DOCTORS ORDER MECHANISM OF SIDE EFFECT ADVERSE EFFECT NURSING CONSIDERATIONS

ACTION
Piperacillin Antibacterial combination More common  Eczema; Assessment & Drug Effects
Tazobactam product consisting of the  Diarrhea  Flaking or peeling of  Obtain history of
4.5g IV semisynthetic piperacillin Less common the skin; hypersensitivity to
and the beta-lactamase  Bladder pain  Inflammation of the penicillins,
inhibitor tazobactam.  bloating or mouth; cephalosporins, or
GENERIC NAME:  Swelling of the hands,
Tazobactam component swelling of the other drugs prior to
Piperacillin feet, and ankles;
does not decrease the face, arms, hands, administration.
Tazobactam lower legs, or feet  Swelling or redness
activity of the piperacillin
along a vein which is  Lab tests: C&S prior
component against  blurred vision to first dose of the
 burning upper extremely tender when
susceptible organisms. touched. drug; start drug
BRAND NAME: abdominal or
Piptaz  Changes in liver pending results.
stomach pain
function Monitor
 changes in
including jaundice (yellowin hematologic status
urination g of skin and eyes) or with prolonged
ROUTE:  chest pain hepatitis; therapy (Hct and
IV push  confusion  Severe diarrhea
 dizziness,
Hgb, CBC with
caused by a certain
differential and
faintness, or superinfection in the gut;
platelet count).
lightheadedness  Convulsions if is given
when getting up in high doses;  Monitor patient
suddenly from a  Short-term changes in carefully during the
lying or sitting kidney function; first 30 min after
position  Cough, fever, initiation of the
 fever or sweating chills, shortness of infusion for signs of
 headache breath and chest pain; hypersensitivity.
 inflammation or  Thrush, especially with
swelling at the prolonged treatment. Patient & Family Education
injection site .  Report rash, itching,
 lower back or side or other signs of
pain hypersensitivity
 nausea or vomiting immediately.
 pain, tenderness,  Report loose stools
or swelling of the or diarrhea as these
foot or leg may indicate
 pain, warmth, or pseudomembranous
 burning in the colitis.
fingers, toes, and  Do not breast feed
legs while taking this
drug without
consulting
physician.

DOCTORS ORDER MECHANISM OF SIDE EFFECT ADVERSE EFFECT NURSING

ACTION CONSIDERATIONS
Aspirin Thought to produce analgesia and GI distress (including High doses of aspirin may produce GI For inflammatory conditions,
exert abdominal distention, bleeding and/or gastric mucosal rheumatic fever, and
80mg tab cramping, heart-burn, mild lesions. Dehydrated, febrile children
 its anti-inflammatory effect by nausea); allergic reaction may experience aspirin toxicity thrombosis, give aspirin on a
inhibiting (including bronchospasm, quickly. Reye’s syndrome, schedule rather than as
GENERIC NAME: pruritus, urticaria). characterized by persistent vomiting,
Acetylsalicylic Acid prostaglandin and other needed.
signs of brain dysfunction, may occur
substances that sensitize in children taking aspirin with recent • Because enteric-coated and
pain receptors. Drug may relieve viral infection (chickenpox, common sustained release tablets are
fever through central action in the cold, or flu). Low-grade aspirin slowly absorbed, they
BRAND NAME: hypothalamic heat-regulating toxicity characterized by tinnitus, aren’t suitable for rapid relief
Bayer center. In low doses, drug also generalized pruritus (may be severe), of acute pain, fever, or
headache, dizziness, flushing, tachy-
appears to interfere with clotting inflammation. They cause less
cardia, hyperventilation, diaphoresis,
by thirst. Marked toxicity characterized GI bleeding and may be better
ROUTE: keeping a platelet-aggregating by hyperthermia, restlessness, suited for long-term therapy,
Oral substance seizures, abnormal breathing such as for arthritis.
from forming. patterns, respiratory failure, coma. • For patients who can’t
FREQUENCY: OD tolerate oral drugs,
ask prescriber about using
aspirin rectal suppositories.
Watch for rectal mucosal
irritation or bleeding.
• Febrile, dehydrated children
can develop
toxicity rapidly.
• Monitor elderly patients
closely because they may be
more susceptible to aspirin’s
toxic effects.
• Monitor salicylate level.
Therapeutic salicylate level for
arthritis is 150 to
300 mcg/ml. Tinnitus may
occur at levels
above 200 mcg/ml, but this
isn’t a reliable indicator of
toxicity, especially in
very young patients and those
older than age 60. With long-
term therapy, severe toxic
effects may occur with levels
exceeding
 400 mcg/ml.
• During prolonged therapy,
assess hematocrit,
hemoglobin level, PT, INR, and
renal function periodically.
• Drug irreversibly inhibits
platelet aggregation.
Stop drug 5 to 7 days before
elective surgery to allow time
for production and
release of new platelets.
• Monitor patient for
hypersensitivity reactions,
such as anaphylaxis and
asthma.

DOCTORS ORDER MECHANISM OF SIDE EFFECT ADVERSE EFFECT NURSING

ACTION
Clopidogrel Active metabolite blocks P2Y12
75mg 1 tab OD compo-nent of ADP receptors on
platelet surface, preventing
GENERIC NAME: activation of GPIIb/IIIa recep-tor
complex. Therapeutic Effect: In-
Clopidogrel
hibits platelet aggregation.
Frequent (15%): Skin
disorders. Occa-sional
(8%–6%): Upper
respiratory tract
infection, chest pain, flu-
like symptoms,
Agranulocytosis, aplastic
anemia/pancy-topenia,
thrombotic thrombocytopenic
purpura (TTP) occur rarely.
Hepatitis, hypersensitivity
reaction, anaphylactoid
CONSIDERATIONS
BASELINE ASSESSMENT
Obtain baseline chemistries,
platelet count, PFA. Perform
platelet counts be-fore drug
therapy, q2days during first
wk of treatment, and wkly
 headache, dizziness, reaction have been reported. thereafter until therapeutic
BRAND NAME: arthralgia. Rare (5%– maintenance dose is reached.
Plavix 3%): Fatigue, edema, Abrupt discontinuation of
hypertension, drug therapy produces
abdominal pain, elevated platelet count within
dyspepsia, diarrhea, 5 days.
ROUTE: nausea, epistaxis, INTERVENTION/EVALUATION
Oral dyspnea, rhinitis. Monitor platelet count for
evidence of
FREQUENCY: OD thrombocytopenia. Assess
Hgb, Hct, for evidence of
bleeding; serum ALT, AST, bil-
irubin, BUN, creatinine;
signs/symptoms of hepatic
insufficiency during therapy.
PATIENT/FAMILY TEACHING •
It may take longer to stop
bleeding during drug therapy.
• Report any un-usual
bleeding. • Inform physicians,
dentists if clopidogrel is being
taken, esp. before surgery is
scheduled or before taking
any new drug.

DOCTORS ORDER MECHANISM OF SIDE EFFECT ADVERSE EFFECT NURSING

ACTION
Trimetazidine 35mg Acts by directly counteracting
1 tab BID all the major metabolic
disorders occurring within the
GENERIC NAME: ischemic cell. The actions of
Trimetazidine trimetazidine include limitation
of intracellular acidosis,
CONSIDERATIONS
dizziness, headache, Rare cases of GI disorders. -use cautiously in patients
rashes, abdominal pain, with heart failure or
nausea, vomiting and hypertension and in elderly
diarrhea. patients.
 correction of disturbances of
BRAND NAME: transmembrane ion exchanges,
Vastarel and prevention of excessive
production of free radicals.
Decrease myocardial oxygen
ROUTE: requirement by decreasing the
Oral heart rate, ventricular volume,
blood pressure and
FREQUENCY: OD contractility. In some cases,
myocardial oxygen delivery is
increased thru reversing
coronary arterial spasm.

DOCTORS ORDER MECHANISM OF SIDE EFFECT ADVERSE EFFECT NURSING

ACTION
Montelukast + Trimetazidine inhibits β-oxidation
Levocetirizine 10/5 mg of fatty acids by blocking long-
1 tab OD chain 3-ketoacyl-CoA thiolase,
thereby enhancing glucose
oxidation. By preserving energy
GENERIC NAME:
metabolism in cells exposed to
Montelukast + ischaemia or hypoxia, it prevents
Levocetirizine decrease in intracellular ATP
levels and ensures proper
functioning of ionic pumps and
BRAND NAME: transmembrane Na-K flow.
ROUTE:
Oral
somnolence, Montelukast:
hyperactivity in Body As A Whole; Asthenia/
children, dry mouth, fatigue, Fever, Abdominal pain
mild drowsiness and Digestive System Disorders;
GI disturbances. Dyspepsia, Infectious
gastroenteritis, Dental Pain
Nervous System/ Psychiatric:
Dizziness Headache
Respiratory System Disorder:
Congestion, nasal, Influenza
Skin/ Skin Appendages Disorder:
Rash
Levocetirizine:
 Immune system
disorders: hypersensitivity
CONSIDERATIONS
NURSING CONSIDERATIONS
• Assess patient’s underlying
condition, and
monitor him for
effectiveness.
Alert: Don’t abruptly
substitute drug for inhaled or
oral corticosteroids. Dose of
inhaled corticosteroids may
be reduced gradually.
Alert: Drug isn’t indicated for
use in patients with acute
asthmatic attacks, status
asthmaticus, or as
monotherapy for
management
 including anaphylaxis. of exercise-induced
FREQUENCY: OD  Psychiatric bronchospasm.
disorders: aggression, Continue appropriate rescue
agitation. drug for acute worsening.
 Eye disorders: visual PATIENT TEACHING
disturbances. • Inform caregiver that the
 Skin and subcutaneous oral granules may be given
disorders: angioneurotic directly into the child’s
edema, fixed drug mouth, dissolved in 1
eruption, pruritus, rash, teaspoon of cold or
urticarial. roomtemperature
baby formula or breast milk,
or mixed in a spoonful of
applesauce, carrots,
rice, or ice cream.
• Tell caregiver not to open
packet until
ready to use and, after
opening, to give the
full dose within 15 minutes.
Tell her that
if she’s mixing the drug with
food, not to
store excess for future use
and to discard the
unused portion.
• Advise patient to take drug
daily, even if
asymptomatic, and to contact
his prescriber
if asthma isn’t well
controlled.
•Warn patient not to reduce
or stop taking other
prescribed antiasthmatics
without prescriber’s
approval.
• Advise patient to seek
 medical attention
if short-acting inhaled
bronchodilators are
needed more often than
usual during drug
therapy.
•Warn patient that drug isn’t
beneficial in acute asthma
attacks or in exercise-induced
bronchospasm, and advise
him to keep appropriate
rescue drugs available.
•Warn patient that drug may
cause behavior and mood
changes, and to report
development of these
symptoms to prescriber.
DOCTORS ORDER MECHANISM OF SIDE EFFECT ADVERSE EFFECT NURSING
ACTION CONSIDERATIONS
Furosemide 40mg IV Inhibits reabsorption of sodium, chloride Expected: Increased Vigorous diuresis may lead to BASELINE ASSESSMENT
in ascending loop of Henle and proxi- urinary frequency/ profound water Check vital signs, esp.
mal/ distal renal tubules. Therapeutic B/P, pulse, for
GENERIC NAME: volume. Frequent: loss/electrolyte depletion,
Effect: Increases excretion of water,
Nausea, dyspepsia, resulting in hypokalemia, hypotension before
Furosemide sodium, chloride, magnesium, calcium.
administration. Assess
abdominal cramps, hyponatremia, dehydra-tion.
diarrhea or consti- Sudden volume depletion may baseline renal function,
pation, electrolyte result in increased risk of serum electro-lytes, esp.
disturbances. thrombosis, circula-tory serum sodium,
BRAND NAME: Occasional: Dizziness, collapse, sudden death. Acute potassium. Assess skin
Lasix light-headedness, head hypo-tensive episodes may turgor, mucous
membranes for
ache, blurred vision, occur, sometimes several days
hydration status;
paresthesia, after beginning therapy.
observe for edema.
ROUTE: photosensitivity, rash, Ototoxicity (deafness, vertigo,
Assess muscle strength,
IV fatigue, bladder spasm, tinnitus) may occur, esp. in pts mental status. Note skin
restlessness, with severe renal impairment. temperature, moisture.
diaphoresis. Can exacerbate diabetes Obtain baseline weight.
Rare: Flank pain. mellitus, systemic lupus Initiate I&O monitoring.
erythematosus, gout, Auscultate lung sounds.
pancreatitis. Blood dyscrasias
have been reported.
In pts with hepatic
cirrhosis and ascites,
consider giving initial
doses in a hospital
setting.
INTERVENTION/EVALUATION
Monitor B/P, vital signs,
serum electrolytes, I&O,
weight. Note extent of
diure-sis. Watch for
symptoms of electrolyte
imbalance: Hypokalemia
may result in changes in
muscle strength,
tremor, muscle cramps,
altered mental status,
cardiac arrhythmias;
hyponatremia may
result in confusion,
thirst, cold/clammy skin.
Consider potassium
supplementation if
hypokalemia occurs.
PATIENT/FAMILY TEACHING
• Expect increased
frequency, volume of
urination.
• Report palpitations,
signs of electrolyte
imbalances (noted
previously), hearing
abnormalities (sense of
fullness in ears,
tinnitus).
• Eat foods high in
potassium such as
whole grains (cereals),
legumes, meat,
bananas, apricots,

DOCTORS ORDER MECHANISM OF
ACTION
Losartan 50 mg 1 tab Blocks vasoconstrictor,
aldosterone-secreting effects of
angiotensin II, inhibiting binding of
GENERIC NAME: angiotensin II to AT1 receptors.
Therapeutic Effect: Causes vaso-
Losartan
dilation, decreases peripheral
resistance, decreases B/P.
orange juice, potatoes
(white, sweet), raisins.
• Avoid sunlight, sun-
lamps.
SIDE EFFECT ADVERSE EFFECT NURSING
CONSIDERATIONS
Frequent (8%): Upper Overdosage may manifest as BASELINE ASSESSMENT
respiratory tract hypotension and tachycardia. Obtain B/P, apical pulse
infection. Occasional Bradycardia occurs less often. immediately before each
(4%–2%): Dizzi-ness, Institute supportive measures. dose, in addition to regular
diarrhea, cough. Rare monitoring (be alert to
(1% or less): Insomnia, fluctuations). Question for
dyspepsia, heartburn, possibility of pregnancy. As-
back/ leg pain, muscle sess medication history (esp.
BRAND NAME: cramps, myalgia, nasal diuretics).
Cozaar congestion, sinusitis, INTERVENTION/EVALUATION
depression. Maintain hydration (offer
fluids frequently). Assess for
evidence of upper respiratory
ROUTE:
infection, cough. Monitor B/P,
Oral pulse. Assist with ambulation
if dizziness occurs. Monitor
daily pattern of bowel activity,
stool consistency.
PATIENT/FAMILY TEACHING •
Female pts of childbearing age
should take measures to avoid
pregnancy.
• Report pregnancy as soon as
possible.
• Avoid tasks that require
alert-ness, motor skills until
response to drug is
established (possible dizziness
effect).
• Report any sign of infection
(sore throat, fever), chest
pain.
• Do not take OTC cold
preparations, nasal
decongestants. • Do not stop
taking medication. • Limit salt
intake.
 DOCTORS ORDER MECHANISM OF
ACTION
Nicardipine 10mg IV Inhibits calcium ion movement
across cell membranes of cardiac,
vascular smooth muscle.
GENERIC NAME: Therapeutic Effect: Relaxes
coronary vascular smooth muscle.
Nicardipine
Causes coronary vasodilation,
increasing myo-cardial oxygen
delivery in angina.
BRAND NAME:
Cardene IV
SIDE EFFECT ADVERSE EFFECT NURSING
CONSIDERATIONS
Frequent (10%–7%): Overdose produces confusion, BASELINE ASSESSMENT
Headache, facial flush- slurred speech, drowsiness, Concurrent therapy with
ing, peripheral edema, marked hypotension, sublingual nitro-glycerin may
light-headedness, bradycardia. be used for relief of anginal
dizziness. Occasional pain. Record onset, type
(6%–3%): Asthenia, (sharp, dull, squeezing),
palpitations, angina, radiation, location, intensity,
tachycardia. Rare (less duration of anginal pain,
than 2%): Nausea, precipitating factors (exertion,
abdominal cramps, dys- emotional stress).
pepsia, dry mouth, rash. INTERVENTION/EVALUATION
Monitor B/P, heart rate during
 and following IV infusion.
ROUTE: Assess for peripheral edema.
IV Assess skin for facial flushing,
dermatitis, rash. Question for
asthenia, headache. Monitor
LFT results. Assess ECG, pulse
for tachycardia.
PATIENT/FAMILY TEACHING •
May take without regard to
food.
• Sustained-release capsule
taken whole; do not break,
chew, crush, or open.
• Avoid alcohol, grapefruit
products; limit caffeine.
• Report if anginal pain not
relieved or if palpitations,
short-ness of breath, swelling,
dizziness, constipation,
nausea, hypotension occurs.
• Avoid tasks requiring motor
skills, alertness until response
to drug is established.