Mikee J.

Delos Santos
BSN III-2

GASTROINTESTINAL AGENT
GENERIC BRAND
INDICATION DOSAGE ADVERSE EFFECT CONTRAINDICATION NURSING CONSIDERATION
NAME NAME
Temporary Laxative Systemic effects not reported. Acute surgical abdomen,  Evaluate periodically patient's
BISACODYL Dulcolax relief of acute Adult: PO 5–15 mg Mild cramping, nausea, diarrhea, nausea, vomiting, need for continued use of drug;
constipation prn (max: 30 mg for fluid and electrolyte disturbances abdominal cramps, bisacodyl usually produces 1 or
and for special procedures) (especially potassium and intestinal obstruction, fecal 2 soft formed stools daily.
evacuation of PR 10 mg prn calcium). impaction; use of rectal  Monitor patients receiving
colon before Child: PO 6 y, 5–10 suppository in presence of concomitant anticoagulants.
surgery, mg prn PR 2 y, 10 anal or rectal fissures, Indiscriminate use of laxatives
proctoscopic, mg; <2 y, 5 mg ulcerated hemorrhoids, results in decreased absorption
sigmoidoscopi proctitis. of vitamin K.
c, and  Add high-fiber foods slowly to
radiologic regular diet to avoid gas and
examinations. diarrhea. Adequate fluid intake
Also used to includes at least 6–8 glasses/d.
cleanse colon  Do not breast feed while taking
before this drug without consulting
delivery and physician.
to relieve
constipation
in patients
with spinal
cord damage.
 Mikee J. Delos Santos
BSN III-2

GENERIC BRAND
INDICATION DOSAGE ADVERSE EFFECT CONTRAINDICATION NURSING CONSIDERATION
NAME NAME
Orally to Laxative Body as a Whole: Flushing, Myocardial damage; heart  Observe constantly when given IV.
MAGNESIUM Epsom Salt relieve acute Adult: PO 10–15 g sweating, extreme thirst, block; cardiac arrest except Check BP and pulse q10–15 min or
SULFATE constipation once/d sedation, confusion, depressed for certain arrhythmias; IV more often if indicated.
and to reflexes or no reflexes, muscle administration during the 2  Monitor respiratory rate closely.
evacuate Preeclampsia, weakness, flaccid paralysis, h preceding delivery; PO Report immediately if rate falls
below 12.
bowel in Eclampsia hypothermia.  use in patients with
 Test patellar reflex before each
preparation Adult: IM/IV 4 g in abdominal pain, nausea,
repeated parenteral dose.
for x-ray of 250 mL D5W CV: Hypotension, depressed vomiting, fecal impaction, Depression or absence of reflexes is
intestines. infused slowly, cardiac function, complete heart or intestinal irritation, a useful index of early magnesium
Parenterally followed by 4–5 g block, circulatory collapse.  obstruction, or perforation. intoxication.
to control IM in alternate  Check urinary output, especially in
seizures in buttocks q4h Respiratory: Respiratory patients with impaired kidney
toxemia of paralysis.  function.
pregnancy, Hypomagnesemia  Observe newborns of mothers who
epilepsy, and Seizures Metabolic: Hypermagnesemia, received parenteral magnesium
acute Adult: IM/IV Mild, hypocalcemia, dehydration, sulfate within a few hours of
nephritis and 1 g q6h for 4 doses; electrolyte imbalance including delivery for signs of toxicity,
including respiratory and
for Severe, 250 mg/kg hypocalcemia with repeated
neuromuscular depression.
prophylaxis infused over 4 h laxative use.
 Observe patients receiving drug for
and Child: IV 20–100 hypomagnesemia for improvement
treatment of mg/kg q4–6h prn in these signs of deficiency:
hypomagnese Irritability, choreiform movements,
mia. Topically Total Parenteral tremors, tetany, twitching, muscle
to reduce Nutrition cramps, tachycardia, hypertension,
edema, Adult: IV 0.5–3 g/d psychotic behavior.
inflammation,  Have calcium gluconate readily
and itching. available in case of magnesium
sulfate toxicity
 Mikee J. Delos Santos
BSN III-2

ELECTROLYTIC AND WATER BALANCE AGENT; REPLACEMENT SOLUTION

GENERIC BRAND
INDICATION DOSAGE ADVERSE EFFECT CONTRAINDICATION NURSING CONSIDERATION
NAME NAME
To prevent and Hypokalemia GI: Nausea, vomiting, diarrhea, Severe renal  Monitor I&O ratio and pattern in
POTASSIUM Apo-K treat Adult: PO 10–100 abdominal distension.  impairment; severe patients receiving the parenteral drug.
CHLORIDE potassium mEq/d in divided Body as a Whole: Pain, mental hemolytic reactions; If oliguria occurs, stop infusion
deficit doses IV 10–40 confusion, irritability, listlessness, untreated Addison's promptly and notify physician.
secondary to paresthesias of extremities,
mEq/h diluted to at disease; crush  Monitor for and report signs of GI
diuretic or muscle weakness and heaviness
least 10–20 syndrome; early ulceration (esophageal or epigastric
corticosteroid of limbs, difficulty in
therapy. Also mEq/100 mL of swallowing, flaccid paralysis.  postoperative oliguria pain or hematemesis).
indicated when solution (max: 200– Urogenital: Oliguria, anuria.  (except during GI  Monitor patients receiving parenteral
potassium is 400 mEq/d, Hematologic: Hyperkalemia.  drainage); adynamic potassium closely with cardiac monitor.
depleted by monitor higher Respiratory: Respiratory ileus; acute Irregular heartbeat is usually the
severe doses carefully) distress.  dehydration; heat earliest clinical indication of
vomiting, CV: Hypotension, cramps, hyperkalemia, hyperkalemia.
diarrhea; Child: PO 1–3 bradycardia; cardiac depression, patients receiving  Be alert for potassium intoxication
intestinal mEq/kg/d in arrhythmias, or arrest; altered potassium-sparing (hyperkalemia, see S&S, Appendix F);
drainage, divided doses; sensitivity to digitalis diuretics, digitalis may result from any therapeutic
fistulas, or glycosides. ECG changes in
sustained release intoxication with AV dosage, and the patient may be
malabsorption; hyperkalemia: Tenting (peaking)
tablets not conduction disturbance. asymptomatic.
prolonged of T wave (especially in right
diuresis, recommended in precordial leads), lowering of R  The risk of hyperkalemia with
diabetic children IV Up to 3 with deepening of S waves and potassium supplement increases (1) in
acidosis. mEq/kg/24 h at a depression of RST; prolonged P-R older adults because of decremental
Effective in the rate <0.02 interval, widened QRS complex, changes in kidney function associated
treatment of mEq/kg/min decreased amplitude and with aging, (2) when dietary intake of
hypokalemic disappearance of P waves, potassium suddenly increases, and (3)
alkalosis prolonged Q-T interval, signs of when kidney function is significantly
(chloride, not right and left bundle compromised.
the gluconate). block, deterioration of QRS
contour and finally ventricular
fibrillation and death
 Mikee J. Delos Santos
BSN III-2

ELECTROLYTE AND WATER BALANCE AGENT; CATION EXCHANGE

GENERIC BRAND
INDICATION DOSAGE ADVERSE EFFECT CONTRAINDICATION NURSING CONSIDERATION
NAME NAME
Hyperkalemia Patients with hypokalemia;  Determine serum
SODIUM Kayexalate Hyperkalemia Adult: PO 15 g GI: Constipation, fecal impaction hypersensitivity to Kayexalate potassium levels daily
POLYSTYRENE . suspended in 70% (in older adults); anorexia, gastric throughout therapy.
SULFONATE sorbitol or 20–100 irritation, nausea, vomiting, Monitor acid–base balance,
mL of other fluid 1– diarrhea (with sorbitol electrolytes, and minerals in
4 times/d PR 30–50 emulsions).  patients receiving repeated
g/100 mL 70% doses.
sorbitol q6h as Metabolic: Sodium retention,  Serum potassium levels do
warm emulsion hypocalcemia, hypokalemia, not always reflect
high into sigmoid hypomagnesemia intracellular potassium
colon deficiency. Observe patient
closely for early clinical
Child: PO Calculate signs of severe
appropriate hypokalemia.
amount on  Consult physician about
exchange rate of 1 restricting sodium content
mEq of potassium from dietary and other
per gram of resin sources since drug contains
and suspend in 70% approximately 100 mg (4.1
sorbitol or other mEq) of sodium per gram (1
appropriate tsp, 15 mEq sodium).
solution (Usual  Check bowel function daily.
dose: 1 g/kg q6h) Usually, a mild laxative is
PR 1 g/kg q2–6h prescribed to prevent
constipation (common
adverse effect). Older adult
patients are particularly
prone to fecal impaction.
 Mikee J. Delos Santos
BSN III-2

ELECTROLYTIC AND WATER BALANCE AGENT; LOOP DIURETIC

GENERIC BRAND
INDICATION DOSAGE ADVERSE EFFECT CONTRAINDICATION NURSING CONSIDERATION
NAME NAME
Treatment of Edema CV: Postural hypotension, dizziness History of hypersensitivity to  Observe patients receiving
FUROSEMIDE Furomide edema Adult: PO 20–80 with excessive diuresis, acute furosemide or sulfonamides; parenteral drug carefully;
associated with mg in 1 or more hypotensive episodes, circulatory increasing oliguria, anuria, fluid closely monitor BP and vital
CHF, cirrhosis divided doses up to collapse. and electrolyte depletion states; signs. Sudden death from
of liver, and Metabolic: Hypovolemia, cardiac arrest has been
600 mg/d if needed hepatic coma; pregnancy
kidney disease, dehydration,hyponatremia hypokale reported.
IV/IM 20–40 mg in (category C), lactation.
including mia, hypochloremia metabolic  Monitor BP during periods of
nephrotic 1 or more divided alkalosis, hypomagnesemia, diuresis and through period of
syndrome. May doses up to 600 hypocalcemia,hyperglycemia, dosage adjustment.
be used for mg/d glycosuria, elevated BUN,  Observe older adults closely
management Child: PO 2 mg/kg, hyperuricemia.  during period of brisk diuresis.
of may be increased GI: Nausea, vomiting, oral and gastric Sudden alteration in fluid and
hypertension, by 1–2 mg/kg q6– burning, anorexia, diarrhea, electrolyte balance may
alone or in 8h (max: 6 constipation, abdominal cramping, precipitate significant adverse
combination mg/kg/dose) IV/IM acute pancreatitis, jaundice.  reactions. Report symptoms
with other 1 mg/kg, may be Urogenital: Allergic interstitial to physician.
antihypertensiv increased by 1 nephritis, irreversible renal failure,  Monitor I&O ratio and
e agents, and urinary frequency.  pattern. Report decrease or
mg/kg q2h if
for treatment Hematologic: Anemia, leukopenia, unusual increase in output.
of needed (max: thrombocytopenic purpura; aplastic Excessive diuresis can result in
hypercalcemia. mg/kg/dose) anemia, agranulocytosis (rare).  dehydration and hypovolemia,
Has been used Neonate: PO 1–4 Special Senses: Tinnitus, vertigo, circulatory collapse, and
concomitantly mg/kg q12–24h hearing loss, blurred vision.  hypotension. Weigh patient
with mannitol IV/IM 1–2 mg/kg Skin: Pruritus, urticaria, exfoliative daily under standard
for treatment q12–24h dermatitis, purpura, photosensitivity, conditions.
of severe necrotizing angiitis (vasculitis).  Monitor urine and blood
cerebral Hypertension  Body as a Whole: Increased glucose & HbA1C closely in
edema, Adult: PO 10–40 perspiration; paresthesias; activation diabetics and patients with
particularly in mg b.i.d. (max: 480 of SLE, muscle spasms, weakness; decompensated hepatic
meningitis. thrombophlebitis, pain at IM cirrhosis. Drug may cause
mg/d)
injection site. hyperglycemia.
 Mikee J. Delos Santos
BSN III-2

FLUID AND ELECTROLYTIC BALANCE AGENT; REPLACEMENT SOLUTION

GENERIC BRAND
INDICATION DOSAGE ADVERSE EFFECT CONTRAINDICATION NURSING CONSIDERATION
NAME NAME
Relief of All doses are in terms GI: Constipation or laxative effect, Hypercalcemia and  Note number and
CALCIUM Caltrate transient of elemental calcium: acid rebound, nausea, hypercalciuria (e.g., consistency of stools. If
CARBONATE symptoms of 1 g calcium eructation, flatulence, vomiting, hyperparathyroidism, vitamin D constipation is a problem,
hyperacidity as carbonate = 400 mg fecal concretions.  overdosage, decalcifying physician may prescribe
in acid (20 mEq, 40%)
tumors, bone metastases), alternate or combination
indigestion, elemental calcium; 1
Metabolic: Hypercalcemia with calcium loss due to therapy with a magnesium
heartburn, g calcium acetate =
peptic 250 mg (12.6 mEq, alkalosis, metastatic calcinosis, immobilization, severe renal antacid or advise patient to
esophagitis, 25%) elemental hypercalciuria, hypomagnesemia, disease, renal calculi, GI take a laxative or stool
and hiatal calcium; 1 g calcium hypophosphatemia (when hemorrhage or obstruction, softener as necessary.
hernia. Also citrate = 210 mg (12 phosphate intake is low).  dehydration, hypochloremic  Lab tests: Determine serum
used as calcium mEq, 21%) elemental alkalosis, ventricular fibrillation, and urine calcium weekly in
supplement calcium; 1g tricalcium CNS: Mood and mental changes.  cardiac disease, pregnancy patients receiving
when calcium phosphate = 390 mg (category C). prolonged therapy and in
intake may be (19.3 mEq, 39%) Urogenital: Polyuria, renal calculi. patients with renal
inadequate and elemental calcium dysfunction.
in treatment of Supplement for
 Record amelioration of
mild calcium Osteoporosis
deficiency Adult: PO 1–2 g b.i.d.
symptoms of hypocalcemia
states. Control or t.i.d. (see Signs & Symptoms,
of Appendix F).
hyperphosphat Antacid  Observe for S&S of
emia in chronic Adult: PO 0.5–2 g 4– hypercalcemia in patients
renal failure 6 times/d receiving frequent or high
(calcium doses, or who have
acetate). Hyperphosphatemia impaired renal function
Adult: PO calcium
acetate 2–4 tablets
with each meal
 Mikee J. Delos Santos
BSN III-2

GENERIC BRAND
INDICATION DOSAGE ADVERSE EFFECT CONTRAINDICATION NURSING CONSIDERATION
NAME NAME
To overcome All doses are in terms Body as a Whole: Tingling Ventricular fibrillation,  Assess for cutaneous
CALCIUM Kalcinate cardiac toxicity of elemental calcium: sensation. With rapid IV, metastatic bone disease, burning sensations and
GLUCONATE of 1 g calcium gluconate sensations of heat waves injection into myocardium; peripheral vasodilation,
hyperkalemia, = 90 mg (4.5 mEq, (peripheral vasodilation), fainting.  administration by SC or IM with moderate fall in BP,
for CPR, to 9.3%) elemental
routes; renal calculi, during direct IV injection.
prevent calcium
hypocalcemia
GI: PO preparation: Constipation, hypercalcemia, predisposition to  Monitor ECG during IV
during Supplement for increased gastric acid secretion.  hypercalcemia administration to detect
transfusion of Osteoporosis (hyperparathyroidism, certain evidence of hypercalcemia:
citrated blood. Adult: PO 1–2 g b.i.d. CV: (With rapid infusion) malignancies); pregnancy decreased QT interval
Also as to q.i.d. IV 7 mEq q1– hypotension, bradycardia, cardiac associated with inverted T
antidote for 3d arrhythmias, cardiac arrest,  wave.
magnesium Child: PO 45–65  Observe IV site closely.
sulfate, for mg/kg/d in divided Skin: Pain and burning at IV site, Extravasation may result in
acute doses. IV 1–7 mEq severe venous thrombosis, tissue irritation and
symptoms of q1–3d necrosis and sloughing (with necrosis.
lead colic, to Neonate: PO 50–130 extravasation).  Monitor for hypocalcemia
decrease mg/kg/d (max: 1 g) IV
capillary mEq q1–3d and hypercalcemia (see
permeability in Signs & Symptoms,
sensitivity Hypocalcemic Tetany Appendix F).
reactions, and Adult: IV 4.5–16 mEq  Lab tests: Determine levels
to relieve prn of calcium and phosphorus
muscle cramps Child: IV 0.5–0.7 (tend to vary inversely) and
from insect mEq/kg t.i.d. or q.i.d. magnesium frequently,
bites or stings. Neonate: IV 2.4 during sustained therapy.
Oral calcium mEq/kg/d in divided Deficiencies in other ions,
may be used to doses
particularly magnesium,
maintain
frequently coexist with
normal calcium CPR
balance during Adult: IV 2.3–3.7 calcium ion depletion.
pregnancy, mEq x 1
Mikee J. Delos Santos
BSN III-2

lactation, and
childhood Hyperkalemia with
growth and to Cardiac Toxicity
prevent Adult: IV 2.25–14
primary mEq q 1–2 min
osteoporosis.
Also in Exchange
osteoporosis, Transfusions with
osteomalacia, Citrated Blood
chronic Adult: IV 1.35 mEq
hypoparathyroi for each 100 mL of
dism, rickets, blood
and as adjunct Neonate: IV 0.45
in treatment of mEq for each 100 mL
myasthenia of blood
gravis and
Eaton-Lambert
syndrome.
 Mikee J. Delos Santos
BSN III-2

 HORMONES AND SYNTHETIC SUBSTITUTES

GENERIC BRAND
INDICATION DOSAGE ADVERSE EFFECT CONTRAINDICATION NURSING CONSIDERATION
NAME NAME
Symptomatic Paget's Disease Body as a Whole: Headache, eye Hypersensitivity to fish proteins  Have on hand epinephrine
CALCITONIN Cibacalcin Paget's Adult: SC Human pain, feverish sensation, or to synthetic calcitonin; 1:1000, antihistamines, and
disease of 0.5 mg/d or 2–3 hypersensitivity history of allergy. Safe use in oxygen in the event of a
bone (osteitis times/wk or 0.25 reactions, anaphylaxis. Reported children, pregnancy (category reaction. Also have readily
deformans), mg/d up to 0.5 mg for calcitonin human only: Urinary C), and lactation not established. available parenteral
postmenopau b.i.d. SC/IM Salmon frequency, chills, chest pressure, calcium, particularly during
sal 100 IU/d, may weakness, paresthesias, tender early therapy. Hypo
osteoporosis. decrease to 50–100 palms and soles, dizziness, nasal calcemic tetany is a
Orphan drug IU/d or q.o.d. congestion, shortness of breath.  theoretical possibility.
approval  Examine urine specimens
(calcitonin Hypercalcemia GI: Transient nausea, vomiting, periodically for sediment
human): Adult: SC/IM anorexia, unusual taste sensation, with long-term therapy.
short-term Salmon 4 IU/kg abdominal pain, diarrhea.   Lab tests: Monitor for
adjunctive q12h, may increase hypocalcemia.
treatment of to 8 IU/kg q6h if Skin: Inflammatory reactions at  Examine nasal passages
severe needed injection site, flushing of face or prior to treatment with the
hypercalcemic hands, pruritus of ear lobes, nasal spray and anytime
emergencies. Postmenopausal edema of feet, skin rashes.  nasal irritation occurs.
Osteoporosis  Nasal ulceration or heavy
Adult: SC/IM Urogenital: Nocturia, diuresis, bleeding are indications for
Salmon 100 IU/d abnormal urine sediment. drug discontinuation.
Intranasal 1 spray
(200 IU) daily,
alternate nostrils
 Mikee J. Delos Santos
BSN III-2

GENERIC BRAND
INDICATION DOSAGE ADVERSE EFFECT CONTRAINDICATION NURSING CONSIDERATION
NAME NAME
Treatment of Diabetes Body as a Whole: Allergic Systemic allergic reactions;  Monitor for S&S of
INSULIN NovoLog diabetes Adult: SC 0.25–0.7 reactions.  history of allergic reactions to hypoglycemia.
ASPART mellitus. units/kg/d injected insulin; hypoglycemia;  Withhold drug and notify
5–10 min before Endocrine: Hypoglycemia, pregnancy physician if patient is
each meal hypokalemia.  hypokalemic.
 Do not inject into areas
Skin: Injection site reaction, with redness, swelling,
lipodystrophy, pruritus, rash. itching, or dimpling.
 Ingest some form of sugar
(e.g., orange juice, dissolved
table sugar, honey) if
symptoms of hypoglycemia
develop, and seek medical
assistance.
 Check blood sugar as
prescribed, especially
postprandial values
 Notify the physician of any
of the following: Fever,
infection, trauma, diarrhea,
nausea or vomiting. Dosage
adjustment may be needed.
 Do not take any other
medication unless approved
by the physician.
 Do not breast feed while
taking this drug without
consulting physician.