Generic: acetaminophen (oral, Brand name: tylenol, Tempra Classification: antipyretic, nonopiod,

rectal analgesic

Use: mild pain, fever, mild to sever pain w/ analgesic Onset: 0.5-1hr Peak: 1-3hr Duration 3-8 hrs half life: Half-
life: Neonates: 7 hr; Infants and Children: 3–4 hr; Adults: 1–3
hr.
Safe Dosage: PO (Adults and Children >12 yr): 325–650 Action: Inhibits synthesis of prostaglandins that may serve as
mg every 6 hr or 1 g 3–4 times daily or 1300 mg every 8 mediators of pain and fever, primarily in the CNS. Has no
hr (not to exceed 3 g or 2 g/24 hr in patients with significant anti-inflammatory properties or GI toxicity.
hepatic/renal impairment).
Adverse Reaction: HEPATOTOXICITY (increase dose) Contraindication: previous hypersensitivity; product
constipation, rash urticaria containing alcohol, aspartame, sever hepatic
impairment/active liver dse.

Precaution: hepatic dse/ renal dse. Alcoholism, Interaction: warfarin, NSAID, propanolol, alcohol
chronic malnutrition.
Nursing Implication: Assess overall health status and alcohol usage before administering acetaminophen. Assess for rash
periodically during therapy. May cause Stevens-Johnson syndrome. Pain: Assess type, location, and intensity prior to and
30–60 min following administration. Fever: Assess fever; note presence of associated signs (diaphoresis, tachycardia, and
malaise). If overdose occurs, acetylcysteine (Acetadote) is the antidote.
Client Teaching: Advise patient to take medication exactly as directed and not to take more than the recommended
amount. Advise patient to avoid alcohol. Advise patient to discontinue acetaminophen and notify health care professional
if rash occurs. Inform patients with diabetes that acetaminophen may alter results of blood glucose monitoring.

Generic: amoxicillin/clavulanate Brand name: Classification: anti-infectives

Augmentin/Augmentin ES/Clavulin
Use: Skin and skin structure infections, Otitis media, Onset: PO 30 min, peak 1–2 hr, duration 8–12 h Half-life: 1–1.3
Sinusitis, Respiratory tract infections, Genitourinary hr
tract infections.
Safe Dosage: PO (Adults and Children >40 kg): 250 mg Action: Binds to bacterial cell wall, causing cell death;
every 8 hr or 500 mg every 12 hr. spectrum of amoxicillin is broader than penicillin. Clavulanate
resists action of beta-lactamase, an enzyme produced by
bacteria that is capable of inactivating some penicillins.
Adverse Reaction: GI: CLOSTRIDIOIDES DIFFICILE- Contraindication: Hypersensitivity to penicillins or clavulanate;
ASSOCIATED DIARRHEA (CDAD), diarrhea, hepatic Suspension and chewable tablets contain aspartame and
dysfunction, nausea, vomiting GU: vaginal candidiasis should be avoided in phenylketonurics; History of
Derm: rash, urticaria amoxicillin/clavulanate-associated cholestatic jaundice.
Precaution: Severe renal insufficiency (dose ↓ Interaction: Probenecid ↓ renal excretion and ↑ blood levels
necessary); Infectious mononucleosis (↑ risk of rash); of amoxicillin–therapy may be combined for this purpose. May
Hepatic impairment (dose cautiously, monitor liver ↑ the effect of warfarin. Concurrent allopurinol therapy ↑ risk
function). of rash. May ↓ the effectiveness of hormonal contraceptives.
Nursing Implication: Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing).
determine previous use of and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin
sensitivity may still have an allergic response. Administer around the clock. Administer at the start of a meal to enhance
absorption and to decrease GI side effects.
Client Teaching: Instruct patient to notify health care professional immediately if diarrhea, abdominal cramping, fever, or
bloody stools occur and not to treat with antidiarrheals without consulting health care professionals. Instruct patients to
take medication around the clock and to finish the drug completely as directed, even if feeling better.

Generic: benazepril- Brand name: Lotensin Classification: ACE inhibitor (benazepril) and a "water
hydroCHLOROthiazide pill"/diuretic (hydrochlorothiazide)
Use: It is used to treat high blood Onset: PO within 1 hr*, peak: 1–2 wks†, duration: 24 hr† Half-
pressure (hypertension) life: Benazeprilat: 10–11 hr.
Safe Dosage: 5mg/6.25mg,10mg/12.5mg, Action: Benazepril works by relaxing blood vessels, causing them to widen. The
20mg/12.5mg,20mg/25mg hydrochlorothiazide diuretic increases the amount of urine you make, which
decreases excess water and salt in your body. Lowering high blood pressure helps
prevent strokes, heart attacks, and kidney problems

Adverse Reaction:  dizziness, light-headedness, Contraindication: Hypersensitivity History of angioedema with

drowsiness, headache, fatigue, blurred vision, or without previous use of ACE inhibitors. Concurrent use with
dry cough, or vomiting as your body adjusts to aliskiren in patients with diabetes or moderate-to-severe renal
the medication.  impairment.
Precaution: This product may affect your potassium Interaction:  aliskiren, cholestyramine, colestipol, diazoxide, 
levels, If you have diabetes, hydrochlorothiazide may dofetilide, certain drugs that weaken the immune
affect your blood sugar.  system/increase the risk of infection

Nursing Implication: Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy.
Assess patient for signs of angioedema (swelling of face, extremities, eyes, lips, tongue, difficulty in swallowing or
breathing); may occur at any time during therapy. Do not confuse benazepril with Benadryl. O For patients with difficulty
swallowing tablets, pharmacist can compound an oral suspension; stable for 30 days if refrigerated. Shake suspension
before each use.
Client Teaching: Instruct patient to take medication as directed at the same time each day, even if feeling well. Take
missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Instruct patient and
family on correct technique for monitoring BP. Caution patient to change positions slowly to minimize hypotension. Use of
alcohol, standing for long periods, exercising, and hot weather may increase orthostatic hypotension.
Generic: cephalexin Brand name: Keflex Classification: anti-infectives (first
generation cephalosporins)
Use: Treatment of the following infections caused by Onset: PO rapid, peak: 1 hr duration: 6–12 hr
susceptible organisms: Skin and skin structure
infections, Respiratory tract infections, Otitis media,
Urinary tract infections, Bone infections.
Safe Dosage: PO (Adults): Most infections– 250–500 mg Action: Binds to bacterial cell wall membrane, causing cell
every 6 hr. Uncomplicated cystitis, skin and soft tissue death.
infections, streptococcal pharyngitis– 500 mg every 12
hr. Maximum dose: 4 g/day
Adverse Reaction: CLOSTRIDIOIDES DIFFICILE- Contraindication: Hypersensitivity to cephalosporins Serious
ASSOCIATED DIARRHEA (CDAD), diarrhea, abdominal hypersensitivity to penicillins.
pain, nausea, vomiting. SEIZURES (HIGH DOSES)
Precaution: Renal impairment History of GI disease, Interaction: Probenecid ↓ excretion and ↑ blood levels of
especially colitis Lactation: Use during breastfeeding renally excreted cephalosporins. Concurrent use of loop
only if benefit to patient outweighs potential risk to diuretics or aminoglycosides may ↑ risk of renal toxicity.
infant.
Nursing Implication: Before initiating therapy, obtain a history to determine previous use of and reactions to penicillins or
cephalosporins. Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing).
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools. PO Administer around the clock. May be
administered on full or empty stomach. Administration with food may minimize GI irritation.
Client Teaching: Instruct patient to notify health care professional if fever and diarrhea develop, especially if diarrhea
contains blood, mucus, or pus. Instruct patient to take medication around the clock at evenly spaced times and to finish
the medication completely as directed, even if feeling better.

Generic: codeine Brand name: Codeine Classification: allergy, cold and cough
**BEERS Drug** remedies antitussives opioid analgesics
Use: Management of mild to moderate pain. Onset: PO 30–45 min peak: 60–120 min duration: 4 hr, Half-
Antitussive (in smaller doses). life: 2.5–4 hr.
Safe Dosage: PO (Adults): Analgesic– 15–60 mg every 4 Action: Binds to opiate receptors in the CNS. Alters the
hr as needed (not to exceed 360 mg/day). Antitussive– perception of and response to painful stimuli while producing
10–20 mg every 4–6 hr as needed (not to exceed 120 generalized CNS depression. Decreases cough reflex.
mg/day). Antidiarrheal – 30 mg up to 4 times daily. Decreases GI motility.
Adverse Reaction: CV: hypotension, GI: constipation, Contraindication: Hypersensitivity; Significant respiratory
nausea, vomiting, Neuro: confusion, sedation, Resp: depression; Acute or severe bronchial asthma (in unmonitored
RESPIRATORY DEPRESSION setting or in absence of resuscitative equipment);

Precaution: Avoid use in breast feeding (↑ risk of Interaction: MAO inhibitors ↑ risk of adverse reactions;
drowsiness and respiratory depression in infant); Head concurrent use or use within previous 14 days contraindicated.
trauma; ↑ intracranial pressure; Severe renal, hepatic, Additive CNS depression with alcohol, antidepressants,
or pulmonary disease; Hypothyroidism; Adrenal antihistamines, benzodiazepines, and sedative/hypnotics.
insufficiency; Alcoholism
Nursing Implication: Assess BP, pulse, and respirations before and periodically during administration. If respiratory rate is
<10/min, assess level of sedation. Assess risk for opioid addiction, abuse, or misuse prior to administration. Assess type,
location, and intensity of pain before and 1 hr (peak) after administration. Cough: Assess cough and lung sounds during
antitussive use. If an opioid antagonist is required to reverse respiratory depression or coma, naloxone is the antidote.
Client Teaching: PO Oral doses may be administered with food or milk to minimize GI irritation. Advise patient that
codeine is a drug with known abuse potential. Protect it from theft, and never give to anyone other than the individual for
whom it was prescribed. Advise patient to change positions slowly to minimize orthostatic hypotension. May cause
drowsiness or dizziness. Advise patient to call for assistance when ambulating or smoking. REMS: Instruct patient on risk of
addiction, abuse, and misuse, which could lead to death.
Generic: diazepam Brand name: Diastat/ Valium Classification: antianxiety agents/
**BEERS Drug** anticonvulsants sedative/hypnotics skeletal
muscle relaxants (centrally acting)
Use: Anxiety disorders, Preoperative sedation, Status Onset: PO 30–60 min peak:1–2 hr duration: up to 24 hr, Half
epilepticus/uncontrolled seizures, Skeletal muscle life: Adults: 20–50 hr (up to 100 hr for metabolites).
spasms. Alcohol withdrawal. Conscious sedation,
Safe Dosage: Antianxiety PO (Adults): 2–10 mg 2–4 times Action: Depresses the CNS, probably by potentiating GABA, an
daily. Skeletal Muscle Relaxation PO (Adults): 2–10 mg 3–4 inhibitory neurotransmitter. Produces skeletal muscle relaxation by
times daily, Alcohol Withdrawal PO (Adults): 10 mg 3–4 times in inhibiting spinal polysynaptic afferent pathways. Has anticonvulsant
first 24 hr, ↓ to 5 mg 3–4 times daily properties due to enhanced presynaptic inhibition.
Adverse Reaction: Neuro: dizziness, drowsiness, Contraindication: Hypersensitivity; Cross-sensitivity with other
lethargy, Resp: RESPIRATORY DEPRESSION, Derm: rash benzodiazepines may occur; Comatose patients; Myasthenia gravis;
Severe pulmonary impairment; Sleep apnea; Severe hepatic
impairment;
Precaution: Severe renal impairment; History of suicide Interaction: Cimetidine, hormonal contraceptives, disulfiram,
attempt or drug dependence; Debilitated patients (dose fluoxetine, isoniazid, ketoconazole, metoprolol, propranolol, or
↓ required); Patients with low albumin; Pregnancy valproic acid may ↓ the metabolism of diazepam, enhancing
(may cause fetal harm); its actions.
Nursing Implication: Monitor BP, pulse, and respiratory rate prior to and periodically throughout therapy and frequently
during IV therapy. Do not confuse diazepam with diltiazem. PO Tablets may be crushed and taken with food or water if
patient has difficulty swallowing. Use lowest effective dose. Taper by 2 mg every 3 days to decrease withdrawal
symptoms. Some patients may require longer taper periods (mo).
Client Teaching: Advise patient that diazepam is a drug with known abuse potential. Medication may cause drowsiness,
clumsiness, or unsteadiness. Caution patient to avoid taking alcohol or other CNS depressants, including opioids,
concurrently with this medication. Abrupt withdrawal of diazepam may cause insomnia, unusual irritability or
nervousness, and seizures. Advise patient that sharing of this medication may be dangerous.

Generic: dimenhydrinate Brand name: Dramamine/ Gravol Classification: antiemetics antihistamines

**BEERS Drug**
Use: Nausea, vomiting, dizziness, and vertigo Onset: PO 15–60 min peak: 1–2 hr duration: 3–6 hr Half-life:
accompanying motion sickness. Unknown.
Safe Dosage: PO (Adults): 50–100 mg every 4 hr (not to Action: Inhibits vestibular stimulation. Has significant CNS
exceed 400 mg/day). depressant, anticholinergic, antihistaminic, and antiemetic
properties.

Adverse Reaction: CNS: drowsiness, GI: anorexia, CV: Contraindication: Hypersensitivity; Some products contain
hypotension, palpitations alcohol or tartrazine; in patients with known intolerance.

Precaution: Angle-closure glaucoma; Seizure disorders; Interaction: Drug-Drug ↑ CNS depression with other
Prostatic hyperplasia. antihistamines, alcohol, opioid analgesics, and
sedative/hypnotics.

Nursing Implication: Monitor intake and output, including emesis. Assess for signs of dehydration. Assess nausea,
vomiting, bowel sounds, and abdominal pain before and after administration of this drug. Dimenhydrinate may mask the
signs of an acute abdomen. Do not confuse dimenhydrinate with diphenhydramine. PO Use calibrated measuring device
when administering liquid dose.
Client Teaching: May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until
response to the drug is known. Inform patient that this medication may cause dry mouth. Frequent oral rinses, good oral
hygiene, and sugarless gum or candy may minimize this effect. Caution patient to avoid alcohol and other CNS depressants
concurrently with this medication. Advise patient to use sunscreen and protective clothing to prevent photosensitivity
reactions.
Generic: digoxin Brand name: Lanoxin/ Toloxin Classification: antiarrhythmics/ inotropics
**BEERS Drug**
Use: Heart failure. Atrial fibrillation and atrial flutter Onset: Digoxin–PO 30–120 min peak:2–8 hr duration:2–4
(slows ventricular rate). Paroxysmal atrial tachycardia. days†
Safe Dosage: PO (Adults): Digitalizing dose– 0.75–1.5 mg Action: Increases the force of myocardial contraction. Prolongs
given as 50% of the dose initially and one quarter of the initial refractory period of the AV node. Decreases conduction
dose in each of 2 subsequent doses at 6–12 hr intervals. through the SA and AV nodes.
Maintenance dose– 0.125–0.5 mg/day depending on patient's
lean body weight, renal function, and serum level. PO Geriatric
Patients: Initial daily dose should not exceed 0.125 mg.
Adverse Reaction: CNS: fatigue, CV: ARRHYTHMIAS, Contraindication: Hypersensitivity; Uncontrolled ventricular
arrhythmias; AV block (in absence of pacemaker); Idiopathic
bradycardia, GI: anorexia, nausea, vomiting,
hypertrophic subaortic stenosis; Constrictive pericarditis; Known
alcohol intolerance (elixir only).
Precaution: Hypokalemia (↑ risk of digoxin toxicity); Hypercalcemia Interaction: Thiazide and loop diuretics,
(↑ risk of toxicity, especially with mild hypokalemia); Hypomagnesemia piperacillin/tazobactam, amphotericin B, corticosteroids, and
(↑ risk of digoxin toxicity); Diuretic use (may cause electrolyte
abnormalities including hypokalemia and hypomagnesemia);
excessive use of laxatives may cause hypokalemia which may
Hypothyroidism; Myocardial infarction ↑ risk of toxicity.
Nursing Implication: Monitor apical pulse for 1 full min before administering. Withhold dose and notify health care professional if pulse
rate is <60 bpm in an adult. Monitor intake and output ratios and daily weights. Observe for signs and symptoms of toxicity. Before
administering initial loading dose, determine whether patient has taken any digoxin in the preceding 2–3 wk. High Alert: Digoxin has a
narrow therapeutic range. PO Administer oral preparations consistently with regard to meals.
Client Teaching: Teach patient to take pulse and to contact health care professional before taking medication if pulse rate
is <60 or >100. Review signs and symptoms of digitalis toxicity with patient and family. Instruct patient to keep digoxin
tablets in their original container and not to mix in pill boxes with other medications; Instruct patient to take medication
as directed, at same time each day.

Generic: diphenhydrAMINE Brand name: Benadryl, Benylin Classification: antihistamines

Use: Relief of allergic symptoms caused by histamine Onset: PO 15–60 min peak: 2–4 hr duration 4–8 hr Half-life:
release including: Anaphylaxis, Seasonal and perennial 2.4–7 hr
allergic rhinitis, Allergic dermatoses.
Safe Dosage: PO (Adults and Children >12 Action: Antagonizes the effects of histamine at H1 -receptor
yr): Antihistaminic/antiemetic/antivertiginic– 25–50 mg every 4–6 hr, not sites; does not bind to or inactivate histamine.
to exceed 300 mg/day
PO (Children  6–12yr):  Antihistaminic/antiemetic /antivertiginic– 12.5–25
mg every 4–6 hr (not to exceed 150 mg/day).   Antidyskinetic– 1–1.5 mg/kg
every 6–8 hr as needed (not to exceed 300 mg/day
Adverse Reaction: GI: anorexia, dry mouth, Neuro: Contraindication: Hypersensitivity; Acute attacks of asthma;
drowsiness, dizziness, headache, Lactation; Known alcohol intolerance (some liquid products).
Precaution: Severe liver disease; Angle-closure Interaction: ↑ risk of CNS depression with other
glaucoma; Seizure disorders; Prostatic hyperplasia; antihistamines, alcohol, opioid analgesics, and
Peptic ulcer; sedative/hypnotics. ↑ anticholinergic effects with tricyclic
antidepressants, quinidine, or disopyramide.
Nursing Implication: Do not confuse Benadryl with benazepril. Do not confuse diphenhydramine with dimenhydrinate.
Administer with meals or milk to minimize GI irritation. Capsule may be emptied and contents taken with water or food.
Orally disintegrating tablets and strips should be left in the package until use. Remove from the blister pouch. Do not push
tablet through the blister;
Client Teaching: May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until
response to drug is known. May cause dry mouth. Inform patient that frequent oral rinses, good oral hygiene, and
sugarless gum or candy may minimize this effect. Advise patients taking diphenhydramine in OTC preparations to notify
health care professional if symptoms worsen or persist for more than 7 days
Generic: dilTIAZem Brand name: Cardizem Classification: antianginals,
antihypertensives
Use: Hypertension. Angina pectoris and vasospastic Onset: PO 30 min peak: 2–3 hr duration 6–8 hr Half-life: 3.5–9
(Prinzmetal's) angina. Supraventricular hr
tachyarrhythmias and rapid ventricular rates in atrial
flutter or fibrillation.
Safe Dosage: PO (Adults): 30–120 mg 3–4 times daily or 180–240 mg Action: Inhibits transport of calcium into myocardial and
once daily as CD or XR capsules or LA tablets (up to 360 vascular smooth muscle cells, resulting in inhibition of
mg/day);  Concurrent simvastatin therapy– Diltiazem dose should not
exceed 240 mg/day and simvastatin dose should not exceed 10 mg/day. excitation-contraction coupling and subsequent contraction.

Adverse Reaction: CV: ARRHYTHMIAS, HF, peripheral Contraindication: Hypersensitivity; Sick sinus syndrome; 2nd-

edema, bradycardia, chest pain, hypotension, or 3rd-degree AV block (unless an artificial pacemaker is in
palpitations, syncope, tachycardia place); Systolic BP
Precaution: Severe hepatic impairment (↓ dose Interaction: ↑ hypotension may occur when used with
recommended); Severe renal impairment; Serious fentanyl, other antihypertensives, nitrates, acute ingestion of
ventricular arrhythmias or HF alcohol, or quinidine. May ↑ digoxin levels

Nursing Implication: Monitor intake and output ratios and daily weight. Assess for signs of HF. Assess for rash periodically
during therapy. May cause Stevens-Johnson syndrome. Monitor ECG continuously during administration. Report
bradycardia or prolonged hypotension promptly. Emergency equipment and medication should be available. Monitor BP
and pulse before and frequently during administration.
Client Teaching: Advise patient to notify health care professional if rash, irregular heartbeats, dyspnea, swelling of hands
and feet, pronounced dizziness, nausea, constipation, or hypotension occurs or if headache is severe or persistent.
Caution patient to change positions slowly to minimize orthostatic hypotension. May cause drowsiness or dizziness.

Generic: HYDROmorphone Brand name: Dilaudid Classification: allergy, cold and cough
remedies (antitussives) opioid analgesics
Use: Moderate to severe pain (alone and in Onset: PO-IR 30 min peak: 30–90 min duration 4–5 hr, Half-
combination with nonopioid analgesics). Antitussive life: Oral (immediate-release), Oral (extended-release)– 8–15
(lower doses). hr.

Safe Dosage: PO (Adults ≥50 kg): Immediate-release– 4–8 mg every 3– Action: Binds to opiate receptors in the CNS. Alters the
4 hr initially (some patients may respond to doses as small as 2 mg perception of and response to painful stimuli while producing
initially); or once 24-hr opioid requirement is determined, convert to
extended-release by administering total daily oral dose once daily.
generalized CNS depression. Suppresses the cough reflex via a
direct central action.
Adverse Reaction: CV: hypotension, GI: constipation, Contraindication: Hypersensitivity; Some products contain
dry mouth, nausea, vomiting, Neuro: confusion, bisulfites and should be avoided in patients with known
sedation, Resp: RESPIRATORY DEPRESSION hypersensitivity; Severe respiratory depression (in absence of
resuscitative equipment) (extended-release only);
Precaution: Head trauma; Hypothyroidism; Seizure Interaction: Exercise extreme caution with MAO inhibitors
disorder; Adrenal insufficiency; Alcoholism; (may produce severe, unpredictable reactions)
Nursing Implication: Assess BP, pulse, and respirations before and periodically during administration. If respiratory rate is
<10/min, assess level of sedation. Dose may need to be decreased by 25–50%. Initial drowsiness will diminish with
continued use. Monitor for respiratory depression, especially during initiation or following dose increase; serious, life-
threatening, or fatal respiratory depression may occur. May cause sleep-related breathing disorders (central sleep apnea
[CSA], sleep-related hypoxemia).
Client Teaching: High Alert: Accidental overdose of opioid analgesics has resulted in fatalities. REMS: Instruct patient on
how and when to ask for pain medication. May cause drowsiness or dizziness. Advise patient to change positions slowly to
minimize orthostatic hypotension. Instruct patient to avoid concurrent use of alcohol or other CNS depressants.

Generic: furosemide Brand name: Lasix Classification: diuretics

Use: Edema due to heart failure, hepatic impairment, or Onset: PO 30–60 peak: min 1–2 duration hr 6–8 hr, Half-life:
renal disease. Hypertension. 30–60 min (↑ in renal impairment).
Safe Dosage: PO (Adults): 20–80 mg/day as a single dose initially, may Action: Inhibits the reabsorption of sodium and chloride from
repeat in 6–8 hr; may ↑ dose by 20–40 mg every 6–8 hr until desired the loop of Henle and distal renal tubule. 0:00 / 0:00 Increases
response. Maintenance doses may be given once or twice daily (doses up
to 2.5 g/day have been used in patients with HF or renal disease).
renal excretion of water, sodium, chloride, magnesium,
Hypertension– 40 mg twice daily initially (when added to regimen, ↓ dose potassium, and calcium.
of other antihypertensives by 50%); adjust further dosing based on
response; Hypercalcemia– 120 mg/day in 1–3 doses.
Adverse Reaction: Derm: ERYTHEMA MULTIFORME, STEVENS- Contraindication: Hypersensitivity; Cross-sensitivity with thiazides
JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, Hemat: APLASTIC and sulfonamides may occur; Hepatic coma or anuria; Some liquid
ANEMIA, AGRANULOCYTOSIS, CV: hypotension, F and E: dehydration, products may contain alcohol, avoid in patients with alcohol
hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia,
hyponatremia, hypovolemia, metabolic alkalosis
intolerance.
Precaution: Severe hepatic impairment, Electrolyte depletion; Interaction: ↑ risk of hypotension with antihypertensives, nitrates, or acute
Diabetes mellitus; OB: Use during pregnancy only if potential maternal ingestion of alcohol. ↑ risk of hypokalemia with other diuretics, amphotericin B,
benefit justifies potential fetal risk Lactation: Use while breastfeeding only stimulant laxatives, and corticosteroids. Hypokalemia may ↑ risk of digoxin toxicity
if potential maternal benefit justifies potential risk to infant and ↑ risk of arrhythmia in patients taking drugs that prolong the QT interval.

Nursing Implication: Assess patient for skin rash frequently during therapy. Discontinue furosemide at first sign of rash;
may be life-threatening. Do not confuse Lasix (furosemide) with Luvox (fluvoxamine). May be taken with food or milk to
minimize gastric irritation. Tablets may be crushed if patient has difficulty swallowing.
Client Teaching: Caution patient to change positions slowly to minimize orthostatic hypotension. Advise patient to contact
health care professional immediately if rash, muscle weakness, cramps, nausea, dizziness, numbness, or tingling of
extremities occurs. Advise diabetic patients to monitor blood glucose closely; may cause increased blood glucose levels.

Generic: meperidine Brand name: Demerol Classification: opioid analgesics

Use: Moderate or severe pain (alone or with nonopioid Onset: PO 15 min peak: 60 min duration 2–4 hr Half-life:
agents). Anesthesia adjunct. Analgesic during labor. Neonates: 12–39 hr; Infants 3–18 mo: 2.3 hr; Children 5–8 yr:
Preoperative sedation 3 hr; Adults: 2.5–4 hr (↑ in impaired renal or hepatic function [7–11 hr]).

Safe Dosage: PO (Adults): Analgesia– 50–150 mg every 3–4 hr; may ↑ Action: Binds to opiate receptors in the CNS. Alters the
as needed (not to exceed 600 mg/24 hr). PO Children: Analgesia– 1.1–1.8 perception of and response to painful stimuli, while producing
mg/kg every 3–4 hr (max = 100 mg/dose).
generalized CNS depression
Adverse Reaction: CV: hypotension, GI: constipation, Contraindication: Binds to opiate receptors in the CNS. Alters
nausea, vomiting Neuro: SEIZURES, confusion, sedation, the perception of and response to painful stimuli, while
producing generalized CNS depression
Resp: RESPIRATORY DEPRESSION Misc:
HYPERSENSITIVITY REACTIONS
Precaution: Head trauma; ↑ intracranial pressure; Interaction: Do not use in patients receiving MAO inhibitors or procarbazine
Severe renal or hepatic impairment; Acute asthma Use with benzodiazepines or other CNS depressants including other opioids, non-
benzodiazepine sedative/hypnotics, anxiolytics, general anesthetics, muscle
attack, COPD, hypoxia, or hypercapnea; relaxants, antipsychotics, and alcohol may cause profound sedation, respiratory
Hypothyroidism; Adrenal insufficiency; Alcoholism; depression, coma, and death;
Nursing Implication: Assess BP, pulse, and respirations before and periodically during administration. Monitor patients on
chronic or high-dose therapy for CNS stimulation (restlessness, irritability, seizures) Rate: High Alert: Administer slowly
over at least 5 min. Rapid administration may lead to increased respiratory depression, hypotension, and circulatory
collaps
Client Teaching: May cause drowsiness or dizziness. Educate patients and caregivers on how to recognize respiratory
depression Advise patient to change positions slowly to minimize orthostatic hypotension. Instruct patient to avoid
concurrent use of alcohol or other CNS depressants.

Generic: metoclopramide Brand name: Reglan Classification: antiemetics

Use: PO Gastroesophageal reflux PO IV Intranasal Acute Onset: PO 30–60 min peak: unknown Duration: 1–2 hr, Half-
and recurrent diabetic gastroparesis. life: 2.5–6 hr.

Safe Dosage: Diabetic Gastroparesis PO IV IM (Adults): 10 mg 30 min Action: Blocks dopamine receptors in chemoreceptor trigger
before meals and at bedtime for 2–8 wk (not to exceed 40 mg/day). zone of the CNS. Stimulates motility of the upper GI tract and
Gastroesophageal Reflux PO (Adults): 10–15 mg 30 min before each meal
and at bedtime (not to exceed 60 mg/day). accelerates gastric emptying.

Adverse Reaction: Neuro: drowsiness, dysgeusia Contraindication: Hypersensitivity; Possible GI obstruction,

(intranasal), extrapyramidal reactions, restlessness, perforation, or hemorrhage; Seizure disorders
NEUROLEPTIC MALIGNANT SYNDROME
Precaution: History of depression; Diabetes (may alter Interaction: MAO inhibitors may cause release of
response to insulin); Cirrhosis or HF (↑ risk of fluid catecholamines which may ↑ BP; avoid concurrent use.
retention) Additive CNS depression with other CNS depressants, including
alcohol, antidepressants, antihistamines, opioid analgesics,
and sedative/hypnotics.
Nursing Implication: Monitor for neuroleptic malignant syndrome (hyperthermia, muscle rigidity, altered consciousness,
irregular pulse or BP, tachycardia, and diaphoresis). Administer doses 30 min before meals and at bedtime.

Client Teaching: Take oral missed doses as soon as remembered if not almost time for next dose. Take oral missed doses
as soon as remembered if not almost time for next dose. Advise patient to avoid concurrent use of alcohol and other CNS
depressants while taking this medication.

Generic: metroNIDAZOLE Brand name: Flagyl Classification: anti-infectives antiprotozoals

antiulcer agents
Use: PO IV Treatment of the following anaerobic infections: Intra- Onset: PO rapid peak: 1–3 hr duration: 8 hr Half-life:
abdominal infections (may be used with a cephalosporin), Gynecologic Neonates: 25–75 hr; Children and adults: 6–12 hr.
infections, Skin and skin structure infections, Lower respiratory tract
infections, Bone and joint infections, CNS infections, Septicemia,
Endocarditis. PO Treatment of the following infections: Amebic dysentery,
amebic liver abscess, and trichomoniasis Peptic ulcer disease caused by
Helicobacter pylori
Safe Dosage: PO (Adults): Anaerobic infections– 7.5 mg/kg every 6 hr Action: Disrupts DNA and protein synthesis in susceptible
(not to exceed 4 g/day). Trichomoniasis– 250 mg every 8 hr for 7 days or organisms. Therapeutic Effect(s): Bactericidal, trichomonacidal,
single 2-g dose or 1 g twice daily for 1 day. Amebiasis– 500–750 mg every
8 hr for 5–10 days. H. pylori– 250 mg 4 times daily or 500 mg twice daily or amebicidal action
for 1–2 wk (with other agents). Antibiotic associated Clostridioides
difficile-associated diarrhea (CDAD)– 250–500 mg 3–4 times/day for 10–14
days.
Adverse Reaction: Derm: STEVENS-JOHNSON SYNDROME (SJS), GI: Contraindication: Contraindicated in: Hypersensitivity; Hypersensitivity to
abdominal pain, anorexia, nausea, SEIZURES, dizziness, headache parabens (topical only); OB: First trimester of pregnancy.
Precaution: History of blood dyscrasias; History of seizures or Interaction: Cimetidine may ↑ levels and risk of toxicity. Phenobarbital and
neurologic problems; Severe hepatic impairment (dose ↓ suggested); rifampin may ↓ levels and effectiveness .
Nursing Implication: Assess for rash periodically during therapy. Giardiasis: Monitor three stool samples taken several days
apart, beginning 3–4 wk after treatment. PO Administer on an empty stomach, or may administer with food or milk to
minimize GI irritation.

Client Teaching: Instruct patient to notify health care professional promptly if rash occurs. Caution patient to avoid intake
of alcoholic beverages or preparations containing alcohol during and for at least 3 days after treatment. Inform patient
that medication may cause an unpleasant metallic taste. Advise patient that frequent mouth rinses, good oral hygiene,
and sugarless gum or candy may minimize dry mouth.

Generic: metFORMIN Brand name: Glucophage, Glycon Classification: antidiabetics

Use: Management of type 2 diabetes mellitus; may be Onset: PO-IR unknown peak: unknown duration: 12 hr. Half-
used with diet, insulin, or sulfonylurea oral life: 17.6 hr.
hypoglycemics.
Safe Dosage: PO (Adults): 500 mg twice daily; may ↑ by 500 mg at Action: Decreases hepatic glucose production. Decreases
weekly intervals up to 2000 mg/day. If doses >2000 mg/day are required, intestinal glucose absorption. Increases sensitivity to insulin.
give in 3 divided doses (not to exceed 2500 mg/day) or 850 mg once daily;
may ↑ by 850 mg at 2-wk intervals (in divided doses) up to 2550 mg/day
in divided doses (up to 850 mg 3 times daily); Extended-release tablets–
500 mg once daily with evening meal, may ↑ by 500 mg at weekly
intervals up to 2000 mg once daily.
Adverse Reaction: F and E: LACTIC ACIDOSIS GI: Contraindication: Hypersensitivity; Metabolic acidosis
abdominal bloating, diarrhea, nausea, vomiting, (including diabetic ketoacidosis); Severe renal impairment (CCr
unpleasant metallic taste Hemat: ↓ vitamin B12 levels
Precaution: Mild to moderate renal impairment, Interaction: Acute or chronic alcohol ingestion or iodinated contrast media ↑
risk of lactic acidosis. Amiloride, digoxin, morphine, procainamide, quinidine,
chronic alcohol use/abuse; Hypoxic states, Pituitary triamterene, trimethoprim, calcium channel blockers, and vancomycin may
deficiency or hyperthyroidism compete for elimination pathways with metformin. Altered responses may occur
Nursing Implication: Patients who have been well controlled on metformin who develop illness or laboratory
abnormalities should be assessed for ketoacidosis or lactic acidosis. Patients stabilized on a diabetic regimen who are
exposed to stress, fever, trauma, infection, or surgery may require administration of insulin.

Client Teaching: Instruct patient to take metformin at the same time each day, as directed. Explain to patient the risk of
lactic acidosis and the potential need for discontinuation of metformin therapy if a severe infection, dehydration, nform
patient that metformin may cause an unpleasant or metallic taste that usually resolves spontaneously

Generic: omeprazole Brand name: Losec PriLOSEC Classification: antiulcer agents

Use: GERD/maintenance of healing in erosive Onset: PO-delayed release within 1 hr peak: within 2 hr
esophagitis. Duodenal ulcers OTC: Heartburn occurring duration: 72–96 hr Half-life: 0.5–1 hr (↑ in liver disease to 3
≥twice/wk. hr).
Safe Dosage: ERD/erosive esophagitis and maintenance of Action: Binds to an enzyme on gastric parietal cells in the
healing of erosive esophagitis– 20 mg once daily. Duodenal presence of acidic gastric pH, preventing the final transport of
ulcers associated with H. pylori– 40 mg once daily in the hydrogen ions into the gastric lumen
morning with clarithromycin for 2 wk, then 20 mg once daily for
2 wk
Adverse Reaction: GI: CLOSTRIDIOIDES DIFFICILE- Contraindication: Hypersensitivity to omeprazole or related
ASSOCIATED DIARRHEA (CDAD), abdominal pain, drugs (benzimidazoles); Concurrent use of rilpivirine.
HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS,
ANGIOEDEMA, OR TUBULOINTERSTITIAL NEPHRITIS)
Precaution: Hepatic impairment (dose ↓ may be Interaction: Omeprazole is metabolized by the CYP450 enzyme
necessary); Patients using high-doses for >1 yr (↑ risk system and may compete with other agents metabolized by
of hip, wrist, or spine fractures and fundic gland this system. May ↑ levels and risk of toxicity of antifungal
polyps); Patients using therapy for >3 yr (↑ risk of agents
vitamin B12 deficiency)
Nursing Implication: Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools, Administer doses
before meals, preferably in the morning. May be administered concurrently with antacids.

Client Teaching: May cause occasional drowsiness or dizziness. advise patient to avoid alcohol, products containing aspirin
or NSAIDs, and foods that may cause an increase in GI irritation. instruct patient to notify health care professional of onset
of black, tarry stools; diarrhea; abdominal pain; or persistent headache or if fever and diarrhea develop, especially if stool
contains blood, pus, or mucus

Generic: Oxycodone/ Brand name:Percocet Classification: opioid analgesics/ antipyretics

acetaminophen (combination) nonopioid analgesics
Use: This combination medication is used to help relieve Onset: O: PO 10–15 min Peak: 60–90 min duration: 3–6 hr/A:
moderate to severe pain. It contains an opioid pain reliever
onset PO 0.5–1 hr Peak: 1–3 hr Duration 3–8 hr†
(oxycodone) and a non-opioid pain reliever (acetaminophen).
Safe Dosage: For oral dosage form (capsules): Action: Binds to opiate receptors in the CNS/ Inhibits
Adults—1 capsule every 6 hours as needed. Children—Use and synthesis of prostaglandins that may serve as mediators of
dose must be determined by your doctor. pain and fever, primarily in the CNS.
For oral dosage form (extended-release tablets): Adults—2
tablets every 12 hours as needed.Children—Use is not
recommended.
Adverse Reaction: Contraindication:   Some products contain alcohol or
Nausea, vomiting, constipation, lightheadedness, dizzines bisulfites and should be avoided in patients with known
s, or drowsiness may occur. intolerance or hypersensitivity;

Precaution: Head trauma; ↑ intracranial pressure; Interaction: Use with caution in patients receiving MAO inhibitors,
Severe renal or hepatic disease; Hypothyroidism; Adrenal Additive CNS depression with alcohol, antihistamines, and
insufficiency; Alcoholism; Seizure disorders sedative/hypnotics.
Nursing Implication: Assess BP, pulse, and respirations before and periodically during administration. Assess overall health
status and alcohol usage before administering acetaminophen Assess risk for opioid addiction, abuse, or misuse prior to
administration. Assess for rash periodically during therapy. Increased serum bilirubin, LDH, AST, ALT, and prothrombin
time may indicate hepatotoxicity.
Client Teaching: Advise patient to avoid alcohol, Medication may cause drowsiness or dizziness. Advise patient that
oxycodone is a drug with known abuse potential. Caution patient to check labels on all OTC products. Advise patients to
avoid taking more than one product containing acetaminophen at a time to prevent toxicity.

Generic: POTASSIUM CHLORIDE Brand name: K-Tab Micro-K Slow-K Classification: mineral and electrolyte
(oral) replacements/supplements
Use: Treatment/prevention of potassium depletion Onset: PO unknown, peak 1–2 hr, duration unknown

Safe Dosage: PO (Adults): 40–80 mEq/day. PO Children: Action: Maintain acid-base balance, isotonicity, and
2–3 mEq/kg/day. electrophysiologic balance of the cell

Adverse Reaction: CV: ARRHYTHMIAS, ECG changes GI: Contraindication: Hyperkalemia Severe renal impairment
abdominal pain, diarrhea, flatulence, nausea, vomiting

Precaution: Cardiac disease Renal impairment Interaction: Use with potassium-sparing diuretics or ACE
inhibitors or angiotensin II receptor antagonists may lead to
hyperkalemia
Nursing Implication: Assess for signs and symptoms of hypokalemia (weakness, fatigue, U wave on ECG, arrhythmias,
polyuria, polydipsia) Monitor serum potassium before and periodically during therapy Symptoms of toxicity are those of
hyperkalemia (slow, irregular heartbeat; fatigue; muscle weakness; paresthesia; confusion; dyspnea) Administer with or
after meals to decrease GI irritation.
Client Teaching: Instruct patient to report dark, tarry, or bloody stools; weakness; unusual fatigue; or tingling of
extremities. Emphasize correct method of administration. GI irritation or ulceration may result from chewing enteric-
coated tablets or insufficient dilution of liquid or powder forms. Advise patient regarding sources of dietary potassium

Generic: redniSONE Brand name: Rayos Sterapred Classification: anti-inflammatories (steroidal)

Winipred (intermediate acting) immune modifiers
Use: Used systemically and locally in a wide variety of Onset: PO hrs, peak: unknown, Duration: 1.25–1.5 days
chronic diseases including: Inflammatory, Allergic,
Hematologic, Neoplastic, Autoimmune disorders.
Safe Dosage: PO (Adults): Most uses– 5–60 mg/day as a Action: In pharmacologic doses, suppresses inflammation and
single dose or in divided doses, PO Children: Nephrotic the normal immune response.
syndrome– 2 mg/kg/day initially given in 1–3 divided
doses
Adverse Reaction: CNS: depression, euphoria, CV: Contraindication: Active untreated infections (may be used in
hypertension, GI: PEPTIC ULCERATION, anorexia, patients being treated for tuberculous meningitis)
nausea,
Precaution: Chronic treatment (leads to adrenal Interaction: Additive hypokalemia with thiazide and loop
suppression; use lowest possible dose for shortest diuretics, amphotericin B, piperacillin, or ticarcillin.
period of time)

Nursing Implication: Indicated for many conditions. Assess involved systems before and periodically during therapy.
Monitor intake and output ratios and daily weights Monitor serum electrolytes and glucose. If dose is ordered daily or
every other day, administer in the morning to coincide with the body's normal secretion of cortisol.

Client Teaching: Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness,
fatigue, dyspnea, hypotension, hypoglycemia) Instruct patient to inform health care professional promptly if severe
abdominal pain or tarry stools occur

Generic: sennosides Brand name: Senokot, Ex-Lax Classification: laxatives

Use: Treatment of constipation, particularly when Onset: PO 6–12 hr, peak: unknown, Duration: 3–4 days
associated with: Slow transit time, Constipating drugs,
Irritable or spastic bowel syndrome, Neurologic
constipation.
Safe Dosage: PO (Adults and Children >12 yr): 12–50 Action: Active components of senna (sennosides) alter water
mg 1–2 times daily. PO (Children 6–12 yr): 6–25 mg 1–2 and electrolyte transport in the large intestine, resulting in
times daily. accumulation of water and increased peristalsis.

Adverse Reaction: cramping, diarrhea, Contraindication: Hypersensitivity; Abdominal pain of

 unknown cause, especially if associated with fever

Precaution: Chronic use (may lead to laxative Interaction: May ↓ absorption of other orally administered
dependence); Possible intestinal obstruction; drugs because of ↓ transit time.

Nursing Implication: Assess patient for abdominal distention, presence of bowel sounds, and usual pattern of bowel
function. Assess color, consistency, and amount of stool produced. Take with a full glass of water. Administer at bedtime
for evacuation 6–12 hr later.

Client Teaching: Take with a full glass of water. Administer at bedtime for evacuation 6–12 hr later. Encourage patient to
use other forms of bowel regulation, such as increasing bulk in the diet, increasing fluid intake, and increasing mobility.
Advise patient not to use laxatives when abdominal pain, nausea, vomiting, or fever is present.

Generic: simethicone Brand name: Flatulex Gas Relief Classification: antiflatulent

Use: Relief of painful symptoms of excess gas in the GI tract Onset:

that may occur postoperatively or as a consequence of: Air
swallowing, Dyspepsia, Peptic ulcer, Diverticulitis
Safe Dosage: PO (Adults): 40–125 mg qid, after meals Action: Causes the coalescence of gas bubbles. 0:00 / 0:00
and at bedtime (up to 500 mg/day). PO (Children 2–12 Does not prevent the formation of gas.
yr): 40 mg 4 times daily.

Adverse Reaction: None significant. Contraindication: Not recommended for infant colic.
Precaution: Not recommended for infant colic. Interaction: None significant.

Nursing Implication: Assess patient for abdominal pain, distention, and bowel sounds prior to and periodically throughout
course of therapy. Assess patient for abdominal pain, distention, and bowel sounds prior to and periodically throughout
course of therapy.

Client Teaching: Explain to patient the importance of diet and exercise in the prevention of gas. Also explain that this
medication does not prevent the formation of gas. Advise patient to notify health care professional if symptoms are
persistent.

Generic: temazepam Brand name: Restoril Classification: sedative/hypnotics

Use: Short-term management of insomnia Onset: PO 30 min, peak: 2–3 hr, Duration: 6–8 hr, Half-life: 10–
20 hr

Safe Dosage: PO (Adults): 15–30 mg at bedtime initially Action: Acts at many levels in the CNS, producing generalized
if needed; some patients may require only 7.5 mg. PO depression.
(Geriatric Patients or Debilitated Patients): 7.5 mg at
bedtime.
Adverse Reaction: CNS: abnormal thinking, behavior Contraindication: Cross-sensitivity with other benzodiazepines
changes, hangover, dizziness, drowsiness, may exist; Pre-existing CNS depression; Severe uncontrolled
hallucinations, pain;
Precaution: Hepatic impairment; History of suicide Interaction: Use with opioids or other CNS depressants,
attempt or drug addiction;

Nursing Implication: Assess mental status (orientation, mood, behavior) and potential for abuse prior to administering
medication. Assess sleep patterns before and periodically throughout therapy. PO Administer with food if GI irritation
becomes a problem

Client Teaching: Teach sleep hygiene techniques (dark room, quiet, bedtime ritual, limit daytime napping, avoidance of
nicotine and caffeine). May cause daytime drowsiness or dizziness. Advise patient to take temazepam only if able to
devote 8 hr to sleep.

Generic: warfarin Brand name: Coumadin Jantoven Classification: anticoagulants

Use: Prophylaxis and treatment of: Venous thrombosis, Onset: PO 36–72 hr peak: 5–7 days duration: 2–5 days, Half-
Pulmonary embolism, Atrial fibrillation with life: 42 hr.
embolization. Management of myocardial infarction
Safe Dosage: PO (Adults): 2–5 mg/day for 2–4 days; PO Action: Interferes with hepatic synthesis of vitamin K-
(Children >1 mo): Initial loading dose– 0.2 mg/kg dependent clotting factors (II, VII, IX, and X).
(maximum dose: 10 mg) for 2–4 days

Adverse Reaction: GI: cramps, nausea GU: Contraindication: Uncontrolled bleeding; Open wounds; Active
CALCIPHYLAXIS Hemat: BLEEDING ulcer disease

Precaution: Malignancy; Patients with history of ulcer, Interaction: fluoroquinolones, metronidazole, NSAIDs, aspirin
liver disease, or acute kidney injury may ↑ the response to warfarin and ↑ the risk of bleeding

Nursing Implication: Assess for signs of bleeding and hemorrhage, monitor stool and urine for occult blood before and
periodically during therapy. Administer medication at same time each day. Medication requires 3–5 days to reach
effective levels; usually begun while patient is still on heparin.
Client Teaching: Advise patient to report any symptoms of unusual bleeding or bruising, and pain, color, or temperature
change to any area of your body. Instruct patient not to drink alcohol or take other Rx, OTC, or herbal products, especially
those containing aspirin or NSAIDs, or to start or stop any new medications during warfarin therapy without advice of
health care professional, Emphasize the importance of frequent lab tests to monitor coagulation factors.

Generic: bisacodyl Brand name: Dulcolax Classification: laxatives

Use: Treatment of constipation. Evacuation of the bowel Onset: Rectal 15–60 min, peak: unknown, duration: unknown
before radiologic studies or surgery. Part of a bowel regimen in
spinal cord injury patients.
Safe Dosage: Rect: (Adults and Children ≥12 yr): 10 Action: Treatment of constipation. Evacuation of the bowel
mg/day single dose. Rect: (Children 2–11 yr): 5–10 before radiologic studies or surgery. Part of a bowel regimen in
mg/day single dose. spinal cord injury patients.
Adverse Reaction: abdominal cramps, nausea, Contraindication: Hypersensitivity; Abdominal pain;
Obstruction; Nausea or vomiting (especially with fever or other
signs of an acute abdomen).
Precaution: Severe cardiovascular disease; Anal or rectal Interaction:Milk, Antacids, histamine H2 -receptor antagonists, and
fissures; Excess or prolonged use (may result in dependence); gastric acid–pump inhibitors may remove enteric coating of tablets
OB: Lactation: May be used during pregnancy and lactation. resulting in gastric irritation/dyspepsia.
Nursing Implication: Do not confuse Dulcolax (bisacodyl) with Dulcolax (docusate sodium). May be administered at bedtime for morning
results. Taking on an empty stomach will produce more rapid results. Do not administer oral doses within 1 hr of milk or antacids;
Suppository or enema can be given at the time a bowel movement is desired. Lubricate suppositories with water or water-soluble lubricant
before insertion. Encourage patient to retain the suppository or enema 15–30 min before expelling.

Client Teaching: Advise patients, other than those with spinal cord injuries, that laxatives should be used only for short-
term therapy. Instruct patients with cardiac disease to avoid straining during bowel movements (Valsalva maneuver).
Advise patient to increase fluid intake to at least 1500–2000 mL/day during therapy to prevent dehydration.

Generic: glycerin Brand name: Fleet Babylax Sani- Classification: antiglaucoma agents
Supp laxatives
Use: Rect: Treatment of constipation. Ophth: Reduction Onset: Rect (laxative effect) unknown, peak: 15–30 min
of corneal edema. duration: unknown, Half-life: 30–45 min
Safe Dosage: Rect: (Adults and Children >6 yr): 1 adult Action: Draws water into the lumen of the colon. Osmotically
suppository 1–2 times/day as needed or 5–15 mL as an draws water from extravascular spaces, including the eye, into
enema. intravascular compartment.

Adverse Reaction: GI: diarrhea, cramping, nausea, Contraindication: Hypersensitivity.

vomiting F and E: dehydration Misc: thirst

Precaution: Severe dehydration Geriatric patients Interaction: None known.

(increased risk of dehydration).

Nursing Implication: Assess patient for abdominal distention, presence of bowel sounds, and normal pattern of bowel
function. Assess color, consistency, and amount of stool produced. Rect: Glycerin suppository or enema usually causes
evacuation of the colon in 15–30 min.

Client Teaching: Advise patient that laxatives should be used only for short-term therapy. Long-term therapy may cause
electrolyte imbalance and dependence.

Generic: phosphate/biphosphate Brand name: Fleet Enema Classification: laxatives (saline)

OsmoPrep
Use: Intermittent treatment of chronic constipation. Onset: Rect 2–5 min, peak: unknown, duration: unknown
OsmoPrep: Cleansing of the bowel as a preparation for
colonoscopy.
Safe Dosage: Each Fleet Enema contains 4.4 g Action: Osmotically active in the lumen of the GI tract. Produces
sodium/118 mL laxative effect by causing water retention and stimulation of peristalsis.
Stimulates motility and inhibits fluid and electrolyte absorption from
the small intestine.
Adverse Reaction: CV: ARRHYTHMIAS, GI: cramping, Contraindication: Abdominal pain, nausea, or vomiting,
nausea, OsmoPrep: abdominal bloating, abdominal especially when associated with fever or other signs of an
pain, vomiting, Neuro: Visicol: dizziness, headache acute abdomen; Severe renal or cardiovascular disease;
Intestinal obstruction;
Precaution: Renal or cardiovascular disease, Interaction: OsmoPrep– Concurrently administered oral
dehydration or concurrent use of diuretics or other medications may not be absorbed due to rapid peristalsis and
drugs known to alter electrolytes diarrhea.
Nursing Implication: Assess patient for fever, abdominal distention, presence of bowel sounds, and usual pattern of
bowel function. Assess color, consistency, and amount of stool produced. May rarely cause arrhythmias. Do not
administer at bedtime or late in the day, Administer on an empty stomach for more rapid results.

Client Teaching: Advise patient that laxatives should be used only for short-term therapy. Advise patient not to take oral
form of this medication within 2 hr of other medications. Advise patient to notify health care professional if unrelieved
constipation, rectal bleeding, or symptoms of electrolyte imbalance (muscle cramps or pain, weakness, dizziness, and so
forth) occur.

Generic: bacitracin Brand name: Polysporin Classification: anti-infectives

Use: Treatment of localized infections due to Onset: unknown
susceptible organisms.

Safe Dosage: Topical (Adults and Children): Apply 1–5 Action: Inhibits bacterial cell wall synthesis by preventing
times daily. transfer of mucopeptides into growing cell wall.

Adverse Reaction: rash Contraindication: Hypersensitivity Renal impairment.

Precaution: Dehydration Interaction: ↑ incidence of nephrotoxicity with other

nephrotoxic drugs ; avoid concurrent use.

Nursing Implication: Topical Apply small amount of ointment to affected area; may be covered with a sterile bandage.

Client Teaching: Instruct patient to only for use on minor cuts or burns. Do not use on animal bites, puncture wounds,
serious burns, or deep cuts. Inform patient that topical form may cause contact dermatitis or pruritus. Advise patient to
use only as long as prescribed; prolonged use may cause overgrowth of resistant organisms.
Generic: hydrocortisone (topical Brand name: Synacort, Anusol HC Classification: anti-inflammatories
(steroidal)
Use: Management of inflammation and pruritis Onset: Topical mins–hrs, peak: hrs–days, duration: hrs–days
associated with various allergic/immunologic skin
problems.
Safe Dosage: Topical (Adults and Children): Apply to Action: Suppress normal immune response and inflammation.
affected area(s) 1–4 times daily (depends on product,
preparation, and condition being treated).

Adverse Reaction: Derm: allergic contact dermatitis, Contraindication: Hypersensitivity or known intolerance to
atrophy, burning, dryness, edema glucocorticoid or components of vehicles (ointment or cream
base, preservative, alcohol
Precaution: Hypersensitivity or known intolerance to Interaction: None significant.
glucocorticoid or components of vehicles (ointment or
cream base, preservative, alcohol
Nursing Implication: Assess affected skin before and daily during therapy. Note degree of inflammation and pruritus,
Apply ointments, creams, or gels sparingly as a thin film to clean, slightly moist skin. Wash hands immediately after
application.

Client Teaching: Instruct patient on correct technique of medication administration. Instruct patient to inform health care
professional if symptoms of underlying disease return or worsen or if symptoms of infection develop.
Generic: mupirocin Brand name: Bactroban Centany Classification: anti-infectives

Use: Treatment of: Impetigo, Secondarily infected traumatic Onset: Topical† unknown peak: 3–5 days duration: 72 hr Half-
skin lesions (up to 10 cm in length or 100 cm2 area) caused by life: 17–36 min.
Staphylococcus aureus and Streptococcus pyogenes.
Safe Dosage: Topical (Adults and Children ≥2 mo): Ointment: Action: Inhibits bacterial protein synthesis.
Apply 3–5 times daily for 5–14 days. Topical (Adults and
Children ≥3 mo): Cream: Apply small amount 3 times/day for 10
days.
Adverse Reaction: Derm: burning, itching, pain, stinging Contraindication: Hypersensitivity to mupirocin or
polyethylene glycol.

Precaution: Renal impairment; Burn patients; Interaction: Drug-Drug None reported

Nursing Implication: Assess lesions before and daily during therapy. Topical Wash affected area with soap and water and
dry thoroughly. Apply a small amount of mupirocin to the affected area 3 times daily and rub in gently. Treated area may
be covered with gauze if desired.

Client Teaching: Instruct patient on the correct application of mupirocin. Advise patient to apply medication exactly as
directed for the full course of therapy. If a dose is missed, apply as soon as possible unless almost time for next dose.
Avoid contact with eyes
Generic: fluticasone (nasal) Brand name: Avamys Flonase Classification: anti-inflammatories
Allergy Relief Flonase Sensimist (steroidal)
Use: Seasonal or perennial allergic rhinitis. Perennial Onset: Intranasal few days, peak: up to 3 wk, duration
nonallergic rhinitis (fluticasone Rx only). Nasal polyps (Xhance unknown, Half-life: 7.8 hr
only).
Safe Dosage: intranasal (Adults and Children ≥12 yr): Action: Potent, locally acting anti-inflammatory and immune
Flonase Sensimist (OTC) and Flonase Allergy Relief modifier.
(OTC)– 2 sprays in each nostril once daily; after 1 wk,
may adjust to 1–2 sprays in each nostril once daily;
Adverse Reaction: Misc: HYPERSENSITIVITY REACTIONS Contraindication: Hypersensitivity (Flonase contains alcohol).
(INCLUDING ANAPHYLAXIS AND ANGIOEDEMA), GI: nausea,
vomiting Neuro: headache Resp: cough, EENT: cataracts,
epistaxis, glaucoma, nasal burning, nasal irritation,
Precaution: Active untreated infections Diabetes Glaucoma or Interaction: Strong CYP3A4 inhibitors, including atazanavir,
cataracts Underlying immunosuppression (due to disease or clarithromycin, conivaptan, indinavir, itraconazole, ketoconazole,
concurrent therapy) Systemic corticosteroid therapy (should lopinavir, nefazodone, nelfinavir, ritonavir, saquinavir, and voriconazole
not be abruptly discontinued when intranasal therapy is started may ↑ levels; concurrent use not recommended.
Nursing Implication: Monitor for signs and symptoms of hypersensitivity reactions (rash, pruritus, swelling of face and
neck, dyspnea) periodically during therapy. Intranasal: Patients also using a nasal decongestant should be given
decongestant 5–15 min before corticosteroid nasal spray. Do not confuse Flovent (fluticasone oral inhalation) with Flonase
(fluticasone nasal spray).
Client Teaching: instruct patient to stop fluticasone and notify health care professional immediately if signs of anaphylaxis
(rash, hives, difficulty breathing, swollen lips or throat) occur. Instruct patient in correct technique for administering nasal
spray (see medication administration techniques). Shake well before use. Before first-time use, prime unit by spraying 6
times. Instruct patient to gently blow nose to clear nostrils prior to administering dose.
Generic: dexamethasone Brand name: Decadron DexPak Classification: anti-inflammatories
(steroidal)
Use: Used systemically and locally in a wide variety of chronic Onset: PO unknown peak: 1–2 hr, duration: 72 hr, IM, IV
diseases including: Inflammatory, Allergic, Hematologic, onset:(phosphate) rapid, peak: unknown, duration: 72 h, half
Endocrine, Neoplastic, Dermatologic, life: Adults: 3–4.5 hr (plasma), 36–54 hr (tissue);
Safe Dosage: PO IM IV (Adults): Anti-inflammatory– Action: in pharmacologic doses, suppresses inflammation and the
0.75–9 mg daily in divided doses every 6–12 hr normal immune response. 0:00 / 0:00 Suppresses adrenal function at
chronic doses of 0.75 mg/day. Has negligible mineralocorticoid activity.
Adverse Reaction: CV: hypertension, Derm: acne, ↓ wound Contraindication: Active untreated infections (may be used in
healing, ecchymoses, hirsutism, petechiae, GI: PEPTIC patients being treated for tuberculous meningitis) Known alcohol or
ULCERATION, anorexia, nausea, Hemat: THROMBOEMBOLISM, bisulfite hypersensitivity or intolerance (some products contain these
and should be avoided in susceptible patients

Precaution: Chronic treatment (will lead to adrenal Interaction: YP3A4 inhibitors, including clarithromycin,
suppression; use lowest possible dose for shortest period of cobicistat, erythromycin, itraconazole, ketoconazole, and
time) Stress (surgery, infections); supplemental doses may be ritonavir may ↑ levels and risk of toxicity.
needed Potential infections (may mask signs)
Nursing Implication: Assess for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting,
anorexia, lethargy, confusion, restlessness) before and periodically during therapy, Monitor intake and output ratios and
daily weights. Monitor serum electrolytes and glucose. May cause hyperglycemia, especially in patients with diabetes.
Suppresses reactions to allergy skin tests. IM doses should not be administered when rapid effect is desirable. D
Client Teaching: Instruct patient on correct technique of medication administration. Review side effects with patient.
Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occur. Corticosteroids
cause immunosuppression and may mask symptoms of infection.
Generic: gentamicin Brand name: Garamycin Classification: anti-infectives

Use: Treatment of serious gram-negative bacterial Onset: IM rapid, peak: 30–90min duration: 8–24 hr, IV onset:
infections and infections caused by staphylococci when rapid, peak:15–30 min‡ duration: 8–24 hr, half life: Adults: 2–4
penicillins or other less toxic drugs are contraindicated. hr (↑ in renal impairment).
Safe Dosage: IM IV (Adults): 1–2 mg/kg every 8 hr (up to 6 Action: Inhibits protein synthesis in bacteria at level of 30S
mg/kg/day in 3 divided doses); IM IV (Adults): 1–2 mg/kg every ribosome.
8 hr (up to 6 mg/kg/day in 3 divided doses);

Adverse Reaction: EENT: ototoxicity (vestibular and Contraindication: Hypersensitivity to gentamicin or other
cochlear) GU: nephrotoxicity, Neuro: ataxia, vertigo aminoglycosides Most parenteral products contain bisulfites
and should be avoided in patients with known intolerance OB:
Pregnancy (may cause fetal harm)
Precaution: Renal impairment (dose adjustments Interaction: Inactivated by penicillins and cephalosporins
necessary; blood level monitoring useful in preventing when coadministered to patients with renal insufficiency.
ototoxicity and nephrotoxicity) Hearing impairment
Neuromuscular diseases such as myasthenia gravis
Nursing Implication: Obtain specimens for culture and sensitivity before initiating therapy. First dose may be given before
receiving results. Keep patient well hydrated (1500–2000 mL/day) during therapy. IM IM administration should be deep
into a well-developed muscle. Alternate injection sites.

Client Teaching: instruct patient to report signs of hypersensitivity, tinnitus, vertigo, hearing loss, rash, dizziness, or
difficulty urinating. Advise female patient to notify health care professional if pregnancy is planned or suspected or if
breastfeeding
Generic: heparin Brand name: Hepalean Hep-Lock Classification: anticoagulants
Hep-Lock U/P
Use: Venous thromboembolism, Pulmonary emboli, Atrial Onset: Heparin subcut 20–60 min, peak: 2 hr, duration: 8–12
fibrillation with embolization, Acute and chronic consumptive hr, Heparin IV onset: immediate, peak: 5–10 min, duration: 2–
coagulopathies, Peripheral arterial thromboembolism. 6 hr, Half-life: 1–2 hr (↑ with increasing dose);
Safe Dosage: SC (Adults): 5000 units IV, followed by initial Action: Potentiates the inhibitory effect of antithrombin on factor Xa
subcut dose of 10,000–20,000 units, then 8000–10,000 units and thrombin. In low doses, prevents the conversion of prothrombin to
every 8 hr or 15,000–20,000 units every 12 hr thrombin by its effects on factor Xa. Higher doses neutralize thrombin,
preventing the conversion of fibrinogen to fibrin.
Adverse Reaction: Hemat: BLEEDING, HEPARIN- Contraindication: Hypersensitivity; Uncontrolled bleeding;
INDUCED THROMBOCYTOPENIA (HIT) (WITH OR History of heparin-induced thrombocytopenia; Severe
WITHOUT THROMBOSIS), anemia, pain at injection site thrombocytopenia; Open wounds (full dose);
Precaution: Severe liver or kidney impairment; Retinopathy Interaction: Risk of bleeding may be ↑ by concurrent use of
(hypertensive or diabetic); Ulcer disease; Exercise Extreme drugs that affect platelet function, including aspirin, NSAIDs,
Caution in: Severe uncontrolled hypertension; Bacterial
endocarditis, bleeding disorders; GI
bleeding/ulceration/pathology;
Nursing Implication: Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; black,
tarry stools; hematuria; fall in hematocrit or BP; guaiac-positive stools). SC Observe injection sites for hematomas,
ecchymosis, or inflammation. Monitor platelet count every 2–3 days during therapy. SC Administer deep into subcut
tissue. Alternate injection sites between arm and the left and right abdominal wall above the iliac crest.
Client Teaching: Advise patient to report any symptoms of unusual bleeding or bruising to health care professional
immediately. Advise patient to report any symptoms of unusual bleeding or bruising to health care professional
immediately.
Generic: INSULIN Brand name: lispro protamine: HumaLOG Mix 75/25 HumaLOG Mix 50/50, aspart Classification:
(mixtures) protamine: NovoLOG Mix 70/30, NPH/regular: HumuLIN 70/30 NovoLIN 70/30 antidiabetics hormones
Use: Control of hyperglycemia in patients with type 1 or Onset: insulin lispro protamine suspension/ insulin lispro injection mixture subcut onset: 15–30
min peak: 2.8 hr duration: 24 hr insulin, aspart protamine suspension/ insulin aspart injection
type 2 diabetes mellitus. mixture subcut onset: 15 min peak: 1–4 hr duration: 18–24 hr, NPH/Regular Insulin mixture
subcutaneous onset: 30 min peak: 2–12 hr duration: 24 hr, Half-life: 5–6 min
Safe Dosage: Dose depends on blood glucose, Action: Lower blood glucose by: stimulating glucose uptake in skeletal
response, and many other factors, SC (Adults and muscle and fat, inhibiting hepatic glucose production, Other actions:
Children): 0.5–1 unit/kg/day. Adolescents during rapid inhibition of lipolysis and proteolysis, enhanced protein synthesis
growth– 0.8–1.2 units/kg/day.
Adverse Reaction: Endo: HYPOGLYCEMIA, Contraindication: Hypoglycemia; Allergy or hypersensitivity to
Misc: HYPERSENSITIVITY REACTIONS (INCLUDING a particular type of insulin, preservatives, or other additive
ANAPHYLAXIS), F and E: hypokalemia
Precaution: Stress and infection (may temporarily ↑ Interaction: Beta blockers and clonidine may mask some of the
insulin requirements); Renal/hepatic impairment (may signs and symptoms of hypoglycemia
↓ insulin requirements);
Nursing Implication: Assess for symptoms of hypoglycemia, Insulins are available in different types and strengths. Check
type, dose, and expiration date with another licensed nurse. Insulin-related medication errors have resulted in patient
harm and death. Clarify ambiguous orders; do not accept orders using the abbreviation "u" for units, Rotate injection sites
to prevent lipodystrophy and cutaneous amyloidosis,
Client Teaching: Instruct patient on proper technique for administration. Explain to patient that this medication controls
hyperglycemia but does not cure diabetes. Therapy is long term. Instruct patient on signs and symptoms of hypoglycemia
and hyperglycemia and what to do if they occur. Patients with diabetes mellitus should carry a source of sugar (candy,
glucose gel) and identification describing their disease and treatment regimen at all times.
Generic: insulin regular Brand name: HumuLIN R, NovoLIN Classification: antidiabetics hormones
R,
Use: Control of hyperglycemia in patients with diabetes Onset: Regular insulin IV onset:10–30 min peak: 15–30 min duration:30–60 min,
mellitus. Concentrated regular insulin U-500: Only for use in Regular insulin subcutaneous onset: 30–60 min peak: 2–4 hr duration: 5–7 hr, Half-
patients with insulin requirements >200 units/day. life: 30–60 min

Safe Dosage: SC (Adults and Children): 0.5–1 Action: Lowers blood glucose by: stimulating glucose uptake in
unit/kg/day in divided doses. Adolescents during rapid skeletal muscle and fat, 0:00 / 0:00 inhibiting hepatic glucose
growth– 0.8–1.2 unit/kg/day in divided doses. production

Adverse Reaction: Endo: HYPOGLYCEMIA F and E: Contraindication: Hypoglycemia; Allergy or hypersensitivity to

hypokalemia Local: cutaneous amyloidosis, a particular type of insulin, preservatives, or other additives.
lipodystrophy, pruritus, erythema, swelling
Precaution: Stress or infection–may temporarily ↑ Interaction: Beta blockers and clonidine may mask some of
insulin requirements; Renal/hepatic impairment–may the signs and symptoms of hypoglycemia.
↓ insulin requirements;
Nursing Implication: Assess patient periodically for symptoms of hypoglycemia, Monitor body weight periodically.
Changes in weight may necessitate changes in insulin dose. Do not confuse Humulin with Humalog (insulin lispro). Do not
confuse Novolin with Novolog, SC Administer regular insulin within 30 min before a meal into the thigh, upper arm,
abdomen, or buttocks. Use only insulin syringes to draw up dose.
Client Teaching: Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur.
Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
Demonstrate technique for mixing insulins by drawing up regular insulin first and rolling intermediate-acting insulin vial
between palms to mix, rather than shaking, Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia
and what to do if they occur.
Generic: NPH insulin (isophane Brand name: HumuLIN N HumuLIN N Classification: antidiabetics hormones
insulin suspension) KwikPen NovoLIN N NovoLIN N FlexPen
Use: Control of hyperglycemia in patients with diabetes Onset: NPH subcutaneous onset: 2–4 hr peak: 4–10 hr duration: 10–16
mellitus. hr, 70% NPH/30% Regular Insulin mixture onset: 30 min, peak: 2–12 hr
duration: 24 hr. Half-life: Unknown
Safe Dosage: Dose depends on blood glucose, response, and many Action: Lowers blood glucose by: stimulating glucose uptake in skeletal muscle
other factors SC (Adults and Children): 0.5–1 unit total insulin/kg/day. and fat, inhibiting hepatic glucose production. Other actions of insulin: inhibition of
Adolescents during rapid growth– 0.8–1.2 units total insulin/kg/day lipolysis and proteolysis, enhanced protein synthesis.

Adverse Reaction: Endo: HYPOGLYCEMIA F and E: hypokalemia Contraindication: Hypoglycemia; Allergy or hypersensitivity to
Local: cutaneous amyloidosis, lipodystrophy, pruritus, erythema, swelling a particular type of insulin, preservatives, or other additives.
Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Precaution: Stress or infection (may temporarily ↑ insulin Interaction: Beta blockers and clonidine may mask some of the
requirements); Renal/hepatic impairment (may ↓ insulin signs and symptoms of hypoglycemia.
requirements); Concomitant use with pioglitazone or
rosiglitazone (↑ risk of fluid retention and worsening HF
Nursing Implication: Assess patient periodically for symptoms of hypoglycemia. Monitor body weight periodically.
Changes in weight may necessitate changes in insulin dose. High Alert: Medication errors involving insulins have resulted
in serious patient harm and death. Use only insulin syringes to draw up dose. SC Administer NPH insulin within 30–60 min
before a meal. Inject subcut in abdomen, thigh, upper arm, or buttocks
Client Teaching: Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long
term. Instruct patient on proper technique for administration. Include type of insulin, equipment, Instruct patient on signs
and symptoms of hypoglycemia and hyperglycemia and what to do if they occur. Patients with diabetes mellitus should
carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times.
Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care
professional.
Generic: morphine Brand name: MS Contin, Morphine Classification: opioid analgesics
HP
Use: Severe pain (the 20 mg/mL oral solution Onset: IM onset: 10–30 min, peak: 30–60 min duration: 4–5
concentration should only be used in opioid-tolerant hr, Subcut onset:20 min peak: 50–90 min duration:4–5 hr, half
patients). life: Adults: 2–4 hr.
Safe Dosage: IM IV SC (Adults ≥50 kg): Usual starting dose for Action: Binds to opiate receptors in the CNS. Alters the
moderate to severe pain in opioid-naive patients– 4–10 mg every 3–4 hr. perception of and response to painful stimuli while producing
MI– 8–15 mg, for very severe pain additional smaller doses may be given
every 3–4 hr. generalized CNS depression.
Adverse Reaction: CV: hypotension, bradycardia, Contraindication: Hypersensitivity; Some products contain
GI: constipation, nausea, vomiting, Neuro: confusion, tartrazine, bisulfites, or alcohol and should be avoided in
sedation, patients with known hypersensitivity;
Precaution: Head trauma; ↑ intracranial pressure; Interaction: Use with extreme caution in patients receiving
Severe renal, hepatic, or pulmonary disease; MAO inhibitors within 14 days prior
Hypothyroidism; Seizure disorder;
Nursing Implication: Assess type, location, and intensity of pain prior to and 1 hr following PO, subcut, IM, and 20 min
(peak) following IV administration. High Alert: Assess level of consciousness, BP, pulse, and respirations before and
periodically during administration. Assess bowel function routinely. Institute prevention of constipation with increased
intake of fluids and bulk and with laxatives to minimize constipating effects. IM SC Use IM route for repeated doses,
because morphine is irritating to subcut tissues. Doses may be administered with food or milk to minimize GI irritation.
Client Teaching: Advise patient to notify health care professional if pain control is not adequate or if severe or persistent
side effects occur. Advise patient to change positions slowly to minimize orthostatic hypotension. May cause drowsiness
or dizziness. Emphasize the importance of aggressive prevention of constipation with the use of morphine. Caution patient
to avoid concurrent use of alcohol or other CNS depressants with this medication.
Generic: albuterol Brand name: Salbutamol Ventolin HFA Ventolin Classification: bronchodilators
Diskus Ventolin Nebules
Use: Treatment or prevention of bronchospasm in asthma or chronic Onset: Inhaln onset: 5–15 min peak: 60–90 min duration: 3–6
obstructive pulmonary disease (COPD). Inhaln Prevention of exercise-
induced bronchospasm. hr. half life: Inhalation: 3.8 hr.
Safe Dosage: Inhaln (Adults and Children ≥4 yr): Via Action: Binds to beta2 -adrenergic receptors in airway smooth muscle, leading to activation of
adenyl cyclase and increased levels of cyclic-3', 5'-adenosine monophosphate (cAMP). Increases in
metered-dose inhaler or dry powder inhaler– 2 cAMP activate kinases, which inhibit the phosphorylation of myosin and decrease intracellular
inhalations every 4–6 hr calcium. Decreased intracellular calcium relaxes smooth muscle airways. Relaxation of airway
smooth muscle with subsequent bronchodilation. Relatively selective for beta2 (pulmonary)
receptors.
Adverse Reaction: CV: chest pain, palpitations, Neuro: Contraindication: Hypersensitivity to adrenergic amines.
nervousness, restlessness, tremor,

Precaution: Cardiac disease; Hypertension; Interaction: Concurrent use with other adrenergic agents will
Hyperthyroidism; Diabetes; Glaucoma; Seizure have ↑ adrenergic side effects.
disorders;
Nursing Implication: Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold medication and
notify health care professional immediately. Assess lung sounds, pulse, and BP before administration and during peak of
medication. Shake inhaler well, and allow at least 1 min between inhalations of aerosol medication. Prime the inhaler
before first use by releasing 4 test sprays into the air away from the face.
Client Teaching: Instruct patient to take albuterol as directed. Instruct patient to contact health care professional
immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations,
or chest pain. Instruct patient to notify health care professional if there is no response to the usual dose or if contents of
one canister are used in less than 2 wk. Asthma and treatment regimen should be re-evaluated and corticosteroids should
be considered.
Generic: ipratropium Brand name: Atrovent Atrovent Classification: allergy, cold and cough
HFA remedies bronchodilators
Use: Inhaln Maintenance therapy of reversible airway Onset: Inhalation onset: 1–3 min, peak: 1–2 hr duration: 4–6
obstruction due to COPD, including chronic bronchitis hr, half life: 2hrs
and emphysema.
Safe Dosage: Inhaln (Adults and Children >12 yr): Action: Inhaln Maintenance therapy of reversible airway
Metered-dose inhaler (nonacute)– 2 inhalations 4 times obstruction due to COPD, including chronic bronchitis and
daily (not to exceed 12 inhalations/24 hr or more emphysema.
frequently than every 4 hr).
Adverse Reaction: CV: hypotension, palpitations, Contraindication: Hypersensitivity to ipratropium, atropine,
GI: GI irritation, nausea Derm: rash Neuro: dizziness, belladonna alkaloids, or bromide; Avoid use during acute
headache, nervousness. bronchospasm;
Precaution: Patients with bladder neck obstruction, Interaction: ↑ anticholinergic effects with other drugs having
prostatic hyperplasia, glaucoma, or urinary retention; anticholinergic properties ( antihistamines, phenothiazines,
disopyramide ).
Nursing Implication: Assess for allergy, Inhaln Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse)
before administration and at peak of medication. When ipratropium is administered concurrently with other inhalation
medications, administer adrenergic bronchodilators first, followed by ipratropium, then corticosteroids. Wait 5 min
between medications
Client Teaching: Instruct patient in proper use of inhaler, nebulizer, or nasal spray and to take medication as directed.
Caution patient not to exceed 12 doses within 24 hr. Caution patient to avoid spraying medication in eyes; may cause
blurring of vision or irritation. Advise patient to inform health care professional if cough, nervousness, headache,
dizziness, nausea, or GI distress occurs.
Generic: budesonide Brand name: Pulmicort Respules Pulmicort Classification: anti-inflammatories
Flexhaler Pulmicort Nebuamp Pulmicort Turbuhaler (steroidal)
Use: Nebulization– Maintenance treatment and Onset: Inhaln onset: within 24 hr, peak: 1–4 wk† duration: unknown,
prophylactic therapy of asthma. Oral inhalation– Nebulization: onset: with 2–8 days, peak: 4–6 wk duration: unknown, Half-life:
Adults– 2–3.6 hr; Children 10–14 yrs– 1.5 hr
Chronic control of persistent bronchial asthma.
Safe Dosage: Inhaln (Adults): –180–360 mcg twice daily Action: Potent, locally acting anti-inflammatory and immune
(not to exceed 720 mcg twice daily). modifier.

Adverse Reaction: EENT: otitis media, Contraindication: Hypersensitivity to budesonide Acute attack
Neuro: headache, GI: abdominal pain, diarrhea, of asthma/status asthmaticus.
dyspepsia, gastroenteritis, nausea, vomiting
Precaution: Active untreated infection Diabetes Interaction: Strong CYP3A4 inhibitors, including ritonavir, atazanavir,
Glaucoma clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, and
saquinavir ↓ metabolism and ↑ levels of budesonide.

Nursing Implication: Inhaln (Adults): –180–360 mcg twice daily (not to exceed 720 mcg twice daily). After the desired
clinical effect has been obtained, attempts should be made to decrease dose to lowest amount required to control
symptoms. Inhaln Allow at least 1 min between inhalations of Flexhaler. Do not shake inhaler or use with spacer.
Client Teaching: Advise patient to notify health care professional if sore throat or mouth or symptoms of anaphylaxis
(rash, severe itching, swelling of the face, mouth, and tongue, trouble breathing or swallowing, chest pain, anxiety or
feeling of doom) occur. Patients using inhalation corticosteroids to control asthma may require systemic corticosteroids
for acute attacks. Advise patient to use regular peak flow monitoring to determine respiratory status. Advise patient to
rinse mouth with water after treatment to decrease risk of developing local candidiasis.

Generic: NITROGLYCERIN Brand name: sublingual: Nitrostat, transdermal ointment: Classification: antianginals
Nitro-Bid, transdermal patch: Nitro-Dur Trinipatch
Use: Acute (translingual, SL, ointment) and long-term Onset: SL/Translingual onset: 1–3 min peak: unknown duration: 30–60 min, PO-
prophylactic (oral, transdermal) management of angina ER onset: 40–60 min, peak: unknown, duration 8–12 hr, Oint onset: 20–60 min,
peak: unknown. Duration: 4–8 hr, Patch onset: 40–60 min, peak: unknown, duration
pectoris. PO Adjunct treatment of HF. 8–24 h, half-life: 1–4 min.
Safe Dosage: SL (Adults): Tablets– 0.3–0.6 mg; may repeat every 5 Action: Increases coronary blood flow by dilating coronary arteries and
min for 2 additional doses for acute attack; PO (Adults): 2.5–9 mg every 8– improving collateral flow to ischemic regions. Produces vasodilation (venous greater
12 hr. Transdermal (Adults): Ointment– 1–2 in. every 6–8 hr. Transdermal than arterial). Decreases left ventricular end-diastolic pressure and left ventricular
patch– 0.2–0.4 mg/hr initially; may titrate up to 0.4–0.8 mg/hr. Patch end-diastolic volume (preload). Reduces myocardial oxygen consumption.
should be worn 12–14 hr/day and then taken off for 10–12 hr/day.
Adverse Reaction: CV: hypotension, tachycardia, Contraindication: Hypersensitivity; ↑ intracranial pressure; Severe
Neuro: dizziness, headache anemia; Pericardial tamponade; Constrictive pericarditis
Precaution: Head trauma or cerebral hemorrhage; Glaucoma; Interaction: Concurrent use of avanafil, sildenafil, tadalafil, or
Hypertrophic cardiomyopathy; Severe liver impairment; vardenafil may result in severe hypotension
Malabsorption or hypermotility (PO)
Nursing Implication: Monitor BP and pulse before and after administration. Assess location, duration, intensity, and
precipitating factors of patient's anginal pain. SL Tablet should be held under tongue until dissolved. Avoid eating,
drinking, or smoking until tablet is dissolved. PO Administer dose 1 hr before or 2 hr after meals with a full glass of water
for faster absorption. Rotate sites of topical application to prevent skin irritation. Remove patch or ointment from
previous site before application.
Client Teaching: Acute Anginal Attacks: Advise patient to sit down and use medication at first sign of attack. Relief usually
occurs within 5 min. Dose may be repeated if pain is not relieved in 5–10 min. Caution patient to change positions slowly
to minimize orthostatic hypotension. First dose should be taken while in a sitting or reclining position. Advise patient to
avoid concurrent use of alcohol with this medication. SL Inform patient that tablets should be kept in original glass
container or in specially made metal containers, with cotton removed to prevent absorption.
Generic: hydrocortisone/pramoxine Brand name: Aero Otic HC, Classification: Otic steroids with anti-infectives
/chloroxylenol drops - otic Cortane B, Cortic, Cortic ND,
Use: This combination medication is used to treat Onset:
outer ear infections (e.g., swimmer's ear).

Safe Dosage: Action: this product contains 3 medications. Hydrocortisone is a

steroid that helps to decrease the redness, swelling,
and itching. Pramoxine is an anesthetic that helps to
decrease pain and itching by blocking the nerve signals. Chloroxylenol
works by stopping the growth of bacteria and fungus.
Adverse Reaction:  new or increased Contraindication:
redness/swelling/pain/irritation in or around the ears.

Precaution: allergic to hydrocortisone, chloroxylenol, Interaction: Interactions are not expected

or pramoxine; or to other corticosteroids (e.g.,
betamethasone); or if you have any other allergies.

Nursing Implication: It is important that you keep the infected ear(s) clean and dry. When bathing, try not to get the infected ear(s) wet.
Do not go swimming unless your doctor or health care professional has told you otherwise.
To prevent the spread of infection, do not share ear products or share towels and washcloths with anyone else. For best results, remove
any ear wax or other debris before using this medicine. Ask your doctor about safe methods of ear wax removal.

Client Teaching: Tell your doctor or health care professional if your ear infection does not get better in a few days. This
medicine is not for long-term use. Do not use for longer than directed without checking with your doctor or health care
professional. Do not use if there is any discharge from the ear.
If rash or allergic reaction occurs, stop using this product immediately and contact your doctor or health care professional.
Generic: codeine/acetaminophen (Rx) Brand name: Tylenol with Classification: Analgesics, Opioid Combos
Codeine, Tylenol #3, Tylenol #4
Use: Mild to Moderately Severe Pain Onset: acetaminophen Route : PO, onset:0.5–1 hr, peak :1–3
hr, Duration :3–8 hr, codeine Route :PO, Onset :30–45 min,
Peak :60–120 min duration :4 hr
Safe Dosage: Tablet: 15-60 mg codeine/dose PO q4- Action: acetaminophen -Inhibits synthesis of prostaglandins that may serve as
6hr; not to exceed 360 mg codeine/day or 4 g mediators of pain and fever, primarily in the CNS. codeine -Binds to opiate receptors
in the CNS. Alters the perception of and response to painful stimuli while producing
acetaminophen/day generalized CNS depression.

Adverse Reaction: acetaminophen- rash, urticaria, Contraindication: acetaminophen- Products containing

renal failure (high doses/chronic use), codeine alcohol, aspartame, saccharin, sugar, or tartrazine, codeine
hypotension, constipation, N&V, confusion, sedation
Significant respiratory depression, Hypersensitivity
Precaution: acetaminophen- Hepatic disease/renal Interaction: acetaminophen- Chronic high-dose acetaminophen (>2 g/day) may
disease, Chronic alcohol use/abuse; codeine head ↑ risk of bleeding with warfarin (INR should not exceed 4). Codeine- MAO
inhibitors ↑ risk of adverse reactions, Additive CNS depression with alcohol,
trauma, alcoholism, severe renal or hepatic or antidepressants, antihistamines, benzodiazepines, and sedative/hypnotics.
pulmonary disease
Nursing Implication: acetaminophen- Assess overall health status and alcohol usage before administering acetaminophen. Patients who are
malnourished or chronically abuse alcohol are at higher risk of developing hepatotoxicity with chronic use of usual doses of this drug. Pain: Assess type, location,
and intensity prior to and 30–60 min following administration. When combined with opioids do not exceed the maximum recommended daily dose of
acetaminophen. Administer with a full glass of water. codeine Assess BP, pulse, and respirations before and periodically during administration. If respiratory
rate is <10/min, assess level of sedation. Assess type, location, and intensity of pain before and 1 hr (peak) after administration. Regularly administered doses may
be more effective than prn administration. Analgesic is more effective if given before pain becomes severe. PO Oral doses may be administered with food or milk
to minimize GI irritation.
Client Teaching: acetaminophen- Advise patient to avoid alcohol, Advise patient to discontinue acetaminophen and notify
health care professional if rash occurs, codeine REMS: Instruct patient on risk of addiction, abuse, and misuse, which
could lead to death. May cause drowsiness or dizziness. Advise patient to call for assistance when ambulating Advise
patient to change positions slowly to minimize orthostatic hypotension.

Generic: cyanocobalamin Brand name: Nascobal Rubramin PC Classification: antianemics

vitamins
Use: Vitamin B12 deficiency Onset: Route:IM, onset:unknown, Peak:3–10 days, Duration:
unknown

Safe Dosage: IM SC Children: 30–50 mcg/day for 2 or Action: Necessary coenzyme for metabolic processes,
more wk (to a total dose of 1000–5000 mcg), then give including fat and carbohydrate metabolism and protein
maintenance dose of 100 mcg/month (doses up to 1000 synthesis.
mcg have been used for maintenance).
Adverse Reaction: headache, heart failure, diarrhea, Contraindication: Hypersensitivity
itching

Precaution: Hereditary optic nerve atrophy (accelerates Interaction: chloramphenicol and antineoplastics may ↓
nerve damage) Renal dysfunction (when using hematologic response to vitamin B12
aluminum-containing products)

Nursing Implication: Assess patient for signs of vitamin B12 deficiency (pallor; neuropathy; psychosis; red, inflamed
tongue) before and periodically during therapy. Vials should be protected from light.
Client Teaching: Encourage patient to comply with diet recommendations of health care professional. Explain that the
best source of vitamins is a well-balanced diet with foods from the four basic food groups. Foods high in vitamin B12
include meats, seafood, egg yolk, and fermented cheeses; few vitamins are lost with ordinary cooking.

Generic: erythromycin ophthalmic Brand name: Ilotycin Ophthalmic Classification: Macrolides, Ophthalmic

Use:  Localized superficial ophthalmic infections (e.g., Onset: Unknown whether erythromycin is absorbed from
bacterial conjunctivitis). mucous membranes to any substantial extent
Safe Dosage: Adults and children: Treatment of Action: Inhibits protein synthesis in susceptible organisms by
infections–½-in. ointment strip 2–6 times daily. binding to 50S ribosomal subunits, thereby inhibiting
translocation of aminoacyl transfer-RNA and inhibiting
polypeptide synthesis
Adverse Reaction: Eye stinging/burning/redness or Contraindication: Minor ocular irritation; hypersensitivity
temporary blurred vision may occur. 

Precaution: May result in overgrowth of no susceptible Interaction: Small amounts may be absorbed and result in
organisms, including fungi. Do not let tip of applicator hypersensitivity reactions.
touch eye; avoid contamination

Nursing Implication: For instillation of ophthalmic solutions, instruct patient to lie down or tilt head back and look at
ceiling. Pull down on lower lid, creating a small pocket, and instill solution into pocket. Do not touch cap or tip of container
to eye, fingers, or any surface.

Client Teaching: After you apply this drug, your vision may become temporarily blurred. Do not drive, use machinery, or
do any activity that requires clear vision until you are sure you can perform such activities safely.

Generic: donepezil Brand name: Aricept Classification: anti-Alzheimers's agents

Use: Mild, moderate, or severe Onset:

dementia/neurocognitive disorder associated with
Alzheimer's disease.
Safe Dosage: PO (Adults): 5 mg once daily; may ↑ to 10 Action: inhibits acetylcholinesterase thus improving
mg once daily after 4–6 wk cholinergic function by making more acetylcholine available.

Adverse Reaction: diarrhea, nausea, headace Contraindication: Hypersensitivity to donepezil or piperidine

derivatives.

Precaution: Underlying cardiac disease, especially sick Interaction: Exaggerates muscle relaxation from
sinus syndrome or supraventricular conduction defects; succinylcholine. Interferes with the action of anticholinergics.
History of ulcer disease or currently taking NSAIDs;
Nursing Implication: Assess cognitive function (memory, attention, reasoning, language, ability to perform simple tasks)
periodically during therapy. Monitor heart rate periodically during therapy. May cause bradycardia. Administer in the
evening just before going to bed. May be taken without regard to food.

Client Teaching: Inform patient/family that it may take weeks before improvement in baseline behavior is observed.
Caution patient and caregiver that donepezil may cause dizziness. Advise patient to avoid driving and other activities
requiring alertness until response to medication is known

Generic: docusate sodium Brand name: Colace Classification: laxatives

Use: PO Prevention of constipation Onset: Route: PO, onset:12–72 hr, peak: unknown duration:
unknown

Safe Dosage: PO (Adults and Children >12 yr): 50–400 Action: Promotes incorporation of water into stool, resulting in
mg in 1–4 divided doses. softer fecal mass.

Adverse Reaction: EENT: throat irritation Contraindication: Abdominal pain, nausea, or vomiting,

GI: mild cramps, diarrhea, Derm: rashes especially when associated with fever or other signs of an
acute abdomen.

Precaution: Excessive or prolonged use may lead to Interaction: None significant

dependence
Nursing Implication: Assess for abdominal distention, presence of bowel sounds, and usual pattern of bowel function.
Administer with a full glass of water or juice. May be administered on an empty stomach for more rapid results.

Client Teaching: Instruct patients with cardiac disease to avoid straining during bowel movements (Valsalva maneuver).
Advise patient not to use laxatives when abdominal pain, nausea, vomiting, or fever is present. Advise patient not to take
docusate within 2 hr of other laxatives.

Generic: Brand name: Classification:

Use: Onset:

Safe Dosage: Action:

Adverse Reaction: Contraindication:

Precaution: Interaction:

Nursing Implication:

Client Teaching:

Generic: Brand name: Classification:

Use: Onset:

Safe Dosage: Action:

Adverse Reaction: Contraindication:

Precaution: Interaction:

Nursing Implication:

Client Teaching: