acyclovir Tablets400, (CAN), capsules200 mg; suspension200 mg/5 Alti-Acyclovir 800 mg; Avirax (CAN), Zovirax mL; powder

Drug class for injection500 mg/vial, 1,000 mg/vial; injection 50 mg/mL; ointment50 mg/g; cream50 mg/g Antiviral Metabolism: T1/2 2.55 hr Purine nucleoside:analogue Distribution:actions placenta; enters breast milk Therapeutic Crosses Excretion: Unchanged in urine  Antiviral activity; inhibits viral DNA replication. Adverse effects  Aciclovir differs from previous nucleoside analogues in Systemic administration only a partial nucleoside structure: the that it contains CNS: Headache, an open-chain structure. It is sugar ring is replaced by vertigo, depression, tremors, encephalopathicconverted changes selectively into acyclo-guanosine Dermatologic: Inflammation or monophosphate (acyclo-GMP) by viralphlebitis at thymidine injection sites, is far more kinase, which rash, hair loss effective (3000 times) in GI: Nausea, than cellular anorexia phosphorylation vomiting, diarrhea,thymidine kinase. GU: Crystalluria with rapid form is further Subsequently, the monophosphate IV administration, hematuria phosphorylated into the active triphosphate form, acycloTopical administrationtriphosphate (acyclo-GTP), by cellular guanosine Dermatologic: a very potent inhibitor of viral kinases. Acyclo-GTP is Transient burning at site of application DNA polymerase; it has approximately 100 times greater Interactions affinity for viral than cellular polymerase. As a substrate, Systemic administration incorporated into viral DNA, resulting in acyclo-GTP is Drug-drug chain termination. It has also been shown that viral Increased effects with probenecid enzymes cannot remove acyclo-GTP from the chain, Increased nephrotoxicity with further activity drugs which results in inhibition of other nephrotoxicof DNA Extreme drowsiness with is fairly rapidly metabolised polymerase. Acyclo-GTP zidovudine Nursing considerations possibly by cellular phosphatases. within the cell, Assessment sum, aciclovir can be considered a prodrug: it is  In y History: Allergy inactive (or seizures, form renal administered in an to acyclovir,less active) CHF, and is disease, lactation, pregnancy

metabolised into a more active species after y Physical: Skin administration. color, lesions; orientation; BP, P, auscultation, perfusion, edema; R, adventitious sounds; Indications urinary output; BUN, creatinine clearance Initial and recurrent mucosal and cutaneous HSV 1 Interventions and 2 and varicella zoster infections in Systemic administration immunocompromised patients y Ensure Severe patient isand hydrated. genital herpes that the initial well recurrent infections in selected patients y Topical administration y Start Herpes simplex encephalitis after onset of signs treatment as soon as possible symptoms. and Treatment of neonatal herpes simplex virus infections y Wear a rubber glove or finger cot when applying drug. Acute treatment of herpes zoster (shingles) and Teachingpoints chickenpox Systemic administration Ointment: Initial HSV oral therapy, and do not y Complete the full course of genital infections; limited mucocutaneous HSV infections in immunocompromised exceed the prescribed dose. patients y Oral acyclovir is not a cure for your disease but should Cream: better. make you feel Recurrent herpes labialis (cold sores) in patients sexual intercourse while visible lesions are y Avoid > 12 yr Unlabeled uses: Cytomegalovirus and HSV present. infection following transplant, herpes simplex infections, y You may experience these side effects: Nausea, varicella pneumonia, disseminated primary eczema vomiting, loss of appetite, diarrhea; headache, dizziness. herpeticum y Report difficulty urinating, rash, increased severity or frequency of recurrences. Contraindications and cautions Topical administration Contraindicated with allergy to acyclovir, seizures, Wear rubber gloves or finger cots when applying CHF, renal disease, lactation. the drug to prevent autoinoculation of other sites and Use cautiously with pregnancy. transmission to others. Available forms

 This drug does not cure the disease; application normal bone development. should during symptom-free periodsHypocalcemia prevent will not therefore be recurrences. corrected before starting therapy. Indications Avoid sexual intercourse while visible lesions are Treatment and prevention of osteoporosis in present. postmenopausal women This drug may cause burning, stinging, itching, Treatment physician if these are pronounced. rash; notify yourof men with osteoporosis Treatment of glucocorticoid-induced osteoporosis Treatment of Paget's disease of bone in patients with alkaline phosphatase at least two times upper limit of normal, those who are symptomatic, those at risk for future complications Contraindications and cautions Contraindicated with allergy to biphosphonates; hypocalcemia. Use cautiously with renal dysfunction, upper GI disease, pregnancy, lactation. Metabolism: Not metabolized; T1/2: More than 10 yr Distribution: Crosses placenta; may enter breast milk Excretion: Urine Adverse effects CNS: Headache GI: Nausea, diarrhea, GI irritation, pain, esophageal erosion Skeletal: Increased or recurrent bone pain, focal osteomalacia

alendronate sodium Interactions Fosamax Drug-drug Drug classes Increased risk of GI distress with aspirin Bisphosphonate Decreased absorption if taken with antacids, calcium, Calcium regulator iron, multivalent cations; separate dosing by at least 30 min Therapeutic actions Drug-food  Slows normal and abnormal bone resorption without Significantly decreased absorption inhibiting bone formation and mineralization. and serum levels if taken inhibits  Alendronate with food; separate dosing from food and osteoclast-mediated bonebeverage by at least bisphosphonates it is chemically resorption. Like all30 min Nursing considerations related to inorganic pyrophosphate, the endogenous CLINICAL ALERT! bone turnover. Whereas pyrophosphate and regulator of Name confusion hasbisphosphonate, etidronate, (alendronate) and the first occurred between Fosamax are capable of Flomax (tamsulosin); useosteoclastic bone resorption as well as the inhibiting both caution. mineralization of the bone newly formed by osteoblasts, Assessment alendronate and the other potent N-containing History: Allergy to bisphosphonates, renal failure, bisphosphonates such as risedronate and ibandronate and upper GI disease, lactation, pregnancy zoledronate specifically inhibit bone resorption without Physical: mineralization at pharmacalogically any effect on Muscle tone, bone pain; bowel sounds; urinalysis, doses. Its inhibition of bone-resorption is achievable serum calcium dose-dependent and approximately 1,000 times stronger Interventions the equimolar effect of etidronate. Under therapy than WARNING: Give in AM and glass of water normal bone tissue develops,with fullalendronate is at least deposited30in min before the first beverage, food, or the bone-matrix in pharmacologically medication of For optimal action enough calcium 30 inactive form. the day. Patient must stay upright forand min to D are needed in the body serious esophageal vitamin decrease risk of potentiallyin order to promote erosion.

 Monitor serum calcium levels before, during, and Management of the signs and symptoms of primary after therapy. and Ensure 6-mo secondary gout rest period after treatment for Paget's Management of required. disease if retreatment is patients with malignancies that result Ensure adequate serum and urinary uric acid in elevations of vitamin D and calcium intake. Management of patients with pain returns. Provide comfort measures if bonerecurrent calcium oxalate calculi whose daily uric acid excretion exceeds Teaching 800 mg/day (males) or 750 mg/day (females) points Orphan drug morning with full glass disease; Take drug in use: Treatment aof Chagas' of plain cutaneous and visceral leishmaniasis minutes before any water (not mineral water), at least 30 Unlabeled medication, and stay upright for 30 beverage, food, or uses: Amelioration of granulocyte suppression with fluorouracil; as afood of the day; mark minutes and until after the first mouthwash to prevent fluorouracil-induced stomatitis calendar for once weekly dosing. Contraindications and cautions You may experience these side effects: Nausea, Contraindicated with allergy to allopurinol, diarrhea; bone pain, headache (analgesic may help).blood dyscrasias. Report twitching, muscle spasms, dark-colored urine, Use cautiously difficulty swallowing. severe diarrhea, with liver disease, renal failure, lactation, pregnancy. Metabolism: Hepatic; T1/2: 11.5 hr, then 2324 hr Distribution: Crosses placenta; may enter breast milk Excretion: Urine Adverse effects CNS: Headache, drowsiness, peripheral neuropathy, neuritis, paresthesias Dermatologic: Rashesmaculopapular, scaly or exfoliativesometimes fatal

GI: Nausea, vomiting, diarrhea, abdominal pain, allopurinol Aloprim, gastritis, hepatomegaly, hyperbilirubinemia, cholestatic Apo-Allopurinol (CAN), Purinol (CAN), Zyloprim jaundice Drug class Antigout drug GU: Exacerbation of gout and renal calculi, renal failure Therapeutic actions Hematologic: Anemia, leukopenia,  Inhibits the enzyme responsible for the conversion of agranulocytosis, thrombocytopenia, aplastic of uric purines to uric acid, thus reducing the productionanemia, bone marrow depression acid with a decrease in serum and sometimes in urinary Interactions acid levels, relieving the signs and symptoms of uric Drug-drug gout Increased structural isomer of hypoxanthine (a  Allopurinol is a risk of hypersensitivity reaction with ACE inhibitors naturally occurring purine in the body) and is an enzyme Increased toxicity with thiazide diuretics Xanthine inhibitor, inhibiting xanthine oxidase.[1] Increased risk of for the successive oxidase is responsiblerash with ampicillin oxidation of Increased risk of bone marrow the production of hypoxanthine and xanthine resulting in suppression with cyclophosphamide, other human agents uric acid, the product ofcytotoxicpurine metabolism.[1] Increased half-life of acid production, inhibition of In addition to blocking uricoral anticoagulants Increased serum levels of theophylline xanthine oxidase causes an increase in hypoxanthine and Increased are converted to closely related purine xanthine, whichrisk of toxic effects with thiopurines, 6MP (azathioprine dose and dose of monophosphates. ribotides adenosine and guanosine 6-MP should be reduced to levels of one-fourth the causes feedback Increased one-third tothese ribotidesusual dose) Nursing considerations inhibition of amidophosphoribosyl transferase, the first Assessment and rate-limiting enzyme of purine biosynthesis. History: Allergy to allopurinol, blood formation Allopurinol therefore decreases both uric aciddyscrasias, liver disease, renal failure, lactation and purine synthesis. Physical: Skin lesions, color; orientation, reflexes; Indications liver evaluation, normal urinary output; normal output; CBC, LFTs, renal function tests, urinalysis

Interventions subunits have different properties, different locations Administer drug following meals. within Encourage patient whatdrink significant, L/day to the brain, and, to is 2.5 to 3 different activities the risk of renal stone development. with regard to benzodiazepines. decrease Benzodiazepines and in particular alprazolam causes a Check urine alkalinityurates crystallize in acid marked suppression of the hypothalamicpituitary-adrenal urine; sodium bicarbonate or potassium citrate may be axis. The alkalinize properties of alprazolam is similar ordered totherapeuticurine. to WARNING: Discontinue drug at first anxiolytic, other benzodiazepines and include sign of skin anticonvulsant, muscle relaxant, hypnotic and amnesics. rash; severe to fatal skin reactions have occurred. Indications Arrange for regular medical follow-up and blood tests. Management of anxiety disorders, short-term relief Teaching of symptoms of anxiety; anxiety associated with points depression.the drug after meals. Take Treatment of panic attacks with or without Avoid over-the-counter medications. Many of these agoraphobia contain vitamin C or other agents that might preparations Unlabeled uses: Social phobia, premenstrual increase the likelihood of kidney stone formation. If you syndrome, depression need an over-the-counter preparation, check with your Contraindications and cautions health care provider. Contraindicated with hypersensitivity to You may experience these side effects: benzodiazepines, gouty attack oracute stones (drink psychoses, Exacerbation of renal narrow-angle glaucoma, shock, coma, acute alcoholic intoxication with plenty 2.53 L/dayof fluids while on this drug); depression of vital of appetite (take after meals or the nausea, vomiting, loss signs, pregnancy (crosses eat placenta; small of congenital malformations, neonatal frequent risk meals); drowsiness (use caution while withdrawal syndrome), labor tasks). driving or performing hazardous and delivery ("floppy infant" syndrome), lactation (secreted in fever, chills; Report unusual bleeding or bruising; breast milk; infants become lethargic and lose weight). skin rash. gout attack; numbness or tingling; flank pain, Use cautiously with impaired liver or kidney function, debilitation. Metabolism: Hepatic; T1/2: 6.326.9 hr

alprazolam Distribution: Crosses placenta; enters (CAN), Niravam, NovoAlprazolam Intensol, Apo-Alpraz breast milk Excretion: Urine Alprazol (CAN), Nu-Alpraz (CAN), Xanax, Xanax TS (CAN), Adverse effects Xanax XR ransient, mild drowsiness initially; CNS: sedation, depression, lethargy, apathy, fatigue, lightDrug classes headedness, disorientation, anger, hostility, episodes of Benzodiazepine mania and hypomania, restlessness, confusion, crying, Anxiolytic delirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia, vertigo, euphoria, nervousness, Therapeutic actions difficulty in concentration, not dreams, psychomotor  Exact mechanisms of actionvividunderstood; main sites retardation, extrapyramidal symptoms; mild paradoxical of action may be the limbic system and reticular excitatory first wk of formation; reactions duringthe 2effects treatment increases of gamma CV: Bradycardia, tachycardia, CV anxiety aminobutyrate, an inhibitory neurotransmitter;collapse, hypertension, hypotension, palpitations, edema blocking effects occur at doses well below those Dermatologic: Urticaria, pruritus, rash, dermatitis necessary to cause sedation, ataxia. EENT: Visual and a high-potency benzodiazepine  Alprazolam is classed as auditory disturbances, diplopia, nystagmus, depressed hearing, nasal is, a benzodiazepine and is a triazolobenzodiazepine, that congestion with GI: Constipation, diarrhea, dry to its salivation, a triazole ring attached mouth, structure. nausea, anorexia, vomiting, difficulty in swallowing, Benzodiazepines produce a variety of therapeutic and gastric effects by binding to the benzodiazepine site on adversedisorders, hepatic dysfunction GU: receptor and changes the function of the the GABAA Incontinence, modulatingin libido, urinary retention, menstrual irregularities GABA receptor, the most prolific inhibitory receptor Hematologic: Elevations of blood enzymesLDH, within the brain. The GABA chemical and receptor alkaline phosphatase, AST, or blood effects of system mediates inhibitory ALT; calming dyscrasias agranulocytosis, leukopenia alprazolam on the nervous system. The GABAA receptor Other: Hiccups, fever, diaphoresis, paresthesias, is made up from 5 subunits out of a possible 19, and muscular disturbances, gynecomastia. Drug dependence GABAA receptors made up of different combinations of with withdrawal syndrome when drug is discontinued;

more common with abrupt discontinuation of higher Avoid for longer than 4 mo dosage used alcohol, sleep-inducing, or over-the-counter drugs. Interactions You may experience these side effects: Drug-drug Drowsiness, dizziness (these with alcohol, other CNS Increased CNS depression effects will be less pronounced propoxyphene depressants, after a few days, avoid driving a car or engaging in other dangerous activities if these disulfiram, Increased effect with cimetidine, occur); GI upset (take drug with food); fatigue; depression; valproic omeprazole, isoniazid, hormonal contraceptives, dreams; crying; nervousness. acid Report severe dizziness, weakness, drowsiness that Decreased effect with carbamazepine, rifampin, persists, rash or skin lesions, difficulty voiding, theophylline palpitations, swelling in the extremities. Possible increased risk of digitalis toxicity with digoxin Decreased antiparkinson effectiveness of levodopa with benzodiazepines Contraindicated with ketoconazole, itraconazole; serious toxicity can occur Drug-food Decreased metabolism and risk of toxic effects if combined with grapefruit juice; avoid this combination Drug-alternative therapy Risk of coma if combined with kava therapy Additive sedative effects with valerian root Nursing considerations CLINICAL ALERT!

Name confusion has occurred among Xanax (alprazolam), Celexa aminophylline (theophylline ethylenediamine) (citalopram), and Cerebyx (fosphenytoin), and between alprazolam Truphylline use caution. and lorazepam; Assessment Drug classes History: Hypersensitivity to benzodiazepines; Bronchodilator psychoses; acute narrow-angle glaucoma; shock; coma; Xanthine acute alcoholic intoxication with depression of vital signs; labor and delivery; lactation; impaired liver or Therapeutic actions kidney function; debilitation  Relaxes bronchial smooth muscle, causing Physical: Skin color, lesions; T; orientation, bronchodilation and increasing vital capacity, which BP; reflexes, affect, ophthalmologic examination; P, has been evaluation,by bronchospasm and air trapping; in liver impaired abdominal examination, bowel sounds, higher concentrations, it also inhibits the release of slownormal output; CBC, LFTs, renal function tests reacting substance of anaphylaxis (SRS-A) and Interventions histamine. Arrange to taper dosage gradually after long-term 1. competitive especially in epileptic patients. inhibitor which therapy, nonselective phosphodiesterase raises intracellular not administer with grapefruit juice. Do cAMP, activates PKA, inhibits TNF-alpha and leukotriene synthesis, drug slowly; decrease by no and innate Taper and reduces inflammation more than immunity 0.5 mg every 3 days. and 2. nonselective adenosine receptor antagonist  points Teaching Aminophylline is less potent and shorter-acting than theophylline. Its most common use as in the treatment of Take this drug exactly is prescribed; take bronchial asthma. form once a day in the AM; place extended-release  Causes disintegrating tablet diuresis, of tongue, where it rapidly bronchodilatation, on top CNS and cardiac stimulation, and gastric acid secretion by blocking will disintegrate and can be swallowed with saliva. phosphodiesterase grapefruit juice while on this drug. Do not drink which increases tissue concentrations of cyclic adenine monophosphate(in long-term therapy) Do not stop taking drug (cAMP) which in turn promotes catecholamine stimulation of lipolysis, without consulting health care provider.

glycogenolysis, and gluconeogenesis and induces release Increased effects with cimetidine, of epinephrine from adrenal medulla cells erythromycin, troleandomycin, clindamycin, lincomycin, influenza Indications virus vaccine, fluoroquinolones,prevention contraceptives Symptomatic relief or hormonal of bronchial asthmaPossibly increased effects withassociated with and reversible bronchospasm thiabendazole, rifampin, allopurinol emphysema chronic bronchitis and Increased cardiacRespiratory stimulant inincreased Unlabeled uses: toxicity with halothane; Cheynelikelihood of seizures when given with ketamine; Stokes respiration; treatment of apnea and bradycardia in increased likelihood of adverse GI effects when given premature babies with tetracyclines Increased or decreased effects with furosemide, Contraindications and cautions levothyroxine, liothyronine, hypersensitivity to any liotrix, thyroglobulin, Contraindicated with thyroid hormones xanthine or to ethylenediamine, peptic ulcer, active Decreased effects in patients or are cigarette gastritis; rectal or colonic irritation whoinfection (use smokers (12 packs rectal preparations). per day); theophylline dosage may need to be increased 50%100% Use cautiously with cardiac arrhythmias, acute Decreased effects phenobarbital, myocardial injury, CHF, corwith pulmonale, severe aminoglutethimide hypertension, severe hypoxemia, renal or hepatic Increased effects, alcoholism, labor, lactation, disease, hyperthyroidism,toxicity of sympathomimetics (especially pregnancy. ephedrine) with theophylline preparations Decreased effects of phenytoin and theophylline Available preparations when given concomitantly Decreased effects of lithium carbonate, Metabolism: Hepatic; T1/2: 315 hr nondepolarizing neuromuscular milk Distribution: Crosses placenta; enters breastblockers given with theophylline preparations Excretion: Urine Mutually antagonistic effects of beta-blockers and theophylline preparations Adverse effects Drug-food

Serum theophylline levels < 20 mcg/mL: Adverse effectsElimination is increased by a low-carbohydrate, uncommon high-protein diet and by charcoal-broiled beef mcg/mL: Serum theophylline levels > 2025 Elimination is diarrhea, a high-carbohydrate, Nausea, vomiting, decreased byheadache, insomnia, low-protein diet of patients) irritability (75% Food may alter bioavailability and absorption of Serum theophylline levels > 3035 mcg/mL: timed-release theophylline preparations, causing toxicity; Hyperglycemia, hypotension, cardiac arrhythmias, these forms should be taken onin premature newborns); tachycardia (> 10 mcg/mL an empty stomach Drug-lab seizures, brain damage test Interference with spectrophotometric CNS: Irritability (especially children); restlessness, determinations of serum seizures, severe depression, dizziness, muscle twitching, theophylline levels by furosemide, speech; abnormal probenecid, theobromine; stammering phenylbutazone, behavior characterized by coffee, tea, cola beverages, chocolate, acetaminophen withdrawal, mutism, and unresponsiveness alternating causehyperactive periods with falsely high values Alteration in assays tachycardia, ventricular CV: Palpitations, sinus of uric acid, urinary catecholamines, plasma free fatty acids by theophylline tachycardia, life-threatening ventricular arrhythmias, preparations circulatory failure GI: Loss of appetite, hematemesis, epigastric pain, Nursing considerations reflux during sleep, increased AST gastroesophageal Assessment GU: Proteinuria, increased excretion of renal History: Hypersensitivity (dehydration), urinary tubular cells and RBCs; diuresis to any xanthine or to ethylenediamine, peptic ulcer, active gastritis, cardiac retention in men with prostate enlargement arrhythmias, acute myocardial injury, CHF, cor Respiratory: Tachypnea, respiratory arrest pulmonale, severe hypertension,hyperglycemia, SIADH, Other: Fever, flushing, severe hypoxemia, renal or hepatic disease, hyperthyroidism, alcoholism, labor, rash lactation, rectal or colonic irritation or infection Interactions (aminophylline rectal preparations) Drug-drug Physical: Bowel sounds, normal output; P, auscultation, BP, perfusion, ECG; R, adventitious

sounds; frequency of urination, voiding, normal output Cordarone, Pacerone pattern, urinalysis, LFTs, renal function tests; liver Drug classes palpation; thyroid function tests; skin color, texture, Antiarrhythmic reflexes, bilateral grip strength, affect, EEG lesions; Adrenergic blocker (not used as sympatholytic drug) Interventions Therapeutic actions Administer to pregnant patients only when clearly  Type III antiarrhythmic: Acts directly on cardiac and cell neededneonatal tachycardia, jitteriness, membrane; apnea observed when mothers refractory withdrawal prolongs repolarization and received period; increases delivery. fibrillation threshold; acts xanthines up until ventricular on peripheral patient notmuscle to decrease peripheral Caution smooth to chew or crush enteric-coated resistance timed-release forms.  Amiodarone is categorized as a classdosage forms with Give immediate-release, liquid III antiarrhythmic agent, GI effects occur. food if and prolongs phase 3 of the cardiac action potential. not give timed-release formseffectsfood; these Do It has numerous other with however, including given on an empty stomach 1 hr to those 2 hr should be actions that are similar before or of antiarrhythmic classes Ia, II, and IV. after meals.  Amiodarone shows beta blocker-like and potassium Maintain adequate hydration. channel blocker-like actions serum theophylline nodes, Monitor results of on the SA and AV levels increases and arrange for reduced dosage if serum levels carefully, the refractory period via sodium- and potassium-channel range of 1020 mcg/mL. intra-cardiac exceed therapeutic effects, and slows conduction of the cardiac action potential, via sodium Take serum samples to determine peak channel effects. theophylline concentration drawn 1530 min after an IV  Amiodarone resembles thyroid hormone, and its binding loading dose. to the nuclear thyroid receptor might contribute to some Monitor for clinical signs of adverse effects, of its pharmacologic and toxic actions levels are not particularly if serum theophylline Indications available. Only for treatment of the following documented Ensure that diazepam is readily available to treat life-threatening recurrent ventricular arrhythmias that do seizures. not respond to other antiarrhythmics or when alternative

Teaching points agentsTake thisnot tolerated:as Recurrent if a timedare drug exactly prescribed; ventricular fibrillation, recurrent hemodynamically an empty release product is prescribed, take this drug on unstable ventricular hour before or 2 hoursand even fatal toxicity stomach, 1 tachycardia. Serious after meals. has been not to chew or crush timed-release preparations. Do reported with this drug; use alternative agents first; very closely monitorsolution receiving this drugafter Administer rectal patient or suppositories Unlabeled uses: emptying the rectum. Treatment of refractory sustained or paroxysmal necessaryfibrillation and around-the It may be atrial to take this drug paroxysmal supraventricular tachycardia;asthma attacks.symptomatic clock for adequate control of treatment of atrial flutter excessive intake of coffee, tea, cocoa, cola Avoid Contraindications and cautions beverages, and chocolate. Contraindicated hypersensitivity to Smoking cigarettes withother tobacco products or amiodarone, sinus node dysfunction,Try not to smoke. impacts the drug's effectiveness. heart block, severe bradycardia, hypokalemia, lactation. if smoking habits Notify your health care provider Use cautiously with thyroid dysfunction, change while taking this drug. pregnancy. Frequent blood tests may be necessary to monitor Adverse the effect of this drug and to ensure safe and effective effects CNS: Malaise, fatigue, for blood tests and other dosage; keep all appointmentsdizziness, tremors, ataxia, paresthesias, lack of coordination monitoring. CV: Cardiac arrhythmias, side cardiac arrest, You may experience these CHF,effects: Nausea, hypotension loss of appetite (taking this drug with food may help if takingEENT: Corneal microdeposits (photophobia, dry the immediate-release or liquid dosage forms); eyes, halos,sleeping, vision); ophthalmic abnormalities blurred depression, emotional lability difficulty including permanent blindness (reversible). Endocrine: nausea, vomiting, hyperthyroidism Report Hypothyroidism or severe GI pain, GI: seizures, irregular anorexia, restlessness,Nausea, vomiting, heartbeat. constipation, abnormal LFTs, liver toxicity Respiratory: amiodarone hydrochloride Pulmonary toxicitypneumonitis, infiltrates (shortness of breath, cough, rales, wheezes)

 Other: Photosensitivity, angioedema loss Interactions of appetite (take with meals; eat small, frequent meals); sensitivity to the sun (use a sunscreen or Drug-drug protective clothing when outdoors); constipation (a Increased digitalis toxicity with digoxin laxative may be ordered); tremors, twitching, dizziness, Increased quinidine toxicity with quinidine loss of coordination (do nottoxicity with procainamide Increased procainamide drive, operate dangerous machinery, or undertake tasks that require coordination Increased flecainide toxicity with amiodarone until drug effects stabilize and toxicity with phenytoin, Increased phenytoin your body adjusts to it). Report unusual bleeding or bruising; fever, chills; ethotoin intolerance to heat or cold; shortness of breath, difficulty Increased bleeding tendencies with warfarin breathing, cough; swellingand heart block with beta of ankles or fingers; Potential sinus arrest palpitations; difficulty with vision. blockers, calcium channel blockers Drug-lab test Increased T3 levels, increased serum reverse T3 levels Nursing considerations CLINICAL ALERT! Name confusion has occurred with amrinone (name has now been changed to inamrinone, but confusion may still occur); use caution. Assessment History: Hypersensitivity to amiodarone, sinus node dysfunction, heart block, severe bradycardia, hypokalemia, lactation, thyroid dysfunction, pregnancy Physical: Skin color, lesions; reflexes, gait, eye examination; P, BP, auscultation, continuous ECG monitoring; R, adventitious sounds, baseline chest xamitriptyline hydrochloride LFTs, serum electrolytes, T4, and ray; liver evaluation; Endep (CAN), Tryptanol (CAN) T3

Interventions Drug class Monitor cardiac rhythm continuously. TCA; tertiary amine Monitor for an extended period when dosage Therapeutic actions are made. adjustments Mechanism of action unknown; TCAsfor safe and effective serum WARNING: Monitor inhibit the reuptake of the neurotransmitters norepinephrine and serotonin, leading to an levels (0.52.5 mcg/mL). increase in their WARNING: Doses of CNS and peripheral effects; anticholinergic at digoxin, quinidine, receptors; procainamide, phenytoin, and warfarin may need to be sedative. Indications reduced one-third to one-half when amiodarone is started. Relief of symptoms of depression (endogenous most Give drug with sedative decrease may help when responsive); meals to effects GI problems. depression is associated with anxiety and sleep Arrange for ophthalmologic examinations; disturbance. any sign of optic neuropathy. reevaluate at Unlabeled periodic chest chronic evaluate Arrange foruses: Control of x-ray to pain (eg, intractable status (every 36 mo). pulmonary pain of cancer, central pain syndromes, peripheral neuropathies, periodic blood neuralgia, liver Arrange for regular postherpetic tests for tic douloureux); prevention of levels. of cluster and migraine enzymes, thyroid hormone onset Teaching headaches; treatment of pathologic weeping and points laughing secondary to forebrain diseasein relation to Drug dosage will be changed (due to MS), insomnia. response of arrhythmias; you will need to be hospitalized Contraindications and cautions therapy; you will be closely during initiation of drug Contraindicated changed. monitored when dosage iswith hypersensitivity to any tricyclic drug; concomitant therapy with an MAOI; Have regular medical follow-up, monitoring of recent rhythm, chest x-ray, eye examination, blood cardiac MI; myelography within previous 24 hr or scheduled within 48 hr; lactation. tests. Use experience these electroshock therapy; You maycautiously with side effects: Changes in preexisting CV dry eyes, sensitivity to light; wear vision (halos, disorders (severe coronary heart disease, progressive heart failure, angina pectoris, paroxysmal sunglasses, monitor light exposure); nausea, vomiting, tachycardia); angle-closure glaucoma, increased IOP,

urinary retention, ureteral or urethral spasm; seizure Drug-drug disorders; hyperthyroidism; impaired hepatic, renal function;Increased TCA levels and pharmacologic psychiatric patients (schizophrenic or paranoid (especially anticholinergic) effects with cimetidine, patients may exhibit a worsening of psychosis with TCA fluoxetine therapy); manic-depressive patients; elective surgery Increased TCA levels with methylphenidate, (discontinue as long as possible before surgery). Availablephenothiazines, hormonal contraceptives, disulfiram forms Hyperpyretic crises, severe seizures, hypertensive Injection10 mg/mL; tablets10, 25, 50, 75, 100, 150 mg episodes and deaths with MAOIs, furazolidone Increased antidepressant response and cardiac Metabolism: Hepatic; T1/2: 1050 hr arrhythmias placenta; enters breast milk Distribution: Crosses with thyroid medication Increased or decreased effects with estrogens Excretion: Urine Delirium with disulfiram Adverse effects Sympathetic hyperactivity, sinus tachycardia, hypertension, agitation with levodopa CNS: Disturbed concentration, sedation and Increased (atropine-like) effects, confusion anticholinergic biotransformation of TCAs in patients who smoke cigarettes (especially in elderly), hallucinations, disorientation, Increased sympathomimetic (especially betadecreased memory, feelings of unreality, delusions, adrenergic) effects of direct-acting sympathomimetic anxiety, nervousness, restlessness, agitation, panic, drugs (norepinephrine, epinephrine) mania, exacerbation insomnia, nightmares, hypomania, Increased anticholinergic effects of of psychosis, drowsiness, weakness, fatigue, headache, anticholinergic drugs (including numbness, tingling, paresthesias ofanticholinergic extremities, antiparkisonians)motor hyperactivity, akathisia, ataxia, incoordination, Increased responseneuropathy, CNS depression) (especially extrapyramidal tremors, peripheral to barbiturates symptoms, seizures, speech blockage, dysarthria, Decreased antihypertensive effect of tinnitus, altered EEG guanethidine, clonidine, other antihypertensives Decreased effects of indirect-acting sympathomimetic drugs (ephedrine)

CV: Orthostatic hypotension, hypertension, Nursing considerations syncope, tachycardia, palpitations, MI, arrhythmias, Assessment heart block, precipitation of CHF, CVA History: Hypersensitivity to any tricyclic sugar, Endocrine: Elevated or depressed blood drug; concomitant therapy with an MAOI; recent MI; elevated prolactin levels, inappropriate ADH secretion myelographyDry mouth, constipation, scheduled within GI: within previous 24 hr or paralytic ileus, 48 hr; lactation; EST; preexisting CV distress, diarrhea, nausea, vomiting, anorexia, epigastric disorders; angleclosure glaucoma, increased taste, increased salivation, flatulence, dysphagia, peculiar IOP, urinary retention, ureteral or urethral spasm; seizure disorders; stomatitis, glossitis, parotid swelling, abdominal cramps, hyperthyroidism; hepatitis, jaundice (rare), function; impaired hepatic, renal elevated black tongue, psychiatric patients; manic-depressive patients; elective transaminase, altered alkaline phosphatase surgery GU: Urinary retention, delayed micturition, dilation Physical: Weight; T; skin color, testicular of the urinary tract, gynecomastia, lesions; orientation, affect, reflexes, vision and hearing; P, BP, swelling; breast enlargement, menstrual irregularity and orthostatic BP, perfusion; decreased libido; impotence galactorrhea; increased or bowel sounds, normal output, liver evaluation; urine flow, normaldepression, including Hematologic: Bone marrow output; usual sexual function, frequency of eosinophilia, menses, breast and purpura, scrotal agranulocytosis; examination; LFTs,leukopenia CBC, ECG thrombocytopenia, urinalysis, Interventions Hypersensitivity: Rash, pruritus, vasculitis, Restrict drug access for depressed and potentially petechiae, photosensitization, edema (generalized, face, suicidal patients. tongue), drug fever Give IM onlySymptoms therapy is impossible. Withdrawal: when oral on abrupt discontinuation Do not therapy: nausea, headache, vertigo, of prolongedadminister IV. Administer nightmares, malaisemajor portion of dose at bedtime if drowsiness, severe anticholinergic effects occur (note Other: Nasal congestion, excessive appetite, that the change; may not tolerate single lacrimation, daily dose weight elderly sweating, alopecia, therapy). hyperthermia, flushing, chills Reduce dosage if minor side effects develop; Interactions discontinue if serious side effects occur.

Arrange for CBC if patient develops fever, sore Use cautiously with CHF, throat, or other sign of infection.pregnancy. Available forms Tablets2.5, 5, 10 mg Teaching points Take drug exactly as prescribed; do not stop Metabolism: Hepatic; T1/2: 3050 hr abruptly or without consulting health care provider. Distribution: Crosses placenta; may enter breast milk Avoid using alcohol, other sleep-inducing drugs, Excretion: Urine over-the-counter drugs. Adverse effects Avoid prolonged exposure to sunlight or CNS: Dizziness, light-headedness, headache, sunlamps; use a sunscreen or protective garments. asthenia, fatigue,experience these side effects: Headache, You may lethargy CV: drowsiness, weakness, blurred vision dizziness, Peripheral edema, arrhythmias Dermatologic: avoid driving (reversible; if severe,Flushing, rash and tasks requiring GI: Nausea, abdominal discomfort alertness while these persist); nausea, vomiting, loss of Interactions appetite, dry mouth (eat frequent small meals; use Drug-drug frequent mouth care and suck on sugarless candies); Possible increased serum levels and toxicity of nightmares, inability to concentrate, confusion; changes cyclosporine if taken concurrently in sexual function. Nursing considerations dry mouth, difficulty in urination, Report CLINICAL ALERT! excessive sedation. Name confusion has been reported between Norvasc (amlodipine) and Navane (thiothixene); use caution. Assessment History: Allergy to amlodipine, impaired hepatic or renal function, sick sinus syndrome, heart block, amlodipine besylate lactation, AmVaz, Norvasc CHF Physical: Skin lesions, color, edema; P, BP, baseline C Pregnancy CategoryECG, peripheral perfusion, auscultation; R,

Drug classes adventitious sounds; liver evaluation, GI normal output; Calcium channel-blocker LFTs, Antianginal drugrenal function tests, urinalysis Interventions Antihypertensive WARNING: Monitor patient carefully (BP, Therapeutic actions cardiac rhythm, and output) while adjusting drug to Inhibits the movement of calcium ions across the membranes of therapeutic dose; cells; inhibits transmembrane CHF. cardiac and arterial muscleuse special caution if patient hascalcium Monitor BP very carefully if patient is also in flow, which results in the depression of impulse formation on nitrates. specialized cardiac pacemaker cells, slowing of the velocity of Monitor conduction of the cardiac cardiac rhythm regularly during impulse, depression of myocardial stabilization of of coronary arteries and arterioles and contractility, and dilationdosage and periodically during long-term peripheraltherapy. these effects lead to decreased cardiac work, arterioles; Administer consumption, and meals. decreased cardiac oxygendrug without regard toin patients with Teaching points vasospastic (Prinzmetal's) angina, increased delivery of oxygen to cardiac cells. Take with meals if upset stomach occurs. You may experience these side effects: Nausea, vomiting (eat frequent small meals); headache (adjust Indications lighting, noise,pectoris due to coronary arterymay be Angina and temperature; medication spasm ordered). (Prinzmetal's variant angina) Report stable angina, alone or in combination Chronic irregular heartbeat, shortness of breath, swelling drugs with otherof the hands or feet, pronounced dizziness, constipation. Essential hypertension, alone or in combination with other antihypertensives Contraindications and cautions amoxicillin trihydrate Contraindicated with allergy to amlodipine, Amoxil, Amoxil Pediatric Drops, Apo-Amoxisick sinus syndrome, impaired hepatic or renal function, (CAN), DisperMox, Novamoxin (CAN), Nu-Amoxi (CAN), Trimox heart block (second or third degree), lactation. Drug class

Antibiotic (penicillinampicillin type) Nursing considerations Therapeutic actions Assessment  Bactericidal: Inhibits synthesis of cell wall of sensitive History: Allergies to penicillins, cephalosporins, or organisms, causing cell death. other allergens; renal disorders; lactation  Amoxicillin acts by inhibiting the synthesis of bacterial Physical: Culture infected area; skin color, linear cell wall. It inhibits cross-linkage between the lesion; R, adventitious sounds; chains that CBC, LFTs, renal peptidoglycan polymer bowel sounds;make up a major function tests, the cell walls of Hct, urinalysis component of serum electrolytes,both Gram-positive and Gram-negative bacteria Interventions Indications Culture infected areato susceptible strains of prior to treatment; reculture Infections due area if response is not as expected. Haemophilus influenzae, Escherichia coli, Proteus Give Neisseria gonorrhoeae, Streptococcus mirabilis, in oral preparations only; amoxicillin is not affected by food. pneumoniae, Enterococcus faecalis, streptococci, non Continue therapy staphylococci penicillinase-producing for at least 2 days after signs of infection have disappeared; continuation for 10 full days Helicobacter pylori infection in combination with is recommended. other agents Use corticosteroids, antihistamines for skin Post-exposure prophylaxis against Bacillus reactions. anthracis Unlabeled use: Chlamydia trachomatis in Teaching pregnancy points Take this drug around-the-clock. Contraindications and cautions Take the full coursewith allergies not stop because Contraindicated of therapy; do to penicillins, you feel better. or other allergens. cephalosporins, This antibiotic is renal disorders, lactation. Use cautiously with specific for this problem and Availableshould not be used to self-treat other infections. forms You may experience mg; side effects: Nausea, Chewable tablets125, 200, 250, 400these tablets500, 875 mg; vomiting, mg; powder frequent small meals); mg/mL; capsules250, 500 GI upset (eat for oral suspension50diarrhea; sore mouth (frequent mouth care may help).

125 mg/5 mL, 200 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL; tablets Report unusual bleeding or bruising, sore throat, for oral suspension200, 400 mg Available fever, rash, hives, severe diarrhea, difficulty breathing. in oral preparations only. Metabolism: T1/2: 11.4 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine, unchanged Adverse effects CNS: Lethargy, hallucinations, seizures GI: Glossitis, stomatitis, gastritis, sore mouth, furry tongue, black "hairy" tongue, nausea, vomiting, diarrhea, abdominal pain, bloody diarrhea, enterocolitis, pseudomembranous colitis, nonspecific hepatitis GU: Nephritis Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time Hypersensitivity: Rash, fever, wheezing, anaphylaxis Other: Superinfectionsoral and rectal moniliasis, vaginitis Interactions Drug-drug Increased effect with probenecid ampicillin Decreased effectiveness with tetracyclines, ampicillin sodium chloramphenicol Oral: Decreased efficacy of hormonal contraceptives Ampicin (CAN), Apo-Ampi (CAN), Novo-Ampicillin (CAN), Drug-food Nu-Ampi(CAN), Penbritin (CAN), Principen with food Delayed or reduced GI absorption Drug classes

Antibiotic Drug-drug Penicillin Increased ampicillin effect with probenecid Therapeutic actions Increased risk of rash sensitive organisms; inhibits  Bactericidal action against with allopurinol Increased bleeding effect with death. synthesis of bacterial cell wall, causing cellheparin, oral anticoagulants  penetrate Gram-positive and some Gram-negative Decreased effectiveness with tetracyclines, bacteria. It differs from penicillin only by the presence of chloramphenicol an amino group. That amino group helps the drug Decreased membrane hormonal contraceptives, penetrate the outerefficacy of of gram-negative bacteria. atenolol with ampicillin  Ampicillin acts as a competitive inhibitor of the enzyme Drug-food transpeptidase, which is needed by bacteria to make their Oral ampicillin may be less effective with food; cell walls. It inhibits the third and final stage of bacterial take wall empty stomach cell on ansynthesis in binary fission, which ultimately Drug-lab test to cell lysis.The holes that appear in the cell walls leads allow False-positive Coombs' test ifto take IV and fight the bodys immune system given over off theDecrease in plasma has received FDA approval bacteria. Ampicillin estrogen concentrations in pregnant women for its action of mechanism. False-positive urine glucose tests if Clinitest, Indications Benedict's solution, infections caused by susceptible Treatment of or Fehling's solution is used; enzymatic glucose Salmonella, E. coli, H. influenzae, P. strains of Shigella, oxidase methods (Clinistix, Tes-Tape) should be usedgonorrhoeae, enterococci, gram-positive mirabilis, N. to check urine glucose Nursing considerations organisms (penicillin Gsensitive staphylococci, Assessment streptococci, pneumococci) History: Allergies by penicillins, cephalosporins, or Meningitis caused to Neisseria meningitidis other allergens; renal disorders; lactation Unlabeled use: Prophylaxis in cesarean section in Physical: patients certain high-riskCulture infected area; skin color, lesion; R, adventitious sounds; Contraindications and cautions bowel sounds; CBC, LFTs, renal function tests, serum electrolytes, Hct, urinalysis Interventions

Contraindicated with allergies to penicillins, Culture infected allergens. cephalosporins, or other area before treatment; reculture area if response is not as expected. Use cautiously with renal disorders. Check IV site carefully for signs of thrombosis or Available forms drug reaction. Capsules250, 500 mg; powder for oral suspension125 mg/5 Do powder IM injections in the same site; g mL, 250 mg/5 mL; not give for injection250, 500 mg, 1, 2atrophy can occur. Monitor injection sites. Administer Metabolism: T1/2: 12 hr oral drug on an empty stomach, 1 hr before or 2 placenta; enters breast milk Distribution: Crosseshr after meals with a full glass of water; do not give unchanged Excretion: Urine, with fruit juice or soft drinks. Teaching points Take this drug around-the-clock. Adverse effects Take Lethargy, hallucinations, do not CNS: the full course of therapy;seizures stop taking the drug if CHFfeel better. CV: you Take Glossitis,drug on an empty stomach, mouth, GI: the oral stomatitis, gastritis, sore 1 hour beforetongue, black "hairy" tongue,take with fruit juice furry or 2 hours after meals; do not nausea, vomiting, or soft drinks; the oral solution is stable for 7 days at diarrhea, abdominal pain, bloody diarrhea, enterocolitis, room temperature or colitis, nonspecific hepatitis pseudomembranous 14 days refrigerated. This antibiotic GU: Nephritis is specific to your problem and should not be used to self-treat other infections. Hematologic: Anemia, thrombocytopenia, You neutropenia, prolonged bleeding time leukopenia, may experience these side effects: Nausea, vomiting, GI upset (eat frequent small fever, diarrhea. Hypersensitivity: Rash, meals), wheezing, Report anaphylaxis pain or discomfort at sites, unusual bleeding or bruising, Pain, phlebitis, rash, hives, at injection site Local: mouth sores, thrombosis fever, itching, severe diarrhea, difficulty breathing. (parenteral) Other: Superinfectionsoral and rectal moniliasis, vaginitis Interactions

 Reduction of risk of recurrent TIAs or stroke in males with history of TIA due to fibrin platelet emboli Reduction of risk of death or nonfatal MI in patients with history of infarction or unstable angina pectoris MI prophylaxis Unlabeled use: Prophylaxis against cataract formation with long-term use Contraindications and cautions Contraindicated with allergy to salicylates or NSAIDs (more common with nasal polyps, asthma, chronic urticaria); allergy to tartrazine (cross-sensitivity to aspirin is common); hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, vitamin K deficiency (increased risk of bleeding) Use cautiously with impaired renal function; chickenpox, influenza (risk of Reye's syndrome in children and teenagers); children with fever accompanied by dehydration; surgery scheduled within 1 wk; aspirin pregnancy (maternal anemia, antepartal and postpartal Apo-ASAhemorrhage, prolonged gestation, andEcotrin, Empirin, (CAN), Aspergum, Bayer, Easprin, prolonged labor Entrophenhave beenGenprin, Halfprincrosses the placenta; possibly (CAN), reported; readily 81, 1/2 Halfprin, Heartline, Norwich, teratogenic; maternal ingestion of ZORprinduring late Novasen (CAN), PMS-ASA (CAN), aspirin pregnancy has Buffered aspirin products: been associated with the following adverse fetal effects: low birth weight, increased Alka-Seltzer, Ascriptin, Asprimox, Bufferin, Buffex, Magnaprin intracranial hemorrhage, stillbirths, neonatal death); lactation.

Drug classes Available forms Antipyretic Tablets81, 165, 325, 500, 650, 975 mg; SR tablets650, Analgesic (nonopioid) 800 mg; suppositories120, 200, 300, 600 mg Anti-inflammatory Antirheumatic Antiplatelet Metabolism: Hepatic (salicylate); T1/2: 15 min12 hr Salicylate Distribution: Crosses placenta; enters breast milk NSAID Excretion: Urine Therapeutic actions Adverse effects Analgesic and antirheumatic effects are attributable to aspirin's Acute synthesis of prostaglandins, alkalosis, ability to inhibit the aspirin toxicity: Respiratory important tachypnea, hemorrhage, mediators hyperpnea, of inflammation. Antipyretic effects areexcitement, not fully confusion, asterixis, pulmonary edema, seizures, tetany, understood, but aspirin probably acts in the thermoregulatory metabolic acidosis, block coma, of endogenous pyrogen center of the hypothalamus to fever, effects CV collapse, renal and respiratory failure (dose related, 2025 g adults, 4 g in by inhibiting synthesis of the prostaglandinin intermediary. Inhibition children) aggregation is attributable to the inhibition of of platelet Aspirin intolerance: Exacerbation of platelet synthesis of thromboxane A2, a potent vasoconstrictor and inducer ofbronchospasm, rhinitis (with nasal polyps,doses and platelet aggregation. This effect occurs at low asthma, rhinitis) lasts for the life of the platelet (8 days). Higher doses inhibit the GI: Nausea, dyspepsia, heartburn, epigastric synthesis of prostacyclin, a potent vasodilator and inhibitor of discomfort, platelet aggregation. anorexia, hepatotoxicity Hematologic: Occult blood loss, hemostatic defects Indications Hypersensitivity: Mild to moderate painAnaphylactoid reactions to anaphylactic shock Fever Salicylism: Dizziness, tinnitus, difficulty hearing, Inflammatory conditionsrheumatic fever, nausea, vomiting, diarrhea, mental rheumatoid arthritis, osteoarthritis confusion, lassitude (dose related) Interactions

Drug-drug Physical: Skin color, lesions; T; eighth cranial Increased risk of bleeding with oral anticoagulants, nerve function, orientation, reflexes, affect; P, BP, heparin perfusion; R, adventitious sounds; liver evaluation, Increased risk of GI ulceration with steroids, bowel sounds; CBC, clotting times, urinalysis, stool phenylbutazone, alcohol, NSAIDs guaiac, LFTs, renal function tests levels due to decreased Increased serum salicylate Interventions salicylate excretion with urine acidifiers (ammonium Give drug acid, methionine) chloride, ascorbic with food or after meals if GI upset occurs. Increased risk of salicylate toxicity with carbonic Give drug with full glass of anhydrase inhibitors, furosemide water to reduce risk of tablet orDecreased serumthe salicylate levels with capsule lodging in esophagus. Do not crush, and ensure that patient does not chew corticosteroids SR preparations. serum salicylate levels due to increased Decreased renal Do not use aspirin that has with acetazolamide, excretion of salicylates a strong vinegar-like odor. methazolamide, certain antacids, alkalinizers WARNING: Institute emergency aspirin with procedures if Decreased absorption of overdose occurs: Gastric lavage, induction of emesis, nonabsorbable antacids activated charcoal, supportive therapy. and toxicity with Increased methotrexate levels Teaching aspirin points Take extra effects of valproic this drug out of the Increased precautions to keep acid secondary to reach of children; this drug can sites displacement from plasma protein be very dangerous for children. Greater glucose lowering effect of sulfonylureas, Use the drug only 2 suggested; avoid insulin with large doses (>as g/day) of aspirin overdose. Avoid Decreasedofantihypertensive effect of captopril, the use other over-the-counter drugs while taking this drug. Many of with salicylates; aspirin, beta-adrenergic blockers these drugs containconsider and serious overdose can discontinuation of aspirin occur. Take the drug uricosuric or after meals probenecid, Decreased with food effect of if GI upset occurs. sulfinpyrazone

Possible decreased diuretic effects of Do not spironolactone, cut, crush, or chew sustained-release furosemide (in patients with products. compromised renal function) Over-the-counter aspirins aremay occur Price equivalent. with Unexpected hypotension does not reflect nitroglycerin effectiveness. Drug-lab test You may experience these side effects: Nausea, GI upset,Decreased serum protein bound iodine (PBI) due to heartburn (take drug with food); easy bruising, gum bleeding (related to competition for binding sites aspirin's effects on blood clotting). False-negative readings for urine glucose by Report ringing in and copper reduction method glucose oxidase method the ears; dizziness, confusion; abdominal pain; rapid or of aspirin with moderate to large doses difficult breathing; nausea, vomiting, bloody stools.urine 5-HIAA determinations by Interference with fluorescent methods but not by nitrosonaphthol colorimetric method Interference with urinary ketone determination by the ferric chloride method Falsely elevated urine VMA levels with most tests; a false decrease in VMA using the Pisano method Nursing considerations Assessment History: Allergy to salicylates or NSAIDs; allergy to tartrazine; hemophilia, bleeding ulcers, hemorrhagic states, blood coagulation defects, hypoprothrombinemia, atenolol vitamin K deficiency; impaired hepatic function; Apo-Atenolol (CAN), Gen-Atenolol (CAN), Novo-Atenol children impaired renal function; chickenpox, influenza; (CAN), Tenorminwith fever accompanied by dehydration; surgery scheduled within 1 wk; pregnancy; lactation Drug classes Beta1-selective adrenergic blocking agent

Antianginal hypoglycemia, elevated serum transaminase, alkaline Antihypertensive phosphatase, Therapeutic actions and LDH Interactions Blocks beta-adrenergic receptors of the sympathetic nervous Drug-drug system in the heart and juxtaglomerular apparatus (kidney), thus Increased of the heart, decreasing cardiac output decreasing the excitabilityeffects with verapamil, anticholinergics, quinidine and oxygen consumption, decreasing the release of renin from the Increased kidney, and lowering BP. risk of orthostatic hypotension with prazosin Indications Increased risk ofangina pectoris due to coronary Treatment of lidocaine toxicity with atenolol Possible atherosclerosis increased BP-lowering effects with aspirin, bismuth subsalicylate, magnesium with other Hypertension, as a step 1 agent, alone or salicylate, sulfinpyrazone, hormonal drugs, especially diuretics contraceptives Decreased antihypertensive effects with NSAIDs, Treatment of MI clonidine Unlabeled uses: Prevention of migraine headaches; Decreased antihypertensive and antianginal effects alcohol withdrawal syndrome, treatment of ventricular of atenolol with ampicillin, calcium and supraventricular arrhythmias salts Possible increased Contraindications and cautions hypoglycemic effect of insulin Drug-lab test Contraindicated with sinus bradycardia, second- or Possible false results with glucose or CHF, third-degree heart block, cardiogenic shock, insulin tolerance tests pregnancy. Nursing considerations Use cautiously with renal failure, diabetes or Assessment thyrotoxicosis (atenolol can mask the usual cardiac signs History: Sinus bradycardia, second- lactation, of hypoglycemia and thyrotoxicosis), or thirddegree heart block, cardiogenic shock, CHF, renal respiratory disease. failure, diabetes or thyrotoxicosis, lactation, pregnancy Metabolism: T1/2Physical: Baseline weight, skin condition, : 67 hr neurologic status, P, enters breast milk Distribution: Crosses placenta;BP, ECG, respiratory status, renal

Excretion: Bile, feces, urine and thyroid function tests, blood and urine glucose, Adverse effects cholesterol, triglycerides Pharyngitis, erythematous rash, Allergic reactions: Interventions sore throat, laryngospasm, respiratory distress fever, WARNING: Do not vertigo, tinnitus, abruptly discontinue drug fatigue, CNS: Dizziness, after long-term (hypersensitivity to emotional depression, therapy paresthesias, sleep disturbances, catecholamines disorientation, memory loss, causing may have developed, hallucinations, slurred exacerbation of angina, MI, and ventricular arrhythmias). speech Taper drug gradually over 2CHF, cardiac arrhythmias, CV: Bradycardia, wk with monitoring. Consult physician about withdrawing drug if sinoatrial or AV nodal block, tachycardia, peripheral patient is to undergo surgery CVA, pulmonary vascular insufficiency, claudication, (withdrawal is controversial). edema, hypotension Teaching pointsDermatologic: Rash, pruritus, sweating, dry skin Take drugEye irritation,GI upset occurs. EENT: with meals if dry eyes, conjunctivitis, Do not stop taking this drug unless told to do so by blurred vision a healthGI: provider. pain, flatulence, constipation, care Gastric Avoid driving or dangerous activities if dizziness diarrhea, nausea, vomiting, anorexia, ischemic colitis, or weakness occur. arterial thrombosis, retroperitoneal renal and mesenteric You may experience these side effects: Dizziness, fibrosis, hepatomegaly, acute pancreatitis light-headedness, loss decreased libido, nightmares, GU: Impotence, of appetite, Peyronie's depression, sexual impotence. disease, dysuria, nocturia, frequent urination Report difficulty breathing, night cough, swelling Musculoskeletal: Joint pain, arthralgia, muscle of extremities, slow pulse, confusion, depression, rash, cramps fever, sore throat. Respiratory: Bronchospasm, dyspnea, cough, bronchial obstruction, nasal stuffiness, rhinitis, pharyngitis (less likely than with propranolol) Other: Decreased exercise tolerance, development of antinuclear antibodies, hyperglycemia or

to reduce the risk of MI and risk for revascularization procedures and angina Contraindications and cautions Contraindicated with allergy to atorvastatin, fungal byproducts, active liver disease or unexplained and persistent elevations of transaminase levels, pregnancy, lactation. Use cautiously with impaired endocrine function. Available forms Tablets10, 20, 40, 80 mg Metabolism: Hepatic and cellular; T1/2: 14 hr Distribution: Crosses placenta; enters breast milk Excretion: Bile Adverse effects CNS: atorvastatin calcium Headache, asthenia GI: Flatulence, abdominal pain, cramps, Lipitor constipation, nausea, dyspepsia, heartburn, liver failure Drug classes Respiratory: Sinusitis, pharyngitis Antihyperlipidemic Other: HMG-CoA inhibitor Rhabdomyolysis with acute renal failure, arthralgia, Therapeutic actionsmyalgia Interactions Inhibits HMG-CoA, the enzyme that catalyzes the first step in the Drug-drug cholesterol synthesis pathway, resulting in a decrease in serum Possible (associated with or rhabdomyolysis with cholesterol, serum LDLs severe myopathy increased risk of CAD), erythromycin, cyclosporine, niacin, antifungals, other and increases serum HDLs (associated with decreased risk of HMG-CoA reductase inhibitors

CAD); increases hepatic LDL recapture sites, enhances reuptake Increased digoxin levels with possible toxicity if and catabolism of LDL; lowers triglyceride levels. taken together; monitor digoxin levels Indications Increased estrogen levels with hormonal Adjunct to diet in treatment of elevated total contraceptives; monitor patients and LDL cholesterol cholesterol, serum triglycerides, on this combination in Drug-food patients with primary hypercholesterolemia (types IIa and Decreased metabolism and risk of toxic effects if IIb) and mixed dyslipidemia, primary combined with grapefruit juice; avoid this dysbetalipoproteinemia, and homozygous familial combination. hypercholesterolemia whose response to dietary Nursing considerations saturated fat and cholesterol and other restriction of CLINICAL ALERT! nonpharmacologic measures has not been adequate Name confusionTo increasereported between written orders for has been HDL-C in patients with primary Lipitor (atorvastatin) and Zyrtecand mixed dyslipidemia caution. hypercholesterolemia (certirizine). Use extreme Assessment Adjunt to diet to treat elevated serum triglyceride levels History: Allergy to atorvastatin, fungal byproducts; active hepatic in treatment serious illness; Adjunct to diet disease; acute of boys and pregnancy, lactation postmenarchal girls ages 1017 with heterozygous Physical: Orientation, affect, muscle strength; liver familial cholesterolemia if diet alone is not adequate to evaluation, abdominal examination; lipid > 190 LFTs, control lipid levels and LDL-C levels arestudies, mg/dL renal function tests or if LDL-C level is > 160 mg/dL and there is a family history of premature CV disease or the child has two or Interventions risk factors for the development of coronary more Obtain LFTs as a baseline and periodically during disease therapy; discontinue drug if AST or ALTadults increase Prevention of CV disease in levels without to 3 times normal levels. clinically evident coronary disease but with multiple risk WARNING: Withhold atorvastatin in smoking, factors for CAD such as age > 55 yr, any acute, serious condition HDL-C, family history of early major hypertension, low (severe infection, hypotension, CAD; surgery, trauma, severe metabolic or endocrine disorder,

seizures) that may suggest myopathy or serve as risk Parasympatholytic development of renal failure. factor for Antiparkinsonian Ensure that patient has tried cholesterol-lowering Antidote diet regimen for 36 mo before beginning therapy. Diagnostic agentAdminister drug without regard to food, but at (ophthalmic preparations) Belladonna alkaloid each day. same time Therapeutic actions Atorvastatin may be combined with a bile acid Competitively blocks theDo not combine with other HMG-CoA binding agent. effects of acetylcholine at muscarinic cholinergic receptors that mediate the effects of parasympathetic reductase inhibitors or fibrates. postganglionic Consult dietitian regarding low-cholesterol diets. impulses, depressing salivary and bronchial secretions, dilating the bronchi, inhibiting vagal influences on the WARNING: Ensure that patient is not pregnant heart, relaxinghas appropriate contraceptives available during and the GI and GU tracts, inhibiting gastric acid secretion therapy; serious fetal damage hasof the associated with (high doses), relaxing the pupil been eye (mydriatic effect), and preventing accommodation for near vision (cycloplegic this drug. effect); also blocks the effects of acetylcholine in the CNS. Indications Teaching points Systemic administration drug once a day, at about the same time Take this Antisialagogue the evening; may be taken with each day, preferably infor preanesthetic medication to prevent or not drink grapefruit juice while taking this food. Do reduce respiratory tract secretions drug. Treatment of parkinsonism; relieves tremor and rigidity Institute appropriate dietary changes. Restoration of periodic blood tests while you are Arrange to have cardiac rate and arterial pressure during this drug. when vagal stimulation produced by taking anesthesia intra-abdominal health care provider that you are onrate, Alert any traction causes a decrease in pulse this lessening the need to of AV block when increased vagal drug; it will degree be discontinued if acute injury or tone is occurs. (eg, some cases due to digitalis) illness a factor Relief of bradycardia while you are on to Do not become pregnant and syncope due this hyperactive carotid sinus reflex If you wish to become drug; use barrier contraceptives.

pregnant or think you are pregnant, consult your health Relief of care provider. pylorospasm, hypertonicity of the small intestine, and hypermotilitythese side effects: Nausea (eat You may experience of the colon Relaxation of the spasm muscle and joint aches frequent small meals); headache, of biliary and ureteral colic and bronchospasm time). and pains (may lessen over Relaxation of the tone of the detrusor muscle of the Report muscle pain, weakness, tenderness; malaise; urinary bladderin color of urine or stool; swelling. fever; changes in the treatment of urinary tract disorders Control of crying and laughing episodes in patients with brain lesions Treatment of closed head injuries that cause acetylcholine release into CSF, EEG abnormalities, stupor, neurologic signs Relaxation of uterine hypertonicity Management of peptic ulcer Control of rhinorrhea of acute rhinitis or hay fever Antidote (with external cardiac massage) for CV collapse from overdose of parasympathomimetic (cholinergic) drugs (choline esters, pilocarpine), or cholinesterase inhibitors (eg, physostigmine, isoflurophate, organophosphorus insecticides) atropine sulfateAntidote for poisoning by certain species of Parenteralmushroom (eg, Amanita muscaria) and oral preparations: Ophthalmic preparations Sal-Tropine AtroPen, Minims (CAN), Diagnostically to produce mydriasis and Ophthalmic solution: cycloplegia-pupillary dilation in acute Atropine Sulfate S.O.P., Isopto Atropine Ophthalmic inflammatory conditions of the iris and uveal tract Drug classes Contraindications and cautions Anticholinergic Antimuscarinic Contraindicated with hypersensitivity to anticholinergic drugs.

Systemic administration Assessment Contraindicated with glaucoma; adhesions between History: stenosing peptic anticholinergic drugs; iris and lens; Hypersensitivity toulcer; pyloroduodenal glaucoma; adhesions between intestinal lens; stenosing obstruction; paralytic ileus; iris and atony; severe peptic ulcer;colitis; toxic obstruction; paralytic ileus; ulcerative pyloroduodenal megacolon; symptomatic intestinal hypertrophy; bladder neck colitis; toxic prostatic atony; severe ulcerative obstruction; megacolon; symptomatic prostatic hypertrophy; bladder bronchial asthma; COPD; cardiac arrhythmias; neck obstruction; bronchial asthma; COPD; cardiac tachycardia; myocardial ischemia; impaired metabolic, arrhythmias; myocardial myastheniaimpaired metabolic, liver, or kidney function; ischemia; gravis. liver, or kidney function; myasthenia gravis; Down Use cautiously with Down syndrome, brain syndrome; spasticity, hypertension, hyperthyroidism, brain damage; spasticity; hypertension; damage, hyperthyroidism; lactation lactation. Physical: Skin color, lesions, texture; T; Ophthalmic solution orientation, reflexes, bilateral grip strength; affect; Contraindicated with glaucoma or tendency to ophthalmic examination; P, BP; R, adventitious sounds; glaucoma. Availablebowel sounds, normal GI output; normal urinary output, forms prostate palpation; LFTs, renal function tests, ECG Tablets0.4 mg; injection0.05, 0.1, 0.3, 0.4, 0.5, 0.8, 1 mg/mL; ophthalmic ointment1%; ophthalmic solution0.5%, 1%, 2%; Interventions auto-injector0.25, 0.5, 1, 2 mg Ensure adequate hydration; provide environmental control (temperature) to Metabolism: Hepatic; T1/2: 2.5 hr prevent hyperpyrexia. Have patient enters breast milk Distribution: Crosses placenta;void before taking medication if urinary Excretion: Urine retention is a problem. Teachingeffects Adverse points When used preoperatively Systemic administration or in other acute situations, incorporate teaching about the drugBlurredteaching about the procedure; the CNS: with vision, mydriasis, cycloplegia, ophthalmic solution is used mainly acutely and will not flushing, be selfphotophobia, increased IOP, headache, administered by the patient; the following apply insomnia, mental nervousness, weakness, dizziness, to oral medication for outpatients:

confusion or excitement (after even small doses in the Take as congestion elderly), nasalprescribed, 30 minutes before meals; avoid excessive dosage. CV: Palpitations, bradycardia (low doses), Avoid hot environments; you will be heat tachycardia (higher doses) intolerant, Dry dangerous reactions may occur. nausea, GI: and mouth, altered taste perception, You dysphagia, heartburn, constipation, bloated vomiting, may experience these side effects: Dizziness, confusion (use caution driving or performing hazardous feeling, paralytic ileus, gastroesophageal reflux tasks); constipationhesitancy and retention;intake, proper GU: Urinary (ensure adequate fluid impotence diet); Other: Decreased sweating and predisposition to dry mouth (sugarless lozenges, frequent mouth care prostration, suppression transient); blurred vision, heat may help; may be of lactation sensitivity to Ophthalmic preparationslight (reversible; avoid tasks that require acute Local: Transient stinging bright light); impotence vision; wear sunglasses in (reversible); difficulty in adverse effects, depending on Systemic: Systemic urination (empty the bladder prior to taking drug). amount absorbed Report rash; flushing; eye pain; difficulty Interactions breathing; tremors, loss of coordination; irregular Drug-drug heartbeat, palpitations; headache; abdominalother drugs Increased anticholinergic effects with distention; hallucinations; severe or persistent dry mouth; difficulty that have anticholinergic activitycertain swallowing; difficulty antiparkinsonian drugs, TCAs, antihistamines, certain in urination; constipation; sensitivity to light. MAOIs Decreased antipsychotic effectiveness of azithromycin haloperidol with atropine Zithromax, Zmax Decreased effectiveness of phenothiazines, but increased incidence of paralytic ileus Drug class If cholinesterase inhibitors and atropine are given Macrolidetogether, opposing effects will render both drugs antibiotic Therapeutic actions ineffective  Bacteriostatic Nursing considerationsor bactericidal in susceptible bacteria.

Azithromycin prevents bacteria from growing by GI: with their protein pain, nausea, dyspepsia, interferingDiarrhea, abdominal synthesis. Azithromycin flatulence, vomiting, melena, pseudomembranous colitis binds to the 50S subunit of the bacterial ribosome, and Other: Superinfections, angioedema, acid thus inhibits translation of mRNA. Nucleic rash, photosensitivity, vaginitis synthesis is not affected. Interactions Indications Drug-drug Treatment of lower respiratory infections: Acute Decreased serum COPD due effectiveness of bacterial exacerbations of levels and to H. influenzae, azithromycin with aluminum and magnesium-containing Moraxella catarrhalis, S. pneumoniae; communityantacids acquired pneumonia due to S. pneumoniae, H. influenzae Possible increased effects of theophyllineinfections: Treatment of lower respiratory Possible pharyngitis and tonsillitis due to Streptococcal increased anticoagulant effects of warfarin Drug-food Streptococcus pyogenes in those who cannot take Food greatly decreases the absorption of penicillins azithromycin of uncomplicated skin infections due to Treatment Nursing considerations aureus, S. pyogenes, Streptococcus Staphylococcus Assessment agalactiae History: of nongonococcal azithromycin, Treatment Hypersensitivity to urethritis and erythromycin, or any macrolide antibiotic; gonorrhea or cervicitis due to C. trachomatis; treatment of PID syphilis, pseudomembranous colitis, hepatic or renal Treatment of acute sinusitis impairment, lactation Treatment of otitis media caused by H. influenzae, Physical: pneumoniae in children color, M. catarrhalis, S.Site of infection; skin > 6 mo lesions; orientation, GI output, bowel sounds, liver evaluation; Treatment of pharyngitis and tonsillitis in children culture and sensitivity tests of infection, urinalysis, > 2 yr who cannot use first-line therapy LFTs, renal function and treatment of disseminated Prevention tests Mycobacterium avium complex (MAC) in patients with Interventions advanced AIDS Culture site of infection before therapy.

Treatment of patients with mild to moderate acute Administer on an empty H. influenzae, Moracellis bacterial sinusitis caused by stomach 1 hr before or 23 hr after meals. Food affectspneumoniae (Zmax) drug. catarrhalis, Streptococcus the absorption of this Prepare Zmax by adding 60 mL water to bottle, Treatment of mild to moderate communityshake well. pneumonia caused by Chlamydophila acquired Counsel patients being treated for STDs about pneumoniae, H. influenzae, Mycoplasma pneumoniae, appropriate precautions and(Zmax) Streptococcus pneumoniae additional therapy. Teaching points Unlabeled uses: Uncomplicated gonococcal Take caused by N. gonorrhoeae; gonococcal infections the full course prescribed. Do not take with antacids. Tablets and by N. gonorrhoeae; chlamydial pharyngitis caused oral suspension can be taken with or without food. by C. trachomatis; prophylaxis after infections caused Prepare sexual attack Zmax by adding 60 mL (1/4 cup) water to bottle, shake well, drink Contraindications and cautions all at once. You may experience with side effects: Stomach these hypersensitivity to Contraindicated cramping, discomfort, diarrhea; macrolide antibiotic. azithromycin, erythromycin, or any fatigue, headache (medication cautiously with gonorrhea or syphilis, Use may help); additional infections in the mouth or vagina (consult with health renal provider for pseudomembranous colitis, hepatic or care impairment, treatment). lactation. Report severe or watery diarrhea, severe nausea or Available forms vomiting, 600 itching, mouth sores, vaginal sores. Tablets250, 500,rash or mg; powder for injection500 mg; powder for oral suspension100 mg/5 mL, 200 mg/5 mL, 1 Metabolism: T1/2: 1148 hr beclomethasone dipropionate enters breast milk Distribution: Crosses placenta; Apo-Beclomethasone (CAN), Beclodisk (CAN), Becloforte Excretion: Bile, urineunchanged Inhaler (CAN), Beclovent Rotacaps (CAN), Beconase AQ, Propaderm (CAN), QVAR Adverse effects CNS: Dizziness, headache, vertigo, somnolence, Drug classes fatigue Corticosteroid

Glucocorticoid Hormone from adrenal insufficiency have occurred during and after transfer Therapeutic actions from systemic to aerosol steroids. Use decongestant nose drops into lower Anti-inflammatory effects; local administration to facilitate penetration of intranasal steroids beneficial excessive respiratory tract or nasal passages maximizes if edema, effects on secretions are decreasing the likelihood of adverse these tissues while present. corticosteroid effects from systemic absorption. Teaching points Indications This respiratory inhalant has been prescribed to Respiratory inhalant use: Control of bronchial prevent that requires corticosteroids along with other asthma asthmatic attacks, not for use during an attack. Allow at least 1 minute between puffs (respiratory therapy inhalant); if you Relief are symptoms of inhalational Intranasal use: also of using an seasonal or bronchodilator (isoproterenol, albuterol, metaproterenol, perennial rhinitis that respond poorly to other treatments; epinephrine), recurrence of nasal before following prevention of use it several minutes polyps using the steroid removal surgicalaerosol. Rinse cautions Contraindications and your mouth after using the respiratory inhalant aerosol. inhalant therapy: Contraindicated with Respiratory acute Use a decongestant before the intranasal steroid, asthmatic attack, status asthmaticus. Use caution and withclear your nose fungalsecretions if nasal passages are systemic of all infections (may cause blocked; intranasal steroids may take several excerbations), allergy to any ingredient, lactation days to produce full benefit. Intranasal therapy: Use caution with untreated local Use (may cause exactly as prescribed; do not take infections this product exacerbations); nasal septal ulcers, more than prescribed, and do not stop taking the drug recurrent epistaxis, nasal surgery or trauma (interferes without consulting your with healing); lactation health care provider. The drug Availablemust not be stopped abruptly but must be slowly tapered. forms You may effects: Local Aerosol40 mcg/actuation,experience these side nasal spray 80 mcg/actuation; 0.042% irritation (use the device correctly), headache (consult your health care provider for treatment). Metabolism: Lungs, GI, and liver; T1/2: 315 hr Report sore throat or sore mouth.

Distribution: Crosses placenta; may enter breast milk Excretion: Feces Adverse effects Respiratory inhalant use Endocrine: Cushing's syndrome with overdose, suppression of hypothalamic-pituitary-adrenal (HPA) function due to systemic absorption Local: Oral, laryngeal, pharyngeal irritation, fungal infections Intranasal use Local: Nasal irritation, fungal infections Respiratory: Epistaxis, rebound congestion, perforation of the nasal septum, anosmia Other: Headache, nausea, urticaria Nursing considerations Assessment History: Acute asthmatic attack, status asthmaticus; systemic fungal infections; allergy to any ingredient; lactation; untreated local infections, nasal septal ulcers, recurrent epistaxis, nasal surgery or trauma Physical: Weight, T; P, BP, auscultation; R, benazepril hydrochloride adventitious sounds; chest radiograph before respiratory Lotensin inhalant therapy; examination of nares before intranasal Drug classes therapy Antihypertensive ACE inhibitor Interventions Therapeutic actions WARNING: Taper systemic steroids carefully Blocks ACE from converting angiotensin I to angiotensin II, a during transfer to inhalational steroids; deaths resulting potent vasoconstrictor, leading to decreased BP, decreased

aldosterone secretion, a small increase in serum potassium levels, Monitor patient for possible fall in BP secondary to and sodium and fluid loss; increased prostaglandin synthesis also reduction in fluid volume (excessive may be involved in the antihypertensive action. perspiration and dehydration, vomiting, diarrhea) because excessive Indications hypotension mayof hypertension alone or in combination Treatment occur. WARNING: Ensure with thiazide-type diuretics that patient is not pregnant; fetal abnormalities and Contraindications and cautions death have occurred if using during second or third trimester. Encourage or other Contraindicated with allergy to benazepril use of contraceptive measures.or third trimester of pregnancy. ACE inhibitors, second Reduce dosage in patients with renal function, Use cautiously with impaired impaired renal function. immunosuppresion, CHF, hypotension, salt or volume Teaching depletion, lactation, first trimester of pregnancy. points Available formsDo not stop taking the medication without consulting your Tablets5, 10, 20, 40 mghealth care provider. Be careful 1011 hr Metabolism: Hepatic; T1/2:in any situation that may lead to a drop in Crosses placenta; (diarrhea, milk Distribution: blood pressure enters breast sweating, vomiting, dehydration); if light-headedness or dizziness occurs, Excretion: Urine consult Adverse effects your health care provider. You should not becomehypotension in salt- this CV: Angina pectoris, pregnant while on or drug. Serious fetal abnormalities could occur; use of volume-depleted patients, palpitations contraceptives is advised. Rash, pruritus, diaphoresis, Dermatologic: You flushing may experience these side effects: GI upset, loss of GI: Nausea, abdominalif persistent consult appetite (transient effects; pain, vomiting, health care provider); light-headedness (transient; change constipation position slowly, andCough,activities bronchitis, dyspnea, Respiratory: limit asthma, to those that do not require alertness and precision); dry cough (irritating but sinusitis not harmful; consult health care provider). Other: Angioedema, impotence, decreased libido, Report mouth sores; asthenia, myalgia, arthralgia sore throat, fever, chills; swelling of the hands, feet; irregular heartbeat, chest

Interactions pains; swelling of the face, eyes, lips, tongue, difficulty Drug-drug breathing, persistent cough. Increased risk of hypersensitivity reactions with allopurinal Increased coughing with capsaicin Decreased antihypertensive effects with indomethacin and other NSAIDs Increased lithium levels and neurotoxicity may occur if combined Increased risk of hyperkalemia with potassiumsparing diuretics or potassium supplements Nursing considerations Assessment History: Allergy to benazepril or other ACE inhibitors, impaired renal function, CHF, salt or volume depletion, lactation, pregnancy Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, LFTs, renal function tests, CBC and differential betamethasone Interventions betamethasone WARNING: Alert surgeon, note use of benazepril Topical dermatologic ointment, cream, angiotensin II formation on patient's chart; the lotion, gel subsequent to compensatory renin release during surgery betamethasone be blocked; hypotension may be reversed with will dipropionate Topical dermatologic ointment, cream, lotion, aerosol: volume expansion. Diprolene, Diprolene AF, Diprosone, Maxivate, Taro-Sone (CAN), Teladar

Available forms betamethasone sodium phosphate Tablets0.6 mg; syrup0.6 mg/5 mL; Systemic, including IV and local injection: injection4 mg, 3 mg betamethasone sodium phosphate with 3 mg betamethasone Betnesol (CAN), Celestone Phosphate acetate; ointment0.1%, 0.05%; cream0.01%, 0.05%, 0.1%; lotion0.1%, 0.05%; gel0.05%and acetate betamethasone sodium phosphate Systemic, IM, and local intra-articular, intralesional, intradermal Metabolism: Hepatic; T1/2: 3654 hr injection: Distribution: Crosses Celestone Soluspan placenta; enters breast milk Excretion: Urine, unchanged betamethasone valerate IV facts Topical dermatologic ointment, cream, lotion: Preparation: No Beta-Val, Celestoderm (CAN), Luxiq, Prevex B Betaderm (CAN), further preparation needed. Infusion: Infuse by direct IV injection over 1 min or into the (CAN), Psorion Cream, Valisone tubing of running IV of dextrose or saline solutions. Adverse effects Drug classes CNS: Vertigo, headache, paresthesias, insomnia, Corticosteroid (long acting) seizures, psychosis, cataracts, increased IOP, glaucoma Glucocorticoid Hormone (in long-term therapy) CV: Hypotension, shock, hypertension, and CHF secondary Therapeutic actions to fluid retention, thromboembolism, Binds to thrombophlebitis, fat embolism, cardiacthereby initiating intracellular corticosteroid receptors, arrhythmias + Electrolyte imbalance: responsible for its antimany natural complex reactions that areNa and fluid retention, hypokalemia, hypocalcemia inflammatory and immunosuppressive effects. Endocrine: Amenorrhea, irregular menses, growth Indications retardation, decreased carbohydrate tolerance, diabetes Systemic administration mellitus, cushingoid associated with cancer Hypercalcemia state (long-term effect), increased blood sugar, increased serum cholesterol, decreased T3

Short-term management of inflammatory and and T4 levels, such as rheumatoid arthritis, (HPA) allergic disorders,hypothalamic-pituitary-adrenalcollagen suppression with SLE), therapy longer diseases diseases (eg systemic dermatologic than 5 days (eg GI: esophageal and pancreatitis, pemphigus), Peptic or asthmaticus, ulcer, autoimmune status abdominal distention, nausea, vomiting, increased disorders appetite,Hematologic (long-term therapy) weight gain disorders: Thrombocytopenia Musculoskeletal: purpura, erythroblastopenia Muscle weakness, steroid myopathy, losscolitis, acute exacerbationsosteoporosis, of muscle mass, Ulcerative of MS, and spontaneous fractures (long-term therapy) palliation in some leukemias and lymphomas Other: Immunosuppression, aggravation, or Trichinosis with neurologic or myocardial masking of involvement infections; impaired wound healing; thin, fragile skin; petechiae, ecchymoses, purpura, striae; Intra-articular or soft-tissue administration subcutaneous psoriaticatrophy; and so forth Arthritis, fat plaques, hypersensitivity or anaphylactoid reactions Dermatologic preparations The following effects areinflammatory and pruritic manifestations Relief of related to various local routes of steroid administration: of steroid-responsive dermatoses Intra-articular: Contraindications and cautions Osteonecrosis, tendon rupture, infection Systemic (oral and parenteral) administration Intralesional therapy: Blindness when applied to Contraindicated with infections, especially face and head tuberculosis, fungal infections, amebiasis, vaccinia and Topical dermatologic ointments, creams, sprays: varicella, and antibiotic-resistant infections, lactation. All forms Local burning, irritation, acneiform lesions, striae, skin atrophy Use cautiously with kidney or liver disease, Interactions hypothyroidism, ulcerative colitis with impending Drug-drug perforation, diverticulitis, active or latent peptic ulcer, Risk of bowel disease, CHF, hypertension, inflammatory severe deterioration of muscle strength in myasthenia gravis patients osteoporosis, seizure thromboembolic disorders, receiving ambenonium, edrophonium, neostigmine, disorders, diabetes mellitus. pyridostigmine

 Decreased steroid blood levels with barbiturates, antacids); rifampin phenytoin, poor wound healing (consult with your care provider); muscle effectiveness fatiguesalicylates with (frequent rest Decreased weakness, of periods will help). betamethasone Drug-lab test Report unusual weight gain, swelling of the extremities, muscle weakness, black or tarry stools, False-negative nitroblue-tetrazolium test for fever, prolonged bacterial infectionsore throat, colds or other infections, worsening of originalskin test reactions Suppression of disorder. Intrabursal, intra-articular therapy Nursing considerations Do not overuse joint after therapy, even if pain is Assessment gone. History (systemic administration): Infections, Topical dermatologic preparations fungal infections, amebiasis, vaccinia and varicella, and Apply sparingly; do not cover with tight dressings. antibiotic-resistant infections; kidney or liver disease; Avoid contact with the colitis with impending hypothyroidism; ulcerative eyes. Report irritation active or latent the site of perforation; diverticulitis;or infection at peptic ulcer; application. inflammatory bowel disease; CHF; hypertension; thromboembolic disorders; osteoporosis; seizure disorders; diabetes mellitus; lactation bisoprolol fumarate Physical: Baseline weight, T, reflexes and grip Zebeta strength, affect and orientation, P, BP, peripheral perfusion, prominence of superficial veins, R and Drug classes adventitious sounds, serum electrolytes, blood glucose Beta-selective adrenergic blocker Interventions Antihypertensive Systemic use Therapeutic actionsdaily dose before 9 AM to mimic normal peak Give Blocks beta-adrenergic receptors (primarily beta1) of the corticosteroid blood levels. sympathetic nervous system in thepatient is subject to stress. Increase dosage when heart and juxtaglomerular apparatus (kidney), thus decreasing the excitability of the heart,

Taper doses when discontinuing high-dose or longdecreasing cardiac output and oxygen consumption, decreasing the term therapy. release of renin from the kidney, andlive virus vaccines with Do not give lowering BP. Indications immunosuppressive doses of corticosteroids. Management of hypertension, used alone or with Topical dermatologic preparations other antihypertensives infections, skin integrity before Examine area for Contraindications and cautions application. Contraindicated with sinus bradycardia, second- or Administer cautiously to pregnant patients; topical third-degree heart block, cardiogenic shock, CHF. corticosteroids have caused teratogenic effects and can absorbed cautiously with renal failure, diabetes or Use from systemic site. be thyrotoxicosis (bisoprolol can mask the usual cardiac WARNING: Use caution when occlusive signs of hypoglycemia and thyrotoxicosis), pregnancy, dressings or tight diapers cover affected area; these can lactation,systemic absorption of the drug. disease. increase and in those with bronchospastic Available forms Avoid prolonged use near eyes, in genital and Tablets5, 10 mg rectal areas, and in skin creases. Dosages points Teaching ADULTSuse Systemic Initially, 5 mg PO daily, alone or added to diuretic therapy; 2.5 mg Do not stop taking the oral drug without consulting may be appropriate; up to 20 mg PO daily has been used. your health care provider. Metabolism: Hepatic;single912 hr alternate-day doses before 9 Take T1/2: dose or Distribution: Crosses placenta; may enter breast milk AM. Excretion: Urine Avoid exposure to infections; ability to fight Adverse effects infections is reduced. Allergicareactions: Pharyngitis, erythematous rash, Wear medical alert tag so emergency care fever, sorewill know that you are on this medication. providers throat, laryngospasm, respiratory distress CNS: Dizziness, vertigo, tinnitus, fatigue, You may experience these side effects: Increase in emotional depression, (counting sleep may help); appetite, weight gain paresthesias,calories disturbances, hallucinations, disorientation, memory meals; take heartburn, indigestion (eat frequent smallloss, slurred speech

 CV: Bradycardia, CHF, cardiac arrhythmias, Teaching sinoatrial or AV nodal block, tachycardia, peripheral points Do insufficiency, this drug unless instructed to do vascular not stop taking claudication, CVA, pulmonary so by a hypotension edema, health care provider. Avoid over-the-counter medications. Dermatologic: Rash, pruritus, sweating, dry skin Avoid driving irritation, dry activities if dizziness, EENT: Eye or dangerous eyes, conjunctivitis, weakness occur. blurred vision You may experience these side effects: Dizziness, GI: Gastric pain, flatulence, constipation, light-headedness, loss of appetite, nightmares, diarrhea, nausea, vomiting, anorexia, ischemic colitis, depression, sexual impotence. renal and mesenteric arterial thrombosis, retroperitoneal Report difficulty breathing, night fibrosis, hepatomegaly, acute pancreatitiscough, swelling of extremities, slow pulse, confusion,libido, Peyronie's GU: Impotence, decreased depression, rash, fever, sore throat.nocturia, frequent urination disease, dysuria, Musculoskeletal: Joint pain, arthralgia, muscle Adverse effects in Italic are most common; those in Bold are lifecramp threatening. Respiratory: Bronchospasm, dyspnea, cough, bronchial obstruction, nasal stuffiness, rhinitis, brompheniramine maleate (parabromdylamine maleate) pharyngitis (less likely than with propranolol) Bidhist, BroveX, BroveX CT, Lodrane XR, LoHist 12 Hour, Other: Decreased exercise tolerance, development VaZol of antinuclear antibodies, hyperglycemia or hypoglycemia, elevated serum transaminase, alkaline Drug class phosphatase, and LDH Antihistamine Interactions (alkylamine type) Therapeutic Drug-drug actions Competitively blocks the effects with verapamil, anticholinergics Increased effects of histamine at H1-receptor sites; has anticholinergic (atropine-like), antipruritic, and sedative Increased risk of orthostatic hypotension with effects. prazosin Indications

Possible increased BP-lowering effects with Symptomatic relief of symptoms associated with aspirin, bismuth subsalicylate, magnesium salicylate, perennial and seasonal contraceptives sulfinpyrazone, hormonal allergic rhinitisrunny nose, sneezing, itchingantihypertensive effects with NSAIDs Decreased nose and throat, watery eyes Contraindications and cautions hypoglycemic effect of insulin Possible increased Drug-lab test Contraindicated with allergy to any antihistamines, allergyPossible false (BroveX with glucosetrimester of to tartrazine results CT), third or insulin pregnancy (newborn or premature infants may have tolerance tests severe reactions). Nursing considerations Use CLINICAL ALERT! cautiously with lactation, narrow-angle glaucoma, stenosing between Zebeta (bisoprolol) and Name confusion has occurredpeptic ulcer, symptomatic prostatic hypertrophy, asthma attack, bladder neck obstruction, DiaBeta (glyburide); use caution. pyloroduodenal obstruction. Use cautiously in the elderly Assessment (this population Sinus bradycardia, cardiac arrhythmias, History: is extremely sensitive to anticholinergic side effects this drug). cardiogenic ofshock, CHF, renal failure, diabetes or Availablethyrotoxicosis, pregnancy, lactation forms Chewable tablets12 mg; ER tablets6 mg; skin capsules Physical: Baseline weight, ER condition, 12 mg; neurologic mg/5 mL; BP, ECG, suspension8 mg/5 mL, liquid2 status, P, oral R, LFTs, renal function 12 mg/5 mL blood and urine glucose tests, Metabolism: Interventions Hepatic; T1/2: 1235 hr Distribution: Crosses placenta; enters breast milk drug abruptly WARNING: Do not discontinue Excretion: Urine long-term after therapy (hypersensitivity to catecholamines may have developed, causing Adverse effects exacerbation of angina, MI, and ventricular arrhythmias). Taper CNS:gradually over 2 wk with dizziness, faintness, drug Drowsiness, sedation, monitoring. disturbed coordination, fatigue, confusion, restlessness, Consult with physician about withdrawing drug if excitation, patient is nervousness, tremor, headache, blurred to undergo surgery (withdrawal is vision, diplopia, vertigo, tinnitus, acute labyrinthitis, controversial). hysteria, tingling, heaviness and weakness of the hands

 CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles GI: Epigastric distress, anorexia, increased appetite and weight gain, nausea, vomiting, diarrhea or constipation GU: Urinary frequency, dysuria, urinary retention, early menses, decreased libido, impotence Hematologic: Hemolytic anemia, hypoplastic anemia, thrombocytopenia, leukopenia, agranulocytosis, pancytopenia Hypersensitivity: Urticaria, rash, anaphylactic shock, photosensitivity Respiratory: Thickening of bronchial secretions, chest tightness, wheezing, nasal stuffiness, dry mouth, dry nose, dry throat, sore throat budesonide Interactions Inhalation: Drug-drug Entocort IncreasedPulmicortwith alcohol, other CNS depressants (CAN), sedation Respules, Pulmicort Turbuhaler, Rhinocort Aqua, Rhinocort Turbuhaler (CAN) Increased and prolonged anticholinergic (drying) effects Oral: with MAOIs Entocort considerations Nursing EC Assessment Drug class History: Allergy to any antihistamines, tartrazine, Corticosteroid narrow-angle glaucoma, stenosing peptic ulcer, Therapeutic actions prostatic hypertrophy, asthmatic attack, symptomatic Anti-inflammatoryneck obstruction, pyloroduodenal obstruction, bladder effect; local administration into nasal passages maximizes beneficial effects on these tissues, while decreasing the third trimester of pregnancy, lactation likelihood of adverse effects from systemic absorption.

Physical: Skin color, lesions, texture; orientation, Indications reflexes, affect; vision examination; P, BP; R, Management of symptoms of seasonal or perennial adventitious sounds; bowel sounds; prostate palpation; allergic rhinitis in adults and children; nonallergic CBC with differential perennial rhinitis in adults Interventions Turbuhaler Give orally with food if GI upset occurs. Teaching pointsMaintenance treatment of asthma as prophylactic therapy in adults and children >excessive dosage; take Take as prescribed; avoid 6 yr and for patients requiring if GI upset occurs. with food corticosteroids for asthma Inhalation suspension alcohol while on this drug; serious sedation Avoid could Maintenance treatment and prophylaxis therapy of occur. asthma in children 12 oral suspensions differ in strength; Oral liquid and mo8 yr Oral do not use interchangeably. Treatment of mild to moderate active Crohn's You may experience these side effects: Dizziness, disease involving the ileum or caution if driving or sedation, drowsiness (use ascending colon performing tasks that require alertness); epigastric Contraindicationsdiarrhea or constipation (take with meals); dry distress, and cautions Inhalationmouth (frequent mouth care, sucking sugarless lozenges Contraindicated of bronchial secretions, dryness of may help); thickening with hypersensitivity to drug or for relief of acute asthma or bronchospasm. nasal mucosa (try a humidifier). Use difficulty with TB, systemic infections, Reportcautiously breathing, hallucinations, tremors, lactation. loss of coordination, unusual bleeding or bruising, visual Oral disturbances, irregular heartbeat. Contraindicated with hypersensitivity to drug, lactation. Use cautiously with TB, hypertension, diabetes mellitus, osteoporosis, peptic ulcer disease, glaucoma, cataracts, family history of diabetes or glaucoma, other

conditions in which glucocorticosteroids may have Prime unit unwanted effects. before use for Pulmicort Turbuhaler; have patient rinse mouth after each use. Nasal Use aerosol within hypersensitivity to drug, well Contraindicated with6 mo of opening. Shake nasal before eachnasal trauma, nasal septal ulcers, recent nasal infections, use. Store Respules upright and protected from light; surgery. gently Use cautiouslyuse; open envelopes should be shake before with lactation, TB, systemic discarded infection. after 2 wk. Oral Available forms Make sure dry powder for cut, crush, or mcg Aerosol32 mcg/actuation; patient does not inhalation200chew capsules; they must be mcg); inhalation (each actuation delivers 160swallowed whole. suspension Administer the drug once mg 0.25 mg/2 mL, 0.5 mg/2 mL; capsules3each day, in the morning; do not administer 1/2: grapefruit (oral); T1/2: 2.8 hr Metabolism: Hepatic; Twith 23.6 hr juice. Encourage patient to complete full 8 wk of drug (inhalation) therapy. Distribution: Crosses placenta; may enter breast milk Excretion: UrineWARNING: Monitor patient for signs of hypercorticismacne, bruising, moon face, swollen ankles, Adverse effects hirsutism, skin striae, buffalo humpwhich could indicate need to decrease dosage.lethargy, fatigue, CNS: Headache, dizziness, Teaching paresthesias, nervousness points Inhalation Dermatologic: Rash, edema, pruritus, alopecia Do not use more often than prescribed; do not stop Endocrine: HPA suppression, Cushing's syndrome without consulting your healthabsorption with overdosage and systemic care provider. It may take dyspepsia, to mouth GI: Nausea,several daysdryachieve good effects; do not stop if effects are not immediate. infection Local: Nasal irritation, fungal Use decongestantEpistaxis, rebound congestion, Respiratory: nose drops first if nasal passages are blocked. cough pharyngitis, Prime unit before use for Pulmicort Turbuhaler; rinse mouth after each use.

Other: Chest pain, asthenia, moon face, acne, Store Respules bruising, back pain upright, protect from light; discard open Interactions envelopes after 2 weeks; gently shake before use. You may experience these side effects: Local Oral use irritation (use your device correctly), dry mouth (suck Drug-drug sugarless lozenges). of corticosteroid toxic effects if Increased risk Report sore mouth, sore throat, worsening of combined with ketoconazole, itraconazole, ritonavir, symptoms, saquinavir, erythromycin, to chickenpox or indinavir, severe sneezing, exposure or other known measles, eye infections. drugs must be used together, CYP3A4 inhibitors; if Oral decrease dosage of budesonide and monitor patient Take the drug once a day in the morning. Do not closely cut, crush, or chew the capsules, they must be swallowed Drug-food whole. Risk of increased toxic effects if combined with If you miss a day, take the capsules grapefruit juice; avoid this combination. as soon as you remember them. Take the next day's capsules at the Nursing considerations regular time. Do not take more than three capsules in a Assessment day. History: Untreated local nasal infections, nasal Take the full course of the drug therapy (8 weeks trauma, septal ulcers, recent nasal surgery, lactation in most cases). Physical: BP, P, auscultation; R, adventitious Do not take this nares sounds; examination of drug with grapefruit juice; avoid grapefruit juice entirely while using this drug. Interventions Store Respules upright, protected from light; Inhalation discard open envelopes after systemic Shake before use. WARNING: Taper 2 weeks. steroids carefully You may to inhalational steroids; deaths from during transfer experience these side effects: Dizziness, headache (avoid driving or operating dangerous adrenal insufficiency have occurred. machinery if theseuse of decongestant nose flatulence Arrange for effects occur); nausea, drops to (frequent penetration if may help; try to maintain your facilitate small meals edema, excessive secretions are fluid and food intake). present.

 Report chest pain, ankle swelling, respiratory drowsiness, fatigue, blurred vision, tinnitus, irreversible infections, increased bruising. hearing loss CV: Orthostatic hypotension, volume depletion, cardiac arrhythmias, thrombophlebitis GI: Nausea, anorexia, vomiting, diarrhea, gastric irritation and pain, dry mouth, acute pancreatitis, jaundice GU: Polyuria, nocturia, glycosuria, renal failure Hematologic: Hypokalemia, leukopenia, anemia, thrombocytopenia Local: Pain, phlebitis at injection site Other: Muscle cramps and muscle spasms, weakness, arthritic pain, fatigue, hives, photosensitivity, rash, pruritus, sweating, nipple tenderness Interactions Drug-drug bumetanide Decreased diuresis and natriuresis with NSAIDs Increased risk of cardiac glycoside toxicity (byoo met' a nide) (secondary to hypokalemia) Bumex, Burinex (CAN) Increased risk of ototoxicity if taken with aminoglycoside antibiotics, cisplatin Drug class Nursing considerations Loop (high ceiling) diuretic Assessment Therapeutic actions History: Allergy to bumetanide, electrolyte Inhibits the reabsorption of sodium and chloride from the proximal and distaldepletion, anuria, severe loop of Henle, hepatic coma, renal tubules and the renal failure, leading to a natriureticSLE, gout, diabetes mellitus, lactation diuresis. Physical: Skin color, lesions; edema; orientation, Indications reflexes, hearing; pulses, baseline ECG, BP, orthostatic

Edema associated with CHF, cirrhosis, renal BP, perfusion; R, pattern, adventitious sounds; liver disease evaluation, bowel sounds; urinary output patterns; CBC, IV: Acute pulmonary edema serum Unlabeled use: Treatmentcalcium), nocturia (not electrolytes (including of adult blood sugar, LFTs, renal function tests, uric effective in men with BPH) acid, urinalysis Interventions Contraindications and cautions Give with food or milk to prevent GI upset. Contraindicated with allergy to bumetanide; Mark calendars or use reminders if intermittent electrolyte depletion; anuria, severe renal failure; hepatic therapy is best for coma; lactation. treating edema. Give cautiously with SLE, gout,increased urination Use single dose early in day so diabetes mellitus, will not disturb sleep. pregnancy. Avoid IV use if oral use is possible. Available forms Tablets0.5, 1,Arrange to monitor serum electrolytes, hydration, 2 mg; injection0.25 mg/mL liver function during long-term therapy. Provide min Metabolism: T1/2: 6090 diet rich in potassium or supplemental potassium. Distribution: Crosses placenta; may enter breast milk Excretion: Urine Teaching points Record alternate day or intermittent therapy on a IV facts calendar be given direct IV Preparation: Mayor dated envelopes. or diluted in solution with 5% dextrose in Take the drug early in day so or lactated urination water, 0.9% sodium chloride, increased Ringer's will not disturb sleep; take with food solution. Discard unused solution after 24 hr. or meals to prevent Infusion: GI upset. direct injection slowly, over 12 min. Further Give by Weigh yourself do regular basis, at the same time, diluted in solution; give slowly;on anot exceed 10 mg/day. and in Adverse effects the same clothing; record the weight on your calendar. CNS: Asterixis, dizziness, vertigo, paresthesias, You fatigue, nystagmus, weakness, Increased confusion, may experience these side effects: headache, volume and frequency of urination; dizziness, feeling faint on arising, drowsiness (avoid rapid position

changes; hazardous activities, such as driving; and Dermatologic: Rash, alopecia, to sunlight (use alcohol consumption); sensitivity dry skin GI: sunglasses, Dry mouth, constipation, nausea, clothing); sunscreen, wear protective vomiting, stomatitis increased thirst (suck sugarless lozenges; use frequent GU: Nocturia, body irritation, (a potassium-rich mouth care); loss ofvaginal potassium testicular swelling Other: Weight loss, needed). diet, or supplement will beflulike symptoms Interactions Report weight change of more than 3 pounds in 1 Drug-drug day; swelling in ankles or fingers; unusual bleeding or Increased risk dizziness, trembling, numbness, bruising; nausea, of adverse effects with levodopa Increased weakness or cramps. fatigue; muscle risk of toxicity with MAOIs Increased risk of seizures with drugs that lower seizure threshold, including alcohol Nursing considerations Assessment History: Hypersensitivity to bupropion, history of seizure disorder, bulimia or anorexia, head trauma, CNS tumor, treatment with MAOI, renal or liver disease, heart disease, lactation bupropion hydrochloride Physical: Skin, weight; orientation, Wellbutrin, Wellbutrin SR, Wellbutrin XL, Zyban affect, vision, coordination; P, rhythm, auscultation; R, adventitious sounds; bowel sounds, condition of mouth Drug classes Interventions Antidepressant Give Smoking deterrent drug three times a day for depression; do not administer Therapeutic actions more than 150 mg in any one dose. Administer SR forms of the day with at effect hr The neurochemical mechanism twice a antidepressant least 8 of bupropionbetween understood; it is chemically unrelated to other is not doses. Increase dosage blocker antidepressant agents; it is a weakslowly toofreduce the risk of neuronal uptake seizures.

serotonin and norepinephrine and inhibits the reuptake of Administer dopamineto some extent. 100-mg tablets four times a day for depression, with at least 4 hr between doses, if patient is Indications receiving > 300 mg/day; use combinations of 75-mg Treatment of depression tablets to avoid givingcessation treatment (Zyban) Aid to smoking > 150 mg in any single dose. Arrange for patient evaluation of neuropathic pain, Unlabeled uses: Treatment after 6 wk. Discontinue MAOI therapy for at least 14 days ADHD before beginning bupropion. Contraindications and cautions Monitor LFTs with hypersensitivity to in patients Contraindicatedand renal function tests bupropion; with a history of liver or renalbulimia or anorexia, head history of seizure disorder, impairment. Have patient quit smoking risk of 2 wk of trauma, CNS tumor (increased within first seizures); treatment with MAOIs; lactation. may be used with for smoking cessation; transdermal nicotine. with renal or liver disease; heart Use cautiously WARNING: pregnancy. disease, history of MI,Monitor response and behavior; Availablesuicide is a risk in depressed patients. forms Teaching points mg; SR tablets100, 150, 200 mg; ER tablets Tablets75, 100 150, 300 mg Take this drug in equally divided doses three to four times a day as prescribed for depression. Take sustained-release forms twice a day, at least 8 hours apart. Do not 1/2: 14 hr; 21 hr or make up missed doses. Metabolism: Hepatic; Tcombine doses (SR) Take once a day, or divided into two doses Distribution: May cross placenta; may enter breast milk at least 8 hours apart for Excretion: Feces, urine smoking cessation. Adverse effectsAvoid or limit the use of alcohol while on this drug. Seizures can occur insomnia, headache, migraine, CNS: Agitation, if these are combined. May be used with transdermal nicotine; most tremor, ataxia, incoordination, seizures, mania, increased effective for smoking cessation if combined with libido, hallucinations, visual disturbances behavioral support program. CV: Dizziness, tachycardia, edema, ECG You may experience these side effects: abnormalities, chest pain, shortness of breath Dizziness, lack of coordination, tremor (avoid driving or performing

tasks that require alertness); dry mouth (use frequent numbness, incoordination, tremor, mouth care; paresthesia, suck sugarless lozenges); headache, depersonalization, dysphoria, noise intolerance, insomnia (consult with care provider if these become a euphoria, doakathisia, fearfulness, loss of interest, problem; not self-medicate); nausea, vomiting, weight disassociative reaction, hallucinations, suicidal ideation, loss (eat frequent small meals). seizures, altered taste and smell, involuntary movements, Report dark urine, light-colored stools; rapid or slowed reaction time irregular heart beat; hallucinations; severe headache or CV: Nonspecific throat. insomnia; fever, chills, sorechest pain, tachycardia or palpitations, syncope, hypotension, hypertension GI: Nausea, dry mouth, vomiting, abdominal or gastric distress, diarrhea, constipation, flatulence, anorexia, increased appetite, salivation, irritable colon and rectal bleeding GU: Urinary frequency, urinary hesitancy, dysuria, increased or decreased libido, menstrual irregularity, spotting Respiratory: Hyperventilation, shortness of breath, chest congestion Other: Musculoskeletal aches and pains, sweating, buspirone hydrochloride BuSpar clamminess, sore throat, nasal congestion Interactions Drug class Drug-drug Anxiolytic Give Therapeutic actions with caution to patients taking alcohol, other  CNS depressants action not known; lacks antiseizure, Mechanism of Decreased effects with properties; sedative, or muscle relaxantfluoxetine binds serotonin Increased serum levels of buspirone if taken with receptors, but the clinical significance is unclear. erythromycin, itraconazole; decrease buspirone dose to

Buspirone functions as a serotonin 5-HT1A receptor 2.5 mg and monitor closely if these combinations are partial agonist. It is this action that is thought to mediate used its anxiolytic and antidepressant effects. Additionally, it Risk of a dopamine D2, as well if 1, and functions as increased haloperidol levels as combined 2Drug-food adrenergic receptor antagonist to a lesser degree, though these Risk of increased serum levels undesirable if taken properties are generally and toxicity in an with grapefruit juice anxiolytic and likely only contribute to side effects. Nursing considerations Indications Assessment Management of anxiety disorders or short-term History: Hypersensitivity to buspirone, marked relief of symptoms of anxiety liver or renal impairment, lactationthe symptoms (aches, Unlabeled use: Decreasing pains,Physical: Weight; T; skin color, lesions; mucous fatigue, cramps, irritability) of PMS membranes, cautions Contraindications andthroat color, lesions, orientation, affect, reflexes, vision examination; P, BP; R, to buspirone; Contraindicated with hypersensitivity adventitious sounds; bowel sounds, normal GI marked liver or renal impairment; lactation.output, liver evaluation; normal urinary output, voidingmild renal or Use cautiously with pregnancy, pattern; LFTs, renal function tests, hepatic impairment. urinalysis, CBC and differential Available forms Interventions Tablets5, 7.5, 10, 15, 30 mg Provide sugarless lozenges or ice chips if dry mouth or altered 311 hr Metabolism: Hepatic; T1/2:taste occurs. Arrange for analgesic for headache or Distribution: May enter breast milk musculoskeletal aches. Excretion: Urine Teachingeffects Adverse points Take this drug exactly as prescribed. CNS: Dizziness, headache, nervousness, insomnia, Avoid the use of alcohol, dream disturbances, light-headedness, excitement, sleep-inducing, or overthe-counter drugs and grapefruit juice; these could cause drowsiness, decreased concentration, anger, hostility, dangerous effects. confusion, depression, tinnitus, blurred vision,

 You may experience these side effects: Trigeminal neuralgia (tic douloureux): Treatment Drowsiness, dizziness, light-headedness (avoid driving of pain associated with true trigeminal neuralgia; also or operating complex machinery); GI upset (eat frequent beneficial in glossopharyngeal neuralgia small meals); dry mouth (suck ice chips or sugarless Treatment nightmares, difficulty mixed episodes candies); dreams, of acute manic and concentrating or associated with bipolar 1 disorder (reversible; will stop sleeping, confusion, excitement (Equetro) Unlabeled uses: Neurogenic diabetes insipidus when the drug is discontinued). (200 mg bidtid); certain psychiatricmovementsincluding Report abnormal involuntary disorders, of facial schizoaffective illness, resistant schizophrenia, and or neck muscles, motor restlessness; sore or cramped dyscontrol syndrome associated with limbic system muscles; abnormal posture; yellowing of the skin or dysfunction; alcohol withdrawal (8001,000 mg/day); eyes. restless leg syndrome (100300 mg/day hs); non-neuritic pain syndrome (6001,400 mg/day); hereditary or nonheriditary chorea in children (1525 mg/kg/day). Contraindications and cautions Contraindicated with hypersensitivity to carbamazepine or TCAs, history of bone marrow depression, concomitant use of MAOIs, lactation, pregnancy. Use cautiously with history of adverse hematologic reaction to any drug (increased risk of severe hematologic toxicity); glaucoma or increased IOP; carbamazepine history of (CAN), Carbatrol, Epitol, Equetro, NovoApo-Carbamazepinecardiac, hepatic, or renal damage; psychiatric Carbamazpatients (may activate latent psychosis). (CAN), Tegretol, Tegretol-XR Available forms Tablets200 Drug class mg; chewable tablets100 mg; ER tablets100, 200, 400 mg; Antiepileptic ER capsules100, 200, 300 mg; suspension 100 mg/5 mL, 200 mg/10 mL Metabolism: Hepatic; T1/2: 2565 hr, then 1217 hr

Therapeutic actions Distribution: Crosses placenta; enters breast milk  Mechanism of action not understood; antiepileptic Excretion: Feces, urine be related to its ability to inhibit activity may Adverse effects polysynaptic responses and block post-tetanic CNS: Dizziness, drowsiness, unsteadiness, potentiation. Drug is chemically related to the TCAs. disturbance of coordination, confusion, headache,  The mechanism of action of carbamazepine and its fatigue, visual hallucinations, depression Voltage-gated derivatives is relatively well understood. with agitation, behavioral changes in children, pores that allow brain sodium channels are the molecular talkativeness, speech disturbances, movements, cells (neurons) abnormal involuntary potentials, the to generate action paralysis and that symptoms of to communicate electrical eventsother allow neurons cerebral arterial insufficiency, peripheral neuritis channels open to over long distances. After the sodiumand paresthesias, tinnitus, action potential, they inactivate, essentially start the hyperacusis, blurred vision, transient diplopia and oculomotor disturbances, nystagmus, scattered closing the channel. Carbamazepine stabilizes the punctate cortical lens opacities, conjunctivitis, inactivated state of sodium channels, meaning that fewer ophthalmoplegia, are chills; SIADH of these channelsfever, available to subsequently open, making CV: cells less excitable (less likely to fire). brain CHF, aggravation of hypertension, hypotension, syncope been shown to edema, GABA Carbamazepine has also and collapse, potentiateprimary thrombophlebitis, thrombophlebitis, receptors made up ofrecurrence ofgamma2 subunits. alpha1, beta2, aggravation of CAD, arrhythmias and AV block; CV Indications complications seizure disorders: Partial seizures with Refractory Dermatologic: (psychomotor, temporal lobe complex symptoms Pruritic and erythematous rashes, urticaria, generalized tonic-clonic (grand mal) seizures, epilepsy), Stevens-Johnson syndrome, photosensitivity reactions, alterations in pigmentation, exfoliative mixed seizure patterns or other partial or generalized dermatitis, alopecia, diaphoresis, erythema multiforme seizures. Reserve for patients unresponsive to other and lupus agents nodosum, purpura, aggravation orofwho are with seizures difficult to control erythematosus experiencing marked side effects, such as excessive GI: sedation Nausea, vomiting, gastric distress, abdominal pain, diarrhea, constipation, anorexia, dryness of mouth or pharynx, glossitis, stomatitis; abnormal LFTs,

cholestatic and hepatocellular jaundice, hepatitis, serum iron; LFTs, urinalysis, BUN, thyroid loss of massive hepatic cellular necrosis with total function tests, liver intactEEG tissue Interventions GU: Urinary frequency, acute urinary retention, Use only hypertension, renal failure, azotemia, oliguria with for classifications listed. Do not use as a general analgesic. Use onlyglycosuria, elevated that are impotence, proteinuria, for epileptic seizures BUN, refractory to other safer agents. microscopic deposits in urine Give drug with food to prevent GI upset. Hematologic: Hematologic disorders (severe Do not mix suspension with other medications or bone marrow depression) elementsprecipitation may occur. Respiratory: Pulmonary hypersensitivity WARNING: Reduce dosage, discontinue, characterized by fever, dyspnea, pneumonitis or substitute pneumonia other antiepileptic medication gradually. Abrupt discontinuation of all antiepileptic medication Interaction may precipitate status epilepticus. Drug-drug Suspension serum levels highermanifestationsthan Increased will produce and peak levels of tabletsstart with a lower dose given more frequently. toxicity with erythromycin, troleandomycin, cimetidine, Ensure that patient swallows verapamil; dosage of danazol, isoniazid, propoxyphene, ER tablets wholedo not cut, crush, may need to be reduced (reductions of carbamazepineor chew. Arrange for frequent LFTs; discontinue drug about 50% recommended with erythromycin) immediately if hepatic dysfunctionlithium Increased CNS toxicity with occurs. WARNING: Arrange for patient with isoniazid Increased risk of hepatotoxicity to have CBC, including platelet, reticulocyte counts, and serum iron (MAOI qualities); because of the chemical similarity of determination, to the initiating because of the serious carbamazepine before TCAs andtherapy; repeat weekly for the interaction of TCAs and MAOIs, discontinue adversefirst 3 mo of therapy and monthly thereafter for at least 23 yr. Discontinue drug if there is evidence of MAOIs for minimum of 14 days before carbamazepine marrow suppression, as follows: administration Erythrocytes < 4 million/mm3 Decreased absorption with charcoal Hct < 32% Hgb < 11 gm/dL

Decreased serum levels and decreased effects of 3 Leukocytes < barbiturates carbamazepine with4,000/mm Platelets < 100,000/mm3 Increased metabolism but no loss of seizure control 2 Reticulocytes primidone with phenytoin, < 0.3% (20,000/mm ) Serum iron 150 g/100 mL Increased metabolism of phenytoin, valproic acid Arrange for anticoagulant examinations, urinalysis, Decreased frequent eye effect of warfarin, oral and BUN determinations. anticoagulants; dosage of warfarin may need to be Arrange for concomitant therapy but decreased if increased during frequent monitoring of serum levels of carbamazepine is withdrawn and other antiepileptics given concomitantly, especially during the first few weeks of Decreased effects of nondepolarizing muscle therapy. haloperidol relaxants,Adjust dosage on basis of data and clinical response. Decreased antimicrobial effects of doxycycline Counsel Nursing considerations women who wish to become pregnant; advise the use of barrier contraceptives. Assessment Evaluate for therapeutic serum levels (usually 412 History: Hypersensitivity to carbamazepine or mcg/mL). TCAs; history of bone marrow depression; concomitant Teaching use of MAOIs; history of adverse hematologic reaction points to anyTake drug with foodincreased IOP; history of drug; glaucoma or as prescribed. Swallow extended-release or renal damage; not cut, crush, or cardiac, hepatic, tablets whole, do psychiatric history; chew them. If using lactation; pregnancy Equetro capsules, they may be opened and contents sprinkled over soft food, such as 1 Physical: Weight; T; skin color, lesions; palpation teaspoon of glands; of lymph applesauce. orientation, affect, reflexes; Do not discontinue this (including or change ophthalmologic examination drug abruptly tonometry, dosage, except on the advice of your physician. funduscopy, slit lamp examination); P, BP, perfusion; Avoid peripheral vascular examination; R, auscultation; alcohol, sleep-inducing, or over-the-counter drugs; these sounds; bowel sounds, normal adventitious could cause dangerous effects. output; oral Arrange for frequent checkups, output, voiding mucous membranes; normal urinary including blood tests, to monitor your platelet, to this drug. Keep all pattern; CBC including response reticulocyte counts and appointments for checkups.

 Use contraceptives at all times; if you wish to eosinophilia, fixed drug eruption; your physician. become pregnant, you should consultasthmatic episodes, fever, Wear a medical alert tag at all times so that any weakness, dizziness, angioneurotic edema, smarting eyes, hypotension, anaphylactoidthat you have emergency medical personnel will know shock Nursing considerations taking antiepileptic medication. epilepsy and are Assessment You may experience these side effects: History: Allergic or idiosyncratic reactions to Drowsiness, dizziness, blurred vision (avoid driving or carisoprodol, meprobamate; acute intermittent or visual performing other tasks requiring alertness porphyria, suspected porphyria; lactation acuity); GI upset (take the drug with food or milk; eat Physical: T; skin frequent small meals). color, lesions; orientation, affect; P, Report bruising, unusual sounds, abdominal pain, BP, orthostatic BP; bowel bleeding, liver evaluation; LFTs, renal the skin or eyes, pale yellowing offunction tests, CBC feces, darkened urine, impotence, central nervous system disturbances, edema, Interventions chills, sore throat, mouth ulcers, rash, pregnancy. fever, WARNING: Monitor patient for potentially serious idiosyncratic reactionsmost likely with first few doses. Reduce dose with liver dysfunction. Provide safety measures if CNS effects occur. Drug may be habit carisoprodol (isomeprobamate) forming. Monitor patient. Soma Teaching points Take this drug exactly as prescribed; do not take a Drug class higher dosage; take with food Centrally acting skeletal muscle relaxantif GI upset occurs. Avoid Therapeutic actions alcohol, sleep-inducing, or over-the-counter Precise drugs; these could cause dangerous effects; related feel mechanism not known; chemically if you to you an anxiolytic; has preparations, consult your health meprobamate, need one of these sedative properties; also found in care provider. animal studies to inhibit interneuronal activity in descending

reticular formation and spinal cord; does not directly relax tense skeletal muscles. You may experience these side effects: Drowsiness, dizziness, vertigo (avoid driving or Indications activities that require alertness); dizziness when you get Relief of discomfort associated with acute, painful up or climb stairs (avoid sudden adjunct in position, use musculoskeletal conditions as an changes to rest, physical caution and other measures therapy,climbing stairs); nausea (take drug with food; eat frequent and meals); Contraindications smallcautions insomnia, headache, depression (transient effects). Contraindicated with allergic or idiosyncratic Report rash, severe nausea, dizziness, insomnia, reactions to carisoprodol, meprobamate (reported crossfever, difficulty meprobamate); acute intermittent reactions withbreathing. porphyria, suspected porphyria, lactation. Use cautiously with renal or hepatic impairment, pregnancy. Available forms Tablets350 mg Metabolism: Hepatic; T1/2: 8 hr Distribution: May cross placenta; enters breast milk Excretion: Urine Adverse effects CNS: Dizziness, drowsiness, vertigo, ataxia, carvedilol tremor, agitation, irritability Coreg CV: Tachycardia, orthostatic hypotension, facial flushing Drug classes GI: Nausea, vomiting, hiccups, epigastric distress Alpha- and beta-adrenergic blocker Allergic or idiosyncratic Hypersensitivity: Antihypertensive (seen with first to fourth dose in patients new reactions to drug)rash, erythema multiforme, pruritus, Therapeutic actions

Competitively blocks alpha-, beta-, and beta2-adrenergic receptors pregnancy, lactation, activity impairment, peripheral and has some sympathomimetic hepatic at beta2-receptors. Both alpha andvascular disease,actions contribute to the anesthesia or beta blocking thyrotoxicosis, diabetes, BP-lowering major surgery effect; beta blockade prevents the reflex tachycardia seen with Physical: Baseline weight, skin condition, most alpha-blocking drugs and decreases plasma renin activity. neurologic plasma renin ECG, respiratory status, LFTs, Significantly reduces status, P, BP,activity. renal Indications and thyroid function tests, blood and urine glucose Hypertension, alone or with other oral drugs, Interventions especially diuretics WARNING: Do to discontinue drug abruptly Treatment of mild not severe CHF of ischemic or after chronic therapy (hypersensitivity to diuretics, ACE cardiomyopathic origin with digitalis, catecholamines may have developed, causing exacerbation of angina, inhibitors MI, and ventricular arrhythmias); taper after MI Left ventricular dysfunction (LVD) drug gradually over 2 wk with monitoring. Contraindications and cautions Consult with physician about withdrawing drug if Contraindicated with decompensated CHF, patient is asthma,undergo block, cardiogenic shock, to bronchial heart surgery (withdrawal is controversial). to carvedilol, pregnancy, lactation. hypersensitivity Givecautiously with hepatic orthostatic hypotension Use with food to decrease impairment, peripheral and adverse effects.thyrotoxicosis, diabetes, anesthesia, vascular disease, major Monitor for orthostatic hypotension and provide surgery. safety precautions. Monitor patients with diabetes closely; drug may Available forms mask 6.25, 12.5, 25 mg Tablets3.125,hypoglycemia or worsen hyperglycemia. WARNING: Monitor Metabolism: Hepatic; T1/2: 710 hr patient for any sign of liver dysfunction (pruritus, dark urine or stools, anorexia, Distribution: Crosses placenta; may enter breast milk jaundice, pain); arrange for LFTs and discontinue drug if Excretion: Bile, feces tests indicate liver injury. Do not restart carvedilol. Adverse effects Teaching points Take drug with meals.

CNS: Dizziness, vertigo, tinnitus, fatigue, Do depression, paresthesias, sleep disturbances emotionalnot stop taking drug unless instructed to do so by a health Bradycardia, orthostatic hypertension, CHF, CV: care provider. Avoid use of over-the-counter medications. cardiac arrhythmias, pulmonary edema, hypotension You may experience these side effects:constipation, GI: Gastric pain, flatulence, Depression, dizziness, light-headedness diarrhea, hepatic failure (avoid driving or performing dangerous activities; gettingpharyngitis, dyspnea Respiratory: Rhinitis, up and changing positions slowly may help ease dizziness). infections Other: Fatigue, back pain, Interactions Report difficulty breathing, swelling of extremities, changes in color of stool or urine, very slow heart rate, Drug-drug continued dizziness. Increased effectiveness of antidiabetics; monitor blood glucose and adjust dosages appropriately Increased effectiveness of clonidine; monitor patient for potential severe bradycardia and hypotension Increased serum levels of digoxin; monitor serum levels and adjust dose accordingly Increased plasma levels of carvedilol with rifampin Potential for dangerous conduction system disturbances with verapamil or diltiazem; if this combination is used, closely monitor ECG and BP Cefaclor Drug-food Apo-Cefaclor (CAN), Ceclor,of Ceclor Pulvules, not decreased Slowed rate absorption but PMS-Cefaclor (CAN), Raniclor effectiveness with food Nursing considerations Drug classes Assessment Antibiotic History: CHF, bronchial asthma, heart block, Cephalosporin (second generation) cardiogenic shock, hypersensitivity to carvedilol,

Therapeutic actions Other: Inhibits synthesis of bacterial cell wall,  Bactericidal: Superinfections Interactions causing cell death. Drug-drug  Cephalosporins are bactericidal and have the same mode Increased as other beta-lactam antibiotics of action nephrotoxicity with aminoglycosides (such as Increased but are less with oral anticoagulants penicillins)bleeding effects susceptible to penicillinases. Cephalosporins disrupt the synthesis of the Drug-lab test peptidoglycan layer of bacterial cell walls. The Possibility of layer is important of cell glucose using peptidoglycan false results on testsfor urinewall structural Benedict's solution, Fehling's solution, in the synthesis integrity. The final transpeptidation stepClinitest tablets; urinary peptidoglycan direct Coombs' test of the 17-ketosteroids;is facilitated by transpeptidases known as penicillin binding proteins (PBPs). PBPs bind Nursing considerations to the D-Ala-D-Ala at the end of muropeptides Assessment (peptidoglycan precursors) to crosslink the History: Penicillin or cephalosporin allergy, peptidoglycan. Beta-lactam antibiotics mimic this site pregnancy or lactation and competitively inhibit PBP crosslinking of Physical: peptidoglycan. Renal function tests, respiratory status, skin Indications status, culture and sensitivity tests of infected area Lower respiratory infections caused by Interventions Streptococcus pneumoniae, Haemophilus influenzae, S. Culture infection before drug therapy. pyogenes Give drug by S. meals or URIs caused with pyogenes food to decrease GI discomfort. Dermatologic infections caused by Staphylococcus Refrigerate aureus, S. pyogenessuspension after reconstitution, and discard aftercaused by E. coli, P. mirabilis, Klebsiella, UTIs 14 days. Discontinue drug if hypersensitivity reaction coagulase-negative staphylococci occurs.Otitis media caused by S. pneumoniae, H. Give pyogenes, staphylococci influenzae, S.patient yogurt or buttermilk in case of diarrhea.

ER tablets: Acute exacerbations of chronic Arrange for oral infections of acute colitis that bronchitis, secondary vancomycin for serious bronchitis, fails to respond to discontinuation of drug. S. pyogenes; pharyngitis, and tonsilitis due to Teaching uncomplicated skin infections points Take this drug with meals or food. Unlabeled use: Acute uncomplicated UTI in select Complete the full patients, single 2-g dose course of this drug, even if you feel better. Contraindications and cautions This drug is prescribedallergy to cephalosporins or Contraindicated with for this particular infection; do not self-treat any other infection. penicillins. You may experience these sidefailure, lactation, Use cautiously with renal effects: Stomach upset, loss of appetite, nausea (take drug with food); pregnancy. Availablediarrhea; headache, dizziness. forms Capsules250,Reportmg; chewable with blood, pus,187,mucus; 500 severe diarrhea tablets125, or 250, 375 mg; rash or hives;suspension125 mg/5unusual tiredness or powder for difficulty breathing; mL, 187 mg/5 mL, 250 mg/5 fatigue; unusual bleeding or bruising. mL, 375 mg/5 mL Metabolism: T1/2: 3060 min Distribution: Crosses the placenta; enters breast milk Excretion: Urine, unchanged cefprozil effects Adverse Cefzil CNS: Headache, dizziness, lethargy, paresthesias GI: Nausea, vomiting, diarrhea, anorexia, Drug classes abdominal pain, flatulence, pseudomembranous colitis, Antibioticliver toxicity Cephalosporin (second generation) GU: Nephrotoxicity Hematologic: Bone marrow depression Therapeutic actions Hypersensitivity: Ranging from rash to fever to  Bactericidal: serum sickness reaction anaphylaxis; Inhibits synthesis of bacterial cell wall, causing cell death.

 The second-generation cephalosporins have a greater Drug-lab test Gram-negative spectrum while retaining some activity Possibility of false results on tests of urine glucose against Gram-positive cocci. They are also more resistant using Benedict's to beta-lactamase. solution, Fehling's solution, Clinitest tablets; urinary are bactericidal and have the same  Cephalosporins 17-ketosteroids; direct Coombs' test.mode of action as other beta-lactam antibiotics (such as Nursing considerations are less susceptible to penicillinases. penicillins) but Assessment Cephalosporins disrupt the synthesis of the History: Penicillin or cephalosporin allergy, peptidoglycan layer of bacterial cell walls. The pregnancy or layer is important for peptidoglycanlactation, renal failure cell wall structural Physical: Renal function tests, respiratory status, integrity. The final transpeptidation step in the synthesis skin status, culture and is facilitated by infected area of the peptidoglycan sensitivity tests of transpeptidases known as penicillin binding proteins (PBPs). PBPs bind Interventions the D-Ala-D-Ala at the end of muropeptides to Culture infection before drugto therapy. (peptidoglycan precursors) crosslink the Give drug with food to antibiotics discomfort. peptidoglycan. Beta-lactam decrease GI mimic this site and Refrigerate suspension after reconstitution, and competitively inhibit PBP crosslinking of discard after 14 peptidoglycan. days. Indications Discontinue if hypersensitivy reaction occurs. Give the patient yogurt or buttermilk in case Pharyngitis or tonsillitis caused by S. pyogenes of diarrhea. Secondary bacterial infection of acute bronchitis Arrange for of chronic bronchitis caused by S. and exacerbation oral vancomycin for serious colitis that fails to respond to discontinuation. pneumoniae, H. influenzae, M. catarrhalis Dermatologic infections caused by S. aureus, S. Teaching pyogenes points Take thismediawith food. by S. pneumoniae, H. Otitis drug caused Complete the full course of this drug, even if you influenzae, M. catarrhalis feel better.

Acute sinusitis caused by S. pneumoniae, S. aureus, influenzae, M. catarrhalis for this particular infection; H. This drug is prescribed do not use it to self-treat Contraindications and cautions any other infection. You may experience these to effects: Stomach Contraindicated with allergyside cephalosporins or upset, loss of appetite, nausea (take drug with food); penicillins. diarrhea; headache, dizziness. renal failure, lactation, Use cautiously with Report pregnancy. severe diarrhea with blood, pus, or mucus; Availablerash or hives; difficulty breathing; unusual tiredness, forms fatigue; mg; powder for or bruising. Tablets250, 500unusual bleeding suspension125, 250 mg/5 mL Metabolism: T1/2: 78 min Distribution: Crosses the placenta, enters breast milk Excretion: Urine, unchanged Adverse effects CNS: Headache, dizziness, lethargy, paresthesias GI: Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, liver toxicity GU: Nephrotoxicity Hematologic: Bone marrow depression ceftazidime Hypersensitivity: Ranging from rash to fever to Ceptaz, Fortaz, Tazicef, serum sickness reaction anaphylaxis; Tazidime Other: Superinfections Drug classes Interactions Antibiotic Drug-drug Cephalosporin (third generation) Increased nephrotoxicity with aminoglycosides Therapeutic actions Increased bleeding effects if taken with oral  Bactericidal: Inhibits synthesis of bacterial cell wall, anticoagulants causing cell death.

 Third-generation cephalosporins have a broad spectrum Infusion: of activity and further or 2-g infusion pack with 100 mL For IV, reconstitute 1- increased activity against Gramsterile water for injection; infuse slowly. For direct injection, negative organisms. slowly over 35 min. For are bactericidal 30 min. Ifthe sameis also  Cephalosporins infusion, over and have patient mode receiving of action as other beta-lactam antibiotics (such as aminoglycosides, administer at separate sites. Incompatibilities: Dobut are less susceptible to penicillinases. penicillins) not mix with sodium bicarbonate injection and aminoglycoside solutions. Cephalosporins disrupt the synthesis of the Adverse effects peptidoglycan layer of bacterial cell walls. The CNS: Headache, important for cell paresthesias peptidoglycan layer is dizziness, lethargy, wall structural GI: final transpeptidation step in the synthesis integrity. The Nausea, vomiting, diarrhea, anorexia, abdominal pain, flatulence, pseudomembranous colitis, of the peptidoglycan is facilitated by transpeptidases liver toxicity known as penicillin binding proteins (PBPs). PBPs bind GU: Nephrotoxicity to the D-Ala-D-Ala at the end of muropeptides Hematologic: Bone marrowcrosslink depression (peptidoglycan precursors) to the decreased WBC, decreased antibiotics mimic this peptidoglycan. Beta-lactamplatelets, decreased Hct site and Hypersensitivity: Ranging from crosslinking of competitively inhibit PBP rash to fever to anaphylaxis, serum sickness reaction peptidoglycan. Local: Pain, abscess at injection site; phlebitis, Indications inflammation at respiratory infections caused by P. Lower IV site Other: Superinfections, disulfiram-like reaction aeruginosa, other Pseudomonas, S. pneumoniae, S. with alcohol aureus, Klebsiella, H. influenzae, P. mirabilis, E. coli, Interactions Enterobacter, Serratia, Citrobacter Drug-drug UTIs caused by P. aeruginosa, Enterobacter, E. Increased nephrotoxicity with aminoglycosides coli, Klebsiella, P. mirabilis, Proteus Increased bleeding effects with oral anticoagulants Gynecologic infections caused by E. coli Drug-lab test Dermatologic infections caused by P. aeruginosa, Possibility false results on tests Proteus, Klebsiella, S. aureus, ofE. coli, Serratia, of urine glucose using Benedict's solution, Fehling's solution, Clinitest tablets; Enterobacter, S. pyogenes urinary 17-ketosteroids; direct Coombs' test

Septicemia caused by P. aeruginosa, E. coli, Nursing considerations influenzae, Serratia, S. pneumoniae, S. Klebsiella, H. Assessment aureus History: Liver and renal dysfunction, lactation, pregnancy coli, S. Intra-abdominal infections caused by E. Physical: aureus, status, LFTs,Klebsiella Skin Bacteroides, renal function tests, culture of affected area, sensitivity tests CNS infections caused by H. influenzae, N. meningitidis Interventions Bone and joint infections caused by P. aeruginosa, Culture infection, S. arrange Klebsiella, Enterobacter,andaureus for sensitivity tests before and during therapy if expected response is not Contraindications and cautions seen. Contraindicated with allergy to cephalosporins or Reconstitute drug for IM use with sterile water or penicillins. bacteriostaticcautiously with renal with 0.5% or 1% Use water for injection or failure, lactation, lidocaine HCl injection to reduce pain; inject deeply into pregnancy. Availablelarge muscle group. forms WARNING: Do 2 injection1, 2 g Powder for injection500 mg, 1,notg; mix with aminoglycoside solutions. Administer these drugs separately. Metabolism: T1/2: 114120 min Powder placenta; enters breast milk Distribution: Crosses theand reconstituted solution darken with storage. Excretion: Urine Have vitamin K available in case IV facts hypoprothrombinemia for direct Preparation: Reconstitute drug occurs. IV injection with sterile Discontinue if hypersensitivity stable occurs. water for injection. Reconstituted solution is reactionfor 24 hr at room temperature for Fortaz and Tazidime, or 18 hr at room Teaching points Ceptaz and Tazicef or 7 days if refrigerated. For temperature for Avoid alcohol diluent; resulting concentration, 11 500-mg vial, mix with 5 mL while taking this drug and for 3 days after because mix reactions often occur. mg/mL. For 1-g vial, severe with 5 (10) mL diluent; resulting You may experience 2-g side effects: Stomach concentration, 180 (100) mg/mL. Forthese vial, mix with 10 mL upset or diarrhea. diluent; resulting concentration, 170180 mg/mL.

 Report severe diarrhea, difficulty breathing, Respiratory tract infections unusual tiredness or fatigue, pain at injectioncaused by site. Streptococcus pneumoniae, group A beta-hemolytic streptococci Adverse effects in Italic are most common; those in Bold are life Skin and skin structure infections caused by threatening. staphylococcus, streptococcus Otitis media caused by S. pneumoniae, Haemophilus influenzae, streptococcus, staphylococcus, Moraxella catarrhalis Bone infections caused by staphylococcus, Proteus mirabilis GU infections caused by Escherichia coli, P. mirabilis, Klebsiella Contraindications and cautions Contraindicated with allergy to cephalosporins or penicillins. Use cautiously with renal failure, lactation, pregnancy. Available forms Capsules250, 500 mg; tablets250, 500 mg, 1 g; oral cephalexin suspension125, 250 mg/5 mL (sef a lex' in) Metabolism: cephalexin T1/2: 5080 min Distribution: (CAN), Biocef, Keflex, Novo-Lexin Apo-CephalexCrosses the placenta, enters breast milk (CAN), NuExcretion: Urine Cephalex (CAN) Adverse effects CNS: Pregnancy Category BHeadache, dizziness, lethargy, paresthesias

Drug classes GI: Nausea, vomiting, diarrhea, anorexia, Antibiotic abdominal pain, flatulence, pseudomembranous colitis, Cephalosporin (first generation) liver toxicity GU: Therapeutic actions Nephrotoxicity Hematologic: Bone marrow depression  Bactericidal: Inhibits synthesis of bacterial cell wall, Hypersensitivity: Ranging from rash to fever to causing cell death. anaphylaxis; serum sickness reaction  Although first-generation cephalosporins are moderate Other: Superinfection spectrum agents, with a spectrum of activity of bacteria Interactions that includes penicillinase-producing, methicillinDrug-drug susceptible staphylococci and streptococci, they are not Increased nephrotoxicity with aminoglycosides the drugs of choice for such infections. Increased are bactericidal and oral the same mode  Cephalosporins bleeding effects withhave anticoagulants Disulfiram-like reaction may occur if (such is of action as other beta-lactam antibiotics alcohol as taken within 72 are less susceptible to penicillinases. penicillins) but hr after cephalexin administration. Drug-lab test Cephalosporins disrupt the synthesis of the Possibility of false results on tests of walls. The peptidoglycan layer of bacterial cell urine glucose using Benedict's solution, Fehling's solution, Clinitest peptidoglycan layer is important for cell wall structural tablets; urinary 17-ketosteroids; direct Coombs' synthesis integrity. The final transpeptidation step in the test. Nursing considerations of the peptidoglycan is facilitated by transpeptidases Assessment known as penicillin binding proteins (PBPs). PBPs bind to theHistory: Penicillin the cephalosporin allergy, D-Ala-D-Ala at or end of muropeptides pregnancy, or lactation (peptidoglycan precursors) to crosslink the Physical: Renal function tests, respiratory status, peptidoglycan. Beta-lactam antibiotics mimic this site skin competitively sensitivity tests crosslinking and status; culture and inhibit PBP of infected area of peptidoglycan Interventions Indications Arrange for culture and sensitivity tests of infection before and during therapy if infection does not resolve.

 Give drug with meals; arrange for small, frequent mealsGI: Nausea, diarrhea, abdominal pain, constipation if GI complications occur. Respiratory: Bronchospasm, after 14 days. Refrigerate suspension, discardpharyngitis Other: Fever, photosensitivity, rash, myalgia, Teaching arthralgia, angioedema points Take this drug with food. Refrigerate suspension; Nursing considerations after 14 days. discard any drug CLINICAL ALERT! Complete the full course of this drug even if you Name confusion has occurred between Zyrtec (cetirizine) and feel better. Zyprexa (olanzapine); useis prescribed for this particular infection; This drug caution. do not self-treat any other infection. Assessment You may experience these side effects: Stomach History: Allergy to any antihistamines, upset, loss of appetite, nausea (take drug with food); hydroxyzine; narrow-angle glaucoma, stenosing peptic diarrhea; headache, dizziness. ulcer, Report severe diarrhea with blood, pus, or mucus; symptomatic prostatic hypertrophy, asthmatic attack, hives; difficulty breathing; unusual tiredness, rash or bladder neck obstruction, pyloroduodenal obstruction; lactation fatigue; unusual bleeding or bruising. Physical: Skin color, lesions, texture; orientation, reflexes, affect; vision examination; R, adventitious sounds; prostate palpation; renal function tests Interventions cetirizine hydrochloride Give without regard to meals. Reactine (CAN), Zyrtec Provide syrup form or chewable tablets for pediatric use if needed. Drug class Antihistamine Arrange for use of humidifier if thickening of secretions, nasal dryness become bothersome; encourage adequate intake of fluids. Therapeutic actions Provide skin care for urticaria.

Potent histamine (H1) receptor antagonist; inhibits histamine release and eosinophil chemotaxis during inflammation, leading to Teaching points reduced swelling and decreased inflammatory response Indications Take this drug without regard to meals. You may experience these side effects: Dizziness, Management of seasonal and perennial allergic sedation, drowsiness (use caution if driving or rhinitis performing tasks that require alertness); thickening of Treatment of chronic, idiopathic urticaria bronchial secretions,year-round allergic rhinitis and dryness of nasal mucosa Treatment of (humidifier may help). chronic idiopathis urticaria in infants > 6 mo Report difficulty Contraindications and cautionsbreathing, hallucinations, tremors, loss of coordination, irregular heartbeat. antihistamines, Contraindicated with allergy to any hydroxyzine. Use cautiously with narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction, pyloroduodenal obstruction (avoid use or use with caution as condition may be exacerbated by drug effects); lactation. Available forms Tablets5, 10 mg; chewable tablets5, 10 mg; syrup 5 mg/5 mL Metabolism: Hepatic; T1/2: 710 hr chloral hydrate Distribution: Crosses placenta; enters breast milk AquachloralFeces, urine PMS-Chloral Hydrate (CAN), Somnote Excretion: Supprettes, Adverse effects Drug class CNS: Somnolence, sedation Sedative-hypnotic (nonbarbiturate) CV: Palpitation, edema Therapeutic actions

Mechanism by which CNS is affected is not known; hypnotic History: Hypersensitivity and quiet, deep sleep; dosage produces mild cerebral depression to chloral derivatives, allergy REM sleep, severe less hangover gastritis, does not depress to tartrazine, produces cardiac disease,than most hepatic or renal impairment, acute intermittent porphyria, barbiturates and benzodiazepines. lactation Indications Physical: Skin color, lesions; orientation, affect, Nocturnal sedation reflexes; P, BP, perfusion; bowel sounds, normal output, Preoperative sedation to lessen anxiety and induce liver without depressing respiration or cough reflex and sleep evaluation; LFTs, renal function tests, CBC differential, stool opiates test analgesics in postoperative Adjunct to guaiac and care and control of pain Interventions Contraindications and cautions Give capsules with a full glass of liquid; ensure that Contraindicated with hypersensitivity to chloral patient swallows capsules whole;(in 324-mg in half glass derivatives; allergy to tartrazine give syrup and 648-mg of water, fruit juice, or ginger ale. suppositories marketed as Aquachloral Supprettes); Supervise disease, gastritis; hepatic or renal severe cardiac dose and amount of drug prescribed for patients who are addiction prone or alcoholic; give least impairment; lactation. amount feasible to with acute intermittent porphyria Use cautiously patients who are depressed or suicidal. (may precipitate attacks). Withdraw gradually over 2 wk if patient has been Available forms maintained on high doses for weeks or months; if patient Capsules500 mg; syrup250, 500 mg/5 mL; suppositories 324, 500, has built up high tolerance, withdrawal should occur in a 648 mg hospital, using supportive therapy similar to that for barbiturate withdrawal; fatal withdrawal reactions have Metabolism: Hepatic; T1/2: 710 hr occurred. Distribution: Crosses placenta; enters breast milk Excretion: Bile, Reevaluate patients with prolonged insomnia; urine therapy Adverse effects for the underlying cause (eg, pain, depression) is preferable toSomnambulism,of sedativehypnotic drugs. CNS: prolonged use disorientation, incoherence, paranoid behavior, excitement, delirium, drowsiness, Teaching points

staggering gait, ataxia, light-headedness, vertigo, Take malaise, mental prescribed: Swallow nightmares, this drug exactly asconfusion, headache, capsules whole hallucinations with a full glass of liquid (take syrup in half glass of water, fruitSkin irritation; ale). Dermatologic: juice, or ginger allergic rashes Do hives, erythema, eczematoid dermatitis, includingnot discontinue the drug abruptly. Consult your health care urticaria provider if you wish to discontinue the drug. Avoid alcohol, sleep-inducing, or over-the-counter GI: Gastric irritation, nausea, vomiting, gastric drugs; these could cause dangerous doses), flatulence, necrosis (following intoxicating effects. You may experience these side effects: diarrhea, unpleasant taste Drowsiness, dizziness, light-headedness (avoid driving Hematologic: Leukopenia, eosinophilia or performing tasks requiring alertness); GI upset (eat Other: Physical, psychological dependence; frequent small meals); sleep-walking, nightmares, tolerance; withdrawal reaction confusion (use caution: close doors, keep medications Interactions out of reach so inadvertent overdose does not occur Drug-drug while Additive CNS depression with alcohol, other CNS confused). Report depressants rash, coffee ground vomitus, black or tarry stools, severeinhibition of metabolism with alcohol Mutual GI upset, fever, sore throat. Complex effects on oral (warfarin) anticoagulants given with chloral hydrate; monitor prothrombin levels and adjust warfarin dosage whenever chloral hydrate is instituted or withdrawn from drug regimen Drug-lab test chlorpheniramine maleate with the copper sulfate test for Interference Aller-Chlor; Allergy; Chlo-Amine; tests for urine catecholamines, glycosuria, fluorometric Chlor-Trimeton Allergy 4 hr, 8 hr, and and urinary 17-hydroxycorticosteroid determinations 12 hr; Chlor-Tripolon (CAN); Efidac 24 and Thorn procedure) (when using the Reddy, Jenkins, Nursing considerations Drug class Assessment Antihistamine (alkylamine type)

adventitious Therapeutic actions sounds; bowel sounds; prostate palpation; CBC with differential Competitively blocks the effects of histamine at H1-receptor sites; has atropine-like, antipruritic, and sedative effects. Interventions Indications Administer with foodof GI upset occurs. Symptomatic relief if symptoms associated with Caution patient allergic rhinitis; chew SR perennial and seasonal not to crush or vasomotor preparations. conjunctivitis. rhinitis; allergic Arrange for periodic blood tests during prolonged Contraindications and cautions therapy. Contraindicated with allergy to any antihistamines, narrow-angle glaucoma, stenosing peptic ulcer, Teaching symptomatic prostatic hypertrophy, asthmatic attack, points Take as obstruction, pyloroduodenal obstruction, bladder neck prescribed; avoid excessive dosage. Take with food if GI upset occurs; do not cut, crush, or chew third trimester of pregnancy, lactation. the sustained-release in pregnancy. Use cautiously preparations. Available forms Avoid over-the-counter drugs; many contain Chewableingredients that could cause mg; ERreactions if taken tablets2 mg; tablets4 serious tablets8, 12, with this antihistamine. 16 mg; syrup2 mg/5 mL; SR capsules8, 12 mg Avoid alcohol; serious sedation may occur. You may experience Metabolism: Hepatic; T1/2: 1215 hr these side effects: Dizziness, sedation, drowsiness may enter breast milk Distribution: Crosses placenta;(use caution driving or performing tasks that Excretion: Urine require alertness); epigastric distress, diarrhea, or constipation (take with meals; consult care provider if Adverse effects severe); dry Drowsiness, sedation, dizziness, disturbed CNS: mouth (frequent mouth care; sucking on sugarless lozenges may help); thickening of excitation, coordination, fatigue, confusion, restlessness, bronchial secretions, dryness of headache, blurred a humidifier). nervousness, tremor, nasal mucosa (use vision, diplopia, Report difficulty breathing; hallucinations, tremors, vertigo, tinnitus, acute labyrinthitis, hysteria, tingling, loss of coordination; unusual bleeding or bruising; visual heaviness and weakness of the hands disturbances; irregular heartbeat.

CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles GI: Epigastric distress, anorexia, increased appetite and weight gain, nausea, vomiting, diarrhea or constipation GU: Urinary frequency, dysuria, urinary retention, early menses, decreased libido, impotence Hematologic: Hemolytic anemia, hypoplastic anemia, thrombocytopenia, leukopenia, agranulocytosis, pancytopenia Respiratory: Thickening of bronchial secretions, chest tightness, wheezing, nasal stuffiness, dry mouth, dry nose, dry throat, sore throat Other: Urticaria, rash, anaphylactic shock, photosensitivity, excessive perspiration, chills Interactions Drug-drug Increased depressant effects with alcohol, other CNS depressants Nursing considerations Assessment History: Allergy to any antihistamines; narrowcimetidine angle glaucoma, stenosing peptic ulcer, symptomatic Apo-Cimetidine (CAN), Gen-Cimetidine (CAN), Novo-Cimetine prostatic hypertrophy, asthmatic attack, bladder neck (CAN), Nu-Cimet (CAN), Tagamet, Tagamet HB, Tagamet HB obstruction, pyloroduodenal obstruction, pregnancy, Suspension lactation Physical: Skin color, lesions, texture; orientation, Drug class reflexes, affect; vision examination; P, BP; R, Histamine2 (H2) antagonist

Therapeutic actions  InhibitsCV: action of histamine at thecardiac arrest, the Cardiac arrhythmias, histamine2 (H2) hypotension (IV use) receptors of the stomach, inhibiting gastric acid secretion GI: Diarrhea and reducing total pepsin output. Hematologic: are competitive antagonists of  The H2 antagonists Increases in plasma creatinine, serum transaminase histamine at the parietal cell H2 receptor. They suppress Other: Impotence (reversible), gynecomastia (in the normal secretion of acid by parietal cells and the long-term treatment), rash, vasculitis, pain at IM meal-stimulated secretion of acid. They accomplish this injection site by two mechanisms: Histamine released by ECL cells in Interactions stomach is blocked from binding on parietal cell H2 the Drug-drug receptors, which stimulate acid secretion; therefore, other Increased promote acid secretion (such as counts substances that risk of decreased white blood cell gastrin with antimetabolites, a reduced agents, other cells and acetylcholine) have alkylating effect on parietaldrugs known to cause neutropenia when the H2 receptors are blocked. Increased serum levels and risk of toxicity of  Like the H1-antihistamines, the H2 antagonists are warfarin-type anticoagulants, phenytoin, beta-adrenergic inverse agonists rather than true receptor antagonists. blocking agents, alcohol, quinidine, lidocaine, Indications theophylline, chloroquine, and maintenance of active Short-term treatment certain benzodiazepines (alprazolam, chlordiazepoxide, diazepam, flurazepam, duodenal ulcer triazolam), nifedipine, pentoxifylline, Short-term treatment of benign gastric ulcer TCAs, procainamide, of pathologic hypersecretory conditions Treatment carbamazepine when taken with cimetidine (Zollinger-Ellison syndrome) Nursing considerations Prophylaxis of stress-induced ulcers and acute Assessment upper GI bleeding in critical patients History: of erosive cimetidine, impaired renal or TreatmentAllergy to GERD hepatic function, Relief of symptoms of heartburn, acid OTC use: lactation Physical: stomach indigestion, sour Skin lesions; orientation, affect; pulse, baseline and (continuous ContraindicationsECG cautions with IV use); liver evaluation,

Contraindicated with allergy to cimetidine. abdominal cautiously with impaired renal or hepatic Use examination, normal output; CBC, LFTs, renal function tests function, lactation, pregnancy. Interventions Available forms Tablets100, Give drug with meals and hs. 200, 300, 400, 800 mg; liquid300 mg/5 mL; injection150 Decrease injection renal and liver dysfunction. 0.9% mg/mL; doses in premixed300 mg/5 mL Administer IM dose undiluted deep into large Nacl muscle group. Arrange for regular follow-up, including blood Metabolism: Hepatic; T1/2: 2 hr tests to evaluate effects. Distribution: Crosses placenta; enters breast milk Teaching points Excretion: Urine Take drug with meals and at bedtime; therapy may IV facts continue IV injections, dilute in Preparation: For for 46 weeks or longer. 0.9% sodium chloride injection, 5% orTake antacids as prescribed, and Ringer's solution, 10% dextrose injection, lactated at recommended times. 5% sodium bicarbonate injection to a volume of 20 mL. Solution is stable for 48 hrInform your health care provider about dilute at room temperature. For IV infusions, your 300 mg incigarette 50 mL of 5% dextrose injection or onedecreases at least smoking habits. Cigarette smoking of above the drug's effectiveness. listed solutions. Infusion: InjectHave regular medical follow-up care to evaluate by direct injection over not less than 2 min; by your response to drug. infusion, slowly over 1520 min. Report sore throat, fever, unusual bruising in Incompatibilities: Incompatible with aminophylline, barbiturate or bleeding, tarry stools, confusion, hallucinations, IV solutions; pentobarbital sodium and pentobarbital sodium and dizziness, syringe. atropine in the same muscle or joint pain. ciprofloxacin Adverse effects Ciloxan (CAN), Cipro, Cipro HC Otic, Cipro I.V., Cipro XR, CNS: Dizziness, somnolence, headache, confusion, Proquin XR hallucinations, peripheral neuropathy; symptoms of brain stem dysfunction (dysarthria, ataxia, diplopia) Drug classes Antibacterial

Fluoroquinolone Tablets100, 250, Therapeutic actions 500, 750 mg; ER tablets500, 1,000 mg; injection200, 400 mg; powder with oral suspension250,  Bactericidal; interferes for DNA replication in 500 mg/5 susceptible bacteria preventing cell reproduction. mL; ophthalmic ointment3.33 mg/g; ophthalmic solution3.5 mg/mL; otic suspension2 mg/mL  Ciprofloxacin is a broad-spectrum antibiotic that is Metabolism: Hepatic; T1/2: 3.54 hr active against both Gram-positive and Gram-negative Distribution: Crosses placenta; enters breastDNA gyrase, a type II bacteria. It functions by inhibiting milk Excretion: Bile, urin topoisomerase, and topoisomerase IV, enzymes IV facts necessary to separate bacterial DNA, thereby inhibiting Preparation: division. a final concentration of 12 mg/mL with cell Dilute to 0.9% This mechanism can also affect mammalian cell NaCl injection or 5% dextrose injection.particular, some congeners of this or at replication. In Stable up to 14 days refrigerated drug room temperature. example those that contain the C-8 fluorine) family (for Infusion: display high activity 60not only against bacterial Administer slowly over min. Incompatibilities: Discontinue the also administration of eukaryotic any other topoisomerases, but against solutions topoisomerases and are infusion. cultured mammalian during ciprofloxacin toxic to Incompatible with aminophylline, and in vivo tumor models. Although quinolones are cells amoxicillin, clindamycin, floxacillin, heparin in solution. highly toxic to mammalian cells in culture, its Adverse effects mechanism of cytotoxic action is not known. Quinolone CNS: damage was first reported in 1986 induced DNA Headache, dizziness, insomnia, fatigue, somnolence, depression, blurred vision Indications CV: Arrhythmias, hypotension, angina caused by For the treatment of infections EENT: Dry eye, eye bacteria, including susceptible gram-negative pain, keratopathy E. coli, P. GI: Nausea, vomiting, dry mouth, diarrhea, mirabilis, K. pneumoniae, Enterobacter cloacae, P. abdominal pain vulgaris, P. rettgeri, M. morganii, P. aeruginosa, Hematologic: S. aureus, S. epidermidis, group D Citrobacter freundii, Elevated BUN, AST, ALT, serum creatinine and alkaline phosphatase; decreased WBC, streptococci neutrophil count, Hct Other: Fever, rash

Treatment of uncomplicated UTIs caused by E. Interactions K. pneumoniae as a one-time dose in patients at low coli, Drug-drug risk of nausea, diarrhea (Proquin XR) Decreased therapetic effect with Otic: Treatment of acute otitis externa iron salts, sucralfate Treatment of chronic bacterial prostatitis Decreased absorption with antacids, didanosine by IV: Treatment of nosocomial pneumonia caused Increased serum levels and toxic effects of Haemophilus influenzae, K. pneumoniae theophyllines if taken concurrently with ciprofloxacin Oral: Typhoid fever Increased effects of coumarin or its derivatives Oral: STDs caused by N. gonorrheae Drug-alternative Prevention of anthrax following exposure to therapy Increased risk of severe photosensitivity reactions anthrax bacilla (prophylactic use in regions suspected of if combined with St. using germ warfare) John's wort therapy. Nursing considerations sinusitis caused by H. influenzae, Acute Assessment Streptococcus pneumoniae, or Moraxella catarrhalis History: Allergy totract infections norfloxacin E. Lower respiratory ciprofloxacin, caused by or other Klebsiella, renal dysfunction; seizures; lactation Coli, quinolones; Enterobacter species, P. mirabilis, P. Physical: influenzae, H. parainfluenzae, S. aeruginosa, H. Skin color, lesions; T; orientation, reflexes, affect; mucous membranes, bowel sounds; pneumoniae LFTs, Unlabeled use: Effective in patients with cystic renal function tests Interventions fibrosis who have pulmonary exacerbations Arrange for culture and sensitivity tests before Contraindications and cautions beginning therapy. Contraindicated with allergy to ciprofloxacin, Continue other for 2 days after signs and norfloxacin or therapy fluoroquinolones, pregnancy, symptoms lactation. of infection are gone. Be aware that Proquin XR is not interchangeable Use cautiously with renal dysfunction, seizures, with other or tendinitis forms. tendon rupture associated with Ensure that the fluoroquinolone use. patient swallows ER tablets whole; Availabledo not cut, crush, or chew. forms Ensure that patient is well hydrated.

 Give antacids at least 2 hr after dosing. Monitor clinical response; if no improvement is Metabolism: Hepatic; T1/2:occurs, repeat culture and sensitivity. seen or a relapse 35 hr Distribution: Crosses placenta; enters breast milk full course of Encourage patient to complete Excretion: Urine therapy. Adverse points Teachingeffects CNS: Somnolence, dizziness, insomnia, tremor, If an antacid is needed, take it at least 2 hours nervousness, dose. before or after headache, anxiety, paresthesia, blurred visionTake Proquin XR with the main meal of the day. CV: Palpitations, vasodilation, orthostatic Do not touch tip of eye ointment or solution for this hypotension, hypertension may contaminate the product. Dermatologic:of fluids while redness taking this Drink plenty Sweating, rash, you are drug. GI: Nausea, dry mouth, constipation, diarrhea, anorexia, flatulence, vomiting You may experience these side effects: Nausea, GU: abdominal disorders vomiting, Ejaculatory pain (eat frequent small meals); Respiratory: Sinusitis, URI, cough, rhinitis diarrhea or constipation; drowsiness, blurring of vision, Interactions dizziness (observe caution if driving or using dangerous Drug-drug equipment). Increased citalopram levels severe GI problems, Report rash, visual changes, and toxicity if taken with MAOIs; ensure weakness, tremors. that patient has been off the MAOI for at least 14 days before administering citalopram Increased citalopram levels with azole antifungals, citalopram hydrobromide Celexa macrolides Possible severe adverse effects if combined with TCAs, erythromycin; use caution Drug classes Antidepressant Possible increased effects of beta blockers; monitor patient and reduce beta blocker dose as needed SSRI Possible Therapeutic actions increased bleeding with warfarin, monitor patient carefully

Potentiates serotonergic activity in the CNS by inhibiting Risk reuptake QT serotonin, resulting in neuronal of prolonged of interval and potentially fatal cardiac arrhythmias with little effect on norepinephrine antidepressant effect, if combined with pimozide; avoid this combination or dopamine reuptake. Drug-alternative are believed to act by inhibiting the reuptake of  SSRIs therapy Increased risk released reaction if How much an serotonin after beingof severe in synapses.combined with St. John's will respond individualwort therapy. to this, however, also depends on Nursing considerations genetics. In addition, several other mechanisms are CLINICAL ALERT! the desired effect, e.g. neuroprotection and suggested for Name confusion has occurred between Celexa (citalopram), anti-inflammatory and immunomodulatory factors. Celebrex Taken together, Xanaxhas(alprazolam), and compared (celecoxib), SSRI several advantages Cerebyx (fosphenytoin); use caution. with tricyclic antidepressants (TCA)s and 5-HTAssessment prodrugs. However, the latter might be required in History: in certain situations. addition to SSRIsMAOI use; allergy to drug or any component of the drug; renal or hepatic impairment, the Indications elderly, pregnancy, lactation, suicidal tendencies Treatment of depression, particularly effective in major Physical: Orientation, reflexes; P, BP, perfusion; depressive disorders bowel Unlabeled normal OCD, panic disorder, PMDD, sounds, uses: output; urinary output; liver evaluation; LFTs, renal function tests social phobia, trichotillomania, PTSD Contraindications and cautions Interventions Contraindicated with MAOI use; allergy to drug or Administer the a day, in the morning; may be any component of oncedrug or other SSRIs; concomitant taken pimozide. use of with food if desired. Encourage patient to renal or hepatic impairment, Use cautiously with continue use for 46 wk, as directed, to ensure adequate patients who depression. pregnancy, lactation, and inlevels to affect are elderly or Limit amount of drug given in prescription to suicidal. Availablepotentially suicidal patients. forms Establish appropriate safety precautions if patient Tablets10, 20, 40 mg; oral solution2 mg/mL experiences adverse CNS effects.

 Institute appropriate therapy for patient suffering Treatment from depression. of acute otitis media, acute maxillary sinusitis due to H. influenzae, M. cararrhalis, S. Teaching pneumoniae points Treatment of mild to moderate community Take this drug exactly as directed, and as long as acquired it may take a few directed; pneumonia in adultweeks to realize the benefits Contraindications and cautions be taken with food if desired. of the drug. The drug may Contraindicated with This drug should not be takenhypersensitivity or during pregnancy to clarithromycin, erythromycin, or any macrolide when nursing a baby; using barrier contraceptives is antibiotic. suggested. Use cautiously with colitis, hepatic oreffects: renal You may experience these side impairment, dizziness, tremor (use caution and avoid Drowsiness, pregnancy, lactation. Availabledriving a car or performing other tasks that require forms Tablets250, 500 mg;you experience daytime drowsiness); GI alertness if granules for suspension125, 250 mg/5 mL; ER tablets500 frequent small meals; perform frequent mouth upset (eat mg care); alterations in sexual function (it may help to know Metabolism: Hepatic; drug effect, and will pass when drug therapy that this is a T1/2: 37 hr Distribution: Crosses placenta; enters breast milk is ended). Excretion: Urine Report severe nausea, vomiting; palpitations; Adverse effects vision; excessive sweating. blurred clarithromycin CNS: Dizziness, headache, vertigo, somnolence, fatigue Biaxin, Biaxin XL GI: Diarrhea, abdominal pain, nausea, dyspepsia, flatulence, vomiting, melena, pseudomembranous Drug class Macrolidecolitis antibiotic Other: Superinfections, increased PT, decreased WB Therapeutic actions Interactions Drug-drug

Inhibits protein synthesis in susceptible bacteria, causing Increased serum levels and effects of cell death. carbamazepine, prevents bacteria from growing by  Clarithromycin theophylline, lovastatin, phenytoin Drug-food interfering with their protein synthesis. Clarithromycin Food decreases the bacterial ribosome of binds to the subunit 50S of therate of absorption and clarithromycin but does not of effectiveness thus inhibits the translationalterpeptides. Clarithromycin Decreased metabolism and risk erythromycin but has similar antimicrobial spectrum as of toxic effects if combined with grapefruit certain gram-negative bacteria, is more effective against juice; avoid this combination. particularly Legionella pneumophila. Besides this Nursing considerations bacteriostatic effect, clarithromycin also has bactericidal Assessment effect on certain strains such as Haemophilus influenzae, History: Hypersensitivity to clarithromycin, Streptococcus pneumoniae and Neisseria gonorrhoeae. erythromycin, or any macrolide antibiotic; Indications pseudomembranous colitis, hepatic or by Streptococcus Treatment of URIs caused renal impairment, lactation, S. pneumoniae pyogenes,pregnancy Physical: Site of infection; skin color, lesions; Treatment of lower respiratory infections caused by orientation, pneumoniae, S. sounds, liver evaluation; MycoplasmaGI output, bowelpneumoniae, Haemophilus culture and sensitivity tests of influenzae, Moraxella catarrhalis infection, urinalysis, LFTs, Treatment of tests and skin-structure infections renal function skin caused by Staphylococcus aureus, S. pyogenes Interventions Treatment of disseminated mycobacterial Culture infection before therapy. infections due to Myobacterium avium and M. Do not intracellular cut or crush, and ensure that patient does not Treatment of active duodenal ulcer associated with chew ER tablets. Monitor patient for anticipated with proton pump Helicobacter pylori in combinationresponse. Administer without regard to meals; administer inhibitor with food if GI effects occur. Teaching points

 Take drug with food if GI effects occur. Take the do course of therapy. Do not drink grapefruit juice fullnot use to treat meningitis; does not cross the blood brain taking while barrier.this drug. Topical dermatologic solution: not refrigerate; do Shake suspension before use; doTreatment of acne vulgaris not cut, crush, or chew extended-release tablets; swallow Vaginal preparation: Treatment of bacterial them whole. vaginosis may experience these side effects: Stomach You Contraindications and cautions diarrhea; fatigue, headache cramping, discomfort, Systemic administration be ordered); additional infections in the (medication may mouth Contraindicated with with care provider for or vagina (consult allergy to clindamycin, history of asthma or other allergies, tartrazine (in 75- and treatment). 150-mg capsules); or hepatic diarrhea, severe nausea or Report severe watery or renal dysfunction; lactation. vomiting, rash or itching, mouth sores, vaginal sores. Use cautiously in newborns and infants due to benzyl alcohol content; associated with gasping syndrome. Topical dermatologic solution, vaginal preparation Contraindicated with allergy to clindamycin or lincomycin. Use caution with history of regional enteritis or ulcerative colitis; history of antibiotic-associated colitis. Available forms clindamycin Capsules75, 150, 300 mg; clindamycin hydrochloride granules for oral solution75 mg/5 mL; Oral:injection150 mg/mL; topical gel1%; topical lotion1%; topical suspension1%; vaginal cream2%; vaginal Cleocin, Dalacin C (CAN) suppository100 mg Metabolism: Hepatic; T1/2: 23 hr clindamycin palmitate hydrochloride Distribution: Crosses placenta; enters breast milk Oral: Excretion: Feces, urine

Cleocin Pediatric IV facts Preparation: Store unreconstituted product at room temperature. clindamycin phosphate Reconstitute by topical dermatologic solution for acne, vaginal Oral, parenteral, adding 75 mL of water to 100-mL bottle of palmitate in preparation: two portions. Shake well; do not refrigerate reconstituted solution. Reconstituted solution is stable for ClindaCleocin Phosphate, Cleocin T, Cleocin Vaginal Ovules, 2 wk at room (CAN), Clindagel, reconstituted solution to a concentration Derm temperature. DiluteClindaMax, Clindets, Dalacin C (CAN) of 300 mg/50 mL or more of diluent using 0.9% sodium chloride injection, Drug class5% dextrose injection, or lactated Ringer's solution. Solution is stable for 16 Lincosamide antibiotic days at room temperature. WARNING: Infusion: Therapeutic actions Do not administer more than 1,200 mg in a single 1-hr infusion. Infusion rates: 300 mg in 50 mL diluent, 10  Inhibits protein synthesis in susceptible bacteria, causing min; 600 cell death. mL diluent, 20 min; 900 mg in 50100 mL mg in 50 diluent, 30 min; 1,200 mga in 100 mL diluent, 40ismin. Rapid  Clindamycin has bacteriostatic effect. It a bacterial infusion can cause cardiac arrest. Protein synthesis inhibitor by inhibiting ribosomal Incompatibilities: Do not a similar calciummacrolides. ampicillin, translocation, in mix with way to gluconate, It does so phenytoin, barbiturates, aminophylline, and magnesium sulfate. by binding preferentially to the 23S rRNA of the large May be mixed withribosomechloride, dextrose, calcium, potassium, bacterial sodium subunit. vitamin B Indications complex, kanamycin, gentamicin, penicillin, carbencillin. Incompatible in syringe withSerious infections caused Systemic administration: tobramycin. Adverse effects by susceptible strains of anaerobes, streptococci, Systemic administration pneumococci; reserve use for penicillinstaphylococci, CV: Hypotension, penicillin is inappropriate; IV allergic patients or when cardiac arrest (with rapidless infusion) toxic antibiotics (erythromycin) should be considered GI: Severe colitis, including pseudomembranous Parenteral: Treatment of septicemia caused by colitis, nausea, vomiting, diarrhea, staphylococci, streptococci; acute abdominal pain, hematogenous esophagitis, anorexia, to surgical treatment of chronic osteomyelitis; adjunct jaundice, liver function changes bone andHematologic: due to susceptible leukopenia, joint infections Neutropenia, organisms; agranulocytosis, eosinophilia

 Hypersensitivity: Rashes, urticaria to You may experience these side effects: Nausea, anaphylactoid reactions vomiting (eat Pain following meals); superinfections in Local: frequent small injection, induration and the mouth, vagina IM injection, thrombophlebitis after sterile abscess after (use frequent hygiene measures; request treatment if severe). IV use Report severe Topical dermatologic solution or watery diarrhea, abdominal pain, inflamed mouth or vagina, skin rash or lesions. CNS: Fatigue, headache Topical dermatologic administration Dermatologic: Contact dermatitis, dryness, gram Apply thin film of acne solution to affected area negative folliculitis twice GI: Pseudomembranous colitis, diarrhea,mucous daily, being careful to avoid eyes, bloody membranes, abraded skin; if throat diarrhea; abdominal pain, sore solution contacts one of these GU: Urinary frequency cool water. areas, flush with lots of Report Vaginal preparation abdominal pain, diarrhea. Vaginal preparation Cervicitis, vaginitis, vulvar irritation GU: Interactions Use vaginal preparation for 7 or 3 consecutive days, preferably at bedtime. Refrain from sexual Systemic administration intercourse during treatment with this product. Drug-drug Report vaginal irritation, itching; diarrhea,with no Increased neuromuscular blockade improvement inblocking agents treated. neuromuscular complaint being Decreased GI absorption with kaolin, aluminum salts Nursing considerations clonazepam Assessment Apo-Clonazepam (CAN), Gen-Clonazepam (CAN), Klonopin, History: Allergy to clindamycin, history of asthma Klonopin or other Rivotril (CAN) to tartrazine (in 75- and 150Wafers, allergies, allergy mg capsules); hepatic or renal dysfunction; lactation; Pregnancy Category regional enteritis or ulcerative colitis; history history of X Controlled Substance C-IV of antibiotic associated colitis

Physical: Site of infection or acne; skin color, Drug classes lesions; BP; R, adventitious sounds; bowel sounds, Benzodiazepine liver evaluation; CBC, LFTs, renal function tests output, Antiepileptic Interventions Therapeutic actions Systemic administration Exact mechanisms not infection before therapy. Culture understood; benzodiazepines potentiate the effects of GABA, an inhibitory neurotransmitter. glass of water or Administer oral drug with a full Indications food to prevent esophageal irritation. with Used alone or as injections of more than LennoxDo not give IM adjunct in treatment of 600 mg; Gastaut syndrome (petit malavoid serious problems. inject deep into large muscle to variant), akinetic and myoclonic seizures;minor bacterial or viralpatients with Do not use for may be useful in infections. absence (petit mal) seizures who have not responded to Monitor LFTs and renal function tests, and blood succinimides; up to therapy. patients show loss of counts with prolonged 30% of effectiveness of drug, often Topical dermatologic administration within 3 mo of therapy (may respond tosolution away from eyes,treatment of panic Keep dosage adjustment), mouth and abraded disorder with or without agoraphobia base will cause skin or mucous membranes; alcohol Unlabeled uses: Periodic stinging. Shake well before use. leg movements during sleep,Keep cool tap water available to bathe eye, mucous hypokinetic dysarthria, acute manic episodes, multifocal tic abraded skin inadvertently contacted by membranes, disorders, neuralgias Contraindications and cautions drug solution. Contraindicated with hypersensitivity to Vaginal preparation benzodiazepines, psychoses, acute narrow-angle Give intravaginally, preferably at hs. Teaching glaucoma, shock, coma, acute alcoholic intoxication with points depression of Systemic administration vital signs; pregnancy (risk of congenital malformations, neonatal withdrawal syndrome), labor Take oral drug with a full glass of water or with and food. delivery ("floppy infant" syndrome), lactation (infants become lethargic and lose weight). drug. Do not Take full prescribed course of oral Use cautiously with impaired liver or stop taking without notifying health care provider. renal function, debilitation.

Available forms examination, orally disintegrating output; CBC, 0.25, Tablets0.5, 1, 2 mg; bowel sounds, normaltablets0.125, LFTs, renal 0.5, 1, 2 mg function tests. Interventions Metabolism: Hepatic; T1/2: 1850 hr Monitor addiction-prone patients Distribution: Crosses placenta; enters breast milkcarefully because of their predisposition to habituation and drug Excretion: Urine dependence. Adverse effects Monitor liver CNS: Transient,function drowsiness initially; mild and blood counts periodically in patients lethargy, apathy, fatigue, lightsedation, depression, on long-term therapy. WARNING: Taper anger, hostility, after longheadedness, disorientation,dosage gradually episodes of term therapy, especially in patients with epilepsy; mania and hypomania, restlessness, confusion, crying, substitute another antiepileptic. delirium, headache, slurred speech, dysarthria, stupor, Monitor patient for therapeutic drug nervousness, rigidity, tremor, dystonia, vertigo, euphoria,levels: 2080 ng/mL. in concentration, vivid dreams, psychomotor difficulty If the patient has epilepsy, arrange for patient to retardation, extrapyramidal symptoms; mild paradoxical wear medical alert during first 2 wk of treatment patient excitatory reactions identification indicating the has epilepsy and is receivingtachycardia, CV collapse, CV: Bradycardia, drug therapy. hypertension and hypotension, palpitations, edema Teaching pointsDermatologic: Urticaria, pruritus, rash, dermatitis Take drug exactly as prescribed; do not stop taking EENT: Visual and auditory disturbances, diplopia, drug (long-term therapy) without consulting health care nystagmus, depressed hearing, nasal congestion provider. Constipation, diarrhea, dry mouth, salivation, GI: Avoid alcohol, sleep-inducing, or in swallowing, nausea, anorexia, vomiting, difficulty over-the-counter drugs. disorders, hepatic dysfunction, encoporesis gastric Avoid pregnancy; serious adverse changes in GU: Incontinence, urinary retention, effects can occur. menstrual irregularities libido, Using barrier contraceptives is advised while taking this drug. You may experience these side effects: Drowsiness, dizziness (may become less pronounced;

Hematologic: Elevations of blood enzymes avoid driving or engaging in other AST, ALT; blood LDH, alkaline phosphatase, dangerous activities); GI upset (take drug with food); fatigue; dreams; crying; dyscrasias: agranulocytosis, leukopenia nervousness; Hiccups, fever, diaphoresis, paresthesias, Other: depression, emotional changes; bedwetting, urinary incontinence. muscular disturbances, gynecomastia. Drug dependence Report severe dizziness, weakness, drowsiness that with withdrawal syndrome when drug is discontinued; persists, rash withskin lesions, difficulty ofvoiding, more common or abrupt discontinuation higher palpitations, for longer than extremities. dosage used swelling in the 4 mo Interactions Drug-drug Increased CNS depression with alcohol Increased effect with cimetidine, disulfiram, omeprazole, hormonal contraceptives Decreased effect with theophylline Risk of increased digoxin levels and toxicity; monitor patient carefully Nursing considerations CLINICAL ALERT! Name confusion has been reported between Klonopin (clonazepam) and clonidine; use caution. Assessment History: Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock; coma; acute alcoholic intoxication; pregnancy; lactation; liver clonidine or renal dysfunction, debilitation. hydrochloride (kloe' ni deen) Physical: Skin color, lesions; T; orientation, Antihypertensives: affect, ophthalmologic examination; P, BP; R, reflexes, adventitious sounds; liver evaluation, abdominal

Apo-Clonidine (CAN), Catapres, Catapres-TTS (transdermal Oral therapy preparation), Dixarit (CAN), Duraclon, Novo-Clonidine (CAN), CNS: Nu-Clonidine (CAN) Drowsiness, sedation, dizziness, headache, fatigue that tend to diminish within 46 wk, dreams, Analgesic: insomnia, hallucinations, delirium, Duraclon nightmares, nervousness, restlessness, anxiety, depression, retinal degeneration Drug classes CV: CHF, orthostatic hypotension, palpitations, Antihypertensive tachycardia, bradycardia, Raynaud's phenomenon, ECG Sympatholytic (centrally acting) abnormalities manifested as Wenckebach period or Central analgesic ventricular Therapeutic actions trigeminy Dermatologic: Rash, angioneurotic edema, hives,  Stimulates CNS alpha2-adrenergic receptors, inhibits urticaria, hair cardioaccelerator and vasoconstrictor sympathetic thinning and alopecia, pruritus, dryness, itching burning of the sympathetic centers,orand decreases eyes, pallor outflow from the CNS. GI: Dry mouth, constipation, anorexia, malaise, nausea, vomiting, parotid pain, parotitis, mild transient  Clonidine treats high blood pressure by stimulating 2 abnormalities in brain, receptors in the LFTs which decreases cardiac output GU: Impotence, resistance, lowering blood and peripheral vascular decreased sexual activity, diminished has specificity towards the presynaptic 2 pressure. It libido, nocturia, difficulty in micturition, urinary retention receptors in the vasomotor center in the brainstem. This Other: Weight gain, transient elevation of and binding decreases presynaptic calcium levels,blood glucose the release of norepinephrine gynecomastia, inhibits or serum creatine phosphokinase,(NE). The net weakness, muscle or joint pain, cramps of the lower effect is a decrease in sympathetic tone. limbs, dryness of the nasal mucosa, fever Indications Transdermal system Hypertension, used alone or as part of combination CNS: Drowsiness, fatigue, headache, lethargy, therapy sedation, insomnia, nervousness GI: Dry mouth, constipation, nausea, change in taste, dry throat

Treatment of severe pain in cancer patients in GU: Impotence, sexual dysfunction combination with opiates; epidural more effective with Local: Transient localized skin reactions, pruritus, neuropathic pain (Duraclon) erythema, allergic contact sensitization and contact Unlabeled uses: Tourette's syndrome; migraine, dermatitis, localized frequency; hyperpigmentation, decreases severity and vesiculation,menopausal flushing, edema, severity and frequency papules, throbbing, decreases excoriation, burning, of episodes; chronic blanching, detoxification; rapid opiate detoxification (in methadone generalized macular rash Interactions up to 17 mcg/kg/day); alcohol and benzodiazepine doses Drug-drug withdrawal treatment; management of hypertensive Decreased clonidine "loading" is with initial "urgencies"; (oral antihypertensive effects used; TCAs (imipramine) dose of 0.2 mg then 0.1 mg every hour until a dose of Paradoxical hypertension with propranolol; also 0.7 mg is reached or until BP is controlled) greater withdrawal Contraindications and cautions hypertension when abruptly discontinued and patient hypersensitivity to clonidine Contraindicated with is taking beta-adrenergic blocking agents or any adhesive layer components of the transdermal Nursing considerations system. CLINICAL ALERT! Use cautiously with severe coronary insufficiency, Name confusion has been reported between clonidine and recent MI, cerebrovascular disease; chronic renal failure; Klonopin pregnancy, lactation. (clonazepam); use caution. Assessment Available forms History: Hypersensitivity to clonidine or adhesive Tablets0.1, 0.2, 0.3 mg; transdermal0.1, 0.2, 0.3 mg/24 hr; layer components of epidural injection100 mcg/mL the transdermal system; severe coronary insufficiency, recent MI, cerebrovascular disease; chronic : 1216 hr, lactation, pregnancy Metabolism: Hepatic; T1/2renal failure;19 hr (transdermal system); 48 hr (epidural) Physical: Body weight; T; skin color, lesions, T; mucous membranescolor, lesion; breast examination; Distribution: Crosses placenta; enters breast milk orientation, affect, reflexes; ophthalmologic Excretion: Urine examination; P, BP, orthostatic BP, perfusion, edema, Adverse effects auscultation; bowel sounds, normal output, liver

evaluation, palpation of salivary glands; normal urinary Plavix output, voiding pattern; LFTs, ECG Interventions Drug classes WARNING: Do not discontinue abruptly; Adenosine diphosphate (ADP) receptor antagonist discontinue therapy by reducing the dosage gradually Antiplatelet over 24 days to avoid rebound hypertension, Therapeutic actions tachycardia, flushing, nausea, vomiting, cardiac  Inhibits platelet aggregation encephalopathy and death arrhythmias (hypertensive by blocking ADP receptors on platelets, preventing clumping of of clonidine). have occurred after abrupt cessation platelets.  Clopidogrel is discontinuewhose action may be related to Do not a pro-drug transdermal therapy prior an adenosine diphosphate (ADP) receptor on platelet surgery; monitor BP carefully during surgery; have other cell membranes. Thereadilyspecifically and irreversibly BP-controlling drugs drug available. inhibits the P2Y12 subtype of therapy within which of Continue oral clonidine ADP receptor, 4 hr is important in aggregation of platelets and thereafter. by surgery, then resume as soon as possible cross-linking the protein fibrin. The blockade of this receptor inhibits Store epidural injection at room temperature; platelet any unused portions. discard aggregation by blocking activation of the glycoprotein IIb/IIIa pathway. The IIb/IIIa complex Reevaluate therapy if clonidine tolerance occurs; functions concomitant as a receptor mainly for increases fibrinogen and giving diuretic the vitronectin but also for fibronectin and von Willebrand antihypertensive efficacy of clonidine. factor. Activation BP this receptor when discontinuing Monitor of carefully complex is the "final common pathway" for platelet aggregation, hr. is clonidine; hypertension usually returns within 48 and important in the cross-linking of platelets bypatch before WARNING: Remove transdermal fibrin. Indications defibrillation to prevent arcing. Treatmentcompliance at risk for ischemic events Assess of patients with drug regimen in a history of MI, ischemic stroke, peripheral artery disease supportive manner with pill counts, or other methods. Treatment of patients with acute coronary Teaching syndrome points Contraindications and cautions

Take this drug exactly as prescribed. Do not miss doses.Contraindicated with the drugto clopidogrel, active Do not discontinue allergy unless instructed by pathological care provider. as peptic ulcer or intracranial your health bleeding such Do not discontinue abruptly; hemorrhage, lactation. effects may occur. If you travel, life-threatening adverse Use cautiously of drug. take an adequate supplywith bleeding disorders, recent surgery, hepatic impairment, pregnancy. Use the transdermal system as prescribed; refer to Availabledirections in package insert, or contact your health care forms Tablets75 mg with questions. Be sure to remove old systems provider before applying new ones. Metabolism: Hepatic; T1/2: 8 hr changes that will reduce your Attempt lifestyle Distribution: Crosses placenta; enters breast milk alcohol; lose blood pressure: Stop smoking and using Excretion: Bile, feces, urine of salt; exercise regularly. weight; restrict intake Adverse effects Use caution with alcohol. Your sensitivity may CNS: Headache, dizziness, weakness, syncope, increase while using this drug. flushingYou may experience these side effects: CV: Hypertension, light-headedness, headache, Drowsiness, dizziness, edema Dermatologic: Rash, observe weakness (often transient; pruritus caution driving or GI: Nausea, GI distress, constipation, or physical performing other tasks that require alertnessdiarrhea, GI bleed dexterity); dry mouth (sucking on sugarless lozenges or Other: Increased bleeding risk ice chips may help); GI upset (eat frequent small meals); Interactions dreams, nightmares (reversible); dizziness, lightDrug-drug headedness when you change position (get up slowly; Increased risk stairs); impotence, other sexual use caution climbing of GI bleeding with NSAIDs, monitor patientdecreased libido (discuss with care dysfunction, carefully Increased bleeding with warfarin; monitor carefully providers); breast enlargement, sore breasts; palpitations. Nursing considerations urinary retention, changes in vision, Report Assessment blanching of fingers, rash. clopidogrel

 History: Allergy to clopidogrel, pregnancy, lactation, bleeding disorders, recent surgery, hepatic Metabolism: Hepatic; T1/2: 3 hr impairment, peptic ulcer Distribution: Crosses placenta; enters breast lesions; orientation, Physical: Skin color, T, milk Excretion: Urine affect; P, BP, orthostatic BP, baseline ECG, reflexes, peripheral perfusion; R, adventitious sounds IV facts Preparation: Protect vials from light. Interventions Infusion: Administer slowly over 5 min meals if GI upset occurs Provide small, frequent by direct injection or into running IV tubing. (not as common as with aspirin). Adverse effects Provide comfort measures and arrange for CNS: headache occurs. analgesics if Sedation, clamminess, sweating, headache, vertigo, floating feeling, dizziness, lethargy, confusion, nervousness, unusual dreams, Teachinglight-headedness, points agitation, euphoria, hallucinations,May be taken with Take daily as prescribed. delirium, insomnia, anxiety, meals. fear, disorientation, impaired mental and physical performance, coma, mood changes, Dizziness, You may experience these side effects: weakness, headache, tremor, (this may light-headedness seizures pass as you adjust to the drug);CV: Palpitation, increasecool environment and headache (lie down in a or decrease in BP, circulatory depression, cardiac arrest, rest; over-the-counter preparations may shock, help); tachycardia, bradycardia, (eat frequent small nausea, gastric distressarrhythmia, palpitationsmeals); Dermatologic: Rash, hives, and health care prolonged bleeding (alert dentists pruritus, flushing, warmth, sensitivity to cold providers of this drug use). EENT: Diplopia, blurred vision fainting, severe Report skin rash, chest pain, GI: Nausea, vomiting, headache, abnormal bleeding. dry mouth, anorexia, constipation, biliary tract spasm GU: Ureteral spasm, spasm of vesical sphincters, urinary retention or hesitancy, oliguria, antidiuretic effect, reduced libido or potency

Local: Phlebitis following IV injection, pain at codeine phosphate injection site; tissue irritation and induration (koe' deen) (subcutaneous injection) Drug classes Respiratory: Slow, shallow respiration; apnea; suppression cough reflex; laryngospasm; Opioid agonist analgesic of bronchospasm Antitussive Other: Physical tolerance and dependence, psychological Therapeutic actions dependence Interactions Acts at opioid receptors in the CNS to produce analgesia, euphoria, Drug-drug sedation; acts in medullary cough center to depress cough reflex. Potentiation of effects of codeine with barbiturate Indications anesthetics; of mild to moderate pain in adultswhen Relief decrease dose of codeine and coadministering children Drug-lab test Suppression of coughing induced by chemical or Elevated biliary tract pressure may cause mechanical irritation of the respiratory system increases in plasma amylase, lipase; determinations of these levels Contraindications and cautions may be unreliable for 24 hypersensitivity to opioids, Contraindicated with hr after administration of opioids physical dependence on an opioid analgesic (drug may Nursing considerations precipitate withdrawal). CLINICAL ALERT! cautiously with pregnancy, labor, lactation, Use Name confusion has been reported respiratory depression,Cardene bronchial asthma, COPD, between codeine and anoxia, (nicardipine) and Lodine (etodolac); use caution. MI, ventricular increased intracranial pressure, acute failure, coronary insufficiency, hypertension, biliary tract Assessment surgery, renal or hepatic dysfunction. Available formsHistory: Hypersensitivity to codeine, physical dependence on an solution15 mg/5 mL; injection Tablets15, 30, 60 mg; oral opioid analgesic, pregnancy, labor, lactation, bronchial asthma, COPD, increased 30, 60 mg/mL intracranial pressure, acute MI, ventricular failure,

coronary insufficiency, hypertension, biliary tract cyclobenzaprine hydrochloride dysfunction surgery, renal or hepatic Apo-Cyclobenzaprine (CAN), Flexeril, Novo-Cycloprine (CAN) Physical: Orientation, reflexes, bilateral grip strength, affect; pupil size, vision; pulse, auscultation, Drug class BP; R, adventitious sounds; bowel sounds, normal Skeletal muscle relaxantrenal function tests output; LFTs, (centrally acting) Interventions Therapeutic actions to nursing women 46 hr before scheduled Give  Precise to minimize drugknown; does not directly relax feeding mechanism not in milk. tense skeletal musclesDuring parenteral mainly at brain WARNING: but appears to act administration, stem levels or opioid antagonist ensure that an in the spinal cord. and facilities for assisted  The mechanism of action are readily available. is unclear. or controlled respirations for cyclobenzaprine Studies from the 1980s in rats indicate into Use caution when injecting subcutaneously that cyclobenzaprine activates the locus ceruleus in the brain chilled body areas or in patients with hypotension or in stem, leading to an increased release of norepinephrine shock; impaired perfusion may delay absorption; with in the ventral horn of the spinal cord and the subsequent repeated doses, an excessive amount may be absorbed inhibitory actionis of norepinephrine on alpha motor when circulation restored. neurons. WARNING: Do not use IV in children. Indications Instruct postoperative patients in pulmonary toilet; Relief of cough reflex. drug suppressesdiscomfort associated with acute, painful musculoskeletal bowel function, arrange rest, laxatives Monitor conditions, as adjunct to for physical therapy (especially senna compoundsapproximate dose of Unlabeled concentrate per management of 187 mg senna use: Adjunct in the120 mg codeine fibrositis syndrome equivalent), bowel training program if severe Contraindications and cautions constipation occurs. Teaching points Contraindicated with hypersensitivity to cyclobenzaprine, acute prescribed. phase of MI, Take drug exactly as recovery arrhythmias, heart block or conduction disturbances, CHF, hyperthyroidism.

Do not take any leftover medication for other Use cautiously anyone else take it. disorders, and do not let with urinary retention, angleclosure glaucoma, increased IOP,side effects: Dizziness, You may experience these lactation, mild hepatic impairment. sedation, drowsiness, impaired visual acuity (avoid Availabledriving and performing other tasks that require forms Tablets5, 10 mg nausea, loss of appetite (lie quietly; eat alertness); frequent small meals); constipation (use a laxative). Metabolism: Hepatic; T1/2: 13 days, 18 hrvomiting, palpitations, Report severe nausea, (range 837 hr) Distribution: Crosses breath or difficulty breathing. shortness of placenta; may enter breast milk Excretion: Urine Adverse effects CNS: Drowsiness, dizziness, fatigue, tiredness, asthenia, blurred vision, headache, nervousness, confusion CV: Arrhythmias, MI GI: Dry mouth, nausea, constipation, dyspepsia, unpleasant taste, liver toxicity GU: Frequency, urinary retention Interactions Drug-drug Additive CNS effects with alcohol, barbiturates, other CNS depressants, MAOIs, TCAs; avoid concomitant use Nursing considerations Assessment

 History: Hypersensitivity to cyclobenzaprine, acute Use cautiously with lactation; history of GI bleed; recovery phase of MI, arrhythmias, CHF, severe liver or renal dysfunction; recent hyperthyroidism, urinary retention,childbirth or angle-closure surgery; history of heparin-induced glaucoma, increased IOP, lactation thrombocytopenia; severe and uncontrolled hypertension, spinal tap, Physical: Orientation, affect, ophthalmic spinal/epidural anesthesia. examination (tonometry); bowel sounds, normal GI Availableoutput; prostate palpation, normal voiding pattern; forms Injection2,500 IU/0.2 mL, 5,000 IU/0.2 mL thyroid function tests Metabolism: T1/2: 4.5 hr Distribution: Interventions May cross placenta, may enter breast milk Excretion: Urine Arrange for analgesics if headache occurs. Adverse effects Teaching pointsHematologic: Hemorrhage; bruising; thrombocytopenia exactly as prescribed. Do not take a Take this drug Hepatic: higher dosage. Elevated concentrations of AST, ALT Hypersensitivity: Chills, fever, or over-the-counter Avoid alcohol, sleep-inducing, urticaria, asthma Other: Fever; pain; local irritation, drugs; these may cause dangerous effects.hematoma, erythema at site of injection; risk ofthese or epidural You may experience spinal side effects: hematoma if dizziness, blurred vision (avoid driving Drowsiness, used with spinal/epidural anesthesia or or spinal tap engaging in activities that require alertness); dyspepsia Interactions drug with food; eat frequent small meals); dry (take Drug-drug mouth (suck sugarless lozenges or ice chips). Increased bleeding tendencies or difficulty voiding, pale Report urinary retention with oral anticoagulants or platelet inhibitors; eyes. stools, yellow skin or clopidogrel, ticlopidine, salicylates Risk of severe bleeding with heparin; avoid this combination Adverse effects in Italic are most common; those in Bold are lifeDrug-lab test threatening. Increased AST, ALT levels Drug-alternative therapy

dalteparin Fragmin Increased risk of bleeding if combined with chamomile, garlic, ginger, ginkgo, and ginseng therapy, high-dose vitamin E Drug classes Nursing considerations Anticoagulant Assessment Antithrombotic History: Recent Low-molecular-weight heparin surgery or injury; sensitivity to heparin, pork Therapeutic actions products, either lowmolecular-weight heparins or enoxaparin, tinzaparin, benzyl alcohol; Low-molecular-weight heparin that inhibits thrombus and clot formation lactation, pregnancy; history of GIpreventing the liver by blocking factor Xa, factor IIa, bleed; renal or formation dysfunction of clots. Indications Physical: Peripheral perfusion, R, stool guaiac test, PTT or other tests of blood coagulation,nonQ-wave MI Treatment of unstable angina and platelet count, renal function testsof complications in patients on aspirin for the prevention Interventions or standard therapy Give 12 hrof DVT,abdominal surgery. pulmonary Prevention before which may lead to Give following abdominal or hip replacement embolism, deep subcutaneous injections; do not give dalteparin by IM injection. surgery Administeruse:deep subcutaneous injection;venous Unlabeled by Systemic anticoagulation in patient should be lying down; alternate administration between and arterial thromboembolic complications; prophylaxis theDVTandsituations that may and leftPE; adjunct to of left in right anterolateral lead to and right posterolateral abdominal wall. Introduce the whole antineoplastic chemotherapy length of and cautions Contraindications the needle into a skin fold at a 45 and 90 angle Contraindicated with hypersensitivity to hold the held between the thumb and forefinger; dalteparin, skin foldpork products, or benzyl alcohol; severe heparin, throughout the injection. Cannot be used interchangeably (unit for unit) thrombocytopenia; uncontrolled bleeding; use of with other low-molecular-weight heparin or unfractionated unstable angina dosage in patients undergoing regional heparin. pregnancy. anesthesia;

 Apply pressure to all injection sites after needle is withdrawn; inspect injection sites for signs of hematoma. IV facts Do not massage injection sites. Preparation: Administer as provided,injections or infusions. Do not mix with other no additional preparation needed. Enter vial only once, discard any unused solution. clear, Store at room temperature; fluid should be Refrigerate. Do not to palevial. Inspect for any discoloring or colorless shake yellow. precipitates before use. health care providers that patient is on Alert all Infusion: dalteparin. by direct IV injection or into tubing of Administer running IV. If thromboembolic episode should occur despite Incompatibilities:discontinue and initiate appropriate therapy. therapy, Do not mix with any other drug solution. WARNING: Keep protamine sulfate (dalteparin Adverse effects readily available in case of overdose. antidote) CNS: Headache, fatigue, Protaminedizziness, Treatment of overdose: asthenia, sulfate (1% seizure, TIA solution). Administer 1 mg of protamine per 100 CV: Hypertension, edema, chest pain, arrhythmias, antifactor Xa IU of dalteparin. Give very slowly IV over chest pain, MI, stroke, CVA 10 min. Teaching pointsGI: Nausea, vomiting, diarrha, abdominal pain Respiratory: URI, dyspnea, parenteral route (not This drug must be given by acough Other: Arthralgias, myalgias, limb pain, clotting orally). You and a significant other may need to learn to of access line, drug subcutaneously, and to safely administer the pain at injection site, development of anti-erythropoetin dispose of syringes. antibodies with subsequent pure red Periodic blood extreme anemia cell aplasia and tests are needed to monitor Nursing considerations response. Assessment Avoid injury while using this druguse an electric razor,History: Hypertension; hypersensitivity to any avoid potentially injurious activities. component of product, pregnancy,of the gums, unusual Report nose bleed, bleeding lactation Physical: Reflexes, affect, BP, or dark urine, bruising, black or tarry stools, cloudyP, R, adventitious sounds, urinary output, renal function, renal function abdominal or lower back pain, severe headache. tests, CBC, Hct, iron levels, electrolytes

darbepoetin alfa Aranesp Interventions WARNING: Ensure chronic, renal nature of Drug class anemia. Darbepoetin is not Erythropoiesis-stimulating protein intended as a treatment of severe anemia and is not a substitute for emergency transfusion. Therapeutic actions Prepare solution by hormone produced by An erythropoetin-like glycoprotein gently mixing. Do not shake; shaking technology; the glycoprotein. Use only recombinant DNAmay denaturestimulates red blood cell one dose per vial; do not in the the vial. Discard unused production in the bone marrowreentersame manner as naturally occurring portions. erythropoetin, a hormone released into the bloodstream Do hypoxia. in response to renalnot administer with any other drug solution. Indications Administer dose once weekly. If administered independent of dialysis, administer into venous access Treatment of anemia associated with chronic renal line. If including during dialysis failure, patient is not on dialysis, administer IV or subcutaneously. of chemotherapy-induced anemia in Treatment Monitor access lines for signs of patients with nonmyeloid malignanciesclotting. Arrange cautions Contraindications and for Hct reading before administration of each dose to determine appropriate dosage. If patient or Contraindicated with uncontrolled hypertension fails to respond to any component of the drug. hypersensitivitywithin 4 wk of therapy, evaluate patient for Use cautiously with hypertension, pregnancy, other causes of the problem. Evaluate iron stores before and periodically during lactation. Availabletherapy. Supplemental iron may be needed. forms Monitor injection25, nutrition; arrange for Polysorbate solution for diet and assess 40, 60, 100, 150, 200, 300, nutritional consult as necessary. 500 mcg/mL Establish : 21 hr (IV), 49 hr (eg siderails, Metabolism: Serum; T1/2safety precautions (subcutaneous) environmental control, lighting) if milk Distribution: Crosses placenta; enters breastCNS effects occur. Maintain seizure precautions during administration. Excretion: Urine

 Provide additional comfort measures, as necessary, to alleviate discomfort from GI effects, headache. Metabolism: Hepatic; T1/2: 27 hr encouragement to deal with Offer support and Distribution: Crosses placenta; enters prolonged therapy and chronic disease and need for breast milk Excretion: Feces, urine testing. Adverse points Teachingeffects CNS: Somnolence, to be given once a week fatigue The drug will need nervousness, dizziness, and only be given IV or subcutaneously or into a dialysis can CV: Tachycardia GI: Dry mouth, schedule access line. Prepare a nausea of administration dates. Respiratory: Bronchospasm, pharyngitis, dry Keep appointments for blood tests; frequent blood throat tests will be needed to determine the effects of the drug Other: count symptoms, hypersensitivity on your bloodFlulike and to determine the appropriate Nursing considerations dosage needed. Assessment Maintain all of the usual activities and restrictions History: Allergy to renal failure. loratadine, other that apply to your chronic desloratadine,If this becomes antihistamines; hepatic or health care provider. difficult, consult with yourrenal impairment; pregnancy; lactation may experience these side effects: Dizziness, You Physical: driving a car reflexes, affect, R, headache (avoidT, orientation,or performing hazardous adventitious sounds, LFTs, renal function tests tasks); headache, fatigue, joint pain (consult with your health care provider if these become bothersome; Interventions medications may be available to help); nausea, vomiting, Administer without is important; consult with your diarrhea (proper nutrition regard to meals. Arrange for use of humidifier if thickening of dietitian to maintain nutrition and ensure ready access to secretions, throat dryness become bothersome; bathroom facilities); upper respiratory tract infection, encourage adequate your health care cough (consult with intake of fluids. provider if this Provide sugarless lozenges to suck and regular occurs). mouth care ifdifficulty breathing, numbness or tingling, Report dry mouth is a problem. chest Provide safety measures if CNS effects occur. pain, seizures, severe headache.

Teaching points desloratadine Take this drug Clarinex, Clarinex Reditabs exactly as prescribed, with or without food. Place rapidly disintegrating tablets on tongue Drug class immediately after opening Antihistamine (nonsedating type) blister pak; administer with or without water. Therapeutic actions You may experience these of histamine at  Competitively blocks the effects side effects: Dizziness, fatigue (use caution if driving or performing tasks that peripheral H1-receptor sites.  require alertness); tricyclic antihistamine, which has a Desloratadine is a dry throat, thickening of bronchial secretions, dryness of nasal mucosa (use a humidifier if selective and peripheral H1-antagonist action. It has a this becomeseffect and does not cause drowsiness long-lasting a problem); dry mouth (sucking on sugarless lozenges and frequent mouth care nervous because it does not readily enter the central may help). Report difficulty breathing, tremors, palpitations. system. Indications Relief of nasal and non-nasal symptoms of seasonal allergic rhinitis in patients > 2 yr Treatment of chronic idiopathic urticaria and allergies caused by indoor and outdoor allergens in patients > 6 mo Contraindications and cautions Contraindicated with allergy to desloratadine, loratadine, or any components of the product; lactation. Use cautiously with hepatic or renal impairment or pregnancy. Available forms Tablets5 mg; rapidly disintegrating tablets5 mg; syrup 2.5 mg/5 mL

dexmethylphenidate hydrochloride dexmethylphenidate, monitor the patient closely and Focalin, Focalin XR decrease dose of the other drugs as needed Risk of adverse effects if combined with pressor Drug class drugs CNS stimulant (dopamine, epinephrine) or antihypertensives; monitor patients closely Nursing considerations Therapeutic actions Assessment Mild cortical stimulant with CNS actions similar to those of the amphetamines; History: Hypersensitivity to dexmethylphenidate is thought to block the reuptake of norephinephrine or methylphenidate; concentration in the synaptic and dopamine, increasing theirmarked anxiety, tension, and cleft; agitation; glaucoma; motor tics, family history not mechanism of effectiveness in hyperkinetic syndromes isor diagnosis of Tourette's syndrome; severe depression of understood. endogenous or exogenous origin; seizure disorders; Indication hypertension; drug attention-deficit hyperactivity Treatment of dependence, alcoholism, emotional instability; patients > yr as part disorder in pregnancy,6lactation of a total treatment Physical: Body weight, height, T, skin color, program lesions, and cautions Contraindicaionsorientation, affect, ophthalmic examination (tonometry), P, BP, auscultation, R, adventitious sounds, Contraindicated with hypersensitivity to bowel sounds, normal methylphenidate; marked dexmethylphenidate oroutput, CBC with differential, platelet tension, and agitation; glaucoma; anxiety, count, baseline ECG (as indicated)motor tics, Interventions family history or diagnosis of Tourette's syndrome; use Ensure proper diagnosis before of MAOIs within the past 14 days. administering to children for behavioral syndromes. Drug should not be Use cautiously with psychosis, seizure disorders; used recent MI, hyperthyroidism; drug dependence, CHF,until other causes and concomitants of abnormal behavior (learning depression of endogenous or alcoholism, severe disability, EEG abnormalities, neurologic deficits) are ruled out. exogenous origin; as treatment of normal fatigue states; Arrange to interrupt drug dosage periodically in pregnancy, lactation. children being treated for behavioral disorders to

Available forms determine if symptoms recur at an intensity that warrants Tablets2.5, 5, 10 mg; ER capsules5, 10 mg continued drug therapy. Monitor 1/2: 2.2 of Metabolism: Hepatic; Tgrowth hr children on long-term dexmethylphenidate therapy. Distribution: Crosses placenta; may enter breast milk WARNING: Arrange to dispense the least feasible Excretion: Urine amount Adverse effects of drug at any one time to minimize risk of overdose. Nervousness, insomnia, dizziness, headache, CNS: Administer drug before 6 Tourette's syndrome, dyskinesia, chorea, drowsiness, PM to prevent insomnia if that is a problem. toxic psychosis, blurred vision, accommodation Arrange difficulties to monitor CBC, platelet counts periodically in patients on long-term therapy. CV: Increased or decreased pulse and blood Monitor BP frequently early in treatment. pressure; tachycardia, angina, arrhythmias, palpitations Arrange for consult with school nurse of school Dermatologic: Skin rash, loss of scalp hair age GI: Anorexia, nausea, abdominal pain; weight patients receiving this drug. Teaching loss, abnormal liver function points Take this drug Leukopenia, anemia It is taken two Hematologic: exactly as prescribed. times Other:at least 4 hours apart. a day, Fever, tolerance, psychological Take drug before 6 PM to with night-time sleep dependence, abnormal behavior avoidabuse disturbance. Interactions Swallow extended-release capsules whole; do not Drug-drug cut, crush, or chew. Risk of severebe opened andcrisis if WARNING: Capsules can hypertensive contents sprinkled over applesauce and taken immediately. combined with MAOIs; do not administer Store this drug in a or within out of of an MAOI dexmethylphenidate withsafe place,14 daysthe reach of children. Possible increased serum levels of coumarin Avoid the use of alcohol and over-the-counter anticoagulants, phenobarbital, phenytoin, primidone, drugs, including nose drops, cold remedies, while taking TCAs, some SSRIs; if any of these drugs are used with this drug; some over-the-counter drugs could cause

dangerous effects. If you feel that you need one of these preparations, consult your health care provider. Available forms may experience these side effects: You Tablets5, 10, 15 mg; SR capsules5, 10, 15 insomnia, impaired Nervousness, restlessness, dizziness, mg thinking (these effects may become less pronounced Metabolism: Hepatic; T1/2:avoid driving a car or engaging in after a few days; 1030 hr Distribution: Crosses placenta;alertness if these occur; notify your activities that require enters breast milk Excretion: Urine health care provider if these are pronounced or Adverse effects bothersome); headache, loss of appetite, dry mouth. CNS: nervousness, insomnia, palpitations, ReportOverstimulation, restlessness, dizziness, insomnia, dyskinesia, euphoria, vomiting, skin rash, depression. dysphoria, tremor, headache, psychotic episodes CV: Palpitations, tachycardia, hypertension . Dermatologic: Urticaria Endocrine: Reversible elevations in serum thyroxine with heavy use GI: Dry mouth, unpleasant taste, diarrhea, constipation, anorexia and weight loss GU: Impotence, changes in libido Other: Tolerance, psychological dependence, social disability with abuse Interactions Drug-drug WARNING: Hypertensive crisis and increased CNS effects if given within 14 days of MAOIs; do not give dextroamphetamine to patients who are taking or who have recently taken MAOIs

dextroamphetamine sulfate Decreased duration of effects Dexedrine, Dexedrine Spansule, DextroStat if taken with urinary alkalinizers (acetazolamide, sodium bicarbonate), furazolidone Drug classes Amphetamine Decreased effects if taken with urinary acidifiers CNS stimulant Decreased efficacy of antihypertensive drugs (guanethidine) given with amphetamines Nursing considerations Therapeutic actions Assessment Acts in the CNS to release norepinephrine from nerve terminals; in History: Hypersensitivity to sympathomimetic higher doses also releases dopamine; suppresses appetite; increases alertness, amines, tartrazine; advanced arteriosclerosis, elevates mood; often improves physical performance, especiallysymptomatic CV disease, moderate to severe when fatigue and sleep-deprivation have caused hypertension, hyperthyroidism, glaucoma, agitated impairment; efficacy in hyperkinetic syndrome, attention-deficit states, history of drug abuse; lactation, pregnancy, use disorders in children appears paradoxical and is not understood. of MAOI in the last 14 days Indications Physical: Weight; T; skin color, lesions; Narcolepsy orientation, affect, ophthalmic examination (tonometry); Adjunct therapy for abnormal behavioral syndrome P, BP, auscultation; R, adventitious sounds; bowel in children (attention-deficit disorder, hyperkinetic sounds, normal output; psychological, tests, syndrome) that includesthyroid functionsocial,blood and urine glucose, baseline educational measures ECG Interventions Contraindications and cautions Ensure proper diagnosis before administering to Contraindicated with hypersensitivity to children for behavioral syndromes. Drug should and sympathomimetic amines, tartrazine (Dexedrine not be used until other causes (learning disability, EEG DextroStat); advanced arteriosclerosis, symptomatic CV abnormalities, neurologic deficits) are ruled disease, moderate to severe hypertension, out. Interrupt drug dosage agitated states. hyperthyroidism, glaucoma,periodically in children being treated forcautiously with history of drug abuse; Use behavioral disorders to determine if symptomatic response pregnancy; lactation. still validates drug therapy.

 Monitor growth of children on long-term Distribution: Crosses placenta; enters breast milk amphetamine therapy. Excretion: Urin Dispense the lowest feasible dose to minimize risk Adverse effects of overdosage; should be in a light-resistant container. Respiratory: Respiratory depression (with Ensure that patient swallows SR tablets whole; do overdose) not cut, crush, or chew. Interactions Give drug early in the day to prevent insomnia. Drug-drug Monitor BP frequently early in therapy. Concomitant MAOI use may cause hypotension, Teachingpoints fever,Take thismyoclonic jerks and coma; avoid this nausea, drug exactly as prescribed. Do not combinationdosage without consulting your health care increase the Nursing considerations drug appears ineffective, consult your provider. If the Assessment health care provider. History: Hypersensitivity to any component; Do not crush or chew sustained-release or longsensitivity to acting tablets.bromides; cough that persists for more than 1 wk or is accompanied by excessive secretions, high Take drug (especially sustained-release form) early fever, rash, nausea, vomiting, in the day to avoid insomnia. or persistent headache; lactation, pregnancy while taking this drug. This drug Avoid pregnancy Physical: to R, fetus. can cause harm T; theadventitious sounds Interventions You may experience these side effects: Ensure restlessness, dizziness, insomnia, impaired Nervousness,drug is used only as recommended. Coughs may be (may diminish a a few underlying disorder thinkingsymptomatic of inseriousdays; avoid driving or that should activities that require alertness); headache, engaging inbe diagnosed and properly treated; drug may mask symptoms of mouth. loss of appetite, dryserious disease. Teaching pointsReport nervousness, insomnia, dizziness, Take this drug exactly as prescribed. palpitations, anorexia, GI disturbances. Do not take more than or for longer than recommended.

dextromethorphan hydrobromide Be cautious when using over-the-counter products; Balminil DM (CAN), Benylin Adult, Benylin Pediatric, Creothey may contain Hold DM, Koffex (CAN), Novahistex Terpin, Delsym, DexAlone,the same ingredients and overdose can occur. DM (CAN), Robitussin Pediatric (CAN), Trocal, Vicks Dry Hacking CoughReport continued or recurring cough, cough accompanied by fever, rash, persistent headache, nausea, vomiting. Drug class Nonopioid antitussive Therapeutic actions Lacks analgesic and addictive properties; controls cough spasms by depressing the cough center in the medulla; analog of codeine. Indication Control of nonproductive cough Contraindications and cautions Contraindicated with hypersensitivity to any component (check label of products for flavorings, vehicles); sensitivity to bromides; cough that persists for more than 1 wk, tends to recur, is accompanied by excessive secretions, high fever, rash, nausea, vomiting, or persistent headache (dextromethorphan should not be used; patient should consult a physician). Use cautiously with lactation, pregnancy. Available forms Gelcaps30 mg; lozenges5, 7.5 mg; liquid7.5 mg/5 mL; 10 mg/15 mL, 15 mg/5 mL, 30 mg/5 mL; syrup7.5 mg/5 mL, 10 mg/5 mL; sustained-action liquid30 mg/5 mL Metabolism: Hepatic; T1/2: 24 hr

diazepam Metabolism: Hepatic; Diastat, Diazemuls (CAN), Diazepam Apo-Diazepam (CAN),T1/2: 2080 hr Distribution: Crosses placenta; enters breast milk Intensol, Valium Excretion: Urine IV facts Drug classes Preparation: Do Benzodiazepine not mix with other solutions; do not mix in plastic bags Anxiolytic or tubing. Infusion: Inject Antiepileptic slowly into large vein, 1 mL/min at most; for children do not relaxant min; do not inject Skeletal muscleexceed 3 (centrally acting) intra-arterially; if injected into actions TherapeuticIV tubing, inject as close to vein insertion as possible. Incompatibilities: Do not mix understood; acts mainly at mix Exact mechanisms of action notwith other solutions; do not the with any other drugs. limbic system and reticular formation; may act in spinal cord and Y-site Incompatibilities: Atracurium, heparin, foscarnet, at supraspinal sites to produce skeletal muscle relaxation; pancuronium, effects of vecuronium. potentiates thepotassium,GABA, an inhibitory neurotransmitter; Adverse effects anxiolytic effects occur at doses well below those necessary to cause sedation, CNS: Transient,effect drowsiness initially; ataxia; has little mild on cortical function. sedation, depression, lethargy, apathy, fatigue, lightIndications headedness, disorientation, restlessness, confusion, Management of anxiety disorders or for short-term crying, symptoms of anxiety relief ofdelirium, headache, slurred speech, dysarthria, stupor, rigidity, tremor, dystonia,may be useful in Acute alcohol withdrawal; vertigo, euphoria, nervousness, relief of acute agitation, tremor, dreams, symptomatic difficulty in concentration, vividdelirium psychomotor retardation, extrapyramidal symptoms; tremens, hallucinosis mild paradoxical excitatory reactions, during first 2 wk Muscle relaxant: Adjunct for relief of reflex of treatment, visual and auditory disturbances, skeletal muscle spasm due to local pathology diplopia, nystagmus, depressed hearing, nasal congestion (inflammation of muscles or joints) or secondary to CV: Bradycardia, tachycardia, CV collapse, trauma; spasticity caused by upper motoneuron disorders hypertension and hypotension, athetosis, stiff-man (cerebral palsy and paraplegia);palpitations, edema Dependence: Drug dependence with withdrawal syndrome syndrome when drug is discontinued (common with

Parenteral: Treatment of tetanus abrupt discontinuation of higher dosage used for and Antiepileptic: Adjunct in status epilepticus longer than 4 recurrent convulsive seizures (parenteral); adjunct severe mo); IV diazepam: 1.7% incidence of fatalities; oral benzodiazepines ingested alone; no wellin seizure disorders (oral) documented fatal overdoses Preoperative (parenteral): Relief of anxiety and Dermatologic: Urticaria, pruritus, skin rash, tension and to lessen recall in patients prior to surgical dermatitis procedures, cardioversion, and endoscopic procedures GI: Constipation; diarrhea, dry refractory patients Rectal: Management of selected,mouth; salivation; nausea; anorexia; require intermittent use to control with epilepsy whovomiting; difficulty in swallowing; gastric disorders; seizure activity bouts of increasedelevations of blood enzymesLDH, alkaline phosphatase,Treatment ofhepatic dysfunction; Unlabeled use: AST, ALT; panic attacks jaundice Contraindications and cautions GU: Incontinence, urinary retention, to Contraindicated with hypersensitivitychanges in libido, menstrual psychoses, acute narrow-angle benzodiazepines; irregularities Hematologic: Decreased hematocrit, blood glaucoma, shock, coma, acute alcoholic intoxication; dyscrasias pregnancy (cleft lip or palate, inguinal hernia, cardiac Other: Phlebitis pyloric stenosis when used in defects, microcephaly, and thrombosis at IV injectionfirst sites, hiccups, fever, diaphoresis, paresthesias, muscular trimester; neonatal withdrawal syndrome reported in disturbances, gynecomastia; pain, burning, and redness newborns); lactation. after IM injection with elderly or debilitated patients; Use cautiously Interactions impaired liver or renal function; and in patients with a Drug-drug history of substance abuse. Increased CNS depression with alcohol, Available forms omeprazole Tablets2, 5, 10 mg; SR capsule15 mg; oral solution Increased pharmacologic effects of diazepam if 1 mg/mL, 5 mg/5 mL; rectal pediatric gel2.5, 5, 10 mg; rectal combined with injection5 mg/mL adult gel10, 15, 20 mg;cimetidine, disulfiram, hormonal contraceptives Decreased effects of diazepam with theophyllines, ranitidine

Nursing considerations drug Assessment with food); dreams, difficulty concentrating, fatigue, nervousness, crying (reversible). History: Hypersensitivity to benzodiazepines; Report severe dizziness, glaucoma, shock, coma, psychoses, acute narrow-angleweakness, drowsiness that persists, rash or intoxication; elderly or debilitated of the acute alcoholic skin lesions, palpitations, swelling ankles, visual or hearing disturbances, difficulty voiding. patients; impaired liver or renal function; pregnancy, lactation Physical: Weight; skin color, lesions; orientation, affect, reflexes, sensory nerve function, ophthalmologic examination; P, BP; R, adventitious sounds; bowel sounds, normal output, liver evaluation; normal output; LFTs, renal function tests, CBC Interventions WARNING: Do not administer intra-arterially; may produce arteriospasm, gangrene. Change from IV therapy to oral therapy as soon as possible. Do not use small veins (dorsum of hand or wrist) for IV injection. Reduce dose of opioid analgesics with IV diazepam; dose should be reduced by at least one-third or eliminated. Carefully monitor P, BP, respiration during IV administration. WARNING: Maintain patients receiving parenteral benzodiazepines in bed for 3 hr; do not permit

ambulatory patients to operate a vehicle following an injection. diclofenac Monitor EEG in patients treated for status epilepticus; seizures may recur after initial control, diclofenacpresumably because of short duration of drug effect. potassium Cataflam, Voltaren Rapide (CAN) Monitor liver and renal function, CBC during longterm therapy. diclofenac sodium dosage gradually after long-term therapy, Taper Novo-Difenac (CAN), Nu-Diclopatients. Solaraze, Voltaren, especially in epileptic (CAN), Voltaren Ophtha (CAN),for epileptic patients to wear medical alert Arrange Voltaren-XR ID indicating that they are epileptics taking this Drug classes medication. Anti-inflammatory Discuss risk of fetal abnormalities with patients NSAID desiring to become pregnant. Teaching points Therapeutic actions this drug exactly as prescribed. Do not stop Take  Inhibits prostaglandin synthetase to cause antipyretic and taking this drug (long-term therapy, antiepileptic anti-inflammatory effects; the exact mechanism is therapy) without consulting your health care provider. unknown.The exact mechanismassess seizures, entirely Caregiver should learn to of action is not known, butrectal form, and monitor patient. administer it is thought that the primary mechanism responsible for its anti-inflammatory, advised while using Use of barrier contraceptives is antipyretic, and analgesic if you become or wish prostaglandin synthesis this drug; action is inhibition of to become pregnant, by inhibition your health care provider. and it appears to consult with of cyclooxygenase (COX) inhibit DNA synthesis.[5] a medical alert ID indicating It is advisable to wear  Inhibition of COX also decreasesantiepileptic). in the your diagnosis and treatment (as prostaglandins epitheliummay experience these side effects: You of the stomach, making it more sensitive to corrosion by dizziness (may lessen; avoid driving or Drowsiness, gastric acid.[citation needed] This is also the main side effect of diclofenac. Diclofenac has(take engaging in other dangerous activities); GI upset a low to moderate preference to block the COX2-isoenzyme

(approximately 10-fold) and is said to have therefore a Nursing considerations incidence of gastrointestinal complaints somewhat lower Assessment noted with indomethacin and aspirin. than History: Renal impairment; impaired the  Diclofenac may also be a unique member ofhearing; allergies; There is some evidence that diclofenac inhibits NSAIDs. hepatic, CV, and GI conditions; lactation, pregnancy the lipoxygenase pathways,[citation needed] thus Physical: Skin color and lesions; (also proreducing formation of the leukotrienes orientation, reflexes, ophthalmologic There is also speculation[by inflammatory autacoids). and audiometric evaluation, peripheral sensation; P, may inhibit phospholipase A2 whom?] that diclofenacedema; R, adventitious sounds; liver evaluation; CBC, clotting times, LFTs, renal as part of its mechanism of action.[citation needed] function tests; serum electrolytes, stool guaiac These additional actions may explain the high potency of diclofenac it is the most potent NSAID on a broad Interventions basis. Indications Administer drug with food or after meals if GI upset Acute or long-term treatment of mild to moderate occurs. Arrange for periodic ophthalmologic examination pain, including dysmenorrhea during long-term therapy. Rheumatoid arthritis WARNING: Osteoarthritis Institute emergency procedures if overdose occurs (gastric lavage, induction of emesis, Ankylosing spondylitis supportive therapy). Treatment of actinic keratosis in conjunction with Teaching sun avoidance points Take drug with food or meals if GI upset occurs. Ophthalmic: Postoperative inflammation from Take only the cataract extraction prescribed dosage. You may experience Contraindications and cautions these side effects: Dizziness, drowsiness (avoid driving or usingto NSAIDs,machinery Contraindicated with allergy dangerous while using this impairment, pregnancy, lactation. significant renal drug). Report sore throat, fever, rash, itching, weight gain, Use cautiously with impaired hearing, allergies, swelling in ankles or fingers, changes in vision; black, hepatic, CV, GI conditions, and in elderly patients. tarry stools.

Digoxin Available forms Digitek, Lanoxicaps, Lanoxin, Novo-Digoxin (CAN) Tablets50 mg; DR tablets25, 50, 75 mg; ER tablets100 mg; topical gel30 mg/g; ophthalmic solution0.1% Drug classes Metabolism: Hepatic; T1/2: 1.52 hr Cardiac glycoside Distribution: Crosses placenta; enters breast milk Cardiotonic Excretion: Feces, urine Therapeutic actions  Increases Adverse effects intracellular calcium and allows more calcium to enter the myocardial dizziness, somnolence, insomnia, CNS: Headache, cell during depolarization via a sodiumpotassium pump mechanism; this effects fatigue, tiredness, tinnitus, ophthamologic increases force Dermatologic: Rash, pruritus, sweating, dry of contraction (positive inotropic effect), increases renal perfusion (seen as diuretic mucous membranes, stomatitis effect in patients with CHF), decreases heart rate (negative chronotropic GI: Nausea, dyspepsia, GI pain, diarrhea, effect), and decreases AV node conduction velocity. vomiting, constipation, flatulence  Digoxin binds to a site onimpairment GU: Dysuria, renal the extracellular aspect of the -subunit of the Na+/K+ ATPase pump in the with Hematologic: Bleeding, platelet inhibition membranes of heart cells (myocytes) and decreases its higher doses function. This causes an edema, anaphylactoid reactions Other: Peripheral increase in the level of sodium ions in the myocytes,shock then leads to a rise in the to fatal anaphylactic which level Interactions of calcium ions. Because there is a sodium/calcium exchanger which depends on sodium gradient to pump Drug-drug out calcium, digoxin reduces and increased risk of Increased serum levels such concentration gradient and subsequently calcium efflux, thus increasing calcium lithium toxicity concentration inrisk of bleeding with anticoagulants; Increased myocardiocytes and pacemaker cells. The proposed mechanism is the following: inhibition of monitor patient closely the Na+/K+ pump leads to increased intracellular Na+ levels, which in turn slows down the extrusion of Ca2+

by the sodium-calcium exchanger that relies on the high Increased incidence of cardiac arrhythmias with Na+ gradient. This effect causes an increase in the length potassium-losing (loop of the cardiac action potential, of Phase 4 and Phase 0 and thiazide) diuretics whichIncreased absorption or increased of digoxin on the when combined with the effects bioavailability of oral digoxin, leading to increased effects a decrease in parasympathetic nervous system, leads towith tetracyclines, erythromycin Increased amounts of Ca2+ heart rate.[citation needed] Decreased therapeutic effects with thyroid are then stored in the sarcoplasmic reticulum and hormones, each action potential, which is released bymetoclopramide, penicillamine unchanged by Decreased absorption of oral digoxin if taken with digoxin. This leads to increased contractility of the heart. cholestyramine, charcoal, colestipol, antineoplastics This is a different mechanism from that of (bleomycin, cyclophosphamide, methotrexate) catecholamines. Increased or decreased activity via its action  Digoxin also increases vagal effects of oral digoxinon the (adjust nervous of digoxin during concomitant therapy) central the dose system, thus decreasing the conduction with oral aminoglycosides of electrical impulses through the AV node . This negatively chronotropic effect is important for its clinical Drug-alternativedifferent arrhythmias use in therapy Indications Increased risk of digoxin toxicity if taken with ginseng, hawthorn, or licorice therapy CHF Decreased absorption with psyllium Atrial fibrillation Decreased serum Contraindications and cautionslevels with St. John's wort Contraindicated with allergy to digitalis Nursing considerations preparations, ventricular tachycardia, ventricular Assessment fibrillation, heart block, sick sinus syndrome, IHSS, acute History: Allergy to digitaliselectrolyte MI, renal insufficiency and preparations, ventricular tachycardia, ventricular fibrillation, heart abnormalities (decreased K+, decreased Mg2+, increased block, sick sinus syndrome, IHSS, acute MI, renal Ca2+). insufficiency, decreased K+, decreased Mg2+ increased Use cautiously with pregnancy and lactation. Ca2+, pregnancy, lactation

Available forms Physical: Weight; orientation, affect, reflexes, Lanoxicaps capsules0.05, 0.1, 0.2 mg; tablets0.125, 0.25, mg, vision; P, BP, baseline ECG, cardiac auscultation, elixir0.05 mg/mL; injection0.25 mg/mL; pediatric injection peripheral pulses, peripheral perfusion, edema; R, 0.1 mg/mL adventitious sounds; abdominal percussion, bowel sounds, liver evaluation; urinary Metabolism: Some hepatic; T1/2: 3040 hroutput; electrolyte levels, LFTs, renal function tests Distribution: May cross placenta; enters breast milk Excretion: Urine, unchanged Interventions IV facts WARNING: or diluted in fourfold or 1 min Preparation: Give undiluted Monitor apical pulse for greaterbefore volume ofadministering; hold dose if 0.9% sodium adult or < 90 in sterile water for injection, pulse < 60 in chloride injection, infant; dextrose injection. Useadult pulse remains < 60 or or 5% retake pulse in 1 hr. If diluted product promptly. infant < 90, contains precipitates. Do not use if solution hold drug and notify prescriber. Note any Infusion: changeslowlybaseline rhythm or rate. Inject from over 5 min or longer. Take not to differentiate Lanoxicaps from Incompatibility: Do caremix with dobutamine. Lanoxin; Adverse effects dosage is very different Check dosage and preparation carefully. CNS: Headache, weakness, drowsiness, visual Avoid IM injections, change disturbances, mental status which may be very painful. Follow diluting instructions carefully, and use CV: Arrhythmias diluted solution promptly. GI: GI upset, anorexia Interactions Avoid giving with meals; this will delay absorption. Drug-drug + Have emergency equipment ready; have digoxin Increased therapeutic and toxic effects ofK salts, lidocaine, phenytoin, atropine, cardiac monitor readily with thioamines, verapamil, amiodarone, quinidine, available in case toxicity develops. quinine, erythromycin, cyclosporine (a decrease in WARNING: be necessary to prevent toxicity; digoxin dosage mayMonitor for therapeutic drug levels: 0.52 ng/mL. when the interacting drug is discontinued, an increase in the digoxin dosage may be necessary) Teaching points

 Do not stop taking this drug without notifying your health care provider.  Negative inotropic effect. Diltiazem causes a modest it Take pulse at the same time each day, and record decrease in heart muscle contractility and reduces on a calendar (normal pulse for you is___); call your myocardium oxygenif your pulse rate falls below ____. health care provider consumption.  Negative chronotropic effect. Diltiazem causessame Weigh yourself every other day with the a modest loweringandheart rate. This effect is due toon the of clothing of at the same time. Record this slowing the SA (sinoatrial) node. It results in reduced calendar. myocardium start taking any prescription or over-the Do not oxygen consumption.  Negative dromotropic effect. By slowinghealth care counter products without talking to your conduction through the AV combinations maynode, diltiazem of provider. Some (atrioventricular) increase the risk increases the time neededput you at risk This results in digoxin toxicity and may for each beat. of adverse reduced myocardium oxygen consumption by the body. reactions. Indications Wear or carry a medical alert tag stating that you on this drug. are Angina pectoris due to coronary artery spasm (Prinzmetal's variant angina) Have regular medical checkups, which may include bloodEffort-associated angina; chronicdosage angina in tests, to evaluate the effects and stable of this patients not controlled by beta-adrenergic blockers, drug. nitrates Report unusually slow pulse, irregular pulse, rapid ER form: Essential hypertension weight gain, loss of appetite, nausea, vomiting, blurred "yellow" vision, unusual tiredness and weakness, or Parenteral: Paroxysmal supraventricular tachycardia,the ankles, legs or fingers, difficulty swelling of atrial fibrillation, atrial flutter Contraindications and cautions breathing. Contraindicated with allergy to diltiazem, impaired hepatic or renal function, sick sinus syndrome, heart block (second or third degree), severe hypertension, cardiogenic shock, acute MI with cardiogenic shock (oral), lactation.

diltiazem hydrochloride Available forms Cardizem, Cardizem CD, Cardizem LA, Apo-Diltiaz (CAN), Tablets30, 60, 90, 120 mg; ER capsules60, 90, 120, 180, 240, Cartia XT, Dilacor XR, Diltia XT, Gen-Diltiazem (CAN), Novo300, 360, 420 mg; Nu-Diltiaz (CAN), Tiazac 300, 360, 420 mg; Diltiazem (CAN), LA tablets120, 180, 240, injection5 mg/mL; powder for injection25 mg Drug classes Metabolism: Hepatic; T1/2: 3.56 hr; 57 hr (ER) Calcium channel blocker Distribution: Crosses placenta; enters breast milk Antianginal Excretion: Urine Antihypertensive IV facts Therapeutic actions infusion, rate of 10 mL/hrcalcium ions across the membranes of Inhibits the movement of is the recommended rate. Do not use continuous infusionmuscle than 24 hr. cardiac and arterial longer cells, resulting in the depression of Incompatibilities: in specialized cardiac pacemaker with slowing impulse formation Do not mix in the same solution cells, furosemide solution. of the velocity of conduction of the cardiac impulse, depression of myocardial contractility, and dilation of coronary arteries and Adverse effects arterioles and peripheral arterioles; these effects lead to decreased CNS: Dizziness, light-headedness, headache, cardiac work, decreased cardiac energy consumption, and in asthenia, fatigue patients with vasospastic (Prinzmetal's) angina, increased delivery CV: Peripheral of oxygento myocardial cells. edema, hypotension, arrhythmias, bradycardia, AV block, increasing Diltiazem is a potent vasodilator, asystole blood flow and Dermatologic: Flushing, rash variably decreasing the heart rate via strong depression of A-V GI: pharmacological activity is somewhat similar node conduction. ItsNausea, hepatic injury, reflux to verapamil. Interactions  Potent vasodilator of coronary vessels. Drug-drug Increased serum levels and This reduces  Vasodilator of peripheral vessels.toxicity of cyclosporine if taken with diltiazem peripheral resistance and afterload.

 Possible depression of myocardial contractility, AV dimenhydrinate conduction if combined with beta blockers; use caution Oral preparations: and monitor patient closely Apo-Dimenhydrinate (CAN), Calm-X, Childrens Dramamine, Drug-food Dimetabs, Dramamine, Gravol (CAN),and increased risk of toxic Decreased metabolism Triptone Parenteraleffects if taken with grapefruit juice; avoid this preparations: Dinate, Dramanate, Dymenate, Hydrate combination Nursing considerations Drug classes Assessment Antimotion sickness drug History: Allergy to diltiazem, impaired hepatic or Antihistamine function, sick sinus syndrome, heart block, renal Anticholinergic lactation, pregnancy Therapeutic actions Physical: Skin lesions, color, edema; P, BP, Antihistamine withECG, peripheralanticholinergic activity; R, baseline antiemetic and perfusion, auscultation; depresses adventitious sounds; liver evaluation, normal output; hyperstimulated labyrinthine function; may block synapses in the vomiting center; peripheral anticholinergic effects LFTs, renal function tests, urinalysis may contribute to antimotion sickness efficacy. Interventions Indications Monitor patient carefully (BP, cardiac rhythm, and Prevention and being titrated to therapeutic dose; output) while drug is treatment of nausea, vomiting, or vertigo may be increased more rapidly in hospitalized dosage of motion sickness Contraindications and cautions patients under close supervision. Contraindicated with allergy to is on concurrent or Monitor BP carefully if patient dimenhydrinate its components, lactation. doses of nitrates. Use cautiously with narrow-angle during Monitor cardiac rhythm regularly glaucoma, stenosing peptic ulcer, symptomatic prostatic long-term stabilization of dosage and periodically during hypertrophy, bronchial asthma, bladder neck obstruction, therapy. pyloroduodenal obstruction, cardiac arrhythmias, Ensure patient swallows ER preparations whole; do pregnancy. not cut, crush, or chew.

Availablepoints Teaching forms Tablets50 mg; chewable tablets50 mg; injection50 mg/mL; Swallow extended-release and long-acting liquid12.5 mg/4 mL,whole; do not cut, crush, or chew; do not preparations 12.5 mg/5 mL; 15.62 mg/5 mL Metabolism: Hepatic; T1/2: Unknown drink grapefruit juice while using this drug. Distribution: Crosses placenta; enters breast milk You may experience these side effects: Nausea, Excretion: Urine (eat frequent small meals); headache (regulate vomiting light, noise, and temperature; medicate if severe). IV facts Report irregular heart beat, shortness of breath, Preparation: Dilute 50 mg in 10 mL sodium chloride injection. swelling of the hands or feet, pronounced dizziness, Infusion: constipation. direct IV injection over 2 min. Administer by Incompatibilities: Do not combine with tetracycline, thiopental. Y-site incompatibilities: Do not mix with aminophylline, heparin, hydrocortisone, hydroxyzine, phenobarbital, phenytoin, prednisolone, promethazine. Adverse effects CNS: Drowsiness, confusion, nervousness, restlessness, headache, dizziness, vertigo, lassitude, tingling, heaviness and weakness of hands; insomnia and excitement (especially in children), hallucinations, seizures, death, blurring of vision, diplopia CV: Hypotension, palpitations, tachycardia Dermatologic: Urticaria, drug rash, photosensitivity GI: Epigastric distress, anorexia, nausea, vomiting, diarrhea or constipation; dryness of mouth, nose, and throat GU: Urinary hesitancy, urinary retention

 Respiratory: Nasal stuffiness, chest tightness, diphenhydramine hydrochloride thickening of bronchial secretions, anaphylaxis Oral: Other: In geriatric patients may cause mental Allerdryl (CAN), AllerMax Caplets, Banophen, Banophen in men, status changes, excessive sedation, constipation; Allergy, Benadryl Allergy, Diphen AF, Diphenhist, Diphenhist Captabs, may cause urinary retension. Genahist, Siladryl, Silphen Cough Interactions Oral prescription preparations: Drug-drug Benadryl, Tusstat depressant effects with alcohol, other CNS Increased Parenteraldepressants preparations: Benadryl Nursing considerations Assessment Drug classes History: Allergy to dimenhydrinate or its Antihistamine components, lactation, narrow-angle glaucoma, Anti-motion sickness drug ulcer, symptomatic prostatic stenosing peptic Sedative-hypnotic hypertrophy, bronchial asthma, bladder neck obstruction, Antiparkinsonian pyloroduodenal obstruction, cardiac arrhythmias Cough suppressant Physical: Skin color, lesions, texture; orientation, Therapeutic actions reflexes, affect; vision examination; P, BP; R,  Competitively blocksbowel sounds; histamine at H1adventitious sounds; the effects of prostate palpation; receptor sites, has atropine-like, antipruritic, and sedative CBC effects. Interventions  Diphenhydramine works by blocking the readilyof WARNING: Keep epinephrine 1:1,000 effect histamine at H1 receptor sites. preparations; available when using parenteralThis results in effects such as the increase of vascular smooth muscle hypersensitivity reactions, including anaphylaxis, have contraction, occurred. thus reducing the redness, hyperthermia and Teaching edema that occurs during an inflammatory reaction. In points addition, by blocking the H1 receptorexcessive dosage. Take drug as prescribed; avoid on peripheral nociceptors, diphenhydramine decreases their sensitization and consequently reduces itching that is

Drug works best if taken before motion sickness associated with an allergic reaction. This is why occurs. diphenhydramine is aserious sedation for treatment of the Avoid alcohol; popular choice could occur. symptoms may experience these sidemotion sickness, and You of allergic rhinitis, hives, effects: Dizziness, insect bites and stings. caution if driving or sedation, drowsiness (use Indications performing tasks that require alertness); epigastric Relief of symptoms associated with perennial and distress, diarrhea or constipation (take drug with food); seasonal allergic rhinitis;mouth care, rhinitis; allergic dry mouth (use frequent vasomotor suck sugarless conjunctivitis; mild, uncomplicated urticaria and lozenges); thickening of bronchial secretions, dryness of angioedema; amelioration motion sickness remedy). nasal mucosa (try another of allergic reactions to blood or plasma; dermatographism; adjunctive therapy tremors, Report difficulty breathing, hallucinations, in anaphylactic reactions loss of coordination, unusual bleeding or bruising, visual Active irregular heartbeat. disturbances,and prophylactic treatment of motion sickness Nighttime sleep aid Parkinsonism (including drug-induced parkinsonism and extrapyramidal reactions), in the elderly intolerant of more potent drugs, for milder forms of the disorder in other age groups, and in combination with centrally acting anticholinergic antiparkinsonian drugs Syrup formulation: Suppression of cough due to colds Contraindications and cautions Contraindicated with allergy to any antihistamines, third trimester of pregnancy, lactation. Use cautiously with narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthmatic attack, bladder neck obstruction,

pyloroduodenal obstruction, pregnancy; elderly patients adventitious sounds; to anticholinergic effects. who may be sensitivebowel sounds; prostate palpation; AvailableCBC with differential forms Capsule soft gels25 mg; capsules25, 50 mg; tablets25, 50 Interventions mg; chewable tablets12.5 mg; elixir12.5 mg/5 mL; syrup Administer with food if mL; injection10, 12.5 mg/5 mL; liquid6.25, 12.5 mg/5 GI upset occurs. Administer mg/5 mL 50 mg/ mL; solution12.5 syrup form if patient is unable to take tablets. Monitor 1/2: 2.57 hr Metabolism: Hepatic; Tpatient response, and arrange for adjustment of dosage enters breast milk Distribution: Crosses placenta;to lowest possible effective dose. Excretion: Urine Teaching points Take as prescribed; avoid excessive dosage. IV facts Take with food if GI upset occurs. Preparation: No additional preparation required. Avoid alcohol; serious sedation min occur. Infusion: Administer slowly each 25 mg over 1couldby direct injection or intoYou may experience these side effects: Dizziness, tubing of running IV. sedation, drowsiness (use with amobarbital, Incompatibilities: Do not combine caution driving or performing tasks cephalothin, hydrocortisone, distress, diarrhea or amphotericin B,requiring alertness); epigastricphenobarbital, constipation phenytoin, thiopental. (take drug with meals); dry mouth (use frequent mouth Do not mix with foscarnet. Y-site incompatibilities: care, suck sugarless lozenges); thickening of bronchial secretions, dryness of nasal mucosa Adverse effects (use a humidifier). Report difficulty breathing, dizziness, disturbed CNS: Drowsiness, sedation,hallucinations, tremors, loss of coordination, unusual bleeding or bruising, visual coordination, fatigue, confusion, restlessness, excitation, disturbances, irregular heartbeat. nervousness, tremor, headache, blurred vision, diplopia CV: Hypotension, palpitations, bradycardia, tachycardia, extrasystoles

GI: Epigastric distress, anorexia, increased disulfiram appetite and weight gain, nausea, vomiting, diarrhea or Antabuse constipation GU: Urinary frequency, dysuria, urinary retention, Drug classes menses, decreased libido, impotence early Antialcoholic drug Hematologic: Hemolytic anemia, hypoplastic Enzyme inhibitor thrombocytopenia, leukopenia, agranulocytosis, anemia, pancytopenia Therapeutic actions Respiratory: Thickening of bronchial secretions, Inhibits the enzyme aldehyde dehydrogenase, blocking oxidation chest tightness, wheezing, nasal stuffiness, dry mouth, of alcoholdry nose, dry throat, sore throat and allowing acetaldehyde to accumulate to concentrations in the blood 510 times anaphylactic shock, Other: Urticaria, rash, higher than normally achieved during alcohol metabolism; perspiration of acetaldehyde photosensitivity, excessive accumulation produces the highly unpleasant reaction described below that deters consumption of alcohol. Interactions Indication Drug-drug Aids in the management of selected chronic Possible increased and prolonged anticholinergic alcoholics who want to remain in a state of enforced effects with MAOIs sobriety Contraindications and cautions Nursing considerations Contraindicated with allergy to disulfiram or other Assessment thiuram derivatives used in pesticides and rubber History: Allergy to any antihistamines, narrowvulcanization, severe myocardial disease or coronary angle glaucoma, stenosing peptic ulcer, symptomatic occlusion; psychoses, current or recent treatment with prostatic hypertrophy, asthmatic attack, bladder neck metronidazole, paraldehyde, obstruction, third trimester obstruction, pyloroduodenal alcohol, alcohol-containing preparations (eg, cough syrups, tonics), pregnancy. of pregnancy, lactation Use cautiously color, lesions, texture; Physical: Skin with diabetes mellitus, orientation, hypothyroidism,vision examination; P, BP; R, reflexes, affect; epilepsy, cerebral damage, chronic and acute nephritis, hepatic cirrhosis or dysfunction.

Monitor CBC, SMA-12 before and every 6 mo Available forms during therapy. Tablets250 mg. Inform T1/2: Unclear Metabolism: Hepatic; patient of the seriousness of disulfiramalcohol reaction and the potential consequences of Distribution: Crosses placenta; enters breast milk alcohol lungs Excretion: Feces,use. Disulfiram should not be taken for at least 12 hr Adverse effectsafter alcohol ingestion, and a reaction may occur up to wk after Disulfiram with2alcohol disulfiram therapy is stopped; all forms of alcohol must throbbing in head and neck, throbbing Flushing, be avoided. Arrange for treatment with nausea, copious headaches, respiratory difficulty, antihistamines if skin reaction occurs. vomiting, sweating, thirst, chest pain, palpitations, WARNING: Institute supportive hypotension, dyspnea, hyperventilation, tachycardia, measures if disulfiram-alcohol reaction occurs; oxygen, confusion; syncope, weakness, vertigo, blurred vision, carbon dioxidereactions may include arrhythmias, CV collapse, severe combination, massive doses of vitamin C IV, ephedrine have been used. seizures, MI, death acute CHF, unconsciousness, Teaching points Disulfiram alone Take drug daily; if drug makes you dizzy or tired, CNS: Drowsiness, fatigability, headache, take it at bedtime. Tablets may be crushedor retrobulbar restlessness, peripheral neuropathy, optic and mixed with liquid. neuritis Abstain from forms of alcohol (beer, wine, liquor, Dermatologic: Skin eruptions, acneiform vinegars, cough mixtures, sauces, aftershave lotions, eruptions, allergic dermatitis liniments,Metallic or garliclike aftertaste, hepatotoxicity GI: colognes, liquid medications). Using alcohol while Interactions taking this drug can cause severe, unpleasant reactionsflushing, copious vomiting, throbbing Drug-drug headache, difficulty breathing, even death. Increased serum levels and risk of toxicity of Wear or its congeners, diazepam, chlordiazepoxide phenytoin and carry a medical ID while you are taking this drug to alert any medical emergency personnel that Increased therapeutic and toxic effects of you are takingand caffeine theophyllines it.

Increased PT caused by disulfiram may lead to a Have periodic blood tests while taking need to adjust dosage of oral anticoagulants drug to evaluate its effects on the liver. reactions with any Severe alcohol-intolerance You may experience these side effects: alcohol-containing liquid medications (eg, elixirs, Drowsiness, headache, fatigue, restlessness, blurred tinctures) visionAcutecaution driving or performing tasks that (use toxic psychosis with metronidazole require alertness); metallic aftertaste (transient). Nursing considerations Report unusual bleeding or bruising, yellowing of Assessment skin or eyes, chest pain,to disulfiram or other ingestion of History: Allergy difficulty breathing, thiuram any alcohol. severe myocardial disease or coronary derivatives; occlusion; psychoses; current or recent treatment with metronidazole, paraldehyde, alcohol, alcohol-containing preparations (eg, cough syrups, tonics); diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, chronic and acute nephritis, hepatic cirrhosis or dysfunction; pregnancy Physical: Skin color, lesions; thyroid palpation; orientation, affect, reflexes; P, auscultation, BP; R, adventitious sounds; liver evaluation; LFTs, renal function tests, CBC, SMA-12 Interventions Do not administer until patient has abstained from alcohol for at least 12 hr. Administer orally; tablets may be crushed and mixed with liquid beverages. Monitor LFTs before, in 1014 days, and every 6 mo during therapy to evaluate for hepatic dysfunction.

doxazosin mesylate Cardura mucous membranes; bowel sounds, normal output; voiding pattern, normal output; renal function tests, urinalysis Drug classes Interventions Alpha-adrenergic blocker Monitor edema, weight in patients with incipient Antihypertensive cardiac decompensation, and arrange to add a thiazide Therapeutic actions diuretic total drug regimen if sodium and alpha Reducesto the peripheral resistance throughfluid retention, causing an antihypertensive effect. The degree blockade, signs of impending CHF occur. WARNING: Monitor patient carefully with first of smooth muscle tone in prostate/bladder neck is also dose; chance of orthostatic hypotension, dizziness mediated by alpha receptors. Its blockade reduces and syncope are great and the first obstructions. urethral resistancewith removesdose. Establish safety precautions.  It is an alpha-1 adrenergic receptor blocker that inhibits Monitor norepinephrine to alpha receptors in the the binding of signs and symptoms of BPH to adjust dosage. autonomic nervous system. The primary effect of this Teaching blockage is relaxed vascular smooth muscle tone points Take this drug exactly as peripheral once a day. (vasodilation), which decreasesprescribed, vascular Dizziness leading to may occur at beginning of resistance,or syncope decreased blood pressure. therapy. Change position slowly to avoid increased dizziness. Indications You may of mild-to-moderate hypertension, alone Treatmentexperience these side effects: Dizziness, weakness (when changing position, or as part of combination therapy in the early morning, after exercise, in hot weather, and after consuming BPH alcohol; some tolerance Contraindications and cautions may occur after a while; avoid driving or engaging inwith lactation. Contraindicated tasks that require alertness; change position slowly, use caution doxazosin, CHF, lie Use cautiously with allergy to in climbing stairs, down if dizziness persists); GI upset (eat frequent small renal failure, pregnancy, hepatic impairment. Availablemeals); impotence; stuffy nose; most of these effects forms gradually disappear with continued therapy. Tablets1, 2, 4, 8 mg Report frequent dizziness or fainting.

doxycycline Metabolism: Hepatic; T1/2: 22 hr (dox i sye' kleen) Distribution: Crosses placenta; enters breast milk Adoxa, Apo-Doxy (CAN), Doryx, Doxy 100, Doxy 200, Doxycin Excretion: Bile, feces, urine (CAN), Monodox, Novo-Doxylin (CAN), Nu-Doxycycline (CAN), Adverse effects Periostat, Vibra-Tabs, Headache, fatigue, dizziness, postural CNS: Vibramycin dizziness, lethargy, vertigo, rhinitis, asthemia, anxiety, Drug classes parasthesia, increased sweating, muscle cramps, Antibioticinsomnia, eye pain, conjunctivitis Tetracycline antibiotic CV: Tachycardia, palpitations, edema, orthostatic Therapeutic actions chest pain hypotension, Bacteriostatic: Inhibits protein synthesisdiarrhea, abdominal pain, GI: Nausea, dyspepsia, of susceptible bacteria, causing cell death. constipation flatulence, Antiprotozoal: GU: used in prophylaxis against malaria. It should It is Sexual dysfunction, increased urinary not be used alone for initial treatment of malaria, even when the frequency parasite is doxycycline-sensitive, increased sweating, rash effect of Other: Dyspnea, because the antimalarial doxycycline is delayed. This delay is related to its mechanism of Interactions action. Its mechanism of action against malaria is to specifically Drug-drug impair the progeny of the hypotensive effects if taken with alcohol, Increased apicoplast genes resulting in their abnormal nitrates, other antihypertensives cell division Antibacterial: It is used in the treatment and prophylaxis of Nursing considerations Bacillus anthracis (anthrax). Assessment Antihelmintic: completely eliminates the release of microfilariae History: Allergy to doxazosin, CHF, renal failure, Indications hepatic impairment, lactation, pregnancy Infections caused skin color, lesions; orientation, Physical: Weight;by rickettsiae; M. pneumoniae; agents reflexes; ophthalmologic examination; P, BP, affect, of psittacosis, ornithosis, lymphogranuloma venereum and granuloma inguinale; B. recurrentis; H. orthostatic BP, supine BP, perfusion, edema, ducreyi; P. pestis; P. tularensis; B. bacilliformis; auscultation; R, adventitious sounds, status of nasal Bacteroides; V. comma; V. fetus; Brucella; E. coli; E.

aerogenes; Shigella; A. calcoaceticus; H. influenzae; GI: Fatty liver, liver failure, anorexia, nausea, Klebsiella; D. pneumoniae; S. aureus vomiting, diarrhea, glossitis, dysphagia, enterocolitis, When penicillin is contraindicated, infections esophageal ulcer caused by N. gonorrhoeae, T. pallidum, T. pertenue, L. Hematologic: Hemolytic anthracis, Chlamydia monocytogenes, Clostridium, B.anemia, thrombocytopenia, neutropenia, eosinophilia, psittaci, C. trachomatis leukocytosis, leukopenia Oral tetracyclines used for acne, uncomplicated adult Local: Local irritation or injection site urethral, endocervical, at rectal infections caused by C. Other: Superinfections, nephrogenic diabetes trachomatis insipidus syndrome amebiasis Acute intestinal Interactions Reduction of incidence and progression of disease Drug-drug following exposure to anthrax Decreased absorption with antacids, iron, alkali Prophylaxis for malaria due to Plasmodium Decreased therapeutic effects with barbiturates, falciparum for short-term use in travelers carbamazepine, phenytoin Treatment of periodontal disease as an adjunct to Increased planing scaling and rootdigoxin toxicity with doxycycline Increased use: Prevention of methoxyflurane Unlabelednephrotoxicity with"traveler's diarrhea" Decreased activity of penicillins commonly caused by enterotoxigenic E. coli Drug-food Contraindications and cautions Decreased effectiveness of doxycycline if taken Contraindicated with allergy to tetracyclines. with food,cautiously with renal or hepatic dysfunction, Use dairy products Drug-lab test pregnancy, lactation. Interference with culture studies for several days Available forms following therapy Tablets50, 75, 100 mg; capsules50, 100 mg; coated pellets, capsules75, 100 mg; powder for oral suspension25 mg; Nursing considerations syrup50 mg; powder for injection100, 200 mg Assessment Metabolism: THistory: Allergy to tetracyclines, renal or hepatic 1/2: 1525 hr dysfunction, pregnancy, lactation

Distribution: Crosses placenta; enters breast milk Physical: Excretion: Feces, urine Skin status, R and sounds, GI function and liver evaluation, urinary output and concentration, IV facts urinalysis and BUN, LFTs, renal function tests; culture infected area before of 10 mg/mL, reconstitute with Preparation: Prepare solutionbeginning therapy 10 mL (100-mg vial): 20 mL (200 mg vial) of sterile water for Interventions injection; dilute further with 1001,000 mL (100-mg vial) or 200 Administer sodium medication without regard to 2,000 mL (200-mg vial) of the oral chloride injection, 5% dextrose injection, food or meals; if GI upset occurs, give with meals; Ringer's injection, 10% invert sugar in water, lactated patients 5% dextrose for periodontal disease should Ringer's injection, being treated in lactated Ringer's, Normosol-M receive tablet D W, or hr before morning 148 in 5% in D5W, Normosol-R in at 5least 1 Plasma-Lyte 56 or and evening Dextrose. meals. in lactated Ringer's or 5% dextrose in lactated If mixed Protect be completed within hr exposure. Ringer's, infusion must patient from light and6sun after reconstitution; otherwise, may be stored up to 72 hr if refrigerated Teaching points light, but infusion should then be completed and protected from Take solution after that time. within 12 hr; discard drug throughout the day for best results; if GI Infusion: upset occurs, take drug with food. If being treated for Infuse slowly over 14 hr. periodontal disease, take at least 1 hour before morning and evening meals. Adverse effects Avoid pregnancy while using this drug; using Dental: Discoloring and inadequate calcification barrier contraceptives is if used by pregnant women, of primary teeth of fetus advised. You may inadequate calcification of permanent discoloring andexperience these side effects: Sensitivity to sunlight (wear protectiveof dental development teeth if used during period clothing, use sunscreen), diarrhea. Dermatologic: Phototoxic reactions, rash, Report rash, itching, difficulty breathing, dark urine exfoliative dermatitis (more frequent and more severe or light-colored stools, pain at injection site. with this tetracycline than with any others) Adverse effects in Italic are most common; those in Bold are lifethreatening.

enalapril maleate Nursing Vasotec considerations Assessment History: Allergy to enalapril, impaired renal enalaprilat function, salt or volume depletion, lactation, pregnancy Vasotec I.V. Physical: Skin color, lesions, turgor; T; orientation, reflexes, affect, peripheral sensation; P, BP, peripheral Drug classes perfusion; mucous membranes, bowel sounds, liver Antihypertensive evaluation; urinalysis, LFTs, renal function tests, CBC, ACE inhibitor and differential Therapeutic actions Renin, synthesized by the kidneys, is released into the circulation Interventions where it acts on a plasma precursor to produce angiotensin I, which WARNING: Alert surgeon, vasoconstrictor that is converted by ACE to angiotensin II, a potent and mark patient's chart with notice that enalapril is being taken; the also causes release of aldosterone from the adrenals; both of these angiotensin II formation the conversion compensatory actions increase BP. Enalapril blocks subsequent to of angiotensin renin release during BP, decreasing blocked; I to angiotensin II, decreasing surgery will bealdosterone secretion, hypotension may be reversed levels, and causing Na+ and slightly increasing serum K+ with volume expansion. Monitor patients on diuretic therapy for involved fluid loss; increased prostaglandin synthesis also may beexcessive hypotension after the first patients with heart in the antihypertensive action. Infew doses of enalapril. failure, Monitor patient closely in and heart size are peripheral resistance, afterload, preload,any situation that may decreased.lead to a drop in BP secondary to reduced fluid volume (excessive perspiration and dehydration, vomiting, Indications diarrhea) because excessive hypotension may occur. Treatment of hypertension alone or in combination Arrange for reduced especially thiazide-type with other antihypertensives,dosage in patients with impaired renal function. diuretics WARNING: Monitor patient carefully because Treatment of acute and chronic CHF peak effect may not be seen for 4 hr. Do not administer second dose until BP has been checked.

Treatment of asymptomatic left ventricular dysfunction (LVD) Teaching pointsUnlabeled use: Diabetic nephropathy Do not stop Contraindications and cautionstaking the medication without consulting your healthwith allergy to enalapril. Contraindicated care provider. Be cautiously with impaired renal function; salt or Usecareful in any situation that may lead to a drop in blood pressure (diarrhea, may occur); vomiting, volume depletion (hypotension sweating, lactation, dehydration). pregnancy. Available formsAvoid over-the-counter medications, especially cough, cold, and allergy medications that Tablets2.5, 5, 10, 20 mg; injection1.25 mg/mL may interact with this 11 hr Metabolism: T1/2: drug. You may experience breast milk Distribution: Crosses placenta; entersthese side effects: GI upset, loss of Excretion: Urine appetite, change in taste perception (will pass with time); mouth sores (frequent mouth care may help); Adverse effects rash; fast heart rate; dizziness, light-headedness (usually CNS: Headache, dizziness, fatigue, insomnia, passes in a few days; change position slowly, limit paresthesias activities to those not requiring alertness and hypotension CV: Syncope, chest pain, palpitations, precision). salt-Report mouth sores; sore throat, fever, chills; in or volume-depleted patients swelling of the hands, feet; irregular heartbeat, chest GI: Gastric irritation, nausea, vomiting, diarrhea, pains; swelling of the face,elevated liver enzymes abdominal pain, dyspepsia, eyes, lips, tongue, difficulty breathing. Proteinuria, renal insufficiency, renal failure, GU: polyuria, oliguria, urinary frequency, impotence Hematologic: Decreased Hct and Hgb Other: Cough, muscle cramps, hyperhidrosis Interactions Drug-drug Decreased hypotensive effect if taken concurrently with indomethacin, rifampin

Interactions Drug-drug enoxaparin Increased bleeding tendencies with oral Lovenox anticoagulants, salicylates, NSAIDs, penicillins, cephalosporins Drug classes Risk of severe bleeding if combined with heparin Drug-lab test Lowmolecular-weight heparin Antithrombotic Increased AST, ALT levels Drug-alternative therapy Increased risk of bleeding if combined with  Therapeutic actions chamomile, garlic, ginger, ginkgo, and ginseng therapy,  Lowmolecular-weight heparin that inhibits thrombus high-dose vitamin E and clot formation by blocking factor Xa, factor IIa, Nursing considerations formation of clots. preventing the Assessment  Enoxaparin binds to and accelerates the activity of History: Recent activating antithrombin to antithrombin III. By surgery or injury; sensitivityIII, heparin, pork products, enoxaparin; lactation; history enoxaparin preferentially potentiates the inhibition of GI bleed; pregnancy coagulation factors Xa and IIa. The anticoagulant effect Physical: Peripheral perfusion, R, stool guaiac test, of enoxaparin can be directly correlated to its ability to PTT or other tests of blood coagulation, conversion of inhibit factor Xa. Factor Xa catalyzes the platelet count, renal function tests prothrombin to thrombin, so enoxaparins inhibition of this process results in decreased thrombin and ultimately Interventions prevention of fibrin clot formation. the Give drug as soon as possible after hip surgery, within 12 hr of knee surgery, and within 2 hr Indications preoperatively forof DVT, which may lead to pulmonary Prevention abdominal surgery. Give deep subcutaneous injections; replacement embolism following hip replacement, knee do not give enoxaparin by IM injection. surgery, abdominal surgery

Prevention of ischemic complications of unstable Administer by deep subcutaneous injection; patient angina and nonQ-wave MI shouldTreatment down. Alternate between the left with be lying of DVT, pulmonary embolus and right anterolateral and posterolateral abdominal wall. warfarin Introduce the whole DVT inof the needle into who are at Prevention of length medical patients a skin fold held between the thumb and forefinger; hold severely risk for thromboembolic complications due to the skin fold throughout the injection. restricted mobility during acute illnesses Apply pressure to Contraindications and cautions all injection sites after needle is withdrawn; inspect injectionwith for signs of hematoma; sites hypersensitivity to Contraindicated do not massage injection sites. enoxaparin, heparin, pork products; severe Do not mix with other injections or thrombocytopenia; uncontrolled bleeding.infusions. Store at room temperature; fluid should be clear, Use cautiously with pregnancy or lactation, history colorless to pale yellow. of GI Provide for safety measures (electric razor, soft Available forms toothbrush) to prevent injury to patient who is at risk for Injection30 mg/0.3 mL; 40 mg/0.4 mL; 60 mg/0.6 mL; 80 mg/0.8bleeding. mg/1 mL; 120 mg/0.8 mL; 150 mg/mL; mL; 100 300 mg/3 mL Check patient for signs of bleeding; monitor blood tests. Metabolism: T1/2: 4.5 hr Alert all placenta; may enter that milk Distribution: May cross health care providersbreastpatient is taking enoxaparin. Excretion: Urine Adverse effects Discontinue and initiate appropriate therapy if thromboembolic episode occurs despite enoxaparin Hematologic: Hemorrhage; bruising; therapy. thrombocytopenia; elevated AST, ALT levels; WARNING: Have protamine sulfate (enoxaparin hyperkalemia antidote) readily available in case of overdose. asthma Hypersensitivity: Chills, fever, urticaria, Treat overdose as follows: Protamine sulfate (1% Other: Fever; pain; local irritation, hematoma, solution). Each mg protamine neutralizes 1 mg erythema at site ofof injection, epidural or spinal enoxaparin. Give very slowly IV over 10 anesthesia hematoma with spinal tap, spinal/epiduralmin. Teaching points

 Have periodic blood tests to monitor your response Nasal decongestant to this drug. Mydriatic You and a significant other may need to learn to give the drug by subcutaneous injection and how to Therapeutic actions properly dispose of needles and syringes. Naturally occurring neurotransmitter, are taking this drug: Useare Avoid injury while you the effects of which an mediated electric razor;beta receptors in target organs. to injury.on by alpha or avoid activities that might lead Effects alpha receptorsReport nose bleed, bleedingcontraction of unusual include vasoconstriction, of the gums, dilator muscles bruising, Effects oron beta receptors include positive of iris. black tarry stools, cloudy or dark urine, chronotropic and inotropic effects pain, severe headache. abdominal or lower back on the heart (beta1 receptors); bronchodilation, vasodilation, and uterine relaxation (beta2 receptors); decreased production of aqueous humor. Indications IV: In ventricular standstill after other measures have failed to restore circulation, given by trained personnel by intracardiac puncture and intramyocardial injection; treatment and prophylaxis of cardiac arrest and attacks of transitory AV heart block with syncopal seizures (Stokes-Adams syndrome); syncope due to carotid sinus syndrome; acute hypersensitivity (anaphylactoid) reactions, serum sickness, urticaria, angioneurotic edema; in acute asthmatic attacks to relieve bronchospasm not controlled by inhalation or subcutaneous injection; relaxation of uterine musculature; additive to local anesthetic solutions for injection to prolong their duration of action and limit systemic absorption

Injection: Relief from respiratory distress of bronchial asthma, epinephrine (adrenaline) chronic bronchitis, emphysema, other COPDs epinephrine bitartrate Aerosols and solutions for nebulization: Temporary Aerosols: Primatenerelief from acute attacks of bronchial asthma, COPD Mist Topical nasal solution: Temporary relief from nasal and nasopharyngeal mucosal congestion due to a cold, epinephrine borate sinusitis, hay Ophthalmic solution: fever, or other upper respiratory allergies; Epinal adjunctive therapy in middle ear infections by decreasing congestion around eustachian ostia 0.1% ophthalmic solution: Conjunctivitis, during epinephrine hydrochloride Injection, eye surgerysolution: bleeding, to produce mydriasis OTC nasal to control Contraindications Adrenalin Chloride and cautions Contraindicated with allergy or hypersensitivity to Insect-sting emergencies: epinephrine or components IM adult dose), EpiPen Jr. EpiPen Auto-Injector (delivers 0.3 mgof preparation (many of the inhalant and ophthalmic children) Auto-Injector (delivers 0.15 mg IM for products contain sulfites: Sodium bisulfite, sodium or potassium metabisulfite; OTC solutions for nebulization: check label before using S2 AsthmaNefrin, microNefrin, Nephron,any of these products in a sulfite-sensitive patient); narrow-angle glaucoma; shock other Drug classes than anaphylactic shock; hypovolemia; general anesthesia with halogenated hydrocarbons or Sympathomimetic cyclopropane; Alpha-adrenergic agonist organic brain damage, cerebral arteriosclerosis; cardiac dilation and coronary Beta1- and beta2-adrenergic agonist insufficiency; tachyarrhythmias; ischemic heart disease; Cardiac stimulant hypertension; renal dysfunction (drug may initially Vasopressor decrease renal blood flow); COPD patients who have Bronchodilator developed degenerative heart disease; diabetes mellitus; Antasthmatic hyperthyroidism; lactation. Opthalmic preparations are

contraindicated for those wearing contact lenses (drug (adrenochrome) deposits in lens), aphakic patients may discolor the contactthe cornea, conjunctiva, or lids with prolonged use (maculopathy with decreased visual acuity may occur). Local: Transitory stinging on initial instillation, Use cautiously with prostatic hypertrophy (may eye pain or ache, conjunctival hyperemia cause bladder sphincter spasm, difficult and painful urination), history of seizure disorders, psychoneurotic Interactions individuals, labor and delivery (may delay second stage Drug-drug labor; can accelerate fetal heart beat; may cause fetal of Increased sympathomimetic effects with has and maternal hypoglycemia), children (syncopeother TCAs (eg, imipramine) occurred when epinephrine has been given to asthmatic Excessive hypertension with propranolol, betachildren) Availableblockers, furazolidone forms Decreased cardiostimulating and 1%; aerosol Solution for inhalation1:100, 1:1,000, 1.125%, bronchodilating 0.35 mg, effects with beta-adrenergic blockers (eg, propranolol)for 0.5%, 0.22 mg; injection1, 5 mg/mL; solution vasopressor effects with injection1:1,000, Decreased 1:2,000, 1:10,000, 1:100,000; suspension for chlorpromazine, phenothiazines Metabolism: Neural Decreased antihypertensive effect Distribution: Crosses placenta; enters breast milk of guanethidine, methyldopa Excretion: Unknown Nursing considerations Assessment IV facts History: Allergy or diluted to 10 mL epinephrine Preparation: 0.5 mL dose may be hypersensitivity towith sodium or components injection; preparation; narrow-angle chloride injection for direct of drug prepare infusion by mixing glaucoma; shock other than anaphylactic shock; 1 mg in 250 mL D5W (4 mcg/mL). Infusion: hypovolemia; direct IV injection or into thehalogenated Administer by general anesthesia with tubing of a hydrocarbons or 1 min, or run organic brain damage, running IV, each 1 mg over cyclopropane; infusion at 14 mcg/min cerebral arteriosclerosis; cardiac dilation and coronary (1560 mL/hr). insufficiency; tachyarrhythmias; ischemic heart disease; Adverse effects hypertension; Systemic administration renal dysfunction; COPD; diabetes mellitus; hyperthyroidism; prostatic hypertrophy; history

CNS: Fear, anxiety, tenseness, restlessness, of seizure light-headedness, dizziness, drowsiness, headache, disorders; psychoneuroses; labor and delivery; lactation; insomnia, tremor, contact lens use, aphakic patients (ophthalmic hallucinations, psychological preparations) disturbances, seizures, CNS depression, weakness, Physical: ocular skin color, temperature, turgor; blurred vision, Weight;irritation, tearing, photophobia, orientation, reflexes, IOP; P, BP; R, symptoms of paranoid schizophreniaadventitious sounds; prostate palpation, normal urine output; urinalysis, renal CV: Arrhythmias, hypertension resulting in function tests, blood and urine glucose, serum intracranial hemorrhage, CV collapse with hypotension, electrolytes, tachycardia, precordial pain palpitations, thyroid function tests, ECG in patients with Interventions ischemic heart disease WARNING: Use extreme caution when GI: Nausea, vomiting, anorexia calculating and preparing of renal blood vessels very GU: Constriction doses; epinephrine is a and potent drug; small errors in dosage can cause serious decreased urine formation (initial parenteral adverse effects. dysuria, vesical dosage. administration), Double-check pediatricsphincter spasm Use minimal doses for minimal periods urinary resulting in difficult and painful urination, of time; "epinephrine-fastness" (a form of retention in males with prostatism drug tolerance) can occur with prolonged use. Other: Pallor, respiratory difficulty, orofacial Protect drug dystonia, sweatingsolutions from light, extreme heat, and freezing; do not use pink or brown solutions. Drug Local injection solutions should be clear sites colorless (does not apply to Local: Necrosis at and of repeat injections (due suspension for injection). intense vasoconstriction) Nasal solution Shake the suspension for injection well before withdrawing the dose. congestion, local burning and Local: Rebound Rotate subcutaneous injection sites to prevent stinging necrosis; monitor injection sites frequently. Ophthalmic solutions Keep a Headache, brow ache, blurred blocker CNS: rapidly acting alpha-adrenergic vision, (phentolamine) or a with night vision, pigmentary photophobia, difficulty vasodilator (a nitrate) readily available in case of excessive hypertensive reaction.

 WARNING: Have an alpha-adrenergic blocker or epoetin alfa (EPO, erythropoietin) positive pressure breathing facilities for intermittent Epogen, Eprex (CAN), Procrit readily available in case pulmonary edema occurs. WARNING: Keep a beta-adrenergic blocker Drug class (propranolol; a cardioselective beta-blocker, such as Recombinant human erythropoietin in patients with respiratory atenolol, should be used distress) readily available in case cardiac arrhythmias Therapeutic actions occur. A natural glycoprotein exceed recommended dosage of stimulates Do not produced in the kidneys, which inhalation RBC production in the bone marrow. products; administer pressurized inhalation drug forms Indications during second half of inspiration, because the airways Treatment and the associated with chronic renal are open wider of anemia aerosol distribution is more failure, including patients on dialysis extensive. If a second inhalation is needed, administer at Treatment of anemia of renal peak effect of previous dose, 35 min. failure requiring dialysis ages 1 mo16 yr; not recommended for states; do Use topical nasal solutions only for acute < 1 mo use for longer anemia related toand do not exceed not Treatment of than 35 days, therapy with AZT in HIV-infecteddosage. Rebound nasal congestion can recommended patients occur Treatment of anemia subsides.to chemotherapy in after vasoconstriction related cancer patients Teaching points Reduction of allogenic blood transfusions in surgical patientsexceed recommended dosage; adverse Do not effects Unlabeledofuse: Pruritus associated with renal or loss effectiveness may result. Read the failure; to decrease the number of RBC transfusions in instructions that come with respiratory inhalant products, critically ill your health care provider or pharmacist if and consult infants who have anemia of prematurity, myelodysplastic syndrome, chronic inflammation you have any questions. associated with rheumatoid arthritisor tilt head backward, To give eye drops: Lie down Contraindications and cautions and look up. Hold dropper above eye; drop medicine inside lower lid while looking up. Do not touch dropper

to eye, fingers, or any surface. Release lower lid; keep open, and do not blink for at least 30 seconds. Apply eye Contraindicated with uncontrolled hypertension; hypersensitivity with fingers to inside cornerproductseye gentle pressure to mammalian cell-derived of the or to albumin human. wait at least 5 minutes before using for about 1 minute; other Use drops. eye cautiously with pregnancy, lactation. Available forms You may experience these side effects: Dizziness, Injection2,000, 3,000, 4,000, 10,000, 20,000, 40,000 units/mL drowsiness, fatigue, apprehension (use caution if driving or performing tasks that require alertness); anxiety, Metabolism: Serum;changes; nausea, vomiting, change in taste emotional T1/2: 413 hr Distribution: frequent placenta; enters breast milk Nasal solution (eat Crosses small meals); fast heart rate. Excretion: Urine may cause burning or stinging when first used IV facts (transient). Ophthalmic solution may cause slight Preparation: As provided; no additional preparation. Enterbrow stinging when first used (transient); headache or vial only once; do(only during the firstDiscard any unused solution. ache not shake vial. few days). Refrigerate. Report chest pain, dizziness, insomnia, weakness, Infusion: tremor or irregular heartIV injection or into tubing of Administer by direct beat (respiratory inhalant, nasal running IV. solution), difficulty breathing, productive cough, failure Incompatibilities: Do not mix with any other drug solution. to respond to usual dosage (respiratory inhalant), Adverse effects in visual acuity (ophthalmic). decrease CNS: Headache, arthralgias, fatigue, asthenia, dizziness, seizure, CVA, TIA CV: Hypertension, edema, chest pain GI: Nausea, vomiting, diarrhea Other: Clotting of access line Nursing considerations Assessment History: Uncontrolled hypertension, hypersensitivity to mammalian cell-derived products or to albumin human, lactation

 Physical: Reflexes, affect; BP, P; urinary output, Oral, ophthalmic ointment,renal function tests; solutionHct, acne, renal function; topical dermatologic CBC, for iron topical dermatologic ointment: levels, electrolytes Akne-mycin, A/T/S, Apo-Erythro (CAN), Diomycin (CAN), Erybid (CAN), Interventions Eryc, EryDerm, Erymax, Ery-Tab, Erythromycin Film-tabs, Ilotycin, PCE Dispertab renal nature of anemia; not Confirm chronic, intended as a treatment of severe anemia or substitute for erythromycin estolatetransfusion. emergency Gently mix; do not shake, shaking may denature erythromycin ethylsuccinate Use only one dose per vial; do not the glycoprotein. Oral: reenter the vial. Discard unused portions. Apo-Erythro ES (CAN), E.E.S. 200,other drug solution. Granules, Do not give with any E.E.S. 400, E.E.S. EryPed, EryPed 200, EryPed 400, EryPed Drops per week. If Administer dose three times administered independent of dialysis, administer into erythromycin gluceptate line. If patient is not on dialysis, venous access Parenteral, IV: administer IV or subcutaneously. Ilotycin Gluceptate Monitor access lines for signs of clotting. Arrange for Hct reading before administration of erythromycin lactobionate each dose to determine dosage. If patient fails to respond Erythrocin I.V. (CAN), Erythrocin Lactobionate patient for other within 8 wk of therapy, evaluate etiologies of the problem. erythromycin stearate iron stores prior to and periodically during Evaluate Apo-Erythro-S (CAN), Nu-Erythromycin-S (CAN) ordered. therapy. Supplemental iron may need to be Institute seizure precautions. Drug class Macrolidepoints Teaching antibiotic Drug must be given three times per week and can Therapeutic actions only be given intravenously, subcutaneously, or into a

dialysis access line. Prepare a schedule of administration Bacteriostatic or bactericidal in susceptible bacteria; binds to cell dates. membrane, causing change in protein function, leading to cell Keep appointments for blood tests necessary to death. determine the effects of the drug on your blood count Indications to determine dosage. and Systemic administration all of the usual activities and restrictions Maintain Acute your chronic renal failure. If this becomes that apply to infections caused by sensitive strains of Streptococcus pneumoniae, Mycoplasma pneumoniae, difficult, consult with your health care provider. Listeria monocytogenes, Legionella pneumophila You may experience these side effects: Dizziness, URIs, lower respiratory driving or performing headache, seizures (avoid tract infections, skin and soft-tissue tasks); fatigue, joint pain (may beta-hemolytic hazardous infections caused by group A be medicated); streptococci when oral treatment is preferred to nausea, vomiting, diarrhea (proper nutrition is injectable benzathine penicillin important). PID caused by N.breathing, numbness or tingling, Report difficulty gonorrhoeae in patients allergic to penicillin chest pain, seizures, severe headache. In conjunction with sulfonamides in URIs caused by Haemophilus influenzae As an adjunct to antitoxin in infections caused by Corynebacterium diphtheriae and Corynebacterium minutissimum Prophylaxis against alpha-hemolytic streptococcal endocarditis before dental or other procedures in patients allergic to penicillin who have valvular heart disease Oral erythromycin: Treatment of intestinal amebiasis caused by Entamoeba histolytica; infections in the newborn and in pregnancy that are caused by Chlamydia trachomatis and in adult chlamydial erythromycin infections erythromycin base when tetracycline cannot be used; primary syphilis (Treponema pallidum) in penicillin-allergic

patients; eliminating Bordetella pertussis organisms Infusion: from the nasopharynx Administer over 2060 min qid; Intermittent infusion: of infected individuals and as infuse slowly to avoidexposed and susceptible individuals prophylaxis in vein irritation. Administer continuous infusion withinUnlabeled uses: Erythromycin base is used with 4 hr, or buffer the solution to neutrality if administration is prolonged. colorectal surgery to reduce wound neomycin before Incompatibilities: Gluceptatedo not diarrhea associated with infection; treatment of severe add to aminophylline, oxytetracycline, pentobarbital, Campylobacter enteritis orsecobarbital, treatment of enterocolitis; tetracycline. Lactobionatedo inguinal, or with cephalothin, heparin, not mix genital, anorectal lymphogranuloma metoclopramide, tetracycline. treatment of Haemophilus ducreyi venereum infection; Y-site incompatibilities: Avoid chloramphenicol, heparin, (chancroid) phenobarbital, phenytoin. Ophthalmic ointment Adverse effectsTreatment of superficial ocular infections caused Systemic administration strains of microorganisms; prophylaxis of by susceptible CNS: Reversible hearing loss, confusion, ophthalmia neonatorum caused by N. gonorrhoeae or C. uncontrollable emotions, abnormal thinking trachomatis CV: Ventricular arrhythmias (with IV) Topical dermatologic solutions for acne GI: Abdominal cramping, anorexia, diarrhea, Treatment of acne vulgaris vomiting, pseudomembranous colitis, hepatotoxicity Topical dermatologic ointment Hypersensitivity: Allergic reactions ranging from Prophylaxis against infection in minor skin rash to anaphylaxis abrasions Other: Superinfections Treatment of skin infections caused by sensitive Ophthalmic ointment microorganisms ContraindicationsDermatologic: Edema, urticaria, dermatitis, and cautions angioneurotic Systemic administration edema Local: Irritation, burning, itching at site of Contraindicated with allergy to erythromycin. applicationcautiously with hepatic dysfunction, lactation Use Topical dermatologic preparations (secreted and may be concentrated in breast milk; may Local: Superinfections, particularly with long-term use

modify bowel flora of nursing infant and interfere with Interactions workups). fever Systemic administration Ophthalmic ointment Drug-drug Contraindicated with allergy to erythromycin; viral, Increased serum levels of digoxin fungal, mycobacterial infections of the eye. Increased effects of oral anticoagulants, Availabletheophyllines, carbamazepine, ergot derivatives, forms disopyramide, calcium blockers, Base: Tablets250, 333, 500 mg; DRHMG-CoA reductase capsules250 mg; inhibitors, midazolam, ophthalmic ointment5 mg/g.proton pump inhibitors, quinidine Estolate: Tablets500 mg; Increased therapeutic and toxic effects of capsules250 mg; suspension125, 250 mg/5 mL. Stearate corticosteroids tablets250, 500 mg ethylsuccinate: Ethylsuccinate tablets200, Increased 400 of cyclosporine and mL; powder 400 mg; suspension200,levelsmg/5 mL, 100 mg/25 risk of renal toxicity for suspension200 mg/5 mL; granules for suspension Drug-food 400 mg/5 mL; topical solution1.5%, 2%; topical gel, ointment Decreased 500, 1,000 and 2%. Lactobionate injection:metabolism mg. increased risk of toxic effects if taken with grapefruit juice; avoid this combination Metabolism: Hepatic; T1/2: 1.52 hr Drug-lab test Distribution: Crosses placenta; enters breast milk Decreased urinary estriol levels due to inhibition of Excretion: Bile, urine IV facts hydrolysis of steroids in the gut Interferes with for IV infusion only with sterile Preparation: Reconstitute powderfluorometric determination of water for urinary catecholamines injection without preservatives10 mL for 250- and Topical vials, 20 mL solution for acne 500-mg dermatologic for 1-g vials. Prepare intermittent infusion as Drug-drug follows: Dilute 250500 mg in 100250 mL of 0.9% sodium chloride injection Increased Prepare foreffects with peeling, or D5W. irritant continuous infusion by desquamating, or to 0.9% sodium chloride injection, adding reconstituted drug abrasive agents lactated Ringer's injection, or D5W that will make a solution of Nursing 1 g/L. considerations Assessment

 History: Allergy to erythromycin, hepatic touching the lactation; mirror may be mycobacterial dysfunction, eye or lid. A viral, fungal, helpful. Gently close the of and roll the eyeball in all directions. infectionseye,the eye (ophthalmologic), pregnancy Drug may cause infection; blurring of vision, Physical: Site of temporary skin color, lesions; stinging, or itching.hearing tests; R, adventitious sounds; orientation, affect, output, bowel sounds, liver itching thatculture and Report stinging or evaluation; becomes GI pronounced. of infection, urinalysis, LFTs sensitivity tests Topical dermatologic solution for acne Interventions Wash and Systemic administration rinse area, and pat it dry before applying solution. Culture site of infection before therapy. Use fingertips erythromycin base apply; wash Administer oral or an applicator toor stearate on hands thoroughly after application. 23 hr after meals, an empty stomach, 1 hr before or with a full glass of water (oral erythromycin estolate, ethylsuccinate, and certain enteric-coated tablets [see manufacturer's instructions] may be given without regard to meals). Administer around the clock to maximize effect; adjust schedule to minimize sleep disruption. Monitor liver function in patients on prolonged therapy. Give some preparations (see above) with meals, or substitute one of these preparations, if GI upset occurs with oral therapy. Topical dermatologic solution for acne Wash affected area, rinse well, and dry before application. Ophthalmic and topical dermatologic preparation

Use topical products only when needed. escitalopram oxalate produced by the topical use of an antibiotic Sensitization Lexapro may preclude its later systemic use in serious infections. Topical antibiotic preparations not normally used Drug classes systemically are best. Antidepressant Culture site before beginning therapy. SSRI Cover the affected area with a sterile bandage if needed (topical). Therapeutic actions Teaching points Potentiates serotonergic Systemic administration activitity in the CNS by inhibiting reuptake of serotonin resulting inan empty stomach, 1 hour before Take oral drug on antidepressant effect with little effect on norepinephrine or dopamine; an isomer of citalopram. or 23 hours after meals, with a full glass of water; some Indications forms may be taken without regard to meals. Do not drink Treatment ofjuice while on this drug. The drug grapefruit major depressive disorder shouldMaintenance treatment for schedule to minimize be taken around the clock; patients with major depressive disorderFinish the full course of the drug sleep disruption. Treatment of generalized anxiety disorder therapy. Unlabeled use: Panic disorderside effects: Stomach You may experience these Contraindications and cautions (take the drug with meals, if cramping, discomfort Contraindicated with emotions, with laughing, appropriate); uncontrollable MAOI use;crying, allergy to drug or to citalopram or any component of the drug. abnormal thinking (reversible). Use cautiously watery diarrhea, severe renal Report severe orin the elderly, and withnausea or hepatic dark urine, illnesses of metabolism or vomiting, impairment, yellowing of the skin or eyes, loss hemodynamic or itching. of hearing, rashresponse, pregnancy, lactation, suicidal patients, patients with mania or seizure disorders. Ophthalmic ointment Available forms Pull the lower eyelid down gently and squeeze a Tablets5, 10, 20 mg; oral solution5 mg/5 mL the sac, avoid one-halfinch ribbon of the ointment into Metabolism: Hepatic metabolism; T1/2: 2732 hour

Distribution: Crosses placenta; enters breast milk Establish appropriate safety precautions if patient Excretion: Urine experiences adverse CNS effects. Adverse effects Institute appropriate therapy for patient suffering CNS: Somnolence, dizziness, insomnia, fatigue from depression. Dermatologic: Sweating GI: Nausea, dry mouth, constipation, diarrhea, Teaching indigestion, abdominal pain, decreased appetite points Take this drug exactly as directed, and as long as GU: Ejaculatory disorders, impotence, anorgasmia directed; it may take libido in females, decreased a few weeks to realize the benefits of drug. The drug may be taken with food if desired. theRespiratory: Rhinitis, sinusitis, flulike symptoms Interactions Avoid the use of alcohol while you are taking this drug. Drug-drug This drug serious not be effectsduring pregnancy or Risk of should toxic taken if combined with when nursing not use these drugs concomitantly citalopram; do a baby; use of barrier contraceptives is suggested. Increased escitalopram levels and toxicity if taken You may experience these side MAOI with MAOIs; ensure that patient has been off theeffects: Drowsiness, dizziness, tremor (use caution and avoid for at least 14 days before administering escitalpram driving Risk of performing syndromea that require a car or serotonin other tasks syndrome alertness if you experience daytime drowsiness); GI characterized by increased BP, T, severe anxiety, upset (frequent small can occur when multiple care may agitation, rigidity, and meals, frequent mouth drugs are help); monitor patient carefully used; alterations in sexual function (this is a drug effect and will pass when drug therapy is ended). Possible severe adverse effects if combined with Report acting CNS drugs, including alcohol; use other centrallysevere nausea, vomiting; blurred vision; excessive sweating, suicidal ideation, sexual dysfunction, caution insomnia. Possible decreased effects of escitalopram if combined with carbamazepine, lithium; monitor patient closely Drug-alternative therapy

Increased risk of severe reaction if combined with estradiol St. John's wort; avoid this combination Nursing considerations estradiol ALERT! CLINICAL Oral: is potential for name confusion between escitalopram and There Estrace, Gynodiol citalopram and Loxitane (loxapine) and Lexapro (escitalopram); Transdermal system: use caution. Alora, Climara, Esclim, Estraderm, Menostar, Vivelle, Vivelle Dot Topical vaginal cream: Assessment Estrace History: MAOI use; allergy to drug, citalopram, or Vaginal ring: component of the drug; renal or hepatic impairment; any Estring the elderly; pregnancy; lactation; suicidal tendencies; Topical emulsion: illnesses or problems with hemodynamic metabolic Estrasorb response; alcoholism Physical: Orientation, reflexes; P, BP, perfusion; estradiol cypionate sounds, normal output; urinary output; liver R, bowel Injection in oil: evaluation; LFTs, renal function tests Depo-Estradiol Interventions estradiol hemihydrate Administer once a day, in the morning or the Vaginal tablet: evening; may be taken with food if desired. Vagifem Encourage patient to continue use for 46 weeks, as directed, to ensure adequate levels to affect estradiol valerate depression. Injection in oil: WARNING: Limit amount of drug given in Delestrogen prescription to potentially suicidal patients. Advise any depressed patients to avoid the use of Drug classes alcohol while being treated with antidepressive drugs. Hormone

Estrogen CV: Increased BP, thromboembolic and thrombotic Therapeutic actions disease Dermatologic: endogenous female sex hormone. Estradiol is the most potent Photosensitivity, peripheral edema, Estrogens chloasma, erythema nodosum orof multiforme, are important in the development the female hemorrhagic eruption, loss characteristics; affect the reproductive system and secondary sexof scalp hair, hirsutism, release of urticaria, dermatitis pituitary gonadotropins; cause capillary dilatation, fluid GI: Gallbladder disease (in postmenopausal retention, protein anabolism and thin cervical mucus; conserve women), hepatic adenoma, nausea, vomiting, calcium and phosphorus and encourage bone formation; inhibit ovulation abdominal cramps, bloating, cholestatic jaundice, and prevent postpartum breast discomfort. They are colitis, acute pancreatitis responsible for the proliferation of the endometrium; absence or GU: Increased risk of symptoms of menopause on decline ofestrogen produces signs andpostmenopausal endometrial cancer, breakthrough bleeding, change in menstrual the uterus, vagina, breasts, cervix; relief in androgen-dependent flow, dysmenorrhea, premenstrual-like androgens prostatic carcinoma is attributable to competition with syndrome, amenorrhea, vaginal candidiasis, cystitis-like for receptor sites, decreasing the influence of androgens. syndrome, endometrial cystic hyperplasia Indications Hematologic: Hypercalcemia, decreased glucose Topical emulsion, all forms: Palliation of moderate tolerance to severe vasomotor symptoms, atrophic vaginitis or Local: Pain at injection site, sterile abscess, kraurosis vulvae associated with menopause postinjection flare Estradiol oral, transdermal, ring, vaginal tablets, Other: Weight changes, of postmenopausal estradiol valerate: Prevention reduced carbohydrate tolerance, aggravation of porphyria, edema, changes in osteoporosis libido, Estradiol oral, transdermal, estradiol cypionate, breast tenderness Topical vaginal cream valerate: Treatment of female hypogonadism, female Systemic castration, primary ovarian failure absorption may cause uterine bleeding in menopausal women and mayEstradiol oral, bleeding of valerate: Palliation of cause serious estradiol remaining endometrial foci in sterilized women with endometriosis. inoperable prostatic cancer Interactions

Estradiol oral: Palliation of inoperable, progressing Drug-drug breast cancer Increased osteoporosis Prevention of therapeutic and toxic effects of corticosteroids Contraindications and cautions Decreased serumwith allergy to estrogens, allergy Contraindicated levels of estradiol with drugs that enhance hepatic metabolism of the drugbarbiturates, to tartrazine (in 2-mg oral tablets), breast cancer (with phenytoin, rifampin, carbamazepine exceptions), estrogen-dependent neoplasm, undiagnosed Drug-lab test abnormal genital bleeding, active or past history of Increased or thromboembolic disorders VIII, IX, thrombophlebitisprothrombin and factors VII, (potential and X; fetal defects; women of with increased PBI, T4, serious thyroid-binding globulin childbearing age should increased uptake risks T3 birth control measures be advised of of free andresin (free T4 is unaltered), serum triglycerides and phospholipid concentration suggested). Decreased antithrombin III, pregnanediol Use cautiously with metabolic bone disease, renal excretion, response to metyrapone test, serum folate insufficiency, CHF, lactation. Availableconcentration forms Impaired glucose tolerance Transdermalrelease rates of 0.014, 0.025, 0.0375, 0.05, 0.075, Nursing considerations 0.1 mg/24 hr; tablets0.5, 1, 1.5, 2 mg; injection5, 10, 20, Assessment 40 mg/mL; vaginal cream0.1 mg/g; vaginal ring2 mg; vaginal tablet25 mcg; History: Allergy to estrogens, tartrazine; breast topical emulsion0.1 mg cancer, estrogen-dependent Metabolism: Hepatic; T1/2: Not known neoplasm; undiagnosed abnormal placenta; enters breast milk Distribution: Crosses genital bleeding; active or previous thrombophlebitis or thromboembolic disorders; Excretion: Urine pregnancy; lactation; metabolic bone disease; renal Adverse effects insufficiency; CHF CNS: Steepening of the corneal curvature with a Physical: in visual acuity and intolerance to resultant change Skin color, lesions, edema; breast examination; injection site; orientation, affect, mental contact lenses, headache, migraine, dizziness,reflexes; P, auscultation, BP, peripheral depression, chorea, seizures perfusion; R, adventitious sounds; bowel sounds, liver evaluation, abdominal examination; pelvic examination; serum calcium,

phosphorus; LFTs, renal function tests; Pap smear; scalp hair, darkening glucose tolerance test of the skin on the face; changes in menstrual patterns. Interventions Report pain inpretreatment calvesperiodic (at chest Arrange for the groin or and of the legs, least pain or sudden shortness of breath, abnormal vaginal annual) history and physical, which should include BP, bleeding, lumps in the breast, suddenPap smear. breasts, abdomen, pelvic organs, and a severe headache, dizziness not use to prevent CV events or dementia; may Do or fainting, changes in vision or speech, weakness or increase risk. numbness in the arm or leg, severe abdominal pain, yellowing ofrisks skin or eyes, severe Caution patient of the the of estrogen use, the mental prevent pregnancy during treatment, for frequent need todepression, pain at injection site. medical follow-up, and for periodic rests from drug treatment. Administer cyclically for short-term only when treating postmenopausal conditions because of the risk of endometrial neoplasm; taper to the lowest effective dose, and provide a drug-free week each month. Apply transdermal system to a clean, dry area of skin on the trunk of the body, preferably the abdomen; do not apply to breasts; rotate the site at least 1 wk between applications; avoid the waistline because clothing may rub the system off; apply immediately after opening and compress for about 10 sec to attach. Insert vaginal ring as deeply as possible into upper one-third of vagina. Ring will remain in place for 3 months. Then, remove and evaluate need for continued therapy. If a ring falls out during 3 mo, rinse with warm water and reinsert.

WARNING: Arrange for the concomitant use of estrogens, conjugated progestin therapy during long-term estrogen therapy in Oral, topical vaginal cream: women with a uterus; this will mimic normal physiologic C.E.S. (CAN), Premarin cycling and allow for a cyclic uterine bleeding that may Parenteral: decrease the risk of endometrial cancer. Women without Premarin Intravenousnot need progestin. a uterus do Synthetic: Administer parenteral preparations by deep IM Cenestin injection only. Monitor injection sites and rotate with each injection to decrease development of abscesses. Drug classes Teaching points Hormone Use this drug in cycles or short term; prepare a Estrogen calendar of drug days, rest days, and drug-free periods. Therapeutic actions transdermal system and vaginal cream Apply Estrogens properly; insert vaginal tablethormones important in the are endogenous female sex as high into the vagina as development of the female reproductive system and secondary sex is comfortable. characteristics. Insert affect the release of vagina; itgonadotropins; They vaginal ring high in pituitary should remain cause capillary dilatation, fluid If it falls out beforeanabolism,rinse in place for 3 months. retention, protein that time, and thin cervical mucus; water andcalcium and phosphorus; encourage with warm conserve reinsert. bone formation;Potentially serious and prevent postpartum breast inhibit ovulation side effects include cancers, discomfort. They are and liver problems; it proliferation of the blood clots, responsible for the is very important to endometrium; absence or decline of estrogenthroughout signs and have periodic medical examinations produces therapy. symptoms of menopause on the uterus, vagina, breasts, women This drug cannot be given to pregnant cervix. Their efficacy asofpalliation in effects to the baby. because serious toxic male patients with androgendependent prostatic carcinoma is attributableside their competition You may experience these to effects: Nausea, with androgens for receptor sites, headache, dizziness, mental vomiting, bloating; thus decreasing the influence of androgens. depression (use caution if driving or performing tasks Indications require alertness); sensitivity to sunlight (use a that Oral sunscreen and wear protective clothing); rash, loss of

 Palliation of moderate to severe vasomotor GI: atrophic vaginitis, (in postmenopausal symptoms, Gallbladder disease or kraurosis vulvae women), with menopause associated hepatic adenoma, nausea, vomiting, abdominal cramps, bloating, hypogonadism; female Treatment of female cholestatic jaundice, colitis, acute pancreatitis castration; primary ovarian failure GU: Increased risk progression Osteoporosis: To retard of endometrial cancer in postmenopausalof inoperable prostatic cancer Palliation women, breakthrough bleeding, change in Palliation flow, dysmenorrhea, premenstrual-like menstrual of metastatic breast cancer syndrome, amenorrhea, vaginal candidiasis, cystitis-like Cenestin: Treatment of moderate to severe syndrome, symptoms associated with menopause vasomotor endometrial cystic hyperplasia Hematologic: Hypercalcemia, decreased glucose Unlabeled use: Postcoital contraceptive Parenteraltolerance Local: Pain at injection site, sterile abscess, Treatment of uterine bleeding due to hormonal postinjection flare imbalance in the absence of organic pathology Vaginal cream Other: Weight changes, reduced carbohydrate tolerance, aggravationatrophic vaginitis andchanges in Treatment of of porphyria, edema, kraurosis libido, associated with menopause vulvae breast tenderness Topical vaginal cream Systemic absorption cautions Contraindications andmay cause uterine bleeding in menopausal women and serious bleeding of remaining endometrial foci in Contraindicated with allergy to estrogens, breast sterilized women (withendometriosis. cancer with exceptions), estrogen-dependent neoplasm, Interactions undiagnosed abnormal genital bleeding, active or past Drug-drug thrombophlebitis or thromboembolic disorders from Increased therapeutic and toxic effects of previous estrogen use, pregnancy (serious fetal defects; corticosteroids women of childbearing age should be advised of risks Decreased measures suggested). and birth control serum levels of estrogen with drugs that enhance hepatic metabolism of the bone disease, renal Use cautiously with metabolic drug: Barbiturates, phenytoin, rifampin, carbamazepine insufficiency, CHF, lactation.

Available forms Drug-lab test Tablets0.3, 0.45, 0.625, 0.9, 1.25 mg; injection25 mg; vaginal Increased prothrombin and factors VII, VIII, IX, cream0.625 mg/g and X; thyroid-binding globulin with increased PBI, T4, Metabolism: Hepatic; T1/2: Unknown increased uptake of free T3 resin milk Distribution: Crosses placenta; enters breast(free T4 is unaltered), serum triglycerides and phospholipid concentration Excretion: Urine Decreased antithrombin III, pregnanediol IV facts excretion, response to metyrapone test, serum folate Preparation: Reconstitute with provided diluent; add to normal concentration saline, dextrose, and invert sugar solutions. Refrigerate unreconstituted Impaired glucose tolerance reconstituted solution parenteral solution; use Nursing few hours. Refrigerated reconstituted solution is stable for within a considerations Assessment not use solution if darkened or precipitates have 60 days; do History: Allergy to estrogens; breast cancer, formed. Infusion: estrogen-dependent neoplasm; undiagnosed abnormal Inject slowly over 25 min. genital bleeding; active or protein hydrolysate, ascorbic Incompatibilities: Do not mix with previous thrombophlebitis or thromboembolic disorders; pregnancy; lactation; acid, or any solution with an acid pH. metabolic bone disease; renal insufficiency; CHF Adverse effects Physical: Skin color, lesions, edema; breast CNS: Steepening of the corneal curvature with a examination; injection site; acuity and intolerance to resultant change in visual orientation, affect, reflexes; P, auscultation, headache, migraine, dizziness, mental contact lenses, BP, peripheral perfusion; R, adventitious sounds; bowel sounds, liver evaluation, abdominal depression, chorea, seizures examination; Increasedexamination; serum calcium, CV: pelvic BP, thromboembolic and phosphorus; LFTs, thrombotic disease renal function tests; Pap smear; glucose tolerance test Photosensitivity, peripheral edema, Dermatologic: Interventions chloasma, erythema nodosum or multiforme, Arrange for pretreatment scalp hair, (at least hemorrhagic eruption, loss of and periodichirsutism, annual) dermatitis urticaria,history and physical, which should include BP, breasts, abdomen, pelvic organs, and a Pap smear.

 Do not use to prevent CV events or dementia; may etanercept increase risk. Enbrel Caution patient of the risks involved with estrogen use, the need to prevent pregnancy during treatment, for Drug classes frequent medical follow-up, and periodic rests from drug Antarthritic treatment. Disease-modifying antirheumatic drug (DMARD) short term only WARNING: Give cyclically for Therapeutic actions postmenopausal conditions because of the when treating Genetically engineered tumor neoplasm; factor receptors lowest risk of endometrial necrosis taper to the from Chinese hamster ovary and provide a drug-free week response to effective dose, cells; keep inflammatory each month. autoimmune disease in check by reactingparenteral solution; use Refrigerate unreconstituted with and deactivating free-floating tumor necrosis factor released by active leukocytes. reconstituted solution within a few hours. Indications Refrigerated reconstituted solution is stable for 60 Reduction of the signs and symptoms that induce days; do not use solution if darkened or precipitates have major formed.clinical response, inhibit the progression of structural damage, Arrange for the concomitant use of WARNING: and improve physical function in patients with moderately long-term estrogen rheumatoid progestin therapy during to severely active therapy in arthritis; thisdelay mimic normal damage associated with women; to will the structural physiologic cycling and rheumatoid arthritis; or may be usedwhich may decrease allow for cyclic uterine bleeding, in combination with methotrexate when patients Women without a uterus the risk of endometrial cancer. do not respond to methotrexate alone do not need progestin. Teaching points Polyarticular-course juvenile rheumatoid arthritis in patients this drug not had an or short term; prepare a Use who have cyclically adequate response to one or more antirheumatic rest days, and drug-free periods. calendar of drug days, drugs Reduction cream and symptoms and to improve Use vaginalof signsproperly. function in patients with side effects can occur: Cancers, Potentially serious psoriatic arthritis; may be used alone or in combination with methotrexate important that blood clots, and liver problems; it is very Treatment of ankylosing spondylitis

you have periodic medical examinations throughout Treatment of adult patients with chronic moderate therapy. to severe plaque psoriasis given to pregnant women This drug cannot be who are candidates for systemicof serious toxic effects to the baby. because therapy or phototherapy. Contraindications and cautions You may experience these side effects: Nausea, Contraindicated headache, to etanercept or vomiting, bloating; with allergydizziness, mental Chinese hamster caution if lactation,or performing tasks depression (use products, driving pregnancy, cancer, severe infection including sepsis, CNS demyelinating that require alertness); sensitivity to sunlight (use a disorders, myelosuppression. sunscreen and wear protective clothing); rash, loss of scalp Use cautiously with renal or hepatic disorders, any hair, darkening of the skin on the face; changes in infection, CHF menstrual patterns. Available forms Report pain in the groin or calves of the legs, chest Powder for injection25 m pain or sudden shortness of breath, abnormal vaginal Metabolism: Tissue; T1/2: 115the breast, sudden severe headache, bleeding, lumps in hr Distribution: Crosses placenta; may enter breast milk or speech, dizziness or fainting, changes in vision Excretion: Tissues or numbness in the arm or leg, severe weakness Adverse effects abdominal pain, yellowing of the skin or eyes, severe mental CNS: CNS demyelinating disorders (MS, depression, pain at injection site. myelitis, optic neuritis) GI: Abdominal pain, dyspepsia Hematologic: Pancytopenia Respiratory: URIs, congestion, rhinitis, cough, pharyngitis Other: Irritation at injection site; increased risk of infections, cancers; ANA development; headache; autoimmune diseases Nursing considerations Assessment

 History: Allergy to etanercept or Chinese hamster sore throat (consult with your health care infections; products; pregnancy, lactation; serious provider for potential treatment if this becomes severe); headache cancer; CNS demyelinating disorders, myelosuppression (analgesics may Skin lesions, color; help); increased Physical: be available to R, adventitious susceptibility to infections (avoid crowded areas and sounds; injection site evaluation; range-of-motion to people who might have infections; use strict monitor drug effectiveness; CNSneurologic handwashing and good hygiene). evaluation, reflexes; CBC Interventions Report fever, chills, lethargy; rash, difficulty breathing; swelling; worsening of and periodicsevere WARNING: Obtain a baseline arthritis; CBC; diarrhea. discontinue drug at signs of severe bone marrow suppression. WARNING: Obtain baseline values of neurologic function; discontinue drug at any sign of CNS demyelinating disorders. Advise patient that this drug does not cure the disease and appropriate therapies for rheumatoid arthritis should be used. Reconstitute for injection by slowly injecting 1 mL sterile bacteriostatic water provided with powder into the vial; swirl gently, do not shake; avoid foaming; liquid should be clear and free of particulate matter; use within 6 hr of reconstitution. Do not mix with any other medications. Rotate injection sites between abdomen, thigh, and upper arm. Maintain a chart to ensure that sites are rotated regularly.

Teach patient and a significant other how to famotidine reconstitute and administer subcutaneous injections; Apo-Famotidine (CAN), Pepcid, Pepcid AC, Pepcid AC Maximum observe the process periodically. Strength, Pepcid Monitor patient for any sign of infection; RPD discontinue drug if infection occurs. Drug class Evaluate drug effectiveness periodically; 12 wk Histaminemay 2) receptor antagonist any change is noted; if no 2 (H be required before Therapeutic actions occurred within 3 mo, discontinue drug. response has  Competitively administer drug with any vaccinations; Do not blocks the action of histamine at the histamineleast2) receptors of the parietal cells of the allow at (H 23 wk between starting this drug and a stomach; inhibits basal gastric acid secretion and vaccination. chemically induced gastric acid secretion. infections and Protect patient from exposure to  The H2 antagonists are competitive antagonists for ensure routine physical examinations and monitoring of histaminecancers parietal cell H2 receptor. They suppress potential at the and autoimmune diseases. Teaching the normal secretion of acid by parietal cells and the points meal-stimulateddrug exactly as prescribed. Note that this Take this secretion of acid. They accomplish by two mechanisms:rheumatoid released by ECL cells in drug does not cure Histamine arthritis and appropriate the stomach is blocked the disease should be followed. therapies to deal with from binding on parietal cell H2 receptors,awhich stimulate acid secretion; therefore, other You and significant other should learn how to prepare substances and to administer secretion (such injections. the drug that promote acid subcutaneous as gastrin and acetylcholine) injection sites to ensure that sites are Prepare a chart of have a reduced effect on parietal cells when the H2 regular basis. blocked. with your health care rotated on a receptors are Consult Indications provider about proper disposal of needles and syringes. Short-term treatment and maintenance of follow-up Arrange for frequent, regular medical duodenal ulcer including blood tests to follow the effects of the visits, Short-term treatment of benign gastric ulcer drug on your body. Treatment experience these side effects: conditions You may of pathologic hypersecretory Signs and (eg, Zollinger-Ellisonrespiratory tract infections, cough, symptoms of upper syndrome)

 Short-term treatment of GERD, esophagitis due to GERD Teaching points OTC: Relief of symptoms of heartburn, acid Take sour stomach indigestion,this drug at bedtime (or in the morning and at bedtime). Therapy may Contraindications and cautions continue for 46 weeks or longer. Place rapidly disintegrating tablet on tongue and Contraindicated with allergy to famotidine; renal swallow with or failure; lactation.without water. Take cautiously withas prescribed,renal or hepatic Use antacid exactly pregnancy, being careful of the times of dysfunction.administration. Have regular medical follow-up while using this Available forms drug 20, 40 mg; response. Tablets10, to evaluate yourchewable tablets10 mg; orally Take over-the-counter drug 1 hour before eating to disintegrating tablets20, 40 mg; gelcaps10 mg; powder for prevent indigestion. Do not take more mg/mL; injection, oral suspension40 mg/5 mL; injection10 than two per day. You may experience these premixed20 mg/50 mL in 0.9% sodium chloride side effects: Constipation or diarrhea; loss of libido or impotence (reversible); headache (adjust Metabolism: Hepatic; T1/2: 2.53.5 hr lights, temperature, noise levels). Distribution: Crosses placenta; enters breast milk Report sore throat, fever, unusual bruising or Excretion: Urine bleeding, severe headache, muscle or joint pain. IV facts Preparation: For direct injection, dilute 2 mL (solution contains 10 mg/mL) with 0.9% sodium chloride injection, water for injection, 5% or 10% dextrose injection, lactated Ringers injection, or 5% sodium bicarbonate injection to a total volume of 510 mL. For infusion, 2 mL diluted with 100 mL 5% dextrose solution or other IVs. Stable for 48 hr at room temperature, 14 days if refrigerated.

Infusion: Inject directly slowly, over not less than 2 min. Infuse felodipine over 1530 min; continuous infusion: 40 mg/24 hr. Plendil, Renedil (CAN) Adverse effects Drug classes CNS: Headache, malaise, dizziness, somnolence, Calcium channel-blocker insomnia Antihypertensive Dermatologic: Rash Therapeutic actionsDiarrhea, constipation, anorexia, abdominal GI:  pain Inhibits the movement of calcium ions across the membranes ofMuscle cramp, increase in total bilirubin, Other: cardiac and vascular smooth muscle cells; greater selectivity for vascular smooth muscle as sexual impotence compared to cardiac muscle; leads to arterial and coronary artery vasodilation and decreased peripheral Nursing considerations vascular resistance. Assessment  Calcium channelAllergy to work by blocking voltageHistory: blockers famotidine; renal failure; gated calcium channels (VGCCs) in cardiac muscle and lactation, pregnancy, hepatic impairment bloodPhysical: Skin lesions; liver evaluation, abdominal vessels. This decreases intracellular calcium leading to a reduction in muscle contraction. In the heart, examination, normal output; renal function tests, serum a decrease bilirubin in calcium available for each beat results in a decrease in cardiac contractility. In blood vessels, a decrease in calcium results in less contraction of the Interventions vascular smooth dose a day, administer drug increase in If using one muscle and therefore an hs. arterial diameter (CCB's do not failure. venous smooth Decrease doses with renal work on muscle), a phenomenon called vasodilation. Vasodilation Arrange for administration of concurrent antacid decreases relieve pain. therapy to total peripheral resistance, while a decrease in cardiac contractility for hospitalized patients not able to Reserve IV use decreases cardiac output. Since blood pressure is determined oral medication as and take oral medications; switch to by cardiac output soon peripheral resistance, blood pressure drops. as possible. Indications

 Essential hypertension, alone or in combination Take this drug with meals if upset stomach occurs; with other antihypertensives swallow and whole, do Contraindicationstabletcautions not cut, crush, or chew. Do not drink Contraindicatedwhile allergy to drug. grapefruit juice with using this felodipine or other You may experience these side effects: Nausea, calcium channel-blockers, sick sinus syndrome, heart vomiting (eat frequent small meals); block (second or third degree), lactation.headache (adjust lighting, noise, and with pregnancy, impaired may be Use cautiously temperature; medication hepatic ordered if function. severe). Report irregular heart beat, shortness of breath, Available forms swelling of the ER tablets2.5, 5, 10 mg hands or feet, pronounced dizziness, constipation. Metabolism: Hepatic; T1/2: 1116 hr Distribution: Crosses placenta; may enter breast milk Excretion: Urine Adverse effects CNS: Dizziness, light-headedness, headache, asthenia, fatigue, lethargy CV: Peripheral edema, arrhythmias Dermatologic: Flushing, rash GI: Nausea, abdominal discomfort, reflux, constipation Interactions Drug-drug Decreased serum levels with barbiturates, hydantoins, carbamazepine Increased serum levels and toxicity with erythromycin, cimetidine, ranitidine, antifungals Drug-food

Decreased metabolism and increased risk of toxic fenofibrate effects if taken with grapefruit juice; avoid this Antara, Lofibra, Tricor, Triglide combination Nursing considerations Drug class ALERT! CLINICAL Antihyperlipidemic drug Name confusion has occurred between Plendil (felodipine) and Isordil (isosorbide); use caution. Therapeutic actions Assessment  Inhibits triglyceride synthesis in the liver resulting in a History: Allergy to felodipine, impaired hepatic reduction sick sinus released intoheart block, may also function, in VLDL syndrome, circulation; lactation, stimulate the breakdown of triglyceride-rich lipoproteins. pregnancy  Fenofibrate is a Skin lesions, derivative whose lipid Physical: fibric acid color, edema; P, BP, modifyingECG, peripheral in humans are mediated via baseline effects reported perfusion, auscultation, R, activation of sounds; liverProliferator Activated Receptor adventitious Peroxisome evaluation, GI normal output; type alpha (PPAR ). Through activation of PPAR LFTs, urinalysis fenofibrate increases the lipolysis and elimination of atherogenic triglyceride-rich particles from plasma by Interventions activating lipoprotein lipasetabletreducing production or Have patient swallow and whole; do not chew of apoprotein CIII. Activation of PPAR also induces an crush. increase in the synthesis of apoproteins AI and AII, Monitor patient carefully (BP, cardiac rhythm and which leads to a reduction in very low therapeuticdensity output) while drug is being adjusted to - and low dose. fractions (VLDL and LDL) containingregularly during Monitor cardiac rhythm apoprotein B and an increase of dosagehigh periodically during long-term stabilization in the and density lipoprotein fraction (HDL) containing apoprotein AI and AII. In addition, therapy. through modulation of the synthesis to meals. Administer drug without regard and catabolism of VLDL fractions, fenofibrate increases the LDL clearance Teaching and reduces small and dense LDL, the levels of which points are elevated in the atherogenic lipoprotein phenotype, a

common disorder in patients at risk for coronary heart bowel disease sounds, normal output, liver evaluation; lipid studies, CBC, LFTs, renal function tests, urinalysis Indications Interventions Adjunct to diet in treating adults with primary Differentiate between brand names used; dosage hypercholesterolemia or mixed dyslipidemia varies. Adjunct to diet for treatment of adults with Administer drug hypertriglyceridemia with meals. Monitor patient carefully. Unlabeled use: Hyperuricemia Ensure that patient continues strict dietary Contraindications and cautions restrictions and exercise program. to fenofibrate, hepatic Contraindicated with allergy Arrange for regular follow-up including cirrhosis, or severe renal dysfunction, primary biliaryblood tests for bladder disease, pregnancy. gall lipids, liver function, and CBC during long-term therapy. cautiously with lactation and in the elderly. Use Give frequent skin care to deal with rashes and Available forms dryness. Tablets48, 50, 145, 160 mg; capsules43, 67, 87, 130, 134, Monitor patient for muscle weakness, aches, 200 mg especially if patient takes Tricor in combination with other cholesterol 20 hr Metabolism: Hepatic; T1/2:lowering drugs. Teaching points Distribution: Crosses placenta; enters breast milk Take Excretion: Urine the drug with meals. Adverse effects Continue to follow strict dietary regimen and exercise program. CV: Angina, arrhythmias, swelling, phlebitis, Arrange to thrombophlebitis have regular follow-up visits to your healthDermatologic:which will include blood tests. and care provider, Rash, alopecia, dry skin, dry brittleYou may experience these side effects: Diarrhea, hair, pruritus, urticaria loss of GI: Nausea, vomiting, diarrhea, bathroom if appetite (ensure ready access to the dyspepsia, this occurs; bloating, small meals may help).pancreatitis, flatulence, frequent stomatitis, gastritis, pepticReport GI hemorrhage ulcer, chest pain, shortness of breath, palpitations, myalgia, malaise, excessive fatigue, fever.

GU: Impotence, decreased libido, dysuria, Fentanyl hematuria, proteinuria, decreased urine output Actiq; Duragesic 25, 50, 75, 100; Sublimaze anemia, eosinophilia, Hematologic: Leukopenia, increased AST and ALT, increased CPK Drug class Other: Myalgia, flulike syndromes, arthralgia, Opioid agonist analgesic weight gain, polyphagia, increased perspiration, systemic Therapeutic actions lupus erythematosus, blurred vision, gynecomastia Acts at specific opioid receptors, causing analgesia, respiratory Interactions depression, physical depression, euphoria. Drug-drug Indications Increased bleeding tendencies if oral anticoagulants Analgesic are given with action of short duration during fenofibrate; reduce dosage of anesthesia and immediate postoperative period anticoagulant Analgesic supplement in general or regional Possible rhabdomyolysis, acute renal failure if anesthesia any statins; avoid this combination given with Administration with a neuroleptic as an anesthetic Decreased absorption and effectiveness if given premedication, for induction administer at least as an with bile acid sequestrants; of anesthesia, and 1 hr adjunctor 46 hr after these drugs general and regional before in maintenance of anesthesia Increased risk of renal toxicity if combined with For use as an anesthetic agent with oxygen in immunosuppressants or other nephrotoxic drugs; use selectedand monitor patient carefully caution high-risk patients Transdermal system: Management of chronic pain Nursing considerations in Assessment patients requiring opioid analgesia over an extended period of time whoAllergy beto fenofibrate, hepatic cannot managed by other means History: and who are already receiving opioid therapy dysfunction, primary biliary cirrhosis, gall bladder Actiq: Treatment impairment, lactation disease, pregnancy, renalof breakthrough pain in cancer patientsPhysical: Skin lesions, color,opioidsP, BP, being treated with and tolerant to T; Contraindications and cautions auscultation, baseline ECG, peripheral perfusion, edema;

 Contraindicated with hypersensitivity to opioids, Do not administer an MAOI bronchial asthma, diarrhea caused by poisoning, acute within 14 days of fentanyl (increased CNS pregnancy. upper airway obstruction,effects) Increased risk of with bradycardia, history of Use cautiously adverse effects and toxicity if combined with alcohol seizures, lactation, renal dysfunction; history of drug Drug-food addiction. Decreased metabolism and risk of toxic effects if Available forms taken with grapefruit juice; avoid 800, 1,200, 1,600 Lozenge on a stick (Actiq)200, 400, 600, this combination mcg; Drug-lab test transdermal12.5, 25, 50, 75, 100 mcg/hr; injection50 mcg/mL Elevated 1.56 tract Metabolism: Liver; T1/2: biliary hr pressure may cause increases in plasma amylase, lipase; enter breast milk Distribution: Crosses placenta; may determinations of these levels may be unreliable for 24 hr after administration of Excretion: Unknown IV facts opioids Preparation: May be used undiluted or diluted with 250 mL of Nursing considerations light. D5W. Protect vials from CLINICAL ALERT! slowly by direct injection, each milliliter Infusion: Administer Name least 1 min, or into running IV fentanyl over atconfusion has occurred betweentubing. and sufentanil; use extreme caution. Do not mix with methohexital, pentobarbital, Incompatibilities: Assessment thiopental. Adverse effectsHistory: Hypersensitivity to fentanyl or opioids, physical dependence on an opioid analgesic, pregnancy, CNS: Sedation, clamminess, sweating, headache, labor, lactation, COPD, respiratory lethargy, confusion, vertigo, floating feeling, dizziness, depression, anoxia, increased intracranial pressure, acute MI, ventricular light-headedness, nervousness, unusual dreams, failure, coronary insufficiency, hypertension, biliary tract agitation, euphoria, hallucinations, delirium, insomnia, surgery, renal or disorientation, impaired mental and anxiety, fear, hepatic dysfunction Physical: Orientation, reflexes, bilateral grip physical performance, coma, mood changes, weakness, strength, affect; pupil size, vision; P, auscultation, BP; R, headache, tremor, seizures adventitious sounds; bowel sounds, normal output; LFTs, renal function tests

CV: Palpitation, increase or decrease in BP, Interventions circulatory depression, cardiac arrest, shock, Administer to women who are palpitations tachycardia, bradycardia, arrhythmia, nursing a baby 46 hr before the next scheduled hives, pruritus, flushing, Dermatologic: Rash, feeding to minimize the amount in milk. warmth, sensitivity to cold WARNING: Keep opioid antagonist and facilities EENT: Diplopia, blurred vision for assisted Nausea, vomiting, dry mouth, anorexia, GI: or controlled respiration readily available during parenteral administration. constipation, biliary tract spasm Prepare site for transdermal form by clipping (not GU: Ureteral spasm, spasm of vesical sphincters, shaving) retention site; hesitancy, oliguria, oils, lotions, urinary hair at or do not use soap, antidiuretic alcohol; allow skin toor potency effect, reduced libido dry completely before application. ApplyLocal: Phlebitis following IV injection, pain at immediately after removal from the sealed package; firmly press the transdermal and induration system in place injection site; tissue irritation with the palm of the hand for 1020 sec, making sure the (subcutaneous injection) contact is complete. Must be worn continually forapnea, Respiratory: Slow, shallow respiration, 72 hr. Do not use anyof system that has been torn or damaged. suppression cough reflex, laryngospasm, Remove old patch before applying a new one. bronchospasm Note that the patch does not work quickly. It may Other: Physical tolerance and dependence, take up to 12dependence; the fullskin irritationeffect. therapeutic with psychological hr to get local Breakthrough medications need to be used. transdermal system Interactions Do not use Actiq in patients who never received opioids before; should be used only in opioid tolerant Drug-drug patients. Potentiation of effects when given with other CNS actingUse caution with Actiq form to keep this drug out drugs or barbiturate anesthetics; decrease dose of of the reach of children (it looks like a lollipop) and fentanyl when coadministering follow the distribution restrictionsoccur when given drug Potentiation of effects may in place with this with very carefully. macrolide antibiotics, ketoconazole, itraconazole, and Teaching protease inhibitors points Do not drink grapefruit juice while using this drug.

 You may experience these side effects: Dizziness, Drug-drug sedation, drowsiness, impaired visual acuity (ask for Increased levels and nausea, toxicity with assistance if you need to move);possible loss of appetite ketoconazole, erythromycin; fexofenadine dose may (lie quietly, eat frequent small meals); constipation (a need to be decreased laxative may help). Decreasedsevere when taken with antacids Report effects nausea, vomiting, palpitations, Nursing considerations shortness of breath, or difficulty breathing. Assessment History: Allergy to any antihistamines, renal impairment, pregnancy, lactation Physical: Mucous membranes, oropharynx, R, adventitious sounds; skin color, lesions; orientation, affect; renal function tests Interventions Arrange for use of humidifier if thickening of secretions, nasal dryness become bothersome; encourage adequate intake of fluids. Provide supportive care if flulike symptoms occur. Teaching points Avoid excessive dosage; take only the dosage prescribed. Do not take at the same time as antacids. You may experience these side effects: Dizziness, sedation, drowsiness (use caution if driving or performing tasks that require alertness); thickening of bronchial secretions, dryness of nasal mucosa (use of a humidifier may help); menstrual irregularities; flulike symptoms (medication may be helpful). Report difficulty breathing, severe nausea, fever.

fexofenadine hydrochloride finasteride Allegra Propecia, Proscar Drug class Antihistamine (nonsedating type) Drug class actions Therapeutic Androgen hormone inhibitor Competitively blocks the effects of histamine at peripheral H1receptor sites; has no anticholinergic (atropine-like) or sedating Therapeutic actions effects. Inhibits the Indications intracellular enzyme that converts testosterone into a potent androgenSymptomatic relief of symptoms associatedin the (DHT); does not affect androgen receptors with body; the seasonal gland depends on DHT for its development and prostate allergic rhinitis in adults and children > 6 yr maintenance. Chronic idiopathic urticaria in adults and children Indications 6 yr > Proscar: Treatment of symptomatic BPH; most Contraindications and cautions effective with long-term allergy to any antihistamines, Contraindicated with use; reduces the need for prostate surgery and reduces the risk of urinary retention; pregnancy, lactation. with doxazosin, to reduce hepatic or renal impairment, in Use cautiously with the risk of progression of BPH symptoms geriatric patients. Propecia: Prevention of male pattern baldness in Available forms patients with family history or early Tablets30, 60, 180 mg; capsules60 mg signs of loss Unlabeled : 14.4 hr Metabolism: Hepatic; T1/2uses: Adjuvant monotherapy following radical prostatectomy; prevention of milk Distribution: Crosses placenta; may enter breastthe progression of first-stage prostate cancer; hirsutism; male chronic pelvic Excretion: Feces, urine pain syndrome Adverse effects Contraindications and cautions CNS: Fatigue, drowsiness Contraindicated with GI: Nausea, dyspepsiaallergy to finasteride or any component ofDysmenorrhea, flulike illnes Other: the product, pregnancy, lactation. Interactions Use cautiously with hepatic impairment.

Available forms fluconazole Tablets1 mg (Propecia), 5 mg (Proscar) Diflucan Metabolism: Hepatic; T1/2: 6 hr Distribution: Crosses placenta; may enter breast milk (not used in Drug class women) Antifungal Feces, urine Excretion: Therapeutic actions Adverse effects  BindsGI: sterols in the fungal cell membrane, changing to Abdominal upset membrane permeability; decreased libido, fungistatic fungicidal or decreased GU: Impotence, depending ejaculation volume of on concentration and organism.  Like Other: imidazole- and triazole-class antifungals, other Gynecomastia fluconazole inhibits the fungal cytochrome P450 enzyme Interactions 14 Drug-lab test -demethylase. Mammalian demethylase activity is much less PSA levels when measured; false decrease Decreased sensitive to fluconazole than fungal demethylase. This inhibition of risk of prostate cancer of does not mean patient is free prevents the conversion lanosterol to Nursing considerations ergosterol, an essential component of the fungal cytoplasmic membrane, and subsequent Assessment accumulation of 14 -methyl sterols. any component, History: Allergy to finasteride or Fluconazole is primarily fungistatic, however may be fungicidal against hepatic impairment, pregnancy, lactation certain Physical: organisms in a dose-dependent abdominal manner. Liver evaluation, Interestingly, renal function tests, normal urine output, examination; when fluconazole was in development at Pfizer itexamination prostate was decided early in the process to avoid producing any chiral centers in the drug so that subsequent synthesis and purification did not encounter Interventions difficulties with enantiomerisseparation and associated Confirm that problem BPH, and other disorders variationscancer, infection,effect. A number ofbladder) (prostate in biological strictures, hypotonic related compounds were found to be extremely potent teratogens have been ruled out. and subsequently discarded. Indications

Administer without regard to meals; protect Treatment of container from light.oropharyngeal, esophageal, vaginal, and systemic candidiasis follow-up, including prostate Arrange for regular Treatment of cryptococcal meningitis examination, PSA levels, and evaluation of urine flow. Prophylaxis flow and output; increase marrow Monitor urine of candidiasis in bone in urine transplants occur in all situations. flow may not WARNING: Do not allow pregnant women to handle Contraindications and cautions because of risk of inadvertent crushed or broken tablets Contraindicated with hypersensitivity to absorption, adversely affecting the fetus. fluconazole,patient that libido may be decreased as well Alert lactation. theUse cautiously with renal or hepatic impairment.the as volume of ejaculate; usually reversible when Availabledrug is stopped. forms Tablets50, 100, 150, 200 mg; powder for oral suspension10, Teaching points 40 mg/mL; injection2 mg/mL Take this drug once a day without regard to meals; protect from light. Metabolism: Hepatic;regular medical follow-up to evaluate your Have T1/2: 30 hr Distribution: Crosses placenta; may enter breastwill monitor your response. Your health care provider milk Excretion: Urine kidney function as well as prostate-specific liver and antigen (PSA) levels. IV facts This drug has serious adverse effects on unborn Preparation: Do Do not allow a pregnant woman for handle the babies. not remove overwrap until ready to use. Inner bag maintains sterility crushed or broken. use plastic containers in tablet if it is of product. Do not series connections. Tear overwrap down side at slit, and Loss of You may experience these side effects: remove solution container.impotence, decreased amount of check for libido, Some opacity of plastic may occur; ejaculate minute leaks, squeezing bag firmly. the drugsolution if anybreast (usually reversible when Discard is stopped); leaks are found.enlargement, tenderness. Infusion: Infuse at a inability to rate of groin mg/hr sore throat, Report maximum void, 200 pain, given as a continuous infusion. fever, weakness. Incompatibilities: Do not add any supplementary medications.

Adverse effects folic acid (folate) CNS: Headache Folvite GI: Nausea, vomiting, diarrhea, abdominal pain; AST/ALT elevations Drug class Other: Rash Folic acid Interactions Vitamin supplement Drug-drug Therapeutic actions Increased serum levels and therefore therapeutic Required and nucleoprotein synthesis and maintenence phenytoin, for toxic effects of cyclosporine, of normal erythropoiesis. benzodiazepines, oral hypoglycemics, warfarin Indications anticoagulants, zidovudine Treatment of megoblastic anemias due rifampin, Decreased serum levels with to sprue, nutritional deficiency, pregnancy, infancy, and childhood theophylline, tacrolimus Contraindications and cautions Contraindicated with allergy to folic acid Nursing considerations preparations; pernicious, aplastic, normocytic anemias. Assessment Use cautiously during lactation. fluconazole, renal History: Hypersensitivity to Availableimpairment, lactation, pregnancy forms Tablets0.4, 0.8, 1 mg; injection5 mg/mL Physical: Skin color, lesions; T; injection site; Dosages orientation, reflexes, affect; bowel sounds; LFTs, renal Administer orallytests; CBC patient has severe intestinal unless and differential; culture of area function malabsorption. involved Metabolism: Hepatic; T1/2: Unknown Interventions Distribution: Crosses placenta; enters breast milk begin treatment Culture infection before therapy; Excretion: Urine results are returned. before lab IV facts Decrease dosage in cases of renal failure. Preparation: Solution is IV only; yellow-orange; may be added Infuse yellow to not intended for IM or to hyperalimentation solution or dextrose solutions. subcutaneous use.

Do not add supplement medication to fluconazole. Infusion: Infuse at rate of 5 mg/min by direct IV equipment may be Administer through sterile injection; at a diluted in maximum rate offor continuous infusion. a continuous hyperalimentation 200 mg/hr given as infusion. Adverse effectsWARNING: Monitor renal function tests weekly, Hypersensitivity: dosage of drug discontinue or decrease Allergic reactions at any sign of Local: Pain and discomfort LFTs monthly increased renal toxicity. Monitorat injection site during Interactions therapy. Drug-drug Teaching points Decrease be given phenytoin as increase in Drug may in serum orally or IVand needed. The seizure activity to be taken for the full course and may drug will need with folic acid preparations Decreased absorption with sulfasalazine, need to be taken long term. aminosalicyclic acid measures to prevent reinfection or Use hygiene spread of infection. Nursing considerations for frequent follow-up while you are Arrange CLINICAL ALERT! drug. Be sure to keep all appointments, taking this Name confusion those for blood tests. between folinic acid including has been reported (leucovorin) andYou may experience these side effects: Nausea, folic acid; use extreme caution. Assessment vomiting, diarrhea (frequent small meals may help); History: Allergy to folic headache (analgesics may be ordered).acid preparations; pernicious, aplastic, normocytic anemias;or urine color, Report rash, changes in stool lactation Physical: Skin lesions, color; R, adventitious difficulty breathing, increased tears or salivation. sounds; CBC, Hgb, Hct, serum folate levels, serum vitamin B12 levels, Schilling test Interventions Administer orally if at all possible. With severe GI malabsorption or very severe disease, give IM, IV, or subcutaneously.

 Test using Schilling test and serum vitamin B12 levels Prevention pernicious anemia. Therapy may mask to rule out of exercise-induced bronchospasm in adults of pernicious yr when used the neurologic signs and children > 12anemia while on an occasional, as-needed basis deterioration continues. Long-term maintenance treatment of WARNING: Use caution when giving the bronchoconstriction in patients with COPD parenteral preparations to premature infants. These Contraindications and cautions preparations contain benzyl alcohol and may produce a Contraindicated with hypersensitivity to fatal gasping syndrome in premature infants. adrenergics, amines, or to patient for hypersensitivity WARNING: Monitor formoterol, acute asthma attack, acute airway obstruction.previously taken. Keep reactions, especially if drug Use equipment and elderly, with pregnancy, supportive cautiously in the emergency drugs readily lactation. in case of serious allergic response. available Availablepoints Teaching forms Inhalation powder in capsules12 megaloblastic anemia is treated When the cause of mcg Metabolism: Hepatic; T1/2: 1014 hr or passes (infancy, pregnancy), there may be no need for Distribution: Crosses because it normally exists in sufficient folic acid placenta; may enter breast milk Excretion: Feces, urine diet. quantities in the Adverse effects Report rash, difficulty breathing, pain or CNS: Tremor, dizziness, insomnia, dysphonia, discomfort at injection site. headache, nervousness CV: Hypertension, tachycardia, chest pain GI: Nausea, dyspepsia, abdominal pain, irritation of the throat and mouth Respiratory: Bronchitis, respiratory infection, dyspnea, tonsillitis Other: Viral infection (most likely in children) Nursing considerations CLINICAL ALERT!

formoterol fumarate Name Aerolizer Foradilconfusion has occurred between Foradil (formoterol) and Toradol (ketorolac); use extreme caution. Assessment Drug classes Beta2 agonist History: Hypersensitivity to adrenergics, amines, or Antasthmatic formoterol, acute asthma attack, acute airway obstruction, Therapeutic actions pregnancy, lactation Physical: R, that binds to beta2 receptors ECG,  Long-acting agonist adventitious sounds, P, BP, in the orientation, reflexes lungs causing bronchodilation; may also inhibit the release of inflammatory mediators in the lung, blocking Interventions swelling and inflammation. Instruct patient in the proper use of Aerolizer  Inhaled formoterol works like other 2-agonists, causing Inhaler. Ensure that patient smooth swallow bronchodilation by relaxing thedoes not muscle in the capsule. airway so as to treat the exacerbation of asthma. The Monitor of of inhaler. action occurs because long duration use formoterol Patient should not wash the inhaler but molecules initially diffuse not the plasma formoterol should keep it dry; it shouldinto be used for delivering of the lung cells, and then are slowly released membrane any other medication. If a bronchodilator is needed between doses, consult with into contact with 2 back outside, where they can come health care provider. Do not use more often than every has been demonstrated adrenergic receptors. Formoterol 12 hr. Encourage patient who than salmeterol as a to have a faster onset of action experiences exerciseinduced asthma to lipophilicity, and has also and result of lower use drug 15 min before activity,been to reserve this to be more potent - a 12 use. demonstrated drug for occasional, as-neededg dose of Ensure that patient continues with equivalent use formoterol has been demonstrated to be appropriate to a of corticosteroids or 50 g dose of salmeterol. other drugs used to block bronchospasm, as appropriate. Indications Arrange for periodic treatment of asthma in Long-term maintenanceevaluation of respiratory condition children > 5 yr adults andduring therapy. Arrange for analgesics as appropriate for headache.

 Establish safety precautions if tremor becomes a Metabolism: Hepatic; T1/2: 12 hr problem. Distribution: Crosses placenta; enters breast milk Teaching points Excretion: Feces, urine]Aerolizer Inhaler as instructed. This is the Use the Adverse effects only inhaler that can be used with this drug. CV: Angina pectoris, Do not wash the inhaler; Use only twice a day. orthostatic hypotension in salt- or dry at all times. Do not use this inhaler to deliver keep it volume-depleted patients, palpitations Dermatologic: Rash, by" date diaphoresis, any other drugs. Check the "use pruritus, on your drug flushing and discard any capsules that have expired. GI:drug is to be used pain, vomiting, diarrhea If Nausea, abdominal periodically for exercise Respiratory: 15 minutes before activity. induced asthma, use Cough, asthma, bronchitis, dyspnea, sinusitis Arrange for periodic evaluation of your respiratory Other: Angioedema, asthenia, myalgia, any other problem while using this drug; continue to usearthralgia, hyperkalemia have been prescribed to control your therapies that Interactions asthma. Drug-drug You may experience these side effects: Headache Decreased effectiveness if combined (use (appropriate analgesics may be ordered); tremors with indomethacin or other NSAIDs tasks if this occurs); fast care in performing dangerous Risk of lithium (monitor combined with ACE heartbeat, palpitations toxicity ifactivity if this occurs, inhibitors rest frequently). Risk of increased headache, levels if taken with Report severe potassium irregular heartbeat, potassium-sparing diuretics worsening of asthma, difficulty breathing. Decreased absorption when given with antacids; separate by at least 2 hr. Nursing considerations CLINICAL ALERT! Name confusion has occurred between fosinopril and lisinopril; use caution.

fosinopril sodium Assessment Monopril History: Allergy to fosinopril and other ACE inhibitors, impaired renal or hepatic function, Drug classes hyperkalemia, salt or volume depletion, lactation, Antihypertensive pregnancy ACE inhibitor Physical: Skin color, lesions, turgor; T; P, BP, peripheral Therapeutic actionsperfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, LFTs, renal function tests, Renin, synthesized by the kidneys, is released into the circulation CBC, a plasma precursor to produce angiotensin I, which where it acts on and differential Interventionsby ACE to angiotensin II, a potent vasoconstrictor that is converted WARNING: Alert surgeon adrenals; patient's also causes release of aldosterone from the and markfosinopril blocks thechart with notice that fosinopril is being taken; the conversion of angiotensin I to angiotensin II, leading to decreasedangiotensin II formation subsequent toan increase in BP, decreased aldosterone secretion, compensatory renin serum potassium release and sodium and fluid loss; increased levels, during surgery will be blocked; hypotension may be reversed with volume expansion. prostaglandin synthesis may be involved in the antihypertensive Arrange to switch to a different drug if pregnancy action. occurs; suggest using barrier contraceptives. Indications Monitor patient closely for a fall in BP secondary Treatment of hypertension, alone or in combination to reduction in fluid volume (excessive perspiration and with thiazide-type diuretics dehydration, vomiting, diarrhea) because excessive Management of CHF as adjunctive therapy hypotension may occur. Contraindications and cautions Teaching pointsContraindicated with allergy to fosinopril or other Do not stop taking the medication without ACE inhibitors; pregnancy. consulting your prescriber. Use cautiously with impaired renal function, Avoid salt or volume depletion, this drug; hyperkalemia,pregnancy while taking lactation. using Availablebarrier contraceptives is advised. forms Be mg Tablets10, 20, 40careful in any situation that may lead to a drop in blood pressure (diarrhea, sweating, vomiting,

dehydration); if light-headedness or dizziness occurs, Contraindications and cautions consult your care provider. Contraindicated You may experience with side effects: GI upset, these hypersensitivity to gabapentin. loss of appetite (these may be transient); light Use cautiously with pregnancy, lactation. headedness (transient; change position slowly and limit Availableactivities to those that do not require alertness and forms Capsules100, 300, cough (not tablets600, 800 mg; oral precision); dry 400 mg; harmful). solution250 mg/5 mL mouth sores; sore throat, fever, chills; Report Metabolism: Hepatic; the : hands, feet; irregular heartbeat, chest swelling of T1/2 57 hr Distribution: Crosses placenta; enters eyes, lips, tongue, difficulty pains; swelling of the face, breast milk Excretion: Urine, unchanged cough. breathing, persistent Adverse effects CNS: Dizziness, insomnia, nervousness, fatigue, somnolence, ataxia, diplopia, tremor Dermatologic: Pruritus, abrasion GI: Dyspepsia, vomiting, nausea, constipation, dry mouth Respiratory: Rhinitis, pharyngitis Other: Weight gain, facial edema, cancer, impotence Interactions Drug-drug Decreased serum levels with antacids Drug-lab test False positives may occur with Ames N-Multistix SG dipstick test for protein in the urine Nursing considerations Assessment

gabapentin History: Hypersensitivity to gabapentin; lactation, Neurontin pregnancy Physical: Weight; T; skin color, lesions; Drug class orientation, affect, reflexes; P; R, adventitious sounds; Antiepileptic bowel sounds, normal output Therapeutic actions Interventions  Mechanism of action not understood; antiepileptic Give drug with food to to its ability activity may be related prevent GI upset. to inhibit Arrange responses and support groups for polysynaptic for consultation with block posttetanic people with potentiation.epilepsy. WARNING: If overdose occurs, hemodialysis  Its exact mechanism of action is unknown, but its may be an action therapeuticoption. on neuropathic pain is thought to Teaching involve voltage-gated N-type calcium ion channels. It is points Take this drug 2 subunit (1 and 2) of the thought to bind to the exactly as prescribed; do not discontinue abruptly or change dosage, the central voltage-dependent calcium channel inexcept on the advice of your nervous systemhealth care provider. Wear a medical alert ID at all times so that any Indications emergency medical personnel will treatment of partial Adjunctive therapy in the know that you have epilepsy with and without secondary generalization in seizures and are taking antiepileptic medication. adultsYou children 312 yr with epilepsy and may experience these side effects: Dizziness, blurred visiondrug use: Treatmentperforming otherlateral Orphan (avoid driving or of amyotrophic tasks requiring sclerosis alertness or visual acuity); GI upset (take drug with food or milk, eat postherpetic neuralgia or pain in Management of frequent small meals); headache, nervousness, insomnia; fatigue (periodic disease has the area affected by herpes zoster after therest periods may treated been help). Report severe headache, sleepwalking, rash, severe Unlabeled uses: Tremors of MS, neuropathic pain, vomiting, chills, migraine prophylaxis bipolar disorder, fever, difficulty breathing.

gemfibrozil Risk of rhabdomyolysis from 3 wk Lopid, NovoApo-Gemfibrozil (CAN), Gen-Gemfibrozil (CAN), to several mo after therapy when combined with HMG-CoA inhibitors Gemfibrozil (CAN) (eg lovastatin, simvastatin) Risk of increased bleeding when combined with Drug class anticoagulants; monitor patient closely Antihyperlipidemic Risk Therapeutic actions of hypoglycemia if combined with sulfonylureas and repaglinide; monitor closely  Inhibits peripheral lipolysis and decreases the hepatic Nursing considerations free fatty acids; this reduces hepatic excretion of Assessment triglyceride production; inhibits synthesis of VLDL History: Allergy decreases VLDL production; carrier apolipoprotein; to gemfibrozil, hepatic or renal dysfunction, concentration. increases HDLprimary biliary cirrhosis, gallbladder disease, pregnancy, lactation  Increases activity of Peroxisome proliferator-activated Physical: Skin ) 'transcription factor range a receptor-alpha (PPAR lesions, color, T; gait,ligand' , of motion; orientation, affect, reflexes; bowel sounds, receptor that is involved in metabolism of carbohydrates normal as well as evaluation; differentiation. This and fats,output, liveradipose tissue lipid studies, CBC, LFTs, renal the synthesis of lipoprotein increase in function tests, blood glucose lipase thereby Interventions increases the clearance of triglycerides. Administer drug with meals or milk if GI upset Indications occurs. Hypertriglyceridemia in adult patients with very Arrange of regular follow-up visits, including high elevations for triglyceride levels (type IV and V blood tests for lipids, liver pancreatitis unresponsive to hyperlipidemia) at risk of function, CBC, blood glucose during long-term therapy. diet therapy Teaching pointsReduction of coronary heart disease risk in patients Take not responded to diet, exercise, and other who have the drug with meals or with milk if GI upset occurs; changes low HDL be needed. agents and have in diet willlevels in addition to high LDL Have regular follow-up visits to your doctor for and triglyceride levels blood tests to evaluate drug effectiveness.

Contraindications and cautions You may experience these side effects: Diarrhea, Contraindicated with allergy to gemfibrozil, loss of or renal flatulence (eat frequent small meals); hepatic appetite, dysfunction, primary biliary cirrhosis, muscular aches and gallbladder disease. pains, bone and joint discomfort; dizziness, faintness, blurred visionpregnancy, if driving Use cautiously with (use caution lactation, or operating and renal equipment). cholethiasis, dangerousimpairment. Available formsReport severe stomach pain with nausea and vomiting, fever and chills or sore throat, severe Tablets600 mg headache, vision 90 min Metabolism: Hepatic; T1/2:changes. Distribution: Crosses placenta; enters breast milk Excretion: Feces, urine Adverse effects CNS: Headache, dizziness, blurred vision, vertigo, insomnia, paresthesia, tinnitus, fatigue, malaise, syncope Dermatologic: Eczema, rash, dermatitis, pruritus, urticaria GI: Abdominal pain, epigastric pain, diarrhea, nausea, vomiting, flatulence, dry mouth, constipation, anorexia, dyspepsia, cholelithiasis, elevated ALT and AST GU: Impairment of fertility Hematologic: Anemia, eosinophilia, leukopenia, hypokalemia, liver function changes, hyperglycemia Other: Painful extremities, back pain, arthralgia, muscle cramps, myalgia, swollen joints Interactions Drug-drug

gentamicin sulfate parkinsonism; Parenteral, intrathecal: infant botulism; burn patients; lactation; pregnancy. Alcomicin (CAN), Garamycin, Pediatric Gentamicin Sulfate Available forms Topical dermatologic cream, ointment: Injection10, 40 mg/mL; ophthalmic solution3 mg/mL; Garamycin ophthalmic Ophthalmic: ointment3 mg/g; topical ointment0.1%; topical cream0.1%; ointment1 mg; Genoptic, Genoptic S.O.P. Garamycin, Gentacidin, Gentak, cream1 mg Metabolism: Hepatic; T PMMA beads: Gentamicin impregnated1/2: 23 hr Distribution: Crosses placenta; enters breast milk Septopal Excretion: Liposome injection: Gentamicin Urine IV facts Maitec Preparation: Dilute single dose in 50200 mL of sterile isotonic saline or D Drug class5W. Do not mix in solution with any other drugs. Infusion: Infuse Aminoglycoside over 30120 min. Adverse effects Therapeutic actions CNS: Ototoxicitytinnitus, dizziness, vertigo, Bactericidal: Inhibits protein synthesis in susceptible strains of deafness (partially reversible to functional integrity of gram-negative bacteria; appears to disrupt irreversible), vestibular paralysis, confusion, disorientation, bacterial cell membrane, causing cell death. depression, lethargy, nystagmus, visual disturbances, headache, numbness, Indications Parenteraltingling, tremor, paresthesias, muscle twitching, seizures, muscular weakness, neuromuscular susceptible strains of Serious infections caused by blockade CV: Palpitations, hypotension, hypertension Pseudomonas aeruginosa, Proteus species, Escherichia Hepatic toxicity, nausea, vomiting, anorexia, coli, GI: Klebsiella-Enterobacter-Serratia species, weight loss, Staphylococcus species Citrobacter, stomatitis, increased salivation GU: Nephrotoxicity Serious infections when causative organisms are Leukemoid reaction, not knownHematologic: (often in conjunction with a penicillin or agranulocytosis, granulocytosis, leukopenia, cephalosporin) leukocytosis, thrombocytopenia, eosinophilia,

Unlabeled use: With clindamycin as alternative pancytopenia, regimen in PIDanemia, hemolytic anemia, increased or decreased reticulocyte count, electrolyte disturbances Intrathecal Hypersensitivity: Purpura, rash, urticaria, Gram-negative infections exfoliative dermatitis, itching Serious CNS infections, such as meningitis, Local: infections caused by susceptible ventriculitis, Pain, irritation, arachnoiditis at IM injection sites Pseudomonas species Other: Ophthalmic preparations Fever, apnea, splenomegaly, joint pain, superinfections of superficial ocular infections due to Treatment Ophthalmic preparations strains of microorganisms susceptible to gentamicin Local: Transient Topical dermatologic preparation irritation, burning, stinging, itching, angioneurotic edema, minor skin vesicular and Infection prophylaxis in urticaria, abrasions maculopapular dermatitis treatment of superficial infections of the skin due to Topical dermatologic organisms amenable to local treatment susceptible preparations Local: Photosensitization, surgical wire Gentamicin-impregnated PMAA beads on superinfections Interactions Orphan drug use: Treatment of chronic Drug-drug osteomyelitis of posttraumatic, postoperative, or Increased ototoxic, nephrotoxic, neurotoxic effects hematogenous origin with other aminoglycosides, cephalothin, potent Gentamicin liposome injection diuretics, cephalosporins, vancomycin, of disseminated Orphan drug use: Treatment methoxyflurane, enflurane Myobacterium avium-intracellulare infection Increased neuromuscular blockade and muscular Contraindications and cautions paralysis Contraindicated with anesthetics, allergy to nondepolarizing with any neuromuscular blocking drugs, succinylcholine, citrateaminoglycosides. anticoagulated blood with renal or hepatic disease; Use cautiously Potential inactivation of both drugs mixed with preexisting hearing loss; active infectionifwith herpes, beta-lactamtype (space myobacterial vaccinia, varicella,antibiotics infections, doses with fungal concomitant therapy) infections (ophthalmic preparations); myasthenia gravis;

 Increased bactericidal effect with penicillins, Amaryl cephalosporins (to treat some gram-negative organisms and enterococci), carbenicillin, ticarcillin (to treat Drug classes Pseudomonas infections) Antidiabetic Nursing considerations Sulfonylurea Assessment (second generation) History: Allergy to any aminoglycosides; renal or Therapeutic actions hepatic disease; preexisting hearing loss; active infection  with herpes, vaccinia, from functioning beta cells in Stimulates insulin release varicella, fungal infections, the pancreas; infections (ophthalmic preparations); myobacterial may improve binding between insulin and insulin receptors or parkinsonism; infant botulism; myasthenia gravis; increase the number of insulin receptors; thought to lactation, pregnancy be more potent in effect than firstgeneration sulfonylureas. infection; skin color, lesions; Physical: Site of  Glimepiride reflexes, eighth cranial nerve function; the orientation, binds with Sulfonylurea receptor on P, surface of adventitious pancreas. --> Blocks the K+ ion BP; R, Beta islet of sounds; bowel sounds, liver channels -->urinalysis, BUN,depolarization --> Voltage evaluation; Cell undergoes serum creatinine, serum dependent Ca++ ion channels open up --> Ca++ influx electrolytes, LFTs, CBC takes Interventions place --> Insulin sacs release insulin from beta islets Give by IM route if at all possible; give by deep IM of pancreas. Indications injection. As an infected area before therapy. Culture adjunct to diet to lower blood glucose in patients with mg/mL (noninsulin-dependent) diabetes Use 2 type 2 intrathecal preparation without mellitus whose hypoglycemia cannot be controlled by preservatives, for intrathecal use. diet and exercise alone therapies because of increased Avoid long-term In combination with metformin may be to better risk of toxicities. Reduction in dose or insulinclinically control glucose as an adjunct to diet and exercise in indicated. patients with type 2 diabetes mellitus Contraindications and cautions

Patients with edema or ascites may have lower Contraindicated to allergy to sulfonylureas; peak concentrations duewithexpanded extracellular fluid diabetes complicated by fever, severe infections, severe volume. trauma, major surgery, ketosis, acidosis, of dermatologic Cleanse area before application coma (insulin is indicated in these conditions); type 1 (insulin-dependent) preparations. diabetes, serious hepatic or renalof patient before and Ensure adequate hydration impairment, uremia, thyroidtherapy. endocrine impairment, or glycosuria, during hyperglycemia associated with primary renal disease; WARNING: Monitor renal function tests, CBCs, labor and deliveryif glimepiride therapy. Consult serum drug levels during long-term is used during pregnancy, discontinue dosage. at least 1 mo before with prescriber to adjust drug Teaching delivery; lactation, safety not established. points Use ophthalmic preparations by tilting head back; place Applycautiously with pregnancy. Availablemedications into conjunctival sac and close eye; apply light forms pressure on Tablets1, 2, 4 mg lacrimal sac for 1 minute. Cleanse area before applying dermatologic preparations; area may be covered if Metabolism: Hepatic; T1/2: 5.57 hr necessary. Distribution: Crosses placenta; enters breast milk You may experience these side effects: Ringing in the Excretion: Bile, urine dizziness (reversible; use safety measures if ears, headache, Adverse effectsperform frequent mouth care); burning, blurring of vision meals, CNS: Drowsiness, asthenia, driving or performing with ophthalmic preparations (avoid nervousness, tremor, dangerous insomnia activities if visual effects occur); photosensitization with dermatologic preparations (wear sunscreen andmortality CV: Increased risk of cardiovascular protective clothing). (possible) Report pain at injection SIADH Endocrine: Hypoglycemia, site, severe headache, dizziness, loss of hearing, changes in urine pattern, GI: Anorexia, nausea, vomiting, epigastric difficulty heartburn, diarrhea discomfort,breathing, rash or skin lesions; itching or irritation (ophthalmic preparations); thrombocytopenia, Hematologic: Leukopenia, worsening of the condition, anemia rash, irritation (dermatologic preparation). glimepiride
severe); nausea, vomiting, loss of appetite (eat frequent small

 Hypersensitivity: Allergic skin reactions, eczema, symptoms erythema, urticaria, photosensitivity, fever, of hypoglycemia and hyperglycemia, pruritus, avoidance of infection, hygiene. eosinophilia, jaundice Teaching pointsOther: Diuresis, tinnitus, fatigue, weight gain Interactions Take this drug once a day with breakfast or the first main meal of the day. Drug-drug Do not discontinue this drug without androgens, Increased risk of hypoglycemia with consulting your health care provider; continuechloramphenicol, with diet and anticoagulants, azole antifungals, exercise program for diabetes control. gemfibrozil, H2 clofibrate, fenfluramine, fluconazole, Monitor urine or salts, MAOIs, methyldopa, blockers, magnesium blood for glucose and ketones as prescribed. oxyphenbutazone, phenylbutazone, probenecid, Do not use this drug if you are pregnant. salicylates, sulfinpyrazone, sulfonamides, TCAs, urinary Avoid acidifiers alcohol while using this drug. Report fever, sore throat, unusual bleeding or Decreased effectiveness of both glimepiride and bruising, ifrash, concurrently diazoxide taken dark urine, light-colored stools, hypoglycemic or risk of hyperglycemia with rifampin, Increased hyperglycemic reactions. thiazides Risk of hypoglycemia and hyperglycemia with ethanol; "disulfiram reaction" has also been reported Possible decreased hypoglycemic effect with beta blockers, calcium channel blockers, cholestyramine, corticosteroids, diazoxide, estrogens, hydantoins, hormonal contraceptives, isoniazid, nicotinic acid, phenothiazines, rifampin, sympathomimetics, thiazide diuretics, thyroid agents, urinary alkalinizers Drug-alternative therapy

Increased risk of hypoglycemia if taken with glipizide juniper berries, ginseng, garlic, fenugreek, coriander, Glucotrol,dandelion root, celery Glucotrol XL Nursing considerations Drug classes Assessment Antidiabetic History: Allergy to sulfonylureas; diabetes Sulfonylurea (second generation) severe infections, severe trauma, complicated by fever, major surgery, ketosis, acidosis, coma (insulin is Therapeutic actions these conditions); type 1 diabetes, serious indicated in  Stimulates insulin release from functioning beta cells or hepatic or renal impairment, uremia, thyroid in the pancreas;impairment, glycosuria, hyperglycemia may improve binding between insulin and endocrine insulin receptors or increase the number of insulin associated with primary renal disease; pregnancy receptors; more potent color, lesions; T; orientation, Physical: Skin in effect than first-generation sulfonylureas. reflexes, peripheral sensation; R, adventitious sounds;  Mechanism of action is produced by blocking potassium liver evaluation, bowel sounds; urinalysis, BUN, serum channels inLFTs, blood glucose, CBC of langerhans. By creatinine, the beta cells of the islets partially blocking the potassium channels, it will increase Interventions the time the cell spends in the calcium release stage of Monitor urine or serum glucose levels frequently to cell signaling leading to drug and dosage calcium. The determine effectiveness of an increase in being used. increase in calcium Transfer to insulin therapy release WARNING: will initiate more insulin during from each high cell (eg infections, surgery, trauma). periods of beta stress Indications Use IV glucose if severe hypoglycemia occurs as a result Adjunct to diet and exercise to lower blood glucose of overdose. with type 2 (noninsulin-dependent) dietitian mellitus Arrange for consultation with diabetes to establish Adjunct to insulin therapy in the weight-loss program and dietary control. stabilization of certain cases of type 1 (insulin-dependent) program, Arrange for thorough diabetic teaching diabetes, reducing the insulin requirement and decreasing and including disease, dietary control, exercise, signs the chance of hypoglycemic reactions Contraindications and cautions

 Contraindicated with allergy to sulfonylureas; liver evaluation, bowel sounds; urinalysis, of serum diabetes with ketoacidosis, sole therapyBUN,type 1 creatinine, diabetes complicated by pregnancy, diabetes diabetes orLFTs, blood glucose, CBC Interventions complicated by fever, severe infections, severe trauma, major Give drug 30 min before breakfast; if(insulin GI surgery, ketosis, acidosis, coma severe is upset occurs or 1 diabetes, 15 mg/day is required, dose indicated); type more than serious hepatic impairment, may be divided and given serious renal impairment. before meals. Monitor urine orwith uremia, thyroid or endocrine Use cautiously serum glucose levels frequently to determine drug effectiveness and dosage. associated with impairment, glycosuria, hyperglycemia WARNING: Transfer to insulin (if glipizide is primary renal disease; labor and deliverytherapy during periods of high stress (eg,discontinue surgery, trauma).mo used during pregnancy, infections, drug at least 1 WARNING: Use IV glucose if severe before delivery); lactation; pregnancy. Availablehypoglycemia occurs as a result of overdose. forms Teaching points Tablets5, 10 mg; ER tablets2.5, 5, 10 mg Take this drug 30 minutes before breakfast for best results. Metabolism: Hepatic; T1/2: 24 hr Do not discontinue this drug without consulting Distribution: Crosses placenta; enters breast milk your health Excretion: Bile, urinecare provider. Monitor urine or blood for glucose and ketones. Adverse effectsDo not use this drug during pregnancy; consult healthCNS:provider. care Drowsiness, asthenia, nervousness, tremor, Avoid alcohol while insomnia, tinnitus, fatigue using this drug. Report fever, sore throat, unusual CV: Increased risk of CV mortality bleeding or bruising, rash, Hypoglycemia, SIADH Endocrine: dark urine, light-colored stools, hypoglycemic or hyperglycemic reactions. GI: Anorexia, nausea, vomiting, epigastric discomfort, heartburn, diarrhea Hematologic: Leukopenia, thrombocytopenia, anemia

Hypersensitivity: Allergic skin reactions, eczema, glyburidepruritus, erythema, urticaria, photosensitivity, fever, DiaBeta, eosinophilia, jaundice Euglucon (CAN), Gen-Glybe (CAN), Glibenclamide, Glynase PresTab, Micronase gain Other: Weight Interactions Drug class Drug-drug Antidiabetic Increased risk of hypoglycemia with sulfonamides, Sulfonylurea chloramphenicol, oxyphenbutazone, phenylbutazone, salicylates, clofibrate Therapeutic actions Decreased effectiveness of glipizide and diazoxide Stimulates taken concurrently if insulin release from functioning beta cells in the pancreas; may Increased binding hyperglycemia with rifampin, improve risk of between insulin and insulin receptors thiazides the number of insulin receptors; more potent or increase in effect than first-generation sulfonylureas. hyperglycemia with Risk of hypoglycemia and Indications ethanol; "disulfiram reaction" also has been reported Adjunct Drug-alternative therapyto diet to lower blood glucose with type 2 (noninsulin-dependent) diabetes mellitus if taken with Increased risk of hypoglycemia Adjunct to metformin when adequate coriander, juniper berries, ginseng, garlic, fenugreek, results are not achieved with either drug alone dandelion root, celery Adjunct Nursing considerations to insulin therapy in the stabilization of certain cases of type 2 diabetes, reducing the insulin Assessment requirement, and decreasingsulfonylureas; hypoglycemic History: Allergy to the chance of diabetes with reactions complications; type 1 diabetes, serious hepatic or renal Contraindications and cautions impairment, uremia, thyroid or endocrine impairment, Contraindicated with allergy to primary renal glycosuria, hyperglycemia associated with sulfonylureas; diabetes pregnancy disease; with ketoacidosis, sole therapy of type 1 (insulin-dependent) diabetes or lesions; complicated by Physical: Skin color, diabetes T; orientation, pregnancy, serious hepatic or renal adventitious sounds; reflexes, peripheral sensation; R, impairment, uremia; diabetes mellitus complicated by fever, severe infections,

severe trauma, major surgery, ketosis, acidosis, coma Interventions (insulin is contraindicated). Give drug before breakfast. If severe GI upset Use cautiously with pregnancy, lactation, thyroid occurs, dose may be divided and given before meals. or endocrine impairment, glycosuria, hyperglycemia Monitor urine or serum disease; labor and delivery associated with primary renalglucose levels frequently to determine drug effectivenesspregnancy, discontinue drug (if glyburide is used during and dosage. Monitor dosage carefully at least 1 mo before delivery). if switching to or from AvailableGlynase. forms WARNING: 5, 6 mg Tablets1.25, 1.5, 2.5, 3, 4.5, Transfer to insulin therapy during periods of high stress (eg, infections, surgery, trauma). WARNING: Metabolism: Hepatic; T1/2: 4 hr Use IV glucose if severe hypoglycemia occurs enters breast milk Distribution: Crosses placenta;as a result of overdose. Teaching points urine Excretion: Bile, Adverse effects Do not discontinue this medication without consulting your health care provider. fatigue, asthenia, CNS: Drowsiness, tinnitus, Monitor urine insomnia nervousness, tremor,or blood for glucose and ketones. Do Increased risk of during pregnancy; consult CV: not use this drug CV mortality health care provider. Endocrine: Hypoglycemia Avoid alcohol while using this drug. GI: Anorexia, nausea, vomiting, epigastric Report fever, diarrhea, weight gain discomfort, heartburn,sore throat, unusual bleeding or bruising, rash, dark Leukopenia, thrombocytopenia, urine, light-colored stools, Hematologic: hypoglycemic or hyperglycemic reactions. anemia Hypersensitivity: Allergic skin reactions, eczema, pruritus, erythema, urticaria, photosensitivity, fever, eosinophilia, jaundice Interactions Drug-drug

Increased risk of hypoglycemia with sulfonamides, guaifenesin chloramphenicol, oxyphenbutazone, phenylbutazone, Allfen; AMBI 1000, clofibrate salicylates, 1200; Diabetic Tussin; Hytuss; Hytuss 2X; Liquibid; Mucinex; Muco-Fen; Organidinglyburide and diazoxide Decreased effectiveness of NR; Robitussin, ScotTussin Expectorant; Siltussin SA if taken concurrently Increased risk of hyperglycemia with rifampin, Drug class thiazides Expectorant Risk of hypoglycemia and hyperglycemia with Therapeutic actions ethanol; "disulfiram reaction" has been reported  Enhances the output of respiratory tract fluid by reducing Drug-alternative therapy adhesiveness and surface tension, facilitating with Increased risk of hypoglycemia if taken the removal berries, ginseng, garlic, fenugreek, coriander, juniper of viscous mucus.  Guaifenesin is celery dandelion root, thought to act as an expectorant by increasing the Nursing considerations volume and reducing the viscosity of secretions CLINICAL ALERT! in the trachea and bronchi. Thus, it may increase the efficiency of the DiaBeta (glyburide) and Name confusion has occurred betweencough reflex and facilitate removal of the secretions; however, objective evidence Zebeta (bisoprolol); use caution. for Assessment this is limited and conflicting. Indications History: Allergy to sulfonylureas; diabetes with Symptomatic diabetes, respiratory conditions complications; type 1 relief of serious hepatic or renal characterizeduremia, nonproductive cough when there is impairment, by dry, thyroid or endocrine impairment, mucus in the respiratory tract. glycosuria, hyperglycemia associated with primary renal Contraindications and cautions disease, pregnancy Contraindicated with allergy to guaifenesin. Physical: Skin color, lesions; T; orientation, Use cautiously with pregnancy, lactation, and reflexes, peripheral sensation; R, adventitious sounds; persistent coughs.bowel sounds; urinalysis, BUN, serum liver evaluation, Availablecreatinine, LFTs, blood glucose, CBC forms Syrup100 mg/5 mL; liquid100, 200 mg/5 mL; capsules 200 mg; tablets100, 200, 400 mg; ER tablets600 mg

heparin Metabolism: Not known; T1/2: Unknown heparin sodium injection Distribution: Not known Hepalean (CAN), Heparin Leo (CAN) Excretion: Urine Adverse effects heparin sodium CNS: Headache, dizziness and 0.9% sodium chloride Dermatologic: Rash, urticaria heparin sodium GI: Nausea, vomiting, GI discomfort lock flush solution Hepalean-Lok (CAN), Heparin Lock Flush, Hep-Lock, Hep-Lock Interactions U/P Drug-lab test Color interference and false results of 5-HIAA and Drug class VMA urinary determinations Anticoagulant Nursing considerations Therapeutic actions CLINICAL ALERT! Heparin inactivates factor reported between Mucinexthrombus and Name confusion has been XA, therefore inhibiting (guaifenesin) clot Mucomyst (acetylcysteine); use caution. of prothrombin to and formation by blocking the conversion thrombin and fibrinogen to fibrin, the final steps in the clotting Assessment process. Heparin also inhibits to guaifenesin; persistent cough History: Allergy the activation of factor XIII, thrombin-induced activation of factorsemphysema; very productive due to smoking, asthma, or V and VIII. Indications cough; pregnancy Prevention and treatment of venous thrombosis and Physical: Skin lesions, color; T; orientation, affect; pulmonary embolism R, adventitious sounds Interventions Treatment of atrial fibrillation with embolization Diagnosis and Monitor reaction to drug; persistent WARNING: treatment of DIC coughPrevention of clotting in blood samples and heparin for more than 1 wk, fever, rash, or persistent lock sets and during dialysis procedures headache may indicate a more serious condition. Unlabeled uses: Adjunct in therapy of coronary Teaching occlusion with acute MI, prevention of left ventricular points

Some extended-release formulations may be cut in thrombi cannot CVA post-MI, prevention of cannot be half but and be crushed or chewed. Mucinex cerebral thrombosis in the or cut. stroke crushed, chewed, evolving Contraindications not take for longer than 1 week; if fever, rash, Do and cautions headache occur, consult your health care provider. Contraindicated with hypersensitivity to heparin; or severeYou may experience uncontrolledeffects: Nausea, thrombocytopenia; these side bleeding; any patient who cannot besmall meals); dizziness, headache vomiting (eat frequent monitored regularly with blood coagulation tests; labor dangerous machinery). (avoid driving or operating and immediate postpartum period;Report fever, rash, severe are at highpersistent women older than 60 yr vomiting, risk for hemorrhaging. cough. Use cautiously with pregnancy; women older than 60 yr are at high risk for hemorrhaging; dysbetalipoproteinemia; recent surgery or injury. Available forms Injection1,000, 2,000, 2,500, 5,000, 7,500, 10,000, 12,500, 20,000, 40,000 units/mL; also single-dose and unit-dose forms. Lock flush solution10, 100 units/mL. Metabolism: T1/2: 30180 min Distribution: Does not cross placenta, does not enter breast milk; broken down in liver Excretion: Urine IV facts Continuous infusion: Can be mixed in normal saline, D5W, Ringer's; mix well; invert bottle numerous times to ensure adequate mixing. Monitor patient closely; infusion pump is recommended. Single dose: Direct, undiluted IV injection of up to 5,000 units (adult) or 50 units/kg (pediatric), given over 60 seconds.

Monitoring: Blood should be drawn for coagulation testing 30 Do not give IV injections to patients on heparin min before each intermittent IM dose or q 46 hr if patient is on therapy (heparin continuous infusion pump. predisposes to hematoma formation). WARNING: Apply pressure to in solution with Incompatibilities: Heparin should not be mixedall injection sites any other after needle is withdrawn; inspect direct incompatibilities drug unless specifically ordered; injection sites for signs of and at Y-site seen injection sites. in solution hematoma; do not massage with amikacin, codeine, Mix well when adding heparin to IV infusion. chlorpromazine, cytarabine, diazepam, dobutamine, doxorubicin, Do not add heparin to infusion lines of haloperidol, droperidol, ergotamine, erythromycin, gentamicin, other drugs, and do not piggyback other drugs into heparin line. If hydrocortisone, kanamycin, levorphanol, meperidine, methadone, this methotrimeprazine, compatibility. netilimicin, methicillin, must be done, ensure drug morphine, Provide for safety measures (electric razor, soft pentazocine, phenytoin, polymyxin B, promethazine, streptomycin, toothbrush) to triflupromazine, vancomycin. tetracycline, tobramycin,prevent injury from bleeding. Check for signs of bleeding; monitor blood tests. Adverse effects Alert all health care providers of heparin use. Dermatologic: Loss of hair WARNING: Have protamine sulfate bruising; (heparin Hematologic: Hemorrhage; antidote) readily available in case of overdose; each mg thrombocytopenia; elevated AST, ALT levels, neutralizes 100 units of heparin. hyperkalemia WARNING: Treatment of overdose: asthma Hypersensitivity: Chills, fever, urticaria,Protamine sulfate (1% solution). Each suppression of renal function Other: Osteoporosis, mg of protamine neutralizes 100 USP heparin units. Give very slowly IV over 10 (long-term, high-dose therapy) min, Interactions not to exceed 50 mg. Establish dose based on blood coagulation studies. Drug-drug Increased bleeding tendencies with oral Teaching anticoagulants, salicylates, penicillins, cephalosporins; points This drug must be given low-moleculer-weight heparins by a parenteral route (cannot Decreased anticoagulation effects if taken be taken orally). Frequent blood tests are concurrently with nitroglycerin necessary to determine blood Drug-lab test clotting time is within the correct range.

Increased AST, ALT levels Be careful to avoid injury: Use Increased thyroid function tests an electric razor, avoid Altered sports and other activities that might lead contact blood gas analyses, especially levels of to injury. carbon dioxide, bicarbonate concentration, and base You may experience loss of hair. excess Report nose bleed, bleeding of the gums, unusual Drug-alternative therapy bruising, black or tarry stools, cloudy combined urine, Increased risk of bleeding if or dark with abdominal or lower ginger, ginkgo, and ginseng therapy; chamomile, garlic, back pain, severe headache. high-dose vitamin E Nursing considerations Assessment History: Recent surgery or injury; sensitivity to heparin; hyperlipidemia; pregnancy Physical: Peripheral perfusion, R, stool guaiac test, PTT or other tests of blood coagulation, platelet count, renal function tests Interventions Adjust dose according to coagulation test results performed just before injection (30 min before each intermittent dose or q 46 hr if continuous IV dose). Therapeutic range aPTT: 1.52.5 times control. Always check compatabilities with other IV solutions. Use heparin lock needle to avoid repeated injections. Give deep subcutaneous injections; do not give heparin by IM injection.

hydrochlorothiazide Adverse effects Apo-Hydro (CAN), Esidrix, Ezide, HydroDIURIL, Microzide Capsules, OreticCNS: Dizziness, vertigo, paresthesias, weakness, headache, drowsiness, fatigue CV: Orthostatic hypotension, venous thrombosis, Drug class volume Thiazide diuretic depletion, cardiac arrhythmias, chest pain Dermatologic: Photosensitivity, rash, purpura, exfoliative Therapeutic actions dermatitis, hives, alopecia GI: Nausea, of sodium and chloride  Inhibits reabsorption anorexia, vomiting, dry inmouth, distal diarrhea, constipation, jaundice, excretion of sodium, renal tubule, increasing the hepatitis, pancreatitis GU: Polyuria, nocturia, impotence, loss of libido chloride, and water by the kidney. Hematologic: Leukopenia, thiazide class of  Hydrochlorothiazide belongs to the thrombocytopenia, agranulocytosis, on the anemia, to reduce sodium (Na) diuretics, acting aplastic kidneys neutropenia Other: Muscle cramps and muscle spasms, fever, reabsorption in the distal convoluted tubule. The major gouty attacks, flushing, weight loss, rhinorrhea, site of action in the nephron appears on an electroneutral electrolyte imbalances, hyperglycemia Na+-Cl- co-transporter by competing for the chloride site Interactions the transporter. Thiazides increase the reabsorption of on Drug-drug calcium in this segment in a manner unrelated to sodium Altered electrolytes with transport. [2]. Contrary to popular loop diueretics, belief, thiazide amphotericin B, work by increasing lumen osmolarity diuretics do not corticosteroids Increased neuromuscular blocking effects and and thereby inducing an osmotic diuresis. Rather, respiratory depression with thiazide diuretics, (and allnondepolarizing muscle other pharmacologic relaxants diuretics), decrease serum osmolarity, which leads the brain toDecreased the body's water intake and increase decrease absorption with cholestyramine, colestipol urination to return osmolarity to normal. Increased risk of cardiac glycoside toxicity if hypokalemia occurs Indications Increased risk of lithium toxicity Decreased effectiveness of antidiabetic drugs

Adjunctive therapy in edema associated with CHF, Drug-lab test cirrhosis, corticosteroid, and estrogen therapy; renal Decreased PBI levels without clinical signs of dysfunction thyroid disturbance as sole therapy or in combination Hypertension Nursing considerations with other antihypertensives Assessment Unlabeled uses: Calcium nephrolithiasis alone or History: or allopurinol to prevent recurrences in with amiloride Allergy to thiazides, sulfonamides; fluid or electrolyte or normal calciuric patients; diabetes hypercalciuric imbalance; renal or liver disease; gout; SLE; glucose tolerance abnormalities, diabetes mellitus; insipidus, especially nephrogenic diabetes insipidus; hyperparathyroidism; manic-depressive disorders; osteoporosis lactation, and cautions Contraindications pregnancy Physical: Skin color, lesions, edema; orientation, Contraindicated with allergy to thiazides, reflexes, muscle strength; pulses, sulfonamides; fluid or electrolytebaseline ECG, renal imbalance; BP, orthostatic lead to azotemia); pattern, adventitious disease (canBP, perfusion; R, liver disease (risk of sounds; liver anuria. hepatic coma);evaluation, bowel sounds, urinary output patterns; CBC, serum electrolytes, blood glucose, LFTs, Use cautiously with gout (risk of attack); SLE; renal function tests, abnormalities, diabetes glucose tolerance serum uric acid, urinalysis mellitus; Interventions hyperparathyroidism; manic-depressive disorder Give with hypercalcemia); pregnancy; (aggravated by food or milk if GI upset occurs. lactation, Mark calendars or provide other reminders of drug elevated triglyceride levels. Availablefor alternate day or 35 days/wk therapy. forms Reduce dosage of other mg/5 mL; capsules Tablets25, 50, 100 mg; solution50 antihypertensives by at 12.5 mg least 50% if given with thiazides; readjust dosages gradually as BP responds. Administer 5.614.8 hr Metabolism: Hepatic; T1/2: early in the day so increased urination will Crosses placenta; Distribution: not disturb sleep. enters breast milk Measure and record weights to monitor fluid Excretion: Urine changes.

Teaching points Record intermittent therapy on a calendar, or use Drug classes prepared, dated envelopes. Take drug early so increased Corticosteroid, short acting disturb sleep. Drug may be taken with urination will not Glucocorticoid or meals if GI upset occurs. food Adrenal cortical steroid Weigh yourself on a regular basis, at the same time Hormone and in the same clothing; record weight on your calendar. Therapeutic actions may experience these side effects: Increased You Enters target cellsand frequency of urination; receptors; initiates volume and binds to cytoplasmic dizziness, feeling many complex on arising, that are responsible rapid its antifaint reactions drowsiness (avoid for position inflammatory, immunosuppressive (glucocorticoid), and saltchanges; hazardous activities, like driving; and alcohol); retaining sensitivity to sunlightactions. Some actions protective (mineralocorticoid) (use sunglasses, wear may be undesirable, depending on drug used clothing, or use a sunscreen); decrease in sexual Indications function; increased thirst (sucking on sugarless lozenges Replacement therapy in adrenal (report and frequent mouth care may help); gout attack cortical insufficiency any sudden joint pain). Allergic statessevere more than 3 pounds in 1 Report weight change of or incapacitating allergic conditions in your ankles or fingers, unusual bleeding day, swelling bruising, dizziness, trembling, cancer or Hypercalcemia associated with numbness, fatigue, Short-term inflammatory and allergic disorders, muscle weakness or cramps. such as rheumatoid arthritis, collagen diseases (SLE), dermatologic diseases (pemphigus), status asthmaticus, and autoimmune disorders Hematologic disordersthrombocytopenic purpura, erythroblastopenia Trichinosis with neurologic or myocardial involvement

hydrocortisone Ulcerative colitis, acute exacerbations of MS, and palliation in hydrocortisone acetatesome leukemias and lymphomas Intra-articular Dermatologic cream, ointment: or soft-tissue administration: Arthritis, Cortef Feminine Cortaid with Aloe,psoriatic plaques Itch, Corticaine, Gynecort Retention enema: For ulcerative colitis, proctitis Female Creme, Lanacort-5, Lanacort-10, Maximum Strength Dermatologic preparations: To relieve Caldecort, Maximum Strength Cortaid inflammatory and pruritic manifestations of dermatoses that are steroid hydrocortisone butyrate responsive Anorectal cream, suppositories: To relieve Dermatologic ointment and cream: Locoid discomfort of hemorrhoids and perianal itching or irritation Contraindications and cautions hydrocortisone cypionate Systemic administration Oral suspension: Cortate (CAN), Contraindicated with fungal infections, amebiasis, Cortef hepatitis B, vaccinia, or varicella, and antibiotic-resistant infections. hydrocortisone sodium phosphate Use cautiously with IV, IM, or subcutaneous injection: kidney disease (risk to edema); liver disease, cirrhosis, hypothyroidism; ulcerative colitis Hydrocortone phosphate with impending perforation; diverticulitis; recent GI surgery; active or latent peptic ulcer; inflammatory hydrocortisone sodium succinate bowel IV, IM injection:disease (risks exacerbations or bowel perforation); hypertension, CHF; thromboembolitic tendencies, Solu-Cortef thrombophlebitis, osteoporosis, seizure disorders, metastatic carcinoma, diabetes mellitus; TB; lactation. hydrocortisone valerate Retention enemas, intrarectal foam Dermatologic cream, ointment, lotion: Contraindicated with systemic fungal infections, Westcort recent intestinal surgery, extensive fistulas. Use cautiously with pregnancy.

Topical dermatologic administration Musculoskeletal: Contraindicated withMuscle weakness, steroid fungal, tubercular, herpes myopathy and loss of osteoporosis, simplex skin infections;muscle mass, varicella; ear vaccinia, spontaneous fractures (long-term therapy) application when eardrum is perforated. Other: Immunosuppression, aggravation or Use cautiously with pregnancy, lactation. Availablemasking of infections, impaired wound healing forms Adverse effects related to oral routes of administration Tablets5, 10, 20 mg; specific suspension10 mg/5 mL, 25, IM repository 50 mg/mL, 100, 250, site 50 mg/mL; injection25, injections: Atrophy at injection500, Intra-articular: Osteonecrosis, tendon 2.5%; 1,000 mg/vial; topical lotion0.25%, 0.5%, 1%, 2%,rupture, infection topical liquid1%; topical oil1%; topical solution1%; topical Intralesional therapy, head and neck: Blindness spray1%; cream0.2%, 0.5%, 1%, 2.5%; ointment0.5%, 1%, (rare) 2.5%; topical gel1%, 2% Intraspinal: Meningitis, adhesive arachnoiditis, conus medullaris 80120 min Metabolism: Hepatic; T1/2: syndrome Intrathecal administration: milk Distribution: Crosses placenta; enters breast Arachnoiditis Retention enema: Local pain, burning; rectal Excretion: Urine bleeding; systemic absorption and adverse effects (see IV facts Systemic Adverse Effects) Topical dermatologic in normal saline sprays: Preparation: Give directly or dilute ointments, creams,or D5W. Local burning, irritation, Administer within 24 hr of diluting acneiform lesions, striae, skin Infusion: atrophy slowly, directly or dilute, and infuse Inject Interactions hydrocortisone phosphate at a rate of 25 mg/min; hydrocortisone Drug-drug sodium succinate at rate of each 500 mg over 3060 sec. Increased steroid blood levels with hormonal Incompatibilities: Do not mix or inject at Y-site with amobarbital, contraceptives, troleandomycin, doxapram, doxorubicin, ampicillin, bleomycin, dimenhydrinate, ketoconazole, estrogen Decreased steroid ephedrine, ergotamine, heparin, blood levels with phenytoin, hydralazine, metaraminol, phenobarbital, rifampin, cholestyramine methicillin, nafcillin, pentobarbital, phenobarbital, phenytoin, Decreased serum level of salicylates prochloperazine, promethazine, secobarbital, tetracyclines.

Adverse effects Decreased effectiveness of anticholinesterases Systemic (ambenonium, edrophonium, neostigmine, CNS: Vertigo, headache, paresthesias, insomnia, pyridostigmine), ketoconazole, estrogen seizures, psychosis Drug-lab test CV: Hypotension, shock, hypertension and CHF False-negative secondary to fluid nitroblue-tetrazolium test for retention, thromboembolism, bacterial infection fat systemic absorption) thrombophlebitis, (withembolism, cardiac arrhythmias Suppression of skin test reactions secondary to electrolyte disturbances May decrease serum potassium levels, T3, and T4 Dermatologic: Thin, fragile skin; petechiae; levels ecchymoses; purpura; striae; subcutaneous fat atrophy Nursing considerations Cataracts, glaucoma (long-term therapy), EENT: Assessment increased IOP History: Infections; kidney disease; liver growth Endocrine: Amenorrhea, irregular menses,disease, hypothyroidism; ulcerative colitis retardation, decreased carbohydrate with impending tolerance and perforation; diverticulitis; recent GI surgery; therapy), diabetes mellitus, cushingoid state (long-term active or latent peptic ulcer; inflammatory bowel than 5 HPA suppression systemic with therapy longerdisease; hypertension, CHF; thromboembolitic tendencies, days thrombophlebitis, or esophageal seizure pancreatitis, disorders, GI: Peptic osteoporosis, ulcer, metastatic distention, diabetes mellitus; lactation. abdominal carcinoma, nausea, vomiting, increased Retention enemas, intrarectal foam: Systemic fungal appetite and weight gain (long-term therapy) infections; recent intestinal +surgery, extensive fistulas. Hematologic: Na and fluid retention, Topical dermatologic administration: Fungal, tubercular, hypokalemia, hypocalcemia, increased blood sugar, herpes simplex cholesterol, decreased serum T3 and T4 increased serum skin infections; vaccinia, varicella; ear application when eardrum is perforated levels Physical: Systemic administration: Weight, T; Hypersensitivity: Anaphylactoid or reflexes, affect, bilateral hypersensitivity reactions grip strength, ophthalmologic examination; BP, P, auscultation, peripheral perfusion, discoloration, pain or prominence of superficial vessels; R, adventitious sounds, chest x-ray; upper GI x-ray

(history or symptoms of peptic ulcer), liver palpation; CBC, Wear a medical alert ID (long-term therapy) so that serum electrolytes, 2-hr postprandial blood any emergency medical personnel will know that serum glucose, urinalysis, thyroid function tests, you are taking this drug. cholesterol. Topical, dermatologic preparations: You may experience these Affected area, integrity of skin side effects: Increase in appetite, weight gain (some of gain may be fluid Interventions retention; monitor intake); heartburn, indigestion (eat Systemic administration frequent small meals; use of antacids may mimic WARNING: Give daily before 9 AM to help); increased susceptibility to infection (avoid crowds during normal peak diurnal corticosteroid levels and minimize peak cold or flu seasons, and avoid anyone with a known HPA suppression. infection); poor wound healing (if injured orthe day. Space multiple doses evenly throughout wounded, consultDo notcare provider); muscle weakness, fatigue health give IM injections if patient has (frequent rest periods may help). thrombocytopenic purpura. Report unusual weight gain, swelling to avoid Rotate sites of IM repository injections of lower extremities, muscle weakness, black or tarry stools, local atrophy. vomiting of minimalepigastricfor minimal duration to Use blood, doses burning, puffing of face, menstrual adverse effects. fever, prolonged sore throat, minimize irregularities, cold or other infection, worsening of symptoms. or long Taper doses when discontinuing high-dose Intra-articular, intralesional administration term therapy. Do not overuseincreased dosage even if the pain is Arrange for the injected joint when patient gone. Adhere to rules of proper rest and exercise. subject to unusual stress. Topical dermatologic administration amount of Ca2+ is taken if Ensure that adequate Apply sparingly, and rub in lightly prolonged administration of steroids. Avoid contacting your eye with the medication. Use alternate-day maintenance therapy with short actingReport burning,whenever possible. corticosteroids irritation, or infection of the site, worsening of the condition. give live virus vaccines with WARNING: Do not Avoid prolonged use. immunosuppressive doses of hydrocortisone. Anorectal preparations

Provide antacids between meals to help avoid pepticMaintain normal bowel function with proper diet, ulcer. adequate fluid intake, and Topical dermatologic administrationregular exercise. Use stool softeners or bulk laxatives if needed. or Use caution with occlusive dressings; tight plasticNotify your health care provider if symptoms do diapers over affected area can increase systemic not improve in 7 days or if bleeding, protrusion, or absorption. seepage occurs. Avoid prolonged use, especially near eyes, in genital and rectal areas, on face, and in skin creases. Teaching points Systemic administration Take this drug exactly as prescribed. Do not stop taking this drug without notifying your health care provider; slowly taper dosage to avoid problems. Dosage reductions may create adrenal insufficiency. Report any fatigue, muscle and joint pains, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness, or low blood sugar (if you monitor blood sugar). Take with meals or snacks if GI upset occurs. Take single daily or alternate-day doses before 9 AM; mark calendar or use other measures as reminder of treatment days. Do not overuse joint after intra-articular injections, even if pain is gone. Frequent follow-up visits to your health care provider are needed to monitor drug response and adjust dosage.

ibuprofen Available forms Advil, Advil Liqui-Gels, Advil Migraine, Apo-Ibuprofen (CAN), Tablets100, 200, 400, 600, Motrin, Genpril, Infants' Motrin, Children's Advil, Children's 800 mg; chewable tablets50, 100 mg; Strength Advil,mg; suspension100 mg/2.5 mL, Midol, 100 Junior capsules200 Junior Strength Motrin, Menadol, mg/5 Maximum Strength Cramp MidolmL; oral drops40 mg/mL Formula, Motrin, Motrin IB, Metabolism: Hepatic; T1/2: 1.82.5 hr (CAN), Nuprin, PediaCare Motrin Migraine Pain, Novo-Profen Distribution: Crosses placenta; Fever, Pediatric Advil Drops may enter breast milk Excretion: Urine Adverse effects Drug classes CNS: Headache, dizziness, somnolence, insomnia, NSAID Analgesicfatigue, tiredness, dizziness, tinnitus, ophthalmologic (nonopioid) Propionic effects acid derivative CV: Therapeutic actionsHypertension, palpitations, arrhythmia Dermatologic: Rash, pruritus, sweating, dry  Anti-inflammatory, analgesic, and antipyretic activities mucous membranes, stomatitis largely related to inhibition of prostaglandin synthesis; GI: Nausea, dyspepsia, known. Inhibits both exact mechanisms of action are not GI pain, diarrhea, vomiting, constipation, 1 and 2. Ibuprofen is cyclooxygenase (COX)flatulence, GI bleeding slightly more GU: Dysuria, renal impairment, menorrhagia selective for COX-1. Hematologic: Bleeding, drugs such as ibuprofen  Non-steroidal anti-inflammatory platelet inhibition with higher inhibiting the enzyme cyclooxygenase (COX), work bydoses, neutropenia, eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis, which converts arachidonic acid to prostaglandin H2 granulocytopenia, aplastic anemia, decreased Hgb to (PGH2). PGH2, in turn, is converted by other enzymes or Hct, bone marrow depression several other prostaglandins (which are mediators of Respiratory: Dyspnea, and to thromboxane A2 pain, inflammation, and fever) hemoptysis, pharyngitis, bronchospasm, rhinitis (which stimulates platelet aggregation, leading to the Other: formation of bloodPeripheral edema, anaphylactoid clots). reactions to anaphylactic shock Interactions Drug-drug

Like aspirin, indomethacin, and most other NSAIDs, Increased toxic effects of lithium COX inhibitor ibuprofen is considered a non-selectivewith ibuprofen that is,Decreased two isoforms of cyclooxygenase, COXit inhibits diuretic effect with loop diuretics bumetanide, furosemide, ethacrynic acid 1 and COX-2. The analgesic, antipyretic, and anti Potential decrease in antihypertensive achieved inflammatory activity of NSAIDs appears to be effect of beta-adrenergic inhibition of COX-2, whereas inhibition mainly through blocking agents and ACE inhibitors Increased risk of gastric ulceration with of COX-1 would be responsible for unwanted effects on bisphosphates platelet aggregation and the gastrointestinal Increased risk of bleeding with anticoagulants tract.However, the role of the individual COX isoforms Nursing considerations anti-inflammatory, and gastric damage in the analgesic, Assessment effects of NSAIDs is uncertain and different compounds cause History: degrees of analgesia and gastric damage different Allergy to ibuprofen, salicylates or other NSAIDs; CV dysfunction, hypertension; peptic Indications ulceration, GI bleeding; impaired hepatic or renal Relief of signs and symptoms of rheumatoid function; pregnancy; lactation arthritis and osteoarthritis Physical: Skin color, pain Relief of mild to moderate lesions; T; orientation, reflexes, ophthalmologicdysmenorrhea audiometric evaluation, Treatment of primary evaluation, reduction sensation; P, BP, edema; R, Fever peripheral adventitious sounds; Prophylactic for migraine; abortive Unlabeled uses: liver evaluation, bowel sounds; CBC, clotting times, treatment for migraine urinalysis, LFTs, renal function tests, serum electrolytes, Contraindications and cautions stool guaiac Contraindicated with allergy to ibuprofen, Interventions salicylates, or other NSAIDs (more common in patients Administer drug with food or nasal polyps). with rhinitis, asthma, chronic urticaria, after meals if GI upset Use cautiously with CV dysfunction, hypertension; occurs. pepticArrange for periodic ophthalmologic examination ulceration, GI bleeding; pregnancy; lactation; during long-term therapy. impaired hepatic or renal function. Discontinue drug if eye changes, symptoms of liver dysfunction, or renal impairment occur.

 WARNING: Institute emergency procedures if Preparation: May be diluted in 50 lavage, diluent, 0.9% emesis, overdose occurs: Gastric mL of induction of sodium chloride, or 5% dextrose injection; one 10-mL vial added to 50 mL supportive therapy. of diluent yields a concentration of 0.017 mg/mL; may also be infused undiluted; diluted solution is stable for 24 hr at room Teaching points temperature or for 48 hr refrigerated. Use drug only as suggested; avoid overdose. Take Infusion: the drug with over 10 after meals if GI upset occurs. Do Infuse slowly food or min. Compatibilities: Compatible with dosage. not exceed the prescribed 5% dextrose injection, 0.9% sodium chloride injection. Avoid over-the-counter drugs. Many of these drugs Incompatibilities: Do notmedications, andwith any overdosage can contain similar mix in solution serious other drugs. occur. Adverse effectsYou may experience these side effects: Nausea, GI light-headedness, dizziness, upset, CNS: Headache,drug with food); diarrhea or dyspepsia (take tingling in arms, numbness dizziness, vertigo, insomnia constipation; drowsiness, CV: when driving or operating dangerous (use caution Ventricular arrhythmias, hypotension, hypertension machinery). GI: Nausea throat, fever, rash, itching, weight gain, Report sore Interactions swelling in ankles or fingers, changes in vision, black or Drug-drug tarry stools. Increased risk of serious to life-threatening arrhythmias with disopyramide, quinidine, procainamide, amiodarone, sotalol; do not give together Increased risk of proarrhythmias with phenothiazines, TCAs, antihistamines Use cautiously with digoxin because ibutilide may mask digoxin cardiotoxicity Nursing considerations Assessment

ibutilide fumarate History: Hypersensitivity to ibutilide; second- or Corvert third-degree AV heart block, time of onset of atrial arrhythmia; prolonged QTc intervals; pregnancy, Drug class lactation; ventricular class III) Antiarrhythmic (predominatelyarrhythmias Physical: Orientation; BP, P, auscultation, ECG; R, actions Therapeuticadventitious sounds Interventions Prolongs cardiac action potential, increases atrial and ventricular Determine time of onset of arrhythmia and refractoriness; produces mild slowing of sinus rate and AV potential benefit before beginning therapy. Conversion is conduction. more likely in patients with arrhythmias of short (< 90 Indications days') Rapid conversion of atrial fibrillation or flutter of duration. recent WARNING:sinus rhythm;patient is adequately onset to Ensure that most effective in anticoagulated, 90 days' for at arrhythmias of < generallyduration least 2 wk, if atrial fibrillation lasts > 23 days. Contraindications and cautions Monitor ECG continually during and for at least 4 Contraindicated with hypersensitivity to ibutilide; hr after or third-degree AV heart possible arrhythmias, second- administration. Be alert forblock, prolonged QTc including intervals. PVCs, sinus tachycardia, sinus bradycardia, varying degrees of block with ventricular arrhythmias, Use cautiously at time of conversion. WARNING: renal and hepatic impairment. pregnancy, lactation,Keep emergency equipment readily Availableavailable during and for at least 4 hr after administration. forms Provide appointments for continued follow-up, Solution0.1 mg/mL including ECG monitoring; tendency to revert to atrial arrhythmia after conversion increases with length of time Metabolism: Hepatic; T1/2: 6 hr patient was placenta, may enter Distribution: Crossesin abnormal rhythm. breast milk Teaching points Excretion: Feces, urine This drug can only be given by IV infusion. You IV facts will need electrocardiogram monitoring during and for 4 hours after administration.

 Arrange for follow-up medical evaluation, including an electrocardiogram, which is important to Drug classes monitor the effect of the drug on your heart. Antidiabetic You may experience these side effects: Rapid or Hormone irregular heartbeat (usually passes shortly), headache. Therapeutic actions chest pain, difficulty breathing, numbness Report Insulin is orhormone secreted by the beta cells of the pancreas that, a tingling. by receptor-mediated effects, promotes the storage of the body's fuels, facilitating the transport of metabolites and ions (potassium) through cell membranes and stimulating the synthesis of glycogen from glucose, of fats from lipids, and proteins from amino acids. Indications Treatment of type 1 (insulin-dependent) diabetes mellitus Treatment of type 2 (noninsulin-dependent) diabetes mellitus that cannot be controlled by diet or oral drugs Regular insulin injection: Treatment of severe ketoacidosis or diabetic coma Treatment of hyperkalemia with infusion of glucose to produce a shift of potassium into the cells Highly purified and human insulins promoted for short courses of therapy (surgery, intercurrent disease), newly diagnosed patients, patients with poor metabolic control, and patients with gestational diabetes Insulin injection concentrated: Treatment of diabetic patients with marked insulin resistance (requirements of > 200 units/day)

insulin Glargine (Lantus): Treatment of adult patients with Insulin injection: type 2 diabetes mellitus who (concentrated), Novolin ge Humulin R, Humulin R Regular U-500require basal insulin control of hyperglycemia Toronto (CAN), Novolin R, Novolin R PenFill, Velosulin Human Treatment of adults and children > 6 yr who BR require Insulin lispro: baseline insulin control Determir (Levemir): Treatment of adults with Humalog diabetes who require basal insulin for the control of Isophane insulin suspension (NPH): Humulin hyperglycemia (CAN), Novolin N, Novolin N PenFill, N, Novolin ge Contraindications and Novolin ge NPH (CAN) cautions Contraindicated Insulin zinc suspension (Lente): with allergy to pork products (varies with human Humulin-L, Lente Ilentin II,preparations;lente (CAN) insulin not Novolin ge Protaminecontraindicated with pork allergy). zinc suspension (PZI): Use Iletin PZI (CAN) cautiously with pregnancy (keep patients under close supervision; rigid control is Insulin zinc suspension, extended (Ultralente): desired; following delivery, Humulin U (CAN) requirements may drop for 2472 hr, rising to normal Insulin Aspart: levels during next 6 wk); lactation (monitor Novolog mother carefully; insulin requirements may decrease during Insulin Detemir: lactation). Available Levemir forms Injection100 units/mL, 500 units/mL (concentrated); prefilled Insulin Glargine: cartridges Lantus and pens100 units/mL Metabolism: Cellular; T1/2: Varies with preparation Insulin Glulisine: Distribution: Crosses placenta; does not enter breast milk Apidra Excretion: Unknown Combination insulins: Humalog 75/25; Humulin 70/30; Humulin 50/50; Novolin 70/30; IV facts Novolin ge 10/90, 20/80, 30/70, 40/60, 50/50 (CAN); Novolog Preparation: May be mixed with standard IV solutions; use of 70/30 plastic tubing or bag will change the amount of insulin delivered.

Infusion: Use of a monitored delivery system is suggested. Rate should be cannot be by patient response and glucose levels. drug, determined mixed in solution with any other including Do insulins. Incompatibilities: othernot add to aminophylline, amobarbital, chlorothiazide, WARNING: Double-check, or have a colleague cytarabine, dobutamine, methylprednisolone, check, the dosage phenytoin, secobarbital, sodium pentobarbital, phenobarbital,drawn up for pediatric patients, for patients receiving concentrated insulin injection, or bicarbonate, thiopental. patients Adverse effects receiving very small doses; even small errors in dosage can cause serious problems. anaphylaxis or Hypersensitivity: Rash, Carefully angioedema monitor patients being switched from one type of insulin to another carefully; dosage adjustments Local: Allergylocal reactions at injection site are oftenswelling, itching; usually resolves in a few days redness, needed. Human insulins often require smaller dosesfew weeks; or changeinsulin; monitor cautiously of to a than beef a pork in type or species source if patientsmay be tried; lipodystrophy; pruritus insulin are switched; lispro insulin is given 15 min before a meal. Levemir is given inketoacidosis Metabolic: Hypoglycemia; the evening. Interactions Store insulin in a cool place away from direct sunlight. Refrigeration is preferred. Do not freeze Drug-drug insulin. Insulin prefilled in glass or plastic syringes is Increased hypoglycemic effects of insulin with stable for 1 blockers, salicylates, or alcohol MAOIs, beta wk refrigerated; this is a safe way of ensuring proper dosage for patients with limited vision or Delayed recovery from hypoglycemic episodes and who have problems symptoms of hypoglycemia if taken masked signs and with drawing up insulin. Monitor urine blocking drugs with beta-adrenergicor serum glucose levels frequently to determine effectiveness of drug and dosage. Patients can Drug-alternative therapy learn to adjust insulin dosage on a sliding if taken with Increased risk of hypoglycemia scale based on test results. juniper berries, ginseng, garlic, fenugreek, coriander, Monitor celery dandelion root, insulin needs during times of trauma or severe stress; dosage adjustments may be needed. Nursing considerations WARNING: Keep life support equipment and CLINICAL ALERT! glucose readily available to deal with ketoacidosis or hypoglycemic reactions.

Name confusion may occur between Lantus and Lente insulin; use extreme caution. Teaching points Assessment Use the same type to pork products; pregnancy; History: Allergy and brand of syringe; use the same type and brand of insulin to avoid dosage errors. lactation Do not change the color, of mixing eyeball turgor; Physical: Skin order lesions; insulins. Rotate injection sites regularly peripheralchart of sites used) to orientation, reflexes, (keep a sensation; P, BP, prevent breakdown atR; urinalysis, blood glucose adventitious sounds; injection sites. Interventions Dosage may vary with activities, stress, diet. Monitor blood or urine glucose levels, and consult Ensure uniform dispersion of insulin suspensions physician if problems arise. by rolling the vial gently between hands; avoid vigorous Store shaking. drug in the refrigerator or in a cool place out of direct sunlight; do not freeze insulin. Give maintenance doses subcutaneously, rotating If sites regularly possible, drug is stable at injection refrigeration is notto decrease incidence of controlled room temperatureinsulin IVof directin severe lipodystrophy; give regular and out or IM sunlight for up to 1 month. ketoacidosis or diabetic coma. your urine or blood for glucose and Monitor patients receiving insulin IV carefully; ketonesIV prescribed. have been reported to remove plastic as infusion sets Wear medical alert tag stating that you have 20%80% ofathe insulin; dosage delivered to the patient diabetes and are taking insulin so that emergency will vary. medical personnel will take proper care concentrated IV; Do not give insulin injection of you. Avoid alcohol; serious can occur. severe anaphylactic reactionsreactions can occur. Report fever, whenthroat, vomiting, hypoglycemic Use caution sore mixing two types of insulin; or hyperglycemic regular insulin into the syringe first; if always draw the reactions, rash. mixing with insulin lispro, draw the lispro first; use mixtures of regular and NPH or regular and Lente insulins within 515 min of combining them; Lantus insulin (insulin glargine) and Levemir (insulin detemir)

ipratropium bromide Use nebulizer mouthpiece instead of face mask to Apo-Ipravent (CAN), Atrovent, Novo-Ipramide (CAN) avoid blurred vision or aggravation of narrow-angle glaucoma. Drug classes AnticholinergicCan mix albuterol in nebulizer for up to 1 hr. Antimuscarinic Ensure adequate hydration, control environmental drug temperature to prevent hyperpyrexia. Parasympatholytic Have patient void before taking medication to avoid urinary Therapeutic actions retention. Teach patient related to inhalator. Anticholinergic, chemically proper use ofatropine, which blocks Teaching points vagally mediated reflexes by antagonizing the action of Use this drug as an inhalation product. Review the acetylcholine. Causes bronchodilation and inhibits secretion from proper use of inhalator; the spray, serous and seromucous glands liningfor nasal mucosa.initiation of pump requires 7 actuations; if not used for 24 hours, 2 Indications actuations will be needed before use. Protect from light; Bronchodilator for maintenance treatment of do not freeze. bronchospasm associated with COPD (solution, aerosol), You may experience these side chronic bronchitis, and emphysema effects: Dizziness, headache, blurred vision (avoid driving or performing Nasal spray: Symptomatic relief of rhinorrhea hazardous tasks); nausea, vomiting, GI cold associated with perennial rhinitis, common upset (proper nutrition is important; Contraindications and cautions consult with your dietitian to maintain nutrition); cough. hypersensitivity to atropine or Contraindicated with Report rash, or pain, difficulty voiding, its derivatives, soy beaneyepeanut allergies (aerosol). palpitations, vision changes. narrow-angle glaucoma, Use cautiously with prostatic hypertrophy, bladder neck obstruction, pregnancy, lactation. Available forms

Aerosol18 mcg/actuation; solution for inhalation0.02% irbesartan (500 mcg/vial) nasal spray0.03% (21 mcg/spray), 0.06% Avapro (42 mcg/spray) Metabolism: Hepatic, T 1/2: 1.6 hr Drug classes May cross placenta, may enter breast milk Distribution: AngiotensinUnknown antagonist (ARB) Excretion: II receptor Antihypertensive Adverse effects CNS: Nervousness, dizziness, headache, fatigue, Therapeutic actions insomnia, blurred vision Selectively blocks the binding distress, dry mouth specific tissue GI: Nausea, GI of angiotensin II to receptors foundRespiratory: Dyspnea, bronchitis, bronchospasms, in the vascular smooth muscle and adrenal gland; this action blocks the vasoconstriction effecthoarseness reninURI, cough, exacerbation of symptoms, of the angiotensin system as well as thepain, chest pain, allergic-type Other: Back release of aldosterone, leading to decreasedreactions, palpitations, rash BP. Indications Nursing considerations Treatment of hypertension as monotherapy or in Assessment combination with other antihypertensives History: Hypersensitivity to atropine, soybeans, Slowing of preparation); acute bronchospasm, peanuts (aerosol the progression of nephropathy in patients with glaucoma, prostatic type 2 (noninsulinnarrow-angle hypertension and hypertrophy, bladder dependent) diabetes neck obstruction, pregnancy, lactation Unlabeled use: CHF color, lesions, texture; T; Physical: Skin Contraindications andreflexes, bilateral grip strength; affect; orientation, cautions Contraindicated with BP; R, adventitious sounds; ophthalmic examination; P,hypersensitivity to irbesartan, pregnancy (use during the second or third trimester can bowel sounds, normal output; normal urinary output, cause injury or even death to the fetus). prostate palpation Interventions Use cautiously with hepatic or renal dysfunction, hypovolemia, lactation, for inhalation from light. Store Protect solution pregnancy. Availableunused vials in foil pouch. forms Tablets75, 150, 300 mg

fluid depleted [extreme hr Metabolism: Hepatic; T1/2: 1115 heat, exertion]; avoid driving or performing hazardous tasks); headache (medications Distribution: Crosses placenta; enters breast milk may be available to help); nausea, vomiting, diarrhea Excretion: Feces, urine (proper Adverse effects nutrition is important; consult a dietitian); symptoms of upper respiratory tract infection, cough (do CNS: Headache, dizziness, syncope, muscle not self-medicate; consult your health care provider if weakness, sleep disturbance this becomes uncomfortable). orthostatic hypotension, CV: Hypotension, Report fever, chills, dizziness, pregnancy. flushing Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin GI: Diarrhea, abdominal pain, nausea, constipation, dry mouth, dental pain Respiratory: URI symptoms, cough, sinus disorders Other: Cancer in preclinical studies, back pain, fever, gout, fatigue, neutropenia, angioedema Interactions Drug-drug Use caution with drugs metabolized by CYP2C9; anticipated effects may be altered. Nursing considerations Assessment History: Hypersensitivity to irbesartan, pregnancy, lactation, hepatic or renal dysfunction, hypovolemia Physical: Skin lesions, turgor; T; reflexes, affect; BP; R, respiratory auscultation; LFTs, renal function tests

Interventions isosorbide nitrates Administer without regard to meals. WARNING: Ensure that patient is not pregnant isosorbidebefore beginning therapy; suggest using barrier birth dinitrate Apo-ISDN (CAN), Dilatrate SR, Isordil, Isordil Titradose deaths control while using irbesartan; fetal injury and isosorbidehave been reported. mononitrate Imdur, ISMO, Isotrate ER, Monoketmethod of feeding the baby if Find an alternative giving drug to a nursing mother. Depression of the reninDrug classes angiotensin system in infants is potentially very Antianginal dangerous. Nitrate WARNING: Alert surgeon and mark patient's Vasodilator chart with notice that irbesartan is being taken. The Therapeutic actionsof the renin-angiotensin system following blockage Relaxes vascular can produce problems. Hypotension may be surgery smooth muscle with a resultant decrease in venous return andwith volume expansion.BP, which reduces left reversed decrease in arterial ventricular workload patient closely in any situation that may Monitor and decreases myocardial oxygen consumption. to a decrease in BP secondary to reduction in fluid lead Indications volume (excessive perspiration, dehydration, vomiting, Dinitrate: Treatment and prevention diarrhea); excessive hypotension can occur. of angina Teaching pectoris points Mononitrate: Prevention of angina pectoris not stop Take this drug without regard to meals. Do Contraindications and cautions taking this drug without consulting your health care Contraindicated with allergy to nitrates, severe provider. anemia, head trauma, cerebral hemorrhage, hypertrophic Use a barrier method of birth control while using cardiomyopathy, narrow-angle this drug; if you become pregnantglaucoma, to become or desire postdural hypotension pregnant, consult your health care provider. Use cautiously with pregnancy, lactation, Dizziness You may experience these side effects: acute MI, CHF. (more likely to occur in any situation where you may be

Available forms WARNING: 30, life support equipment readily Dinitrate: tablets5, 10, 20, Keep40 mg; SR tablets40 mg; SR available if overdose 5, 10 mg; cardiac condition capsules40 mg; SL tablets2.5, occurs orchewable tablets5, 10 mg worsens. WARNING: Gradually reduce dose if mg Mononitrate: Tablets10, 20 mg; ER tablets 30, 60, 120 anginal treatment is T1/2: min, then 25 hr Metabolism: Hepatic; being5terminated; rapid discontinuation can lead to problems of withdrawal. Distribution: May cross placenta; may enter breast milk Teaching points Excretion: Urine Place sublingual tablets under your tongue or in your cheek; do not chew or swallow the tablet. Take the Adverse effects isosorbide before chest pain begins, when restlessness, CNS: Headache, apprehension, activities or situation may precipitate an faintness weakness, vertigo, dizziness, attack. Take oral isosorbide dinitrateCV: an Tachycardia, retrosternal discomfort, on empty stomach, 1 hour before or 2 hours after meals; do not chew or crush sustained-release palpitations, hypotension, syncope, collapse, orthostatic preparations; do not take isosorbide mononitrate to hypotension, angina, rebound hypertension, atrial relieve acute anginal episodes. fibrillation, postdural hypertension You may experience these exfoliative dermatitis, Dermatologic: Rash, side effects: Dizziness, light-headedness (may with flushing use care to change cutaneous vasodilation be transient; positions Nausea, vomiting, incontinence of urine cool GI: slowly); headache (lie down in a and environment, rest; over-the-counter preparations may not feces, abdominal pain, diarrhea help; GU: drug with meals); flushing of the neck or face take Dysuria, impotence, urinary frequency (reversible). Muscle twitching, pallor, perspiration, cold Other: Report blurred vision, persistent or severe sweat, arthralgia, bronchitis headache, rash, more frequent or more severe angina Interactions Drug-drug Increased systolic BP and decreased antianginal effect if taken concurrently with ergot alkaloids Drug-lab test

False report of decreased serum cholesterol if done labetalol hydrochloride by the Zlatkis-Zak color reaction Normodyne, Trandate Nursing considerations CLINICAL ALERT! Drug classes Name confusion has occurred between Isordil (isosorbide) and Alpha- and beta-adrenergic blocker Plendil (felodipine); use caution. Antihypertensive Assessment Therapeutic actions History: Allergy to nitrates, severe anemia, GI Competitively blocks alpha1- and beta1- cerebral hemorrhage, hypermobility, head trauma, and beta2-adrenergic receptors, hypertrophic cardiomyopathy, pregnancy, lactation beta2and has some sympathomimetic activity at receptors. Alpha-Physical: Skin color, temperature, the BPand beta-blocking actions contribute to lesions; lowering effect; beta blockade prevents the reflex tachycardia seen orientation, reflexes, affect; P, BP, orthostatic BP, with most alpha-blockingperipheral perfusion; R, plasma renin drugs and decreases adventitious baseline ECG, activity. sounds; liver evaluation, normal output; CBC, Hgb Indications Interventions Hypertension, preparations under the oral drugs, Give sublingual alone or with other tongue or in especially diuretics the buccal pouch; discourage the patient from Parenteral preparations: Severe hypertension swallowing. Unlabeled uses: Control of BP Create a nitrate-free period to minimize tolerance.in pheochromocytoma; Give chewable tablets slowly, only WARNING: clonidine withdrawal hypertension Contraindications and cautions severe hypotension can occur; 5 mg initially, because Contraindicated does not chew or second or ensure that patient with sinus bradycardia, crush SR third-degree heart block, cardiogenic shock, CHF, preparations. asthma. Give oral preparations on an empty stomach, 1 hr Use 2 hr after meals; take or hypoglycemia (can before or cautiously with diabetes with meals if severe, mask cardiac signs occurs. uncontrolled headache of hypoglycemia), nonallergic bronchospasm (oral drugIV is absolutely contraindicated), pheochromocytoma (paradoxical increases in BP have occurred), pregnancy, lactation.

Possible falsely elevated urinary catecholamines in Available forms lab 200, 300 a trihydroxyindole reaction Tablets100,tests usingmg; injection5 mg/mL Nursing considerations Metabolism: Hepatic; T1/2: 68 hr Assessment Crosses placenta; enters breast milk Distribution: History: Sinus bradycardia, second- or thirdExcretion: Urine degree heart block, cardiogenic shock, CHF, asthma, IV facts pregnancy, lactation, diabetes or hypoglycemia, nonallergic bronchospasm, pheochromocytoma Preparation: Add 200 mg to 160 mL of a compatible IV fluid to Physical: Weight, skin condition, 200 mg (2 make a 1 mg/mL solution; infuse at 2 mL/min, or add neurologic ampules) status, P, BP, ECG, respiratory status, renal and thyroid to 250 mg of IV fluid to make a 2 mg/3 mL solution, infuse at 3function, blood and urine fluids include Ringer's, lactated mL/min. Compatible IV glucose Ringer's, 0.9% sodium chloride, 2.5% dextrose and 0.45% sodium Interventions dextrose, 5% dextrose and Ringer's, 5% dextrose and chloride, 5% WARNING: Do not and 0.2%, drug or 0.9% 5% lactated Ringer's, and 5% dextrose discontinue0.33%, abruptly after sodium chloride. long-term for therapy. in these solutions to Stable 24 hr (Hypersensitivity at catecholamines and have developed, causing concentrations between 1.25 may3.75 mg/mL. Infusion: exacerbationinfusion at 23 mL/min; inject slowly over 2 Administer of angina, MI and ventricular arrhythmias; taper drug gradually over 2 wk with monitoring.) min. Consult with physician in 5% sodium bicarbonate Incompatibilities: Do not dilute drug about withdrawing the drug if the alkaline solutions, including furosemide. injection or other patient is to undergo surgery (withdrawal is controversial). Y-site incompatibilities: Do not give with cefoperazone, nafcillin. Keep patient supine during parenteral therapy, and assist Adverse effectsinitial ambulation. Position to decrease effects of edema. depression, CNS: Dizziness, vertigo, fatigue, Provide sleep paresthesias, support and encouragement to deal with disturbances, hallucinations, drug effects and disease. disorientation, memory loss, slurred speech Teaching points

CV: CHF, cardiac arrhythmias, peripheral vascular Take drug with meals. insufficiency, claudication, CVA, pulmonary edema, Do not hypotension stop taking unless instructed to do so by a health care provider. Rash, pruritus, sweating, dry skin Dermatologic: If you have diabetes, monitoreyes, blood glucose EENT: Eye irritation, dry your conjunctivitis, carefully. This drug may mask usual symptoms of blurred vision hypoglycemia. GI: Gastric pain, flatulence, constipation, You may experience these side ischemic colitis, diarrhea, nausea, vomiting, anorexia,effects: Dizziness, light-headedness, appetite, nightmares, renal and mesentericloss ofthrombosis, retroperitoneal arterial depression, sexual impotence. fibrosis, hepatomegaly, acute pancreatitis Report Impotence, decreased libido, Peyronie's GU: difficulty breathing, night cough, swelling of extremities, slow pulse, confusion, priapism, urinary disease, dysuria, nocturia, polyuria, depression, rash, fever, sore throat. retention Respiratory: Bronchospasm, dyspnea, cough, bronchial obstruction, nasal stuffiness, rhinitis, pharyngitis Other: Decreased exercise tolerance, development of antinuclear antibodies, hyperglycemia or hypoglycemia, elevated liver enzymes Interactions Drug-drug Risk of excessive hypotension with enflurane, halothane, or isoflurane Potential for added anithypertensive effects with nitroglycerin Additive A-V block with calcium channel-blockers Drug-lab test

lansoprazole Adverse Prevacid Prevacid,effects IV CNS: Pregnancy Category B Headache, dizziness, asthenia, vertigo, insomnia, anxiety, paresthesias, dream abnormalities Dermatologic: Rash, inflammation, urticaria, Drug classes pruritus, alopecia, dry skin, acne Antisecretory GI: Diarrhea, abdominal pain, nausea, vomiting, Proton pump inhibitor constipation, Therapeutic actions dry mouth Respiratory: Suppresses gastric acid secretion Gastric acid-pump inhibitor: URI symptoms, cough, epistaxis by Other: Gastric cancer in preclinical studies, back specific inhibition of the hydrogenpotassium ATPase enzyme system at pain, fever surface of the gastric parietal cells; blocks the secretory Interactions the final step of acid production. Drug-drug Indications Decreased serum levels (up to 4 wk) of active Short-term treatment if taken concurrently with sucralfate duodenal ulcer Decreased serum Short-term treatment (uplevelswk) of gastric ulcers to 8 of ketoconazole, theophylline when treatment (up to 8 wk) of GERD: Short-term taken with lansoprazole Nursing considerations Severe erosive esophagitis; poorly responsive Assessment symptomatic GERD History: Hypersensitivity to lansoprazole or any of Long-term treatment of pathological its components; conditions (eg, hypersecretory pregnancy; lactation Zollinger-Ellison Physical: Skin lesions; body T; reflexes, affect; syndrome, multiple adenomas, systemic mastocytosis) urinaryMaintenance therapy examination; of erosive output, abdominal for healing respiratory auscultation esophagitis, duodenal ulcers Eradication of Helicobacter pylori infection in Interventions patients with active or recurrent duodenal ulcers in Administer before meals. amoxicillin combination with clarithromycin andCaution patient to swallow capsules whole, not to open, chew, or crush. If patient has difficulty swallowing, open capsule and

Short-term treatment (up to 8 wk) of symptomatic sprinkle granules on apple sauce, Ensure, 111 yr GERD and erosive esophagitis in children yogurt, cottage cheese, or strained pears; for 7 days) of alltube, mix Short-term treatment (up to nasogastric grades of granules from capsule with 40 mL apple juice take oral erosive esophagitis when patient is unable to and inject through tube, medication (IVflush tube with additional apple juice; or granules and cautions Contraindications for oral suspension can be added to 30 mL water, stir well, and havewith hypersensitivity to patient drink immediately. Contraindicated Place orally or any of its components. lansoprazole disintegrating tablet on tongue; follow with water Use cautiously with pregnancy, lactation. after it dissolves. WARNING: Arrange for further evaluation of Available forms patient 30 mg; wk of therapy for acute gastroreflux DR capsules15,after 4 orally disintegrating DR tablets15, 30 mg; DR disorders forsymptomatic improvement does not rule out granules if oral suspension15, 30 mg; injection gastric cancer, which did occur in preclinical studies. 30 mg/vial Switch to oral drug from IV as soon as patient is able to take T1/2: 2 hr, Use of IV Metabolism: Hepatic;oral drugs. 1.3 hr (IV)drug for > 7 days is not approved. Distribution: Crosses placenta; may enter breast milk Teaching points Excretion: Bile Take the drug before meals. Swallow the capsules IV facts wholedo not chew, open, or crush. If you are unable to swallow capsule, open mL sterile granules injection Preparation: Reconstitute with 5and sprinkle water for on apple (resulting sauce, or6 use granules, gently until be added to 30 mL solution mg/mL); mix which can powder is dissolved; water, stirred, and for 1 immediately. If Dilute in 50 reconstituted solution is stabledrunk hr before dilution. using orally mL 0.9%disintegrating tablet, place on lactated Ringers,allow5% sodium chloride injection, your tongue and or to dissolve. Follow with hr (0.9% water. dextrose injection. Stable for 24a drink of sodium chloride, lactated Arrange to have Ringers) or 12 hr (5% dextrose). regular medical follow-up care Infusion: whilein-line filter provided with product. Infuse over 30 Use you are taking this drug. You may experience these side min; flush line with appropriate dilution fluid. effects: Dizziness (avoid driving car or performing hazardous tasks); Incompatibilities: Do notaadminister with other drugs. headache (medications may be available to help); nausea,

vomiting, diarrhea (proper nutrition is important, consult Contraindicated with hypersensitivity to of upper a dietitian to maintain nutrition); symptoms levodopa; allergy to tartrazine (marketed as Dopar); glaucoma, respiratory tract infection, cough (reversible; do not selfespecially consult your health care provider if this medicate, angle-closure glaucoma; history of melanoma; suspicious or undiagnosed becomes uncomfortable). skin lesions; lactation. Use cautiously in psychiatric patients, especially Report severe headache, worsening of symptoms, the depressed fever, chills. or psychotic; and with severe CV or pulmonary disease; occlusive cerebrovascular disease; history of MI with residual arrhythmias; bronchial asthma; renal, hepatic, endocrine disease; history of peptic ulcer; pregnancy. Available forms Tablets100, 250, 500 mg; capsules100, 250, 500 mg Metabolism: Hepatic; T1/2: 13 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine Adverse effects CNS: Adventitious movement (eg, dystonic movements), ataxia, increased hand tremor, headache, dizziness, numbness, weakness and faintness, bruxism, confusion, insomnia, nightmares, hallucinations and delusions, agitation and anxiety, malaise, fatigue, euphoria, mental changes (including paranoid ideation), psychotic episodes, depression with or without suicidal tendencies, dementia, bradykinesia ("on-off" phenomenon), muscle twitching and blepharospasm, diplopia, blurred vision, dilated pupils CV: Cardiac irregularities, palpitations, orthostatic hypotension

levodopa Dopar, LarodopaDermatologic: Flushing, hot flashes, increased sweating, rash GI: Anorexia, nausea, vomiting, abdominal pain or Drug class distress, Antiparkinsonian dry mouth, dysphagia, dysgeusia, bitter taste, sialorrhea, Therapeutic actions trismus, burning sensation of the tongue, diarrhea, constipation, flatulence, weight change, upper Biochemical precursor of the neurotransmitter dopamine, which is deficient GI hemorrhage in patients parkinsonism patients; unlike in the basal ganglia of with history of peptic ulcer GU: penetrates the bloodbrain barrier. dopamine, levodopaUrinary retention, urinary incontinence It is transformed in Hematologic: Leukopenia, anemia, elevated BUN, the brain to dopamine; thus, levodopa is a form of AST, ALT, LDH, bilirubin, alkaline phosphatase, replacement therapy. It is efficacious for 25 yr in relieving the symptomsprotein-bound iodine not drug-induced extrapyramidal of parkinsonism but Respiratory: Bizarre breathing patterns disorders. Interactions Indications Drug-drug Treatment of parkinsonism (postencephalitic, WARNING: Increased therapeutic effects and arteriosclerotic, and idiopathic types) and symptomatic possible hypertensive injury to the nervous withdraw parkinsonism, followingcrisis with MAOIs; system by MAOIs at least 14 days before starting levodopa therapy carbon monoxide or manganese intoxication Decreased efficacy carbidopa (Lodosyn; fixed with pyridoxine (vitamin B6), Given with phenytoin, papaverine, TCAs, enzyme inhibitor that combinations, Sinemet), an benzodiazepines Drug-lab test decreases the activity of dopa decarboxylase in the May thus reducing blood levels of levodopa and periphery, interfere with urine tests for sugar or ketones False the intensity and incidence of many of the decreasing Coombs' test results adverseFalse elevations of uric acid when using effects of levodopa colorimetric method Relief of herpes zoster (shingles) Unlabeled use: Nursing considerations syndrome pain; restless leg Assessment Contraindications and cautions History: Hypersensitivity to levodopa, tartrazine; glaucoma; history of melanoma; suspicious or

undiagnosed skin lesions; severe CV or pulmonary levofloxacin disease; occlusive cerebrovascular disease; history of MI Levaquin with residual arrhythmias; bronchial asthma; renal, hepatic, endocrine disease; history of peptic ulcer; Drug classes psychiatric disorders; lactation, pregnancy Antibiotic Physical: Weight; T; skin color, lesions; Fluoroquinolone orientation, affect, reflexes, bilateral grip strength, vision Therapeutic actions P, BP, orthostatic BP, auscultation; R, examination; Bactericidal: Interferes with DNA by bowel sounds, normal depth, adventitious sounds; inhibiting DNA gyrase replication in susceptible gram-negative and normal output, output, liver evaluation; voiding pattern, gram-positive bacteria, preventing cell reproduction. prostate palpation; LFTs, renal function tests; CBC with Indications differential Treatment of adults with community-acquired pneumonia, bacterial sinusitis caused by susceptible Interventions bacteria, including multidrug resistant strains dosage if WARNING: Arrange to decrease therapyTreatment of acute exacerbation of chronic is interrupted; observe for the development of bronchitis caused by susceptible bacteria suicidal tendencies. Treatment of complicated occurs. Give with meals if GI upsetand uncomplicated skin and skin structure infections before receiving dose if Ensure that patient voids caused by susceptible bacteriaretention is a problem. urinary Treatment hepatic, renal, and uncomplicated UTIs Monitor of complicated hematopoietic, and CV and acute pyelonephritis caused by susceptible bacteria function. Treatment of chronictake multivitamins provide For patients who bacterial prostatitis due to Escherichia coli, Enterococcus pyridoxine. Larobec, a preparation without faecalis, Staphylococcus Treatment of nosocomial pneumonia due to Staphylococcus aureus, Teaching methicillin-sensitive points Pseudomonas drug exactly as prescribed. Take this strains, Serratia, Escherichia coli, Klebsiella, Haemophilus influenzae, Streptococcus pneumoniae

Do not take multivitamin preparations with Treatment of postexposure inhalational anthrax pyridoxine. These may prevent any therapeutic effect of Unlabeled your health care provider if you need levodopa. Notify uses: Traveler's diarrhea, epididymitis, gonococcal infection, pelvic inflammatory disease, vitamins. urethritis You may experience these side effects: Contraindications and cautions confusion, blurred vision (avoid Drowsiness, dizziness, Contraindicated with allergy to require alertness driving or engaging in activities that fluoroquinolones, lactation. and visual acuity); nausea (take with meals; eat frequent small Use cautiously with renal dysfunction, seizures, meals); dry mouth (suck sugarless lozenges or ice pregnancy. chips); painful or difficult urination (empty bladder Availablebefore each dose); constipation (maintain adequate fluid forms Tablets250, 500, 750 mg; regularly, request750 mg; premixed intake and exercise injection500, correctives); dark injection250, 500, 750(not harmful); dizziness or faintness when sweat or urine mg; oral solution25 mg/mL you get up (change position slowly and use caution when Metabolism: Hepatic; T1/2: 47 hr climbing stairs). Distribution: Crosses placenta; enters breast milk Report fainting, light-headedness, dizziness; Excretion: Urine uncontrollable movements of the face, eyelids, mouth, IV facts tongue, neck, arms, hands, or legs; mental changes; Preparation: No heartbeat or palpitations; difficult using the irregular further preparation is needed if urination; premixed severe or dilute single-use vials in 50100 mL D5W. solution; persistent nausea or vomiting. Infusion: Administer slowly over at least 6090 min. Do not administer IM or subcutaneously. Compatibilities: Can be further diluted in 0.9% sodium chloride injection, 5% dextrose injection, 5% dextrose/0.9% sodium chloride, 5% dextrose in lactated Ringer's, Plasma-Lyte 56 and 5% Dextrose injection, 9% dextrose/0.45% sodium chloride, 0.15% potassium chloride, sodium lactate injection. Adverse effects

 CNS: Headache, dizziness, insomnia, fatigue, levothyroxine sodium blurred vision T4) somnolence, (L-thyroxine, Levothroid, Levoxine, Nausea, vomiting, Thyro-Tabs, Unithroid GI: Levoxyl, Synthroid, dry mouth, diarrhea, abdominal pain (occur less with this drug than with Drug class oflaxacin), constipation, flatulence Thyroid hormone Hematologic: Elevated BUN, AST, ALT, serum Therapeutic actions and alkaline phosphatase; neutropenia, creatinine, Increases anemia the metabolic rate of body tissues, thereby increasing oxygen consumption; respiration andphotosensitivity, protein, and Other: Fever, rash, HR; rate of fat, muscle carbohydrate metabolism; and growth and maturation. joint tenderness, increased serum glucose Indications Interactions Replacement therapy in hypothyroidism Drug-drug Pituitary TSH suppression in the treatmentsalts, Decreased therapeutic effect with iron and prevention of euthyroid goiters and in the management sulcrafate, antacids, zinc, magnesium (separate by at of thyroid cancer least 2 hr) Thyrotoxicosis seizures with NSAIDs; avoid this Increased risk of in conjunction with antithyroid drugs and to prevent goitrogenesis, hypothyroidism, and combination thyrotoxicosis Drug-alternative therapy during pregnancy Treatment risk of severe coma Increased of myxedema photosensitivity reactions Contraindications and cautions if combined with St. John's wort therapy Contraindicated with allergy to active or Nursing considerations extraneous constituents of drug, thyrotoxicosis, and acute Assessment MI uncomplicatedAllergy to fluoroquinolones, renal History: by hypothyroidism. Use seizures, lactation, pregnancy dysfunction, cautiously with Addison's disease (treat hypoadrenalism with corticosteroids before thyroid Physical: Skin color, lesions; T; orientation, therapy), lactation, patients membranes, bowel sounds; reflexes, affect; mucous with coronary artery disease or angina. function tests; blood glucose (diabetics) LFTs, renal Available forms Interventions

Arrange for culture and sensitivity tests before Tablets25, 50, 75, 88, 100, 112, 125, 137, 150, 175, 200, beginning therapy. 300 mcg; powder for injection200, indicated for condition being Continue therapy as 500 mcg/vial treated. Metabolism: Hepatic; T1/2: oral days without regard to meals with Administer 67 drug Distribution: Crosses placenta; entersoral drug from other cation a glass of water; separate breast milk Excretion: Bile administration, including antacids, by at least 2 hr. Ensure that patient is well hydrated during course IV facts of therapy. Preparation: Add 5 mL 0.9% Discontinue druginjection, sign of WARNING: sodium chloride at any USP or bacteriostatic sodium chloride injection, USP with at complaint of hypersensitivity (rash, photophobia) or benzyl alcohol. Shake thetendon pain, inflammation, or rupture. immediately after vial to ensure complete mixing. Use reconstitution. Discard any unused portion. if no improvement is Monitor clinical response; Infusion: seen or a relapse occurs, repeat culture and sensitivity Inject directly, each 100 mcg over 1 min. Incompatibilities: Do not mix with any other IV fluids. test. Adverse effects Teaching points CNS: Tremors, headache, nervousness, insomniaan Take oral drug without regard to meals. If CV: Palpitations, tachycardia, angina, cardiac antacid is needed, do not take it within 2 hours of arrest levofloxacin dose. Dermatologic:of fluids skin reactions, partial loss Drink plenty Allergic while you are using this of hair in first few months of therapy in children drug. GI: may experience vomiting, gagging, tablet You Diarrhea, nausea,these side effects: Nausea, stuck in throat, choking vomiting, abdominal pain (eat frequent small meals); Interactions diarrhea or constipation (consult nurse or physician); Drug-drug drowsiness, blurred vision, dizziness (use caution if Decreased absorption of oral thyroid preparation driving or operating dangerous equipment); sensitivity to with cholestyramine sunlight (avoid exposure, use a sunscreen if necessary). Increased risk of changes, with warfarinreduce Report rash, visual bleeding severe GI problems, dosage of anticoagulant when T4 is begun

 Decreased effectiveness of digitalis glycosides if lidocaine taken with thyroid replacement hydrochloride) Decreased theophylline clearance when patient is lidocaine HCl in 5% dextrose monitor levels and patient response in hypothyroid state; as euthyroid state is achieved lidocaineconsiderations Nursing HCl without preservatives Antiarrhythmic preparations: Assessment Xylocaine HCl IV for Cardiac Arrhythmiasactive or extraneous History: Allergy to Local anesthetic preparations:drug, thyrotoxicosis, acute MI constituents of Octocaine, Xylocaine HClby hypothyroidism, Addison's disease, uncomplicated (injectable) Topical for mucous membranes: lactation Anestacon, Burn-O-Jel, Skin lesions, color, T, texture;ELA-Max, Physical: Dentipatch, DermaFlex, T; muscle Xylocaine, Zilactin-L tone, orientation, reflexes; P, auscultation, baseline ECG, Topical dermatologic: BP; R, adventitious sounds; thyroid function tests Lidoderm, Numby Stuff, Xylocaine Interventions Drug classes Monitor response carefully at start of therapy, and Antiarrhythmic dosage. Full therapeutic effect may not be seen for adjust Local anesthetic days. several Therapeutic actions that patient swallows tablet with a full glass Ensure Type 1 of water. antiarrhythmic: Decreases diastolic depolarization, decreasing automaticity of ventricular cells; T4 products, due to Do not change brands of increases ventricular fibrillation threshold. possible bioequivalence problems. Local anesthetic: Blocks the generation andIV fluids. of action Do not add IV doses to other conduction potentials in sensory nerves patients with CV disease. Use caution in by reducing sodium permeability, reducing heightAdminister oral drug asaction potential, increasing and rate of rise of the a single daily dose before excitation breakfast with a full glass of water. velocity. threshold, and slowing conduction Indications

Arrange for regular, periodic blood tests of thyroid As antiarrhythmic: Management of acute function. ventricular arrhythmias during cardiac surgery swallow For children and other patients who cannot and MI (IV use). Use and when IV in a small amountnot water or tablets, crush IM suspend administration is of possible or when ECG monitoringover soft food. Administer formula, or sprinkle is not available and the danger of ventricular arrhythmias is great (single-dose IM use, immediately. for example, by paramedics in a mobileadverse effects WARNING: Most CV and CNS coronary care unit) indicate that the dose is too high. Stop drug for several As anesthetic: Infiltration anesthesia, peripheral days and reinstitute at a lower dose. Teaching and sympathetic nerve blocks, central nerve blocks, points spinalTake as acaudal dose before breakfast with a and and single anesthesia, retrobulbar full transtracheal injection; topical anesthetic for skin glass of water. disorders and accessible mucous membranes This drug replaces an important hormone and will Contraindicationsbe taken for life. Do not discontinue without need to and cautions Contraindicated with allergy to lidocaine problems consulting your health care provider; serious or amidetypeoccur. anesthetics, CHF, cardiogenic shock, secondcan local or third-degree heart block (if no artificial pacemaker), Wear a medical ID tag to alert emergency medical Wolff-Parkinson-White Stokes-Adams personnel that you are usingsyndrome, this drug. syndrome. Arrange to have periodic blood tests and medical Use Keep your with hepatic or renal evaluations. cautiously scheduled appointments. disease, inflammation headache, in the region palpitations, fever, Report or sepsis chest pain, of injection (local anesthetic), labor and delivery nervousness, irritability, weight loss, sleeplessness, (epidural anesthesia may prolong sweating, intolerancelabor; monitor for fetal and unusual the second stage of to heat, diarrhea. neonatal CV and CNS toxicity), and lactation. Available forms Direct injection10, 20 mg/mL; IV injection (admixture) 40, 100, 200 mg/mL; IV infusion2, 4, 8 mg/mL; topical liquid2.5%, 5%; topical ointment2.5%, 5%; topical cream0.5%; topical gel0.5%, 2.5%; topical spray0.5%, 10%; topical solution

2%, 4%; topical jelly2%; injection0.5%, 1%, 1.5%, 2%, 4%, History: Allergy to lidocaine or amide-type local 5%; patchvaries anesthetics, CHF, cardiogenic shock, second- or thirddegree heart 1/2: 10 Wolff-Parkinson-White syndrome, Metabolism: Hepatic; Tblock, min, then 1.53 hr Stokes-Adams syndrome, breast milk Distribution: Crosses placenta; enters hepatic or renal disease, inflammation or sepsis in region of injection, lactation, Excretion: Urine pregnancy Physical: T; skin color, rashes, lesions; orientation, IV facts speech, reflexes, sensation and as follows: (local Preparation: Prepare solution for IV infusion movement 12 g lidocaine anesthetic); dextrose in water = 0.1%0.2% solution; 1 to 1 L 5% P, BP, auscultation, continuous ECG monitoring during use after dilution. 2 mg lidocaine/mL. Stable for 24 hras antiarrhythmic; edema; R, Infusion: adventitious sounds; bowel rate of 2550 mg/min. An IV bolus: Give 50100 mg at sounds, liver evaluation; urine output; serum electrolytes, LFTs, renal function infusion rate of 14 mL/min of a 1 mg/mL solution will provide 1 tests 4 mg lidocaine/min. Use only preparations of lidocaine specifically Interventions labeled for IV infusion. WARNING: Check drug concentration carefully; many Adverse effectsconcentrations are available. Antiarrhythmic Reduce dosageadministration renal failure. with systemic with hepatic or Continuously monitor light-headedness, used as CNS: Dizziness or response when fatigue, antiarrhythmic or injected as local anesthetic. drowsiness, unconsciousness, tremors, twitching, vision WARNING: Keep life-support equipment and changes; may progress to seizures vasopressors readily available in case severe adverse CV: Cardiac arrhythmias, cardiac arrest, reaction (CNS, CV, or respiratory) occurs when vasodilation, hypotension lidocaine is injected. GI: Nausea, vomiting WARNING: Establish anaphylactoid reactions Hypersensitivity: Rash, safety precautions if CNS changes occur; have IV diazepam orand arrest Respiratory: Respiratory depression short-acting barbiturate (thiopental, thiamylal) readily fever, local Other: Malignant hyperthermia, available in case of seizures. injection site reaction

Injectable local anesthetic for epidural or caudal anesthesia WARNING: Monitor for malignant hyperthermia CNS: Headache, backache, septic meningitis, (jaw muscle spasm, rigidity); have life-support persistent sensory, motor, or autonomic deficit of lower equipment and IV dantrolene readily available. spinal segments, sometimes with incomplete recovery Titrate dose to minimum needed for CV: Hypotension due to sympathetic block cardiac stability, when using lidocaine as antiarrhythmic. Dermatologic: Urticaria, pruritus, erythema, Reduce dosage when treating arrhythmias in CHF, edema digitalis toxicity with AVretention, geriatric patients. GU: Urinary block, and urinary or fecal Monitor incontinence fluid load carefully; more concentrated solutions can Topical local anesthetic be used to treat arrhythmias in patients on fluid restrictions. Dermatologic: Contact dermatitis, urticaria, Have patients who have received lidocaine as a cutaneous lesions spinalHypersensitivity: Anaphylactoid reactions anesthetic remain lying flat for 612 hr afterward, and ensure thatBurning, adequately tenderness, minimize Local: they are stinging, hydrated to swelling, risk of headache. tissue sloughing and necrosis tissue irritation, WARNING: Check lidocaine preparation Other: Methemoglobinemia, seizures (children) carefully; epinephrine is added to solutions of lidocaine to Interactions retard the absorption of the local anesthetic from the injection site. Be sure that such solutions are used only to Drug-drug produce local anesthesia. These solutions should be Increased lidocaine levels with beta blockers injected cautiously in body areas supplied by end arteries (propranolol, metoprolol, nadolol, pindolol, atenolol), and used cautiously in patients with peripheral vascular cimetidine, ranitidine disease, hypertension, thyrotoxicosis, or diabetes. Prolonged apnea with succinylcholine Drug-lab test Use caution to prevent choking. Patient may have difficulty swallowing given IM use of oral topical Increased CPK if following anesthetic. Do not give food or drink for 1 hr after use of oral anesthetic. Nursing considerations Apply lidocaine ointments or creams to a gauze or Assessment bandage before applying to the skin.

 WARNING: Monitor for safe and effective serum Available drug concentrations (antiarrhythmic use: 15 mcg/mL). forms Tablets2.5, 5, > 610 30, 40 mg usually toxic. Doses 10, 20, mcg/mL are Metabolism: Hepatic; T1/2: 12 hr Teaching points Distribution: Crosses placenta; enters breast milk in response to Dosage is changed frequently Excretion: Urine rhythm on monitor. cardiac Adverse effectsOral lidocaine can cause numbness of the tongue, CNS: Headache, eat or drink for 1 hour after cheeks, and throat. Do notdizziness, insomnia, fatigue, paresthesias using oral lidocaine to prevent biting cheeks or tongue choking. and CV: Orthostatic hypotension, tachycardia, angina pectoris, MI,may experience these CHF, effects: Raynaud's syndrome, side severe You hypotension in salt- or volume-depleted patients nausea, Drowsiness, dizziness, numbness, double vision; GI: stinging, burning, local irritation (local vomiting; Gastric irritation, nausea, diarrhea, peptic ulcers, dysgeusia, cholestatic jaundice, hepatocellular anesthetic). injury, anorexia, constipation Report difficulty speaking, thick tongue, numbness, GU: Proteinuria, renal pain or numbness at IV tingling, difficulty breathing,insufficiency, renal failure, polyuria, oliguria, frequency site, swelling, or pain at site of local anesthetic use. Hematologic: Neutropenia, agranulocytosis, thrombocytopenia, hemolytic anemia, pancytopenia Other: Angioedema (particularly of the face, extremities, lips, tongue, larynx); death has been reported with airway obstruction; cough, muscle cramps, impotence, rash, pruritis Interaction Drug-drug Decreased antihypertensive effects if taken with lisinopril NSAIDs Exacerbation of cough if combined with capsaicin

Apo-Lisinopril (CAN), Prinivil, Zestril Nursing considerations CLINICAL ALERT! Drug classes Name confusion Antihypertensive has occurred between lisinopril and fosinopril; use caution. ACE inhibitor Assessment Therapeutic actions History: Allergy to is released enalapril, impaired Renin, synthesized by the kidneys, lisinopril or into the circulation renal a plasma precursor or volume depletion, I, which where it acts onfunction, CHF, salt to produce angiotensinlactation, pregnancy is converted by ACE to angiotensin II, a potent vasoconstrictor that Physical: Skin color, lesions, turgor; Lisinopril also causes release of aldosterone from the adrenals. T; P, BP, blocks theperipheral perfusion; mucousto angiotensin II, leading to conversion of angiotensin I membranes, bowel sounds, decreasedliver decreased aldosterone secretion, a small increase in BP, evaluation; urinalysis, LFTs, renal function tests, CBC and differential serum potassium levels, and sodium and fluid loss. Indications Interventions Treatment of hypertension alone or in combination Begin drug diuretics with thiazide-type within 24 hr of acute MI; ensure that patient Adjunctive therapy in treatment (eg patients is also receiving standard CHF for aspirin, thrombolytics, beta-adrenergic blockers). unresponsive to diuretics and digitalis alone WARNING: Keep epinephrine readily available in Treatment of stable patients within 24 hr of acute case improve survival the beta blocker, region; if MI toof angioedema of with face or neck aspirin, or breathing difficulty occurs, consult physician, and thrombolytics administer epinephrine. Contraindications and cautions WARNING: Alert surgeon, and mark patient's Contraindicated with allergy to lisinopril or chart with enalapril. notice that lisinopril is being taken. The angiotensin II formation impaired renal function, CHF, Use cautiously with subsequent to compensatory renin release during surgery lactation. salt or volume depletion, pregnancy, will be blocked. Hypotension may be reversed with volume expansion.

 Monitor patients on diuretic therapy for excessive hypotension following the first few doses of lisinopril. Monitor patients closely in any situation that may lithium carbonate a decrease in BP secondary to reduction in fluid lead to Carbolith volume Duralith (CAN), Eskalith, Eskalith dehydration, (CAN), (excessive perspiration and CR, Lithane (CAN), Lithobid, Lithonate, because excessive hypotension may vomiting, diarrhea) Lithotabs, PMS-Lithium Carbonate (CAN) occur. Arrange for reduced dosage in patients with lithium citrate impaired renal function. Cibalith-S (CAN) Suggest the use of contraceptives; if pregnancy should occur, discontinue drug as soon as possible. Drug class Antimanic drug Teaching points Therapeutic actions this drug once a day. It may be taken with Take Mechanism is not known; stop taking without consulting your meals. Do not alters sodium transport in nerve and muscle cells; inhibits release of norepinephrine and dopamine, but prescriber. not serotonin, Be careful in situations that may lead to a drop in from stimulated neurons; slightly increases intraneuronal stores of catecholamines; decreases intraneuronal blood pressurediarrhea, sweating, vomiting, content of second messengers and may or dizziness occurs, dehydration. If light-headedness thereby selectively modulate consult your health care hyperactive neurons that might the responsiveness of provider. contribute to theDo not state this drug during pregnancy; use of manic take Indications contraceptive measures is advised. Treatment experienceepisodes of effects: GI upset, You may of manic these side manic-depressive illness; appetite, change in taste prevent or (may be loss of maintenance therapy to perception diminish frequency and intensity of subsequent manic episodes transient; take with meals); rash; fast heart rate; Unlabeled use: Improvement of change position dizziness, light-headedness (transient; neutrophil counts in patientslimit activities to those that do not require with cancer chemotherapyinduced slowly, and neutropenia and in children with chronic neutropenia and alertness and precision); headache, fatigue, sleeplessness. HIV patients on zidovudine therapy (doses of 300 lithium

Report mouth sores; sore throat; fever; chills; 1,000 mg/day, serum or feet; irregular heartbeat; chest swelling of the hands levels of 0.5 and 1 mEq/L); prophylaxis of of the face, eyes, and cyclic migraine pains; swelling cluster headache lips, or tongue; and headache,breathing. of SIADH, hypothyroidism (doses difficulty treatment of 600900 mg/day) Contraindications and cautions Contraindicated with hypersensitivity to tartrazine; significant renal or CV disease; severe debilitation, dehydration; sodium depletion, patients on diuretics (lithium decreases sodium reabsorption, and hyponatremia increases lithium retention); pregnancy; lactation. Use cautiously with protracted sweating and diarrhea; suicidal or impulsive patients; infection with fever. Available forms Capsules150, 300, 600 mg; tablets300 mg; SR tablets 300 mg; CR tablets450 mg; syrup300 mg/5 mL Metabolism: Hepatic; T1/2: 1736 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine Adverse effects Reactions are related to serum lithium levels. (Toxic lithium levels are close to therapeutic levels. Therapeutic levels in acute mania range between 1 and 1.5 mEq/L; therapeutic levels for maintenance are 0.61.2 mEq/L) < 1.5 mEq/L

 CNS: Lethargy, slurred speech, muscle weakness, Encephalopathic syndrome (weakness, lethargy, fine hand tremor fever,GI: tremulousness, confusion, thirst extrapyramidal Nausea, vomiting, diarrhea, symptoms,Polyuria GU: leukocytosis, elevated serum enzymes) with irreversible moderate toxic reactions) 1.52 mEq/L (mild to brain damage when taken with haloperidol Greater risk of hypothyroidism with iodide salts CNS: Coarse hand tremor, mental confusion, Decreased effectiveness due to increased excretion hyperirritability of muscles, drowsiness, incoordination of lithium ECG changes alkalinizers, including antacids, CV: with urinary tromethamine GI: Persistent GI upset, gastritis, salivary gland Drug-alternative therapy swelling, abdominal pain, excessive salivation, Increased effects and toxicity with juniper, flatulence, indigestion dandelion 22.5 mEq/L (moderate to severe toxic reactions) Nursing considerations CNS: Ataxia, giddiness, fasciculations, tinnitus, Assessment blurred vision, clonic movements, seizures, stupor, coma History: Hypersensitivity to tartrazine; significant CV: Serious ECG changes, severe hypotension renal cardiac arrythmias with or CV disease; severe debilitation, dehydration; sodium depletion, patients onurine GU: Large output of dilute diuretics; protracted sweating, diarrhea; Fatalities secondary to pulmonary Respiratory: suicidal or impulsive patients; infection with fever; pregnancy; lactation complications Physical: Weight and T; skin color, lesions; > 2.5 mEq/L (life-threatening toxicity) orientation, affect, reflexes; ophthalmic examination; P, General: Complex involvement of multiple organ BP, R, adventitious sounds; bowel sounds,collapse, systems, including seizures, arrythmias, CV normal output; coma stupor, normal fluid intake, normal output, voiding Reactions pattern; thyroid, renal glomerular and tubular function unrelated to serum levels tests, urinalysis, CBC and differential, baseline ECGbrain CNS: Headache, worsening of organic syndromes, fever, reversible short-term memory Interventions impairment, dyspraxia Give with caution and daily monitoring of serum lithium levels to patients with renal or CV disease,

CV: ECG changes; hyperkalemia associated with debilitation, or syncope; tachycardia-bradycardia ECG changes; dehydration or life-threatening psychiatric disorders. arrhythmias, syndrome; rarely, CHF, diffuse Give drug with myocarditis, death food or milk or after meals. WARNING: Pruritus with or without rash; Dermatologic: Monitor clinical status closely, especially duringacneiform, and therapy; monitor for maculopapular, initial stages of follicular eruptions; therapeutic serumedema of 0.61.2or wrists cutaneous ulcers; levels ankles mEq/L. Individuals vary in their reponse to this drug; some Endocrine: Diffuse nontoxic goiter; patients may exhibithypercalcemia serum lithium levels toxic signs at associated hypothyroidism; with considered within the therapeutic range. hyperglycemia; hyperparathyroidism; transient Advise patient that diabetes insipidus, which irreversible nephrogenic this drug may cause serious fetal harm with cannot be used during pregnancy; urge improves and diuretic therapy; impotence or sexual use of barrier contraceptives. dysfunction Decrease dosage after thedistortion), salty taste; GI: Dysgeusia (taste acute manic episode is controlled; lithium tolerance is greater during the acute swollen lips; dental caries manic Other: Weight gain (510 kg); chest symptoms phase and decreases when manic tightness; subside. or painful joints, eye irritation, worsening of swollen WARNING: Ensure that cataracts, disturbance of visual patient maintains accommodation, adequate intake of salt and adequate intake of fluid leukocytosis (2,5003,000 mL/day). Interactions Teaching points Drug-drug Take this drug exactly as prescribed, after meals or Increased risk of toxicity with thiazide diuretics with to decreased renal clearance of lithiumreduced due food or milk. Eat a normal be with normal salt intake; maintain lithium dosage maydiet necessary adequate fluid intake (atlithium levels with indomethacin Increased plasma least 2.5 quarts/day). Arrange for frequent checkups, including blood and some other NSAIDsphenylbutazone, piroxicam, tests. Keepas well as fluoxetine and methyldopa the most ibuprofen, all appointments for checkups to get benefits with the least toxicity. Increased CNS toxicity with carbamazepine

 Use contraception to avoid pregnancy. If you wish Tablets10 mg; syrup5 mg/5 mL; rapidly disintegrating tablets to become pregnant or believe that you have become (Reditabs)10 mg; consultdisintegrating tablets10 mg pregnant, orally your care provider. Discontinue drug, and notify care provider if Metabolism: Hepatic; T1/2: 8.4 hr toxicity occursdiarrhea, vomiting, ataxia, tremor, Distribution: Crosses lack of coordination or milk drowsiness, placenta; enters breast muscular weakness. Excretion: Feces,You may experience these side effects: urine Drowsiness, dizziness (avoid driving or performing tasks Adverse effects that require alertness); GI upset (eat frequent small CNS: Headache, dizziness, meals); mild thirst, greater thannervousness, volume, fine usual urine depression, drowsiness hand tremor (may persist throughout therapy; notify heath CV: Palpitations, edema care provider if severe). GI: Appetite increase, nausea, diarrhea, abdominal Report diarrhea or fever. pain Respiratory: Bronchospasm, pharyngitis Other: Fever, photosensitivity, rash, myalgia, arthralgia, angioedema, weight gain Interactions Drug-drug Additive CNS depressant effects with alcohol or other CNS depressants Increased and prolonged anticholinergic (drying) effects with MAOIs; avoid this combination Drug-lab test False skin testing procedures if done while patient is taking antihistamines Nursing considerations Assessment

loratadine History: Hives Relief, Claritin Reditabs, Claritin Alavert, Claritin, Claritin Allergy to any antihistamines; narrowangle glaucoma, Children's ND Non-Drowsy Allergy, 24-Hour Allergy, Dimetapp stenosing peptic ulcer, symptomatic prostatic hypertrophy, asthma, bladder neck obstruction, Tavist ND, Triaminic Allerchews pyloroduodenal obstruction; lactation, pregnancy Physical: Skin color, lesions, texture; orientation, Drug class reflexes, affect; type) Antihistamine (nonsedating vision examinations; R, adventitious sounds; prostate palpation; serum transaminase levels Therapeutic actions Interventions Competitively blocks the effects of histamine at peripheral H1 Administer without (atropine-like) receptor sites; has anticholinergic regard to meals.and antipruritic Teaching effects. points If using rapid or orally dissolving tablets, place on Indications tongue, tablet will dissolve within seconds, and seasonal Symptomatic relief of perennial swallow with or without rhinitis, allergic water. vasomotor rhinitis, allergic Avoid the use of alcohol; serious urticaria and conjunctivitis, and mild, uncomplicatedsedation could occur. angioedema You may experienc these side effects: Dizziness, Treatment of rhinitis and chronic urticaria in sedation, drowsiness (use caution if driving or children > 2 yr performing tasks that Contraindications and cautions require alertness); headache; thickening of bronchial secretions, any antihistamines; Contraindicated with allergy to dryness of nasal mucosa (use a humidifier). stenosing peptic ulcer, narrow-angle glaucoma, Report prostatic breathing, hallucinations, tremors, symptomatic difficulty hypertrophy, asthma, bladder neck loss of coordination, irregular heartbeat. obstruction. Use cautiously with pyloroduodenal obstruction (avoid use or use with caution, condition may be exacerbated by drug); lactation, pregnancy Available forms

lorazepam Adverse effects Apo-Lorazepam (CAN), Ativan, Novo-Lorazem (CAN), Nu-Loraz CNS: Transient, mild drowsiness initially; (CAN) sedation, depression, lethargy, apathy, fatigue, lightheadedness, disorientation, anger, hostility, episodes of Drug classes mania Benzodiazepine and hypomania, restlessness, confusion, crying, delirium, headache, slurred speech, dysarthria, stupor, Anxiolytic rigidity, Sedative-hypnotic tremor, dystonia, vertigo, euphoria, nervousness, difficulty Therapeutic actions concentrating, vivid dreams, psychomotor retardation, extrapyramidal symptoms; mild subcortical Exact mechanisms are not understood; acts mainly atparadoxical excitatory reactions during first 2 wk of treatment levels of the CNS, leaving the cortex relatively unaffected. Main CV: the limbic system and reticular collapse, sites of action may be Bradycardia, tachycardia, CV formation; hypertension and the effects of GABA, edema benzodiazepines potentiatehypotension, palpitations, an inhibitory Dermatologic: Urticaria, at doses rash, dermatitis neurotransmitter; anxiolytic effects occur pruritus, well below those EENT: Visual ataxia. necessary to cause sedation andand auditory disturbances, diplopia, nystagmus, depressed hearing, nasal congestion Indications GI: Constipation, diarrhea, dry mouth, salivation, Oral: Management of anxiety disorders or for nausea, anorexia, vomiting, difficulty in or anxiety short-term relief of symptoms of anxiety swallowing, gastric disorders, hepatic dysfunction associated with depression; insomnia due to anxiety of GU: Incontinence, transient situational stress urinary retention, changes in libido,Parenteral: irregularities medication in adults to menstrual Preanesthetic Hematologic: Elevations of and decrease recall of produce sedation, relieve anxiety, blood enzymes: LDH, alkaline phosphatase, AST, ALT; blood epilepticus events related to surgery; treatment of status dyscrasias agranulocytosis, leukopenia use: Management of status Unlabeled parenteral Other: Hiccups, fever, diaphoresis, paresthesias, epilepticus, chemotherapy-induced nausea and vomiting, muscular disturbances, gynecomastia. Drug dependence acute alcohol withdrawal with withdrawal syndrome when drug is discontinued; Contraindications and cautions

Contraindicated with hypersensitivity to more common with abrupt discontinuation of glycol benzodiazepines, propylene glycol, polyethylene higher dosage used for > (parenteral lorazepam); psychoses; or benzyl alcohol4 mo Interactions acute narrow-angle glaucoma; shock; coma; acute Drug-drug alcoholic intoxication with depression of vital signs; Increased CNS placenta; risk of and other pregnancy (crosses depression with alcohol congenital sedating medications, such as withdrawal opioids malformations and neonatalbarbiturates andsyndrome); labor Decreased effectiveness with theophyllines and delivery ("floppy infant" syndrome); and Risk lactation. of toxicity if combined with probenecid, valproate; reduce lorazepam dose by 50% Use cautiously with impaired hepatic or renal Drug-herbfunction. Kava Available forms kava increases the sedative effects of benzodiazepines; solution2 been reported with Injection2, 4 mg/mL; oral coma has mg/mL; tablets0.5, 1, concurrent us 2 mg Nursing considerations CLINICAL ALERT! Metabolism: Hepatic; T1/2: 1020 hr Name confusion has occurred between lorazepam Distribution: Crosses placenta; enters breast milk and alprazolam; use caution. Excretion: Urine Assessment IV facts History: Hypersensitivity before IV use. For Preparation: Dilute lorazepam immediatelyto benzodiazepines, direct IV propylene or injection into IV line, dilutebenzyl an equal injection glycol, polyethylene glycol or with alcohol; volume ofpsychoses; acute narrow-angle glaucoma; shock;sodium compatible solution (sterile water for injection, coma; acute alcoholic intoxication with depression of vital chloride injection, or 5% dextrose injection); do not use if solution signs; pregnancy; lactation; impaired liver is discolored or contains a precipitate. Protect from light. or renal Infusion: function,inject slowly, or infuse at maximum rate of Direct debilitation Physical: Skin color, lesions; T; orientation, 2 mg/min. reflexes, affect, ophthalmologic examination; P, BP; R, Y-site incompatibilities: Do not mix with foscarnet, ondansetron. adventitious sounds; liver evaluation, abdominal

examination, bowel sounds, normal output; CBC, LFTs, losartan potassium renal function tests Cozaar Interventions Drug classes Sublingual administration has more rapid ARB absorption than PO, and bioavailability compares to IM Antihypertensive use. Therapeutic actions administer intra-arterially; arteriospasm or Do not Selectively blocks the binding of angiotensin II to specific tissue gangrene may result. receptors found Give IM injections of muscle anddrug deep into in the vascular smooth undiluted adrenal gland; this action blocks the vasoconstriction effect of the reninmuscle mass, monitor injection sites. angiotensin system notwell solutions that arealdosterone or contain Do as use as the release of discolored leading to decreaseda precipitate. Protect drug from light, and refrigerate oral BP. Indications solution. Treatment of hypertension, alone or in combination Intensol is a concentrated solution; it is with other antihypertensives with water, juice, soda, recommended it be mixed Treatment of diabetic neuropathy with an elevated applesauce, or pudding. serumWARNING: Keep equipment patients with type 2 creatinine and proteinuria in to maintain a patent (noninsulin-dependent) diabetes given history of airway readily available when drug isand a IV. hypertension Refrigerate injection and oral solution (36 to 46 F). Reduction of the risk of stroke in patients with hypertension and left ventricular hypertrophy least half in Reduce dose of opioid analgesics by at Contraindications and cautions patients who have received parenteral lorazepam. Contraindicated with hypersensitivity to losartan, Keep patients who have received parenteral doses pregnancy observation, preferably in third trimester Do under close(use during the second or bed, up to 3 hr. can cause injury or even death to the to drive following an not permit ambulatory patients fetus), lactation. Use injection. cautiously with hepatic or renal dysfunction, hypovolemia.

WARNING: Taper dosage gradually after longAvailableterm therapy, especially in patients with epilepsy. forms Tablets Metabolism: Hepatic; T1/2: 2 hr, then 69 hr Teaching points Distribution: Crosses placenta; enters breast milk not stop taking Take drug exactly as prescribed; do Excretion: Feces, urine drug (in long-term therapy) without consulting health care provider. Adverse effects You may experience these side effects: CNS: dizziness dizziness, syncope, insomnia Drowsiness,Headache, (may be transient; avoid driving or CV: Hypotension engaging in dangerous activities); GI upset (take drug with Dermatologic: Rash, urticaria, pruritus, alopecia, food); nocturnal sleep disturbances for several dry skin nights after discontinuing the drug if used as a sedative GI: and hypnotic;Diarrhea, abdominal emotional nausea, depression, dreams, pain, upset, constipation, dry mouth crying. Respiratory: URI weakness, cough, sinus Report severe dizziness,symptoms, drowsiness that disorders persists, rash or skin lesions, palpitations, edema of the Other: Back pain, fever, gout, muscle weakness extremities; visual changes; difficulty voiding. Interactions Drug-drug Decreased serum levels and effectiveness if taken concurrently with phenobarbital, indomethacin, and rifamycin Losartan is converted to an active metabolite by cytochrome P450-3A4 and 2C9 (fluconazole). Drugs that inhibit 3A4 (ketoconazole, fluconazole, diltiazem) may decrease the antihypertensive effects of losartan Nursing considerations Assessment

 History: Hypersensitivity to losartan, pregnancy, meclizinelactation, hepatic or renal dysfunction, hypovolemia hydrochloride Bonamine (CAN) Physical: Skin lesions, turgor; T; reflexes, affect; Oral prescription tablets: BP; R, respiratory auscultation; LFTs, renal function Antivert, Antrizine, Dramamine Less Drowsy Formula, Meni-D tests Drug classes Interventions Antiemetic Administer without regard to meals. Anti-motion sickness drug WARNING: Ensure that patient is not pregnant Antihistamine beginning therapy. Suggest using barrier birth before Anticholinergic while using losartan; fetal injury and deaths have control Therapeutic actions been reported. Reduces sensitivity of the labyrinthine apparatus; probablybaby at Find an alternative method of feeding the acts if least partly by to a nursing mother. synapses in of the reningiven blocking cholinergic Depression the vomiting center, which receives input from the chemoreceptor trigger zone angiotensin system in infants is potentially very and from dangerous. nerve pathways; peripheral anticholinergic peripheral effects may contribute to efficacy. WARNING: Alert surgeon and mark patient's Indications chart with notice that losartan is being taken. The Prevention renin-angiotensin system vomiting, blockage of the and treatment of nausea, following motion sickness surgery can produce problems. Hypotension may be Possibly effective for the reversed with volume expansion. management of vertigo associated withpatient closely in any vestibular that may Monitor diseases affecting the situation system Contraindications decrease in BP secondary to reduction in fluid lead to a and cautions Contraindicated with allergy to meclizine or volumeexcessive perspiration, dehydration, vomiting, cyclizine. diarrheaexcessive hypotension can occur. Use cautiously with lactation, narrow-angle Teaching glaucoma, stenosing peptic ulcer, symptomatic prostatic points hypertrophy, bronchial asthma, bladder neck obstruction, pyloroduodenal obstruction, cardiac arrhythmias,

Take drug without regard to meals. Do not stop postoperative state (hypotensive effects health care may be taking this drug without consulting your confusing and dangerous), pregnancy. provider. Available forms a barrier method of birth control while on this Use Tablets12.5, 25, 50 mg; chewable tablets25desire to become drug; if you become pregnant or mg; capsules25 mg pregnant, consult with your health care provider. Metabolism: T1/2: 6 hr experience these side effects: Dizziness You may Distribution: Crosses placenta; mayperforming hazardous tasks); (avoid driving a car or enter breast milk Excretion: Feces headache (request medications); nausea, vomiting, Adverse effects (proper nutrition is important, consult a dietitian diarrhea maintain nutrition); symptoms of upper respiratory CNS: Drowsiness, confusion, euphoria, to nervousness, restlessness, insomnia and consult your tract infection, cough (do not self-medicate; excitement, seizures, vertigo, tinnitus, blurred vision, diplopia, health care provider if uncomfortable). auditory and fever, chills, dizziness, pregnancy. Report visual hallucinations CV: Hypotension, palpitations, tachycardia Dermatologic: Urticaria, rash GI: Dry mouth, anorexia, nausea, vomiting, diarrhea or constipation GU: Urinary frequency, difficult urination, urinary retention Respiratory: Respiratory depression, death (due to overdose, especially in young children), dry nose and throat Interactions Drug-drug Increased sedation with alcohol or other CNS depressants Nursin considerations

Assessment medroxyprogesterone acetate History: Allergy to meclizine or cyclizine, Oral: pregnancy, narrow-angle glaucoma, stenosing peptic Alti-MPAulcer, symptomatic prostatic hypertrophy, bronchial (CAN), Gen-Medroxy (CAN), Novo-Medrone (CAN), Provera asthma, bladder neck obstruction, pyloroduodenal Parenteral: obstruction, cardiac arrhythmias, postoperative patients, Depo-Provera, Depo-subQ Provera 104 lactation, pregnancy Physical: Skin color, lesions, texture; orientation, Drug classes reflexes, affect; ophthalmic examination; P, BP; R, Hormone adventitious sounds; bowel sounds, normal output, status Progestin of mucous membranes; prostate palpation, urinary output Antineoplastic Interventions Contraceptive Monitor I & O, and take appropriate measures with Therapeutic actions urinary retention. Progesterone derivative; endogenous progesterone transforms Teaching points proliferative endometrium into secretory endometrium; inhibitsyou Take as prescribed. Avoid excessive dosage. If the secretion are using chewable tablets, chew them carefully before of pituitary gonadotropins, which prevents follicular maturation and ovulation; inhibits spontaneous uterine contraction. swallowing. Indications Anti-motion sickness drugs work best if used ahead time for prevention. endometrial hyperplasia in Reduction of of postmenopausal women Avoid alcohol; serious sedation could occur. Oral: may experience these side effects: Dizziness, You Treatment of secondary amenorrhea Oral: Abnormal uterine bleeding due performing sedation, drowsiness (use caution driving orto hormonal imbalancerequireabsence of organic pathology diarrhea, tasks that in the alertness); epigastric distress, constipation (take with food); dryand palliation of Parenteral: Adjunctive therapy mouth (practice or inoperable, recurrent, and metastatic endometrial frequent mouth care, suck sugarless lozenges); dryness carcinoma or renal carcinomamotion sickness, antivertigo of nasal mucosa (try another Subcutaneous depot: Long-acting contraceptive; remedy). management of endometriosis-associated pain

Report difficulty breathing, hallucinations, tremors, loss Unlabeled use for depot form: Treatment of breast of coordination, visual disturbances, irregular cancer heartbeat. Contraindications and cautions Contraindicated with allergy to progestins; thrombophlebitis, thromboembolic disorders, cerebral hemorrhage or history of these conditions; hepatic disease, carcinoma of the breast, ovaries, or endometrium, undiagnosed vaginal bleeding, missed abortion; pregnancy (fetal abnormalities, including masculinization of the female fetus have been reported); lactation. Use cautiously with epilepsy, migraine, asthma, cardiac or renal dysfunction. Available forms Tablets2.5, 5, 10 mg; injection104, 150, 160, 400 mg/mL Dosages Metabolism: Hepatic; T1/2: Unknown Distribution: Crosses placenta; enters breast milk Excretion: Unknown Adverse effects CNS: Sudden, partial, or complete loss of vision; proptosis, diplopia, migraine, precipitation of acute intermittent porphyria, mental depression, pyrexia, insomnia, somnolence, nervousness, fatigue CV: Thrombophlebitis, cerebrovascular disorders, retinal thrombosis, pulmonary embolism, thromboembolic and thrombotic disease, increased BP

 Dermatologic: Rash with or without pruritus, headache or vomiting, dizziness alopecia, hirsutism, acne, melasma or chloasma, or fainting, visual disturbances, numbness orurticaria in the arm or leg. photosensitivity, pruritus, tingling GI: Cholestatic jaundice, nausea GU: Breakthrough bleeding, spotting, change in menstrual flow, amenorrhea, changes in cervical erosion and cervical secretions, breast tenderness and secretion Other: Fluid retention, edema, increase or decrease in weight, decreased glucose tolerance, bone loss Interactions Drug-lab test Inaccurate tests of hepatic and endocrine function Nursing considerations Assessment History: Allergy to progestins; thrombophlebitis; thromboembolic disorders; cerebral hemorrhage; hepatic disease; carcinoma of the breast, ovaries, or endometrium; undiagnosed vaginal bleeding; missed abortion; epilepsy; migraine; asthma; cardiac or renal dysfunction; pregnancy; lactation Physical: Skin color, lesions, turgor; hair; breasts; pelvic examination; orientation, affect; ophthalmologic examination; P, auscultation, peripheral perfusion, edema; R, adventitious sounds; liver evaluation; LFTs, renal function tests, glucose tolerance, Pap smear Interventions

Arrange for pretreatment and periodic (at least meperidine hydrochloride (pethidine) which should include BP, annual) history and physical, Demerol breasts, abdomen, pelvic organs, and a Pap smear. Before therapy begins, caution patient to prevent Drug class pregnancy and to have frequent medical follow-up visits. Opioid agonist analgesic WARNING: Discontinue medication and consult physician if sudden, partial, or complete loss of vision Therapeutic actions papilledema or retinal vascular lesions are occurs; if y Acts as discontinue drug. present, agonist at specific opioid receptors in the CNS to produce analgesia, Discontinue sedation; the receptors WARNING: euphoria, medication and consult mediating these effects of thought to be disease (leg physician at the first signare thromboembolicthe same as those mediating the effects of endogenous opioids pain, swelling, peripheral perfusion changes, shortness of (enkephalins, endorphins). breath). y Teaching acting as an agonist at the -opioid receptor. In addition points to its If you are taking the oral form of this drug, mark strong opioidergic and anticholinergic effects, it days you anesthetic activity related to its interactions has local should take the medication on a calendar. This drug should not with sodium ion channels. be taken during pregnancy Indications to risk of serious fetal abnormalities; using barrier due Oral, parenteral: Relief contraceptives is suggested. of moderate to severe acute pain You may experience these side effects: Sensitivity to light (avoid exposure to the medication, supportand Parenteral: Preoperative sun; use sunscreen of protective clothing); dizziness, sleeplessness, depression anesthesia, and obstetric analgesi (use caution cautions Contraindications and driving or performing tasks that require alertness); skin rash, color changes, loss of hair; fever; Contraindicated with hypersensitivity to opioids, nausea. caused by poisoning (before toxins are diarrhea eliminated), bronchial asthma, COPD, cor pulmonale, Report pain or swelling and warmth in the calves, respiratory pain or shortness of breath, sudden acute acute chest depression, anoxia, kyphoscoliosis, severe alcoholism, increased intracranial pressure, pregnancy,

seizure disorder, renal dysfunction. Contraindicated in Major hazards: Respiratory depression, apnea, premature infants. circulatory depression, respiratory arrest, shock, Use cautiously with acute abdominal conditions, cardiac arrest CV disease, supraventricular tachycardias, myxedema, Other: Sweating, physical tolerance and delirium tremens, cerebral arteriosclerosis, ulcerative dependence, psychological dependence colitis, fever, Addison's disease, prostatic hypertrophy, Interactions urethral stricture, recent GI or GU surgery, toxic Drug-drug psychosis, labor or delivery (opioids given to the mother WARNING: Severe and sometimes fatal reactions can cause respiratory depression of neonate; premature (resembling especially at risk), renal or hepatic infants are opioid overdose; characterized by seizures, hypertension,lactation. dysfunction, hyperpyrexia) when given to patients Availablereceiving or who have recently received MAOIs; do not forms give meperidine to patients on MAOIs Tablets50, 100 mg; syrup50 mg/mL; injection25, 50, 75, Potentiation of effects with barbiturate anesthetics; 100 mg/mL decrease dose of meperidine when coadministering Increased 38 hr Metabolism: Hepatic; T1/2: likelihood of respiratory depression, hypotension, profound sedation, or coma with Distribution: Crosses placenta; enters breast milk phenothiazines Excretion: Urine Drug-lab test IV facts Elevated biliary tract pressure may injection using Preparation: Dilute parenteral solution prior to IV cause increases in and lactated Ringer's; determinations combinations; 5% dextroseplasma amylase, lipase; dextrose-saline of these levels 2.5%, 5%,may10% dextrose in water, Ringer's, or administration of or be unreliable for 24 hr after lactated Ringer's; opioids 0.45% or 0.9% sodium chloride; 1/6 molar sodium lactate. Nursing considerations slow IV injection over 45 min or by Infusion: Administer by Assessmentinfusion when diluted to 1 mg/mL. continuous History: Hypersensitivity meperidine diarrhea WARNING: Incompatibilities: Do not mixto opioids, solutions caused barbiturates, aminophylline, heparin, morphine with solutions of by poisoning, bronchial asthma, COPD, cor pulmonale, respiratory depression, anoxia, kyphoscoliosis, acute alcoholism, increased intracranial

sulfate, methicillin, phenytoin, sodium bicarbonate, iodide, pressure; acute sulfadiazine, sulfisoxazole. abdominal conditions, CV disease, supraventricular Do not give with cefoperazone, Y-site incompatibilities: tachycardias, myxedema, seizure disorders, delirium tremens, mezlocillin, minocycline, tetracycline. cerebral arteriosclerosis, ulcerative colitis, fever, Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, Adverse effects toxic psychosis,Light-headedness, dizziness, pregnancy, CNS: renal or hepatic dysfunction, sedation, lactation dysphoria, delirium, insomnia, agitation, euphoria, anxiety,Physical: T; skin disorientation, drowsiness, fear, hallucinations, color, texture, lesions; orientation, reflexes,mental and physical performance, lethargy, impaired bilateral grip strength, affect, pupil size; P, mood changes, weakness, headache, tremor, coma, auscultation, BP, orthostatic BP, perfusion; R, adventitious sounds; bowel sounds, normal output; seizures, miosis, visual disturbances, suppression of frequency and pattern of voiding, normal output; ECG; cough reflex EEG; LFTs, renal and thyroid function tests circulatory CV: Facial flushing, peripheral Interventions collapse, tachycardia, bradycardia, arrhythmia, Administer to palpitations, chest lactating women 46 hypertension, wall rigidity, hr before the next feeding to minimizehypotension,in milk. hypotension, orthostatic the amount syncope WARNING: Keep opioid urticaria, laryngospasm, Dermatologic: Pruritus, antagonist and facilities for assisted or controlled respiration readily available bronchospasm, edema during GI: Nausea, vomiting, dry mouth, anorexia, parenteral administration. WARNING: Use caution when constipation, biliary tract spasm, increased injecting colonic subcutaneously into chilled areas of the body or in motility in patients with chronic ulcerative colitis patients with hypotensionspasm in vesical sphincters, GU: Ureteral spasm, or of shock; impaired perfusionretention orabsorption; with repeated doses, an urinary may delay hesitancy, oliguria, antidiuretic excessive amount may be absorbed when circulation is effect, reduced libido or potency restored.Local: Tissue irritation and induration Reduce dosage of (subcutaneous injection) meperidine by 25%50% in patients receiving phenothiazines or other tranquilizers.

 Give each dose of the oral syrup in half glass of water. CNS: Light-headedness, dizziness, drowsiness, If taken undiluted, it may exert a slight local headache, effect on mucous membranes. anesthetic fever, blurred vision Dermatologic: Urticaria, pruritus,is unlikely; most Reassure patient that addiction rash GI: Nausea, vomiting, for medical reasons do not patients who receive opiatesGI upset, liver dysfunction Other: Hemolytic anemia, develop dependence syndromes. leukopenia Interactions WARNING: Use meperidine with extreme caution Drug-drug patients with renal dysfunction or those requiring in Increased risk of sedation with other CNS repeated dosing due to accumulation of normeperidine, a depressants and alcohol cause seizures. toxic metabolite that may Drug-lab test Teaching points False-positive Benedict's test; Take drug exactly as prescribed. use of a more specific Avoid test is advised glucose alcohol, antihistamines, sedatives, tranquilizers, over-the-counter drugs. Nursing considerations take leftover medication for other disorders, Do not Assessment do not let anyone else take this prescription. and History: Hypersensitivity to metaxalone; tendency You may experience these side effects: Nausea, for hemolytic or other anemias; severe renal or hepatic loss of appetite (take with food and lie quietly, eat dysfunction; lactation, pregnancy (request a laxative); frequent small meals); constipation Physical: T; skin color, lesions; orientation, acuity dizziness, sedation, drowsiness, impaired visual affect, vision examination, reflexes;other tasks that normal bowel sounds, require (avoid driving, performing output; CBC, LFTs, renal function tests alertness, visual acuity). Report severe nausea, vomiting, constipation, Interventions shortness of breath, or difficulty breathing. Establish safety precautions if dizziness, drowsiness, blurred vision occur (use side rails, accompany patient when ambulating).

metaxalone Arrange for analgesics if headache occurs (and Skelaxin possibly as adjunct for relief of discomfort of muscle spasm). Drug class Provide positioning, massage, warm soaks as Skeletal muscle relaxant (centrally acting) appropriate for relief of pain of muscle spasm. Provide support and encouragement to deal with Therapeutic actions discomfort of underlying condition and be due to general Precise mechanism of action not known, but may drug effects. Teaching points does not directly relax tense skeletal muscles or CNS depression; Take this drug exactly as prescribed. directly affect the motor endplate or motor nerves. Do not take a higher dosage than that prescribed. Indications Continue to rest, of rest, physical therapy,other Adjunct the use physical therapy, and and other measuresthe relieve the discomfort associated with measures for to relief of discomfort. acute, Avoid the use of alcohol, sleep-inducing or overpainful musculoskeletal disorders the-counter drugs while Contraindications and cautions you are taking this drug. These could cause dangerous effects. If you feel that you need Contraindicated with hypersensitivity to one of these preparations, consult or other anemias; metaxalone; tendency for hemolytic your health care provider. or hepatic disfunction, lactation. severe renal You may experience these Use cautiously with mild liver side effects: dysfunction, Drowsiness, dizziness (avoid driving a car or engaging in pregnancy. Availableactivities that require alertness if these occur); nausea forms (take drug with Tablets400, 800 mg food and eat frequent small meals). Report rash, itching, yellow discoloration of the skin or eyes. Metabolism: Hepatic; T1/2: 23 hr Distribution: Crosses placenta; may enter breast milk Excretion: Urine Adverse effects

metformin hydrochloride Fortamet, Glucophage, Glucophage XR, Glumetza, Metformin Nursing Riomet HCl ER, considerations Assessment History: Allergy to metformin; diabetes Drug class complicated by fever, severe infections, severe trauma, Antidiabetic major surgery, ketosis, acidosis, coma; type 1 diabetes, Therapeutic actions serious is not or renal impairment, uremia, peripheral Exact mechanism hepatic understood; possibly increases thyroid or glycosuria, hyperglycemia utilizationendocrine impairment,hepatic glucose production and of glucose, decreases associated with of glucose. alters intestinal absorption primary renal disease, CHF, pregnancy, lactation Indications Physical: Skin color, lesions; T, orientation, Adjunct to diet to lower blood glucose with type 2 reflexes, peripheral sensation; R, adventitious sounds; (noninsulin-dependent) diabetes mellitus in patients > liver evaluation, bowel17 yr 10 yr; ER in patients > sounds; urinalysis, BUN, serum creatinine, LFTs, blood glucose, CBCwith a sulfonylurea As part of combination therapy or insulin when either drug alone cannot control glucose Interventions in patients with type 2 diabetes mellitus levels Monitor cautions Contraindications and urine or serum glucose levels frequently to determine effectiveness of drug and dosage. Contraindicated with allergy to metformin; CHF; WARNING: Arrange for transfer to severe diabetes complicated by fever, severe infections, insulin therapy major surgery, ketosis, acidosis, coma (use trauma, during periods of high stress (infections, surgery, trauma). insulin); type 1 (insulin-dependent) diabetes, serious hepatic WARNING: serious renal glucose if uremia, impairment, Use IV impairment, severe hypoglycemia endocrine impairment, thyroid or occurs as a result of overdose. glycosuria, hyperglycemia associated with primary renal disease; Teaching labor and delivery (if metformin is used during points Do discontinue drug at medication before pregnancy, not discontinue this least 1 mo without consulting your health care provider. delivery); lactation (safety not established).

Use cautiously with the elderly. Monitor urine or blood for glucose and ketones as Available forms prescribed. Tablets500, 850, 1,000 mg; ER tablets500, 750, 1,000 mg; Swallow extended-release tablets whole; do not oral solution500 mg/5 mL cut, crush, or chew. Metabolism: T1/2: 6.2 and 17.6 hr Do not use this drug during pregnancy; if you Distribution: Crosses placenta; enters breast milk become Excretion: Urine pregnant, consult with your health care provider for appropriate therapy. Adverse effects Avoid using alcohol while taking acidosis Endocrine: Hypoglycemia, lacticthis drug. Report Anorexia, nausea, vomiting, bleeding or fever, sore throat, unusual epigastric GI: bruising, rash, dark urine, light-colored stools, hypo- or discomfort, heartburn, diarrhea, flatulence hyperglycemic reactions.Allergic skin reactions, eczema, Hypersensitivity: pruritus, erythema, urticaria Interactions Drug-drug Increased risk of hypoglycemia with cimetidine, furosemide, cationic drugs such as digoxin, amiloride, vancomycin Increased risk of lactic acidosis with glucocorticoids or ethanol Increased risk of acute renal failure and lactic acidosis with iodinated contrast material used in radiologic studies; stop metformin for 48 hr before and after such studies Drug-alternative therapy Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, celery

methadone hydrochloride CV: HCl flushing, peripheral circulatory Dolophine, Methadone Facial Diskets, Methadone HCl Intensol, collapse, arrhythmia, palpitations, chest wall rigidity, Methadose hypertension, hypotension, orthostatic hypotension, syncope Drug class Dermatologic: Pruritus, urticaria, laryngospasm, Opioid agonist analgesic bronchospasm, edema, hemorrhagic urticaria (rare) GI: Therapeutic actions Nausea, vomiting, dry mouth, anorexia, constipation, biliary receptors in increased colonic Acts as agonist at specific opioidtract spasm; the CNS to produce analgesia,motility in sedation;with receptors mediating these effects euphoria, patients the chronic ulcerative colitis are thought to GU:the same spasm, spasm of vesical sphincters, be Ureteral as those mediating the effects of urinary retention or hesitancy, oliguria, antidiuretic endogenous opioids (enkephalins, endorphins); when used in approved effect, reduced libido or potency methadone maintenance programs, can substitute for Local: and induration heroin, other illicit opioids Tissue irritationwant to terminate a in patients who drug use. (subcutaneous injection) Major hazards: Respiratory depression, apnea, Indications circulatory of severe pain respiratory arrest, shock, Relief depression, cardiacDetoxification and temporary maintenance arrest Other: Sweating (more common in ambulatory treatment of opioid addiction (ineffective for relief of patients anxiety)those without severe pain), physical general and tolerance and cautions Contraindications and dependence, psychological dependence Interactions Contraindicated with hypersensitivity to opioids, Drug-drug diarrhea caused by poisoning (before toxins are Potentiation of effects of methadone with eliminated), bronchial asthma, COPD, cor pulmonale, barbiturate anestheticsdecrease kyphoscoliosis, acute respiratory depression, anoxia, dose of meperidine when coadministering intracranial pressure. alcoholism, increased Decreased effectiveness of methadone with Use cautiously with acute abdominal conditions, hydantoins, rifampin, urinary acidifiers (ammonium CV disease, supraventricular tachycardias, myxedema,

seizure disorders, delirium tremens, cerebral chloride, potassium acid phosphate, sodium acid arteriosclerosis, ulcerative colitis, fever, Addison's phosphate) disease, prostatic hypertrophy, urethral stricture, recent or Increased effects and toxicity of methadone with GI GU surgery, toxic psychosis, pregnancy prior to cimetidine, protease inhbitors labor (crosses placenta; neonatal withdrawal observed in Drug-lab test infants born to drug-using mothers; safety for use in Elevated biliary not pressure (opioid or delivery pregnancy before labortract established), laboreffect) may cause increases in plasma mother can lipase; amylase, (administration of opioids to cause determinations of these levels may be unreliable for for respiratory depression of neonaterisk greatest 24 hr after administration of opioids hepatic dysfunction, premature neonates), renal or Nursing considerations lactation. Assessment Available forms History: Hypersensitivity to opioids, diarrhea Tablets5, 10 mg; oral solution5 mg/5 mL, 10 mg/5 mL; oral caused by poisoning, bronchialmg/mL; COPD, cor concentrate10 mg/mL; injection10 asthma, dispersible pulmonale, respiratory depression, kyphoscoliosis, acute tablets40 mg alcoholism, 1/2: 25 hr Metabolism: Hepatic; Tincreased intracranial pressure; acute abdominal placenta and enters breast supraventricular Distribution: Crosses conditions, CV disease, milk tachycardias, Excretion: Bile, feces myxedema, seizure disorders, delirium tremens, cerebral arteriosclerosis, ulcerative colitis, fever, Adverse effects Addison's disease, prostatic hypertrophy, urethral stricture, recent GI or GU surgery, toxic psychosis; CNS: Light-headedness, dizziness, sedation, pregnancy; dysphoria, delirium, insomnia, agitation, euphoria, labor; lactation anxiety,Physical: T; skin disorientation, drowsiness, fear, hallucinations, color, texture, lesions; orientation, reflexes,mental and physical performance, lethargy, impaired bilateral grip strength, affect, pupil size; pulse, auscultation, weakness, headache, tremor, coma, mood changes, BP, orthostatic BP, perfusion; R, adventitious sounds; bowel sounds, suppression of seizures, miosis, visual disturbances, normal output; frequency and pattern of voiding, normal output; ECG; cough reflex EEG; LFTs, renal and thyroid function tests

Interventions Wegener agranulomatosis, dermatomyositis, relapsing Give to lactating women 46 hr before the next remitting MS, myositis, ulcerative colitis, refractory feeding to minimize the amount in milk. Crohn's WARNING: Keep psoriatic arthritis disease, uveitis, SLE opioid antagonist and equipment for assisted or controlled respiration readily Contraindications during parenteral administration. available and cautions Contraindicated with pregnancy, injecting WARNING: Use caution when lactation, alcoholism, chronic chilled areas of the body or in subcutaneously into liver disease, immune deficiencies, blood dyscrasias, hypersensitivity methotrexate. patients with hypotension or toin shockimpaired Use cautiously absorption; with repeated doses, an perfusion may delay with renal disease, infection, peptic ulcer, ulcerative colitis, be absorbed when circulation is excessive amount may debility. Availablerestored. forms Tablets2.5, 5, Teaching points 7.5, 10, 15 mg; powder for injection20 mg, 1 g per vial; injection25 mg/mL as prescribed. Take drug exactly Avoid alcoholserious adverse effects may occur. Metabolism: T1/2: 24 take leftover medication for other disorders; Do not hr Distribution: Crosses placenta; take the prescription. do not let anyone else enters breast milk Excretion: Urine Avoid pregnancy while taking this drug; using barrier contraceptives is advised. IV facts You may experience these side effects: Nausea, Preparation: of appetite (take withand 50-mg vials with an loss Reconstitute 20- food, lie quietly, eat frequent appropriate sterile preservative-free medium, 5% dextrose solution small meals); constipation (laxative may help); dizziness, or sodium chloride drowsiness, a concentration no greater than sedation, injection to impaired visual acuity (avoid 25 mg/mL; reconstitute 1-g vialother 19.4 mL to a concentration of driving, performing with tasks that require alertness, 50 mg/mL. visual acuity). Infusion: Administer diluted drug by direct IV injection at a rate Report severe nausea, vomiting, constipation, of not more than 10 of breath, or difficulty breathing. shortness mg/min. WARNING: Do not give formulations with benzyl alcohol or preservatives intrathecally or for high-dose therapy.

methotrexate (methopterin, MTX) Incompatibilities: Do not combine Trexall Rheumatrex, Rheumatrex Dose Pak, with bleomycin, fluorouracil, prednisolone. Y-siteclasses Drug incompatibility: Do not give with droperidol. Antimetabolite Adverse effects Antineoplastic CNS: Headache, drowsiness, blurred vision, Antipsoriatic aphasia, hemiparesis, paresis, seizures, fatigue, malaise, Antirheumatic dizziness Therapeutic actions Dermatologic: Erythematous rashes, pruritus, Inhibits folic acid reductase, leading to inhibition of DNA synthesis urticaria, photosensitivity, depigmentation, alopecia, and inhibition of cellular replication; selectively affects ecchymosis, telangiectasia, acne, furunculosis the most rapidly dividing cells (neoplastic and psoriatic cells). GI: Ulcerative stomatitis, gingivitis, pharyngitis, Indications anorexia, nausea, vomiting, diarrhea, hematemesis, Treatment of gestational choriocarcinoma, melena, GI ulceration and bleeding, enteritis, hepatic chorioadenoma destruens, hydatidiform mole toxicity Treatment and prophylaxis of meningeal leukemia GU: Renal failure, effects on fertility (defective Symptomatic control of severe, recalcitrant, oogenesis, defective spermatogenesis, transient disabling psoriasis oligospermia, menstrual dysfunction, classical, or definite Management of severe, active, infertility, abortion, fetal defects) rheumatoid arthritis Hematologic: Severe bone marrow depression, Management of polyarticular course juvenile increased susceptibility to infection rheumatoid arthritis Hypersensitivity: Anaphylaxis, sudden death High-dose regimen followed by leucovorin rescue Respiratory: Interstitial pneumonitis, chronic for adjuvant therapy of nonmetastatic osteosarcoma interstitial obstructive pulmonary disease (orphan drug designation) Other: Chills and To reduce corticosteroid fever, metabolic changes Unlabeled uses: (diabetes, osteoporosis), cancer severe corticosteroidrequirements in patients with Interactions dependent asthma; as a maintenance regimen for Drug-drug

 WARNING: Potentially serious to fatal reactions when This drug may cause birth defects or miscarriages. given with NSAIDs; use extreme caution if this Use birth control while taking this drug and for 3 months combination is used thereafter. Men using thisof toxicity if also use barrier WARNING: Risk drug should combined with contraceptives.this combination alcohol; avoid Avoid alcohol; serious side effects may occur. Increased risk of toxicity with salicylates, Arrange for frequent, regular phenytoin, probenecid, sulfonamides medical follow-up visits,Decreased blood tests to follow the drug's effects of including serum levels and therapeutic effects. You may experience these side effects: Nausea, digoxin vomiting (request medication; eat frequent small meals); May decrease theophylline clearance numbness, tingling, dizziness, drowsiness, blurred Nursing considerations vision, difficulty speaking (drug effects; seek dosage Assessment adjustment; avoid driving or operating dangerous History: Allergy to methotrexate, hematopoietic machinery); mouth sores (frequent mouth care is depression, severe hepatic or renal disease, infection, needed); infertility; loss hair (obtain a wig or other peptic ulcer, ulcerativeof colitis, debility, psoriasis, suitable head covering; keep the head covered at pregnancy, lactation extremes of temperature); T; skin lesions, color; hair; Physical: Weight; rash, sensitivity to sun and ultraviolet light orientation, reflexes, sunscreen and vision, speech, (avoid sun; use a sensation; R, protective clothing). adventitious sounds; mucous membranes, liver Report black, tarry stools; fever; chills; sore throat; evaluation, abdominal examination; CBC, differential; unusual bleeding or tests; urinalysis, blood and urine LFTs, renal function bruising; cough or shortness of breath; darkenedtolerance test, chestabdominal, flank, or glucose, glucose or bloody urine; x-ray joint Interventions pain; yellow color to the skin or eyes; mouth sores. Arrange for tests to evaluate CBC, urinalysis, renal Adverse effects in Italic are most common; before in Bold are lifefunction tests, LFTs, chest x-ray those therapy, during threatening. therapy, and for several weeks after therapy.

Ensure that patient is not pregnant before methylphenidate hydrochloride counsel patient about the severe administering this drug; Concerta, risks of fetal abnormalities ER, Methylin, this drug. ER, Metadate CD, Metadate associated with Methylin PMS-Methylphenidate (CAN), Ritalin, Ritalin LA, Ritalin SR renal WARNING: Reduce dosage or discontinue if failure occurs. Drug class Reconstitute powder for intrathecal use with CNS stimulant preservative-free sterile sodium chloride injection; Therapeutic actions one dose only; discard remainder. The intended for y Mild cortical stimulant with CNS actions similar should solution for injection contains benzyl alcohol andto those of be given intrathecally. notthe amphetamines; efficacy in hyperkinetic syndrome, attention-deficit disorders to in children appears WARNING: Arrange have leucovorin readily paradoxical antidote understood available as and is notfor methotrexate overdose or when y Methylphenidate belongs to the doses of class of large doses are used. In general, piperidine leucovorin compounds and increases the levels of dopamine and (calcium leucovorin) should be equal or higher than norepinephrine in the and through reuptake inhibition doses of methotrexate brain should be given within the of the monoamine transporters. first hour. Up to 75 mg IV within 12 hr, followed by Indications mg IM q 6 hr for four doses. For average doses of 12 Ritalin, Ritalin adverse effects, give 612 mg methotrexate that cause SR, Metadate ER, Methylin: Narcolepsy leucovorin IM, q 6 hr for four doses or 10 mg/m2 PO Attention-deficit disorders, hyperkinetic syndrome, followed by 10 mg/m2 q 6 hr for 72 hr. minimal brain for an antiemetic if nausea adults with a Arrange dysfunction in children or and vomiting behavioral are severe. syndrome characterized by the following symptoms: Moderate to severe distractibility, short Arrange for adequate hydration during therapy to attention risk hyperuricemia. reduce the span,ofhyperactivity, emotional lability, and impulsivity, not secondary to any other medications Do administer environmental factors or psychiatric disorders containing alcohol. Teaching points Unlabeled use: Treatment of depression in the elderly, cancer and stroke patients; alleviation of Prepare a calendar of treatment days. neurobehavioral symptoms after traumatic brain injury;

improvement in pain control and sedation in patients Physical: receiving opiates Weight; T; skin color, lesions; orientation, affect, examination Contraindications and cautions ophthalmologic (tonometry); P, BP, auscultation; R,hypersensitivity to adventitious sounds; Contraindicated with bowel sounds, normal output; CBC with differential, methylphenidate; marked anxiety, tension, and agitation; platelet count, baseline family history or diagnosis of glaucoma; motor tics, ECG Interventions Tourette syndrome; severe depression of endogenous or Ensure proper diagnosis states. exogenous origin; normal fatiguebefore administering to children Use behavioral syndromes; seizure disorders; for cautiously with drug should not be used until other causes or concomitants of abnormal hypertension; drug dependence, alcoholism; emotional behavior (learning disability, instability; lactation, pregnancy. EEG abnormalities, Availableneurologic deficits) are ruled out. forms Tablets5, 10,Interrupt drug dosage periodically 5, 10 mg; SR 20 mg; chewable tablets2.5, in children to determine symptoms warrant continued drug therapy. tablets20 mg; ERif tablets10, 18, 20, 27, 36, 54 mg; ER capsules20, 30Monitor growth of and 20, 30, 40 mg (Ritalin mg (Metadate CD); children on long-term methylphenidate therapy. LA) Ensure that all timed-release tablets and capsules are Hepatic; T whole, hr chewed or Metabolism: swallowed 1/2: 13 not(6.8 hr ER) crushed. Dispense the smallest feasible milk Distribution: Crosses placenta; may enter breast dose to minimize risk of Excretion: Urineoverdose. Give before 6 PM to prevent insomnia. Adverse effectsMonitor CBC and platelet counts periodically in patients on long-term therapy. CNS: Nervousness, insomnia, dizziness, headache, Monitor BP frequently early in treatment. dyskinesia, chorea, drowsiness, Tourette syndrome, toxic psychosis, blurred vision, accommodation difficulties Teaching points CV: Increased or decreased pulse and BP; Take this drug cardiac arrhythmias, Timed-release tachycardia, angina, exactly as prescribed.palpitations tablets and capsules must be swallowed whole, not chewed or crushed. Metadate CD capsules may be

Dermatologic: Rash, urticaria, fever, arthralgia, opened and entire contents sprinkled multiforme with exfoliative dermatitis, erythema on soft fooddo not chew or crush granules. thrombocytopenic purpura, necrotizing vasculitis and Take hair loss of scalpdrug before 6 PM to avoid nighttime sleep disturbance. GI: Anorexia, nausea, abdominal pain, weight loss Avoid alcohol and over-the-counter drugs, Hematologic: Leukopenia, anemia including nose Tolerance, psychological dependence, Other: drops, cold remedies; some over-thecounter drugs couldwith abuse abnormal behavior cause dangerous effects. You may experience these side effects: Interactions Nervousness, restlessness, dizziness, insomnia, impaired Drug-drug thinking (may lessen; avoid guanethidine;engagingthis Decreased effects of driving or avoid in activities that require alertness); headache, loss of combination appetite, dry mouth. Increased effects and toxicity of methylphenidate Keep with MAOIs drug in secure place; do not share with others. Increased serum levels of phenytoin, TCAs, oral Report nervousness, insomnia, monitor for anticoagulants, SSRIs with methylphenidate;palpitations, vomiting, rash, fever. toxicity Drug-lab test Methylphenidate may increase the urinary excretion of epinephrin Nursing considerations Assessment History: Hypersensitivity to methylphenidate; marked anxiety, tension, and agitation; glaucoma; motor tics, Tourette syndrome; severe depression; normal fatigue state; seizure disorders; hypertension; drug dependence, alcoholism, emotional instability; pregnancy, lactation

methylprednisolone Contraindicated with infections, especially TB, methylprednisolone fungal infections, amebiasis, vaccinia and varicella, and Oral: Medrol antibiotic-resistant infections; lactation; allergy to tartrazine or aspirin in products labeled Medrol. Use cautiously with kidney or liver disease, methylprednisolone acetate hypothyroidism, ulcerative colitis with impending IM injection: perforation, diverticulitis, active or latent peptic depMedalone, Depo-Medrol, Depopred40, Depopred80 ulcer, inflammatory bowel disease, CHF, hypertension, thromboembolic disorders, osteoporosis, seizure methylprednisolone sodium succinate disorders, IV, IM injection: diabetes mellitus, pregnancy. Available forms A-Methapred, Solu-Medrol Tablets4, 8, 16, 24, 32 mg; powder for injection40, 125, 500 mg/mL, 1, 2 g/vial; suspension for injection20, 40, Drug classes 80 mg/mL Corticosteroid Glucocorticoid Metabolism: Hepatic; T1/2: 78188 min Hormone Distribution:actions placenta; enters breast milk Therapeutic Crosses Excretion: Urine target cells and binds to intracellular y Enters corticosteroid receptors, initiating many complex IV facts reactions that are responsible for its anti-inflammatory Preparation: immunosuppressive effects. required. and No additional preparation is Infusion: Glucocorticoids into vein or into tubing of running IV; Inject directly bind to the cytosolic glucocorticoid y administer slowly, over 120 min to reduce cardiacis activated by receptor (GR). This type of receptor effects. Incompatibilities:binding. After a hormone bindsgluconate, Do not combine with calcium ligand to the glycopyrrolate, insulin, nafcillin, penicillin G sodium, tetracycline. corresponding receptor, the newly-formed receptorligand complex translocates itself into the cell nucleus, Adverse effects it binds to glucocorticoid response elements where Effects depend on dose, route, and duration of therapy.

(GRE) in the promoter region of the target genes CNS: the regulation of gene expression. This resulting in Vertigo, headache, paresthesias, insomnia, seizures, psychosis, cataracts, increased IOP, glaucoma process is commonly referred to as transactivation. oCV: Hypotension,encoded hypertension and CHF The proteins shock, by these upregulated secondarygenes have a wide range of effects including to fluid retention, thromboembolism, thrombophlebitis, fat embolism, cardiac arrhythmias for example: Electrolyte imbalance: Na+ and lipocortin I and  anti-inflammatory fluid retention, hypokalemia, hypocalcemia p11/calpactin binding protein Endocrine: Amenorrhea, irregular menses, growth  increased gluconeogenesis retardation, decreased carbohydrate tolerance, diabetes glucose-6-phosphatase and tyrosine mellitus, cushingoid state (long-term effect), increased aminotransferase blood sugar, increased serum cholesterol, decreased T3 Indications and T4 levels, HPA associated with cancer Hypercalcemia suppression with systemic therapy longerShort-term management of various inflammatory than 5 days GI: disorders, such as ulcer, pancreatitis, and allergicPeptic or esophageal rheumatoid arthritis, abdominal distention,SLE), dermatologic diseases (eg, collagen diseases (eg, nausea, vomiting, increased appetite, weight gain asthmaticus, and autoimmune pemphigus), status Hypersensitivity: Anaphylactoid reactions disorders Musculoskeletal: Muscle weakness, steroid Hematologic disorders: Thrombocytopenia myopathy, loss of muscle mass, osteoporosis, purpura, erythroblastopenia spontaneous fractures acute exacerbations of MS, and Ulcerative colitis, Other: Immunosuppression; aggravation or palliation in some leukemias and lymphomas masking of infections; impaired woundorhealing; thin, Trichinosis with neurologic myocardial fragile skin; petechiae, ecchymoses, purpura, striae; involvement subcutaneous fat atrophy Unlabeled use: Septic shock, respiratory distress Interactions syndrome, acute spinal cord injury Drug-drug Contraindications and cautions Increased therapeutic and toxic effects with erythromycin, ketoconazole, troleandomycin

 Risk of severe deterioration of muscle strength metoclopramidegiven to myasthenia gravis patients who are when Apo-Metoclop (CAN), Maxolon, Nu-Metoclopramide (CAN), receiving ambenonium, edrophonium, neostigmine, Octamide pyridostigmine Reglan PFS, Reclomide, Decreased steroid blood levels with barbiturates, Drug classes phenytoin, rifampin GI stimulant Decreased effectiveness of salicylates Antiemetic Drug-lab test Dopaminergic blocker False-negative nitroblue-tetrazolium test for Therapeutic actions bacterial infection y Stimulates motility of upper GI tract without stimulating Suppression of skin test reactions gastric, biliary, Nursing considerations or pancreatic secretions; appears to sensitize tissues to action of acetylcholine; relaxes Assessment pyloricHistory: Infections; kidney or with effects on sphincter, which, when combined liver disease, motility, accelerates gastric emptying and intestinal hypothyroidism, ulcerative colitis, diverticulitis, active or transit;peptic ulcer, inflammatory bowel colon motility; latent little effect on gallbladder or disease, CHF, increases lower esophageal sphincter pressure; has hypertension, thromboembolic disorders, osteoporosis, sedativedisorders, diabetes mellitus; of prolactin.lactation seizure properties; induces release pregnancy; y It appears to bind to dopamine D2 receptors where it is a Physical: Weight, T, reflexes and grip strength, receptor antagonist, and isP, BP, mixed 5-HT3perfusion affect and orientation, also a peripheral receptor antagonist/5-HT4 receptorveins, R and adventitious prominence of superficial agonist. The anti-emetic action of metoclopramide is due to its antagonist activity sounds, serum electrolytes, blood glucose at D2 Interventions receptors in the chemoreceptor trigger zone (CTZ) in the central nervousthe 24-mg (CNS)this action Use caution with system tablets marketed as prevents nausea and vomiting triggered by most stimuli. Medrol; these contain tartrazine, which may cause At higher doses, 5-HT3 antagonist activity may also allergic reactions, especially in people who are allergic contribute to aspirin. to the anti-emetic effect. Indications

Give daily dose before 9 AM to mimic normal peak Relief of symptoms of corticosteroid blood levels. acute and recurrent diabetic gastroparesis dosage when patient is subject to stress. Increase Short-term therapy (412 wk) fordiscontinuing WARNING: Taper doses when adults with symptomatic gastroesophageal reflux who fail to adrenal high-dose or long-term therapy to allow respond to conventional therapy recovery. Parenteral: Prevention of nausea vaccines with WARNING: Do not give live virus and vomiting associated with emetogenic cancer chemotherapy immunosuppressive doses of corticosteroids. Teaching pointsProphylaxis of postoperative nausea and vomiting when nasogastric suction taking the oral drug without Do not to stop is undesirable Single-dose parenteral use: Facilitation of smallconsulting your health care provider. bowelAvoid exposure to infections. not pass the pylorus intubation when tube does with conventional maneuvers Report unusual weight gain, swelling of the Single-dose parenteral use: Stimulation of stools, extremities, muscle weakness, black or tarry gastric emptying and intestinal transitcolds or other infections, fever, prolonged sore throat, of barium when delayed emptying interferes with radiologic exam of the stomach worsening of disorder. or small intestine Adverse effectsUnlabeled uses: Improvement of lactation (doses of in Italic are most common; those in Bold are life3045 mg/day); treatment of nausea and vomiting of a threatening. variety of etiologies: Emesis during pregnancy and labor, gastric ulcer, anorexia nervosa Contraindications and cautions Contraindicated with allergy to metoclopramide; GI hemorrhage, mechanical obstruction or perforation; pheochromocytoma (may cause hypertensive crisis); epilepsy. Use cautiously with previously detected breast cancer (one third of such tumors are prolactin dependent); lactation, pregnancy.

Teaching forms Availablepoints Tablets5, 10 Takeconcentrated solution10 mg/mL; injection mg; this drug exactly as prescribed. Do not use alcohol, sleep remedies, sedatives; 5 mg/mL serious sedation could occur. You may hr Metabolism: Hepatic; T1/2: 56experience these side effects: Drowsiness, dizziness (do breast milk Distribution: Crosses placenta; enters not drive or perform other tasks Excretion: Urinethat require alertness); restlessness, anxiety, depression, headache, insomnia (reversible); nausea, IV facts diarrhea. Report involuntary mL of a parenteral eyes, or Preparation: Dilute dose in 50 movement of the face, solution (dextrose limbs, severe depression, severeinjection, dextrose 5% in 5% in water, sodium chloride diarrhea. 0.45% sodium chloride, Ringer's injection, or lactated Ringer's injection). May be stored for up to 48 hr if protected from light or up to 24 hr under normal light. Infusion: Give direct IV doses slowly (over 12 min); give infusions over at least 15 min. Incompatibilities: Do not mix with solutions containing chloramphenicol, sodium bicarbonate, cisplatin, erythromycin. Y-site incompatibility: Do not give with furosemide. Adverse effects CNS: Restlessness, drowsiness, fatigue, lassitude, insomnia, extrapyramidal reactions, parkinsonism-like reactions, akathisia, dystonia, myoclonus, dizziness, anxiety CV: Transient hypertension GI: Nausea, diarrhea

Interactions metoprolol Drug-drug Apo-Metoprolol (CAN), Betaloc (CAN),digoxin from the stomach Decreased absorption of Lopressor, Novometoprol (CAN), Nu-Metop (CAN) toxic and immunosuppressive effects of Increased metoprolol succinate cyclosporine Toprol-XL metoprolol tartrate Nursing considerations Lopressor Injection Assessment History: Allergy to metoclopramide, GI Drug classes hemorrhage, mechanical obstruction or perforation, Beta1-selective adrenergic blocker pheochromocytoma, epilepsy, lactation, previously Antihypertensive breast cancer detected Therapeutic actions Physical: Orientation, reflexes, affect; P, BP; Competitively blocks beta-adrenergic receptors in the heart and bowel sounds, normal output; EEG juxtaglomerular apparatus, decreasing the influence of the Interventions sympathetic nervous systemcarefully during IV administration. of Monitor BP on these tissues and the excitability the heart, decreasing cardiac output and thereactions, and consult Monitor for extrapyramidal release of renin, and lowering BP; acts in the CNS to reduce sympathetic outflow and physician if they occur. vasoconstrictor Monitor diabetic patients, arrange for alteration in tone. Indications insulin dose or timing if diabetic control is compromised alterations in timing of food absorption. by Hypertension, alone or with other drugs, especially diuretics WARNING: Keep diphenhydramine injection Immediate-release extrapyramidal reactions occur readily available in casetablets and injection: Prevention of reinfarction (50 mg IM). in MI patients who are hemodynamically stableWARNING: Have phentolamine readily available or within 310 days of the acute MI Treatment of angina pectoris in case of hypertensive crisis (most likely to occur with Toprol-XL only: Treatment undiagnosed pheochromocytoma).of stable, symptomatic CHF of ischemic, hypertensive, or cardiomyopathic origin

Contraindications and cautions Increased effects of sinus bradycardia (HR < is Contraindicated with both drugs if metoprolol 45 taken with second- or beats/min),hydralazine third-degree heart block (PR Increased serum levels and toxicity of IV lidocaine, interval > 0.24 sec), cardiogenic shock, CHF, systolic BP if given concurrently < 100 mm Hg; lactation. Increased risk with diabetes hypotension with Use cautiously of orthostatic or thyrotoxicosis; prazosin asthma or COPD; pregnancy. Decreased antihypertensive effects if taken with Available forms NSAIDs, mg; ER tablets25, 50, 100, 200 mg; Tablets50, 100 clonidine, rifampin Decreased therapeutic effects with barbiturates injection1 mg/mL Hypertension followed by severe bradycardia if given concurrently with Metabolism: Hepatic; T1/2: 34 hrepinephrine Drug-lab test Crosses placenta; enters breast milk Distribution: Possible false results with glucose or insulin Excretion: Urine tolerance tests (oral) Nursing considerations IV facts Assessment No additional preparation is required. Preparation: Infusion: InjectHistory:into vein or into tubing of< 45 beats/min), directly Sinus bradycardia (HR running IV over second- bolus; monitor carefully; (PR interval > 0.24 1 min. Inject as aor third-degree heart block wait 2 min between doses; do sec),give if bradycardia CHF, 45 beats/min, 100 mm Hg; not cardiogenic shock, of < systolic BP < heart block, diabetes or thyrotoxicosis; asthma or COPD; lactation, systolic pressure < 100 mm Hg. pregnancy Incompatibilities: Do not mix with amino acids, aztreonam, Physical: Weight, skin condition, neurologic dopamine. status, P, BP, ECG, respiratory status, renal and thyroid function Adverse effects tests, blood and urine glucose Interventions Allergic: Pharyngitis, erythematous rash, fever, WARNING: Do not sore throat, laryngospasm discontinue drug abruptly after long-term therapy (hypersensitivity to catecholamines may have developed, causing

CNS: Dizziness, vertigo, tinnitus, fatigue, exacerbation of angina, paresthesias, sleep arrhythmias). emotional depression, MI, and ventricular disturbances, Taper drug gradually over 2 wk with monitoring. slurred hallucinations, disorientation, memory loss, Ensure that patient swallows the ER tablets whole; speech do not CV: crush, orcardiac them. XL tablets may be cut, CHF, chew arrhythmias, peripheral divided atinsufficiency, claudication, CVA, pulmonary vascular the score; divided tablets should be swallowed whole, not crushed or chewed. edema, hypotension Consult physician about withdrawing drug Dermatologic: Rash, pruritus, sweating, dry skin if patientEENT: Eye irritation, dry eyes, conjunctivitis, is to undergo surgery (controversial). Give oral blurred vision drug with food to facilitate absorption. ProvideGastric pain, flatulence, constipation, GI: continual cardiac monitoring for patients receiving IV metoprolol. diarrhea, nausea, vomiting, anorexia, ischemic colitis, Teaching renal and mesenteric arterial thrombosis, retroperitoneal points Do not stop taking this pancreatitis fibrosis, hepatomegaly, acute drug unless instructed to do so by aGU: Impotence, decreased libido, Peyronie's health care provider. Swallow the extended-release tablets whole; do not disease, dysuria, nocturia, frequent urination cut, crush, or chew them. If using Toprol XL, you can Musculoskeletal: Joint pain, arthralgia, muscle divide the tablets at the score; divided tablets must be cramp swallowed whole, not Bronchospasm, dyspnea, cough, Respiratory: crushed or chewed. You obstruction, these stuffiness, rhinitis, bronchial may experience nasal side effects: Dizziness, drowsiness, light-headedness, blurred vision (avoid pharyngitis driving or dangerous activities); nausea, loss of appetite Other: Decreased exercise tolerance, development (eat frequent small meals); nightmares, depression of ANA, hyperglycemia or hypoglycemia, elevated serum (discuss change of medication); sexual impotence. transaminase, alkaline phosphatase Interactions Report difficulty breathing, night cough, swelling of Drug-drug extremities, slow pulse, confusion, depression, rash, fever, Increased effects of metoprolol with verapamil, sore throat. cimetidine, methimazole, propylthiouracil

metronidazole injection, bacteriostatic 0.9% sodium chloride injection to Flagyl Apo-Metronidazole (CAN), Flagyl, Flagyl 375, Flagyl ER,the vial and mix IV, Flagyl thoroughly. Resultant volume is 5 mL NidaGel IV RTU, MetroGel, MetroGel-Vaginal, with a concentration of Protostat (CAN), Noritate, 100 mg/mL. Solution should be clear to pale yellow to yellow-green; do not use if cloudy or if containing precipitates; use within 24 hr; protect from light. Add reconstituted Drug classes solution to Antibiotic glass or plastic container containing 0.9% sodium chloride injection, 5% dextrose injection or lactated Ringer's; Antibacterial discontinue other solutions while running metronidazole. Amebicide Infusion: Before administration, add 5 mEq sodium bicarbonate Antiprotozoal injection for each 500 mg used (if not using premixed bags); mix thoroughly. Do not refrigerate neutralized solution. Do not Therapeutic actions administer solution that has not been neutralized. Infuse over 1 hr.  Bactericidal: Inhibits DNA synthesis in specific Adverse effects (obligate) anaerobes, causing cell death; antiprotozoal CNS: Headache, dizziness, ataxia, vertigo, trichomonacidal, amebicidal: Biochemical mechanism of incoordination, seizures, peripheral action is not known.insomnia, neuropathy, fatigue  Metronidazole, taken up by diffusion, is selectively GI: Unpleasant bacteria and anorexia, nausea, absorbed by anaerobic metallic taste, sensitive protozoa. vomiting, diarrhea, anaerobes, it is Once taken up by GI upset, cramps non-enzymatically GU: Dysuria, incontinence, darkening of which is reduced by reacting with reduced ferredoxin,the urine Local: pyruvate:ferredoxin oxido-reductase. This generated by Thrombophlebitis (IV); redness, burning, dryness, and skin the production of reduction causes irritation (topical) toxic products to Other: and allows for selective accumulation in anaerobic cells,Severe, disulfiram-like interaction with alcohol, candidiasis (superinfection) anaerobes. Interactions Indications Drug-drug Acute infection with susceptible anaerobic bacteria Decreased effectiveness with Acute intestinal amebiasis barbiturates Disulfiram-like reaction (flushing, tachycardia, Amebic liver abscess nausea, vomiting) with alcohol

Trichomoniasis (acute and partners of patients with acute Psychosis if taken with disulfiram infection) Increased bleeding tendencies postoperative with oral Preoperative, intraoperative, anticoagulants prophylaxis for patients undergoing colorectal surgery Drug-lab test Topical application: Treatment of inflammatory Falsely low (or zero) values in AST, papules, pustules, and erythema of rosacea ALT, LDH, triglycerides, hexokinase glucose tests Unlabeled uses: Prophylaxis for patients Nursing considerations undergoing gynecologic, abdominal surgery; hepatic Assessment encephalopathy; Crohn's disease; antibiotic-associated History: CNS or hepatic disease; candidiasis pseudomembranous colitis; treatment of Gardnerella (moniliasis); blood (use recommended by the CDC) vaginalis, giardiasisdyscrasias; pregnancy; lactation Physical: Reflexes, Contraindications and cautions affect; skin lesions, color (with topical Contraindicatedabdominal hypersensitivity liver application); examination, with to palpation; urinalysis, CBC, LFTs metronidazole; pregnancy (do not use for trichomoniasis in first trimester). Interventions Use cautiously with CNS diseases, hepatic disease, WARNING: Avoid use unless necessary. candidiasis (moniliasis), blood dyscrasias, lactation. AvailableMetronidazole is carcinogenic in some rodents. forms Administer oral doses with food. Tablets250, 500 mg; ER tablets750 mg; capsules375 mg; Apply topically (MetroGel) mg/100 mL; lotion, powder for injection500 mg; injection500 after cleansing the area. Advise patient that cosmetics may be cream, gel0.75%; cream1%; vaginal gel0.75%used over the area after application. Reduce dosage in hepatic disease. Metabolism: Hepatic; T1/2: 68 hr Distribution: Crosses placenta; enters breast milk Teaching points Excretion: Feces, urine Take full course of drug therapy; take the drug with IV facts food if GI upset occurs. Preparation: Reconstitute by adding 4.4 mL of sterile water for injection, bacteriostatic water for injection, 0.9% sodium chloride

 Do not drink alcohol (beverages or preparations Availablecontaining alcohol, cough syrups); severe reactions may forms Vaginal suppositories100, 200, 1,200 mg; topical cream2%; occur. vaginal cream2%;urine maypowder2%;this is expected. Your topical appear dark; topical spray2%; topical ointment2%; spray powder or liquid2%; solution2% Refrain from sexual intercourse during treatment for trichomoniasis unless partner wears a condom. Metabolism: Hepatic; the topical preparation by cleansing the area Apply T1/2: 2124 hr Distribution: then rubbing a thin film into breast milk area. Avoid and Crosses placenta; may enter the affected Excretion: Feces,with the eyes. Cosmetics may be applied to the contact urine area after application. Adverse effectsYou may experience these side effects: Dry mouth Vaginal suppositories metallic taste (frequent mouth care, sucking with strange Local: Irritation, sensitization or vulvovaginal sugarless candies may help); nausea, vomiting, diarrhea burning, pelvic cramps (eat frequent small meals). Other: Rash, headache dizziness, unusual fatigue Report severe GI upset, Topical application or weakness, fever, chills. Local: Irritation, burning, maceration, allergic contact dermatitis Nursing considerations Assessment History: Allergy to miconazole or components used in preparation; lactation, pregnancy Physical: Skin color, lesions, area around lesions; T; orientation, affect; culture of area involved Interventions Culture fungus involved before therapy. Insert vaginal suppositories high into the vagina; have patient remain recumbent for 1015 min after

miconazole nitrate Topical: insertion; provide sanitary napkin to protect clothing from Antifungal, Fungoid Tincture, Lotrimin AF, Breeze Mist stains. Monitor response; if none is noted, arrange for Maximum Strength Desenex Antifungal, Micatin, Monistat Derm further cultures to determine causative organism. Cream (CAN), Tetterine, Ting, Zeasorb-AF Apply lotion Vaginal suppositories, topical: to intertriginous areas if topical application is required; if cream 1 (CAN), Monistat 3, Femisol-M, Micozole (CAN), Monistat is used, apply sparingly to avoid maceration of the area. Monistat 7, Monistat Dual Pak, M-Zole 3, M-Zole 7 Dual Pack Ensure patient receives the full course of therapy to eradicate the fungus and to prevent recurrence. Drug class WARNING: Discontinue topical or vaginal Antifungal administration if rash or sensitivity occurs. Therapeutic actions Fungicidal: Alters fungal cell membrane permeability, causing cell Teaching points death; also may alter fungal cell DNA and RNA metabolism or Take the peroxides of drug therapy even if cause accumulation of toxicfull courseintracellularly. symptoms improve. Continue during menstrual period Indications even if Vaginal route is being used. Long-term use will vaginal suppositories: Local treatment of be needed; beneficial effects may not vulvovaginal candidiasis (moniliasis) be seen for several weeks. Topical administration: Tinea pedis, tinea cruris, tinea Insert vaginal suppositoriesTrichophyton vagina. corporis caused by high into the rubrum, Use hygienementagrophytes, measures to prevent reinfection or Trichophyton Epidermophyton spread of infection. floccosum; cutaneous candidiasis (moniliasis), tinea This versicolor drug is for the fungus being treated; do not self-medicate cautions Contraindications and other problems with this drug. Refrain from sexual intercourse, ormiconazole or Contraindicated with allergy to advise partner to use a condom in preparation. components used to avoid reinfection; with vaginal form of Use cautiously with pregnancy, lactation. drug, use a sanitary napkin to prevent staining of clothing.

 You may experience these side effects: Irritation, Continuous burning, stinging. sedation of intubated and mechanically ventilated patients as a irritation, burning (topical component of anesthesia or Report local during treatment in the critical care setting application); rash, irritation, pelvic pain (vaginal use). Unlabeled uses: Treatment of epileptic seizure or refractory status epilepticus Adverse effects in Italic are most common; those in Bold are lifeContraindications and cautions threatening. Contraindicated with hypersensitivity to benzodiazepines; psychoses, acute narrow-angle glaucoma, shock, coma, acute alcoholic intoxication; pregnancy (cleft lip or palate, inguinal hernia, cardiac defects, microcephaly, pyloric stenosis have been reported when used in first trimester; neonatal withdrawal syndrome reported in infants); neonates. Use cautiously in elderly or debilitated patients; with impaired liver or kidney function, lactation. Available forms Injection5 mg/mL, 1 mg/mL IV facts Preparation: Do not mix with other solutions; do not mix in plastic bags or tubing; may be used undiluted or diluted in D5W, 0.9% normal saline, or lactated Ringers. Infusion: Inject slowly into large vein over 2 min, monitoring patient response. Incompatibilities: Do not mix with any other drugs. Y-site incompatibilities: Albumin, ampicillin, ceftazidime, cefuroxime, clonidine, dexamethasone, foscarnet, furosemide,

midazolam hydrochloride hydrocortisone, methotrexate, nafcillin, omeprazole, sodium bicarbonate. Drug classes Benzodiazepine (short-acting) Metabolism: Hepatic metabolism; T1/2: 1.86.8 hr CNS depressant Distribution:actions placenta; enters breast milk Therapeutic Crosses Excretion: Urine  Exact mechanisms of action not understood; acts mainly at the limbic system and reticular formation; potentiates Adverse effects the effects of GABA, an inhibitory neurotransmitter; CNS: amnesia mild occur at doses below anxiolytic and Transient, effects drowsiness (initially); sedation, depression, sedation, ataxia; has fatigue, lightthose needed to cause lethargy, apathy, little effect on headedness, disorientation, restlessness, confusion, cortical function.  crying, delirium,not activate slurred speech, dysarthria, midazolam does headache, GABAA receptors directly stupor, with other benzodiazepines, it enhances the effect but, as rigidity, tremor, dystonia, vertigo, euphoria, nervousness, difficulty GABA on the GABAA receptors of the neurotransmitter in concentration, vivid dreams, psychomotor retardation, extrapyramidalthesymptoms; resulting in neural inhibition. Almost all of properties mildbe explained excitatory reactions (during first 2 wk can paradoxical by the actions of benzodiazepines on of treatment), visual and auditory disturbances,following GABAA receptors. This results in the diplopia, nystagmus, depressed hearing, nasal congestion sedation, pharmacological properties being produced: CV: Bradycardia, tachycardia, CV hypnotic, anxiolytic, anterograde amnesia, collapse, muscle hypertension, hypotension, palpitations, edema relaxation and anti-convulsant Dermatologic: Urticaria, pruritus, skin rash, Indications dermatitis IM: Sedation, anxiolysis, and amnesia prior IV or diagnostic, therapeutic, or endoscopic procedures or GI: Constipation, diarrhea, dry mouth, salivation, to nausea, anorexia, vomiting, difficulty in swallowing, surgery gastric disorders, general anesthesia Induction of elevations of blood enzymes: LDH, alkaline phosphatase, AST, ALT, hepatic dysfunction, jaundice

 GU: Incontinence, urinary retention, changes in libido,Arrange to irregularities and kidney function and menstrual monitor liver CBC Hematologic: Decreased Hct, blood dyscrasias at intervals during long-term therapy. EstablishPhlebitis and thrombosis at IV injection Other: safety precautions if CNS changes occur (use side rails, accompany ambulating patient). muscular sites, hiccups, fever, diaphoresis, paresthesias, Provide comfort measures and reassurance for disturbances, gynecomastia; pain, burning, and redness patients receiving diazepam for tetanus. after IM injection Arrange to taper dosage gradually afterwithdrawal Dependence: Drug dependence with long-term therapy. when drug is discontinued (more common syndrome Provide patient with written information used for with abrupt discontinuation of higher dosage regarding recovery andmo) longer than 4 follow-up care. Midazolam is a potent amnesiac and memory may be altered. Interactions Drug-drug Teaching points of increased CNS depression if combined with Risk This drug will help opioids, other sedatives; alcohol, antihistamines,you to relax and will make you go to sleep; this drugdose by up to 50% if and youthese decrease midazolam is a potent amnesiac any of will not remember are used happened to you. combinations what has Decreased effectiveness if given with carbamazepine, Avoid using alcohol or sleep-inducing or over-the counter drugs before receiving this drug. If you feel that phenytoin, rifampin, rifabutin, phenobarbital; monitor you need one ofcarefully patient response these preparations, consult your health care provider. Drug-food Decreased may experience increased effects of You metabolism and these side effects: Drowsiness,with grapefruit (these avoid thisbecome less dizziness juice; may combination midazolam pronounced after a few days; avoid driving a car or Nursing considerations engaging in other dangerous activities if these occur); GI Assessment upset; History: Hypersensitivity to benzodiazepines; dreams, difficulty concentrating, fatigue, nervousness, crying (it may help to know that these are psychoses, acute narrow-angle glaucoma, shock, coma, effects alcoholic intoxication with depression of vital acute of the drug; consult your health care provider if these become bothersome).

signs; elderly or debilitated patients; impaired liver or Report severe dizziness, weakness, drowsiness that kidney function; pregnancy, lactation persists, rash Weight; skin color, visual or hearing Physical: or skin lesions, lesions; orientation, disturbances, difficulty voiding.function, ophthalmologic affect, reflexes, sensory nerve examination; P, BP; respiratory rate, adventitious sounds; bowel sounds, normal output, liver evaluation; normal output; LFTs, renal function tests, CBC Interventions WARNING: Do not administer intra-arterially, which may produce arteriospasm or gangrene. Do not use small veins (dorsum of hand or wrist) for IV injection. Administer IM injections deep into muscle. Monitor IV injection site for extravasation. Arrange to reduce dose of midazolam if patient is also being given opioid analgesics; reduce dosage by at least 50% and monitor patient closely. Monitor level of consciousness before, during, and for at least 26 hr after administration of midazolam. Carefully monitor P, BP, and respirations carefully during administration. WARNING: Keep resuscitative facilities readily available; have flumazenil available as antidote if overdose should occur. Keep patients in bed for 3 hr; do not permit ambulatory patients to operate a vehicle following an injection.

miglitol Assessment Glyset History: Hypersensitivity to the drug; diabetic ketoacidosis; cirrhosis; inflammatory bowel disease; Drug class intestinal obstruction or predisposition to intestinal Antidiabetic obstruction; type Alpha-glucosidase inhibitor 1 diabetes; conditions that would deteriorate with increased gas in the bowel; renal impairment; Therapeutic actions pregnancy; lactation Physical: Skin delays the digestion of ingested An alpha-glucosidase inhibitor thatcolor, lesions; T; orientation, reflexes, peripheral sensation; R, adventitious glucose carbohydrates, leading to a smaller increase in blood sounds; following liver evaluation, bowel sounds; urinalysis, BUN, blood meals and a decrease in glycosylated Hgb; does not glucose enhance insulin secretion and so its effects are additive to those of Interventions the sulfonylureas in controlling blood glucose. Indications Give drug tid with the first bite of each meal. Monitor urine to serum glucose levels patients Adjunct to diet or lower blood glucose in often to determine effectiveness of drug and dosage. with type 2 (noninsulin-dependent) diabetes mellitus whose Tell patient abdominal pain and by diet alone hyperglycemia cannot be managed flatulence are likely. Combination therapy with a sulfonylurea to Arrange for consult those patients with type 2 enhance glycemic control in with dietitian to establish weight loss program and dietary control as appropriate. diabetes who do not receive adequate control with diet Planeither drug diabetic teaching program to include and thorough disease, dietary control, Contraindications and cautions exercise, signs and symptoms of hypoglycemia and with hypersensitivity to the drug; Contraindicated hyperglycemia, avoidance of infection, ketoacidosis; cirrhosis; inflammatory bowel diabetic and hygiene. Teaching disease; intestinal obstruction or predisposition to points Do not discontinue intestinal obstruction; typethis medication without 1 (insulin-dependent) consulting conditions that would diabetes; your health care provider. deteriorate with Take this the three increased gas indrugbowel. times a day with the first bite of each meal.

Use cautiously with renal impairment, pregnancy, Monitor blood for glucose and ketones as lactation. Availableprescribed. forms Continue Tablets25, 50, 100 mg diet and exercise program established for control of diabetes. You may experience these Metabolism: Not metabolized; T1/2: 2 hr side effects: Abdominal pain, flatulence, Distribution: Very little bloating. Report fever, sore throat, unusual bleeding or Excretion: Urine bruising, severe abdominal pain. Adverse effects Dermatologic: Rash Endocrine: Hypoglycemia (taken in combination with other antidiabetic drugs) GI: Abdominal pain, flatulence, diarrhea, anorexia, nausea, vomiting Interactions Drug-drug Decreased bioavailability and effectiveness of propranolol, ranitidine Miglitol is less effective if taken with digestive enzymes or charcoal; avoid combining Drug-alternative therapy Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, celery Nursing considerations

minocycline hydrochloride Capsules50, 75, 100 mg; pellet-filled capsules50, 100 mg; Arestin, Dynacin, Gen-Minocycline (CAN), Minocin IV, Novooral suspension50 Minocycline (CAN) mg/5 mL; powder for injection100 mg; tablets50, 75, 100 mg; sustained-release microsphere1 mg Drug classes Metabolism: Hepatic; T1/2: 1126 hr Antibiotic Distribution: Tetracycline Crosses placenta; enters breast milk Excretion: Feces, urine Therapeutic actions IV facts Bacteriostatic: Inhibits protein synthesis of susceptible y Preparation: Dissolve powder and then further dilute to 500 bacteria, causing cell death. 1,000 mL withanti-inflammatory, minocycline inhibits apoptosis y As an sodium chloride injection, dextrose injection, dextrose (cell sodium chloride injection, Ringer's injection, or and death) via attenuation of TNF-alpha, lactated Ringer's injection;pro-inflammatory cytokine output. This downregulating administer immediately. Infusion: effect is mediated byhr;direct actiondiluted solution not Infuse slowly over 6 a discard any of minocycline on used within 24 hr. the activated T cells and on microglia, which results in Incompatibilities: Avoid solutionsTwith calcium; a precipitate the decreased ability of cells to contact microglia may form.which impairs cytokine production in T cell-microglia Y-site incompatibilities: DoMinocycline also inhibits microglial signal transduction . not inject with hydromorphone, meperidine, morphine. activation, through blockade of NF-kappa B nuclear translocation. Adverse effects Indications Dental: Discoloring by rickettsiae; Mycoplasma Infections caused and inadequate calcification of primary teeth of fetus of used by pregnant women; if psittacosis, ornithosis, pneumoniae; agents discoloring and inadequate and granuloma inguinale; lymphogranuloma venereum calcification of permanent teeth if used during period of dental development Borrelia recurrentis; Hemophilus ducreyi; Pasteurella Dermatologic: Phototoxic reactions, rash, pestis; Pasteurella tularensis; Bartonella bacilliformis; exfoliative dermatitis comma; Vibrio fetus; Brucella; Bacteroides; Vibrio (more frequent, more severe with this tetracycline than with any others)

Escherichia coli; Enterobacter aerogenes; Shigella; GI: Fatty liver, liver H. influenzae; Klebsiella; Acinetobacter calcoaceticus; failure, anorexia, nausea, vomiting, diarrhea, glossitis, dysphagia, enterocolitis, Diplococcus pneumoniae; Staphylococcus aureus esophageal ulcer When penicillin is contraindicated, infections Hematologic: Hemolytic anemia, caused by Neisseria gonorrhoeae, Treponema pallidum, thrombocytopenia, eosinophilia, Treponema pertenue, neutropenia, monocytogenes, Listeria leukocytosis, Bacillus Clostridium, leukopeniaanthracis. As an adjunct to Local: Local intestinal injection amebicides in acuteirritation atamebiasis site Other: Superinfections, nephrogenic diabetes Oral tetracyclines are indicated for treatment of insipidus syndrome acne, uncomplicated urethral, endocervical, or rectal infections in adults caused by Chlamydia trachomatis Interactions Oral minocycline is indicated in treatment of Drug-drug asymptomatic carriers of N. meningitidis (not useful for Decreased infection); infections caused by treating the absorption of minocycline with antacids, iron, alkali Mycobacterium marinum; uncomplicated urethral, Increased rectal toxicity endocervical, ordigoxininfections caused by Ureaplasma Increased nephrotoxicity with methoxyflurane urealyticum; uncomplicated gonococcal urethritis in men Decreased activity due to N. gonorrhoeae of penicillin Drug-food Arestin: Adjunct to scaling and root planing to Decreased absorption of with adult periodontitis reduce pocket depth in patients minocycline if taken with food, dairy products Alternative to sulfonamides in the Unlabeled use: treatment of nocardiosis Nursing considerations Contraindications and cautions Assessment Contraindicated with allergy to tetracylines. History: Allergy to tetracyclines, renal or hepatic Use cautiously with renal or hepatic dysfunction, dysfunction, pregnancy, lactation pregnancy, lactation. Physical: Skin status, orientation and reflexes, R Available forms and adventitious sounds, GI function and liver

evaluation, urinalysis and BUN, LFTs, renal function catecholamines from area tests; culture infected tumor); acute MI; dissecting aortic aneurysm; lactation. Interventions Use cautiously with malignant hypertension; CHF (use Administerangina pectoris without regard to food diuretic); oral medication (use a beta-blocker); pregnancy. GI upset occurs, give with meals. or meals; if Available forms Tablets2.5, 10 Teaching points mg; topical 2%, 5% Take drug throughout the day for best results. Metabolism: Hepatic; T1/2mealshr GI upset occurs. Take with : 4.2 if Distribution: Crosses placenta; enters breast milk Arestin: After treatment, avoid eating hard, Excretion: Urine or sticky foods for 1 week and postpone crunchy, brushing for a 12-hour period. Adverse effectsYou may experience these side effects: Sensitivity sunlight Fatigue,protective clothing, use sunscreen); to CNS: (wear headache CV: Tachycardia diarrhea, nausea (take with(unless given with small meals; eat frequent betaadrenergic blocker or other sympatholytic drug), meals). pericardial effusion and tamponade; changes in direction Report rash, itching; difficulty breathing; dark and magnitude of T-waves; cardiac necrotic lesions urine or light-colored stools; severe cramps, watery (reported in patients with known ischemic heart disease, diarrhea. but risk of minoxidil-associated cardiac damage cannot be excluded) Dermatologic: Temporary edema, hypertrichosis (elongation, thickening, and enhanced pigmentation of fine body hair occurring within 36 wk of starting therapy; usually first noticed on temples, between eyebrows and extending to other parts of face, back, arms, legs, scalp); rashes including bullous eruptions; Stevens-Johnson syndrome; darkening of the skin

minoxidil GI: Nausea, vomiting Topical: Hematologic: Initial decrease in Hct, Hgb, RBC Rogaine, Rogaine Extra Strength count Drug classes Antihypertensive Local: Irritant dermatitis, allergic contact dermatitis, eczema, pruritus, dry skin/scalp, flaking, Vasodilator alopecia (topical use) Respiratory: Bronchitis, upper respiratory tract Therapeutic actions infection, sinusitis (topical use) Acts directly on vascular smooth muscle to cause vasodilation, Interactions reducing elevated systolic and diastolic BP; does not interfere with Drug-drug does not usually cause orthostatic hypotension but CV reflexes; Risk of profound renin release, leading to sodium does cause reflex tachycardia and orthostatic hypotension if given and waterwith guanethidine; stop guanethidine; if growth is not retention; mechanism in stimulating hair not possible, hospitalize patient known, possibly related to arterial dilation. Nursing considerations Indications Assessment Severe hypertension that is symptomatic or History: target organ to minoxidil is not associated with Hypersensitivity damage and or any component with maximum therapeutic doses of a of the topical preparation; manageable pheochromocytoma; acute MI, dissecting use in diuretic plus two other antihypertensive drugs; aortic aneurysm; malignant recommended CHF; angina milder hypertension not hypertension; pectoris; lactation,(when compounded as a 1%5% lotion Topical use pregnancy 1% ointment): Alopecialesions, hair, scalp; pattern Physical: Skin color, areata and male P, BP, or orthostatic BP, supine BP, perfusion, edema, alopecia auscultation; cautions Contraindications andbowel sounds, normal output; CBC with differential, renal function tests, urinalysis, ECG Contraindicated with hypersensitivity to minoxidil Interventionsany component of the topical preparation (topical); or Apply topical (may stimulate release if pheochromocytoma preparation to affected area; of fingers are used to facilitate drug application, wash hands thoroughly afterward.

 Do not apply other topical drugs, including topical mirtazapine corticosteroids, retinoids, and petrolatum or agents Remeron, known to enhance cutaneous drug absorption. Remeron SolTab Do not apply topical preparation to open lesions or Drug class breaks in the skin, which could increase risk of systemic Antidepressant (tetracyclic) absorption. Therapeutic actions WARNING: Arrange to withdraw oral drug Mechanism of actionespecially from children; similarly to TCAs, gradually, unknown; appears to act rapid withdrawal which inhibit the presynaptic reuptake of thein BP (rebound neurotransmitters may cause a sudden increase norepinephrine and serotonin; reported in children, CNS with hypertension has been anticholinergic at even and peripheralgradual withdrawal; use caution and monitor BP clinical receptors; sedating; relation of these effects to closely efficacy iswhen withdrawing from children). unknown. Arrange for echocardiographic evaluation of Indicationpossible pericardial effusion; more vigorous diuretic Relief of other treatment (including minoxidil therapy, dialysis,symptoms of depression (endogenous depression most responsive) withdrawal) may be required. Teaching points Contraindications and cautions Oral Contraindicated with hypersensitivity to any Take this drug exactly as prescribed. Take all other tricyclic or tetracyclic drug;been prescribed. Do not medications that have concomitant therapy with an MAOI; recent MI;drug or reduce the previous 24 hr or discontinue any myelography within dosage without scheduled your health care provider. consulting within 48 hr; pregnancy (limb reduction abnormalities reported); lactation side effects: Enhanced You may experience these Use cautiously with ECT; preexisting CV disorders growth and darkening of fine body and face hair (do not (eg, severe medicationheart disease, progressive heart discontinue coronary without consulting health care failure, angina (eat frequent small meals).tachycardia provider); GI upset pectoris, paroxysmal [possible increased risk of rate of > 20 beats per minute Report increased heart serious CVS toxicity with TCAs]); angle-closure glaucoma, increased IOP, urinary over normal (your normal heart rate is ___ beats per retention, ureteral or urethral spasm; seizure disorders

minute); rapid weight gain of more than 5 pounds; (TCAs lower theofseizure threshold); hyperthyroidism unusual swelling the extremities, face, or abdomen; (predisposes to CVS toxicity, lying down; cardiac difficulty breathing, especially when including new or arrhythmias); impairedangina (chest, renal or function; hepatic, aggravated symptoms of arm, shoulder psychiatric patients (schizophrenic or paranoid patients pain); severe indigestion; dizziness, light-headedness, or may exhibit a worsening of psychosis with TCAs); fainting. Topical manic-depressive disorder (may shift to hypomanic or manicApply the prescribed amount to affectedshould be phase); elective surgery (TCAs area twice discontinued as the fingers to facilitate surgery) a day. If using long as possible before application, wash Availablehands thoroughly after application. It may take 4 months forms Tablets15, longer for any noticeable hair regrowth to appear. or 30, 45 mg; orally disintegrating tablet15, 30, 45 mg Response to this drug is very individual. If no response is seen within 4 months, consult with your health care Metabolism: Hepatic; T1/2: 2040 hr provider about efficacy of continued use. Distribution: Crosses placenta; enters breast or larger applications. Do not apply more frequent milk Excretion: Feces, urine speed up or increase hair growth but may This will not Adverse effects side effects. increase CNS: or two daily anticholinergic (atropine-like) If one Sedation andapplications are missed, restart effects; confusion (especially in elderly), disturbed twice-daily applications, and return to usual schedule. concentration, to make up missed applications.decreased Do not attempt hallucinations, disorientation, memory, not apply any other topical medication to the Do feelings of unreality, delusions, anxiety, nervousness, restlessness, agitation, panic, insomnia, area while you are using this drug. nightmares, apply to any sunburned, broken skin or Do not hypomania, mania, exacerbation of psychosis, drowsiness, weakness, of systemic effects. open lesions; this increases the risk fatigue, headache, numbness, agitation part of the body other drug the scalp. Do not apply to any (less likely with this than than with other antidepressants) of the drug will be necessary to Twice daily use CV: Orthostatic hypotension, hypertension, retain or continue the hair regrowth. syncope, tachycardia, palpitations, MI, arrhythmias, heart block, precipitation of CHF, stroke

 Endocrine: Elevated or depressed blood sugar; Place orally disintegrating tablet on tongue; it can elevated prolactin levels; inappropriate ADH secretion be swallowed without water. Open blister pack with dry GI: Dry mouth, constipation, paralytic ileus, hands and uselikely with this drug thancut or break nausea (less tablet immediately; do not with other tablet. antidepressants), increased appetite, weight gain, Avoid anorexia, epigastric distress, diarrhea, vomiting, using alcohol, other sleep-inducing drugs, or over-the-counter drugspeculiar taste, increased salivation, flatulence, dysphagia, while using this drug. Avoid prolonged exposure to sunlight or sunlamps; stomatitis, glossitis, parotid swelling, abdominal cramps, use a tongue, liver enzyme elevations if long exposure black sunscreen or protective garments to sunlight is unavoidable. GU: Urinary retention, delayed micturition, You may experience these side effects: testicular dilation of urinary tract, gynecomastia, Headache, dizziness, indrowsiness, weakness, blurred vision swelling men; breast enlargement, menstrual (reversible; avoid driving in women; increased that irregularity, galactorrhea or performing tasks or require alertness);impotence decreased libido; nausea, vomiting, loss of appetite, dry mouth (eat frequentAgranulocytosis, neutropeniamouth Hematologic: small meals; use frequent care, suck on sugarless candies); nightmares, inability to Hypersensitivity: Rash, pruritus, vasculitis, concentrate, confusion; changes in sexual function. petechiae, photosensitization, edema Interactions Report fever, flulike illness, any infection, dry mouth, difficulty urinating, excessive sedation, suicidal Drug-drug thoughts. WARNING: Risk of serious, sometimes fatal reactions if combined with MAOIs; do not use this combination or within 14 days of MAOI therapy Nursing considerations Assessment History: Hypersensitivity to any antidepresssant; concomitant therapy with MAOI; recent MI; myelography within previous 24 hr or scheduled within 48 hr; lactation; ECT; preexisting CV disorders; angle-

closure glaucoma; increased IOP, urinary retention, montelukast sodium ureteral or urethral spasm; seizure disorders; Singulair hyperthyroidism; impaired hepatic, renal function; psychiatric problems; manic-depressive patients; elective Drug classes surgery; pregnancy, lactation Antasthmatic Physical: Body weight; T; skin color, lesions; Leukotriene receptor antagonist orientation, affect, reflexes, vision and hearing; P, BP, Therapeutic actions BP, perfusion; bowel sounds, normal output, orthostatic  Selectively and competitively blocks the receptor that liver evaluation; urine flow, normal output; usual sexual inhibits leukotriene formation, thus blocking and scrotal function, frequency of menses, breast many of the signs and LFTs, urinalysis, asthmaneutrophil and examination; symptoms of CBC, ECG eosinophil migration, neutrophil and monocyte Interventions aggregation, leukocyte adhesion, increasedpotentially WARNING: Ensure that depressed and capillary permeability, and smooth muscle limited quantities of suicidal patients have access only to contraction. These actions contribute to inflammation, edema, mucus the drug. secretion, and bronchoconstriction associated with the Administer orally disintegrating tablets to patients signs havesymptoms of asthma. Open blister pack and who and difficulty swallowing:  Montelukast place tablet on tongue. Do notis it blocks the have patient is a CysLT1 antagonist; that split tablet. actionExpect clinical response in 37 days ligands LTC4 of leukotriene D4 (and secondary up to 23 wk and LTE4) on usual). (latter is more the cysteinyl leukotriene receptor CysLT1 in the Arrange forbronchial patientby binding fever, This lungs and CBC if tubes develops to it. sore reduces the bronchoconstriction during therapy. by the throat, or other sign of infection otherwise caused leukotriene, andsafety precautions if CNS changes occur Establish results in less inflammation. Indications side rails, accompany patient when ambulating). (use Teaching points Prophylaxis and chronic treatment of asthma in adultsTakechildren > 12 mo as prescribed; do not stop and this drug exactly takingRelief drug abruptly of seasonal allergic rhinitis in the of symptoms or without consulting your adults and children > 2 yr health care provider.

 Relief of symptoms of perennial allergic rhinitis in adultsAvoid the use>of mo and children 6 aspirin or NSAIDs if you have a known sensitivity to Chronic urticaria, atopic dermatitis Unlabeled uses: these drugs. Montelukast will not prevent reactions. Contraindications and cautions You may experience with side effects: Dizziness Contraindicated these hypersensitivity to (use caution when driving or performing activities that montelukast or any of its components; acute asthma require alertness); nausea, vomiting (eat frequent small attacks; status asthmaticus. meals, take drug with food); headache (analgesics may Use cautiously with pregnancy and lactation. Availablebe available). forms acute asthma attacks, flulike Tablets10 mg; Report fever, tablets4, 5 mg; granules chewable symptoms, lethargy. 4 mg/packet Metabolism: Hepatic; T1/2: 2.75.5 hr Distribution: Crosses placenta and enters breast milk Excretion: Feces, urine Adverse effects CNS: Headache, dizziness GI: Nausea, diarrhea, abdominal pain, dental pain Respiratory: Influenza, cold, nasal congestion Other: Generalized pain, fever, rash, fatigue Interactions Drug-drug Decreased effects and bioavailability if taken with phenobarbital, rifampin; monitor patient and adjust dosage as needed Nursing considerations Assessment

History: Hypersensitivity to montelukast or any of naproxenits components; acute asthma attacks; status asthmaticus, naproxen pregnancy and lactation Apo-Naproxen (CAN), Apo-Naproxen SR (CAN),R, adventitious Physical: T; orientation, reflexes; EC-Naprosyn, Naprelan, sounds; GI Naxen (CAN), Novo-Naprox (CAN) Naprosyn, evaluation Interventions naproxen sodium Administer in the evening without regard to food. Aleve, Anaprox,Ensure that drug is taken continually for optimal Anaprox DS, Apo-Napro-Na (CAN) effect. Drug classes Do not administer for acute asthma attack or acute NSAID bronchospasm. Analgesic(nonopioid) the use of aspirin or NSAIDs in patients Avoid Therapeutic actions sensitivities while they are using this drug. with known  Analgesic, anti-inflammatory, andpatient has a readily WARNING: Ensure that antipyretic activities largely related to inhibition for prostaglandin attacks or available rescue medication of acute asthma synthesis; exact mechanismsshort-acting inhaled agent is needed. situations when a of action are not known.  points Teaching It works by inhibiting both the COX-1 and COX-2 enzymes. this drug regularly as prescribed; do not stop Take Indications taking this drug during symptom-free periods; do not Mild this drug without stop takingto moderate pain consulting your health care Treatment of primary dysmenorrhea, rheumatoid provider. Continue taking any other drugs for treating arthritis,that have been ankylosing spondylitis, tendinitis, asthma osteoarthritis, prescribed for you. Notify your bursitis, acute gout if your asthma becomes worse. health care provider OTC take this drug for an acute asthma attack or Do notuse: Temporary relief of minor aches and pains bronchospasm; this drug is not acold, headache, acute associated with the common bronchodilator, toothache, muscular aches, backache, minor followed and routine emergency procedures should be pain of arthritis, painattacks. during acute of menstrual cramps, reduction of fever Treatment of juvenile arthritis (Naproxen)

Contraindications and cautions Arrange for periodic ophthalmologic examination Contraindicated with allergy to naproxen, during long-term therapy. salicylates, other NSAIDs; pregnancy; lactation. WARNING: If overdose occurs, institute Use cautiously with asthma, chronic urticaria, CV emergency hypertension; GI lavage, peptic ulcer; dysfunction; proceduresgastric bleeding; induction of emesis, supportive renal function. impaired hepatic ortherapy. Teaching forms Availablepoints Tablets250, Take drugmg; 220, 275, 500if GI (as naproxen 375, 500 with food or meals mg upset occurs; sodium); take only the prescribed mg; CR tablets375, 500 mg; DR tablets375, 500 dosage. Dizziness, suspension125 mg/5 mLdrowsiness can occur (avoid driving or the use of dangerous machinery). Report 1/2: 1215 hr Metabolism: Hepatic; Tsore throat; fever; rash; itching; weight gain; swelling in ankles or fingers; changes in vision; Distribution: Crosses placenta; enters breast milk black, tarry stools. Excretion: Urine Adverse effects CNS: Headache, dizziness, somnolence, insomnia, fatigue, tiredness, dizziness, tinnitus, ophthalmic effects Dermatologic: Rash, pruritus, sweating, dry mucous membranes, stomatitis GI: Nausea, dyspepsia, GI pain, diarrhea, vomiting, constipation, flatulence GU: Dysuria, renal impairment, including renal failure, interstitial nephritis, hematuria Hematologic: Bleeding, platelet inhibition with higher doses, neutropenia, eosinophilia, leukopenia, pancytopenia, thrombocytopenia, agranulocytosis, granulocytopenia, aplastic anemia, decreased Hgb or Hct, bone marrow depression, menorrhagia

Respiratory: Dyspnea, hemoptysis, pharyngitis, nifedipine bronchospasm, rhinitis (nye fed' i peen) Other: Peripheral edema, anaphylactoid Adalat, Adalat CC, anaphylactic shock Apo-Nifed (CAN), reactions to Adalat XL (CAN), Nifedical XL, Novo-Nifedin (CAN), Procardia, Procardia XL Interactions Drug-drug Drug classes Increased serum lithium levels and risk of toxicity Calcium channel-blocker with naproxen Antianginal Drug-lab test Antihypertensive Falsely increased values for urinary 17-ketogenic Therapeutic actions steroids; discontinue naproxen therapy for 72 hr before  Inhibits function tests adrenal the movement of calcium ions across the membranes of cardiac and arterial muscle cells; Inaccurate measurement of urinary 5inhibition of transmembrane calcium flow results in the hydroxyindoleacetic acid depression of Nursing considerations impulse formation in specialized cardiac pacemaker cells, in slowing of the velocity of conduction Assessment of the History:impulse, in the depression of myocardial cardiac Allergy to naproxen, salicylates, other contractility, and in chronic urticaria, CV dysfunction; NSAIDs; asthma, the dilation of coronary arteries and arterioles and GI bleeding; peptic ulcer; impaired hepatic hypertension; peripheral arterioles; these effects lead to decreased cardiac work, decreased cardiac energy or renal function; pregnancy; lactation consumption, and increased and lesions; orientation, Physical: Skin color delivery of oxygen to myocardial cells. reflexes, ophthalmologic and audiometric evaluation,  Calcium channel blockersBP, edema; R, adventitious peripheral sensation; P, work by blocking voltagegated calcium channels (VGCCs) clotting times, LFTs, sounds; liver evaluation; CBC, in cardiac muscle and bloodfunction tests; serum electrolytes; stool guaiac renal vessels. This decreases intracellular calcium leading to a reduction in muscle contraction. In the heart, Interventions a decrease with food or after meals if GI upsetresults in a Give in calcium available for each beat occurs. decrease in cardiac contractility. In blood vessels, a decrease in calcium results in less contraction of the

vascular smooth muscle and therefore an increase in Taper dosage of do not work before nifedipine arterial diameter (CCB's beta-blockers on venous smooth therapy. muscle), a phenomenon called vasodilation. Vasodilation Protect drug from light and moisture. decreases total peripheral resistance, while a decrease in Teaching cardiac contractility decreases cardiac output. Since points blood Do not chew, cut, or by cardiac output and pressure is determined crush sustained-release tablets. Swallow whole. peripheral resistance, blood pressure drops. You may experience these side effects: Nausea, Indications vomiting (eat pectoris due to meals); dizziness, spasm Angina frequent small coronary artery lightheadedness, variant angina) (Prinzmetal'svertigo (avoid driving, operating dangerous machinery; take special precautions to avoid falling); Chronic stable angina (effort-associated angina) muscle preparation only: Treatment of hypertension SR cramps, joint stiffness, sweating, sexual difficulties (reversible).Treatment of interstitial cystitis Orphan drug use: Report irregular Contraindications and cautions heartbeat, shortness of breath, swelling of the hands or allergy pronounced dizziness, Contraindicated with feet, to nifedipine. constipation. Use cautiously with lactation, pregnancy. Available forms ER tablets30, 60, 90 mg; capsules10, 20 mg Metabolism: Hepatic; T1/2: 25 hr Distribution: Crosses placenta; enters breast milk Excretion: Feces, urine Adverse effects CNS: Dizziness, light-headedness, headache, asthenia, fatigue, nervousness, sleep disturbances, blurred vision

CV: Peripheral edema, angina, hypotension, nitrofurantoin arrhythmias, AV block, asystole (nye troe fyoor an' toyn) Dermatologic: Flushing, rash, dermatitis, pruritus, urticaria nitrofurantoin GI: Nausea, diarrhea, constipation, cramps, Apo-Nitrofurantoin (CAN), Furadantin, Novo-Furantoin (CAN) flatulence, hepatic injury Other: Nasal congestion, cough, fever, chills, nitrofurantoin macrocrystals muscle cramps, joint stiffness, sexual shortness of breath, Macrobid,difficulties Macrodantin Interactions Drug classes Drug-drug Urinary tract anti-infective Increased effects with cimetidin Antibacteria Nursing considerations Therapeutic actions Assessment  Bacteriostatic in Allergy concentrations, possibly by low History: to nifedipine; pregnancy; interfering with bacterial carbohydrate metabolism; lactation bactericidal in Skin lesions, color, edema; orientation, Physical: high concentrations, possibly by disruptingP,bacterial cell wall formation, causing cell reflexes; BP, baseline ECG, peripheral perfusion, death. auscultation; R, adventitious sounds; liver evaluation,  The mechanism ofLFTs of nitrofurantoin is unique and normal GI output; action complex. The drug works by damaging bacterial DNA, Interventions since its reduced form is highlypatient carefully made WARNING: Monitor reactive. This is (BP, possiblerhythm, and output) while drug is being adjusted cardiac by the rapid reduction of nitrofurantoin inside thetherapeutic dose; flavoproteins (nitrofuran reductase) to bacterial cell by the dosage may be increased more to multiplehospitalized patients under close supervision. rapidly in reactive intermediates that attack ribosomal proteins, DNA, respiration, pyruvate metabolism and Do not exceed 30 mg/dose increases. other Ensure that patients do the cell. It or not known macromolecules within not chew is divide SR which of the actions of nitrofurantoin is primarily tablets. responsible for its bacteriocidal acitivity.

Indications Arrange for UTIs and sensitivity tests before and Treatment ofculture caused by susceptible strains of during therapy. Escherichia coli, Staphylococcus aureus, Klebsiella, Give with food or Enterobacter, Proteus milk to prevent GI upset. Continue drug for at least 3 days of UTIs Prophylaxis or long-term suppression after a sterile urine specimen is obtained. Contraindications and cautions Monitor clinical response; if no improvement is Contraindicated with allergy to nitrofurantoin, seen dysfunction; pregnancy, lactation. renal or a relapse occurs, send urine for repeat culture and sensitivity. cautiously in patients with G6PD deficiency, Use anemia,WARNING: Monitor pulmonary function diabetes. Availablecarefully; reactions can occur within hours or weeks of forms nitrofurantoin therapy. Capsules25, 50, 100 mg; Dual-release capsules100 mg; oral suspension25Arrange for periodic CBC and LFTs during longmg/5 mL term therapy. Teaching points Metabolism: Hepatic; T1/2: 2060 min Take placenta; food or milk. Complete the full Distribution: Crossesdrug withenters breast milk course Excretion: Urine of drug therapy to ensure a resolution of the infection. Take this drug at regular intervals around the clock; Adverse effects consult your nurse or pharmacist to set up a convenient schedule. neuropathy, headache, dizziness, CNS: Peripheral You drowsiness, vertigo nystagmus, may experience these side effects: Nausea, vomiting, abdominal pain (eat frequent smallStevens Dermatologic: Exfoliative dermatitis, meals); diarrhea; syndrome, alopecia, vision, dizziness Johnson drowsiness, blurring ofpruritus, urticartia, (observe caution driving or using dangerous equipment); angioedema brown or yellow-rust urine (expected cramps, vomiting, GI: Nausea, abdominal effect). Report fever, chills, cough, chest hepatotoxicity diarrhea, anorexia, parotitis, pancreatitis, pain, difficulty breathing, rash, numbness or tingling of the in G6PD Hematologic: Hemolytic anemia fingers or toes. deficiency; granulocytopenia, agranulocytosis,

leukopenia, thrombocytopenia, eosinophilia, nitroglycerin megaloblastic anemia (nye troe gli' ser in) Respiratory: Pulmonary hypersensitivity Intravenous: Other: Superinfections of the GU tract; Nitro-Bid hypotension; muscular aches; brown-rust urine IV, Nitroject (CAN) Spray: Nitrolingual InteractionsPumpspray Sublingual: Drug-drug NitroQuick, Nitrostat or decreased absorption with magnesium Delayed Sustained-release: magaldrate trisilicate, Nitro-Time Drug-lab test Topical: False elevations of urine glucose, bilirubin, alkaline Nitro-Bid phosphatase, BUN, urinary creatinine Transdermal: False-positive urine glucose when using Benedict's Deponit, Minitran, Nitrek, Nitro-Dur, Nitrodisc, Transderm-Nitro or Fehling's reagent Translingual: Nitrolingual Nursing considerations Transmucosal: Assessment Nitrogard History: Allergy to nitrofurantoin, renal dysfunction, G6PD deficiency, anemia, diabetes, Drug classes pregnancy, lactation Antianginal Physical: Skin color, lesions; orientation, reflexes; Nitrate R, adventitious sounds; liver evaluation; CBC; LFTs, Therapeutic actions renal function tests; serum electrolytes; blood, urine Relaxes vascular urinalysismuscle with a resultant decrease in glucose, smooth venous return and decrease in arterial BP, which reduces left ventricular Interventions workload and decreases myocardial oxygen consumption.

preparations, topical allergic reactionstopical Indications nitroglycerin ointment Sublingual, translingual preparations: Acute angina GI: Nausea, vomiting, incontinence of urine and Oral SR, sublingual, topical, transdermal, feces, abdominal pain translingual, transmucosal preparations: Prophylaxis of anginaLocal: Local burning sensation at the point of dissolution (sublingual) IV: Angina unresponsive to recommended doses of Other: Ethanol intoxication organic nitrates or beta-blockers with high-dose IV use (alcohol in diluent) IV: Perioperative hypertension Interactions IV: CHF associated with acute MI Drug-drug IV: To produce controlled hypertension during Increased risk of hypertension and decreased surgery antianginal effectuses: Reduction of cardiac workload in Unlabeled with ergot alkaloids acute Decreased pharmacologic effects of heparin MI and in CHF (sublingual, topical); adjunctive Risk of severe hypotension and adverse CV events treatment of Raynaud's disease (topical) with sildenafil, tadalafil, vardenafil; avoid this Contraindications and cautions combination Contraindicated with allergy to nitrates, severe Drug-lab test anemia, early MI, head trauma, cerebral hemorrhage, False report of decreased serum cholesterol if hypertrophic cardiomyopathy, pregnancy, lactation. done by the Use cautiously with hepatic or renal disease, Zlatkis-Zak color reaction Nursing considerationsor hypovolemia, increased intracranial hypotension CLINICAL ALERT! pressure, constrictive pericarditis, pericardial tamponade, Name confusion has occurred pressure or low PCWP. low ventricular filling between NitroBid (nitrogylcerin) and Nicotral (nicotine); between nitroglycerin and nitroprusside; Available forms use caution. Injection0.5, 5 mg/mL; injection solution25, 50, 100, 200 mg; Assessment tablets0.3, 0.4, 0.6 mg; translingual spray sublingual History: Allergy to nitrates, severe anemia, early 0.4 mg/spray; transmucosal tablets1, 2, 3 mg; transmucosal SR MI, 2.5, trauma, oral SR hemorrhage, hypertrophic tablets1, 2, head 3, 5 mg; cerebral capsules2.5, 6.5, 9 mg; cardiomyopathy, hepatic or renal disease, hypotension or

transdermal0.1, 0.2, 0.3, 0.4, 0.6, 0.8 mg/hr; topical ointment hypovolemia, increased intracranial pressure, 2% constrictive pericarditis, pericardial tamponade, low ventricular T1/2: pressure Metabolism: Hepatic;filling14 min or low PCWP, pregnancy, lactation Distribution: Crosses placenta; enters breast milk Physical: Skin color, T, lesions; orientation, Excretion: Urine reflexes, affect; P, BP, orthostatic BP, baseline ECG, IV facts peripheral perfusion; R, adventitious sounds; liver evaluation, in 5% output; injection or 0.9% sodium Preparations: Dilute normal dextroseLFTs, renal function tests (IV); CBC, Hgb chloride injection. Do not mix with other drugs; check the Interventions instructions carefully because products vary manufacturer's considerably in Give sublingual preparations under the tongue or in concentration and volume per vial. Use only with the buccal pouch. Encourage sets provided. Protect Ask glass IV bottles and the administration patient not to swallow.from patient if the tablet "fizzles" or burns. Always check the light and extremes of temperature. Infusion: expiration date on the bottle; store rate based on patient Do not give by IV push; regulate at room temperature, response. protected from light. Discard unused drug 6 mo after bottle is Do not (conventional tablets); stabilized Incompatibilities: opened mix in solution with other drugs. tablets (Nitrostat) are less subject to loss of potency. Adverse effectsGive SR preparations with water; warn the patient not to chew the tablets or capsules; do not restlessness, CNS: Headache, apprehension, crush these preparations. weakness, vertigo, dizziness, faintness Administer topical ointment by applying the CV: Tachycardia, retrosternal discomfort, ointment over a 6 6 inchsyncope,acollapse, orthostatic palpitations, hypotension, area in thin, uniform layer using the applicator. Cover area with plastic wrap held in hypotension, angina place by adhesive tape. Rash, exfoliative dermatitis, Dermatologic: Rotate sites of application to decrease the chance of inflammationflushing, and sensitization; cutaneous vasodilation with pallor, close tube tightly when finished. dermatitistransdermal perspiration, cold sweat, contact Administer transdermal systems to skin site free of hair and not subject to much movement. Shave areas that

have a lot of hair. Do not apply to distal extremities. norethindrone acetate slightly to decrease the chance of local Change sites Aygestin irritation and sensitization. Remove transdermal system before attempting defibrillation or cardioversion. Drug classes Remove old system before applying a new one. Hormone Administer transmucosal tablets by placing them Progestin between the lip and gum above the incisors or between Therapeutic actionsand gum. Encourage patient not to swallow the cheek Progesterone not to chew the tablet. and derivative. Progesterone transforms proliferative endometrium into secretorythe translingualinhibitsdirectly onto the Administer endometrium; spray the secretion of pituitary gonadotropins, which prevents to be inhaled. oral mucosa; preparation is not follicular maturation and ovulation; and inhibits spontaneous uterine contraction. Progestins WARNING: Arrange to withdraw drug gradually. have varying profiles of recommended withdrawal period for and 46 wk is the estrogenic, antiestrogenic, anabolic, the androgenic activity. preparations. transdermal Indications Teaching points Treatment of tablets under abnormal uterine Place sublingual amenorrhea; your tongue or in bleeding duedo not chew or swallow the tablet; the tablet your cheek; to hormonal imbalance Treatment "fizzle" under should burn or of endometriosis the tongue. Take the Base: Component of some hormonal when you nitroglycerin before chest pain begins,contraceptive preparations your activities or situation may precipitate anticipate that Contraindications and cautions your dose every 5 minutes for an attack. You may repeat total of three tablets. If the pain is not relieved, go to an Contraindicated with allergy to progestins; a thrombophlebitis, Do not buy large quantities; this drug emergency room. thromboembolic disorders, cerebral hemorrhage or history the drug in conditions; place, in does not store well. Keep of these a dark, dry hepatic disease, carcinoma ofbottle breast a or genital organs, a dark-colored glass the with tight lid; do not undiagnosed other drugs.bleeding, missed abortion; combine with vaginal pregnancy; lactation. Do not chew or crush the timed-release Use cautiously with epilepsy, migraine, asthma, preparations; take on an empty stomach. cardiac or renal dysfunction.

Spread a thin layer of topical ointment on the skin using the applicator. Do not rub or massage the area. AvailableCover with plastic wrap held in place with adhesive tape. forms Tablets5 mg your hands after application. Keep the tube tightly Wash Metabolism: Hepatic; T1/2: Unknownfrequently to prevent local closed. Rotate the sites Distribution: Crosses placenta; enters breast milk irritation. Excretion: Feces, urine To use transdermal systems, you may need to shave Adverse effects for application. Apply to a slightly different area an area CNS: Sudden, partial, or complete loss of vision; each day. Remove the old system before you apply a proptosis; diplopia; migraine; precipitation of has a new one. Use care if changing brands; each system acute intermittent porphyria; different concentration. mental depression; pyrexia; insomnia; somnolence tablets between the lip and gum Place transmucosal CV: the gum and cheek. Do not chew; try not to or between Thrombophlebitis, cerebrovascular disorders, retinal pulmonary embolism, swallow. thrombosis, thromboembolic and thrombotic disease, increased BP Spray translingual spray directly onto oral mucous Dermatologic: inhale. Use without membranes; do not Rash with or 510 minpruritus, before acne, melasma anticipate will precipitate an attack. activities that you or chloasma, alopecia, hirsutism, photosensitivity experience these side effects: Dizziness, You may GI: Cholestatic jaundice, nausea light-headedness (may be transient; change positions GU: Breakthrough bleeding, spotting, change in slowly); headache (lie down in a cool environment and menstrual flow, amenorrhea, changes in cervical erosion rest; over-the-counter preparations may not help); and cervical secretions,face (transient). and secretion flushing of the neck or breast tenderness Other: Decreased glucose tolerance, fluid Report blurred vision, persistent or severe retention, edema,more frequent or more severe angina headache, rash, increase in weight Interactions attacks, fainting. Drug-lab test Inaccurate tests of hepatic and endocrine function . Nursing considerations Assessment

 History: Allergy to progestins; thrombophlebitis, norgestrel thromboembolic disorders, cerebral hemorrhage; hepatic Ovrette disease, carcinoma of the breast or genital organs, undiagnosed vaginal bleeding, missed abortion; Drug classes pregnancy; lactation; epilepsy, migraine, asthma, cardiac Hormone or renal dysfunction Progestin Physical: Skin color, lesions, turgor; hair; breasts; Hormonalpelvic examination; orientation, affect; ophthalmologic contraceptive Therapeutic actions examination; P, auscultation, peripheral perfusion, Progestational agent; the endogenous female progestin, edema; R, adventitious sounds; liver evaluation; LFTs, progesterone, transforms proliferative tolerance, Pap smear renal function tests, glucose endometrium into secretory endometrium; Interventions inhibits the secretion of pituitary gonadotropins, which prevents Arrange for pretreatment ovulation; and(at least follicular maturation and and periodic inhibits spontaneous uterine contractions. The primary mechanism by annual) history and physical, including BP, breasts, which norgestrel prevents conception is Pap known, but progestinabdomen, pelvic organs, and a not smear. only hormonal Warn patient prior to therapy to prevent pregnancy contraceptives alter the cervical mucus, exert a progestional to obtain frequent medical follow-up care. and effect on the endometrium that interferes with implantation, and in someUse caution when ovulation. WARNING: patients, suppress administering drug to Indication ensure preparation ordered is the one being used; Prevention is pregnancy twice potent as norethindrone acetateof approximately using ashormonal contraceptives; norethindrone. somewhat less efficacious (3 pregnancies per 100 woman years) medication and consult than the combined WARNING: Discontinue estrogen/progestin partial physician if suddenhormonalor contraceptives (about 1 complete loss of vision pregnancy per 100 or retinal vascular lesions on occurs; if papilledema woman years, depending are formulation) present, discontinue drug. Contraindications and cautions WARNING: Discontinue medication and consult Contraindicated with allergy to progestins, physician at sign of thromboembolic diseaseleg pain, tartrazine; thrombophlebitis, thromboembolic disorders, cerebral hemorrhage, or history of these conditions;

swelling, peripheral perfusion changes, shortness of CAD; breath.hepatic disease, carcinoma of the breast or genital Teaching organs, undiagnosed vaginal bleeding, missed abortion; points as a Take drugs in accordance with a marked calendar. diagnostic test for pregnancy; pregnancy (fetal abnormalitiesmasculinization of the female fetus, Avoid pregnancy; serious fetal abnormalities or congenital could occur. and limb reduction defects); fetal death heart defects, lactation. may experience these side effects: Sensitivity You light (avoid exposure to epilepsy, use sunscreen and Use cautiously with the sun; migraine, asthma, to cardiac or renal dysfunction. sleeplessness, depression protective clothing); dizziness, Available(use caution driving or performing tasks that require forms Tablets0.075 mg skin rash, color changes, loss of hair; fever; alertness); nausea. Metabolism: Hepatic; T1/2: Unknown and warmth in the calves, Report pain or swelling Distribution: Crosses pain or shortness of breath, sudden severe acute chest placenta; enters breast milk Excretion: Urine or vomiting, dizziness or fainting, numbness or headache Adverse effects in the arm or leg. tingling CNS: Neuro-ocular lesions, mental depression, migraine, changes in corneal curvature, contact lens intolerance CV: Thrombophlebitis, thrombosis, pulmonary embolism, coronary thrombosis, MI, cerebral thrombosis, Raynaud's disease, arterial thromboembolism, renal artery thrombosis, cerebral hemorrhage, hypertension Dermatologic: Rash with or without pruritus, acne, melasma GI: Gallbladder disease, liver tumors, hepatic lesions, nausea, vomiting, abdominal cramps, bloating, cholestatic jaundice

 GU: Breakthrough bleeding, spotting, change in idea to use an amenorrhea, changes in cervical if any menstrual flow,additional method of birth controlerosion tablets are missed. and cervical secretions, endocervical hyperplasia, Discontinue vaginal candidiasis drug and consult your health care provider if you decide to tenderness and It may be Other: Breast become pregnant. secretion, suggested that you use a edema, increase or of birth enlargement; fluid retention,nonhormonal form decrease control for in weight a few months before becoming pregnant. Interactions Do not take this drug during pregnancy; serious fetal abnormalities have been reported. If you think that Drug-drug you are pregnant consult physician immediately. Decreased effectiveness of hormonal Tell all contraceptives health care providers, including dentists, with barbiturates, hydantoins, that you take rifampin, griseofulvin, penicillins, carbamazepine, this drug. If other medications are prescribed, use may decrease birth control if these tetracyclines;they alternate form of the effectiveness of hormonal contraceptives and an additional method of drugs are needed birth control may Drug-alternative therapy be needed. You may experience these side effects: Sensitivity Decreased effectiveness if taken with St. John's to light (avoid exposure to the sun; use sunscreen and wort protective clothing); dizziness, sleeplessness, depression Nursing considerations (use Assessment caution driving or performing tasks that require alertness); rash, skin color changes, loss of hair; fever; History: Allergy to progestins, tartrazine; nausea; breakthrough bleeding or disorders, cerebral thrombophlebitis, thromboembolic spotting (transient); intolerance to contact lenses disease, carcinoma of hemorrhage; CAD; hepatic due to corneal changes. the breastReport painorgans, undiagnosed vaginal bleeding, or genital or swelling and warmth in the calves, acute chest pain or shortness of breath, sudden severe missed abortion; epilepsy, migraine, asthma, cardiac or headache or vomiting, dizziness or renal dysfunction; pregnancy; lactation fainting, visual disturbances, numbness or lesions, turgor; hair; breasts; Physical: Skin color, tingling in the arm or leg, breakthrough bleeding or spotting that lasts into the pelvic examination; orientation, affect; ophthalmologic second month P, auscultation, peripheral perfusion, examination; of therapy.

edema; R, adventitious sounds; liver evaluation; LFTs, nortriptyline hydrochloride renal function tests, glucose tolerance, Pap smear, Aventyl, Pamelor, PMS-Nortriptyline (CAN) pregnancy test Interventions Drug class Arrange for pretreatment and periodic (at least TCA (secondary amine) and physical, including BP, breasts, annual) history abdomen, pelvic organs, and a Pap smear. Therapeutic actions no earlier than 4 wk postpartum for Start Mechanism of action use. postpartum unknown; the TCAs are structurally related to the phenothiazine antipsychotic drugs (eg, chlorpromazine), but WARNING: Discontinue drug and consult inhibit the presynaptic reuptake or complete loss of vision physician if sudden partial of the neurotransmitters norepinephrine and papilledema or retinal vascular lesions and occurs; if serotonin; anticholinergic at CNS are peripheralpresent on examination, discontinue. of these effects to receptors; sedating; the relationship clinical efficacyDiscontinue drug and consult physician at any sign is unknown. Indications thromboembolic diseaseleg pain, swelling, of Relief of symptoms shortness of breath. peripheral perfusion changes,of depression (endogenous Teaching depression most responsive) points Unlabeled uses: Treatment of panic disorders (25 Take exactly as prescribed at intervals not 75 mg/day), hours. Take depression (50125 meal to exceeding 24premenstrual at bedtime or with amg/day), dermatologic disorders (75 mg/day), chronic pain, establish a routine; medication must be taken daily for headache prophylaxis prevention of pregnancy; if you miss one tablet, take as Contraindications and cautions soon as remembered, then take the next tablet at regular time. IfContraindicated with hypersensitivityone of any you miss two consecutive tablets, take to the tricyclic drug; concomitant therapy with an MAOI; missed tablets, discard the other, and take daily tablet at recent MI; If you miss three previous 24 hr or usual time. myelography within consecutive tablets, scheduled immediately, pregnancy (limb reduction discontinue within 48 hr; and use another method of abnormalities); lactation. birth control until your cycle starts again. It is a good Use cautiously with EST (increased hazard with TCAs); preexisting CV disorders (possibly increased risk

of serious CVS toxicity); angle-closure glaucoma, Other: urinary retention, excessive urethral increased IOP; Nasal congestion, ureteral or appetite, weight (anticholinergic sweating, may exacerbate these spasm gain or loss; effects alopecia, lacrimation, hyperthermia, flushing, chills conditions); seizure disorders; hyperthyroidism Interactions (predisposes to CVS toxicity, including cardiac Drug-drug arrhythmias); impaired hepatic, renal function; Increased (schizophrenic or pharmacologic psychiatric patients TCA levels andparanoid patients (especially a worsening of psychosis); with cimetidine, may exhibit anticholinergic) effects manic-depressive fluoxetine(may shift to hypomanic or manic phase); disorder Altered (discontinued as long arrhythmias and elective surgery response, including as possible before hypertension with sympathomimetics surgery). Risk of severe hypertension with clonidine Available forms Hyperpyretic solution10 seizures, Capsules10, 25, 50, 75 mg; crises, severemg/5 mL hypertensive episodes, and deaths when MAOIs are given with TCAs Decreased : 1828 hr Metabolism: Hepatic; T1/2hypotensive activity of guanethidine Note: MAOIs Crosses placenta; enters breast successfully in some Distribution: and TCAs have been used milk patients resistant to therapy with single agents; however, case Excretion: Urine reports indicate that the combination can cause serious and potentially fatal adverse effects. Adverse effects Nursing considerations CNS: Sedation and anticholinergic (atropine-like) Assessment effects (dry mouth, blurred vision, disturbance of History: for near vision, any tricyclic drug; accommodation Hypersensitivity tomydriasis, increased concomitant therapy with an MAOI; recent MI; IOP), confusion (especially in elderly), disturbed myelography within previous 24 hr or scheduled within concentration, hallucinations, disorientation, decreased 48 hr; pregnancy; of unreality, delusions, anxiety, memory, feelings lactation; EST; preexisting CV disorders; angle-closure glaucoma, panic, insomnia, nervousness, restlessness, agitation, increased IOP, urinary retention, ureteral or urethral spasm; seizure nightmares, hypomania, mania, exacerbation of disorders; hyperthyroidism; impaired hepatic, renal psychosis, drowsiness, weakness, fatigue, headache,

numbness, tingling, paresthesias of extremities, function; psychiatric patients; manic-depressive patients; incoordination, motor hyperactivity, akathisia, ataxia, elective surgery tremors, peripheral neuropathy, extrapyramidal Physical: Weight; T; skin color, symptoms, seizures, speech blockage, dysarthria lesions; orientation, affect, reflexes, hypotension, hearing; P, BP, CV: Orthostatic vision and hypertension, orthostatic tachycardia, palpitations, MI,normal output, syncope, BP, perfusion; bowel sounds, arrhythmias, liver evaluation; urine flow,CHF, stroke heart block, precipitation of normal output; usual sexual function, frequency of menses, breast blood scrotal Endocrine: Elevated or depressed and sugar; examination; LFTs, urinalysis, CBC, ECG secretion elevated prolactin levels; inappropriate ADH Interventions GI: Dry mouth, constipation, paralytic ileus, WARNING: Limit drug access to depressed and nausea, vomiting, anorexia, epigastric distress, diarrhea, potentially dysphagia, peculiar taste, increased salivation, flatulence, suicidal patients. When doses parotid swelling, are given, plasma stomatitis, glossitis,of > 100 mg/day abdominal cramps, levels tongue, hepatitis; elevated transaminase, altered black of nortriptyline should be monitored and maintained in the range of 50 to 150 ng/mL. alkaline phosphatase Give major portion of dose hsdelayed micturition, GU: Urinary retention, if drowsiness, severe anticholinergic effects occur. gynecomastia, testicular dilation of the urinary tract, Reduce enlargement, menstrual irregularity and swelling; breastdosage if minor side effects develop; discontinue ifincreased or decreased libido; impotence galactorrhea; serious side effects occur. Arrange for CBC if patient develops fever, sore Hematologic: Bone marrow depression, including throat, or other sign of infection. agranulocytosis; eosinophilia; purpura; Teaching thrombocytopenia; leukopenia points Take drug exactly as prescribed; do not stop taking Hypersensitivity: Rash, pruritus, vasculitis, this drug abruptly or without consulting your health care petechiae, photosensitization, edema (generalized, facial, provider.drug fever tongue), Avoid alcohol, other sleep-inducing, over-theWithdrawal: Symptoms with abrupt counter drugs. of prolonged therapy: nausea, headache, discontinuation Avoid prolonged exposure to sunlight or sunlamps; vertigo, nightmares, malaise use a sunscreen or protective garments if possible.

 You may experience these side effects: Headache, Tablets500,000 units; oral suspension100,000 units/mL; dizziness, drowsiness, weakness, blurred vision troche200,000 units; vaginal measures if severe;units; driving (reversible; use safety tablets100,000 avoid topical cream, ointment, powder100,000 units/g or performing tasks that require alertness); nausea, vomiting, loss of appetite, dry mouth (eat frequent small Excretion: Feces, unchanged (oral mouth care, and suck sugarless meals, perform frequent use) candy); nightmares, inability to concentrate, confusion; Adverse effects in sexual function. changes Oral Report dry mouth, difficulty in urination, excessive GI: sedation. Nausea, vomiting, diarrhea, GI distress Vaginal Local: Irritation, vulvovaginal burning Topical Local: Local irritation Nursing considerations Assessment History: Allergy to nystatin or components used in preparation, pregnancy, lactation Physical: Skin color, lesions, area around lesions; bowel sounds; culture of area involved Interventions Culture fungus before therapy. Have patient retain oral suspension in mouth as long as possible before swallowing. Paint suspension on each side of the mouth. Continue local treatment for at least 48 hr after clinical improvement is noted.

nystatinOral, oral suspensions, oral troche: Prepare nystatin in the form of frozen flavored popsicles Candistatin (CAN), Mycostatin, Nilstat, PMS Nystatin (CAN) to improve Vaginal preparations: oral retention of the drug for local application. Mycostatin Administer Topical application: nystatin troche orally for the treatment of oral candidiasis; have patient dissolve 12 tablets in Mycostatin, Nilstat mouth. Drug classInsert vaginal suppositories high into the vagina. Have patient remain recumbent for 1015 min after insertion. Antifungal Provide sanitary napkin to protect clothing from stains. Therapeutic actions Fungicidal Cleanse affected area to sterols in theapplication unless and fungistatic: Binds before topical cell membrane of otherwise resultant the fungus with a indicated. change in membrane permeability, Monitor response to drug therapy. and response is allowing leakage of intracellular components If no causing cell noted, arrange for further cultures to determine causative death. organism. Indications Ensure that patient receives the full course of Oral: Treatment of oropharyngeal candidiasis therapy to eradicate the fungus and to prevent recurrence. Oral suspension, troche: Treatment of oral candidiasis DiscontinueLocal treatment of vaginal candidiasis Vaginal: topical or vaginal administration if rash or sensitivity occurs. (moniliasis) Teaching points Topical applications: Treatment of cutaneous or Take the full course of infections caused by Candida mucocutaneous mycotic drug therapy even if symptoms improve. and other Candida species albicans Continue during menstrual period if vaginal route is being used. Long-term use of the drug may be Contraindications and cautions needed; beneficial effects may not be seen components Contraindicated with allergy to nystatin or for several weeks. preparation. used in Vaginal suppositories should be inserted high into the vagina. with pregnancy, lactation. Use cautiously Available Use appropriate hygiene measures to prevent reinfection forms or spread of infection.

This drug is for the fungus being treated; do not self Contraindicated medicate other problems. with allergy to olanzapine, myeloproliferative disorders, severe CNS depression, Refrain from sexual intercourse or advise partner to use comatose to avoid reinfection; use a sanitary napkin to a condom states, lactation. Use cautiously in elderly or debilitated prevent staining of clothing with vaginal use. patients, or with CVmaycerebrovascular disease, dehydration,Nausea, You or experience these side effects: seizure disorders, Alzheimer's disease, prostate enlargement, vomiting, diarrhea (oral use); irritation, burning, stinging narrow-angle (local use). glaucoma, history of paralytic ileus or breast cancer, pregnancy; phenylketonuria (if using Report worsening of condition; local irritation, burning orally disintegrating rash, irritation, pelvic pain (vaginal (topical application);tablets, contain phenylalanine). Availableuse); nausea, GI distress (oral administration). forms Tablets2.5, 5, 7.5, 10, 15, 20 mg; orally disintegrating tablets 5, 10, 15, 20 mg; powder for injection10 mg Metabolism: Hepatic; T1/2: 30 hr Distribution: Crosses placenta; enters breast milk Excretion: Feces, urine Adverse effects CNS: Somnolence, dizziness, nervousness, headache, akathisia, personality disorders, tardive dyskinesia, neuroleptic malignant syndrome CV: Orthostatic hypotension, peripheral edema, tachycardia GI: Constipation, abdominal pain Respiratory: Cough, pharyngitis Other: Fever, weight gain, joint pain, development of diabetes mellitus Interactions

olanzapine Drug-drug Zyprexa, Zyprexa IntraMuscular, Zyprexa Zydis Increased risk of orthostatic hypotension with antihypertensives, alcohol, benzodiazepines; avoid use of alcohol and use caution with antihypertensives Drug classes Antipsychotic Increased risk of seizures with anticholinergics, CNS drugs Dopaminergic blocking agent May decrease effectiveness of levodopa, dopamine agonists Therapeutic actions Decreased effectiveness with rifampin, Mechanism of action not fully understood; blocks dopamine receptors omeprazole, carbamazepine, smoking blocks serotonin in the brain, depresses the RAS; receptor sites; Increased risk of toxicity with fluvoxamine alphaanticholinergic, antihistaminic (H1), and Nursing considerations adrenergic blocking activity may contribute to some of its CLINICAL ALERT! therapeutic (and adverse) actions; produces fewer extrapyramidal Name than most has occurred between Zyprexa (olanzapine) and effects confusion antipsychotics. Zyrtec (cetirizine); use caution. Indications Assessment Treatment of schizophrenia History: Allergy to olanzapine, myeloproliferative Treatment of acute mixed or manic episodes disorders, severe CNS disorder and maintenance of associated with bipolar 1 depression, comatose states, history bipolar 1of seizure monotherapy,lactation; CV with disorder as disorders, or combined or cerebrovascular disease, dehydration, Alzheimer's lithium or valproate disease, Treatmentenlargement, narrow-angle glaucoma, prostate of agitation associated with history of paralytic ileus mania (injection) schizophrenia and bipolar 1 or breast cancer, elderly or debilitated patients, pregnancy related to Alzheimer's Unlabeled use: Dementia Physical: T, weight; reflexes, orientation, IOP, disease ophthalmologic examination; P, BP, orthostatic BP, Contraindications and cautions ECG; R, adventitious sounds; bowel sounds, normal output, liver evaluation; prostate palpation, normal urine output; CBC, urinalysis, LFTs, renal function tests

Interventions olmesartan medoxomil Do not dispense more than 1-wk supply at a time. Benicar Peel back foil on blister pack of disintegrating tablets; do not push through foil; use dry hands to Drug classes remove tablet and place in mouth. Angiotensin II receptor antagonist for IM injection using 2.1 mL Prepare solution Antihypertensive water for injection. Resulting solution contains sterile Therapeutic actions 5 mg/mL. Solution should be clear yellow. Use within 1 Selectively blocks the binding of angiotensin II to specific tissue hr of reconstitution. Discard any unused portion. receptors found Monitor for thesmooth possibleand adrenal gland; in the vascular many muscle drug interactions this action blocks the vasoconstricting effect of the renin before beginning therapy. angiotensin system as well as theMonitor of elderly patients for WARNING: release aldosterone leading to decreaseddehydration and institute remedial measures promptly; BP; may prevent the vessel remodeling associated with the development ofand decreased sensation of thirst related to CNS sedation atherosclerosis. Indication effects of drug can lead to dehydration. Treatment of hypertension,before taking the drug to Encourage patient to void alone or in combination with other antihypertensives help decrease anticholinergic effects of urinary retention. Contraindications and cautions Monitor for elevations of temperature and Contraindicated with hypersensitivity to any differentiate between infection and neuroleptic malignant component syndrome. of the drug; pregnancy (use during the second or third for orthostaticcause injury or even death Monitor trimester can hypotension and provide to the fetus), lactation. appropriate safety measures as needed. Teaching points Use cautiously with renal dysfunction, hypovolemia, salt depletion. as prescribed; do not change Take this drug exactly Availabledose without consulting your health care provider. forms Tablets5, 20, 40 mgback foil on blister pack of disintegrating Peel tablets; do not push through foil; use dry hands to Metabolism: Hydrolyzed in GI tract;tablet 13 mouth. remove tablet, place entire T1/2: in hr Distribution: Crosses placenta; enters breast milk

This drug cannot be taken during pregnancy. If you Excretion: Feces, urine pregnant or wish to become pregnant, think you are Adverse effects your health care provider. contact CNS: may experience these side effects: You Headache, dizziness, syncope, muscle weakness Drowsiness, dizziness, sedation, seizures (avoid driving, CV: machinery, or performing operating Hypotension, tachycardia tasks that require Dermatologic: Rash, inflammation, (change concentration); dizziness, faintness on arising urticaria, pruritus, slowly, use caution); increased salivation (if positionsalopecia, dry skin GI: contact abdominal pain, nausea, bothersome, Diarrhea,your health care provider); constipation, dry mouth, dental health care provider for constipation (consult with yourpain Hematologic: Increased CPK, hyperglycemia, appropriate relief measures); fast heart rate (rest and take hypertriglyceridemia your time if this occurs). Respiratory: URI weakness, fever, sore cough, Report lethargy, symptoms, bronchitis, throat, sinusitis, rhinitis, pharyngitis malaise, mouth ulcers, and flulike symptoms. Other: Back pain, flulike symptoms, fatigue, hematuria, arthritis, angioedema Nursing considerations Assessment History: Hypersensitivity to any component of the drug, pregnancy, lactation, hepatic or renal dysfunction, hypovolemia, salt depletion Physical: Skin lesions, turgor; body T; reflexes, affect; BP; R, respiratory auscultation; LFTs, renal function tests, serum electrolytes Interventions Administer without regard to meals. Ensure that patient is not pregnant before beginning therapy; suggest the use of barrier birth control while

using olmesartan; fetal injury and deaths have been olmesartan medoxomil reported. Benicar Find an alternate method of feeding the infant if given to a nursing mother. Depression of the renin Drug classes angiotensin system in infants is potentially very Angiotensin II receptor antagonist dangerous. Antihypertensive WARNING: Alert surgeon and mark patient's Therapeutic actions notice that olmesartan is being taken. The chart with Selectively blocks the binding of angiotensin IIsystem following blockage of the reninangiotensin to specific tissue receptors surgery can vascular smooth muscle and adrenal gland; found in the produce problems. Hypotension may be this action blocks the vasoconstricting effect of the renin reversed with volume expansion. angiotensin system as well as the releasein any situationleading to Monitor patient closely of aldosterone that may decreasedlead to a decrease the BP secondary to reduction in fluid BP; may prevent in vessel remodeling associated with the development of atherosclerosis. volumeexcessive perspiration, dehydration, vomiting, Indication diarrhea; excessive hypotension can occur. Teaching pointsTreatment of hypertension, alone or in combination with other antihypertensives Take drug without regard to meals. Do not stop Contraindications and cautions taking this drug without consulting your health care Contraindicated with hypersensitivity to any provider. component barrier method of birth control while on this Use a of the drug; pregnancy (use during the secondif you become pregnant orinjury or to become drug; or third trimester can cause desire even death to the fetus), lactation. your health care provider. pregnant, consult with Use cautiously with maintain your fluid Take special precautions to renal dysfunction, hypovolemia, salt depletion.precautions in any situation intake and provide safety Availablethat might cause a loss of fluid volumeexcessive forms Tablets5, 20, 40 mg dehydration, vomiting, diarrhea; excessive perspiration, hypotension can occur. Metabolism: Hydrolyzed in GI tract; T1/2: 13 hr Distribution: Crosses placenta; enters breast milk

You may experience these side effects: Dizziness Excretion: Feces,driving a car or performing hazardous tasks); (avoid urine headache (medications may be available to help); nausea, Adverse effects vomiting, diarrhea (proper nutrition is important, consult CNS: maintain dizziness, syncope, upper a dietitian to Headache,nutrition); symptoms ofmuscle weakness respiratory tract, cough (do not self-medicate, consult with CV: Hypotension, tachycardia if this becomes your health care provider Dermatologic: Rash, inflammation, urticaria, uncomfortable). pruritus, alopecia, dry skin Report fever, chills, dizziness, pregnancy, swelling. GI: Diarrhea, abdominal pain, nausea, constipation, dry mouth, dental pain Hematologic: Increased CPK, hyperglycemia, hypertriglyceridemia Respiratory: URI symptoms, bronchitis, cough, sinusitis, rhinitis, pharyngitis Other: Back pain, flulike symptoms, fatigue, hematuria, arthritis, angioedema Nursing considerations Assessment History: Hypersensitivity to any component of the drug, pregnancy, lactation, hepatic or renal dysfunction, hypovolemia, salt depletion Physical: Skin lesions, turgor; body T; reflexes, affect; BP; R, respiratory auscultation; LFTs, renal function tests, serum electrolytes Interventions Administer without regard to meals. Ensure that patient is not pregnant before beginning therapy; suggest the use of barrier birth control while

using olmesartan; fetal injury and deaths have been ondansetron hydrochloride reported. (on dan' sah tron) an alternate method of feeding the infant if Find Zofran, Zofran ODT nursing mother. Depression of the renin given to a angiotensin system in infants is potentially very Drug class dangerous. Antiemetic WARNING: Alert surgeon and mark patient's Therapeutic actions notice that olmesartan is being taken. The chart with Blocks specific receptorthe reninangiotensin are associated with blockage of sites (5-HT3), which system following nausea and vomiting inproduce problems. trigger zone, centrally surgery can the chemoreceptor Hypotension may be and at specific sites peripherally. It is not known whether its reversed with volume expansion. antiemetic actions are from actions at the any situation that may Monitor patient closely in central, peripheral, or combinedlead to a decrease in BP secondary to reduction in fluid sites. Indications volumeexcessive perspiration, dehydration, vomiting, Parenteral and oral: Prevention of diarrhea; excessive hypotension can occur. nausea and associated with emetogenic cancer Teaching vomiting points chemotherapy in patients >regard of age Take drug without 6 mo to meals. Do not stop Prevention without consulting your vomiting taking this drugof postoperative nausea and health care to prevent further episodes or, when postoperative provider. nausea and vomiting must be avoided on this Use a barrier method of birth control while (oral), prophylactically (parenteral) in patients > 1 mo ofbecome drug; if you become pregnant or desire to age Prevention with your health care provider. pregnant, consult of nausea and vomiting associated with radiotherapyspecial precautions to maintain your fluid Take intakeUnlabeled uses: Treatment of nausea and vomiting and provide safety precautions in any situation associated with acetaminophen poisoning, prostacyclin that might cause a loss of fluid volumeexcessive therapy; treatment of acutevomiting, diarrhea; psychosis; perspiration, dehydration, levodopa-induced excessive reduction of can occur. in bulimia nervosa; treatment of hypotension episodes spinal or epidural morphine-induced pruritus

You may experience these side effects: Dizziness Contraindications and cautionsor performing hazardous tasks); (avoid driving a car Contraindicated with allergy to ondansetron. headache (medications may be available to help); nausea, Use diarrhea (proper nutrition lactation. vomiting, cautiously with pregnancy,is important, consult Availableaforms dietitian to maintain nutrition); symptoms of upper Tablets4, 8, 24 mg; orally disintegrating self-medicate,mg; oral respiratory tract, cough (do not tablets4, 8 consult solution4 mg/5 mL; injection2 mg/mL, 32 mg/50 mL becomes with your health care provider if this Metabolism: Hepatic; T1/2: 3.56 hr uncomfortable). Distribution: Crosses placenta; may enter breast milk Report fever, chills, dizziness, pregnancy, swelling. Excretion: Urine IV facts Preparation: Dilute in 50 mL of 5% dextrose injection or 0.9% sodium chloride injection; stable for 48 hr at room temperature after dilution. Infusion: Infuse slowly over 15 min diluted or 25 min undiluted. Compatibilities: May be diluted with 0.9% sodium chloride injection, 5% dextrose injection, 5% dextrose and 0.9% sodium chloride injection; 5% dextrose and 0.45% sodium chloride injection; 3% sodium chloride injection. Incompatibilities: Do not mix with alkaline solutions. Adverse effects CNS: Headache, dizziness, drowsiness, shivers, malaise, fatigue, weakness, myalgia CV: Chest pain, hypotension Dermatologic: Pruritus GI: Abdominal pain, constipation GU: Urinary retention

 Local: Pain at injection site uropathies, glaucoma, myasthenia gravis, CV instability Interactions in Drug-food acute hemorrhage, urinary retention. Increased extent of absorption if takenrenal impairment; Use cautiously with hepatic, orally with food pregnancy; lactation. Available forms Nursing considerations Tablets5 Assessmentmg; syrup5 mg/5 mL; ER tablets5, 10, 15 mg; transdermal patch3.9 mg/day History: Allergy to ondansetron, pregnancy, Metabolism: Hepatic; T1/2:and vomiting lactation, nausea Unknown Distribution: Crosses placenta; may enter breast milk orientation, Physical: Skin color and texture; Excretion: Urine bilateral grip strength, affect; P, BP; abdominal reflexes, examination; urinary output Adverse effects Interventions CNS: Drowsiness, dizziness, blurred vision, Ensure that the timing of drug doses corresponds to dilatation of the pupil, cycloplegia, that of the chemotherapy or radiation. increased ocular tension, weakness oral drug for 12 days following Administer CV: Tachycardia, palpitations completion of chemotherapy or radiation. Teaching points GI: Dry mouth, nausea, vomiting, constipation, bloated Take oral drug for 12 days following feeling GU: Urinary radiation therapy to maximize chemotherapy or hesitancy, retention, impotence Hypersensitivity: Allergic reactions including prevention of nausea and vomiting. Take the drug every urticaria, dermal effect 8 hours around the clock for best results. Other: experience these side effects: Weakness, You mayDecreased sweating, heat prostration in high environmental temperatures secondary to loss of dizziness (change position slowly to avoid injury); sweating dizziness, drowsiness (do not drive or perform tasks that Interactions require alertness). Drug-drug Report continued nausea and vomiting, pain at Decreased effectiveness of phenothiazines with injection site, chest pain, palpitations. oxybutynin

Decreased effectiveness of haloperidol and oxybutynin chloride development of tardive dyskinesia Apo-Oxybutynin (CAN), Ditropan, Ditropan XL, Novo Increased toxicity if combined with amantadine, Oxybutynin (CAN), Oxytrol nitrofurantoin Nursing considerations Drug classes Assessment Anticholinergic History: Allergy to oxybutynin, intestinal Urinary antispasmodic obstructions Therapeutic actions or lesions, intestinal atony, obstructive uropathies, glaucoma, myasthenia gravis, the effects of Acts directly to relax smooth muscle and inhibits CV instability in at muscarinic receptors; reported renal impairment, acetylcholine acute hemorrhage, hepatic or to be less potent an pregnancy, lactation anticholinergic than atropine but more potent as antispasmodic and Physical: Skin at skeletal neuromuscular junctions devoid of antinicotinic activity color, lesions; T; orientation, affect, reflexes; ophthalmologic examination, ocular pressure or autonomic ganglia. measurement; P, rhythm, BP; bowel sounds, liver Indications evaluation; LFTs, renal function tests, cystometry Relief of symptoms of bladder instability Interventions associated with voiding in patients with uninhibited Arrange reflex neurogenic bladder neurogenic andfor cystometry and other diagnostic tests beforeER tablets: treatment. of signs and symptoms of and during Treatment Arrange for (incontinence, examination before overactive bladder ophthalmologic urgency, frequency); therapy and pediatric patients therapy. treatment ofperiodically during> 6 yr with symptoms of Teaching detrusor overactivity associated with a neurological points Take this drug as prescribed. condition (eg spina bifida) (Ditropan XL) If using the transdermal patch, apply to dry, intact Contraindications and cautions skin on the abdomen, hip, or buttock every 34 days Contraindicated with allergy to oxybutynin, pyloric (twice weekly). Remove obstructive intestinal lesions or or duodenal obstruction, the old system before applying a new one. Selectatony, megacolon, colitis, of each new ileus, intestinal a new site for application obstructive system.

 Periodic bladder examinations will be needed seizure delirium tremens, cerebral during this disorders, to evaluate therapeutic response. treatment arteriosclerosis, experience these side effects: Dry mouth You may ulcerative colitis, fever, Addison's disease, prostatic hypertrophy, urethral stricture, care); (suck sugarless lozenges and use frequent mouth recent or GU surgery, toxic psychosis, renal driving or GI upset; blurred vision; drowsiness (avoid or hepatic dysfunction. performing tasks that require alertness); decreased Availablesweating forms (avoid high temperatures; serious Tablets5 mg; IR capsules5 mg; because you will mg; heat complications can occur IR tablets15, 30 be CR tablets10, 20, 40, 80, 160 mg; oral solution5 mg/5 mL; intolerant). solution concentrate20 mg/mL vision, fever, rash, nausea, Report blurred Metabolism: Hepatic; T1/2: 23 hr vomiting. Distribution: Crosses placenta; enters breast milk Excretion: Urine Adverse effects CNS: Light-headedness, dizziness, sedation, euphoria, dysphoria, delirium, insomnia, agitation, anxiety, fear, hallucinations, disorientation, drowsiness, lethargy, impaired mental and physical performance, coma, mood changes, weakness, headache, tremor, seizures, miosis, visual disturbances CV: Facial flushing, peripheral circulatory collapse, tachycardia, bradycardia, arrhythmia, palpitations, chest wall rigidity, hypertension, hypotension, orthostatic hypotension, syncope, circulatory depression, shock, cardiac arrest Dermatologic: Pruritus, urticaria, edema, hemorrhagic urticaria (rare)

oxycodone hydrochloride GI: Nausea, vomiting, sweating (more common in Endocodone, M-oxy, OxyContin, Oxydose, OxyFAST, OxyIR, ambulatory patients and those without severe pain), Percolone, Roxicodone, Roxicodone Intensol, Supeudol (CAN) dry mouth, anorexia, constipation, biliary tract spasm; increased colonic motility in patients with chronic Drug class ulcerative colitis Opioid agonist analgesic GU: Therapeutic actions Ureteral spasm, spasm of vesical sphincters, urinary retention or receptors oliguria, to produce Acts as agonist at specific opioidhesitancy, in the CNS antidiuretic analgesia,effect, reduced libido or receptors mediating these effects euphoria, sedation; the potency Respiratory: are thought to be the same asSuppression of cough reflex, those mediating the effects of respiratory depression, apnea, respiratory arrest, endogenous opioids (enkephalins, endorphins). laryngospasm, bronchospasm Indications Other: Physical tolerance severe pain Relief of moderate to moderately and dependence, psychological dependence CR tablets: Management of moderate to severe Interactions when a continuous, around-the-clock analgesic is pain Drug-drug needed for an extended period of time Increased likelihood of respiratory depression, Contraindications and cautions hypotension, profoundwith hypersensitivity in opioids, Contraindicated sedation or coma to patients receiving barbiturate general diarrhea caused by poisoning anesthetics, protease (before toxins are inhibitors eliminated); pregnancy (readily crosses placenta; Drug-lab test neonatal withdrawal); labor or delivery (opioids given to Elevated cause respiratory depression in neonate; the mother canbiliary tract pressure may cause increases in plasma infants are at special risk; may for 24 labor); premature amylase, lipase; determinationsprolonghr after administration bronchial asthma, COPD, cor pulmonale, respiratory Nursing considerations depression, anoxia, kyphoscoliosis, acute alcoholism, Assessment increased intracranial pressure, lactation. History: Hypersensitivity to opioids, diarrhea Use cautiously with acute abdominal conditions, caused by supraventricular tachycardias, myxedema, CV disease, poisoning, pregnancy, labor or delivery, bronchial asthma, COPD, cor pulmonale, respiratory

depression, kyphoscoliosis, acute alcoholism, increased pantoprazole intracranial pressure, acute abdominal conditions, CV Pantoloc (CAN), Protonix, Protonixseizure disorders, cerebral IV disease, myxedema, arteriosclerosis, ulcerative colitis, fever, Addison's Drug classes disease, prostatic hypertrophy, urethral stricture, recent Antisecretory or GU surgery, toxic psychosis, renal or hepatic GI drug Proton pump inhibitor lactation dysfunction, Therapeutic actions Physical: T; skin color, texture, lesions; Gastric acid-pump inhibitor: Suppresses gastric acid secretion by orientation, reflexes, bilateral grip strength, affect, pupil specific inhibitionauscultation, BP, orthostatic BP, perfusion; R, size; P, of the hydrogen-potassium ATPase enzyme system at adventitious sounds; of the gastric parietal cells; output; the secretory surface bowel sounds, normal blocks the final step of acid and pattern of voiding, normal output; ECG; frequency production. Indications EEG; LFTs, renal and thyroid function tests Interventions Oral: Short-term (< 8 wk) and long-term treatment of GERD Administer to nursing women 46 hr before the Maintenance healing of erosive esophagitis next feeding to minimize amount in milk. of DoLong-term or allow patient topathological not crush treatment chew CR hypersecretory conditions preparations. IV: Short-termimmediate-release preparations in Administer (710 days) treatment of GERD to patients unable to continue oral therapy cover breakthrough pain. Treatment of pathological hypersecretory WARNING: OxyFAST and Roxicodone Intensol conditions concentrated preparations. Use extreme care are highly associated with Zollinger-Ellison syndrome and other neoplastic conditions with these preparations. Unlabeled uses: Treatment of duodenaland facilities WARNING: Keep opioid antagonist ulcer Contraindications and cautions for assisted or controlled respiration readily available Contraindicated with hypersensitivity to any proton during parenteral administration. pump inhibitor or any drug components. Use cautiously with pregnancy, lactation.

Reassure patient about addiction liability; most Availablepatients who receive opiates for medical reasons do not forms DR tablet20, 40 dependence syndromes. develop mg; powder for injection40 mg/vial Metabolism: Hepatic; T1/2: 1.5 hr Teaching points Distribution: Crossesdrug exactly asenter breast milk not crush or Take placenta; may prescribed. Do Excretion: Bile, urine chew controlled-release preparations. Do not take any leftover medication for other IV facts disorders, and do not let anyone else take the Preparation: Reconstitute with 10 mL 0.9% sodium chloride; may prescription. then be further diluted with 100 mL 5% dextroseeffects: Nausea, You may experience these side injection, 0.9% sodium chloride injection (take with food, lie quietly, eat frequent loss of appetite or lactated Ringer's, final concentration 0.4 mg/mL; reconstitutedconstipation be stored 2 hr, dilution up to small meals); solution can (use a laxative); dizziness, 12 hr at room temperature. sedation, drowsiness, impaired visual acuity (avoid Infusion: driving, performing other using in-linerequire alertness, Infuse over at least 15 min tasks that filter. Incompatibilities: Do not mix with or administer through the visual acuity). same line as other IV solutions. nausea, vomiting, constipation, Report severe Adverse effects of breath, or difficulty breathing. shortness CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy Respiratory: URI symptoms, cough, epistaxis Other: Cancer in preclinical studies, back pain, fever Interactions Drug-drug

 Fewer drug interactions reported than with other paroxetine hydrochloride proton pump inhibitors Paxil, Paxil CR, Pexeva Nursing considerations Assessment Drug class History: Hypersensitivity to any proton pump Antidepressant inhibitor or any drug components; pregnancy; lactation Therapeutic actions Physical: Skin lesions; T; reflexes, affect; urinary y Potentiates serotonergic activity in the CNS, resulting output, abdominal examination; respiratory auscultationin antidepressant effect. Interventions y Paroxetine is the most twice a and Caution the most Administer once or potent day. one of patient to specific tablets whole; not to cut, chew, or crush them. 5swallow selective serotonin (5-hydroxytryptamine, HT) reuptake inhibitors (SSRI).[64] This activity of the WARNING: Arrange for further evaluation of drug onafter 4neurons therapy forto be responsible for its patient brain wk of is thought gastroreflux disorders. antidepressant improvement does not rule out gastric Symptomatic effects. Indications cancer; gastric cancer did occur in preclinical studies. Treatment supportive treatment as appropriate for Maintain of major depressive disorder Treatment of OCD underlying problem. Treatment of panic disorders Switch patients on IV therapy to oral dosage as Treatment soon as possible.of social anxiety disorder (social phobia) Treatment of generalized anxiety disorder alleviate Provide additional comfort measures to Treatment GI effects discomfort from of PTSD and headache. Teaching pointsTreatment of PMDD Unlabeleddrug once or twice diabeticSwallow the Take the uses: Treatment of a day. neuropathy, headaches, hot flashes chew, cut, or crush them. tablets wholedo not Contraindications and cautions regular medical follow-up care Arrange to have whileContraindicated with MAOI use. you are using this drug. Use cautiously in the elderly, with renal or hepatic impairment, pregnancy, lactation, suicidal patients.

Maintain all of the usual activities and restrictions Availablethat apply to your condition. If this becomes difficult, forms Tablets10, 20, your health care provider. 12.5, 25, 37.5 mg; consult 30, 40 mg; CR tablets, suspension10You may experience these side effects: Dizziness mg/5 mL (avoid driving a car or performing hazardous tasks); Metabolism: Hepatic; T1/2: 24your health care provider if these headache (consult hr Distribution: Crosses placenta; enters breast milk be available to become bothersome, medications may Excretion: Urinenausea, vomiting, diarrhea (proper nutrition is help); important, consult a dietitian to maintain nutrition; stay Adverse effects bathroom); symptoms of upper respiratory tract near a CNS: Somnolence, dizziness, that this a drug infection, cough (it may help to know insomnia,istremor, nervousness, headache, anxiety, paresthesia, blurred effect, do not self-medicate, consult your health care vision if this becomes uncomfortable). provider CV: Palpitations, orthostatic Report severe headache,vasodilation,of symptoms, worsening hypotension, blurred vision, periorbital pain. fever, chills, hypertension Dermatologic: Sweating, rash, redness GI: Nausea, dry mouth, constipation, diarrhea, anorexia, flatulence, vomiting GU: Ejaculatory disorders, male genital disorders, urinary frequency Respiratory: Yawns, pharyngitis, cough Other: Headache, asthenia Interactions Drug-drug Increased paroxetine levels and toxicity with cimetidine, MAOIs Decreased therapeutic effects of phenytoin, digoxin Decreased effectiveness of paroxetine with phenobarbital, phenytoin

 Increased serum levels and possible toxicity of procyclidine, tryptophane, warfarin Drug classes Risk of serotonin syndrome (hypertension, Antibiotichyperthermia, mental status changes) if used with SSRIs Penicillin (acid stable) Drug-alternative therapy Therapeutic actions Increased sedative-hypnotic effects with St. John's y Bactericidal: Inhibits cell wall synthesis of sensitive wort organisms, causing cell death. Nursing considerations y Phenoxymethylpenicillin exerts a bactericidal action Assessment against penicillin sensitive microorganisms during the History: Hypersensitivity to paroxetine, renal or stage of impairment, seizure disorder; through the hepatic active multiplication. It acts pregnancy, inhibition of biosynthesis of cell-wall Peptidoglycan. It is lactation not active against the Beta-lactamase-producing bacteria, Physical: Orientation, reflexes; P, BP, perfusion; which include many strains of staphylococci. R, adventitious sounds; bowel sounds, normal output; Indications urinary output; liver evaluation; LFTs, renal function tests Mild to moderately severe infections caused by sensitive organismsstreptococci, pneumococci, Interventions staphylococci, fusospirochetes the morning. Administer once a day in Prophylaxis against bacterial endocarditis in Shake suspension well before using. patients with that patient swallows CR tablets whole; do Ensure valvular heart disease undergoing dental or upper respiratory chew. not cut, crush, or tract surgery Unlabeled uses: Prophylacticto potentially children Limit amount of drug given treatment of suicidal with sickle cell anemia, mild to moderate anaerobic patients. infections, Lyme disease, post-exposure result in anthrax Abruptly discontinuing drug may prophylaxis discontinuation symptoms (agitation, palpitations); Contraindicationstapering. consider and cautions Contraindicated with allergies to penicillins, Advise patient to avoid using if pregnant or cephalosporins, or other allergens. lactating.

Teaching points Use this drug with as directed and as long as Take cautiously exactlyrenal disorders, pregnancy, lactation Shake suspension well before using. Swallow directed. (may cause diarrhea or candidiasis in the infant). controlled-release tablets whole; do not cut, crush, or Availablechew. forms Tablets250, 500 mg; powder for the drug without tapering the Abruptly stopping oral solution125, 250 mg/5 mL dose may cause symptoms including agitation and palpitations. Metabolism: Hepatic; T1/2: 30 min be taken during pregnancy or This drug should not Distribution: Crosses placenta; enters breast milkcontraceptives is when nursing a baby; using barrier Excretion: Urine advised. Adverse effects You may experience these side effects: CNS: dizziness, tremor (use caution Drowsiness,Lethargy, hallucinations, seizures and avoid GI: Glossitis, other tasks that require alertness); driving or performing stomatitis, gastritis, sore mouth, furry tongue, black "hairy" tongue, nausea, vomiting, GI upset (eat frequent small meals, use frequent mouth diarrhea, abdominal pain, bloody diarrhea, enterocolitis, care); alterations in sexual function. pseudomembranous colitis, nonspecific hepatitis Report severe nausea, vomiting; palpitations; GU: Nephritisoliguria, proteinuria, hematuria, blurred vision; excessive sweating. casts, azotemia, pyuria Hematologic: Anemia, thrombocytopenia, leukopenia, neutropenia, prolonged bleeding time Hypersensitivity reactions: Rash, fever, wheezing, anaphylaxis (sometimes fatal) Other: Superinfections, sodium overload leading to CHF; potassium poisoninghyperreflexia, coma, cardiac arrhythmias, cardiac arrest (potassium penicillinpreparations) V potassium) V (penicillin Novo-Pen VK (CAN), Veetids Interactions

Drug-drug benzodiazepines,effectiveness with tetracyclines effect of Decreased barbiturates potentiate the GABA at this Nursing considerations receptor. In addition to this GABA-ergic effect, barbiturates also block the AMPA receptor, a Assessment subtype of glutamate receptor. Glutamate is the principal History: Allergies to penicillins, cephalosporins, or excitatory neurotransmitter in pregnancy; lactation other allergens; renal disorders; the mammalian CNS. Taken together, Culture infection; barbiturateslesions; R, Physical: the findings that skin color, potentiate inhibitory GABAA bowel sounds: CBC, LFTs, renal adventitious sounds; receptors and inhibit excitatory AMPA receptors canelectrolytes, CNS-depressant effects function tests, serum explain the Hct, urinalysis of Interventionsthese agents. At higher concentration they inhibit the Ca2+-dependentinfection before beginning treatment; release of neurotransmitters. Culture Barbiturates produce theiraspharmacological effects by reculture if response is not expected. increasing the duration for chloride 2 days after infection Continue therapy of at least ion channel opening at disappeared, usually 710 days. has the GABAA receptor (pharmacodynamics: this increases not the efficacy drug with milk, fruit juices, Do administer oral of GABA), whereas benzodiazepines full glass thewater is preferred; this oral or soft drinks; a increase of frequency of the chloride ion channel opening by food thanGABAA receptor penicillin is less affected at the other penicillins. Teaching (pharmacodynamics: this increases the potency of points GABA). The direct gating orother infectionschloride this Avoid self-treating opening of the with ion channel is the reason specific for the infection being antibiotic because it is for the increased toxicity of barbiturates compared to ofbenzodiazepines in treated. Complete the full course drug therapy. overdose. may experience these side effects: Nausea, You Indications vomiting, diarrhea, mouth sores. Oral or difficulty breathing, rashes, severe diarrhea, Report parenteral: Sedative Oral or parenteral: Hypnotic, treatment mouth sores, unusual bleeding or bruising. of insomnia for up to 2 wk phenobarbital Oral: Long-term treatment of generalized tonicclonic phenobarbital and cortical focal seizures

Oral preparations: Oral: Emergency control of certain acute seizures Bellatal, Solfoton (eg, those associated with status epilepticus, eclampsia, meningitis, phenobarbital sodium tetanus, and toxic reactions to strychnine or local anesthetics) Parenteral: Parenteral: Preanesthetic Luminal Sodium Parenteral: Treatment of generalized tonic-clonic and Drug classes cortical focal seizures Parenteral: Barbiturate (long acting) Emergency control of acute seizures Sedative (tetanus, eclampsia, epilepticus) Contraindications and cautions Hypnotic Contraindicated with hypersensitivity to Antiepileptic barbiturates, Therapeutic actions manifest or latent porphyria; marked liver impairment; depressant; barbiturates inhibit impulse y General CNS nephritis; severe respiratory distress; previous addiction to sedative-hypnotic drugs cerebral conduction in the ascending RAS, depress the (may be ineffective cerebellar function, to further addiction); cortex, alterand may contribute depress motor output, pregnancy (fetal and can produce damage, neonatal withdrawal excitation, sedation, hypnosis, syndrome). anesthesia, and deep coma; at subhypnotic doses, has Use activity, making it suitable for long-term use antiseizure cautiously with acute or chronic pain (drug may antiepileptic. as an cause paradoxical excitement or mask important symptoms); seizure disorders action of barbiturates is y The principal mechanism of (abrupt discontinuation of daily doses can result in status epilepticus); receptor believed to be their affinity for the GABAA lactation (secreted in breast milk; drowsiness channel complex). (Acts on GABA : BDZ receptor Cl- in nursing infants); fever, hyperthyroidism, diabetes mellitus, severe anemia, GABA is the principal inhibitory neurotransmitter in the pulmonary central nervous system asthmaticus, shock, mammalianor cardiac disease, status (CNS). Barbiturates uremia; impaired liver or renal function, debilitation. bind to the GABAA receptor at the alpha subunit, which are binding sites distinct from GABA itself and also Availabledistinct from the benzodiazepine binding site. Like forms

Tablets15, 16, 16.2, 30, 60, 90, 100 mg; capsules16 mg; elixir15 mg/5History: 20 mg/5 mL; injection30, manifest mL, Hypersensitivity to barbiturates, 60, 65, or 130 mg/mL latent porphyria; marked liver impairment; nephritis; severe respiratory distress; previous addiction to sedative-hypnotic drugs; Metabolism: Hepatic; T1/2: 79 hr pregnancy; acute or chronic pain; seizure disorders; lactation, fever; Distribution: Crosses placenta; enters breast milkhyperthyroidism; diabetes Excretion: Urine mellitus; severe anemia; cardiac disease; shock; uremia; impaired liver or renal function; debilitation Physical: Weight; T; skin color, lesions; IV facts orientation, affect, reflexes; P, BP, Preparation: No further preparation is needed. orthostatic BP; R, Infusion: adventitious slowly, each 60sounds, normal output, liver Infuse very sounds; bowel mg over 1 min, directly IV evaluation; LFTs, renal function dose and observe for or into tubing or running IV; inject partial tests, blood and urine glucose, BUN response before continuing. It may require > 15 min to achieve Interventions brain tissue. Avoid overdosing by observing effects peak levels in before continued Monitor patient responses, blood levels (as dosing. appropriate) if combine with drugs listed above are Incompatibilities: Do notany interactingchlorpromazine, codeine, ephedrine,given with phenobarbital; suggest insulin, meperidine, hydralazine, hydrocortisone, alternative means of contraception to women using hormonal contraceptives. methadone, procaine, promazine, vancomycin. Adverse effects WARNING: Do not give intra-arterially; may produce CNS: Somnolence, agitation, confusion, arteriospasm, thrombosis, gangrene. Administer IV doses vertigo, CNS depression, hyperkinesia, ataxia, slowly. Administer IM doses deep sedation (hangover), nightmares, lethargy, residual in a large muscle mass (gluteus maximus, vastus lateralis) or other areas where paradoxical excitement, nervousness, psychiatric there is little hallucinations, insomnia, anxiety, dizziness, disturbance, risk of encountering a nerve trunk or major artery. abnormality thinking WARNING: Monitor injection sites carefully for CV: Bradycardia, hypotension, syncope irritation, extravasation (IV use). Solutions arediarrhea, GI: Nausea, vomiting, constipation, alkaline and very irritating to the tissues. epigastric pain

Hypersensitivity: Rashes, angioneurotic edema, serum Monitor P, morbiliform rash, urticaria; rarely, sickness, BP, respiration carefully during IV administration. exfoliative dermatitis, Stevens-Johnson syndrome Arrange Pain, tissue lab tests of hematopoietic, Local: for periodic necrosis at injection site, renal, and hepatic systems with inadvertent therapy. gangrene; arterial spasm during long-term intra-arterial WARNING: Taper dosage gradually after repeated injection; thrombophlebitis; permanent neurologic deficit use, especially innerve if injected near a patients with epilepsy. When changing from one Respiratory: drug to another, taper dosage of antiepileptic Hypoventilation, apnea, the drug being discontinued while increasing the dosage respiratory depression, laryngospasm, of the replacement drug. bronchospasm, circulatory collapse Other: Tolerance, psychological and physical Teaching dependence, withdrawal syndrome points Interactions This drug will make you drowsy and less anxious; do Drug-drug not try to get up after you have received this drug (request assistance to sit levels movetherapeutic and toxic Increased serum up or and around). effects with valproic acid Take this drug exactly as prescribed; this drug is habit Increased CNSeffectiveness in alcohol forming; its depression with facilitating sleep disappears after a short time. of nephrotoxicity with Increased risk methoxyflurane this drug longer than 2 weeks (for Do not take insomnia), and do not neuromusculardosage without Increased risk of increase the excitation and consulting thewith barbiturate anesthetics hypotension prescriber. Do not reduce effects of or discontinue this drug Decreased the dosage the following drugs: (when used for epilepsy); abrupt discontinuation could Theophyllines, oral anticoagulants, beta-blockers, result in a serious increase in seizures. doxycycline, corticosteroids, hormonal contraceptives and Wear a medical metronidazole, emergency medical alert tag so that phenylbutazones, estrogens, personnel will know you have epilepsy and are taking quinidine, felodipine, fenoprofenNursing this medication. considerations Assessment

 Avoid pregnancy while taking this drug; use a means Contraindicated with hypersensitivity to of contraception other than hormonal hydantoins, sinus bradycardia, sinoatrial block, Stokescontraceptives. Adams You may experience these side effects: syndrome, pregnancy (data suggest an association dizziness, hangover, impaired thinking (may Drowsiness, between antiepileptic use and an elevated incidence of birth days; however, do or discontinue lessen after a few defects;avoid driving not engaging in antiepileptic therapy in pregnant drug who are dangerous activities); GI upset (takewomenwith food); receiving such therapy to prevent major seizures; this is dreams, nightmares, difficulty concentrating, fatigue, likely to precipitate status epilepticus, with attendant nervousness (reversible). hypoxia and risk to both mother and fetus), lactation. that Report severe dizziness, weakness, drowsiness Use cautiously lesions, fever, sore throat, mouth persists, rash or skin with acute intermittent porphyria, hypotension, severe or bleeding, nosebleed, diabetes sores, easy bruising myocardial insufficiency,petechiae, mellitus, hyperglycemia. pregnancy. Available forms Chewable tablets50 mg; oral suspension125 mg/5 mL; capsules30, 100 mg; ER capsules200, 300 mg; injection 50 mg/mL Metabolism: Hepatic; T1/2: 624 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine IV facts Preparation: Administration by IV infusion is not recommended because of low solubility of drug and likelihood of precipitation; however, this may be feasible if proper precautions are observed. Use suitable vehicle of 0.9% sodium chloride or lactated Ringer's phenytoin (diphenylhydantoin, phenytoin sodium) injection, appropriate concentration; prepare immediately before (fen' i toe in) administration, and use an in-line filter.

Dilantin-125, Dilantin Infatab, Dilantin Injection, Dilantin Infusion: Phenytek Kapseals, Infuse slowly in small increments, each 2550 mg over 15 min; infuse flush immediately after drug to reduce the risk of damage to vein and tissues. Drug classes Incompatibilities: Do not combine with other medications in Antiepileptic solution. Antiarrhythmic, group 1b Y-site incompatibilities: Do not give with potassium chloride. Hydantoin Adverse effects Therapeutic actions Some adverse effects are related to plasma concentrations, as Has antiepileptic activity without causing general CNS depression; follows: neuronal membranes and prevents hyperexcitability stabilizes Plasma Concentration stimulation; Effects the spread of seizure Adverse limits caused by excessive activity from 510 mcg/mL an active focus; therapeutic effects treating cardiac Some also effective in arrhythmias, especially those induced by digitalis; antiarrhythmic 1020 mcg/mL Usual therapeutic range properties are to those nystagmus both > 20 mcg/mL very similarFar-lateralof lidocaine;risk are class IB antiarrhythmics. > 30 mcg/mL Ataxia is usually seen Indications > 40 mcg/mL Significantly diminished Control mental capacity of grand mal (tonic-clonic) and psychomotor seizures CNS: Nystagmus, ataxia, dysarthria, slurred Prevention and treatment of seizures occurring speech, mental confusion, dizziness, drowsiness, during or following neurosurgery insomnia, transient nervousness, motor twitchings, Parenteral administration: Control of status fatigue, irritability, depression, numbness, tremor, epilepticus of the grand mal type headache, photophobia, diplopia, conjunctivitis Unlabeled uses: Antiarrhythmic, particularly in CV: CV collapse, hypotension (when administered digitalis-induced arrhythmias (IV preparations); rapidly IV; not to exceed 50 mg/min) treatment of trigeminal neuralgia (tic douloureux) Dermatologic: Dermatologic reactions, Contraindications and cautions scarlatiniform, morbilliform, maculopapular, urticarial and nonspecific rashes; serious and sometimes fatal

dermatologic reactionsbullous, exfoliative, or purpuric dermatitis, lupus erythematosus, and Drug-lab test Stevens-Johnson syndrome, toxic epidermal necrolysis, Interference with the metyrapone and features, hirsutism, alopecia, coarsening of the facial the 1-mg dexamethasone tests for at least 7 disease enlargement of the lips, Peyronie'sdays Drug-food GI: Nausea, vomiting, diarrhea, constipation, Enteral tube feedings hepatitis, absorption of gingival hyperplasia, toxic may delayliver damage, drug. Provide a 2-hr window between Dilantin doses and sometimes fatal; hypersensitivity reactions with hepatic tube feedings including hepatocellular degeneration and involvement, Nursing considerations fatal hepatocellular necrosis Assessment GU: Nephrosis History: Hypersensitivity to hydantoins; sinus Hematologic: Hematopoietic complications, bradycardia, AV heart thrombocytopenia, leukopenia, block, Stokes-Adams syndrome, sometimes fatal: acute intermittent porphyria, hypotension, severe granulocytopenia, agranulocytosis, pancytopenia; myocardial and megaloblastic diabetes that mellitus, macrocytosis insufficiency, anemia usually hyperglycemia, pregnancy, lactation respond to folic acid therapy; eosinophilia, monocytosis, Physical: T; skin color, lesions; lymph node leukocytosis, simple anemia, hemolytic anemia, aplastic palpation; orientation, affect, reflexes, vision anemia, hyperglycemia examination; P,complications: Hypotension, transient BP; R, adventitious sounds; bowel IV use sounds, normal drowsiness, nystagmus, periodontal output, liver evaluation; circumoral hyperkinesia, examination; LFTs, urinalysis, CBCCNS depression tingling, vertigo, nausea, CV collapse, and differential, blood proteins, blood and Pulmonary fibrosis, ECG urine glucose, EEG and acute Respiratory: Interventions pneumonitis Use only clear parenteral hyperplasia, faint yellow Other: Lymph node solutions; a sometimes color may develop, but this has lymphoma, monoclonal progressing to frank malignant no effect on potency. If the solution is refrigeratedmyeloma (prolonged therapy), gammopathy and multiple or frozen, a precipitate might form, but this will dissolve if the solution is chest pain, polyarthropathy, osteomalacia, weight gain, allowed to stand at room temperature. Do not use solutions that periarteritis nodosa, hirsutism, alopecia have haziness or a precipitate.

Interactions WARNING: Administer IV slowly to prevent severe hypotension; the margin of safety between full Drug-drug therapeutic and toxic doses is small. Continually monitor Increased pharmacologic effects with patient's cardiac rhythm and check BP frequently and chloramphenicol, cimetidine, disulfiram, isoniazid, regularly during phenylbutazone, Suggest use of IV infusion. phenacemide, sulfonamides, fosphenytoin sodium if IV route is needed. trimethoprim Monitor injection sites and effects when phenytoin Complex interactions carefully; drug solutions are veryvalproic acidirritating. together; phenytoin toxicity and alkaline and are given with WARNING: normal for therapeutic serumlevels; apparently Monitor serum phenytoin levels of 1020 mcg/mL. levels of valproic acid; breakthrough decreased plasma Give oral drug with or without together seizures when the two drugs are givenfood in a consistent manner. Give with foodpharmacologic if patient complains of GI upset. Decreased effects with Recommend that the oral folic acid, sucralfate, antineoplastics, diazoxide, phenytoin prescription be filled with the same brand each time; differences in rifampin, theophylline (applies only to oral hydantoins, bioavailability have been documented. absorption of which is decreased) Suggest that adult patientseffects and toxicity with Increased pharmacologic who are controlled 300-mg extended oxyphenbutazone, phenytoin capsules try amiodarone, once-a-day primidone, dosage to increasefluconazole, isoniazid chloramphenicol, compliance and convenience. WARNING: Reduce acetaminophen Increased hepatotoxicity withdosage, discontinue phenytoin, or substitute other antiepileptic medication Decreased pharmacologic effects of the following: gradually; abrupt discontinuation may precipitate status Corticosteroids, cyclosporine, disopyramide, epilepticus. doxycycline, estrogens, furosemide, levodopa, Phenytoin is ineffective mexiletine, in controllinghormonal absence methadone, metyrapone, (petit mal) seizures. Patients with combined seizures will contraceptives, quinidine, atracurium, pancuronium, need other medication for their absence seizures. tubocurarine, vecuronium, carbamazepine, diazoxide WARNING: Discontinue drug if rash, depression Severe hypotension and bradycardia when IV of blood count, enlarged lymph nodes, hypersensitivity phenytoin is given with dopamine reaction, signs of liver damage, or Peyronie's disease

(induration of the corpora cavernosa of the penis) occurs. pioglitazone Institute another antiepileptic drug promptly. Actos Monitor hepatic function periodically during longterm therapy; monitor blood counts, urinalysis monthly. Drug classes Monitor blood or urine sugar of patients with Antidiabetic diabetes mellitus regularly. Adjustment of dosage of Thiazolidinedione hypoglycemic drug may be necessary because Therapeutic actions drug may inhibit insulin release and induce antiepileptic Resensitizes tissues to insulin; stimulates insulin receptor sites to hyperglycemia. lower blood glucose and improve the action ofnode enlargement WARNING: Have lymph insulin; decreases hepatic gluconeogenesis and increases insulin-dependent muscle occurring during therapy evaluated carefully. glucose uptake. Lymphadenopathy that simulates Hodgkin's disease has Indications occurred. Lymph node hyperplasia may progress to Monotherapy as an adjunct to diet and exercise to lymphoma. improve glucose control in patients with type 2 (non Monitor blood proteins to detect early malfunction insulin-dependent) diabetesmultiple myeloma). of the immune system (eg, As part of combination proper a oral hygiene sulfonylurea, Arrange instruction in with metformin, orlong-term patients to prevent plus a single technique for insulin when diet, exercise development agent alone does not result in adequate glycemic control of gum hyperplasia. Teaching in type 2 diabetes points Contraindications and cautions Take this drug exactly as prescribed, with food to any enhance Contraindicated reduce GIallergy ortowithout absorption and with upset, thiazolidinedione; type 1 (insulin-dependent) in which foodbut maintain consistency in the manner diabetes, ketoacidosis, lactation. careful not to miss a dose if you you take it; be especially onUse cautiously with advanced heart disease, liver are once-a-day therapy. failure, pregnancy. Do not discontinue this drug abruptly or change Availabledosage, except on the advice of your prescriber. forms Tablets15, 30, 45 mg

Maintain good oral hygiene (regular brushing and Metabolism: Hepatic;prevent gum disease; arrange frequent dental flossing) to T1/2: 37 hr Distribution: Crosses prevent serious gum disease. checkups to placenta; enters breast milk Excretion: Feces, urine for frequent checkups to monitor your Arrange response to this drug. Adverse effectsMonitor your blood or urine sugar regularly, and reportCNS: abnormalitypain,your health care provider if any Headache, to myalgia have diabetes. you CV: Fluid retention Endocrine: Hypoglycemia, for use during This drug is not recommended hyperglycemia, aggravated diabetesadvisable to use some form of pregnancy. It is GI: Diarrhea, than injury contraception other liver hormonal contraceptives. Respiratory: Sinusitis, tag so that any emergency Wear a medical alert URI, rhinitis Other: Infections, fatigue, tooth have epilepsy and medical personnel will know that you disorders Interactions taking antiepileptic medication. are Drug-drug You may experience these side effects: Decreased of hormonal Drowsiness, dizziness, effectiveness confusion, blurred vision (avoid contraceptives, which other tasks ovulation and risk of driving or performingmay result inrequiring alertness or pregnancy; suggest upset of an alternative food, of visual acuity); GI the use (take drug with method eat birth control or consider a higher dose of the frequent small meals). contraceptive rash, severe nausea or vomiting, Report Drug-alternative therapyslurred speech, impaired coordination drowsiness, Increased glands, bleeding, swollen or with (ataxia), swollen risk of hypoglycemia if takentender juniper berries, discoloration of fenugreek, coriander, gums, yellowish ginseng, garlic, the skin or eyes, joint dandelion root, celery pain, unexplained fever, sore throat, unusual bleeding or bruising, persistent headache, malaise, any indication of Nursing considerations or bleeding tendency, abnormal erection, an infection CLINICAL ALERT! pregnancy. Name confusion has been reported between Actos (pioglitazone) and Actonel (risedronate); use caution

Assessment potassium saltsHistory: Allergy to any thiazolidinedione; type 1 potassiumdiabetes, ketoacidosis, serious hepatic impairment, acetate advanced heart disease, pregnancy, lactation potassium chloride Physical: T; orientation, reflexes, peripheral Oral: sensation; R, adventitious sounds; liver evaluation; Apo-K (CAN), blood glucose, CBC Gen-K, Kaon-Cl, Kay Ciel, LFTs, Cena-K, Effer-K, Kaylixir, K-Dur 10, K-Dur 20, K-Lor, K-Tab, Klor-Con, Klorvess, Interventions Klotrix, K-Lyte/Cl, Kolyum, K+ blood ET, K + 8, K + frequently to Monitor urine or Care glucose levels 10, Micro-K Extentabs,determine effectiveness of drug and dosage being used. Potasalan, Rum-K, Ten K Injection: Monitor baseline LFTs before beginning therapy Potassiumand periodically during therapy. Chloride Administer without regard to meals. potassium gluconate Arrange for consultation with dietitian to establish Kaon, K-G Elixir, Kolyum, Tri-K, Twin-Kcontrol as appropriate. weight loss program and dietary Arrange for thorough diabetic teaching program to Drug class include disease, dietary control, exercise, signs and Electrolyte symptoms of hypoglycemia and hyperglycemia, Therapeutic actionsof infection, hygiene. avoidance Principal intracellular cation of most body tissues, participates in a Teaching points number of physiologic discontinue this medication without Do not processesmaintaining intracellular tonicity, transmission of nerve impulses, contraction of diet and consulting health care provider; continue with cardiac, skeletal, exercise program for diabetes control. of normal renal and smooth muscle, maintenance function; also plays athis drug with meals. If dose is missed,various Take role in carbohydrate metabolism and it may enzymaticbe taken at the next meal. If dose is missed for an entire reactions. Indications do not double dose the next day. day, Prevention andor blood for glucose and deficiency; Monitor urine correction of potassium ketones as when associated adjusting to drug. potassium chloride; prescribed while with alkalosis, use

Use barrier contraceptives if currently taking when associated with acidosis,drugs potassium acetate, hormonal contraceptives; these use may be ineffective bicarbonate, with pioglitazone. if combined citrate, or gluconate IV: Treatment of throat, arrhythmias due to Report fever, sore cardiac unusual bleeding or cardiac glycosides dark urine, light-colored stools, bruising, rash, Contraindications and cautions hypoglycemic or hyperglycemic reactions. Contraindicated with allergy to tartrazine, aspirin (tartrazine is found in some preparations marketed as Kaon-Cl, Klor-Con); severe renal impairment with oliguria, anuria, azotemia; untreated Addison's disease; hyperkalemia; adynamia episodica hereditaria; acute dehydration; heat cramps; GI disorders that delay passage in the GI tract. Use cautiously with cardiac disorders, especially if treated with digitalis, pregnancy, lactation. Available forms Liquids20, 40, 45 mEq/15 mL; powders15, 20, 25 mEq/packet; effervescent tablets20, 25, 50 mEq; CR tablets6.7, 8, 10, 20 mEq; CR capsules8, 10 mEq; tablets 500, 595 mg; injection2, 4, 10, 20, 30, 40, 60, 90 mEq Metabolism: Cellular; T1/2: Unknown Distribution: Crosses placenta; enters breast milk Excretion: Urine IV facts Preparation: Do not administer undiluted potassium IV; dilute in dextrose solution to 4080 mEq/L; in critical states, potassium chloride can be administered in saline.

Infusion: Adjust dosage based on patient response at a maximum of 10 mEq/L. Caution patient not to use salt substitutes. Teaching points Incompatibilities: Do not mix with amphotericin B. Take drug after meals with diazepam, a full glass Y-site incompatibilities: Do not give or with food andergotamine, of phenytoin. water to decrease GI upset. Do not chew or crush tablets, swallow tablets whole. Mix or dissolve oral liquids, Adverse effects soluble powders, and effervescent tablets completely in 38 ounces of cold water, juice, or other Dermatologic: Rash suitable beverage, and vomiting, diarrhea, the drug as GI: Nausea, drink it slowly. Take abdominal prescribed; GI obstruction, GI bleeding, GI ulceration or discomfort, do not take more than prescribed. Do not perforation use salt substitutes. You may find Hyperkalemiaincreased stool. K+, Hematologic: wax matrix capsules in the serumThe wax matrix is not absorbed in the GI tract. of P waves, ECG changes (peaking of T waves, loss Have periodic blood prolongation of QTc interval) depression of ST segment, tests and medical evaluation. You may experience these local effects: Nausea, Local: Tissue sloughing, side necrosis, local vomiting, and venospasm with injection meals, diluting phlebitis, diarrhea (taking the drugs with them Interactions further may help). Report tingling of the hands or feet, unusual Drug-drug tiredness or weakness, feeling of heaviness in the legs, Increased risk of hyperkalemia with potassiumsevere nausea, vomiting, abdominal pain, black or tarry sparing diuretics, salt substitutes using potassium stools, pain at Nursing considerationsIV injection site. Assessment History: Allergy to tartrazine, aspirin; severe renal impairment; untreated Addison's disease; hyperkalemia; adynamia episodica hereditaria; acute dehydration; heat cramps, GI disorders that cause delay in passage in the GI tract, cardiac disorders, lactation

Physical: Skin color, lesions, turgor; injection pramlintide acetate baseline ECG; bowel sounds, abdominal sites; P, Symlin examination; urinary output; serum electrolytes, serum bicarbonate Interventions Drug classes Arrange for serial serum potassium levels before Amylinomimetic and during therapy. Antidiabetic Administer liquid form to any patient with delayed Therapeutic emptying. GI action A synthetic analog of human amylin, a hormone produced by the Administer oral drug after meals or with food and a beta cells full glass of water tohelps to control glucose levels in the in the pancreas that decrease GI upset. postprandial period; modulates not to chew or crush tablets; have Caution patient gastric emptying, causes a feeling of fullness or satiety, prevents the postprandial rise in serum patient swallow tablet whole. glucagons levels all leading to lower serum glucose levels Mix or dissolve oral liquids, soluble powders, and Indications effervescent tablets completely in 38 oz of cold water, juice, Adjunct treatmentbeverage, and have patient drink or other suitable in patients with type 1 diabetes who use it slowly.mealtime insulin and who have failed to achieve desired glucose control despite optimal insulin therapyGI Arrange for further dilution or dose reduction if Adjunct treatment in type 2 diabetes patients who effects are severe. use mealtime prepared and solution to prevent to achieve Agitate insulin IV who have failed "layering" desired glucose not add potassium to an insulin therapy of potassium; do control despite optimal IV bottle in the with or position. hangingwithout a concurrent sulfonylurea or metformin Contraindications and cautions Monitor IV injection sites regularly for necrosis, Contraindicated with tissue sloughing, phlebitis. known hypersensitivity to pramlintide or any of its components; gastroparesis; Monitor cardiac rhythm carefully during IV hypoglycemia administration.unawareness. Use cautiously with pregnancy,wax matrix capsules Caution patient that expended lactation. Availablewill be found in the stool. forms Solution for injection0.6 mg/mL

 Inject 1/2: drug before any major meal that you are Metabolism: Renal: Tthis 48 min eating; do not use if you are not going to be eating; if Distribution: May cross placenta; may pass into breast milk you forget Excretion: Urine a dose, do not inject after you have eaten. Be aware that alcohol consumption can change your blood glucose levels and may alter your response to Adverse effects this CNS: drug. Dizziness, headache, fatigue Do Nausea, anorexia, vomiting, abdominal pain GI:not take this drug if you are not able to eat or if you plan to skip a meal or ifpharyngitis sugar is too low. Respiratory: Cough, your blood Do not change the dosage of site drug without Other: Hypoglycemia, injection this reaction consulting your health care provider. Interactions It is not known how this drug affects a pregnancy. If Drug-Drug you think you are pregnant or would like to become pregnant,delayed absorption of oral medications because Risk of consult your health care provider. effects not gastric how this drug could affectis needed, of It is on known emptying; if rapid effect a nursing baby. oral medication 1 baby, consult your 2 hr after take If you are nursing a hr prior to or health care provider. pramlintide RiskYou will need to regularly gastric emptying if of combined effects on monitor your blood glucose levels. Your health caredrugs or drugschange the combined with anticholinergic provider may that slow dose of pramlintideof nutrients; avoid this combination. intestinal absorption or your other antidiabetic drugs, based on your Nursing considerationsblood glucose response. It is important that you follow the diet, exercise and Assessment drug guidelines Hypersensitivity to pramlintide or any of History: related to your disease. its Review the signs and symptoms of hypoglycemia; components; gastroparesis; hypoglycemia be prepared to treat hypoglycemia with fast-acting sugar unawareness, pregnancy, lactation or glucagon. Physical: Orientation, reflexes, affect; abdominal Do not injection site; blood glucose levels examination; drive a car or operate potentially dangerous machinery until you are aware of how pramlintide will

Interventions affect Inject subcutaneously before each major meal of your blood sugar. Low blood sugar can cause dizziness inject it into in thinking. is more than 2 inches the day; and changes a site that This drug affects how fast your away from the site of insulin injection. stomach empties, this may not combine in syringe with insulin. Do affect other drugs you may be taking; consult your health care provider about drugs, diet and exercise Maintain other antidiabetic the need to change the timing offor control of diabetes. regimen drug administration. You may oral medications at least 1 hr Injection Administerexperience these side effects: before or site reactions (proper injection and rotation of injection 2 hr after administering pramlintide. sites should help; if problems occur, consult your health Monitor serum glucose levels and HbA1c levels care provider); hypoglycemia (use fast acting drug on frequently to evaluate effectiveness of sugars or glucagons if this occurs, proper use and eating of meals controlling glucose levels. should preventfor thorough diabetic teaching program to Arrange this effect); nausea (this usually passes after a few days). dietary control, exercise, signs and include disease, Report hypoglycemic reactions; hyperglycemia, symptoms of hypoglycemia and redness, pain or swelling atof infection andstomach pain; vomiting. avoidance injection sites; hygiene. Teaching points This drug is given subcutaneously. Use sterile technique. Dispose of syringes appropriately. Do not use any solution that appears cloudy; do not combine this drug in syringe with insulin. Inject it into a site on your thigh, abdomen, or upper arm; rotate injection sites periodically; inject into a site that is at least 2 inches away from the site of your insulin injection. Store unopened vials in the refrigerator. Opened bottles may be kept at room temperature. Throw away any out-of-date bottles.

pravastatin sodium Possible severe myopathy or rhabdomyolysis with Pravachol cyclosporine, erythromycin, gemfibrozil, niacin Drug classes Possible increased digoxin, warfarin levels if combined; Antihyperlipidemic monitor patient and decrease dosage as needed HMG-CoA reductase inhibitor Increased pravastatin levels with itraconazole; Therapeutic actions avoid this HMG-CoA Inhibits the enzyme combination that catalyzes the first step in the Decreased pravastatin levels a decrease with bile cholesterol synthesis pathway, resulting in if combined in serum acid sequestrants; space at with hr apart cholesterol, serum LDLs (associatedleast 4increased risk of CAD), Nursing considerations and either an increase or no change in serum HDLs (associated Assessment with decreased risk of CAD). Indications History: Allergy to pravastatin, fungal byproducts; impaired hepatic function; cataracts; pregnancy; lactation Prevention of first MI and reduction of death from disease in patients with hypercholesterolemia at risk CV Physical: Orientation, affect, ophthalmologic examination; liver evaluation; lipid studies, LFTs of first MI Interventions Adjunct to diet in the treatment of elevated total Ensure and LDL cholesterol with primary cholesterol that patient is on a cholesterol-lowering diet before and during therapy. hypercholesterolemia (types IIa and IIb) in patients Caution to dietary this drug of saturated during unresponsive patient thatrestrictioncannot be usedfat and pregnancy; and other nonpharmacologiccontraceptives. cholesterol advise patient to use barrier measures Administer drug hs; highest rates of cholesterol Slow the progression of coronary atherosclerosis in synthesis are between midnightCAD5to reduce the risk of patients with clinically evident and AM. Arrange events in hypercholesterolemia patients acute coronary for periodic ophthalmologic examination to check forthecataract stroke or TIA inmonitor liver Reduce risk of development; patients with function. MI and normal cholesterol levels history of Teaching points Take drug at bedtime.

Reduce the risk of recurrent MI and death from Continue your with history of MI diet and heart disease in patients cholesterol-loweringand normal exercise program. cholesterol levels This drug cannot be taken 8 yr with heterozygous Treatment of children > during pregnancy; using barrier contraceptives is advised. an adjust to diet and familial hypercholesterolemia as Have exercise. periodic ophthalmic examinations while you are using and cautions Contraindications this drug. You may experience these side effects: Nausea (eat Contraindicated with allergy to pravastatin, fungal frequent small meals); headache, muscle and joint aches byproducts, pregnancy, lactation. and pains cautiously with sensitivity hepatic function, Use (may lessen); impaired to sunlight (use sunblock and wear protective clothing). cataracts, alcoholism. Report severe GI upset, changes in vision, unusual Available forms bleeding or bruising, dark urine or light-colored stools, Tablets10, 20, 40, 80 mg muscle pain or weakness. Metabolism: Hepatic; T1/2: 1.8 hr Distribution: Crosses placenta; enters breast milk Excretion: Feces, urine Adverse effects CNS: Headache, blurred vision, dizziness, insomnia, fatigue, muscle cramps, cataracts GI: Flatulence, abdominal pain, cramps, constipation, nausea, vomiting, heartburn Hematologic: Elevations of CPK, alkaline phosphatase, and transaminases Interactions Drug-drug prednisone

Apo-Prednisone (CAN), Liquid Pred, Meticorten, Novo Electrolyte imbalance: Prednicen-M, retention, Prednisone (CAN), Orasone, Panasol-S, Na+ and fluidPrednisone hypokalemia, hypocalcemia Intensol Concentrate, Sterapred DS, Sterapred (regular), Winpred Endocrine: Amenorrhea, irregular menses, growth (CAN) retardation, decreased carbohydrate tolerance, diabetes mellitus, cushingoid state (long-term effect), increased Drug classes blood sugar, increased serum cholesterol, decreased T3 Corticosteroid (intermediate acting) and GlucocorticoidT4 levels, HPA suppression with systemic therapy Hormone longer than 5 days GI: Therapeutic actions Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, vomiting, increased Enters target cells and binds to intracellular corticosteroid receptors, appetite, weight gainmany complex reactions that are thereby initiating (long-term therapy) or responsible for itsHypersensitivity: and immunosuppressive anti-inflammatory Hypersensitivity effects. anaphylactoid reactions Musculoskeletal: Muscle weakness, steroid Indications myopathy, loss of therapy in adrenal cortical muscle mass, osteoporosis, Replacement spontaneous insufficiencyfractures (long-term therapy) Other: Immunosuppression, aggravation or Hypercalcemia associated with cancer masking of infections; impaired wound healing; thin, Short-term management of various inflammatory fragile skin; petechiae, ecchymoses, purpura, striae; and allergic disorders, such as rheumatoid arthritis, subcutaneous fat (eg, SLE), dermatologic diseases (eg, collagen diseasesatrophy Interactions pemphigus), status asthmaticus, and autoimmune Drug-drug disorders Increased disorders: and toxic effects with Hematologictherapeutic thrombocytopenia purpura, troleandomycin, ketoconazole erythroblastopenia Increased therapeutic and exacerbations of MS and Ulcerative colitis, acute toxic effects of estrogens, including hormonal contraceptives palliation in some leukemias and lymphomas

Trichinosis with neurologic or myocardial Risk of involvement severe deterioration of muscle strength in myasthenia gravis patients who also are receiving Contraindications and cautions ambenonium, edrophonium, neostigmine, especially TB, Contraindicated with infections, pyridostigmine fungalDecreased steroid blood levels and varicella, and infections, amebiasis, vaccinia with barbiturates, phenytoin, rifampin antibiotic-resistant infections; lactation. Decreased effectiveness of salicylatesliver disease, Use cautiously with renal or Drug-lab test hypothyroidism, ulcerative colitis with impending False-negative nitroblue-tetrazolium test for perforation, diverticulitis, active or latent peptic ulcer, bacterial infection inflammatory bowel disease, CHF, hypertension, Suppression skin test thromboembolic ofdisorders,reactions osteoporosis, seizure Nursing considerations disorders, diabetes mellitus; hepatic disease; pregnancy Assessment (monitor infants for adrenal insufficiency). Available forms History: Infections; renal or liver disease, hypothyroidism, Tablets1, 2.5, 5, 10, 20,ulcerative oral solution5 impending 50 mg; colitis with mg/5 mL, 5 mg/mL; perforation, diverticulitis, active or latent peptic ulcer, syrup5 mg/5 mL inflammatory bowel disease, CHF, hypertension, thromboembolic disorders, osteoporosis, seizure Metabolism: Hepatic; T1/2: 3.5 hr disorders, diabetes mellitus; breast disease; lactation Distribution: Crosses placenta; enters hepaticmilk Physical: Weight, T, reflexes and grip strength, Excretion: Urine affect Adverse effects and orientation, P, BP, peripheral perfusion, prominence of superficial veins, R, adventitious sounds, CNS: Vertigo, headache, paresthesias, insomnia, serum electrolytes, blood glucose seizures, psychosis, cataracts, increased IOP, glaucoma (long-term therapy); euphoria, depression Interventions CV: Hypotension, shock, hypertension and CHF Administer once-a-day doses before 9 AM to secondary to fluid retention, thromboembolism, mimic normal peak corticosteroid blood levels. thrombophlebitis, fat embolism, cardiac arrhythmias Increase dosage when patient is subject to stress.

 WARNING: Taper doses when discontinuing epinephrine anaphylactic high-dose or and other measures) to inavoid adrenal long-term therapy reactions insufficiency. Treatment and prevention of motion sickness; Do not give live virus vaccines with prevention and control corticosteroids. immunosuppressive doses ofof nausea and vomiting associated with anesthesia and surgery Teaching pointsPreoperative, postoperative, or obstetric sedation Adjunct to analgesics to control postoperative pain Do not stop taking the drug without consulting Adjunctive IV therapy with reduced amounts of your health care provider. meperidine or other opioid analgesics in special surgical Avoid exposure to infections. situations, such as repeated bronchoscopy, ophthalmic Report unusual weight gain, swelling of the surgery, or inmuscle weakness, black or tarry stools, extremities, poor-risk patients Contraindications and cautionsthroat, colds or other infections, fever, prolonged sore Contraindicated with worsening of the disorder for which hypersensitivity to the drug is being antihistamines or phenothiazines, coma or severe CNS depression, bone marrow depression, vomiting of unknown cause, concomitant therapy with MAOIs, lactation (lactation may be inhibited). Use cautiously with lower respiratory tract disorders (may cause thickening of secretions and impair expectoration), glaucoma, prostatic hypertrophy, CV disease or hypertension, breast cancer, thyrotoxicosis, pregnancy (jaundice and extrapyramidal effects in infants; drug may inhibit platelet aggregation in neonate if taken by mother within 2 wk of delivery), children (antihistamine overdose may cause hallucinations, seizures, and death), a child with a history of sleep apnea, a family history of SIDS, or Reye's syndrome (may mask the symptoms of Reye's syndrome and

promethazine hydrochloride Phenadoz,contribute to its development), the elderly (more likely to Phenergan cause dizziness, sedation, syncope, toxic confusional states, Drug classes hypotension, and extrapyramidal effects). Available forms Phenothiazine Tablets12.5, blocking agent 25, 50 mg; syrup6.25, 25 mg/5 mL; Dopaminergic suppositories12.5, 25, 50 mg; injection25, 50 mg/mL Antihistamine Antiemetic Metabolism: Hepatic; T1/2: Unknown Anti-motion sickness drug Distribution: Crosses placenta; enters breast milk Sedative or hypnotic Excretion: Urine Therapeutic actions Selectively blocks H1 receptors, diminishing the effects of IV facts histamine on cells of the upper respiratory tract and eyes and Preparation: Dilute to a mucus production, itching, and tearing decreasing the sneezing, concentration no greater than 25 mg/mL. Infusion: Infuse allergic reactions mg/min. that accompany no faster than 25 in sensitized people exposed to Incompatibilities: Do not combine the vomiting center that antigens; blocks cholinergic receptors in with aminophylline, chloramphenicol, heparin, methicillin, are believed to mediate the nausea hydrocortisone, and vomiting caused by gastric pentobarbital,input from the vestibular apparatus (motion sickness, irritation, by thiopental. Y-site associated with vestibular not give and by input from the nausea incompatibilities: Do neuritis), with cefoperazone, foscarnet, heparin, hydrocortisone, potassium chloride. chemoreceptor trigger zone (drug- and radiation-induced emesis); depresses the RAS, including the parts of the brain involved with Adverse effects wakefulness. CNS: Dizziness, drowsiness, poor coordination, Indications confusion, restlessness, excitation, seizures, seasonal Symptomatic relief of perennial and tremors, headache, blurred vision, diplopia, vertigo, tinnitus allergic rhinitis, vasomotor rhinitis, allergic CV: bradycardia, conjunctivitis; Hypotension, palpitations, urticaria and mild, uncomplicated tachycardia, extrasystoles of allergic reactions to blood angioedema; amelioration plasma; dermatographism, adjunctive therapy (with Dermatologic: Urticaria, rash, photosensitivity, or chills

 GI: Epigastric distress, nausea, vomiting, diarrhea, Maintain constipation fluid intake, and use precautions against heat stroke Urinary frequency, dysuria, urinary retention, GU: in hot weather. Report sore throat, decreased libido, impotence fever, unusual bleeding or bruising, rash, weakness, tremors, impaired vision, dark Hematologic: Hemolytic anemia, hypoplastic urine, pale stools, yellowing of the skin agranulocytosis, anemia, thrombocytopenia, leukopenia,or eyes. pancytopenia Adverse effects Respiratory:most common; those in Bold are lifein Italic are Thickening of bronchial secretions; threatening. chest tightness; dry mouth, nose, and throat; respiratory depression; suppression of cough reflex, potential for aspiration Other: Tingling, heaviness and wetness of the hands Interactions Additive anticholinergic effects with anticholinergic drugs Increased frequency and severity of neuromuscular excitation and hypotension with methohexital, thiamylal, phenobarbital anesthetic, thiopental Enhanced CNS depression with alcohol Nursing considerations Assessment History: Hypersensitivity to antihistamines or phenothiazines, severe CNS depression, bone marrow depression, vomiting of unknown cause, concomitant therapy with MAOIs, lactation, lower respiratory tract disorders, glaucoma, prostatic hypertrophy, CV disease or hypertension, breast cancer, thyrotoxicosis,

pregnancy, history of sleep apnea or a family history of propoxyphene child with Reye's syndrome SIDS, propoxyphene hydrochloride (dextropropoxyphene) Physical: Weight, T; reflexes, orientation, IOP; P, Darvon BP, orthostatic BP; R, adventitious sounds; bowel sounds and normal output, liver evaluation; urinary propoxyphene napsylate size; CBC; urinalysis; LFTs, renal and output, prostate Darvocet-N, Darvon-N tests thyroid function Interventions Drug class Do not give tablets, rectal suppositories to children Opioid agonist analgesic < 2 yr. Therapeutic actionsIM injections deep into muscle. Give Acts as agonist Dospecific opioid receptors in the CNS to necrosis at not administer subcutaneously; tissue produce analgesia,may occur.sedation; the receptors mediating these effects euphoria, are thought to WARNING: Do thoseadminister intra-arterially; be the same as not mediating the effects of endogenous opioids (enkephalins, endorphins) may result. arteriospasm and gangrene of the limb Indications Reduce dosage of barbiturates given concurrently Relief of mild by at least pain with promethazine to moderate half; arrange for dosage Contraindications andopioid analgesics given concomitantly by reduction of cautions Contraindicated one-fourth to one-half. with hypersensitivity to opioids, Teaching pregnancy (neonatal withdrawal has occurred; neonatal points safetyTake drug exactly as labor or delivery (especially not established), prescribed. when Avoid usingaalcohol. delivery of premature infant is expected; opioids given Avoid driving or engaging in other dangerous to mother can cause respiratory depression of neonate; if dizziness, labor), lactation, suicidal or activities may prolong drowsiness, or vision changes addiction-prone patients. occur. Use cautiously withexposure hepatic dysfunction, Avoid prolonged renal or to sun, or use a emotional depression, excessive sunscreen or covering garments. alcohol use; use of antianxiety, antidepressant drugs.

Available forms sedation, drowsiness, impaired visual acuity (avoid Capsules65 mg; tablets100 mg driving or performing other tasks that require alertness, visual acuity). Metabolism: Hepatic; T1/2: 612 hr Report severe nausea, vomiting, constipation, Distribution: Crosses placenta; enters breast milk shortness Excretion: Urine of breath or difficulty breathing. Adverse effects CNS: Headache, weakness, dizziness, sedation, light-headedness, euphoria, dysphoria, minor visual disturbances Dermatologic: Rashes GI: Nausea, vomiting, constipation, abdominal pain, liver dysfunction Other: Tolerance and dependence, psychological dependence Interactions Drug-drug Increased likelihood of respiratory depression, hypotension, profound sedation, or coma with barbiturate general anesthetics Increased serum levels and toxicity of carbamazepine Decreased absorption and serum levels with charcoal Nursing considerations Assessment

History: Hypersensitivity to opioids, pregnancy, propranolol hydrochloride or hepatic dysfunction, emotional lactation, renal Apo-Propranolol (CAN), Inderal, Inderal LA, InnoPran XL, depression Propranolol Intensolol Physical: Skin color, texture, lesions; orientation, reflexes, affect; bowel sounds, normal output; LFTs, Drug classes function tests renal Beta-adrenergic blocker (nonselective) Interventions Antianginal Administer to lactating women 46 hr before the Antiarrhythmicfeeding to minimize the amount in milk. next Antihypertensive WARNING: Limit amount of drug dispensed to Therapeutic actions emotionally labile, or potentially suicidal depressed, Competitively blocks beta-adrenergic receptors in theother CNS patients; propoxyphene intake alone or with heart and juxtoglomerular apparatus, decreasing with deaths. depressants has been associated the influence of the sympathetic nervous system on these tissues, the excitability of the WARNING: Keep opioid antagonist and facilities heart, cardiacassisted or and oxygenrespiration on standby in case for workload controlled consumption, and the release of renin respiratory depression occurs. and lowering BP; has membrane-stabilizing (local anesthetic) effects that contribute toor food if GI upset occurs. acts Give drug with milk its antiarrhythmic action; in the CNS to Reassure patient about addiction vasoconstrictor reduce sympathetic outflow and liability; most tone. The patients whoby whichopiates for medical reasons do not mechanism receive it prevents migraine headaches is unknown.develop dependence syndromes. Indications Teaching points Hypertension alone prescribed. Take drug exactly asor with other drugs, especially diuretics not take leftover medication for other disorders, Do do not letpectoris else take the prescription. and Angina anyone caused by coronary atherosclerosis Idiopathic intake while subaortic stenosis to Avoid alcoholhypertrophic using this drug. manage associated stress-induced side effects: Nausea, You may experience these angina, palpitations, and syncope loss of appetite (take drug with food, eat frequent small meals); constipation (request laxative); dizziness,

 Cardiac arrhythmias, especially supraventricular GU: and ventricular tachycardias Peyronie's tachycardia, Impotence, decreased libido, induced by disease, or catecholamines digitalis dysuria, nocturia, frequency Musculoskeletal: Joint pain,inarthralgia, muscle Prevention of reinfarction clinically stable cramp patients 521 days after MI Respiratory: Bronchospasm, dyspnea, cough, Pheochromocytoma, an adjunctive therapy after bronchial obstruction, nasal rhinitis, treatment with an alpha-adrenergicstuffiness,to manage blocker pharyngitis tachycardia before or during surgery or if the Other: Decreased exercise pheochromocytoma is inoperable tolerance, development of Prophylaxis for migraine hypoglycemia, elevated ANAs, hyperglycemia or headache serum transaminase,of essential tremor, and LDH or Treatment alkaline phosphatase, familial Interactions hereditary Drug-drug Unlabeled uses: Recurrent GI bleeding in cirrhotic Increased effects with verapamil patients, schizophrenia, tardive dyskinesia, acute panic Decreased effects symptoms, anxiety, CHF with indomethacin, ibuprofen, piroxicam, sulindac, barbiturates Contraindications and cautions Prolonged hypoglycemic allergy of insulin Contraindicated with effects to beta-blocking agents, Initial bradycardia, second- or third-degree heart sinus hypertensive episode followed by bradycardia with epinephrine block, cardiogenic shock, CHF, bronchial asthma, Increased first-dose response to prazosin bronchospasm, COPD, pregnancy (neonatal bradycardia, Increased serum levels low birth weight hypoglycemia, and apnea, and and toxic effects with lidocaine, use during long-term cimetidine pregnancy), lactation. Increased serum hypoglycemia and diabetes, Use cautiously with levels of propranolol and phenothiazines, hydralazine if the thyrotoxicosis, hepatic dysfunction. two drugs are taken Availableconcurrently forms Paradoxical hypertension when 20, 40, 60, given ER capsules60, 80, 120, 160 mg; tablets10, clonidine is 80, 90 with beta-blockers; increased rebound mg/mL; oral mg; SR capsules60, 80, 120, 160 mg; injection1 hypertension when clonidine is discontinued in patients on solution4, 8 mg/mL; concentrated oral solution80 mg/mLbetablockers

Decreased serum levels and therapeutic effects with methimazole, propylthiouracil Metabolism: Hepatic; T1/2: 35 hr; 811 hr (SR form) Decreased bronchodilator effects of Distribution: Crosses placenta; enters breast milk theophyllines Decreased antihypertensive effects with NSAIDs Excretion: Urine (ie, ibuprofen, indomethacin, piroxicam, sulindac), IV facts rifampin Preparation: No further preparation is needed. Drug-lab Inject directly IV or into tubing of running IV; do not Infusion:test Interference with glucose or insulin tolerance tests, exceed 1 mg/min. glaucoma screening tests Adverse effects Nursing considerations reactions: Pharyngitis, erythematous rash, Allergic Assessment fever, sore throat, laryngospasm, respiratory distress History: Dizziness, beta-blocking agents, sinus CNS: Allergy to vertigo, tinnitus, fatigue, bradycardia, second- paresthesias, sleep heart block, emotional depression, or third-degree disturbances, cardiogenic CHF, bronchial hallucinations, shock, disorientation, memory loss, asthma, slurred bronchospasm, COPD, hypoglycemia and diabetes, speech thyrotoxicosis, hepatic dysfunction,cardiac arrhythmias, CV: Bradycardia, CHF, pregnancy, lactation Physical: Weight, skin color, lesions, vascular sinoatrial or AV nodal block, peripheraledema, T; reflexes, affect,claudication, CVA, pulmonary P, ECG, insufficiency, vision, hearing, orientation; BP, edema, peripheral perfusion; R, auscultation; bowel sounds, hypotension normal output, liver evaluation; bladder palpation; skin Dermatologic: Rash, pruritus, sweating, dry LFTs, thyroid function tests; blood and urine glucose EENT: Eye irritation, dry eyes, conjunctivitis, Interventions blurred vision WARNING: Dopain, discontinue drug abruptly not flatulence, constipation, GI: Gastric after long-term therapy (hypersensitivity to diarrhea, nausea, vomiting, anorexia, ischemic colitis, catecholamines may have developed, causing renal and mesenteric arterial thrombosis, retroperitoneal exacerbation of angina, acute pancreatitis arrhythmias). fibrosis, hepatomegaly, MI, and ventricular Taper drug gradually over 2 wk with monitoring.

 WARNING: Ensure that alpha-adrenergic blocker Cenafed, has been given beforeEltor (CAN), Sudafed, Sudodrin, Decofed, Efidac/24, giving propranolol when treating Triaminicpatients Congestion pheochromocytoma; Allergy and others, Unifed with endogenous catecholamines secreted by the tumor can cause severe pseudoephedrine sulfate if vascular beta receptors are blocked hypertension Drixoral Non-Drowsy Formula, ElixSure Children's Congestion without concomitant alpha blockade. Consult with physician about withdrawing drug if Pregnancy Category C to undergo surgery (withdrawal is patient is controversial). Drug classes Provide continuous cardiac and regular BP Nasal decongestant with IV form. Change to oral form as soon as monitoring Sympathomimetic amine possible. Therapeutic actionsoral drug with food to facilitate absorption. Give Effects are mediated by alpha-adrenergic receptors; causes Teaching points vasoconstrictionTake this drug with meals.nasalnot discontinue the in mucous membranes of Do passages, resulting in their medication abruptly;promotes drainage and improves shrinkage, which abrupt discontinuation can cause a ventilation. worsening of your disorder. Indications If you have diabetes, the normal signs of Temporary relief of nasal congestion caused by the hypoglycemia (tachycardia) may be blocked by this common cold, yourfever, other respiratory allergies eat drug; monitor hay blood or urine glucose carefully; Nasal congestion take your diabetic medication regular meals, and associated with sinusitis Promotes nasal or sinus drainage regularly. Relief of eustachian tube congestion You may experience these side effects: Dizziness, Contraindications andlight-headedness, blurred vision (avoid drowsiness, cautions Contraindicated with MAOI therapy, allergy of driving or performing hazardous tasks); nausea, loss or idiosyncrasy tofrequent small meals); nightmares, sympathomimetic amines, severe appetite (eat hypertension and CAD. depression (request change of your medication); sexual Use impotence. cautiously with hyperthyroidism, diabetes mellitus, arteriosclerosis, ischemic heart disease,

Report difficulty breathing, night cough, swelling increased IOP, prostaticconfusion, depression, rash, hypertrophy, lactation, of extremities, slow pulse, pregnancy. throat. fever, sore Available forms Tablets30, 60 mg; CR tablets240 mg; ER tablets120 mg; chewable tablets15 mg; capsules30, 60 mg; liquid15, 30 mg/5 mL; drops7.5 mg/0.8 mL; syrup15 mg/5 mL Metabolism: Hepatic; T1/2: 7 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine Adverse effects CNS: Fear, anxiety, tenseness, restlessness, headache, light-headedness, dizziness, drowsiness, tremors, insomnia, hallucinations, psychological disturbances, prolonged psychosis, seizures, CNS depression, weakness, blurred vision, ocular irritation, tearing, photophobia, orofacial dystonia CV: Hypertension, arrhythmias, CV collapse with hypotension, palpitations, tachycardia, precordial pain Dermatologic: Pallor, sweating GI: Nausea, vomiting, anorexia GU: Dysuria, urinary retention in BPH Respiratory: Respiratory difficulty Interactions Drug-drug pseudoephedrine Increased hypertension with MAOIs, guanethidine, pseudoephedrine hydrochloride (d-isoephedrine hydrochloride) furazoladine

 Increased duration of action with urinary alkalinizers (potassium citrate, sodium citrate, sodium Drug classes lactate, tromethamine, sodium acetate, sodium Dibenzothiazepine bicarbonate) Antipsychotic Decreased therapeutic effects and increased Therapeutic actions of pseudoephedrine with urinary acidifiers elimination Mechanism of action not fully understood: Blocks dopamine and (ammonium chloride, sodium acid phosphate, potassium serotonin phosphate) the brain; also acts as a receptor antagonist receptors in at histamine and adrenergic receptor sites (which maymethyldopato Decreased antihypertensive effects of contribute the adverse effects of orthostatic hypotension and somnolence). Nursing considerations Indications Assessment Treatment of schizophreniaor patients > 18 yr to in idiosyncrasy History: Allergy Short-term amines, of acute manic episodes sympathomimetic treatment severe hypertension and associated with bipolar I disorder,diabetes as monotherapy or in CAD, hyperthyroidism, mellitus, combination with lithium or divalproex arteriosclerosis, increased IOP, prostatic hypertrophy, Contraindications and cautions pregnancy, lactation Contraindicated with coma or severe affect, CNS Physical: Skin color, T; reflexes, depression, allergy to quetiapine, lactation. orientation, peripheral sensation, vision; BP, P, Use cautiously with CV disease, hypotension, auscultation; R, adventitious sounds; urinary output, hepatic dysfunction,prostate palpation to extreme heat, bladder percussion, seizures, exposure autonomic instability, tardive dyskinesia, dehydration, Interventions thyroid disease, pregnancy. WARNING: Administer cautiously to patients Availablewith CV disease, diabetes mellitus, hyperthyroidism, forms Tablets25, 100, 200, 300 mg increased IOP, hypertension, and to patients > 60 yr who Metabolism: Hepatic; T1/2: 6 hr sensitivity to sympathomimetic may have increased Distribution: Crosses placenta; enters breast milk amines. Excretion: Feces, urine Avoid prolonged use; underlying medical problems may be causing the congestion. Adverse effects

Monitor CV effect carefully; hypertensive patients Autonomic: Dry mouth, who take this drug may experiencesalivation, in BP changes nasal congestion, nausea, vomiting, anorexia, fever, pallor, because of the additional vasoconstriction. However, if a flushed facies, sweating, constipation nasal decongestant is needed, pseudoephedrine is the CNS: Drowsiness, insomnia, vertigo, headache, drug of choice. Teaching weakness, tremor, tardive dyskinesias, neuroleptic points malignant not exceed the recommended daily dose; Do syndrome serious CV: Hypotension, orthostatic hypotension, overdose can occur. Use caution when using syncope more than one over-the-counter preparation because manyHematologic: Increased ALT, total cholesterol and of these drugs contain pseudoephedrine, triglycerides overdose may occur. unintentional Other: prolonged use because diabetes mellitus Avoid Risk of development of underlying medical Interactions problems can be disguised. Drug-drug You may experience these side effects: Dizziness, CNS effects light-headedness, tremors CNS weakness, restlessness, potentiated by alcohol, (avoid depressants driving or performing hazardous tasks). Effects palpitations, nervousness, sleeplessness, Report decreased with phenytoin, thioridazine, carbamazepine, phenobarbital, rifampin, glucocorticoids; sweating. monitor patient closely and adjust dosages appropriately when these drugs are added to or discontinued from regimen Increased effects of antihypertensives, lorazepam Decreased effects of levodopa, dopamine antagonists Potential for heatstroke and intolerance with drugs that affect temperature regulation (anticholinergics); use extreme caution and monitor patient closely quetiapine fumarate Seroquel Nursing considerations

Assessment History: Coma or severe CNS depression; allergy Drug classes quetiapine, lactation, pregnancy, CV disease, to Antihypertensive hypotension, hepatic dysfunction, seizures, exposure to ACE inhibitor extreme heat, autonomic instability, tardive dyskinesia, dehydration, thyroid disease, suicidal tendencies Therapeutic actions Physical: Body weight, T; reflexes, orientation, Quinapril IOP; P, BP, orthostatic BP; R, adventitious sounds; blocks ACE from converting angiotensin I to angiotensin II, a powerful vasoconstrictor, leading and thyroid function tests CBC, urinalysis, LFTs, renal to decreased BP, decreased aldosterone secretion, a small increase in serum potassium levels, Interventions and sodium andWARNING: Administer small quantity to also fluid loss; increased prostaglandin synthesis any may be involved in thesuicidal ideation. action. patient with antihypertensive Indications Monitor elderly patients for dehydration and Treatment of measures promptly; sedation and institute remedial hypertension alone or in combination with thiazide-type diuretics related to CNS effects of decreased sensation of thirst Adjunctive therapy in the management of CHF drug can lead to severe dehydration. with cardiac glycosides, diuretics, and beta-adrenergic Monitor patient closely in any setting that would blockers overheating. promote Contraindications and cautions patient for signs and symptoms Regularly monitor diabetes mellitus. with allergy to quinapril or other Contraindicated of ACE inhibitors, pregnancy, angioedema. Consult physician about dosage reduction and use anticholinergic antiparkinsonians (controversial) if Use cautiously with impaired renal function, of unilateral, bilateral renal artery stenosis, salt or volume extrapyramidal effects occur. Teaching depletion, lactation. points Available forms Take this drug exactly as prescribed. Tablets5, 10, 20, 40 mg should not be used during pregnancy; This drug using barrier contraceptives is advised. Metabolism: Hepatic; T1/2: 2 hr Distribution: Crosses placenta; enters breast milk

Maintain fluid intake and use precautions against Excretion: Urine heat stroke in hot weather. You may experience these side effects: Dizziness, Adverse effects drowsiness, fainting (avoid driving or engaging in other CV: Angina pectoris, orthostatic loss of appetite dangerous activities); dry mouth, nausea, hypotension in salt- or volume-depleted frequent small meals, and (frequent mouth care, patients, palpitations Dermatologic: Rash, increased fluid intake may help). pruritus, diaphoresis, flushing, photosensitivity fever, unusual bleeding or Report sore throat, GI: rash, weakness, tremors, bruising, Elevated LFTs, pancreatitisdark-colored urine, pale Respiratory: Cough the skin or eyes, suicidal stools, yellowing of Other: Angioedema, arthralgia thoughts. Interactions Drug-drug Increased lithium levels Decreased tetracycline absorption. Separate drugs by 12 hr. Nursing considerations Assessment History: Allergy to quinapril, other ACE inhibitors; impaired renal function; CHF; salt or volume depletion; lactation, pregnancy Physical: Skin color, lesions, turgor; T; P, BP, peripheral perfusion; mucous membranes, bowel sounds, liver evaluation; urinalysis, LFTs, renal function tests, CBC and differential Interventions quinapril hydrochloride WARNING: Alert surgeon and mark patient's Accupril chart with notice that quinapril is being taken; the

angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; Drug classes hypotension may be reversed with volume expansion. Antisecretory drug WARNING: Caution patient that this drug should Proton pump inhibitor during pregnancy; advise the use of barrier not be used Therapeutic actions contraceptives. Gastric acid-pump inhibitor: Suppressesin any situation that may Monitor patient closely gastric acid secretion by specific inhibition a fall hydrogen and potassium ATPase in fluid lead to of the in BP secondary to reduction enzyme system at volume (excessive of the gastric parietal cells; blocks the secretory surface perspiration and dehydration, the final step of acid diarrhea) because excessive hypotension may vomiting, production Indications occur. Teaching pointsHealing and maintenance of erosive or ulcerative GERD;Do not stop taking the medication 8without 48 wk therapy; may use additional wk as needed consulting your health care provider. Treatment of daytime and nighttime lead to a drop Be careful in any situation that may heartburn and other symptoms of GERD in blood pressure (diarrhea, sweating, vomiting, Maintenance of healing of or dizziness should dehydration); if light-headedness erosive or ulcerative GERDconsult your health care provider. occur, and reduction of relapse rates Healing of duodenal ulcersused during pregnancy; This drug should not be as short-term treatment < 4 wk using barrier contraceptives is advised. Treatment of hypersecretory You may experiencepathological effects: GI upset, these side conditions (eg, Zollinger-Ellison syndrome, multiple loss of appetite (transient); light-headedness (usually adenomas,change position slowly and limit activities to transient; systemic mastocytosis) those Eradication of Helicobacter pylori infection when that do not require alertness and precision); dry used in combination cough (not harmful). with amoxicillin and clarithromycin Unlabeled use: Treatment of gastric ulcers chills; Report mouth sores; sore throat, fever, swelling of the hands, feet; irregular heartbeat, chest Contraindications and cautions

pains; swelling of the face, eyes, lips, tongue; difficulty Contraindicated with breathing; persistent cough.hypersensitivity to any proton pump inhibitor or any drug components. Use cautiously with pregnancy, lactation. Available forms DR tablet20 mg Metabolism: Hepatic; T1/2: 1.5 hr Distribution: Crosses placenta; may enter breast milk Excretion: Feces, urine Adverse effects CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy Respiratory: URI symptoms, cough, epistaxis Other: Cancer in preclinical studies, back pain, fever Interactions Drug-drug WARNING: Risk of severe hypoglycemia if combined with gemfibrozil and itraconazole; avoid this combination Increased serum levels and potential increase in toxicity of rabeprazole sodium benzodiazepines when taken concurrently Aciphex

 Risk of hypoglycemia if combined with raloxifene gemfibrozil; use caution if this combination is used and hydrochloride Evista monitor patient closely Nursing considerations Drug class Assessment Selective estrogen receptorHypersensitivity to any proton pump History: modulator Therapeutic actions any drug components; pregnancy; lactation inhibitor or Increases bone Physical: Skin lesions; body T; reflexes, affect; mineral density without stimulating endometrium in women; modulates effects of endogenous estrogen respiratory urinary output, abdominal examination; at specific receptor sites. auscultation Indications Interventions Prevention and treatment of osteoporosis in Administer once a day. Caution patient to swallow postmenopausal women tablets whole, not to cut, chew, or crush. Unlabeled use: Prevention of breast cancerrule out Symptomatic improvement does not Contraindications and cautions gastric cancer. If Contraindicated with they may be administered administering antacids, allergy to raloxifene, pregnancy, lactation, active concomitantly with rabeprazole. or history of DVT, pulmonary embolism, or retinal vein thrombosis. Maintain supportive treatment as appropriate for Use problem. underlying cautiously with history of smoking, venous thrombosis. additional comfort measures to alleviate Provide Availablediscomfort such as from GI effects or headache. forms Tablets60 mg Teaching points Take the drug once a day. Swallow the tablets Metabolism: Hepatic; T1/2: 27.7 cut, or crush. This drug will need wholedo not chew, hr Distribution: Crossesfor up to 4enters breast milk therapy) or for to be taken placenta; weeks (short-term Excretion: Feces a prolonged period depending on the condition being treated. Adverse effects

Arrange to have regular medical follow-up care CNS: using this drug. while you are Depression, insomnia, vertigo, neuralgia, hypoesthesia all of the usual activities and restrictions Maintain CV: to your condition. If this that apply Venous thromboembolism becomes difficult, Dermatologic: Hot flashes, consult your health care provider. skin rash GI: Nausea, vomiting, these distaste You may experience food side effects: Dizziness GU: Vaginal bleeding, vaginal discharge (avoid driving a car or performing hazardous tasks); Other: Peripheral health headache (consult youredema care provider if these Interactions become bothersome; medications may be available to Drug-drug help); nausea, vomiting, diarrhea (proper nutrition is Increased risk a dietitian to oral anticoagulants; important, consult of bleeding with maintain nutrition; monitor PT or INR to bathroom facilities); symptoms of ensure ready accessclosely upper Decreased tract infection, cough (it may help to respiratory raloxifene absorption if taken with cholestyramine; is a this effect, do not self-medicate, know that this avoiddrug combination Nursing considerations consult with your health care provider if this becomes Assessment uncomfortable). History: Allergy to raloxifene, symptoms, Report severe headache, worsening of pregnancy, lactation, smoking, history of venous thrombosis fever, chills. Physical: Skin lesions, color, turgor; pelvic examination; orientation, affect, reflexes; peripheral pulses, edema; LFTs, CBC and differential, bone density Interventions Administer daily without regard to food. Arrange for periodic blood counts during therapy. WARNING: Monitor patient for possible longterm effects, including cancers, thromboses associated with other drugs in this class.

 WARNING: Counsel patient about the need to use Distribution: Crosses placenta; enters breast milk contraceptive measures to avoid pregnancy while taking Excretion: Feces, urine this drug; inform patient that serious fetal harm could Adverse effects occur. CV: Tachycardia, angina pectoris, MI, deal with Provide comfort measures to help patientRaynaud's syndrome, CHF, Hot flashes in (control volume-depleted drug effects: hypotension salt- or environmental patients, syncope temperature); headache, depression (monitor light and noise);Dermatologic: Rash, good hygiene). vaginal bleeding (use pruritus, pemphigoid-like Teaching reaction, photosensitivity, erythema multiforme, points Stevens-Johnson syndrome Take this drug as prescribed. GI: Gastric irritation,serious fetal harmdysgeusia, This drug can cause aphthous ulcers, and must cholestatic during hepatocellular injury, anorexia, not be takenjaundice,pregnancy. Contraceptive measures constipation, pancreatitis should be used while you are taking this drug. If you GU: Proteinuria, renal like to become pregnant, become pregnant or would insufficiency, renal failure, polyuria, oliguria, urinary frequency consult your health care provider immediately. Hematologic: Neutropenia, agranulocytosis, You may experience these side effects: Bone pain; thrombocytopenia, hemolytic places pancytopenia hot flashes (staying in cool anemia,may help); nausea, Cough, malaise, vomitingOther: frequent small meals); dry mouth, (eat weight gain; lymphadenopathy, angioedema dizziness, headache, light-headedness (use caution if Interactions driving or performing tasks that require alertness). Drug-drug Report marked weakness, sleepiness, mental Exacerbation swelling taken legs, shortness of confusion, pain orof cough if of thewith capsaicin Increased serum breath, blurred vision. levels and increased toxicity with lithium; monitor patient closely Drug-food Rate of absorption is decreased with food Drug-lab test False-positive test for urine acetone Nursing considerations

ramipril Assessment Altace History: Allergy to ramipril, impaired renal function, CHF, salt or volume depletion, pregnancy, Drug classes lactation Antihypertensive ACE inhibitor Physical: Skin color, lesions, turgor; T; P, BP, peripheral Therapeutic actionsperfusion; mucous membranes, bowel sounds, liver ACE from urinalysis, LFTs, renal to angiotensin Ramipril blocksevaluation; converting angiotensin I function tests, CBC and differential II, a powerful vasoconstrictor, leading to decreased BP, decreased Interventions aldosterone secretion, a small increase in serum potassium levels, Discontinue diuretic for 23 days before beginning and sodium and fluid loss; increased prostaglandin synthesis also therapy, the antihypertensive action. may be involved inif possible, to avoid severe hypotensive effect. Open capsules and sprinkle contents over a small Indications amount of applesauce or mix inalone or in combination Treatment of hypertension applesauce or water if patient has difficulty swallowing capsules. Mixture is with thiazide-type diuretics stableTreatmenthr CHF in stable patients in the48 hr if for 24 of at room temperature and first few refrigerated. days after MI WARNING: Alert of MI, stroke, death from CV To decrease the risk surgeon and mark chart that ramipril patients used; the angiotensin II disease inis being at risk for developing CAD formation subsequent to cautions Contraindications and compensatory renin release during surgery will be blocked; hypotension mayramipril, pregnancy Contraindicated with allergy to be reversed with volume expansion. (embryocidal in preclinical studies). Monitor patientwith impaired renal function, CHF, Use cautiously closely for falling BP secondary to reduction in depletion, lactation. salt or volumefluid volume (excessive perspiration and Availabledehydration, vomiting, diarrhea) because excessive forms hypotension 10 occur. Capsules1.25, 2.5, 5,maymg Reduce dosage in patients with impaired renal function. Metabolism: Hepatic; T1/2: 1317 hr

Teaching points Tablets5, 30, Do mg stop taking without consulting your health 35 not care provider. Metabolism: Not metabolized; T1/2: Initial half-life: 1.5 hr; terminal half-life: 48 hr Be careful in any situation that may lead to a drop Distribution: blood pressure may enter breast milk vomiting, in Crosses placenta; (diarrhea, sweating, Excretion: Urine dehydration); if light-headedness or dizziness should Adverse effects consult your health care provider. occur, CNS:may experience these side effects: GI upset, You Headache, paresthesia, dizziness CV: Chest change in hypertension loss of appetite, pain, edema,taste perception (transient) EENT: Glaucoma, conjunctivitis, help); mouth sores (frequent mouth care maycataractrash; fast heart GI: Nausea, diarrhea, dyspepsia, abdominal pain, rate; dizziness, light-headedness (transient; change anorexia position slowly, and limit your activities to those that do Skeletal: Increased or recurrent not require alertness and precision). bone pain Other: Arthralgia, bone sore throat, fever, chills; Report mouth sores; pain, leg cramps, rash Interactions swelling of the hands, feet; irregular heartbeat, chest Drug-drug pains; swelling of the face, eyes, lips, tongue, difficulty Absorption of risedronate decreased by calcium, breathing. aspirin, aluminum, magnesium; avoid these drugs for 2 hr before to 2 hr after taking risedronate Nursing considerations Assessment History: Allergy to bisphosphonates, renal failure, hypocalcemia, pregnancy, lactation Physical: Muscle tone, bone pain; bowel sounds; eye examination; urinalysis, serum calcium; orientation, affect Interventions

risedronate sodium WARNING: Administer with a full glass of plain Actonel (not mineral) water, at least 30 min before or after any other beverage, food, or medication; have patient remain Drug class in an Bisphosphonateupright position for at least 30 min to decrease the incidence Therapeutic actionsof GI effects. Patients taking weekly dose should mark calendar as a reminder. Affects osteoclast activity by reducing the enzymatic and transport Monitor serum calcium levels before, during, the processes that lead to resorption of the bone and by inhibiting and osteoclast after therapy. leading to a rate of bone turnover near protein pump, WARNING: disease. normal in patients with Paget's Ensure at least a 2-mo rest period after 2-mo course of treatment if retreatment is required for Indications Paget's disease. Ensure adequate vitamin D and of bone intake. Treatment of Paget's disease calcium in patients Provide phosphatase at least two times the upper with alkaline comfort measures if bone pain returns. Teaching limit of normal, those who are symptomatic, those at risk points future complications for Take this drug with a full glass of water (plain water, Treatment and prevention 30 minutes before or not mineral water), at least of osteoporosis in after any other beverage, foods, or medication; remain in postmenopausal women an upright position andat prevention of glucocorticoid Treatment for least 30 minutes to decrease the GI side effects of the drug. If taking a once-weekly dose, induced osteoporosis mark calendar as a reminder. Contraindications and cautions Maintain adequate vitamin D to bisphosphonates; Contraindicated with allergy and calcium intake while you aredisease, hypocalcemia, inability to stand or severe renal using this drug. upright for at least 30 min.these side effects: Nausea, You may experience sit diarrhea; bone pain, with renal dysfunction, lactation, Use cautiously headache (analgesics may be available to help); rash (appropriate skin care will be pregnancy. suggested). Available forms Report twitching, muscle spasms, dark-colored urine, edema, bone pain, rash.

risperidone History: Allergy to risperidone, lactation, CV Risperdal, Risperdal Consta, Risperdal M-TAB disease, pregnancy, renal or hepatic impairment, hypotension Drug classes Antipsychotic Physical: T, weight; reflexes, orientation; P, BP, orthostatic BP; R, adventitious sounds; bowel sounds, Benzisoxazol normal output, liver evaluation; CBC, urinalysis, LFTs, Therapeutic actions renal function tests Mechanism of action not fully understood: Blocks dopamine and Interventions serotonin receptors in the brain, depresses the RAS; WARNING: and alpha-adrenergic blocking anticholinergic, antihistaminic, Maintain seizure precautions, especially when initiating therapy and increasing adverse activity may contribute to some of its therapeutic and dosage. WARNING: Mix oral solution with 34 oz of actions. water, coffee, orange juice, or low-fat milk. Do not mix Indications with cola or tea.of schizophrenia Treatment Open blister units ofin long-term treatment of Delaying relapse orally disintegrating tablets individually; do not push tablet through the foil. Use dry schizophrenia hands Short-term tabletimmediately manic on tongue. to remove treatment of acute place or mixed Do not allow patient with bipolar 1 disorder; alone or in episodes associated to chew tablet. WARNING: Monitor patient (oral only) combination with lithium or valproateregularly for signs and symptoms of diabetes Contraindications and cautions mellitus. Monitor T. If fever with hypersensitivity to occurs, rule out underlying Contraindicated infection, and consult risperidone, lactation. physician for appropriate comfort measures. cautiously with CV disease, pregnancy, renal Use Advise patient hypotension. or hepatic impairment,to use contraception during drug Availabletherapy. forms Tablets0.25, WARNING:4Follow guidelines for discontinuation 0.5, 1, 2, 3, mg; oral solution1 mg/mL; orally or reinstitution of 1, 2 mg; powder disintegrating tablets0.5, the drug carefully. for injection25, Teaching points 37.5, 50 mg

Dosage will be increased gradually to achieve most Metabolism: Hepatic; T1/2: 20 hr effective dose. Do not take more than Distribution: Crosses placenta; enters breast milk your prescribed dosage. Do not make up missed doses; contact your Excretion: Feces, urine health care provider if this occurs. Do not stop taking this drug suddenly; gradual reduction of dosage is Adverse effects neededCNS: Insomnia, anxiety, agitation, headache, to prevent side effects. Mix oral solution dizziness, tardive water, coffee, somnolence, aggression, in 34 ounces of dyskinesias orange juice, or low-fat milk. Do not mix with cola or CV: Orthostatic hypotension, arrhythmias tea. Dermatologic: Rash, dry skin, seborrhea, Remove orally disintegrating tablet with dry hands. photosensitivity Do push tablet through foil. Immediately abdominal notGI: Nausea, vomiting, constipation, place tablet on tongue; do not split or chewsaliva The tablet will discomfort, dry mouth, increased tablet. disintegrate within seconds and youcoughing,swallow. Respiratory: Rhinitis, can then sinusitis, This drug cannot pharyngitis, dyspnea be taken during pregnancy. If you think Other: Chest pain, arthralgia, become pregnant, you are pregnant or wish to back pain, fever, contact your health care provider. neuroleptic malignant syndrome, diabetes mellitus, You hyperglycemiamay experience these side effects: Drowsiness, dizziness, sedation, seizures (avoid driving, Interactions operating machinery, or performing tasks that require Drug-drug concentration); dizziness, faintness toxic effects with Increased therapeutic and on arising (change positions slowly; use caution); increased salivation clozapine (reversible); constipation; sensitivity to the sun (use a Decreased therapeutic effect with carbamazepine sunscreen or protective clothing).levodopa Decreased effectiveness of Report Nursing considerations lethargy, weakness, fever, sore throat, malaise, mouth ulcers, palpitations, increased thirst, Assessment increased urination, increased hunger.

ritonavir Drug-alternative therapy Norvir Decreased effectiveness if taken with St. Johns wort Drug class Nursing considerations Antiretroviral CLINICAL ALERT! Therapeutic actions Name confusion has been reported between activity, leading to Antiviral activity; inhibits HIV protease Retrovir (zidovudine) and ritonavir; use caution. decrease in production of HIV particles. Indications Assessment Treatment of HIV infection in combination with History: Allergy to ritonavir, hepatic dysfunction, other antiretrovirals pregnancy, cautions Contraindications andlactation Physical: T; orientation, reflexes; BP, P, peripheral Contraindicated with allergy to ritonavir. perfusion; R, adventitious sounds; pregnancy, hepatic bowel sounds; skin Use cautiously with color, perfusion; LFTs impairment, lactation. Available forms Interventions mg; oral solution80 mg/mL Capsules100 Capsules and oral solution should be stored in refrigerator; T1/2: 35 hr Metabolism: Hepatic; solution may be refrigerated or left at room temperature if used within 30 breast milk Distribution: Crosses placenta; may enterdays; protect from light and extreme heat. Excretion: Feces, urine Adverse effects Administer with meals or food to increase absorption. CNS: Asthenia, peripheral and circumoral WARNING: Carefully screen headache, to avoid paresthesias, anxiety, dreams, drug history dizziness, potentially dangerous drug changes hallucinations, personality interactions. CV: Hemorrhage, hypotension, syncope, Teaching tachycardia points Take this drug with meals or food; store capsules in refrigerator. Taste of solution may be improved if mixed

Dermatologic: Acne, dry skin, contact dermatitis, with rash chocolate milk, Ensure, or Advera 1 hour before taking. GI: not drink grapefruit juice while using this Do Nausea, vomiting, diarrhea, anorexia, drug. abdominal pain, taste perversion, dry mouth, hepatitis, Take the full course of liver dysfunction, dehydration therapy as prescribed; do not GU: Dysuria, hematuria, nocturia, pyelonephritis take double doses if one is missed; do not change dosage without consultingdyspnea, cough, rhinitis Respiratory: Apnea, your health care provider. Always take in combination chills, back pain, chest pain, Other: Hypothermia, with your other HIV drugs. This drug edema, cachexia does not cure HIV infection; long-term effects are not yet known; continue to take precautions as Interactions the Drug-drug risk of transmission is not reduced by this drug. Potentially large any other drugs, prescription or overDo not take increase in serum concentration of the-counter, without consulting your ergotamine, amiodarone, bepridil, bupropion, clozapine,health care provider; drug interacts piroxicam, propafenone, flecainide,this meperidine, with many other drugs and serious problems can occur. propoxyphene, quinidine, rifabutin; potential for serious You may experience fatal reactions; do not arrhythmias, seizures, and these side effects: Nausea, vomiting, ritonavir with any diarrhea, abdominal pain, administer loss of appetite, of these drugs headache, dizziness, numbness, tingling.concentration of Potentially large increases in serum these Report severe hypnotics:severe nausea,clonazepam, sedatives and diarrhea, Alprazolam, personality changes, changes in color of urine midazolam, triazolam, diazepam, estazolam, flurazepam, or stool, fever, chills. zolpidem; extreme sedation and respiratory depression could occur; do not administer ritonavir with any of these drugs Drug-food Absorption increased by presence of food; taking drug with food is strongly recommended Decreased metabolism and risk of toxic effects if combined with grapefruit juice; avoid this combination

rosiglitazone maleate Administer without regard to meals. Avandia Arrange for consult with dietitian to establish weight loss program and dietary control as appropriate. Drug classes Antidiabetic Arrange for thorough diabetic teaching program to include Thiazolidinedione disease, dietary control, exercise, signs and symptoms Therapeutic actions of hypo- and hyperglycemia, avoidance of infection, to insulin; Resensitizes tissues hygiene. decreases hepatic gluconeogenesis Teaching points and increases insulin-dependent muscle glucose uptake. Do not discontinue this medication without Indications consulting your health an adjunct to diet and exercise to Monotherapy as care provider; continue with diet and exercise program for in patients with improve glucose control diabetes control. type 2 (non Take this drug with insulin-dependent) diabetes meals if desired. If dose is missed, it may combination with insulin, metformin oris As part of be taken at the next meal. If dose a missed for an entire day, do not double dose the next sulfonylurea when diet, exercise, and either agent alone day. does not result in adequate glycemic control in type 2 Monitor urine or blood for glucose and ketones as diabetes prescribed; watch very Contraindications and cautionsclosely while adjusting to drug. Report fever, sore throat, unusual bleedingany or Contraindicated with allergy to bruising, rash, dark urine, (insulin-dependent) diabetes, thiazolidinedione; type 1 light-colored stools, hypo- or hyperglycemic reactions. ketoacidosis, lactation. Use cautiously with advanced heart disease, liver Adverse effects in Italic are most common; those in Bold are lifefailure, pregnancy, heart failure. threatening. Available forms Tablets2, 4, 8 mg Metabolism: Hepatic; T1/2: 34 hr Distribution: Crosses placenta; enters breast milk

Excretion: Feces, urine salmeterol xinafoate Serevent Diskus Adverse effects CNS: Headache, pain Drug classes Endocrine: Hypoglycemia, hyperglycemia Beta2-selective GI: Diarrhea, liver injury adrenergic agonist Antasthmatic Respiratory: Sinusitis, URI, rhinitis Therapeutic actions Other: Infections, fatigue, accidental injury, Long-acting agonist that binds to beta2 receptors in the lungs, edema causing bronchodilation; also inhibits the release of inflammatory Interactions mediators Drug-drugin the lung, blocking swelling and inflammation. Indications Risk of increased serum levels if combined with Prevention of and maintenance dosage as gemfibrozil; monitor patient and adjust therapy for bronchospasm in select patients with asthma, chronic needed. obstructive pulmonary disease, and exercise-induced Nursing considerations asthma Assessment Contraindications and cautions to any thiazolidinedione; type 1 History: Allergy Contraindicated with hypersensitivity salmeterol, diabetes, ketoacidosis, serious hepatic toimpairment, acute asthma attack, worsening or deteriorating asthma advanced heart disease, pregnancy, lactation (life-threatening), acuteorientation, reflexes, peripheral Physical: T; airway obstruction. Use R, adventitious sounds; liver evaluation; sensation; cautiously with pregnancy, lactation. AvailableLFTs, blood glucose, CBC forms Inhalation powder50 mcg (Diskus) Interventions Metabolism: Hepatic; T1/2:serum glucose levels frequently to Monitor Unknown Distribution: Crosses placenta; maydrug and dosage being used. determine effectiveness of enter breast milk Excretion: Feces Monitor baseline LFTs before beginning therapy and periodically during therapy. Adverse effects

 CNS: Headache, tremor sertraline hydrochloride CV: Tachycardia, palpitations, hypertension Zoloft Respiratory: Worsening of asthma, difficulty breathing, bronchospasm, asthma related deaths (risk Drug classes higher in black than white patients) Antidepressant Interactions SSRI Drug-drug Therapeutic actions of severe bronchospasm if combined with Risk Acts as an antidepressant by a cardioselectiveneuronal uptakeand beta-blockers; use inhibiting CNS beta-blocker of serotonin;monitor patient closelyserotonin with little used blocks uptake of if this combination is effect on norepinephrine, Potential forhistaminergic, and alpha1-adrenergic muscarinic, worsened hypokalemia and ECG or dopaminergic receptors.combined with diuretics; monitor patient abnormalities if Indications closely very Treatment of major depressive disorder Administer with extreme caution to patients being Treatment of OCD treated with MAOIs or TCAs, or within 2 wk of Treatment such agents because the without discontinuation ofof panic disorder with oraction of agoraphobia be potentiated by these agents salmeterol may Treatment Nursing considerations of PTSD; long-term use to prevent relapse and sustain symptom improvement Assessment Treatment Allergy to salmeterol; pregnancy, acute History: of PMDD Treatment of social asthma, lactation asthma attack, worsening anxiety disorder (social phobia) Contraindications and cautions Physical: R, adventitious sounds; P, BP, ECG; Contraindicated with orientation, reflexes; LFTs hypersensitivity to sertraline. Interventions Use cautiously with impaired hepatic or renal function, lactation, is not used to treat acute asthma or Ensure that drug pregnancy; in children and adolescents with major depressive disorder. of death). with worsening or deteriorating asthma (risk Available forms Instruct in the proper use of Diskus. Tablets25, 50, 100 mg; oral concentrate20 mg/mL

Monitor use of inhaler; use of more than 4 Metabolism: Hepatic; T1/2: 26 hr (104active metabolite) puffs/day may worsen asthma; obtain evaluation by Distribution: Crosses placenta; may enter breast milk physician. Excretion: Feces, urine Have patients who experience exercise-induced asthma use it 3060 min before activity. Adverse effects Arrange for periodic evaluation of respiratory CNS: condition. Headache, nervousness, drowsiness, anxiety, Teaching tremor, dizziness, insomnia, light-headedness, agitation, points sedation, abnormal gait, seizures, vision changes, fatigue Use the pressurized metered-dose inhaler as CV: Shake well before using. Use only instructed. Hot flashes, palpitations, chest pain twice a day. IfDermatologic: Sweating, rash, pruritus, acne, drug is to be used periodically for exercisecontact asthma, use induceddermatitis 3060 minutes before activity. GI: Nausea, vomiting, diarrhea, dry mouth, To gain full therapeutic benefit in the treatment of anorexia, dyspepsia, constipation, taste changes, reversible airway obstruction, administer twice a day flatulence, gastroenteritis, (morning and evening). dysphagia, gingivitis GU: Painful menstruation, of your respiratory Obtain periodic evaluations sexual dysfunction, frequency, problem. cystitis, impotence, urgency, vaginitis Respiratory: URIs, these side cough, dyspnea, You may experience pharyngitis,effects: Headache bronchitis, rhinitis (request analgesics); tremors (use care in performing Other: Hot fast heartbeat, palpitations dangerous tasks);flashes, fever, back pain, thirst (monitor activity; rest frequently). Interactions Report severe headache, irregular heartbeat, Drug-drug worsening of asthma, difficulty breathing. WARNING: Serious, sometimes fatal, reactions with MAOIs; allow at least 14 days to elapse between MAOI and sertraline use WARNING: Possible risk of increased QTc interval if combined with pimozide; do not use together Increased serum levels of sertraline with cimetidine

Drug-food Increased rate of absorption with food Drug class Drug-alternative therapy Impotence drugIncreased risk of severe reaction if combined with Phosphodiesterase inhibitor St. John's wort therapy Therapeutic actions Nursing considerations Selectively Assessment inhibits cGMP-specific phosphodiesterase type 5. The mechanism of penile erection involves the to sertraline; impaired History: Hypersensitivity release of nitric oxide into the corpus cavernosum of the penis during sexual stimulation. hepatic or renal function; lactation, pregnancy Nitrous oxide Physical: cGMP, which causes lesions; reflexes, activates Weight; T; skin rash, smooth muscle relaxation, allowing the flow of blood into the corpusP, peripheral affect; bowel sounds, liver evaluation; cavernosum. Sildenafil perfusion;the breakdown of cGMP by phosphodiesterase, prevents urinary output, LFTs, renal function tests leading to increased cGMP levels and prolonged smooth muscle relaxation, promoting the flow of blood into the corpus Interventions cavernosum, and decreasing pressure in the pulmonary with hepatic Use lower dose in elderly patients and bed. Indication renal impairment. or Treatment ofconcentrate in 4 oz water, presence of Dilute oral erectile dysfunction in the ginger ale, sexual stimulation lemonade, or orange juice only; lemon-lime soda, Treatment of pulmonary arterial administer immediately after diluting. hypertension to improve exercise ability WARNING: Establish suicide precautions for Contraindications depressed patients. Limit number of tablets severely and cautions given Contraindicated with allergy to any component of at any time. the tablet,drug once a day, morning or evening.children; Give contraindicated for women or concomitant use of nitrates. Increase dosage at intervals of not less than 1 wk. Use cautiously with nonhormonal contraceptives; Counsel patient to usehepatic or renal dysfunction; with anatomical deformationdue therisk to fetus. known pregnancy should be avoided of to penis; with cardiac disease (effects of sexual activity need to be Teaching evaluated). points Available forms

Take this drug once a day, at the same time, Tablets20 mg (Revatio); 25, 50, 100 exceed the prescribed dose. morning or evening; do not mg It may take 46 weeks to see any improvement. Metabolism: Hepatic; T1/2: 4 hr Dilute concentrate immediately before use in 4 Distribution: Not intended for ale, lemon-lime no clear studies on ounces water, ginger use in women, soda, lemonade, or crossing the placenta or entering breast milk orange juice only. Excretion: Feces and urine health care provider if you think that Consult your Adverse effects pregnant or wish to become pregnant. you are CNS: Headache, abnormal side effects: Dizziness, You may experience these vision, dizziness, nasal congestion, ischemic optic neuropathy(avoid driving or drowsiness, nervousness, insomnia CV: Flushing performing hazardous tasks); nausea, vomiting (eat GI: small meals); dry frequent Dyspepsia, diarrhea mouth (suck sugarless Other: UTI, rash lozenges, perform frequent mouth care); excessive Interactions sweating (monitor temperature; avoid overheating). Drug-drug Report rash, mania, seizures, edema, difficulty WARNING: Possible thoughts of suicide. breathing, increased depression,severe hypotension and serious cardiac events if combined with nitrates or alpha adrenergic blockers; this combination must be avoided Possible increased sildenafil levels and effects if taken with cimetidine, amlodipine, erythromycin, protease inhibitors; monitor patient and reduce dosage as needed Drug-food Decreased rate of absorption and onset of action if taken with a high-fat meal Decreased metabolism and risk of toxic effects if sildenafil combined with grapefruit juice; avoid this combination citrate Drug-alcohol Revatio, Viagra

 Concomitant use may result in decrease in BP, HMG-CoA reductasehypertension orthostatic inhibitor Therapeutic actions Nursing considerations Inhibits HMG-CoA reductase, the enzyme that catalyzes the first Assessment step in the cholesterol synthesis pathway, component of decrease in History: Allergy to any resulting in a the tablet; serum cholesterol, or renal dysfunction; an increase or no hepatic serum LDLs, and either with anatomical change in deformation of the penis, known cardiac disease; serum HDLs. Indications concomitant use of nitrates Adjunct Orientation, treatment color, lesions; P, Physical:to diet in theaffect; skin of elevated total cholestrol and LDL cholesterol with primary BP, ECG, LFTs, renal function tests hypercholesterolemia (types IIa and IIb) in those Interventions unresponsive diagnosis ofrestriction of saturated fat and Ensure to dietary pulmonary arterial hypertension cholesterol and other nonpharmacologic measures (Revatio) Ensure diagnosis riskerectile dysfunction and mortality, To reduce the of of coronary disease, determine underlying causes including stroke, TIA, MI and reduction and CV events, and other appropriate treatment. need for patient that drug does not work in thein patients in Advise bypass surgery and angionplasty absence of sexual stimulation. Limit use to once per day. with coronary heart disease and hypercholesterolemia Remind patient that drug does not protect against sexually Treatment of patients transmitted diseases and appropriate measures with beisolated should taken. hypertriglyceridemia WARNING: Advise patient to never take this drug Treatment of type III even fatal complications can with nitrates; serious and hyperlipoproteinemia occur. Treatment of adolescents 10-17 yr with heterozygous familial hypercholesterolemia WARNING: Advise patients receiving HIV Contraindications and cautions is an increased risk of sidenafilmedications that there Contraindicated with allergyreactions, to simvastatin, fungal associated adverse drug including byproducts, pregnancy, lactation.and priapism. Do not hypotension, visual changes, Use cautiously with 48 hr. exceed 25 mg of sildenafil inimpaired hepatic and renal function, cataracts. Advise patients not to take this drug WARNING: Availablewithin 4 hr of administration of alpha blockers. forms Tablets5, 10, 20, 40, 80 mg

eaching points Metabolism: Hepatic; this : 3 hr 30 minutes to 4 hours before Take T1/2 drug Distribution: Crossessexual activity. The usual timing is 1 hour. anticipated placenta; enters breast milk Excretion: Feces, urine have no effect in the absence of sexual The drug will stimulation for erectile dysfunction. Adverse effects If taking this drug for pulmonary arterial CNS: Headache, asthenia, sleep disturbances hypertension, take three times a day; make sure the doses are 4-GI: Flatulence, diarrhea, abdominal pain, cramps, 6 hours apart. constipation, drug effects will be slowed if taken with a high Onset of nausea, dyspepsia, heartburn, liver failure fat meal; plan accordingly. Avoid drinking grapefruit juice if Respiratory: Sinusitis, pharyngitis using this drug. Rhabdomyolysis, acute renal failure, Other: This myalgia arthralgia,drug will not protect you from sexually transmitted diseases; use appropriate precautions. Interactions Stop the drug and call your health care provider Drug-drug immediately if you experience sudden of myopathy and WARNING: Increased risk loss of vision. Do not take this drug if you are erythromycin, HIV rhabdomyolysis with clarithromycin, taking any nitrates; serious side effects and even death can occur. protease inhibitors, itraconazole, ketoconazole, You may experience these side effects: Headache, nefazodone; avoid concomitant use, or suspend therapy dizziness, rash, flushing. clarithromycin, erythromycin, during treatment with Report difficult or itraconazole, and ketoconazole painful urination, rash, dizziness, palpitations, loss of vision. Increased risk of myopathy and rhabdomyolysis with amiodarone, verapamil; do not exceed 20 mg simvastatin daily simvastatin Increased risk of myopathy and rhabdomyolysis Zocor with cyclosporine, fibrates, niacin; monitor patient closely if use together cannot be avoided. Do not exceed Drug classesmg simvastatin daily 10 Antihyperlipidemic

 Digoxin levels may increase slightly; closely Binds to serotoninplasma digoxin levels at the start of simvastatin monitor receptors to cause vascular constrictive effects on cranialtherapyvessels, causing the relief of migraine in selective blood patients. Increased risk for hepatotoxicity with hepatotoxic Indications drugs; avoid concurrent use Treatment of slightly enhance attacks with or Simvastatin may acute migraine the anticoagulant without warfarin; monitor PT and INR at the start of effect ofaura (oral, nasal) Acute during dose cluster headaches (subcutaneous therapy and treatment of adjustment injection) Drug-food Contraindications andmetabolism and risk of toxic effects if Decreased cautions Contraindicated juice; avoid to sumatriptan, combined with grapefruitwith allergythis combination cerebrovascular Nursing considerations or peripheral vascular syndromes, severe hepatic impairment, MAOIs, uncontrolled hypertension, Assessment hemiplegic migraine, pregnancy, coronary artery disease. History: Allergy to simvastatin, fungal byproducts; Use cautiously with the elderly, lactation, renal impaired hepatic function; pregnancy; lactation function impairment. Physical: Orientation, affect; liver evaluation, Availableabdominal examination; lipid studies, LFTs forms Tablets25, 50, 100 mg; injection6 mg/0.5 mL; nasal spray5, Interventions 20 mg Ensure that patient has tried a cholesterol-lowering diet regimen for 36 mo before beginning therapy. Metabolism: Hepatic;in 1/2: 115 min highest rates of cholesterol Give T the evening; Distribution: Crosses placenta; midnight andmilk synthesis are between enters breast 5 AM. Excretion: Urine, feces (tablets) this drug cannot be taken during Advise patient that Adverse effects pregnancy; advise patient to use barrier contraceptives. CNS: for regular follow-up during anxiety, Arrange Dizziness, vertigo, headache, long-term malaise Consider reducing dose if therapy. or fatigue, weakness, myalgia cholesterol falls belowCV: BP alterations, tightness or pressure in chest target. Teaching pointsGI: Abdominal discomfort, dysphagia

Take drug in the evening. Do not drink grapefruit Local: Injection site juice while using this drug. discomfort, nose and throat discomfort (nasal spray) tests. Have periodic blood Other: Tingling, warm or hot sensations, burning This drug cannot be taken during pregnancy; using sensation, feeling of recommended. barrier contraceptives is heaviness, pressure sensation, numbness, may experience these side effects: Nausea cold You feeling of tightness, feeling strange, (eat sensation frequent small meals); headache, muscle and joint aches Nasal spray pains (may lessen); sensitivity to light (use a and GI: Bad taste in mouth, nausea suncreen and wear protective clothing). Interactions Report severe GI upset, changes in vision, unusual Drug-drug bleeding or bruising, dark urine or light-colored stools, Prolonged vasoactive fever, muscle pain, or soreness. reactions with ergotcontaining drugs (should not be used within 24 hr of each other) Increased serum levels and toxicity of sumatriptan with MAOIs; avoid this combination and for 2 wk after MAOI discontinuation Drug-alternative therapy Increased risk of severe reaction if combined with Nursing considerations sumatriptan succinate Assessment Imitrex History: Allergy to sumatriptan; active CAD; uncontrolled hypertension; hemiplegic migraine; Drug classes pregnancy, lactation Antimigraine drug (triptan) Physical: Serotonin-selective agonist Skin color and lesions; orientation, reflexes, peripheral sensation; P, BP; LFTs, renal Therapeutic actions function tests Interventions

 Administer to relieve acute migraine, not as a Phosphodiesterase-5 inhibitor prophylactic measure. Therapeutic actions Administer as subcutaneous injection just below Selectively inhibits cGMP-specific phosphodiesterase type 5. The the skin as soon as possible after symptoms begin. mechanism of penile erection involves afterrelease if relief is not Repeat injection only the 1 hr of nitric oxide into the corpus cavernosum of the penis duringgiven each 24 hr. obtained; only two injections may be sexual stimulation. Nitrous oxide AdministercGMP, which causes smooth hr if no activates PO with fluids; may repeat in 2 muscle relaxationrelief. allowing the flow of blood into the corpus cavernosum. Tadalafil prevents the breakdown of cGMP byheadache returns or Repeat nasal spray after 2 hr if phosphodiesterase, leading todoes not respond. levels and prolonged smooth muscle increased cGMP relaxation, promoting the flow patients withinto the corpus Monitor BP of of blood possible CAD; cavernosum. discontinue at any sign of angina, prolonged high BP. Indications Teaching points Treatment use the autoinjector; injection may be Learn to of erectile dysfunction in the presence of sexual stimulation 1 hour if relief is not obtained; do not repeated only after Contraindications and cautions injections in 24 hours. administer more than two Contraindicated the allergy to any possible after Inject just belowwith skin as soon as component of the tablet, concurrent use of is for an or alpha blockers; onset of migraine; this drug nitrates acute attack only, contraindicated for use in women or children. not for use to prevent attacks. Use cautiously with hepatic or renal dysfunction; Administer nasal spray as a single dose; repeat if with anatomical deformation of the penis, with known needed only after 2 hours. cardiac disease drug with fluids, may be repeated inbe Take oral (effects of sexual activity need to 2 evaluated), relief or return of headache. interval, unstable hours if no congenital prolonged QT angina; hypotension not be taken during pregnancy; if This drug should (systolic < 90); uncontrolled hypertension that 170/110), severe hepatic impairment; you suspect (> you are pregnant, consult your health end-stage renal stop using drug. dialysis; hereditary care provider and disease with degenerative retinal disorders. Available forms Tablets5, 10, 20 mg

Contact your health care provider immediately if Metabolism: Hepatic, T1/2:severe or continuous chest pain or you experience 17.5 hr Distribution: Not intended for use in women pressure. Excretion: Feces, urine experience these side effects: Dizziness, You may drowsiness (avoid driving or the use of dangerous Adverse effects machinery); numbness, tingling, feelings of tightness or CNS: pressure. Headache, abnormal vision, changes in color vision, fatigue, ischemic optic neuropathy Report feelings of heat, flushing, tiredness, feelings of CV: Flushing, angina, chest sickness, swelling of lips or eyelids. pain, hypertension, hypotension, MI, palpitation, postural hypotension, tachycardia A GI: Dyspepsia, diarrhea, abdominal pain, dry mouth, esophagitis, gastritis, GERD, nausea, abnormal liver function test results GU: Abnormal erection, spontaneous erection, priapism Respiratory: Rhinitis, sinusitis, dyspnea, epistaxis, pharyngitis, nasal congestion Other: Flulike syndrome, edema, pain, rash, sweating, myalgia Interactions Drug-drug WARNING: Possible severe hypotension and serious tadalafil cardiac events if combined with nitrates, alpha blockers; this combination is contraindicated. Cialis Possible increased tadalafil levels and effects if taken with Drug classes ketoconazole, itraconazole, erythromycin; monitor patient Impotence drug and reduce dosage as needed

Increased tadalafil serum levels if combined with Combining this drug with alcohol could limit indinavir, ritonavir; if these drugs are being used, cause dizziness, loss of blood pressure, period tadalafil dose to 10 mg in a 72-hr or increased flushing. Reduced tadalafil levels and effectiveness if Headache, You may experience these side effects: combined dizziness, upset stomach, runny nose, muscle pains. with rifampin These side increased cardiac effects,within a couple or Risk for effects should go away decreased BP, of hours. If side effects persist, consult your health this flushing if combined with alcohol; warn patient of care provider. possibility if patient uses alcohol Report difficult or painful urination, vision Drug-food changes, fainting, erection that persists for longer than 4 Possible increased tadalafil levels if taken with hours (if juice grapefruitthis occurs, seek medical assistance as soon as possible), sudden Nursing considerations loss of vision. Assessment History: Allergy to any component of the tablet, concurrent use of nitrates or alpha blockers; unstable angina; hypotension; uncontrolled hypertension; severe hepatic impairment; end-stage renal disease with dialysis; hereditary degenerative retinal disorders; anatomical deformation of the penis, cardiac disease, congenital prolonged QT interval Physical: Orientation, affect; skincolor, lesions; R, adventitious sounds; P, BP, ECG, LFTs, renal function tests tamoxifen citrate Interventions Apo-Tamox (CAN), Nolvadex, Novo-Tamoxifen (CAN), Tamofen Ensure diagnosis of erectile dysfunction and (CAN) determine underlying causes and other appropriate treatment. Drug class Antiestrogen

Advise patient that drug does not work without Antineoplastic stimulation. Limit use to once per day. sexual Therapeutic actions patient that drug does not protect against Remind Potent antiestrogenic effects: Competes and appropriate measures sexually transmitted diseases with estrogen for binding sites in target tissues, such as the breast. should be taken. Indications WARNING: Advise patient to never take this drug with Treatment of metastatic breast serious and even nitrates or alpha-adrenergic blockers; cancer in women and men; in premenopausal fatal complications can occur. women with metastatic breastWarn patient tamoxifen ofis an BP or dizziness cancer, of the risk lowered alternative to oophorectomy with alcohol. if drug is takenor ovarian irradiation Teaching points Treatment of node-positive breast cancer in postmenopausal drug before anticipated sexual activity. Take this women following total mastectomy or segmental mastectomy, axillary for more and days. The drug will stay in your body dissection,than 3 breast irradiation The drug will have no effect unless there is sexual Treatment of axillary node-negative breast cancer stimulation. in women following total protect you fromsegmental This drug will not mastectomy or sexually mastectomy, axillary dissection, and precautions. transmitted diseases; use appropriate breast irradiation Reduction this drug if invasive breast cancer in Do not take in risk of you are taking any nitrates, women with ductal other drugs for treating erectile alpha blockers, or carcinoma in situ (DCIS) following breast surgery and radiation dysfunction; serious side effects and even death can occur. Reduction in occurrence of contralateral breast cancerMany drugs receiving adjuvant tamoxifen therapy in patients may interact with tadalafil; always for breast cancer consult your health care provider before taking any drug, Reduction in incidence of breast herbal therapies. including over-the-counter drugs and cancer in women at high adjustments may be Dosage risk for breast cancer needed. Unlabeled uses: Treatmentcontact your health care Stop taking the drug and of mastalgia; useful for decreasing size and pain sudden loss of vision. provider if you experienceof gynecomastia; treatment of McCuneAlbright syndrome and precocious puberty in

female patients 210 yr; malignant carcinoid tumor, Arrange for periodic blood counts. carcinoid syndrome Arrange for initial Contraindications and cautions ophthalmologic examination and periodic examinations if visual changes occur. tamoxifen, Contraindicated with allergy to Counsel patient to use who require concomitant pregnancy, lactation, women contraception while taking this drug; inform patient that therapy or in womencould coumarin-type anticoagulation serious fetal harm with occur. a history of DVT or PE. Decrease dosage ifin women with a history of Use cautiously adverse effects become severe. thromboembolic events. Teaching forms Availablepoints Tablets10, 20For doses greater than 20 milligrams, take the drug mg twice a day, in the morning and evening. Do not drink grapefruit juice while using Metabolism: Hepatic; T1/2: 714 daysthis drug. This drug can may serious fetal harm Distribution: Crosses placenta;cause enter breast milk and must not be Excretion: Fecestaken during pregnancy. Contraceptive measures should Adverse effects be used. If you become pregnant or decide you want to become pregnant,light-headedness,health care consult your CNS: Depression, dizziness, provider immediately. headache, corneal opacity, decreased visual acuity, Have regular retinopathy, stroke gynecologic examinations during therapy. Dermatologic: Hot flashes, rash, Stevens You may experience these side effects: Bone pain; Johnson syndrome hot flashes (staying in cool food distaste,help); nausea, GI: Nausea, vomiting, places may alterations in vomiting (eat frequent small meals); weight gain; liver enzymes menstrual irregularities;bleeding, vaginal discharge, dizziness, headache, light GU: Vaginal headedness irregularities, ifpruritus vulvae, endometrial menstrual (use caution driving or performing tasks that require alertness). cancer, uterine sarcoma Report marked weakness, sleepiness, mental Hematologic: Hypercalcemia, especially with bone confusion, pain or swelling of the legs, anemia, DVT metastases, thrombocytopenia, leukopenia, shortness of breath, blurred vision.

Other: Peripheral edema; increased bone and tumor pain and local disease (initially seen with a good tumor response, usually subsides); cancer in animal studies, changes in LFTs, P Interactions Drug-drug Increased risk of bleeding with oral anticoagulants Increased serum levels with bromocriptine Increased risk of thromboembolic events if given with cytotoxic agents Drug-food Decreased metabolism and risk of toxic effects if combined with grapefruit juice; avoid this combination Drug-lab test Possible increase in calcium levels, T4 levels without hyperthyroidism Nursing considerations Assessment History: Allergy to tamoxifen; pregnancy, lactation, previous DVT or PE Physical: Skin lesions, color, turgor; pelvic examination; orientation, affect, reflexes; ophthalmologic examination; peripheral pulses, edema; tamsulosin hydrochloride LFTs, CBC and differential, estrogen receptor evaluation Flomax of tumor cells Drug class Interventions Alpha-adrenergic blocker (peripherally acting) and the evening. Administer bid, in the morning Therapeutic actions

Blocks the smooth muscle alpha1-adrenergic receptors in the Alert surgeon that patient is on this bladder neck, prostate, prostatic capsule, prostatic urethra, and drug if patient leading tois going to have cataract surgery; increased risk the relaxation of the bladder and prostate and improving of intraoperative floppy iris syndrome may require flow of urine in cases of BPH additional surgical intervention. Indications Teaching pointsTreatment of the signs and symptoms of BPH Take this drug exactly as prescribed, once a day. Contraindications and cautions Do not chew, crush, or open capsules; capsules must be Contraindicated with hypersensitivity to swallowed prostate cancer, when beginning therapy; the tamsulosin,whole. Use care pregnancy, lactation. chance of cautiously with hypotension. Use dizziness or syncope is greatest at that time. AvailableChange position slowly to avoid increased dizziness. forms Take the Capsules0.4 mg drug 30 minutes after the same meal each day. Tell your surgeon that you are taking this drug if you are considering cataract Metabolism: Hepatic; T1/2: 915 hr surgery. You may experience these side effects: Dizziness, Distribution: May cross placenta; enters breast milk weakness (more Excretion: Feces, urine likely when you change position, in the early Adverse effectsmorning, after exercise, in hot weather, and when you have consumed alcohol; some tolerance may occur CNS: Somnolence, insomnia after you have taken the drug for asyncopeavoid driving CV: Orthostatic hypotension, while; or engaging in tasks that require alertness; change GI: Nausea, dyspepsia position slowly, use caution in climbing stairs, lielibido, GU: Abnormal ejaculation, decreased down if dizziness persists); GI upset (eat frequent small meals); increased urinary frequency impotence (discuss this with your health care provider); Other: Cough, sinusitis, rhinitis, increased risk of stuffy nose. floppy iris sydrome with cataractdisappear intraoperative Most of these effects will surgery gradually with continued therapy. Interactions Report frequent dizziness or fainting, worsening of Drug-drug symptoms. Increased hypotensive effects with other alphaadrenergic antagonists

Risk of increased toxic effects of cimetidine Nursing considerations CLINICAL ALERT! Name confusion has occurred between Fosamax (alendronate) and Flomax (tamsulosin); use caution. Assessment History: Allergy to tamsulosin; pregnancy, lactation; prostatic cancer, hypotension Physical: Body weight; skin color, lesions; orientation, affect, reflexes; ophthalmologic examination; P, BP, orthostatic BP; R, adventitious sounds, status of nasal mucous membranes; voiding pattern, normal output, urinalysis Interventions Ensure that patient does not have prostatic cancer before beginning treatment. Administer once a day, 30 min after the same meal each day. Resume therapy at 0.4 mg daily if therapy is interrupted for any reason. Ensure that patient does not crush, chew, or open capsule. Capsule should be swallowed whole. temazepam Monitor patient carefully for orthostatic hypotension; chance of orthostatic hypotension, Apo-Temazepam (CAN), Novo-Temazepam (CAN), Restoril dose. dizziness, and syncope is high with the first Establish safety precautions as appropriate. Drug classes

Benzodiazepine Hematologic: Decreased Hct (primarily with longSedative-hypnotic term therapy), Therapeutic actions blood dyscrasias Other: action fever, diaphoresis, paresthesias, Exact mechanisms of Hiccups,not understood; acts mainly at muscular of the CNS, leaving the subcortical levels disturbances, gynecomastia cortex relatively Interactions unaffected; main sites of action may be the limbic system and Drug-drug mesencephalic reticular formation; benzodiazepines potentiate the Increased CNS depression with effects of GABA, an inhibitory neurotransmitter. alcohol and other CNS Indications depressants (eg, barbiturates, opioids) Decreased sedative by difficulty theophylline, Insomnia characterized effects with falling asleep, aminophylline, dyphylline, oxitriphylline early morning frequent nocturnal awakenings, or Nursing considerations awakening Assessment Recurring insomnia or poor sleeping habits History: chronic medical situations requiring Acute or Hypersensitivity to benzodiazepines; psychoses; acute narrow-angle glaucoma; shock, coma; restful sleep acute alcoholic intoxication; pregnancy, lactation, Contraindications and cautions impairedContraindicatedkidney function, debilitation, liver or with hypersensitivity to depression, suicidal tendencies benzodiazepines, psychoses, acute narrow-angle Physical: Skin color, lesions; T; orientation, glaucoma, shock, coma, acute alcoholic intoxication with reflexes, affect, ophthalmologic examination; congenital depression of vital signs, pregnancy (risk of P, BP; R, adventitious sounds; liver evaluation, abdominal malformations, neonatal withdrawal syndrome), labor examination, bowel sounds, normal output; CBC, LFTs, and delivery ("floppy infant" syndrome), lactation renal function tests lethargic and lose weight). (infants may become Use cautiously with impaired liver or kidney Interventions function, debilitation, depression, suicidal tendencies. WARNING: Taper dosage gradually after longAvailable forms term therapy, especially in patients with epilepsy to Capsules7.5, 15, 22.5, 30 mg prevent refractory seizures.

Metabolism: Hepatic; T1/2: 1020 hr Caution patient to avoid pregnancy while taking Distribution: Crosses placenta; enters breast milk this drug; Excretion: Urine advise patient to use barrier contraceptives. Prolonged therapy is generally not recommended. Adverse effects Teaching points CNS: Transient, mild drowsiness initially; Take drug exactly as prescribed. sedation, depression, lethargy, apathy, fatigue, light During disorientation, restlessness, confusion, headedness, long-term therapy, do not stop taking this drug without consulting your health care provider. crying, delirium, headache, slurred speech, dysarthria, Avoid pregnancy while taking this drug; serious stupor, rigidity, tremor, dystonia, vertigo, euphoria, fetal harm could occur. Using contraceptive measures is nervousness, difficulty concentrating, vivid dreams, advised. psychomotor retardation, extrapyramidal symptoms, mild Nocturnal sleep may be disturbed for several wk of paradoxical excitatory reactions during first 2 nights after discontinuing thein psychiatric patients, aggressive treatment (especially drug. You with experience children, and may high dosage), these side auditory visual and effects: Drowsiness, dizziness (may lessen;depressed hearing, disturbances, diplopia, nystagmus, avoid driving or engaging in other dangerous activities); GI upset (take nasal congestion drug with water); depression, dreams, emotional upset, CV: Bradycardia, tachycardia, CV collapse, crying. hypertension and hypotension, palpitations, edema Report severe dizziness, weakness, drowsiness that Dependence: Drug dependence with withdrawal persists, rash or drug lesions, palpitations, swelling of the syndrome when skin is discontinued extremities, visual changes, difficulty voiding.dermatitis Dermatologic: Urticaria, pruritus, rash, GI: Constipation, diarrhea, dry mouth, salivation, nausea, anorexia, vomiting, difficulty in swallowing, gastric disorders, elevations of blood enzymes; hepatic terazosin dysfunction, jaundice hydrochloride Hytrin GU: Incontinence, urinary retention, changes in libido, menstrual irregularities Drug classes Antihypertensive

Alpha1-adrenergic blocker WARNING: Administer or have patient take first Therapeutic actions dose just postsynaptic lessen likelihood first dose Selectively blocksbefore bedtime to alpha1-adrenergic of receptors, effect, syncope, believed due to excessive arterioles decreasing sympathetic tone on the vasculature, dilatingorthostatic hypotension. and veins, and lowering supine and standing BP; unlike WARNING: Have patient lie down, and treat conventional alpha-adrenergic blocking agents (eg, phentolamine), supportively if syncope occurs; receptors, does not cause it does not also block alpha2 presynaptic condition is self-limiting. Monitor patient for orthostatic by blocking which reflex tachycardia. Relaxes the smooth muscle hypotension,alpha1is most marked in bladder neck is accentuated by hot adrenergic receptors in thethe morning, andand prostate thereby improvingweather, alcohol, exercise. the symptoms of BPH. Monitor edema, weight in patients with incipient Indications cardiac decompensation, and add a thiazide diuretic to Treatment of symptomatic BPH the Treatment of sodium and fluid or in combination drug regimen ifhypertension alone retention, signs of impending CHF, with other drugs occur. Teachingpoints Unlabeled use: Symptomatic treatment of chronic Take this drug abacterial prostatitis exactly as prescribed. Take the first dose just before bedtime. Do not drive or operate Contraindications and cautions machinery for 4 hours after the first dose. to terazosin, Contraindicated with hypersensitivity during may experience these side effects: Dizziness, and You lactation. weakness (more likely to occur when taking change you Use cautiously in patients other position, in the early morning, after exercise, in hot antihypertensives, CHF, renal failure, pregnancy. Availableweather, and with alcohol use; some tolerance may occur forms after 5, 10 the Capsules1, 2,taking mg drug for a while, but avoid driving or engaging in tasks : 12 hr Metabolism: Unknown; T1/2that require alertness; change position slowly; use placenta; may enter breast milk Distribution: Crossescaution when climbing stairs; lie down for a while if dizziness Excretion: Feces and urine persists); GI upset (eat frequent small meals); Adverse effects impotence; dry mouth (suck on sugarless lozenges or ice chips); stuffy nose. Most effects will gradually disappear.

CNS: Dizziness, headache, drowsiness, lack of Report frequent dizziness or nervousness, vertigo, energy, weakness, somnolence, faintness. depression, paresthesia CV: Palpitations, sodium and water retention, increased plasma volume, edema, syncope, tachycardia, orthostatic hypotension, angina Dermatologic: Rash, pruritus, alopecia EENT: Blurred vision, reddened sclera, epistaxis, tinnitus, dry mouth, nasal congestion GI: Nausea, vomiting, diarrhea, constipation, abdominal discomfort or pain GU: Urinary frequency, incontinence, impotence, priapism Respiratory: Dyspnea, nasal congestion, sinusitis Other: Diaphoresis Nursing considerations Assessment History: Hypersensitivity to terazosin; CHF; renal failure; pregnancy, lactation Physical: Weight; skin color, lesions; orientation, affect, reflexes; ophthalmologic examination; P, BP, orthostatic BP, supine BP, perfusion, edema, auscultation; R, adventitious sounds, status of nasal mucous membranes; bowel sounds, normal output; voiding pattern, urinary output; renal function tests, urinalysis tetracycline hydrochloride Interventions Apo-Tetra (CAN), Nu-Tetra (CAN), Sumycin

Drug classes Drug-drug Antibiotic Decreased absorption with calcium salts, Tetracycline magnesium Therapeutic actions salts, zinc salts, aluminum salts, bismuth salts, iron, urinary synthesis Bacteriostatic: Inhibits proteinalkalinizers,offood, dairy products, susceptible bacteria, charcoal preventing cell replication. Indications Increased digoxin toxicity Increased Systemic administration nephrotoxicity with methoxyflurane Decreased effectiveness of hormonal Infections caused by rickettsiae; Mycoplasma contraceptives, although rare, has been reported with a pneumoniae; agents of psittacosis, ornithosis, risk of breakthrough bleeding or pregnancy lymphogranuloma venereum and granuloma inguinale; Decreased activity of penicillins Borrelia recurrentis, Haemophilus ducreyi, Yersinia Nursing considerations pestis, Yersinia tularensis, Bartonella bacilliformis, Assessment Bacteroides, Vibrio cholerae, Campylobacter fetus, History: Systemic coli, Enterobacter aerogenes, Brucella, Escherichia administration and dermatologic solutions: Allergy to any of the tetracyclines; hepatic or Shigella, Acinetobacter calcoaceticus, Haemophilus renal dysfunction, pregnancy, lactation. influenzae, Klebsiella, trachoma Physical: Systemic administration, topical When penicillin is contraindicated, infections dermatologic solutions: Site of Treponema pallidum, caused by Neisseria gonorrhoeae, infection, skin color, lesions; R, sounds, output, Treponema adventitious sounds; bowel monocytogenes, pertenue, Listeria liver evaluation;Bacillus urinalysis, anthracis, BUN, LFTs, Fusobacterium renal function Clostridium, tests. Dermatologic ointment: Site of infection. fusiforme, Actinomyces Interventions Adjunct to amebicides in acute intestinal amebiasis Administer oral medicationendocervical or rectal Uncomplicated urethral, on an empty stomach, 1 hr before or 23 hr after meals. Do not give with infections in adults caused by Chlamydia trachomatis antacids. If antacids must be used, acne them 3 hr after Adjunctive therapy for severe give the dose and cautions Contraindicationsof tetracycline. Culture and dermatologic solution Systemic administrationinfection before beginning drug therapy.

Contraindicated with allergy to any of the Do not pregnancy (toxic to the fetus); is toxic tetracyclines; administer during pregnancy; druglactation to the fetus. (causes damage to the teeth of infant). WARNING: Do not use outdated drugs; degraded Available forms drug is highly oral suspension125 not be used. Capsules250, 500 mg;nephrotoxic and shouldmg/5 mL Arrange for regular renal function tests with longterm 1/2: 612 Metabolism: Ttherapy. hr Teaching points Distribution: Crosses placenta; enters breast milk Take the Excretion: Feces, urine drug throughout the day for best results. The drug should be taken on an empty stomach, 1 hour Adverse effects before or 23 Systemic administration hours after meals, with a full glass of water. Do not take the drug with food, dairy products, Dermatologic: Phototoxic reactions, rash, iron preparations, or exfoliative dermatitisantacids. Finish your complete inadequate calcification of GI: Discoloring and prescription; if any is left, discard it immediately. used primary teeth of fetus if Never bytake an outdated pregnant women, tetracycline and inadequate calcification of permanent discoloring product. There during period of of pregnancy occurring teeth if used have been reportsdental development, fatty when taking tetracycline with hormonal contraceptives. liver, liver failure, anorexia, nausea, vomiting, diarrhea, To be certain of avoiding pregnancy, use an additional glossitis, dysphagia, enterocolitis, esophageal ulcers type of contraceptive. Hematologic: Hemolytic anemia, This drug should not be used during pregnancy; thrombocytopenia, neutropenia, eosinophilia, using barrier leukopenia leukocytosis, contraceptives is advised. You may experience these sidefrom urticaria to Hypersensitivity: Reactions effects: Stomach upset, nausea (reversible); superinfections in the anaphylaxis, including intracranial hypertension mouth, vagina Other: Superinfections, help this irritation at (frequent washing may local problem; if severe, request medication); sensitivity of the skin to parenteral injection sites sunlight (use protective clothing and a sunscreen). Interactions

 Report severe cramps, watery diarrhea, rash or Use cautiously with dark urine itching, difficulty breathing, diabetes ororthyrotoxicosis light-colored (timolol can mask the usual stools, yellowing of the skin or eyes. cardiac signs of hypoglycemia and thyrotoxicosis). Available forms Tablets5, 10, 20 mg; ophthalmic solution, gel0.25%, 0.5% Metabolism: Hepatic; T1/2: 34 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine Adverse effects Oral Allergic reactions: Pharyngitis, erythematous rash, fever, sore throat, laryngospasm, respiratory distress CNS: Dizziness, vertigo, tinnitus, fatigue, emotional depression, paresthesias, sleep disturbances, hallucinations, disorientation, memory loss, slurred speech CV: CHF, cardiac arrhythmias, sinoatrial or AV nodal block, peripheral vascular insufficiency, claudication, CVA, pulmonary edema, hypotension Dermatologic: Rash, pruritus, sweating, dry skin EENT: Eye irritation, dry eyes, conjunctivitis, blurred vision GI: Gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, anorexia, ischemic colitis, renal and mesenteric arterial thrombosis, retroperitoneal timolol maleate fibrosis, hepatomegaly, acute Timoptic, Apo-Timol (CAN), Betimol, Blocadren,pancreatitisTimoptic-XE GU: Impotence, decreased libido, Peyronie's disease, dysuria, nocturia, frequent urination

Drug classes Beta-adrenergic Musculoskeletal: Joint pain, arthralgia, muscle blocker cramp Antihypertensive Respiratory: Bronchospasm, dyspnea, cough, Antiglaucoma drug bronchial Therapeutic actions obstruction, nasal stuffiness, rhinitis, pharyngitis beta-adrenergic receptors in the Competitively blocks(less likely than with propranolol) heart and juxtaglomerularOther: Decreased exercise the influence of the apparatus, decreasing tolerance, development of antinuclear antibodies tissues hyperglycemia or sympathetic nervous system on these (ANA), and decreasing the hypoglycemia, decreasing cardiac output excitability of the heart,elevated serum transaminase and oxygen Ophthalmic consumption, decreasing the release of renin, and lowering BP; Local: Ocular irritation, decreased corneal reduces IOP by decreasing the production of aqueous humor and sensitivity, visual refractive outflow. possibly by increasing aqueous humor changes, diplopia, ptosi Interactions Indications Drug-drug Hypertension, used alone or in combination with other Increased effects with verapamil antihypertensives, especially thiazide-type diuretics Increased of reinfarction in MI patients who are Prevention risk of orthostatic hypotension with prazosin hemodynamically stable Decreased of migraine Prophylaxisantihypertensive effects with NSAIDs, clonidine Ophthalmic solution: Reduction of IOP in chronic Decreased elimination of theophyllines with open-angle glaucoma, some patients with secondary resultant glaucoma,decrease in patients with glaucoma ocular aphakic expected actions of both drugs when taken concurrently hypertension Peripheral ischemia and possible gangrene with Contraindications and cautions ergotamine, methysergide, dihydroergotamine (HR < 45 Contraindicated with sinus bradycardia Increased risk or third-degree heart block (PR beats/min), second- of hypoglycemia and masked signs of hypoglycemia with cardiogenic shock, CHF, asthma, interval > 0.24 sec), insulin Hypertension followed COPD, pregnancy, lactation. by severe bradycardia with epinephrine

 All of the above may occur with ophthalmic Drug class timolol; in addition, additive effects are possible with Antimuscarinic oral beta-blockers Therapeutic actions Drug-lab test Competitively Possible false results receptor sites;or bladder blocks muscarinic with glucose insulin contraction is mediated (oral) tolerance tests by muscarinic receptorsblocking these receptors considerations contraction. Nursing decreases bladder Indications Assessment Treatment Sinus bradycardia, second- or thirdHistory: of overactive bladder in patients with symptoms of block, cardiogenic shock, CHF, asthma, degree heart urinary frequency, urgency, or incontinence Contraindications and cautions COPD, pregnancy, lactation, diabetes or thyrotoxicosis Contraindicated with urinary retention, Physical: Weight, skin condition, neurologic uncontrolled ECG, respiratory status, gastric retention, status, P, BP, narrow-angle glaucoma, renal and thyroid allergy to the drug or any of its components. function, blood and urine glucose Use cautiously with renal or hepatic impairment, pregnancy, lactation. Interventions Available forms WARNING: Do not discontinue drug abruptly Tablets1, 2 mg; ER capsules2, 4 mg (hypersensitivity after long-term therapy to catecholamines may have developed, causing Metabolism: Hepatic; T1/2: 1.93.7 hrand ventricular arrhythmias). exacerbation of angina, MI, Distribution: Crosses placenta;over 2 wk with monitoring. Taper drug gradually enters breast milk Excretion: Urine Consult with surgeon about withdrawal if patient is to undergo surgery (withdrawal is controversial). Adverse effects Teaching points CNS: Blurred vision, headache, dizziness, somnolence stop taking this drug unless instructed to do Do not so by Dermatologic: Pruritus, rash, erythema, dry skin your health care provider. GI: Nausea, vomiting, constipation, dyspepsia, flatulence, dry mouth, abdominal pain

Avoid driving or dangerous activities if dizziness GU: occurs. or shaking Dysuria, urinary retention; impotence, UTIs Other: Weight gain, form, fatigue, acute myopia If using ophthalmic pain, administer eye drops and secondary angle closure glaucoma properly to minimize systemic absorption. (pain, visual changes, redness, increased IOP) night cough, swelling Report difficulty breathing, Interactions extremities, slow pulse, confusion, depression, rash, of Drug-drug fever, sore throat. Risk of increased serum levels and toxicity if given with drugs that inhibit CYP450 2D6 (such as fluoxetine); reduce dose to 1 mg PO bid (2 mg daily ER capsules) Nursing considerations Assessment History: Presence of urinary retention; uncontrolled narrow-angle glaucoma; allergy to the drug or any of its components; renal or hepatic impairment; pregnancy, lactation Physical: Bowel sounds, normal output; normal urinary output, prostate palpation; IOP, vision; LFTs; renal function tests; skin color, lesions, texture; weight Interventions Provide small, frequent meals if GI upset is severe. Provide frequent mouth hygiene or skin care if dry mouth or skin occur. Arrange for safety precautions if blurred vision occurs. Monitor bowel function and arrange for bowel tolterodine tartrate program Detrol, Detrol LA if constipation occurs. Teaching points

 Take drug exactly as prescribed. Tablets25, 50, 100, 200 mg; sprinkle capsules15, 25 mg You may experience these side effects: Metabolism: Hepatic; (ensure hr Constipation T1/2: 21 adequate fluid intake, proper diet, Distribution: Crosses placenta; care provider if this becomes a consult your health enters breast milk Excretion: Urine dry mouth (suck sugarless lozenges, practice problem); Removedfrequent mouth care; this effect sometimes lessens over by hemodialysis: Supplemental dose may be needed. Adverse effects blurred vision (it may help to know that these are time); CNS: Ataxia, go away when you discontinue the drug effects that will somnolence, dizziness, nystagmus, nervousness, anxiety, tremor, vision); difficulty in drug; avoid tasks that require acutespeech impairment, paresthesias, confusion, depression urination (it may help to empty the bladder immediately GI: Nausea, dose of drug). before taking each dyspepsia, anorexia, vomiting GU: Dysmenorrhea Report rash, flushing, eye pain, difficulty Hematologic: loss of breathing, tremors,Leukopenia coordination, irregular Respiratory: URI, pharyngitis, sinusitis heartbeat, palpitations, headache, abdominal distention. Other: Fatigue, rash, acute myopia and secondary angle-closure glaucoma (pain, visual disturbances, pupil dilation, redness, increased IOP), weight loss Interactions Drug-drug Increased CNS depression if taken with alcohol or CNS depressants; use extreme caution Increased risk of renal stone development with carbonic anhydrase inhibitors Decreased effects of hormonal contraceptives with topiramate; suggest use of barrier contraceptives instead topiramate Decreased serum levels if combined with Topamax phenytoin, carbamazepine Nursing considerations Drug class CLINICAL ALERT!

Antiepileptic Name confusion has Therapeutic actions occurred between Topamax and Toprol-XL (metoprolol); use caution. Mechanism of action not understood; antiepileptic effects may be due to the actions of blocking sodium channels in neurons with Assessment sustained depolarization; increasing GABA activity at receptors, History: Hypersensitivity to neurotransmitter; the thus potentiating the effects of this inhibitoryany component of and drug; pregnancy, lactation; renal or receptor sites. blocking excitatory neurotransmitters at neuronhepatic impairment; renal Indications stones Physical: Skin the treatment orientation, 10 yr Monotherapy forcolor, lesions; of patients >affect, reflexes, vision examination; R, adventitious sounds; with partial onset or primary generalized tonic-clonic LFTs, renal function tests seizures. Interventions Adjunctive therapy for partial-onset seizure WARNING: children 216 yr treatment in adults andReduce dosage; discontinue or substitute other therapy for seizures associated with antiepileptic gradually; abrupt Adjunctive discontinuation may precipitate status epilepticus.> 2 yr Lennox-Gastaut syndrome in adults and children WARNING: Stop the drug immediately and Adjunctive therapy for primary generalized tonicarrange for appropriate consultations at first sign of clonic seizures in adults and children 216 yr blurred vision, periorbital edema, or redness. Prophylaxis of migraine headaches in adults Administer with foodCluster headaches, infantile Unlabeled uses: if GI upset occurs. Caution dependence, chew nervosa, tablets spasms, alcoholpatient not to bulimia or break weight because of bitter taste. loss Have patient swallow sprinkle capsules whole or Contraindications and cautions by carefully opening capsule and sprinkling onto a soft Contraindicated with hypersensitivity to any food. Swallow this immediately; do not allow it to be component of the drug. chewed. cautiously with pregnancy (use only if benefits Use Encourage patients to fetus), lactation, renal or outweigh potential risks with a history of renal stone development to maintain adequate fluid intake while hepatic impairment, renal stones Availableusing this drug. forms

Suggest using barrier contraceptives to patients

y y y y

Drug classes taking this drug. Antisecretory agent Arrange for consultation with appropriate epilepsy Proton pump inhibitor

Report fatigue, vision changes, speech problems, CNS: Headache, dizziness, asthenia, vertigo, insomnia, apathy, personality changes.
anxiety, paresthesias, dream abnormalities Dermatologic: Rash, inflammation, urticaria, pruritus, alopecia, dry skin GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy, flatulence Respiratory: URI symptoms, sinusitis, cough, epistaxis

support groups as needed.

Teaching points Therapeutic actions Take this suppresses gastric acid secretion not break Gastric acid-pump inhibitor: drug exactly as prescribed. Do by specific inhibition or chew tablets; they haveATPase enzyme taste. Sprinkle of the hydrogenpotassium a very bitter system at the capsule the gastric parietal cells; blocks the using sprinkle secretory surface of may also be swallowed whole. Iffinal step of acid production;capsules, open carefully and sprinkle onto soft food and is broken down less in the first pass through the liver than the parent compound omeprazole, allowing notincreased serum levels. swallow immediately; do for chew.
Indications dosage except on the advice of your health care provider. y Gastroesophageal reflux diseasetreatment of heartburn and Arrange for frequent check-ups to monitor your other related symptoms response to this drug. It is very important that you keep y Erosive esophagitisshort-term (48 wk) treatment for healing all symptom relief; also used andappointments for check-ups. for maintenance therapy Wear a medical alert bracelet following healing of erosive esophagitis at all times so that any emergency medical personnel treatment of duodenal y As part of combination therapy for the will know that you ulcer associated and are taking antiepileptic medication. have epilepsy with Helicobacter pylori

Do not discontinue this drug abruptly or change

Interactions Drug-drug y Increased serum levels and potential increase in toxicity of benzodiazepines and phenytoin when taken concurrently y May interfere with absorption of drugs dependent upon presence of acidic environment (eg ketoconazole, iron salts, digoxin) Nursing considerations CLINICAL ALERT! Potential for name confusion exists between esomeprazole and omeprazole; use caution. Assessment y History: Hypersensitivity to any proton pump inhibitor; hepatic dysfunction; pregnancy, lactation y Physical: Skin lesions; body temperature; reflexes, affect; urinary output, abdominal exam; respiratory auscultation, liver function tests Generic name: esomeprazole magnesium Interventions Trade name: Nexium

Avoid using alcohol while you are taking this drug;

Contraindications and cautions serious sedation could occur. y Contraindicated may experience these toside effects: with hypersensitivity omeprazole, You esomeprazole, or other proton pump inhibitor. Drowsiness, dizziness, sleepiness (avoid driving or y Use cautiously with hepatic dysfunction, pregnancy, lactation.

performing other tasks that require alertness; symptoms may occur initially but usually disappear with continued therapy); T1/2: 11.5 hr Metabolism: Hepatic; vision changes (avoid performing tasks that require visual acuity); enter breast milk Distribution: Crosses placenta; may GI upset (take drug with food; eat Excretion: frequent small meals). Urine and bile
Adverse effects

Arrange for further evaluation of patient after 4 wk of therapy

health care provider if these become bothersome, medications may be available to help); nausea, vomiting, diarrhea (proper Contraindications: anuria, hypersensitivity to other nutrition is important, consult with your dietitian to maintain sulphonamide-devised drugs. Intravascular volume nutrition; ensure ready access to bathroom facilities); symptoms depletion. Sever renal or hepatic impairment. Pregnancy, of upper respiratory tract infection, cough (it may help to know lactation that this is a drug effect, do not self-medicate, consult with your Form: tab 30s care provider if this becomes uncomfortable). health Nursing Responsibilities: y Report severe headache, worsening of symptoms, fever, chills,  darkening of the systemic hypertension and stool. Observe for skin, changes in color of urine or tachycardia especially in patients with CHF, hyponatremia, high dose diuretics ore severe volume depletion.  Monitor BP in supine position, electrolytes, urinalysis and CBC.

for gastroesophageal reflux disorders. Symptomatic Indications: Hypertension improvement does not rule out gastric cancer. Drug Classification: Antihypertensive y If of Action: antacids, they may be administered Mechanism administering As a selective and competitive, nonconcomitantly with esomeprazole. peptide angiotensin II receptor antagonist, Losartan y Ensure that the vasoconstrictor capsulealdosterone-secreting blocks the patient swallows and whole; do not crush, or chew; patients having difficulty swallowing may open capsule effects of angiotensin II; Losartan interacts reversibly at and sprinkle in applesauce; do not crush or chew pellets. the AT1 and liver receptors of many tissues and has y Obtain baseline AT2 function tests and monitor periodically slow dissociation kinetics; its affinity for the AT1 during therapy. receptors is 1000 greater appropriate for receptor. y Maintain supportive treatment asthan the At2 underlying Angiotensin II receptor antagonists may induce a more problem. complete inhibition of measures to alleviate discomfort y Provide additional comfort the rennin-angiotensin system from GI effects and headache. do not affect the response to than ACE inhibitors, they y Establish safety precautions if dizziness or other CNS effects brdykinin, and are less likely ti be associated with nonoccur (use side rails, accompanyLosartan increases urinary renin-angiotensin effects. patient). flow rate and in addition to being natriuretic and Teaching points kaliuretic, increases excretion of chloride, magnesium, y Take the drug at least 1 hr before meals. Swallow the capsules uric acid, calcium and phosphate whole; do not chew or crush. If you cannot swallow the capsule, Dosage: 1 tab once a day, may increase applesauce or mixed2intabs it can be opened and sprinkled in to a maximum of tap daily water, orange or apple juice, or yogurt; do not crush or chew the Special pellets. This drug hypotensionbe taken for 48 wk, at which Precautions: will need to and electrolyte/ fluid time your condition willadjustments of antidiabetic agents imbalance. Dosage be reevaluated. y Arrange to have regular medical SLE and insulin may be required, follow-up while you are using this drug. Pregnancy Risk Category: C (first trimester) D ( second y trimester) Maintain all of the usual activities and restrictions that apply to Adverse your condition. If this becomes difficult, consult with your nurse reaction: dizziness, angioedema, diarrhea, or physician. hypersensitivity may occur: Dizziness (avoid driving a car or reaction, hyperuracemia and or gout, y These side effects increase hazardous tasks); TG levels, cough, your performing in cholesterol or headaches (consult withrarely hepatitis.

Generic Name: Losartan Potassium Brand Name: Lifezar

Generic name: omeprazole o Physical: Skin lesions; Brand name: Losec (CAN), Prilosec, Zegerid T; reflexes, affect; urinary Proton abdominal examination; Drug classes: Antisecretory agentoutput, pump inhibitor respiratory auscultation Therapeutic actions Gastric acid-pump inhibitor: Suppresses gastric acid secretion by Interventions specific inhibition of the hydrogen-potassium ATPase enzyme  Administer before meals. Caution patient to system at the secretory surface of the gastric parietal cells; blocks the final step of acidswallow capsules wholenot to open, chew, production. or crush them. If using oral suspension, empty Indications packet into of active duodenal ulcer  Short-term treatment a small cup containing 2 tbsp of water. Stir in treatment of immediately;  First-line therapy and have patient drinkheartburn or fill cup with symptoms of GERD water and have patient drink this water. Do not use any benign gastric  Short-term treatment of active other diluent. ulcer  severe erosive esophagitis, poorly responsive  GERD, WARNING: Arrange for further evaluation of patient after 8 wk of therapy symptomatic GERD for therapy: Treatment  Long-term gastroreflux disorders; notof intended for pathologic maintenance therapy. Symptomatic hypersecretory conditions (Zollinger-Ellison syndrome, multipleimprovement does not rule out gastric cancer, adenomas, systemic mastocytosis) which did occur in preclinical studies.  Eradication of Helicobacter pylori with amoxicillin  Administer antacids, if needed. or metronidazole and clarithromycin  Prilosec OTC: Treatment of frequent heartburn (2 or Teaching points days per week) more o Take Posterior laryngitis; enhance efficacy  Unlabeled use:the drug before meals. Swallow the capsules whole; do not chew, open, or crush of pancreatin for the treatment of steatorrhea in cystic fibrosis them. If using the oral suspension, empty packet into Contraindications and cautions a small cup containing 2 tablespoons Stir and drink  Contraindicated of water. with hypersensitivity immediately; fill cup with water and drink this to omeprazole or its components. water. Do not use any other liquid or food to

 Use cautiously with pregnancy, lactation. dissolve the packet. This drug will need to be Metabolism: Hepatic; T1/2: 0.51 hr taken for up to 8 enter breast milk Distribution: Crosses placenta; may weeks (short-term therapy) or for Excretion: Bile, urine a prolonged period (> 5 years in some cases). Adverse effects o Have regular medical follow-up visits.  CNS: Headache, dizziness, asthenia, vertigo, insomnia, o You may experience abnormalities apathy, anxiety, paresthesias, dream these side effects: Dizziness  Dermatologic: Rash, (avoid driving urticaria, pruritus, inflammation, or performing hazardous tasks); headache (request alopecia, dry skin medications); nausea, vomiting, diarrhea  GI: Diarrhea, abdominal pain, nausea, vomiting, (maintain proper mouth, tongue atrophy upper constipation, dry nutrition); symptoms of respiratory tract infection, cough (do  Respiratory: URI symptoms, cough, epistaxis not selfmedicate; consult with your health  Other: Cancer in preclinical studies, back pain, fevercare provider if uncomfortable). Interactions o Report severe headache, worsening of symptoms, fever, chills. Drug-drug o WARNING: Increased serum levels and potential increase in toxicity of benzodiazepines, phenytoin, warfarin; if these combinations are used, monitor patient very closely o Decreased absorption with sucralfate; give these drugs at least 30 min apart Nursing considerations Assessment o History: Hypersensitivity to omeprazole or any of its components; pregnancy, lactation

Generic name: Spironolactone Genericname: Aldactone (folate) Brand name: folic acid Brand name: Folvite Indication: management of edema associated with excessive Drug class aldosterone excretion, hypertension, primary Folic acidhyperaldosteronism, hypokalemia, treatment of Vitamin supplement cirrhosis of liver accompanied by edema or hirsutism, Therapeutic actions ascites Required for nucleoprotein synthesis diuretic, potassium Drug classification: anti-hypertensive agent, and maintenence of normal sparing erythropoiesis. Indications Mechanism of action: competes with aldosterone for receptor Treatment of megoblastic anemias due sites in the distal renal tubules, increasing to sprue, sodium nutritional deficiency, pregnancy, infancy, and childhood chloride and water excretion while conserving potassium Contraindications and cautions block the effect of aldosterone and hydrogen ions, may onContraindicated with allergy well arteriolar smooth muscle as to folic acid preparations; pernicious, aplastic, normocytic anemias. Dosage: essential hypertension Adult Use cautiously during lactation. may be gradually 50-100mg/day. Severe case: Metabolism: Hepatic; T1/2intervals up to 200mg/day increased at 2weekly : Unknown Distribution: Crosses placenta; enters breast milk Edematous disorders Excretion: Urine Total daily dose may be given either in divided doses or IV facts as single daily dose. CHF adult 100mg/day. Maintenance: 25-200mg/day. Cirrhosis urinary Na+/K+ Preparation: Solution is yellow to yellow-orange; may be added ratio to hyperalimentation solution or dextrose solutions. Infusion: > 1:100 rate of 5 mg/min<1:200-400mh/day. Nephritic Infuse at mg/day, ratio by direct IV injection; may be syndrome 100-200mg/day. Edema in children initially diluted in hyperalimentation for continuous infusion. 3mg/kg Adverse effects body wt daily in divided dose, reduced to 12mg/kg for maintenance therapy. Malignant Hypersensitivity: Allergic reactions hypertension adjunctive therapy, initially 100mg/day Local: Pain and discomfort at injection site increased as necessary at 2weekly intervals to

400mg/day. Hypokalemia/hypomagnesaemia 25-100mg Interactions Diagnosis and treatment of primary aldosteronism: daily. Drug-drug long test:400mg/day for 3-4 wks. Short test 400 mg/day Decrease for 4 days. in serum phenytoin and increase in seizure activity with folic acid use with other K-retaining drugs Special precaution: concomitantpreparations prDecreased K- supplements; impaired renal function;absorption lactation; with sulfasalazine, aminosalicyclic acid anaesthesia Nursing considerations Pregnancy risk factor D CLINICAL ALERT! Adverse reactions: gynecomastia; GI symptoms; drowsiness; Name confusion has been mental condusion; ataxia; lethargy; headache; reported between folinic acid (leucovorin) and folic acid; use extreme caution. post menopose impotence; menstrual irregularities; Assessment bleedidng; rarely agranulocytosis; usticaria; fever; History: acute acid preparations; Contraindications: Allergy to folicinsufficiency, renal anuria, pernicious, aplastic, normocytic anemias; lactation hyperkalemia. pregnancy Physical: Skin lesions, color; R, x 100s Form: tab 25mg x 100s, 50mg x 100s; 100mg adventitious sounds; CBC, Hgb, Hct, Nursing responsibilities: serum folate levels, serum vitamin B12 levels, Schilling avoid hazardous activity such as  Educate patient to test Interventions driving until response to drug is known. Take with meals orAdminister orally if at ingestion of food high in milk; avoid excessive all possible. With severe GI malabsorption or very severe disease, give IM, IV, or potassium or use of salt substitutes subcutaneously.  Diuretic effect may be delayed 2-3 days and maximum Test using may be delayed 2-3weeks; monitor I levels hypertensive Schilling test and serum vitamin B12 and O to rule out pernicious anemia. Therapy may mask Na) ratios and daily weight, BP, serum electrolytes (K,signs of pernicious anemia while the neurologic deterioration and renal function continues. WARNING: Use caution when giving the parenteral preparations to premature infants. These preparations contain benzyl alcohol and may produce a fatal gasping syndrome in premature infants.

WARNING: Monitor patient for hypersensitivity 1 sachet especially if drug previously taken. Keep reactions, of Acetylcysteine 200 mg or 2 sachets of Acetylcysteine supportive equipment and emergency drugs readily 100 mg, 2-3case ofaserious allergic response. available in times day Teaching 1 Acetylcysteine 600 mg effervescent tablet daily ( points preferably in cause of megaloblastic anemia is treated or When the the evening) For the prevention of exacerbation, no use of passes (infancy, pregnancy), there may be the need for FLUIMUCIL 200 mg sachets is recommended. folic acid because it normally exists in sufficient Children: quantities in the diet. Aged up to 2 years: 1 sachet of 200 paindaily or 2 sachets Report rash, difficulty breathing, mg or discomfort at of 100 mg daily. injection site. 3-7 years: 1 sachet of 200 mg twice daily or 2 sachets of 100 mg twice a day. The duration of treatment should be 5-10 days in acute phase, whereas it may be continued in the chronic state for several months, according to the advise of physician. Special Precaution: Use with caution in patients > 60 years of age. Use with caution in patients with High blood pressure, ischemic heart disease, diabetes, increased intraocular pressure, GI or GU obstruction, asthma, thyroid disease, or prostatic hypertrophy. Not recommended for use in children. Pregnancy risk category B Adverse Effects: Hypersensitivity reactions have been reported in patients receiving acetylcysteine, including bronchospasm, angioedema, rashes and pruritus, may occur. Other adverse effects reported include nausea and vomiting, fever, syncope, sweating, arthralgia, blurred vision, disturbances of liver function. Contraindication: MAO inhibitor therapy within 14 days initiating therapy; severe hypertension; severe. Coronary artery

Generic name: Acetylcysteine disease,name: Fluimucil to pseudoedephrine, acrivastine or any Brand hypersensitivity component; renal impairment. Indication: Treatment of respiratory affections characterized by Form: and viscousSodium: 10%; 20% acute bronchitis, chronic thick Solution, as hypersecretions: Nursing Responsibilities: bronchitis and its exacerbations; pulmonary emphysema,  Monitor effectiveness mucoviscidosis and bronchiectasis. of therapy and advent of adverse/allergic effects. Instruct Mucolytic appropriate Drug Classification: Therapeutic category: patient in agent use and adverse Mechanism of Action: effects to report.  Exerts mucolytic action through its free sulfhydryl group which opens up the disulfide bonds in the mucoproteins thus lowering mucous viscosity. The exact mechanism of action in acetaminophen toxicity is unknown. It is thought to act by providing substrate for conjugation with the toxic metabolite.  A mucolytic agent or expectorant is any agent which dissolves thick mucus and is usually used to help relieve respiratory difficulties. It does so by hydrolyzing glycosaminoglycans, tending to break down/lower the viscosity of mucin-containing body secretions/components. The viscosity of mucous secretions in the lungs is dependent upon the concentrations of mucoprotein, the presence of disulfide bonds between these macromolecules and DNA.  acetylcysteine acts to reduce mucus viscosity by splitting disulfide bonds linking proteins present in the mucus (mucoproteins).  Dosage: Adults:

GENERIC NAME: lenalidomide, y Dexamethasone or a combination of Adriamycin (doxorubicin) and vincristine (VAD). In brain tumours BRAND NAME: (primary or metastatic), dexamethasone is used to y Decilone Forte counteract the CLASSIFICATION(S): development of edema, which could eventually compress other brain structures. y Cortecosteroids Dexamethasone is also given in cord compression where INDICATIONS: a tumor is compressing the spinal cord. responsive to y Inflammatory & allergic conditions Endocrine corticosteroid therapy eg skin diseases, collagen y Dexamethasone dyscrasia, certain neoplastic congenital diseases, blood can be used in the context of disease & adrenal hyperplasia, to prevent virilisation of a female adrenocortical insufficiency. fetus. OF ACTION: MECHANISM If one or both parents are carriers of mutations to the CYP21 (CYP21A2) gene, the motherthe normal may start y All agents suppress inflammation and dexamethasone treatment within 7 weeks of cortisol in immune response. Replace endogenous conception. At the 12th week, a chorionic villus sample will deficiency states. determine SPECIFIC MOA: whether the fetus is male (in which case the dexamethasone is stopped) or female. Subsequent DNA Anti-inflammatory analysis can then revealtowhether the inflammatory is a y Dexamethasone is used treat many female fetus and carrier of the mutation,suchwhich case dexamethasone autoimmune conditions, in as rheumatoid arthritis. treatment must continue until birth. The side-effects for y It is also given in small amounts (usually 5-6 the mother can be severe and the long-term impact on the tablets[citation needed]) before and/or after some forms child is not clear. of dental surgery, such as the extraction of the wisdom y In adrenal insufficiency and Addison's disease, teeth, an operation which often leaves the patient with dexamethasonecheeks. puffy, swollen is prescribed when the person doesn't respond well to prednisone or methylprednisone. y It is injected into the heel when treating plantar fasciitis, Obstetrics sometimes in conjunction with triamcinolone acetonide. y Dexamethasone may be given to women at risk of y It is useful to counteract allergic anaphylactic shock, if delivering prematurely in order to promote maturation of given in high doses. It is present in certain eye drops the fetus' lungs. This has been associated with low birth

particularly post-eye surgery drops and as a nasal spray weight, name Dexacort), and ear certain of neonatal (trade although not with increased rates ear drops death. (Sofradex, when combined with an antibiotic and an y High altitude illnesses antifungal). y Dexamethasone is used in the treatmentscrew-in altitude transvenous of high cardiac cerebralleads to minimize the inflammatory response of pacing edema as well as pulmonary edema. It is commonly carried on mountain climbing expeditionsthe the myocardium. The steroid is released into to help climbers as soon as the screw is extended and can myocardium deal with altitude sickness play a significant role in minimizing the acute pacing CONTRAINDICATIONS: reduction of inflammatory response. threshold due to the y Active untreated infections. in a lead tip is bisulfite, or The typical quantity present Known alcohol,less than 1.0 tartazine hypersensitivity or intolerance (some product mg. contain these is should be avoided in antibiotics y Dexamethasoneand often administered before susceptible patients. in cases of bacterial meningitis. It then acts to reduce the inflammatory response of the body to the bacteria killed SIDE EFFECTS: antibiotics (bacterial death releases proby the y Excessive mental stimulation, increase aappetite, muscle inflammatory mediators that can cause response which is harmful wt gain, tachycardia, insomnia & psychic twitching, to the patient), thus improving prognosis and outcome. disturbances. Oncologic uses NSG. RESPONSIBILITIES: In oncology, it should to cancer patients y Instruct patient itis givenbe taken with food. undergoing chemotherapy, cause immunosuppression and may their y Corticosteroids to counteract certain side-effects of mask antitumor treatment. Dexamethasone can augment the symptoms of infection. antiemetic effect avoid people with antagonists like y Instruct patient to of 5-HT3 receptorknown contagious ondansetron. Dexamethasone is also immediately. illnesses and to report possible infectionsused in certain hematological to notify health care professional of y Advise patientmalignancies, especially in the treatment of multiple myeloma, in which dexamethasone is given medication regimen before treatment. alone or together with thalidomide (thal-dex) or

Explain need for continued medical follow-up to assess contraction, and possible the redness, hyperthermia effectivenessthus reducing side-effects of medication. and edema that occurs during an inflammatory reaction. In addition, by blocking the H1 receptor on peripheral nociceptors, diphenhydramine decreases their sensitization and consequently reduces itching that is associated with an allergic reaction. This is why diphenhydramine is a popular choice for treatment of the symptoms of allergic rhinitis, hives, motion sickness, and insect bites and stings. y In the 1960s it was found that diphenhydramine inhibits reuptake of the neurotransmitter serotonin. This discovery led to a search for viable antidepressants with similar structures and fewer side effects, culminating in the invention of fluoxetine (Prozac), a selective serotonin reuptake inhibitor (SSRI). A similar search hadpreviously led to the synthesis of the first SSRI zimelidine from brompheniramine, also an antihistamine. y Diphenhydramine also acts as a sodium channel blocker, which is responsible for its actions as a local anesthetic. Adverse effect: sedation tiredness sleepiness dizziness disturbed coordination drying and thickening of oral and other respiratory secretions Generic name: stomach distress Dipenhydramine low blood pressure y

Brand Name: palpitations increased heart rate Benadryl confusion Classification: nervousness Anti-motion sickness agent irritability Sedative-hypnotic blurred vision Antiparkinsonian double vision Cough suppressant tremor Anti histamine loss or appetite Indications: nausea used for the relief of nasal and non-nasal symptoms of various Contraindications: allergic conditions such as seasonal allergic rhinitis Allergy to any antihistamines Asthmatic attack Not(hives) used used to alleviate cold symptoms and chronic urticaria to be inused for allergic reactions involving the eyes (allergic neonates Nursing considerations: or treat active motion sickness, and for conjunctivitis), to prevent Administer Parkinsonism, upset occurs. mild cases of with food if GI including drug-induced Parkinsonism Administer syrupinsomnia. used for treating form if patient is unable to take tablets. Monitor patient Mode of action: response, and arrange for adjustment of dosage to lowest possibleblocking the effect of histamine at H1 receptor y works by effective dose. Patient teachings: results in effects such as the increase of sites. This take the missed dose as soon as you remember.thus reducing itthe vascular smooth muscle contraction, However, if is almost time for thehyperthermia andthe missed dose and during an redness, next dose, skip edema that occurs take only the next regularly scheduled dose. In addition, by blocking the H1 inflammatory reaction. do not take a double peripheral nociceptors, diphenhydramine receptor on dose of this medication unless otherwise directed by doctor. their sensitization and consequently reduces decreases if over 60 years of is associated with an allergic reaction itching that age, may be more likely to experience side effects from diphenhydramine. may by blocking the effect this y Diphenhydramine works require a lower dose of of medication. histamine at H1 receptor sites. This results in effects use caution when the increase of vascular smooth muscle such as driving, operating machinery, or performing other hazardous activities..

use alcohol cautiously. Alcohol may increase drowsiness and SIDE EFFECTS: dizziness while taking diphenhydramine. y CNS: confusion, dizziness, drowsiness, hallucination, and headache, y CV: arrthymias, y GI: altered taste, black tongue, constipation, dark stool, diarrhea, drug- induced hepatitis, nausea. NSG. RESPONSIBILITIES: y Instruct patient to take medication as directed for the full course of therapy, even if feeling better. y Advise patients taking OTC preparations not to take the maximum dose continuously for more than 2 weeks. Without consulting health care professional. y Inform patient that smoking interferes with the action of histamine antagonist. y 4. May cause drowsiness or dizziness. Caution patient to avoid driving or other activities requiring alertness until response to the drug is known.

GENERIC NAME: GENERIC NAME: clozapine Ranitidine BRAND NAME: Clozaril BRAND NAME: DRUG CLASS AND MECHANISM: Clozapine is an antiZantac psychotic medication that works by blocking receptors in the brain CLASSIFICATION(S): for several neurotransmitters (chemicals that nerves use to

Histamine2 Antagonist communicate with each other) including dopamine type 4 INDICATIONS: receptors, Short term treatment of active duodenal ulcer and benign serotonin type 2 receptors, norepinephrine receptors, y acetylcholine receptors, and histamine receptors. Unlike heartburn, gastric ulcer. Treatment and prevention of traditional anti-psychotic indigestion, and sour stomach. acid agents, such as chlorpromazine (Thorazine) and haloperidol (Haldol) as well as the newer anti-psychotics, MECHANISM OF ACTION: risperidone (Risperdal) and olanzapine (Zyprexa), clozapine only y Inhibits the action of histamine at the H2 receptor site weakly blocks dopamine type 2 gastric parietal cells, resulting in located primarily in receptors. DRUG INTERACTIONS: Risperidone (Risperdal) may cause an inhibition of gastric acid secretion. increase in the amount of clozapine in competitive antagonists of y The H2 antagonists are the blood. This could lead to an increased risk of side effects from clozapine. histamine at the parietal cell H2 receptor. They suppress SIDE EFFECTS: Clozapine mayacid by a severe cells and the the normal secretion of cause parietal reduction in white blood cell count, a condition of acid. as agranulocytosis, in meal-stimulated secretion known They accomplish this approximately 1 in 100 patients who takereleased by ECL cells in by two mechanisms: Histamine it for at least one year. White blood cells fightisinfections,from binding on parietalin white the stomach blocked and a severe reduction cell H2 blood cells can result in stimulate acid secretion; therefore, early, receptors, which severe infections. If not caught other agranulocytosis can be fatal. Therefore, the white (such cellgastrin substances that promote acid secretion blood as count should beand acetylcholine) have a test) prior to starting treatment measured (with a blood reduced effect on parietal cells and regularly (weekly) receptors are blocked. this medication, and when the H2 while patients receive for 4 y weeks after it isH1-antihistamines, the H2 antagonists are Like the stopped. inverse agonists rather than true receptor antagonists. Among elderly patients with dementia-related psychosis, treatment CONTRAINDICATIONS: with clozapine isconfusion, dizziness, increased risk of death for y CNS: associated with an drowsiness, hallucinations, unclear reasons. Clozapine is not approved for use in dementiaand headache. related psychosis. y CV: arryhtmias y GI: occurred in approximately 1 of every Seizures have altered taste, dark stools, diarrhea, nausea. 20 to 30 y HEMAT: anemia, Patients receiving higher doses persons receiving clozapine. neutropenia,thrombocytopenia. seem to be at higher risk.

Indications Dizziness may occur in 1 of 5 persons taking clozapine. In some Acute and long-term orthostatic signs and symptoms of cases this may be due to treatment of hypotension, a marked rheumatoid arthritis and osteoarthritis when going from a lying or decrease in blood pressure that occurs sitting position to a standing position. The drop in blood pressure Reduction consciousness or even cardiac and in familial may lead to loss ofof the number of colorectal polyps respiratory adenomatous polyposis (FAP) arrest. This reaction is more common during the first few weeks of Management of acute pain therapy while the dose is increasing, when drug is stopped briefly, when patients are taking benzodiazepines such as diazepam or Treatment of primary dysmenorrhea Relief other anti-psychotic drugs. (Valium) or of signs and symptoms of anklylosing spondylitis Contraindications and cautions Contraindicated effect of clozapine is drowsiness. Other The most common side with allergies to sulfonamides, celecoxib, NSAIDs, or include increased heart rate, increased salivation, side effects aspirin; significant renal impairment; pregnancy (third trimester); lactation. headache, tremor, low blood pressure, and fever. Clozapine has Use cautiously with impaired hearing, hepatic, smooth anticholinergic effects that interfere with the function of and CV conditions.This can lead to blurred vision and difficulty urinating muscles. Adverse effects (when there is enlargement of the prostate) due to effects on the CNS: Headache, dizziness, somnolence, insomnia, fatigue, muscles of the eye and bladder. Clozapine slows the intestine and tiredness, dizziness, in approximately 14% of patients. Paralysis leads to constipationtinnitus, ophthamologic effects of theCV: MI, CVA intestinal muscles can lead to paralytic ileus, a condition in Dermatologic: Rash, which the intestine stops working. pruritus, sweating, dry mucous membranes, stomatitis GI: Nausea, abdominal pain, dyspepsia, flatulence, GI bleed Hematologic: Generic name: celecoxib Neutropenia, eosinophilia, leukopenia, pancytopenia, agranulocytosis, Brand name: Celebrexthrombocytopenia, granulocytopenia, aplastic anemia, decreased Hgb or Hct, bone Drug classes: marrow NSAID depression, menorrhagia Other: Peripheral edema, anaphylactoid reactions to Analgesic (nonopioid) anaphylactic shock

Specific COX-2 enzyme blocker Nursing considerations Therapeutic actions Name confusion has occurred between Celebrex (celecoxib), y Analgesic and anti-inflammatory activities related to Celexa inhibition of the COX-2 (alprazolam), andactivated in (citalopram), Xanax enzyme, which is Cerebyx (fosphenytoin); use caution. cause the signs and symptoms inflammation to Assessment associated with inflammation; does not affect the COX-1 History: Renal impairment, lining of the GI tract and has enzyme, which protects the impaired hearing, allergies, hepatic and CV conditions, lactation, pregnancy blood clotting and renal functions. Physical: is y Celecoxib Skina color and lesions;COX-2 inhibitor and highly selective orientation, reflexes, ophthalmologic andinhibits this isoform of cyclooxygenase (and primarily audiometric evaluation, peripheral sensation; P, edema;thus adventitious sounds;of prostaglandin CBC, LFTs, R, causes inhibition liver evaluation; production), renal function tests;traditional NSAIDs inhibit both COX-1 and whereas serum electrolytes Interventions COX-2.[citation needed] Celecoxib is approximately 10 Administer drug with food or after meals if GI upset occurs. 20 times more selective for COX-2 inhibition over COX Establish safety measures ifpolar sulfonamide side chain to a 1.[4] It binds with its CNS, visual disturbances occur. Arrange for periodic ophthalmologic to the active COX-2 hydrophilic side pocket region close examination during long-term binding site.[5] In theory, this selectivity allows therapy. WARNING: overdose occurs, institute to reduce celecoxib andIf other COX-2 inhibitors emergency proceduresgastric lavage, induction of while emesis, minimizing supportive inflammation (and pain) therapy. gastrointestinal adverse drug reactions (e.g. stomach Provide further comfort measures to reduce pain ulcers) that are common with non-selective NSAIDs. (eg, positioning, environmental control), and to reduce inflammation y Celecoxib inhibits COX-2 without affecting COX-1. (eg, warmth, positioning, rest). in synthesis of prostaglandins and COX-1 is involved Teaching thromboxane, but COX-2 is only involved in the points Take drug with of prostaglandin. upset occurs. synthesis food or meals if GI Therefore, inhibition of Take only the prescribed dosage. COX-2 inhibits only prostaglandin synthesis without Youaffecting thromboxaneside effects: Dizziness, drowsiness may experience these and thus has no effect on platelet (avoid driving or the use blood clotting.machinery while taking this aggregation or of dangerous drug).

 Report sore throat, fever, rash, itching, weight gain, swelling  Observe changes in vision. in ankles or fingers;for paradoxical bronchospasm (wheezing). If conditions occur, withhold medication and notify physician of other health care professional immediately.  Monitor heart rate, CNS stimulation, notify physician if palpitations, chest pain, tachycardia occurs Salbutamol 1 neb q 8 hours

Brand name: Ansimar Generic name: ALBUTEROL SULFATE Generic name: Doxofylline Brand name: (SALBUTAMOL) Drug Classification: Antiasthmatic & COPD Preparations CLASSIFICATION: Bronchodilators Indication: Bronchial asthma & pulmonary disease w/ spastic ACTION: bronchial component. y Relaxes action: Adrenergic bronchodilators and Mechanism of bronchial, uterine, and vascular smooth muscle by stimulating beta2inhibitors both work by increasing phosphodiesterase receptors y Binds to beta2-adrenergic receptors in airway smooth intracellular level of cyclic-3,5adenosine muscle, leading (cAMP); adrenergics by increasing monophosphate to activation of adenylcyclase and increased levels of cyclic-3', 5'-adenosine

production and phosphodiesterase inhibitors by monophosphate (cAMP). Increased in cAMP activate decreasing breakdown. Increases levels of cAMP kinases, which inhibit the phosphorylation of myosin and produce bronchodilation. Corticosteroids act by decrease intracellular calcium. Decreased intracellular decreasing airway inflammation. Anticholinergics calcium relaxesproduce muscle airways. by decreasing (ipratropium) smooth brondhodilation y Relaxation of airway smoothguanosinewith subsequent intracellular levels of cyclic muscle monophosphate bronchodilation (cGMP). Leukotriene receptor antagonists and mast cell y As a 2-agonist, salbutamol also of substances that can stabilizers decrease the release finds use in obstetrics. Intravenous salbutamol can be used as a tocolytic to contribute to bronchospasm. relax the tab bid- tid. Syr muscle >12 yr 10 mL onceDosage: Tab Adult 1uterine smooth Children to delay premature labour. While preferredbid. agents such as atosiban and tid, <12 yrs 6-9 mg/kg over ritodrine, its role hypotension, lactation Contraindication: Acute MI, has largely been replaced by the calcium-channel blocker nifedipine obstructive lung Special Precaution: Liver disease, CHF, chronicwhich is more effective,concomitant infections. Pregnancy. disease, better tolerated and orally administered.[ INDICATIONS: Adverse Reaction: Nausea, vomiting, epigastric pain, cephalalgia, irritability, insomnia, extrasystole, y Used as a bronchodilatortachycardia,management of in the tachypnea, hyperglycemia, albuminuria. reversible airway obstruction caused by asthma or COPD Form: Tablet- 400amg; syrup- 100mg/5mL y Used as quick-relief agent for acute bronchospasm and Pregnancy Risk Category: (Not yet applicable) for prevention of exercise-induced bronchospasm Nursing Responsibilities: Use cautiously in patients w/ CV CONTRAINDICATIONS:  hyperthyroidism, or pulse mellitus pressure before disorders, Assess lung sounds, diabetesand bloodand in those who administration and during are unusually responsive to adrenergics.peak of medication. Not amount, color, and character of sputum produced. ADVERSE EFFECT: tremor, nervousness, dizziness, insomnia,  hyperactivity, weakness, CNS, tests before initiating headache,Monitor pulmonary function stimulation, malaise. therapy restlessness, tremor, headache, insomnia. CNS: nervousness,and periodically during therapy to determine CV: chesteffectiveness of medication. pain palpitations, angina, arrhythmias, hypertension. GI: nausea, vomiting. Endo: hyperglycemia.

F and E: hypokalemia. Mechanism of Neuro: tremor Action: y hypoglycemic sulfonylurea- oral antidiabetic NURSING CONSIDERATION: y BEFORE:Gliclazide works mainly by stimulating the cells in the ~Assess pancreas that produce insulin. These cells are called beta lung sounds, pulse, and blood pressure before cells. Gliclazide causes the beta cells to produce more administration and during peak of medication. Note amount, color, insulin and character of sputum produced. Dosage: 1 pulmonary function tests per day initiating therapy and ~Monitor to 4 tablets (30 mg tablet) before as a single dose Special Precaution: Follow as closely possible the diet prescribed periodically throughout course to determine effectiveness of by medication. the doctor Regularly carry out the laboratory tests as prescribed or recommended by the doctor Inform the DURING:doctor in the ff. cases: Surgery, trauma, fever or ~Observe infection, difficulty in eating Planned If condition for paradoxical bronchospasm (wheezing). pregnancy. Administration of other drugs, in particular, an antioccurs, withhold medication and notify physician or other health inflammatory agent, care professional immediately. beta- Blocker, corticoid Pregnancymother to take missed dose as soon as remembered, ~ Instruct risk category Adverseremaining Hypoglycemic manifestations: not doublepallor, spacing Effects: doses at regular intervals. Do sweating, doses intense or frequency of doses. or increase the dosehunger, malaise. Skin reactions: urticaria, itching, skin rash. Nausea, diarrhea, stomach upsets, AFTER: constipation, hepatitis. Abnormal laboratory results ~ Inform affecting blood and liver functions child and to avoid the mother not to smoke near the Contraindication: Should not be used in the following cases: respiratory irritants. ~ Advise Allergy to thisrinse the childs mouth with water after the mother to medicine Diabetes requiring treatment with dose to minimize dry mouth. each inhalation insulin or insulin-dependent diabetes Keto-acidosis, diabetic precoma, severe liver or kidney disease, treatment with miconazole Breastfeeding Form: Tablet 80 mg x 100s Nursing Responsibilities:

Patients who are NPO may need to have their dose held to avoid hypoglycemia

Take exactly as directed; with meal(s) at the same time each day. y Do not change dose or discontinue without consulting prescriber. y Avoid alcohol while taking this medication; could cause severe reaction. y Inform prescriber of all other prescription or OTC medications you are taking y do not introduce new medication without consulting prescriber y Do not take other medication within 2 hours of this medication unless advised by prescriber y If you experience hypoglycemic reaction, contact prescriber immediately. y Maintain regular Brand name: Diamicron dietary intake and exercise routine and always carry quick Generic name: gliclazide source of sugar with you Generic name: pioglitazone Indication: Brand name: Actos y For non-insulin dependent diabetes (type 2), in Drug classes association with dietary measures and with exercise, Antidiabetic these measures alone are not sufficient. when Thiazolidinedione of hyperglycemia in gliclazide responsive y Control Therapeutic actions diabetes mellitus of stable Resensitizes tissues to insulin; diabetic agent Drug Classification: Oral anti stimulates insulin receptor sites to lower blood glucose and improve the action of insulin; decreases y

hepatic gluconeogenesis and increases insulin-dependent muscle glucose uptake. Arrange for consultation with dietitian to establish weight loss program and dietary control as appropriate. Indications Arrange for as an adjunct to diet and exercise to Monotherapythorough diabetic teaching program to include disease, dietary patients with type 2 (non improve glucose control in control, exercise, signs and symptoms of hypoglycemia and hyperglycemia, insulin-dependent) diabetes avoidance of infection, hygiene. with a sulfonylurea, As part of combination Teachingmetformin, or insulin when diet, exercise plus a single points Do not discontinue this medication control agent alone does not result in adequate glycemic without consulting health care provider; continue with diet and in type 2 diabetes exercise and cautions Contraindicationsprogram for diabetes control. Take this drug with meals. Ifallergy is missed, it dose Contraindicated with to any may be taken at the next (insulin-dependent) diabetes, thiazolidinedione; type 1 meal. If dose is missed for an entire day, do not double ketoacidosis, lactation. dose the next day. Monitor urine or blood for glucose and ketones as Use cautiously with advanced heart disease, liver prescribed while adjusting to drug. failure, pregnancy. Use barrier hr Metabolism: Hepatic; T1/2: 37contraceptives if currently taking hormonal contraceptives; these drugs may Distribution: Crosses placenta; enters breast milk be ineffective if combined with Excretion: Feces, urine pioglitazone. Adverse effects Report fever, sore throat, unusual bleeding or bruising, rash, dark pain, myalgia CNS: Headache, urine, light-colored stools, hypoglycemic or hyperglycemic reactions. CV: Fluid retention Endocrine: Hypoglycemia, hyperglycemia, aggravated diabetes GI: Diarrhea, liver injury Respiratory: Sinusitis, URI, rhinitis Other: Infections, fatigue, tooth disorders Interactions

Drug-drug Decreased effectiveness of hormonal contraceptives, which may result in ovulation and risk of pregnancy; suggest the use of an alternative method of birth control or consider a higher dose of the contraceptive Drug-alternative therapy Increased risk of hypoglycemia if taken with juniper berries, ginseng, garlic, fenugreek, coriander, dandelion root, celery Nursing considerations CLINICAL ALERT! Name confusion has been reported between Actos (pioglitazone) and Actonel (risedronate); use caution Assessment History: Allergy to any thiazolidinedione; type 1 diabetes, ketoacidosis, serious hepatic impairment, advanced heart disease, pregnancy, lactation Physical: T; orientation, reflexes, peripheral sensation; R, adventitious sounds; liver evaluation; Generic name: LFTs, blood glucose, CBC Captopril Interventions Brand name: Monitor urine or blood glucose levels frequently Apo-Capto (CAN), Capoten, Gen-Captopril (CAN), Novoto determine effectiveness of drug and dosage being Captopril (CAN), Nu-Capto (CAN) used. Drug classes Monitor baseline LFTs before beginning therapy ACE inhibitor and periodically during therapy. Antihypertensive Administer without regard to meals. Therapeutic actions

Blocks ACE from converting angiotensin I to angiotensin II, a Other: Cough, malaise, dry mouth, powerful vasoconstrictor, leading to decreased BP, decreased lymphadenopathy aldosterone secretion, a small increase in serum potassium levels, and sodium and fluid loss; increased prostaglandin synthesis also Interactions may be involved in the antihypertensive action. Drug-drug How Ace Inhibitors Work to Lower Blood Pressure Blood pressure Increased risk of hypersensitivity reactions with medications come in different forms and each is allopurinol intended to cause a different reaction in the blood or blood vessels. Decreased antihypertensive effects with An ace inhibitor is one such medication used in the treatment of indomethacin hypertension. Increased Enzyme (ACE) inhibitors prevent the Angiotensin Converting captopril effects with probenecid Drug-food of a hormone in the body called angiotensin II. manufacture Decreased absorption of captopril with food Angiotensin II makes blood vessels narrower. When the hormone Drug-lab test blocked, the arteries remain wider and allow blood to production is False-positive test for urine acetone flow through with less pressure on the vessels, thereby lowering blood pressure. Nursing considerations Indications Assessment Treatment of hypertension alone or in combination History: Allergy with thiazide-type diuretics to captopril, history of angioedema, impaired renal patients unresponsive or Treatment of CHF in function, CHF, salt to volume depletion, pregnancy, lactation and digitalis conventional therapy; used with diuretics Physical: Skin color, lesions, turgor; T; P, BP, Treatment of diabetic nephropathy peripheral perfusion; mucous membranes, bowel sounds, Treatment of left ventricular dysfunction after MI liver evaluation; urinalysis, LFTs, renal function tests, Unlabeled uses: Management of hypertensive CBC and differential rheumatoid arthritis; diagnosis of crises; treatment of anatomic renal artery stenosis, hypertension related to Interventions scleroderma renal crisis; diagnosis of primary Administer 1 hr before or 2 hr after meals.

aldosteronism, idiopathic edema; Bartter's syndrome; WARNING: Raynaud's syndromeEnsure that patient is not pregnant before and cautions Contraindications beginning treatment. Encourage use of contraceptives; if pregnancy is detected, stop drug. Contraindicated with allergy to captopril, history of WARNING: third surgeon and mark patient's angiodema, second orAlert trimester of pregnancy. chart Use cautiouslythat captopril is being taken; the with notice with impaired renal function; CHF; angiotensin II depletion, lactation. salt or volume formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion. Monitor Metabolism: T1/2: 2 hr patient closely for fall in BP secondary to reduction in fluid volume (due to milk Distribution: Crosses placenta; enters breastexcessive perspiration and dehydration, vomiting, diarrhea); excessive Excretion: Urine hypotension may occur. Adverse effects Reduce dosage in patients with impaired renal function. Tachycardia, angina pectoris, MI, Raynaud's CV: syndrome, CHF, hypotension in salt- or volume-depleted Teachingpatients points Take drug 1 hourRash, pruritus, do not take with Dermatologic: before meals; scalded mouth food. Do not pemphigoid-like stop without consulting your health care sensation, reaction, exfoliative provider. alopecia, photosensitivity dermatitis, Be careful of drop in blood pressureulcers, peptic GI: Gastric irritation, aphthous (occurs most often with diarrhea, cholestatic vomiting, dehydration); if ulcers, dysgeusia, sweating, jaundice, hepatocellular light-headedness constipation occurs, consult your health injury, anorexia, or dizziness care provider. GU: Proteinuria, renal insufficiency, renal failure, Severe fetal urinary can occur polyuria, oliguria, damagefrequency if captopril is taken during pregnancy. Use of contraceptives is advised; if Hematologic: Neutropenia, agranulocytosis, pregnancy should occur, stop drug andpancytopenia thrombocytopenia, hemolytic anemia, notify your health care provider.

 Avoid over-the-counter medications, especially cough, cold, allergy medications that may contain ingredients that Adverse Drug Reactions will interact with ACE inhibitors. Consult your health care provider. Nausea, vomiting, constipation, diarrhoea, abdominal pain, dry You may experience these side effects: GI upset, mouth, dyspepsia, flatulence, dizziness, somnolence, headache, loss ofchanges, nightmares, amnesia,perception pruritus. confusion, mood appetite, change in taste sweating, (limited effects, will pass); mouth sores (frequent mouth care . may help); rash; fast heart rate; dizziness, lightDrug Interactions headedness (usually passes after the first few days; Increased change serotonin slowly, and limit your activities triptans. risk position syndrome with SSRI and to those Increased that do not require alertness and precision). risk of seizures of SSRI, TCA, antipsychotics, centrally acting analgesics or local anaesthesia. sore throat, fever, chills; Report mouth sores; Decreased tramadol levels with carbamazepine. Decreased analgesic efficacy of tramadol swelling of the hands, feet; irregular heartbeat, chest with ondansetron. Increased INR warfarin. pains; swelling of the face, eyes, lips, with tongue, difficulty breathing. Potentially Fatal: Increased risk of serotonin syndrome with MAOIs, avoid concurrent use or within 2 wk of discontinuation from MAOIs. Increased risk of CNS and respiratory depression with CNS depressants (e.g. alcohol, opioids, anaesthetic agents, narcotics, phenothiazines, tranquilizers or sedative hypnotics). . Paracetamol + tramadol (Dulcet) NURSING RESPONSIBILITIES: Indication TRAMADOL Moderate to for level of pain relief and administer dose as needed y Assess severe pain. Class:N02AX02 - tramadol; Belongs to the class of other opioids. but not to exceed the recommended total daily dose UsedDiscontinue drug and notify the physician if s/sx of to relieve pain. y hypersensitivity occur

N02BE01 - paracetamol; Belongs to the class of anilide y Take appropriate safety pain and fever preparations. Used to relieve precautions. y To be taken with Mechanism of action food to avoid GI upset. Tramadol is a centrally acting opioid analgesic which binds to muopioid receptors and weakly inhibits the reuptake of norepinephrine and serotonin. Paracetamol, a para-aminophenol derivative, has analgesic, antipyretic and weak anti-inflammatory activity. Used together, tramadol and paracetamol combination has a faster onset of action compared to tramadol alone and longer duration of action compared to paracetamol alone. Contraindications Hypersensitivity to tramadol, paracetamol or opioids. Situations where opioid use may be contra-indicated (e.g. acute intoxication with alcohol, hypnotic drugs, centrally-acting analgesics, opioids or psychotropic drugs). Severe hepatic impairment, uncontrolled epilepsy. Concurrent use or within 2 wk of discontinuation from MAOIs. Special Precautions Not recommended in severe renal impairment (CrCl <10 ml/min), severe respiratory insufficiency, liver disease or opioid dependent patients. Increased intracranial pressure or head injury, patients at risk of seizures or on drugs that may lower the seizure threshold (e.g. SSRI, TCA, antipsychotics, centrally acting analgesics or Generic Name: acetaminophen /paracetamol a state of shock or local anaesthesia), biliary tract disorders, in Brand Name: Aceta, impair ability to drive or operate machinery. unconsciousness. May Apacet, Atasol (CAN), Genapap, Genebs, Liquiprin, Mapap, Panadol, Tapanol, Tempra, Tylenol symptoms, Avoid abrupt withdrawal. May cause withdrawal Drug classes: Antipyretic/Analgesic (nonopioid) dependence and abuse. Elderly. Pregnancy, lactation.

Therapeutic actions c. Common cold, directly on the and bacterial  Reduces fever by acting flu, other viral hypothalamic infections with to cause vasodilation and heat-regulating center pain and fever d. which helps dissipate heat. sweating, Unlabeled use: Prophylactic for children receiving DPT vaccination to reduce incidence  Paracetamol is usually classified along with nonsteroidal of fever and pain antiinflammatory drugs (NSAID),[by whom?] but is not Contraindications and cautions part of the class of drugs known considered one, rather is a. analgesics. Like with to as aniline Contraindicated all drugs of thisallergyits main class, acetaminophen. mechanism of action is the inhibition of cyclooxygenase b. Use cautiously with impaired hepatic function, (COX),] an enzyme responsible for the production of chronic alcoholism, important mediators of prostaglandins, which are pregnancy, lactation. Adverse effects inflammation, pain and fever. Therefore, all NSAIDs are said a. possess Headache to CNS: anti-inflammatory, analgesic (anti-pain), and b. CV: Chest pain, dyspnea, myocardial specific antipyretic (anti-fever) properties. The damage when doses of 58 g/day are ingested daily for actions of each NSAID drug depends upon their several weeks or when doses of 4 g/day are pharmacological properties, distribution and metabolism ingested of enzymes are responsible for the  The COX family for 1 yr c. GI: Hepatic toxicity and prostaglandin H2, an metabolism of arachidonic acid tofailure, jaundice d. molecule, which is, failure, converted to unstable GU: Acute kidney in turn, renal tubular numerous necrosis other pro-inflammatory compounds. Classical e. Hematologic: Methemoglobinemiacyanosis; anti-inflammatories, such as the NSAIDs, block this step. hemolytic anemiahematuria, anuria; Only when appropriately oxidized is the COX enzyme neutropenia, pancytopenia, highly active. Paracetamol leukopenia, oxidized form of reduces the the COXthrombocytopenia, hypoglycemiaforming proenzyme, preventing it from f. Hypersensitivity: Rash, fever inflammatory chemicals.. Thus reducing the amount of Prostaglandin E2 in the CNS and thus lowering the Drug-drug Interactionsset point in the thermoregulatory centre. hypothalamic a. Inhibition Increased toxicity withCOX3 is specifically of another enzyme long-term, excessive ethanol ingestion

implicated in the case of paracetamol. COX3 is not seen b. Increased hypoprothrombinemic effect of oral outside the CNS Article text. Paracetamol also modulates anticoagulants the endogenous cannabinoid system. Paracetamol is c. Increased risk of hepatotoxicity and several metabolized to AM404, a compound with possible decreased therapeutic effects with barbiturates, actions; most important, it inhibits the uptake of the carbamazepine, hydantoins, rifampin, endogenous cannabinoid/vanilloid anandamide by neurons. sulfinpyrazone uptake would result in the Anandamide d. activation Possible delayed receptor (nociceptor) of the of the main pain or decreased effectiveness body, thewith anticholinergics TRPV1 (older name: vanilloid receptor). e. Possible reduced absorption of acetaminophen Furthermore, AM404 inhibits sodium channels, as do the with activated charcoal anesthetics lidocaine and procaine. Either of these f. Possible decreased effectiveness of zidovudine actions by themselves has been shown to reduce pain, Nursing considerations and are a possible mechanism for paracetamol, though it Assessment been demonstrated that, after blocking cannabinoid has a. and hence making acetaminophen, impaired receptors History: Allergy toany action of cannabinoid hepatic function, alcoholism, reuptake irrelevant, paracetamol chronic loses analgesic effect, pregnancy, lactation suggesting its pain-relieving action is mediated by the b. Physical: Skin color, lesions; T; liver endogenous cannabinoid system. evaluation; CBC, LFTs, renal function tests Analgesic: Site and mechanism of action unclear. Interventions Indications a. Do not exceed the recommended dosage. a. Analgesic-antipyretic in patients with aspirin b. Consult physician if needed for children < 3 allergy, hemostatic disturbances, bleeding yr; if needed for longer than 10 days; if diatheses, upper GI disease, gouty arthritis continued fever, severe or recurrent pain b. Arthritis and rheumatic disorders involving occurs (possible serious illness). musculoskeletal pain (but lacks clinically c. Avoid using multiple preparations containing significant antirheumatic and antiacetaminophen. Carefully check all OTC inflammatory effects) products.

d. Give drug with food if GI upset occurs. Side Effects e. Discontinue drug if hypersensitivity reactions Adverse events associated with the use of Januvia may include, but occur. are not limited f. the following: overdose: Monitor serum levels to, Treatment of * Upper Respiratory Tract Infection regularly, N-acetylcysteine should be available * Nasopharyngitis a specific antidote; basic life support as * Headache. measures may be necessary. Contraindication: patients with a history of a serious hypersensitivity reaction to Teaching points sitagliptin, such as anaphylaxis or angioedema dose; do not take a. Do not exceed recommended Nursing considerations: for longer than 10 days. The usual doseb. this medication only for complaints indicated; it of Take the drug is 100 mg taken by mouth once daily with or without food. anti-inflammatory agent. is not an c. Avoid the use of other over-the-counter preparations. They may contain acetaminophen, and serious overdosage can occur. If you need an over-the-counter preparation, consult your health care provider. d. Report rash, unusual bleeding or bruising, yellowing of skin or eyes, changes in voiding patterns Generic name: Generic name: Mefenamic acid Sitagliptin BRAND NAMEDolfenal INDICATION: CLASSIFICATION: DM II Non-steroidal anti-inflammatory drug Indicated as an adjunct to diet and exercise, to improve glycemic INDICATION control in adults with type 2 diabetes mellitus when treatment with both sitagliptin and metformin is appropriate.

Mechanism of Action Relief is an an orally-active inhibitor of the dipeptidyl peptidaseJanuviaof pain including muscular, rheumatic, traumatic, dental, post-op and postpartum pain, enzyme migraine, fever, 4 (DPP-4) enzyme. The DPP-4 headache, inactivates incretin dysmenorrhea hormones, which are involved in the physiologic regulation of ACTION glucose homeostasis. Januvia slows the inactivation of incretin y hormones Aspirin-like increases has analgesic,antipyretic, & antiand thus drug that and prolongs their action. By inhibiting inflammatory activities DPP-4, Januvia increases and prolongs active incretin y levels. Mefenamic acid has analgesic, anti-inflammatory and anti-pyretic properties. It inhibits the synthesis of Januvia isprostaglandins. Mefenamic acid dipeptidyl central and an orally-active inhibitor of the shows peptidase-4 owes these properties to its (DPP-4) peripheral The DPP-4it enzyme inactivates incretin enzyme. action and hormones,capacity to inhibit cyclooxygenase. which are involved in the physiologic regulation of glucose homeostasis. By inhibiting DPP-4, Januvia increases and prolongs Most NSAIDs act as non-selective inhibitors insulin active incretin levels. This in turn increases of the y release and decreases glucagon levels inhibiting in the circulation inthe a enzyme cyclooxygenase, both glucose-dependent manner. (COX-1) and cyclooxygenase-2 cyclooxygenase-1 (COX-2) isoenzymes. Cyclooxygenase catalyzes the Januvia isformation ofindicated for the improvement of glycemic specifically prostaglandins and thromboxane from control in arachidonic acid II(itself derived from the cellular patients with type diabetes mellitus as monotherapy or combination therapy with metformin phospholipase or a peroxisome phospholipid bilayer by A2). proliferatoractivated receptor gamma (PPAR) agonist (e.g., Prostaglandins act (among other things) as messenger thiazolidinediones) when the process agent inflammation. This the single of does not provide molecules in adequate glycemic control.action was elucidated by John Vane mechanism of (1927-2004), who later received a Nobel Prize for his Januvia iswork (see Mechanismmg or 100 mg tablets designed for supplied as 25 mg, 50 of action of aspirin). A newly oral administration. The recommended initial dose ofhave drug is the some discovered[when?] COX-3 may also 100 mg once daily role.[citation needed]

y NSAIDS have antipyretic activity and can be used to Indications: Angina . pectoris is including by elevated levels of treat fever Fever caused Prinzmetals angina, hypertension, E2, which alters the firing rate of neurons prostaglandin supraventricular tachyarrythmias and rapid ventricular hypothalamus that control thermoregulation within the rates in atrial flutter of fibrillation. Drug Classification: Calcium antagonist .Antipyretics work by inhibiting the enzyme Mechanism of action: cyclooxygenase, which causes the general inhibition of  Block calcium biosynthesis cardiac and vascular smooth entrance into (PGE2) prostanoid within the muscle cells by blocking the to the hypothalamus to hypothalamus. PGE2 signals L-type voltage sensitive calcium the body's which is abundant in cardiac been increase channel thermal set point. Ibuprofen has and smooth to be more smooth muscle, calcium binds to shown muscle. In effective as an antipyretic than calmodulin resulting in activating myosin light chain acetaminophen kinase, an enzyme that phosphorylates the myosin light y chain. This phosphorylation is essential for muscle y contraction, thus CONTRAINDICATION by decreasing calcium levels in the vascular smooth hypersensitivity, active contraction. Pregnancy & lactation, muscle these agents lessenulceration or  In the heart, of either upper troponin GIT, blood chronic inflammation calcium binding toor lower removes the disorders, inhibitory effect of troponin on liver actin-myosin poor platelet function, kidney or the impairment, children <interaction thus allowing contraction. Thus, blockade of 14 yrs the slow calcium ADVERSE REACTION channel by these agents can result in negative inotropic effect. If rash occurs, administration should be stopped, asthmatics, Hx of liver and kidney disease  Calcium channel blockers work by blocking voltageADVERSE RXN gated calcium channels (VGCCs) in cardiac muscle and GI discomfort, vessels. This constipation,intracellular calcium gas pain, nausea, blood diarrhea or decreases vomiting, leading to a reduction in muscle contraction. In the heart, drowsiness a decrease in calcium available for each beat results in a NURSING CONSIDERATION decrease in cardiac contractility. In blood vessels, a > assess pt.s pain before therapy decrease in calcium results in less contraction of the >monitor vascular smooth induced adverse reactions increase in for possible drug muscle and therefore an

>advice pt. not to take drug for more than 7 days arterial diameter (CCB's persistence on venous relieve >advice pt. to report immediately do not workor failure to smooth muscle), a phenomenon called vasodilation. Vasodilation pain decreases total peripheral resistance, if drug toxicity is >Watch for side effects and call the physicianwhile a decrease in observed. cardiac contractility decreases cardiac output. Since blood pressure is after giving the drug. >Assess the patient before anddetermined by cardiac output and peripheral resistance, blood pressure >Assess the drugs effectiveness to the patient. drops. Dosage: Angina pectoris, 90-360 mg daily in divided dosage. Before: Hypertension, 180-360 mg/24 hr in divided doses. - Assess patients condition Special Precaution: Impaired renal or hepatic function; heart -Perform hand washing failure physicians order -Verify Pregnancy Risk Category: C -Prepare medication Adverse Reactions: CNS: abnormal dreams, anxiety, confusion, dizziness, During : drowsiness, -Identify patient headache, nervousness, psychiatric disturbances, weakness -Assess client in semi-fowlers position -Assess in administering the medication to the patient EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus After: Resp: cough, dyspnea -Document CV: Arrythmias, CHF, peripheral edema, bradycardia, -Assess patient 30-60 mins. after administration and document chest pain, hypotension, palpitations, syncope, response to medication tachycardia GI: abnormal function liver studies, anorexia, Brand name: Dilzem constipation, diarrhea, dry mouth, dysgeusia, dyspepsia, Generic name: Diltiazem nausea, vomiting GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency

Derm: dermatitis, erythema multiforme, flushing, ADULTS increased sweating, photosensitivity, pruritus/ urticaria, 40 mg POrash for maintenance healing of erosive esophagitis for daily < 8 wk. 8-wk course may be repeated if healing has not occurred; Endo: gynecomastia, hyperglycemia give continually for hypersecretory disoders; 40 mg/day IV for 7 Hemat: anemia, leucopenia, thrombocytopenia 10 days. UpDilzem) mg/day PO or IV has been used for (continuation to 240 hypersecretory syndromes. Metab: weight gain MS: joint stiffness, muscle cramps PEDIATRIC PATIENTS < 18 YR Neuro: paresthesia, tremor Safety and efficacy not established. Misc: Stevens- Johnson syndrome, gingival hyperplasia Contraindications: sick sinus syndromes; 2nd or 3rd degree AV PATIENTS WITH HEPATIC pregnancy acute MI block; hypotension, IMPAIRMENT Use caution and monitor patient closely. Form: Tablet- 30mg, 60mg, 90 mg, 120 mg Nursing Responsibilities: Metabolism:  Monitor BP & pulse before therapy, during titration, and Hepatic; T1/2: 1.5 hr during therapy. Monitor ECG periodically periodically Distribution: prolonged therapy. during Crosses placenta; may enter output ratios and daily weight.  Monitor intake & breast milk Excretion:  Angina: Assess location, duration, intensity, & Bile, urine precipitating factors of patients anginal pain. Adverse effects  Arrythmias: Monitor ECG continuously during CNS: Headache, Monitor BP and pulse before and administration. dizziness, asthenia, vertigo, insomnia, apathy, anxiety, paresthesias, dream abnormalities frequently during administration. Dermatologic: potassium and renal hepatic pruritus,  Monitor serum Rash, inflammation, urticaria, functions alopecia, dry skin periodically. GI: Diarrhea, abdominal pain, nausea, vomiting, constipation, dry mouth, tongue atrophy Respiratory: URI symptoms, cough, epistaxis Generic name: Pantoprazole Other: Cancer in preclinical studies, back pain, fever

Brand name: Interactions Pantoloc (CAN), Protonix, Protonix IV Drug-drug Drug classes: Fewer drug interactions reported Antisecretory drug; Proton pump inhibitor than with other proton pump inhibitors Therapeutic actions Nursingacid-pump inhibitor: Suppresses gastric acid secretion by Gastric considerations Assessment specific inhibition of the hydrogen-potassium ATPase enzyme History: Hypersensitivity of the gastric parietal cells; or any system at the secretory surface to any proton pump inhibitor blocks drug components; pregnancy; lactation the final step of acid production. Indications Physical: Skin lesions; T; reflexes, affect; urinary output, abdominal examination; respiratory auscultation Oral: Short-term (< 8 wk) and long-term treatment of GERD Interventions Maintenance healing of erosive esophagitis Administer once or twice a day. Caution patient to swallow Long-term treatment of pathological hypersecretory tablets whole; not to cut, chew, or crush them. conditions WARNING: Arrange for further evaluation of patient after 4 IV: Short-term (710 days) treatment of GERD in patients wk of continue oral therapy unable to therapy for gastroreflux disorders. Symptomatic improvement does not of pathological hypersecretory cancer did Treatment rule out gastric cancer; gastric conditions occur in preclinical studies. associated with Zollinger-Ellison syndrome and other neoplastic Maintain supportive treatment as appropriate for underlying conditions problem. Unlabeled uses: Treatment of duodenal ulcer Contraindications and cautions therapy to oral dosage as soon as Switch patients on IV possible. Contraindicated with hypersensitivity to any proton pump Provide drug components. inhibitor or anyadditional comfort measures to alleviate discomfort from GI effects and headache. Use cautiously with pregnancy, lactation. Teaching points Available forms tablet20,the drugpowder for injection40 mg/vialthe tablets Take 40 mg; once or twice a day. Swallow DR wholedo not chew, cut, or crush them. Dosages Arrange to have regular medical follow-up care while you are using this drug.

 Maintain all of the usual activities and restrictions that apply to y yourTo remove ingested becomesfrom the lower GIT. condition. If this poisons difficult, consult your health y As adjunt in anthelminthic therapy. care provider. Contraindications: Acute these side abdomen or intestinal You may experience surgical effects: Dizziness (avoid obstruction, severe dehydration, faecal impaction, chronic use. driving a car or performing hazardous tasks); headache (consult Ileus, intestinal obstruction, acute surgical abdominal conditions your health care provider if these become bothersome, medications like be available to help); nausea, bowel diseases, (proper may appendicitis, acute inflammatoryvomiting, diarrheaintestinal rectal, is stomach bleeding, and in severe dehydration. nutritionor important, consult a dietitian to maintain nutrition; stay Hypersensitivity to the drug. near a bathroom); symptoms of upper respiratory tract infection, Special may help to Swallow the drug effect, Pregnancy; cough (it Precautions:know that this is atab whole. do not selfinflammatory bowelyour health care provider if this becomes medicate, consult disease. Adverse Drug Reactions: Abdominal discomfort (colic, cramps). uncomfortable). Suppositories may causeheadache, and proctitis. symptoms, fever, Report severe irritation worsening of Drug Interactions: Do not give antacids or milk within 1 hr of chills, blurred vision, periorbital pain. taking the drug (enteric coated). Side effect: y stomach cramps y upset stomach y diarrhea y stomach and intestinal irritation y faintness y irritation or burning in the rectum (from suppositories) Nursing Considerations:  Take Dulcolax by mouth with or without food.  Take Dulcolax with a full glass of water (8 oz/240 mL). Generic name: Bisacodyl

Brand name: Dulcolax  Swallow Dulcolax whole. Do not break, MIMS Class : Laxatives, Purgatives crush, or chew before swallowing. Mechanism of Action:  y Bisacodyl acts Do not in the Dulcolax within 1 hour after mainly take large intestine by increasng its taking an antacid or motility to effect bowel evacuation.milk.  Use y Stimulates peristalsisDulcolax with caution in the by directly irritating the smooth muscle of the ELDERLY;possibly the colonic sensitive to intestine, they may be more intramural its effects. plexus; alters water and electrolyte secretion producing net  intestinal fluid Dulcolax should not be used in CHILDREN accumulation and laxation younger than 6 years old; safety and y Stimulant laxatives encourage bowel movements by acting effectiveness They children the muscle on the intestinal wall. in these increase have not been confirmed. contractions that move along the stool mass. Stimulant laxatives are a popular type of laxative for self-treatment. PatientHowever, they also are more likely to cause side effects. Teaching:  If you laxatives, dehydrocholic acid, are One of the stimulant miss a dose of Dulcolax and may taking it certain conditions as soon as also be used for treating regularly, take it of the biliary possible. If it is almost time for your next tract. dose, skip the missed dose and go back to Indication: your regular dosing schedule. basis take 2 y Bisacodyl, a laxative, is used on a short-termDo notto treat constipation. Itdoses at once. to empty the bowels before also is used  Do not use for longer than 1 week without surgery and examinations such as X-ray procedures using checking with available with or Dulcolax barium enemas. Bisacodyl is your doctor. Using without a prescription. for a long time may result in loss of normal bowel function. y This medication is sometimes prescribed for other uses; ask  Do not take additional laxatives or stool your doctor or pharmacist for more information. softeners with Dulcolax unless directed by y Short-term relief of constipation. your doctor. y It prevents straining. bleeding or failure to have a bowel  Rectal y To evacuate bowel for diagnostic procedures.after use of a movement within 12 hours

laxative may be a sign of a serious medicines have not been tested in older people. Therefore,doctor. condition. Stop use and contact your it may not be known whetherIf you notice a sudden change theybowel they work exactly the same way in do in  younger adults or if they cause different sideweeks or more, do not habits that lasts for 2 effects or problems in older people. There is no specific information about the use of continue using Dulcolax . Instead, check vitamin K in the elderly. your doctor. with Adverse reactions: PREGNANCY and BREAST-FEEDING: If   Decreased appetite; decreased your doctor. you become pregnant, contact movement or activity; need to in breathing; enlarged You will difficulty discuss the benefits and liver; using body swelling; irritability; risks ofgeneralDulcolax while pregnant. It is muscle stiffness; paleness; yellow eyes or not known if Dulcolax is found in breast skin. milk. If you are or will be breast-feeding  Less Dulcolax , check with your doctor. take common: Difficulty in swallowing; fast or irregular breathing; lightheadedness Discuss any possible risks to your baby. or fainting; shortness of breath; skin rash, hives and/or itching; swelling of eyelids, face, or lips; tightness in chest; troubled breathing and/or wheezing. Blue color or flushing or redness of skin; dizziness; fast and/or weak heartbeat; increased sweating; low blood pressure (temporary).  Rare: Flushing of face; redness, pain, or swelling at place of injection; skin lesions at place of injection (rare); unusual taste. Nursing considerations/Patient teaching:  If you take warfarin (a blood thinner), you should know that vitamin K or foods containing vitamin K can affect how the Generic name: VITAMIN K drug works.

Brand names: AquaMEPHYTON, Mephyton  Drug classification: Vitamin K deficiency is very rare. It occurs Clotting vitamin/agent when the body can't properly absorb the vitamin from the intestinal tract. Indications: Vitamin K deficiency can also occur after For those  with vitamin K deficiency, thus usually more likely to long-term treatment with antibiotics. have bruising and bleeding.  If given taking anticoagulant prevent Vitamin K is routinely you areto newborn infants tomedicine bleeding problems. (blood thinners), the amount of vitamin K in your diet may affect how well these Mode of Action: medicines work. plays an important role in Vitamin K is a fat-soluble vitamin that Your doctor or health care professional may recommend changes in blood clotting. Contraindications: your diet to help these medicines work better. In patients receiving anticoagulants (blood thinners) as vitamin K decreases the effects of these drugs. Caution: PregnancyVitamin K has not been reported to cause birth defects or other problems in humans. However, the use of vitamin K supplements during pregnancy is not recommended because it has been reported to cause jaundice and other problems in the baby. Breast-feedingVitamin K taken by the mother has not been reported to cause problems in nursing babies. You should check with your doctor if you are giving your baby an unfortified formula. In that case, the baby must get the vitamins needed some other way. ChildrenChildren may be especially sensitive to the effects of vitamin K, especially menadiol or high doses of phytonadione. This may increase the chance of side effects during treatment. Newborns, especially premature babies, may be more sensitive to these effects than older children. Older adultsMany Generic name: Tranexamic acid

Brand name: Cyklokapron Drug classes Indication: This medication is used for short-term control of Antibiotic;bleeding in hemophiliacs, including dental extraction Cephalosporin (third generation) Therapeutic actions procedures. Bactericidal: InhibitsHemostatic, systemic; anti-fibrimolytic agent Drug classification: synthesis of bacterial cell wall, causing cell death. Mechanism of Action: This acts against breakdown of clots (by Indications inhibiting or stopping plasminogen activation and fibrinolysis), and so it is useful in stopping severe blood Lower respiratory infections caused by P. aeruginosa, other clot formation. S. pneumoniae, S. loss as it increases Pseudomonas, aureus, Klebsiella, H. surgery, P. mirabilis, E. coli, Dosage: IV, Immediately beforeinfluenzae,10 mg/kg; then, after Enterobacter, Serratia, Citrobacter surgery, PO, 25 mg/kg t.i.d.-q.i.d. for 2-8 days. Alternative caused by P. 25 mg/kg t.i.d.-q.i.d. one day UTIs regimen: PO, aeruginosa, Enterobacter, E. coli, Klebsiella, P. mirabilis, Proteus prior to surgery. Gynecologic using this drug, by your doctor your Special Precautions: Beforeinfections caused tell E. coli medical history, including: any allergies, aeruginosa, Dermatologic infections caused by P. history of S. aureus, orE. coli, eye problems blood clots bleeding, Serratia, Proteus, Klebsiella, Enterobacter, S. pyogenes (retina/color vision), kidney disease, head injury (subarachnoid Septicemia caused by P. aeruginosa, E. this hemorrhage). Tell your doctor if you are pregnant before usingcoli, Klebsiella, H. influenzae, Serratia, S. pneumoniae, S. drug. This drug is excreted into human milk. Consult your doctor aureus before breast-feeding. Pregnancy riskIntra-abdominal infections caused by E. coli, S. category: C Adverse aureus, Bacteroides,vomiting, diarrhea might occur. If reaction: Nausea, Klebsiella these persist infections caused by H. influenzae, N. CNS or worsen, notify your doctor promptly. meningitidis Very unlikely but report promptly: vision changes, dizziness. and joint infections caused by P. aeruginosa, Bone Klebsiella, Enterobacter, S. aureus Contraindications: Subarachnoid hemorrhage, acquired defective Contraindications and cautions color vision. Form: Tablets; Contraindicated with allergy to cephalosporins or syrup (for pediatric use) penicillins.

Nursing Responsibilities:  Assess Use cautiously pulse before starting IV, patient baseline BP and with renal failure, lactation, pregnancy. frequently for hypotension during IV infusion which Adverse effects may indicate the infusion is to fast. Slow the IV and repot CNS: physician. dizziness, lethargy, paresthesias to the Headache, GI: Nausea, vomiting, diarrhea, anorexia,  Observe patient for signs and symptoms of thrombosis, abdominal pain, flatulence, pseudomembranous colitis, such as leg pain, respiratory distress, o chest pain and liver toxicity report. GU: reduced dosage in patients with impaired  Anticipate Nephrotoxicity Hematologic: Bone marrow depression renal function. decreased WBC, decreased platelets, decreased Hct  Stress the importance of opthalmological examinations at Hypersensitivity: Ranging regular intervals during therapy. from rash to fever to anaphylaxis, serum sickness reaction Local: Pain, abscess at injection site; phlebitis, inflammation at IV site Other: Superinfections, disulfiram-like reaction with alcohol Interactions Drug-drug Increased nephrotoxicity with aminoglycosides Increased bleeding effects with oral anticoagulants Drug-lab test Possibility of false results on tests of urine glucose using Benedict's solution, Fehling's solution, Clinitest tablets; urinary 17-ketosteroids; direct Coombs' test Nursing considerations Assessment Generic nameL Ceftazidime History: Liver and renal dysfunction, lactation, pregnancy Brand name: Tazidime, Ceptaz, Fortaz, Tazicef

Physical: Skin status, LFTs, renal function tests, culture of 4) euphoria affected area, sensitivity tests 5) headacheInterventions - RESP: Culture infection, and arrange for sensitivity tests 1) asthma before and during therapy if expected response is not 2) dyspnea seen. - CV: Reconstitute drug for IM use with sterile water or 1) edema bacteriostatic water for injection or with 0.5% or 1% 2) pallor lidocaine HCl injection to reduce pain; inject deeply into 3) vasodilation muscle group. large - GI: WARNING: Do not mix with aminoglycoside 1) GI Bleeding solutions. Administer these drugs separately. 2) abnormal taste Powder and reconstituted solution darken with 3) diarrhea storage. 4) dry mouth Have vitamin K available in case 5) dyspepsia hypoprothrombinemia occurs. 6) GI pain Discontinue if hypersensitivity reaction occurs. 7) nausea - GU: Teaching points 1) oliguria Avoid alcohol while taking this drug and for 3 days 2) renal toxicity after because severe reactions often occur. 3) urinaryfrequency may experience these side effects: Stomach You - DERM: upset or diarrhea. 1) pruritis Report severe diarrhea, difficulty breathing, 2) purpura unusual tiredness or fatigue, pain at injection site. 3) sweating 4) urticaria NAME: GENERIC

Ketorolac - HEMAT: BRAND NAME: 1) prolonged bleeding time Toradol - LOCAL: CLASSIFICATION: 1) injection site pain Nonsteroidal anti-inflammatory agents, nonopioid analagesics - NEURO: DOSAGE: 1) paresthesia IM 30mg/amp1 amp - MISC: MECHANISM OF ACTION: 1) allergicprostaglandin synthesis, producing peripherally mediated - Inhibits reaction, anaphylaxis NURSING IMPLICATIONS/RESPONSIBILITIES: analgesia - Also has antipyretic and anti-inflammatory properties. and nasal Patients who have asthma, aspirin-induced allergy, polyps are at increased risk for developing hypersensitivity - Therapeutic effect:Decreased pain reactions. Assess for rhinitis, asthma, and urticaria. INDICATION: - Assess pain (note type, of pain (not to exceed 5 days total for all Short term management location, and intensity) prior to and 1-2 hr following administration. routes combined) - Ketorolac therapy should always be given initially by the IM or CONTRAINDICATIONS: IV route. Oral therapy should be used only as a continuation of - Hypersensitivity parenteral therapy. with other NSAIDs may existPre- or - Cross-sensitivity - Caution patient to avoid concurrent use of alcohol, aspirin, perioperative use NSAIDs, alcohol intoleranceUseother OTCin: - Known acetaminophen, or cautiously medications without consulting of GI bleeding 1) History health care professional. - Advise impair-mentconsult if rash, itching,be required) 2) Renal patient to (dosage reduction may visual disturbances, tinnitus, weight gain, edema, black stools, persistent headche, or 3) Cardiovascular disease influenza-like syndromes (chills,fever,muscles aches, pain) occur. SIDE EFFECTS/ ADVERSE EFFECTS: - CNS: Effectiveness of therapy can be demonstrated by decrease in severity of pain. Patients who do not respond to one NSAIDs may 1) drowsiness respond to another. 2) abnormal thinking 3) dizziness Generic name: CEFTRIAXONE

Brand names: Rocephin, Rocephin IM Convenience Kit Indication: (obsolete) NUBAIN is indicated for the relief of moderate to severe pain. INDICATION: NUBAIN can also be used as a supplement to balanced anesthesia, Typhoid fever for preoperative and postoperative analgesia, and for obstetrical Susceptible infections analgesiaprophylaxis and delivery. Surgical during labor Side effect: Uncomplicated gonorrhea CNS Effects: Nervousness, depression, restlessness, crying, secondary meningococcal meningitis 2 euphoria, floating, hostility, unusualmore of the penicillin-binding MOA: Ceftriaxone binds to one or dreams, confusion, faintness, hallucinations, dysphoria, feelingthe heaviness, numbness, tingling, proteins (PBPs) which inhibits of final transpeptidation step of unreality. The synthesis in bacterial cell wall,effects, inhibiting peptidoglycan incidence of psychotomimetic thus such as unreality, and arresting cell wall delusions, resulting in bacterial dysphoria and biosynthesis depersonalization, assembly hallucinations has been shown to be less than that which occurs cell death. with pentazocine. Contraindications Cardiovascular: to Hypertension, hyperbilirubinaemic neonates. bradycardia, Hypersensitivity cephalosporins; hypotension, tachycardia. calcium or calcium-containing solutions or products Do not use Gastrointestinal: Cramps,ceftriaxone bitter taste. with or within 48 hr of dyspepsia, administration due to risk of Respiratory: Depression, dyspnea, asthma. calcium-ceftriaxone precipitate formation. Dermatologic: Itching, burning, urticaria. Miscellaneous: Speech difficulty, urinary urgency, blurred vision, Special Precautions flushing of penicillin allergy; severe renal impairment; pregnancy History and warmth. NURSING CONSIDERATIONS: and lactation; superinfection. Do NOT use Nubain if: Adverse Drug Reactions * you are allergic to any diarrhoea; Nubain or to blood Superinfection; anaphylaxis; ingredient inlocal reactions;another opioid analgesic (eg, morphine or hydromorphone) dyscrasias; rash, fever, pruritus; elevated transaminases and * you have diarrhea due to poisoning, a certain type of bowel alkaline phosphatase; leucopenia, neutropenia. problem (pseudomembranous colitis), or are dependent on any Potentially Fatal: Pseudomembranous colitis; nephrotoxicity. medicine or substance Drug Interactions * you are taking sodium oxybate (GHB)

Disulfiram-like reaction with alcohol. Contact your doctor or health care provider right away if any of SE: these apply to you. diarrhea that is watery or bloody; fever or chills; skin rash, bruising, severe tingling, numbness, pain, muscle weakness; blistering, peeling, and red skin rash; white patches or sores inside your mouth or on your lips; pale or yellowed skin, dark colored urine, confusion or weakness; urinating less than usual or not at all; swelling, pain, or irritation where the injection was given; or chalky-colored stools, stomach pain just after eating a meal, nausea, heartburn, bloating, and severe upper stomach pain that may spread to your back.

Generic name: METOCLOPROMIDE Brand Name: PLASIL CLASSIFICATIONS NUBAIN / NALBUPHIN Therapeutic:

Antiemetics Brand name: Apo-Furosemide (CAN), Furosemide Special ACTIONS (CAN), Lasix Physiologic Mechanism Drug class: nausea and vomiting. Decreased Loop diuretic Therapeutic actions: Inhibits stasis. Decreased symptoms of gastric the reabsorption of sodium and chloride from the ascending Pharmacologic Mechanism limb of the loop of Henle, leading to a sodium-rich diuresis. Blocks dopamine receptors in chemoreceptor trigger zone of the Indications CNS. a) Oral, IV: Edema upper GI with CHF, cirrhosis, renal Stimulates motility of the associated tract and accelerates gastric emptying.disease b) IV: Acute pulmonary muscle relaxation produced by Plasil inhibits gastric smoothedema c) dopamine,Oral: Hypertension therefore increasing cholinergic response of the Contraindications and muscle. It accelerates intestinal transit and gastrointestinal smooth cautions a) Contraindicated with allergy to furosemide, gastric emptying by preventing relaxation of gastric body and increasingsulfonamides; activity of antrum. Simultaneously, this the phasic allergy to tartrazine (in oral solution); anuria, severe renal failure; the upper small intestine, action is accompanied by relaxation of hepatic coma; pregnancy; resulting lactation. in an improved coordination between the body and b) antrum ofUse cautiouslyand the upper small intestine. Plasil also the stomach with SLE, gout, diabetes mellitus. Excretion:reflux into the esophagus by increasing the resting decreases Feces, urine Adverse effects lower esophageal sphincter and improves acid pressure of the a. CNS: Dizziness, vertigo, paresthesias, clearance from the esophagus by increasing amplitude of xanthopsia, weakness, dopamine antagonist esophageal peristaltic contractions. Plasil'sheadache, drowsiness, fatigue, activity in the tinnitus, irreversible action raises the threshold ofblurred vision, chemoreceptor trigger zone and decreases hearing loss afferent visceral nerves. Studies the input from b. CV: Orthostatic hypotension, volume have also shown that high doses of metoclopramide can antagonize depletion, cardiac arrhythmias, 5-hydroxytryptamine (5-HT) receptors in the peripheral nervous system in animals. thrombophlebitis

SIDE EFFECTS: Metoclopramide is generally well-tolerated c. Dermatologic: Photosensitivity, rash, pruritus, when used in low doses for brief periods. Neurological side effects urticaria, purpura, increase with higher doses and longer exfoliativeof dermatitis, periods treatment. erythema multiforme Common side effects of metoclopramide include drowsiness, d. GI: Nausea, anorexia, vomiting, sedation. restlessness, fatigue, anxiety, insomnia, depression, and oral and gastric irritation, constipation, diarrhea, acute The most serious neurological side effects of metoclopramide are pancreatitis, jaundice symptoms mimicking Parkinson's disease, involuntary muscle e. grimacing, and nocturia, glycosuria, urinary movements, facial GU: Polyuria, dystonic reactions resembling bladder spasm tetanus. Fortunately, these more serious side effects are infrequent f. Hematologic: Leukopenia, anemia, and usually - though not always - disappear when metoclopramide thrombocytopenia, fluid and electrolyte is discontinued. Patients with Parkinson's disease can experience imbalances, metoclopramide. Metoclopramide worsening of symptoms with hyperglycemia, hyperuricemia may impair theg. Other: Muscle cramps and muscle spasms mental and/or physical abilities to drive or operate Drug-drug machinery. Interactions a. Increased risk of cardiac arrhythmias with INDICATION digitalis glycosides (due to electrolyte Management of esophageal reflux imbalance) Treatment and prevention of postoperative nausea and vomiting b. Increased risk of ototoxicity with NURSING CONSIDERATIONS aminoglycoside antibiotics, cisplatin Assess patient for nausea, vomiting, abdominal distention, and c. Decreased absorption bowel sounds before and after administration.of furosemide with phenytoin May cause drowsiness. d. Decreased natriuretic and antihypertensive Advise patient to avoid concurrent use of alcohol and other CNS effects medication. depressant while taking this with indomethacin, ibuprofen, other Advise patient to NSAIDs notify health care professional immediately if e. Decreased face or limbs with charcoal involuntary movement of eyes,GI absorption occurs. f. May Lasix/FurosemideBID reduce effect of insulin or oral antidiabetic agents because blood glucose Generic name: Furosemide levels can become elevated Nursing considerations

CLINICAL ALERT! Generic name: has occurred Name confusionspironolactone between furosemide and torsemide; Brand names: Aldactone, Novospiroton (CAN) use extreme caution. Assessment Drug classes: Potassium-sparing diuretic; sulfonamides, tartrazine; History: Allergy to furosemide, Aldosterone antagonist Therapeutic actions electrolyte depletion anuria, severe failure; hepatic coma; SLE; Competitively blocks the effects pregnancy gout; diabetes mellitus; lactation, of aldosterone in the renal tubule, causingPhysical: Skin color, lesions, retentionorientation, reflexes, loss of sodium and water and edema; of potassium. Indications hearing; pulses, baseline ECG, BP, orthostatic BP, perfusion; R, a. Diagnosis and maintenance of sounds; pattern, adventitious sounds; liver evaluation, bowel primary hyperaldosteronism urinary output patterns; CBC, serum electrolytes (including b. Adjunctive renal in edema associated with calcium), blood sugar, LFTs, therapy function tests, uric acid, urinalysis, weight CHF, nephrotic syndrome, hepatic cirrhosis when other therapies are inadequate or Interventions inappropriate Administer with food or milk to prevent GI upset. c. Treatment of hypokalemia or prevention of Reduce dosage if given with other antihypertensives; readjust dosage gradually as hypokalemia in patients who would be at high BP responds. risk day so that increased urination will not Give early in the if hypokalemia occurred: Digitalized patients, patients with cardiac arrhythmias disturb sleep. Avoid IVd. if oral use hypertension, usually in combination use Essential is at all possible. with not drugs WARNING: Doother mix parenteral solution with highly e. Unlabeled 3.5. acidic solutions with pH belowuses: Treatment of hirsutism due to its light, may discolor tablets palliation of Do not expose toantiandrogenic properties, or solution; do symptoms of PMS, treatment of familial male not use discolored drug or solutions. precocious puberty, Discard diluted solution after 24 hr. short-term treatment of acne vulgaris Refrigerate oral solution. Contraindicationsrecord weight to monitor fluid changes. Measure and and cautions

Arrange to monitor serum electrolytes, hydration, liver and Contraindicated with allergy to spironolactone, renal function. hyperkalemia, renal disease, anuria, amiloride Arrange for potassium-rich diet or supplemental potassium as or triamterene use. needed. Teaching points Use cautiously with pregnancy, lactation. Record intermittent therapy on a calendar or dated envelopes. ADULTS When possible, take the drug early so increased urination will not disturbEdema: Initially, 100 mg/day (range 25200 upset. when sleep. Take with food or meals to prevent GI mg/day) given as the sole agent; continue > 5 days, then adjust dose or add another diuretic or both. a regular basis, at the same time and in the Weigh yourself on same Diagnosis of hyperaldosteronism: 400 mg/day PO for 34 wk clothing, and record the weight on your calendar. (long test). Correction of hypokalemia temporarily elevatedare Blood glucose levels may become and hypertension in presumptive diabetes of primary hyperaldosteronism. 400 mg/day patients with evidence after starting this drug. PO You may (short test). If side K+ increases but decreases for 4 days experience theseserumeffects: Increased volume and when drug is stopped, presumptive diagnosis canfaint on arising, frequency of urination; dizziness, feeling be made. Maintenance position changes; hazardous activities, like drowsiness (avoid rapid therapy for hyperaldosteronism: 100400 mg/day PO. consumption of alcohol); sensitivity to sunlight (use driving; and sunglasses,Essential hypertension: 50100 amg/day PO. increased wear protective clothing, or use sunscreen); May be combined with other diuretics. thirst (suck on sugarless lozenges; use frequent mouth care); loss body potassium (a potassium-richPO. or potassium supplement of Hypokalemia: 25100 mg/day diet will be needed). PEDIATRIC PATIENTS of more than 3 pounds in 1 day, swelling Report loss or gain yourEdema: 13.3 mg/kg/day PO adjusted tobruising, dizziness, in ankles or fingers, unusual bleeding or patient's response, administered as singlefatigue, muscle weakness or cramps. trembling, numbness, or divided dose. Excretion: Urine Adverse effects a. CNS: Dizziness, headache, drowsiness, fatigue, ataxia, confusion b. Dermatologic: Rash, urticaria

GI: Cramping, diarrhea, dry mouth, thirst, Avoid foods that are rich in potassium (fruits, vomiting. Sanka); avoid licorice. GU: Impotence, irregular menses, amenorrhea, You may experience these side effects: postmenopausal bleeding Increased volume and frequency of urination; Hematologic: Hyperkalemia, hyponatremia, dizziness, confusion, feeling faint on arising, agranulocytosis f. drowsiness (avoid rapid position changes, Other: Carcinogenic in animals, deepening of hazardous hirsutism, gynecomastia the voice, activities: driving, using alcohol); increased thirst (suck on sugarless lozenges; Drug-drug Interactions a. use frequent hyperkalemiachanges in potassium Increased mouth care); with menstrual cycle, deepening ofinhibitors, diets rich in supplements, ACE the voice, impotence, enlargement of the breasts can occur potassium b. (reversible). Decreased diuretic effect with salicylates e. Report weight change of more than effect of c. Decreased hypoprothrombinemic 3 pounds in one day, swelling in your ankles or fingers, anticoagulants dizziness, trembling, numbness, fatigue, Drug-food enlargement of breasts, deepening of voice, Increased absorption when taken with food impotence, muscle weakness or cramps. Drug-lab test Interference with radioimmunoassay for digoxin; false increase in serum digoxin levels Drug-alternative therapy Decreased effectiveness if combined with licorice therapy Nursing considerations Assessment History: Allergy to spironolactone; hyperkalemia; renal disease; pregnancy, lactation

c. c. d. d. e.

Physical: Skin color, lesions, edema; orientation, reflexes, muscle strength; P, baseline ECG, BP; R, pattern, adventitious Generic liver evaluation, bowel sounds; urinary output patterns, sounds; name: Aminoleban MIMS Class : Enteral/Nutritional Products renal function tests, menstrual cycle; CBC, serum electrolytes, Contents urinalysis Per 50 g L-isoleucine 1.9225 g, L-leucine 2.037 g, lysine HCl Interventions 0.2425 g, L-threonine 0.133 g, L-valine 1.602 g, L-arginine HCl a. Mark calendars of edema outpatients as 0.302 g, L-histidinereminders of g, L-tryptophan 73.5to 5-day/wk HCl 0.1875 alternate day or 3- mg, gelatin hydrolysate 6.5 g, rice oil 3.5 g, dextrin 31.05 g, retinol palmitate therapy. 466 iu, ergocalciferol 46.6dailybisbentiamine 0.145 that riboflavin b. Give iu, doses early so mg, increased 0.155 mg, pyridoxine HCl 0.245 not interfere with sleep.0.5 mcg, urination does mg, cyanocobalamin folic acid 50 mcg, Na L-ascorbate 6.9 mg, tocopherol acetate 9.3 c. Make suspension as follows: Tablets may be mg, phytonadione 5.5 mcg, Ca and given in cherry syrup for young pulverized pantothenate 1.19 mg, nicotinamide 1.515 mg, biotin 25 mcg, cholinesuspension 12.3 mg, for 1sulfate children. This bitartrate is stable Mg mo if 0.205 g, Ca glycerophosphate 0.305 g, Na dihydrogen phosphate refrigerated. dihydrate 0.195 g, Na Fe citrate 12.5 mg, cupricweight to monitor d. Measure and record regular sulfate 0.515 mg, Zn sulfate 3.755 mg, K iodide 12.5edemamanganese sulfate 0.815 mobilization of mcg, fluid. mg, KCl 0.1875 g Avoid giving food rich in potassium. e. Mechanism off. Arrange for regular evaluation of serum Action y Pharmacology: In experiments using rats and dogs with electrolytes, BUN. Teachingportacaval shunts (PCS) as a chronic hepatic points insufficiency model, Aminoleban ENon a calendar,the a. Record alternate-day therapy normalized or imbalanced plasma and brain Take the drug early prepare dated envelopes. free amino acid concentration patterns and urination. because of increased in particular, improved abnormal Weigh yourself on a regular basis, at the same b. intracerebral serotonin metabolism. y In experimental coma the same by loading ammonia the time and in induced clothing, and record on normal rats, Aminoleban calendar. to prevent the onset weight on your EN tended of coma and to reduce the duration of coma. In

ammonia-loaded PCS rats, Aminoleban EN inhibited the Flavors andelectroencephalographic voltage. decrease of fibrous vegetables may be mixed with the preparation to improve rats used as an acute hepatic In hepatic devascularizedpalatability. Fresh fruit juice should not bemodel, Aminoleban EN improved plasma insufficiency combined since the acidity of fruit juices may cause gel amino acid and brain free formation. concentration imbalances and y Others: The regular daily dosage (150 g) of Aminoleban abnormal intracerebral amine metabolism. EN PCS rats 40.5 g as a chronic hepatic insufficiency y In provides used of protein and a total of 630 kCal. When repeated administration of and calories, the model, the patient needs more protein Aminoleban EN balance should weight and produced positive nitrogen increased body be supplemented in theapatient's diet. y When a patient the protein efficiency ratio to its taste balance. Also, rejects Aminoleban EN due tended to (particularly aits bitterness), injury catabolic the product increase. In postoperative the dosage of state in the may rats, repeated administration of Aminoleban EN PCS be reduced to approximately 0.8 kCal/mL [reconstitute 1 weight and producedAminolebannitrogen increased body package (50 g) of a positive EN in approximately 230 mL hepatic insufficiency induced by balance. In rats with of water or warm water]. y When a patient requires tetrachloride, water intake, EN treatment with carbon restriction of Aminoleban the dosage of the decrease in EN may beand producedto suppressed Aminoleban body weight increased a positive nitrogen balance. approximately 2 kCal/mL [reconstitute 1 package (50 g) of rats with obstructiveapproximately 80 mL of water or y In Aminoleban EN in jaundice produced by ligation of warm water]. bile duct, Aminoleban EN increased body the common weight and produced a positive nitrogen balance. Contraindications: AllergyUsefulness: The clinical dietary value y Clinical Studies: to milk Adverse of Aminoleban EN Hypoglycemia. GI & that of a Drug Reactions: was compared with metabolic dusturbances, headache & dulldiet alone in hepatic insufficiency conventional liver headache. patients, mostly those with hepatic encephalopathy. Usefulness was assessed based on global improvement of electroencephalogram (EEG) findings, neuropsychiatric symptoms, subjective and objective symptoms and Fischer's ratio, and safety. According to y y

the results, Aminoleban EN was determined to be useful Generic name: Filgrastim113) of the patients studied. in 65.5% (74 of (GCSF) Trade name: aNeupoge y In long-term study with Aminoleban EN using Drug type: G-CSF is a biologic response modifier. It isusefulness decompensated hepatic insufficiency patients, classified as a colony stimulating factor. on the global improvement and was assessed based Mechanism of action: including the grade of encephalopathy, quality of life, FilgrastimKarnofskys performance score As a change in patient binds to the G-CSF receptor. and G-CSF analog, it controls proliferation ofinpatient toprogenitor cells and influences status from committed outpatient. Usefulness was their maturation into mature neutrophils. Filgrastim also stimulates demonstrated in 72.9% (70 of 96) of the patients studied. the release of neutrophils from bone marrow storage pools rate y Effect on Patient Survival: The cumulative survival and reduces their maturation time.with Aminoleban EN for 6 months in the patients treated Filgrastim acts to increase the phagocytic activity of mature neutrophils. In in the patients of was significantly greater than that patients receiving cytotoxic historical data group. chemotherapy, Filgrastim can accelerate neutrophil recovery, Nutritional Improvement: Aminoleban EN neutropenic leading to a reduction in duration of the produced a y phase positive nitrogen balance and normalized serum protein used for: levels. 1. Filgrastim is used to stimulate of production of Indications Improvement of nutritional state the chronic hepatic granulocytes (a type of white blood cell) in patients insufficiency patients including those w/ hepatic encephalopathy. Cautions undergoing therapy that will cause low white blood cell For Usage counts. Administration: Aminoleban EN is intended for y Route ofThis medication is used to prevent infection and neutropenic (low white blood cells) fevers caused by oral feeding and should not be administered into a blood chemotherapy. vessel. 2. Method of is a supportfor Administration: Aminoleban Filgrastim Preparation medication. It does not treat y cancer. EN should be reconstituted before use (within 10 hrs). If How this necessary, the preparation should be stored in a cool drug is given: 1. place. Filgrastim may be given by subcutaneous (the layer between the skin and muscle) injection or infused into a y Boiling water should not be used for reconstitution to vein (intravenous, IV). avoid denaturation of the protein.

Filgrastim is generally given on a daily basis. The Contact your health care provider immediately, day or number of days you receive filgrastim will be prescribed night, if you by your doctor.should experience any of the following 3. symptoms: should be refrigerated. Filgrastim Remove from a. Fever of 100.5 F injection. higher, chills refrigerator 30 minutes before(38 C) or Do not shake (possible signs of infection) the medication. b. Shortness of breath 4. The amount of filgrastim that you will receive depends c. Rapid including on many factors,heart beat your height and weight, your d. Bleeding that health problems, and the type of general health or other does not stop after a few minutes e. cancer orAny new rashes ontreated. Your doctor will condition being your skin 2. determine your dose and schedule. Do not take aspirin, products containing aspirin unless your doctor specifically permits side effects : less common side effects this. 3. Apply a warm compress if you have any pain, go away 1. Pain (bone pain) - Bone pain that does notredness or swelling at the recommended notify your doctor. despite takinginjection site, and pain reliever; Always 4. inform your at risk of infection so if you avoid crowds or You may be health care provider try to experience any people symptoms unusualwith colds, and report fever or any other signs of infection immediately to (temporary elevation in 2. Blood test abnormalities your health care provider.lactate 5. dehydrogenase, and alkaline phosphatase). These will Wash your hands often. 6. return to normal onceor activities that could cause injury. Avoid contact sports treatment is discontinued. 7. This medication site of little nausea. But if you should 3. Tenderness at thecauses injection experience nausea, take anti-nausea medications as Adverse effect: prescribed by your doctor, and eat (4%); cardiac events Cardiovascular: Hypertension, hypotension small, frequent meals. Sucking on lozenges, and chewing gum may also help. (eg, MI, arrhythmias [3%]). 8. In general, drinking (7%); generalized weakness (4%). CNS: Fatigue (11%); headache alcoholic beverages should be kept to a Alopecia or avoided completely. rash 12%; Dermatologic: minimum (18%); petechiae (17%); You should cutaneousdiscuss this with your doctor. preexisting skin disorders vasculitis; exacerbation of 9. Get (eg, psoriasis).plenty of rest. 10. Maintain good nutrition. EENT: Epistaxis (15%); sore throat (4%).

2. 1.

GI: Nausea/vomiting (57%); diarrhea (14%); mucositis (12%); 11. If you experience symptoms or side effects, be sure anorexia (9%); stomatitis, constipation (5%); peritonitis (2%). to discuss them with your health insufficiency. Genitourinary: Hematuria/proteinuria; renal care team. They can prescribe medications and/or offer other suggestions that Hematologic-Lymphatic are effective in managing such Respiratory: Dyspnea (9%); cough (6%). problems. Monitoring and testing: Drug Interactions You will bemay potentiate the by your of neutrophils, such as Drugs that checked regularly release health care professional while you are taking used withtocaution. Use effects caution in lithium, should be filgrastim monitor side with and check your response toother drugsPeriodicto lowerworkplatelet count. conjunction with therapy. known blood the to monitor your complete blood count (CBC) as well as the function of other Monitor organs (such as your kidneys and liver) will also be ordered by y Myelosuppressive chemotherapy-Obtain CBC, WBC, your doctor. platelet count prior to chemotherapy and 2 times/wk and How this during filgrastim therapy. drug works: Colony-Stimulating Factors: In the body's bone marrow (the soft, sponge-like material found y Bone marrow transplant- Obtain CBC and platelet count inside bones) blood cells are produced. There are three major at least 3 times/wk following marrow transplantation. typesyof blood cells; white blood cells, which fight infection;with red Severe chronic neutropenia- Obtain CBC blood cells, which carry platelet count 2 remove waste products differential and oxygen to and times/wk during first 4 from organs andfilgrastimand platelets, which enablewk following wk of tissues; therapy, and during the 2 the blood to clot. Cancerdose adjustment; once chemotherapy and radiation any treatments such as stable, obtain once monthly therapy can effectyear then at least quarterly thereafter. Perform for first these cells which put a person at risk for developing infections, anemia and bleeding problems. Colonybone marrow and cytogenetic evaluations annually in stimulating factorswith congenital neutropenia. the production of patients are substances that stimulate blood cells and promote their abilitycell function. They do not y Peripheral blood progenitor to collection/therapy directlyneutrophil count after 4 days of filgrastim. Considerblood affect tumors but through their role in stimulating dose Obtain cells they canifbe helpful as greater than 100,000/mm 3 modification WBC count support of the persons immune system during cancer treatment. Filgrastim is a growth factor that stimulates the production, NURSING INTERVENTION: maturation and activation of neutrophils. Filgrastim also

stimulates the release of neutrophils (a type of white blood cell) (parenteral) to allow decreased from the bone marrow. In patients receiving chemotherapy, opioid dosage filgrastim can accelerate the recovery of neutrophils, reducing the v. in administration: Management to neutropenic phase (the time IM which people are susceptible of the acutely disturbed or hysterical infections). patient; the acute or chronic alcoholic with anxiety withdrawal symptoms or delirium tremens; as preoperative and postoperative and prepartum and postpartum adjunctive medication to permit reduction in narcotic dosage, allay anxiety, and control emesis Contraindications and cautions i. Contraindicated with allergy to hydroxyzine, pregnancy, lactation. ii. Use cautiously with uncomplicated vomiting in children (may contribute to Reye's syndrome or unfavorably influence its outcome; extrapyramidal effects may obscure diagnosis of Reye's syndrome). Excretion: Urine Adverse effects i. CNS: Drowsiness, involuntary motor activity, including tremor and seizures

Generic name: hydroxyzine ii. Brand name: Vistaril, Iterax GI: Dry mouth, reflux, constipation iii. GU: Urinary retention Drug classes; Anxiolytic; Antihistamine; Antiemetic Wheezing, Therapeutic actions iv. Hypersensitivity: dyspnea, chest tightness Mechanisms of action not understood; actions may be due to suppression of subcortical areas of the CNS; has clinically Drug-drug Interactions demonstrated antihistaminic, analgesic, antispasmodic, antiemetic, Potentiating action when used concomitantly with CNS mild antisecretory, and bronchodilator activity depressants Indications (opioids, barbiturates) i. Symptomatic relief of anxiety and Nursing considerations tension associated with Assessment psychoneurosis; adjunct in organic History: Allergy to hydroxyzine states in which anxiety is disease or cetirizine, uncomplicated vomiting in children, lactation, pregnancy alcoholism and asthma; manifested; Physical: Skin color, lesions,dental procedures before texture; orientation, reflexes, affect; R, adventitious sounds ii. Management of pruritus due to Interventions allergic conditions, such as chronic WARNING: Determine and treat underlying cause of urticaria, atopic and contact vomiting. Drug may maskdermatosis, symptoms of serious signs and and in histamineconditions, such as brain tumor, intestinal obstruction, mediated pruritus appendicitis. iii. Sedation when used as Do not administer parenteral solution subcutaneously,general premedication and following IV, or intra-arterially; tissue necrosisanesthesia has occurred with subcutaneous and intra-arterial injection, and hemolysis with IV injection. iv. Control of nausea and vomiting and Give IM injections deep into a large muscle. In adults, use as adjunct to analgesia upper outer quadrant of buttocks or midlateral thigh; in children preoperatively and postoperatively use midlateral thigh muscles; use deltoid area only if well developed.

SIDE EFFECTS: This medication may cause headache, nausea, dizziness, points yeast infection and irritation at the injection site. Teaching vaginal If any of this drug as prescribed. or worsen, notify your doctor Take these effects persist Avoid excessive dosage. promptly. Tell your doctor immediately if you have any sedation, You may experience these side effects: Dizziness, of these unlikely but(use caution if drivingmental/mood changes, vomiting, drowsiness serious side effects: or performing tasks that require severe stomach alcohol, sedatives,or bloody (serious overdosage alertness); avoid cramps, watery sleep aids diarrhea, fever or unusualresult); dry mouth (frequent mouth care, sucking on weakness, muscle twitching (myoclonus), unusual could bleeding lozenges mayyellowing of the eyes or skin. Tell your sugarless or bruising, help). doctor immediately if you have any of these very coordination, Report difficulty breathing, tremors, loss of unlikely but serious side effects: change in amount of urine, seizures. An sore muscles, or muscle spasms. allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of an allergic reaction include: skin rash, hives, severe dizziness, itching, difficulty breathing.. If you notice other effects not listed above, contact your doctor or pharmacist. PRECAUTIONS: Tell your doctor if you have: allergies (especially to penicillin, cephalosporins or other antibiotics), kidney disease, liver disease, bleeding disorders, seizure disorders, colitis. Use of this medication for prolonged or repeated periods may result in a secondary infection (e.g., oral, bladder, colon or vaginal yeast infection). Use in patients under 2 months of age has not been established. Caution is advised when using this drug in the elderly because they may be more sensitive to the effects of the drug. Tell your doctor if you are pregnant before using this medication. This drug is excreted into breast milk in small amounts. Consult with your doctor before breast-feeding. DRUG INTERACTIONS: Tell your doctor of any nonprescription or prescription medication you may take,

including: blood thinners, water pills (diuretics), other antibiotics. This drug may interfere with the INJECTION (SEFF-eh-peem) GENERIC NAME: CEFEPIMEeffectiveness of birth control pills. Discuss NAME(S): Maxipime BRANDusing other methods of birth control with your doctor. This drug may cause Mode of action:false positive results in some diabetic urine testing products or Maxipime inhibits bacterial cell wall or pharmacist Cefepime(cupric sulfate-type). Consult your doctor formation and for recommendations. Do not start or stop any medicine without the bacteria dies. doctor TO USE: This medication is given by injection into a HOW or pharmacist approval. muscle o vein usually twice a day for 7 to 10 days based on the type and severity of your infection. Antibiotics work best when the amount of medicine in your body is kept at a constant level. Do this by using the medication at evenly spaced intervals throughout the day and night as prescribed. Continue to use this medication for the full time prescribed even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow resulting in a reoccurrence of the infection. Do not use this medication if cloudy. Use: Cefepime or Maxipime is a cephalosporin antibiotic used in bacterial infections that are susceptible. It has a broad spectrum of activity, and is available only for injection. Cephalosporin antibiotics are classified in "generation" according to their antibacterial activity: first generation - cefadroxil, cefazolin, cephalexin, cephalothin, cephapirin, cephradine; second generation - cefaclor, cefamandole, cefmetazole, cefonicid, ceforanide, cefotetan, cefoxitin, cefprozil, cefuroxime, loracarbef; third generation - cefixime, cefoperazone, cefotaxime, cefpodoxime, ceftazidime, ceftizoxime, ceftriaxone.

Generic name: fluconazole BrandCulture Diflucan before therapy; begin treatment before lab name: infection results are returned. Drug class: Antifungal Decrease dosage in cases sterols failure. Therapeutic actions: Binds to of renalin the fungal cell membrane, Infuse IV only; not intended for fungicidal or fungistatic changing membrane permeability; IM or subcutaneous use. Do not concentration medication to depending onadd supplementand organism. fluconazole. Administer fungal infections in at a maximum with ** Prevention ofthrough sterile equipment cancer patientsrate of 200 mg/hr given as a continuous amphotericin B or fluconazole. infusion. WARNING: Monitor renal function tests weekly, discontinue Cancer patients treated with chemotherapy or who receive a bone or decrease dosage have an any sign risk of acquiring fungal marrow transplant of drug at increased of increased renal toxicity. Monitor LFTs monthly during therapy. infections. Such infections can be life-threatening. Antifungal Teaching points drugs are therefore often given prophylactically to such patients, or Drug may be given review could not detect The drug will when they have a fever. The orally or IV as needed. a difference in need between amphotericin B and fluconazole, but be taken long effectto be taken for the full course and may need to several of the term. trials were designed or analysed in a way that disfavoured Use B which is the to prevent reinfection or spread of amphotericinhygiene measures only antifungal drug for which an infection. effect on mortality has been shown. Arrange for frequent follow-up while you are taking this Indications drug. Be sure to keep all i. Treatment including those for blood appointments, of oropharyngeal, tests. esophageal, vaginal, and systemic You may experience these side effects: Nausea, vomiting, candidiasis diarrhea (frequent small ii. Treatment meals may help); headache (analgesics of cryptococcal may be ordered). meningitis Report rash, changes in stool orofurine color, difficulty iii. Prophylaxis candidiasis in bone breathing, increased tears or salivation. marrow transplants Contraindications and cautions

i. Contraindicated with Generic Name: zolpidem tartrate hypersensitivity to fluconazole, Brand name: Ambien, Ambien CR lactation. Drug class: Sedative or hypnotic (nonbarbiturate) renal or hepatic ii. Use cautiously with Therapeutic actions: Modulates GABA receptors to cause impairment. suppressionUrine neurons, leading to sedation, anticonvulsant, Excretion: of anxiolytic, and relaxant properties. Adverse effects Indication Headache CNS: Short-term treatment of insomnia abdominal pain; AST/ALT GI: Nausea, vomiting, diarrhea, Treatment of insomnia in adults who experience difficulties elevations with sleep onset and sleep maintenance (ER tablets) Other: Rash Contraindications and cautions Contraindicated with Drug-drug Interactions hypersensitivity to zolpidem. Use cautiously with acute intermittenttherapeutic and toxic Increased serum levels and therefore porphyria, impaired hepatic or renal function, addiction-prone patients, pregnancy, effects of cyclosporine, phenytoin, benzodiazepines, oral lactation. hypoglycemics, warfarin anticoagulants, zidovudine GERIATRIC PATIENTS levels with rifampin, theophylline, Decreased serum Increased tacrolimus chance of confusion, acute brain syndrome; initiate treatment with 5 mg PO Nursing considerationsor 6.25 mg/day PO ER tablets. Assessment Excretion: Urine History: Hypersensitivity to fluconazole, renal impairment, Adverse pregnancy lactation, effects CNS: Seizures, hallucinations, ataxia, EEG changes, pyrexia, Physical: Skin color, lesions; T; injection site; orientation, morning drowsiness, hangover, headache, function vertigo, acute reflexes, affect; bowel sounds; LFTs, renal dizziness,tests; CBC and brain syndrome and confusion; paradoxical excitation, anxiety, differential; culture of area involved depression, nightmares, dreaming, diplopia, blurred vision, suppression Interventionsof REM sleep; REM rebound when drug is discontinued GI: Esophagitis, vomiting, nausea, diarrhea, constipation

 Hypersensitivity: Generalized allergic reactions; pruritus, lactation; allergy to tartrazine or aspirin in rash products labeled Medrol. Other: Influenza-like symptoms, dry mouth, infection b. Use Nursing considerations cautiously with kidney or liver disease, hypothyroidism, ulcerative colitis with Assessment impending perforation, diverticulitis, active or History: Hypersensitivity to zolpidem, acute intermittent latent peptic ulcer, inflammatory bowel porphyria, impaired hepatic or renal function, addiction-prone disease, patients, lactation, pregnancyCHF, hypertension, thromboembolic disorders, osteoporosis, seizure Physical: T; skin color, lesions; orientation, affect,disorders, reflexes, diabetes bowel pregnancy. vision examination; P, BP;mellitus,sounds, normal output, liver Excretion: Urine evaluation; CBC with differential; LFTs, renal function tests Adverse effects Effects depend Interventions on dose, route, and duration of therapy. a) CNS: Vertigo, headache, dispensed to patients who WARNING: Limit amount of drug paresthesias, insomnia, seizures, psychosis, cataracts, increased IOP, glaucoma are depressed or suicidal. b) WARNING: Withdraw shock, hypertension and CHF CV: Hypotension, drug gradually if patient has used secondary to fluid retention, thromboembolism, drug long-term or if patient has developed tolerance. Supportive thrombophlebitis, withdrawal from barbiturates may therapy similar to that for fat embolism, cardiac arrhythmias be c) to prevent imbalance: Na+ and fluid necessary Electrolytedangerous withdrawal symptoms. retention, hypokalemia, hypocalcemia d) points Teaching Endocrine: Amenorrhea, irregular menses, growth retardation, drug exactly as prescribed. Do notdiabetes Take this decreased carbohydrate tolerance, exceed prescribedmellitus, Long-term use is not recommended. increased dosage. cushingoid state (long-term effect), blood sugar,experience serum side effects:decreased T3 You may increased these cholesterol, Drowsiness, dizziness, and T4 levels, HPA suppression with performing tasks blurred vision (avoid driving or systemic therapy requiring longer than 5visual acuity); GI upset (eat frequent small alertness or days e) meals). GI: Peptic or esophageal ulcer, pancreatitis, abdominal distention, nausea, fever, bruising. Report rash, sore throat, vomiting, increased appetite, weight gain

Generic Name: methylprednisolone f) Hypersensitivity: Anaphylactoid reactions Brand Name: Medrol g) Musculoskeletal: Muscle weakness, Drug classes: Corticosteroid; Glucocorticoid steroid myopathy, loss of muscle mass, osteoporosis, spontaneous fractures Therapeutic actions: Enters target cells and binds to intracellular h) Other: Immunosuppression; aggravation or masking of corticosteroid receptors, initiating many complex reactions that are infections; anti-inflammatory and thin, fragile skin; responsible for its impaired wound healing;immunosuppressive effects. petechiae, ecchymoses, purpura, striae; subcutaneous fat atrophy Indications Drug-drug Interactions a. Hypercalcemia associated with cancer a. Increased b. Short-term therapeutic and toxicofeffects with management various erythromycin, and allergic troleandomycin inflammatory ketoconazole,disorders, such as b. rheumatoid arthritis, collagenmuscle strength Risk of severe deterioration of diseases (eg, when dermatologic diseases (eg, pemphigus), SLE), given to myasthenia gravis patients who are asthmaticus, and autoimmune disorders statusreceiving ambenonium, edrophonium, neostigmine, disorders: c. Hematologic pyridostigmineThrombocytopenia c. purpura, erythroblastopenia Decreased steroid blood levels with barbiturates, phenytoin, exacerbations of MS, d. Ulcerative colitis, acuterifampin d. and palliation in some leukemias and Decreased effectiveness of salicylates Nursing considerations lymphomas Assessment e. Trichinosis with neurologic or myocardial a. involvement History: Infections; kidney or liver disease, hypothyroidism, ulcerative colitis, f. Unlabeled use: Septic shock, respiratory diverticulitis, active or latent peptic ulcer, distress syndrome, acute spinal cord injury inflammatory bowel disease, CHF, Contraindications and cautions hypertension, thromboembolic disorders, a. Contraindicated with infections, especially TB, osteoporosis, seizure disorders, diabetes fungal infections, amebiasis, vaccinia and mellitus; and antibiotic-resistant infections; varicella, pregnancy; lactation b. Physical: Weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral

perfusion prominence of superficial veins, R GI: Nausea, diarrhea, abdominal pain, dental and adventitious sounds, serum electrolytes, pain glucose blood Interventions c. Respiratory: Influenza, cold, nasal congestion d. Other: Generalizedthe 24-mg tabletsfatigue a. Use caution with pain, fever, rash, marketed Drug-drug Interactions as Medrol; these contain tartrazine, which may Decreased effects andreactions, especiallytaken with cause allergic bioavailability if in people phenobarbital, rifampin;are allergicpatient and adjust dosage as who monitor to aspirin. needed b. Give daily dose before 9 AM to mimic normal Nursing considerations corticosteroid blood levels. peak Assessment c. Increase dosage when patient is subject to a. History: Hypersensitivity to montelukast or stress. d. any of its components; acute asthma attacks; WARNING: Taper doses when discontinuing status asthmaticus, pregnancy and lactation high-dose or long-term therapy to allow b. Physical: T; orientation, reflexes; R, adrenal recovery. e. adventitious sounds; GI evaluation WARNING: Do not give live virus vaccines with immunosuppressive doses of Interventions corticosteroids. Teaching points a. Administer stopthe evening oral drug without Do not to in taking the without regard to food. consulting your health care provider. b. Avoid exposure to infections. b. Ensure that drug is taken continually for Report unusual weight gain, swelling of the extremities, muscle optimal effect. weakness, black or tarry stools, fever, prolonged sore throat, colds or other infections, worsening of disorder. c. Do not administer for acute asthma attack or acute bronchospasm. b.

Generic Name: montelukast sodium/Montemax Brand Name: d. Avoid the use of aspirin or NSAIDs in patients Singulair with known sensitivities while they are Drug classes: Antasthmatic; Leukotriene receptor antagonist using this drug. Therapeutic actions: Selectively and competitively blocks the receptor that inhibits leukotriene formation, thus blocking many of the signs and e. WARNING: Ensure that patient haseosinophil symptoms of asthmaneutrophil and a readily available monocyte aggregation, leukocyte migration, neutrophil and rescue medication for acute asthma adhesion, increasedattacks or permeability,when smooth muscle capillary situations and a short-acting contraction. These inhaled agent is needed. inflammation, edema, actions contribute to Teaching points and bronchoconstriction associated with the signs mucus secretion, and symptoms a. asthma. this drug regularly as prescribed; do not of Take stop taking this drug during symptom-free Indications a. periods; do and chronic treatmentdrug without Prophylaxis not stop taking this of asthma in consulting children > 12 mo provider. Continue adults and your health care b. taking of symptoms of seasonal allergic rhinitis Relief any other drugs for treating asthma that have been prescribed 2 yr you. Notify your in adults and children > for your asthma allergic c. health care symptomsif of perennial becomes Relief of provider worse. in adults and children > 6 mo rhinitis b. Do not take this drug for an acute asthma d. Unlabeled uses: Chronic urticaria, atopic attack or acute bronchospasm; this drug is not dermatitis a bronchodilator, and routine emergency Contraindications and cautions be a. procedures shouldwith followed during acute Contraindicated hypersensitivity to attacks. montelukast or any of its components; acute c. Avoid the use status asthmaticus. asthma attacks; of aspirin or NSAIDs if you b. havecautiously with pregnancy and lactation. Use a known sensitivity to these drugs. Montelukast will not prevent reactions. Excretion: Feces, urine d. Adverse effects You may experience these side effects: a. Dizziness (use dizziness when driving or CNS: Headache, caution performing activities that require alertness);

nausea, vomiting (eat frequent small meals, Treatment with adolescents 10-17(analgesics yr with take drug of food); headache heterozygous familial hypercholesterolemia may be available). Contraindications and cautions acute asthma attacks, flulike e. Report fever, Contraindicated with allergy to simvastatin, symptoms, lethargy. fungal byproducts, pregnancy, lactation. Use cautiously with impaired hepatic and renal function, cataracts. Excretion: Feces, urine Adverse effects a. CNS: Headache, asthenia, sleep disturbances b. GI: Flatulence, diarrhea, abdominal pain, cramps, constipation, nausea, dyspepsia, heartburn, liver failure c. Respiratory: Sinusitis, pharyngitis d. Other: Rhabdomyolysis, acute renal failure, arthralgia, myalgia Drug-drug Interactions a. WARNING: Increased risk of myopathy and rhabdomyolysis with clarithromycin, erythromycin, HIV protease inhibitors, itraconazole, ketoconazole, nefazodone; avoid concomitant use, or suspend therapy during treatment with clarithromycin, erythromycin, itraconazole, and ketoconazole b. Increased risk of myopathy and rhabdomyolysis with amiodarone, verapamil; do not exceed 20 mg simvastatin daily e.

c. Increased risk of myopathy and Generic name: simvastatin rhabdomyolysis with cyclosporine, fibrates, Brand name: Zocor niacin; monitor patient closely if use together Drug classes: Antihyperlipidemic; HMG-CoA reductase inhibitor cannot be avoided. Do not exceed 10 mg Therapeutic action: Inhibits HMG-CoA reductase, the enzyme simvastatin the cholesterol synthesis pathway, that catalyzes the first step in daily resulting in a d. Digoxin serum cholesterol, serum LDLs, and decrease in levels may increase slightly; closely either an increase ormonitor plasma digoxin levels at the start of no change in serum HDLs. simvastatin therapy Indications e. Increasedto diet infor treatment of elevated risk a. Adjunct the hepatotoxicity with hepatotoxic drugs;and LDL cholesterol with total cholestrol avoid concurrent use f. Simvastatin may slightly (types IIa and primary hypercholesterolemia enhance the anticoagulantunresponsive to dietary restriction IIb) in those effect of warfarin; monitor PT andsaturated fat and therapy and duringother of INR at the start of cholesterol and dose adjustment nonpharmacologic measures Drug-food b. To reduce the risk of coronary disease, a. Decreased metabolism and risk of toxic stroke, mortality, and CV events, including effects if combined with grapefruit need for bypass TIA, MI and reduction in juice; avoid this combinatio angionplasty in patients with surgery and Nursing considerations coronary heart disease and Assessment hypercholesterolemia a. History: Allergy to simvastatin, fungal impaired c. byproducts; of patientshepatic function; Treatment with isolated pregnancy; lactation hypertriglyceridemia b. Physical: Orientation, affect; liver evaluation, d. abdominal of type III hyperlipoproteinemia Treatment examination; lipid studies, LFTs Interventions

a. b. c.

d. Teaching points a. b. c. d.

Ensure that patient has tried a cholesterollowering diet regimen for 36 mo before beginning therapy. Give in the evening; highest rates of cholesterol synthesis are between midnight and 5 AM. Advise patient that this drug cannot be taken during pregnancy; advise patient to use barrier contraceptives. Arrange for regular follow-up during longterm therapy. Consider reducing dose if cholesterol falls below target. Take drug in the evening. Do not drink grapefruit juice while using this drug. Have periodic blood tests. This drug cannot be taken during pregnancy; using barrier contraceptives is recommended. You may experience these side effects: Nausea (eat frequent small meals); headache, muscle and joint aches and pains (may lessen); sensitivity to light (use a suncreen and wear protective clothing). Report severe GI upset, changes in vision, unusual bleeding or bruising, dark urine or light-colored stools, fever, muscle pain, or soreness.

e.