Terbutaline sulfate

C H E C K
Check why the How will you know the Exact time should the Client teaching tips Key to be given safely.
medication is given. medication will be medication is given.
effective?
To prevent or reverse Relieves bronchospasm TABLETS • Teach patient how to • Use terbutaline cautiously in
bronchospasm from in chronic obstructive Adults and use terbutaline patients with cardiovascular
asthma, bronchitis, or pulmonary disease adolescents age 15 aerosol inhaler or give disease because drug can
emphysema. (COPD) and significantly and over. subcutaneous adversely affect cardiovascular
increases vital capacity. 2.5 to 5 mg three times injection, as needed. function.
Promotes relaxation of a day at 6-hr intervals • Instruct patient not Monitor patient’s heart rate and
vascular smooth muscle, while awake. Maximum: to increase dose or rhythm and blood pressure and
contraction of GI and 15 mg daily. frequency without assess for chest pain.
urinary sphincters, consulting prescriber. • For subcutaneous use, inject
increase in renin, Children ages 12 to • Urge patient to seek into lateral deltoid area.
pancreatic beta-cell 15: immediate medical • Assess patient’s respiratory
secretion, and serum 2.5 mg three times attention if symptoms rate, depth, and quality; oxygen
HDL-cholesterol a day at 6-hr intervals worsen. saturation; and activity
concentration. Increases while awake. • Inform patient that tolerance at regular intervals
uterine relaxation Maximum: 7.5 mg daily. she may experience because continuous use of
(thereby preventing or transient nervousness beta2-agonists for 12 months or
abolishing high Children ages 6 to 11: or tremors during longer accelerates the decline
intrauterine pressure). 50 to 75 mcg/kg terbutaline therapy. in pulmonary function.
three times a day at 6-hr
intervals while
awake. Maximum: 150
mcg/kg/dose or
5 mg daily.

C H
Check why the How will you know the
medication is given. medication will be
effective?
To manage premature Beta2- adrenergic
labor in selected agonist clinically effective
patients. in preventing or delaying
preterm labor (tocolytic
effect). Uterine
contractions will
decrease in frequency
and intensity during
treatment.
Ritodrine
E C K
Exact time should the Client teaching tips Key to be given safely.
medication is given.
Start 30 min before Report immediately Monitor continuously for
terminating infusion, 10 any of the following: pronounced dose-related
mg q2h for first 24 h, palpitations, chest adverse effects to maternal and
then 10–20 mg q4–6h pain, dizziness, fetal heart rates and maternal
(max: 120 mg/d) IV 50– respiratory distress, BP while infusion is running.
100 mcg/min, may weakness, tremors, Be alert to S&S of pulmonary
increase by 50 mcg/min sweating or chills. edema.
q10min until uterine Do not breast feed
relaxation is achieved, while taking this drug.
may continue for up to
12 h after contractions
have ceased.
 Nifedipine
C H E C K
Check why the How will you know the Exact time should the Client teaching tips Key to be given safely.
medication is given. medication will be medication is given.
effective?
Vasospastic "variant" or Reduces myocardial To manage angina • Instruct patient to  Monitor BP carefully
Prinzmetal's angina and oxygen utilization and capsules (adalat, apo- swallow E.R. tablets during titration period.
chronic stable angina supply and relaxes and nifed, novo-nifedin, whole, not to crush, Patient may become
without vasospasm. prevents coronary artery nu-nifed, procardia) chew, or break them. severely hypotensive,
Mild to moderate spasm; has little or no Inform her that their especially if also taking
hypertension alone or in effect on SA and AV Adults. Initial: 10 mg empty shells may other drugs known to
combination with a nodal conduction with three times daily, appear in stool. lower BP. Withhold drug
diuretic. therapeutic dosing. increased over 1 to 2 wk • Urge patient to take and notify physician if
Decreases peripheral as needed. nifedipine exactly as systolic BP <90.
vascular resistance and Maintenance: 10 to 20 prescribed, even  Monitor blood sugar in
increases cardiac output. mg three times daily when she’s feeling diabetic patients.
Vasodilation of both Maximum: 180 mg well. Nifedipine has
coronary and peripheral daily, 30 mg/dose. Advise her to notify diabetogenic properties.
vessels is greater than e.r. tablets (adalat xl, prescriber if she  Monitor for gingival
that produced by procardia xl) misses two or more hyperplasia and report
verapamil or diltiazem doses. promptly. This is a rare
and frequently results in • Urge patient not to but serious adverse
reflex tachycardia. To manage take drug within effect (similar to
Decreased peripheral hypertension 1 hour of a high-fat phenytoin-induced
vascular resistance also e.r. tablets (adalat cc) meal or grapefruit. hyperplasia).
leads to a rise in Urge her not to alter
peripheral blood flow, the Adults. Initial: 30 mg the amount of
basis for use of this drug daily. Maintenance: grapefruit in her diet
in treatment of 30 to 60 mg daily, without consulting
Raynaud's phenomenon. increased or decreased prescriber.
Minimal effect on over 7 to 14 days based • Teach patient to
myocardial contractility. on patient response. measure pulse rate
Maximum: 90 mg daily. and
e.r. tablets (adalat pa) blood pressure, and
advise her to call
prescriber if they drop
below accepted
levels. Suggest
keeping a log of
weekly
measurements and
taking it to follow-up
visits.
• Instruct patient to
notify prescriber
immediately about
chest pain, difficulty
breathing, ringing in
ears, and swollen
gums.
• Advise patient to
avoid hazardous
activities until drug’s
CNS effects are
known.
• Urge patient to avoid
alcoholic beverages
because they may
worsen dizziness,
drowsiness, and
hypotension.
• Teach patient to
minimize constipation
by
increasing her intake
of fluids, if allowed,
and dietary fiber.
• Emphasize the need
to comply with
prescribed lifestyle
changes, such as

C H
Check why the How will you know the
medication is given. medication will be
effective?
alcohol moderation,
low-fat or low sodium
diet, regular exercise,
smoking
cessation, stress
reduction, and weight
reduction.
• Emphasize the need
for good oral hygiene
and regular dental
visits.
• Caution patient that
hot tubs, saunas, and
prolonged hot
showers may cause
dizziness and fainting.
• Advise patient to
avoid prolonged sun
exposure and to wear
sunscreen outdoors.
Indomethacin
E C K
Exact time should the Client teaching tips Key to be given safely.
medication is given.
Palliative treatment in Antipyretic and anti- Rheumatoid Arthritis • Urge patient to take  Use indomethacin with
active stages of inflammatory actions Adult: PO 25–50 mg indomethacin extreme caution in
moderate to severe may be related to its b.i.d or t.i.d. (max: 200 capsules with full patients with history of
rheumatoid arthritis, ability to inhibit mg/d) or 75 mg glass of water and to ulcer disease or GI
ankylosing rheumatoid prostaglandin sustained release 1–2 avoid lying down for bleeding because
spondylitis, acute gouty biosynthesis. It is a times/d 15 to 30 minutes NSAIDs such as
arthritis, and potent analgesic. afterward. This helps indomethacin increase
osteoarthritis of hip in Pediatric Arthritis prevent drug from risk of GI bleeding and
patients intolerant to or Child: PO 1–2 mg/kg/d lodging in esophagus ulceration. Expect to use
unresponsive to in 2–4 divided doses and causing drug for shortest time
adequate trials with (max: 4 mg/kg/d) or irritation. Caution possible in these
salicylates and other 150–200 mg/d patient not to open or patients.
therapy. Also used IV to crush capsules.  Be aware that serious GI
close patent ductus Acute Gouty Arthritis • Instruct patient to tract ulceration,
arteriosus in the Adult: PO/PR 50 mg take drug with food or bleeding, and
premature infant. t.i.d. until pain is an antacid to reduce perforation may occur
tolerable, then rapidly GI distress. without warning
taper • Instruct patient to symptoms.
make sure  Elderly patients are at
Bursitis suppository greater risk. To minimize
Adult: PO 25–50 mg stays in rectum at risk, give oral
t.i.d. or q.i.d. (max: 200 least 1 hour. indomethacin with food,
mg/d) or 75 mg • Urge patient to avoid a full glass of water (not
sustained release 1–2 alcohol during suspension), or an
times/d indomethacin therapy. antacid to reduce GI
• Remind patient that distress.
improvement may not  If GI distress occurs,
occur for 2 to 4 weeks withhold drug and notify
after starting prescriber immediately.
indomethacin and that  Use indomethacin
he should continue cautiously in patients
taking drug, as with hypertension, and
prescribed. monitor blood pressure
• Inform breastfeeding closely throughout
patient that therapy. Drug
indomethacin appears  may cause hypertension

C H
Check why the How will you know the
medication is given. medication will be
effective?
in breast milk and or worsen it.
may cause seizures in
infants. Urge her to Shake suspension well
use another feeding before giving it. For
method during arthritis, give up to 100
therapy. mg of daily dose (not
E.R. capsules) at
bedtime to reduce
nighttime pain and
morning stiffness.
Oxytocin
E C K
Exact time should the Client teaching tips Key to be given safely.
medication is given.
To initiate or improve By direct action on Antepartum Inform patient about  Continuously monitor
uterine contraction at myofibrils, produces Adult: IV Start at 1 risks and benefits of contractions, fetal and
term only in carefully phasic contractions mU/min, may increase oxytocin-induced maternal heart rate, and
selected patients and characteristic of normal by 1 mU/min q15min labor. maternal blood pressure
only after cervix is delivery. Promotes milk (max: 20 mU/min) and ECG.
dilated and presentation ejection (letdown) reflex Teach patient to  Discontinue infusion if
of fetus has occurred; in nursing mother, Postpartum recognize and uterine hyperactivity
used to stimulate thereby increasing flow Adult: IV Infuse a total of immediately report occurs.
letdown reflex in nursing (not volume) of milk; also 10 U at a rate of 20–40 adverse drug effects.  Monitor patient
mother and to relieve facilitates flow of milk mU/min after delivery extremely closely during
pain from breast during period of breast first and second stages
engorgement. Uses engorgement. Uterine To Promote Milk of labor because of risk
include management of sensitivity to oxytocin Ejection of cervical laceration,
inevitable, incomplete, increases during Adult: Nasal 1 spray or uterine rupture, and
or missed abortion; gestation period and 1 drop in 1 or both maternal and fetal
stimulation of uterine peaks sharply before nostrils 2–3 min before death.
contractions during third parturition. Not used for nursing or pumping  When giving drug to
stage of labor; elective induction of control postpartum
stimulation to overcome labor. bleeding, monitor and
uterine inertia; control of record vaginal bleeding.
postpartum hemorrhage  Assess fluid intake and
and promotion of output. Watch
postpartum uterine for signs and symptoms
involution. Also used to of water
induce labor in cases of intoxication.
maternal diabetes,
preeclampsia,
eclampsia, and
erythroblastosis fetalis.

Ergonovine
C H E C K
 Check why the How will you know the Exact time should the Client teaching tips Key to be given safely.
medication is given. medication will be medication is given.
effective?
As single agent or in In vascular headache, Postpartum Report severe  Monitor vital signs
combination with exerts vasoconstrictive Hemorrhage cramping for (particularly BP) and
caffeine to prevent or action on previously Adult: PO 0.2–0.4 mg increased bleeding. uterine response during
abort migraine, cluster dilated cerebral vessels, q6–12h until danger of Report any of the and after parenteral
headache (histamine reduces amplitude of atony passes (2–7 d) following: Cold or administration of
cephalalgia), and other arterial pulsations, and IM/IV 0.2 mg q2–4h numb fingers or toes, methylergonovine until
vascular headaches. antagonizes effects of (max: 5 doses) nausea or vomiting, partum period is
Not recommended for serotonin. chest or muscle pain. stabilized (about 1–2 h).
migraine prophylaxis Do not breast feed  Notify physician if BP
because of the while taking this drug. suddenly increases or if
possibility of adverse there are frequent
effects. periods of uterine
relaxation.

Methylergonovine
 C H E C
Check why the How will you know the Exact time should the
medication is given. medication will be medication is given.
effective?
Prevention and It minimizes the risk of Adults: 0.2 mg I.M.;
treatment of postpartum postpartum hemorrhage. repeat q 2 to 4
hemorrhage hours as needed to a
total of five doses.
In emergencies, 0.2 mg
I.V. over 1 minute.
After initial I.M. or I.V.
dose, 0.2
mg P.O. q 6 to 8 hours
for 2 to 7 days;
decrease dosage if
cramping occurs.
K
Client teaching tips Key to be given safely.
● Inform patient and  Know that if used during
family of reason third stage of labor, drug
for using drug and increases risk of
provide reassurance. hemorrhage and
● Tell patient drug infection.
may cause nausea,  When giving I.V., closely
vomiting, dizziness, monitor blood pressure,
increased blood pulse, uterine
pressure, headache, contractions, and
ringing in ears, bleeding.
chest pain, or  Monitor patient for
shortness of breath. adverse effects.
Advise her to report
severe or
troublesome
symptoms.
● As appropriate,
review all other
significant
and life-threatening
adverse reactions and
interactions,
especially
those related to the
drugs and test
mentioned above.

C H
Check why the How will you know the
medication is given. medication will be
effective?
 Cervical ripening Contractions are
qualitatively similar to
 To induce those that occur during
abortion term labor. Has high
success rate when used
 Nonmetastatic as abortifacient before
gestational twentieth week and for
trophoblastic stimulation of labor in
disease (benign cases of intrauterine fetal
hydatidiform death.
mole)
Dinosprostone
E C K
Exact time should the Client teaching tips Key to be given safely.
medication is given.
Cervical ripening ● Advise patient to  Assess for lethargy and
Adults: 0.5 mg stay in supine drowsiness.
endocervical gel position,  Monitor for dizziness,
vaginally; as prescribed, after nausea, and vomiting
if response is poor,may administration. (possible indicators of
repeat in 6 hours (not to ● Instruct patient to drug toxicity).
exceed 1.5 mg in 24 report fever,
hours). Or one 10-mg bleeding, or
vaginal insert. abdominal cramps.
● Tell patient to
To induce abortion avoid douches,
Adults: One 20-mg tampons,
vaginal suppository; tub baths, and sexual
repeat q 3 to 5 hours (not intercourse
to exceed total dosage of for at least 2 weeks
240 mg or duration after receiving drug.
of 48 hours). ● As appropriate,
review all other
Nonmetastatic significant
gestational and life-threatening
trophoblastic adverse reactions
disease (benign and interactions,
hydatidiform especially those
mole) related to the drugs
Adults: Insert one 20-mg mentioned above.
suppository
high into vagina; may
repeat at 3- to
5-hour intervals for up to
2 days if
necessary.

C H
Check why the How will you know the
medication is given. medication will be
effective?
Carboprost tromethanine
E C K
Exact time should the Client teaching tips Key to be given safely.
medication is given.
To induce abortion Effectively stimulates Abortion, Postpartum Report promptly onset Monitor uterine contractions and
between 13th and 20th uterine contraction and is Bleeding of bleeding, foul- observe and report excessive
week of pregnancy, as used to induce abortion Adult: IM Initial: 250 smelling discharge, vaginal bleeding and cramping
calculated from first day over a wide range of mcg (1 mL) repeated at abdominal pain, or pain. Save all clots and tissue
of last menstrual period. gestational age. Useful in 1 ½–3 ½-h intervals if fever. for physician inspection and
Also for refractory treatment of postpartum indicated by uterine Since ovulation may laboratory analysis.
postpartum bleeding. hemorrhage due to response. Dosage may reoccur as early as 2 Check vital signs at regular
uterine atony be increased to 500 wk. post-abortion, you intervals. Carboprost-induced
unresponsive to usual mcg (2 mL) if uterine may wish to consider febrile reaction occurs in more
measures. contractility is appropriate than 10% of patients and must
inadequate after several contraception. be differentiated from
doses of 250 mcg (1 Do not breast feed endometritis, which occurs
mL), not to exceed total while taking this drug. around third day after abortion.
dose of 12 mg or
continuous
administration for more
than 2 d.

Meperidine
C H E C K
 Check why the How will you know the Exact time should the Client teaching tips Key to be given safely.
medication is given. medication will be medication is given.
effective?
Relief of moderate to Control of moderate to Moderate to severe ● Tell patient using  Monitor vital signs. Don’t
severe pain, for severe pain. pain oral solution or give
preoperative Adults: 50 to 150 mg syrup to take drug drug if patient has
medication, for support P.O., I.M., or with a half-glass of significant respiratory or
of anesthesia, and for subcutaneously water to minimize CNS depression.
obstetric analgesia. q 3 to 4 hours as local anesthetic
needed effect.  Reassess patient’s pain
Children: 1.1 to 1.8 ● Caution patient to level after
mg/kg P.O., I.M., avoid driving and administration.
or subcutaneously q 3 to other hazardous
4 hours, not activities, because  Watch for seizures,
to exceed 100 mg/dose drug agitation,
may cause dizziness irritability, nervousness,
or drowsiness. tremors, twitches, and
Preoperative sedation ● Advise patient to myoclonus in patients at
Adults: 50 to 100 mg avoid alcohol. risk for normeperidine
I.M. or subcutaneously ● Instruct ambulatory accumulation (such as
30 to 90 minutes before patient to change those with renal or
anesthesia position slowly to hepatic
Children: 1 to 2.2 avoid orthostatic impairment).
mg/kg I.M. or hypotension.
subcutaneously ● Tell female patient  Use with extreme
30 to 90 minutes before to inform caution in
anesthesia. Don’t prescriber if she is patients with head injury.
exceed adult dosage. pregnant or Drug may increase ICP
breastfeeding. and cause adverse
Support of anesthesia ● As appropriate, reactions that obscure
Adults: Fractional review all other clinical course.
doses (such as 10 significant
mg/ml) by repeated slow and life-threatening  Closely monitor patients
I.V. injections adverse with acute abdominal
or continuous I.V. reactions and pain. Drug may obscure
infusion of a more interactions, diagnosis and clinical

C H
Check why the How will you know the
medication is given. medication will be
effective?
dilute solution (such as especially course of GI condition.
1 mg/ml). those related to the
Dosages should be drugs, tests, herbs,  Evaluate bowel and
individualized. and behaviors bladder function.
mentioned above.  With long-term or
Analgesia during labor repeated use,
Adults: 50 to 100 mg watch for psychological
I.M. or subcutaneously and physical drug
when contractions are dependence and
regular. tolerance.
May repeat q 1 to 3  With pediatric patients,
hours. stay alert for increased
risk of seizures
Magsulfate SO4
E C K
Exact time should the Client teaching tips Key to be given safely.
medication is given.
Orally to relieve acute Effective parenterally as Laxative ●Teach patient about  When giving prolonged
constipation and to a CNS depressant, Adult: PO 10–15 g adverse reactions. or repeated I.V.
evacuate bowel in smooth muscle relaxant once/d infusions, assess
preparation for x-ray of and anticonvulsant in ●Instruct him to report patellar reflex and
intestines. Parenterally labor and delivery, and Preeclampsia, symptoms monitor for respiratory
to control seizures in cardiac disorders. It is a Eclampsia that occur during I.V. rate of 16
toxemia of pregnancy, laxative when taken Adult: IM/IV 4 g in 250 administration. breaths/minute or more.
epilepsy, and acute orally. mL D5W infused slowly,  With I.V. use, monitor
nephritis and for followed by 4–5 g IM in ●Advise patient to blood magnesium level
prophylaxis and alternate buttocks q4h consult prescriber (desired level is 3 to 6
treatment of before using mg/ dl or 2.5 to 5
hypomagnesemia. Hypomagnesemia magnesium if he’s mEq/L).
Topically to reduce Seizures taking  Check for signs and
edema, inflammation, Adult: IM/IV Mild, 1 g other drugs. symptoms of
and itching. q6h for 4 doses; Severe, Magnesium may magnesium toxicity
250 mg/kg infused over delay or (hypotension, nausea,
4h enhance absorption of vomiting, ECG changes,
Child: IV 20–100 mg/kg other drugs. muscle weakness,
q4–6h prn mental or respiratory
● Inform patient that depression, coma).
repeated or prolonged  Keep injectable calcium
use of magnesium on hand to counteract
citrate, magnesium toxicity.
hydroxide, or sulfate  Monitor urine output,
may cause laxative which should measure
dependence. Inform 100 ml or more every 4
him that hours.
healthy diet and  If I.V. magnesium was
exercise can reduce given before delivery,
need for laxatives. assess neonate for
● Tell pregnant signs and symptoms of
female to make sure magnesium toxicity,
prescriber knows she such as neuromuscular
is pregnant or respiratory
before taking drug. depression.
 Monitor electrolyte levels
 ● As appropriate, and liver function tests.
review all other
significant
and life-threatening
adverse
reactions and
interactions,
especially
those related to the
drugs and tests
mentioned above

C H
Check why the How will you know the
medication is given. medication will be
effective?
Butorphanol tartrate
E C K
Exact time should the Client teaching tips Key to be given safely.
medication is given.
Relief of moderate to Analgesic that relieves Pain Relief ●Teach patient how to  Monitor respiratory
severe pain, moderate to severe pain Adult: IM 1–4 mg q3–4h use nasal spray status closely, especially
preoperative or with apparently low as needed (max: 4 properly. after I.V. administration.
preanesthetic sedation potential for mg/dose) IV 0.5–2 mg ● Emphasize  Watch for signs and
and analgesia, dependence. q3–4h as needed importance of using symptoms of withdrawal
obstetrical analgesia Geriatric: IM/IV 0.5–2 drug in long-term use and in
during labor, cancer mg q6–8h Intranasal 1 exactly as prescribed. opioid-dependent
pain, renal colic, burns. mg (1 spray) in one ● Caution patient that patients.
nostril, may repeat in 90 drug may be  Assess elderly patient
s, then may repeat habit-forming. closely for sensitivity to
these 2 doses q3–4h ● Advise patient to drug.
prn avoid driving and
other hazardous
activities until he
knows how drug
affects concentration
and alertness.
● As appropriate,
review all other
significant
and life-threatening
adverse
reactions and
interactions,
especially
those related to the
drugs and behaviors
mentioned above.

Nalbuphine
C H E C K
 Check why the How will you know the Exact time should the
medication is given. medication will be medication is given.
effective?
Symptomatic relief of Analgesic action that IV, IM, SQ: ADULTS,
moderate to severe relieves moderate to ELDERLY: 10 mg q3–
pain. Also, preoperative severe pain with 6h as needed. Do not
sedation analgesia and apparently low potential exceed maximum single
as a supplement to for dependence. dose of 20 mg or daily
surgical anesthesia. dose of 160 mg.
CHILDREN 1 YR
AND OLDER: 0.1–0.2
mg/kg q3–4h as
needed. Maximum: 20
mg/dose, 160 mg/day.
Client teaching tips Key to be given safely.
Avoid alcohol.  Question medical history
• Avoid tasks that as listed in Precautions.
require alertness,  Obtain vital signs before
motor skills until giving medication. If
response to drug is respirations are 12/min
established. or less (20/min or less in
• May cause dry children), withhold
mouth. medication, contact
• May be habit physician. Assess onset,
forming. type, location, duration
of pain. Effect of
medication is reduced if
full pain recurs before
next dose

Bethametasone
 C H E C K
Check why the How will you know the Exact time should the Client teaching tips Key to be given safely.
medication is given. medication will be medication is given.
effective?
Reduces serum calcium Relieves anti- Anti-inflammatory ● Advise patient to  Monitor weight daily and
in hypercalcemia, inflammatory Agent report signs and report sudden increase,
suppresses undesirable manifestations and is an Adult: PO 0.6–7.2 mg/d symptoms of which suggests fluid
inflammatory or immune immunosuppressive IM/IV 0.5–9 mg/d as infection. retention.
responses, produces agent. sodium phosphate ● Tell patient to report  Monitor blood glucose
temporary remission in visual disturbances level for
nonadrenal disease, Topical (long-term drug use hyperglycemia.
and blocks ACTH Child: PO 0.0175–0.25 may cause  Assess serum
production in diagnostic mg/kg/d or 0.5–0.75 cataracts). electrolyte levels for
tests. Topical use mg/m2/d divided q6–8h ● Instruct patient to sodium and potassium
provides relief of Child: IM 0.0175–0.125 eat low sodium, imbalances.
inflammatory mg/kg/d or 0.5–0.75 high potassium diet.  Watch for signs and
manifestations of mg/m2/d divided q6–8h Advise patient to carry symptoms of infection
corticosteroid- medical identification (which drug may mask).
responsive dermatoses. describing drug
therapy.
● Inform female
patients that drug
may cause menstrual
irregularities.
2Caution patient not
to stop taking drug
abruptly.
● As appropriate,
review all other
significant
and life-threatening
adverse
reactions and
interactions,
especially
those related to the

C H
Check why the How will you know the
medication is given. medication will be
effective?
drugs, tests, herbs,
and behaviors
mentioned above.
Vitamin K
E C K
Exact time should the Client teaching tips Key to be given safely.
medication is given.
Drug of choice as Promotes liver synthesis Anticoagulant Maintain consistency  Use cautiously in
antidote for overdosage of clotting factors by Overdose in diet and avoid pregnant or
of coumarin and unknown mechanism. Adult: PO/SC/IM 2.5–10 significant increases breastfeeding patients,
indandione oral Does not reverse mg; rarely up to 50 in daily intake of children, and neonates
anticoagulants. Also anticoagulant action of mg/d, may repeat vitamin K–rich foods (if product contains
reverses heparin. Reportedly parenteral dose after 6– when drug regimen is benzyl alcohol).
hypoprothrombinemia demonstrates wide 8 h if needed or PO stabilized. Know  Avoid P.O. use in
secondary to margin of safety when dose after 12–24 h IV sources rich in vitamin disorders that may
administration of oral used in newborns. Emergency only: 10–15 K: Asparagus, prevent adequate
antibiotics, quinidine, mg at a rate of 1 broccoli, cabbage, absorption.
quinine, salicylates, mg/min, may be lettuce, turnip greens,
sulfonamides, excessive repeated in 4 h if pork or beef liver,
vitamin A, and bleeding continues green tea, spinach,
secondary to watercress, and
inadequate absorption Hemorrhagic Disease tomatoes.
and synthesis of vitamin of Newborns
K (as in obstructive Infant: IM/SC 0.5–1 mg
jaundice, biliary fistula, immediately after
ulcerative colitis, delivery, may repeat in
intestinal resection, 6–8 h if necessary
prolonged
hyperalimentation). Also
prophylaxis of and
therapy for neonatal
hemorrhagic disease.

Dexamethasone
C H E C K
 Check why the How will you know the Exact time should the Client teaching tips Key to be given safely.
medication is given. medication will be medication is given.
effective?
Adrenal insufficiency Drug has anti- Allergies, ● Instruct patient to  Monitor blood glucose
concomitantly with a inflammatory and Inflammation, immediately level closely in diabetic
mineralocorticoid; immunosuppression Neoplasias report sudden weight patients receiving drug
inflammatory conditions, properties. gain, swelling of orally.
allergic states, collagen Adult: PO 0.25–4 mg face or limbs,
diseases, hematologic b.i.d. to q.i.d. IM 8–16 excessive  Monitor hemoglobin and
disorders, cerebral mg q1–3 wk or 0.8–1.6 nervousness or potassium levels.
edema, and Addisonian mg intralesional q1–3 sleep disturbances,
shock. Also palliative wk excessive body hair  Assess for occult blood
treatment of neoplastic growth, vision loss.
disease, as adjunctive Child: PO/IV/IM 0.08– changes, difficulty
short-term therapy in 0.3 mg/kg/d divided q6– breathing, muscle  In long-term therapy,
acute rheumatic 12h weakness, persistent never discontinue drug
disorders and GI abdominal pain or abruptly. Dosage must
diseases, and as a Cerebral Edema change in stool color. be tapered gradually.
diagnostic test for Adult: IV 10 mg followed ● Tell patient to take
Cushing's syndrome by 4 mg q4h, reduce oral drug with or Monitor patient for
and for differential dose after 2–4 d then after meals. increased IOP after
diagnosis of adrenal taper over 5–7 d ● Advise patient to intravitreal injection.
hyperplasia and adrenal report vision
adenoma. Child: PO/IV/IM 1–2 changes and if eye
mg/kg loading dose, becomes red,
then 1–1.5 mg/kg/d sensitive to light, or
divided q4–6h (max: 16 painful after
mg/d) intravitreal implant, to
promptly report this to
Shock ophthalmologist.
Adult: IV 1–6 mg/kg as a ● Inform patient that
single dose or 40 mg drug makes him
repeated q2–6h if more susceptible to
needed infection. Advise
him to avoid crowds
and exposure to
 Dexamethasone illness.
Suppression Test ● Caution patient not
Adult: PO 0.5 mg q6h to stop taking drug
for 48 h abruptly.
● As appropriate,
review all other
significant
and life-threatening
adverse
reactions and
interactions,
especially
those related to the
drugs, tests, herbs,
and behaviors
mentioned above.

C H
Check why the How will you know the
medication is given. medication will be
effective?
Yutopar
E C K
Exact time should the Client teaching tips Key to be given safely.
medication is given.
To manage premature Beta2- adrenergic Premature Labor Report immediately  Monitor continuously for
labor in selected agonist clinically effective Adult: PO Start 30 min any of the following: pronounced dose-
patients. in preventing or delaying before terminating palpitations, chest related adverse effects
preterm labor (tocolytic infusion, 10 mg q2h for pain, dizziness, to maternal and fetal
effect). Uterine first 24 h, then 10–20 respiratory distress, heart rates and maternal
contractions will mg q4–6h (max: 120 weakness, tremors, BP while infusion is
decrease in frequency mg/d) IV 50–100 sweating or chills. running.
and intensity during mcg/min, may increase Do not breast feed Be alert to S&S of
treatment. by 50 mcg/min q10min while taking this drug. pulmonary edema
until uterine relaxation is
achieved, may continue
for up to 12 h after
contractions have
ceased

Hydralazine
C H E C K
 Check why the How will you know the Exact time should the Client teaching tips Key to be given safely.
medication is given. medication will be medication is given.
effective?
For Hypertension Diastolic response is Hypertension ● Tell patient to take  Monitor CBC, lupus
often greater than Adults: Initially, 10 mg tablets with food. erythematosus cell
systolic response. P.O. q.i.d. After ● Instruct patient to studies, and antinuclear
Vasodilation reduces 2 to 4 days, may move slowly when antibody titers before
peripheral resistance and increase to 25 mg P.O. rising (especially in and periodically during
substantially improves q.i.d. for remainder of morning on therapy.
cardiac output, and renal first week; may awakening),  Monitor blood pressure,
and cerebral blood flow. then increase further to to avoid dizziness pulse rate and regularity,
Postural hypotensive 50 mg P.O. from sudden and daily weight To
effect is reportedly less q.i.d., up to 300 mg/day. blood pressure avoid rapid blood
than that produced by Once maintenance decrease. pressure drop, taper
ganglionic blocking dosage is established, 2Instruct patient to dosage gradually before
agents. may give immediately discontinuing.
in two daily doses. report fever,muscle  Assess for lupus like
Children: Initially, 0.75 and joint aches, or signs and symptoms,
mg/kg/day P.O. sore throat. including joint pain,
in four divided doses; ● Tell patient to report fever, myalgia,
may increase chest pain or pharyngitis, and
gradually over 3 to 4 numbness or tingling splenomegaly.
weeks to 7.5 mg/ of hands or feet.  Watch for peripheral
kg or 200 mg/day ● To minimize GI neuritis. If it occurs,
Neonates: 0.5 mg/kg upset, advise patient expect to give
P.O., I.M., or I.V. to eat small, frequent pyridoxine.
q 4 to 6 hours meals.
● Caution patient not
to discontinue
drug abruptly,
because severe
hypertension
may result.
● As appropriate,
review other
significant

C H
Check why the How will you know the
medication is given. medication will be
effective?
and life-threatening
adverse reactions
and interactions,
especially those
related to the drugs,
tests, and behaviors
mentioned above.
Calcium gluconate
E C K
Exact time should the Client teaching tips Key to be given safely.
medication is given.
Rapidly and effectively Hypocalcemia ● Instruct patient to Monitor calcium levels
restores serum calcium emergency consume plenty frequently especially in elderly
levels in acute Adults: 7 to 14 mEq I.V. of milk and dairy patients.
hypocalcemia of various of 10% calcium products during
origins and effective gluconate solution, 2% therapy.
cardiac stabilizer under to 10% ● Refer patient to
conditions of calcium chloride dietitian for help in
hyperkalemia or solution, or 22% calcium meal planning and
resuscitation. gluceptate solution preparation.
Children: 1 to 7 mEq ● As appropriate,
calcium gluconate review all other
I.V. significant
Infants: Up to 1 mEq and life-threatening
calcium gluconate adverse
I.V. reactions and
interactions,
especially
Hypocalcemia tetany those related to the
Adults: 4.5 to 16 mEq drugs, tests, and
calcium gluconate foods mentioned
I.V., repeated as above.
indicated until
tetany is controlled
Children: 0.5 to 0.7
mEq/kg calcium
gluconate I.V. three to
four times daily
as indicated until tetany
is controlled
Neonates: 2.4 mEq/kg
calcium gluconate
I.V. daily in divided
doses

Cardiac arrest
 Adults: 0.027 to 0.054
mEq/kg calcium
chloride I.V., 4.5 to 6.3
mEq calcium
gluceptate I.V., or 2.3 to
3.7 mEq calcium
gluconate I.V.
Children: 0.27 mEq/kg
calcium chloride
I.V., repeated in 10
minutes if
needed. Check calcium
level before
giving additional doses.

Magnesium
intoxication
Adults: Initially, 7 mEq
I.V.; subsequent
dosages based on
patient response

C H
Check why the How will you know the
medication is given. medication will be
effective?
Beractant
E C K
Exact time should the Client teaching tips Key to be given safely.
medication is given.
Beractant is a sterile Beractant lowers Most upper and lower Inform patient that ● Check temperature, and
nonpyrogenic minimum surface tension respiratory tract Rales and moist watch for signs and symptoms
pulmonary surfactant. and restores pulmonary infections; otitis breath sounds can of superinfection.
Endogenous pulmonary compliance and media; skin infections; occur transiently after ● Monitor liver function tests.
surfactant lowers oxygenation in Legionnaires’ disease administration. Watch for signs and symptoms
surface tension on premature infants. Adults: 250 mg P.O. q 6 Endotracheal of hepatotoxicity.
alveolar surfaces during hours, or 333 mg P.O. q suctioning or other ● Assess patient’s hearing for
respiration and 8 hours, or 500 mg P.O. remedial action is not signs of ototoxicity.
stabilizes the alveoli q 12 hours (base, necessary unless
against collapse at estolate, or stearate); or clear-cut signs of
resting pressures. 400 mg P.O. q 6 hours airway obstruction are
Deficiency of surfactant or 800 mg P.O. q present.
causes respiratory 12 hours
distress syndrome (ethylsuccinate); or 250
(RDS) in premature to 500 mg I.V. (up to 1
infants. g) q 6 hours (gluceptate
or lactobionate)
Children: 30 to 50
mg/kg/day (base,
estolate, ethylsuccinate,
or lactobionate)
I.V. or P.O., in divided
doses q 6 hours when
giving I.V. and q 6 to 8
hours when giving
P.O.Maximum
dosage is 2 g/day for
base or estolate,
3.2 g/day for
ethylsuccinate, and 4 g/
day for lactobionate.

Erythromycin ophthalmic ointment

C H E C K
 Check why the How will you know the Exact time should the Client teaching tips Key to be given safely.
medication is given. medication will be medication is given.
effective?
To prevent More active against Moderate to Severe ● Instruct patient to  Report onset of GI
isoimmunization in Rh- gram-positive than gram- Infections take with 8 oz of symptoms after PO
negative individuals negative bacteria. Adult: PO 250–500 mg water 1 hour before or administration to
exposed to Rh-positive Effectiveness against q6h; 333 mg q8h 2 hours after physician. These are
RBC (see above). Chlamydia trachomatis is Child: PO 30–50 meals, and to avoid dose related; if
Rho(D) immune globulin basis for its topical use in mg/kg/d divided q6h grapefruit juice. symptoms persist after
micro-dose is for use prophylaxis of neonatal ● If drug causes GI dosage reduction,
only after spontaneous inclusion conjunctivitis. Topical upset, encourage physician may prescribe
or induced abortion or Apply ointment to patient to take it with drug to be given with
termination of ectopic infected eye 1 or more food. meals in spite of
pregnancy up to and times/d ● Tell patient not to impaired absorption.
including 12 wk of Neonate: PO 7 d, 10 swallow chewable  Monitor for adverse GI
gestation. mg/kg q12h; >7 d, 10 tablets whole and not effects.
mg/kg q8–12h Topical to chew or crush Pseudomembranous
0.5–1 cm in conjunctival enteric-coated tablets. enterocolitis (see
sac once ●Advise patient to Appendix F), a
immediately potentially life-
report irregular heart threatening condition,
beats, unusual may occur during or
tiredness, yellowing of after antibiotic therapy.
skin or eyes, or  Observe for S&S of
signs and symptoms superinfection by
of new infection. overgrowth of no
● Tell patient he’ll susceptible bacteria or
undergo periodic fungi. Emergence of
blood tests to monitor resistant staphylococcal
liver function. strains is highly
● As appropriate, predictable during
review all other prolonged therapy.
significant  Lab tests: Periodic liver
and life-threatening function tests during
adverse prolonged therapy.
reactions and  Monitor for S&S of
 interactions, hepatotoxicity.
especially Premonitory S&S
those related to the include: Abdominal pain,
drugs, tests, and nausea, vomiting, fever,
foods mentioned leukocytosis, and
above. eosinophilia; jaundice
may or may not be
present. Symptoms may
appear a few days after
initiation of drug but
usually occur after 1–2
wk of continuous
therapy. Symptoms are
reversible with prompt
discontinuation of
erythromycin.
 Monitor for ototoxicity
that appears to develop
most frequently in
patients receiving 4 g/d
or more, older adults,
female patients, and
patients with kidney or
liver dysfunction. It is
reversible with prompt
discontinuation of drug.

RHₒ(D) immune globulin (RHOGAM)

C H E C K
Check why the How will you know the Exact time should the Client teaching tips Key to be given safely.
medication is given. medication will be medication is given.
effective?
To prevent Effective for exposure in Antepartum Be aware that Obtain history of systemic
isoimmunization in Rh- Rh-negative women Prophylaxis administration of allergic reactions to human
negative individuals when Rh-positive fetal Adult: IM/IV 1 vial or 300 Rho(D) immune immune globulin preparations
exposed to Rh-positive RBCs enter maternal mcg at approximately 28 globulin (antibody) prior to drug administration.
RBC (see above). circulation during third wk; followed by 1 vial of prevents hemolytic Send sample of newborn's cord
Rho(D) immune globulin stage of labor, fetal- mini-dose or 120 mcg disease of the blood to laboratory for cross-
micro-dose is for use maternal hemorrhage (as within 72 h of delivery if newborn in a match and typing immediately
only after spontaneous early as second infant is Rh-positive subsequent after delivery and before
or induced abortion or trimester), pregnancy. administration of Rho(D)
termination of ectopic amniocentesis, or other Postpartum immune globulin. Confirm that
pregnancy up to and trauma during Prophylaxis mother is Rho(D) and Du-
including 12 wk of pregnancy, termination Adult: IM/IV 1 vial or 300 negative. Infant must be Rh-
gestation. of pregnancy, and mcg within 72 h of positive.
following transfusion with delivery if infant is Rh-
Rh-positive RBC, whole positive
blood, or components
(platelets, WBC) Following
prepared from Rh- Amniocentesis,
positive blood. Miscarriage, Abortion,
Ectopic Pregnancy
Adult: IM 1 vial of the
microdose, preferably
within 3 h but at least
within 72 h

Transfusion Accident
Adult: IM/IV 1 vial or 300
mcg for each volume of
RBCs infused divided by
15, given within at least
72 h of accident