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INTERACTIONS: Alcohol/anesthetics/antihistamines/barbiturates/CNS
depressants/narcotics/phenothiazines/nonbarbiturate sedative-hypnotics - potentiates or
adds to CNS depressant effects; concomitant use may lead to drowsiness, lethargy,
stupor, respiratory collapse, coma, or death;
cimetidine/disulfiram/erythromycin/flouxetine/isoniazid/ketoconazole/metoprolol/ oral
contraceptives/probenecid/propoxyphene/ranitidine/rifampin/valproic acid - ↑ effect of
Temazepam reacting to ↓ liver breakdown
INTERACTIONS: Warfarin is responsible for more adverse drug interactions than any
other group; clients on anticoagulant therapy must be monitored carefully each time a
drug is added or withdrawn; since potentiation may mean hemorrhages, a lengthened
prothrombin time (PT) or International Normalized Ratio (INR) warrants reduction of the
dosage of the anticoagulant; MULTIPLE DRUG INTERACTIONS (too many to list)
CONTRAINDICATIONS: Lactation; IM use; use of large loading dose (30 mg) is not
recommended due to increased risk of hemorrhage and lack of more rapid protection
NURSING CONSIDERATIONS: Drink glass of water with each dose; may take oral
solutions with milk or juice to help mask taste; may take 1-3 days to soften fecal matter
due to minimally absorbing docusate salts; assess activity levels, diet, water intake,
exercise routines; have client identify habits and BM activities; note length of time it
takes for laxative to take effect; with abdominal pain and discomfort, note location,
triggers, type of discomfort, rule out other intestinal disorders/obstruction where laxatives
should not be used
NURSING CONSIDERATIONS: Do not use Nitro-Bid with Nicobid; Store from 15-
30˚C (59-86˚F); squeeze ointment onto application papers and fold paper in half, rub
back and forth, apply onto non-hairy part of skin; rotate sites to prevent irritation; once
dose established, use same type of covering to ensure same amount administered each
time; remove at bedtime or as directed to prevent tolerance or loss of drug effect
GENERIC NAME: MULTIVITAMINS
TRADE NAME: Centrum, One-A-Day, Equate Complete
CLASSIFICATION: Essential, organic, non-caloric, required for normal metabolism
ACTION: Essential for promoting growth, health, vitality, life, general well being,
prevention and cure of many health problems and diseases; necessary for metabolic
processes responsible for transforming foods into energy or tissue; formation and
maintenance of red blood cells, chemicals supporting the nervous system, hormones and
genetic material
INDICATIONS: Fat-soluble – A, D, E, K; water-soluble – C, B-complex; do not
provide energy (non-caloric) but some convert calories in fats, carbohydrates, and
proteins into usable body energy; cannot be assimilated without ingesting food; should be
taken with a meal; regulate metabolism, help convert fat and carbohydrates into energy;
assist in forming bone and tissue
ROUTES OF ADMINISTRATION: Tablet
USUAL DOSAGE: A – 5,000 (males), 4000 (females) international units (IU); B1 – 0.3-
1.5mg; B2 – 0.4-2.0mg; B3 – 5-20mg; B6 – 1.3-1.7mg; Folacin – 400mcg; Pantothenic
acid – 4-7mg; B12 – 6mcg; B7 – 100-300mcg; C – 90mg (men), 75mg (women), extra
35mg (smokers); D – 100-1500 IU; E – 22-33 IU; K – 80mcg (men), 65mcg (women)
SEVERE DIFICIENCY DISEASES: Scurvy, Rickets, Pellagra, pernicious anemia,
xerophthalmia, beriberi, osteomalacia, infantile hemolytic anemia, hemorrhagic diseases
of newborn; moderate vitamin deficiencies may also produce symptoms of impaired
health
INTERACTIONS: No major interactions involved; water-soluble vitamins mix well in
blood, are excreted by kidneys, only small amounts accumulate in tissues; regular intake
essential; fat-soluble vitamins stored in body after binding to specific plasma globulins in
fat parts of body; may accumulate in body and cause adverse reactions
CONTRAINDICATIONS: No adverse effects; no contraindications; vitamin D
deficiency is often underdiagnosed and undertreated in older population; clients with
impaired liver function should not take large amounts of fat-soluble vitamins unless
specifically prescribed due to toxicity potential from cumulative effects; pregnant and
breast-feeding women require more of some vitamins than most adults; vitamin
deficiency usually involves multiple rather than single deficiencies and is rare in US; can
usually be attributed to poor lifestyle choices or poor dietary habits with inadequate
intake of many vitamins.
NURSING CONSIDERATIONS: Document indications for therapy; assess metabolic
panel and vitamin levels; monitor levels to ensure requirements met and levels are as
desired; well-balanced diet with foods from basic groups is best source; take with food
for best absorption; avoid self-medication greater than RDA amounts
GENERIC NAME: METOPROLOL TARTRATE
TRADE NAME: Lopressor
CLASSIFICATION: Beta-adrenergic Blocking Agent
ACTION: Combines reversibly mainly with beta1-adrenergic receptors to block the
response to sympathetic nerve impulses, circulating catecholamines, or adrenergic drugs;
Blockage of beta1-receptors decreases heart rate, myocardial contractility, and cardiac
output and slows AV conduction, all of which decreases blood pressure
INDICATIONS: Hypertension; Acute MI in hemodynamically stable patients; Angina
pectoris
ROUTES OF ADMINISTRATION: Injection, Tablets
USUAL DOSAGE: Hypertension: 100 mg/day in single or divided doses; may be
increased weekly to 100-450 mg/day; Angina pectoris; 100 mg/day in 2 divided doses,
can be increased weekly until response obtained or heart rate slows; effective dose is
100-400 mg/day; Aggressive behavior: 200-300 mg/day; Ventricular arrhythmias: 200
mg/day: IV: Early MI treatment: Three IV bolus injections of 5 mg each at approx. 2 min
intervals; then give 50 mg q 6 hr PO starting 15 min after last IV dose; continue for 48
hrs then 100 mg twice a day, continue for 1-3 months
ADVERSE REACTIONS: Fatigue, dizziness, depression, shortness of breath,
bradycardia, diarrhea
CLASSIFICATION: Glucocorticoid
ACTION: Inhibits influx of calcium through the cell membrane, resulting in depression
of automaticity and conduction velocity in cardiac muscle; decreases SA and AV
conduction and prolongs AV node effective and functional refractory periods; slight
decrease in heartrate; possible slight decrease in myocardial contractility; cardiac output
is increased; moderate decrease in peripheral vascular resistance
USUAL DOSAGE: 5 mg/day, up to maximum of 10 mg/day; titrate dose over 7-14 days
CLASSIFICATION: Antifungal
ACTION: Is highly selective inhibitor of fungal cytochrome P450 and sterol C-14 alpha-
demethylation; loss of normal sterols correlates with accumulation of 14 alpha-methyl
sterols in fungi and may be responsible for the fungistatic activity; decrease in cell wall
integrity and extrusion of intracellularmaterial, leading to death
INDICATIONS: Oropharyngeal and esophageal candidiasis; serious systemic candidal
infection (including UTIs, peritonitis, candidemia, disseminated candidiasis, and
pneumonia); cryptococcal meningitis
NURSING CONSIDERATIONS: Daily dose same for either IV or PO; store tablets
under 30ºC (86ºF); loading dose of twice daily dose is recommended for first day to
obtain plasma levels close to steady state by second day; due to long half-life, once daily
dosing (either IV or PO) is possible; do not use IV solution if cloudy, precipitated, or seal
broken; do not exceed continuous IV infusion rate of 200 mg/hr; check site frequently for
extravasation/necrosis; describe clinical presentation of fungal infection
INTERACTIONS: Colistimethate/colistin/ethacrynic
acid/furosemide/polymyxin B/vancomycin - ↑ risk of renal toxicity;
probenecid - ↑ effect of cephalosporins by ↓ excretion by kidney
CLASSIFICATION: Sympathomimetic
USUAL DOSAGE: 1 gtt (drop) in the affected eye(s) three times a day,
with doses about 8 hr apart
CLASSIFICATION: Anticholinergic
USUAL DOSAGE: 2 inhalations (34 mcg) 4 times daily; may take more but not to
exceed 12 inhalations/day
ADVERSE REACTIONS: Headache, dizziness, chest pain, URTI, nausea, bronchitis,
coughing, dyspnea, pharyngitis, pain
TRADE NAME: Advil, Motrin, Midol, Menadol, PediaCare and all derivatives
INTERACTIONS: Alcohol/aminosalicyclic
acid/Cholestyramine/colchidine/ neomycin, para-aminosalicylic acid/timed-
release potassium - ↓ Vitamin B12 absorption; cimetidine - ↓ digestion and
release of vitamin B12; ↓ absorption of cyanocobalamin
ACTION: Folic acid is necessary for normal production of RBCs and for
synthesis of nucleoproteins; is converted into tetrahydrofolic acid which is a
cofactor in the biosynthesis of purines and thymidylates of nucleic acids
ADVERSE REACTIONS: Constipation, dry mouth, nausea & vomiting, mild itching,
drowsiness, lightheadedness, anorexia, weakness
ACTION: Has both alpha- and beta-adrenergic blocking activities; decreases cardiac
output, reduces exercise- or isoproterenol-induced tachycardia, reduces reflex orthostatic
hypotension, causes vasodilation, and reduces peripheral vascular resistance; BP is
lowered more in the standing than in the supine position; significantly lowers plasma
resin activity when given for at least 4 weeks
USUAL DOSAGE: 30 mg or 60 mg once daily initially, then after several days dosage
may be increased to 120 mg (given as single 120 mg tablet or as two-60 mg tablets);
suggested regimen to give dose in a.m. on arising
ADVERSE REACTIONS: Dizziness, headache, hypotension, nausea and
vomiting, increased cough, allergic reaction
ACTION: Promote diuresis by decreasing the rate at which sodium and chloride are
reabsorbed by the distal renal tubules of the kidney; by increasing the excretion of
sodium and chloride, forces excretion of additional water; also increases the excretion of
potassium and, to a lesser extent, bicarbonate, as well as decreases the excretion of
calcium and uric acid; sodium and chloride are excreted in approximately equal amount
INDICATIONS: Edema accompanying CHF; edema accompanying renal diseases,
including nephritic syndrome and conditions of reduced renal function
USUAL DOSAGE: Edema due to renal disease: 5-20 mg once daily (for those who
experience paroxysmal nocturnal dyspnea, a larger dose may be required to ensure
prolonged diuresis and saluresis for a 24-hr period
ADVERSE REACTIONS: Dizziness, headache, muscle cramps, malaise, lethargy,
lassitude, joint pain/swelling, chest pain
USUAL DOSAGE: 5-60 mg/day in four equally divided doses after meals and at
bedtime; decrease gradually by 5-10 mg q 4-5 days to establish minimum maintenance
dosage (5-10 mg) or discontinue altogether until symptoms recur
ACTION: Inhibits reabsorption of both sodium and chloride in the proximal tubule and
the ascending loop of Henle; possible activity in proximal tubule to promote phosphate
excretion
INDICATIONS: Edema associated with CHF, nephritic syndrome, hepatic disease;
adjunct to treat acute pulmonary edema; especially useful in clients refractory to other
diuretics
USUAL DOSAGE: Tablets for edema – 0.5-2 mg once daily; if response is inadequate, a
second or third dose may be given at 4-5 hr intervals up to a maximum of 10 mg/day
ADVERSE REACTIONS: Dizziness, hypotension, headache, nausea,
muscle cramps, encephalopathy in those with preexisting liver disease
ACTION: Hydromorphone is 710 times more analgesic than morphine, with a shorter
duration of action; it manifests less sedation, less vomiting, and less nausea than
morphone, although it induces pronounced respiratory depression
INDICATIONS: Moderate to severe pain (e.g. surgery, cancer, biliary colic, burns, renal
colic, MI, bone and soft tissue trauma); dilaudid-HP is a concentrated solution intended
for those tolerant to narcotics
USUAL DOSAGE: 1-2 mg IM or SC q 4-6 hr as needed; for severe pain, 3-4 mg q 4-6
hr; may be given by slow IV over 2-3 min
ADVERSE REACTIONS: Constipation, N&V, asthenia, headache,
sleepiness/sedation/somnolence, itching/pruritis
CLASSIFICATION: Antihyperlipidemic
CLASSIFICATION: Antibiotic
ACTION: Calcium is essential for maintaining normal function of nerves, muscles, the
skeletal system, and permeability of cell membranes and capillaries; normal serum
calcium level is 9-10.4 mg.dL (4.5-5.2 mEq/L). Hypocalcemia is characterized by
muscular fibrillation, twitching, skeletal muscle spasms, leg cramps, titanic spasms,
cardiac arrythmias, smooth muscle hyperexcitability, mental depression, and anxiety
states
INDICATIONS: Mild hypocalcemia; Antacid (including heartburn, sour stomach, and
acid indigestion); anithyperphosphatemic
ROUTES OF ADMINISTRATION: Capsules, gum, gum tablets, lozenges, powder,
suspension, tablets, chewable tablets
USUAL DOSAGE: Hypocalcemia/Nutritional supplement – 1.25-1.5 grams 1-3 times
daily with or without meals; antihyperphosphatemic – 5-13 grams daily in divided doses
with meals
INTERACTIONS: : May enhance the activity of oral anticoagulants which may need
reduced doses. When taken concurrently with digitalis glycosides may decrease serum
digitalis levels. Cholestyramine binds to thyroid hormone in the GI tract, possibly
reducing the absorption of both drugs. Diabetic patiens may require increased doses of
their hypoglycemic drugs. With epinephrine in patients with coronary disease, may
induce coronary insufficiency.
USUAL DOSAGE: Adults & adolescents (PO) – 5-10 mg (repeat dose q 3-4 hr as
needed, not to exceed 40 mg/day; (rectal suppository) - 25 mg twice daily; maleate
sustained-release tablets (maleate tablets) – 5-10 mg 3-4 times daily (up to 40 mg/day);
for extended release capsules, the dose is 15-30 mg once daily in the morning (or 10 mg
q 12 hr, up to 40 mg/day)
ADVERSE REACTIONS: Drowsiness, dizziness, amenorrhea, blurred vision, skin
reactions, hypotension, extrapyramidal reactions
CONTRAINDICATIONS: Use in clients who weigh less than 44 kg or who are under 2
y/o
NURSING CONSIDERATIONS: For the elderly, use doses in lower range as they are
more susceptible to hypotension and neuromuscular reactions; store all forms of the drug
in tight-closing amber-colored bottles; store suppositories below 37°C (98.6°F); DO
NOT GIVE SC; Do not mix other agents in syringe if given IV; Do not mix with any
agent containing preservative parabens; parenteral prescribing limits are 20 mg/day for
children 2-5 y/o, 25 mg/day for children 6-12 y/o; assess mental status; note behavioral
presentation/manifestations; moniotor CBC, LFT’s, ECG; do not exceed prescribed dose;
auscultate bowel sounds and assess function
INDICATIONS: Relief of mild to moderate pain, either when pain is present alone or
when accompanied by fever
ADVERSE REACTIONS: Fine hand tremor, polyuria, thirst, transient and mild nausea,
general discomfort
INTERACTIONS: Acetazolamide / urea / urinary alkanizers / mannitol- ↓ lithium effect
by ↑ renal excretion; Bumetanide / ethacrynic acid / furosemide - ↑ lithium toxicity R/T ↓
renal clearance; Carbamazepine / phenytoin / probenecid - ↑ risk of lithium toxicity;
Diazepam - ↑ risk of hypothermia; Haloperidol - ↑ risk of neurologic toxicity; NSAID’s -
↓ lithium clearance, possibly R/T inhibition of renal prostaglandin synthesis
ACTION: Exerts direct antispasmodic effect on smooth muscle and inhibits action of
acetylcholine at postganglionic cholinergic sites, thus decreasing bladder capacity and
delaying the initial desire to void by reducing the number of motor impulses reaching the
detrusor muscle
USUAL DOSAGE: Adult: Oral, 5 mg two or three times a day, dosage being adjusted as
needed and tolerated; oral prescribing limits – 5 mg 4 times a day or 20 mg daily
USUAL DOSAGE: Dietary supplement: Adults: 10-20 mg/day for 2 weeks, then 2-5
mg/day as part of a multivitamin preparation for several weeks; High urine oxylate
levels: 25-300 mg/day; PMS: 40-500 mg/day; Tardive dyskinesia due to antipsychotic
drugs: 100 mg/day for 4 weeks
ADVERSE REACTIONS: Paresthesia, numbness of feet, perioral numbness, unstable
gait. Decreased sensation to touch, temperature, and vibration
INTERACTIONS: Chloramphenicol / oral contraceptives / Cycloserine / Ethionamide /
Hydralazine / immunosuppressant’s / isoniazid / penicillamine : ↑ Pyridoxine
requirements; Levadopa: doses exceeding the 5 mg/day pyridoxine antagonize
therapeutic effect of levadopa; Phenobarbital: ↓ serum phenobarbitol levels; Phenytoin: ↓
serum phenytoin levels
NURSING CONSIDERATIONS: Monitor uric acid levels, renal, LFTs; assess for
dysfunction; best source of vitamins are with foods high in Vitamin B6, potatoes, broccoli,
lima beans, bananas, chicken breast, liver, yeast, wheat germ, whole-grain cereals; if
prescribing levadopa, avoid vitamin supplements containing vitamin B6, do not take OTC
vitamin supplements without provider approval
GENERIC NAME: METOPROLOL SUCCINATE
INDICATIONS: Late or early MI, hypertension, angina, heart failure, irregular heart
rate, migrane prevention
USUAL DOSAGE: PO: 100-450 mg/day divided bid-tid IV/PO/ 3 bolus injections of 5
mg at 2 min intervals followed in 15 min by 50 mg PO every 6 hrs for 48 hrs, thereafter
100 mg PO bid
ADVERSE REACTIONS: Hypokalemia may develop is cases of brisk diuresis or
severe cirrhosis, dizziness, lightheadedness, drowsiness, diarrhea, unusual dreams,
trouble sleeping, vision problems, cold hands, feet, decreased pulse.
INTERACTIONS: General anesthesia, clonidine, insulin, thiazides, lithium, NSAIDs,
antidiabetics, CA channel blockers, Digoxin, epinephrine, anti-hypertensives, thyroid
medications and anti-depressants.
USUAL DOSAGE: Initial: 10 mg once daily, including elderly or those with hepatic
impairment; increase dose to 20 mg, if necessary, after a minimum of a week;
maintenance: 10 or 20 mg/day for up to 36 weeks after initial 8 weeks of treatment
ADVERSE REACTIONS: Nausea, dry mouth, increased sweating, dizziness, diarrhea,
flu-like symptoms, fatigue, insomnia, somnolence, rhinitis, ejaculation disorder
ACTION: Major effects are on the cardiovascular system; hydralazine lowers blood
pressure by exerting a peripheral vasodilating effect thru direct relaxation of vascular
smooth muscle; alters cellular calcium metabolism, interferes with calcium movements
within vascular smooth muscle; decreased arterial blood pressure; decreased peripheral
vascular resistance
NURSING CONSIDERATIONS: DO NOT give with any other drug solutions; at time
of SC administration, the drug may be admixed in a syringe with bacteriostatic 0.9%
NaCl injection with benzylalcohol,0.9% at 1:1 ratio (benzyl alcohol acts as anesthetic
that may reduce discomfort at the SC site; individualize dose for each client; IV usually
given as a bolus 3 times/week; during hemodialysis, may require increased
anticoagulation with heparin to prevent clotting of artificial kidney; determine hematocrit
twice weekly; if hematocrit approaches 36%, decrease dose to maintain suggested
hematocrit target range; Individualize hemoglobin target level; do not shake vial; do not
use vials showing particulate matter or discolorization
ADVERSE REACTIONS: Few when taken in usual therapeutic doses; GI upset in some
INTERACTIONS: Alcohol, Ethyl – Chronic use →↑ toxicity of larger therapeutic doses
of acetaminophen; Barbiturates / Carbamazepine / Hydantoins / Isoniazid / Propanolol /
Sulfinpyrazone / Rifampin - ↑ potential of hepatotoxicity R/T ↑ liver breakdown of
acetaminophen; Diuretics, loop - ↓ effect R/T ↓ renal prostaglandin excretion and ↓
plasma renin; NSAIDs - ↑ risk of hypertension in women; Propanolol - ↑ effect R/T ↓
liver breakdown
CONTRAINDICATIONS: Renal insufficiency, anemia; clients with cardiac or
pulmonary disease are more susceptible to acetaminophen toxicity
NURSING CONSIDERATIONS: Do not combine products containing acetaminophen,
many of which are OTC; read labels on all OTC products; take as directed with food or
milk to decrease GI upset; report signs and symptoms of toxicity immediately (nausea,
vomiting, abdominal pain, bluish coloration of nailbeds/skin, complaints of shortness of
breath, weakness, headache, dizziness; report paleness, weakness, and heart beat skips
(signs and symptoms of hemolytic anemia); do not exceed 4 grams/24 hr period in adults
and 75 mg/kg/day for children; do not take for more than 5 days for pain in children, 10
days for pain in adults, or more than 3 days for fever in adults or children without seeking
a doctor; note reasons for therapy, prescribed dosage and expected outcomes
ACTION: Long-acting recombinant human insulin analog; differs from human insulin in
that the amino acid asparagine is replaced by glycine and two arginines are added to the
C-terminus of the B-chain; is designed to have low aqueous solubility at neutral pH; at
pH 4, it is completely soluble; allows a relatively constant concentration/time profile over
24 hr with no pronounced peak
INDICATIONS: Once daily at bedtime for treatment of adult and pediatric clients (6
years and older) with type 1 diabetes mellitus or adults with type 2 diabetes mellitus who
require long-acting insulin to control hyperglycemia
GENERIC NAME:
TRADE NAME:
CLASSIFICATION:
ACTION:
INDICATIONS:
ROUTES OF ADMINISTRATION:
USUAL DOSAGE:
ADVERSE REACTIONS:
INTERACTIONS:
CONTRAINDICATIONS:
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