PAIN MED.

MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction
Mild Pain  Relief of signs and  Headache  Assess pain  Administer in the  Inhibits prostaglandin  Therefore drugs that
 Tylenol  Adults: Oral 325-650 symptoms of rheumatoid  Chest pain,  Assessmusculoskeletal morning with a full glass synthesis by decreasing increase the action of
(Acetaminophen) mg every 4-6 hours. arthritis and  Hepatic toxicity and status: ROMbefore dose of water at least 60 min the activity of the liver enzymes that
NSAIDS: (maximum daily dose is osteoarthritis failure, jaundice and 1 hr. after before the first enzyme, cyclooxygenase, metabolize
4 grams)Suppository  Relief of mild to  Acute kidney failure,  Monitor liver function beverage, food, and which results in acetaminophen [for
650mg every 4-6 hours. moderate pain renal tubular necrosis studies medication of the day. decreased formation example, carbamazepine
 Children: Oral 40-650  Treatment of primary  Rash  Monitor renal function  Patient must stay up prostaglandin (Tegretol), isoniazid
mg every 4 dysmenorrhea  fever studies right for 60min after precursors. (INH, Nydrazid, and
hoursSuppository 80-  Fever reduction  Monitor bloodstudies: taking the tablet to Laniazid), rifampin
325 mg every 4-6 hours  Unlabeled uses: CBC,Hgb, Hct,proteome avoid potentially serious (Rifamate, Rifadin, and
depending on age. Prophylactic for migraine; if patient is on long- esophageal erosion Rimactane)] reduce the
abortive treatment for term therapy  Do not exceed levels of acetaminophen
 Motrin  Children (general): 10 migraine  Check I&O ratio recommended dose; do and may decrease the
(Ibuprofen) to 15 mg per kg of  Assesshepatotoxicity- not take for longer than action of
body weight, every 4 to  Assess 10 days. acetaminophen. Doses
6 hours, to a maximum forallergicreactions,  Take the drug only for of acetaminophen
of 65 mg/kg in 24 visualchanges complaints indicated; it greater than the
hours. andototoxicity is not an anti- recommended doses are
 Adults: 325 mg to 650  Identify prior drug inflammatory agent. toxic to the liver and
mg every 4 to 6 hours history may result in severe liver
to a maximum of 4,000  Identify fever:length of damage. The potential
mg in 24 hours. time inevidence for acetaminophen to
andrelatedsymptoms harm the liver is
 Toridol (Ketorolac)  10-40 mg every 4-6 increased when it is
hours combined with alcohol
or drugs that also harm
the liver.

Moderate Pain  4-6 pain  Lightheadedness  BP ____ HR ____  Dizzy >no standing  Management of  Anticholinergic:
OPIOID ANALGESICS  Analgesia for moderate  Dizziness  Postural Hypotension  N/V > call nurse moderate to severe Increased risk of ileus,
 Norco (Hydrocodone)  7.5-10mg (oral) every to severe acute pain  Drowsiness  N/V  Inform patient that pain. sever constipation and
4-6 hours  Alternative to Narcotic  Nausea  Pain ___ /10 (PQRST) hydrocodone and  Binds to opiate urine retention.
Analgesic  Vomiting acetaminophen may receptors in the CNS  Antidiarrheal: Increased
 Vicodine  Intramuscular Dose  Constipation cause dizziness and  Alters the perception of risk of CNS depression
(Hydrocodone) Regular 30-120mg drowsiness. ad response to painful and severe constipation.
Low 15-60mg  Advise patient to avoid stimuli, while producing  Barbiturate anesthetics:
 Intravenous Dose hazardous activities until generalized CNS Possibly increased
Regular 30mg drugs CN effects are depression respiratory and CNS
Low 15mg known. depression.
 Oral Dose  Advise patient to change
Maximum 40mg position slowly to
Regular 10-20mg minimize effects of
Low 10mg orthostatic hypotension
 10-80mg (oral)

 Oxycontin  2.5-10mg (oral)

(Oxycodone HCl)

 Percocet (Oxycodone)
Severe Pain  7-10 pain  Constipation  BP ____ HR ____  Avoid alcohol and other  Binds to opiate receptors  High risk of CNS
OPIOID ANALGESICS  PCA pump  Dizziness  Postural Hypotension CNS depressants while in the CNS depression with alcohol,
 Dilaudid  1mg IV Q 4-6 hours prn  Symptomatic relief of  Hypotension  N/V receiving morphine.  Alters the perception of antidepressant,
(Hydromorphone)  Peak 15-30min sever, acute and chronic  Blurred vision  Pain ___ /10 (PQRST)  Do not use OTC drug and response to painful antihistamines, and
 Onset 10-15min pain after non-narcotic  Nausea and vomiting  Morphine unless approved by stimuli while producing sedative/hypnotics
 Duration 2-3 hour analgesics have failed  Urine Retention  Allergy to Sulfa Drugs physician generalized CNS including
and preanasthetic  Do not smoke or depression benzodiazepines and

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MED Name/Class Safedose/Rout
 (Morphine)  Adult: (PO) 10-30mg q4h
(IV) 2.5-15mg q4h
(IM/SC) 5-20mg (PR) 10-
20mg
 (Fentanyl)  0.5-1mcg/kg/dose, may
repeat after 30-60min.
 (Demerol)  100 mg/ 2mL
Anti-Anxiety
>Benzodiazepines<
 Ativan (Lorazopam)  adult: PO 2–6 mg/d in
divided doses (max: 10
mg/d)
 geriatric: PO 0.5–1 mg/d
(max: 2 mg/d)
 child: PO/IV 0.05 mg/kg
q4–8h (max: 2 mg/dose)
> Barbiturates<
 Phenobarbitol  15-120 mg/day PO
divided BID/TID
Uses/Goals
medication
 Used to relieve dyspnea
of acute left ventricular
failure and pulmonary
edema and pain of MI.
 Management of anxiety
disorders and for short-
term relief of symptoms
of anxiety. Also used for
preanesthetic medication
to produce sedation and
to reduce anxiety and
recall of events related to
day of surgery; for
management of status
epilepticus.
 Sedative (oral or
parenteral)
 Hypnotic, short-term (up
to 2 wk.) treatment of
insomnia (oral or
parenteral)
 Long-term treatment of
generalized tonic-conic
and cortical focal seizures
(oral)
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PAIN MED.
SE
 Drowsiness
 Headache
 Hyper/hypotension
 Nausea and vomiting
 Vertigo
 CNS Depression
 Nausea and vomiting
 Constipation / diarrhea
RN Consider Pt Teaching Action Drug 2 Drug Interaction
ambulate without  Suppresses the cough phenothiazines.
assistance after reflex via a direct central
receiving drug. Bedside action.
rails are advised  Pain Control
 Use caution or avoid
tasks requiring alertness
(e.g. Driving a car) until
response to drug is
known since drug may
cause drowsiness,
dizziness, or blurred
vision
 Do not breast feed while
taking this drug
 Be aware that SL  Do not drive or engage  Most potent of the  Increased CNS depression
administration has more in other hazardous available with alcohol and other
rapid absorption than activities for a least 24– benzodiazepines. Effects sedating medications,
PO, and bioavailability 48 h after receiving IM (anxiolytic, sedative, such as barbiturates and
compares to IM use. injection of lorazepam. hypnotic, and skeletal opioids
 Do not administer intra-  Do not drink large- muscle relaxant) are  Decreased effectiveness
arterially; arteriospasm, volumes of coffee. mediated by the with theophylline’s
gangrene may result. Anxiolytic effects of inhibitory
 Give IM injections of lorazepam can neurotransmitter GABA.
undiluted drug deep significantly be altered Action sites: thalamic,
into muscle mass, by caffeine. hypothalamic, and limbic
monitor injection sites.  Do not consume levels of CNS.
 Do not use solutions alcoholic beverages for
that are discolored or at least 24–48 h after an
contain a precipitate. injection and avoid
Protect drug from light, when taking an oral
and refrigerate oral regimen.
solution.  Notify physician if
 Keep equipment to daytime psychomotor
maintain a patent function is impaired; a
airway on standby when change in regimen or
drug is given IV. drug may be needed.
 Terminate regimen
gradually over a period
of several days. Do not
stop long-term therapy
abruptly; withdrawal
may be induced with
feelings of panic, tonic–
clonic seizures, tremors,
abdominal and muscle
cramps, sweating,
vomiting.
 Monitor patient  This drug will make you  General CNS depressant;  Increased serum levels
responses, blood levels drowsy and less anxious; barbiturates inhibit and therapeutic and toxic
(as appropriate) if any of do not try to get up after impulse conduction in effects with valproic acid
the above interacting youhave received this the ascending RAS,  Increased CNS depression
drugs are given with drug (request assistance depress the cerebral with alcohol
phenobarbital; suggest to sit up or move cortex, alter cerebellar  Increased risk of
alternative means of around). function, depress motor nephrotoxicity with
contraception to  Take this drug exactly as output, and can produce methoxyflurane
women using hormonal prescribed; this drug is excitation, sedation,  Increased risk of
contraceptives. habit forming; its hypnosis, anesthesia, neuromuscular excitation
 Do not administer intra- effectiveness and deep coma; at sub and hypotension with
arterially; may produce infacilitating sleep hypnotic doses, has barbiturate anesthetics
arteriospasm, disappears after a short anticonvulsant activity,
thrombosis, gangrene. time. making it suitable for
 Administer IV doses  Do not take this drug long-term use as an
Page 3
 PAIN MED.
MED Name/Class Safedose/Rout Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
slowly. longer than 2 wk. (for antiepileptic.
 Administer IM doses insomnia), and do not
deep in a large muscle increase thedosage
mass (gluteus maximus, without consulting the
vastus laterals) or other prescriber.
areas where there is
little risk of
encountering a nerve
trunk or major artery.

GI : SBO, GERD, Ulcers, Gastritis

MED Name/class
PPI (proton pump inhibitor)
“Prazole”
 Protonix (pantoprazole)
 Prilosec (omeprazole)
Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
 Stress Ulcers  Headache  Assess for epigastric or  Report severe diarrhea  Blocks final step of acid  Contraindicated in
 GERD  Diarrhea abdominal pain and  If patientsdiabetic may production hypersensitivity, metabolic
 Adult 20-80mg  Gastritis  Abdominal pain occult blood in stool cause hyperglycemia  Inhibits H+/K+ ATPas in alkalosis and hypocalcaemia.
 Absence of epigastric pain  Nausea emesis or gastric aspirate  Avoid hazardous gastric parietal cell  ↑ Pantoprazole serum levels w/
 Fullness  Vomiting  Known hypersensitivity, activities as dizziness may suppressing gastric meds: diazepam, flurezepam,
 20mg PO Q12  Pain  Insomnia hypocalcaemia or if occur secretion. triazolam, clarithromycin,
 Hyperglycemia taking any meds that  Avoid salicylates,  Binds to an enzyme on phenytoin
interact with this drug. ibuprofen gastric parietal cells in the  ↓ Absorption w/meds: calcium
 ETOH- may cause GI presence of acidic gastric carbonate, vit B12, sucralfate.
irritation PH.  ↑  Blding  w/  warfarin
 Preventing the final
transportation of
hydrogen ions into the
gastric lumen.

H2 Blockers“tidine”
Anti-Acids
(Tums)  2-4 teaspoons (10-20 mL)
4 times a day taken
20min to 1 hr. after meals
and at bedtime or as
directed by the physician.
 Treatment and
prevention of heartburn,
acid indigestion, and sour
stomach.
 Relieve heartburn
 Major symptom of gastro
esophageal reflux disease
or acids indigestion.
 Treatment of ulcers
 Dizziness  Assess patient for  Blocks HCl production  Hypersensitivity, Cross-sensitivity
 Arrhythmias epigastric or abdominal  Turns down Volume of may occur; some oral liquids
 Drowsiness pain and frank or occult Stomach Acid production contain alcohol and should be
 Headache blood in the stool, avoided in patients with known
 Nausea emesis, or gastric intolerance.
aspirate.
 Nurse should know that
it may cause false-
positive results for urine
protein; test with
sulfosalicylic acid.
 Inform patient that it
may cause drowsiness or
dizziness.
 Inform patient that
increased fluid and fiber
intake may minimize
constipation.
 Advise patient to report
onset of black, tarry
stools; fever, sore throat;
diarrhea; dizziness; rash;
confusion; or
hallucinations to health
care professional
promptly.
 Upset stomach  Observe  ’10  rights’  in    Instruct patient to avoid Neutralizes Stomach Acids  Aluminum hydroxide may form
 Vomiting drug administration to caffeine, alcohol, harsh 20-30min. complexes withcertain drugs e.g.,
 Stomach pain avoid medication errors. spices, and black pepper tetracycline’s,digoxin
 Belching  Monitor and record pain because it may aggravate andvitamins, resulting in
 constipation scales to serve as the underlying decreased absorption. Thisshould

Page 4
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MED Name/Class Safedose/Rout Uses/Goals
(Suspension) resulting from excessive
acidity.
Stool Softeners
 Colace (docusate  100mg PO BID  Prevention of
sodium) constipation.
 Used as enema to soften
 Bisacodyl (Dulcolax)  5-15 mg tablets fecal impaction
 10 mg suppository  Promotes incorporation
of water into stool,
resulting in softer fecal
mass.
 May also promote
electrolyte and water
secretion.
GI : SBO, GERD, Ulcers, Gastritis
SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
baseline data and to GIcondition. be borne in mind when
determinethe  Instruct patient to concomitantadministration is
effectiveness of the drug. increase fiber and fluid considered.
 Give drug 20 min- 1 hour intake and regular 
after meal to counteract physical activity to help
the hydrochloric acid ease constipation.
production by  Instruct patient to eat
neutralizing the acidity. banana if diarrhea
 Administer with at least occurred.
8 ounces of water to
enhance absorption
 Monitor stool
consistency to prevent
diarrhea and
constipation. `
 Abdominal Pain  Assess for abdominal  Advice patients that  Promotes incorporation  Electrolyte imbalance
 Nausea distention, presence of laxatives should be used of water into stool,
 Vomiting bowel sounds, and usual only for short-term resulting in softer fecal
pattern of bowel therapy. mass, may also promote
function.  Encourage patient to use electrolyte and water
 Asses color, consistency other forms of bowel secretion into the colon.
and amount of stool regulation, such as
produced. increasing bulk in the
diet, increasing fluid
intake and increasing
mobility.
 Advice patient not to use
laxative when abdominal
pain, nausea, vomiting or
fever is present.
 Advice patient not to
take docusate within 2
hour of other laxatives.

Anti-Emetic
 Zofran (Ondansetron)  0.12 mg/kg or 32mg
single dose
 Compazine  PO: 2.5mg-10mg max
(Prochlorperazine) 40mg/day
 IM: 0.1-10mg max
40mg/day
 IV: 2.5-10mg max
40mg/day
 Rectal: 25mg bid
 IV not recommended for
children
 Treatment for nausea and  Headache  Assess for nausea,  Advice patient to notify  Blocks the effects of  May be affected by drugs
vomiting  Dizziness vomiting, abdominal health care professional serotonin at 5ht receptor altteringthe activity of liver
 Prevent symptoms of  Diarrhea distention and bowel immediately if sites located in vagal enzymes.
gastric static and  Constipation sounds prior to and involuntary movement of nerve terminals and the  May cause transient increase in
esophageal reflux.  Abdominal Pain following administration. eyes, face or limbs occur. chemoreceptor trigger serum bilirubin, AST and ALT
 Assess patient for zone in the CNS. levels.
extrapyramidal effect  Decreases incidence and
periodically severity of nausea and
 Assess patient BP vomiting.
 Canbeusedastranquilizerfornon-
psychoticanxiety,butotherdrugsma
y have more favorable side effect
profile  (e.g., benzodiazepines)

 Reglan  10mg q6-8hour  Restlessness

(metoclopramide)  Anxiety
 Depression
 Irritability
 Hyper/hypotension

Page 5
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 CARDIAC: CHF, MI, HTN, ^cholesterol
MED Name/class dose/Route/Freq MAX Daily Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction
ACE Inhibitor “PRIL”
 Prinivil, Zestril (Lisinopril)  2.5-40mg  40mg/day  Hypertension  Insomnia  H/O Angio-  Advice patient take  Stops Angiotensin 1 to  Decreased
 Management of  Vertigo Edema the med same time converting to Angiotensin antihypertensive
 Capoten (Captopril) congestive heart  Weakness  Mod-severe daily. 2 in the R.A.A.S effects if taken with
 0.3-25mg PO failure (CHF)  Cough aortic stenosis  Change position  Decrease B/P indomethacin
 Reduces the risk of  Hypotension  Systolic BP <90, slowly  Excretion of sodium and  Exacerbation of cough
death or development  Chest pain Cr>3.0 water and retention of if combined with
of CHF after  Tachycardia  K+ >5.5 potassium capsaicin
myocardial infarction  BP_____
(MI) HR_____
 Slows the progression
of left ventricular  Assess Vital Signs
dysfunction into overt before giving Rx.
heart failure  Monitor BP and
 Used to decreased the pulse frequently
progression of diabetic during initial
neuropathy dose adjustment
 Monitor weight
and assess lungs
for rales/crackles
 Assess for
peripheral
edema, jugular
venous
distention
ARB angiotensin block
 Valsartan  Treatment of  Headache  BP_____  Take drug without  Selectively blocks the  Contraindicated with
 1 tab daily; 25-  360mg/day hypertension, alone or  Dizziness HR_____ regard to means binding of angiotensin II to hypersensitivity to
100mg/d in combination with  Hypotension  Administer  Report fever chills, specific tissue receptors valsartan, pregnancy
 2-32 other  Diarrhea without regard dizziness and found in thevascular (use during second
 Candesartan  16mg once daily mg/day as antihypertensive.  URI Symptoms to meals. pregnancy. smooth muscle and  Or third trimester can
a single  Treatment of heart  Ensure that adrenal gland; this action cause injury or even
dose or failure in patients who patients is not blocks the death to fetus),
divided are intolerant of pregnant before vasoconstriction effect lactation.
into 2 angiotensin-converting beginning of the  Use cautiously with
daily enzyme (ACE_ therapy renin\u2013angiotensin hepatic or renal
doses inhibitors. system as well as the dysfunction,
release of aldosterone, hypovolemic
 Losartan  50mg OD leading to decreasedBP;
may prevent the vessel
remodeling associated
with the development of
Atherosclerosis.
Aldosterone Antagonist  Decrease BP  Headache  Check blood  Be aware that the  Block Altosterone in  Increased hyperkalemia
 Aldactone(Spironolactone)  100-200  Take Pressure Off  diarrhea, pressure before maximal diuretic R.A.A.S decrease total with potassium
mg/dayPO for  L Ventricle of heart  cramps, initiation of effect may not body fluid supplements, ACE
edema;100-  Treat high blood  drowsiness, therapy and at occur until third day  BP inhibitors, diets rich in
400mg/day PO pressure. Lowering high  rash, regular intervals of therapy and that  Mild diuretic that acts potassium.
for blood pressure helps  nausea, throughout diuresis may on the distal tubule to  Decreased diuretic
hyperaldostero prevent strokes, heart  vomiting, therapy. continue for 2–3 d inhibit sodium exchange effect with salicylates
nism; 50-100 attacks, and kidney  impotence,  Lab tests: after drug is for potassium, resulting  Decreased
mg/day PO for problems. It is also  irregular menstrual Monitor serum withdrawn. inincreased secretion of hypoprothrombinemic
hypertension used to treat swelling periods, electrolytes  Report signs of sodium andwater effect of anticoagulants
 Pediatric :3.3 (edema)  irregular hair growth (sodium and hypernatremia or conservation of
mg/kg/day PO potassium) hyperkalemia (see potassium.
100mg/day PO especially during Appendix F), most Analdosterone
BID early therapy; likely to occur in antagonist
 Inspra (Eplerenone) monitor digoxin patients with severe  Manifests a
 25-50mg/day level when used cirrhosis. slightantihypertensiveef

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 CARDIAC: CHF, MI, HTN, ^cholesterol
MED Name/Class Safedose/Rout MAX daily Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction

 for 4 weeks  concurrently.  Avoid replacing fect. Interferes with

 Assess for signs fluid losses with synthesis of
of fluid and large amounts of testosterone and
electrolyte free water mayincrease formation
imbalance, and of estradiol from
signs of digoxin estrogenthus leading to
toxicity. endocrine abnormalities
 Monitor daily
I&O and check
for edema.
Report lack of
diuretic response
or development
of edema; both
may indicate
tolerance to
drug.
 Weigh patient
under standard
conditions
before therapy
begins and daily
throughout
therapy. Weight
is a useful index
of need for
dosage
adjustment. For
patients with
ascites, physician
may want
measurements of
abdominal girth.
Loop Diuretics
 Lasix (Furosemide)  20mg/tab  Treatment of edema  orthostatic  BP_____ HR_____  s/s Hypo K+  Inhabits sodium and  Cross-sensitivity with
associated with CHF, hypertension  Weights  Posteral Syncope chloride reabsorption thiazides and
 Bumex(Bumetanide)  0.5-1mg/day  10mg/day hepatic cirrhosis, and  thrombophlebitis (trending)  advise patient at the proximal tubules, sulfonamides may occur
renal disease.  chronic aortitis  1___2 ___3 ___4 totake drug with distal tubules and
 Demadex (Torsemide)  5-20mg/day Hypertension.  vertigo ___ food toprevent GI ascending loop of
 headache  K+ ____ upsetinform patient Henley leading to
 Assess patient's of possibleneed for excretion of water
underlying potassium together with sodium,
condition. ormagnesium chloride and potassium.
 Monitor for renal, supplements Diuretic
cardiac, antihypertensive.
neurologic, GI,
pulmonary
manifestation of
hypokalemia.
 Assess fluid
volume.
Thiazide Diuretics
 Hydrochlorothiazide  5-20mg/day  80mg/day  For pain on  heartburn  BP_____ HR_____  Record intermittent  Inhibits reabsorption of  Taking insulin with
(Metolazone) integumentary  Thirst  Assess for pain: therapy on a sodium and chloride in Hydrochlorothiazide
structures, myalgia,  fever type, location and calendar, or use distal renal tubule, may cause high blood
neuralgia, headache,  dimness of vision pattern prepared dated increasing the sugar (hyperglycemia.
dysmenorrhea, gout.  Note for asthma envelopes. Take drug  Excretion of sodium,

Page 7
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MED Name/Class
Ca+ Channel Block
“PINES”
 Norvasc (Amlodipine)
Beta Block
 Zabeta (Bisoprolol)
 Coreg (Carvedilol)
 Lopressor Metroprolol
CARDIAC: CHF, MI, HTN, ^cholesterol
Safedose/Rout MAX daily Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
Arthritis, SLE, acute  asthma like symptoms  Monitor renal,LFTs  early so increased  chloride, and water by
rheumatic fever and CBC urination will not the kidney.
 Determine history disturb sleep. Drug
of peptic ulcers or may be taken with
 osteoporosis bleeding food or meals if GI
tendencies. upset occurs.
 Weigh yourself on a
regular basis, at the
same time and in the
same clothing;
 Record weight on
your calendar.
 CHR  Dizziness  Monitor patients  Take with meals if  Block Ca+ channels of cell  The body breaks down
 5mg/tab OD  Angina  headache BP, cardiac upset stomach  inhabits the movement of (metabolizes)
 hypertension  Peripheral edema rhythm, and occurs. calcium ions across the amlodipine using liver
 Flushing rush output. membranes of cardiac enzymes known as CYP
 Nausea and arterial muscle cells 3A4 enzymes. Drugs
 Abdominal discomfort  inhabits trans known as CYP 3A4
membranecalcium flow, inducers speed up the
which results in the activity of these
depression of impulse enzymes, causing the
formation in specialized body to metabolize
cardiac pacemaker cells amlodipine too quickly.
This may make
amlodipine less
effective.
 CHF  Pharyngitis  Baseline weight,  Do not stop taking  Blocks beta-adrenergic  Increased effects with
 1.25mg  10mg  Tachycardia  Dizziness skin condition, this drug unless receptors of the verapamil,
 3.125mg x 2  25 -  Management of  Vertigo neurologic instructed to do so sympathetic nervous anticholinergic
50mg x hypertension, used  Bardycardia status, P, BP, by a health care system in the heart and  Increased risk of
2 alone or with other  CHF ECG, R,kidney provider. juxtaglomerular orthostatic hypotension
 If >85kg antihypertensive  Cardiac Arrhythmias and liver function  Avoid over-the- apparatus (kidney), thus with prazosin
agents  Rush tests, blood and counter decreasing the excitability  Possible increased BP-
 12.5 – 25mg  200mg x
urine glucose medications. of the heart, decreasing lowering effects with
1
 Avoid driving or cardiac output and aspirin, bismuth
dangerous activities oxygen consumption, subsalicylate,
if dizziness, decreasing the release of  magnesium salicylate,
weakness occur. renin fromthe kidney, and sulfinpyrazone,
 These side effects lowering blood pressure. hormonal
may occur: contraceptives
Dizziness, light-  Decreased
headedness, loss of antihypertensive
appetite, effects with NSAIDs
nightmares,  Possible increased
depression, and hypoglycemic effect of
sexual impotence. insulin
 Report difficulty
breathing, night
cough, swelling of
extremities, slow
pulse,
 Confusion,
depression, rash,
fever, sore throat.
Page 8
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 CARDIAC: CHF, MI, HTN, ^cholesterol
MED Name/Class Safedose/Rout MAX daily Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction

Inotropic
Cardiac Glycosides  Heart failure-  Headache  Dig Toxic0.8-  Instruct patient not  Digoxin is a cardiac  effectiveness reduced
 Lanoxin (Digoxin)  0.125mg x 1  0.125 Supraventricular  Weakness 2.0ng/ml to stop taking drug glycoside which has by phenytoin,
mg – arrhythmias-  Drowsiness  Low K+ levels (^dig without notifying positive inotropic activity neomycin,sulphasalazin
0.25mg Emergency heart  visual disturbances toxic) physician. characterized by an e, kaolin, pectin,
x1 failure  mental status change  BP_____ HR_____  Instruct to report increase in the force of antacids and inpatients
 Arrhythmias EKG slow or irregular myocardial contraction. It receiving radiotherapy-
 GI upset, anorexia  Monitor apical pulse, rapid weight also reduces the Metoclopramide may
pulse for 1 minute gain, loss of conductivity of the heart alter the absorption of
before appetite, nausea, through the solid dosage forms of
administering. diarrhea, vomiting, atrioventricular (AV) digoxin- Blood levels
 Administer as blurred or yellow node. Digoxin also exerts increased by calcium
indicated. vision, unusual direct action on vascular channel blockers,
 Check dosage and tiredness or smooth muscle and spironolactone,
preparation weakness, swelling indirect effects mediated quinidine and calcium
carefully.- Avoid of the ankles, legs or primarily by the salts.- Electrolyte
giving with meals; fingers, difficulty autonomic nervous imbalances such as
this will delay breathing. system and an increase in hypokalemiaand
absorption  Weigh patient every vagal activity hypomagnesaemia(e.g.
other day. admin of potassium-
 Instruct to have losing diuretics,
regular medical corticosteroids) can
check-ups, which increase the risk of
may include blood cardiac toxicity
tests, to evaluate
effects of drug.
 Do proper
documentation.
Nitrates VASODILATOR  MI, /CAD  Headache  Viagra  NO Viagra (Vascular  Reduces cardiac oxygen  Viagra
 Nitro (Nitroglycerin)  0.2-0.6 mg SL q  3doses  Treatment of angina  Restlessness  BP_____ HR_____ Collapse) demand by decreasing
5 minutes in 15 pectoris  Nausea Vomiting  Monitor blood  Instruct patient to leftventricularpressure
minutes  Hypotension pressure and heart take medication and systemicvascular
 Tachycardia rate on a regular while sitting down resistance; dilates
basis and to change coronaryarteries
positionsslowly. andimproves collateral
 Instruct patient to flow to ischemic regions
allow tablets to
dissolve under
tongue, and not to
chewer swallow
sublingual tablets.
 Instruct patient to
seek emergency
help promptly if
chest pain is
unresolved after 15
minutes.
 Instruct patient not
to change brands
without
consultingprescriber
. Instruct patient to
keep tablets in
original, air-tight
container
Blood Thinners  Dizziness  Observe patients  Protect from injury ASA:  Use of heparin, ASA,
(anti-coagulants)  Headache receiving and notify Dr of  Prevent bleeding by Tylenol,

Page 9
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MED Name/Class Safedose/Rout MAX daily Uses/Goals
 81mg Q Day
 ASPRIN (anti-platelet)
 325mg CP
 Heparin (Heparin Sodium)  150=10,000
U/kg IV
 Lovenox (enoxaparin)  40mg SQ daily
 Coumadin (Warfarin)  2.5 mg/1 tab
OD
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CARDIAC: CHF, MI, HTN, ^cholesterol

SE RN Consider Pt Teaching Action Drug
 2 Drug Interaction

 Anticoagulation for  Insomnia parenteral drug pink, red, dark inactivation of  glucocorticoids,
purposes of stroke,  Constipation carefully; closely brown or cloudy thrombin formation, sulfonamides,
PE, deep venous  N/V monitor BP and urine, red or dark inhibition of formation cephalosporin’sincrea
thrombosis,  Urinary Retention vital signs. brown vomitus; red of fibrin se effects of warfarin.
prophylaxis for  Bleeding  Observe older or black stools, Phenobarbital,
venous thrombosis,  Anemia adults closely bleeding gums or Heparin: tegrtol, Dilantin, oral
acute MI  Thrombocytopenia during period of oral mucosa;  exerts direct effect on contraceptives
 Prophylaxis and Tx of brisk diuresis. ecchymosis, blood coagulation decreases
venous thrombosis Sudden hematoma, (clotting) by enhancing anticoagulation
and pulmonary alteration in fluid epistaxis, bloody the inhibitory actions effects.
embolism and to and electrolyte sputum; chest pain; of antithrombin III on
prevent balance may abdominal or several factors
thromboembolic precipitate lumbar pain or essential to normal
complications arising significant swelling; unusual blood clotting, thereby
from cardiac and adverse increase in blocking the
vascular surgery, reactions. Report menstrual flow; conversion of
frostbite, and during symptoms to pelvic pain; severe prothrombin
acute stage of MI. physician. or continuous tothrombin and
Also used in Tx of  Monitor for S&S headache, faintness, fibrinogen to fibrin.
disseminated of hypokalemia. or dizziness
intravascular  Monitor I&O  Menstruation may Coumadin:
coagulation (DIC), ratio and be somewhat  Warfarin is used to
atrial fibrillation with pattern. Report increased and treat blood clots (such
embolization, and as decrease or prolonged; as in deep vein
anticoagulant in unusual increase  Learn correct thrombosis-DVT or
blood transfusions, in output. technique for SC pulmonary embolus-
estracorporealcirculat admin if discharged PE) and/or to prevent
ion, and dialysis from hospital on new clots from forming
procedures heparin in your body.
 Prevention o  Engage in normal Preventing harmful
thrombus formation activities such as blood clots helps to
 Systemic shaving with a reduce the risk of a
anticoagulation for safety razor in the stroke or heart attack
prevention of absence of a low
ischemic or platelet count.
thrombotic events  Alcohol and
 Prevents further smoking may alter
extension of formed the response to
existing clot, heparin and are not
prevention of new advised
clot formation, and  Do not take aspirin
secondary or any other OTC
thromboembolic meds without the
complications. And Dr approval
for treatment of
hyperkalemia.
Page 10

MED Name/class ONSET/ Peak/ Duration Uses (Goals)
Insulin
Rapid  Acting  “LOG”  15min ONSET
 Apidra (Glusine)  30 - 90 min PEAK
 Aspart (Novolog)  4-6 hour DURATION
 Lispro (Humalog)
Short  Acting  “LIN”  30 – 60 min ONSET
 Humalin/Novolin R  2-4 hr. PEAK
 DURATION
Intermediate (cloudy)  1-2HR ONSET
 NPH  6-10 hr. PEAK
 DURATION
Long Act  4 Hr. ONSET
 Glargine (Lantus)  NO PEAK
 Detremir (Levemir)  18 – 24 Hr. DURATION
MED Name/class Safe dose/Route/ Freq Uses (Goals)
Anti-Diabetic
(Metformin) Glucophage  500-1000mg  improve
 Max. 2000mg/day (child)
 2500mg/day (adult)
 Extended-Release form
 Diabetes Mellitus
 Regulate sugar in your bloodstream
glycemiccontrolling
clients with type
2diabetes
used to treat type2
diabetes as initial therapy
Insulin & Diabetic
RN Consider
 Assess patient
periodically for
symptoms of
hypoglycemia (anxiety;
restlessness; mood
changes; tingling in
hands, feet, lips or
tongue; chills; cold
sweats; confusion; cool
pale skin; difficulty in
concentration;
drowsiness; excessive
hunger; headache
 Monitor body weight
 Roll NPH to mix
 Asses for symptoms of
hypoglycemia.
 Monitor body weight.
SE RN Consider
 Diarrhea  Assess for patients history
 Nausea of diabetes
 Unpleasant metallic taste.  Monitor  patients’  blood   risks/advantages of
glucose before and after
giving medications.
 Assess for
hypersensitivity to
Metformin
 Assess Patients renal
function
 Monitor sign and
symptoms of
hypoglycemic reaction.
Pt. Teaching
 Hypoglycemia
 H.A.N.D.W.A.S.H
 Headache
 Altered
 Nervousness
 Disoriented
 W
 Anxiety
 Shaky
Pt. Teaching
 Inform the patient of
potential
therapy and of alternative
modes of therapy
 Do not discontinue this
medication without
consulting your health
care provider.
 Monitor urine or blood
for glucose and ketones
as prescribed.
 Do not use this drug
during pregnancy; if you
become pregnant, consult
with your
 Health care provider for
appropriate therapy.
Action Drug 2 Drug Interaction
 Lowers blood glucose by  Lantus/Lefemir
stimulating glucose  NO MIXING!!!! With
uptake in skeletal muscle other  insulin’s
and fat and inhibiting  Beta blockers may block
hepatic glucose some of the signs and
production. symptoms of
 Insulin also inhabits hypoglycemia and delay
lipolysis and proteolysis recovery from
and enhances protein hypoglycemia
synthesis. (Lopressor)
 A rapid-acting insulin  Alcohol may decrease
with more rapid onset insulin requirements.
and shorter duration
than human regular
insulin; should be used
with intermediate or
long acting insulin.
Action Drug 2 Drug Interaction
 Decreases heptic glucose  decongestants can make
production metformin less effective,
 Decreases intestinal increasing your chance of
glucose absorption. high blood sugar
 Increases sensitivity to (hyperglycemia)
insulin.

Page 11
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MED Name/class Safe dose/Route/ Freq
Bronchodilators
Beta 2 Agonist  PO (Adults and Children
more than 12 years): 2-
 Proventil (Albuterol) 4 mg 3-4 times a day or
4-8 mgof extended
dose tablets twice a
day.
Methylaxthine   Bronchospasm of COPD
 Theophylline  1.4 mg poq12h
 Maintenance 3mg/kg q
(Elixophyllin)
8hr.
Anti - Cholinergic
 Ipratropium Inhaler  2 inhalations (36 mcg)
qid.
(Atrovent,Apovent,Aerov
ent)
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RESPIRATORY: COPD (Asthma, Emphysema, Chronic Bronchitis) Restrictive Airway Disease
Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction
 To control and prevent  Restlessness  Relief and prevention of  Do not exceed  in low doses, acts  Increased
reversible airway  cardiac arrhythmias bronchospasm in recommended dosage; relatively selectively at sympathomimetic
obstruction caused by  palpitation patients with reversible adverse effects or loss beta2-adrenergic effects with other
asthma or chronic  sweating obstructive of effectiveness may receptors to cause sympathomimetic drugs
obstructive pulmonary  nausea & vomiting  airway disease  Result. Read the  bronchodilator and  Increased risk of
disorder (COPD)  Inhalation: Treatment instructions that come vasodilation; at higher toxicity, especially
 Quick relief for of acute attacks of with respiratory doses, beta2 selectivity cardiac, when used with
bronchospasm bronchospasm inhalant. is lost, and the drug theophylline,
 For the prevention of  Prevention of exercise-  These side effects may  Acts at beta2 receptors  aminophylline,
exercise-induced induced bronchospasm occur: Dizziness, to cause typical oxtriphylline
bronchospasm4. Long-  Unlabeled use: Adjunct drowsiness, fatigue, sympathomimetic  Decreased
term control agent for in treating serious headache (use cardiac effects. bronchodilating effects
patients with chronic or hyperkalemia in dialysis  caution if driving or with beta-adrenergic
persistent patients; performing tasks that blockers (eg,
bronchospasm  seems to lower require alertness); propranolol)
potassium nausea, vomiting,  Decreased effectiveness
concentrations when  change in taste (eat of insulin, oral
inhaled by patients on small, frequent meals); hypoglycemic drugs
 hemodialysis rapid heart rate,  Decreased serum levels
anxiety, sweating, and therapeutic effects
 Flushing, insomnia. of digoxin
 Report chest pain,
dizziness, insomnia,
weakness, tremors or
irregular heartbeat,
 difficulty breathing,
productive cough,
failure to respond to
usual dosage
 Nausea Vomiting  Monitor theophylline  Take this drug exactly  Relaxes bronchial  Drinking alcohol can
 Bronchial asthma  Palpitation blood levels as prescribed smooth muscle, causing increase the level of
 Chronic bronchitis  Hyperglycemia  Monitor I&O  Avoid excessive intake bronchodilator and theophylline in your
 Anxiety  Assess for signs of of coffee, tea, cocoa, increasing vital capacity blood, which can cause
 Insomnia toxicity: irritability, cola, and chocolates.  that has been impaired dangerous side effects.
insomnia, restlessness,  Have frequent blood by bronchospasm and It is best to avoid
tremors test to monitor drug air trapping; actions alcohol while taking
 Monitor respiratory effects and ensure safe may be mediated by theophylline.
rate, rhythm and dept. and effective dosage.  inhibition of
 Assess for allergic phosphodiesterase,
reaction. which increases the
concentration of cyclic
adenosine
 monophosphate; in
concentrations that may
be higher than those
reached clinically, it also
 Inhibits the release of
slow-reacting substance
of anaphylaxis and
histamine.
 Bronchodilator for  Nausea  Asses History of  Use as an inhalation  STOPS(inhibits)
maintenance treatment  GI distress hypersensitivity to product secretion from serous
of bronchospasm  Dry mouth atropine  Side effect may occur and seromucous glands
associated with COPD  Dyspnea  Asses skin color lesion  Report rash, eye pain, lining the nasal mucosa.

(solution, aerosol),  bronchitis texture difficulty voiding, Anticholinergic,
chronic bronchitis, and  Back pain  BP, P, R adventitious palpitation, vision chemically related to
emphysema  Chest pain. sounds changes atropine, which blocks
 Nasal spray:  Bowel sounds vagally mediated
Symptomatic relief of reflexes
rhinorrhea associated  By antagonizing the
with perennial rhinitis, action of acetylcholine.
Page 12
 RESPIRATORY: COPD (Asthma, Emphysema, Chronic Bronchitis) Restrictive Airway Disease
 Causes bronchodilator

MED Name/Class Safedose/Rout  Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction

 common cold
Anti-Inflam Agents  Replacement therapy in  ^Blood sugar & Infection  Assess physical weight,  Do not immediately  Inhabitations of  Increased therapeutic
adrenal cortical  ^ Edema (retain Na+) T, reflexes and grip stop taking the leukocyte infiltration at and toxic effects with
Corticosteroids  10mg/5ml OD on full insufficiency  Wt gain strength, affect and corticosteroid, need to the site of inflammation troleandomycin,
 Prednisone stomach  Hyperkalemia associated  bloating orientation, P, BP, be tapered OFF,  Interference in the ketoconazole
(Deltasone/Flovent) with cancer  moon face peripheral perfusion, ADRENAL crisis may faction of mediators of  Increased therapeutic
 Short-term management prominence of occur inflammatory response, and toxic effects of
of various inflammatory superficial veins, R,  Avoid exposure to and suppression of estrogens, including
and allergic disorders, Adventitious sounds, infections. humeral immune hormonal
such as serum electrolytes,  Report unusual weight responses.  contraceptives
 rheumatoid arthritis, blood glucose. gain, swelling of the  Risk of severe
collagen diseases (e.g., extremities, muscle deterioration of muscle
SLE), dermatologic weakness, black or tarry strength in myasthenia
diseases (e.g., stools, fever, prolonged gravis patients who
pemphigus), status sore throat, colds or  also are receiving
asthmatics, and other infections, ambenonium,
autoimmune disorders worsening of the edrophonium,
 Hematologic disorders: disorder for which the neostigmine,
thrombocytopenia drug is being taken pyridostigmine
purpura,  Decreased steroid blood
erythroblastopenia levels with barbiturates,
 Ulcerative colitis, acute phenytoin, rifampin
exacerbations of  Decreased effectiveness
multiple sclerosis and of salicylates
palliation in some
leukemia’s  and  
lymphomas
 Trichinosis with
neurologic or myocardial
involvement

Mast Cell Stabilizer Inhalers or Nasal spray  involvement H/A Ensure proper use of Educate Prevents allergy and
 CromolynSodium Treats asthma, COPD, Hay Trouble Swollowing inhailer MEDS WORK SLOWLY inflammation Reaction from
Fever or Chronic Skin itchy (exhale completely before 2-6 weeks to become releasing histamines that
(Intal
inflammation of the major Muscle pain inhailing drug with admin of effective cause allergic inflammation
Rynacrom) pathways of the respiratory inhailor)
tract  (bronchioles/’   DO NOT USE for immediate
bronchi) Respiratory assessment allergy relief or acute
Lung Sounds asthma attack

SE: Runny Nose, Throat

irritation, HA
CALL DR. if white sores in
throat OR swelling tough

Leukotrine Rec. Antagonist
 zafirlukast (Astra,  ADULTS AND CHILDREN
> 12 YR
Accolate)
 20 mg PO bid on an
 (Singulair) empty stomach.
 PEDIATRIC PATIENTS
5\u201311 YR
 10 mg PO bid on an
empty stomach
 Leukotriene modifiers  Headache  Ensure that drug is taken  Take this drug on an  Selectively and  Increased risk of
reduce inflammation in  Dizziness continually for optimal empty stomach, 1 hr. competitively blocks bleeding with warfarin
the lung tissue  Nausea effect. before or 2 hr. after receptor for leukotriene  Potentially for increased
treatment of bronchial  diarrhea  Do not administer for meals. D4 and E4, components effects and toxicity of
asthma  abdominal pain acute asthma attack or  Take this drug regularly of SRS-A, thus blocking calcium channel-
 Vomiting acute bronchospasm. as prescribed; do not airway edema, smooth blockers, cyclosporine.
stop taking it during muscle constriction, and  Decreased effective with
symptom-free periods; cellular activity erythromycin,
do not stop taking it associated with theophylline.
without consulting your inflammatory process
health care provider. that contribute to signs
 Do not take this drug for and symptoms of
acute asthma attack or asthma.

Page 13
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MED Name/Class Safedose/Rout
Anti-Allergic  150 to 375 mg is
 Xolair (Omalizumab) administered SC every 2
or 4 weeks
MED Name/class Safe dose/Route/ Freq
Blood 1-2 units over 2-4 hours
(faster admin will neg. affect
kidneys)
Fe+ (iron)  PO:
 ADULTS, ELDERLY: 2-3
mg/kg/day or 50-100mg
elemental iron 2 time/day
up to 100mg 4time/day.
CHILDREN: 3 mg/kg/day
elemental iron in 1-3
divided doses
Blood Thinners
(anti-coagulants)
ASA  81mg Q Day
 325mg CP
Heparin (Heparin Sodium)  SQ 5,000 – 10,000 UNITS
 Adults: Initially, 5,000
units by I.V. bolus; then
20,000 to 40,000
units/day by I.V. infusion
with pump. Titrate hourly
rate based on PTT results
(every 4 to 6 hours in the
early stages of
treatment).
 Children: Initially, 50
units/kg I.V.; then 25
units/kg/hour or 20,000
units/m
 2 daily by I.V. infusion
pump.
Lovenox (Enoxaparin)  40 mg once daily SQ
RESPIRATORY: COPD (Asthma, Emphysema, Chronic Bronchitis) Restrictive Airway Disease
Uses/Goals
 moderate to sever
persistent asthma who
have a positive skin test
otinvitro reactivity to a
perennial aeroallergen
and whose symptoms
are inadequately
controlled with inhaled
corticosteroids.
Uses (Goals)
Anemia
Blood loss S/P Sx
 prevention or treatment
of iron deficiency anemia
due to inadequate diet,
malabsorption pregnancy,
and blood loss
 Clot Prevention, ^CMS
 Boost Circulation
 prophylaxis and Tx of
venous thrombosis and
pulmonary embolism and
to prevent
thromboembolic
complications arising
from cardiac and vascular
surgery, frostbite, and
during acute stage of MI.
Also used in Tx of
disseminated
intravascular coagulation
(DIC), atrial fibrillation
with embolization, and as
anticoagulant in blood
transfusions,
estracorporealcirculation,
and dialysis procedures
 Prevention of
DVT/Pulmonary
Embolism
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SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
 acute bronchospasm;
 Wheezing  Assess lung sounds and  Take daily  Inhibits binding of IgE  CI in hypersensitivity
 tightness in your cheat RR, assess for allergic  Use flow meter to every toreceptors on mast and acute
 skin rash reactions within 2 hr of AM to track lung cells andeosinophils, bronchospasm
 feeling anxious first injection, monitor copasity from day to day preventing of mediators
 Swelling face, lips, for injection site of theallergic response.
tongue reactions.Solution is Alsodecreases amount
viscous and maytake 5- of IgEreceptors on
10 sec. to administer basophils.
POST OP (Blood & Bones)
SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction
Allergic Rx H/H _____ RBC____ Benadryl O (Universal Donor) A-A
Lysed cells BP____ HR____ TEMP____ Cortisone AB (universal Reciever) B-B
Death VS before Back pain, Diff breathing, Rh + (receives everyone +/- O – O & GIVE TO ALL,
VS 15 min into Rapid HR s/s RX Rh – (ONLY receives Neg.) AB-Recieves ALL
VS Q 30 min
VS After
 Mild, transient nausea  Assess for clinical  Expect stools to darken in  essential component in  Doxycycline,
 Heartburn improvement, record of color. the formation of mycophenolate,
 Anorexia relief of symptoms  If gastrointestinal hemoglobin, myoglobin penicillamine, or thyroid
 Constipation (fatigue, irritability, discomfort occurs, take andenzymes. It is hormones
 Diarrhea pallor, paresthesia, and after meals or with food. necessary for effective (eg,levothyroxine)
headache).  Do not take within 2 erythropoiesis and
hours of antacids because transport or utilization of
it prevents absorption oxygen
 Easy Bruising  Check: - Black Stool (call PMD)  exerts direct effect on  Antihistamines
 Increased r/f bleeding  H/H: ___ - Easy Bruising & Bleeding blood coagulation  Digoxin
 Fever  Plt, ___ - Brush teeth slowly to (clotting) by enhancing  Tetracycline
 Rhinitis  INR ___ prevent bleeding gums the inhibitory actions of
 Hyperkalemia  (2.0-3.0 Therp. Warforin) - NO shaving with Razors antithrombin III on
 Irritation  PTT: ___ - Safety! several factors essential
 Mild Pain  NO Give: GI Bleed, Ulcers to normal blood clotting,
 APTT thereby blocking the
conversion of
prothrombintothrombin
and fibrinogen to fibrin
Page 14
 POST OP (Blood & Bones)

MED Name/Class Safedose/Rout Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction

Coumadin (Warfarin)  2.5-10mg per day for 2-4  Management of

days then adjust daily Myocardial infarction:
dose by results of decreases risk of death,
prothrombin time or INR decreases risk of
subsequent MI

Page 15
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 POST OP (Blood & Bones)
ANTI-INFECTIVES
`MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction
Penicillin
 Amoxil (Amoxicillin)  Adult: 250-500mg every  Infections of the resp.  Dizziness  Obtain  pt.’shas  of    Teach patient to  Prevents bacterial cell wall  Allopurinol: increased
8hours tract,  Nausea and vomiting allergy. report adverse synthesis during replication risk of rash
 Children: 20-  skin and skin  Diarrhea  Assess pt. for any s/s reactions. chlothromycins, sulfon-
40/mg/kg/day divided structures,  Abdominal pain of infection  Notify prescriber if amides
dosage given every 8  Para nasal sinuses,  Asses  for  pt.’s   infection worsens or  tetracycline’s:  Reduced  
hours  genitourinary tract, sensitivity to doesn’t  improve  after   bactericidal effect of
 otitis media, penicillin or other 72 hours amoxicillin
 Polycillin (Ampicillin)  20-500mg  sinusitis cephalosporin’s  Methotrexate:
 Meningitis.  Assess for allergic Increased risk of
 Geocillin (Carbenicillin  382 to 764 mg  UTI reaction during methotrexate
Indanyl Sodium) therapy.

NO
Assess for bowel
 Zosyn pattern
(Piperacillin/Tazobactam)  3.375-4.5g every 6 hours
AMINOGLYCO
 Bicillin (Penicillin G IV TUBING
Sodium)  1-4mL

 Bactocil (Oxacillin
Sodium)

Cephalosporin’s  Staphylococcus  Loss of appetite  Be alert of adverse  Tell patient to take  Bind to bacterial cell wall
st
>1 Gen< Infections  Mild diarrhea reactions and drug entireamount of drug membrane,causing cell death.
 Ancef (cefazolin)  IV/IM 0.5-1 g 6-12 hrly. -Lower Lungs  Nausea interaction. exactly asprescribed,
Max: 6 g/day, up to 12 - Bones Infections  Stomach cramps  This drug should be even after he ** ALLERGY: PENICILLIN*
g/day in severe - Blood Infections  Vomiting used extremely feelsbetter.
 Respiratory tract carefully because of  Advise patient to
infections.
infections its potent notify prescriber if NO PENECILLIN
 Keflex (Cefalexin)  500mg 1cap q6hrs
 Duricef, Ultracef  1 g/day P.O. or 500 mg  Skin and skin structure vasoconstrictor rash develops or signs IV TUBING
(cefadroxil) P.O. q 12 hours infections action. IV use may and symptoms of
nd
>2 Gen<  Bone and joints induce sudden super infection
infections hypertension and appear.
Mandol(Cefamandole)
cerebrovascular  Inform patient not to
Cefzil(Cefprozil)  250 to 500 mg, every 8 accidents. As a last crush, cut,or chew
hours, PO resort, give IV slowly extended-
Zinacef, Ceftin (Cefuroxime)  125-500mg over several minutes releasetablets.
rd
>3 Gen< and monitor blood
 Cefizox (Ceftizoxime)  IM/IV 1-2g max of 3-4g pressure closely.
 Rocephin (Ceftriaxone)  1-2 g IV/IM qDay or
divided BID for 4-14
days depending on
type and severity of
infection
 Claforan (cefotaxime)  1 to 2 g IV/IM q8hr
Tetracycline’s  Acne  Dizziness  Assess patient for  Sun screen d/t making  Inhibits bacterial protein synthesis
 Doryx (Doxycycline)  200mg once daily PO  H. Pylori  Vestibular reaction infection (vital signs, skin sensitive to at the level of the 30s bacterial No DAIRY
 Gonorrhea  Diarrhea appearance of sunlight ribosome. NO IRON
 Achromycin  Adult: 500mg PO bid  Certain types of  Nausea and vomiting wound, sputum,  Yellow Teeth NO Anti-acids
(Tetracycline)  Child: 25-50mg/kg PO pneumonia  Photosensitivity urine, and stool;  NO dairy
qid  Lyme disease WBC) at beginning of  NO Iron
 PO: Onset-Rapid, Peak and throughout  NO antiacids
2-3hours; Duration 6-12 therapy  Not with food
hours

 Terramycin  10-50mg/kg
(Oxytetracline)
`MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction
Macrolides  URI  Nausea  Assess skin color,  Take the full course  Azithromycinblockstranspeptidation  Coumadin
 Zithromax (Azithromycin)  500mg/daily for 3 days.  GU  Vomiting  GI output prescribed. by binding to50s ribosomal subunit  Theophylline
 Mild moderate nausea,  abdominal pain  Bowel sounds  Do not take with of susceptible organismsand  Prednisone

Page 16
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MED Name/Class
 Biaxin (Clarithromycin)
 (E-Mycin) Erythromycin
Aminoglycosides
 Garamycin (Gentamicin)
 Kantrex (kanamycin)
 Mycifradin (Neomycin)
Fluroquinolones
 Cipro (ciprofloxacin)
 Levaquin (lomefloxacin)
 (Floxin)
Safedose/Rout
 500mg 1tac Bid PO
 250mg every 8 hours PO
 Adult: IV/IM 1.5–2
mg/kg loading dose
followed by 3–5
mg/kg/d in 2–3 divided
doses Intrathecal 4–8
mg preservative free
q.d. Topical 1–2 drops of
solution in eye q4h up to
2 drops q1h or small
amount of ointment
b.i.d. or t.i.d.
 Child: IV/IM 6–7.5
mg/kg/d in 3–4 divided
doses Intrathecal >3 mo,
1–2 mg preservative free
q.d.
 Neonate: IV/IM 2.5
mg/kg q12–24h
 500mg BID Per Orem
 250-750mg Q 24 hr.
 Oral Adults 600-1800
mg/day in 2-4 equal
doses. Childn>1 mth 8-25
mg/kg/day in 3-4 equal
doses
 IM/IV
AdultSeriousinfections
2400-2700 mg in 2-4
equal doses. Less
complicated infections
1200-1800 mg/day in 3-4
equal doses.
Childn>1mth 20-40
mg/kg in 3-4 equal doses.
Neonates <1 mth 15-20
mg/kg in 3-4 equal doses.
SimpleNursing.com 82% or higher on your next nursing Test Guaranteed
POST OP (Blood & Bones)
Uses/Goals SE RN Consider Pt Teaching Action Drug 2 Drug Interaction
vomiting, abdominal  dyspepsia  antacids. disrupting RNA-dependent protein  Dopamine
pain, dyspepsia,  Diahhrea  May exp. side effects synthesis at the chain elongation  Contraindicated with
flatulence, diarrhea,  Report severe or watery step hypersensitivity to
cramping; angioedema, diarrhea, azithromycin,
cholestasis jaundice; nausea/vomiting0 erythromycin, or any
dizziness, headache, macrolide antibiotic
vertigo, somnolence;
transient elevations of
liver enzyme values
 Parenteral use  NEPHRO TOXICITY  Perform C&S and Weekly Blood Draws  Broad-spectrum aminoglycoside  History of
restricted to treatment  Tennatus (ringing in RENAL function (BUN/ To check antibiotic derived from hypersensitivity to or
of serious infections of ears) Creat) prior to first Peak & trough levels Micromonospora purpose. Action toxic reaction with any
GI, respiratory, and  Skeletal muscle dose and periodically (TOXICITY LEVELS is usually bactericidal. aminoglycoside
urinary tracts, CNS, weakness during therapy; &Theraputic range) antibiotic. Safe use
bone, skin, and soft  Apnea therapy may begin during pregnancy
tissue (including burns)  Nausea pending test results. Report: (category C) or
when other less toxic  Vomiting Determine creatinine - Tennatus (ringing in ears) lactation is not
antimicrobial agents clearance and serum may indicate Kidney established
are ineffective or are drug concentrations at toxicity
contraindicated. Has frequent intervals,
NO
been used in particularly for patients
combination with with impaired renal PENECILLIN
other antibiotics. Also
used topically for
function, infants (renal
immaturity), older
IV TUBING
primary and secondary adults, and patients
skin infections and for receiving high doses or
superficial infections of therapy beyond 10 d,
external eye and its patients with fever or
adnexa. extensive burns,
edema, obesity.
 Resp:  Diarrhea  Assess for level of pain  Exercise caution with  Inhibition of topoisomerase(DNA  Do not take with
 GU  Difficulty sleeping relief and administer potentially hazardous gyrase) enzymes, which inhibits Cisapride, droperidol,
 Bone  headache prn dose as needed activities until response relaxation of super coiled DNA and some medicines for
 Skin  nausea, vomiting but not to exceed the to drug is known. promotes breakage of double irregular heart rhythm.
 Infections  stomach upset, gas recommended total  Understand potential stranded DNA NOT WITH FOOD
 unusual taste daily dose. adverse effects and NO MILK
 vaginal irritation  Monitor vital signs and report problems with NO IRON
assess for orthostatic bowel and bladder 
hypotension or signs of function, CNS
CNS depression. impairment, and any
 Discontinue drug and other bothersome
notify physician if S&S adverse effects to
of hypersensitivity physician.
occur.  Do not breast feed
 Assess bowel and while taking this drug.
bladder function;
report urinary NOT WITH FOOD
frequency or retention. NO MILK
 Use seizure NO IRON
precautions for
patients who have a
history of seizures or
who are concurrently
using drugs that lower
the seizure threshold.
 Monitor ambulation
and take appropriate
safety precautions.
Page 17
 POST OP (Blood & Bones)

`MED Name/class Safe dose/Route/ Freq Uses (Goals) SE RN Consider Pt. Teaching Action Drug 2 Drug Interaction
Sulfanamides  Tab 2 tab Forer tab. 1  Resp tract,  Fatigue  Assess for infection  Instruct patient to  Interferes with bacterial growth by  Oral Anticoag./
 Bactrim, Septra tab infant & children TM  renal GIT,  Nausea (vital signs; notify health care inhibiting bacterial folic acid Diuretics
(Trimethoprim- 6 mg &SMZ 30 mg/kg  GUT.  Vomiting appearance of professional if rash, or synthesisthrough competitive  no work
Sulfamethoxazole) body wt daily. To be  Osteomyelitis,  diarrhea wound, sputum, fever and diarrhea antagonism of PABA.  K+ Supplements
given in bid. Gonorrhea pneumocystis carinii  Crystalluria urine, and stool;WBC) develop, especially if  Anta-Acids & Ca+ Block
5 tab bid or 2 ½ forte pneumonia,  Toxic epidermal at beginning and diarrhea contains
tab bid for 1 day.  toxoplasmosis, during therapy. blood, mucus, or pus.
actinomycetoma,  Obtain specimens for Advise patient not to
 acute brucellosis, culture and sensitivity treat diarrhea without
 nocardiosis before initiating consulting health care
therapy. professional.
 Inspect IV site  Caution patient to use
frequently. Phlebitis sunscreen and
is common. protective clothing to
 Monitor CBC and prevent
urinalysis periodically photosensitivity
during therapy reactions.
The Others:
 Vancocin (vancomycin)  2 g/day IV divided q6-  Treat a severe  Chills  Assess patient for  Instructed patient on  Treatment of potentially life-  Ototoxic and
12hr; may increase based intestinal condition  Drug fever infection range of Vancomycin threatening infections when less nephrotoxic drugs
on body weight or to known as Clostridium  Rash  Vital signs toxicity (toxicity is toxic anti-infective are (aspirin,
achieve higher trough difficile-associated  Eosinophilia  appearance of wound, reported at levels contraindicated. Particularly useful aminoglycosides,
values, increase toxicity >4 diarrhea.  Reversible neutropenia sputum, urine, and sustained above 80 to in staphylococcal infections, cyclosporine cisplatin,
g/day  Treats only bacterial stool 100 mcg/ml). Patient including:endocarditis, meningitis, loop diuretics): no
 Flagyl(Metronidazole) infections of the  WBC verbalized osteomyelitis, and pneumonia depolarizing
 Capsules: 375 mg intestines.  Beginning of and understanding of septicemia, soft-tissue infections in neuromuscular
 Injection: 5mg/mLOral throughout therapy. instructions given. patients who have allergies to blocking agents:
 suspension:200mg/5ml  Allergy to medication  Instructed patient on penicillin or its derivatives or when general anesthetics.
 Tablets:200mg, 250mg, monitor I/O Vancomycin adverse sensitivity testing demonstrates
400mg, 500mg effects such as: resistance to methicillin.
 Zyvox (Linezolid)  Topical gel: 0.75 %, 1% erythroderrma,
thrombocytopenia,
 600mg every 12 hour for neutropenia,
 Clindamycin(Cleocin) 14-28 days ototoxicity, and
nephrotoxicity. Patient
 Oral verbalized
 150-300mg q6hr. understanding of
instructions given.
 IV VANCOMYCIN>>>>>>>
 600mg/day in 2-4equal  RED MANS
doses SYNDROME:
 up to 4.8g/day UV ir IM (NOT A ALLERGY
RX)infusing too rapidly
may cause REDDING of
skin, NOT a adverse
RX, only a Side Effect

hypotensive symptoms.
Patient verbalized
understanding of
instructions given.

Page 18
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