Name Indication Action Adverse Effect Contraindication Nursing Patient Teaching

Consideration
1. Dexamethasone -Hypercalemia Enters target cell CNS: Contraindicated Nursing Systemic
associated with and binds to -Seizures, vertigo, with infections, considerations administration
cancer specific receptor, headaches, especially Assessment -Do not stop taking
-Short term initiating many psedotumor cerebri, tuberculosis, fungal -History for the oral drug
management of complex reaction euphoria, insomnia, infections, systemic without consulting
various inflammatory that are responsible mood swings, amebiasis, vaccinia administration: health care
and allergic disorder for its anti- depression, and varicella, and Active infections; provider.
-Hematologic inflammatory and psychosis, antibiotic-resistant renal or hepatic -Avoid exposure to
disorders immunosuppressive intracerebral infections, allergy to disease; infection.
(Thrombocytopenia, effects. hemorrhage, any component of hypothyroidism, -Report unusual
pupura, reversible cerebral the preparation ulcerative colitis; weight gain,
erythroblastopenia) atrophy in infants, used. diverticulitis; active swelling of the
-Trichinosis with cataracts, IOP, or latent peptic ulcer; extremities, muscle
neurologic or glaucoma Use cautiously with inflammatory bowel weakness, black or
myocardial CV: renal or hepatic disease; CHF, tarry stools, fever,
involvement Hypertension, heart disease; hypertension, prolonged sore
-Ulcerative colitis, failure, necrotizing hypothyroidism, thromboembolic throat, colds or
acute exacerbation angiitis ulcerative colitis disorders; other infections,
of MS, and palliation Endocrine: with impending osteoporosis; worsening of this
in some leukemia Growth retardation, perforation; seizure disorders; disorder.
and lymphomas. decreasing diverticulitis; active diabetes mellitus; Intra-articular
Cerebral Edema carbohydrate or latent peptic lactation administration
associated with tolerance, diabetes ulcer; inflammatory For ophthalmic -Do not overuse
brain tumor, mellitus, cushingoid bowel disease; preparations: acute joint after therapy,
craniotomy and state decondary CHF, hypertension, superficial herpes even if pain is
head injury. adrenocortical and thromboembolic simplex keratitis, gone.
-Intra-articular or soft pituitary disorders; fungal infections of Respiratory:
tissue unresponsiveness. osteoporosis; ocular structures; inhalant, intranasal
administration; GI: seizure disorders; vaccinia, varicella, preparation
Arthritis, psoriatic Peptic and diabetes mellitus; and other viral -Do not use more
plaques esophageal ulcer, lactation. diseases of the often than
-Respiratory Inhalant pancreatitis and cornea and prescribed.
: Control of bronchial abdominal conjunctiva; ocular -Do not stop using
asthma requiring distention tuberculosis this drug without
corticosteroids in GU: -Physical for consulting health
conjunction with Amenorrhea, systemic care provider.
therapy irregular menses administration: -Use the
-Intranasal: Relief of Hematologic: Baseline body inhalational
symptoms of Fluid and electrolyte weight, temperature; bronchodilator
seasonal or disturbances, reflexes, and grip drug before using
perennial rhinitis that negative nitrogen strength, affect, and the oral inhalant
responds poorly to balance, increase orientation; P, BP, product when
other treatments. blood sugar, peripheral perfusion, using both.
-Dermatologic glycosuria, increase prominence of -Administer
preparation: Relief of serum cholesterol, superficial veins; R decongestant nose
inflammatory and decrease serum T3 and adventitious drops first if nasal
pruritic manifestation and T4 levels sounds; serum passages are
dermatoses that are Hypersensitivity: electrolytes, blood blocked.
steroid responsive Muscle weakness, glucose Topical:
-Ophthalmic steroid myopathy, For topical -Apply the drug
preparations: loss of mucle mass, dermatologic sparingly.
Inflammation of the osteoporosis, preparations: -Avoid contact with
lid, conjunctiva, spontaneous affected area for eyes.
cornea, and globe fracture infections, skin injury -Report any
irritation or
Interventions infection at the site
-For systemic of application.
administration, do Ophthalmic
not give drug to -Administer as
nursing mothers; follows: Lie down
drug is secreted in or tilt head
breast milk. backward and look
-Give daily doses at ceiling. Warm
before 9 AM to tube of ointment in
mimic normal peak hand for several
corticosteroid blood minutes. Apply
levels. one-fourth to one-
-Increase dosage half inch of
when patient is ointment, or drop
subject to stress. suspension inside
-Taper doses when lower eyelid while
discontinuing high- looking up. After
dose or long-term applying ointment,
therapy. close eyelids and
-Do not give live roll eyeball in all
virus vaccines with directions. After
immunosuppressive instilling eye drops,
doses of release lower lid,
corticosteroids. but do not blink for
-For respiratory at least 30 sec;
inhalant, intranasal apply gentle
preparation, do not pressure to the
use respiratory inside corner of the
inhalant during an eye for 1 min. Do
acute asthmatic not close eyes
attack or to manage tightly, and try not
status asthmaticus. to blink more often
-Do not use than usual; do not
intranasal product touch ointment
with untreated local tube or dropper to
nasal infections, eye, fingers, or any
epistaxis, nasal surface.
trauma, septal -Wait at least 10
ulcers, or recent min before using
nasal surgery. any other eye
-Taper systemic preparations.
steroids carefully -Eyes will become
 during transfer to more sensitive to
inhalational steroids; light (use
adrenal insufficiency sunglasses).
deaths have Report worsening
occurred. of the condition,
-For topical pain, itching,
dermatologic swelling of the eye,
preparations, use failure of the
caution when condition to
occlusive dressings, improve after 1 wk.
tight diapers cover
affected area; these
can increase
systemic absorption.
-Avoid prolonged
use near the eyes, in
genital and rectal
areas, and in skin
creases.

Name Indication Action Adverse Effect Contraindication Nursing Patient Teaching

Consideration
-Management of Exact mechanisms of CNS: Contraindicated with Assessment -Take this drug
2. Diazepam anxiety disorders or action not Transient, mild hypersensitivity to History: exactly as
for short-term relief understood; acts drowsiness initially; benzodiazepines; Hypersensitivity to prescribed. Do not
of symptoms of mainly at the limbic sedation, depression, psychoses, acute benzodiazepines; stop taking this drug
anxiety system and reticular lethargy, apathy, narrow-angle psychoses, acute (long-term therapy,
-Acute alcohol formation; may act in fatigue, light- glaucoma, shock, narrow-angle antiepileptic therapy)
withdrawal; may be spinal cord and at headedness, coma, acute glaucoma, shock, without consulting
useful in supraspinal sites to disorientation, alcoholic intoxication; coma, acute your health care
symptomatic relief of produce skeletal restlessness, pregnancy (cleft lip alcoholic intoxication; provider.
acute agitation, muscle relaxation; confusion, crying, or palate, inguinal elderly or debilitated -Caregiver should
tremor, delirium potentiates the delirium, headache, hernia, cardiac patients; impaired learn to assess
tremens, hallucinosis effects of GABA, an slurred speech, defects, liver or kidney seizures, administer
-Muscle relaxant: inhibitory dysarthria, stupor, microcephaly, pyloric function; pregnancy, rectal form, and
Adjunct for relief of neurotransmitter; rigidity, tremor, stenosis when used lactation monitor patient.
reflex skeletal anxiolytic effects dystonia, vertigo, in first trimester; Physical: Weight; -Use of barrier
muscle spasm due to occur at doses well euphoria, neonatal withdrawal skin color, lesions; contraceptives is
local pathology below those nervousness, syndrome reported in orientation, affect, advised while using
(inflammation of necessary to cause difficulty in newborns); lactation. reflexes, sensory this drug; if you
muscles or joints) or sedation, ataxia; has concentration, vivid nerve function, become or wish to
secondary to trauma; little effect on cortical dreams, Use cautiously with ophthalmologic become pregnant,
spasticity caused by function. psychomotor elderly or debilitated exam; P, BP; R, consult with your
upper motoneuron retardation, patients; impaired adventitious sounds; health care provider.
disorders (cerebral extrapyramidal liver or kidney bowel sounds, -These side effects
palsy and symptoms; mild function. normal output, liver may occur:
paraplegia); paradoxical evaluation; normal Drowsiness,
athetosis, stiff-man excitatory reactions, output; liver and dizziness (may
syndrome during first 2 wk of kidney function tests, lessen; avoid driving
-Parenteral: treatment, visual and CBC or engaging in other
Treatment of tetanus auditory dangerous activities);
-Antiepileptic: disturbances, Interventions GI upset (take drug
Adjunct in status diplopia, nystagmus, -Do not administer with food); dreams,
epilepticus and depressed hearing, intra-arterially; may difficulty
severe recurrent nasal congestion produce concentrating,
convulsive seizures CV: arteriospasm, fatigue, nervousness,
(parenteral); adjunct Bradycardia, gangrene. crying (reversible).
in convulsive tachycardia, CV -Change from IV -Report severe
disorders (oral) collapse, therapy to oral dizziness, weakness,
-Preoperative hypertension and therapy as soon as drowsiness that
(parenteral): Relief of hypotension, possible. persists, rash or skin
anxiety and tension palpitations, edema -Do not use small lesions, palpitations,
and to lessen recall Dependence: veins (dorsum of swelling of the
in patients prior to Drug dependence hand or wrist) for IV ankles, visual or
surgical procedures, with withdrawal injection. hearing
cardioversion, and syndrome when drug -Reduce dose of disturbances,
endoscopic is discontinued narcotic analgesics difficulty voiding.
procedures (common with abrupt with IV diazepam;
-Rectal: discontinuation of dose should be
Management of higher dosage used reduced by at least
selected, refractory for longer than 4 one-third or
patients with epilepsy mo); IV diazepam: eliminated.
who require 1.7% incidence of -Carefully monitor P,
intermittent use to fatalities; oral BP, respiration
control bouts of benzodiazepines during IV
increased seizure ingested alone; no administration.
activity well-documented -Maintain patients
-Unlabeled use: fatal overdoses receiving parenteral
Treatment of panic Dermatologic: benzodiazepines in
attacks Urticaria, pruritus, bed for 3 hr; do not
skin rash, dermatitis permit ambulatory
GI: patients to operate a
Constipation; vehicle following an
diarrhea, dry mouth; injection.
salivation; nausea; -Monitor EEG in
anorexia; vomiting; patients treated for
difficulty in status epilepticus;
swallowing; gastric seizures may recur
disorders; elevations after initial control,
of blood enzymes— presumably because
LDH, alkaline of short duration of
phosphatase, AST, drug effect.
ALT; hepatic -Monitor liver and
dysfunction; jaundice kidney function, CBC
GU: during long-term
Incontinence, urinary therapy.
retention, changes in -Taper dosage
 libido, menstrual gradually after long-
irregularities term therapy,
Hematologic: especially in epileptic
Decreased patients.
hematocrit, blood -Arrange for epileptic
dyscrasias patients to wear
Other: medical alert ID
Phlebitis and indicating that they
thrombosis at IV are epileptics taking
injection sites, this medication.
hiccups, fever, -Discuss risk of fetal
diaphoresis, abnormalities with
paresthesias, patients desiring to
muscular become pregnant.
disturbances,
gynecomastia; pain,
burning, and redness
after IM injection

Name Indication Action Adverse Effect Contraindication Nursing Patient Teaching

Consideration
3. Digoxin CHF Increases CNS: Headache, -Contraindicated with Assessment -Do not stop taking
Atrial fibrillation intracellular calcium weakness, allergy to digitalis History: Allergy to this drug without
and allows more drowsiness, visual preparations, digitalis preparations, notifying your health
calcium to enter the disturbances, mental ventricular ventricular care provider.
myocardial cell status change tachycardia, tachycardia, -Take pulse at the
during depolarization CV: Arrhythmias ventricular fibrillation, ventricular fibrillation, same time each day,
via a sodium– GI: GI upset, heart block, sick heart block, sick and record it on a
potassium pump anorexia sinus syndrome, sinus syndrome, calendar
mechanism; this IHSS, acute MI, renal IHSS, acute MI, renal -Weigh yourself
increases force of insufficiency and insufficiency, every other day with
contraction (positive electrolyte decreased K+, the same clothing
inotropic effect), abnormalities decreased Mg++ and at the same
increases renal (decreased K+, increased Ca++ time. Record this on
perfusion (seen as decreased Mg++, Physical: Weight; the calendar.
diuretic effect in increased Ca++). orientation, affect, -Wear or carry a
patients with CHF), -Use cautiously with reflexes, vision; P, medical alert tag
decreases heart rate pregnancy and BP, baseline ECG, stating that you are
(negative lactation. cardiac auscultation, using this drug.
chronotropic effect), peripheral pulses, -Have regular
and decreases AV peripheral perfusion, medical checkups,
node conduction edema; R, which may include
velocity. adventitious sounds; blood tests, to
abdominal evaluate the effects
percussion, bowel and dosage of this
sounds, liver drug.
evaluation; urinary -Report unusually
output; electrolyte slow pulse, irregular
levels, liver and renal pulse, rapid weight
function tests gain, loss of appetite,
nausea, vomiting,
Interventions blurred or "yellow"
-Monitor apical pulse vision, unusual
for 1 min before tiredness and
administering; hold weakness, swelling
dose if pulse < 60 in of the ankles, legs or
adult or < 90 in fingers, difficulty
infant; retake pulse in breathing.
1 hr. If adult pulse
remains < 60 or
infant < 90, hold drug
and notify prescriber.
Note any change
from baseline rhythm
or rate.
-Take care to
differentiate
Lanoxicaps from
Lanoxin; dosage is
very different
-Check dosage and
preparation carefully.
-Avoid IM injections,
which may be very
painful.
-Follow diluting
instructions carefully,
and use diluted
solution promptly.
-Avoid giving with
meals; this will delay
absorption.
-Have emergency
equipment ready;
have K+ salts,
lidocaine, phenytoin,
atropine, cardiac
monitor on standby
in case toxicity
develops.
-Monitor for
therapeutic drug
levels: 0.5–2 ng/mL.
 Name Indication Action Adverse Effect Contraindication Nursing Patient Teaching
Consideration
4. Diphenhyramine -Relief of symptoms Competitively General: -Contraindicated Assessment: -Take as
hydrochloride associated perennial blocks the effect of  Urticaria, drug rash, with allergy to History: Allergy to prescribed, avoid
and seasonal histamine at H1 – anaphylactic shock, antihistamines, third antihistamines, excessive dosage
allergic rhinitis; receptor sites, has photosensitivity, trimester of narrow angle -Take with food if GI
vasomotor whinitis; atropine like, anti- excessive pregnancy, lactation glaucoma, upset occurs
allergic pruritic and perspiration, chills, stenosing peptic Avoid alcohol,
conjunctivitis, mild sedative effect. dryness of the -Use cautiously with ulcer, symptomatic serious sedation
uncomplicated mouth, nose and narrow angle prostatic could occur
urticaria and throat. glaucoma, stenosing hypertrophy -These side effect
angioedema peptic ulcer, asthmatic attack may occur:
amelioration of Cardiovascular symptomatic bladder neck Dizziness, sedation,
allergic reaction to System:  prostatic obstruction, drowsiness (use
blood or to plasma, Hypotension, hypertrophy, pyloroduodenal caution driving or
dermatographism; headache, asthmatic attack, obstruction, third performing task
adjunctive theraphy palpitations, bladder neck trimester of requiring
in anaphylactic tachycardia, obstruction, pregnancy, lactation alertness) ;
reaction. extrasystoles. pyloroduodenal Physical: Skin color, epigastric distress,
-Active and obstruction lesions, texture, diarrhea,
prophylactic Hematologic pregnancy, elderly orientation, reflex, constipation (take
treatment of motion System:  patients who may be affect, vision drug with meals) ;
sickness Hemolytic anemia, sensitive to examination, dry mouth (use
-Nighttime sleep thrombocytopenia, anticholinergic adventitious sound, frequent mouth
aids agranulocytosis. effects. bowel sound, care, suck
-Parkinsonism protate palpation, sugarless
(including drug Nervous System:  CBC with lozenges);
induced Sedation, differentials thickening of
parkinsonism and sleepiness, Interventions: bronchial secretion,
extrapyramidal dizziness, disturbed -Administer with dryness of mucosa,
reactions), in the coordination, fatigue, food if GI upset (use a humidifier )
early intolerant of confusion, occurs -Report difficulty of
more potent drugs of restlessness, -Administer syrup breathing,
milder forms of the form if patient is hallucinations,
disorder in other excitation, unble to take tablets tremors, loss of
age group nd in nervousness, -Monitor patient coordination,
combination with tremor, irritability, response; and unusual bleeding or
centrally acting insomnia, euphoria, arrange for bruising, visual
anticholinergic paresthesia, blurred adjustment of disturbance
antiparkinsonian vision, diplopia, dosage to lowest irregular heartbeat.
drugs vertigo, tinnitus, possible effective
Syrup formulation. acute labyrinthitis, dose.
Suppresion of cough neuritis, convulsions.
due to cold and
allergy GI System: 
Epigastric distress,
anorexia, nausea,
vomiting, diarrhea,
constipation.

GU System: 
Urinary frequency,
difficult urination,
urinary retention,
early menses.

Respiratory
System: 
Thickening of
bronchial secretions,
tightness of chest
and wheezing, nasal
stuffiness.