Pharm Phlash - Pharmacology Phlash Cards 2 Edition

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Pharm Phlash!
Pharmacology Flash Cards
2nd Edition
Valerie I. Leek, MSN, RN, CMSRN
Nursing Faculty Adjunct Faculty (Volunteer)
Cape May County University of Medicine &
Technical School Dentistry of New Jersey
Cape May Courthouse, Newark, New Jersey
New Jersey
Uploaded by MEDBOOKSVN.ORG
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F. A. Davis Company As new scientific information becomes available through basic and
1915 Arch Street clinical research, recommended treatments and drug therapies undergo
changes. The author(s) and publisher have done everything possible to
Philadelphia, PA 19103 make this book accurate, up to date, and in accord with accepted stan-
www.fadavis.com dards at the time of publication. The author(s), editors, and publisher
are not responsible for errors or omissions or for consequences from
application of the book, and make no warranty, expressed or implied, in
Copyright © 2013, 2009 by F. A. Davis Company. All rights regard to the contents of the book. Any practice described in this book
reserved. This book is protected by copyright. No part of it should be applied by the reader in accordance with professional standards
may be reproduced, stored in a retrieval system, or transmitted of care used in regard to the unique circumstances that may apply in
in any form or by any means, electronic, mechanical, photo- each situation. The reader is advised always to check product information
(package inserts) for changes and new information regarding dose and
copying, recording, or otherwise, without written permission contraindications before administering any drug. Caution is especially
from the publisher. urged when using new or infrequently ordered drugs.
Printed in China Authorization to photocopy items for internal or personal use, or the
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Dedication
Thank you to my loving husband, Dave; my sons, Jeffrey and Zachary; my grand-daughter,
Cadence; and my parents, Pauline and Harry. You are my heart.
A big thank you to all of my nursing students, past, present, and future. You enrich my
life and give me the joy and desire to continue to teach.
Acknowledgments
Thank you to all the nursing professionals who interact so graciously with my nursing
students. A good role model in the clinical setting is priceless. My sincerest thanks to all
the wonderful people I’ve worked with at F.A. Davis Company.
Valerie I. Leek
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Davis’s Success Series

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Keyword: Success Series to learn more.
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vii
Reviewers
Deborah S. Bridgewater, RN, MSN
Professor, Coordinator of Academic Support
St. Mary’s School of Nursing
Huntington, West Virginia
Sally K. Davis, RN, MSN

Nursing Instructor
Western Wisconsin Technical College
LaCrosse, Wisconsin
Linda C. McIntosh, PhD, RN, LPC

Psychologist, Addiction (Substance Use Disorder)
Greensboro, North Carolina
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ix
Icons
Gastrointestinal System Drugs Central Nervous System Drugs
Endocrine System Drugs Cardiovascular System Drugs
Urologic System Drugs Respiratory System Drugs
Immune System Drugs Sensory System Affecting the Eye
Musculoskeletal System Drugs
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Abbreviations Used on Cards

ABGs arterial blood gases bpm beats per minute CVP central venous pressure
ac before meals BUN blood urea nitrogen CXR chest x-ray
ACE angiotensin-converting Ca+ serum calcium D5/0.9% 5% dextrose and normal
enzyme cAMP cyclic adenosine NaCl saline solution (0.9% NaCl)
ADH antidiuretic hormone monophosphate D5/1/2 NS 5% dextrose and half
ADHD attention-deficit/hyperactivity cap capsule normal saline solution
disorder CBC complete blood count (0.45% NaCl)
AFB acid-fast bacillus cGMP cyclic guanosine D5W 5% dextrose in water
ALT alanine aminotransferase monophosphate derm dermatology
AM ante meridian CHF congestive heart failure DKA diabetic ketoacidosis
ANA antinuclear antibodies Cl- chloride ion dL deciliter
APAP acetaminophen CNS central nervous system DM diabetes mellitus
aPTT activated partial thrombo- CO cardiac output DMARD disease-modulating
plastin time COPD chronic obstructive pulmonary antirheumatic drug
ARDS adult respiratory distress disease DNA deoxyribonucleic acid
syndrome CPK creatine phosphokinase DVT deep vein thrombosis
ASA acetylsalicylic acid CR controlled or continuous ECG electrocardiogram
AST aspartate aminotransferase release EEG electroencephalogram
AV atrioventricular CSF colony-stimulating factor; EENT eye, ear, nose, and throat
bid two times a day cerebrospinal fluid EMS Emergency Medical Services
BMS bone marrow suppression CT computerized tomography endo endocrine
BNP brain natriuretic peptide CV cardiovascular EPS extrapyramidal symptoms
BP blood pressure CVA cerebrovascular accident ER extended-release
BPH benign prostatic hyperplasia CVC central venous catheter ESRD end-stage renal disease
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F and E fluid and electrolyte hs hour of sleep/bedtime mcg microgram(s)

g gram HTN hypertension MDI metered dose inhaler
GABA gamma-aminobutyric acid 5HT1 5-hydroxytryptamine- mEq milliequivalent
GERD gastroesophageal reflux 1-receptor agonist metab metabolic
disease 5HT3 5-hydroxytryptamine- mg milligram
GFR glomerular filtration rate 3-receptor antagonist Mg+ magnesium ion
GGT gamma-glutamyl ICP intracranial pressure MI myocardial infarction
transpeptidase IM intramuscular min minute(s)
GI gastrointestinal Inhaln inhalation misc miscellaneous
GTT glucose tolerance test INR international normalized mL milliliter
GU genitourinary ratio mo month(s)
H+ hydrogen ion I&O intake and output MRI magnetic resonance
Hb A1c hemoglobin A1c glycoslated IOP intraocular pressure imaging
hemoglobin IT intrathecal MS musculoskeletal
HCO3 bicarbonate IV intravenous Na sodium
HCP health-care professional/ K+ potassium NaCl sodium chloride
provider KCl potassium chloride 0.9% NaCl 0.9% NaCl solution/normal
Hct hematocrit kg kilogram saline
HDLs high-density lipoproteins l liter neuro neurologic
hemat hematologic LA long-acting NG nasogastric
Hgb hemoglobin LDH lactic dehydrogenase NMDA N-methyl-D-aspartate
HIV human immunodeficiency LDLs low-density lipoproteins NPO nothing by mouth
virus LFT liver function tests NRTI nucleoside reverse transcrip-
HMG-CoA 3-hydroxy-3-methylglutaryl- LR lactated Ringer’s solution tase inhibitor
coenzyme A MAO monoamine oxidase NS(S) normal saline (solution)
hr hour(s) MAOIs monoamine oxidase NSAIDs nonsteroidal anti-
HRT hormone replacement therapy inhibitors inflammatory drugs
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OCD obsessive-compulsive RA rheumatoid arthritis subcut (sc) subcutaneously

disorder RANKL receptor activator of nuclear supp suppository
oint ointment factor kappa B ligand tab tablet
ophth ophthalmic RBC red blood cell TB tuberculosis
OTC over-the-counter RDA recommended daily tbs tablespoon(s)
oz ounce(s) allowance TCAs tricyclic antidepressants
pc after meals rect rectum tid three times a day
PCA patient-controlled analgesia REM rapid-eye movement TNF tumor necrosis factor
PCWP pulmonary capillary wedge resp respiratory Top topically or topical
pressure RFT renal function tests tsp teaspoon
PDE5 phosphodiesterase RNA ribonucleic acid VFib ventricular fibrillation
inhibitor type 5 inhibitor Rx prescription VLDL very low-density lipoproteins
PE pulmonary embolus SA sinoatrial VS vital signs
PM post-meridian SAMe S-adenosyl-L-methionine VT ventricular tachycardia
PO by mouth, orally sec second(s) WBC white blood cell
PRN as needed SL sublingual wk week(s)
PSA prostate-specific antigen SNRIs serotonin and norepineph- yr year(s)
PT prothrombin time rine reuptake inhibitors ↑ increased, high
PUD peptic ulcer disease SOB shortness of breath ↓ decreased, low
PVC premature ventricular con- soln solution
tractions SR sustained release
PVD peripheral vascular disease SSRIs selective serotonin reuptake
q every inhibitors
qid four times a day stat immediately
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Introduction
Memorization of drugs as single entities is response! It is also very productive to begin this
almost impossible, even for those with great process of memorization at the beginning of the
recall. After years of trial and error teaching nursing program, using these cards for repetitive
pharmacology, I decided that grouping the practice. I also recommend that students prac-
drugs in body systems and therapeutic or phar- tice their knowledge by reinforcing quizzes and
macologic classes would be the best method of tests. I have written 8 quizzes and 2 tests that
instruction to promote student recall. Pharm can be accessed on the DavisPlus Web site.
Phlash! 2nd Edition was created to help students Medications are grouped into systems and
use body system association linked with drug then into pharmacologic classes or therapeutic
classification to aid in drug memorization. classes with similar action. There is a table of
Pharm Phlash! 2nd Edition is a tried-and-true contents for general access and a full index that
method of pharmacology instruction. Students will direct you by classification, generic, brand
learn to take clues from both the generic and name, and Canadian brand names. The
trade names. When I pose a question such as, cards are designed with the drug names on
“What kind of drug ends with ‘olol,’ ‘ilol,’ or the front with their body system designation.
‘alol’?” students quickly answer that these are Additionally, frequently used herbal prepara-
beta-adrenergic blockers and are used for the tions have been added in the new edition
cardiovascular system. What a wonderful and are listed in appropriate body systems.
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Included are new drug classes, changes in brand Again, extremely important information is
names, and drugs taken off the market. Many in bold red type. Laboratory and vital sign
new brand-name drugs are combinations of the parameters are listed here, along with
drugs included in Pharm Phlash! 2nd Edition and nursing implications and evaluative data.
are not covered separately. Routes and dosages 7. Adult route and dosage information is list-
are typical for the adult. Pediatric routes and ed at the bottom of each card for all drugs
dosages are not included. listed in that classification.
On the back of the cards you will find:
This learning system is not meant to replace
1. Therapeutic/Pharmacologic class (these a complete drug reference or pharmacology text.
are always listed in this order) It is meant as a tool to group and learn com-
2. Indications for use of the drug mon drugs mentally. Students who employ this
3. Action of the drug system will “make the connection” and learn
4. Adverse Reactions/Side Effects detailing all their medications, laboratory values that are
reactions; important information will important for safe administration, and vital sign
appear in bold, red type parameters. Have a great time learning this
5. Keep in Mind sections that include client important subject!
teaching
6. Make the Connection areas where informa- Valerie I. Leek, MSN, RN, CMSRN
tion crucial to safe medication is listed.
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 1
GASTROINTESTINAL
Calcium Carbonate, 1 Pantoprazole, 7 Docusate Calcium, 19

Calcium Citrate, 1 Lansoprazole, 7 Docusate Sodium, 19
Calcium Gluconate, 1 Misoprostol, 8 Magnesium Oxide, 20
Calcium Acetate, 1 Sucralfate, 9 Magnesium Hydroxide, 20
Potassium Chloride, 2 Bismuth Subsalicylate, 10 Magnesium Citrate, 20
Sodium Bicarbonate, 3 Hyoscyamine, 11 Scopolamine, 21
Sodium Citrate and Diphenoxylate/ Meclizine, 22
Citric Acid, 3 Atropine, 12 Prochlorperazine, 23
Ginger, 4 Loperamide, 12 Metoclopramide, 24
Sodium Polystyrene Alosetron, 13 Ondansetron, 25
Sulfonate, 5 Psyllium, 14 Palonosetron, 25
Famotidine, 6 Methylcellulose, 14 Granisetron, 25
Ranitidine, 6 Polyethylene glycol/ Dolasetron, 25
Cimetidine, 6 Electrolyte, 15 Dronabinol, 26
Nizatidine, 6 Simethicone, 16 Nabilone, 26
Esomeprazole, 7 Sennosides, 17 Mesalamine, 27
Rabeprazole, 7 Bisacodyl, 17 Olsalazine, 27
Omeprazole, 7 Lactulose, 18 Sulfasalazine, 27
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Gastrointestinal System Drugs Calcium Salts 1
Calcium Calcium
Carbonate Gluconate
(kal-see-um kar-bo-nate) (kal-see-um gloo-koh-nate)
Os-Cal, Tums, Tums Kalcinate

E-X, Nephro-Calci
Apo-Cal
Calcium Calcium
Citrate Acetate
(kal-see-um si-trate) (kal-see-um ass-e-tate)
Cal-Citrate 250, Calphron, PhosLo

Citrical, Citrical Liquitab
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Gastrointestinal System Drugs Calcium Salts 1

Therapeutic/Pharmacologic Class • Vitamin D must be taken in adequate amounts.
Mineral and electrolyte replacement or supplement; • Watch for signs of deficiency (paresthesias,
acid buffer/electrolyte (calcium salts) Chvostek’s sign, tremors).
Indications • Excessive use (PO form) may result in arrhythmias
Treatment of osteoporosis. Antacid treatment of and decrease effectiveness of calcium channel
gastritis. Treatment of electrolyte imbalance. blockers.
Action • Avoid high-oxalate foods, and report any kidney
discomfort or passage of sediment or stones.
Acts as an activator in the transmission of nerve
impulses and contraction of cardiac, skeletal, and
smooth muscle. Essential for bone formation and Make the Connection
blood coagulation. Buffers acidity. Calcium acetate • Serum levels must be assessed prior to
binds with phosphorus to decrease phosphorous levels. and after administration (9–10.5 mg/dL).
Adverse Reactions/Side Effects • Assess effectiveness if used for gastritis.
CNS: syncope (IV only), tingling. CV: cardiac • Concurrent administration may render other
arrest (IV only), arrhythmias, bradycardia. GI: con- medications useless. Give separately.
stipation, nausea, vomiting, rebound acidity. GU: • Monitor BP, pulse, and ECG frequently through-
calculi, hypercalciuria. Local: phlebitis (IV only). out parenteral therapy. May cause vasodilation
with resulting hypotension, bradycardia,
Keep in Mind arrhythmias, and cardiac arrest.
Teach client:
• Drugs may cause constipation and rebound
stomach acidity.
Route/Dosage: Calcium carbonate: PO/1–2 g/day in 3–4 divided doses, Calcium gluconate: PO/0.5–2 g daily in 2–4 divided doses; IV/2–15 g/day,
Calcium citrate: PO/1–2 g/day in 3–4 divided doses, Calcium acetate: PO/1334–2668 mg with each meal
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Gastrointestinal System Drugs Potassium Supplement 2
Potassium Chloride
(poe-tass-ee-um clor-ide)
K-Dur, K-Lor, Klor-Con, Micro-K

ExtenCaps, Slow-K
Apo-K, K-Long
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Gastrointestinal System Drugs Potassium Supplement 2

Therapeutic/Pharmacologic Class • Avoid foods with a high content of this mineral,
Mineral and electrolyte replacement and/or such as melons, bananas, orange juice, potatoes,
supplement meats, and salt substitutes.
Indications
PO, IV: Treatment/prevention of depletion of min- Make the Connection
erals and electrolytes. IV: Treatment of arrhythmias
due to digoxin toxicity. • Serum level must be assessed prior to
administration (3.5–5 mEq/L).
Action • Monitor for tented T waves (indicates high serum
Maintains acid-base balance. Essential for nerve K+ levels).
conduction. Essential for contraction of cardiac, • As serum electrolyte levels decrease, the likelihood
skeletal, and smooth muscle. of digoxin toxicity increases.
Adverse Reactions/Side Effects • IV solutions must not exceed 10 mEq/hr in
CNS: confusion, restlessness, weakness. CV: adults.
arrhythmias, ECG changes. GI: abdominal • Sodium polystyrene sulfonate can be given to
pain, nausea, vomiting, flatulence, diarrhea, GI decrease toxic levels.
ulceration. Neuro: paralysis/paresthesia. Local: • Never give undiluted.
(IV only) irritation at injection site.
Keep in Mind
Teach client:
• Report unusual fatigue, weakness, or palpitations.
Route/Dosage: PO/40–80 mEq/day; IV/(K-rider) 10–20 mEq/dose (maximum, 40 mEq/dose) to infuse over 2–3 hr (maximum infusion rate, 40 mEq/hr)
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Gastrointestinal System Drugs Alkalizing Agents 3
Sodium Bicarbonate
(soe-dee-um bye-kar-boe-nate)
Baking soda, Bell-Ans, Citrocarbonate,

Neut, Soda Mint
Sodium Citrate
and Citric Acid
(soe-dee-um sye-trate and sit-rik AS-id)
Bicitra, Oracit
PMS-Dicitrate
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Gastrointestinal System Drugs Alkalizing Agents 3

Therapeutic/Pharmacologic Class Adverse Reactions/Side Effects
Antiulcer agent; antiurolithic; mineral replacement/ CV: edema. GI: (PO) flatulence, gastric distention,
alkalinizing agents diarrhea. F and E: metabolic alkalosis, hyperna-
Indications tremia, hypocalcemia, hypokalemia, sodium and
PO, IV: Management of metabolic acidosis. PO, IV: water retention, fluid overload. Local: irritation at
Alkalinization of urine and promotion of excretion IV site. Neuro: tetany.
of certain drugs in overdosage situations (pheno-
barbital, aspirin). PO: Antacid. Prevention of
Keep in Mind
Teach client:
aspiration pneumonitis during surgical procedures.
Management of chronic metabolic acidosis associ- • Take medication as directed.
ated with chronic renal insufficiency or renal tubular • Taking milk products concurrently with this
medication can result in renal calculi or hypercal-
acidosis.
cemia (milk-alkali syndrome).
Action • Dyspepsia that persists longer than 2 wk should
Acts as an alkalinizing agent by releasing bicarbonate be evaluated by HCP.
ions. Following oral administration, releases bicar- • Avoid high-sodium foods (canned, processed,
bonate, which is capable of neutralizing gastric pickled).
acid. Therapeutic Effects: Alkalinization of body
fluids. Neutralization of gastric acid. Increase of
blood pH. Make the Connection
• Monitor serum electrolyte level. This
electrolyte must be in the 135–145 mEq/L
range and ABG.
Route/Dosage: Sodium bicarbonate: PO/up to 4 g daily in divided doses; IV/2–5 mEq/kg in a 4–8 hr infusion; (cardiac arrest) 1 mEq/kg, repeat
0.5 mEq/kg q 10 min, Sodium citrate and citric acid: PO/10–30 mL solution diluted in water 4 times daily
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Gastrointestinal System Drugs Antiemetic (Herbal) 4
Ginger
(jin-jer)
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Gastrointestinal System Drugs Antiemetic (Herbal) 4

Therapeutic/Pharmacologic Class • May increase bleeding time in clients with ↑ risk
Antiemetic of bleeding, such as those on anticoagulant
Indications therapy, antiplatelets, or thrombolytics, or those
Treatment of nausea and vomiting related to with platelet disorders.
motion sickness, anesthesia, and chemotherapy. • May have an additive effect on antidiabetic
medications.
Action
Has an antiemetic effect due to increasing GI motility • May increase the effect of calcium channel blockers.
and transport; may act on serotonin receptors. • Use herbal medications only if monitored by a HCP.
Shown to be hypoglycemic, hypotensive or hyper- • Use prior to an event that may cause nausea or
vomiting.
tensive, and positive inotropic agent. Inhibits
prostaglandins and platelets, lowers cholesterol,
and improves appetite and digestion. Make the Connection
Adverse Reactions/Side Effects • Assess client for epigastric pain prior to
GI: minor heartburn. Derm: dermatitis and after administration when drug is used as a
(when used topically). gastroprotective agent.
• Monitor BP and heart rate in patients with CV
Keep in Mind disease, including HTN; if palpitations occur, the
Teach client: drug must be stopped immediately.
• This drug should not be taken during pregnancy • Monitor blood glucose and coagulation panels
(preliminary evidence that ginger might affect periodically during therapy; watch for easy bruising
fetal sex hormones) or lactation. or bleeding.
• Pregnant and lactating clients should not use
this herbal medication.
Route/Dosage: PO/up to 2 g (not to exceed 4 g/day)
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Gastrointestinal System Drugs Cationic Exchange Resin 5
Sodium Polystyrene
Sulfonate
(soe-dee-um po-lee-stye-reen sul-fon-ate)
Kayexalate
K-Exit
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Gastrointestinal System Drugs Cationic Exchange Resin 5

Therapeutic/Pharmacologic Class • Foods with high-K+ level should be avoided
Hypokalemic; electrolyte modifier/cationic exchange (melons, bananas, orange juice, potatoes).
resin • Report constipation.
Indications
Treatment of mild to moderate hyperkalemia. If Make the Connection
severe, glucose/insulin infusion may be used.
Action
• Assess ECG changes for hyperkalemia
and hypokalemia.
Exchanges sodium ions for K+ ions in the intestine
(each 1 g is exchanged for 1 mEq K+). Therapeutic
• Monitor I&O and daily weight. Assess for symp-
toms of fluid overload (dyspnea, rales/crackles,
Effects: Reduction of serum K+ levels. jugular venous distention, peripheral edema).
Adverse Reactions/Side Effects • Remember to keep K+ levels in the range of
GI: constipation, fecal impaction, anorexia, 3.5–5 mEq/L. As K+ levels fall, digoxin toxicity
gastric irritation, nausea, and vomiting. F and E: can occur.
hypocalcemia, hypokalemia, Na retention, • Assess abdomen, bowel sounds, and frequency of
hypomagnesemia. stools. Monitor all electrolyte levels.
Keep in Mind
Teach client:
• Report signs of hypokalemia, such as muscle
weakness and fatigue.
• A low-Na diet will be ordered.
Route/Dosage: PO/15 g 1–4 times daily in water or sorbitol (up to 40 g 4 times daily); Rect/30–50 g as a retention enema; repeat as needed q 6 hr.
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Gastrointestinal System Drugs Histamine H2 Receptor Antagonists 6
Famotidine Cimetidine
(fa-moe-ti-deen) (sye-me-ti-deen)
Pepcid Tagamet
Apo-Cimetidine
Ranitidine Nizatidine
(ra-ni-ti-deen) (ni-za-ti-deen)
Zantac Axid
Zantac-C
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Gastrointestinal System Drugs Histamine H2 Receptor Antagonists 6

Therapeutic/Pharmacologic Class Keep in Mind
Antiulcer agent/histamine H2 receptor antagonists Teach client:
Indications • Take medication as directed for the full course of
therapy.
Treatment of active duodenal ulcers and GERD.
Management of gastric hypersecretory states • Notify a HCP if difficulty swallowing occurs or
abdominal pain persists.
(Zollinger-Ellison syndrome). IV: Prevention and
treatment of upper GI bleed. • Smoking interferes with the action of histamine
receptor antagonists.
Action • Avoid alcohol, products containing aspirin or
Inhibit the action of histamine at the H2-receptor NSAIDs, excessive amounts of caffeine, and foods
site located primarily in gastric parietal cells, resulting that may cause an increase in GI irritation.
in inhibition of gastric acid secretion. • Report immediately signs of bone marrow suppres-
Adverse Reactions/Side Effects sion, such as bleeding, purpura, and sore throat.
CNS: confusion, dizziness, drowsiness, halluci- • Report confusion or hallucinations immediately.
nations, headache. CV: arrhythmias. GI: consti-
pation, diarrhea, drug-induced hepatitis, nausea.
GU: decreased sperm count, impotence. Endo:
Make the Connection
gynecomastia. Hemat: agranulocytosis, aplastic • Monitor the CBC and differential counts
daily.
anemia. Misc: hypersensitivity reactions.
• Other medications may be less effective because
of increased stomach pH.
• Direct IV doses are given over specific time frames.
Route/Dosage: Famotidine: PO/40 mg/day at bedtime or 20 mg twice daily, for up to 8 wk initially (maintenance dose, 20 mg/day); IV/20 mg
q 12 hr, diluted and given over 2 min, Cimetidine: PO/300 mg 4 times daily, or 800 mg at bedtime, or 400–600 mg twice daily (not to exceed
2.4 g/day), Ranitidine: PO/150 mg twice daily; IV/50 mg q 6–8 hr (not to exceed 400 mg/day); continuous IV infusion/6.25 mg/hr, Nizatidine:
PO/150 mg once daily at bedtime
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Gastrointestinal System Drugs Proton (Gastric) Pump Inhibitors 7
Esomeprazole Omeprazole
(es-o-mep-ra-zole) (o-mep-ra-zole)
Nexium Prilosec, Prilosec OTC

Losec
Rabeprazole Pantoprazole
(ra-bep-ra-zole) (pan-toe-pra-zole)
Aciphex Protonix; Protonix IV

Pariet
Lansoprazole
(lan-soe-pra-zole)
Prevacid, Prevacid 24 hr
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Gastrointestinal System Drugs Proton (Gastric) Pump Inhibitors 7

Therapeutic/Pharmacologic Class • Report abdominal pain; diarrhea; or black, tarry
Proton (gastric) pump inhibitor/antiulcer agents stools to HCP immediately.
Indications
Treatment of GERD with or without esophageal Make the Connection
erosion, duodenal ulcers (Helicobacter pylori), upper
GI bleeds, and hypersecretory conditions. • Monitor liver enzymes.
• Best if given on an empty stomach 1 hr prior to
Action other drugs or food. Monitor for improvement in
Decreases gastric acid by binding to an enzyme on symptoms.
gastric parietal cells. Prevents proton pump from • Lansoprazole IV must be given through a special
releasing acid into the gastric lumen, raising gastric pH. filter. Pantoprazole IV is given direct IV, undiluted,
Adverse Reactions/Side Effects over 2 min. Some capsules can be opened and
CNS: headache. Endo: changes in blood glucose sprinkled on applesauce, followed by water.
levels. GI: abdominal pain, flatulence, diarrhea. Expect higher dosages if a hypersecretory
Derm: rash. condition exists.
• Remember, clients can get too much of a good
Keep in Mind thing. We need stomach acid. Watch for diges-
Teach client: tive problems with foods and medications.
• Avoid alcohol, ASA, NSAIDS, smoking, caffeine, • Many of these drugs are given in combination
and foods that cause gastric distress. Take drugs with an antibiotic to combat H. pylori infections.
for duration ordered by HCP.
Route/Dosage: Esomeprazole: PO/20 mg or 40 mg once daily for 4–8 wk, with maintenance dose of 20 mg/daily; IV/20 or 40 mg once daily, Omeprazole:
PO/20 mg once daily (40 mg daily for duodenal ulcers associated with H. pylori), Rabeprazole: PO/20 mg once daily, Pantoprazole: PO/40 mg once
daily; IV/40 mg daily for 7–10 days, Lansoprazole: PO/15 mg daily (30 mg daily for duodenal ulcers associated with H. pylori)
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Gastrointestinal System Drugs Prostaglandin 8
Misoprostol
(mye-soe-prost-ole)
Cytotec
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Gastrointestinal System Drugs Prostaglandin 8

Therapeutic/Pharmacologic Class • Report diarrhea persisting for more than 1 wk; the
Prostaglandin/antiulcer agent; cytoprotective agent onset of black, tarry stools; or severe abdominal
Indications pain. Avoid alcohol, tobacco, and foods that may
Prevention of gastric mucosal injury from NSAIDs, cause an increase in GI irritation.
including aspirin, in high-risk clients (elderly clients, • Misoprostol will cause spontaneous abortion.
debilitated clients, or those with a history of ulcers). Contraception must be used throughout therapy.
With mifepristone for termination of pregnancy.
Unlabeled uses: Treatment of duodenal ulcers. Make the Connection
Action • Assess client routinely for epigastric or
Acts as a prostaglandin analogue, decreasing gastric abdominal pain and for frank or occult blood in
acid secretion and increasing the production of the stool, emesis, or gastric aspirate.
protective mucus. Causes uterine contractions. • Assess women of childbearing age for pregnancy.
Adverse Reactions/Side Effects Misoprostol is usually begun on 2nd or 3rd day
CNS: headache. GI: abdominal pain, diarrhea, of menstrual period following a negative preg-
constipation, dyspepsia, flatulence, nausea, and nancy test result.
vomiting. GU: miscarriage, menstrual disorders.
Keep in Mind
Teach client:
• Take medication as directed for the full course of
therapy when first starting NSAID therapy.
Route/Dosage: PO/200–400 mcg bid–qid

1882_Tab01_001-027 10/10/12 12:40 PM Page 9
Gastrointestinal System Drugs Gastric Mucosa Protectant 9
Sucralfate
(soo-kral-fate)
Carafate
Sulcrate
1882_Tab01_001-027 10/10/12 12:40 PM Page 9
Gastrointestinal System Drugs Gastric Mucosa Protectant 9

Therapeutic/Pharmacologic Class • May decrease effectiveness (absorption) of some
Antiulcer agent/GI protectant medications. Check with HCP.
Indications
Management of peptic ulcers. Suspension used for Make the Connection
mucositis/stomatitis/oral ulcers.
• Assess for effectiveness of medication.
Action • Monitor drug levels, such as phenytoin, to assess
Activated by stomach acid to form a thick, protective bioavailability.
paste. • Tablets may begin to dissolve in the esophagus if
Adverse Reactions/Side Effects client cannot swallow effectively, causing a choking
CNS: dizziness and drowsiness. GI: constipation, risk. Tablet will go easily into suspension.
diarrhea, indigestion, nausea. Derm: rash, Administer in this way with extra fluid.
pruritus.
Keep in Mind
Teach client:
• Report changes in bowel habit.
• Exercise, fiber, and fluids can stave off
constipation.
• Take medication for entire course.
• Take 1 hr prior to meals on an empty stomach.
Route/Dosage: PO/1 g qid 1 hr before meals and at bedtime or 2 g bid

1882_Tab01_001-027 10/10/12 12:40 PM Page 10
Gastrointestinal System Drugs Adsorbent 10
Bismuth Subsalicylate
(biz-muth sub-sa-lis-i-late)
Pepto-Bismol, Kaopectate,
Kaopectolin, Bismatrol
1882_Tab01_001-027 10/10/12 12:40 PM Page 10
Gastrointestinal System Drugs Adsorbent 10

Therapeutic/Pharmacologic Class • If symptoms are not controlled within 24 hours,
Antidiarrheal/adsorbent or if symptoms of dehydration (decreased urina-
Indications tion, change in level of consciousness, weakness)
To decrease water content of stool. occur, report immediately to HCP.
Action
Promotes intestinal absorption of fluid and elec- Make the Connection
trolytes. Absorbent. •
Salicylates cause Reye’s syndrome in
Adverse Reactions/Side Effects pediatric clients.
GI: hepatic impairment, constipation, change in • Monitor frequency and character of stools.
stool color. Immune: risk for Reye’s syndrome.
Keep in Mind
Teach client:
• Use pediatric preparations to prevent
complications.
• Rest the gut; slowly introduce clear liquids
(not apple juice).
• Use OTC electrolyte solutions for pediatric clients
to prevent dehydration.
Route/Dosage: Bismuth subsalicylate: PO/2 tabs or 30 mL (not to exceed 4.2 g/24 hr)
1882_Tab01_001-027 10/10/12 12:40 PM Page 11
Gastrointestinal System Drugs Anticholinergic 11
Hyoscyamine
(hi-oh-si-a-meen)
Anaspaz, Levsin
1882_Tab01_001-027 10/10/12 12:40 PM Page 11

Therapeutic/Pharmacologic Class urticaria. Misc: allergic reactions including
Antispasmodic/anticholinergic anaphylaxis, fever (especially in children),
Indications suppression of lactation.
Treatment of spastic bladder and bowel; including Keep in Mind
diverticulitis, infant colic, and biliary and renal Teach client:
colic; peptic ulcer disease; irritable bowel syndrome;
and neurogenic bowel disturbances. • Take exactly as directed. May cause drowsiness;
avoid activities requiring alertness. Oral rinses,
Action sugarless gum or candy, and frequent oral
Inhibit the muscarinic effect of acetylcholine in hygiene may help relieve dry mouth. Report
smooth muscle, secretory glands, and the CNS. change in urinary stream in males with BPH.
Adverse Reactions/Side Effects
CNS: confusion/excitement (especially in geriatric
clients), dizziness, flushing, headache, insomnia,
Make the Connection
lightheadedness (IM, IV, SC), nervousness. EENT: •
Anticholinergic medications cause
symptoms that are categorized with the saying
blurred vision, cycloplegia, increased intraocular
“hot as a hare, dry as a bone, red as a beet,
pressure, mydriasis, photophobia. CV: palpita-
mad as a hatter, and blind as a bat.”
tions, tachycardia. GI: dry mouth, altered taste
perception, bloated feeling, constipation, nausea,
paralytic ileus, vomiting. GU: impotence, urinary
hesitancy/retention. Derm: decreased sweating,
Route/Dosage: PO, SL/0.125–0.25 mg 3–4 times daily or 0.375–0.75 mg as SR form every 12 hr; IM, IV, SC/(GI anticholinergic) 0.25–0.5 mg 3–4 times
daily as needed
1882_Tab01_001-027 10/10/12 12:40 PM Page 12
Gastrointestinal System Drugs Antidiarrheals 12
Diphenoxylate/Atropine
(dye-fen-ox-i-late/a-troe-peen)
Lomotil, Lonox, Logen
Loperamide
(loe-per-a-mide)
Imodium, Imodium AD, Neo-Diaral
1882_Tab01_001-027 10/10/12 12:40 PM Page 12
Gastrointestinal System Drugs Antidiarrheals 12

Therapeutic/Pharmacologic Class • May cause drowsiness and dizziness.
Antidiarrheals • Use hard candy or sugarless gum to moisten mouth.
Indications • Report any increased abdominal discomfort or
Adjunctive therapy of acute diarrhea. Treatment of urinary difficulties.
chronic diarrhea associated with inflammatory bowel
disease. Decreases the volume of ileostomy drainage.
Make the Connection
Action
Inhibits excess GI motility. Inhibits peristalsis and • These drugs contain mild opioid agonists
but have no analgesic effects. Combining mild
prolongs transit time by a direct effect on nerves in opioids with atropine or other drugs decreases
the intestinal muscle wall. Reduces fecal volume; the likelihood of abuse.
increases fecal viscosity and bulk while diminishing
loss of fluid and electrolytes. Diphenoxylate/atropine • Drugs cause anticholinergic effects. Remember
by the saying, “hot as a hare, dry as a bone, red
also exerts an anticholinergic effect on the bowel. as a beet, mad as a hatter, and blind as a bat.”
Adverse Reactions/Side Effects • Monitor I&O, and character and number of stools.
CNS: drowsiness, dizziness, nervousness. GI: • Check bowel sounds. An area of increased bowel
constipation, abdominal pain/distention/ sounds may indicate ileus, especially if additional
discomfort, dry mouth, nausea, vomiting, clinical signs such as nausea and abdominal dis-
ileus. Misc: allergic reactions. tention are present.
Keep in Mind • Monitor LFT and serum amylase levels if on
Teach client: long-term therapy.
• When atropine is added, expect anticholinergic
effects. Take with plenty of fluids.
Route/Dosage: Diphenoxylate/atropine: PO/2 tabs qid, Loperamide: PO/4 mg initially, then 2 mg after each loose stool (maintenance dose usually
4–8 mg/day in divided doses, not to exceed 8 mg/day for OTC use or 16 mg/day for Rx use)
1882_Tab01_001-027 10/10/12 12:40 PM Page 13
Gastrointestinal System Drugs 5-HT3 Antagonist 13
Alosetron
(a-low-se-tron)
Lotronex
1882_Tab01_001-027 10/10/12 12:40 PM Page 13
Gastrointestinal System Drugs 5-HT3 Antagonist 13

Therapeutic/Pharmacologic Class • Be aware of and watch for signs of acute
Anti-irritable bowel syndrome agent/5-HT3 receptor ischemic colitis.
antagonist • Report worsening abdominal pain or rectal
Indications bleeding.
Treatment of IBS characterized by diarrhea.
Action Make the Connection
5-HT3 receptor site antagonism results in slowing of • IBS can be characterized by either diarrhea
colonic transit time in IBS characterized by diarrhea. or constipation.
Adverse Reactions/Side Effects • Monitor therapy and watch for signs of abdominal
CNS: headache. GI: acute ischemic colitis, distress.
constipation, abdominal discomfort, abdominal • Monitor bowel sounds.
distention, flatulence, nausea, GI viral infections, • Note character, amount, and ease of stooling.
hemorrhoids, regurgitation or reflux.
Keep in Mind
Teach client:
• Take exactly as directed. Be aware of the risks
and benefits of pharmacotherapy and the impact
of IBS symptoms on one’s life. This is especially
important for those with IBS characterized by
diarrhea because of the risk of acute ischemic
colitis.
Route/Dosage: PO/(women) 0.5 mg twice daily

1882_Tab01_001-027 10/10/12 12:40 PM Page 14
Gastrointestinal System Drugs Bulk-Forming Agents 14
Psyllium
(sill-i-yum)
Metamucil
Karacil
Methylcellulose
(meth-i-sell-you-lose)
Citrucel
1882_Tab01_001-027 10/10/12 12:40 PM Page 14
Gastrointestinal System Drugs Bulk-Forming Agents 14

Therapeutic/Pharmacologic Class • Follow mixture with another 8 oz of fluid.
Laxative/bulk-forming agents • Become aware of natural bowel patterns, and do
Indications not force a bowel movement.
Management of simple or chronic constipation, • Do not take laxatives when abdominal pain,
particularly if associated with a low-fiber diet. cramping, or fever is present.
Useful in situations in which straining should be
avoided (after MI, rectal surgery, or prolonged bed Make the Connection
rest). Used in the management of chronic watery
diarrhea. • Bulk-forming agents are used for both
constipation and diarrhea.
Action • It is better to allow the natural processes of the
Combines with water in the intestines to form an body time to work to produce a bowel movement.
emollient gel or viscous solution that promotes Dietary choices, increasing fluid intake, and adding
peristalsis and reduces transit time. moderate exercise can promote regularity.
Adverse Reactions/Side Effects • Never allow the client, especially the elderly or
Resp: bronchospasm. GI: cramps, intestinal or those with risk of choking, to drink a gelled
esophageal obstruction, nausea, and vomiting. mixture.
Keep in Mind
Teach client:
• Do not let the mixture gel prior to drinking as this
may cause a choking risk.
Route/Dosage: Psyllium: PO/up to 30 g daily in divided doses, Methylcellulose: PO/A heaping tablespoon up to 3 times/day
1882_Tab01_001-027 10/10/12 12:40 PM Page 15
Gastrointestinal System Drugs Osmotic 15
Polyethylene
glycol/Electrolyte
(po-lee-eth-e-leen glye-kole/e-lek-troe-lite)
GoLYTELY, NuLytely, Colyte

Klean-Prep
1882_Tab01_001-027 10/10/12 12:40 PM Page 15

Therapeutic/Pharmacologic Class • If using the liquid preparation, the client will
Osmotic/laxative drink 240 mL every 10 min until 4 L have been
Indications consumed or fecal discharge is clear and free of
Bowel cleansing in preparation for GI examination. solid matter.
Unlabeled uses: Treatment of acute iron overdose • Rapidly drinking each 240-mL portion is preferred
in children. over drinking small amounts continuously.
Action
Polyethylene glycol (PEG) in solution acts as an Make the Connection
osmotic agent, drawing water into the lumen of the • May be administered on the morning of
GI tract. the examination as long as time is allotted to drink
Adverse Reactions/Side Effects solution (3 hr) and evacuate bowel (1 additional
GI: abdominal fullness, diarrhea, bloating, hr). For barium enema, administer solution early
cramps, nausea, vomiting. Misc: allergic in the evening (6 PM) prior to exam to allow
reactions (rare). proper mucosal coating by barium.
• Solution may be reconstituted with tap water.
Keep in Mind Shake vigorously until powder is dissolved.
Teach client: May be administered via NG tube at a rate of
• If using for bowel preparation, fast for 3–4 hr 20–30 mL/min.
prior to administration and never have solid food • Monitor electrolytes, stool character, and subjective
within 2 hr of administration. data from client.
• Clear liquids only are allowed after administration.
Route/Dosage: PO/4 L (240 mL taken every 10 min)

1882_Tab01_001-027 10/10/12 12:40 PM Page 16
Gastrointestinal System Drugs Antiflatulent 16
Simethicone
(si-meth-i-kone)
Gas-X, Mylicon, Phazyme

Ovol, Ovol-40
1882_Tab01_001-027 10/10/12 12:40 PM Page 16
Gastrointestinal System Drugs Antiflatulent 16

Therapeutic/Pharmacologic Class • Eat, chew, and swallow slowly to prevent excess
Antiflatulent gas formation.
Indications • Avoid carbonated beverages.
Relief of painful symptoms of excess gas in the GI
tract that may occur postoperatively or as a conse- Make the Connection
quence of air swallowing, dyspepsia, peptic ulcer,
or diverticulitis. • Assess client for abdominal pain,
distention, and bowel sounds prior to and peri-
Action odically throughout course of therapy. Frequency
Causes the coalescence of gas bubbles. Does not of belching and passage of flatus should also be
prevent the formation of gas. assessed.
Adverse Reactions/Side Effects • Administer after meals and at bedtime for best
None results. Shake liquid preparations well prior to
administration.
Keep in Mind • Chewable tabs should be chewed thoroughly
Teach client: before swallowing for faster and more complete
• Diet and exercise are important in the prevention results. Give the chewable tabs after other
of gas. This medication does not prevent the for- medications.
mation of gas. • Drops can be mixed with 30 mL of cool water,
• Notify HCP if symptoms are persistent. infant formula, or other liquid as directed.
• Lie in fetal position with legs drawn to chest to
relieve gas discomfort, especially after laparoscopic
procedures.
Route/Dosage: PO/40–125 mg qid, after meals and at bedtime (up to 500 mg/day)
1882_Tab01_001-027 10/10/12 12:40 PM Page 17
Gastrointestinal System Drugs Stimulant Laxatives 17
Sennosides
(sen-oh-sides)
Ex-Lax, Fletcher’s Castoria, Senokot
Bisacodyl
(bis-a-koe-dill)
Dulcolax,
Bisaco-Lax, Laxit
1882_Tab01_001-027 10/10/12 12:40 PM Page 17
Gastrointestinal System Drugs Stimulant Laxatives 17

Therapeutic/Pharmacologic Class not use laxatives when abdominal pain, nausea,
Laxative/stimulant laxatives vomiting, or fever is present.
Indications
Treatment of constipation, particularly when asso- Make the Connection
ciated with slow transit time, constipating drugs,
and irritable or spastic bowel syndrome. • Assess client for abdominal distention,
presence of bowel sounds, and usual pattern of
Action bowel function.
Active components alter water and electrolyte • Assess color, consistency, and amount of stool
transport in the large intestine, resulting in accumu- produced.
lation of water and increased peristalsis. • Abnormal bowel habits can cause dependence on
Adverse Reactions/Side Effects laxatives (impaired peristalsis), diverticula devel-
Neuro: dizziness, asthenia. CV: edema. Resp: opment, and hemorrhoids. Natural is better.
shortness of breath. GI: cramping, diarrhea, • These laxatives can be added to OTC “diet”
nausea. GU: discoloration of urine. F and E: elec- aids. May be used as the initial part of bowel
trolyte abnormalities. Misc: laxative dependence. preparation.
Keep in Mind
Teach client:
• Take for short-term therapy only.
• Clients with cardiac disease should avoid straining
during bowel movements (Valsalva maneuver). Do
Route/Dosage: Sennosides: PO/12–50 mg bid, Bisacodyl: PO/5–15 mg daily (up to 30 mg/day)

1882_Tab01_001-027 10/10/12 12:40 PM Page 18
Lactulose
(lak-tyoo-lose)
Cephulac, Kristalose, Chronulac

Lactulax
1882_Tab01_001-027 10/10/12 12:40 PM Page 18

Therapeutic/Pharmacologic Class • Medication may cause belching, flatulence, or
Laxative/osmotic abdominal cramping. Notify HCP if this becomes
Indications bothersome or if diarrhea occurs.
Treatment of chronic constipation in adults and
geriatric clients. Used in diabetic clients with gas- Make the Connection
troparesis. Adjunct in the management of portal
systemic (hepatic) encephalopathy (PSE). • Assess client for presence of bowel sounds.
• Assess mental status before and periodically
Action throughout course of therapy.
Increases water content and softens the stool. • Monitor serum ammonia levels (↓ 25%–50%) and
Lowers the pH of the colon, which inhibits the serum glucose levels if diabetic.
diffusion of ammonia from the colon into the • Monitor serum electrolytes periodically. May cause
blood, thereby reducing blood ammonia levels. diarrhea with resulting hypokalemia and hyperna-
Adverse Reactions/Side Effects tremia. Metabolic acidosis can occur. Remember:
GI: belching, cramps, distention, flatulence, Loss of GI fluid from above the waist, such as
diarrhea. Endo: hyperglycemia (diabetic clients). from vomiting and nasogastric tube (NGT)
suctioning, causes gain of base, which leads to
Keep in Mind metabolic alkalosis. Loss of GI fluid from below
Teach client: the waist, such as from diarrhea, causes loss of
• Increasing bulk in the diet, fluid intake, and base, which leads to metabolic acidosis.
mobility are other effective forms of bowel regu- • To administer enema, use rectal balloon catheter.
lation. Becoming aware of natural elimination Mix 300 mL of lactulose with 700 mL of water or
patterns is important. 0.9% NaCl. Have client retain for 30–60 min.
Route/Dosage: PO/up to 60 mL/day or 10–20 g as powder

1882_Tab01_001-027 10/10/12 12:40 PM Page 19
Gastrointestinal System Drugs Stool Softeners 19
Docusate Calcium
(dok-yoo-sate kal-see-um)
Surfak, DC Softgels
Docusate Sodium
(dok-yoo-sate soe-dee-um)
Colace
Regulex
1882_Tab01_001-027 10/10/12 12:40 PM Page 19
Gastrointestinal System Drugs Stool Softeners 19

Therapeutic/Pharmacologic Class • Choose foods to enhance elimination.
Laxative/stool softeners • Cardiac and surgical clients (rectal/ocular)
Indications should not strain.
Prevention of constipation and straining at stool • Never use when abdominal pain, nausea, vomiting,
(cardiac clients, recent rectal surgery). Can be used or fever exists.
rectally to soften fecal impaction.
Adsorbent: pulls water into stool. Increases electrolyte • This is not a stimulant laxative.
and water secretion into colon. • Give with increased amounts of clear fluid.
Adverse Reactions/Side Effects • Do not give within 2 hr of other laxatives, especially
GI: mild cramps. EENT: throat irritation. Derm: mineral oil.
rashes. • Oral liquid is more palatable if diluted or mixed
with juice.
Keep in Mind
Teach client:
• Should be used for short-term use only and may
take time to work.
• Follow instructions for natural promotion of
bowel movement.
Route/Dosage: Docusate calcium: PO/240 mg daily, Docusate sodium: PO/50–400 mg in divided doses
1882_Tab01_001-027 10/10/12 12:40 PM Page 20
Gastrointestinal System Drugs Salines (Magnesium Salts) 20
Magnesium Magnesium
Oxide Citrate
(mag-nee-zhum ox-ide) (mag-nee-zhum si-trate)
Mag-Ox 400 Citrate of Magnesia
Magnesium Hydroxide
(mag-nee-zhum hye-drox-ide)
Dulcolax Magnesia Tablets, Phillips

Magnesia Tablets, Phillips Milk of
Magnesia, MOM
1882_Tab01_001-027 10/10/12 12:40 PM Page 20
Gastrointestinal System Drugs Salines (Magnesium Salts) 20

Therapeutic/Pharmacologic Class report signs of GI bleeding (black, tarry stools;
Laxative/saline; magnesium salts coffee-ground emesis).
Indications • Laxatives should be used only for short-term
Treatment and prevention of hypomagnesemia. A therapy; long-term therapy may cause electrolyte
laxative/bowel evacuant. PO liquid is also used as imbalance and dependence. Notify HCP if unre-
an antacid. lieved constipation, rectal bleeding, or symptoms
of electrolyte imbalance (muscle cramps or pain,
Action weakness, dizziness) occur.
Essential for the activity of many enzymes. Plays an
important role in neurotransmission and muscular
excitability. Osmotically active in GI tract, drawing Make the Connection
water into the lumen and causing peristalsis. •
Monitor electrolytes carefully.
Adverse Reactions/Side Effects • Watch BP.
GI: diarrhea, bloating, cramping. Derm: flushing,
sweating. F and E: electrolyte imbalance.
Keep in Mind
Teach client:
• Do not take this medication within 2 hr of taking
other medications, especially fluoroquinolones,
nitrofurantoin, and tetracyclines. As an antacid:
Route/Dosage: Magnesium oxide: PO/270–300 mg/day, Magnesium citrate: PO/240 mL in divided doses of 30 mL, Magnesium hydroxide:
PO/30–60 mL daily
1882_Tab01_001-027 10/10/12 12:40 PM Page 21
Scopolamine
(scoe-pol-a-meen)
Isopto Hyoscine, Transderm-Scop

Transderm-V
1882_Tab01_001-027 10/10/12 12:40 PM Page 21

Antiemetic/anticholinergic Teach client:
Indications • Medication may cause drowsiness or blurred
Transdermal: Prevention of motion sickness. vision. Avoid driving or other activities requiring
Management of nausea and vomiting associated alertness until response to medication is known.
with opioid analgesia or general anesthesia/recovery • Use caution when exercising and in hot weather;
from anesthesia. Reduction of secretions in the dying overheating may result in heatstroke.
client in hospice care. IM, IV, SC: Preoperatively for • Avoid concurrent use of alcohol and other CNS
the production of amnesia and the reduction of sali- depressants with this medication.
vation and excessive respiratory secretions. • Frequent mouth rinses, good oral hygiene, and
sugarless gum or candy may minimize dry mouth.
Action
Inhibits the muscarinic activity of acetylcholine. • Transdermal: Apply at least 4 hr (U.S. product)
before exposure to travel to prevent motion sickness.
Corrects the imbalance of acetylcholine and norepi- Apply to hairless site. May bathe with patch in place.
nephrine in the CNS, which may be responsible for Remove if eye pain or excessive side effects occur.
motion sickness.
CNS: drowsiness, confusion. EENT: blurred Make the Connection
vision, mydriasis, photophobia. CV: tachycardia, • When using an anticholinergic, remember
palpitations. GI: dry mouth, constipation. GU: the saying “hot as a hare, dry as a bone, red as
urinary hesitancy, urinary retention. Derm: a beet, mad as a hatter, and blind as a bat” to
decreased sweating. help identify side effects.
• Assess client for nausea and vomiting periodically
Route/Dosage: Transderm/1 patch (0.5–1.5 mg over 3 days) every 3 days
during therapy. Assess level of consciousness after
(place 4 hr prior to travel); IM, SC, IV/0.2–0.6 mg qid surgical procedure.
1882_Tab01_001-027 10/10/12 12:40 PM Page 22
Gastrointestinal System Drugs Antiemetic (Antihistamine) 22
Meclizine
(mek-li-zeen)
Antivert, Bonine, Dramamine II

Bonamine
1882_Tab01_001-027 10/10/12 12:40 PM Page 22
Gastrointestinal System Drugs Antiemetic (Antihistamine) 22

Therapeutic/Pharmacologic Class • Frequent mouth rinses, good oral hygiene, and
Antiemetic; antihistamine sugarless gum or candy may decrease dryness of
Indications mouth.
Management/prevention of motion sickness and • Avoid concurrent use of alcohol and other CNS
vertigo. depressants with this medication.
Action • When using as prophylaxis for motion sickness,
take medication at least 1 hr before exposure to
Has central anticholinergic, CNS depressant, and conditions that may cause motion sickness.
antihistaminic properties. Decreases excitability of
the middle ear labyrinth and depresses conduction
in middle ear vestibular-cerebellar pathways. Make the Connection
Adverse Reactions/Side Effects • Assess client for level of sedation after
CNS: drowsiness, fatigue. EENT: blurred vision. administration. Assess client for nausea and
GI: dry mouth. vomiting before and 60 min after administration.
Assess degree of vertigo periodically in clients
Keep in Mind receiving this medication for labyrinthitis. May
Teach client: cause false-negative results in skin tests using
• Take medication exactly as directed. If a dose is allergen extracts. Discontinue this medication
missed, take as soon as possible unless it is 72 hr before testing.
almost time for next dose. Do not double doses. • Administer oral doses with food, water, or milk
• May cause drowsiness. Avoid driving or other to minimize GI irritation. Chewable tab may be
activities requiring alertness until response to the chewed or swallowed whole.
medication is known.
Route/Dosage: PO/25–100 mg daily (high-end dose for vertigo)

1882_Tab01_001-027 10/10/12 12:40 PM Page 23
Gastrointestinal System Drugs Phenothiazine 23
Prochlorperazine
(proe-klor-pair-a-zeen)
Compazine
Stemetil
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Gastrointestinal System Drugs Phenothiazine 23

Antiemetic; antipsychotic/phenothiazine Teach client:
Indications • Report uncontrolled tremor or muscle contraction
Management of nausea and vomiting. immediately. Change positions slowly to minimize
orthostatic hypotension. May cause drowsiness.
Action Avoid taking alcohol or other CNS depressants
Alters the effects of dopamine in the CNS. Possesses concurrently with this medication.
significant anticholinergic and alpha-adrenergic
blocking activity. Depresses the chemoreceptor • Use sunscreen and protective clothing to prevent
photosensitivity reactions.
trigger zone (CTZ) in the CNS.
• Use good oral hygiene and sugarless gum or
Adverse Reactions/Side Effects candy for dry mouth. Urine may turn pink to
CNS: neuroleptic malignant syndrome, reddish-brown.
extrapyramidal reactions, sedation. EENT:
blurred vision, dry eyes, lens opacities. CV: ECG
changes, hypotension, tachycardia. GI: consti- Make the Connection
pation, dry mouth, anorexia, drug-induced • Side effects are serious. Never give to
hepatitis, ileus. GU: pink or reddish-brown clients younger than 16 years.
discoloration of urine, urinary retention. Derm: • Assess for EPS; refer to a movement specialist if
photosensitivity, pigment changes, rashes. Endo: symptoms noted.
galactorrhea. Hemat: agranulocytosis, leukopenia. • Assess for relief of nausea and vomiting.
Metab: hyperthermia. Misc: allergic reactions, • Monitor chemistry panel and CBC with differential.
Reye’s syndrome in children younger than
16 years.
Route/Dosage: PO/5–10 mg tid or qid; IV/2.5–10 mg (not to exceed 40 mg/day); Rect/25 mg bid
1882_Tab01_001-027 10/10/12 12:40 PM Page 24
Gastrointestinal System Drugs Gastric Stimulant 24
Metoclopramide
(met-oh-kloe-pra-mide)
Reglan, Reglan ODT

Apo-Metoclop
1882_Tab01_001-027 10/10/12 12:40 PM Page 24
Gastrointestinal System Drugs Gastric Stimulant 24

Antiemetic/gastric stimulant Teach client:
Indications • May cause drowsiness.
Prevention of emesis related to chemotherapy and • Report any tremor or uncontrollable muscle
surgery. Reduction of GERD. Prevention of microaspi- contraction immediately.
ration in clients with enteral feedings. Unlabeled • Maintain hydration and protect from extremes of
uses: treatment of hiccups. temperature.
Action • Avoid CNS depressants.
Blocks dopamine receptors in the chemoreceptor
trigger zone (CTZ) of the CNS. Stimulates motility Make the Connection
of the upper GI tract and accelerates gastric
emptying.
• Assess for nausea, abdominal distention,
and bowel sounds before giving.
Adverse Reactions/Side Effects • Assess for EPS; refer to a movement specialist if
CNS: drowsiness, extrapyramidal reactions, symptoms are noted.
neuroleptic malignant syndrome, anxiety, • Observe for depression.
depression. CV: arrhythmias, hypertension, • Monitor hepatic panel and serum prolactin and
hypotension. GI: constipation, diarrhea, aldosterone (increases).
dry mouth, nausea. Endo: gynecomastia. • Have client rate nausea severity on a 0–10 scale.
Hemat: methemoglobinemia, bone marrow
suppression.
Route/Dosage: PO, IM, IV/10–15 mg 30 min before meals and at bedtime

1882_Tab01_001-027 10/10/12 12:40 PM Page 25
Gastrointestinal System Drugs 5-HT3 Antagonists 25
Ondansetron Granisetron
(on-dan-se-tron) (gra-nees-e-tron)
Zofran Kytril
Palonosetron Dolasetron
(pa-lone-o-se-tron) (dol-a-se-tron)
Aloxi Anzemet
1882_Tab01_001-027 10/10/12 12:40 PM Page 25
Gastrointestinal System Drugs 5-HT3 Antagonists 25

Antiemetic/5-HT3 receptor antagonists Teach client:
Indications • Take as directed. Notify HCP immediately if
Prevention of nausea and vomiting associated involuntary movement of eyes, face, or limbs
with chemotherapy and radiation therapy. IM, IV: occurs.
Prevention and treatment of postoperative nausea
and vomiting. Make the Connection
Action • Assess for EPS; refer to a movement
Blocks the effects of serotonin at receptor sites specialist if symptoms are noted.
(selective antagonist) located in vagal nerve • Assess effectiveness of antiemetic on a 0–10 scale
terminals and in the chemoreceptor trigger zone of nausea severity.
(CTZ) in the CNS. • Monitor for nausea, bowel sounds, and gastric
Adverse Reactions/Side Effects distention.
CNS: headache, dizziness, drowsiness, fatigue, • May cause transient ↑ in serum bilirubin, AST,
weakness. GI: constipation, diarrhea, abdominal and ALT levels.
pain, dry mouth, increased liver enzymes. • If giving direct IV, look up time frame for infusion.
Neuro: extrapyramidal reactions.
Route/Dosage: Ondansetron: PO/8–24 mg 30 min prior to anesthesia or chemotherapy, or for treatment of nausea and vomiting; IV/0.15 mg/kg
15–30 min prior to chemotherapy or for treatment of nausea and vomiting, Granisetron: PO/1–2 mg together or in divided dose 60 min prior to
chemotherapy; IV/20–40 mcg/kg/day 30 min prior to chemotherapy, Palonosetron: PO/0.5 mg 1 hr prior to chemotherapy; IV/0.25 mg 30 min prior to
chemotherapy, Dolasetron: PO/100 mg 1 hr prior to chemotherapy or surgery; IV/12.5 mg 2 hr prior to surgery
1882_Tab01_001-027 10/10/12 12:40 PM Page 26
Gastrointestinal System Drugs Cannabinoids 26
Dronabinol
(droe-nab-i-nol)
THC, Marinol
Nabilone
(na-bi-lone)
Cesamet
1882_Tab01_001-027 10/10/12 12:40 PM Page 26
Gastrointestinal System Drugs Cannabinoids 26

Antiemetic; appetite stimulant/cannabinoids Teach client:
Indications • Take exactly as directed.
Treatment of nausea and vomiting due to • Signs of overdose (mood changes, confusion, hallu-
chemotherapy that has not responded to other cinations, depression, nervousness, fast or pound-
conventional antiemetics. Stimulation of appetite in ing heartbeat) may occur with increased doses.
the cachexic client. • May cause dizziness, orthostatic hypotension,
drowsiness, and impaired judgment and
Action coordination.
Active ingredient in marijuana, with a wide variety
of CNS effects, including inhibition of the vomiting • Avoid taking alcohol or other CNS depressants
concurrently.
control mechanism in the medulla oblongata.
CNS: anxiety, concentration difficulty, confu- Make the Connection
sion, dizziness, drowsiness, mood change, • Monitor client closely for altered mental
abnormal thinking, depression, disorientation, status. Monitor VS periodically during therapy.
hallucinations, headache, impaired judgment, • May cause anemia; monitor CBC.
memory lapse, paranoia. EENT: dry mouth. CV: • Appetite stimulation: Institute I&O, daily weight,
palpitations, syncope, tachycardia. GI: abdominal as well as calorie counts.
pain, nausea, vomiting. Derm: facial flushing.
Neuro: ataxia, paresthesia. Misc: physical
dependence, psychological dependence (high
doses or prolonged therapy).
Route/Dosage: Dronabinol: PO/2.5 mg bid (5 mg/m2 1–3 hr prior to chemotherapy), Nabilone: PO/1–2 mg bid (not to exceed 6 mg/day)
1882_Tab01_001-027 10/10/12 12:40 PM Page 27
Gastrointestinal System Drugs Gastrointestinal Anti-Inflammatories 27
Mesalamine Sulfasalazine
(me-sal-a-meen) (sul-fa-sal-a-zeen)
Asacol, Asacol-HD, Azulfadine

Lialda, Pentasa, PMS-Sulfasalazine
Canasa, Rowasa
Salofalk
Olsalazine
(ole-sal-a-zeen)
Dipentum
1882_Tab01_001-027 10/10/12 12:40 PM Page 27
Gastrointestinal System Drugs Gastrointestinal Anti-Inflammatories 27

Gastrointestinal anti-inflammatories Teach client:
Indications • May cause dizziness.
Treatment of inflammatory bowel diseases, including • Notify HCP if skin rash, sore throat, fever, mouth
Crohn’s disease and ulcerative colitis. sores, unusual bleeding or bruising, wheezing,
fever, or hives occur.
Action
Locally acting anti-inflammatory action in the colon, • May take 1–2 months for full effect.
where activity is probably due to inhibition of • If cramping, acute abdominal pain, bloody
diarrhea, fever, headache, or rash occur, discon-
prostaglandin synthesis.
tinue therapy and notify HCP immediately.
Adverse Reactions/Side Effects • Increase oral intake of fluids to prevent renal
CNS: headache, dizziness, malaise, weakness. lithiasis.
EENT: pharyngitis, rhinitis. CV: pericarditis. GI:
diarrhea, eructation, flatulence, nausea, vomit-
ing. GU: interstitial nephritis, pancreatitis, renal Make the Connection
failure. Derm: hair loss, rash. Local: anal irrita- • Assess client for allergy to sulfonamides
tion (enema, suppository). MS: back pain. or salicylates.
Misc: anaphylaxis, acute intolerance syndrome, • Fluid intake should be 1500–2000 mL/day.
fever. Monitor daily weight and I&O.
• Monitor blood chemistries for liver and renal
function and CBC with differential.
• Monitor amylase and lipase levels (pancreatitis).
Route/Dosage: Mesalamine: PO/(Asacol) 800 mg tid for 6 wk, PO/(Asacol HD) 1.6 g tid for 6 wk, PO/(Lialda) 2.4–4.8 g daily for up to 8 wk,
PO/(Pentasa) 1 g qid for up to 8 wk; Rect/(Rowasa) 4-g enema (60 mL) hr, Sulfasalazine: PO/500 mg q 6 hr, Olsalazine: PO/500 mg bid
ENDOCRINE
Insulin Aspart, rDNA Metformin, 34 Propylthiouracil, 42

Origin, 28 Sitagliptin, 35 Cortisone, 43
Insulin Glulisine (rDNA Linagliptin, 35 Methylprednisolone, 43
Origin) Injection, 28 Saxagliptin, 35 Hydrocortisone, 43
Insulin Lispro, rDNA Repaglinide, 36 Prednisone, 43
Origin, 28 Nateglinide, 36 Fludrocortisone, 44
Regular Insulin, 29 Acarbose, 37 Oxytocin, 45
Neutral Protamine Miglitol, 37 Desmopressin, 46
Hagedorn (NPH), 30 Glipizide, 38 Vasopressin, 46
Insulin (Isophane Glyburide, 38 Somatropin, 47
Insulin Suspension), 30 Glimepiride, 38 Octreotide, 48
Intermediate Type, 30 Rosiglitazone, 39 Lanreotide, 48
Insulin Detemir, 31 Pioglitazone, 39 Megestrol, 49
Insulin Glargine, 31 Glucagon, 40 Pegvisomant, 50
Pramlintide, 32 Levothyroxine, 41
Exenatide, 33 Thyroid, 41
Exenatide ER Liothyronine, 41
Suspension, 33 Methimazole, 42
1882_Tab02_028-050 10/10/12 12:46 PM Page 28
Endocrine System Drugs Pancreatics (Rapid-Acting Insulin) 28
Insulin Aspart, Insulin Lispro,

rDNA Origin rDNA Origin
(in-su-lin as-spart) (in-su-lin liss-pro)
Novolog Humalog
Insulin Glulisine
(rDNA Origin) Injection
(in-su-lin gloo-lye-seen)
Apidra
1882_Tab02_028-050 10/10/12 12:46 PM Page 28
Endocrine System Drugs Pancreatics (Rapid-Acting Insulin) 28

Antidiabetic agent, hormone/pancreatic agents Teach client:
Indications • Use U-100 syringes with solutions containing
Treatment of diabetes mellitus. These antidiabetic 100 units/mL. If using a prefilled pen, prime with
agents are described as very rapid acting (onset 2 units prior to dialing dosage.
5–15 min, with peak 30–60 min). • Sick days require more monitoring.
Action • Carry a source of glucose.
Lowers blood glucose by stimulating glucose uptake • Wear a Medic-Alert bracelet.
in skeletal muscle and fat, inhibiting hepatic glucose • Recognize signs and symptoms of hyperglycemia
and hypoglycemia, and be aware of self-treatment
production. Other actions are inhibition of lipolysis measures if these occur.
and proteolysis.
Derm: urticaria. Endo: hypoglycemia, rebound Make the Connection
hyperglycemia (Somogyi effect). Local: lipodys- • Because of high error rate, two nurses
trophy (lipoatrophy, lipohypertrophy), itching, should check the insulin type, dosage, and
redness, swelling. Misc: allergic reactions, expiration date.
including anaphylaxis. • Very rapid-acting agents are called “dose and
eat” for a reason. Onset 5–15 min.
• Memorize the peak time of these medications!
Look for hypoglycemia (normal 70–120 mg/dL).
• Hypoglycemia resembles an anxiety attack, with
the person having cold, clammy skin.
Route/Dosage: Insulin aspart: SC/0.5–1 unit/kg/day, Insulin lispro: SC/0.2–0.6 unit/kg/day, Insulin glulisine injection: SC/wt. based on glucose/
lifestyle
1882_Tab02_028-050 10/10/12 12:46 PM Page 29
Endocrine System Drugs Pancreatic (Short-Acting Insulin) 29
Regular Insulin
(reg-yu-ler in-sul-in)
Humulin R, Novulin R, Velosulin

Insulin-Toronto
1882_Tab02_028-050 10/10/12 12:46 PM Page 29
Endocrine System Drugs Pancreatic (Short-Acting Insulin) 29

Therapeutic/Pharmacologic Class • Recognize signs and symptoms of hyperglycemia
Antidiabetic agent, hormone/pancreatic agent and hypoglycemia, and be aware of self-treatment
Indications measures if these occur.
Treatment of diabetes mellitus; can be used to treat DKA. • Hypoglycemia occurs during the peak time of this
drug (2–4 hr after injection).
Action
Lowers blood glucose by stimulating glucose uptake • Consult with HCP if feeling ill.
in skeletal muscle and fat, inhibiting hepatic glucose
production. Also inhibits lipolysis and proteolysis, Make the Connection
enhancing protein synthesis. • Because of high error rate, two nurses
Adverse Reactions/Side Effects should check the insulin type, dosage, and expi-
Derm: urticaria. Endo: hypoglycemia, rebound ration date.
hyperglycemia (Somogyi effect). Local: lipodys- • Rotate injection sites. May be injected SC into
trophy (lipoatrophy, lipohypertrophy), itching, abdominal wall, thigh, or upper arm.
redness, swelling. Misc: allergic reactions, • This is the only insulin type that can be given IV
including anaphylaxis. as a direct dose or continuous infusion.
• Monitor for hypoglycemia. Hypoglycemia resembles
Keep in Mind an anxiety attack, with the person having cold,
Teach client: clammy skin.
• Follow instructions for proper administration. • Remember the classic 3 “Ps” of diabetes
• Administer the insulin at the correct time. Its (polyuria, polyphagia, and polydipsia).
onset is 30 min. • Long-term effects of poor glycemic control include
neuropathy, nephropathy, and retinopathy.
Route/Dosage: SC/0.5–1 unit/kg/day; IV/0.1 unit/kg/hr continuous infusion

1882_Tab02_028-050 10/10/12 12:46 PM Page 30
Endocrine System Drugs Pancreatics (Intermediate-Acting Insulin) 30
Neutral Protamine
Hagedorn (NPH)
Insulin (Isophane
Insulin Suspension)
Intermediate Type
(nu-tral pro-ta-meen hag-e-dorn in-sul-in)
Humulin N
Novolin ge NPH
1882_Tab02_028-050 10/10/12 12:46 PM Page 30
Endocrine System Drugs Pancreatics (Intermediate-Acting Insulin) 30

Antidiabetic agent, hormone/pancreatic agents Teach client:
Indications • Proper use of syringes and vials is important, as is
Treatment of diabetes mellitus. Because of the the proper storage of the insulin.
delayed and prolonged duration, cannot be used in • Testing of serum glucose and ketones is important,
the acute treatment of DKA. Intermediate suspen- especially for sick care.
sions have onset of 1–2 hr and peak of 4–12 hr. • Carry a glucose source and wear a Medic-Alert
bracelet!
Action
Lowering of blood glucose levels by stimulating • Carbohydrate counting is a useful method for
diet planning to control blood glucose.
glucose uptake in skeletal muscle and fat, inhibiting
hepatic glucose production. Other actions include • Recognize signs and symptoms of hyperglycemia
inhibition of lipolysis and proteolysis. measures if these occur.
Adverse Reactions/Side Effects • Notify HCP if pregnancy is planned or suspected.
Derm: urticaria. Endo: hypoglycemia, rebound
hyperglycemia (Somogyi effect). Local: lipodys-
trophy (lipoatrophy, lipohypertrophy), itching, Make the Connection
redness, swelling. Misc: allergic reactions, • Because of high error rate, two nurses
including anaphylaxis. should check the insulin type, dosage, and
expiration date.
• Memorize peak times. Hypoglycemia will happen
during these times.
• Hypoglycemia resembles an anxiety attack, with
the person having cold, clammy skin.
Route/Dosage: SC/0.5–1 unit total insulin/kg/day
1882_Tab02_028-050 10/10/12 12:46 PM Page 31
Endocrine System Drugs Pancreatics (Basal Insulin) 31
Insulin Detemir
(in-su-lin de-te-mir)
Levemir
Insulin Glargine
(in-su-lin glar-jeen)
Lantus
1882_Tab02_028-050 10/10/12 12:46 PM Page 31
Endocrine System Drugs Pancreatics (Basal Insulin) 31

Therapeutic/Pharmacologic Class • Make sure that U-100 syringes are used with
Antidiabetic agent, hormone/pancreatic agents 100-unit/mL insulin. Onset is from 1–2 hr.
Indications • If using a prefilled pen, prime with 2 units before
Treatment of diabetes mellitus. Because of its delayed dialing dosage.
onset (1–2 hr) and prolonged duration, medication • Recognize signs and symptoms of hyperglycemia
cannot be used in the acute treatment of DKA. and hypoglycemia, and be aware of self-treatment
measures if these occur.
Action
Lowers blood glucose by stimulating glucose uptake • Carry a simple sugar or glucose tablets in case of
hypoglycemia.
in skeletal muscle and fat; inhibits hepatic glucose
production. Other actions include inhibition of lipoly- • Consult with health care professional if feeling ill.
sis and proteolysis, and enhanced protein synthesis. • Follow instructions for testing blood glucose.

Derm: urticaria. Endo: hypoglycemia, rebound Make the Connection
hyperglycemia (Somogyi effect). Local: lipodys- • Two nurses should check the insulin
trophy (lipatrophy, lipohypertrophy), itching, type, dosage, and expiration date.
redness, swelling. Misc: allergic reactions, • Rotate injection sites.
including anaphylaxis. • Monitor for hypoglycemia. Hypoglycemia resembles
an anxiety attack, with the person having cold,
Keep in Mind clammy skin.
Teach client: • Basal insulins cannot be mixed.
• Follow instructions for proper administration
techniques.
Route/Dosage: Insulin detemir: SC/0.1–0.2 units/kg once daily, Insulin glargine: SC/2–100 units/day
1882_Tab02_028-050 10/10/12 12:46 PM Page 32
Endocrine System Drugs Hormone (Amylinomimetic) 32
Pramlintide
(pram-lin-tide)
Symlin
1882_Tab02_028-050 10/10/12 12:46 PM Page 32
Endocrine System Drugs Hormone (Amylinomimetic) 32

Antidiabetic agent/hormone, amylinomimetic Teach client:
Indications • Take the drug exactly as prescribed, at mealtimes.
Treatment of type 1 and type 2 diabetes in conjunc- • Do not mix this drug in the same syringe with
tion with other antidiabetic agents. insulin.
Action • Do not drink alcohol, as this may result in
severe hypoglycemia.
Slows the rate of gastric emptying, reducing the
amount of glucose absorbed postprandially. • Recognize signs and symptoms of hyperglycemia
Decreases the level of glucagon and reduces
appetite.
Adverse Reactions/Side Effects Make the Connection
CNS: anxiety, blurred vision, seizures, coma, • HbA1c level and postprandial levels are
headache, nightmares, dizziness, depression, the best indicators of control.
confusion. Derm: cool, pale skin. Resp: cough, • A 0.3-mL U-100 syringe is best to give this drug.
pharyngitis, shortness of breath, wheezing. GI: Dosing is in mcg, and administration is in units,
difficulty swallowing, vomiting, weight loss, so carefully check dosage. Rotate injection sites.
increased hunger. MS: muscle pain or stiffness, • Watch for hypoglycemia within the first 3 hr
pain in joints. CV: fast heartbeat, tightness in following injection.
chest. Misc: hives; itching; puffiness or swelling • Monitor for severe nausea and vomiting.
of the eyelids or around the eyes, face, lips, or
tongue; skin rash; and other allergic reactions,
including anaphylaxis.
Route/Dosage: SC/60–120 mcg ac (type 2 insulin-using) SC/15–60 mcg ac (type 1)

1882_Tab02_028-050 10/10/12 12:46 PM Page 33
Endocrine System Drugs Incretin Mimetic Agents 33
Exenatide
(ex-en-a-tide)
Byetta
Exenatide ER Suspension
(ex-en-a-tide)
Bydureon
1882_Tab02_028-050 10/10/12 12:46 PM Page 33
Endocrine System Drugs Incretin Mimetic Agents 33

Antidiabetic agent/incretin mimetic agents Teach client:
Indications • Administer 60 min before a meal. Do not take
Treatment of type 2 diabetes uncontrolled by after a meal. Bydureon is given independently
metformin and/or a sulfonylurea. Control of post- of meals.
prandial glucose levels. • Follow instructions for SC administration with
prefilled pens and for Bydureon with vials and
Action diluent.
Mimics the action of incretin, which promotes
insulin secretion from pancreas, decreases absorp- • Follow prescribed diet, medication, and exercise
regimen to remain euglycemic.
tion of glucose from the gut, decreases the action
of glucagon, and decreases appetite. • Watch for signs of hypoglycemia and
hyperglycemia.
Adverse Reactions/Side Effects • Stomach emptying is delayed with this medication,
CV: dizziness, headache, jitteriness, weakness. which may interfere with other medications. Take
GI: diarrhea, nausea, vomiting, dyspepsia, GI medications 1 hr prior to this drug.
reflux. Derm: hyperhidrosis. Metab: ↓ appetite, • Wear a Medic-Alert bracelet.
weight loss.
Make the Connection
• Monitor serum glucose, LFT, and weight.
• An incretin mimetic acts like GLP-1, a hormone
that helps to decrease appetite and regulate glucose
levels, especially postprandial levels (after meals).
Route/Dosage: Exenatide: SC/5–10 mcg within 1 hr before AM and PM meal, Exenatide ER suspension: SC/2 mg q 7 days (premeasured vial) (Bydureon)
1882_Tab02_028-050 10/10/12 12:46 PM Page 34
Endocrine System Drugs Biguanide 34
Metformin
(met-for-min)
Fortamet, Glucophage,
Glucophage XR
Novo-Metformin
1882_Tab02_028-050 10/10/12 12:46 PM Page 34
Endocrine System Drugs Biguanide 34

Therapeutic/Pharmacologic Class • Inform HCP of medication regimen before
Antidiabetic agent/biguanide diagnostics or surgery.
Indications
Management of type 2 diabetes mellitus; may be used Make the Connection
with diet, insulin, or sulfonylurea oral hypoglycemics.
• Remember, this drug works differently
Action from an insulin secretagogue, so it is used in
Decreases hepatic glucose production. Decreases combination with other antidiabetic agents.
intestinal glucose absorption. Increases sensitivity • Lactic acidosis occurs more frequently in persons
of the cell receptors to insulin. with renal insufficiency.
Adverse Reactions/Side Effects • Assess renal function before initiating and at least
GI: abdominal bloating, diarrhea, nausea, annually during therapy.
vomiting, unpleasant metallic taste. Endo: • Monitor LFT, creatinine level, serum folic acid,
hypoglycemia. F and E: lactic acidosis. Misc: and vitamin B12.
decreased vitamin B12 levels. • This drug, when combined with iodinated contrast
dye, can cause kidney damage. The drug should
Keep in Mind be held on the day of the imaging procedure and
Teach client: for 48 hr after.
• Follow prescribed diet, medication, and exercise • XR tablets must be swallowed whole; do not
regimen to remain euglycemic. crush or chew.
• Symptoms of lactic acidosis should be reported
to the HCP immediately.
Route/Dosage: PO/500–2000 mg/day

1882_Tab02_028-050 10/10/12 12:46 PM Page 35
Endocrine System Drugs Dipeptidyl Peptidase-4 Inhibitors 35
Sitagliptin Saxagliptin
(sit-a-glip-tin) (sax-a-glip-tin)
Januvia Onglyza
Linagliptin
(lin-a-glip-tin)
1882_Tab02_028-050 10/10/12 12:46 PM Page 35
Endocrine System Drugs Dipeptidyl Peptidase-4 Inhibitors 35

Antidiabetic agent/dipeptidyl peptidase-4 inhibitors Teach client:
Indications • Watch for signs and symptoms of hypoglycemic
Adjunct to diet and exercise to improve glycemic reactions, especially if combined with other
control in clients with type 2 diabetes mellitus; may antidiabetic agents.
be used as monotherapy or combination therapy • Monitor glucose as directed.
with metformin or a thiazolidinedione. • May be administered with or without food.
Action • Follow prescribed diet, medication, and exercise
Inhibits the enzyme dipeptidyl peptidase-4 (DPP-4),
which slows the inactivation of incretin hormones. • Do not use during pregnancy or if lactating.
These hormones are released by the intestine • Wear a Medic-Alert bracelet.
throughout the day and are involved in appetite
control, increase in insulin release, and decrease in Make the Connection
glucagon levels. • This antidiabetic works differently than
Adverse Reactions/Side Effects a secretagogue does.
CNS: headache. • Often combined with another antidiabetic.
Route/Dosage: Sitagliptin: PO/100 mg/day, Saxagliptin: PO/2.5–5 mg/day, Linagliptin: PO/5 mg daily
1882_Tab02_028-050 10/10/12 12:46 PM Page 36
Endocrine System Drugs Meglitinides 36
Repaglinide
(re-pag-gli-nide)
Gluconorm, Prandin
Nateglinide
(na-teg-li-nide)
Starlix
1882_Tab02_028-050 10/10/12 12:46 PM Page 36
Endocrine System Drugs Meglitinides 36

Therapeutic/Pharmacologic Class • Watch for signs of hypoglycemia and hyperglycemia,
Antidiabetic agent/meglitinides and take appropriate action.
Indications • Test blood glucose levels before meals and
Treatment of type 2 diabetes mellitus, with diet and before bed.
exercise; may be used with metformin, rosiglitazone, • Wear Medic-Alert bracelet.
or pioglitazone. • Not recommended during pregnancy; insulin is
safer.
Action
Stimulates the release of insulin from pancreatic • Concurrent use of chromium and coenzyme Q10
can cause an increase in hypoglycemia.
beta cells by closing K+ channels, which results in
the opening of Ca+ channels in beta cells. This is • Blood glucose levels may rise with emotional or
physiological stress.
followed by release of insulin. This is a secretagogue.
CV: angina, chest pain. Endo: hypoglycemia, Make the Connection
hyperglycemia. • Know the normal serum glucose level and
HbA1c. The nurse must act appropriately if these
Keep in Mind levels are abnormal.
Teach client: • Do not give this medication if the blood glucose
• Take 30 min before each meal, exactly as directed. level is low or if the client is NPO.
• Follow prescribed diet, medication, and exercise • Notice the clue in the brand name indicating that
regimen to remain euglycemic. these drugs reduce postprandial glucose levels.
Route/Dosage: Repaglinide: PO/0.5–4 mg ac, Nateglinide: PO/120 mg 3 times daily ac

1882_Tab02_028-050 10/10/12 12:46 PM Page 37
Endocrine System Drugs Alpha-Glucosidase Inhibitors 37
Acarbose
(aye-kar-bose)
Precose
Miglitol
(mi-gli-tole)
Glyset
1882_Tab02_028-050 10/10/12 12:46 PM Page 37
Endocrine System Drugs Alpha-Glucosidase Inhibitors 37

Therapeutic/Pharmacologic Class • Carry an oral form of glucose for hypoglycemia.
Antidiabetic agent/alpha-glucosidase inhibitors Remember that sucrose is not digested.
Indications • Wear a Medic-Alert bracelet.
Management of diabetes in conjunction with • Monitor blood glucose levels. Do not take the
dietary therapy; may be used with insulin or other medication if glucose level is low.
hypoglycemic agents. • High sucrose intake causes increased GI side
effects.
Action
Lowers blood glucose by inhibiting the enzyme
alpha-glucosidase in the GI tract. Sucrose is not Make the Connection
digested and passes through the GI tract • This drug stops sucrose from being
unchanged. digested and used to increase the blood glucose
Adverse Reactions/Side Effects level; thus, the old remedy of candy, table sugar,
GI: abdominal pain, diarrhea, flatulence, ↑ in or cake icing will not work.
transaminases. • Memorize serum glucose (65–110 mg/dL range)
and HbA1c (below 7) levels.
Keep in Mind • Monitor transaminases after baseline obtained.
Teach client: • This medication alone does not cause hypo-
• Watch for signs of hypoglycemia and hyperglycemia, glycemia, but it is often used with other antidia-
and take appropriate actions. betics and potentiates their effect.
• Follow prescribed diet, medication, and exercise • Administer with first bite of each meal 3 times/day.
Route/Dosage: Acarbose: PO/25–100 mg tid, Miglitol: PO/25–100 mg tid

1882_Tab02_028-050 10/10/12 12:46 PM Page 38
Endocrine System Drugs Sulfonylureas 38
Glipizide Glimepiride
(glip-i-zide) (glye-me-pi-ride)
Glucotrol, Amaryl
Glucotrol XL
Glyburide
(glye-byoo-ride)
DiaBeta, Micronase, Glynase PresTab

Apo-Glyburide
1882_Tab02_028-050 10/10/12 12:46 PM Page 38
Endocrine System Drugs Sulfonylureas 38

Antidiabetic agent/sulfonylureas Teach client:
Indications • Watch for signs of hypoglycemia, and take
PO: Treatment of type 2 diabetes mellitus, as an appropriate actions.
adjunct to diet therapy or in cases of insulin resistance. • Follow prescribed diet.
Action • Monitor glucose levels before meals and at
bedtime.
Lowers blood sugar by stimulating the release of
insulin from the pancreas (secretagogue) and • May occasionally cause dizziness or drowsiness.
Avoid activities requiring alertness.
increasing the sensitivity to insulin at receptor sites.
May also decrease hepatic glucose production. • Do not use alcohol (disulfiram-like effect).
• Use sunscreen to prevent rash and burns.
Adverse Reactions/Side Effects • Wear a Medic-Alert bracelet.
CNS: dizziness, drowsiness, headache, weakness. • Report sore throat, unusual bruising, shortness of
GI: constipation, cramps, diarrhea, drug-induced breath, rash, or hives immediately.
hepatitis, dyspepsia, increased appetite, nausea,
vomiting. Derm: photosensitivity, rashes. Endo:
hypoglycemia. F and E: hyponatremia. Hemat: Make the Connection
aplastic anemia, agranulocytosis, leukopenia, • Monitor glucose and HbA1c levels,
pancytopenia, thrombocytopenia. postprandial glucose levels, CBC with differential
count, and liver and renal studies.
• Assess client for allergy to sulfonamides. Remember
that cross-sensitivity can occur.
Route/Dosage: Glipizide: PO/2.5–40 mg/day, Glimepiride: PO/1–4 mg/day, Glyburide: PO/DiaBeta, range 1.25–20 mg/day; Glynase PresTab
(micronized), range 0.75–12 mg/day
1882_Tab02_028-050 10/10/12 12:46 PM Page 39
Endocrine System Drugs Thiazolidinediones 39
Rosiglitazone
(roe-zi-glit-a-zone)
Avandia
Pioglitazone
(pi-o-glit-a-zone)
Actos
1882_Tab02_028-050 10/10/12 12:46 PM Page 39
Endocrine System Drugs Thiazolidinediones 39

Therapeutic/Pharmacologic Class • Laboratory studies will be necessary to assess
Antidiabetic agent/thiazolidinediones glycemic control, liver function, lipid profile, and
Indications renal function.
Treatment of type 2 diabetes mellitus, as an adjunct • Report edema, sudden weight gain, or shortness
to diet and exercise. May be used alone or with of breath immediately.
other diabetic agents.
In insulin resistance, improves receptor affinity of • Not for use in pregnant or lactating
cells for glucose. women.
Adverse Reactions/Side Effects • Weigh the client and assess lungs for crackles
CV: CHF, edema. Derm: urticaria. Hemat: (CHF).
anemia. Metab: increased cholesterol, LDL, • Monitor laboratory chemistries, CBC, and BNP
and HDL; weight gain. Misc: angioedema (rare). (especially in those clients with a history of CHF).
Keep in Mind
Teach client:
• Does not cause hypoglycemia and can be taken
without regard to food.
• If taken with other antidiabetic agents, monitor
for signs and symptoms of hypoglycemia and take
appropriate action.
Route/Dosage: Rosiglitazone: PO/2–8 mg/day, Pioglitazone: PO/15–45 mg/day

1882_Tab02_028-050 10/10/12 12:46 PM Page 40
Endocrine System Drugs Pancreatic (Antihypoglycemic) 40
Glucagon
(gloo-ka-gon)
GlucaGen
1882_Tab02_028-050 10/10/12 12:47 PM Page 40
Endocrine System Drugs Pancreatic (Antihypoglycemic) 40

Therapeutic/Pharmacologic Class • Oral glucose and a protein should be consumed
Hormone/pancreatic; antihypoglycemic after the severe hypoglycemic episode is corrected.
Indications • If hypoglycemia causes unconsciousness, position
Acute management of severe hypoglycemia. the client on his or her side.
Action • Wear a Medic-Alert bracelet.
Stimulates hepatic production of glucose from
glycogen stores. Relaxes the musculature of the GI Make the Connection
tract, temporarily inhibiting movement. Has a posi- • Know the signs of hypoglycemia.
tive inotropic and chronotropic effect on the heart. • Hypoglycemia will occur at antidiabetic agents’
Adverse Reactions/Side Effects peak times.
CV: transient increase in heart rate and BP. GI: • Monitor glucose levels for 3–4 hr after
nausea, vomiting. Misc: hypersensitivity reactions, administration.
including anaphylaxis. • May be given IV.
Keep in Mind
Teach client:
• Used for hypoglycemia, which looks like an anxiety
attack, with the person having cold, clammy skin.
• Follow instructions for administering the injection.
Teach family members how to give the injection
in case of emergency.
Route/Dosage: IV, IM, SC/1 mg; may be repeated in 15 min if necessary

1882_Tab02_028-050 10/10/12 12:47 PM Page 41
Endocrine System Drugs Thyroid Hormones 41
Levothyroxine Liothyronine
(lee-voe-thye-rox-een) (lye-oh-thye-roe-neen)
Levothroid, Levoxyl, Cytomel, Triostat, T3

Synthroid, T4
PMS-Levothyroxine
Sodium
Thyroid
(thye-royd)
Armour Thyroid, Westhroid, Thyrar
1882_Tab02_028-050 10/10/12 12:47 PM Page 41
Endocrine System Drugs Thyroid Hormones 41

Hormone/thyroid hormones Teach client:
Indications • Take medication in the morning to prevent insomnia.
Replacement therapy in clients without thyroid hor- • Report chest pain, palpitations, or dizziness
mone or pharmacologic doses to enhance diminished immediately.
thyroid function. Replacement or pharmacologic • Full effects may not be felt for several weeks.
doses in neonates to correct inborn errors of • Report excessive weight loss.
metabolism (prevents developmental delay).
Metabolism of all nutrients is increased, promoting • The previously sluggish heart will beat
cell growth and increased protein synthesis. faster, increasing myocardial O2 needs. This may
Adverse Reactions/Side Effects lead to angina or even MI.
CNS: insomnia, irritability, nervousness, headache. • Monitor T3, T4, and thyroid-stimulating hormone
CV: CV collapse, arrhythmias, tachycardia, angina (TSH) levels (TSH is high when thyroid function
pectoris, BP changes, increased CO. GI: cramps, is low).
diarrhea, vomiting. Derm: hair loss in children, • Monitor glucose, weight, and increasing physical
diaphoresis. Endo: hyperthyroidism, menstrual and mental energy.
irregularities. Metab: weight loss, heat intolerance.
MS: accelerated bone maturation in children.
Route/Dosage: Levothyroxine: PO/1.5 mcg/kg/day; IM, IV/hypothyroidism, 50–100 mcg/day; IV/myxedema, 200–500 mcg, Liothyronine:
PO/25–50 mcg/day; IV/myxedema, 25–50 mcg initially, Thyroid: PO/60 mg/day
1882_Tab02_028-050 10/10/12 12:47 PM Page 42
Endocrine System Drugs Antithyroids 42
Methimazole
(meth-im-a-zole)
Tapazole
Propylthiouracil
(proe-pill-thye-oh-yoor-a-sill)
PTU
Propyl-Thyracil
1882_Tab02_028-050 10/10/12 12:47 PM Page 42
Endocrine System Drugs Antithyroids 42

Therapeutic/Pharmacologic Class • Report sore throat, unusual bleeding, bruising,
Antithyroid agents pallor, SOB, or extreme fatigue immediately.
Indications • Wear a Medic-Alert bracelet.
Palliative treatment of hyperthyroidism. An • Laboratory tests will be done frequently to assess
adjunct to control hyperthyroidism in preparation effectiveness of the drug.
for thyroidectomy or radioactive iodine therapy.
Inhibits the synthesis of thyroid hormones. • Watch for thyroid storm (thyrotoxicosis)
Adverse Reactions/Side Effects characterized by tachycardia, palpitations,
CNS: drowsiness, headache, vertigo. GI: diarrhea, nervousness, insomnia, fever, diaphoresis, heat
drug-induced hepatitis, loss of taste, nausea, intolerance, tremors, and weight loss.
parotitis, vomiting. Derm: rash, skin discoloration, • Conversely, watch for signs of hypothyroidism.
urticaria. Hemat: agranulocytosis, anemia, • Assess client for skin rash or swelling of cervical
leukopenia, thrombocytopenia. MS: arthralgia. lymph nodes. Treatment may be discontinued if
Misc: fever, lymphadenopathy. this occurs.
• Monitor thyroid function studies at baseline and
Keep in Mind when treatment is initiated.
Teach client: • Monitor for signs of bone marrow suppression
• Monitor weight 2–3 times/wk. Notify HCP of and CBC results.
significant changes. • Monitor LFT.
• May cause drowsiness.
Route/Dosage: Methimazole: PO/5–30 mg/kg/day, Propylthiouracil: PO/50–600 mg/day

1882_Tab02_028-050 10/10/12 12:47 PM Page 43
Endocrine System Drugs Corticosteroids 43
Cortisone Hydrocortisone
(kor-ti-sone) (hye-droe-kor-ti-sone)
Cortone Cortef, Cortifoam,

Solu-Cortef
Methylprednisolone Prednisone
(meth-ill-pred-niss-oh-lone) (pred-ni-sone)
Medrol, Solu-Medrol Sterapred

(IV), PredPak
1882_Tab02_028-050 10/10/12 12:47 PM Page 43
Endocrine System Drugs Corticosteroids 43

Therapeutic/Pharmacologic Class Hemat: thromboembolism, thrombophlebitis.
Anti-inflammatory (steroidal) agent, immunosup- Metab: weight gain, hyperglycemia. MS: muscle
pressant/glucocorticosteroids wasting, osteoporosis, aseptic necrosis of joints,
Indications muscle pain. Misc: cushingoid appearance,
Systemic and local treatment of a wide variety of increased susceptibility to infection.
inflammatory diseases and conditions. Replacement
Keep in Mind
therapy in adrenal insufficiency.
Teach client:
Action • Do not stop the medication suddenly.
Suppresses inflammation and the normal immune • Avoid grapefruit juice and limit caffeine when
response. taking oral forms.
CNS: depression, euphoria, headache, ICP
(children only), personality changes, psychoses, Make the Connection
restlessness. EENT: cataracts, increased • Monitor I & O, daily weight, edema, lung
intraocular pressure. CV: HTN. GI: peptic ulcer- sounds, serum electrolytes, CBC, and glucose level.
ation. Derm: acne, decreased wound healing, • Give with food in the AM to decrease gastric
ecchymoses, fragility, hirsutism, petechiae. upset and mimic natural cortisol.
Endo: adrenal suppression, hyperglycemia.
F and E: fluid retention, hypokalemia.
Route/Dosage: Cortisone: PO/25–300 mg/day, Hydrocortisone: PO/20–240 mg/day; IM, IV/100–500 mg q 2–6 hr, Methylprednisolone: PO/varies
with condition, 2–60 mg/day usual; IM, IV/100–500 mg q 2–6 hr, Prednisone: PO/5–60 mg/day
1882_Tab02_028-050 10/10/12 12:47 PM Page 44
Endocrine System Drugs Corticosteroid (Mineralocorticoid) 44
Fludrocortisone
(floo-droe-kor-ti-sone)
Florinef
1882_Tab02_028-050 10/10/12 12:47 PM Page 44
Endocrine System Drugs Corticosteroid (Mineralocorticoid) 44

Hormone/corticosteroid; mineralocorticoid Teach client:
Indications • Take medication as directed. Abrupt discontinua-
Treatment of Na loss and hypotension associated tion may lead to addisonian crisis.
with adrenocortical insufficiency (given with hydro- • Follow dietary modification prescribed by HCP.
cortisone or cortisone). Management of Na loss due • Wear a Medic-Alert bracelet.
to congenital adrenogenital syndrome (congenital • Watch for signs and symptoms of addisonian crisis.
adrenal hyperplasia). Unlabeled uses: Treatment of
idiopathic orthostatic hypotension (with increased Make the Connection
Na intake).
• Monitor BP periodically during therapy.
Action • Monitor for fluid retention (weigh daily, assess
Causes Na reabsorption, hydrogen and M+ excretion, for edema, and auscultate lungs for rales/crackles).
and water retention by its effects on the distal renal
tubule.
• Monitor clients with Addison’s disease closely,
and stop treatment if a significant increase in
Adverse Reactions/Side Effects weight or BP, edema, or cardiac enlargement
CNS: dizziness, headache. CV: CHF, arrhythmias, occurs. Clients with Addison’s disease are more
edema, HTN. GI: anorexia, nausea. Endo: sensitive to the action of this drug and may have
adrenal suppression, weight gain. F and E: an exaggerated response.
hypokalemia, hypokalemic alkalosis. MS: arthral- • Monitor serum electrolytes periodically during
gia, muscular weakness, tendon contractures. therapy. This drug causes ↓ in serum K+ levels.
Neuro: ascending paralysis. Misc: hypersensitivity
reactions.
Route/Dosage: PO/50–200 mcg/day

1882_Tab02_028-050 10/10/12 12:47 PM Page 45
Endocrine System Drugs Oxytocic 45
Oxytocin
(ox-i-toe-sin)
Pitocin
Syntocinon
1882_Tab02_028-050 10/10/12 12:47 PM Page 45
Endocrine System Drugs Oxytocic 45

Therapeutic/Pharmacologic Class E: maternal—hypochloremia, hyponatremia, water
Hormone/oxytocic agent intoxication. Misc: maternal—increased uterine
Indications motility, painful contractions, abruptio placentae,
IV: Induction or augmentation of labor at term. decreased uterine blood flow, hypersensitivity.
Can be used as an abortive agent. Postpartum Keep in Mind
control of bleeding after expulsion of the placenta. Teach client:
IM: Prevention of postpartum hemorrhage after
separation of placenta. Unlabeled uses: Evaluation • Expect contractions to become more severe and
last longer.
of fetal competence (fetal stress test).
Action
Stimulates uterine smooth muscle, producing uterine Make the Connection
contractions similar to those in spontaneous labor. • Assess character, frequency, and duration
Contracts the uterus to squeeze closed the attach- of uterine contractions; resting uterine tone;
ment sites of the placenta, so it stops excess post- and fetal heart rate frequently throughout
partum bleeding. Stimulates mammary gland smooth administration.
muscle, facilitating lactation. Has vasopressor and • This drug occasionally causes water intoxication.
antidiuretic effects. • Make sure there is a physician in-house at all
times when the client is on a continuous drip.
CNS: maternal—coma, seizures; fetal—intracranial
hemorrhage. Resp: fetal—asphyxia, hypoxia. CV:
maternal—hypotension; fetal—arrhythmias. F and
Route/Dosage: IV/labor induction, 5–6 milliunits/min; maximum 20 milliunits/min IM/postpartum hemorrhage, 10 units
1882_Tab02_028-050 10/10/12 12:47 PM Page 46
Endocrine System Drugs Antidiuretic Hormones 46
Desmopressin
(des-moe-press-in)
DDAVP, DDAVP Rhinal Tube,

DDAVP Rhinyle Drops, Stimate
Vasopressin
(vay-soe-press-in)
Pitressin
Pressyn
1882_Tab02_028-050 10/10/12 12:47 PM Page 46
Endocrine System Drugs Antidiuretic Hormones 46

Hormone/antidiuretic hormones Teach client:
Indications • Notify HCP if bleeding is not controlled or if
Management of primary nocturnal enuresis headache, dyspnea, heartburn, nausea, abdominal
unresponsive to other treatment modalities cramps, vulval pain, or severe nasal congestion or
(desmopressin). Treatment of pulseless VT or irritation occurs.
VFib, GI hemorrhage, vasodilatory shock, and • Avoid use of alcohol with this medication as
diabetes insipidus caused by a deficiency. alcohol decreases the antidiuretic hormone effect.
Action • If increased urine output occurs, contact HCP for
dosage adjustment.
Analogues or derivatives of naturally occurring
antidiuretic hormone. The primary action is • Wear a Medic-Alert bracelet.
enhanced reabsorption of water in the kidneys.
CNS: drowsiness, headache, listlessness. EENT: • Assess client for symptoms of dehydration.
intranasal (DDAVP)—nasal congestion, rhinitis. • Weigh client daily and assess for edema.
Resp: dyspnea. CV: HTN, hypotension, tachy- • Assess for signs of bleeding. Monitor clotting
cardia. GI: mild abdominal cramps, nausea. factors.
GU: vulval pain. Derm: flushing. F and E: water • Monitor BP and serum Na level.
intoxication/hyponatremia. • Monitor for signs and symptoms of water
intoxication.
Route/Dosage: Desmopressin: PO/diabetes insipidus, 0.1–1.2 mg/day; Intranasal/5–40 mcg; SC, IV/0.1–1.2 mg/day, Vasopressin: IM, SC/diabetes
insipidus, 5–10 units 2–4 times daily; IV/pulseless VT/VFib, 10 units once; vasodilatory shock, 0.01–0.1 units/min (titrate to effect)
1882_Tab02_028-050 10/10/12 12:47 PM Page 47
Endocrine System Drugs Growth Hormone 47
Somatropin
(soe-ma-troe-pin)
Humatrope, Serostim
1882_Tab02_028-050 10/10/12 12:47 PM Page 47

Therapeutic/Pharmacologic Class • Follow up with endocrinologist as recommended.
Hormone/growth hormone • Report any joint pain (fingers, legs, hips), as this
Indications could be an epiphyseal abnormality.
Treatment of growth hormone (GH) deficiency in
adults as a result of pituitary disease, hypothalamic Make the Connection
disease, surgery, radiation, trauma, or childhood
onset. Treatment of short stature in children with • Epiphyses must be open in order for
medication to have an effect on children with
open epiphyses. short stature.
Action • Observe for epiphyseal abnormalities, such as
Produces skeletal and cellular growth. limping, pain, or joint disfigurement.
Adverse Reactions/Side Effects • Measure growth and reassure child that the
CV: edema of the hands and feet. Endo: hyper- medication is working.
glycemia, hypothyroidism, insulin resistance. • Watch glucose levels (GH increases blood glucose
Local: pain at injection site. MS: arthralgia, level) and monitor thyroid function.
carpal tunnel syndrome.
Keep in Mind
Teach client:
• Follow instructions for IM or SC injections and
proper disposal of syringes.
Route/Dosage: SC/0.006 mg/kg/day; children, 0.18–0.30 mg/kg/wk

1882_Tab02_028-050 10/10/12 12:47 PM Page 48
Endocrine System Drugs Hormones 48
Octreotide
(ok-tree-oh-tide)
Sandostatin, Sandostatin LAR
Lanreotide
(lan-ree-o-tide)
Somatuline Depot
1882_Tab02_028-050 10/10/12 12:47 PM Page 48
Endocrine System Drugs Hormones 48

Therapeutic/Pharmacologic Class GI: abdominal pain, cholelithiasis, diarrhea, fat
Hormones malabsorption, nausea, vomiting. Derm: flush-
Indications ing. Endo: hyperglycemia, hypoglycemia.
Treatment of severe diarrhea and flushing episodes Local: injection site pain.
in clients with GI endocrine tumors, including
metastatic carcinoid tumors and vasoactive intes-
Keep in Mind
Teach client:
tinal peptide (VIP) tumors (VIPomas). Used with
endoscopy for injection of bleeding esophageal • May cause dizziness, drowsiness, or visual
disturbances.
varices. Treatment of symptoms and suppression of
tumor growth in clients with pituitary tumors asso- • Change positions slowly to minimize orthostatic
hypotension.
ciated with acromegaly. Management of diarrhea in
AIDS clients or clients with fistulas. • Keep record of number and characteristics of
bowel movements.
Action
Suppresses secretion of serotonin and gastroentero-
hepatic peptides. Increases absorption of fluid and Make the Connection
electrolytes from the GI tract and increases transit • Assess frequency and consistency of
time. Suppresses secretion of GH, insulin, and stools and bowel sounds throughout therapy.
glucagon. • Monitor pulse and BP.
Adverse Reactions/Side Effects • Assess client’s F and E balance.
CNS: dizziness, drowsiness, fatigue, headache, • Monitor diabetic clients for signs of hypoglycemia.
weakness. EENT: visual disturbances. CV: • Assess for gallbladder disease.
edema, orthostatic hypotension, palpitations.
Route/Dosage: Octreotide: SC, IV/100–300 mcg tid, Lanreotide: SC/90 mg every 4 wk for 3 mo initially
1882_Tab02_028-050 10/10/12 12:47 PM Page 49
Endocrine System Drugs Progestin 49
Megestrol
(me-jess-trole)
Megace
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Endocrine System Drugs Progestin 49

Therapeutic/Pharmacologic Class • Report to HCP any unusual vaginal bleeding or
Antineoplastic, hormone/progestin signs of deep vein thrombophlebitis.
Indications • This medication may have teratogenic effects.
Palliative treatment of endometrial and breast Contraception should be used during therapy and
carcinoma, either alone or with surgery or radiation for at least 4 mo after therapy is completed.
(tablets only). Treatment of anorexia, weight loss, and • There is a possibility of hair loss.
cachexia associated with AIDS (oral suspension only).
Antineoplastic effect may result from inhibition of • Assess client for swelling (usually
pituitary function. Progestins increase appetite in unilaterally), pain, or tenderness in legs or
those suffering from anorexia related to AIDS. armpit. Measure circumference and report
Adverse Reactions/Side Effects these signs of deep vein thrombophlebitis.
CV: thromboembolism, edema. GI: GI irritation. • May be administered with meals if GI irritation
Derm: alopecia. Endo: asymptomatic adrenal becomes a problem.
suppression (chronic therapy). Hemat: throm- • Any ovarian hormone may pose a risk for throm-
bophlebitis. MS: carpal tunnel syndrome. bophlebitis and embolus formation.
• Smoking increases the risk for thrombotic embolus
Keep in Mind formation.
Teach client:
• Take medication exactly as directed; do not skip
or double up on missed doses.
Route/Dosage: PO/400–800 mg/day

1882_Tab02_028-050 10/10/12 12:47 PM Page 50
Pegvisomant
(peg-vis-o-mant)
Somavert
1882_Tab02_028-050 10/10/12 12:47 PM Page 50

Therapeutic/Pharmacologic Class • Avoid OTC and herbal medications unless cleared
Hormone/growth hormone by HCP.
Indications • May cause dizziness. Avoid driving or other activi-
Treatment of acromegaly in patients who do not ties requiring alertness until effect of the drug is
respond to or are not candidates for surgery, radia- known.
tion, or other medical therapies. • Notify HCP promptly if skin or whites of the eyes
turn yellow (jaundice); if urine turns dark or
Action stools turn light in color; or if decreased appetite,
Binds to GH receptor sites on cell surfaces, blocking nausea, unexplained tiredness, or abdominal pain
the effects of endogenous GH. Bound to polyethylene occurs.
glycol (PEG) to reduce clearance and increase dura-
tion of action, resulting in decreased manifestations • Notify HCP if pregnancy is planned or suspected,
or if breastfeeding.
of acromegaly and normalized insulin-like growth
factor-1 (IGF-1) levels. • Frequent laboratory tests are necessary to adjust
dose and monitor for adverse effects.
CV: HTN, peripheral edema. GI: ↑ LFT. MS:
back pain. Endo: growth hormone deficiency, Make the Connection
↑ glucose tolerance. Derm: lipohypertrophy. • Assess patient for signs and symptoms
of acromegaly.
Keep in Mind • Monitor serum IGF-1 levels at 4–6 wk and
Teach client: every 6 mo.
• Missed doses should be omitted; return to • Monitor for ↓ glucose levels; and ↑ALT, AST,
schedule the next day. total bilirubin, and alkaline phosphatase levels.
Route/Dosage: SC/10 mg/day

UROLOGIC
Tolterodine, 51 Vardenafil, 56 Epoetin, 62

Darifenacin, 51 Tadalafil, 56 Iron Dextran, 63
Solifenacin, 51 Doxazosin, 57 Iron Sucrose, 63
Oxybutynin, 51 Terazosin, 57 Iron Polysaccharide, 63
Bethanechol, 52 Tamsulosin, 57 Trospium, 64
Spironolactone, 53 Alfuzosin, 57 Tolterodine, 64
Amiloride, 53 Finasteride, 58 Fesoterodine , 64
Triamterene, 53 Dutasteride, 58 Saw Palmetto, 65
Furosemide, 54 Sevelamer, 59
Bumetanide, 54 Calcium Acetate, 59
Chlorothiazide, 55 Vitamin B with
Hydrochlorothiazide, 55 Vitamin C, 60
Sildenafil, 56 Calcitriol, 61
1882_Tab03_051-065 10/10/12 12:47 PM Page 51
Urologic System Drugs Anticholinergics 51
Tolterodine Solifenacin
(tol-ter-oh-deen) (so-li-fen-a-sin)
Detrol, Detrol LA VESIcare
Darifenacin Oxybutynin
(dar-i-fen-a-sin) (ox-i-byoo-ti-nin)
Enablex Gelnique (gel),

Oxytrol (transdermal
system), Ditropan and
Ditropan XL (oral)
1882_Tab03_051-065 10/10/12 12:47 PM Page 51
Urologic System Drugs Anticholinergics 51

Therapeutic/Pharmacologic Class • May cause dizziness and blurred vision. Avoid
Urinary tract antispasmodic/anticholinergics driving and other activities that require alertness
Indications until response to medication is known.
Treatment of overactive bladder resulting in symptoms
of urinary frequency, urgency, or urge incontinence. Make the Connection
Action • Monitor voiding pattern and assess
Acts as a muscarinic (cholinergic) receptor antagonist; symptoms of overactive bladder.
antagonizes bladder smooth muscle contraction. • Tablets must be swallowed whole; do not break,
Adverse Reactions/Side Effects crush, or chew.
EENT: blurred vision. GI: constipation, dry • Remember, anticholinergic works against the
mouth, dyspepsia, nausea. “feed/breed/pee/poo” branch of the autonomic
nervous system.
Keep in Mind • Side effects of anticholinergics are always “hot
Teach client: as a hare, dry as a bone, red as a beet, mad as
• Be aware of anticholinergic side effects (constipa- a hatter, and blind as a bat.”
tion, urinary retention, blurred vision, heat pros-
tration in a hot environment).
Route/Dosage: Tolterodine: PO/2–4 mg/day, Solifenacin: PO/5–10 mg/day, Darifenacin: PO/7.5–15 mg/day, Oxybutynin: gel/contents of one sachet
(100 mg/g) once daily; transdermal/a 3.9-mg system twice weekly; PO/5 mg 2–3 times daily; XL/5-30 mg daily
1882_Tab03_051-065 10/10/12 12:47 PM Page 52
Urologic System Drugs Cholinergic 52
Bethanechol
(be-than-e-kole)
Urecholine, Duvoid, Urabeth
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Urologic System Drugs Cholinergic 52

Urinary tract stimulant/cholinergic Teach client:
Indications • Change positions slowly to minimize orthostatic
Treatment of postpartum and postoperative nonob- hypotension.
structive urinary retention or urinary retention • Report abdominal discomfort, salivation, sweating,
caused by neurogenic bladder. or flushing to HCP.
Action
Stimulates cholinergic receptors. Effects include Make the Connection
contraction of the urinary bladder, decreased
bladder capacity, increased frequency of ureteral
• Monitor BP, pulse, and respirations
before administering.
peristaltic waves, increased tone and peristalsis • Monitor I&O.
in the GI tract, increased pressure in the lower • Palpate abdomen for bladder distention.
esophageal sphincter, and increased gastric
secretions.
• Catheterization or bladder scan may be ordered
to assess postvoid residual.
Adverse Reactions/Side Effects • Monitor liver and pancreatic enzymes.
CNS: headache, malaise. EENT: lacrimation, • Notice the “chol” in both the generic and brand.
miosis. Resp: bronchospasm. CV: heart block, That is a clue to its actions.
syncope/cardiac arrest, bradycardia, hypoten- • Remember the acronym SLUDGE: salivation,
sion. GI: abdominal discomfort, diarrhea, nausea, lacrimation, urination, defecation, GI distress,
salivation, vomiting. GU: urgency. Misc: flushing, and emesis for cholinergic/anticholinesterase
sweating, hypothermia. drugs.
Route/Dosage: PO/25–50 mg tid

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Urologic System Drugs Potassium-Sparing Diuretics 53
Spironolactone Triamterene
(speer-oh-no-lak-tone) (trye-am-ter-een)
Aldactone Dyrenium
Novospiroton
Amiloride
(a-mill-oh-ride)
Midamor
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Urologic System Drugs Potassium-Sparing Diuretics 53

Diuretic, potassium-sparing diuretics Teach client:
Indications • Avoid salt substitutes and high-potassium foods.
Management of primary hyperaldosteronism. • May cause dizziness.
Management of edema associated with CHF, cirrho- • BP and laboratory work will be monitored.
sis, and nephrotic syndrome. Management of essen- • Wear a Medic-Alert bracelet.
tial HTN. Treatment of hypokalemia (counteracts • Notify HCP if muscle weakness or cramps;
K+ loss caused by other diuretics). fatigue; or severe nausea, vomiting, palpitations,
or diarrhea occur.
Action
Causes loss of sodium bicarbonate and Ca+ while
saving K+ and hydrogen ions by antagonizing aldos- Make the Connection
terone. Blocks reabsorption of Na in the distal con-
voluted tubules and collecting ducts of the
• Monitor I&O and daily weight (the best
indicator) during therapy.
nephrons, while conserving K+. • Always assess K+ level (3.5–5 mEq/L) and BP
Adverse Reactions/Side Effects before administering.
CNS: dizziness, clumsiness, headache. CV: • Monitor ECG for signs of hyperkalemia (tented
arrhythmias. GI: GI irritation. GU: impotence, T waves).
dysuria. Endo: gynecomastia (in men), breast
tenderness, deepening of voice, increased hair
growth (in women). F and E: hyperkalemia,
hyponatremia, hyperchloremic metabolic acidosis.
Hemat: agranulocytosis. MS: muscle cramps.
Misc: allergic reactions.
Route/Dosage: Spironolactone: PO/25–400 mg/day, Triamterene: PO/25–100 mg/day, Amiloride: PO/5–20 mg/day
1882_Tab03_051-065 10/10/12 12:47 PM Page 54
Urologic System Drugs Loop Diuretics 54
Furosemide
(fur-oh-se-mide)
Lasix
Apo-Furosemide
Bumetanide
(byoo-met-a-nide)
Bumex
Burinex
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Urologic System Drugs Loop Diuretics 54

Diuretic/loop diuretics Teach client:
Indications • Change position slowly to minimize effects of
Treatment of edema due to CHF, hepatic or renal orthostatic hypotension.
disease, and HTN. • Consume high-potassium foods or prescribed K+
supplements (as directed).
Action
Inhibits reabsorption of Na and chloride from the • Use sunscreen.
loop of Henle and distal renal tubule. Increases • Report any unusual bleeding, bruising, sore
throat, or SOB.
water, NaCl, Mg+, H+, Ca+, and K+. May have
peripheral vasodilatory effects. • Report, prior to starting therapy, any allergic
reaction to sulfonamides.
CNS: dizziness, encephalopathy, headache,
insomnia, nervousness. EENT: hearing loss, tin- Make the Connection
nitus. CV: hypotension. GI: constipation, diarrhea, • Always check K+ level (3.5–5 mEq/L)
dry mouth, dyspepsia, nausea, vomiting. GU: and BP prior to administering.
excessive urination. Derm: photosensitivity, • Watch the+ ECG for arrhythmias, especially with
rashes. Endo: hyperglycemia. F and E: dehydra- altered K levels.
tion, hypochloremia, hypokalemia, hypomagne- • BMS can occur.
semia, hyponatremia, hypovolemia, metabolic • Photosensitivity may be severe.
alkalosis due to loss of hydrogen ion. Hemat: • Low K+ causes digoxin toxicity.
blood dyscrasias. Metab: hyperglycemia,
hyperuricemia. MS: arthralgia, muscle cramps,
myalgia. Misc: increased BUN.
Route/Dosage: Furosemide: PO/0–80 mg/day, Bumetanide: PO/0.2–5 mg/day
1882_Tab03_051-065 10/10/12 12:47 PM Page 55
Urologic System Drugs Thiazide Diuretics 55
Chlorothiazide
(klor-oh-thye-a-zide)
Diuril
Hydrochlorothiazide
(hye-droe-klor-oh-thye-a-zide)
Microzide, Oretic
Apo-Hydro
1882_Tab03_051-065 10/10/12 12:47 PM Page 55
Urologic System Drugs Thiazide Diuretics 55

Antihypertensive; diuretic/thiazide diuretics Teach client:
Indications • Change position slowly to minimize effects of
Management of mild-to-moderate HTN. Treatment orthostatic hypotension.
of edema associated with CHF, renal dysfunction, cir- • Consume high-potassium foods.
rhosis, corticosteroid therapy, and estrogen therapy. • Use sunscreen.
Action • Report any unusual bleeding, bruising, sore throat,
or SOB.
Increases excretion of Na and water by inhibiting
Na reabsorption in the distal tubule. Promotes • Report, prior to starting therapy, any allergic
reaction to sulfonamides.
excretion of chloride, K+, Mg+, and HCO3. May
produce arteriolar dilation. • Report severe abdominal pain or yellow coloration
of skin or whites of eyes.
CNS: dizziness, drowsiness, lethargy, weakness.
CV: hypotension. GI: anorexia, cramping, hepati- Make the Connection
tis, nausea, vomiting. Derm: photosensitivity, rash- • Always check K+ level (3.5–5 mEq/L)
es. Endo: hyperglycemia. F and E: hypokalemia, and BP prior to administering.
dehydration, hypercalcemia, hypochloremic alkalo- • Watch the ECG for arrhythmias, especially if K+ is
sis, hypomagnesemia, hyponatremia, hypophos- altered.
phatemia, hypovolemia. Hemat: blood dyscrasias. • BMS can occur, so monitor the CBC.
Metab: hyperuricemia, elevated lipids. MS: muscle • Photosensitivity may be severe.
cramps. Misc: pancreatitis. • Low K+ causes digoxin toxicity.
• Monitor LFT and amylase and lipase levels.
Route/Dosage: Chlorothiazide: PO/125 mg–2 g/day, Hydrochlorothiazide: PO/12.5–100 mg/day
1882_Tab03_051-065 10/10/12 12:47 PM Page 56
Urologic System Drugs Phosphodiesterase Type 5 Inhibitors 56
Sildenafil Tadalafil
(sil-den-a-fil) (ta-da-la-fil)
Revatio, Viagra Cialis, Adcirca
Vardenafil
(var-den-a-fil)
Levitra
1882_Tab03_051-065 10/10/12 12:47 PM Page 56
Urologic System Drugs Phosphodiesterase Type 5 Inhibitors 56

Anti-impotence agent/phosphodiesterase type 5 Teach client:
(PDE5) inhibitors • Take as prescribed before sexual activity.
Indications • Do not take with other drugs, unless directed to
Treatment of erectile dysfunction. do so by HCP.
Action • Erections lasting longer than 4 hr (priapism) or
sudden, decreased vision loss in one or both eyes
Enhances effects of nitric oxide released during sexual must be reported immediately.
stimulation. Nitric oxide activates guanylate cyclase,
which produces increased levels of cGMP. Cyclic
adenosine monophosphate produces smooth muscle Make the Connection
relaxation of the corpus cavernosum, which promotes
increased blood flow and subsequent erection.
• This medication causes vasodilation in the
penis and in other areas of the body; so, it should
Adverse Reactions/Side Effects not be given with any other vasodilating agent.
CNS: headache, dizziness, insomnia. EENT: • Assess effectiveness through interview.
abnormal vision (color tinge to vision, increased
sensitivity to light, blurred vision), epistaxis,
nasal congestion. CV: MI, sudden death, car-
diovascular collapse. GI: dyspepsia, diarrhea.
GU: priapism, urinary tract infection. Derm:
flushing, rash. MS: myalgia. Neuro: paresthesias.
Route/Dosage: Sildenafil: PO/25–100 mg 30 min–4 hr prior to sexual activity, Tadalafil: PO/10 mg prior to sexual activity or 2.5 mg once daily,
Vardenafil: PO/10 mg 1 hr prior to sexual activity or 2.5 mg once daily
1882_Tab03_051-065 10/10/12 12:47 PM Page 57
Urologic System Drugs Peripherally Acting Antiadrenergics 57
Doxazosin Tamsulosin
(dox-ay-zoe-sin) (tam-soo-loe-sin)
Cardura, Cardura XL Flomax
Terazosin Alfuzosin
(ter-a-zoe-sin) (al-fyoo-zoe-sin)
Hytrin Uroxatral
1882_Tab03_051-065 10/10/12 12:47 PM Page 57
Urologic System Drugs Peripherally Acting Antiadrenergics 57

Antihypertensive; prostatic urethra relaxant/ Teach client:
peripherally acting antiadrenergics • Take this medication exactly as prescribed.
Indications • Avoid driving or other activities requiring alertness
Treatment of symptomatic BPH. Management of until response to medication is known.
outflow obstruction in male patients with BPH. • Change positions slowly to decrease orthostatic
Collaborative treatment of HTN. hypotension.
Action • Maintaining appointments for follow-up visits is
important to determine effectiveness of therapy.
Decreases contractions in smooth muscle of the
prostatic capsule by preferentially binding to • Avoid drinking alcohol, as this may cause worsen-
ing orthostatic hypotension.
alpha1-adrenergic receptors.
CNS: dizziness, headache, depression, drowsi- Make the Connection
ness, fatigue, nervousness, weakness. EENT: • Monitor BP and pulse 2–6 hr after first
abnormal vision, blurred vision, conjunctivitis, dose, with each increase in dose, and periodically
epistaxis. Resp: dyspnea. CV: first-dose ortho- during therapy. Report significant changes.
static hypotension, arrhythmias, chest pain, • Monitor I&O and weight, and assess for edema.
edema, palpitations. GI: abdominal discomfort, • Assess client for symptoms of prostatic hyperplasia
constipation, diarrhea, dry mouth, flatulence, prior to and periodically during therapy.
nausea, vomiting. GU: decreased libido, sexual
dysfunction, retrograde/diminished ejaculation.
Derm: flushing, rash, urticaria. MS: arthralgia,
arthritis, gout, myalgia.
Route/Dosage: Doxazosin: PO/2–16 mg/day, Tamsulosin: PO/0.4–0.8 mg/day, Terazosin: PO/5–10 mg hs, Alfuzosin: PO/10 mg/day
1882_Tab03_051-065 10/10/12 12:47 PM Page 58
Urologic System Drugs Androgen Inhibitors 58
Finasteride
(fi-nas-teer-ide)
Propecia, Proscar
Dutasteride
(doo-tas-te-ride)
Avodart
1882_Tab03_051-065 10/10/12 12:47 PM Page 58
Urologic System Drugs Androgen Inhibitors 58

Therapeutic/Pharmacologic Class • Women who are pregnant or may become preg-
BPH agent/androgen inhibitors nant should avoid exposure to semen of a partner
Indications taking this medication and should not handle
Management of the symptoms of BPH in men with crushed finasteride because of the potential for
an enlarged prostate gland. Proscar is used to treat absorption. Absorption may cause birth defects
male-pattern baldness. if the woman is pregnant.
Action • Follow-up examinations and laboratory work
should be expected.
Inhibits the enzyme 5-alpha-reductase, which is
responsible for converting testosterone to its potent
metabolite 5-alpha-dihydrotestosterone in prostate, Make the Connection
liver, and skin. 5-alpha-dihydrotestosterone is partial- • Assess PSA levels (normal levels are
ly responsible for prostatic hyperplasia and hair loss. 0–4 ng/mL) at baseline and during treatment.
Adverse Reactions/Side Effects Direct digital rectal examination by HCP should
GU: decreased libido, decreased volume of be done periodically, also.
ejaculate, impotence. • Assess urinary stream.
• Assess nocturia, hesitation, and urgency.
Keep in Mind • Remember, this is a testosterone inhibitor.
Teach client: Significant birth defects could occur in the case
• Volume of ejaculate may be decreased during of women who come into contact with the med-
therapy, but this will not interfere with normal ication (through sperm or the tablet itself) who
sexual function. Sexual dysfunction side effects are pregnant.
will diminish over time.
Route/Dosage: Finasteride: BPH: PO 5 mg/day; alopecia: 1 mg/day, Dutasteride: PO/0.5 mg/day

1882_Tab03_051-065 10/10/12 12:47 PM Page 59
Urologic System Drugs Phosphate Binders 59
Sevelamer
(se-vel-a-mer)
Renagel, Renvela
Calcium Acetate
(kal-see-um ass-e-tate)
Calphron, PhosLo
1882_Tab03_051-065 10/10/12 12:47 PM Page 59
Urologic System Drugs Phosphate Binders 59

Therapeutic/Pharmacologic Class • If GI effects are severe or prolonged, notify HCP.
Electrolyte modifier/phosphate binders • Report palpitations or tingling if the calcium form
Indications is used.
Reduction of serum phosphate levels in clients with
hyperphosphatemia associated with ESRD. Make the Connection
Action • Assess client for GI side effects periodically
Polymers that bind phosphate in the GI tract, pre- during therapy.
venting its absorption or exchange of phosphate for • Monitor serum phosphorus, Ca+, bicarbonate,
Ca+ in excretory system. and chloride levels periodically during therapy.
Adverse Reactions/Side Effects • Doses of concurrent medications, especially
GI: diarrhea, dyspepsia, vomiting, constipation, antiarrhythmics, should be spaced at least 1 hr
flatulence, nausea. CNS: tingling. CV: arrhyth- before or 3 hr after these medications.
mias, bradycardia, vomiting. GU: calculi, • Administer with meals. Tablets should not be
hypercalciuria. broken, chewed, or crushed.
Keep in Mind
Teach client:
• Do not break, crush, or chew tablets.
• Space concurrent medications at least 1 hr before
or 3 hr after these medications.
Route/Dosage: Sevelamer: PO/800–1600 mg with each meal, Calcium acetate: PO/1334–2668 mg with each meal
1882_Tab03_051-065 10/10/12 12:47 PM Page 60
Urologic System Drugs Water-Soluble Vitamin 60
Vitamin B with
Vitamin C
(vye-ta-min B with vye-ta-min C)
Renal Caps, Nephrocaps
1882_Tab03_051-065 10/10/12 12:47 PM Page 60
Urologic System Drugs Water-Soluble Vitamin 60

Therapeutic/Pharmacologic Class
Vitamin/water-soluble vitamin Make the Connection
Indications • Remember, dialysis flushes water-soluble
Treatment and prevention of vitamin deficiencies in vitamins out of the body.
dialyzed clients. • Monitor client for anaphylaxis (wheezing,
urticaria, edema); contains thiamine.
Action
Contains most or all of the B-complex vitamins
• Monitor laboratory values for hematology and
B vitamins.
(B1, B2, B3, B5, B6, B12) and vitamin C, a diverse
group of compounds necessary for normal growth
• Monitor ability to heal and occurrence of
gingivitis.
and development that act as coenzymes or catalysts
in numerous metabolic processes.
• B vitamins are vital to “b”lood and “b”rain
health.
GU: bright yellow urine. Misc: anaphylaxis
(vitamin B1-thiamine), allergic reactions to
preservatives.
Keep in Mind
Teach client:
• Comply with diet recommendations of HCP.
• Consume a well-balanced diet.
• Watch for signs and symptoms of vitamin B and
C deficiency.
Route/Dosage: PO/1 daily

1882_Tab03_051-065 10/10/12 12:47 PM Page 61
Urologic System Drugs Fat-Soluble Vitamin 61
Calcitriol
(kal-si-trye-ole)
Rocaltrol, Calcijex
1882_Tab03_051-065 10/10/12 12:47 PM Page 61
Urologic System Drugs Fat-Soluble Vitamin 61

Therapeutic/Pharmacologic Class Metab: hyperthermia. MS: bone pain, metastat-
Vitamin/fat-soluble vitamin ic calcification, muscle pain. Misc: allergic reac-
Indications tions (pruritus, rash, urticaria).
Management of hypocalcemia in clients undergoing
Keep in Mind
chronic renal dialysis (IV and PO). Treatment of
Teach client:
hypocalcemia in clients with hypoparathyroidism or
pseudohypoparathyroidism (PO only). Management • Consume foods high in calcium and vitamin D. +
of secondary hyperparathyroidism (PO only). • Avoid concurrent use of antacids containing Mg .
Topical gel form is used to treat plaque psoriasis.
Promotes the absorption of calcium and decreases • Observe client+carefully for hypocalcemia.
parathyroid hormone concentrations. • Ca+, phosphorus, Mg , alkaline phosphatase, and
Adverse Reactions/Side Effects intact parathyroid hormone concentrations will
CNS: headache, somnolence, weakness. EENT: be monitored at least monthly.
conjunctivitis, photophobia, rhinorrhea. CV:
arrhythmias, HTN. GI: abdominal pain, anorexia,
constipation, dry mouth, LFT elevation, metallic
taste, nausea, pancreatitis, polydipsia, vomiting,
weight loss. GU: albuminuria, azotemia, decreased
libido, nocturia, polyuria. Derm: pruritus. F and
E: hypercalcemia. Local: pain at injection site.
Route/Dosage: PO/0.5–1 mcg/day; IV/0.01–0.05 mcg/kg 3 times/wk

1882_Tab03_051-065 10/10/12 12:47 PM Page 62
Urologic System Drugs Hormone 62
Epoetin
(e-poe-e-tin)
Epogen, Procrit, EPO

Eprex
1882_Tab03_051-065 10/10/12 12:47 PM Page 62
Urologic System Drugs Hormone 62

Antianemic/hormone Make the Connection
Indications • Institute seizure precautions in clients
Treatment of anemia associated with chronic renal who experience a greater than 4-point increase in
failure. Hct in a 2-wk period or exhibit change in mental
status.
Action
Stimulates erythropoiesis (RBC production).
• Do not shake the vial. It will turn into unusable
suds, and the medication is expensive.
Adverse Reactions/Side Effects • Monitor CBC.
CNS: seizures, headache. CV: hypertension, • May need more heparin during hemodialysis.
thrombotic events. Derm: transient rashes. • Monitor BP for increases that may need treatment.
Endo: restored fertility, resumption of menses. • Monitor thrill and bruit in arteriovascular grafts.
Keep in Mind
• Monitor serum ferritin, transferrin, and iron levels.
Teach client:
• Menses and fertility may return in women of
childbearing age.
• Learn how to sense and protect oneself from
seizures (teach family members, also).
• Consume foods high in iron, like meat and eggs,
or take an iron supplement.
Route/Dosage: SC/50–150 units/kg to achieve a Hgb of 10–12 mg/dL; presurgical, SC/300–600 units/kg 21, 14, and 7 days preoperatively.
1882_Tab03_051-065 10/10/12 12:47 PM Page 63
Urologic System Drugs Iron Supplements 63
Iron Dextran Iron

(eye-ern dex-tran)
Polysaccharide
(eye-ern poll-ee-sak-a-ride)
DexFerrum, InFeD
Niferex, Hytinic,
Nu-Iron
Iron Sucrose
(eye-ern su-krose)
Venofer
1882_Tab03_051-065 10/10/12 12:47 PM Page 63
Urologic System Drugs Iron Supplements 63

Therapeutic/Pharmacologic Class • A balanced diet is important.
Antianemic/iron supplements • Watch for symptoms of CHF (rare) such as activity
Indications intolerance, edema, lethargy, and palpitations.
Prevention/treatment of anemia in clients undergoing
hemodialysis who are concurrently receiving epoetin.
Make the Connection
Action
An essential mineral found in Hgb, myoglobin, and
• Monitor serum levels.
many enzymes, essential for RBC formation.
• Monitor CBC, especially reticulocyte, Hgb, and
Hct levels.
Adverse Reactions/Side Effects • Monitor for allergic reactions. Give an IV test
CNS: IM, IV—seizures, dizziness, headache, dose of 5 mL before proceeding.
syncope. CV: IM, IV—hypotension, tachycardia, • If giving PO, use a straw to avoid staining teeth.
hemochromatosis, heart failure. GI: nausea, • If giving IM, give by Z-track to avoid staining the skin.
constipation, dark stools, diarrhea, epigastric • Monitor for stomach pain, which is one of the
pain, GI bleeding, taste disorder. Derm: IM, first signs of toxicity.
IV—flushing, urticaria. Local: pain at injection • Assess weight, activity tolerance, and lung sounds
site, skin staining. MS: arthralgia, myalgia. to rule out CHF.
Misc: staining of teeth, allergic reactions. • Avoid giving coffee, tea, dairy, eggs, and whole
Keep in Mind grain breads for 1 hr after PO dose.
Teach client: • Orange juice (PO form) aids in absorption.
• Stools may become very dark. They should have
a dark green (not red) halo when water is
mixed. Report constipation to HCP.
Route/Dosage: Iron dextran: IM, IV/total dose (mL) based on Hgb and body weight, Iron polysaccharide: PO/50–100 mg bid, Iron sucrose: IV/100 mg
each dialysis session
1882_Tab03_051-065 10/10/12 12:47 PM Page 64
Urologic System Drugs Muscarinic Receptor Antagonists 64
Trospium Fesoterodine
(tros-pee-yum) (fee-soe-ter-o-deen)
Sanctura, Toviaz
Sanctura XL
Tolterodine
(tol-ter-oh-deen)
Detrol, Detrol LA
1882_Tab03_051-065 10/10/12 12:47 PM Page 64
Urologic System Drugs Muscarinic Receptor Antagonists 64

Urinary tract antispasmodics/muscarinic receptor Teach client:
antagonists • Heat prostration (fever and heat stroke due to
Indications decreased sweating) may occur when taken in a
Treatment of overactive bladder with symptoms hot environment.
of urge urinary incontinence, urgency, and urinary • May cause dry mouth, urinary retention, and
frequency. constipation. Drink recommended amount of
water, consume fiber, exercise, and use sugar-free
Action hard candy or gum for dry mouth.
Antagonizes the effect of acetylcholine at muscarinic
receptors in the bladder; this parasympatholytic
• May cause drowsiness, dizziness, and blurred
vision. Avoid driving and other activities requiring
action reduces bladder smooth muscle tone. alertness until response to medication is known.
Adverse Reactions/Side Effects Avoid alcohol (may increase drowsiness).
CNS: headache, dizziness, drowsiness, fatigue.
EENT: blurred vision. GI: constipation, dry
mouth, dyspepsia. GU: urinary retention, urinary Make the Connection
tract infection. Misc: fever, heat stroke. • Monitor voiding pattern and I&O ratios.
Route/Dosage: Trospium: PO/20 mg bid, 60 mg XL form once daily, Fesoterodine: PO/4–8 mg daily ≤, Tolterodine: PO/2 mg bid, 2–4 mg once daily
(ER); tolterodine: PO/2 mg bid, 2–4 mg XL form once daily
1882_Tab03_051-065 10/10/12 12:47 PM Page 65
Urologic System Drugs Benign Prostatic Hyperplasia Agent 65
Saw Palmetto
(saw paul-met-o)
Saw Palmetto Berry, Cabbage

Palm, Sabal, Serenoa repens,
Ju-Zhong
1882_Tab03_051-065 10/10/12 12:47 PM Page 65
Urologic System Drugs Benign Prostatic Hyperplasia Agent 65

Therapeutic/Pharmacologic Class • Saw palmetto does not alter the size of the
Benign prostatic hyperplasia agent prostate, but it should relieve the symptoms asso-
Indications ciated with BPH.
Herbal treatment of BPH. • Taking with food should reduce the GI effects
and make it easier to tolerate.
Action
Exerts antiandrogenic, anti-inflammatory, and
antiproliferative properties in prostate tissue, resulting Make the Connection
in improvement in BPH symptoms such as frequent • Assess client for symptoms of BPH such
urination, hesitancy, urgency, and nocturia. as urinary hesitancy, feeling of incomplete bladder
Comparable in efficacy to finasteride but may be emptying, interruption in urinary stream, impair-
less effective than prazosin. ment in size and force of urinary stream, terminal
Adverse Reactions/Side Effects urinary dribbling, straining to start flow, dysuria,
CNS: dizziness, headache. GI: nausea, vomiting, and urgency before and periodically during therapy.
constipation, and diarrhea. • Rectal examinations should be done prior to and
periodically throughout therapy to assess
Keep in Mind prostate size.
Teach client:
• Start therapy with this herbal supplement only
after evaluation by a HCP who will provide con-
tinued follow-up care.
Route/Dosage: PO/(lipophilic extract, 80%–90% fatty acids) 160 mg twice daily or 320 mg once daily; (whole berries) 1–2 g daily; (liquid extract from
berry pulp) 1–2 mL 3 times daily
IMMUNE
Cyclosporine, 66 Dirithromycin, 74 Doxycycline, 81

Pimecrolimus, 67 Clindamycin, 75 Tetracycline, 81
Indomethacin, 68 Gentamicin, 76 Ceftriaxone
Naproxen, 68 Kanamycin, 76 (third generation), 82
Ibuprofen, Oral, 68 Amikacin, 76 Ceftazidime
Ketorolac, 68 Tobramycin, 76 (third generation), 82
Aspirin, 69 Vancomycin, 77 Cephalexin
Methotrexate, 70 Ciprofloxacin, 78 (first generation), 82
Infliximab, 71 Moxifloxacin, 78 Cefepime
Etanercept, 71 Levofloxacin, 78 (fourth generation), 82
Filgrastim, 72 Besifloxacin, 78 Imipenem/Cilastatin, 83
Pegfilgrastim, 72 Amoxicillin, 79 Doripenem, 83
Sargramostim, 72 Amoxicillin/ Meropenem, 83
Calcipotriene, 73 Clavulanate, 79 Ertapenem, 83
Azithromycin, 74 Ampicillin/Sulbactam, 79 Quinupristin/
Erythromycin, 74 Piperacillin/ Dalfopristin, 84
Clarithromycin, 74 Tazobactam, 80 Isoniazid, 85
Continued
IMMUNE
Pyrazinamide, 85 Micafungin, 88 Darunavir, 92

Ethambutol, 85 Acyclovir, 89 Saquinavir, 92
Rifampin, 85 Valacyclovir, 89 Nelfinavir, 92
Trimethoprim/ Famciclovir, 89 Efavirenz, 93
Sulfamethoxazole, 86 Zanamivir, 90 Nevirapine, 93
Fluconazole, 87 Oseltamivir, 90 Delavirdine, 93
Ketoconazole Abacavir, 91 Etravirine, 93
(systemic), 87 Lamivudine, 91 Rilpivirine, 93
Amphotericin B, 87 Didanosine, 91 Enfuvirtide, 94
Voriconizole, 87 Zidovudine, 91 Maraviroc, 95
Caspofungin, 88 Ritonavir, 92 Raltegravir, 96
1882_Tab04_066-096 11/10/12 2:38 PM Page 66
Immune System Drugs Polypeptide (Cyclic) 66
Cyclosporine
(sye-kloe-spor-een)
Sandimmune, Neoral,
Restasis, Genfraf
1882_Tab04_066-096 11/10/12 2:38 PM Page 66
Immune System Drugs Polypeptide (Cyclic) 66

Therapeutic/Pharmacologic Class Metab: hyperlipidemia, hyperuricemia. Neuro:
Immunosuppressant; DMARD/polypeptide (cyclic) hyperesthesia, paresthesia. Misc: gingival hyper-
Indications plasia, hypersensitivity reactions, infections.
Prevention and treatment of organ rejection.
Keep in Mind
Prevention and treatment of graft-versus-host dis-
Teach client:
ease in bone marrow transplant clients. Treatment
of autoimmune diseases such as RA and psoriasis. • For most indications, this drug will be needed
for life.
Treatment of inflammatory dry eye.
Action
• Report sore throat or feelings of ill health.
Inhibits normal immune responses by inhibiting
• Cosmetic changes (hirsutism, acne) may occur.
interleukin-2, a factor necessary for initiation of
• Do not take St. John’s wort, as it will interfere
with antirejection properties.
T-cell activity.
CNS: seizures, tremor, confusion, flushing, Make the Connection
headache, psychiatric problems. CV: HTN. • Monitor CBC with differential, RFT,
GI: diarrhea, hepatotoxicity, nausea, vomiting, chemistries, serum drug levels, and LFT.
abdominal discomfort, anorexia, pancreatitis. • Monitor I&O, daily weight, and BP.
GU: nephrotoxicity. Derm: hirsutism, acne. • Assess for symptoms of organ rejection.
F and E: hyperkalemia, hypomagnesemia. • When administering IV, monitor client for signs
Hemat: bone marrow suppression. and symptoms of hypersensitivity.
Route/Dosage: Neoral: PO/2.5 mg/kg/day given in 2 divided doses, Sandimmune: IV/5–6 mg/kg/dose 4 to 12 hr before transplant, then 2–10 mg/kg/day
Uploaded
in divided doses q 8–24 hr, Restasis: intraocular/1 by MEDBOOKSVN.ORG
drop to each eye bid
1882_Tab04_066-096 11/10/12 2:38 PM Page 67
Immune System Drugs Immunomodulator 67
Pimecrolimus
(pi-me-cro-li-mus)
Elidel
1882_Tab04_066-096 11/10/12 2:39 PM Page 67
Immune System Drugs Immunomodulator 67

Anti-inflammatory/immunomodulator Teach client:
Indications • Avoid eyes.
Treatment of atopic dermatitis. Second-line therapy • Do not apply occlusive dressing over the applica-
for autoimmune skin eruptions. tion site.
Action • Do not use on children younger than 2 yr.
Prevents activation of cytokines, agents of the
inflammatory process. Make the Connection
Adverse Reactions/Side Effects • Do not use on viral or malignant skin
CNS: headache. Resp: cough, nasopharyngitis. conditions because this will decrease immunity
Derm: redness or burning at application site. (suppresses cytokines).
• Discontinue if any unusual lymphatic swelling
occurs.
Route/Dosage: Topical/apply a thin film bid Uploaded by MEDBOOKSVN.ORG

1882_Tab04_066-096 11/10/12 2:39 PM Page 68
Immune System Drugs Nonsteriodal Anti-Inflammatory Agents 68
Indomethacin Ibuprofen,
(in-doe-meth-a-sin)
Oral
(eye-byoo-proe-fen)
Indocin
Apo-Indomethacin
Motrin, Advil
Apo-Ibuprofen
Naproxen Ketorolac
(na-prox-en) (kee-toe-role-ak)
Aleve, Anaprox, Toradol, Sprix

Naprosyn Toradol
Apo-Napro-Na
1882_Tab04_066-096 11/10/12 2:39 PM Page 68
Immune System Drugs Nonsteriodal Anti-Inflammatory Agents 68

Therapeutic/Pharmacologic Class Hemat: blood dyscrasias, prolonged bleeding time.
Antirheumatic; analgesic/nonsteroidal anti- Misc: allergic reactions, including anaphylaxis.
inflammatory agents (COX-1 inhibitor) (Ketorolac,
pyrroziline carboxylic acid) Keep in Mind
Teach client:
Indications
Treatment of mild-to-moderate musculoskeletal • Take with food or milk and remain upright for
30 min to decrease irritation of the lower esopha-
pain or dysmenorrhea. Treatment of inflammatory
gus. Alcohol increases the potential for stomach
disorders, including those of the eye. Treatment of
irritation.
fever and pain in adults and children. Used IV for
ductus arteriosus patency. • May cause drowsiness or dizziness.
Action
• Report abdominal/stomach pain or black-red,
odorous stools.
Inhibits prostaglandin synthesis. • Wear sunscreen and protective clothing.
Adverse Reactions/Side Effects • Report rash or sore throat immediately.
CNS: headache, dizziness, drowsiness, psychic
disturbances. EENT: amblyopia, blurred vision,
tinnitus. CV: arrhythmias, edema, MI, CVA. Make the Connection
GI: GI bleeding, hepatitis, constipation, • Assess for rhinitis, asthma, and urticaria
dyspepsia, nausea, vomiting, abdominal (hypersensitivity).
discomfort. GU: cystitis, hematuria, renal failure. • Monitor VS and pain level.
Derm: exfoliative dermatitis, Stevens-Johnson • Monitor BUN, serum creatinine, CBC with
syndrome, toxic epidermal necrolysis, rashes. differential, electrolytes, bleeding time, and
LFT periodically.
Route/Dosage: Indomethacin: PO/25–50 mg bid–qid or 75-mg ER cap once or twice daily, Ibuprofen, oral: PO/200–800 mg q 4–6 hr, Naproxen:
PO/250–500 mg daily, Ketorolac: PO/10 mg qUploaded byq 6MEDBOOKSVN.ORG
4–6 hr; IM/30–60 mg hr; IV/30 mg q 6 hr; intranasal/(Sprix) 1 spray each nostril q 6–8 hr
1882_Tab04_066-096 11/10/12 2:39 PM Page 69
Immune System Drugs Salicylate 69
Aspirin
(as-pir-in)
Bayer Aspirin, Ecotrin

Apo-ASA
1882_Tab04_066-096 11/10/12 2:39 PM Page 69
Immune System Drugs Salicylate 69

Therapeutic/Pharmacologic Class • Report tinnitus (toxicity level reached).
Antipyretic; nonopioid analgesic/salicylate • Avoid taking with other NSAIDs.
Indications • If the tabs smell like vinegar, they are no longer
Treatment of inflammatory disorders, mild-to- effective.
moderate pain, and fever. Prophylaxis of transient • Contraindicated for children younger than16 yr
ischemic attacks and MI. Unlabeled uses: (Reye’s syndrome).
Adjunctive treatment of Kawasaki disease. • A 325-mg dose of ASA should be taken if unre-
lieved chest pain occurs.
Action
Inhibits the production of prostaglandins. Also
decreases platelet aggregation. Make the Connection
Adverse Reactions/Side Effects • Monitor liver and renal function,
EENT: hearing loss, tinnitus. GI: GI bleeding, electrolytes, bleeding time, CBC, and serum
dyspepsia, epigastric distress, heartburn, nau- drug levels if on long-term therapy.
sea, abdominal pain, anorexia, hepatotoxicity, • Tinnitus is a sign of toxicity.
vomiting. Hemat: anemia, hemolysis, increased • Monitor for drug effectiveness.
bleeding time. Misc: allergic reactions (anaphy- • Part of essential first-line care for MI. A 81-mg
laxis, laryngeal edema), noncardiogenic pul- daily dose helps to prevent clot formation and
monary edema. may reduce cholesterol accumulation.
Keep in Mind
Teach client:
• Take with food or milk.
Uploaded
Route/Dosage: PO/80–325 mg daily (antiplatelet); by mg
PO, Rect/325–1000 MEDBOOKSVN.ORG
q 4–6 hr (pain and fever)
1882_Tab04_066-096 11/10/12 2:39 PM Page 70
Immune System Drugs Antimetabolite 70
Methotrexate
(meth-o-trex-ate)
Rheumatrex, Trexall
1882_Tab04_066-096 11/10/12 2:39 PM Page 70
Immune System Drugs Antimetabolite 70

Therapeutic/Pharmacologic Class Metab: hyperuricemia. MS: osteonecrosis, stress
Antineoplastic; DMARD; immunosuppressant/ fracture. Misc: nephropathy, chills, fever, soft
antimetabolite tissue necrosis.
Indications Keep in Mind
Alone or with other treatment modalities in
Teach client:
the treatment of carcinoma/leukemia/mycosis
fungoides. Treatment of severe psoriasis and • Report SOB, bruising, or sore throat.
RA unresponsive to conventional therapy. • Avoid alcohol to prevent GI irritation.
Action
• Avoid vaccinations without advice of HCP.
Interferes with folic acid metabolism. Result is
inhibition of DNA synthesis and cell reproduction. Make the Connection
Also has immunosuppressive activity. • Auscultate lungs and monitor character of
Adverse Reactions/Side Effects respirations and presence of cough (pulmonary
CNS: dizziness, drowsiness, headaches, malaise. fibrosis).
EENT: blurred vision, dysarthria, transient • Monitor CBC with differential, liver and renal
blindness. Resp: pulmonary fibrosis, intestinal function, and uric acid levels prior to and fre-
pneumonitis. GI: anorexia, hepatotoxicity, quently during therapy.
nausea, stomatitis, vomiting. GU: infertility.
Derm: alopecia, painful plaque erosions, photo-
sensitivity, pruritus, rashes, skin ulceration,
urticaria. Hemat: bone marrow suppression.
Uploaded
Route/Dosage: PO, IM, IV/(psoriasis) 10–25 mg/weekly by 30MEDBOOKSVN.ORG
(not to exceed mg/wk); PO/(arthritis) 2.5 mg q 12 hr
1882_Tab04_066-096 11/10/12 2:39 PM Page 71
Immune System Drugs Tumor Necrosis Factor Blockers 71
Infliximab
(in-flix-i-mab)
Remicade
Etanercept
(e-tan-er-sept)
Enbrel
1882_Tab04_066-096 11/10/12 2:39 PM Page 71
Immune System Drugs Tumor Necrosis Factor Blockers 71

DMARD/TNF blockers Teach client:
Indications • Do not receive live vaccines during therapy and
To decrease progression, signs, and symptoms of avoid exposure to ill people.
RA, juvenile arthritis, ankylosing spondylitis, and • Notify HCP if upper respiratory or other infec-
psoriatic arthritis or plaque psoriasis when tions occur.
response has been inadequate to other disease-
modifying agents. May be used with other agents. Make the Connection
Used in Crohn’s disease and ulcerative colitis.
• Monitor clients who develop a new
Action infection. Do not initiate therapy in clients with
Binds to TNF, making it inactive. TNF is a mediator active infections.
of inflammatory response. • Assess for latent TB with a tuberculin skin test
Adverse Reactions/Side Effects prior to initiation of therapy.
CNS: headache, dizziness, weakness. EENT: • Monitor for allergic reaction (IV).
rhinitis, pharyngitis, sinusitis. Resp: upper • Monitor CBC with differential and ANA.
respiratory tract infection, cough, respiratory • Monitor for improvement in treated autoimmune
disorder. GI: abdominal pain, dyspepsia. disease.
Derm: rash. Hemat: bone marrow suppression.
Local: injection site reactions. Misc: infections,
↑ risk of malignancies.
Route/Dosage: Infliximab: IV/3–5 mg/kg at 2,Uploaded by MEDBOOKSVN.ORG

6, and 8 wks, Etanercept: SC/25–50 mg once weekly (starting dose)
1882_Tab04_066-096 11/10/12 2:39 PM Page 72
Immune System Drugs Colony-Stimulating Factors 72
Filgrastim (granulocyte Sargramostim

colony-stimulating (recombinant human
factor [G-CSF]) granulocyte/macrophage
(fil-gra-stim) colony-stimulating factor
[rHu GM-CSF])
Neupogen (sar-gram-oh-stim)
Leukine
Pegfilgrastim (G-CSF)
(peg-fil-gra-stim)
Neulasta
1882_Tab04_066-096 11/10/12 2:39 PM Page 72
Immune System Drugs Colony-Stimulating Factors 72

Colony-stimulating factor/colony-stimulating factors Make the Connection
Indications • Monitor heart rate, ECG, BP, and respiratory
status before and periodically during therapy.
Acceleration of bone marrow recovery after
chemotherapy or ablative bone marrow transplant. • Assess bone pain throughout therapy. Pain is
usually mild to moderate and is an indication of
Management of severe chronic leukopenia. renewed WBCs.
Action • Monitor CBC with differential, uric acid and
Glycoproteins that bind to and stimulate immature alkaline phosphatase concentrations, serum
WBCs to divide and differentiate. Also activate albumin (circulating protein), RFT, and LFT.
mature WBCs. • Refrigerate. Do not shake (causes foaming).
Adverse Reactions/Side Effects • Assess for peripheral edema daily throughout
CNS: headache, malaise, weakness. Resp: dyspnea. therapy. Capillary leak syndrome (swelling of feet
CV: pericardial effusion, peripheral edema, tran- or lower legs, sudden weight gain, dyspnea) and
sient supraventricular tachycardia. GI: diarrhea. pleural or pericardial effusion may occur.
Derm: itching, rash. MS: arthralgia, bone pain, • May cause flushing with first dose.
myalgia. Misc: chills, fever, first-dose reaction.
Keep in Mind
Teach client:
• Notify HCP if dyspnea or palpitations occur.
• Follow instructions for home administration.
Route/Dosage: Filgrastim: IV, SC/5 mcg/kg/day (initial dose), Sargramostim: IV, SC/250 mcg/m2/day initially, Pegfilgrastim: SC/6 mg per
chemotherapy cycle Uploaded by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 73
Immune System Drugs Synthetic vitamin D3 Analogue 73
Calcipotriene
(kal-si-poe-try-een)
Dovonex
1882_Tab04_066-096 11/10/12 2:39 PM Page 73
Immune System Drugs Synthetic vitamin D3 Analogue 73

Therapeutic/Pharmacologic Class • Report any signs of local adverse reactions, per-
Antipsoriatic/synthetic vitamin D3 analogue sistent irritation, or facial rash to HCP. May
Indications cause irritation of lesions and surrounding skin.
Management of moderate plaque psoriasis. Discontinuation of the drug may be required.
Action • Regular laboratory tests will be done to monitor
Ca+ concentrations.
Modulates skin cell development and production by
acting as a synthetic form of vitamin D.
• Expect improvement in 2–8 wk.

Derm: burning, itching, skin irritation, dry skin, Make the Connection
erythema, peeling, rash, worsening/spreading of • Monitor Ca+ concentrations before and
psoriatic lesions. F and E: hypercalcemia. periodically during therapy. May cause transient,
rapidly reversible hypercalcemia. If hypercalcemia
Keep in Mind occurs, discontinue and monitor Ca+ levels weekly
Teach client: until normal Ca+ levels are restored.
• This drug is for external use only; contact with • Excessive use may cause hypercalcemia.
face or eyes should be avoided. Wash hands after • If ultraviolet B treatment is concurrent, use the
application. cream after the light therapy.
• Apply a thin layer to affected skin twice daily and • Remember, sunlight is the natural enemy of
rub in completely; do not cover. psoriasis.
• Do not use for any disorder other than that for • Vitamin D increases the absorption of Ca+; so,
which it was prescribed. even topical application can cause hypercalcemia.
Route/Dosage: Topical/apply bid Uploaded by MEDBOOKSVN.ORG

1882_Tab04_066-096 11/10/12 2:39 PM Page 74
Immune System Drugs Macrolides 74
Azithromycin Clarithromycin
(aye-zith-roe-mye-sin) (kla-rith-roe-mye-sin)
Zithromax, Zmax Biaxin, Biaxin XL
Erythromycin Dirithromycin
(eh-rith-roe-mye-sin) (di-rith-roe-mye-sin)
E-Mycin, E.E.S., Dynabac

EryPed, EryGel
Apo-Erythro-EC,
Novo-Rythro,
Sans-Acne
1882_Tab04_066-096 11/10/12 2:39 PM Page 74
Immune System Drugs Macrolides 74

Therapeutic/Pharmacologic Class cholestatic jaundice, elevated liver enzymes,
Agent for atypical mycobacterium; anti-infective/ dyspepsia, melena, oral candidiasis. GU: nephritis,
macrolides vaginitis. Hemat: anemia, leukopenia, thrombocy-
Indications topenia. Derm: photosensitivity, Stevens-Johnson
Treatment of the following infections due to suscep- syndrome, rashes. EENT: ototoxicity. F and E:
tible organisms: upper respiratory tract infections, hyperkalemia. Misc: angioedema.
lower respiratory tract infections; acute otitis media;
Keep in Mind
skin and skin structure infections; genitourinary
Teach client:
infections, PUD, and ophth prophylaxis in the
neonate. Prevention of disseminated Mycobacterium • Take the entire prescription as directed with food.
avium complex (MAC) infection in clients with • Report blood in stool.
advanced HIV infection.
Inhibits protein synthesis at the level of the 50S • Culture and sensitivity tests should be
bacterial ribosome. Effective against many gram- performed prior to starting therapy.
positive and gram-negative bacteria, as well as • Observe for signs and symptoms of anaphylaxis.
mycobacteria. • Monitor CBC with differential.
CNS: dizziness, seizures, drowsiness, fatigue,
headache. CV: chest pain, hypotension, palpita-
tions, arrhythmias (rare). GI: pseudomembra-
nous colitis, abdominal pain, diarrhea, nausea,
Route/Dosage: Azithromycin: PO/500 mg first day, then 250 mg once daily for 4 days; Zmax, 2 g dose (ER), Clarithromycin: PO/250–500 mg q 12 hr,
or 1 g daily (XL), Erythromycin: PO/250 mg q Uploaded
6 hr; IV/250–500 mgby MEDBOOKSVN.ORG
q 6 hr, Dirithromycin: PO/500 mg/day
1882_Tab04_066-096 11/10/12 2:39 PM Page 75
Immune System Drugs Lincosamide Antibiotic 75
Clindamycin
(klin-da-mye-sin)
Cleocin, Cleocin T
Dalacin C
1882_Tab04_066-096 11/10/12 2:39 PM Page 75
Immune System Drugs Lincosamide Antibiotic 75

Anti-infective/lincosamide antibiotic Teach client:
Indications • Take the drug as directed until finished.
Treatment of skin and skin structure infections, respi- • Notify HCP immediately if diarrhea, abdominal
ratory tract infections, septicemia, intra-abdominal cramping, fever, or bloody stool occurs.
infections, gynecologic infections, and osteomyelitis. • Be aware of risk of Candida (yeast) infection.
Prevention of endocarditis. Unlabeled uses: • Refrain from vaginal intercourse if intravaginal
Treatment of opportunistic disease in HIV-positive preparation is used.
clients. • If a rash occurs, discontinue medication and notify
HCP immediately.
Action
Inhibits protein synthesis in susceptible bacteria
at the level of the 50S bacterial ribosome. Effective Make the Connection
against most gram-positive aerobic cocci. Also
effective against anaerobic bacteria of reproduc-
• Culture and sensitivity tests should be
performed before therapy is begun.
tive tract. • Monitor CBC with differential (“good” cells can
Adverse Reactions/Side Effects also be affected), and liver and renal laboratory
CNS: dizziness, headache, vertigo. CV: arrhyth- tests.
mias, hypotension. GI: pseudomembranous • Monitor for improvement in condition clinically
colitis, diarrhea, bitter taste (IV), nausea, vomit- and by laboratory tests.
ing. Derm: rashes. Local: phlebitis at IV site.
Uploaded
Route/Dosage: PO/150–450 mg q 6 hr; IM, IV/300–600 mg q 6–8by
hr MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 76
Immune System Drugs Aminoglycosides 76
Gentamicin Amikacin
(jen-ta-mye-sin) (am-i-kay-sin)
Garamycin, Jenamicin Amikin

Cidomycin
Kanamycin Tobramycin
(kan-a-mye-sin) (toe-bra-mye-sin)
Kantrex Nebcin, TOBI

1882_Tab04_066-096 11/10/12 2:39 PM Page 76
Immune System Drugs Aminoglycosides 76

Anti-infective/aminoglycosides Teach client:
Indications • Report tinnitus, vertigo, hearing loss, rash,
Treatment of serious gram-negative bacterial infec- dizziness, or difficulty urinating.
tions and infections caused by staphylococci when • Drink plenty of liquids.
penicillins or other less toxic drugs are contraindi- • Topical application if applicable. Assess skin and
cated. In combination with other agents in the inform HCP if skin irritation develops or infection
management of serious enterococcal infections. worsens.
Prevention of infective endocarditis. Used with
other anti-infectives to treat TB. Prophylactic IV Make the Connection
treatment in the neonate.
• Culture and sensitivity test should be
Action performed before initiating therapy.
Inhibits protein synthesis in bacteria at level of the • Monitor for hearing loss or ataxia.
30S bacterial ribosome. • Monitor I&O and daily weight.
Adverse Reactions/Side Effects • Monitor CBC with differential, LFT, and RFT.
CNS: ataxia, vertigo. EENT: ototoxicity • Monitor peak and trough serum blood levels.
(vestibular and cochlear). GU: nephrotoxicity. • Neonates should be assessed by audiometric
MS: muscle paralysis (high parenteral doses). studies prior to discharge.
Misc: hypersensitivity reactions. • Monitor for fungal infections.
Route/Dosage: Gentamicin: IM, IV/6 mg/kg/day in 3 divided doses, Amikacin: IM, IV/15 mg/kg/day divided q 8–12 hr, Kanamycin: IM, IV/5 mg/kg
q 8 hr, or 7.5 mg/kg q 12 hr, Tobramycin: IM, IV/3–6 mg/kg/day in 3 divided doses; Inhaln/40–80 mg 2 to 3 times daily (standard), 300 mg bid for
28 days (high dose) Uploaded by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 77
Immune System Drugs Anti-Infective 77
Vancomycin
(van-koe-mye-sin)
Vancocin
1882_Tab04_066-096 11/10/12 2:39 PM Page 77
Immune System Drugs Anti-Infective 77

Anti-infective Teach client:
Indications • Oral forms are to be taken exactly as directed.
IV: Treatment of potentially life-threatening infec- • Report tinnitus, rash, vertigo, or hearing loss.
tions when less toxic anti-infectives are contraindi- • Report flushing of the skin, or dizziness.
cated. Particularly useful in methicillin-resistant
staphylococcal infections. PO: Treatment of staphy- Make the Connection
lococcal enterocolitis or pseudomembranous colitis
due to Clostridium difficile. • Culture and sensitivity tests are performed
prior to initiating therapy.
Action • Monitor IV site closely to avoid extravasation.
Binds to bacterial cell wall, resulting in cell death
(bacteriocidal). Effective against gram-positive
• Monitor BP and presence of skin flushing
throughout IV infusion.
pathogens. • Monitor I&O and daily weight. Cloudy or pink
Adverse Reactions/Side Effects urine may be a sign of nephrotoxicity.
EENT: ototoxicity. CV: hypotension, massive • Assess bowel status.
histamine release called “red-man syndrome” • Monitor CBC with differential, and liver and renal
with rapid IV infusion. GI: nausea, vomiting. function. Monitor peak and trough drug levels.
GU: nephrotoxicity. Derm: rashes. Hemat: Report subtherapeutic or toxic levels immediately.
eosinophilia, leukopenia. Local: phlebitis. • Administer IV over at least 60–90 min to prevent
MS: back and neck pain. Misc: anaphylaxis, “red-man syndrome” (massive histamine release).
superinfection. • Look for Candida infections.
Route/Dosage: IV/500 mg q 6 hr Uploaded by MEDBOOKSVN.ORG

1882_Tab04_066-096 11/10/12 2:39 PM Page 78
Immune System Drugs Fluoroquinolones 78
Ciprofloxacin Levofloxacin
(sip-roe-flox-a-sin) (le-voe-flox-a-sin)
Cipro, Cipro XR Levaquin
Moxifloxacin Besifloxacin
(mox-i-flox-a-sin) (be-si-flox-a-sin)
Avelox Besivance
1882_Tab04_066-096 11/10/12 2:39 PM Page 78
Immune System Drugs Fluoroquinolones 78

Therapeutic/Pharmacologic Class Local: phlebitis at IV site. MS: tendonitis, tendon
Anti-infective/fluoroquinolones rupture. Neuro: peripheral neuropathy. Misc:
Indications anaphylaxis.
PO, IV: Treatment of the following bacterial infec-
Keep in Mind
tions: urinary tract and gynecologic infections;
Teach client:
respiratory tract infections; skin and skin structure
infections; bone and joint infections; infectious diar- • Take medication as directed.
rhea; complicated intra-abdominal infections; and • Drink plenty of fluids daily to prevent crystalluria.
typhoid fever. Postexposure prophylaxis of inhala- • Do not take with antacids.
tional anthrax. Treatment of cutaneous anthrax. • May cause dizziness and drowsiness.
Unlabeled uses: Treatment of febrile neutropenia. • Use sunscreen and protective clothing.
Action
• Report rash, tendon pain, or blood in stool.
Inhibits bacterial DNA synthesis by inhibiting DNA
gyrase enzyme (bacteriocidal). Effective against Make the Connection
gram-positive and gram-negative bacteria. • Culture and sensitivity tests should be
Adverse Reactions/Side Effects performed before initiating therapy.
CNS: seizures, dizziness, drowsiness, headache, • Monitor for anaphylactic reaction.
insomnia/agitation, confusion. GI: pseudomem- • Monitor CBC with differential, liver and renal
branous colitis, abdominal pain, diarrhea, studies, and blood glucose.
abnormal liver enzymes, nausea. GU: vaginitis. • Monitor for signs of Candida infection.
Derm: photosensitivity, rash. Endo: hyper- • Best if given on an empty stomach.
glycemia, hypoglycemia. Hemat: eosinophilia.
Route/Dosage: Ciprofloxacin: PO/500–750 mg q 12 hr; IV/400 mg q 12 hr, Levofloxacin: PO, IV/250–750 q 24 hr, Moxifloxacin: PO/400 mg daily,
Besifloxacin: Ophth/1 drop in affected eye tidUploaded by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 79
Immune System Drugs Aminopenicillins (includes beta-lactamase inhibitors) 79
Amoxicillin Ampicillin/
(a-mox-i-sill-in)
Sulbactam
(am-pi-sil-in/sul-bak-tam)
Amoxil, Trimox
Apo-Amoxi
Unasyn
Amoxicillin/Clavulanate
(a-mox-i-sill-in/klav-yoo-lan-ate)
Augmentin, Augmentin ES, Augmentin XR

Clavulin
1882_Tab04_066-096 11/10/12 2:39 PM Page 79
Immune System Drugs Aminopenicillins (includes beta-lactamase inhibitors) 79

Anti-infective/aminopenicillins; beta lactamase Teach client:
inhibitor with clavulanate or sulbactam • Take as directed.
Indications • Women taking oral contraceptives should use a
Treatment of skin and skin structure infections, otitis barrier method while on this medication.
media, sinusitis, respiratory infections, and genitouri- • Be aware that yeast infections may occur.
nary infections. Prevention of endocarditis. Postexposure • Notify HCP immediately if diarrhea, abdominal
inhalational anthrax prophylaxis. Treatment of infec- cramping, fever, or bloody stools occur.
tions with resistant organisms. Unlabeled uses: Lyme • Calculate and measure doses accurately if admin-
disease in children younger than 8 yr. istering to pediatric client, using proper measur-
ing device.
Action
Binds to bacterial cell wall, causing cell death
(bacteriocidal). Depending on agent, drugs are Make the Connection
broad spectrum and can kill resistant organisms. • Observe for signs and symptoms of
Adverse Reactions/Side Effects anaphylaxis (rash, pruritus, laryngeal edema,
CNS: seizures (high doses). GI: pseudomem- wheezing).
branous colitis, diarrhea, nausea, vomiting, • Obtain specimens for culture and sensitivity
elevated liver enzymes. Derm: rashes, urticaria. testing prior to therapy.
Hemat: bone marrow suppression. Misc: • Monitor bowel function.
anaphylaxis, serum sickness, superinfection. • Monitor CBC with differential and liver enzymes.
Route/Dosage: Amoxicillin: PO/250–500 mg q 8 hr, or 500–875 mg q 12 hr, Ampicillin/sulbactam: IM, IV/1–2 g ampicillin q 6–8 hr,
Amoxicillin/clavulanate: PO/250 mg q 8 hr, orUploaded
500 mg q 12 hr by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 80
Immune System Drugs Extended-Spectrum Penicillins 80
Piperacillin/
Tazobactam
(pi-per-a-sill-in/tay-zoe-bak-tam)
Zosyn
1882_Tab04_066-096 11/10/12 2:39 PM Page 80
Immune System Drugs Extended-Spectrum Penicillins 80

Therapeutic/Pharmacologic Class including anaphylaxis and serum sickness, fever
Anti-infectives/extended-spectrum penicillins (↑ in cystic fibrosis patients), superinfection.
Appendicitis and peritonitis, skin and skin structure
Teach client:
infections, gynecologic infections, and community-
acquired and nosocomial pneumonia caused by • Report rash/itching immediately.
piperacillin-resistant, beta-lactamase–producing • Notify HCP if fever and diarrhea occur, especially
if stool contains blood, pus, or mucus.
bacteria.
Action
Piperacillin: Binds to bacterial cell wall membrane, Make the Connection
causing cell death. Spectrum is extended compared • Obtain specimens for culture prior to
with other penicillins; Tazobactam: Inhibits beta- beginning medication.
lactamase, an enzyme that can destroy penicillins. • Assess for improvement of infection.
Adverse/Side Effects • Obtain a history before initiating therapy to deter-
CNS: seizures at higher doses, confusion, mine previous use of and reactions to penicillins
dizziness, headache, insomnia, lethargy. GI: or cephalosporins. Cross-sensitivity may occur.
pseudomembranous colitis, diarrhea, constipation, • Observe patient for signs and symptoms of
drug-induced hepatitis, nausea, vomiting. GU: anaphylaxis.
interstitial nephritis. Derm: rashes (↑ in cystic fibro- • Evaluate RFT, LFT, CBC, serum K+, BUN, serum
sis patients), urticaria. Hemat: bleeding, leukope- bilirubin, alkaline phosphatase, and PT/aPTT.
nia, neutropenia, thrombocytopenia. Local: pain, • May cause proteinuria; hematuria; pyuria; hyper-
phlebitis at IV site. Misc: hypersensitivity reactions glycemia; ↓ total protein or albumin; and abnor-
malities in Na, K+, and Ca+ levels.
Route/Dosage: IV/3.375 g q 6 hr; nosocomialUploaded
pneumonia, 4–5 g qby
6 hr MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 81
Immune System Drugs Tetracyclines 81
Doxycycline
(dox-i-sye-kleen)
Doryx, Vibramycin,
Oracea, Periostat
Apo-Doxy
Tetracycline
(te-tra-sye-kleen)
Sumycin
Apo-Tetra
1882_Tab04_066-096 11/10/12 2:39 PM Page 81
Immune System Drugs Tetracyclines 81

Therapeutic/Pharmacologic Class rashes. Hemat: BMS. Local: phlebitis at IV site.
Anti-infective/tetracyclines Misc: hypersensitivity reactions, superinfection.
Treatment of various infections caused by unusual
Teach client:
organisms, including Mycoplasma, Chlamydia,
Rickettsia, and Borrelia burgdorferi. Treatment of • Take as directed. Report rash (allergic reaction).
inhalational anthrax (postexposure) and cutaneous • Avoid taking antacids and dairy products.
anthrax. Treatment of gonorrhea and syphilis in • Women should use a nonhormonal method of
contraception (barrier method).
penicillin-allergic clients. Prevention of exacerba-
tions of chronic bronchitis. Treatment of acne. • Use sunscreen and protective clothing.
Action
• Watch for signs of yeast infection.
Inhibits bacterial protein synthesis at the level
of the 30S bacterial ribosome (bacteriostatic). Make the Connection
Low-dose products used in the management of • Culture and sensitivity testing are done
periodontitis inhibit collagenase. Effective against before initiating therapy.
some gram-positive and gram-negative bacteria, as • Monitor renal and liver functions, amylase and
well as Mycoplasma and Rickettsia. lipase levels, and CBC with differential.
Adverse Reactions/Side Effects • Pregnant women and children younger than
CNS: benign intracranial HTN (higher in children). 8 yr should not take these preparations, as they
GI: diarrhea, nausea, vomiting, esophagitis, hepa- affect teeth (brown, speckled stain) and bones.
totoxicity, pancreatitis. Derm: photosensitivity,
Uploaded
Route/Dosage: Doxycycline: PO/100 mg bid; PO, by 100
IV/(anthrax inhalation) MEDBOOKSVN.ORG
mg bid, Tetracycline: PO/250–500 mg q 6 hr, or 500 mg–1 g q 12 hr
1882_Tab04_066-096 11/10/12 2:39 PM Page 82
Immune System Drugs Cephalosporins 82
Ceftriaxone Cephalexin
(3rd generation) (1st generation)
(sef-try-ax-one) (sef-a-lex-in)
Rocephin Keflex
Apo-Cephalex
Ceftazidime Cefepime
(3rd generation) (4th generation)
(sef-tay-zi-deem) (seff-e-peem)
Fortaz, Tazicef Maxipime

1882_Tab04_066-096 11/10/12 2:39 PM Page 82
Immune System Drugs Cephalosporins 82

Anti-infective/cephalosporins Teach client:
Indications • Take as directed.
Treatment of skin and skin structure infections; • Notify HCP if fever and diarrhea develop, espe-
bone and joint infections; complicated and uncom- cially if stool contains blood, pus, or mucus.
plicated urinary tract infections; uncomplicated • These medications are related to penicillins; so,
gynecologic infections, including gonorrhea; lower report preexisting allergy.
respiratory tract infections; intra-abdominal infec- • Women should use a barrier method of birth control.
tions; septicemia; meningitis; otitis media; and • Report rash or signs of yeast infection.
perioperative prophylaxis.
Binds to the bacterial cell wall membrane, causing
cell death (bacteriocidal). Spectrum varies depend-
• Before initiating therapy, obtain a history
to determine previous use of and reactions to
ing on drug generation. Third generation is more penicillins or other beta-lactam medications.
effective against more organisms. • Obtain specimens for culture and sensitivity
Adverse Reactions/Side Effects testing before initiating therapy.
CNS: seizures (high doses). GI: pseudomembra- • Observe client for signs and symptoms of
nous colitis, diarrhea, cholelithiasis, sludging in anaphylaxis.
the gallbladder. Derm: rashes, urticaria. Hemat: • Monitor CBC with differential.
BMS. Local: pain at IM site, phlebitis at IV site. • Discuss alternative forms of birth control with
Misc: allergic reactions including anaphylaxis, female clients.
superinfection.
Route/Dosage: Ceftriaxone: IM, IV/1–2 g q 12–24 hr, Cephalexin: PO/250–500 mg q 6 hr, Ceftazidime: IM, IV/500 mg–1 g q 8 hr, Cefepime: IV/0.5–1 g
q 12 hr Uploaded by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 83
Immune System Drugs Carbapenems 83
Imipenem/ Meropenem
(mer-oh-pen-nem)
Cilastatin
(i-me-pen-em/sye-la-stat-in)
Merrem
Primaxin
Doripenem Ertapenem
(do-ri-pen-em) (er-ta-pen-em)
Doribax Invanz
1882_Tab04_066-096 11/10/12 2:39 PM Page 83
Immune System Drugs Carbapenems 83

Anti-infective/carbapenems Teach client:
Indications • Watch for signs and symptoms of yeast infection.
Treatment of lower respiratory tract infections, • Notify HCP if fever and diarrhea occur, especial-
urinary tract infections, abdominal infections, ly if stool contains blood, pus, or mucus.
gynecologic infections, skin and skin structure Symptoms may occur for up to several weeks
infections, bone and joint infections, bacteremia, after discontinuation of medication.
endocarditis, polymicrobic infections, and infec-
tions with resistant organisms. Make the Connection
Action • Obtain a history before initiating therapy
Binds to the bacterial cell wall, resulting in cell to determine previous use of and reactions to
death (bacteriocidal). Combination of drugs pre- beta-lactam drugs.
vents renal inactivation. Many enzymes that degrade
most other beta-lactam drugs do not affect this
• Obtain specimens for culture and sensitivity
testing before initiating therapy.
drug. Broad spectrum against gram-positive and
gram-negative aerobes and anaerobes.
• Observe client for signs and symptoms of
anaphylaxis.
Adverse Reactions/Side Effects • Monitor CBC with differential to assess effectiveness.
CNS: seizures, dizziness, somnolence. CV: • Monitor LFT and RFT. This drug has very high
hypotension. GI: pseudomembranous colitis, renal concentrations.
diarrhea, nausea, vomiting. Derm: rash, pruritus, • Do not administer direct IV. Drug must be diluted.
sweating, urticaria. Hemat: eosinophilia. Local:
phlebitis at IV site. Misc: anaphylaxis, fever,
superinfection.
Uploaded
Route/Dosage: Imipenem/cilastatin: IV/200–500 by MEDBOOKSVN.ORG
mg q 6 hr, Meropenem: IV/0.5–1 g q 8 hr, Doripenem: IV/500 mg q 8 hr, Ertapenem: IV, IM/1 g daily
1882_Tab04_066-096 11/10/12 2:39 PM Page 84
Immune System Drugs Streptogramins 84
Quinupristin/
Dalfopristin
(kwin-oo-pris-tin/dal-foe-pris-tin)
Synercid
1882_Tab04_066-096 11/10/12 2:39 PM Page 84
Immune System Drugs Streptogramins 84

Anti-infective/streptogramins Teach client:
Indications • Notify HCP if fever and diarrhea develop,
Treatment of serious or life-threatening infections especially if stool contains blood, pus, or
associated with vancomycin-resistant Enterococcus mucus.
faecium (VREF) and complicated skin/skin structure
infections caused by Staphylococcus aureus (methicillin Make the Connection
susceptible) or Streptococcus pyogenes.
• Monitor for improvement of symptoms by
Action clinical signs and CBC with differential.
Quinupristin inhibits the late phase of protein • Obtain specimens for culture and sensitivity
synthesis at the level of the bacterial ribosome; before initiating therapy.
dalfopristin inhibits the early phase. • Monitor infusion site.
Adverse Reactions/Side Effects • Observe patient for signs and symptoms of
CNS: headache. CV: thrombophlebitis. GI: anaphylaxis.
pseudomembranous colitis, diarrhea, nausea, • Arthralgia and myalgia may be severe.
vomiting. Derm: pruritus, rash. Local: edema/ • Monitor LFT.
inflammation/pain at infusion site, infusion site • Inhibits the cytochrome P450 3A4 drug metabo-
reactions. Misc: allergic reactions including lizing enzyme system; inhibits metabolism of
anaphylaxis, pain. many drugs, increasing the risk of toxicity.
Route/Dosage: IV/7.5 mg/kg q 8 hr Uploaded by MEDBOOKSVN.ORG

1882_Tab04_066-096 11/10/12 2:39 PM Page 85
Immune System Drugs Antitubercular Anti-infectives 85
Isoniazid Ethambutol
(eye-soe-nye-a-zid) (e-tham-byoo-tole)
INH Myambutol
PMS Isoniazid Etibi
Pyrazinamide Rifampin
(peer-a-zin-a-mide) (rif-am-pin)
PMS Rifadin
Pyrazinamide Rofact
1882_Tab04_066-096 11/10/12 2:39 PM Page 85
Immune System Drugs Antitubercular Anti-infectives 85

Antitubercular/bacteriostatic; bacteriocidal Teach client:
anti-infectives • Take medication exactly as directed. Therapy may
Indications be continued for 6 mo–2 yr.
First-line therapy of active TB, in combination with • Report numbness of extremities or decrease in
other agents. Multidrug regimen prevents resistance. vision. Take pyridoxine (B6) to ↓ neuropathy.
Preventive treatment (exposed to active TB) may be • Avoid the use of alcohol.
accomplished with monotherapy. • Avoid tyramine-containing foods.
Action • Maintain appointments for regular follow-up.
Inhibits mycobacterial cell wall synthesis and inter- • Be aware that urine may change color (“r” drug = red).
feres with metabolism; one first-line drug interferes
with RNA transcription. Bactericidal/bacteriostatic Make the Connection
action. • Monitor CBC with differential, LFT, and
Adverse Reactions/Side Effects uric acid levels.
CNS: psychosis, seizures, optic neuritis. EENT: • Teach the client about the regimen, public health
visual disturbances, drug that begins with “e” concerns, and possible side effects.
causes eye problems (optic neuropathy: e = eye). • Monitor vision and for nerve pain/paresthesias.
GI: drug-induced hepatitis, nausea, vomiting. • Therapy will continue until 2 sputum samples for
Derm: rashes. Endo: gynecomastia. Hemat: bone AFB are negative.
marrow changes. Neuro: peripheral neuropathy.
Misc: fever; drug that begins with “r” causes red
discoloration of the urine (r = red).
Route/Dosage: Isoniazid: PO, IM/300 mg daily, Ethambutol: PO/15–25 mg/kg/day, Pyrazinamide: PO/15–30 mg/kg/day, Rifampin: PO, IV/600 mg/day,
or 10 mg/kg/day Uploaded by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 86
Immune System Drugs Sulfonamide 86
Trimethoprim/
Sulfamethoxazole
(trye-meth-oh-prim/sul-fa-meth-ox-a-zole)
Bactrim, Bactrim DS,

SMZ/TMP, Septra
Apo-Sulfatrim DS
1882_Tab04_066-096 11/10/12 2:39 PM Page 86
Immune System Drugs Sulfonamide 86

Anti-infective; antiprotozoal/folate antagonist; Teach client:
sulfonamide • Take medication as directed.
Indications • Use sunscreen and protective clothing.
Treatment of bronchitis, Shigella enteritis, otitis • Notify HCP if skin rash, sore throat, fever, mouth
media, Pneumocystis carinii pneumonia (PCP), urinary sores, or unusual bleeding or bruising occurs.
tract infections, and traveler’s diarrhea. Prevention • Maintain appointments for regular follow-up.
of PCP in HIV-positive clients. • Increase fluid intake to decrease the risk of renal
crystals.
Action
Combination inhibits the metabolism of folic acid
in bacteria at two different points (bacteriocidal). Make the Connection
Effective against gram-negative and gram-positive
bacteria.
• Obtain specimens for culture and sensitivity
testing before initiating therapy.
Adverse Reactions/Side Effects • Inspect IV site frequently. Phlebitis is common.
CNS: fatigue, hallucinations, headache, insom- • Assess client for allergy to sulfonamides.
nia, mental depression. GI: hepatic necrosis, • Monitor I&O. Promote adequate fluid intake.
nausea, vomiting, diarrhea, stomatitis, hepatitis, • Monitor CBC with differential and liver and renal
cholestatic jaundice. GU: crystalluria. Derm: laboratory tests.
severe exfoliative rashes, photosensitivity.
Hemat: BMS. Local: phlebitis at IV site.
Misc: allergic reactions, fever.
Route/Dosage: PO, IV/(TMP) 6–12 mg/kg/day in divided doses q 12 hr (moderate infection), 15–20 mg/kg/day in divided doses q 6–8 hr
(pneumocystis); PO/(prophylaxis), 1 DS tab daily
1882_Tab04_066-096 11/10/12 2:39 PM Page 87
Immune System Drugs Antifungals 87
Fluconazole Amphotericin B
(floo-kon-a-zole) (am-foe-ter-i-sin)
Diflucan Amphotec, AmBisome

Fungizone
Ketoconazole Voriconizole
(vor-i-kon-a-zole)
(systemic)
(kee-toe-koe-na-zole)
VFEND
Nizoral
1882_Tab04_066-096 11/10/12 2:39 PM Page 87
Immune System Drugs Antifungals 87

Therapeutic/Pharmacologic Class amphotericin. Neuro: peripheral neuropathy
Antifungals (systemic) with amphotericin.
PO, IV: Treatment of fungal infections caused by
Teach client:
susceptible organisms.
Action
• Take medication as directed.
Inhibits synthesis of fungal sterols, a necessary com-
• Notify HCP if skin rash, abdominal pain, fever,
diarrhea, unusual fatigue, anorexia, nausea,
ponent of the cell membrane (fungistatic). Destroys vomiting, jaundice, unusual bruising, bleeding,
fungi at higher doses (fungicidal). palpitations, dark urine, or pale stools occur.
Adverse Reactions/Side Effects • Report development of a rash immediately.
CNS: headache, dizziness, tremor, seizures.
GI: hepatotoxicity, abdominal discomfort,
diarrhea, nausea, vomiting. Derm: exfoliative Make the Connection
skin disorders. Endo: hypokalemia, hypocal- • Specimens for culture should be obtained
cemia, hypomagnesemia, hypertriglyceridemia. before instituting therapy.
Misc: allergic reactions, including anaphylaxis; • Monitor LFT, RFT, and CBC with differential.
acute infusion reactions. Resp: dyspnea, • Monitor VS every 15–30 min during test dose
hypoxia, wheezing with certain drugs. and every 30 min for 2–4 hr after administration
CV: hypotension, arrhythmias with ampho- of amphotericin. May need to premedicate with
tericin. GU: nephrotoxicity, hematuria with meperidine, dantrolene, and diphenhydramine.
amphotericin. MS: arthralgia, myalgia with • Assess respiratory status daily after administra-
tion of amphotericin.
Route/Dosage: Fluconazole: PO, IV/200 mg initially, then 100 mg daily, Amphotericin B: IV/0.25–1.5 mg/kg/day; bladder irrigation/50 mcg/mL,
Uploaded
Ketoconazole: PO/200–400 mg day, Voriconizole: IV/3 mg/kg q 12byhr MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 88
Immune System Drugs Echinocandins 88
Caspofungin
(kas-po-fun-gin)
Cancidas
Micafungin
(my-ka-fun-gin)
Mycamine
1882_Tab04_066-096 11/10/12 2:39 PM Page 88
Immune System Drugs Echinocandins 88

Systemic antifungal/echinocandins Teach client:
Indications • Be aware of the purpose and expected result of
Treatment of invasive refractory aspergillosis, drug therapy.
candidemia, and associated serious infections • Notify HCP immediately if symptoms of allergic
(intra-abdominal abscesses, peritonitis, pleural reactions (rash, facial swelling, pruritus, sensa-
space infections), esophageal candidiasis, and tion of warmth, difficulty breathing) occur.
suspected fungal infections in febrile neutropenic
patients. Make the Connection
Action • Concurrent use with cyclosporine may
Inhibits the synthesis of beta (1, 3)-D-glucan, a cause hepatic toxicity.
necessary component of the fungal cell wall. • Assess for effectiveness of therapy daily.
Adverse Reactions/Side Effects • Monitor for signs of anaphylaxis (rash, dyspnea,
CNS: headache, chills. GI: diarrhea, ↑ liver stridor) during therapy.
enzymes, nausea, vomiting. Resp: bron- • Monitor for ↑ serum alkaline phosphatase, serum
chospasm. GU: ↑ creatinine. Derm: flushing, creatinine, AST, ALT, eosinophils, urine protein,
pruritus, rash. Local: venous irritation at injec- and RBCs. May also cause ↓ serum K+, hgb,
tion site. Misc: allergic reactions, including hct, and WBCs.
anaphylaxis and angiodema.
Uploaded
Route/Dosage: Caspofungin: IV/70 mg initially, by MEDBOOKSVN.ORG
followed by 50 mg/day, Micafungin: IV/150 mg/day for 15 days
1882_Tab04_066-096 11/10/12 2:39 PM Page 89
Immune System Drugs Antivirals 89
Acyclovir Famciclovir
(ay-sye-kloe-veer) (fam-sye-kloe-veer)
Zovirax Famvir
Avirax
Valacyclovir
(val-ay-sye-kloe-veer)
Valtrex
1882_Tab04_066-096 11/10/12 2:39 PM Page 89
Immune System Drugs Antivirals 89

Therapeutic/Pharmacologic Class phlebitis, local irritation. MS: joint pain.
Antivirals/purine analogue (acyclovir) Misc: polydipsia.
PO, IV: Treatment of recurrent genital herpes
Teach client:
infections. Treatment of localized cutaneous
herpes zoster infections (shingles) and chickenpox • Take medication as directed.
(varicella). Treatment of herpes simplex encephalitis • Condoms should always be used during sexual
contact.
in immunocompromised clients. Topical: Treatment
of recurrent herpes labialis (cold sores). • Women with genital herpes should have yearly
Papanicolaou smears.
Action • Follow instructions for proper application of
Interferes with viral DNA synthesis. topical creams or ointments.
Adverse Reactions/Side Effects • Wash hands after touching affected areas to
CNS: seizures, dizziness, headache, hallucina- avoid spreading the viral infection to other areas
tions, trembling. GI: diarrhea, nausea, vomiting, of the body. Avoid drug contact in or around the
elevated liver enzymes, hyperbilirubinemia, eyes.
abdominal pain, anorexia. GU: renal failure,
crystalluria, hematuria. Derm: acne, hives, skin
rashes, unusual sweating, Stevens-Johnson Make the Connection
syndrome. Endo: changes in menstrual cycle. • Monitor BUN, serum creatinine, and
Hemat: thrombotic thrombocytopenic purpura/ creatinine clearance rate (CCr) before and during
hemolytic uremic syndrome (high doses therapy. ↑ BUN and serum creatinine levels or
in immunosuppressed clients). Local: pain, ↓ CCr may indicate renal failure.
Uploaded
Route/Dosage: Acyclovir: PO/200 mg q 4 hr, Famciclovir: PO/500by
mg q MEDBOOKSVN.ORG
8 hr, Valacyclovir: PO/1 g tid
1882_Tab04_066-096 11/10/12 2:39 PM Page 90
Immune System Drugs Neuraminidase Inhibitors 90
Zanamivir
(za-na-mi-veer)
Relenza
Oseltamivir
(owe-sell-tam-i-veer)
Tamiflu
1882_Tab04_066-096 11/10/12 2:39 PM Page 90
Immune System Drugs Neuraminidase Inhibitors 90

Therapeutic/Pharmacologic Class • Persons with a history of asthma should have a
Antiviral/neuraminidase inhibitors fast-acting inhaled bronchodilator available in
Indications case of bronchospasm. If using bronchodilator
Treatment of uncomplicated acute illness caused by and the medication concurrently, administer
influenza virus in adults and children older than 7 yr bronchodilator first.
who have been symptomatic no more than 2 days.
Inhibits the enzyme neuraminidase, which may alter • Assess client for signs and symptoms of
virus particle aggregation and release. influenza (fever, headache, myalgia, cough, sore
Adverse Reactions/Side Effects throat) before administration. Determine dura-
Resp: bronchospasm. tion of symptoms. Indicated for clients who have
been symptomatic for up to 2 days.
Keep in Mind
Teach client:
• Take exactly as directed and finish entire 5-day
course, even if feeling better. Follow instructions
for the use of the Diskhaler. Client education
pamphlet accompanies the inhaler.
• This medication is not a substitute for a flu shot.
Uploaded
Route/Dosage: Zanamivir: Inhaln/10 mg (2 inhalations by Oseltamivir:
of 5 mg each), MEDBOOKSVN.ORG
PO/75 mg bid (treatment), 75 mg daily (prevention)
1882_Tab04_066-096 11/10/12 2:39 PM Page 91
Immune System Drugs Nucleoside Reverse Transcriptase Inhibitors (NRTI) 91
Abacavir Didanosine
(ah-back-ah-veer) (dye-dan-oh-seen)
Ziagen ddI, Dideoxyinosine,

Videx, Videx EC
Lamivudine Zidovudine
(la-mi-vyoo-deen) (zye-doe-vyoo-deen)
Epivir, Epivir HBV, AZT, Retrovir

3TC Apo-Zidovudine
1882_Tab04_066-096 11/10/12 2:39 PM Page 91
Immune System Drugs Nucleoside Reverse Transcriptase Inhibitors (NRTI) 91

Therapeutic/Pharmacologic Class • Always use a condom, and avoid sharing needles
Antiretroviral/nucleoside reverse transcriptase or donating blood.
inhibitors (NRTI) • Report any signs of allergic reaction.
Indications • Maintain appointments for regular follow-up
Management of HIV infection (AIDS) in combination examinations and blood counts.
with other antiretrovirals. Combining antiretrovirals
prevents the development of resistant strains. See Make the Connection
special combination regimens in drug guide.
• Assess client for change in severity of HIV
Action symptoms and for symptoms of opportunistic
Inhibits the activity of HIV-1 reverse transcriptase, infections throughout therapy.
interfering with the order of transcription, which in • Assess for signs of hypersensitivity reactions.
turn terminates viral DNA growth. • Monitor LFT, serum glucose, lipid panel, and
Adverse Reactions/Side Effects serum lactate levels.
CNS: headache, insomnia. GI: hepatotoxicity, • Monitor viral load and CD4 cell count regularly
diarrhea, nausea, vomiting, anorexia. Derm: during therapy. Chart on a graph to show
rashes. F and E: lactic acidosis. Misc: hypersen- progress (encourages compliance).
sitivity reactions. • Monotherapy with zidovudine is used during
pregnancy.
Keep in Mind • Initial combination therapy usually includes two
Teach client: NRTIs and one protease inhibitor.
• Take medications as directed.
Route/Dosage: Abacavir: PO/300 mg bid, Didanosine: PO/400 mg daily (EC), Lamivudine: PO/300 mg daily, Zidovudine: PO/300 mg bid; IV/1 mg/kg
infused over 1 hr q 4 hr Uploaded by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 92
Immune System Drugs Protease Inhibitors 92
Ritonavir Saquinavir
(ri-toe-na-veer) (sa-kwin-a-veer)
Norvir Invirase
Darunavir Nelfinavir
(da-ru-na-veer) (nell-finn-a-veer)
Prezista Viracept
1882_Tab04_066-096 11/10/12 2:39 PM Page 92
Immune System Drugs Protease Inhibitors 92

Therapeutic/Pharmacologic Class MS: increased creatine phosphokinase, myalgia.
Antiretroviral/protease inhibitors Neuro: circumoral paresthesia, peripheral pares-
Indications thesia. Misc: hypersensitivity reactions, including
Treatment of HIV infection (with other antiretrovirals). Stevens-Johnson syndrome and anaphylaxis; fat
redistribution; fever.
Action
Inhibits the action of HIV protease, which acts like Keep in Mind
scissors that cut the DNA chain to appropriate Teach client:
length. Without the HIV protease, the chain is • Take exactly as directed.
sensed as abnormal and is terminated. • Use condoms; do not share needles or donate
Adverse Reactions/Side Effects blood.
CNS: seizures, abnormal thinking, weakness, • Sex with another HIV-positive person may result
dizziness, headache, malaise, somnolence, in spread of different strains of HIV.
syncope. EENT: pharyngitis, throat irritation. • Smoking may interfere with the drug.
Resp: angioedema, bronchospasm. CV: ortho- • Redistribution of body fat may occur.
static hypotension, vasodilation. GI: abdominal
pain, altered taste, anorexia, diarrhea, nausea,
vomiting, constipation, dyspepsia, flatulence. Make the Connection
GU: renal insufficiency. Derm: rash, skin erup- • Monitor viral load and CD4 counts.
tions, sweating, urticaria. Endo: hyperglycemia. • Monitor LFT, CPK, lipid panel, serum uric acid,
F and E: dehydration. Metab: hyperlipidemia. and serum glucose levels.
Route/Dosage: Ritonavir: PO/600 mg bid (maintenance), Saquinavir: PO/600 mg tid within 2 hr of a meal, Darunavir: PO/600 mg/day with
ritonavir (100 mg), Nelfinavir: PO/1250 mg bid
1882_Tab04_066-096 11/10/12 2:39 PM Page 93
Immune System Drugs Nonnucleoside Reverse Transcriptase Inhibitors

(NNRTIs) 93
Efavirenz Delavirdine
(e-fav-i-renz) (de-la-veer-deen)
Sustiva Rescriptor
Nevirapine Etravirine
(ne-veer-a-peen) (e-tra-veer-een)
Viramune Intelence
Rilpivirine
(ril-pi-vir-een)
Eduant
1882_Tab04_066-096 11/10/12 2:39 PM Page 93
Immune System Drugs Nonnucleoside Reverse Transcriptase Inhibitors

(NNRTIs) 93
Antiretroviral/nonnucleoside reverse transcriptase Teach client:
inhibitor (NNRTI) • Take exactly as directed. Must always be used in
Indications combination with other antiretroviral drugs.
Treatment of HIV infection (in combination with • May cause dizziness, impaired concentration, or
one or more other antiretroviral agents to prevent drowsiness. Avoid activities requiring alertness.
resistance to the medication). • These medications do not cure HIV/AIDS.
Action • Use a condom, do not share needles, and do not
donate blood.
Inhibits HIV reverse transcriptase, which results in
disruption of DNA synthesis. The chain is seen as • Notify HCP immediately if rash occurs.
corrupt and is terminated. • Maintain appointments for regular follow-up.
CNS: abnormal dreams, depression, dizziness, Make the Connection
drowsiness, fatigue, headache, impaired concen- • Assess for rash, especially during first
tration, insomnia, nervousness, psychiatric month of therapy.
symptomatology. GI: nausea, abdominal pain, • Assess client for CNS and psychiatric symptoms.
anorexia, diarrhea, dyspepsia, flatulence. GU: • Monitor LFT, lipid panel, viral load, and CD4 cell
hematuria, renal calculi. Derm: rash, increased count regularly during therapy.
sweating, pruritus. Neuro: hypoesthesia. • May cause false-positive urine cannabinoid
results.
Route/Dosage: Efavirenz: PO/600 mg/day, Delavirdine: PO/400 mg tid, Nevirapine: PO/200 mg bid, Etravirine: PO/200 mg bid, Rilpivirine: PO/25 mg
daily Uploaded by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 94
Immune System Drugs Fusion Inhibitor 94
Enfuvirtide
(en-foo-veer-tide)
Fuzeon
1882_Tab04_066-096 11/10/12 2:39 PM Page 94
Immune System Drugs Fusion Inhibitor 94

Therapeutic/Pharmacologic Class • Does not reduce the risk of transmission of
Antiretroviral/fusion inhibitor HIV to others through sexual contact or blood
Indications contamination. Use a condom, and avoid sharing
Management of HIV infection in combination with needles or donating blood.
other antiretrovirals in patients with evidence of • May cause dizziness.
progressive HIV-1 replication despite ongoing • Notify HCP if pregnancy is planned or suspected,
treatment. or if breastfeeding.
Action • Look for signs of injection site infection.
Prevents entry of HIV-1 into cells by interfering with • Maintain appointments for regular follow-up
examinations and blood counts.
the fusion of the virus with cellular membranes.
CNS: fatigue. EENT: conjunctivitis. Resp: Make the Connection
cough, pneumonia, sinusitis. GI: diarrhea, • Assess patient for change in severity of
nausea, abdominal pain, anorexia, dry mouth, HIV symptoms and for symptoms of opportunis-
pancreatitis, weight loss. Local: injection site tic infections throughout therapy.
reactions. MS: myalgia, limb pain. Misc: • Assess patient for injection site reactions, includ-
hypersensitivity reactions, herpes simplex. ing nodule formation.
• Assess patient for signs and symptoms of pneu-
Keep in Mind monia, especially those with low CD4 cell count
Teach client: and high viral load.
• Learn correct procedure to self-inject medication • Monitor for hypersensitivity reactions.
using return demonstration teaching method. • Monitor viral load and CD4 cell count, CBC, LFT,
RFT, creatinine phosphokinase, and GGT.
Route/Dosage: SC/90 mg bid Uploaded by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 95
Immune System Drugs CCR5 Coreceptor Antagonist 95
Maraviroc
(ma-ra-vi-rok)
Selzentry
1882_Tab04_066-096 11/10/12 2:39 PM Page 95
Immune System Drugs CCR5 Coreceptor Antagonist 95

Antiretrovirals/CCR5 coreceptor antagonist Teach client:
Indications • Discontinue and notify HCP if chest pain, signs
HIV infection (with other antiretrovirals), specifically of hepatotoxicity (itchy rash, yellow-colored skin
in treatment-experienced or treatment-naive clients or eyes, dark urine, vomiting, or abdominal
with CCR5-tropic HIV-1 infection. Use is determined pain), or signs of immune reconstitution syn-
by tropism testing. drome (signs and symptoms of an infection)
occur.
Action
Blocks a specific receptor on CD4 and T-cell • May cause dizziness.
surfaces that prevents CCR5-tropic HIV-1 from • Avoid driving and other activities requiring alert-
ness until response to medication is known.
entering the cell.
• Make position changes slowly to minimize pos-
Adverse Reactions/Side Effects tural hypotension.
CNS: dizziness. CV: myocardial ischemia/
infarction, orthostatic hypotension. Resp:
• Do not take any herbal or OTC medication with-
out notifying the HCP.
cough, upper respiratory tract infection.
GI: abdominal pain, appetite disorder, hepato-
toxicity. Derm: rash. MS: musculoskeletal Make the Connection
pain. Misc: allergic reactions, fever, immune • Assess for signs of hepatitis or allergic
reconstitution syndrome, ↑ risk of infection. reaction.
• Monitor LFT, total bilirubin, absolute neutrophil
count, amylase, and lipase.
• Monitor viral load and CD4 cell count for
improvement.
Route/Dosage: PO/50 mg bid Uploaded by • Monitor for opportunistic infection.
MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 96
Immune System Drugs Integrase Strand Transfer Inhibitor (INSTI) 96
Raltegravir
(ral-teg-ra-veer)
Isentress
1882_Tab04_066-096 11/10/12 2:39 PM Page 96
Immune System Drugs Integrase Strand Transfer Inhibitor (INSTI) 96

Therapeutic/Pharmacologic Class essential (condoms). Needles should not be
Antiretrovirals/integrase strand transfer inhibitor shared.
(INSTI) • Notify the HCP immediately if depressive or
Indications suicidal thoughts occur.
HIV-1 infection (with other antiretrovirals) in • Women must notify HCP if a pregnancy is
treatment-experienced or treatment-naive clients. suspected. Breastfeeding should be avoided.
Action • Periodic laboratory visits are required to monitor
progress.
Inhibits HIV-1 integrase, which is required for viral
replication.
CNS: suicidal thoughts, headache, depression, • Monitor for anxiety, depression, suicidal
dizziness, fatigue, weakness. CV: MI. GI: ideation, and paranoia.
diarrhea, abdominal pain, gastritis, hepatitis, • Monitor viral load, CD4 cell count, absolute
vomiting. GU: renal failure/impairment. neutrophil count, CBC, serum glucose (↑), LFT,
Hemat: anemia, neutropenia. Metabolic: GGT, total bilirubin, alkaline phosphatase, pan-
lipodystrophy. Misc: hypersensitivity reactions, creatic amylase, serum lipase, and creatinine
immune reconstitution syndrome, fever. kinase concentrations.
Keep in Mind
Teach client:
• This drug does not prevent spread of HIV to
others, thus caution during sexual contact is
Route/Dosage: PO/400 mg bid Uploaded by MEDBOOKSVN.ORG

MUSCULOSKELETAL
Cyclobenzaprine, 97 Alendronate, 100 Calcitonin (salmon), 102

Metaxolone, 97 Ibandronate, 100 Denosumab, 103
Baclofen, 97 Etidronate, 100 Teriparitide, 104
Carisoprodol, 97 Zoledronic Acid, 100 Celecoxib, 105
Dantrolene, 98 Risedronate, 100 Colchicine, 106
Edrophonium, 99 Raloxifene, 101 Allopurinol, 107
Pyridostigmine, 99 Toremefine, 101 Abatecept, 108
Neostigmine, 99 Tamoxifen, 101
1882_Tab05_097-108 10/10/12 12:48 PM Page 97
Musculoskeletal System Drugs Centrally Acting Skeletal Muscle Relaxants 97
Cyclobenzaprine Baclofen
(sye-kloe-ben-za-preen) (bak-loe-fen)
Flexeril, Amrix Lioresal
Metaxolone Carisoprodol
(me-tax-a-lone) (kar-i-sop-roe-dole)
Skelaxin Soma, Vanadom

1882_Tab05_097-108 10/10/12 12:48 PM Page 97
Musculoskeletal System Drugs Centrally Acting Skeletal Muscle Relaxants 97

Therapeutic: skeletal muscle relaxants (centrally Teach client:
acting) • Take medication exactly as directed.
Indications • Medication may cause drowsiness, dizziness, and
Management of acute, painful MS conditions blurred vision. Avoid activities requiring alertness.
associated with muscle spasm. Unlabeled uses: • Do not use alcohol or other CNS depressants
Management of fibromyalgia. One in this class may with this medication.
also be used for treatment of reversible spasticity due • Take with food to decrease stomach irritation.
to multiple sclerosis or spinal cord lesions (IT adminis- • Increase fluid intake and bulk in diet to decrease
tration) and PO to treat pain in trigeminal neuralgia. likelihood of constipation.
Action • Report symptoms of urinary retention.
Reduces tonic somatic muscle activity at the level • Use good oral hygiene and sugarless gum or
candy for dry mouth.
of the brainstem. Structurally similar to tricyclic
antidepressants. One in this class inhibits reflexes • Do not discontinue therapy abruptly.
at the spinal level.
CNS: dizziness, drowsiness, confusion, fatigue, • It is important to remember the CNS
headache, nervousness. EENT: dry mouth, depression associated with these drugs.
blurred vision. CV: arrhythmias. GI: constipation, • Assess client for improvement in pain or spasticity.
dyspepsia, nausea, unpleasant taste. GU: urinary • Almost all drugs used for MS illness are GI irritants.
retention. Neuro: ataxia (seizures [IT]). Metab:
hyperglycemia, weight gain. Misc: Hypersensitivity
reactions, sweating.
Uploaded
Route/Dosage: Cyclobenzaprine: PO/10 mg tid, bytid, MEDBOOKSVN.ORG
Baclofen: PO/5 mg Metaxolone: PO/800 mg 3–4 times/day, Carisoprodol: PO/250–350 qid
1882_Tab05_097-108 10/10/12 12:48 PM Page 98
Musculoskeletal System Drugs Direct-Acting Skeletal Muscle Relaxant 98
Dantrolene
(dan-troe-leen)
Dantrium
1882_Tab05_097-108 10/10/12 12:48 PM Page 98
Musculoskeletal System Drugs Direct-Acting Skeletal Muscle Relaxant 98

Therapeutic/Pharmacologic Class impotence, incontinence, nocturia. Derm: pruri-
Skeletal muscle relaxant (direct acting)/hydantoin tus, sweating, urticaria. Hemat: eosinophilia.
derivative Local: irritation at IV site, phlebitis. MS: myalgia.
Indications Misc: chills, drooling, fever.
PO: Treatment of spasticity associated with spinal
Keep in Mind
cord injury, stroke, cerebral palsy, and multiple scle-
Teach client:
rosis. Prophylaxis of malignant hyperthermia. IV:
Emergency treatment of malignant hyperthermia. • May cause dizziness, drowsiness, visual distur-
bances, and muscle weakness.
Action • Avoid taking alcohol or other CNS depressants
Acts directly on skeletal muscle, causing relaxation concurrently with this medication.
by decreasing Ca+ release from sarcoplasmic reticulum • Wear sunscreen.
in muscle cells. Prevents intense catabolic process
associated with malignant hyperthermia.
CNS: drowsiness, muscle weakness, confusion, • Assess bowel function for diarrhea.
dizziness, headache, insomnia, malaise, nervous- • Assess neuromuscular status to establish a
ness. EENT: excessive lacrimation, visual distur- baseline before initiating therapy.
bances. Resp: pleural effusions. CV: changes in • On the day of administration, assess gag reflex
BP, tachycardia. GI: hepatotoxicity, diarrhea, and have client “dry swallow” to see the rise of the
anorexia, cramps, dysphagia, GI bleeding, larynx prior to giving food.
vomiting. GU: crystalluria, dysuria, frequency,
Route/Dosage: PO/25–100 mg daily, increasedUploaded by

gradually; IV/1 mg/kg MEDBOOKSVN.ORG
up to a maximum of 10 mg/kg for malignant hyperthermia
1882_Tab05_097-108 10/10/12 12:48 PM Page 99
Musculoskeletal System Drugs Anticholinesterases (Cholinergics) 99
Edrophonium Neostigmine
(e-droh-fone-ee-yum) (nee-oh-stig-meen)
Enlon, Tensilon Prostigmin
Pyridostigmine
(peer-id-oh-stig-meen)
Mestinon, Mestinon Timespan, Regonol

Mestinon SR
1882_Tab05_097-108 10/10/12 12:48 PM Page 99
Musculoskeletal System Drugs Anticholinesterases (Cholinergics) 99

Therapeutic/Pharmacologic Class cramps, diarrhea, dysphagia, excess salivation,
Antimyasthenic/anticholinesterase; cholinergics vomiting, nausea. GU: incontinence, urinary
Indications frequency. Derm: sweating, rashes. MS:
Diagnosis of myasthenia gravis. Assessment of fasciculation.
adequacy of anticholinesterase therapy in myasthenia
gravis. Differentiating myasthenic from cholinergic
Keep in Mind
Teach client:
crisis. Reversal of muscle paralysis from nondepo-
larizing neuromuscular blocking agents. Other agents • Wear a Medic-Alert bracelet.
in this class increase muscle strength in symptomatic • Take medication exactly as directed.
treatment of myasthenia gravis and prevent and • Lifelong treatment will be required.
treat postoperative bladder distention/urinary • Space activities to avoid fatigue.
retention or ileus.
Inhibits the breakdown of acetylcholine by acetyl- • To differentiate myasthenic from cholinergic
cholinesterase in the neural synapse, resulting in a crisis, assess for increased cholinergic symptoms
prolonged effect. Cause muscular contraction. (SLUDGE—salivation, lacrimation, urination,
Adverse Reactions/Side Effects diarrhea, GI distress, emesis).
CNS: seizures, dizziness, dysphasia, dysphonia, • Give exactly when ordered.
weakness. EENT: diplopia, lacrimation, miosis. • Atropine, an anticholinergic, may be used for
Resp: bronchospasm, excess secretions. CV: treatment of cholinergic symptoms.
bradycardia, hypotension. GI: abdominal
Route/Dosage: Edrophonium: IV/2 mg; if no response, administer an additional 8 mg after 45 sec; may repeat test in 30 min, Neostigmine: PO/15 mg
q 3–4 hr initially, ↑ at daily intervals until optimal response is achieved (usual maintenance dose, 150 mg/day [up to 375 mg/day may be needed]);
SC, IM/0.5 mg, Pyridostigmine: PO/600 mg/day Uploaded by MEDBOOKSVN.ORG
in divided doses (maintenance); IV/2 mg q 2–3 hr
1882_Tab05_097-108 10/10/12 12:48 PM Page 100
Musculoskeletal System Drugs Biphosphonates 100
Alendronate Etidronate
(a-len-drone-ate) (eh-tih-droe-nate)
Fosamax, Binosto Didronel
Ibandronate Zoledronic Acid

(i-ban-dro-nate) (zoe-led-dron-ic as-id)
Boniva Reclast, Zometa
Risedronate
(riss-ed-roe-nate)
Actonel/Atelvia
1882_Tab05_097-108 10/10/12 12:48 PM Page 100
Musculoskeletal System Drugs Biphosphonates 100

Therapeutic/Pharmacologic Class perversion, vomiting. Derm: erythema, photosen-
Bone resorption inhibitors/biphosphonates sitivity, rash. MS: musculoskeletal pain. Immune:
Indications (IV Reclast) pyrexia. F and E: hypocalcemia,
Treatment and prevention of postmenopausal hypophosphatemia, hypomagnesia, hypokalemia.
osteoporosis and osteoporosis in men, Paget’s
Keep in Mind
disease of the bone, corticosteroid-induced osteo-
Teach client:
porosis in clients (men and women) who are
receiving 7.5 mg of prednisone/day (or equivalent) • Take the medication first thing in the morning,
30 min before other medications, beverages, or
with evidence of decreased bone mineral density,
food, and remain upright.
and treatment of hypercalcemia of malignancy.
Action
• Consult HCP about the need for calcium and vita-
min D supplements.
Inhibits resorption of bone by inhibiting osteoclast • Engage in weight-bearing exercise.
activity.
CNS: headache. EENT: blurred vision, conjunc- Make the Connection
tivitis, eye pain/inflammation. GI: abdominal • Assess Ca+ and phosphate levels for
distention, abdominal pain, acid reflux and baseline and during therapy.
esophageal ulceration, constipation, diarrhea, • Give this medication separately from other
gastritis, dysphagia, flatulence, nausea, taste medications and food.
Route/Dosage: Alendronate: PO/5–10 mg once daily or 35–75 mg weekly; alendronate effRx: PO/70 mg/wk, Etidronate: PO/5–10 mg/kg/day single
dose (hip replacement, 20 mg/kg/day for 1 mo before and 3 mo after surgery; spinal injury, 20 mg/kg/day for 2 wk, then decreased to 10 mg/kg/day
for 10 wk), Ibandronate: PO/2.5 mg once daily, or 150 mg once monthly; IV/3 mg every 3 mo, Zoledronic acid: IV/(Reclast) 5 mg once yearly for
prevention of osteoporosis; (Zometa) 4 mg for hypercalcemia due to malignancy may be repeated after 7 days; (multiple myeloma and bone metas-
tases from solid tumors) 4 mg q 3–4 wk (has been used for up to 15 mo), Risedronate: PO/(Actonel) 5 mg daily, 75 mg bimonthly, or 150 mg
monthly; (Atelvia) 35 mg/wk Uploaded by MEDBOOKSVN.ORG
1882_Tab05_097-108 10/10/12 12:48 PM Page 101
Musculoskeletal System Drugs Selective Estrogen Receptor Modulators 101
Raloxifene Tamoxifen
(ra-lox-i-feen) (ta-mox-i-fen)
Evista Alpha-Tamoxifen,
Novo-Tamoxifen
Toremefine
(tore-em-i-feen)
Fareston
1882_Tab05_097-108 10/10/12 12:48 PM Page 101
Musculoskeletal System Drugs Selective Estrogen Receptor Modulators 101

Therapeutic/Pharmacologic Class vaginal bleeding. F and E: hypercalcemia.
Bone resorption inhibitor; antineoplastic (tamoxifen)/ Hemat: leukopenia, thrombocytopenia.
selective estrogen receptor modulators (SERM) Metab: hot flashes. Misc: tumor flare.
Treatment and prevention of osteoporosis in post-
Teach client:
menopausal women and adjuvant therapy of breast
cancer after surgery and radiation (delays recurrence). • Take as directed; bone pain should be reported.
Palliative or adjunctive treatment of advanced • Engage in regular weight-bearing exercise.
breast cancer. Prevention of breast cancer in high- • Report leg pain (DVT).
risk clients. • May cause hot flashes or induce ovulation.
Action
• Monitor weight weekly. Report weight gain.
Binds to estrogen receptors, producing estrogen-
like effects on bone, resulting in reduced resorption Make the Connection
of bone and decreased bone turnover. Competes • Assess client for bone mineral density.
for estrogen-binding sites in the breast, reducing • Monitor lipid panel; hormone panel; and serum
estrogen response. Ca+, phosphate, total protein, and albumin.
Adverse Reactions/Side Effects • Monitor CBC for a decrease in platelet count.
MS: leg cramps, bone pain. CNS: confusion, • Discuss the Study of Tamoxifen and Raloxifene
depression, headache, weakness. EENT: blurred (STAR) clinical trial, which compared these SERMs
vision. CV: pulmonary embolism, stroke, edema. for effectiveness in prevention and postsurgical
GI: nausea, vomiting. GU: uterine malignancies, treatment of breast cancer.
Route/Dosage: Raloxifene: PO/60 mg daily, Tamoxifen: PO/20 mg daily for osteoporosis; 20 mg daily for 5 yr for prevention of breast cancer,
Toremefine: PO/60 mg daily Uploaded by MEDBOOKSVN.ORG
1882_Tab05_097-108 10/10/12 12:48 PM Page 102
Musculoskeletal System Drugs Hormone 102
Calcitonin (salmon)
(kal-si-toe-nin)
Miacalcin, Fortical
1882_Tab05_097-108 10/10/12 12:48 PM Page 102
Musculoskeletal System Drugs Hormone 102

Hypocalcemic agent/hormone Teach client:
Indications • Take medication exactly as directed.
Treatment of Paget’s disease of bone. Adjunctive • Report allergy to salmon or other seafood.
therapy for hypercalcemia. Management of post- • Flushing and warmth may occur (1 hr).
menopausal osteoporosis. Treatment of hypercal- • Diet should be high in calcium and vitamin D.
cemia related to bone cancer. • Alternate nares daily when using nasal spray to
avoid nosebleeds.
Action
Decreases Ca+ by a direct effect on bone, kidney, • Weight-bearing exercise is beneficial for treatment
of osteoporosis.
and GI tract. Promotes renal excretion of Ca+.
Routes include intranasally, IM, and SC.
CNS: headaches. EENT: intranasal only—epistaxis, • Observe client for signs of hypersensitivity.
nasal irritation, rhinitis. GI: nausea, vomiting, • Assess for tetany, monitor the ECG, and check for
altered taste, diarrhea. GU: urinary frequency. Chvostek’s and Trousseau’s signs.
Derm: rashes. Local: injection site reactions. • Monitor Ca+ levels (9–10.5 mg/dL).
MS: arthralgia, back pain. Misc: allergic reactions, • Ask the client to report nasal irritation.
including anaphylaxis, facial flushing; swelling,
tingling, and tenderness in the hands.
Uploaded
Route/Dosage: Calcitonin (rDNA): IM, SC/100 byintranasal/1
units every other day; MEDBOOKSVN.ORG
spray (200 units)/day
1882_Tab05_097-108 10/10/12 12:48 PM Page 103
Musculoskeletal System Drugs Monoclonal Antibody (RANKL Inhibitor) 103
Denosumab
(de-no-su-mab)
Prolia
1882_Tab05_097-108 10/10/12 12:48 PM Page 103
Musculoskeletal System Drugs Monoclonal Antibody (RANKL Inhibitor) 103

Bone resorption inhibitor/monoclonal antibody; • Notify HCP immediately of spasms, twitches, or
RANKL inhibitor cramps in muscles; numbness or tingling in fin-
Indications gers, toes, or around mouth; fever; chills; skin
Treatment of osteoporosis in postmenopausal that is red, swollen, hot, or tender to touch;
women who are at high risk for fracture or those severe abdominal pain; frequent or urgent need
who have failed/are intolerant of conventional to urinate or burning during urination or skin
osteoporosis treatments. rashes.
Action • Have regular dental check-ups.
A monoclonal antibody that binds specifically to • Female clients should notify HCP if pregnancy is
planned or suspected or if breastfeeding.
the human RANKL, inhibiting its action, which is
required for formation, function, and survival of
osteoclasts. Binding inhibits osteoclast formation, Make the Connection
function, and survival. • Contraindicated in lactation and
Adverse Reactions/Side Effects hypocalcemia; caution should be used in pregnancy.
GI: pancreatitis. GU: cystitis. Derm: dermatitis, • Monitor bone density studies.
eczema, rashes. F and E: hypocalcemia. • Assess Ca+, phosphorus, and K+ levels before and
Metabolic: hypercholesterolemia. MS: back periodically during therapy. Hypocalcemia and
pain, extremity pain, musculoskeletal pain, vitamin D deficiency should be treated before
osteonecrosis of the jaw, suppression of bone initiating therapy. Increases risk for anemia and
turnover. Misc: infection. ↑ cholesterol.
Route/Dosage: SC/60 mg every 6 mo Uploaded by MEDBOOKSVN.ORG

1882_Tab05_097-108 10/10/12 12:48 PM Page 104
Musculoskeletal System Drugs Human Parathyroid Hormone (rDNA Origin) 104
Teriparitide
(ter-i-par-a-tide)
Forteo
1882_Tab05_097-108 10/10/12 12:48 PM Page 104
Musculoskeletal System Drugs Human Parathyroid Hormone (rDNA Origin) 104

Hormone/human parathyroid hormone (rDNA • Administer medication at the same time each day.
origin) Administer missed doses as soon as remembered
Indications that day. Do not take more than 1 injection/day.
Treatment of osteoporosis in postmenopausal Learn how to prime pen and deliver appropriate
women at high risk for fractures. Increases bone dosage.
mass in men with primary or hypogonadal osteo- • Be aware of the importance of other treatments
porosis at high risk for fractures. Treatment of for osteoporosis, including supplemental calcium
osteoporosis in men and women with glucocorticoid- and/or vitamin D, weight-bearing exercise, and
induced osteoporosis at high risk for fractures. modification of behavioral factors (smoking
Most useful for those who have failed or are and/or alcohol consumption). Appointments for
intolerant of other osteoporosis therapies. follow-up bone density scans and laboratory visits
must be kept.
Action
Regulates Ca+ and phosphate metabolism in bone • May be lightheaded at first. Rise slowly and sit at
edge of bed until stable to prevent falls.
and kidney by binding to specific cell receptors;
stimulates osteoblastic activity. Increases Ca+ and • Notify HCP of nausea, vomiting, constipation,
and muscle weakness (hypercalcemia).
decreases serum phosphorus. Overall effect is to
strengthen bones and prevent fractures.
CV: orthostatic hypotension. MS: muscle • Contraindicated in pregnancy, lactation,
spasms. Paget’s disease, and ↑ alkaline phosphatase.
• Monitor bone density studies and for ↑ Ca+ and
↑ uric acid levels.
Uploaded
Route/Dosage: SC/20 mcg once daily (multidose pen) by MEDBOOKSVN.ORG
1882_Tab05_097-108 10/10/12 12:48 PM Page 105
Musculoskeletal System Drugs Cyclooxygenase-2 (COX-2) Inhibitor 105
Celecoxib
(sel-e-kox-ib)
Celebrex
1882_Tab05_097-108 10/10/12 12:48 PM Page 105
Musculoskeletal System Drugs Cyclooxygenase-2 (COX-2) Inhibitor 105

Antirheumatic, NSAID/cyclooxygenase-2 (COX-2) Teach client:
inhibitor • Do not take this drug if a history of high BP or
Indications heart failure exists.
Relief of signs and symptoms of osteoarthritis, RA, • Do not take this drug if a history of stomach
and ankylosing spondylitis. Reduction of the number ulcers and GI bleeding exists.
of adenomatous colorectal polyps in familial • Report a rash immediately.
adenomatous polyposis (FAP), as an adjunct to • Report nausea, fatigue, lethargy, itching, jaundice,
usual care (endoscopic surveillance, surgery). upper right-quadrant tenderness, flu-like symptoms,
Management of acute pain, including primary or edema.
dysmenorrhea. • Watch for signs of GI bleeding (stomach pain;
black-red, tarry, odorous stools).
Action
Inhibits the enzyme COX-2, which is required for • Do not take this drug if an allergy to sulfonamides,
aspirin, or other NSAIDs exists.
the synthesis of prostaglandins. Has analgesic,
anti-inflammatory, and antipyretic properties.
CNS: dizziness, headache, insomnia. CV: MI, • Monitor BP and for signs of heart failure.
CVA, edema. GI: GI bleeding, abdominal pain, This drug has been implicated in the development
diarrhea, dyspepsia, flatulence, nausea. Derm: of MI and CVA.
exfoliative dermatitis, Stevens-Johnson syn- • Respond to development of a rash or GI bleeding
drome, toxic epidermal necrolysis, rash. immediately.
• Assess for effectiveness. Monitor LFT and RFT.
Route/Dosage: PO/100–200 mg daily Uploaded by MEDBOOKSVN.ORG

1882_Tab05_097-108 10/10/12 12:48 PM Page 106
Musculoskeletal System Drugs Antigout Agent 106
Colchicine
(kol-chi-seen)
Colcrys
1882_Tab05_097-108 10/10/12 12:48 PM Page 106
Musculoskeletal System Drugs Antigout Agent 106

Therapeutic/Pharmacologic Class • Report nausea, vomiting, abdominal pain, diar-
Antigout agent rhea, unusual bleeding, bruising, sore throat,
Indications fatigue, malaise, or rash promptly.
Treatment and prevention of acute attacks of gouty • Increase daily fluid intake as directed.
arthritis.
Interferes with the functions of WBCs in initiating • Assess client for toxicity.
and perpetuating the inflammatory response to • An overdose can be fatal. Cumulative dose by
monosodium urate crystals. any route should not exceed 4 mg.
Adverse Reactions/Side Effects • During initiation of therapy, monitor for drug
GI: diarrhea, nausea, vomiting, abdominal pain. response (pain relief in affected area) every 1–2 hr.
GU: anuria, hematuria, renal damage. Derm: • Monitor I&O.
alopecia. Hemat: bone marrow suppression. • Monitor LFT, RFT, chemistries, and CBC with
Local: phlebitis at IV site. Neuro: peripheral differential.
neuritis. • Administer oral doses with food to minimize GI
irritation.
Keep in Mind • Monitor IV site carefully to avoid extravasation.
Teach client:
• Take the medication as directed.
• Do not consume alcohol and maintain dietary
restrictions.
Route/Dosage: PO/1.2 mg initially, then 0.6 mgUploaded by

1 hr later (maximum doseMEDBOOKSVN.ORG
of 1.8 mg in 1 hr)
1882_Tab05_097-108 10/10/12 12:48 PM Page 107
Musculoskeletal System Drugs Xanthine Oxidase Inhibitor 107
Allopurinol
(al-oh-pure-i-nole)
Zyloprim, Lopurin, Alloprim

Apo-Allopurinol
1882_Tab05_097-108 10/10/12 12:48 PM Page 107
Musculoskeletal System Drugs Xanthine Oxidase Inhibitor 107

Therapeutic/Pharmacologic Class • Report skin rash or influenza symptoms to
Antigout and antihyperuricemic agent/xanthine the HCP immediately; this may indicate
oxidase inhibitor hypersensitivity.
Indications • Take with food to minimize GI distress.
Prevention of attacks of gouty arthritis and • Increase daily fluid intake as directed.
nephropathy. Treatment of secondary hyper-
uricemia, which may occur during treatment of Make the Connection
tumors or leukemias.
• Minimum fluid intake for persons being
Action treated for gout is 2500–3000 mL/day.
Inhibits the production of uric acid by inhibiting the • Monitor for clinical signs of toxicity or hypersensi-
action of xanthine oxidase. tivity (vomiting, diarrhea, or rash).
Adverse Reactions/Side Effects • Monitor the CBC with differential, RFT, LFT, and
CNS: drowsiness. GI: diarrhea, hepatitis, nausea, blood glucose.
vomiting. GU: renal failure. Derm: rash, urticaria. • Recent studies have shown that this medication
Hemat: bone marrow suppression. Misc: hyper- combined with colchicine may be more effective
sensitivity reactions. at preventing gouty flare-ups.
Keep in Mind
Teach client:
• Dietary changes must be made (alkaline ash
diet). Alcohol must be avoided to avoid gouty
attacks.

1882_Tab05_097-108 10/10/12 12:48 PM Page 108
Musculoskeletal System Drugs Fusion Protein 108
Abatecept
(a-bat-a-sept)
Orencia
1882_Tab05_097-108 10/10/12 12:48 PM Page 108
Musculoskeletal System Drugs Fusion Protein 108

Therapeutic/Pharmacologic Class • Notify HCP if upper respiratory or other infec-
Antirheumatics/fusion protein tions occur. Therapy may need to be discontinued
Indications if serious infection occurs.
Reduction of signs/symptoms and disease progres-
sion in moderate to severely active RA in adults Make the Connection
(to be used as monotherapy or in with other
DMARDs, other than TNF inhibitors). • Assess range of motion, degree of swelling,
and pain in affected joints before and periodically
Action during therapy.
Inhibits T-cell activation (and the inflammatory
process) by binding to specific receptors.
• Assess for infusion-related reaction (dizziness,
headache, HTN) and signs of allergic reaction
Adverse Reactions/Side Effects (hypotension, urticaria, dyspnea). Infusion-related
CNS: headache, dizziness. Misc: Hypersensitivity reactions usually occur within 1 hr of start of
reactions including anaphylaxis, infections, infusion. Keep epinephrine, an antihistamine,
infusion-related events. and resuscitation equipment close by in case of
an anaphylactic reaction.
Keep in Mind • Assess for latent TB with a tuberculin skin test.
Teach client: Treat TB infection before starting this drug.
• Do not receive live vaccines during, or 3 mo following, Screen for the presence of hepatitis, as this drug
therapy. may reactivate the illness.
• Methotrexate, analgesics, NSAIDs, corticosteroids, • Remember: This drug decreases inflammation
and salicylates may be continued during therapy. and the immune response, thus monitor closely
for infection and report signs and symptoms to
HCP immediately.
Route/Dosage: IV/500–1000 mg monthly (by Uploaded
weight) by MEDBOOKSVN.ORG
CENTRAL NERVOUS SYSTEM
Tramadol, 109 Phenobarbital, 115 Lamotrigine, 125

Fentanyl Secobarbital, 115 Lacosamide, 125
(transdermal), 110 Midazolam, 116 Divalproex, 126
Oxycodone/ Zolpidem, 117 Valproate Sodium, 126
Acetaminophen, 111 Eszopiclone, 117 Valproic Acid, 126
Hydrocodone/ Ramelteon, 118 Selegiline, 127
Ibuprofen, 111 Levetiracetam, 119 Selegiline
Hydrocodone/ Gabapentin, 120 Transdermal, 127
Acetaminophen, 111 Topiramate, 120 Rasagiline, 127
Meperidine, 112 Tiagabine, 120 Ropinirole, 128
Hydromorphone, 112 Pregabalin, 120 Pramipexole, 128
Morphine, 112 Carbamazepine, 121 Amantadine, 129
Tapentadol, 112 Oxcarbazepine (carba- Bromocriptine, 130
Naloxone, 113 mazepine analogue), 121 Tolcapone, 131
Nalmefene, 113 Phenytoin, 122 Entacapone, 131
Naltrexone, 113 Fosphenytoin, 122 Carbidopa/Levodopa, 132
Propofol, 114 Primidone, 123 Benztropine, 133
Pentobarbital, 115 Ethosuximide, 124 Trihexyphenidyl, 133
Continued
CENTRAL NERVOUS SYSTEM
Donepezil, 134 Duloxetine, 140 Ergotamine, 150

Rivastigmine, 134 Desipramine, 141 Dihydroergotamine, 150
Galantamine, 134 Imipramine, 141 Sibutramine, 151
Tacrine, 134 Nortriptyline, 141 Methylphenidate, 152
Alprazolam, 135 Clomipramine, 141 Dexmethylphenidate, 152
Clonazepam, 135 Phenelzine, 142 Amphetamine, 153
Diazepam, 135 Isocarboxazid, 142 Atomoxetine, 154
Lorazepam, 135 Tranylcypromine, 142 Modafinil, 155
Buspirone, 136 Haloperidol, 143 Almotriptan, 156
Fluoxetine, 137 Droperidol, 143 Rizatriptan, 156
Fluvoxamine, 137 Chlorpromazine, 144 Sumatriptan, 156
Citalopram, 137 Perphenazine, 144 Naratriptan, 156
Paroxetine, 137 Fluphenazine, 144 Epinephrine, 157
Escitalopram, 137 Thiothixene, 145 Terbutaline, 158
Lithium, 138 Aripiprazole, 146 Butorphanol, 159
Bupropion, 139 Risperidone, 147 St. John’s Wort
Venlafaxine, 140 Olanzapine, 148 (Hypericum
Desvenlafaxine, 140 Ziprasidone, 149 perforatum), 160
1882_Tab06_109-160 11/10/12 2:39 PM Page 109
Central Nervous System Drugs Opioids 109
Tramadol
(tra-ma-dol)
Ultram, Ultram ER, Ryzolt

Ralivia
1882_Tab06_109-160 11/10/12 2:39 PM Page 109
Central Nervous System Drugs Opioids 109

Centrally acting analgesic/opioid Teach client:
Indications • Ask for pain medication before the pain becomes
Treatment of moderate to moderately severe pain. severe.
Action • This drug may cause dizziness and drowsiness.
Binds to mu-opioid receptors, but has low affinity. • Change position slowly from lying to sitting or
standing.
Inhibits reuptake of serotonin and norepinephrine
in the CNS, which decreases stimulation of • Avoid concurrent use of alcohol or other CNS
depressants with this medication.
nociceptors.
• Report use of antidepressant medications.
CNS: seizures, serotonin sickness, dizziness,
headache, somnolence, anxiety, CNS stimula- Make the Connection
tion, confusion, coordination disturbance, • Assess pain relief objectively.
euphoria, malaise, nervousness, sleep disorder, • Assess for BP and respiratory rate changes.
weakness. EENT: visual disturbances. CV: • Assess bowel function routinely (constipation).
vasodilation. GI: constipation, nausea, • Monitor client for seizures. Risk ↑ with higher
abdominal pain, anorexia, diarrhea, dry doses.
mouth, dyspepsia, flatulence, vomiting. GU: • Monitor LFT, RFT, CBC for hemoglobin level, and
menopausal symptoms, urinary retention/ urinalysis for proteinuria.
frequency. Derm: pruritus, sweating. Neuro: • Medication causes↑ risk of serotonin syndrome
hypertonia. Misc: physical dependence, when used with SSRI or SNRI antidepressants,
psychological dependence, tolerance. TCAs, MAOIs, or 5-hydroxytryptamine1 agonists.
Route/Dosage: PO/50–100 mg q 4–6 hr Uploaded by MEDBOOKSVN.ORG

1882_Tab06_109-160 11/10/12 2:39 PM Page 110
Central Nervous System Drugs Opioid Agonist 110
Fentanyl
(transdermal)
(fen-ta-nil)
Duragesic
1882_Tab06_109-160 11/10/12 2:39 PM Page 110
Central Nervous System Drugs Opioid Agonist 110

Opioid analgesic; analgesic adjunct/opioid agonists Teach client:
Indications • Fatalities have occurred from children having
Treatment of moderate-to-severe chronic pain access to improperly discarded patches.
requiring continuous opioid analgesic therapy for • May be worn while bathing, showering, or swimming.
an extended time. This transdermal analgesic is • May cause drowsiness or dizziness.
not recommended for the control of postoperative, • Change positions slowly to minimize dizziness.
mild, or intermittent pain, nor should it be used for • Avoid concurrent use of alcohol or other CNS
short-term pain relief. depressants with this medication.
Action • Good oral hygiene and use of sugarless gum or
candy may decrease dry mouth.
Binds to opiate receptors in the CNS, altering the
response to and perception of pain.
CNS: confusion, sedation, weakness, dizziness, • Objectively assess pain and record client
restlessness. Resp: apnea, bronchoconstriction, response.
laryngospasm, respiratory depression. CV: brady- • Assess bowel function routinely for constipation.
cardia. GI: anorexia, constipation, dry mouth, • Monitor plasma amylase and lipase levels.
nausea, vomiting. Derm: sweating, erythema. • Naloxone (Narcan) is the antidote.
Local: application site reactions. MS: skeletal • Discontinue gradually.
and thoracic muscle rigidity. Misc: physical • Apply to nonhairy areas. Change after 72 hours.
dependence, psychological dependence. • Full effectiveness takes several hours as system
begins to release the medication, thus current pain
medications should be titrated down accordingly.
Route/Dosage: Transdermal system/12.5–100Uploaded by based
mcg/hr (calculate need MEDBOOKSVN.ORG
on equianalgesic guidelines if on morphine)
1882_Tab06_109-160 11/10/12 2:39 PM Page 111
Central Nervous System Drugs Opioid Agonists and Nonopioid

Analgesic Combinations 111
Oxycodone/ Hydrocodone/
Acetaminophen Acetaminophen
(ox-i-koe-done/ (hye-droe-koe-done/
a seet-a-min-oh-fen) a-seet-a-min-oh-fen)
Percocet, Tylox, Lorcet, Lortab,

Endocet, Roxycet, Vicodin, Anexsia
Magnacet
Hydrocodone/Ibuprofen
(hye-droe-koe-done/eye-byoo-proe-fin)
Vicoprofen, Reprexain, Ibudone

1882_Tab06_109-160 11/10/12 2:39 PM Page 111
Central Nervous System Drugs Opioid Agonists and Nonopioid

Analgesic Combinations 111
Opioid analgesic/opioid agonists and nonopioid Teach client:
combinations • Take as directed.
Indications • Addition of acetaminophen increases the risk of
Management of moderate-to-severe pain. liver and renal damage.
Action • Ask for analgesic before pain becomes severe, to
Binds to opiate receptors in the CNS. Alters the abort excessive discomfort.
perception of and response to painful stimuli, while • The medication may cause drowsiness or dizziness.
producing generalized CNS depression. • Change positions slowly to minimize dizziness.
Adverse Reactions/Side Effects • Avoid concurrent use of alcohol or other CNS
depressants with this medication.
CNS: confusion, sedation, dysphoria, euphoria,
floating feeling, hallucinations, headache, unusual • Use good oral hygiene and sugarless gum or
candy to decrease dry mouth.
dreams. EENT: blurred vision, diplopia, miosis.
Resp: respiratory depression. CV: hypotension, • Report constipation.
bradycardia. GI: constipation, nausea, vomiting.
GU: urinary retention. Derm: sweating. Misc: Make the Connection
physical dependence, psychological dependence, • Pain level should be assessed objectively.
tolerance. • Monitor plasma amylase and lipase concentrations.
• Naloxone (Narcan) is the antidote.
• Discontinue gradually after long-term use.
• Administer with food or milk to minimize GI
irritation.
Route/Dosage: Oxycodone/acetaminophen: PO/2.5–10 mg oxycodone in combination with 325–650 mg acetaminophen, Hydrocodone/
acetaminophen: PO/2.5–10 mg hydrocodone in combination with 325–750 mg acetaminophen, Hydrocodone/ibuprofen: PO/2.5–10 mg
hydrocodone in combination with 200 mg ibuprofen
1882_Tab06_109-160 11/10/12 2:39 PM Page 112
Central Nervous System Drugs Opioid Agonists 112
Meperidine Morphine
(me-per-i-deen) (mor-feen)
Demerol Astramorph, MS
Contin, Kadian,
Avinza, Duramorph
Morphine H.P.,
Epimorph
Hydromorphone Tapentadol
(hye-droe-mor-fone) (ta-pen-ta-dol)
Dilaudid, Dilaudid-HP, Nucynta

Exalgo, Hydrostat IR
PMS Hydromorphone
1882_Tab06_109-160 11/10/12 2:39 PM Page 112
Central Nervous System Drugs Opioid Agonists 112

Opioid analgesic/Opioid agonists Teach client:
Indications • Take as directed. Medication is more effective if
Treatment of moderate or severe pain (alone or with taken before the pain is severe.
nonopioid agents). • May cause drowsiness or dizziness.
Action • Change positions slowly to minimize dizziness.
Binds to opiate receptors in the CNS. Alters the • Avoid concurrent use of alcohol or other CNS
perception of and response to painful stimuli, while depressants to minimize risk of respiratory
producing generalized CNS depression. depression.
Adverse Reactions/Side Effects • Report constipation.
CNS: seizures, confusion, sedation, dysphoria,
euphoria, floating feeling, hallucinations, Make the Connection
headache, unusual dreams. EENT: blurred vision, • Use a pain scale to objectively assess pain.
diplopia, miosis. Resp: respiratory depression. • Monitor plasma amylase and lipase concentrations.
CV: hypotension, bradycardia. GI: constipation, • Naloxone (Narcan) is the antidote.
nausea, vomiting. GU: urinary retention. Derm:
flushing, sweating. Misc: physical dependence,
• Discontinue gradually after long-term use to
prevent withdrawal symptoms.
psychological dependence, tolerance. • For direct IV administration, always dilute and
administer over 5 min after checking dose
calculation with second practitioner.
Route/Dosage: Meperidine: PO, SC, IM/50–100 mg q 3–4 hr, Morphine: PO, Rect/30 mg q 3–4 hr; IM, IV, SC/4–10 mg q 3–4 hr; SR/total day’s
dose q 12 hr; epidural/5 mg/day, Hydromorphone: PO/4–8 mg q 3–4 hr; IV, SC, IM/1.5–2 mg q 3–4 hr; continuous infusion/0.2–30 mg/hr; Rect/
3 mg q 6–8 hr, Tapentadol: PO/50–100 mg q Uploaded
4–6 hr by MEDBOOKSVN.ORG
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Central Nervous System Drugs Opioid Antagonists 113
Naloxone Naltrexone
(nal-ox-one) (nal-treks-one)
Narcan Vivitrol (injection),

ReVia (oral)
Nalmefene
(nal-me-feen)
Revex
1882_Tab06_109-160 11/10/12 2:39 PM Page 113
Central Nervous System Drugs Opioid Antagonists 113

Antidote (for opioids)/opioid antagonists Make the Connection
Indications • Monitor respiratory rate, rhythm, and
Reversal of CNS depression and respiratory depres- depth; pulse; ECG; BP; and level of consciousness
sion because of suspected opioid overdosage and frequently for 3–4 hr after administration.
alcohol abuse. Unlabeled uses: Narcotic-induced • If used to treat postoperative respiratory depres-
pruritus (low-dose IV infusion). sion, assess effectiveness, but also remember that
these medications reverse the effects of analgesia.
Action
Competitively blocks the effects of opioids, including
• Assess pain using a pain scale.
CNS and respiratory depression, without producing
• Assess client for signs and symptoms of opioid or
alcohol withdrawal. Symptoms may occur from
any agonist (opioid-like) effects. within a few minutes to 2 hr.
Adverse Reactions/Side Effects • Excessive dose in postoperative patients may
CV: HTN, hypotension, ventricular fibrillation, cause excitement, pain, hypotension, HTN,
VT. GI: nausea, vomiting. pulmonary edema, ventricular tachycardia and
fibrillation, and seizures.
Keep in Mind
Teach client:
• The purpose and effects of these drugs are to
decrease fear of physical symptoms of withdrawal.
• Wear a Medic-Alert bracelet if receiving opioids
for chronic pain.
Route/Dosage: Naloxone: IV/0.02–2 mg q 2–3 min, or as a continuous infusion, until desired response obtained, Naltrexone: PO/50 mg daily after a
Uploaded
negative naloxone challenge and 7–10 days of opioid bymg/mo;
abstinence; IM/380 MEDBOOKSVN.ORG
alcohol dependence: PO/50 mg daily, Nalmefene: IV/0.25–1 mcg/kg
1882_Tab06_109-160 11/10/12 2:39 PM Page 114
Central Nervous System Drugs General Anesthetic 114
Propofol
(proe-poe-fol)
Diprivan
1882_Tab06_109-160 11/10/12 2:39 PM Page 114
Central Nervous System Drugs General Anesthetic 114

General anesthetic Teach client:
Indications • This medication decreases or eliminates mental
Induction of general anesthesia in children older than recall of the procedure.
3 yr and adults. Maintenance of balanced anesthesia • May cause drowsiness or dizziness. Ability to be alert
when used with other agents in children older than may be affected for 24 hr following administration.
2 mo and adults. Initiation and maintenance of mon- • Avoid alcohol or other CNS depressants for 24 hr
itored anesthesia care (MAC). Sedation of intubated, following administration.
mechanically ventilated clients in intensive care units. • The medication will sting and burn when administered.
Action
Short- and rapid-acting (40 sec) sedative-hypnotic. Make the Connection
Mechanism of action is unknown, but because it
is highly lipophilic, it has affinity for CNS tissue.
• Assess respiratory status, pulse, and
BP continuously throughout therapy. Frequently
Produces amnesia, but has no analgesic properties. causes apnea. Maintain patent airway, apply
Adverse Reactions/Side Effects nasal cannula, and maintain adequate ventilation.
CNS: dizziness, headache. Resp: apnea, cough. Endotracheal intubation tray and resuscitation
CV: bradycardia, hypotension, hypertension. GI: equipment should be readily available.
abdominal cramping, hiccups, nausea, vomiting. • Be certain client has maintained NPO status prior
Derm: flushing. Local: burning, pain, stinging, to the procedure.
coldness, numbness, tingling at IV site. MS: • May be administered as an intermittent or
involuntary muscle movements, perioperative continuous infusion for clients on mechanical
myoclonia. GU: discoloration of urine (green). ventilation.
Misc: fever.
Route/Dosage: IV/2–2.5 mg/kg for induction; Uploaded by
100–200 mcg/kg/min MEDBOOKSVN.ORG
for maintenance
1882_Tab06_109-160 11/10/12 2:39 PM Page 115
Central Nervous System Drugs Barbiturates 115
Pentobarbital Secobarbital
(pen-toe-bar-bi-tal) (see-koe-bar-bi-tal)
Nembutal Seconal
Novopentobarb Novosecobarb
Phenobarbital
(fee-noe-bar-bi-tal)
Luminal, Solfoton
Ancalixir
1882_Tab06_109-160 11/10/12 2:39 PM Page 115
Central Nervous System Drugs Barbiturates 115

Therapeutic/Pharmacologic Class Derm: rashes, urticaria. Local: phlebitis at
Anticonvulsant; sedative-hypnotic/barbiturates IV site. MS: arthralgia, myalgia, neuralgia.
Indications Misc: hypersensitivity reactions including
Treatment of insomnia (short term). Preoperative angioedema and serum sickness, physical
sedation and induction of coma in clients with dependence, psychological dependence.
cerebral ischemia and ICP. Treatment of seizures.
Keep in Mind
Action Teach client:
Depresses the CNS, probably by potentiating • Do not discontinue medication abruptly.
GABA, an inhibitory neurotransmitter. Produces all • This medication may cause daytime
levels of CNS depression, including the sensory cor- drowsiness.
tex and motor activity, as well as altered cerebellar • Avoid taking alcohol or other CNS depressants
function. Anticonvulsant effect due to decreased concurrently with this medication.
synaptic transmission and increased seizure threshold.
May decrease cerebral blood flow, cerebral edema,
and intracranial pressure (IV only). Make the Connection
Adverse Reactions/Side Effects • Monitor respiratory status, pulse, and
CNS: drowsiness, hangover, lethargy, delirium, BP frequently.
excitation, mental depression, vertigo. Resp: • Monitor CBC with differential, and LFT and RFT
respiratory depression; IV—laryngospasm, if on long-term therapy.
bronchospasm. CV: IV—hypotension. GI: • May increase need for adjustment of dosage for
constipation, diarrhea, nausea, vomiting. other meds (↑ liver enzymes).
Route/Dosage: Pentobarbital: PO/20 mg 3–4 times daily for sedation; IM/150–200 mg as hypnotic/preoperative sedative; IV/100–500 mg as an
anticonvulsant; IV/5–7 mg/kg for induction of coma, Secobarbital: PO/100–300 mg for sedation or sleep; Phenobarbital: IV/15–18 mg/kg for status
epilepticus; IV, PO/1–3 mg/kg/day for maintenance
1882_Tab06_109-160 11/10/12 2:39 PM Page 116
Central Nervous System Drugs Benzodiazepine 116
Midazolam
(mid-ay-zoe-lam)
Versed
1882_Tab06_109-160 11/10/12 2:39 PM Page 116
Central Nervous System Drugs Benzodiazepine 116

Antianxiety agent; sedative-hypnotic/benzodiazepines Teach client:
Indications • This medication decreases mental recall of the
Promotion of presurgical sedation and anxiolysis in procedure.
pediatric clients (oral). Promotion of presurgical • Drowsiness or dizziness may be experienced for
sedation/anxiolysis/amnesia in adult clients (IM or IV). 24 hr after administration.
Commonly used for conscious sedation. Aids in the • Arrange for someone to provide transportation
induction of anesthesia and as part of balanced anes- home from the procedure.
thesia. Provision of sedation of mechanically ventilated • Avoid alcohol or other CNS depressants for 24 hr
clients in a critical care setting (continuous infusion). following administration.
Action
Acts at many levels of the CNS to produce general- Make the Connection
ized CNS depression. Effects may be mediated by
GABA, an inhibitory neurotransmitter.
• Assess level of sedation and level of
consciousness throughout and for 2–6 hr following
Adverse Reactions/Side Effects administration.
CNS: agitation, drowsiness, excess sedation, • Monitor BP, pulse, respiration, and arterial blood
headache. EENT: blurred vision. Resp: apnea, gas continuously during IV administration. Oxygen
laryngospasm, respiratory depression, bron- should be given by nasal cannula. Resuscitative
chospasm, coughing. CV: cardiac arrest, arrhyth- equipment should be immediately available. Two
mias. GI: hiccups, nausea, vomiting. Derm: practitioners should check dose calculations.
rashes. Local: phlebitis at IV site, pain at IM site. • The antidote is flumazenil (Romazicon).
Uploaded
Route/Dosage: IM/5 mg prior to surgery; IV/1–2.5 by MEDBOOKSVN.ORG
mg initially, increased as needed up to 5 mg, for conscious sedation
1882_Tab06_109-160 11/10/12 2:39 PM Page 117
Central Nervous System Drugs Hypnotics 117
Zolpidem
(zole-pi-dem)
Ambien, Ambien CR, Edluar,

Zolpimist, Intermezzo
Eszopiclone
(es-zop-i-klone)
Lunesta
1882_Tab06_109-160 11/10/12 2:40 PM Page 117
Central Nervous System Drugs Hypnotics 117

Therapeutic/Pharmacologic Class • Avoid concurrent use of alcohol or other CNS
Hypnotic/cyclopyrrolones (eszopiclone only) depressants.
Indications • A bitter taste sensation that may or may not be
Treatment of insomnia. transient may be experienced.
Action • Report any episodes of sleepwalking while on this
medication immediately to the HCP.
Produces CNS depression by binding to GABA
receptors. Possesses no analgesic properties.
CNS: amnesia, daytime drowsiness, dizziness, • Prolonged use of up to 7–10 days may
“drugged” feeling. GI: diarrhea, nausea, vomit- lead to physical and psychological dependence.
ing. Misc: hypersensitivity reactions, physical • Older clients require half the regular dose.
dependence, psychological dependence, tolerance. • Sleepwalking, sleep-eating, and sleep-driving
have been reported under the influence of this
Keep in Mind medication.
Teach client: • Discuss a therapeutic sleep regimen with
• Take as directed. client. Discuss how to protect client from
• Go to bed immediately after taking the medica- injury. Remember: GABA is an inhibitory
tion, as it has a rapid onset. neurotransmitter.
• May cause daytime drowsiness or dizziness. • Tablets should be swallowed whole.
Route/Dosage: Zolpidem: PO, SL/10 mg at bedtime, 12.5 mg ER tab; SL/1.75 mg (women) or 3.5 mg (men) within 4 hr of middle-of-the-night awaken-
Uploaded
ing (Intermezzo), Eszopiclone: PO/2–3 mg immediately by MEDBOOKSVN.ORG
before bedtime
1882_Tab06_109-160 11/10/12 2:40 PM Page 118
Central Nervous System Drugs Melatonin Receptor Agonist 118
Ramelteon
(ram-ell-tee-on)
Rozerem
1882_Tab06_109-160 11/10/12 2:40 PM Page 118
Central Nervous System Drugs Melatonin Receptor Agonist 118

Sedative-hypnotic/melatonin receptor agonists Make the Connection
Indications • Monitor sleep patterns and occurrence
Treatment of insomnia. of somnolence.
Action • Maintain a safe care environment. Place the client
in a monitored room, make certain the side rails
Binds to melatonin 1 and 2 receptors in suprachias- are up (top), keep call light in reach, and keep
matic nucleus, promoting sleep. the room clear of obstructions.
Adverse Reactions/Side Effects • Monitor serum testosterone and prolactin levels.
CNS: somnolence, fatigue. Endo: decreased • Administer medication at least 2 hr after the last
testosterone and cortisol levels, increased pro- evening meal.
lactin levels. Misc: anaphylaxis, angioedema. • Discuss natural sleep patterns, exercise, diet, and
sleep hygiene with the client.
Keep in Mind
Teach client:
• Sleepwalking must be reported immediately.
• Fatigue or dizziness may be experienced; avoid
activities that require alertness.
• Report unexplained amenorrhea, decreased
libido, or fertility issues.
• Avoid becoming pregnant.
• Avoid breastfeeding.
• Follow a sleep hygiene regimen.
Uploaded
Route/Dosage: PO/8 mg within 30 min of going to bed by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 119
Central Nervous System Drugs Pyrrolidines 119
Levetiracetam
(le-ve-teer-a-se-tam)
Keppra, Keppra XR
1882_Tab06_109-160 11/10/12 2:40 PM Page 119
Central Nervous System Drugs Pyrrolidines 119

Therapeutic/Pharmacologic Class • Do not discontinue abruptly.
Anticonvulsant/Pyrrolidines • May cause dizziness and somnolence.
Indications • Avoid driving until physician gives clearance
Treatment of partial-onset seizures (adjunct). based on control of seizure disorder.
Action • Notify HCP if pregnancy is planned or suspected.
Appears to inhibit burst firing without affecting • Wear a Medic-Alert bracelet.
normal neuronal excitability and may selectively
prevent hypersynchronization of epileptiform burst Make the Connection
firing and propagation of seizure activity. In many
sources, the exact action of these medications is
• Assess and record location, duration,
and characteristics of seizure activity.
unknown. • Assess client for CNS adverse effects throughout
Adverse Reactions/Side Effects therapy.
CNS: dizziness, fatigue/somnolence, weakness, • Monitor CBC with differential and LFT for
behavioral abnormalities, depression. Neuro: abnormalities.
coordination difficulties (adults only). GI: • Place on seizure precautions.
nausea. Resp: rhinitis. Derm: photosensitivity. • Give information on the ketogenic diet, which
seems to have a positive effect on seizure control.
Keep in Mind
Teach client:
• Follow instructions for proper use of a calibrated
measuring device for accurate child dosing.
Route/Dosage: PO, IV/500–1000 mg bid; ER, Uploaded

1000 mg/day by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 120
Central Nervous System Drugs Anticonvulsants 120
Gabapentin Tiagabine
(ga-ba-pen-tin) (tye-a-ga-been)
Gralise, Neurontin Gabitril
Topiramate Pregabalin
(tope-ear-a-mate) (pre-gab-a-lin)
Topamax Lyrica
1882_Tab06_109-160 11/10/12 2:40 PM Page 120

Therapeutic/Pharmacologic Class ataxia, tremors. Misc: allergic reactions, chills,
Anticonvulsants lymphadenopathy.
Adjunctive treatment of partial seizures. Some are used Teach client:
for mood stabilization and adjunctive analgesia (diabetic
neuropathy, postherpetic neuralgia, and fibromyalgia).
• Do not discontinue abruptly (↑ seizure activity).
Action • Notify HCP immediately if frequency of seizures
Involved in enhancing the activity of GABA, an increases.
inhibitory neurotransmitter. May cause blockage of • May cause dizziness. Do not resume driving until
Na channels in neurons. Most drugs in this class physician gives clearance based on control of
have unknown actions. seizure disorder.
CNS: dizziness, drowsiness, nervousness, weak-
ness, cognitive impairment, confusion, difficulty Make the Connection
concentrating (especially in children), hallucina- • Assess and record location, duration,
tions, headache, mental depression, personality and characteristics of seizure activity.
disorder. EENT: abnormal vision, tinnitus. Resp: • Assess mental status.
dyspnea, epistaxis. CV: chest pain, edema, • Therapeutic serum levels have not been determined.
HTN, palpitations, syncope, tachycardia. GI: • Administer with food if nausea occurs.
abdominal pain, gingivitis, nausea, stomatitis, • Always discontinue anticonvulsants gradually to
weight changes. Derm: alopecia, dry skin, rash, avoid recurrence or worsening of seizure activity.
sweating. MS: arthralgia, neck pain. Neuro: • Give information on ketogenic diet.
Route/Dosage: Gabapentin: PO/900–1800 mg/day in 3 divided doses, Tiagabine: PO/4–8 mg/day, up to 56 mg/day in 2–4 divided doses,
Uploaded
Topiramate: PO/50–400 mg/day in divided doses, by MEDBOOKSVN.ORG
Pregabalin: PO/50–150 mg bid
1882_Tab06_109-160 11/10/12 2:40 PM Page 121
Carbamazepine
(kar-ba-maz-e-peen)
Tegretol, Tegretol XR, Teril,

Epitol, Carbatrol
Apo-Carbamazepine
Oxcarbazepine
(carbamazepine analogue)
(ox-kar-baz-e-peen)
Trileptal
1882_Tab06_109-160 11/10/12 2:40 PM Page 121

Anticonvulsant Teach client:
Indications • Take as directed. Do not discontinue abruptly.
Monotherapy or adjunctive therapy of tonic-clonic, • May cause dizziness, drowsiness, or CNS changes.
mixed, and complex partial seizures in adults with Do not resume driving until physician gives clear-
epilepsy. Adjunctive therapy of partial seizures in ance based on control of seizure disorder.
clients 4–16 yr old with epilepsy. • Do not take alcohol or other CNS depressants
concurrently with this medication.
Action
Blocks sodium channels in neural membranes, • Wear a Medic-Alert bracelet.
stabilizing hyperexcitable states, inhibiting repetitive • Report dyspnea, bruising, edema in dependent
areas, or frequent infections.
neuronal firing, and decreasing propagation of
synaptic impulses.
CNS: dizziness/vertigo, drowsiness/fatigue, • Assess and record frequency, location,
headache, cognitive symptoms. EENT: abnormal duration, and characteristics of seizure activity.
vision, diplopia, nystagmus. GI: abdominal pain, • Monitor client for CNS changes.
dyspepsia, nausea, vomiting, thirst. CV: heart • Monitor ECG and serum electrolytes before and peri-
failure. Derm: acne, rash, urticaria. F and E: odically during therapy. May cause hyponatremia.
hyponatremia. Neuro: ataxia, gait disturbances, • Auscultate lungs for crackles and assess for
tremor. Misc: allergic reactions; hypersensitivity dependent edema (CHF).
reactions, including Stevens-Johnson syndrome • Implement seizure precautions as indicated.
and multiorgan reactions; lymphadenopathy. • Give client information about ketogenic diet.
Uploaded
Route/Dosage: Carbamazepine: PO/600–1200/day byOxcarbazepine:
in divided doses, MEDBOOKSVN.ORG
PO/300–1200 mg/day
1882_Tab06_109-160 11/10/12 2:40 PM Page 122
Central Nervous System Drugs Hydantoins 122
Phenytoin
(fen-i-toyn)
Dilantin, Phenytek
Fosphenytoin
(fos-fen-i-toyn)
Cerebyx
1882_Tab06_109-160 11/10/12 2:40 PM Page 122
Central Nervous System Drugs Hydantoins 122

Therapeutic/Pharmacologic Class reactions, including Stevens-Johnson syndrome;
Anticonvulsant/hydantoin fever; lymphadenopathy.
Treatment and prevention of tonic-clonic seizures
Teach client:
and complex partial seizures.
Action
• Take as directed; may cause drowsiness.
Limits seizure propagation by altering ion transport.
• Do not drive until physician has given clearance
based on seizure control; wear a Medic-Alert
May also decrease synaptic transmission. Fosphenytoin bracelet.
is rapidly converted to phenytoin in the body. • Avoid alcohol or other CNS depressants.
Adverse Reactions/Side Effects • Side effects such as urine discoloration and
CNS: ataxia, agitation, cerebral edema, coma, unwanted hair growth may occur.
dizziness, drowsiness, dysarthria, dyskinesia, • Flossing and brushing carefully are recommended.
extrapyramidal syndrome, headache, nervousness, • Maintain a well-balanced diet.
weakness. EENT: diplopia, nystagmus, tinnitus.
CV: hypotension, tachycardia, vasodilation.
GI: gingival hyperplasia, nausea, altered taste, Make the Connection
anorexia, constipation, drug-induced hepatitis, • Monitor ECG, CBC with differential,
dry mouth, vomiting, weight loss. GU: pink, serum drug level (10–20 mcg/mL), and LFT.
red, reddish-brown coloration of urine. Derm: • Assess for skin rash, which may progress to
hirsutism, exfoliative dermatitis, pruritus. F and E: severe exfoliative dermatitis.
hypocalcemia. Hemat: BMS. MS: allergic • Assess for hypersensitivity syndrome.
Route/Dosage: Phenytoin: PO/200–1200 mg/day; IV/15–20 mg/kg for status epilepticus, Fosphenytoin: (phenytoin sodium equivalents [PE])
IV/15–20 mg PE/kg Uploaded by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 123
Primidone
(pri-mi-done)
Mysoline
Apo-Primidone
1882_Tab06_109-160 11/10/12 2:40 PM Page 123

Therapeutic/Pharmacologic Class • May cause drowsiness or dizziness. Do not
Anticonvulsant resume driving until physician gives medical
Indications clearance based on control of seizure disorder.
Management of tonic-clonic, complex partial, and • Avoid taking alcohol or other CNS depressants
focal seizures. concurrently with this medication.
Action • Avoid sudden changes in position to decrease
dizziness.
Decreases neuronal excitability. Increases the threshold
of electric stimulation of the motor cortex. • Wear a Medic-Alert bracelet.
• Notify HCP if skin rash, unsteady gait, joint pain,
Adverse Reactions/Side Effects fever, changes in vision, dyspnea, pregnancy, or
CNS: ataxia, drowsiness, vertigo, excitement paradoxical excitement occurs.
(increased in children). EENT: visual changes. • Routine examinations and laboratory tests will be
Resp: dyspnea. CV: edema, orthostatic hypoten- required.
sion. GI: anorexia, drug-induced hepatitis, • Eat green, leafy vegetables to ensure the diet
nausea, vomiting. Derm: alopecia, rash. Hemat: contains adequate folic acid.
blood dyscrasias, megaloblastic anemia. Misc:
folic acid deficiency.
Make the Connection
Keep in Mind • Assess and record location, duration,
Teach client: frequency, and characteristics of seizure activity.
• Take the medication at the same time each day Institute and document seizure precautions.
exactly as directed. Abrupt withdrawal may lead • Assess client for signs of folic acid deficiency.
to status epilepticus. • Monitor CBC with differential and blood
chemistries.
Route/Dosage: PO/250 mg 3–4 times/day Uploaded by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 124
Ethosuximide
(eth-oh-sux-i-mide)
Zarontin
1882_Tab06_109-160 11/10/12 2:40 PM Page 124

Indications • Take the medication exactly as directed. Sudden
Treatment of absence seizures (petit mal). withdrawal may precipitate seizures.
Action • Avoid activities requiring alertness.
Elevates the seizure threshold. Suppresses abnormal • Notify HCP if skin rash, joint pain, sore throat,
wave and spike activity associated with absence fever, unusual bleeding or bruising, swollen
(petit mal) seizures. glands, pink/brown urine, or pregnancy occurs.
CNS: increased frequency of tonic-clonic • Laboratory tests and follow-up examinations will
be required.
seizures, ataxia, dizziness, drowsiness,
euphoria, fatigue, headache, hyperactivity,
irritability, psychiatric disturbances. EENT: Make the Connection
myopia. GI: abdominal pain, anorexia,
cramping, diarrhea, nausea, vomiting, weight
• Assess and record location, duration,
frequency, and characteristics of seizure activity.
loss, hiccups. GU: pink/brown discoloration
of urine, vaginal bleeding. Derm: Stevens-
• Monitor CBC with differential, hepatic function
tests, and urinalysis routinely, and drug levels
Johnson syndrome, hirsutism, rashes, urticaria. throughout the course of prolonged therapy.
Hemat: BMS. Neuro: ataxia. Misc: systemic
lupus erythematosus.
• Measure liquid preparations with calibrated
measuring device to ensure accurate dosage.
• Administer with food or milk to minimize GI
irritation.
• This drug is one of two drugs of choice for
Uploaded
Route/Dosage: PO/20–40 mg/kg/day in 2 divided doses absence seizures.
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 125
Lamotrigine
(la-moe-tri-jeen)
Lamictal, Lamictal XR
Lacosamide
(la-kose-a-mide)
Vimpat
1882_Tab06_109-160 11/10/12 2:40 PM Page 125

Anticonvulsants Teach client:
Indications • Take medication as ordered, regularly. Do not
Adjunct treatment of partial seizures in adults discontinue the medication abruptly, as this may
and children with epilepsy; treatment of Lennox- cause increased seizure activity.
Gastaut syndrome; adjunct treatment of primary • Notify HCP immediately if a skin rash, fever, or
generalized tonic-clonic seizures in adults and swollen lymph glands occur, or if seizure incidence
children. increases.
Action • Wear sunscreen and protective clothing to prevent
photosensitivity reactions.
Stabilizes neuronal membranes by inhibiting Na
transport. Lacosamide may also bind to collapsin- • Wear a Medic-Alert bracelet.
response mediator protein-2 (CRMP-2), which is • Report any signs of depression, suicidal
thoughts, being angry or violent, trouble
involved in neural differentiation and growth. sleeping, somnolence, or anxiety.
Adverse/Side Effects
CNS: Aseptic meningitis, suicidal thoughts,
ataxia, dizziness, headache, behavior changes, Make the Connection
depression, drowsiness, insomnia, tremor. EENT: • Monitor for suicidal ideation.
blurred vision, double vision, rhinitis. GI: nausea, • Assess for skin rash frequently, especially in the
vomiting. GU: vaginitis. Derm: photosensitivity, initial 2–8 wk of therapy.
rash (higher incidence in children, patients taking • Monitor for therapeutic plasma range (proposed
valproic acid, high initial doses, or rapid dose to be 1–5 mcg/mL).
increases). MS: arthralgia. Misc: Stevens-Johnson
syndrome.
Uploaded
Route/Dosage: PO/300–500 mg/day in 2 divided doses by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 126
Divalproex Valproic Acid

(dye-val-proe-ex) (val-proe-ik as-id)
Depakote, Depakene, Stavzor

Depakote ER Apo-Valproic
Epival
Valproate Sodium
(val-proe-ate soe-dee-um)
Depacon
1882_Tab06_109-160 11/10/12 2:40 PM Page 126

Indications • Take the medication at the same time each day
Treatment of simple and complex absence seizures exactly as directed. Abrupt withdrawal may lead
and partial seizures with complex symptomatology, to status epilepticus.
treatment of manic episodes associated with bipolar • May cause drowsiness or dizziness. Do not
disorder, and treatment of migraine headache. resume driving until physician gives medical clear-
ance based on control of seizure disorder.
Action
Increase levels of GABA, an inhibitory neurotrans- • Avoid taking alcohol or other CNS depressants
concurrently with this medication.
mitter for the CNS.
• Wear a Medic-Alert bracelet.
CNS: confusion, dizziness, headache, sedation.
EENT: visual disturbances. GI: hepatotoxicity, Make the Connection
indigestion, diarrhea, hypersalivation, increased • Assess and record location, duration,
appetite, pancreatitis. Derm: rashes. Hemat: frequency, and characteristics of seizure activity.
BMS. Metab: increase in serum ammonia levels. Institute and document seizure precautions.
Neuro: ataxia, paresthesia. • Monitor CBC with differential; LFT; and amylase,
lipase, and serum drug levels.
• May be administered with food to minimize GI
effects.
Route/Dosage: Divalproex: PO/10–60 mg/kg/day, Valproic acid: PO/10–60 mg/kg/day (valproic acid ER [Stavzor]: 15–60 mg/kg/day), Valproate
sodium: IV/10–60 mg/kg/day Uploaded by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 127
Central Nervous System Drugs Monoamine Oxidase Type B Inhibitors 127
Selegiline Selegiline
(se-le-ji-leen)
Transdermal
(se-le-ji-leen tranz-derm-al)
Eldepryl, Carbex
Apo-Selegiline
Emsam
Rasagiline
(ra-za-ji-leen)
Azilect
1882_Tab06_109-160 11/10/12 2:40 PM Page 127
Central Nervous System Drugs Monoamine Oxidase Type B Inhibitors 127

Anti-Parkinson agents/monoamine oxidase (MAO) Teach client:
type B inhibitors • Take medication as directed with food.
Indications • Notify HCP immediately if severe headache occurs.
Management of Parkinson’s disease (with levodopa • Change positions slowly to ↓ dizziness.
or levodopa/carbidopa) in clients who fail to • Report increased body temperature, sweating, men-
respond to levodopa/carbidopa alone. tal status change, muscle twitching, or confusion.
Action • Increase fluids or use sugarless gum, candy, or ice
to minimize dry mouth symptoms.
Following conversion by MAO to its active form,
this drug inactivates MAO by irreversibly binding to
it at type B (brain) sites. Inactivation of MAO leads Make the Connection
to increased amounts of dopamine, serotonin, and
norepinephrine available in the CNS. Rasagiline
• Concurrent use with meperidine or
other opioid analgesics may result in a poten-
differs from selegiline by its nonamphetamine tially fatal reaction. Serotonin syndrome may
characteristics. Selegiline transdermal is used for occur with concurrent use of SSRIs, SRNIs, or
major depression. TCAs.
Adverse Reactions/Side Effects • Monitor sleep pattern changes and presence of
CNS: confusion, dizziness, fainting, hallucina- nightmares. Keep room free of obstacles.
tions, insomnia, vivid dreams. GI: nausea, • Monitor LFT and RFT.
abdominal pain, dry mouth.
Uploaded
Route/Dosage: Selegiline: PO/5 mg bid, 1.25–2.5 by MEDBOOKSVN.ORG
mg daily (oral disintegrating tab); transdermal 6–12 mg/24 hr, Rasagiline: PO/0.5–1 mg/day
1882_Tab06_109-160 11/10/12 2:40 PM Page 128
Central Nervous System Drugs Dopamine Agonists Agents 128
Ropinirole
(rope-in-er-ole)
Requip, Requip XL
Pramipexole
(pram-i-pex-ole)
Mirapex
1882_Tab06_109-160 11/10/12 2:40 PM Page 128
Central Nervous System Drugs Dopamine Agonists Agents 128

Anti-Parkinson agent/dopamine agonist Teach client:
Indications • Take medication as directed.
Management of mild Parkinson’s disease as • May cause drowsiness and unexpected episodes
monotherapy and as adjunctive therapy with of falling asleep. Notify HCP if episodes of
levodopa/carbidopa in more advanced cases. falling asleep occur.
Treatment of restless leg syndrome (rapid-release • Change positions slowly to ↓ dizziness.
form only). • Use good oral hygiene and sugarless gum or
Action candy to minimize dry mouth.
Act as dopamine agonists, directly stimulating • If uncontrollable urges occur, such as the urge to
postsynaptic dopaminergic receptors in the CNS. gamble, report this immediately to the HCP.
Some actions are unknown.
CNS: sleep attacks, drowsiness, dyskinesia, hal-
lucinations, confusion, insomnia. EENT: rhinitis.
• Assess for decrease in signs and symptoms
of Parkinson’s disease.
Resp: dyspnea. CV: orthostatic hypotension,
arrhythmias (atrial premature contractions,
• Assess for confusion or hallucinations. Notify
physician or other HCP if these occur.
sinus tachycardia), HTN, palpitations. GI: con- • Assess client for drowsiness and sleep attacks.
stipation, nausea, abdominal pain, diarrhea, dry • Monitor ECG and BP frequently.
mouth, dyspepsia. Neuro: compulsive behaviors. • Administer with meals to minimize nausea.
• Monitor LFT, RFT, and behavioral changes.
Uploaded
Route/Dosage: Ropinirole: PO/up to 9 mg/day by
(ER form, up to 24 MEDBOOKSVN.ORG
mg/day), Pramipexole: PO/1.5–4.5 mg/day in 3 divided doses
1882_Tab06_109-160 11/10/12 2:40 PM Page 129
Central Nervous System Drugs Anti-Parkinson Agents 129
Amantadine
(a-man-ta-deen)
Symmetrel
1882_Tab06_109-160 11/10/12 2:40 PM Page 129
Central Nervous System Drugs Anti-Parkinson Agents 129

Therapeutic/Pharmacologic Class • Dry mouth can be relieved with good oral hygiene
Anti-Parkinson agent; antiviral and use of sugarless gum or candy.
Indications • Notify HCP if confusion, mood changes, difficulty
Symptomatic initial and adjunctive treatment of with urination, edema, SOB, or worsening of
Parkinson’s disease. Treatment of viral illness. Parkinson’s symptoms occur.
Action • Full effect for Parkinson’s disease relief may take
up to 2 wk of therapy.
Potentiates the action of dopamine in the CNS.
• Wean from the drug gradually.
CNS: ataxia, dizziness, insomnia, anxiety, confu-

sion, depression, drowsiness, psychosis, seizures. Make the Connection
GI: nausea, vomiting, anorexia, constipation. • Monitor BP periodically.
EENT: blurred vision, dry mouth. Resp: dyspnea. • Monitor VS and mental status periodically during
CV: hypotension, CHF, edema. GU: urinary first few days of treatment.
retention. Derm: mottling, rashes. Hemat: • Assess for CHF, especially in clients on chronic
leukopenia, neutropenia. therapy or with a history of CHF.
• Assess client for the appearance of a diffuse red
Keep in Mind mottling of the skin (livedo reticularis), especially
Teach client: in the lower extremities or on exposure to cold.
• Take medication around the clock as directed. • Monitor I&O closely in geriatric clients. May
• May cause dizziness or blurred vision. Change cause urinary retention.
position slowly to avoid dizziness. • Symptoms of toxicity include CNS stimulation.
Physostigmine has been used to reverse CNS
effects.
Route/Dosage: PO/100 mg 1–2 times daily Uploaded by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 130
Central Nervous System Drugs Dopamine Agonists 130
Bromocriptine
(broe-moe-krip-teen)
Parlodel, Cycloset
Apo-Bromocriptine
1882_Tab06_109-160 11/10/12 2:40 PM Page 130

Anti-Parkinson agent; antidiabetic/dopamine agonists Teach client:
Adjunct to levodopa in the treatment of parkin- • May cause drowsiness and dizziness.
sonism. Parlodel is used only for treatment of • Avoid concurrent use of alcohol.
hyperprolactinemia (female infertility), prolactin- • Watch for signs of MI and notify HCP immediately
secreting adenomas, and acromegaly. Cycloset is if any occur.
used for treatment of type 2 DM. • Women should consult with HCP regarding a
nonhormonal method of birth control.
Action
Activates dopamine receptors in the CNS. • Maintain appointments for regular follow-up.
Decreases prolactin and growth hormone secre-
tion. Decreases blood glucose by action on Make the Connection
growth hormone. • Assess client for allergy to ergot derivatives.
Adverse Reactions/Side Effects • Monitor BP; severe hypotension may occur.
CNS: dizziness, confusion, drowsiness, halluci- • Assess for symptom relief before and throughout
nations, headache, insomnia, nightmares. therapy.
EENT: burning eyes, nasal stuffiness, visual • Monitor LFT; RFT; and CPK, alkaline phosphatase,
disturbances. Resp: effusions, pulmonary and uric acid levels.
infiltrates. CV: MI, hypotension. GI: nausea, • Auscultate the lungs every shift for crackles.
abdominal pain, anorexia, dry mouth, metallic • This medication is often given concurrently with
taste, vomiting. Derm: urticaria. MS: leg cramps. levodopa or a levodopa/carbidopa combination
Misc: digital vasospasm (acromegaly only). in the treatment of Parkinson’s disease.
• Administer with food or milk to minimize GI distress.
Route/Dosage: PO/2.5–100 mg/day in dividedUploaded
doses by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 131
Central Nervous System Drugs Catechol-O-Methyltransferase Inhibitors 131
Tolcapone
(toll-ca-pone)
Tasmar
Entacapone
(en-tah-ca-pone)
Comtan
1882_Tab06_109-160 11/10/12 2:40 PM Page 131
Central Nervous System Drugs Catechol-O-Methyltransferase Inhibitors 131

Anti-Parkinson agent/Catechol-O-methyltransferase Teach client:
(COMT) inhibitor • Take as directed.
Indications • Watch for signs of liver dysfunction.
Treatment of Parkinson’s disease as an adjunct to • Report severe diarrhea.
levodopa/carbidopa therapy to decrease fluctuation • This drug may cause drowsiness.
of dopamine (off periods). • Report insomnia, hallucinations, or vivid dreams.
Action • Report severe headache or visual changes.
Inhibits the enzyme that breaks down levodopa, • Report suspected pregnancy to HCP immediately.
greatly increasing its availability to the CNS. • Change position slowly to ↓dizziness.
Prolongs duration of response to levodopa without
end-of-dose motor fluctuations. Make the Connection
Adverse Reactions/Side Effects • Assess LFT periodically. This drug can
CNS: hallucination, somnolence, vivid dreams, cause serious liver problems quickly.
confusion, headache, syncope, agitation. CV: • Do not give concurrently with MAOI type A or
orthostatic hypotension, angina. EENT: tinnitus. B drugs, SSRIs, SNRIs, or TCAs.
GI: severe diarrhea, nausea, hepatotoxicity. • Give with levodopa/carbidopa.
GU: erectile dysfunction, urinary tract infection.
MS: myalgia. Derm: rash. Misc: anaphylaxis,
hypertensive crisis with concurrent use of MAOI
type A or B, SSRIs, or TCAs.
Uploaded
Route/Dosage: Tolcapone: PO/200 mg tid, Entacapone: PO/200 by
mg up MEDBOOKSVN.ORG
to 8 times daily
1882_Tab06_109-160 11/10/12 2:40 PM Page 132
Carbidopa/Levodopa
(kar-bi-doe-pa/lee-voe-doe-pa)
Parcopa, Sinemet, Sinemet CR

1882_Tab06_109-160 11/10/12 2:40 PM Page 132

Therapeutic/Pharmacologic Class • GI irritation may be decreased by eating food
Anti-Parkinson agent/dopamine agonist shortly after taking medications, but high-protein
Indications meals may impair the drug’s effects.
Treatment of Parkinson’s disease. These drugs are • May cause drowsiness or dizziness.
not useful for drug-induced extrapyramidal reactions. • Change positions slowly to ↓ dizziness.
Action • Dry mouth can be relieved by using good oral
hygiene and sugarless gum or candy.
Levodopa is converted to dopamine in the CNS,
where it serves as a neurotransmitter. Carbidopa, a • Avoid multivitamins. Pyridoxine (vitamin B6) and
iron may decrease effectiveness.
decarboxylase inhibitor, prevents peripheral destruc-
tion of levodopa. Consequently, more levodopa is • Harmless darkening of urine or sweat may occur.
delivered to the CNS using a smaller dose when • Notify HCP if palpitations, urinary retention,
involuntary movements, behavioral changes, severe
used with carbidopa.
nausea and vomiting, or new skin lesions occur.
CNS: involuntary movements, anxiety, dizziness,
hallucinations, memory loss, psychiatric prob- Make the Connection
lems. EENT: blurred vision, mydriasis. GI: nausea, • Assess BP and pulse frequently during
vomiting, anorexia, dry mouth, hepatotoxicity. period of dose adjustment.
Derm: melanoma. Hemat: hemolytic anemia, • Monitor hepatic and renal function tests and
leukopenia. Misc: darkening of urine or sweat. CBC with differential.
Keep in Mind • Assess for signs of toxicity (involuntary muscle twitch-
ing, facial grimacing, spasmodic eye winking, exagger-
Teach client: ated protrusion of tongue, behavioral changes).
• Take this drug as directed.
Uploaded
Route/Dosage: PO/25 mg carbidopa with levodopa byto 8MEDBOOKSVN.ORG
100 mg tid (up tablets daily); ER/carbidopa 50 mg with levodopa 200 mg bid
1882_Tab06_109-160 11/10/12 2:40 PM Page 133
Central Nervous System Drugs Anticholinergics 133
Benztropine
(benz-troe-peen)
Cogentin
Apo-Benztropine
Trihexyphenidyl
(trye-hex-ee-fen-i-dill)
Artane, Artane Sequels (ER)

Apo-Trihex
1882_Tab06_109-160 11/10/12 2:40 PM Page 133
Central Nervous System Drugs Anticholinergics 133

Anti-Parkinson agent/anticholinergic Teach client:
Indications • Take as directed.
Adjunctive treatment of all forms of Parkinson’s • May cause drowsiness or dizziness.
disease, including drug-induced extrapyramidal • Dry mouth may be relieved by use of sugarless
effects and acute dystonic reactions. gum or candy and frequent good oral hygiene.
Action • Change positions slowly to ↓ dizziness.
Blocks cholinergic activity in the CNS, which is par- • Avoid taking antacids or antidiarrheals within
1–2 hr of administration.
tially responsible for the symptoms of Parkinson’s
disease. Restores the natural balance of neurotrans-
mitters in the CNS. Make the Connection
Adverse Reactions/Side Effects • Assess parkinsonian and EPS before and
CNS: confusion, depression, dizziness, halluci- throughout therapy.
nations, headache, sedation, weakness. EENT: • Assess bowel function daily.
blurred vision, dry eyes, mydriasis. CV: arrhythmias, • Monitor I&O.
hypotension, palpitations, tachycardia. GI: con- • Remember, anticholinergics cause side effects of
stipation, dry mouth, ileus, nausea. GU: hesitancy, “hot as a hare, dry as a bone, red as a beet,
urinary retention. Misc: decreased sweating. mad as a hatter, blind as a bat.”
• If administering the drug IV (for acute dystonic
reactions), monitor pulse, ECG, and BP closely
and maintain bed rest for 1 hr after administration.
Route/Dosage: Benztropine: PO/1–2 mg/day; PO, IM, IV/1–4 mg/day for dystonia or EPS, Trihexyphenidyl: PO/6–10 mg/day in 3 divided doses,
ER-PO/5 mg q 12 hr Uploaded by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 134
Central Nervous System Drugs Cholinergics (Cholinesterase Inhibitors) 134
Donepezil Galantamine
(doe-nep-i-zill) (ga-lant-a-meen)
Aricept, Aricept Razadyne,

Oral Disintegrating Razadyne ER
Tablets (ODT)
Rivastigmine Tacrine
(rye-va-stig-meen) (tak-rin)
Exelon, Exelon Cognex

Transdermal Patch
1882_Tab06_109-160 11/10/12 2:40 PM Page 134
Central Nervous System Drugs Cholinergics (Cholinesterase Inhibitors) 134

Anti-Alzheimer agent/cholinergic; cholinesterase Teach client:
inhibitor • Take the medication daily, as directed.
Indications • May cause dizziness.
Treatment of mild-to-moderate dementia associated • Notify HCP if abdominal pain, coffee ground
with Alzheimer’s disease. emesis, nausea, diarrhea, or changes in color of
stool occur, or if new symptoms occur or previously
Action noted symptoms increase in severity.
Improves cholinergic function, which is lacking in
clients with Alzheimer’s disease, by inhibiting • Follow-up will be scheduled to monitor progress.
acetylcholinesterase, thus prolonging the effect • These medications slow the progress of the
disease but do not provide a cure.
of acetylcholine (the neurotransmitter of the
cholinergic system).
CNS: headache, abnormal dreams, depression, • Assess cognitive function (memory, attention,
dizziness, drowsiness, fatigue, insomnia, syncope. reasoning, language, ability to perform simple
CV: atrial fibrillation, HTN, hypotension, vasodi- tasks) periodically during therapy.
lation. GI: diarrhea, nausea, anorexia, vomiting, • Remember SLUDGE—salivation, lacrimation,
peptic ulcers. GU: frequent urination. Derm: urination, diarrhea, GI distress, emesis—are
ecchymoses. Metab: hot flashes, weight loss. cholinergic side effects.
MS: arthritis, muscle cramps. • Administer in the evening just before going to bed.
• Give the family information on local Alzheimer’s
day-care and respite-care facilities.
Route/Dosage: Donepezil: PO/5–10 mg daily, Galantamine: PO/4–12 mg bid; PO (ER)/8–16 mg once daily, Rivastigmine: PO/1.5–3 mg bid;
Uploaded
transdermal/4.6–9.5 mg/24 hr, Tacrine: PO/10–20 by160MEDBOOKSVN.ORG
mg qid (maximum mg daily)
1882_Tab06_109-160 11/10/12 2:40 PM Page 135
Central Nervous System Drugs Benzodiazepines 135
Alprazolam Diazepam
(al-pray-zoe-lam) (dye-az-e-pam)
Xanax, Xanax Valium, Diastat

XR, Niravam Apo-Diazepam
Apo-Alpraz,
Novo-Alprazol
Clonazepam Lorazepam
(kloe-na-ze-pam) (lor-az-e-pam)
Klonopin Ativan
Syn-Clonazepam Apo-Lorazepam
1882_Tab06_109-160 11/10/12 2:40 PM Page 135
Central Nervous System Drugs Benzodiazepines 135

Antianxiety agent; sedative-hypnotic agent/ Teach client:
benzodiazepine • Take medication exactly as directed.
Indications • May cause drowsiness or dizziness.
Treatment of anxiety; also a centrally acting muscle • Older clients may have an increased “hangover effect”
relaxer and adjunctive analgesic. Diazepam is used in the morning and are at increased risk for falls.
for treatment of stiff-man syndrome and in con- • Avoid drinking grapefruit juice during therapy.
scious sedation. • Avoid the use of alcohol or other CNS depressants
Action concurrently with these drugs.
Acts at many levels in the CNS to produce anxiolytic
effect. May produce CNS depression. Effects may be Make the Connection
mediated by GABA, an inhibitory neurotransmitter.
• Kava, valerian, and chamomile can ↑
Adverse Reactions/Side Effects CNS depression.
CNS: dizziness, drowsiness, lethargy, confusion,
hangover, headache, mental depression, para-
• Assess degree and manifestations of anxiety during
therapy.
doxical excitation. EENT: blurred vision. GI:
constipation, diarrhea, nausea, vomiting. Derm:
• Monitor CBC with differential, and liver and renal
function.
rashes. Misc: physical dependence, psychological
dependence, tolerance.
• Plan to give more of your time to the anxious client;
remain nonjudgmental. Offer yourself (“I will stay”).
Route/Dosage: Alprazolam: PO/0.25–0.5 mg 2–3 times daily; PO (panic attack)/0.5–1 mg tid; PO (ER)/3–6 mg/day, Diazepam: PO/2–10 mg
2–4 times daily; IM, IV/2–10 mg q 3–4 hr, Clonazepam: PO/0.5 mg daily; PO (panic attack)/1 mg daily, Lorazepam: PO/1–3 mg 2–3 times daily;
SL/2–3 mg in divided doses Uploaded by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 136
Central Nervous System Drugs Antianxiety Agent 136
Buspirone
(byoo-spye-rone)
BuSpar
1882_Tab06_109-160 11/10/12 2:40 PM Page 136
Central Nervous System Drugs Antianxiety Agent 136

Antianxiety agent Teach client:
Indications • Take exactly as directed.
Management of generalized anxiety disorder. • May cause dizziness or drowsiness.
Action • Avoid concurrent use of alcohol or other CNS
depressants.
Binds to serotonin and dopamine receptors in the brain.
Increases norepinephrine metabolism in the brain. • Consult HCP before taking OTC medications or
herbal products with this drug.
Adverse Reactions/Side Effects • Notify HCP if any chronic abnormal muscle
CNS: dizziness, drowsiness, excitement, fatigue, movements occur or if pregnancy is suspected.
headache, insomnia, nervousness, weakness,
personality changes. EENT: blurred vision, nasal
• Maintain appointments for follow-up
examinations.
congestion, sore throat, tinnitus, altered taste or
smell, conjunctivitis. Resp: chest congestion,
• Report palpitations, chest discomfort, or
faintness immediately.
hyperventilation, SOB. CV: chest pain, palpita-
tions, tachycardia, HTN, hypotension, syncope.
GI: nausea, abdominal pain, constipation, Make the Connection
diarrhea, dry mouth, vomiting. GU: changes in • Concomitant use of kava, valerian, or
libido, dysuria, urinary frequency, urinary hesi- chamomile can ↑ CNS depression. Grapefruit
tancy. Derm: rashes, alopecia, blisters, dry skin, juice will ↑ serum levels.
easy bruising, edema, flushing, pruritus. Endo: • Concomitant use of MAOIs will cause HTN.
irregular menses. MS: myalgia. Neuro: incoordi- • Assess degree and manifestations of anxiety
nation, numbness, paresthesia, tremor. Misc: before and periodically during therapy.
clamminess, sweating, fever. • Monitor LFT and RFT.
Route/Dosage: PO/20–30 mg day in 2 dividedUploaded
doses • Monitor ECG and assess for chest discomfort.
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 137
Central Nervous System Drugs Selective Serotonin Reuptake Inhibitors 137
Fluoxetine Citalopram
(floo-ox-uh-teen) (si-tal-oh-pram)
Prozac, Prozac Celexa

Weekly, Sarafem
Fluvoxamine Paroxetine
(floo-voks-a-meen) (par-ox-e-teen)
Luvox, Luvox CR Paxil, Paxil ER, Pexeva
Escitalopram
(ess-sit-al-o-pram)
Lexapro
1882_Tab06_109-160 11/10/12 2:40 PM Page 137
Central Nervous System Drugs Selective Serotonin Reuptake Inhibitors 137

Therapeutic/Pharmacologic Class pruritus, erythema nodosum, flushing, rashes.
Antidepressant/selective serotonin reuptake inhibitor Endo: dysmenorrhea. MS: arthralgia, back pain,
(SSRI) myalgia. Neuro: tremor. Misc: allergic reactions,
Indications fever, flu-like syndrome, hot flashes, sensitivity
Treatment of various forms of depression, OCD, reaction.
social phobias, bulimia and anorexia nervosa, and Keep in Mind
panic disorder. Sarafem: Management of premen- Teach client:
strual dysphoric disorder (PMDD).
Action
• Take the medication exactly as directed.
Selectively inhibits the reuptake of serotonin from
• May cause drowsiness, dizziness, impaired
judgment, blurred vision, and dry mouth.
the neural synapse. • Avoid alcohol, CNS depressant drugs, and herbal
Adverse Reactions/Side Effects products such as SAMe and St. John’s wort.
CNS: seizures, anxiety, drowsiness, headache, • The medication may cause decreased libido.
insomnia, nervousness, abnormal dreams, • Report chest discomfort, palpitations, or suicidal
dizziness, fatigue, hypomania, mania, weakness. thoughts immediately.
EENT: stuffy nose, visual disturbances. Resp:
cough. CV: chest pain, palpitations. GI: diarrhea,
abdominal pain, abnormal taste, anorexia,
Make the Connection
constipation, dry mouth, dyspepsia, nausea, • Assess for suicidal tendencies, especially
in the first 2–4 wk.
vomiting, weight loss. GU: sexual dysfunction,
urinary frequency. Derm: excessive sweating, • Monitor appetite and nutrition intake.
• Monitor CBC, LFT, and RFT.
Route/Dosage: Fluoxetine: PO/20 mg daily; PO (ER)/90 mg weekly, Citalopram: PO/20–40 mg daily, Fluvoxamine: PO/50–100 mg at bedtime; PO
Uploaded
(CR)/100–300 mg at bedtime, Paroxetine: PO/20–50 by MEDBOOKSVN.ORG
mg daily; PO (CR)/25–62.5 mg daily, Escitalopram: PO/10–20 mg once daily
1882_Tab06_109-160 11/10/12 2:40 PM Page 138
Central Nervous System Drugs Mood Stabilizer 138
Lithium
(lith-ee-um)
Lithobid
Carbolith
1882_Tab06_109-160 11/10/12 2:40 PM Page 138
Central Nervous System Drugs Mood Stabilizer 138

Therapeutic/Pharmacologic Class hyperglycemia, hyperthyroidism. F and E:
Mood stabilizer hyponatremia. Hemat: leukocytosis. Metab:
Indications weight gain. MS: muscle weakness, hyperirri-
Treatment of bipolar affective disorders (treatment tability, rigidity. Neuro: tremors.
of acute manic episodes and prophylaxis against
Keep in Mind
recurrence).
Teach client:
Action • Report palpitations or SOB to HCP immediately.
Alters cation transport in nerve and muscle. • May cause dizziness or drowsiness.
Influences reuptake of neurotransmitters. • Do not limit sodium intake. Take as directed.
Adverse Reactions/Side Effects • Unwanted weight gain and acne may occur.
CNS: seizures, fatigue, headache, impaired • Do not drink coffee, tea, or cola in large amounts.
memory, ataxia, confusion, dizziness, drowsiness, • Notify HCP if fever, vomiting, or diarrhea occurs.
psychomotor retardation, restlessness, stupor.
EENT: aphasia, blurred vision, dysarthria, tinnitus.
CV: arrhythmias, ECG changes, edema, Make the Connection
hypotension. GI: abdominal pain, anorexia, • Assess for suicidal ideation and react
bloating, diarrhea, nausea, dry mouth, metallic swiftly.
taste. GU: polyuria, glycosuria, nephrogenic • Monitor I&O; electrolytes; and CBC, LFT, and RFT.
diabetes insipidus, renal toxicity. Derm: acne, • Monitor serum drug levels (0.5–1.5 mEq/L).
folliculitis, alopecia, diminished sensation, The client with toxicity looks like a person who
pruritus. Endo: hypothyroidism, goiter, is inebriated, with ataxia, slurred speech, and
drowsiness.
Uploaded
Route/Dosage: PO/300 mg 3–4 times daily; PO (ER)/300 mg tid by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 139
Central Nervous System Drugs Aminoketones 139
Bupropion
(byoo-proe-pee-on)
Wellbutrin, Wellbutrin SR,

Budeprion XL, Zyban, Aplenzin
1882_Tab06_109-160 11/10/12 2:40 PM Page 139
Central Nervous System Drugs Aminoketones 139

Antidepressant; smoking deterrent/aminoketone Teach client:
Treatment of major depression, often in conjunction • May cause drowsiness and blurred vision.
with psychotherapy. • Avoid concurrent use of alcohol or other CNS
depressant drugs.
Action
Alters the effects of serotonin in the CNS. • Expect follow-up examinations.
• Report any suicidal ideation immediately to
Adverse Reactions/Side Effects the HCP.
CNS: lower seizure threshold, drowsiness,
confusion, dizziness, fatigue, hallucinations,
headache, insomnia, nightmares, slurred speech, Make the Connection
syncope, weakness. EENT: blurred vision, tinnitus. • Concomitant use of herbal products
CV: hypotension, arrhythmias, chest pain, HTN, such as kava, valerian, or chamomile can ↑ CNS
palpitations, tachycardia. GI: dry mouth, altered depression.
taste, constipation, diarrhea, excess salivation, • The risk of serotonin syndrome increases when
flatulence, nausea, vomiting. GU: hematuria, medication is taken with St. John’s wort or SAMe.
impotence, priapism, urinary frequency. Derm: • Monitor BP, pulse, and ECG as baseline, then
rashes. Hemat: anemia, leukopenia. MS: myalgia. periodically.
Neuro: tremor. • Assess mental status and mood changes.
• There are fewer problems with sexual side effects
than with SSRIs.
• Monitor CBC, LFT, and RFT.
Uploaded
Route/Dosage: PO/100–450 mg daily in divided by MEDBOOKSVN.ORG
doses; PO (XR, XL)/150 mg daily
1882_Tab06_109-160 11/10/12 2:40 PM Page 140
Central Nervous System Drugs Serotonin and Norepinephrine Reuptake

Inhibitors 140
Venlafaxine Duloxetine
(ven-la-fax-een) (do-lox-e-teen)
Effexor, Effexor XR Cymbalta
Desvenlafaxine
(des-ven-la-faz-een)
Pristiq
1882_Tab06_109-160 11/10/12 2:40 PM Page 140
Central Nervous System Drugs Serotonin and Norepinephrine Reuptake

Inhibitors 140
Therapeutic/Pharmacologic Class loss. GU: sexual dysfunction, urinary frequency,
Antidepressant; antianxiety agent/Serotonin and urinary retention. Derm: ecchymoses, itching,
norepinephrine reuptake inhibitor (SNRI) photosensitivity, skin rash. Neuro: paresthesia,
Indications twitching. Misc: chills, yawning.
Treatment of major depressive illness or relapse, often Keep in Mind
in conjunction with psychotherapy. Treatment of gen- Teach client:
eralized anxiety disorder and social anxiety disorder.
Action
• The medication may cause drowsiness or dizziness.
Inhibits serotonin and norepinephrine reuptake in • Avoid using alcohol or other CNS depressant drugs.
the CNS. • Report suicidal thoughts immediately.
CNS: seizures, abnormal dreams, anxiety, dizzi-
ness, headache, insomnia, nervousness, weakness,
Make the Connection
abnormal thinking, agitation, confusion, deper- • The risk of serotonin syndrome increases
with use of MAOIs, St. John’s wort, or SAMe.
sonalization, drowsiness, emotional lability,
worsening depression. EENT: rhinitis, visual • Assess suicidal tendencies, especially in early
therapy.
disturbances, tinnitus. CV: chest pain, HTN,
palpitations, tachycardia. GI: abdominal pain, • Monitor CBC, LFT, RFT, and electrolyte levels.
altered taste, anorexia, constipation, diarrhea,
dry mouth, dyspepsia, nausea, vomiting, weight
Route/Dosage: Venlafaxine: PO/75–225 mg daily in divided doses; PO (XL)/75–225 mg daily, Duloxetine: PO/60–120 mg once daily,
Desvenlafaxine: PO/50 mg once daily Uploaded by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 141
Central Nervous System Drugs Tricyclic Antidepressants 141
Desipramine Nortriptyline
(dess-ip-pra-meen) (nor-trip-ti-leen)
Norpramin Aventyl, Pamelor

Pertofrane
Imipramine Clomipramine
(im-ip-pra-meen) (cloe-mip-pra-meen)
Tofranil, Tofranil PM, Anafranil

Norfranil, Tipramine
Apo-imipramine,
Novopramine
1882_Tab06_109-160 11/10/12 2:40 PM Page 141
Central Nervous System Drugs Tricyclic Antidepressants 141

Therapeutic/Pharmacologic Class • This medication may cause drowsiness.
Antidepressant/tricyclic antidepressant (TCA) • Dizziness on standing, sedation, and confusion
Indications are common side effects.
Treatment of depression, often in conjunction with • Avoid alcohol or other CNS depressant drugs.
psychotherapy. Treatment of OCD (clomipramine). • Use sunscreen and protective clothing.
Action • An increase in appetite may occur.
Potentiates the effect of serotonin and norepinephrine in • Notify HCP immediately if having any suicidal
thoughts.
the CNS. Produces significant anticholinergic side effects.
CNS: lethargy, sedation. EENT: blurred vision, Make the Connection
dry eyes, dry mouth. CV: arrhythmias, hypoten- • Appears on Beers Criteria list as a drug
sion, ECG changes. GI: constipation, hepatitis, that is inappropriate for older clients. Increases
paralytic ileus. GU: urinary retention. Derm: the risk for falls.
photosensitivity. Endo: changes in blood glucose, • May ↑ risk of suicide attempt/ideation, especially
gynecomastia. Hemat: blood dyscrasias. Misc: during early treatment.
increased appetite, weight gain. • Serotonin syndrome may occur when medication
is combined with SAMe or St. John’s wort.
Keep in Mind • Anticholinergic effects are “hot as a hare, dry as
Teach client: a bone, red as a beet, mad as a hatter, and
• Take the medication exactly as directed. It is best blind as a bat.”
taken at bedtime because of the sedating effects. • Monitor CBC, LFT, RFT, serum glucose, and
serum alkaline phosphatase.
Route/Dosage: Desipramine: PO/100–200 mg once daily, or 300 mg in divided doses, Nortriptyline: PO/25 mg 3–4 times daily, up to 150 mg daily,
Imipramine: PO/25–50 mg 3–4 times daily, up to 300 mg daily; IM/100 mg daily in divided doses, Clomipramine: PO/25 mg tid, up to 250–350 mg
in divided doses Uploaded by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 142
Central Nervous System Drugs Monoamine Oxidase Inhibitors 142
Phenelzine Tranylcypromine
(fen-el-zeen) (tran-ill-sip-roe-meen)
Nardil Parnate
Isocarboxazid
(eye-soe-car-box-a-zid)
Marplan
1882_Tab06_109-160 11/10/12 2:40 PM Page 142
Central Nervous System Drugs Monoamine Oxidase Inhibitors 142

Antidepressant/monoamine oxidase inhibitor (MAOI) Teach client:
Indications • Take the medication as directed.
Treatment of neurotic or atypical depression • Avoid alcohol, CNS depressants, OTC deconges-
(usually reserved for clients who do not tolerate or tant drugs, excessive caffeine intake, and foods or
respond to other modes of therapy [eg, TCAs, beverages containing tyramine (give client a list).
SSRIs, SNRIs, electroconvulsive therapy]). • This medication may cause dizziness or drowsiness.
Action • Wear a Medic-Alert bracelet.
Inhibits the enzyme MAO, resulting in an accumula- • Ophth testing will also be done periodically.
tion of various neurotransmitters (dopamine, epineph-
rine, norepinephrine, serotonin) in the neural synapse. Make the Connection
Adverse Reactions/Side Effects • Serious, potentially fatal adverse reactions
CNS: seizures, dizziness, drowsiness, fatigue, (serotonin syndrome) may occur with concur-
headache, hyperreflexia, insomnia, tremor, twitch- rent use of other antidepressants. Avoid using
ing, weakness, euphoria, paresthesia, restlessness. within 2–5 wk of each other.
EENT: blurred vision, glaucoma, nystagmus. • This medication may cause severe HTN and
CV: hypertensive crisis, edema, orthostatic seizures when combined with opioids, trypto-
hypotension. GI: constipation, dry mouth, abdom- phan, tyrosine, phenylalamine, tyramine, or high
inal pain, ↑ LFT, nausea, vomiting. GU: sexual caffeine intake.
dysfunction, urinary retention. Derm: pruritus, • Assess for suicidal tendencies, especially during
rashes. F and E: hypernatremia. Endo: weight gain. early therapy.
• Monitor LFT.
Route/Dosage: Phenelzine: PO/60–90 mg daily in divided doses, Tranylcypromine: PO/30–60 mg bid, Isocarboxazid: PO/10–60 mg daily in
2–4 divided doses Uploaded by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 143
Central Nervous System Drugs Butyrophenones 143
Haloperidol
(ha-loe-per-i-dole)
Haldol, Haldol Decanoate

PMS-Haloperidol
Droperidol
(droe-per-i-dole)
Inapsine
1882_Tab06_109-160 11/10/12 2:40 PM Page 143
Central Nervous System Drugs Butyrophenones 143

Therapeutic/Pharmacologic Class Metab: hyperpyrexia. Misc: neuroleptic
Antipsychotic agent/butyrophenones malignant syndrome, hypersensitivity reactions.
Treatment of acute and chronic psychotic disorders, Teach client:
including schizophrenia, manic states, and drug-
induced psychoses. Also useful in the management • Take the medication as directed. Do not discon-
tinue abruptly.
of aggressive or agitated clients. Treatment of
Tourette’s syndrome. • Report abnormal muscle movements or twitches.
Action
• This medication may cause drowsiness.
• Avoid using alcohol or other CNS depressants.
Alters the effects of dopamine in the CNS. Also
has anticholinergic and alpha-adrenergic blocking
• Extremes of temperature should also be avoided.
activity.
CNS: seizures, extrapyramidal reactions, confu- • Assess mental status.
sion, drowsiness, restlessness, tardive dyskinesia. • Monitor BP for orthostatic hypotension.
EENT: blurred vision, dry eyes. Resp: respiratory • May cause QT interval changes on ECG.
depression. CV: hypotension, tachycardia. • Refer immediately to movement disorders
specialist if EPS occur.
GI: constipation, dry mouth, anorexia, drug-
induced hepatitis, ileus. GU: urinary retention. • Monitor for development of neuroleptic
malignant syndrome.
Derm: diaphoresis, photosensitivity, rashes.
Endo: galactorrhea. Hemat: anemia, leukopenia. • Monitor CBC and LFT.
Route/Dosage: Haloperidol: PO, IV, IM/0.5–5 mg daily in divided doses; IM/(haloperidol decanoate) 100–300 mg monthly, Droperidol:
IV/0.5–1.25 mg q 4 hr (antiemetic) Uploaded by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 144
Central Nervous System Drugs Phenothiazines 144
Chlorpromazine Fluphenazine
(klor-proe-ma-zeen) (floo-fen-a-zeen)
Thorazine Prolixin, Prolixin

Novo- Decanoate
Chlorpromazine Apo-Fluphenazine
Perphenazine
(per-fen-a-zeen)
Trilafon
Apo-Perphenazine
1882_Tab06_109-160 11/10/12 2:40 PM Page 144
Central Nervous System Drugs Phenothiazines 144

Therapeutic/Pharmacologic Class pigment changes, rashes. Endo: galactorrhea.
Antipsychotic agent/phenothiazine (older antipsy- Hemat: agranulocytosis, leukopenia. Metab:
chotic agent) hyperthermia. Misc: allergic reactions.
Treatment of acute and chronic psychoses, particu- Teach client:
larly when accompanied by increased psychomotor
activity. Treatment of nausea and vomiting. • Take the medication exactly as directed.
Treatment of intractable hiccups. • Report abnormal muscle movement or twitches
immediately to HCP.
Action • This medication may cause drowsiness.
Alters the effects of dopamine in the CNS. Has sig- • Avoid using alcohol or other CNS depressants.
nificant anticholinergic/alpha-adrenergic blocking
activity.
• Extremes of temperature should be avoided.
CNS: neuroleptic malignant syndrome, sedation,
Make the Connection
extrapyramidal reactions, tardive dyskinesia. • Assess client’s mental status prior to and
periodically throughout therapy.
EENT: blurred vision, dry eyes, lens opacities.
CV: hypotension (increased with IM, IV), tachycar- • Refer to a movement disorder specialist if EPS occur.
dia. GI: constipation, dry mouth, anorexia, hepatitis, • Monitor for orthostatic hypotension.
ileus. GU: urinary retention. Derm: photosensitivity, • Monitor for development of neuroleptic malignant
syndrome.
• Monitor CBC, LFT, and ocular acuity.
Route/Dosage: Chlorpromazine: PO/200 mg daily in divided doses; IM/25–50 mg initially, repeated in an hr (up to 1 g daily) for severe psychosis,
Fluphenazine: PO/0.5–10 mg daily in divided doses q 6–8 hr; IM/(fluphenazine decanoate) 12.5–25 mg q 3 wk, up to 100 mg daily,
Uploaded
Perphenazine: PO/2–16 mg daily in divided doses; byIV/1–5
IM/15–30 mg daily; MEDBOOKSVN.ORG
mg, or 0.5 mg/min as infusion, for nausea or intractable hiccups
1882_Tab06_109-160 11/10/12 2:40 PM Page 145
Central Nervous System Drugs Thioxanthines 145
Thiothixene
(thye-oh-thix-een)
Navane
1882_Tab06_109-160 11/10/12 2:40 PM Page 145
Central Nervous System Drugs Thioxanthines 145

Therapeutic/Pharmacologic Class • Report symptoms such as abnormal muscle
Antipsychotic agent/thioxanthene movement or twitches immediately.
Indications • This medication may cause drowsiness.
Management of psychotic disorders. • Avoid using alcohol or other CNS depressants.
Action • Extremes of temperature should be avoided.
Alters the effect of dopamine in the CNS. • This medication may cause breast enlargement.
• Routine follow-up examinations and continued
Adverse Reactions/Side Effects participation in psychotherapy are needed.
CNS: neuroleptic malignant syndrome,
extrapyramidal reactions, sedation, tardive
dyskinesia, seizures. EENT: blurred vision, dry Make the Connection
eyes, lens opacities. CV: hypotension, tachycardia, • Assess client’s mental status prior to and
nonspecific ECG changes. GI: constipation, dry periodically throughout therapy.
mouth, anorexia, ileus, nausea. GU: urinary • Monitor for orthostatic hypotension.
retention. Derm: photosensitivity, pigment • Refer to a movement disorder specialist if EPS
changes, rashes. Endo: breast enlargement, occur.
galactorrhea. Hemat: leukocytosis, leukopenia. • Monitor for development of neuroleptic malig-
Metab: hyperpyrexia. Misc: allergic reactions. nant syndrome.
• Monitor CBC, LFT, and ocular acuity.
Keep in Mind • Avoid contact with all forms of solution because
Teach client: it may cause dermatitis.
Route/Dosage: PO/2 mg tid (mild), 5 mg bid Uploaded by

(severe), up to 20–30 MEDBOOKSVN.ORG
mg daily
1882_Tab06_109-160 11/10/12 2:40 PM Page 146
Central Nervous System Drugs Dihydrocarbostyril 146
Aripiprazole
(a-ri-pip-ra-zole)
Abilify
1882_Tab06_109-160 11/10/12 2:40 PM Page 146
Central Nervous System Drugs Dihydrocarbostyril 146

Therapeutic/Pharmacologic Class tachycardia, HTN. GI: constipation, anorexia,
Antipsychotic agent; mood stabilizer/dihydrocarbostyril dry mouth, increased salivation, nausea, vomit-
Indications ing, weight loss. GU: incontinence. Derm:
Treatment of schizophrenia. Acute and maintenance sweating, dry skin, ecchymosis, skin ulcer. MS:
therapy of manic and mixed episodes associated muscle cramps, neck pain. Endo: hyperglycemia.
with bipolar disorder (as monotherapy or with lithium Hemat: bone marrow changes including ane-
or valproate); adjunctive treatment of depression in mia, leukopenia, and neutropenia.
adults; and treatment of agitation associated with Keep in Mind
schizophrenia or bipolar disorder and irritability Teach client:
associated with autistic disorder in children.
Action
• Report abnormal muscle movements or seizures
to HCP immediately.
Psychotropic activity may be due to agonist activity
at dopamine D2 and serotonin 5-HT1A receptors
• May cause drowsiness; avoid concurrent use of
alcohol or other CNS depressants.
and antagonist activity at the 5-HT2A receptor. Also
has alpha1-adrenergic blocking activity.
CNS: neuroleptic malignant syndrome, suicidal • Monitor client’s mental status, BP, CBC,
LFT, HgA1c and serum glucose.
thoughts, seizures, drowsiness, sedation, tardive
dyskinesia, nervousness, lightheadedness, insom- • Refer to a movement disorder specialist if EPS
occur.
nia, confusion, manic reactions, akathisia, EPS,
impaired cognitive function, abnormal gait, • Monitor for development of neuroleptic
malignant syndrome.
tremor. EENT: visual disturbances, conjunctivitis,
ear pain. CV: chest pain, orthostatic hypotension,
1882_Tab06_109-160 11/10/12 2:40 PM Page 147
Central Nervous System Drugs Benzisoxizoles 147
Risperidone
(ris-pear-i-doen)
Risperdal, Risperdal M-TAB,

Risperdal Consta
1882_Tab06_109-160 11/10/12 2:40 PM Page 147
Central Nervous System Drugs Benzisoxizoles 147

Therapeutic/Pharmacologic Class photosensitivity, seborrhea. Endo: galactorrhea,
Antipsychotics; mood stabilizers/benzisoxizoles hyperglycemia. Hemat: agranulocytosis, leukopenia,
Indications neutropenia. MS: arthralgia, back pain.
Treatment of schizophrenia, bipolar disorder, and Keep in Mind
irritability in autistic children. Teach client:
Action • Take the medication exactly as directed.
May act by antagonizing dopamine and serotonin
in the CNS.
• Watch for abnormal muscle movements or
twitches and report these symptoms immediately.
Adverse Reactions/Side Effects • This medication may cause seizures and drowsiness.
CNS: neuroleptic malignant syndrome, suicidal • Avoid concurrent use of alcohol and other CNS
thoughts, aggressive behavior, dizziness, depressants.
extrapyramidal reactions, headache, ↑ dreams,
↑ sleep duration, insomnia, sedation, fatigue,
impaired temperature regulation, nervousness,
Make the Connection
tardive dyskinesia. EENT: pharyngitis, rhinitis, • Monitor client’s mental status before and
periodically during therapy.
visual disturbances. Resp: cough, dyspnea. CV:
arrhythmias, orthostatic hypotension, tachycar- • Monitor for orthostatic hypotension.
dia. GI: constipation, diarrhea, dry mouth, • Monitor ECG for cardiac abnormalities.
nausea, abdominal pain, anorexia, dyspepsia, ↑ • Refer to a movement disorder specialist if EPS occur.
salivation, vomiting, weight gain, weight loss, poly- • Monitor for development of neuroleptic malignant
syndrome.
dipsia. GU: ↓ libido, dysmenorrhea/menorrhagia,
difficulty urinating, polyuria. Derm: itching/ • Monitor CBC and LFT.
skin rash, dry skin, ↑ pigmentation, sweating,
Route/Dosage: PO/1 mg bid; IM/25–50 mg qUploaded
2 wk by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 148
Central Nervous System Drugs Thienobenzodiazepines 148
Olanzapine
(oe-lanz-a-peen)
Zyprexa, Zyprexa Relprevv, Zyprexa

Intramuscular, Zyprexa Zydis
1882_Tab06_109-160 11/10/12 2:40 PM Page 148
Central Nervous System Drugs Thienobenzodiazepines 148

Therapeutic/Pharmacologic Class EENT: amblyopia, rhinitis, ↑ salivation, pharyngitis.
Antipsychotic; mood stabilizer/Thienobenzodiazepines Resp: cough, dyspnea. CV: bradycardia, chest pain,
Indications orthostatic hypotension, tachycardia. GI: constipa-
Acute therapy of manic or mixed episodes associated tion, dry mouth, ↑ liver enzymes, weight loss or
with bipolar I disorder (as monotherapy or with lithi- gain, abdominal pain, ↑ appetite, nausea, ↑ thirst.
um or valproate) and maintenance therapy of bipolar GU: impotence, ↓ libido, urinary incontinence.
I disorder. Treatment of acute agitation due to schizo- Hemat: agranulocytosis, leukopenia, neutropenia.
phrenia or bipolar I mania (IM), depressive episodes Keep in Mind
associated with bipolar I disorder (when used with Teach client:
fluoxetine), and treatment-resistant depression (when
used with fluoxetine). Unlabeled uses: Anorexia • Take the medication exactly as directed.
nervosa and emesis associated with chemotherapy. • Report abnormal muscle movements or seizure to
HCP immediately.
Action • May cause drowsiness so avoid concurrent use of
Antagonizes dopamine and serotonin type 2 in the alcohol and other CNS depressants.
CNS and has anticholinergic, antihistaminic, and
anti–alpha1-adrenergic effects.
CNS: neuroleptic malignant syndrome, seizures, • Monitor client’s mental status, BP, ECG,
CBC, and LFT.
suicidal thoughts, agitation, delirium, dizziness,
headache, restlessness, sedation, weakness, • Refer to a movement disorder specialist if EPS occur.
dystonia, insomnia, mood changes, personality • Monitor for development of neuroleptic malig-
nant syndrome.
disorder, speech impairment, tardive dyskinesia.
Route/Dosage: PO/10 mg daily; IM/300 mg qUploaded

2 wk by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 149
Central Nervous System Drugs Piperizine Derivative 149
Ziprasidone
(zye-pras-i-doen)
Geodon
1882_Tab06_109-160 11/10/12 2:40 PM Page 149
Central Nervous System Drugs Piperizine Derivative 149

Antipsychotic; mood stabilizer/piperizine derivatives Teach client:
Indications • Take the medication exactly as directed.
Treatment of schizophrenia. IM form is reserved for • Watch for abnormal muscle movements or
control of acutely agitated patients and treatment twitches and report these symptoms immediately.
of bipolar mania (acute manic and manic/mixed • This medication may cause seizures and drowsiness.
episodes). • Avoid concurrent use of alcohol and other CNS
depressants.
Action
Effects probably mediated by antagonism of
dopamine type 2 (D2) and serotonin type 2 (5-HT2). Make the Connection
Adverse Reactions/Side Effects • Monitor client’s mental status before and
CNS: neuroleptic malignant syndrome, periodically during therapy.
seizures, dizziness, drowsiness, restlessness, • Monitor for orthostatic hypotension.
EPS, syncope, tardive dyskinesia. Resp: • Monitor ECG for cardiac abnormalities.
cough/runny nose. CV: prolonged QT interval, • Refer to a movement disorder specialist if EPS
orthostatic hypotension. GI: constipation, occur.
diarrhea, nausea, dysphagia. GU: amenorrhea, • Monitor for development of neuroleptic
impotence. Hemat: agranulocytosis, leukopenia, malignant syndrome.
neutropenia. Endo: galactorrhea. Derm: rash, • Monitor CBC and LFT.
urticaria.
Route/Dosage: PO/20 mg daily initially (up toUploaded bymgMEDBOOKSVN.ORG

40–80 mg bid); IM/40 daily in divided doses
1882_Tab06_109-160 11/10/12 2:40 PM Page 150
Central Nervous System Drugs Ergot Alkaloids 150
Ergotamine
(er-got-a-meen)
Ergomar, Ergostat
Gynergen
Dihydroergotamine
(dye-hye-droe-er-got-a-meen)
D.H.E. 45, Migranal

Dihydroergotamine-Sandoz
1882_Tab06_109-160 11/10/12 2:40 PM Page 150
Central Nervous System Drugs Ergot Alkaloids 150

Vascular headache suppressant/ergot alkaloid Teach client:
Indications • Use pain scale as instructed to objectively rate
severity of migraine symptoms.
Treatment of vascular, cluster, and migraine headache.
Methylergonovine is an oxytocic that contracts the • Report palpitations or chest pain immediately.
uterus to prevent postpartum hemorrhage. • Do not take this medication if you have uncon-
trolled HTN, PVD, or ischemic heart disease.
Action • Laboratory tests will be scheduled periodically.
Vasoconstriction of dilated blood vessels by stimu-
lating alpha-adrenergic and serotonergic (5-HT)
receptors. Larger doses may produce alpha- Make the Connection
adrenergic blockade and vasodilation. • Monitor pain level using a scale, and
Adverse Reactions/Side Effects report relief of migraine headache.
CNS: dizziness. CV: MI, HTN, angina pectoris, • Monitor ECG and ask client to report palpitations.
arterial spasm, intermittent claudication. GI: • Monitor LFT and RFT periodically.
abdominal pain, nausea, vomiting, diarrhea, poly- • Assess for signs of ergotism (cold, numb fingers
dipsia. MS: extremity stiffness, muscle pain, stiff and toes; nausea; vomiting; headache; muscle
neck, stiff shoulders. Neuro: leg weakness, numb- pain; weakness)
ness or tingling in fingers or toes. Misc: fatigue. • Medicate at the first sign of migraine pain to
possibly abort the migraine headache.
Route/Dosage: Ergotamine: PO, SL/1–2 mg initially, then 1–2 mg q 30 min, until attack subsides or a total of 6 mg has been given; PO/(cluster
headache) 1–2 mg at bedtime for 10–14 days, Dihydroergotamine: IM, SC/1 mg, may repeat in 1 hr, not to exceed 3 mg; IV/0.5 mg, may repeat in
Uploaded
1 hr, not to exceed 2 mg daily; nasal spray/1 spray by
each nostril, may MEDBOOKSVN.ORG
repeat in 15 min (Migranal)
1882_Tab06_109-160 11/10/12 2:40 PM Page 151
Central Nervous System Drugs Appetite Suppressant 151
Sibutramine
(si-byoo-tra-meen)
Meridia
1882_Tab06_109-160 11/10/12 2:40 PM Page 151
Central Nervous System Drugs Appetite Suppressant 151

Weight control agent/appetite suppressant Teach client:
Treatment of obesity in clients with body mass • Avoid using other CNS depressants or excessive
index >30 kg/m2 (or >27 kg/m2 in clients with amounts of alcohol with this medication.
diabetes, HTN, or other risk factors) in conjunction • Take weight at the same time, using the same
with other interventions (dietary restriction, exercise); scale, with the same clothing weekly.
used to produce and maintain weight loss.
Acts as an inhibitor of the reuptake of serotonin,
norepinephrine, and dopamine; increases the
• Concurrent use of other centrally acting
appetite suppressants, MAOIs, SSRIs, 5-HT1
satiety-producing effects of serotonin. agonists, dihydroergotamine, dextromethorphan,
Adverse Reactions/Side Effects meperidine, pentazocine, fentanyl, lithium, or
CNS: seizures, headache, insomnia, CNS stimu- tryptophan may result in potentially fatal “sero-
lation, dizziness, drowsiness, emotional lability, tonin syndrome.”
nervousness. EENT: laryngitis/pharyngitis, rhinitis, • Monitor clients for weight loss and adjust concur-
sinusitis. CV: HTN, palpitations, tachycardia, rent medications as needed.
vasodilation. GI: anorexia, constipation, dry • Monitor BP and heart rate regularly during
mouth, altered taste, dyspepsia, increased therapy. Increases in BP or heart rate, especially
appetite, nausea. GU: dysmenorrhea. Derm: during early therapy, may require decrease in
increased sweating, rash. dose or discontinuation of this drug.
Route/Dosage: PO/10–15 mg once daily Uploaded by MEDBOOKSVN.ORG

1882_Tab06_109-160 11/10/12 2:40 PM Page 152
Central Nervous System Drugs Central Nervous System Stimulants 152
Methylphenidate
(meth-ill-fen-i-date)
Concerta, Metadate CD, Metadate ER,

Methylin, Ritalin, Ritalin LA, Ritalin-SR
PMS-Methylphenidate
Daytrana Transdermal Patch
Dexmethylphenidate
(dex-meth-ill-fen-i-date)
Focalin, Focalin XR
1882_Tab06_109-160 11/10/12 2:40 PM Page 152

Central nervous system (CNS) stimulant Teach client:
Indications • Take medication as directed before 6 PM.
Treatment of attention deficit/hyperactivity disorder • Weight will be assessed 2–3 times weekly.
(ADHD). Symptomatic treatment of narcolepsy. • Avoid using caffeine-containing beverages.
Unlabeled uses: Management of some forms of • Report palpitations or insomnia.
refractory depression. • Parents are to notify school nurse of medication
regimen (ADHD).
Action
Produce CNS and respiratory stimulation with weak
sympathomimetic activity. Make the Connection
Adverse Reactions/Side Effects • Using with MAOIs or vasopressors may
CNS: hyperactivity, insomnia, restlessness, result in hypertensive crisis.
tremor, dizziness, headache, irritability. EENT: • Monitor BP, pulse, and respiration.
blurred vision. CV: HTN, palpitations, tachycardia, • Medication has a high dependence and abuse
hypotension. GI: anorexia, constipation, cramps, potential.
diarrhea, dry mouth, metallic taste, nausea, • Assess effectiveness when used for ADHD or
vomiting. Derm: rashes. Neuro: akathisia, narcolepsy.
dyskinesia. Misc: fever, hypersensitivity reactions, • Monitor CBC.
physical dependence, psychological dependence,
suppression of weight gain (children), tolerance.
Route/Dosage: Methylphenidate: transdermal/(children) 10–30 mg over a wk, gradually increased; PO/5–20 mg 2–3 times a day (ER varies as to
formulation), Dexmethylphenidate: PO/2.5–10Uploaded
mg bid; 10 mg bidby
(ER) MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 153
Amphetamine
(am-fet-a-meen)
Amphetamine Salt, Adderall,

Adderall XR
1882_Tab06_109-160 11/10/12 2:40 PM Page 153

Central nervous system (CNS) stimulant Teach client:
Indications • Take the medication at least 6 hr before bedtime.
Treatment of narcolepsy. Adjunct in the management • Report insomnia or palpitations.
of ADHD. • Weight will be assessed frequently.
Action
Causes release of norepinephrine from nerve endings. Make the Connection
Adverse Reactions/Side Effects • Using with MAOIs or meperidine can
CNS: hyperactivity, insomnia, irritability, rest- result in hypertensive crisis.
lessness, tremor, dizziness, headache, cardiomy- • Monitor BP, pulse, and respiration.
opathy (increased with prolonged use, high • Medication may produce a false sense of euphoria
doses). CV: palpitations, tachycardia, HTN, and well-being.
hypotension. GI: anorexia, constipation, cramps, • Medication has high dependence and abuse
diarrhea, dry mouth, metallic taste, nausea, potential.
vomiting. GU: erectile dysfunction, increased • Monitor weight biweekly.
libido. Derm: urticaria. Endo: growth inhibition • Assess effectiveness in treatment of ADHD or
(with long-term use in children). Misc: psycho- narcolepsy.
logical dependence.
Uploaded
Route/Dosage: PO/(narcolepsy) 10–60 mg daily in divided doses; by MEDBOOKSVN.ORG
PO/(ADHD) 20 mg ER formulation once daily
1882_Tab06_109-160 11/10/12 2:40 PM Page 154
Central Nervous System Drugs Selective Norepinephrine Reuptake Inhibitor 154
Atomoxetine
(a-to-mox-e-teen)
Strattera
1882_Tab06_109-160 11/10/12 2:40 PM Page 154
Central Nervous System Drugs Selective Norepinephrine Reuptake Inhibitor 154

Attention deficit disorder agent/selective norepi- Teach client:
nephrine reuptake inhibitor • Take medication as directed.
Indications • Avoid pregnancy or breastfeeding.
Treatment of ADHD. • Notify school nurse of ADHD medication regimen.
Action
Selectively inhibits the presynaptic transporter of Make the Connection
norepinephrine. • Contraindicated if used concurrently
Adverse Reactions/Side Effects with or within 2 wk of MAOIs.
CNS: dizziness, fatigue, mood swings, insomnia • Contraindicated in clients with narrow-angle
(adults). CV: HTN, orthostatic hypotension, glaucoma or CV history.
tachycardia. GI: dyspepsia, severe liver injury • This medication may ↑ risk of suicide attempt/
(rare), nausea, vomiting; dry mouth, constipa- ideation.
tion. Derm: rash, urticaria. GU: dysmenorrhea, • Concurrent albuterol or vasopressor use
ejaculatory problems, ↓ libido, erectile dysfunc- increases risk of adverse CV reactions.
tion, urinary hesitation, urinary retention. • Assess effectiveness for treatment of ADHD.
Metab: decreased appetite, weight/growth loss. • Monitor BP, pulse, and LFT.
Misc: allergic reactions including angioneurotic
edema.
Route/Dosage: PO/40–100 mg daily in dividedUploaded byearlyMEDBOOKSVN.ORG

doses in the AM and PM
1882_Tab06_109-160 11/10/12 2:40 PM Page 155
Central Nervous System Drugs Central Nervous System Stimulant 155
Modafinil
(mo-daf-i-nil)
Provigil
1882_Tab06_109-160 11/10/12 2:40 PM Page 155
Central Nervous System Drugs Central Nervous System Stimulant 155

Therapeutic/Pharmacologic Class disorder, neck pain. Neuro: ataxia, dyskinesia,
Central nervous system (CNS) stimulant hypertonia, paresthesia, tremor. Misc: infection.
Improvement of wakefulness in clients with excessive Teach client:
daytime drowsiness due to narcolepsy, obstructive
sleep apnea, or shift work sleep disorder. • Take the medication as directed.
Action
• This medication may impair judgment.
• Avoid pregnancy or breastfeeding.
Produces CNS stimulation through several pathways
(weak dopaminergic activity, alpha1-adrenergic ago-
• Notify HCP immediately if rash, hives, or other
allergic reactions occur.
nism, and decrease in GABA transmission).
CNS: headache, amnesia, anxiety, cataplexy,
Make the Connection
confusion, depression, dizziness, insomnia, ner- • Contraindicated in patients with CV
problems.
vousness. EENT: rhinitis, abnormal vision, ambly-
opia, epistaxis, pharyngitis. Resp: dyspnea, lung • May cause elevated liver enzymes, so monitor
LFT periodically.
disorder. CV: arrhythmias, chest pain, HTN,
hypotension, syncope, vasodilation. GI: nausea, • Administer as a single dose in the morning or 1 hr
before the start of work shift for clients with shift
abnormal liver function, anorexia, diarrhea,
work sleep disorder.
gingivitis, mouth ulcers, thirst, vomiting. GU:
abnormal ejaculation, albuminuria, urinary
retention. Derm: dry skin, herpes simplex. Endo:
hyperglycemia. Hemat: eosinophilia. MS: joint
Uploaded
Route/Dosage: PO/200 mg daily as a single dose by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 156
Central Nervous System Drugs 5-HT1 Agonists 156
Almotriptan Sumatriptan
(al-moe-trip-tan) (su-ma-trip-tan)
Axert Imitrex, Imitrex

STATdose, Sumavel
DosePro
Rizatriptan Naratriptan
(ri-za-trip-tan) (nar-a-trip-tan)
Maxalt, Maxalt-MLT Amerge

1882_Tab06_109-160 11/10/12 2:40 PM Page 156
Central Nervous System Drugs 5-HT1 Agonists 156

Therapeutic/Pharmacologic Class • Lying down in a darkened room following drug
Vascular headache suppressant/5-HT1 agonist administration may further help relieve headache.
Indications • Avoid pregnancy or breastfeeding.
Treatment of acute migraine headache. • Notify HCP prior to next dose of the drug if
there is pain or tightness in the chest or if pain
Action is severe or does not subside.
Acts as an agonist at specific 5-HT1 receptor sites in
intracranial blood vessels and sensory trigeminal nerves. • May cause dizziness or drowsiness.
• Avoid alcohol, which aggravates headache.
Adverse Reactions/Side Effects • Follow instructions for proper method of SC
CNS: drowsiness, headache. CV: coronary artery self-injection of medication.
vasospasm, MI, myocardial ischemia, VFib, VT.
GI: dry mouth, nausea. Neuro: paresthesia.
Make the Connection
Keep in Mind • Medication is contraindicated in basilar
Teach client: or hemiplegic migraine.
• Medication should be used only during a • Concurrent use with MAOI inhibitors, SSRIs, or
migraine attack. other 5-HT1 agonists is contraindicated.
• Medication should be used as soon as symptoms • Tablets should be swallowed whole with liquid.
of a migraine attack appear. • SC-administered medications may abort a vascular
• Do not take medication within 24 hr of another headache within several minutes.
vascular headache suppressant. • Monitor ECG.
Route/Dosage: Almotriptan: PO/6.25 mg initially. May repeat in 2 hr (2 dose maximum), Sumatriptan: PO/25–50 mg initially, may repeat in 2 hr
(300 mg/day maximum); SC/6 mg, may repeat in 1 hr (12 mg daily maximum); intranasal/5, 10, or 20 mg spray in one nostril, may repeat in
2 hr (40 mg daily maximum), Rizatriptan: PO/5–10 mg, may repeat in 2 hr (3 doses/24 hr maximum), Naratriptan: PO/1 or 2.5 mg, may repeat
in 4 hr (5 mg/24 hr maximum) Uploaded by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 157
Central Nervous System Drugs Adrenergics 157
Epinephrine
(e-pi-nef-rin)
Adrenalin, AsthmaNefrin,
EpiPen, S-2 (racepinephrine)
1882_Tab06_109-160 11/10/12 2:40 PM Page 157

Antiasthmatic agent; bronchodilator; vasopressor/ Teach client:
adrenergic agent • Take medication exactly as directed.
Indications • Contact HCP immediately if SOB is not relieved
Management of cardiac arrest. Increase of contrac- by medication or is accompanied by diaphoresis,
tility, heart rate, and urinary output in shock. dizziness, palpitations, or chest pain.
Action • Follow instructions for proper use of MDIs.
Results in the accumulation of cAMP at beta-
adrenergic receptors. Affects both beta1-adrenergic Make the Connection
(cardiac) receptors and beta2-adrenergic (pulmonary)
receptor sites. Produces bronchodilation. Also has
• Contraindicated in hypersensitivity to
adrenergic amines and in cardiac arrhythmias.
alpha-adrenergic agonist properties, which result in
vasoconstriction. Inhibits the release of mediators
• Assess lung sounds, respiratory pattern, pulse,
BP, and ECG.
of immediate hypersensitivity reactions from mast cells.
• Observe for paradoxical bronchospasm
Adverse Reactions/Side Effects (wheezing).
CNS: nervousness, restlessness, tremor,
headache, insomnia. Resp: paradoxical bron-
• Assess for hypersensitivity reaction (rash;
urticaria; swelling of the face, lips, or eyelids).
chospasm (excessive use of inhalers). CV: angina,
arrhythmias, HTN, tachycardia. GI: nausea,
• May cause an increase in blood glucose and
serum lactic acid concentrations.
vomiting. Endo: hyperglycemia. • Client harm or fatalities have occurred from
medication errors with this drug. Have second
practitioner check dose calculations (IV).
Route/Dosage: SC, IM/0.1–0.5 mg, may repeat q 10–15 min for anaphylaxis; IV/0.1–0.25 mg q 5–15 min for severe anaphylaxis; Inhaln/MDI
Uploaded
delivering 160–250 mcg in one puff, may repeat byq 3–4
once after 1 min, then MEDBOOKSVN.ORG
hr
1882_Tab06_109-160 11/10/12 2:40 PM Page 158
Terbutaline
(ter-byoo-ta-leen)
1882_Tab06_109-160 11/10/12 2:40 PM Page 158

Bronchodilator/adrenergic agent Teach client:
Management of reversible airway disease due to • Contact HCP immediately if SOB is not relieved
asthma or COPD; Inhaln and SC agents used for or if chest pain occurs.
short-term control and oral agent for long-term • Consult HCP before taking any OTC medications
control. or consuming alcoholic beverages.
Action • Avoid smoking and other respiratory irritants.
Results in the accumulation of cAMP at beta-
adrenergic receptors. Relaxes smooth muscle in Make the Connection
the airways, vessels, and uterus. • Assess lung sounds, respiratory pattern,
Adverse Reactions/Side Effects ECG, pulse, and BP before administration and
CNS: nervousness, restlessness, tremor, headache, during peak of medication.
insomnia. Resp: paradoxical bronchospasm • Observe for paradoxical bronchospasm
(excessive use of inhalers). CV: angina, arrhyth- (wheezing).
mias, HTN, tachycardia. GI: nausea, vomiting. • Symptoms of overdose include persistent agitation,
Endo: hyperglycemia. chest pain or discomfort, decreased BP, dizziness,
hyperglycemia, hypokalemia, seizures, tachyarrhyth-
mias, persistent trembling, and vomiting.
Uploaded
Route/Dosage: PO/2.5–5 mg tid; SC/250 mcg, byminMEDBOOKSVN.ORG
may repeat in 15–30 (500 mcg in 4 hr maximum); IV/2.5–10 mcg/min infusion for tocolysis
1882_Tab06_109-160 11/10/12 2:40 PM Page 159
Central Nervous System Drugs Opioid Agonist Antagonist 159
Butorphanol
(byoo-tor-fa-nole)
Stadol, Stadol NS
1882_Tab06_109-160 11/10/12 2:40 PM Page 159
Central Nervous System Drugs Opioid Agonist Antagonist 159

Opioid analgesic/opioid agonist antagonist Teach client:
Indications • Request pain medication prior to the pain becoming
Management of moderate-to-severe pain. severe.
Treatment of labor pain. Sedation prior to surgery • Medication may cause drowsiness or dizziness. Call
and supplement in balanced anesthesia. for assistance when ambulating. Change positions
slowly to minimize orthostatic hypotension.
Action
Binds to opiate receptors in the CNS. Alters the • Turn, cough, and deep-breathe or use incentive
spirometer q 2 hr to prevent atelectasis.
perception of and response to painful stimuli while
producing generalized CNS depression. Has partial
antagonist properties that may result in opioid Make the Connection
withdrawal in physically dependent patients. • Assess pain level using a scale or client
Adverse Reactions/Side Effects behavior.
CNS: confusion, dysphoria, hallucinations, • Monitor VS regularly, especially respiratory rate
sedation, euphoria, floating feeling, headache, and pulse oximetry.
unusual dreams. EENT: blurred vision, diplopia, • Assess previous analgesic history. Administering
miosis (high doses). Resp: respiratory depres- this medication to a client who is opioid-dependent
sion. CV: HTN, hypotension, palpitations. GI: may cause immediate withdrawal symptoms.
nausea, constipation, dry mouth, ileus, vomiting. • Monitor for ↑ serum amylase and lipase.
GU: urinary retention. Derm: sweating, clammy • Antidote is naloxone.
feeling. Misc: physical dependence, psychological
dependence, tolerance.
Route/Dosage: IM/1–4 mg q 3–4 hr; IV/0.5–2Uploaded by MEDBOOKSVN.ORG

mg q 3–4 hr; intranasal/1–2 mg (1–2 sprays) q 3–4 hr
1882_Tab06_109-160 11/10/12 2:40 PM Page 160
Central Nervous System Drugs Antidepressants 160
St. John’s Wort

(Hypericum perforatum)
(saynt jonz wort)
Amber, Demon chaser,

Goatweed, Hardhay, Klamath
weed, Rosin rose, Tipton weed
1882_Tab06_109-160 11/10/12 2:40 PM Page 160
Central Nervous System Drugs Antidepressants 160

Therapeutic/Pharmacologic Class wort should be taken for 4–6 wk. If no improve-
Antidepressants ment, see HCP.
Indications • Tell HCP if herbals are being used. Buy herbals
Treatment of mild depressive symptoms. from reputable supplier.
Action • Avoid sun exposure and use protective sunscreen
Derived from Hypericum perforatum; the active com- to reduce the risk of photosensitivity reactions.
ponent is hypericin. PO: Antidepressant action may • Do not use alcohol while taking St. John’s wort.
be due to ability to inhibit reuptake of serotonin and • St. John’s wort may reduce the therapeutic effec-
other neurotransmitters. Topical: Anti-inflammatory, tiveness of several drugs and may potentiate
antifungal, antiviral, and antibacterial properties. effect of sedatives and side effects of other antide-
pressants. Do not take within 2 wk of MAOIs,
Adverse Reactions/Side Effects SSRIs, TCAs, or SNRIs.
CNS: dizziness, restlessness, sleep disturbances.
CV: HTN. Endo: hypoglycemia. GI: abdominal
pain, bloating, diarrhea, dry mouth, feeling of full- Make the Connection
ness, flatulence, nausea, vomiting. Neuro: neuropa- • Use with MAOIs, tramadol, and selective
thy. Derm: allergic skin reactions (hives, itching, skin serotonin agonists could result in serotonin
rash), phototoxicity. Misc: serotonin syndrome. syndrome.
• May ↓ effectiveness of oral contraceptives, pheny-
Keep in Mind toin, and phenobarbital.
Teach client:
• Assess client for improvement of depressive symp-
• Depression should be evaluated by HCP. toms or improvement of skin lesions (topical).
Standard therapy may be of greater benefit
for moderate-to-severe depression. St. John’s
Route/Dosage: PO/300 mg tid Uploaded by MEDBOOKSVN.ORG
CARDIOVASCULAR
Protamine Sulfate, 161 Inamrinone, 170 Valsartan, 176

Heparin, 162 Nesiritide, 171 Irbesartan, 176
Tinzaparin, 162 Dopamine, 172 Clonidine, 177
Dalteparin, 163 Metoprolol, 173 Procainamide, 178
Enoxaparin, 163 Carvedilol, 173 Lidocaine
Warfarin, 164 Atenolol, 173 (parenteral), 178
Ticlopidine, 165 Labetalol, 173 Amiodarone, 178
Clopidogrel, 165 Amlodipine, 174 Quinidine, 178
Cilostazol, 165 Verapamil, 174 Isosorbide
Aminocaproic Acid, 166 Nifedipine, 174 Mononitrate, 179
Alteplase, 167 Diltiazem, 174 Nitroglycerin, 179
Tenecteplase, 167 Enalapril, Enalaprilat, 175 Isosorbide Dinitrate, 179
Streptokinase, 167 Lisinopril, 175 Gemfibrozil, 180
Reteplase, 167 Ramipril, 175 Fenofibrate, 180
Phytonadione, 168 Captopril, 175 Atorvastatin, 181
Digoxin, 169 Losartan, 176 Rosuvastatin, 181
Milrinone, 170 Candesartan, 176 Simvastatin, 181
Continued
CARDIOVASCULAR
Lovastatin, 181 Omega-3-Acid Ethyl Atropine, 188

Ezetimibe, 182 Esters, 184 Dabigatran, 189
Colestipol, 183 Folic Acid, 185 Desirudin, 189
Cholestyramine Aliskiren, 186 Oprelvekin, 190
Resin, 183 Pegfilgrastim, 187 Fondaparinux, 191
Colesevelam, 183 Filgrastim, 187 Rivaroxaban, 191
1882_Tab07_161-191 11/10/12 2:41 PM Page 161
Cardiovascular System Drugs Antiheparin 161
Protamine Sulfate
(proe-ta-meen soll-fate)
Protamine Sulfate (Injection)

1882_Tab07_161-191 11/10/12 2:41 PM Page 161
Cardiovascular System Drugs Antiheparin 161

Antidote/antiheparin agent Teach client:
Indications • Report recurrent bleeding immediately.
Acute management of severe heparin overdosage. • Avoid activities that may result in bleeding.
Neutralization of heparin received during dialysis,
cardiopulmonary bypass, and other procedures. Make the Connection
Unlabeled uses: Management of overdose of
heparin-like compounds. • Assess for bleeding and hemorrhage
throughout therapy.
Action • Assess for allergy to fish (salmon) or previous
A strong base that forms a complex with heparin reaction to or use of insulins containing this
(an acid). drug or to the drug itself. Observe client for
Adverse Reactions/Side Effects signs and symptoms of hypersensitivity reaction.
Resp: dyspnea. CV: bradycardia, HTN, hypoten- • Vasectomized and infertile men also have higher
sion, pulmonary hypertension. GI: nausea, risk for hypersensitivity reaction because of the
vomiting. Derm: flushing, warmth. Hemat: presence of antibodies to the drug found in
bleeding. MS: back pain. Misc: hypersensitivity their serum.
reactions, including anaphylaxis, angioedema, • Monitor clotting factors.
and pulmonary edema. • In severe cases, fresh frozen plasma or whole
blood may be required to control bleeding.
• Dosage varies with type of heparin, route of
heparin therapy, and amount of time elapsed
since discontinuation of heparin.
• May be given as a direct, undiluted IV infusion.
Uploaded
Route/Dosage: IV/0.5–1.5 mg/100 units heparin by and
(based on time frame MEDBOOKSVN.ORG
route)
1882_Tab07_161-191 11/10/12 2:41 PM Page 162
Cardiovascular System Drugs Antithrombotics 162
Heparin
(hep-a-rin)
Hep-Lock, Hep-Lock U/P

Hepalean
Tinzaparin
(Tin-za-par-in)
Innohep
1882_Tab07_161-191 11/10/12 2:41 PM Page 162
Cardiovascular System Drugs Antithrombotics 162

Anticoagulant/antithrombotic agent Teach client:
Indications • Report any symptoms of unusual bleeding or
Prophylaxis and treatment of various thromboem- bruising to the HCP immediately.
bolic disorders, including venous and arterial • Do not take antiplatelet agents.
thrombosis, embolism, pulmonary emboli, coagu- • Use a soft toothbrush and an electric razor.
lopathies, and atrial fibrillation with embolization. • Wear a Medic-Alert bracelet at all times.
Action
Potentiates the inhibitory effect of antithrombin on Make the Connection
factor Xa and thrombin. In low doses, prevents the • Assess client for signs of bleeding and
conversion of prothrombin to thrombin by its effects hemorrhage.
on factor Xa. In higher doses, neutralizes thrombin, • Monitor for hypersensitivity reactions.
preventing the conversion of fibrinogen to fibrin. • Assess LFT, K+, CBC, aPTT, and D-dimer studies.
Adverse Reactions/Side Effects • Two practitioners should independently check the
GI: drug-induced hepatitis. Derm: alopecia order, calculate the dose (especially in weight-
(long-term use), rash, urticaria. Hemat: bleed- based applications), and set the infusion pump.
ing, anemia, thrombocytopenia. Local: pain at The two practitioners then cosign the MAR.
the injection site. MS: osteoporosis (long-term • Antidote is protamine sulfate.
use). Misc: fever, hypersensitivity.
Route/Dosage: Heparin: SC/5000 units q 8–12 hr; IV/35–70 units/kg continuous infusion (weight-based dosage changes with partial thromboplastin time
Uploaded
(PTT) level/weight calculation), Tinzaparin: SC/175 IU/kg daily by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 163
Cardiovascular System Drugs Antithrombotics (Low Molecular Weight

Heparins) 163
Dalteparin
(dal-te-pa-rin)
Fragmin
Enoxaparin
(e-nox-a-pa-rin)
Lovenox
1882_Tab07_161-191 11/10/12 2:41 PM Page 163
Cardiovascular System Drugs Antithrombotics (Low Molecular Weight

Heparins) 163
Anticoagulant/antithrombotic agent; low molecular Teach client:
weight heparins • Report any symptoms of unusual bleeding or
Indications bruising to the HCP immediately.
Prevention of DVT and PE after abdominal surgery • Do not concurrently take antiplatelet agents.
or knee/hip surgery or replacement. • Use a soft toothbrush and an electric razor.
Action • Wear a Medic-Alert bracelet at all times.
Potentiates the inhibitory effect of antithrombin on • Follow instructions for proper method of inject-
ing the drug.
factor Xa and thrombin.
CNS: dizziness, headache, insomnia. CV: edema. Make the Connection
GI: constipation, nausea, reversible increase in • Assess client for signs of bleeding and
liver enzymes, vomiting. Derm: ecchymosis, hemorrhage.
pruritus, rash, urticaria. Hemat: bleeding, anemia, • Monitor for hypersensitivity reactions.
thrombocytopenia. Local: pain at the injection • Monitor CBC with platelets and D-dimer studies.
site, hematoma. Misc: fever, hypersensitivity. • Monitor LFT.
Neuro: epidural or spinal hematoma with use of • Antidote is protamine sulfate.
these anticoagulants during spinal procedures. • Injection systems have special instructions
(Lovenox is given in the “love handles”).
Uploaded
Route/Dosage: Dalteparin: SC/2500 IU 2 hr before by MEDBOOKSVN.ORG
surgery, Enoxaparin: SC/30–40 mg daily
1882_Tab07_161-191 11/10/12 2:41 PM Page 164
Cardiovascular System Drugs Coumarins 164
Warfarin
(war-fa-rin)
Coumadin, Jantoven
Warfilone
1882_Tab07_161-191 11/10/12 2:41 PM Page 164
Cardiovascular System Drugs Coumarins 164

Therapeutic/Pharmacologic Class • Use a soft toothbrush, floss gently, and shave
Anticoagulant/coumarin with an electric razor during therapy.
Indications • Report any symptoms of unusual bleeding or
Prophylaxis and treatment of venous thrombosis, bruising.
PE, and atrial fibrillation with embolization. • Do not drink alcohol or take antiplatelet
Management of MI. Decrease of risk for death medications.
and subsequent MI and PE. Prevention of thrombus • Frequent laboratory tests will be done.
formation and embolization after prosthetic valve • Wear a Medic-Alert bracelet at all times.
placement. • Inform all involved health-care personnel of
anticoagulant therapy before laboratory tests,
Action treatment, or surgery.
Interferes with hepatic synthesis of vitamin
K-dependent clotting factors (II, VII, IX, X).
GI: cramps, nausea. Derm: dermal necrosis. • Assess client for signs of bleeding and
Hemat: bleeding. Misc: fever. hemorrhage.
• Monitor PT, INR, and CBC.
Keep in Mind • Assess stool and urine occult blood before and
Teach client: periodically throughout therapy.
• Take medication exactly as directed. • The antidote is vitamin K.
• Do not eat excessive amounts of foods containing • This medication requires 3–5 days to reach
vitamin K (give client a list). effective levels.
Route/Dosage: PO, IV/2–5 mg daily, adjustedUploaded

by INR by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 165
Cardiovascular System Drugs Platelet Aggregation Inhibitors 165
Ticlopidine Cilostazol
(tye-cloe-pi-deen) (sil-os-tah-zol)
Pletal
Clopidogrel
(kloh-pid-oh-grel)
Plavix
1882_Tab07_161-191 11/10/12 2:41 PM Page 165
Cardiovascular System Drugs Platelet Aggregation Inhibitors 165

Antiplatelet agent/platelet aggregation inhibitor Teach client:
Reduction of atherosclerotic events in clients at risk • Notify HCP promptly if fever, chills, sore throat,
for such events, including those with recent MI, or unusual bleeding or bruising occurs.
acute coronary syndrome (unstable angina/ • Avoid taking OTC medications containing aspirin
non–Q-wave MI), stroke, or PVD/PAD. or NSAIDs without consulting HCP.
Action
Decreases blood viscosity by inhibiting platelet Make the Connection
aggregation and decreasing fibrinogen. Inhibits
platelet aggregation by irreversibly inhibiting the
• Assess client for symptoms of stroke,
peripheral vascular disease, and MI periodically
binding of ATP to platelet receptors. during therapy.
Adverse Reactions/Side Effects • Monitor client for signs of thrombotic thrombo-
CNS: depression, dizziness, fatigue, headache. cytic purpura.
EENT: epistaxis. Resp: cough, dyspnea. • Prolonged bleeding time is expected. Monitor
CV: chest pain, edema, HTN. GI: GI bleeding, CBC with differential and platelet count periodi-
abdominal pain, diarrhea, dyspepsia, gastritis. cally during therapy.
Derm: pruritus, purpura, rash. Hemat: bleed- • Monitor LFT, lipid panel, and uric acid level.
ing, neutropenia, thrombotic thrombocy- • Contraindicated in idiopathic thrombocytopenic
topenic purpura. Metab: hypercholesterolemia. purpura.
MS: arthralgia, back pain. Misc: fever, hypersen-
sitivity reactions.
Uploaded
Route/Dosage: Ticlopidine: PO/250 mg bid with food, Cilostazol:by MEDBOOKSVN.ORG
PO/100 mg bid, Clopidogrel: PO/75 mg/day
1882_Tab07_161-191 11/10/12 2:41 PM Page 166
Cardiovascular System Drugs Fibrinolysis Inhibitors 166
Aminocaproic Acid
(a-mee-noe-ka-pro-ik as-id)
Amicar, epsilon
aminocaproic acid
1882_Tab07_161-191 11/10/12 2:41 PM Page 166
Cardiovascular System Drugs Fibrinolysis Inhibitors 166

Therapeutic/Pharmacologic Class • When medication is given IV, make position
Hemostatic agent/fibrinolysis inhibitor changes slowly to avoid orthostatic hypotension.
Indications
Management of acute, life-threatening hemorrhage Make the Connection
due to systemic hyperfibrinolysis or urinary fibri-
nolysis. Prevention of recurrent subarachnoid • Contraindicated in active intravascular
clotting.
hemorrhage. Prevention of bleeding following oral
surgery in hemophiliacs. Management of severe • Concurrent use with conjugated estrogens may
result in a hypercoagulable state and resultant
hemorrhage caused by thrombolytic agents. thrombus formation.
Action • Monitor BP, pulse, and respiratory status as
Inhibits activation of plasminogen. Plasminogen is a indicated by severity of bleeding.
serum protease that can be activated to form clots. • Monitor for overt bleeding every 15–30 min.
Adverse Reactions/Side Effects • Monitor neurologic status in clients with sub-
CNS: dizziness, malaise. EENT: nasal stuffiness, arachnoid hemorrhage.
tinnitus. CV: arrhythmias, hypotension (IV only). • Monitor I&O frequently.
GI: anorexia, bloating, cramping, diarrhea, nau- • Notify physician of positive Homans’ sign, leg
sea. GU: diuresis, renal failure. MS: myopathy. pain and edema, hemoptysis, dyspnea, or chest
pain.
Keep in Mind • Monitor platelet count and clotting factors.
Teach client: • Monitor for increased CPK, AST, and serum
• Notify the nurse immediately if bleeding recurs or aldolase, which may indicate myopathy.
if thromboembolic symptoms develop. • May elevate serum potassium, so assess
electrolytes frequently.
Route/Dosage: PO, IV/6 mg/day Uploaded by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 167
Cardiovascular System Drugs Plasminogen Activators 167
Alteplase Streptokinase
(al-te-plase) (strep-toe-kye-nase)
Cathflo Activase, tissue Kabbikinase,

plasminogen activator, Streptase
t-PA, Activase
Activase rt-PA
Tenecteplase Reteplase
(te-nek-te-plase) (re-te-plase)
TNKase Retavase
1882_Tab07_161-191 11/10/12 2:41 PM Page 167
Cardiovascular System Drugs Plasminogen Activators 167

Therapeutic/Pharmacologic Class Local: hemorrhage at injection site, phlebitis
Thrombolytic agent/plasminogen activator at injection site. MS: MS pain. Misc: allergic
Indications reactions including anaphylaxis, fever.
Treatment of acute MI. Treatment of acute ischemic
stroke. Treatment of PE. Clearance of occluded
Keep in Mind
Teach client:
central venous access devices. Treatment of DVT.
Treatment of acute peripheral arterial thrombosis. • Maintain bed rest and move carefully to prevent injuries.
Action
Directly converts plasminogen to plasmin, which Make the Connection
then degrades clot-bound fibrin. • Contraindicated in clients with active
Adverse Reactions/Side Effects internal bleeding, history of CVA or recent (within
CNS: intracranial hemorrhage. EENT: epistaxis, 2 mo) history of arteriovenous or CNS structural
gingival bleeding. Resp: bronchospasm, hemop- abnormalities, severe HTN, or bleeding tendencies.
tysis. CV: reperfusion arrhythmias, hypotension, • Assess client for hypersensitivity reaction,
recurrent ischemia/thromboembolism. GI: GI neurologic status, and bleeding.
bleeding, nausea, retroperitoneal bleeding, • For MI, must be given within 6 hr of onset of
vomiting. GU: GU tract bleeding. Derm: ecchy- symptoms. Remember, time is muscle!
moses, flushing, urticaria. Hemat: bleeding. • For CVA, must be given within 2–3 hr of onset of
symptoms. Remember, time is brain!
• Monitor CBC, D-dimer, fibrinogen, PT, aPTT,
and thrombin time.
• Antidote is aminocaproic acid (Amicar).
Route/Dosage: Alteplase: IV/15 mg bolus, then 0.75 mg/kg over 30 min, and 0.5 mg/kg over next hr, Streptokinase: IV/1.5 million units over 60 min,
Uploaded
Tenecteplase: IV/30–50 mg (weight-based), Reteplase: IV/10 unitsby MEDBOOKSVN.ORG
(repeat in 30 min)
1882_Tab07_161-191 11/10/12 2:41 PM Page 168
Cardiovascular System Drugs Fat-Soluble Vitamin 168
Phytonadione
(fye-toe-na-dye-one)
Mephyton, vitamin K
1882_Tab07_161-191 11/10/12 2:41 PM Page 168
Cardiovascular System Drugs Fat-Soluble Vitamin 168

Therapeutic/Pharmacologic Class • The diet should remain consistent, with no
Antidote, vitamin/fat-soluble vitamin drastic changes, while taking this drug.
Indications • Be aware of the rationale for this drug therapy.
Prevention and treatment of hypoprothrombine- • Watch for and report any symptoms of unusual
mia, which may be associated with excessive bleeding or bruising.
doses of oral anticoagulants, salicylates, certain • While on this drug, consult with the HCP about
anti-infective agents, nutrition deficiencies, and taking OTC medications.
prolonged TPN. Prevention of hemorrhagic disease • Wear a Medic-Alert bracelet.
of the newborn. • Frequent laboratory tests will be required to
monitor coagulation factors.
Action
Required for hepatic synthesis of blood coagulation
factors II (prothrombin), VII, IX, and X. Make the Connection
Adverse Reactions/Side Effects • Monitor for frank and occult bleeding.
GI: gastric upset, unusual taste. Derm: flushing, • Monitor pulse and BP frequently.
rash, urticaria. Hemat: hemolytic anemia. Local: • PT and INR should be monitored.
erythema, pain at injection site, swelling. Misc: • The parenteral route is preferred for this drug.
allergic reactions, hyperbilirubinemia (large Because of severe, potentially fatal hypersensitivity
doses in very premature infants), kernicterus. reactions, the IV route is not recommended.
• This drug is the antidote for warfarin overdose.
Keep in Mind • Hint: “K” is for “Koagulation” (German form of
Teach client: the word “coagulation”).
• Take this medication as ordered.
Uploaded
Route/Dosage: SC, IV/10 mg; PO/2.5–25 mg/day by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 169
Cardiovascular System Drugs Digitalis Glycosides 169
Digoxin
(di-jox-in)
Lanoxicaps, Lanoxin
1882_Tab07_161-191 11/10/12 2:41 PM Page 169
Cardiovascular System Drugs Digitalis Glycosides 169

Antiarrhythmic agent; inotropic agent/digitalis Teach client:
glycoside • Take medication as directed. Report nausea,
Indications vomiting, or anorexia.
Treatment of CHF, tachyarrhythmias, atrial fibrilla- • Wear a Medic-Alert bracelet, and inform other
tion, atrial flutter, and paroxysmal atrial tachycardia. HCPs of this drug regimen.
Action • Routine follow-up examinations will be scheduled.
Slows and strengthens the force of myocardial con-
traction by prolonging the refractory period of the Make the Connection
atrioventricular (AV) node and decreasing conduc-
tion through the SA and AV nodes.
• Contraindicated in hypersensitivity,
uncontrolled ventricular arrhythmias, and AV blocks.
Adverse Reactions/Side Effects • Electrolyte abnormalities, especially of K+ (low),
CNS: fatigue, headache, weakness. EENT: predisposes to toxicity. Monitor electrolytes, LFT,
blurred vision, yellow or green vision. CV: and RFT.
arrhythmias, bradycardia, ECG changes, AV • Monitor apical pulse for 1 full min before admin-
block, SA block. GI: anorexia, nausea, vomiting, istering the drug.
diarrhea. Endo: gynecomastia. Hemat: throm- • Monitor I&O and daily weight. Assess for peripheral
bocytopenia. Metab: hyperkalemia with acute edema, and auscultate lungs for rales/crackles
toxicity. throughout therapy.
• Therapeutic serum digoxin levels range from
0.5 to 2 ng/mL.
• Digoxin immune Fab (Digibind) is the antidote.
• Monitor BNP levels.
Uploaded
Route/Dosage: IV/0.5–1 mg (50% of dose), followed by
by 25% of total doseMEDBOOKSVN.ORG
at 6- to 12-hr intervals; PO/0.125–5 mg daily
1882_Tab07_161-191 11/10/12 2:41 PM Page 170
Cardiovascular System Drugs Bipyridines 170
Milrinone
(mill-ri-none)
Primacor
Inamrinone
(in-am-ri-none)
Inocor
1882_Tab07_161-191 11/10/12 2:41 PM Page 170
Cardiovascular System Drugs Bipyridines 170

Inotropic agent, vasodilator/bipyridines Teach client:
Indications • Be aware of the reasons for administration and
Short-term treatment of CHF unresponsive to con- the desired effect.
ventional therapy with digoxin, diuretics, and • ECG will be monitored.
vasodilators. • A decrease in SOB and edema should be
experienced.
Action
Increases myocardial contractility. Decreases pre- • This drug will not cure CHF, but its use is a
temporary measure to control the symptoms.
load (amount of blood returning to the heart) and
afterload (pressure in the aorta that the heart must
overcome to push blood out of the heart) by a Make the Connection
direct dilating effect on vascular smooth muscle. • Monitor pulse and BP. Slow or stop the
Adverse Reactions/Side Effects infusion if the BP drops significantly, because
CNS: headache, tremor. CV: ventricular this is a sign of overdose.
arrhythmias, angina pectoris, chest pain, • Monitor I&O and daily weight.
hypotension, supraventricular arrhythmias. • Monitor ECG continuously during infusion.
CV: skin rash. GI: liver function abnormalities. Arrhythmias are common and may be life
F and E: hypokalemia. Hemat: thrombocytopenia. threatening.
• Monitor platelet count, electrolytes, and renal
function frequently during administration.
• Have second practitioner check dose calculations.
• Monitor peripheral IV site carefully.
• Monitor BNP levels.
Route/Dosage: Milrinone: IV/0.5 mcg/kg/min,Uploaded bymcg/kg/min
Inamrinone: IV/5–10 MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 171
Cardiovascular System Drugs Vasodilators (Human B-type Natriuretic

Peptide) 171
Nesiritide
(ne-sir-i-tide)
Natrecor
1882_Tab07_161-191 11/10/12 2:41 PM Page 171
Cardiovascular System Drugs Vasodilators (Human B-Type Natriuretic

Peptide) 171
Therapeutic/Pharmacologic Class reactions. MS: back pain, leg cramps. Neuro:
Vasodilators; human B-type natriuretic peptide paresthesia, tremor. Misc: fever.
Treatment of acutely decompensated CHF in hospi-
Teach client:
talized clients who have dyspnea at rest or with
minimal activity. • ECG will be monitored.
Action
• This drug will not cure CHF, but it will control the
symptoms.
Binds to guanylyl cyclase receptors in vascular
smooth muscle and endothelial cells, producing
increased intracellular guanosine 3´5´-cyclic Make the Connection
monophosphate (cGMP) and smooth muscle cell • Monitor BP, pulse, ECG, respiratory ease,
relaxation. cGMP acts as a “second messenger” to CVP (hypotension can be severe). Remember
dilate veins and arteries. BP low—down the head goes; BP high—head to
Adverse Reactions/Side Effects the sky.
CNS: anxiety, confusion, dizziness, headache, • Monitor I&O, daily weight, and RFT.
hypotension (dose related), insomnia, drowsi- • Monitor BNP levels.
ness. EENT: amblyopia. Resp: apnea, cough, • Have second practitioner independently check
hemoptysis. CV: HTN, arrhythmias, bradycar- dose calculations.
dia. GI: abdominal pain, nausea, vomiting. GU:
↑ creatinine, renal failure. Derm: itching, rash,
sweating. Hemat: anemia. Local: injection site
Route/Dosage: IV/0.01–0.03 mcg/kg/min Uploaded by MEDBOOKSVN.ORG

1882_Tab07_161-191 11/10/12 2:41 PM Page 172
Cardiovascular System Drugs Adrenergic 172
Dopamine
(dope-a-meen)
Intropin
Revimine
1882_Tab07_161-191 11/10/12 2:41 PM Page 172
Cardiovascular System Drugs Adrenergic 172

Inotropic agent, vasopressor/adrenergic Teach client:
Indications • Inform the nurse immediately if chest pain,
Adjunct to standard measures to improve blood dyspnea, numbness, tingling, or burning of
pressure, cardiac output, and urinary output extremities occurs.
in treatment of shock unresponsive to fluid • Inform nurse immediately of pain or discomfort
replacement. at the site of administration.
Action
Small doses (0.5–3 mcg/kg/min) stimulate dopamin- Make the Connection
ergic receptors, producing renal vasodilation. Larger
doses (2–10 mcg/kg/min) stimulate dopaminergic
• Contraindicated in tachyarrhythmias,
pheochromocytoma, or hypersensitivity to
and beta1-adrenergic receptors, producing cardiac bisulfites.
stimulation and renal vasodilation. Doses greater
than 10 mcg/kg/min stimulate alpha-adrenergic
• Do not administer with MAOI, ergot alkaloids
(ergotamine), or some antidepressants because
receptors and may cause renal vasoconstriction. the combination can result in severe HTN.
Adverse Reactions/Side Effects • Using with IV phenytoin may cause hypotension
CNS: headache. EENT: mydriasis (high dose). and bradycardia.
Resp: dyspnea. CV: arrhythmias, hypotension, • Monitor BP, heart rate, PCWP, CO, CVP, ECG, and
angina, ECG change, palpitations, vasocon- urinary output continuously during administration.
striction. GI: nausea, vomiting. Derm: piloerec- • If hypotension occurs, administration rate should
tion. Local: irritation at IV site. be increased; if HTN occurs, rate is decreased.
• Have second practitioner independently check
dose calculations.
Route/Dosage: IV/1–15 mcg/kg/min (may be Uploaded
increased based on by MEDBOOKSVN.ORG
condition; renal perfusion at lower end of dosage)
1882_Tab07_161-191 11/10/12 2:41 PM Page 173
Cardiovascular System Drugs Beta-Adrenergic Blockers 173
Metoprolol Atenolol
(me-toe-proe-lole) (a-ten-oh-lole)
Lopressor, Toprol-XL Tenormin

Betaloc-ZOK, Apo-Atenolol
Lopresor
Carvedilol Labetalol
(kar-ve-dil-ole) (la-bet-a-lole)
Coreg, Coreg CR Trandate

1882_Tab07_161-191 11/10/12 2:41 PM Page 173
Cardiovascular System Drugs Beta-Adrenergic Blockers 173

Therapeutic/Pharmacologic Class drug-induced hepatitis, nausea, vomiting. GU:
Antianginals; antihypertensives; antiarrhythmics/ erectile dysfunction, decreased libido, urinary
beta-adrenergic receptor blocker (beta blocker) frequency. Derm: rash. Endo: hyperglycemia,
Indications hypoglycemia. MS: arthralgia. Misc: drug-
Treatment of HTN. Prevention of MI and decrease induced lupus syndrome.
of mortality in clients with recent MI. Management
Keep in Mind
of stable, symptomatic CHF.
Teach client:
Action • Notify HCP if slow pulse or dyspnea occurs.
Blocks stimulation of beta1-adrenergic receptors.
Do not usually affect beta2-adrenergic receptor sites
if cardioselective. Make the Connection
Adverse Reactions/Side Effects • Assess the pulse and BP prior to
CNS: fatigue, weakness, anxiety, depression, administering.
dizziness, drowsiness, insomnia, memory loss, • Monitor LFT, RFT, electrolytes, ANA, I&O, and
mental status changes, nervousness, nightmares. daily weight.
EENT: blurred vision, stuffy nose. Resp: bron- • Notice the endings olol, ilol, or alol in the generic
chospasm, wheezing. CV: bradycardia, CHF, names.
pulmonary edema, hypotension, peripheral
vasoconstriction. GI: constipation, diarrhea,
Route/Dosage: Metoprolol: IV/5 mg q 2 min 3 times; PO/25–100 mg/day, Atenolol: PO/50–100 mg/day, Carvedilol: PO/6.25 mg bid; XR/20 mg/day,
Uploaded
Labetalol: PO/400–800 mg/day in 2—3 divided doses; by MEDBOOKSVN.ORG
IV/2 mg/min infusion
1882_Tab07_161-191 11/10/12 2:41 PM Page 174
Cardiovascular System Drugs Calcium Channel Blockers 174
Amlodipine Nifedipine
(am-loe-di-peen) (nye-fed-i-peen)
Norvasc Procardia, Procardia XL,

Adalat CC
Apo-Nifed,
Novo-Nifedin
Verapamil Diltiazem
(ver-ap-a-mil) (dil-tye-a-zem)
Calan, Calan SR, Cardizem, Cardizem LA,

Covera-HS, Isoptin, CartiaXT, Dilacor XR,
Isoptin SR Diltia XT, Tiazac
Novo-Veramil, Apo-Diltiaz,
Nu-Verap Novo-Diltazem
1882_Tab07_161-191 11/10/12 2:41 PM Page 174
Cardiovascular System Drugs Calcium Channel Blockers 174

Therapeutic/Pharmacologic Class constipation, diarrhea. GU: dysuria, nocturia,
Antianginal agent; antiarrhythmic agent (class IV); polyuria, sexual dysfunction, urinary frequency.
antihypertensive agent/calcium channel blocker Derm: dermatitis, flushing, increased sweating,
Indications photosensitivity, rash. Endo: gynecomastia,
Treatment of hypertension, angina pectoris and hyperglycemia. Hemat: anemia, leukopenia,
Prinzmetal’s angina, and arrhythmias. thrombocytopenia. Metab: weight gain.
MS: joint stiffness, muscle cramps. Neuro:
Action paresthesia, tremor. Misc: Stevens-Johnson
Inhibits transport of calcium into myocardial and syndrome, gingival hyperplasia.
vascular smooth muscle cells, resulting in inhibition
of excitation of muscle. Keep in Mind
Adverse Reactions/Side Effects Teach client:
CNS: abnormal dreams, anxiety, confusion, • Report unrelieved chest pain or SOB immediately.
dizziness, drowsiness, headache, nervousness,
psychiatric disturbances, weakness. EENT:
blurred vision, disturbed equilibrium, epistaxis, Make the Connection
tinnitus. Resp: cough, dyspnea. CV: arrhyth- • Take BP and pulse prior to administration.
mias, CHF, peripheral edema, bradycardia, • Monitor ECG, I&O, and daily weight.
chest pain, hypotension, palpitations, syncope, • Monitor LFT, RFT, CBC, serum glucose level,
tachycardia. GI: abnormal LFT, anorexia, and K+.
• Notice the “Ca” in most brand names.
Route/Dosage: Amlodipine: PO/5–10 mg/day, Nifedipine: PO/10–30 mg tid; XL/30–90 mg daily, Verapamil: PO/80–120 mg tid; XL/80–240 mg/day;
IV/5–10 mg/kg, Diltiazem: PO/30–120 mg 3–4Uploaded by LA/up
times/day; SR/180–240; MEDBOOKSVN.ORG
to 360 mg/day
1882_Tab07_161-191 11/10/12 2:41 PM Page 175
Cardiovascular System Drugs ACE Inhibitors 175
Enalapril, Ramipril
(ra-mi-pril)
Enalaprilat
(e-nal-a-pril, e-nal-a-pril-at)
Altace
Vasotec,
Vasotec IV
Lisinopril Captopril
(lyse-sin-oh-pril) (kap-toe-pril)
Prinivil, Zestril Capoten

1882_Tab07_161-191 11/10/12 2:41 PM Page 175
Cardiovascular System Drugs ACE Inhibitors 175

Therapeutic/Pharmacologic Class GU: proteinuria, erectile dysfunction, renal
Antihypertensive agent/angiotensin-converting failure. Derm: rash. F and E: hyperkalemia.
enzyme (ACE) inhibitor Hemat: BMS. Misc: angioedema, fever.
Used alone or with other agents in the management
Teach client:
of HTN. Reduction of death or development of
CHF after MI. Slowed progression of left ventricular • Take this medication exactly as directed.
dysfunction. • Report to the HCP immediately if chest pain;
palpitations; or swelling of the lips, face, or
Action tongue occurs.
ACE inhibitors block the conversion of angiotensin I • This medication may cause drowsiness.
to angiotensin II, a potent vasoconstrictor. They also
inhibit the renin-angiotensin-aldosterone system,
reducing the amount of aldosterone (the body’s Make the Connection
salt) in the bloodstream. • Always take the BP prior to administration.
Adverse Reactions/Side Effects • Monitor I&O and daily weight.
CNS: dizziness, fatigue, headache, insomnia, • Monitor for signs of angioedema.
weakness. Resp: cough, eosinophilic pneu- • Assess for signs of CHF.
monitis. CV: hypotension, angina pectoris, • Monitor LFT, RFT, CBC, serum glucose, and
tachycardia. GI: taste disturbances, anorexia, K+(↑).
diarrhea, hepatotoxicity (rare), nausea. • Notice the ending “pril” in the generic names.
Route/Dosage: Enalapril: PO/2.5–5 mg/day; IV/0.625–1.25 mg q 6 hr, Ramipril: PO/2.5–20 mg/day in divided doses, Lisinopril: PO/10–40 mg/day,
Captopril: PO/12.5–25 mg 2–3 times/day Uploaded by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 176
Cardiovascular System Drugs Angiotensin II Receptor Antagonists 176
Losartan Valsartan
(loe-sar-tan) (val-sar-tan)
Cozaar Diovan
Candesartan Irbesartan
(can-de-sar-tan) (ir-be-sar-tan)
Atacand Avapro
1882_Tab07_161-191 11/10/12 2:41 PM Page 176
Cardiovascular System Drugs Angiotensin II Receptor Antagonists 176

Therapeutic/Pharmacologic Class • Report to the HCP immediately if a rash; mouth
Antihypertensive agent/angiotensin II receptor sores; sore throat; fever; swelling of the hands or
antagonists feet; irregular heartbeat; chest pain; dry cough;
Indications hoarseness; swelling of the face, lips, or tongue;
Management of HTN. Treatment of CHF in clients difficulty swallowing; or breathing occurs.
who cannot tolerate ACE inhibitors. Reduction of • Report nausea, vomiting, diarrhea, or a metallic
stroke risk in clients with CHF and left ventricular taste that produces anorexia.
hypertrophy. • Do not use salt substitutes.
Action • Follow instructions for correct method of assess-
ing BP.
Block receptors for angiotensin II, disabling the
renin-angiotensin-aldosterone system. • Women of childbearing age should use
contraception.
Adverse Reactions/Side Effects • This medication may cause drowsiness.
CNS: dizziness, fatigue, headache. CV: hypoten-
sion. GI: diarrhea, drug-induced hepatitis.
GU: renal failure. F and E: hyperkalemia. Make the Connection
• Always take the BP prior to administration.
Keep in Mind • Monitor ECG periodically during prolonged
Teach client: therapy. May cause prolonged PR interval.
• Take this medication exactly as directed. • Monitor I&O and daily weight.
• Assess for signs of CHF and angioedema.
• Monitor LFT, RFT, CBC, and K+ level.
• Notice the ending “sartan” in the generic names.
Route/Dosage: Losartan: PO/25–100 mg/day, Valsartan: PO/80–160 mg/day, Candesartan: PO/16–32 mg/day (divided doses),
Irbesartan: PO/150–300 mg/day Uploaded by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 177
Cardiovascular System Drugs Central Alpha-Adrenergic Agonists 177
Clonidine
(klon-i-deen)
Catapres, Catapres-TTS
Dixarit
1882_Tab07_161-191 11/10/12 2:41 PM Page 177
Cardiovascular System Drugs Central Alpha-Adrenergic Agonists 177

Antihypertensive agent/alpha-adrenergic stimulant Teach client:
(centrally acting) • Take the drug at the same time each day.
Indications • Notify HCP if itching or redness of skin (with
Management of mild-to-moderate HTN. Epidural: transdermal patch), mental depression, swelling
Management of cancer pain unresponsive to of feet and lower legs, or vivid dreams or night-
opioids alone. Unlabeled Uses: Management of mares occur.
opioid withdrawal. • Self-monitor BP.
Action • Follow instructions for proper application of
transdermal system. Change every 7 days.
Stimulates alpha-adrenergic receptors in the brainstem,
which decreases sympathetic outflow inhibiting car-
dioacceleration and vasoconstriction centers. Prevents Make the Connection
pain signal transmission to the CNS by stimulation of
alpha-adrenergic receptors in the spinal cord.
• Monitor I&O and daily weight, and assess
for edema daily.
Adverse Reactions/Side Effects • Monitor BP and pulse prior to administering this
CNS: drowsiness, depression, dizziness, nervous- medication.
ness, nightmares. CV: bradycardia, hypotension
(increased with epidural), palpitations. GI: dry
mouth, constipation, nausea, vomiting. GU:
impotence. Derm: rash, sweating. F and E: Na
retention. Metab: weight gain. Misc: withdrawal
phenomenon.
Uploaded
Route/Dosage: PO/0.1–0.2 mg/day; transdermal/0.1–0.3 mg/24 by
hr q 7 MEDBOOKSVN.ORG
days
1882_Tab07_161-191 11/10/12 2:41 PM Page 178
Cardiovascular System Drugs Antiarrhythmics 178
Procainamide Amiodarone
(proe-kane-ah-mide) (am-ee-oh-da-rone)
Cordarone, Pacerone,
Nexterone
Lidocaine Quinidine
(kwin-i-deen)
(parenteral)
(lye-doe-kane)
Apo-quinidine
LidoPen, Xylocaine,
Lidoderm
Xylocard
1882_Tab07_161-191 11/10/12 2:41 PM Page 178
Cardiovascular System Drugs Antiarrhythmics 178

Antiarrhythmic agents Teach client:
Treatment of a wide variety of ventricular and atrial • Notify HCP immediately if fever, chills, joint
arrhythmias. pain or swelling, pain with breathing, skin rash,
or unusual bleeding or bruising occurs.
Action
Decreases myocardial excitability.
CNS: seizures, confusion, dizziness. CV: asys- • CBC with differential should be monitored
tole, heart block, ventricular arrhythmias, every 2 wk during the first 3 mo of therapy for
CHF, hypotension. GI: diarrhea, anorexia, signs of BMS.
bitter taste, nausea, vomiting. Derm: rash. • Monitor ANA, LFT, chemistries, and hematology
Hemat: BMS. Misc: chills, drug-induced tests during prolonged therapy.
systemic lupus syndrome, fever. • Monitor serum drug levels to prevent toxicity.
• When using antiarrhythmic agents, it is important
to remember that by interfering with the elec-
trolytes responsible for cardiac conduction, new
arrhythmias can occur or the heart rate may slow
and cause CHF.
Route/Dosage: Procainamide: IM/50 mg/kg/day in divided doses q 3–6 hr; IV/100 mg q 5 min until arrhythmia is resolved, then 1–4 mg/min infusion,
Amiodarone: PO/400 mg/day; IV/0.5 mg/min,Uploaded by MEDBOOKSVN.ORG
Lidocaine: IV/1–4 mg/min, Quinidine: PO/200–400 mg q 4–6 hr
1882_Tab07_161-191 11/10/12 2:41 PM Page 179
Cardiovascular System Drugs Nitrates 179
Isosorbide Isosorbide
Mononitrate Dinitrate
(eye-soe-sor-bide (eye-soe-sor-bide
mo-noe-nye-trate) dye-nye-trate)
IMDUR, ISMO, Dilatrate SR, Isordil,

Monoket Isotrate
Apo-ISMN Apo-ISDN
Nitroglycerin
(nye-tro-gli-ser-in)
Nitro-Time, Nitro-Bid IV, Tridil, Nitrolingual,

Nitro-Bid, Nitrostat, NitroQuick, Minitran,
Nitrek, Nitro-Dur
Nitrogard SR
1882_Tab07_161-191 11/10/12 2:41 PM Page 179
Cardiovascular System Drugs Nitrates 179

Antianginal agent/nitrate Teach client:
Acute (translingual and SL) and long-term prophylac- • Avoid concurrent use of alcohol with this medication.
tic (oral, buccal, transdermal) management of angina • Headache is a common side effect.
pectoris. Adjunctive treatment of chronic CHF. • Acute anginal attacks: Sit down and use medica-
tion. If pain does not subside, repeat dose and
Action call EMS.
Increases coronary blood flow by dilating coronary
arteries and improving collateral flow to ischemic • Store tablets in dark glass container away from
(body) heat. Replace 6 mo after opening.
regions. Produces vasodilation (venous greater than
arterial). Decreases preload. Reduces myocardial
oxygen consumption. Make the Connection
Adverse Reactions/Side Effects • Use of nitrates in any form with sildenafil,
CNS: dizziness, headache, apprehension, tadalafil, and vardenafil increases the risk of
restlessness, weakness. EENT: blurred vision. serious and potentially fatal hypotension.
CV: hypotension, tachycardia, syncope. GI: • Always assess the BP prior to administration.
abdominal pain, nausea, vomiting. Derm: • Clients receiving IV nitrates require continuous
contact dermatitis (transdermal or ointment). ECG and BP monitoring.
Misc: cross-tolerance, flushing, tolerance.
Route/Dosage: Isosorbide mononitrate: PO/5–20 mg bid (ISMO/Monoket), 30–60 mg/day (IMDUR), Isosorbide dinitrate: SL/2.5–5 mg repeated
q 5–10 min for 3 doses; PO/5–20 mg 3–4 times/day, Nitroglycerin: SL/0.3–0.6 mg (repeat up to 3 times); transdermal/ointment, 1–2 inches q 6–8 hr;
Uploaded
patch/0.4–0.8 mg/hr, on 12 hr and off 12 hr; IV/5–20 mcg/min by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 180
Cardiovascular System Drugs Fibric Acid Derivatives 180
Gemfibrozil
(gem-fye-broe-zil)
Lopid
Fenofibrate
(fen-o-fi-brate)
Antara, Lofibra, Tricor, Triglide

Lipidil Micro
1882_Tab07_161-191 11/10/12 2:41 PM Page 180
Cardiovascular System Drugs Fibric Acid Derivatives 180

Lipid-lowering agent/fibric acid derivative Teach client:
Management of type IIb hyperlipidemia (decreased • This medication should be used in conjunction
HDL, increased LDL, increased triglycerides) in with dietary restrictions, exercise, and cessation
clients who do not yet have clinical coronary artery of smoking.
disease and have failed therapy with diet, exercise, • Notify HCP promptly if any of the following
weight loss, or other agents (niacin, bile acid symptoms occur: severe stomach pains with
sequestrants). nausea and vomiting, fever, chills, sore throat,
rash, diarrhea, muscle cramping, general
Action abdominal discomfort, or persistent flatulence.
Inhibits peripheral lipolysis. Decreases triglyceride
production by the liver. Decreases production of
the triglyceride carrier protein. Increases HDL. Make the Connection
Adverse Reactions/Side Effects • Assess lipid panel, LFT, CBC, and
CNS: dizziness, headache. EENT: blurred vision. electrolytes at baseline and periodically while on
GI: abdominal pain, diarrhea, epigastric pain, medication.
flatulence, gallstones, heartburn, nausea, vomit- • Administration of these drugs with HMG-CoA
ing. Derm: alopecia, rash, urticaria. Hemat: reductase inhibitors increases the risk for rhab-
anemia, leukopenia. MS: myositis. domyolysis that can result in renal failure.
Uploaded
Route/Dosage: Gemfibrozil: PO/600 mg bid 30 byandMEDBOOKSVN.ORG
min before breakfast dinner, Fenofibrate: PO/145 mg/day (Tricor)
1882_Tab07_161-191 11/10/12 2:41 PM Page 181
Cardiovascular System Drugs HMG-CoA Reductase Inhibitors 181
Atorvastatin Simvastatin
(a-tore-va-stat-in) (sim-va-sta-tin)
Lipitor Zocor
Rosuvastatin Lovastatin
(roe-soo-va-sta-tin) (loe-va-sta-tin)
Crestor Mevacor, Altoprev

1882_Tab07_161-191 11/10/12 2:41 PM Page 181
Cardiovascular System Drugs HMG-CoA Reductase Inhibitors 181

Therapeutic/Pharmacologic Class rhabdomyolysis, arthralgia, arthritis, myalgia,
Lipid-lowering agent/HMG-CoA reductase inhibitor myositis. Misc: hypersensitivity reactions,
Indications including angioneurotic edema.
Adjunctive management of primary hypercholes-
Keep in Mind
terolemia and mixed dyslipidemia. Primary preven-
Teach client:
tion of coronary heart disease (MI, stroke, angina,
and coronary revascularization) in asymptomatic • Take this medication exactly as directed.
clients with increased total and LDL cholesterol and • Avoid drinking more than 1 quart of grapefruit
juice per day during therapy.
decreased HDL cholesterol.
Action
• Notify HCP if unexplained muscle pain,
tenderness, or weakness occurs, especially
Inhibits HMG-CoA reductase, an enzyme responsi- if accompanied by fever or malaise.
ble for catalyzing an early step in the synthesis of • Avoid pregnancy or breastfeeding.
cholesterol.
CNS: dizziness, headache, insomnia, weakness. Make the Connection
EENT: rhinitis. Resp: bronchitis. CV: chest pain, • Evaluate serum cholesterol and triglyceride
peripheral edema. GI: abdominal cramps, con- levels before initiating medication, after 2–4 wk of
stipation, diarrhea, flatus, heartburn, altered therapy, and periodically thereafter.
taste, drug-induced hepatitis, dyspepsia, • Monitor LFT prior to beginning medication, at
elevated liver enzymes, nausea, pancreatitis. 12 wk, and then every 6 mo.
GU: impotence. Derm: rash, pruritus. MS: • If muscle tenderness develops during therapy
with CPK ↑, this is indicative of rhabdomyolysis.
Uploaded
Route/Dosage: Atorvastatin: PO/10–80 mg/day, by mg/day,
Simvastatin: PO/5–80 MEDBOOKSVN.ORG
Rosuvastatin: PO/5–40 mg/day, Lovastatin: PO/20–80 mg/day
1882_Tab07_161-191 11/10/12 2:41 PM Page 182
Cardiovascular System Drugs Cholesterol-Absorption Inhibitors 182
Ezetimibe
(e-zet-i-mibe)
Zetia
Ezetrol
1882_Tab07_161-191 11/10/12 2:41 PM Page 182
Cardiovascular System Drugs Cholesterol-Absorption Inhibitors 182

Therapeutic/Pharmacologic Class • This medication should be used in conjunction
Lipid-lowering agent/cholesterol-absorption inhibitor with diet restrictions, exercise, and cessation of
Indications smoking.
Used alone or with other agents (HMG-CoA reduc- • Notify HCP if unexplained muscle pain, tender-
tase inhibitors) in the management of dyslipidemias, ness, or weakness occurs. Risk of symptoms may
including primary hypercholesterolemia and geneti- increase when used with HMG-CoA reductase
cally induced hypercholesterolemia. inhibitors.
Action • Notify HCP immediately if breathing or swallow-
ing becomes difficult.
Inhibits the absorption of cholesterol in the small
intestine. • Follow-up examinations will be scheduled.

GI: cholecystitis, cholelithiasis, ↑ hepatic Make the Connection
transaminases (with HMG-CoA reductase • Obtain a diet history, especially with
inhibitors), nausea, pancreatitis. Derm: rash. regard to fat consumption.
Misc: angioedema. • Evaluate serum cholesterol and triglyceride levels
before initiating medication, after 2–4 wk of
Keep in Mind therapy, and periodically thereafter.
Teach client: • Administer without regard to meals. May be
• Take this medication as directed, at the same taken at the same time as HMG-CoA reductase
time each day, even if feeling well. inhibitor (medication is frequently combined with
• Be aware that medication helps control, but does simvastatin [Vytorin]).
not cure, elevated serum cholesterol levels. • Monitor for angioedema.
Route/Dosage: PO/10 mg/day Uploaded by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 183
Cardiovascular System Drugs Bile Acid Sequestrants 183
Colestipol Colesevelam
(koe-les-ti-pole) (koe-less-sev-i-lam)
Colestid Welchol
Cholestyramine Resin
(koe-less-tear-a-meen re-zin)
LoCHOLEST, LoCHOLEST Light,

Prevalite, Questran, Questran Light
1882_Tab07_161-191 11/10/12 2:41 PM Page 183
Cardiovascular System Drugs Bile Acid Sequestrants 183

Lipid-lowering agent/bile acid sequestrant Teach client:
Indications • Take medication before meals. May be mixed
Management of primary hypercholesterolemia. with cool foods.
Treatment of pruritus associated with elevated • Constipation may occur.
levels of bile acids. • Notify HCP if unusual bleeding or bruising;
petechiae; or black, tarry stools occur. Treatment
Action with vitamin K may be necessary.
Binds bile acids in the GI tract, forming an insolu-
ble complex. The liver must use more cholesterol to
make more bile acids. Result is increased clearance Make the Connection
of cholesterol. • Obtain a diet history, especially with
Adverse Reactions/Side Effects regard to fat consumption.
EENT: irritation of the tongue. GI: abdominal • Assess for constipation and presence of bowel
discomfort, constipation, nausea, fecal sounds.
impaction, flatulence, hemorrhoids, perianal • Serum cholesterol and triglyceride levels should
irritation, steatorrhea, vomiting. Derm: irrita- be evaluated before and frequently during the
tion, rash. F and E: hyperchloremic acidosis. first few months of therapy.
Metab: vitamin A, D, and K deficiency. • Administer before meals and spaced 1–2 hr apart
from other drugs (may bind with them).
• Monitor LFT, electrolytes, and PT.
Route/Dosage: Colestipol: PO/granules, 5 g 1–2 times/day; tablets, 2–16 g 1–2 times/day, Colesevelam: PO/3 tabs tid or suspension, 3.75 pack/day,
Uploaded
Cholestyramine resin: PO/4–24 g/day in divided doses by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 184
Cardiovascular System Drugs Fatty Acid 184
Omega-3-Acid
Ethyl Esters
(oh-me-ga three as-id eth-il es-ters)
Lovaza
1882_Tab07_161-191 11/10/12 2:41 PM Page 184
Cardiovascular System Drugs Fatty Acid 184

Therapeutic/Pharmacologic Class (e.g., diabetes mellitus, hypothyroidism) that may
Lipid-lowering agent/fatty acid contribute to hypertriglyceridemia.
Indications • Follow-up examinations and laboratory tests will
Treatment of hypertriglyceridemia in adults; used be scheduled to determine effectiveness.
with specific diet.
Inhibits synthesis of triglycerides. • Use with caution in clients with
Adverse Reactions/Side Effects hypersensitivity to fish.
GI: altered taste, eructation. Derm: rash. • Obtain a diet history, especially with regard to
fat consumption.
Keep in Mind • Monitor serum triglyceride levels and serum LDL
Teach client: levels (may increase) prior to and periodically
• Take this medication as directed. during therapy, and LFT periodically during
• Be aware that medication helps control, but therapy.
does not cure, elevated serum triglyceride levels.
• This medication should be used in conjunction
with diet restrictions (fat, cholesterol, carbohy-
drates, alcohol), exercise, weight loss in over-
weight clients, and control of medical problems
Route/Dosage: PO/2 g bid or 4 g/day Uploaded by MEDBOOKSVN.ORG

1882_Tab07_161-191 11/10/12 2:41 PM Page 185
Cardiovascular System Drugs Water-Soluble Vitamin 185
Folic Acid
(foe-lik as-id)
Folate, Folvite, vitamin B

Apo-Folic
1882_Tab07_161-191 11/10/12 2:41 PM Page 185
Cardiovascular System Drugs Water-Soluble Vitamin 185

Therapeutic/Pharmacologic Class • The effectiveness of megadoses of this nutrient
Antianemic agent; vitamin/water-soluble vitamin for treatment of various medical conditions is
Indications unproven and may cause side effects.
Prevention and treatment of megaloblastic and • This nutrient may make urine more intensely
macrocytic anemias. Given during pregnancy to yellow.
promote normal fetal development. • Notify HCP if rash occurs, which may indicate
hypersensitivity.
Action
Required for protein synthesis and red blood cell • Follow-up examinations and laboratory tests will
be scheduled.
function. Stimulates the production of red RBCs,
WBCs, and platelets. Necessary for normal fetal
development. Make the Connection
Adverse Reactions/Side Effects • Monitor plasma vitamin levels and Hbg,
Derm: rash. CNS: irritability, difficulty sleeping, Hct, and reticulocyte counts before and periodi-
malaise, confusion. Misc: fever. cally during therapy.
• Because of infrequency of solitary vitamin
Keep in Mind deficiencies, combinations are commonly
Teach client: administered.
• Comply with diet recommendations of HCP. The • May be given SC, deep IM, or IV when PO route
best source of vitamins is a well-balanced diet. is not feasible.
• Foods high in this nutrient include vegetables • Antacids should be given at least 2 hr after the
(green leafy), fruits, and organ meats. medication.
• The medication should be given 2 hr before or
4–6 hr after cholestyramine.
Route/Dosage: PO, SC, IM, IV/0.5–1 mg/day Uploaded by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 186
Cardiovascular System Drugs Renin Inhibitor 186
Aliskiren
(a-lis-ki-ren)
Tekturna
1882_Tab07_161-191 11/10/12 2:41 PM Page 186
Cardiovascular System Drugs Renin Inhibitor 186

Therapeutic/Pharmacologic Class • Apprise HCP of all Rx or OTC medications, vita-
Antihypertensives/renin inhibitor mins, or herbal products being taken, especially
Indications methadone and other antiretrovirals.
Treatment of HTN (alone or with other agents). • Advise female patients to notify HCP if pregnancy
is planned or suspected, or if breastfeeding.
Action
Inhibition of renin results in decreased formation
of angiotensin II, a powerful vasoconstrictor. Make the Connection
Adverse Reactions/Side Effects • Monitor BP and pulse frequently during
Resp: cough. GI: abdominal pain, diarrhea initial dose adjustment and periodically during
(↑ in females and elderly), dyspepsia, reflux. therapy. If an excessive fall in BP occurs, place
Misc: angioedema. patient in a supine position and administer IV
0.9% NaCl, if necessary. Remember: BP low—
Keep in Mind down the head goes; BP high—head to the sky!
Teach client: • May cause minor ↑ in BUN, serum creatinine, K+,
• May cause dizziness. Caution patient to lie down uric acid, and creatine kinase; may cause a small
and notify HCP. Avoid driving and other activities ↓ in hemoglobin and hematocrit.
requiring alertness until response to the drug is • Monitor for angioedema.
known.
• Report signs and symptoms of angioedema
(swelling of face, extremities, eyes, lips, or
tongue, or difficulty swallowing or breathing)
to HCP immediately.
Route/Dosage: PO/150–300 mg/day Uploaded by MEDBOOKSVN.ORG

1882_Tab07_161-191 11/10/12 2:41 PM Page 187
Cardiovascular System Drugs Colony-Stimulating Factors 187
Pegfilgrastim
(peg-fil-gra-stim)
Neulasta
Filgrastim
(fil-gra-stim)
Neupogen, G-CSF,
Granulocyte-Stimulating Factor
1882_Tab07_161-191 11/10/12 2:41 PM Page 187
Cardiovascular System Drugs Colony-Stimulating Factors 187

Therapeutic/Pharmacologic Class laryngeal edema) or signs of splenic rupture
Colony-stimulating factors (left upper abdominal or shoulder tip pain)
Indications occur.
To decrease the incidence of infection (febrile neu- • Compliance with therapy and regular monitoring
tropenia) in patients with nonmyeloid malignancies of blood counts is essential.
receiving myelosuppressive antineoplastics associated
with a high risk of febrile neutropenia. Make the Connection
Action • Assess for bone pain throughout therapy.
These drugs are glycoproteins. They bind to and Pain is usually mild to moderate and controllable
stimulate neutrophils to divide and differentiate. with nonopioid analgesics, but may require opioid
They also activate mature neutrophils. Binding to a analgesics.
polyethylene glycol molecule prolongs its effects. • Assess patient periodically for signs of ARDS
Adverse Reactions/Side Effects (fever, lung infiltration, respiratory distress).
Resp: ARDS. GI: splenic rupture. Hemat: sickle • Obtain CBC and platelet count before chemother-
cell crisis, leukocytosis. MS: medullary bone pain. apy. Monitor hematocrit and platelet count
Misc: allergic reaction including anaphylaxis. regularly. May cause elevated LDH, alkaline
phosphatase, and uric acid levels.
Keep in Mind • Monitor for acute allergic reaction or signs of
Teach client: splenic rupture.
• Notify HCP immediately if signs of allergic reac-
tion (shortness of breath, hives, rash, pruritus,
Uploaded
Route/Dosage: Pegfilgrastim: SC/6 mg for each byFilgrastim:
chemotherapy cycle, MEDBOOKSVN.ORG
SC, IV/5 mcg/kg/day
1882_Tab07_161-191 11/10/12 2:41 PM Page 188
Cardiovascular System Drugs Anticholinergic (Antimuscarinic) 188
Atropine
(at-ro-peen)
AtroPen
1882_Tab07_161-191 11/10/12 2:41 PM Page 188
Cardiovascular System Drugs Anticholinergic (Antimuscarinic) 188

Antiarrhythmic/anticholinergic; antimuscarinic Teach client:
Indications • May cause drowsiness and visual changes.
Given preoperatively to decrease oral and respiratory • Frequent oral hygiene may help relieve dry mouth.
secretions (IM). Treatment of sinus bradycardia, • Atropine impairs heat regulation. Strenuous activ-
heart block, reversal of adverse muscarinic effects ity in a hot environment may cause heat stroke.
of anticholinesterase agents or anticholinesterase • Males with BPH should report changes in urinary
poisoning (IM, IV). Used in Inhaln form to treat stream to HCP.
exercise-induced bronchospasm.
Inhibits the action of acetylcholine at postganglion- • Side effects are “hot as a hare, dry as a
ic sites located in smooth muscle, secretory glands, bone, red as a beet, mad as a hatter, and blind
and the CNS (antimuscarinic activity). as a bat.”
Adverse Reactions/Side Effects • Assess VS and ECG tracings during IV drug
CNS: drowsiness, confusion, hyperpyrexia. therapy.
EENT: blurred vision, cycloplegia, photophobia, • Monitor I&O and bowel sounds.
dry eyes, mydriasis. CV: tachycardia, palpita- • If overdose occurs, physostigmine is the antidote.
tions, arrhythmias. GI: dry mouth, constipation,
impaired GI motility. GU: urinary hesitancy,
retention, erectile dysfunction. Resp: tachypnea,
pulmonary edema. Misc: flushing, decreased
sweating.
Route/Dosage: IM, IV, SC, PO/0.4–0.6 mg 30–60 min preoperatively; IV/0.5–1 mg, may repeat as needed q 5 min, not to exceed a total of 2 mg, for
bradycardia; Inhaln/0.025–0.05 mg/kg/dose qUploaded by MEDBOOKSVN.ORG
4–6 hr as needed (maximum 2.5 mg/dose).
1882_Tab07_161-191 11/10/12 2:41 PM Page 189
Cardiovascular System Drugs Direct Thrombin Inhibitors 189
Dabigatran
(da-bye-gat-ran)
Pradaxa
Desirudin
(des-i-rude-in)
Iprivask
1882_Tab07_161-191 11/10/12 2:41 PM Page 189
Cardiovascular System Drugs Direct Thrombin Inhibitors 189

Therapeutic/Pharmacologic Class • Tell HCP about all Rx or OTC medications,
Anticoagulant/direct thrombin inhibitor vitamins, or herbal products being taken. Do not
Indications discontinue this drug without notifying HCP.
To ↓ risk of stroke/systemic embolization associated • Advise female patient to notify HCP if pregnancy
with nonvalvular atrial fibrillation. is planned or suspected, or if breastfeeding.
Action
Act as a direct inhibitor of thrombin. Make the Connection
Adverse Reactions/Side Effects • Assess patient for symptoms of stroke or
GI: abdominal pain, diarrhea, dyspepsia, peripheral vascular disease periodically during
gastritis, nausea. Hemat: bleeding. Misc: therapy.
anaphylaxis. • Assess for anaphylaxis.
• Assess for uncontrolled bleeding from any
Keep in Mind orifice.
Teach client: • Assess vital signs at each visit.
• May bleed more easily or longer than usual.
Notify HCP if bleeding or vomiting of blood
occurs.
Uploaded
Route/Dosage: Dabigatran: PO/150 mg bid, Desirudin: SC/15 mgby
q 12 MEDBOOKSVN.ORG
hr
1882_Tab07_161-191 11/10/12 2:41 PM Page 190
Cardiovascular System Drugs Interleukin (Thrombopoetic Growth Factor) 190
Oprelvekin
(o-prell-ve-kin)
Neumega
1882_Tab07_161-191 11/10/12 2:41 PM Page 190
Cardiovascular System Drugs Interleukin (Thrombopoetic Growth Factor) 190

Therapeutic/Pharmacologic Class abdominal pain. Derm: alopecia, ecchymoses,
Colony-stimulating factors/interleukins; throm- rash. F and E: sodium and water retention.
bopoetic growth factors Local: injection site reactions. MS: bone pain,
Indications myalgia. Misc: chills, fever, infection, pain.
Prevention of severe thrombocytopenia and
Keep in Mind
reduction of the need for platelet transfusions
Teach client:
following myelosuppressive chemotherapy in
patients with nonmyeloid malignancies at risk • May cause transient blurred vision or dizziness.
for thrombocytopenia. • Notify HCP if pregnancy is planned or suspected.
Action
• Notify HCP if chest pain, SOB, fatigue, blurred
vision, or irregular heartbeat persists.
Stimulates production of megakaryocytes and
platelets.
CNS: dizziness, headache, insomnia, nervous- • Assess for signs of fluid retention.
ness, weakness. EENT: conjunctival hemorrhage, • Monitor CBC and platelet count prior to and peri-
blurred vision, changes in visual acuity, blind- odically during therapy. Hgb and Hct will decrease
ness, papilledema, pharyngitis, rhinitis. Resp: due to dilutional anemia (3–5 days after therapy is
cough, dyspnea, pleural effusions. CV: ventricu- begun), then diminish. Monitor platelet count until
lar arrhythmias, atrial fibrillation, edema, pal- postnadir count greater than 50,000 cells/mL.
pitations, syncope, tachycardia, vasodilation. • Monitor electrolyte concentrations in patients
GI: anorexia, constipation, diarrhea, dyspepsia, receiving chronic diuretic therapy. Hypokalemia
mucositis, nausea, oral moniliasis, vomiting, may be fatal. Remember: Normal K+ level is
3.5–5. May cause ↑ in plasma fibrinogen.
Uploaded
Route/Dosage: SC/50 mcg/kg once daily for 10–21 days by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 191
Cardiovascular System Drugs Active Factor X (Xa) Inhibitors 191
Fondaparinux
(fond-a-par-i-nux)
Arixtra
Rivaroxaban
(ri-va-rox-a-ban)
Xarelto
1882_Tab07_161-191 11/10/12 2:41 PM Page 191
Cardiovascular System Drugs Active Factor X (Xa) Inhibitors 191

Therapeutic/Pharmacologic Class • Do not to take aspirin or NSAIDs without con-
Anticoagulant/active factor X inhibitor sulting HCP during therapy.
Indications
Prevention and treatment of DVT and PE.
Make the Connection
Action
Bind selectively to antithrombin III (AT III). This • Assess for signs of bleeding and hemorrhage
from any orifice.
binding potentiates the neutralization (inactivation)
of active factor X (Xa). • Assess for evidence of additional or increased
thrombosis. Symptoms will depend on area of
Adverse Reactions/Side Effects involvement.
CNS: confusion, dizziness, headache, insomnia. • Monitor neurologic status frequently for signs of
CV: edema, hypotension. GI: constipation, impairment, especially in patients with indwelling
diarrhea, dyspepsia, ↑ liver enzymes, nausea, epidural catheters.
vomiting. GU: urinary retention. Derm: bullous • Monitor platelet count closely (may cause throm-
eruption, hematoma, purpura, rash. Hemat: bocytopenia). PT and aPTT are not adequate indi-
bleeding, thrombocytopenia. F and E: cators of this drug’s action. INR level desired is 2–3.
hypokalemia. Misc: fever, ↑ wound drainage. • Monitor CBC, serum creatinine levels, and stool
(for occult blood) during therapy.
Keep in Mind • May cause asymptomatic ↑ in AST and ALT.
Teach client: Elevations are fully reversible.
• Report any symptoms of unusual bleeding or
bruising, dizziness, itching, rash, fever, swelling,
or difficulty breathing to HCP immediately.
Route/Dosage: Fondaparinux: SC/2.5–10 mg Uploaded

once daily (based onby MEDBOOKSVN.ORG
weight range), Rivaroxaban: PO/10 mg/day
RESPIRATORY
Aminophylline, 192 Isoproterenol, 195 Budesonide, 199

Theophylline, 192 Acetylcysteine, 196 Triamcinolone, 199
Ipratropium, 193 Guaifenesin, 197 Cromolyn, 200
Albuterol, 194 Fexofenadine, 198 Montelukast, 201
Salmeterol, 194 Diphenhydramine, 198 Zyleuton, 201
Metaproterenol, 194 Loratadine, 198 Zafirlukast, 201
Formoterol, 194 Beclomethasone, 199 Roflumilast, 202
Levalbuteral, 194 Fluticasone, 199
1882_Tab08_192-202 10/10/12 12:51 PM Page 192
Respiratory System Drugs Xanthines 192
Aminophylline
(am-in-off-i-lin)
Phyllocontin
Theophylline
(thee-off-i-lin)
Theo-24, Elixophyllin,
Quibron-T
Apo-Theo LA,
Novo-Theophyl SR
1882_Tab08_192-202 10/10/12 12:51 PM Page 192
Respiratory System Drugs Xanthines 192

Bronchodilator/xanthine Teach client:
Indications • PO doses need to be taken at the prescribed time.
Long-term control of reversible airway obstruction • Increase fluid intake to a minimum of eight 8-oz
caused by asthma or COPD. Increases diaphragmatic glasses of fluid daily. Avoid caffeine.
contractility. Used to treat apnea of prematurity. • Do not eat charbroiled meats, use large amounts
of pepper, or consume large amounts of crucifer-
Action ous vegetables because they interfere with the
Inhibits phosphodiesterase, producing increased action of the drug.
tissue concentrations of cAMP. Increased levels of
cAMP result in bronchodilation, CNS stimulation, • Supplement vitamin B6 to overcome depletion
caused by this drug.
positive inotropic and chronotropic effects, diuresis,
and gastric acid secretion. • Avoid alcohol consumption while on this
medication.
Adverse Reactions/Side Effects • Blood will be drawn for routine laboratory tests.
CNS: seizures, anxiety, headache, insomnia.
CV: arrhythmias, angina, tachycardia, palpita-
tions. GI: nausea, vomiting, anorexia, cramps. Make the Connection
Neuro: tremor. • Serum drug levels range from 10 to
15 mcg/mL. Low levels will precipitate bron-
chospasm. High levels will result in toxicity.
• Monitor I&O, CXR, respiratory ease, pulse oximetry,
and K+ and Mg+ levels.
Route/Dosage: Aminophylline: IV/loading dose 6 mg/kg over 30 min, followed by 0.7 mg/kg/hr continued infusion, Theophylline: PO/5 mg/kg,
Uploaded
followed by 10 mg/kg/day in divided doses q 8–12 hr by MEDBOOKSVN.ORG
1882_Tab08_192-202 10/10/12 12:51 PM Page 193
Respiratory System Drugs Anticholinergic 193
Ipratropium
(i-pra-troe-pee-um)
Atrovent, Atrovent HFA

1882_Tab08_192-202 10/10/12 12:51 PM Page 193
Respiratory System Drugs Anticholinergic 193

Allergy, cold, cough remedy; bronchodilator/ Teach client:
anticholinergic agent • Follow instructions for proper use of inhaler or
Indications nasal spray, and take as directed.
Inhaln: Maintenance therapy of reversible airway • Pulmonary function tests will be scheduled.
obstruction due to COPD and bronchospasm due
to asthma. Intranasal: Treatment of rhinorrhea.
Make the Connection
Action • When multiple inhalation medications
Given by inhalation, the drug inhibits cholinergic are given, use beta2-adrenergic agonists (adrener-
receptors in bronchial smooth muscle tissue, result- gics) first, then this class, and inhaled steroids
ing in decreased concentrations of cGMP. Decreased last. Remember: 1 min between inhalations of
cGMP produces local bronchodilation. Given the same medications and 5 min between each
intranasally, application inhibits secretions from different medication.
glands lining the nasal mucosa (local effects). • Assess respiratory status breath sounds, pulse
Adverse Reactions/Side Effects oximetry and CXR (if available) carefully prior to
CNS: dizziness, headache, nervousness. EENT: and after inhalation of medication.
blurred vision, sore throat; epistaxis, nasal • Anticholinergic inhalers promote plugging of
dryness/irritation (intranasal only). Resp: mucus in clients with tracheostomy. Have suction
bronchospasm, cough. CV: hypotension, catheters and normal saline at the bedside.
palpitations. GI: GI irritation, nausea. Derm:
rash. Misc: allergic reactions.
Uploaded
Route/Dosage: Inhaln/MDI, 2 puffs qid; intranasal/2 by 2–3
sprays each nostril MEDBOOKSVN.ORG
times/day
1882_Tab08_192-202 10/10/12 12:51 PM Page 194
Respiratory System Drugs Beta2-Agonists 194
Albuterol Metaproterenol
(al-byoo-ter-ole) (met-a-proe-ter-e-nole)
Proventil Alupent
Hydrofluoroakane
(HFA), Ventolin HFA, Formoterol
VoSpire ER, AccuNeb, (for-mo-te-role)
ProAir HFA
Novo-Salmol Foradil, Perforomist
Salmeterol Levalbuteral
(sal-me-te-role) (leev-al-byoo-ter-ole)
Serevent Xopenex, Xopenex HFA,

Xopenex Concentrate
1882_Tab08_192-202 10/10/12 12:51 PM Page 194

Bronchodilator/adrenergic agent; beta2-agonist Teach client:
Indications • Take this medication as directed. A spacer assists
Used as a bronchodilator for control and preven- in dose delivery.
tion of reversible airway obstruction caused by • Contact the HCP immediately if SOB is not
asthma or COPD. relieved by medication.
Action • Adrenergic inhalers are used before anticholiner-
gic or steroid inhalers. To repeat inhaled doses of
Binds to beta2-adrenergic receptors in airway the same drug, wait 1 min; for repeat doses of a
smooth muscle, increases levels of cAMP. Selective different drug, wait 5 min; rinse mouth.
for beta2 receptors in lungs. cAMP decreases action
of myosin and CA+, resulting in relaxation of airway
smooth muscle. Make the Connection
Adverse Reactions/Side Effects • Using medication with MAOIs may lead
CNS: nervousness, restlessness, tremor, headache, to HTN crisis.
insomnia, hyperactivity in children. CV: chest • Observe for paradoxical bronchospasm (wheezing).
pain, palpitations, angina, arrhythmias, HTN. • Monitor for palpitations/arrhythmias.
GI: nausea, vomiting. Endo: hyperglycemia.
F and E: hypokalemia. Neuro: tremor.
Route/Dosage: Albuterol: PO/2–4 mg 3 to 4 times daily, 4–8 mg of ER tabs twice daily; Inhaln/(metered dose inhaler) 2 puffs q 4–6 hr or 2 puffs 15
min before exercise, Metaproterenol: PO/20 mg 3 to 4 times/day; Inhaln/0.2–0.3 mL of 5% solution, Salmeterol: Inhaln/a 50-mcg inhalation q 12 hr,
Uploaded
Formoterol: Inhaln/1 cap (12 mcg) q 12 hr, Levalbuteral: Inhaln/2by
puffs MEDBOOKSVN.ORG
q 4–6 hr
1882_Tab08_192-202 10/10/12 12:51 PM Page 195
Isoproterenol
(eye-soe-proe-ter-e-nole)
Isuprel, Medihaler-Iso
1882_Tab08_192-202 10/10/12 12:51 PM Page 195

Bronchodilator; antiarrhythmic agent/beta2-agonist Teach client:
Indications • Avoid smoking and other respiratory irritants.
Management of bronchospasm during anesthesia. • Contact HCP immediately if SOB is not relieved
Treatment of asthma or COPD. Management of by medication or is accompanied by diaphoresis,
bradycardia (IV only). dizziness, palpitations, or chest pain.
Action
Results in the accumulation of cAMP at beta- Make the Connection
adrenergic receptors. Produces bronchodilation. • Assess lung sounds, respiratory pattern,
Inhibits the release of mediators of immediate pulse, and BP before administration and during
hypersensitivity reactions from mast cells. Has peak of medication effect.
additional significant beta (cardiac)-adrenergic • Note amount, color, and character of sputum
action, which results in positive inotropic and produced.
chronotropic effects. • Monitor pulmonary function tests.
Adverse Reactions/Side Effects • Symptoms of overdose include persistent agita-
CNS: nervousness, restlessness, tremor, tion, chest pain or discomfort, decreased BP,
headache, insomnia. CV: arrhythmias, angina, dizziness, hyperglycemia, hypokalemia, seizures,
HTN, tachycardia. GI: nausea, vomiting, xero- tachyarrhythmias, persistent trembling, and
stomia. Endo: hyperglycemia. Misc: pink/red vomiting. Treatment includes discontinuing
discoloration of saliva. beta-adrenergic agonists and instituting symp-
tomatic, supportive therapy.
Uploaded
Route/Dosage: IV/0.02–0.06 mg may be followed by bronchospasm,
by 5-mcg/min infusion; MEDBOOKSVN.ORG
0.01–0.02 mg; IM, SC/0.2 mg; Inhaln/1–2 puffs
1882_Tab08_192-202 10/10/12 12:51 PM Page 196
Respiratory System Drugs Mucolytics 196
Acetylcysteine
(a-se-teel-sis-teen)
Acetadote
Mucomyst, Parvolex
1882_Tab08_192-202 10/10/12 12:51 PM Page 196
Respiratory System Drugs Mucolytics 196

Mucolytic, antidote for acetaminophen Teach client:
Indications • Clear airway by coughing deeply before taking
IV use: Antidote for the management of potentially aerosol inhalation treatment.
hepatotoxic overdosage of acetaminophen (should • There is an unpleasant odor to this drug.
be administered within 8–24 hours of ingestion • The face may feel sticky after using the mask
depending on overdosage amount). Inhaln use: nebulizer, and the residue can be easily cleaned.
Reduction of mucous viscosity associated with • Suctioning may be necessary after mucolytic
thick secretions. therapy.
Action
Decreases the buildup of a hepatotoxic metabolite Make the Connection
in acetaminophen overdosage. Degrades mucus,
allowing easier mobilization and expectoration.
• Keep suction available; as mucus thins, it
may be too copious for the client to expectorate.
Adverse Reactions/Side Effects • When used as antidote in acetaminophen over-
CNS: drowsiness. CV: vasodilation. EENT: dose, assess plasma acetaminophen levels.
rhinorrhea. Resp: bronchospasm, bronchial/ • Monitor LFT, RFT, ECG, glucose, and electrolytes.
tracheal irritation, chest tightness, increased • Notify HCP if nausea, vomiting, or urticaria
secretions. GI: nausea, vomiting, stomatitis. occurs.
Derm: pruritus, rash, urticaria, clamminess.
Misc: allergic reactions (primarily with IV),
including anaphylaxis, angioedema, chills, fever.
Uploaded
Route/Dosage: PO/140 mg/kg initially, followed by 70 mg/kg q 4 by MEDBOOKSVN.ORG
hr; IV/loading dose, 150 mg/kg over 60 min
1882_Tab08_192-202 10/10/12 12:51 PM Page 197
Respiratory System Drugs Expectorants 197
Guaifenesin
(gwye-fen-e-sin)
Robitussin, Hytuss,
Guiatuss, Mucinex
Benylin-E
1882_Tab08_192-202 10/10/12 12:51 PM Page 197
Respiratory System Drugs Expectorants 197

Therapeutic/Pharmacologic Class • Limit talking, stop smoking, and maintain mois-
Allergy, cold, and cough remedy; expectorant ture in the environment. Cool mist is best.
Indications • Sugarless gum and candy may be used to assist in
Treatment of coughs associated with viral upper keeping the mouth moist.
respiratory tract infections. Treatment of chronic • If cough causes gagging, persists for longer than
lung conditions. 1 wk, or is accompanied by a fever, rash, or sore
throat; contact HCP.
Action
Reduces viscosity of tenacious secretions by increas-
ing respiratory tract fluid. Make the Connection
Adverse Reactions/Side Effects • Assess lung sounds and frequency and
CNS: dizziness, headache. GI: nausea, diarrhea, type of cough during therapy.
stomach pain, vomiting. Derm: rash, urticaria. • Assess color and amount of secretions. Clients
may swallow secretions, so do not assume that
Keep in Mind the cough is nonproductive because of this. If on
Teach client: auscultation rhonchi occur, move, and disappear
• Cough effectively. Sit upright, take three deep with coughing, this is a finding that indicates a
breaths, and cough deeply with the hand placed productive cough.
loosely in front of the mouth (positive airway • Give with a full glass of water.
pressure). Do this several times. • ER tabs should be swallowed whole; not
• This drug may cause dizziness, so avoid activities crushed, chewed, or broken.
that require alertness until the effect of the drug
is known.
Route/Dosage: PO/600–1200 mg q 12 hr Uploaded by MEDBOOKSVN.ORG

1882_Tab08_192-202 10/10/12 12:51 PM Page 198
Respiratory System Drugs Antihistamines 198
Fexofenadine Loratadine
(fex-oh-fen-a-deen) (lor-a-ta-deen)
Allegra Alavert, Claritin, Claritin

24–Hour Allergy, Claritin Hives
Relief, Children’s Loratadine,
Claritin Reditabs, Clear-Atadine,
Dimetapp Children’s ND
Non-Drowsy Allergy
Diphenhydramine
(dye-fen-hye-dra-meen)
Benadryl, Sominex, Unisom Nightime Sleep Aid,

Benadryl Allergy
Allerdryl
1882_Tab08_192-202 10/10/12 12:51 PM Page 198
Respiratory System Drugs Antihistamines 198

Therapeutic/Pharmacologic Class • This drug may cause drowsiness, so avoid driving
Allergy, cold, and cough remedy/antihistamine or other activities requiring alertness until response
Indications to drug is known.
Relief of symptoms of seasonal allergic rhinitis. • Contact the HCP if symptoms persist.
Management of chronic idiopathic urticaria. May be
used, depending on product, as a sedative/hypnotic. Make the Connection
Action • Assess allergy symptoms (rhinitis,
Antagonizes the effects of histamine at peripheral conjunctivitis, hives) before and periodically
histamine1 (H1) receptors. Inhibition of these recep- during therapy.
tors can be used for histamine-related inflammation, • Assess lung sounds and character of bronchial
like pruritus and urticaria. Medications also have a secretions.
drying effect on the nasal mucosa. • Maintain fluid intake of 1500–2000 mL/day to
Adverse Reactions/Side Effects decrease viscosity of secretions.
CNS: drowsiness, fatigue. GI: dyspepsia. Endo: • Medication causes false-negative reactions on
dysmenorrhea. allergy skin tests; discontinue 3 days before such
testing.
Keep in Mind • Administer with food or milk to decrease GI
Teach client: irritation. Caps and tabs should be taken with
• Take the medication as directed. water or milk, not juice.
• If the drug is taken for sleep, assess quality of
sleep and sleep patterns.
Route/Dosage: Fexofenadine: PO/60 mg bid, Uploaded by MEDBOOKSVN.ORG

Loratadine: PO/10 mg/day, Diphenhydramine: PO/25–50 mg q 4–6 hr; IM, IV/25–50 mg q 4 hr
1882_Tab08_192-202 10/10/12 12:51 PM Page 199
Respiratory System Drugs Corticosteroids 199
Beclomethasone Budesonide
(be-kloe-meth-a-sone) (byoo-des-oh-nide)
Qvar Pulmicort Respules,

Pulmicort Flexhaler
Fluticasone Triamcinolone
(floo-ti-ka-sone) (trye-am-sin-oh-lone)
Flovent HFA, Flovent AllerNaze,

Diskus Nasacort AQ
1882_Tab08_192-202 10/10/12 12:51 PM Page 199
Respiratory System Drugs Corticosteroids 199

Anti-inflammatory agent (steroidal)/corticosteroid Teach client:
agent • When using inhalation corticosteroids and
Indications bronchodilator, use bronchodilator first and
Maintenance treatment of asthma as prophylactic allow 5 min to elapse before administering
therapy. Possible decrease in requirement for or the corticosteroid, unless otherwise directed
elimination of systemic corticosteroid use in clients by HCP.
with asthma. • Do not use this drug for rescue.
Action • Rinse the mouth after using.
Potent, locally acting anti-inflammatory and
immune modifier. Make the Connection
Adverse Reactions/Side Effects • Monitor respiratory status and lung
CNS: headache. EENT: cataracts, dysphonia, sounds.
oropharyngeal fungal infections, pharyngitis, • Assess clients changing from systemic to inhalation
rhinitis, sinusitis. Resp: bronchospasm, cough, corticosteroids for signs of adrenal insufficiency.
wheezing. Endo: adrenal suppression (increased • Periodic adrenal function tests may be ordered.
dose, long-term therapy only), decreased growth • May cause increased serum and urine glucose
(children). MS: back pain. concentrations if significant absorption occurs.
Route/Dosage: Beclomethasone: Inhaln/40–160 mcg bid, Budesonide: Inhaln/180–360 mcg bid, Fluticasone: Inhaln/88–440 mcg bid; Inhaln
(powder)/100–1000 mcg bid, Triamcinolone: Uploaded by MEDBOOKSVN.ORG
Inhaln/55 mcg per metered spray
1882_Tab08_192-202 10/10/12 12:51 PM Page 200
Respiratory System Drugs Mast Cell Stabilizers 200
Cromolyn
(kroe-moe-lin)
Gastrocrom, NasalCrom
Apo-Cromolyn
1882_Tab08_192-202 10/10/12 12:51 PM Page 200
Respiratory System Drugs Mast Cell Stabilizers 200

Therapeutic/Pharmacologic Class • Prime the canister with 3 puffs before the first use
Antiasthmatic agent; antiallergy agent/mast cell and if the canister remains unused for more than
stabilizer 7 days to ensure adequate and accurate dosing.
Indications • Notify HCP if asthmatic symptoms do not
Management of mild to moderate asthma or allergy- improve within 4 wk, worsen, or recur.
induced asthmatic reactions. • This medication is not for rescue during acute
episodes of respiratory distress. Use bron-
Action chodilators for rescue.
Prevents the release of histamine and slow-reacting
substance of anaphylaxis (SRS-A) from sensitized
mast cells. Make the Connection
Adverse Reactions/Side Effects • Evaluate pulmonary function testing.
CNS: dizziness, fatigue, headache. EENT: • Assess lung sounds and respiratory function
pharyngitis, rhinitis. CV: chest pain. Resp: bron- before and periodically during therapy.
chospasm, cough, dyspnea. GI: unpleasant • Reduction in dose of other asthma medications
taste, diarrhea, dyspepsia, nausea, vomiting. may be possible after 2–4 wk of therapy.
Derm: rash. Misc: fever. • Pretreatment with a bronchodilator may be
required to increase delivery of inhalation
Keep in Mind product.
Teach client:
• Medication must be used as directed.
• Follow instructions for proper use of the metered-
dose inhaler.
Route/Dosage: Inhaln/1 ampule (20 mg) of theUploaded

nebulizer solution 4 by MEDBOOKSVN.ORG
times daily; intranasal/1 spray each nostril 3 to 4 times daily; PO/400 mg qid
1882_Tab08_192-202 10/10/12 12:51 PM Page 201
Respiratory System Drugs Leukotriene Receptor Antagonists 201
Montelukast Zafirlukast
(mon-te-loo-kast) (za-feer-loo-kast)
Singulair Accolate
Zyleuton
(zye-loo-ton)
Zyflo CR
1882_Tab08_192-202 10/10/12 12:51 PM Page 201
Respiratory System Drugs Leukotriene Receptor Antagonists 201

Allergy, cold, and cough remedy; bronchodilator/ Teach client:
leukotriene receptor antagonist • These drugs are not for rescue. In the case of
Indications bronchospasm, use the prescribed inhaler.
Prevention and chronic treatment of asthma. • Take as recommended for prophylaxis.
Management of seasonal allergic rhinitis.
Antagonizes the effects of leukotrienes, which
are mediators of the inflammatory response.
• Remember the part played by leukotrienes
in the inflammatory process (inflammation is the
Decrease airway edema and smooth muscle root of many problems, thus it should be given
constriction. Asthma and allergy are caused by your complete attention). Look for clues in the
chronic inflammation. generic name that would connect them with
Adverse Reactions/Side Effects leukotrienes (luk)!
CNS: headache, dizziness, weakness. • Assess for effectiveness.
GI: abdominal pain, diarrhea, drug-induced • Long-term therapy requires periodic assessment
hepatitis (women), dyspepsia, nausea, of liver and renal function.
vomiting. MS: arthralgia, back pain, myalgia. • Remember: Only beta2-agonists should be used
Misc: Churg-Strauss syndrome (angiitis; for bronchospasm.
vasculitis), fever, infection (geriatric clients),
pain.
Route/Dosage: Montelukast: PO/10 mg daily,Uploaded

Zafirlukast: PO/20by MEDBOOKSVN.ORG
mg bid, Zyleuton: PO/1200 mg bid
1882_Tab08_192-202 10/10/12 12:51 PM Page 202
Respiratory System Drugs Phosphodiesterase Inhibitor 202
Roflumilast
(row-floo-mi-last)
Daliresp
1882_Tab08_192-202 10/10/12 12:51 PM Page 202
Respiratory System Drugs Phosphodiesterase Inhibitor 202

Chronic obstructive pulmonary disease (COPD) Teach client:
agents/phosphodiesterase inhibitor • This drug is not a bronchodilator and should not
Indications be used for treating bronchospasm.
To ↓ the risk of exacerbations in patients with • Monitor weight regularly. If weight loss is noted,
severe COPD and a history of chronic bronchitis the drug may be discontinued.
with exacerbations. • Notify HCP if thoughts about suicide or dying,
trouble sleeping, depression, anxiety, acting on
Action dangerous impulses, or other unusual changes
Roflumilast and one active metabolite (roflumilast in behavior or mood occur. Teach family
N-oxide) act as selective inhibitors of phosphodi- members to watch for these behaviors also.
esterase 4 (PDE4), responsible for breaking down
cAMP. The result is decreased inflammation and • Notify HCP of any Rx or OTC medications,
vitamins, or herbal products being taken.
reduction of neutrophils, eosinophils, and total
inflammatory cells in sputum.
CNS: Suicidal thoughts, anxiety, depression, • Assess respiratory status and number of
dizziness, headache, insomnia. GI: diarrhea, exacerbations periodically.
abdominal pain, ↓ appetite, dyspepsia, gastritis, • Monitor weight regularly.
nausea, vomiting. Metabolic: weight loss. • Assess mental status for suicidal ideation.
MS: muscle spasms. Neuro: tremor.
Route/Dosage: PO/500 mcg daily Uploaded by MEDBOOKSVN.ORG

SENSORY
Acetazolamide, 203 Dipivefrin, 205 Ranibizumab, 207

Brinzolamide, 203 Brimonidine, 205 Verteporfin, 208
Dorzolamide, 203 Apraclonidine, 205 Pegaptanib, 209
Carbachol, 204 Latanoprost, 206 Lutein, 210
Acetylcholine, 204 Bimatoprost, 206 Zeaxanthin, 210
Pilocarpine, 204 Travoprost, 206
1882_Tab09_203-210 10/10/12 12:52 PM Page 203
Sensory System Drugs Carbonic Anhydrase Inhibitors 203
Acetazolamide Dorzolamide
(a-set-a-zole-a-mide) (door-zole-a-mide)
Diamox, Trusopt
Diamox Sequels
Apo-Acetazolamide
Brinzolamide
(brin-zole-a-mide)
Azopt
1882_Tab09_203-210 10/10/12 12:52 PM Page 203
Sensory System Drugs Carbonic Anhydrase Inhibitors 203

Therapeutic/Pharmacologic Class syndrome, rash. Endo: hyperglycemia. F and E:
Antiglaucoma agent; diuretic; ocular hypotensive agent; hyperchloremic acidosis, hypokalemia, growth
anticonvulsant agent/carbonic anhydrase inhibitor retardation (in children receiving chronic therapy).
Indications Hemat: aplastic anemia, hemolytic anemia,
Lowering of intraocular pressure in the treatment of leukopenia. Metab: weight loss, hyperuricemia.
glaucoma. Neuro: paresthesias. Misc: allergic reactions
including anaphylaxsis.
Action
Inhibition of carbonic anhydrase in the eye results in Keep in Mind
decreased secretion of aqueous humor. Inhibition Teach client:
of renal carbonic anhydrase results in self-limiting • Take the medication as directed.
urinary excretion of Na, K+, bicarbonate, and water. • Take PO form with food.
CNS inhibition of carbonic anhydrase and resultant • Report any rash immediately.
diuresis may ↓ abnormal neuronal firing. Alkaline
diuresis prevents precipitation of uric acid or cystine
in the urinary tract. Make the Connection
Adverse Reactions/Side Effects • Assess for hypersensitivity or cross-sensitivity
CNS: depression, tiredness, weakness, drowsiness. with sulfonamides.
EENT: transient nearsightedness. GI: anorexia, • Assess tonometry readings when used for glaucoma.
metallic taste, nausea, vomiting, melena. GU: Normal IOP is 10–21 mm Hg.
crystalluria, renal calculi. Derm: Stevens-Johnson • Monitor serum electrolytes, CBC, glucose levels,
and LFT.
• Assess ABG for metabolic acidosis.
Route/Dosage: Acetazolamide: PO/250–1000 mg/daily; IV/250–500 mg (maximum, 1 g)/daily, rate less than 500 mg/min, Dorzolamide: Ophth/
1 drop of 2% soln tid, Brinzolamide: Ophth/1 Uploaded
drop of 1% soln tid by MEDBOOKSVN.ORG
1882_Tab09_203-210 10/10/12 12:52 PM Page 204
Sensory System Drugs Cholinergics (Direct-Acting) 204
Carbachol Pilocarpine
(carb-a-kol) (pie-loe-car-peen)
Carboptic, Isopto Isopto Carpine,

Carbachol Ocusert Pilo
Acetylcholine
(a-ceet-till-choe-leen)
Miochol-E
1882_Tab09_203-210 10/10/12 12:52 PM Page 204
Sensory System Drugs Cholinergics (Direct-Acting) 204

Intraocular pressure-reducing agent/cholinergic Teach client:
(direct-acting) • Use this medication as directed by HCP.
Indications • This medication may sting when administered.
Management of open-angle glaucoma not • Drop into conjunctival pocket, not directly onto
controlled with short-acting miotics. Also used the eyeball.
to facilitate miosis after ophthalmic surgery or to • Hold the lacrimal duct for 1 min following
reverse mydriatics. administration to prevent systemic absorption.
Action • Report immediately any unexpected changes in vision.
Cholinergic nerve fibers are stimulated directly in • Do not drive or operate machinery at night because
pupils will be constricted and vision impaired.
the eye, promoting miosis. This increases outflow
of aqueous humor, decreasing intraocular pressure. • Periodic examinations will be scheduled.
CNS: headache and eye pain. CV: hypotension, Make the Connection
syncope, cardiac arrhythmias, flushing (large • Reverse this drug with atropine, an
systemic absorption). EENT: change in eye anticholinergic.
accommodation, stinging and burning, iritis, • Use cautiously in clients with chronic lung
salivation. GI: cramps, vomiting, diarrhea, conditions, such as asthma (large systemic
epigastric distress. GU: bladder spasm. absorption can cause bronchospasm).
Resp: bronchospasm. Misc: sweating. • Normal IOP is 10–21 mm Hg.
Route/Dosage: Carbachol: Ophth/1–2 drops of 0.01%–3% soln 1 to 3 times daily, Pilocarpine: Ophth/1–2 drops of 0.5%–4% soln up to 6 times
daily; gel, 1/2 -inch strip of 4% gel at bedtime; counteracting sympathomimetic mydriatics, 1 drop of 1% soln, Acetylcholine: Ophth/0.5–2 mL into
anterior chamber (surgical) Uploaded by MEDBOOKSVN.ORG
1882_Tab09_203-210 10/10/12 12:52 PM Page 205
Sensory System Drugs Sympathomimetics 205
Dipivefrin Apraclonidine
(di-pi-ve-frin) (a-pra-clon-i-deen)
Propine Iopidine
Brimonidine
(bri-mon-i-deen)
Alphagan P
1882_Tab09_203-210 10/10/12 12:52 PM Page 205
Sensory System Drugs Sympathomimetics 205

Therapeutic/Pharmacologic Class • Avoid activities that require good visual acuity.
Antiglaucoma agent/sympathomimetic agent Mydriasis causes visual disturbances and sensitivity
Indications to light.
Management of glaucoma. • Report palpitations to the HCP.
Action • Periodic examinations for intraocular pressure
and visual acuity will be scheduled.
Lowers intraocular pressure by decreasing forma-
tion of aqueous humor.
CNS: headache, nervousness, drowsiness. CV: • Monitor BP, pulse, and rhythm when
palpitations, arrhythmias, HTN (large systemic the client first begins to self-administer the
absorption). EENT: stinging, burning eye pain, medication.
sensitivity to light. • Monitor tonometry readings. Normal IOP is
10–21 mm Hg.
Keep in Mind • Avoid concurrent use of MAOI agents.
Teach client:
• Follow instructions for proper method of instilla-
tion. Place in conjunctival pocket and not directly
on eyeball.
• Hold lacrimal duct for 1 min after instillation to
prevent systemic absorption.
Uploaded
Route/Dosage: Dipivefrin: Ophth/1 drop of 0.1% by MEDBOOKSVN.ORG
soln q 12 hr, Apraclonidine: Ophth/1–2 drops of 0.5% soln tid, Brimonidine: Ophth/1 drop q 8 hr
1882_Tab09_203-210 10/10/12 12:52 PM Page 206
Sensory System Drugs Prostaglandin Agonists 206
Latanoprost Travoprost
(lat-an-oe-prost) (trav-oe-prost)
Xalatan Travatan
Bimatoprost
(bye-mat-toe-prost)
Lumigan
1882_Tab09_203-210 10/10/12 12:52 PM Page 206
Sensory System Drugs Prostaglandin Agonists 206

Therapeutic/Pharmacologic Class • Hold lacrimal duct for 1 min after instillation to
Antiglaucoma agent/prostaglandin agonist prevent systemic absorption.
Indications • Eye color may change to brown; local irritation
Management of glaucoma. and eyelash growth may occur.
Action • Periodic examinations for intraocular pressure
and visual acuity will be scheduled.
Anti-inflammatory action reduces obstruction to
aqueous humor outflow, lowering intraocular
pressure. Make the Connection
Adverse Reactions/Side Effects • Do not administer when contact lenses
EENT: local irritation, stinging, foreign body are in the eye.
sensation, increased eyelash growth, increased • Monitor tonometry readings. Normal IOP is
brown eye pigment (may change eye color to 10–21 mm Hg.
brown). CV: palpitations (excessive systemic
absorption).
Keep in Mind
Teach client:
• Follow instructions for proper method of instilla-
tion. Place in conjunctival pocket, not directly on
eyeball.
Route/Dosage: Latanoprost: Ophth/1 drop of 0.005% soln once daily, Travoprost: Ophth/1 drop of 0.004% soln once daily (PM),
Uploaded
Bimatoprost: Ophth/1 drop of 0.03% soln once daily (PM) by MEDBOOKSVN.ORG
1882_Tab09_203-210 10/10/12 12:52 PM Page 207
Sensory System Drugs Monoclonal Antibody 207
Ranibizumab
(ran-i-bi-zoo-mab)
Lucentis
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Sensory System Drugs Monoclonal Antibody 207

Ocular agents/monoclonal antibodies Teach client:
Indications • Notify ophthalmologist immediately if eye
Treatment of neovascular (wet) macular becomes red, sensitive to light, or painful, or
degeneration. develops a change in vision, as this indicates
acute glaucoma.
Action
Binds to vascular endothelial growth factor A • Signs and symptoms of ocular infection.
(VEGF-A) receptor sites, preventing the binding
of endogenous VEGF-A, resulting in decreased Make the Connection
endothelial proliferation, vascular leakage, and new
vessel formation. Arrests visual damage related to
• Contraindicated in hypersensitivity or in
the presence of ocular or periocular infections.
the genesis of leaky endothelial vessel formation. • Caution if needed during pregnancy or lactation
Adverse Reactions/Side Effects (maternal benefit outweighs risk to fetus).
EENT: conjunctival hemorrhage, eye pain, • Assess eye for signs of infection frequently during
↑ intraocular pressure, intraocular inflamma- week following injection.
tion, vitreal floaters, endophthalmitis, retinal • Check perfusion of optic nerve head immediately
detachment. CV: arterial thromboembolic after injection, use tonometry to measure intraoc-
events. ular pressure within 30 min following the injec-
tion (normal pressure is 10–21 mm Hg), and use
biomicroscopy between 2 and 7 days following
injection. Increases in intraocular pressure have
been seen within 30 min of injection.
Route/Dosage: Intravitreal/0.5 mg monthly forUploaded by

4 mo, then q 1–3 mo MEDBOOKSVN.ORG
1882_Tab09_203-210 10/10/12 12:52 PM Page 208
Sensory System Drugs Photodynamic Agent 208
Verteporfin
(ver-te-por-fin)
Visudyne
1882_Tab09_203-210 10/10/12 12:52 PM Page 208
Sensory System Drugs Photodynamic Agent 208

Photodynamic agent Teach client:
Indications • Avoid exposure of skin or eyes to direct sunlight
Treatment of age-related macular degeneration in or bright indoor light for 5 days due to photo-
patients with predominantly classic subfoveal sensitivity. If the client must go outdoors, dark
choroidal neovascularization. glasses and sunscreen must be used.
Action • Exposure to indoor ambient light is helpful and
causes the expected reaction in the eye and skin.
Vertoporfin is activated by nonthermal red light
in the presence of oxygen to form reactive oxygen • Appointments for follow-up evaluations every
3 mo must be kept.
radicals. The resultant compound produces local
damage to neovascular epithelium and subse-
quent vessel occlusion. Make the Connection
Adverse Reactions/Side Effects • Contraindicated in hypersensitivity and
CNS: headache, weakness. EENT: visual porphyria.
disturbances, cataracts, conjunctivitis/ • The largest arm vein, preferably the antecubital,
conjunctival injection, dry eyes, ocular itching, should be used for injection.
severe vision loss, subconjunctival/subretinal/ • If extravasation occurs, stop infusion immedi-
vitreous hemorrhage. Derm: photosensitivity. ately and apply cold compresses. The area of
Local: injection site reactions including extravasation must be protected from light until
extravasation and rashes. MS: back pain swelling and discoloration have faded, to pre-
(during infusion). Misc: fever, flu-like syndrome. vent a potentially severe local burn.
• Monitor CBC for anemia and for ↓ or ↑ WBC;
monitor for ↑ LFT, ↑ creatinine, and albuminuria.
Uploaded
Route/Dosage: IV/6 mg/m2 infused over 10 min, followed by laserby MEDBOOKSVN.ORG
treatment
1882_Tab09_203-210 10/10/12 12:52 PM Page 209
Sensory System Drugs Vascular Endothelial Growth Factor Antagonists 209
Pegaptanib
(peg-apt-i-nib)
Macugen
1882_Tab09_203-210 10/10/12 12:52 PM Page 209
Sensory System Drugs Vascular Endothelial Growth Factor Antagonists 209

Therapeutic/Pharmacologic Class change in vision that can indicate acute glaucoma
Ocular agents/vascular endothelial growth factor develops.
antagonist • Signs and symptoms of infection of the eye.
Indications
Neovascular (wet) age-related macular degeneration. Make the Connection
Action • Must not be administered if an ocular or
Acts as an antagonist of vascular endothelial periocular infection is present. Assess the eye
growth factor (VEGF). VEGF may be responsible for frequently for signs of infection for 1 week follow-
the formation of incompetent, leaky blood vessels ing injection.
associated with macular degeneration. Inhibition of • Check perfusion of optic nerve head immediately
vessel growth decreases the loss of visual acuity. after injection.
Adverse Reactions/Side Effects • Use tonometry to measure intraocular pressure
EENT: cataract, blurred vision, conjunctival within 30 min following the injection, and use
bleeding, irritation/pain, ↑ IOP, ocular inflam- biomicroscopy between 2 and 7 days following
mation, infection (rare), retinal detachment injection (normal pressure is 10–21 mm Hg).
(rare), traumatic cataract formation (rare). Increases in intraocular pressure have been seen
Misc: anaphylaxis, angioedema. within 30 min of injection.
• Monitor for anaphylaxis or angioedema.
Keep in Mind
Teach client:
• Contact ophthalmologist immediately if eye
becomes red, sensitive to light, or painful, or a
Route/Dosage: Intravitreal/0.3 mg every 6 wk Uploaded by MEDBOOKSVN.ORG

1882_Tab09_203-210 10/10/12 12:52 PM Page 210
Sensory System Drugs Xanthophyll Carotenoids 210
Lutein
(loo-teen)
Zeaxanthin
(zee-a-zan-thin)
1882_Tab09_203-210 10/10/12 12:52 PM Page 210
Sensory System Drugs Xanthophyll Carotenoids 210

Therapeutic/Pharmacologic Class • Consuming a healthy diet with whole grains,
Phytochemicals/Xanthophyll carotenoids fruits, and vegetables can supply lutein and
Indications zeaxanthin in therapeutic doses.
Prevention of central blindness or age-related • Vision examinations should be a normal part of a
macular degeneration. healthy life—at least yearly.
Action
Lutein and zeaxanthin are yellow pigments found Make the Connection
concentrated in the macula and are thought to • Lutein and zeaxanthin are contained in
protect the macula from oxidative stress and high- many ocular supplements, but they may be con-
energy photons of blue light. Supplementation sumed as part of a healthy diet. Food sources
of lutein and zeaxanthin increases this yellow include spinach, corn, broccoli, and eggs.
pigment. • Monitor clients for visual deficits when
Adverse Reactions/Side Effects doing initial assessments, and refer to an
Unknown at common supplemental dosages. ophthalmologist.
• Understand risk factors for age-related macular
Keep in Mind degeneration, and assess lifestyle factors that may
Teach client: contribute to disease.
• Lifestyle choices are important, also. Do not
smoke, or take steps to discontinue smoking.
Avoid prolonged exposure to sunlight without
protection, including effective sunglasses.
Uploaded
Route/Dosage: Lutein: PO/6–20 mg/day, Zeaxanthin: by
PO/2 mg/day MEDBOOKSVN.ORG
INDEX
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211
Index Aleve, 68
Alfuzosin, 57
Aminocaproic acid, 166
Aminophylline, 192
Apo-Amoxi, 79
Apo-ASA, 69
Note: Proprietary names are in
italic. Aliskiren, 186 Amiodarone, 178 Apo-Atenolol, 173
Allegra, 198 Amlodipine, 174 Apo-Benztropine, 133
A Allerdryl, 198 Amoxicillin, 79 Apo-Bromocriptine, 130
Abacavir, 91 AllerNase, 199 Amoxicillin/clavulanate, 79 Apo-Cal, 1
Abatecept, 108 Alloprim, 107 Amoxil, 79 Apo-carbamazepine, 121
Abilify, 146 Allopurinol, 107 Amphetamine, 153 Apo-Cephalex, 82
Acarbose, 37 Almotriptan, 156 Amphetamine Salt, 153 Apo-Cimetidine, 6
Accolate, 201 Alosetron, 13 Amphotec, 87 Apo-Cromolyn, 200
AccuNeb, 194 Aloxi, 25 Amphotericin B, 87 Apo-Diazepam, 135
Acetadote, 196 Alpha-Tamoxifen, 101 Ampicillin/sulbactam, 79 Apo-Diltiaz, 174
Acetazolamide, 203 Alphagan P, 205 Amrix, 97 Apo-Doxy, 81
Actonel/Atelvia, 100 Alprazolam, 135 Anafranil, 141 Apo-Erythro-EC, 74
Acetylcholine, 204 Altace, 175 Anaprox, 68 Apo-Fluphenazine, 144
Acetylcysteine, 196 Alteplase, 167 Anaspaz, 11 Apo-Folic, 185
Aciphex, 7 Altoprev, 181 Ancalixir, 115 Apo-Furosemide, 54
Activase/ Activase rt-PA, 167 Alupent, 194 Anexsia, 111 Apo-Glyburide, 38
Actos, 39 Amantadine, 129 Antara, 180 Apo-Hydro, 55
Acyclovir, 89 Amaryl, 38 Antivert, 22 Apo-imipramine, 141
Adalat CC, 174 Amber, 160 Anzemet, 25 Apo-Indomethacin, 68
Adcirca, 56 Ambien/Ambien CR, 117 Aricept/Aricept Oral Disintegrating Apo-ISDN, 179
Adderall/Adderall XR, 153 AmBisome, 87 Tablets (ODT), 134 Apo-ISMN, 179
Adrenalin, 157 Amerge, 156 Apidra, 28 Apo-K, 2
Alavert, 198 Amicar, 166 Aplenzin, 139 Apo-Lorazepam, 135
Albuterol, 194 Amikacin, 76 Apo-Acetazolamide, 203 Apo-Metoclop, 24
Aldactone, 53 Amikacin, 76 Apo-Allopurinol, 107 Apo-Napro-Na, 68
Alendronate, 100 Amiloride, 53 Apo-Alpraz, 135 Apo-Nifed, 174
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212
Apo-Perphenazine, 144 Avandia, 39 Biaxin/Biaxin XL, 74 Calan/Calan SR, 174
Apo-Primidone, 123 Avapro, 176 Bicitra, 3 Calcijex, 61
Apo-quinidine, 178 Avelox, 78 Bimatoprost, 206 Calcipotriene, 73
Apo-Selegiline, 127 Aventyl, 141 Binostro, 100 Calcitonin (salmon), 102
Apo-Sulfatrim DS, 86 Avinza, 112 Bisaco-Lax, 17 Calcitriol, 61
Apo-Tetra, 81 Avirax, 89 Bisacodyl, 17 Calcium acetate, 1, 59
Apo-Theo LA, 192 Avodart, 58 Bismatrol, 10 Calcium carbonate, 1
Apo-Trihex, 133 Axert, 156 Bismuth subsalicylate, 10 Calcium citrate, 1
Apo-Valproic, 126 Axid, 6 Bonamine, 22 Calcium gluconate, 1
Apo-Zidovudine, 91 Azilect, 127 Bonine, 22 Calphron, 1, 59
Apraclonidine, 205 Azithromycin, 74 Boniva, 100 Canasa, 27
Aripiprazole, 146 Azopt, 203 Brimonidine, 205 Cancidas, 88
Arixtra, 191 AZT, 91 Brinzolamide, 203 Candesartan, 176
Armour Thyroid, 41 Azulfadine, 27 Bromocriptine, 130 Capoten, 175
Artane/Artane Sequels (ER), 133 Budeprion XL, 139 Captopril, 175
Asacol/Asacol-HD, 27 B Budesonide, 199 Carafate, 9
Aspirin, 69 Baclofen, 97 Bumetanide, 54 Carbachol, 204
AsthmaNefrin, 157 Bactrim/Bactrim DS, 86 Bumex, 54 Carbamazepine, 121
Astramorph, 112 Baking soda, 3 Bupropion, 139 Carbatrol, 121
Atacand, 176 Bayer Aspirin, 69 Burinex, 54 Carbex, 127
Atenolol, 173 Beclomethasone, 199 BuSpar, 136 Carbidopa/levodopa, 132
Ativan, 135 Bell-Ans, 3 Buspirone, 136 Carbolith, 138
Atomoxetine, 154 Benadryl/Benadryl Allergy, 198 Butorphanol, 159 Carboptic, 204
Atorvastatin, 181 Benylin-E, 197 Bydureon, 33 Cardizem/Cardizem LA, 174
AtroPen, 188 Benztropine, 133 Byetta, 33 Cardura/Cardura XL, 57
Atropine, 188 Besifloxacin, 78 Carisoprodol, 97
Atrovent/Atrovent HFA, 193 Besivance, 78 C CartiaXT, 174
Augmentin/Augmentin Betaloc-ZOK, 173 Cabbage palm, 65 Carvedilol, 173
ES/Augmentin XR, 79 Bethanechol, 52 Cal-Citrate 250, 1 Caspofungin, 88
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213
Catapres/Catapres-TTS, 177 Claritin/Claritin 24-Hour Allergy/ Coumadin, 164 Denosumab, 103
Cathflo Activase, 167 Claritin Hives Relief/Claritin Covera-HS, 174 Depacon, 126
Cefepime, 82 Reditabs, 198 Cozaar, 176 Depakene, 126
Ceftazidime, 82 Clavulin, 79 Crestor, 181 Depakote/Depakote ER, 126
Ceftriaxone, 82 Clear-Atadine, 198 Cromolyn, 200 Desipramine, 141
Celebrex, 105 Cleocin/Cleocin T, 75 Cyclobenzaprine, 97 Desirudin, 189
Celecoxib, 105 Clindamycin, 75 Cycloset, 130 Desmopressin, 46
Celexa, 137 Clomipramine, 141 Cyclosporine, 66 Desvenlafaxine, 140
Cephalexin, 82 Clonazepam, 135 Cymbalta, 140 Detoconazole (systemic), 87
Cephulac, 18 Clonidine, 177 Cytomel, 41 Detrol/Detrol LA, 51, 64
Cerebyx, 122 Clopidogrel, 165 Cytotec, 8 DexFerrum, 63
Cesamet, 26 Cogentin, 133 Dexmethylphenidate, 152
Children’s Loratadine, 198 Cognex, 134 D D.H.E. 45, 150
Chlorothiazide, 55 Colace, 19 Dabigatran, 189 DiaBeta, 38
Chlorpromazine, 144 Colchicine, 106 Dalacin C, 75 Diamox/Diamox Sequels, 203
Cholestyramine resin, 183 Colcrys, 106 Daliresp, 202 Diastat, 135
Chronulac, 18 Colesevelam, 183 Dalteparin, 163 Diazepam, 135
Cialis, 56 Colestid, 183 Dantrium, 98 Didanosine, 91
Cidomycin, 76 Colestipol, 183 Dantrolene, 98 Dideoxyinosine, 91
Cilostazol, 165 Colyte, 15 Darifenacin, 51 Didronel, 100
Cimetidine, 6 Compazine, 23 Darunavir, 92 Diflucan, 87
Cipro/Cipro XR, 78 Comtan, 131 Daytrana Transdermal Patch, 152 Digoxin, 169
Ciprofloxacin, 78 Concerta, 152 DC Softgels, 19 Dihydroergotamine-Sandoz,
Citalopram, 137 Cordarone, 178 DDAVP/DDAVP Rhinal Tube/ 150
Citrate of magnesia, 20 Coreg/Coreg CR, 173 DDAVP Rhinyl Drops, 46 Dilacor XR, 174
Citrical/Citracal Liquitab, 1 Cortef, 43 ddI, 91 Dilantin, 122
Citrocarbonate, 3 Cortifoam, 43 Delavirdine, 93 Dilatrate SR, 179
Citrucel, 14 Cortisone, 43 Demerol, 112 Dilaudid/Dilaudid-HP, 112
Clarithromycin, 74 Cortone, 43 Demon chaser, 160 Diltia XT, 174
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214
Diltiazem, 174 Ducolax Magnesia Tablets, 20 Enoxaparin, 163 Evista, 101
Dimetapp Children’s ND Ducosate calcium, 19 Entacapone, 131 Ex-Lax, 17
Non-Drowsy Allergy, 198 Duloxetine, 140 Epimorph, 112 Exalgo, 112
Diovan, 176 Duragesic, 110 Epinephrine, 157 Exelon/Exelon Transdermal
Dipentum, 27 Duramorph, 112 EpiPen, 157 Patch, 134
Diphenhydramine, 198 Dutasteride, 58 Epitol, 121 Exenatide/exenatide ER
Diphenoxylate/atropine, 12 Duvoid, 52 Epival, 126 suspension, 33
Dipivefrin, 205 Dynabac, 74 Epivir/Epivir HBV, 91 Ezetimibe, 182
Diprivan, 114 Dyrenium, 53 EPO, 62 Ezetrol, 182
Dirithromycin, 74 Epoetin, 62
Ditropan/Ditropan XL, 51 E Epogen, 62 F
Diuril, 55 E-Mycin, 74 Eprex, 62 Famciclovir, 89
Divalproex, 126 Ecotrin, 69 Epsilon, 166 Famivir, 89
Dixarit, 177 Edluar, 117 Ergomar, 150 Famotidine, 6
Docusate sodium, 19 Edrophonium, 99 Ergostat, 150 Fareston, 101
Dolasetron, 25 Eduant, 93 Ergotamine, 150 Fenofibrate, 180
Donepezil, 134 E.E.S., 74 Ertapenem, 83 Fentanyl (transdermal), 110
Dopamine, 172 Efavirenz, 93 EryGel, 74 Fesoterodine, 64
Doribax, 83 Effexor/Effexor XR, 140 EryPed, 74 Fexofenadine, 198
Doripenem, 83 Eldepryl, 127 Erythromycin, 74 Filgrastim (granulocyte
Doryx, 81 Elidel, 67 Escitalopram, 137 colony-stimulating factor
Dorzolamide, 203 Elixophyllin, 192 Esomeprazole, 7 [G-CSF]), 72, 187
Dovonex, 73 Enablex, 51 Eszopiclone, 117 Finasteride, 58
Doxazosin, 57 Enalapril, 175 Etanercept, 71 Fletcher’s Castoria, 17
Doxycycline, 81 Enalaprilat, 175 Ethambutol, 85 Flexeril, 97
Dramamine II, 22 Enbrel, 71 Ethosuximide, 124 Flomax, 57
Dronabinol, 26 Endocet, 111 Etibi, 85 Florinef, 44
Droperidol, 143 Enfuvirtide, 94 Etidronate, 100 Flovent HFA/Flovent Diskus, 199
Ducolax, 17 Enlon, 99 Etravirine, 93 Fluconazole, 87
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215
Fludrocortisone, 44 Garamycin, 76 Granulocyte/macrophage Hypericum perforatum
Fluoxetine, 137 Gas-X, 16 colony-stimulating factor, (St. John’s Wort), 160
Fluphenazine, 144 Gastrocrom, 200 recombinant human (rHu Hytinic, 63
Fluticasone, 199 Gelnique, 51 GM-CSF), 72 Hytrin, 57
Fluvoxamine, 137 Gemfibrozil, 180 Guaifenesin, 197 Hytuss, 197
Focalin/Focalin XR, 152 Genfraf, 66 Guiatuss, 197
Folate, 185 Gentamicin, 76 Gynergen, 150 I
Folic acid, 185 Geodon, 149 Ibandronate, 100
Folvite, 185 Ginger, 4 H Ibudone, 111
Fondaparinux, 191 Glimepiride, 38 Haldol/Haldol Decanoate, 143 Ibuprofen, oral, 68
Foradil, 194 Glipizide, 38 Haloperidol, 143 IMDUR, 179
Formoterol, 194 GlucaGen, 40 Hardhay, 160 Imipenem/cilastatin, 83
Fortamet, 34 Glucagon, 40 Hep-Lock/Hep-Lock U/P, 162 Imipramine, 141
Fortaz, 82 Gluconorm, 36 Hepalean, 162 Imitrex/Imitrex STATdose, 156
Forteo, 104 Glucophage/Glucophage XR, 34 Heparin, 162 Imodium/Imodium AD, 12
Fortical, 102 Glucotrol/Glucotrol XL, 38 Humalog, 28 Inamrinone, 170
Fosamax, 100 Glyburide, 38 Humatrope, 47 Inapsine, 143
Fosphenytoin, 122 Glynase PresTab, 38 Humulin N, 30 Indocin, 68
Fragmin, 163 Glyset, 37 Humulin R, 29 Indomethacin, 68
Fungizone, 87 GM-CSF (granulocyte/ Hydrochlorothiazide, 55 InFeD, 63
Furosemide, 54 macrophage colony- Hydrocodone/acetaminophen, Infliximab, 71
Fuzeon, 94 stimulating factor), 72 111 INH, 85
Goatweed, 160 Hydrocodone/ibuprofen, Innohep, 162
G GoLYTELY, 15 111 Inocor, 170
G-CSF (granulocyte colony- Gralise, 120 Hydrocortisone, 43 Insulin, regular, 29
stimulating factor), 72, 187 Granisetron, 25 Hydrofluoroakane (HFA), 194 Insulin aspart rDNA
Gabapentin, 120 Granulocyte colony- Hydromorphone, 112 origin, 28
Gabitril, 120 stimulating factor Hydrostat IR, 112 Insulin detemir, 31
Galantamine, 134 (G-CSF), 72, 187 Hyoscyamine, 11 Insulin glargine, 31
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216
Insulin glulisine (rDNA Isosorbide dinitrate, 179 Klonopin, 135 Levothyroxine, 41
origin) injection, 28 Isosorbide mononitrate, 179 Klor-Con, 2 Levoxyl, 41
Insulin (isophane insulin Isotrate, 179 Kristalose, 18 Levsin, 11
suspension) intermediate Isuprel, 195 Kytril, 25 Lexapro, 137
type, 30 Lialda, 27
J
Insulin lispro rDNA origin, 28 L Lidocaine (parenteral), 178
Jantoven, 164
Insulin-Toronto, 29 Labetalol, 173 Lidoderm, 178
Januvia, 35
Intelence, 93 Lacosamide, 125 LidoPen, 178
Jenamicin, 76
Intermezzo, 117 Lactulax, 18 Linagliptin, 35
Ju-Zhong, 65
Intropin, 172 Lactulose, 18 Lioresal, 97
Invanz, 83 K Lamictal/Lamictal XR, 125 Liothyronine, 41
Invirase, 92 K-Dur, 2 Lamivudine, 91 Lipidil Micro, 180
Iopidine, 205 K-Exit, 5 Lamotrigine, 125 Lipitor, 181
Ipratropium, 193 K-Long, 2 Lanoxicaps, 169 Lisinopril, 175
Iprivask, 189 K-Lor, 2 Lanoxin, 169 Lithium, 138
Irbesartan, 176 Kabbikinase, 167 Lanreotide, 48 Lithobid, 138
Iron dextran, 63 Kadian, 112 Lansoprazole, 7 LoCHOLEST/LoCHOLEST
Iron polysaccharide, 63 Kalcinate, 1 Lantus, 31 Light, 183
Iron sucrose, 63 Kanamycin, 76 Lasix, 54 Lofibra, 180
Isentress, 96 Kantrex, 76 Latanoprost, 206 Logen, 12
ISMO, 179 Kaopectate, 10 Laxit, 17 Lomotil, 12
Isocarboxazid, 142 Kaopectolin, 10 Leukine, 72 Lonox, 12
Isoniazid, 85 Karacil, 14 Levalbuteral, 194 Loperamide, 12
Isoproterenol, 195 Kayexalate, 5 Levaquin, 78 Lopid, 180
Isoptin/Isoptin SR, 174 Keflex, 82 Levemir, 31 Lopresor, 173
Isopto Carbachol, 204 Keppra/Keppra XR, 119 Levetiracetam, 119 Lopressor, 173
Isopto Carpine, 204 Ketorolac, 68 Levitra, 56 Lopurin, 107
Isopto Hyoscine, 21 Klamath weed, 160 Levofloxacin, 78 Loratadine, 198
Isordil, 179 Klean-Prep, 15 Levothroid, 41 Lorazepam, 135
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Lorcet, 111 Medihaler-Iso, 195 Micronase, 38 Naloxone, 113
Lortab, 111 Medrol, 43 Microzide, 55 Naltrexone, 113
Losartan, 176 Megace, 49 Midamor, 53 Naprosyn, 68
Losec, 7 Megestrol, 49 Midazolam, 116 Naproxen, 68
Lotronex, 13 Meperidine, 112 Miglitol, 37 Naratriptan, 156
Lovastatin, 181 Mephyton, 168 Migranal, 150 Narcan, 113
Lovaza, 184 Meridia, 151 Milrinone, 170 Nardil, 142
Lovenox, 163 Meropenem, 83 Minitran, 179 Nasacort AQ, 199
Lucentis, 207 Merrem, 83 Miochol-E, 204 NasalCrom, 200
Lumigan, 206 Mesalamine, 27 Mirapex, 128 Nateglinide, 36
Luminal, 115 Mestinon/Mestinon Timespan/ Misoprostol, 8 Natrecor, 171
Lunesta, 117 Mestinon SR, 99 Modafinil, 155 Navane, 145
Lutein, 210 Metadate CD/Metadate ER, 152 MOM (milk of magnesia), 20 Nebcin, 76
Luvox/Luvox CR, 137 Metamucil, 14 Monoket, 179 Nembutal, 115
Lyrica, 120 Metaproterenol, 194 Montelukast, 201 Nelfinavir, 92
Metaxolone, 97 Morphine, 112 Neo-Diaral, 12
M Metformin, 34 Morphine H.P., 112 Neoral, 66
Macugen, 209 Methimazole, 42 Moxifloxacin, 78 Neostigmine, 99
Mag-Ox 400, 20 Methotrexate, 70 MS Contin, 112 Nephro-Calci, 1
Magnacet, 111 Methylcellulose, 14 Mucinex, 197 Nephrocaps, 60
Magnesium citrate, 20 Methylin, 152 Mucomyst, 196 Nesiritide, 171
Magnesium hydroxide, 20 Methylphenidate, 152 Myambutol, 85 Neut, 3
Magnesium oxide, 20 Methylprednisolone, 43 Mycamine, 88 Neulasta, 72, 187
Maraviroc, 95 Metoclopramide, 24 Mylicon, 16 Neumega, 190
Marinol, 26 Metoprolol, 173 Mysoline, 123 Neupogen, 72, 187
Marplan, 142 Mevacor, 181 Neural protamine Hagedorn
Maxalt/Maxalt-MLT, 156 Miacalcin, 102 N (NPH), 30
Maxipime, 82 Micafungin, 88 Nabilone, 26 Neurontin, 120
Meclizine, 22 Micro-K/ Micro-K ExtenCaps, 2 Nalmefene, 113 Nevirapine, 93
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218
Nexium, 7 Novo-Tamoxifen, 101 Oracit, 3 Pegvisomant, 50
Nexterone, 178 Novo-Theophyl, 192 Orencia, 108 Pentasa, 27
Nifedipine, 174 Novo-Veramil, 174 Oretic, 55 Pentobarbital, 115
Niferex, 63 Novolin ge NPH, 30 Os-Cal, 1 Pepcid, 6
Niravam, 135 Novolog, 28 Oseltamivir, 90 Pepto-Bismol, 10
Nitrek, 179 Novopentobarb, 115 Ovol/ Ovol-40, 16 Percocet, 111
Nitro-Bid/Nitro-Bid IV, 179 Novopramine, 141 Oxcarbazepine Perforomist, 194
Nitro-Dur, 179 Novosecobarb, 115 (carbamazepine analog), Periostat, 81
Nitro-Time, 179 Novospiroton, 53 121 Perphenazine, 144
Nitrogard SR, 179 Novulin R, 29 Oxybutynin, 51 Pertofrane, 141
Nitroglycerin, 179 NPH (neural protamine Oxycodone/acetaminophen, Pexeva, 137
Nitrolingual, 179 Hagedorn), 30 111 Phazyme, 16
NitroQuik, 179 Nu-Iron, 63 Oxytocin, 45 Phenelzine, 142
Nitrostat, 179 Nu-Verap, 174 Oxytrol, 51 Phenobarbital, 115
Nizatidine, 6 Nucynta, 112 Phenytek, 122
Nizoral, 87 NuLytely, 15 P Phenytoin, 122
Norfranil, 141 Pacerone, 178 Phillips Magnesia Tablets, 20
Norpramin, 141 O Palonosetron, 25 Phillips Milk of Magnesia, 20
Nortriptyline, 141 Octreotide, 48 Pamelor, 141 Phos-Lo, 1
Norvasc, 174 Ocusert Pilo, 204 Pantoprazole, 7 PhosLo, 59
Norvir, 92 Olanzapine, 148 Parcopa, 132 Phyllocontin, 192
Nova-Theophyl SR, 192 Olsalazine, 27 Pariet, 7 Phytonadione, 168
Novo-Alprazol, 135 Omega-3-acid ethyl esters, Parlodel, 130 Pilocarpine, 204
Novo-Chlorpromazine, 144 184 Parnate, 142 Pimecrolimus, 67
Novo-Diltazem, 174 Omeprazole, 7 Paroxetine, 137 Pioglitazone, 39
Novo-Metformin, 34 Ondansetron, 25 Parvolex, 196 Piperacillin/tazobactam, 80
Novo-Nifedin, 174 Onglyza, 35 Paxil/Paxil ER, 137 Pitocin, 45
Novo-Rythro, 74 Oprelvekin, 190 Pegaptanib, 209 Pitressin, 46
Novo-Salmol, 194 Oracea, 81 Pegfilgrastim (G-CSF), 72, 187 Plavix, 165
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Pletal, 165 Prinivil, 175 Q Renal Caps, 60
PMS-Dicitrate, 3 Pristiq, 140 Questran/Questran Light, 183 Renvela, 59
PMS-Haloperidol, 143 ProAir HFA, 194 Quibron-T, 192 Repaglinide, 36
PMS Hydromorphone, 112 Procainamide, 178 Quinidine, 178 Reprexain, 111
PMS-Isoniazid, 85 Procardia/Procardia XL, 174 Quinupristin/dalfopristin, 84 Requip/Requip XL, 128
PMS-Levothyroxine Prochlorperazine, 23 Qvar, 199 Rescriptor, 93
sodium, 41 Procrit, 62 Restasis, 66
PMS-Methylphenidate, 152 Prolia, 103 R Retavase, 167
PMS Pyrazinamide, 85 Prolixin/Prolixin Decanoate, Rabeprazole, 7 Reteplase, 167
PMS-Sulfasalazine, 27 144 Ralivia, 109 Retrovir, 91
Polyethylene glycol/ Propecia, 58 Raloxifene, 101 Revatio, 56
electrolyte, 15 Propine, 205 Raltegravir, 96 Revex, 113
Potassium chloride, 2 Propofol, 114 Ramelteon, 118 ReVia (oral), 113
Pradaxa, 189 Propyl-Thyracil, 42 Ramipril, 175 Revimine, 172
Pramipexole, 128 Propylthiouracil, 42 Ranibizumab, 207 Rheumatrex, 70
Pramlintide, 32 Proscar, 58 Ranitidine, 6 Rifadin, 85
Prandin, 36 Prostigmin, 99 Rasagiline, 127 Rifampin, 85
Precose, 37 Protamine sulfate (injection), Razadyne/Razadyne ER, 134 Rilpivirine, 93
Prednisone, 43 161 Reclast, 100 Risedronate, 100
PredPak, 43 Protonix/Protonix IV, 7 Recombinant human Risperdal/Risperdal M-TAB/
Pregabalin, 120 Proventil, 194 granulocyte/macrophage Risperdal Consta, 147
Pressyn, 46 Provigil, 155 colony-stimulating factor Risperidone, 147
Prevacid/Prevacid 24 hr, 7 Prozac/Prozac Weekly, 137 (rHu GM-CSF), 72 Ritalin/Ritalin LA/Ritalin-SR,
Prevalite, 183 Psyllium, 14 Reglan/Reglan ODT, 24 152
Prezista, 92 PTU, 42 Regonol, 99 Ritonavir, 92
Prilosec/Prilosec OTC, 7 Pulmicort Respules/Pulmicort Regulex, 19 Rivaroxaban, 191
Primacor, 170 Flexhaler, 199 Relenza, 90 Rivastigmine, 134
Primaxin, 83 Pyrazinamide, 85 Remicade, 71 Rizatriptan, 156
Primidone, 123 Pyridostigmine, 99 Renagel, 59 Robitussin, 197
1882_Index_211-222 11/10/12 1:37 PM Page 220
220
Rocaltrol, 61 Saw palmetto, 65 Sodium citrate/citric acid, 3 Sumavel DosePro, 156
Rocephin, 82 Saw palmetto Sodium polystyrene Sumycin, 81
Rofact, 85 berry, 65 sulfonate, 5 Surfak, 19
Roflumilast, 202 Saxagliptin, 35 Solfoton, 115 Sustiva, 93
Ropinirole, 128 Scopolamine, 21 Solifenacin, 51 Symlin, 32
Rosiglitazone, 39 Secobarbital, 115 Solu-Cortef, 43 Symmetrel, 129
Rosin rose, 160 Seconal, 115 Solu-Medrol (IV), 43 Syn-Clonazepam, 135
Rosuvastatin, 181 Selegiline/selegiline Soma, 97 Synercid, 84
Rowasa, 27 transdermal, 127 Somatropin, 47 Synthroid, 41
Roxycet, 111 Selzentry, 95 Somatuline Depot, 48 Syntocinon, 45
Rozerem, 118 Sennosides, 17 Somavert, 50
Ryzolt, 109 Senokot, 17 Sominex, 198 T
Septra, 86 Spironolactone, 53 T3, 41
S Serenoa repens, 65 Sprix, 68 T4, 41
S-2 (racepinephrine), 157 Serevent, 194 St. John’s Wort (Hypericum t-PA, 167
Sabal, 65 Serostim, 47 perforatum), 160 Tacrine, 134
Salmeterol, 194 Sevelamer, 59 Starlix, 36 Tadalafil, 56
Salofalk, 27 Sibutramine, 151 Stavzor, 126 Tagamet, 6
Sanctura/Sanctura XL, 64 Sildenafil, 56 Stemetil, 23 Tamiflu, 90
Sandimmune, 66 Simethicone, 16 Sterapred, 43 Tamoxifen, 101
Sandostatin/Sandostatin LAR, 48 Simvastatin, 181 Stimate, 46 Tamsulosin, 57
Sans-Acne, 74 Sinemet/Sinemet CR, 132 Stradol/Stradol NS, 159 Tapazole, 42
Saquinavir, 92 Singulair, 201 Strattera, 154 Tapentadol, 112
Sarafem, 137 Sitagliptin, 35 Streptase, 167 Tasmar, 131
Sargramostim (recombinant Skelaxin, 97 Streptokinase, 167 Tazicef, 82
human granulocyte/ Slow-K, 2 Sucralfate, 9 Tegretol/Tegretol XR, 121
macrophage colony- SMZ/TMP, 86 Sulcrate, 9 Tekturna, 186
stimulating factor [rHu Soda Mint, 3 Sulfasalazine, 27 Tenecteplase, 167
GM-CSF]), 72 Sodium bicarbonate, 3 Sumatriptan, 156 Tenormin, 173
1882_Index_211-222 11/10/12 1:37 PM Page 221
221
Tensilon, 99 Topiramate, 120 U VESIcare, 51
Terazosin, 57 Toprol-XL, 173 Ultram/Ultram ER, 109 VFEND, 87
Terbutaline, 158 Toradol, Toradol 68 Unasyn, 79 Viagra, 56
Teril, 121 Toremefine, 101 Unisom Nightime Sleep Vibramycin, 81
Teriparitide, 104 Toviaz, 64 Aid, 198 Vicodin, 111
Tetracycline, 81 Tramadol, 109 Urabeth, 52 Vicoprofen, 111
THC, 26 Trandate, 173 Urecholine, 52 Videx/Videx EC, 91
Theo-24, 192 Transderm-Scop, 21 Uroxatral, 57 Vimpat, 125
Theophylline, 192 Transderm-V, 21 Viracept, 92
Thiothixene, 145 Tranylcypromine, 142 V Viramune, 93
Thorazine, 144 Travatan, 206 Valacyclovir, 89 Visudyne, 208
3TC, 91 Travoprost, 206 Valium, 135 Vitamin B, 185
Thyrar, 41 Trexall, 70 Valproate sodium, 126 Vitamin B with vitamin C,
Thyroid, 41 Triamcinolone, 199 Valproic acid, 126 60
Tiagabine, 120 Triamterene, 53 Valsartan, 176 Vitamin K, 168
Tiazac, 174 Tricor, 180 Valtrex, 89 Vivitrol (injection), 113
Ticlopidine, 165 Tridil, 179 Vanadom, 97 Voriconazole, 87
Tinzaparin, 162 Triglide, 180 Vancocin, 77 VoSpire ER, 194
Tipramine, 141 Trihexyphenidyl, 133 Vancomycin, 77
W
Tipton weed, 160 Trilafon, 144 Vardenafil, 56
Warfarin, 164
Tissue plasminogen activator Trileptal, 121 Vasopressin, 46
Warfilone, 164
(t-PA), 167 Trimethoprim/ Vasotec/Vasotec IV, 175
Welchol, 183
TNKase, 167 sulfamethoxazole, 86 Velosulin R, 29
Wellbutrin/Wellbutrin SR, 139
TOBI, 76 Trimox, 79 Venlafaxine, 140
Westhroid, 41
Tobramycin, 76 Triostat, 41 Venofer, 63
Tofranil/Tofranil PM, 141 Trospium, 64 Ventolin HFA, 194 X
Tolcapone, 131 Trusopt, 203 Verapamil, 174 Xalatan, 206
Tolterodine, 51, 64 Tums/Tums E-X, 1 Versed, 116 Xanax/Xanax XR, 135
Topamax, 120 Tylox, 111 Verteporfin, 208 Xarelto, 191
1882_Index_211-222 11/10/12 1:37 PM Page 222
222
Xopenex/Xopenex HFA/Xopenex Zarontin, 124 Zocar, 181 Zyflo CR, 201
Concentrate, 194 Zeaxanthin, 210 Zofran, 25 Zyleuton, 201
Xylocaine, 178 Zestril, 175 Zoledronic acid, 100 Zyloprim, 107
Xylocard, 178 Zetia, 182 Zolpidem, 117 Zyprexa/Zyprexa Relprevv/Zyprexa
Ziagen, 91 Zolpimist, 117 Intramuscular/Zyprexa Zydis,
Z Zidovudine, 91 Zometa, 100 148
Zafirlukast, 201 Ziprasidone, 149 Zosyn, 80
Zantac/ Zantac-C, 6 Zithromax, 74 Zovirax, 89
Zanamivir, 90 Zmax, 74 Zyban, 139

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1882_FM_i-xvi 11/10/12 1:34 PM Page i

Davis’s Success Series

The tools for

Sally K. Davis, RN, MSN

Linda C. McIntosh, PhD, RN, LPC

Gastrointestinal System Drugs Central Nervous System Drugs

Endocrine System Drugs Cardiovascular System Drugs

Urologic System Drugs Respiratory System Drugs

Immune System Drugs Sensory System Affecting the Eye

Musculoskeletal System Drugs

Abbreviations Used on Cards

F and E fluid and electrolyte hs hour of sleep/bedtime mcg microgram(s)

OCD obsessive-compulsive RA rheumatoid arthritis subcut (sc) subcutaneously

Calcium Carbonate, 1 Pantoprazole, 7 Docusate Calcium, 19

Gastrointestinal System Drugs Calcium Salts 1

Os-Cal, Tums, Tums Kalcinate

Cal-Citrate 250, Calphron, PhosLo

Gastrointestinal System Drugs Calcium Salts 1

Gastrointestinal System Drugs Potassium Supplement 2

K-Dur, K-Lor, Klor-Con, Micro-K

Gastrointestinal System Drugs Potassium Supplement 2

Gastrointestinal System Drugs Alkalizing Agents 3

Baking soda, Bell-Ans, Citrocarbonate,

Gastrointestinal System Drugs Alkalizing Agents 3

Gastrointestinal System Drugs Antiemetic (Herbal) 4

Gastrointestinal System Drugs Antiemetic (Herbal) 4

Gastrointestinal System Drugs Cationic Exchange Resin 5

Gastrointestinal System Drugs Cationic Exchange Resin 5

Gastrointestinal System Drugs Histamine H2 Receptor Antagonists 6

Gastrointestinal System Drugs Histamine H2 Receptor Antagonists 6

Gastrointestinal System Drugs Proton (Gastric) Pump Inhibitors 7

Nexium Prilosec, Prilosec OTC

Aciphex Protonix; Protonix IV

Gastrointestinal System Drugs Proton (Gastric) Pump Inhibitors 7

Gastrointestinal System Drugs Prostaglandin 8

Gastrointestinal System Drugs Prostaglandin 8

Route/Dosage: PO/200–400 mcg bid–qid

Gastrointestinal System Drugs Gastric Mucosa Protectant 9

Gastrointestinal System Drugs Gastric Mucosa Protectant 9

Route/Dosage: PO/1 g qid 1 hr before meals and at bedtime or 2 g bid

Gastrointestinal System Drugs Adsorbent 10

Gastrointestinal System Drugs Adsorbent 10

Gastrointestinal System Drugs Anticholinergic 11

Gastrointestinal System Drugs Anticholinergic 11

Gastrointestinal System Drugs Antidiarrheals 12

Lomotil, Lonox, Logen

Imodium, Imodium AD, Neo-Diaral

Gastrointestinal System Drugs Antidiarrheals 12

Gastrointestinal System Drugs 5-HT3 Antagonist 13

Gastrointestinal System Drugs 5-HT3 Antagonist 13

Route/Dosage: PO/(women) 0.5 mg twice daily

Gastrointestinal System Drugs Bulk-Forming Agents 14

Gastrointestinal System Drugs Bulk-Forming Agents 14

Gastrointestinal System Drugs Osmotic 15

GoLYTELY, NuLytely, Colyte

Gastrointestinal System Drugs Osmotic 15

Route/Dosage: PO/4 L (240 mL taken every 10 min)

Gastrointestinal System Drugs Antiflatulent 16

Gas-X, Mylicon, Phazyme

Gastrointestinal System Drugs Antiflatulent 16