Medications Generic / Trade Dose/Route/ Time (Frequency) Class/Rationale for the patient Contraindication Mechanism of action Onset of action

Common side effects / food and drug Interaction SE: Confusion, epidural or spinal hematoma, fever, paralysis, stroke Interactions: cefamandole, cefoperazone, cefotetan, plicamycin, valproic acid: Possibly increased risk of hemorrhage NSAIDs; oral anticoagulants; platelet aggregation inhibitors, such as aspirin, and ticlopidine; thrombolytics, such as streptokinase, and urokinase: Possibly increased risk of bleeding SE: Hearing loss, tinnitus Interaction: ACE inhibitors: Decreased Nursing considerations

Enoxapain (Lovenox)

30mg, 0.3ml SubQ daily Injection

Antithrombotic/ Patient is taking this medication to prevent DVT

Active major bleeding; hypersensitivity to benzyl alcohol (if only the multidose vial is available), enoxaparin, heparin (including low-molecularweight heparins), or pork products; thrombocytopenia and positive antiplatelet antibody test while taking lowmolecular-weight heparins

Potentiates the action of antithrombin III, a coagulation inhibitor. By binding with antithrombin III, enoxaparin rapidly binds with and inactivates clotting factors (primarily thrombin and factor Xa). Without thrombin, fibrinogen cant convert to fibrin and clots cant form

Use enoxaparin with extreme caution in patients with a history of heparin-induced thrombocytopenia or increased risk of hemorrhage. Use cautiously in those with bleeding diathesis, diabetic retinopathy, hepatic or renal impairment, recent GI ulceration or hemorrhage, or uncontrolled hypertension. Expect delayed elimination in elderly patients and those with renal insufficiency. Don't crush timedrelease or controlled -release aspirin tablets

Aspirin (acetylsalicylic acid)

325mg, 1 tab oral

Anti-inflammatory, antiplatelet, antipyretic/ Patient is taking this medication for antiplatelet

Hypersensitivity to aspirin, allergy to tartrazine dye, asthma, bleeding problems (such as hemophilia), peptic

Aspirin inhibits platelet aggregation by interfering with the production of throm-boxane A2, a substance that stimulates platelet

prophylactics

ulcer diseas

aggregation.

antihypertensive effect unless antacids, urine directed. alkalinizers: Ask about tinnitus. Decreased aspirin This reaction effectiveness usually occurs anticoagulants: when blood aspirin Increased risk of level reaches or bleeding; prolonged exceeds maximum bleeding time for therapeutic effect. SE: infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation, and hypervolemia. Be aware that hypertonic (1.8%) and hypotonic (0.45%) saline solutions exist. Ensure appropriat e concentrat ion before use.

N5 9 % Normal Saline

1,000 Ml, IV , 100ml/hr

Isotonic expander/ patient is taking this medication to increase blood volume before giving any vasopressin

Severe Hypertens ion Pulmonary edema

Normal Saline is a sterile, nonpyrogenic solution for fluid and electrolyte replenishment.

Interactions: Compatible with most, if not Check individual medications before administration.

Vanomycin

700mg IV, Q36H

Antibiotic/ Patient is taking this medication for her infection and pneumonia

Hypersensitivity to vancomycin or its components, hypersensitivity to corn or corn products when vancomycin is given with dextrose solutions

-Inhibits bacterial RNA and cell wall synthesis; alters permeability of bacterial membranes, causing cell wall lysis and cell death.

SE: anxiousness, dizziness, fatigue, fever, headache, Interactions: Phenobarital: decreased amount of circulating montelukast

-Be aware that drug should not be given for acute asthma attack ot status asthmaticus -Be are that montelukast should not be abruptly substituted for inhaled or oral cosrticosterioids, expect to taper corticosteroid disease gradually. -Monitor patient for adverse reactions, such as cardiac and pulmonary symptoms

Dronedarone (Hydrochloride )

400mg Tab

Class I or III antiarrhythmics/ Patient is taking this medication for his heart condition

Medications Generic / Trade Ergocalciferol (Vitamin D2 50,000 In Units cap)

Dose/Route/ Time (Frequency) 50, 000 Int/units =1 cap, oral, once, now

Class/Rationale for the patient Fat-soluble vitamin/ patients vitamin D2 level is low thus this supplement will correct this fat soluble

Contraindication

Mechanism of action Onset of action Stimulates intestinal calcium and phosphorus absorption, sitmulates bone mineralization

Common side effects / food and drug Interaction SE: headache, nausea, malaise, vomiting, anorexia, anemia, weakness Interactions: use with mineral oil may cause oral fat soluble vitamin malabsorption, decrease efficacy especially with chronic mineral oil use, combo with thiazide may increase risk of hypercalcemia,

Nursing considerations

Hypersensitivity, hypercalemia, hyperphosphatemia, vitamin D toxicity

-Monitor BUN, serum creatinine, alkaline phosphatase, parathyroid hormone levels, urinary calcium/creatinine ratio, 24hour urine calcium periodically. Decrease alkaline phosphatase levels may signal onset of hypercalcemia.

Insulin aspart (Novolog)

2 units INJ sub AC Blood sugar: 114 -Insulin coverage Q6H

Antidiabetc agent / patient has a history of diabetes mellitus

Hypersensitivity to insulin asparte

-lower blood glucose by stimulating glucose reuptake in skeletal muscle and fat, inhibiting hepatic glucose production.

SE: hypoglycemia, urticaria Interaction: beta blockers may alter glucose metabolism, prolong hypoglycemia, mask hypoglycemia

-Watch for signs and symptoms of hypoglycemia and hyperglycemia and know what to do if they occur

Sevelamer (Sevelamer HCL

800mg cap Oral TID

Antihyperphosphatemic/ patient has a history of end stage renal disease

Fecal impaction, GI obstruction, hypersensitivity to sevelamer or its components, hypophosphatemia, ileus

Inhibits phosphate absorption in the intestine by binding dietary phosphate, thereby lowering serum phosphorus level.

SE: Headache, fever Hypertension, hypotension, thrombosis Nasopharyngitis Abdominal pain, constipation (severe), diarrhea, fecal impaction, flatulence, ileus, indigestion, intestinal obstruction oir perforation, nausea, vomiting Interactions: antiarrhythmics, anticonvulsants, digoxin, levothyroxine, liothyronine, quinolones, tetracyclines, theophylline, warfarin: Possibly altered absorption of these drugs

- Give other drugs at least 1 hour before or 3 hours after sevelamer to prevent interaction. -Be aware that severe hypophosphatemia may occur in-patient with dysphagia, major GI tract surgery, or severe GI disorder (including severe constipation) because drug prevents phosphate absorption. -Monitor blood pressure frequently. -Monitor serum phosphorus level to determine drugs effectiveness; - Monitor other serum electrolyte levels, especially bicarbonate and chloride, to detect imbalance

Montelukast (Singulair)

10mg, 1 tab, oral Qevening

Antiasthmatic/ Patient is diagnosed with hospital acquired pneumonia as

-Hypersensitive to drug/class

-antagonized receptor for cysteinyl leukotrienes, which are

SE: anxiousness, dizziness, fatigue,

-Be aware that drug should not be given for acute asthma attack ot status

shown in the chest-X-ray which shows pulmonary vascular congestion. Patient is taking this medication to prevent asthma

produced by arachidonic acid metanolim and released from mast cells.

fever, headache, Interactions: Phenobarital: decreased amount of circulating montelukast

asthmaticus -Be are that montelukast should not be abruptly substituted for inhaled or oral cosrticosterioids, expect to taper corticosteroid disease gradually. -Monitor patient for adverse reactions, such as cardiac and pulmonary symptoms

Ipratripium (Atrovent)

0.5mg-2.5ml

Anticholinergic, bronchilator / Patients chest X-ray shows pulmonary congestion with left inferior lung infiltrate .

Allergy to tartrazine dye, asthma, bleeding problems (such as hemophilia), peptic ulcer disease

Preventing clotting by keeping the platelet aggregating substance from forming,

SE: tinnitus, hearing loss, GI bleeding, occult bleeding Interaction: increase effects with anticoagulants

-Monitor patients closely because they may be more susceptible to aspirins toxic effects.

Heparin

5000 units/ml Injection 1 mL

Anticoagulant /Patient has a history of coronary artery disease. Patient is taking this medication for prophylactic.

-Hypersensitive to heparin or its components; severe thrombocytopenia; uncontrolled bleeding, except in DIC

Binds with antithrombin III, enhancing antithrombin IIIs inactivation of the coagulation enzymes thrombin (factor IIa) and factors Xa and XIa. At low doses, heparin inhibits factor Xa and prevents the conversion of prothrombin to thrombin

SE: Chills, dizziness, fever, headache, peripheral neuropathy Interactions: Antihistamines, digoxin, nicotine, tetracyclines: Decreased anticoagulant effect of heparin aspirin, NSAIDs, platelet aggregation inhibitors, sulfinpyrazone: Increased platelet inhibition and risk of bleeding

-Use heparin cautiously in alcoholics; menstruating women; patients over age 60, especially women; and patients with mild hepatic or renal disease or a history of allergies, asthma, or GI ulce

Piperacillin (Tazobactam)

2.25gm=1 vial IV Push

Ampicillin/ Patient has pneumonia with lower respiratory tract infection

Hypersensitivity to cephalosporins, penicillins, or their components

Binds to specific penicillin-binding proteins and inhibits the third and final stage of bacterial cell wall synthesis by interfering with an autolysin inhibitor. Uninhibited autolytic enzymes destroy the cell wall and result in

SE: Dizziness, fever, hallucinations, headache, lethargy, seizures, stroke Interaction: aminoglycosides: Additive or synergistic effects against some

Obtain blood, sputum, or other samples for culture and sensitivity testing, as ordered, before giving piperacillin. Expect to begin piperacillin therapy before results are available. Be aware that sunlight may darken

cell lysis.

bacteria, possibly mutual inactivation

piperacillin powder for dilution but wont alter drug potency.

Medications Generic / Trade Potassium phosphate

Dose/Route/ Time (Frequency) IV 42.5 ml./hr for 6 hours once a day

Class/Rationale for the patient Genitourinary, Acid/ Base/patient is taking this supplement since she is on NPO diet to prevent hypokalemia

Contraindication

Mechanism of action Onset of action Phosphorous is an essential component and participant in physiologic systems and reaction

Common side effects / food and drug Interaction SE: abdominal pain, confusion, nausea/vomiting, diarrhea, weakness Interactions: may increase risk of hyperkalemia with ACE inhibitor, furesomide

Nursing considerations -Monitor plasma potassium levels in patients with cardiac disease, renal impairment, or acidosis, monitor of acid-base balance, ECG is recommended -Teach patient to report unusual fatigue

Hypersenstive to drug/class, hyperkalemia, hyperphosphatemia, renal impairment,

Insulin aspart (Novolog)

5 units INJ sub AC -Insulin coverage Q6H

Antidiabetc agent / patient has a history of diabetes mellitus type 2

Hypersensitivity to insulin asparte

-lower blood glucose by stimulating glucose reuptake in skeletal muscle and fat, inhibiting hepatic glucose production.

SE: hypoglycemia, urticaria Interaction: beta blockers may alter glucose metabolism, prolong hypoglycemia, mask hypoglycemia

-Watch for signs and symptoms of hypoglycemia and hyperglycemia and know what to do if they occur

Acetylcysteine (Mucomyst)

600mg cap BID

Mucolytic, amino acid derivative/ patient just had a CT with radioconstrate therefore this medication will help reduce the radiocontrast induced renal dysfunction

Hypersensitive to drug/class/compone nt Except for acetaminophen overdose tx duse. -Caution if inadequate cough -caution in patients with asthma and GI bleeding risk

Decreases the buildup of a hepatotoxic metabolite and degrades mucus, allowing easier mobilization and can prevent radiocontrastinduced renal dysfunction

SE: bronchospasm (inhaled) drowsiness Interactions: discolor with rubber, iron, copper, Ag, incompatible with multiple antibiotic-administer drugs separately

- Inform patient of increase productive cough, clear airway before aerosol administration -Monitor LFTs, ECG, glucose and electrolytes -Notify HCP if nausea, vomiting or urticaria occurs.

Rosuvastain (Rosuvastatain)

10 mg TAB oral Qbedtime

Antilipemic HMGCoA reductase inhibitor/Patient has a history of high cholesterols

-Hypersensitive to drug/class -Hepatic disease - Unexplained elevated LFTs

-Inhibits 3 hydroxy-3methyglutarylcoe nzyme A (HMGCoA) reductase to reduce cholesterol levels

SE: weakness, stomach, pain, constipation, diarrhea Interactions: Avoid Atorvastatin duplicate therapy due to increase risk of elevated LFTs, myopathy, rhabdomyolysis

-Do not stop using rosuvastain without first talking to the doctor. -

Acetylsalicylic acid (Aspirin)

81 mg oral once a day oral

Analgesics / Patient has history of high cholesterol levels. Patient is taking this drug to prevent heart disease.

Allergy to tartrazine dye, asthma, bleeding problems (such as hemophilia), peptic ulcer disease

Preventing clotting by keeping the platelet aggregating substance from forming,

SE: tinnitus, hearing loss, GI bleeding, occult bleeding Interaction: increase effects with anticoagulants

-Monitor patients closely because they may be more susceptible to aspirins toxic effects.

Medications Generic / Trade Ibuprofen (Motrin 600mg tab)

Dose/Route/ Time (Frequency) 600mg tab as needed

Class/Rationale for the patient

Contraindication

Mechanism of action Onset of action Blocks the activity of cyclooxygenase, the enzyme needed to synthesize prostaglandins.

Common side effects / food and drug Interaction SE: dizziness, headache, nervousiness Interactions: possibly increased renal effects with acetaminophen, increased risk of bleeding with NSAIDs

Nursing considerations -use motrin with extreme caution in patients with a history of ulcer disease or GI bleeding -Be aware of serious GI tract ulcerations

Anti-inflammatory and analgesic /P patient has a history of arthritis

Coronary artery bypass graft surgery, known hypersensitivity to ibuprofen, & asthma,

Levetiracetam (KepPRA)

250 mg Tab

Anticonvulsant/ patient has a history of seizure and epilepsy

Hypersensitivity to levetiracetam or its components

Protect against secondary generalized seizure activity by preventing coordination of epileptiform burst firing.

SE: anger, ataxia, confusion, depersonalization & dizzines Interaction: Keppra may increase the effects of other drugs such as antidepressant, alcohol, antihistamines and sedatives.

-Assess compliance during first 4 weeks of therapy, when adverse reactions are most common -Stopping drug may increase seizure activity. Expect to taper dosage gradually.

0.2 mg/hr patch Nitroglycerin

Antianginal, antihypertensive/ patient has chest pain thus, medication will relieve chest pain.

Acute MI (SL), angle-closure glaucoma, cerebral hemorrhage

Interact with nitrate receptors in vascular smooth muscle cell membrane.

SE: anxiety, dizziness, insomnia, syncope Interactions: any acetycholine and norepinephrine will decreased therapeutic effects of these drugs, heparin drug will decrease anticoagulant effects, opiord analgesic will increased orthostatic hypotension

- use nitroglycerin cautiously in elderly patients/ Dont break or crush ER tablets or capsules. Have patient sawllow them whole with a full glass of water. -Open transdermal match immediately before use. Apply patch to hairless area, and press edge to seal.

150 mg table oral Oxcarbazepine (Trileptal)

Anticonvulsant/Patie nt had a history of seizure

Hypersensivity to carbamazepine, oxcarbazepine, or their components

Halt seizures by closing or blocking sodium channels in neuronal cell membrane.

SE: dizziness, somnolence, tremor, abdominal pain, nausea, headache Interactions: Carbamazepine, phenobarital, phenytoin, valproic acid decreased blood oxcarbazepine level, increase blood levels of Phenobarbital and phentoin felodipine

-monitor serum sodium level for signs of hyponatremia, especially during first 3 months -monitor therapeutic oxcarbazepine levels during initiation and

titration.

Acetylsalicylic acid (Aspirin)

81 mg oral once a day oral

Analgesics / Patient has chest pain and high cholesterol level. Patient is taking this drug to prevent heart attack.

Allergy to tartrazine dye, asthma, bleeding problems(such as hemophilia), peptic ulcer disease

Preventing clotting by keeping the platelet aggregating substance from forming,

SE: tinnitus, hearing loss, GI bleeding, occult bleeding Interaction: increase effects with anticoagulants

-Monitor patients closely because they may be more susceptible to aspirins toxic effects.

Medications Generic / Trade Dose/Route/ Time (Frequency) Class/Rationale for the patient Contraindication Mechanism of action Onset of action Common side effects / food and drug Interaction SE: Confusion, epidural or spinal hematoma, fever, paralysis, stroke Interactions: cefamandole, cefoperazone, cefotetan, plicamycin, valproic acid: Possibly increased risk of hemorrhage NSAIDs; oral anticoagulants; platelet aggregation inhibitors, such as aspirin, and ticlopidine; thrombolytics, such as streptokinase, and urokinase: Possibly increased risk of bleeding SE: Hearing loss, tinnitus Nursing considerations

Enoxapain (Lovenox)

40 mg, 0.4ml subQ

Antithrombotic/ Patient is taking this medication to prevent DVT

Active major bleeding; hypersensitivity to benzyl alcohol (if only the multidose vial is available), enoxaparin, heparin (including lowmolecular-weight heparins), or pork products; thrombocytopenia and positive antiplatelet antibody test while taking lowmolecular-weight heparins

Potentiates the action of antithrombin III, a coagulation inhibitor. By binding with antithrombin III, enoxaparin rapidly binds with and inactivates clotting factors (primarily thrombin and factor Xa). Without thrombin, fibrinogen cant convert to fibrin and clots cant form

Use enoxaparin with extreme caution in patients with a history of heparin-induced thrombocytopenia or increased risk of hemorrhage. Use cautiously in those with bleeding diathesis, diabetic retinopathy, hepatic or renal impairment, recent GI ulceration or hemorrhage, or uncontrolled hypertension. Expect delayed elimination in elderly patients and those with renal insufficiency.

Aspirin (acetylsalicylic acid)

81mg, 1 tab oral

Anti-inflammatory, antiplatelet, antipyretic/ Patient is taking this medication for antiplatelet

Hypersensitivity to aspirin, allergy to tartrazine dye, asthma, bleeding problems (such as hemophilia), peptic

Aspirin inhibits platelet aggregation by interfering with the production of throm-boxane A2, a substance that stimulates platelet

Don't crush timedrelease or controlled-release aspirin tablets Interaction: ACE unless directed. inhibitors: Decreased Ask about tinnitus. antihypertensive effect This reaction

prophylactics

ulcer disease

aggregation.

antacids, urine alkalinizers: Decreased aspirin effectiveness Anticoagulants: Increased risk of bleeding; prolonged bleeding time

usually occurs when blood aspirin level reaches or exceeds maximum for therapeutic effect.

Methylprednisolone (Solumedrol)

40mg, 1mL IV INJ Q8H

Steroid ant0inflammatory / patient is taking this medication to preventive symptoms of GERD

Fungal infection, hypersensitivity to methylprednisolone or its components, idiopathic thrombocytopenic purpura (I.M.

To treat GERD by binding to intracellular glucocorticoid receptors and suppressing inflammatory and immune responses

SE: dystonic reaction common with high doses, fluid retention, restlessness and drowsiness Interactions: Increase risk of serotonin syndrome with sertraline, venlafaxine

-Monitor for extrapyramidal effects

Olanzapine (Zyprexa)

25m oral QBedtime

Antipyschotic / Patient is taking this to prevent schizophrenia, psychotic disorders, and acute agitation

Blood dyscrasias, bone marrow depression, cerebral arteriosclerosis, coma, coronary artery disease, hepatic dysfunction, highdose CNS depressants, hypersensitivity to olanzapine or its components

-May achieve its antipsychotic effects by antagonizing dopamine and serotonin receptors.

SE: Abnormal gait, agitation, akathisia, altered thermoregulation, Interactions: Anticholinergics: Increased anticholinergic effects, altered thermoregulation Antihypertensives: Increased effects of both drugs, increased risk of hypotension

- Be alert for and immediately report to prescriber signs of neuroleptic malignant syndrome.

1. Digoxin (Digoxin 0.125mg Tab) Class: Antiarrhythmic agent, inotropic agent/cardiac glycoside Use/Rationale: treatment of atrial fibrillation, atrial flutter, and CHF, tachyarrhythmias/ Patient has a history of atrial fibrillation Action: slows and strengthens the force of myocardial contraction by prolonging the refractory period f the atrioventricular (AV) node SE: fatigue, headache, weakness, arrhythmias, bradycardia, nausea. Vomiting Interactions: increase effects with alprazolam, amiodarone, azoleantifungals, beta-blockers and NSAIDs Contraindication: drug hypersensitivity 2. Carvedilol (Coreg 12.5mg Tab) Class: Antihypertensive agent/Beta-adrenergeic receptor blocker (beta-blockers

Use/Rationale: treatment of hypertension. Prevention of MI and decrease of mortality in clients with recent MI/ Patient is taking this medication because of his history of hypertension and heart problems Action: blocks stimulation of beta1 adrenergic receptors. Do not usually affect beta2 adrenergic receptor site if cardioslective SE: fatigue, weakness, anxiety, depression, bradycardia, nervousness, mask hypoglycemia, hyperglycemia Interactions: increase effects with cimetidine, Clonidine, MAOIs

3. Potassium chloride (Potassium chloride 20 mEq/15ml Liq 15ml) Class: mineral and electrolyte replacement and or supplement Use/Rational: Treatment and prevention of depletion of mineral and electrolytes/ Patient is taking this medication due to hypokalemia Actions: maintains acid-base balance, essential for nerve conduction, essential for contraction of cardiac skeletal and smooth muscle SE: confusion, restlessness, weakness, arrhythmias, ECG changes, Interactions: increase with K+ sparing diuretics, salt substitutes

4. Ditiazem (Cardizem) 120 mg/24 hours CD cap Class: antianginal agent, antiarrhythmic agent (Class IV), antihypertensive agent and calcium channel blockers Use/rational: treatment of hypertension and arrhythmias/ Patient is on this medication for hypertension and atrial fibrillation. Actions: inhibit transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation of muscle. SE: nervousness, weakness, nervousness, confusion, bradycardia, chest pain, peripheral edema, hypotension Interaction: use with cimetidine may increase risk of bradycardia, use with amiodarone may increase risk of hypotension, bradycardia

1. Digoxin (Digoxin 0.125mg Tab) Class: Antiarrhythmic agent, inotropic agent/cardiac glycoside Use/Rationale: treatment of atrial fibrillation, atrial flutter, and CHF, tachyarrhythmias/ Patient has a history of atrial fibrillation Action: slows and strengthens the force of myocardial contraction by prolonging the refractory period f the atrioventricular (AV) node SE: fatigue, headache, weakness, arrhythmias, bradycardia, nausea. Vomiting Interactions: increase effects with alprazolam, amiodarone, azoleantifungals, beta-blockers and NSAIDs 2. Carvedilol (Coreg 12.5mg Tab) Class: Antihypertensive agent/Beta-adrenergeic receptor blocker (beta-blockers Use/Rationale: treatment of hypertension. Prevention of MI and decrease of mortality in clients with recent MI/ Patient is taking this medication because of his history of hypertension and heart problems Action: blocks stimulation of beta1 adrenergic receptors. Do not usually affect beta2 adrenergic receptor site if cardioslective SE: fatigue, weakness, anxiety, depression, bradycardia, nervousness, mask hypoglycemia, hyperglycemia Interactions: increase effects with cimetidine, Clonidine, MAOIs

3. Potassium chloride (Potassium chloride 20 mEq/15ml Liq 15ml)

Class: mineral and electrolyte replacement and or supplement Use/Rational: Treatment and prevention of depletion of mineral and electrolytes/ Patient is taking this medication due to hypokalemia Actions: maintains acid-base balance, essential for nerve conduction, essential for contraction of cardiac skeletal and smooth muscle SE: confusion, restlessness, weakness, arrhythmias, ECG changes, Interactions: increase with K+ sparing diuretics, salt substitutes

4. Ditiazem (Cardizem) 120 mg/24 hours CD cap Class: antianginal agent, antiarrhythmic agent (Class IV), antihypertensive agent and calcium channel blockers Use/rational: treatment of hypertension and arrhythmias/ Patient is on this medication for hypertension and atrial fibrillation. Actions: inhibit transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation of muscle. SE: nervousness, weakness, nervousness, confusion, bradycardia, chest pain, peripheral edema, hypotension Interaction: use with cimetidine may increase risk of bradycardia, use with amiodarone may increase risk of hypotension, bradycardia

Non-Psychotic Medications

Dose/Route/ Time (Frequency)

Class/Rationale for the patient

Range / Therapeutic Levels

Mechanism of action Onset of action

Common side effects / food and drug Interaction

Nursing considerations

Acetylsalicylic acid (Aspirin)

325 mg oral once a day

Analgesics / Patient had a history of coronary artery disease. Patient was taking this drug to prevent heart attack.

10 to 30 mg/dl

Preventing clotting by keeping the platelet aggregating substance from forming,

SE: tinnitus, hearing loss, GI bleeding, occult bleeding Interaction: increase effects with anticoagulants

-Monitor elderly patients closely because they may be more susceptible to aspirin s toxic effects.

5% w/w Permethrin topical (Elimite cream) 60mg tropical once a day

Scabicides/patient had a intense rash on his upper shoulder

10 to 30mg

Acts on nerve cell membrane of the louse or mite to disrupt the Na+ sodium channel current that regulates the polarization of the membrane

SE: Itching; mild burning or stinging; redness; swelling Interaction: no known drug

-avoid contact with the eyes, flushing eyes thoroughly with water if medication accidently gets in eyes

interaction

Hydrocortisone cream

0.5 % topical apply as needed

Corticosteriod /patient had a rash on his upper shoulder

0.5 % to 1 %

Acts as anti-inflammatory action, inhibits multiple inflammatory cytokines, produces multiple glucocorticoid

SE: Drying or cracking of the skin, acne or changing in color Interaction: Avoid alefacept, growth hormone, telaprevir

-teach patient to not use alcohol, avoid virus vaccines, abrupt D/C of drug, take with food, may mask symptoms infections

Clindamycin

150mg q 6h

Antibiotic /patient had a rash on his upper shoulder

150-450 mg PO

Binds to 50S ribosomal subunit, interfering with protein synthesis

SE: diarrhea, nausea, vomiting, abdominal pain, rash, pruritus, jaundice, urticaria Interaction: Increased: neuromuscular blockade with neuromuscular blocking agents Decreased GI absorption with

Determine if patient is allergic to clindamycin, history of asthma or other allergies, hepatic or renal dysfunction; lactation

kaolin, aluminum salts

Psychotic Medications Generic / Trade

Dose/Route/ Time (Frequency)

Class/Rationale for the patient

Range / Therapeutic Levels No therapeutic level

Mechanism of action Onset of action

Common side effects / food and drug Interaction SE: Confusion, headache, insomnia, weight gain, dizziness Interactions: increase effect with azole antifungals SE: headache, anxiety, insomnia, somnolence, bradycardia, weight gain Interaction: increase effect with ketoconazole, decrease effect with carbamazepine, grapefruit may increase drug level.

Nursing considerations

Quetiapine (Seroquel)

300mg oral once a day

Atypical Antipsychotic/Patient was taking this medication to treat his bipolar affective disorder. Atypical antipsychotic medication/ Patient was prescribed for this medication due to his mixed episodes associated with bipolar disorder and major depression

Action blocks dopamine and serotonin 5-HT2 receptors in the brain. Dopamine and serotonin antagonist

-Watch for evidence of neuroleptic malignant syndrome. -Monitor patient for symptoms of metabolic sydrome -watch for life threatening medical emergency such as Neuroleptic Malignant Syndrome: severe extrapyramidal: severe muscle rigidity, and cogwheeling

10 mg oral twice a day Aripiprazole (Abilify)

No therapeutic level

20 mg oral twice a day Citalopram (Celexa)

Antidepressant and SSRI/ Patient had symptoms of depression, thus this medication would help to prevent feelings of suicidal.

No therapeutic level

Action: inhibit reuptake of serotonin

SE: somnolence, insomnia, anxiety, sexual dysfunction Interaction: increase effect with azole antifunals, cimetidine, and beta blockers

-Combining triptans with an SSRI or an SSNRI may cause serotonin syndrome. Signs and symptoms include restlessness, hallucinations.

2 mg oral twice a day Benztropine (Congentin)

Anticholinergic medication/Patient was taking this drug to prevent EPS side effect

No therapeutic level

Block central cholinergic receptors. Helping balance cholinergic activity

SE: dilated pupils, blurred vision, dry mouth, constipation Interactions: increase

-Never stop drug abruptly -Monitor vital signs carefully for tardive dyskinesia.

effect with Amantadine, phenothiazine Prescrib ed dose Psychiatric Rx(w/refs) Usual Dose range Class/Purpose 1. indication 2. Action 3. Side effect Major nursing responsibilities Rationale for this client

GENERIC (TRADE) 1. 1mg oral Q4H 1. Lorazepam (Ativan) 1. 1-10 MG/D PO 1. Benzodiazepine for Anxiety

1. Indication: treat anxiety, Action: works via postsynaptic GABA receptors SE: memory impair, EPS, dizziness, respiratory depression 2. Indication: short term treatment for insomnia Action: hypnotic agent, SE: headache, dizziness, myalgia

1. Monitor hepatic, renal, and hematopoietic function. Use of this drug may lead to abuse and addiction. Don t stop drug abruptly

1. This medication is used to treat symptoms of anxiety. Patient is diagnosed of anxiety.

2. Alert: anaphylaxis and angiooedema may occur as

2. Patient has insomnia

2.Zolpidem(Ambien) 2. 10mg oral Bedtime

2. 5-10MG PO

2. Sedative agent/ for insomnia

early as first dose. Monitor closely. Use drug for only short time management

and need sleep pill at night to make sure he has plenty of sleep.

3. Indication: schizophrenia Action: antagonizes dopamine D2 receptors serotonin 5HT2A receptors SE: akathisia, dystonia

3. paliperidone (Invega)

3. 3mg ER tab oral Q morning

3. 3-12MG PO

3. Antipsychotic/to treat schizophrenia

3. monitor patient for atypical ventricular tachycardia such as torsades de pointes, ECG changes, lengthening QT interval.

3. Patient has a long history of schizophrenia and paranoid type

4.Divalproex sodium(Depakote ER) 4. 1000mg oral Qbedtim e

4. 1251000MG ORAL QBEDTIME

4. mood stablizer/ to prevent mania episodes, for mood stabilizing

4. Indication: mania, mood stabilzer Action: inhibit GABA NT. SE: dizziness, headache, nervousness

4. obtain liver function test results, platelet count, and PT and INR before starting therapy

4. This medication is given to help control anxiety and mania episode

PSYCHIATRIC MEDICATIONS ONLY

Prescribeddose Psychiatric Rx(w/refs) Usual Dose range Class/Purpose 1. indication 2. Action 3. Side effect Major nursing responsibilities Rationale for this client

GENERIC (TRADE) 1. 1mg oral Q4H PRN 1. Lorazepam (Ativan) 1. 1-10 MG/D PO 1. Benzodiazepine for Anxiety

1. Indication: to treat anxiety, Action: works via postsynaptic GABA receptors SE: confusion, dry mouth EPS, hypotension, dizziness,

1. Monitor hepatic, renal, and hematopoietic function. Use of this drug may lead to abuse and addiction. Don t stop drug abruptly

1. This medication is used to treat symptoms of anxiety. Patient has frequent episode of anxiety and stress.

2. Indication: short term treatment for insomnia Action: hypnotic agent SE: headache, dizziness, myalgia, nausua. 3. Indication: schizophrenia Action: antagonizes dopamine D2 receptors serotonin 5-HT2A receptors SE: less EPS, more ant-cholinergic effect 2. 5-10MG PO 2. Sedative agent/ for insomnia

2. 10mg oral Bedtime PRN

2. Alert: anaphylaxis and angiooedema may occur as early as first dose. Monitor closely. Use drug for only short

2. Patient is diagnosed with bipolar affective disorder and in order to prevent

2.Zolpidem(Ambi en)

4. Indication: treat schizophrenia . Action: binds to dopamine receptors SE: akinesia, akathisia, weakness,

time management.

mania episode, patient needs to have plenty of sleep.

3. 25 mg IM Q2 weeks

3. Watch for metabolic syndrome and anticholinergic effect. 3. 25-50MG MAX Q2 WEEK 3. Atypical Antipsychotic/to treat schizophrenia

3. Patient has a long history of auditory hallucination.

4. 400mg oral 4. Watch for agranulocytosis and metabolic syndrome, weight gain and drooloing 4. 150400MG PO BID ORRAL 4. Atypical Antipsychotic/ to treat schizophrenia, reduce risk of recurrent suicidal behavior 4. This patient is on Clozapine to reduce the risk of suicidal behavior from bipolar affective disorders, mania and hallucination

3. Risperidone (Risperdal Consta)

4. Clozapine (Clozaril) (FazaClo)

Prescribed dose Psychiatric Rx(w/refs)

Usual Dose range Class/Purpose

1. indication 2. Action 3. Side effect Major nursing responsibilities Rationale for this client

GENERIC( TRADE)

1. Risperidone

1. 3MG TAB QBEDTIME

(Risperdal Consta)

1. 2550MG MAX Q2 WEEK

1. Atypical Antipsychotic/to treat schizophrenia

1. Indication: schizophrenia Action: antagonizes dopamine D2 receptors serotonin 5-HT2A receptors SE: less EPS, more ant-cholinergic effect 2. Indication: to treat anxiety, Action: works via postsynaptic GABA receptors SE: confusion, dry mouth EPS, hypotension, dizziness,

1. Watch for metabolic syndrome and anticholinergic effect.

1. Patient has a long history of auditory hallucination.

2. Benzodiazepine for Anxiety

2.Lorazepam

(Ativan)

2. 1mg=1 tab, tab oral Q6 H interval PRN

2. . 110 MG/D PO

2. Monitor hepatic, renal, and hematopoietic function. Use of this drug may lead to abuse and addiction. Don t stop drug abruptly

2. This medication is used to treat symptoms of anxiety. Patient has frequent episode of anxiety and stress.

Medications Generic / Trade Dose/Route/ Time (Frequency) 400mg tab oral bimeals Class/Rationale for the patient Contraindication Mechanism of action Onset of action Common side effects / food and drug Interaction Nursing considerations

Dronedarone (Multaq)

Antiarrhythmics / Patient is taking this medication for coronary artery disease

Bradycardia of less than 50 beats per minute, heart failure, second or third degree atrioventricular block or sick sinus syndrome

Inhibits calcium, sodium and potassium channels and is an alpha- and beta adrenergic receptor antagonist.

SE: abdominal pain, asthenia, serum creatinine raised

Carvediol (coreg)

12.5 mg Tab bimeal

Beta-blockers/ Patient is taking this medication to reduce cardiac ouput

Hypersensitivity to aspirin, allergy to tartrazine dye, asthma, bleeding problems (such as hemophilia), peptic ulcer disease

Reduces cardiac output and tachycardia, causes vasodilation and decreases peripheral vascular resistance, which reduce blood pressure and cardiac workload

Interactions: Amiodarone: combo may increase levels of both drugs, risk of adverse effects, may increase risk of QT prologation, cardiac arrhythmias SE: Angina, AV block, -Monitor blood bradycardia, edema, glucose level depression since carvediol may altered Interaction: increase effects blood glucose with cimetidine, clonidine level and MAOIs.

-monitor Liver function tests, especially during 6 months of treatment -monitor electrolytes at baseline

Montelukast (Singular)

10 mg Tab Q evening

Antiasthmatic/ Patient is diagnosed with pulmonary edema and Chest Xray shows congestion. Patient is taking this medication to prevent asthma

Hypersensitive to drug/class Caution if severe asthma, caution if tapering systemic steroids

To prevent or treat asthma

SE: anxiousness, asthenia, dizziness fatigue and fever Interactions: Gemfibrozil: Combdo may increase montelukast levels risk of adverse effects

-drug should not be given for acute asthma attack

Budesonide-Formoterol (Symbicott 160/4.5 inhalation)

2 putts INH BID inhaler

Gluccorticoid or antiasthmatic / Patient is taking this medication to help him manage better breathing

Hypersensitive to drug/ class and systemic fungal infection

To manage symptoms of seasonal or perennial allergic rhinitis

SE: Amnesia, asthenia, dizziness, fatigue, fever, headache Interactions: Drugs clarithromycin, erythromycin, itraconazole, ketoconazole, other CYP3A4 inhibitors: Possibly increased blood budesonide level

Use budesonide cautiously if patient has tubercular infection; untreated fungal, bacterial, or systemic viral infection; or ocular herpes simplex.

Medications Generic / Trade Dose/Route/ Time (Frequency) 400mg tab oral bimeals Class/Rationale for the patient Contraindication Mechanism of action Onset of action Common side effects / food and drug Interaction Nursing considerations

Dronedarone (Multaq)

Antiarrhythmics / Patient is taking this medication for coronary artery disease

Bradycardia of less than 50 beats per minute, heart failure, second or third degree atrioventricular block or sick sinus syndrome

Inhibits calcium, sodium and potassium channels and is an alpha- and beta adrenergic receptor antagonist.

SE: abdominal pain, asthenia, serum creatinine raised

Carvediol (coreg)

12.5 mg Tab bimeal

Beta-blockers/ Patient is taking this medication to reduce cardiac ouput

Hypersensitivity to aspirin, allergy to tartrazine dye, asthma, bleeding problems (such as hemophilia), peptic ulcer disease

Reduces cardiac output and tachycardia, causes vasodilation and decreases peripheral vascular resistance, which reduce blood pressure and cardiac workload

Interactions: Amiodarone: comb may increase levels of both drugs, risk of adverse effects, may increase risk of QT prologation, cardiac arrhythmias SE: Angina, AV block, -Monitor blood bradycardia, edema, glucose level depression since carvediol may altered Interaction: increase effects blood glucose with cimetidine, clonidine level and MAOIs.

-monitor Liver function tests, especially during 6 months of treatment -monitor electrolytes at baseline

Montelukast (Singular)

10 mg Tab Q evening

Antiasthmatic/ Patient is diagnosed with pulmonary edema and Chest Xray shows congestion. Patient is taking this medication to prevent asthma

Hypersensitive to drug/class Caution if severe asthma, caution if tapering systemic steroids

To prevent or treat asthma

SE: anxiousness, asthenia, dizziness fatigue and fever Interactions: Gemfibrozil: Combdo may increase montelukast levels risk of adverse effects

-drug should not be given for acute asthma attack

Budesonide-Formoterol (Symbicott 160/4.5 inhalation)

2 putts INH BID inhaler

Gluccorticoid or antiasthmatic / Patient is taking this medication to help him manage better breathing

Hypersensitive to drug/ class and systemic fungal infection

To manage symptoms of seasonal or perennial allergic rhinitis

SE: Amnesia, asthenia, dizziness, fatigue, fever, headache Interactions: Drugs clarithromycin, erythromycin, itraconazole, ketoconazole, other CYP3A4 inhibitors: Possibly increased blood budesonide level

Use budesonide cautiously if patient has tubercular infection; untreated fungal, bacterial, or systemic viral infection; or ocular herpes simplex.