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Med Surg Nursing Drug Cards Combo

Terms in this set (68)

Name: Ertapenam (Sodium): Also known as Invanz

Uses: Adults with moderate to severe infections such as intraabdominal infections, complicated skin infections, community acquired pneumonia, acute pelvic infections, and infection prophylaxis prior to elective colorectal surgery.

Contraindications and Precautions: Children, geriatrics, GI/renal/hepatic disease, and anaphylactic reactions to beta-lactams
*Dosage and Routes: Adults1 gram/day duration depending on the reason for medication use anywhere between 5-14 days. Children 15mg/kg/bid between 5-14 days depending on reason for medication. Surgical infection prophylaxis 1gram given 1 hour before surgery.
*Side Effects: Insomnia, Seizures, tachycardia, N/V, dyspnea, cough, crackles, anaphylaxis
*Drug Tests: Hepatic Enzymes
*Teach: report severe diarrhea, avoid breastfeeding, and report overgrowth of infection such as black furry tongue, vaginal itching, and foul smelling stools.
*Overdose Treatment: Epinephrine and antihistamines
Name: K-Lor also known as potassium bicarbonate or potassium chloride

Uses: Prevention and treatment of hypokalemia

Contraindications: Severe renal disease, severe hemolytic disease, Addison's disease, hyperkalemia, acute dehydration, and extensive tissue breakdown.
*Dosage and Routes: Hypokalemia prevention adult 20 mEq/day 1-2 doses PO for adults, for hypokalemia or digoxin toxicity IV max 10 mEq/1hr with a max of 200mEq in 24 hours. P) 40-100 mEq/kg/hour in 2-4 doses
*Side Effects: Confusion, bradycardia, cardiac depression and arrhythmias, N/V, oliguria, cold extremities and rash.
*Assess: signs of hyperkalemia
*Teach: Add potassium to diet, avoid OTC products such as antacids, and report signs of hyperkalemia
*Trade Name: Dilaudid
*Generic Name: Hydromorphone
*Classification: Analgesics (Narcotics)
*Action: Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception.
*Use: Morderate to severe pain, non-productive cough
*Safe Dose: 2.5 - 10 mg q 3-6 hrs orally or 1-2 mg q 4-6 hrs by injection
*Common/Life Threatening SE: Drowsiness, dizziness, confusion, headache, sedation, euphoria, seizures, hypotension, N&V, constipation, cramps, rash, increased urinary output, respiratory depression
*Contraindications: Hypersensitivity; respiratory depression, opioid-naïve patients. Pregnancy.
*Nursing Considerations: Respiratory dysfunction. I&O ratio (urinary retention); CNS changes (dizziness, LOC); Pain (control). Assist with ambulation and use safety measures.
*Pt Teaching: Report any symptoms of CNS changes, allergic reactions. Physical dependency may occur. Withdrawal may occur. Avoid driving.
*Trade Name: Lasix
*Generic Name: Furosemide
*Classification: Diuretics (Loop)
*Action: Inhibits reabsorption of sodium and chloride at proximal and distal tubule and in the loop of Henle.
*Use: Pulmonary edema; edema with CHF, hepatic disease, nephrotic syndrome, ascites, hypertension.
*Safe Dose: 20-80 mg/day in AM. After 6 hrs up to 600 mg/day. 20-40 mg IV.
*Common/Life Threatening SE: Headache, fatigue, orthostatic hypotension, chest pain, circulatory collapse, loss of hearing, blurred vision, hypokalemia, hypomagnesemia, hypocalcemia, hyponatremia, hyperglycemia, nausea, diarrhea, polyuria, renal failure, thrombocytopenia, agranulocytosis, leukopenia, anemia, rash, pruitis, Stevens-Johnson syndrome, cramps
*Contraindications: breast feeding, infants, anuria, hypovolemia, electrolyte depletion.
*Nursing Considerations: weight, daily I&O; Hypertension - B/P lying, standing; Hypokalmeia - postural hypotension, malaise tachycardia; rashses, temp; Hearing - tinnitus; Electrolyte, BUN, Glucose in urine, allergies.
*Pt Teaching: high potassium diet; rise slowly from lying or sitting position; recognize adverse reactions; exercise, diet, stress relief; use of sunscreen; take early in day to avoid sleeplessness; avoid OTC medications unless ordered by prescriber.
*Trade Name: Lanoxin
*Generic Name: Digoxin
*Classification: Antiarrythmic (Cardiac Glycoside)
*Action: Inhibits the sodium-postassium ATPase pump, which makes more calcium available for contractile proteins, thereby resulting in increased cardiac output.
*Use: Heart failure, atrial fibrillation, atrial flutter, atrial tachycardia, cardiogenic shock, paroxysmal atrial tachycardia, rapid digitalization in these disorders.
*Safe Dose: 10-15 mcg/kg in 3 divided doses q 6-8 hrs.
*Common/Life Threatening SE: Headache, drowsiness, apathy, confusion, dysrhythmias, hypotension, bradycardia, AV block, blurred vision, yellow-green halos, N&V, abdominal pain, diarrhea.
*Contraindications: Hypersensitivity to digoxin, ventricular fibrillation, ventricular tachycardia, carotid sinus syndrome, 2nd or 3rd degree heart block.
*Nursing Considerations: Assess pulse for 1 min before giving product (if pulse <60 take again in 1 hr); check electrolyte (K, Na, Cl, Mg, Ca); renal function tests; I&O ratio; Cardiac status.
*Pt Teaching: Do not stop product abruptly; avoid OTC medication and herbal remedies; notify prescriber of loss of appetite; toxic symptoms of product; maintain a sodium restricted diet as ordered; report SOB, difficulty breathing, weight gain, edema, persistent cough.
*Trade Name: Humulin R
*Generic Name: Insulin Regular
*Classification: Antidiabetic Agent
*Action: Acts via specific membrane-bound receptors on target tissues to regulate metabolism of carbohydrate, protein, and fats.
*Onset of action: 0.5 hrs; Peak: 2.5-5 hrs
Duration of action: 4-12hrs
*Use: Treatment of Type 1 diabetes mellitus, type 2 diabetes mellitus, adjunct to parental nutrition. To keep blood glucose levels in accurate range (80-140mg/dL).
*Safe Dose: SubQ (regular insulin can be given IV). The number and size of daily doses, time of administration, and diet all require continuous supervision. Usual maintenance range: 0.5-1.2 units/kg/day
*Common/Life Threatening SE: Hypoglycemia is most common adverse effect. Cardio: palpitation, pallor, tachycardia. CNS: fatigue, hypothermia. Derm: uticaria, redness. GI: hunger, nausea, numbness of mouth. Local: atrophy or hypertrophy of subQ fat tissue, edema, itching pain. OCULAR: transient presbyopia, blurred vision. MISC: anaphylaxis, diaphoresis
*Contraindications:Hypersensitivity to any component of the formulation.
*Nursing Considerations:Assess for potential interactions with other products pt may be taking. Assess lab results, therapeutic effectiveness, and adverse response.
*Patient Teaching: Educate patient: do not take any new medication during therapy unless approved by doctor, Should be administered 30-60 minutes before a meal.
*Trade Name: NovoLog
*Generic Name: Insulin Aspart
*Classification: Antidiabetic Agent
*Action: Acts via specific membrane-bound receptors on target tissues to regulate metabolism of carbohydrate, protein, and fats.
*Use: Treatment of type 1 diabetes mellitus, and type 2 diabetes mellitus to improve glycemic control.
*Safe Dose: SC injection.
Usual maintenance dose: 0.2-0.6
units/kg/day in divided doses.
*Common/Life Threatening SE: Hypoglycemia is most common adverse effect. Cardio: palpitation, pallor, tachycardia. CNS: fatigue, hypothermia. Derm: uticaria, redness. GI: hunger, nausea, numbness of mouth. Local: atrophy or hypertrophy of subQ fat tissue, edema, itching pain. OCULAR: transient presbyopia, blurred vision. MISC: anaphylaxis, diaphoresis
*Contraindications: Hypersensitivity to any component of the formulation.
*Nursing Considerations: Assess for potential interactions with other products pt may be taking. Assess lab results, therapeutic effectiveness, and adverse response.
*Patient Teaching: Educate patient: do not take any new medication during therapy unless approved by doctor, Should be administered 30-60 minutes before a meal.
*Trade Name: Rocephin
*Generic Name: Ceftriaxone sodium
*Classification: Cephalosporin (3rd generation)
*Action: To reduce the development of drug-resistant bacteria
*Use: Serious lower respiratory tract, urinary tract, skin, gonococcal, intraabdominal infections, septicemia, meningitis, bone, joint infections, otitis media.
*Safe Dose: Adult: IM/IV 1-2 g/day, max q12-24hr
IM peak 2-3 hours
IV onset 5 mins
*Common/Life Threatening SE: Assess sensitivity to penicillin and other cephalosporin's. Severe diarrhea-discontinue. Can cause nephrotoxicity, anaphylaxis, perineal itching, fever, malaise, redness, pain, swelling. Can increase bleeding if taking anticoagulants, thrombolytics, valproic acid, pilacamycin, and NSAIDS. Can decrease absorption of iron.
*Contraindications: If allergic to penicillin, has severe diarrhea. Hyperbilirubinemic neonates, especially prematures, should not be treated with Rocephin.
*Patients with these conditions should avoid rocephin: Liver Problems, Disease of the Gallbladder, Serious Kidney Problems, Clostridium Difficile Bacteria Related Colitis, Yellowing of the Skin in a Newborn Child, Hemolytic Anemia
*Nursing Considerations: Check IV site for extravasation and phlebitis before administering medication. Assess bowel patterns daily; if severe diarrhea starts-discontinue medication immediately. Check for bleeding (ecchymosis, bleeding gums, hematuria, stool guaiac). If diabetic- check blood glucose.
*Patient Teachings: This medication passes into breast milk and may have undesirable effects on a nursing infant. Patients should have electrolytes checked monthly (K, Na, Cl) if patient is on long-term therapy. Tell patient to report ant sore throat, bruising, bleeding, joint pain-may indicate blood dyscrasias. Tell patient to use this medicine for the full-prescribed length of time.
*Trade Name: Levaquin
*Generic Name: Levoflaxacin
*Classification: Anti-infective (Fluoroquinolone)
*Action: Interferes with conversion of intermediate DNA fragments into high-molecular-weight DNA in bacteria; inhibits topoisomerase IV
*Use: Acute sinusitis, acute chronic bronchitis, community-acquired pneumonia, uncomplicated skin infections, complicated UTI, cellulitis, PID, prostatitis, inhalational anthrax, acute pyelonephritis
*Safe Dose: Acute bacterial exacerbation of chronic bronchitis: Adult PO/IV 500 mg q24hr x 7 days
Acute bacterial sinusitis: Adult 500 mg q24hr x 10-14 days or 750mg q24hr x 5 days
Acute Pyelonephritis: Adult PO 250mg q24hr x 10 days or 750mg q24hr x 5 days
Chronic bacterial prostitis: Adult PO 500mg q24hr x 28 days
Pneumonia, acquired: Adult PO/IV 500mg q24hr x 7-14 days or 750mg q24hr x 5 days
Skin infections: Adult PO/IV 750mg q24hr x 7-14 days.
UTI: Adult PO/IV 250mg q24hr x 10 days
Otitis Media: Adult PO 100-200mg bid-tid x 3-14 days.
*Common/Life Threatening SE: Headache, dizziness, insomnia, anxiety, seizures, chest pain, vasodilation, palpitations, dry mouth, visual impairment, nausea, flatulence, vomiting, diarrhea, abdominal pain, vaginitis, rash, pruritus, photosensitivity, tendon rupture, pneumonitis, anaphylaxis, organ failure, Stevens Johnson syndrome, hemolytic anemia.
*Contraindications: Hypersensitivity to quinolones.
Precautions: pregnancy, breastfeeding, children, photosensitivity, acute MI, atrial fibrillation, colitis, dehydration, diabetes, QT prolongation, myasthenia gravis, renal disease, seizure disorder, syphilis.
*Nursing Considerations: Assess previous sensitivity reaction, signs/symptoms of infection, allergic reactions, anaphylaxis, bowel pattern daily (stop if severe diarrhea occurs), renal function. Increase fluid intake to 2L/day to prevent crystalluria.
*Patient Teaching: Teach patient to contact prescriber if vaginal itching; loose, foul-smelling stools; furry tongue occur; to report itching, rash, pruritus, urticarial. Notify prescriber of diarrhea with blood or pus. To take product 4 hours before or 2 hours after antacids, iron, calcium, zinc products. To complete full course of therapy, to avoid hazardous activities until response is known, to use frequent rinsing of mouth, avoid other medication unless approved by prescriber, to prevent sun exposure or to use sunscreen to prevent phototoxicity.
*Trade Name: Zestril
*Generic Name: Lisinopril
*Classification: Angiotensin Converting Enzyme Inhibitor
*Action: Selectively suppresses renin-angiotensin-aldosterone system, inhibits ACE, thereby preventing conversion of angiotensin I to angiotensin II.
*Use: Mild to moderate hypertension, adjunctive therapy of systolic CHF, and acute MI.
*Safe Dose: HTN: 10-40 mg/ daily; max 80 mg, MI: 5 mg w/in 24 hr of s&s then 5 mg after 24 hrs then 10mg after 48 hrs. Renal: CCr <30 ml/min reduce dose by 50%, initially 5 mg/day, max 40 mg/day; CCr <10 ml/min, 2.5 mg/day, max 40 mg/day.
*Common/Life Threatening Side Effects: Vertigo, depression, stroke, headache, fatigue, dizziness, chest pain, hypotension, blurred vision, vomiting, anorexia, and constipation.
*Contraindications: Hypersensitivity, angioedema, pregnancy (2nd & 3rd trimesters, black box warning)
*Nursing Considerations: Blood studies (platelets and WBCs q3mo), baseline renal & hepatic studies, angioedema, pregnancy, HTN, electrolytes (K, Na, Cl), CHF, skin turgor, therapeutic response.
*Patient Teachings: Do not discontinue abruptly, rise slowly from sitting or standing, avoid increasing potassium in diet, report dry cough, report pregnancy or planning to become pregnant.
*Trade Name: Morphine
*Generic Name: Morphine Sulfate
*Classification: Analgesic (Narcotic)
*Action: Depresses pain impulses transmission at the spinal cord level by interacting with opioid receptors.
*Use: Moderate to severe pain.
*Safe Dose: PO: 10-30 mg q4hr prn, IV: 2.5-15 mg diluted in 4-5 ml water for inj over 5 min, SUBCUT/IM: 5-10 mg q4hr (opiate naive) 5-20 mg q4hr (prior opiate use).
*Common/Life Threatening Side Effects: Drowsiness, dizziness, confusion, headache, sedation, euphoria, insomnia, seizures, bradycardia, shock, cardiac arrest, tachycardia, blurred vision, N&V, constipation, thrombocytopenia, resp depression, resp arrest, apnea.
*Contraindications: Hypersensit-ivity, opioid adduction, hemorrhage, bronchial asthma, increased ICP, hypovolemia, shock, resp depression. Precautions: pregnancy, breast feeding, <18yo, geriatric, addictive personality, acute MI, heart disease, renal/hepatic disease, bowel impaction.
*Nursing Considerations: Assess pain, bowel status, I&O, BP, pulse, resp, CNS changes, allergic reactions, assistance with ambulation, safety, gradual withdraw therapeutic response.
*Patient Teachings: Change position slowly, report CNS changes, physical dependency may result in long term use, avoid alcohol & other CNS depressants, withdraw S&S may occur.
*Trade Name: Pepcid
*Generic Name: Famotidine
*Classification: H2 Histamine receptor antagonist
*Action: Competitively inhibits histamine at histamine H2-receptor site, thus decreasing gastric secretion while pepsin remains at a stable level
*Use: Short-term treatment of active duodenal ulcer, Zollinger-Ellison syndrome, multiple endocrine adenomas, gastric ulcers; gastro esophageal reflux disease, heartburn Unlabeled: GI disorders in those taking NSAIDS; urticaria; prevention; prevention of stress ulcers, aspiration pneumonitis, inactivation of oral pancreatic enzymes in pancreatic disorders
*Safe Dose:
*Common/Life Threatening Side Effects: Seizures in renal disease, dysrhythmias, QT prolongation (impaired renal functioning), Thrombocytopenia, aplastic anemia, toxic epidermal necrolysis, Stevens-Johnson syndrome, pneumonia
*Contraindications:
*Nursing Considerations: Assess ulcers, blood dycrasias and bruising, fatigue, bleeding, poor healing Evaluate therapeutic response
*Patient Teachings: Product must be continued for prescribed time in prescribed method to be effective; not to double dose. To report bleeding, bruising, fatigue, malaise, since blood dycrasias occur. About possibility of decreased libido; that this is reversible after discontinuing therapy. To avoid irritating foods, alcohol, aspirin, extreme-temp foods that may irritate GI system. That smoking should be avoided because it diminishes effectiveness of product. To avoid tasks requiring alertness because dizziness, drowsiness may occur
*Trade Name: Spiriva
*Generic Name: Tiotropium
*Classification: Anticholinergic Bronchodilators
*Action: Inhibits interaction of acetylcholine at receptor sites on the bronchial smooth muscle, thereby resulting in decreased cGMP and bronchodilation
*Use: COPD; for the long-term treatment and once-daily maintenance of bronchospasm associated with COPD, including chronic bronchitis and emphysema
*Safe Dose:
*Common/Life Threatening Side Effects: angioedema
*Contraindications:
*Nursing Considerations: Assess respiratory status Evaluate therapeutic response
*Patient Teachings: Signs of closed-angle glaucoma. That product is used for long-term maintenance, not for immediate relief of breathing problems; that effect takes 20 minutes, last 24 hrs. Rinse mouth after use, to use hard candy or oral hygiene to reduce dry mouth. Breath out completely; not to breathe into mouthpiece at any time. With head upright, to breathe in slowly & deeply, but allow the cap to vibrate; to breathe until the lungs to fill; to hold breath and remove mouthpiece; to resume normal breathing. To hold the handihaler with mouthpiece upward; to press button in once, completely, and release: this allows for medication to be released upward; to press button in once, completely, and release: this allows for medication to be released
*Trade Name: Synthroid
*Generic Name: Levothyroxine
Sodium
*Classification: Thyroid preparation
*Action: Increase metabolic rate, control protein synthesis, increase cardiac output, renal blood flow, o2 consumption, body temp., blood volume
*Use: Hypothyroid-ism, myxedema coma, thyroid hormone replacement
*Safe Dose: Age <50: 100-200 mcg/day
*Common/Life Threatening Side Effects: Anxiety, insomnia, tremor, thyroid storm, tachycardia, palpitation, angina, dysrhythmia, alopecia
*Contraindications: Acute MI, thyrotoxicosis at any etiology, uncorrected adrenal insufficiency. Cautions: elderly, angina pectoris, hypertension, other CV disease, adrenal insufficiency, myxedema, diabetes mellitus and insipidus, swallowing disorders
*Nursing Considerations: Obtain baseline weight, Blood pressure, pulse, weight, t3, t4, and pt levels. Signs and symptoms of diabetes mellitus, diabetes insipidus, adrenal insufficiency, hypopituitarism may become intensified. Treat with adrenocortical steroids before thyroid therapy in coexisting hypothyroidism and hypoadrenalism. Observe for tremors, anxiety. Assess appetite and sleep pattern
*Patient Teachings: Do not d/c drug therapy. Hypothyroidism treatment is lifelong. Follow up visits and thyroid function tests are essential. Take meds at the same time each day, preferably in the morning. Report pulse of over 100 beats per min. Notify physician with chest pain, weight loss, anxiety, tremors, and insomnia. Full therapeutic effect may take 1-3 weeks
*Trade Name: Sandostatin
*Generic Name: Octreotide
*Classification:
*Action: Mimics naturally occurring somatostatin. Inhibitor of growth hormone, glucagon and insulin
*Use: Used for long-term maintenance in acromegalic patients who have inadequate response to other therapies. Long-term treatment of severe diarrhea and flushing episodes
*Safe Dose: 50 mcg SC q8h initially, titrate up to 500 mcg if necessary. After success for 2 weeks, initiate treatment with depot injection
*Common/Life Threatening Side Effects: Gallbladder problems, dysglycemia, hypothyroidism, bradycardia, ecg changes
*Contraindications: Hypersensitivity, may need to adjust dose for hepatic/renal impairment, use caution with patients with CV disease
*Nursing Considerations: May impair gallbladder function, use with caution with patients with renal impairment, monitor glucose levels in patients with diabetes and even those without diabetes, can be given IV, IM, or SC
*Patient Teachings: Instruct patient to report abdominal pain, monitor blood sugar
*Classification: Glucocorticoid, fast acting
*Generic name: methylprednisolone
*Trade/Brand name: Solu-Medrol
*Action: Decreases inflammation by suppressing the migration of polymorphonuclear leukocytes, fibroblasts; reversal of increased capillary permeability and lysosomal stabilization.
*Use: Severe inflammation, shock, adrenal insufficiency, collagen disorders, management of acute spinal cord injury, multiple sclerosis.
*Safe Dose: Anti-inflammatory, Immunosuppressive: IV: 10-40mg. May repeat q 4-6hrs prn. PO 2-60mg/day in 1-4 divided doses. IM (methylprednisolone acetate): 10-80mg q 1-2wks. Intra-articular, intralesional: 20-60mg q 1-5wks. Status Asthmaticus: IV: Initially 2mg/kg/dose, then 0.5-1mg/kg/dose q6hrs. Spinal Cord Injury: IV Bolus: 30mg/kg over 15min, followed by 5.4mg/kg/hr over 23hrs; given within 45 min of bolus dose.
**Methylprednisolone acetate IV should be reconstituted with D5W, 0.9% NaCl; Should give IV push over 3-15min. Give IV piggyback dose of 250mgover 15-30min; dose of 500-999 over at least 30 mine; dose of 1g over 1hr.
-Administer PO with food or milk to decrease GI symptoms. IM use a 21G needle in a large muscle mass; avoid deltoid.
*Common/Life Threatening SE: Insomnia, heartburn, anxiety, abdominal distension, diaphoresis, acne, mood swings, increased appetite, facial flushing, GI distress, delayed wound healing, increases susceptibility to infection, diarrhea, and constipation. Life threatening: Circulatory collapse, thrombophlebitis, embolism, GI hemorrhage, and thrombocytopenia. Occasional: Headache, edema, tachycardia, change in skin color, frequent urination, depression. Rare: Psychosis, hallucinations, increased blood coagulability.
*Contraindications: Hypersensitivity, Cushing's syndrome, measles, varicella, fungal infections
*Nursing considerations:
**ASSESS for adrenal insufficiency: weight loss, nausea, vomiting, confusion, anxiety, hypotension, weakness, plasma cortisol levels during long-term therapy
-Assess BP and pulse q4hr, notify prescriber of chest pain, crackles
-Assess potassium depletion: parethesias, nausea, vomiting, fatigue, depression, polyuria, dysrhythmias, and weakness.
-Assess for edema, hypertension, cardiac symptoms
-Mental status: affect, mood, behavioral changes, aggression
-K+, blood glucose, urine glucose while receiving long term therapy; hypokalemia and hyperglycemia
-Joint mobility, pain, edema if product given intraarticularly
-I&O ratio, decreased urine output, increased edema, assess weight and notify if >5lb daily
*Pt Teaching:
-DO NOT discontinue abruptly because adrenal crisis can result
-Increase intake of K+, Ca, and protein
-Avoid OTC products: salicylates, alcohol in cough products, cold preparations unless directed by prescriber, to avoid vaccinations because immunosuppression occurs.
-Adrenal insufficiency symptoms: nausea, anorexia, fatigue, dizziness, dyspnea, weakness, join pain
-Carry emergency ID as corticosteroid user
-Notify prescriber if therapeutic response decreases; dosage adjustment may be needed.
*Classification: Opioid Antagonist/ Pharmacotherapeutic
Generic name: entereg
Brand name: Alvimopan
*Action: Binds to opioid receptors in the GI tract. Therapeutically works by accelerating the GI recovery period and is defined by time to first bowel movement or flatus.
*Use: To accelerate recovery time to upper and lower GI following partial large or small bowel resection surgery with primary anastomosis.
*Safe Dose: 12mg given 30 min to 5hrs prior to surgery followed by 12mg bid beginning the day after surgery for a maximum of 7 days or until discharge. Pt should not receive more than 15 doses.
-First dose given 30 min to 5hrs prior to surgery; remaining dosage given without regard to meals.
*Common/Life Threatening SE: Hypokalemia, constipation, flatulence, dyspepsia (epigastric distress, heartburn, indigestion) Rare SE: Back pain, urinary retention
*Contraindications: Pts taking opioids for more than 7 consecutive days prior to initiation of alvimopan because recent exposure to opioids heightens the pts sensitivity to drugs effects and increases vulnerability to abdominal pain, nausea, vomiting, and diarrhea.
*Nursing considerations:
-Asses pt has not taken opioids in the past 7 days prior to administering Alvimopan
-Monitor for hepatotoxicity (abdominal pain lasting more than a few days, white bowel movements, dark urine, jaundice), increases AST, ALT, serum bilirubin.
*Pt Teaching:
-Teach pt that recent use of opioids may increase susceptibility to adverse reactions, primarily to the GI tract such as, abdominal pain, nausea, vomiting, diarrhea
-Inform pt most common side effects in bowel resection are constipation, dyspepsia, flatulence
-Report abdominal pain, nausea, vomiting, diarrhea
Motrin
*Generic/Trade Name: Ibuprofen
BLACK BOX ALERT. Hepatic Precautions. Increased risk of serious cardiovascular thrombotic events, including myocardial infarction, CVA. Increased risk of severe GI reactions, including ulceration, bleeding, perforation. Increased risk of new onset or worsening of preexisting hypertension.
In first trimester: cleft palate and cardiovascular anomalies
*Action: Analgesic/Anti-inflammatory/nonsteroidal anti-inflammatory drug (NSAID). Treats fever and pain, by inhibiting prostaglandin synthesis by decreasing the activity of the enzyme that makes its precursor.
*Side Effects: edema, hypertension, dizzy, nervous, headache, pruritis, rash, fluid retention, GI ulceration, N&V, heartburn and vision changes.
*Dosage: ADULT - 200mg/4-6hrs prn (max of 1200mg/24hrs). 200-400mg for pain, fever and dysmenorrhea. 400-800mg/3-4xs/day for inflammatory disease.
*Nursing Consideration: Administer with food/milk to decrease upset stomach. monitor urine output and occult blood loss
Ferrous Sulfate
*Generic/Trade Name: Iron
*Action: Ferrous sulfate provides the iron needed by the body to produce red blood cells by entering the bone marrow where it is turned to hemoglobin. It is used to treat or prevent iron-deficiency anemia, a condition that occurs when the body has too few red blood cells because of pregnancy, poor diet, excess bleeding, or other medical problems.
*Side Effects: constipation and upset stomach
*Dosage: ADULT - 2-3mg/kg/day or 60-100mg/4xs/day
*Nursing Consideration: This medication should be taken on an empty stomach, at least 1 hour before or 2 hours after eating.
Prenatal Vitamin
Folic acid helps prevent neural tube defects. These defects are serious abnormalities of the brain and spinal cord.
Iron supports the baby's growth and development. Iron also helps prevent anemia, a condition in which blood lacks adequate healthy red blood cells. Iron helps blood -- in both the mother and baby -- carry oxygen.
*Action: vitamin and mineral supplements intended to be taken before and during pregnancy and during postnatal lactation, help cover any nutritional gaps in the mother's diet.Their folic acid, iron, and calcium are especially important.
*Side Effects: constipation, nausea and vomiting
*Dosage: usually one pill per day
*Nursing Consideration: drink plenty of fluids, increase fiber in diet, take before bed to reduce N&V
Toradol
*Generic/Trade Name: Ketorolac
*Action: Treats pain and inflammation caused by arthritis, menstrual cramps, and other medical problems, by inhibiting prostaglandin synthesis by decreasing the activity of the enzyme that makes its precursor.. This is a nonsteroidal anti-inflammatory drug (NSAID).
*Side Effects: ulcers, edema, hypertension, dizzy, nervous, headache, pruritis, rash, fluid retention, GI ulceration, N&V, heartburn and vision changes.
*Dosage: ADULT - IM 30mg, IV 15mg, oral 10mg/q4-6hrs
*Nursing Consideration: Administer with food, IM or IV bolus. Monitor pain relief, urine output and occult blood
Norco
*Generic/Trade Name: Hydrocodone/Acetaminophen
Warning: Norco may impair your thinking or reactions. Avoid driving or operating machinery until you know how Norco will affect you. Avoid drinking alcohol. It may increase your risk of liver damage while taking acetaminophen.
*Action: treats pain and fever by inhibiting pain receptors in CNS and decreasing prostaglandin synthesis.
*Side Effects: light-headed, confusion, seizures, bloody or cloudy urine, GI problems, kidney and liver problems, constipation, mood changes, blurred vision, etc.
*Dosage: 10-15mg/kg/dose every 4-6 hrs prn. No more than 5 doses per day.
*Nursing Consideration: Avoid alcohol and dont take longer than 10 days, take with food and swallow whole.
Percocet
*Generic/Trade Name: acetaminophen and oxycodone. Opioid/Narcotic.
Percocet contains a combination of acetaminophen and oxycodone
*Action: Relieves moderate to severe pain.
*Side Effects: CNS depression, hypotension, bradycardia, shallow breathing, slow heartbeat, light-headed, fainting, confusion, N&V, GI problems, dizzy, drowsy, constipation and dry mouth
*Dosage: 1-2 tabs/q4-6 hrs prn. Maximum dose is 4g/day
*Nursing Consideration: Monitor pain relief, respirations, mental status and blood pressure
Tylenol
*Generic/Trade Name: Acetaminophen and Codeine
*Action: relieves mild to moderate pain
*Side Effects: kidney and liver injury, bradycardia, hypotension, CNS depression, shallow breathing, slow heartbeat, light-headed, fainting, confusion, N&V, GI problems, dizzy, drowsy, constipation and urinary retention
*Dosage: ADULT - 1-2 tabs/4hrs. Max is 12 tabs/24hrs
*Nursing Consideration: observe for excessive sedation and respiratory distress. Administer with food and shake suspension well.
Mylicon
*Generic/Trade Name: simethicone
*Action: relieve symptoms of extra gas caused by air swallowing or certain foods/infant formulas. Simethicone helps break up gas by allows gas bubbles in the stomach and intestines to come together more easily, which allows for easier passage of gasbubbles in the gut.
*Side Effects: Allergic reaction
*Dosage: 20-40mg/q4hrs/day. Adults 40-250 mg at bedtime, dont exceed 500mg/day.
*Nursing Consideration: avoid carbonated drinks
Lovenox (anticoagulant)
*Generic/Trade Name: Enoxaparin sodium
*Action: Prevents and treats blood clots. Also used to treat certain types of acute heart attacks. This medicine is a blood thinner.
*Side Effects: edema, confusion, fever, N&V, diarrhea, hemorrhage, anemia, hematuria and skin necrosis
*Dosage: ADULT 45kg/day
*Nursing Consideration: report any unusual bleeding
Measles Mumps Rubella (MMR)
*Action: active immunity to MMR
*Side Effects: soreness, swelling, hives, respiratory distress, rash and weakness.
*Dosage: 0.5mL/dose SubQ
*Nursing Consideration:
Nystatin
*AKA Bio-Statin, Nystat, Nystop, Pedi-Dri and ratio-Nystatin
*Action: Interferes w/ fungal DNA replication; binds sterols in fungal cell membrane which increases permeability, leaking of cell nutrients
*Uses: Candida species causing oral & intestinal infections
*Dosage & Routes:
``child-adult: 400,000-600,000 units Qid, use 1/2 dose in each side of mouth, swish & swallow, use atleast 48 hrs after symptoms (don't mix with food).
``infants: 200,000 units Qid (100,000 each side of mouth)
```newborns/premies: 100,000 units Qid
~~GI INFECTIONS
``Adult: 500,000-1,000,000 units tid
~~~CUTANEOUS
```Adult/child: apply to infected area bis; powder apply to infected area

*Nursing Considerations
Assess - Allergic Reaction: rash, urticaria, irritated oral mucous membrandes; product may be discontinued/ obtain culture, histologic test to confirm organism/ predisposing factors: antibiotic therapy, pregnancy, diabetes mellitus, sexual partner infection ( vaginal infection )
Perform/Provide: Storage in fridge (Oral)/ Store in tight, light-resistant container at room temp (Tabs)
Evaluate: therapuetic response - culture negative for Candida
Teach (Pt & fam): LT therapy may be needed to clear infection/ complete entire course of meds/ avoid commercial mouthwash for mouth infection/ SHAKE before measuring each dose/ NOTIFY prescriber for irritation (may be discontinued)
Lovenox
*AKA: Enoxaparin
*Action: Binds to antithrombin III inactivating factors Xa and IIa, thereby resulting in a higher ratio of anti-factor Xa and IIa
*Uses: Prevention of DVT/PE (inpatient) in hip & knee replacement/ abd Sx @ risk 4 thrombosis/ unstable angina/ non-Q-wave MI.
*Precautions: Pregnancy (B)/ breast-feeding/ children/ geriatric PTS/ Low weight (men < 57kg, women < 45kg)/ severe renal hepatic disease/ blood dyscrasias/ severe hypertension/ sub acute bacterial endocarditis/ acute nephritis/ recent burn/ spinal SX/ indwelling catheters
*Dosage&Routes:
`DVT prvt b4 hip/knee SX -Adult: SUBCUT 30mg bid 12-24 hrs postop 7-10 days until diminished risk
`DVT prvt b4 hip rplcmt: 40mg/day 9-15 hrs preop OR 30mg q12hr 12-24 hrs postop until risk diminished OR PT adequately on anticoagulant
`DVT prophylaxis b4 abd SX: Adult SUBCUT 40mg/dy 24 hrs prior to SX X 7-10 days to prevent thromboembolic complications

*Nursing Consids:
Assess: blood studies (Hct/Hgb, CBC, coagulation studies, platelets, occult blood in stool)/ anti-factor Xa (checked every 4hrs after inj)/ thrombocytopenia may occur/ renal studies - BUN-creatine baseline & periodically
Bleeding: gums/ petechiae/ ecchymosis/ black tarry stool/ hematuria/ notify prescriber ***BLK BOX: Neurologic symptoms in PTS who've rcvd spinal anasthesia**
PERFORM/PROVIDE: Store @ 77F (25C) dont freeze.
EVALUATE: therapuetic response, prvt of DVT
TEACH PT & FAM: use soft toothbrush avoid bleeding gums; to use electric razor/ report signs of bleeding: gums, under skin, urine, stool/ Avoid OTC products w/ aspirin unless approved by prescriber.
Warfarin
*AKA Coumadin, Jantoven
*Action: Interferes with blood clotting by indirect means; depresses hepatic synthesis of vit-K-dependent coagulation factors (II, VII, IX, X)
*Uses: antiphospholipid antibody syndrome, arterial thromboembolism, prophylaxis, after MI, stroke prophylaxis, thrombosis prophylaxis
*Precautions: geriatics/ Alc-ism, CHF, Debilitated PTS, trauma, indwelling caths, Severe HTN, active infections, protein C defic, polycythemia vera, vasculitis, severe DIABS, Asians (CYP2C9, VKORC1)
*DOSE & RTE:
Adult PO/IV 2.5-10 mg/dy X 2-4 days then titrated to INR/PT
infant-adolescent: PO/IV 0.2mg/kg/dy X 2 days titrated to INR
Administer at same time/day to maintain stdy bld lvls w/o regards to food; food decreases rate but not extent of absorption; DONT change brands.
*Nursing Consids:
Storage in tight container
Therapeutic response: decrease in deep vein thrombosis
Avoid OTC preparations that may cause serious product interactions unless directed by prescriber.
Carry emergency ID while taking product
Drug compliance needs to be discussed with pt.
Report any signs of bleeding, soft bristle toothbush and electric razor use.
Avoid hazardous activities/work.
No unusual changes in diet, vitamin intake or life.
INFORM of anticoagulant intake.
Heparin
*AKA Hepalean, Heparin Leo, Hep-lock, Hep-Lock U/P, Monoject Prefill
*Action: prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III
*Uses: Prevention of deep vein thrombosis, PE, MI, open heart Sx, atrial fibrillation, etc as an anticoagulant in transfusion and dialysis procedures, pvtn of DVT/PE to maintain patency of indwelling venipuncture devices
*Dosage/Route
Deep vein thrombosis/Pulmonary embolism:
Adult - IV BOL 80 int'l units/kg; IV INF 18 int'l units/kg/hr
Thrombosis prophylaxis (open heart/CV Sx):
Adult IV greater than or equal to 150 int'l units/kg
Thrombosis prophylaxis (PCI, not rcvg abciximab): Adult IV BOL 60-100 int'l units/kg
Prophylaxis for DVT/PE: Adult SUBCUT 5000 units q8-12hrs
IV catheter occlusion prophylaxis:
Adult/child IV: 10-1000 units/ml
Infant (below 10 kg) IV: 10 units/ml

Nursing Consiids:
*Assess: blood studies q3mo; platelet count q2-3 days as thrombocytopenia may occur on 4th day / Hypersensitivity: rash, chills, fever or itching needs to be reported to prescriber.
*Storage at room temp
*Therapeutic response: decrease of DVT, adequate anticoagulation based on aPTT
*Avoid OTC preparations that may cause serious product interactions/ Can be held during menstruation/ avoid bleeding or contact sports/ Carry emergency ID with you at all times/ report bleeding and any signs of hypersensitivity (rash, chills, fever, itching
Fondaparinux
*AKA: Arixtra
*Action: Act by antithrombin III mediated selective inhibition of factor Xa; neutralizing of factor Xa interrupts blood coag and inhibits thrombin formation; doesnt inactivate thrombin or affect platelets
*Uses: Prevention/treatment of DVT, PE in hip/knee replac, hip fracture or abdom surgery, nlabeled use: acute coronary syndrome.
Precautions: Pregnant/ child, geriatric pts, alc's, severe uncontrolled HTN, severe hepatic disease ****BLK BOX: spinal/epiduralanesthesia, lumbar puncture; can lead to neurologic impairement*****
*Dose/RTE: DVT/PE - Adult less than 50kg SUBCUT 5mg/day X 5days until INR 2-3, can give w/ warfarin within 72hrs
-Adult 50-100kg SUBCUT 7.5mg/day X 5days until INR 2-3, can give w/ warfarin within 72 hrs
-Adult more than100kg SUBCUT 10mg/day X 5days until INR 2-3, can give w/ warfarin within 72 hrs
-DVT prevention: Adult SUBCUT 2.5 mg/day given 6hrs after surgery for 5-9 days; hip surgery up to 32 days; abd surgery up to 24 days.
-Unlabeled use: Adult SUBCUT 2.5mg until hospital discharge or no more than 8 days with standard treatment
-Renal disease: SUBCUT CCr less than 30ml/min do NOT use.
*Nurs Consids:
-Assess: blood studies, bleeding gums, black tarry stool, hemorrhage risk, hypersensitivity (rash, fever, chills)
-Perform/provide: store at 25 degrees C (77F), do NOT freeze
-Evaluate: DVT prevention
-Teach: avoid OTC meds; report unusual bleeding incl gum bleeds; use soft toothbrush and electric razor.
Lispro Insulin - Rapid Acting
*AKA: Humulin, Humalog
*Onset 15-30 min, peak 1/2 - 1 1/2 hr, duration 3-5 hrs.
*Action: Decrease blood glucose by transport of glucose into cells and the conversion of glucose to glycogen (indirectly incr blood pyruvate and lactate, decr phospate and potassium)
Uses: Type 1 diabetes mellitus, Type 2 diabetes mellitus, gestational diabetes lispro may be used w/ sulfonylureas un children older than 3**
*Dosage/Rte: Adult/Adlcs/Child SUBCUT 15mins b4 meal; external insulin pump SUBCUT INF/ Adult SUBCUT 1/2 - 1 hr b4 meal
Nursing Considerations
*Assess: Fasting test to identify treatment effectiveness q3mo; Urine Keytones during illness - insulin req can incr during stress, illness and surgery; Hypoglycemic reaction that can occur during peak time (sweating, dizzy, chills, confusion, headaches, nausea, rapid weak pulse, fatigue, tachycardia, memory lapse, anxiety, etc).; Hyperglycemia: acetone breath, polyuria, fatigue, polydipsia, flushed and dry skin, lethargy.
*Perform/provide: store @ room temp for less than 1month, away from heat and sunlight, fridge for rest of supply, dont freeze -- IV route
*Evaluate: therapeutic response - decr in polyuria, polyphagia, absence of dizziness, stable gait
*Teach: w/ blurred vision dont change lenses until vision controlled, carry equipment and treatment at all times, emergency ID, dosage, route and mixing
-ketoacidosis: nausea, thirst polyuria, dry mouth, decr b/p, dry and flushed skin, acetone breath, drowsiness.
Glargine Insulin - Long Acting
AKA: Lantus
Onset 1.5 hr, no peak, duration less than or equal to 24 hrs.
on: Decrease blood glucose by transport of glucose into cells and the conversion of glucose to glycogen (indirectly incr blood pyruvate and lactate, decr phospate and potassium)
Uses: Type 1 diabetes mellitus, Type 2 diabetes mellitus, gestational diabetes
*Dosage/Rte: Adult and child age 6 up 10 international units/day; range 2-100 intl units per day.
Nursing Considerations
*Assess: Fasting test to identify treatment effectiveness q3mo; Urine Keytones during illness - insulin req can incr during stress, illness and surgery; Hypoglycemic reaction that can occur during peak time (sweating, dizzy, chills, confusion, headaches, nausea, rapid weak pulse, fatigue, tachycardia, memory lapse, anxiety, etc).; Hyperglycemia: acetone breath, polyuria, fatigue, polydipsia, flushed and dry skin, lethargy.
*Perform/provide: store @ room temp for less than 1month, away from heat and sunlight, fridge for rest of supply, dont freeze -- IV route
*Evaluate: therapeutic response - decr in polyuria, polyphagia, absence of dizziness, stable gait
*Teach: w/ blurred vision dont change lenses until vision controlled, carry equipment and treatment at all times, emergency ID, dosage, route and mixing
-ketoacidosis: nausea, thirst polyuria, dry mouth, decr b/p, dry and flushed skin, acetone breath, drowsiness.
Glipizide
*AKA: Glucotrol, Glucotrol XL
*Action: Causes functioning beta cells in pancreas to release insulin; decr blood glucose levels; may improve insulin binding sites on receptors with prolonged admin; may also reduce basal hepatic glucose secretion; NOT effective if pt doesnt have functioning beta cells
*Uses: Type 2 diabetes mellitus
*Precautions: Pregnant, geriatrics, cardiac disease, severe renal/hepatic disease
*Dose/Rte: 30 mins b4 food
Adult PO 5 mg initial b4 breakfast then increase by 2.5-5mgs after days to get desired response; max 40mg/day or 15 mg/dose~~ PO (XL) 5mg/day w/ breakfast, may increase to 10mg/day, max 20mg/day ;Hepatic disease: Adult PO 2.5mg initially then increase to desired response; max 40mg/day or 15 mg/dose
-Geriatric PO 2.5mg/day, increase as needed.
*Nurs Consids:
-Assess: hypo/hyperglycemic reaction may occur soon after meals, blood glucose
-Perform/provide: store in tight, light-resistant container @ room temp
-Eval: decr in polyuria, polydipsia, polyphagia, no dizziness and stable gait
-Teach: may cause nausea, headache, cramps, flushing and hypoglycemia (carry sugar packs); report bleeding bruising, weight gain, edema, SOB, weakness & sore throat; taken @ AM, dont discontinue; avoid OTC; use sunscreen; follow glucose meter.
MiraLax
*AKA Polyethylene glycol
*Action: softening the stool and increasing the frequency of bowel movements by retaining water in the stool. Osmotic effect. Therapeutic Induces diarrhea, cleanses bowel without depleting electrolytes.
*Uses: laxative solution that increases the amount of water in the intestinal tract to stimulate bowel movements; to treat occasional constipation or irregular bowel movements.
*Precaution: Renal impairment: not recommended. Nausea, vomiting, abdominal pain or IBS: exclude bowel obstruction. Avoid prolonged, frequent, or excessive use. Bowel perforation, gastric retention, GI obstruction, megacolon, toxic colitis, toxic ileus. Ulcerative colitis, Pregnancy. Nursing mothers.
****DONT use if intestinal/stomach blockage, enlarged colon, loss of muscle strength or chronic inflammation of intestinal muscle****
*Dos & RTE: Mix 17 grams in 4-8 oz of any liquid until dissolved then drink; not for children under 17yrs old.
*Nurs Consids: store at room temp; dont use for more than 2 wks; dont double dose, if missed; notify prescriber if pregnant or breastfeeding; may experience cramps, gas, bloating, nausea or diarrhea;
*Nurs consids:
Assess - Do not give oral medication within 1 hr of start of therapy (may not adequately be absorbed before GI cleansing).
Evaluation - Assess bowel sounds for peristalsis. Monitor daily pattern of bowel activity, stool consistency; record time of evacuation. Assess for abdominal disturbances. Monitor serum electrolytes, BUN, glucose, urine osmolality.
Teach - May take 2-4 days to produce a bowel movement. Report unusual cramps, bloating, diarrhea
Neurontin
*AKA: GABAPENTIN, GRALISE, HORIZANT
*Action: Mechanism unknown; may increase seizure threshold; structurally similar to GABA; gabapentin binding sites in neocortex, hippocampus
*Uses: adjunct treatment of partial seizures, with/without generalization in patients >12 yrs; adjunct for partial seizures in children 3-12 yr, postherpetic neuarlgia, primary restless leg syndrome in adults
*Precautions: pregnancy; breastfeeding; children <3 y; geriatric patients, renal disease, hemodialysis; suicidal thoughts; depression
*Dose/Rte: Adult and child >12 yr: PO 900-1800 mg/day in 3 divided doses; may tritate by giving 300 mg on the 1st day; 300 mg bid on the 2nd day; 300 mg tid on the 3rd day; may increase to 1800-2400 mg/day by adding 300mg on subsequent days
*Nurse Considerations:
-Assess: Seizures: aura, locations, duration, activity at onset; Pain: location, duration, characteristics if using for chronic pain, migraine; Mental status: mood, sensorium, affect, behavioral changes, suicidal thoughts/behaviors, if mental status changes notify prescriber; Eye problems, need for ophthalmic exam before, during, after treatment (slit lamp, funduscopy, tonometry); WBC, gabapentin level (therapeutic 5.9-21 mcg/ml, toxic >85 mcg/ml)
-Evaluate: therapeutic response: decreased seizure activity in chronic pain
-Teach: carry emergency ID ; avoid driving & anything that requires alertness b/c dizziness, drowsiness may occur; don't discontinue intake, dont double doses, take dose 2hrs in btw; notify if pregnant or breastfeeding; dont use with antacid w/in 2hrs.
Colace
*AKA: Docusate sodium, Correctal, Regulex, Silace, Soflax
*Action: Inc water, fat penetration in intestines; easier passage of stool.
*Uses: Prevention of hard, dry stool
*Precautions: Pregnant, breast feeding
*Dose & RTE: PO 50-300 mg/day (sodium) 240 mg (calcium) prn; ENEMA 4ml; swallow tabs whole; oral solution diluted in milk/fruit juice taken in AM or PM.
*Nurs Consids:
Assess - Id if fluids, bulk or exercise missing from life; cramping, rectal bleed, nausea, vomit (discontinue use)
Perform- store in cool environment, no freezing
Evaluate - decr in constipation
Teach - Daily BM's not always expected; if abd pain, nausea or vomit dont use; muscle cramp, pain, weakness, dizzy, excessive thirst or constipated still notify prescriber; may take 3 days to soften stool; take dose with full glass of water (unless on fluid restriction) and increase fluid intake.
Carvedilol
*AKA: Coreg
***BLK BOX dont discontinue b4 surgery**
*Action: mix of nonselective alpha & beta adrenergic blocking activity; decr cardiac output, exercise induced tachycardia, reflex orthostatic tachycardia; cause vasodilation, reduction in peripheral vascular resistance.
*Uses: essential hypertension alone or with antihypertensives, CHF, LV dysfunction after MI, cardiomyopathy, angina, pediatric pts.
*Dos & RTE:
Essential HTN: Adult: PO 6.25mg bid x 7-14 days; if tolerated increase to 12.5mg; if tolerated may increase to 25mg bid. Dont exceed 50mg/day. EXT REL cap 20 mg/day; may increase after 7-14 days to 40mg/day
CHF: Adult PO 3.125 mg bid x 2wks; tolerated 6.25mg bid, then double q2wk to max dose of 25mg bid. EXT REL caps (Coreg) 10mg /day x 2wks, increase 20, 40, 80 over 2 wk interval.
Postmyocardial infarction:
Adult PO 6.25 mg bid w/food x 3-10 days, can start on lower dose; titrate upwards as tolerated; incrs to 12.5mg bid then titrate to 25mg bid. PO EXT REL 20mg w/food; lower dose of 10mg/day can be used then titrate after 3-10 days to 40mg/day.
Angina: Adult PO 25-50 mg bid.
Forms: tab & ext rel cap, b4 meals, bedtime; ext rel w/food, swallow whole.
*Nurs Consids:
Assess - BP, pulse, edema in feet/legs daily, dyspnea, weight gain, jugular venous dystention, fatigue and crackles
Evaluate - Decr BP with HTN
Teach - Comply w/dose; rise slowly; report complications; weight & take BP and pulse @ home; dont discontinue abruptly; avoid hazardous activity; avoid OTC meds; Emergency ID; inform other providers of meds.
Metroprolol
*AKA: Betaloc, Lopressor, Toprol-XL
*Action: Lower BP by beta-b;locking effects; reduce elevated renin plasma levels; block beta-2-adrenergic receptors in bronchial, vascular smooth muscle at high doses; negative chronotrophic effects.
*Uses: mild-moderate HTN, acute MI to reduce cardio mortality, angina pectoris, heart failure, migraines, a-fib HR control, tremor and angina.
Availability: Tabs, Injection, ext rel tab
*Dose & RTE:
HTN - Adult PO 50mg bid or 100mg/day; up to 200-450mg in divided doses; EXT REL 25-100mg/day , titrate weekly, 400mg/day max -- Geriatric PO 25mg/day initially, incrs wkly as needed
Myocardial infarction - Adult IV BOL (early treatment) 5mg q2min x 3 then 50mg PO 15 mins after last dose & q6hrs x 48hrs; (late treatment) PO maintenance 50-100 mg bid for 1-3 yrs.
Heart failure - Adult PO EXT REL 25mg/day x 2wks (class II); 12.5mg/day (class III); PO (unlabeled) 5mg bid, titrate to 100-150 mg/day in 2-3 divided doses.
Angina - Adult PO 100mg/day single dose or 2 divided doses, incrs wkly prn or 100mg EXT REL daily, MAX 400 mg/day ext rel.
Migraine - Adult PO 25-100mg bid-qid; 50-200 mg daily (XL)
A-fib - Adult: IV BOL (acute) 2.5-5 mg over 2 mins, may repeat x 3; PO (nonacute) 25-100 mg bid.
Tremor - Adult PO 50mg/day, max 300 mg/day in divided doses; EXT REL 100 mg/day, max 400mg/day.
*Nurs Consids:
Assess - ECG directly when giving IV during intial treatment; I&O, daily weight, check for CHF; BP intial & periodically; pulse q4hrs, HR; Pulse b4 admin (signif changes or pulse below 50 bpm); renal baseline study b4 therapy begins; skin turgor, dryness of mucous membranes
Perform - storage in dry area @ room temp, no freezing.
Evaluate - decr BP after 1-2wks; decr angina pain.
Teach - take after meal to prevent orthostatic HTN; dont discontinue abruptly, no OTC w/ nasal decongestants or cold preparations unless directed by prescriber; take VS @ home; report bradycardia, dizzy, confusion, depression, fever, sore throat, SOB, decr vision, Raynaud's symptoms; avoid hazardous activity; wear supportive hose.
Norvasc
*AKA: Amlodipine
*Action: inhibits Ca++ ion influx across cell membrane during cardiac depolarization, incrs myocardial oxygen, relaxes vascular smooth muscle.
*Uses: chronic stable pectoris angina, HTN, variant angina; may use with other anti HTN & antianginals.
*Dose & RTE:
CAD - Adult PO 5-10mg/day
HTN - Adult PO 2.5-5mg/day initial, max 10 mg/day; Geriatric PO 2.5 mg/day, may incrs to 5mg/day, max 10mg/day.
Hepatic dose - Adult PO 2.5mg/day, may incrs to 10mg/day (antiHTN); 5mg/day may incrs to 10mg/day (antianginal)
Nusr Consids:
Assess - cardiac status, BP, pulse, respirations, ECG; if severe CAD may develop severe angina, acute MI after Ca++ channels blocked; I&O ratio, daily weight, CHF, peripheral edema, dyspnea, jugular vein distention, crackles; angina intensity, duration and location.
Evaluate - decr angina pain & BP, incrs exercise tolerance.
Teach - take every dose; avoid hazardous activities, avoid OTC, keep medical regimen; notify id irregular heart beat, SOB, edema (feet, face, hands), dizzy, constipated, nausea, HTN, chest pain doesnt improve; monitor pulse, notify below 50 bpm, avoid alcohol & alor of grapefuit juice, prevent orthostatic HTN, use sunscreen.
Hydrochlorothiazide
*AKA: Apo-Hydro, Diovan, Ezide, Neo-Codema
*Action: incrs excretion of water, sodium, chloride and potassium from distal tubule and ascending limb of Loop of Henle.
*Uses: edema, HTN, Diuresis, CHF, estrogen, NSAIDs, diabetes insipidus, hyper calciuria, nephrolithiasis, premenstrual syndrome, renal calculus.
*Dose & RTE: Adult PO 12.5-25mg/day, may incrs to 50mg/day in 1-2 divided doses.
Nurs Consids:
Assess - weight, I&O daily for fluid loss, respirations rate, depth & rhythm; BP in diff positions; blood studies; metabolic alkalosis (dizzy restless); hypokalemia (postural HTN, malaise, fatigue, tachycardia, leg cramps, weakness, dehydration); Confusion
Evaluate - edema improvement (feet, leg, sacral area daily); decr BP
Teach - 2-3 L/day of fluid, orthostatic HTN; notify of muscle weakness, crmap, nausea, dizzy, hypokalema; take meds w/ food or milk & take early in day to avoid nocturia; use sunscreen, check blood glucose; avoid alc & OTC meds.
Cardiazem
*AKA: Apo-Diltiaz, Diltiazem, Cartia XT, Dilacor XR, Dilt-CD, Dilt-XR, Diltia XT, Matzim LA, Novo-Diltiazem, Taztia XT, Tiazac
*Action: Inhibits calcium movement across cardiac, vascular smooth-muscle cell membranes (causes dilation of coronary arteries, peripheral arteries, arterioles). Therapeutic Effect: Decreases heart rate, myocardial contractility; slows SA, AV conduction; decreases total peripheral vascular resistance by vasodilation.
*Uses: PO: Treatment of angina due to coronary artery spasm (Prinzmetal's variant angina), chronic stable angina (effort-associated angina). Extended-release: Treatment of essential hypertension, angina. Cardizem LA: Treatment of chronic stable angina. Parenteral: Temporary control of rapid ventricular rate in atrial fibrillation/flutter. Rapid conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm. OFF-LABEL: Stable narrow complex tachycardia, recurrent SVT, pediatric hypertension.
*Precautions: pregnant, breast feeding, kids, geriatrics, CHF, aortic stenosis, bradycardia, GERD, hepatic disease, hiatal hernia, ventricular dysfunction
*Dose & RTE:
Angina - PO (IMMEDIATE-RELEASE) (CARDIZEM): ADULTS, ELDERLY: Initially, 30 mg 4 times a day. Range: 120-320 mg/day; PO (EXTENDED-RELEASE) ADULTS, ELDERLY: Initially, 120-180 mg once daily. Range: 120-320 mg. Maximum: 480 mg/day.
(EXTENDED-RELEASE) (TIAZAC, TAZTIA XT): ADULTS, ELDERLY: Initially, 120-180 mg once daily. Range: 120-320 mg/day. Maximum: 540 mg/day.
(EXTENDED-RELEASE) (CARDIZEM LA): Initially, 180 mg/day. Range: 120-320 mg. Maximum: 360 mg/day.
Hypertension - PO (CARDIZEM CD, CARTIA XT, DILACOR XR, DILT-CD, DILTIA XT, TIAZAC): ADULTS, ELDERLY: Initially, 180-240 mg/day. Range: 180-420 mg/day, Tiazac: 120-540 mg/day.
PO (SUSTAINED-RELEASE): ADULTS, ELDERLY: Initially, 60-120 mg twice a day. May increase at 14-day intervals. Maintenance: 240-360 mg/day.
PO (CARDIZEM LA): ADULTS, ELDERLY: Initially, 180-240 mg/day. May increase at 14-day intervals. Range: 120-540 mg/day.
Temporary Control of Rapid Ventricular Rate in Atrial Fibrillation/Flutter; Rapid Conversion of Paroxysmal Supraventricular Tachycardia to Normal Sinus Rhythm
IV PUSH: ADULTS, ELDERLY: Initially, 0.25 mg/kg (average dose: 20 mg) actual body weight over 2 min. May repeat in 15 min at dose of 0.35 mg/kg (average dose: 25 mg) actual body weight. Subsequent doses individualized; IV INFUSION: ADULTS, ELDERLY: After initial bolus injection, may begin infusion at 5-10 mg/hr; may increase by 5 mg/hr up to a maximum of 15 mg/hr. Infusion duration should not exceed 24 hrs.

*Nurs Consids:
Assess - Record onset, type (sharp, dull, squeezing), radiation, location, intensity, duration of anginal pain, precipitating factors (exertion, emotional stress). Assess baseline renal/hepatic function tests. Assess B/P, apical pulse immediately before drug is administered.
Evaluate - ist with ambulation if dizziness occurs. Assess for peripheral edema behind medial malleolus (sacral area in bedridden pts). Monitor pulse rate for bradycardia. Assess B/P, renal/hepatic function tests, EKG with IV therapy. Question for asthenia (loss of strength, energy), headache.
Teach - Do not abruptly discontinue medication. Compliance with therapy regimen is essential to control anginal pain. To avoid hypotensive effect, rise slowly from lying to sitting position, wait momentarily before standing. Avoid tasks that require alertness, motor skills until response to drug is established. Contact physician if palpitations, shortness of breath, pronounced dizziness, nausea, constipation occurs. Avoid alcohol (may increase risk of hypotension or vasodilation).
Tricor
*AKA: Antara, Apo-Fenofibrate, Fenoglide, Lipofen, Lofibra, Novo-Fenofibrate, Triglide
*Action: Incrs lipolysis & eliminate triglyceride rich particles from plasma by activating lipoprotein lipase, results in changes in triglyceride size and composition of LDL; rapid breakdown of LDL; mobilizes triglycerides from tissue; incr excretion and neutral sterols.
*Uses: Hypercholesterolemia, types IV and V hyperlipidemia that dont respond to other treatment and the incrs risk for pancreatitis, Fredrickson type IIa, IIB and hypertriglyceridemia.
*Precautions: Pregnancy, breast feeding, geriatrics, peptic ulcer, pancreatitis, renal/hepatic disease
*Dose & RTE:
Hypertriglyceridemia
PO (ANTARA): ADULTS, ELDERLY: 43-130 mg/day. PO (FENOGLIDE): ADULTS, ELDERLY: 40-120 mg/day with meals. PO (LIPOFEN): ADULTS, ELDERLY: 50-150 mg/day with meals. PO (LOFIBRA): ADULTS, ELDERLY: 67-200 mg/day with meals. PO (TRICOR): ADULTS, ELDERLY: 48-145 mg/day. PO (TRIGLIDE): ADULTS, ELDERLY: 50-160 mg/day.
Hypercholesterolemia, Mixed Hyperlipidemia
PO (ANTARA): ADULTS, ELDERLY: 130 mg/day. PO (FENOGLIDE): ADULTS, ELDERLY: 120 mg/day with meals. PO (LIPOFEN): ADULTS, ELDERLY: 150 mg/day with meals. PO (LOFIBRA): ADULTS, ELDERLY: 200 mg/day with meals. PO (TRICOR): ADULTS, ELDERLY: 145 mg/day. PO (TRIGLIDE): ADULTS, ELDERLY: 160 mg/day.
Dosage in Renal Impairment
Monitor renal function/lipid profile before adjusting dose. Decrease dose or increase dosing interval for pts with renal failure. Initial Doses: Antara: 43 mg/day Lofibra: 67 mg/day. Then: Fenoglide: 40 mg/day Tricor: 48 mg/day
Lipofen: 50 mg/day Triglide: 50 mg/day

*Nurs Consids:
Assess - Obtain diet history, esp. fat consumption. Obtain serum cholesterol, triglycerides, hepatic function tests (including ALT), blood counts during initial therapy and periodically during treatment. Treatment should be discontinued if hepatic enzyme levels persist greater than 3 times normal limit.
Evaluate - decrs triglycerides, cholesterol levels
Teach - compliance; risk factors are decreased high fat diet, smoking, alc, absence of exercise; notify if pregnant; report GU symptoms (decr libido, impotence, dysuria, proteinuria, oliguria, hematuria); notify of muscle pain, weakness, fever, fatigue, epigastric pain.
Zocor
*AKA: Simvastatin
*Action: Inhibits HMG-CoA reductase enzyme which reduces cholesterol synthesis
*Uses: As adjunct for primary hypercholesterolemia, isolated hypertriglyceridemia (Fredrickson's) and type III hyperlipidproteinemia, CAD, heterozygous familial hypercholesterolemia.
*Precautions: past hepatic disease, alc, severe acute infections, trauma, severe metabolic disorders, electrolyte imbalances, Chinese pts.
*Dose & RTE:
Prevention of Cardiovascular Events, Hyperlipidemias - PO: ADULTS, ELDERLY: 20-40 mg once a day. Range: 5-80 mg/day.
Homozygous Familial Hypercholesterolemia
PO: ADULTS, ELDERLY: 40 mg once a day in evening or 80 mg/day in 3 divided doses (20 mg, 20 mg, 40 mg as evening dose).
With diltiazem - Adult PO 5-10mg in PM, max 10mg/day with amiodarone/amlodipine/ ranolazine; ADULT PO 5-20mg in PM, max 20mg/day.
Hypercholesterolemia - PO: CHILDREN 10-17 YRS: 10 mg once a day in evening. Range: 10-40 mg/day.
*Nurs Consids:
Assess - Obtain dietary history, esp. fat consumption. Question for possibility of pregnancy before initiating therapy (Pregnancy Category X). Question for history of hypersensitivity to simvastatin. Assess baseline lab results: serum cholesterol, triglycerides, hepatic function tests.
Evaluate - Decr in LDL, total cholesterol, triglycerides, incrs in HDL; slowing CAD
Perform - Store in cool environment in tight container protected from light.
Teach - Use appropriate contraceptive measures, Periodic blood work are essential part of therapy. Maintain appropriate diet. Report unexplained muscle pain, tenderness, weakness.
Albuterol
*AKA: AccuNeb, Airomir, Apo-Salvent, PMS-Salbutamol, ProAir HFA, Proventil HFA, Ventolin HFA, VoSpire ER
*Action: Stimulates beta2-adrenergic receptors in lungs, resulting in relaxation of bronchial smooth muscle. Produces bronchodilation, CNS, cardiac timulation & incr diuresis and gastric acid secretion; longer acting than isoproterenol
*Uses: Prevention of exercise induced asthma, acute bronchospasm, bronchitis, emphysema, bronchiectasis or other reversible airway obstruction; hyperkalemia in dialysis pts.
*Precautions: pregnant, breastfeeding, cardiac/renal disease, hyperthyroidism, DM, HTN, prostatic hypertrophy, glaucoma, seizures, exercise induced bronchospasm in kids, hypoglycemia.
*Dose & RTE:
Acute Bronchospasm - INHALATION: ADULTS, ELDERLY, CHILDREN OLDER THAN 12 YRS: 4-8 puffs q20min up to 4 hrs, then q1-4h as needed.
NEBULIZATION: ADULTS, ELDERLY, CHILDREN OLDER THAN 12 YRS: 2.5-5 mg q20min for 3 doses, then 2.5-10 mg q1-4h or 10-15 mg/hr continuously. Chronic Bronchospasm - PO: ADULTS, CHILDREN OLDER THAN 12 YRS: 2-4 mg 3-4 times a day. Maximum: 8 mg 4 times a day. ELDERLY: 2 mg 3-4 times a day. Maximum: 8 mg 4 times a day.
PO (EXTENDED-RELEASE): ADULTS, CHILDREN OLDER THAN 12 YRS: 4-8 mg q12h. Maximum: 32 mg/day. CHILDREN 6-12 YRS: 4 mg q12h. Maximum: 24 mg/day.
NEBULIZATION: ADULTS, ELDERLY, CHILDREN 5 YRS AND OLDER: 1.25-5 mg q4-8h as needed.
INHALATION: ADULTS, ELDERLY, CHILDREN 4 YRS AND OLDER: 1-2 puffs q4-6h. Maximum: 12 puffs per day.
Exercise-Induced Bronchospasm - INHALATION: ADULTS, ELDERLY, CHILDREN 5 YRS AND OLDER: 2 puffs 5 min before exercise.

Nurs Consids:
Assess - lung sounds, lung function, Monitor rate, depth, rhythm, type of respiration; quality and rate of pulse; EKG; serum potassium, glucose, ABG determinations. Assess lung sounds for wheezing (bronchoconstriction), pulse, B/P, color & character of sputum noted. Offer emotional support (high incidence of anxiety due to difficulty in breathing and sympathomimetic response to drug). Allergic reactions; for bronchospasm hold meds and notify prescriber.
Evaluation - Absence of dyspnea, wheezing after 1 hr, improved airway exchange, improved ABG's
Teach - Follow guidelines for proper use of inhaler. Review package and demonstrate on how to use, avoid eye contact or using near flames, wash inhaler daily, avoid smoking.
Advair (combination of fluticasone and salmeterol)
*AKA: Flovent Diskus, Serevent Diskus
*Action: Decr inflammation by inhibiting mast cells, macrophages and leukotrienes; antiinflammatory and vasoconstrictior properties; bronchodilation by beta 2 receptors increasing cAMP, relaxes smooth m uscle w/ little effect on HR; prevents nocturnal asthma symptoms
*Uses: Prevent chronic asthma during maintenance treatment in those requiring oral corticosteroids; nasal symptoms; allergic/nonallergic rhinitis; COPD; exercise induced bronchospasm
*Precautions: Pregnant, breastfeeding, active infections, glaucoma, diabetes, immunocomprimised pts., cardiac disorders, hyperthyroidism, DM, HTN, glaucoma, seizures.
*Dose & RTE: (Flovent Diskus) Adult & child over 12 - INH 100mcg bid, max 500mcg (taking bronchodilators b4); INH 100-250mcg bid, max 500mcg bid (taking inhaled corticosteroids b4); INH 500-1000mcg bid, max 1000mcg bid (taking oral corticosteroid b4)
(Salmeterol) - Adult & child over 4 yrs INH 50mcg (1 inhalation of dry powder) q12hr; exercised induced bronchispasm 50mcg (1 inhalation) 1/2-1 hr b4 exercise.
*Nurs Consids:
Assess - respiratory status, withdrawal symptoms, adrenal insufficiency, growth rate in child, blood glucose and serum potassium for all pts.; parodoxical bronchospasm
Evaluate - Decr severity of asthma; absence of dyspnea, wheezing
Teach - bronchodilator b4 inhaler (if taking both); oral corticosteroid for acute asthma attack; avoid smokers and non-vaccinated against chickenpox or measles; decr oral candidiasis by rinsing mouth after inhalation; dont use OTC med because of extra stimulation.
Clopidogrel
*AKA: Plavix
*** BLK BOX: Diminished effectiveness in CYP2C19 metabolizers increases risk for cardiovascular events.*****
*Action: Inhibits ADP-induced platelet aggregation.
*Uses: Reduced risk of MI or stroke, vascular death, PAD in high risk pts, acute coronary syndrome, transient ischemic attack (TIA), unstable angina, cardiac surgery (infant & child) and Kawasaki disease
*Precautions: pregnant, breast feeding, child, previous hepatic disease, incrs bleeding risk, neutropenia, agranulocytosis, renal disease, Asian/Black/Caucasian pts.
*Dose & RTE:
Recent MI, stroke, PAD - PO: ADULTS, ELDERLY: 75 mg/ day w/ or w/out aspirin.
Acute Coronary Syndrome (ACS) - PO: ADULTS loading dose 300mg then 75mg/day w/ aspirin.
*Nurs Consids:
Assess- blood studies, hepatic studies, symptoms of stroke or MI and thrombotic purpura.
Evaluation - Absence of stroke, MI
Teach - Blood work necessary for treatment; report bruising or bleeding; take with food; report diarrhea, rash, bleeding, chills, fever or sore throat; inform other prescribers.
Sertaline
*AKA: Zoloft
*Action: inhibits serotonin reuptake in CNS; incrs action of serontonin; doesnt affect dopamine, norepinephrine
*Uses: MDD, OCD, PTSD, panic disorder, social anxiety disorder, PMDD, premature ejaculation, hot flashes, breast cancer pts taking tamoxifen, men w/ prostate cancer secondary to androgen-deprivation therapy.
*Precautions: Pregnant, breast feeding, geriatrics, renal/hepatic disease, epilepsy, recent MI latex sensitivity (dropper or oral concentration)
*Dose & RTE:
MDD/OCD - Adult PO 25-50mg/day; may incrs to max of 200mg/day; dont change dose @ intervals of 1wk; admin daily at same time.
PMDD - Adult PO 50-150 mg nightly
Premature Ejaculation - Adult PO 50mg/day
Pruritus - Adult PO 50-100mg/day
Hot Flashes - Adult PO 50mg/day x 4wks; w/prostate cancer (androgen therapy) 50-100mg/day.
*Nurs Consids:
Asses - mental status, serotonin syndrome, bleeding, LFTs at baseline and periodically, BP, pulse & VS q4hr, weight qweek, urinary retention, alc consumption.
Perform - store @ rm temp, ambulation with therapy b/c of drowsiness and dizziness
Evaluate - significant improvement in depression; OCD
Teach - effect may take about 1wk; use caution w/alert activites; dont discontinue quickly; avoid alc; notify if pregnant, planning or breastfeeding.
Esomeprazole
*AKA: Nexium
*Action: Suppresses gastric secretions by inhibiting hydrogen/potassium ATPase enzyme system in gastric parietal cell; gstric acid pump b/c it block final step of acid production
*Uses: GERD, severe erosive esophagitis, active duodenal ulcers w/ antiinfective for H. pylori infection; long term use for hypersecretory conditions.
*Precautions: Pregnant, breast feeding, children and geriatrics.
*Dose & RTE:
Duodenal Ulcer w/ H. Pylori - PO: ADULTS, ELDERLY: 40 mg/day x 10 days in combination w/ clarithromycin 500mg bid x 10 days and amoxicillin 1,000 mg bid x 10 days
Hepatic dose - Adult PO/IV max 20mg/day (severe hepatic disease)
Erosive Esophagitis/GERD - PO: ADULTS 20-40 mg/day x 4-8 wks; no adjustment in renal/liver failure, geriatric pts; IV 20 or 40 mg/day up to 10 days

* Nurs Consids:
Assess - GI system, hepatic failure, hepatitis, serious skin disorders.
Evaluate - absence of epigastric pain
Teach - Report severe diarrhea, abd pain, blk tarry stool; in diabetics hypoglycemia may occur; avoid hazardous activities and alc.
Bactrim (sulfamethoxazole and trimethoprim)
*AKA: trimethobenzamide, tigan
*Action: centrally blocking chemoreceptor trigger zone, which acts on vomitting center
*Uses: nausea,vomitting
*Precautions: pregnant, child, geriatrics, cardiac dysrhythmias, acute febrile illness, encephalitis, gastroenteris, dehydration, electrolyte imbalance, Reye's syndrome
*Dose & RTE:
Nausea & Vomitting - Adult IM 200mg 3-4 x per day; PO 300mg 3-4 x per day.
Postop - Adult IM 200mg followed by 2nd dose 1hr later
Renal - Adult IM CCr 15-30 ml/min; give 50% of dose.
*Nurs Consids:
Assess - Nausea & Vomitting before and after treatment, VS, Signs of toxicity, drowsiness and dizziness
Evaluate - decr nausea and vomitting
Teach - avoid hazardous activity, avoid alc, keep out of kids reach.
Reglan
*AKA: Metoclopramide, metoclop, metozolv
**** BLK BOX: EPS, tardive dyskinesia; more likely in geriatric pts *********
*Action: enhance response to acetylcholine of tissue in upper GI tract, causes contraction of gastric muscle; relaxes pyloric, duodenal segments; incrs peristalsis w/out stimulating secretions; blocks dopamine in chemoreceptor trigger zone of CNS
*Uses: prevent nausea, vomitting induced by checmotherapy, radiation, delayed gastric emptying, GERD, hiccups,migraines, breastfeeding induction, lung cancer
*Precautions: pregnancy, breastfeeding, GI hemorrhage, CHF, Parkinsons
*Dose & RTE:
Nausea/vomit (chemotherapy) - Adult IV 1-2mg/kg 30 min b4 admin of chemo, then q2hr x 2 doses, then q3hr x 3 doses.
Facilitate small bowel intubation for radiologic exams - Adult and child over 14 yrs IV 10mg over 1-2 mins.
Diabetic Gastroparesis - Adult PO 10mg 30mins b4 meals, @ bedtime X 2-8wks; Geriatric PO 5mg 30mins b4 meals, @ bedtime, incr to 10mg if needed.
GERD - Adult PO 10-15mg qid 30 min b4 meals and at bedtime
Renal Dose - Adult CCr below 40mL/min 50% of dose
Lactation Induction - Adult PO 10mg bid-tid, may incr to 25-45mg/day in divided doses.
Non-small-cell lung cancer radiation sensitizer - Adult IV (Sensamide IV) 2mg/kg given 1hr prior to radiation therapy 3x's/wk.
Hiccups - Adult PO/IM/IV 10mg q6hrs.
*Nurs Consids:
Assess - Neuroleptic malignant syndrome (hyperthermia, change in BP or pulse, tachycardia, sweating rigidity, altered consciousness), mental status (depression, anxiety, irritability), GI complaints (nausea, vomit, anorexia, constipation).
Perform - protect from light w/aluminum foil during inf; disgard open capsules
Evaluate - absence of nausea, vomitting, anorexia or fullness
Teach - Avoid hazardous activities, alc, and CNS depressants.
Fluoxetine
*AKA: Prozac Sarafem, Selfemra
****BLACK BOX ALERT Increased risk of suicidal thinking and behavior in children, adolescents, young adults 18-24 yrs of age with major depressive disorder, other psychiatric disorders.**
*Action: Selectively inhibits serotonin uptake in CNS, enhancing serotonergic function. Therapeutic Effect: Relieves depression; reduces obsessive-compulsive, bulimic behavior.
*Uses: Treatment of clinical depression, OCD, bulimia nervosa, PMDD, panic disorder,resistant or bipolar 1 depression, body dysmorphic disorder, fibromyalgia, hot flashes, PTSD, Raynaud's phenomena, premature ejaculation, selective mutism.
*Precautions: Use within 14 days of MAOIs or thioridazine
*Dose & RTE:
Depression - PO: ADULTS: Initially, 20 mg each morning. If therapeutic improvement does not occur after 2 wks, gradually increase to maximum of 80 mg/day in 2 equally divided doses in morning and at noon. ELDERLY: Initially, 10 mg/day. May increase by 10-20 mg q2wks. Prozac Weekly: 90 mg/wk, begin 7 days after last dose of 20 mg. CHILDREN 8-18 YRS: Initially, 5-10 mg/day. Titrate upward as needed. Usual dosage: 20 mg/day.
Panic Disorder - PO: ADULTS, ELDERLY: Initially, 10 mg/day. May increase to 20 mg/day after 1 wk. Maximum: 60 mg/day.
Bulimia Nervosa - PO: ADULTS: 60-80 mg each morning.
OCD - PO: ADULTS, ELDERLY: 40-80 mg/day. CHILDREN 7-18 YRS: Initially, 10 mg/day. May increase to 20 mg/day after 2 wks. Range: 10-60 mg/day.
Depression w/Bipolar Disorder - PO: ADULTS, ELDERLY: Initially, 20 mg/day. May increase after several wks. Range: 20-60 mg/day. Maximum: 80 mg/day.
PMDD (Sarafem) - PO: ADULTS: 20 mg/day or 20 mg/day beginning 14 days prior to menstruation and continuing through first full day of menses (repeated with each cycle).

*Nurs Consids:
Assess: appearance, behavior, mood, suicidal tendencies. For pts on long-term therapy, baseline hepatic/renal function tests, blood counts; testing should be performed periodically thereafter.
Evaluation: Supervise suicidal-risk pt closely during early therapy (as depression lessens, energy level improves, increasing suicide potential). Monitor mental status, anxiety, social functioning, appetite, nutritional intake. Monitor daily pattern of bowel activity, stool consistency. Assess skin for rash. Monitor serum hepatic function tests, glucose, sodium, weight.
Teach: Maximum therapeutic response may require 4 or more wks of therapy. Do not abruptly discontinue medication. Avoid tasks that require alertness, motor skills until response to drug is established. Avoid alcohol. To avoid insomnia, take last dose of drug before 4 PM.
Zosyn
*AKA: Piperacillin/Tazobactam
*Action: Interferes w/cell wall replication of susceptible orgs; osmotically unstable cell wall swells and bursts from osmotic pressue; tazobactam is a beta lactamase inhibitor that protects piperacillin from enzymatic degradation.
*Uses: Moderate to severe infections; piperacillin-resistant, beta lactamase producing strains causing infection in respiratory, skin, urine tract, bone, gonorrhea, pneumonia; MRSA and resistant microorganisms
*Precautions: Pregnant, breastfeeding, renal insufficiency in kids, hypersensitivity to cephalosporins, CHF, seizures, GI diease, electrolyte imbalance.
*Dose & RTE:
Nasocromial pneumonia - Adult IV 4.5g q6hr or 3.375g q4hrs w/aminoglycoside or antipsuedomonal fluoroquinolone x 1-2wks; continue aminoglycoside only if Pseudomonas aerginosa is isolated
Other infections - Adult IV INF 6-12g/day given 2.25g q8hr to 3.375g q6hrs over 30 mins x 7-10 days.
Renal dose - Adult IV CCr 20-40ml/min; Nosocromial pneumonia give 3.375g q6hrs; other indications give 2.25g q6hrs; if CCR less than 20ml/min give 2.25g q6hrs and 2.25g q8hrs, respectively.
*Nurs Consids:
Assess - Infection, I&O ratio, hepatic studies, blood studies, renal studies, C&S b4 product therapy, pseudomembranous colitis, skin eruptions, respiratory status and anaphylaxis.
Perform - adequate intake of fluids, 2L; discard after 24hrs stored @ room temp.
Evaluate - absence of fever, purulent drainage, redness, inflammation; culture shows decr organisms.
Teach - Culture may be taken after medication completion; notify of diarrhea; carry emergency ID; report sore throat, fever, fatigue, CNS effects, psuedomembranous colitis.
Bactroban
*AKA: Mupironcin
*Action: Interferes w/ bacterial protein synthesis.
*Uses: Skin infections, minor burns, wounds, skin grafts, primary pyodermas, otitis externa.
*Precautions: Pregnant, breast feeding, impaired renal function, external ear or perforated ear drum.
*Dose & RTE: Cream, use enough medication to cover lesions completely; after cleansing w/soap and water dry well before each application; w/ impaired renal function use on less than 20% of body surface.
*Nurs Consids:
Assess - Allergic reactions: burning, stinging, swelling and redness; signs of nephrotoxicity or ototoxicity.
Perform - dry place @ room temp.
Evaluate - decr in size & number of lesions
Vancomycin
*AKA: Vancocin
*Action: Inhibits bacterial cell wall synthesis, blocks glycopeptides.
*Uses: Resistant staph infections, pseudomembranous colitis, staph enterocolitis, endocarditis prophylaxis for dental procedures and diphtheroid endocarditis.
*Precautions: pregnant, breastfeeding, neonates, geriatrics and renal disease.
*Dose & RTE:
Serious Staph infection - Adult IV 500mg q6-8hrs or 1g q12 hrs
Pseudomembranous/ staph enterocollitis - Adult PO 125mg qid X 10-14 days
Endocarditis Prophylaxis - Adult IV 1g over 1hr given 1hr b4 procedure
Renal dose - Adult IV CCr more than 70ml/min, no dose adjustment; CCR 50-70 then loading dose of 15mg/kg, reduce dose to 750mg-1g q18-24hrs; CCr less than 49 then initial dose is 15mg/kg w/subsequent dosing based on concentration q24-72hrs or longer.
*Nurs Consids:
Assess- Infection, I&O ratio, Serum levels, C&S, Auditory function during and after treatment, BP during admin, hearing loss, skin eruptions, respiratory status and allergies.
Perform - store @ room temp for at least 2wks; adequate intake of fluids (2L/day)
Evaluate - absence of fever, sore throat, negative culture.
Teach - aspect of product therapy, finish entire course, take dosage in equal intervals around the clock to maintain blood levels; report sore throat, fever and fatigue whcih could indicate superinfection.
Metaxalone
*AKA: Skelaxin
*Action: Depress CNS resulting in sedation, may reduce skeletal muscle spasms to provide pain relief. Treating discomfort associated with acute painful muscle conditions along with rest, physical therapy, or other measures; muscle relaxant. works in the brain to help relax the muscles.
*Uses: muscle spasms. It is approved for use along with rest, physical therapy, and other treatments to relieve pain from acute (short-term) painful muscle spasms, fibromyalgia pain
*Precautions: Pregnant, breastfeeding, allergies, liver disease, kidney disease, or anemia
*Dose & RTE: adults and children over 12 years of age is one 800 mg qid tablet three to four times a day
*Nurs Consids:
Assess - Dont take w/ food, monitor for excesive drowsiness/respiratory depression, renal function, liver function; notify other providers of medication regimen; provide rest
Teach - Take as prescribed on empty stomach; avoid hazardous activity and alc; notify prescriber if rash or itching occur.
Aspirin
AKA: Bufferin, Ecotrin, Equaline, Acetylsaliclic Acid
Action: Blocks pain impulse in CNS, reduces inflammation by inhibition of prostaglandin synthesis, decreases platelet aggregation.
Uses: Mild to moderate pain or fever including OA, RA, TIA and MI
Dosge:
*Arthritis PO: 3g/day in divided doses 4-6hrs
*Pain/fever PO/Rect: 325-650 mg q4hrs prn, max 4g/day
*Thromboembolic PO: 325-650 mg/day or bid
*TIA PO: 50-325mg/day
*STEMI PO: 160-325mg nonenteric, chewed and swallowed
...
Motrin
*Generic/Trade Name: Ibuprofen
BLACK BOX ALERT. Hepatic Precautions. Increased risk of serious cardiovascular thrombotic events, including myocardial infarction, CVA. Increased risk of severe GI reactions, including ulceration, bleeding, perforation. Increased risk of new onset or worsening of preexisting hypertension.
In first trimester: cleft palate and cardiovascular anomalies
*Action: Analgesic/Anti-inflammatory/nonsteroidal anti-inflammatory drug (NSAID). Treats fever and pain, by inhibiting prostaglandin synthesis by decreasing the activity of the enzyme that makes its precursor.
*Side Effects: edema, hypertension, dizzy, nervous, headache, pruritis, rash, fluid retention, GI ulceration, N&V, heartburn and vision changes.
*Dosage: ADULT - 200mg/4-6hrs prn (max of 1200mg/24hrs). 200-400mg for pain, fever and dysmenorrhea. 400-800mg/3-4xs/day for inflammatory disease.
*Nursing Consideration: Administer with food/milk to decrease upset stomach. monitor urine output and occult blood loss
Ferrous Sulfate
*Generic/Trade Name: Iron
*Action: Ferrous sulfate provides the iron needed by the body to produce red blood cells by entering the bone marrow where it is turned to hemoglobin. It is used to treat or prevent iron-deficiency anemia, a condition that occurs when the body has too few red blood cells because of pregnancy, poor diet, excess bleeding, or other medical problems.
*Side Effects: constipation and upset stomach
*Dosage: ADULT - 2-3mg/kg/day or 60-100mg/4xs/day
*Nursing Consideration: This medication should be taken on an empty stomach, at least 1 hour before or 2 hours after eating.
Prenatal Vitamin
Folic acid helps prevent neural tube defects. These defects are serious abnormalities of the brain and spinal cord.
Iron supports the baby's growth and development. Iron also helps prevent anemia, a condition in which blood lacks adequate healthy red blood cells. Iron helps blood -- in both the mother and baby -- carry oxygen.
*Action: vitamin and mineral supplements intended to be taken before and during pregnancy and during postnatal lactation, help cover any nutritional gaps in the mother's diet.Their folic acid, iron, and calcium are especially important.
*Side Effects: constipation, nausea and vomiting
*Dosage: usually one pill per day
*Nursing Consideration: drink plenty of fluids, increase fiber in diet, take before bed to reduce N&V
Toradol
*Generic/Trade Name: Ketorolac
*Action: Treats pain and inflammation caused by arthritis, menstrual cramps, and other medical problems, by inhibiting prostaglandin synthesis by decreasing the activity of the enzyme that makes its precursor.. This is a nonsteroidal anti-inflammatory drug (NSAID).
*Side Effects: ulcers, edema, hypertension, dizzy, nervous, headache, pruritis, rash, fluid retention, GI ulceration, N&V, heartburn and vision changes.
*Dosage: ADULT - IM 30mg, IV 15mg, oral 10mg/q4-6hrs
*Nursing Consideration: Administer with food, IM or IV bolus. Monitor pain relief, urine output and occult blood
Norco
*Generic/Trade Name: Hydrocodone/Acetaminophen
Warning: Norco may impair your thinking or reactions. Avoid driving or operating machinery until you know how Norco will affect you. Avoid drinking alcohol. It may increase your risk of liver damage while taking acetaminophen.
*Action: treats pain and fever by inhibiting pain receptors in CNS and decreasing prostaglandin synthesis.
*Side Effects: light-headed, confusion, seizures, bloody or cloudy urine, GI problems, kidney and liver problems, constipation, mood changes, blurred vision, etc.
*Dosage: 10-15mg/kg/dose every 4-6 hrs prn. No more than 5 doses per day.
*Nursing Consideration: Avoid alcohol and dont take longer than 10 days, take with food and swallow whole.
Percocet
*Generic/Trade Name: acetaminophen and oxycodone. Opioid/Narcotic.
Percocet contains a combination of acetaminophen and oxycodone
*Action: Relieves moderate to severe pain.
*Side Effects: CNS depression, hypotension, bradycardia, shallow breathing, slow heartbeat, light-headed, fainting, confusion, N&V, GI problems, dizzy, drowsy, constipation and dry mouth
*Dosage: 1-2 tabs/q4-6 hrs prn. Maximum dose is 4g/day
*Nursing Consideration: Monitor pain relief, respirations, mental status and blood pressure
Tylenol
*Generic/Trade Name: Acetaminophen and Codeine
*Action: relieves mild to moderate pain
*Side Effects: kidney and liver injury, bradycardia, hypotension, CNS depression, shallow breathing, slow heartbeat, light-headed, fainting, confusion, N&V, GI problems, dizzy, drowsy, constipation and urinary retention
*Dosage: ADULT - 1-2 tabs/4hrs. Max is 12 tabs/24hrs
*Nursing Consideration: observe for excessive sedation and respiratory distress. Administer with food and shake suspension well.
Mylicon
*Generic/Trade Name: simethicone
*Action: relieve symptoms of extra gas caused by air swallowing or certain foods/infant formulas. Simethicone helps break up gas by allows gas bubbles in the stomach and intestines to come together more easily, which allows for easier passage of gasbubbles in the gut.
*Side Effects: Allergic reaction
*Dosage: 20-40mg/q4hrs/day. Adults 40-250 mg at bedtime, dont exceed 500mg/day.
*Nursing Consideration: avoid carbonated drinks
Lovenox (anticoagulant)
*Generic/Trade Name: Enoxaparin sodium
*Action: Prevents and treats blood clots. Also used to treat certain types of acute heart attacks. This medicine is a blood thinner.
*Side Effects: edema, confusion, fever, N&V, diarrhea, hemorrhage, anemia, hematuria and skin necrosis
*Dosage: ADULT 45kg/day
*Nursing Consideration: report any unusual bleeding
Measles Mumps Rubella (MMR)
*Action: active immunity to MMR
*Side Effects: soreness, swelling, hives, respiratory distress, rash and weakness.
*Dosage: 0.5mL/dose SubQ
*Nursing Consideration:
THIS SET IS OFTEN IN FOLDERS WITH...