MATERI DARI A TO Z DRUG FACTS

1. Candesartan
Atacand
Tablets: 4 mg
Tablets: 8 mg
Tablets: 16 mg
Tablets: 32 mg
Class: Antihypertensive, Angiotensin II antagonist

Action Antagonizes the effect angiotension II (vasoconstriction and aldosterone

secretion) by blocking the angiotension II receptor (AT1 receptor) in vascular smooth
muscle and the adrenal gland, producing decreased BP.

Indications Treatment of hypertension.

Contraindications Standard considerations.

Route/Dosage
Adults: Initial dose: PO 16 mg/day; consider lower dose if volume-depleted. Total daily
doses range from 8 to 32 mg in 1 or 2 doses.

Interactions
Lithium: Plasma concentrations may be increased by candesartan, resulting in an
increase in the pharmacologic and adverse effects of lithium.

Lab Test Interferences None well documented.

Adverse Reactions
CNS: Headache; dizziness; fatigue. EENT: Rhinitis; sinusitis; pharynigitis. GI: Nausea;
abdominal pain; diarrhea; vomiting. RESPIRATORY: Upper respiratory tract infection;
bronchitis; cough. OTHER: Back pain; chest pain; edema; arthralgia; albuminuria.

Precautions
Pregnancy: Category D (second and third trimester); Category C (first trimester). Can
cause injury or death to fetus if used during second or third trimester. Lactation:
Undetermined. CHILDREN: Safety and efficacy not established. Renal function
impairment: Use caution in treating patients whose renal function may depend on the
activity of the renin-angiotensin-aldosterone system (eg, patients with severe CHF).
Hypotension/Volume-depleted patients: Symptomatic hypotension may occur after
initiation of candesarten in patients who are intravascularly volume depleted (eg, those
treated with diuretics). Correct these conditions prior to administration of candesaratan or
use a lower starting dose. African-Americans: Candesartan may not be as effective in
African-Americans.
PATIENT CARE CONSIDERATIONS

Administration/Storage
Administer without regard to food.
Check BP before administration.
Anticipate a synergistic or additive effect with concomitant use of thiazides and other
antihypertensive medications.
Do not administer if patient is pregnant or breastfeeding or otherwise contraindicated.
Store at controlled room temperature in a tightly closed container. Protect from moisture
.
Assessment/Interventions
Obtain complete drug history including any known allergies.
Closely monitor infants exposed to candesartan in utero for hypotension, oliguria, and
hyperkalemia. Supportive measures for renal perfusion and BP stabilization may be
necessary. Exchange transfusions and dialysis may be required.
Monitor BP and pulse. Should hypotension, tachycardia, or bradycardia result, withhold
the medication and notify health care provider.
Monitor for symptomatic hypotension especially in salt- or volume-depleted patients
such as those on diuretics. Correct condition prior to treatment or monitored under close
medical supervision. If hypotension occurs, place the patient in the supine position and
have an IV infusion of normal saline available.
Institute fall precautions in unstable patients.
Closely monitor patients with severe CHF or progressive azotemia and (rarely)
symptoms of acute renal failure.
Monitor patients with impaired renal function for decreased urinary output and for
adverse reactions.
Assess patient for signs of hyperkalemia, especially if they are using a potassium-sparing
diuretic.
Review available laboratory tests for the following abnormal findings: creatine and
BUN, hemoglobin, hematocrit, WBCs, platelets, LFTs.
Monitor for signs of hypersensitivity, which includes angioedema, involving swelling of
the face, lips, and tongue. Where there is involvement of the tongue, glottis, or larynx
likely to cause airway obstruction, promptly administer emergency therapy, which could
include epinephrine.

OVERDOSAGE: SIGNS & SYMPTOMS

Hypotension, tachycardia
Patient/Family Education
 Provide patient information pamphlet.
 Instruct patient to take the medication as prescribed at the same time each day.
 Inform patient that candesartan can control but does not cure hypertension.
 Caution patient to take the dose exactly as prescribed and not to stop taking the
medication even if they feel better.
 Instruct patient not to decrease or increase their dosage without talking with their
health care provider.
 Inform patient of the following possible adverse effects: dry cough, renal function
impairment, fetal injury.
 Advise women to notify health care provider if pregnant, planning to become
pregnant, or breastfeeding.
 Instruct the patient in BP and pulse measurement skills. Caution patient to call
health care provider should abnormal readings occur.
 Instruct patient that other methods of fall prevention, including rising slowly and
sitting on the side of the bed before standing, especially early in therapy.
 Instruct patient that other medications, especially hypertensive medications, can
have additive or synergistic effects. Have patient inform health care provider of
all medication including OTC drugs they are presently taking.
 Inform patient of the importance of adjunct therapies such as dietary planning, a
regular exercise program, weight reduction, a low sodium diet, smoking cessation
program, alcohol reduction, and stress management.
 Instruct patient to monitor renal, hepatic, and hematologic symptoms including
urinary output and any discomfort during urination, weakness, fatigue, dizziness,
lightheadedness, and jaundice. Patient should inform primary caregiver if
symptoms occur.
 Warn patient that inadequate fluid intake, excessive perspiration, diarrhea, or
vomiting, resulting in reduced fluid volume, may lead to an excessive fall in BP,
lightheadness, and possible fainting.
 Tell patient not to use potassium supplement or salt substitutes containing
potassium to prevent possible hyperkalemia.
 Instruct patient to report any indications of an infection such as a sore throat,
which could indicate neutropenia.
 Caution patient to inform health care provider or dentist of drug therapy prior to
surgery or treatment.
2. Concor
Class: Beta-adrenergic blocker

Action Blocks beta receptors, primarily affecting cardiovascular system (decreases heart
rate, cardiac contractility and BP) and lungs (promotes bronchospasm).

Indications Hypertension. Unlabeled use(s): Angina pectoris; supraventricular

tachycardias; premature ventricular contractions.

Contraindications Hypersensitivity to beta-blockers; sinus bradycardia; greater than

first-degree heart block; CHF unless secondary to tachyarrhythmia treatable with beta-
blockers; overt cardiac failure; cardiogenic shock.

Route/Dosage
Hypertension

ADULTS: PO 5 to 20 mg qd. Dosage should be individualized; some patients may be

given starting dose of 2.5 mg/day.

Interactions
Clonidine: May enhance or reverse antihypertensive effect; potentially life-threatening
situations may occur, especially on withdrawal. NSAIDs: Some agents may impair
antihypertensive effect. Prazosin: May increase orthostatic hypotension. Verapamil: May
potentiate effects of both drugs.

Lab Test Interferences None well documented.

Adverse Reactions
CV: Hypotension; bradycardia; CHF; cold extremities; second- or third-degree heart
block. CNS: Insomnia; fatigue; dizziness; depression; lethargy; drowsiness;
forgetfulness; anxiety; headache; slurred speech. DERM: Rash; hives; alopecia. EENT:
Dry eyes; blurred vision; tinnitus; sore throat. GI: Nausea; vomiting; diarrhea;
constipation; abdominal pain; dry mouth. GU: Impotence; painful, difficult or frequent
urination; increased creatinine and BUN. HEMA: Agranulocytosis; thrombocytopenic
purpura. HEPA: Elevated liver function test results. META: Hyperglycemia;
hypoglycemia. RESP: Bronchospasm; dyspnea; wheezing. OTHER: Weight changes;
fever; facial swelling; muscle weakness; increased serum uric acid, potassium and
phosphorus; elevated serum lipids; possible development of antinuclear antibodies.

Precautions
Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not
established. Anaphylaxis: Deaths have occurred; aggressive therapy may be required.
CHF: Administer cautiously in patients whose CHF is controlled by digitalis and
diuretics. Diabetes mellitus: May mask symptoms of hypoglycemia (eg, tachycardia, BP
changes). May potentiate insulin-induced hypoglycemia. Nonallergic bronchospastic
disease (eg, chronic bronchitis, emphysema): In general, beta-blockers are not given to
patients with bronchospastic diseases. Peripheral vascular disease: May precipitate or
aggravate symptoms of arterial insufficiency. Renal/hepatic impairment: Reduce daily
dose. Thyrotoxicosis: May mask clinical signs (eg, tachycardia) of developing or
continuing hyperthyroidism. Abrupt withdrawal may exacerbate symptoms of
hyperthyroidism, including thyroid storm.

Administration/Storage
May be given without regard to meals.

Assessment/Interventions
Obtain patient history, including drug history and any known allergies. Note CHF,
diabetes mellitus or hypertension.
Assess for withdrawal syndrome. Beta-blocker withdrawal syndrome (eg, hypertension,
tachycardia, anxiety, angina, MI) may occur 1 to 2 wk after sudden discontinuation.
Gradually withdraw therapy over 1 to 2 wk if possible.
Ensure that baseline AST, ALT, uric acid, creatinine, BUN, serum potassium, glucose
and phosphorus levels have been obtained before starting treatment with this medication.
Monitor BP and pulse prior to each dosage.
In diabetic patients, monitor blood glucose level and diabetic medications closely.
Carefully monitor patients with CHF, COPD or asthma and report changes in cardiac or
respiratory status to physician.

OVERDOSAGE: SIGNS & SYMPTOMS

Bradycardia, CHF, hypotension, bronchospasm,
hypoglycemia

Patient/Family Education
 Explain that drug will be tapered slowly before stopping to prevent rebound
symptoms and adverse effects.
 Teach patients how to monitor pulse before taking oral medication and advise to
contact physician if pulse is < 50 bpm.
 Inform diabetic patient to monitor blood glucose level closely.
 Instruct patient to report the following symptoms to physician: Dizziness,
decreased pulse, shortness of breath, confusion, rash or any unusual bleeding.
 Advise patient that drug may cause drowsiness, and to use caution while driving
or performing other tasks requiring mental alertness.
 Instruct patient not to take otc medications (including diet aids, cold or nasal
preparations [alpha-adrenergic stimulants]) without consulting physician.
3. Digoxin
Class: Cardiac glycoside

Action Increases force and velocity of myocardial systolic contraction (positive

inotropic action), slows heart rate, and decreases conduction through atrioventricular
node.

Indications Treatment of CHF, atrial fibrillation, atrial flutter, paroxysmal atrial

tachycardia, cardiogenic shock.

Contraindications Ventricular fibrillation; ventricular tachycardia except in certain

cases; digitalis toxicity; beriberi heart disease; hypersensitivity to digoxin; some cases of
hypersensitive carotid sinus syndrome.

Route/Dosage
ADULTS: Rapid digitalization with loading dose: IV 0.4 to 0.6 mg or PO tablets 0.5 to
0.75 mg or capsules 0.4 to 0.6 mg in previously undigitalized patients; additional doses
may be given cautiously at 6 to 8 hr intervals (IV 0.1 to 0.3 mg or PO tablets 0.125 to
0.375 mg or capsules 0.1 to 0.3 mg) until clinical response is achieved; thereafter adjust
dosage based on levels (usual range 0.125 to 0.5 mg/day as single daily dose). In
previously digitalized patients, adjust dosage in proportion to ratio of desired vs current
serum levels. INFANTS & CHILDREN: Rapid digitalization with loading dose:
Individualize dosage. Usual pediatric doses are listed at end of section.

Interactions
Amiodarone, anticholinergics, bepridol, benzodiazepines, ACE inhibitors,
clarithromycin, cyclosporine, diltiazem, erythromycin, indomethacin, itraconazole,
propafenone, quinidine, quinine, tetracycline, verapamil: May increase digoxin serum
levels. Antacids, antineoplastics, cholestyramine, colestipol, kaolin/pectin,
metoclopramide: May decrease absorption and effect of digoxin. Penicillamine: May
decrease effect of digoxin. Potassium-sparing diuretics: May alter effect of digoxin.
Thiazide or loop diuretics: May increase effect of digoxin. St. John's wort, thyroid
hormones, thioamines: May decrease effect of digoxin.

Lab Test Interferences None well documented.

Adverse Reactions
CV: Arrhythmias (supraventricular arrhythmias are more common in infants and
children), including ventricular tachycardia and premature ventricular contractions. CNS:
Headache; weakness; apathy; drowsiness; mental depression; confusion; disorientation.
EENT: Visual disturbances (blurred vision, halo effect). GI: Anorexia; nausea; vomiting;
diarrhea.
Precautions
Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Newborns show
varying tolerance. Premature and immature infants are particularly sensitive; reduce and
individualize dose as needed. Elderly: Use with caution; renal clearance likely to be
reduced. Cardiovascular disease: Electrical conversion of arrhythmias may require dose
reduction. Digitalis toxicity: Anorexia, nausea, and vomiting may be associated with
toxicity or CHF. Arrhythmias for which digoxin is indicated may also be a reflection of
toxicity. Impaired renal function: Excretion may be decreased, leading to digoxin
accumulation and toxicity; adjust dosage. Electrolyte imbalance: Maintain normal serum
potassium, calcium, and magnesium levels. Lanoxicaps: Have greater bioavailability
than standard tablets. The 0.2 mg capsule is equivalent to 0.25 mg tablet; the 0.1 mg
capsule to 0.125 mg tablet; the 0.05 mg capsule to 0.0625 mg tablet.

PATIENT CARE CONSIDERATIONS

Administration/Storage
Administer IM doses deep into gluteal muscles and massage well to reduce painful, local
reactions. IM route should be avoided; use only when other routes not available.
Do not use solutions that are discolored or contain precipitate if dilution for IV
administration is desired.
For IV administration, digoxin injection may be diluted (up to 4-fold) with normal saline,
D5W, or Sterile Water for Injection. Infuse slowly, over 5 min or longer.
Do not mix digoxin solution with other drugs.
Before administering loading dose, determine if patient has taken digoxin or other
digitalis preparation in past 2 wks.

Assessment/Interventions
Obtain patient history, including drug history and any known allergies.
Monitor apical pulse for 1 full min before administering. Withhold dose and notify
physician if pulse rate is < 60 bpm in adult, < 70 bpm in child, or < 90 bpm in infant.
Assess for peripheral edema and auscultate lungs for rales/crackles before and
throughout therapy.
Plan for dosage adjustments when changing from parenteral to oral (and vice versa) route
of administration.
Notify physician if signs of toxicity occur (eg, abdominal pain, anorexia, nausea,
vomiting, visual disturbance, bradycardia, ECG changes, arrhythmias, headache,
seizure). Be prepared to administer digoxin antibodies (digoxin-immune Fab) for severe
overdose toxicity.
Measure and record patient's daily weight and I&O.
Monitor serum electrolyte levels, renal and hepatic function studies, and digoxin serum
levels and report changes to physician.

OVERDOSAGE: SIGNS & SYMPTOMS

May involve signs and symptoms of the following: GI tract (eg, anorexia, nausea,
vomiting, diarrhea); nervous system (eg, headache, weakness, apathy, drowsiness,
visual disturbances such as blurred, yellow or green vision, halo effect),
depression, confusion, restlessness, disorientation, seizures, EEG abnormalities;
delirium, hallucinations, neuralgia and psychosis; cardiovascular system (eg,
ventricular tachycardia, PVCs, paroxysmal and nonparoxysmal nodal rhythms,
AV dissociation, accelerated nodal rhythm and premature atrial contraction with
block, atrial fibrillation, ECG changes, all alterations in cardiac rate and rhythm).
Conduction disturbances are common manifestations of toxicity in children.

Patient/Family Education
 Instruct patient to take digoxin at same time each day to ensure steady-state
dosing and to contact physician for instructions if dose is missed.
 Teach patient and family name, action, administration, side effects, and toxic
effects of particular digoxin preparation.
 Emphasize importance of regular follow-up exams to determine effectiveness and
to monitor for toxicity.
 Caution patient to avoid taking otc medications without consulting physician.
Antacids and antidiarrheals, for example, slow absorption of digoxin.
 Teach patient and family to take pulse and to seek physician's advice for rates
lower than 60 bpm or higher than 100 bpm (adults).
 If patient is directed by physician, help identify ways to supplement potassium
intake.
4. Sprironolactone
Class: Potassium-sparing diuretic

Action Competitively inhibits aldosterone in distal tubules, resulting in increased

excretion of sodium and water and decreased excretion of potassium.

Indications Short-term preoperative treatment of primary hyperaldosteronism; long-term

maintenance therapy for idiopathic hyperaldosteronism; management of edematous
conditions in CHF, cirrhosis of liver and nephrotic syndrome; management of essential
hypertension; treatment of hypokalemia. Unlabeled use(s): Treatment of hirsutism; relief
of PMS symptoms; short-term treatment of familial male precocious puberty; and short-
term treatment of acne vulgaris.

Contraindications Anuria; acute renal insufficiency; impaired renal excretory function;

hyperkalemia.

Route/Dosage

Diagnosis of Primary Hyperaldosteronism

ADULTS: PO 400 mg/day for 4 days (short test) or 3 to 4 wk (long test).

Maintenance Therapy for Hyperaldosteronism

ADULTS: PO 100 to 400 mg daily in single or divided doses.

Edema

ADULTS: PO 25 to 200 mg/day in single or divided doses. CHILDREN: PO 3.3

mg/kg/day in single or divided doses.

Essential Hypertension

ADULTS: PO 50 to 100 mg/day in single or divided doses. CHILDREN: PO 1 to 2

mg/kg bid.

Diuretic-Induced Hypokalemia

ADULTS: PO 25 to 100 mg/day when oral potassium or other potassium-sparing

regimens are inappropriate.
Interactions
ACE inhibitors: May result in severely elevated serum potassium levels. Digitalis
glycosides: May decrease digoxin clearance, resulting in increased serum digoxin levels
and toxicity; may attenuate inotropic action of digoxin. Mitotane: May decrease
therapeutic response to mitotane. Potassium preparations: May severely increase serum
potassium levels, possibly resulting in cardiac arrhythmias or cardiac arrest. Do not take
with potassium preparations. Salicylates: May result in decreased diuretic effect.

Lab Test Interferences Drug may cause falsely elevated serum digoxin values with
radioimmunoassay (assay specific) for measuring digoxin.

Adverse Reactions
CNS: Drowsiness; lethargy; headache; mental confusion; ataxia. DERM: Maculopapular
or erythematous cutaneous eruptions; urticaria. GI: Cramping; diarrhea; gastric bleeding;
gastric ulceration; gastritis; vomiting. GU: Inability to achieve or maintain erection.
HEMA: Agranulocytosis. META: Hyperchloremic metabolic acidosis in decompensated
hepatic cirrhosis. OTHER: Gynecomastia; irregular menses or amenorrhea;
postmenopausal bleeding; hirsutism; deepening of voice; drug fever; carcinoma of
breast.

Precautions
Pregnancy: Category D. Lactation: Excreted in breast milk. Electrolyte imbalances and
BUN increase: Hyperkalemia (serum potassium > 5.5 mEq/L), hyponatremia,
hypochloremia and increases in BUN may occur.

PATIENT CARE CONSIDERATIONS

Administration/Storage
If single dose is prescribed, administer in morning.
Take medication with food.
May crush tablets and administer as suspension.
Suspension is stable for 30 days under refrigeration. Protect from light.
Store tablets at room temperature.

Assessment/Interventions
Obtain patient history, including drug history and any known allergies.
Assess fluid and electrolyte status prior to therapy.
Monitor potassium levels. If level is > 5.5 mEq/L, withhold medication and notify
physician.
Monitor serum electrolytes, I&O, weight and BP daily.
Monitor ABGs, liver and renal function studies.
If deep rapid respirations or headaches develop, notify physician.
Assess urinary status. If patient develops frequency, dysuria, edema or reduced urinary
output, notify physician.
Assess for any changes in hepatic status. If patient appears jaundiced and mentally
confused, notify physician.
If nausea, vomiting, distention, diarrhea or anorexia occur, notify physician.
Note any changes in neurologic status. If drowsiness, ataxia, lethargy, confusion or
headache occurs, notify physician.

OVERDOSAGE: SIGNS & SYMPTOMS

Electrolyte imbalance

Patient/Family Education
 Explain that medication's full diuretic effect may not be achieved for 1 to 2 wk.
 Instruct patient to avoid large quantities of potassium-rich foods or potassium salt
substitutes.
 For patient being treated for hypertension, explain that patient may feel tired for
several wks because body needs to adjust to lowered BP.
 Instruct patient to take drug with food to minimize GI irritation.
 Tell patient to weigh self twice wkly and to notify physician of any increase.
 Instruct patient to notify physician if new symptoms develop.
 Tell patient to report these symptoms to physician: GI cramping, diarrhea,
lethargy, thirst, headache, skin rash, menstrual abnormalities, deepening of voice
and breast enlargement in men.
 Advise patient that drug may cause drowsiness and to use caution while driving
or performing other tasks requiring mental alertness.
 Instruct patient not to take prescription or otc medications without consulting
physician.
5. Furosemide
Class: Loop diuretic

Action Inhibits reabsorption of sodium and chloride in proximal and distal tubules and
loop of Henle.

Indications Treatment of edema associated with CHF, hepatic cirrhosis, and renal
disease; hypertension.

Contraindications Hypersensitivity to sulfonylureas; anuria.

Route/Dosage

Edema

ADULTS: PO 20 to 80 mg/day as a single dose; may titrate up to 600 mg/day. IV/IM 20

to 40 mg qd or bid.

Hypertension

ADULTS: PO 40 mg bid. Maximum dose: 6 mg/kg.

CHF and Chronic Renal Failure

ADULTS: PO Up to 2 to 2.5 g/day. IV Up to 2 to 2.5 g/day. Maximum IV bolus: 1 g/day

over 30 min.

Acute Pulmonary Edema

ADULTS: IV 40 mg (over 1 to 2 min). If response not satisfactory within 1 hr, increase

to 80 mg. INFANTS & CHILDREN: PO Usual dose: 0.5 to 2 mg/kg qd or bid.
Maximum dose: 6 mg/kg. IV/IM Usual dose: 1 mg/kg. Maximum dose 6 mg/kg.

Interactions
Aminoglycosides: May increase auditory toxicity. Charcoal: May reduce absorption of
furosemide. Cisplatin: May cause additive ototoxicity. Digitalis glycosides: Electrolyte
disturbances may predispose to digitalis-induced arrhythmias. Lithium: May increase
plasma lithium levels and toxicity. Nonsteroidal anti-inflammatory drugs: May decrease
effects of furosemide. Phenytoin: May reduce diuretic effects of furosemide. Salicylates:
May impair diuretic response in patients with cirrhosis and ascites. Thiazide diuretics:
Synergistic effects that may result in profound diuresis and serious electrolyte
abnormalities. INCOMPATIBILITIES: Gentamicin, milrinone, or netilmicin in D5W or
normal saline: Do not add to furosemide solution; precipitate forms. Highly acidic
solutions of pH < 5.5: Do not mix with furosemide solution.
Lab Test Interferences None well documented.

Adverse Reactions
CV: Orthostatic hypotension; thrombophlebitis; chronic aortitis. CNS: Vertigo;
headache; dizziness; paresthesia; restlessness; fever. DERM: Photosensitivity; urticaria;
pruritus; necrotizing angiitis (eg, vasculitis, cutaneous vasculitis); exfoliative dermatitis;
erythema multiforme; rash; occasionally, local irritation and pain with parenteral use.
EENT: Blurred vision; xanthopsia (yellow vision); tinnitus; hearing impairment. GI:
Anorexia; nausea; vomiting; diarrhea; oral and gastric irritation; cramping; constipation;
pancreatitis. GU: Urinary bladder spasm; interstitial nephritis; glycosuria. HEMA:
Anemia; leukopenia; purpura; aplastic anemia; thrombocytopenia; agranulocytosis.
HEPA: Jaundice; ischemic hepatitis. META: Hyperuricemia; hyperglycemia;
hypokalemia; metabolic alkalosis. OTHER: Muscle spasm; weakness.

Precautions
Pregnancy: Category C. Lactation: Excreted in breast milk. Children: May increase
incidence of patent ductus arteriosus in premature infants with respiratory distress
syndrome, especially in first few weeks of life. Dehydration: Excessive diuresis may
cause dehydration and decreased blood volume with circulatory collapse and possible
vascular thrombosis and embolism, especially in elderly. Diarrhea: Furosemide solution
vehicle contains sorbitol and may induce diarrhea, especially in children. Hepatic
cirrhosis and ascites: Sudden alterations of electrolyte balance may precipitate hepatic
encephalopathy and coma; monitor carefully. Hypersensitivity: Patients with known
sulfonamide sensitivity may show allergic reactions to furosemide. Ototoxicity:
Associated with rapid injection, severe renal impairment, very large doses, or concurrent
use of other ototoxic drugs. Photosensitivity: Photosensitization may occur. Renal
impairment: If severe effects occur, may need to discontinue. If high-dose parenteral
therapy is used, controlled IV infusion is advised. Systemic lupus erythematosus: May be
exacerbated or activated.

PATIENT CARE CONSIDERATIONS

Administration/Storage
Administer oral medication with food to prevent GI irritation.
Administer qd dose in morning and bid doses at 8 AM and 2 PM to avoid nocturia and
sleep disturbance.
Do not exceed infusion rate of 4 mg/min in adults.
Use infusion solutions mixed with cefoperazone sodium in 5% Dextrose within 24 hr if
stored at room temperature and within 5 days if kept refrigerated.
Do not use if discolored.
Store medication at room temperature; avoid excessive exposure to light.
 Assessment/Interventions
Obtain patient history, including drug history and any known allergies. Note renal or
hepatic impairment, systemic lupus erythematosus, hearing impairment or
hypersensitivity to sulfonamides.
Obtain baseline hearing evaluation.
Ensure that baseline BP; apical pulse; weight; serum electrolyte, calcium, glucose, uric
acid, CO2, BUN and serum creatine levels; CBC; and liver and renal function tests have
been obtained before beginning therapy and monitor regularly.
Monitor I&O and weigh patient daily.
Monitor renal function and notify physician if increasing azotemia, oliguria, or increases
in BUN or creatinine occur.
Notify physician if sudden alteration in fluid and electrolyte status is noted.
Monitor for signs and symptoms of hypokalemia.

OVERDOSAGE: SIGNS & SYMPTOMS

Acute profound water loss, volume and electrolyte depletion, dehydration, reduction of
blood volume, circulatory collapse with possibility of vascular thrombosis and
embolism

Patient/Family Education
 Instruct patient to take medication early in day to avoid disruption of sleep from
increased urination and to take with food or milk to avoid GI upset.
 Teach patient to take and monitor pulse daily, especially if patient is taking
cardiac drugs in addition to furosemide.
 Advise patient to eat diet high in potassium. Provide list of suggested foods (eg,
baked potato, bananas, cantaloupe, avocados, dates, raisins, orange juice,
peaches, watermelon).
 Emphasize importance of follow-up visits and frequent assessment of BP while
taking drug.
 Advise patient to control hypertension through weight loss, sodium restriction,
and exercise.
 Explain to diabetic patients that drug may increase blood glucose levels and
affect urine glucose test results, and that glucose levels should be monitored
carefully.
 For patients taking furosemide to lower BP, explain that they may feel fatigued
during the first few weeks of therapy. Instruct patient to continue taking drug, but
to consult with physician if problem persists.
 Instruct patient to report the following symptoms to physician: Indication of
weakness, dizziness, mental confusion, anorexia, lethargy, vomiting, cramps,
persistent headache or fever, abdominal pain, diarrhea, rapid or irregular heart
beat, yellowing of skin or eyes, or dyspnea.
 Caution patient to avoid sudden position changes to prevent orthostatic
hypotension.
 Advise patient to avoid exposure to sunlight and to use sunscreens or wear
protective clothing to avoid photosensitivity reaction.
 Instruct patient not to take aspirin or otc medications without consulting
physician.