DRUG TO DRUG

MEDICATION ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATION

INTERACTION
Caution must be  The use of  Rebound  Perform a physical
Generic Name
Pharmacodynamic Decreases used when there topical nasal congestion examination to
Acetaminophen
s nasal is lesion or decongestants  Local stinging establish baseline data
congestion erosion in the is and burning for assessing the
&
Rapidly absorbed associated with mucous contraindicated which may occur effectiveness of the
Chlorpheniramin
from the GI tract the common membrane that with concurrent the first few drug and the
e
and exerts its cold, allergic could lead to use of times the drug is occurrence of any
antitussive effect in rhinitis. systemic cyclopropane used adverse effects
Brand Name
15-30 minutes absorption. or halothane  Adverse effects associated with drug
after oral anesthesia related to the therapy.
Coricidin
administration. The Caution should because serious sympathomime  Assess skin color and
duration of action also be used in cardiovascular tic effects are temperature to assess
is approximately 3- patients with any effects could more likely to the sympathetic
Classification
6 hours with condition that occur. occur, including response.
Antihistamine
conventional might be  Many OTC feelings of  Evaluate orientation
dosage forms. exacerbated by products, anxiety and reflexes to
Antitusive
sympathetic including cold tenseness, evaluate the central
Pharmacokinetics activity. remedies, restlessness, nervous system (CNS)
Dosage &
Frequency Caution should be allergy tremors, hypert effects of the drug.
&route used in any medications, ension, arrythmi  Monitor pulse, blood
Its metabolites are patient who has and flu a, sweating and pressure, and cardiac
excreted via the an active remedies may pallor. auscultation to assess
Tablet
kidney. Depending infection, contain cardiovascular and
4mg
on the metabolism including pseudoephedri sympathomimetic
30mg
phenotype up to tuberculosis ne; taking many effects.
1 tab every 6
hours; max 4
11% may be because systemic of these  Evaluate respirations
excreted absorption would products and adventitious
tabs/day.
unchanged or up to interfere with the concurrently breath sounds to
100% as inflammatory and can cause assess the
demethylated immune response. serious adverse effectiveness of the
conjugated effects. drug and the potential
morphinan excess effect.
compounds. In the
 first 24 hours after  Evaluate nasal mucous
dosing, less than membrane to monitor
0.1% is eliminated for lesions that could
in the feces. lead to systemic
absorption and to
evaluate the
decongestant effect.
 Monitor urinary
output to evaluate
for urinary retention.
 Monitor temperature
to monitor for the
possibility of acute
infection.

DRUG TO DRUG
MEDICATION ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATION
INTERACTION
 Use with  Colchicine, para-  hives,  Instruct the patient to
Generic Name
Pharmacodynamic A prescription caution in amino salicylic regularly follow
Cyanocobalamin
s medicine used patients with acid and heavy  difficulty recommended dose
to treat the Leber optic alcohol intake breathing, and frequency.
Coenzyme; symptoms of nerve for longer than  Patients should be
Brand Name
metabolic B12 Deficiency, atrophy 2 weeks may  swelling of your warned about the
functions include Pernicious  Parenteral produce face, lips, danger of taking folic
protein synthesis Anemia and as product may malabsorption tongue, or acid in place of vitamin
Nascobal
and carbohydrate Nutritional contain of vitamin B12. throat, B12, because the
Classification
metabolism Supplementati aluminum;  Injection is former may prevent
on toxic incompatible  easy bruising, anemia but allow
Plays role in cell aluminum with warfarin progression of
Nutritional
replication and concentratio and several  unusual subacute combined
Supplementation
 hematopoiesis ns may occur phenothiazines degeneration of the
Dosage & Distributed to liver, with renal bleeding, spinal cord.
Frequency bone marrow, and dysfunction,  Remind the patient
&route other tissues high doses,  purple or red the importance of
Protein bound: or prolonged spots under your returning for follow-up
tablet Binding to use skin, blood tests every 3 to
100mcg transcobalamins  6 months to confirm
250mcg  leg cramps, adequacy of the
500mcg therapy.
1000mcg  constipation,

tablet, extended Pharmacokinetics  irregular

release heartbeats,
1000mcg The bioavailability
of the nasal spray  fluttering in your
tablet, sublingual relative to the chest,
2500mcg intramuscular
injection was found
 increased thirst
injectable to be 6.1%. About
or urination,
solution 3-8 mcg of B12 is
1000mcg/mL secreted into the
 numbness or
GI tract daily via
tingling,
nasal spray the bile. About 80-
500mcg/spray 90% of an
 muscle
intramuscular dose
weakness, and
up to 50 mcg is
retained in the
body; this  limp feeling
percentage drops
to 55% for a 100
mcg dose, and
decreases to 15%
when a 1000 mcg
dose is given.
 DRUG TO DRUG
MEDICATION ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATION
INTERACTION
Generic Name Acetaminophe Acetamenophen Acetamenophen Acetamenophen Acetamenophen
Acetamenophen n is used for
Acetamenophen &
diphenhydramine
the treatment  Hypersensitiv Felodipine- the  Angioedema  Hypersensitivity and
Pharmacodynamic of mild to ity metabolism of  Disorientation anaphylactic reactions
s moderate pain  Severe active Acetaminophen can  Dizziness reported; discontinue
Brand Name and reduction liver disease be decreased when  Pruritic immediately if
Tylenol PM Animal and clinical of fever. combined with maculopapular symptoms of allergic
studies have Felodipine. rash or hypersensitivity
determined that  Rash reactions occur
Classification acetaminophen has Diphenhydram Diphenhydramine Metoprolol- the  Hyperammone  Acetaminophen is
both antipyretic ine metabolism of mia available in many
Dosage & and analgesic is a H1  Documented Acetaminophen can  Stevens- dosage forms and
Frequency&rout effects. This drug receptor hypersensitivi be decreased when Johnson products, check label
e has been shown to antihistamine ty combined with syndrome carefully to avoid
lack anti- used in various  Lower Metoprolol  Toxic epidermal overdose
500mg//Oral inflammatory allergic respiratory necrolysis  Use caution in patients
effects. As opposed reactions tract disease, Furosemide- may  Urticaria with hepatic
to the salicylate including such as acute increase the  Gastrointestina impairment or active
drug class, sneezing, asthma excretion rate of l hemorrhage liver disease
acetaminophen runny nose, (controversial Acetaminophen  Laryngeal  Risk of hepatotoxicity
does not disrupt itchy/watery ) which could result in edema is higher in patients
tubular secretion eyes, itching of a lower serum level  Agranulocytosis taking chronic high
of uric acid and nose or throat and potentially a  Leukopenia dose, or use of more
does not affect and allergic reduction in  Neutropenia than one
acid-base balance if rashes. efficacy.  Pancytopenia acetaminophen-
taken at the  Thrombocytop containing product
recommended Famotidine- the enia  Use caution in patients
doses. metabolism of  Thrombocytop with severe renal
Acetaminophen Acetaminophen can enic purpura impairment; consider
does not disrupt be decreased when  Hepatotoxicity dosage adjustments
hemostasis and combined with  Liver failure  Use caution in patients
does not have Famotidine.  Nephrotoxicity with chronic
inhibitory activities  Pneumonitis malnutrition
against platelet Levofloxacin-  Anaphylactoid  Limit acetaminophen
aggregation.Allergi Acetaminophen dose from all sources
c reactions are rare may decrease the Diphenhydramine and routes to <4 g/day
occurrences excretion rate of in adults
following Levofloxacin which  Sedation
acetaminophen could result in a  Confusion
use. higher serum level.  Anticholinergic
effects Diphenhydramine
Pharmacokinetics Zolpidem- the  May decrease
metabolism of cognitive  Elderly patients:
Upon ingestion, Zolpidem can be function in Considered high-risk
acetaminophen is increased when geriatric medication for this age
rapidly absorbed combined with patients group because it may
from the Acetaminophen. increase risk of falls
 Dry nasal
gastrointestinal and has high incidence
mucosa
(GI) tract and Diphenhydramine of anticholinergic
 Pharyngeal
quickly distributed effects; may
dryness
throughout the Metoprolol- the exacerbate existing
 Thick bronchial
body. Peak plasma metabolism of lower urinary tract
sputum
concentrations are Diphenhydramine conditions or benign
 Tachycardia
achieved within 30 can be decreased prostatic hyperplasia;
 Hypotension
to 60 minutes when combined use in special
 Nervousness
 with Metoprolol.  Restlessness situations may be
Diphenhydramine  Blurred vision appropriate; not
Felodipine- the risk  Palpitations recommended for
Pharmacodynamic or severity of QTc  Constipation treatment of
s prolongation can be  Urinary insomnia, because
increased when retention tolerance develops
Diphenhydramine Felodipine is  Tinnitus and risk of
has anti-histaminic combined with anticholinergic effects
(H1-receptor), anti- Diphenhydramine. increases
emetic, anti-vertigo
and sedative and Docusate- the
hypnotic therapeutic efficacy
properties . The of Docusate can be
anti-histamine decreased when
action occurs by used in combination
blocking the with
spasmogenic and Diphenhydramine.
congestive effects
of histamine by Famotidine- the risk
competing with or severity of QTc
histamine for H1 prolongation can be
receptor sites on increased when
effector cells, Famotidine is
preventing but not combined with
reversing Diphenhydramine.
responses
mediated by Levofloxacin- the
histamine alone. risk or severity of
Such receptor sites QTc prolongation
may be found in can be increased
the gut, uterus, when
large blood vessels, Diphenhydramine is
bronchial muscles, combined with
and elsewhere. Levofloxacin.
 Anti-emetic action
is by inhibition at Zolpidem-
the medullary Diphenhydramine
chemoreceptor may increase the
trigger zone. Anti- central nervous
vertigo action is by system depressant
a central (CNS depressant)
antimuscarinic activities of
effect on the Zolpidem.
vestibular
apparatus and the
integrative
vomiting center
and medullary
chemoreceptor
trigger zone of the
midbrain 
Pharmacokinetics

DRUG TO DRUG
MEDICATION ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATION
INTERACTION
Pharmacodynami Metoprolol  is Hypersensitivity Acetaminophen can  Dizziness  Use with caution in
Generic Name
metoprolol
cs indicated for be decreased when  Headache cerebrovascular
the treatment  Second- combined with  Tiredness insufficiency, CHF, liver
succinate
Administration of of angina, heart and third- Metoprolol.  Depression disease, renal
Brand Name
metoprolol in failure, degree heart  Bradycardia impairment, peripheral
Toprol XL
normal subjects is myocardial block, Diphenhydramine-  Dyspnea vascular disease,
widely reported to infarction, deompensate the metabolism of  Constipation  bronchospastic disease;
produce a dose- hypertension. d heart Diphenhydramine  Heart failure monitor closely
Classification
 dependent failure, sick can be decreased  Hypotension  Beta blockers can cause
Dosage & reduction on heart sinus when combined with  Nausea myocardial depression
Frequency&rout rate and cardiac syndrome Metoprolol.  Heartburn and may precipitate
e output. This effect (except in  Wheezing heart failure and
is generated due patients with Cyanocobalamin-  Bronchospas cardiogenic shock
100mg/ OD/ Oral to a decreased functioning may decrease the m  Sudden discontinuance
cardiac artificial excretion rate of  Postmarketin can exacerbate angina
excitability, pacemaker), Metoprolol which g reports and lead to MI and
cardiac output, severe could result in a  Anxiety/nerv ventricular arrhythmias
and myocardial bradycardia, higher serum level. ousness in patients with CAD
oxygen cardiogenic  Hallucination  Worsening cardiac
demand. In the shock Furosemide- may s failure may occur during
case of increase the  Paresthesia up-titration of
arrhythmias, excretion rate of  Hepatitis metoprolol succinate; if
metoprolol Metoprolol which  Vomiting such symptoms occur,
produces its effect could result in a  Dry eyes increase diuretics and
by reducing the lower serum level  Photosensitiv restore clinical stability
slope of the and potentially a ity before advancing the
pacemaker reduction in efficacy.  Taste dose of metoprolol
potential as well disturbance succinate; it may be
as suppressing the Zolpidem- the necessary to lower the
rate of metabolism of dose of metoprolol
atrioventricular Zolpidem can be succinate or temporarily
conduction. decreased when discontinue it
The Metoprolol combined with  Bradycardia, including
Atherosclerosis Metoprolol. sinus pause, heart block,
Prevention in and cardiac arrest, has
Hypertensives been reported; patients
(MAPHY) trial with 1° atrioventricular
showed a block, sinus node
significant dysfunction, or
improvement in conduction disorders
sudden cardiac may be at increased risk
death and  Increased risk of stroke
myocardial after surgery
infarction when  Caution in patients with
patients were history of psychiatric
given with illness; may cause or
metoprolol as exacerbate CNS
compared with depression
diuretics. As well,
in clinical trials
performed in
1990, metoprolol
reduces mortality
and re-infarction
in 17% of the
individuals when
administered
chronically after
an episode of
myocardial
infarction.

Pharmacokinetics

Metoprolol is a
beta-1-adrenergic
receptor inhibitor
specific to cardiac
cells with
negligible effect
on beta-2
receptors. This
inhibition
decreases cardiac
output by
producing
negative
chronotropic and
inotropic effects
without
presenting activity
towards
membrane
stabilization nor
intrinsic
sympathomimetic
s.

When metoprolol
is administered
orally, it is almost
completely
absorbed in the
gastrointestinal
tract. The
maximum serum
concentration is
achieved 20 min
after intravenous
administration
and 1-2 hours
after oral
administration.
The bioavailability
of metoprolol is of
100% when
administered
intravenously and
when
administered
 orally it presents
about 50% for the
tartrate derivative
and 40% for the
succinate
derivative.
The absorption of
metoprolol in the
form of the
tartrate derivative
is increased by the
concomitant
administration of
food.

DRUG TO DRUG
MEDICATION ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATION
INTERACTION
Renal or hepatic  Administer drug on an
Generic Name
Pharmacodynamic Indicated for impairment. They Severe Interactions  Vomiting empty stomach, 1
s the should be used of fexofenadine  Headache hour before or 2 hours
Fexofenadine
symptomatic with caution in include:  Cough after meals, to
hydrochloride
The mechanism of treatment of renal or hepatic  grapefruit  Diarrhea increase the
Brand Name
action of allergic rhinitis impairment, Serious Interactions  Upper absorption.
fexofenadine is to and chronic which could alter of fexofenadine respiratory tract  Because of the drying
selectively idiopathic the metabolism include: infection nature of
Allegra
antagonize H1 urticaria. and excretion of  isocarboxazi  Back pain antihistamines,
 receptors on the the drug. d  Muscle pain suggest sugarless
Classification surface of cells on Arrhythmias.  ivacaftor  Fever candies or lozenges to
multiple different Special care  tranylcypro  Menstrual relieve some of the
Antihistamine organ systems. It is should be taken mine cramps discomforts.
a second- when these drugs Moderate  Dizziness  Provide safety
Dosage & generation H1 are used by any Interactions of  Stomach measures as
Frequency receptor blocker patient with a fexofenadine discomfort or appropriate if CNS
&route and is non- history of include: upset effects occur to
sedating. arrhythmias or  bosutinib  Pain in prevent patient injury.
Orally Fexofenadine also prolonged QT  crizotinib extremities  Increase humidity and
disintegrating affects intervals because  crofelemer  Drowsiness push fluids to
tablets (ODT) inflammatory fatal cardiac  daclatasvir  Runny or stuffy decrease the problem
30mg mediators. arrhythmias have  eliglustat nose of thickened
been associated  eluxadoline  Nausea secretions and dry
Oral Suspension Pharmacokinetics with the use of  lomitapide  Sleepiness nasal mucosa.
30mg/ml certain  lurasidone  Tiredness  Have patient void
antihistamines  nefazodone before each dose to
Tablets Fexofenadine and drugs that  ombitasvir/ decrease urinary
30mg hydrochloride increase QT paritaprevir retention if this is a
60mg was rapidly intervals, /ritonavir problem.
180mg absorbed following including  phenelzine  Provide skin care as
oral administration erythromycin.  ponatinib needed if skin dryness
Adult: 180 mg of a single dose of  quinidine and lesions become a
orally once/day two 60 mg capsules  sofosbuvir/e problem to prevent
or 60 mg orally to healthy male lbasvir skin breakdown.
twice daily volunteers with a  vemurafeni  Avoid
mean time to b alcohol. Caution the
maximum plasma patient to avoid
concentration alcohol while taking
occurring at 2.6 these drugs because
hours post-dose. serious sedation can
occur.
 DRUG TO DRUG
MEDICATION ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATION
INTERACTION
Pharmacodynamics  Treatm  Hypersensi  Alcohol -  GI bleeding  baseline
Generic Name
Aspirin EC
Inhibits cyclo- ent for tivity to NSAIDs may  gastric assessment
oxygenase enzyme mild to salicylates increase risk of mucosal lesions o do not
Brand Name
via acetylation. moderate  Asthma, GI effects  dehydrated give to patient who
Ecotrin
Inhibits formation pain, fever. rhinitis, aspirin (ulceration)  children may recently had viral
of prostaglandin  Reduce intolerance  Antacids, experience infection
Classification
derivative s  nasal Urinary aspirin toxicity o history of
thromboxane A. Inflammati polyps Alkalinizers - quickly GI bleeding
Anticoagulants,
Antiplatelets and
Therapeutic Effect: on related  inherited or increases  Reye’s  monitor urinary
Reduces to acquired excretion syndrome pH
Thrombolytics/
Nonsteroidal
inflammatory Rheumatoi bleeding Anticoagulants, (persistent  assess skin for
response, intensity d Arthritis disorders heparin, vomiting, signs of evidence of
Anti-
inflammatory
of pain; decreases (RA),  children thrombolytics, brain ecchymosis
Drugs (NSAIDs)
fever; inhibits juvenile younger than rivaroxaban - dysfunction) -  evaluate for
platelet arthritis, 16 years increases risk of may occur with therapeutic response
Dosage &
aggregation. osteoarthri  do not use bleeding recent viral (relief of pain,
Frequency tis, for at least 7 infection stiffness, swelling)
Adults/ Elderly:
Pharmacokinetics rheumatic days after  tachycardia,  instruct patient to not
Rapidly and fever. tonsillectomy dizziness, chew, crush, dissolve
325 - 650 mg q4-
completely platelet or oral flushing, pruritus, or divide enteric-
6h/Oral
absorbed from GI aggregation surgery diaphoresis, coated tablets
tract; enteric- inhibitor in the hyperventilation,
Stock Dose
coated absorption prevention of thirst
Caplets: 325 mg,
500 mg.
delayed; rectal transient  respiratory
absorption delayed ischemic failure, seizures,
Suppositories:
and incomplete. attack, cerebral restlessness,
300 mg, 600 mg.
Tablets: 325 mg. Protein binding: thromboembol abnormal
Tablets High. Widely ism, MI or breathing
(Chewable): 81 distributed. Rapidly reinfarction. patterns, coma
mg hydrolyzed to
salicylate. Half-life:
15–20 min
(aspirin); 2–3 hrs
(salicylate at low
dose); more than
20 hrs (salicylate at
high dose).

DRUG TO DRUG
MEDICATION ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATION
INTERACTION
Pharmacodynamics  Chroni  Presence None Significant  Atonic non-  question usual
Generic Name
Decreases surface c of abdominal functioning colon stool frequency,
docusate sodium
film tension by Constipatio pain which is and consistency
Brand Name
mixing liquid with n not hypokalaemia  screen for
Colace
bowel contents.   Adjunc constipation- (prolonged use); intestinal obstruction
t in related, ear pain or  assess hydration
Pharmacokinetics abdominal nausea and inflammation status
Classification
class of
Minimal absorption radiological vomiting, (otic).  encourage
softeners,
from GI tract. Acts procedures intestinal  Gastrointesti adequate fluid intake
emollients
in small and large  softeni obstruction nal disorders:  assess bowel
intestines. Results ng of ear (oral, rectal); Burning sounds for peristalsis
laxatives
usually occur 1–2 wax rectocolitis, sensation in the  monitor daily
days after first dose constipation  ileus, mouth and pattern of bowel
Dosage &
but may take 3–5 inflammatory throat (oral activity, stool
Frequency
days. bowel solution); consistency
Adult: 50-
500mg/day/OD/
disease, anal anorectal pain or  record time of
bleeding, bleeding (rectal). evacuation
Oral
Children 2-11 haemorrhoids Rarely,  take measures to
years: 50- or anal diarrhoea, promote defecation
150mg/day/OD fissures nausea,  high fiber diet
or divided  (rectal). abdominal  advise to not use for
doses/Oral  Otic: cramps longer than 1 week
Eardrum  General
Stock Dose perforation, disorders and
Capsules: 50 mg, ear administration
100 mg, 250 mg. inflammation site conditions:
Liquid: 50 mg/5 or pain.  Rarely,
mL. Syrup: 60  Oral: application site
mg/15 mL. Concomitant reactions
use with including
mineral oil transient stinging
laxatives (e.g. or irritation
liquid (otic).
paraffin).  Skin and
subcutaneous
tissue disorders:
Rash, pruritus;
contact
dermatitis,
allergic skin
reactions (otic).

DRUG TO DRUG
MEDICATION ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATION
INTERACTION
Pharmacodynamics  Furose  Document  Furosemide   diarrhea,  Assess fluid status.
Generic Name
mide is ed may  constipation, Monitor daily
Furosemide Furosemide a loop hypersens increase the  loss of weight, intake and
manages diureti itivity to ototoxic appetite, output ratios,
hypertension and c used furosemid potential of  numbness or amount, skin
Brand Name edema associated to treat e or aminoglycos tingling, turgor, and
with congestive hypert sulfonami ide  headache, mucous
Lasix
heart failure, ension des antibiotics,  dizziness membranes.
cirrhosis, and renal and  Hypersens especially in  blurred  Notify health care
Classification         disease, including edema itivity; the vision professionals if
                               nephrotic in  Cross- presence of  Excess uric thirst, dry mouth,
syndrome. conges sensitivity impaired acid in the lethargy,
Diuretics Furosemide is a tive with renal blood weakness,
potent loop heart thiazides function. (hyperuricem hypotension, or
diuretic that works failure, and Except in ia) oliguria occurs.
to increase the liver sulfonami life-  Low blood  Monitor BP and
Dosage & excretion of Na+ cirrhosi des may threatening pulse before and
potassium
Frequency and water by the s, renal occur; situations, during
levels
20mg IV Push x 1 kidneys by disease  Hepatic avoid this administration. 
(hypokalemia
inhibiting their , and coma or combination )  Geri:  Diuretic use
reabsorption from hypert anuria .  Postmarketin is associated with
the proximal and ension  Some  Furosemide g side effects increased risk for
distal tubules, as  Furose liquid should not of falls in older
well as the loop of mide is products be used furosemide adults. Assess falls
Stock Dose
Henle. indicat may concomitant reported risk and
It works directly ed for contain ly with include: implement fall
Tablet:
20mg, 40mg and
acts on the cells of the alcohol, ethacrynic  toxic prevention
the nephron and treatm avoid in acid epidermal strategies.
80 mg
indirectly modifies ent of patients because of necrolysis  Assess patient’s
the content of the edema with the  Stevens- for tinnitus and
renal filtrate. associa alcohol possibility of Johnson hearing loss.
Ultimately, ted intoleranc ototoxicity. Syndrome Audiometry is
furosemide with e Patients  erythema recommended for
increases the urine conges  diabetes. receiving multiforme patients receiving
output by the tive  a type of high doses  drug rash prolonged high-
kidney.  heart joint of with dose IV therapy.
Protein-bound failure, disorder salicylates eosinophilia Hearing loss is
furosemide is cirrhosi due to concomitant and systemic most common
delivered to its site s of the excess ly with symptoms after rapid or
of action in the liver, uric acid LASIX, as in  acute high-dose IV
kidneys and and in the rheumatic generalized administration in
secreted via active renal blood disease, exanthemato patients with
secretion by disease called may us pustulosis decreased renal
nonspecific organic , gout. experience  exfoliative function or those
transporters includi  low salicylate dermatitis taking other
expressed at the ng the amount of toxicity at  bullous ototoxic drugs.
luminal site of nephro magnesiu lower doses pemphigoid 
action. tic m in the because of purpura
Pharmacokinetics syndro blood. competitive  itching
me, in  low renal
Furosemide adults. amount of excretory
promotes diuresis  Oral calcium in sites.
by blocking tubular furose the blood.  Furosemide 
  
reabsorption of mide is  low is not given
sodium and indicat amount of in lower
chloride in the ed sodium in doses and
proximal and distal alone the blood. with
tubules, as well as for the  low positive
in the thick manag amount of fluid
ascending loop of ement potassium balance
Henle.  of mild in the when used
This diuretic effect to blood. to achieve
is achieved through moder  low forced
the competitive ate amount of diuresis
inhibition of hypert chloride in during
sodium-potassium ension the blood. cisplatin
-chloride or  treatment.
cotransporters severe
(NKCC2) expressed hypert
along these tubules ension
in the nephron, in
preventing the combin
transport of ation
 sodium ions from with
the lumenal side other
into the basolateral antihyp
side for ertensi
reabsorption. This ve
inhibition results in medica
increased excretion tions.
of water along with Intravenous
sodium, chloride, furosemide is
magnesium, indicated as
calcium, and adjunctive
hydrogen.  therapy in
acute
pulmonary
edema when a
rapid onset of
diuresis is
desired.

DRUG TO DRUG
MEDICATION ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATION
INTERACTION
Pharmacodynamics  Famoti  Hypersens  Famotidine  headache;  Assess the History:
Generic Name
dine is itivity to can reduce the  dizziness; or Allergy to
Famotidine Famotidine indicated in famotidine or absorption of  constipation famotidine; renal
decreases the adult other H2- other drugs, or diarrhea. failure; hepatic
Brand Name production of patients receptor due to its effect  Confusion, impairment
Pepcid, Zantac gastric acid, (with the antagonists. on reducing hallucination  Assess Physical:
360 suppresses acid body  Famotidine is intragastric s, agitation, Skin lesions; liver
concentration and weight of contraindicat acidity, leading lack of evaluation,
Classification         pepsin content, 40 kg and ed in patients to loss of energy; abdominal
                               and decreases the above) for with a history efficacy of the  a seizure; examination,
Histamine H2
volume of gastric the of serious concomitant  fast or normal output;
secretion. manageme hypersensitivi drug. pounding renal function
antagonist
Famotidine inhibits nt of active ty reactions Concomitant heartbeats, tests, serum
both basal and duodenal (e.g., administration of sudden bilirubin
Dosage &
nocturnal gastric ulcer (DU), anaphylaxis) PEPCID with dizziness (like  Notify the
Frequency
acid secretion, as active to famotidine dasatinib, you might physician if the
20mg bid well as acid gastric or other H2 delavirdine pass out); or patient
secretion ulcer, receptor mesylate,  unexplained experience 
Stock Dose stimulated by food, symptomati antagonists. cefditoren, and muscle pain, Constipation or
caffeine, insulin, c non- fosamprenavir is not tenderness, diarrhea; loss of
injection solution and pentagastrin. erosive recommended. See or weakness libido or
(Rx) Famotidine has a gastroesop the prescribing especially if impotence
 10mg/mL dose-dependent hageal information for you also have (reversible);
 0.4mg/mL therapeutic action, reflux other drugs fever, headache (adjust
oral suspension with the highest disease dependent on unusual lights,
(Rx) dose having the (GERD), and gastric pH for tiredness, temperature,
 40mg/5 most extended erosive absorption for and dark noise levels).
mL (generic) duration of action esophagitis administration colored  Report sore throat,
tablet (OTC) and the highest due to instructions, urine. fever, unusual bruising
 10mg inhibitory effect on GERD, including atazanavir, or bleeding, severe
(Pepcid AC, gastric acid diagnosed erlotinib, headache, muscle or
Zantac 360, secretion. by biopsy. ketoconazole, joint pain.
generic) Following oral  It is itraconazole,  
 20mg administration, the also ledipasvir/sofosbuvi
(Pepcid AC, onset of action is indicated r, nilotinib, and
Zantac 360, within one hour, in adult rilpivirine. 
generic) and the peak effect patients
 40mg is reached within 1- for the
(Pepcid AC, 3 hours. The treatment
generic) duration of effect is of
tablet, chewable about 10-12 hours. pathologic
(OTC)   al
Pharmacokinetics hypersecr
 10mg
 (Pepcid AC, etory
generic) Histamine acts as a conditions
 20mg local hormone that (e.g.,
(Pepcid AC) stimulates the acid Zollinger-
output by parietal Ellison
cells via a paracrine Syndrome,
mechanism. multiple
Neuroendocrine endocrine
cells called neoplasias
enterochromaffin- ) and
like (ECL) cells lie reduction
close to the of the risk
parietal cells and of DU
regulate the basal recurrence
secretion of .
histamine.
Histamine release
is also promoted
from stimulation by
acetylcholine
Gastrin (G) cells
release gastrin,
which works on
CCK2 receptors on
ECL cells. 

DRUG TO DRUG
MEDICATION ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATION
INTERACTION
Pharmacodynamics Indicated in  Contraindic  Concurrent  Headache,  Monitor any signs
Generic Name
adult patients ated in persons administration  Hunger, or symptoms of liver
Levofloxacin is for the with known of Levaquin  Sweating, injury including: loss
Levofloxacin rapidly and treatment of hypersensitivity with antacids  Irritability, of appetite, nausea,
essentially community- to levofloxacin, containing  Dizziness, vomiting, fever,
Brand Name completely acquired or other magnesium, or  Nausea, weakness, tiredness,
absorbed after oral pneumonia quinolone aluminum, as  Elevated right upper quadrant
Levaquin administration. due to antibacterial well as heart rate, tenderness, itching,
Peak plasma methicillin-  The risk of sucralfate,  Feeling yellowing of the skin
concentrations are susceptible developing metal cations anxious or shaky, and eyes, light colored
Classification usually attained Staphylococcus fluoroquinolon such as iron,  Numbness or bowel movements or
one to two hours aureus, e-associated and tingling in your dark colored urine.
A member of the after oral dosing.  Streptococcus tendinitis and multivitamin hands, arms, legs  Inform patient
fluoroquinolone Undergoes limited pneumoniae tendon rupture preparations or feet, that diarrhea is a
class of metabolism in (including is increased in with zinc may  Weakness in common problem
antibacterial humans and is multi-drug- patients over interfere with your arms, caused by antibiotics
agents primarily excreted resistant 60 years of age, the hands, legs or which usually ends
as unchanged drug Streptococcus in those taking gastrointestinal feet, when the antibiotic is
Dosage & in the urine. pneumoniae corticosteroid absorption of  Burning pain discontinued
Frequency [MDRSP]), drugs, and in levofloxacin, in your arms,  Instruct patients
Pharmacokinetics Haemophilus patients with resulting in hands, legs or to contact their
250mg daily - influenzae, kidney, heart or systemic levels feet, healthcare provider if
IVPB Clinically relevant Haemophilus lung considerably  Serious they experience pain,
range (1 to 10 parainfluenzae, transplants lower than mood or swelling, or
mcg/mL) of Klebsiella  Associated desired. behavioral inflammation of a
Stock Dose serum/plasma pneumoniae, with an  Enhances tendon, or weakness
changes
levofloxacin Moraxella increased risk the effects of  Tendon or inability to use one
Tablets is 250 concentrations, catarrhalis, of central warfarin. of their joints; rest
rupture
mg, 500 mg, or levofloxacin is Chlamydophila nervous system Elevations of and refrain from

750 mg approximately 24 pneumoniae, (CNS) effects, the exercise; and
administered to 38% bound to Legionella including prothrombin discontinue Levaquin
orally every 24 serum proteins pneumophila, convulsions, time in the treatment.
hours across all species or Mycoplasma toxic psychosis, setting of  Inform patients
studied, as pneumoniae increased concurrent that peripheral
determined by the intracranial warfarin and neuropathies have
equilibrium dialysis pressure Levaquin use been associated with
method. (including have been levofloxacin use, If
 Levofloxacin is pseudotumor associated with symptoms of
mainly bound to cerebri) in episodes of peripheral neuropathy
serum albumin in patients with bleeding. including pain,
humans. Peripheral  Disturbance burning, tingling,
Levofloxacin Neuropathy. s of blood numbness and/or
binding to serum  Have glucose, weakness develop,
proteins is neuromuscular including immediately
independent of the blocking hyperglycemia discontinue Levaquin
drug activity and and and tell them to
concentration. may exacerbate hypoglycemia, contact their
muscle have been physician.
weakness in reported in
patients with patients
myasthenia treated
gravis. concomitantly
with
fluoroquinolon
es and an
antidiabetic
agent.

DRUG TO DRUG
MEDICATION ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATION
INTERACTION
Pharmacodynamics Indicated for  Contraindi  Ketoconazol  Chest pain,  Monitor Blood
Generic Name
 Following the treatment cated to e, itraconazole, facial edema, Pressure and
Felodipine oral of patients with erythromycin, flu-like illness Heart rate
administration hypertension, Hypotension grapefruit juice,  Arrhythmia,  Instruct the
, felodipine is to lower blood and allergic cimetidine may tachycardia patient to take
almost pressure. reaction to lead to several-  Insomnia, Plendil whole and
Brand Name completely Felodipine fold increases depression,a not to crush or
 absorbed and  Caution in the plasma nxiety chew the tablets.
Plendil undergoes exercise in levels of disorders   Inform the patient
extensive first- patients with felodipine,  Dyspnea, that mild gingival
Classification pass heart failure either due  an pharyngitis, hyperplasia (gum
metabolism or increase in bronchitis swelling) may be
Calcium Channel  Crosses the compromised bioavailability  erythema, experienced.
Blockers blood-brain ventricular or due to a urticaria,  Elderly patient
Dosage & barrier and the function. decrease in leukocytoclastic should start a low
Frequency placenta.  Patients metabolism vasculitis dose of Plendil
 Administra with impaired and prolongs  Instruct the
10mg PO daily tion of Plendil liver function half-life of patient to not
Stock Dose to may have Felodipine drink grapefruit
hypertensive elevated  Significant juice with Plendil.
Tablets, patients, mean plasma interaction may  Instruct the
extended-release peak plasma concentration be anticipated patient to limit
concentrations s of felodipine with sodium intake.
2.5 mg at steady state and may anticonvulsant  Encourage daily
5 mg are about 20% respond to therapy such as moderate exercise.
10 mg higher than lower doses of phenytoin,
after a single Plendil; carbamazepine,
dose. Blood therefore, a or
pressure starting dose phenobarbital
response is of 2.5 mg
correlated once a day is
with plasma recommended
concentrations 
of felodipine.

Pharmacokine
tics

 It
reversibly
 competes with
nitrendipine
and/or other
calcium
channel
blockers for
dihydropyridin
e binding sites,
blocks voltage-
dependent
Ca++ currents
vascular
smooth
muscle and
atrial cells, and
blocks
potassium-
induced portal
vein.
 Mean peak
concentrations
following the
administration
of Plendil are
reached in 2.5
to 5 hours.

DRUG TO DRUG
MEDICATION ACTION INDICATION CONTRAINDICATION ADVERSE EFFECTS NURSING CONSIDERATION
INTERACTION
Pharmacodynamics Contraindicated Overdose may Assess B/P, pulse,
Generic Name
to patients who produce: respirations, mental
Zolpidem is a short- Insomnia, short are in the Alcohol, other CNS  severe ataxia status, sleep patterns.
Zolpidem
 acting term following depressants (e.g., (clumsiness, Raise bed rails, provide
nonbenzodiazepine treatment; conditions: gabapentin, unsteadiness), call light. Provide an
Brand Name hypnotic and it insomnia with Lorazepam,  bradycardia environment conducive to
interacts with difficulty of  drug morphine) may  diplopia sleep (back rub, quiet
Ambien, Edluar gamma- sleep/onset abuse increase CNS  severe environment, low
aminobutyric acid maintenance. depression. drowsiness lighting). Do not give
Classification (GABA) -  depressio  nausea unless a full night of sleep
benzodiazepine n HERBAL: Gotu kola,  vomiting is planned
sedative- receptor kava kava, valerian  difficulty
hypnotics complexes and  aggressive may increase CNS breathing Monitor sleep pattern of
shares some of the behavior depression.  unconsciousn pt. Evaluate for
Dosage & pharmacological ess.  therapeutic response to
Frequency properties of  attention St. John’s wort may insomnia: decrease in
benzodiazepines. deficit decrease Abrupt withdrawal number of nocturnal
PO 5 mg at Most GABA (A) disorder with concentration/effect following long term awakenings, increase in
bedtime; EXT REL receptors consist of hyperactivity . use may produce: length of sleep. Monitor
6.25 mg; SL 5 mg alpha, beta, and  weakness daytime alertness,
at bedtime gamma subunits  myastheni FOOD: None known.  facial respiratory rate, behavior
Stock Dose which contain a gravis, a LAB flushing profile
multiple isoforms skeletal  diaphoresis
Tabs 5,10 mg or variants. GABA muscle VALUES: None  vomiting
ext rel tabs 6.25, (A) receptors disorder significant.  tremor 1. Do not abruptly
12.5 mg composed of Drug discontinue
SL: 1.75, 3.5, 5, different subunits  worsening tolerance/depen medication after
10 mg have different of debilitating dence may occur long-term use
Oral spray 5 kinetics, cellular chronic lung with prolonged 2. Avoid alcohol and
mg/spray distributions, and disease called use of high tasks that require
pharmacological COPD dosages. May alertness, motor
profiles cause amnesic skills until
response to drug
 liver events that
Pharmacokinetics include cooking, is established
problems
sleepwalking, 3. Tolerance,
PO: Onset up to 1.5 dependence may
 severe sexual activity,
hr, metabolized by driving occur with
liver disease
liver, excreted by
kidneys, crosses  memory prolonged use of
placenta, excreted loss high dosages.
in breastmilk, half- 4. Do not break,
life 2-3 hr  hallucinati chew, crush,
ons dissolve, or divide
Ambien CR
 sleep tablets; swallow
apnea whole
5. Therapy may need
 weakened to be discontinued
patient if cooking, driving,
sleepwalking
 complex occurs without
sleep recollection
behaviors like Do not take unless a
eating or full 8 hrs of sleep is
driving while planned.
asleep