Nystatin (Nystatin Oral Suspension) 500,000 units 4xDaily Swish/ Swal

Therapeutic: antifunal
!"#erse $eactions/Si"e %ffects
&': diarrhea, nausea, stomach pain (large doses), vomiting. Der(: contact dermatitis, Stevens-Johnson syndrome.
'n"ications
)o*enes, oral suspension: Local treatment of oropharyngeal candidiasis. Treatment of intestinal candidiasis
!spirin (!spirin +hewa,le Ta,let) -. ( Daily /O
Therapeutic: antipyretics, nonopioid analgesics
/har(acoloic: salicylates
!"#erse $eactions/Si"e %ffects %%NT: tinnitus. &': G !L""#$G, dyspepsia, epigastric distress, nausea, a%dominal pain,
anore&ia, hepatoto&icity, vomiting. 0e(at: anemia, hemolysis. Der(: rash, urticaria.1isc: 'LL"(G) ("')T*$S $)L+#$G
'$',-.L'/S '$# L'(.$G"'L "#"0'.
'n"ications nflammatory disorders including: : (heumatoid arthritis, , *steoarthritis. 0ild to moderate pain. 1ever. ,rophyla&is of
transient ischemic attac2s and 0. 2nla,elle" 2se: 'd3unctive treatment of 4a5asa2i disease.
!ction
,roduce analgesia and reduce inflammation and fever %y inhi%iting the production of prostaglandins. #ecreases platelet
aggregation. Therapeutic %ffects: 'nalgesia. (eduction of inflammation. (eduction of fever. #ecreased incidence of transient
ischemic attac2s and 0.
Nursin i(plications
,atients 5ho have asthma, allergies, and nasal polyps or 5ho are allergic to tartra6ine are at an increased ris2 for developing
hypersensitivity reactions, /ain: 'ssess pain and limitation of movement7 note type, location, and intensity %efore and at the pea2
(see Time8'ction ,rofile) after administration, 3e#er: 'ssess fever and note associated signs (diaphoresis, tachycardia, malaise,
chills), Lab Test Considerations: 0onitor hepatic function %efore antirheumatic therapy and if symptoms of hepatoto&icity occur7
more li2ely in patients, especially children, 5ith rheumatic fever, systemic lupus erythematosus, 3uvenile arthritis, or pre-e&isting
hepatic disease. 0ay cause 9 serum 'ST, 'LT, and al2aline phosphatase, especially 5hen plasma concentrations e&ceed :;
mg8<== mL. 0ay return to normal despite continued use or dose reduction. f severe a%normalities or active liver disease occurs,
discontinue and use 5ith caution in future, 0onitor serum salicylate levels periodically 5ith prolonged high-dose therapy to
determine dose, safety, and efficacy, especially in children 5ith 4a5asa2i disease, 0ay alter results of serum uric acid, urine
vanillylmandelic acid (>0'), protirelin-induced thyroid-stimulating hormone (TS-), urine hydro&yindoleacetic acid (;--'')
determinations, and radionuclide thyroid imaging, ,rolongs %leeding time for ?@A days and, in large doses, may cause prolonged
prothrom%in time. 0onitor hematocrit periodically in prolonged high-dose therapy to assess for G %lood loss, Toxicity and
Overdose: 0onitor for the onset of tinnitus, headache, hyperventilation, agitation, mental confusion, lethargy, diarrhea, and
s5eating. f these symptoms appear, 5ithhold medication and notify physician or other health care professional immediately.
!tor#astatin +alciu( ()ipitor) 40 ( Daily /O
Therapeutic: lipid-lo5ering agents
/har(acoloic: -0G-)o' reductase inhi%itors
!"#erse $eactions/Si"e %ffects
+NS: di66iness, headache, insomnia, 5ea2ness. +5: chest pain, peripheral
edema.%%NT: rhinitislo#astatin: %lurred vision. $esp: %ronchitis. &': a%dominal
cramps, constipation,diarrhea, flatus, heart%urn, altered taste, drug-induced hepatitis, dyspepsia, elevated liver en6ymes,
nausea, pancreatitis. &2: erectile dysfunction. Der(: rashes, pruritus.1S: (-'!#*0.*L.SS, arthralgia, arthritis,
myalgia, myopathy (9 5ith simvastatin B= mg8day dose). 1isc: hypersensitivity reactions
'n"ications
'd3unctive management of primary hypercholesterolemia and mi&ed dyslipidemias.!tor#astatin: ,rimary prevention of
cardiovascular disease (C ris2 of 0 or stro2e) in patients 5ith multiple ris2 factors for coronary heart disease )-# or type :
dia%etes mellitus (also C ris2 of angina or revascsulari6ation procedures in patients 5ith multiple ris2 factors for )-#). !tor#astatin an"
/ra#astatin: Secondary prevention of cardiovascular disease (C ris2 of 0, stro2e, revasculari6ation procedures, angina, and
hospitali6ations for -1) in patients 5ith clinically evident )-#. 3lu#astatin: Secondary prevention of coronary revasculari6ations
procedures in patients 5ith clinically evident )-#. 3lu#astatin an" lo#astatin: Slo5 progression of coronary atherosclerosis in patients
5ith )-#. )o#astatin:,rimary prevention of )-# (C ris2 of 0, unsta%le angina, and coronary revasculari6ation) in patients
5ithout symptomatic cardiovascular disease 5ith 9 total and lo5-density lipoprotein (L#L) cholesterol and C high-density
lipoprotein (-#L) cholesterol. /ra#astatin:,rimary prevention of )-# (C ris2 of 0, coronary revasculari6ation, and
cardiovascular mortality) in patients 5ithout clinically evident )-#. Si(#astatin: Secondary prevention of cardiovascular
events (C ris2 of 0, coronary revasculari6ation, stro2e, and cardiovascular mortality) in patients 5ith clinically evident )-# or those at
high-ris2 for )-# (history of dia%etes, peripheral arterial disease, or stro2e). $osu#astatin: Slo5 progression of coronary
atherosclerosis. $osu#astatin: ,rimary prevention of cardiovascular disease (reduces ris2 of stro2e, myocardial infarction, and
revasculari6ation) in patients 5ithout clinically evident coronary heart disease %ut 5ith an increased ris2 of cardiovascular
disease %ecause of age (D;= yr for men7 DE= yr for 5omen), hs)(, D: mg8L, and the presence of D< ris2 factor for
cardiovascular disease (hypertension, lo5 -#L- ), smo2ing, or premature family history of coronary heart disease)
!ction
nhi%it an en6yme, F-hydro&y-F-methylglutaryl-coen6yme ' (-0G-)o') reductase, 5hich is responsi%le for cataly6ing an early
step in the synthesis of cholesterol. Therapeutic %ffects: Lo5ers total and L#L cholesterol and triglycerides. Slightly
increase -#L. Slo5s of the progression of coronary atherosclerosis 5ith resultant decrease in )-#-related events
(all agents e&cept rosuvastatin have indication for C events).
N2$S'N& '1/)'+!T'ONS
*%tain a dietary history, especially 5ith regard to fat consumption.
Lab Test Considerations: "valuate serum cholesterol and triglyceride levels %efore initiating, after ?@E 52 of therapy, and
periodically thereafter. 0onitor liver function tests, including 'ST, %efore, at <: 52 after initiation of therapy or after dose
elevation, and then G E mo. f 'ST levels 9 to F times normal, -0G-)o' reductase inhi%itor therapy should %e reduced or
discontinued. 0ay also cause 9 al2aline phosphatase and %iliru%in levels. f patient develops muscle tenderness during therapy,
monitor )4 levels. f )4 levels are H<= times the upper limit of normal or myopathy occurs, therapy should %e
discontinued.
3urose(i"e ()asix) 40 ( Daily /O
Therapeutic: diuretics
/har(acoloic: loop diuretics
!"#erse $eactions/Si"e %ffects
+NS: di66iness, encephalopathy (9 5ith %umetanide, furosemide), headache, insomnia (9 5ith torsemide), nervousness (9 5ith
torsemide). %%NT: hearing loss, tinnitus.+5: hypotension. &': constipation, diarrhea, dry mouth, dyspepsia, 9 liver
en6ymes (furosemide), nausea, vomiting. &2: 9 !+$, e&cessive urination. Der(: ST">"$S-J*-$S*$
S.$#(*0", T*/) ",#"(0'L $")(*L.SS, photosensitivity, rashes. %n"o: hyperglycemia.3 an"
% dehydration, hypochloremia, hypo2alemia, hypomagnesemia, hyponatremia,hypovolemia, meta%olic
al2alosis. 0e(at: %lood dyscrasias (furosemide only).1eta,: hypercholesterolemia, hyperglycemia, hypertriglyceridemia,
hyperuricemia.1S: arthralgia (9 5ith torsemide), muscle cramps, myalgia (9 5ith torsemide).
'n"ications
urose(i"e: -ypercalcemia of malignancy.
!ction
nhi%it the rea%sorption of sodium and chloride from the loop of -enle and distal renal tu%ule. ncrease renal e&cretion of 5ater,
sodium, chloride, magnesium, hydrogen, and calcium. 0ay have renal and peripheral vasodilatory effects. "ffectiveness
persists in impaired renal function. Therapeutic %ffects: #iuresis and su%seGuent mo%ili6ation of e&cess fluid (edema,
pleural effusions). #ecreased !,.
Nursin '(plications
'ssess fluid status during therapy. 0onitor daily 5eight, inta2e and output ratios, amount and location of edema, lung sounds, s2in
turgor, and mucous mem%ranes.$otify health care provider if thirst, dry mouth, lethargy, 5ea2ness, hypotension, or oliguria
occurs. 0onitor !, and pulse %efore and during administration. 0onitor freGuency of prescription refills to determine compliance in
patients treated for hypertension.
'ssess patients receiving digo&in for anore&ia, nausea, vomiting, muscle cramps, paresthesia, and confusion. ,atients ta2ing
digo&in are at increased ris2 of digo&in to&icity %ecause of the potassium-depleting effect of the diuretic. ,otassium supplements
or potassium-sparing diuretics may %e used concurrently to prevent hypo2alemia.
'ssess patient for tinnitus and hearing loss. 'udiometry is recommended for patients receiving prolonged high-dose > therapy.
-earing loss is most common follo5ing rapid or high-dose > administration in patients 5ith decreased renal function or those
ta2ing other ototo&ic drugs.
'ssess for allergy to sulfonamides.
'ssess patient for s2in rash freGuently during therapy. #iscontinue diuretic at first sign of rash7 may %e life-threatening. Stevens-
Johnson syndrome or to&ic epidermal necrolysis may develop. Treat symptomatically7 may recur once treatment is
stopped.
Lab Test Considerations: 0onitor electrolytes, renal and hepatic function, serum glucose, and uric acid levels prior to and
periodically during therapy. 0ay cause C serum potassium, calcium, and magnesium concentrations. 0ay also cause 9 !+$,
serum glucose, creatinine, and uric acid levels.. Bumetanide may cause an 9 in urinary phosphate concentrations..
Torsemide may cause 9 in total plasma cholesterol and lipids during initial therapy. Those elevations usually return to normal
5ith chronic therapy.
/antopra*ole (/rotonix) 40 ( Daily 6 0700 /O
Therapeutic: antiulcer agents
/har(acoloic: proton-pump inhi%itors
!"#erse $eactions/Si"e %ffects
+NS: headache. &': a%dominal pain, diarrhea, eructation, flatulence. %n"o: hyperglycemia. 3 an" % hypomagnesemia (especially
if treatment duration DF mo). 1S: %one fracture.
'n"ications
"rosive esophagitis associated 5ith G"(#. #ecrease relapse rates of daytime and nighttime heart%urn symptoms on patients
5ith G"(#. ,athologic gastric hypersecretory conditions. 2nla,elle" 2se: 'd3unctive treatment of duodenal ulcers associated
5ith Helicobacter pylori.
!ction
!inds to an en6yme in the presence of acidic gastric p-, preventing the final transport of hydrogen ions into the gastric
lumen. Therapeutic %ffects: #iminished accumulation of acid in the gastric lumen, 5ith lessened acid reflu&. -ealing of duodenal
ulcers and esophagitis. #ecreased acid secretion in hypersecretory conditions.
Nursin i(plications
'ssess patient routinely for epigastric or a%dominal pain and for fran2 or occult %lood in stool, emesis, or gastric aspirate. Lab
Test Considerations: 0ay cause a%normal liver function tests, including 9 'ST, 'LT, al2aline phosphatase, and %iliru%in. 0ay
cause hypomagnesemia. 0onitor serum magnesium prior to and periodically during therapy.
Ta(sulosin 0+l (3lo(ax) 084 ( 0S /O
Therapeutic: none assigned
/har(acoloic: peripherally acting antiadrenergics
!"#erse $eactions/ Si"e %ffects
+NS: di66iness, headache. %%NT: rhinitis. +5: orthostatic hypotension. &2: priapism, retrograde8diminished e3aculation.
'n"ications
0anagement of outflo5 o%struction in male patients 5ith prostatic hyperplasia.
!ction
#ecreases contractions in smooth muscle of the prostatic capsule %y preferentially %inding to alpha<-adrenergic
receptors. Therapeutic %ffects: #ecreased symptoms of prostatic hyperplasia (urinary urgency, hesitancy, nocturia)
Nursin '(plications
'ssess patient for symptoms of prostatic hyperplasia (urinary hesitancy, feeling of incomplete %ladder emptying, interruption of
urinary stream, impairment of si6e and force of urinary stream, terminal urinary dri%%ling, straining to start flo5, dysuria, urgency)
%efore and periodically during therapy.
'ssess patient for first-dose orthostatic hypotension and syncope. ncidence may %e dose related. *%serve patient closely during
this period and ta2e precautions to prevent in3ury.
0onitor inta2e and output ratios and daily 5eight, and assess for edema daily, especially at %eginning of therapy. (eport 5eight
gain or edema.
(ectal e&ams prior to and periodically throughout therapy to assess prostate si6e are recommended.
"mphasi6e the importance of continuing to ta2e this medication, even if feeling 5ell. nstruct patient to ta2e medication at the
same time each day. f a dose is missed, ta2e as soon as remem%ered unless almost time for ne&t dose. #o not dou%le
doses..
0ay cause di66iness. 'dvise patient to avoid driving or other activities reGuiring alertness until response to medication is 2no5n.
)aution patient to change positions slo5ly to minimi6e orthostatic hypotension.
nstruct patient to notify health care professional of all (& or *T) medications, vitamins, or her%al products %eing ta2en and
consult health care professional %efore ta2ing any ne5 medications, especially cough, cold, or allergy remedies.
"mphasi6e the importance of follo5-up visits to determine effectiveness of therapy.
9arfarin So"iu( (+ou(a"in) 4 ( :e"ti(e Once /O
Therapeutic: anticoagulants
/har(acoloic: coumarins
!"#erse $eactions/Si"e %ffects
&': cramps, nausea. Der(: dermal necrosis. 0e(at: !L""#$G. 1isc: fever
'n"ications
,rophyla&is and treatment of:: >enous throm%osis,, ,ulmonary em%olism,, 'trial fi%rillation 5ith em%oli6ation. 0anagement of
myocardial infarction:: #ecreases ris2 of death,, #ecreases ris2 of su%seGuent 0,, #ecreases ris2 of future throm%oem%olic
events. ,revention of throm%us formation and em%oli6ation after prosthetic valve placement
!ctions
nterferes 5ith hepatic synthesis of vitamin 4-dependent clotting factors (, >, /, and /). Therapeutic %ffects: ,revention of
throm%oem%olic events
Nursin '(plications
'ssess for signs of %leeding and hemorrhage (%leeding gums7 nose%leed7 unusual %ruising7 tarry, %lac2 stools7 hematuria7 fall in
hematocrit or !,7 guaiac-positive stools, urine, or nasogastric aspirate).
'ssess for evidence of additional or increased throm%osis. Symptoms depend on area of involvement.
Geri: ,atients over E= yr e&hi%it greater than e&pected ,T8$( response. 0onitor for side effects at lo5er therapeutic ranges.
,edi: 'chieving and maintaining therapeutic ,T8$( ranges may %e more difficult in the pediatric patient. 'ssess ,T8$( levels
more freGuently.
Lab Test Considerations: 0onitor ,T, $( and other clotting factors freGuently during therapy. Therapeutic ,T ranges <.F@<.;
times greater than control7 ho5ever, the $(, a standardi6ed system that provides a common %asis for communicating and
interpreting ,T results, is usually referenced. $ormal $( (not on anticoagulants) is =.B@<.:. 'n $( of :.;@F.; is recommended
for patients at very high ris2 of em%oli6ation (for e&ample, patients 5ith mitral valve replacement and ventricular hypertrophy).
Lo5er levels are accepta%le 5hen ris2 is lo5er. -eparin may affect the ,T8$(7 dra5 %lood for ,T8$( in patients receiving %oth
heparin and 5arfarin at least ; hr after the > %olus dose, ? hr after cessation of > infusion, or :? hr after su%cut heparin
in3ection. 'sian patients and those 5ho carry the ).,:)IJ: allele and8or the ).,:)IJF allele, or those 5ith >4*()< ''
genotype may reGuire more freGuent monitoring and lo5er doses..
0onitor hepatic function and )!) %efore and periodically throughout therapy..
0onitor stool and urine for occult %lood %efore and periodically during therapy.
Toxicity and Overdose: Kithholding < or more doses of 5arfarin is usually sufficient if $( is e&cessively elevated or if minor
%leeding occurs. f overdose occurs or anticoagulation needs to %e immediately reversed, the antidote is vitamin 4
(phytonadione, 'Gua0",-.T*$). 'dministration of 5hole %lood or plasma also may %e reGuired in severe %leeding
%ecause of the delayed onset of vitamin 4
3luticasone/Sal(eteral (!"#air Dis;us 400<50) 4 inh =4.0 'N0
Therapeutic: anti<infla((atories (steroi"al)
/har(acoloic: corticosteroi"s
!"#erse $eactions/Si"e %ffects
+NS: headache. %%NT: epista&is, nasal %urning, nasal irritation, nasopharyngeal fungal infection, pharyngitis. &': nausea,
vomiting. %n"o: adrenal suppression (9 dose, long-term therapy only), C gro5th (children). Der(: rash,
urticaria. $esp: cough. 1isc: '$',-.L'/S,'$G*"#"0'
'n"ications
Seasonal or perennial allergic rhinitis. Seasonal or perennial nonallergic rhinitis (1lonase only)
!ction
,otent, locally acting anti-inflammatory and immune modifier. Therapeutic %ffects:#ecrease in symptoms of allergic and
nonallergic rhinitis
Nursin '(plications
0onitor degree of nasal stuffiness, amount and color of nasal discharge, and freGuency of snee6ing..
,atients on long-term therapy should have periodic otolaryngologic e&aminations to monitor nasal mucosa and passages for
infection or ulceration..
0onitor gro5th rate in children receiving chronic therapy7 use lo5est possi%le dose.
0onitor for signs and symptoms of hypersensitivity reactions (rash, pruritis, s5elling of face and nec2, dyspnea) periodically during
therapy.
Lab Test Considerations: ,eriodic adrenal function tests may %e ordered to assess degree of hypothalamic-pituitary-adrenal
(-,') a&is suppression in chronic therapy. )hildren and patients using higher than recommended doses are at highest ris2
for -,' suppression.
0eparin So"iu( (/orcine) 50 units =.4 0 '53)2S0
Therapeutic: anticoagulants
/har(acoloic: antithrom%otics
!"#erse $eactions/Si"e %ffects
&': drug-induced hepatitis. Der(: alopecia (long-term use), rashes, urticaria.0e(at: !L""#$G, -",'($-$#+)"#
T-(*0!*).T*,"$' (-T) (KT- *( KT-*+T T-(*0!*SS), anemia. )ocal: pain at in3ection site. 1S: osteoporosis
(long-term use).1isc: fever, hypersensitivity.
'n"ications
,rophyla&is and treatment of various throm%oem%olic disorders including:: >enous throm%oem%olism,, ,ulmonary em%oli,, 'trial
fi%rillation 5ith em%oli6ation,, 'cute and chronic consumptive coagulopathies,, ,eripheral arterial throm%oem%olism. +sed in very
lo5 doses (<=@<== units) to maintain patency of > catheters (heparin flush).
!ction
t produces its ma3or anticoagulant effect %y inactivating throm%in and activated factor / (factor /a) through an antithrom%in ('T)-
dependent mechanism
Nursin i(plications
'd3ust dose according to coagulation test results performed 3ust %efore in3ection (F= min %efore each intermittent dose or G ?@E hr
if continuous > dose). Therapeutic range ',TT: <.;@:.; times control, 'l5ays chec2 compata%ilities 5ith other > solutions, +se
heparin loc2 needle to avoid repeated in3ections, Give deep su%cutaneous in3ections7 do not give heparin %y 0 in3ection, do not
give 0 in3ections to patients on heparin therapy (heparin predisposes to hematoma formation), 9!$N'N&: 'pply pressure to all
in3ection sites after needle is 5ithdra5n7 inspect in3ection sites for signs of hematoma7 do not massage in3ection sites, 0i& 5ell
5hen adding heparin to > infusion, #o not add heparin to infusion lines of other drugs, and do not piggy%ac2 other drugs into
heparin line. f this must %e done, ensure drug compati%ility, provide for safety measures (electric ra6or, soft tooth%rush) to prevent
in3ury from %leeding, )hec2 for signs of %leeding7 monitor %lood tests, 'lert all health care providers of heparin use, 9!$N'N&:
-ave protamine sulfate (heparin antidote) readily availa%le in case of overdose7 each mg neutrali6es <== units of heparin,
9!$N'N&: 1or treatment of overdose, give protamine sulfate (<L solution). "ach mg of protamine neutrali6es <== +S, heparin
units. Give very slo5ly > over <= min, not to e&ceed ;= mg. "sta%lish dose %ased on %lood coagulation studies.
!l,uteral/'pratropiu( (Duone, Ne, Solution) > (l =40 N%:
Therapeutic: %ronchodilators
/har(acoloic: adrenergics
!"#erse $eactions/Si"e %ffects
+NS: nervousness, restlessness, tremor, headache, insomnia (,edi: occurs more freGuently in young children than adults),
hyperactivity in children. $esp: ,'('#*/)'L !(*$)-*S,'S0 ("/)"SS>" +S" *1 $-'L"(S). +5: chest
pain, palpitations, angina, arrhythmias, hypertension. &': nausea, vomiting. %n"o: hyperglycemia. 3 an"
% hypo2alemia.Neuro: tremor
'n"ications
+sed as a %ronchodilator to control and prevent reversi%le air5ay o%struction caused %y asthma or )*,#. 'nhaln: +sed as a
Guic2-relief agent for acute %ronchospasm and for prevention of e&ercise-induced %ronchospasm. /O: +sed as a long-term control
agent in patients 5ith chronic8persistent %ronchospasm.
!ction
!inds to %eta:-adrenergic receptors in air5ay smooth muscle, leading to activation of adenyl cyclase and increased levels of
cyclic-FM, ;M- adenosine monophosphate (c'0,). ncreases in c'0, activate 2inases, 5hich inhi%it the phosphorylation of
myosin and decrease intracellular calcium. #ecreased intracellular calcium rela&es smooth muscle air5ays. (ela&ation
of air5ay smooth muscle 5ith su%seGuent %ronchodilation. (elatively selective for %eta: (pulmonary)
receptors. Therapeutic %ffects: !ronchodilation.
Nursin '(plications
'ssess lung sounds, pulse, and !, %efore administration and during pea2 of medication. $ote amount, color, and character of
sputum produced.
0onitor pulmonary function tests %efore initiating therapy and periodically during therapy.
*%serve for parado&ical %ronchospasm (5hee6ing). f condition occurs, 5ithhold medication and notify health care professional
immediately.
Lab Test Considerations: 0ay cause transient C in serum potassium concentrations 5ith ne%uli6ation or higher-than-
recommended doses
Tra(a"ol 0+l (2ltra() 400 ( =40 /$N /O /ain (se#ere -<40)
Therapeutic: analesics (centrally actin)
!"#erse $eactions/Si"e %ffects
+NS: S"N+("S, di66iness, headache, somnolence, an&iety, )$S stimulation, confusion, coordination distur%ance, euphoria,
malaise, nervousness, sleep disorder, 5ea2ness.%%NT: visual
distur%ances. +5: vasodilation. &': constipation, nausea, a%dominal pain, anore&ia, diarrhea, dry mouth, dyspepsia,
flatulence, vomiting. &2: menopausal symptoms, urinary retention8freGuency. Der(: pruritus,
s5eating. Neuro: hypertonia. 1isc: S"(*T*$$ S.$#(*0", physical dependence, psychological dependence, tolerance
'n"ications
0oderate to moderately severe pain (e&tended-release formulations indicated for patients 5ho reGuire around-the-cloc2 pain
management)
!ction
!inds to mu-opioid receptors. nhi%its reupta2e of serotonin and norepinephrine in the )$S.Therapeutic %ffects: #ecreased pain
Nursin '(plications
'ssess type, location, and intensity of pain %efore and :@F hr (pea2) after administration.
'ssess !, and respiratory rate %efore and periodically during administration. (espiratory depression has not occurred 5ith
recommended doses.
'ssess %o5el function routinely. ,revention of constipation should %e instituted 5ith increased inta2e of fluids and %ul2 and 5ith
la&atives to minimi6e constipating effects.
'ssess previous analgesic history. Tramadol is not recommended for patients dependent on opioids or 5ho have previously
received opioids for more than < 527 may cause opioid 5ithdra5al symptoms.
,rolonged use may lead to physical and psychological dependence and tolerance, although these may %e milder than 5ith
opioids. This should not prevent patient from receiving adeGuate analgesia. 0ost patients 5ho receive tramadol for pain do not
develop psychological dependence. f tolerance develops, changing to an opioid agonist may %e reGuired to relieve pain.
0onitor patient for sei6ures. 0ay occur 5ithin recommended dose range. (is2 is increased 5ith higher doses and in patients
ta2ing antidepressants (SS(s, S$(s, tricyclics, or 0'* inhi%itors), opioid analgesics, or other drugs that decrease the
sei6ure threshold. 'lso monitor for serotonin syndrome (mental-status changes (e.g., agitation, hallucinations, coma), autonomic
insta%ility (e.g., tachycardia, la%ile !,, hyperthermia), neuromuscular a%errations (e.g., hyperrefle&ia, incoordination) and8or
gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea) in patients ta2ing these drugs concurrently.
Lab Test Considerations: 0ay cause 9 serum creatinine, 9 liver en6ymes, C hemoglo%in, and proteinuria.
Toxicity and Overdose: *verdose may cause respiratory depression and sei6ures. $alo&one ($arcan) may reverse some, %ut
not all, of the symptoms of overdose. Treatment should %e symptomatic and supportive. 0aintain adeGuate respiratory
e&change. -emodialysis is not helpful %ecause it removes only a small portion of administered dose. Sei6ures may %e managed
5ith %ar%iturates or %en6odia6epines7 nalo&one increases ris2 of sei6ures
1etoclorpra(i"e 0+l ($elan) 40 ( =?h /$N '5/ Nausea/ #o(itin
Therapeutic: antiemetics
!"#erse $eactions/Si"e %ffects
+NS: dro5siness, e&trapyramidal reactions, restlessness, $"+(*L",T) 0'LG$'$T S.$#(*0", an&iety, depression,
irrita%ility, tardive dys2inesia. +5: arrhythmias (supraventricular tachycardia, %radycardia), hypertension,
hypotension. &': constipation, diarrhea, dry mouth, nausea. %n"o: gynecomastia. 0e(at: methemoglo%inemia,
neutropenia, leu2openia, agranulocytosis
'n"ications
,revention of chemotherapy-induced emesis. Treatment of postsurgical and dia%etic gastric stasis. 1acilitation of small %o5el
intu%ation in radiographic procedures. 0anagement of gastroesophageal reflu&. Treatment and prevention of postoperative
nausea and vomiting 5hen nasogastric suctioning is undesira%le. 2nla,elle" 2se: Treatment of hiccups. 'd3unct
management of migraine headaches
!ction
!loc2s dopamine receptors in chemoreceptor trigger 6one of the )$S. Stimulates motility of the upper G tract and accelerates
gastric emptying. Therapeutic %ffects: #ecreased nausea and vomiting. #ecreased symptoms of gastric stasis. "asier passage
of nasogastric tu%e into small %o5el
Nursin '(plications
'ssessfor nausea, vomiting, a%dominal distention, and %o5el sounds %efore and after administration.
'ssess for e&trapyramidal side effects (parkinsoniandifficulty spea2ing or s5allo5ing, loss of %alance control, pill rolling, mas2-
li2e face, shuffling gait, rigidity, tremors7 and dystonicmuscle spasms, t5isting motions, t5itching, ina%ility to move eyes,
5ea2ness of arms or legs) periodically throughout course of therapy. 0ay occur 5ee2s to months after initiation of therapy
and are reversi%le on discontinuation. #ystonic reactions may occur 5ithin minutes of > infusion and stop 5ithin :? hr of
discontinuation of metoclopramide. 0ay %e treated 5ith ;= mg of 0 diphenhydramine or diphenhydramine < mg82g > may %e
administered prophylactically <; min %efore metoclopramide > infusion.
0onitor for tardive dys2inesia (uncontrolled rhythmic movement of mouth, face, and e&tremities7 lip smac2ing or puc2ering7 puffing
of chee2s7 uncontrolled che5ing7 rapid or 5orm-li2e movements of tongue). +sually occurs after a year or more of continued
therapy7 ris2 of tardive dys2inesia increases 5ith total cumulative dose. (eport immediately and discontinue metoclopramide7
may %e irreversi%le.
0onitor for neuroleptic malignant syndrome (hyperthermia, muscle rigidity, altered consciousness, irregular pulse or !,,
tachycardia, and diaphoresis).
'ssess for signs of depression periodically throughout therapy.
Lab Test Considerations: 0ay alter hepatic function test results..
0ay cause 9 serum prolactin and aldosterone concentrations
Diphenhy"ra(ine 0+) (:ena"ryl) .5 ( :e"ti(e /$N /O 'nso(nia
Therapeutic: allergy, cold, and cough remedies, antihistamines, antitussives
!"#erse $eactions/Si"e %ffects
+NS: dro5siness, di66iness, headache, parado&ical e&citation (increased in children).%%NT: %lurred vision,
tinnitus. +5: hypotension, palpitations. &': anore&ia, dry mouth, constipation, nausea. &2: dysuria, freGuency,
urinary retention. Der(: photosensitivity.$esp: chest tightness, thic2ened %ronchial secretions, 5hee6ing. )ocal: pain at 0
site
'n"ications
(elief of allergic symptoms caused %y histamine release including:: 'naphyla&is,, Seasonal and perennial allergic rhinitis,, 'llergic
dermatoses. ,ar2insonOs disease and dystonic reactions from medications. 0ild nighttime sedation. ,revention of motion sic2ness.
'ntitussive (syrup only).
!ceta(inophen (Tylenol) ?50 ( =40 /$N /O /ain ((il" 4<>)
Therapeutic: antipyretics, nonopioid analgesics
!"#erse $eactions/Si"e %ffects
+NS: agitation (9 in children) (>), an&iety (>), headache (>), fatigue (>), insomnia (>).$esp: atelectasis (9 in children) (>),
dyspnea (>). +5: hypertension (>), hypotension (>).&': -",'T*T*/)T. (9 #*S"S), constipation (9 in children) (>),
9 liver en6ymes, nausea (>), vomiting (>). 3 an" % hypo2alemia (>). &2: renal failure (high doses8chronic
use).0e(at: neutropenia, pancytopenia. 1S: muscle spasms (>), trismus (>). Der(: rash, urticaria
'n"ications
/O, $ect: Treatment of:: 0ild pain,, 1ever. '5: Treatment of:: 0ild to moderate pain,, 0oderate to severe pain 5ith opioid
analgesics,, 1ever.
!ction
nhi%its the synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in the )$S. -as no significant
anti- inflammatory properties or G to&icity.Therapeutic %ffects: 'nalgesia. 'ntipyresis
Nursin '(plications
'ssess overall health status and alcohol usage %efore administering acetaminophen. ,atients 5ho are malnourished or
chronically a%use alcohol are at higher ris2 of developing hepatoto&icity 5ith chronic use of usual doses of this drug..
'ssess amount, freGuency, and type of drugs ta2en in patients self-medicating, especially 5ith *T) drugs. ,rolonged use of
acetaminophen increases the ris2 of adverse renal effects. 1or short-term use, com%ined doses of acetaminophen and salicylates
should not e&ceed the recommended dose of either drug given alone.
/ain: 'ssess type, location, and intensity prior to and F=@E= min follo5ing administration.
3e#er: 'ssess fever7 note presence of associated signs (diaphoresis, tachycardia, and malaise).
Lab Test Considerations: "valuate hepatic, hematologic, and renal function periodically during prolonged, high-dose therapy..
0ay alter results of %lood glucose monitoring. 0ay cause falsely C values 5hen measured 5ith glucose o&idase8pero&idase
method, %ut pro%a%ly not 5ith he&o2inase8GE,# method. 0ay also cause falsely 9 values 5ith certain instruments7 see
manufacturerPs instruction manual..
ncreased serum %iliru%in, L#-, 'ST, 'LT, and prothrom%in time may indicate hepatoto&icity.
Toxicity and Overdose: f overdose occurs, acetylcysteine ('cetadote) is the antidote
!l 0y"rox/1 0y"rox/Si(ethicone >0 (l =?0 /$N /O 0eart,urn/in"iestion
Therapeutic: antiulcer agents, hypophospatemics (al hydro)
/har(acoloic: antacids, phosphate %inders
!"#erse $eactions/Si"e %ffects (al 0y"ro)
&': constipation. 3 an" % hypophosphatemia
'n"ications
Lo5ering of phosphate levels in patients 5ith chronic renal failure. 'd3unctive therapy in the treatment of peptic, duodenal, and
gastric ulcers. -yperacidity, indigestion, reflu& esophagitis
:isaco"yl (Dulcolax) 40 ( Daily /$N /O +onstipation
Therapeutic: la&atives
/har(acoloic: stimulant la&atives
!"#erse $eactions/Si"e %ffects
&': a%dominal cramps, nausea, diarrhea, rectal %urning. 3 an" % hypo2alemia (5ith chronic use). 1S: muscle 5ea2ness (5ith
chronic use). 1isc: protein-losing enteropathy, tetany (5ith chronic use)
'n"ications
Treatment of constipation. "vacuation of the %o5el %efore radiologic studies or surgery. ,art of a %o5el regimen in spinal cord
in3ury patients
!lteplase $eco(,inant (+athflo !cti#ase) . ( as "irecte" /$N intracathe )ine Occlusion
Therapeutic: throm%olytics
/har(acoloic: plasminogen activators
!"#erse $eactions/Si"e %ffects
+NS: $T(')('$'L -"0*((-'G". %%NT: epista&is, gingival %leeding. $esp: %ronchospasm, hemoptysis. +5: reperfusion
arrhythmias, hypotension, (")+(("$T S)-"0'8T-(*0!*"0!*LS0. &': G !L""#$G,
nausea, ("T(*,"(T*$"'L !L""#$G, vomiting. &2: G+ T(')T !L""#$G. Der(: ecchymoses, flushing,
urticaria. 0e(at: !L""#$G.)ocal: hemorrhage at in3ection site, phle%itis at in3ection site. 1S: musculos2eletal
pain.1isc: 'LL"(G) ("')T*$S $)L+#$G '$',-.L'/S, fever
'n"ications
'cute myocardial infarction (0). 'cute ischemic stro2e. ,ulmonary em%olism (,"). *ccluded central venous access
devices. 2nla,elle" 2se: #eep venous throm%osis (#>T). 'cute peripheral arterial throm%osis.
!ction
#irectly converts plasminogen to plasmin, 5hich then degrades clot-%ound fi%rin.Therapeutic %ffects: Lysis of throm%i in
coronary arteries, 5ith improvement of ventricular function, and reduced ris2 of heart failure or death. Lysis of pulmonary
em%oli. Lysis of throm%i causing ischemic stro2e, reducing ris2 of neurologic seGuelae. (estoration of cannula or catheter
function
Nursin '(plications
!egin therapy as soon as possi%le after the onset of symptoms..
0onitor vital signs, including temperature, continuously for myocardial infarction and at least every ? hr during therapy for other
indications. #o not use lo5er e&tremities to monitor !,. $otify health care professional if systolic !, H<B= mm -g or diastolic
!, H<<= mm -g. Throm%olytic therapy should not %e given if hypertension is uncontrolled. nform health care
professional if hypotension occurs. -ypotension may result from the drug, hemorrhage, or cardiogenic shoc2..
'ssess patient carefully for %leeding every <; min during the <st hr of therapy, every <;@F= min during the ne&t B hr, and at least
every ? hr for the duration of therapy. 1ran2 %leeding may occur from sites of invasive procedures or from %ody orifices.
nternal %leeding may also occur (decreased neurologic status7 a%dominal pain 5ith coffee-grounds emesis or %lac2, tarry
stools7 hematuria7 3oint pain). f uncontrolled %leeding occurs, stop medication and notify health care professional
immediately..
'ssess patient for hypersensitivity reaction (rash, dyspnea, fever, changes in facial color, s5elling around the eyes, 5hee6ing). f
these occur, inform health care professional promptly. 4eep epinephrine, an antihistamine, and resuscitation eGuipment close
%y in the event of an anaphylactic reaction..
'ssess neurologic status throughout therapy. 'ltered sensorium or neurologic changes may %e indicative of intracranial %leeding.
1yocar"ial 'nfarction: 0onitor ")G continuously. $otify health care professional if significant arrhythmias occur. > lidocaine or
procainamide (,ronestyl) may %e ordered prophylactically. 0onitor cardiac en6ymes. (adionuclide myocardial
scanning and8or coronary angiography may %e ordered A@<= days after therapy to monitor effectiveness of therapy..
'ssess intensity, character, location, and radiation of chest pain. $ote presence of associated symptoms (nausea, vomiting,
diaphoresis). 'dminister analgesics as directed. $otify health care professional if chest pain is unrelieved or recurs..
0onitor heart sounds and %reath sounds freGuently. nform health care professional if signs of -1 occur (rales8crac2les, dyspnea,
SF heart sound, 3ugular venous distention, relieved )>,).
!cute 'sche(ic Stro;e: 'ssess neurologic status. #etermine time of onset of stro2e symptoms. 'lteplase must %e administered
5ithin F@?.; hr of onset (5ithin F hrs in patients older than B= years, those ta2ing oral anticoagulants, those 5ith a %aseline
$ational nstitutes of -ealth Stro2e Scale score :;, or those 5ith %oth a history of stro2e and dia%etes).
/ul(onary %(,olis(: 0onitor pulse, !,, hemodynamics, and respiratory status (rate, degree of dyspnea, '!Gs).
Deep 5ein Thro(,osis/!cute !rterial Occlusion: *%serve e&tremities and palpate pulses of affected e&tremities every hour.
$otify health care professional immediately if circulatory impairment occurs. )omputeri6ed tomography, impedance
plethysmography, Guantitative #oppler effect determination, and8or angiography or venography may %e used to determine
restoration of %lood flo5 and duration of therapy7 ho5ever, repeated venograms are not recommended.
+annula/+atheter Occlusion: 0onitor a%ility to aspirate %lood as indicator of patency. "nsure that patient e&hales and holds
%reath 5hen connecting and disconnecting > syringe to prevent air em%olism
Lab Test Considerations: -ematocrit, hemoglo%in, platelet count, fi%rin8fi%rin degradation product (1#,8fdp) titer, fi%rinogen
concentration, prothrom%in time, throm%in time, and activated partial throm%oplastin time may %e evaluated %efore and
freGuently during therapy. !leeding time may %e assessed %efore therapy if patient has received platelet aggregation
inhi%itors..
*%tain type and crossmatch and have %lood availa%le at all times in case of hemorrhage..
Stools should %e tested for occult %lood loss and urine for hematuria periodically during therapy.
Toxicity and Overdose: High Alert: f local %leeding occurs, apply pressure to site. f severe or internal %leeding occurs,
discontinue infusion. )lotting factors and8or %lood volume may %e restored through infusions of 5hole %lood, pac2ed (!)s,
fresh fro6en plasma, or cryoprecipitate. #o not administer de&tran7 it has antiplatelet activity. 'minocaproic acid ('micar)
may %e used as an antidote
!tropine Sulfate(!tropine Syrine) 4 ( /$N '5/ 0eart $ate
Therapeutic: antiarrhythmics
/har(acoloic: anticholinergics, antimuscarinics
!"#erse $eactions/Si"e %ffects
+NS: dro5siness, confusion, hyperpyre&ia. %%NT: %lurred vision, cycloplegia, photopho%ia, dry eyes, mydriasis. +5: tachycardia,
palpitations, arrhythmias. &': dry mouth, constipation, impaired G motility. &2: urinary hesitancy, retention,
impotency. $esp: tachypnea, pulmonary edema. 1isc: flushing, decreased s5eating
'n"ications
'1: Given preoperatively to decrease oral and respiratory secretions. '5: Treatment of sinus %radycardia and heart
%loc2. /O: 'd3unctive therapy in the management of peptic ulcer and irrita%le %o5el syndrome. '5: (eversal of adverse
muscarinic effects of anticholinesterase agents (neostigmine, physostigmine, or pyridostigmine). '1, '5: Treatment of
anticholinesterase (organophosphate pesticide) poisoning. 'nhaln: Treatment of e&ercise-induced %ronchospasm
)e#ofloxacin 750 (/D59 450 (l 450 () 6 400(ls/hr 450(l '5/ =.40
Therapeutic: anti-infectives
Parmacologic: fluoroquinolones
Adverse Reactions/Side Effects
CNS: ELEVATED INTRACRANIAL PRESSURE (INCLUDING PSEUDOTUOR CERE!RI"# SEI$URES# %&it%tion# %n'iet(# confusion#
)e*ression# )i++iness# )ro,siness# -%llucin%tions# -e%)%c-e# inso.ni%# ni&-t.%res# *%r%noi%# tre.or/ CV: TORSADE DE POINTES #
0T interv%l *rolon&%tion/G: 1EPATOTO2ICIT3# PSEUDOE!RANOUS COLITIS# n%use%# %4)o.in%l *%in# )i%rr-e%#
vo.itin&/ G!: v%&initis/ "erm: STEVENS-5O1NSON S3NDROE# *-otosensitivit(# r%s-/Endo: -(*er&l(ce.i%#
-(*o&l(ce.i%/ #ocal: *-le4itis %t IV site/ Neuro: *eri*-er%l neuro*%t-(/$S: %rt-r%l&i%# ten)onitis# ten)on
ru*ture/ $isc: 13PERSENSITIVIT3 REACTIONS INCLUDING ANAP13LA2IS/
ndications
P%& V: Tre%t.ent of t-e follo,in& 4%cteri%l infections6 6 Urin%r( tr%ct infections# inclu)in& c(stitis# *(elone*-ritis# %n) *rost%titis# #
Res*ir%tor( tr%ct infections# inclu)in& %cute sinusitis# %cute e'%cer4%tions of c-ronic 4ronc-itis# co..unit(-%cquire) *neu.oni%# %n)
nosoco.i%l *neu.oni%# # Unco.*lic%te) %n) co.*lic%te) s7in %n) s7in structure infections/ Post-e'*osure tre%t.ent of
in-%l%tion%l %nt-r%'/
Actions
In-i4its 4%cteri%l DNA s(nt-esis 4( in-i4itin& DNA &(r%se en+(.e/ Therapeutic Effects:De%t- of susce*ti4le 4%cteri%/ Spectrum: Active
%&%inst &r%.-*ositive *%t-o&ens# inclu)in&6 6 Staphylococcus aureus# # Staphylococcus epidermidis# # Staphylococcus saprophyticus#
# Streptococcus pyogenes# # Streptococcus pneumoniae# # Enterococcus faecalis# # Bacillus anthracis/ Gr%.-ne&%tive s*ectru.
not%4le for %ctivit( %&%inst6 6Escherichia coli# # Klebsiella pneumoniae# # Enterobacter cloacae# # Proteus mirabilis# #Pseudomonas
aeruginosa# # Serratia marcescens# # Haemophilus influenzae# # Moraxella catarrhalis/ A))ition%l s*ectru. inclu)es6 6 Chlamydophylia
pneumoniae# # Legionella pneumoniae# # Mycoplasma pneumoniae
Nursing mplications
Assess for infection (vit%l si&ns8 %**e%r%nce of ,oun)# s*utu.# urine# %n) stool8 9!C8 urin%l(sis8 frequenc( %n) ur&enc( of urin%tion8 clou)(
or foul-s.ellin& urine" %t 4e&innin& of %n) )urin& t-er%*(/
O4t%in s*eci.ens for culture %n) sensitivit( 4efore initi%tin& t-er%*(/ :irst )ose .%( 4e &iven 4efore receivin& results/
O4serve *%tient for si&ns %n) s(.*to.s of %n%*-(l%'is (r%s-# *ruritus# l%r(n&e%l e)e.%# ,-ee+in&"/ Discontinue )ru& %n) notif( *-(sici%n or
ot-er -e%lt- c%re *rofession%l i..e)i%tel( if t-ese *ro4le.s occur/ ;ee* e*ine*-rine# %n %nti-ist%.ine# %n) resuscit%tion equi*.ent
close 4( in c%se of %n %n%*-(l%ctic re%ction/
onitor 4o,el function/ Di%rr-e%# %4)o.in%l cr%.*in&# fever# %n) 4loo)( stools s-oul) 4e re*orte) to -e%lt- c%re *rofession%l *ro.*tl( %s %
si&n of *seu)o.e.4r%nous colitis/ %( 4e&in u* to sever%l ,ee7s follo,in& cess%tion of t-er%*(/
Assess for r%s- *erio)ic%ll( )urin& t-er%*(/ %( c%use Stevens-5o-nson s(n)ro.e/ Discontinue t-er%*( if severe or if %cco.*%nie) ,it- fever#
&ener%l .%l%ise# f%ti&ue# .uscle or <oint %c-es# 4listers# or%l lesions# con<unctivitis# -e*%titis %n)=or eosino*-ili%/
Lab Test Considerations: %( c%use > seru. AST# ALT# LD1# 4iliru4in# %n) %l7%line *-os*-%t%se//
%( %lso c%use > or ? seru. &lucose/
%noxaparin So"iu( ?0 ( S= :'D
Therapeutic: %ntico%&ul%nts
Parmacologic: %ntit-ro.4otics
Adverse Reactions/Side Effects
CNS: )i++iness# -e%)%c-e# inso.ni%/ CV: e)e.%/ G: consti*%tion# > liver en+(.es# n%use%# vo.itin&/ G!: urin%r(
retention/ "erm: ecc-(.oses# *ruritus# r%s-# urtic%ri%/ ' and E -(*er7%le.i%/ (emat: 4lee)in&# %ne.i%#
t-ro.4oc(to*eni%/ #ocal: er(t-e.% %t in<ection site# -e.%to.%# irrit%tion# *%in/ $isc: fever/
ndications
Prevention of venous t-ro.4oe.4olis. (VTE" ()ee* vein t-ro.4osis (DVT" %n)=or *ul.on%r( e.4olis. (PE"" in sur&ic%l or .e)ic%l
*%tients/ Tre%t.ent of DVT ,it- or ,it-out PE (,it- ,%rf%rin"/ Prevention of isc-e.ic co.*lic%tions (,it- %s*irin" fro. unst%4le %n&in% %n)
non-ST- se&.ent-elev%tion I/ Tre%t.ent of %cute ST-se&.ent-elev%tion I (,it- t-ro.4ol(tics or *ercut%neous coron%r( intervention"/
Actions
Potenti%tes t-e in-i4itor( effect of %ntit-ro.4in on f%ctor 2% %n) t-ro.4in/ Therapeutic Effects: Prevention of t-ro.4us for.%tion/
Nursing mplications
Assess for si&ns of 4lee)in& %n) -e.orr-%&e (4lee)in& &u.s8 nose4lee)8 unusu%l 4ruisin&8 4l%c7# t%rr( stools8 -e.%turi%8 f%ll in -e.%tocrit or
!P8 &u%i%c-*ositive stools"8 4lee)in& fro. sur&ic%l site/ Notif( -e%lt- c%re *rofession%l if t-ese occur//
Assess *%tient for evi)ence of %))ition%l or incre%se) t-ro.4osis/ S(.*to.s )e*en) on %re% of involve.ent//
Assess loc%tion# )ur%tion# intensit(# %n) *reci*it%tin& f%ctors of %n&in%l *%in//
onitor *%tient for -(*ersensitivit( re%ctions (c-ills# fever# urtic%ri%"/ Re*ort si&ns to -e%lt- c%re *rofession%l//
onitor *%tients ,it- e*i)ur%l c%t-eters frequentl( for si&ns %n) s(.*to.s of neurolo&ic i.*%ir.ent/
Su)cut: O4serve in<ection sites for -e.%to.%s# ecc-(.osis# or infl%..%tion/
Lab Test Considerations: onitor C!C# *l%telet count# %n) stools for occult 4loo) *erio)ic%ll( )urin& t-er%*(/ If t-ro.4oc(to*eni% occurs#
.onitor closel(/ If -e.%tocrit )ecre%ses une'*ecte)l(# %ssess *%tient for *otenti%l 4lee)in& sites//
S*eci%l .onitorin& of clottin& ti.es (%PTT" is not necess%r( in .ost *%tients/ onitorin& of t-e %PTT .%( 4e consi)ere) in cert%in *%tient
*o*ul%tions (suc- %s o4ese *%tients or *%tients ,it- ren%l insufficienc("//
onitorin& of Antif%ctor 2% levels .%( 4e necess%r( to titr%te )oses in *e)i%tric *%tients T-er%*eutic r%n&e @/ABC unit=.L//
%( c%use > in AST %n) ALT levels//
%( c%use -(*er7%le.i%/
Toxicity and Overdose: :or over)ose# *rot%.ine sulf%te C .& for e%c- .& of eno'%*%rin s-oul) 4e %).inistere) 4( slo, IV in<ection/
1anesiu( 0y"roxi"e >0 (l /O Daily /$N
Therapeutic: .iner%l %n) electrol(te re*l%ce.ents=su**le.ents# l%'%tives
Parmacologic: s%lines
Adverse Reactions/Side Effects
G: )i%rr-e%/ "erm: flus-in&# s,e%tin&/
ndications
Tre%t.ent=*revention of -(*o.%&nese.i%/ As %6 L%'%tive# !o,el ev%cu%nt in *re*%r%tion for sur&ic%l=r%)io&r%*-ic *roce)ures/ il7 of
%&nesi% -%s %lso 4een use) %s %n %nt%ci)/
Actions
Essenti%l for t-e %ctivit( of .%n( en+(.es/ Pl%( %n i.*ort%nt role in neurotr%ns.ission %n) .uscul%r e'cit%4ilit(/ Are os.otic%ll( %ctive in GI
tr%ct# )r%,in& ,%ter into t-e lu.en %n) c%usin& *erist%lsis/ Therapeutic Effects: Re*l%ce.ent in )eficienc( st%tes/ Ev%cu%tion of t-e
colon
Nursing mplications
Antacid: Assess for -e%rt4urn %n) in)i&estion %s ,ell %s loc%tion# )ur%tion# c-%r%cter# %n) *reci*it%tin& f%ctors of &%stric *%in/
Te(a*epa( 45 ( (ay repeat once if necessary /O :%DT'1% /$N
Therapeutic: se)%tive=-(*notics
Parmacologic: 4en+o)i%+e*ines
Adverse Reactions/Side Effects
CNS: %4nor.%l t-in7in&# 4e-%vior c-%n&es# -%n&over# )i++iness# )ro,siness# -%llucin%tions# let-%r&(# *%r%)o'ic e'cit%tion# slee*D
)rivin&/ EENT: 4lurre) vision/ G: consti*%tion# )i%rr-e%# n%use%# vo.itin&/ "erm: r%s-es/ $isc: *-(sic%l )e*en)ence#
*s(c-olo&ic%l )e*en)ence# toler%nce/
ndications
S-ort-ter. .%n%&e.ent of inso.ni% (EF ,ee7s"/
Nitrolycerin 084 (h S) =51 /$N
Therapeutic: %nti%n&in%ls
Parmacologic: nitr%tes
Adverse Reactions/Side Effects
CNS: )i++iness# -e%)%c-e# %**re-ension# restlessness# ,e%7ness/ EENT: 4lurre) vision/CV: -(*otension# t%c-(c%r)i%#
s(nco*e/ G: %4)o.in%l *%in# n%use%# vo.itin&/ "erm: cont%ct )er.%titis (tr%ns)er.%l"/ $isc: %lco-ol into'ic%tion (l%r&e IV )oses
onl("# cross-toler%nce# flus-in&# toler%nce/
ndications
Acute (translingual& S#& ointment" %n) lon&-ter. *ro*-(l%tic (oral& transdermal" .%n%&e.ent of %n&in% *ectoris/ P%: A)<unct tre%t.ent of
1:/ V: A)<unct tre%t.ent of %cute I/ Pro)uction of controlle) -(*otension )urin& sur&ic%l *roce)ures/ Tre%t.ent of 1: %ssoci%te)
,it- %cute I/
Actions
Incre%ses coron%r( 4loo) flo, 4( )il%tin& coron%r( %rteries %n) i.*rovin& coll%ter%l flo, to isc-e.ic re&ions/ Pro)uces v%so)il%tion (venous
&re%ter t-%n %rteri%l"/ Decre%ses left ventricul%r en)-)i%stolic *ressure %n) left ventricul%r en)-)i%stolic volu.e (*relo%)"/ Re)uces
.(oc%r)i%l o'(&en consu.*tion/ Therapeutic Effects: Relief or *revention of %n&in%l %tt%c7s/ Incre%se) c%r)i%c out*ut/ Re)uction of
!P/
Nursing mplications
Assess loc%tion# )ur%tion# intensit(# %n) *reci*it%tin& f%ctors of *%tientGs %n&in%l *%in/
onitor !P %n) *ulse 4efore %n) %fter %).inistr%tion/ P%tients receivin& IV nitro&l(cerin require continuous ECG %n) !P .onitorin&/
A))ition%l -e.o)(n%.ic *%r%.eters .%( 4e .onitore)/
Lab Test Considerations: %( c%use > urine c%tec-ol%.ine %n) urine v%nill(l.%n)elic %ci) concentr%tions//
E'cessive )oses .%( c%use > .et-e.o&lo4in concentr%tions//
%( c%use f%lsel( > seru. c-olesterol levels/
On"ansetron 4 ( '5/ =?0 /$N
Therapeutic: %ntie.etics
Parmacologic: A-1TH %nt%&onists
Adverse Reactions/Side Effects
CNS: -e%)%c-e# )i++iness# )ro,siness# f%ti&ue# ,e%7ness/ CV: TORSADE DE POINTES# 0T interv%l
*rolon&%tion/ G: consti*%tion# )i%rr-e%# %4)o.in%l *%in# )r( .out-# > liver en+(.es/Neuro: e'tr%*(r%.i)%l re%ctions/
ndications
Prevention of n%use% %n) vo.itin& %ssoci%te) ,it- -i&-l( or .o)er%tel( e.eto&enic c-e.ot-er%*(/ P%: Prevention of n%use% %n) vo.itin&
%ssoci%te) ,it- r%)i%tion t-er%*(/ Prevention %n) tre%t.ent of *osto*er%tive n%use% %n) vo.itin&/
Actions
!loc7s t-e effects of serotonin %t A-1THBrece*tor sites (selective %nt%&onist" loc%te) in v%&%l nerve ter.in%ls %n) t-e c-e.orece*tor tri&&er
+one in t-e CNS/ Therapeutic Effects: Decre%se) inci)ence %n) severit( of n%use% %n) vo.itin& follo,in& c-e.ot-er%*( or sur&er(/
Nursing mplications
Assess *%tient for n%use%# vo.itin&# %4)o.in%l )istention# %n) 4o,el soun)s *rior to %n) follo,in& %).inistr%tion/
Assess *%tient for e'tr%*(r%.i)%l effects (involunt%r( .ove.ents# f%ci%l &ri.%cin&# ri&i)it(# s-ufflin& ,%l7# tre.4lin& of -%n)s" *erio)ic%ll(
)urin& t-er%*(/
onitor ECG in *%tients ,it- -(*o7%le.i% or -(*o.%&nese.i%# 1:# 4r%)(%rr-(t-.i%s# or *%tients t%7in& conco.it%nt .e)ic%tions t-%t
*rolon& t-e 0T interv%l/
Lab Test Considerations: %( c%use tr%nsient > in seru. 4iliru4in# AST# %n) ALT levels/
1etoclopra(i"e 0+) 5 ( '5/ =?0 /$N
Therapeutic: %ntie.etics
Adverse Reactions/Side Effects
CNS: )ro,siness# e'tr%*(r%.i)%l re%ctions# restlessness# NEUROLEPTIC ALIGNANT S3NDROE# %n'iet(# )e*ression# irrit%4ilit(#
t%r)ive )(s7inesi%/ CV: %rr-(t-.i%s (su*r%ventricul%r t%c-(c%r)i%# 4r%)(c%r)i%"# -(*ertension# -(*otension/ G: consti*%tion#
)i%rr-e%# )r( .out-# n%use%/ Endo: &(neco.%sti%/ (emat: .et-e.o&lo4ine.i%# neutro*eni%# leu7o*eni%# %&r%nuloc(tosis/
ndications
Prevention of c-e.ot-er%*(-in)uce) e.esis/ Tre%t.ent of *ostsur&ic%l %n) )i%4etic &%stric st%sis/ :%cilit%tion of s.%ll 4o,el intu4%tion in
r%)io&r%*-ic *roce)ures/ %n%&e.ent of &%stroeso*-%&e%l reflu'/ Tre%t.ent %n) *revention of *osto*er%tive n%use% %n) vo.itin&
,-en n%so&%stric suctionin& is un)esir%4le/ !nla)elled !se: Tre%t.ent of -iccu*s/ A)<unct .%n%&e.ent of .i&r%ine -e%)%c-es/
Actions
!loc7s )o*%.ine rece*tors in c-e.orece*tor tri&&er +one of t-e CNS/ Sti.ul%tes .otilit( of t-e u**er GI tr%ct %n) %cceler%tes &%stric
e.*t(in&/ Therapeutic Effects: Decre%se) n%use% %n) vo.itin&/ Decre%se) s(.*to.s of &%stric st%sis/ E%sier *%ss%&e of n%so&%stric
tu4e into s.%ll 4o,el/
Nursing mplications
Assessfor n%use%# vo.itin&# %4)o.in%l )istention# %n) 4o,el soun)s 4efore %n) %fter %).inistr%tion/
Assess for e'tr%*(r%.i)%l si)e effects (parinsonian!)ifficult( s*e%7in& or s,%llo,in&# loss of 4%l%nce control# *ill rollin&# .%s7-li7e f%ce#
s-ufflin& &%it# ri&i)it(# tre.ors8 %n) dystonic!.uscle s*%s.s# t,istin& .otions# t,itc-in&# in%4ilit( to .ove e(es# ,e%7ness of %r.s
or le&s" *erio)ic%ll( t-rou&-out course of t-er%*(/ %( occur ,ee7s to .ont-s %fter initi%tion of t-er%*( %n) %re reversi4le on )iscontinu%tion/
D(stonic re%ctions .%( occur ,it-in .inutes of IV infusion %n) sto* ,it-in IF -r of )iscontinu%tion of .etoclo*r%.i)e/ %( 4e
tre%te) ,it- A@ .& of I )i*-en-()r%.ine or )i*-en-()r%.ine C .&=7& IV .%( 4e %).inistere) *ro*-(l%ctic%ll( CA .in 4efore
.etoclo*r%.i)e IV infusion/
onitor for t%r)ive )(s7inesi% (uncontrolle) r-(t-.ic .ove.ent of .out-# f%ce# %n) e'tre.ities8 li* s.%c7in& or *uc7erin&8 *uffin& of
c-ee7s8 uncontrolle) c-e,in&8 r%*i) or ,or.-li7e .ove.ents of ton&ue"/ Usu%ll( occurs %fter % (e%r or .ore of continue) t-er%*(8
ris7 of t%r)ive )(s7inesi% incre%ses ,it- tot%l cu.ul%tive )ose/ Re*ort i..e)i%tel( %n) )iscontinue .etoclo*r%.i)e8 .%( 4e irreversi4le/
onitor for neurole*tic .%li&n%nt s(n)ro.e (-(*ert-er.i%# .uscle ri&i)it(# %ltere) consciousness# irre&ul%r *ulse or !P# t%c-(c%r)i%# %n)
)i%*-oresis"/
Assess for si&ns of )e*ression *erio)ic%ll( t-rou&-out t-er%*(/
Lab Test Considerations: %( %lter -e*%tic function test results//
%( c%use > seru. *rol%ctin %n) %l)osterone concentr%tions/
:isaco"yl 40 ( /$ =-0 /$N
Therapeutic: l%'%tives
Parmacologic: sti.ul%nt l%'%tives
Adverse Reactions/Side Effects
G: %4)o.in%l cr%.*s# n%use%# )i%rr-e%# rect%l 4urnin&/ ' and E -(*o7%le.i% (,it- c-ronic use"/ $S: .uscle ,e%7ness (,it- c-ronic
use"/ $isc: *rotein-losin& entero*%t-(# tet%n( (,it- c-ronic use"/
ndications
Tre%t.ent of consti*%tion/ Ev%cu%tion of t-e 4o,el 4efore r%)iolo&ic stu)ies or sur&er(/ P%rt of % 4o,el re&i.en in s*in%l cor) in<ur( *%tients/
!(itriptyline 0+) .5 ( :e"ti(e /O
Therapeutic: antidepressants
Pharmacologic: tric*clic antidepressants
Adverse Effects/ Side Effects
CNS: SUICIDAL T1OUG1TS# let-%r&(# se)%tion/ EENT: 4lurre) vision# )r( e(es# )r( .out-/CV: ARR13T1IAS# TORSADE DE
POINTES# -(*otension# ECG c-%n&es# 0T interv%l *rolon&%tion/ G: consti*%tion# -e*%titis# *%r%l(tic ileus# > %**etite# ,ei&-t
&%in/ G!: urin%r( retention# ? li4i)o/ "erm: *-otosensitivit(/ Endo: c-%n&es in 4loo) &lucose# &(neco.%sti%/(emat: 4loo)
)(scr%si%s
ndications
De*ression/ !nla)elled !se: An'iet(# inso.ni%# tre%t.ent-resist%nt )e*ression/ C-ronic *%in s(n)ro.es (i/e/# fi4ro.(%l&i%# neuro*%t-ic
*%in=c-ronic *%in# -e%)%c-e# lo, 4%c7 *%in"/
Action
Potenti%tes t-e effect of serotonin %n) nore*ine*-rine in t-e CNS/ 1%s si&nific%nt %ntic-oliner&ic *ro*erties/ Therapeutic
Effects: Anti)e*ress%nt %ction
Nursing ntervension
O4t%in ,ei&-t %n) !I initi%ll( %n) *erio)ic%ll( )urin& tre%t.ent/
Assess f%stin& &lucose %n) c-olesterol levels in over,ei&-t=o4ese in)ivi)u%ls/
onitor !P %n) *ulse 4efore %n) )urin& initi%l t-er%*(/ Notif( -e%lt- c%re *rofession%l of )ecre%ses in !P (C@BI@ .. 1&" or su))en incre%se
in *ulse r%te/ P%tients t%7in& -i&- )oses or ,it- % -istor( of c%r)iov%scul%r )ise%se s-oul) -%ve ECG .onitore) 4efore %n)
*erio)ic%ll( )urin& t-er%*(/
"epression: onitor .ent%l st%tus (orient%tion# .oo) 4e-%vior" frequentl(/ Assess for suici)%l ten)encies# es*eci%ll( )urin& e%rl( t-er%*(/
Restrict %.ount of )ru& %v%il%4le to *%tient//
Assess for suici)%l ten)encies# es*eci%ll( )urin& e%rl( t-er%*(/ Restrict %.ount of )ru& %v%il%4le to *%tient/ Ris7 .%( 4e incre%se) in c-il)ren#
%)olescents# %n) %)ults JIF (rs/ After st%rtin& t-er%*(# c-il)ren# %)olescents# %n) (oun& %)ults s-oul) 4e seen 4( -e%lt- c%re
*rofession%l %t le%st ,ee7l( for F ,7# ever( H ,7 for ne't F ,7# %n) on %)vice of -e%lt- c%re *rofession%l t-ere%fter/
Pain: Assess intensit(# qu%lit(# %n) loc%tion of *%in *erio)ic%ll( )urin& t-er%*(/ %( require sever%l ,ee7s for effects to 4e seen/ Use *%in
sc%le to .onitor effectiveness of .e)ic%tion/ Assess for se'u%l )(sfunction ()ecre%se) li4i)o8 erectile )(sfunction"/Geri6 Geri%tric
*%tients st%rte) on %.itri*t(line .%( 4e %t %n incre%se) ris7 for f%lls8 st%rt ,it- lo, )ose %n) .onitor closel(/ Assess for %ntic-oliner&ic effects
(,e%7ness %n) se)%tion"/
Lab Test Considerations: Assess leu7oc(te %n) )ifferenti%l 4loo) counts# liver function# %n) seru. &lucose 4efore %n) *erio)ic%ll( )urin&
t-er%*(/ %( c%use %n > seru. 4iliru4in %n) %l7%line *-os*-%t%se/ %( c%use 4one .%rro, )e*ression/ Seru. &lucose .%( 4e > or ?/
Eno+aparin Sodium ,#oveno+- ./ mg 0" S1
Therapeutic6 %ntico%&ul%nts
Pharmacologic6 %ntit-ro.4otics
Adverse Effects/Side Effects
CNS: )i++iness# -e%)%c-e# inso.ni%/ CV: e)e.%/ G: consti*%tion# > liver en+(.es# n%use%# vo.itin&/ G!: urin%r(
retention/ "erm: ecc-(.oses# *ruritus# r%s-# urtic%ri%/ ' and E -(*er7%le.i%/ (emat: 4lee)in&# %ne.i%#
t-ro.4oc(to*eni%/ #ocal: er(t-e.% %t in<ection site# -e.%to.%# irrit%tion# *%in/ $isc: fever/
ndications
Prevention of venous t-ro.4oe.4olis. (VTE" ()ee* vein t-ro.4osis (DVT" %n)=or *ul.on%r( e.4olis. (PE"" in sur&ic%l
or .e)ic%l *%tients/ Tre%t.ent of DVT ,it- or ,it-out PE (,it- ,%rf%rin"/ Prevention of isc-e.ic co.*lic%tions
(,it- %s*irin" fro. unst%4le %n&in% %n) non-ST-se&.ent-elev%tion I/ Tre%t.ent of %cute ST-se&.ent-elev%tion I (,it-
t-ro.4ol(tics or *ercut%neous coron%r( intervention"/
Action
Potenti%tes t-e in-i4itor( effect of %ntit-ro.4in on f%ctor 2% %n) t-ro.4in/ Therapeutic Effects: Prevention of t-ro.4us
for.%tion
Nursing mplications
Assess for si&ns of 4lee)in& %n) -e.orr-%&e (4lee)in& &u.s8 nose4lee)8 unusu%l 4ruisin&8 4l%c7# t%rr( stools8 -e.%turi%8 f%ll
in -e.%tocrit or !P8 &u%i%c-*ositive stools"8 4lee)in& fro. sur&ic%l site/ Notif( -e%lt- c%re *rofession%l if t-ese
occur//
Assess *%tient for evi)ence of %))ition%l or incre%se) t-ro.4osis/ S(.*to.s )e*en) on %re% of involve.ent//
Assess loc%tion# )ur%tion# intensit(# %n) *reci*it%tin& f%ctors of %n&in%l *%in//
onitor *%tient for -(*ersensitivit( re%ctions (c-ills# fever# urtic%ri%"/ Re*ort si&ns to -e%lt- c%re *rofession%l//
onitor *%tients ,it- e*i)ur%l c%t-eters frequentl( for si&ns %n) s(.*to.s of neurolo&ic i.*%ir.ent/
Su)cut: O4serve in<ection sites for -e.%to.%s# ecc-(.osis# or infl%..%tion/
Lab Test Considerations: onitor C!C# *l%telet count# %n) stools for occult 4loo) *erio)ic%ll( )urin& t-er%*(/ If
t-ro.4oc(to*eni% occurs# .onitor closel(/
If -e.%tocrit )ecre%ses une'*ecte)l(# %ssess *%tient for *otenti%l 4lee)in& sites//
S*eci%l .onitorin& of clottin& ti.es (%PTT" is not necess%r( in .ost *%tients/ onitorin& of t-e %PTT .%( 4e consi)ere) in
cert%in *%tient *o*ul%tions (suc- %s o4ese *%tients or *%tients ,it- ren%l insufficienc("//
onitorin& of Antif%ctor 2% levels .%( 4e necess%r( to titr%te )oses in *e)i%tric *%tients T-er%*eutic r%n&e @/ABC unit=.L//
%( c%use > in AST %n) ALT levels//
%( c%use -(*er7%le.i%/
Toxicity and Overdose: :or over)ose# *rot%.ine sulf%te C .& for e%c- .& of eno'%*%rin s-oul) 4e %).inistere) 4( slo, IV
in<ection/
$upirocin ,0actro)an %intment 22 G$-
T-er%*eutic6 %nti-infectives
Adverse Reactions/Side Effects
CNS: nasal onl*: -e%)%c-e/ EENT: nasal onl*: cou&-# itc-in&# *-%r(n&itis# r-initis# u**er res*ir%tor( tr%ct
con&estion/ G: n%use% nasal onl*: %ltere) t%ste/ "erm: topical onl*:4urnin&# itc-in&# *%in# stin&in&/
ndications
Topical: Tre%t.ent of66 I.*eti&o## Secon)%ril( infecte) tr%u.%tic s7in lesions (u* to C@ c. in len&t- or C@@
c.
I
%re%" c%use) 4( Staphylococcus aureus %n) Streptococcus pyogenes/ntranasal: Er%)ic%tes n%s%l coloni+%tion
,it- .et-icillin-resist%nt S" aureus/
Action
In-i4its 4%cteri%l *rotein s(nt-esis/ Therapeutic Effects: In-i4ition of 4%cteri%l &ro,t- %n)
re*ro)uction/ Spectrum: Gre%test %ctivit( %&%inst &r%.-*ositive or&%nis.s# inclu)in&66 S" aureus## !et%--e.ol(tic
stre*tococci/ Resolution of i.*eti&o/ Er%)ic%tion of S" aureusc%rrier st%te/
N!RSNG $P#CAT%NS
Assessment
Assess lesions 4efore %n) )%il( )urin& t-er%*(/
Al4uterol=I*r%tro*iu. H.l
T-er%*eutic6 4ronc-o)il%tors
P-%r.%colo&ic6 %)rener&ic
Adverse Reactions/Side Effects
CNS: nervousness# restlessness# tre.or# -e%)%c-e# inso.ni% (Pe)i6 occurs .ore frequentl( in (oun& c-il)ren t-%n %)ults"#
-(*er%ctivit( in c-il)ren/ Resp: PARADO2ICAL !RONC1OSPAS (E2CESSIVE USE O: IN1ALERS"/ CV: c-est
*%in# *%l*it%tions# %n&in%# %rr-(t-.i%s# -(*ertension/ G: n%use%# vo.itin&/ Endo: -(*er&l(ce.i%/ ' and
E -(*o7%le.i%/Neuro: tre.or/
ndications
Use) %s % 4ronc-o)il%tor to control %n) *revent reversi4le %ir,%( o4struction c%use) 4( %st-.% or COPD/ nhaln: Use) %s % quic7-
relief %&ent for %cute 4ronc-os*%s. %n) for *revention of e'ercise-in)uce) 4ronc-os*%s./ P%: Use) %s % lon&-ter. control %&ent in
*%tients ,it- c-ronic=*ersistent 4ronc-os*%s./
Action
!in)s to 4et%I-%)rener&ic rece*tors in %ir,%( s.oot- .uscle# le%)in& to %ctiv%tion of %)en(l c(cl%se %n) incre%se) levels of c(clic-HK#
AK-%)enosine .ono*-os*-%te (cAP"/ Incre%ses in cAP %ctiv%te 7in%ses# ,-ic- in-i4it t-e *-os*-or(l%tion of .(osin %n) )ecre%se
intr%cellul%r c%lciu./ Decre%se) intr%cellul%r c%lciu. rel%'es s.oot- .uscle %ir,%(s/ Rel%'%tion of %ir,%( s.oot- .uscle ,it-
su4sequent 4ronc-o)il%tion/ Rel%tivel( selective for 4et%I (*ul.on%r(" rece*tors/ Therapeutic Effects: !ronc-o)il%tion/
N!RSNG $P#CAT%NS
Assess lun& soun)s# *ulse# %n) !P 4efore %).inistr%tion %n) )urin& *e%7 of .e)ic%tion/ Note %.ount# color# %n) c-%r%cter of s*utu.
*ro)uce)/
onitor *ul.on%r( function tests 4efore initi%tin& t-er%*( %n) *erio)ic%ll( )urin& t-er%*(/
O4serve for *%r%)o'ic%l 4ronc-os*%s. (,-ee+in&"/ If con)ition occurs# ,it--ol) .e)ic%tion %n) notif( -e%lt- c%re *rofession%l
i..e)i%tel(/
Lab Test Considerations: %( c%use tr%nsient ? in seru. *ot%ssiu. concentr%tions ,it- ne4uli+%tion or -i&-er-t-%n-reco..en)e)
)oses
or*-ine Sulf%te (OR*-ine"
T-er%*eutic6 o*ioi) %n%l&esics
P-%r.%colo&ic6 o*ioi) %&onist
Adverse Reactions/Side Effects
CNS: confusion# se)%tion# )i++iness# )(s*-ori%# eu*-ori%# flo%tin& feelin&# -%llucin%tions# -e%)%c-e# unusu%l )re%.s/ EENT: 4lurre)
vision# )i*lo*i%# .iosis/ Resp: RESPIRATOR3 DEPRESSION/ CV: -(*otension# 4r%)(c%r)i%/ G: consti*%tion# n%use%#
vo.itin&/ G!: urin%r( retention/ "erm: flus-in&# itc-in&# s,e%tin&/ $isc: *-(sic%l )e*en)ence# *s(c-olo&ic%l )e*en)ence# toler%nce/
ndications
Severe *%in (t-e I@ .&=.L or%l solution concentr%tion s-oul) onl( 4e use) in o*ioi)-toler%nt *%tients"/ Pul.on%r( e)e.%/ P%in
%ssoci%te) ,it- I/
On)%nsetron 1CL ($ofr%n"
T-er%*eutic6 %ntie.etics
P-%r.%colo&ic6 A-1TH %nt%&onists
Adverse Reactions/Side Effects
CNS: -e%)%c-e# )i++iness# )ro,siness# f%ti&ue# ,e%7ness/ CV: TORSADE DE POINTES# 0T interv%l
*rolon&%tion/ G: consti*%tion# )i%rr-e%# %4)o.in%l *%in# )r( .out-# > liver en+(.es/Neuro: e'tr%*(r%.i)%l re%ctions/
ndications
Prevention of n%use% %n) vo.itin& %ssoci%te) ,it- -i&-l( or .o)er%tel( e.eto&enic c-e.ot-er%*(/ P%: Prevention of n%use% %n)
vo.itin& %ssoci%te) ,it- r%)i%tion t-er%*(/ Prevention %n) tre%t.ent of *osto*er%tive n%use% %n) vo.itin&/
Action
!loc7s t-e effects of serotonin %t A-1THBrece*tor sites (selective %nt%&onist" loc%te) in v%&%l nerve ter.in%ls %n) t-e c-e.orece*tor
tri&&er +one in t-e CNS/ Therapeutic Effects: Decre%se) inci)ence %n) severit( of n%use% %n) vo.itin& follo,in& c-e.ot-er%*( or
sur&er(/
N!RSNG $P#CAT%NS
Assess *%tient for n%use%# vo.itin&# %4)o.in%l )istention# %n) 4o,el soun)s *rior to %n) follo,in& %).inistr%tion/
Assess *%tient for e'tr%*(r%.i)%l effects (involunt%r( .ove.ents# f%ci%l &ri.%cin&# ri&i)it(# s-ufflin& ,%l7# tre.4lin& of -%n)s"
*erio)ic%ll( )urin& t-er%*(/
onitor ECG in *%tients ,it- -(*o7%le.i% or -(*o.%&nese.i%# 1:# 4r%)(%rr-(t-.i%s# or *%tients t%7in& conco.it%nt .e)ic%tions
t-%t *rolon& t-e 0T interv%l/
Lab Test Considerations: %( c%use tr%nsient > in seru. 4iliru4in# AST# %n) ALT levels/
i)%+ol%. 1CL (Verse)"
T-er%*eutic6 %nti%n'iet( %&ents# se)%tive=-(*notics
P-%r.%colo&ic6 4en+o)i%+e*ines
Adverse Reactions/Side Effects
CNS: %&it%tion# )ro,siness# e'cess se)%tion# -e%)%c-e/ EENT: 4lurre) vision/ Resp: APNEA#LAR3NGOSPAS# RESPIRATOR3
DEPRESSION# 4ronc-os*%s.# cou&-in&/ CV: CARDIAC ARREST# %rr-(t-.i%s/ G: -iccu*s# n%use%#
vo.itin&/ "erm: r%s-es/ #ocal: *-le4itis %t IV site # *%in %t I site
ndications
P%: Pre*roce)ur%l se)%tion %n) %n'iol(sis in *e)i%tric *%tients/ $& V: Preo*er%tive se)%tion=%n'iol(sis=%.nesi%/ V: Provi)es
se)%tion=%n'iol(sis=%.nesi% )urin& t-er%*eutic# )i%&nostic# or r%)io&r%*-ic *roce)ures (conscious se)%tion"66 Ai)s in t-e in)uction of
%nest-esi% %n) %s *%rt of 4%l%nce) %nest-esi%## As % continuous infusion# *rovi)es se)%tion of .ec-%nic%ll( ventil%te) *%tients )urin&
%nest-esi% or in % critic%l c%re settin&## St%tus e*ile*ticus
Di*-en-()r%.ine 1CL IA .&
T-er%*eutic6 %ller&(# col)# %n) cou&- re.e)ies# %nti-ist%.ines# %ntitussives
Adverse Reactions/Side Effects (CAPITALS in)ic%te life-t-re%tenin&8un)erlines in)ic%te .ost frequent/"
CNS: )ro,siness# )i++iness# -e%)%c-e# *%r%)o'ic%l e'cit%tion (incre%se) in c-il)ren"/EENT: 4lurre) vision#
tinnitus/ CV: -(*otension# *%l*it%tions/ G: %nore'i%# )r( .out-# consti*%tion# n%use%/ G!: )(suri%# frequenc(# urin%r(
retention/ "erm: *-otosensitivit(/Resp: c-est ti&-tness# t-ic7ene) 4ronc-i%l secretions# ,-ee+in&/ #ocal: *%in %t I site/
ndications
Relief of %ller&ic s(.*to.s c%use) 4( -ist%.ine rele%se inclu)in&66 An%*-(l%'is## Se%son%l %n) *erenni%l %ller&ic r-initis## Aller&ic
)er.%toses/ P%r7insonLs )ise%se %n) )(stonic re%ctions fro. .e)ic%tions/ il) ni&-tti.e se)%tion/ Prevention of .otion sic7ness/
Antitussive (s(ru* onl("
Nitro*russi)e
T-er%*eutic6 %nti-(*ertensives
P-%r.%colo&ic6 v%so)il%tors
Adverse Reactions/Side Effects (CAPITALS in)ic%te life-t-re%tenin&8un)erlines in)ic%te .ost frequent/"
CNS: )i++iness# -e%)%c-e# restlessness/ EENT: 4lurre) vision# tinnitus/ CV: )(s*ne%# -(*otension# *%l*it%tions/ G: %4)o.in%l
*%in# n%use%# vo.itin&/ ' and E %ci)osis/#ocal: *-le4itis %t IV site/ $isc: C3ANIDE TO2ICIT3# t-ioc(%n%te to'icit(
ndications
1(*ertensive crises/ Controlle) -(*otension )urin& %nest-esi%/ C%r)i%c *u.* f%ilure or c%r)io&enic s-oc7 (%lone or ,it- )o*%.ine"
Insulin 1u.%n Re&ul%r (1u.ulin R"
Therapeutic: antidiabetics, hormones
Pharmacologic: pancreatics
Adverse Reactions/Side Effects (CAPITALS indicate life-threatening;underlines indicate most frequent.)
Endo: HP!"LC#$IA. Local: li%od&stro%h&' %ruritus' er&thema' s(elling. Misc: ALL#)"IC )#ACTI!*S
I*CL+,I*" A*APHLA-IS
Indications
Control of h&%ergl&cemia in %atients (ith dia.etes mellitus. Concentrated regular insulin U-500: !nl&
for use in %atients (ith insulin requirements /011 units2da&. Unlabelled Use:Treatment of h&%er3alemia.
Action
Lo(ers .lood glucose .&44 stimulating glucose u%ta3e in s3eletal muscle and fat'' inhi.iting he%atic
glucose %roduction. !ther actions of insulin44 inhi.ition of li%ol&sis and %roteol&sis'' enhanced %rotein
s&nthesis. Therapeutic Effects: Control of h&%ergl&cemia in dia.etic %atients.
NURSING IMPLICATIONS
Assessment
Assess %atient %eriodicall& for s&m%toms of h&%ogl&cemia (an5iet&; restlessness; tingling in hands' feet'
li%s' or tongue; chills; cold s(eats; confusion; cool' %ale s3in; difficult& in concentration; dro(siness;
nightmares or trou.le slee%ing; e5cessi6e hunger; headache; irrita.ilit&; nausea; ner6ousness;
tach&cardia; tremor; (ea3ness; unstead& gait) and h&%ergl&cemia (confusion' dro(siness; flushed' dr&
s3in; fruit-li3e .reath odor; ra%id' dee% .reathing' %ol&uria; loss of a%%etite; unusual thirst) during
thera%&.
$onitor .od& (eight %eriodicall&. Changes in (eight ma& necessitate changes in insulin dose.
Lab Test Considerations: $onitor .lood glucose e6er& 7 hr during thera%&' more frequentl& in
3etoacidosis and times of stress. A8C ma& .e monitered e6er& 9:7 mo to determine effecti6eness.
Toxicity and Overdose: !6erdose is manifested .& s&m%toms of h&%ogl&cemia. $ild h&%ogl&cemia ma&
.e treated .& ingestion of oral glucose. Se6ere h&%ogl&cemia is a life-threatening emergenc&; treatment
consists of I; glucose' glucagon' or e%ine%hrine.
<entan&l (Su.lima=e)
T-er%*eutic6 o*ioi) %n%l&esics
P-%r.%colo&ic6 o*ioi) %&onists
Adverse Reactions/Side Effects (CAPITALS in)ic%te life-t-re%tenin&8un)erlines in)ic%te .ost frequent/"
CNS: confusion# *%r%)o'ic%l e'cit%tion=)eliriu.# *osto*er%tive )e*ression# *osto*er%tive )ro,siness/ EENT: 4lurre)=)ou4le
vision/ Resp: APNEA# LAR3NGOSPAS# %ller&ic 4ronc-os*%s.# res*ir%tor( )e*ression/ CV: %rr-(t-.i%s# 4r%)(c%r)i%# circul%tor(
)e*ression# -(*otension/ G: 4ili%r( s*%s.# n%use%=vo.itin&/ "erm: f%ci%l itc-in&/ $S: s7elet%l %n) t-or%cic .uscle ri&i)it( (,it-
r%*i) IV infusion"
ndications
An%l&esic su**le.ent to &ener%l %nest-esi%8 usu%ll( ,it- ot-er %&ents (ultr%Bs-ort-%ctin& 4%r4itur%tes# neuro.uscul%r 4loc7in& %&ents#
%n) in-%l%tion %nest-etics" to *ro)uce 4%l%nce) %nest-esi%/ In)uction=.%inten%nce of %nest-esi% (,it- o'(&en or o'(&en=nitrous o'i)e
%n) % neuro.uscul%r 4loc7in& %&ents"/ Neurole*t%n%l&esi%=neurole*t%nest-esi% (,it- or ,it-out nitrous o'i)e"/ Su**le.ent to
re&ion%l=loc%l %nest-esi%/ Preo*er%tive %n) *osto*er%tive %n%l&esi%/ !nla)elled !se: Continuous IV infusion %s *%rt of PCA
eto*rolol (Lo*ressor"
T-er%*eutic6 %nti%n&in%ls# %nti-(*ertensives
P-%r.%colo&ic6 4et% 4loc7er
Adverse Reactions/Side Effects (CAPITALS in)ic%te life-t-re%tenin&8un)erlines in)ic%te .ost frequent/"
CNS: f%ti&ue# ,e%7ness# %n'iet(# )e*ression# )i++iness# )ro,siness# inso.ni%# .e.or( loss# .ent%l st%tus c-%n&es# nervousness#
ni&-t.%res/ EENT: 4lurre) vision# stuff( nose/Resp: 4ronc-os*%s.# ,-ee+in&/ CV: !RAD3CARDIA# 1:# PULONAR3
EDEA# -(*otension# *eri*-er%l v%soconstriction/ G: consti*%tion# )i%rr-e%# )ru&-in)uce) -e*%titis# )r( .out-# fl%tulence# &%stric
*%in# -e%rt4urn# > liver en+(.es# n%use%# vo.itin&/ G!: erectile )(sfunction# ? li4i)o# urin%r(
frequenc(/ "erm: r%s-es/ Endo: -(*er&l(ce.i%# -(*o&l(ce.i%/$S: %rt-r%l&i%# 4%c7 *%in# <oint *%in/ $isc: )ru&-in)uce) lu*us
s(n)ro.e/
ndications
1(*ertension/ An&in% *ectoris/ Prevention of I %n) )ecre%se) .ort%lit( in *%tients ,it- recent I/ %n%&e.ent of st%4le#
s(.*to.%tic (cl%ss II or III" -e%rt f%ilure )ue to isc-e.ic# -(*ertensive or c%r)io.(o*%t-c ori&in (.%( 4e use) ,it- ACE in-i4itors#
)iuretics %n)=or )i&o'in8 To*rol 2L onl("/ !nla)elled !se: Ventricul%r %rr-(t-.i%s=t%c-(c%r)i%/ i&r%ine *ro*-(l%'is/ Tre.ors/
A&&ressive 4e-%vior/ Dru&-in)uce) %7%t-isi%/ An'iet(/
Action
!loc7s sti.ul%tion of 4et%C(.(oc%r)i%l"-%)rener&ic rece*tors/ Does not usu%ll( %ffect 4et%I(*ul.on%r(# v%scul%r# uterine"-%)rener&ic
rece*tor sites/ Therapeutic Effects:Decre%se) !P %n) -e%rt r%te/ Decre%se) frequenc( of %tt%c7s of %n&in% *ectoris/ Decre%se) r%te of
c%r)iov%scul%r .ort%lit( %n) -os*it%li+%tion in *%tients ,it- -e%rt f%ilure/
N!RSNG $P#CAT%NS
onitor !P# ECG# %n) *ulse frequentl( )urin& )ose %)<ust.ent %n) *erio)ic%ll( )urin& t-er%*(/
onitor frequenc( of *rescri*tion refills to )eter.ine co.*li%nce/
onitor vit%l si&ns %n) ECG ever( ABCA .in )urin& %n) for sever%l -ours %fter *%renter%l %).inistr%tion/ If -e%rt r%te EF@ 4*.#
es*eci%ll( if c%r)i%c out*ut is %lso )ecre%se)# %).inister %tro*ine @/IAB@/A .& IV/
onitor int%7e %n) out*ut r%tios %n) )%il( ,ei&-ts/ Assess routinel( for si&ns %n) s(.*to.s of 1: ()(s*ne%# r%les=cr%c7les# ,ei&-t
&%in# *eri*-er%l e)e.%# <u&ul%r venous )istention"/
Angina: Assess frequenc( %n) c-%r%cteristics of %n&in%l %tt%c7s *erio)ic%ll( )urin& t-er%*(/
Lab Test Considerations: %( c%use > !UN# seru. li*o*rotein# *ot%ssiu.# tri&l(ceri)e# %n) uric %ci) levels//
%( c%use > ANA titers//
%( c%use > in 4loo) &lucose levels//
%( c%use > seru. %l7%line *-os*-%t%se# LD1# AST# %n) ALT levels