DIPHENHYDRAMINE DEXTROMETHORPHAN

GENERAL DRUG CLASSIFICATION: Anticholinergic agents GENERAL DRUG CLASSIFICATION: Antitussives

GENERIC NAME: Diphenhydramine GENERIC NAME: Dextromethorphan

BRAND NAME: Allerdryl (can), Banophen, Benadryl, Benadryl Allergy, Diphenhist BRAND NAME: , Balminil DM, Broncho-Grippol-DM, Calmylin #1, Creo-Terpin,
CapTabs, Genahist, Hyrexin, Nytol QuickCaps, Siladryl, Creomulsion, Delsym, DexAlone, Hold DM, KoffexDM,

MECHANISM OF ACTION: Binds to central and peripheral H1 receptors, MECHANISM OF ACTION: Depresses cough reflex through direct effect on
competing with histamine for these sites and preventing it from reaching its site cough center in medulla. Has no expectorant action and does not inhibit ciliary
of action. Diphenhydramine produces antidyskinetic effects, possibly by inhibiting action, although related to opioids structurally, lacks analgesic and addictive
acetylcholine in the CNS. It also produces antitussive effects by directly properties.
suppressing the cough center in the medulla oblongata in the brain.
SIDE EFFECTS: Drowsiness and sedation, nausea, constipation, dry mouth, GI
SIDE EFFECTS upset
Skin eruption and itching, Dysuria, urinary hesitancy, GI upset, nausea, Drying of
the GI mucous membranes, Drowsiness and sedation COMMON ADVERSE EFFECT: dizziness, sedation, nausea, vomiting, and
stomach pain.
COMMON ADVERSE EFFECT: Confusion, dizziness, drowsiness, arrhythmias,
palpitations, tachycardia, blurred vision, diplopia, epigastric distress, nausea, INDICATIONS: Diphenhydramine is used to relieve red, irritated, itchy, watery
agranulocytosis, hemolytic anemia, thrombocytopenia, thickened bronchial eyes; sneezing; and runny nose caused by hay fever, allergies, or the common
secretions, and photosensitivity. cold. Diphenhydramine is also used to relieve cough caused by minor throat or
airway irritation.
INDICATIONS: For temporary relief of cough; especially useful for non-
productive cough due to minor throat and bronchial irritation associated with the CONTRAINDICATIONS: Overactive thyroid gland, Increased pressure in the
common cold, inhaled irritants, or chronic bronchitis. eye, Closed angle glaucoma, High blood pressure, Stenosing peptic ulcer,
Blockage of the urinary bladder, Enlarged prostate, An inability to completely
CONTRAINDICATIONS: Asthma, Bronchitis, Emphysema or other conditions empty the bladder, Chronic idiopathic constipation
where persistent or chronic cough occurs, Concomitant use or within 14 days of
MAOI or SSRI therapy, Children <12 years. NURSING CONSIDERATION
 Monitor cough frequency and type, and assess sputum characteristics.
NURSING CONSIDERATION  Assess hydration status. Increase patient’s fluid input to help moisten
 Expect to give parenteral form of diphenhydramine only when oral ingestion secretions.
isn’t possible
 Keep elixir container tightly closed. Protect elixir and parenteral forms from NURSING DIAGNOSIS
light.  Ineffective airway clearance related to excessive drug effects
 Expect to discontinue drug at least 72 hours before skin tests for allergies  Disturbed sensory perceptions related to CNS effects
because drug may inhibit cutaneous histamine response, thus producing false
negative results.

NURSING DIAGNOSIS
 Acute pain related to GI, CNS or skin effects of the drug
 Disturbed sensory perception (Kinesthetic) related to CNS effects
 GUAIFENESIN SALBUTAMOL

GENERAL DRUG CLASSIFICATION: Expectorants GENERAL DRUG CLASSIFICATION: Bronchodilator (therapeutic). Adrenergics
(pharmacologic)
GENERIC NAME: Guaifenesin
GENERIC NAME: Albuterol
BRAND NAME: Intuniv, Tenex
BRAND NAME: Proventil, Ventolin
MECHANISM OF ACTION: Decreases sympathetic nerve impulse outflow from
the vasomotor center of the brain to the heart and blood vessels by stimulating MECHANISM OF ACTION: Relaxes the smooth muscles of all airways, from the
central alpha2-adrenergic receptors. This action reduces peripheral vascular trachea to the terminal bronchioles. It acts as an agonist to relax the airway
resistance, renovascular resistance, heart rate, and blood pressure. irrespectove of the spasmogen involved thus protecting against broncho-
constrictor challenges.
SIDE EFFECTS: Dizziness, Drowsiness, decreased uric acid levels, Stomach pain,
Nausea, Vomiting, Headache, and Rashes. SIDE EFFECTS: Nervousness, shaking, mouth/throat dryness or irritation, cough,
dizziness, headache, trouble sleeping, or nausea.
COMMON ADVERSE EFFECT: Anxiety, asthenia, confusion, depression,
dizziness, drowsiness, fatigue, headache, irritability, lethargy, nervousness, COMMON ADVERSE EFFECT: Cause tolerance when it is used continuously.
sedation, seizures, somnolence, syncope, weakness, atrioventricular block, Also, co-factor of in asthma deaths. Inhaled salbutamol can cause tremor, inner
bradycardia, chest pain, hypertension, orthostatic hypotension, sinus arrhythmia, agitation, palpitation due to sinus tachycardia, muscle cramps or headaches. High
conjunctivitis, dry mouth, abdominal pain, constipation, dyspepsia, elevated liver ministered nebulizer can provoke premature contractions and ECG changes,
enzyme levels, nausea, enuresis, impotence, urinary frequency, asthma, hypokalemia or psychotic reactions.
dermatitis, diaphoresis, pallor, pruritus, purpura, rash, and increased weight
INDICATION: Bronchial asthma, bronchopulmonary, dysplasia, croup, and
INDICATIONS: For the treatment of cough associated with colds and minor allergic rhinitis
upper respiratory tract infections and for loosening phlegm and thin bronchial
secretions to aid in clearing bronchial passages and making coughs more CONTRAINDICATIONS: Hypersensitivity to budesonide or any of the ingredients
productive. of this preparation, compromised liver function and acute pulmonary, and
tuberculosis.
CONTRAINDICATIONS: Overactive thyroid gland, diabetes, closed angle
glaucoma, high blood pressure, enlarged prostate, systemic mastocytosis, alcohol
intoxication, decreased lung function, sleep apnea NURSING CONSIDERATION
 As with any medication, albuterol has side effects to be aware of. Most
NURSING CONSIDERATION commonly, it makes a person feel anxious, jittery, and he or she may feel his
 Use guanfacine cautiously in patients with cerebrovascular disease, chronic or her heart racing.
renal or hepatic failure, recent MI, or severe coronary insufficiency.  Albuterol is not to be used for patients that have a known hypersensitivity to
 Give drug at bedtime to minimize daytime sedation. warning Expect to stop adrenergic amines. If a person has heart disease, hypertension,
hypertension treatment by decreasing dosage gradually over 2 to 4 days. hypothyroidism, or a seizure disorder, use of this drug is cautioned.
 If you suspect that patient has drug-related depression, notify prescriber
immediately and expect to discontinue drug.
NURSING DIAGNOSIS
NURSING DIAGNOSIS  Ineffective breathing pattern related to cough
 Acute pain related to GI, CNS, or skin effects of the drug.  Imbalanced nutrition: less than body requirements related to dry mouth and
 Ineffective airway clearance related to bronchospasm. GI upsets.
 BUDESONIDE IPRATROPIUM

GENERAL DRUG CLASSIFICATION: Glucocorticosteroid GENERAL DRUG CLASSIFICATION: Bronchodilators, anticholinergics

GENERIC NAME: Budesonide GENERIC NAME: Ipratropium

BRAND NAME: Entocort EC, Pulmicort Flexhaler, Pulmicort, Rhinocort Allergy, BRAND NAME
Ucerris Atrovent HFA, Apo-Ipratropuim, Ipratrovent, and Combivent

MECHANISM OF ACTION: Inhibits accumulation of inflammatory cells. It MECHANISM OF ACTION: It blocks the action of acetylcholine at
controls the rate of protein synthesis, depresses the migration of parasympathetic sites in bronchial smooth muscle causing bronchodilation.
polymorphonuclear leukocytes, fibroblasts, reverses capillary permeability and
lysosomal stabilization at the cellular level to prevent or control inflammation. SIDE EFFECTS: Cough, dry mouth, headache, nausea, nasal irritation, dizziness,
transient increased bronchospasm, hypotension, insomnia, metallic/unpleasant
SIDE EFFECTS: Mild nasopharyngeal irritation, burning, stinging, dryness, taste, palpitations, urinary retention, diarrhea, constipation, dry throat,
headache, cough, dry mouth, dyspepsia, rebound congestion, rhinorrhea, loss of abdominal pain, and nasal congestion.
taste, back pain, vomiting, altered taste, voice changes, abdominal pain, and
nausea. COMMON ADVERSE EFFECT: Worsening of angle-closure glaucoma, acute eye
pain, hypotension occurs rarely.
COMMON ADVERSE EFFECT: Acute hypersensitivity reaction (urticaria,
INDICATIONS: wheezing, shortness of breath, coughing, and chest tightness in
angioedema, severe bronchospasm)
people with chronic obstructive pulmonary disease
INDICATION: Bronchial spasms, bronchopulmonar dysplasia, croup, and allergic
CONTRAINDICATIONS: closed angle glaucoma, blockage of the urinary bladder,
rhinitis.
enlarged prostate, and an inability to completely empty the bladder.
CONTRAINDICATIONS: active and untreated tuberculosis, inactive tuberculosis,
herpes simplex infection of the eye, a herpes simplex infection, an infection due
NURSING CONSIDERATION
to a fungus, intestinal infection caused by the roundworm Strongyloides, a
 Auscultate lung sounds. Question history of glaucoma, urinary retention,
condition with low thyroid hormone levels, and diabetes.
myasthenia gravis.
 Increase fluid intake
NURSING CONSIDERATION
 Monitor respiration and observe retraction
 Question for hypersensitivity to any corticosteroids, components. Auscultate
 Do not take 2 inhalations at one time.
lung sounds.
 Avoid excessive use of caffeine derivatives
NURSING DIAGNOSIS
 Loss of skin collagen and SC atrophy; NURSING DIAGNOSIS
 Local hypopigmentation of deeply pigmented skin  Impaired gas exchange related to decreased oxygen-carrying capacity of
 blood
 Ineffective airway clearance related to shortness of breath
 SALMETEROL MONTELUKAST

GENERAL DRUG CLASSIFICATION: Bronchodilators GENERAL DRUG CLASSIFICATION: Leukotriene receptor inhibitor

GENERIC NAME: Salmeterol GENERIC NAME: Montelukast

BRAND NAME: Adeflo, Salmeflo, Kovent SF, Advair, Serevent Diskhaler Disk, BRAND NAME: Apo-Montelukast, Singulair, Stelix, Kastair, Montalon, Zykast,
Serevent Diskus Liecet M

MECHANISM OF ACTION: Stimulates beta2-adrenergic receptors in lungs, MECHANISM OF ACTION: Binds to cysteinyl leukotriene receptors, inhibiting
resulting in relaxation of bronchial smooth muscle. effects of leukotrienes on bronchial smooth muscle. Decreases
bronchoconstriction, vascular permeability, mucosal edema, mucus production.
SIDE EFFECTS: Headache, cough, tremor, dizziness, vertigo, throat
dryness/irritation, pharyngitis, palpitations, tachycardia, nausea, heartburn, GI SIDE EFFECTS: Headache, influenza, abdominal pain, cough, dyspepsia,
distress, and diarrhea. dizziness, fatigue, dental pain, diarrhea, laryngitis, pharyngitis, nausea, otitis
media, sinusitis, and viral infection.
COMMON ADVERSE EFFECT: May prolong QT interval (can precipitate
ventricular arrhythmias). Hypokalemia, hyperglycemia may occur. COMMON ADVERSE EFFECT: Suicidal ideation and behavior, depression have
been noted.
INDICATIONS: To treat asthma andprevent asthma-induced bronchospasm in
patients with reversible obstructive airway disease who are currently using an INDICATIONS: Indicated for prophylaxis and chronic treatment of asthma
inhaled corticosteroid but are inadequately controlled
CONTRAINDICATIONS: Montelukast is contraindicated in patients with a history
CONTRAINDICATIONS: Hypersensitivity to salmeterol, its components, or to of hypersensitivity to the drug or its components. For patients with
phenylketonuria (PKU), caution should be exercised with phenylalanine-containing
milk proteins (severe); Primary treatment of status asthmaticus or other acute
formulations.
episodes of asthma or COPD where intensive measures are required; treatment of
asthma without use of an inhaled corticosteroid NURSING CONSIDERATION
 Chewable tablet contains phenylalanine (component of aspartame); parents
NURSING CONSIDERATION of phenylketonuric pts should be informed.
 Question history of cardiac disease, hepatic impairment, seizure disorder.  Assess lung sounds for wheezing. Assess for allergy symptoms. Question
 Screen for concomitant medications known to prolong QT interval. Assess history of depression, suicidal ideation.
lung sounds, vital signs.
NURSING DIAGNOSIS
 Ineffective airway clearance related to obstruction or presence of thickened
NURSING DIAGNOSIS secretions.
 Acute pain related to headache and GI upset.  Self-concept disturbance related to the condition.
 Deficient knowledge regarding drug therapy.
 FLUTICASONE THEOPHYLLINE

GENERAL DRUG CLASSIFICATION: Anti-inflammatory, Antipruritic GENERAL DRUG CLASSIFICATION: Xanthine Derivativess

GENERIC NAME: Fluticasone GENERIC NAME: Theophylline

BRAND NAME BRAND NAME: Respbid, T-Phyl, Aerolate III, Slo - Bid Gyrocaps, Theo - 24,
Flovent HFA, Flovent Diskus, ArmonAir, Flovent Rotadisk, Flonase, Advair TheoCap, Theocron

MECHANISM OF ACTION: Direct local effect as potent vasoconstriction. It also MECHANISM OF ACTION: It causes two distinct actions in the airways of
prevents and controls inflammation. This medication also directly increases beta-2 patients with reversible obstruction - smooth muscle relaxation and non-
receptors on airway smooth muscle and decreases mucus gland secretions. bronchodilator prophylactic effects. Bronchodilatation is mediated by the inhibition
of two isozymes of phosphodiesterase (PDE lll and to a lesser extent, PDE lV)
SIDE EFFECTS: Throat irritation, hoarseness, dry mouth, cough, temporary while non-bronchodilator prophylactic actions are probably mediated through
wheezing, oropharyngeal candidiasis, mild nasopharyngeal irritation, nasal different molecular mechanisms.
burning, stinging, dryness, rebound congestion, rhinorrhea, altered sense of
taste, headache,topical Stinging, burning of skin. SIDE EFFECTS: excitement, headache, insomnia, irritability, restlessness,
seizure Diarrhea, nausea, vomiting, increased urination, exfoliative dermatitis,
COMMON ADVERSE EFFECT: Adrenal suppression, growth suppression , muscle tremors, fast heart rate, high calcium levels, and difficulty urinating
bruising, osteoporosis, cataracts, glaucoma, metabolic abnormalities
COMMON ADVERSE EFFECT: Arrhythmias, convulsions, hypokalemia and
INDICATIONS: Maintenance and prophylactic treatment of asthma. May rhabdomyolysis.r
decrease requirement for or avoid use of systemic corticosteroids and delay
pulmonary damage that occurs from chronic asthma. INDICATIONS: Symptomatic relief or prevention of bronchial asthma and
reversible bronchospasm associated with chronic bronchitis and emphysema.
CONTRAINDICATIONS: Active tuberculosis, inactive tuberculosis, herpes Treatment of apnea and bradycardia of prematurity
simplex infection of the eye, nasal fungal infection, decreased function of the
adrenal gland, increased pressure in the eye, wide-angle glaucoma, cataracts, CONTRAINDICATIONS: Hypersensitivity, pregnancy
ulcers of the nasal septum, varicella zoster virus, measles

NURSING CONSIDERATION NURSING CONSIDERATION

 Establish baseline history of skin disorder, asthma, rhinitis. Question  Assess Skin color, texture, lesions; reflexes, bilateral grip strength, affect; P,
hypersensitivity, esp. milk products or lactose. auscultation, BP, perfusion; R, adventitious sounds; bowel sounds, normal
 Question medical history as listed in Precautions. output; frequency, voiding pattern, normal urinary output; ECG; EEG; LFTs,
renal and thyroid function tests.
NURSING DIAGNOSIS  These should be given on an empty stomach, 1 hr before or 2 hr after meals.
 Acute pain related to local effects of the drug  Teach the patient to take the drug exactly as prescribed. If a timed-release
 Deficient Knowledge regarding drug therapy product is prescribed, take it on an empty stomach.
 Do not chew or crush timed-release preparations;
 Avoid excessive intake of coffee, tea, cocoa, cola beverages, and chocolate.
These contain theophylline-related substances that may increase your side
effects.
 No smoking

NURSING DIAGNOSIS
●Acute pain related to headache and GI Upset
●Distributed thought related to CNS effects
 METROPROLOL ENALAPRIL

GENERAL DRUG CLASSIFICATION: Beta1- adrenergic blocker. GENERAL DRUG CLASSIFICATION: Angiotensin-converting enzyme (ACE)
inhibitor.
GENERIC NAME: Metroprolol
GENERIC NAME: Enalapril Antihypertensive.
BRAND NAME: Apo-Metoprolol, Lopressor, Toprol XL
BRAND NAME: Epaned, Vasotec
MECHANISM OF ACTION: Selectively blocks beta1-adrenergic receptors. It
slows heart rate, decreases cardiac output, reduces B/P. Decreases MECHANISM OF ACTION: Suppresses renin-angiotensin-aldosterone system
myocardialischemia severity. (prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor;
may inhibit angiotensin II at local vascular, renal sites). Decreases plasma
SIDE EFFECTS: diminished sexual function, drowsiness, insomnia, unusual angiotensin II, increases plasma renin activity, decreases aldosterone secretion.
fatigue/ weakness, anxiety, diarrhea, constipation, nausea, vomiting, nasal In hypertension, reduces peripheral arterial resistance. In HF, increases cardiac
congestion, abdominal discomfort, dizziness, difficulty breathing, cold hands/feet, output; decreases peripheral vascular resistance, B/P, pulmonary capillary wedge
altered taste, dry eyes, nightmares, paresthesia, allergic reaction (rash, pruritus). pressure, heart size.

COMMON ADVERSE EFFECT: bradycardia, hypotension, bronchospasm. SIDE EFFECTS: headache, dizziness, orthostatic hypotension, fatigue, diarrhea,
Abrupt withdrawal may result in diaphoresis, palpitations, headache, cough, syncope, angina, abdominal pain, vomiting, nausea, rash, asthenia.
tremulousness, exacerbation of angina, MI, ventricular arrhythmias.
thyroid storm, peripheral ischemia, and hypoglycemia . COMMON ADVERSE EFFECT: excessive hypotension, severe salt or volume
depletion, angioedema, hyperkalemia, granulocytosis, neutropenia, collagen
INDICATIONS: angina, heart failure, myocardial infarction, atrial fibrillation, vascular diseases, nephrotic syndrome.
atrial flutter and hypertension.
INDICATION: heart failure and hypertension
CONTRAINDICATION: sinus bradycardia, greater than first-degree heart block,
cardiogenic shock, sick sinus syndrome (unless a permanent pacemaker is in CONTRAINDICATION: sinus bradycardia, greater than first-degree heart block,
place), or overt cardiac failure, patients with HR less than 45 beats/minute, cardiogenic shock, sick sinus syndrome, overt cardiac failure when used to treat
greater than first-degree heart block, PR interval of 0.24 second or longer with HTN or angina, patients with HR less than 45 beats/minute, greater than first-
first-degree heart block, systolic BP less than 100 mm Hg, or moderate to severe degree heart block, PR interval of 0.24 second or longer with first-degree heart
cardiac failure. block, systolic BP less than 100 mm Hg, or moderate to severe cardiac failure.

NURSING CONSIDERATION NURSING CONSIDERATION

 Assess baseline renal function, LFT. Assess B/P, apical pulse immediately  Obtain BUN, serum creatinine, CrCL. Receive full medication history, esp.
before drug administration (if pulse is 60/min or less or systolic B/P is less potassium-sparing diuretics. Obtain B/P immediately before each dose (be
than 90 mm Hg, withhold medication, contact physician). alert to fluctuations).
 Antianginal: Record onset, type (sharp, dull, squeezing), radiation, location,  In pts with renal impairment, autoimmune disease, or taking drugs that
intensity, duration of anginal pain, precipitating factors (exertion, emotional affect leukocytes/immune response, CBC should be performed before
stress). beginning therapy, q2wks for 3 mos, then periodically thereafter.
NURSING DIAGNOSIS
NURSING DIAGNOSIS
 Acute pain related to CNS, GI, and systemic
 Decreased cardiac output related to effect of drug in increasing fluid volume
 Decreased cardiac output related to CV effects
excretion
 Impaired skin integrity related to dermatological effects of the drug
 LOSARTAN HYDRALAZINE

GENERAL DRUG CLASSIFICATION: Angiotensin II receptor antagonists. GENERAL DRUG CLASSIFICATION: Vasodilators

GENERIC NAME: Losartan GENERIC NAME: Hydralazine

BRAND NAME: Losium, Losmac, Medzart, Natrasol, Neosartan, Parten-50, BRAND NAME: Dralzine Apresazide, Apresoline-Esidrix, BiDil, Dralserp, Hydra-
Prozart, RiteMED Losartan, Sartan, Torlos-50/Torlos-100, Wilopres,Xartan, Anzar, Zide Hydrap-ES, Marpres, Ser-Ap-Es, Serathide, Serpazide, Serpex, Unipres.
Arbloc, Besartan, Cozaar, Doxar, Getzar, Hartzar, Hextan, Hyperthree, Kardiostan
Kenzar, Losacar 50/Losacar 100, Losargard/Losargard Plus, Losart MECHANISM OF ACTION: Hydralazine is a direct-acting vasodilator which acts
predominantly on the arterioles. The exact mechanism of action is unknown, but
MECHANISM OF ACTION: a competitive angiotensin II receptor antagonist. It it is thought to exert its vasodilating effect through direct relaxation of vascular
selectively blocks AT1 receptors found in many tissues (e.g. vascular smooth smooth muscle by inhibition of Ca release from the sarcoplasmic reticulum and
muscle, adrenal gland), thereby reducing the vasoconstricting and aldosterone- inhibition of myosin phosphorylation in the arterial smooth muscle cells.
secreting effects of angiotensin II. Losartan is less likely to be associated with
non-renin-angiotensin effects (e.g. cough, angioedema) due to the lack of effect SIDE EFFECTS: Flushing, headache, upset stomach, vomiting, loss of appetite,
to the response to bradykinin. diarrhea, constipation, eye tearing, stuffy nose,rash, fainting, joint or muscle
pain, fever, rapid heartbeat,chest pain, swollen ankles or feet, numbing or
SIDE EFFECTS: Chest pain, Diarrhea, Dizziness, Fatigue, Insomnia, Low blood tingling in hands or feet
sugar, Muscle cramps, Nasal congestion, Urinary tract infections (UTIs)
Weakness, Losartan also may cause, Cough, Hyperkalemia, Impotence, Muscle INDICATION: Hypertension
breakdown
CONTRAINDICATION: Hypersensitivity to drug or tartrazine, Coronary artery
COMMON ADVERSE EFFECT: Renal failure, renal insufficiency, symptomatic disease, Mitral valvular rheumatic heart disease
hypotension, hyperkalaemia,angioedema, Anaemia, Atrial fibrillation, Tinnitus,
Asthenia, Urticaria. COMMON ADVERSE EFFECT: drug-induced lupus syndrome

INDICATION: Hyper tension and heart failure NURSING CONSIDERATION

 Monitor BP and pulse frequently during initial dose adjustment and
CONTRAINDACATION: Impaired renal or hepatic function, hypotension, periodically during therapy. About 50–65% of Caucasians, Black, South
tachycardia, and bradycardia. Indians, and Mexicans are slow acetylators at risk for toxicity, while 80–90%
of Eskimos, Japanese, and Chinese are rapid acetylators at risk for decreased
NURSING CONSIDERATION levels and treatment failure.
 Losartan may be used alone or in combination with other drugs.  Monitor frequency of prescription refills to determine adherence.
 Losartan should not be used during pregnancy. When pregnancy is first  Monitor CBC, electrolytes, LE cell prep, and ANA titer prior to and periodically
detected, losartan should be stopped. during prolonged therapy.
 Losartan should be discontinued by females who are nursing.
 This drug may occasionally cause dizziness or drowsiness, if affected, do not NURSING DIAGNOSIS
drive or operate machinery.  Ineffective tissue perfusion (Indications)
 Noncompliance (Patient/Family/Teaching)
NURSING DIAGNOSIS
 Impaired skin integrity related to dermatological effects of the drug
 Increased risk for infection related to potential decreasing effect of drug to
circulating blood cells
 DIGOXIN VALSARTAN

GENERAL DRUG CLASSIFICATION: Antidysrhythmic, V; Inotropic Agents, GENERAL DRUG CLASSIFICATION: Angiotensin II Receptor Blocker
Cardiac glycoside, Cardiotonic
GENERIC NAME: Valsartan
GENERIC NAME: Digoxin
BRAND NAME: Diovan, Entresto, Exforge and Byvalson
BRAND NAME: Lanoxicaps, Lanoxin, Digitek
MECHANISM OF ACTION: Valsartan belongs to the angiotensin II receptor
MECHANISM OF ACTION: Digoxin induces an increase in intracellular sodium blocker (ARB) family of drugs, which selectively bind to angiotensin receptor 1
that will drive an influx of calcium in the heart and cause an increase in (AT1) and prevent angiotensin II from binding and exerting it hypertensive
contractility. Cardiac output increases with a subsequent decrease in ventricular effects. These include vasoconstriction, stimulation and synthesis of aldosterone
filling pressures. Digoxin exerts hemodynamic, electrophysiologic, and and ADH, cardiac stimulation and renal reabsorption of sodium among others.
neurohormonal effects on the cardiovascular system. It reversibly inhibits the Na- Overall, valsartan’s physiologic effects lead to reduced blood pressure, lower
K ATPase enzyme, leading to beneficial effects. The Na-K ATPase enzymes aldosterone levels, reduced cardiac activity, and increased excretion of sodium.
functions to maintain the intracellular environment by regulating the entry and It is an oral medication that is used to treat high blood pressure and congestive
exit of sodium, potassium, and calcium (indirectly). heart failure.

SIDE EFFECTS: Nausea, vomiting, headache, loss of appetite, anorexia and SIDE EFFECTS: headache, dizziness, fatigue, abdominal pain, diarrhea, sinusitis,
diarrhea may occur. Serious side effects occur: weakness, mental/mood changes, stomach pain, cold symptoms, swelling, blurred vision, back pain, joint pain, and
vision changes, enlarged/tender breast in men. nausea, chest pain, fainting, palpitations, weight loss, vomiting, hyperkalemia,
impotence, reduced renal function and allergic reactions.
COMMON ADVERSE EFFECT: fatal cardiac arrythmias.
COMMON ADVERSE EFFECT: Rhabdomyolysis, and angioedema
INDICATION: Heart failure, Tachyarrhythmia, Atrial fibrillation and flutter,
Paroxysmal atrial tachycardia INDICATION: Hypertension

CONTRAINDICATION: Hypersensitivity to drug, Uncontrolled ventricular CONTRAINDICATION: Concurrent aliskiren therapy in diabetic patients,
arrhythmias, AV block, Idiopathic hypertrophic subaortic stenosis, Constrictive Hypersensitivity to valsartan or its components
pericarditis
NURSING CONSIDERATION
NURSING CONSIDERATION  Assess for the mentioned contraindications to this drug (e.g. renal
 Allergy to digitalis preparations, ventricular tachycardia, ventricular impairment, hyponatremia, hypovolemia, etc.) to prevent potential adverse
fibrillation, heat block, sick sinus syndrome, IHSS, acute MI, renal effects.
insufficiency, decreased K+, decreased Mg2+ increased Ca2+, pregnancy,  Obtain baseline status for weight, vital signs, overall skin condition, and
lactation laboratory tests like renal and hepatic function tests, serum electrolyte, and
 Monitir weight, orientation, affect, reflexes, vision; P, BP, baseline ECG, complete blood count (CBC) with differential to assess patient’s response to
cardiac auscultation, peripheral pulses, peripheral perfusion, edema; R, therapy.
adventitious sounds; abdominal percussion, bowel sounds, liver evaluation;
urinary output; electrolyte levels, LFTs, renal function tests NURSING DIAGNOSIS
 Decreased cardiac output related to effect of drug in increasing fluid volume
NURSING DIAGNOSIS excretion
 Risk for Decreased Cardiac Output  Impaired skin integrity related to dermatological effects of the drug
 Risk for Poisoning
 AMLODIPINE FONDAPARINUX

GENERAL DRUG CLASSIFICATION: Calcium channel- blocker, Antianginal GENERAL DRUG CLASSIFICATION: Anticoagulants
Drug, Antihypertensive
GENERIC NAME: Fondaparinux
GENERIC NAME: Amlodipine
BRAND NAME: Arixtra
BRAND NAME: Norvasc
MECHANISM OF ACTION: Selectively binds to antithrombin III, which enhances
MECHANISM OF ACTION: Inhibits the movements of calcium ion across the the inactivation of clotting factor Xa by antithrombin III. Inactivation of factor Xa
membranes of cardiac and arterial muscle cells; Inhibits transmembrane calcium interrupts the blood coagulation pathway, which then inhibits thrombin formation.
flow, which results in the depression of impulse formation in specialized cardiac Without thrombin, fibrinogen can’t convert to fibrin and clots can’t form.
pacemaker cells, slowing of the velocity of conduction of the cardiac impulse,
depression of myocardial contractility, and dilation of coronary arties and SIDE EFFECTS: Bleeding, bruising, sleep problems (insomnia), rash, blisters,
arterioles and peripheral arterioles; these effects lead to decreased cardiac work. dizziness, confusion or minor bleeding, rash, itching or oozing where the medicine
was injected.
SIDE EFFECTS: Swelling of the ankles or feet, Difficult or labored breathing,
dizziness, irregular, or racing heartbeat or pulse, feeling of warmth, redness of COMMON ADVERSE EFFEC: elevated serum aminotransferase level,
the face, tightness in the chest, Bleeding gums, blood in the urine or stools, dark hypotension, UTI, Anemia, bleeding, elevated APTT, hematoma, postoperative
yellow urine, blurred vision, extreme fatigue, fainting, fever, itching of the skin hemorrhage, thrombocytopenia, thrombocytopenia with thrombosis

COMMON ADVERSE EFFECT: Peripheral edema, arrhythmias, arthralgia, INDICATION: Prevention of Venous Thromboembolism
cramps, myalgia
CONTRAINDICATION: Hypersensitivity to drug, Bacterial endocarditis, Severe
INDICATIONS: Hypertension, chronic stable angina pectoris, and vasospastic renal disease, Active major bleeding
angina (Prinzmetal’s angina)
NURSING CONSIDERATION
CONTRAINDICATION:: Hypersensitivity to drug  Fondaparinux shouldn’t be given as prophylaxis for patients who have had a
hip fracture, who are having hip or knee replacement or abdominal surgery,
or who weigh less than 50 kg (110 lb) because of increased risk of bleeding.
NURSING CONSIDERATION  Use fondaparinux cautiously in elderly patients, especially those weighing
 May cause gingival hyperplasia less than 50 kg (110 lb) and are receiving the drug for pulmonary embolism
 Grapefruit juice may increase drug level or deep vein thrombosis, because the risk of druginduced bleeding increases
 Monitor blood pressure and pulse prior to and during therapy with age.
 Assess of signs of CHF  Don’t give initial dose of fondaparinux less than 6 hours after surgery.
 Instruct patient of interventions for hypertension and how to take blood  Inspect fondaparinux for particles or discoloration before administration.
pressure.  Alternate injection sites using left and right anterolateral or left and right
posterolateral abdominal wall. Don’t expel air bubble from prefilled syringe
NURSING DIAGNOSIS before injection to prevent expelling drug from syringe. Don’t give drug by
 Decreased cardiac output related to hypotension and vasodilating effect of I.M. injection.
the drug.
 Risk for injury related to cardiovascular and CNS adverse drug effects. NURSING DIAGNOSIS
 Ineffective tissue perfusion (Indications)
 Risk for injury (Side effects)
 CLOPIDOGREL ATORVASTATIN

GENERAL DRUG CLASSIFICATION: Platelet aggration inhibitor, Thienopyridine GENERAL DRUG CLASSIFICATION: Class.lipid-lowering agents
derivative Pharm. Class.hmg coa reductase inhibitors cholesterol absorption inhibitors

GENERIC NAME: Clopidogrel bisulfate GENERIC NAME: Atorvastatin

BRAND NAME: Plavix BRAND NAME: Lipitor, Liptruzet

MECHANISM OF ACTION: Inhibits first amd second phases of ADP-induces MECHANISM OF ACTION: Atorvastatin– Inhibits 3-hydroxy-3-methylglutaryl-
effects in platelet aggregation. coenzyme A (HMG-CoA) reductase, an enzyme which is responsible for
catalyzing an early step in the synthesis of cholesterol.
SIDE EFFECTS: Excessive tiredness, headache, dizziness, nausea, vomiting, Ezetimibe– Inhibits absorption of cholesterol in the small intestine.
stomach pain, diarrhea, nosebleed. Therapeutic Effect(s): Lowering of lipids with decreased progression of
atherosclerosis.
COMMON ADVERSE EFFECT: Confusion, hallucinations, fatal intracranial
bleeding, edema, hypertension, chest pain, nausea, vomiting, diarrhea, GI SIDE EFFECTS: Diarrhea, runny nose, joint pain, insomnia, UTI, nausea, loss of
discomforT, Glomerulonephritis appetite, muscle pain.

INDICATIONS: Recent myocardial infarction (MI) or stroke or established COMMON ADVERSE EFFECT: MYOPATHY/RHABDOMYOLYSIS, arthralgia,
peripheral arterial disease musculoskeletal pain, muscle weakness.

CONTRAINDICATIONS: Hypersensitivity to drug, Active pathologic bleeding INDICATIONS: Primary prevention of Cardiovascular disease in high-risk pts.
Reduces risk of stroke and heart attack in pts with type 2 diabetes.
Contraindications
NURSING CONSIDERATION
 Assess for thrombolic/ thrombocytic purpura fever, thrombocytopenia , CONTRAINDICATIONS: Active hepatic disease, breastfeeding, hypersensitivity
neorolytic anemia. to atorvastatin or its components, pregnancy, unexplained persistent rise in
 Monito liver function test: AST, ALT, bilirubin, creatinine if the patient is on serum transaminase level
long-term therapy (4months or more)
 Monitor blood studies: CBS, Hct, Hgb, protime, Cholesterol of patient if long- NURSING CONSIDERATION
term therapy.  Assess for the mentioned contraindications to prevent potential adverse
effects.
NURSING DIAGNOSIS  Conduct thorough physical assessment before beginning drug therapy to
 Acute pain related to CNS and GI effects establish baseline status, determine effectivity of therapy and evaluate
 Risk for injury related to CNS effects and bleeding tendencies potential adverse effects.
 Obtain baseline status for weight while noting recent manifestations that
increases or decreases to determine patient’s fluid status.
 Assess bowel elimination patterns, including frequency of stool passage and
stool characteristics to monitor the development of constipation and possible
fecal impaction.
 Assess closely patient’s heart rate and blood pressure to identify
cardiovascular changes that may warrant change in drug dose

NURSING DIAGNOSIS
 Risk for injury related to CNS drug effects and potential for bleeding
 Altered elimination pattern related to constipation

FUROSEMIDE MANNITOL

GENERAL DRUG CLASSIFICATION: Diuretics GENERAL DRUG CLASSIFICATION: Osmotic Diuretic

GENERIC NAME: Furosemide GENERIC NAME: Mannitol

BRAND NAME: Lasix BRAND NAME: Osmitrol

MECHANISM OF ACTION: Inhibit reabsorption of sodium and chloride from the MECHANISM OF ACTION: Increases osmotic pressure of plasma in glome rular
loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, filtrate, inhibiting tubular reabsorption of water and electrolytes (including sodium
chloride, magnesium, hydrogen, and calciuM. May have renal and peripheral and potassium). These actions enhance water flow from various tissues and
vasodilatory effects. Effectiveness persists in impaired renal function. Indicated ultimately decrease intracranial and intraocular pressures.
for Edema due to CHF, Hepatic or renal disease or hypertension.
SIDE EFFECTS: Dehydration, Anuria, Intracranial bleeding, Headache, Blurred
SIDE EFFECTS: Low blood pressure, dehydration and electrolyte depletion (for vision, Nausea and vomiting, Volume expansion, Chest Pain
example, sodium, potassium).
COMMON ADVERSE EFFECT: Pulmonary edema, Thirst, Tachycardia,
COMMON ADVERSE EFFECT: Jaundice , ringing in the ears(tinnitus), sensitivity Hypokalemia (increases the risk of digoxin toxicity), Chronic renal failure
to light(photophobia), rash, pancreatitis, nausea, diarrhea, abdominal pain, and
dizziness. Increased blood sugar and uric acid levels. INDICATIONS: Reduces increased ICP due to cerebral edema, IOP due to acute
glaucoma. Promotes urinary excretion of toxic substances.
INDICATIONS: Treatment of edema associated with HF and renal/hepatic
disease; acute pulmonary edema. Treatment of hypertension CONTRAINDICATIONS: Active intracranial bleeding (except during craniotomy),
anuria, hypersensitivity to mannitol or its components, severe pulmonary vascular
CONTRAINDICATIONS: Anuria, hypersensitivity to furosemide or its congestion or pulmonary edema, severe hypovolemia
components
NURSING CONSIDERATION
NURSING CONSIDERATION Before:
 Assess patient’s underlying condition before therapy.  Check vital signs and urine output.
 Monitor for renal cardiac, neurologic, GI, manifestations of hypokalemia.  Assess signs of dehydration and muscle weakness
 Monitor for CNS, GI, Cardiovascular, integumentarym neurologic  Monitor neurologic status and intracranial pressure
manifestations of jypocalcemia. During:
 Monitor for CNS, hyperactive reflexes, depressed cardiac output, nausea,  Administer over 30min
vomiting, tachycardia.  Monitor urine output and refer in accordance with parameters set by
 Assess fluid volume status (urine color, quality and specific gravity) physician
 Assess patient tinnitus, or pain.  Ensure safety and report signs of electrolyte imbalance
After:
NURSING DIAGNOSIS  Check effectiveness of therapy
 Impaired urinary elimination related to drug effect  Continuously monitor neurologic status and urine output
 Imbalanced nutrition: less than body requirements related to GI upset and  Reassess signs/symptoms of dehydration
metabolic changes
NURSING DIAGNOSIS
 Risk for deficient fluid volume related to increase fluid volume excretion
 Risk for injury related to changes in fluid volume and electrolyte balance
 RANITIDINE

GENERAL DRUG CLASSIFICATION: H2 Blockers OMEPRAZOLE

GENERIC NAME: Ranitidine GENERAL DRUG CLASSIFICATION: Proton pump inhibitors

BRAND NAME: Zantac GENERIC NAME: Omeprazole

MECHANISM OF ACTION: Inhibits histamine action at histamine H2-receptors BRAND NAME: Prilosec, Zegerid
of gastric parietal cells. Therapeutic Effect: Inhibits gastric acid secretion.
Reduces gastric volume, hydrogen ion concentration. MECHANISM OF ACTION: Inhibits hydrogen-potassium adenosine
Indications: Duodenal Ulcer, Gastric Ulcer (Benign), Hypersecretory Conditions, triphosphatase (H+/K+ ATP pump), an enzyme on the surface of gastric parietal
GERD, Erosive Esophagitis, Prevention of Heartburn (OTC) cells. Therapeutic Effect: Increases gastric pH, reduces gastric acid production.

SIDE EFFECTS: Diarrhea, Constipation, headache (may be severe). Reversible SIDE EFFECTS: Loss of appetite. Nausea/vomiting. Unusual weight loss.
hepatitis, blood dyscrasias occur rarely. Bone/muscle pain. Mental/mood changes (e.g.,confusion). Headache. Increased
thirst/urination. Unusual weakness/tiredness
COMMON ADVERSE EFFECTS:
COMMON ADVERSE EFFECTS: Confusion
INDICATIONS: Duodenal Ulcer, Gastric Ulcer (Benign), Hypersecretory
Conditions, GERD, Erosive Esophagitis, Prevention of Heartburn (OTC) INDICATIONS: Erosive Esophagitis, Reflux Disease (GERD), Zollinger-Ellison
Syndrome, Duodenal Ulcer Caused by Helicobacter Pylori, Heartburn (OTC)
CONTRAINDICATIONS: Hypersensitivity to raNITIdine. OTC: Do not use if
trouble or pain when swallowing food, vomiting with blood, or bloody or black CONTRAINDICATIONS: Hypersensitivity to esomeprazole, other proton pump
stool is present. Do not use 150 mg with kidney disease (unless medically inhibitors. Cautions: May increase risk of hip, wrist, spine fractures; hepatic
advised). Cautions: Renal/hepatic impairment, elderly pts, history of acute impairment; elderly; Asian populations. Concurrent use of CYP3A4 inducers (e.g.,
porphyria. rifAMPin).

NURSING CONSIDERATION: NURSING CONSIDERATION:

 Obtain history of epigastric/abdominal pain.  Evaluate for therapeutic response (relief of GI symptoms)
 Assess mental status in elderly. Question present abdominal pain, GI  Report headache, onset of black, tarry stools, diarrhea, abdominal pain.
distress.  Avoid alcohol.
 Smoking decreases effectiveness of medication.  Swallow capsules whole; do not chew, crush, dissolve, or divide.
 Do not take medicine within 1 hr of magnesium- or aluminumcontaining  Take before eating.
antacids.
 Transient burning/ pruritus may occur with IV administration. NURSING DIAGNOSIS:
 Report headache.  Acute Pain related to excess gastric secretion
 Avoid alcohol, aspirin.

NURSING DIAGNOSIS:
 Acute Pain related to excess gastric secretion
 SIMETHICONE ALUMINUM HYDROXIDE & MAGNESIUM HYDROXIDE

GENERAL DRUG CLASSIFICATION: Gastrointestinal agent GENERAL DRUG CLASSIFICATION: Antacid class

GENERIC NAME: Simethicone GENERIC NAME: Aluminum Hydroxide+ Magnesium Hydroxide

BRAND NAME: Mylicon BRAND NAME: Mylanta, Mygel, DiGel, Gelusil, Rulox

MECHANISM OF ACTION: Changes surface tension of gas bubbles, allowing MECHANISM OF ACTION: Maalox is a balanced mixture of 2 antacids:
easier elimination of gas. Therapeutic Effect: Disperses, prevents formation of gas Aluminum hydroxide is a slow-acting antacid and magnesium hydroxide is fast
pockets in GI tract. acting. The 2 are frequently combined in antacid mixtures. Aluminum
hydroxideon its own is astringent and may cause constipation.This effect is
SIDE EFFECTS: hives, difficulty breathing; swelling of your face, lips, tongue, or balanced by the effect of magnesium hydroxide, which, in common with other
throat. magnesium salts, may cause diarrhea. Aluminum Hydroxide dissolves in acidic
gastric secretions, releasing anions that partially neutralize
COMMON ADVERSE EFFECTS: None known
SIDE EFFECTS: Loss of appetite. Nausea/vomiting. Unusual weight loss.
INDICATIONS: Antiflatulent Bone/muscle pain. Mental/mood changes (e.g.,confusion). Headache. Increased
thirst/urination. Unusual weakness/tiredness
CONTRAINDICATIONS:
COMMON ADVERSE EFFECTS: severe nausea, vomiting, or diarrhea; no bowel
NURSING CONSIDERATION: movement after using the medicine as a laxative; rectal bleeding; or. worsening
 Evaluate for therapeutic response (relief for flatulence, abdominal bloating). symptoms.
 Avoid carbonated beverages.
 To reduce air swallowing, take after meals atr bedtime for best results. INDICATIONS: Symptomatic relief of hyperacidity

NURSING DIAGNOSIS: CONTRAINDICATIONS: High calcium levels (hypercalcemia).

 Knowledge, Deficient of causes of pain and discomfort; inexperience with Stomach/intestinal blockage. Kidney disease(e.g., kidneystones). Severe loss
treatment measures, nonpharmacologic and pharmacologic; ofbody water(dehydration)
 Pain, Acute related to episiotomy, perineal laceration, or hemorrhoids
NURSING CONSIDERATION:
 Observe ’10 rights’ in drug administration to avoid medication errors.
 Monitor and record pain scales to serve as baseline data and to determine
the effectiveness of the drug.
 Give drug 20 min- 1hour after meal to counteract the hydrochloric acid
production by neutralizing the acidity. Administer with atleast 8 ounces of
water to enhance absorption.
 Monitor stool consistency to prevent diarrhea and constipation.

NURSING DIAGNOSIS:
 Health Maintenance, Ineffective related to misuse of antacids.
 Knowledge, Deficient related to misinterpretation of information.
 ERCEFLORA LOPERAMIDE

GENERAL DRUG CLASSIFICATION: Antidiarrheals GENERAL DRUG CLASSIFICATION: Antidiarrheals

GENERIC NAME: Bacillus Clausii GENERIC NAME: Loperamide Hcl

BRAND NAME: Erceflora BRAND NAME: Imodium

MECHANISM OF ACTION: Contributes to the recovery of the intestinal microbial MECHANISM OF ACTION: Directly affects intestinal wall muscles through opioid
flora altered during the course of microbial disorders of diverse origin. It produces receptor. Therapeutic Effect: Slows intestinal motility, prolongs transit time of
various vitamins, particularly group B vitamins thus contributing to correction of intestinal contents by reducing fecal volume, diminishing loss of fluid,
vitamin disorders caused by antibiotics & chemotherapeutic agents. Promotes electrolytes, increasing viscosity, bulk of stool. Increases tone of anal sphincter.
normalization of intestinal flora.
SIDE EFFECTS: Dry mouth, drowsiness, abdominal discomfort, allergic reaction
SIDE EFFECTS: rash, urticaria and angioedema (rash, pruritus). Toxicity results in constipation, GI irritation (nausea, vomiting),
CNS depression. Activated charcoal is used to treat loperamide toxicity.
COMMON ADVERSE EFFECTS: none known
COMMON ADVERSE EFFECTS: cardiac arrhythmias and electrolyte disturbances
INDICATIONS: Acute diarrhea with duration of ≤ 14 days dues to infection,
drugs or poisons. Chronic or persistent diarrhea with duration of ≥ 14 days. INDICATIONS: Acute Diarrhea, Traveler’s Diarrhea

CONTRAINDICATIONS: Not for use in immunocompromised patients (cancer CONTRAINDICATIONS: Hypersensitivity to loperamide. Abdominal pain without
patients on chemotherapy, patients taking immunopressant meds). diarrhea;

NURSING CONSIDERATION: NURSING CONSIDERATION:

Before:  Do not administer if GI bleeding, mechanical obstruction is suspected.
 Check the doctor’s order. Investigate cause of diarrhea
 Shake drug well before administration.  Do not exceed prescribed dose.
 Administer drug within 30 minutes after opening container.  Avoid tasks that require alertness, motor skills until response to drug
During:  Instruct pt to avoid alcohol
 Administer the right drug.
 Explain to the patient about the importance and purpose of the drug. NURSING DIAGNOSIS:
 Administer at the right time and right dosage.  Diarrhea related to laxative abuse.
After:  Nutrition, Imbalanced: Less than Body Requirements related to
 Document and record. misconceptions regarding OTC drugs.
 Take note of side effects: stomach upset or diarrhea.  Fluid Volume, Risk for Imbalanced
 Report severe diarrhea, difficulty breathing and unususal

NURSING DIAGNOSIS:
 Diarrhea related to laxative abuse.
 Nutrition, Imbalanced: Less than Body Requirements related to
misconceptions regarding OTC drugs.
 BISACODYL METACLOPRAMIDE

GENERAL DRUG CLASSIFICATION: Stimulant laxatives GENERAL DRUG CLASSIFICATION: Prokinetic agents

GENERIC NAME: Bisacodrl GENERIC NAME: Metaclopramide

BRAND NAME: Dulcolax BRAND NAME: Reglan

MECHANISM OF ACTION: Direct effect on colonic smooth musculature by MECHANISM OF ACTION: Blocks dopamine/serotonin receptors in
stimulating intramural nerve plexi. Therapeutic effect: Promotes fluid and ion chemoreceptor trigger zone of the CNS. Enhances acetylcholine response in upper
accumulation in colon increasing peristalsis, producing laxative affect. GI tract, causing increased motility and accelerated gastric emptying without
stimulating gastric, biliary, or pancreatic secretions; increases lower esophageal
SIDE EFFECTS: Some degree of abdominal discomfort, nausea, mild cramp, sphincter tone. Therapeutic Effect: Accelerates intestinal transit, promotes gastric
faintness, rectal administration: burning of rectal mucosa, mild proctitis, laxative emptying. Relieves nausea, vomiting.
dependence, chronic constipation, loss of normal bowel function. Chronic use or
overdose may result in electrolyte or metabolic disturbances (hypokalemia, SIDE EFFECTS: Drowsiness, restlessness, fatigue, lethargy, anxiety, headache,
hypocalcemia, matabolic acidosis, alkalosis), persistent diarrhea, vomiting, m insomnia, breast tenderness, altered menstruation, constipation, rash, dry mouth,
nuscle weakness, malabsoption, weight loss. galactorrhea, gynecomastia, hypotension, hypertension, tachycardia.

COMMON ADVERSE EFFECTS: none known COMMON ADVERSE EFFECTS: Extrapyramidal reactions occur most frequently
in children, young adults (18–30 yrs) receiving large doses (2 mg/kg) during
INDICATIONS: Constipation chemotherapy and usually are limited to akathisia (involuntary limb movement,
facial grimacing, motor restlessness). Neuroleptic malignant syndrome
CONTRAINDICATIONS: Abdominal pain, appendicitis, intestinal obstruction (diaphoresis, fever, unstable B/P, muscular rigidity) has been reported.
nausea, undiagnosed rectal bleeding, vomiting. Cautions: Excessive use may lead
to fluid alectrolyte imbalance. INDICATIONS: Diabetic Gastroparesis, Prevention of Chemotherapy-Induced
Nausea/Vomiting
NURSING CONSIDERATION:
 Assess bowel sounds for peristalsis. CONTRAINDICATIONS: Hypersensitivity to metoclopramide. Concurrent use of
 Monitor daily pattern of bowel activity and stool consistency; record time of medications likely to produce extrapyramidal reactions.Situations in which GI
evacuation. motility may be dangerous (e.g., GI hemorrhage, GI perforation/obstruction),
 Assess for abdominal disturbances. history of seizure disorder, pheochromocytoma. Cautions: Renal impairment, HF,
 Monitor serum electrolytes in those exposed to prolonged, frequent, or cirrhosis, hypertension, depression, Parkinson’s disease, elderly.
excessive use of medication.
NURSING CONSIDERATION:
NURSING DIAGNOSIS:  Assess for dehydration
 Constipation, Risk for.  Assess for nausea, vomiting, abdominal distention, bowel sounds.
 Pain, Acute (fear of) related to first postdelivery bowel movement secondary  Monitor for anxiety, restlessness, extrapyramidal symptoms (EPS) during IV
to episiotomy, hemorrhoids, or perineal wounds administration.
 Monitor daily pattern of bowel activity, stool consistency. Assess skin for
rash.
 Evaluate for therapeutic response from gastroparesis (Monitor renal function,
B/P, heart rate.

NURSING DIAGNOSIS:
 Nutrition, Imbalanced: Less than Body Requirements related to inability to
ingest food.
 Fluid Volume, Risk for Deficient
PROPYLTHIOURACIL
INSULIN ISOPHANE SUSPENSION
GENERAL DRUG CLASSIFICATION: Antithyroid agents
GENERAL DRUG CLASSIFICATION: Intermediate-acting insulin
GENERIC NAME: Propylthiouracil
GENERIC NAME: Insulin Isophane Suspension
BRAND NAME: Propyl-Thyracil (CAN)
BRAND NAME: HumuLIN N, HumuLIN N KwikPen, NovoLIN N, ReliOn/NovoLIN N
MECHANISM OF ACTION: Blocks conversion of thyroxine to triiodothyronine in
peripheral tissues. Therapeutic Effect: Inhibits synthesis of thyroid hormone. MECHANISM OF ACTION: NPH insulin is an isophane suspension of human
insulin and is categorized as an intermediate-acting insulin. It helps increase the
SIDE EFFECTS: Urticaria, rash, pruritus, nausea, skin pigmentation, hair loss, cellular intake of glucose in the liver, adipose tissue, and skeletal muscles. It acts
headache, paresthesia. Occasional: Drowsiness, lymphadenopathy, vertigo. Rare: as basal insulin and stimulates the liver to promote hepatic glycogen synthesis,
Drug fever, lupus-like syndrome. fatty acid metabolism for lipoprotein synthesis. In skeletal muscles, it promotes
glycogen and protein synthesis. In adipose tissue, it helps in triglyceride synthesis
COMMON ADVERSE EFFECTS: Agranulocytosis (may occur as long as 4 mos and regulates lipolysis by inhibiting triglyceride hydrolysis. At the cellular level, it
after therapy), pancytopenia, fatal hepatitis have occurred. makes the cell membrane permeable for ions such as potassium, magnesium, and
phosphorus and increases their cellular uptake.
INDICATIONS: Hyperthyroidism
SIDE EFFECTS: Incidence not known. Redness, swelling, or itching skin at the
CONTRAINDICATIONS: Hypersensitivity to propylthiouracil. Cautions: In injection site. Weight gain. Anxiety, bloating or swelling of the face, arms, hands,
combination with other agranulocytosis-inducing drugs. lower legs, or feet, blurred vision, chills, cold sweats, coma, confusion,
convulsions, cool, pale skin, cough, decreased urine, depression, difficulty,
NURSING CONSIDERATIONS: swallowing, dizziness, dry mouth, fast heartbeat, headache, hives, itching, or
BASELINE ASSESSMENT rash, increased hunger, increased thirst, irregular heartbeat, loss of appetite,
 Obtain baseline weight, pulse. Obtain baseline T3, T4, TSH level, LFT. muscle pain or cramps, nausea or vomiting, nightmares, numbness or tingling in
INTERVENTION/EVALUATION the hands, feet, or lips, puffiness or swelling of the eyelids or around the eyes,
 Monitor pulse, weight daily. face, lips, or tongue, rapid weight gain, shakiness, slurred speech tightness in the
 Check for skin eruptions, pruritus, swollen lymph glands. Be alert for signs, chest, tingling of the hands or feet, unusual tiredness or weakness, unusual
symptoms of hepatic injury, hepatitis (nausea, vomiting, drowsiness, weight gain or loss.
jaundice).
 Monitor hematology results for bone marrow suppression; observe for signs COMMON ADVERSE EFFECTS: Hypoglycemia
of infection, bleeding.
INDICATIONS: Adult and pediatric with type 1 and type 2 diabetes mellitus .
NURSING DIAGNOSIS:
 Activity Intolerance related to imbalanced thyroid hormone. CONTRAINDICATIONS: Hypersensitivity reactions. Allergic reactions
 Health Maintenance, Ineffective related to inability to maintain drug regimen.
 Tissue Perfusion, Ineffective Peripheral related to deficient thyroid hormone NURSING CONSIDERATIONS:
 Healthcare workers should teach patients how to resuspend
 NPH premixed insulin before injection patient's physical activity.
 Monitor electrolyte.
 Frequent glucose monitoring is required in children on NPH insulin

NURSING DIAGNOSIS:
 Skin Integrity, Risk for Impaired.
 Nutrition, Readiness for Enhanced related to excessive intake associated with
metabolic need.
 Knowledge, Deficient related to inexperience with insulin therapy
INSULIN GLARGINE GLIMEPERIDE

GENERAL DRUG CLASSIFICATION: Long-acting insulins GENERAL DRUG CLASSIFICATION:

GENERIC NAME: Insulin Glargine (rdna original) injection GENERIC NAME: Glimeperide

BRAND NAME: Lantus BRAND NAME: Amaryl

MECHANISM OF ACTION: Insulin glargine lowers blood glucose level by MECHANISM OF ACTION:Stimulates release of insulin from beta cells of
stimulating peripheral glucose uptake and by inhibiting hepatic glucose pancreas, decreases glucose output from liver, increases insulin sensitivity at
production. Lixisenatide increases glucose-dependent insulin release,decreases peripheral sites. Lowers serum glucose.
glucagon secretion, and slows gastric emptying.
SIDE EFFECTS:Altered taste, dizziness, drowsiness, weight gain, constipation,
SIDE EFFECTS: Dizziness, sweating, confusion, headache, shakiness, fast diarrhea, heartburn, nausea, vomiting, stomach fullness, headache,
heartbeat, anxiety, sudden weight gain, shortness of breath photosensitivity, peeling of skin, pruritus, rash.

COMMON ADVERSE EFFECTS: Heart Failure, Hypokalemia, Hypoglycemia COMMON ADVERSE EFFECTS: Overdose or insufficient food intake may produce
hypoglycemia (esp. with increased glucose demands). GI hemorrhage, cholestatic
INDICATIONS: Improve glycemic control in adults and pediatric patients with hepatic jaundice, leukopenia, thrombocytopenia, pancytopenia, agranulocytosis,
type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. aplastic or hemolytic anemia

CONTRAINDICATIONS: Hypoglycemia, hypersensitivity INDICATIONS: Diabetes Mellitus

NURSING CONSIDERATIONS: CONTRAINDICATIONS: Hypersensitivity to glimepiride, sulfonamides. Diabetic

 Monitor for signs and symptoms of hypoglycemia. ketoacidosis (with or without coma). Cautions: Renal/hepatic impairment,
 Monitor fasting blood glucose and periodically. PATIENT/FAMILY TEACHING: glucose-altering conditions (fever, trauma, infection), G6PD deficiency, elderly,
 Do not inject into areas with redness, swelling, itching, or dimpling. malnourished. Allergy to sulfa. Hypersensitivity to glimepiride, sulfonamides.
 Absorption patterns for this drug are not dependent on the injection site. Diabetic ketoacidosis (with or without coma). Cautions: Renal/hepatic
 Ingest some form of sugar if symptoms of hypoglycemia develop; and seek impairment, glucose-altering conditions (fever, trauma, infection), G6PD
medical assistance. deficiency, elderly, malnourished. Allergy to sulfa.
 Check blood sugar as prescribed.
NURSING CONSIDERATIONS:
 Do not take any other medication unless approved by physician.
 Check serum glucose level. Discuss lifestyle to determine extent of learning,
 Do not breast feed while taking this drug without consulting physician.
emotional needs.
INTERVENTION/EVALUATION
NURSING DIAGNOSIS:
 Monitor serum glucose level, food intake.
 Assess for hypoglycemia, hyperglycemia. Be alert to conditions that alter
 Skin Integrity, Risk for Impaired.
glucose requirements (fever, increased activity or stress, trauma, surgical
 Nutrition, Readiness for Enhanced related to excessive intake associated with
procedure).
metabolic need.
PATIENT/ FAMILY TEACHING
 Knowledge, Deficient related to inexperience with insulin therapy
 Diet and exercise are principal parts of treatment; do not skip or delay
meals.
 Avoid alcohol.
 NURSING DIAGNOSIS:
NURSING DIAGNOSIS:
 Injury, Risk for.  Nutrition, Readiness for Enhanced related to excessive food intake.
 Nutrition, Readiness for Enhanced related to excessive food intake.  Knowledge, Deficient related to lack of exposure to teaching about taking
adequate food with oral antidiabetics

METFORMIN
PIOGLITAZONE
GENERAL DRUG CLASSIFICATION: Biguanides
GENERAL DRUG CLASSIFICATION: Thiazolidinediones
GENERIC NAME: Metformin HCl
GENERIC NAME: Pioglitazone
BRAND NAME: Glucophage, Glucophage XR, Fortamet, Glumetza, Riomet
BRAND NAME: Actos
MECHANISM OF ACTION: Decreases hepatic production of glucose. Decreases
intestinal absorption of glucose, improves insulin sensitivity. Therapeutic Effect: MECHANISM OF ACTION: Improves target-cell response to insulin without
Improves glycemic control, stabilizes/decreases body weight, improves lipid increasing pancreatic insulin secretion. Decreases hepatic glucose output,
profile. increases insulin-dependent glucose utilization in skeletal muscle. Therapeutic
Effect: Lowers serum glucose concentration.
SIDE EFFECTS: GI disturbances (diarrhea, nausea, vomiting, abdominal
bloating, flatulence, anorexia) that are transient and resolve spontaneously SIDE EFFECTS: Headache, upper respiratory trant infection, sinusitis, myalgia,
during therapy, unpleasant/ metallic taste that resolves spontaneously during pharyngitis, aggravated diabetes mellitus.
therapy. Lactic acidosis occurs rarely (0.03 cases/1,000 pts) but is a serious and
often fatal (50%) complication. Lactic acidosis is characterized by increase in COMMON ADVERSE EFFECTS: Hepatotoxicity occurs rarely. May cause/worsen
blood lactate levels (greater than 5 mmol/L), decrease in blood pH, electrolyte macular edema. Increased risk of CHF. May increase risk of fracture. Pts with
disturbances. Symptoms include unexplained hyperventilation, myalgia, malaise, ischemic heart disease are at high risk of MI.
drowsiness.
INDICATIONS: Diabetes Mellitus, Combination Therapy, Monotherapy, Dosage
COMMON ADVERSE EFFECTS: cardiovascular collapse, acute HF, acute MI, Adjustment in CHF
prerenal azotemia.
CONTRAINDICATIONS: Active hepatic disease; diabetic ketoacidosis; increased
INDICATIONS: Diabetes Mellitus serum transaminase, including ALT greater than 2.5 times normal serum level;
type 1 diabetes mellitus; heart failure. Cautions: Hepatic impairment, edematous
CONTRAINDICATIONS: Hypersensitivity to metformin. Severe renal pts.
disease/dysfunction; acute or chronic metabolic acidosis (with or without coma).
Cautions: HF, hepatic impairment, excessive acute/chronic alcohol intake, elderly. NURSING CONSIDERATIONS:
 Obtain hepatic enzyme levels before initiating therapy and periodically
NURSING CONSIDERATIONS: thereafter. Ensure follow-up instruction if pt, family do not thoroughly
 Verify pt has not received IV contrast dye within last 48 hrs. Obtain CBC, understand diabetes management, glucose-testing technique.
renal function test, fasting serum glucose, Hgb A1c.  Monitor serum glucose, Hgb , hepatic function tests, esp. AST, ALT. Assess
 Monitor fasting serum glucose, Hgb A1c, renal function, CBC. Monitor folic for hypoglycemia, hyperglycemia. Be alert to conditions that alter serum
acid, renal function tests for evidence of early lactic acidosis. If pt is on glucose requirements: fever, increased activity, stress,, surgical procedures.
concurrent oral sulfonylureas, assess for hypoglycemia Monitor for sign/symptoms of CHF.
 Report symptoms of lactic acidosis (unexplained hyperventilation, muscle  Avoid alcohol and Inform physician of chest pain, palpitations, abdominal
aches, extreme fatigue, unusual drowsiness). pain, fever, rash, hypoglycemic reactions, yellowing of skin/eyes, dark urine,
 Avoid alcohol. light stool, nausea, vomiting.
 Report any change in vision. Report rapid weight gain, edema, difficulty  Monitor patient for tachycardia; monitor ECG for PR-interval prolongation.
breathing  Refer patients with elevated serum calcitonin level or thyroid nodules on
examination or neck imaging to an endocrinologist
NURSING DIAGNOSIS:
 Nutrition, Readiness for Enhanced related to excessive food intake. NURSING DIAGNOSIS:
 Knowledge, Deficient related to lack of exposure to teaching about taking  Skin Integrity, Risk for Impaired.
adequate food with oral antidiabetics  Nutrition, Readiness for Enhanced related to excessive intake associated with
metabolic need.
 Knowledge, Deficient related to inexperience with insulin therapy
TRULICITY GLYXAMBI

GENERAL DRUG CLASSIFICATION: GLP-1 (glucagon-like peptide-1) receptor GENERAL DRUG CLASSIFICATION: DPP-4 inhibitor medication
agonists
GENERIC NAME: Empagliflozin and Linagliptin tablets
GENERIC NAME: Dulaglutide injection
BRAND NAME: Glyxambi
BRAND NAME: Trulicity
MECHANISM OF ACTION: GLYXAMBI is the first and only diabetes treatment in
MECHANISM OF ACTION: A human glucagon-like peptide-1 (GLP-1) receptor the U.S. to combine the dual mechanisms of action of a sodium glucose co-
agonist that, like endogenous GLP-1, binds to and activates the GLP-1 receptor in transporter-2 (SGLT2) inhibitor and a dipeptidyl peptidase-4 (DPP-4) inhibitor in a
the pancreatic beta cells, leading to glucose-dependent insulin release. Also once-daily tablet taken in the morning.
decreases glucagon secretion and slows gastric emptying.
SIDE EFFECTS: Urinary tract infection. Common cold symptoms. Upper
SIDE EFFECTS: Severe pain in your upper stomach, spreading to your back, respiratory tract infections. Genital yeast infection. Increased urination. Joint
nausea, vomiting, swelling or a lump in your neck,,trouble swallowing, hoarse pain. Nausea. Runny or stuffy nose.
voice,,shortness of breath, headache, hunger, weakness, sweating ,confusion,
irritability, dizziness, fast heart rate, feeling jittery, little or no urination, swelling COMMON ADVERSE EFFECTS: None known
of your feet or ankles, and tiredness.
INDICATIONS: type 2 diabetes mellitus, cardiovascular disease
COMMON ADVERSE EFFECTS: none known
CONTRAINDICATIONS: Severe renal impairment, end-stage renal disease, or
INDICATIONS: Type 2 diabetes mellitus. dialysis. Hypersensitivity to empagliflozin, linagliptin, or any of the excipients in
GLYXAMBI such as anaphylaxis, angioedema, exfoliative skin conditions, urticaria,
CONTRAINDICATIONS: patients with a personal or family history of medullary or bronchial hyper reactivity
thyroid carcinoma (MTC) and in patients with multiple endocrine neoplasia
syndrome type 2. NURSING CONSIDERATIONS:
 Glyxambi is usually taken in the morning, with or without food.
NURSING CONSIDERATIONS:  Your blood sugar will need to be checked often, and you may also need to
 Use caution when initiating dulaglutide therapy or escalating dosage in test the level of ketones in your urine.
patients with renal insufficiency.
 Monitor renal function, especially in patients who report severe GI adverse NURSING DIAGNOSIS:
reactions (nausea, vomiting, diarrhea, dehydration).  Skin Integrity, Risk for Impaired.
 Monitor patients for signs and symptoms of pancreatitis (including persistent  Nutrition, Readiness for Enhanced related to excessive intake associated with
severe abdominal pain, sometimes radiating to the back, which may or may metabolic need.
not be accompanied by vomiting).  Knowledge, Deficient related to inexperience with insulin therapy
 Discontinue drug if pancreatitis is suspected. Don't restart drug if pancreatitis
is confirmed.
  Report fever, sore throat, muscle aches, sudden weight gain, swelling, loss of
appetite, or fatigue. Avoid alcohol, minimize use of caffeine.
 Report symptoms of elevated blood sugar levels (blurred vision, headache,
increased thirst, frequent urination).
 Maintain strict oral hygiene.
 Do not abruptly discontinue without physician’s approval.

NURSING DIAGNOSIS:
 Electrolyte Imbalance, Risk for, especially sodium and potassium.
 Knowledge, Deficient of drug regimen related to complicated dosing
PREDNISONE schedule.
FINASTERIDE
GENERAL DRUG CLASSIFICATION: Corticosteroids
GENERAL DRUG CLASSIFICATION: 5-alpha reductase inhibitors
GENERIC NAME: Prednisolone
GENERIC NAME: Finasteride
BRAND NAME: Pediapred, FloPred, Orapred, Orapred ODT, Millipred, Millipred
DP, Prelone Syrup, Veripred 20 BRAND NAME: Propecia

MECHANISM OF ACTION: Inhibits accumulation of inflammatory cells at MECHANISM OF ACTION: Inhibits 5-alpha reductase, an intracellular enzyme
inflammation sites, phagocytosis, lysosomal enzyme release/synthesis, release of that converts testosterone into dihydrotestosterone (DHT) in prostate gland,
mediators of inflammation. Therapeutic Effect: Prevents/suppresses cell-mediated resulting in decreased serum DHT. Therapeutic Effect: Reduces size of prostate
immune reactions. Decreases/prevents tissue response to inflammatory process. gland.

SIDE EFFECTS: Insomnia, heartburn, nervousness, abdominal distention, SIDE EFFECTS: Hypersensitivity reaction, circumoral swelling, testicular pain
diaphoresis, acne, mood swings, increased appetite, facial flushing, delayed occur rarely.
wound healing, increased susceptibility to infection, diarrhea, constipation.
Headache, edema, change in skin color, frequent urination. COMMON ADVERSE EFFECTS:

COMMON ADVERSE EFFECTS: Tachycardia, allergic reaction (rash, urticaria), INDICATIONS: Benign Prostatic Hyperplasia (BPH), Hair Loss
psychological changes, hallucinations, depression.
CONTRAINDICATIONS: Hypersensitivity to finasteride, pregnancy or women of
INDICATIONS: treat endocrine, rheumatic, and hematologic disorders. childbearing potential. Cautions: Hepatic impairment, urinary outflow obstruction,
urinary retention. Women who are attempting to conceive should avoid exposure
CONTRAINDICATIONS: Acute superficial herpes simplex keratitis, systemic to crushed or broken tablets.
fungal infections, varicella, administration of live or attenuated virus vaccines.
Hyperthyroidism, cirrhosis, ocular herpes simplex, respiratory tuberculosis, NURSING CONSIDERATIONS:
untreated systemic infections, renal/hepatic impairment, following acute MI,  Digital rectal exam, serum prostate-specific antigen (PSA) determination
cataracts, glaucoma, seizures, peptic ulcer disease, osteoporosis, myasthenia should be performed in pts with benign prostatic hyperplasia (BPH) before
gravis, hypertension, HF, ulcerative colitis, thromboembolic disorders, elderly, pts initiating therapy and periodically thereafter. Assess usual urinary
at risk for hyperglycemia characteristics (frequency, ability to empty bladder, urinary flow). Assess
degree of urinary retention with baseline bladder scan.
NURSING CONSIDERATIONS:  Diligently monitor I&O, esp. in pts with large residual urinary volume,
 Monitor B/P, serum electrolytes, glucose, results of bone mineral density severely diminished urinary flow, or obstructive uropathy. Obtain periodic
test, height, weight in children. Be alert to infection (sore throat, fever, bladder scan to assess treatment effectiveness (or to assess for acute urinary
vague symptoms); assess oral cavity daily for signs of Candida infection. retention).
Monitor for symptoms of adrenal insufficiency, immunosuppression.  Treatment may cause impotence, decreased volume of ejaculate.
 May not notice improved urinary flow even if prostate gland shrinks.  Monitor fluid intake and urine output. Drug causes urine retention and
 Must take medication longer than 6 mos, and it is unknown if medication urinary hesitancy
decreases need for surgery.
 Because of potential risk to male fetus, women who are or may become NURSING DIAGNOSIS:
pregnant should not handle tablets or be exposed to pt’s semen.  Urinary Retention related to atropine administration
 Immediately report inability to urinate or severe bladder pain.  Oral Mucous Membrane, Impaired related to decreased oral secretions
 Injury, Risk for
NURSING DIAGNOSIS:  Constipation, Risk for
 Impaired Tissue Integrity

ATROPINE DOPAMINE

GENERAL DRUG CLASSIFICATION: Antiarrhythmics: Anticholinergics– GENERAL DRUG CLASSIFICATION: Inotropic Agents, Sympathomimetic
belladonna alkaloids (adrenergic agonist): Cardiac stimulant, vasopressor

GENERIC NAME: Atropine GENERIC NAME: Dopamine

BRAND NAME: Isopto Atropine BRAND NAME: Intropin

MECHANISM OF ACTION: Inhibits muscarinic actions of acetylcholine at MECHANISM OF ACTION: Stimulates adrenergic and dopaminergic receptors.
parasympathetic neuroeffector junction, blocking vagal effects on SA and AV Effects are dose dependent. Lower dosage stimulates dopaminergic receptors,
nodes, enhancing conduction through AV node and increasing HR causing renal vasodilation. Higher doses stimulate both dopaminergic and beta1-
adrenergic receptors, causing cardiac stimulation and renal vasodilation. Higher
SIDE EFFECTS: dry mouth, decreased perspiration, blurred vision, tachycardia, doses stimulate alpha-adrenergic receptors, causing vasoconstriction, increased
constipation, and urinary retention. BP.

COMMON ADVERSE EFFECTS: nausea, headache, dry skin, abdominal SIDE EFFECTS: Headache, arrhythmias, tachycardia, anginal pain, palpitations,
distension, hypotension or hypertension, impotence, photophobia (intolerance of vasoconstriction, hypotension, nausea, vomiting, dyspnea. Piloerection (goose
bright light), and coma.hypoglycemia, hyponatremia, hypokalemia, rash, and bumps), bradycardia, widening of QRS complex.
anaphylaxis.
COMMON ADVERSE EFFECTS: Ventricular arrhythmias, tachycardia. Pts with
INDICATIONS: hypersalivation, bronchial secretions, or bradycardia occlusive vascular disease are at high risk for further compromise of circulation to
extremities, which may result in gangrene. Tissue necrosis with sloughing may
CONTRAINDICATIONS: hypersensitive to drug, hyperthermia, acute angle- occur with extravasation of IV solution.
closure glaucoma, obstructive uropathy, obstructive disease of GI tract, and
paralytic ileus, toxic megacolon, and intestinal atony, hyperthyroidism, CAD, HTN, INDICATIONS: To treat shock and correct hemodynamic imbalances; to improve
HF, tachycardia, hiatal hernia with reflux esophagitis, prostatic hypertrophy, perfusion to vital organs; to increase cardiac output; to correct hypotension
myasthenia gravis, or renal or hepatic impairment, and in elderly patients, Down
syndrome because they may be more sensitive to drug. CONTRAINDICATIONS: Contraindicated in patients with uncorrected
tachyarrhythmias, pheochromocytoma, or ventricular fibrillation. Use cautiously in
NURSING CONSIDERATIONS: patients with occlusive vascular disease, cold injuries, diabetic endarteritis, and
 Doses less than 0.5 mg in adults and less than 0.1 mg in children may arterial embolism; in those with a history of sulfite sensitivity; and in those taking
increase risk of paradoxical bradycardia. MAO inhibitors.
 Watch for tachycardia in cardiac patients because it may lead to ventricular
fibrillation. NURSING CONSIDERATIONS:
 Pt must be on continuous cardiac monitoring. Determine weight (for dosage  Avoid giving dobutamine to patients with uncorrected hypovolemia. Expect
calculation). Obtain initial B/P, heart rate, respirations. Assess patency of IV prescriber to order whole blood or plasma volume expanders to correct
access. hypovolemia. Also avoid giving dobutamine to patients with acute MI because
 Continuously monitor for cardiac arrhythmias. Measure urinary output it can intensify or extend myocardial ischemia
frequently.  Use drug cautiously in patients allergic to sulfites because drug may cause
 Assess peripheral circulation(palpate pulses, note color/temperature of anaphylacticlike signs and symptoms; commercially available dobutamine
extremities). Be alert to excessive vasoconstriction injections contain sodium bisulfite. Also use drug cautiously in patients with
atrial fibrillation because drug increases AV conduction. Keep in mind that
NURSING DIAGNOSIS: patient should be adequately digitalized before administration.
 Activity Intolerance, Risk for
 Falls, Risk for NURSING DIAGNOSIS:
 Knowledge, Deficient related to unfamiliar medications  Decreased Cardiac Output
 Ineffective Tissue Perfusion
DOBUTAMINE

GENERAL DRUG CLASSIFICATION: Cardiac stimulant: Synthetic EPINEPHRINE

catecholamine
GENERAL DRUG CLASSIFICATION: Alpha- and beta-adrenergic agonists
GENERIC NAME: Dobutamine (sympathomimetic agents)

BRAND NAME: Dobutrex GENERIC NAME: Epinephrine

MECHANISM OF ACTION: Mainly stimulates beta1-adrenergic receptors, and BRAND NAME: Adrenaclick, Adrenalin, Adrenalin Chloride,
mildly stimulates beta2- and alpha1-adrenergic receptors. Beta1-receptor Auvi Q · Epipen · Epipen Jr · Twinject
stimulation produces a positive inotropic effect on the myocardium, increasing
cardiac output by boosting myocardial contractility and stroke volume. Increased MECHANISM OF ACTION: It works by relaxing the muscles in the airways and
myocardial contractility raises coronary blood flow and myocardial oxygen tightening the blood vessels.induces increased vascular smooth muscle
consumption. Systolic blood pressure typically rises as a result of increased stroke contraction, pupillary dilator muscle contraction, and intestinal sphincter muscle
volume. contraction.

SIDE EFFECTS: increased heart rate and increased blood pressure, SIDE EFFECTS: skin redness, swelling, warmth, or tenderness at the site of
ventricular ectopic activity, nervousness, headache, nausea, vomiting, injection, difficulty breathing, pounding, fast, or irregular heartbeat, nausea,
palpitations, low platelet counts (thrombocytopenia), or swelling at the injection vomiting, sweating, dizziness, nervousness, anxiety, or restlessness, weakness,
site. pale skin, headache, uncontrollable shaking of a part of your body.

COMMON ADVERSE EFFECTS: Fever, headache, nervousness, restlessness CV: COMMON ADVERSE EFFECTS: Anxiety, apprehensiveness,
Angina, bradycardia, hypertension, hypotension, palpitations, PVCs, tachycardia hallucinations,insomnia, seizures, stroke, temporary worsening of Parkinson’s
GI: Nausea, vomiting, Dyspnea, Extravasation with tissue necrosis and sloughing, disease, tremor, arrhythmias, chest discomfort, severe hypertension,
rash, Hypokalemia hyperglycemia in diabetics, anorexia, tissue necrosis hyperkalemia; hypokalemia,
hypoaesthesia.
INDICATIONS: low cardiac output and heart failure
INDICATIONS: To treat bronchospasm, croup, anaphylaxis, severe anaphylactic
CONTRAINDICATIONS: Hypersensitivity to dobutamine or its components, shock cardiac arrest
idiopathic hypertrophic subaortic stenosis
CONTRAINDICATIONS: Cerebral arteriosclerosis, coronary insufficiency,
NURSING CONSIDERATIONS: counteraction of phenothiazine-induced hypotension, dilated cardiomyopathy,
general anesthesia with halogenated hydro carbons or cyclopropane.
 CONTRAINDICATIONS: bronchial asthma or related bronchospastic conditions,
NURSING CONSIDERATIONS: decompensated NYHA functional class IV heart failure requiring intravenous
 Use epinephrine with extreme caution in patients with angina, arrhythmias, inotropic therapy, severe liver impairment, second- or third-degree
asthma, degenerative heart disease, or emphysema. . atrioventricular block, sick sinus syndrome.
 Use drug cautiously in elderly patients and those with cardiovascular disease
(other than listed above), diabetes mellitus, hypertension, hyperthyroidism, NURSING CONSIDERATIONS:
prostatic hypertrophy, and psychoneurologic disorders.  Monitor BP and pulse frequently during dose adjustment period and
 Be aware that some preparations contain sulfites, which may cause allergic- periodically
type reactions.
 Monitor patient closely for adverse effects. NURSING DIAGNOSIS:

NURSING DIAGNOSIS:
 Impaired gas exchange related to ventilation perfusion imbalance.
 Ineffective breathing pattern related to the swelling of the nasal mucosa wall
CARVEDILOL DONEPEZIL

GENERAL DRUG CLASSIFICATION: Alpha- and Beta-adrenergic blocker: GENERAL DRUG CLASSIFICATION: Antidementia: Piperidine derivative
Antihypertensive
GENERIC NAME: Donepezil
GENERIC NAME: Carvedilol
BRAND NAME: Aricept and Aricept ODT
BRAND NAME: Betacard
MECHANISM OF ACTION: Reversibly inhibits acetylcholine and improves
MECHANISM OF ACTION: inhibits exercise induce tachycardia through its acetylcholine's concentrantration at cholinergic synapses. Raising acetylcholine
inhibition of beta adrenoceptors. Carvedilol's action on alpha-1 adrenergic level in the cerebral cortex may improve cognition. Donepezil becomes less
receptors relxes smooth muscle in vasuculture resistance and an overall reduction effective as Alzheimer's disease progresses and number of intact cholinergic
in blood pressure. At higher doses, calcium channel blocking and antioxidant neurons declines.
activity of carvedilol prevents oxidation of low-density lipoprotein and its uptake
into coronary circulation. SIDE EFFECTS: Nausea, diarrhea, headache, insomnia, nonspecific pain,
dizziness, mild muscle cramps, fatigue, vomiting, anorexia, ecchymosis,
SIDE EFFECTS: dizziness; diarrhea; dry eyes; tired feeling; or weight gain, depression, abnormal dreams, weight loss, arthritis, drowsiness, syncope,
hives, difficulty breathing; swelling of your face, lips, tongue and throat, a light frequent urination.
headed feeling, like you might pass out; slow or uneven heartbeats; swelling,
COMMON ADVERSE EFFECTS: none known
rapid weight gain, feeling short of breath, cold feeling of numbness in your
fingers or toes; chest pain, dry cough, wheezing, chest tightness, trouble INDICATIONS: Indicated for the treatment of dementia of the Alzheimer's type.
breathing, or high blood sugar. Efficacy has been demonstrated in patients with mild, moderate, and severe
Alzheimer's disease.
COMMON ADVERSE EFFECTS: Bradycardia, AV block, angina pectoris,
hypervolemia, leucopenia, hypotension, peripheral edema, allergy, malaise, CONTRAINDICATIONS: Donepezil is not recommended for patients with known
melena, periodontitis, hyperuricemia, hyponatremia, increased alkaline hypersensitivity to donepezil hydrochloride or piperidine derivatives.
phosphatase, glycosuria, prothrombin times, SGPT and SGzoY levels, purpura,
somnolence, impotence, albuminuria, hypokinesia. NURSING CONSIDERATIONS:
 Use donepezil cautiously in patients with bladder obstruction because drug's
INDICATIONS: chronic therapy of heart failure with reduced ejection fraction weak peripheral cholinergic effect could obstruct outflow.
(HFrEF), hypertension, and left ventricular dysfunction
 Use drug cautiosly in patients with asthma, COPD, or other pulmonary NURSING CONSIDERATIONS:
disorders because it has weak affinity for peripheral cholinesteraze, which  Monitor periodic LFTs and renal and hematopoietic function studies in
may increade bronchoconstriction and bronchial secretions. patients receiving repeated or prolonged therapy.
 If patient has cardiac disease, monitor heart rate and rhythm for  Monitor elderly patients for dizziness, ataxia, and mental status changes.
bradycardia, which may result from increased vagal tonr caused by drug's Patients are at an increased risk for falls.
inhibition of peripheral cholinesterase, reduced heart rate may be especially
significant if patient has sick sinus syndrome, bradycardia, or other NURSING DIAGNOSIS:
supraventricular arrhythmia.  Risk for injury related to adverse reactions
 Take safety precautions if patient is dizzy or has other adverse CNS  Impaired physical mobility related to sedation
reactions.  Noncompliance related to long-term therapy
 Deficient knowledge related to drug therapy
NURSING DIAGNOSIS:

 Ineffective airway clearance related to lack of broncho dilating effects

 Risk for injury related to CNS effects
 Diarrhea related to increased parasympathetic activity

DIAZEPAM PHENOBARBITAL

GENERAL DRUG CLASSIFICATION: Anxiolytics: Benzodiazepines GENERAL DRUG CLASSIFICATION: Anticonvulsant, sedative-hypnotic:
Barbiturate
GENERIC NAME: Diazepam
GENERIC NAME: Phenobarbital
BRAND NAME: Valium, Diastat, and DiastatAcuDial
BRAND NAME: Solfoton
MECHANISM OF ACTION: potentiates the effects of GABA, depresses the CNS,
and suppresses the spread of seizure activity. For status epilepticus, partial and MECHANISM OF ACTION: Inhibits ascending conduction of impulses in the
tonic-clonic seizures, muscle spasms, anxiety, sedation induction, and alcohol reticular formation, which controls CNS arousal to produce drowsiness, hypnosis,
withdrawal. and sedation. Phenobarbital also decreases the spread of seizure activity in
cortex, thalamus, and limbic system. It promotes an increased threshold for
SIDE EFFECTS: drowsiness, dizziness, tiredness, muscle weakness, headache, electrical stimulation in the motor cortex, which may contribute to its
dry mouth, nausea, constipation, confusion, difficulty urinating, frequent anticonvulsant properties
urination, changes in sex drive or ability
SIDE EFFECTS: drowsiness, headache, dizziness, excitement or increased
COMMON ADVERSE EFFECTS: CV collapse, bradycardia, neutropenia, activity (especially in children), nausea, and vomiting
respiratory depression, apnea
COMMON ADVERSE EFFECTS: anxiety, depression, dizziness, drowsiness,
headache, irritability, lethargy, mood changes, paradoxical stimulation, sedation,
INDICATIONS: status epilepticus, partial and tonic-clonic seizures, muscle
vertigo, hypotension, sinus bradycardia, miosis, ptosis, Constipation, diarrhea,
spasms, anxiety, sedation induction, and alcohol withdrawal.
nausea, vomiting, decreased libido, impotence, sexual dysfunction, arthralgia,
CONTRAINDICATIONS: hypersensitive to drug and in infants younger than age bone tenderness, bronchospasm, respiratory depression, dermatitis,
photosensitivity, rash, urticaria.
6 months (oral form), myasthenia gravis, severe respiratory insufficiency, severe
hepatic insufficiency, or sleep apnea syndrome, acute angle-closure glaucoma, INDICATIONS: To treat Seizures and Status epilepticus
patients experiencing shock, coma, or acute alcohol intoxication, elderly and
debilitated patients and in patients with hepatic or renal impairment, depression, CONTRAINDICATIONS: Hepatic disease; history of addiction to hypnotics or
history of substance abuse, impaired gag reflex, or chronic open-angle glaucoma. sedatives; hypersensitivity to phenobarbital, other barbiturates, or their
components; nephritis; porphyria; severe respiratory disease with airway CONTRAINDICATIONS: Hypersensitivity. Active peptic ulcer disease.
obstruction or dyspnea
NURSING CONSIDERATIONS:
NURSING CONSIDERATIONS:  Patients given implantable device for intrathecal delivery need to learn about
 Be aware that phenobarbital shouldn’t be given during third trimester of the programmable delivery system, frequent checks; how to adjust dose and
pregnancy because repeated use can cause dependence in neonate.Use I.V. programming.
route cautiously in patients with CV disease, hypotension, pulmonary
 Give with caution to patients whose spasticity contributes to upright posture
disease, or shock because drug may cause adverse hemodynamic.
or balance in locomotion or whenever spasticity is used to increase function.
 Because drug can cause respiratory depression, assess respiratory rate and
depth before use, especially in patient with bronchopneumonia, pulmonary  Taper dosage gradually to prevent hallucinations, possible psychosis, or other
disease, respiratory tract infection, or status asthmaticus. serious effects; abrupt discontinuation can cause serious reactions
 If necessary, crush tablets and mix with food or fluids.
NURSING DIAGNOSIS:
NURSING DIAGNOSIS:  Acute pain related to GI and CNS effects
 Risk for trauma or suffocation related to loss of large or small muscle  Disturbed thought processes related to CNS effects
coordination.  Risk for injury related to CNS effects
 Risk for ineffective airway clearance related to neuromuscular impairment.
BACLOFEN PHENYTOIN

GENERAL DRUG CLASSIFICATION: Antispastic:Centrally acting skeletal muscle GENERAL DRUG CLASSIFICATION: Anticonvulsant: Hydantoin derivative
relaxant
GENERIC NAME: Phenytoin
GENERIC NAME: Baclofen
BRAND NAME: Dilantin-30 (CAN), Dilantin-125, Dilantin Infatabs, Dilantin,
BRAND NAME: Apo-Baclofen (CAN), Gen-Baclofen (CAN), Lioresal, Lioresal Dilantin Kapseals, Phenytex
Intrathecal
MECHANISM OF ACTION: Limits the spread of seizure activity and the start of
MECHANISM OF ACTION: Baclofen (beta-[4-chlorophenyl]-GABA) is an agonist new seizures by regulating voltagedependent sodium and calcium channels in
at the beta subunit of gamma-aminobutyric acid on mono and polysynaptic neurons, inhibiting calcium movement across neuronal membranes, and
neurons at the spinal cord level and brain. The thinking is that baclofen reduces enhancing sodium-potassium ATP activity in neurons and glial cells. These actions
the release of excitatory neurotransmitters in the pre-synaptic neurons and all help stabilize the neurons.
stimulates inhibitory neuronal signals in the post-synaptic neurons with resultant
relief of spasticity. Baclofen is also found to have an affinity for voltage-gated SIDE EFFECTS: headaches, feeling drowsy, sleepy or dizzy, feeling nervous,
calcium channels. However, its clinical efficacy in this regard is still unclear. unsteady or shaky, feeling or being sick, constipation, sore or swollen gums, mild
skin rash.
SIDE EFFECTS: Vomiting, weak muscle tone, drowsiness, vision problems, coma,
difficulty breathing, and seizures. COMMON ADVERSE EFFECTS: Ataxia, Amblyopia,Gynecomastia, hyperglycemia,
Glycosuria, Peyronie’s disease, priapism, Exfoliative dermatitis, maculoÂpapular
COMMON ADVERSE EFFECTS: Sedation, ataxia, confusion, hallucinations, skin or morbilliform rash, purpuric dermatitis, Stevens-Johnson syndrome, toxic
reactions. Respiratory or CV depression, seizures. epidermal necrolysis

INDICATIONS: Alleviation of signs and symptoms of spasticity resulting from INDICATIONS: To treat tonic-clonic, simple, or complex partial seizures in
MS, particularly for the relief of flexor spasms and concomitant pain, clonus, patients who have had no prior treatment, status epilepticus, seizures during
muscular rigidity (for patients with reversible spasticity to aid in restoring residual neurosurgery
function); treatment of central spasticity (via SynchroMed pump)
Spinal cord injuries and other spinal cord diseases
CONTRAINDICATIONS: Adams-Stokes syndrome, delavirdine therapy,  Monitor CBC, renal and liver function test; teach client to take medication
hypersensitivity to phenytoin or its components, SA block, second- or thirddegree exactly as prescribed.
heart block, sinus bradycardia  Caution client not to engage in activities that require mental alertness until
dizziness and vertigo resolves.
NURSING CONSIDERATIONS:  Instruct to rise slowly from sitting or lying down position; Client should be
 Be aware that preferred administration routes for phenytoin are oral and I.V. use reliable birth control method.
injection. With I.M. administration, phenytoin has a variable absorption rate.
 If patient has difficulty swallowing, open prompt (rapid-release) capsules and NURSING DIAGNOSIS:
mix contents with food or fluid.
 Shake oral suspension before measuring dose, and use a calibrated  Risk for Trauma or Suffocation
measuring device.  Risk for Ineffective Airway Clearance
 To minimize GI distress, give phenytoin with or just after meals.  Situational Low Self-Esteem
 Deficient Knowledge
NURSING DIAGNOSIS:
 Risk for Trauma or Suffocation
 Risk for Ineffective Airway Clearance
 Situational Low Self-Esteem

LEVETIRACETAM
CARBIDOPA - LEVODOPA
GENERAL DRUG CLASSIFICATION: Anticonvulsants: Pyrrolidine derivative
GENERAL DRUG CLASSIFICATION: Dopamine Precursor: Antiparkinson agent
GENERIC NAME: Levetiracetam
GENERIC NAME: Carbidopa-Levodopa
BRAND NAME: Keppra, Keppra XR, Spritam
BRAND NAME: Levocarb CR, Parcopa, Atamet, Sinemet, Sinemet CR
MECHANISM OF ACTION: Modulation of synaptic neurotransmitter release
through binding to the synaptic vesicle protein SV2A in the brain. Brain cells
MECHANISM OF ACTION: Converted to dopamine in basal ganglia, increasing
normally "talk" to each other using electrical signals and chemicals. Seizures can
dopamine concentration in brain, inhibiting hyperactive cholinergic activity.
happen when the brain cells are not working properly or working faster than
Carbidopa prevents peripheral breakdown of levodopa, making more levodopa
usual. Levetiracetam slows down these electrical signals to stop seizure s
available for transport into brain. Reduces tremor.
SIDE EFFECTS: headaches, feeling sleepy and a blocked nose or itchy throat,
SIDE EFFECTS: Involuntary movements of face, tongue, arms, upper body,
COMMON ADVERSE EFFECTS: somnolence, headache, nervousness, ataxia nausea/vomiting; anorexia, depression, anxiety, confusion, nervousness, urinary
vertigo, mental status and personality changes, withdrawal seizures. retention, palpitations, dizziness, light-headedness, decreased appetite, blurred
vision, constipation, dry mouth, flushed skin, headache, insomnia, diarrhea,
INDICATIONS: Levetiracetam tablets are indicated as adjunctive therapy in the unusual fatigue, darkening of urine and sweat, hypertension, ulcer, hemolytic
treatment of partial onset seizures in adults and children 4 years of age and older anemia.
with epilepsy.
COMMON ADVERSE EFFECTS: High incidence of involuntary choreiform,
CONTRAINDICATIONS: This product should not be administered to patients dystonic, dyskinetic movements in those on long-term therapy. Numerous mild to
who have previously exhibited hypersensitivity to levetiracetam or any of the severe CNS.
inactive ingredients in levetiracetam tablets.
INDICATIONS: Treatment of idiopathic Parkinson’s disease (paralysis agitans),
NURSING CONSIDERATIONS: postencephalitic parkinsonism, symptomatic parkinsonism following CNS injury by
CO2 poisoning, manganese intoxication.
 children and adults, for treatment of severe behavior problems in children of
CONTRAINDICATIONS: Narrow-angle glaucoma, use within 14 days of MAOIs, combative, explosive hyperexcitability.
undiagnosed skin lesions, history of melanoma, history of MI, arrhythmias,
bronchial asthma, emphysema, severe cardiac, pulmonary, renal/hepatic CONTRAINDICATIONS: breast cancer, thyrotoxicosis crisis, untreated decreased
impairment; active peptic ulcer, treated openangle glaucoma, seizure disorder, level of thyroid hormones, low amount of magnesium in the blood, low amount of
elderly. potassium in the blood, very low levels of granulocytes, a type of white blood cell,
low levels of white blood cells, low levels of a type of white blood cell called
NURSING CONSIDERATIONS: neutrophils, a type of movement disorder called parkinsonism, tardive dyskinesia, a
 Monitor B/P (standing, sitting, supine). disorder characterized by involuntary movements of the face, mouth and tongue,
 Avoid tasks that require alertness, motor skills until response to drug is extrapyramidal disease.
established.
 Sugarless gum, sips of tepid water may relieve dry mouth NURSING CONSIDERATIONS:
 Instruct patient to get out of bed slowly, resting their feet on the floor for a
NURSING DIAGNOSIS: few minutes before standing up.
 Impaired physical mobility (Indications)  Instruct patients to tell your doctor if they have or have ever had Parkinson's
 Risk for injury (Indications) disease,the doctor will probably tell the patient not to take haloperidol.

NURSING DIAGNOSIS:

 Disturbed Thought Process related to repressed fears

HALOPERIDOL
MEMANTINE
GENERAL DRUG CLASSIFICATION: Anti-psychotics
GENERAL DRUG CLASSIFICATION: Revistagmine: N-methyl-D-aspartate
GENERIC NAME: Haloperidol (NMDA) receptor antagonist

BRAND NAME: Haldol, Peridol, Haldol Decanoate, Haloperidol LA GENERIC NAME: Memantine

MECHANISM OF ACTION: it exerts its antipsychotic effect through its strong BRAND NAME: Namenda, Namenda XR
antagonism of the dopamine receptor (mainly D2), particularly within the
mesolimbic and mesocortical systems of the brain. Haloperidol is known to inhibit MECHANISM OF ACTION: The principal mechanism of action of memantine is
the effects of dopamine and increase its turnover. They bind more tightly than believed to be the blockade of current flow through channels of N-methyl- D-
dopamine itself to the dopamine D2 receptor, with dissociation constants that are aspartate (NMDA) receptors — a glutamate receptor subfamily broadly involved in
lower than that for dopamine. brain function. Surprisingly, other drugs that block NMDA receptor channels, such
as ketamine, exhibit serious deleterious effects. The unusual therapeutic utility of
SIDE EFFECTS: dry mouth, increased saliva, blurred vision, loss of appetite, memantine probably results from inhibitory mechanisms shared with ketamine,
constipation, diarrhea, heartburn, nausea, vomiting, difficulty falling asleep or combined with actions specific to memantine.
staying asleep, blank facial expression, uncontrollable eye movements,
uncontrollable movements of any part of the body, restlessness, agitation, SIDE EFFECTS: severe blurred vision, pounding in your neck or ears, seizure
nervousness, mood changes, dizziness (convulsions), unusual changes in mood or behavior, diarrhea, dizziness, and
headache
COMMON ADVERSE EFFECTS: seizures, eye pain or discoloration, decreased
vision especially at night, seeing everything with a brown tint, rash, yellowing of COMMON ADVERSE EFFECTS: Heart failure, Myocardial infarction, peripheral
the skin or eyes, and an erection that lasts for hours. edema, syncope, tachycardia, Stevens-Johnson syndrome, arthralgia, neuroleptic
malignant syndrome
INDICATIONS: treatment of schizophrenia, for the manifestations of psychotic
disorders, for the control of tics and vocal utterances of Tourette’s Disorder in
INDICATIONS: Memantine is used to manage moderate to severe Alzheimer's CONTRAINDICATIONS: Hypersensitivity to morphine; respiratory insufficiency
dementia. or depression; severe CNS depression; attack of bronchial asthma; heart failure
secondary to chronic lung disease; cardiac arrhythmias; increased intracranial or
cerebrospinal pressure; head injuries; brain tumor; acute alcoholism; delirium
CONTRAINDICATIONS: Patients with hypersensitivity to memantine tremens; convulsive disorders; after biliary tract surgery; surgical anastomosis.
hydrochloride or any agents used in the formulation.
NURSING CONSIDERATIONS:
NURSING CONSIDERATIONS:
 Monitor blood pressure prior to administration. Hold if systolic BP < 100 mm
 Monitor respiratory and CV status, especially with preexisting heart disease.
Hg or 30 mm Hg below baseline.
 Assess for and report S&S of focal neurologic deficits (e.g., TIA, ataxia,
 Monitor patient's respiratory rate prior to administration.
vertigo).
 Reassess pain after administration of morphine.
 Lab tests: Periodic Hct& Hgb, serum sodium, alkaline phosphatase, and blood
 Monitor for respiratory depression and hypotension frequently up to 24 hours
glucose.
after administration of morphine.
 Report any of the following to the physician: problems with vision, skin rash,
 Place call light signal close to patient. Accompany patient if need to get out
shortness of breath, swelling in throat or tongue, agitation or restlessness,
of bed to minimize risk of falls
confusion, dizziness, or incontinence.
NURSING DIAGNOSIS:
NURSING DIAGNOSIS:
 Impaired gas exchange related to respiratory depression
 Cognitive Deficits
 Disturbed sensory perception related to CNS effects

NALOXONE HYDROCHLORIDE
MORPHINE SULFATE
GENERAL DRUG CLASSIFICATION: Opioid antagonists
GENERAL DRUG CLASSIFICATION: Opioid analgesics
GENERIC NAME: Naloxone Hydrochloride
GENERIC NAME: Morphine Sulphate
BRAND NAME: Narcan
BRAND NAME: Roxanol, Astramorph
MECHANISM OF ACTION: Naloxone is a competitive inhibitor of the µ-opioid
MECHANISM OF ACTION: Morphine and its metabolites act as agonists of the receptor. Naloxone antagonizes the action of opioids, reversing their effects. If a
mu and kappa opioid receptors. The mu-opioid receptor is integral to morphine's patient has not taken opioids, naloxone does not have a significant effect on
effects on the ventral tegmental area of the brain. Morphine's activation of the patients.
reward pathway is mediated by agonism of the delta-opioid receptor in the
nucleus accumbens, while modification of the respiratory system and addiction SIDE EFFECTS: Nausea, vomiting, diarrhea, stomach pain, fever, sweating, body
disorder are mediated by agonism of the mu-opioid receptor aches, weakness, tremors or shivering, fast heart rate, pounding heartbeats,
increased blood pressure, feeling nervous, restless, or irritable, goose bumps,
SIDE EFFECTS: Drowsiness, dizziness, tiredness, constipation, stomach pain, shivering, runny nose, yawning, and in babies younger than 4 weeks: seizures,
nausea, vomiting, sweating, and feelings of extreme happiness or sadness crying, stiffness, and overactive reflexes.
COMMON ADVERSE EFFECTS: Respiratory depression and, to a lesser degree, COMMON ADVERSE EFFECTS: Acute narcotic abstinence syndrome
circulatory depression, respiratory arrest, shock, and cardiac arrest
INDICATIONS: Naloxone nasal sprays are indicated for the emergency
INDICATIONS: Morphine is used for the management of chronic, moderate to treatment of an opioid overdose or suspected opioid overdose. Intramuscular,
severe pain. Effective for the short term management of pain. Patients taking intravenous, and subcutaneous injections are indicated for complete or partial
opioids long term may need to be monitored for the development of physical reversal of opioid depression, diagnosis of known or suspected opioid overdose,
dependence, addiction disorder, and drug abuse. and as an adjunct therapy in the treatment of septic shock.
CONTRAINDICATIONS: Allergy to narcotic antagonists, Pregnancy, lactation, Use cautiously in patients with any type of liver disease and in patients with long
Narcotic addiction, term alcohol use because therapeutic doses cause hepatotoxicity in these
CV disease.
patients.

NURSING CONSIDERATIONS:
NURSING CONSIDERATIONS:
 Many OTC and prescription products contain acetaminophen; be aware of
 Assess for mentioned cautions and contraindications (e.g. drug allergy,
history of narcotic addiction, myocardial infarction, etc.) to prevent untoward this when calculating total daily dose.
complications.  In children, don’t exceed five doses in 24 hours.
 Conduct pain assessment with patient to establish baseline and evaluate  May increase risk for bleed with warfarin therapy
effectiveness of drug therapy.  May alter blood glucose measurements
 Perform thorough physical (neurological status, respiratory rate and rhythm,
vital signs) to establish baseline status before beginning therapy, determine NURSING DIAGNOSIS:
drug effectiveness and evaluate for any potential adverse effects.  Hyperthermia related to decreased circulation secondary to dehydration
 Obtain an electrocardiogram as appropriate to evaluate for cardiac effects.  Acute pain related to biological injury agent

NURSING DIAGNOSIS:
 Decreased cardiac output related to CV effects
 Acute pain related to withdrawal and CV effects
 Risk for injury related to CNS effects

ACETAMINOPHEN

GENERAL DRUG CLASSIFICATION: Analgesics

TRAMADOL HYDROCHLORIDE
GENERIC NAME: Acetaminophen

BRAND NAME: Acephen, Acetadryl, Tylenol GENERAL DRUG CLASSIFICATION: Opiate (narcotic) analgesics

MECHANISM OF ACTION: Thought to produce analgesia by inhibiting GENERIC NAME: Tramadol Hydrochloride
prostaglandin and other substances that sensitize pain receptors. Drug may
relieve fever through central action in the hypothalamic heat-regulating center. BRAND NAME: Buprenex, Subutexv

SIDE EFFECTS: nausea, stomach pain, loss of appetite, headache, dark urine, MECHANISM OF ACTION: Binds with opioid receptors in the CNS, altering
perception of and emotional response to pain
COMMON ADVERSE EFFECTS: hemolytic anemia, leukopenia, neutropenia,
SIDE EFFECTS: seizures, hives, rash, blisters, difficulty swallowing or breathing,
pancytopenia, jaundice, hypoglycemia, rash, urticarial
swelling of the eyes, face, throat, tongue, lips, hands, feet, ankles, or lower legs,
hoarseness, agitation, hallucinations, fever, sweating, confusion, fast heartbeat,
INDICATIONS: Acetaminophen (APAP) is considered a non-opioid analgesic and shivering, severe muscle stiffness or twitching, loss of coordination, nausea,
antipyretic agent used to treat pain and fever. Clinicians can use it for their vomiting, or diarrhea.
patients as a single agent for mild to moderate pain and in combination with an
opioid analgesic for severe pain. COMMON ADVERSE EFFECTS: Sedation, vertigo, euphoria, bradycardia,
cyanosis, flushing, blurred vision, conjunctivitis, miosis, nausea, constipation,
CONTRAINDICATIONS: Contraindicated in patients hypersensitive to drug.
respiratory depression, dyspnea
INDICATIONS: Tramadol is an FDA-approved medication for pain relief. It has
specific indications for moderate to severe pain, postoperative pain, adjunct to INDICATIONS: Osteoarthritis, Rheumatoid Arthritis, Juvenile Rheumatoid
surgical anesthesia with a local anesthetic, severe chronic pain in terminally ill Arthritis, Ankylosing Spondylitis, Acute Pain, Primary Dysmenorrhea
patients, adjunct to surgical anesthesia during circumcision and opioid
dependence. CONTRAINDICATIONS: Known hypersensitivity to celecoxib or any components
of the drug produce or sulfonamides. History of asthma, urticaria, or other
CONTRAINDICATIONS: Contraindicated in patients hypersensitive to drug. allergic-type reactions after taking aspirin or other NSAIDs. In the setting of
Use cautiously in elderly or debilitated patients; patients who are opioid CABG surgery.
dependent; in those undergoing biliary tract surgery; and in those with head
NURSING CONSIDERATIONS:
injury, intracranial lesions, and increased intracranial pressure; etc.
 Assess range of motion, degree of swelling, and pain in affected joints before
and periodically throughout therapy.
NURSING CONSIDERATIONS:
 Assess patient for allergy to sulfonamides, aspirin, or NSAIDs. Patients with
 Reassess patient’s level of pain 15 and 30 minutes after parenteral
these allergies should not receive celecoxib.
administration.  Assess patient for skin rash frequently during therapy.
 Treat accidental skin exposure by removing exposed clothing and rinsing skin
with water. NURSING DIAGNOSIS:
 Drug may cause constipation. Assess bowel function and need for stool  Sleep deprivation related to pain
softeners and stimulant laxatives.  Severe pain related to inflammation
 If dependence occurs, withdrawal symptoms may appear up to 14 days after
drug is stopped.

NURSING DIAGNOSIS:
 Acute pain related to impaired comfort.
 Chronic pain related to nerve compression
 Acute pain related to physical injury patient
CELECOXIB
KETOROLAC
GENERAL DRUG CLASSIFICATION: Nonsteroidal anti-inflammatory drug GENERAL DRUG CLASSIFICATION: NSAIDs
GENERIC NAME: Celecoxib GENERIC NAME: Ketorolac
BRAND NAME: Celebrex BRAND NAME: Toradol
MECHANISM OF ACTION: Celecoxib blocks the enzyme that makes MECHANISM OF ACTION: It works by blocking your body's production of certain
prostaglandins (cyclooxygenase 2), resulting in lower concentrations of natural substances that cause inflammation.
prostaglandins. As a consequence, inflammation and its accompanying pain,
fever, swelling and tenderness are reduced. SIDE EFFECTS: Headache, heartburn, upset stomach, nausea, vomiting,
diarrhea, stomach pain, bloating, gas, constipation, dizziness, drowsiness,
SIDE EFFECTS: Swelling, rapid weight gain, shortness of breath, bloody or tarry
stools, coughing up blood or vomit that looks like coffee grounds, nausea, upper sweating, and ringing in the ears.
right side stomach pain, itching, tiredness, dark urine, yellowing of the skin or
eyes (jaundice),little or no urination, swelling in your feet or ankles, feeling tired, COMMON ADVERSE EFFECTS: rhinitis, hemoptysis, dyspnea, GI pain, diarrhea,
pale skin, lightheadedness, and cold hands and feet vomiting, nausea, dizziness, fatigue, insomnia, headache, neutropenia,
leukopenia, decreased Hgb or Hct, bone marrow depression, sweating, dry
COMMON ADVERSE EFFECTS: Peripheral edema, bleeding, hypertension, Stroke mucous membrane, pruritus
INDICATIONS: Moderate to severe acute onset pain CONTRAINDICATIONS: Allergy to cephalosporins and/or carbapenems, Adjust
dose in renal failure; evaluate rash and differentiate from hypersensitivity
CONTRAINDICATIONS: Ketorolac is contraindicated in individuals who have
adverse reactions or are allergic to NSAIDs. It is not recommended to be given reaction, Endocarditis prophylaxis: Use only for high-risk patients, per American
intraoperatively or preoperatively due to the increased risk for bleeding. It is not Heart Association Guidelines, Prolonged use associated with fungal or bacterial
recommended during labor and delivery, as it negatively affects fetal circulation superinfection.
and decreases uterine contraction.[9] In patients with renal disease or renal
failure, ketorolac is contraindicated because it may increase fluid retention and NURSING CONSIDERATIONS:
worsen renal function. GI-related contraindications for ketorolac include patients  Obtain patient history of infection before and during therapy to assess
with active peptic ulcer disease, recent GI bleed, or GI perforations. Extreme response.
caution is necessary when administering ketorolac in the geriatric population.  Assess patient for signs and symptoms of infection, fever, characteristics of
wounds, sputum, urine, stool, earache and WBC count.
NURSING CONSIDERATIONS:  Monitor renal function: urine output, urinalysis, protein and blood, BUN,
 Don’t forget to assess first the patient before administering this drug: creatinine.
know the history (e.g. allergies, renal impairment, etc.) and physical  Monitor blood studies: AST, ALT, CBC, Hct., bilirubin, LDH, alkaline
condition of the patient (reflexes, ophthalmologic and audiometric evaluation, phosphate.
orientation, clotting times, serum electrolytes, etc.)  Given by direct IV over 3-5 mins. in lower dosages
 To maintain serum levels and control pain effectively, administer it every six
NURSING DIAGNOSIS:
hours.
 Altered Body Temperature
 Report any signs of itching, swelling in the ankles, sore throat, easy bruising,  Hyperthermia
etc.

NURSING DIAGNOSIS:
 Moderate pain related to postpartum uterine contractions
 Mild pain related to episiotomy
AMPICILLIN
CEFUROXIME
GENERAL DRUG CLASSIFICATION: Penicillin
GENERAL DRUG CLASSIFICATION: Cephalosporin antibiotics
GENERIC NAME: Ampicillin
GENERIC NAME: Cefuroxime
BRAND NAME: Excillin
BRAND NAME: Zegen
MECHANISM OF ACTION: Interferes with cell wall synthesis of susceptible
organisms, preventing bacterial multiplication. It works by killing bacteria.
MECHANISM OF ACTION: acts by inhibition of bacterial cell wall synthesis.
Antibiotics such as ampicillin will not work for colds, flu, or other viral infections.
Cefuroxime has activity in the presence of some beta-lactamases, both
Taking antibiotics when they are not needed increases your risk of getting an
penicillinases and cephalosporinases, of Gram-negative and Gram-positive
infection later that resists antibiotic treatment.
bacteria
SIDE EFFECTS: Dizziness, Fatigue, Insomnia, Reverse hyperactivity.
SIDE EFFECTS: Dizziness and drowsiness, diarrhea, nausea, vomiting, strange
taste in the mouth, or stomach pain. Diaper rash may occur in young children.
COMMON ADVERSE EFFECTS: Thrombophlebitis at injection site, Neurotoxicity
COMMON ADVERSE EFFECTS: Thrombophlebitis, Pruritus, Urticarial,
INDICATIONS: Treatment of respiratory tract and soft tissue infections,
Pseudomembrane coliti
bacterial meningitides, septicemia and gonococcal infections
INDICATIONS: Treatment of bone and joint infections, bronchitis and other COMMON ADVERSE EFFECTS: Eosinophilia, Casts in urine, Thrombocytosis,
LRTIs, gonorrhea, meningitis, pharyngitis, UTI Leucopenia

CONTRAINDICATIONS: diarrhea from an infection with Clostridium difficile INDICATIONS: Treatment of susceptible infections including chancroid,
bacteria, a decrease in the blood clotting protein prothrombin, chronic kidney gastroenteritis, lyme disease, meningitis, syphilis, typhoid
disease stage 4 (severe), chronic kidney disease stage 5 (failure)
CONTRAINDICATIONS: diarrhea from an infection with Clostridium difficile
bacteria, a type of blood disorder where the red blood cells burst called hemolytic
NURSING CONSIDERATIONS:
 Assess patient history of allergies particularly cephalosporins and penicillins. anemia, liver problems, disease of the gallbladder, severe renal impairment,
 Assess mouth for white patches in mucous membranes and tongue. jaundice.
 Monitor bowel activity and stool consistency carefully.
 Monitor I&O and renal function reports for nephrotoxicity. NURSING CONSIDERATIONS:
 Monitor for drug adverse effects: pruritus, abdominal pain, mouth sores  Assess patient previous sensitivity to cephalosporins/penicillins.
 Assess patient for signs and symptoms of infection.
NURSING DIAGNOSIS:  Assess for allergic reaction and anaphylaxis.
 Impaired skin integrity related to inflammation  Assess renal function before and during therapy.
 Acute Pain related to infection  Obtain C&S before beginning therapy to identify if correct treatment has
been initiated.
 Monitor hematologic, electrolyte and hepatic status on long term therapy.

NURSING DIAGNOSIS:
 Risk for Infection
 Activity Intolerance

CEFTRIAXONE AZITHROMYCIN

GENERAL DRUG CLASSIFICATION: Cephalosporin antibiotics GENERAL DRUG CLASSIFICATION: Macrolide antibiotics.

GENERIC NAME: Ceftriaxone GENERIC NAME: Azithromycin

BRAND NAME: Forgram BRAND NAME: Zithromax, Azasite, Zmax

MECHANISM OF ACTION: Inhibits bacterial cell wall osmotically, rendering cell MECHANISM OF ACTION: Azithromycin blocks transpeptidation by binding
wall osmotically unstable, leading to cell death.works by inhibiting the to50s ribosomal subunit of susceptible organisms and disrupting RNA-dependent
mucopeptide synthesis in the bacterial cell wall. The beta-lactam moiety of protein synthesis at the chain-elongation step.
ceftriaxone binds to carboxypeptidases, endopeptidases, and transpeptidases in
the bacterial cytoplasmic membrane. These enzymes are involved in cell-wall SIDE EFFECTS: Mild to moderate nausea, vomiting, abdominal pain, dyspepsia,
synthesis and cell division. flatulence, diarrhea, cramping

SIDE EFFECTS: Pain, Rash, Diarrhea, Black, tarry stools, chest pain, shortness of COMMON ADVERSE EFFECTS: angioedema, cholestatic, headache, vertigo,
breath, sore throat, sores, ulcers, or white spots on the lips or in the mouth, somnolence, transient elevation of liver enzyme values.
swollen glands, unusual tiredness or weakness
INDICATIONS: Treatment of lower respiratory infections: acute bacterial COMMON ADVERSE EFFECTS: death, severe infection to the colon, severe
exacerbations of COPD due to Hemophilus influenzae, Moraxella catarrhalis, diarrhea
Streptococcus pneumoniae; community-acquired pneumonia due to S.
pneumoniae, H. influenzae. Treatment of lower respiratory infections: INDICATIONS: Indicates for the treatment of various infections by gram-
Streptococcal pharyngitis and tonsillitis in those who cannot take penicillins. positive and gram-negative bacteria, aerobes and anaerobes, as well other types
Treatment of uncomplicated skin infections due to Staphylococcus aureus, S. of bacteria.
pyogenes, Streptococcus agalactiae. Pneumonia and other respiratory tract infections; certain infections of the skin or
eye; infections of the lymphatic, intestinal, genital, and urinary systems; and
CONTRAINDICATIONS: diarrhea from an infection with Clostridium difficile certain other infections that are spread by ticks, lice, mites, infected animals, or
bacteria, low amount of magnesium in the blood, low amount of potassium in the contaminated food and water.
blood, myasthenia gravis, a skeletal muscle disorder, hearing loss, torsades de
CONTRAINDICATIONS: Pregnancy or breastfeeding due to teratogenicity and
pointes, a type of abnormal heart rhythm, and slow heartbeat.
permanent teeth discoloration after in utero exposure, Children under the age of
12 due to teeth discoloration, Allergy to tetracycline antibiotics, Use with penicillin
NURSING CONSIDERATIONS:
 Culture site of infection before therapy. or isotretinoin.
 Administer on an empty stomach 1 hour before or 2-3 hours after meals.
Food affects the absorption of this drug. NURSING CONSIDERATIONS:
 Take the full course prescribed. Do not take with antacids. Tablets and oral  Use caution with liver impairment
suspension can be taken with or without food.  Assess for infection
 Report severe or watery diarrhea, severe nausea or vomiting, rash or itching,  Obtain culture prior to initiating therapy
mouth sores, vaginal sores.  Monitor renal and liver labs

NURSING DIAGNOSIS: NURSING DIAGNOSIS:

 Ineffective Airway Clearance  Risk for Infection
 Ineffective Breathing Pattern  Deficient Knowledge

DOXYCYCLINE
AMIKACIN
GENERAL DRUG CLASSIFICATION: Tetracycline antibiotics
GENERAL DRUG CLASSIFICATION: Aminoglycoside antibiotics.
GENERIC NAME: Doxycycline
GENERIC NAME: Amikacin
BRAND NAME: Doryx
BRAND NAME: Amikin, Amikin Pediatric
MECHANISM OF ACTION: Tetracyclines such as doxycycline are thought to
inhibit translation by binding to the 16S rRNA portion of the ribosome, preventing MECHANISM OF ACTION: Inhibits protein synthesis by binding directly to the
binding of tRNA to the rRNA-30S bacterial ribosomal subunit, which is necessary 30S ribosomal subunit; bactericidal (bactericidal action against susceptible
for the delivery of amino acids for protein synthesis. As a result of the above bacteria).
actions, the initiation of protein synthesis by polyribosome formation is blocked.
This stop replication of bacteria and produces aa bacteriostatic effect. SIDE EFFECTS: Drowsiness, unsteady gait, weakness, clumsiness, paresthesias,
tremors, convulsions, peripheral neuritis. Nausea, vomiting, hepatotoxicity. Skin
SIDE EFFECTS: antibiotic-associated diarrhea, mild diarrhea, loss of appetite, rash, urticaria, pruritus, redness. Oliguria, urinary frequency, hematuria, tubular
nausea and vomiting, rash, and hives necrosis, azotemia.

COMMON ADVERSE EFFECTS: Nerotoxicity

 eyelid redness, itching, dizziness, confusion, tremors, hallucinations,
INDICATIONS: Primarily for short-term treatment serious infections of hypersensitivity reaction, insomnia, dry mouth, paresthesia.
respiratory tract, bones, joints, skin, and soft tissue, CNS (including meningitis)
and peritonitis burns COMMON ADVERSE EFFECTS: Superinfection, nephropathy, cardiopulmonary
arrest, cerebral thrombosis may occur. Hypersensitivity reaction (rash, pruritus,
CONTRAINDICATIONS: diarrhea from an infection with Clostridium difficile blisters, edema, burning skin), photosensitivity have occurred. Sensitization to
bacteria, low amount of calcium in the blood, dehydration, a type of movement ophthalmic form may contraindicate later systemic use of ciprofloxacin.
disorder called parkinsonism, myasthenia gravis, a skeletal muscle disorder,
INDICATIONS: Complicated intra-abdominal infections caused by E. coli, P.
ringing in the ears, disorder of nerve that controls hearing and balance
aeruginosa, P. mirabilis, K. pneumonia or Bacteroides fragilis

NURSING CONSIDERATIONS: CONTRAINDICATIONS: diarrhea from an infection with Clostridium difficile

 Assess for hypersensitivity to aminoglycoside. bacteria, diabetes, low blood sugar, glucose-6-phosphate dehydrogenase (G6PD)
 Obtain specimen for culture and sensitivity test.
deficiency, low amount of magnesium in the blood, low amount of potassium in
 Weight patient and review renal function before therapy begins.
 Correct dehydration before therapy begins because of increased risk of the blood, a low seizure threshold.
toxicity.
 Monitor renal function; urine output, specific gravity, urinalysis, BUN and NURSING CONSIDERATIONS:
creatinine clearance.  Question for history of hypersensitivity to ciprofloxacin, quinolones.
 Watch for signs and symptoms of incessant infection.  Obtain urinalysis for microscopic analysis for crystalluria prior to and during
treatment.
NURSING DIAGNOSIS:  Monitor daily pattern of bowel activity, stool consistency.
 Risk for Infection  Encourage pt to drink several glasses of water daily (reduces risk of
 Deficient Knowledge crystalluria).
 Monitor for dizziness, headache, visual changes, tremors.
 Assess for chest, joint pain. Ophthalmic: Observe therapeutic response

NURSING DIAGNOSIS:
 Infection (risk for indications, side effect)
 Diarrhea (side effect)
CIPROFLAXIN CLINDAMYCIN

GENERAL DRUG CLASSIFICATION: Fluoroquinolones GENERAL DRUG CLASSIFICATION: Lincomycin antibiotics

GENERIC NAME: Ciprofloxacin GENERIC NAME: Clindamycin

BRAND NAME: Apo-Cipoflox, Cetraxal, Ciloxan, Cipro, Cipro IV, Cipro XR, Novo- BRAND NAME: Apo-Clindamycin, Cleocin, Cleocin Pediatric, Cleocin T, Cleocin
Ciprofloxacin Vaginal, Clindagel, Clindamax, Clindesse, Novo-Clindamycin

MECHANISM OF ACTION: Inhibits enzyme, DNA gyrase, in susceptible MECHANISM OF ACTION: Inhibits protein synthesis or bacterial cell wall by
bacteria, interfering with bacterial cell replication. bonding to bacterial ribosomal receptor sites. Topically, decreases fatty acid
Therapeutic Effect: concentration of skin. Prevents outbreaks of acne vulgaris.
Bactericidal
SIDE EFFECTS:Abdominal pain, nausea, vomiting, diarrhea, dry, scaly skin,
SIDE EFFECTS: Nausea, diarrhea, dyspepsia, vomiting, constipation, flatulence, vaginitis, pruritus, phlebitis, thrombophlebitis with IV administration, pain,
confusion, crystalluria, burning, crusting in corner of eye, abdominal induration at IM injection site, allergic reaction, urticaria, pruritis, contact
pain/discomfort, headache, rash, bad taste, sensation of foreign body in eye,
dermatitis, abdominal pain, mild diarrhea, burning, stinging, headache, dizziness, INDICATIONS: Oropharyngeal and esophageal candidiasis; Vaginal candidiasis;
nausea, vomiting, abdominal pain, hypersensitivity reaction Prevention of candidiasis in bone marrow transplant; Cryptococcal meningitis.

COMMON ADVERSE EFFECTS: Antibiotic-associated colitis, other superinfections CONTRAINDICATIONS: low amount of magnesium in the blood. low amount of
(abdominal cramps, severe watery diarrhea, fever) may occur during and several potassium in the blood. torsades de pointes, a type of abnormal heart rhythm.
weeks after clindamycin. prolonged QT interval on EKG. abnormal EKG with QT changes from birth.
abnormal liver function tests. pregnancy. chronic kidney disease.
INDICATIONS: Serious infections caused by susceptible strains of anaerobes,
streptococci, staphylococci, pneumococci, Treatment of septicemia, Treatment of
acne, Treatment of bacterial vaginosis, Treatment of serious infections caused by NURSING CONSIDERATIONS:
susceptible strains of anaerobes Assess for signs and symptoms of infection.
Monitor hepatotoxicity.
CONTRAINDICATIONS: diarrhea from an infection with Clostridium difficile Monitor for hypersensitivity or anaphylaxis.
bacteria. myasthenia gravis, a skeletal muscle disorder. Crohn's disease. Monitor for possible adverse reactions like headaches, nausea/vomiting, Stevens
Johnson Syndrome.
ulcerative colitis, an inflammatory condition of the intestines. severe liver disease.
blood in the bowel movement. severe renal impairment. NURSING DIAGNOSIS:
 Impaired Oral Mucous Membrane
NURSING CONSIDERATIONS:  Risk for Infection
 Question pt for history of allergies. Avoid, if possible, concurrent use of
neuromuscular blocking agents.
 Monitor daily pattern of bowel activity, stool consistency.
 Report diarrhea promptly due to potential for serious colitis (even with
topical or vaginal administration).
 Assess skin for rash with topical application.
 With all routes of administration, be alert for superinfection; fever, vomiting,
diarrhea, anal/genital pruritis, oral mucosal changes (ulcerations, pain,
erythema)

NURSING DIAGNOSIS:
 Infection (risk for indication, side effect)
 Knowledge deficit related to medication regimen (patient/family teaching)
FLUCONAZOLE METRONIDAZOLE

GENERAL DRUG CLASSIFICATION: Triazoles GENERAL DRUG CLASSIFICATION: Nitroimidazole antimicrobials

GENERIC NAME: Fluconazole GENERIC NAME: Metronidazole

BRAND NAME: Diflucan/Dyzolor BRAND NAME: Apo-Metronizade, Flagyl ER, Flagyl 375, MetroCream, MetroGel-
Vaginal, NidaGel, Noritate, Zalvos
MECHANISM OF ACTION: Inhibits fungal CYP, an enzyme responsible for
fungal steroid synthesis, and weakens fungal cell wall. MECHANISM OF ACTION: Disrupts DNA, inhibiting nucleic acid synthesis.
Produces bactericidal, antiprotozoal, amebicidal, trichomonacidal effects. Produces
SIDE EFFECTS: Headache, Seizures, Rash, Foliative skin disorder, Nausea, anti-inflammatory, immunosuppressive effects when applied topically. It works by
Vomiting, Abdominal pain, Diarrhea, stopping the growth of bacteria. Antibiotics will not work for colds, flu, or other
viral infections.
COMMON ADVERSE EFFECTS: Leucopenia.
SIDE EFFECTS: Anorexia, Nausea, Dry mouth, Metallic taste, Symptomatic
cervicitis/ vaginitis, abdominal cramps, uterine pain. Diarrhea, Constipation, COMMON ADVERSE EFFECTS: Acute renal failure, anemia, ataxia, neurological
vomiting, Dizziness, Erythematous rash, urticaria, reddish-brown urine. reactions, psychosis, severe local inflammation (sometimes heading to
ulceration), tremors, thrombocytopenia;
COMMON ADVERSE EFFECTS: furry tongue, glossitis, cystitis, dysuria,
pancreatitis. Peripheral neuropathy, Seizures INDICATIONS: Recurrent genital herpes infection (PO)
Localized cutaneous herpes zoster infection (shingles)
INDICATIONS: Bacterial infections caused by anaerobis microorganisms Chickenpox (varicella)
Severe initial episodes of genital herpes in non-immunosuppressed patients
CONTRAINDICATIONS: meningitis not due to an infection. low levels of a type Herpes simplex encephalitis
of white blood cell called neutrophils. alcoholism. alcohol intoxication. low seizure Recurrent herpes labialis (cold sores)
threshold. peripheral neuropathy. prolonged QT interval on EKG. seizures. Acute mucocutaneous HSV infections in immunocompromised patients.

CONTRAINDICATIONS: Hypersensitivity
NURSING CONSIDERATIONS:
 Question for history of hypersensitivity to mentronidazole, other NURSING CONSIDERATIONS:
nitroimidazole derivatives (and parabens with topical).  Question for history of allergies, esp. to acyclovir. Assess herpes simplex
 Obtain specimens for diagnostic tests, cultures before giving first dose lesions before treatment to compare baseline with treatment effect.
(therapy may begin before results are known)  Assess IV site for phlebitis (heat, pain, red streaking, over vein). Evaluate
 Monitor daily pattern of bowel activity, stool consistency. cutaneous lesions.
 Monitor I&O, assess for urinary problems.  Ensure adequate ventilation.
 Be alert to neurologic symptoms (dizziness; paresthesia of extremities).  Manage chickenpox and disseminated herpes zoster with strict isolation.
 Assess for rash, urticaria.  Provide analgesics and comfort measures; esp. exhausting to elderly.
 Watch for onset of superinfection (ulceration/change of oral mucosa, furry  Encourage fluids.
tongue, vaginal discharge, genital/anal pruritus).
NURSING DIAGNOSIS:
NURSING DIAGNOSIS:  Infection, risk for (use)
 Cardiac output decreased (indications adverse reactions)  Knowledge deficit (teaching)
 Knowledge deficit related to medication regimen (patient/family teaching)

REMDESIVIR
ACYCLOVIR
GENERAL DRUG CLASSIFICATION: Nucleotide analog.
GENERAL DRUG CLASSIFICATION: Synthetic nucleoside analogues
GENERIC NAME: Remdesivir
GENERIC NAME: Acyclovir
BRAND NAME: Veklury
BRAND NAME: Apo-Acyclovir (CAN), Gen-Acyclovir (CAN), ratio-Acyclovir (CAN),
Zovirax MECHANISM OF ACTION: The active form of remdesivir acts as a nucleoside
analog and inhibits the RNA-dependant RNA polymerase (RdRp) of coronaviruses
MECHANISM OF ACTION: It interferes with DNA synthesis by conversion to including SARA-CoV-2. Remdesivir is incorporated by the RdRp into the growing
acyclovir triphosphate, causing decreased viral replication, time of lesion healing. RNA product and allows for addition of three more nucleotides before RNA
synthesis stalls.
SIDE EFFECTS: Abdominal pain, diarrhea, fatigue, headache, nausea, and
photosensitivity, pruritis, rash, urticarial, vomiting, confusion, convulsions,
dizziness, drowsiness, dysarthria, dyspnea, hallucinations, agitation, fever,
SIDE EFFECTS: low or high blood pressure, dizziness, slow/fast heartbeat, fever, transferrin. It also induces cytotoxic T-cell differentiation. Lastly, it binds soluble
nausea, vomiting, sweating, and shivering. and membrane bound IL-6 receptors, preventing IL-6 mediated inflammation.

COMMON ADVERSE EFFECTS: none known SIDE EFFECTS: Constipation, Anxiety, Diarrhea, Insomnia, Hypertension,
Nausea, Increased levels of liver enzymes.
INDICATIONS: Velkury is indicated for adults and pediatric patients (12 years of
age and older and weighing at least 40 kg) for the treatment of coronavirus COMMON ADVERSE EFFECTS: None known
disease 2019 (COVID-19) requiring hospitalization. VELKURY should only be
administered in a hospital or in a healthcare setting capable of providing acute
INDICATIONS: For the treatment of Rheumatoid Arthritis (RA), Giant cell
care comparable to inpatients hospital care.
arteritis (GCA), Polyarticular Juvenile Idiopathic Arthritis (PJIA), Systemic Juvenile
Idiopathic Arthritis (SJIA), Cytokine Release Syndrome (CRS)
CONTRAINDICATIONS: Velkury is contraindicated in patients with a history of
clinically significant hypersensitivity reactions to Velkury or any components of
CONTRAINDICATIONS: Hepatic impairment
the product.
NURSING CONSIDERATIONS:
NURSING CONSIDERATIONS:
 Ensure that patient receives “Fact Sheet for Patients and Parent/Caregivers
 Check baseline vital signs such as temperature, pulse rate, respiratory rate,
Emergency Use Authorization (EUA) of remdesivir for coronavirus disease
blood pressure, and oxygen saturation.
2019 (COVID-19)” and is documented in their Medical Record.
 Review patient’s laboratory results such as AALT/AST, creatinine, and etc.
 Check if patient has history of allergy/hypersensitivity to remdesivir or its
 Ask patient for history of known hypersensitivity reactions of the drug
components.
components.
 Check labs baseline renal and hepatic function should be obtained for
 Monitor patients for possible adverse effects.
ordering remdesivir.

NURSING DIAGNOSIS: NURSING DIAGNOSIS:

 Infection related to failure to avoid pathogen secondary to exposure to
COVID-19  Acute/Chronic pain related to distention of tissue by the accumulation of
 Deficient knowledge related to unfamiliarity with disease transmission fluid/inflammation process, synovial joints.
information.
 Hyperthermia related to increase in metabolic rate.
 Impaired breathing pattern related to shortness of breath.
 Anxiety related to unknown etiology of the disease.

TOCILIZUMAB

GENERAL DRUG CLASSIFICATION: Interleukin-6 (IL-6) receptor inhibitors.

GENERIC NAME: Tocilizumab

BRAND NAME: Actemra

MECHANISM OF ACTION: Inteluekin 6 (IL-6) is an inflammatory cytokine

produced by cells including T-cells, B-cell, lymphocytes, monocytes and
fibroblasts. IL-6 rapidly induces C-reactive protein, serum amyloid A, fibrinogen,
albumin, and transferrin while inhibiting production of fibroectin, albumin,