALT, bilirubin,
creatinine prior
to therapy if
long-term
therapy is
anticipated; may
cause hepatic
toxicity at doses
>4 g/day with
chronic use. Renal
studies: BUN,
Urine creatinine,
occult blood,
albumin. I&O
ratio; decreasing
output may
indicate renal
failure.
Hepatotoxicity:
dark urine; clay-
colored stools;
yellowing of skin,
sclera; itching,
abdominal pain;
fever; diarrhea if
pt is on long-term
therapy.
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Func class: Anti- Hypertension Hyperkalemia:

lisinopril hypertensive, potassium salt
angiotensin- Adult: PO 10- substitutes,
(Prinivil, Zestril) converting 40 mg/day; potassium-sparing
enzyme (ACE) may increase diuretics,
inhibitor. to 80 mg/day potassium
if required. supplements.
Chem class: Possible toxicity:
Enalaprilat lysine Geriatric: PO lithium, digoxin
analog 2.5-5 mg/day, Decrease:
increase lisinopril effects
q7days. – aspirin,
NSAIDs.
CHF Drug/Herb –
Increase:
Adult: PO 5 toxicity, death –
mg initially aconite.
with Decrease:
diuretics/digo antihypertensive
xin, range 5- effect – guarana,
40 mg. khat, licorice.
Drug/Food –
High-potassium
diets (bananas,
orange juice,
avocados, nuts,
spinach) should
be avoided;
Hyperkalemia may
occur. Drug/Lab
Test-
Interference:
glucose/insulin
tolerance tests,
ANA titer.
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