NAME OF MECHANISM SIDE AFFECT/ ADVERSE NURSING

THE OF AFFECT INTERVENTION

DRUG ACTION
BEFORE:

CNS: drowsiness, -Monitor BP, pulse, respirations, and

Stimulates urinary output and observe patient
headache,
closely following IV administration.
alpha- nervousness, tremor, Epinephrine may widen pulse pressure. If
adrenergic cerebral hemorrhage, disturbances in cardiac rhythm occur,
receptors stroke, vertigo, pain, withhold epinephrine and notify physician
EPINEPHRIN (vasoconstriction disorientation, agitation, immediately.
E , anxiety, apprehensiveness,
fear, restlessness, dizziness, -Keep physician informed of any changes
(ADRENALIN pressor
weakness, subarachnoid in intake-output ratio.
E)
effects), hemorrhage.
DURING:
beta1- -Use cardiac monitor with patients
adrenergic CV: palpitations, ventricular
receiving epinephrine
fibrillation, shock, widened IV. Have full crash cart immediately
receptors pulse pressure, HTN, available.
(cardiac tachycardia, anginal
stimulation), pain, -Check BP repeatedly when epinephrine is
beta2-adrenergic cardiac administered IV during first 5 min, then
arrhythmias, altered ECG q3–5min until stabilized.
receptors
(including
decreased T-wave amplitude). AFTER:
(bronchial -Advise patient to report to physician if
dilation, symptoms are not relieved in 20 min or if
vasodilation). GI: nausea, vomiting.
they become worse following inhalation.
Respiratory: dyspnea,
Therapeutic respiratory difficulties. -Advise patient to report bronchial
irritation, nervousness, or sleeplessness.
Effect: Skin: urticaria, hemorrhage at Dosage should be reduced.
Relaxes injection site, pallor,
sweating. -Monitor blood glucose & HbA1c for loss
smooth of glycemic control if diabetic.
muscle of Other: tissue necrosis.
NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
Acts by selectively CNS: headache, restlessness, - Monitor vital signs. HR is a sensitive indicator of patient's
blocking all muscarinic insomnia, dizziness, ataxia, response to atropine. Be alert to changes in quality, rate, and
responses to disorientation, rhythm of HR and respiration and to changes in BP and
temperature.
acetylcholine (ACh), hallucinations, delirium, excitement,
whether excitatory or agitation, confusion, fever. CV: -Initial paradoxical bradycardia following IV atropine usually
ATROPINE inhibitory. Selective bradycardia, palpitations, lasts only 1–2 min; it most likely occurs when IV is administered
SULFATE depression of CNS tachycardia, atrial and ventricular slowly (more than 1 min) or when small doses (less than 0.5 mg)
are used. Postural hypotension occurs when patient ambulates
relieves rigidity and arrhythmias. too soon after parenteral administration.
tremor of Parkinson's
syndrome. EENT: blurred vision, mydriasis, DURING:
- Monitor I&O, especially in older adults and patients who have
Antisecretory action photophobia, cycloplegia, increased
had surgery (drug may contribute to urinary retention). Palpate
(vagolytic effect) IOP. lower abdomen for distention. Have patient void before giving
suppresses sweating, atropine.
lacrimation, GI: dry mouth, constipation, thirst,
-Monitor CNS status. Older adults and debilitated patients
salivation, and nausea, vomiting. sometimes manifest drowsiness or CNS stimulation
secretions from nose, (excitement, agitation, confusion) with usual doses of drug or
mouth, pharynx, and GU: urine retention, other belladonna alkaloids. In addition to dosage adjustment,
side rails and supervision of ambulation may be indicated.
bronchi. Blocks vagal erectile dysfunction.
impulses to heart with -Monitor infants, small children, and older adults for "atropine
resulting decrease in Hematologic: leukocytosis. fever" (hyperpyrexia due to suppression of perspiration and
AV conduction time, Metabolic: hyperglycemia, heat loss), which increases the risk of heatstroke.
increase in heart rate hypoglycemia, hyponatremia, AFTER:
and cardiac output, hypokalemia. - Patients receiving atropine via inhalation sometimes manifest
and shortened PR mild CNS stimulation with doses in excess of 5 mg and mental
depression and other mental disturbances with larger doses.
interval. Skin: rash.

Other: anaphylaxis.

REFERENCES: Saunders Nursing Drug Handbook 2021

 NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
A class IB CNS: confusion, tremor, stupor, - Stop infusion immediately if ECG indicates
excessive cardiac depression (e.g., prolongation
antiarrhythmic that restlessness, light-headedness, of PR interval or QRS complex and the
decreases the seizures, appearance or aggravation of arrhythmias).
LIDOCAINE depolarization, lethargy, somnolence, anxiety,
HYDROCHLORIDE automaticity, hallucinations, nervousness,
(Xylocard) and excitability in the paresthesia,
ventricles during the muscle twitching. DURING:
diastolic phase by - Monitor BP and ECG constantly; assess
direct action CV: hypotension, bradycardia, respiratory and neurologic status frequently to
on the tissues, new or worsened avoid potential overdosage and toxicity.
especially the Purkinje arrhythmias, cardiac arrest. - Auscultate lungs for basilar rales, especially in
patients who tend to metabolize the drug slowly
network. (e.g., CHF, cardiogenic shock, hepatic
EENT: blurred or double vision, dysfunction).
tinnitus. -

GI: Anorexia, nausea , vomiting. AFTER:

- Watch for neurotoxic effects (e.g., drowsiness,
dizziness, confusion, paresthesias, visual
Respiratory: respiratory depression disturbances, excitement, behavioral changes) in
and arrest. patients receiving IV infusions or with high
lidocaine blood levels.
Skin: soreness at injection site.
Note: Lidocaine blood levels of 1.5–6 mcg/mL are
reported to provide "usually effective" antiarrhythmic
Other: anaphylaxis, sensation of activity. Blood levels greater than 7 mcg/mL are
cold. potentially toxic.

REFERENCES: Lippincott Williams-Wilkins

Nursing Drug Handbook 2021
NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
Calcium is an essential BEFORE:
element for regulating - Assess for cutaneous burning sensations and
the excitation threshold peripheral vasodilation, with moderate fall in BP,
CNS: tingling sensations, sense of during direct IV injection.
of nerves and muscles, oppression or heat waves with IV - Monitor ECG during IV administration to detect
for blood clotting
use, syncope with rapid IV use. evidence of hypercalcemia: decreased QT interval
mechanisms, cardiac associated with inverted T wave.
function (rhythm,
tonicity, contractility), CV: bradycardia, arrhythmias,
DURING:
maintenance of renal cardiac arrest - Observe IV site closely. Extravasation may result
CALCIUM function, for body with rapid IV use, mild drop in BP, in tissue irritation and necrosis.
GLUCONATE skeleton and teeth. Also vasodilation. - Monitor for hypocalcemia and hypercalcemia
plays a role in regulating (see Signs & Symptoms, Appendix F).
storage and release of GI: constipation, - Lab tests: Determine levels of calcium and
phosphorus (tend to vary inversely) and
neurotransmitters and irritation, chalky taste, magnesium frequently, during sustained therapy.
hormones; regulating hemorrhage, nausea, vomiting, Deficiencies in other ions, particularly
amino acid uptake and thirst, abdominal pain. magnesium, frequently coexist with calcium ion
absorption of vitamin depletion.
B12, gastrin secretion,
GU: polyuria, renal calculi.
and in maintaining AFTER:
structural and functional
Metabolic: hypercalcemia. - Report S&S of hypercalcemia (see Appendix F)
integrity of cell promptly to your care provider.
membranes and - Milk and milk products are the best sources of
capillaries. Calcium calcium (and phosphorus). Other good sources
include dark green vegetables, soy beans, tofu,
gluconate acts like
and canned fish with bones.
digitalis on the heart,
- Calcium absorption can be inhibited by zinc-rich
increasing cardiac foods: nuts, seeds, sprouts, legumes, soy
muscle tone and force products (tofu).
of systolic contractions - Check with physician before self-medicating with
(positive inotropic a calcium supplement.
effect).
REFERENCES: Lippincott Williams-Wilkins
Nursing Drug Handbook 2021
NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
- Inspect insertion site for redness, pain, swelling,
and other signs of extravasation during IV
Enhances action of CNS: Retrograde amnesia, infusion.
gamma-aminobutyric headache, euphoria, drowsiness, - Monitor for hypotension, especially if the
acid (GABA), one of excessive sedation, confusion. patient is premedicated with a narcotic agonist
MIDAZOLAM the major inhibitory analgesic.
neurotransmitters CV: Hypotension.
in the brain. DURING:
Therapeutic Effect: Special Senses: Blurred vision, - Monitor vital signs for entire recovery period. In
Produces anxiolytic, diplopia, nystagmus, pinpoint pupils. obese patient, half-life is prolonged during IV
hypnotic, infusion; therefore, duration of effects is
anticonvulsant, GI: Nausea, vomiting. Respiratory: prolonged (i.e., amnesia, postoperative
recovery).
muscle relaxant, Coughing, laryngospasm (rare), - Be aware that overdose symptoms include
amnestic effects. respiratory arrest. somnolence, confusion, sedation, diminished
reflexes, coma, and untoward effects on vital
Skin: Hives, swelling, burning, pain, signs.
induration at injection site,
AFTER:
tachypnea. - Do not drive or engage in potentially hazardous
activities until response to drug is known. You
Body as a Whole: Hiccups, chills, may feel drowsy, weak, or tired for 1–2 d after
weakness. drug has been given.
- Be prepared for amnesia to prevent an upsetting
postoperative period.
- Review written instructions to assure future
understanding and compliance. Patient teaching
during amnestic period may not be
remembered. Even if dose is small and depth of
amnesia is unclear, relearn information.

REFERENCES: Saunders Nursing Drug Handbook 2021 &

Lippincott Williams-Wilkins Nursing Drug Handbook 2021
NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
- Monitor for adverse reactions. Most are dose related.
Body as a Whole: Throat and chest Physician will rely on accurate observation and reports of
patient response to the drug to determine lowest effective
Psychotherapeutic pain. maintenance dose.
agent related to - Monitor for therapeutic effectiveness. Maximum effect
may require 1–2 wk; patient tolerance to therapeutic
chlordiazepoxide; CNS: Drowsiness, fatigue, ataxia, effects may develop after 4 wk of treatment.
DIAZEPAM reportedly superior in confusion, paradoxic rage, dizziness, - Observe necessary preventive precautions for suicidal
tendencies that may be present in anxiety states
antianxiety and vertigo, amnesia, vivid dreams, accompanied by depression.
anticonvulsant headache, slurred speech, tremor; - Observe patient closely and monitor vital signs when
diazepam is given parenterally; hypotension, muscular
activity, with EEG changes, tardive dyskinesia. weakness, tachycardia, and respiratory depression may
somewhat shorter occur.
Lab tests: Periodic CBC and liver function tests during
duration of action. CV: Hypotension, tachycardia, prolonged therapy.
Like chlordiazepoxide, edema, cardiovascular collapse.
DURING:
it appears to act at - Supervise ambulation. Adverse reactions such as drowsiness
both limbic and Special Senses: Blurred vision, and ataxia are more likely to occur in older adults and
debilitated or those receiving larger doses. Dosage
subcortical levels of diplopia, nystagmus. adjustment may be necessary.
CNS. - Monitor I&O ratio, including urinary and bowel elimination.
- Note: Psychic and physical dependence may occur in
GI: Xerostomia, nausea, patients on long-term high dosage therapy, in those with
constipation, hepatic dysfunction. histories of alcohol or drug addiction, or in those who self-
medicate.

Urogenital: Incontinence, urinary AFTER:

- Avoid alcohol and other CNS depressants during therapy
retention, gynecomastia (prolonged unless otherwise advised by physician. Concomitant use of
use), menstrual irregularities, these agents can cause severe drowsiness, respiratory
depression, and apnea.
ovulation failure. - Do not drive or engage in other potentially hazardous
activities or those requiring mental precision until reaction
to drug is known.
Respiratory: Hiccups, coughing, - Tell physician if you become or intend to become pregnant
laryngospasm. during therapy; drug may need to be discontinued.
- Take drug as prescribed; do not change dose or dose
intervals.
Other: Pain, venous thrombosis, - Check with physician before taking any OTC drugs.
- Do not breast feed while taking this drug without
phlebitis at injection site. consulting physician.
REFERENCES: Saunders Nursing Drug Handbook 2021
NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
- Monitor BP, vital signs, and I&O. Report
Reactivates CNS: Dizziness, headache, oliguria or changes in I&O ratio.
cholinesterase drowsiness - Monitor closely. It is difficult to differentiate
toxic effects of organophosphates or
PRALIDOXIME inhibited by
atropine from toxic effects of pralidoxime.
CHLORIDE phosphate esters by GI: Nausea
- Be alert for and report immediately:
(Protopam displacing the enzyme Reduction in muscle strength, onset of
Chloride) from its receptor Special Senses: Blurred vision, muscle twitching, changes in respiratory
sites: the free enzyme diplopia and impaired pattern, altered level of consciousness,
then can resume its accommodation increases or changes in heart rate and
function of degrading rhythm.
accumulated CV: Tachycardia, hypertension DURING:
acetylcholine, thereby (dose-related). - Observe necessary safety precautions with
restoring normal unconscious patient because excitement and
neuromuscular Body as Whole: Hyperventilation, manic behavior reportedly may occur
following recovery of consciousness.
transmission. muscular weakness, laryngospasm,
- Keep patient under close observation for
muscle rigidity.
48– 72 h, particularly when poison was
ingested, because of likelihood of continued
absorption of organophosphate from lower
bowel.

AFTER:
- In patients with myasthenia gravis,
overdosage with pralidoxime may convert
cholinergic crisis into myasthenic crisis.

REFERENCES: Rob Holland Nursing Drug Guide

NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
Special Senses: Nasal burning or BEFORE:
stinging, dryness of nasal mucosa, - Monitor BP, pulse, respirations, and urinary
Naturally occurring sneezing, rebound congestion. output and observe patient closely
catecholamine following IV administration. Epinephrine
Body as a Whole: Nervousness, may widen pulse pressure. If disturbances in
obtained from animal
restlessness, sleeplessness, fear, anxiety, cardiac rhythm occur, withhold epinephrine
EPINEPHRINE adrenal glands; also
tremors, severe headache, and notify physician immediately.
prepared cerebrovascular accident, weakness, - Keep physician informed of any changes in
synthetically. Acts dizziness, syncope, pallor, sweating, intake-output ratio.
directly on both alpha dyspnea.
and beta receptors; DURING:
the most potent Digestive: Nausea, vomiting. - Use cardiac monitor with patients receiving
activator of alpha epinephrine IV. Have full crash cart
receptors. Cardiovascular: Precordial pain, immediately available.
Strengthens palpitations, hypertension, MI, - Check BP repeatedly when epinephrine is
myocardial tachyarrhythmias including ventricular administered IV during first 5 min, then q3–
fibrillation. 5min until stabilized.
contraction; increases
systolic but may
Respiratory: Bronchial and pulmonary AFTER:
decrease diastolic edema. - Advise patient to report to physician if
blood pressure; symptoms are not relieved in 20 min or if
increases cardiac rate Urogenital: Urinary retention. they become worse following inhalation.
and cardiac output. Skin: Tissue necrosis with repeated - Advise patient to report bronchial irritation,
injections. nervousness, or sleeplessness. Dosage
should be reduced.
Metabolic: Metabolic acidoses, elevated - Monitor blood glucose & HbA1c for loss of
serum lactic acid, transient elevations glycemic control if diabetic.
of blood glucose.
REFERENCES: Saunders Nursing Drug Handbook
Nervous System: Altered state of 2021 & Lippincott Williams-Wilkins Nursing Drug
perception and thought, psychosis. Handbook 2021
NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
In large doses, CNS: Headache, tremor, - Take care to avoid extravasation. Observe
increases rate of convulsions, dizziness, transient injection site for signs of inflammation or
MANNITOL electrolyte excretion muscle rigidity. edema.
- Lab tests: Monitor closely serum and urine
by the kidney,
electrolytes and kidney function during
particularly sodium, CV: Edema, CHF, angina-like pain,
therapy.
chloride, and hypotension, hypertension,
potassium. thrombophlebitis. Eye: Blurred DURING:
vision. - Measure I&O accurately and record to
achieve proper fluid balance.
GI: Dry mouth, nausea, vomiting. - Monitor vital signs closely. Report
significant changes in BP and signs of CHF.
Urogenital: Marked diuresis, urinary - Monitor for possible indications of fluid and
retention, nephrosis, uricosuria. electrolyte imbalance (e.g., thirst, muscle
cramps or weakness, paresthesias, and signs
of CHF).
Metabolic: Fluid and electrolyte
imbalance, especially hyponatremia;
AFTER:
dehydration, acidosis. - Be alert to the possibility that a rebound
increase in ICP sometimes occurs about 12 h
Other: With extravasation (local after drug administration. Patient may
edema, skin necrosis; chills, fever, complain of headache or confusion.
allergic reactions). - Take accurate daily weight.

REFERENCES: Saunders Nursing Drug Handbook

2021 & Lippincott Williams-Wilkins Nursing Drug
Handbook 2021
NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
CNS: euphoria, insomnia, psychotic BEFORE:
Not clearly defined. behavior, pseudotumor cerebri, vertigo, - Establish baseline and continuing data on BP,
Decreases weight, fluid and electrolyte balance, and blood
headache, paresthesia, seizures.
glucose.
inflammation, mainly by CV: heart failure, hypertension, edema, - Lab tests: Periodic serum electrolytes blood
HYDROCORTISONE stabilizing leukocyte arrhythmias, thrombophlebitis, glucose, Hct and Hgb, platelet count, and WBC
lysosomal membranes; thromboembolism. with differential.
suppresses immune EENT: cataracts, glaucoma. - Monitor for adverse effects. Older adults and
response; stimulates GI: peptic ulceration, GI irritation, in- patients with low serum albumin are especially
bone marrow; and creased appetite, pancreatitis, nausea, susceptible to adverse effects.
influences protein, fat, vomiting. - Be alert to signs of hypocalcemia (see Appendix
and carbohydrate GU: menstrual irregularities, increased F).
metabolism. urine calcium levels.
DURING:
Hematologic: easy bruising. Metabolic: - Ophthalmoscopic examinations are
hypokalemia, hyperglycemia, and recommended every 2–3 mo, especially if
carbohydrate intolerance; patient is receiving ophthalmic steroid therapy.
hypercholesterolemia; hypocalcemia. - Monitor for persistent backache or chest pain;
Musculoskeletal: growth suppression in compression and spontaneous fractures of long
children, muscle weakness, bones and vertebrae present hazards.
osteoporosis. Skin: hirsutism, delayed - Monitor for and report changes in mood and
wound healing, acne, skin eruptions. behavior, emotional instability, or psychomotor
Other: cushingoid state, susceptibility activity, especially with long-term therapy.
to infections, acute adrenal
AFTER:
insufficiency after increased stress or - Be alert to possibility of masked infection and
abrupt withdrawal after long-term delayed healing (antiinflammatory and
therapy. After abrupt withdrawal: immunosuppressive actions).
rebound inflammation, fatigue, Note: Dose adjustment may be required if patient is
weakness, arthralgia, fever, dizziness, subjected to severe stress (serious infection, surgery, or
lethargy, depression, fainting, injury).
orthostatic hypotension, dyspnea,
anorexia, hypoglycemia. After REFERENCES: Saunders Nursing Drug Handbook 2021 ,
prolonged use, sudden withdrawal may Lippincott Williams-Wilkins Nursing Drug Handbook 2021
& Rob Holland Nursing Drug Guide
be fatal.
NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
- Observe constantly when given IV. Check BP and pulse q10–
Orally: Acts as a Body as a Whole: Flushing, 15 min or more often if indicated.
- Lab tests: Monitor plasma magnesium levels in patients
laxative by osmotic sweating, extreme thirst, sedation, receiving drug parenterally (normal: 1.8–3.0 mEq/L). Plasma
retention of fluid, confusion, depressed reflexes or no levels in excess of 4 mEq/L are reflected in depressed deep
MAGNESIUM tendon reflexes and other symptoms of magnesium
which distends colon, reflexes, muscle weakness, flaccid intoxication (see ADVERSE EFFECTS). Cardiac arrest occurs at
SULFATE increases water paralysis, hypothermia. levels in excess of 25 mEq/L. Monitor calcium and
phosphorus levels also.
content of feces, and - Early indicators of magnesium toxicity (hypermagnesemia)
causes mechanical CV: Hypotension, depressed cardiac include cathartic effect, profound thirst, feeling of warmth,
sedation, confusion, depressed deep tendon reflexes, and
stimulation of bowel function, complete heart block, muscle weakness
activity. Parenterally: circulatory collapse. DURING:
- Monitor respiratory rate closely. Report immediately if rate
Acts as a CNS falls below 12.
depressant and also Respiratory: Respiratory paralysis. - Test patellar reflex before each repeated parenteral dose.
Depression or absence of reflexes is a useful index of early
as a depressant of magnesium intoxication.
smooth, skeletal, and Metabolic: Hypermagnesemia, - Check urinary output, especially in patients with impaired
kidney function. Therapy is generally not continued if urinary
cardiac muscle hypocalcemia, dehydration, output is less than 100 mL during the 4 h preceding each
function. electrolyte imbalance including dose.
Anticonvulsant hypocalcemia with repeated AFTER:
properties thought to laxative use. - Observe newborns of mothers who received parenteral
magnesium sulfate within a few hours of delivery for signs of
be produced by CNS toxicity, including respiratory and neuromuscular
depression, principally depression.
- Observe patients receiving drug for hypomagnesemia for
by decreasing the improvement in these signs of deficiency: Irritability,
amount of choreiform movements, tremors, tetany, twitching, muscle
cramps, tachycardia, hypertension, psychotic behavior.
acetylcholine - Have calcium gluconate readily available in case of
liberated from motor magnesium sulfate toxicity.
nerve terminals, thus REFERENCES: Saunders Nursing Drug Handbook 2021 & Lippincott
producing peripheral Williams-Wilkins Nursing Drug Handbook 2021
neuromuscular
blockade.
NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
Hematologic: Spontaneous bleeding, BEFORE:
Exerts direct effect transient thrombocytopenia, - Lab tests: Baseline blood coagulation tests, Hct,
hypofibrinogenemia, "white clot Hgb, RBC, and platelet counts prior to initiation
on the cascade of of therapy and at regular intervals throughout
HEPARIN blood coagulation syndrome."
therapy.
SODIUM (clotting) by - Monitor APTT levels closely.
Body as a Whole: Fever, chills, - Note: In general, dosage is adjusted to keep
enhancing the
urticaria, pruritus, skin rashes, itching APTT between 1.5–2.5 times normal control
inhibitory actions of and burning sensations of feet, level.
antithrombin III numbness and tingling of hands and
(heparin cofactor) on feet, elevated BP, headache, nasal DURING:
several factors congestion, - Draw blood for coagulation test 30 min before
essential to normal lacrimation, conjunctivitis, chest pains, each scheduled SC or intermittent IV dose and
blood clotting, arthralgia, bronchospasm, approximately q4h for patients receiving
anaphylactoid reactions. continuous IV heparin during dosage adjustment
thereby blocking the period. After dosage is established, tests may be
conversion of done once daily.
prothrombin to Endocrine: Osteoporosis, - Patients vary widely in their reaction to heparin;
hypoaldosteronism, suppressed renal risk of hemorrhage appears greatest in women,
thrombin and
function, hyperkalemia; rebound all patients >60 y, and patients with liver disease
fibrinogen to fibrin.
hyperlipidemia (following termination or renal insufficiency.
of heparin therapy).
AFTER:
GI: increased AST, ALT. - Monitor vital signs. Report fever, drop in BP,
rapid pulse, and other S&S of hemorrhage.
- Observe all needle sites daily for hematoma and
Urogenital: Priapism (rare).
signs of inflammation (swelling, heat, redness,
pain).
Skin: Injection site reactions: pain, - Antidote: Have on hand protamine sulfate (1%
itching, ecchymoses, tissue irritation solution), specific heparin antagonist.
and sloughing; cyanosis and pains in
arms or legs (vasospasm), reversible REFERENCES: Saunders Nursing Drug Handbook 2021,
transient alopecia (usually around Lippincott Williams-Wilkins Nursing Drug Handbook 2021
temporal area). & Rob Holland Nursing Drug Guide
NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
- Obtain baseline respiratory rate, depth, and rhythm and size
Natural opium alkaloid CNS: sedation, somnolence, clouded
of pupils before administering the drug. Respirations of
with agonist activity sensorium, euphoria, seizures, 12/min or below and miosis are signs of toxicity. Withhold
dizziness, nightmares, physical drug and report to physician.
MORPHINE by binding with the - Be alert to elevated pulse or respiratory rate, restlessness,
SULFATE same receptors as dependence, light- headedness, anorexia, or drawn facial expression that may indicate need
hallucinations, nervousness, for analgesia.
endogenous opioid - Differentiate among restlessness as a sign of pain and the
peptides. Narcotic depression, syncope. need for medication, restlessness associated with hypoxia,
and restlessness caused by morphine-induced CNS
agonist effects are stimulation (a paradoxic reaction that is particularly common
CV: hypotension, bradycardia, in women and older adult patients).
identified with 3 types
shock, cardiac arrest, tachycardia,
of receptors: hypertension. GI: nausea, vomiting, DURING:
- Monitor for respiratory depression; it can be severe for as
Analgesia at constipation, ileus. dry mouth, biliary long as 24 h after epidural or intrathecal administration.
supraspinal level, tract spasms, anorexia. GU: urine - Monitor carefully those at risk for severe respiratory
depression after epidural or intrathecal injection: Older adult
euphoria, respiratory retention. or debilitated patients or those with decreased respiratory
depression and reserve (e.g., emphysema, severe obesity, kyphoscoliosis).
- Continue monitoring for respiratory depression for at least
physical dependence; Hematologic: thrombocytopenia.
24 h after each epidural or intrathecal dose.
analgesia at spinal Respiratory: respiratory depression, - Assess vital signs at regular intervals. Morphine-induced
level, sedation and apnea, respiratory arrest. respiratory depression may occur even with small doses, and
it increases progressively with higher doses (generally max: 90
miosis; and dysphoric, min after SC, 30 min after IM, and 7 min after IV).
hallucinogenic and Skin: pruritus and skin flushing, AFTER:
diaphoresis, edema. - Encourage changes in position, deep breathing, and
cardiac stimulant coughing (unless contraindicated) at regularly scheduled
intervals. Narcotic analgesics also depress cough and sigh
effects. Other: decreased libido reflexes and thus may induce atelectasis, especially in
postoperative patients.
- Be alert for nausea and orthostatic hypotension (with light-
headedness and dizziness) in ambulatory patients or when a
supine patient assumes the head-up position or in patients
not experiencing severe pain.
- Monitor I&O ratio and pattern. Report oliguria or urinary
retention. Morphine may dull perception of bladder stimuli;
therefore, encourage the patient to void at least q4h.
Palpate lower abdomen to detect bladder distention.

REFERENCES: Rob Holland Nursing Drug Guide

 NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
Analog of Body as a Whole: Reversal of - Observe patient closely; duration of action
oxymorphone. A analgesia, tremors, hyperventilation, of some narcotics may exceed that of
NALOXONE "pure" narcotic slight drowsiness, sweating. naloxone. Keep physician informed; repeat
naloxone dose may be necessary.
HYDROCHLORIDE antagonist, essentially
- May precipitate opiate withdrawal if
free of agonistic CV: Increased BP, tachycardia.
administered to a patient who is opiate
(morphine-like) dependent.
properties. Thus, it GI: Nausea, vomiting. - Note: Narcotic abstinence symptoms
produces no induced by naloxone generally start to
significant analgesia, Hematologic: Elevated partial diminish 20–40 min after administration and
respiratory thromboplastin time usually disappear within 90 min.
depression,
psychotomimetic
effects, or miosis DURING:
when administered in - Monitor respirations and other vital signs.
- Monitor surgical and obstetric patients
the absence of
closely for bleeding. Naloxone has been
narcotics and
associated with abnormal coagulation test
possesses more results. Also observe for reversal of
potent narcotic analgesia, which may be manifested by
antagonist action. nausea, vomiting, sweating, tachycardia.

AFTER:
- Report postoperative pain that emerges
after administration of this drug to physician.

REFERENCES: Rob Holland Nursing Drug Guide

NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION

CNS: Sedation, euphoria, dizziness, BEFORE:

Synthetic, potent diaphoresis, delirium, convulsions - Monitor vital signs and observe patient
FENTANYL narcotic agonist with high doses. for signs of skeletal and thoracic muscle
CITRATE analgesic with (depressed respirations) rigidity and
pharmacologic actions CV: Hypotension, bradycardia, weakness.
qualitatively similar to circulatory depression,
those of morphine cardiac arrest. DURING:
and meperidine, but - Watch carefully for respiratory
action is more prompt Special Senses: Miosis, blurred depression and for movements of
and less prolonged. vision. various groups of skeletal muscle in
Principal actions: extremities, external eye, and neck
analgesia and GI: Nausea, vomiting, constipation, during postoperative period. These
sedation. Drug- ileus. movements may present patient
induced alterations in management problems; report promptly.
respiratory rate and Respiratory: Laryngospasm,
alveolar ventilation bronchoconstriction, respiratory AFTER:
may persist beyond depression or arrest. - Duration of respiratory depressant
the analgesic effect. effect may be considerably longer than
Emetic effect is less Body as a Whole: Muscle rigidity, narcotic analgesic effect. Have
than with either especially muscles of respiration immediately available oxygen,
morphine or after rapid IV infusion, urinary resuscitative and intubation equipment,
meperidine. retention, and an opioid antagonist such as
naloxone.
Skin: Rash, contact dermatitis from
patch.
REFERENCES: Rob Holland Nursing Drug Guide
NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
- Have equipment for maintaining patent
airway immediately available before
Most potent of the Body as a Whole: Usually disappear starting IV administration.
LORAZEPAM available with continued medication or with
benzodiazepines. reduced dosage. DURING:
Effects (anxiolytic, - IM or IV lorazepam injection of 2–4 mg
sedative, hypnotic, CNS: Anterograde amnesia, is usually followed by a depth of
and skeletal muscle drowsiness, sedation, dizziness, drowsiness or sleepiness that permits
relaxant) are mediated weakness, unsteadiness, patient to respond to simple instructions
by the inhibitory disorientation, depression, sleep whether patient appears to be asleep or
neurotransmitter disturbance, restlessness, confusion, awake.
GABA. Action sites: hallucinations. - Supervise ambulation of older adult
thalamic, patients for at least 8 h after lorazepam
hypothalamic, and CV: Hypertension or hypotension. injection to prevent falling and injury.
limbic levels of CNS.
Special Senses: Blurred vision, AFTER:
diplopia; depressed hearing. - Lab tests: Assess CBC and liver function
tests periodically for patients on long-
GI: Nausea, vomiting, abdominal term therapy.
discomfort, anorexia - Supervise patient who exhibits
depression with anxiety closely; the
possibility of suicide exists, particularly
when there is apparent improvement in
mood.

REFERENCES: Rob Holland Nursing Drug Guide

NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION

Sedative-hypnotic CNS: Headache, dizziness, twitching, BEFORE:

PROPOFOL used in the induction bucking, jerking, thrashing, - Monitor hemodynamic status and assess
and maintenance of clonic/myoclonic movements. for dose-related hypotension.
anesthesia or
sedation. Special Senses: Decreased DURING:
intraocular pressure. - Take seizure precautions. Tonic-clonic
seizures have occurred following general
CV: Hypotension, ventricular anesthesia with propafol.
asystole (rare). - Be alert to the potential for drug
induced excitation (e.g., twitching,
GI: Vomiting, abdominal cramping. tremor, hyperclonus) and take
appropriate safety measures.
Respiratory: Cough, hiccups, apnea.
Other: Pain at injection site. AFTER:
- Provide comfort measures; pain at the
injection site is quite common especially
when small veins are used.

REFERENCES: Rob Holland Nursing Drug Guide

NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
- Take apical pulse for 1 full min, noting rate, rhythm,
and quality before administering drug.
Widely used cardiac CNS: Fatigue, muscle weakness, - Withold medication and notify physician if apical
DIGOXIN glycoside of Digitalis headache, facial neuralgia, mental pulse falls below ordered parameters (e.g., <50 or
60/min in adults and <60 or 70/min in children).
lanata. Acts by depression, paresthesias, - Be familiar with patient's baseline data (e.g., quality
increasing the force hallucinations, confusion, of peripheral pulses, blood pressure, clinical
and velocity of drowsiness, agitation, dizziness. symptoms, serum electrolytes, creatinine clearance)
as a foundation for making assessments.
myocardial systolic - Lab tests: Baseline and periodic serum digoxin,
contraction (positive CV: Arrhythmias, hypotension, potassium, magnesium, and calcium. Draw blood
inotropic effect). It AV block. samples for determining plasma digoxin levels at least
6 h after daily dose and preferably just before next
also decreases scheduled daily dose.
conduction velocity Special Senses: Visual disturbances.
through the DURING:
- Monitor for S&S of drug toxicity: In children, cardiac
atrioventricular node. GI: Anorexia, nausea, vomiting, arrhythmias are usually reliable signs of early toxicity.
Action is more prompt diarrhea. Early indicators in adults (anorexia, nausea, vomiting,
and less prolonged diarrhea, visual disturbances) are rarely initial signs in
children.
than that of digitalis Other: Diaphoresis, recurrent - Monitor I&O ratio during digitalization, particularly in
and digitoxin. malaise, dysphagia. patients with impaired renal function. Also monitor
for edema daily and auscultate chest for rales.
- Monitor serum digoxin levels closely during concurrent
antibiotic–digoxin therapy, which can precipitate
toxicity because of altered intestinal flora.

AFTER:
- Observe patients closely when being transferred from
one preparation (tablet, elixir, or parenteral) to
another; when tablet is replaced by elixir potential for
toxicity increases since 30% of drug is absorbed.

REFERENCES: Rob Holland Nursing Drug Guide

 NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
Nonselective beta- CNS: fatigue, lethargy, vivid dreams, - Obtain careful medical history to rule out allergies,
asthma, and obstructive pulmonary disease.
blocker of both hallucinations, mental depression, light-
Propranolol can cause bronchiolar constriction even
PROPRANOLOL cardiac and bronchial headedness, insomnia. in normal subjects.
DURING:
HYDROCHLORIDE adrenoreceptors - Monitor apical pulse, respiration, BP, and circulation
CV: bradycardia, hypotension, heart
which competes with to extremities closely throughout period of dosage
failure, intermittent claudication,
epinephrine and intensification of AV block.
adjustment. Consult physician for acceptable
parameters.
norepinephrine for - Evaluate adequate control or dosage interval for
available beta- GI: abdominal cramping, constipation patients being treated for hypertension by checking
receptor sites. In diarrhea, nausea, vomiting. blood pressure near end of dosage interval or before
administration of next dose.
higher doses, exerts - Be aware that adverse reactions occur most
direct quinidine-like Hematologic: agranulocytosis. frequently following IV administration soon after
effects, which therapy is initiated; however, incidence is also high
Respiratory: bronchospasm. following oral use in the older adult and in patients
depresses cardiac with impaired kidney function. Reactions may or may
function including not be dose related.
contractility and Skin: rash. - Lab tests: Obtain periodic hematologic, kidney, liver,
and cardiac functions when propranolol is given for
arrhythmias. Lowers prolonged periods.
Other: fever.
both supine and - Monitor I&O ratio and daily weight as significant
standing blood indexes for detecting fluid retention and developing
heart failure.
pressures - Consult physician regarding allowable salt intake.
in hypertensive Drug plasma volume may increase with consequent
patients. Mechanism risk of CHF if dietary sodium is not restricted in
patients not receiving concomitant diuretic therapy.
of AFTER:
antimigraine action - Fasting for more than 12 h may induce hypoglycemic
unknown but thought effects fostered by propranolol.
- If patient complains of cold, painful, or tender feet or
to be related to hands, examine carefully for evidence of impaired
inhibition of cerebral circulation. Peripheral pulses may still be present
vasodilation and even though circulation is impaired. Caution patient to
avoid prolonged exposure of extremities to cold.
arteriolar spasms. REFERENCES: Rob Holland Nursing Drug Guide
NAME OF THE MECHANISM OF SIDE AFFECT/ ADVERSE AFFECT NURSING INTERVENTION
DRUG ACTION
BEFORE:
Aspirin and other Body as a Whole: Hypersensitivity (urticaria, - Monitor for loss of tolerance to aspirin. The
salicylates are thought to bronchospasm, anaphylactic shock reaction is nonimmunologic; symptoms usually
produce analgesia by (laryngeal edema). occur 15 min to 3 h after ingestion: profuse
ASPIRIN rhinorrhea, erythema, nausea, vomiting,
blocking generation of pain
(ACETYLSALICYLIC intestinal cramps, diarrhea.
impulses, probably by CNS: Dizziness, confusion, drowsiness.
ACID) - Lab tests: frequent PT and IRN with concurrent
inhibiting prostaglandin Special Senses: Tinnitus, hearing loss.
synthesis in the CNS or the anticoagulant therapy; more frequent fasting
synthesis or action of GI: Nausea, vomiting, diarrhea, anorexia, blood glucose levels with diabetes.
heartburn, stomach pains, ulceration, DURING:
other substances that
occult bleeding, GI bleeding. - Monitor the diabetic child carefully for need to
sensitize pain receptors to
adjust insulin dose. Children on high doses of
mechanical or chemical
Hematologic: Thrombocytopenia, hemolytic aspirin are particularly prone to hypoglycemia
stimulation. It’s thought to (see Appendix F).
anemia, prolonged bleeding time. Skin:
relieve fever by central - Monitor for salicylate toxicity. In adults, a
Petechiae, easy bruising, rash.
action in the hypo- sensation of fullness in the ears, tinnitus, and
thalamic heat-regulating Urogenital: Impaired renal function. Other: decreased or mufled hearing are the most
center. Exerts its anti- Prolonged pregnancy and labor with frequent symptoms associated with chronic
inflammatory effect by increased bleeding.ac salicylate overdosage.
inhibiting prostaglandin - Monitor children closely because salicylate
synthesis; also, may inhibit toxicity is enhanced by the dehydration that
the synthesis or action of frequently accompanies fever or illness. Children
other mediators of the tend to manifest salicylate toxicity by
hyperventilation, agitation, mental confusion, or
inflammatory response. In
other behavioral changes, drowsiness, lethargy,
low doses, aspirin also
sweating, and constipation.a
appears to impede clotting AFTER:
by blocking prostaglandin - Potential for toxicity is high in older adults and
synthesis, which prevents patients with asthma, nasal polyps, perennial
formation of the platelet- vasomotor rhinitis, hay fever, or chronic urticaria.
aggregating substance,
thromboxane A2.

REFERENCES: Rob Holland Nursing Drug Guide