Drug Name

(Generic & Trade Name) & Route

Category/
Classification

Medication Work Sheet

Side Effects: Common/life-threatening
Dose/Frequency
italics = common; red = life-threatening

amoxicillin/clavulanate
Augmentin suspension PO
(Other trade name: Amoclan)

Broad-spectrum
anitinfective
(penicillin)

Nausea, diarrhea, vomiting, vaginitis, moniliasis, Rash,

pseudomembranous colitis, seizures, glomerulonephritis
Hema: Anemia, bone marrow depression, granulocytopenia, leukopenia,
eosinophilia, toxic epidermal necrolysis, Anaphylaxis, respiratory distress,
serum sickness, superinfection, Stevens-Johnson syndrome

Febrile neutropenia Adult/adolescent >16

yrs/child 40 kg: 2 g Q8H 7 days or until
neutropenia resolves
Urinary tract infections (mild to moderate):
0.5-1 g q12hr 7-10 days
Urinary tract infections (severe)
Adult/adolescent >16 yr/child 40 kg: 2 g
q12hr 10 days

cefepime IVPB
(Trade name: Maxipime [4th generation])
TEACHING
Check blood glucose if diabetic
Report sore throat, bruising, bleeding,
joint pain
Report consistent diarrhea, especially
with mucous and/or blood
Can be taken with oral birth control

PO 250-500 mg q8hr or 500-875 mg q12hr,

depending on severity of infection

Broad-spectrum
antibiotics/
cephalosporin

Pneumonia (moderate to severe): 1-2 g q12hr 10

days
Dosage reduction indicated with renal impairment
(CCr <50 ml/min)

IV after diluting in 50-100 ml or more D5,

NS; give over 30 min
For 7-10 days to ensure organism death,
prevent superinfection

CNS: Headache, dizziness, weakness, paresthesia, fever, chills, seizures,

dyskinesia (cefdinir)
CV: Heart failure, syncope (cefdinir)
EENT: Oral candidiasis
GI: Nausea, vomiting, diarrhea, anorexia, pain, glossitis, bleeding;
increased AST, ALT, bilirubin, LDH, alk phos; abdominal pain,
pseudomembranous colitis; cholestasis (cefotaxime)
GU: Proteinuria, vaginitis, pruritus, candidiasis, increased BUN,
nephrotoxicity, renal failure
Hema: Leukopenia, thrombocytopenia, agranulocytosis, anemia,
neutropenia, lymphocytosis, eosinophilia, pancytopenia, hemolytic
anemia
Integ: Rash, urticaria, dermatitis
Resp: Dyspnea
Syst: Anaphylaxis, serum sickness, Stevens-Johnson syndrome, toxic
epidermal necrolysis

Purpose for Medication

(Reasons a patient would take
the medication)
Lower respiratory tract
infections, sinus infections,
pneumonia, otitis media, skin
infection, UTI; effective for
strains of Escherichia coli,
Proteus mirabilis, Haemophilus
influenzae, Streptococcus
faecalis, Streptococcus
pneumoniae, and some lactamaseproducing organisms

Gram-negative bacilli:
Escherichia coli, Proteus,
Klebsiella; gram-positive
organisms: Streptococcus
pneumoniae, Streptococcus
pyogenes, Staphylococcus
aureus; lower respiratory tract,
urinary tract, skin, bone
infections; febrile neutropenia
intraabdominal infection

Available forms: Powder for inj - 0.5, 1, 2 g;

1 g/50 ml, 2 g/100 ml
colace PO
(Trade name: Kao-Tin, Stool Softener
DC, Sur-Q-Lax, Walgreen's Stool Softener,
Colace, Correctol, Diocto, Doc-Q-Lace,
Laxative,
Docu DOK, Doculace, Enemeez, Equaline
emollient; stool
Stool Softener, Good Sense Stool
softener
Softener, Leader Stool Softener, Phillip's
Stool Softener, Select Brand Docusate
Sodium, Top Care Stool Softener,
Walgreen's Stool Softener)

digoxin PO
(Trade name: Lanoxin)

enoxaparin
Lovenox Sub-Q

furosemide IV/IV push

(Trade name: Lasix)
TEACHING
To discuss the need for a high-potassium diet or
potassium replacement with prescriber
To rise slowly from lying or sitting position
because orthostatic hypotension may occur
To recognize adverse reactions that may occur:

PO 50-300 mg/day (sodium) or 240 mg

(calcium) prn

EENT: Bitter taste, throat irritation

GI: Nausea, anorexia, cramps, diarrhea
Integ: Rash

CNS: Headache, drowsiness, apathy, confusion, disorientation, fatigue,

Cardiac glycoside,
depression, hallucinations
PO 125-500 mcg Daily, depending on CCr and
inotropic,
CV: Dysrhythmias, hypotension, bradycardia, AV block
lean body weight
antidysrhythmic
EENT: Blurred vision, yellow-green halos, photophobia, diplopia
GI: Nausea, vomiting, anorexia, abdominal pain, diarrhea

Anticoagulant,
antithrombotic

Loop diuretic

Prevention of dry, hard stools

Nursing Assessments: (patient assessments that should be

made prior to administering drug; any administration
information to remember when giving the drug)

ASSESS:
Penicillin allergy
C & S result for infection
HOLD IF:
Allergy

Assess penicillin/other cephalosporin allergies

Nephrotoxicity: increased BUN, creatinine; urine output:
if decreasing, notify prescriber
Blood studies: AST, ALT, CBC, Hct, bilirubin, LDH, alk phos,
Coombs test monthly if patient is on long-term therapy
Electrolytes: K, Na, Cl monthly if patient is on long-term
therapy
Pseudomembranous colitis: bowel pattern daily; if severe
diarrhea occurs, product should be discontinued
IV site for extravasation, phlebitis
Anaphylaxis: rash, urticaria, pruritus, chills, fever, joint
pain, angioedema; may occur a few days after therapy begins
wait 10 min, assess IV site
Bleeding: ecchymosis, bleeding gums, hematuria, stool
guaiac
Overgrowth of infection: perineal itching, fever, malaise,
redness, pain, swelling, drainage, rash, diarrhea, change in
cough, sputum

Cause of constipation; identify whether fluids, bulk, or

exercise missing from lifestyle; constipating products
Cramping, rectal bleeding, nausea, vomiting; if these occur,
product should be discontinued

Apical pulse for 1 min before giving product; if pulse <60 in

adult or <90 in infant, take again in 1 hr; if <60 in adult, call
prescriber; note rate, rhythm, character; monitor ECG
Heart failure, atrial fibrillation,
continuously during parenteral loading dose
atrial flutter, atrial tachycardia,
Electrolytes: K, Na, Cl, Mg, Ca; renal function studies:
cardiogenic shock, paroxysmal
BUN, creatinine; blood studies: ALT, AST, bilirubin, Hct, Hgb
atrial tachycardia, rapid
before initiating treatment and periodically thereafter
digitalization in these disorders
I&O ratio, daily weights; monitor turgor, lung sounds,
edema
Monitor product levels; therapeutic level 0.5-2 ng/ml
Cardiac status: apical pulse, character, rate, rhythm

DVT prevention before hip or knee surgery

Adult: SUBCUT 30 mg bid given 12-24 hr
postop for 7-10 days until DVT risk is
diminished
DVT prevention before hip replacement
Prevention of DVT (inpatient or
Adult: SUBCUT 40 mg/day started 9-15 hr
outpatient), PE (inpatient) in
preop or 30 mg q12hr started 12-24 hr postop,
hip and knee replacement,
continued until DVT risk diminished or
Hemorrhage, hypochromic anemia, thrombocytopenia, bleeding
abdominal surgery at risk for
patient adequately on anticoagulant
thrombosis; unstable
Treatment of DVT or PE (peripheral edema)
angina/nonQ-wave MI
Adult: SUBCUT 1 mg/kg q12hr (without PE,
outpatient); 1 mg/kg q12hr or 1.5 mg/kg/day
(with or without PE, inpatient); warfarin
should be started within 72 hr, continued 5
days until INR is 2-3 (usually 7 days)
Edema: 20-40 mg; increase by 20 mg q2hr
CNS: Headache, fatigue, weakness, vertigo, paresthesias
Pulmonary edema; edema with
until desired response
CV: Orthostatic hypotension, chest pain, ECG changes, circulatory
CHF, hepatic disease, nephrotic
collapse
syndrome, ascites, hypertension
Acute pulmonary edema: 40 mg given over EENT: Loss of hearing, ear pain, tinnitus, blurred vision
several min, repeated after 1 hr; increase to Elect: Hypokalemia, hypochloremic alkalosis, hypomagnesemia,
80 mg if needed
hyperuricemia, hypocalcemia, hyponatremia, metabolic alkalosis
Unlabeled uses:
Endo: Hyperglycemia
Hypercalcemia with malignancy,
Antihypercalcemia: 80-100 mg q1-4hr
GI: Nausea, diarrhea, dry mouth, vomiting, anorexia, cramps, oral, gastric hypertensive
irritations, pancreatitis
emergency/urgency, pulmonary

ASSESS:
Platelets, blood studies: CBC, PTT
Blood in stools, bleeding gums, hematuria
HOLD IF:
Platelets <150,000

CHF: weight, I&O daily to determine fluid loss; effect of

product may be decreased if used daily
Hypertension: B/P lying, standing; postural hypotension
may occur
Metabolic alkalosis: drowsiness, restlessness
Assess potassium level during treatment
- Hold if K+ 3.5
Rashes, temp elevation daily
Confusion, especially in geriatric patients; take safety

Acute/chronic renal failure: 100-200 mg,

max 600-800 mg
muscle cramps, weakness, nausea, dizziness
About the entire treatment regimen, including
exercise, diet, stress relief for hypertension
To use sunscreen or protective clothing to
prevent photosensitivity
To use sunscreen or protective clothing to
prevent photosensitivity
To take early in the day to prevent
sleeplessness
To avoid OTC medications unless directed by
prescriber

Hypertensive emergency/urgency
(unlabeled): 40-80 mg
Pulmonary edema/prevention of adverse
hemodynamic effects associated with blood product
transfusion (unlabeled): 40 mg injected slowly then
80 mg injected slowly after 2 hr if needed

Available form: 10 mg/ml

Undiluted; 20 mg/min; may be added to NS
or D5W; if large doses required and given as
IV inf, max 4 mg/min - use inf pump

Edema/CHF: PO 20-80 mg/day in am; may

give another dose after 6 hr up to 600
mg/day
furosemide
Lasix PO

Loop diuretic

Antihypercalcemia: PO 120 mg/day or

divided bid
Acute/chronic renal failure: PO 80 mg/day,
increase by 80-120 mg/day to desired
response

heparin Sub-Q
(Trade names: Hep-Lock, Hep-Lock U/P,
Monoject Prefill)

Anticoagulant,
antithrombotic

Adult: 5000 units q8-12h

1-2 mg q4-6hr prn, may be increased

hydromorphone IV push
(Trade names: Dilaudid HP, Exalgo)
TEACHING
Do not drive
Physical dependency and/or withdrawal
(nausea, cramps, fever, etc) is possible
Report CNS symptoms such as dizziness

Opiate analgesic

Direct: diluted with 5 ml sterile water/NS;

give 2 mg over 3-5 min
IV INF: Dilute each 0.1-1 mg/ml NS (0.1-1
mg/ml), deliver by opioid syringe infusor;
may be diluted in D5W, D5/NaCl, 0.45% NaCl,
NS for larger amounts, delivery through inf
pump
Available forms: Inj 1, 2, 4, 10 mg/ml; tabs 2,
4, 8 mg; supp 3 mg; oral sol 5 mg/5 ml; ext
rel tab 8, 12, 16 mg

influenza vaccine IM
(Trade names: Afluria, FluMist, Fluogen,
Vaccine
Adult/child >12yr: 0.5 mL/1 dose
Flu-Shield, Fluvirin, Fluzone, influenza
virus vaccine, trivalent)
KCl (potassium chloride) IVPB
Electrolyte, mineral Hypokalemia: max 10 mEq/1 hr with 24-hr
(Trade names: Epiklor, Klor-Con, K-Tab,
replacement
max dose 200 mEq, initial dose of 20-40 mEq
Micro-K)
has been recommended
TEACHING
Add to diet: bananas, orange juice, avocados,
whole grains, broccoli, carrots, prunes, cocoa
after product is discontinued
To avoid OTC products: antacids, salt
substitutes, analgesics, vitamin preparations
unless specifically directed by prescriber; to
avoid licorice in large amounts because it may
cause hypokalemia, sodium retention
To report hyperkalemia symptoms (lethargy,
confusion, diarrhea, nausea, vomiting, fainting,
decreased output) or continued hypokalemia
symptoms (fatigue, weakness, polyuria,
polydipsia, cardiac changes)

Conc max 80 mcg/L for peripheral line, 120

mEq/L for central line
Dehydrated patients should receive 1 L of
potassium-free hydrating solution then infuse
10 mEq/hr; in severe hypokalemia, rate may
be 40 mEq/hr

GU: Polyuria, renal failure, glycosuria

Hema: Thrombocytopenia, agranulocytosis, leukopenia, neutropenia,
anemia
Integ: Rash, pruritus, purpura, Stevens-Johnson syndrome, sweating,
photosensitivity, urticaria
MS: Cramps, stiffness

precautions if needed
Hearing, including tinnitus and hearing loss, when giving
high doses for extended periods
Rate, depth, rhythm of respiration, effect of exertion,
edema or prevention of
lung sounds
hemodynamic effects associated
Electrolytes (potassium, sodium, chloride); include BUN,
with blood product transfusion,
blood glucose, CBC, serum creatinine, blood pH, ABGs, uric
ascites
acid
Glucose in urine if patient diabetic
Allergies to sulfonamides, thiazides
Hold if anuria (<45 mL/day)

CHF: weight, I&O daily to determine fluid loss; effect of

product may be decreased if used daily
Hypertension: B/P lying, standing; postural hypotension
CNS: Headache, fatigue, weakness, vertigo, paresthesias
may occur
CV: Orthostatic hypotension, chest pain, ECG changes, circulatory collapse
Metabolic alkalosis: drowsiness, restlessness
EENT: Loss of hearing, ear pain, tinnitus, blurred vision
Hypokalemia: postural hypotension, malaise, fatigue,
Elect: Hypokalemia, hypochloremic alkalosis, hypomagnesemia,
tachycardia, leg cramps, weakness
hyperuricemia, hypocalcemia, hyponatremia, metabolic alkalosis
Rashes, temp elevation daily
Endo: Hyperglycemia
Pulmonary edema; edema with Confusion, especially in geriatric patients; take safety
GI: Nausea, diarrhea, dry mouth, vomiting, anorexia, cramps, oral, gastric
CHF, hepatic disease, nephrotic precautions if needed
irritations, pancreatitis
syndrome, ascites, hypertension Hearing, including tinnitus and hearing loss, when giving
GU: Polyuria, renal failure, glycosuria
high doses for extended periods
Hema: Thrombocytopenia, agranulocytosis, leukopenia, neutropenia,
Rate, depth, rhythm of respiration, effect of exertion,
anemia
lung sounds
Integ: Rash, pruritus, purpura, Stevens-Johnson syndrome, sweating,
Electrolytes (potassium, sodium, chloride); include BUN,
photosensitivity, urticaria
blood glucose, CBC, serum creatinine, blood pH, ABGs, uric
MS: Cramps, stiffness
acid
Glucose in urine if patient diabetic
Allergies to sulfonamides, thiazides
Prevention of DVT, PE, MI, open
heart surgery, disseminated
intravascular clotting syndrome, ASSESS FOR:
atrial fibrillation with
PTT, INR
Fever, Rash, Hematuria, Hemorrhage, thrombocytopenia, anemia,
embolization, as an
Anaphylaxis
anticoagulant in transfusion and HOLD IF:
dialysis procedures, prevention PTT >70 sec
of DVT/PE, to maintain patency INR >1 (5.5 critical)
of indwelling venipuncture
devices;
BLACK BOX WARNING:
Respiratory dysfunction: respiratory depression, character,
CNS: Drowsiness, dizziness, confusion, headache, sedation, euphoria,
rate, rhythm; notify prescriber if assess RR <12/min
mood changes, seizures
CV: Palpitations, bradycardia, change in B/P, hypotension, tachycardia,
peripheral vasodilation
I&O ratio; check for decreasing output; may indicate
EENT: Tinnitus, blurred vision, miosis, diplopia
Moderate to severe pain,
urinary retention
GI: Nausea, vomiting, anorexia, constipation, cramps, dry mouth,
unproductive cough
CNS changes: dizziness, drowsiness, hallucinations,
paralytic ileus
euphoria, LOC, pupil reaction
GU: Increased urinary output, dysuria, urinary retention
Bowel function, constipation
Integ: Rash, urticaria, bruising, flushing, diaphoresis, pruritus
Allergic reactions: rash, urticaria
Resp: Respiratory depression, dyspnea
Need for pain medication, physical dependence
Assess pain: control, sedation by scoring on 0-10 scale, ATC
dosing is best for pain control
ASSESS FOR:
Prevention of Russian, Chilean, Chicken egg allergy
N/A
Philippine influenza
HOLD IF:
YES
CNS: Confusion
Prevention/treatment of
Assess potassium level during treatment
CV: Bradycardia, cardiac depression, dysrhythmias, arrest; peaking T
hypokalemia
- Hold if K+ 3.5
waves, lowered R, depressed RST, prolonged P-R interval, widened QRS
Determine hydration status, I&O ratio
complex
- Hold if pt is dehydrated
GI: Nausea, vomiting, cramps, pain, diarrhea, ulceration of small bowel
- watch for decreased urinary output; notify prescriber
GU: Oliguria
immediately
Integ: Cold extremities, rash
Assess cardiac status: rate, rhythm, CVP, PWP, PAWP if
being monitored directly
Assess renal funtion

MUST BE DILUTED max PUMP rate 25 mL/hr

Available forms: inj for prep of IV 1.5, 2, 2.4,
3, 3.2, 4.4, 4.7 mEq/ml

 About the importance of regular follow-up

visits
That potassium levels will need to be
monitored periodically

ketorolac IM
(Trade name: Toradol)

NSAID/Nonopioid
analgesic

30-60mg single dose

15-30mg q6h

drowsiness, seizures, CV thrombotic events, MI, stroke, GI bleeding,

Mild to moderate pain (shortperforation, hepatitis, hepatic failure, Nephrotoxicity: dysuria, hematuria,
term); seasonal allergic
oliguria, azotemia, Blood dyscrasias, angioedema, Stevens-Johnson
conjunctivitis (ophthalmic)
syndrome, toxic epidermal necrolysis

FULL PAIN ASSESSMENT

NONPHARMACOLOGICAL AGENTS:
Pillows, repositioning, etc.

Hypertension: PO 50 mg bid or 100 mg/day;

may give up to 200-450 mg in divided doses;
EXT REL 25-100 mg daily, titrate at weekly
intervals; max 400 mg/day
Heart failure (NYHA class II/III): PO EXT REL
25 mg daily 2 wk (class II); 12.5 mg daily
(class III); PO (unlabeled) 5 mg bid, titrate to
100-150 mg/day in 2-3 divided doses

metoprolol PO
(Trade name: Toprol-XL)

Antihypertensive,
antianginal

Angina: PO 100 mg/day as a single dose or in

Insomnia, dizziness, Hypotension, palpitations, Nausea, vomiting,
2 divided doses, increase weekly prn or 100
diarrhea, hiccups, bradycardia, cardiac arrest, AV block,
mg EXT REL daily, max 400 mg/day ext rel
pulmonary/peripheral edema, chest pain, Agranulocytosis, eosinophilia,
thrombocytopenia, purpura, Bronchospasm
Migraine prevention (unlabeled): PO 25-100
mg bid-qid; 50-200 mg daily (XL)

ASSESS:
Mild to moderate hypertension,
HR, BP
acute MI to reduce
cardiovascular mortality, angina
HOLD IF:
pectoris, NYHA class II, III heart
HR <50
failure
BP 90/60

Heart rate control for atrial

fibrillation/flutter without accessory
pathway (unlabeled): PO (nonacute setting)
25-100 mg bid
Essential tremor (unlabeled): PO 50 mg/day,
may increase, max 300 mg/day in divided
doses; EXT REL 100 mg/day, max 400 mg/day
morphine IM/SUBCUT
(Astramorph PF, Avinza, Depo Dur,
Infumorph PF, Kadian)

5-10 mg q4h (opiate nave)

Opioid analgesic
5-20 mg q4h (prior opiate use)

Seizures, bradycardia, shock, cardiac arrest, tachycardia,

Thrombocytopenia, Respiratory depression, respiratory arrest, apnea

Moderate to severe pain

ASSESS:
RR
HOLD IF:
RR<12

Moderate to severe pain

ASSESS:
RR, breath sounds
HOLD IF:
RR<12
Assess drug effect within 15 min

morphine IV
(Trade names: Astramorph PF, Avinza,
Depo Dur, Infumorph PF, Kadian)
TEACHING
2.5-15 mg diluted in 4-5 ml sterile water/NS Seizures, bradycardia, shock, cardiac arrest, tachycardia,
Opioid analgesic
Change positions slowly, OH may occur
for inj over 5 min prn pain
Thrombocytopenia, Respiratory depression, respiratory arrest, apnea
Report CNS changes (drowsiness)
Physical dependency may occur
Withdrawal may occur- N/V, cramps,
fever, faintness
Avoid alcohol use and CNS depressants
NPH Insulin Sub-Q (intermittent)
Sub-Q dosage individualized by blood, urine
(Trade names: Humulin N, Novolin N,
Antidiabetic,
glucose; usual dose 7-26 units; may increase Hypoglycemia, Anaphylaxis
Novolin N Prefilled, ReliOn N)
pancreatic hormone
by 2-10 units/day if needed
ASK FOR MED CALCULATION
Prevention of nausea/vomiting (cancer
chemotherapy): 0.15 mg/kg infused over 15
min given 30 min before start of cancer
chemotherapy; 0.15 mg/kg given 4 hr and 8
hr after 1st dose or 32 mg as single dose;
dilute in 50 ml of D5 or 0.9% NaCl before
giving
ondansentron IVPB/IV push
(Trade names: Zofran, Zofran ODT,
Zuplenz)
Antiemetic
TEACHING
Report diarrhea, constipation, rash,
discomfort at IV site

Prevention of postoperative
nausea/vomiting: 4 mg undiluted over >30
sec prior to induction of anesthesia
Hepatic dose: Max dose 8 mg/day
Hyperemesis gravidarum (unlabeled): 4-8
mg bid-tidInj 2 mg/ml, 32 mg/50 ml
(premixed); tabs 4, 8 mg; oral sol 4 mg/5 ml;
oral disintegrating tabs 4, 8 mg; oral
dissolving film 4, 8 mg

CNS: Headache, dizziness, drowsiness, fatigue, EPS

GI: Diarrhea, constipation, abdominal pain, dry mouth
Misc: Rash, bronchospasm (rare), musculoskeletal pain, wound problems,
shivering, fever, hypoxia, urinary retention

Type 1 diabetes mellituts, type 2

ASSESS:
diabetes mellitus, gestational
Blood sugar
diabetes

Prevention of nausea, vomiting

associated with cancer
chemotherapy, radiotherapy;
prevention of postoperative
nausea, vomiting

Absence of nausea, vomiting during chemotherapy

Hypersensitivity reaction: rash, bronchospasm (rare)
EPS: shuffling gait, tremors, grimacing, rigidity periodically

Unlabeled uses:
Pruritus (rectal use), alcoholism,
hyperemesis gravidarum

Direct IV route: After diluting single dose in

50 ml NS or D5W, 0.45% NaCl or NS; give over
15 min

pantoprazole IVPB/IV push

Proton pump

Available forms: Inj 2 mg/ml, 32 mg/50 ml

(premixed); tabs 4, 8 mg; oral sol 4 mg/5 ml;
oral disintegrating tabs 4, 8 mg; oral
dissolving film 4, 8 mg
Erosive esophagitis: 40 mg/day 7-10 day
CNS: Headache, insomnia

Gastroesophageal reflux disease GI system: bowel sounds q8hr; abdomen for pain, swelling;

Pathologic hypersecretory conditions: 80

mg q12hr, max 240 mg/day

(Trade names: Protonix)

TEACHING
Report severe diarrhea, black/tarry
stools, abd pain
Hyperglycemia may occur in diabetics
Avoid alcohol, NSAIDs GI irritation
Notify prescriber if
pregnant/breastfeeding
Continue taking even if feeling better

inhibitor

Available form: powder for inj 40 mg/vial

GI: Diarrhea, abdominal pain, flatulence, pancreatitis

Integ: Rash
Meta: Hyperglycemia, weight gain/loss, hyponatremia, hypomagnesemia
MS: Rhabdomyolysis, myalgia
Resp: Pneumonia
Syst: Stevens-Johnson syndrome, toxic epidermal necrolysis,
anaphylaxis, angioedema

Nosocomial pneumonia: 4.5 g q6hr or 3.375

g q4hr with an aminoglycoside or
antipseudomonal fluoroquinolone 1-2 wk;
continue aminoglycoside only if Pseudomonas
aeruginosa is isolated
IV INF: 6-12 g/day given 2.25 g q8hr to 3.375
g q6hr over 30 min 7-10 days
Renal dose: CCr 20-40 ml/min, give 3.375 g
q6hr (nosocomial pneumonia); give 2.25 g
q6hr (all other indications); CCr <20 ml/min,
give 2.25 g q6hr (nosocomial pneumonia),
give 2.25 g q8hr (all other indications)

piperacillin / tazobactam IVPB

(Trade name: Zosyn)
TEACHING
Report sore throat, fever, fatigue
(superinfection)
Report CNS effects (anxiety,
depression, seizures)

IV route: Reconstitute each 40-mg vial with

10 ml 0.9% NaCl
Direct IV route: Give undiluted (4 mg/mL)
over 2 min
Intermittent IV INF route: Further dilute
with D5W, 0.9% NaCl, LR (0.4-0.8 mg/ml),
give over 15 min (<3 mg/min)

Antiinfective,
broad spectrum

CNS: Lethargy, hallucinations, anxiety, depression, twitching, insomnia,

headache, fever, dizziness, seizures, vertigo
CV: Cardiac toxicity
GI: Nausea, vomiting, diarrhea; increased AST, ALT; abdominal pain,
glossitis, pseudomembranous colitis, constipation
Separate aminoglycoside from piperacillin GU: Oliguria, proteinuria, hematuria, vaginitis, moniliasis,
to avoid inactivation
glomerulonephritis, renal failure
Product after C&S is complete
Hema: Anemia, increased bleeding time, bone marrow depression,
agranulocytosis, hemolytic anemia
Intermittent IV INF route: Reconstitute each Integ: Rash, pruritus, exfoliative dermatitis
1 g of product/5 ml 0.9% NaCl for inj or
Meta: Hypokalemia, hypernatremia
sterile water for inj, dextrose 5%; shake well; Syst: Serum sickness, anaphylaxis, Stevens-Johnson syndrome
further dilute in 50 ml compatible IV sol,
run as int inf over 30 min
Available forms:
Powder for inj 2 g pip/0.25 g taz,
3 g pip/0.375 g taz,
4 g pip/0.5 g taz,
36 g pip/4.5 g taz

Pneumococcal Vaccine IM
(Trade names: Pneumovax 23, PnuImune 23)
Regular Insulin Sub-Q (short acting)
(Trade names: Humulin R, Novolin R,
ReliOn R)
ASK FOR MED CALCULATION

synthroid PO
(Trade names: Levothroid, Levoxyl,
Synthroid, Tirosint, Unithroid)

Vaccine

Adult/child >2yr: 0.5 mL

Antidiabetic,
BASED ON SLIDING BLOOD SUGAR SCALE
pancreatic hormone - 1 hr meals

Thyroid hormone

Hypothyroidism:
Adult 50 yr: PO 1.7 mcg/kg/day, 6-8 wk,
average dose 100-200 mcg/day; max 200
mcg/day IM/IV 50-100 mcg/day as single
dose or 50% of usual oral dosage
Adult >50 yr without heart disease or <50
yr with heart disease: PO 25-50 mcg/day,
titrate q6-8wk
Adult >50 yr with heart disease: PO 12.5-25
mcg/day, titrate by 12.5-25 mcg q6-8wk

N/A

Hypoglycemia, Anaphylaxis

CNS: Anxiety, insomnia, tremors, headache, thyroid storm, excitability

CV: Tachycardia, palpitations, angina, dysrhythmias, hypertension,
cardiac arrest
GI: Nausea, diarrhea, increased or decreased appetite, cramps
Misc: Menstrual irregularities, weight loss, sweating, heat intolerance,
fever, alopecia, decreased bone mineral density

Subclinical hypothyroidism: PO 1
mcg/kg/day may be sufficient
Tylenol Suspension PO
(Trade/generic names: Acephen,
Aminofen, Apacet, APAP,Apra, Children's
Feverall, Equaline Children's Pain
Relief, Equaline Infant's Pain Relief,
Genapap, GoodSense Acetaminophen,
GoodSense Children's Pain Relief,
Infantaire, Leader Children's Pain
Reliever, Mapap, Maranox, Meda,
Neopap, Ofirmev, Oraphen-PD, Q-Pap,
Q-Pap Children's, Redutemp, Ridenol,
Silapap, Tapanol, Tempra, T-Painol,
Tylenol, UniAce, Walgreen's Non-Aspirin,

Nonopioid
analgesic,
antipyretic
Unlabeled:
Migraines

325-1000mg q4h, 1000mg q24 max

CNS: Stimulation, drowsiness

GI: Nausea, vomiting, abdominal pain; hepatotoxicity, hepatic seizure
(overdose), GI bleeding
GU: Renal failure (high, prolonged doses)
Hema: Leukopenia, neutropenia, hemolytic anemia (long-term use),
thrombocytopenia, pancytopenia
Integ: Rash, urticaria
Syst: Hypersensitivity
Toxicity: Cyanosis, anemia, neutropenia, jaundice, pancytopenia, CNS
stimulation, delirium followed by vascular collapse, seizures, coma, death

(GERD), severe erosive

esophagitis; maintenance of
long-term pathologic
hypersecretory conditions,
including Zollinger-Ellison
syndrome

anorexia
Hepatic studies: AST, ALT, alk phos during treatment
Serious skin reactions: toxic epidermal necrolysis,
Stevens-Johnson syndrome, exfoliative dermatitis: fever,
sore throat, fatigue, thin ulcers; lesions in the mouth, lips
Electrolyte imbalances: hyponatremia; hypomagnesemia
in patients using product 3 mo to 1 year; if hypomagnesemia
occurs, use of magnesium supplements may be sufficient; if
Unlabeled uses:
severe, discontinuation of product may be required
Duodenal/gastric ulcer, NSAID
Rhabdomyolysis, myalgia: muscle pain, increased CPK;
ulcer prophylaxis, Helicobacter- weakness, swelling of affected muscles
pyloriassociated ulcer,
For vit B12 deficiency in patients receiving long-term
dyspepsia
therapy

Infection: temp, stools, urine, sputum, wounds

I&O ratio; report hematuria, oliguria because penicillin in
high doses is nephrotoxic; maintain hydration unless
contraindicated
Moderate to severe infections:
Hepatic studies: AST, ALT before treatment and periodically
piperacillin-resistant, thereafter
lactamaseproducing strains
Blood studies: WBC, RBC, Hct, Hgb, bleeding time before
causing infections in respiratory, treatment and periodically thereafter; serum potassium
skin, urinary tract, bone,
Renal studies: urinalysis, protein, blood, BUN, creatinine
gonorrhea, pneumonia; effective before treatment and periodically thereafter
for resistant Staphylococcus
C&S before product therapy; product may be given as soon
aureus, resistant Escherichia
as culture is taken
coli, Bacteroides fragilis,
Pseudomembranous colitis: diarrhea, bloody stools, fever,
Bacteroides ovatus, Bacteroides abdominal cramps; may occur 2 mo after treatment; bowel
thetaiotaomicron, Bacteroides
pattern before and during treatment
vulgatus, Haemophilus
Skin eruptions after administration of penicillin to 1 wk
influenzae
after discontinuing product
Respiratory status: rate, character, wheezing, tightness in
chest
Anaphylaxis: wheezing, laryngeal edema, rash, itching;
discontinue product, have emergency equipment nearby

Pneumococcal immunization

Hypersensitivity, Hodgkin's disease, ARDS

ASSESS:
Type 1 diabetes mellituts, type 2
Blood sugar
diabetes mellitus, gestational
HOLD IF:
diabetes
Blood sugar < lowest unit on sliding scale
B/P, pulse periodically during treatment
Weight daily in same clothing, using same scale, at same
time of day
Height, growth rate of child
T3, T4, FTIs, which are decreased; radioimmunoassay of
Hypothyroidism, myxedema
TSH, which is increased; radio uptake, which is increased if
coma, thyroid hormone
patient receiving too low a dose of medication
replacement, thyrotoxicosis,
PT may require decreased anticoagulant; check for
congenital hypothyroidism,
bleeding, bruising
some types of thyroid cancer,
Increased nervousness, excitability, irritability, which may
pituitary TSH suppression
indicate too high a dose of medication, usually after 1-3 wk
of treatment
Cardiac status: angina, palpitation, chest pain, change in
VS
Mild to moderate pain or fever,
arthralgia, dental pain,
dysmenorrhea, headache,
myalgia, osteoarthritis

Hepatic studies: AST, ALT, bilirubin, creatinine before

therapy if long-term therapy is anticipated; may cause
hepatic toxicity at doses >4 g/day with chronic use
Renal studies: BUN, urine creatinine, occult blood,
albumin, if patient is on long-term therapy; presence of
blood or albumin indicates nephritis
Blood studies: CBC, PT if patient is on long-term therapy
I&O ratio; decreasing output may indicate renal failure
(long-term therapy)
For fever and pain: type of pain, location, intensity,
duration
Chronic poisoning: rapid, weak pulse; dyspnea; cold,
clammy extremities; report immediately to prescriber

XS pain reliever, Walgreen's

Acetaminophen)
Before breakfast
Daily
BID
TID
QID
Dinner
Bedtime

Hepatotoxicity: dark urine; clay-colored stools;

yellowing of skin, sclera; itching; abdominal pain; fever;
diarrhea if patient is on long-term therapy
Allergic reactions: rash, urticaria; if these occur, product
may have to be discontinued

0700
0900 (or by facility protocol)
0900 1800
0900 1200 1800
0900 1200 1800 2200
1800
2200