GENERIC NAME:  digoxin immune Fab  TRADE NAME: Digibind, DigiFab CLASSIFICATION:  antidote – digoxin specific USES:  life-threatening digoxin toxicity DOSAGE & ROUTE: 1 (38-mg) vial binds 0.5 mg digoxin Digoxin toxity (known amount) (tabs, oral sol, IM) – Adult & child: IV dose (mg) – dose ingested (mg) x 0.8/1000 x 38; if ingested amount is unknown, give 760 mg IV; Toxicity (known amount) (cap, IV) – Adult & child: IV dose = dose ingested (mg)/0.5 x 38; Toxicity (known amount) by serum digoxin concentration (SDCs) – adult & child: IV SDC (ng/ml) x kg of weight/100 x 38; Digoxin  toxicity (unknown amount) – adult & child: >20 kg: IV 228mg (6 vials), infant & child: <20 kg: IV 38mg (1 vial); Acute ingestion – adult: IV 380 mg (10 vials) Life-threatening ingestion – adult: IV760mg (20 vials); Skin test – adult: ID 9.5 mcg SIDE EFFECTS:  CV: CHF, ventricular rate increase, atrial fibrillation, low cardiac output, hypotension.  INTEG: hypersensitivity, allergic reactions, facial swelling, redness, phlebitis.  META: hypokalemia. MISC: anaphylaxis (rare). RESP: impaired respiratory function, rapid respiratory rate.

  NURSING CONSIDERATION: assess: hypokalemia: ST depression, flat T waves, presence of U wave, ventricular dysrhythmia; potassium levels may decrease rapidly.  CHF: dyspnea, crackles, peripheral edema, B/P, volume overload.  Administer: test doses have proven to be ineffective in the general population; only use test dose in those with known allergies or those previously treated with digoxin immune FAB.  For test dose dilute 0.1 ml or reconstituted product (9.5 mg/ml) in 9.9 ml sterile isotonic saline, inj 0.1 ml (1:100 dislution) ID and observe for wheal with erythema; read in 20 min.  for scratch test place 1 gtt of sol on skin and make a scratch through the drop with a sterile needle; read in 20 min.  after diluting 38 mg/4ml of sterile H2O for inj 10 mg/ml mix; may be further diluted with normal saline, sol should be clear, colorless.  By bolus if cardiac arrest is imminent or IV over 30 min using a 0.22-µm filter.  Perform/provide: storage of reconstituted sol for up to 4 hr in refrigerator.  Do not freeze DigiFag.  Evaluate:  therapeutic response: correction of digoxin toxicity; check digoxin levels 0.5-2 ng/ml; digitoxin level 9-25ng/ml.  teach patient/family:  the purpose of medication; to report delayed hypersensitivity; fever, chills, itching, swelling, dyspnea

      GENERIC NAME:  digoxin              TRADE NAME:  lanoxicaps, lanoxin CLASSIFICATION:  cardiac glycoside, inotropic, antidysrhythmic USES:  heart failure, atrial fibrillation, atrial flutter, atrial tachycardia, cardiogenic shock, paroxysmal atrial tachycardia, rapid digitalization in these disorders DOSAGE & ROUTES:  adult: IV digitalizing dose 0.6-1 mg given as 50% of the dose initially, additional fractions given at 4-8 hr intervals; PO digitalizing dose 0.75-1.25mg given as 50% of the dose initially, additional fractions given at 4-8 hr intervals; maintenance 0.125-0.5 mg/day (tabs), or 0.25-0.5 mg/day (gelatin cap) child >10 yr: IV digitalizing dose 8-12 mcg/kg given as 50% of the dose initially, additional fractions given 4-8 hr intervals; PO digitalizing dose 0.01-0.015 mg/kg given 50% of the dose initially, additional fractions given at 6-8 hr intervals; maintenance 25%-35% of the loading dose daily as a single dose. Child 5-10yr:IV digitalizing dose 0.015-0.03 mg/kg given as 50% of the dose initially, additional fractions given at 4-8 hr intervals. PO digitalizing dose 0.02-0.025 mg/kg given as 50% of the dose initially, additional fractions given at 6-8 hr intervals;

  maintenance 25%-35% Of the loading dose daily in 2 divided doses. Child 2-5yr: IV digitalizing dose 0.025-035 mg/kg given 50% of the dose initially, additional fractions given at 4-8 hr intervals. PO digitalizing dose 0.03-0.04 mg/kg given 50% of the dose initially,additional fractions given at 6-8 hr intervals; maintenance 25%-35% of the loading dose daily in 2 divided doses. Child 1-2yr: IV digitalizing dose 0.03-0.05 mg/kg given as 50% of the dose initially, additional fractions given at 4-8 hr intervals; PO digitalizing dose 0.035-0.06 mg/kg given as 50% of the dose initially, additional fractions given at 4-8 hr intervals; maintenance 25%-35% of the loading dose daily in 2 divided doses. Infant: IV digitalizing dose 0.02-0.03 mg/kg given as 50% of the dose initially, additional fractions given at 4-8 hr intervals; PO digitalizing dose 0.025-0.035 mg/kg given as 50% of the dose initially, additional fractions given at 4-8 hr intervals; maintenance 25%-35% of the loading dose daily in 2 divided doses. Infant, premature: IV digitalizing dose 0.015-0.025 mg/kg given as 50% of the dose initially, additional fractions given at 4-8 hr intervals; PO digitalizing dose 0.02-0.03 mg/kg given as 50% of the dose initially, additional fractions given at 4-8 hr intervals; maintenance 20%-30% of the loading

 

dose daily in 2 Divided doses.  Available forms: caps 0.05, 0.1, 0.2 mg; elix 0.05 mg/ml; tabs 0.125, 0.25, 0.5 mg; inj 0.5, 0.25 mg/ml; pediatric inj 0.1 mg/ml NURSING CONSIDERATIONS: assess: apical pulse for 1 min before giving product; if pulse <60 in adult or <90 in an infant, take again in 1 hr; if <60 in adult, call prescriber; note rate, rhythm, character; monitor ECG continuously during parenteral,loading dose.  Electrolytes: K, Na, Cl, Mg, Ca; renal function studies: BUN creatinine; blood studies: ALT, AST, bilirubin, Hct, Hgb before initiating treatment and periodically thereafter.  I&O ratio, daily weights; monitor turgor, lung sounds, edema.  Monitor product levels (therapeutic level 0.5-2 ng/ml).  cardiac status; apical pulse, character, rate rhythm.  Administer: PO route: do not break, crush, or chew caps.  PO with or without food; may crush tabs, only mix with food/fluids.  Potassium supplements if ordered for potassium levels <3, or foods high in potassium: bananas, orange juice.  IV therapeutic response: decreased weight, edema, pulse, respiration, route: undiluted or 1 ml of product/4 ml sterile H2O, D5 or NS; give >5 min through Y-tube or 3-way stopcock; during digitalization close

  monitoring is necessary.  Perform/provide: storage protected from light.  Evaluate: crackles; increased urine output; serum digoxin level (0.5-2 ng/ml).  teach patient/family: not to stop product abruptly; teac all aspects of product, to take exactly as ordered; how to monitor heart rate.  To avoid OTC medications, herbal remedies since many adverse product interactions may occur; do not take antacid at same time. To notify prescriber of loss of appetite, lower stomach pain, diarrhea, weakness, drowsiness, headache, blurred or yellow vision, rash, depression, toxicity.  The toxic symptoms of this product and when to notify prescriber.  To maintain a sodium-restricted diet as ordered. To report shortness of breath, difficulty breathing, weight gain, edema, persistent cough. SIDE EFFECTS:  CNS: headache, drowsiness, apathy, confusion, disorientation, fatigue, depression, hallucinations. CV: dysrhythmias, hypotension, bradycardia, AV block. EENT: blurred vision, yellow-green halos, photophobia, diplopia. GI: nausea, vomiting, anorexia, abdominal pain, diarrhea  

      GENERIC NAME: procainamide    TRADE NAME:  promine, pronestyl CLASSIFICATION:  antidysrhythnic (class IA) USES:  life-threatening ventricular dysrhythmias DOSAGE & ROUTE:  atrial fibrillation/PAT: adult: PO 1-1.25g; may give another 750mg if needed; if no response, 500mg-1g q2hr until desired response; maintenance 50mg/kg in divided doses q6hr. ventricular tachycardia – adult: PO 1g; maintenance 50mg/kg/day given in 3-hr intervals. Other dysrhythmias – adult: IV BOL 100mg q5min, given 25-50mg/min, max 500mg; or 17 mg/kg total then IV INF 2-6 mg/min. renal dose – adult: IV CCr 10-50 ml/min give q6-12hr; CCr < 10 ml/min give q8-24hr.  available forms: caps 250, 375, 500 mg; tabs 250, 500 mg; inj 100, 500 mg/ml SIDE EFFECTS:  CNS: headache, dizziness, confusion, psychosis, restlessness, irritability, weakness, depression. CV: hypotension, heart block, cardiovascular collapse, arrest. GI: nausea, vomiting, anorexia, diarrhea, hepatomegaly, pain, bitter taste. HEMA: SLE syndrome, agranulocytosis, thrombocytopenia, neutropenia, hemolytic anemia. INTEG: rash, urticaria, Edema, swelling (rare), pruritus, flushing, angioedema. SYST: SLE. NURSING CONSIDERATIONS:  assess: ECG continuously if using IV to determine increased PR or QRS segments; discontinue immediately, watch for increased

  ventricular ectopic beats, maximum need to rebolus. Blood levels, 3-10 mcg.ml or NAPA levels 10-20 mcg/ml.  CBC q2wk x 3 mo; leukocyte, neutrophil, platelet counts may be decreased, treatment may need to be discontinued. I&O ratio; electrolytes (K, Na, Cl), weigh weekly, report gain >2. Toxicity: confusion, drowsiness, nausea, vomiting, tachydysrhythmias, oliguria.  ANA titer, during long-term treatment, watch for lupuslike syndromes.  Cardiac rate, rhythm, character, B/P continuously for fluctuations.   Respiratory status: rate, rhythm, character, lung fields; bilateral crackles may occur in CF patient; watch for respiratory depression.  CNS effects: dizziness, confusion, psychosis, paresthesias, seizures, product should be discontinued. Administer: IM route – IM inj in deltoid; aspirate to avoid intravascular administration. IV route – after diluting 100 mg/ml of D5W or sterile H2O for inj; give 20 mg or less/1 min; may dilute 1 g/250-500 ml D5W, run at 2-6 mg/min. evaluate: therapeutic response: decreased  dysrhythmias .teach patient/family that wax matrix may appear in stools.  Not to discontinue without health care provider’s advice.  To notify prescriber immediately if lupuslike symptoms appear, (joint pain, butterfly rash, fever, chills, dyspnea).  To notify prescriber of leucopenia (sore mouth, gums, throat) or thrombocytopenia (bleeding, bruising).  How to take pulse and when to report to prescriber.  To avoid driving, other hazardous activities until effect is known.

 

GENERIC NAME: adenosine    TRADE NAME:  adenocard, adeno-jec, adenoscan CLASSIFICATION:  antidysrhythmic USES:  SVT, as a diagnostic aid to assess myocardial perfusion defects in CAD, Wolff-Parkinson-White (WPW) syndrome DOSAGE & ROUTE:  antidysrhythmic- adult & child >50kg: IV BOL 6 mg; if conversion to normal sinus rhythm does not occur within 1-2 min, give 12 mg by rapid IV BOL; may repeat 12 mg dose again in 1-2 min. infant & child <50kg; IV BOL 0.05 mg/kg; if not effective, increase dose by 0.05 mg/kg q2min to a max of 0.3 mg/kg/dose or 12 mg. diagnostic use – adult: IV INF 140 mcg/kg/min x 6 min. Wolff-Parkinson-White (WPW) syndrome – adult/adolescent/child ≥ 50 kg; rapid IV BOL 6 MG, follow with saline flush; then IV BOL 12 mg if needed.  Wide-complex tachycardia diagnosis (unlabeled) – adult/adolescent/child ≥ 50kg: rapid IV BOL 12 mg if needed. SIDE EFFECTS:  CNS: light-headedness, dizziness, arm tingling, numbness, apprehension, blurred vision, headache. CV: chest pain, pressure, atrial tachydysrhythmias, sweating, palpatations, hypotension, facial flushing. GI: nausea, metallic taste, throat tightness, groin pressure. RESP: dyspnea, chest pressure, hyperventilation, bronchospasm (asthmatics)

  NURSING CONSIDERATIONS:  assess: I&O ratio, electrolytes (K, Na, Cl).  Cardiopulmonary status: B/P, pulse, respiration, ECG intervals (PR, QRS, QT); check for transient dysrhythmias (PVCs, PACs, sinus tachycardia, AV block). Respiratory status: rate, rhythm, lung fields for crackles, watch for respiratory depression; bilateral crackles may occur in CHF patient; increased respiration, increased pulse, product should be discontinued.  CNS effects: dizziness, confusion, psychosis, paresthesias, seizures; product should be discontinued.  Administer: IV direct route – undiluted; give 6 mg or less by rapid inj over 1-2 sec; if using an IV line; use port near insertion site, flush with NS (50 ml). CONT IV INF route – give 30 ml vial, undiluted, by peripheral vein.  Perform/provide: storage at room temperature; sol should be clear, discard unused product.  Evaluate: therapeutic response: normal sinus rhythm or diagnosis of perfusion defect. Teach patient/family: to report facial flushing, dizziness, sweating palpitations, chest pain.  To rise from sitting or standing slowly to prevent orthostatic hypotension.

      GENERIC NAME: lidocaine    TRADE NAME:lidopen auto-injector, xylocaine, xylocard  CLASSIFICATION:  antidysrhythmic (class 1b) USES:  ventricular tachycardia, ventricular dysrhythmias during cardiac surgery, myocardial infarction, digoxin toxicity, cardiac catheterization DOSAGE & ROUTE:  adult: IV BOL 50-100mg (1 mg/kg) over 2-3 min, repeat q3-5 min, not to exceed 300 mg in 1 hr; begin IV INF; IV INF 20-50 mcg/kg/min; IM 200-300 mg (4.3 mg/kg) in deltoid muscle, may repeat in 1-1 ½ hr if needed. Child: ID (zingo) 0.5 mg applied 1-3 min prior to needle insertion. CHF, reduced hepatic function – geriatric: IV BOL give ½ adult dose. Child: IV BOL 1 mg/kg, then IV INF 30 mcg/kg/min. SIDE EFFECTS:  CNS: headache, dizziness, involuntary movement, confusion, tremor, drowsiness, euphoria, seizures. CT: hypotension, bradycardia, heart block, CV collapse, arrest. EENT: tinnitus, blurred vision. GI: nausea, vomiting, anorexia. HEMA: methemoglobinemia. INTEG: rash, urticaria, edema, swelling. MISC: febrile response, phlebitis at inj site. RESP: dyspnea, respiratory depression. NURSING CONSIDERATIONS:  assess: ECG continuously to determine increased PR or QRS segments; if these develop, discontinue or reduce rate; watch for increased

  ventricular extopic beats; may have to rebolus, B/P.  IV inf rate using inf pump; run at <4 mg/min.  blood levels (therapeutic level: 1.5-5 mcg/ml).  I&O ratio, electrolytes (K, Na, Cl).  Malignant hyperthermia: tachypnea, tachycardia, changes in B/P, increased temp.  respiratory status: rate, rhythm, lung fields for crackles, watch for respiratory depression; lung fields, bilateral crackles may occur in CHF patient; increased repiration, increased pulse; product should be discontinued.  CNS effects: dizziness, confusion, psychosis, paresthesias, convulsions; product should be discontinued. Administer: IM in in deltoid; aspirate to avoid intravascular administration; shcek site daily for infiltration or extravasation. IV route – bolus undiluted (1%, 2% only) give 50 mg or less over 1 min or dilute 1 g/250-500 ml of D5W; titrate to patient response; use of inf pump; pediatric inf is 120 mg of lidocaine/100 ml D5W; 1-2.5 ml/kg/hr = 20-50 mcg/kg/min; use only 1%, 2% sol for IV bol. Evaluate: therapeutic response: decreased dysrhythmias. Teach patient/family: the use of automatic lidocaine injection device if ordered for personal use.

GENERIC NAME: prazosin    TRADE NAME: minipress, prazosin CLASSIFICATION: antihypertensive USES:  hypertension, refractory CHF, Raynaud’s vasopasm DOSAGE & ROUTE:  hypertension – adult:  PO 1 mg bid or tid, increasing to 20 mg/day in divided doses if requires; usual rang 6-15 mg/day,  not to exceed 1 mg initially; max 20-40 mg/day. Child: PO 5 mcg/kg q6hr; max 400 mcg/kg/day. Benign prostatic hyperplasia (unlabeled) - adult: PO 2 mg bid. Raynaud’s phenomenon (unlabeled) – adult: PO 0.5-3 mg bid. CHF(unlabeled) – adult: PO 1 mg bid-tid. May gradually increase to max 20 mg/day. Child: PO 5 mcg/kg q6hr, may gradually increase to 25 mcg/kg q6hr. hypertensive urgency (unlabeled) – adult: PO 10-20mg, may repeat in 30 min. SIDE EFFECTS:  CNS: dizziness, headache, drowsiness, anxiety, depression, vertigo, weakness, fatigue. CV: palpitations, orthostatic hypotension, tachycardia, edema, rebound hypertension. EENT: blurred vision, epistaxis, tinnitus, dry mouth, red sclera. GI: nausea, vomiting, diarrhea, constipation, abdominal pain. GU: urinary frequency, incontinence, impotence, priapism, H2O, sodium retention. NURSING CONSIDERATIONS:  assess: B/P (sitting, standing) during initial treatment, periodically thereafter, pulse, jugular venous distention q4hr.  BUN, uric

  Acid if on long-term therapy. Weight daily, I&O; edema in feet, legs daily. Skin turgor, dryness of mucous membranes for hydration status. Crackles, dyspnea, orthopnes q30min. administer: 1st dose at bedtime to avoid fainting. Evaluate: therapeutic response decreased B/P. teach patient/family: that fainting occasionally occurs after 1st dose; take 1st dose at bedtime or do not drive or operate machinery for 4 hr after 1st dose; that full effect may take 4-6 wk. to change positions slowly, to prevent orthostatic hypotension. To avoid OTC medications unless approved by prescriber.

      GENERIC NAME: nitroprusside    TRADE NAME:  nitropress, sodium nitroprusside CLASSIFICATION:  antihypertensive, vasodilator USES:  hypertensive crisis, to decrease bleeding by creating hypotension during surgery; acute CHF DOSAGE & ROUTE: adult/child: IV INF 0.3-8 mcg/kg/min; max 10 mcg/kg/min SIDE EFFECTS:  CNS: dizziness, headache, agitation, twitching, decreased reflexes, restlessness. CV: bradycardia, ECG changes, tachycardia, hypotension. GI: nausea, vomiting, abdominal pain.  INTEG: pain, irritation at inj, sweating. MISC: cyanide, thiocyanate toxicity, flushing, hypothyroidism NURSING CONSIDERATIONS:  assess: electrolytes: K, Na, Cl, CO2, CBC, serum glucose, serum methemoglobin if pulmonary O2 levels are decreased; use IV 1-2 mg/kg methylene blue given over several min for methemoglobinemia.  Renal studies: catecholamines, BUN, creatinine. Hepatic studies: AST, ALT, alk phos. B/P by direct means if possible; check ECG continuously; pulse, jugular vein distention; PSWP; rebound hypertension may occur after nitroprusside is discontinued.  Weight daily, I&O. thiocyanate, lactate, cyanide levels daily in inf >3 mcg/kg/min; thiocyanate level should be ≤1 mmol/L; thiocyanate toxicity includes confusion, weakness, seizures, hyperreflexia, psychosis, tinnitus, coma.  Nausea, vomiting, diarrhea.  Edema in feet,

  Legs daily; skin turgor, dryness of mucous membranes for hydration status.  Crackles, dyspnea, orthopnea q30min.  for decrease in bicarbonate, PCO2 blood pH, acidosis. Administer: antidote is sodium thiosulfate. IV route – depending on B/P reading q15min.  IV after diluting 50 mg/2-3 of D5W, further dilute in 250 ml of D5W; use an infusion pump only; wrap bottle with aluminum foil to protect from light; observe for color change in the inf; discard if highly discolored (blue, green, dark red); titrate to patient response.  Evaluate: therapeutic response: decreased B/P, absence of bleeding.  Teach patient/family: to report headache, dizziness, loss of hearing, blurred vision, dyspnea, faintness.  The reason for giving product and expected results.

GENERIC NAME:  furosemide   TRADE NAME:  lasix CLASSIFICATION:  loop diuretic USES:  pulmonary edema; edema in CHF, hepatic disease, nephritic syndrome, ascites, hypertension DOSAGE & ROUTE:  edema – adult: Initially, 20–80 mg/day PO as a single dose. If needed, a second dose may be given in 6–8 hr. If response is unsatisfactory, dose may be increased in 20- to 40-mg increments at 6- to 8-hr intervals. Up to 600 mg/day may be given. Intermittent dosage schedule (2–4 consecutive days/wk) is preferred for maintenance, or 20–40 mg IM or IV (slow IV injection over 1–2 min). May increase dose in increments of 20 mg in 2 hr. High-dose therapy should be given as infusion at rate not exceeding 4mg/min.  Acute pulmonary edema: 40 mg IV over 1–2 min. May be increased to 80 mg IV given over 1–2 min if response is unsatisfactory after 1 hr.· Hypertension: 40 mg bid PO. If needed, additional antihypertensive agents may be sadded at 50% usual dosage. SIDE EFFECTS:  CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache, drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss· CV: Orthostatic hypotension, volume depletion, cardiac arrhythmias, thrombophlebitis Dermatologic: Photosensitivity, rash, pruritus, urticaria, purpura, exfoliative dermatitis, erythema multiforme GI: Nausea, anorexia, vomiting, oral and gastric irritation, constipation, diarrhea, acute pancreatitis, jaundice GU: Polyuria, nocturia, glycosuria, urinary bladder spasm Hematologic: Leukopenia, anemia, thrombocytopenia, fluid and electrolyte imbalancess Other: Muscle cramps and muscle spasms

  NURSING CONSIDERATIONS:  Assess:· History: Allergy to furosemide, sulfonamides, tartrazine; electrolyte depletion anuria, severe renal failure; hepatic coma; SLE; gout; diabetes mellitus; lactation, pregnancy· Physical: Skin color, lesions, edema; orientation, reflexes, hearing; pulses, baseline ECG, BP, orthostatic BP, perfusion; R, pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns; CBC, serum electrolytes (including calcium), blood sugar, liver and renal function tests, uric acid, urinalysis Interventions:· Administer with food or milk to prevent GI upset. Reduce dosage if given with other antihypertensives; readjust dosage gradually as BP responds.· Give early in the day so that increased urination will not disturb sleep.· Avoid IV use if oral use is at all possible.· Do not mix parenteral solution with highly acidic solutions with pH below 3.5.· Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions.· Discard diluted solution after 24 hr.· Refrigerate oral solution.· Measure and record weight to monitor fluid changes.· Arrange to monitor serum electrolytes, hydration, liver function.· Arrange for potassium-rich diet or supplemental potassium as needed.  Teaching points: · Record intermittent therapy on a calendar or dated envelopes. When possible, take the drug early so increased urination will not disturb sleep. Take with food or meals to prevent GI upset.· Weigh yourself on a regular basis, at the same time and in the same clothing, and record the weight on your calendar.· These side effects may occur: increased volume and frequency of urination; dizziness, feeling faint on arising, drowsiness (avoid rapid position changes; hazardous activities, like driving; and consumption of alcohol); sensitivity to sunlight (use sunglasses, wear protective clothing, or use a sunscreen); increased thirst (suck on sugarless lozenges; use frequent mouth care); loss of body potassium (a potassiumrich diet or potassium supplement will be necessary).· Report loss or gain of more than 3 lb in 1 day, swelling in your ankles or fingers, unusual bleeding or bruising, dizziness, trembling, numbness, fatigue, muscle weakness or cramps.

      GENERIC NAME: diltiazem TRADE NAME:  CLASSIFICATION:  Calcium channel blocker, Antianginal, AntihypertensiveUSES:  Angina pectoris due to coronary artery spasm (Prinzmetal's variant angina). Effort-associated angina; chronic stable angina in patients not controlled by beta-adrenergic blockers, nitrates. Sustained- and extended-release forms: Essential hypertension. Parenteral: Paroxysmal supraventricular tachycardia, atrial fibrillation, atrial flutterDOSAGE & ROUTE:  ADULTSInitially, 30 mg PO qid before meals and hs; gradually increase dosage at 1- to 2-day intervals to 180–360 mg PO in three to four divided doses. Sustained and extended release Cardizem SR: Initially, 60–120 mg PO bid; adjust dosage when maximum antihypertensive effect is achieved (around 14 days); optimum range is 240–360 mg/day. Cardizem CD and Cartia XT: 180–240 mg daily PO for hypertension; 120–180 mg daily PO for angina. Dilacor XR and Diltia XT: 180–240 mg daily PO as needed; up to 480 mg has been used. Tiazac: 120–240 mg daily PO for hypertension—once daily dose; 120–180 mg PO once daily for angina. IV Direct IV bolus: 0.25 mg/kg (20 mg for the average patient); second bolus of 0.35 mg/kg. Continuous IV infusion: 5–10 mg/hr with increases up to 15 mg/hr; may be continued for up to 24 hr.

  SIDE EFFECTS: CNS: Dizziness, light-headedness, headache, asthenia, fatigue CV: Peripheral edema, hypotension, arrhythmias, bradycardia, AV block, asystole Dermatologic: Flushing, rash GI: Nausea, hepatic injury, refluxNURSING CONSIDERATIONS: Assess: History: Allergy to diltiazem, impaired hepatic or renal function, sick sinus syndrome, heart block, lactation, pregnancy. Physical: Skin lesions, color, edema; P, BP, baseline ECG, peripheral perfusion, auscultation; R, adventitious sounds; liver evaluation, normal output; liver and renal function tests, urinalysis. Interventions: •Monitor patient carefully (BP, cardiac rhythm, and output) while drug is being titrated to therapeutic dose; dosage may be increased more rapidly in hospitalized patients under close supervision. Monitor BP carefully if patient is on concurrent doses of nitrates. Monitor cardiac rhythm regularly during stabilization of dosage and periodically during long-term therapy. Ensure patient swallows ER and SR preparations whole; do not cut, crush, or chew. Teaching points: Swallow SR, ER, and LA preparations whole; do not cut, crush, or chew; do not drink grapefruit juice while using this drug. These side effects may occur: Nausea, vomiting (eat frequent small meals); headache (regulate light, noise, and temperature; medicate if severe). Report irregular heart beat, shortness of breath, swelling of the hands or feet, pronounced dizziness, constipation.

GENERIC NAME: potassium acetate TRADE NAME:  k-electrolyteCLASSIFICATION:  electrolyte, mineral replacementUSES:  prevention and treatment of hypokalemiaDOSAGE & ROUTE:  potassium acetate – hypokalemia: adult/child: PO 40-100 mEq/day in divided doses 2-4 daysSIDE EFFECTS:  CNS: confusion. CV: bradycardia, cardiac depression, dysrhythmias, arrest, peaking T waves, lowered R and depressed RST, prolonged P-R interval, widened QRS, complex. GI: nausea, vomiting, cramps, pain, diarrhea, ulceration of small bowel. GU: oliguria. INTEG: cold extremities, rash.NURSING CONSIDERATIONS:  assess: ECG for peaking T waves, lowered R, depressed RST, prolonged P-R interval, widening QRS complex, hyperalemia; product should be reduced or discontinued. Potassium level during treatment (3.5-5 mg/dl is normal level). I&O ratio; watch for decreased urinary output; notify prescriber imeediately. Cardiac status: rate, rhythm, CVP, PWP, PAWP, ikf being monitored directly. Administer: PO ROUTE: do not break, crush, or chew ext rel tabs/caps or enteric products. With or after meals; dissolve effervescent tabs, powder in 8 oz cold water or juice; do not give IM, SUBCUT. Caps with full glass of liquid. IV ROUTE: through large-bore needle to decrease vein inflammation; check for extravasation. In large vein, avoiding scalp vein in child (IV). IV after diluting in large volume if IV sol

  and five as an inf, slowly by IV inf to prevent toxicity; never give IV bolus or IM. Perform/provide: storage at room temperature. Evaluate: therapeutic response: absence of fatigue, muscle weakness; decreased thirst and urinary output; cardiac changes. Teach patient/family: to add potassium-rich foods to diet: bananas, orange juice, avocados; whole grains, broccoli, carrots, prunes, coca after this medication is discontinued. To avoid OTC products: antacids, salt substitutes, analgesics, vitamin preparations, unless specifically directed by prescriber; avoid licorice in large amounts, may cause hypokalemia, sodium retention. To report hyperkalemia symptoms (lethargy, confusion, diarrhea, nausea, vomiting, fainting, decreased output) or continued hypokalemia symptoms (factigue, wakness, polyuria, polydipsia, cardiac changes). To dissolve powder or tablet completely in at least 120 ml water or juice. Importance or regular follow-up visits. That potassium levels will need to be monitored periodically.

      GENERIC NAME: albumin    TRADE NAME:  albuminar 5%, albutein 5%CLASSIFICATION:  blood derivativeUSES:  restores plasma volume in burns, hyperbilirubinemia, shock, hyperproteinemia, prevention of cerebral edema, cardiopulmonary bypass procedures, ARDS, nephritic syndromeDOSAGE & ROUTE:  BURNS: adult: IV dose to maintain plasma albumin at 30-50 g/L, use 5% sol initially, then 25% sol after 24 hr. SHOCK adult: IV 500 ml of 5% sol q30min, as needed. Child:IV 0.5-1 g/kg/dose. HYPOPROTEINEMIA: adult: IV 1000-2000 ml of 5% sol/day, max 5-10 ml/min or 25-100 g of 25% sol/day, max 3 ml/min, titrated to patient response. HYPERBILIRUBINEMIA/ERYTHROBLASTOSIS FETALIS: infant IV 1 g of 25% sol/kg -2 hr before transfusionSIDE EFFECTS:  CNS: fever, chills, flushing, headache. CV: fluid overload, hypotension, erratic pulse, tachycardia. GI: nausea, vomiting, increased salivation. RESP: altered respirations, pulmonary edema. INTEG: rash, urticaria.

  NURSING CONSIDERATIONS:  assess: blood studies Hct, Hgb; if serum protein declines, dyspnea, hypoxemia can result. Decreased B/P, erratic pulse, respiration. I&O ration: urinary output may decrease. CVP, pulmonary wedge pressure will increase if overload occurs. Allergy: fever, rash, itching, chills, flushing, urticaria, nausea, vomiting Hypotension, requires discontinuation of infusion, use of new lot if therapy reinstituted; premedicate with diphenhydrAMINE. CVP reading: distended neck veins indicate circulatory overload; shortness of breath, anxiety, insomnia, expiratory crackles, frothy blood-tinged cough, cyanosis indicate pulmonary overload. Administer: IV ROUTE: slowly, to prevent fluid overload; dilute with NS for injection or D5W; 5% may be given undiluted; 25% may be given diluted, give over 4 hr, use infusion pump. Perform/provide: adequate hydration before, during administration. Check type of albumin; some stored t room temperature, some need to be refrigerated. Evaluate: therapeutic response: increased B/P, decreased edema, increased serum albumin levels, increased plasma protein.

GENERIC NAME: dipyridamole    TRADE NAME:  PersantineCLASSIFICATION:  coronary vasodilator, antiplatelet agentUSES:  Dipyridamole keeps blood flowing smoothly by preventing blood cells from clumping together (coagulating). It is used after heart valve replacement. It is taken in combination with a "blood thinner" such as warfarin.DOSAGE & ROUTE:  75 – 100 mg four times daily as adjunct to warfarin therapySIDE EFFECTS:  Loss of appetite, nausea, diarrhea, headache or dizziness may occur at first as your body adjusts to the medication. If these effects persist or become bothersome, inform your doctor. Notify your doctor promptly if the following occur: unusual bleeding or bruising, fainting, skin rash, yellowing eyes/skin. Seek immediate medical attention if the following occur: trouble breathing. If you notice other effects not listed above, contact your doctor or pharmacist.NURSING CONSIDERATIONS:  Monitor vital signs, EKG, chem. tests; document mental status, skin color, cardiopulmonary findings; helps prevent clots by inhibiting platelet stickiness; avoid alcohol and tobacco usage due to hypotensive vasoconstrictive effects; avoid use of unprescribed drugs without approval; avoid quick movements due to ↓ BP; try small meals frequently if nausea or gastric distress experiencedMonitor vital signs, EKG, chem. tests; document mental status, skin color, cardiopulmonary findings; helps prevent clots by inhibiting platelet stickiness; avoid alcohol and tobacco usage due to hypotensive vasoconstrictive effects; avoid use of unprescribed drugs without approval; avoid quick movements due to ↓ BP; try small meals frequently if nausea or gastric distress experienced

  GENERIC NAME: warfarin sodium TRADE NAME: CoumadinCLASSIFICATION: Anticoagulant, coumarin derivativeUSES: Prophylaxis and treatment of venous thrombosis and its extension; Prophylaxis and treatment of atrial fibrillation with embolization; Prophylaxis and treatment of pulmonary embolism; Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillationDOSAGE & ROUTES : Init: 5-10 mg/day for 2-4 days; then adjust dose on prothrombin or INR determinations (lower in geriatric or debilitated patients): Maintenance: 2-10 mg/day based on prothrombin or INRSIDE EFFECTS: Bleeding/hemorrhage is main side effect; may occur from any organ or tissueNURSING CONSIDERATIONS: Take oral warfarin as prescribed and at same time each day; must be compliant with drug therapy; do not change brands (may alter response); does not dissolve clots but decreases clotting ability of blood and helps to prevent formation of blood clots in vessels and heart valves; avoid IM shots, activities that may cause injury or cuts and bruises; protect from light (store at controlled room temperature); dispense in tight light-resistant container; vial not for multiple uses; discard unused solution; note any bleeding tendencies; determine if pregnant (may cause fetal malformations and neonatal hemorrhage)

      GENERIC NAME: ezetimibe T RADE NAME : ZetiaCLASSIFICATION: AntihyperlipidemicUSES: Primary hypercholesterolemia, either as monotherapy or combination therapy with HMG-CoA reductase inhibitors; with atorvastatin or simvastatin for homozygous familial hypercholesterolemia; as adjunct therapy to diet for homozygous sitosterolemiaDOSAGE & ROUTE : 10 mg once daily with or without foodSIDE EFFECTS:  Back pain, diarrhea, arthralgia, sinusitis, abdominal painNURSING CONSIDERATIONS: Place client on a standard cholesterol-lowering diet before therapy and for duration of treatment; give at least 2 hr prior or 4 hr after giving a bile acid sequestrant; store from 15-30°C (59-86°F) protected from moisture; monitor CBC, lipid panel, renal and LFTs; schedule LFTs at the beginning of therapy; list all medications preascribed to ensure none interact unfavorably; identify cardiac risk factors; take daily as directed with or without food; avoid taking with antacids (reduces drug effect); low-cholesterol diet must be followed during drug therapy; report any S&S of infection

  GENERIC NAME: levothyroxine TRADE NAME: Synthroid, Levoxyl, Levothroid, othersCLASSIFICATION: Synthetic Thyroid PreparationUSES: preferred drug for treatment of hypothyroidism because its hormonal content is standardized and its effect is predictable. Also used to treat goiters, as replacement therapy in patients who have had thyroidectomysDOSAGE & ROUTE : 25-300 mcg/day (25-200 mcg/day most common) IM/IV: 50% of oral dose; IV 200-500 mcg in a single dose; repeat next day 100-300 mcg if necessary. Pediatric 0-12 yr, PO: 25-150 mcg/daySIDE EFFECTS: usually a result of overdose. Cardiac dysrhythmia with the risk for life-threatening or fatal irregularities, tachycardia, palpitations, angina, hypertension, cardiac arrest, insomnia, tremors, headache, anxiety, nausea, diarrhea, increased or decreased appetite, cramps, menstrual irregularities, weight loss, sweating, heat intolerance, fever.NURSING CONSIDERATIONS: Half life long enough that it only needs to be administered once a day. Pregnancy category A. Switching between courses of treatments should be minimized. Thyroid function tests should be monitored

GENERIC NAME: glyburide TRADE NAME: Diaßeta, Glynase, PresTab, MicronaseCLASSIFICATION: Antidiabetic, oral; second generation sulfonylureaUSE S : Diabetes mellitus; may be used with metformin when diet and glyburide or diet and metformin alone do not provide adequate controlDOSAGE & ROUTE : Initial for adults (Nonmicronized) – 2.5 – 5 mg/day given with breakfast (or first main meal), then increase by 2.5 mg at weekly intervals to achieve the desired response; maintenance – 1.25 – 20 mg/day; clients sensitive to sulfonylureas should start with 1.25 mg/day; initial for adults (Micronized) – 1.5 – 3 mg/day given with breakfast (or first main meal); those sensitive to sulfonylureas should start with 0.75 mg/day; increase by no more than 1.5 mg at weekly intervals to achieve the desired responseSIDE EFFECTS:  Hypoglycemia, nausea, epigastric distress, heartburn, allergic skin reactions, blurred visionsNURSING CONSIDERATIONS: Do not confuse glyburide with glipizide or Glucatrol; administer 30 minutes prior to meals; do not exceed 20 mg/day of nonmicrozized and 12 mg/day of micronized products; note reasons for therapy; explain that it works by causing pancreas to release more insulin into the blood stream, helps insulin get into cells to lower blood sugar and help restore the way you use food to make energy; take as directed with food; record finger sticks at various times (fasting, 1 – 2 hr after meals, before bedtime), continue regular daily exercise, lifestyle changes, BP control, weight loss, and dietary restrictions to control cholesterol and glucose; avoid alcohol, OTC agents without approval; practice reliable contraception

  GENERIC NAME: metformin TRADE NAME: Fortamet, Glucophage, Glucophage XR, Glumetza, RiometCLASSIFICATION: Oral Antidiabetic, BiguanideUSE S : As monotherapy, as adjunct to diet and exercise, to improve glycemic control in clients with type 2 diabetes; Immediate-release tablets and PO solution can be used in clients 10 yrs and older; Extended Release form used to treat type 2 diabetes as initial therapy or in conjunction with a sulfonylurea or insulin in clients 17 y/o and olderUSUAL DOSAGE: Oral Solution: Adult up to 2,550 mg/day; child up to 2,000 mg/day Tablets: Start dose 500 mg twice daily with food; dosage increases may be made in 500 mg every week, divided doses, up to maximum of 2,500 mg; If 2,500 mg needed, may be tolerable in 3 equal doses dailySIDE EFFECTS:  Lactic acidosis, hypoglycemia, diarrhea, nausea & vomiting, asthenia, flatulence, headache, abdominal pain/discomfortNURSING CONSIDERATIONS: Lactic acidosis is a rare, but serious, metabolic complication that can occur due to metformin accumulation (50 % fatal); do not confuse Glucophage with Glucovance; individualize dosage based on tolerance and effectiveness; give with meals and start at a low dose with gradual escalation (will reduce GI side effects); may safely switch from metformin to metformin extended-release; may cause a metallic taste (will subside): 

      GENERIC NAME: guaifenesin TRADE NAME: Naldecon, Senior EX, Robitussin, Scot-Tussin Expectorant, Siltussin SA, Alterussin, Guiatuss, Humabid Maximum Strength, MucinexCLASSIFICATION: Diabetic Tussin, Organidin NRUSE S : Dry, nonproductive cough due to colds and minor upper respiratory tract infections where there is mucus in respiratory tract; to loosen phlegm and thin bronchial secretionsDOSAGE & ROUTE : Expectorant: Over 12 y/o 200-400 mg q 4 hr, not exceeding 2,400 mg/day; 6-11 y/o 100-200 mg q 4 hr not exceeding 1,200 mg/day, 2-5 y/o 50-100 mg q 4 hr not exceeding 600 mg/day, 6 mos-2 yrs 25-50 mg q 4 hr not exceeding 300 mg/daySIDE EFFECTS:  Nausea & vomiting; GI discomfortNURSING CONSIDERATIONS: Assess for tobacco use, fever/chills, loss of appetite, or increased fatigue; if symptoms persist for more than one week, recur, or are accompanied by a persistent headache, fever or rash, notify provider; do not perform activities that require mental alertness (drug may cause drowsiness); report any evidence of increased bruising/bleeding, fever, change in secretions, or lack of response

  GENERIC NAME: streptokinase    TRADE NAME:  streptaseCLASSIFICATION:  thrombolytic enzymeUSES:  deep vein thrombosis, PE, arterial thrombosis, arterial embolism, lysis of coronary artery thrombi after acute MI, acute evolving transmural MIDOSAGE & ROUTE:  lysis of coronary artery thrombi – adult: IC 20,000 international units, then 2000 international units/min over 1 hr as IV INF. Thrombosis/embolism/deep vain thrombosis/pulmonary embolism – adult:IV INF 250,000 international units over ½ hr, then 100,000 international unites/hr, then 100,000 international units/hr for 72 hr for deep vein thrombosis; 100,000 international units/hr x 24-72 hr for arterial thrombsis or embolism. Acute evolving transmural MI - adult: IV INF 1,500,000 international units diluted to a volume of 45 ml; give within 1 hr via inf pump; intracoronary INF 20k000 international units by BOL, then 2000 international units/min x 1 hr, total dose 140,000 international units. Arterovenous cannula occlusion (unlabeled) – adult: IV INF 10,000 international units/3 ml sol into occluded limb of cannula; clamp for 1 hr distally; apirate contents; flush wit NaCl sol and reconnect (serious reactions have been reported).SIDE EFFECTS:  CNS: headache, fever, Guillan-Barre syndrome. CV: dysrhythmias, hypotension, noncardiogenic pulmonary edema, PE. EENT: periorbital edema. GI: Nausea. HEMA: decreased Hct, bleeding, anemia. INTEG: rash, urticaria, phlebitis at IV inf site, itching, flushing. MS: low back pain, arthralgia, myalgia. RESP: altered respirations, shortness of breath, bronchospasm, pulmonary bleeding. SYST: GI, GU intracranial, retroperitoneal bleeding, surface bleeding, anaphylaxis. NURSING CONSIDERATIONS: assess: allergy: fever, rash, itching, chills; mild reaction may be treated with antihistamines. For bleeding during 1st hr of treatment; hematuria, hematemesis, bleeding from mucous membranes, epistaxis, ecchymosis; may require transfusion (rare), continue to assess for bleeding for 24 hr.

blood studies (Hct, platelets, PTT, PT, TT, aPTT) before starting therapy; PT or aPTT must be less than 2X control before starting therapy; PTT or PT q3-4hr during treatment. For hypersentsitive reactions: fever, rash, dyspnea, facial swelling; product should be discontinued; for streptokinase reactions previously; notify prescriber immediately, stop product, keep resuscitative equipment nearby. VS, B/P, pulse, respirations, neurologic signs, temp at least q4hr; temp >104o F (40oC) indicates internal bleeding; systolic pressure increase > 25 mm Hg should be reported to prescriber; assess neurologic status, neurologic change may indicate intracranial bleeding. For neurologic changes that may indicate intracranial bleeding. Retroperitoneal bleeding: back pain, leg weakness, diminished pulses. For Guillain-Barre syndrome that may occur after treatment with this product. ECG continuously, cardiac enzymes, radionuclide myocardial scanning/coronary angiography. For respiratory depression. Administer: IV ROUTE: as soon as thrombi identified; not useful for thrombi over 1 wk old. Cryoprecipitate or fresh frozen plasma if bleeding occurs. Loading dose at beginning of therapy; may require increased loading doses. Heparin after fibrinogen level >100 mg/dl; heparin infusion to increase PTT to 1.5-2 x baseline for 3-7 days; IV heparin discontinuing streptokinase to prevent redevelopment of thrombi. After reconstituting with 5 ml NS or D5W; do not shake; further dilute to total volume of 45 ml; may be diluted to 500 ml in 45 ml increments; may dilute vial in 15 ml NS, further dilute 750,000 international units/50 ml NS or D5W; further dilute 1,500,000 international units dose/100 ml or more. About 10% patients have high streptococcal antibody titers requiring increased loading doses. IV therapy using 0.8 µm filter. Perform/provide: storage of reconstituted sol in refrigerator; discard after 24 hr. bed rest during entire course of treatment. Avoid venous or arterial puncture, inj, rectal temp; any invasive treatment. Treatment of fever with acetaminophen or aspirin. Pressure for 30 sec to minor bleeding sites; inform prescriber if this does not attain hemostatis; apply pressure dressing. Evaluate: therapeutic response: resolution of thrombosis, embolism. Teach patient/family: reason for medication and expected results.

  GENERIC NAME: nicotinic acid (niacin)   TRADE NAME:  slo-niacinCLASSIFICATION:  vitamin B3, antihyperlipidemicUSES:  pellagra, hyperlipidemias (types 4, 5), peripheral vascular disease that presents a risk for pancreatitis.DOSAGE & ROUTE:  niacin deficiency – adult: PO 100-500 mg/day in divided doses; IM/SUBCUT 5-100 mg 5 or more x/day; IV 25-100 mg bid or tid. Child: PO up to 300 mg/day in divided doses. Adjunct in hyperlipidemia – adult: PO 250 mg after evening meal; may increase dose at 1-4 wk intervals to 1-2 g tid, max 6 g/day; EXT REL 500 mg at bedtime for wk 5-8; do not increase by more than 500 mg q4wk, max 2000 mg/day. Pellagra – adult: PO 300-5000 mg/day in divided doses. Child: PO 100-300 mg/day in divided doses. Peripheral vascular disease – adult: PO 250-800 mg/day in divided doses.SIDE EFFECTS:  CNS; paresthesias, headache, dizziness, anxiety. CV: postural hypotension, vasovagal attacks, dysrhythmias, vasodilation. EENT: blurred vision, ptosis. GI: nausea, vomiting, anorexia, jaundice, hepatotoxicity, diarrhea, peptic ulcer, dyspepsia. GU: hyperuricemia, glycosuria, hypoalbuminemia. INTEG: flushing, dry skin, rash, pruritus, itching, tingling.

      NURSING CONSIDERATIONS:  assess: hepatic studies: AST, ALT, bilirubin, uric acid, alk phos; blood glucose before and ruing treatment. Cardiac status: rate, rhythm, quality; postural hypotension, dysrhythmias. Nutritional status; liver, yeast, legumes, organ meat, lean poultry; fat in diet. Hepatic dysfunction: clay-colored stools, itching, dark urine, jaundice. CNS symptoms: headache, paresthesias, blurred vision. For symptoms of niacin deficiency: nausea, vomiting, anemia, poor memory, confusion, dermatitis. For lip, triglyceride, cholesterol level, if using for hyperlipidemia. Administer: do not break, crush, or chew ext rel tabs, caps. With meals for GI symptoms, And 81-325 mg aspirin or NSAIDs ½ hr before dose to decrease flushing. Evaluate: therapeutic response: decreased lipids, warm extremities, absence of numbness in extremities. Teach patient/family: that flushing and increase in feelings of warmth will occur several hr after taking product (PO); after 2 wk of therapy, these side effects diminish. To remain recumbent if postural hypotension occurs; to rise slowly to prevent orthostatic hypotension. To abstain from alcohol if product is prescribed for hyperlipidemia. To avoid sunlight if skin lesions are present. To report clay-colored stools, anorexia, jaundiced sclera, skin; dark urine, hepatotoxicity may occur.

  GENERIC NAME: corticotropin    TRADE NAME:  acthar gelCLASSIFICATION:  pituitary hormoneUSES:  testing adrenocortical function, treatment of adrenal insufficiency caused by administratioin of corticosteroids (long term), MS, infantile spasmsDOSAGE & ROUTE:  acute exacerbations of multiple sclerosis - adult: IM 80-120 units/day x 14-21 days. Infantile spasms – infant: IM GEL 20 units/day x 2 wk, increase if needed.SIDE EFFECTS:  CNS: convulsions, dizziness, euphoria, incomnia, headache, depression, psychosis. END: diabetes. GI: nausea, vomiting, peptic ulcer perforatin, pancreatitis. GU: water and sodium retention, hypokalemia. MUSCULOSKELETAL: hypocalcemia with possible pathologic bone fractures. OCULAR: cataracts. OTHER: sweating, acne, hyperpigmentation, weakness, muscle atrophy, myalgia, arthralgia.NURSING CONSIDERATIONS:  Assessment: Assess for disorders for which hypothalamic and pituitary hormones are given: For children with impaired growth, assess height and weight (actual and compared with growth charts) and diagnostic x-ray reports of bone age. For clients with diabetes insipidus, assess baseline blood pressure, weight, ratio of fluid intake to urine output, urine specific gravity, and laboratory reports

GENERIC NAME: vasopressin    TRADE NAME:  pitressinCLASSIFICATION:  pituitary hormoneUSES:  diabetes insipidus (nonnephrogenic/nonpsychogenic), abdominal distention postoperatively, bleeding esophageal varicesDOSAGE & ROUTE:  diabetes insipidus - adult: IM/SUBCUT 5-10 units bid-qid as needed; IM/SUBCUT 2.5-5 units q2-3 days (Pitressin Tannate) for chronic therapy; CONT IV INF 0.0005 units/kg/hr (0.05 milliunit/kg/hr), double dose 130min as needed. Child: IM/SUBCUT 2.5-10 units bid-qid asneeded; IM/SUBCUT 1.25-2.5 units q2-3 days (pitressin Tannate) for chronic therapy. Abdominal distention – adult: IM 5 units, then q3-4hr, increasing to 10 units if needed (aqueous).SIDE EFFECTS:  CNS: drowsiness, headache, lethargy, flushing, vertigo. CV: increased B/P, dysrhythmias. EENT: nasal irritation, congestion, rhinitis. GI: nausea, heartburn, cramps, vomiting, flatus. GU: vulval pain, uterine cramping. MISC: tremor, sweating, vertigo, urticaria, bronchial constriction.NURSING CONSIDERATIONS:  ASSESS: nasal mucosa if given by intranasal spray; for irritation. Pulse, B/P, when giving product IV or IM. I&O ration, weight daily, fluid/electrolyte balance; check for edema in extremities; if water retention is severe, diuretic may be prescribed. H2O intoxication: lethargy, behavioral changes, disorientatin, neuromuscular excitability.

Evaluate: therapeutic response: absence of Severe thirst, decreased urine output, osmolality. Teach patient/family: to measure and record I&O. to avoid alcohol, all OTC medications unless approved by prescriber.

  of serum electrolytes. For clients with diarrhea, assess number and consistency of stools per day as well as hydration status. Nursing Diagnoses: Deficient Knowledge: Drug administration and effects Altered Growth and Development Anxiety related to multiple injections Risk for Injury: Adverse drug effects Planning/Goals: The client will: Experience relief of symptoms without serious adverse effects Take or receive the drug accurately Comply with procedures for monitoring and follow-up Interventions: For children receiving growth hormone, assist the family to set reasonable goals for increased height and weight and to comply with accurate drug administration and follow-up procedures (periodic x-rays to determine bone growth and progress toward epiphyseal closure, recording height and weight at least weekly). For clients with diabetes insipidus, assist them to develop a daily routine to monitor their response to drug therapy (eg, weigh themselves, monitor fluid intake and urine output for approximately equal amounts, or check urine specific gravity [should be at least 1.015] and replace fluids accordingly). Evaluation: Interview and observe for compliance with instructions for taking the drug(s). Observe for relief of symptoms for which pituitary hormones were prescribed.

      GENERIC NAME: desmopressin    TRADE NAME:  minirin, octostimCLASSIFICATION:  pituitary hormoneUSES:  hemophilia A, von Willebrand’s disease type 1, nonnephrogenic diabetes insipidus, symptoms of polyuria/polydipsia caused by pituitary dysfunction, nocturnal enuresisDOSAGE & ROUTE:  adult: Diabetes insipidus, intranasally; 0.1–0.4 mL/d, usually in two divided doses; Hemophilia A, von Willebrand’s; disease, IV 0.3 mcg/kg in 50 mL sterile saline, infused over 15–30 min. child: 3 mo–2 y: Diabetes insipidus, intranasally 0.05–0.3 mL/d in 1–2 doses Weight >10 kg: Hemophilia A, von Willebrand’s disease, same as adult dosage Weight ≤10 kg: Hemophilia A, von Willebrand’s disease, IV 0.3 mcg/kg in 10 mL of sterile saline.SIDE EFFECTS:  CNS: drowsiness, headache, lethargy, flushing. CV: increased B/P, palpitations, tachycardia. EENT: nasal irritation, congestion, rhinitis. GI: nausea, heartburn, cramps. GU: vulval pain. META: hyponatremia, hyponatremia-induced seizures. Syst: ANAPHYLAXIS (IV)NURSING CONSIDERATIONS:  ASSESS: pulse, B/P when giving IV or SUBCUT. I&O ration, weight daily; check for edema in extremities; if water retention is severe, diuretic may be prescribed. Water intoxication: lethargy, behavioral changes,

  disorientation, neuromuscular excitability. Intranasal use: nausea, congestion, cramps, headache; usually decreased with decreased dose; for nasal mucosa changes: congestion, edema, discharge, scaring (nasal route). For severe allergic reaction including anaphylaxis (IV route). Urine vol/osmolality and plasma osmolality (diabetes insipidus) Factor VIII coagulant activity before using for hemostasis. Nocturnal enuresis: frequency of enuresis before and during treatment. Administer: undiluted over 1 min in diabetes insipidus. Diluted, one single dose/50 ml of 0.9% NaCl (adult and child >10 kg), a single dose/10 ml as an IV inf over 15-30 min in von Willebrand’s disease or hemophilia A. perform/provide: storage in refrigerator or cool environment. Evaluate: therapeutic response: absence of severe thirst, decreased urine output, decreased osmolality. Teach patient/family: the proper technique for nasal instillation: to insert tube into nostril to instill product. To avoid OTC products: cough, hay fever products, since these preparations may contain epinephrine, decrease product response; do not use with alcohol, adverse reactions may occur. To wear emergency ID specifying therapy. That if dose is missed, take when remembered up to 1 hr before next dose; do not double dose. To report to prescriber upper respiratory infection, nasal congestion.

GENERIC NAME: levothyroxine    TRADE NAME:  Synthroid, LevothroidCLASSIFICATION:  thyroid hormoneUSES:  hypothyroidism, myxedema coma, thyroid hormone replacement, thyrotoxicosis, congenital hypothyroidism, some types of thyroid cancer, pituitary TSH suppression.DOSAGE & ROUTE:  adult: PO 0.05 mg/d initially, increased by 0.025 mg every 2–3 wk until desired response obtained; usual maintenance dose, 0.1–0.2 mg/d (100–200 mcg/d) Myxedema coma, IV 0.4 mg in a single dose; then 0.1–0.2 mg daily Thyroid-stimulating hormone (TSH) suppression in thyroid cancer, nodules, and euthyroid goiters,PO 2.6 mcg/kg/d for 7–10 days Older adults, clients with cardiac disorders, and clients with hypothyroidism of long duration: PO 0.0125–0.025 mg/d for 6 wk, then dose is doubled every 6–8 wk until the desired response is obtained Myxedema coma, same as adult dosage Child: Congenital hypothyroidism, PO as follows: Birth–6 mo: 25–50 mcg/d (or 8–10 mcg/kg/d) 6–12 mo: 50–75 mcg/d (or 6–8 mcg/kg/d) 1–5 y: 75–100 mcg/d (or 5–6 mcg/kg/d) 6–12 y: 100–150 mcg/d (or 4–5 mcg/kg/d) >12 y: >150 mcg/d (or 2–3 mcg/kg/d)SIDE EFFECTS:  CNS: anxiety, insomnia, tremors, headache, thyroid storm, excitability. CV: tachycardia, palpitations, angina, dysrhythmias, hypertension, cardiac arrest. GI: nausea, diarrhea, increased or decreased bone mineral density.NURSING CONSIDERATIONS: assess: B/P, pulse periodically during treatment. Weight daily in same clothing, using same scale, at same time of day. Height, growth rate of a child. T3, T4, FTIs, which are decreased; radioimmunoassay of TSH, which is increased; radio uptake, which is increased if patient is on too low a dose of medication. PT may require decreased anticoagulant; check for bleeding, bruising.

  Increased nervousness, excitability, irritability, which may indicate too high dose of medication, usually after 1-3 wk of treatment. Cardiac status: angina, palpitation, chest pain, change in VS. administer: PO route-in AM if possible as a single dose to decrease sleeplessness; at same time each day to maintain product level; take on empty stomach. Only for hormone imbalances; not to be used for obesity, male infertility, menstrual conditions, lethargy. Lowest dose that relieves symptoms; lower dose to the geriatric patient and in cardiac diseases. Crushed and mixed with water; nonsoy formula, or breast milk for infants/children. Separate antacids, iron, calcium products by 4 hr. IV direct route- IV after diluting with provided diluent 0.5 mg/5 ml; shake; give through Y-tube or 3-way stopcock; give 0.1 mg or less over 1 min; do not add to IV inf; 0.1 mg = 1 ml. considered to be incompatible in syringe with all other products. Perform/provide: storage in tight, light-resistant container; sol should be discarded if not used immediately. Withdrawal of medication 4 wk before RAIU test. Evaluate: therapeutic response: absence of depression; increased weight loss, diuresis, pulse, appetite; absence of constipation, peripheral edema, cold intolerance; pale, cool, dry skin; brittle nails, alopecia, coarse hair, menorrhhagia, night blindness, paresthesias, syncope, stupor, coma, rosy cheeks. Teach patient/family: that hair loss will occur in child, is temporary. To report excitability, irritability, anxiety, which indicate overdose. Not to switch brands unless approved by prescriber. That product may be discontinued after giving birth, thyroid panel evaluated after 1-2 mo. That hypothyroid child will show almost immediate behavior/personality change. That product is not to be taken to reduce weight. To avoid OTC preparations with iodine; read labels; separate antacids, iron, calcium products by 4 hr. to avoid iodine food, iodized salt, soybeans, tofu, turnips, high-iodine seafood, some bread. That product is not a cure but controls symptoms and treatment is lifelong.

      GENERIC NAME:  Propylthiouracil   TRADE NAME:  PIV, PTUCLASSIFICATION:  thyroid hormone antagonist (antithyroid)USES:  preparation for thyroidectomy, thyrotoxic crisis, hyperthyroidism, thyroid stormDOSAGE & ROUTE:  adult: PO 300–400 mg/d in divided doses q8h, until theclient is euthyroid; then 100–150 mg/d in three divided doses, for maintenance. Child: >10 y: PO 150–300 mg/d in divided doses q8h; usual maintenance dose, 100–300 mg/d in two divided doses, q12h 6–10 y: 50–150 mg/d in divided doses q8hSIDE EFFECTS:  CNS: drowsiness, headache, vertigo, fever, paresthesias, neuritis. GI: nausea, diarrhea, vomiting, jaundice, hepatitis, loss of taste. GU: nephritis. HEMA: agranulocytosis, leucopenia, thrombocytopenia, hypotherombinemia, lymphadenopathy, bleeding, vasculitis, periarteritis. INTEG: rash, uritcaria, pruritus, alopecia, hyperpigmentation, lupuslike syndrome. MS: myalgia, arthralgia, nocturnal muscle cramps, osteoporosis. NURSING CONSIDERATIONS:  assess: pulse, B/P, temp. I&O ratio; check for edema: puffy hands, feet, periorbits; indicates hypothyroidism. Weight daily; same clothing, scale, time of day. T3, T4, which are increased; serum TSH, which is decreased; free thyroxine index, which is increased if dosage is too low; discontinue product 3-4 wk before RAIU. Blood studies: CBC for blood dyscrasias: leucopenia, thrombocytopenia, agranulocytosis; LFTs. Overdose: peripheral edema, heat intolerance, diaphoresis,

  palpitations, dysrhythmias, severe tachycardia, increased temp, delirium, CNS irritability.Hypersensitivity: rash, enlarged cervical lymph nodes; product may have to be discontinued. Hypoprothrombinemia: bleeding, petechiae, ecchymosis. Clinical response: after 3 wk shoulc include increased weight, pulse; decreased T4. bone marrow depression: sore throat, fever, fatigue. Administer: with meals to decrease GI upset. At same time each day to maintain product level. Lowest dose that relieves symptoms. Perform/provide: storage in light-resistant container. Fluids to 3-4 L/day, unless contraindicated. Evaluate: therapeutic response: weight gain, decreased pulse, decreased T4, decreased B/P. teach patient/family: to abstain from breastfeeding after delivery. To take pulse daily. To report redness, swelling, sore throat, mouth lesions, which indicate blood dyscrasias. To keep graph of weight, pulse, mood. To avoid OTC products that contain iodine. That seafood, other iodine products may be restricted. Not to discontinue this medication abruptly; thyroid crisis may occur; stress response. That response may take several months if thyroid is large. The symptoms/signs of overdose: periorbital edema, cold intolerance, metal depression. The symptoms of inadequate does: tachycardia, diarrhea, fever, irritability. To take medication as prescribed; not to skip or double dose; missed doses should be taken when remembered up to 1 hr before next dose. to carry emergency ID listing condition, medication.

GENERIC NAME: insulin lispro    TRADE NAME:  humalogCLASSIFICATION:  antidiabetic, pancreatic hormoneUSES:  type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes, insulin lispro may be used in combination with sulfonylureas in children >3 yr.DOSAGE & ROUTE:  adult: SUBCUT 15 min before mealsSIDE EFFECTS:  EENT: blurred vision, dry mouth. INTEG: flushing, rash, urticaria, warmth, lipodystrophy, lipohypertrophy, swelling, redness. META: hypoglycemia, rebound hyperglycemia (somogyi effect 12-72 hr or longer). SYST: anaphylaxis.NURSING CONSIDERATIONS:  assess: fasting vlood glucose, 2 hr PP (80-150 mg/dl, normal fasting level; 70-130 mg/dl, noral 2 hr level); also A1c may be drawn to identify treatment effectiveness q3mo. Urine ketones during illness; insulin requirements may increase during stress, illness, surgery. For hypoglycemic reaction that can occur during peak time (seating, weakness, dizziness, chills, confusion, headache, nausea, reapid weak pulse, fatigue, tachycardia, memory lapses, slurred speech, staggering gait, anxiety, tremors, hunger). For hyperglycemia: acetone breath; polyuria; fatigue; polydipsia; flushed, dry skin; lethargy. Administer: SUBCUT ROUTE – after warming to room temperature by rotating in palms to prevent injecting cold insulin; use only insulin syringes with markings or syringe matching units/ml; rotate inj sites within one area: Abdomen, upper back, thighs, upper arm, buttocks; keep record of sites. Increased dosages if tolerance occurs. Premixed insulins and NPH are cloudy suspensions. Regular human insulin, rapid-acting analogs, and long-acting analogs are clear; do not use if cloudy, thick, or discolored.

  CONT SUBCUT ROUTE (INSULIN INFUSION CSII) – do not mix with other insulins when using a pump. Insulin lispro 3 ml cartridges are to be used in Disetronic H-TROM plus V100 pump using Disetronic rapid inf sets; the inf set and the cartridge adapter should be changed q48hr; replace 3 ml cartridge q7 days. IV ROUTE (INSULIN GLULISINE ONLY) – dilute to 1 international unit/ml in inf systems with 0.9% NaCl using PVC viaflex if bags and PVC tubing; use dedicated line; do not admix. IV ROUTE (REGULAR ONLY) 0 when regular insulin is administered IV, monitor glucose, potassium often to prevent fatal hypoglycemia, hypokalemia. IV direct undiluted via vein, Y-site, 3-way stopcock; give at 50 units/min or less. By cont inf after diluting with IV sol and run at prescribed rate; use IV inf pump for correct dosing; give reduced dose at serum glucose level of 250 mg/100 ml. perform/provide: store at room temperature for <1 mo (some insulins); keep away from heat and sunlight; refrigerate all other supply; NPH, premixed insulins are cloudy; regular, rapid-acting analogs, long-acting analogs are clear; do not freeze – IV route, regular only. Evaluate: therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gain. Teach patient/family: that blurred vision occurs; not to change corrective lens until vision is stabilized 1-2 mo. To keep insulin, equipment available at all times; carry a glucagons kit, candy, or lump of sugar to treat hypoglycemia. That product does not cure diabetes but controls symptoms. To carry emergency ID as diabetic. To recognized hypoglycemia reaction: headache, tremors, fatigue, weakness. To recognize hyperglycemia reaction: frequent urination, thirst, fatigue, hunger. The dosage, route, mixing instructions, if any diet restrictions, disease process. The symptoms of ketoacidosis: nausea; thirst; polyuria; dry mouth; decreased B/P; dry, flushed skin; acetone breath; drowsiness; Kussmaul respirations. That a plan is necessary for diet, exercise; all food on diet should be eaten; exercise routine should not vary. About blood glucose testing; make sure patient is able to determine glucose level. To avoid OTC products unless directed by prescriber.

      GENERIC NAME:  glipizide   TRADE NAME:  glucotrolCLASSIFICATION:  antidiabeticUSES:  type 2 diabetes mellitusDOSAGE & ROUTE:  PO, initially 5 mg daily in a single dose, 30 min before breakfast. Maximum dose, 40 mg daily.SIDE EFFECTS:  CNS: headache, weakness, dizziness, drowsiness, tinnitus, fatigue, vertigo. ENDO: hypoglycemia. GI: hepatotoxicity, cholestatic jaundice, nausea, vomiting, diarrhea, heartburn. HEMA: leucopenia, thrombocytopenia, agranulocytosis, aplastic anemia; increased AST, ALT, alk phos; pancytopenia, hemolytic anemia. INTEG: rash, allergic reactions, pruritus, urticaria, eczema, photosensitivity, erythema.NURSING CONSIDERATIONS:  assess: hypo/hyperglycemic reaction that can occur soon after meals; for severe hypoglycemia give IV D5W, then IV dextrose solution. Blood, A1c levels during treatment to determine diabetes control. CBC baseline and throughout treatment. Administer: do not break, crush, or chew ext rel tabs; may crush tabs and mix with fluids if unable to swallow whole. Product 30 min before meals; if patient is NPO, may need to hold dose to prevent hypoglycemia. Perform/provide: storage in tight, light-resistant container at room temperature. Evaluate: therapeutic response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of

  Dizziness; stable gait; improved serum glucose A1c. teach patient/family: not to drink; explain disulfiram reaction (nausea, headache, cramps, flushing, hypoglycemia). To check for symptoms of cholestatic jaundice: dark urine, pruritus, yellow sclera; prescriber should be notified. The symptoms of hypo/hyperglycemia, what to do about each; to have glucagons emergency kit available, carry sugar packets. That product must be continued on dialy basis; explain consequences of discontinuing product abruptly. To take product in morning to prevent hypoglycemic reactions at night. To use sunscreen or stay out of the sun to prevent photosensitivity. To avoid OTC medications unless ordered by prescriber. That diabetes is a lifelong illness; product will not cure disease. That all food in diet plan must be eaten to prevent hypoglycemia. To carry emergency ID with prescriber and medications. To test using blood glucose meter while on this product. To continue weight control, dietary restrictions, exercise, hygiene. Ext rel tab may appear in stool.

GENERIC NAME: prednisone    TRADE NAME:  orasoneCLASSIFICATION:  corticosteroidUSES:  severe inflammation, immunosuppression, neoplasms, multiple sclerosis, collagen disorders, dermatologic disorders.DOSAGE & ROUTE:  adult: PO 20–60 mg/d. child: PO 2 mg/kg/d initially.SIDE EFFECTS:  CNS: depression, flushing, sweating, headache, mood changes. CV: hypertension, circulatory collapse, thrombophlebitis, embolism, tachycardia. EENT: fungal infections, increased intraocular pressure, blurred vision. GI: diarrhea, nausea, abdominal distention, GI hemorrhage, increased appetite, pancreatitis. HEMA: thrombocytopenia. INTEG: acne, poor wound healing, ecchymosis, petechiae. META: hyperglycemia. MS: fractures, osteoporosis, weakness.NURSING CONSIDERATIONS:  assess: adrenal insufficiency: nausea, vomiting, anorexia, confusion, hypotension. Potassium, blood glucose, urine glucose while on long-term therapy; hypokalemia and hyperglycemia. Weight daily; notify prescriber of weekly gain > 5 lb. B/P q4hr, pulse; notify prescriber of chest pain; monitor for crackles, dyspnea if edema is present. I&O ration; be alert for decreasing urinary output, increasing edema. Plasma cortisol (long-tem therapy) (normal: 138-635 nmol/L SI units drawn at 8 am). Infection: increased temp, WBC, even after withdrawal of medication;

  product masks infection. Potassium depletion: paresthesias, fatigue, nausea, vomiting Depression, polyuria, dysrhythmias, weakness. Edema, hypertension, cardiac symptoms. Mental status: affect, mood, behavioral changes, aggression. Administer: for long-term use, alternate-day therapy is recommended to decrease adverse reactions. Titrated dose; use lowest effective dose. With food or milk to decrease GI symptoms. Perform/provide: assistance with ambulation to patient with bone tissue disease to prevent fractures. Evaluate: therapeutic response: ease of respirations, decreased inflammation. Teach patient/family: that emergency ID as steroid user should be carried; information on product being taken and condition. To notify prescriber if therapeutic response decreases; dosage adjustment may be needed. To avoid vaccinations. Not to discontinue abruptly, or adrenal crisis can result. To avoid OTC products; salicylates, cough products with alcohol, cold preparations unless directed by prescriber. About cushingoid symptoms: moon face, weight gain. That product causes immunosuppression; to report any symptoms of infection (fever, sore throat, cough). The symptoms of adrenal insufficiency: nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain.

      GENERIC NAME: estrogen, conjugated    TRADE NAME:  premarin, premphaseCLASSIFICATION:  estrogen, hormoneUSES:  vasomotor symptoms (menopause), inoperable breast cancer, prostatic cancer, abnormal uterine bleeding, hypogonadism, primary ovarian failure, prevention of osteoporosisDOSAGE & ROUTE:  menopausal: PO 0.3–1.25 mg daily for 21 d followed by 7 d without the drug. Hypogonadism: PO 2.5–7.5 mg daily in divided doses, cyclically, 20 d on, 10 d off the drug. Osteoporosis: PO 0.625 mg daily for 21 d, then 7 d without the drugSIDE EFFECTS:  CNS: dizziness, headache, migraine, depression, seizures, mood disturbances. CV: hypotension, thrombophlebitis, edema, thromboembolism, stroke, pulmonary embolism, myocardial infarction. EENT: contact lens intolerance, increased myopia, astigmatism. GI: nausea, vomiting, diarrhea, anorexia, pancreatitis, cramps, constipation, increased appetite, cholestatic jaundice, hepatic adenoma, weight gain/loss. GU: amenorrhea, cervical erosion, breakthrough bleeding, dysmenorrheal, vaginal candidiasis, breast changes, gynecomastia, testicular atrophy, impotence, increased risk of breast cancer, endometrial cancer, libido changes. INTEG: rash, urticaria, acne, hirsutism, alopecia, oily skin, seborrhea, purpura, melasma. META: folic acid deficiency, Hypercalcemia, hyperglycemia.NURSING CONSIDERATIONS: assess: blood glucose if diabetic patient, hyperglycemia may occur. Weight daily; notify prescriber of weekly weight gain >5 lb; if increase, diuretic may be ordered. B/P q4hr; watch for increase caused by H2O and Na retention. I&O ration; be alert for decreasing urinary output, increasing edema. Hepatic studies: AST, ALT, bilirubin, alk phos.

  Hypertension, cardiac symptoms, jaundice, hypercalcemia. Mental status: affect, mood, behavioral changes, aggression. Female patient for intact uterus; if so, progesterone should be added to estrogen therapy to decrease risk of endometrial cancer; abnormal uterine bleeding, breast exam. Administer: titrated dose, use lowest effective dose. IM ROUTE- IM reconstitute after withdrawing >5 ml of air from container and inject sterile diluent on vial side, rotate to dissolve; give inj deep in large muscle mass. With food or milk to decrease GI symptoms (PO). VAGINAL ROUTE – use applicator provider. IV, DIRECT ROUTE – IV, after reconstituting as for IM, inject into distal port of running IV line of D5W, 0.9% NaCl, LR at 5 mg/min or less. Evaluate: therapeutic response: absence of breast engorgement, reversal of menopause symptoms, or decrease in tumor size in prostate cancer. Teach patient/family: to avoid breastfeeding, since product is excreted in breast milk. To weigh weekly, report gain >5 lb. to report breast lumps, vaginal bleeding, edema, jaundice, dark urine, clay-colored stools, dyspnea, headache, blurred vision, abdominal pain, leg pain and redness, numbness or stiffness in legs, chest pain; male to report impotence or gynecomastia. To avoid sunlight or wear sunscreen; burns may occur. To notify prescriber if pregnancy is suspected. That vasomotor symptoms improve in 2 wk, max relief in 8 wk.to report breast lumps, vaginal bleeding, edema, jaundice, dark urine, clay-colored stools, dyspnea, headache, blurred vision, abdominal pain, leg pain and redness, numbness or stiffness in legs, chest pain; male to report impotence or gynecomastia. To avoid sunlight or wear sunscreen; burns may occur. To notify prescriber if pregnancy is suspected. That vasomotor symptoms improve in 2 wk, max relief in 8 wk.

GENERIC NAME: clomiphene    TRADE NAME:  clomid, serophenCLASSIFICATION:  ovulation stimulantUSES:  female infertility (ovulatory failure)DOSAGE & ROUTE:  adult: PO 50-100 mg/day x 5 days or 50-100 mg/day beginning on day 5 of cycle; may be repeated until conception occurs or 3 cycles of therapy have been completedSIDE EFFECTS:  CNS: headache, depression, restlessness, anxiety, nervousness, fatigue, insomnia, dizziness, glushing. CV: vasomotor flushing, phlebitis, deep-vein thrombosis. EENT: blurred vision, diplopia, photophobia. GI: nausea, vomiting, constipation, abdominal pain, bloating. GU: polyuria, urinary frequency, birth defects, spontaneous abortions, multiple ovulation, breast pain, oliguria, abnormal uterine, bleeding, ovarian cyst, hypertrophy of ovary. INTEG: rash, dermatitis, urticaria, alopecia.NURSING CONSIDERATIONS:  assess: for LFTs before therapy: AST, ALT, alk phos. Serum progesterone, urinary excretion of pregnanediol to identify occurrence of ovulation. Ovarian size, cervical condition by pelvic examination. For endometrial carcinoma in women over 35 by endometrial biopsy. Administer: after discontinuing estrogen therapy. At same time daily to maintain product level. Evaluate: therapeutic response: fertility. Teach patient/family: that multiple births are common. To notify

  Prescriber immediately if low abdominal pain occurs; may indicate ovarian cyst, cyst rupture. To notify prescriber of photophobia, blurred vision, diplopia, abnormal bleeding, hot flashes, nausea, vomiting, headache. That if dose is missed, to double it nest time; if more than one dose is missed, to call prescriber. That response usually occurs 4-10 days after last day of treatment. The method for taking, recording basal body temp to determine whether ovulation has occurred. If ovulation can be determined (there is a slight decrease in temp, then a sharp increase for ovulation), to attempt coitus 3 days before and every other day until after ovulation. If pregnancy is suspected, to notify prescriber immediately.

      GENERIC NAME: raloxifene    TRADE NAME:  evistaCLASSIFICATION:  hormone modifier, selective estrogen receptor modulator 9SERM)USES:  prevention, treatment of osteoporosis in postmenopausal women; breast cancer prophylaxisDOSAGE & ROUTE:  adult: PO 60 mg/day, max 60 mg/daySIDE EFFECTS:  CNS: insomnia, CVA. CV: hot flashes. EENT: retinal vein occlusion (rare). GI: nausea, vomiting, diarrhea, dyspepsia. GU: vaginitis, leucorrhea, cystitis, hot flashes. INTEG: rash, sweating. META: weight gain, peripheral edema. MS: arthralgia, myalgia, leg cramps, arthritis. RESP: sinusitis, pharyngitis, increased cough, pneumonia, laryngitis, bronchitis, pulmonary embolism, flulike symptoms.NURSING CONSIDERATIONS:  assess: weight daily, notify prescriber of weekly weight gain > 5 lb. B/P, watch for increase caused by H2O and sodium retention. I&O ratio; decreasing urinary output, increasing edema. Hepatic studies, including AST, ALT, bilirubin, alk phos. Bone density test baseline and throughout treatment, bone-specific alk phos. Administer: without regard to meals, vit D. add calcium supplement if inadequate. Evaluate: therapeutic response: prevention, treatment of osteoporosis. Teach patient/family: to weigh weekly, report gain >5 lb. To discontinue

  72 hr before prolonged bed rest; advise to avoid one position for long periods. To take calcium supplements, vit D if intake is inadequate. To increase exercise using weights. To stop smoking and to Decrease alcohol consumption. That this product does not help control hot flashes. To report fever, acute migraine, insomnia, emotional distress; urinary tract infection, or vaginal burning/itching; swelling, warmth, or pain calves.

GENERIC NAME: norethindrone    TRADE NAME:  ortho micronor, errinCLASSIFICATION:  progestogenUSES:  uterine bleeding (abnormal), amenorrhea, endometriosis, contraceptionDOSAGE & ROUTE:  amenorrhea, abnormal uterine bleeding (aygestin) – adult: PO 2.5-10 mg/day on days 5-25 of menstrual cycle. Endometriosis (aygestin) – adult: PO 5 mg/day x 2 wk, then increased by 2.5 mg/day x 2 wk, up to 15 mg/day. Contraception – adult: PO 0.35 mg on 1st day of menses, then 0.35 mg/day.SIDE EFFECTS:  CNS: dizziness, headache, migraines, depression, fatigue. CV: hypotension, thrombophlebitis, edema, thromboembolism, CVA, stroke, PE, MI. EENT: diplopia. GI: nausea, vomiting, anorexia, cramps, increased weight, cholestatic jaundice. GU: amenorrhea, cervical erosion, break through bleeding, dysmenorrheal, vaginal candidiasis, breast changes, (gynecomastia, testicular atrophy, impotence), endometriosis, spontaneous abortion, breast tenderness. INTEG; rash, urticaria, acne, hirsutism, alopecia, oily skin, seborrhea, purpura, melasma. META: hyperglycemia.NURSING CONSIDERATIONS:  assess: weight daily: notify prescriber of weekly weight gain >5 lb. B/P at beginning of treatment and periodically. I&O ratio; be alert for decreasing urinary

  output, increasing edema. Hepatic studies: ALT, AST, bilirubin, periodically during long-term therapy. Edema, hypertension, cardiac symptoms, jaundice, thromboembolism. Mental status: affect, mood, behavioral changes, depression. Hypercalcemia. Administer: titrate does; use lowest effective dose. In one Dose in AM. With food or milk to decrease GI symptoms. At same time of day; do not interrupt between pill packs. Perform/provide: storage in dark area. Evaluate: therapeutic response: decreased abnormal uterine bleeding, absence of amenorrhea. Teach patient/family: about cushingoid symptoms. To report breast lumps, vaginal bleeding, amenorrhea, edema, jaundice, dark urine, clay-colored stools, dyspnea, headache, blurred vision, abdominal pain, numbness or stiffness in legs, check pain; men to report impotence or gynecomastia. To take at same time of day; do not interrupt between pill packs. To report suspected pregnancy immediately, to wait ≥3 mo after stopping medication to become pregnant. To avoid smoking; CV reactions may occur. Product does not protect against HIV, STDs. That product may mask onset of menopause.

      GENERIC NAME: alendronate    TRADE NAME:  fosamaxCLASSIFICATION:  bone-resorption inhibitorUSES:  treatment and prevention of osteoporosis in postmenopausal women, treatment of osteoporosis in men, Paget’s disease, treatment of corticosteroid-induced osteoporosis in postmenopausal women not receiving estrogen and men who are on continuing corticosteroid treatment with low bone mass.DOSAGE & ROUTE:  Osteoporosis: Postmenopausal women: Prevention, PO 5 mg once daily or 35 mg once weekly; treatment, PO 10 mg once daily or 70 mg once weekly Men, 10 mg once daily; Glucocorticoid-induced, 5 mg once daily Paget’s disease, PO 40 mg daily for 6 mo; repeated if necessarySIDE EFFECTS:  CNS: headache. GI: abdominal pain, constipation, nausea, vomiting, esophageal ulceration, acid reflux, dyspepsia, esophageal perforation, diarrhea. META: hypophosphatemia, hypocalcemia. MS: bone pain, osteonecrosis of the jaw. SYST: angioedema, Stevens-Jonshon syndrome, toxic epidermal necrolysis.NURSING CONSIDERATIONS:  assess: serious actions: angioedema, Stevens-Johnson syndrome, toxic epidermal necrolysis. Hormonal status if a woman, prior to treatment. For osteoporosis: bone density test before and ruing treatment. For Paget’s disease: increased skull size, bone pain, headache; decreased vision, hearing. Electrolytes; renal

  Function studies,; Ca, P, Mg, K. for hypercalcemia: paresthesias, twitching, laryngospasm, Chvostek’s, Trousseau’s signs. Alk phos levels, baseline and periodically, 2 x upper limit of normal is indicative of Paget’s disease. Dental status: regular dental exams should be done. Administer: for 6 months to be effective in Paget’s disease; take with8 ox of water 30 min before 1st food, beverage, or medication of the day. Perform/provide: storage in cool environment, out of direct sunlight. Evaluate: therapeutic response: increased bone mass, absence of fractures. Teach patient/family: to remain upright for 30 min after dose to prevent esophageal irritation, if dose is missed, skip dose, do not double doses or take later in day. To take in AM before food, other meds, take with 6-8 oz of water only (no mineral water). To take calcium, vit D if instructed by health care provider. To use weight-bearing exercise to increase bone density. To let health care provider know if pregnant or if pregnancy is planned or if breastfeeding.

GENERIC NAME: medroxyprogesterone    TRADE NAME:  depo-proveraCLASSIFICATION:  antineoplastic, hormone, contraceptiveUSES:  hot flashes, symptoms of menopause; paraphilia (men), hot flashes (men), in prostate cancerDOSAGE & ROUTE:  Dysfunctional uterine: bleeding: PO 5–10 mg daily for 5–10 d beginning on 16th or 21st d of cycle. IM 400–1000 mg weekly until improvement, then 400 mg monthlySIDE EFFECTS:  CNS: dizziness, migraines, fatigue, depression, headache. CV: hypotension, thrombophlebitis, edema, thromboembolism, stroke, PE, MI. EENT: diplopia. GU: amenorrhea, cervical erosion, break-through bleeding, dysmenorrheal, vaginal candidiasis, breast changes, gynecomastia, testicular atrophy, impotence, endometriosis, spontaneous abortion. GI: nausea, vomiting, anorexia, cramps, increased weight, cholestatic jaundice, abdominal pain. INTEG: rash, urticaria, acne, hirsutism, alopecia, oily skin, seborrhea, purpura, melasma, photosentivity. META: hyperglycemia. MS: decreased bone density. SYST: angioedema, anaphylaxisNURSING CONSIDERATIONS:  assess: symptoms indicating severe allergic reaction, angioedema, have epinephrine and rescusitative equipment available. Weight daily; notify prescriber of weekly weight gain >5 lb; bone mineral density. B/P at beginning

  Of treatment and periodically. I&O ratio; be alert for decreasing urinary output, increasing edema. Hepatic studies: ALT, AST, bilirubin, periodically during long-term therapy. Edema, hypertension, cardiac symptoms, jaundice. Mental status: affect, mood, behavioral changes, depression. Administer: titrated dose; use lowest effective dose. Oil solution deep in large muscle mass (IM); rotate sites. With food or milk to decrease GI symptoms (PO). Perform/provide: storage in dark area. Evaluate: therapeutic response: decreased abnormal uterine bleeding, absence of amenorrhea. Teach patient/family: to avoid sunlight or use sunscreen; photosensitivity can occur. Cushingoid symptoms: weight gain, moon face, buffalo hump, acne. To report breast lumps, vaginal bleeding, edema, jaundice, dark urine, clay-colored stools, dyspnea, headache, blurred vision, abdominal pain, sudden change in speech/coordination, numbness or stiffness in legs, chest pain; male to report impotence or gynecomastia. To report suspected pregnancy; fertility returns in 6-12 months after discontinuing. Long-term use decreases bone density; exercise and calcium supplements can help lessen this.

      GENERIC NAME: Choriogonadotropin alfa    TRADE NAME:  OvidrelCLASSIFICATION:  ovulation stimulant.USES:  female infertility in selected patientsDOSAGE & ROUTE:  adult: To induce ovulation, IM 5000–10,000 units in one dose, 1 d after treatment with menotropins. Child: To induce ovulation, IM 5000–10,000 units in one dose, 1 d after treatment with menotropinsSIDE EFFECTS:  CARDIOVASCULAR: tachycardia, phlebitis, deep vein thrombosis, hypovolemia. CNS: dizziness, headache, flushing, depression, restlessness, anxiety, nervousness, fatigue. GI: nausea, bloating, constipation, abdominal pain, vomiting, anorexia. MISC: urticaria, ovarian hyperstimulation, multiple pregnancies, blurred vision, diplopia, photophobia, breast pain, fever.NURSING CONSIDERATIONS: Assess: Assess for disorders for which hypothalamic and pituitary hormones are given: For children with impaired growth, assess height and weight (actual and compared with growth charts) and diagnostic x-ray reports of bone age. For clients with diabetes insipidus, assess baseline blood pressure, weight, ratio of fluid intake to urine output, urine specific gravity, and laboratory reports of serum electrolytes. For clients with diarrhea, assess number and consistencyof stools per day as well as hydration status.

  Nursing Diagnoses: Deficient Knowledge: Drug administration and effects Altered Growth and Development Anxiety related to multiple injections Risk for Injury: Adverse drug effects. Planning/Goals: The client will: Experience relief of symptoms without serious adverse effects Take or receive the drug accurately Comply with procedures for monitoring and follow-up. Interventions: For children receiving growth hormone, assist the family to set reasonable goals for increased height and weight and to comply with accurate drug administration and follow-up procedures (periodic x-rays to determine bone growth and progress toward epiphyseal closure, recording height and weight at least weekly). For clients with diabetes insipidus, assist them to develop a daily routine to monitor their response to drug therapy (eg, weigh themselves, monitor fluid intake and urine output for approximately equal amounts, or check urine specific gravity [should be at least 1.015] and replace fluids accordingly). Evaluation: Interview and observe for compliance with instructions for taking the drug(s). Observe for relief of symptoms for which pituitary hormones were prescribed.

     

GENERIC NAME: fluoxymesterone    TRADE NAME:  androxyCLASSIFICATION:  hormone-androgenUSES:  inoperable female breast cancer, male hypogonadism, delayed male pubertyDOSAGE & ROUTE:  androgen replacement in male hypogonadism – adult: PO 5 mg 1-4 x/day, may increase dose, max 40 mg/day. Delayed male puberty – adult and adolescent: PO 2.5-10 mg/day x 4-6 mo, max 20 mg/day. Inoperable female breast cancer – adult: PO 10-40 mg/day in divided doses, continue for ≥2-3 moSIDE EFFECTS:  CNS: heart failure. GI: hepatitis. GU: amenorrhea, feminization, virilization, prostatic hypertrophy, priapism, oligospermia, oligomenorrhea, gynecomastia. HEMA: coagulation disorders (clotting factors II, V, VII, X). INTEG: alopecia, acne, hirsutism, seborrhea. MISC: edema, hypercalcemia.NURSING CONSIDERATIONS:  assess: weight daily; notify prescriber if weekly weight gain is >5 lb. I&O ratio; be alert for decreasing urinary output, increasing edema. Growth rate in children; growth rate may be uneven (linear/bone growth) with extended use. Electrolytes: K, Na, Cl, Ca; cholesterol. Hepatic studies: ALT, AST, bilirubin. Edema, hypertension, cardiac symptoms. Signs of masculinization in female: in creased libido, deepening of voice, decreased breast tissue, enlarged clitoris, menstrual

  irregularities; male: gynecomastia, impotence, testicular atrophy. Hypercalcemia: lethargy, polyuria, polydipsia, nausea, vomiting, constipation; product may have to be Decreased. Hypoglycemia in diabetics; oral antidiabetic action is increased. Administer: as a single dose or up to 4x/day. Perform/provide: storage at controlled room temperature (68o – 77oF). Evaluate: therapeutic response: decreased advance of inoperable female breast cancer, male puberty. Teach patient/family: to notify prescriber if therapeutic response decreases; if edema occurs. About changes in sex characteristics. That women should report menstrual irregularities, voice changes, acne, facial hair growth. To notify prescriber if pregnancy is planned or suspected; use contraception while taking product. That 2-3 mo course is necessary to determine objective treatment in breast cancer. To report signs/symptoms of hepatic disorder.

GENERIC NAME: dextromethorphan    TRADE NAME:  robitussin pediatric, sucret cough control, vicks formula 44 cough reliefCLASSIFICATION:  antitussive, nonopioidUSES:  nonproductive coughDOSAGE & ROUTE:  adult/child ≥12 yr: PO 10-20 mg q4hr, or 30 mg q6-8hr, not to exceed 120 mg/day; SUS-REL LIQ 60 mg q12hr, not to exceed 120 mg/day. Child 6-12yr: PO 5-10 mg q4hr; SUS-REL LIQ 30 mg bid, LOZ 5-10 mg q1-4hr; max 60 mg/day. Child 2-6yr: PO 2.5-5 mg q4hr, or 7.5 mg q6-8hr, max 30 mg/day; SUS REL LIQ 15 ml bid.SIDE EFFECTS:  CNS: dizziness, sedation, confusion, ataxia, fatigue. GI: nausea.NURSING CONSIDERATIONS:  assess: cough: type, frequency, character, including sputum. Administer: decreased dose to geriatric patients; metabolism may be slowed. Perform/provide: increased fluids to liquefy secretions. Humidification of patient’s room. Evaluate: therapeutic response: absence of cough. Teach patient/family: to avoid driving, other hazardous activities until patient is stabilized on this medication. To avoid smoking, smoke-filled rooms, perfumes, dust, environmental pollutants, cleaners that increase cough. To avoid alcohol, CNS depressants. To notify prescriber if cough persists over a few days.

  GENERIC NAME: sildenafil    TRADE NAME:  revatio, viagraCLASSIFICATION:  erectile agent, antihypertensive, peripheral vasodilatorUSES:  treatment of erectile dysfunction, pulmonary hypertensionDOSAGE & ROUTE:  PO 25-100 mg 1 h before sexual activity, no more than once daily.SIDE EFFECTS:  CNS: headache, flushing, dizziness, transient global amnesia. CV: MI, sudden death, CV collapse. MISC: dyspepsia, nasal congestion, UTI, abnormal vision, diarrhea, rash, nonarteritic ischemic optic neuropathy, hearing loss, priapismNURSING CONSIDERATIONS:  assess: for any severe loss of vision while taking this or any similar products; these products should not be used. Use of organic nitrates that should not be used with this product. Cardiac status in pulmonary hypertension: B/P, pulse. ADMINISTER: approximately 1 hr before sexual activity; do not use more than once a day. Evaluate: therapeutic response: decreasing pulmonary hypertension; ability to perform sexually (male). Teach patient/family: that product does not protect against sexually transmitted disease, including HIV. That product absorption is reduced with a high-fat meal. That product should not be used with nitrates in any form. That abs may be split. To notify prescriber immediately and stop taking product if vision loss occurs, or erections >4 hr.

     

GENERIC NAME: aminophylline    TRADE NAME:  phyllocontin, truphyllineCLASSIFICATION:  bronchodilator, spasmolyticUSES:  bronchial astma, bronchospasm associated with chronic bronchitis, emphysema, bradycardia, apnea in iinfancy for respiratory/myocardial stimulationDOSAGE & ROUTE:  Adults and children up to 16 years of age, loading dose: Equivalent of 5-6 mg of anhydrous theophylline/kg. Bronchodilator, acute attacks, in clients currently receiving theophylline. Adults and children up to 16 years of age: If possible, a serum theophylline level should be obtained first. Then, base loading dose on the premise that each 0.5 mg theophylline/kg lean body weight will result in a 0.5-1.6-mcg/mL increase in serum theophylline levels. If immediate therapy is needed and a serum level cannot be obtained, a single dose of the equivalent of 2.5 mg/kg of anhydrous theophylline can be given. Maintenance in acute attack, based on equivalent of anhydrous theophylline. Young adult smokers: 4 mg/kg q 6 hr; healthy, nonsmoking adults: 3 mg/kg q 8 hr; geriatric clients or clients with cor pulmonale: 2 mg/kg q 8 hr; clients with CHF or liver failure: 2 mg/kg q 8-12 hr. Pediatric, 12-16 years: 3 mg/kg q 6 hr; 9-12 years: 4 mg/kg q 6 hr; 1-9 years: 5 mg/kg q 6 hr; 6-12 months: Use the formula: dose (mg/kg q 8 hr) = (0.05) (age in weeks) + 1.25; up to 6 months: Use the formula: dose (mg/kg q 8 hr) = (0.07) (age in weeks) + 1.7. Chronic therapy, based on equivalent of anhydrous theophylline. Adults, initial: 6-8 mg/kg up to a maximum of 400 mg/day in three to four divided doses at 6-8-hr intervals; then, dose can be increased in 25% increments at 2-3 day intervals up to a maximum of 13 mg/kg or 900 mg/day, whichever is less.

  Pediatric, initial: 16 mg/kg up to a maximum of 400 mg/day in three to four divided doses at 6-8 hr intervals; then, dose may be increased in 25% increments at 2-3 day intervals up to the following maximum doses (without measuring serum theophylline): 16 years and older: 13 mg/kg or 900 mg/day, whichever is less; 12-16 years: 18 mg/kg/day; 9-12 years: 20 mg/kg/day; 1-9 years: 24 mg/kg/day; up to 12 months, Use the following formula: dose (mg/kg/day) = (0.3) (age in weeks) + 8.0. •Enteric-Coated Tablets Bronchodilator, chronic therapy, based on equivalent of anhydrous theophylline. Adults, initial: 6-8 mg/kg up to a maximum of 400 mg/day in three to four divided doses at 6-8-hr intervals; then, dose may be increased, if needed and tolerated, by increments of 25% at 2-3 day intervals up to a maximum of 13 mg/kg/day or 900 mg/day, whichever is less, without measuring serum theophylline. Pediatric, over 12 years of age, initial: 4 mg/kg q 8-12 hr; then, dose may be increased by 2-3 mg/kg/day at 3- day intervals up to the following maximum doses (without measuring serum levels): 16 years and older: 13 mg/kg/day or 900 mg/day, whichever is less; 12-16 years: 18 mg/kg/day. Enema For use as a bronchodilator for loading doses and for maintenance in acute attacks, see doses for oral solution and tablets. •IV Infusion Bronchodilator, acute attacks, for clients not currently on theophylline. Adults and children up to 16 years, loading dose based on anhydrous theophylline: 5 mg/kg given over a period of 20 min

      Bronchodilator, acute attack, for clients currently on theophylline. Adults and children up to 16 years, loading dose based on anhydrous theophylline: If possible, a serum theophylline level should be obtained first. Then, base loading dose on the premise that each 0.5 mg theophylline/kg lean body weight will result in a 0.5-1.6 mcg/mL increase in serum theophylline levels. If immediate therapy is needed and a serum level cannot be obtained, a single dose of the equivalent of 2.5 mg/kg of anhydrous theophylline can be given. Maintenance for acute attacks, based on equivalent of anhydrous theophylline. Young adult smokers: 0.7 mg/kg/hr; nonsmoking, healthy adults: 0.43 mg/kg/hr; geriatric clients or clients with cor pulmonale: 0.26 mg/kg/hr; clients with CHF or liver failure: 0.2 mg/kg/hr. Pediatric, 12-16 years, nonsmokers: 0.5 mg/kg/hr; 9-12 years, 0.7 mg/kg/hr; 1-9 years, 0.8 mg/kg/hr; up to 1 year, Based on the following formula: dose (mg/kg/hr) = (0.008) (age in weeks) + 0.21. SIDE EFFECTS:  CNS: anxiety, restlessness, insomnia, dizziness, seizures, headache, light-headedness, muscle twitching, tremors. CV: palpitations, sinus tachycardia, hypotension, flushing, dysrhythmias, edema. GI: nausea, vomiting, diarrhea, dyspepsia, anal irritation (suppositories), epigastric pain, reflux, anorexia. GU: urinary frequency, SIADH. INTEG: flushing, urticaria. MISC: hyperglycemia. RESP: tachypnea, increased respiratory rate.2 L/day to decrease secretion viscosity. To avoid smoking; decreases blood levels and terminal half-life. NURSING CONSIDERATIONS:  assess: theophylline blood levels (therapeutic level is 10-20 mcg/ml); toxicity may occur with small increase above 20 mcg/ml, especially in geriatric

  patients. Monitory I&O; diuresis occurs; dehydration may occur in geriatric patients or children. Whether theophylline was given recently (24hr). respiratory rate, rhythm, depth; auscultate lung fields bilaterally; notify prescriber of abnormalities. Allergic reactions: rash, urticaria; if these occur, product should be discontinued. Administer: avoid IM inj; pain and tissue damage may occur. PO ROUTE – do not break, crush, or chew enteric-coated or cont rel tabs. Avoid giving with food. RECTAL ROUTE: if patient is unable to take PO, retain rectal dose for ½ hr. remain in bed 15-20 min after rect supp is inserted to avoid removal. IV ROUTE: only clear sol; flush IV line before dose. May be diluted for IV INF in 100-200 ml in D5W, D10W, D20W, 0.9% NaCl, 0.45% NaCl, LR. Give loading dose over ½ hr; max rate of inf 25 mg/min, use infusion pump; after loading dose give by cont inf. Perform/provide: storage of dilutd solution for 24 hr if refrigerated. Evaluate: therapeutic response: decreased dyspnea, respiratory stimulation in infancy, clear lung fields bilaterally. Teach patient/family: to take doses as prescribed, not to skip dose, not to double dose. To check OTC medications, current prescription medications for ephedrine; will increase CNS stimulation; not to drink alcohol or caffeine products (tea, coffee, chocolate, colas). To avoid hazardous activities; dizziness may occur. If GI upset occurs, to take product with 8 oz water; avoid food, since absorption may be decreased. To notify prescriber of toxicity: insomnia, anxiety, nausea, vomiting, rapid pulse, seizures, flushing, headache, diarrhea; notify prescriber immediately. To notify prescriber of change in smoking habit; a change in dose may be required. To increase fluids to

GENERIC NAME: theophylline    TRADE NAME:  theo-dur, accurbronCLASSIFICATION:  brondhodilatorUSES:  bronchial asthma, bronchospasm of COPD, chronic bronchitis, emphysemaDOSAGE & ROUTE:  hepatic dose – adult: PO 6 mg/kg loading dose, then 2 mg/kg q8hr x 2 doses, then 1-2 mg/kg q12hr; IV 4.7 mg/kg, then 0.39 mg/kg/hr for 12 hr, then 0.08-0.16 mg/kg/hr maintenance. Bronchospasm, bronchial asthma – adult: PO 100-200 mg q6hr; dosage must be individualized; max 800 mg/day. Child: PO 50-100 mg q6hr, max 12 mg/kg/24 hr. COPD, chronic bronchitis – adult: PO 300-800 mg q6-8hr after meals. Child 1-9yr: PO 5 mg/kg loading dose, then 4 mg/kg q6hr. child 9-16yr: PO 5 mg/kg loading dose, then 4 mg/kg q6hr. apnea of prematurity – neonate: 2-10 mg/kg/day divided q8-12hr (usual loading dose is 4 mg/kg PO).SIDE EFFECTS:  CNS: anxiety, restlessness, insomnia, dizziness, seizures, headache, light-headednes, muscle twitching, remors. CV: palpitations, sinus tachycardia, hypotension, dysrhythmias, fluid retention with tachycardia. ENDO: hyperglycemia. GI: nausea, vomiting, anorexia, diarrhea, bitter taste, dyspepsia, gastric distress. INTEG: flushing, urticaria. MISC: SIADH, urinary frequency. RESP: increased rate, tachypnea.NURSING CONSIDERATIONS: assess: theophylline blood levels (therapeutic level is 5-15 mcg/ml); toxicity may occur with small increase above 10 mcg/ml. monitor I&O;

  Diuresis occurs; geriatric patients or children may be dehydrated. Signs of toxicity: irritability, insomnia, restlessness, tremors, nausea, vomiting. Respiratory rate, rhythm, depth; auscultate lung fields bilaterally; notify prescriber of abnormalities. Allergic reactions: rash, urticaria; product should be discontinued. Administer: do not break, crush, chew, or dissolve time-release products. PO wit 8 oz of water for GI symptoms; avoid food; absorption may be affected; take dose consistently; do not take Theo-24 with meals. Contents of bead-filled capsule sprinkled over food for children’s use. Check OTC medications, current prescriptions for ephedrine, which will increase stimulation. IV ROUTE: loading dose over 20-30 min, max 20-25 mg/min; do not give by rapid IV, use only cont inf. Evaluate: therapeutic response: ability to breathe more easily. Teach patient/family: to check OTC medications, current prescription medications for ephedrine, which will increase stimulation; to avoid alcohol, caffeine. To avoid hazardous activities; dizziness may occur. That if GI upset occurs, to take product with 8 oz of H2O; avoid food; take at same time of day; absorption may be decreased. To notify prescriber of toxicity: nausea, vomiting, anxiety, insomnia, seizures. To notify prescriber of change in smoking habit; dosage may have to be changed.

      GENERIC NAME: zileuton    TRADE NAME:  zyfloCLASSIFICATION:  antileukotrieneUSES:  oral prophylaxis and long-term treatment of asthma.DOSAGE & ROUTE:  adult/child ≥12: PO 600 mg qidSIDE EFFECTS:  The side effects mentioned here, if arise should be informed to your prescriber or health care professional as soon as it occurs: chest pain, difficulty breathing, wheezing, flu-like symptoms (chills, fatigue, fever, muscle aches), nausea, pruritus, skin rash or itching, unusual weakness or tiredness, yellowing of the skin. The side effects that usually do not require medical attention include: back pain, dizziness, drowsiness, dyspepsia, headache, insomnia, numbness or tingling in the hands or feet, stomach pain and weakness.NURSING CONSIDERATIONS:  Assessment: History: Hypersensitivity to zileuton; impaired hepatic function; lactation; pregnancy; acute asthma or bronchospasm. Physical: T; orientation, reflexes; R, adventitious sounds; GI evaluation; liver function tests Interventions: Obtain baseline hepatic function tests before beginning therapy; monitor liver enzymes on a regular basis during therapy; discontinue drug and consult prescriber if enzymes rise more than three times normal. Administer without regard to food. Ensure

  that drug is taken continually for optimal effect. Do not administer for acute asthma attack or acute bronchospasm. Teaching points: Take this drug regularly as prescribed; do not stop taking this drug during symptom-free periods; do not stop taking this drug without consulting your health care provider. Continue taking any other antasthmatics that have been prescribed for you. Do not take this drug for an acute asthma attack or acute bronchospasm; this drug is not a bronchodilator; routine emergency procedures should be followed during acute attacks. Avoid the use of over-the-counter drugs while you are using this medication; many of them contain products that can interfere with or cause serious side effects when used with this drug. If you feel that you need one of these products, consult your nurse or physician. These side effects may occur: Dizziness (use caution when driving or performing activities that require alertness); nausea, vomiting (eat frequent small meals; take drug with food); headache (analgesics may be helpful). Report fever, acute asthma attacks, flulike symptoms, lethargy, pruritus, changes in color of urine or stool.