DRUG ACTION
CONTRAINDICATIONS
Acetycysteine Decreases viscosity of
secretions, promoting
secretion removal through
coughing, postural drainage,
and mechanical means.
CLASS:
Mucolytic
INDICATIONS AND ADVERSE REACTIONS INTERACTIONS PATIENT MONITORING AND
TEACHING
Indications: CNS: dizziness, drowsiness, Drug-drug.  Monitor respirations,
 Mucolytic agent in headache Activated charcoal: cough, and character of
adjunctive treatment increased absorption secretions.
of acute and chronic CV: hypotension, and decreased  Instruct patient to report
broncho-pulmonary hypertension, tachycardia
 efficacy of worsening cough and other
disease acetylcysteine respiratory symptoms.
 Diagnostic bronchial EENT: severe rhinorrhea
  Advise patient to mix oral
studies Nitroglycerin: form with juice or cola to
GI: nausea, vomiting,
 Acetaminophen increased mask bad taste and odor.
stomatitis, constipation, nitroglycerin effects,
overdose
anorexia
 causing hypotension
Contraindications: and headache

Hepatic: hepatotoxicity

 Hypersensitivity to Respiratory: hemoptysis,
Drug-diagnostic
drug tests.
tracheal and bronchial
 Status asthmaticus irritation, increased secre-
Liver function tests:
tions, wheezing, chest
abnormal results
tightness, bronchospasm

Skin: urticaria, rash,
clamminess, angioedema

Other: tooth damage, chills,
fever, hypersensitivity
including anaphylaxis
DRUG ACTION
Chlorthalidone Unclear. Enhances excretion
of sodium, chloride, and
water by interfering with
transport of sodium ions
across renal tubular
epithelium. Also may dilate
CLASS: arterioles.
Diuretic
INDICATIONS AND
CONTRAINDICATIONS
Indications:
 Edema associated with
heart failure, renal
dysfunction, cirrhosis,
corticosteroid therapy,
and estrogen therapy
 Management of mild
to moderate
hypertension
 changes, chest pain,
Contraindications:
 Hypersensitivity to
drug 
 cramping, anorexia,
 Renal decompensation
ADVERSE REACTIONS
CNS: dizziness, vertigo,
drowsiness, lethargy,
confusion, headache, insomnia,
nervousness, paresthesia,
asterixis, nystagmus,
encephalopathy
  Monitor CBC with white
CV: hypotension, ECG
arrhythmias,
thrombophlebitis
GI: nausea, vomiting,
pancreatitis
 barbiturates, nitrates,
GU: polyuria, nocturia, erectile
dysfunction, loss of libido

Hematologic: blood
dyscrasias
Metabolic: gout attack,
dehydration, hyperglycemia,
hypokalemia, hypo- calcemia,
hypomagnesemia,
hyponatremia,
hypophosphatemia,
hyperuricemia, hyperlipidemia,
hypochloremic alkalosis
Musculoskeletal: muscle
cramps, muscle spasms
 tests.
Skin: flushing,
photosensitivity, hives, rash,
exfoliative dermatitis, toxic
INTERACTIONS PATIENT MONITORING AND
TEACHING
Drug-drug.  Closely monitor patient
Allopurinol: with renal insufficiency.

increased risk of  Assess for signs and
hypersensitivity symptoms of hematologic
reaction disorders.
Amphotericin B, cell differential and serum
corticosteroids, uric acid and electrolyte
mezocillin, levels.

piperacillin,  Assess for signs and
ticarcillin: additive symptoms of
hypokalemia
 hypersensitivity reactions,
especially dermatitis.
Antihypertensives,  Watch for fluid and
electrolyte imbalances.
opiates: increased  Instruct patient to consume
hypotension a low sodium diet
containing plenty of
Cholestyramine,
potassium-rich foods and
colestipol: decreased
beverages (such as
chlorthalidone blood
bananas, green leafy
level

vegetables, and citrus
juice).

Digoxin: increased
 Caution patient to avoid
risk of hypokalemia
driving and other
Lithium: increased hazardous activities until
risk of lithium he knows whether drug
toxicity
 makes him dizzy or affects
concentration and
NSAIDs: decreased alertness.
diuretic effect  Tell patient with diabetes
to check urine or blood
Drug-diagnostic glucose level frequently.
Bilirubin, calcium,
creatinine, uric acid:
epidermal necrolysis
 increased levels


Other: fever, weight loss, Glucose (in diabetic

hypersensitivity reactions patients): increased
blood and urine
levels


Magnesium,
potassium, protein-
bound iodine,
sodium, urine
calcium: decreased
levels


Drug-herbs. Ginkgo:
decreased
antihypertensive
effects


Licorice, stimulant
laxative herbs (aloe,
cascara sagrada,
senna): increased risk
of potassium
depletion

Drug-behaviors.
Acute alcohol
ingestion: additive
hypotension


Sun exposure:
increased risk of
photosensitivity
DRUG ACTION
Clonidine Stimulates alpha-adrenergic
receptors in CNS,
decreasing sympathetic out-
flow, inhibiting
vasoconstriction, and
ultimately reducing blood
CLASS: pressure. Also prevents
Anti- transmission of pain
hypertensive impulses by inhibiting pain
pathway signals in brain.
INDICATIONS AND ADVERSE REACTIONS INTERACTIONS PATIENT MONITORING AND
CONTRAINDICATIONS TEACHING
Indications: CNS: drowsiness, depression, Drug-drug.  Monitor patient for signs
 Mild to moderate dizziness, nervousness, and symptoms of adverse
hypertension nightmares
 Amphetamines,beta- cardiovascular reactions.

 Severe pain in cancer adrenergic blockers,  Frequently assess vital
patients CV: hypotension (especially MAO inhibitors, signs, especially blood
with epidural use), palpitations, prazosin,tricyclicanti pressure and pulse.
Contraindications: bradycardia depressants:  Monitor patient for drug
decreased tolerance and efficacy.
 Hypersensitivity to GI: nausea, vomiting, antihypertensive  Instruct patient to move
drug
 constipation, dry mouth
 effect slowly when sitting up or
 Hypersensitivity to standing, to avoid dizziness
components of GU: urinary retention, nocturia, Beta-adrenergic or light-headedness caused
adhesive layer erectile dysfunction
 blockers: increased by sudden blood pressure
(transdermal form)
 withdrawal decrease.
 Metabolic: sodium retention
 phenomenon
Infection at epidural  Caution patient not to stop
injection site, bleeding taking drug abruptly.
problems (epidural Skin: rash, sweating, pruritus, CNS depressants
use)
 dermatitis (including antihista-
 Concurrent mines, opioids,
Other: weight gain, sedative hypnotics):
anticoagulant therapy
withdrawal phenomenon additive sedation
Epidurally
administered local
anesthetics:
prolonged clonidine
effects
Levodopa: decreased
levodopa efficacy
Myocardial
depressants
(including beta-
adrenergic blockers):
additive bradycardia
Other anti-
hypertensives,
nitrates: additive
hypotension

Verapamil: increased
risk of adverse
cardiovascular
reactions


Drug-herbs.
Capsicum: reduced
anti- hypertensive
effect


Drug-behaviors.
Alcohol use:
increased sedation
DRUG ACTION
Ferrous Sulfate Essential component in the
formation of hemoglobin,
myoglobin and enzymes. It is
necessary for effective
erythropoiesis and transport or
utilization of oxygen.
CLASS:
Enzymatic Mineral and Iron
Preparation
INDICATIONS AND ADVERSE REACTIONS
CONTRAINDICATIONS TEACHING
Indications: Large doses may aggravate:
 The prevention or
treatment of iron  peptic ulcer
deficiency anemia.  regional enteritis
 ulcerative colitis.
Contraindications:
Severe iron poisoning
 Patients receiving
repeated blood Vomiting
transfusion.
Severe abdominal pain
Diarrhea
Dehydration
Hyperventilation
Pallor/Cyanosis
Cardiovascular collapse
PATIENT MONITORING AND
 Assess nutritional status
and dietary history to
determine possible cause of
anemia and need for
patient teaching.
 Assess bowel function for
constipation or diarrhea.
 Give between meals with
water.
 Monitor serum iron, total
iron binding capacity,
reticulocyte count,
hemoglobin and ferritin.
 Assess for clinical
improvement, record of
relief of symptoms.