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NURS 2516 Clinical Medications Worksheets

(You will need to make additional copies of these forms)

Generic Name Trade Name Classification Dose Route Time/frequency

Duloxetine Cymbalta Antidepressants 20mg PO 0900 daily
Peak Onset Duration For IV meds, compatibility with IV drips and /or solutions
6 hr unknown 12 hr N/A

Mechanism of action and indications Nursing Implications (what to focus on)

(Why med ordered) Contraindications/warnings/interactions
Inhibits serotonin and norepinephrinereuptake in the Hypersensitivity. Use cautiously in: History of suicide
CNS. Both antidepressant and pain inhibition are attempt or ideation; History of mania (may activate
centrally mediated. mania/hypermania); Concurrent use of other centrally-acting
Depression, pain. drugs (increased risk of adverse reactions); History of
seizure disorder. Pedi: May increase risk of suicide
attempt/ideation especially during dose early treatment or
dose adjustment; risk may be greater in children and
adolescents (safe use in children and adolescents not
established). Increased risk of hepatotoxicity with alcohol
Common side effects
SEIZURES, fatigue, drowsiness, insomnia, decreased
appetite, constipation, dry mouth, nausea, dysuria,
increased sweating

Interactions with other patient drugs, OTC or herbal Lab value alterations caused by medicine
medicines (ask patient specifically) May increase ALT, AST, bilirubin, CPK, and alkaline
none phosphatase.
Be sure to teach the patient the following about this
Instruct pt. to take as directed at the same time each day.
Take missed doses as soon as possible unless time for next
dose. Do not stop abruptly; must be decreased gradually.
Encourage pt. and family to be alert for emergence of
anxiety, agitation, panic attacks, insomnia, irritability,
hostility, impulsivity, akathisia, hypomania, mania,
worsening of depression and suicidal idealation, especially
during early antidepressant therapy. If these symptoms,
notify health care professional. May cause drowsiness.
Caution pt. to avoid driving or other activities requiring
alertness until response to medication is known. Advise pt to
consult health care professional prior to taking any Rx, OTC,
or herbal products. Instruct p. to notify healthcare
professional if signs of liver damage (pruritus, dark uring,
jaundice, right upper quadrant tenderness, unexplained “flu-
like symptoms) occur. Advise pt. to avoid taking alcohol
during duloxetine therapy. Instruct pt. to notify health care
professional if pregnancy is suspected.

Nursing Process- Assessment Assessment Evaluation

(Pre-administration assessment) Why would you hold or not give this Check after giving
Monitor blood pressure before and med? Increased sense of well-being,
periodically during therapy. Monitor appetite Sustained hypertention, occurrence of renewed interest in
and nutritional intake. Assess mental status severe side effects. surroundings. Need for
and mood. Assess suicidal tendencies. therapy should be periodically
Assesspain intensity, quality, and location. reassessed. Pts. May notice
improvement within -4 wks,
but should be advised to
continue therapy as directed.
Therapy is usually continued
for several months.

Dose Range:no pediatric range available because safe use in children/adolescents is not
established. Adult dose range for antidepressant use is 20-30 mg twice daily and for
neuropathic pain is 60 mg once daily.