ACE inhibitors/ ends in PRIL
Use: tx of hypertension, HF,Diabetic nephropathy, MI
S/E: severe hypotension in pt taking diuretics with high BP or who have hyponatremia, dry nonproductive cough rash and report metallic taste in mouth, angioedema/swelling of mouth,throat due to inhib of kinase 2 that isn't able to break down, hyperkalemia, neutropenia/decrease in WBC
Nursing:Diuretics may be temporarily
stopped before first dose of given, monitor Bp before first dose, tx angioedema with iv epinephrine,Monitor potassium levels,wbc monitor 2 weeks for first 3 month therapy.
PT: lie down lightheadedness first dose, report dry cough,rash, metallic or decreased taste foods decreased intake with wt loss, don't use potassium supplements
* potassium sparing diuretics increase risk of hyperkalemia,nais decrease effect,ace cause lithium toxicity
Loop Diuretic/fruit loop
used to manage edema associated with hF & renal disease control hypertension
Side Effects: Electrolyte imbalance: hyponatremia:low sodium, hypochloremia: low chloride, dehydration, hypokalemia:low potassium, hypotension, ototoxicity/all loop diuretic can be temp or permanent depending on drug, hyperglycemia/increase BS, increased uric acid levels:hyperuricemia, possible grout
nurse: Monitor F& E balance
Patient Teaching: eat foods rich in potassium/citrus fruits,potatoes and bananas,report imbalance as confusion,muscle twitching or weakness, irregular pulse and nausea, have BP monitor regularly, report dizziness,syncope,onset hearing loss,ringing in ear,or vertigo, pt that have DM monitor BS closely
:interaction:lithium toxicity, digoxin toxicity with potassium or mag def, corticosteroids increase risk of hypokalemia, NSAIDS decrease diuretic effect
Use:maintenance for HF,tx cardiac dysrhythmias,AFib,Aflutter
S/E:N/V/anorexia can be adverse effects of early toxicity,HA, visual disturbances yellow vision and blurry, early sign of toxicity, cardiac Dysrhythmias,hypokalemia
Nursing:monitor level serum digoxin and potassium levels
PT: HA,decrease toxicity lower serum levels don't skip or double dose, report s/s hypokalemia as muscle weakness
interaction:erythromycin increase digoxin levels, diuretics increase risk for digoxin toxicity by decrease potassium levels, herbals ginseng increase risk digoxin toxicity st john wort decrease
use:Angina, to decrease mortality MI, cardiac dysrhythmias, HF/Metoprolol
S/E Brady,Sob,edema, cough at night,fatigue, cause angina pain or MI when sudden stopping
Nursing: check BP before giving
PT: cK plus daily before taking drug anything below 60 hold, report Sob, edema, night cough, don't stop drug suddenly, report increase in angina or newest chest pain. Report sensations of cold numbness in hands or feet
Interactions: antacids decrease absorption, digoxin has added effect and increase brady,hyperglycemia agents increase risk for hypoglycemia
use: prevent blockage of coronary artery stents, stroke,vascular death
S/E Gastric upset, abdominal pain, D/N, gastric ulceration/bleeding(less than aspirin), bleeding
Nursing:Monitor:d/c 1 week before surgery,hematemesis/blood vomit
PT:take with food,milk or 8oz of water to lower GI effects, diarrhea occur drink plenty of clear fluids, avoid alcohol, report Gi irritation and bleeding,
Interactions: giner, ginkgo,fever few,evening primrose,oil increase bleeding risk
Use: Reduces LDL & triglycerides,increase HDL cholesterol,
S/E:myopath: pain in muscles and joints, which can progress to rhabdomyolysis/ breakdown of muscle protein cause kidney damage, Liver toxicity
nursing: monitor Liver function
Pt:take with food report muscle or joint pain to provider, report abdominal pain,jaundice and fatigue, comply with liver function testing, greatest effect of drug take in evening with or without food, raisins,baked potato,Lima beans,tomato sauce,squash,spinach cooked, prunes dried,prune juice,bananas, beats cooked,Brussels
interactions: drinking large amount of grape fruit also inhibits CYP3A4 and increase risk for adverse effects. warfarin with statins increase bleeding an PT levels
long term management of asthma,prevention of exercise induced asthma, tx ongoing asthma exacerbations
Side Effects: tachy,heart palpitations and angina,tremors
Patient teaching: report chest pain and heart palpitations,avoid caffeine, report increase heart rate, notify dr if tremors interfere with ADLS
Interactions: beta blockers reduce the effectiveness of this beta 2, MAOIS risks for hypertension,tachy,angina, hypoglycemic increased dosing
use chest pain/angina
S/E:HA when first taking drug, orthostatic hypotension, tachy,tolerance may develop fast to all forms
nursing:Nitro patch: are for prevention only, apply to hairless are and rotate sites,remove for 10-12 hrs daily to prevent tolerance,apply in morning, remove at night,
topical: measure as amount squeeze from tube, sublingual tabs under tongue, take in 5 mins if not relieved call 911,max is 3 tabs, sprays 1 or 2 sprays no more than 3 sprays in a 15 min period, store in dark area no light
PT:take over counter analgesic for HA, HA will subside within 20 mins usually, report
Interactions:interaction: beta blocker and calcium decrease tachy caused by nitro, increase hypotension result when used with other antihypertensive drug or alcohol
potassium-sparing diuretic; aldosterone antagonist
use:tx hypertension,HF following MI, Edema caused by HF,cirrhosis of Liver, Hypokalemia
Admin: maxiym effect of eplernone may take up 4wks, reduce does for pt taking CYP3A4 inhibitors/ liver enzymes,antibiotics, Spironolactone: tabs may be crushed and mixed with food or fluid
Side Effects: hyperkalemia, menstrual irregularities, abnormal hair growth,gynecomastia breast growth can happen in men to,hypertension
Patient Teaching: Report Palpitations,irregular HR, muscle twitching, weakness or paresthesia in extremities, don't take potassium supplements or large amounts of high potassium good and salt substitutes.
Interactions: counteracts adverse effect hypokalemia of loop and thiazide diuretics, drugs with CYP3A4 ketoconazole,erythromycin increase risk for toxicity and hyperkalemia,raise potassium levels Ace inhibitors may cause lithium toxicity
use: used with other drugs tx HF, tx cirrhosis of the liver and renal Failure,tx hypertension
Side effects: electrolyte imbalance: Hyponatremia: decrease in sodium, hypochloremia: Low chloride, dehydration, and hypokalemia: low Potassium, hyperglycemia in DM, increased uric acid levels: hyperuricemia with possible gouty arthritis
nursing:monitor BS, insulin may need to be increased
Patient Teaching: eat foods rich in potassium, citrus fruits, potatoes,bananas, report signs of electrolyte imbalance confusion,muscle twitching or weakness, irregular pulse, nausea, pt w/DM monitor Bs increase ,patents with hx of gout need to report to dr, give last does of day by 3pm to prevent sleep loss.
Interactions:lithium toxicity, digoxin toxicity with potassium or mag def, corticosteroids increase risk of hypokalemia.
don't give sulfa allergy
Macrolide remember Thromycin ENDING
Use: pneumonia),whooping cough, tx certain pneumonias,ophthalmic ointment prevents eye infections in neonates.
nursing: take 1hr before or 2hr after means give with 8oz of water,
S/E Cardiac s/s ventricular tachy, know as torsades de pointes, dysrhythmias, increase in QT on EKG, ototoxicity: hearing loss,vertigo,and tinnitus able to reverse
PT: don't drink grapefruit, give on empty stomach 1hr before or 2hr after meal give with 8oz water,report hearing loss,vertigo,palpitations and fainting spells
*CPY3A inhibitors can decrease erythrocytes metabolism which increase blood levels, helps break down many types of drugs,and this drug is one of them. this is what can cause the increase in QT intervals
use: adjunct therapy to tx TB,tx meningitis,tx leprosy
GI S/S, Liver Toxicity/hepatitis,Red-orange color body fluids,urine,saliva,tears,sweat:harmless.
nursing:monitor S/E and labs AST AND ALT
Pt:report abdominal pain,N,fatigue or jaundice,wearing soft contact lenses permanent staining with red color tears,food decrease absorption take 1hr before meals and 2 hr after meals, to prevent gi s/s empty cap into food.
Cephalosporin (1st Generation) (Antibiotic)
Use: to tx infection of gram + cocci causes
S/E:possible cross-allergy to penicillin allergy/with severe penicillin allergy,risk for hemorrhage with cefotetan(cefotan)only,thrombophlebitis iv only, cefotetan(cefotan):disulfiram like reaction if pt taks with alcohol
Nursing:prepare tx rash/hive with antihistamines, anaphylaxis w/epinephrine & histames, monitor INR,expect admin V-K if bleeding occurs.
pt: Cephalexin only comes in caps,tabs,oral,report unusual bleeding,bursing,inform pt potential N/V/HA, hypotension are disulfiram like reactions when you combine alcohol with this Cefotetan
use: sever infections, MRSA(methicillin-resistant staphylococcus aureus infection), infections in pt w/allergic to penicillin,antibiotics therapy cause pseudomembranous colitis /infection in the colon
S/E:hypotension and flushing of the face and trunk/red-person syndrome occurs with rapid iv infusion, hearing loss due to ototoxicity usually reversible, kidney damage secondary to nephrotoxicity, thrombophlebitis to iv site
Nursing: admin over 1 hr. dilution,monitor vitals, monitor vancomycin blood levels, bun:10/20,creatinine:M: 90-130 mL/min,F: 80-125 mL/min,give oral form for colitis
PT:report facial flushing,feeling faintness,hearing loss,pain,swelling redness at ive site, ototoxicity/ringing, humming( tinnitus)
don't give if allergic to corn, metformin can increase risk of lactic acid
"Uses: Cogulation disorders, venous thrombosis, pulmonary embolism
Side Effects:Hemorrhage, Toxicity/overdose
Monitor: vitals,hypotension and tachy,pt/inr 2-4 wks, hematocrit and blood counts, overdose admin Vitamin K, control bleeding with frozen plasma or whole blood. expect effect 8-12hr full 3-5 days
Patient teaching: stop taking if s/s of hemorrhage, report bruising,petechiae,hematomas,black tarry stool, wear id of taking, avoid alcohol, avoid razors and use soft tooth brush, dont take nsaids
Interactions:heparin,aspirin,Nsaids increase anticoagulation, excessive intake of food high in vitamin K such as dark green leafy vegs/ cabbage,broccoli and brussels sprouts,mayo,canola and soybean oils decrease anticoagulatio
Factor xa and thrombin inhibitor-Heparin
Factor xa inhibitor- enoxaparin (Lovenox)
use:Treat pulmonary embolism and evolving cerebrovascular accident, acute MI, ,unstable angina and some dysrhythmias
Side effects: hemorrhage, thrombocytopenia (low platelet count), hypersensitive reaction neurologic injury hematoma formation during lumbar puncture
Monitor: Vitals and indications of hemorrhage (hypotension and tachycardia). APTT 4-6hr Enoxaparin doesn't require and platelet counts(stop if below 100,000 a non heparin anticoag as lepirudin/refludan
Teaching: report bruising or black stools, calf pain and SOB, itching, rash, no bleeding in the gums
SE: tx of several types of cancer, acute leukemias,lymphomas,choriocarcinoma/uterine cancer. cancer of the head,neck and pelvis, also used for Rheumatoid arthritis
S/E Bone marrow suppression decreased Platelets,RBC and WBC,oral and GI ulcers, Liver Damage,pulmonary fibrosis.
Nursing: monitor CBC,fever,colony-stimulating drugs filgrastim to mini neutropenia,bleeding,apply pressure for puncture sites and small needles if injection,monitor for resp distress.
give high dose cancer therapy give leucovorin as reduce for of folic acid as an antidote for serve bone marrow suppression
PT: with or without food report fever, wash fresh fruits and vegs,oral care to prevent stomatitis/yeast in mouth,use soft toothbrush and electric razor to prevent bleeding, avoid alcohol,report yellowing of skin & eyes stat, SOB,use contraception at least 6 months of tx
use gram - aerobic bacilli can cause severe infections all aminos, tx severe infections that some gram + cocci cause, topical form for skin and eye infections.
S/E: elevated trough levels of drug early sings include tinnitus,HA and vertigo cause ototoxicity. nephrotoxicity/polyura,protein and cast in urine, elevated bun,creatinine
PT:report onset tinnitus,HA,vertigo,hearing loss,report increase in the output of dilute urine, inner canthus press for 1-2 mins and same for eyes keep shut for 1-2 mins
mucosal protectant Remember as Sucker-flame-fighter
use: Acute duodenal ulcers
S/E:Constipation, N/V, Dyspepsia( upper adbominal discomfort,burning sensation,bloating or gassiness)
Nursing: monitor bowel function and admin stool softeners.give drug 4x a day 1hr before meals and again at bedtime, don't give antacids within 30-60 mins. give this drug 2hr before these drugs (warfarin,phenytoin,digoxin,diazepam)
pt: increase fluid and clear fluids and fiber intake, increased activity and exercise, take antacids to lower symptoms but don't take within 3o mins of taking this drug, report GI bleeding and coffee ground emesis
dont give to kids/
use: peptic ulcer disease, GERD/reflux disease
S/E constipation (aluminum and calcium antacids), Diarrhea (magnesium antacids), hypophosphatemia: low phosphate ,hypomagnesemia-low magnesium.
nursing: monitor phosphorus and magnesium levels, monitor bowel funtion and give stool softener give oraly 4x a day give 4oz of water or milk, if liquid form drink water.don't give drugs of admin in 2hr that interact with antacids
pt: increased fiber and fluid intake, increased activity and exercise, report stomach pain, report muscle weakness or cramp diff swallowing or tremors.
interactions: decrease absorption: warfarin,phenytoin,NSAIDS
class: pancreatic enzyme
Indication: pancreatic insufficiency, ductal obstruction
Action: replacement of pancreatic enzymes: lipase, amylase, protease
- contraindicated with pig products allergy
- can cause shortness of breath, nausea, diarrhea, rash
- assess nutritional status
- monitor for steatorrhea
- may increase uric acid levels
- instruct patient to follow diet
- take with meals and snacks
Pt- do not take if you are allergic to pork proteins .Call doctor if you have severe or unusual stomach pain, vomiting, bloating, diarrhea, or constipation.
use: motion sickness
S/E: sedation,drowsiness,dizziness, dry mouth,urinary retention, constipation.
nursing: monitor pts when walking,electrolyte bowel pattern,urinary elimination pattern. admin dose 30-60 min activity triggers N, give doses before meals and at bedtime.
pt:dont give prior driving, sit or lie down feeling drowsy,change positions slowly, dry mouth suck on hard candy,chew gum and sip water,increase fiber and fluids increase activity levels,urinate every 4hr report changes in peeing
dont give to kids younger than 2 years old, angle-closure glaucoma, CNS depression.
proton pump remember PRETZEL
use: gastric and duodenal ulcers,prolonged dyspepsia,GERD/reflux disease
S/E Bone loss/long term use, ESOMEPRAZOLE: s/s are HA,N,Bone loss
Nursing: limit durg therapy to the lowest does shortest duration. long term monitor for bone loss via bone density scanning, give this drug orally 1x daily before the first meal of the day, do not crush or chew or break., monitor hypomag
pt: perform WT bearing exercises daily, consume calcium and V-D,report s/s of GI bleeding and coffee ground emesis.
Interactions: Ginkgo biloba and st john wort decrease drug levels, food can reduce absorption
remember man farmer
use type 2 dm
S/E:lactic acidosis rare but fatal when happens, vitamin def B12,
nursing: monitor lactic acidosis, expect severe lactic acidosis hemodialysis.monitor vitamin b12 or folic acid, give 2xa day with the morning and evening meals.
pt:avoid drinking alcohol,report weakness,fatigue,lethargy,lie down if when feeling N,main adequate carbohydrate and fluid intake,report weakness,fatigue,pallor or reddened tongue
interaction:alcohol and cimetidine increase risk of lactic acidosis,herbals:garlic,ginseng hypoglycemic effects
use: tx urinary retention
S/E: hypotension,brady,excessive gastric acid,salivation,Diarrhea,fecal inco, dizziness,fainting, bronchoconstriction/constriction of airway, a
nursing: monitor S/E, atropine have available
pt: report dizziness, increase fluid intake maintain hydration,sit or lie down if feeling dizzy and report fainting and sob,dmin drug oral 3-4x a day, take 1hr before or 2 hr after meals.
interactions:worsen cholinergic effect increase the risk of toxicity.
herapeutic: , is an oral diebetic med to treat dm 2
Common S/E nausea;heartburn; or full feeling.
S/E dark urine, jaundice (yellowing of the skin or eyes);severe skin rash, redness, or itching;
pale skin, easy bruising or bleeding;
fever, chills, sore throat, mouth sores; or
low levels of sodium in the body--headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady.
S/E: priapism/long erection, HA,hypotension,fainting,dizziness,sudden loss of hearing,irreversible loss of vision. give orally 1hr before sex,high fat foods reduce effects, expect to last up to 4hrs,dont dont give if using nitrates dont give more than 1dose in 24hr period
Nursing:explain tx involves aspirating blood from the corpus cavernosum and irritating with vasoconstrictor, monitor S/E.
PT: seek medical care if erection last more than 4hr, report hA,report dizziness,check bp reg,stop taking drug is hearing loss is suspected or vision,
can give terbutaline or pseudoephedrine to resolve the erection should work within 30 mins
interactions:dont give med if using nitrates increase risk for life threatening hypotension., don't take with grape fruit juice Pulmonary Vasodilators
Right Ventricular failure/cor pulmonale
nursing:monitor thyroid, monitor anxiety, tachy,tremors, diarrhea,fever,wt loss, menstrual irregularities,give daily empty stomach at least 30 min before breakfast. monitor T4 and TSH
pt:report anxiety,rapid HR,palpitations, tremors,D,wt loss and menstrual irregularities
interaction:antacids,iron,calcium, sucralfate, reduce absorption of pt should not take with 4hr of these drugs, food reduces absorption,warfarin increase
Histamine 2 receptor antagonists
use: gastric and duodenal ulcers,heartburn,dyspepsis,GERD/Reflux disease.
S/E: impotenct,reduced libido with CIMETIDINE not RANITIDINE, CNS effects:depression,restlessness,seizures more common with CIMETIDINE.
Nursing: pts with impotence or reduced libido or pt with Cns effects recommend switching to RANITIDINE, when ADMIN avoid bradycardia. don't give antacids with 1 hr of taking drug.
PT: report sexual desire or function,lethargy,depression,restlessness,drink plenty of fluids,report GI bleeding , coffee-ground emesis, take antacids to help minminze symptoms.
It can treat and prevent infections. It can also treat duodenal ulcers caused by H pylori.
S/E: ha, steven johnson syndrome, rash,diarrhea,n
nursing: blood stools,abdominal cramping, monitor for blood in stool, emesis or gastric aspirate, give with food or milk, monitor F & E dont admin with 4hr of zidovudine(hiv med).
PT:take med around the clock unitl finished, report vagianl intching and discharge loos or fould smelling stools, report rash,
use: constipation from opiod use, used for color evacuation prior procedure
S/E: abdominal cramps,burning sensation/suppositories, laxative abuse,proctitis/ long term use of suppositories. monitor K+ and cramping and F & E
nursing: tell pt expect rectal or anal burning with suppositories, monitor for rectal discomfrot discharge of mucus or pus,monitor I&O and bowel patterns, expect semi fluid stools 6-12hr oral, supp 15-60 mins.take 1hr after drinking milk or taking antancts.
pt: drink plenty of fluids,execet burning, drink at least 2-3L and add high fiber foods/fresh fruit,vegs slowly to avoid diarrhea
use:relieves s/s of parkinson's disease
S/E Darkening of urine and sweat normal,orthostatic hypotension,tremors,twitching order symmetrel as ordered, hallucinations,on-off episodes of parkinson's
Nursing. Addition of carbidopa (at
least 75 mg/day) relieves GI
symptoms ,admin dopamine agonist if on off episodes occur ( pramipexole), 6 month full effect,should work in 30 mins,extended 4-6hrs
PT: take drug with food,warn darkening of urine,avoid high protein foods, change positions slowly,
*don't give if narrow angle glaucoma,suicidal thoughts. MAOI may cause hypertensive crisis,high protein meals decrease action of drug
use: tonic-clonic & partial seizures
s/e:Gingival hyperplasia (abnormal
growth of tissue around gums), steven johnson syndrome, w-drawls long term use.
nursing:monitor vitals,iv slowly, monitor plasma lvls 10 and 20 mcg/mL.
Levels greater than 30 mcg/mL
can be toxic.
pt:don't drive with drug,dental ck ups,rash call dr,don't stop drug suddenly
don't give if brady,allergy to hydantoins,skin rash. diazepam increase levels of drug, alcohol may increase or decrease lvls,
use:type 2 dm
Nursing:give 15-20 g carb give glucose orally , 4 ounces of
fruit juice, 6 saltines, or 1
tablespoon of honey, ck bs 15-20 mins, admin oral 30 min before meals
pt: test bs,consume snake of 15-20 gm of carbs,retest 15-20 mins,
*don't give diabetic ketoacidosis, alcohol poses a risk for disulfiram antabuse, Nsaids increase effect. beta blockers maks effects of hypoglycemia
use prevent or controlling mania in bipolar mood disorder.
S/E: seizures,arrhythmias,hypotension, renal toxicity and leukocytosis
Nursing:give drug with a full glass of water and after meals , monitor serum lithium levels,F&E, ekg and I&O, monitor lithium toxicity:D/V/D,tremors and muscle weakness
PT: effects begin 5 to 7 days, may take 2 to 3 weeks full. Dring 8 to 12 glasses of water/day. Take as prescribed 2 to 3 times/day
avoid-avoid breastfeeding while tx, diuretics and nsaids cause toxicity
use: severe unresponsive schizophrenia
S/E: drowsiness,dizziness,tachy and hypotension,seizures,Dvt,cardiac arrest,neuroleptic malignant syndrome
nursing monitor for seizures and avoid sudden stop and cns,chest pain,monitor wbcs every wk during tx and after 4wks,agranulocytosis 18-24 after therapy
pt: inform patient /monitor for extrapyramidal symptoms
- cigarette smoking may decrease clozapine levels
- avoid alcohol and CNS depressants,notify MD if unexplained palpitations, tachypnea,
chest pain, sore throat, flu-like symptoms,Notify if pregnant or breastfeeding
*warning: oral contraceptive and caffein my increase effect,opiods and sedatives increase cns depression, DONT TAKE ST/JOHN
use: for epileptic seizures, manic and depressive episodes
S/E-Double or blurred vision, dizziness, headache, nausea, vomiting
-Serious skin rashes (Stevens-Johnson Syndrome)
Nursing:monitor serum drugs and therapeutic levels lithium levels: at initiation of treatment, monitor levels every 2-3 days until stable, and then every 1-3 months; levels should be obtained in the morning, usually 12 hours after last dose
During initial treatment: levels should be between 0.8-1.4,Maintenance: 0.4-1.0,Plasma levels greater than 1.5 mEq/L can result in toxicity
pt: oral contraceptives decrease effect,grapefruit,warfarin phenytoin
use:antipsychotic drug for management of schizophrenia and psychotic disorders
S/E: tardive dyskinesia,sleepiness,HA,dizziness,orthostatic hypotension,wt gain,sedation
Nursing: neuroleptic malignant syndrome/muscle rigidity,high fever and change mental state
PT: discontinue med gradually,inform patient of extrapyramidal symptoms and
- notify MD if suicidal thoughts, new or worsening
depression, anxiety or panic attacks
- monitor EKG, HR and pulse before increasing/
used to treat glaucoma. as a direct acting miotic. As a result, the pupil constricts.
S/E: may cause eye pain, blurred vision and HA,retinal detachment,decreased visual acuity.
nursing:Apply gentle pressure to the nasolacrimal duct for 1 min after instilling the drops.,Do not touch the tip of the dropper.Remove contact lenses prior to instilling the drops., hold pressure on sace at least 60 secs, don't put contact lens in place
patient should not rub eyes, report urinary
urgency, slow heart rate, and
wheezing to provider
Don't give: hypotension,inflammatory eye disease and asthma, beta blockers increased systemic effects,calcium channel increase,
Use: Generalized anxiety disorder and panic disorder,Seizure disorders
ETOH withdrawal Induction of anesthesia
s/e:CNS depression: sedation, lightheadedness, ataxia, decreased cognitive function.Acute toxicity:
For oral toxicity, gastric lavage can be used, followed by the administration of activated charcoal or saline cathartics.
For IV toxicity, administer: flumazenil (Romazicon),:may need to give flumazenil for overdose,give 30 mins before bed
PT: take 30 mins before bedtime,short term use only,Advise clients to avoid abrupt D/C
When D/C benzodiazepines that have been taken regularly for long periods of time, taper the dose over several weeks.
Administer the medication with meals or snacks if GI upset occurs.
Advise clients to swallow sustained release tablets and to avoid chewing or crushing the tablets.
warning:Contradicted for concurrent use with MAOI antidepressants for 14 days after MAOIs are d/c
infections caused by gram
positive cocci and bacilli
S/E:superinfection with candida albicans,allergy to penicillin,GI effects
Nursing: Expect to treat Candida
infections with an antifungal
agent, Ask patients if they are allergic,For injectable penicillins (IM or
IV), keep patient in facility for
30 min after administration , Give amoxicillin with
PT:repot watery or blood D,vaginal burning,
*don't give penicillins, infectious mono, probenecid, increased penicillin blood levels
Therapeutic: Prevention of pregnancy
Admin:Confirm negative pregnancy
status before starting therapy. Use an additional method of contraception during the first cycle. Take pills at the same time
S/E: Thromboembolism, Hyperkalemia (due to the
drospirenone in this drug), Hypertension, Uterine bleeding, Increased growth of breast
Interventions: Monitor for and report any
indications of DVT, pulmonary
infarction, and cerebrovascular
accident. Encourage patients who smoke
to quit. Monitor blood pressure.
Precautions: Hypertension, Diabetes mellitus, Heart disease, Migraines
Interactions: ATB, St. John's wort can reduce
the effectiveness of oral
• Oral contraceptives can
reduce the effects of warfarin
(Coumadin) and hypoglycemic
Therapeutic: skeletal muscle relaxant
Management of acute painful musculo-skeletal conditions associated with muscle
spasm.Unlabeled Use:Management of fibromyalgia
S/E- dizziness, drowsiness, confusion, fatigue, headache, nervousness, dry
mouth, blurred vision, arrhythmias, constipation, dyspepsia, nausea, unpleasant taste,urinary retention
Assess patient for pain, muscle stiffness, and range of motion before and periodically throughout therapy
PO:May be administered with meals to minimize gastric irritation.
Swallow extended-release capsules whole; do not open, crush, or chew
Acts directly on skeletal muscle, causing relaxation by decreasing calcium release from sarcoplasmic reticulum in muscle cells. Prevents intense catabolic process associated with malignant hyperthermia. Therapeutic Effects: Reduction of muscle spasticity. Prevention of malignant hyperthermia.
Adverse Reactions/Side Effects
CNS: drowsiness, muscle weakness, confusion, dizziness, headache, insomnia, malaise, nervousness. EENT: excessive lacrimation, visual disturbances. Resp: pleural effusions. CV: changes in blood pressure, tachycardia. GI: HEPATOTOXICITY, diarrhea, anorexia, cramps, dysphagia, GI bleeding, vomiting. GU: crystalluria, dysuria, frequency, erectile dysfunction, incontinence, nocturia. Derm: pruritus, sweating, urticaria. Hemat: eosinophilia. Local: irritation at IV site, phlebitis. MS: myalgia. Misc: chills, drooling, fever.
Suppression/chemoprophylaxs of malaria. Treatment of severe rheumatoid arthritis/systemic lupus erythematosus.
Inhibits protein synthesis in susceptible organisms by inhibiting DNA and RNA polymerase. Therapeutic Effects: Death of plasmodia responsible for causing malaria. Also has anti-inflammatory properties.
Adverse Reactions/Side Effects
CNS: SEIZURES, aggressiveness, anxiety, apathy, confusion, fatigue, headache, irritability, personality changes, psychoses. EENT: keratopathy, ototoxicity, retinopathy, tinnitus, visual disturbances. CV: ECG changes, hypotension. GI: abdominal cramps, anorexia, diarrhea, epigastric discomfort, nausea, vomiting, hepatic failure. Derm: bleaching of hair, alopecia, hyperpigmentation, photosensitivity, Stevens-Johnson syndrome. Hemat: AGRANULOCYTOSIS, APLASTIC ANEMIA, leukopenia, thrombocytopenia. Neuro: neuromyopathy, peripheral neuritis.
Potentiates the inhibitory effect of antithrombin on factor Xa and thrombin.Thera-peuticEffects:Prevention of thrombus formation
Adverse Reactions/Side Effects
CNS:dizziness, headache, insomnia.
GI:constipation, liver enzymes,nausea, vomiting.
GU:urinary retention.Decipherable, ecchymoses, pruritus,rash, urticaria.F and E:hyperkalemia.Hemat: bleeding, anemia, eosinophilia, thrombocytopen.
Local: erythema at injection site, hematoma, irritation, pain.MS:osteoporosis.Misc:fever.
Pharmacologic:calcium channel blocker
used to treat high blood pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. Verapamil belongs to a class of drugs known as calcium channel blockers. It works by relaxing blood vessels so blood can flow more easily.
Dizziness, slow heartbeat, constipation, nausea, headache, or tiredness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Tell your doctor right away if you have any serious side effects, including: severe dizziness, fainting, new or worsening symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain), very slow heartbeat.
This drug may rarely cause serious (possibly fatal) liver disease. Get medical help right away if you have any symptoms of liver damage, such as: nausea/vomiting that doesn't stop, loss of appetite, stomach/abdominal pain, yellowing eyes/skin, dark urine.
A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
Client should be on a cardiac monitor for IV use. Monitor heart rhythm and blood pressure. Monitor for adverse reactions.
Inhibits the action of acetylcholine at postganglionic sites located in: Smooth muscle,Secretory glands, CNS (antimuscarinic activity). Low doses decrease: Sweating, Sali-vation, Respiratory secretions. Intermediate doses result in: Mydriasis (pupillary di-lation), Cycloplegia (loss of visual accommodation), Increased heart rate. GI and GUtract motility are decreased at larger doses.TherapeuticEffects:Increased heartrate. Decreased GI and respiratory secretions. Reversal of muscarinic effects. Mayhave a spasmolytic action on the biliary and genitourinary tract
Adverse Reactions/Side Effects
CNS:drowsiness, confusion, hyperpyrexia.EENT:blurred vision, cycloplegia, pho-tophobia, dry eyes, mydriasis.CV:tachycardia, palpitations, arrhythmias.GI:drymouth, constipation, impaired GI motility.GU:urinary hesitancy, retention, impo-tency.Resp:tachypnea, pulmonary edema.Misc:flushing, decreased sweating.
●May cause drowsiness. Caution patients to avoid driving or other activities requir-ing alertness until response to medication is known.
●Instruct patient that oral rinses, sugarless gum or candy, and frequent oral hygienemay help relieve dry mouth.
●Caution patients that atropine impairs heat regulation. Strenuous activity in a hotenvironment may cause heat stroke.Advise patient to notify health care profes-sional of all Rx or OTC medications, vitamins, or herbal products being taken andto consult with health care professional before taking other medications.
●Pedi:Instruct parents or caregivers that medication may cause fever and to notifyhealth care professional before administering to a febrile child.
●Geri:Inform male patients with benign prostatic hyperplasia that atropine maycause urinary hesitancy and retention. Changes in urinary stream should be re-ported to health care professional
Patients who have, or are at
risk for, experiencing a calcium
Give calcium supplements
1 hr before or 1 to 2 hr after glucocorticoids, thyroid supplements, and tetracycline and quinolone antibiotics.
• Give calcium-based antacids 1 hr after meals and at bedtime.
◦Chewable tablets should be chewed before swallowing. ◦Give patients glass of water
Hypercalcemia, Nausea, vomiting, and constipation, Kidney stones
Teach patients signs of hypercalcemia (constipation, nausea and vomiting, increased urine output, depression).
• Instruct patients to eat high- fiber diet and take laxative as necessary for constipation.
Instruct patients to take calcium supplements 1 hr before or 1
to 2 hr after glucocorticoids, thyroid supplements, and tetracycline and quinolone antibiotic
Calcium supplements decrease absorption of thyroid hormones, and tetracycline and quinolone antibiotics.
Avoid taking calcium with foods such as spinach, Swiss chard, and whole-grain breads and cereals.