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Allergies:_NO KNOWN DRUG ALLERGIES ______________ Time Drug Dose/ Route/ Frequency Specific Classificatio n Chemical Action of Drug Why is your patient taking the drug Incompatibilit ies Major Side Effects or Nursing Implications 0.9% NS NACL Mineral and electrolyte replacement supplement Maintaining acid-base balance and electrophysiologic balance of the cell No known incompatibilit ies. May cause hypernatremia. Monitor signs of hydration. Monitor Sodium lab values. 1\2 NS 20 MEQ KCL Mineral and electrolyte replacement supplement Maintaining acid-base balance and electrophysiologic balance of the cell Hyperkalemia can result with the use of potassium sparing diuretics or ace inhibitors Side effects include abdominal pain and diarrhea nausea and vomitingassess patient for signs and symptoms of hypokalemia and hyperkalemia Monitor pulse blood pressure and ECG throughout IV therapy Acarbose Precose Antidiabetics Alpha glucosidase inhibitors Lowers blood glucose by inhibiting the enzyme alpha glucosidase in the GI tract. Delays and reduces glucose absorption. CI in hypersensitivi ty, diabetic ketoacidosis, cirrhosis, pregnancy, lactation, or children. Side effects include: abdominal pain, diarrhea, flatulence. Assess for signs of hypoglycemia, monitor glucose and A1C levels. Does not cause hypoglycemia when taken while fasting. Administer with first bite of each meal 3 times a day. Acebtolol sectral Antianginal Antiarrhythmi cs Antihypertens ive Beta blocker selective Block stimulation of beta1 adrenergic receptors, usually without affecting beta2 receptor sites. General anesthesia and verapamil may cause decrease in myocardial depression. CI in pulmonary disease and renal disease, Side effects include fatigue, weakness, blurred vision, brochospasm, wheezing, and impotence. Administer with meals or directly after eating. Take apical pulse, if <50bpm withhold

Drug Rationale

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Page 1: Drug Rationale

Allergies:_NO KNOWN DRUG ALLERGIES______________

Time Drug Dose/Route/Frequency

Specific Classification

Chemical Action of Drug Why is your patient taking the drug

Incompatibilities Major Side Effects or Nursing Implications

0.9% NS NACL Mineral and electrolyte replacement supplement

Maintaining acid-base balance and electrophysiologic balance of the cell

No known incompatibilities.  May cause hypernatremia.

Monitor signs of hydration.  Monitor Sodium lab values.

1\2 NS 20 MEQ KCL

Mineral and electrolyte replacement supplement

Maintaining acid-base balance and electrophysiologic balance of the cell

Hyperkalemia can result with the use of potassium sparing diuretics or ace inhibitors

Side effects include abdominal pain and diarrhea nausea and vomitingassess patient for signs and symptoms of hypokalemia

and hyperkalemia Monitor pulse blood pressure and ECG throughout IV therapy

Acarbose

Precose

Antidiabetics

Alpha glucosidase inhibitors

Lowers blood glucose by inhibiting the enzyme alpha glucosidase in the GI tract. Delays and reduces glucose absorption.

CI in hypersensitivity, diabetic ketoacidosis, cirrhosis, pregnancy, lactation, or children.

Side effects include: abdominal pain, diarrhea, flatulence. Assess for signs of hypoglycemia, monitor glucose and A1C levels. Does not cause hypoglycemia when taken while fasting. Administer with first bite of each meal 3 times a day.

Acebtolol

sectral

AntianginalAntiarrhythmicsAntihypertensive

Beta blocker selective

Block stimulation of beta1 adrenergic receptors, usually without affecting beta2 receptor sites.

General anesthesia and verapamil may cause decrease in myocardial depression. CI in pulmonary disease and renal disease, bradycardia and heart block.

Side effects include fatigue, weakness, blurred vision, brochospasm, wheezing, and impotence.Administer with meals or directly after eating. Take apical pulse, if <50bpm withhold medication. Monitor for bradycardia, dizziness, dyspnea and seizures. Assess I and O monitor for pulmonary edema. Administer atropine if pulse <40 bpm.

Acetaminophen

 

Tylenol

Antipyretics

Nonopiod analgesic

Inhibit the synthesis of prostaglandins that may serve as mediators of pain and fever

Hepatotoxicity is additive with other hepatotoxic substances

Side effects include liver failure liver damage rash renal failure

assess type location and  intensity of pain  before and 30 minutes after administration

assess fever

Page 2: Drug Rationale

Acyclovir

Avirax

Antiviral

Purine analogue

Interferes with the viral DNA synthesis.

Probenecid increases blodd levels, Nephrotoxic drugs increases renal effects, Zidovudine and IT methotrexate may increase CNS side effects.

Seizure, dizziness, headache, diarrhea, nausea, vomiting, Renal failure, thrombocytopenic prpura/ hemolytic uremic syndrome, pain and phlebitis may occur. Advise patient that this therapy is not a cure. Avoid sexual contact while lesions are present. Use condoms in the absence of lesions.

Alatrofloxacin

Trovan

Anti infective

Fluoroquinolone

Inhibit bacterial DNA synthesis by inhibiting DNA gyrase.

CI in hypersensitivity and pregnancy. Y site incomp 0.9%nacl and lr. Temp discontinue other solutions when admin. Flush line before and after administration.

Side effects include: dizziness, drowsiness, headache, insomnia, abdominal pain, diarrhea, nausea hypoglycemia and phlebitis at IV site. Assess patient for signs of infection, obtain culture before therapy is started, and observe for signs of anaphylaxis. Administer over 60 minutes.

Albuterol sulfate 0.083%

Bronchodilators

Adrenergics

Result in the accumulation of cyclic adenosine monophosphate at beta adrenergic receptor. Produces bronchodiliation. Inhibits the release of mediators of immediate hypersensitivity reactions form mast cells.

Concurrent use with other adrenergic agents will cause increased adrenergic effects beta-blockers may decrease effects. Use with herbs and caffeine containing ephedra may increase stimulant effect.

Side effects include nervousness restlessness tremor palpitations or tachycardia angina hypertension assess lung sounds, respiratory pattern and blood pressure before administration and during peak of medicationObserve for bronchospasm. If condition occurs, withhold medication and notify physician immediately. for nebulizer compressed air or oxygen flows should be 6 to 10 L a minute a single treatment of 3 mL last about 10 minutes.

Alendronate

Fosamax

Bone resorption inhibitors

Biphosphonates

Inhibits resorption of bone by inhibiting osteoclast activity.

Calcium supplements, antacids, and other oral medications lowers the absorption of alendronate. Increased GI events with NSAIDS. Food, Caffeine, mineral water, and orange juice significantly lowers absorption.

Headahe, blurred vision, abdominal distention, and musculoskeletal pain may occur. Administer first thing in the a.m with 6-8 oz plain water 30 min before other meds, beverages, or food. Instruct patient to remain upright for 30 min following dose to facilitate passage to stomach. Advise patient to wear sunscreen and protective clothing to prevent photosensitivity.

Page 3: Drug Rationale

Amikacin

Amikin

Antiinfective

Aminoglycoside

Inhibits protein synthesis in bacteria at level of 30s ribosome. Has a bactericidal action.

CI in hypersensitivity. Inactivated by penicillins and cephalosporins when administered in renal insufficiency.

Side effects include: ototoxicity, nephrotoxicity, muscle paralysis and hypersensitivity. Assess patient for signs of infection, obtain culture before admin. Evaluate hearing and balance before admin therapy. Keep patient well hydrated, may be admin without meals, IM should be deep into well developed muscle, IV infuse over 30-60 min.

Amiloride(Midamor)

Spironolactone (Aldactone)

Triamterene(Dyrenium)

Potassium sparing diuretics

Cause loss of sodium bicarbonate and calcium while saving potassium and hydrogen ions.

Increased hypotension with use of alcohol and other antihypertinsives, or nitrates. Increased risk of hyperkalemia with ACE inhibitors, angiotension II receptor antagonist, indomethacin, potassium supplements, or cyclosporine. Decreased effectiveness with NSAIDS. Increases effects of digoxin.

Triamterene: bluish urine.

Hyperkalemia is most frequent side effect.

Potassium levels should be monitored before and during therapy. Administer in the a.m to avoid sleep pattern interruption. Caution patient to avoid using salt substitutes.

 Amino AcidProstat 64      

 Amino acid replacement

 Pro-Stat® 64 liquid protein formula is an enzyme- hydrolyzed concentrated protein fortified with L-tryptophan. Per serving, Pro-Stat® 64 has 15 grams of protein and 60 k/cal per 30 ml (one ounce) and is sugar and carbohydrate free. Pro-Stat 64 is rich in Arginine, Glycine, Proline and Hydroxyproline, with high nitrogen donor capability to accelerate tissue healing, a critical factor in replenishing depleted protein stores in patients with pressure ulcers, malnutrition, and low albumin levels.

 Do not add prostate with any other substance. Must irrigate before and after administration.

 Feeding tubes should be flushed prior to administration. Flush the tube with 30-50 mL water. Do NOT add Pro-Stat® (or any other substance) to an open or closed system of the tube feeding formula or into a container of enteral feeding prior to administering.

Aminophylline Bronchodilators

Phosphodiesterase inhibitors

Inhibits phosphodiesterase, producing increased tissue concentrations of CAMP. Increased levels of Camp result in bronchodilation, cns

Do not use in uncontrolled arrhythmias. Additive cv and cns side effects

Side effects include: anxiety, tachycardia, nausea, vomiting. Assess bp, pulse, RR before therapy. Monitor I & O. monitor drug levels and

Page 4: Drug Rationale

Xanthines stimulation, diuresis and gastric acid secretion.

with adrenergic agents. Phenytoin and rifampin may decrease effectiveness

observe for toxicity signs such as anorexia, vomiting, nausea, diarrhea, confusion, headache, flushing or seizures. Administer over 30 minutes Advise patient to drink plenty of fluids, avoid otc cough, cold, or breathing preparations, minimize caffeine intake and to have serum levels tested periodically.

Amitriptyline Antidepressant

Tricyclic antidepressant

Potentiates the effect of serotonin and norepinephrine in the CNS and also has anticholinergic properties.

CI in pregnancy and lactation and narrow angle glaucoma.

Side effects include: fatigue, sedation, blurred vision, dry eyes, constipation, dry mouth and weight gain. Monitor BP and Pulse before giving, monitor mental status, suicidal tendencies, and assess for pain. Administer with or immediately after a meal, do not administer IV.

Amlodipine

Norvasc

Antianginal AntihypertensiveAntiarrhythmics

Calcium channel blocker

Inhibits the transport of calcium into myocardial and vascular smooth muscle cells resulting in inhibition of excitation-contraction coupling and subsequent contraction

Additive hypotension may occur when used with other antihypertensives bradycardia may result when used with beta-blockers. Concurrent ingestion of grapefruit juice increases blood levels and effects.

Side effects include anxiety confusion peripheral edema diarrhea nausea vomiting hyperglycemia arrhythmias nocturia. Monitor blood pressure and pulse before administration.

Amoxicillin Anti infective

Antiulcer

Aminopenicillins

Binds to bacterial cell wall, causing cell death.

CI in hypersensitivities to penicillins, contains aspartame, avoid in patients with PKU.Probenecid decreases renal excretion and increases blood levels of amoxicillin.

Side effects include: diarrhea, rashes, anaphylaxis, pseudomembranous colitis. Assess patient for infection. Obtain culture before starting therapy. Observe for signs of anaphylaxis; evaluate renal and hepatic function, cbc, k levels, and bleeding times. Monitor bowel function for pseudomembranous colitis. Administer around the clock, may be given without regard to meals.

Amoxicillin

Amoxil

Anti-infective

Anti-ulcer

Binds to bacterial cell wall, causing cell death. Active against H.pylori

Probenecid decreases renal excretion. May increase effects of warfarin. May decrease effectiveness of oral

Seizure, Psuedomembranous colitis, diarrhea, rash, and anaphylaxis/ serum sickness may occur. Monitor bowel function. May be given without regard to meals.

Page 5: Drug Rationale

contraceptives.

Amoxicillin/clavulanate

Anti infective

Aminopenicillins

Beta lactamase inhibitors

Binds to bacterial cell wall, causing cell death.

CI in hypersensitivities to penicillins, contains aspartame, avoid in patients with PKU.Probenecid decreases renal excretion and increases blood levels of amoxicillin.

Side effects include: diarrhea, rashes, anaphylaxis, pseudomembranous colitis. Assess patient for infection. Obtain culture before starting therapy. Observe for signs of anaphylaxis; evaluate renal and hepatic function, cbc, k levels, and bleeding times. Monitor bowel function for pseudomembranous colitis. Administer around the clock, may be given without regard to meals.

Amphotericin b deoxycholate

Amphotericin b cholesteryl sulfate

Amphotericin b lipid complex

Amphotericin b liposome

Antifungal Binds to fungal cell membrane, allowing leakage of cellular contents. Toxicity is less with lipid formulations.

CI in hypersensitivity and lactation. Increased risk of renal toxicity if used with antineoplastics.

Side effects include: headache, hypotensiion, diarrhea, nausea, vomiting, nephrotoxicity, hypokalemia, chills and fever. Assess injection site for thrombophlebitis may need to add heparin. Assess RR and status, monitor CBC and platelet counts. See drug card for info on each drug.

Ampicillin/sulbactam

Unasyn

Anti infective

Aminopenicillins

Beta lactamase inhibitors

Binds to bacterial cell wall, causing cell death.

CI in hypersensitivities to penicillins,.Probenecid decreases renal excretion and increases blood levels of ampicillin. Y site incompatibility if aminoglycosides and penicillins must be given concurrently, administer in separate sites at least 1 hr apart.

Side effects include: diarrhea, rashes, anaphylaxis, pseudomembranous colitis. Assess patient for infection. Obtain culture before starting therapy. Observe for signs of anaphylaxis; evaluate renal and hepatic function, cbc, k levels, and bleeding times. Monitor bowel function for pseudomembranous colitis. IV may be administered over 10-15 min within 1 hr of reconstitution. More rapid administration may cause seizures.

Anistreplase thrombolytic agents

Converts plasminogen to plasmin, which then degrades

fibrin clots.

Asprin, NSAIDS, warfarin, heparin and heparin like

agents.Y site: Do not

admix or administer with any other med

Intacranial Hemorrhage, reperfusion arrythmias, anaphylaxis, Gi bleed, retroperitoneal bleeding,GU tract bleeding.Assess for bleeding every15-30 min during the next8 hr, and at least every 4 hr for the duration of therapy. Assess neuro status throughout therapy(changes may indicate Intracranial hemorrhage)

Page 6: Drug Rationale

Administer over 2-5 min. Reconstitute with 5ml Sterile water.

Aprepitant

Emend

Antiemectic

Neurokinin antagonists

Acts as a selective antagonist at substance p receptors in the brain.

CI in lactation, hypersensitivity

Side effects include: dizziness fatigue, weakness, diarrhea, hiccups. Assess nausea, vomiting, appetite, bowel sounds, and abdominal pain prior to and following administration. Monitor hydration and nutritional status. May be administered without regard to food.

Ascorbic acid Vitamin C Involved in oxidation reduction reactions;tyrosine, folic acid iron, and carbohydrate metabolism; lipid and protein synthesis; cellular respiration; and resistance to infection

Recurrent kidney stones Avoid chronic use of large doses in pregnant women

drowsiness, fatigue, headache, insomnia, cramps, diarrhea, heartburn, nausea, vomiting, kidney stones, flushing, deep vein thrombosis, hemolysis (in G6PD deficiency), sickle cell crisis, If urinary acidification occurs, may increase excretion and decrease effects of mexiletine , amphetamine , or tricyclic antidepressants, Large doses (>10 g/day) may decrease response to warfarin

Antipyretics

Nonopioid analgesics

Salicylates

Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins.

Increased risk of bleeding with warfarin, heparin, heparin like agents, thrombolytics, ticlopidine, clopidogrel, tirofiban, or eptifibatide. May increase the activity of penicillins, phenytoin, methotrexate, valppoic acid, oral hypoglycemic agents and sulfonamides. Corticosteroids may decrease levels. May blunt the therapeutic response to diuretics, antihypertensives and NSAIDS.

Anaphylaxis, Laryngeal edema, and reyes syndrome (in children) may be fatal if they occur. Dyspepsia, epigastric distress, heartburn, and nausea are common. Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at increased risk for developing hypersensitivity reactions. Administer after meals or with food or an antacid to minimize gastric irritation. Do not use alcohol. Report unusual bleeding to doctor. Take with a full glass of water. Report tinnitus.

Aspirin Antipyretics Produce analgesia and reduce inflammation and fever by

Increased risk of bleeding with

Anaphylaxis, Laryngeal edema, and reyes syndrome

Page 7: Drug Rationale

Nonopioid analgesics

Salicylates

inhibiting the production of prostaglandins.

warfarin, heparin, heparin like agents, thrombolytics, ticlopidine, clopidogrel, tirofiban, or eptifibatide. May increase the activity of penicillins, phenytoin, methotrexate, valppoic acid, oral hypoglycemic agents and sulfonamides. Corticosteroids may decrease levels. May blunt the therapeutic response to diuretics, antihypertensives and NSAIDS.

(in children) may be fatal if they occur. Dyspepsia, epigastric distress, heartburn, and nausea are common. Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at increased risk for developing hypersensitivity reactions. Administer after meals or with food or an antacid to minimize gastric irritation. Do not use alcohol. Report unusual bleeding to doctor. Take with a full glass of water. Report tinnitus.

Atenolol

Tenormin

AntianginalAntiarrhythmicsAntihypertensive

Beta blocker selective

Block stimulation of beta1 adrenergic receptors, usually without affecting beta2 receptor sites.

General anesthesia and verapamil may cause decrease in myocardial depression. CI in pulmonary disease and renal disease, bradycardia and heart block.

Side effects include fatigue, weakness, blurred vision, brochospasm, wheezing, and impotence.Administer with meals or directly after eating. Take apical pulse, if <50bpm withhold medication. Monitor for bradycardia, dizziness, dyspnea and seizures. Assess I and O monitor for pulmonary edema. Administer atropine if pulse <40 bpm.

Atropine AntiarrhythmicsAnticholinergicsAntimuscarinics

Inhibits action of acetylcholine in smooth muscle, secretory glands, and CNS. Low doses decrease sweating, salivation, and respiratory secretions. Intermediate doses produce mydriasis, cycloplegia, and tachycardia. Larger doses decrease GI and GU tract motility.

CI in hypersensitivity, glaucoma, cardiac insufficiency or hemorrhage. Antacids decrease absorption.

Side effects include: drowsiness, blurred vision, tachycardia, dry mouth, urinary hesitancy or retention. Assess vital signs and ECG. Intense flushing of the face and trunk may occur 15-20 min after admin. Is expected. Give iv undiluted or dilute in 10 ml of sterile water.

Atrovastatin

(Lipitor)

Lipid lowering agentHGM-CoA reductase inhibitor

Inhibits 3-hydroxy-3 methylglutaryl-coenzyme A reductase, which is responsible for an early step in the synthesis of cholesterol. Lowers LDL, Increases HDL, decreases VLDL and triglycerides. Slows the progression of CAD with a decrease in MI and need for

Additive cholesterol lowering effect or decreased effectiveness with bile acid sequestrants, May slightly increase digoxin levels,

Abdominal cramps, constipation, diarrhea, flatus, heartburn, rashes and rhabdomyolysis may occur. Ophthalmologic exams are recommended before and yearly during therapy. If patient develops muscle tenderness during therapy,

Page 8: Drug Rationale

myocardial revascularization. May increase effects of warfarin. Grapefruit juice increases blood levels and increases risk of toxicity.

monitor CPK levels. If CPK levels are markedly increased or myopathy occurs, therapy should be discontinued.

Azathioprine

Azasan

Imuran

Immunosuppresants

Antagonizes purine metabolism with subsequent inhibition of DNA and RNA synthesis. Suppression of cell mediated immunity and altered antibody formation.

Additive myelosuppression with antineoplastics, cyclosporine, and myleosuppressive agents. Allopurinol increases toxicity. Echinacea and melatonin may interfere with immunosuppression.

Anorexia, hepatotoxicity, nausea, vomiting, anemia, leucopenia, pancytopenia, thrombocytopenia, chills, and fever may occur. Assess for infection. Monitor I&O, and daily weight. Decreased urine output may lead to toxicity. A decrease in hemoglobin may indicate bone marrow suppression. Monitor renal, hepatic, and hematologic functions before therapy, weekly during first month, bi-weekly for the next 2-3 months, and monthy thereafter. Advise patient to stay away people with know contagious diseases.

Azithromycin

Zithromax

Anti infective

Macrolides

Inhibits protein synthesis at the level of the 50s bacterial ribosome.

CI in hypersensitivity to macrolides. Nelfinavir increases serum levels, increases serum levels and effects of digoxin, theophylline, ergotamine, triazolam phenytoin, and warfarin.

Side effects include: abdominal pain, diarrhea, nausea, hyperglycemia, hyperkalemia, angioedema. Assess patient for infection. Obtain culture before starting therapy. observe for signs of anaphylaxis, evaluate renal and hepatic function, cbc, k levels, and bleeding times. Administer 1 hr before or 2 hr after meals. Do not administer as a bolus. Administer the 1mg/ml solution over 3 hr or the 2mg/ml solution over 1 hr.

Beclomethasone AntiasthmaticsCorticosteroids

Potent, locally acting anti inflammatory and immune modifier.

Use cautiously in diabetes and glaucoma, underlying immunosuppression.

Side effects include: headache, dysphonia, hoarseness, oropharyngeal fungal infections, and flu like syndrome. Monitor RR and lung sounds. Assess for adrenal insufficiency such as anorexia, nausea, weakness, fatigue, hypotension and hypoglycemia. May cause increase in serum glucose levels. Teach that this should not be used to treat an attack. Assess for signs and symptoms of infection.

Page 9: Drug Rationale

Benazepril

Lotensin

Antihypertensiveace inhibitor

Angiotensin converting enzyme inhibitors block the conversion of angiotensin one to the vasoconstrictor angiotensin two.

Excessive hypotension may occur with use of other antihypertensive. Y site incompatibility amphotericin b, cefepime, phenytoin.

Side effects include cough hypotension taste disturbances proteinuriamonitor blood pressure and pulse frequently during dose adjustments and periodically during therapy. Monitor weight and assess for fluid overload, monitor cbc, wbc and urine protein prior and during therapy. Teach patient to change positions slowly to reduce orthostatic hypotension and avoid excessive salt intake.

Benztropine

Cogentin

Antiparkinson agentAnticholinergic

Blocks cholinergic activity in the CNS, which is partially responsible for the symptoms of Parkinson’s disease. Restores the natural balance of neurotransmitters in the CNS.

CI in hypersensitivity, glaucoma, and tardive dyskinesia.

Side effects include:blurred vision, dry eyes, constipation, dry mouth, and urinary retention. Assess bowel function daily, monitor I & O, monitor pulse and bp and maintain bedrest for 1 hr after administration. Teach patient to change positions slowly to avoid orthostatic hypotension. Administer with food o after meals. Administer at a rate of 1mg over 1 min.

Betamethasone AntiasthmaticsLong actingCorticosteroids

Suppress inflammation and the normal immune response. Suppresses adrenal function. Has negligible mineralocorticoid activity.

CI in active infections, lactation, stress, and pregnancy. Use with NSAIDS increases risk of adverse GI effects.

Side effects include: depression, euphoria, hypertension, anorexia, nausea, acne, decreased wound healing, adrenal suppression, cusingoid appearance. Only betamethasone sodium phosphate may be given IV. Administer undiluted and over at least 1 min. Monitor I & O, teach patient not to stop medication abruptly, assess glucose and K levels.

Betaxolol

kerlone

AntianginalAntiarrhythmicsAntihypertensive

Beta blocker selective

Block stimulation of beta1 adrenergic receptors, usually without affecting beta2 receptor sites.

General anesthesia and verapamil may cause decrease in myocardial depression. CI in pulmonary disease and renal disease, bradycardia and heart block.

Side effects include fatigue, weakness, blurred vision, brochospasm, wheezing, and impotence.Administer with meals or directly after eating. Take apical pulse, if <50bpm withhold medication. Monitor for bradycardia, dizziness, dyspnea and seizures. Assess I and O monitor for pulmonary edema. Administer atropine if pulse <40 bpm.

Page 10: Drug Rationale

Bisacodyl

Dulcolax

Laxative

Stimulant laxative

Stimulates peristalsis by altering fluid and electrolyte transport, producing fluid accumulation in the colon.

Antacids, histamine H2-receptor agonists, and gastric acid pump inhibitors may remove enteric coating on tablet. May decrease absorption of other oral meds. Milk may remove enteric coating.

Abdominal cramps and nausea may occur. Assess for abdominal distention, presence of bowel sounds, and usual pattern of function.

Bisoprolol

Zebeta

AntianginalAntiarrhythmicsAntihypertensive

Beta blocker selective

Block stimulation of beta1 adrenergic receptors, usually without affecting beta2 receptor sites.

General anesthesia and verapamil may cause decrease in myocardial depression. CI in pulmonary disease and renal disease, bradycardia and heart block.

Side effects include fatigue, weakness, blurred vision, brochospasm, wheezing, and impotence.Administer with meals or directly after eating. Take apical pulse, if <50bpm withhold medication. Monitor for bradycardia, dizziness, dyspnea and seizures. Assess I and O monitor for pulmonary edema. Administer atropine if pulse <40 bpm.

Budesonide

pulmicort

AntiasthmaticsCorticosteroids

Potent, locally acting anti inflammatory and immune modifier.

Use cautiously in diabetes and glaucoma, underlying immunosuppression.

Side effects include: headache, dysphonia, hoarseness, oropharyngeal fungal infections, and flu like syndrome. Monitor RR and lung sounds. Assess for adrenal insufficiency such as anorexia, nausea, weakness, fatigue, hypotension and hypoglycemia. May cause increase in serum glucose levels. Teach that this should not be used to treat an attack. Do not shake inhaler, inhale forcefully and do not blow back into inhaler. Assess for signs and symptoms of infection.

Bupropion

Wellbutrin

Antidepressant

Smoking deterrent

Decreases neuronal reuptake of dopamine in the CNS. Diminished neuronal uptake of serotonin and norepinephrine.

CI in hypersensitivity, MAOI use, history of seizures, bulimia or anorexia nervosa.

Side effects include: agintation, headache, dry mouth, nausea, vomiting and tremor. Monitor mood changes, suicidal tendencies and hepatic and renal function closely. Admin. Doses in equally spaced time increments throughout day to minimize the risk of seizures. May be admin with food to lessen GI irritation.

Page 11: Drug Rationale

Calcium acetate gelcaps,

calcium citrate

calcium gluceptate 

Phoslogelcap

Mineral and electrolyte replacement

Acts as an activator in the transmission of nerve impulses and in the contraction of cardiac, skeletal, and smooth muscle.

Calcium acetate should not be given concurrently with other calcium supplements.

Side effects include syncope, arrhythmias, constipation and vomiting.  Monitor serum calcium or ionized calcium levels.  Follow oral doses with a full glass of water.  Administer with meals for patients with hyperphosphatemia.

Calcium Carbonate

 Caltrate

Calcium glucanate

Calcium lactate

Tricalcium phosphate

Mineral and electrolyte replacement/ supplement

Essential for nervous, muscular and skeletal systems.  Maintains cell membrane and capillary permeability.  Essential for bone formation and blood coagulation.

Use cautiously with cardiac disease. 

Side effects include:  arrhythmias, constipation, nausea and vomiting.  Observe for symptoms of hypocalcemia.  Monitor serum calcium.  Patients calcium level on 10/26/07 9.1.  Administer after meals and at bedtime.  Follow oral dose with full glass of water.

Candesartan

Atacand

Antihypertensive

Angiotensin II receptor antagonist

Blocks vasoconstrictor and aldosterone-produing effects of angiotensin II at receptor sites, including vascular smooth muscle and the adrenal glands.

NSAIDS may decrease drug effects. Risk of hypotension when used with diuretics.

Side effects include: dizziness, fatigue, headache, hypotension, renal failure and hyperkalemia. Assess bp and pulse before administering. Assess patient for signs of angioedema (dyspnea and facial swelling), monitor I & O, auscultate lungs for rales or crackles, monitor labs. May be administered with or without meals.

Captopril

capoten

Antihypertensiveace inhibitor

Angiotensin converting enzyme inhibitors block the conversion of angiotensin one to the vasoconstrictor angiotensin two.

Excessive hypotension may occur with use of other antihypertensive. Y site incompatibility amphotericin b, cefepime, phenytoin.

Side effects include cough hypotension taste disturbances proteinuriamonitor blood pressure and pulse frequently during dose adjustments and periodically during therapy. Monitor weight and assess for fluid overload, monitor cbc, wbc and urine protein prior and during therapy. Teach patient to change positions slowly to reduce orthostatic hypotension and avoid excessive salt intake. Administer 1 hr before or 2 hr after meals. Tabs may be crushed and may have a sulfurous odor.

Page 12: Drug Rationale

Carbamazepine Anticonvulsant Decreases synaptic transmission in the CNS.

CI in bone marrow suppression, hypersensitivity and pregnancy.

Side effects include: ataxia, drowsiness and blurred vision. Assess for seizure, trigeminal neuralgia, monitor cbc, platelet count and iron levels, LFT and thyroid tests. Implement seizure precautions, admin with food, do not crush extended release tabs.

Carboplatin Antineoplastics

Alkylating agents

Inhibits DNA synthesis by producing cross linking of parent DNA strands.

Increased nephrotoxicity and ototoxicity with other nephrotoxic and ototoxic drugs. Increased bone marrow depression with other bone marrow depressing drugs or radiation therapy. May decrease antibody response to live-virus vaccines.

Anemia, leucopenia, thrombocytopenia, and anaphylactic like reactions may be fatal if they occur. Abdominal pain, nausea, vomiting, hypocalcemia, hypokalemia, hypomagnesemia, and hyponatremia are common.

Assess for nausea and vomiting. Monitor for bone marrow suppression. Monitor for signs of anaphylaxis. Monitor electrolyte balance.

Carteolol

cartrol

AntianginalAntihypertensiveAntiarrhythmics

Beta BlockerNon selective

Block stimulation of beta adrenergic and beta two adrenergic receptor sitesDecreases heart rate and blood pressure, produces less bradycardia than other beta blockers.

Hypotension may occur with other antihypertensivesNSAIDs may decrease antihypertensive actions. CI in uncompensated CHF or pulmonary edema.

Side effects include fatigue, weakness, anxiety, blurred vision, arrhythmias, impotence, constipation, and diarrhea. May be administered with food. Patients receiving IV must have continuous ECG monitoring. Take apical pulse, if <50bpm withhold medication. Tell patient to change positions slowly to avoid orthostatic hypotension.

Carvedilol

coreg

AntianginalAntihypertensiveAntiarrhythmics

Beta BlockerNon selective

Block stimulation of beta adrenergic and beta two adrenergic receptor sitesDecreases heart rate and blood pressure, produces less bradycardia than other beta blockers.

Hypotension may occur with other antihypertensivesNSAIDs may decrease antihypertensive actions. CI in uncompensated CHF or pulmonary edema.

Side effects include fatigue, weakness, anxiety, blurred vision, arrhythmias, impotence, constipation, and diarrhea. May be administered with food. Patients receiving IV must have continuous ECG monitoring. Take apical pulse, if <50bpm withhold medication. Tell patient to change positions slowly to avoid orthostatic hypotension.

Page 13: Drug Rationale

Cefaclor

Ceclor

Anti infective

Second generation cephalosporin

Binds to bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy.

Cefadroxil

Duricef

Anti infective

First generation cephalosporin

Binds to bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Admin around the clock, can be on empty stomach, IM may be diluted with lidocaine to min. injection discomfort, inject deep into well developed muscle, massage well, administer IV slowly over 3-5 min.

Cefazolin

ancef

Anti infective

First generation cephalosporin

Binds to bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics. Y site incom amphotericin B cholesteryl sulfate complex, idarubicin, pentamidine, vinorelbine. Syringe incom lidocaine.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Administered over 30-60min.

Cefdinir

Omnicef

Anti infectiveThird generation cephalosporins

Bind to the bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Do not administer within 2 hrs of an antacid or 2 hrs after an iron supplement.

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Cefditoren

Spectracef

Anti infectiveThird generation cephalosporins

Bind to the bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Administer with meals to enhance absorption. Do not administer concomitantly with antacids.

Cefepime

Maxipime

Anti infectiveThird generation cephalosporins

Bind to the bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics. Y site incomp acyclovir, amphotericin b, amphotericin b cholesteryl sulfate, chlordiazepoxide, chlorpromazine, cimetidine, ciprofloxacin, diphenhydramine.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Administer over 30 minutes.

Cefmetazole

Zefazone

Anti infective

Second generation cephalosporin

Binds to bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics. Y site imcomp diphenhydramine, dobutamine,droperidol, erythromycin lactobionate, haloperidol, prochlorperazine, promethazine.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Administer over 10-60 min.

Cefonicid

Monocid

Anti infective

Second generation cephalosporin

Binds to bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics. Y site

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Administer over 20-30 minutes.

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incomp filgrastim, sargramostim.

Cefoperazone

Cefobid

Anti infectiveThird generation cephalosporins

Bind to the bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics. Y site incomp amifostine, filgrastim, labetalol, meperidine, ondansetron, promethazine.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Administer over 15-30 minutes. Syringe compatibility is heparin.

Cefotaxime

Claforan

Anti infectiveThird generation cephalosporins

Bind to the bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics. Y site incomp allopurinol, filgrastim, fluconazole, gemcitabine, hetastarch, pentamidine

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Syringe comp. is heparin and ofloxacin. Administer over 20-30 minutes.

Cefotetan

Cefotan

Anti infective

Second generation cephalosporin

Binds to bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics. Y site incomp. Promethatzine, vinorelbine.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Administer over 20-30 minutes.

Cefoxitin

Mefoxin

Anti infective

Second generation cephalosporin

Binds to bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics. Y site incomp. Stop other mediations during infustion,

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Administer over 15-30 minutes.

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filgrastim, gatifloxacin, pentamidine.

Cefpodoxime

Vantin

Anti infectiveThird generation cephalosporins

Bind to the bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Do not administer within 2 hr of an antacid.

Cefprozil

Cefzil

Anti infective

Second generation cephalosporin

Binds to bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy.

Ceftazidime Anti infectiveThird generation cephalosporins

Bind to the bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics. Y site incomp amphotericin b, doxorubicin, fluconazole, midazolam and warfarin.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Syringe compatibility is hydromorphone. Administer over 15-30 minutes.

CeftibutenCedax

Anti infectiveThird generation cephalosporins

Bind to the bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy.

Ceftizoxime

Cefizox

Anti infectiveThird generation cephalosporins

Bind to the bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics. Y site

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Administer over 15-30 inutes.

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incomp filgrastim.Ceftriaxone

rocephin

Anti infectiveThird generation cephalosporins

Bind to the bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics. Y site incomp amphotericin b cholesteryl sulfate, filgrastim, fluconazole, labetalol, pentamidine, vinorelbine.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Administer over 15-30 minutes.

Cefuroxime

Ceftin, zinacef

Anti infective

Second generation cephalosporin

Binds to bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics. Y site incomp discontinue primary solution when administering cefuroxime via y site. Filgrastim, fluconazole, midazolam, vinorelbine.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Administer over 15-60 minutes

Celecoxib Antiheumatics,

NSAID

COX-2 inhibitors

Inhibits the enzyme COX-2. This enzyme is required for the synthesis of prostaglandins. Has analgesic, anti-inflammatory, and antipyretic properties.

May decrease the effectiveness of ACE inhibitors, thiazide diuretics, and furosemide. May increase risk of bleeding wth warfarin. May increase levels of lithium.

GI bleeding. Assess patients range of motion, degree of swelling, and pain in affected joints before and periodically throughout therapy.

Cephadrine

velosef

Anti infective

First generation cephalosporin

Binds to bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy.

Cephalexin Anti infective Binds to bacterial cell wall Probenecid Side effects include: pain at

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keflex First generation cephalosporin

membrane, causing cell death. decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics.

IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy.

Cephapirin

cefadyl

Anti infective

First generation cephalosporin

Binds to bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy. Administer over at least 15-20 min. solution may be diluted in 500-1000 ml.

Chlordiazepoxide Sedative/ Hypnotic

Barbiturate

Antianxiety agent

Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.

Additive CNS depression with alcohol, antihistamines, opoid analgesics.Decreased effectiveness with: levodopa, barbiturates or rifampin

Dizziness, drowsiness, pain at IM site. Monitor CBC and liver function tests. May cause increased bilirubin, AST, and ALT.

Chlorothiazide(Diuril)

Chlorthalidone

Hydrochlorothiazide

Thiazide diuretic

Antihypertensive

Increases excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule.

Increased risk of hypotension with other antihypertinsives, or nitrates. Hypokalemia is increased with the use of amphotericin B, mezlocillin, stimulant laxatives, piperacillin, or ticarcillin. Decreased effectiveness with NSAIDS.

Hypokalemia and hyperuricimia is common. Monitor electrolytes, blood glucose, BUN, creatinine, and uric acid levels before and periodically through therapy. Monitor blood pressue before and periodically throughout therapy. Assess I&O, daily weights, and feetlegs and sacral area for edema daily.

Choline and magnesium salicylate

Antipyretics

Nonopioid analgesics

Salicylates

Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins.

May increase the activity of penicillins, phenytoin, methotrexate, valppoic acid, oral hypoglycemic

Anaphylaxis, Laryngeal edema, and reyes syndrome (in children) may be fatal if they occur. Dyspepsia, epigastric distress, heartburn, and nausea are common. Patients who have asthma,

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agents and sulfonamides. Corticosteroids may decrease levels. May blunt the therapeutic response to diuretics, antihypertensives and NSAIDS.

allergies, and nasal polyps or who are allergic to tartrazine are at increased risk for developing hypersensitivity reactions. Administer after meals or with food or an antacid to minimize gastric irritation.

Choline Salicylate

Arthropan

Antipyretics

Nonopioid analgesics

Salicylates

Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins.

May increase the activity of penicillins, phenytoin, methotrexate, valppoic acid, oral hypoglycemic agents and sulfonamides. Corticosteroids may decrease levels. May blunt the therapeutic response to diuretics, antihypertensives and NSAIDS.

Anaphylaxis, Laryngeal edema, and reyes syndrome (in children) may be fatal if they occur. Dyspepsia, epigastric distress, heartburn, and nausea are common. Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at increased risk for developing hypersensitivity reactions. Administer after meals or with food or an antacid to minimize gastric irritation.

Cimetidine Antiulcer agents

Histamine H2 antagonist

Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.

May increase levels of toxicity with benzodiazepines and some beta blockers, caffeine, calcium channel blockers, carbamazepine, chloroquine, lidocaine and warfarin. Lowers absorption of ketoconazole

Confusion, Agranulocytosis, and aplastic anemia may occur. Asses for abdominal or epigastric pain and occult blood. Monitor CBC and Diff periodically throughout therapy. Avoid administration of antacids within 30 min-1hr of administration. Sucralfate 2hrs after administration. Administer with meals or immediately afterward and at bedtime to prolong effect.

Ciprofloxacin

Cipro

Anti-infective

fluoroquinolone

Inhibit bacterial DNA synthesis by inhibiting DNA gyrase. Causes death of susceptible bacteria.

Concurrent use with corticosteroids may increase the risk of tendon rupture.

Side effects include: Dizziness, drowsiness, headache, insomnia, abdominal pain, diarrhea, nausea. Ciprofloxacin should not be taken with milk or yogurt alone. May be

Page 20: Drug Rationale

administered with meals. Monitor for signs of infection.

Cisplatin

Plantinol

Antineoplastics

Alkylating agents

Inhibits DNA synthesis by producing cross linking parent DNA strands.

Increased nephrotoxicity and ototoxicity with other nephrotoxic and ototoxic drugs. Increased bone marrow depression with other bone marrow depressing drugs or radiation therapy. May decrease antibody response to live-virus vaccines.

Seizures, leukopenia, and thrombocytopenia may be deadly if they occur. Ototoxicity, tinnitus, sever nausea, vomiting, hypocalcemia, hypokalemia, hypomagnesemia, and anemia are common. Encourage patient to drink 2000-3000 ml/day to promote excretion of uric acid. Administer antiemetics 30-45 min before therapy.

Citalopram

Hydrobromide

Celexa

Treatment of depression, often in conjunction with psychothereapy

Inhibits the reuptake of serotonin in the CNS

History of mania, history of suicide attempt during dose adjustment, history of seizure disorder, hepatic impairment or geriatric pts. pregnancy and lactation

Apathy, confusion, drowsiness, insomnia, weakness, agitation, amnesia, anxiety, decreased libido, dizziness, fatigue, impaired concentration, depression, migrane, abnormal accommodation, cough, postural hypotension, abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia, flatulence, increased saliva, nausea, altered taste, increased appetite, vomiting, increased sweating, tremor.

Clarithromycin

biaxin

Anti infectiveAntiulcer

macrolides

Inhibits protein synthesis at the level of the 50s bacterial ribosome.

CI in hypersensitivity to macrolides. May increase risk of arrhythmias with pimozide.

Side effects include: abdominal pain, diarrhea, nausea, dyspepsia, ventricular arrhythmias, headache and abnormal taste. Assess patient for infection. Obtain culture before starting therapy. observe for signs of anaphylaxis, evaluate renal and hepatic function, cbc, k levels, and bleeding times. Administeraround the clock, without regard to meals. Food slows but does not decrease the extent of absorption. Do not administer within 4 hr of zidovudine.

ClonidineCatapres

Antihypertensive Stimulates alpha adrenergic receptors in the CNS which result in decreased sympathetic

Additive sedation with CNS depressants

Side effects include drowsiness dry mouth withdrawal phenomenon

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outflows inhibiting cardio acceleration and vasoconstriction centers

additive bradycardia with myocardial depressant including beta-blockers

dizziness hypotensionPatch - administer to hairless site on chest or upper arm. Wash area with soap and water dry before application.

Clopidogrel Antiplatelet agents

Platelet aggregation inhibitors

Inhibits platelet aggregation by irreversibly inhibiting the binding of adenosine triphosphate to platelet receptors.

Increased risk of bleeding with abciximab, eptifibatide, tirofiban, aspirin, NSAIDS, heparin, heparinoids, thrombolytic agents, ticlopidine, or warfarin.

GI Bleeding, Bleeding, neutropenia, thrombotic thrombocytopenic purpura may be deadly if they occur. Assess for signs and symptoms of stroke, PVD, or MI periodically during therapy. Discontinue clopidogrel 5-7 days before planned surgerical procedures. Advise patient to notify health care provider if fever, chills, sore throat, or unusual bleeding or bruising occurs.

Codeine

Paveral

Opioid antagonists

Allergy, cold, and cough remedies, antitissives

Binds to the opiate receptors in the CNS-alters perception and response to painful stimuli. Produces CNS depression.

Use extreme caution if patient takes MAOI.Increases CNS depression when used with other sedatives.

Confusion, sedation, hypotension, constipation, nausea, vomiting.Increase intake of fluids, bulk, stool softeners and laxatives.

Colchicine Anti gout agent Interferes with the functions of WBC in initiating and perpetuating the inflammatory response to monosodium urate crystals.

Additive bone marrow depression if used with bone marrow depressants.

Diarrhea, nausea, and vomiting are common.

ConazepamKlonopin

AnticonvulsantsBenzodiazepine

Anticonvulsant effects may be caused by presynaptic inhibition. Produces sedative effects in the CNS, probably by stimulating inhibitory GABA receptors.

Alcohol, antidepressants and other benzos may have additive CNS depression.

Side effects include behavioral changes, drowsiness and ataxia. Observe for seizure activity, assess mental status and for drowsiness. Institute seizure precautions, administer with food to minimize gastric irritation.

Concentrated regular insulin

Regular Iletin II U-500

Antidiabetics, hormones

Pancreatics

Lower blood glucose by increasing transport into cells and promoting the conversion of glucose to glycogen. Promote the conversion of amino acids to proteins in muscle and stimulate triglyceride formation. Inhibit the release of free fatty acids.

CI in hypersensitivity to insulin, infection.

Side effects include hypoglycemia, lipdystrophy, anaphylaxis. Assess for signs and symptoms of hypoglycemia, blood glucose and ketones. Must be verified by another nurse, use only insulin syringes to draw up dose. Draw up clear insulin

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before mixed. Administer SQ at 45 degree angle. Should not be administered IV

:Onset 30-60 min Peak 2-4 hr Duration 5-7 hr

Conjugated Estrogen

Premarin

Hormone Promote the growth and evelopment of female sex organs and the maintenance of secondary sex characteristics in women. Restoration of hormonal balance in various deficiency states

Thromboembolic disease undiagnosed vaginal bleeding Pregnancy lactation

MI Thromboembolism edema htn headache intolerance to contact lenses worsening of myopia or astigmatism nausea weight changes amenorrhea breakthrough bleeding dysmenorrheal impotence testicular atrophy acne oily skin gynecomastia breast tenderness

Cortisone Antiasthmaticsshort actingcorticosteroids

Suppress inflammation and the normal immune response. Suppresses adrenal function. Replaces endogenous cortisol in deficiency states. Also has potent mineralocorticoid activity.

CI in active infections, lactation, stress, and pregnancy. Use with NSAIDS increases risk of adverse GI effects.

Side effects include: depression, euphoria, hypertension, anorexia, nausea, acne, decreased wound healing, adrenal suppression, cusingoid appearance. Monitor I & O, teach patient not to stop medication abruptly, assess glucose and K levels.

Cyclophosphamide

Antineoplastics

Immunosuppressant

Alkylating agent

Interferes with protein synthesis (cell-cycle phase specific). Death of rapidly replicating cells, particularly malignant ones. Immunosuppressant action in small doses.

Phenobarbitol or Rifanpin may increase toxicity. Allopurinol or thiazide diuretics may increase bone marrow suppression. Cardiotoxicity may be increased with other cardiotoxic agents. May potentiate the effects of warfarin.

Anorexia, nausea, vomiting, alopecia, leucopenia, thrombocytopenia, pulmonary fibrosis, myocardial fibrosis, hemorrhagic cystitis and anemia may occur. Monitor urinary output. Fluid intake should be > 3000 ml/day. Assess for fever chills, sore throat, and signs of infection. Assess for bleeding. Avoid IM injections or rectal temps. Antimedics may be given 30min before to minimize GI effects. Monitor CBC and Diff before and throughout therapy.

Cyclosporine Immunosuppress Inhibits normal immune responses (cellular and

Risk of toxicity with amphotericin

Seizure, tremor, hypertension, diarrhea, hepatotoxicity,

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Antiantirheumatic

humoral) by inhibiting interleukin-2.

B, aminoglycosides, amiodarone, anabolic steroids, and sone calcium channel blockers, NSAIDS, hormonal contraceptives and sone HIV protease inhibitors. Increased immunosuppression with other immunosuppresants. Grapefruit or grapefruit juice increases absorption and should be avoided.

nausea, vomiting, nephrotoxicity, hirsutism, gingival hyperplasia, hypersensitivity reactions and infections may occur. Monitor I&O and B/P closely. Monitor for increased BUN and Creatinine for Nephrotoxicity. Monitor for increased AST, ALT, alkaline phosphate, amylase, and biliruben levels for hepatotoxicity. Patient should be isolated from other sick patients and visitors. Patient should have frequent mouth care and dental examinations every 3 months.

D5 ½ NS Nutritional supplement

Increases the intake of calories for patients who are unable to eat or are on NPO status.

May increase glucose levels in patients with diabetes.

Side effects include confusion, loss of consciousness, dizziness, hypertension, chf, pulmonary edema and hyperglycemia.  Monitor electrolyte levels and blood glucose.

D5 1\2 NS 20 MEQ KCL

Mineral and electrolyte replacement supplement

Maintaining acid-base balance and electrophysiologic balance of the cell

Hyperkalemia can result with the use of potassium sparing diuretics or ace inhibitors

Side effects include abdominal pain and diarrhea

nausea and vomiting Assess patient for signs and symptoms of hypokalemia

and hyperkalemia Monitor pulse blood pressure and ECG throughout IV therapy

D5 Lactated Ringers

Electrolyte supplement/ replacement

This medication is an intravenous (IV) solution used to supply water and electrolytes (e.g., calcium, potassium, sodium, chloride), either with or without calories (dextrose), to the body.

Use cautiously with diabetes and heart disease.  Monitor for fluid overload.

Side effects include: fever, trouble breathing, and swelling. 

Daclizumab

Zenapax

Immunosuppressant

Monoclonal antibodies

Binds specifically to interleukin-2 receptor sites on activated lymphocytes, acting as an IL-2 receptor antagonist. This prevents further activation of lymphocytes and allograft

AStragalus, Echinacea, and melatonin may interfere with immunosuppression.

Pulmonary edema may occur. Assess for fluid overload. Monitor I&O, daily weights, and lung sounds. Obtain chest x-ray within 24hrs of first dose. Monitor for

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rejection. Do not admix or administer in line containing other meds.

anaphylactic and hypersensitivity reactions at each dose. Monitor for infection.Flush before and after admin with saline. Administer over 15 min via peripheral or central line.

Darbepoetin

Aranesp

Antianemics

Hormones rDNA

Stimulates erythropoiesis

Maintains and may elevate rbc counts, decreasing the need for transfusions.

CI in uncontrolled htn.

Side effects include: dizziness, fatigue, headache, cough, dyspnea, htn, hypotension, abdominal pain, nausea, diarrhea, vomiting and fever. Monitor BP before and during therapy. Monitor cbc for anemia. Monitor iron levels and renal function throughout therapy. IV administer undiluted and do not administer in conjunction with other drugs or solutions.

Desirudin

Iprivask

AnticoagulantThrombin inhibitor

Selectively inhibits free and clot bound thrombin. Inhibition of thrombin prevents activation of factor 5, 8, 12, conversion of fibrinogen to fibrin, platelet adhesion and aggregation.

CI in active bleeding and coagulation disorders. Do not mix with other diluents or medications.

Side effects include: nausea, bleeding, anemia, wound secretion. Assess patient for signs of bleeding, thrombosis, cbc and aptt. Rotate sites for SQ injection. Do not rub site , inject entire length of needle while pinching skin between thumb and forefinger.

dexamethasone AntiasthmaticsLong actingcorticosteroids

Suppress inflammation and the normal immune response. Suppresses adrenal function. Has negligible mineralocorticoid activity.

CI in active infections, lactation, stress, and pregnancy. Use with NSAIDS increases risk of adverse GI effects.

Side effects include: depression, euphoria, hypertension, anorexia, nausea, acne, decreased wound healing, adrenal suppression, cusingoid appearance. May be given undiluted do not administer suspension IV, administer over 1 min. Monitor I & O, teach patient not to stop medication abruptly, assess glucose and K levels.

Diazepam Antianxiety

Anticonvulsant

Sedative/Hypnotic

benzodiazepine

Depresses the CNS, probably by potentiating GABA. Produces skeletal muscle relaxation by inhibiting spinal polysynaptic afferent pathways. Has anticonvulsant properties because of enhanced presynaptic inhibition.

Additive CNS depression with alcohol, antihistamines, opoid analgesics. Decreased effectiveness with: levodopa, barbiturates or rifampin

Dizziness, drowsiness, lethargy.Avoid driving or other activities that require alertness. Abrupt withdrawl may cause insomnia, irritability, nervousness, or seizure.

Diclofenac Nonopioid Inhibits prostaglandin Aspirin may GI bleeding, abdominal pain,

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analgesics

NSAID

synthesis. decrease effectiveness. Increased GI effects with aspirin, NSAIDS, colchicines, corticosteroids or alcohol.

dyspepsia, heartburn, and anaphylaxis.May cause increased BUN, serum creatinine, and electrolytes. Take with full glass of ater. Wear sun protection to prevent photosensitivity reaction. Contact doctor if flu like symptoms occur.

Diltiazem

Cardizem

AntihypertensiveAntiarrhythmics

Calcium channel blocker

Inhibits the transport of calcium into myocardial and vascular smooth muscle cells resulting in inhibition of excitation-contraction coupling and subsequent contraction

Additive hypotension may occur when used with other antihypertensives bradycardia may result when used with beta-blockers. Concurrent ingestion of grapefruit juice increases blood levels and effects.

Side effects include anxiety confusion peripheral edema diarrhea nausea vomiting hyperglycemia arrhythmias nocturiaMay be administered undiluted administer each dose as a bolus over two minutes.Monitor blood pressure and pulse before administration.

Diphenhydramine

Benadryl

Allergy and antihistamine

Antagonizes effects of histamine at H1 receptors, does not bind to or inactivate histamine. Significant CNS depressant and anticholinergic effects.

Increased risk of CNS depression with other antihistamines, opiod analgesics and sedative hypnotics.

Side effects include: Drowsiness, anorexia, dry mouth, constipation, and diarrhea. Assess degree of itching. Assess sleep patterns. Administer with meals or milk to minimize GI irritation. Capsule may be emptied and contents taken with water or food.

Diphenoxylate/atropine

Difenoxin/atropine

Antidiarrheals

Anticholinergics

Inhibits excess GI motility. Structurally related to opioid analgesics but has no analgesic properties. Atropine added to discourage abuse.

CI in dehydration, liver disease, infectious diarrhea and children <2yo. Additive CNS depression with other CNS depressants including alcohol, and sedatives. Do not use with MAOI’s.

Side effects include: dizziness, constipation, blurred vision, tachycardia and urinary retention and flushing. May be administered with food, teach patient good oral hygiene, take medication exactly as directed. May cause drosiness.

Dipyridamole Antiplatelet agents

Platelet adhesion

Decreases platelet aggregation by inhibiting the enzyme phosphodiesterase.

Additive effects with aspirin. Increased risk of bleeding with heparins, warfarin, NSAIDS, thrombolytics, sulfinpyrazone, ticlopidine, clopidogrel, abciximab,

Dissiness, headache, hypotension and nausea are common. PO: Monitor BP and pulse before and during therapy. Administer with full glass of water at least one hr before or 2 hrs after meals. If GI irritation occurs, administer with meals. IV: Dilute in at least a 12 ratio

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tirofiban, epitibatide, valproic acid, or plicamycin. Increased hypotension with alcohol.

of 0.45% NaCl, 0.9% NaCl, or D5W for a total volume of 20-50ml. Infuse over 4 min. Notify health care provider if dyspnea or chest pain occurs.

Divalproex sodiumValproate sodium

Valproic acid

AnticonvulsantsVascular headache suppressants

Increases levels of GABA and inhibitory neurotransmitter in the CNS.

CI in liver impairment and hypersensitivity. Increased risk of bleeding when used with antiplatelet agents.

Side effects include: indigestion, nausea, vomiting and hyper salivation. Assess mood and behavior, assess seizure activities, monitor for headaches, and monitor liver function and thyroid tests. Administer with or after meals. Infuse over at least 60 minutes

Docusate calcium

Docusate sodium(Colace)

Laxative

Stool softeners

Promotes incorporation of water into stool, resulting in softer fecal mass.

Ni significant incompatibilities.

Administer with full glass of water or juice. Faster absorption on empty stomach. Assess for abdominal distention, presence of bowel sounds, and usual pattern of function.

Donepezil(Aricept)

Reversible CholinesteraseInhibitor

Elevates acetylcholine concentrations by slowing degradation of acetylcholine released in cholinergic neurons, does not alter underlying dementia.

Other anticholerginics may decrease the effects of this drug.

Nausea, vomiting, and diarrhea are common. Atrial fibrillation may be fatal if it occurs.

Doxazosin

Cardura

AntihypertensivePeripherally acting antiadrenergics

Dilates both arteries and veins by blocking postsynaptic alpha adrenergic receptors.

CI in hypersensitivity. Increased hypotension with other antihypertensives, alcohol, or nitrates.

Side effects include: dizziness, headache, weakness, nasal conogestion, orthostatic hypotension, nausea and vomiting. Assess bp and pulse before administering. Syncope may occur 30-120 mi after administration, monitor I and O. administer initial dose at bedtime.

Doxepin AntidepressantAntianxiety agentantihistamineTricyclic antidepressant

Prevents reuptake of norepinephrine serotonin by presynaptic neurons, resultant accumulation of neurotransmitters potentiates activity.

CI in pregnancy and lactation and narrow angle glaucoma.

Side effects include: fatigue, sedation, blurred vision, dry eyes, constipation, dry mouth and weight gain. Monitor BP and Pulse before giving, monitor mental status, suicidal tendencies, and

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assess for pain. Administer with or immediately after a meal, do not mix with carbonated beverages or grape juice.

Doxorubicin hydrochloride

Antineoplastics

Anthracyclines

Inhibits DNA and Rna synthesis by forming complex with DNA; action is cell cycle S phase specific.

Increased bone marrow depression with other bone marrow depressing drugs or radiation therapy. May decrease antibody response to live-virus vaccines.

Cardiomyopathy and ECG changes may be fatal if they occur. Diarrhea, esophagitis, nausea, stomatitis, vomiting, red urine, alopecia, anemia, leukopenia, thrombocytopenia, and phlebitis at IV site are common.

Doxycycline

Minocycline

Tetracycline

Anti infectives Inhibits bacterial protein synthesis at the level of the 30 s bacterial ribosome,

CI in hypersensitivity, pregnancy and lactation. May increase the effects of warfarin.. sulcrafate may bind to tetracycline and prevent its absorption form the GI tract. Y sit e incomp. Allopurinol, heparin, piperacillin/taxobactam.

Side effects include:dizziness, vestibular reactions, diarrhea, nausea, vomiting, photosensitivity and superinfection. Assess patient for infection. Obtain culture before starting therapy. Assess IV site for thrombophlebitis. Administer around the clock. Administer with a full glass of liquid and at least 1 hr before going to bed to avoid esophageal ulceration.

Drotrecogin

Xigris

Anti infective

Activated protein c, human

Probably acts by suppressing widespread inflammation associated with sepsis.

CI in hypersensitivity, patients with a high risk of bleeding, stroke, head trauma, epidural catheter, increased chance of bleeding when used with antiplateley, anticoagulants, thrombolytic and other agents that may affect coagulation. Y sit eincompatibility administer via a dedicated IV line or a dedicated lumen of a multilumen central venous

Side effects include: bleeding. Assess patient for signs of bleeding and hemorrhage, assess for infection, monitor apt and pt. discontinue 2 hr prior to invasive surgical procedures.

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catheter.Efavirenz

Sustiva

Anti-retrovirals

Non-nucleoside reverse transcriptase inhibitor

Inhibits HIV reverse transcriptase, which results in disruption of DNA synthesis.

Increased CNC depression with other CNS depressants. Ritonavir may increase hepatoxicity. May alter effectiveness of hormonal contraception. May alter effects of warfarin.

Nausea and rash are common. Asses for change in severity of HIV symptoms or symptoms of opportunistic infections. Assess for CNS and psychiatric symptoms which may occur 1-2 days after therapy and resolve within 2-4 wks. Monitor CD4 and viral load counts during therapy. Inform patient that this therapy does not cure HIV and the Importance of strict drug adherence.

Emtricitabine

Emtriva

Anti-retrovirals

Nucleoside reverse transcriptase inhibitor

Phosphorylated intacellularly where it inhibits HIV reverse transcriptase, resulting in viral DNA chain termination.

No incompatibilities noted.

Headache, diarrhea, nausea and rash are common. Severe hepatomegaly with steatosis is fatal if occurs. Asses for change in severity of HIV symptoms or symptoms of opportunistic infections. Assess for signs of lactic acidosis and severe hepatomegaly with steatosis ( increased serum lactate levels, elevated liver enzymes, and liver enlargement on palpation. If these signs are present, stop therapy. Contact MD.

Enalaprilat

Vasotec

Antihypertensiveace inhibitor

Angiotensin converting enzyme inhibitors block the conversion of angiotensin one to the vasoconstrictor angiotensin two.

Excessive hypotension may occur with use of other antihypertensive

Side effects include cough hypotension taste disturbances proteinuriamonitor blood pressure and pulse frequently during dose adjustments and periodically during therapymay be administered undilutedadminister over at least five minutes

Enoxacin

Penetrex

Anti infective

Fluoroquinolone

Inhibit bacterial DNA synthesis by inhibiting DNA gyrase.

CI in hypersensitivity and pregnancy.

Side effects include: dizziness, drowsiness, headache, insomnia, abdominal pain, diarrhea, nausea hypoglycemia and phlebitis at IV site. Assess patient for signs of infection, obtain culture before therapy is started, observe for signs of anaphylaxis.

Enoxaparin sodium LovenoxDalteparin

AnticoagulantsAntithrombotic

Potentiate the inhibitory effect of antithrombin on factor XA and thrombin

Increased risk for bleeding when using warfarin aspirin and drugs

Side effects include anemia thrombocytopenia dizziness headache insomnia constipation nausea

Page 29: Drug Rationale

tinzaparin that affect platelet function

administer deep into subcutaneous tissue inject entire length of needle at 45° or 90° angle do not aspirate or massage

Epinephrine BronchodilatorsAntiasthmaticsVasopressorsAdrenergics

Results in the accumulation of cAMP at beta adrenergic receptors. Produces broondhodilation. Inhibits the release of mediators of immediate hypersensitivity reactions from mast cells.

CI in hypersensitivity. Concurrent use with other adrenergic agents will have increased effects. Y site inc. ampicillin thiopental

Side effects include: nervousness, tremor, angina, htn, and tachycardia. Assess lung sounds, PFT, wheezing, BP, Pulse, RR, volume status. SQ massage inj site , avoid IM. IV admin over at least 1 min.

Eplerenone

Inspara

Antihypertensive

Aldosterone antagonist

Blocks the effects of aldosterone by attaching to mineralocorticoid receptors.

CI in serum k >5.5, use with k sparing diuretics and lactation.

Side effects include: dizziness, fatigue, abdominal pain, diarrhea, hyperkalemia, flulike symptoms. . Assess bp and pulse before administering. Syncope may occur 30-120 mi after administration, monitor I and O.

Epoetin

Epogen

Anti-anemic

Hormones rDNA

Stimulates erythropoiesis. May increase the requirement for heparin during hemodialysis.

Side effects include seizures, headache, and hypertension. Monitor blood pressure before and during therapy. Monitor Hematocrit before and twice weekly during initial therapy for two to six weeks after dose change. Administer undiluted.

Eprosartan

Teveten

Antihypertensive

Angiotensin II receptor antagonist

Blocks vasoconstrictor and aldosterone-produing effects of angiotensin II at receptor sites, including vascular smooth muscle and the adrenal glands.

NSAIDS may decrease drug effects. Risk of hypotension when used with diuretics.

Side effects include: dizziness, fatigue, headache, hypotension, renal failure and hyperkalemia. Assess bp and pulse before administering. Assess patient for signs of angioedema (dyspnea and facial swelling), monitor I & O, auscultate lungs for rales or crackles, monitor labs. May be administered with or without meals.

Eptifibatide

Integrilin

Antiplatelet agent

Glycoprotein IIb/IIIa inhibitors

Decreases platelet aggregation by reversibly antagonizing the binding of fibrinogen to the glycoprotein IIb/IIIa binding site on platelet surfaces.

Increased risk of bleeding with heparins, warfarin, NSAIDS, thrombolytics, dipyridamole, ticlopidine, clopidogrel, some cephlosporines, valproates, plicamycin.

Bleeding (including GI and intracranial bleeding, hematuria and hematomas) could be fatal if it occurs. Direct Iv:Administer undiluted. Iv push over 1-2 minutes.Intermittent infusion: Based on pt wt. Y site incompatibility: furosemide.Y site compatible: 0.9% NaCl,

Page 30: Drug Rationale

D5/0.9% NaCl, up to 60 meq KCL. Assess for bleeding. Instruct patient to notify health care provider if bleeding occurs. Minimize use of arterial and venous punctures, IM injections, and use of urinary catherters, nasotracheal intubation, and NG tubes.

Erythromycin

Erythromycin base

Erythromycin estolate

Erythromycin ethylsuccinate

Erythromycin gluceptate

Erythromycin lactobionate

Erythromycin stearate

Anti infective

Macrolides

Suppresses protein synthesis at the level of the 50s ribosome.

CI in hypersensitivity, hepatic dysfunction

Side effects include: nausea, vomiting, phlebitis at IV site. Assess patient for infection. Obtain culture before starting therapy. observe for signs of anaphylaxis, evaluate renal and hepatic function, cbc, k levels, and bleeding times. Administer around the clock at least 1 hr before or 2 hr after meals. Take with a full glass of water. IV administer slowly over 20-60 min to prevent phlebitis.

Escitalopram AntidepressantSSRI

Selectively inhibits the reuptake of serotonin in the CNS.

CI in hypersensitivity and MAOI use, and concurrent use of citalopram. Wait at least 14 days after discontinuing MAOI use to begin using this drug.

Side effects include: insomnia, diarrhea, nausea, hyponatremia, and increased appetite. Monitor mood changes, assess for suicidal tendencies. Administer as a single dose in the morning or evening without regard to meals.

Esomeprazole

Nexium

Antiulcer

Proton pump inhibitor

Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH preventing the final transport of hydrogen ions into the gastric lumen

. May increase risk of bleeding with warfarin

Side effects include headache abdominal pain constipation

diarrhea nausea. Administer at least one hour

before meals. Assess patient routinely for epigastric or abdominal pain and occult blood in the stool

or gastric aspirate. IV push mix in 5 mL normal saline infused over three minutes flush before and after administration

Ezetimible Lipid lowering agent

Inhibits absorption of cholesterol in the small

Effects may be lowered by

Increased hepatic transaminases may occur.

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(Zetia)Cholesterol absorption inhibitor

intestine. cholestyramine or other bile acis sequestrants. Concurrent use of fibrates may increase blood levels of ezetimible and also increases the risk of cholelithiasis. Cyclosporine may increase ezetimible levels.

Administer without regard to meals. May be taken at the same time as HMG-CoA reductase inhibitors.

Instruct patient to notify health care professional if unexplained muscle pain, tenderness, or weakness occur.

Famciclovir

Famvir

Antiviral Inhibits viral DNA synthesis in herpes infected cells only.

Probenecid increases blodd levels.

Headaches may occur. Inform the patient that famciclovir does not prevent the spread of infection. Until all lesions have crusted, precautions should be taken around others who have never had chicken pox or varicella vaccine or peole who are immunosuppressed. Advise patient that this therapy is not a cure. Avoid sexual contact while lesions are present. Use condoms in the absence of lesions.

Famotidine Antiulcer agents

Histamine H2 antagonist

Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.

Lowers the absorption of ketoconazole. Antacids and sucralfate decreases absorption.

Fentanyl

 

Duragesic

Opiod Analgesic Bind to opiate receptors in the CNS altering the response to and the perception of pain

Additive CNS depression when used with other CNS depressants

Side effects include confusion sedation weakness anorexia constipation dry mouth  vomiting sweating

Apply to flat non-irritated site such as chest back or upper arm.  Press firmly in place with palm of hand for 30 seconds.

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Ferrous Fumarate

Chromagen

Hematinic Replaces iron stores needed for red blood cell development, energy and oxygen transport, utilization.

Contraindicated in hemolytic anemia. Decreased absorption with dairy products, caffeine and eggs.

Side effects include: Nausea, constipation, black and red tarry stools, vomiting, diarrhea and temporary discolored tooth enamel and eyes. Swallow tabs whole. Give between meals for best absorption, do not give with milk or antacids.

Ferrous sulfate 325mg/oral/bid

Antianemics

iron supplements

An essential mineral found in hemoglobin, myoglobin, and many enzymesParenteral iron enters the bloodstream and organs of the reticuloendothelial system (liver, spleen, bone marrow), where iron is separated out and becomes part of iron stores

Primary hemochromatosis, Hemolytic anemias and other anemias not due to iron deficiency, Some products contain alcohol, tartrazine, or sulfites and should be avoided in patients with known intolerance or hypersensitivity

SEIZURES, dizziness, headache, syncope, hypotension, tachycardia, nausea, constipation, dark stools, diarrhea, epigastric pain, GI bleeding GI bleeding, taste disorder, vomiting, flushing, urticaria, ALLERGIC REACTIONS INCLUDING ANAPHYLAXIS, fever, lymphadenopathy

Fluconazole

Diflucan

Anti-fungal Inhibit's synthesis of fungal sterols, a necessary component of the cell membrane.

May increase the activity of warfarin.

Side effects include headache, Hepatotoxicity, abdominal discomfort, diarrhea and vomiting. Monitor BUN levels and serum creatinine before and during therapy, patients with renal dysfunction will require dosage adjustment. Infuse at a maximum rate of 200 mg per hour.

Flunisolide AntiasthmaticsCorticosteroids

Potent, locally acting anti inflammatory and immune modifier.

Use cautiously in diabetes and glaucoma, underlying immunosuppression.

Side effects include: headache, dysphonia, hoarseness, oropharyngeal fungal infections, and flu like syndrome. Monitor RR and lung sounds. Assess for adrenal insufficiency such as anorexia, nausea, weakness, fatigue, hypotension and hypoglycemia. May cause increase in serum glucose levels. Teach that this should not be used to treat an attack.

Fluoxetine

Prozac

AntidepressantSSRI

Selectively inhibits the reuptake of serotonin in the CNS.

CI in hypersensitivity and MAOI use, and concurrent use of citalopram. Wait at least 14 days after discontinuing

Side effects include: anxiety, drowsiness, sexual dysfunction, excessive sweating, pruritus, tremor, insomnia, diarrhea, nausea, hyponatremia, and increased appetite. Monitor mood changes, assess for suicidal

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MAOI use to begin using this drug.

tendencies, and monitor appetitie and nutritional intake. Administer as a single dose in the morning or evening without regard to meals.

Fluticasone

flovent

AntiasthmaticsCorticosteroids

Potent, locally acting anti inflammatory and immune modifier.

Use cautiously in diabetes and glaucoma, underlying immunosuppression.

Side effects include: headache, dysphonia, hoarseness, oropharyngeal fungal infections, and flu like syndrome. Monitor RR and lung sounds. Assess for adrenal insufficiency such as anorexia, nausea, weakness, fatigue, hypotension and hypoglycemia. May cause increase in serum glucose levels. Teach that this should not be used to treat an attack. Assess for signs and symptoms of infection.

Fluvastatin

(Lescol)

Lipid lowering agentHGM-CoA reductase inhibitor

Inhibits 3-hydroxy-3 methylglutaryl-coenzyme A reductase, which is responsible for an early step in the synthesis of cholesterol. Lowers LDL, Increases HDL, decreases VLDL and triglycerides. Slows the progression of CAD with a decrease in MI and need for myocardial revascularization.

Additive cholesterol lowering effect or decreased effectiveness with bile acid sequestrants, May slightly increase digoxin levels, May increase effects of warfarin. Grapefruit juice increases blood levels and increases risk of toxicity.

Abdominal cramps, constipation, diarrhea, flatus, heartburn, rashes and rhabdomyolysis may occur. Administer in the evening.Ophthalmologic exams are recommended before and yearly during therapy. If patient develops muscle tenderness during therapy, monitor CPK levels. If CPK levels are markedly increased or myopathy occurs, therapy should be discontinued.

Folic Acid Supplement Needed for erythropoieses, increases RBCC, WBC, and platlet formation in megaloblastic anemias.

Increased need for folic acid with the use of Estrogen, glucocorticoids, and hudantoins. Sulfonamides decrease the action of folic acid.

May cause flushing of the sking or bronchospasm. Offer the patient foods high in folic acid: bran, yeast, dried beans, nuts, fruits, fresh veggies, and asparagus. Assess pt for fatigue, weakness, dyspnea, shortness of breath and activity intolerance, which are signs of megaloblastic anemia.

Fondaparinux

Arixtra

AnticoagulantAntithrombotic

Potentiate the inhibitory effect of antithrombin on factor XA and thrombin.

Risk of bleeding may be increased by concurrent use of warfarin, asprin and nsaids. Cannot be used interchangeably with heparin or

Side effects include: headache, edema, constipation, anemia, and thrombocytopenia. Assess for signs of bleeding and hemorrhage. Monitor CBC, platelet count and stools for occult blood during therapy.

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LMWH. Administer at least 6 hours after surgery. Do not expel air bubble before injection. Administer deep into SQ tissue into abdominal wall at a 45 to 90 degree angle 1” around umbilicus. Do not massage, administer im or aspirate injection.

Formoterol

Foradil

BronchodilatorsAdrenergics

Result in the accumulation of cyclic adenosine monophosphate at beta adrenergic receptor. Produces bronchodiliation. Inhibits the release of mediators of immediate hypersensitivity reactions form mast cells.

Concurrent use with other adrenergic agents will cause increased adrenergic effects beta-blockers may decrease effects. Use with herbs and caffeine containing ephedra may increase stimulant effect.

Side effects include nervousness restlessness tremor palpitations or tachycardia angina hypertension assess lung sounds, respiratory pattern and blood pressure before administration and during peak of medicationObserve for bronchospasm. If condition occurs, withhold medication and notify physician immediately. Do not wet capsule. Do not use a spacer.

Fosinopril

monopril

Antihypertensiveace inhibitor

Angiotensin converting enzyme inhibitors block the conversion of angiotensin one to the vasoconstrictor angiotensin two.

Excessive hypotension may occur with use of other antihypertensive. Y site incompatibility amphotericin b, cefepime, phenytoin.

Side effects include cough hypotension taste disturbances proteinuriamonitor blood pressure and pulse frequently during dose adjustments and periodically during therapy. Monitor weight and assess for fluid overload, monitor cbc, wbc and urine protein prior and during therapy. Teach patient to change positions slowly to reduce orthostatic hypotension and avoid excessive salt intake.

FurosemideLasix

BumetanideBumex

Loop diuretic Inhibit the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule.

Increased hypotension with antihypertensives  May increase the effects of warfarin.  Increased risk of hypokalemia when used with other diuretics.

Furosemide: Y site incompatibility: ciprofloxacin, diltiazem,

Side effects include dizziness hypotension constipation diarrhea dehydration and increased BUN levels.  Monitor daily weight and intake and output.  Monitor blood pressure and pulse before and during administration.  Monitor electrolyte levels.  Give undiluted.  Administer slowly over two minutes.

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droperidol, esmolol, filgrastim, fluconazole, gatifloxacin, gemcitabine, gentamicin, hydralazine, idarubicin, levofloxacin, metoclopramide, midazolam, milrinone, netilmicin, ondansetron, quinidine gluconate, thiopental, vecuronium, vinblastine, vincristine vonorelbine

Bumex Y site incompatibility: Midazolam

Gabapentin

Neurontin

Analgesic adjuncts

Anticonvulsant

Mechanism of action is not known. May affect transport of amino acids across and stabilize neuronal membranes.

CI in hypersensitivity.

Side effects include: confusion, depression, drowsiness, and anxiety. Assess for seizure activity and chronic pain. May be administered without regard to meals. Should be discontinued gradually over at least 1 wk.

Gatifloxacin

Tequin

Anti infective

Fluoroquinolone

Inhibit bacterial DNA synthesis by inhibiting DNA gyrase.

CI in hypersensitivity and pregnancy. Ysite incomp do not mix or administer with other medications. Temp discontinue other solutions. Flush line before and after administration..

Side effects include: dizziness, drowsiness, headache, insomnia, abdominal pain, diarrhea, nausea hypoglycemia and phlebitis at IV site. Assess patient for signs of infection, obtain culture before therapy is started, observe for signs of anaphylaxis. Administer over 60 minutes, avoid rapid or bolus IV infusion.

Gemfibrozil Lipid lowering agent

Fibric acid derivatives

Inhibits peripheral lipolysis. Decreases triglyceride production by the liver. Decreases production of the triglyceride carrier protein. Increases high-density lipoproteins.

May increase the effects of warfarin or sulfonylurea oral hypoglycemic agent. May decrease the effect of

Abdominal pain, diarrhea, and epigastric pain may occur.

Administer 30 min before breakfast or dinner.

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cyclosporine.

Gemifloxacin

Factive

Anti infective

Fluoroquinolone

Inhibit bacterial DNA synthesis by inhibiting DNA gyrase.

CI in hypersensitivity and pregnancy.

Side effects include: dizziness, drowsiness, headache, insomnia, abdominal pain, diarrhea, nausea hypoglycemia and phlebitis at IV site. Assess patient for signs of infection, obtain culture before therapy is started, observe for signs of anaphylaxis.

gentamicin Antiinfective

Aminoglycoside

Inhibits protein synthesis in bacteria at level of 30s ribosome. Has a bactericidal action.

CI in hypersensitivity. Inactivated by penicillins and cephalosporins when administered in renal insufficiency.

Side effects include: ototoxicity, nephrotoxicity, muscle paralysis and hypersensitivity. Assess patient for signs of infection, obtain culture before admin. Evaluate hearing and balance before admin therapy. Do not use solutions that are discolored. Infuse slowly over 30 min-2 hr.

Glimedpiride

Glipizide

Glyburide

Antidiabetics

Sulfonylureas

Lowers blood glucose by stimulating the release of insulin form the pancreas and increasing the sensitivity to insulin at receptor sites. May also decrease hepatic glucose production.

CI in hypersensitivity, insulin dependent diabetics, ketoacidosis, uncontrolled infection.

Side effects include: photosensitivity, hypoglycemia. Assess for hypoglycemia, monitor cbc. May be administered once in the morning or divided into 2 doses. Glipizide should be taken 30 min before a meal. Glyburide should not be taken wit a meal high in fat.Glimedpiride Onset :unknown Peak 2-3 hr Duration 24 hrGlipizide onset: 15-30 min Peak 1-2 hr Duration: 24hrGlyburide onset 45-60 min Peak 1.5-3hr 24 hr

Granisetron Antiemetics

5-HT3 antagonists

Blocks the effects of serotonin at receptor sites located in vagal nerve terminals and in the chemoreceptor trigger zone in the CNS,

CI in hypersensitivity. Increased risk of extrapyramidal reactions with other agents causing extrapyramidal reactions. Y site amphotericin B incompatable

Side effects include: headache and constipation. Assess patient for nausea, vomiting, abdominal distention and bowel sounds prior to and following administration. Administer undiluted over 30 sec, diluted over 5 minutes.

Haloperidon Antipsychotics Alters the effects of dopamine in the CNS. Has anticholinergic

Increases hypotension with

Seizure and neuroleptic malignant syndrome may be

Page 37: Drug Rationale

Haldol and alpha-adrenergic blocking activity.

antihypertensives, nitrates, or acute ingestion of alcohol. Increased anticholinergic effects with drugs having anticholinergic properties. Increased CNS depression with other CNS depressants. Acute encephalopathic syndrome may occur when used with lithium.

fatal if they occur. Extrapyramidal reactions, blurred vision, dry eyes, constipation, and dry mouth are common. Monitor bp and pulse during therapy. Monitor I&O daily. Monitor for alkathisia. Monitor for tardive dyskinesia. Monitor for development of neuroleptic malignant syndrome.

Heparin sodium AnticoagulantsAntithrombotic

Potentiate the inhibitory effect of antithrombin on factor xa and thrombin

Risk of bleeding may be increased by concurrent use of group of drugs that affect platelet function including aspirin and NSAIDs.

Side effects include bleeding, anemia, thrombocytopenia. Assess patient for signs of bleeding. Monitor PTT and hematocrit. Monitor platelet count. Administer deep into subcutaneous tissue. Inject entire length of needle at a 45 to 90° angle. Do not aspirate or massage.

Hydralazine hydrochloride

Apresoline

Antihypertensive

Vasodilator

Direct acting peripheral arteriolar vasodilator.

Additive hypotension with use of other antihypertensiveNSAIDs may decrease anti-hypertensive response

Side effects include tachycardia sodium retention drug induced lupus syndromeAdminister undiluted use solution as quickly as possible after drawling through needle into syringe. Monitor blood pressure and pulse during dosage adjustment &during therapy.

Hydrocodone

 

Acetaminophen

Opiod analgesic Binds to Opiate receptors in the CNS.  Alters perception of and response to painful stimuli while producing generalized CNS depression.

Increased CNS depression with sedatives.

Side effects include confusion sedation hypotension and constipation.  Assess blood pressure pulse and respirations before and periodically during administration.  Assess bowel function routinely.  Assess type location and intensity of pain before and one hour after administration.

Hydrocortisone Antiasthmatics Suppress inflammation and the CI in active Side effects include:

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short actingcorticosteroids

normal immune response. Suppresses adrenal function. Replaces endogenous cortisol in deficiency states. Also has potent mineralocorticoid activity.

infections, lactation, stress, and pregnancy. Use with NSAIDS increases risk of adverse GI effects.

depression, euphoria, hypertension, anorexia, nausea, acne, decreased wound healing, adrenal suppression, cusingoid appearance. Reconstitute with 2 ml of sterile saline. Monitor I & O, teach patient not to stop medication abruptly, assess glucose and K levels.

Hydromorphone

 

Dilaudid

Opiod Agonist Binds to opiate receptors in the CNS alters perception of response to painful stimuli while producing generalized CNS depression.

Amphotericin B

diazepam phenobarbital sodium bicarbonate

Side effects include confusion sedation

hypotension constipation. Dilute with at least 5 mL of sterile water for injection. Administer slightly at a rate not to exceed 2 mg over three

to five minutes. Assess blood pressure pulse and respirations before and after

administration Assess bowel

function routinely. Assess Thai location and intensity of pain prior to and one hour following administration.

Hydroxyzine Sedative/Hypnotic

antihistamine

Acts as a CNS depressant at the subractical level of the CNS. Has anticholinergic, antihistaminic, and antiemedic properties.

Additive CNS depression with alcohol, antihistamines, opoid analgesics.Added anticholinergic properties with other drugs possessing anticholingeric properties.

Drowsiness, dry mouth. Inform patient that frequent mouth rinses, good oral hygiene, and sugarless gum or candy will help with dry mouth.

Imipramine Antidepressant

Tricyclic antidepressant

Potentiates the effect of serotonin and norepinephrine in the CNS and also has anticholinergic properties.

CI in pregnancy and lactation and narrow angle glaucoma.

Side effects include: fatigue, sedation, blurred vision, dry eyes, constipation, dry mouth and weight gain. Monitor BP and Pulse before giving, monitor mental status, suicidal tendencies, and assess for pain. Administer with or immediately after a meal, IM may be slightly yellow or red, crystals may develop, place under warm water for 1 min to dissolve.

Indapamide(Lozol)

Antihypertensives

Increases excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule.

Increased hypotension with use of alcohol

Hypokalemia and hyperuricimia is common.Monitor electrolytes, blood

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Thiazide diuretic Promotes excretion of magnesium, chloride, potassium, and bicarbonate. May produce arteriolar dilation.

and other antihypertinsives, or nitrates. Hypokalemia is increased with the use of amphotericin B, mezlocillin, piperacillin, or ticarcillin.

glucose, BUN, creatinine, and uric acid levels before and periodically through therapy. Monitor blood pressue before and periodically throughout therapy. Assess I&O, daily weights, and feetlegs and sacral area for edema daily.

Indomethacin Antiheumatics

NSAIDS

Inhibits prostaglandin synthesis.

Aspirin, NSAIDS, potassium supplements, corticosteroids and alcohol may decrease effectiveness.

Dizziness, drowsiness, headache, psychic disturbance. GI bleeding, drup induced hepatitis, constipation, dyspepsia, nausea, vomiting, Anaphylaxis.Caution patient to wear sun protection against photosensitivity. May cause an increase in serum tests: potassium, BUN, creatinine, AST, ALT.

Insulin

Humulin R

Regular Insulin

Antidiabetics, hormones

Pancreatics

Lower blood glucose by increasing transport into cells and promoting the conversion of glucose to glycogen. Promote the conversion of amino acids to proteins in muscle and stimulate triglyceride formation. Inhibit the release of free fatty acids.

CI in hypersensitivity to insulin, infection. Beta blockers Thiazide diuretics , corticosteroids , acetazolamide , morphine , diltiazem , dobutamine , thyroid preparations , estrogens , nicotine , protease inhibitor antiretrovirals , alcohol

Lipodystrophy, pruritus, rash, allergic reactions, and hypoglycemia, Assess for signs and symptoms of hypoglycemia, blood glucose and ketones. Must be verified by another nurse, use only insulin syringes to draw up dose. Draw up clear insulin before mixed. Administer SQ at 45 degree angle. DO NOT MIX ANY OTHER IINSULINS USE A SEPARTATE SYRINGE TO ADMINISTER. Administer once daily at the same time each day.

Insulin aspart

novolog

Antidiabetics, hormones

Pancreatics

Lower blood glucose by increasing transport into cells and promoting the conversion of glucose to glycogen. Promote the conversion of amino acids to proteins in muscle and stimulate triglyceride formation. Inhibit the release of free fatty acids.

CI in hypersensitivity to insulin, infection.

Side effects include hypoglycemia, lipdystrophy, anaphylaxis. Assess for signs and symptoms of hypoglycemia, blood glucose and ketones. Must be verified by another nurse, use only insulin syringes to draw up dose. Draw up clear insulin before mixed. Administer SQ at 45 degree angle.Onset 15 min

Peak 1-3 hr

Duration 3-5 hrInsulin glargine Antidiabetics, Lower blood glucose by CI in Side effects include

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Lantushormones

Pancreatics

increasing transport into cells and promoting the conversion of glucose to glycogen. Promote the conversion of amino acids to proteins in muscle and stimulate triglyceride formation. Inhibit the release of free fatty acids.

hypersensitivity to insulin, infection.

hypoglycemia, lipdystrophy, anaphylaxis. Assess for signs and symptoms of hypoglycemia, blood glucose and ketones. Must be verified by another nurse, use only insulin syringes to draw up dose. Draw up clear insulin before mixed. Administer SQ at 45 degree angle. DO NOT MIX ANY OTHER IINSULINS USE A SEPARTATE SYRINGE TO ADMINISTER. Administer once daily at the same time each day. Do not administer IV.:Onset 1.1 hr Peak 5 hr Duration 24 hr

Insulin lispro

Humalog

Antidiabetics, hormones

Pancreatics

Lower blood glucose by increasing transport into cells and promoting the conversion of glucose to glycogen. Promote the conversion of amino acids to proteins in muscle and stimulate triglyceride formation. Inhibit the release of free fatty acids.

CI in hypersensitivity to insulin, infection.

Side effects include hypoglycemia, lipdystrophy, anaphylaxis. Assess for signs and symptoms of hypoglycemia, blood glucose and ketones. Must be verified by another nurse, use only insulin syringes to draw up dose. Draw up clear insulin before mixed. Administer SQ at 45 degree angle. Use only U-100 syringes to draw up this insulin. Administer within 15 min before a meal. Onset 15 min

Peak 30-90 min

Duration 6-8 hrInsulin lispro/protamine insulin lispro mixture

Humalog 75/25, humalog 50/50

Antidiabetics, hormones

Pancreatics

Lower blood glucose by increasing transport into cells and promoting the conversion of glucose to glycogen. Promote the conversion of amino acids to proteins in muscle and stimulate triglyceride formation. Inhibit the release of free fatty acids.

CI in hypersensitivity to insulin, infection.

Side effects include hypoglycemia, lipdystrophy, anaphylaxis. Assess for signs and symptoms of hypoglycemia, blood glucose and ketones. Must be verified by another nurse, use only insulin syringes to draw up dose. Draw up clear insulin before mixed. Administer SQ at 45 degree angle. Use only U-100 syringes to draw up this insulin. Administer within 15 min before a meal. Onset 15 min

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Peak 30-90 min

Duration 6-8 hrInsulin zinc suspension extended ultralente insulinHumulin U

Antidiabetics, hormones

Pancreatics

Lower blood glucose by increasing transport into cells and promoting the conversion of glucose to glycogen. Promote the conversion of amino acids to proteins in muscle and stimulate triglyceride formation. Inhibit the release of free fatty acids.

CI in hypersensitivity to insulin, infection.

Side effects include hypoglycemia, lipdystrophy, anaphylaxis. Assess for signs and symptoms of hypoglycemia, blood glucose and ketones. Must be verified by another nurse, use only insulin syringes to draw up dose. Draw up clear insulin before mixed. Administer SQ at 45 degree angle. :Onset 4-6 hr Peak 18-24hr Duration 36 hr

Insulin zinc suspension lente insulinHumulin l

Antidiabetics, hormones

Pancreatics

Lower blood glucose by increasing transport into cells and promoting the conversion of glucose to glycogen. Promote the conversion of amino acids to proteins in muscle and stimulate triglyceride formation. Inhibit the release of free fatty acids.

CI in hypersensitivity to insulin, infection.

Side effects include hypoglycemia, lipdystrophy, anaphylaxis. Assess for signs and symptoms of hypoglycemia, blood glucose and ketones. Must be verified by another nurse, use only insulin syringes to draw up dose. Draw up clear insulin before mixed. Administer SQ at 45 degree angle. :Onset 1-3 hr Peak 8-12 hr Duration 18-28 hr

Ipratropium

Atrovent

Bronchodilator Inhibit cholinergic receptors in bronchial smooth muscle resulting in decreased concentrations of cyclic guanosine monophosphate

Increased anti-cholinergic properties with other drugs having Anticholinergic properties

Side effects include dizziness headache blurred vision bronchospasm hypotensionwhen administering with other inhalation medications administer adrenergic bronchodilator's firstAssess respiratory status before administration and at peak of medication. Assess bowel function daily, monitor I & O, monitor pulse and bp and maintain bedrest for 1 hr after administration. Teach patient to change positions slowly to avoid orthostatic hypotension.

Irbesartan

Avapro

Antihypertensive

Angiotensin II receptor antagonist

Blocks vasoconstrictor and aldosterone-produing effects of angiotensin II at receptor sites, including vascular smooth muscle and the adrenal glands.

NSAIDS may decrease drug effects. Risk of hypotension when used with diuretics.

Side effects include: dizziness, fatigue, headache, hypotension, renal failure and hyperkalemia. Assess bp and pulse before administering. Assess patient for signs of angioedema (dyspnea and

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facial swelling), monitor I & O, auscultate lungs for rales or crackles, monitor labs. May be administered with or without meals.

Isoniazid

INH

Antitubercular Inhibits mycobacterial cell wass synthesis and interferes with metabolism.

Additive CNS toxicity with other antituberculars. Aluminum containing antacids may decrease absorption. Increased risk of hypatotaxicity with other hypatotoxic drugs. Avoid foods with tyramine.

Drug induced hepatitis may be fatal if occurs. Peripheral neuropathy is common. May be administered with food or antacids if GI irritation occurs. Have Pyrodoxine (vitamin B) on hand in case of overdose. Do not use alcohol during therapy.

Isosorbide dinitrate

Antianginal

Nitrates

Produces vasodilatation (venous greater than arterial). Decreases left ventricular end diastolic pressure and left ventricular end diastolic volume; net effect is reduced myocardial oxygen consumption. Increases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions.

Use cautiously with head Injuries or cerebral hemorrhage. Additive hypotension when used with other antihypertensives.

Side effects include: dizziness, headache, hypotension and tachycardia. Assess location, duration, intensity, and precipitating factors of anginal pain. Monitor blood pressure and pulse routinely during period of dosage adjustment. Administer 1 hr or 2 hr after meals with a full glass of water for faster absorption. Teach patient to change position slowly, headache is common and can be treated with asprin or Tylenol.

Isosorbide mononitrate

Antianginal

Nitrates

Produces vasodilatation (venous greater than arterial). Decreases left ventricular end diastolic pressure and left ventricular end diastolic volume; net effect is reduced myocardial oxygen consumption. Increases coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions.

Use cautiously with head Injuries or cerebral hemorrhage. Additive hypotension when used with other antihypertensives.

Side effects include: dizziness, headache, hypotension and tachycardia. Assess location, duration, intensity, and precipitating factors of anginal pain. Monitor blood pressure and pulse routinely during period of dosage adjustment. Administer on empty stomach with a full glass of water for faster absorption. Teach patient to change position slowly,

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headache is common and can be treated with aspirin or Tylenol.

Itraconazole Antifungal Inhibits enzymes necessary for integrity of the fungal cell membrane.

CI in hypersensitivity. Increased risk of myopathy when used with simvastatin or lovastatin.

Side effects include: dizziness, fatigue, nausea, toxic epidermal necrolysis, rhabdomyolysis and fever. Assess for signs of infection before and throughout therapy. Cultures should be taken before therapy is started. Monitor liver function tests, monitor serum k levels may cause hypokalemia. Admin. Capsules with meals. Admin. Oral solution without food. IV administer 60 ml over 60 min.

Ketoconazole Anti-fungal Disrupts fungal cell membrane. Interferes with fungal metabolism. Also inhibits the production of adrenal steroids.

CI in hypersensitivity, concurrent astemizon\le, pregnancy and lactation.

Side effects include: dizziness, nausea, vomiting abdominal pain and diarrhea. Administer with meals, do not administer within 2 hr of antacids. Assess for signs of infection. Monitor lft.

Ketorolac Tromethamine

 

Toradol

NSAID, Nonopiod analgesic

Inhibits prostaglandin synthesis, producing peripherally mediated analgesia and also has anti-inflammatory properties.

Concurrent use with aspirin may decrease effects.

Side effects include:  Drowsiness, GI bleeding, pruritus, urticaria, nausea and diarrhea.  Assess pain before and 1-2 hours after administration.  Insert needle at 90 degree angle, aspirate and apply pressure at site after administration.

Ketorolac Tromethamine

 

Toradol

NSAID, Nonopiod analgesic

Inhibits prostaglandin synthesis, producing peripherally mediated analgesia and also has anti-inflammatory properties.

Concurrent use with aspirin may decrease effects. 

Side effects include:  Drowsiness, GI bleeding, pruritus, urticaria, nausea and diarrhea.  Assess pain before and 1-2 hours after administration.  Insert needle at 90 degree angle, aspirate and apply pressure at site after administration.

Labetalol

Trandate

Antihypertensive

Beta blocker

Block stimulation of beta adrenergic and beta two adrenergic receptor sitesDecreases heart rate and blood pressure

Hypotension may occur with other antihypertensivesNSAIDs may decrease antihypertensive actions

Side effects include fatigue, weakness, anxiety, blurred vision, arrhythmias, impotence, constipation, and diarrhea.administer undiluted slowly over two minutesassess blood pressure and pulse before and after administration. Take apical pulse, if <50bpm withhold

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medication.patients must be supine during and for 3 hr after admin. Monitor vital signs every 5-15 min after admin. For several hours.

Lactated Ringers Electrolyte supplement/ replacement

This medication is an intravenous (IV) solution used to supply water and electrolytes (e.g., calcium, potassium, sodium, chloride), either with or without calories (dextrose), to the body.

Use cautiously with diabetes and heart disease.  Monitor for fluid overload.

Side effects include: fever, trouble breathing, and swelling. 

Lactulose Laxative

Osmotic

Increases water content and softens stool. Lowers the ph of the colon, which inhibits the diffusion of ammonia from the colon into the blood, thereby reducing blood ammonia levels.

Should not be used with other laxatives in hepatic encephalopathy. Anti infectives may diminish effectiveness in hepatic encephalopathy.

Cramps, belching, distention, and flatulence may occur. Mix with fruit juice, water, milk, or carbonated citrus beverage to improve taste. Take with full glass of liquid. Assess for abdominal distention, presence of bowel sounds, and usual pattern of function.

Lamivudine

Epivir

Anti-retrovirals

Antivirals

Nucleoside reverse transcriptase inhibitor

Inhibits viral DNA by inhibiting the enzyme reverse transcriptase.

Trimethoprim/ sulfamethoxazole increases blood levels. Increased risk of pancreatitis with other drugs that cause pancreatitis. Increased risk of neuropathy with other drugs that cause neuropathy. Tenofovir and abacavir should not be used, they may lead to virologic nonresponse.

Seizures, hepatomegaly with steatosis, Pancreatitis, anaphylaxis, and stevens-johnson syndrome may be fatal if occurs. Fatigue, headache, insomnia, malaise, cough, anorexia, diarrhea, nausea, vomiting, musculoskeletal pain, and neuropathy are common.

Asses for change in severity of HIV symptoms or symptoms of opportunistic infections. Assess liver function tests. Inform patient that this therapy does not cure HIV and the Importance of strict drug adherence.

Lansoprazole

Prevacid

Antiulcer

Proton pump inhibitor

Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH preventing the final transport of hydrogen ions into the gastric lumen.

Sucralfate lowers absorption. May increase risk of bleeding with warfarin.

Dizziness, headache, and rash may occur. Assess patient routinely for epigastric or abdominal pain and occult blood in the stool or gastric aspirate. Administer before meals. Do not crush or chew

capsules.

Levalbuterol

Xopenex

Bronchodilators

Adrenergics

Result in the accumulation of cyclic adenosine monophosphate at beta

Concurrent use with other adrenergic agents

Side effects include nervousness restlessness tremor palpitations or

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adrenergic receptor. Produces bronchodiliation. Inhibits the release of mediators of immediate hypersensitivity reactions form mast cells.

will cause increased adrenergic effects beta-blockers may decrease effects. Use with herbs and caffeine containing ephedra may increase stimulant effect.

tachycardia angina hypertension assess lung sounds, respiratory pattern and blood pressure before administration and during peak of medicationObserve for bronchospasm. If condition occurs, withhold medication and notify physician immediately. Protect vial from sun, do not mix other drugs in nebulizer. Do not inject or administered orally.

Levofloxacin

Levaquin

Anti-infective

Fluoroquinolones

Inhibits bacterial DNA synthesis by inhibiting DNA gyrase.

Administration with antacids iron salts and zinc salts decreases absorption of fluoroquinolones.

Side effects include seizures dizziness drowsiness headache insomnia abdominal pain diarrhea and nausea. Administer by infusion over at least 60 minutes, avoid rapid bolus injections.

Levothyroxine

Liothryronine

Liotrix

Thyroid

Hormones

Thyroid preparations

Principle effect is increasing metabolic rate of body tissues: Promotes gluconegenesis, Increases utilization and mobilization of glycogen stores, Stimulates protein synthesis, Promotes cell growth and differentiation, Aids in the development of the brain and CNS, Contains T3 and T4 activity.

Bile acid sequestrants lower the absorption of oral thyroid preparations. May alter effects of Warfarin. May increase insulin requirement or hypoglycemic agents, concurrent estrogen therapy may increase thyroid replacement requirements. Increased CV effects with adrenergics, May decrease response to beta blockers.

Insomnia, irritability, nervousness, CV collapse, arrythmias, tachycardia, weight loss may occur. Assess apical pulse and blood pressure periodically during therapy. Monitor thyroid function prior to and during therapy. Administer with breakfast. Instruct patient to take medication as directed at same time every day. Therapy is lifelong. Instruct patient to notify physician if nervousness, diarrhea, heat intolerance, headache, excessive sweating, chest pain, increased HR, palpitations, wt loss >2lb/wk, or ant unusual symptoms.

Lisinopril

Prinivil

zestril

Antihypertensiveace inhibitor

Angiotensin converting enzyme inhibitors block the conversion of angiotensin one to the vasoconstrictor angiotensin two.

Excessive hypotension may occur with use of other antihypertensive. Y site incompatibility amphotericin b, cefepime, phenytoin.

Side effects include cough hypotension taste disturbances proteinuriamonitor blood pressure and pulse frequently during dose adjustments and periodically during therapy. Monitor weight and assess for fluid overload, monitor cbc, wbc and urine protein prior and

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during therapy. Teach patient to change positions slowly to reduce orthostatic hypotension and avoid excessive salt intake.

Lomefloxacin

Maxaquin

Anti infective

Fluoroquinolone

Inhibit bacterial DNA synthesis by inhibiting DNA gyrase.

CI in hypersensitivity and pregnancy.

Side effects include: dizziness, drowsiness, headache, insomnia, abdominal pain, diarrhea, nausea hypoglycemia and phlebitis at IV site. Assess patient for signs of infection, obtain culture before therapy is started, observe for signs of anaphylaxis.

Loperamide Antidiarrheal Inhibits peristalsis and prolongs transit time by a direct effect on nerves in the intestinal muscle wall. Reduces fecal volume and increases fecal viscosity and bulk while diminishing loss of fluid and electrolytes.

CI in hypersisitivity, in patients whom constipation must be avoided, alcohol intolerance. Additive CNS depression with other CNS depressants.

Side effects include: drowsiness, constipation, dry mouth and nausea. Assess frequency and consistency of stools and bowel sounds before and throughout therapy. Assess fluid and electrolyte balance and skin turgor for dehydration. Administer with clear fluids to help prevent dehydration that may accompany diarrhea.

Lopinavir/ Ritonavir

Anti-retrovirals

Protease inhibitors

Metabolic inhibitors

Lopinavir: inhibita HIV viral protease.Ritonavir: Inhibits the action of HIV protease and prevents the cleavage viral polyproteins, it is combines with Lopinavir to inhibit the metabolism of lopinavir thus increasing plasma levels.

Life threatening drug interactions may occur with concurrent use of flecainide, amiodarone, propafenone, dihydroergotamine, ergonovine, ergotamine, methylergonovine, pimozide, midazolam, and triazolam.

Diarrhea, and taste aversion (in children) are common. Asses for change in severity of HIV symptoms or symptoms of opportunistic infections. Assess for pancreatitis. Assess liver function tests. May cause hyperglycemia. Inform patient that this therapy does not cure HIV and the Importance of strict drug adherence.

Loracarbef

lorabid

Anti infective

Second generation cephalosporin

Binds to bacterial cell wall membrane, causing cell death.

Probenecid decreases excretion and increases blood levels. Increased risk of renal toxicity when used with loop diuretics.

Side effects include: pain at IM site, phlebitis, anaphylaxis, serum sickness, diarrhea, nausea, vomiting, rashes and superinfection. Assess patient for infection. Obtain culture before initiating therapy.

Loratadine Antihistamine Blocks peripheral effects of histamine released during

Incompatible with lactation hepatic

Confusion, drowsiness, paradoxical excitation,

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Claritin allergic reactions. Decrease symptoms of allergic reactions

impairment use cautiously in geriatrics pregnancy or children younger than 2

blurred vision, dry mouth, gi upset, photosensitivity, rash, weight gain.

LorazepamAtivan

Antianxiety

Anticonvulsant

Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.

Additive CNS depression with alcohol, antihistamines, opoid analgesics. Decreased effectiveness with: levodopa, barbiturates or rifampin

Dizziness, drowsiness, lethargy are common. Abrupt withdrawl may cause insomnia, irritability, nervousness, or seizure. Hold med if the patient is lethargic per doctor’s orders.

Losartan

Cozaar

Antihypertensive

Angiotensin II receptor antagonist

Blocks vasoconstrictor and aldosterone-produing effects of angiotensin II at receptor sites, including vascular smooth muscle and the adrenal glands.

NSAIDS may decrease drug effects. Risk of hypotension when used with diuretics.

Side effects include: dizziness, fatigue, headache, hypotension, renal failure and hyperkalemia. Assess bp and pulse before administering. Assess patient for signs of angioedema (dyspnea and facial swelling), monitor I & O, auscultate lungs for rales or crackles, monitor labs. May be administered with or without meals.

Lovastatin Lipid lowering agentHGM-CoA reductase inhibitor

Inhibits 3-hydroxy-3 methylglutaryl-coenzyme A reductase, which is responsible for an early step in the synthesis of cholesterol. Lowers LDL, Increases HDL, decreases VLDL and triglycerides. Slows the progression of CAD with a decrease in MI and need for myocardial revascularization.

Additive cholesterol lowering effect or decreased effectiveness with bile acid sequestrants, May slightly increase digoxin levels, May increase effects of warfarin. Grapefruit juice increases blood levels and increases risk of toxicity.

Blurred vision, Abdominal cramps, constipation, diarrhea, flatus, heartburn, rashes and rhabdomyolysis may occur. Administer with food. Ophthalmologic exams are recommended before and yearly during therapy. If patient develops muscle tenderness during therapy, monitor CPK levels. If CPK levels are markedly increased or myopathy occurs, therapy should be discontinued.

Magnesium salicylate

Antipyretics

Nonopioid analgesics

Salicylates

Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins.

May increase the activity of penicillins, phenytoin, methotrexate, valppoic acid, oral hypoglycemic agents and sulfonamides. Corticosteroids may decrease levels. May blunt

Anaphylaxis, Laryngeal edema, and reyes syndrome (in children) may be fatal if they occur. Dyspepsia, epigastric distress, heartburn, and nausea are common. Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at increased risk for developing hypersensitivity reactions.

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the therapeutic response to diuretics, antihypertensives and NSAIDS.

Administer after meals or with food or an antacid to minimize gastric irritation.

Meperdine

Demerol

Opioid antagonists

Binds to the opiate receptors in the CNS-alters perception and response to painful stimuli. Produces CNS depression.

Use extreme caution if patient takes MAOI or procarbazine. Increases CNS depression when used with other sedatives.

Confusion, sedation, hypotension, constipation, nausea, vomiting.Advise patient to rise slowly to minimize orthostatic hypotension.

Metaproterenol Bronchodilators

Adrenergics

Result in the accumulation of cyclic adenosine monophosphate at beta adrenergic receptor. Produces bronchodiliation. Inhibits the release of mediators of immediate hypersensitivity reactions form mast cells.

Concurrent use with other adrenergic agents will cause increased adrenergic effects beta-blockers may decrease effects. Use with herbs and caffeine containing ephedra may increase stimulant effect.

Side effects include nervousness restlessness tremor palpitations or tachycardia angina hypertension assess lung sounds, respiratory pattern and blood pressure before administration and during peak of medicationObserve for bronchospasm. If condition occurs, withhold medication and notify physician immediately. Do not use if solution is brown.

Metformin

Glucophage

Antidiabetic

Biguanide

Decreases hepatic production of glucose. Decreases intestinal absorption of glucose. Increases sensitivity to insulin.

Onset several daysPeak 2-4 wk

Duration 12 hr

CI in hypersensitivity, metabolic acidosis, dehydration, sepsis, renal dysfunction and CHF.

Side effects include: bloating, diarrhea, nausea, vomiting. Whithold med before or at time of studies requiring IV administration of iodinated contrast media and for 48 hr after study. Administer with meals.

Methotrexate Immunosuppressants

Antineoplastics

Antirheumatics

Interferes with folic acid metabolism. Results in inhibition of DNA synthesis and cell reproduction (cell cycle S phase-specific). Also has immunosuppressant activity.

The following may increase toxicity: salicylates, NSAIDS, oral hypoglycemic agents, phenytoin, tertracyclines, prebenecid. Radiation therapy may increase the risk of soft tissue necrosis.

Arachnoiditis, Pulmonary fibrosis, anorexia, hepatotoxicity, nausea, stomatitis, vomiting, Aplastic anemia, anemia, leucopenia, thrombocytopenis, and nephropathy may occur. Monitor I&O, daily weights, and lung sounds. Monitor for bone marrow suppression. Assess for bleeding. Avoid IM injections and rectal temps. Monitor methotrexate levels every 12-24hrs during high dose therapy until levels are <5X10M.

Methylprednisolone

AntiasthmaticsIntermediate

Suppress inflammation and the normal immune response.

CI in active infections,

Side effects include: depression, euphoria,

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actingcorticosteroids

Suppresses adrenal function. Has minimal mineralocorticoid activity.

lactation, stress, and pregnancy. Use with NSAIDS increases risk of adverse GI effects.

hypertension, anorexia, nausea, acne, decreased wound healing, adrenal suppression, cusingoid appearance. May be admin. Direct IV push over 1 to several minutes. Monitor I & O, teach patient not to stop medication abruptly, assess glucose and K levels.

Metoclopramide Antiemetic Blocks dopamine receptors in chemoreceptor trigger zone of the CNS. Stimulates motility of the upper GI tract and accelerates gastric emptying.

CI in GI obstruction, seizures, Parkinson’s. additive CNS depression with alcohol, antidepressants and sedatives.

Side effects include: drowsiness, eps, restlessness, arrhythmias. Assess patient for nausea, vomiting, abdominal distention and bowel sounds before and after administration. Monitor for tardive dyskinesia. Administer IV dose undiluted slowly over 1-2 minutes.

Metolazone(Mykrox) (Zaroxolyn)

Antihypertensives

Thiazide diuretic

Increases excretion of sodium and water by inhibiting sodium reabsorption in the distal tubule. Promotes excretion of magnesium, chloride, potassium, and bicarbonate. May produce arteriolar dilation.

Increased risk of hypotension with other antihypertinsives, or nitrates. Hypokalemia is increased with the use of amphotericin B, mezlocillin, stimulant laxatives, piperacillin, or ticarcillin. Food mat increase the extent of absorption.

Hypokalemia and hyperuricimia is common.Monitor electrolytes, blood glucose, BUN, creatinine, and uric acid levels before and periodically through therapy. Monitor blood pressue before and periodically throughout therapy. Assess I&O, daily weights, and feetlegs and sacral area for edema daily.

MetoprololSuccinate

AntianginalAntiarrhythmic

Beta Blocker

Block stimulation of beta1 adrenergic receptors, usually without affecting beta2 receptor sites.

General anesthesia and verapamil may cause decrease in myocardial depression. CI in pulmonary disease and renal disease, bradycardia and heart block.

Side effects include fatigue, weakness, blurred vision, brochospasm, wheezing, and impotence.Administer with meals or directly after eating. Take apical pulse, if <50bpm withhold medication. Monitor for bradycardia, dizziness, dyspnea and seizures. Assess I and O monitor for pulmonary edema. Administer atropine if pulse <40 bpm.

MetronidazoleWith SalinePGBK

Anti-infectiveAntiprotozoalAntiulcer

Disruptes DNA and protein synthesis in susceptible organisms

Increases effects of warfarindo not mix with other medicationsdiscontinue primary IV during

Side effects include dizziness headache abdominal pain anorexia diarrheaassess patient for infection monitor intake and output and daily weight

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metronidazole infusion

Midazolam Antianxiety agent

Sedative/Hypnotic

Acts at many levels of the CNC to produce generalized CNS depression. Effects may be mediated by GABA.

Additive CNS depression with alcohol, antihistamines, opoid analgesics.Increased risk of hypotension with alcohol or nitrates.

Apnea, Laryngospasm, respiratory depression, Cardiac arrest, phlebitis at IV site.

Midodrine HCL Antihypotensive, Vasopressor

Increases vascular resistance and ultimately raises blood pressure

Hypotension Severe coronary aretery disease, acute renal disease, urinary retention, thyrotoxicosis

Paresthesia, vasodilation,bradycardia, supine hypertension, dry mouth, urinary retention, frequency, or urgency. Monitor Kidney studies. Stay alert for paresthesias. Pt should report dizziness pounding in ears blurred vision, and headache.

Miglitol

Glyset

Antidiabetics

Alpha glucosidase inhibitors

Lowers blood glucose by inhibiting the enzyme alpha glucosidase in the GI tract. Delays and reduces glucose absorption.

CI in hypersensitivity, diabetic ketoacidosis, cirrhosis, pregnancy, lactation, inflammatory bowel disease or impaired absorption.

Side effects include: abdominal pain, diarrhea, flatulence. Assess for signs of hypoglycemia, monitor glucose and A1C levels. Does not cause hypoglycemia when taken while fasting. Administer with first bite of each meal 3 times a day. Onset rapid

Peak 1 hr

Duration unknownMineral oil Used to soften

impacted feces in the management of constipation

Coats surface of stool and intestine with lubricant film to allow passage of stool through intestine. Improves water retention of stool

Appears on Beers list due to increased risk of aspiration resulting in lipid pneumonia and other adverse effects. Chronic use during pregnancy decreases absorption of fat-soluble vitamins and may cause hypoprothrombinemia in newborn

Lipid pneumonia, Diarrhea, anal irritation, rectal seepage of mineral oil. Decreases absorption of fat soluble vitamins ADE and K. Concurrent use with stool softeners may increase absorption of mineral oil or produce more diarrhea

Mirtazapine

Remeron

Antidepressant Tetracyclic and tidepressant

Potentiates the effects of norepinephrine and serotonin.

CI in hypersensitivity and MAOI use.

Side effects include: drowsiness, constipation, dry mouth, increased appetite and weight gain. Assess

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mental status, bp and pulse rate, and monitor for seizure activity. May be given at bedtime to decrease drowsiness. Can be taken without regard to meals.

Moexipril

univasc

Antihypertensiveace inhibitor

Angiotensin converting enzyme inhibitors block the conversion of angiotensin one to the vasoconstrictor angiotensin two.

Excessive hypotension may occur with use of other antihypertensive. Y site incompatibility amphotericin b, cefepime, phenytoin.

Side effects include cough hypotension taste disturbances proteinuriamonitor blood pressure and pulse frequently during dose adjustments and periodically during therapy. Monitor weight and assess for fluid overload, monitor cbc, wbc and urine protein prior and during therapy. Teach patient to change positions slowly to reduce orthostatic hypotension and avoid excessive salt intake. Administer on an empty stomach, 1 hr before a meal.

Morphine sulfate Opiod analgesics Binds to opiate receptors in the CNS.  Alters  perception of and response to painful stimuli while producing generalized CNS depression

Increased CNS depression with sedatives.

May increase the anticoagulant effect of warfarin.

Side effects include confusion sedation hypotension constipation

Administer 2.5 to 15 mg over four to five minutes dilute with at least 5 mL of sterile water.

Moxifloxacin

Avelox

Anti infective

Fluoroquinolone

Inhibit bacterial DNA synthesis by inhibiting DNA gyrase.

CI in hypersensitivity and pregnancy. Do not dilute premixed bags. Temp discontinue other solutions. Flush line before and after administration..

Side effects include: dizziness, drowsiness, headache, insomnia, abdominal pain, diarrhea, nausea hypoglycemia and phlebitis at IV site. Assess patient for signs of infection, obtain culture before therapy is started, observe for signs of anaphylaxis. Administer over 60 minutes avoid rapid or bolus infusion.

Multi-vitamin

Neprocaps

Vitamins Needed for adequate metabolism

There are no oral Incompatibilities.

No known side effects at recommended dosage.  Assess for vitamin deficiencies.  Take oral with glass of water.

Multiple vitamins 1tabOralDaily

Treatment and prevention of vitamin

Contain fat-soluble vitamins (A, D, and E) and most water-soluble vitamins, These

Hypersensitivity to preservatives, colorants, or

Urin discoloration, allergic reactions to preservatives, additives or colorants, Large

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Theragran deficiencies. Special formulations are available for patients with particular needs

vitamins are a diverse group of compounds necessary for normal growth and development. Many act as coenzymes or catalysts in numerous metabolic processes

additives, including tartrazine, saccharin, and aspartame, Some products contain alcohol and should be avoided in patients with known intolerance

amounts of vitamin B may interfere with the beneficial effect of levodopa

Mycophenolate Immunosuppressants

Inhibits the enzyme inosine monophosphate dehydrogenase, which is involved in the purine synthesis. This inhibition results in suppression of T and B lymphocyte proliferation.

Magnesium and aluminum hydroxide antacids lower the absorption. Toxicity may be increased with salicylates. May interfere with the action of oral contraceptives.

GI bleeding, diarrhea, vomiting, leucopenia, sepsis may occur. Monitor CBC and Diff weekly during first week, twice monthly for 2-3 months, and then monthly for 1st year of therapy.

Nabumetone Antiheumatics

NSAIDS

Inhibits prostaglandin synthesis.

Aspirin, NSAIDS, potassium supplements, corticosteroids and alcohol may decrease effectiveness.

GI bleeding, andominal pain, diarrhea, anaphylaxis, angioneurotic edema.Assess patients range of motion, degree of swelling, and pain in affected joints before and periodically throughout therapy.

Nadolol

corgard

AntianginalAntihypertensiveAntiarrhythmics

Beta BlockerNon selective

Block stimulation of beta adrenergic and beta two adrenergic receptor sitesDecreases heart rate and blood pressure, produces less bradycardia than other beta blockers.

Hypotension may occur with other antihypertensivesNSAIDs may decrease antihypertensive actions. CI in uncompensated CHF or pulmonary edema.

Side effects include fatigue, weakness, anxiety, blurred vision, arrhythmias, impotence, constipation, and diarrhea. May be administered with food. Patients receiving IV must have continuous ECG monitoring. Take apical pulse, if <50bpm withhold medication. Tell patient to change positions slowly to avoid orthostatic hypotension.

Naloxone

 

Narcan

Antidote

 

Opioid antagonists

Completely blocks the effects of opioids, including CNS and repiratory depression, without producing any agonist effects.

Can precipitate withdrawal in patients physically dependent on opioid analgesics. 

Side effects include:  Hypertension, hypotension, ventricular fibrillation, nausea and vomiting.  Monitor RR, rhythm, depth, pulse, BP and level of consciousness.  Administer undiluted for opioid overdose.  For RR depression, dilute 0.4 mg in 10 ml of Normal saline. 

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Administer at a rate of 0.5 ml direct IV push every 2 minutes.  Titrate dose to avoid withdrawal and severe pain.

Naproxen NSAIDNon opioid analgesic

Inhibits prostaglandin synthesis.

Aspirin may decrease effectiveness. Increased risk of bleeding with anticoagulants, and thrombolytics. May increase serum levels of lithium.

Dizziness, drowsiness, headache, Drug induced hepatitis, GI bleeding, constipation, dyspepsia, nausea, anaphylaxis. More effective if given before pain becomes severe. Administer 30 min before or 2 hrs after meals. May take with food, milk, or antacids to decrease GI irritation.

Nefazodone

Serzone

Antidepressant Inhibits the reuptake of serotonin and norepinephrine by neurons. Antagonizes alpha adrenergic receptors.

CI in hypersensitivity, MAOI use and active liver disease.

Side effects include: dizziness, insomnia, somnolence, constipation, dry mouth, nausea. Monitor mood changes, suicidal tendencies, bp and pulse before and during therapy, monitor liver function. Administer doses twice a day.

Nefinavir

Viracept

Anti-retrovirals

Protease inhibitors

Inhibits the action of HIV protease and prevents the cleavage viral polyproteins.

Life threatening drug interactions may occur with concurrent use of amiodarone, dihydroergotamine, ergonovine, ergotamine, methylergonovine, pimozide, midazolam, quinidine, simvastatin, lovastatin and triazolam. Food increases absorption.

Seizure can be fatal if occur. Diarrhea is common.Asses for change in severity of HIV symptoms or symptoms of opportunistic infections. Assess liver function tests. May cause hyperglycemia. Inform patient that this therapy does not cure HIV and the Importance of strict drug adherence. Administer with meals.

Neomycin sulfate Anti infectiveaminoglycosides

Decrease the number of ammonia producing bacteria in the gut. Inhibits prtein synthesis in bacteria at level of 30S ribosome

Hypersensitivity to neomycin or other aminoglycosides

N/V diarrhea, hypersensitivity reactions. Enhance possible respiratory paralysis after inhalation anesthetics. Or neuromuscular blockers

Netilmicin

netromycin

Antiinfective

Aminoglycoside

Inhibits protein synthesis in bacteria at level of 30s ribosome. Has a bactericidal action.

CI in hypersensitivity. Inactivated by penicillins and cephalosporins when administered in renal insufficiency.

Side effects include: ototoxicity, nephrotoxicity, muscle paralysis and hypersensitivity. Assess patient for signs of infection, obtain culture before admin. Evaluate hearing and balance before admin therapy. Infuse slowly over 30 min-2 hr.

Nicardipiine Antianginal Inhibits the transport of calcium Additive Side effects include anxiety

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CardeneAntihypertensiveAntiarrhythmics

Calcium channel blocker

into myocardial and vascular smooth muscle cells resulting in inhibition of excitation-contraction coupling and subsequent contraction

hypotension may occur when used with other antihypertensives. bradycardia may result when used with beta-blockers. Concurrent ingestion of grapefruit juice increases blood levels and effects.

confusion peripheral edema diarrhea nausea vomiting hyperglycemia arrhythmias nocturia. Monitor blood pressure and pulse before administration. Monitor I & O and for peripheral edema.

Nifedipine

Procardia

Antianginal AntihypertensiveAntiarrhythmics

Calcium channel blocker

Inhibits the transport of calcium into myocardial and vascular smooth muscle cells resulting in inhibition of excitation-contraction coupling and subsequent contraction

Additive hypotension may occur when used with other antihypertensives. bradycardia may result when used with beta-blockers. Concurrent ingestion of grapefruit juice increases blood levels and effects.

Side effects include anxiety confusion peripheral edema diarrhea nausea vomiting hyperglycemia arrhythmias nocturia. Monitor blood pressure and pulse before administration.

Nitrofurantoin Anti infective Interferes with bacterial enzumes.

CI in hypersensitivity, oliguria, anuruia. Probenedcid and sulfinpyrazone prevent high urinary concentration may decrease effectiveness.

Side effects include: anorexia, nausea, vomiting, hypersensitivity reactions and dizziness. Assess for signs and symptoms of urinary tract infection before and during therapy. Obtain specimens for culture and sensitivity before and during administration, monitor intake and output, cbc. Administer with food or milk to minimize GI irritation and to delay and increase absorption. Do not crush tablets.

Nitroglycerin

Nitrostat

Anti-anginal

Nitrates

Acute and long-term prophylactic management of angina pectoris.

Additive hypotension with antihypertensives

Side effects include dizziness, headache, hypotension, tachycardia. Inform patient that the tablets should be kept in original glass container. Replace tablet after six months of opening. Ensure patient correctly places tablet under the tongue.

Nizatidine Antiulcer agents

Histamine H2 antagonist

Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion.

Lowers the absorption of ketoconazole. Antacids and sucralfate decreases absorption.

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Norepinephrine Cardiac stimulant

Stimulates beta1 and alpha1 receptors in sympathetic nervous system, causing vasoconstriction, increased blood pressure, enhanced contractility, and decreased heart rate

In case of anaphylactic episode Hypotension, thrombosis, cardiac disease, peripheral vascular disease, hypertension.

Headache, anxiety, bradycardia, severe hypertension, arrhythmias, respiratory difficulty. Check blood pressure every 2 minutes until desired pressure is achieved. Maintain continuous ecg monitoring. Headache may signal extreme hypertension and overdose. Watch for signs and symptoms of peripheral vascular insufficiency.

Norfloxacin

Noroxin

Anti infective

Fluoroquinolone

Inhibit bacterial DNA synthesis by inhibiting DNA gyrase.

CI in hypersensitivity and pregnancy.

Side effects include: dizziness, drowsiness, headache, insomnia, abdominal pain, diarrhea, nausea hypoglycemia and phlebitis at IV site. Assess patient for signs of infection, obtain culture before therapy is started, observe for signs of anaphylaxis.

NPH insulin

Humulin N

Humulin 50/50, humulin 70/30, novolin 70/30

Antidiabetics, hormones

Pancreatics

Lower blood glucose by increasing transport into cells and promoting the conversion of glucose to glycogen. Promote the conversion of amino acids to proteins in muscle and stimulate triglyceride formation. Inhibit the release of free fatty acids.

CI in hypersensitivity to insulin, infection.

Side effects include hypoglycemia, lipdystrophy, anaphylaxis. Assess for signs and symptoms of hypoglycemia, blood glucose and ketones. Must be verified by another nurse, use only insulin syringes to draw up dose. Draw up clear insulin before mixed. Administer SQ at 45 degree angle. :Onset 3-4 hr Peak 6-12 hr Duration 18-24 hr

Nystatin Powder Antifungal Inteferes with fungal cell-wall synthesis causing osmotic instability

Fungal infection between folds Renal or hepatic disease pregnant or breastfeeding in patients younger than 2 use cautiously.

Can cause pruritus increases corticosteroid absorption. Monitor area of use for increase in redness, swelling, or irritation.

Ofloxacin

Floxin

Anti infective

Fluoroquinolone

Inhibit bacterial DNA synthesis by inhibiting DNA gyrase.

CI in hypersensitivity and pregnancy. Y site incomp amphotericin b cholesteryl sulfate, cefepime,

Side effects include: dizziness, drowsiness, headache, insomnia, abdominal pain, diarrhea, nausea hypoglycemia and phlebitis at IV site. Assess patient for signs of infection,

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doxorubicin liposome.

obtain culture before therapy is started, observe for signs of anaphylaxis. Administer over 60 minutes.

Olanzapine

Zyprexia

Antipsychotic Antagonizes dopamine and serotonin type 2 in the CNS. Also has anticholinergic, antihistaminic, and anti alpha adrenergic effects.

Effects may be decreased by carbamazepine, omeprazole, or rifampin. Increased hypotension with antihypertensives Increased CNS depression with CNS depressants. May antagonize the effects of levodopa or dopamine antagonist.

Seizure and neuroleptic malignant syndrome may be fatal if they occur. Agitation, dizziness, headache, restlessness, sedation, weakness, amblyopia, rhinitis, orthostatic hypotension, tachycardia, constipation, dry mouth, weight gain, and tremor are common. Monitor bp and pulse during therapy. Monitor I&O daily. Monitor for alkathisia. Monitor for tardive dyskinesia. Monitor for development of neuroleptic malignant syndrome. Advise patient to protect against photosensitivity.

Omalizumab

Xolair

AntiasthmaticsMonoclonal antibodies

Inhibits binding of IgE to receptors on mast cells and eosinophils, preventing the release of mediators of the allergic response. Also decreases amount of IgE receptors on basophils.

CI in hypersensitivity and acute bronchospasm.

Side effects include: injection site reactions and anaphylaxis. Assess lung sounds and RR, assess for allergic reactions within 2 hr of first injection, monitor for injection site reactions. Solution is viscous and may take 5-10 sec. to administer.

Ondansetron

Zofran

Anti-emetic Blocks the effects of serotonin at receptor sites located in vagal nerve terminals and the chemoreceptor trigger zone in the CNS.

Lorazepam piperacillin sodium bicarbonate ampicillin

Side effects include headache constipation diarrheaadminister undiluted immediately before induction of anesthesia or postoperatively if nausea and vomiting occur shortly after surgeryAssess patient for nausea and vomiting abdominal distention in bowel sounds prior to and following administration.

Oxycodone HCL

 

Tylox

Opiod Analgesic Binds to opiate receptors in the CNS.  Alters perception of and response to painful stimuli while producing generalized CNS depression.

Increases CNS depression when used with other sedatives.

Side effects include confusion sedation hypotension constipation.  Administer tables with food or milk to minimize GI irritation.  Assess pain, BP, pulse and respirations before administration.  Do not give is RR <10bpm.

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Oxybutynin Chloride

Ditropan

Antispasmodic

anticholinergic

Inhibits the action of acetylcholine at postganglionic receptors. Has direct spasmolytic action on smooth muscle, including smooth cuscle lining the GU tract without affecting vascular smooth muscle

Increases bladder capacityDelayed desire to voidDecreases urge incontinence urgency and frequency

Side effects include dizziness, drowsiness, hallucinations, insomnia, weakness, blurred vision, increased intraocular pressure palpitations dry mouth urinary retention nausea and vomiting

Oxytocin Hormone

Oxytocics

Stimulates uterine and mammary gland smooth muscle, producing uterine contractions similar to spontaneous labor contractions.

Severe hypertension may occur if given with vasopressors. Concurrent use with cyclopropane anesthesia may result in excessive hypotension

Maternal: coma, seizure, increased uterine motility, painful contractions.Fetal: Intracranial hemorrhage, asphyxia.Advise patient to expect contractions similar to menstrual cramps after administration. Assess aharecter, frequency, and duration of uterine contractions; resting uterine tone; and fetal heart rate. If contractions occur ,2min apart and are .50-65mm Hg on monitor, if they last 60-90 sec or longer, or change in fetal heart tone develops, stop the infusion and turn patient on her left side to prevent fetal anoxia. Notify physician immediately.

palonosetron Antiemetics

5-HT3 antagonists

Blocks the effects of serotonin at receptor sites located in vagal nerve terminals and in the chemoreceptor trigger zone in the CNS,

CI in hypersensitivity. Concurrent diuretic or antiarrhythmic therapy increases risk of arrhythmias. Do not mix with other drugs.

Side effects include: headache and constipation. Assess patient for nausea, vomiting, abdominal distention and bowel sounds prior to and following administration. Administer undiluted over 30 sec,

Pantoprazole

 

Protonix

Antiulcer agent

 

Gastric acid-pump inhibitor

Binds to an enzyme in the presence of acidic gastric PH, preventing the final transport of hydrogen ions into the gastric lumen.

May alter bioavailability of drugs for which absorption is PH dependant. 

Side effects include:  Headache, abdominal pain, diarrhea and hyperglycemia.  Assess for epigastric pain.  May be administered with or without food.  Do not break, crush or chew tablets.

Paroxetine

Paxil

AntidepressantSSRI

Selectively inhibits the reuptake of serotonin in the CNS.

CI in hypersensitivity and MAOI use,

Side effects include: anxiety, drowsiness, sexual dysfunction, excessive

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and concurrent use of citalopram. Wait at least 14 days after discontinuing MAOI use to begin using this drug.

sweating, pruritus, tremor, insomnia, diarrhea, nausea, hyponatremia, and increased appetite. Monitor mood changes, assess for suicidal tendencies, and monitor appetitie and nutritional intake. Administer as a single dose in the morning or evening without regard to meals.

PenbutololLevatol

AntianginalAntihypertensiveAntiarrhythmics

Beta BlockerNon selective

Block stimulation of beta adrenergic and beta two adrenergic receptor sitesDecreases heart rate and blood pressure, produces less bradycardia than other beta blockers.

Hypotension may occur with other antihypertensivesNSAIDs may decrease antihypertensive actions. CI in uncompensated CHF or pulmonary edema.

Side effects include fatigue, weakness, anxiety, blurred vision, arrhythmias, impotence, constipation, and diarrhea. May be administered with food. Patients receiving IV must have continuous ECG monitoring. Take apical pulse, if <50bpm withhold medication. Tell patient to change positions slowly to avoid orthostatic hypotension.

Penicillins

Penicillin g potassium

Penicillin v

Procaine penicillin g

Benzathine penicillin g

Anti infective

Penicillins

Bind to bacterial cell wall, resulting in cell death.

CI in hypersensitivities to penicillin, procaine or benzathine. Penicillin v may decrease the effectiveness of oral contraceptive agents. Neomycin may decrease the absorption of penicillin v. y sit e incomp. If aminoglycosides and penicillins must be administered concurrently, administer in separate sites at least 1 hr apart.

Side effects include: diarrhea, epigastric distress, nausea, vomiting, rashes, and pain at IM site, phlebitis, anaphylaxis and serum sickness. Assess patient for infection. Obtain culture before starting therapy. Observe for signs of anaphylaxis; administer around the clock. Pen v may be administered without regard to meals. Inject penicillin deep into muscle. Change iv sites every 48 hr to prevent phlebitis. Administer slowly and observe for hypersensitivity.

Perindopril

aceon

Antihypertensiveace inhibitor

Angiotensin converting enzyme inhibitors block the conversion of angiotensin one to the vasoconstrictor angiotensin two.

Excessive hypotension may occur with use of other antihypertensive. Y site incompatibility amphotericin b, cefepime,

Side effects include cough hypotension taste disturbances proteinuriamonitor blood pressure and pulse frequently during dose adjustments and periodically during therapy. Monitor weight and assess for fluid overload, monitor cbc, wbc

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phenytoin. and urine protein prior and during therapy. Teach patient to change positions slowly to reduce orthostatic hypotension and avoid excessive salt intake.

Phenobarbital Sedative/ Hypnotic

Barbiturate

Anticonvulsant

Produces all levels of CNS depression, Inhibits transmission in CNS and increases seizure threshold.

Additive CNS depression with alcohol, antihistamines, opoid analgesics, and other sedative/hypnotic. MAOI’S, valproic acid, or divalproex may decrease metabolism

Hangover, Laryngospam, angioedema, serum sickness.Assess respiratory status, pulse, and b/p frequently. Equipment for resuscitation and artificial ventilation should be readily available.

Phenytoin

Dilantin

AntiarrhythmicsAnticonvulsantsHydantoins

Limits seizure propagation by altering ion transport. Antiarrhythmic properties cause im;provement in AV conduction. May also decrease synaptic transmission.

CI in heart block and hypersensitivity.Y site incompatability cipro, diltiazem, enalaprilat, hydromorphone, kcl, sufentanil, vit b complex

Side effects include: ataxia, diplopia, nystagmus, hypotension, gingival hyperplasia, nausea and rashes. Institute seizure precautions, administer with food to minimize gastric irritation. Administer at a rate not to exceed 50 mg over 1 min to minimize hypotension.

Phosphate/Biphosphate

Laxative

Saline

Osmotically active in the lumen of the GI tract. Produces laxative effect by causing water retention and stimulation of peristalsis. Stimulates motility and inhibits fluid and electrolyte absorption from the small intestine.

Visicol: Concurrently administered oral meds may not be absoebed.

Visicol: dizziness, headache, abnominal bloating and pain, vomiting.Arrythmias, cramping, nausea.Assess for abdominal distention, presence of bowel sounds, and usual pattern of function. Do not administer at bedtime or late in the day.

Pindolol

Visken

AntianginalAntihypertensiveAntiarrhythmics

Beta BlockerNon selective

Block stimulation of beta adrenergic and beta two adrenergic receptor sitesDecreases heart rate and blood pressure, produces less bradycardia than other beta blockers.

Hypotension may occur with other antihypertensivesNSAIDs may decrease antihypertensive actions. CI in uncompensated CHF or pulmonary edema.

Side effects include fatigue, weakness, anxiety, blurred vision, arrhythmias, impotence, constipation, and diarrhea. May be administered with food. Patients receiving IV must have continuous ECG monitoring. Take apical pulse, if <50bpm withhold medication. Tell patient to change positions slowly to avoid ortho.hypotension.

Pioglitazone

Actos

Antidiabetic

Thiazolidnediones

Improves sensitivity to insulin by acting as an agonist at receptor sites involved in insulin responsiveness and

CI in hypersensitivity, insulin dependent diabetics,

Side effects include: edema and anemia. Assess for hypoglycemia, monitor cbc, liver studies and cpk levels.

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subsequent glucose production and utilization. Requires insulin for activity.

ketoacidosis, uncontrolled infection.

May be taken with or without meals.Onset: 30 min

Peak: 2-4 hr

Duration: 24 hrPiperacillinTazobactam

Zosyn

Anti-infectiveExtended spectrum penicillins

Binds to bacterial cell wall causing cell death.

Potassium losing diuretics corticosteroids or amphotericin b may increase the risk of hypokalemia

Side effects include hypokalemia pain at IM site anaphylaxis serum sicknessreconstitute with 5 mL sterile water for injection. Shake well until dissolved. Administer over at least 30 minutes.

Pirbuterol

maxair

Bronchodilators

Adrenergics

Result in the accumulation of cyclic adenosine monophosphate at beta adrenergic receptor. Produces bronchodiliation. Inhibits the release of mediators of immediate hypersensitivity reactions form mast cells.

Concurrent use with other adrenergic agents will cause increased adrenergic effects beta-blockers may decrease effects. Use with herbs and caffeine containing ephedra may increase stimulant effect.

Side effects include nervousness restlessness tremor palpitations or tachycardia angina hypertension assess lung sounds, respiratory pattern and blood pressure before administration and during peak of medicationObserve for bronchospasm. If condition occurs, withhold medication and notify physician immediately

Polyethylene glycol/electrolyte

Laxative

Osmotic

Polyethylene glycol solution acts as an osmotic agent, drawing water into the lumen of the GI tract.

Interferes with the absorption of orally administered drugs.

Do not administer within one hour of other oral meds. Abdominal fullness and diarrhea may occur. Patient should fast 3-4 before administration and hold food for 2 hrs after administration. Do not add extra flavoring or ingredients to solution.

Potassium Chloride

 

Micro K

Mineral and electrolyte replacement/ supplement

Maintain acid-base balance, isotonicity, and electrophysiologic balance of the cell.  Required fro transmission of nerve impulses.

Use cautiously with cardiac disease and Diabetes Mellitus.

Side effects include:  Abdominal pain, diarrhea, nausea, vomiting.  Assess for signs of hypo and hyperkalemia.  Administer with or after meals to reduce GI irritation.  These capsules may be opened and sprinkled on soft food and swallowed immediately with water.

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Pravastatin

(Pravachol)

Lipid lowering agentHGM-CoA reductase inhibitor

Inhibits 3-hydroxy-3 methylglutaryl-coenzyme A reductase, which is responsible for an early step in the synthesis of cholesterol. Lowers LDL, Increases HDL, decreases VLDL and triglycerides. Slows the progression of CAD with a decrease in MI and need for myocardial revascularization.

Additive cholesterol lowering effect or decreased effectiveness with bile acid sequestrants, May slightly increase digoxin levels, May increase effects of warfarin. Grapefruit juice increases blood levels and increases risk of toxicity.

Abdominal cramps, constipation, diarrhea, flatus, heartburn, rashes and rhabdomyolysis may occur. Administer in the evening, no regard to food. Ophthalmologic exams are recommended before and yearly during therapy. If patient develops muscle tenderness during therapy, monitor CPK levels. If CPK levels are markedly increased or myopathy occurs, therapy should be discontinued.

Prednisolone AntiasthmaticsIntermediate actingcorticosteroids

Suppress inflammation and the normal immune response. Suppresses adrenal function. Has minimal mineralocorticoid activity.

CI in active infections, lactation, stress, and pregnancy. Use with NSAIDS increases risk of adverse GI effects.

Side effects include: depression, euphoria, hypertension, anorexia, nausea, acne, decreased wound healing, adrenal suppression, cusingoid appearance. Admin. IV push at no more than 10 mg/min. Monitor I & O, teach patient not to stop medication abruptly, assess glucose and K levels.

Prednisone AntiasthmaticsIntermediate actingCorticosteroids

Suppress inflammation and the normal immune response. Suppresses adrenal function. Has minimal mineralocorticoid activity.

CI in active infections, lactation, stress, and pregnancy. Use with NSAIDS increases risk of adverse GI effects.

Side effects include: depression, euphoria, hypertension, anorexia, nausea, acne, decreased wound healing, adrenal suppression, cusingoid appearance. Monitor I & O, teach patient not to stop medication abruptly, assess glucose and K levels.

Prochlorperazine

Compazine

Antipsychotics

Antiemedics

Alters effects of dopamine in the CNS.

CI in hypersisitivity, bone marrow depression, liver or heart disease. Increased hypotension when used withantihypertensives, nitrates or alcohol. Do not mix with any other meds in the same syringe. Ysite income: allopurinol, amphotericin B, cefepime, peperacillin and

Side effects include: epx, blurred vision, constipation, dry mouth, anorexia, photosensitivity and allergic reactions. Monitor bp and pulse during therapy. Assess patient for nausea and vomiting before and 30-60 min after administration. Avoid getting solution on hands. IM keep patient recumbent for at least 30 min after injection to minimize hypotensive effects.

Side effects include: epx, blurred vision, constipation, dry mouth, anorexia, photosensitivity and allergic reactions. Monitor bp and pulse during therapy. Assess patient for nausea and vomiting before and 30-60 min after administration. Avoid getting solution on hands. IM keep patient recumbent for at least 30 min after injection to minimize hypotensive effects.

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tazobactam.Promethazine Antiemedic

antihistamine

sedative/hypnotic

Blocks the effects of histamine. Has inhibitory effect on chemoreceptor trigger zone in the medulla. Alters the effects of dopamine in the CNS.

Additive CNS depression with alcohol, antihistamines, opoid analgesics.Increased CNS side effects with MAOI’S

Confusion, disorientation, sedation, NEUROLEPTIC MALIGNANT SYNDROME.Assess for nausea and vomiting before and after administration.

 Propofol

Diprivan     

   General anesthetic

Produces dose dependent CNS depression, action is unknown.

 CI in hypersensitivity to drug or soybean oil, egg, and hyperlipidemia.

 Side effects include:jerking, fever, dizziness, shivering, increased ICP, impaired cerebral flow, seizures, asystole, pancreatitis, apnea, cough and hypoxia. Use d5w to dilute. Give over 3-5 minutes. Use only glass containers when mixing.

Propoxyphene Napsylate

 

Davocet-N

Opiod Analgesic Binds to opiate receptors in the CNS.  Alters perception of and response to painful stimuli while producing generalized CNS depression.

Increases CNS depression when used with other sedatives.

Side effects include:  dizziness, weakness and nausea.  May be administered with food or milk to minimize GI irritation.  Assess pain for location, intensity and type before and after administration. 

Propranolol

Inderal

AntianginalAntihypertensiveAntiarrhythmics

Beta Blocker

Block stimulation of beta adrenergic and beta two adrenergic receptor sitesDecreases heart rate and blood pressure

Hypotension may occur with other antihypertensivesNSAIDs may decrease antihypertensive actions

Side effects include fatigue, weakness, anxiety, blurred vision, arrhythmias, impotence, constipation, and diarrhea. May be administered with food. Patients receiving IV must have continuous ECG monitoring. Take apical pulse, if <50bpm withhold medication.

Psyllium LaxativeBulk-forming agent

Combines with water in the intestinal contents to form an emollient gel or viscous solution that promotes peristalsis and reduces transit time.

May decrease the absorption of warfarin, salicylates, or digitalis glycosides.

Cramping, nausea and vomiting may occur.Assess for abdominal distention, presence of bowel sounds, and usual pattern of function.

 Pulmocare     

Nutritional supplement

 PULMOCARE is a high-fat, low-carbohydrate formula specifically designed to reduce carbon dioxide production, thereby minimizing CO, retention resulting from chronic obstructive pulmonary disease,

 May cause an increase in blood sugar levels.

 IF YOU ARE TAKING FEEDINGS THROUGH A FEEDING TUBE, be sure the product is at room temperature before using.SIDE EFFECTS that may go away during feedings include

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cystic fibrosis or respiratory failure.Appropriate for ambulatory or ventilator-dependent patients.

nausea, vomiting, stomach cramps, diarrhea, and constipation.

Quinapril

accupril

Antihypertensiveace inhibitor

Angiotensin converting enzyme inhibitors block the conversion of angiotensin one to the vasoconstrictor angiotensin two.

Excessive hypotension may occur with use of other antihypertensive. Y site incompatibility amphotericin b, cefepime, phenytoin.

Side effects include cough hypotension taste disturbances proteinuriamonitor blood pressure and pulse frequently during dose adjustments and periodically during therapy. Monitor weight and assess for fluid overload, monitor cbc, wbc and urine protein prior and during therapy. Teach patient to change positions slowly to reduce orthostatic hypotension and avoid excessive salt intake.

Rabeprazole

Aciphex

Antiulcer

Proton pump inhibitor

Binds to an enzyme on gastric parietal cells in the presence of acidic gastric pH preventing the final transport of hydrogen ions into the gastric lumen.

Lowers blood levels of ketoconazole. Increases digoxin levels. May increase risk of bleeding with warfarin.

Side effects include headache abdominal pain, constipation,

diarrhea and nausea. Assess patient routinely for epigastric or abdominal pain and occult blood in the stool

or gastric aspirate.

Raloxifene Bone resorption inhibitors

Binds to estrogen receptors, producing estrogen-like effects on bone, resulting in reduced resorption of bone and decreased bone turnover.

Cholestyramine decreases absorption. May alter effects of warfarin and other highly protein-bound drugs. It is not recommended to take estrogen concurrently.

Leg cramps and hot flashes may occur. May be administered without regard to meals. Calcium supplements may be necessary. Emphasize the importance of regular weight bearing exercises. Do not take during prolonged immobilization because of increased risk of thrombosis.

Ramipril

altace

Antihypertensiveace inhibitor

Angiotensin converting enzyme inhibitors block the conversion of angiotensin one to the vasoconstrictor angiotensin two.

Excessive hypotension may occur with use of other antihypertensive. Y site incompatibility amphotericin b, cefepime, phenytoin.

Side effects include cough hypotension taste disturbances proteinuriamonitor blood pressure and pulse frequently during dose adjustments and periodically during therapy. Monitor weight and assess for fluid overload, monitor cbc, wbc and urine protein prior and during therapy. Teach patient to change positions slowly to reduce orthostatic hypotension and avoid excessive salt intake. Capsules may be opened and sprinkled on apple sauce,

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store prepared mixtures for 24 hours at room temp or 48 hrs if refrigerated.

Ranitidine bismuth citrate

Tritec

Antiulcer agents

Histamine H2 antagonist

Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion. Some antibacterial action against h.pylori.

Lowers the absorption of ketoconazole. Antacids and sucralfate decreases absorption.

Regular insulin

Humulin R

Novolin R

Antidiabetics, hormones

Pancreatics

Lower blood glucose by increasing transport into cells and promoting the conversion of glucose to glycogen. Promote the conversion of amino acids to proteins in muscle and stimulate triglyceride formation. Inhibit the release of free fatty acids.

CI in hypersensitivity to insulin, infection.

Side effects include hypoglycemia, lipdystrophy, anaphylaxis. Assess for signs and symptoms of hypoglycemia, blood glucose and ketones. Must be verified by another nurse, use only insulin syringes to draw up dose. Draw up clear insulin before mixed. Administer SQ at 45 degree angle. This is the only insulin that can be given IV. Do not use if it is cloudy, discolored or viscous. May be administered IV undiluted directly into vein or through Y site.

For IV :Onset 10-30 min Peak 15-30 min Duration 30-60 min

For SQ:Onset 30-60 min Peak 2-4 hr Duration 5-7 hr

Repaglonide

Gluconorm

Prandin

Antidiabetics

Meglitinides

Stimulates the release of insulin from pancreatic beta cells by closing potassium channels, which results in the opening of calcium channels in beta cells. This is followed by release of insulin.

CI in hypersensitivity, lactation, diabetic ketoacidosis, insulin dependent diabetes.

Side effects include: angina, chest pain, hypoglycemia, and hyperglycemia. Administer up to 30 min before meals. Assess for signs and symptoms of hypoglycemia, blood glucose and ketones. Onset: within 30 minPeak: unknownDuration: unknown

Resperidone

Resperdal

Anti-psychotic Antagonizes dopamine and serotonin in the CNS.

May decrease the antiparkinsonian effects of lovedopa or other dopamine antagonist. Carbamazepine may decrease

Neuroleptic malignant syndrome may be fatal if it occurs. Aggressive behavior, dizziness, extrapyramidal reactions, headache, increased dreams, increased sleep duration, insomnia, sedation, pharyngitis, rhinitis,

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effects. Clozapine may increase the effects. Increased CNS depression with CNS depressants.

visual disturbance, cough, constipation, diarrhea, dry mouth, nausea, decreased libido, dysmenorrheal, itching/skin rash and weight gain are common. Monitor bp and pulse during therapy. Monitor I&O daily. Monitor for alkathisia. Monitor for tardive dyskinesia. Monitor for development of neuroleptic malignant syndrome. Advise patient to protect against photosensitivity.

Reteplase thrombolytic agents

Converts plasminogen to plasmin, which then degrades

fibrin clots.

Asprin, NSAIDS, warfarin, heparin and heparin like agents.Y site: heparin. No other med should be infused or injected into line used for reteplase.

Intacranial Hemorrhage, reperfusion arrythmias, anaphylaxis, GI bleed, retroperitoneal bleeding,GU tract bleeding.Assess for bleeding every15-30 min during the next8 hr, and at least every 4 hr for the duration of therapy. Assess neuro status throughout therapy(changes may indicate Intracranial hemorrhage)

Rifampin Antitubercular Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms.

Increased risk of hypatotoxicity with other hypatotoxic drugs. Lowers the effectiveness of hormonal contraceptive agents.

Red discoloration of all body fluids, abdominal pain, diarrhea, flatulence, heart burn, nausea, vomiting.Advise patient to contact physician immediately if signs of hepatitis occur. Do not use alcohol during therapy.

Risedronate

Actenel

Bone resorption inhibitors

Biphosphonates

Inhibits bone resorption by binding to bone hydroxyapatite, which inhibits osteoclast activity.

NDAIS or asprin may increase GI irritation. Absorption is lowered by food and calcium supplements or antacids.

Weakness, abdominal pain, diarrhea, rash and arthralgia may occur. Administer first thing in the a.m with 6-8 oz plain water 30 min before other meds, beverages, or food. Instruct patient to remain upright for 30 min following dose to facilitate passage to stomach. Advise patient to wear sunscreen and protective clothing to prevent photosensitivity. Assess cacium and vitamin D before and periodically during therapy.

rosiglitazone Antidiabetic

Thiazolidnedione

Improves sensitivity to insulin by acting as an agonist at receptor sites involved in

CI in hypersensitivity, insulin dependent

Side effects include: edema and anemia. Assess for hypoglycemia, monitor cbc,

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s insulin responsiveness and subsequent glucose production and utilization. Requires insulin for activity.

diabetics, ketoacidosis, uncontrolled infection.

liver studies and cpk levels. May be taken with or without meals.

Rosuvastatin

(Crestor)

Lipid lowering agentHGM-CoA reductase inhibitor

Inhibits 3-hydroxy-3 methylglutaryl-coenzyme A reductase, which is responsible for an early step in the synthesis of cholesterol. Lowers LDL, Increases HDL, decreases VLDL and triglycerides. Slows the progression of CAD with a decrease in MI and need for myocardial revascularization.

Additive cholesterol lowering effect or decreased effectiveness with bile acid sequestrants, May slightly increase digoxin levels, May increase effects of warfarin. Grapefruit juice increases blood levels and increases risk of toxicity.

Abdominal cramps, constipation, diarrhea, flatus, heartburn, rashes and rhabdomyolysis may occur. Ophthalmologic exams are recommended before and yearly during therapy. If patient develops muscle tenderness during therapy, monitor CPK levels. If CPK levels are markedly increased or myopathy occurs, therapy should be discontinued.

Salmeterol

Serevent

Bronchodilators

Adrenergics

Result in the accumulation of cyclic adenosine monophosphate at beta adrenergic receptor. Produces bronchodiliation. Inhibits the release of mediators of immediate hypersensitivity reactions form mast cells.

Concurrent use with other adrenergic agents will cause increased adrenergic effects beta-blockers may decrease effects. Use with herbs and caffeine containing ephedra may increase stimulant effect.

Side effects include nervousness restlessness tremor palpitations or tachycardia angina hypertension assess lung sounds, respiratory pattern and blood pressure before administration and during peak of medicationMetered dose inhaler should be primed or tested before 1st use. Do not use spacer and discard after every use. Observe for bronchospasm. If condition occurs, withhold medication and notify physician immediately

Salsalate Antipyretics

Nonopioid analgesics

Salicylates

Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins.

May increase the activity of penicillins, phenytoin, methotrexate, valppoic acid, oral hypoglycemic agents and sulfonamides. Corticosteroids may decrease levels. May blunt the therapeutic response to diuretics, antihypertensives and NSAIDS.

Anaphylaxis, Laryngeal edema, and reyes syndrome (in children) may be fatal if they occur. Dyspepsia, epigastric distress, heartburn, and nausea are common. Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at increased risk for developing hypersensitivity reactions. Administer after meals or with food or an antacid to minimize gastric irritation.

Saquinavir Anti-retrovirals Inhibits the action of HIV Concurrent use of Seizure and Steven Johnson

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Protease inhibitors

protease and prevents the cleavage viral polyproteins.

Rifampin and rifabutin is contraindicated. Midazolam and triazolam increases CNS depression. Grapefruit juice increases serum levels. Garlic decreases levels.

Syndrome can be fatal if they occur. Abdominal discomfort, diarrhea, increased liver enzymes, jaundice, and nausea are common.Asses for change in severity of HIV symptoms or symptoms of opportunistic infections. Assess hematologic and hepatic tests. May cause anemia and thrombocytopenia. May cause hyperglycemia. Inform patient that this therapy does not cure HIV and the Importance of strict drug adherence. Administer within 2 hrs after full meal.

sennosides

Senokot

Stimulant laxative

Active components of senna alter water and electrolyte transport in the large intestine resulting in an accumulation of water and Increased peristalsis.

May decrease absorption of other orally administered drugs because of decreased transit time.

Side effects include cramping and diarrhea.  Assess patient for abdominal distention, presence of bowel sounds, and usual pattern of bowel function.  Assess color, consistency, and amount of stool produced.  Administer on an empty stomach for better results. Take with a full glass of water

Sertraline

Zoloft

AntidepressantSSRI

Selectively inhibits the reuptake of serotonin in the CNS. Has little effect on norepinephrine or dopamine.

CI in hypersensitivity and MAOI use and concurrent use of citalopram. Wait at least 14 days after discontinuing MAOI use to begin using this drug.

Side effects include: anxiety, drowsiness, sexual dysfunction, excessive sweating, pruritus, tremor, insomnia, diarrhea, nausea, hyponatremia, and increased appetite. Monitor mood changes, assess for suicidal tendencies, and monitor appetitie and nutritional intake. Administer as a single dose in the morning or evening without regard to meals.

Simvastatin

(Zocor)

Lipid lowering agentHGM-CoA reductase inhibitor

Inhibits 3-hydroxy-3 methylglutaryl-coenzyme A reductase, which is responsible for an early step in the synthesis of cholesterol. Lowers LDL, Increases HDL, decreases VLDL and triglycerides. Slows the progression of CAD with a decrease in MI and need for myocardial revascularization.

Additive cholesterol lowering effect or decreased effectiveness with bile acid sequestrants, May slightly increase digoxin levels, May increase effects of warfarin. Grapefruit juice increases blood levels and

Abdominal cramps, constipation, diarrhea, flatus, heartburn, rashes and rhabdomyolysis may occur. Administer in the evening, no regard to food. Ophthalmologic exams are recommended before and yearly during therapy. If patient develops muscle tenderness during therapy, monitor CPK levels. If CPK levels are markedly increased or myopathy occurs, therapy should be discontinued.

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increases risk of toxicity.

Sodium Chloride Mineral and electrolyte

Helps maintain water distribution, fluid and electrolyte balance Reduces Crneal edema by an osmotic effect

Use cautiously in geriatric patients thos with ng suctioning vomiting diarrhea CHF severe renal failure severe liver disease.

Side effects CHF, Pulmonary Edema, Edema, Hypernatremia and hypokalemia

Sodium salicylate Antipyretics

Nonopioid analgesics

Salicylates

Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins.

May increase the activity of penicillins, phenytoin, methotrexate, valppoic acid, oral hypoglycemic agents and sulfonamides. Corticosteroids may decrease levels. May blunt the therapeutic response to diuretics, antihypertensives and NSAIDS.

Anaphylaxis, Laryngeal edema, and reyes syndrome (in children) may be fatal if they occur. Dyspepsia, epigastric distress, heartburn, and nausea are common. Patients who have asthma, allergies, and nasal polyps or who are allergic to tartrazine are at increased risk for developing hypersensitivity reactions. Administer after meals or with food or an antacid to minimize gastric irritation.

Sotalol

Betapace

AntianginalAntihypertensiveAntiarrhythmics

Beta BlockerNon selective

Block stimulation of beta adrenergic and beta two adrenergic receptor sitesDecreases heart rate and blood pressure, produces less bradycardia than other beta blockers.

Hypotension may occur with other antihypertensivesNSAIDs may decrease antihypertensive actions. CI in uncompensated CHF or pulmonary edema.

Side effects include fatigue, weakness, anxiety, blurred vision, arrhythmias, impotence, constipation, and diarrhea. May be administered with food. Patients receiving IV must have continuous ECG monitoring. Take apical pulse, if <50bpm withhold medication. Tell patient to change positions slowly to avoid orthostatic hypotension.

Sparfloxacin

Zagam

Anti infective

Fluoroquinolone

Inhibit bacterial DNA synthesis by inhibiting DNA gyrase.

CI in hypersensitivity and pregnancy, photosensitivity to other agents, unavoidable

Side effects include: dizziness, drowsiness, headache, insomnia, abdominal pain, diarrhea, nausea hypoglycemia and phlebitis at IV site. Assess

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exposure to sun, bright natural light or uv rays.

patient for signs of infection, obtain culture before therapy is started, observe for signs of anaphylaxis.

Stavudine Anti-retrovirals

Nucleoside reverse transcriptase inhibitor

Converted intracellularly to stavudine triphosphate, which inhibits viral DNA synthesis and replication.

Use cautiously with drugs causing peripheral neuropathy.

Pancreatitis and hepatitis may be deadly if they occur. Peripheral neuropathy is common. Asses for change in severity of HIV symptoms or symptoms of opportunistic infections. Assess for peripheral neuropathy and pancreatitis. Assess liver function tests. Inform patient that this therapy does not cure HIV and the Importance of strict drug adherence.

streptokinase thrombolytic agents

Converts plasminogen to plasmin, which then degrades

fibrin clots.

Asprin, NSAIDS, warfarin, heparin and heparin like

agents.

Intacranial Hemorrhage, reperfusion arrythmias, anaphylaxis, Gi bleed, retroperitoneal bleeding,GU tract bleeding.Assess for bleeding every15-30 min during the next8 hr, and at least every 4 hr for the duration of therapy. Assess neuro status throughout therapy(changes may indicate Intracranial hemorrhage)

streptomycin Antiinfective

Aminoglycoside

Inhibits protein synthesis in bacteria at level of 30s ribosome. Has a bactericidal action.

CI in hypersensitivity. Inactivated by penicillins and cephalosporins when administered in renal insufficiency.

Side effects include: ototoxicity, nephrotoxicity, muscle paralysis and hypersensitivity. Assess patient for signs of infection, obtain culture before admin. Evaluate hearing and balance before admin therapy.

Tacrolimus Immunosuppressants

Inhibits T-lymphocyte activation.

Grapefruit juice increases absorption. Potassium sparing diuretics or ACE inhibitors increases the risk of hyperkalemia. Risk of nephrotoxicity is increased by aminoglycosides, amphotericin B, cisplatin, or cyclosporine.

Seizure, insomnia, tremor, ascites, hypertension, peripheral edema, GI bleeding, pain, anorexia, diarrhea, nausea, vomiting, nephrotoxicity, urinary tract infection, pruritus, rash, hyperglycemia, hyperkalemia, hypomagnesemia, anemia, lymphocytosis, thrombocytopenia, pareshesia, Anaphylaxis, and generalized pain may occur. Monitor B/P closely. Monitor CBC and platelet count. Inform patient of increased risk of lymphoma with this therapy.

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Telmisartan

Micardis

Antihypertensive

Angiotensin II receptor antagonist

Blocks vasoconstrictor and aldosterone-produing effects of angiotensin II at receptor sites, including vascular smooth muscle and the adrenal glands.

NSAIDS may decrease drug effects. Risk of hypotension when used with diuretics.

Side effects include: dizziness, fatigue, headache, hypotension, renal failure and hyperkalemia. Assess bp and pulse before administering. Assess patient for signs of angioedema (dyspnea and facial swelling), monitor I & O, auscultate lungs for rales or crackles, monitor labs. May be administered with or without meals.

Temazepam Sedative/Hypnotic

Benzodiazepine

Acts at many levels of the CNC to produce generalized CNS depression. Effects may be mediated by GABA.

Additive CNS depression with alcohol, antihistamines, opoid analgesics. Decreased effectiveness with: levodopa, barbiturates,Rifampin or smoking

Hangover.Prolonged use may cause physical or psychological dependence. Administer with food to prevent GI irritation.

Tenecteplase thrombolytic agents

Converts plasminogen to plasmin, which then degrades

fibrin clots.

Asprin, NSAIDS, warfarin, heparin and heparin like agents.Y site: Dextrose-containing solutions. Do not admix

Intacranial Hemorrhage, reperfusion arrythmias, anaphylaxis, GI bleed, retroperitoneal bleeding,GU tract bleeding.Assess for bleeding every15-30 min during the next8 hr, and at least every 4 hr for the duration of therapy. Assess neuro status throughout therapy(changes may indicate Intracranial hemorrhage)Administer as IV bolusOver 5 sec. flush with Saline before and after.

Terazosin

Hytrin

Antihypertensive

Peripherally acting antiadrenergics

Dilates both arteries and veins by blocking postsynaptic alpha adrenergic receptors.

CI in hypersensitivity. Increased hypotension with other antihypertensives, alcohol, or nitrates.

Side effects include: dizziness, headache, weakness, nasal conogestion, orthostatic hypotension, nausea and vomiting. Assess bp and pulse before administering. Syncope may occur 30-120 mi after administration, monitor I and O. administer initial dose at bedtime.

Terbutaline Bronchodilators

Adrenergics

Result in the accumulation of cyclic adenosine monophosphate at beta adrenergic receptor. Produces bronchodiliation. Inhibits the release of mediators of immediate hypersensitivity reactions form mast cells.

Concurrent use with other adrenergic agents will cause increased adrenergic effects beta-blockers may decrease

Side effects include nervousness restlessness tremor palpitations or tachycardia angina hypertension assess lung sounds, respiratory pattern and blood pressure before

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effects. Use with caffeine @ ephedra may increase stimulant effect.

administration and during peak of medicationObserve for bronchospasm.

Teriparatide Hormone

Parathyroid hormone

Regulates calcium and phosphate metabolism in bone and kidney by binding to specific cell receptors; stimulates osteoblastic activity. Increases calcium and decreases phosphorus.

Transient hypercalcemia may increase the risk of dogoxin toxicity.

Orthostatic hypotension may occur. Administer subcut into thigh or abdominal wall once daily. Solution should be clear and colorless. Store pen in refrigerator. Use immediately and return to refrigerator. Forteo pen can be used for up to 28 days. Discard after 28 days. Instruct patient to report signs of hypercalcemia (nausea, vomiting, constipation, lethargy, and muscle weakness).

Theophylliine Bronchodilators

Phosphodiesterase inhibitors

Xanthines

Inhibits phosphodiesterase, producing increased tissue concentrations of CAMP. Increased levels of Camp result in bronchodilation, cns stimulation, diuresis and gastric acid secretion.

Do not use in uncontrolled arrhythmias. Additive cv and cns side effects with adrenergic agents. Phenytoin and rifampin may decrease effectiveness. Y site incompatablility phenytoin.

Side effects include: anxiety, tachycardia, nausea, vomiting. Assess bp, pulse, RR before therapy. Monitor I & O. monitor drug levels and observe for toxicity signs such as anorexia, vomiting, nausea, diarrhea, confusion, headache, flushing or seizures. Administer over 30 minutes. Advise patient to drink plenty of fluids, avoid otc cough, cold, or breathing preparations, minimize caffeine intake and to have serum levels tested periodically.

ThiamineVitamin B1

Vitamin supplement

Needed for pyruvate metabolism and carbohydrate metabolism.

No known interactions

Circulatory collapse and pulmonary edema can be deadly if they occur. Nausea and diarrhea are common. Patient needs to increase yeast, beef, liver, legumes, and whole grains in the diet.

Ticarcillin

Ticarcillin/clavulanate

Anti-infective

Extended spectrum penicillins

Binds to bacterial cell wall membrane, causing cell death. Clavulanate enhances resistance to beta lactamase, an enzyme that can inactiviate penicillins.

CI in hypersensitivity to penicillins. Probenecid increases blood levels. Diuretics and corticosteroids increase the risk of hypokalemia.

Side effects include: diarrhea, hypokalemia, rashes, phlebitis and anaphylaxis. Assess patient for infection. Obtain culture before starting therapy. observe for signs of anaphylaxis, evaluate renal and hepatic function, cbc, k levels, and bleeding times. Change IV sites every 48 hrs

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to prevent phlebitis, inject ticarcillin only deep into a well muscled mass to minimize discomfort and massage well. Ticarcillin/clavulanate administer over 30 min via Y site or direct IV.

Ticlopidine

Ticlid

Antiplatelet agents

Platelet aggregation inhibitors

Inhibits platelet aggregation by altering the function of platelet membranes. Prolongs bleeding time.

Increased risk of bleeding with warfarin, heparins, tirofiban, epifibatide, clopidogrel, or thrombolytic agents. Absorption is increased with food.

Agranulocytosis, aplastic anemia, intracranial bleeding, and neutropenia may be deadly if they occur. Diarrhea and rashes are common. Monitor bleeding time during therapy. Administer with food with food or immediately after eating to minimize GI discomfort and increase absorption.

Timolol

Blocadren

AntianginalAntihypertensiveAntiarrhythmics

Beta BlockerNon selective

Block stimulation of beta adrenergic and beta two adrenergic receptor sitesDecreases heart rate and blood pressure, produces less bradycardia than other beta blockers.

Hypotension may occur with other antihypertensivesNSAIDs may decrease antihypertensive actions. CI in uncompensated CHF or pulmonary edema.

Side effects include fatigue, weakness, anxiety, blurred vision, arrhythmias, impotence, constipation, and diarrhea. May be administered with food. Patients receiving IV must have continuous ECG monitoring. Take apical pulse, if <50bpm withhold medication. Tell patient to change positions slowly to avoid orthostatic hypotension.

Tizanidine HCL Antispasiticity agents

Adrenergics

Acts as an agonist at central alpha adrenergic receptor sites. Reduces spasticity by increasing presynaptic inhibition of motor neurons.

Use cautiously in renal impairment, concurrent antihypertensive therapy, geriatric patients and impaired hepatic function.

 Side effects include:anxiety, depression, dizziness, sedation, weakness, hypotension, abd pain, diarrhea, dyspepsia and fever. Monitor BP and pulse. May be taken without regard to meals.

tobramycin Antiinfective

Aminoglycoside

Inhibits protein synthesis in bacteria at level of 30s ribosome. Has a bactericidal action.

CI in hypersensitivity. Inactivated by penicillins and cephalosporins when administered in renal insufficiency.

Side effects include: ototoxicity, nephrotoxicity, muscle paralysis and hypersensitivity. Assess patient for signs of infection, obtain culture before admin. Evaluate hearing and balance before admin therapy. IV infuse over 30-60 min.

Topiramate

Topamax

Anticonvulsant Action may be a result of blockade of na channels in neurons. Enhancement of GABA, and inhibitory

CI in hypersensitivity.

Side effects include: dizziness, drowsiness, fatigue, abnormal vision, nausea, ataxia and

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neurotransmitter. Prevention of activation of excitatory receptors.

paresthesia. Assess for seizure activity and chronic pain. May be administered without regard to meals. Should be discontinued gradually.

Torsemide

 

Demadex

Loop diuretic Inhibit the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule.

Increased hypotension with antihypertensives  May increase the effects of warfarin.  Increased risk of hypokalemia when used with other diuretics.

Torsemide: Y site incompatibilities: Do not mix with other drugs or solutions.

Side effects include dizziness hypotension constipation diarrhea dehydration and increased BUN levels.  Monitor daily weight and intake and output.  Monitor blood pressure and pulse before and during administration.  Monitor electrolyte levels.  Give undiluted.  Administer slowly over two minutes.

Trandolapril

mavik

Antihypertensiveace inhibitor

Angiotensin converting enzyme inhibitors block the conversion of angiotensin one to the vasoconstrictor angiotensin two.

Excessive hypotension may occur with use of other antihypertensive. Y site incompatibility amphotericin b, cefepime, phenytoin.

Side effects include cough hypotension taste disturbances proteinuriamonitor blood pressure and pulse frequently during dose adjustments and periodically during therapy. Monitor weight and assess for fluid overload, monitor cbc, wbc and urine protein prior and during therapy. Teach patient to change positions slowly to reduce orthostatic hypotension and avoid excessive salt intake.

Trazodone Antidepressant Alters the effects of serotonin in the CNS.

CI in hypersensitivity, recovery period after MI, concurrent electroconvulsive therapy. May increase digoxin or phenytoin levels.

Side effects include: Drowsiness, hypotension, dry mouth, and tremor. Monitor mood changes, suicidal tendencies, bp and pulse before and during therapy,

Triamcinolone AntiasthmaticsCorticosteroids

Potent, locally acting anti inflammatory and immune modifier.

Use cautiously in diabetes and glaucoma, underlying immunosuppression.

Side effects include: headache, dysphonia, hoarseness, oropharyngeal fungal infections, and flu like syndrome. Monitor RR and lung sounds. Assess for adrenal insufficiency such as anorexia, nausea, weakness, fatigue, hypotension and hypoglycemia. May cause

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increase in serum glucose levels. Teach that this should not be used to treat an attack. Assess for signs and symptoms of infection.

Triazolam Sedative/Hypnotic

Benzodiazepine

Acts at many levels of the CNC to produce generalized CNS depression. Effects may be mediated by GABA.

Additive CNS depression with alcohol, antihistamines, opoid analgesics. Decreased effectiveness with: levodopa. Avoid grapefruit juice.

Dizziness, excessive sedation, hangover, headache.

Trimethoprim/sulfamethoxazole

Anti infective

Antiprotozoal

Folate antagonist

Sulfonamides

Combination inhibits the metabolism of folic acid in bacteria at two different points.

CI in hypersensitivity to sulfonamides or trimethoprim. Y site imcomp. Fluconazole, midazolam, vinorelbine. Manufacturer rec. that no other medication or solution be admixed with trimethoprim/sulfamethoxazole.

Side effects include: nausea, vomiting, rashes, phlebitis at IV site, erythema multiforme and fever. Assess patient for infection. Obtain culture before starting therapy. Assess IV site for phlebitis. Do not administer IM. Administer around the clock with a full glass of water. Infuse over 60-90 min, do not administer rapidly or by bolus injection.

Trovafloxacin

trovan

Anti infective

Fluoroquinolone

Inhibit bacterial DNA synthesis by inhibiting DNA gyrase.

CI in hypersensitivity and pregnancy.

Side effects include: dizziness, drowsiness, headache, insomnia, abdominal pain, diarrhea, nausea hypoglycemia and phlebitis at IV site. Assess patient for signs of infection, obtain culture before therapy is started, observe for signs of anaphylaxis. May be taken without regard to meals.

Urokinase thrombolytic agents

Converts plasminogen to plasmin, which then degrades

fibrin clots.

Asprin, NSAIDS, warfarin, heparin and heparin like agents.

Intacranial Hemorrhage, reperfusion arrythmias, anaphylaxis, GI bleed, retroperitoneal bleeding,GU tract bleeding.Assess for bleeding every15-30 min during the next8 hr, and at least every 4 hr for the duration of therapy. Assess neuro status throughout therapy(changes may indicate Intracranial hemorrhage)Administer via infusion pump

Valacyclovir Antiviral Interferes with the viral DNA synthesis.

Probenecid and Cimetine

Headache and nausea may occur. Thrombocytopenic

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Valtrex increases blodd levels

prpura/ hemolytic uremic syndrome is fatal if occurs. Inform the patient that Valacyclovir does not prevent the spread of infection. Until all lesions have crusted, precautions should be taken around others who have never had chicken pox or varicella vaccine or peole who are immunosuppressed. Advise patient that this therapy is not a cure. Avoid sexual contact while lesions are present. Use condoms in the absence of lesions.

Valsartan

diovan

Antihypertensive

Angiotensin II receptor antagonist

Blocks vasoconstrictor and aldosterone-produing effects of angiotensin II at receptor sites, including vascular smooth muscle and the adrenal glands.

NSAIDS may decrease drug effects. Risk of hypotension when used with diuretics.

Side effects include: dizziness, fatigue, headache, hypotension, renal failure and hyperkalemia. Assess bp and pulse before administering. Assess patient for signs of angioedema (dyspnea and facial swelling), monitor I & O, auscultate lungs for rales or crackles, monitor labs. May be administered with or without meals.

Vancomycin Anti infective Binds to bacterial cell wall, resulting in cell death.

CI in hypersensitivity. May cause additive ototoxicity and nephrotoxicity with other ototoxic and nephrotoxic drugs. Increased risk of histamine flush when used with general anesthetics in children.

Side effects include nephrotoxicity, phlebitis, anaphylaxis, fever and chills. Assess for infection, monitor IV site closely. Vancomycin is irritating to tissues and causes necrosis and pain. Monitor bp during iv infusion. Assess bowel status. Administer over 60 min. do not administer rapidly.

Venlafaxine

Effexor

Antidepressant

Antianxiety

Inhibits serotonin and norepinephrine reuptake in the CNS.

CI in hypersensitivity, MAOI use and active liver disease.

Side effects include: abnormal dreams, anxiety, dizziness, headache, insomnia, nervousness, weakness, rhinitis, abdominal pain, ecchymoses, paresthesia and chills. . Monitor mood changes, suicidal tendencies, bp and pulse before and during therapy, monitor liver function.

Verapamil Antianginal Antihypertensive

Inhibits the transport of calcium into myocardial and

Additive hypotension may

Side effects include anxiety confusion peripheral

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Antiarrhythmics

Calcium channel blocker

vascular smooth muscle cells resulting in inhibition of excitation-contraction coupling and subsequent contraction. Decrease SA and AV conduction and prolong AV node refractory period in conduction tissue.

occur when used with other antihypertensives. bradycardia may result when used with beta-blockers. Concurrent ingestion of grapefruit juice increases blood levels and effects.

edema diarrhea nausea vomiting hyperglycemia arrhythmias nocturia. Monitor blood pressure and pulse before administration. Monitor I & O and for peripheral edema. Patient should remain recumbent for at least 1 hr after iv admin. In order to minimize hypotensive effects. Admin. Undiluted over 2 min for each single dose.

Voriconazole Antifungal Inhibits fungal ergosterol synthesis leading to production of abnormal fungal cell wall.

CI in current use of rifampin, Phenobarbital, mephobarbital and lactose intolerance. Do not infuse with other drugs including parenteral nurtrition, blood or other medications.

Side effects include: visual disturbances, allegic reactions, tachycardia photosensitivity and dizziness. Monitor visual function, allergic reactions during infusion, monitor lft and renal function. Administer 1 hr before or 1 hr after meals. Infuse over 1-2 hr at a rate not to exceed 3mg/kg/hr.

Warfarin

Coumadin

Anticoagulants

Coumarins

Interferes with hepatic synthesis of vitamin k dependent clotting factors 2,7,9,10.

CI in pregnancy, uncontrolled bleeding, open wounds, active ulcer disease, recent brain, eye, or spinal cord injury or surgery, uncontrolled htn. Antidote is vitamin k is case of overdose.

Side effects include:cramps, nausea, dermal necrosis, bleeding and fever. Assess patient for signs of bleeding and hemorrhage and thrombosis. Monitor pt and other clotting factors. Inr needs to be 2-3 times the control value. Monitor stool and urine for blood. Med required 3-5 days to reach effective levels. Administer as low bolus injection over 1-2 min into a peripheral vein. Avoid IM injections.

Zidovudine Anti-retrovirals

Nucleoside reverse transcriptase inhibitor

After intracellular conversion to its active form, inhibits viral RNA synthesis by inhibiting the enzyme DNA polymerase. Prevents viral replication.

Increased bone marrow suppression with other drugs that have bone marrow suppressing agents. Increased neurotoxicity with acyclovir.

Seizures may be fatal if they occur. Headache, weakness, abdominal pain, diarrhea, nausea, anemia, and granulocytopenia are common. Asses for change in severity of HIV symptoms or symptoms of opportunistic infections. Monitor CBC q 2wks during first 8 wks of therapy, decrease to q 4 wks after the first 2 mo. Inform patient that this therapy does not cure HIV and the Importance of strict drug

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adherence.

Zolpidem

 

Ambien

Sedative/

Hypnotic

Produces CNS depression by binding to GABA receptors.

CNS depression with sedative hypnotics, opioid analgesics and antihistamines.  Food decreases and delays absorption.

Side effects include:  amnesia, dizziness, diarrhea, nausea and vomiting.  Assess mental status and sleep patterns.  Provide comfort measures.  Tablets should be swallowed whole with a full glass of water.