Republic of the Philippines

Western Mindanao State University

College of Nursing
Normal Road, Baliwasan, Zamboanga City 7000

DRUGSTUDY
In

PHARMACOLOGY
NCM106

SUBMITTED TO:
Prof. Sarah S. Taupan, RN, DPA

SUBMITTED BY:
Karenza T. Aquino
BSN II-E

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 “To do what nobody else will do, a
way that nobody else can do, in
spite of all we go through; that is to
be a nurse.”
– Rawsi Williams

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Table of contents

I. Thrombolytic
II. Antineoplastic
III. Anticonvulsant
IV. Anesthetics
V. Narcotics
VI. Antianginal
VII. Anti-Depressant
VIII. Corticosteroid
IX. Antidiabetic
X. Antipsychotic Agents
XI. Antipyretics
XII. Antihistamine
XIII. Anticoagulant
XIV. Antihypertensive
XV. Antibacterial
XVI. Sedatives
XVII. Anti-inflammatory
XVIII. Anti-Spasmodic
XIX. Antiplatelet
XX. Anticholinergics
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DRUG CLASSIFICATION:
THROMBOLYTICS

GENERIC NAME:STREPTOKINASE
BRAND NAME: STREPTASE

DOSAGES AND FREQUENCY

(Adults ): 10 units, followed 30 min later by
an additional 10 units.

MECHANISM OF ACTION
Lysis of thrombi in coronary arteries,
with preservation of ventricular function.Lysis
of pulmonary emboli and subsequent
restoration of blood flow.Restoration of
cannula patency and function.

INDICATIONS
Acute myocardial infarction
(MI).Pulmonary embolism (PE).Deep vein
thrombosis (DVT).Acute peripheral arterial
thrombosis.Occluded arteriovenuscannulae.

CONTRAINDICATIONS
Intracranial neoplasm, arteriovenous
malformation, or aneurysm; Severe
uncontrolled hypertension; Known bleeding
tendencies

SIDE EFFECTS/ADVERSE REACTIONS

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CNS: INTRACRANIAL HEMORRHAGE. EENT:
epistaxis, gingival bleeding. Resp:
bronchospasm, hemoptysis. CV: reperfusion
arrhythmias, hypotension, RECURRENT
ISCHEMIA/THROMBOEMBOLISM.

NURSING RESPONSIBILITIES
• Monitor vital signs, including
temperature, continuously for myocardial
infarction. Do not use lower extremities to
monitor BP. Notify health care professional if
systolic BP >180 mm Hg or diastolic BP >110
mm Hg. Thrombolytic therapy should not be
given if hypertension is uncontrolled. Inform
health care professional if hypotension
occurs. Hypotension may result from the
drug, hemorrhage, or cardiogenic shock.

Patient and Family Education

• Explain purpose of medication and
the need for close monitoring to patient and
family. Instruct patient to report
hypersensitivity reactions (rash, dyspnea) and
bleeding or bruising.
• Explain need for bedrest and minimal
handling during therapy to avoid injury. Avoid
all unnecessary procedures such as shaving
and vigorous tooth brushing.

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GENERIC NAME:ANISTREPLASE
BRAND NAME:ANISOYLATED
PLASMINOGEN–STREPTOKINASE
ACTIVATOR COMPLEX, APSAC

DOSAGES AND FREQUENCY

IV: (Adults ): 30 units over 2–5 min

MECHANISM OF ACTION
Combines with plasminogen to
formactivator complexes, then
convertsplasminogen to plasmin, which is
then able to degrade clot-bound fibrin.

INDICATIONS
Acute myocardial infarction (MI).Pulmonary
embolism (PE).
CONTRAINDICATIONS
Active internal bleeding; History of
cerebrovascular accident; Recent (within 2
mo) intracranial or intraspinal injury or
trauma; Intracranial neoplasm, arteriovenous
malformation, or aneurysm.
SIDE EFFECTS/ADVERSE REACTIONS
CNS: INTRACRANIAL HEMORRHAGE. EENT:
epistaxis, gingival bleeding. Resp:
bronchospasm, hemoptysis. CV: reperfusion
arrhythmias, hypotension

NURSING RESPONSIBILITIES

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• Begin therapy as soon as possible
after the onset of symptoms.
• Monitor vital signs, including
temperature, continuously for myocardial
infarction. Do not use lower extremities to
monitor BP. Notify physician if systolic BP
>180 mm Hg or diastolic BP >110 mm Hg.
Thrombolytic therapy should not be given if
hypertension is uncontrolled. Inform
physician if hypotension occurs. Hypotension
may result from the drug, hemorrhage, or
cardiogenic shock.
Patient and Family Education
• Explain purpose of medication and
the need for close monitoring to patient and
family. Instruct patient to report
hypersensitivity reactions (rash, dyspnea) and
bleeding or bruising.

GENERIC NAME:RETEPLASE
BRAND NAME:RETAVASE

DOSAGES AND FREQUENCY

IV: (Adults ): 10 units, followed
30 min later by an additional
10 units.

MECHANISM OF ACTION
Directly converts plasminogen to plasmin,
which then degrades clot-bound

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fibrin.Therapeutic Effects: Lysis of thrombi in
coronary arteries, with improvement of
ventricular function, and reduced risk of
heart failure or death.
INDICATIONS
Acute myocardial infarction (MI). Unlabeled
Uses: Occluded central venous access
devices. Deep venous thrombosis
(DVT).Acute peripheral arterial thrombosis.

CONTRAINDICATIONS
Active internal bleeding; History of
cerebrovascular accident; Recent (within 2
mo) intracranial or intraspinal injury or
trauma

SIDE EFFECTS/ADVERSE REACTIONS

CNS: INTRACRANIAL HEMORRHAGE. EENT:
epistaxis, gingival bleeding. Resp:
bronchospasm, hemoptysis. CV: reperfusion
arrhythmias, hypotension

NURSING RESPONSIBILITIES
• Assess patient carefully for bleeding
every 15 min during the 1st hr of therapy,
every 15–30 min during the next 8 hr, and at
least every 4 hr for the duration of therapy.
Frank bleeding may occur from sites of
invasive procedures or from body orifices.
Internal bleeding may also occur (decreased
neurologic status; abdominal pain with
coffee-grounds emesis or black, tarry stools;

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hematuria; joint pain). If uncontrolled
bleeding occurs, stop medication and notify
health care professional immediately.
Patient and Family Education
• Explain need for bedrest and minimal
handling during therapy to avoid injury. Avoid
all unnecessary procedures such as shaving
and vigorous tooth brushing.

DRUG CLASSIFICATION:
ANTINEOPLASTICS

GENERIC NAME:BENDAMUSTINE
HYDROCHLORIDE
BRAND NAME:TREANDA

DOSAGES AND FREQUENCY

Adults: 100 mg/m2 by I.V.
infusion over 30 minutes on
days 1 and 2 of 28-day cycle
for up to six cycles
MECHANISM OF ACTION
Unclear. Dissociates into electrophilic
alkyl groups, which form covalent bonds with
electron-rich nucleophilic moieties

INDICATIONS
Chronic lymphocytic leukemia

CONTRAINDICATIONS
● Hypersensitivity to drug or mannitol

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Precautions
Use cautiously in:
● mild or moderate renal impairment (not
recommended in creatinine clearance less
than 40 ml/minute)
● mild hepatic impairment (not
recommended in moderate or severehepatic
impairment)

SIDE EFFECTS/ADVERSE REACTIONS

● myelosuppression
● concurrent use of CYP1A2 inhibitors or
inducers
● pregnant or breastfeeding patients

NURSING RESPONSIBILITIES
● Closely monitor complete blood count with
differential and renal and hepatic function
test results.
2Monitor for skin reactions, including rash,
toxic reactions, and bullous exanthema. Such
reactions may be progressive and worsen
with further treatment. In severe or
progressive skin reaction, withhold or
discontinue drug.
Patient and Family Education
● Instruct patient to report unusual bleeding
or bruising, fever, chills, and lip or mouth
sores.
● Inform patient that drug may increase risk
of infection. Advise patient to wash hands
frequently, wear mask in public places, and
avoid people with infections.

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GENERIC NAME:BICALUTAMIDE
BRAND NAME:SANDOZ
BICALUTAMIDE

DOSAGES AND FREQUENCY

Adults: 50 mg P.O. once daily

MECHANISM OF ACTION
Use cautiously in:
● previous hypersensitivity or serious adverse
reaction to flutamide or nilutamide

INDICATIONS
● Hypersensitivity to drug
● Women who are or may become pregnant
CONTRAINDICATIONS
Metastatic prostate cancer

SIDE EFFECTS/ADVERSE REACTIONS

Adverse reactions
CNS: headache, weakness, dizziness,
depression, hypertonia, paraesthesia,
lethargy

NURSING RESPONSIBILITIES
● Monitor prostate-significant antigen levels,
CBC, and liver and kidney function test
results.

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● If patient is receiving warfarin concurrently,
evaluate prothrombin time and International
Normalized Ratio.
Patient and Family Education
● Instruct patient to take drug at same time
each day, along with prescribed LHRH analog.
● Tell patient that any drug-related hair loss
should reverse once therapy

GENERIC NAME:BLEOMYCINSULFATE
BRAND NAME:BLENOXANE

DOSAGES AND FREQUENCY

Adults: 10 to 20 units/m2 I.V., I.M.,
or subcutaneously once or twice
weekly. After 50% response, maintenance
dosage is 1 unit/m2 I.M. or I.V. daily or 5
units/m2 I.M. or I.V. weekly.

MECHANISM OF ACTION
Unclear. Appears to inhibit DNA synthesis
and, to a lesser degree, RNA and protein
synthesis. Binds to DNA, causing severing of
single DNA strands.
INDICATIONS
Malignant pleural effusion; prevention of
recurrent pleural effusions
Squamous cell carcinoma of head

CONTRAINDICATIONS

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Hypersensitivity to drug Pregnancy or
breastfeeding

SIDE EFFECTS/ADVERSE REACTIONS

CNS: disorientation, weakness, aggressive
behavior
CV: hypotension, peripheral vasoconstriction

NURSING RESPONSIBILITIES
● Assess baseline pulmonary function status
before initiating therapy; monitor throughout
therapy.
● Monitor chest X-rays and assess breath
sounds to detect signs of pulmonary toxicity.
Patient and Family Education
● Tell patient to avoid spicy, hot, or rough
foods (may cause GI upset).
● Urge patient to use reliable contraceptive
method during therapy.
● Tell patient not to receive vaccinations
without consulting prescriber. Instruct
patient to immediately notify prescriber if
breathing difficulties, fever, or chills occur.

DRUG CLASSIFICATION:
ANTICONVULSANTS

GENERIC NAME: AMOBARBITAL

BRAND NAME: AMYTAL

DOSAGES AND FREQUENCY

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ADULTS
IV: sedative: 30-50 mg b.i.d
hypnotic: 65-200 mg
PEDIATRIC
IV: 65-500 mg (3-5mg/kg)
IM: 2-3 mg/kg

MECHANISM OF ACTION
Produces all CNS depression, depresses
sensory cortex, decreases motor activity,
alters cerebral function, inhibits transmission
in the CNS and raises seizure.

INDICATIONS
Preoperative sedative and in other situations
where sedation may be required,
hypertension.

CONTRAINDICATIONS
Hypersensitivity, comatose patients, pre-
existing CNS depression, severe uncontrolled
pain, pregnancy and lactation.

SIDE EFFECTS
Sleepiness, confusion, nervousness,
insomnia, dizziness, nausea, vomiting,
constipation.

ADVERSE REACTIONS
CNS: drowsiness, hangover
RESP: respiratory depression
CV: hypotension, bradycardia
GI: nausea, vomiting

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NURSING RESPONSIBILITIES
Monitor respiratory status, pulse and blood
pressure frequently in patients receiving
amobarbital IV.
Patient and Family Education
-May cause daytime drowsiness; avoid
driving and other activities requiring
alertness until response to medication is
known.
-Avoid taking alcohol or other CNS
depressants concurrently with this
medication.
-Use a no hormonal method of contraception
while taking ambarbital and notify physician
immediately if pregnancy is suspected.

GENERIC NAME: PHENOBARBITAL

BRAND NAME:PYRIDIATE

DOSAGES AND FREQUENCY

ADULTS:
PO: 200 mg t.i.D
PEDIATRIC:
PO: 4mg/kg t.i.d

MECHANISM OF ACTION
Acts locally on the urinary tract mucosa to
produce analgesic or local anaesthetics
effects. Has no antimicrobial activity.

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INDICATIONS
Provides relief from the following urinary
tract symptoms, which may occur in
association with infection or following
urologic procedures.

CONTRAINDICATIONS
Hypersensitivity, glomerulonephritis, severe
hepatitis, uraemia or renal failure.

SIDE EFFECTS
Dizziness, drowsiness, problems with
memory or concentration,
excitation,irritability,aggression, confusion
(especially in children or older adults); loss of
balance or coordination.

ADVERSE REACTIONS
CNS: headache, vertigo
GI: nausea, hepatotoxicity
GU: renal failure
DERM: rash
HEMAT: methemoglobinemia,
hemolyticanemia

NURSING RESPONSIBILITIES
Assess patient for urgency, frequency and
pain on urination prior to and throughout
therapy.

Patient and Family Education

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-Take medication exactly as directed; if a
dose is missed take as soon as remembered
unless almost time for next dose.
-Drug causes reddish-orange discoloration of
urine that may stain clothing or bedding, use
sanitary napkin.

GENERIC NAME: PRIMIDONE

BRAND NAME: MYIDONE

DOSAGES AND FREQUENCY

PO: 100-125 mg h.s for 3 days,
then 100-125 mg bid.
PEDIATRIC (>8)
PO: 100-125 mg h.s for 3 days, then 100-125
mg bid.
PEDIATRIC (<8)
PO: 50-100 mg h.s

MECHANISM OF ACTION
Decreases neuron excitability, increases the
threshold of electric stimulation of the motor
cortex.

INDICATIONS
Management of tonic-clonic, complex partial
and focal seizures.

CONTRAINDICATIONS

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Contraindicated in previous hypertensitivity
and porphyria
SIDE EFFECTS
Slow or slurred speech., Numbness and
tingling. Loss of control of bodily movements.
Spinning sensation (vertigo) Blurred vision.
Skin rash.Loss of appetite.Impotence.

ADVERSE REACTIONS
CNS: drowsiness, ataxia, vertigo, lethargy
CV: edema, orthostatic, hypotension
GI: nausea, anorexia, vomiting, hepatitis
DERM: rashes
HEMAT: blood dyscrasias,
megaloblasticanemia
MISC: folic acid deficienc

NURSING RESPONSIBILITIES
Assess patient for signs of folic deficiency.
Assess location, duration, frequency and
characteristics of seizure activity. Institute
seizure precautions.Monitor foliate
concentrations periodically during therapy.

Patient and Family Education

-Take medication exactly as directed, if a
dose is missed take as soon as remembered
unless within 1hr of next dose. Abrupt
withdrawal may lead to status epilectus.

-Avoid taking alcohol or other CNS

depressants

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DRUG CLASSIFICATION:
ANESTHETICS

GENERIC NAME:METHOHEXITAL
BRAND NAME:BREVITAL SODIUM

DOSAGES AND FREQUENCY

ADULT:50-120 mg (70 mg average) IV
Push at 10 mg ( 1 mL of 1% solution)
over 5 seconds,depending on patient
response.

PEDIATRIC:6.6-10mg/kg IM administered as a
5% (50 mg/mL) solution OR 25 mg/kg PR
administered as a 1% (10 mg/mL) solution

MECHANISM OF ACTION
Produces anesthesia by depressing the CNS,
probably by potentiating GABA, an inhibitory
neurotransmitter.

INDICATIONS
Induction of general anesthesia. Sole
anesthesia in short (<15 min), minimally
painful procedures. Supplement to other
anesthetic agents. To produce
unconsciousness during balanced anesthesia.

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CONTRAINDICATIONS
Contraindicated in: Hypersensitivity; Intra-
arterial injection; Porphyria; Lactation:
Lactation. Use Cautiously in: Addison’s
disease; Severe anemia; Severe CV or hepatic
disease; Myxedema; Shock or hypotension;
Pulmonary disease; Debilitated patients;
Geriatric: Appears on Beers list. Geriatric
patientare at increased risk for side effects
(dose reduction recommended); Obstetric:
Safety not established.

SIDE EFFECTS
Signs of an allergic reaction, like rash; hives;
itching; red, swollen, blistered, or peeling skin
with or without fever; wheezing; tightness in
the chest or throat; trouble breathing,
swallowing, or talking; unusual hoarseness;
or swelling of the mouth, face, lips, tongue,
or throat.Very bad dizziness or passing out.A
fast heartbeat, Seizures, Anxiety.This drug
may cause tissue damage if the drug leaks
from the vein.

ADVERSE REACTIONS
The adverse effects of methohexital include
respiratory depression, apnea, hiccoughs,
cardiovascular depression, and
laryngospasm.

NURSING RESPONSIBILITIES

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 Assess BP, ECG, heart rate, and
respiratory status continuously throughout
methohexital therapy. Methohexital should
be used only by individuals qualified to
administer anesthesia and experienced in
endotracheal intubation. Equipment for this
procedure should be immediately available.
Apnea may occur immediately after IV
injection, especially in the presence of opioid
premedication.Monitor IV site carefully.
Extravasation may cause pain, swelling,
ulceration, and necrosis. Intraarterial
injection may cause arteritis, vasospasm,
edema, thrombosis, and gangrene of
theextremity.Overdose may occur from rapid
injection (drop in BP, possibly toshock levels)
or excessive or repeated injections
(respiratory distress, laryngospasm, apnea).

Patient and Family Education

Methohexital may cause psychomotor
impairment for 24 hr after administration.
Caution patient to avoid driving or other
activities requiring alertness for 24
hr.Advisepatient to avoid use of alcohol or
other CNS depressants for 24 hr after
anesthesia, unless directed by health care
professional.

GENERIC NAME:PROPOFOL
BRAND NAME:DIPRIVAN

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DOSAGES AND FREQUENCY
ADULT:55 years ASA I/II: 40 mg
IVP q10sec until onset (2-2.5 mg/kg
IV when not premedicated with oral
benzodiazepines or intramuscular opioids)
PEDIATRIC:3-16 years ASA I/II: 2.5-3.5 mg/kg
IVP over 20-30 sec when not premedicated or
when lightly premedicated with oral
benzodiazepines or intramuscular opioids;
younger patients may require higher
induction doses than older children; lower
dosage recommended for children ASA III/IV

MECHANISM OF ACTION
Propofol works by increasing GABA-mediated
inhibatory tone in the CNS. Propofol
decreases the rate of dissociation of the
GABA from the receptor, thereby increasing
the duration of the GABA-activated opening
of the chloride channel with resulting
hyperpolarization of cell membranes.

INDICATIONS
Induction and maintenance of monitored
anesthesia care (MAC) sedation; combined
sedation and regional anesthesia; and ICU
sedation of intubated, mechanically
ventilated adult patients. Induction of
general anesthesia in patients ≥3yrs of age.
Maintenance of general anesthesia in
patients ≥2 months of age.

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CONTRAINDICATIONS
Hypersensitivity to propofol or any
component of the formulation;
hypersensitivity to eggs, egg products,
soybeans, or soy products; when general
anesthesia or sedation is contraindicated.

SIDE EFFECTS
Fast or slow heart rate, high or low blood
pressure, injection site reactions (burning,
stinging, or pain), apnea, rash, and Itching

ADVERSE REACTIONS
Transient local pain at the injection site is the
most common adverse reaction which may
be decreased by administering IV lidocaine
before propofol bolus. Hypotension,
Myoclonus Occasionally has been seen to
cause EKG changes (QT interval
prolongation). This is rarely clinically
significant. Discolored urine (a green tint);
this is exceeding rare.

NURSING RESPONSIBILITIES
Monitor hemodynamic status and assess for
dose- related hypotension. Take seizure
precautions. Tonic-clonic seizures have
occurred following generalanesthesiawith
propafol. Be alert to the potential for drug
induced excitation (e.g.,twitching, tremor,
hyperclonus) and take appropriate safety
measures. Provide comfort measures; pain at

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the injection site is quite common especially
when small veins are used.

Patient and Family Education

Educate patients about the risks and
symptoms of respiratory depression and
sedation. (Moderate) Initially, vasopressors
may reduce propofol serum.

GENERIC NAME:KETAMINE
BRAND NAME:KETALAR

DOSAGES AND FREQUENCY

ADULT:IV: 1-4.5 mg/kg slow IV once
Alternatively (off-label): 0.5-2 mg/kg
slow IV if adjuvant drugs (eg, midazolam)
are used, OR IM: 6.5-13 mg/kg IM once
Alternatively (off-label)
: 4-10 mg/kg IM once if adjuvant drugs (eg,
midazolam) are used.
PEDIATRIC:IV: 1-4.5 mg/kg slow IV once
Alternatively (off-label): 0.5-2 mg/kg slow IV
if adjuvant drugs (eg, midazolam) are used,
OR IM: 6.5-13 mg/kg IM once
Alternatively (off-label): 4-10 mg/kg IM once
if adjuvant drugs (eg, midazolam) are used.

MECHANISM OF ACTION
Ketamine interacts with N-methyl-D-
aspartate (NMDA) receptors, opioid

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receptors, monoaminergic receptors,
muscarinic receptors and voltage sensitive Ca
ion channels. Unlike other general
anaesthetic agents, ketamine does not
interact with GABA receptors.
INDICATIONS
Ketamine is indicated as an anesthetic agent
for recommended diagnostic and surgical
procedures. If skeletal muscle relaxation is
needed, it should be combined with a muscle
relaxant. If the surgical procedure involves
visceral pain, it should be supplemented with
an agent that obtunds visceral pain.
Ketamine can be used for induction of
anaesthesia prior other general anesthetic
agents and as a supplement of low potency
agents.

CONTRAINDICATIONS
Ketamine is contraindicated in those patients
who have underlying conditions in which
increased blood pressure would pose a risk
of complications such as aortic dissection,
uncontrolled hypertension, myocardial
infarction or aneurysms.

SIDE EFFECTS
The most common side effects associated
with ketamine are nausea, vomiting,
dizziness, diplopia, drowsiness, dysphoria,
and confusion.

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ADVERSE REACTIONS
Emergence reactions, High blood pressure
(hypertension), Increased cardiac output
Increased intracranial pressure, Fast or slow
heart rate, Seizures,Visual hallucinations,
Vivid dreams, Double vision, Low blood
pressure (hypotension) Increased
intraocular (eye) pressure, Injection site,
Pain, Involuntary eye movement.

NURSING RESPONSIBILITIES
Assess level of consciousness frequently
throughout therapy. Ketamine produces a
dissociative state. The patient does not
appear to be asleep and experiences a feeling
of dissociation from the environment.
Monitor BP, ECG, and respiratory status
frequently throughout therapy.
Patient and Family Education
Psychomotor impairment may last for 24 hr
after anesthesia. Caution patient to avoid
driving or other activities requiring alertness
until response to medication is known.
Advise patient to avoid alcohol or other CNS
depressants for 24 hr after anesthesia.

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DRUG CLASSIFICATION:
NARCOTICS

GENERIC NAME:FENTANYL
BRAND NAME:DURAGESIC

DOSAGES AND FREQUENCY

ADULT: One 200-mcg lozenge
(Actiq) dissolved in mouth over
15 minutes; additional unit may
be given 15 minutes later.

MECHANISM OF ACTION
Binds to specific opioid receptors in CNS,
inhibiting pain pathways, altering pain
perception, and increasing pain threshold.

INDICATIONS
Breakthrough pain in opioidtolerant patients
with cancer.

CONTRAINDICATIONS
● Hypersensitivity to drug or transdermal
adhesive (with fentanyl transdermal).
● Opioid-nontolerant patient.
● Intermittent pain (on as-needed basis).
● Management of acute or mild pain.
● Management of postoperative pain (except
for injection form).
● Acute or severe bronchial asthma
(Duragesic), significant respiratory
depression, especially in unmonitored
settings without resuscitation equipment.

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● Known or suspected paralytic ileus.

SIDE EFFECTS/ADVERSE REACTIONS

CNS: headache, dizziness, vertigo, floating
feeling, lethargy, confusion, light-
headedness, nervousness, hallucinations,
delirium, insomnia, anxiety, fear,mood
changes, tremor, sedation, coma, seizures.
CV: palpitations, hypotension, hypertension,
tachycardia, bradycardia,
arrhythmias, circulatory depression,
cardiac arrest, shock.
EENT: blurred vision, diplopia,
pharyngolaryngeal pain, laryngospasm.
GI: nausea, vomiting, constipation, biliary
tract spasm, dry mouth, anorexia.

NURSING RESPONSIBILITIES
Assess for muscle rigidity in
patients receiving high doses; discuss
need for neuromuscular blockers with
prescriber. Patient receiving blocker
will need ventilator.
Patient and Family Education
Caution patient to keep transmucosal
(lozenge) form out of children’s reach even
though it is supplied in individually sealed,
child-resistant.

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GENERIC NAME:HYDROCODONE
BITARTRATE
BRAND NAME:ANEXSIA,
CETA-PLUS, CO-GESIC,HYDROCET,
LORTAB, NORCO, STAGESIC,
VICODIN, VICODIN ES, VICODIN
HP,XODOL, ZYDONE.

DOSAGES AND FREQUENCY

ADULT:2.5 to 10 mg P.O. q 4 to 6 hoursp.r.n.
When giving hydrocodone/acetaminophen,
don’t exceed 60 mg/day; when giving
hydrocodone/ ibuprofen, don’t exceed 37.5
mg/day.
PEDIATRIC: 0.15 to 0.2 mg/kg P.O. q 6 hours

MECHANISM OF ACTION
Blocks release of inhibitory
neurotransmitters, altering perception of and
emotional response to pain.Hydrocodone/
ibuprofen combination raises pain threshold
by nonselectively inhibiting cyclooxygenase;
prostaglandin synthesis then decreases and
anti-inflammatory and analgesic effects
occur.

INDICATIONS
Moderate to severe pain

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CONTRAINDICATIONS
Hypersensitivity to hydrocodone,
acetaminophen, aspirin, ibuprofen, or
homatropinemethylbromide (for
corresponding combination products) or to
alcohol, aspartame, saccharine, sugar, or
tartrazine (with some products).

SIDE EFFECTS/ADVERSE REACTIONS

CNS : Confusion, drowsiness, sedation,
dysphoria, euphoria, floating feeling,
hallucinations, headache, anxiety,
depression, fatigue, insomnia, lethargy,
nervousness, slurred speech, tremor,
asthenia, unusual dreams
CV: orthostatic hypotension, bradycardia,
peripheraledema, palpitations, arrhythmias
EENT: blurred vision, vision changes, diplopia,
miosis, tinnitus, pharyngitis, rhinitis, sinusitis
GI: nausea, vomiting, constipation,
dysphagia, esophagitis, dyspepsia, flatulence,
gastritis, gastroenteritis, mouth ulcers, dry
mouth, anorexia
GU: urinary retention or frequency, erectile
dysfunction
Respiratory: respiratory depression,
bronchitis, dyspnea
Skin: pruritus, urticaria, diaphoresis,
Flushing

NURSING RESPONSIBILITIES

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In patients receiving concurrent MAO
inhibitors, know that hydrocodone may
produce severe, unpredictable reactions.
Initial dosage may need to be 25% lower than
usual dosage
Patient and Family Education
● severe renal, hepatic, or pulmonary
disease; increased intracranial pressure;
hypothyroidism; adrenal insufficiency;
prostatic hypertrophy; thrombocytopenia;
alcoholism.

GENERIC NAME:HYDROMORPHONE
BRAND NAME:DILAUDID, DILAUDID-5,
DILAUDID-HP, HYDROMORPH CONTIN,
HYDROMORPH-IR, PALLADONE ,
PALLADONE SR , PHLHYDROMORPHONE,
PMSHYDROMORPHONE.

DOSAGES AND FREQUENCY

ADULT:Adults weighing more than 50 kg (110
lb): 2 mg P.O. (tablets) q 4 to 6 hours p.r.n.
For more severe pain, 4 mg
P.O. (tablets) may be given q 4 to 6 hours. If
pain increases in severity, analgesia isn’t
adequate, or tolerance develops, a gradual
increase in dosage may be required. Or 2.5 to
10 mg P.O. (oral solution) q 4 to 6 hours p.r.n.

31
as directed by clinical situation. Or 1 to 2 mg
subcutaneously, I.M., or I.V. q 4 to 6 hours
p.r.n.; or 3 mg P.R. q 6 to 8 hours p.r.n. Adjust
dosage based on pain severity, underlying
disease, and patient’s age and size.

MECHANISM OF ACTION
Binds to opiate receptors in spinal cord and
CNS, altering perception of and response to
painful stimuli while producing generalized
CNS depression. Also subdues cough reflex
and decreases GI motility

INDICATIONS
Moderate to severe pain.

CONTRAINDICATIONS
● Hypersensitivity to narcotics or bisulfites
● Acute or severe bronchial asthma or upper
respiratory tract obstruction

SIDE EFFECTS/ADVERSE REACTIONS

CNS: confusion, sedation, dysphoria,
euphoria, floating feeling, hallucinations,
headache, unusual dreams, anxiety, dizziness,
drowsiness
CV: hypotension, hypertension, palpitations,
bradycardia, tachycardia.
EENT: blurred vision, diplopia, miosis,
nystagmus, tinnitus, laryngeal edema,
laryngospasm.

32
GI: nausea, vomiting, constipation,
abdominal cramps, biliary tract spasm,
anorexia.
GU: urinary retention, dysuria

NURSING RESPONSIBILITIES
Be aware that high-potency hydromorphone
(Dilaudid-HP) is a highly concentrated
solution and shouldn’t be confused with
standard parenteral formulations of
hydromorphone or other opioids. Overdose
and death may result.

Patient and Family Education

● increased intracranial pressure; severe
renal, hepatic, or pulmonary disease;
hypothyroidism; adrenal insufficiency;
prostatic hypertrophy; alcoholism
● Concurrent use of MAO inhibitors

DRUG CLASSIFICATION:
ANTIANGINALS

GENERIC: AMYL NITRITE

BRAND: CYANIDE ANTIDOTE KIT

33
 DOSAGE AND FREQUENCY
Adult:
liquid for inhalation
0.3 mL (0.85-103%) crushable glass ampule
Acute Relief of Angina
0.3 mL by inhalation of crushed ampule, may
repeat q3-5min
Wave crushed ampule under nose multiple
times for 2-6 nasal inhalations
Cyanide Poisoning
0.3 mL ampule crushed and contents poured
onto a gauze and placed in front of patient's
mouth or endotracheal tube, if patient
intubated, to inhale over 15-30 sec; repeat
qMin until IV sodium nitrite available
Each ampul lasts ~3 min; separate
administration by at least 30 sec to allow
patient to adequate oxygenate
Pedia:
liquid for inhalation
0.3 mL (0.85-103%) crushable glass ampule
Angina Pectoris
Safety & efficacy not established
Cyanide Poisoning (Off-label)
0.3 mL ampule crushed and contents poured
onto a gauze and placed in front of patient's
mouth or endotracheal tube if patient
intubated to inhale over 15-30 sec; repeat
qMin until IV sodium nitrite available
Each ampul lasts ~3 min; separate
administration by at least 30 sec to allow
patient to adequate oxygenate.

34
MECHANISM OF ACTION
Reduces systemic arterial pressure (reduces
afterload). Forms methemoglobin, which
combines with cyanide, forming a nontoxic
compound (cyanmethemoglobin).
Therapeutic Effects: Relief of angina pectoris.
Prevention of fatal outcome in cyanide
poisoning.

INDICATIONS
Acute treatment of angina pectoris.
Unlabeled Uses: Acute management of
cyanide poisoning. Diagnosis of cardiac
murmurs.

CONTRAINDICATIONS AND PRECAUTIONS

Contraindicated in: Hypersensitivity; Patients
taking sildenafil, tadalafil, or vardenafil;
Severe anemia; Cerebral hemorrhage;
Glaucoma; Recent head trauma; Pregnancy
and lactation.
Use Cautiously in: Hypotension;
Hypovolemia; Constrictive pericarditis or
cardiac tamponade; Hyperthyroidism; Recent
MI; Hypertrophic cardiomyopathy; Geriatric
patients (increased risk of orthostatic
hypotension)

SIDE EFFECTS
headache, dizziness, flushing of the face, light
headedness or fainting, involuntary urination
or defecation, low blood pressure, nausea,
vomiting, shortness of breath, cold sweat,

35
pale skin, rapid heart rate, restlessness,
weakness, or slowed breathing

ADVERSE EFFECTS
CNS: headache, restlessness, dizziness,
fainting, weakness. EENT: ↑ intraocular
pressure. Resp: shortness of breath. CV:
hypotension, tachycardia, flushing. Derm:
cyanosis of lips, fingernails, or palms
(indicates methemoglobinemia). GI: nausea.
Hemat: HEMOLYTIC ANEMIA,
METHEMOGLOBINEMIA.
NURSE RESPONSIBILITIES
Assess heart rate and BP before and
periodically throughout therapy.
Angina: Assess patient for location, duration,
intensity, and cause of chest pains before and
after administration.
Cyanide Poisoning: Determine source of
cyanide and assess patient for signs of
cyanide poisoning (tachycardia, headache,
drowsiness, hypotension, coma, convulsions).
Heart Murmurs: Assess heart rate before and
throughout administration.

PATIENT FAMILY EDUCATION

Caution patient to change positions slowly to
minimize orthostatic hypotension.
Angina: Instruct patient in correct technique
for use of amyl nitrite ampules. Relief should
occur within 1–5 min. If pain is not relieved 5

36
min after one dose, the patient or family
member should call 911 immediately.
Instruct patient to remain seated or lying
during and after administration to prevent
dizziness.
Inform patient that headache is a common
side effect.
Instruct patient to wash hands after using
this medication.
Caution patient to avoid drinking alcohol or
taking sildenafil, tadalafil, or vardenafil
concurrently with amyl nitrite.
Amyl nitrite is flammable; instruct patient to
avoid exposing to heat or flame (e.g.
cigarettes).
Instruct patient to store medication in cool
place away from light.
Cyanide Poisoning: Explain purpose and
procedure for therapy to patient.

GENERIC: ATENOLOL
BRAND: TENORMIN

DOSAGE AND FREQUENCY

PO: (Adults ): Antianginal—
50 mg once daily; may be ↑ after
1 wk to 100 mg/day (up to 200
mg/day). Antihypertensive—25–50
mg once daily; may be ↑ after 2 wk
to 50–100 mg once daily. MI—50 mg

37
, then 50 mg 12 hr later, then 100 mg/day as
a single dose or in 2 divided doses for 6–9
days or until hospital discharge.
Renal Impairment
PO: (Adults ): CCr 15–35 mL/min—dosage
should not exceed 50 mg/day; CCr <15
mL/min—dosage should not exceed 50 mg
every other day.

MECHANISM OF ACTION
Blocks stimulation of beta1(myocardial)-
adrenergic receptors. Does not usually affect
beta2(pulmonary, vascular, uterine)-receptor
sites. Therapeutic Effects: Decreased BP and
heart rate. Decreased frequency of attacks of
angina pectoris. Prevention of MI.

INDICATIONS
Management of hypertension. Management
of angina pectoris. Prevention of MI.

CONTRAINDICATIONS AND PRECAUTIONS

Contraindicated in: Uncompensated HF;
Pulmonary edema; Cardiogenic shock;
Bradycardia or heart block.
Use Cautiously in: Renal impairment (dosage
↓ recommended if CCr ≤35 mL/min); Hepatic
impairment; Geriatric patients (↑ sensitivity
to beta blockers; initial dosage ↓
recommended); Pulmonary disease (including
asthma; beta selectivity may be lost at higher
doses); Diabetes mellitus (may mask signs of
hypoglycemia); Thyrotoxicosis (may mask

38
symptoms); Patients with a history of severe
allergic reactions (intensity of reactions may
be ↑); OB: Crosses the placenta and may
cause fetal/neonatal bradycardia,
hypotension, hypoglycemia, or respiratory
depression; Lactation: Pedi: Safety not
established.
ADVERSE REACTIONS AND SIDE EFFECTS
CNS: fatigue, weakness, anxiety, depression,
dizziness, drowsiness, insomnia, memory
loss, mental status changes, nervousness,
nightmares. EENT: blurred vision, stuffy nose.
Resp: bronchospasm, wheezing. CV:
BRADYCARDIA, HF, PULMONARY EDEMA,
hypotension, peripheral vasoconstriction. GI:
constipation, diarrhea, ↑ liver enzymes,
nausea, vomiting. GU: erectile dysfunction, ↓
libido, urinary frequency. Derm: rashes.
Endo: hyperglycemia, hypoglycemia. MS:
arthralgia, back pain, joint pain. Misc: drug-
induced lupus syndrome.

NURSE RESPONSIBILITIES
Monitor BP, ECG, and pulse frequently during
dosage adjustment period and periodically
throughout therapy.
Monitor intake and output ratios and daily
weights. Assess routinely for HF (dyspnea,
rales/crackles, weight gain, peripheral
edema, jugular venous distention).
Monitor frequency of prescription refills to
determine adherence.

39
Angina: Assess frequency and characteristics
of angina periodically throughout therapy.
Lab Test Considerations: May cause ↑ BUN,
serum lipoprotein, potassium, triglyceride,
and uric acid levels.
May cause ↑ ANA titers.
May cause ↑ in blood glucose levels.
Toxicity and Overdose: Monitor patients
receiving beta blockers for signs of overdose
(bradycardia, severe dizziness or fainting,
severe drowsiness, dyspnea, bluish
fingernails or palms, seizures). Notify
physician immediately if these signs occur.

PATIENT FAMILY EDUCATION

Instruct patient to take atenolol as
directed at the same time each day, even if
feeling well; do not skip or double up on
missed doses. Take missed doses as soon as
possible up to 8 hr before next dose. Abrupt
withdrawal may cause life-threatening
arrhythmias, hypertension, or myocardial
ischemia.
Advise patient to make sure enough
medication is available for weekends,
holidays, and vacations. A written
prescription may be kept in wallet in case of
emergency.
Teach patient and family how to
check pulse and BP. Instruct them to check
pulse daily and BP biweekly and to report
significant changes.

40
 May cause drowsiness or dizziness.
Caution patients to avoid driving or other
activities that require alertness until response
to the drug is known.
Advise patients to change positions slowly to
minimize orthostatic hypotension.
Caution patient that atenolol may
increase sensitivity to cold.
Instruct patient to notify health care
professional of all Rx or OTC medications,
vitamins, or herbal products being taken, to
avoid alcohol, and to consult health care
professional before taking any new
medications, especially cold preparations.
Patients with diabetes should closely monitor
blood glucose, especially if weakness,
malaise, irritability, or fatigue occurs.
Medication does not block sweating as a sign
of hypoglycemia.
Advise patient to notify health care
professional if slow pulse, difficulty
breathing, wheezing, cold hands and feet,
dizziness, light-headedness, confusion,
depression, rash, fever, sore throat, unusual
bleeding, or bruising occurs.
Instruct patient to inform health care
professional of medication regimen before
treatment or surgery.
Advise patient to carry identification
describing disease process and medication
regimen at all times.
Hypertension: Reinforce the need to continue
additional therapies for hypertension (weight

41
loss, sodium restriction, stress reduction,
regular exercise, moderation of alcohol
consumption, and smoking cessation).
Medication controls but does not cure
hypertension.

GENERIC: BEPRIDIL
BRAND: BEPADIN

DOSAGE AND FREQUENCY

PO: (Adults ): 200 mg once
daily, may increase after 10 days
to 300 mg/day (not to exceed 400
mg/day).

MECHANISM OF ACTION
Inhibits the transport of calcium into
myocardial and vascular smooth muscle cells,
resulting in inhibition of excitation-
contraction coupling and subsequent
contraction. Inhibits fast sodium inward
current in myocardial and vascular smooth
muscles. Also has effects on conduction that
may result in onset of new serious
arrhythmias (proarrhythmic action).
Therapeutic Effects: Coronary vasodilation,
resulting in decreased frequency and severity
of attacks of angina.

42
INDICATIONS
Management of angina pectoris.

CONTRAINDICATIONS AND PRECAUTIONS

Contraindicated in: Hypersensitivity; Sick
sinus syndrome; 2nd- or 3rd-degree AV block
(unless an artificial pacemaker is in place); BP
<90 mmHg; Serious ventricular arrhythmias,
severe cardiac insufficiency, prolonged QT
interval.
Use Cautiously in: Severe hepatic impairment
(dosage reduction recommended); Geriatric
patients (dosage reduction recommended;
increased risk of hypotension); Severe renal
impairment (dosage reduction necessary);
History of serious ventricular arrhythmias or
HF; Pregnancy, lactation, or children (safety
not established).

ADVERSE REACTIONS AND SIDE EFFECTS

CNS: dizziness, headache, nervousness,
abnormal dreams, anxiety, confusion,
psychiatric disturbances, sedation, shakiness,
weakness. EENT: blurred vision, disturbed
equilibrium, epistaxis, tinnitus. Resp:
congestion, cough, dyspnea, shortness of
breath. CV: ARRHYTHMIAS, HF, peripheral
edema, bradycardia, chest pain, hypotension,
palpitations, syncope, tachycardia. GI:
nausea, abnormal liver function studies,
anorexia, constipation, diarrhea, dry mouth,

43
dysgeusia, dyspepsia, vomiting. GU: dysuria,
nocturia, polyuria, sexual dysfunction, urinary
frequency. Derm: dermatitis/rash, erythema
multiforme, increased sweating,
photosensitivity, pruritus/urticaria. Endo:
gynecomastia, hyperglycemia. Hemat:
anemia, leukopenia, thrombocytopenia.
Metab: weight gain. MS: joint stiffness,
muscle cramps. Neuro: tremor, paresthesia.
Misc: STEVENS-JOHNSON SYNDROME,
gingival hyperplasia.

NURSE RESPONSIBILITIES
Monitor BP and pulse before therapy, during
dosage titration, and periodically throughout
therapy. Monitor ECG periodically during
prolonged therapy. Bepridil may cause
increased QT interval and altered T-wave
morphology.
Monitor intake and output ratios and daily
weight. Assess for signs of HF (peripheral
edema, rales/crackles, dyspnea, weight gain,
jugular venous distention).
Angina: Assess location, duration, intensity,
and precipitating factors of patient’s anginal
pain.
Lab Test Considerations: Total serum calcium
concentrations are not affected by calcium
channel blockers.
Monitor serum potassium periodically.
Hypokalemia increases the risk of
arrhythmias and should be corrected.

44
Monitor renal and hepatic functions
periodically during long-term therapy. May
cause increase in hepatic enzymes after
several days of therapy; returns to normal on
discontinuation of therapy.

PATIENT FAMILY EDUCATION

Advise patient to take medication exactly as
directed, even if feeling well. If a dose is
missed, take as soon as possible unless
almost time for next dose; do not double
doses. May need to be discontinued
gradually.
Instruct patient on correct technique for
monitoring pulse. Instruct patient to contact
health care professional if heart rate is <50
bpm.
Caution patient to change positions slowly to
minimize orthostatic hypotension.
May cause drowsiness or dizziness. Advise
patient to avoid driving or other activities
requiring alertness until response to the
medication is known.
Instruct patient on importance of maintaining
good dental hygiene and seeing dentist
frequently for teeth cleaning to prevent
tenderness, bleeding, and gingival
hyperplasia (gum enlargement).
Instruct patient to avoid concurrent use of
alcohol or OTC medications, especially cold
preparations, without consulting health care
professional.

45
Advise patient to notify health care
professional if irregular heartbeat, dyspnea,
swelling of hands and feet, pronounced
dizziness, nausea, constipation, or
hypotension occurs or if headache is severe
or persistent.
Advise patient to inform health care
professional of medication regimen before
treatment or surgery.
Angina: Instruct patient on concurrent nitrate
or beta-blocker therapy to continue taking
both medications as directed and use SL
nitroglycerin as needed for anginal attacks.
Advise patient to contact physician if chest
pain does not improve or worsens after
therapy or occurs with diaphoresis; if
shortness of breath occurs; or if severe,
persistent headache occurs.
Caution patient to discuss exercise
restrictions with health care professional
before exertion.

DRUG CLASSIFICATION:
ANTI DEPRESSANT DRUG

GENERIC NAME: AMITRIPTYLINE

HYDROCHLORIDE
BRAND NAME: ELAVIL

46
Dosages
Adults: 75 mg P.O. daily in divided doses; may
increase gradually to 150 mg/day. Or start
with 50 to 100 mg P.O. at bedtime and
increase by 25 to 66 amitriptyline
hydrochloride Canada UK Hazardous drug
High-alert drug 50 mg as needed, to a total
dosage of 150 mg. Hospitalized patients
initially may receive 100 mg P.O. daily, with
gradual increases as needed to a total dosage
of 300 mg P.O.

Mechanism of Action:
Unclear. Inhibits norepinephrine and
serotonin reuptake at presynaptic neuron,
increasing levels of these neurotransmitters
in brain. Also has sedative, anticholinergic,
and mild peripheral vasodilating effects

Indications: Depression (often given in

conjunction with psychotherapy)

Contraindications:
S Hypersensitivity to drug or other tricyclic
antidepressants (TCAs) ● Acute recovery
phase after myocardial infarction ● MAO
inhibitor use within past 14 days ● Children
younger than age 12

47
Side Effects:
• constipation, diarrhea;
• nausea, vomiting, upset stomach;
• mouth pain, unusual taste, black
tongue;
• appetite or weight changes;
• urinating less than usual;
• itching or rash;
• breast swelling (in men or women);
or.
• decreased sex drive, impotence, or
difficulty having an orgasm

Adverse Effects:
CNS: headache, fatigue, agitation, numbness,
paresthesia, peripheral neuropathy,
weakness, restlessness, panic, anxiety,
dizziness, drowsiness, difficulty speaking,
excitement, hypomania, psychosis
exacerbation, extrapyramidal effects, poor
coordination, hallucinations, insomnia,
nightmares,seizures, coma, suicidal behavior
or ideation (especially in children and
adolescents)
CV: ECG changes, tachycardia, hypertension,
orthostatic hypotension, arrhythmias, heart
block, myocardial infarction
EENT: blurred vision, dry eyes, mydriasis,
abnormal visual accommodation, increased
intraocular pressure, tinnitus
GI: nausea, vomiting, constipation, dry
mouth, epigastric pain, anorexia, paralytic
ileus

48
 GU: urinary retention, delayed voiding,
urinary tract dilation, gynecomastia
Hematologic: agranulocytosis,
thrombocytopenia, thrombocytopenic
purpura, leukopenia Metabolic: changes in
blood glucose level Skin: photosensitivity
rash, urticaria, flushing, diaphoresis
Other: increased appetite, weight gain, high
fever, edema, hypersensitivity reaction.

Nursing Responsibilities:
Monitor patient closely. Drug may cause
serious or life-threatening adverse reactions.
2Watch for slow onset of life-threatening
arrhythmias, especially after giving loading
dose. 2Monitor ECG continuously during
loading dose and when dosage is changed.
● Check patient’s blood pressure, pulse, and
heart rhythm regularly.
● Assess for signs and symptoms of lung
inflammation.
● Monitor baseline and subsequent chest X-
rays, as well as pulmonary, liver, and thyroid
function test results.
● Closely monitor patient who’s receiving
other drugs concurrently because
amiodarone can interact with many drugs.
Check digoxin blood level if patient is
receiving digoxin; monitor PT or International
Normalized Ratio if patient is receiving
anticoagulants.

49
Patient Teaching: Inform patient that drug
may cause serious adverse reactions. Instruct
him to report these immediately.
● Tell patient to take oral doses with meals.
Advise him to divide daily dose into two
doses if drug causes GI upset.
● Tell patient that adverse reactions are most
common with high doses and may become
more frequent after 6 months of therapy.
● Inform patient that he’ll undergo regular
blood testing, eye examinations, chest X-rays,
and pulmonary function tests during therapy.

GENERIC NAME: DESIPRAMINE

BRAND NAME: NORPRAMINE

Dosages:
PO: ADULTS: 75 mg/day. May
gradually increase to 150–200
mg/day. Maximum: 300 mg/day.
ELDERLY: Initially, 10–25 mg/ day.
May gradually increase to 75– 100
mg/day. Maximum: 150 mg/day. CHILDREN
OLDER THAN 12 YRS: Initially, 25–50 mg/day.
May gradually increase to 100 mg/day.
Maximum: 150 mg/day. CHILDREN 6–12 YRS
(OFF-LABEL): 1–3 mg/ kg/day. Maximum: 5
mg/kg/day.

Mechanism of Action: Blocks reuptake of

neurotransmitters, (norepinephrine,
serotonin) at presynaptic membranes,

50
increasing their availability at postsynaptic
receptor sites. Strong anticholinergic activity.
Therapeutic Effect: Relieves depression.
Indications: Treatment of depression, often in
conjunction with psychotherapy. OFF-LABEL:
Treatment of ADHD, adjunct in chronic pain
treatment, neurogenic pain, depression in
children 6–12 yrs.

Contraindications: Use within 14 days of

MAOIs, acute recovery phase of MI. Initiation
in pts receiving linezolid. Cautions:
Cardiovascular disease, cardiac conduction
disturbances, urinary retention, diabetes,
BPH, glaucoma, narrowangle glaucoma,
xerostomia, visual problems, constipation,
history of bowel obstruction, seizure
disorders, hyperthyroidism, pts taking thyroid
replacement therapy, high risk of suicide,
renal/hepatic impairment, elderly
Side Effects:
Frequent: Drowsiness, fatigue, dry mouth,
blurred vision, constipation, delayed
urination, orthostatic hypotension,
diaphoresis, impaired concentration,
increased appetite, urinary retention.
Occasional: GI disturbances (nausea, GI
distress, metallic taste). Rare: Paradoxical
reactions (agitation, restlessness, nightmares,
insomnia), extrapyramidal symptoms
(particularly fine hand tremor).

Adverse Effects:

51
 Overdose may produce confusion, seizures,
drowsiness, arrhythmias, fever,
hallucinations, dyspnea, vomiting, unusual
fatigue, weakness. Abrupt discontinuation
after prolonged therapy may produce severe
headache, malaise, nausea, vomiting, vivid
dreams.

Nursing Responsibilities:
Monitor for worsening of depression, suicidal
ideation. Assess appearance, behavior,
speech pattern, level of interest mood.
Therapeutic serum level: 115– 300 ng/ml;
toxic serum level: greater than 400 ng/ml.
Monitor EKG if pt has history of arrhythmias.
Patient Teaching: Go from lying to standing
slowly. • Tolerance to postural hypotension,
sedative, anticholinergic effects usually
develops during early therapy. • Maximum
therapeutic effect may be noted in 2–4 wks.
• Do not abruptly discontinue medication.
• Avoid alcohol, grapefruit products. •
Report worsening depression, suicidal
ideation, unusual changes in behavior (esp. at
initiation of therapy or with changes in
dosage).

GENERIC NAME: BUPROPION

BRAND NAME: APLENZIN,
WELLBUTRIN

Dosages:

52
PO (Immediate-Release):
ADULTS: Initially, 100 mg twice a
day. May increase to 100 mg 3
times a day no sooner than 3 days
after beginning therapy. Maximum: 150 mg
3 times/day.
ELDERLY: Initially, 50–100 mg/day. May
increase by 50–100 mg/day q3–4 days.
Maintenance: Lowest effective dosage.
PO (Sustained-Release):
ADULTS: Initially, 150 mg/day as a single dose
in the morning. May increase to 150 mg twice
a day as early as day 4 after beginning
therapy. Maximum: 400 mg/day in 2 divided
doses.
PO (Extended-Release):
ADULTS: 150 mg once a day. May increase to
300 mg once a day. Maximum: 450 mg/day.
(Forfivo XL): Use only after initial dose
titration. (Aplenzin): Initially, 174 mg once
daily in morning; may increase as soon as 4
days to 348 mg/day. Maximum: 522 mg/day.

Mechanism of Action:
Blocks reuptake of neurotransmitters,
(dopamine, norepinephrine) at CNS
presynaptic membranes. Therapeutic Effect:
Relieves depression. Eliminates nicotine
withdrawal symptoms.
Indications: Treatment of depression,
including seasonal affective disorder (SAD).
Zyban assists in smoking cessation. OFF-
LABEL: Treatment of ADHD in adults,

53
children. Depression associated with bipolar
disorder.
Contraindications:
Current or prior diagnosis of anorexia
nervosa or bulimia, seizure disorder, use
within 14 days of MAOIs; concomitant use of
other bupropion products; pts undergoing
abrupt discontinuation of alcohol or
sedatives. Initiation of bupropion in pt
receiving linezolid. Aplenzin (additional):
Conditions increasing seizure risk, severe
head injury, stroke, CNS tumor/infection,
abrupt discontinuation of barbiturates or
antiepileptics. Cautions: History of seizure,
cranial or head trauma, cardiovascular
disease, history of hypertension or coronary
artery disease, elderly, pts at high risk for
suicide, renal/hepatic impairment.
Concurrent use of antipsychotics,
antidepressants, theophylline, steroids,
stimulants, hypoglycemic agents, excessive
use of alcohol, sedatives/hypnotics, opioids.
Side Effects: Frequent (32%–18%):
Constipation, weight gain or loss, nausea,
vomiting, anorexia, dry mouth, headache,
diaphoresis, tremor, sedation, insomnia,
dizziness, agitation. Occasional (10%–5%):
Diarrhea, akinesia, blurred vision,
tachycardia, confusion, hostility, fatigue.

Adverse Effects:
Risk of seizures increases in pts taking more
than 150 mg/dose; in pts with history of

54
bulimia, seizure disorders, discontinuing
drugs that may lower seizure threshold.

Nursing Responsibilities:
Assess psychological status, thought content,
suicidal tendencies, appearance. For pts on
long-term therapy, hepatic/ renal function
tests should be performed periodically.
Supervise suicidal-risk pt closely during early
therapy and dose changes (as depression
lessens, energy level improves, increasing
suicide potential). Assess appearance,
behavior, speech pattern, level of interest,
mood changes.

Patient Teaching: • Full therapeutic effect

may be noted in 4 wks. • Avoid tasks that
require alertness, motor skills until response
to drug is established. • Report
signs/symptoms of seizure, worsening
depression, suicidal ideation, unusual
behavioral changes. • Avoid alcohol. •
Do not chew, crush, dissolve, or divide
sustained-, extended-release tablets.

55
DRUG CLASSIFICATION:
CORTICOSTEROID

GENERIC: BETAMETHASONE
BRAND: DIPROLENE

DOSAGE AND FREQUENCY:

Adults
Systemic administration
Oral (betamethasone):
Initial dosage,
0.6–7.2 mg/day.
● IM (betamethasone sodium phosphate;
betamethasone sodium phosphate and
acetate): Initial dosage, 0.5–9 mg/day.
Dosage range is one-third to one-half oral
dose given every 12 hr. In life-threatening
situations, dose can be in multiples of the
oral dose. Intrabursal, intra-articular,
intradermal, intralesional (betamethasone
sodium phosphate and acetate) 1.5–12 mg
intra-articular, depending on joint size; 0.2
mL/cm3 intradermally, not to exceed 1
mL/wk; 0.25–1 mL at 3- to 7-day intervals for
disorders of the foot. Topical dermatologic
cream, ointment (betamethasone
dipropionate) Apply sparingly to affected
area daily or bid Pediatric patients Systemic
administration
Individualize dosage on the basis of severity
and response rather than by formulas that
correct adult doses for age or weight.

56
Carefully observe growth and development in
infants and children on prolonged therapy.

MECHANISM OF ACTION:
Binds to intracellular corticosteroid
receptors, thereby initiating many natural
complex reactions that are responsible for its
anti-inflammatory and immunosuppressive
effects

INDICATIONS:
Management of adrenocortical insufficiency;
chronic use in other situations is limited
because of mineralocorticoid activity. Used
systemically and locally in a wide variety of
chronic diseases including: Inflammatory,
Allergic, Hematologic, Neoplastic,
Autoimmune disorders. Replacement therapy
in adrenal insufficiency. Unlabeled
Use: Short-term administration to high-risk
mothers before delivery to prevent
respiratory distress syndrome in the
newborn.

CONTRAINDICATIONS:
Contraindicated with infections, especially
tuberculosis, fungal infections, amebiasis,
vaccinia and varicella, and antibioticresistant
infections, lactation.

SIDE EFFECTS/ ADVERSE EFFECTS:

CNS: Vertigo, headache, paresthesias,
insomnia, seizures, psychosis, cataracts,

57
increased IOP, glaucoma (in long-term
therapy)
● CV: Hypotension, shock, hypertension, and
heart failure secondary to fluid retention,
thromboembolism, thrombophlebitis, fat
embolism, cardiac arrhythmias
● Electrolyte imbalance: Na+ and fluid
retention, hypokalemia, hypocalcemia
● Endocrine: Amenorrhea, irregular menses,
growth retardation, decreased carbohydrate
tolerance, diabetes mellitus, cushingoid state
(long-term effect), increased blood sugar,
increased serum cholesterol, decreased T3
and T4 levels, HPA suppression with systemic
therapy longer than 5 days
● GI: Peptic or esophageal ulcer, pancreatitis,
abdominal distention, nausea, vomiting,
increased appetite, weight gain (longterm
therapy)
● Musculoskeletal: Muscle weakness, steroid
myopathy, loss of muscle mass, osteoporosis,
spontaneous fractures (long-term therapy)
● Other: Immunosuppression, aggravation, or
masking of infections; impaired wound
healing; thin, fragile skin; petechiae,
ecchymoses, purpura, striae; subcutaneous
fat atrophy; hypersensitivity or anaphylactoid
reactions

NURSING RESPONSIBILITIES:
Interventions
Systemic use

58
● Give daily dose before 9 AM to mimic
normal peak corticosteroid blood levels.
● Increase dosage when patient is subject to
stress.
● Taper doses when discontinuing high-dose
or long-term therapy.
● Do not give live-virus vaccines with
immunosuppressive doses of corticosteroids.

PATIENT/FAMILY TEACHING:
Do not stop taking the oral drug without
consulting your health care provider.
● Take single dose or alternate-day doses
before
9 AM.
● Avoid exposure to infections; ability to fight
infections is reduced.

GENERIC: PREDNISONE
BRAND: APO-PREDNISONE

DOSAGE AND FREQUENCY:

Adults
Individualize dosage depending
on severity of condition and patient’s
response. Administer daily dose
before 9 AM to minimize adrenal
suppression.
If long-term therapy is needed, consider
Salternate-day therapy. After long-term
therapy,

59
withdraw drug slowly to avoid adrenal
insufficiency. Initial dose, 5–60 mg/day PO.
For
maintenance therapy, reduce initial dose in
small increments at intervals until lowest
dose
that maintains satisfactory clinical response is
reached. For acute exacerbations of MS, 200
mg/day PO for 1 wk, then 80 mg PO every
other
day for 1 month.
Pediatric patients
● Physiologic replacement: 0.05–2 mg/kg/day
PO or 4–5 mg/m2/day PO in equal divided
doses every 12 hr.
● Other indications: Individualize dosage
depending
on severity of condition and the
patient’s response rather than by strict
adherence
to formulas that correct adult doses for
age or body weight. Carefully observe growth
and development in infants and children on
prolonged therapy.

MECHANISM OF ACTION:
Enters target cells and binds to intracellular
corticosteroid receptors, initiating many
complex
reactions that are responsible for its
antiinflammatory
and immunosuppressive effects.

60
INDICATIONS:
Replacement therapy in adrenal cortical
insufficiency
● Hypercalcemia associated with cancer
● Short-term management of various
inflammatory
and allergic disorders, such as rheumatoid
arthritis, collagen diseases (eg, SLE),
dermatologic diseases (eg, pemphigus),
status
asthmaticus, and autoimmune disorders

CONTRAINDICATIONS:
Contraindicated with infections, especially
tuberculosis, fungal infections, amebiasis,
vaccinia and varicella, and antibiotic-resistant
infections; lactation.

SIDE EFFECTS/ ADVERSE EFFECTS:

CNS: Vertigo, headache, paresthesias,
insomnia,
seizures, psychosis, cataracts, increased
IOP, glaucoma (long-term therapy),
euphoria, depression
● CV: Hypotension, shock, hypertension and
HF secondary to fluid retention,
thromboembolism,
thrombophlebitis, fat embolism,
cardiac arrhythmias
● Electrolyte imbalance: Sodium and
fluid retention, hypokalemia, hypocalcemia
● Endocrine: Amenorrhea, irregular menses,
growth retardation, decreased carbohydrate

61
tolerance, diabetes mellitus, cushingoid state
(long-term effect), increased blood sugar,
increased
serum cholesterol, decreased T3 and
T4 levels, HPA suppression with systemic
therapy
longer than 5 days
● GI: Peptic or esophageal ulcer, pancreatitis,
abdominal distention, nausea, vomiting,
increased
appetite, weight gain (long-term
therapy)
● Hypersensitivity: Hypersensitivity or
anaphylactoid
reactions
● Musculoskeletal: Muscle weakness, steroid
myopathy, loss of muscle mass, osteoporosis,
spontaneous fractures (long-term therapy)
● Other: Immunosuppression, aggravation
or masking of infections; impaired wound
healing; thin, fragile skin; petechiae,
ecchymoses,
purpura, striae; subcutaneous fat atrophy

NURSING RESPONSIBILITIES:
Interventions
● Administer once-a-day doses before 9 AM
to
mimic normal peak corticosteroid blood
levels.
● Increase dosage when patient is subject to
stress.

62
PATIENT/FAMILY TEACHING:
Do not stop taking the drug without
consulting
your health care provider; take once-daily
doses at about 9 AM.
● Avoid exposure to infections.
● Report unusual weight gain, swelling of the
extremities, muscle weakness, black or tarry
stools, fever, prolonged sore throat, colds or
other infections, worsening of the disorder
for
which the drug is being taken

GENERIC: METHYLPREDNISOLONE
BRAND: MEDROL

DOSAGE AND FREQUENCY:

Adults
Oral
4–48 mg/day. For alternate-day
therapy, givetwice the usual
dose every other morning.
IV, IM
10–40 mg IV administered over several min.
Give subsequent doses IV or IM.
● High-dose therapy: 30 mg/kg IV infused
over 10–30 min; may repeat every 4–6 hr
but not longer than 72 hr.

Pediatric patients
Individualize dosage on the basis of severity
and response rather than by formulas of

63
correct doses for age or weight. Carefully
observe
growth and development in infants
and children on prolonged therapy. Minimum
dose of methylprednisolone is 0.5
mg/kg per 24 hr.

MECHANISM OF ACTION:
Enters target cells and binds to intracellular
corticosteroid receptors, initiating many
complex reactions that are responsible for
its anti-inflammatory and
immunosuppressive
effects.

INDICATIONS:
Short-term management of various
inflammatory
and allergic disorders, such as
rheumatoid arthritis, collagen diseases (eg,
SLE), dermatologic diseases (eg, pemphigus),
status asthmaticus, and autoimmune
disorders (eg, MS)
● Hematologic disorders: Thrombocytopenia
purpura, erythroblastopenia

CONTRAINDICATIONS:
Contraindicated with infections, especially
TB, fungal infections, amebiasis, vaccinia
and varicella, and antibiotic-resistant
infections;
lactation.

64
SIDE EFFECTS/ ADVERSE EFFECTS
CNS: Vertigo, headache, paresthesias,
insomnia,
seizures, psychosis, cataracts, increased
IOP, glaucoma
● CV: Hypotension, shock, hypertension

DRUG CLASSIFICATION:
ANTIDIABETIC

GENERIC NAME: ACARBOSE

BRAND NAME: GLUCOBAY , PRANDASE,
PRECOSE

Dosages: Adults: Initially, 25 mg P.O

. t.i.d. Increase q 4 to 8 weeks as
needed until maintenance dosage
is reached. Maximum dosage is
100 mg P.O. t.i.d. for adults
weighing more than 60 kg (132 lb

65
); 50 mg P.O. t.i.d. for adults weighing 60 kg
or less.
Mechanism of Action: Improves blood
glucose control by slowing carbohydrate
digestion in intestine and prolonging
conversion of carbohydrates to glucose

Indications: Treatment of type 2 (non-insulin

dependent) diabetes mellitus when diet
alone doesn’t control blood glucose

Contraindications: ● Hypersensitivity to drug

● Renal dysfunction ● Type 1 diabetes
mellitus, diabetic ketoacidosis ● GI disease ●
Cirrhosis ● Colonic ulcers ● Inflammatory
bowel disease ● Intestinal obstruction ●
Pregnancy or breastfeeding

Side Effects: Diarrhea, gas, or abdominal

discomfort/pain

Adverse Effects: GI: diarrhea, abdominal

pain, flatulence Metabolic: hypoglycemia
(when used with insulin or sulfonylureas)
Other: edema, hypersensitivity reaction
(rash)

Nursing Responsibilities: Monitor patient for

hypoglycemia if he’s taking drug concurrently
with insulin or sulfonylureas. ● Stay alert for
hyperglycemia during periods of increased
stress. ● Assess GI signs and symptoms to
differentiate drug effects from those caused

66
by paralytic ileus. ● Check 1-hour
postprandial glucose level to gauge drug’s
efficacy. ● Monitor liver function test results.
Report abnormalities so that dosage
adjustments may be made as needed
Patient Teaching: Inform patient that drug
may cause serious interactions with many
common medications, so he should tell all
prescribers he’s taking it.
● Teach patient about other ways to control
blood glucose level, such as
recommendations regarding diet, exercise,
weight reduction, and stress management.
● Stress importance of testing urine and
blood glucose regularly.
● Teach patient about signs and symptoms
of hypoglycemia. Tell him that although this
drug doesn’t cause hypoglycemia when used
alone, hypoglycemic symptoms may arise if
he takes it with other hypoglycemics.
● Urge patient to keep oral glucose on hand
to correct mild hypoglycemia; inform him
that sugar in candy won’t correct
hypoglycemia.
● Inform patient that GI symptoms such as
flatulence may result from delayed
carbohydrate digestion in intestine. ● Advise
patient to obtain medical alert identification
and to carry or wear it at all times. ● As
appropriate, review all other significant and
life-threatening adverse reactions and
interactions, especially those related to the
drugs and tests mentioned above

67
GENERIC NAME: PRAMLINTIDE
BRAND NAME: (SYMLINPEN 60,
SYMLINPEN 120)

Dosages:
Type 1 Diabetes Mellitus Subcutaneous:
ADULTS, ELDERLY: Initially, 15 mcg
immediately before major meal. Titrate in 15-
mcg increments every 3 days (if no significant
nausea occurs) to target dose of 30–60 mcg.
Type 2 Diabetes Mellitus Subcutaneous:
ADULTS, ELDERLY: Initially, 60 mcg
immediately before major meal. After 3–7
days, increase to 120 mcg if no significant
nausea occurs (if nausea occurs at 120 mcg
dose, reduce to 60 mcg

Mechanism of Action:
Consecrated with insulin by pancreatic beta
cells, reduces postprandial glucose increases
by slowing gastric emptying time, reducing
postprandial glucagon secretion, reducing
caloric intake through centrally mediated
appetite suppression. Therapeutic Effect:
Improves glycemic control by reducing

68
postprandial glucose concentrations in pts
with type 1, type 2 diabetes mellitus.

Indications:
Adjunctive treatment with mealtime insulin
in type 1, type 2 diabetes mellitus pts who
have failed to achieve desired glucose control
despite optimal insulin therapy, with/without
concurrent sulfonylurea and/or metformin in
type 2 diabetes mellitus.
Contraindications:
Diagnosed gastroparesis, presence of
hypoglycemia or recurrent severe
hypoglycemic episodes in the past 6 mos.
Cautions: Coadministration with insulin may
induce severe hypoglycemia (usually within 3
hrs following administration); concurrent use
of other glucose-lowering agents may
increase risk of hypoglycemia. History of
nausea, visual or dexterity impairment, poor
compliance with insulin monitoring or
current insulin therapy, pts with hemoglobin
A1c greater than 9%, pts with conditions or
taking concurrent medications likely to impair
gastric motility (e.g., anticholinergics), pts
requiring medication to stimulate gastric
emptying.

Side Effects:
TYPE 1 DIABETES MELLITUS Frequent (48%):
Nausea. Occasional (17%– 11%): Anorexia,
vomiting. Rare (7%–5%): Fatigue, arthralgia,

69
allergic reaction, dizziness. TYPE 2 DIABETES
MELLITUS Frequent (28%): Nausea.
Occasional (13%– 8%): Headache, anorexia,
vomiting, abdominal pain. Rare (7%–5%):
Fatigue, dizziness, cough, pharyngitis.

Adverse Effects:
Overdose produces severe nausea, vomiting,
diarrhea, vasodilation, dizziness. No
hypoglycemia was reported. Increased risk of
severe hypoglycemia when given
concurrently with non-titrated insulin.

Nursing Responsibilities: Check serum

glucose concentration before administration,
both before and after meals and at bedtime.
Discuss lifestyle to determine extent of
learning, emotional needs. Ensure follow-up
instruction if pt, family does not thoroughly
understand diabetes management, glucose
testing technique.

Patient Teaching: Diabetes mellitus requires

lifelong control. • Prescribed diet, exercise
are principal parts of treatment; do not skip/
delay meals. • Continue to adhere to
dietary instructions, regular exercise
program, regular testing of serum glucose. •
When taking combination drug therapy, have
source of glucose available to treat
symptoms of low blood sugar.

GENERIC NAME: INSULIN

70
BRAND NAME: (AFREZZA):
INHALATION POWDER
INSULIN ASPART: (NOVOLOG)
INSULIN GLULISINE: (APIDRA)
INSULIN LISPRO: (HUMALOG)
SHORT-ACTING: REGULAR INSULIN:
(HUMULIN R, NOVOLIN R)
INTERMEDIATE-ACTING: NPH:
(HUMULIN N, NOVOLIN N)
LONG-ACTING: INSULIN DETEMIR:
(LEVEMIR)

Dosages:
Type 1 Diabetes: Multiple daily injections,
guided by glucose monitoring or continuous
subcutaneous insulin infusions, is standard of
care. Initial dose: 0.5–1 unit/kg/day in divided
doses. Maintenance: 0.5–1.2 units/kg/ day in
divided doses.
Type 2 Diabetes: Goal is to achieve HbA1c
less than 7% using safe medication titration.

Mechanism of Action:
Acts via specific receptor to regulate
metabolism of carbohydrates, protein, and
fats. Acts on liver, skeletal muscle, and
adipose tissue. Liver: Stimulates hepatic
glycogen synthesis, synthesis of fatty acids.
Muscle: Increases protein, glycogen
synthesis. Adipose tissue: Stimulates
lipoproteins to provide free fatty acids,

71
triglyceride synthesis. Therapeutic Effect:
Controls serum glucose levels.
Indications: Treatment of insulin-dependent
type 1 diabetes mellitus; non–insulin-
dependent type 2 diabetes mellitus (NIDDM)
to improve glycemic control.

Contraindications:
Hypersensitivity, hypoglycemia.

Side Effects:
Occasional: Localized redness, swelling,
itching (due to improper insulin injection
technique), allergy to insulin cleansing
solution. Infrequent: Somogyi effect
(rebound hyperglycemia) with chronically
excessive insulin dosages. Systemic allergic
reaction (rash, angioedema, anaphylaxis),
lipodystrophy (depression at injection site
due to breakdown of adipose tissue),
lipohypertrophy (accumulation of
subcutaneous tissue at injection site due to
inadequate site rotation). Rare: Insulin
resistance

Adverse Effects:
Severe hypoglycemia (due to
hyperinsulinism) may occur with insulin
overdose, decrease/delay of food intake,
excessive exercise, pts with brittle diabetes.
Diabetic ketoacidosis may result from stress,

72
illness, omission of insulin dose, longterm
poor insulin control.

Nursing Responsibilities:
Check blood glucose level. Discuss lifestyle to
determine extent of learning, emotional
needs. If given IV, obtain serum chemistries
(esp. serum potassium). Assess for
hypoglycemia (refer to pharmacokinetics
table for peak times and duration): cool, wet
skin, tremors, dizziness, headache, anxiety,
tachycardia, numbness in mouth, hunger,
diplopia. Assess sleeping pt for restlessness,
diaphoresis. Check for hyperglycemia:
polyuria (excessive urine output), polyphagia
(excessive food intake), polydipsia (excessive
thirst), interferon alfa-2b 639 Canadian trade
name Non-Crushable Drug High Alert drug I
nausea/vomiting, dim vision, fatigue, deep
and rapid breathing (Kussmaul respirations).
Be alert to conditions altering glucose
requirements: fever, trauma, increased
activity/stress, surgical procedure

Patient Teaching: • Instruct on proper

technique for drug administration, testing of
glucose, signs/ symptoms of hypoglycemia
and hyperglycemia. • Prescribed diet is an
essential part of treatment; do not skip/delay
meals. • Carry candy, sugar packets, other
sugar supplements for immediate response
to hypoglycemia. • Wear or carry medical
alert identification. • Check with physician

73
when insulin demands are altered (e.g., fever,
infection, trauma, stress, heavy physical
activity). • Do not take other medication
without consulting physician. • Weight
control, exercise, hygiene (including foot
care), not smoking are integral parts of
therapy. • Protect skin, limit sun exposure. •
Inform dentist, physician, surgeon of
medicine.

DRUG CLASSIFICATION:
ANTIPSYCHOTIC AGENTS

GENERIC NAME: CHLORPROMAZINE

BRAND:THORAZINE

DOSAGE AND FREQUENCY:

Adults: Hospitalized patients
—Initially, 25 mg I.M; if necessary,give
an additional 25 to 50 mg in 1 hour.
Increase dosage gradually, as needed, for
several days (up to 400 mg q 4 to 6 hours in
exceptionally severe cases) until symptoms
are controlled; then give 500 mg P.O. daily. In
less acutely disturbed patients,25 mg P.O.

74
t.i.d., increased gradually until effective
dosage is reached (usually 400 mg P.O.
daily).Acutely disturbed outpatients—
Initially,10 mg P.O. three or four times daily
or 25 mg P.O. two or three times daily. In
more severe cases, 25 mg P.O. t.i.d.; after 1
or 2 days, increase daily dosage by 20 to 50
mg at semi weekly intervals until effective
dosage is reached. Children ages 6 months to
12 years: 0.55 mg/kg P.O.(15 mg/m2) q 4 to 6
hours as needed, or 0.55 mg/kg I.M. (15
mg/m2) q 6 to 8 hours (not to exceed 40
mg/day in children ages 6 months to 5 years,
or 75 mg/day in children ages 6 to 12)
➣Nausea and vomiting Adults: 10 to 25 mg
P.O. q 4 to 6 hours, increased if necessary; or
25 mg I.M. If no hypertension occurs, give 25
to 50 mg I.M. q 3 to 4 hours as needed until
vomiting stops; then switch to oral dosing
➣Nausea and vomiting during surgery
Adults: 12.5 mg I.M., repeated in 30 minutes
p.r.n. if no hypotension occurs; or 2 mg I.V.at
2-minute intervals (not to exceed 25 mg)
Children ages 6 months to 12 years: 0.275
mg/kg I.M.; may repeat in 30 minutes as
needed

➣Preoperative sedation Adults: 25 to 50 mg

P.O.2 to 3 hours before surgery, or 12.5 to 25
mg I.M.1 to 2 hours before surgery Children
ages 6 months to 12 years: 0.55 mg/kg
P.O.(15 mg/m2) 2 to 3 hours before surgery,
or 0.55 mg/kg I.M.1 to 2 hours before surgery

75
 ➣Intractable hiccups Adults: 25 to 50 mg
P.O. three to four times daily. If symptoms
continue for 2 to 3 days, give 25 to 50 mg
I.M.; if symptoms still persist, give 25 to 50
mg by slow I.V. infusion with patient
positioned flat in bed.
➣Acute intermittent porphyria Adults: 25 to
50 mg P.O. three to four times daily. Drug is
usually discontinued after several weeks, but
some patients require maintenance doses. Or
25 mg I.M. t.i.d. until patient can tolerate oral
doses.
➣Tetanus Adults: 25 to 50 mg P.O. three to
four times daily (given with barbiturates, as
prescribed).Total dosage and frequency
determined by patient response. Children
ages 6 months to 12 years: 0.55 mg/kg I.M.
or 0.55 mg/kg I.V. q 6 to 8 hours

MECHANISM OF ACTION
May block postsynaptic dopamine receptors
in brain and depress areas involved in
wakefulness and emesis. Also possesses
anticholinergic, antihistaminic, and
adrenergic-blocking properties.

INDICATION
For the treatment of schizophrenia.
1. To control nausea and vomiting.
2. For relief of restlessness and
apprehension before surgery.
3. For acute intermittent porphyria.

76
4. As an adjunct in the treatment of
tetanus.
5. To control the manifestations of the
manic type of manic-depressive illness.
6. For relief of intractable hiccups.

CONTRAINDICATION
● Hypersensitivity to drug, other
phenothiazines, sulfites (injection),benzyl
alcohol (sustained-release capsules)
● Angle-closure glaucoma
● Bone marrow depression
● Severe hepatic or cardiovascular disease
SIDE EFFECTS
There are many side effects of phenothiazine
antipsychotics. Common side effects include:
drowsiness, dizziness, headache, low blood
pressure, and blurred vision.

ADVERSE EFFECTS
CNS: sedation, drowsiness, extrapyramidal
reactions, tardive dyskinesia,
pseudoparkinsonism, neuroleptic malignant
syndrome, seizures
CV: tachycardia, hypotension (especially with
I.M. or I.V. use) EENT: blurred vision, dry
eyes, lens opacities, nasal congestion GI:
constipation, ileus, anorexia, dry mouth GU:
urinary retention, menstrual irregularities,
galactorrhea, gynecomastia, inhibited
ejaculation, priapism Hematologic:
eosinophilia, agranulocytosis, leukopenia,
hemolytic anemia, aplastic anemia,

77
thrombocytopenia Hepatic: jaundice,
hepatitis Skin: rash, photosensitivity,
pigmentation changes, sterile abscess Other:
allergic reactions, hyperthermia, pain at
injection site

NURSING RESPONSIBILITIES
1. Monitor blood pressure closely
during I.V. infusion.
2. Stay alert for signs and symptoms of
neuroleptic malignant syndrome
(hyperpyrexia, muscle rigidity, altered mental
status, irregular pulse or blood pressure,
tachycardia, diaphoresis, and
arrhythmias).Stop drug immediately if these
occur.
3. Assess for extrapyramidal symptoms.

PATIENT/FAMILY EDUCATION
1. Tell patient to take capsules or
tablets with a full glass of water, with or
without food.
2. Instruct patient not to crush
sustained-release capsules.
3. Tell patient to mix oral concentrate in
juice, soda, applesauce, or pudding.
4. Caution patient to avoid driving and
other hazardous activities until he

GENERIC NAME: FLUPHENAZINE

BRAND: MODITEN

78
DOSAGE AND FREQUENCY
➣Psychotic disorders
ADULTS: 2.5 to 10 mg/day
(hydrochloride) P.O.in divided
doses q 6 to 8 hours or as a
single dose at bedtime; typical
daily dosage is 1 to 5 mg; give
oral doses above 20 mg/day with
caution. Or initially, 1.25 mg I.M.,
divided and given q 6 to 8 hours.
Parenteral hydrochloride dosage is one-third
to one-half of oral dosage. Or 12.5 to 25 mg
I.M. or subcutaneously (decanoate); base
subsequent dosage and dosing intervals of 1
to 4 weeks on patient response; don’t exceed
100 mg.
PEDIATRIC: Not recommended.

MECHANISM OF ACTION
May alter postsynaptic mesolimbic dopamine
receptors in brain and reduce release of
hypothalamic and hypophyseal hormones
thought to depress reticular activating
system, thereby preventing psychotic
symptoms

INDICATION
A long acting parenteral antipsychotic agent
indicated in the maintenance therapy of
schizophrenia.

79
CONTRAINDICATIONS
● Hypersensitivity to drug, sulfites (with
injectable form),or benzyl alcohol
● Angle-closure glaucoma
● Bone marrow depression
● Severe hepatic or cardiovascular disease

SIDE EFFECTS
Drowsiness, lethargy, dizziness, light
headedness, nausea, loss of appetite,
sweating, dry mouth, blurred vision,
headache, and constipation may occur.

ADVERSE EFFECTS
CNS: drowsiness, sedation, extrapyramidal
reactions, tardive dyskinesia, pseudo
parkinsonism, neuroleptic malignant
syndrome, seizures CV: hypotension,
tachycardia
EENT: blurred vision, dry eyes, lens opacities,
nasal congestion
GI: constipation, dry mouth, anorexia,
paralytic ileus
GU: urinary retention, menstrual
irregularities, inhibited ejaculation, priapism,
gynecomastia, lactation
Hematologic: eosinophilia, hemolytic anemia,
aplastic anemia, agranulocytosis, leukopenia,
thrombocytopenia
Hepatic: jaundice, hepatitis Metabolic:
galactorrhea, hyperthermia Skin:
photosensitivity, rash

80
Other: allergic reactions, pain at injection
site, sterile abscess
NURSING RESPONSIBILITIES
1. Monitor patient for signs and
symptoms of neuroleptic malignant
syndrome (extrapyramidal symptoms,
hyperthermia, autonomic symptoms).
2. Stop giving drug and notify prescriber
immediately if patient shows signs or
symptoms of blood dyscrasias (fever,
infection, sore throat, cellulitis, or weakness).
3. Observe for tardive dyskinesia.
4. Watch for bleeding tendency.
5. Monitor CBC ,bilirubin level, and liver
function test results.
6. Assess kidney function and
ophthalmic test results in patients on long
term therapy.

PATIENT/FAMILY EDUCATION
1. Tell patient not to stop taking drug
suddenly, because serious adverse effects
may occur.
2. Advise patient to report urinary
retention or constipation. 2Instruct patient to
immediately report unusual bleeding or
bruising.
3. Caution patient to avoid driving and
other hazardous activities until he
knows how drug affects concentration,
alertness, and vision.
4. Tell patient to avoid activities that
can cause injury. Advise him to use soft

81
toothbrush and electric razor to avoid gum
and skin injury.
5. Inform patient that he’ll undergo
regular blood testing during therapy.
6. Tell female patient to inform
prescriber if she is pregnant or breastfeeding.
7. As appropriate, review all other
significant and life-threatening adverse
reactions and interactions, especially those
related to the drugs, tests, herbs, and
behaviors mentioned above.

GENERIC NAME: OLANZAPINE

BRAND NAME:ZYPREXA

DOSAGE AND FREQUENCY

➣Schizophrenia Adults: Initially,
5 to 10 mg (Zyprexa, Zyprexa Zydis)
P.O. daily with a target dosage of
10 mg/day within several days;
may increase or decrease q week
by 5 mg/day (not to exceed 20
mg/day). Periodically reevaluate longterm
usefulness of drug for individual patient. Or,
for Zyprexa Relprevv dosages corresponding
to Zyprexa target oral dosages.
Adolescents: Initially, 2.5 or 5 mg (Zyprexa,
Zyprexa Zydis) P.O. daily with a target dosage
of 10 mg/day. When dosage adjustments are

82
needed, increments or decrements of 2.5 or
5 mg are recommended to a maximum of 20
mg/day.
➣Bipolar I disorder (manic or mixed
episodes) Adults: Initially,10 or 15 mg
(Zyprexa, Zyprexa Zydis) P.O. daily; may
increase or decrease q 24 hours by 5 mg/day
(not to exceed 20 mg/day).Or 10 mg I.M.
(Zyprexa Intra Muscular); maximum dosage is
three 10-mg doses I.M. 2 to 4 hours apart. Or
initially, 10 mg (Zyprexa, Zyprexa Zydis) P.O.
daily when administered as adjunctive
treatment to lithium or valproate.
Adolescents: Initially, 2.5 or 5 mg (Zyprexa,
Zyprexa Zydis) P.O. daily with a target dosage
of 10 mg/day. When dosage adjustments are
necessary, increments or decrements of 2.5
or 5 mg are recommended to a maximum of
20 mg/day.
➣Agitation associated with schizophrenia
and bipolar I mania Adults: 10 mg
I.M.(Zyprexa Intra Muscular) or 5 mg or 7.5
mg I.M. when clinically warranted; maximum
of three doses 2 to 4 hours apart. If agitation
persists after initial dose, subsequent doses
up to 10 mg may be given. If on going
olanzapine therapy is clinically indicated,5 to
20 mg/day (Zyprexa, Zyprexa Zydis) P.O. may
be initiated as soon as clinically appropriate.
➣Depressive episodes associated with
bipolar I disorder Adults: Initially,5 mg
(Zyprexa, Zyprexa Zydis) P.O. and 20 mg
fluoxetine P.O. daily in the evening. Dosage

83
adjustments, if indicated, can be made
according to efficacy and tolerability within
ranges of 5 to 12.5 mg (Zyprexa or Zyprexa
Zydis) and fluoxetine 20 to 50 mg.

MECHANISM OF ACTION
Olanzapine is a drug that is used to treat
schizophrenia and acute manic episodes
associated with bipolar I disorder.
The exact mechanism of action of olanzapine
is not known. It may work by blocking
receptors for several neurotransmitters
(chemicals that nerves use to communicate
with each other) in the brain.

INDICATION
Bipolar disorder: as monotherapy or with
lithium or valproate for short-term use in
acute mixed or manic episodes, or for
maintenance. In combination with fluoxetine:
depressive episodes associated with bipolar I
disorder, or treatment resistant depression
(TRD).

CONTRAINDICATION
Documented hypersensitivity

SIDE EFFECTS
Drowsiness, dizziness, light headedness,
stomach upset, dry mouth, constipation,
increased appetite, or weight gain may occur.
If any of these effects persist or worsen, tell
your doctor or pharmacist promptly.

84
ADVERSE EFFECTS
Somnolence, sedation, dizziness,
constipation, weight gain, increased appetite,
personality disorder, akathisia, asthenia,
postural hypotension, headache, abdominal
pain, dry mouth, fatigue, tremor,
extremity/back pain, nausea, diarrhea,
vomiting, cough, nasopharyngitis;
neutropenia, hyperprolactinemia, elevated
liver enzymes, EPS.

NURSING RESPONSIBILITIES
1. Assess patient’s mental status during
therapy.
2. Monitor vital signs during dosage
adjustment periods.
3. Make sure patient takes drug and
doesn’t hoard it. 2Watch for signs and
symptoms of neuroleptic malignant
syndrome (fever, respiratory distress,
tachycardia, seizures, diaphoresis,
hypertension or hypotension, tiredness,
severe muscle stiffness, loss of bladder
control).
4. Evaluate patient for onset of
akathisia, tardive dyskinesia, and
extrapyramidal effects. Watch for signs of
increasing depression. 2Monitor blood
glucose level closely, especially in patient
with diabetes mellitus. Severe hyperglycemia,
coma, and death may occur.

85
5. Watch for orthostatic hypotension
before I.M.injection. Keep patient recumbent
if drowsiness or dizziness follows injection.
6. Monitor baseline and periodic lipid
and liver enzyme levels.

PATIENT/FAMILY EDUCATION
1. You can take olanzapine with or
without food.
2. Take olanzapine at the time(s)
recommended by your doctor.
3. You can cut or crush the tablet.

DRUG CLASSIFICATION:
ANTIPYRETICS

GENETIC NAME: ACETAMINOPHEN

BRAND NAME: ACTAMIN

dosage and frequency

ADULT AND CHILDREN >12YR
PO: 325-1000 mg q4-6h prn or
1300 mg q8h.
RECT: 325-650 mg q4h prn

MECHANISM OF ACTION
inhibits the synthesis of prostaglandins that
may serve as mediators of pain and fever.

86
INDICATIONS
mild to moderate pain, fever

CONTRAINDICATIONS
previous hypersensitivity, products
containing alcohol, aspartame, saccharin,
sugar or tartrazine.

SIDE EFFECTS/ ADVERSE EFFECTS

GI: heptic necrosis
DERM: rashes, urticarial

NURSING RESPONSIBILITIES
1. assess overall health status and alcohol
usage before administering acetaminophen.
Malnourished patients or chronic alcohol
abusers are at high risk of developing
hepatotoxicity with chronic use of usual
doses of this drug.
2. Assess amount, frequency and type of
drugs taken in patients self medicating
especially OTC drugs.
3. PAIN: assess type, location and intensity
prior to 30-60 min following administration
4. FEVER: assess fever: note presence of
associated signs (diaphoresis, tachycardia
and malaise)

PATIENT/FAMILY EDUCATION
1. Renal damage may occur with prolong use
of acetaminophen and salicylates or NSAIDS.
2. Adults should not take acetaminophen
longer than 10 days and children not longer

87
than 5 days unless directed by physician or
other health care provider.
3. Avoid alcohol if taking more that
occasional 1-2 doses and avoid taking
concurrently with salicylates or NSAIDS.

GENERIC NAME: ASPIRIN

BRAND NAME:ASPERGUM

dosage and frequency

ADULTS
PO/RECT: 325-500 mg q3h or 325-
650mg q4h or 650-1000mg q6h
(do not exceed 4g/day)
CHILDREN (2-11yr)
PO/RECT: 60-80mg/kg/day in 4-6 divided
doses

MECHANISM OF ACTION
produce analgesia and reduce inflammation
and fever by inhibiting the production of
prostaglandins, Aspirin decreases platelet
aggregation.

INDICATION
prophylaxis of transient ishmeic attacks and
myocardial infraction
CONTRAINDICATIONS
hypersensitivity to aspirin

SIDE EFFECTS/ADVERSE EFFECTS

88
EENT: tinnitus, hearing loss
GI: dyspepsia, heartburn, epigastric distress,
nausea
HEMAT: anemia hemolysis increased
bleeding time
MISC: noncardiogenic pulmonary edema

NURSING RESPONSIBILITIES
1. Asses pain and limitation of movement,
note type location and intensity prior to and
at the peak
2. Asses fever and note associated signs

PATIENT/FAMILY EDUCATION
1. Report tinnitus, unusual bleeding of gums,
bruising black tarry stools or fever lasting
longer than 3days.
2. Avoid concurrent use of alcohol with this
medication to minimize possible gastric
irritation.

GENERIC NAME: CHOLINE AND

MAGNESIUM SALICYLATES
TRICOSAL

DOSAGE AND FREQUENCY

ADULT
PO: 2-3g/day in 2-3 divided
doses
CHILDREN

89
PO (>37kg) 2.2g of salicylate/day in 2 divided
doses
PO(<37kg) 50mg of salicylate/day in 2 divided
doses.

MECHANISMI OF ACTION
produce analgesia and reduce inflammation
and fever by inhibiting the production of
prostaglandins.
INDICATION
management of inflammatory disorders
including: rheumatoid arthritis,
osteoarthritis. Treatment of mild to
moderate pain, fever.

CONTRAINDICATIONS
hypersensitivity to aspirin, tartarazine or
other salicylates.

SIDE EFFECTS/ADVERSE EFFECTS

EENT: tinnitus, hearing loss
GI: dyspepsia, heartburn, epigastric distress,
nausea
MISC: noncardiogenic pulmonary edema
NURSING RESPONSIBILITIES
1. Asses pain and limitation of movement,
note type location and intensity prior to and
at the peak
2. Asses fever and note associated signs

PATIENT/FAMILY EDUCATION

90
1. Report tinnitus, unusual bleeding of gums,
bruising black tarry stools or fever lasting
longer than 3days.
2. Avoid concurrent use of alcohol with this
medication to minimize possible gastric
irritation

DRUG CLASSIFICATION:
ANTIHISTAMINE

GENERIC NAME: AZELASTINE

BRAND NAME:ASTELLIN

DOSAGES AND FREQUENCY

ADULT
2 sprays per nostril twice a day
PEDIATRIC
1 spray in each nostril twice a day

MECHANISM OF ACTION
Used to relieve nasal symptoms such as
runny nose, sneezing, and post-nasal drip
caused by allergies or otherconditions.

INDICATIONS
Azelastine HCI Nasal Solution, 0.15% is
indicated for the relief of symptoms of
seasonal and perennial allergic rhinitis.

CONTRAINDICATIONS

91
Hypersensitivity

SIDE EFFECTS
Bitter taste in your mouth, drowsiness, a
burning feeling inside the nose, sneezing fits,
cough, nose bleeds, runny nose, nausea, dry
mouth, headache, weigh gain, muscle aches,
red eyes

ADVERSE REACTIONS
CNS: drowsiness, dizziness, dysesthesia,
fatigue, headache
EENT: epistaxis, nasal burning, pharyngitis,
sinusitis, sneezing
GI: bitter taste, dry mouth, nausea
METAB: weight gain
MS: myalgia
NURSING RESPONSIBILITIES
● Assess allergy symptoms (rhinitis, sneezing,
conjunctivitis, hives)
Patient and Family Education
● Instruct patient in the proper technique for
administration of azelastine.
●May cause drowsiness. Caution patient to
avoid driving or other activities requiring
alertness until effects of the medication are
known.
● Alcohol or other central depressants should
be avoided.
● Keep spray out of eyes. NURSING
RESPONSIBILITIES

92
● Assess allergy symptoms (rhinitis,
conjunctivitis, hives) before and periodically
during therapy.
● Assess lung sounds and character of
bronchial secretions. Maintain fluid intake of
1500-2000 ml/day to decrease viscosity of
secretions.

Patient and Family Education

● Instruct patient to take medication as
directed
● May cause drowsiness. Caution patient to
avoid driving or other activities requiring
alertness until effects of the medication are
known.
● Advice patient to avoid taking alcohol

GENERIC NAME:CETIRIZINE
BRAND NAME:ZYRTEC

DOSAGES AND FREQUENCY

ADULT
PO 5-10 mg once daily
PEDIATRIC
(2-5 yr) PO: 2.5 mg once daily;
may be ↑ to 5 mg once daily or
2.5 mg every 12 hr (1-2 yr)
PO: 2.5 mg once daily;may be

93
↑ to 2.5 mg every 12 hr(6-12 mo) PO: 2.5
once daily

MECHANISM OF ACTION
Antagonizes the effects of histamine at H1-
receptor sites; does not bind to or inactivate
histamine.

INDICATIONS
Relief of allergic symptoms caused by
histamine release including; Seasonal and
perennial allergic rhinitis, Chronic urticaria

CONTRAINDICATIONS
Hypersensitivity to cetirizine, hydroxyzine or
any component.
SIDE EFFECTS
Drowsiness, dry mouth, blurred vision and
over heating

ADVERSE REACTIONS
CNS: dizziness, drowsiness (significant with
doses >10 mg/day), fatigue
EENT: pharyngitis
GI: dry mouth

NURSING RESPONSIBILITIES
● Assess allergy symptoms (rhinitis,
conjunctivitis, hives) before and periodically
during therapy.
● Assess lung sounds and character of
bronchial secretions. Maintain fluid intake of

94
1500-2000 ml/day to decrease viscosity of
secretions.

Patient and Family Education

● Instruct patient to take medication as
directed
● May cause drowsiness. Caution patient to
avoid driving or other activities requiring
alertness until effects of the medication are
known.
● Advice patient to avoid taking alcohol

GENERIC NAME:LORATADINE
BRAND NAME:CLARITIN

DOSAGES AND FREQUENCY

ADULT
PO: 10 mg daily
PEDRIATRIC
(≥2-5 yr) PO: 5 mg once daily

ADVERSE REACTIONS
CNS: confusion, drowsiness (rare),
paradoxical excitation
EENT: blurred vision
GI: dry mouth, GI upset
DERM: photosensitivity, rash
METAB: weight gain

MECHANISM OF ACTION

95
Blocks peripheral effects of histamine
released during allergic reactions. Decreased
symptoms of allergic reactions (nasal
stuffiness; red, swollen eyes, itching)
INDICATIONS
Relief of symptoms of seasonal
allergies.Management of chronic idiopathic
urticaria.Management of hives.

CONTRAINDICATIONS
Hypersensitivity

SIDE EFFECTS
Sleepiness, tiredness, stomach pain,
headache, dry eyes, mouth & throat.diarrhea

NURSING RESPONSIBILITIES
● Assess allergy symptoms (rhinitis,
conjunctivitis, hives) before and periodically
during therapy.
● Asses lung sounds and character bronchial
secretion. Maintain fluid intake of 1500-2000
mL/day.

Patient and Family Education

● Instruct patient to take medication as
directed.
● May cause dizziness or drowsiness. Caution
patient to avoid drinking or other activities
requiring alertness

96
● Caution patient to use sunscreen and
protective clothing to prevent
photosensitivity

DRUG CLASSIFICATION:
ANTICOAGULANT

GENERIC NAME:RIVAROXABAN
BRAND NAME:XARELTO

DOSAGES AND FREQUENCY

ADULT:10 mg once daily, initiated 6– 10 hr
post- operatively (when hemostasis is
achieved continued for 35 days after hip
replacement or 12 days after knee
replacement.

MECHANISM OF ACTION
Acts as selective factor X inhibitor that
blocks the active site of factor Xa,

97
inactivating the cascade of coagulation.
Therapeutic Effects: Prevention of blood
clots and subsequent pulmonary emboli
following knee/hip replacement surgery.

INDICATIONS
Prevention of deep vein thrombosis that may
lead to pulmonary embolism following knee
or hip replacement surgery.Reduction in risk
of stroke/systemic embolism in patients
withnonvalvular atrial fibrillation.

CONTRAINDICATIONS
Hypersensitivity; Active major bleeding;
Severe renal impairment [CCr 30 mL/min
(deep vein thrombosis/pulmonary embolism
treatmentor prevention). Severe hepatic
impairment or any liver pathology.
SIDE EFFECTS/ADVERSE REACTIONS
CNS: syncope. Derm: blister, prutitus.
Hemat: BLEEDING. Local: wound secretion.
MS:extremity pain, muscle spasm.
NURSING RESPONSIBILITIES
Assess for signs of bleeding and
hemorrhage(bleeding gums; nosebleed;
unusual bruising;black, tarry stools;
hematuria; fall in hematocritor BP; guaiac-
positive stools); bleeding from surgical site.
Notify health care professional if these occur.

Patient and Family Education

Advise patient to report any symptoms of

98
unusual bleeding or bruising (bleeding gums;
nosebleed; black, tarry stools; hematuria;
excessive menstrual flow) and symptoms of
spinal or epidural hematoma (tingling;
numbness, especially in lower extremities;
muscular weakness) to health care
professional immediately.

GENERIC NAME:DABIGATRAN
BRAND NAME:PRADAXA

DOSAGES AND FREQUENCY

ADULT:150 mg twice daily

MECHANISM OF ACTION
Acts as a direct inhibitor of
thrombin.Therapeutic Effects:
Lowered risk ofthromboticsequelae
(stroke and systemicembolization)
of non-valvular atrial fibrillation.

INDICATIONS
To reduce the risk of stroke/systemic
embolization associated with non-
valvularatrial fibrillation.
CONTRAINDICATIONS
Hypersensitivity; Active pathological
bleeding; Concurrent use of P— glycoprotein
(P-gp) inducers; Prosthetic heart valves
(mechanical or bioprosthetic).

99
SIDE EFFECTS/ADVERSE REACTIONS
GI: abdominal pain, diarrhea, dyspepsia,
gastritis, nausea.
Hemat: BLEEDING,
thrombocytopenia.
Misc: ANGIOEDEMA, hypersensitivity
reactions including ANAPHYLAXIS.

NURSING RESPONSIBILITIES
• Assess for symptoms of stroke or
peripheral vascular disease periodically
during therapy.
• Monitor renal function prior to and
periodically during therapy. Patients with
renal impairment may require dose reduction
or discontinuation.
Patient and Family Education
Instruct patient to take dabigatran as
directed. Take missed doses as soon as
remembered within 6 hrs. If 6hrs. until next
dose, skip dose and take next dose when
scheduled; do not double doses. Do not
discontinuewithout consulting health care
professional.

If temporarily discontinued,
restart as soon as possible. Store
dabigatranat room temperature. After
opening bottle, use within 4 mo; discard
unused dabigatranafter 4 mo.

GENERIC NAME:ENOXAPARIN

100
BRAND NAME:LOVENOX

DOSAGES AND FREQUENCY

NURSING RESPONSIBILITIES
• Assess for signs of
bleeding andhemorrhage
(bleeding gums; nosebleed;
unusual bruising; black, tarry
stools; hematuria; fall in
haematocritor BP;guaiac-positive stools);
bleeding from surgical site. Notify health care
professional if these occur.
• Monitor patient for hypersensitivity
reactions (chills, fever, urticaria). Report signs
to health care professional
Patient and Family Education
• Advise patient to report any
symptoms of unusual bleeding or bruising,
dizziness, itching, rash, fever, swelling, or
difficulty breathing to health care
professional
immediately.
• Instruct patient not to take aspirin,
naproxen, or ibuprofen without
consulting health care professional
while on enoxaparin therapy.

ADULT:Knee replacement surgery—30 mg q

12 hr starting 12– 24 hr after surgery for 7–
10 days; Hip replacement—30 mg q
12 hr starting 12– 24 hr postop or 40 mg
once daily starting 12 hr before surgery
Abdominal surgery—40 mg once daily

101
starting 2 hr before surgery and then
continued for 7– 12 days or until ambulatory
(up to 14 days);

MECHANISM OF ACTION
Potentiates the inhibitory effect of
antithrombin on factor Xa and thrombin
INDICATIONS
Prevention of venous thromboembolism
(VTE) (deep vein thrombosis (DVT) and/or
pulmonary embolism (PE)) in surgical or
medical patients.Treatment of DVT with or
without PE (with warfarin). Prevention of
ischemic complications (with aspirin)
fromstable angina and non-ST-segment-
elevation MI. Treatment of acute ST-
segment-elevation MI (with thrombolyticsor
percutaneous coronary intervention).

CONTRAINDICATIONS
Hypersensitivity ; Hypersensitivity to
benzyl alcohol (multidose vial); Positive in
vitro test for antiplatelet antibody in the
presence of enoxaparin; Active, major
bleeding.

SIDE EFFECTS/ADVERSE REACTIONS

CNS: dizziness, headache, insomnia.
CV:edema. GI:constipation,qliver enzymes,
nausea, vomiting. GU: urinary retention.
Derm: alopecia, ecchymoses, pruritus,
rash, urticaria. F and E: hyperkalemia.
Hemat: bleeding, anemia, eosinophilia,

102
thrombocytopenia. Local: erythema at
injection site, hematoma, irritation, pain.
MS: osteoporosis.Misc: fever.

DRUG CLASSIFICATION:
ANTIHYPERTENSIVES

GENERIC NAME:BENAZEPRIL
HYDROCHLORIDE
BRAND NAME:LOTENSIN

DOSAGES AND FREQUENCY

Use extreme caution if patient has
family history of angioedema.
● When giving concurrently with
diuretics, know that drug may cause
excessive hypotension. If possible, stop
diuretic therapy 2 to 3 days before starting
benazepril.
● Give with or without food.
● Know that drug may be used alone or in
conjunction with other

MECHANISM OF ACTION
Benazeprilat has much greater ACE inhibitory
activity than does benazepril. ACE is a
peptidyldipeptidase that catalyzes the

103
conversion of angiotensin I to the
vasoconstrictor substance, angiotensin II..

INDICATIONS
Lotensin® is indicated for the treatment of
hypertension, to lower blood pressure.
Lowering blood pressure reduces the risk of
fatal and nonfatal cardiovascular events,
primarily strokes and myocardial infarctions.

CONTRAINDICATIONS
● Hypersensitivity to drug or to other ACE
inhibitors ● Angioedema with or without
previous ACE inhibitor treatment
ADVERSE REACTIONS
CNS: dizziness, drowsiness, fatigue, syncope,
light-headedness, headache,insomnia CV:
angina pectoris, hypotension,tachycardia
EENT: sinusitis GI: diarrhea, nausea, anorexia
GU: proteinuria, erectile
dysfunction,decreasedlibido,renal failure
Hematologic: agranulocytosis Metabolic:
hyperkalemia
Respiratory: cough, dyspnea, bronchitis,
asthma, eosinophilic pneumonitis Skin: rash,
angioedema Other: fever, altered taste

NURSING RESPONSIBILITIES
Monitor for signs and symptoms of
angioedema, including laryngeal edema and
shock. ● Measure blood pressure regularly

104
Monitor CBC, electrolyte levels, kidney and
liver function test results, and urinary protein
level.

PATIENT AND FAMILY EDUCATION

Tell patient to immediately report change in
urination pattern, difficulty breathing, or
swelling of throat or lips. ● Instruct patient to
record blood pressure at various intervals
daily. ● Tell patient to report dizziness,
fainting, or light-headedness during initial
therapy. ● Advise patient to increase fluid
intake during exercise and in hot weather.

GENERIC NAME:AMLODIPINE BESYLATE

BRAND NAME: NORVASC

DOSAGES AND FREQUENCY

➣ Essential hypertension, chronic stable
angina pectoris, and vasospastic angina
(Prinzmetal’s angina) Adults: 5 to 10 mg P.O.
once daily Dosage adjustment ● Hepatic
impairment ● Elderly patients Off-label uses
● Pulmonary hypertension ● Raynaud’s
disease

105
MECHANISM OF ACTION
Inhibits influx of extracellular calcium ions,
thereby decreasing myocardial contractility,
relaxing coronary and vascular muscles, and
decreasing peripheral resistance

INDICATIONS
NORVASC® is indicated for the treatment of
hypertension, to lower blood pressure.
Lowering blood pressure reduces the risk of
fatal and nonfatal cardiovascular events,
primarily strokes and myocardial infarctions.
CONTRAINDICATIONS
● Hypersensitivity to drug, Precautions Use
cautiously in: ● aortic stenosis, severe
hepatic impairment, heart failure ● elderly
patients ● pregnant or breastfeeding
patients ● children.

ADVERSE REACTIONS
CNS: headache, dizziness, drowsiness,
light-headedness, fatigue, weakness,lethargy
CV: peripheral edema, angina, bradycardia,
hypotension, palpitations GI: nausea,
abdominal discomfort CNS: headache,
dizziness, drowsiness,
light-headedness, fatigue, weakness,lethargy
CV: peripheral edema, angina, bradycardia,
hypotension, palpitations GI: nausea,
abdominal discomfort Musculoskeletal:
muscle cramps, muscle pain or inflammation
Respiratory: shortness of breath, dyspnea,

106
wheezing Skin: rash, pruritus, urticaria,
flushing

NURSING RESPONSIBILITIES
Monitor patient for worsening angina. ●
Monitor heart rate and rhythm and blood
pressure, especially at start of therapy.
Assess for heart failure; report signs and
symptoms (peripheral edema, dyspnea) to
prescriber promptly. Give sublingual
nitroglycerin, as prescribed, if patient has
signs or symptoms of acute myocardial
infarction(especially when dosage is
increased).

PATIENT AND FAMILY EDUCATION

● If patient also uses sublingual nitroglycerin,
tell him he can take nitroglycerinas needed
for acute angina.
● Caution patient to avoid driving and other
hazardous activities until he knows how drug
affect concentration and alertness.

GENERIC NAME:BOSENTAN
BRAND NAME:TRACLEER

DOSAGES AND FREQUENCY

● Give tablets in morning and
evening,with or without food.
● Consider gradual dosage
reduction when discontinuing drug. Route
Onset Peak Duration

107
P.O. Variable 3-5 hr Unknown
MECHANISM OF ACTION
Binds to and blocks receptor sites
forendothelin A and B in endothelium and
vascular smooth muscle. This action reduces
elevated endothelin levels in patients with
pulmonary arterial hypertension, and inhibits
vasoconstriction resulting from endothelin-1
(ET-1). blood pressure. Lowering blood
pressure reduces the risk of fatal and
nonfatal cardiovascular events, primarily
strokes and myocardial infarctions.

CONTRAINDICATIONS
● Hypersensitivity to drug, Precautions Use
cautiously in: ● aortic stenosis, severe
hepatic impairment, heart failure ● elderly
patients ● pregnant or breastfeeding
patients ● children.

INDICATIONS
Drug-drug. Cyclosporine: decreased
cyclosporine blood level, increased bosentan
blood level CYP2C9 inhibitors (such as
amiodarone, fluconazole), moderate CYP3A
inhibitors (such as amprenavir, diltiazem,
erythromycin, fluconazole), strong CYP3A
inhibitors (such as
itraconazole,ketoconazole): largely increased
bosentan plasma concentration
Drugs metabolized by CYP2C9 and CYP3A:
decreased plasma concentrations of these
drugs

108
Glyburide: decreased blood levels of both
drugs, increased risk of hepatic damage
Hormonal contraceptives: decreased
bosentan efficacy
Lopinavir/ritonavir
combination:increasedbosentan trough
concentration

ADVERSE REACTIONS
Adverse reactions CNS: headache, fatigue CV:
edema, hypotension, palpitations EENT:
nasopharyngitis GI: dyspepsia Hepatic:
hepatic dysfunction, hepatic injury,
hepatotoxicity Skin: pruritus, flushing

NURSING RESPONSIBILITIES
● Assess serum transaminase levels within
first 3 days of therapy and then monthly. ●
Evaluate hemoglobin level 1 month after
therapy and then every 3 months. 2If signs of
pulmonary edema occur, consider the
possibility of underlying pulmonary veno-
occlusive disease and discontinue treatment
if necessary. ● Assess female patient for
pregnancy every month during therapy.

PATIENT AN DFAMILY EDUCATION

● Tell patient to take drug with or without
food in morning and evening. ● Caution
female patient to avoidpregnancy, and
discuss reliable contraceptive methods.
Instruct her to contact prescriber
immediately if she thinks she may be

109
pregnant. ● Because of the potential for
adverseeffects in the breastfeeding infant, a
decision should be made to discontinue
breastfeeding or discontinue drug, taking into
account the importance of drug to the
mother. ● Inform patient that he’ll undergo
CBC measurement and liver function testing
regularly during therapy.

DRUG CLASSIFICATION:
ANTIBIOTICS

GENERIC NAME: CEFDINIR

BRAND NAME: OMNICEF

DOSAGES AND FREQUENCY

PO: adults and elderly: 300mgfor
q12h or 600mg once daily.
Children 6mos.To 12 years:7mg/kg
once daily. Max 600mg/day

MECHANISM OF ACTION
Treatment of susceptible infections due to S.
pyogenes, S. pneumoniae, H.influenzae, H.
parainfluenzae, M. catarrhalis, including
community-acquiredpneumonia, acute
exacerbation of chronic bronchitis, acute
maxillary sinusitis,pharyngitis, tonsillitis,
uncomplicated skin or skin structure
infections, otitis media
INDICATIONS

110
Treatment of the following infections caused
by susceptible organisms: Community-
acquired pneumonia (adults only); acute
exacerbations of chronic bronchitis (adults
only); Acute maxillary sinusitis (adults only);
Pharyngitis and tonsillitis; Uncomplicated skin
and skin structure infections; Acute bacterial
otitis media (children only)

CONTRAINDICATIONS
Hypersensitivity to cefdinir.History of
anaphylacticreaction to cephalosporins.
Cautions: Hypersensitivity to penicillins;
renalimpairment

SIDE EFFECTS
Frequent: oral candidiasis, milddiarhhea and
mild abdomen cramping, vaginal candidiasis.
Occasional: nausea, serum sickness,
Rare: allergic reaction.

ADVERSE REACTIONS
Colitis, other superinfections,
nephrotoxic,penicillin allergy, hypersensitivity
reaction.
NURSING RESPONSIBILITIES
Baseline Assessment:
Obtain CBC, renal function tests.
Question for hypersensitivity to cefdinir
Orother cephalosporins, penicillins

Intervention or Evaluation:
Observe for rash. Monitor daily pattern

111
of bowel activity, stool consistency. Mild
GI effects may be tolerable (increasing
severity may indicate onset of antibiotic
associated colitis). Be alert for superinfection:
fever, vomiting, diarrhea,and anal/genital
pruritus, oral mucosal changes
(ulceration,pain, and erythema).
Monitorhematology reports.

Patient and Family Education

-Take antacids 2 hrs before or
followingmedication. Continue medication
for full length of treatment; do not skip
doses.
-Doses should be evenly spaced.
-Report persistent severe diarrhea, rash,
muscle aches, fever, enlarged lymphnodes,
joint pain.

GENERIC NAME: CEFIXIME

BRAND NAME: SUPRAX

DOSAGES AND FREQUENCY

Usual dosage:
PO: adults, elderly, children 12yrs
Older weighing more than 45kgs.
400mg/day single dose or 2 in divided
doses.
Children 6mos. - 12 years weighing
45kgs or less: 8mg/kg/day as single dose.
maximum 400mg

MECHANISM OF ACTION

112
Treatment of susceptible infections due to S.
pneumoniae, S. pyogenes, M. catarrhalis,
H. influenzae, E. coli, mirabilis, including otitis
media, acutebronchitis, acute exacerbations
of
chronic bronchitis, pharyngitis, tonsillitis,
uncomplicated UTI
INDICATIONS
SUPRAX is indicated in the treatment of
adults and pediatric patients six months of
age or older with uncomplicated urinary tract
infections caused by susceptible isolates of
Escherichia coli and Proteus mirabilis.

CONTRAINDICATIONS
History of hypersensitivity/anaphylactic
reaction tocefixime, cephalosporins.
Cautions: History of penicillin allergy,
renalimpairment.
SIDE EFFECTS
Frequent: Oral candidiasis, mild diarrhea
Mild abdominal cramp, vaginal candidiasis,
Occasional: nausea, serum sickness,
Rare: Allergic reactions.

ADVERSE REACTIONS
Colitis, superinfections,
nephrotoxicity,Penicillin allergy,
hypersensitivity reaction.

NURSING RESPONSIBILITIES
Baseline Assessment:

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Obtain CBC, renal function tests. Question for
hypersensitivity to cefixime orother
cephalosporins, penicillins.

Intervention/ EvaluationsAssess oral cavity

for white patches on mucous membranes
tongue (thrush). Monitor daily pattern of
bowel activity stool consistency. Mild GI
effects may be tolerable (increasing severity
may indicate onset of antibiotic-associated
colitis).Monitor renal function testsfor
evidence of nephrotoxicity. Be alertforsuper
infection: fever, vomiting,diarrhea, and
anal/genital pruritus, oral. Mucosalchanges
(ulceration, pain, and erythema)

Patient and Family Education

-continue medication for full treatm.
-doses should be evenly spaced
-may cause GI upset
-report persistent diarrhea.

GENERIC NAME: CEFADROXIL

BRAND NAME: APO- CEFADROXIL

DOSAGES AND FREQUENCY

Usual Dosage
PO: ADULTS, ELDERLY: 1–2 g/day as
single dose. or in 2 divided doses.
CHILDREN: 30 mg/kg/day in 2 divided
doses. Maximum: 2 g/day

114
MECHANISM OF ACTION
Treatment of susceptible infections due to
group A streptococci,
staphylococci,S.pneumoniae, H. influenzae,
Klebsiella spp. E coli, P. mirabilis, including
impetigo pharyngitis/tonsillitis, skin/skin
structure, UTI

INDICATIONS
Treatment of the following infections due to
susceptible organisms: Skin and skin
structure infections (including burn wounds),
Pharyngitis and/or tonsillitis, Urinary tract
infections. Not suitable for the treatment of
meningitis.

CONTRAINDICATIONS
History of hypersensitivity/anaphylactic
reaction tocefadroxil, cephalosporins.
Cautions: Severe renal impairment, history
ofpenicillin allergy. History of GI disease
(colitis)
SIDE EFFECTS
Side Effects:
Frequent: oral candidiasis, mild diarrheamild
abdominal cramping, vaginal candidiasis,
Occasional: nausea, unusual bleeding,Serum
sickness.
rare:Allergic reaction.

ADVERSE REACTIONS

115
Colitis, other superinfections,
nephrotoxicpenicillin Allergy that can result
Hypersensitiviy.

NURSING RESPONSIBILITIES
Baseline assessment
Obtain CBC, renal function tests. Questionfor
history of allergies,
particularlycephalosporins, penicillins

Intervention/Evaluation
Assess oral cavity for white patches on
mucous membranes, tongue (thrush).
Monitor daily pattern of bowel activity,stool
consistency. Mild GI effects maybe tolerable
(increasing severity may indicate onset of
antibiotic-associatedcolitis).
Monitor I&O, renal function testsfor
nephrotoxicity. Be alert for
superinfection: fever, vomiting,
diarrhea,anal/genital pruritus, oral
mucosalchanges (ulceration, pain, erythema)

Patient and Family Education

Patient/family teaching
-Continue therapy for full length of
treatment.
-Doses should be evenly spaced.
-May cause GI upset (may take with food,
milk).
-Refrigerate oral suspension.
- Report persistent diarrhea

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DRUG CLASSIFICATION:

SEDATIVES

GENERIC NAME: BENZODIAZEPINE

BRAND NAME: MIDAZOLAM

DOSAGE AND FREQUENCY

Adult – P.O 2mg/mL
IV 1mg/mL or 5mg/mL
IM 70-80 mcg/kg (dose range ~5 mg)
30-60 minutes before surgery (reduce 50%
for chronically ill or geriatric patients)
IV • Initial: Usually 0.5-1 mg given over 2
minutes (not to exceed 2.5 mg/dose); wait 2-
3 minutes to evaluate sedative effect after
each dose adjustment; total dose >5 mg
usually not necessary to reach desired
sedation; use 30% less midazolam if patient
premedicated with narcotics or other CNS
depressants
• Debilitated or chronically ill patients:
1.5 mg IV initially; may repeat with 1
mg/dose IV q2-3 min PRN; not to exceed
cumulative dose of 3.5 mg; peak effect may
be delayed in elderly, so increments should
be smaller and rate of injection slower
• Maintenance: 25% of initial effective
dose PRN by slow titration; reduce 30% if
premedicated with opiate (50% in
elderly/chronically ill)

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PEDIATRICS –
syrup: Schedule IV
• 2mg/mL
injectable solution: Schedule IV
• 1mg/mL
• 5mg/mL
Sedation
500-750 mcg/kg PO once diluted by juice 20-
30 minutes prior to procedure; not to exceed
20 mg
100-150 mcg/kg IM; up to 500 mcg/kg used;
not to exceed 10 mg
IV
• <6 months: Initial, 50 mcg/kg IV over
2-3 minutes; titrate with small increments to
clinical effect; monitor closely
• 6 months-6 years: Initial, 50-100
mcg/kg IV over 2-3 minutes; repeat q2-3min
PRN; may require up to 600 mcg/kg total
dose; not to exceed 6 mg total dose
• 6-12 years: Initial, 25-50 mcg/kg IV
over 2-3 minutes; repeat q2-3min PRN; may
require up to 400 mcg/kg; not to exceed 10
mg total dose

MECHANISIM OF ACTION
Midazolam is a relatively short-acting
benzodiazepine central nervous system (CNS)
depressant. Benzodiazepines are believed to
increase the activity of GABA, thereby
calming the patient, relaxing skeletal
muscles, and, in high doses, producing sleep.
Although the exact mechanisms of the

118
actions of benzodiazepines have not been
completely established, it has been
postulated that the actions of
benzodiazepines are mediated through the
inhibitory neurotransmitter gamma-
aminobutyric acid (GABA), which is one of the
major inhibitory neurotransmitters in the
brain. Benzodiazepines are believed to
increase the activity of GABA, thereby
calming the patient, relaxing skeletal
muscles, and, in high doses, producing sleep.
Benzodiazepines act as agonists at
the benzodiazepine receptors, which have
been shown to form a component of the
benzodiazepine-GABA receptor-chloride
ionophore complex. Most anxiolytics appear
to act through at least one component of this
complex to enhance the inhibitory action of
GABA. Other actions of benzodiazepines,
such as sedative, anticonvulsant, and muscle
relaxant effects, may be mediated through a
similar mechanism, although different
receptor subtypes may be involved

INDICATIONS
Preoperative
sedation/anxiolysis/amnesia (IV or IM).
Sedation/anxiolysis/amnesia prior to or
during diagnostic, therapeutic or endoscopic
procedures either alone or in combination
with other CNS depressants (IV).

CONTRAINDICATIONS

119
 Benzodiazepines require special
precaution if used in the elderly, during
pregnancy, in children, in alcohol- or other
drug-dependent individuals or those with
comorbid psychiatric disorders. Additional
caution is required in critically ill patients, as
accumulation of midazolam and its active
metabolites may occur. Kidney or liver
impairments may slow down the elimination
of midazolam leading to prolonged and
enhanced effects. Contraindications include
hypersensitivity, acute narrow-angle
glaucoma, shock, hypotension, or head
injury. Most are relative contraindications.

ADVERSE EFFECTS
• headache,
• nausea,
• vomiting
• cough,
• drowsiness,
• hiccups
• over-sedation
• injection site reactions (pain,
swelling, redness, stiffness, blood clots, and
tenderness).

NURSING RESPONSIBILITIES
1. Before administering, have oxygen
and resuscitation equipment available in case
of severe respiratory depression.
2. Monitor and record patient response
to medication.

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3. Observe site closely for
extravasation.
4. Monitor for adverse reactions.
5. Continuous cardiorespiratory
monitoring.
6. Monitor BP and oxygen saturation.
7. Assess sedated infant for signs of
pain (midazolam does not possess analgesic
properties).

PATIENT AND FAMILY EDUCATION

Adult and Pediatrics
Intravenous midazolam has been associated
with respiratory depression and respiratory
arrest, especially when used for sedation in
noncritical care settings. In some cases,
where this was not recognized promptly and
treated effectively, death or hypoxic
encephalopathy has resulted. Intravenous
midazolam should be used only in hospital or
ambulatory care settings, including
physicians' and dental offices, that provide
for continuous monitoring of respiratory and
cardiac function, ie, pulse oximetry.
Immediate availability of resuscitative drugs
and age- and size-appropriate equipment for
bag/valve/mask ventilation and intubation,
and personnel trained in their use and skilled
in airway management should be assured
(see WARNINGS). For deeply sedated
pediatric patients, a dedicated individual,
other than the practitioner performing the

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procedure, should monitor the patient
throughout the procedure.
Neonates
Midazolam should not be administered by
rapid injection in the neonatal population.
Severe hypotension and seizures have been
reported following rapid IV administration,
particularly with concomitant use of fentanyl.

GENERIC NAME: ALPRAZOLAM

BRAND NAME: XANAX

DOSAGE AND FREQUENCY

Treatment may be initiated with a
dose of 0.5 mg three times daily. Depending
on the response, the dose may be increased
at intervals of 3 to 4 days in increments of no
more than 1 mg per day. Slower titration to
the dose levels greater than 4 mg/day may be
advisable to allow full expression of the
pharmacodynamic effect of XANAX. To lessen
the possibility of interdose symptoms, the
times of administration should be distributed
as evenly as possible throughout the waking
hours, that is, on a three or four times per
day schedule. Generally, therapy should be
initiated at a low dose to minimize the risk of
adverse responses in patients especially

122
sensitive to the drug. Dose should be
advanced until an acceptable therapeutic
response (ie, a substantial reduction in or
total elimination of panic attacks) is achieved,
intolerance occurs, or the maximum
recommended dose is attained. In all
patients, dosage should be reduced gradually
when discontinuing therapy or when
decreasing the daily dosage. Although there
are no systematically collected data to
support a specific discontinuation schedule, it
is suggested that the daily dosage be
decreased by no more than 0.5 mg every 3
days. Some patients may require an even
slower dosage reduction.

MECHANISM OF ACTION
The exact mechanism of action of alprazolam
is unknown. Benzodiazepines bind to gamma
aminobutyric acid (GABA) receptors in the
brain and enhance GABA-mediated synaptic
inhibition; such actions may be responsible
for the efficacy of alprazolam in anxiety
disorder and panic disorder.

INDICATION
XANAX Tablets (alprazolam) are indicated for
the management of anxiety disorder (a
condition corresponding most closely to the
APA Diagnostic and Statistical Manual [DSM-
IIIR] diagnosis of generalized anxiety
disorder) or the short-term relief of
symptoms of anxiety. Anxiety or tension

123
associated with the stress of everyday life
usually does not require treatment with an
anxiolytic.
XANAX is also indicated for the treatment of
panic disorder, with or without agoraphobia.
Studies supporting this claim were conducted
in patients whose diagnoses corresponded
closely to the DSM-III-R/IV criteria for panic
disorder.

CONTRAINDICATION
• Benzodiazepine hypersensitivity
• Abrupt discontinuation,
benzodiazepine dependence, seizure
disorder, seizures, status epilepticus,
substance abuse. ...
• Anxiety. ...
• Bipolar disorder, depression, mania,
psychosis, suicidal ideation.
ADVERSE EFFECTS
Commonly reported side effects of
alprazolam include: ataxia, cognitive
dysfunction, constipation, depression,
difficulty in micturition, drowsiness,
dysarthria, fatigue, headache, memory
impairment, menstrual disease, nervousness,
sedated state, skin rash, tremor, weight gain,
weight loss, anxiety, blurred vision, diarrhea,
insomnia, decreased libido, increased
appetite, irritability, and decreased appetite.
Other side effects include: depersonalization,
hyperventilation, hypoesthesia, hypotension,
paresthesia, sexual disorder, sialorrhea,

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muscle twitching, and increased libido. See
below for a comprehensive list of adverse
effects.

NURSING RESPONSIBILITIES
Assessment
History: Hypersensitivity to
benzodiazepines; psychoses; acute narrow-
angle glaucoma; shock; coma; acute alcoholic
intoxication with depression of vital signs;
labor and delivery; lactation; impaired liver or
kidney function; debilitation
Physical: Skin color, lesions; T;
orientation, reflexes, affect, ophthalmologic
examination; P, BP; liver evaluation,
abdominal examination, bowel sounds,
normal output; CBC, LFTs, renal function tests
Interventions
Arrange to taper dosage gradually
after long-term therapy, especially in
epileptic patients.
Do not administer with grapefruit
juice.
Taper drug slowly; decrease by no
more than 0.5 mg every 3 days.

PATIENT TEACHING
Take this drug exactly as prescribed;
take extended-release form once a day in the
morning; place rapidly disintegrating tablet
on top of tongue, where it will disintegrate
and can be swallowed with saliva.

125
 Do not drink grapefruit juice while on
this drug.
Do not stop taking drug (in long-term
therapy) without consulting health care
provider; drug should not be stopped
suddenly.
Avoid alcohol, sleep-inducing, or
over-the-counter drugs.
You may experience these side
effects: Drowsiness, dizziness (these effects
will be less pronounced after a few days,
avoid driving a car or engaging in other
dangerous activities if these occur); GI upset
(take drug with food); fatigue; depression;
dreams; crying; nervousness.
Report severe dizziness, weakness,
drowsiness that persists, rash or skin lesions,
difficulty voiding, palpitations, swelling in the
extremities.

GENERIC NAME: DIAZEPAM

BRAND NAME: VALIUM

DOSAGE AND FREQUENCY

Adult and pediatric
tablet: Schedule IV
• 2mg
• 5mg
• 10mg
oral solution: Schedule IV

126
• 1mg/1mL
• 5mg/mL
rectal gel: Schedule IV
• 2.5mg
• 10mg
• 20mg
injectable solution: Schedule IV
• 5mg/mL
intramuscular device: Schedule IV
• 5mg/mL
Sedative/Muscle Relaxant
Potentially toxic dose in patients <6 years:
>0.5 mg/kg
<6 months: Not recommended
>12 years
• 0.12-0.8 mg/kg/day PO divided q6-
8hr, OR
• 0.04-0.2 mg/kg IV/IM q2-4hr; no
more than 0.6 mg/kg within 8 hours

MECHANISIM OF ACTION

Benzodiazepines exert their effects by

facilitating the activity of GABA at various
sites. Specifically, benzodiazepines bind at an
allosteric site at the interface between the
alpha and gamma subunits on GABA-A
receptor chloride ion channels. The allosteric
binding of diazepam at the GABA-A receptor
leads to an increase in the frequency at which
the chloride channel opens, leading to an
increased conductance of chloride ions. This
shift in charge leads to a hyperpolarization of

127
the neuronal membrane and reduced
excitability of the neuron.

INDICATIONS
Valium is indicated for the management of
anxiety disorders or for the shortterm relief
of the symptoms of anxiety. Anxiety or
tension associated with the stress of
everyday life usually does not require
treatment with an anxiolytic. In acute alcohol
withdrawal, Valium may be useful in the
symptomatic relief of acute agitation, tremor,
impending or acute delirium tremens and
hallucinosis.
Valium is a useful adjunct for the relief of
skeletal muscle spasm due to reflex spasm to
local pathology (such as inflammation of the
muscles or joints, or secondary to trauma),
spasticity caused by upper motor neuron
disorders (such as cerebral palsy and
paraplegia), athetosis, and stiff-man
syndrome.
Oral Valium may be used adjunctively in
convulsive disorders, although it has not
proved useful as the sole therapy.
The effectiveness of Valium in long-term use,
that is, more than 4 months, has not been
assessed by systematic clinical studies. The
physician should periodically reassess the
usefulness of the drug for the individual
patient.

CONTRAINDICATIONS

128
Contraindications to diazepam include
patients with a known hypersensitivity to
diazepam and, due to a lack of sufficient
clinical evidence, diazepam is also
contraindicated in patients under 6 months
of age. Other contraindications to diazepam
include patients with severe respiratory
insufficiency, myasthenia gravis, sleep apnea
syndrome, and severe hepatic insufficiency. It
is permissible in patients with open-angle
glaucoma who are receiving appropriate
therapy but is contraindicated in acute
narrow-angle glaucoma.
ADVERSE EFFECTS
Like most benzodiazepines, the adverse
reactions of diazepam include CNS and
respiratory depression, dependence, and
benzodiazepine withdrawal syndrome.
Serious adverse effects of diazepam include:
• Respiratory depression
• Seizures
• Suicidality
• Dependency and abuse
• Withdrawal symptoms
• Cardiovascular collapse
• Bradycardia
• Hypotension
• Syncope
• Paradoxical CNS stimulation
Common adverse effects of diazepam
include:
• Sedation
• Fatigue

129
• Confusion
• Anterograde amnesia
• Depression
• Ataxia
• Irritability
• Disinhibition
• Local injection site reaction
• Headache
• Tremor
• Dystonia
• Urinary retention
• Incontinence
• Nausea
• Constipation
• Diplopia
• Libido changes
• Rash
• Menstrual irregularities
• ALT and/or AST elevation

NURSING RESPONSIBILITIES
-Assess baseline vital signs.
- Assess blood pressure, pulse and respiration
if IV administration.
- Provide frequent sips of water for dry
mouth.
- Provide fluids and fibre for constipation.
- Evaluate therapeutic response, mental state
and physical dependency after long-term use.
Patient teaching
-Do not use for everyday stress.
- Do not use for more than four months
unless directed by a clinician.

130
- Do not take more than the prescribed dose.
- Avoid non-prescribed medications unless
approved by a clinician.
- May cause drowsiness - avoid driving or any
other activities requiring alertness.
- Avoid other psychotropic medications
unless prescribed.
- Avoid alcohol.
- Rise slowly as fainting may occur.
- Seek psychiatric help if depressed.
- Store securely.

DRUG CLASSIFICATION:
ANTI-INFLAMMATORY AGENTS

GENERIC NAME: DICLOFENAC

BRAND NAME: CATAFLAM

DOSAGE AND FREQUENCY

For dysmenorrhea: 50mg TID
For osteoarthritis: 100-150mg, 50 mg BID or
TID
For rheumatoid arthritis: 150-200 mg, 50mg
TID or QID

MECHANISM OF ACTION

131
 Cataflam (diclofenac potassium) is a
nonsteroidal anti-inflammatory drug (NSAID).
Diclofenac works by reducing substances in
the body that cause pain and inflammation.
Cataflam is used to treat mild to moderate
pain, or signs and symptoms of osteoarthritis
or rheumatoid arthritis.
Cataflam is also used to treat menstrual
cramps.
Catalfam may also be used for purposes not
listed in this medication guide

INDICATION
Cataflam (diclofenac potassium) is a
nonsteroidal anti-inflammatory drug (NSAID).
Diclofenac works by reducing substances in
the body that cause pain and inflammation.
Cataflam is used to treat mild to moderate
pain, or signs and symptoms of osteoarthritis
or rheumatoid arthritis.

CONTRAINDICATIONS
• Known hypersensitivity (e.g.,
anaphylactic reactions and serious skin
reactions) to diclofenac or any components
of the drug product (see WARNINGS;
Anaphylactic Reactions, Serious Skin
Reactions).
• History of asthma, urticaria, or
allergic-type reactions after taking aspirin or
other NSAIDs. Severe, sometimes fatal,
anaphylactic reactions to NSAIDs have been
reported in such patients (see WARNINGS;

132
Anaphylactic Reactions, Exacerbation of
Asthma Related to Aspirin Sensitivity).
• In the setting of coronary artery
bypass graft (CABG) surgery (see WARNINGS;
Cardiovascular Thrombotic Events).

ADVERSE EFFECTS
• indigestion, gas, stomach pain,
nausea, vomiting;
• diarrhea, constipation;
• headache, dizziness, drowsiness;
• stuffy nose;
• itching, increased sweating;
• increased blood pressure; or.
• swelling or pain in your arms or legs.

NURSING RESPONSIBILITIES
History: Renal impairment; impaired
hearing; allergies; hepatic, CV, and GI
conditions; lactation, pregnancy
Physical: Skin color and lesions;
orientation, reflexes, ophthalmologic and
audiometric evaluation, peripheral sensation;
P, edema; R, adventitious sounds; liver
evaluation; CBC, clotting times, renal function
tests, LFTs, serum electrolytes, stool guaiac

PATIENT TEACHING
Take drug with food or meals if GI
upset occurs.
Take only the prescribed dosage.
You may experience these side
effects: Dizziness, drowsiness (avoid driving

133
or using dangerous machinery while using
this drug).
Report sore throat, fever, rash,
itching, weight gain, swelling in ankles or
fingers, changes in vision; black, tarry stools.

GENERIC NAME: IBUPROFEN

BRAND NAME: ADVIL

DOSAGE AND FREQUENCY

12 years of age and older:
• 1 tablet/caplet/gel caplet every 4 to 6
hours while symptoms persist.
• If pain or fever does not respond to 1
tablet/caplet/gel caplet, 2 may be used.
• Do not exceed 6 tablets/caplets/gel
caplets in 24 hours unless directed by a
doctor.
Under 12 years of age:
• Ask a doctor.

134
MECHANISM OF ACTION
Ibuprofen is a non-selective inhibitor
of an enzyme called cyclooxygenase (COX),
which is required for the synthesis of
prostaglandins via the arachidonic acid
pathway. COX is needed to convert
arachidonic acid to prostaglandin H2 (PGH2)
in the body. This PGH2 is then converted to
prostaglandins.

INDICATIONS
Ibuprofen is used to relieve pain from
various conditions such as headache,
dentalpain, menstrual cramps, muscle aches,
or arthritis. It is also used to reduce feverand
to relieve minor aches and pain due to the
common cold or flu. Ibuprofen is a
nonsteroidal anti-inflammatory drug (NSAID).

CONTRAINDICATIONS
• systemic mastocytosis.
• increased risk of bleeding due to
clotting disorder.
• an increased risk of bleeding.
• alcoholism.
• high blood pressure.
• a heart attack.
• chronic heart failure.
• a stroke.

ADVERSE EFFECTS

135
• upset stomach, mild heartburn,
nausea, vomiting;
• bloating, gas, diarrhea, constipation;
• dizziness, headache, nervousness;
• mild itching or rash; or.
• ringing in your ears.

NURSING RESPONSIBILITIES
History: Allergy to ibuprofen,
salicylates or other NSAIDs; CV dysfunction,
hypertension; peptic ulceration, GI bleeding;
impaired hepatic or renal function;
pregnancy; lactation
Physical: Skin color, lesions; T;
orientation, reflexes, ophthalmologic
evaluation, audiometric evaluation,
peripheral sensation; P, BP, edema; R,
adventitious sounds; liver evaluation, bowel
sounds; CBC, clotting times, urinalysis, LFTs,
renal function tests, serum electrolytes, stool
guaiac

PATIENT TEACHING
Use drug only as suggested; avoid
overdose. Take the drug with food or after
meals if GI upset occurs. Do not exceed the
prescribed dosage.
Avoid over-the-counter drugs. Many
of these drugs contain similar medications,
and serious overdosage can occur.
You may experience these side
effects: Nausea, GI upset, dyspepsia (take
drug with food); diarrhea or constipation;

136
drowsiness, dizziness, vertigo, insomnia (use
caution when driving or operating dangerous
machinery).
Report sore throat, fever, rash,
itching, weight gain, swelling in ankles or
fingers, changes in vision, black or tarry
stools.

GENERIC NAME:
ACETYLSALICYLIC ACID
(ASA)
BRAND NAME:
ASPIRIN

DOSAGE AND
FREQUENCY:
Mild to moderate pain: 350-650 mg q4h,
500mg q6hFor rheumatoid
arthritis: 500mg q4h-q6h, 650mg q4h,
1000mg q4h-q6h, 950mg BID

MECHANISM OF ACTION
Aspirin is non-selective and
irreversibly inhibits both forms (but is weakly
more selective for COX-1). It does so by
acetylating the hydroxyl of a serine residue.
Normally COX produces prostaglandins, most
of which are pro-inflammatory, and
thromboxanes, which promote clotting.

INDICATIONS

137
 Aspirin is used to reduce fever and
relieve mild to moderate pain from
conditions such as muscle aches, toothaches,
common cold, and headaches. It may also be
used to reduce pain and swelling in
conditions such as arthritis. Aspirin is known
as a salicylate and a nonsteroidal anti-
inflammatory drug (NSAID).

CONTRAINDICATIONS
Aspirin is contraindicated if the risk of
bleeding is increased, such as with alcohol
use, ulcers, or other bleeding disorders.
Children and teenagers should not take
aspirin if they're experiencing chicken pox or
flu-like symptoms because it can cause a life
threatening condition called Reye's
syndrome.

ADVERSE EFFECTS
• ringing in your ears, confusion,
hallucinations, rapid breathing, seizure
(convulsions);
• severe nausea, vomiting, or stomach
pain;
• bloody or tarry stools, coughing up
blood or vomit that looks like coffee grounds;
• fever lasting longer than 3 days; or.
• swelling, or pain lasting longer than
10 days.

NURSING RESPONSIBILITIES

138
 Assess pain and/or pyrexia one hour
before or after medication. - In long-term
therapy monitor renal and liver function and
ototoxicity. - Assess other medication for
possible interactions - especially warfarin
which is a special hazard.

PATIENT TEACHING
Take extra precautions to keep this
drug out of the reach of children; this drug
can be very dangerous for children.
Use the drug only as suggested; avoid
overdose. Avoid the use of other over-the-
counter drugs while taking this drug. Many of
these drugs contain aspirin, and serious
overdose can occur.
Take the drug with food or after
meals if GI upset occurs.
Do not cut, crush, or chew sustained-
release products.
Over-the-counter aspirins are
equivalent. Price does not reflect
effectiveness.
You may experience these side
effects: Nausea, GI upset, heartburn (take
drug with food); easy bruising, gum bleeding
(related to aspirin’s effects on blood clotting).
Report ringing in the ears; dizziness,
confusion; abdominal pain; rapid or difficult
breathing; nausea, vomiting, bloody stools.

139
DRUG CLASSIFICATION:
ANTISPASMODICS

GENERIC NAME: DICYCLOMINE

BRAND NAME: BENTYL

DOSAGE AND FREQUENCY (ADULT)

P.O = 20mg q4h (initial week)
= 40mg q4h (following week)
IM = 10mg – 20mg q4h
PEDIATRIC
P.O 10mg t.i.d or q.i.d

MECHANISM OF ACTION
Anticholinergic drugs decrease the
activity of muscles in the gut and reduce
production of sweat, saliva, digestive juices,
urine, and tears. Additionally, anticholinergic
drugs help to balance the production of
dopamine, another neurotransmitter that
plays an important role in maintaining mood,

140
movement, memory, attention, problem
solving, motivation, and pleasure.

INDICATION
BENTYL® (dicyclomine hydrochloride)
is indicated for the treatment of patients with
functional bowel/irritable bowel syndrome.
The recommended initial dose is 20 mg four
times a day.

CONTRAINDICATIONS
BENTYL is contraindicated in infants
less than 6 months of age, nursing mothers
and in patients with:
• unstable cardiovascular status in
acute hemorrhage
• myasthenia gravis [see WARNINGS
AND PRECAUTIONS]
• glaucoma [see ADVERSE REACTIONS
and DRUG INTERACTIONS]
• obstructive uropathy [see WARNINGS
AND PRECAUTIONS]
• obstructive disease of the
gastrointestinal tract [see WARNINGS AND
PRECAUTIONS]
• severe ulcerative colitis [see
WARNINGS AND PRECAUTIONS]
• Sections or subsections omitted from
the full prescribing information are not listed.
• reflux esophagitis

ADVERSE EFFECTS
• Blurred vision

141
• Dry mouth
• Dry eyes
• Decreased urine production
• Decreased sweat production
• Constipation
• Memory impairment
• Delirium
• Confusion
When possible, the use of
anticholinergics should be avoided in the
elderly because anticholinergic side effects
are particularly common and problematic in
older individuals.
NURSING RESPONSIBILITIES
• Monitor for adverse effects especially
in infants. Treatment of infant colic with
dicyclomine includes some risk, especially in
infants <2 mo of age. Doubling the usual dose
of 5 mg can produce serious toxic effects.
Infants <6 wk have developed respiratory
symptoms as well as seizures, fluctuations in
heart rate, weakness, and coma within
minutes after taking syrup formulation.
Symptoms generally last 20–30 min and are
believed to be due to local irritation.
• Monitor I&O to assess for urinary
retention.
• If drug produces drowsiness and
light-headedness, supervision of ambulation
and other safety precautions are warranted.

PATIENT TEACHING

142
 This medication may impair your
thinking or reactions. Be careful if you drive
or do anything that requires you to be alert.
Drinking alcohol can increase certain side
effects of dicyclomine.
Avoid becoming overheated or dehydrated
during exercise and in hot weather.
Dicyclomine can decrease your sweating,
which can lead to heat stroke in a hot
environment.
Stop using dicyclomine and call your doctor
right away if you have serious side effects
such as confusion, hallucinations, unusual
thoughts or behavior, fast or uneven heart
rate, or if you urinate less than usual or not at
all.

GENERIC NAME: LOPERAMIDE

BRAND NAME: IMODIUM

DOSAGE AND FREQUENCY

Acute Diarrhea
Adults: The recommended initial
dose is 4mg (two capsules) followed by 2 mg
(one capsule) after each unformed stool.
Daily dose should not exceed 16mg (eight
capsules). Clinical improvement is usually
observed within 48 hours.
Children: In children 2 to 5 years of age (20 kg
or less), the non-prescription liquid
formulation (IMODIUM® A-D 1 mg/7.5 mL)
should be used; for ages 6 to 12, either

143
IMODIUM® Capsules or IMODIUM® A-D
Liquid may be used. For children 2 to 12 years
of age, the following schedule for capsules or
liquid will usually fulfill initial dosage
requirements:

MECHANISM OF ACTION
IMODIUM® (loperamide
hydrochloride) acts by slowing intestinal
motility and by affecting water and
electrolyte movement through the
bowel.Loperamide binds to the opiate
receptor in the gut wall.

INDICATIONS
IMODIUM® (loperamide
hydrochloride) is indicated for the control
and symptomatic relief of acute nonspecific
diarrhea and of chronic diarrhea associated
with inflammatory bowel disease. IMODIUM®
(loperamide hcl) is also indicated for reducing
the volume of discharge from ileostomies.

CONTRAINDICATIONS
Contraindications. Imodium is
contraindicated in patients with a known
hypersensitivity to loperamide hydrochloride
or to any of the excipients. Imodium is
contraindicated in patients with abdominal
pain in the absence of diarrhea. Imodium is
not recommended in infants below 24
months of age.

144
ADVERSE EFFECTS
Imodium Side Effects
Generic Name: loperamide
Medically reviewed by Drugs.com. Last
updated on Dec 9, 2018.
• Overview
• Side Effects
• Dosage
• Professional
• Interactions
• More
• Professional
• Managing Side Effects
For the Consumer
Applies to loperamide: oral capsule,
oral capsule liquid filled, oral liquid, oral
solution, oral suspension, oral tablet, oral
tablet chewable
Along with its needed effects,
loperamide (the active ingredient contained
in Imodium) may cause some unwanted
effects. Although not all of these side effects
may occur, if they do occur they may need
medical attention.
Check with your doctor immediately if any of
the following side effects occur while taking
loperamide:
Rare
• Bloating
• constipation
• loss of appetite
• stomach pain (severe) with nausea
and vomiting

145
Check with your doctor as soon as possible if
any of the following side effects occur while
taking loperamide:
Rare
• Skin rash
Some side effects of loperamide may occur
that usually do not need medical attention.
These side effects may go away during
treatment as your body adjusts to the
medicine. Also, your health care professional
may be able to tell you about ways to
prevent or reduce some of these side effects.
Check with your health care professional if
any of the following side effects continue or
are bothersome or if you have any questions
about them:
Rare
• Dizziness or drowsiness
• dryness of mouth

NURSING RESPONSIBILITIES
Assess fluid and electrolyte balance
and skin turgor for dehydration. PO:
Administer with clear fluids to help prevent
dehydration, which may accom- pany
diarrhea. with this medication. Instruct
patient to notify health care professional if
diarrhea persists or if fever, ab- dominal pain,
or distention occurs.
PATIENT TEACHING
Loperamide for diarrhoea Imodium.
For adults with acute diarrhoea: take two
tablets/capsules as soon as possible, then

146
take one tablet/capsule after each time you
go to the toilet with diarrhoea. Have lots of
water to drink to prevent you from becoming
dehydrated. Eat as normally as possible, as
soon as you feel able.

GENERIC NAME: PROMETHAZINE

BRAND NAME:
PHENERGAN

DOSAGE AND
FREQUENCY
tablet
• 12.5mg
• 25mg
• 50mg
suppository
• 12.5mg
• 25mg
• 50mg
injectable solution
• 25mg/mL
• 50 mg/mL
syrup
• 6.25mg/5Ml

Allergic Conditions
PO/PR: 25 mg at bedtime or 12.5 mg before
meals and at bedtime (dosage range, 6.25-
12.5 mg q8hr)

147
IV/IM: 25 mg; may be repeated in 2 hours
when necessary; switch to PO as soon as
possible
Nausea & Vomiting
PO/PR: 12.5-25 mg q4-6hr PRN
IV/IM: 12.5-25 mg q4-6hr PRN
Motion Sickness
25 mg PO/PR 30-60 minutes before
departure and q8-12hr PRN; on succeeding
travel days, 25 mg PO/PR every morning and
every evening.

MECHANISM OF ACTION
Promethazine. Mechanism of Action:
a phenothiazine (antipsychotic) derivative
with very weak dopamine receptor
antagonism, that also blocks H1 receptors. It
produces clinically useful anti-emetic and
sedative effects.

INDICATIONS
Phenergan is used to treat allergy
symptoms such as itching, runny nose,
sneezing, itchy or watery eyes, hives, and
itchy skin rashes. Phenergan also prevents
motion sickness, and treats nausea and
vomiting or pain after surgery.

CONTRAINDICATIONS
Promethazine hydrochloride tablets
are contraindicated in comatose states, and
in individuals known to be hypersensitive or

148
to have had an idiosyncratic reaction to
promethazine or to other phenothiazines.

ADVERSE EFFECTS
• drowsiness, dizziness;
• ringing in your ears;
• double vision;
• feeling nervous;
• dry mouth; or.
• tired feeling, sleep problems
(insomnia).

NURSING RESPONSIBILITIES
History: Hypersensitivity to
antihistamines or phenothiazines, severe CNS
depression, bone marrow depression,
vomiting of unknown cause, concomitant
therapy with MAOIs, lactation, lower
respiratory tract disorders, glaucoma,
prostatic hypertrophy, CV disease or
hypertension, breast cancer, thyrotoxicosis,
pregnancy, history of sleep apnea or a family
history of SIDS, child with Reye’s syndrome
Physical: Weight, T; reflexes,
orientation, IOP; P, BP, orthostatic BP; R,
adventitious sounds; bowel sounds and
normal output, liver evaluation; urinary
output, prostate size; CBC; urinalysis; LFTs,
renal and thyroid function tests

PATIENT TEACHING
Take drug exactly as prescribed.

149
 Avoid using alcohol.
Avoid driving or engaging in other
dangerous activities if dizziness, drowsiness,
or vision changes occur.
Avoid prolonged exposure to sun, or
use a sunscreen or covering garments.
Maintain fluid intake, and use
precautions against heat stroke in hot
weather.
Report sore throat, fever, unusual
bleeding or bruising, rash, weakness,
tremors, impaired vision, dark urine, pale
stools, yellowing of the skin or eyes.

DRUG CLASSIFICATION
ANTI PLATELETS

GENERIC NAME: CLOPIDOGREL

BRAND NAME: PLAVIX

DOSAGE AND FREQUENCY

Dosage Forms & Strengths
tablet
• 75mg
• 300mg
Acute Coronary Syndrome

150
Unstable angina, non-ST-segment elevation
MI (NSTEMI): 300 mg loading dose; initiating
therapy without a loading dose will delay
establishment of antiplatelet effect by
several days; following the loading dose,
administer 75 mg/day PO for up to 12
months; may administer beyond 12 months if
used in combination with aspirin (75-100
mg/day); long-term combination therapy
with aspirin, following stent placement, is
individualized depending on how a patient
tolerates long-term dual antiplatelet therapy
(DAPT), whether they have stable coronary
artery disease, and do NOT have risk factors
(eg, TIA or stroke, age >75 years, bleeding
risk, low body wt, concurrent medications)
ST-segment elevation MI (STEMI): 75 mg/day
PO in combination with aspirin 162-325
mg/day and then 81-162 mg/day
<75 years
• 300 mg loading dose followed by 75
mg for 14 days up to 12 months (if no
bleeding)
• Concomitant therapy with aspirin:
Administer in combination with aspirin 75-
325 mg qDay with or without thrombolytics
>75 years
• No loading dose
• 75 mg for 14 days up to 12 months (if
no bleeding)
Recent MI, Stroke, or Established Peripheral
Arterial Disease

151
75 mg PO qDay without a loading dose;
recommended as alternative to aspirin or
concomitantly with aspirin if patient not at
increased risk for bleeding but at high risk for
cardiovascular disease
Coronary Artery Disease
75 mg PO qDay
Cardioembolic Stroke
Prophylaxis if patient not candidate for oral
anticoagulation
75 mg/day PO
Carotid Artery Stenting (Off-label)
300 mg PO plus aspirin 81-325 mg for 1 dose
on day before carotid artery stenting (CAS),
then 75 mg/day PO plus aspirin 81-325
mg/day for at least 30 days after CAS
Alternative: 300-600 mg PO once, then 75
mg/day for 4 days before CAS in combination
with aspirin 81-325 mg/day

MECHANISM OF ACTION
Clopidogrel is an inhibitor of platelet
activation and aggregation through the
irreversible binding of its active metabolite to
the P2Y12 class of ADP receptors on
platelets.

INDICATION
To reduce the rate of MI and stroke
in patients with: non-ST-segment elevation
acute coronary syndrome (unstable
angina/non-ST-elevation MI) or acute ST-
elevation MI; history of recent MI, recent

152
stroke, or established peripheral arterial
disease; see full labeling.

CONTRAINDICATION
• increased risk of bleeding due to
clotting disorder
• an increased risk of bleeding
• bleeding from the retina
• bleeding within the skull
• thrombotic thrombocytopenic
purpura
• a type of blood disorder
• bleeding
• stomach or intestinal ulcer
• bleeding of the stomach or intestines
• recent operation
• CYP2C19 poor metabolizer
• acquired hemophilia
• CYP2C19 intermediate metabolizer
• chronic kidney disease stage 3A
(moderate)
• chronic kidney disease stage 3B
(moderate)
• chronic kidney disease stage 5
(failure)

ADVERSE EFFECTS
• headaches or dizziness.
• nausea.
• diarrhoea or constipation.
• indigestion (dyspepsia)
• stomach ache or abdominal pain.
• nosebleeds.

153
• increased bleeding (your blood taking
longer to clot – for example, when you cut
yourself), or easy bruising.

NURSING RESPONSIBILITIES
Drug Interactions: 1) increased risk
of bleeding with aspirin, NSAIDS, heparin,
enoxaparin, and other anti-clotting drugs; 2)
Omeprazole and other proton pump
inhibitors may decrease efficacy of
clopidogrel; 3) Feverfew, garlic, ginger, and
ginkgo may increase risk of bleeding.
Do not administer clopidogrel to ACS
patients if CABG is planned within 5 – 7 days.
[Controversial evidence about this warning!]
Platelet function and bleeding time
return to baseline in 7 – 10 days.
Monitor patient for signs of
thrombotic thrombocytopenic purpura (low
platelet count, neuro symptoms, renal
dysfunction, fever).
Monitor for signs and symptoms of
bleeding (urine, stool, hematoma, epistaxis,
petechiae).
May cause elevation of serum liver
enzymes–establish baseline enzymes and
bilirubin levels.

GENERIC NAME: PRASUGREL

154
BRAND NAME: EFFIENT

DOSAGE AND FREQUENCY

Dosage Forms & Strengths
tablet
• 5mg
• 10mg
Acute Coronary Syndrome
Reduction of thrombotic cardiovascular
events (including stent thrombosis) in
patients with acute coronary syndrome (ACS)
managed by means of percutaneous
coronary intervention (PCI) who have either
(a) unstable angina or non-ST-elevation MI
(NSTEMI) or (b) ST-elevation MI (STEMI)
when managed with primary or delayed PCI
60 mg PO once as loading dose, then 10
mg/day PO in combination with aspirin 81-
325 mg/day; if patient <60 kg, consider 5
mg/day PO because of potentially increased
bleeding risk (efficacy and safety not
established)

MECHANISM OF ACTION
Prasugrel is an inhibitor of platelet
activation and aggregation through the
irreversible binding of its active metabolite to
the P2Y12 class of ADP receptors on
platelets. Mechanism of Action: Prasugrel is a
thienopyridine compound that inhibits
adenosine diphosphate (ADP) induced
platelet aggregation. Prasugrel, similar to
clopidogrel, is an inactive prodrug and

155
requires hepatic conversion to an active
metabolite; however unlike clopidogrel, this
activation is a rapid single-step process. The
active metabolite irreversibly binds and
antagonizes the platelet P2Y12 receptor for
the life of the platelet, thus preventing ADP
binding. With ADP unable to bind to the
platelet, activation of glycoprotein IIb/IIIa
(GIIb/IIIa) complex is impaired. Because the
GIIb/IIIa complex is the major platelet
receptor for fibrinogen, fibrinogen binding
and ultimately platelet aggregation is also
impaired.

INDICATIONS
To reduce risk of thrombotic
cardiovascular events (including stent
thrombosis) in patients with acute coronary
syndrome who are to be managed with
percutaneous coronary intervention (patients
with unstable angina (UA) or non-ST-
elevation myocardial infarction (NSTEMI);
patients with ST-elevation MI (STEMI) when
managed with either primary or delayed PCI).

CONTRAINDICATIONS
Active pathological bleeding (eg,
peptic ulcer, intracranial hemorrhage). Prior
TIA or stroke. Do not start if patient likely to
undergo urgent CABG.

ADVERSE EFFECTS

156
 This medication can cause serious
bleeding. Tell your doctor right away if you
have any signs of serious bleeding, including:
unusual pain/swelling/discomfort, unusual
bruising, prolonged bleeding from cuts or
gums, persistent/frequent nosebleeds,
unusually heavy/prolonged menstrual flow,
coughing up blood, bloody/black/tarry stools,
bloody urine, vomit that is bloody or looks
like coffee grounds, severe headache,
dizziness/fainting, shortness of breath, chest
pain, difficulty swallowing.
NURSING RESPONSIBILITIES
-Assess baseline vital signs.
- Assess blood pressure, pulse and respiration
if IV administration.
- Provide frequent sips of water for dry
mouth.
- Provide fluids and fibre for constipation.
- Evaluate therapeutic response, mental state
and physical dependency after long-term use.

PATIENT TEACHING
• You should not take prasugrel if you
have active bleeding such as a stomach ulcer
or bleeding in the brain, if you have ever had
a stroke or "mini-stroke", or if you are
scheduled to have surgery, especially heart
bypass surgery.
• Prasugrel increases your risk of
bleeding, which can be severe or life-
threatening. Call your doctor or seek
emergency medical attention if you have

157
bleeding that will not stop, if you have black
or bloody stools, or if you cough up blood or
vomit that looks like coffee grounds.
• You may need to stop using the
medicine for a short time before any surgery
or dental treatment. Do not stop taking
prasugrel unless your doctor tells you to.

GENERIC NAME: TICAGRELOR

BRAND NAME: BRILINTA

DOSAGE AND FREQUENCY

Dosage Forms & Strengths
tablet
• 60mg
• 90mg
Acute Coronary Syndrome
P2Y(12) platelet inhibitor
indicated to reduce the rate of thrombotic
cardiovascular events in patients with ACS
(unstable angina, non-ST elevation MI, or ST
elevation MI) or a history of MI
Ticagrelor also reduces the rate of stent
thrombosis in patients who have been
stented for treatment of ACS
For at least the first 12 months
following ACS, it is superior to clopidogrel to
lower risk of further major adverse
cardiovascular events (MACE) (PLATO study)
Loading dose (following ACS event):
180 mg PO (two 90-mg tablets)

158
Maintenance dose (for first year following
ACS event): 90 mg PO BID
Maintenance dose (after 1 year of
maintenance): 60 mg PO BID
Administer with aspirin: Initial loading dose
of 325 mg, then maintenance aspirin dose of
75-100 mg/day; DO NOT exceed aspirin dose
of 100 mg/day (see Black Box Warnings)

MECHANISM OF ACTION
Ticagrelor and its major metabolite
reversibly interact with the platelet P2Y12
ADP-receptor to prevent signal transduction
and platelet activation. Ticagrelor and its
active metabolite are approximately
equipotent. Ticagrelor is a crystalline powder
with an aqueous solubility of approximately
10 μg/mL at room temperature.
BRILINTA 90 mg tablets for oral
administration contain 90 mg of ticagrelor
and the following ingredients: mannitol,
dibasic calcium phosphate, sodium starch
glycolate, hydroxypropyl cellulose,
magnesium stearate, hydroxypropyl
methylcellulose, titanium dioxide, talc,
polyethylene glycol 400, and ferric oxide
yellow.
BRILINTA 60 mg tablets for oral
administration contain 60 mg of ticagrelor
and the following ingredients: mannitol,
dibasic calcium phosphate, sodium starch
glycolate, hydroxypropyl cellulose,
magnesium stearate, hydroxypropyl

159
methylcellulose, titanium dioxide,
polyethylene glycol 400, ferric oxide black,
and ferric oxide red.

INDICATION
BRILINTA is indicated to reduce the
rate of cardiovascular death, myocardial
infarction, and stroke in patients with acute
coronary syndrome (ACS) or a history of
myocardial infarction (MI). For at least the
first 12 months following ACS, it is superior to
clopidogrel.
BRILINTA also reduces the rate of
stent thrombosis in patients who have been
stented for treatment of ACS.

CONTRAINDICATION
• operation on the spine
• atrioventricular block
• a type of slow heart rhythm disorder
• bleeding within the skull
• bleeding
• liver problems
• severe liver disease
• recent operation
• procedure to place indwelling
epidural catheter
• neuraxial anesthesia
• local anesthesia injected in the
epidural space or subarachnoid space

ADVERSE EFFECTS
• bruising

160
• bleeding more easily
• nosebleeds
• headache
• dizziness
• cough
• nausea
• diarrhea
• irregular heartbeat
• high blood pressure
• back pain
• low blood pressure
• fatigue, and
• chest pain.

DRUG CLASSIFICATION
ANTICHOLIGERNIC

GENERIC NAME: BENZTROPINE

MESYLATE
BRAND NAME: COGENTIN

Dosage and Frequency:

Since there is no significant
difference in onset of effect after
intravenous or intramuscular
injection, usually there is no need
to use the intravenous route. The
drug is quickly effective after either route,
with improvement sometimes noticeable a

161
few minutes after injection. In emergency
situations, when the condition of the patient
is alarming, 1 to 2 mL of the injection
normally will provide quick relief. If the
Parkinsonian effect begins to return, the dose
can be repeated.

MECHANISMS OF ACTION
Benztropine has anticholinergic effects.
Anticholinergic drugs block the action of
acetylcholine, a neurotransmitter (chemical)
that nerves use to communicate with other
nerves. In Parkinson's there is an imbalance
between levels of dopamine and
acetylcholine neurotransmitters.

INDICATION
For use as an adjunct in the therapy of all
forms of Parkinsonism. Useful also in the
control of extrapyramidal disorders (except
tardive dyskinesia due to neuroleptic drugs
(e.g., phenothiazine).
CONTRAINDICATION
Hypersensitivity to any component of
Cogentin injection. Because of its atropine-
like side effects, this drug is contraindicated
in pediatric patients under three years of age,
and should be used with caution in older
pediatric patients.
ADVERSE REACTION
CNS: disorientation, hallucinations,
depression, toxic psychosis, confusion,
memory impairment, nervousness.

162
CV: tachycardia.
EENT: dilated pupils, blurred vision.
GI: dry mouth, constipation, nausea,
vomiting, paralytic ileus.
GU: urine retention, dysuria.

NURSING RESPONSIBILITY
• Assess therapeutic effectiveness.
Clinical improvement may not be evident for
2–3 d after oral drug is started.
• Monitor input and output ratio and
pattern.
• Advise patient to report difficulty in
urination or infrequent voiding. Dosage
reduction may be indicated.
• Closely monitor for appearance of
S&S of onset of paralytic ileus including
intermittent constipation, abdominal pain,
diminution of bowel sounds on auscultation,
and distention.
• Monitor for and report muscle
weakness or inability to move certain muscle
groups. Dosage reduction may be needed.
• Supervise ambulation and use bed
side rails as necessary.
• Report immediately S&S of CNS
depression or stimulation. These usually
require interruption of drug therapy.

PATIENT AND FAMILY TEACHING

• Explain to patient that the full effect
of drug may not occur for 2 to 3 days.

163
• Caution patient not to stop drug
suddenly; dosage should be reduced
gradually.
• Tell patient that drug may increase
sensitivity of eyes to light.

GENERIC NAME: CYCLOPENTOLATE

HYDROCHLORIDE
BRAND NAME: CYCLOGYL

Dosage and Frequency:

Adult: 1-2 gtt. of 1% solution in eye; may
repeat in 5 minutes PRN; cycloplegia &
mydriasis may last for 24 hours. Use 2% in
heavily pigmented iris
Pediatric: 1-2 gtt. of 0.5%, 1% or 2% solution
in eye; may repeat 5 minutes later by second
application of 0.5% or 1% solution if
necessary.

MECHANISMS OF ACTION
Cyclopentolate is an anticholinergic drug that
blocks the responses of the sphincter muscle
of the iris and the accommodative muscle of
the ciliary body to stimulation by

164
acetylcholine. Dilation of the pupil (mydriasis)
and paralysis of accommodation (cycloplegia)
result.
INDICATION
Cyclopentolate hydrochloride ophthalmic
solution is used to produce mydriasis and
cycloplegia.

CONTRAINDICATION
Cyclopentolate is contraindicated for use in
patients with untreated narrow angle
glaucoma (closed-angle glaucoma). Use
cautiously in those with Down's syndrome
and in those predisposed to increases in
intraocular pressure. Cyclopentolate contains
benzalkonium chloride, which may be
absorbed by contact lenses.

ADVERSE REACTION
CNS: irritability, confusion, somnolence,
hallucinations, ataxia, seizures, behavioral
disturbances in children.
CV: tachycardia.
EENT: eye burning on instillation, blurred
vision, eye dryness, photophobia, ocular
congestion, contact dermatitis in eye,
conjunctivitis, increased intraocular pressure,
transient stinging and burning, irritation,
hyperemia.
GU: urine retention.
Skin: dryness.

165
NURSING RESPONSIBILITY
• Monitor cardiac status especially
with preexisting heart disease.

PATIENT AND FAMILY TEACHING

• Do not touch the dropper to any
surface, including your skin or eyes.
• Exercise caution when driving or
engaging in other potentially hazardous
activities as cyclopentolate ophthalmic may
cause blurred vision. If you experience
blurred vision, avoid these activities.
• Protect your eyes when in bright
light. Cyclopentolate ophthalmic may cause
increased light sensitivity.
• Do not wear soft contact lenses when
the eye drops are being inserted.
• Report immediately any of the
following: difficulty breathing, swelling of
your lips, tongue, face or hives; palpitations;
and unusual behavior.

GENERIC NAME: BENZTROPINE

BRAND NAME: BENCOGEN

DOSAGES AND FREQUENCY

Parkinsonism
Adult: PO 0.5–1 mg/d, may gradually increase
as needed up to 6 mg/d

Extrapyramidal Reactions

166
Adult: PO 1–2 mg b.i.d. IM/IV 1–2 mg as
needed
Child: PO/IM/IV >3 y, 0.02–0.05 mg/kg, 1–2
times/d

MECHANISM OF ACTION
Benztropine has anticholinergic effects.
Anticholinergic drugs block the action of
acetylcholine, a neurotransmitter (chemical)
that nerves use to communicate with other
nerves. In Parkinson's there is an imbalance
between levels of dopamine and
acetylcholine neurotransmitters.

INDICATION
Symptomatic treatment of all forms of
parkinsonism (arteriosclerotic, idiopathic,
postencephalitic) and to relieve
extrapyramidal symptoms associated with
neuroleptic drugs, e.g., haloperidol (Haldol),
phenothiazines, thiothixene (Navane).
Commonly used as supplement with
trihexyphenidyl, carbidopa, or levodopa
therapy.

CONTRAINDICATION
Narrow angle glaucoma; myasthenia gravis;
obstructive diseases of GU and GI tracts;
tendency to tachycardia; tardive dyskinesia,
children. Safety during pregnancy (category
C) or lactation is not established.
ADVERSE EFFECTS

167
CNS: Sedation, drowsiness, dizziness,
paresthesias; agitation, irritability,
restlessness, nervousness, insomnia,
hallucinations, delirium, mental confusion,
toxic psychosis, muscular weakness, ataxia,
inability to move certain muscle groups. CV:
Palpitation, tachycardia, flushing. Special
Senses: Blurred vision, mydriasis,
photophobia. GI: Nausea, vomiting,
constipation, dry mouth, distention, paralytic
ileus. Urogenital: Dysuria.
NURSING RESPONSIBILITIES
Assessment & Drug Effects
• Assess therapeutic effectiveness.
Clinical improvement may not be evident for
2–3 d after oral drug is started.
• Monitor I&O ratio and pattern.
Advise patient to report difficulty in urination
or infrequent voiding. Dosage reduction may
be indicated.
• Closely monitor for appearance of
S&S of onset of paralytic ileus including
intermittent constipation, abdominal pain,
diminution of bowel sounds on auscultation,
and distention.
• Monitor for and report muscle
weakness or inability to move certain muscle
groups. Dosage reduction may be needed.
• Supervise ambulation and use bed
side rails as necessary.
• Report immediately S&S of CNS
depression or stimulation. These usually
require interruption of drug therapy.

168
PATIENT AND FAMILY EDUCATION
• Do not drive or engage in potentially
hazardous activities until response to drug is
known. Seek help walking as necessary.
• Avoid alcohol and other CNS
depressants because they may cause additive
drowsiness. Do not take OTC cold, cough, or
hay fever remedies unless approved by
physician.
• Sugarless gum, hard candy, and
rinsing mouth with tepid water will help dry
mouth.
• Avoid doing manual labor or
strenuous exercise in hot weather;
diminished sweating may require dose
adjustments because of possibility of heat
stroke. This condition is most apt to occur in
the older adults.
• Do not breast feed while taking this
drug without consulting physician.

Fin

169