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PAIN MED. MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction Mild Pain

Tylenol (Acetaminophen) NSAIDS:

Motrin (Ibuprofen)

Toridol (Ketorolac)

Adults: Oral 325-650

mg every 4-6 hours. (maximum daily dose is 4 grams)Suppository 650mg every 4-6 hours.

Children: Oral 40-650 mg every 4 hoursSuppository 80-325 mg every 4-6 hours depending on age.

Children (general): 10

to 15 mg per kg of body weight, every 4 to 6 hours, to a maximum of 65 mg/kg in 24 hours.

Adults: 325 mg to 650 mg every 4 to 6 hours to a maximum of 4,000 mg in 24 hours.

10-40 mg every 4-6

hours

Relief of signs and symptoms of rheumatoid arthritis and osteoarthritis

Relief of mild to moderate pain

Treatment of primary dysmenorrhea

Fever reduction Unlabeled uses:

Prophylactic for migraine; abortive treatment for migraine

Headache Chest pain, Hepatic toxicity and

failure, jaundice Acute kidney failure,

renal tubular necrosis Rash fever

Assess pain Assessmusculoskeletal

status: ROMbefore dose and 1 hr. after

Monitor liver function studies

Monitor renal function studies

Monitor bloodstudies: CBC,Hgb, Hct,proteome if patient is on long-term therapy

Check I&O ratio Assesshepatotoxicity- Assess

forallergicreactions, visualchanges andototoxicity

Identify prior drug history

Identify fever:length of time inevidence andrelatedsymptoms

Administer in the morning with a full glass of water at least 60 min before the first beverage, food, and medication of the day.

Patient must stay up right for 60min after taking the tablet to avoid potentially serious esophageal erosion

Do not exceed recommended dose; do not take for longer than 10 days.

Take the drug only for complaints indicated; it is not an anti-inflammatory agent.

Inhibits prostaglandin synthesis by decreasing the activity of the enzyme, cyclooxygenase, which results in decreased formation prostaglandin precursors.

Therefore drugs that increase the action of liver enzymes that metabolize acetaminophen [for example, carbamazepine (Tegretol), isoniazid (INH, Nydrazid, and Laniazid), rifampin (Rifamate, Rifadin, and Rimactane)] reduce the levels of acetaminophen and may decrease the action of acetaminophen. Doses of acetaminophen greater than the recommended doses are toxic to the liver and may result in severe liver damage. The potential for acetaminophen to harm the liver is increased when it is combined with alcohol or drugs that also harm the liver.

Moderate Pain OPIOID ANALGESICS

Norco (Hydrocodone)

Vicodine (Hydrocodone)

Oxycontin (Oxycodone HCl)

Percocet (Oxycodone)

7.5-10mg (oral) every

4-6 hours Intramuscular Dose

Regular 30-120mg Low 15-60mg

Intravenous Dose Regular 30mg Low 15mg

Oral Dose Maximum 40mg Regular 10-20mg Low 10mg

10-80mg (oral)

2.5-10mg (oral)

4-6 pain Analgesia for moderate

to severe acute pain Alternative to Narcotic

Analgesic

Lightheadedness Dizziness Drowsiness Nausea Vomiting Constipation

BP ____ HR ____ Postural Hypotension N/V Pain ___ /10 (PQRST)

Dizzy >no standing N/V > call nurse Inform patient that

hydrocodone and acetaminophen may cause dizziness and drowsiness.

Advise patient to avoid hazardous activities until drugs CN effects are known.

Advise patient to change position slowly to minimize effects of orthostatic hypotension

Management of moderate to severe pain.

Binds to opiate receptors in the CNS

Alters the perception of ad response to painful stimuli, while producing generalized CNS depression

Anticholinergic: Increased risk of ileus, sever constipation and urine retention.

Antidiarrheal: Increased risk of CNS depression and severe constipation.

Barbiturate anesthetics: Possibly increased respiratory and CNS depression.

Severe Pain OPIOID ANALGESICS

Dilaudid (Hydromorphone)

1mg IV Q 4-6 hours prn Peak 15-30min Onset 10-15min Duration 2-3 hour

7-10 pain PCA pump Symptomatic relief of

sever, acute and chronic pain after non-narcotic analgesics have failed and preanasthetic

Constipation Dizziness Hypotension Blurred vision Nausea and vomiting Urine Retention

BP ____ HR ____ Postural Hypotension N/V Pain ___ /10 (PQRST) Morphine Allergy to Sulfa Drugs

Avoid alcohol and other CNS depressants while receiving morphine.

Do not use OTC drug unless approved by physician

Do not smoke or

Binds to opiate receptors in the CNS

Alters the perception of and response to painful stimuli while producing generalized CNS depression

High risk of CNS depression with alcohol, antidepressant, antihistamines, and sedative/hypnotics including benzodiazepines and


(Morphine)

(Fentanyl)

(Demerol)

Adult: (PO) 10-30mg q4h (IV) 2.5-15mg q4h (IM/SC) 5-20mg (PR) 10-20mg

0.5-1mcg/kg/dose, may

repeat after 30-60min.

100 mg/ 2mL

medication Used to relieve dyspnea

of acute left ventricular failure and pulmonary edema and pain of MI.

ambulate without assistance after receiving drug. Bedside rails are advised

Use caution or avoid tasks requiring alertness (e.g. Driving a car) until response to drug is known since drug may cause drowsiness, dizziness, or blurred vision

Do not breast feed while taking this drug

Suppresses the cough reflex via a direct central action.

Pain Control

phenothiazines.

Anti-Anxiety >Benzodiazepines<

Ativan (Lorazopam) > Barbiturates<

Phenobarbitol

adult: PO 26 mg/d in

divided doses (max: 10 mg/d)

geriatric: PO 0.51 mg/d (max: 2 mg/d)

child: PO/IV 0.05 mg/kg q48h (max: 2 mg/dose)

15-120 mg/day PO

divided BID/TID

Management of anxiety disorders and for short-term relief of symptoms of anxiety. Also used for preanesthetic medication to produce sedation and to reduce anxiety and recall of events related to day of surgery; for management of status epilepticus.

Sedative (oral or

parenteral) Hypnotic, short-term (up

to 2 wk.) treatment of insomnia (oral or parenteral)

Long-term treatment of generalized tonic-conic and cortical focal seizures (oral)

Drowsiness Headache Hyper/hypotension Nausea and vomiting Vertigo CNS Depression Nausea and vomiting Constipation / diarrhea

Be aware that SL administration has more rapid absorption than PO, and bioavailability compares to IM use.

Do not administer intra-arterially; arteriospasm, gangrene may result.

Give IM injections of undiluted drug deep into muscle mass, monitor injection sites.

Do not use solutions that are discolored or contain a precipitate. Protect drug from light, and refrigerate oral solution.

Keep equipment to maintain a patent airway on standby when drug is given IV.

Monitor patient

responses, blood levels (as appropriate) if any of the above interacting drugs are given with phenobarbital; suggest alternative means of contraception to women using hormonal contraceptives.

Do not administer intra-arterially; may produce arteriospasm, thrombosis, gangrene.

Administer IV doses

Do not drive or engage in other hazardous activities for a least 2448 h after receiving IM injection of lorazepam.

Do not drink large-volumes of coffee. Anxiolytic effects of lorazepam can significantly be altered by caffeine.

Do not consume alcoholic beverages for at least 2448 h after an injection and avoid when taking an oral regimen.

Notify physician if daytime psychomotor function is impaired; a change in regimen or drug may be needed.

Terminate regimen gradually over a period of several days. Do not stop long-term therapy abruptly; withdrawal may be induced with feelings of panic, tonicclonic seizures, tremors, abdominal and muscle cramps, sweating, vomiting.

This drug will make you drowsy and less anxious; do not try to get up after youhave received this drug (request assistance to sit up or move around).

Take this drug exactly as prescribed; this drug is habit forming; its effectiveness infacilitating sleep disappears after a short time.

Do not take this drug

Most potent of the available benzodiazepines. Effects (anxiolytic, sedative, hypnotic, and skeletal muscle relaxant) are mediated by the inhibitory neurotransmitter GABA. Action sites: thalamic, hypothalamic, and limbic levels of CNS.

General CNS depressant;

barbiturates inhibit impulse conduction in the ascending RAS, depress the cerebral cortex, alter cerebellar function, depress motor output, and can produce excitation, sedation, hypnosis, anesthesia, and deep coma; at sub hypnotic doses, has anticonvulsant activity, making it suitable for long-term use as an

Increased CNS depression with alcohol and other sedating medications, such as barbiturates and opioids

Decreased effectiveness with theophyllines

Increased serum levels

and therapeutic and toxic effects with valproic acid

Increased CNS depression with alcohol

Increased risk of nephrotoxicity with methoxyflurane

Increased risk of neuromuscular excitation and hypotension with barbiturate anesthetics

PAIN MED.

MED Name/Class Safedose/Rout Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction


slowly. Administer IM doses

deep in a large muscle mass (gluteus maximus, vastus laterals) or other areas where there is little risk of encountering a nerve trunk or major artery.

longer than 2 wk. (for insomnia), and do not increase thedosage without consulting the prescriber.

antiepileptic.

GI : SBO, GERD, Ulcers, Gastritis MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt Teaching Action Drug 2 Drug Interaction PPI (proton pump inhibitor) Prazole

Protonix (pantoprazole)

Prilosec (omeprazole)

Adult 20-80mg 20mg PO Q12

Stress Ulcers GERD Gastritis Absence of epigastric pain Fullness Pain

Headache Diarrhea Abdominal pain Nausea Vomiting Insomnia Hyperglycemia

Assess for epigastric or abdominal pain and occult blood in stool emesis or gastric aspirate

Known hypersensitivity, hypocalcaemia or if taking any meds that interact with this drug.

Report severe diarrhea If patientsdiabetic may

cause hyperglycemia Avoid hazardous

activities as dizziness may occur

Avoid salicylates, ibuprofen

ETOH- may cause GI irritation

Blocks final step of acid production

Inhibits H+/K+ ATPas in gastric parietal cell suppressing gastric secretion.

Binds to an enzyme on gastric parietal cells in the presence of acidic gastric PH.

Preventing the final transportation of hydrogen ions into the gastric lumen.

Contraindicated in hypersensitivity, metabolic alkalosis and hypocalcaemia.

Pantoprazole serum levels w/ meds: diazepam, flurezepam, triazolam, clarithromycin, phenytoin

Absorption w/meds: calcium carbonate, vit B12, sucralfate.

Blding w/ warfarin

H2 Blockerstidine Treatment and prevention of heartburn, acid indigestion, and sour stomach.

Dizziness Arrhythmias Drowsiness Headache Nausea

Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.

Nurse should know that it may cause false-positive results for urine protein; test with sulfosalicylic acid.

Inform patient that it may cause drowsiness or dizziness.

Inform patient that increased fluid and fiber intake may minimize constipation.

Advise patient to report onset of black, tarry stools; fever, sore throat; diarrhea; dizziness; rash; confusion; or hallucinations to health care professional promptly.

Blocks HCl production Turns down Volume of

Stomach Acid production

Hypersensitivity, Cross-sensitivity may occur; some oral liquids contain alcohol and should be avoided in patients with known intolerance.

Anti-Acids (Tums)

2-4 teaspoons (10-20 mL)

4 times a day taken 20min to 1 hr. after meals and at bedtime or as directed by the physician.

Relieve heartburn Major symptom of gastro

esophageal reflux disease or acids indigestion.

Treatment of ulcers

Upset stomach Vomiting Stomach pain Belching constipation

Observe 10 rights in

drug administration to avoid medication errors.

Monitor and record pain scales to serve as

Instruct patient to avoid

caffeine, alcohol, harsh spices, and black pepper because it may aggravate the underlying

Neutralizes Stomach Acids 20-30min.

Aluminum hydroxide may form

complexes withcertain drugs e.g., tetracyclines,digoxin andvitamins, resulting in decreased absorption. Thisshould

PAIN MED. MED Name/Class Safedose/Rout Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction


(Suspension) resulting from excessive acidity.

baseline data and to determinethe effectiveness of the drug.

Give drug 20 min- 1 hour after meal to counteract the hydrochloric acid production by neutralizing the acidity.

Administer with at least 8 ounces of water to enhance absorption

Monitor stool consistency to prevent diarrhea and constipation. `

GIcondition. Instruct patient to

increase fiber and fluid intake and regular physical activity to help ease constipation.

Instruct patient to eat banana if diarrhea occurred.

be borne in mind when concomitantadministration is considered.

Stool Softeners Colace (docusate

sodium)

Bisacodyl (Dulcolax)

100mg PO BID 5-15 mg tablets 10 mg suppository

Prevention of

constipation. Used as enema to soften

fecal impaction Promotes incorporation

of water into stool, resulting in softer fecal mass.

May also promote electrolyte and water secretion.

Abdominal Pain Nausea Vomiting

Assess for abdominal

distention, presence of bowel sounds, and usual pattern of bowel function.

Asses color, consistency and amount of stool produced.

Advice patients that

laxatives should be used only for short-term therapy.

Encourage patient to use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid intake and increasing mobility.

Advice patient not to use laxative when abdominal pain, nausea, vomiting or fever is present.

Advice patient not to take docusate within 2 hour of other laxatives.

Promotes incorporation

of water into stool, resulting in softer fecal mass, may also promote electrolyte and water secretion into the colon.

Electrolyte imbalance

Anti-Emetic Zofran (Ondansetron)

Compazine (Prochlorperazine)

Reglan (metoclopramide)

0.12 mg/kg or 32mg

single dose PO: 2.5mg-10mg max

40mg/day IM: 0.1-10mg max

40mg/day IV: 2.5-10mg max

40mg/day Rectal: 25mg bid IV not recommended for

children 10mg q6-8hour

Treatment for nausea and

vomiting Prevent symptoms of

gastric static and esophageal reflux.

Headache Dizziness Diarrhea Constipation Abdominal Pain Restlessness Anxiety Depression Irritability Hyper/hypotension

Assess for nausea,

vomiting, abdominal distention and bowel sounds prior to and following administration.

Assess patient for extrapyramidal effect periodically

Assess patient BP

Advice patient to notify

health care professional immediately if involuntary movement of eyes, face or limbs occur.

Blocks the effects of

serotonin at 5ht receptor sites located in vagal nerve terminals and the chemoreceptor trigger zone in the CNS.

Decreases incidence and severity of nausea and vomiting.

May be affected by drugs

altteringthe activity of liver enzymes.

May cause transient increase in serum bilirubin, AST and ALT levels.

Canbeusedastranquilizerfornon-

psychoticanxiety,butotherdrugsmay have more favorable side effect prole (e.g., benzodiazepines)

GI : SBO, GERD, Ulcers, Gastritis



CARDIAC: CHF, MI, HTN, ^cholesterol MED Name/class dose/Route/Freq MAX Daily Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction ACE Inhibitor PRIL

Prinivil, Zestril (Lisinopril)

Capoten (Captopril)

2.5-40mg 0.3-25mg PO

40mg/day

Hypertension Management of

congestive heart failure (CHF)

Reduces the risk of death or development of CHF after myocardial infarction (MI)

Slows the progression of left ventricular dysfunction into overt heart failure

Used to decreased the progression of diabetic neuropathy

Insomnia Vertigo Weakness Cough Hypotension Chest pain Tachycardia

H/O Angio-

Edema Mod-severe

aortic stenosis Systolic BP 3.0 K+ >5.5 BP_____

HR_____ Assess Vital Signs

before giving Rx. Monitor BP and

pulse frequently during initial dose adjustment

Monitor weight and assess lungs for rales/crackles

Assess for peripheral edema, jugular venous distention

Advice patient take

the med same time daily.

Change position slowly

Stops Angiotensin 1 to

converting to Angiotensin 2 in the R.A.A.S

Decrease B/P Excretion of sodium and

water and retention of potassium

Decreased

antihypertensive effects if taken with indomethacin

Exacerbation of cough if combined with capsaicin

ARB angiotensin block Valsartan

Candesartan

Losartan

1 tab daily; 25-100mg/d

16mg once daily

50mg OD

360mg/day

2-32

mg/day as a single dose or divided into 2 daily doses

Treatment of

hypertension, alone or in combination with other antihypertensive.

Treatment of heart failure in patients who are intolerant of angiotensin-converting enzyme (ACE_ inhibitors.

Headache Dizziness Hypotension Diarrhea URI Symptoms

BP_____

HR_____ Administer

without regard to meals.

Ensure that patients is not pregnant before beginning therapy

Take drug without

regard to means Report fever chills,

dizziness and pregnancy.

Selectively blocks the

binding of angiotensin II to specific tissue receptors found in thevascular smooth muscle and adrenal gland; this action blocks the vasoconstriction effect of the renin\u2013angiotensin system as well as the release of aldosterone, leading to decreasedBP; may prevent the vessel remodeling associated with the development of Atherosclerosis.

Contraindicated with

hypersensitivity to valsartan, pregnancy (use during second

Or third trimester can cause injury or even death to fetus), lactation.

Use cautiously with hepatic or renal dysfunction, hypovolemic

Aldosterone Antagonist Aldactone(Spironolactone)

Inspra (Eplerenone)

100-200

mg/dayPO for edema;100-400mg/day PO for hyperaldosteronism; 50-100 mg/day PO for hypertension

Pediatric :3.3 mg/kg/day PO 100mg/day PO BID

25-50mg/day

Decrease BP Take Pressure Off L Ventricle of heart Treat high blood

pressure. Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. It is also used to treat swelling (edema)

Headache diarrhea, cramps, drowsiness, rash, nausea, vomiting, impotence, irregular menstrual

periods, irregular hair growth

Check blood pressure before initiation of therapy and at regular intervals throughout therapy.

Lab tests: Monitor serum electrolytes (sodium and potassium) especially during early therapy; monitor digoxin level when used

Be aware that the maximal diuretic effect may not occur until third day of therapy and that diuresis may continue for 23 d after drug is withdrawn.

Report signs of hypernatremia or hyperkalemia (see Appendix F), most likely to occur in patients with severe cirrhosis.

Block Altosterone in R.A.A.S decrease total body fluid

BP Mild diuretic that acts

on the distal tubule to inhibit sodium exchange for potassium, resulting inincreased secretion of sodium andwater conservation of potassium. Analdosterone antagonist

Manifests a slightantihypertensiveef

Increased hyperkalemia with potassium supplements, ACE inhibitors, diets rich in potassium.

Decreased diuretic effect with salicylates

Decreased hypoprothrombinemic effect of anticoagulants


for 4 weeks

concurrently. Assess for signs

of fluid and electrolyte imbalance, and signs of digoxin toxicity.

Monitor daily I&O and check for edema. Report lack of diuretic response or development of edema; both may indicate tolerance to drug.

Weigh patient under standard conditions before therapy begins and daily throughout therapy. Weight is a useful index of need for dosage adjustment. For patients with ascites, physician may want measurements of abdominal girth.

Avoid replacing fluid losses with large amounts of free water

fect. Interferes with synthesis of testosterone and mayincrease formation of estradiol from estrogenthus leading to endocrine abnormalities

Loop Diuretics Lasix (Furosemide)

Bumex(Bumetanide)

Demadex (Torsemide)

20mg/tab

0.5-1mg/day

5-20mg/day

10mg/day

Treatment of edema

associated with CHF, hepatic cirrhosis, and renal disease. Hypertension.

orthostatic

hypertension thrombophlebitis chronic aortitis vertigo headache

BP_____ HR_____ Weights

(trending) 1___2 ___3 ___4

___ K+ ____ Assess patient's

underlying condition.

Monitor for renal, cardiac, neurologic, GI, pulmonary manifestation of hypokalemia.

Assess fluid volume.

s/s Hypo K+ Posteral Syncope advise patient

totake drug with food toprevent GI upsetinform patient of possibleneed for potassium ormagnesium supplements

Inhabits sodium and

chloride reabsorption at the proximal tubules, distal tubules and ascending loop of Henley leading to excretion of water together with sodium, chloride and potassium. Diuretic antihypertensive.

Cross-sensitivity with

thiazides and sulfonamides may occur

Thiazide Diuretics Hydrochlorothiazide

(Metolazone)

5-20mg/day

80mg/day

For pain on

integumentary structures, myalgia, neuralgia, headache, dysmenorrhea, gout.

heartburn Thirst fever dimness of vision

BP_____ HR_____ Assess for pain:

type, location and pattern

Note for asthma

Record intermittent

therapy on a calendar, or use prepared dated envelopes. Take drug

Inhibits reabsorption of

sodium and chloride in distal renal tubule, increasing the

Excretion of sodium,

Taking insulin with

Hydrochlorothiazide may cause high blood sugar (hyperglycemia.

CARDIAC: CHF, MI, HTN, ^cholesterol MED Name/Class Safedose/Rout MAX daily Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction


Arthritis, SLE, acute rheumatic fever

osteoporosis

asthma like symptoms

Monitor renal,LFTs and CBC

Determine history of peptic ulcers or bleeding tendencies.

early so increased urination will not disturb sleep. Drug may be taken with food or meals if GI upset occurs.

Weigh yourself on a regular basis, at the same time and in the same clothing;

Record weight on your calendar.

chloride, and water by the kidney.

Ca+ Channel Block PINES

Norvasc (Amlodipine)

5mg/tab OD

CHR Angina hypertension

Dizziness headache Peripheral edema Flushing rush Nausea Abdominal discomfort

Monitor patients

BP, cardiac rhythm, and output.

Take with meals if

upset stomach occurs.

Block Ca+ channels of cell inhabits the movement of

calcium ions across the membranes of cardiac and arterial muscle cells

inhabits trans membranecalcium flow, which results in the depression of impulse formation in specialized cardiac pacemaker cells

The body breaks down

(metabolizes) amlodipine using liver enzymes known as CYP 3A4 enzymes. Drugs known as CYP 3A4 inducers speed up the activity of these enzymes, causing the body to metabolize amlodipine too quickly. This may make amlodipine less effective.

Beta Block CHF Tachycardia Management of

hypertension, used alone or with other antihypertensive agents

Pharyngitis Dizziness Vertigo Bardycardia CHF Cardiac Arrhythmias Rush

Baseline weight, skin condition, neurologic status, P, BP, ECG, R,kidney and liver function tests, blood and urine glucose

Do not stop taking this drug unless instructed to do so by a health care provider.

Avoid over-the-counter medications.

Avoid driving or dangerous activities if dizziness, weakness occur.

These side effects may occur: Dizziness, light-headedness, loss of appetite, nightmares, depression, and sexual impotence.

Report difficulty breathing, night cough, swelling of extremities, slow pulse,

Confusion, depression, rash, fever, sore throat.

Blocks beta-adrenergic receptors of the sympathetic nervous system in the heart and juxtaglomerular apparatus (kidney), thus decreasing the excitability of the heart, decreasing cardiac output and oxygen consumption, decreasing the release of renin fromthe kidney, and lowering blood pressure.

Increased effects with verapamil, anticholinergic

Increased risk of orthostatic hypotension with prazosin

Possible increased BP-lowering effects with aspirin, bismuth subsalicylate,

magnesium salicylate, sulfinpyrazone, hormonal contraceptives

Decreased antihypertensive effects with NSAIDs

Possible increased hypoglycemic effect of insulin

Zabeta (Bisoprolol) 1.25mg 10mg Coreg (Carvedilol) 3.125mg x 2 25 -

50mg x 2

If >85kg Lopressor Metroprolol 12.5 25mg 200mg x

1



Inotropic

Cardiac Glycosides Lanoxin (Digoxin)

0.125mg x 1

0.125

mg 0.25mg x 1

Heart failure- Supraventricular arrhythmias- Emergency heart failure

Headache Weakness Drowsiness visual disturbances mental status change Arrhythmias GI upset, anorexia

Dig Toxic0.8-2.0ng/ml

Low K+ levels (^dig toxic)

BP_____ HR_____ EKG

Monitor apical pulse for 1 minute before administering.

Administer as indicated.

Check dosage and preparation carefully.- Avoid giving with meals; this will delay absorption

Instruct patient not to stop taking drug without notifying physician.

Instruct to report slow or irregular pulse, rapid weight gain, loss of appetite, nausea, diarrhea, vomiting, blurred or yellow vision, unusual tiredness or weakness, swelling of the ankles, legs or fingers, difficulty breathing.

Weigh patient every other day.

Instruct to have regular medical check-ups, which may include blood tests, to evaluate effects of drug.

Do proper documentation.

Digoxin is a cardiac glycoside which has positive inotropic activity characterized by an increase in the force of myocardial contraction. It also reduces the conductivity of the heart through the atrioventricular (AV) node. Digoxin also exerts direct action on vascular smooth muscle and indirect effects mediated primarily by the autonomic nervous system and an increase in vagal activity

effectiveness reduced by phenytoin, neomycin,sulphasalazine, kaolin, pectin, antacids and inpatients receiving radiotherapy- Metoclopramide may alter the absorption of solid dosage forms of digoxin- Blood levels increased by calcium channel blockers, spironolactone, quinidine and calcium salts.- Electrolyte imbalances such as hypokalemiaand hypomagnesaemia(e.g. admin of potassium-losing diuretics, corticosteroids) can increase the risk of cardiac toxicity

Nitrates VASODILATOR Nitro (Nitroglycerin)

0.2-0.6 mg SL q

5 minutes

3doses

in 15 minutes

MI, /CAD Treatment of angina

pectoris

Headache Restlessness Nausea Vomiting Hypotension Tachycardia

Viagra BP_____ HR_____ Monitor blood

pressure and heart rate on a regular basis

NO Viagra (Vascular Collapse)

Instruct patient to take medication while sitting down and to change positionsslowly.

Instruct patient to allow tablets to dissolve under tongue, and not to chewer swallow sublingual tablets.

Instruct patient to seek emergency help promptly if chest pain is unresolved after 15 minutes.

Instruct patient not to change brands without consultingprescriber. Instruct patient to keep tablets in original, air-tight container

Reduces cardiac oxygen demand by decreasing leftventricularpressure and systemicvascular resistance; dilates coronaryarteries andimproves collateral flow to ischemic regions

Viagra

Blood Thinners (anti-coagulants)

Dizziness Headache

Observe patients receiving

Protect from injury and notify Dr of

ASA: Prevent bleeding by

Use of heparin, ASA, Tylenol,



ASPRIN (anti-platelet)

81mg Q Day 325mg CP

Anticoagulation for purposes of stroke, PE, deep venous thrombosis, prophylaxis for venous thrombosis, acute MI

Insomnia Constipation N/V Urinary Retention Bleeding Anemia Thrombocytopenia

parenteral drug carefully; closely monitor BP and vital signs.

Observe older adults closely during period of brisk diuresis. Sudden alteration in fluid and electrolyte balance may precipitate significant adverse reactions. Report symptoms to physician.

Monitor for S&S of hypokalemia.

Monitor I&O ratio and pattern. Report decrease or unusual increase in output.

pink, red, dark brown or cloudy urine, red or dark brown vomitus; red or black stools, bleeding gums or oral mucosa; ecchymosis, hematoma, epistaxis, bloody sputum; chest pain; abdominal or lumbar pain or swelling; unusual increase in menstrual flow; pelvic pain; severe or continuous headache, faintness, or dizziness

Menstruation may be somewhat increased and prolonged;

Learn correct technique for SC admin if discharged from hospital on heparin

Engage in normal activities such as shaving with a safety razor in the absence of a low platelet count.

Alcohol and smoking may alter the response to heparin and are not advised

Do not take aspirin or any other OTC meds without the Dr approval

inactivation of thrombin formation, inhibition of formation of fibrin

Heparin:

exerts direct effect on blood coagulation (clotting) by enhancing the inhibitory actions of antithrombin III on several factors essential to normal blood clotting, thereby blocking the conversion of prothrombin tothrombin and fibrinogen to fibrin.

Coumadin:

Warfarin is used to treat blood clots (such as in deep vein thrombosis-DVT or pulmonary embolus-PE) and/or to prevent new clots from forming in your body. Preventing harmful blood clots helps to reduce the risk of a stroke or heart attack

glucocorticoids,

sulfonamides, cephalosporinsincrease effects of warfarin. Phenobarbital, tegrtol, Dilantin, oral contraceptives decreases anticoagulation effects.

Heparin (Heparin Sodium) 150=10,000 U/kg IV

Prophylaxis and Tx of venous thrombosis and pulmonary embolism and to prevent thromboembolic complications arising from cardiac and vascular surgery, frostbite, and during acute stage of MI. Also used in Tx of disseminated intravascular coagulation (DIC), atrial fibrillation with embolization, and as anticoagulant in blood transfusions, estracorporealcirculation, and dialysis procedures

Lovenox (enoxaparin) 40mg SQ daily Prevention o thrombus formation

Systemic anticoagulation for prevention of ischemic or thrombotic events

Coumadin (Warfarin)

2.5 mg/1 tab OD

Prevents further extension of formed existing clot, prevention of new clot formation, and secondary thromboembolic complications. And for treatment of hyperkalemia.



Insulin & Diabetic MED Name/class ONSET/ Peak/ Duration Uses (Goals) RN Consider Pt. Teaching Action Drug 2 Drug Interaction Insulin

Diabetes Mellitus Regulate sugar in your bloodstream

Assess patient periodically for symptoms of hypoglycemia (anxiety; restlessness; mood changes; tingling in hands, feet, lips or tongue; chills; cold sweats; confusion; cool pale skin; difficulty in concentration; drowsiness; excessive hunger; headache

Monitor body weight

Hypoglycemia H.A.N.D.W.A.S.H Headache Altered Nervousness Disoriented W Anxiety Shaky

Lowers blood glucose by stimulating glucose uptake in skeletal muscle and fat and inhibiting hepatic glucose production.

Insulin also inhabits lipolysis and proteolysis and enhances protein synthesis.

A rapid-acting insulin with more rapid onset and shorter duration than human regular insulin; should be used with intermediate or long acting insulin.

Lantus/Lefemir NO MIXING!!!! With

other insulins Beta blockers may block

some of the signs and symptoms of hypoglycemia and delay recovery from hypoglycemia (Lopressor)

Alcohol may decrease insulin requirements.

Rapid Acting LOG Apidra (Glusine) Aspart (Novolog) Lispro (Humalog)

15min ONSET 30 - 90 min PEAK 4-6 hour DURATION

Short Acting LIN Humalin/Novolin R

30 60 min ONSET 2-4 hr. PEAK DURATION

Intermediate (cloudy) NPH

1-2HR ONSET 6-10 hr. PEAK DURATION

Roll NPH to mix

Long Act Glargine (Lantus) Detremir (Levemir)

4 Hr. ONSET NO PEAK 18 24 Hr. DURATION

Asses for symptoms of hypoglycemia.

Monitor body weight. MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction Anti-Diabetic (Metformin) Glucophage 500-1000mg

Max. 2000mg/day (child) 2500mg/day (adult)

improve glycemiccontrolling clients with type 2diabetes

Extended-Release form

used to treat type2 diabetes as initial therapy

Diarrhea Nausea Unpleasant metallic taste.

Assess for patients history of diabetes

Monitor patients blood glucose before and after giving medications.

Assess for hypersensitivity to Metformin

Assess Patients renal function

Monitor sign and symptoms of hypoglycemic reaction.

Inform the patient of potential risks/advantages of therapy and of alternative modes of therapy

Do not discontinue this medication without consulting your health care provider.

Monitor urine or blood for glucose and ketones as prescribed.

Do not use this drug during pregnancy; if you become pregnant, consult with your

Health care provider for appropriate therapy.

Decreases heptic glucose production

Decreases intestinal glucose absorption.

Increases sensitivity to insulin.

decongestants can make metformin less effective, increasing your chance of high blood sugar (hyperglycemia)


RESPIRATORY: COPD (Asthma, Emphysema, Chronic Bronchitis) Restrictive Airway Disease MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction Bronchodilators

PO (Adults and Children more than 12 years): 2-4 mg 3-4 times a day or 4-8 mgof extended dose tablets twice a day.

To control and prevent reversible airway obstruction caused by asthma or chronic obstructive pulmonary disorder (COPD)

Quick relief for bronchospasm

For the prevention of exercise-induced bronchospasm4. Long-term control agent for patients with chronic or persistent bronchospasm

Restlessness cardiac arrhythmias palpitation sweating nausea & vomiting

Relief and prevention of bronchospasm in patients with reversible obstructive

airway disease Inhalation: Treatment

of acute attacks of bronchospasm

Prevention of exercise-induced bronchospasm

Unlabeled use: Adjunct in treating serious hyperkalemia in dialysis patients;

seems to lower potassium concentrations when inhaled by patients on

hemodialysis

Do not exceed recommended dosage; adverse effects or loss of effectiveness may

Result. Read the instructions that come with respiratory inhalant.

These side effects may occur: Dizziness, drowsiness, fatigue, headache (use

caution if driving or performing tasks that require alertness); nausea, vomiting,

change in taste (eat small, frequent meals); rapid heart rate, anxiety, sweating,

Flushing, insomnia. Report chest pain,

dizziness, insomnia, weakness, tremors or irregular heartbeat,

difficulty breathing, productive cough, failure to respond to usual dosage

in low doses, acts relatively selectively at beta2-adrenergic receptors to cause

bronchodilator and vasodilation; at higher doses, beta2 selectivity is lost, and the drug

Acts at beta2 receptors to cause typical sympathomimetic cardiac effects.

Increased sympathomimetic effects with other sympathomimetic drugs

Increased risk of toxicity, especially cardiac, when used with theophylline,

aminophylline, oxtriphylline

Decreased bronchodilating effects with beta-adrenergic blockers (eg, propranolol)

Decreased effectiveness of insulin, oral hypoglycemic drugs

Decreased serum levels and therapeutic effects of digoxin

Beta 2 Agonist Proventil (Albuterol)

Methylaxthine Theophylline

(Elixophyllin)

1.4 mg poq12h Maintenance 3mg/kg q

8hr.

Bronchospasm of COPD Bronchial asthma Chronic bronchitis

Nausea Vomiting Palpitation Hyperglycemia Anxiety Insomnia

Monitor theophylline blood levels

Monitor I&O Assess for signs of

toxicity: irritability, insomnia, restlessness, tremors

Monitor respiratory rate, rhythm and dept.

Assess for allergic reaction.

Take this drug exactly as prescribed

Avoid excessive intake of coffee, tea, cocoa, cola, and chocolates.

Have frequent blood test to monitor drug effects and ensure safe and effective dosage.

Relaxes bronchial smooth muscle, causing bronchodilator and increasing vital capacity

that has been impaired by bronchospasm and air trapping; actions may be mediated by

inhibition of phosphodiesterase, which increases the concentration of cyclic adenosine

monophosphate; in concentrations that may be higher than those reached clinically, it also

Inhibits the release of slow-reacting substance of anaphylaxis and histamine.

Drinking alcohol can increase the level of theophylline in your blood, which can cause dangerous side effects. It is best to avoid alcohol while taking theophylline.

Anti - Cholinergic Ipratropium Inhaler

(Atrovent,Apovent,Aerovent)

2 inhalations (36 mcg)

qid.

Bronchodilator for maintenance treatment of bronchospasm associated with COPD (solution, aerosol), chronic bronchitis, and emphysema

Nasal spray: Symptomatic relief of rhinorrhea associated with perennial rhinitis,

Nausea GI distress Dry mouth Dyspnea bronchitis Back pain Chest pain.

Asses History of hypersensitivity to atropine

Asses skin color lesion texture

BP, P, R adventitious sounds

Bowel sounds

Use as an inhalation product

Side effect may occur Report rash, eye pain,

difficulty voiding, palpitation, vision changes

STOPS(inhibits) secretion from serous and seromucous glands lining the nasal mucosa.

Anticholinergic, chemically related to atropine, which blocks vagally mediated reflexes

By antagonizing the action of acetylcholine.


common cold

Causes bronchodilator

Anti-Inflam Agents 10mg/5ml OD on full

stomach

Replacement therapy in adrenal cortical insufficiency

Hyperkalemia associated with cancer

Short-term management of various inflammatory and allergic disorders, such as

rheumatoid arthritis, collagen diseases (e.g., SLE), dermatologic diseases (e.g., pemphigus), status asthmatics, and autoimmune disorders

Hematologic disorders: thrombocytopenia purpura, erythroblastopenia

Ulcerative colitis, acute exacerbations of multiple sclerosis and palliation in some leukemias and lymphomas

Trichinosis with neurologic or myocardial involvement

^Blood sugar & Infection ^ Edema (retain Na+) Wt gain bloating moon face

Assess physical weight, T, reflexes and grip strength, affect and orientation, P, BP, peripheral perfusion, prominence of superficial veins, R, Adventitious sounds, serum electrolytes, blood glucose.

Do not immediately stop taking the corticosteroid, need to be tapered OFF, ADRENAL crisis may occur

Avoid exposure to infections.

Report unusual weight gain, swelling of the extremities, muscle weakness, black or tarry stools, fever, prolonged sore throat, colds or other infections, worsening of the disorder for which the drug is being taken

Inhabitations of leukocyte infiltration at the site of inflammation

Interference in the faction of mediators of inflammatory response, and suppression of humeral immune responses.

Increased therapeutic and toxic effects with troleandomycin, ketoconazole

Increased therapeutic and toxic effects of estrogens, including hormonal

contraceptives Risk of severe

deterioration of muscle strength in myasthenia gravis patients who

also are receiving ambenonium, edrophonium, neostigmine, pyridostigmine

Decreased steroid blood levels with barbiturates, phenytoin, rifampin

Decreased effectiveness of salicylates

Corticosteroids Prednisone

(Deltasone/Flovent)

Mast Cell Stabilizer CromolynSodium

(Intal Rynacrom)

Inhalers or Nasal spray involvement Treats asthma, COPD, Hay Fever or Chronic inflammation of the major pathways of the respiratory tract (bronchioles/ bronchi)

H/A Trouble Swollowing Skin itchy Muscle pain

Ensure proper use of inhailer (exhale completely before inhailing drug with admin of inhailor) Respiratory assessment Lung Sounds

Educate MEDS WORK SLOWLY 2-6 weeks to become effective DO NOT USE for immediate allergy relief or acute asthma attack SE: Runny Nose, Throat irritation, HA CALL DR. if white sores in throat OR swelling tough

Prevents allergy and inflammation Reaction from releasing histamines that cause allergic inflammation

Leukotrine Rec. Antagonist zafirlukast (Astra,

Accolate) (Singulair)

ADULTS AND CHILDREN

> 12 YR 20 mg PO bid on an

empty stomach. PEDIATRIC PATIENTS

5\u201311 YR 10 mg PO bid on an

empty stomach

Leukotriene modifiers reduce inflammation in the lung tissue treatment of bronchial asthma

Headache Dizziness Nausea diarrhea abdominal pain Vomiting

Ensure that drug is taken continually for optimal effect.

Do not administer for acute asthma attack or acute bronchospasm.

Take this drug on an empty stomach, 1 hr. before or 2 hr. after meals.

Take this drug regularly as prescribed; do not stop taking it during symptom-free periods; do not stop taking it without consulting your health care provider.

Do not take this drug for acute asthma attack or

Selectively and competitively blocks receptor for leukotriene D4 and E4, components of SRS-A, thus blocking airway edema, smooth muscle constriction, and cellular activity associated with inflammatory process that contribute to signs and symptoms of asthma.

Increased risk of bleeding with warfarin

Potentially for increased effects and toxicity of calcium channel-blockers, cyclosporine.

Decreased effective with erythromycin, theophylline.

RESPIRATORY: COPD (Asthma, Emphysema, Chronic Bronchitis) Restrictive Airway Disease



acute bronchospasm; Anti-Allergic

Xolair (Omalizumab) 150 to 375 mg is

administered SC every 2 or 4 weeks

moderate to sever persistent asthma who have a positive skin test otinvitro reactivity to a perennial aeroallergen and whose symptoms are inadequately controlled with inhaled corticosteroids.

Wheezing tightness in your cheat skin rash feeling anxious Swelling face, lips,

tongue

Assess lung sounds and RR, assess for allergic reactions within 2 hr of first injection, monitor for injection site reactions.Solution is viscous and maytake 5-10 sec. to administer

Take daily Use flow meter to every

AM to track lung copasity from day to day

Inhibits binding of IgE toreceptors on mast cells andeosinophils, preventing of mediators of theallergic response. Alsodecreases amount of IgEreceptors on basophils.

CI in hypersensitivity and acute bronchospasm

POST OP (Blood & Bones) MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction

Blood 1-2 units over 2-4 hours (faster admin will neg. affect kidneys)

Anemia Blood loss S/P Sx

Allergic Rx Lysed cells Death

H/H _____ RBC____ BP____ HR____ TEMP____ VS before VS 15 min into VS Q 30 min VS After

Benadryl Cortisone Back pain, Diff breathing, Rapid HR s/s RX

O (Universal Donor) AB (universal Reciever) Rh + (receives everyone +/- Rh (ONLY receives Neg.)

A-A B-B O O & GIVE TO ALL, AB-Recieves ALL

Fe+ (iron) PO: ADULTS, ELDERLY: 2-3

mg/kg/day or 50-100mg elemental iron 2 time/day up to 100mg 4time/day. CHILDREN: 3 mg/kg/day elemental iron in 1-3 divided doses

prevention or treatment of iron deficiency anemia due to inadequate diet, malabsorption pregnancy, and blood loss

Mild, transient nausea Heartburn Anorexia Constipation Diarrhea

Assess for clinical improvement, record of relief of symptoms (fatigue, irritability, pallor, paresthesia, and headache).

Expect stools to darken in color.

If gastrointestinal discomfort occurs, take after meals or with food.

Do not take within 2 hours of antacids because it prevents absorption

essential component in the formation of hemoglobin, myoglobin andenzymes. It is necessary for effective erythropoiesis and transport or utilization of oxygen

Doxycycline, mycophenolate, penicillamine, or thyroid hormones (eg,levothyroxine)

Blood Thinners (anti-coagulants)

Easy Bruising Increased r/f bleeding Fever Rhinitis Hyperkalemia Irritation Mild Pain

Check: H/H: ___ Plt, ___ INR ___ (2.0-3.0 Therp. Warforin) PTT: ___ NO Give: GI Bleed, Ulcers APTT

- Black Stool (call PMD) - Easy Bruising & Bleeding - Brush teeth slowly to

prevent bleeding gums - NO shaving with Razors - Safety!

exerts direct effect on blood coagulation (clotting) by enhancing the inhibitory actions of antithrombin III on several factors essential to normal blood clotting, thereby blocking the conversion of prothrombintothrombin and fibrinogen to fibrin

Antihistamines Digoxin Tetracycline ASA 81mg Q Day

325mg CP Clot Prevention, ^CMS Boost Circulation

Heparin (Heparin Sodium) SQ 5,000 10,000 UNITS Adults: Initially, 5,000

units by I.V. bolus; then 20,000 to 40,000 units/day by I.V. infusion with pump. Titrate hourly rate based on PTT results (every 4 to 6 hours in the early stages of treatment).

Children: Initially, 50 units/kg I.V.; then 25 units/kg/hour or 20,000 units/m

2 daily by I.V. infusion pump.

prophylaxis and Tx of venous thrombosis and pulmonary embolism and to prevent thromboembolic complications arising from cardiac and vascular surgery, frostbite, and during acute stage of MI. Also used in Tx of disseminated intravascular coagulation (DIC), atrial fibrillation with embolization, and as anticoagulant in blood transfusions, estracorporealcirculation, and dialysis procedures

Lovenox (Enoxaparin) 40 mg once daily SQ Prevention of DVT/Pulmonary Embolism

RESPIRATORY: COPD (Asthma, Emphysema, Chronic Bronchitis) Restrictive Airway Disease



Coumadin (Warfarin)

2.5-10mg per day for 2-4 days then adjust daily dose by results of prothrombin time or INR

Management of Myocardial infarction: decreases risk of death, decreases risk of subsequent MI

POST OP (Blood & Bones) MED Name/Class Safedose/Rout Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction


ANTI-INFECTIVES `MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction Penicillin

Amoxil (Amoxicillin)

Polycillin (Ampicillin)

Geocillin (Carbenicillin Indanyl Sodium)

Zosyn

(Piperacillin/Tazobactam)

Bicillin (Penicillin G Sodium)

Bactocil (Oxacillin

Sodium)

Adult: 250-500mg every

8hours Children: 20-

40/mg/kg/day divided dosage given every 8 hours

20-500mg

382 to 764 mg

3.375-4.5g every 6 hours 1-4mL

Infections of the resp.

tract, skin and skin

structures, Para nasal sinuses, genitourinary tract, otitis media, sinusitis Meningitis. UTI

Dizziness Nausea and vomiting Diarrhea Abdominal pain

Obtain pt.shas of

allergy. Assess pt. for any s/s

of infection Asses for pt.s

sensitivity to penicillin or other cephalosporins

Assess for allergic reaction during therapy.

Assess for bowel pattern

Teach patient to

report adverse reactions.

Notify prescriber if infection worsens or doesnt improve after 72 hours

Prevents bacterial cell wall

synthesis during replication

Allopurinol: increased

risk of rash chlothromycins, sulfon-amides

tetracyclines: Reduced bactericidal effect of amoxicillin

Methotrexate: Increased risk of methotrexate

NO AMINOGLYCO IV TUBING

Cephalosporins >1st Gen<

Staphylococcus Infections

-Lower Lungs - Bones Infections - Blood Infections Respiratory tract

infections Skin and skin structure

infections Bone and joints

infections

Loss of appetite Mild diarrhea Nausea Stomach cramps Vomiting

Be alert of adverse reactions and drug interaction.

This drug should be used extremely carefully because of its potent vasoconstrictor action. IV use may induce sudden hypertension and cerebrovascular accidents. As a last resort, give IV slowly over several minutes and monitor blood pressure closely.

Tell patient to take entireamount of drug exactly asprescribed, even after he feelsbetter.

Advise patient to notify prescriber if rash develops or signs and symptoms of super infection appear.

Inform patient not to crush, cut,or chew extended-releasetablets.

Bind to bacterial cell wall membrane,causing cell death.

** ALLERGY: PENICILLIN*

NO PENECILLIN IV TUBING

Ancef (cefazolin) IV/IM 0.5-1 g 6-12 hrly. Max: 6 g/day, up to 12 g/day in severe infections.

Keflex (Cefalexin) 500mg 1cap q6hrs Duricef, Ultracef

(cefadroxil) 1 g/day P.O. or 500 mg

P.O. q 12 hours >2nd Gen< Mandol(Cefamandole)

Cefzil(Cefprozil) 250 to 500 mg, every 8 hours, PO

Zinacef, Ceftin (Cefuroxime) 125-500mg >3rd Gen<

Cefizox (Ceftizoxime)

IM/IV 1-2g max of 3-4g Rocephin (Ceftriaxone) 1-2 g IV/IM qDay or

divided BID for 4-14 days depending on type and severity of infection

Claforan (cefotaxime) 1 to 2 g IV/IM q8hr Tetracyclines

Doryx (Doxycycline) Achromycin

(Tetracycline) Terramycin

(Oxytetracline)

200mg once daily PO Adult: 500mg PO bid Child: 25-50mg/kg PO

qid PO: Onset-Rapid, Peak

2-3hours; Duration 6-12 hours

10-50mg/kg

Acne H. Pylori Gonorrhea Certain types of

pneumonia Lyme disease

Dizziness Vestibular reaction Diarrhea Nausea and vomiting Photosensitivity

Assess patient for infection (vital signs, appearance of wound, sputum, urine, and stool; WBC) at beginning of and throughout therapy

Sun screen d/t making skin sensitive to sunlight

Yellow Teeth NO dairy NO Iron NO antiacids Not with food

Inhibits bacterial protein synthesis at the level of the 30s bacterial ribosome.

No DAIRY NO IRON NO Anti-acids

`MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction Macrolides

Zithromax (Azithromycin)

500mg/daily for 3 days.

URI GU Mild moderate nausea,

Nausea Vomiting abdominal pain

Assess skin color, GI output Bowel sounds

Take the full course prescribed.

Do not take with

Azithromycinblockstranspeptidation by binding to50s ribosomal subunit of susceptible organismsand

Coumadin Theophylline Prednisone

POST OP (Blood & Bones)


Biaxin (Clarithromycin) (E-Mycin) Erythromycin

500mg 1tac Bid PO 250mg every 8 hours PO

vomiting, abdominal pain, dyspepsia, flatulence, diarrhea, cramping; angioedema, cholestasis jaundice; dizziness, headache, vertigo, somnolence; transient elevations of liver enzyme values

dyspepsia Diahhrea

antacids. May exp. side effects Report severe or watery

diarrhea, nausea/vomiting0

disrupting RNA-dependent protein synthesis at the chain elongation step

Dopamine Contraindicated with

hypersensitivity to azithromycin, erythromycin, or any macrolide antibiotic

Aminoglycosides Garamycin (Gentamicin) Kantrex (kanamycin) Mycifradin (Neomycin)

Adult: IV/IM 1.52

mg/kg loading dose followed by 35 mg/kg/d in 23 divided doses Intrathecal 48 mg preservative free q.d. Topical 12 drops of solution in eye q4h up to 2 drops q1h or small amount of ointment b.i.d. or t.i.d.

Child: IV/IM 67.5 mg/kg/d in 34 divided doses Intrathecal >3 mo, 12 mg preservative free q.d.

Neonate: IV/IM 2.5 mg/kg q1224h

Parenteral use

restricted to treatment of serious infections of GI, respiratory, and urinary tracts, CNS, bone, skin, and soft tissue (including burns) when other less toxic antimicrobial agents are ineffective or are contraindicated. Has been used in combination with other antibiotics. Also used topically for primary and secondary skin infections and for superficial infections of external eye and its adnexa.

NEPHRO TOXICITY Tennatus (ringing in

ears) Skeletal muscle

weakness Apnea Nausea Vomiting

Perform C&S and

RENAL function (BUN/ Creat) prior to first dose and periodically during therapy; therapy may begin pending test results. Determine creatinine clearance and serum drug concentrations at frequent intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, and patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity.

Weekly Blood Draws To check Peak & trough levels (TOXICITY LEVELS &Theraputic range) Report: - Tennatus (ringing in ears) may indicate Kidney toxicity

Broad-spectrum aminoglycoside

antibiotic derived from Micromonospora purpose. Action is usually bactericidal.

History of

hypersensitivity to or toxic reaction with any aminoglycoside antibiotic. Safe use during pregnancy (category C) or lactation is not established

NO PENECILLIN IV TUBING

Fluroquinolones Cipro (ciprofloxacin) Levaquin (lomefloxacin) (Floxin)

500mg BID Per Orem 250-750mg Q 24 hr.

Oral Adults 600-1800

mg/day in 2-4 equal doses. Childn>1 mth 8-25 mg/kg/day in 3-4 equal doses

IM/IV AdultSeriousinfections 2400-2700 mg in 2-4 equal doses. Less complicated infections 1200-1800 mg/day in 3-4 equal doses. Childn>1mth 20-40 mg/kg in 3-4 equal doses. Neonates


`MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction Sulfanamides

Bactrim, Septra (Trimethoprim- Sulfamethoxazole)

Tab 2 tab Forer tab. 1 tab infant & children TM 6 mg &SMZ 30 mg/kg body wt daily. To be given in bid. Gonorrhea 5 tab bid or 2 forte tab bid for 1 day.

Resp tract, renal GIT, GUT. Osteomyelitis,

pneumocystis carinii pneumonia,

toxoplasmosis, actinomycetoma,

acute brucellosis, nocardiosis

Fatigue Nausea Vomiting diarrhea Crystalluria Toxic epidermal

Assess for infection (vital signs; appearance of wound, sputum, urine, and stool;WBC) at beginning and during therapy.

Obtain specimens for culture and sensitivity before initiating therapy.

Inspect IV site frequently. Phlebitis is common.

Monitor CBC and urinalysis periodically during therapy

Instruct patient to notify health care professional if rash, or fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise patient not to treat diarrhea without consulting health care professional.

Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.

Interferes with bacterial growth by inhibiting bacterial folic acid synthesisthrough competitive antagonism of PABA.

Oral Anticoag./ Diuretics

no work K+ Supplements Anta-Acids & Ca+ Block

The Others: Vancocin (vancomycin)

Flagyl(Metronidazole)

Zyvox (Linezolid)

Clindamycin(Cleocin)

2 g/day IV divided q6-

12hr; may increase based on body weight or to achieve higher trough values, increase toxicity >4 g/day

Capsules: 375 mg Injection: 5mg/mLOral suspension:200mg/5ml Tablets:200mg, 250mg,

400mg, 500mg Topical gel: 0.75 %, 1% 600mg every 12 hour for

14-28 days

Oral 150-300mg q6hr.

IV 600mg/day in 2-4equal

doses up to 4.8g/day UV ir IM

Treat a severe

intestinal condition known as Clostridium difficile-associated diarrhea.

Treats only bacterial infections of the intestines.

Chills Drug fever Rash Eosinophilia Reversible neutropenia

Assess patient for

infection Vital signs appearance of wound,

sputum, urine, and stool

WBC Beginning of and

throughout therapy. Allergy to medication

monitor I/O

Instructed patient on

range of Vancomycin toxicity (toxicity is reported at levels sustained above 80 to 100 mcg/ml). Patient verbalized understanding of instructions given.

Instructed patient on Vancomycin adverse effects such as: erythroderrma, thrombocytopenia, neutropenia, ototoxicity, and nephrotoxicity. Patient verbalized understanding of instructions given.

VANCOMYCIN>>>>>>> RED MANS

SYNDROME: (NOT A ALLERGY RX)infusing too rapidly may cause REDDING of skin, NOT a adverse RX, only a Side Effect

hypotensive symptoms. Patient verbalized understanding of instructions given.

Treatment of potentially life-

threatening infections when less toxic anti-infective are contraindicated. Particularly useful in staphylococcal infections, including:endocarditis, meningitis, osteomyelitis, and pneumonia septicemia, soft-tissue infections in patients who have allergies to penicillin or its derivatives or when sensitivity testing demonstrates resistance to methicillin.

Ototoxic and

nephrotoxic drugs (aspirin, aminoglycosides, cyclosporine cisplatin, loop diuretics): no depolarizing neuromuscular blocking agents: general anesthetics.

POST OP (Blood & Bones)

drug card manuscript

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