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Pharm Phlash!
Pharmacology Flash Cards
2nd Edition
Valerie I. Leek, MSN, RN, CMSRN
Nursing Faculty Adjunct Faculty (Volunteer)
Cape May County University of Medicine &
Technical School Dentistry of New Jersey
Cape May Courthouse, Newark, New Jersey
New Jersey

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F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2013, 2009 by F. A. Davis Company. All rights
reserved. This book is protected by copyright. No part of it
may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photo-
copying, recording, or otherwise, without written permission
from the publisher.
Printed in China
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Acquisitions Editor: Thomas A. Ciavarella
Director of Content Development: Darlene D. Pedersen
Project Editor: Echo K. Gerhart
Manager of Art and Design: Carolyn O’Brien
As new scientific information becomes available through basic and
clinical research, recommended treatments and drug therapies undergo
changes. The author(s) and publisher have done everything possible to
make this book accurate, up to date, and in accord with accepted stan-
dards at the time of publication. The author(s), editors, and publisher
are not responsible for errors or omissions or for consequences from
application of the book, and make no warranty, expressed or implied, in
regard to the contents of the book. Any practice described in this book
should be applied by the reader in accordance with professional standards
of care used in regard to the unique circumstances that may apply in
each situation. The reader is advised always to check product information
(package inserts) for changes and new information regarding dose and
contraindications before administering any drug. Caution is especially
urged when using new or infrequently ordered drugs.
Authorization to photocopy items for internal or personal use, or the
internal or personal use of specific clients, is granted by F. A. Davis
Company for users registered with the Copyright Clearance Center
(CCC) Transactional Reporting Service, provided that the fee of
$.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers,
MA 01923. For those organizations that have been granted a
photocopy license by CCC, a separate system of payment has been
arranged. The fee code for users of the Transactional Reporting
Service is: 978-0-8036-2994-3/13 0 + $.25.
1882_FM_i-xvi 11/10/12 1:34 PM Page iii

iii

Dedication
Thank you to my loving husband, Dave; my sons, Jeffrey and Zachary; my grand-daughter,
Cadence; and my parents, Pauline and Harry. You are my heart.
A big thank you to all of my nursing students, past, present, and future. You enrich my
life and give me the joy and desire to continue to teach.

Acknowledgments
Thank you to all the nursing professionals who interact so graciously with my nursing
students. A good role model in the clinical setting is priceless. My sincerest thanks to all
the wonderful people I’ve worked with at F.A. Davis Company.
Valerie I. Leek

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Davis’s Success Series

Q&A Course Review and NCLEX Prep
99Thousands of NCLEX-style questions
99Alternate-item-format questions
99Rationales for correct and incorrect answers
Visit www.fadavis.com
Keyword: Success Series to learn more.

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1882_FM_i-xvi 11/10/12 1:34 PM Page vi

The tools for

nclex success!

Visit www.fadavis.com
Keyword: NCLEX to learn more.
1882_FM_i-xvi 11/10/12 1:34 PM Page vii

vii

Reviewers
Deborah S. Bridgewater, RN, MSN
Professor, Coordinator of Academic Support
St. Mary’s School of Nursing
Huntington, West Virginia

Sally K. Davis, RN, MSN

Nursing Instructor
Western Wisconsin Technical College
LaCrosse, Wisconsin

Linda C. McIntosh, PhD, RN, LPC

Psychologist, Addiction (Substance Use Disorder)
Greensboro, North Carolina

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ix

Icons

Gastrointestinal System Drugs Central Nervous System Drugs

Endocrine System Drugs Cardiovascular System Drugs

Urologic System Drugs Respiratory System Drugs

Immune System Drugs Sensory System Affecting the Eye

Musculoskeletal System Drugs

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xi

Abbreviations Used on Cards

ABGs arterial blood gases bpm beats per minute CVP central venous pressure
ac before meals BUN blood urea nitrogen CXR chest x-ray
ACE angiotensin-converting Ca+ serum calcium D5/0.9% 5% dextrose and normal
enzyme cAMP cyclic adenosine NaCl saline solution (0.9% NaCl)
ADH antidiuretic hormone monophosphate D5/1/2 NS 5% dextrose and half
ADHD attention-deficit/hyperactivity cap capsule normal saline solution
disorder CBC complete blood count (0.45% NaCl)
AFB acid-fast bacillus cGMP cyclic guanosine D5W 5% dextrose in water
ALT alanine aminotransferase monophosphate derm dermatology
AM ante meridian CHF congestive heart failure DKA diabetic ketoacidosis
ANA antinuclear antibodies Cl- chloride ion dL deciliter
APAP acetaminophen CNS central nervous system DM diabetes mellitus
aPTT activated partial thrombo- CO cardiac output DMARD disease-modulating
plastin time COPD chronic obstructive pulmonary antirheumatic drug
ARDS adult respiratory distress disease DNA deoxyribonucleic acid
syndrome CPK creatine phosphokinase DVT deep vein thrombosis
ASA acetylsalicylic acid CR controlled or continuous ECG electrocardiogram
AST aspartate aminotransferase release EEG electroencephalogram
AV atrioventricular CSF colony-stimulating factor; EENT eye, ear, nose, and throat
bid two times a day cerebrospinal fluid EMS Emergency Medical Services
BMS bone marrow suppression CT computerized tomography endo endocrine
BNP brain natriuretic peptide CV cardiovascular EPS extrapyramidal symptoms
BP blood pressure CVA cerebrovascular accident ER extended-release
BPH benign prostatic hyperplasia CVC central venous catheter ESRD end-stage renal disease

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xii

F and E fluid and electrolyte hs hour of sleep/bedtime mcg microgram(s)

g gram HTN hypertension MDI metered dose inhaler
GABA gamma-aminobutyric acid 5HT1 5-hydroxytryptamine- mEq milliequivalent
GERD gastroesophageal reflux 1-receptor agonist metab metabolic
disease 5HT3 5-hydroxytryptamine- mg milligram
GFR glomerular filtration rate 3-receptor antagonist Mg+ magnesium ion
GGT gamma-glutamyl ICP intracranial pressure MI myocardial infarction
transpeptidase IM intramuscular min minute(s)
GI gastrointestinal Inhaln inhalation misc miscellaneous
GTT glucose tolerance test INR international normalized mL milliliter
GU genitourinary ratio mo month(s)
H+ hydrogen ion I&O intake and output MRI magnetic resonance
Hb A1c hemoglobin A1c glycoslated IOP intraocular pressure imaging
hemoglobin IT intrathecal MS musculoskeletal
HCO3 bicarbonate IV intravenous Na sodium
HCP health-care professional/ K+ potassium NaCl sodium chloride
provider KCl potassium chloride 0.9% NaCl 0.9% NaCl solution/normal
Hct hematocrit kg kilogram saline
HDLs high-density lipoproteins l liter neuro neurologic
hemat hematologic LA long-acting NG nasogastric
Hgb hemoglobin LDH lactic dehydrogenase NMDA N-methyl-D-aspartate
HIV human immunodeficiency LDLs low-density lipoproteins NPO nothing by mouth
virus LFT liver function tests NRTI nucleoside reverse transcrip-
HMG-CoA 3-hydroxy-3-methylglutaryl- LR lactated Ringer’s solution tase inhibitor
coenzyme A MAO monoamine oxidase NS(S) normal saline (solution)
hr hour(s) MAOIs monoamine oxidase NSAIDs nonsteroidal anti-
HRT hormone replacement therapy inhibitors inflammatory drugs
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OCD obsessive-compulsive RA rheumatoid arthritis subcut (sc) subcutaneously

disorder RANKL receptor activator of nuclear supp suppository
oint ointment factor kappa B ligand tab tablet
ophth ophthalmic RBC red blood cell TB tuberculosis
OTC over-the-counter RDA recommended daily tbs tablespoon(s)
oz ounce(s) allowance TCAs tricyclic antidepressants
pc after meals rect rectum tid three times a day
PCA patient-controlled analgesia REM rapid-eye movement TNF tumor necrosis factor
PCWP pulmonary capillary wedge resp respiratory Top topically or topical
pressure RFT renal function tests tsp teaspoon
PDE5 phosphodiesterase RNA ribonucleic acid VFib ventricular fibrillation
inhibitor type 5 inhibitor Rx prescription VLDL very low-density lipoproteins
PE pulmonary embolus SA sinoatrial VS vital signs
PM post-meridian SAMe S-adenosyl-L-methionine VT ventricular tachycardia
PO by mouth, orally sec second(s) WBC white blood cell
PRN as needed SL sublingual wk week(s)
PSA prostate-specific antigen SNRIs serotonin and norepineph- yr year(s)
PT prothrombin time rine reuptake inhibitors ↑ increased, high
PUD peptic ulcer disease SOB shortness of breath ↓ decreased, low
PVC premature ventricular con- soln solution
tractions SR sustained release
PVD peripheral vascular disease SSRIs selective serotonin reuptake
q every inhibitors
qid four times a day stat immediately

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Introduction
Memorization of drugs as single entities is
almost impossible, even for those with great
recall. After years of trial and error teaching
pharmacology, I decided that grouping the
drugs in body systems and therapeutic or phar-
macologic classes would be the best method of
instruction to promote student recall. Pharm
Phlash! 2nd Edition was created to help students
use body system association linked with drug
classification to aid in drug memorization.
Pharm Phlash! 2nd Edition is a tried-and-true
method of pharmacology instruction. Students
learn to take clues from both the generic and
trade names. When I pose a question such as,
“What kind of drug ends with ‘olol,’ ‘ilol,’ or
‘alol’?” students quickly answer that these are
beta-adrenergic blockers and are used for the
cardiovascular system. What a wonderful
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xv
response! It is also very productive to begin this
process of memorization at the beginning of the
nursing program, using these cards for repetitive
practice. I also recommend that students prac-
tice their knowledge by reinforcing quizzes and
tests. I have written 8 quizzes and 2 tests that
can be accessed on the DavisPlus Web site.
Medications are grouped into systems and
then into pharmacologic classes or therapeutic
classes with similar action. There is a table of
contents for general access and a full index that
will direct you by classification, generic, brand
name, and Canadian brand names. The
cards are designed with the drug names on
the front with their body system designation.
Additionally, frequently used herbal prepara-
tions have been added in the new edition
and are listed in appropriate body systems.
1882_FM_i-xvi 11/10/12 1:34 PM Page xvi
Included are new drug classes, changes in brand
names, and drugs taken off the market. Many
new brand-name drugs are combinations of the
drugs included in Pharm Phlash! 2nd Edition and
are not covered separately. Routes and dosages
are typical for the adult. Pediatric routes and
dosages are not included.
On the back of the cards you will find:
1. Therapeutic/Pharmacologic class (these
are always listed in this order)
2. Indications for use of the drug
3. Action of the drug
4. Adverse Reactions/Side Effects detailing all
reactions; important information will
appear in bold, red type
5. Keep in Mind sections that include client
teaching
6. Make the Connection areas where informa-
tion crucial to safe medication is listed.
xvi
Again, extremely important information is
in bold red type. Laboratory and vital sign
parameters are listed here, along with
nursing implications and evaluative data.
7. Adult route and dosage information is list-
ed at the bottom of each card for all drugs
listed in that classification.
This learning system is not meant to replace
a complete drug reference or pharmacology text.
It is meant as a tool to group and learn com-
mon drugs mentally. Students who employ this
system will “make the connection” and learn
their medications, laboratory values that are
important for safe administration, and vital sign
parameters. Have a great time learning this
important subject!
Valerie I. Leek, MSN, RN, CMSRN
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GASTROINTESTINAL

Calcium Carbonate, 1 Pantoprazole, 7 Docusate Calcium, 19

Calcium Citrate, 1 Lansoprazole, 7 Docusate Sodium, 19
Calcium Gluconate, 1 Misoprostol, 8 Magnesium Oxide, 20
Calcium Acetate, 1 Sucralfate, 9 Magnesium Hydroxide, 20
Potassium Chloride, 2 Bismuth Subsalicylate, 10 Magnesium Citrate, 20
Sodium Bicarbonate, 3 Hyoscyamine, 11 Scopolamine, 21
Sodium Citrate and Diphenoxylate/ Meclizine, 22
Citric Acid, 3 Atropine, 12 Prochlorperazine, 23
Ginger, 4 Loperamide, 12 Metoclopramide, 24
Sodium Polystyrene Alosetron, 13 Ondansetron, 25
Sulfonate, 5 Psyllium, 14 Palonosetron, 25
Famotidine, 6 Methylcellulose, 14 Granisetron, 25
Ranitidine, 6 Polyethylene glycol/ Dolasetron, 25
Cimetidine, 6 Electrolyte, 15 Dronabinol, 26
Nizatidine, 6 Simethicone, 16 Nabilone, 26
Esomeprazole, 7 Sennosides, 17 Mesalamine, 27
Rabeprazole, 7 Bisacodyl, 17 Olsalazine, 27
Omeprazole, 7 Lactulose, 18 Sulfasalazine, 27

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Gastrointestinal System Drugs Calcium Salts 1

Calcium Calcium
Carbonate Gluconate
(kal-see-um kar-bo-nate) (kal-see-um gloo-koh-nate)

Os-Cal, Tums, Tums Kalcinate

E-X, Nephro-Calci
Apo-Cal

Calcium Calcium
Citrate Acetate
(kal-see-um si-trate) (kal-see-um ass-e-tate)

Cal-Citrate 250, Calphron, PhosLo

Citrical, Citrical Liquitab
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Gastrointestinal System Drugs
Therapeutic/Pharmacologic Class
Mineral and electrolyte replacement or supplement;
acid buffer/electrolyte (calcium salts)
Indications
Treatment of osteoporosis. Antacid treatment of
gastritis. Treatment of electrolyte imbalance.
Action
Acts as an activator in the transmission of nerve
impulses and contraction of cardiac, skeletal, and
smooth muscle. Essential for bone formation and
blood coagulation. Buffers acidity. Calcium acetate
binds with phosphorus to decrease phosphorous levels.
Adverse Reactions/Side Effects
CNS: syncope (IV only), tingling. CV: cardiac
arrest (IV only), arrhythmias, bradycardia. GI: con-
stipation, nausea, vomiting, rebound acidity. GU:
calculi, hypercalciuria. Local: phlebitis (IV only).
Keep in Mind
Teach client:
• Drugs may cause constipation and rebound
stomach acidity.
Route/Dosage: Calcium carbonate: PO/1–2 g/day in 3–4 divided doses, Calcium gluconate: PO/0.5–2 g daily in 2–4 divided doses; IV/2–15 g/day,
Calcium citrate: PO/1–2 g/day in 3–4 divided doses, Calcium acetate: PO/1334–2668 mg with each meal
Calcium Salts 1
• Vitamin D must be taken in adequate amounts.
• Watch for signs of deficiency (paresthesias,
Chvostek’s sign, tremors).
• Excessive use (PO form) may result in arrhythmias
and decrease effectiveness of calcium channel
blockers.
• Avoid high-oxalate foods, and report any kidney
discomfort or passage of sediment or stones.
Make the Connection
• Serum levels must be assessed prior to
and after administration (9–10.5 mg/dL).
• Assess effectiveness if used for gastritis.
• Concurrent administration may render other
medications useless. Give separately.
• Monitor BP, pulse, and ECG frequently through-
out parenteral therapy. May cause vasodilation
with resulting hypotension, bradycardia,
arrhythmias, and cardiac arrest.
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Gastrointestinal System Drugs Potassium Supplement 2

Potassium Chloride
(poe-tass-ee-um clor-ide)

K-Dur, K-Lor, Klor-Con, Micro-K

ExtenCaps, Slow-K
Apo-K, K-Long

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Gastrointestinal System Drugs Potassium Supplement 2

Therapeutic/Pharmacologic Class • Avoid foods with a high content of this mineral,
Mineral and electrolyte replacement and/or such as melons, bananas, orange juice, potatoes,
supplement meats, and salt substitutes.
Indications
PO, IV: Treatment/prevention of depletion of min- Make the Connection
erals and electrolytes. IV: Treatment of arrhythmias
due to digoxin toxicity. • Serum level must be assessed prior to
administration (3.5–5 mEq/L).
Action • Monitor for tented T waves (indicates high serum
Maintains acid-base balance. Essential for nerve K+ levels).
conduction. Essential for contraction of cardiac, • As serum electrolyte levels decrease, the likelihood
skeletal, and smooth muscle. of digoxin toxicity increases.
Adverse Reactions/Side Effects • IV solutions must not exceed 10 mEq/hr in
CNS: confusion, restlessness, weakness. CV: adults.
arrhythmias, ECG changes. GI: abdominal • Sodium polystyrene sulfonate can be given to
pain, nausea, vomiting, flatulence, diarrhea, GI decrease toxic levels.
ulceration. Neuro: paralysis/paresthesia. Local: • Never give undiluted.
(IV only) irritation at injection site.

Keep in Mind
Teach client:
• Report unusual fatigue, weakness, or palpitations.

Route/Dosage: PO/40–80 mEq/day; IV/(K-rider) 10–20 mEq/dose (maximum, 40 mEq/dose) to infuse over 2–3 hr (maximum infusion rate, 40 mEq/hr)
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Gastrointestinal System Drugs Alkalizing Agents 3

Sodium Bicarbonate
(soe-dee-um bye-kar-boe-nate)

Baking soda, Bell-Ans, Citrocarbonate,

Neut, Soda Mint

Sodium Citrate
and Citric Acid
(soe-dee-um sye-trate and sit-rik AS-id)

Bicitra, Oracit
PMS-Dicitrate
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Gastrointestinal System Drugs Alkalizing Agents 3

Therapeutic/Pharmacologic Class Adverse Reactions/Side Effects
Antiulcer agent; antiurolithic; mineral replacement/ CV: edema. GI: (PO) flatulence, gastric distention,
alkalinizing agents diarrhea. F and E: metabolic alkalosis, hyperna-
Indications tremia, hypocalcemia, hypokalemia, sodium and
PO, IV: Management of metabolic acidosis. PO, IV: water retention, fluid overload. Local: irritation at
Alkalinization of urine and promotion of excretion IV site. Neuro: tetany.
of certain drugs in overdosage situations (pheno-
barbital, aspirin). PO: Antacid. Prevention of
Keep in Mind
Teach client:
aspiration pneumonitis during surgical procedures.
Management of chronic metabolic acidosis associ- • Take medication as directed.
ated with chronic renal insufficiency or renal tubular • Taking milk products concurrently with this
medication can result in renal calculi or hypercal-
acidosis.
cemia (milk-alkali syndrome).
Action • Dyspepsia that persists longer than 2 wk should
Acts as an alkalinizing agent by releasing bicarbonate be evaluated by HCP.
ions. Following oral administration, releases bicar- • Avoid high-sodium foods (canned, processed,
bonate, which is capable of neutralizing gastric pickled).
acid. Therapeutic Effects: Alkalinization of body
fluids. Neutralization of gastric acid. Increase of
blood pH. Make the Connection
• Monitor serum electrolyte level. This
electrolyte must be in the 135–145 mEq/L
range and ABG.
Route/Dosage: Sodium bicarbonate: PO/up to 4 g daily in divided doses; IV/2–5 mEq/kg in a 4–8 hr infusion; (cardiac arrest) 1 mEq/kg, repeat
0.5 mEq/kg q 10 min, Sodium citrate and citric acid: PO/10–30 mL solution diluted in water 4 times daily
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Gastrointestinal System Drugs Antiemetic (Herbal) 4

Ginger
(jin-jer)

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Gastrointestinal System Drugs
Therapeutic/Pharmacologic Class
Antiemetic
Indications
Treatment of nausea and vomiting related to
motion sickness, anesthesia, and chemotherapy.
Action
Has an antiemetic effect due to increasing GI motility
and transport; may act on serotonin receptors.
Shown to be hypoglycemic, hypotensive or hyper-
tensive, and positive inotropic agent. Inhibits
prostaglandins and platelets, lowers cholesterol,
and improves appetite and digestion.
Adverse Reactions/Side Effects
GI: minor heartburn. Derm: dermatitis
(when used topically).
Keep in Mind
Teach client:
• This drug should not be taken during pregnancy
(preliminary evidence that ginger might affect
fetal sex hormones) or lactation.
Route/Dosage: PO/up to 2 g (not to exceed 4 g/day)
Antiemetic (Herbal) 4
• May increase bleeding time in clients with ↑ risk
of bleeding, such as those on anticoagulant
therapy, antiplatelets, or thrombolytics, or those
with platelet disorders.
• May have an additive effect on antidiabetic
medications.
• May increase the effect of calcium channel blockers.
• Use herbal medications only if monitored by a HCP.
• Use prior to an event that may cause nausea or
vomiting.
Make the Connection
• Assess client for epigastric pain prior to
and after administration when drug is used as a
gastroprotective agent.
• Monitor BP and heart rate in patients with CV
disease, including HTN; if palpitations occur, the
drug must be stopped immediately.
• Monitor blood glucose and coagulation panels
periodically during therapy; watch for easy bruising
or bleeding.
• Pregnant and lactating clients should not use
this herbal medication.
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Gastrointestinal System Drugs Cationic Exchange Resin 5

Sodium Polystyrene
Sulfonate
(soe-dee-um po-lee-stye-reen sul-fon-ate)

Kayexalate
K-Exit

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Gastrointestinal System Drugs Cationic Exchange Resin 5

Therapeutic/Pharmacologic Class
Hypokalemic; electrolyte modifier/cationic exchange
resin
Indications
Treatment of mild to moderate hyperkalemia. If
severe, glucose/insulin infusion may be used.
Action
Exchanges sodium ions for K+ ions in the intestine
(each 1 g is exchanged for 1 mEq K+). Therapeutic
Effects: Reduction of serum K+ levels.
Adverse Reactions/Side Effects
GI: constipation, fecal impaction, anorexia,
gastric irritation, nausea, and vomiting. F and E:
hypocalcemia, hypokalemia, Na retention,
hypomagnesemia.
• Foods with high-K+ level should be avoided
(melons, bananas, orange juice, potatoes).
• Report constipation.
Make the Connection
• Assess ECG changes for hyperkalemia
and hypokalemia.
• Monitor I&O and daily weight. Assess for symp-
toms of fluid overload (dyspnea, rales/crackles,
jugular venous distention, peripheral edema).
• Remember to keep K+ levels in the range of
3.5–5 mEq/L. As K+ levels fall, digoxin toxicity
can occur.
• Assess abdomen, bowel sounds, and frequency of
stools. Monitor all electrolyte levels.

Keep in Mind
Teach client:
• Report signs of hypokalemia, such as muscle
weakness and fatigue.
• A low-Na diet will be ordered.

Route/Dosage: PO/15 g 1–4 times daily in water or sorbitol (up to 40 g 4 times daily); Rect/30–50 g as a retention enema; repeat as needed q 6 hr.
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Gastrointestinal System Drugs Histamine H2 Receptor Antagonists 6

Famotidine Cimetidine
(fa-moe-ti-deen) (sye-me-ti-deen)

Pepcid Tagamet
Apo-Cimetidine

Ranitidine Nizatidine
(ra-ni-ti-deen) (ni-za-ti-deen)

Zantac Axid
Zantac-C

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Gastrointestinal System Drugs Histamine H2 Receptor Antagonists 6

Therapeutic/Pharmacologic Class
Antiulcer agent/histamine H2 receptor antagonists
Indications
Treatment of active duodenal ulcers and GERD.
Management of gastric hypersecretory states
(Zollinger-Ellison syndrome). IV: Prevention and
treatment of upper GI bleed.
Action
Inhibit the action of histamine at the H2-receptor
site located primarily in gastric parietal cells, resulting
in inhibition of gastric acid secretion.
Adverse Reactions/Side Effects
CNS: confusion, dizziness, drowsiness, halluci-
nations, headache. CV: arrhythmias. GI: consti-
pation, diarrhea, drug-induced hepatitis, nausea.
GU: decreased sperm count, impotence. Endo:
gynecomastia. Hemat: agranulocytosis, aplastic
anemia. Misc: hypersensitivity reactions.
Route/Dosage: Famotidine: PO/40 mg/day at bedtime or 20 mg twice daily, for up to 8 wk initially (maintenance dose, 20 mg/day); IV/20 mg
q 12 hr, diluted and given over 2 min, Cimetidine: PO/300 mg 4 times daily, or 800 mg at bedtime, or 400–600 mg twice daily (not to exceed
2.4 g/day), Ranitidine: PO/150 mg twice daily; IV/50 mg q 6–8 hr (not to exceed 400 mg/day); continuous IV infusion/6.25 mg/hr, Nizatidine:
PO/150 mg once daily at bedtime
Keep in Mind
Teach client:
• Take medication as directed for the full course of
therapy.
• Notify a HCP if difficulty swallowing occurs or
abdominal pain persists.
• Smoking interferes with the action of histamine
receptor antagonists.
• Avoid alcohol, products containing aspirin or
NSAIDs, excessive amounts of caffeine, and foods
that may cause an increase in GI irritation.
• Report immediately signs of bone marrow suppres-
sion, such as bleeding, purpura, and sore throat.
• Report confusion or hallucinations immediately.
Make the Connection
• Monitor the CBC and differential counts
daily.
• Other medications may be less effective because
of increased stomach pH.
• Direct IV doses are given over specific time frames.
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Gastrointestinal System Drugs Proton (Gastric) Pump Inhibitors 7

Esomeprazole Omeprazole
(es-o-mep-ra-zole) (o-mep-ra-zole)

Nexium Prilosec, Prilosec OTC

Losec

Rabeprazole Pantoprazole
(ra-bep-ra-zole) (pan-toe-pra-zole)

Aciphex Protonix; Protonix IV

Pariet

Lansoprazole
(lan-soe-pra-zole)

Prevacid, Prevacid 24 hr
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Gastrointestinal System Drugs Proton (Gastric) Pump Inhibitors 7

Therapeutic/Pharmacologic Class
Proton (gastric) pump inhibitor/antiulcer agents
Indications
Treatment of GERD with or without esophageal
erosion, duodenal ulcers (Helicobacter pylori), upper
GI bleeds, and hypersecretory conditions.
Action
Decreases gastric acid by binding to an enzyme on
gastric parietal cells. Prevents proton pump from
releasing acid into the gastric lumen, raising gastric pH.
Adverse Reactions/Side Effects
CNS: headache. Endo: changes in blood glucose
levels. GI: abdominal pain, flatulence, diarrhea.
Derm: rash.
Keep in Mind
Teach client:
• Avoid alcohol, ASA, NSAIDS, smoking, caffeine,
and foods that cause gastric distress. Take drugs
for duration ordered by HCP.
• Report abdominal pain; diarrhea; or black, tarry
stools to HCP immediately.
Make the Connection
• Monitor liver enzymes.
• Best if given on an empty stomach 1 hr prior to
other drugs or food. Monitor for improvement in
symptoms.
• Lansoprazole IV must be given through a special
filter. Pantoprazole IV is given direct IV, undiluted,
over 2 min. Some capsules can be opened and
sprinkled on applesauce, followed by water.
Expect higher dosages if a hypersecretory
condition exists.
• Remember, clients can get too much of a good
thing. We need stomach acid. Watch for diges-
tive problems with foods and medications.
• Many of these drugs are given in combination
with an antibiotic to combat H. pylori infections.

Route/Dosage: Esomeprazole: PO/20 mg or 40 mg once daily for 4–8 wk, with maintenance dose of 20 mg/daily; IV/20 or 40 mg once daily, Omeprazole:
PO/20 mg once daily (40 mg daily for duodenal ulcers associated with H. pylori), Rabeprazole: PO/20 mg once daily, Pantoprazole: PO/40 mg once
daily; IV/40 mg daily for 7–10 days, Lansoprazole: PO/15 mg daily (30 mg daily for duodenal ulcers associated with H. pylori)
1882_Tab01_001-027 10/10/12 12:40 PM Page 8

Gastrointestinal System Drugs Prostaglandin 8

Misoprostol
(mye-soe-prost-ole)

Cytotec

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Gastrointestinal System Drugs Prostaglandin
Therapeutic/Pharmacologic Class
Prostaglandin/antiulcer agent; cytoprotective agent
Indications
Prevention of gastric mucosal injury from NSAIDs,
including aspirin, in high-risk clients (elderly clients,
debilitated clients, or those with a history of ulcers).
With mifepristone for termination of pregnancy.
Unlabeled uses: Treatment of duodenal ulcers.
Action
Acts as a prostaglandin analogue, decreasing gastric
acid secretion and increasing the production of
protective mucus. Causes uterine contractions.
Adverse Reactions/Side Effects
CNS: headache. GI: abdominal pain, diarrhea,
constipation, dyspepsia, flatulence, nausea, and
vomiting. GU: miscarriage, menstrual disorders.
Keep in Mind
Teach client:
• Take medication as directed for the full course of
therapy when first starting NSAID therapy.
Route/Dosage: PO/200–400 mcg bid–qid
8
• Report diarrhea persisting for more than 1 wk; the
onset of black, tarry stools; or severe abdominal
pain. Avoid alcohol, tobacco, and foods that may
cause an increase in GI irritation.
• Misoprostol will cause spontaneous abortion.
Contraception must be used throughout therapy.
Make the Connection
• Assess client routinely for epigastric or
abdominal pain and for frank or occult blood in
the stool, emesis, or gastric aspirate.
• Assess women of childbearing age for pregnancy.
Misoprostol is usually begun on 2nd or 3rd day
of menstrual period following a negative preg-
nancy test result.
1882_Tab01_001-027 10/10/12 12:40 PM Page 9

Gastrointestinal System Drugs Gastric Mucosa Protectant 9

Sucralfate
(soo-kral-fate)

Carafate
Sulcrate

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Gastrointestinal System Drugs Gastric Mucosa Protectant 9

Therapeutic/Pharmacologic Class • May decrease effectiveness (absorption) of some
Antiulcer agent/GI protectant medications. Check with HCP.
Indications
Management of peptic ulcers. Suspension used for Make the Connection
mucositis/stomatitis/oral ulcers.
• Assess for effectiveness of medication.
Action • Monitor drug levels, such as phenytoin, to assess
Activated by stomach acid to form a thick, protective bioavailability.
paste. • Tablets may begin to dissolve in the esophagus if
Adverse Reactions/Side Effects client cannot swallow effectively, causing a choking
CNS: dizziness and drowsiness. GI: constipation, risk. Tablet will go easily into suspension.
diarrhea, indigestion, nausea. Derm: rash, Administer in this way with extra fluid.
pruritus.

Keep in Mind
Teach client:
• Report changes in bowel habit.
• Exercise, fiber, and fluids can stave off
constipation.
• Take medication for entire course.
• Take 1 hr prior to meals on an empty stomach.

Route/Dosage: PO/1 g qid 1 hr before meals and at bedtime or 2 g bid

1882_Tab01_001-027 10/10/12 12:40 PM Page 10

Gastrointestinal System Drugs Adsorbent 10

Bismuth Subsalicylate
(biz-muth sub-sa-lis-i-late)

Pepto-Bismol, Kaopectate,
Kaopectolin, Bismatrol

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Gastrointestinal System Drugs Adsorbent 10

Therapeutic/Pharmacologic Class • If symptoms are not controlled within 24 hours,
Antidiarrheal/adsorbent or if symptoms of dehydration (decreased urina-
Indications tion, change in level of consciousness, weakness)
To decrease water content of stool. occur, report immediately to HCP.
Action
Promotes intestinal absorption of fluid and elec- Make the Connection
trolytes. Absorbent. •
Salicylates cause Reye’s syndrome in
Adverse Reactions/Side Effects pediatric clients.
GI: hepatic impairment, constipation, change in • Monitor frequency and character of stools.
stool color. Immune: risk for Reye’s syndrome.

Keep in Mind
Teach client:
• Use pediatric preparations to prevent
complications.
• Rest the gut; slowly introduce clear liquids
(not apple juice).
• Use OTC electrolyte solutions for pediatric clients
to prevent dehydration.

Route/Dosage: Bismuth subsalicylate: PO/2 tabs or 30 mL (not to exceed 4.2 g/24 hr)
1882_Tab01_001-027 10/10/12 12:40 PM Page 11

Gastrointestinal System Drugs Anticholinergic 11

Hyoscyamine
(hi-oh-si-a-meen)

Anaspaz, Levsin

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Gastrointestinal System Drugs Anticholinergic 11

Therapeutic/Pharmacologic Class
Antispasmodic/anticholinergic
Indications
Treatment of spastic bladder and bowel; including
diverticulitis, infant colic, and biliary and renal
colic; peptic ulcer disease; irritable bowel syndrome;
and neurogenic bowel disturbances.
Action
Inhibit the muscarinic effect of acetylcholine in
smooth muscle, secretory glands, and the CNS.
Adverse Reactions/Side Effects
CNS: confusion/excitement (especially in geriatric
clients), dizziness, flushing, headache, insomnia,
lightheadedness (IM, IV, SC), nervousness. EENT:
blurred vision, cycloplegia, increased intraocular
pressure, mydriasis, photophobia. CV: palpita-
tions, tachycardia. GI: dry mouth, altered taste
perception, bloated feeling, constipation, nausea,
paralytic ileus, vomiting. GU: impotence, urinary
hesitancy/retention. Derm: decreased sweating,
urticaria. Misc: allergic reactions including
anaphylaxis, fever (especially in children),
suppression of lactation.
Keep in Mind
Teach client:
• Take exactly as directed. May cause drowsiness;
avoid activities requiring alertness. Oral rinses,
sugarless gum or candy, and frequent oral
hygiene may help relieve dry mouth. Report
change in urinary stream in males with BPH.
Make the Connection
•
Anticholinergic medications cause
symptoms that are categorized with the saying
“hot as a hare, dry as a bone, red as a beet,
mad as a hatter, and blind as a bat.”

Route/Dosage: PO, SL/0.125–0.25 mg 3–4 times daily or 0.375–0.75 mg as SR form every 12 hr; IM, IV, SC/(GI anticholinergic) 0.25–0.5 mg 3–4 times
daily as needed
1882_Tab01_001-027 10/10/12 12:40 PM Page 12

Gastrointestinal System Drugs Antidiarrheals 12

Diphenoxylate/Atropine
(dye-fen-ox-i-late/a-troe-peen)

Lomotil, Lonox, Logen

Loperamide
(loe-per-a-mide)

Imodium, Imodium AD, Neo-Diaral

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Gastrointestinal System Drugs
Therapeutic/Pharmacologic Class
Antidiarrheals
Indications
Adjunctive therapy of acute diarrhea. Treatment of
chronic diarrhea associated with inflammatory bowel
disease. Decreases the volume of ileostomy drainage.
Action
Inhibits excess GI motility. Inhibits peristalsis and
prolongs transit time by a direct effect on nerves in
the intestinal muscle wall. Reduces fecal volume;
increases fecal viscosity and bulk while diminishing
loss of fluid and electrolytes. Diphenoxylate/atropine
also exerts an anticholinergic effect on the bowel.
Adverse Reactions/Side Effects
CNS: drowsiness, dizziness, nervousness. GI:
constipation, abdominal pain/distention/
discomfort, dry mouth, nausea, vomiting,
ileus. Misc: allergic reactions.
Keep in Mind
Teach client:
• When atropine is added, expect anticholinergic
effects. Take with plenty of fluids.
Route/Dosage: Diphenoxylate/atropine: PO/2 tabs qid, Loperamide: PO/4 mg initially, then 2 mg after each loose stool (maintenance dose usually
4–8 mg/day in divided doses, not to exceed 8 mg/day for OTC use or 16 mg/day for Rx use)
Antidiarrheals 12
• May cause drowsiness and dizziness.
• Use hard candy or sugarless gum to moisten mouth.
• Report any increased abdominal discomfort or
urinary difficulties.
Make the Connection
• These drugs contain mild opioid agonists
but have no analgesic effects. Combining mild
opioids with atropine or other drugs decreases
the likelihood of abuse.
• Drugs cause anticholinergic effects. Remember
by the saying, “hot as a hare, dry as a bone, red
as a beet, mad as a hatter, and blind as a bat.”
• Monitor I&O, and character and number of stools.
• Check bowel sounds. An area of increased bowel
sounds may indicate ileus, especially if additional
clinical signs such as nausea and abdominal dis-
tention are present.
• Monitor LFT and serum amylase levels if on
long-term therapy.
1882_Tab01_001-027 10/10/12 12:40 PM Page 13

Gastrointestinal System Drugs 5-HT3 Antagonist 13

Alosetron
(a-low-se-tron)

Lotronex

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Gastrointestinal System Drugs 5-HT3 Antagonist 13

Therapeutic/Pharmacologic Class • Be aware of and watch for signs of acute
Anti-irritable bowel syndrome agent/5-HT3 receptor ischemic colitis.
antagonist • Report worsening abdominal pain or rectal
Indications bleeding.
Treatment of IBS characterized by diarrhea.
Action Make the Connection
5-HT3 receptor site antagonism results in slowing of • IBS can be characterized by either diarrhea
colonic transit time in IBS characterized by diarrhea. or constipation.
Adverse Reactions/Side Effects • Monitor therapy and watch for signs of abdominal
CNS: headache. GI: acute ischemic colitis, distress.
constipation, abdominal discomfort, abdominal • Monitor bowel sounds.
distention, flatulence, nausea, GI viral infections, • Note character, amount, and ease of stooling.
hemorrhoids, regurgitation or reflux.

Keep in Mind
Teach client:
• Take exactly as directed. Be aware of the risks
and benefits of pharmacotherapy and the impact
of IBS symptoms on one’s life. This is especially
important for those with IBS characterized by
diarrhea because of the risk of acute ischemic
colitis.

Route/Dosage: PO/(women) 0.5 mg twice daily

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Gastrointestinal System Drugs Bulk-Forming Agents 14

Psyllium
(sill-i-yum)

Metamucil
Karacil

Methylcellulose
(meth-i-sell-you-lose)

Citrucel

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Gastrointestinal System Drugs
Therapeutic/Pharmacologic Class
Laxative/bulk-forming agents
Indications
Management of simple or chronic constipation,
particularly if associated with a low-fiber diet.
Useful in situations in which straining should be
avoided (after MI, rectal surgery, or prolonged bed
rest). Used in the management of chronic watery
diarrhea.
Action
Combines with water in the intestines to form an
emollient gel or viscous solution that promotes
peristalsis and reduces transit time.
Adverse Reactions/Side Effects
Resp: bronchospasm. GI: cramps, intestinal or
esophageal obstruction, nausea, and vomiting.
Keep in Mind
Teach client:
• Do not let the mixture gel prior to drinking as this
may cause a choking risk.
Route/Dosage: Psyllium: PO/up to 30 g daily in divided doses, Methylcellulose: PO/A heaping tablespoon up to 3 times/day
Bulk-Forming Agents 14
• Follow mixture with another 8 oz of fluid.
• Become aware of natural bowel patterns, and do
not force a bowel movement.
• Do not take laxatives when abdominal pain,
cramping, or fever is present.
Make the Connection
• Bulk-forming agents are used for both
constipation and diarrhea.
• It is better to allow the natural processes of the
body time to work to produce a bowel movement.
Dietary choices, increasing fluid intake, and adding
moderate exercise can promote regularity.
• Never allow the client, especially the elderly or
those with risk of choking, to drink a gelled
mixture.
1882_Tab01_001-027 10/10/12 12:40 PM Page 15

Gastrointestinal System Drugs Osmotic 15

Polyethylene
glycol/Electrolyte
(po-lee-eth-e-leen glye-kole/e-lek-troe-lite)

GoLYTELY, NuLytely, Colyte

Klean-Prep

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Gastrointestinal System Drugs Osmotic
Therapeutic/Pharmacologic Class
Osmotic/laxative
Indications
Bowel cleansing in preparation for GI examination.
Unlabeled uses: Treatment of acute iron overdose
in children.
Action
Polyethylene glycol (PEG) in solution acts as an
osmotic agent, drawing water into the lumen of the
GI tract.
Adverse Reactions/Side Effects
GI: abdominal fullness, diarrhea, bloating,
cramps, nausea, vomiting. Misc: allergic
reactions (rare).
Keep in Mind
Teach client:
• If using for bowel preparation, fast for 3–4 hr
prior to administration and never have solid food
within 2 hr of administration.
• Clear liquids only are allowed after administration.
Route/Dosage: PO/4 L (240 mL taken every 10 min)
15
• If using the liquid preparation, the client will
drink 240 mL every 10 min until 4 L have been
consumed or fecal discharge is clear and free of
solid matter.
• Rapidly drinking each 240-mL portion is preferred
over drinking small amounts continuously.
Make the Connection
• May be administered on the morning of
the examination as long as time is allotted to drink
solution (3 hr) and evacuate bowel (1 additional
hr). For barium enema, administer solution early
in the evening (6 PM) prior to exam to allow
proper mucosal coating by barium.
• Solution may be reconstituted with tap water.
Shake vigorously until powder is dissolved.
May be administered via NG tube at a rate of
20–30 mL/min.
• Monitor electrolytes, stool character, and subjective
data from client.
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Gastrointestinal System Drugs Antiflatulent 16

Simethicone
(si-meth-i-kone)

Gas-X, Mylicon, Phazyme

Ovol, Ovol-40

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Gastrointestinal System Drugs Antiflatulent 16

Therapeutic/Pharmacologic Class • Eat, chew, and swallow slowly to prevent excess
Antiflatulent gas formation.
Indications • Avoid carbonated beverages.
Relief of painful symptoms of excess gas in the GI
tract that may occur postoperatively or as a conse- Make the Connection
quence of air swallowing, dyspepsia, peptic ulcer,
or diverticulitis. • Assess client for abdominal pain,
distention, and bowel sounds prior to and peri-
Action odically throughout course of therapy. Frequency
Causes the coalescence of gas bubbles. Does not of belching and passage of flatus should also be
prevent the formation of gas. assessed.
Adverse Reactions/Side Effects • Administer after meals and at bedtime for best
None results. Shake liquid preparations well prior to
administration.
Keep in Mind • Chewable tabs should be chewed thoroughly
Teach client: before swallowing for faster and more complete
• Diet and exercise are important in the prevention results. Give the chewable tabs after other
of gas. This medication does not prevent the for- medications.
mation of gas. • Drops can be mixed with 30 mL of cool water,
• Notify HCP if symptoms are persistent. infant formula, or other liquid as directed.
• Lie in fetal position with legs drawn to chest to
relieve gas discomfort, especially after laparoscopic
procedures.

Route/Dosage: PO/40–125 mg qid, after meals and at bedtime (up to 500 mg/day)
1882_Tab01_001-027 10/10/12 12:40 PM Page 17

Gastrointestinal System Drugs Stimulant Laxatives 17

Sennosides
(sen-oh-sides)

Ex-Lax, Fletcher’s Castoria, Senokot

Bisacodyl
(bis-a-koe-dill)

Dulcolax,
Bisaco-Lax, Laxit

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Gastrointestinal System Drugs
Therapeutic/Pharmacologic Class
Laxative/stimulant laxatives
Indications
Treatment of constipation, particularly when asso-
ciated with slow transit time, constipating drugs,
and irritable or spastic bowel syndrome.
Action
Active components alter water and electrolyte
transport in the large intestine, resulting in accumu-
lation of water and increased peristalsis.
Adverse Reactions/Side Effects
Neuro: dizziness, asthenia. CV: edema. Resp:
shortness of breath. GI: cramping, diarrhea,
nausea. GU: discoloration of urine. F and E: elec-
trolyte abnormalities. Misc: laxative dependence.
Keep in Mind
Teach client:
• Take for short-term therapy only.
• Clients with cardiac disease should avoid straining
during bowel movements (Valsalva maneuver). Do
Route/Dosage: Sennosides: PO/12–50 mg bid, Bisacodyl: PO/5–15 mg daily (up to 30 mg/day)
Stimulant Laxatives 17
not use laxatives when abdominal pain, nausea,
vomiting, or fever is present.
Make the Connection
• Assess client for abdominal distention,
presence of bowel sounds, and usual pattern of
bowel function.
• Assess color, consistency, and amount of stool
produced.
• Abnormal bowel habits can cause dependence on
laxatives (impaired peristalsis), diverticula devel-
opment, and hemorrhoids. Natural is better.
• These laxatives can be added to OTC “diet”
aids. May be used as the initial part of bowel
preparation.
1882_Tab01_001-027 10/10/12 12:40 PM Page 18

Gastrointestinal System Drugs Osmotic 18

Lactulose
(lak-tyoo-lose)

Cephulac, Kristalose, Chronulac

Lactulax

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Gastrointestinal System Drugs
Therapeutic/Pharmacologic Class
Laxative/osmotic
Indications
Treatment of chronic constipation in adults and
geriatric clients. Used in diabetic clients with gas-
troparesis. Adjunct in the management of portal
systemic (hepatic) encephalopathy (PSE).
Action
Increases water content and softens the stool.
Lowers the pH of the colon, which inhibits the
diffusion of ammonia from the colon into the
blood, thereby reducing blood ammonia levels.
Adverse Reactions/Side Effects
GI: belching, cramps, distention, flatulence,
diarrhea. Endo: hyperglycemia (diabetic clients).
Keep in Mind
Teach client:
• Increasing bulk in the diet, fluid intake, and
mobility are other effective forms of bowel regu-
lation. Becoming aware of natural elimination
patterns is important.
Route/Dosage: PO/up to 60 mL/day or 10–20 g as powder
Osmotic 18
• Medication may cause belching, flatulence, or
abdominal cramping. Notify HCP if this becomes
bothersome or if diarrhea occurs.
Make the Connection
• Assess client for presence of bowel sounds.
• Assess mental status before and periodically
throughout course of therapy.
• Monitor serum ammonia levels (↓ 25%–50%) and
serum glucose levels if diabetic.
• Monitor serum electrolytes periodically. May cause
diarrhea with resulting hypokalemia and hyperna-
tremia. Metabolic acidosis can occur. Remember:
Loss of GI fluid from above the waist, such as
from vomiting and nasogastric tube (NGT)
suctioning, causes gain of base, which leads to
metabolic alkalosis. Loss of GI fluid from below
the waist, such as from diarrhea, causes loss of
base, which leads to metabolic acidosis.
• To administer enema, use rectal balloon catheter.
Mix 300 mL of lactulose with 700 mL of water or
0.9% NaCl. Have client retain for 30–60 min.
1882_Tab01_001-027 10/10/12 12:40 PM Page 19

Gastrointestinal System Drugs Stool Softeners 19

Docusate Calcium
(dok-yoo-sate kal-see-um)

Surfak, DC Softgels

Docusate Sodium
(dok-yoo-sate soe-dee-um)

Colace
Regulex

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Gastrointestinal System Drugs Stool Softeners 19

Therapeutic/Pharmacologic Class • Choose foods to enhance elimination.
Laxative/stool softeners • Cardiac and surgical clients (rectal/ocular)
Indications should not strain.
Prevention of constipation and straining at stool • Never use when abdominal pain, nausea, vomiting,
(cardiac clients, recent rectal surgery). Can be used or fever exists.
rectally to soften fecal impaction.
Action Make the Connection
Adsorbent: pulls water into stool. Increases electrolyte • This is not a stimulant laxative.
and water secretion into colon. • Give with increased amounts of clear fluid.
Adverse Reactions/Side Effects • Do not give within 2 hr of other laxatives, especially
GI: mild cramps. EENT: throat irritation. Derm: mineral oil.
rashes. • Oral liquid is more palatable if diluted or mixed
with juice.
Keep in Mind
Teach client:
• Should be used for short-term use only and may
take time to work.
• Follow instructions for natural promotion of
bowel movement.

Route/Dosage: Docusate calcium: PO/240 mg daily, Docusate sodium: PO/50–400 mg in divided doses
1882_Tab01_001-027 10/10/12 12:40 PM Page 20

Gastrointestinal System Drugs Salines (Magnesium Salts) 20

Magnesium Magnesium
Oxide Citrate
(mag-nee-zhum ox-ide) (mag-nee-zhum si-trate)

Mag-Ox 400 Citrate of Magnesia

Magnesium Hydroxide
(mag-nee-zhum hye-drox-ide)

Dulcolax Magnesia Tablets, Phillips

Magnesia Tablets, Phillips Milk of
Magnesia, MOM
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Gastrointestinal System Drugs Salines (Magnesium Salts) 20

Therapeutic/Pharmacologic Class
Laxative/saline; magnesium salts
Indications
Treatment and prevention of hypomagnesemia. A
laxative/bowel evacuant. PO liquid is also used as
an antacid.
Action
Essential for the activity of many enzymes. Plays an
important role in neurotransmission and muscular
excitability. Osmotically active in GI tract, drawing
water into the lumen and causing peristalsis.
Adverse Reactions/Side Effects
GI: diarrhea, bloating, cramping. Derm: flushing,
sweating. F and E: electrolyte imbalance.
report signs of GI bleeding (black, tarry stools;
coffee-ground emesis).
• Laxatives should be used only for short-term
therapy; long-term therapy may cause electrolyte
imbalance and dependence. Notify HCP if unre-
lieved constipation, rectal bleeding, or symptoms
of electrolyte imbalance (muscle cramps or pain,
weakness, dizziness) occur.
Make the Connection
•
Monitor electrolytes carefully.
• Watch BP.

Keep in Mind
Teach client:
• Do not take this medication within 2 hr of taking
other medications, especially fluoroquinolones,
nitrofurantoin, and tetracyclines. As an antacid:

Route/Dosage: Magnesium oxide: PO/270–300 mg/day, Magnesium citrate: PO/240 mL in divided doses of 30 mL, Magnesium hydroxide:
PO/30–60 mL daily
1882_Tab01_001-027 10/10/12 12:40 PM Page 21

Gastrointestinal System Drugs Anticholinergic 21

Scopolamine
(scoe-pol-a-meen)

Isopto Hyoscine, Transderm-Scop

Transderm-V

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Gastrointestinal System Drugs
Therapeutic/Pharmacologic Class
Antiemetic/anticholinergic
Indications
Transdermal: Prevention of motion sickness.
Management of nausea and vomiting associated
with opioid analgesia or general anesthesia/recovery
from anesthesia. Reduction of secretions in the dying
client in hospice care. IM, IV, SC: Preoperatively for
the production of amnesia and the reduction of sali-
vation and excessive respiratory secretions.
Action
Inhibits the muscarinic activity of acetylcholine.
Corrects the imbalance of acetylcholine and norepi-
nephrine in the CNS, which may be responsible for
motion sickness.
Adverse Reactions/Side Effects
CNS: drowsiness, confusion. EENT: blurred
vision, mydriasis, photophobia. CV: tachycardia,
palpitations. GI: dry mouth, constipation. GU:
urinary hesitancy, urinary retention. Derm:
decreased sweating.
Route/Dosage: Transderm/1 patch (0.5–1.5 mg over 3 days) every 3 days
(place 4 hr prior to travel); IM, SC, IV/0.2–0.6 mg qid
Anticholinergic 21
Keep in Mind
Teach client:
• Medication may cause drowsiness or blurred
vision. Avoid driving or other activities requiring
alertness until response to medication is known.
• Use caution when exercising and in hot weather;
overheating may result in heatstroke.
• Avoid concurrent use of alcohol and other CNS
depressants with this medication.
• Frequent mouth rinses, good oral hygiene, and
sugarless gum or candy may minimize dry mouth.
• Transdermal: Apply at least 4 hr (U.S. product)
before exposure to travel to prevent motion sickness.
Apply to hairless site. May bathe with patch in place.
Remove if eye pain or excessive side effects occur.
Make the Connection
• When using an anticholinergic, remember
the saying “hot as a hare, dry as a bone, red as
a beet, mad as a hatter, and blind as a bat” to
help identify side effects.
• Assess client for nausea and vomiting periodically
during therapy. Assess level of consciousness after
surgical procedure.
1882_Tab01_001-027 10/10/12 12:40 PM Page 22

Gastrointestinal System Drugs Antiemetic (Antihistamine) 22

Meclizine
(mek-li-zeen)

Antivert, Bonine, Dramamine II

Bonamine

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Gastrointestinal System Drugs
Therapeutic/Pharmacologic Class
Antiemetic; antihistamine
Indications
Management/prevention of motion sickness and
vertigo.
Action
Has central anticholinergic, CNS depressant, and
antihistaminic properties. Decreases excitability of
the middle ear labyrinth and depresses conduction
in middle ear vestibular-cerebellar pathways.
Adverse Reactions/Side Effects
CNS: drowsiness, fatigue. EENT: blurred vision.
GI: dry mouth.
Keep in Mind
Teach client:
• Take medication exactly as directed. If a dose is
missed, take as soon as possible unless it is
almost time for next dose. Do not double doses.
• May cause drowsiness. Avoid driving or other
activities requiring alertness until response to the
medication is known.
Route/Dosage: PO/25–100 mg daily (high-end dose for vertigo)
Antiemetic (Antihistamine) 22
• Frequent mouth rinses, good oral hygiene, and
sugarless gum or candy may decrease dryness of
mouth.
• Avoid concurrent use of alcohol and other CNS
depressants with this medication.
• When using as prophylaxis for motion sickness,
take medication at least 1 hr before exposure to
conditions that may cause motion sickness.
Make the Connection
• Assess client for level of sedation after
administration. Assess client for nausea and
vomiting before and 60 min after administration.
Assess degree of vertigo periodically in clients
receiving this medication for labyrinthitis. May
cause false-negative results in skin tests using
allergen extracts. Discontinue this medication
72 hr before testing.
• Administer oral doses with food, water, or milk
to minimize GI irritation. Chewable tab may be
chewed or swallowed whole.
1882_Tab01_001-027 10/10/12 12:40 PM Page 23

Gastrointestinal System Drugs Phenothiazine 23

Prochlorperazine
(proe-klor-pair-a-zeen)

Compazine
Stemetil

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1882_Tab01_001-027 10/10/12 12:40 PM Page 23
Gastrointestinal System Drugs
Therapeutic/Pharmacologic Class
Antiemetic; antipsychotic/phenothiazine
Indications
Management of nausea and vomiting.
Action
Alters the effects of dopamine in the CNS. Possesses
significant anticholinergic and alpha-adrenergic
blocking activity. Depresses the chemoreceptor
trigger zone (CTZ) in the CNS.
Adverse Reactions/Side Effects
CNS: neuroleptic malignant syndrome,
extrapyramidal reactions, sedation. EENT:
blurred vision, dry eyes, lens opacities. CV: ECG
changes, hypotension, tachycardia. GI: consti-
pation, dry mouth, anorexia, drug-induced
hepatitis, ileus. GU: pink or reddish-brown
discoloration of urine, urinary retention. Derm:
photosensitivity, pigment changes, rashes. Endo:
galactorrhea. Hemat: agranulocytosis, leukopenia.
Metab: hyperthermia. Misc: allergic reactions,
Reye’s syndrome in children younger than
16 years.
Route/Dosage: PO/5–10 mg tid or qid; IV/2.5–10 mg (not to exceed 40 mg/day); Rect/25 mg bid
Phenothiazine 23
Keep in Mind
Teach client:
• Report uncontrolled tremor or muscle contraction
immediately. Change positions slowly to minimize
orthostatic hypotension. May cause drowsiness.
Avoid taking alcohol or other CNS depressants
concurrently with this medication.
• Use sunscreen and protective clothing to prevent
photosensitivity reactions.
• Use good oral hygiene and sugarless gum or
candy for dry mouth. Urine may turn pink to
reddish-brown.
Make the Connection
• Side effects are serious. Never give to
clients younger than 16 years.
• Assess for EPS; refer to a movement specialist if
symptoms noted.
• Assess for relief of nausea and vomiting.
• Monitor chemistry panel and CBC with differential.
1882_Tab01_001-027 10/10/12 12:40 PM Page 24

Gastrointestinal System Drugs Gastric Stimulant 24

Metoclopramide
(met-oh-kloe-pra-mide)

Reglan, Reglan ODT

Apo-Metoclop

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1882_Tab01_001-027 10/10/12 12:40 PM Page 24

Gastrointestinal System Drugs Gastric Stimulant 24

Therapeutic/Pharmacologic Class Keep in Mind
Antiemetic/gastric stimulant Teach client:
Indications • May cause drowsiness.
Prevention of emesis related to chemotherapy and • Report any tremor or uncontrollable muscle
surgery. Reduction of GERD. Prevention of microaspi- contraction immediately.
ration in clients with enteral feedings. Unlabeled • Maintain hydration and protect from extremes of
uses: treatment of hiccups. temperature.
Action • Avoid CNS depressants.
Blocks dopamine receptors in the chemoreceptor
trigger zone (CTZ) of the CNS. Stimulates motility Make the Connection
of the upper GI tract and accelerates gastric
emptying.
• Assess for nausea, abdominal distention,
and bowel sounds before giving.
Adverse Reactions/Side Effects • Assess for EPS; refer to a movement specialist if
CNS: drowsiness, extrapyramidal reactions, symptoms are noted.
neuroleptic malignant syndrome, anxiety, • Observe for depression.
depression. CV: arrhythmias, hypertension, • Monitor hepatic panel and serum prolactin and
hypotension. GI: constipation, diarrhea, aldosterone (increases).
dry mouth, nausea. Endo: gynecomastia. • Have client rate nausea severity on a 0–10 scale.
Hemat: methemoglobinemia, bone marrow
suppression.

Route/Dosage: PO, IM, IV/10–15 mg 30 min before meals and at bedtime

1882_Tab01_001-027 10/10/12 12:40 PM Page 25

Gastrointestinal System Drugs 5-HT3 Antagonists 25

Ondansetron Granisetron
(on-dan-se-tron) (gra-nees-e-tron)

Zofran Kytril

Palonosetron Dolasetron
(pa-lone-o-se-tron) (dol-a-se-tron)

Aloxi Anzemet

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1882_Tab01_001-027 10/10/12 12:40 PM Page 25

Gastrointestinal System Drugs 5-HT3 Antagonists 25

Therapeutic/Pharmacologic Class Keep in Mind
Antiemetic/5-HT3 receptor antagonists Teach client:
Indications • Take as directed. Notify HCP immediately if
Prevention of nausea and vomiting associated involuntary movement of eyes, face, or limbs
with chemotherapy and radiation therapy. IM, IV: occurs.
Prevention and treatment of postoperative nausea
and vomiting. Make the Connection
Action • Assess for EPS; refer to a movement
Blocks the effects of serotonin at receptor sites specialist if symptoms are noted.
(selective antagonist) located in vagal nerve • Assess effectiveness of antiemetic on a 0–10 scale
terminals and in the chemoreceptor trigger zone of nausea severity.
(CTZ) in the CNS. • Monitor for nausea, bowel sounds, and gastric
Adverse Reactions/Side Effects distention.
CNS: headache, dizziness, drowsiness, fatigue, • May cause transient ↑ in serum bilirubin, AST,
weakness. GI: constipation, diarrhea, abdominal and ALT levels.
pain, dry mouth, increased liver enzymes. • If giving direct IV, look up time frame for infusion.
Neuro: extrapyramidal reactions.

Route/Dosage: Ondansetron: PO/8–24 mg 30 min prior to anesthesia or chemotherapy, or for treatment of nausea and vomiting; IV/0.15 mg/kg
15–30 min prior to chemotherapy or for treatment of nausea and vomiting, Granisetron: PO/1–2 mg together or in divided dose 60 min prior to
chemotherapy; IV/20–40 mcg/kg/day 30 min prior to chemotherapy, Palonosetron: PO/0.5 mg 1 hr prior to chemotherapy; IV/0.25 mg 30 min prior to
chemotherapy, Dolasetron: PO/100 mg 1 hr prior to chemotherapy or surgery; IV/12.5 mg 2 hr prior to surgery
1882_Tab01_001-027 10/10/12 12:40 PM Page 26

Gastrointestinal System Drugs Cannabinoids 26

Dronabinol
(droe-nab-i-nol)

THC, Marinol

Nabilone
(na-bi-lone)

Cesamet

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1882_Tab01_001-027 10/10/12 12:40 PM Page 26
Gastrointestinal System Drugs
Therapeutic/Pharmacologic Class
Antiemetic; appetite stimulant/cannabinoids
Indications
Treatment of nausea and vomiting due to
chemotherapy that has not responded to other
conventional antiemetics. Stimulation of appetite in
the cachexic client.
Action
Active ingredient in marijuana, with a wide variety
of CNS effects, including inhibition of the vomiting
control mechanism in the medulla oblongata.
Adverse Reactions/Side Effects
CNS: anxiety, concentration difficulty, confu-
sion, dizziness, drowsiness, mood change,
abnormal thinking, depression, disorientation,
hallucinations, headache, impaired judgment,
memory lapse, paranoia. EENT: dry mouth. CV:
palpitations, syncope, tachycardia. GI: abdominal
pain, nausea, vomiting. Derm: facial flushing.
Neuro: ataxia, paresthesia. Misc: physical
dependence, psychological dependence (high
doses or prolonged therapy).
Route/Dosage: Dronabinol: PO/2.5 mg bid (5 mg/m2 1–3 hr prior to chemotherapy), Nabilone: PO/1–2 mg bid (not to exceed 6 mg/day)
Cannabinoids 26
Keep in Mind
Teach client:
• Take exactly as directed.
• Signs of overdose (mood changes, confusion, hallu-
cinations, depression, nervousness, fast or pound-
ing heartbeat) may occur with increased doses.
• May cause dizziness, orthostatic hypotension,
drowsiness, and impaired judgment and
coordination.
• Avoid taking alcohol or other CNS depressants
concurrently.
Make the Connection
• Monitor client closely for altered mental
status. Monitor VS periodically during therapy.
• May cause anemia; monitor CBC.
• Appetite stimulation: Institute I&O, daily weight,
as well as calorie counts.
1882_Tab01_001-027 10/10/12 12:40 PM Page 27

Gastrointestinal System Drugs Gastrointestinal Anti-Inflammatories 27

Mesalamine Sulfasalazine
(me-sal-a-meen) (sul-fa-sal-a-zeen)

Asacol, Asacol-HD, Azulfadine

Lialda, Pentasa, PMS-Sulfasalazine
Canasa, Rowasa
Salofalk

Olsalazine
(ole-sal-a-zeen)

Dipentum
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1882_Tab01_001-027 10/10/12 12:40 PM Page 27
Gastrointestinal System Drugs
Therapeutic/Pharmacologic Class
Gastrointestinal anti-inflammatories
Indications
Treatment of inflammatory bowel diseases, including
Crohn’s disease and ulcerative colitis.
Action
Locally acting anti-inflammatory action in the colon,
where activity is probably due to inhibition of
prostaglandin synthesis.
Adverse Reactions/Side Effects
CNS: headache, dizziness, malaise, weakness.
EENT: pharyngitis, rhinitis. CV: pericarditis. GI:
diarrhea, eructation, flatulence, nausea, vomit-
ing. GU: interstitial nephritis, pancreatitis, renal
failure. Derm: hair loss, rash. Local: anal irrita-
tion (enema, suppository). MS: back pain.
Misc: anaphylaxis, acute intolerance syndrome,
fever.
Route/Dosage: Mesalamine: PO/(Asacol) 800 mg tid for 6 wk, PO/(Asacol HD) 1.6 g tid for 6 wk, PO/(Lialda) 2.4–4.8 g daily for up to 8 wk,
PO/(Pentasa) 1 g qid for up to 8 wk; Rect/(Rowasa) 4-g enema (60 mL) hr, Sulfasalazine: PO/500 mg q 6 hr, Olsalazine: PO/500 mg bid
Gastrointestinal Anti-Inflammatories 27
Keep in Mind
Teach client:
• May cause dizziness.
• Notify HCP if skin rash, sore throat, fever, mouth
sores, unusual bleeding or bruising, wheezing,
fever, or hives occur.
• May take 1–2 months for full effect.
• If cramping, acute abdominal pain, bloody
diarrhea, fever, headache, or rash occur, discon-
tinue therapy and notify HCP immediately.
• Increase oral intake of fluids to prevent renal
lithiasis.
Make the Connection
• Assess client for allergy to sulfonamides
or salicylates.
• Fluid intake should be 1500–2000 mL/day.
Monitor daily weight and I&O.
• Monitor blood chemistries for liver and renal
function and CBC with differential.
• Monitor amylase and lipase levels (pancreatitis).
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 3
ENDOCRINE
Insulin Aspart, rDNA
Origin, 28
Insulin Glulisine (rDNA
Origin) Injection, 28
Insulin Lispro, rDNA
Origin, 28
Regular Insulin, 29
Neutral Protamine
Hagedorn (NPH), 30
Insulin (Isophane
Insulin Suspension), 30
Intermediate Type, 30
Insulin Detemir, 31
Insulin Glargine, 31
Pramlintide, 32
Exenatide, 33
Exenatide ER
Suspension, 33
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Metformin, 34 Propylthiouracil, 42
Sitagliptin, 35 Cortisone, 43
Linagliptin, 35 Methylprednisolone, 43
Saxagliptin, 35 Hydrocortisone, 43
Repaglinide, 36 Prednisone, 43
Nateglinide, 36 Fludrocortisone, 44
Acarbose, 37 Oxytocin, 45
Miglitol, 37 Desmopressin, 46
Glipizide, 38 Vasopressin, 46
Glyburide, 38 Somatropin, 47
Glimepiride, 38 Octreotide, 48
Rosiglitazone, 39 Lanreotide, 48
Pioglitazone, 39 Megestrol, 49
Glucagon, 40 Pegvisomant, 50
Levothyroxine, 41
Thyroid, 41
Liothyronine, 41
Methimazole, 42
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 4
1882_Tab02_028-050 10/10/12 12:46 PM Page 28

Endocrine System Drugs Pancreatics (Rapid-Acting Insulin) 28

Insulin Aspart, Insulin Lispro,

rDNA Origin rDNA Origin
(in-su-lin as-spart) (in-su-lin liss-pro)

Novolog Humalog

Insulin Glulisine
(rDNA Origin) Injection
(in-su-lin gloo-lye-seen)

Apidra

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1882_Tab02_028-050 10/10/12 12:46 PM Page 28

Endocrine System Drugs Pancreatics (Rapid-Acting Insulin) 28

Therapeutic/Pharmacologic Class Keep in Mind
Antidiabetic agent, hormone/pancreatic agents Teach client:
Indications • Use U-100 syringes with solutions containing
Treatment of diabetes mellitus. These antidiabetic 100 units/mL. If using a prefilled pen, prime with
agents are described as very rapid acting (onset 2 units prior to dialing dosage.
5–15 min, with peak 30–60 min). • Sick days require more monitoring.
Action • Carry a source of glucose.
Lowers blood glucose by stimulating glucose uptake • Wear a Medic-Alert bracelet.
in skeletal muscle and fat, inhibiting hepatic glucose • Recognize signs and symptoms of hyperglycemia
and hypoglycemia, and be aware of self-treatment
production. Other actions are inhibition of lipolysis measures if these occur.
and proteolysis.
Adverse Reactions/Side Effects
Derm: urticaria. Endo: hypoglycemia, rebound Make the Connection
hyperglycemia (Somogyi effect). Local: lipodys- • Because of high error rate, two nurses
trophy (lipoatrophy, lipohypertrophy), itching, should check the insulin type, dosage, and
redness, swelling. Misc: allergic reactions, expiration date.
including anaphylaxis. • Very rapid-acting agents are called “dose and
eat” for a reason. Onset 5–15 min.
• Memorize the peak time of these medications!
Look for hypoglycemia (normal 70–120 mg/dL).
• Hypoglycemia resembles an anxiety attack, with
the person having cold, clammy skin.
Route/Dosage: Insulin aspart: SC/0.5–1 unit/kg/day, Insulin lispro: SC/0.2–0.6 unit/kg/day, Insulin glulisine injection: SC/wt. based on glucose/
lifestyle
1882_Tab02_028-050 10/10/12 12:46 PM Page 29

Endocrine System Drugs Pancreatic (Short-Acting Insulin) 29

Regular Insulin
(reg-yu-ler in-sul-in)

Humulin R, Novulin R, Velosulin

Insulin-Toronto

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1882_Tab02_028-050 10/10/12 12:46 PM Page 29
Endocrine System Drugs Pancreatic (Short-Acting Insulin)
Therapeutic/Pharmacologic Class
Antidiabetic agent, hormone/pancreatic agent
Indications
Treatment of diabetes mellitus; can be used to treat DKA.
Action
Lowers blood glucose by stimulating glucose uptake
in skeletal muscle and fat, inhibiting hepatic glucose
production. Also inhibits lipolysis and proteolysis,
enhancing protein synthesis.
Adverse Reactions/Side Effects
Derm: urticaria. Endo: hypoglycemia, rebound
hyperglycemia (Somogyi effect). Local: lipodys-
trophy (lipoatrophy, lipohypertrophy), itching,
redness, swelling. Misc: allergic reactions,
including anaphylaxis.
Keep in Mind
Teach client:
• Follow instructions for proper administration.
• Administer the insulin at the correct time. Its
onset is 30 min.
Route/Dosage: SC/0.5–1 unit/kg/day; IV/0.1 unit/kg/hr continuous infusion
29
• Recognize signs and symptoms of hyperglycemia
and hypoglycemia, and be aware of self-treatment
measures if these occur.
• Hypoglycemia occurs during the peak time of this
drug (2–4 hr after injection).
• Consult with HCP if feeling ill.
Make the Connection
• Because of high error rate, two nurses
should check the insulin type, dosage, and expi-
ration date.
• Rotate injection sites. May be injected SC into
abdominal wall, thigh, or upper arm.
• This is the only insulin type that can be given IV
as a direct dose or continuous infusion.
• Monitor for hypoglycemia. Hypoglycemia resembles
an anxiety attack, with the person having cold,
clammy skin.
• Remember the classic 3 “Ps” of diabetes
(polyuria, polyphagia, and polydipsia).
• Long-term effects of poor glycemic control include
neuropathy, nephropathy, and retinopathy.
1882_Tab02_028-050 10/10/12 12:46 PM Page 30

Endocrine System Drugs Pancreatics (Intermediate-Acting Insulin) 30

Neutral Protamine
Hagedorn (NPH)
Insulin (Isophane
Insulin Suspension)
Intermediate Type
(nu-tral pro-ta-meen hag-e-dorn in-sul-in)

Humulin N
Novolin ge NPH
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1882_Tab02_028-050 10/10/12 12:46 PM Page 30
Endocrine System Drugs Pancreatics (Intermediate-Acting Insulin)
Therapeutic/Pharmacologic Class
Antidiabetic agent, hormone/pancreatic agents
Indications
Treatment of diabetes mellitus. Because of the
delayed and prolonged duration, cannot be used in
the acute treatment of DKA. Intermediate suspen-
sions have onset of 1–2 hr and peak of 4–12 hr.
Action
Lowering of blood glucose levels by stimulating
glucose uptake in skeletal muscle and fat, inhibiting
hepatic glucose production. Other actions include
inhibition of lipolysis and proteolysis.
Adverse Reactions/Side Effects
Derm: urticaria. Endo: hypoglycemia, rebound
hyperglycemia (Somogyi effect). Local: lipodys-
trophy (lipoatrophy, lipohypertrophy), itching,
redness, swelling. Misc: allergic reactions,
including anaphylaxis.
Route/Dosage: SC/0.5–1 unit total insulin/kg/day
30
Keep in Mind
Teach client:
• Proper use of syringes and vials is important, as is
the proper storage of the insulin.
• Testing of serum glucose and ketones is important,
especially for sick care.
• Carry a glucose source and wear a Medic-Alert
bracelet!
• Carbohydrate counting is a useful method for
diet planning to control blood glucose.
• Recognize signs and symptoms of hyperglycemia
and hypoglycemia, and be aware of self-treatment
measures if these occur.
• Notify HCP if pregnancy is planned or suspected.
Make the Connection
• Because of high error rate, two nurses
should check the insulin type, dosage, and
expiration date.
• Memorize peak times. Hypoglycemia will happen
during these times.
• Hypoglycemia resembles an anxiety attack, with
the person having cold, clammy skin.
1882_Tab02_028-050 10/10/12 12:46 PM Page 31

Endocrine System Drugs Pancreatics (Basal Insulin) 31

Insulin Detemir
(in-su-lin de-te-mir)

Levemir

Insulin Glargine
(in-su-lin glar-jeen)

Lantus

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1882_Tab02_028-050 10/10/12 12:46 PM Page 31
Endocrine System Drugs Pancreatics (Basal Insulin)
Therapeutic/Pharmacologic Class
Antidiabetic agent, hormone/pancreatic agents
Indications
Treatment of diabetes mellitus. Because of its delayed
onset (1–2 hr) and prolonged duration, medication
cannot be used in the acute treatment of DKA.
Action
Lowers blood glucose by stimulating glucose uptake
in skeletal muscle and fat; inhibits hepatic glucose
production. Other actions include inhibition of lipoly-
sis and proteolysis, and enhanced protein synthesis.
Adverse Reactions/Side Effects
Derm: urticaria. Endo: hypoglycemia, rebound
hyperglycemia (Somogyi effect). Local: lipodys-
trophy (lipatrophy, lipohypertrophy), itching,
redness, swelling. Misc: allergic reactions,
including anaphylaxis.
Keep in Mind
Teach client:
• Follow instructions for proper administration
techniques.
Route/Dosage: Insulin detemir: SC/0.1–0.2 units/kg once daily, Insulin glargine: SC/2–100 units/day
31
• Make sure that U-100 syringes are used with
100-unit/mL insulin. Onset is from 1–2 hr.
• If using a prefilled pen, prime with 2 units before
dialing dosage.
• Recognize signs and symptoms of hyperglycemia
and hypoglycemia, and be aware of self-treatment
measures if these occur.
• Carry a simple sugar or glucose tablets in case of
hypoglycemia.
• Consult with health care professional if feeling ill.
• Follow instructions for testing blood glucose.
Make the Connection
• Two nurses should check the insulin
type, dosage, and expiration date.
• Rotate injection sites.
• Monitor for hypoglycemia. Hypoglycemia resembles
an anxiety attack, with the person having cold,
clammy skin.
• Basal insulins cannot be mixed.
1882_Tab02_028-050 10/10/12 12:46 PM Page 32

Endocrine System Drugs Hormone (Amylinomimetic) 32

Pramlintide
(pram-lin-tide)

Symlin

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1882_Tab02_028-050 10/10/12 12:46 PM Page 32
Endocrine System Drugs Hormone (Amylinomimetic)
Therapeutic/Pharmacologic Class
Antidiabetic agent/hormone, amylinomimetic
Indications
Treatment of type 1 and type 2 diabetes in conjunc-
tion with other antidiabetic agents.
Action
Slows the rate of gastric emptying, reducing the
amount of glucose absorbed postprandially.
Decreases the level of glucagon and reduces
appetite.
Adverse Reactions/Side Effects
CNS: anxiety, blurred vision, seizures, coma,
headache, nightmares, dizziness, depression,
confusion. Derm: cool, pale skin. Resp: cough,
pharyngitis, shortness of breath, wheezing. GI:
difficulty swallowing, vomiting, weight loss,
increased hunger. MS: muscle pain or stiffness,
pain in joints. CV: fast heartbeat, tightness in
chest. Misc: hives; itching; puffiness or swelling
of the eyelids or around the eyes, face, lips, or
tongue; skin rash; and other allergic reactions,
including anaphylaxis.
Route/Dosage: SC/60–120 mcg ac (type 2 insulin-using) SC/15–60 mcg ac (type 1)
32
Keep in Mind
Teach client:
• Take the drug exactly as prescribed, at mealtimes.
• Do not mix this drug in the same syringe with
insulin.
• Do not drink alcohol, as this may result in
severe hypoglycemia.
• Recognize signs and symptoms of hyperglycemia
and hypoglycemia, and be aware of self-treatment
Make the Connection
• HbA1c level and postprandial levels are
the best indicators of control.
• A 0.3-mL U-100 syringe is best to give this drug.
Dosing is in mcg, and administration is in units,
so carefully check dosage. Rotate injection sites.
• Watch for hypoglycemia within the first 3 hr
following injection.
• Monitor for severe nausea and vomiting.
1882_Tab02_028-050 10/10/12 12:46 PM Page 33

Endocrine System Drugs Incretin Mimetic Agents 33

Exenatide
(ex-en-a-tide)

Byetta

Exenatide ER Suspension
(ex-en-a-tide)

Bydureon

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1882_Tab02_028-050 10/10/12 12:46 PM Page 33
Endocrine System Drugs Incretin Mimetic Agents
Therapeutic/Pharmacologic Class
Antidiabetic agent/incretin mimetic agents
Indications
Treatment of type 2 diabetes uncontrolled by
metformin and/or a sulfonylurea. Control of post-
prandial glucose levels.
Action
Mimics the action of incretin, which promotes
insulin secretion from pancreas, decreases absorp-
tion of glucose from the gut, decreases the action
of glucagon, and decreases appetite.
Adverse Reactions/Side Effects
CV: dizziness, headache, jitteriness, weakness.
GI: diarrhea, nausea, vomiting, dyspepsia, GI
reflux. Derm: hyperhidrosis. Metab: ↓ appetite,
weight loss.
Route/Dosage: Exenatide: SC/5–10 mcg within 1 hr before AM and PM meal, Exenatide ER suspension: SC/2 mg q 7 days (premeasured vial) (Bydureon)
33
Keep in Mind
Teach client:
• Administer 60 min before a meal. Do not take
after a meal. Bydureon is given independently
of meals.
• Follow instructions for SC administration with
prefilled pens and for Bydureon with vials and
diluent.
• Follow prescribed diet, medication, and exercise
regimen to remain euglycemic.
• Watch for signs of hypoglycemia and
hyperglycemia.
• Stomach emptying is delayed with this medication,
which may interfere with other medications. Take
medications 1 hr prior to this drug.
• Wear a Medic-Alert bracelet.
Make the Connection
• Monitor serum glucose, LFT, and weight.
• An incretin mimetic acts like GLP-1, a hormone
that helps to decrease appetite and regulate glucose
levels, especially postprandial levels (after meals).
1882_Tab02_028-050 10/10/12 12:46 PM Page 34

Endocrine System Drugs Biguanide 34

Metformin
(met-for-min)

Fortamet, Glucophage,
Glucophage XR
Novo-Metformin

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1882_Tab02_028-050 10/10/12 12:46 PM Page 34
Endocrine System Drugs Biguanide
Therapeutic/Pharmacologic Class
Antidiabetic agent/biguanide
Indications
Management of type 2 diabetes mellitus; may be used
with diet, insulin, or sulfonylurea oral hypoglycemics.
Action
Decreases hepatic glucose production. Decreases
intestinal glucose absorption. Increases sensitivity
of the cell receptors to insulin.
Adverse Reactions/Side Effects
GI: abdominal bloating, diarrhea, nausea,
vomiting, unpleasant metallic taste. Endo:
hypoglycemia. F and E: lactic acidosis. Misc:
decreased vitamin B12 levels.
Keep in Mind
Teach client:
• Follow prescribed diet, medication, and exercise
regimen to remain euglycemic.
• Symptoms of lactic acidosis should be reported
to the HCP immediately.
Route/Dosage: PO/500–2000 mg/day
34
• Inform HCP of medication regimen before
diagnostics or surgery.
Make the Connection
• Remember, this drug works differently
from an insulin secretagogue, so it is used in
combination with other antidiabetic agents.
• Lactic acidosis occurs more frequently in persons
with renal insufficiency.
• Assess renal function before initiating and at least
annually during therapy.
• Monitor LFT, creatinine level, serum folic acid,
and vitamin B12.
• This drug, when combined with iodinated contrast
dye, can cause kidney damage. The drug should
be held on the day of the imaging procedure and
for 48 hr after.
• XR tablets must be swallowed whole; do not
crush or chew.
1882_Tab02_028-050 10/10/12 12:46 PM Page 35

Endocrine System Drugs Dipeptidyl Peptidase-4 Inhibitors 35

Sitagliptin Saxagliptin
(sit-a-glip-tin) (sax-a-glip-tin)

Januvia Onglyza

Linagliptin
(lin-a-glip-tin)

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1882_Tab02_028-050 10/10/12 12:46 PM Page 35

Endocrine System Drugs Dipeptidyl Peptidase-4 Inhibitors 35

Therapeutic/Pharmacologic Class Keep in Mind
Antidiabetic agent/dipeptidyl peptidase-4 inhibitors Teach client:
Indications • Watch for signs and symptoms of hypoglycemic
Adjunct to diet and exercise to improve glycemic reactions, especially if combined with other
control in clients with type 2 diabetes mellitus; may antidiabetic agents.
be used as monotherapy or combination therapy • Monitor glucose as directed.
with metformin or a thiazolidinedione. • May be administered with or without food.
Action • Follow prescribed diet, medication, and exercise
regimen to remain euglycemic.
Inhibits the enzyme dipeptidyl peptidase-4 (DPP-4),
which slows the inactivation of incretin hormones. • Do not use during pregnancy or if lactating.
These hormones are released by the intestine • Wear a Medic-Alert bracelet.
throughout the day and are involved in appetite
control, increase in insulin release, and decrease in Make the Connection
glucagon levels. • This antidiabetic works differently than
Adverse Reactions/Side Effects a secretagogue does.
CNS: headache. • Often combined with another antidiabetic.

Route/Dosage: Sitagliptin: PO/100 mg/day, Saxagliptin: PO/2.5–5 mg/day, Linagliptin: PO/5 mg daily
1882_Tab02_028-050 10/10/12 12:46 PM Page 36

Endocrine System Drugs Meglitinides 36

Repaglinide
(re-pag-gli-nide)

Gluconorm, Prandin

Nateglinide
(na-teg-li-nide)

Starlix

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Endocrine System Drugs Meglitinides 36

Therapeutic/Pharmacologic Class • Watch for signs of hypoglycemia and hyperglycemia,
Antidiabetic agent/meglitinides and take appropriate action.
Indications • Test blood glucose levels before meals and
Treatment of type 2 diabetes mellitus, with diet and before bed.
exercise; may be used with metformin, rosiglitazone, • Wear Medic-Alert bracelet.
or pioglitazone. • Not recommended during pregnancy; insulin is
safer.
Action
Stimulates the release of insulin from pancreatic • Concurrent use of chromium and coenzyme Q10
can cause an increase in hypoglycemia.
beta cells by closing K+ channels, which results in
the opening of Ca+ channels in beta cells. This is • Blood glucose levels may rise with emotional or
physiological stress.
followed by release of insulin. This is a secretagogue.
Adverse Reactions/Side Effects
CV: angina, chest pain. Endo: hypoglycemia, Make the Connection
hyperglycemia. • Know the normal serum glucose level and
HbA1c. The nurse must act appropriately if these
Keep in Mind levels are abnormal.
Teach client: • Do not give this medication if the blood glucose
• Take 30 min before each meal, exactly as directed. level is low or if the client is NPO.
• Follow prescribed diet, medication, and exercise • Notice the clue in the brand name indicating that
regimen to remain euglycemic. these drugs reduce postprandial glucose levels.

Route/Dosage: Repaglinide: PO/0.5–4 mg ac, Nateglinide: PO/120 mg 3 times daily ac

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Endocrine System Drugs Alpha-Glucosidase Inhibitors 37

Acarbose
(aye-kar-bose)

Precose

Miglitol
(mi-gli-tole)

Glyset

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Endocrine System Drugs Alpha-Glucosidase Inhibitors 37

Therapeutic/Pharmacologic Class • Carry an oral form of glucose for hypoglycemia.
Antidiabetic agent/alpha-glucosidase inhibitors Remember that sucrose is not digested.
Indications • Wear a Medic-Alert bracelet.
Management of diabetes in conjunction with • Monitor blood glucose levels. Do not take the
dietary therapy; may be used with insulin or other medication if glucose level is low.
hypoglycemic agents. • High sucrose intake causes increased GI side
effects.
Action
Lowers blood glucose by inhibiting the enzyme
alpha-glucosidase in the GI tract. Sucrose is not Make the Connection
digested and passes through the GI tract • This drug stops sucrose from being
unchanged. digested and used to increase the blood glucose
Adverse Reactions/Side Effects level; thus, the old remedy of candy, table sugar,
GI: abdominal pain, diarrhea, flatulence, ↑ in or cake icing will not work.
transaminases. • Memorize serum glucose (65–110 mg/dL range)
and HbA1c (below 7) levels.
Keep in Mind • Monitor transaminases after baseline obtained.
Teach client: • This medication alone does not cause hypo-
• Watch for signs of hypoglycemia and hyperglycemia, glycemia, but it is often used with other antidia-
and take appropriate actions. betics and potentiates their effect.
• Follow prescribed diet, medication, and exercise • Administer with first bite of each meal 3 times/day.
regimen to remain euglycemic.

Route/Dosage: Acarbose: PO/25–100 mg tid, Miglitol: PO/25–100 mg tid

1882_Tab02_028-050 10/10/12 12:46 PM Page 38

Endocrine System Drugs Sulfonylureas 38

Glipizide Glimepiride
(glip-i-zide) (glye-me-pi-ride)

Glucotrol, Amaryl
Glucotrol XL

Glyburide
(glye-byoo-ride)

DiaBeta, Micronase, Glynase PresTab

Apo-Glyburide

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Endocrine System Drugs Sulfonylureas 38

Therapeutic/Pharmacologic Class Keep in Mind
Antidiabetic agent/sulfonylureas Teach client:
Indications • Watch for signs of hypoglycemia, and take
PO: Treatment of type 2 diabetes mellitus, as an appropriate actions.
adjunct to diet therapy or in cases of insulin resistance. • Follow prescribed diet.
Action • Monitor glucose levels before meals and at
bedtime.
Lowers blood sugar by stimulating the release of
insulin from the pancreas (secretagogue) and • May occasionally cause dizziness or drowsiness.
Avoid activities requiring alertness.
increasing the sensitivity to insulin at receptor sites.
May also decrease hepatic glucose production. • Do not use alcohol (disulfiram-like effect).
• Use sunscreen to prevent rash and burns.
Adverse Reactions/Side Effects • Wear a Medic-Alert bracelet.
CNS: dizziness, drowsiness, headache, weakness. • Report sore throat, unusual bruising, shortness of
GI: constipation, cramps, diarrhea, drug-induced breath, rash, or hives immediately.
hepatitis, dyspepsia, increased appetite, nausea,
vomiting. Derm: photosensitivity, rashes. Endo:
hypoglycemia. F and E: hyponatremia. Hemat: Make the Connection
aplastic anemia, agranulocytosis, leukopenia, • Monitor glucose and HbA1c levels,
pancytopenia, thrombocytopenia. postprandial glucose levels, CBC with differential
count, and liver and renal studies.
• Assess client for allergy to sulfonamides. Remember
that cross-sensitivity can occur.

Route/Dosage: Glipizide: PO/2.5–40 mg/day, Glimepiride: PO/1–4 mg/day, Glyburide: PO/DiaBeta, range 1.25–20 mg/day; Glynase PresTab
(micronized), range 0.75–12 mg/day
1882_Tab02_028-050 10/10/12 12:46 PM Page 39

Endocrine System Drugs Thiazolidinediones 39

Rosiglitazone
(roe-zi-glit-a-zone)

Avandia

Pioglitazone
(pi-o-glit-a-zone)

Actos

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Endocrine System Drugs Thiazolidinediones 39

Therapeutic/Pharmacologic Class
Antidiabetic agent/thiazolidinediones
Indications
Treatment of type 2 diabetes mellitus, as an adjunct
to diet and exercise. May be used alone or with
other diabetic agents.
Action
In insulin resistance, improves receptor affinity of
cells for glucose.
Adverse Reactions/Side Effects
CV: CHF, edema. Derm: urticaria. Hemat:
anemia. Metab: increased cholesterol, LDL,
and HDL; weight gain. Misc: angioedema (rare).
• Laboratory studies will be necessary to assess
glycemic control, liver function, lipid profile, and
renal function.
• Report edema, sudden weight gain, or shortness
of breath immediately.
Make the Connection
• Not for use in pregnant or lactating
women.
• Weigh the client and assess lungs for crackles
(CHF).
• Monitor laboratory chemistries, CBC, and BNP
(especially in those clients with a history of CHF).

Keep in Mind
Teach client:
• Does not cause hypoglycemia and can be taken
without regard to food.
• If taken with other antidiabetic agents, monitor
for signs and symptoms of hypoglycemia and take
appropriate action.

Route/Dosage: Rosiglitazone: PO/2–8 mg/day, Pioglitazone: PO/15–45 mg/day

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Endocrine System Drugs Pancreatic (Antihypoglycemic) 40

Glucagon
(gloo-ka-gon)

GlucaGen

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Endocrine System Drugs Pancreatic (Antihypoglycemic) 40

Therapeutic/Pharmacologic Class • Oral glucose and a protein should be consumed
Hormone/pancreatic; antihypoglycemic after the severe hypoglycemic episode is corrected.
Indications • If hypoglycemia causes unconsciousness, position
Acute management of severe hypoglycemia. the client on his or her side.
Action • Wear a Medic-Alert bracelet.
Stimulates hepatic production of glucose from
glycogen stores. Relaxes the musculature of the GI Make the Connection
tract, temporarily inhibiting movement. Has a posi- • Know the signs of hypoglycemia.
tive inotropic and chronotropic effect on the heart. • Hypoglycemia will occur at antidiabetic agents’
Adverse Reactions/Side Effects peak times.
CV: transient increase in heart rate and BP. GI: • Monitor glucose levels for 3–4 hr after
nausea, vomiting. Misc: hypersensitivity reactions, administration.
including anaphylaxis. • May be given IV.
Keep in Mind
Teach client:
• Used for hypoglycemia, which looks like an anxiety
attack, with the person having cold, clammy skin.
• Follow instructions for administering the injection.
Teach family members how to give the injection
in case of emergency.

Route/Dosage: IV, IM, SC/1 mg; may be repeated in 15 min if necessary

1882_Tab02_028-050 10/10/12 12:47 PM Page 41

Endocrine System Drugs Thyroid Hormones 41

Levothyroxine Liothyronine
(lee-voe-thye-rox-een) (lye-oh-thye-roe-neen)

Levothroid, Levoxyl, Cytomel, Triostat, T3

Synthroid, T4
PMS-Levothyroxine
Sodium

Thyroid
(thye-royd)

Armour Thyroid, Westhroid, Thyrar

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Endocrine System Drugs Thyroid Hormones 41

Therapeutic/Pharmacologic Class
Hormone/thyroid hormones
Indications
Replacement therapy in clients without thyroid hor-
mone or pharmacologic doses to enhance diminished
thyroid function. Replacement or pharmacologic
doses in neonates to correct inborn errors of
metabolism (prevents developmental delay).
Action
Metabolism of all nutrients is increased, promoting
cell growth and increased protein synthesis.
Adverse Reactions/Side Effects
CNS: insomnia, irritability, nervousness, headache.
CV: CV collapse, arrhythmias, tachycardia, angina
pectoris, BP changes, increased CO. GI: cramps,
diarrhea, vomiting. Derm: hair loss in children,
diaphoresis. Endo: hyperthyroidism, menstrual
irregularities. Metab: weight loss, heat intolerance.
MS: accelerated bone maturation in children.
Keep in Mind
Teach client:
• Take medication in the morning to prevent insomnia.
• Report chest pain, palpitations, or dizziness
immediately.
• Full effects may not be felt for several weeks.
• Report excessive weight loss.
Make the Connection
• The previously sluggish heart will beat
faster, increasing myocardial O2 needs. This may
lead to angina or even MI.
• Monitor T3, T4, and thyroid-stimulating hormone
(TSH) levels (TSH is high when thyroid function
is low).
• Monitor glucose, weight, and increasing physical
and mental energy.

Route/Dosage: Levothyroxine: PO/1.5 mcg/kg/day; IM, IV/hypothyroidism, 50–100 mcg/day; IV/myxedema, 200–500 mcg, Liothyronine:
PO/25–50 mcg/day; IV/myxedema, 25–50 mcg initially, Thyroid: PO/60 mg/day
1882_Tab02_028-050 10/10/12 12:47 PM Page 42

Endocrine System Drugs Antithyroids 42

Methimazole
(meth-im-a-zole)

Tapazole

Propylthiouracil
(proe-pill-thye-oh-yoor-a-sill)

PTU
Propyl-Thyracil

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Endocrine System Drugs Antithyroids 42

Therapeutic/Pharmacologic Class
Antithyroid agents
Indications
Palliative treatment of hyperthyroidism. An
adjunct to control hyperthyroidism in preparation
for thyroidectomy or radioactive iodine therapy.
Action
Inhibits the synthesis of thyroid hormones.
Adverse Reactions/Side Effects
CNS: drowsiness, headache, vertigo. GI: diarrhea,
drug-induced hepatitis, loss of taste, nausea,
parotitis, vomiting. Derm: rash, skin discoloration,
urticaria. Hemat: agranulocytosis, anemia,
leukopenia, thrombocytopenia. MS: arthralgia.
Misc: fever, lymphadenopathy.
Keep in Mind
Teach client:
• Monitor weight 2–3 times/wk. Notify HCP of
significant changes.
• May cause drowsiness.
• Report sore throat, unusual bleeding, bruising,
pallor, SOB, or extreme fatigue immediately.
• Wear a Medic-Alert bracelet.
• Laboratory tests will be done frequently to assess
effectiveness of the drug.
Make the Connection
• Watch for thyroid storm (thyrotoxicosis)
characterized by tachycardia, palpitations,
nervousness, insomnia, fever, diaphoresis, heat
intolerance, tremors, and weight loss.
• Conversely, watch for signs of hypothyroidism.
• Assess client for skin rash or swelling of cervical
lymph nodes. Treatment may be discontinued if
this occurs.
• Monitor thyroid function studies at baseline and
when treatment is initiated.
• Monitor for signs of bone marrow suppression
and CBC results.
• Monitor LFT.

Route/Dosage: Methimazole: PO/5–30 mg/kg/day, Propylthiouracil: PO/50–600 mg/day

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Endocrine System Drugs Corticosteroids 43

Cortisone Hydrocortisone
(kor-ti-sone) (hye-droe-kor-ti-sone)

Cortone Cortef, Cortifoam,

Solu-Cortef

Methylprednisolone Prednisone
(meth-ill-pred-niss-oh-lone) (pred-ni-sone)

Medrol, Solu-Medrol Sterapred

(IV), PredPak

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Endocrine System Drugs Corticosteroids
Therapeutic/Pharmacologic Class
Anti-inflammatory (steroidal) agent, immunosup-
pressant/glucocorticosteroids
Indications
Systemic and local treatment of a wide variety of
inflammatory diseases and conditions. Replacement
therapy in adrenal insufficiency.
Action
Suppresses inflammation and the normal immune
response.
Adverse Reactions/Side Effects
CNS: depression, euphoria, headache, ICP
(children only), personality changes, psychoses,
restlessness. EENT: cataracts, increased
intraocular pressure. CV: HTN. GI: peptic ulcer-
ation. Derm: acne, decreased wound healing,
ecchymoses, fragility, hirsutism, petechiae.
Endo: adrenal suppression, hyperglycemia.
F and E: fluid retention, hypokalemia.
Route/Dosage: Cortisone: PO/25–300 mg/day, Hydrocortisone: PO/20–240 mg/day; IM, IV/100–500 mg q 2–6 hr, Methylprednisolone: PO/varies
with condition, 2–60 mg/day usual; IM, IV/100–500 mg q 2–6 hr, Prednisone: PO/5–60 mg/day
43
Hemat: thromboembolism, thrombophlebitis.
Metab: weight gain, hyperglycemia. MS: muscle
wasting, osteoporosis, aseptic necrosis of joints,
muscle pain. Misc: cushingoid appearance,
increased susceptibility to infection.
Keep in Mind
Teach client:
• Do not stop the medication suddenly.
• Avoid grapefruit juice and limit caffeine when
taking oral forms.
Make the Connection
• Monitor I & O, daily weight, edema, lung
sounds, serum electrolytes, CBC, and glucose level.
• Give with food in the AM to decrease gastric
upset and mimic natural cortisol.
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Endocrine System Drugs Corticosteroid (Mineralocorticoid) 44

Fludrocortisone
(floo-droe-kor-ti-sone)

Florinef

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Endocrine System Drugs Corticosteroid (Mineralocorticoid)
Therapeutic/Pharmacologic Class
Hormone/corticosteroid; mineralocorticoid
Indications
Treatment of Na loss and hypotension associated
with adrenocortical insufficiency (given with hydro-
cortisone or cortisone). Management of Na loss due
to congenital adrenogenital syndrome (congenital
adrenal hyperplasia). Unlabeled uses: Treatment of
idiopathic orthostatic hypotension (with increased
Na intake).
Action
Causes Na reabsorption, hydrogen and M+ excretion,
and water retention by its effects on the distal renal
tubule.
Adverse Reactions/Side Effects
CNS: dizziness, headache. CV: CHF, arrhythmias,
edema, HTN. GI: anorexia, nausea. Endo:
adrenal suppression, weight gain. F and E:
hypokalemia, hypokalemic alkalosis. MS: arthral-
gia, muscular weakness, tendon contractures.
Neuro: ascending paralysis. Misc: hypersensitivity
reactions.
Route/Dosage: PO/50–200 mcg/day
44
Keep in Mind
Teach client:
• Take medication as directed. Abrupt discontinua-
tion may lead to addisonian crisis.
• Follow dietary modification prescribed by HCP.
• Wear a Medic-Alert bracelet.
• Watch for signs and symptoms of addisonian crisis.
Make the Connection
• Monitor BP periodically during therapy.
• Monitor for fluid retention (weigh daily, assess
for edema, and auscultate lungs for rales/crackles).
• Monitor clients with Addison’s disease closely,
and stop treatment if a significant increase in
weight or BP, edema, or cardiac enlargement
occurs. Clients with Addison’s disease are more
sensitive to the action of this drug and may have
an exaggerated response.
• Monitor serum electrolytes periodically during
therapy. This drug causes ↓ in serum K+ levels.
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Endocrine System Drugs Oxytocic 45

Oxytocin
(ox-i-toe-sin)

Pitocin
Syntocinon

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Endocrine System Drugs Oxytocic
Therapeutic/Pharmacologic Class
Hormone/oxytocic agent
Indications
IV: Induction or augmentation of labor at term.
Can be used as an abortive agent. Postpartum
control of bleeding after expulsion of the placenta.
IM: Prevention of postpartum hemorrhage after
separation of placenta. Unlabeled uses: Evaluation
of fetal competence (fetal stress test).
Action
Stimulates uterine smooth muscle, producing uterine
contractions similar to those in spontaneous labor.
Contracts the uterus to squeeze closed the attach-
ment sites of the placenta, so it stops excess post-
partum bleeding. Stimulates mammary gland smooth
muscle, facilitating lactation. Has vasopressor and
antidiuretic effects.
Adverse Reactions/Side Effects
CNS: maternal—coma, seizures; fetal—intracranial
hemorrhage. Resp: fetal—asphyxia, hypoxia. CV:
maternal—hypotension; fetal—arrhythmias. F and
Route/Dosage: IV/labor induction, 5–6 milliunits/min; maximum 20 milliunits/min IM/postpartum hemorrhage, 10 units
45
E: maternal—hypochloremia, hyponatremia, water
intoxication. Misc: maternal—increased uterine
motility, painful contractions, abruptio placentae,
decreased uterine blood flow, hypersensitivity.
Keep in Mind
Teach client:
• Expect contractions to become more severe and
last longer.
Make the Connection
• Assess character, frequency, and duration
of uterine contractions; resting uterine tone;
and fetal heart rate frequently throughout
administration.
• This drug occasionally causes water intoxication.
• Make sure there is a physician in-house at all
times when the client is on a continuous drip.
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Endocrine System Drugs Antidiuretic Hormones 46

Desmopressin
(des-moe-press-in)

DDAVP, DDAVP Rhinal Tube,

DDAVP Rhinyle Drops, Stimate

Vasopressin
(vay-soe-press-in)

Pitressin
Pressyn
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Endocrine System Drugs Antidiuretic Hormones 46

Therapeutic/Pharmacologic Class
Hormone/antidiuretic hormones
Indications
Management of primary nocturnal enuresis
unresponsive to other treatment modalities
(desmopressin). Treatment of pulseless VT or
VFib, GI hemorrhage, vasodilatory shock, and
diabetes insipidus caused by a deficiency.
Action
Analogues or derivatives of naturally occurring
antidiuretic hormone. The primary action is
enhanced reabsorption of water in the kidneys.
Adverse Reactions/Side Effects
CNS: drowsiness, headache, listlessness. EENT:
intranasal (DDAVP)—nasal congestion, rhinitis.
Resp: dyspnea. CV: HTN, hypotension, tachy-
cardia. GI: mild abdominal cramps, nausea.
GU: vulval pain. Derm: flushing. F and E: water
intoxication/hyponatremia.
Keep in Mind
Teach client:
• Notify HCP if bleeding is not controlled or if
headache, dyspnea, heartburn, nausea, abdominal
cramps, vulval pain, or severe nasal congestion or
irritation occurs.
• Avoid use of alcohol with this medication as
alcohol decreases the antidiuretic hormone effect.
• If increased urine output occurs, contact HCP for
dosage adjustment.
• Wear a Medic-Alert bracelet.
Make the Connection
• Assess client for symptoms of dehydration.
• Weigh client daily and assess for edema.
• Assess for signs of bleeding. Monitor clotting
factors.
• Monitor BP and serum Na level.
• Monitor for signs and symptoms of water
intoxication.

Route/Dosage: Desmopressin: PO/diabetes insipidus, 0.1–1.2 mg/day; Intranasal/5–40 mcg; SC, IV/0.1–1.2 mg/day, Vasopressin: IM, SC/diabetes
insipidus, 5–10 units 2–4 times daily; IV/pulseless VT/VFib, 10 units once; vasodilatory shock, 0.01–0.1 units/min (titrate to effect)
1882_Tab02_028-050 10/10/12 12:47 PM Page 47

Endocrine System Drugs Growth Hormone 47

Somatropin
(soe-ma-troe-pin)

Humatrope, Serostim

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Endocrine System Drugs Growth Hormone 47

Therapeutic/Pharmacologic Class
Hormone/growth hormone
Indications
Treatment of growth hormone (GH) deficiency in
adults as a result of pituitary disease, hypothalamic
disease, surgery, radiation, trauma, or childhood
onset. Treatment of short stature in children with
open epiphyses.
Action
Produces skeletal and cellular growth.
Adverse Reactions/Side Effects
CV: edema of the hands and feet. Endo: hyper-
glycemia, hypothyroidism, insulin resistance.
Local: pain at injection site. MS: arthralgia,
carpal tunnel syndrome.
• Follow up with endocrinologist as recommended.
• Report any joint pain (fingers, legs, hips), as this
could be an epiphyseal abnormality.
Make the Connection
• Epiphyses must be open in order for
medication to have an effect on children with
short stature.
• Observe for epiphyseal abnormalities, such as
limping, pain, or joint disfigurement.
• Measure growth and reassure child that the
medication is working.
• Watch glucose levels (GH increases blood glucose
level) and monitor thyroid function.

Keep in Mind
Teach client:
• Follow instructions for IM or SC injections and
proper disposal of syringes.

Route/Dosage: SC/0.006 mg/kg/day; children, 0.18–0.30 mg/kg/wk

1882_Tab02_028-050 10/10/12 12:47 PM Page 48

Endocrine System Drugs Hormones 48

Octreotide
(ok-tree-oh-tide)

Sandostatin, Sandostatin LAR

Lanreotide
(lan-ree-o-tide)

Somatuline Depot

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Endocrine System Drugs Hormones 48

Therapeutic/Pharmacologic Class GI: abdominal pain, cholelithiasis, diarrhea, fat
Hormones malabsorption, nausea, vomiting. Derm: flush-
Indications ing. Endo: hyperglycemia, hypoglycemia.
Treatment of severe diarrhea and flushing episodes Local: injection site pain.
in clients with GI endocrine tumors, including
metastatic carcinoid tumors and vasoactive intes-
Keep in Mind
Teach client:
tinal peptide (VIP) tumors (VIPomas). Used with
endoscopy for injection of bleeding esophageal • May cause dizziness, drowsiness, or visual
disturbances.
varices. Treatment of symptoms and suppression of
tumor growth in clients with pituitary tumors asso- • Change positions slowly to minimize orthostatic
hypotension.
ciated with acromegaly. Management of diarrhea in
AIDS clients or clients with fistulas. • Keep record of number and characteristics of
bowel movements.
Action
Suppresses secretion of serotonin and gastroentero-
hepatic peptides. Increases absorption of fluid and Make the Connection
electrolytes from the GI tract and increases transit • Assess frequency and consistency of
time. Suppresses secretion of GH, insulin, and stools and bowel sounds throughout therapy.
glucagon. • Monitor pulse and BP.
Adverse Reactions/Side Effects • Assess client’s F and E balance.
CNS: dizziness, drowsiness, fatigue, headache, • Monitor diabetic clients for signs of hypoglycemia.
weakness. EENT: visual disturbances. CV: • Assess for gallbladder disease.
edema, orthostatic hypotension, palpitations.

Route/Dosage: Octreotide: SC, IV/100–300 mcg tid, Lanreotide: SC/90 mg every 4 wk for 3 mo initially
1882_Tab02_028-050 10/10/12 12:47 PM Page 49

Endocrine System Drugs Progestin 49

Megestrol
(me-jess-trole)

Megace

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Endocrine System Drugs Progestin
Therapeutic/Pharmacologic Class
Antineoplastic, hormone/progestin
Indications
Palliative treatment of endometrial and breast
carcinoma, either alone or with surgery or radiation
(tablets only). Treatment of anorexia, weight loss, and
cachexia associated with AIDS (oral suspension only).
Action
Antineoplastic effect may result from inhibition of
pituitary function. Progestins increase appetite in
those suffering from anorexia related to AIDS.
Adverse Reactions/Side Effects
CV: thromboembolism, edema. GI: GI irritation.
Derm: alopecia. Endo: asymptomatic adrenal
suppression (chronic therapy). Hemat: throm-
bophlebitis. MS: carpal tunnel syndrome.
Keep in Mind
Teach client:
• Take medication exactly as directed; do not skip
or double up on missed doses.
Route/Dosage: PO/400–800 mg/day
49
• Report to HCP any unusual vaginal bleeding or
signs of deep vein thrombophlebitis.
• This medication may have teratogenic effects.
Contraception should be used during therapy and
for at least 4 mo after therapy is completed.
• There is a possibility of hair loss.
Make the Connection
• Assess client for swelling (usually
unilaterally), pain, or tenderness in legs or
armpit. Measure circumference and report
these signs of deep vein thrombophlebitis.
• May be administered with meals if GI irritation
becomes a problem.
• Any ovarian hormone may pose a risk for throm-
bophlebitis and embolus formation.
• Smoking increases the risk for thrombotic embolus
formation.
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Endocrine System Drugs Growth Hormone 50

Pegvisomant
(peg-vis-o-mant)

Somavert

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Endocrine System Drugs Growth Hormone
Therapeutic/Pharmacologic Class
Hormone/growth hormone
Indications
Treatment of acromegaly in patients who do not
respond to or are not candidates for surgery, radia-
tion, or other medical therapies.
Action
Binds to GH receptor sites on cell surfaces, blocking
the effects of endogenous GH. Bound to polyethylene
glycol (PEG) to reduce clearance and increase dura-
tion of action, resulting in decreased manifestations
of acromegaly and normalized insulin-like growth
factor-1 (IGF-1) levels.
Adverse Reactions/Side Effects
CV: HTN, peripheral edema. GI: ↑ LFT. MS:
back pain. Endo: growth hormone deficiency,
↑ glucose tolerance. Derm: lipohypertrophy.
Keep in Mind
Teach client:
• Missed doses should be omitted; return to
schedule the next day.
Route/Dosage: SC/10 mg/day
50
• Avoid OTC and herbal medications unless cleared
by HCP.
• May cause dizziness. Avoid driving or other activi-
ties requiring alertness until effect of the drug is
known.
• Notify HCP promptly if skin or whites of the eyes
turn yellow (jaundice); if urine turns dark or
stools turn light in color; or if decreased appetite,
nausea, unexplained tiredness, or abdominal pain
occurs.
• Notify HCP if pregnancy is planned or suspected,
or if breastfeeding.
• Frequent laboratory tests are necessary to adjust
dose and monitor for adverse effects.
Make the Connection
• Assess patient for signs and symptoms
of acromegaly.
• Monitor serum IGF-1 levels at 4–6 wk and
every 6 mo.
• Monitor for ↓ glucose levels; and ↑ALT, AST,
total bilirubin, and alkaline phosphatase levels.
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 5

UROLOGIC

Tolterodine, 51 Vardenafil, 56 Epoetin, 62

Darifenacin, 51 Tadalafil, 56 Iron Dextran, 63
Solifenacin, 51 Doxazosin, 57 Iron Sucrose, 63
Oxybutynin, 51 Terazosin, 57 Iron Polysaccharide, 63
Bethanechol, 52 Tamsulosin, 57 Trospium, 64
Spironolactone, 53 Alfuzosin, 57 Tolterodine, 64
Amiloride, 53 Finasteride, 58 Fesoterodine , 64
Triamterene, 53 Dutasteride, 58 Saw Palmetto, 65
Furosemide, 54 Sevelamer, 59
Bumetanide, 54 Calcium Acetate, 59
Chlorothiazide, 55 Vitamin B with
Hydrochlorothiazide, 55 Vitamin C, 60
Sildenafil, 56 Calcitriol, 61

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Urologic System Drugs Anticholinergics 51

Tolterodine Solifenacin
(tol-ter-oh-deen) (so-li-fen-a-sin)

Detrol, Detrol LA VESIcare

Darifenacin Oxybutynin
(dar-i-fen-a-sin) (ox-i-byoo-ti-nin)

Enablex Gelnique (gel),

Oxytrol (transdermal
system), Ditropan and
Ditropan XL (oral)

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Urologic System Drugs Anticholinergics 51

Therapeutic/Pharmacologic Class
Urinary tract antispasmodic/anticholinergics
Indications
Treatment of overactive bladder resulting in symptoms
of urinary frequency, urgency, or urge incontinence.
Action
Acts as a muscarinic (cholinergic) receptor antagonist;
antagonizes bladder smooth muscle contraction.
Adverse Reactions/Side Effects
EENT: blurred vision. GI: constipation, dry
mouth, dyspepsia, nausea.
Keep in Mind
Teach client:
• Be aware of anticholinergic side effects (constipa-
tion, urinary retention, blurred vision, heat pros-
tration in a hot environment).
• May cause dizziness and blurred vision. Avoid
driving and other activities that require alertness
until response to medication is known.
Make the Connection
• Monitor voiding pattern and assess
symptoms of overactive bladder.
• Tablets must be swallowed whole; do not break,
crush, or chew.
• Remember, anticholinergic works against the
“feed/breed/pee/poo” branch of the autonomic
nervous system.
• Side effects of anticholinergics are always “hot
as a hare, dry as a bone, red as a beet, mad as
a hatter, and blind as a bat.”

Route/Dosage: Tolterodine: PO/2–4 mg/day, Solifenacin: PO/5–10 mg/day, Darifenacin: PO/7.5–15 mg/day, Oxybutynin: gel/contents of one sachet
(100 mg/g) once daily; transdermal/a 3.9-mg system twice weekly; PO/5 mg 2–3 times daily; XL/5-30 mg daily
1882_Tab03_051-065 10/10/12 12:47 PM Page 52

Urologic System Drugs Cholinergic 52

Bethanechol
(be-than-e-kole)

Urecholine, Duvoid, Urabeth

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Urologic System Drugs Cholinergic
Therapeutic/Pharmacologic Class
Urinary tract stimulant/cholinergic
Indications
Treatment of postpartum and postoperative nonob-
structive urinary retention or urinary retention
caused by neurogenic bladder.
Action
Stimulates cholinergic receptors. Effects include
contraction of the urinary bladder, decreased
bladder capacity, increased frequency of ureteral
peristaltic waves, increased tone and peristalsis
in the GI tract, increased pressure in the lower
esophageal sphincter, and increased gastric
secretions.
Adverse Reactions/Side Effects
CNS: headache, malaise. EENT: lacrimation,
miosis. Resp: bronchospasm. CV: heart block,
syncope/cardiac arrest, bradycardia, hypoten-
sion. GI: abdominal discomfort, diarrhea, nausea,
salivation, vomiting. GU: urgency. Misc: flushing,
sweating, hypothermia.
Route/Dosage: PO/25–50 mg tid
52
Keep in Mind
Teach client:
• Change positions slowly to minimize orthostatic
hypotension.
• Report abdominal discomfort, salivation, sweating,
or flushing to HCP.
Make the Connection
• Monitor BP, pulse, and respirations
before administering.
• Monitor I&O.
• Palpate abdomen for bladder distention.
• Catheterization or bladder scan may be ordered
to assess postvoid residual.
• Monitor liver and pancreatic enzymes.
• Notice the “chol” in both the generic and brand.
That is a clue to its actions.
• Remember the acronym SLUDGE: salivation,
lacrimation, urination, defecation, GI distress,
and emesis for cholinergic/anticholinesterase
drugs.
1882_Tab03_051-065 10/10/12 12:47 PM Page 53

Urologic System Drugs Potassium-Sparing Diuretics 53

Spironolactone Triamterene
(speer-oh-no-lak-tone) (trye-am-ter-een)

Aldactone Dyrenium
Novospiroton

Amiloride
(a-mill-oh-ride)

Midamor

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Urologic System Drugs Potassium-Sparing Diuretics 53

Therapeutic/Pharmacologic Class Keep in Mind
Diuretic, potassium-sparing diuretics Teach client:
Indications • Avoid salt substitutes and high-potassium foods.
Management of primary hyperaldosteronism. • May cause dizziness.
Management of edema associated with CHF, cirrho- • BP and laboratory work will be monitored.
sis, and nephrotic syndrome. Management of essen- • Wear a Medic-Alert bracelet.
tial HTN. Treatment of hypokalemia (counteracts • Notify HCP if muscle weakness or cramps;
K+ loss caused by other diuretics). fatigue; or severe nausea, vomiting, palpitations,
or diarrhea occur.
Action
Causes loss of sodium bicarbonate and Ca+ while
saving K+ and hydrogen ions by antagonizing aldos- Make the Connection
terone. Blocks reabsorption of Na in the distal con-
voluted tubules and collecting ducts of the
• Monitor I&O and daily weight (the best
indicator) during therapy.
nephrons, while conserving K+. • Always assess K+ level (3.5–5 mEq/L) and BP
Adverse Reactions/Side Effects before administering.
CNS: dizziness, clumsiness, headache. CV: • Monitor ECG for signs of hyperkalemia (tented
arrhythmias. GI: GI irritation. GU: impotence, T waves).
dysuria. Endo: gynecomastia (in men), breast
tenderness, deepening of voice, increased hair
growth (in women). F and E: hyperkalemia,
hyponatremia, hyperchloremic metabolic acidosis.
Hemat: agranulocytosis. MS: muscle cramps.
Misc: allergic reactions.
Route/Dosage: Spironolactone: PO/25–400 mg/day, Triamterene: PO/25–100 mg/day, Amiloride: PO/5–20 mg/day
1882_Tab03_051-065 10/10/12 12:47 PM Page 54

Urologic System Drugs Loop Diuretics 54

Furosemide
(fur-oh-se-mide)

Lasix
Apo-Furosemide

Bumetanide
(byoo-met-a-nide)

Bumex
Burinex
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Urologic System Drugs Loop Diuretics 54

Therapeutic/Pharmacologic Class Keep in Mind
Diuretic/loop diuretics Teach client:
Indications • Change position slowly to minimize effects of
Treatment of edema due to CHF, hepatic or renal orthostatic hypotension.
disease, and HTN. • Consume high-potassium foods or prescribed K+
supplements (as directed).
Action
Inhibits reabsorption of Na and chloride from the • Use sunscreen.
loop of Henle and distal renal tubule. Increases • Report any unusual bleeding, bruising, sore
throat, or SOB.
water, NaCl, Mg+, H+, Ca+, and K+. May have
peripheral vasodilatory effects. • Report, prior to starting therapy, any allergic
reaction to sulfonamides.
Adverse Reactions/Side Effects
CNS: dizziness, encephalopathy, headache,
insomnia, nervousness. EENT: hearing loss, tin- Make the Connection
nitus. CV: hypotension. GI: constipation, diarrhea, • Always check K+ level (3.5–5 mEq/L)
dry mouth, dyspepsia, nausea, vomiting. GU: and BP prior to administering.
excessive urination. Derm: photosensitivity, • Watch the+ ECG for arrhythmias, especially with
rashes. Endo: hyperglycemia. F and E: dehydra- altered K levels.
tion, hypochloremia, hypokalemia, hypomagne- • BMS can occur.
semia, hyponatremia, hypovolemia, metabolic • Photosensitivity may be severe.
alkalosis due to loss of hydrogen ion. Hemat: • Low K+ causes digoxin toxicity.
blood dyscrasias. Metab: hyperglycemia,
hyperuricemia. MS: arthralgia, muscle cramps,
myalgia. Misc: increased BUN.
Route/Dosage: Furosemide: PO/0–80 mg/day, Bumetanide: PO/0.2–5 mg/day
1882_Tab03_051-065 10/10/12 12:47 PM Page 55

Urologic System Drugs Thiazide Diuretics 55

Chlorothiazide
(klor-oh-thye-a-zide)

Diuril

Hydrochlorothiazide
(hye-droe-klor-oh-thye-a-zide)

Microzide, Oretic
Apo-Hydro

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Urologic System Drugs Thiazide Diuretics 55

Therapeutic/Pharmacologic Class Keep in Mind
Antihypertensive; diuretic/thiazide diuretics Teach client:
Indications • Change position slowly to minimize effects of
Management of mild-to-moderate HTN. Treatment orthostatic hypotension.
of edema associated with CHF, renal dysfunction, cir- • Consume high-potassium foods.
rhosis, corticosteroid therapy, and estrogen therapy. • Use sunscreen.
Action • Report any unusual bleeding, bruising, sore throat,
or SOB.
Increases excretion of Na and water by inhibiting
Na reabsorption in the distal tubule. Promotes • Report, prior to starting therapy, any allergic
reaction to sulfonamides.
excretion of chloride, K+, Mg+, and HCO3. May
produce arteriolar dilation. • Report severe abdominal pain or yellow coloration
of skin or whites of eyes.
Adverse Reactions/Side Effects
CNS: dizziness, drowsiness, lethargy, weakness.
CV: hypotension. GI: anorexia, cramping, hepati- Make the Connection
tis, nausea, vomiting. Derm: photosensitivity, rash- • Always check K+ level (3.5–5 mEq/L)
es. Endo: hyperglycemia. F and E: hypokalemia, and BP prior to administering.
dehydration, hypercalcemia, hypochloremic alkalo- • Watch the ECG for arrhythmias, especially if K+ is
sis, hypomagnesemia, hyponatremia, hypophos- altered.
phatemia, hypovolemia. Hemat: blood dyscrasias. • BMS can occur, so monitor the CBC.
Metab: hyperuricemia, elevated lipids. MS: muscle • Photosensitivity may be severe.
cramps. Misc: pancreatitis. • Low K+ causes digoxin toxicity.
• Monitor LFT and amylase and lipase levels.
Route/Dosage: Chlorothiazide: PO/125 mg–2 g/day, Hydrochlorothiazide: PO/12.5–100 mg/day
1882_Tab03_051-065 10/10/12 12:47 PM Page 56

Urologic System Drugs Phosphodiesterase Type 5 Inhibitors 56

Sildenafil Tadalafil
(sil-den-a-fil) (ta-da-la-fil)

Revatio, Viagra Cialis, Adcirca

Vardenafil
(var-den-a-fil)

Levitra

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Urologic System Drugs Phosphodiesterase Type 5 Inhibitors 56

Therapeutic/Pharmacologic Class Keep in Mind
Anti-impotence agent/phosphodiesterase type 5 Teach client:
(PDE5) inhibitors • Take as prescribed before sexual activity.
Indications • Do not take with other drugs, unless directed to
Treatment of erectile dysfunction. do so by HCP.
Action • Erections lasting longer than 4 hr (priapism) or
sudden, decreased vision loss in one or both eyes
Enhances effects of nitric oxide released during sexual must be reported immediately.
stimulation. Nitric oxide activates guanylate cyclase,
which produces increased levels of cGMP. Cyclic
adenosine monophosphate produces smooth muscle Make the Connection
relaxation of the corpus cavernosum, which promotes
increased blood flow and subsequent erection.
• This medication causes vasodilation in the
penis and in other areas of the body; so, it should
Adverse Reactions/Side Effects not be given with any other vasodilating agent.
CNS: headache, dizziness, insomnia. EENT: • Assess effectiveness through interview.
abnormal vision (color tinge to vision, increased
sensitivity to light, blurred vision), epistaxis,
nasal congestion. CV: MI, sudden death, car-
diovascular collapse. GI: dyspepsia, diarrhea.
GU: priapism, urinary tract infection. Derm:
flushing, rash. MS: myalgia. Neuro: paresthesias.

Route/Dosage: Sildenafil: PO/25–100 mg 30 min–4 hr prior to sexual activity, Tadalafil: PO/10 mg prior to sexual activity or 2.5 mg once daily,
Vardenafil: PO/10 mg 1 hr prior to sexual activity or 2.5 mg once daily
1882_Tab03_051-065 10/10/12 12:47 PM Page 57

Urologic System Drugs Peripherally Acting Antiadrenergics 57

Doxazosin Tamsulosin
(dox-ay-zoe-sin) (tam-soo-loe-sin)

Cardura, Cardura XL Flomax

Terazosin Alfuzosin
(ter-a-zoe-sin) (al-fyoo-zoe-sin)

Hytrin Uroxatral

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Urologic System Drugs Peripherally Acting Antiadrenergics
Therapeutic/Pharmacologic Class
Antihypertensive; prostatic urethra relaxant/
peripherally acting antiadrenergics
Indications
Treatment of symptomatic BPH. Management of
outflow obstruction in male patients with BPH.
Collaborative treatment of HTN.
Action
Decreases contractions in smooth muscle of the
prostatic capsule by preferentially binding to
alpha1-adrenergic receptors.
Adverse Reactions/Side Effects
CNS: dizziness, headache, depression, drowsi-
ness, fatigue, nervousness, weakness. EENT:
abnormal vision, blurred vision, conjunctivitis,
epistaxis. Resp: dyspnea. CV: first-dose ortho-
static hypotension, arrhythmias, chest pain,
edema, palpitations. GI: abdominal discomfort,
constipation, diarrhea, dry mouth, flatulence,
nausea, vomiting. GU: decreased libido, sexual
dysfunction, retrograde/diminished ejaculation.
Derm: flushing, rash, urticaria. MS: arthralgia,
arthritis, gout, myalgia.
Route/Dosage: Doxazosin: PO/2–16 mg/day, Tamsulosin: PO/0.4–0.8 mg/day, Terazosin: PO/5–10 mg hs, Alfuzosin: PO/10 mg/day
57
Keep in Mind
Teach client:
• Take this medication exactly as prescribed.
• Avoid driving or other activities requiring alertness
until response to medication is known.
• Change positions slowly to decrease orthostatic
hypotension.
• Maintaining appointments for follow-up visits is
important to determine effectiveness of therapy.
• Avoid drinking alcohol, as this may cause worsen-
ing orthostatic hypotension.
Make the Connection
• Monitor BP and pulse 2–6 hr after first
dose, with each increase in dose, and periodically
during therapy. Report significant changes.
• Monitor I&O and weight, and assess for edema.
• Assess client for symptoms of prostatic hyperplasia
prior to and periodically during therapy.
1882_Tab03_051-065 10/10/12 12:47 PM Page 58

Urologic System Drugs Androgen Inhibitors 58

Finasteride
(fi-nas-teer-ide)

Propecia, Proscar

Dutasteride
(doo-tas-te-ride)

Avodart

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Urologic System Drugs Androgen Inhibitors
Therapeutic/Pharmacologic Class
BPH agent/androgen inhibitors
Indications
Management of the symptoms of BPH in men with
an enlarged prostate gland. Proscar is used to treat
male-pattern baldness.
Action
Inhibits the enzyme 5-alpha-reductase, which is
responsible for converting testosterone to its potent
metabolite 5-alpha-dihydrotestosterone in prostate,
liver, and skin. 5-alpha-dihydrotestosterone is partial-
ly responsible for prostatic hyperplasia and hair loss.
Adverse Reactions/Side Effects
GU: decreased libido, decreased volume of
ejaculate, impotence.
Keep in Mind
Teach client:
• Volume of ejaculate may be decreased during
therapy, but this will not interfere with normal
sexual function. Sexual dysfunction side effects
will diminish over time.
Route/Dosage: Finasteride: BPH: PO 5 mg/day; alopecia: 1 mg/day, Dutasteride: PO/0.5 mg/day
58
• Women who are pregnant or may become preg-
nant should avoid exposure to semen of a partner
taking this medication and should not handle
crushed finasteride because of the potential for
absorption. Absorption may cause birth defects
if the woman is pregnant.
• Follow-up examinations and laboratory work
should be expected.
Make the Connection
• Assess PSA levels (normal levels are
0–4 ng/mL) at baseline and during treatment.
Direct digital rectal examination by HCP should
be done periodically, also.
• Assess urinary stream.
• Assess nocturia, hesitation, and urgency.
• Remember, this is a testosterone inhibitor.
Significant birth defects could occur in the case
of women who come into contact with the med-
ication (through sperm or the tablet itself) who
are pregnant.
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Urologic System Drugs Phosphate Binders 59

Sevelamer
(se-vel-a-mer)

Renagel, Renvela

Calcium Acetate
(kal-see-um ass-e-tate)

Calphron, PhosLo

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Urologic System Drugs Phosphate Binders
Therapeutic/Pharmacologic Class
Electrolyte modifier/phosphate binders
Indications
Reduction of serum phosphate levels in clients with
hyperphosphatemia associated with ESRD.
Action
Polymers that bind phosphate in the GI tract, pre-
venting its absorption or exchange of phosphate for
Ca+ in excretory system.
Adverse Reactions/Side Effects
GI: diarrhea, dyspepsia, vomiting, constipation,
flatulence, nausea. CNS: tingling. CV: arrhyth-
mias, bradycardia, vomiting. GU: calculi,
hypercalciuria.
Keep in Mind
Teach client:
• Do not break, crush, or chew tablets.
• Space concurrent medications at least 1 hr before
or 3 hr after these medications.
Route/Dosage: Sevelamer: PO/800–1600 mg with each meal, Calcium acetate: PO/1334–2668 mg with each meal
59
• If GI effects are severe or prolonged, notify HCP.
• Report palpitations or tingling if the calcium form
is used.
Make the Connection
• Assess client for GI side effects periodically
during therapy.
• Monitor serum phosphorus, Ca+, bicarbonate,
and chloride levels periodically during therapy.
• Doses of concurrent medications, especially
antiarrhythmics, should be spaced at least 1 hr
before or 3 hr after these medications.
• Administer with meals. Tablets should not be
broken, chewed, or crushed.
1882_Tab03_051-065 10/10/12 12:47 PM Page 60

Urologic System Drugs Water-Soluble Vitamin 60

Vitamin B with
Vitamin C
(vye-ta-min B with vye-ta-min C)

Renal Caps, Nephrocaps

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Urologic System Drugs Water-Soluble Vitamin 60

Therapeutic/Pharmacologic Class
Vitamin/water-soluble vitamin Make the Connection
Indications • Remember, dialysis flushes water-soluble
Treatment and prevention of vitamin deficiencies in vitamins out of the body.
dialyzed clients. • Monitor client for anaphylaxis (wheezing,
urticaria, edema); contains thiamine.
Action
Contains most or all of the B-complex vitamins
• Monitor laboratory values for hematology and
B vitamins.
(B1, B2, B3, B5, B6, B12) and vitamin C, a diverse
group of compounds necessary for normal growth
• Monitor ability to heal and occurrence of
gingivitis.
and development that act as coenzymes or catalysts
in numerous metabolic processes.
• B vitamins are vital to “b”lood and “b”rain
health.
Adverse Reactions/Side Effects
GU: bright yellow urine. Misc: anaphylaxis
(vitamin B1-thiamine), allergic reactions to
preservatives.

Keep in Mind
Teach client:
• Comply with diet recommendations of HCP.
• Consume a well-balanced diet.
• Watch for signs and symptoms of vitamin B and
C deficiency.

Route/Dosage: PO/1 daily

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Urologic System Drugs Fat-Soluble Vitamin 61

Calcitriol
(kal-si-trye-ole)

Rocaltrol, Calcijex

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Urologic System Drugs Fat-Soluble Vitamin 61

Therapeutic/Pharmacologic Class Metab: hyperthermia. MS: bone pain, metastat-
Vitamin/fat-soluble vitamin ic calcification, muscle pain. Misc: allergic reac-
Indications tions (pruritus, rash, urticaria).
Management of hypocalcemia in clients undergoing
Keep in Mind
chronic renal dialysis (IV and PO). Treatment of
Teach client:
hypocalcemia in clients with hypoparathyroidism or
pseudohypoparathyroidism (PO only). Management • Consume foods high in calcium and vitamin D. +
of secondary hyperparathyroidism (PO only). • Avoid concurrent use of antacids containing Mg .
Topical gel form is used to treat plaque psoriasis.
Action Make the Connection
Promotes the absorption of calcium and decreases • Observe client+carefully for hypocalcemia.
parathyroid hormone concentrations. • Ca+, phosphorus, Mg , alkaline phosphatase, and
Adverse Reactions/Side Effects intact parathyroid hormone concentrations will
CNS: headache, somnolence, weakness. EENT: be monitored at least monthly.
conjunctivitis, photophobia, rhinorrhea. CV:
arrhythmias, HTN. GI: abdominal pain, anorexia,
constipation, dry mouth, LFT elevation, metallic
taste, nausea, pancreatitis, polydipsia, vomiting,
weight loss. GU: albuminuria, azotemia, decreased
libido, nocturia, polyuria. Derm: pruritus. F and
E: hypercalcemia. Local: pain at injection site.

Route/Dosage: PO/0.5–1 mcg/day; IV/0.01–0.05 mcg/kg 3 times/wk

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Urologic System Drugs Hormone 62

Epoetin
(e-poe-e-tin)

Epogen, Procrit, EPO

Eprex

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Urologic System Drugs Hormone 62

Therapeutic/Pharmacologic Class
Antianemic/hormone Make the Connection
Indications • Institute seizure precautions in clients
Treatment of anemia associated with chronic renal who experience a greater than 4-point increase in
failure. Hct in a 2-wk period or exhibit change in mental
status.
Action
Stimulates erythropoiesis (RBC production).
• Do not shake the vial. It will turn into unusable
suds, and the medication is expensive.
Adverse Reactions/Side Effects • Monitor CBC.
CNS: seizures, headache. CV: hypertension, • May need more heparin during hemodialysis.
thrombotic events. Derm: transient rashes. • Monitor BP for increases that may need treatment.
Endo: restored fertility, resumption of menses. • Monitor thrill and bruit in arteriovascular grafts.
Keep in Mind
• Monitor serum ferritin, transferrin, and iron levels.
Teach client:
• Menses and fertility may return in women of
childbearing age.
• Learn how to sense and protect oneself from
seizures (teach family members, also).
• Consume foods high in iron, like meat and eggs,
or take an iron supplement.

Route/Dosage: SC/50–150 units/kg to achieve a Hgb of 10–12 mg/dL; presurgical, SC/300–600 units/kg 21, 14, and 7 days preoperatively.
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Urologic System Drugs Iron Supplements 63

Iron Dextran Iron

(eye-ern dex-tran)
Polysaccharide
(eye-ern poll-ee-sak-a-ride)
DexFerrum, InFeD
Niferex, Hytinic,
Nu-Iron

Iron Sucrose
(eye-ern su-krose)

Venofer

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Urologic System Drugs Iron Supplements
Therapeutic/Pharmacologic Class
Antianemic/iron supplements
Indications
Prevention/treatment of anemia in clients undergoing
hemodialysis who are concurrently receiving epoetin.
Action
An essential mineral found in Hgb, myoglobin, and
many enzymes, essential for RBC formation.
Adverse Reactions/Side Effects
CNS: IM, IV—seizures, dizziness, headache,
syncope. CV: IM, IV—hypotension, tachycardia,
hemochromatosis, heart failure. GI: nausea,
constipation, dark stools, diarrhea, epigastric
pain, GI bleeding, taste disorder. Derm: IM,
IV—flushing, urticaria. Local: pain at injection
site, skin staining. MS: arthralgia, myalgia.
Misc: staining of teeth, allergic reactions.
Keep in Mind
Teach client:
• Stools may become very dark. They should have
a dark green (not red) halo when water is
mixed. Report constipation to HCP.
Route/Dosage: Iron dextran: IM, IV/total dose (mL) based on Hgb and body weight, Iron polysaccharide: PO/50–100 mg bid, Iron sucrose: IV/100 mg
each dialysis session
63
• A balanced diet is important.
• Watch for symptoms of CHF (rare) such as activity
intolerance, edema, lethargy, and palpitations.
Make the Connection
• Monitor serum levels.
• Monitor CBC, especially reticulocyte, Hgb, and
Hct levels.
• Monitor for allergic reactions. Give an IV test
dose of 5 mL before proceeding.
• If giving PO, use a straw to avoid staining teeth.
• If giving IM, give by Z-track to avoid staining the skin.
• Monitor for stomach pain, which is one of the
first signs of toxicity.
• Assess weight, activity tolerance, and lung sounds
to rule out CHF.
• Avoid giving coffee, tea, dairy, eggs, and whole
grain breads for 1 hr after PO dose.
• Orange juice (PO form) aids in absorption.
1882_Tab03_051-065 10/10/12 12:47 PM Page 64

Urologic System Drugs Muscarinic Receptor Antagonists 64

Trospium Fesoterodine
(tros-pee-yum) (fee-soe-ter-o-deen)

Sanctura, Toviaz
Sanctura XL

Tolterodine
(tol-ter-oh-deen)

Detrol, Detrol LA

Uploaded by MEDBOOKSVN.ORG
1882_Tab03_051-065 10/10/12 12:47 PM Page 64
Urologic System Drugs Muscarinic Receptor Antagonists
Therapeutic/Pharmacologic Class
Urinary tract antispasmodics/muscarinic receptor
antagonists
Indications
Treatment of overactive bladder with symptoms
of urge urinary incontinence, urgency, and urinary
frequency.
Action
Antagonizes the effect of acetylcholine at muscarinic
receptors in the bladder; this parasympatholytic
action reduces bladder smooth muscle tone.
Adverse Reactions/Side Effects
CNS: headache, dizziness, drowsiness, fatigue.
EENT: blurred vision. GI: constipation, dry
mouth, dyspepsia. GU: urinary retention, urinary
tract infection. Misc: fever, heat stroke.
Route/Dosage: Trospium: PO/20 mg bid, 60 mg XL form once daily, Fesoterodine: PO/4–8 mg daily ≤, Tolterodine: PO/2 mg bid, 2–4 mg once daily
(ER); tolterodine: PO/2 mg bid, 2–4 mg XL form once daily
64
Keep in Mind
Teach client:
• Heat prostration (fever and heat stroke due to
decreased sweating) may occur when taken in a
hot environment.
• May cause dry mouth, urinary retention, and
constipation. Drink recommended amount of
water, consume fiber, exercise, and use sugar-free
hard candy or gum for dry mouth.
• May cause drowsiness, dizziness, and blurred
vision. Avoid driving and other activities requiring
alertness until response to medication is known.
Avoid alcohol (may increase drowsiness).
Make the Connection
• Monitor voiding pattern and I&O ratios.
1882_Tab03_051-065 10/10/12 12:47 PM Page 65

Urologic System Drugs Benign Prostatic Hyperplasia Agent 65

Saw Palmetto
(saw paul-met-o)

Saw Palmetto Berry, Cabbage

Palm, Sabal, Serenoa repens,
Ju-Zhong

Uploaded by MEDBOOKSVN.ORG
1882_Tab03_051-065 10/10/12 12:47 PM Page 65

Urologic System Drugs Benign Prostatic Hyperplasia Agent 65

Therapeutic/Pharmacologic Class • Saw palmetto does not alter the size of the
Benign prostatic hyperplasia agent prostate, but it should relieve the symptoms asso-
Indications ciated with BPH.
Herbal treatment of BPH. • Taking with food should reduce the GI effects
and make it easier to tolerate.
Action
Exerts antiandrogenic, anti-inflammatory, and
antiproliferative properties in prostate tissue, resulting Make the Connection
in improvement in BPH symptoms such as frequent • Assess client for symptoms of BPH such
urination, hesitancy, urgency, and nocturia. as urinary hesitancy, feeling of incomplete bladder
Comparable in efficacy to finasteride but may be emptying, interruption in urinary stream, impair-
less effective than prazosin. ment in size and force of urinary stream, terminal
Adverse Reactions/Side Effects urinary dribbling, straining to start flow, dysuria,
CNS: dizziness, headache. GI: nausea, vomiting, and urgency before and periodically during therapy.
constipation, and diarrhea. • Rectal examinations should be done prior to and
periodically throughout therapy to assess
Keep in Mind prostate size.
Teach client:
• Start therapy with this herbal supplement only
after evaluation by a HCP who will provide con-
tinued follow-up care.

Route/Dosage: PO/(lipophilic extract, 80%–90% fatty acids) 160 mg twice daily or 320 mg once daily; (whole berries) 1–2 g daily; (liquid extract from
berry pulp) 1–2 mL 3 times daily
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 6

Uploaded by MEDBOOKSVN.ORG
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 7

IMMUNE

Cyclosporine, 66 Dirithromycin, 74 Doxycycline, 81

Pimecrolimus, 67 Clindamycin, 75 Tetracycline, 81
Indomethacin, 68 Gentamicin, 76 Ceftriaxone
Naproxen, 68 Kanamycin, 76 (third generation), 82
Ibuprofen, Oral, 68 Amikacin, 76 Ceftazidime
Ketorolac, 68 Tobramycin, 76 (third generation), 82
Aspirin, 69 Vancomycin, 77 Cephalexin
Methotrexate, 70 Ciprofloxacin, 78 (first generation), 82
Infliximab, 71 Moxifloxacin, 78 Cefepime
Etanercept, 71 Levofloxacin, 78 (fourth generation), 82
Filgrastim, 72 Besifloxacin, 78 Imipenem/Cilastatin, 83
Pegfilgrastim, 72 Amoxicillin, 79 Doripenem, 83
Sargramostim, 72 Amoxicillin/ Meropenem, 83
Calcipotriene, 73 Clavulanate, 79 Ertapenem, 83
Azithromycin, 74 Ampicillin/Sulbactam, 79 Quinupristin/
Erythromycin, 74 Piperacillin/ Dalfopristin, 84
Clarithromycin, 74 Tazobactam, 80 Isoniazid, 85
Continued
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 8

IMMUNE

Pyrazinamide, 85 Micafungin, 88 Darunavir, 92

Ethambutol, 85 Acyclovir, 89 Saquinavir, 92
Rifampin, 85 Valacyclovir, 89 Nelfinavir, 92
Trimethoprim/ Famciclovir, 89 Efavirenz, 93
Sulfamethoxazole, 86 Zanamivir, 90 Nevirapine, 93
Fluconazole, 87 Oseltamivir, 90 Delavirdine, 93
Ketoconazole Abacavir, 91 Etravirine, 93
(systemic), 87 Lamivudine, 91 Rilpivirine, 93
Amphotericin B, 87 Didanosine, 91 Enfuvirtide, 94
Voriconizole, 87 Zidovudine, 91 Maraviroc, 95
Caspofungin, 88 Ritonavir, 92 Raltegravir, 96

Uploaded by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:38 PM Page 66

Immune System Drugs Polypeptide (Cyclic) 66

Cyclosporine
(sye-kloe-spor-een)

Sandimmune, Neoral,
Restasis, Genfraf
1882_Tab04_066-096 11/10/12 2:38 PM Page 66
Immune System Drugs Polypeptide (Cyclic)
Therapeutic/Pharmacologic Class
Immunosuppressant; DMARD/polypeptide (cyclic)
Indications
Prevention and treatment of organ rejection.
Prevention and treatment of graft-versus-host dis-
ease in bone marrow transplant clients. Treatment
of autoimmune diseases such as RA and psoriasis.
Treatment of inflammatory dry eye.
Action
Inhibits normal immune responses by inhibiting
interleukin-2, a factor necessary for initiation of
T-cell activity.
Adverse Reactions/Side Effects
CNS: seizures, tremor, confusion, flushing,
headache, psychiatric problems. CV: HTN.
GI: diarrhea, hepatotoxicity, nausea, vomiting,
abdominal discomfort, anorexia, pancreatitis.
GU: nephrotoxicity. Derm: hirsutism, acne.
F and E: hyperkalemia, hypomagnesemia.
Hemat: bone marrow suppression.
Route/Dosage: Neoral: PO/2.5 mg/kg/day given in 2 divided doses, Sandimmune: IV/5–6 mg/kg/dose 4 to 12 hr before transplant, then 2–10 mg/kg/day
Uploaded
in divided doses q 8–24 hr, Restasis: intraocular/1
drop to each eye bid
66
Metab: hyperlipidemia, hyperuricemia. Neuro:
hyperesthesia, paresthesia. Misc: gingival hyper-
plasia, hypersensitivity reactions, infections.
Keep in Mind
Teach client:
• For most indications, this drug will be needed
for life.
• Report sore throat or feelings of ill health.
• Cosmetic changes (hirsutism, acne) may occur.
• Do not take St. John’s wort, as it will interfere
with antirejection properties.
Make the Connection
• Monitor CBC with differential, RFT,
chemistries, serum drug levels, and LFT.
• Monitor I&O, daily weight, and BP.
• Assess for symptoms of organ rejection.
• When administering IV, monitor client for signs
and symptoms of hypersensitivity.
by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:38 PM Page 67

Immune System Drugs Immunomodulator 67

Pimecrolimus
(pi-me-cro-li-mus)

Elidel
1882_Tab04_066-096 11/10/12 2:39 PM Page 67

Immune System Drugs Immunomodulator 67

Therapeutic/Pharmacologic Class Keep in Mind
Anti-inflammatory/immunomodulator Teach client:
Indications • Avoid eyes.
Treatment of atopic dermatitis. Second-line therapy • Do not apply occlusive dressing over the applica-
for autoimmune skin eruptions. tion site.
Action • Do not use on children younger than 2 yr.
Prevents activation of cytokines, agents of the
inflammatory process. Make the Connection
Adverse Reactions/Side Effects • Do not use on viral or malignant skin
CNS: headache. Resp: cough, nasopharyngitis. conditions because this will decrease immunity
Derm: redness or burning at application site. (suppresses cytokines).
• Discontinue if any unusual lymphatic swelling
occurs.

Route/Dosage: Topical/apply a thin film bid Uploaded by MEDBOOKSVN.ORG

1882_Tab04_066-096 11/10/12 2:39 PM Page 68

Immune System Drugs Nonsteriodal Anti-Inflammatory Agents 68

Indomethacin Ibuprofen,
(in-doe-meth-a-sin)
Oral
(eye-byoo-proe-fen)
Indocin
Apo-Indomethacin
Motrin, Advil
Apo-Ibuprofen

Naproxen Ketorolac
(na-prox-en) (kee-toe-role-ak)

Aleve, Anaprox, Toradol, Sprix

Naprosyn Toradol
Apo-Napro-Na
1882_Tab04_066-096 11/10/12 2:39 PM Page 68
Immune System Drugs Nonsteriodal Anti-Inflammatory Agents
Therapeutic/Pharmacologic Class
Antirheumatic; analgesic/nonsteroidal anti-
inflammatory agents (COX-1 inhibitor) (Ketorolac,
pyrroziline carboxylic acid)
Indications
Treatment of mild-to-moderate musculoskeletal
pain or dysmenorrhea. Treatment of inflammatory
disorders, including those of the eye. Treatment of
fever and pain in adults and children. Used IV for
ductus arteriosus patency.
Action
Inhibits prostaglandin synthesis.
Adverse Reactions/Side Effects
CNS: headache, dizziness, drowsiness, psychic
disturbances. EENT: amblyopia, blurred vision,
tinnitus. CV: arrhythmias, edema, MI, CVA.
GI: GI bleeding, hepatitis, constipation,
dyspepsia, nausea, vomiting, abdominal
discomfort. GU: cystitis, hematuria, renal failure.
Derm: exfoliative dermatitis, Stevens-Johnson
syndrome, toxic epidermal necrolysis, rashes.
Route/Dosage: Indomethacin: PO/25–50 mg bid–qid or 75-mg ER cap once or twice daily, Ibuprofen, oral: PO/200–800 mg q 4–6 hr, Naproxen:
PO/250–500 mg daily, Ketorolac: PO/10 mg qUploaded
4–6 hr; IM/30–60 mg
68
Hemat: blood dyscrasias, prolonged bleeding time.
Misc: allergic reactions, including anaphylaxis.
Keep in Mind
Teach client:
• Take with food or milk and remain upright for
30 min to decrease irritation of the lower esopha-
gus. Alcohol increases the potential for stomach
irritation.
• May cause drowsiness or dizziness.
• Report abdominal/stomach pain or black-red,
odorous stools.
• Wear sunscreen and protective clothing.
• Report rash or sore throat immediately.
Make the Connection
• Assess for rhinitis, asthma, and urticaria
(hypersensitivity).
• Monitor VS and pain level.
• Monitor BUN, serum creatinine, CBC with
differential, electrolytes, bleeding time, and
LFT periodically.
byq 6MEDBOOKSVN.ORG
hr; IV/30 mg q 6 hr; intranasal/(Sprix) 1 spray each nostril q 6–8 hr
1882_Tab04_066-096 11/10/12 2:39 PM Page 69

Immune System Drugs Salicylate 69

Aspirin
(as-pir-in)

Bayer Aspirin, Ecotrin

Apo-ASA
1882_Tab04_066-096 11/10/12 2:39 PM Page 69
Immune System Drugs Salicylate
Therapeutic/Pharmacologic Class
Antipyretic; nonopioid analgesic/salicylate
Indications
Treatment of inflammatory disorders, mild-to-
moderate pain, and fever. Prophylaxis of transient
ischemic attacks and MI. Unlabeled uses:
Adjunctive treatment of Kawasaki disease.
Action
Inhibits the production of prostaglandins. Also
decreases platelet aggregation.
Adverse Reactions/Side Effects
EENT: hearing loss, tinnitus. GI: GI bleeding,
dyspepsia, epigastric distress, heartburn, nau-
sea, abdominal pain, anorexia, hepatotoxicity,
vomiting. Hemat: anemia, hemolysis, increased
bleeding time. Misc: allergic reactions (anaphy-
laxis, laryngeal edema), noncardiogenic pul-
monary edema.
Keep in Mind
Teach client:
• Take with food or milk.
Uploaded
Route/Dosage: PO/80–325 mg daily (antiplatelet);
PO, Rect/325–1000 MEDBOOKSVN.ORG
69
• Report tinnitus (toxicity level reached).
• Avoid taking with other NSAIDs.
• If the tabs smell like vinegar, they are no longer
effective.
• Contraindicated for children younger than16 yr
(Reye’s syndrome).
• A 325-mg dose of ASA should be taken if unre-
lieved chest pain occurs.
Make the Connection
• Monitor liver and renal function,
electrolytes, bleeding time, CBC, and serum
drug levels if on long-term therapy.
• Tinnitus is a sign of toxicity.
• Monitor for drug effectiveness.
• Part of essential first-line care for MI. A 81-mg
daily dose helps to prevent clot formation and
may reduce cholesterol accumulation.
by mg
q 4–6 hr (pain and fever)
1882_Tab04_066-096 11/10/12 2:39 PM Page 70

Immune System Drugs Antimetabolite 70

Methotrexate
(meth-o-trex-ate)

Rheumatrex, Trexall
1882_Tab04_066-096 11/10/12 2:39 PM Page 70
Immune System Drugs Antimetabolite
Therapeutic/Pharmacologic Class
Antineoplastic; DMARD; immunosuppressant/
antimetabolite
Indications
Alone or with other treatment modalities in
the treatment of carcinoma/leukemia/mycosis
fungoides. Treatment of severe psoriasis and
RA unresponsive to conventional therapy.
Action
Interferes with folic acid metabolism. Result is
inhibition of DNA synthesis and cell reproduction.
Also has immunosuppressive activity.
Adverse Reactions/Side Effects
CNS: dizziness, drowsiness, headaches, malaise.
EENT: blurred vision, dysarthria, transient
blindness. Resp: pulmonary fibrosis, intestinal
pneumonitis. GI: anorexia, hepatotoxicity,
nausea, stomatitis, vomiting. GU: infertility.
Derm: alopecia, painful plaque erosions, photo-
sensitivity, pruritus, rashes, skin ulceration,
urticaria. Hemat: bone marrow suppression.
Uploaded
Route/Dosage: PO, IM, IV/(psoriasis) 10–25 mg/weekly
(not to exceed mg/wk); PO/(arthritis) 2.5 mg q 12 hr
70
Metab: hyperuricemia. MS: osteonecrosis, stress
fracture. Misc: nephropathy, chills, fever, soft
tissue necrosis.
Keep in Mind
Teach client:
• Report SOB, bruising, or sore throat.
• Avoid alcohol to prevent GI irritation.
• Avoid vaccinations without advice of HCP.
Make the Connection
• Auscultate lungs and monitor character of
respirations and presence of cough (pulmonary
fibrosis).
• Monitor CBC with differential, liver and renal
function, and uric acid levels prior to and fre-
quently during therapy.
by 30MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 71

Immune System Drugs Tumor Necrosis Factor Blockers 71

Infliximab
(in-flix-i-mab)

Remicade

Etanercept
(e-tan-er-sept)

Enbrel
1882_Tab04_066-096 11/10/12 2:39 PM Page 71

Immune System Drugs Tumor Necrosis Factor Blockers 71

Therapeutic/Pharmacologic Class Keep in Mind
DMARD/TNF blockers Teach client:
Indications • Do not receive live vaccines during therapy and
To decrease progression, signs, and symptoms of avoid exposure to ill people.
RA, juvenile arthritis, ankylosing spondylitis, and • Notify HCP if upper respiratory or other infec-
psoriatic arthritis or plaque psoriasis when tions occur.
response has been inadequate to other disease-
modifying agents. May be used with other agents. Make the Connection
Used in Crohn’s disease and ulcerative colitis.
• Monitor clients who develop a new
Action infection. Do not initiate therapy in clients with
Binds to TNF, making it inactive. TNF is a mediator active infections.
of inflammatory response. • Assess for latent TB with a tuberculin skin test
Adverse Reactions/Side Effects prior to initiation of therapy.
CNS: headache, dizziness, weakness. EENT: • Monitor for allergic reaction (IV).
rhinitis, pharyngitis, sinusitis. Resp: upper • Monitor CBC with differential and ANA.
respiratory tract infection, cough, respiratory • Monitor for improvement in treated autoimmune
disorder. GI: abdominal pain, dyspepsia. disease.
Derm: rash. Hemat: bone marrow suppression.
Local: injection site reactions. Misc: infections,
↑ risk of malignancies.

Route/Dosage: Infliximab: IV/3–5 mg/kg at 2,Uploaded by MEDBOOKSVN.ORG

6, and 8 wks, Etanercept: SC/25–50 mg once weekly (starting dose)
1882_Tab04_066-096 11/10/12 2:39 PM Page 72

Immune System Drugs Colony-Stimulating Factors 72

Filgrastim (granulocyte Sargramostim

colony-stimulating (recombinant human
factor [G-CSF]) granulocyte/macrophage
(fil-gra-stim) colony-stimulating factor
[rHu GM-CSF])
Neupogen (sar-gram-oh-stim)

Leukine

Pegfilgrastim (G-CSF)
(peg-fil-gra-stim)

Neulasta
1882_Tab04_066-096 11/10/12 2:39 PM Page 72
Immune System Drugs Colony-Stimulating Factors
Therapeutic/Pharmacologic Class
Colony-stimulating factor/colony-stimulating factors
Indications
Acceleration of bone marrow recovery after
chemotherapy or ablative bone marrow transplant.
Management of severe chronic leukopenia.
Action
Glycoproteins that bind to and stimulate immature
WBCs to divide and differentiate. Also activate
mature WBCs.
Adverse Reactions/Side Effects
CNS: headache, malaise, weakness. Resp: dyspnea.
CV: pericardial effusion, peripheral edema, tran-
sient supraventricular tachycardia. GI: diarrhea.
Derm: itching, rash. MS: arthralgia, bone pain,
myalgia. Misc: chills, fever, first-dose reaction.
Keep in Mind
Teach client:
• Notify HCP if dyspnea or palpitations occur.
• Follow instructions for home administration.
Route/Dosage: Filgrastim: IV, SC/5 mcg/kg/day (initial dose), Sargramostim: IV, SC/250 mcg/m2/day initially, Pegfilgrastim: SC/6 mg per
chemotherapy cycle Uploaded by MEDBOOKSVN.ORG
72
Make the Connection
• Monitor heart rate, ECG, BP, and respiratory
status before and periodically during therapy.
• Assess bone pain throughout therapy. Pain is
usually mild to moderate and is an indication of
renewed WBCs.
• Monitor CBC with differential, uric acid and
alkaline phosphatase concentrations, serum
albumin (circulating protein), RFT, and LFT.
• Refrigerate. Do not shake (causes foaming).
• Assess for peripheral edema daily throughout
therapy. Capillary leak syndrome (swelling of feet
or lower legs, sudden weight gain, dyspnea) and
pleural or pericardial effusion may occur.
• May cause flushing with first dose.
1882_Tab04_066-096 11/10/12 2:39 PM Page 73

Immune System Drugs Synthetic vitamin D3 Analogue 73

Calcipotriene
(kal-si-poe-try-een)

Dovonex
1882_Tab04_066-096 11/10/12 2:39 PM Page 73
Immune System Drugs Synthetic vitamin D3 Analogue
Therapeutic/Pharmacologic Class
Antipsoriatic/synthetic vitamin D3 analogue
Indications
Management of moderate plaque psoriasis.
Action
Modulates skin cell development and production by
acting as a synthetic form of vitamin D.
Adverse Reactions/Side Effects
Derm: burning, itching, skin irritation, dry skin,
erythema, peeling, rash, worsening/spreading of
psoriatic lesions. F and E: hypercalcemia.
Keep in Mind
Teach client:
• This drug is for external use only; contact with
face or eyes should be avoided. Wash hands after
application.
• Apply a thin layer to affected skin twice daily and
rub in completely; do not cover.
• Do not use for any disorder other than that for
which it was prescribed.
Route/Dosage: Topical/apply bid Uploaded by MEDBOOKSVN.ORG
73
• Report any signs of local adverse reactions, per-
sistent irritation, or facial rash to HCP. May
cause irritation of lesions and surrounding skin.
Discontinuation of the drug may be required.
• Regular laboratory tests will be done to monitor
Ca+ concentrations.
• Expect improvement in 2–8 wk.
Make the Connection
• Monitor Ca+ concentrations before and
periodically during therapy. May cause transient,
rapidly reversible hypercalcemia. If hypercalcemia
occurs, discontinue and monitor Ca+ levels weekly
until normal Ca+ levels are restored.
• Excessive use may cause hypercalcemia.
• If ultraviolet B treatment is concurrent, use the
cream after the light therapy.
• Remember, sunlight is the natural enemy of
psoriasis.
• Vitamin D increases the absorption of Ca+; so,
even topical application can cause hypercalcemia.
1882_Tab04_066-096 11/10/12 2:39 PM Page 74

Immune System Drugs Macrolides 74

Azithromycin Clarithromycin
(aye-zith-roe-mye-sin) (kla-rith-roe-mye-sin)

Zithromax, Zmax Biaxin, Biaxin XL

Erythromycin Dirithromycin
(eh-rith-roe-mye-sin) (di-rith-roe-mye-sin)

E-Mycin, E.E.S., Dynabac

EryPed, EryGel
Apo-Erythro-EC,
Novo-Rythro,
Sans-Acne
1882_Tab04_066-096 11/10/12 2:39 PM Page 74

Immune System Drugs Macrolides 74

Therapeutic/Pharmacologic Class cholestatic jaundice, elevated liver enzymes,
Agent for atypical mycobacterium; anti-infective/ dyspepsia, melena, oral candidiasis. GU: nephritis,
macrolides vaginitis. Hemat: anemia, leukopenia, thrombocy-
Indications topenia. Derm: photosensitivity, Stevens-Johnson
Treatment of the following infections due to suscep- syndrome, rashes. EENT: ototoxicity. F and E:
tible organisms: upper respiratory tract infections, hyperkalemia. Misc: angioedema.
lower respiratory tract infections; acute otitis media;
Keep in Mind
skin and skin structure infections; genitourinary
Teach client:
infections, PUD, and ophth prophylaxis in the
neonate. Prevention of disseminated Mycobacterium • Take the entire prescription as directed with food.
avium complex (MAC) infection in clients with • Report blood in stool.
advanced HIV infection.
Action Make the Connection
Inhibits protein synthesis at the level of the 50S • Culture and sensitivity tests should be
bacterial ribosome. Effective against many gram- performed prior to starting therapy.
positive and gram-negative bacteria, as well as • Observe for signs and symptoms of anaphylaxis.
mycobacteria. • Monitor CBC with differential.
Adverse Reactions/Side Effects
CNS: dizziness, seizures, drowsiness, fatigue,
headache. CV: chest pain, hypotension, palpita-
tions, arrhythmias (rare). GI: pseudomembra-
nous colitis, abdominal pain, diarrhea, nausea,
Route/Dosage: Azithromycin: PO/500 mg first day, then 250 mg once daily for 4 days; Zmax, 2 g dose (ER), Clarithromycin: PO/250–500 mg q 12 hr,
or 1 g daily (XL), Erythromycin: PO/250 mg q Uploaded
6 hr; IV/250–500 mgby MEDBOOKSVN.ORG
q 6 hr, Dirithromycin: PO/500 mg/day
1882_Tab04_066-096 11/10/12 2:39 PM Page 75

Immune System Drugs Lincosamide Antibiotic 75

Clindamycin
(klin-da-mye-sin)

Cleocin, Cleocin T
Dalacin C
1882_Tab04_066-096 11/10/12 2:39 PM Page 75
Immune System Drugs Lincosamide Antibiotic
Therapeutic/Pharmacologic Class
Anti-infective/lincosamide antibiotic
Indications
Treatment of skin and skin structure infections, respi-
ratory tract infections, septicemia, intra-abdominal
infections, gynecologic infections, and osteomyelitis.
Prevention of endocarditis. Unlabeled uses:
Treatment of opportunistic disease in HIV-positive
clients.
Action
Inhibits protein synthesis in susceptible bacteria
at the level of the 50S bacterial ribosome. Effective
against most gram-positive aerobic cocci. Also
effective against anaerobic bacteria of reproduc-
tive tract.
Adverse Reactions/Side Effects
CNS: dizziness, headache, vertigo. CV: arrhyth-
mias, hypotension. GI: pseudomembranous
colitis, diarrhea, bitter taste (IV), nausea, vomit-
ing. Derm: rashes. Local: phlebitis at IV site.
Uploaded
Route/Dosage: PO/150–450 mg q 6 hr; IM, IV/300–600 mg q 6–8by
hr
75
Keep in Mind
Teach client:
• Take the drug as directed until finished.
• Notify HCP immediately if diarrhea, abdominal
cramping, fever, or bloody stool occurs.
• Be aware of risk of Candida (yeast) infection.
• Refrain from vaginal intercourse if intravaginal
preparation is used.
• If a rash occurs, discontinue medication and notify
HCP immediately.
Make the Connection
• Culture and sensitivity tests should be
performed before therapy is begun.
• Monitor CBC with differential (“good” cells can
also be affected), and liver and renal laboratory
tests.
• Monitor for improvement in condition clinically
and by laboratory tests.
MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 76

Immune System Drugs Aminoglycosides 76

Gentamicin Amikacin
(jen-ta-mye-sin) (am-i-kay-sin)

Garamycin, Jenamicin Amikin

Cidomycin

Kanamycin Tobramycin
(kan-a-mye-sin) (toe-bra-mye-sin)

Kantrex Nebcin, TOBI

1882_Tab04_066-096 11/10/12 2:39 PM Page 76

Immune System Drugs Aminoglycosides 76

Therapeutic/Pharmacologic Class Keep in Mind
Anti-infective/aminoglycosides Teach client:
Indications • Report tinnitus, vertigo, hearing loss, rash,
Treatment of serious gram-negative bacterial infec- dizziness, or difficulty urinating.
tions and infections caused by staphylococci when • Drink plenty of liquids.
penicillins or other less toxic drugs are contraindi- • Topical application if applicable. Assess skin and
cated. In combination with other agents in the inform HCP if skin irritation develops or infection
management of serious enterococcal infections. worsens.
Prevention of infective endocarditis. Used with
other anti-infectives to treat TB. Prophylactic IV Make the Connection
treatment in the neonate.
• Culture and sensitivity test should be
Action performed before initiating therapy.
Inhibits protein synthesis in bacteria at level of the • Monitor for hearing loss or ataxia.
30S bacterial ribosome. • Monitor I&O and daily weight.
Adverse Reactions/Side Effects • Monitor CBC with differential, LFT, and RFT.
CNS: ataxia, vertigo. EENT: ototoxicity • Monitor peak and trough serum blood levels.
(vestibular and cochlear). GU: nephrotoxicity. • Neonates should be assessed by audiometric
MS: muscle paralysis (high parenteral doses). studies prior to discharge.
Misc: hypersensitivity reactions. • Monitor for fungal infections.

Route/Dosage: Gentamicin: IM, IV/6 mg/kg/day in 3 divided doses, Amikacin: IM, IV/15 mg/kg/day divided q 8–12 hr, Kanamycin: IM, IV/5 mg/kg
q 8 hr, or 7.5 mg/kg q 12 hr, Tobramycin: IM, IV/3–6 mg/kg/day in 3 divided doses; Inhaln/40–80 mg 2 to 3 times daily (standard), 300 mg bid for
28 days (high dose) Uploaded by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 77

Immune System Drugs Anti-Infective 77

Vancomycin
(van-koe-mye-sin)

Vancocin
1882_Tab04_066-096 11/10/12 2:39 PM Page 77
Immune System Drugs Anti-Infective
Therapeutic/Pharmacologic Class
Anti-infective
Indications
IV: Treatment of potentially life-threatening infec-
tions when less toxic anti-infectives are contraindi-
cated. Particularly useful in methicillin-resistant
staphylococcal infections. PO: Treatment of staphy-
lococcal enterocolitis or pseudomembranous colitis
due to Clostridium difficile.
Action
Binds to bacterial cell wall, resulting in cell death
(bacteriocidal). Effective against gram-positive
pathogens.
Adverse Reactions/Side Effects
EENT: ototoxicity. CV: hypotension, massive
histamine release called “red-man syndrome”
with rapid IV infusion. GI: nausea, vomiting.
GU: nephrotoxicity. Derm: rashes. Hemat:
eosinophilia, leukopenia. Local: phlebitis.
MS: back and neck pain. Misc: anaphylaxis,
superinfection.
Route/Dosage: IV/500 mg q 6 hr Uploaded by MEDBOOKSVN.ORG
77
Keep in Mind
Teach client:
• Oral forms are to be taken exactly as directed.
• Report tinnitus, rash, vertigo, or hearing loss.
• Report flushing of the skin, or dizziness.
Make the Connection
• Culture and sensitivity tests are performed
prior to initiating therapy.
• Monitor IV site closely to avoid extravasation.
• Monitor BP and presence of skin flushing
throughout IV infusion.
• Monitor I&O and daily weight. Cloudy or pink
urine may be a sign of nephrotoxicity.
• Assess bowel status.
• Monitor CBC with differential, and liver and renal
function. Monitor peak and trough drug levels.
Report subtherapeutic or toxic levels immediately.
• Administer IV over at least 60–90 min to prevent
“red-man syndrome” (massive histamine release).
• Look for Candida infections.
1882_Tab04_066-096 11/10/12 2:39 PM Page 78

Immune System Drugs Fluoroquinolones 78

Ciprofloxacin Levofloxacin
(sip-roe-flox-a-sin) (le-voe-flox-a-sin)

Cipro, Cipro XR Levaquin

Moxifloxacin Besifloxacin
(mox-i-flox-a-sin) (be-si-flox-a-sin)

Avelox Besivance
1882_Tab04_066-096 11/10/12 2:39 PM Page 78
Immune System Drugs Fluoroquinolones
Therapeutic/Pharmacologic Class
Anti-infective/fluoroquinolones
Indications
PO, IV: Treatment of the following bacterial infec-
tions: urinary tract and gynecologic infections;
respiratory tract infections; skin and skin structure
infections; bone and joint infections; infectious diar-
rhea; complicated intra-abdominal infections; and
typhoid fever. Postexposure prophylaxis of inhala-
tional anthrax. Treatment of cutaneous anthrax.
Unlabeled uses: Treatment of febrile neutropenia.
Action
Inhibits bacterial DNA synthesis by inhibiting DNA
gyrase enzyme (bacteriocidal). Effective against
gram-positive and gram-negative bacteria.
Adverse Reactions/Side Effects
CNS: seizures, dizziness, drowsiness, headache,
insomnia/agitation, confusion. GI: pseudomem-
branous colitis, abdominal pain, diarrhea,
abnormal liver enzymes, nausea. GU: vaginitis.
Derm: photosensitivity, rash. Endo: hyper-
glycemia, hypoglycemia. Hemat: eosinophilia.
Route/Dosage: Ciprofloxacin: PO/500–750 mg q 12 hr; IV/400 mg q 12 hr, Levofloxacin: PO, IV/250–750 q 24 hr, Moxifloxacin: PO/400 mg daily,
Besifloxacin: Ophth/1 drop in affected eye tidUploaded by MEDBOOKSVN.ORG
78
Local: phlebitis at IV site. MS: tendonitis, tendon
rupture. Neuro: peripheral neuropathy. Misc:
anaphylaxis.
Keep in Mind
Teach client:
• Take medication as directed.
• Drink plenty of fluids daily to prevent crystalluria.
• Do not take with antacids.
• May cause dizziness and drowsiness.
• Use sunscreen and protective clothing.
• Report rash, tendon pain, or blood in stool.
Make the Connection
• Culture and sensitivity tests should be
performed before initiating therapy.
• Monitor for anaphylactic reaction.
• Monitor CBC with differential, liver and renal
studies, and blood glucose.
• Monitor for signs of Candida infection.
• Best if given on an empty stomach.
1882_Tab04_066-096 11/10/12 2:39 PM Page 79

Immune System Drugs Aminopenicillins (includes beta-lactamase inhibitors) 79

Amoxicillin Ampicillin/
(a-mox-i-sill-in)
Sulbactam
(am-pi-sil-in/sul-bak-tam)
Amoxil, Trimox
Apo-Amoxi
Unasyn

Amoxicillin/Clavulanate
(a-mox-i-sill-in/klav-yoo-lan-ate)

Augmentin, Augmentin ES, Augmentin XR

Clavulin
1882_Tab04_066-096 11/10/12 2:39 PM Page 79

Immune System Drugs Aminopenicillins (includes beta-lactamase inhibitors) 79

Therapeutic/Pharmacologic Class
Anti-infective/aminopenicillins; beta lactamase
inhibitor with clavulanate or sulbactam
Indications
Treatment of skin and skin structure infections, otitis
media, sinusitis, respiratory infections, and genitouri-
nary infections. Prevention of endocarditis. Postexposure
inhalational anthrax prophylaxis. Treatment of infec-
tions with resistant organisms. Unlabeled uses: Lyme
disease in children younger than 8 yr.
Action
Binds to bacterial cell wall, causing cell death
(bacteriocidal). Depending on agent, drugs are
broad spectrum and can kill resistant organisms.
Adverse Reactions/Side Effects
CNS: seizures (high doses). GI: pseudomem-
branous colitis, diarrhea, nausea, vomiting,
elevated liver enzymes. Derm: rashes, urticaria.
Hemat: bone marrow suppression. Misc:
anaphylaxis, serum sickness, superinfection.
Keep in Mind
Teach client:
• Take as directed.
• Women taking oral contraceptives should use a
barrier method while on this medication.
• Be aware that yeast infections may occur.
• Notify HCP immediately if diarrhea, abdominal
cramping, fever, or bloody stools occur.
• Calculate and measure doses accurately if admin-
istering to pediatric client, using proper measur-
ing device.
Make the Connection
• Observe for signs and symptoms of
anaphylaxis (rash, pruritus, laryngeal edema,
wheezing).
• Obtain specimens for culture and sensitivity
testing prior to therapy.
• Monitor bowel function.
• Monitor CBC with differential and liver enzymes.

Route/Dosage: Amoxicillin: PO/250–500 mg q 8 hr, or 500–875 mg q 12 hr, Ampicillin/sulbactam: IM, IV/1–2 g ampicillin q 6–8 hr,
Amoxicillin/clavulanate: PO/250 mg q 8 hr, orUploaded
500 mg q 12 hr by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 80

Immune System Drugs Extended-Spectrum Penicillins 80

Piperacillin/
Tazobactam
(pi-per-a-sill-in/tay-zoe-bak-tam)

Zosyn
1882_Tab04_066-096 11/10/12 2:39 PM Page 80
Immune System Drugs Extended-Spectrum Penicillins
Therapeutic/Pharmacologic Class
Anti-infectives/extended-spectrum penicillins
Indications
Appendicitis and peritonitis, skin and skin structure
infections, gynecologic infections, and community-
acquired and nosocomial pneumonia caused by
piperacillin-resistant, beta-lactamase–producing
bacteria.
Action
Piperacillin: Binds to bacterial cell wall membrane,
causing cell death. Spectrum is extended compared
with other penicillins; Tazobactam: Inhibits beta-
lactamase, an enzyme that can destroy penicillins.
Adverse/Side Effects
CNS: seizures at higher doses, confusion,
dizziness, headache, insomnia, lethargy. GI:
pseudomembranous colitis, diarrhea, constipation,
drug-induced hepatitis, nausea, vomiting. GU:
interstitial nephritis. Derm: rashes (↑ in cystic fibro-
sis patients), urticaria. Hemat: bleeding, leukope-
nia, neutropenia, thrombocytopenia. Local: pain,
phlebitis at IV site. Misc: hypersensitivity reactions
Route/Dosage: IV/3.375 g q 6 hr; nosocomialUploaded
pneumonia, 4–5 g qby
6 hr
80
including anaphylaxis and serum sickness, fever
(↑ in cystic fibrosis patients), superinfection.
Keep in Mind
Teach client:
• Report rash/itching immediately.
• Notify HCP if fever and diarrhea occur, especially
if stool contains blood, pus, or mucus.
Make the Connection
• Obtain specimens for culture prior to
beginning medication.
• Assess for improvement of infection.
• Obtain a history before initiating therapy to deter-
mine previous use of and reactions to penicillins
or cephalosporins. Cross-sensitivity may occur.
• Observe patient for signs and symptoms of
anaphylaxis.
• Evaluate RFT, LFT, CBC, serum K+, BUN, serum
bilirubin, alkaline phosphatase, and PT/aPTT.
• May cause proteinuria; hematuria; pyuria; hyper-
glycemia; ↓ total protein or albumin; and abnor-
malities in Na, K+, and Ca+ levels.
MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 81

Immune System Drugs Tetracyclines 81

Doxycycline
(dox-i-sye-kleen)

Doryx, Vibramycin,
Oracea, Periostat
Apo-Doxy

Tetracycline
(te-tra-sye-kleen)

Sumycin
Apo-Tetra
1882_Tab04_066-096 11/10/12 2:39 PM Page 81
Immune System Drugs Tetracyclines
Therapeutic/Pharmacologic Class
Anti-infective/tetracyclines
Indications
Treatment of various infections caused by unusual
organisms, including Mycoplasma, Chlamydia,
Rickettsia, and Borrelia burgdorferi. Treatment of
inhalational anthrax (postexposure) and cutaneous
anthrax. Treatment of gonorrhea and syphilis in
penicillin-allergic clients. Prevention of exacerba-
tions of chronic bronchitis. Treatment of acne.
Action
Inhibits bacterial protein synthesis at the level
of the 30S bacterial ribosome (bacteriostatic).
Low-dose products used in the management of
periodontitis inhibit collagenase. Effective against
some gram-positive and gram-negative bacteria, as
well as Mycoplasma and Rickettsia.
Adverse Reactions/Side Effects
CNS: benign intracranial HTN (higher in children).
GI: diarrhea, nausea, vomiting, esophagitis, hepa-
totoxicity, pancreatitis. Derm: photosensitivity,
Uploaded
Route/Dosage: Doxycycline: PO/100 mg bid; PO,
IV/(anthrax inhalation) MEDBOOKSVN.ORG
81
rashes. Hemat: BMS. Local: phlebitis at IV site.
Misc: hypersensitivity reactions, superinfection.
Keep in Mind
Teach client:
• Take as directed. Report rash (allergic reaction).
• Avoid taking antacids and dairy products.
• Women should use a nonhormonal method of
contraception (barrier method).
• Use sunscreen and protective clothing.
• Watch for signs of yeast infection.
Make the Connection
• Culture and sensitivity testing are done
before initiating therapy.
• Monitor renal and liver functions, amylase and
lipase levels, and CBC with differential.
• Pregnant women and children younger than
8 yr should not take these preparations, as they
affect teeth (brown, speckled stain) and bones.
by 100
mg bid, Tetracycline: PO/250–500 mg q 6 hr, or 500 mg–1 g q 12 hr
1882_Tab04_066-096 11/10/12 2:39 PM Page 82

Immune System Drugs Cephalosporins 82

Ceftriaxone Cephalexin
(3rd generation) (1st generation)
(sef-try-ax-one) (sef-a-lex-in)

Rocephin Keflex
Apo-Cephalex

Ceftazidime Cefepime
(3rd generation) (4th generation)
(sef-tay-zi-deem) (seff-e-peem)

Fortaz, Tazicef Maxipime

1882_Tab04_066-096 11/10/12 2:39 PM Page 82
Immune System Drugs Cephalosporins
Therapeutic/Pharmacologic Class
Anti-infective/cephalosporins
Indications
Treatment of skin and skin structure infections;
bone and joint infections; complicated and uncom-
plicated urinary tract infections; uncomplicated
gynecologic infections, including gonorrhea; lower
respiratory tract infections; intra-abdominal infec-
tions; septicemia; meningitis; otitis media; and
perioperative prophylaxis.
Action
Binds to the bacterial cell wall membrane, causing
cell death (bacteriocidal). Spectrum varies depend-
ing on drug generation. Third generation is more
effective against more organisms.
Adverse Reactions/Side Effects
CNS: seizures (high doses). GI: pseudomembra-
nous colitis, diarrhea, cholelithiasis, sludging in
the gallbladder. Derm: rashes, urticaria. Hemat:
BMS. Local: pain at IM site, phlebitis at IV site.
Misc: allergic reactions including anaphylaxis,
superinfection.
Route/Dosage: Ceftriaxone: IM, IV/1–2 g q 12–24 hr, Cephalexin: PO/250–500 mg q 6 hr, Ceftazidime: IM, IV/500 mg–1 g q 8 hr, Cefepime: IV/0.5–1 g
q 12 hr Uploaded by MEDBOOKSVN.ORG
82
Keep in Mind
Teach client:
• Take as directed.
• Notify HCP if fever and diarrhea develop, espe-
cially if stool contains blood, pus, or mucus.
• These medications are related to penicillins; so,
report preexisting allergy.
• Women should use a barrier method of birth control.
• Report rash or signs of yeast infection.
Make the Connection
• Before initiating therapy, obtain a history
to determine previous use of and reactions to
penicillins or other beta-lactam medications.
• Obtain specimens for culture and sensitivity
testing before initiating therapy.
• Observe client for signs and symptoms of
anaphylaxis.
• Monitor CBC with differential.
• Discuss alternative forms of birth control with
female clients.
1882_Tab04_066-096 11/10/12 2:39 PM Page 83

Immune System Drugs Carbapenems 83

Imipenem/ Meropenem
(mer-oh-pen-nem)
Cilastatin
(i-me-pen-em/sye-la-stat-in)
Merrem
Primaxin

Doripenem Ertapenem
(do-ri-pen-em) (er-ta-pen-em)

Doribax Invanz
1882_Tab04_066-096 11/10/12 2:39 PM Page 83
Immune System Drugs Carbapenems
Therapeutic/Pharmacologic Class
Anti-infective/carbapenems
Indications
Treatment of lower respiratory tract infections,
urinary tract infections, abdominal infections,
gynecologic infections, skin and skin structure
infections, bone and joint infections, bacteremia,
endocarditis, polymicrobic infections, and infec-
tions with resistant organisms.
Action
Binds to the bacterial cell wall, resulting in cell
death (bacteriocidal). Combination of drugs pre-
vents renal inactivation. Many enzymes that degrade
most other beta-lactam drugs do not affect this
drug. Broad spectrum against gram-positive and
gram-negative aerobes and anaerobes.
Adverse Reactions/Side Effects
CNS: seizures, dizziness, somnolence. CV:
hypotension. GI: pseudomembranous colitis,
diarrhea, nausea, vomiting. Derm: rash, pruritus,
sweating, urticaria. Hemat: eosinophilia. Local:
phlebitis at IV site. Misc: anaphylaxis, fever,
superinfection.
Uploaded
Route/Dosage: Imipenem/cilastatin: IV/200–500
mg q 6 hr, Meropenem: IV/0.5–1 g q 8 hr, Doripenem: IV/500 mg q 8 hr, Ertapenem: IV, IM/1 g daily
83
Keep in Mind
Teach client:
• Watch for signs and symptoms of yeast infection.
• Notify HCP if fever and diarrhea occur, especial-
ly if stool contains blood, pus, or mucus.
Symptoms may occur for up to several weeks
after discontinuation of medication.
Make the Connection
• Obtain a history before initiating therapy
to determine previous use of and reactions to
beta-lactam drugs.
• Obtain specimens for culture and sensitivity
testing before initiating therapy.
• Observe client for signs and symptoms of
anaphylaxis.
• Monitor CBC with differential to assess effectiveness.
• Monitor LFT and RFT. This drug has very high
renal concentrations.
• Do not administer direct IV. Drug must be diluted.
by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 84

Immune System Drugs Streptogramins 84

Quinupristin/
Dalfopristin
(kwin-oo-pris-tin/dal-foe-pris-tin)

Synercid
1882_Tab04_066-096 11/10/12 2:39 PM Page 84
Immune System Drugs Streptogramins
Therapeutic/Pharmacologic Class
Anti-infective/streptogramins
Indications
Treatment of serious or life-threatening infections
associated with vancomycin-resistant Enterococcus
faecium (VREF) and complicated skin/skin structure
infections caused by Staphylococcus aureus (methicillin
susceptible) or Streptococcus pyogenes.
Action
Quinupristin inhibits the late phase of protein
synthesis at the level of the bacterial ribosome;
dalfopristin inhibits the early phase.
Adverse Reactions/Side Effects
CNS: headache. CV: thrombophlebitis. GI:
pseudomembranous colitis, diarrhea, nausea,
vomiting. Derm: pruritus, rash. Local: edema/
inflammation/pain at infusion site, infusion site
reactions. Misc: allergic reactions including
anaphylaxis, pain.
Route/Dosage: IV/7.5 mg/kg q 8 hr Uploaded by MEDBOOKSVN.ORG
84
Keep in Mind
Teach client:
• Notify HCP if fever and diarrhea develop,
especially if stool contains blood, pus, or
mucus.
Make the Connection
• Monitor for improvement of symptoms by
clinical signs and CBC with differential.
• Obtain specimens for culture and sensitivity
before initiating therapy.
• Monitor infusion site.
• Observe patient for signs and symptoms of
anaphylaxis.
• Arthralgia and myalgia may be severe.
• Monitor LFT.
• Inhibits the cytochrome P450 3A4 drug metabo-
lizing enzyme system; inhibits metabolism of
many drugs, increasing the risk of toxicity.
1882_Tab04_066-096 11/10/12 2:39 PM Page 85

Immune System Drugs Antitubercular Anti-infectives 85

Isoniazid Ethambutol
(eye-soe-nye-a-zid) (e-tham-byoo-tole)

INH Myambutol
PMS Isoniazid Etibi

Pyrazinamide Rifampin
(peer-a-zin-a-mide) (rif-am-pin)

PMS Rifadin
Pyrazinamide Rofact
1882_Tab04_066-096 11/10/12 2:39 PM Page 85

Immune System Drugs Antitubercular Anti-infectives 85

Therapeutic/Pharmacologic Class
Antitubercular/bacteriostatic; bacteriocidal
anti-infectives
Indications
First-line therapy of active TB, in combination with
other agents. Multidrug regimen prevents resistance.
Preventive treatment (exposed to active TB) may be
accomplished with monotherapy.
Action
Inhibits mycobacterial cell wall synthesis and inter-
feres with metabolism; one first-line drug interferes
with RNA transcription. Bactericidal/bacteriostatic
action.
Adverse Reactions/Side Effects
CNS: psychosis, seizures, optic neuritis. EENT:
visual disturbances, drug that begins with “e”
causes eye problems (optic neuropathy: e = eye).
GI: drug-induced hepatitis, nausea, vomiting.
Derm: rashes. Endo: gynecomastia. Hemat: bone
marrow changes. Neuro: peripheral neuropathy.
Misc: fever; drug that begins with “r” causes red
discoloration of the urine (r = red).
Route/Dosage: Isoniazid: PO, IM/300 mg daily, Ethambutol: PO/15–25 mg/kg/day, Pyrazinamide: PO/15–30 mg/kg/day, Rifampin: PO, IV/600 mg/day,
or 10 mg/kg/day Uploaded by MEDBOOKSVN.ORG
Keep in Mind
Teach client:
• Take medication exactly as directed. Therapy may
be continued for 6 mo–2 yr.
• Report numbness of extremities or decrease in
vision. Take pyridoxine (B6) to ↓ neuropathy.
• Avoid the use of alcohol.
• Avoid tyramine-containing foods.
• Maintain appointments for regular follow-up.
• Be aware that urine may change color (“r” drug = red).
Make the Connection
• Monitor CBC with differential, LFT, and
uric acid levels.
• Teach the client about the regimen, public health
concerns, and possible side effects.
• Monitor vision and for nerve pain/paresthesias.
• Therapy will continue until 2 sputum samples for
AFB are negative.
1882_Tab04_066-096 11/10/12 2:39 PM Page 86

Immune System Drugs Sulfonamide 86

Trimethoprim/
Sulfamethoxazole
(trye-meth-oh-prim/sul-fa-meth-ox-a-zole)

Bactrim, Bactrim DS,

SMZ/TMP, Septra
Apo-Sulfatrim DS
1882_Tab04_066-096 11/10/12 2:39 PM Page 86
Immune System Drugs Sulfonamide
Therapeutic/Pharmacologic Class
Anti-infective; antiprotozoal/folate antagonist;
sulfonamide
Indications
Treatment of bronchitis, Shigella enteritis, otitis
media, Pneumocystis carinii pneumonia (PCP), urinary
tract infections, and traveler’s diarrhea. Prevention
of PCP in HIV-positive clients.
Action
Combination inhibits the metabolism of folic acid
in bacteria at two different points (bacteriocidal).
Effective against gram-negative and gram-positive
bacteria.
Adverse Reactions/Side Effects
CNS: fatigue, hallucinations, headache, insom-
nia, mental depression. GI: hepatic necrosis,
nausea, vomiting, diarrhea, stomatitis, hepatitis,
cholestatic jaundice. GU: crystalluria. Derm:
severe exfoliative rashes, photosensitivity.
Hemat: BMS. Local: phlebitis at IV site.
Misc: allergic reactions, fever.
Route/Dosage: PO, IV/(TMP) 6–12 mg/kg/day in divided doses q 12 hr (moderate infection), 15–20 mg/kg/day in divided doses q 6–8 hr
Uploaded by MEDBOOKSVN.ORG
(pneumocystis); PO/(prophylaxis), 1 DS tab daily
86
Keep in Mind
Teach client:
• Take medication as directed.
• Use sunscreen and protective clothing.
• Notify HCP if skin rash, sore throat, fever, mouth
sores, or unusual bleeding or bruising occurs.
• Maintain appointments for regular follow-up.
• Increase fluid intake to decrease the risk of renal
crystals.
Make the Connection
• Obtain specimens for culture and sensitivity
testing before initiating therapy.
• Inspect IV site frequently. Phlebitis is common.
• Assess client for allergy to sulfonamides.
• Monitor I&O. Promote adequate fluid intake.
• Monitor CBC with differential and liver and renal
laboratory tests.
1882_Tab04_066-096 11/10/12 2:39 PM Page 87

Immune System Drugs Antifungals 87

Fluconazole Amphotericin B
(floo-kon-a-zole) (am-foe-ter-i-sin)

Diflucan Amphotec, AmBisome

Fungizone

Ketoconazole Voriconizole
(vor-i-kon-a-zole)
(systemic)
(kee-toe-koe-na-zole)
VFEND
Nizoral
1882_Tab04_066-096 11/10/12 2:39 PM Page 87
Immune System Drugs Antifungals
Therapeutic/Pharmacologic Class
Antifungals (systemic)
Indications
PO, IV: Treatment of fungal infections caused by
susceptible organisms.
Action
Inhibits synthesis of fungal sterols, a necessary com-
ponent of the cell membrane (fungistatic). Destroys
fungi at higher doses (fungicidal).
Adverse Reactions/Side Effects
CNS: headache, dizziness, tremor, seizures.
GI: hepatotoxicity, abdominal discomfort,
diarrhea, nausea, vomiting. Derm: exfoliative
skin disorders. Endo: hypokalemia, hypocal-
cemia, hypomagnesemia, hypertriglyceridemia.
Misc: allergic reactions, including anaphylaxis;
acute infusion reactions. Resp: dyspnea,
hypoxia, wheezing with certain drugs.
CV: hypotension, arrhythmias with ampho-
tericin. GU: nephrotoxicity, hematuria with
amphotericin. MS: arthralgia, myalgia with
Route/Dosage: Fluconazole: PO, IV/200 mg initially, then 100 mg daily, Amphotericin B: IV/0.25–1.5 mg/kg/day; bladder irrigation/50 mcg/mL,
Uploaded
Ketoconazole: PO/200–400 mg day, Voriconizole: IV/3 mg/kg q 12byhr MEDBOOKSVN.ORG
87
amphotericin. Neuro: peripheral neuropathy
with amphotericin.
Keep in Mind
Teach client:
• Take medication as directed.
• Notify HCP if skin rash, abdominal pain, fever,
diarrhea, unusual fatigue, anorexia, nausea,
vomiting, jaundice, unusual bruising, bleeding,
palpitations, dark urine, or pale stools occur.
• Report development of a rash immediately.
Make the Connection
• Specimens for culture should be obtained
before instituting therapy.
• Monitor LFT, RFT, and CBC with differential.
• Monitor VS every 15–30 min during test dose
and every 30 min for 2–4 hr after administration
of amphotericin. May need to premedicate with
meperidine, dantrolene, and diphenhydramine.
• Assess respiratory status daily after administra-
tion of amphotericin.
1882_Tab04_066-096 11/10/12 2:39 PM Page 88

Immune System Drugs Echinocandins 88

Caspofungin
(kas-po-fun-gin)

Cancidas

Micafungin
(my-ka-fun-gin)

Mycamine
1882_Tab04_066-096 11/10/12 2:39 PM Page 88
Immune System Drugs Echinocandins
Therapeutic/Pharmacologic Class
Systemic antifungal/echinocandins
Indications
Treatment of invasive refractory aspergillosis,
candidemia, and associated serious infections
(intra-abdominal abscesses, peritonitis, pleural
space infections), esophageal candidiasis, and
suspected fungal infections in febrile neutropenic
patients.
Action
Inhibits the synthesis of beta (1, 3)-D-glucan, a
necessary component of the fungal cell wall.
Adverse Reactions/Side Effects
CNS: headache, chills. GI: diarrhea, ↑ liver
enzymes, nausea, vomiting. Resp: bron-
chospasm. GU: ↑ creatinine. Derm: flushing,
pruritus, rash. Local: venous irritation at injec-
tion site. Misc: allergic reactions, including
anaphylaxis and angiodema.
Uploaded
Route/Dosage: Caspofungin: IV/70 mg initially,
followed by 50 mg/day, Micafungin: IV/150 mg/day for 15 days
88
Keep in Mind
Teach client:
• Be aware of the purpose and expected result of
drug therapy.
• Notify HCP immediately if symptoms of allergic
reactions (rash, facial swelling, pruritus, sensa-
tion of warmth, difficulty breathing) occur.
Make the Connection
• Concurrent use with cyclosporine may
cause hepatic toxicity.
• Assess for effectiveness of therapy daily.
• Monitor for signs of anaphylaxis (rash, dyspnea,
stridor) during therapy.
• Monitor for ↑ serum alkaline phosphatase, serum
creatinine, AST, ALT, eosinophils, urine protein,
and RBCs. May also cause ↓ serum K+, hgb,
hct, and WBCs.
by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 89

Immune System Drugs Antivirals 89

Acyclovir Famciclovir
(ay-sye-kloe-veer) (fam-sye-kloe-veer)

Zovirax Famvir
Avirax

Valacyclovir
(val-ay-sye-kloe-veer)

Valtrex
1882_Tab04_066-096 11/10/12 2:39 PM Page 89

Immune System Drugs Antivirals 89

Therapeutic/Pharmacologic Class phlebitis, local irritation. MS: joint pain.
Antivirals/purine analogue (acyclovir) Misc: polydipsia.
Indications Keep in Mind
PO, IV: Treatment of recurrent genital herpes
Teach client:
infections. Treatment of localized cutaneous
herpes zoster infections (shingles) and chickenpox • Take medication as directed.
(varicella). Treatment of herpes simplex encephalitis • Condoms should always be used during sexual
contact.
in immunocompromised clients. Topical: Treatment
of recurrent herpes labialis (cold sores). • Women with genital herpes should have yearly
Papanicolaou smears.
Action • Follow instructions for proper application of
Interferes with viral DNA synthesis. topical creams or ointments.
Adverse Reactions/Side Effects • Wash hands after touching affected areas to
CNS: seizures, dizziness, headache, hallucina- avoid spreading the viral infection to other areas
tions, trembling. GI: diarrhea, nausea, vomiting, of the body. Avoid drug contact in or around the
elevated liver enzymes, hyperbilirubinemia, eyes.
abdominal pain, anorexia. GU: renal failure,
crystalluria, hematuria. Derm: acne, hives, skin
rashes, unusual sweating, Stevens-Johnson Make the Connection
syndrome. Endo: changes in menstrual cycle. • Monitor BUN, serum creatinine, and
Hemat: thrombotic thrombocytopenic purpura/ creatinine clearance rate (CCr) before and during
hemolytic uremic syndrome (high doses therapy. ↑ BUN and serum creatinine levels or
in immunosuppressed clients). Local: pain, ↓ CCr may indicate renal failure.

Uploaded
Route/Dosage: Acyclovir: PO/200 mg q 4 hr, Famciclovir: PO/500by
mg q MEDBOOKSVN.ORG
8 hr, Valacyclovir: PO/1 g tid
1882_Tab04_066-096 11/10/12 2:39 PM Page 90

Immune System Drugs Neuraminidase Inhibitors 90

Zanamivir
(za-na-mi-veer)

Relenza

Oseltamivir
(owe-sell-tam-i-veer)

Tamiflu
1882_Tab04_066-096 11/10/12 2:39 PM Page 90

Immune System Drugs Neuraminidase Inhibitors 90

Therapeutic/Pharmacologic Class • Persons with a history of asthma should have a
Antiviral/neuraminidase inhibitors fast-acting inhaled bronchodilator available in
Indications case of bronchospasm. If using bronchodilator
Treatment of uncomplicated acute illness caused by and the medication concurrently, administer
influenza virus in adults and children older than 7 yr bronchodilator first.
who have been symptomatic no more than 2 days.
Action Make the Connection
Inhibits the enzyme neuraminidase, which may alter • Assess client for signs and symptoms of
virus particle aggregation and release. influenza (fever, headache, myalgia, cough, sore
Adverse Reactions/Side Effects throat) before administration. Determine dura-
Resp: bronchospasm. tion of symptoms. Indicated for clients who have
been symptomatic for up to 2 days.
Keep in Mind
Teach client:
• Take exactly as directed and finish entire 5-day
course, even if feeling better. Follow instructions
for the use of the Diskhaler. Client education
pamphlet accompanies the inhaler.
• This medication is not a substitute for a flu shot.

Uploaded
Route/Dosage: Zanamivir: Inhaln/10 mg (2 inhalations by Oseltamivir:
of 5 mg each), MEDBOOKSVN.ORG
PO/75 mg bid (treatment), 75 mg daily (prevention)
1882_Tab04_066-096 11/10/12 2:39 PM Page 91

Immune System Drugs Nucleoside Reverse Transcriptase Inhibitors (NRTI) 91

Abacavir Didanosine
(ah-back-ah-veer) (dye-dan-oh-seen)

Ziagen ddI, Dideoxyinosine,

Videx, Videx EC

Lamivudine Zidovudine
(la-mi-vyoo-deen) (zye-doe-vyoo-deen)

Epivir, Epivir HBV, AZT, Retrovir

3TC Apo-Zidovudine
1882_Tab04_066-096 11/10/12 2:39 PM Page 91

Immune System Drugs Nucleoside Reverse Transcriptase Inhibitors (NRTI) 91

Therapeutic/Pharmacologic Class • Always use a condom, and avoid sharing needles
Antiretroviral/nucleoside reverse transcriptase or donating blood.
inhibitors (NRTI) • Report any signs of allergic reaction.
Indications • Maintain appointments for regular follow-up
Management of HIV infection (AIDS) in combination examinations and blood counts.
with other antiretrovirals. Combining antiretrovirals
prevents the development of resistant strains. See Make the Connection
special combination regimens in drug guide.
• Assess client for change in severity of HIV
Action symptoms and for symptoms of opportunistic
Inhibits the activity of HIV-1 reverse transcriptase, infections throughout therapy.
interfering with the order of transcription, which in • Assess for signs of hypersensitivity reactions.
turn terminates viral DNA growth. • Monitor LFT, serum glucose, lipid panel, and
Adverse Reactions/Side Effects serum lactate levels.
CNS: headache, insomnia. GI: hepatotoxicity, • Monitor viral load and CD4 cell count regularly
diarrhea, nausea, vomiting, anorexia. Derm: during therapy. Chart on a graph to show
rashes. F and E: lactic acidosis. Misc: hypersen- progress (encourages compliance).
sitivity reactions. • Monotherapy with zidovudine is used during
pregnancy.
Keep in Mind • Initial combination therapy usually includes two
Teach client: NRTIs and one protease inhibitor.
• Take medications as directed.
Route/Dosage: Abacavir: PO/300 mg bid, Didanosine: PO/400 mg daily (EC), Lamivudine: PO/300 mg daily, Zidovudine: PO/300 mg bid; IV/1 mg/kg
infused over 1 hr q 4 hr Uploaded by MEDBOOKSVN.ORG
1882_Tab04_066-096 11/10/12 2:39 PM Page 92

Immune System Drugs Protease Inhibitors 92

Ritonavir Saquinavir
(ri-toe-na-veer) (sa-kwin-a-veer)

Norvir Invirase

Darunavir Nelfinavir
(da-ru-na-veer) (nell-finn-a-veer)

Prezista Viracept
1882_Tab04_066-096 11/10/12 2:39 PM Page 92
Immune System Drugs Protease Inhibitors
Therapeutic/Pharmacologic Class
Antiretroviral/protease inhibitors
Indications
Treatment of HIV infection (with other antiretrovirals).
Action
Inhibits the action of HIV protease, which acts like
scissors that cut the DNA chain to appropriate
length. Without the HIV protease, the chain is
sensed as abnormal and is terminated.
Adverse Reactions/Side Effects
CNS: seizures, abnormal thinking, weakness,
dizziness, headache, malaise, somnolence,
syncope. EENT: pharyngitis, throat irritation.
Resp: angioedema, bronchospasm. CV: ortho-
static hypotension, vasodilation. GI: abdominal
pain, altered taste, anorexia, diarrhea, nausea,
vomiting, constipation, dyspepsia, flatulence.
GU: renal insufficiency. Derm: rash, skin erup-
tions, sweating, urticaria. Endo: hyperglycemia.
F and E: dehydration. Metab: hyperlipidemia.
Route/Dosage: Ritonavir: PO/600 mg bid (maintenance), Saquinavir: PO/600 mg tid within 2 hr of a meal, Darunavir: PO/600 mg/day with
Uploaded by MEDBOOKSVN.ORG
ritonavir (100 mg), Nelfinavir: PO/1250 mg bid
92
MS: increased creatine phosphokinase, myalgia.
Neuro: circumoral paresthesia, peripheral pares-
thesia. Misc: hypersensitivity reactions, including
Stevens-Johnson syndrome and anaphylaxis; fat
redistribution; fever.
Keep in Mind
Teach client:
• Take exactly as directed.
• Use condoms; do not share needles or donate
blood.
• Sex with another HIV-positive person may result
in spread of different strains of HIV.
• Smoking may interfere with the drug.
• Redistribution of body fat may occur.
Make the Connection
• Monitor viral load and CD4 counts.
• Monitor LFT, CPK, lipid panel, serum uric acid,
and serum glucose levels.
1882_Tab04_066-096 11/10/12 2:39 PM Page 93

Immune System Drugs Nonnucleoside Reverse Transcriptase Inhibitors

(NNRTIs) 93

Efavirenz Delavirdine
(e-fav-i-renz) (de-la-veer-deen)

Sustiva Rescriptor

Nevirapine Etravirine
(ne-veer-a-peen) (e-tra-veer-een)

Viramune Intelence

Rilpivirine
(ril-pi-vir-een)

Eduant
1882_Tab04_066-096 11/10/12 2:39 PM Page 93
Immune System Drugs Nonnucleoside Reverse Transcriptase Inhibitors
(NNRTIs)
Therapeutic/Pharmacologic Class
Antiretroviral/nonnucleoside reverse transcriptase
inhibitor (NNRTI)
Indications
Treatment of HIV infection (in combination with
one or more other antiretroviral agents to prevent
resistance to the medication).
Action
Inhibits HIV reverse transcriptase, which results in
disruption of DNA synthesis. The chain is seen as
corrupt and is terminated.
Adverse Reactions/Side Effects
CNS: abnormal dreams, depression, dizziness,
drowsiness, fatigue, headache, impaired concen-
tration, insomnia, nervousness, psychiatric
symptomatology. GI: nausea, abdominal pain,
anorexia, diarrhea, dyspepsia, flatulence. GU:
hematuria, renal calculi. Derm: rash, increased
sweating, pruritus. Neuro: hypoesthesia.
Route/Dosage: Efavirenz: PO/600 mg/day, Delavirdine: PO/400 mg tid, Nevirapine: PO/200 mg bid, Etravirine: PO/200 mg bid, Rilpivirine: PO/25 mg
daily Uploaded by MEDBOOKSVN.ORG
93
Keep in Mind
Teach client:
• Take exactly as directed. Must always be used in
combination with other antiretroviral drugs.
• May cause dizziness, impaired concentration, or
drowsiness. Avoid activities requiring alertness.
• These medications do not cure HIV/AIDS.
• Use a condom, do not share needles, and do not
donate blood.
• Notify HCP immediately if rash occurs.
• Maintain appointments for regular follow-up.
Make the Connection
• Assess for rash, especially during first
month of therapy.
• Assess client for CNS and psychiatric symptoms.
• Monitor LFT, lipid panel, viral load, and CD4 cell
count regularly during therapy.
• May cause false-positive urine cannabinoid
results.
1882_Tab04_066-096 11/10/12 2:39 PM Page 94

Immune System Drugs Fusion Inhibitor 94

Enfuvirtide
(en-foo-veer-tide)

Fuzeon
1882_Tab04_066-096 11/10/12 2:39 PM Page 94
Immune System Drugs Fusion Inhibitor
Therapeutic/Pharmacologic Class
Antiretroviral/fusion inhibitor
Indications
Management of HIV infection in combination with
other antiretrovirals in patients with evidence of
progressive HIV-1 replication despite ongoing
treatment.
Action
Prevents entry of HIV-1 into cells by interfering with
the fusion of the virus with cellular membranes.
Adverse Reactions/Side Effects
CNS: fatigue. EENT: conjunctivitis. Resp:
cough, pneumonia, sinusitis. GI: diarrhea,
nausea, abdominal pain, anorexia, dry mouth,
pancreatitis, weight loss. Local: injection site
reactions. MS: myalgia, limb pain. Misc:
hypersensitivity reactions, herpes simplex.
Keep in Mind
Teach client:
• Learn correct procedure to self-inject medication
using return demonstration teaching method.
Route/Dosage: SC/90 mg bid Uploaded by MEDBOOKSVN.ORG
94
• Does not reduce the risk of transmission of
HIV to others through sexual contact or blood
contamination. Use a condom, and avoid sharing
needles or donating blood.
• May cause dizziness.
• Notify HCP if pregnancy is planned or suspected,
or if breastfeeding.
• Look for signs of injection site infection.
• Maintain appointments for regular follow-up
examinations and blood counts.
Make the Connection
• Assess patient for change in severity of
HIV symptoms and for symptoms of opportunis-
tic infections throughout therapy.
• Assess patient for injection site reactions, includ-
ing nodule formation.
• Assess patient for signs and symptoms of pneu-
monia, especially those with low CD4 cell count
and high viral load.
• Monitor for hypersensitivity reactions.
• Monitor viral load and CD4 cell count, CBC, LFT,
RFT, creatinine phosphokinase, and GGT.
1882_Tab04_066-096 11/10/12 2:39 PM Page 95

Immune System Drugs CCR5 Coreceptor Antagonist 95

Maraviroc
(ma-ra-vi-rok)

Selzentry
1882_Tab04_066-096 11/10/12 2:39 PM Page 95
Immune System Drugs CCR5 Coreceptor Antagonist
Therapeutic/Pharmacologic Class
Antiretrovirals/CCR5 coreceptor antagonist
Indications
HIV infection (with other antiretrovirals), specifically
in treatment-experienced or treatment-naive clients
with CCR5-tropic HIV-1 infection. Use is determined
by tropism testing.
Action
Blocks a specific receptor on CD4 and T-cell
surfaces that prevents CCR5-tropic HIV-1 from
entering the cell.
Adverse Reactions/Side Effects
CNS: dizziness. CV: myocardial ischemia/
infarction, orthostatic hypotension. Resp:
cough, upper respiratory tract infection.
GI: abdominal pain, appetite disorder, hepato-
toxicity. Derm: rash. MS: musculoskeletal
pain. Misc: allergic reactions, fever, immune
reconstitution syndrome, ↑ risk of infection.
Route/Dosage: PO/50 mg bid Uploaded by
MEDBOOKSVN.ORG
95
Keep in Mind
Teach client:
• Discontinue and notify HCP if chest pain, signs
of hepatotoxicity (itchy rash, yellow-colored skin
or eyes, dark urine, vomiting, or abdominal
pain), or signs of immune reconstitution syn-
drome (signs and symptoms of an infection)
occur.
• May cause dizziness.
• Avoid driving and other activities requiring alert-
ness until response to medication is known.
• Make position changes slowly to minimize pos-
tural hypotension.
• Do not take any herbal or OTC medication with-
out notifying the HCP.
Make the Connection
• Assess for signs of hepatitis or allergic
reaction.
• Monitor LFT, total bilirubin, absolute neutrophil
count, amylase, and lipase.
• Monitor viral load and CD4 cell count for
improvement.
• Monitor for opportunistic infection.
1882_Tab04_066-096 11/10/12 2:39 PM Page 96

Immune System Drugs Integrase Strand Transfer Inhibitor (INSTI) 96

Raltegravir
(ral-teg-ra-veer)

Isentress
1882_Tab04_066-096 11/10/12 2:39 PM Page 96
Immune System Drugs Integrase Strand Transfer Inhibitor (INSTI)
Therapeutic/Pharmacologic Class
Antiretrovirals/integrase strand transfer inhibitor
(INSTI)
Indications
HIV-1 infection (with other antiretrovirals) in
treatment-experienced or treatment-naive clients.
Action
Inhibits HIV-1 integrase, which is required for viral
replication.
Adverse Reactions/Side Effects
CNS: suicidal thoughts, headache, depression,
dizziness, fatigue, weakness. CV: MI. GI:
diarrhea, abdominal pain, gastritis, hepatitis,
vomiting. GU: renal failure/impairment.
Hemat: anemia, neutropenia. Metabolic:
lipodystrophy. Misc: hypersensitivity reactions,
immune reconstitution syndrome, fever.
Keep in Mind
Teach client:
• This drug does not prevent spread of HIV to
others, thus caution during sexual contact is
Route/Dosage: PO/400 mg bid Uploaded by MEDBOOKSVN.ORG
96
essential (condoms). Needles should not be
shared.
• Notify the HCP immediately if depressive or
suicidal thoughts occur.
• Women must notify HCP if a pregnancy is
suspected. Breastfeeding should be avoided.
• Periodic laboratory visits are required to monitor
progress.
Make the Connection
• Monitor for anxiety, depression, suicidal
ideation, and paranoia.
• Monitor viral load, CD4 cell count, absolute
neutrophil count, CBC, serum glucose (↑), LFT,
GGT, total bilirubin, alkaline phosphatase, pan-
creatic amylase, serum lipase, and creatinine
kinase concentrations.
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 9
MUSCULOSKELETAL
Cyclobenzaprine, 97
Metaxolone, 97
Baclofen, 97
Carisoprodol, 97
Dantrolene, 98
Edrophonium, 99
Pyridostigmine, 99
Neostigmine, 99
Alendronate, 100 Calcitonin (salmon), 102
Ibandronate, 100 Denosumab, 103
Etidronate, 100 Teriparitide, 104
Zoledronic Acid, 100 Celecoxib, 105
Risedronate, 100 Colchicine, 106
Raloxifene, 101 Allopurinol, 107
Toremefine, 101 Abatecept, 108
Tamoxifen, 101
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 10

Uploaded by MEDBOOKSVN.ORG
1882_Tab05_097-108 10/10/12 12:48 PM Page 97

Musculoskeletal System Drugs Centrally Acting Skeletal Muscle Relaxants 97

Cyclobenzaprine Baclofen
(sye-kloe-ben-za-preen) (bak-loe-fen)

Flexeril, Amrix Lioresal

Metaxolone Carisoprodol
(me-tax-a-lone) (kar-i-sop-roe-dole)

Skelaxin Soma, Vanadom

1882_Tab05_097-108 10/10/12 12:48 PM Page 97
Musculoskeletal System Drugs Centrally Acting Skeletal Muscle Relaxants
Therapeutic/Pharmacologic Class
Therapeutic: skeletal muscle relaxants (centrally
acting)
Indications
Management of acute, painful MS conditions
associated with muscle spasm. Unlabeled uses:
Management of fibromyalgia. One in this class may
also be used for treatment of reversible spasticity due
to multiple sclerosis or spinal cord lesions (IT adminis-
tration) and PO to treat pain in trigeminal neuralgia.
Action
Reduces tonic somatic muscle activity at the level
of the brainstem. Structurally similar to tricyclic
antidepressants. One in this class inhibits reflexes
at the spinal level.
Adverse Reactions/Side Effects
CNS: dizziness, drowsiness, confusion, fatigue,
headache, nervousness. EENT: dry mouth,
blurred vision. CV: arrhythmias. GI: constipation,
dyspepsia, nausea, unpleasant taste. GU: urinary
retention. Neuro: ataxia (seizures [IT]). Metab:
hyperglycemia, weight gain. Misc: Hypersensitivity
reactions, sweating.
Uploaded
Route/Dosage: Cyclobenzaprine: PO/10 mg tid,
Baclofen: PO/5 mg
97
Keep in Mind
Teach client:
• Take medication exactly as directed.
• Medication may cause drowsiness, dizziness, and
blurred vision. Avoid activities requiring alertness.
• Do not use alcohol or other CNS depressants
with this medication.
• Take with food to decrease stomach irritation.
• Increase fluid intake and bulk in diet to decrease
likelihood of constipation.
• Report symptoms of urinary retention.
• Use good oral hygiene and sugarless gum or
candy for dry mouth.
• Do not discontinue therapy abruptly.
Make the Connection
• It is important to remember the CNS
depression associated with these drugs.
• Assess client for improvement in pain or spasticity.
• Almost all drugs used for MS illness are GI irritants.
bytid, MEDBOOKSVN.ORG
Metaxolone: PO/800 mg 3–4 times/day, Carisoprodol: PO/250–350 qid
1882_Tab05_097-108 10/10/12 12:48 PM Page 98

Musculoskeletal System Drugs Direct-Acting Skeletal Muscle Relaxant 98

Dantrolene
(dan-troe-leen)

Dantrium
1882_Tab05_097-108 10/10/12 12:48 PM Page 98
Musculoskeletal System Drugs
Therapeutic/Pharmacologic Class
Skeletal muscle relaxant (direct acting)/hydantoin
derivative
Indications
PO: Treatment of spasticity associated with spinal
cord injury, stroke, cerebral palsy, and multiple scle-
rosis. Prophylaxis of malignant hyperthermia. IV:
Emergency treatment of malignant hyperthermia.
Action
Acts directly on skeletal muscle, causing relaxation
by decreasing Ca+ release from sarcoplasmic reticulum
in muscle cells. Prevents intense catabolic process
associated with malignant hyperthermia.
Adverse Reactions/Side Effects
CNS: drowsiness, muscle weakness, confusion,
dizziness, headache, insomnia, malaise, nervous-
ness. EENT: excessive lacrimation, visual distur-
bances. Resp: pleural effusions. CV: changes in
BP, tachycardia. GI: hepatotoxicity, diarrhea,
anorexia, cramps, dysphagia, GI bleeding,
vomiting. GU: crystalluria, dysuria, frequency,
Route/Dosage: PO/25–100 mg daily, increasedUploaded
gradually; IV/1 mg/kg
Direct-Acting Skeletal Muscle Relaxant 98
impotence, incontinence, nocturia. Derm: pruri-
tus, sweating, urticaria. Hemat: eosinophilia.
Local: irritation at IV site, phlebitis. MS: myalgia.
Misc: chills, drooling, fever.
Keep in Mind
Teach client:
• May cause dizziness, drowsiness, visual distur-
bances, and muscle weakness.
• Avoid taking alcohol or other CNS depressants
concurrently with this medication.
• Wear sunscreen.
Make the Connection
• Assess bowel function for diarrhea.
• Assess neuromuscular status to establish a
baseline before initiating therapy.
• On the day of administration, assess gag reflex
and have client “dry swallow” to see the rise of the
larynx prior to giving food.
by
MEDBOOKSVN.ORG
up to a maximum of 10 mg/kg for malignant hyperthermia
1882_Tab05_097-108 10/10/12 12:48 PM Page 99

Musculoskeletal System Drugs Anticholinesterases (Cholinergics) 99

Edrophonium Neostigmine
(e-droh-fone-ee-yum) (nee-oh-stig-meen)

Enlon, Tensilon Prostigmin

Pyridostigmine
(peer-id-oh-stig-meen)

Mestinon, Mestinon Timespan, Regonol

Mestinon SR
1882_Tab05_097-108 10/10/12 12:48 PM Page 99

Musculoskeletal System Drugs Anticholinesterases (Cholinergics) 99

Therapeutic/Pharmacologic Class cramps, diarrhea, dysphagia, excess salivation,
Antimyasthenic/anticholinesterase; cholinergics vomiting, nausea. GU: incontinence, urinary
Indications frequency. Derm: sweating, rashes. MS:
Diagnosis of myasthenia gravis. Assessment of fasciculation.
adequacy of anticholinesterase therapy in myasthenia
gravis. Differentiating myasthenic from cholinergic
Keep in Mind
Teach client:
crisis. Reversal of muscle paralysis from nondepo-
larizing neuromuscular blocking agents. Other agents • Wear a Medic-Alert bracelet.
in this class increase muscle strength in symptomatic • Take medication exactly as directed.
treatment of myasthenia gravis and prevent and • Lifelong treatment will be required.
treat postoperative bladder distention/urinary • Space activities to avoid fatigue.
retention or ileus.
Action Make the Connection
Inhibits the breakdown of acetylcholine by acetyl- • To differentiate myasthenic from cholinergic
cholinesterase in the neural synapse, resulting in a crisis, assess for increased cholinergic symptoms
prolonged effect. Cause muscular contraction. (SLUDGE—salivation, lacrimation, urination,
Adverse Reactions/Side Effects diarrhea, GI distress, emesis).
CNS: seizures, dizziness, dysphasia, dysphonia, • Give exactly when ordered.
weakness. EENT: diplopia, lacrimation, miosis. • Atropine, an anticholinergic, may be used for
Resp: bronchospasm, excess secretions. CV: treatment of cholinergic symptoms.
bradycardia, hypotension. GI: abdominal
Route/Dosage: Edrophonium: IV/2 mg; if no response, administer an additional 8 mg after 45 sec; may repeat test in 30 min, Neostigmine: PO/15 mg
q 3–4 hr initially, ↑ at daily intervals until optimal response is achieved (usual maintenance dose, 150 mg/day [up to 375 mg/day may be needed]);
SC, IM/0.5 mg, Pyridostigmine: PO/600 mg/day Uploaded by MEDBOOKSVN.ORG
in divided doses (maintenance); IV/2 mg q 2–3 hr
1882_Tab05_097-108 10/10/12 12:48 PM Page 100

Musculoskeletal System Drugs Biphosphonates 100

Alendronate Etidronate
(a-len-drone-ate) (eh-tih-droe-nate)

Fosamax, Binosto Didronel

Ibandronate Zoledronic Acid

(i-ban-dro-nate) (zoe-led-dron-ic as-id)

Boniva Reclast, Zometa

Risedronate
(riss-ed-roe-nate)

Actonel/Atelvia
1882_Tab05_097-108 10/10/12 12:48 PM Page 100

Musculoskeletal System Drugs Biphosphonates 100

Therapeutic/Pharmacologic Class
Bone resorption inhibitors/biphosphonates
Indications
Treatment and prevention of postmenopausal
osteoporosis and osteoporosis in men, Paget’s
disease of the bone, corticosteroid-induced osteo-
porosis in clients (men and women) who are
receiving 7.5 mg of prednisone/day (or equivalent)
with evidence of decreased bone mineral density,
and treatment of hypercalcemia of malignancy.
Action
Inhibits resorption of bone by inhibiting osteoclast
activity.
Adverse Reactions/Side Effects
CNS: headache. EENT: blurred vision, conjunc-
tivitis, eye pain/inflammation. GI: abdominal
distention, abdominal pain, acid reflux and
esophageal ulceration, constipation, diarrhea,
gastritis, dysphagia, flatulence, nausea, taste
perversion, vomiting. Derm: erythema, photosen-
sitivity, rash. MS: musculoskeletal pain. Immune:
(IV Reclast) pyrexia. F and E: hypocalcemia,
hypophosphatemia, hypomagnesia, hypokalemia.
Keep in Mind
Teach client:
• Take the medication first thing in the morning,
30 min before other medications, beverages, or
food, and remain upright.
• Consult HCP about the need for calcium and vita-
min D supplements.
• Engage in weight-bearing exercise.
Make the Connection
• Assess Ca+ and phosphate levels for
baseline and during therapy.
• Give this medication separately from other
medications and food.

Route/Dosage: Alendronate: PO/5–10 mg once daily or 35–75 mg weekly; alendronate effRx: PO/70 mg/wk, Etidronate: PO/5–10 mg/kg/day single
dose (hip replacement, 20 mg/kg/day for 1 mo before and 3 mo after surgery; spinal injury, 20 mg/kg/day for 2 wk, then decreased to 10 mg/kg/day
for 10 wk), Ibandronate: PO/2.5 mg once daily, or 150 mg once monthly; IV/3 mg every 3 mo, Zoledronic acid: IV/(Reclast) 5 mg once yearly for
prevention of osteoporosis; (Zometa) 4 mg for hypercalcemia due to malignancy may be repeated after 7 days; (multiple myeloma and bone metas-
tases from solid tumors) 4 mg q 3–4 wk (has been used for up to 15 mo), Risedronate: PO/(Actonel) 5 mg daily, 75 mg bimonthly, or 150 mg
monthly; (Atelvia) 35 mg/wk Uploaded by MEDBOOKSVN.ORG
1882_Tab05_097-108 10/10/12 12:48 PM Page 101

Musculoskeletal System Drugs Selective Estrogen Receptor Modulators 101

Raloxifene Tamoxifen
(ra-lox-i-feen) (ta-mox-i-fen)

Evista Alpha-Tamoxifen,
Novo-Tamoxifen

Toremefine
(tore-em-i-feen)

Fareston
1882_Tab05_097-108 10/10/12 12:48 PM Page 101
Musculoskeletal System Drugs
Therapeutic/Pharmacologic Class
Bone resorption inhibitor; antineoplastic (tamoxifen)/
selective estrogen receptor modulators (SERM)
Indications
Treatment and prevention of osteoporosis in post-
menopausal women and adjuvant therapy of breast
cancer after surgery and radiation (delays recurrence).
Palliative or adjunctive treatment of advanced
breast cancer. Prevention of breast cancer in high-
risk clients.
Action
Binds to estrogen receptors, producing estrogen-
like effects on bone, resulting in reduced resorption
of bone and decreased bone turnover. Competes
for estrogen-binding sites in the breast, reducing
estrogen response.
Adverse Reactions/Side Effects
MS: leg cramps, bone pain. CNS: confusion,
depression, headache, weakness. EENT: blurred
vision. CV: pulmonary embolism, stroke, edema.
GI: nausea, vomiting. GU: uterine malignancies,
Route/Dosage: Raloxifene: PO/60 mg daily, Tamoxifen: PO/20 mg daily for osteoporosis; 20 mg daily for 5 yr for prevention of breast cancer,
Toremefine: PO/60 mg daily Uploaded by MEDBOOKSVN.ORG
Selective Estrogen Receptor Modulators 101
vaginal bleeding. F and E: hypercalcemia.
Hemat: leukopenia, thrombocytopenia.
Metab: hot flashes. Misc: tumor flare.
Keep in Mind
Teach client:
• Take as directed; bone pain should be reported.
• Engage in regular weight-bearing exercise.
• Report leg pain (DVT).
• May cause hot flashes or induce ovulation.
• Monitor weight weekly. Report weight gain.
Make the Connection
• Assess client for bone mineral density.
• Monitor lipid panel; hormone panel; and serum
Ca+, phosphate, total protein, and albumin.
• Monitor CBC for a decrease in platelet count.
• Discuss the Study of Tamoxifen and Raloxifene
(STAR) clinical trial, which compared these SERMs
for effectiveness in prevention and postsurgical
treatment of breast cancer.
1882_Tab05_097-108 10/10/12 12:48 PM Page 102

Musculoskeletal System Drugs Hormone 102

Calcitonin (salmon)
(kal-si-toe-nin)

Miacalcin, Fortical
1882_Tab05_097-108 10/10/12 12:48 PM Page 102
Musculoskeletal System Drugs
Therapeutic/Pharmacologic Class
Hypocalcemic agent/hormone
Indications
Treatment of Paget’s disease of bone. Adjunctive
therapy for hypercalcemia. Management of post-
menopausal osteoporosis. Treatment of hypercal-
cemia related to bone cancer.
Action
Decreases Ca+ by a direct effect on bone, kidney,
and GI tract. Promotes renal excretion of Ca+.
Routes include intranasally, IM, and SC.
Adverse Reactions/Side Effects
CNS: headaches. EENT: intranasal only—epistaxis,
nasal irritation, rhinitis. GI: nausea, vomiting,
altered taste, diarrhea. GU: urinary frequency.
Derm: rashes. Local: injection site reactions.
MS: arthralgia, back pain. Misc: allergic reactions,
including anaphylaxis, facial flushing; swelling,
tingling, and tenderness in the hands.
Uploaded
Route/Dosage: Calcitonin (rDNA): IM, SC/100
units every other day; MEDBOOKSVN.ORG
Hormone 102
Keep in Mind
Teach client:
• Take medication exactly as directed.
• Report allergy to salmon or other seafood.
• Flushing and warmth may occur (1 hr).
• Diet should be high in calcium and vitamin D.
• Alternate nares daily when using nasal spray to
avoid nosebleeds.
• Weight-bearing exercise is beneficial for treatment
of osteoporosis.
Make the Connection
• Observe client for signs of hypersensitivity.
• Assess for tetany, monitor the ECG, and check for
Chvostek’s and Trousseau’s signs.
• Monitor Ca+ levels (9–10.5 mg/dL).
• Ask the client to report nasal irritation.
byintranasal/1
spray (200 units)/day
1882_Tab05_097-108 10/10/12 12:48 PM Page 103

Musculoskeletal System Drugs Monoclonal Antibody (RANKL Inhibitor) 103

Denosumab
(de-no-su-mab)

Prolia
1882_Tab05_097-108 10/10/12 12:48 PM Page 103
Musculoskeletal System Drugs Monoclonal Antibody (RANKL Inhibitor)
Therapeutic/Pharmacologic Class
Bone resorption inhibitor/monoclonal antibody;
RANKL inhibitor
Indications
Treatment of osteoporosis in postmenopausal
women who are at high risk for fracture or those
who have failed/are intolerant of conventional
osteoporosis treatments.
Action
A monoclonal antibody that binds specifically to
the human RANKL, inhibiting its action, which is
required for formation, function, and survival of
osteoclasts. Binding inhibits osteoclast formation,
function, and survival.
Adverse Reactions/Side Effects
GI: pancreatitis. GU: cystitis. Derm: dermatitis,
eczema, rashes. F and E: hypocalcemia.
Metabolic: hypercholesterolemia. MS: back
pain, extremity pain, musculoskeletal pain,
osteonecrosis of the jaw, suppression of bone
turnover. Misc: infection.
Route/Dosage: SC/60 mg every 6 mo Uploaded by MEDBOOKSVN.ORG
103
Keep in Mind
• Notify HCP immediately of spasms, twitches, or
cramps in muscles; numbness or tingling in fin-
gers, toes, or around mouth; fever; chills; skin
that is red, swollen, hot, or tender to touch;
severe abdominal pain; frequent or urgent need
to urinate or burning during urination or skin
rashes.
• Have regular dental check-ups.
• Female clients should notify HCP if pregnancy is
planned or suspected or if breastfeeding.
Make the Connection
• Contraindicated in lactation and
hypocalcemia; caution should be used in pregnancy.
• Monitor bone density studies.
• Assess Ca+, phosphorus, and K+ levels before and
periodically during therapy. Hypocalcemia and
vitamin D deficiency should be treated before
initiating therapy. Increases risk for anemia and
↑ cholesterol.
1882_Tab05_097-108 10/10/12 12:48 PM Page 104

Musculoskeletal System Drugs Human Parathyroid Hormone (rDNA Origin) 104

Teriparitide
(ter-i-par-a-tide)

Forteo
1882_Tab05_097-108 10/10/12 12:48 PM Page 104
Musculoskeletal System Drugs Human Parathyroid Hormone (rDNA Origin)
Therapeutic/Pharmacologic Class
Hormone/human parathyroid hormone (rDNA
origin)
Indications
Treatment of osteoporosis in postmenopausal
women at high risk for fractures. Increases bone
mass in men with primary or hypogonadal osteo-
porosis at high risk for fractures. Treatment of
osteoporosis in men and women with glucocorticoid-
induced osteoporosis at high risk for fractures.
Most useful for those who have failed or are
intolerant of other osteoporosis therapies.
Action
Regulates Ca+ and phosphate metabolism in bone
and kidney by binding to specific cell receptors;
stimulates osteoblastic activity. Increases Ca+ and
decreases serum phosphorus. Overall effect is to
strengthen bones and prevent fractures.
Adverse Reactions/Side Effects
CV: orthostatic hypotension. MS: muscle
spasms.
Uploaded
Route/Dosage: SC/20 mcg once daily (multidose pen)
104
Keep in Mind
• Administer medication at the same time each day.
Administer missed doses as soon as remembered
that day. Do not take more than 1 injection/day.
Learn how to prime pen and deliver appropriate
dosage.
• Be aware of the importance of other treatments
for osteoporosis, including supplemental calcium
and/or vitamin D, weight-bearing exercise, and
modification of behavioral factors (smoking
and/or alcohol consumption). Appointments for
follow-up bone density scans and laboratory visits
must be kept.
• May be lightheaded at first. Rise slowly and sit at
edge of bed until stable to prevent falls.
• Notify HCP of nausea, vomiting, constipation,
and muscle weakness (hypercalcemia).
Make the Connection
• Contraindicated in pregnancy, lactation,
Paget’s disease, and ↑ alkaline phosphatase.
• Monitor bone density studies and for ↑ Ca+ and
↑ uric acid levels.
by MEDBOOKSVN.ORG
1882_Tab05_097-108 10/10/12 12:48 PM Page 105

Musculoskeletal System Drugs Cyclooxygenase-2 (COX-2) Inhibitor 105

Celecoxib
(sel-e-kox-ib)

Celebrex
1882_Tab05_097-108 10/10/12 12:48 PM Page 105
Musculoskeletal System Drugs Cyclooxygenase-2 (COX-2) Inhibitor
Therapeutic/Pharmacologic Class
Antirheumatic, NSAID/cyclooxygenase-2 (COX-2)
inhibitor
Indications
Relief of signs and symptoms of osteoarthritis, RA,
and ankylosing spondylitis. Reduction of the number
of adenomatous colorectal polyps in familial
adenomatous polyposis (FAP), as an adjunct to
usual care (endoscopic surveillance, surgery).
Management of acute pain, including primary
dysmenorrhea.
Action
Inhibits the enzyme COX-2, which is required for
the synthesis of prostaglandins. Has analgesic,
anti-inflammatory, and antipyretic properties.
Adverse Reactions/Side Effects
CNS: dizziness, headache, insomnia. CV: MI,
CVA, edema. GI: GI bleeding, abdominal pain,
diarrhea, dyspepsia, flatulence, nausea. Derm:
exfoliative dermatitis, Stevens-Johnson syn-
drome, toxic epidermal necrolysis, rash.
Route/Dosage: PO/100–200 mg daily Uploaded by MEDBOOKSVN.ORG
105
Keep in Mind
Teach client:
• Do not take this drug if a history of high BP or
heart failure exists.
• Do not take this drug if a history of stomach
ulcers and GI bleeding exists.
• Report a rash immediately.
• Report nausea, fatigue, lethargy, itching, jaundice,
upper right-quadrant tenderness, flu-like symptoms,
or edema.
• Watch for signs of GI bleeding (stomach pain;
black-red, tarry, odorous stools).
• Do not take this drug if an allergy to sulfonamides,
aspirin, or other NSAIDs exists.
Make the Connection
• Monitor BP and for signs of heart failure.
This drug has been implicated in the development
of MI and CVA.
• Respond to development of a rash or GI bleeding
immediately.
• Assess for effectiveness. Monitor LFT and RFT.
1882_Tab05_097-108 10/10/12 12:48 PM Page 106

Musculoskeletal System Drugs Antigout Agent 106

Colchicine
(kol-chi-seen)

Colcrys
1882_Tab05_097-108 10/10/12 12:48 PM Page 106

Musculoskeletal System Drugs Antigout Agent 106

Therapeutic/Pharmacologic Class • Report nausea, vomiting, abdominal pain, diar-
Antigout agent rhea, unusual bleeding, bruising, sore throat,
Indications fatigue, malaise, or rash promptly.
Treatment and prevention of acute attacks of gouty • Increase daily fluid intake as directed.
arthritis.
Action Make the Connection
Interferes with the functions of WBCs in initiating • Assess client for toxicity.
and perpetuating the inflammatory response to • An overdose can be fatal. Cumulative dose by
monosodium urate crystals. any route should not exceed 4 mg.
Adverse Reactions/Side Effects • During initiation of therapy, monitor for drug
GI: diarrhea, nausea, vomiting, abdominal pain. response (pain relief in affected area) every 1–2 hr.
GU: anuria, hematuria, renal damage. Derm: • Monitor I&O.
alopecia. Hemat: bone marrow suppression. • Monitor LFT, RFT, chemistries, and CBC with
Local: phlebitis at IV site. Neuro: peripheral differential.
neuritis. • Administer oral doses with food to minimize GI
irritation.
Keep in Mind • Monitor IV site carefully to avoid extravasation.
Teach client:
• Take the medication as directed.
• Do not consume alcohol and maintain dietary
restrictions.

Route/Dosage: PO/1.2 mg initially, then 0.6 mgUploaded by

1 hr later (maximum doseMEDBOOKSVN.ORG
of 1.8 mg in 1 hr)
1882_Tab05_097-108 10/10/12 12:48 PM Page 107

Musculoskeletal System Drugs Xanthine Oxidase Inhibitor 107

Allopurinol
(al-oh-pure-i-nole)

Zyloprim, Lopurin, Alloprim

Apo-Allopurinol
1882_Tab05_097-108 10/10/12 12:48 PM Page 107
Musculoskeletal System Drugs Xanthine Oxidase Inhibitor
Therapeutic/Pharmacologic Class
Antigout and antihyperuricemic agent/xanthine
oxidase inhibitor
Indications
Prevention of attacks of gouty arthritis and
nephropathy. Treatment of secondary hyper-
uricemia, which may occur during treatment of
tumors or leukemias.
Action
Inhibits the production of uric acid by inhibiting the
action of xanthine oxidase.
Adverse Reactions/Side Effects
CNS: drowsiness. GI: diarrhea, hepatitis, nausea,
vomiting. GU: renal failure. Derm: rash, urticaria.
Hemat: bone marrow suppression. Misc: hyper-
sensitivity reactions.
Keep in Mind
Teach client:
• Dietary changes must be made (alkaline ash
diet). Alcohol must be avoided to avoid gouty
attacks.
Route/Dosage: PO/100–200 mg daily Uploaded by MEDBOOKSVN.ORG
107
• Report skin rash or influenza symptoms to
the HCP immediately; this may indicate
hypersensitivity.
• Take with food to minimize GI distress.
• Increase daily fluid intake as directed.
Make the Connection
• Minimum fluid intake for persons being
treated for gout is 2500–3000 mL/day.
• Monitor for clinical signs of toxicity or hypersensi-
tivity (vomiting, diarrhea, or rash).
• Monitor the CBC with differential, RFT, LFT, and
blood glucose.
• Recent studies have shown that this medication
combined with colchicine may be more effective
at preventing gouty flare-ups.
1882_Tab05_097-108 10/10/12 12:48 PM Page 108

Musculoskeletal System Drugs Fusion Protein 108

Abatecept
(a-bat-a-sept)

Orencia
1882_Tab05_097-108 10/10/12 12:48 PM Page 108
Musculoskeletal System Drugs Fusion Protein
Therapeutic/Pharmacologic Class
Antirheumatics/fusion protein
Indications
Reduction of signs/symptoms and disease progres-
sion in moderate to severely active RA in adults
(to be used as monotherapy or in with other
DMARDs, other than TNF inhibitors).
Action
Inhibits T-cell activation (and the inflammatory
process) by binding to specific receptors.
Adverse Reactions/Side Effects
CNS: headache, dizziness. Misc: Hypersensitivity
reactions including anaphylaxis, infections,
infusion-related events.
Keep in Mind
Teach client:
• Do not receive live vaccines during, or 3 mo following,
therapy.
• Methotrexate, analgesics, NSAIDs, corticosteroids,
and salicylates may be continued during therapy.
Route/Dosage: IV/500–1000 mg monthly (by Uploaded
weight) by MEDBOOKSVN.ORG
108
• Notify HCP if upper respiratory or other infec-
tions occur. Therapy may need to be discontinued
if serious infection occurs.
Make the Connection
• Assess range of motion, degree of swelling,
and pain in affected joints before and periodically
during therapy.
• Assess for infusion-related reaction (dizziness,
headache, HTN) and signs of allergic reaction
(hypotension, urticaria, dyspnea). Infusion-related
reactions usually occur within 1 hr of start of
infusion. Keep epinephrine, an antihistamine,
and resuscitation equipment close by in case of
an anaphylactic reaction.
• Assess for latent TB with a tuberculin skin test.
Treat TB infection before starting this drug.
Screen for the presence of hepatitis, as this drug
may reactivate the illness.
• Remember: This drug decreases inflammation
and the immune response, thus monitor closely
for infection and report signs and symptoms to
HCP immediately.
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 11

CENTRAL NERVOUS SYSTEM

Tramadol, 109 Phenobarbital, 115 Lamotrigine, 125

Fentanyl Secobarbital, 115 Lacosamide, 125
(transdermal), 110 Midazolam, 116 Divalproex, 126
Oxycodone/ Zolpidem, 117 Valproate Sodium, 126
Acetaminophen, 111 Eszopiclone, 117 Valproic Acid, 126
Hydrocodone/ Ramelteon, 118 Selegiline, 127
Ibuprofen, 111 Levetiracetam, 119 Selegiline
Hydrocodone/ Gabapentin, 120 Transdermal, 127
Acetaminophen, 111 Topiramate, 120 Rasagiline, 127
Meperidine, 112 Tiagabine, 120 Ropinirole, 128
Hydromorphone, 112 Pregabalin, 120 Pramipexole, 128
Morphine, 112 Carbamazepine, 121 Amantadine, 129
Tapentadol, 112 Oxcarbazepine (carba- Bromocriptine, 130
Naloxone, 113 mazepine analogue), 121 Tolcapone, 131
Nalmefene, 113 Phenytoin, 122 Entacapone, 131
Naltrexone, 113 Fosphenytoin, 122 Carbidopa/Levodopa, 132
Propofol, 114 Primidone, 123 Benztropine, 133
Pentobarbital, 115 Ethosuximide, 124 Trihexyphenidyl, 133
Continued
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 12
Donepezil, 134
Rivastigmine, 134
Galantamine, 134
Tacrine, 134
Alprazolam, 135
Clonazepam, 135
Diazepam, 135
Lorazepam, 135
Buspirone, 136
Fluoxetine, 137
Fluvoxamine, 137
Citalopram, 137
Paroxetine, 137
Escitalopram, 137
Lithium, 138
Bupropion, 139
Venlafaxine, 140
Desvenlafaxine, 140
Uploaded by MEDBOOKSVN.ORG
CENTRAL NERVOUS SYSTEM
Duloxetine, 140 Ergotamine, 150
Desipramine, 141 Dihydroergotamine, 150
Imipramine, 141 Sibutramine, 151
Nortriptyline, 141 Methylphenidate, 152
Clomipramine, 141 Dexmethylphenidate, 152
Phenelzine, 142 Amphetamine, 153
Isocarboxazid, 142 Atomoxetine, 154
Tranylcypromine, 142 Modafinil, 155
Haloperidol, 143 Almotriptan, 156
Droperidol, 143 Rizatriptan, 156
Chlorpromazine, 144 Sumatriptan, 156
Perphenazine, 144 Naratriptan, 156
Fluphenazine, 144 Epinephrine, 157
Thiothixene, 145 Terbutaline, 158
Aripiprazole, 146 Butorphanol, 159
Risperidone, 147 St. John’s Wort
Olanzapine, 148 (Hypericum
Ziprasidone, 149 perforatum), 160
1882_Tab06_109-160 11/10/12 2:39 PM Page 109

Central Nervous System Drugs Opioids 109

Tramadol
(tra-ma-dol)

Ultram, Ultram ER, Ryzolt

Ralivia
1882_Tab06_109-160 11/10/12 2:39 PM Page 109
Central Nervous System Drugs Opioids
Therapeutic/Pharmacologic Class
Centrally acting analgesic/opioid
Indications
Treatment of moderate to moderately severe pain.
Action
Binds to mu-opioid receptors, but has low affinity.
Inhibits reuptake of serotonin and norepinephrine
in the CNS, which decreases stimulation of
nociceptors.
Adverse Reactions/Side Effects
CNS: seizures, serotonin sickness, dizziness,
headache, somnolence, anxiety, CNS stimula-
tion, confusion, coordination disturbance,
euphoria, malaise, nervousness, sleep disorder,
weakness. EENT: visual disturbances. CV:
vasodilation. GI: constipation, nausea,
abdominal pain, anorexia, diarrhea, dry
mouth, dyspepsia, flatulence, vomiting. GU:
menopausal symptoms, urinary retention/
frequency. Derm: pruritus, sweating. Neuro:
hypertonia. Misc: physical dependence,
psychological dependence, tolerance.
Route/Dosage: PO/50–100 mg q 4–6 hr Uploaded by MEDBOOKSVN.ORG
109
Keep in Mind
Teach client:
• Ask for pain medication before the pain becomes
severe.
• This drug may cause dizziness and drowsiness.
• Change position slowly from lying to sitting or
standing.
• Avoid concurrent use of alcohol or other CNS
depressants with this medication.
• Report use of antidepressant medications.
Make the Connection
• Assess pain relief objectively.
• Assess for BP and respiratory rate changes.
• Assess bowel function routinely (constipation).
• Monitor client for seizures. Risk ↑ with higher
doses.
• Monitor LFT, RFT, CBC for hemoglobin level, and
urinalysis for proteinuria.
• Medication causes↑ risk of serotonin syndrome
when used with SSRI or SNRI antidepressants,
TCAs, MAOIs, or 5-hydroxytryptamine1 agonists.
1882_Tab06_109-160 11/10/12 2:39 PM Page 110

Central Nervous System Drugs Opioid Agonist 110

Fentanyl
(transdermal)
(fen-ta-nil)

Duragesic
1882_Tab06_109-160 11/10/12 2:39 PM Page 110
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Opioid analgesic; analgesic adjunct/opioid agonists
Indications
Treatment of moderate-to-severe chronic pain
requiring continuous opioid analgesic therapy for
an extended time. This transdermal analgesic is
not recommended for the control of postoperative,
mild, or intermittent pain, nor should it be used for
short-term pain relief.
Action
Binds to opiate receptors in the CNS, altering the
response to and perception of pain.
Adverse Reactions/Side Effects
CNS: confusion, sedation, weakness, dizziness,
restlessness. Resp: apnea, bronchoconstriction,
laryngospasm, respiratory depression. CV: brady-
cardia. GI: anorexia, constipation, dry mouth,
nausea, vomiting. Derm: sweating, erythema.
Local: application site reactions. MS: skeletal
and thoracic muscle rigidity. Misc: physical
dependence, psychological dependence.
Route/Dosage: Transdermal system/12.5–100Uploaded
mcg/hr (calculate need MEDBOOKSVN.ORG
Opioid Agonist 110
Keep in Mind
Teach client:
• Fatalities have occurred from children having
access to improperly discarded patches.
• May be worn while bathing, showering, or swimming.
• May cause drowsiness or dizziness.
• Change positions slowly to minimize dizziness.
• Avoid concurrent use of alcohol or other CNS
depressants with this medication.
• Good oral hygiene and use of sugarless gum or
candy may decrease dry mouth.
Make the Connection
• Objectively assess pain and record client
response.
• Assess bowel function routinely for constipation.
• Monitor plasma amylase and lipase levels.
• Naloxone (Narcan) is the antidote.
• Discontinue gradually.
• Apply to nonhairy areas. Change after 72 hours.
• Full effectiveness takes several hours as system
begins to release the medication, thus current pain
medications should be titrated down accordingly.
by based
on equianalgesic guidelines if on morphine)
1882_Tab06_109-160 11/10/12 2:39 PM Page 111

Central Nervous System Drugs Opioid Agonists and Nonopioid

Analgesic Combinations 111

Oxycodone/ Hydrocodone/
Acetaminophen Acetaminophen
(ox-i-koe-done/ (hye-droe-koe-done/
a seet-a-min-oh-fen) a-seet-a-min-oh-fen)

Percocet, Tylox, Lorcet, Lortab,

Endocet, Roxycet, Vicodin, Anexsia
Magnacet

Hydrocodone/Ibuprofen
(hye-droe-koe-done/eye-byoo-proe-fin)

Vicoprofen, Reprexain, Ibudone

1882_Tab06_109-160 11/10/12 2:39 PM Page 111

Central Nervous System Drugs Opioid Agonists and Nonopioid

Analgesic Combinations 111
Therapeutic/Pharmacologic Class Keep in Mind
Opioid analgesic/opioid agonists and nonopioid Teach client:
combinations • Take as directed.
Indications • Addition of acetaminophen increases the risk of
Management of moderate-to-severe pain. liver and renal damage.
Action • Ask for analgesic before pain becomes severe, to
Binds to opiate receptors in the CNS. Alters the abort excessive discomfort.
perception of and response to painful stimuli, while • The medication may cause drowsiness or dizziness.
producing generalized CNS depression. • Change positions slowly to minimize dizziness.
Adverse Reactions/Side Effects • Avoid concurrent use of alcohol or other CNS
depressants with this medication.
CNS: confusion, sedation, dysphoria, euphoria,
floating feeling, hallucinations, headache, unusual • Use good oral hygiene and sugarless gum or
candy to decrease dry mouth.
dreams. EENT: blurred vision, diplopia, miosis.
Resp: respiratory depression. CV: hypotension, • Report constipation.
bradycardia. GI: constipation, nausea, vomiting.
GU: urinary retention. Derm: sweating. Misc: Make the Connection
physical dependence, psychological dependence, • Pain level should be assessed objectively.
tolerance. • Monitor plasma amylase and lipase concentrations.
• Naloxone (Narcan) is the antidote.
• Discontinue gradually after long-term use.
• Administer with food or milk to minimize GI
irritation.
Route/Dosage: Oxycodone/acetaminophen: PO/2.5–10 mg oxycodone in combination with 325–650 mg acetaminophen, Hydrocodone/
acetaminophen: PO/2.5–10 mg hydrocodone in combination with 325–750 mg acetaminophen, Hydrocodone/ibuprofen: PO/2.5–10 mg
Uploaded by MEDBOOKSVN.ORG
hydrocodone in combination with 200 mg ibuprofen
1882_Tab06_109-160 11/10/12 2:39 PM Page 112

Central Nervous System Drugs Opioid Agonists 112

Meperidine Morphine
(me-per-i-deen) (mor-feen)

Demerol Astramorph, MS
Contin, Kadian,
Avinza, Duramorph
Morphine H.P.,
Epimorph

Hydromorphone Tapentadol
(hye-droe-mor-fone) (ta-pen-ta-dol)

Dilaudid, Dilaudid-HP, Nucynta

Exalgo, Hydrostat IR
PMS Hydromorphone
1882_Tab06_109-160 11/10/12 2:39 PM Page 112
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Opioid analgesic/Opioid agonists
Indications
Treatment of moderate or severe pain (alone or with
nonopioid agents).
Action
Binds to opiate receptors in the CNS. Alters the
perception of and response to painful stimuli, while
producing generalized CNS depression.
Adverse Reactions/Side Effects
CNS: seizures, confusion, sedation, dysphoria,
euphoria, floating feeling, hallucinations,
headache, unusual dreams. EENT: blurred vision,
diplopia, miosis. Resp: respiratory depression.
CV: hypotension, bradycardia. GI: constipation,
nausea, vomiting. GU: urinary retention. Derm:
flushing, sweating. Misc: physical dependence,
psychological dependence, tolerance.
Route/Dosage: Meperidine: PO, SC, IM/50–100 mg q 3–4 hr, Morphine: PO, Rect/30 mg q 3–4 hr; IM, IV, SC/4–10 mg q 3–4 hr; SR/total day’s
dose q 12 hr; epidural/5 mg/day, Hydromorphone: PO/4–8 mg q 3–4 hr; IV, SC, IM/1.5–2 mg q 3–4 hr; continuous infusion/0.2–30 mg/hr; Rect/
3 mg q 6–8 hr, Tapentadol: PO/50–100 mg q Uploaded
4–6 hr
Opioid Agonists 112
Keep in Mind
Teach client:
• Take as directed. Medication is more effective if
taken before the pain is severe.
• May cause drowsiness or dizziness.
• Change positions slowly to minimize dizziness.
• Avoid concurrent use of alcohol or other CNS
depressants to minimize risk of respiratory
depression.
• Report constipation.
Make the Connection
• Use a pain scale to objectively assess pain.
• Monitor plasma amylase and lipase concentrations.
• Naloxone (Narcan) is the antidote.
• Discontinue gradually after long-term use to
prevent withdrawal symptoms.
• For direct IV administration, always dilute and
administer over 5 min after checking dose
calculation with second practitioner.
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:39 PM Page 113

Central Nervous System Drugs Opioid Antagonists 113

Naloxone Naltrexone
(nal-ox-one) (nal-treks-one)

Narcan Vivitrol (injection),

ReVia (oral)

Nalmefene
(nal-me-feen)

Revex
1882_Tab06_109-160 11/10/12 2:39 PM Page 113

Central Nervous System Drugs Opioid Antagonists 113

Therapeutic/Pharmacologic Class
Antidote (for opioids)/opioid antagonists
Indications
Reversal of CNS depression and respiratory depres-
sion because of suspected opioid overdosage and
alcohol abuse. Unlabeled uses: Narcotic-induced
pruritus (low-dose IV infusion).
Action
Competitively blocks the effects of opioids, including
CNS and respiratory depression, without producing
any agonist (opioid-like) effects.
Adverse Reactions/Side Effects
CV: HTN, hypotension, ventricular fibrillation,
VT. GI: nausea, vomiting.
Keep in Mind
Teach client:
• The purpose and effects of these drugs are to
decrease fear of physical symptoms of withdrawal.
• Wear a Medic-Alert bracelet if receiving opioids
for chronic pain.
Make the Connection
• Monitor respiratory rate, rhythm, and
depth; pulse; ECG; BP; and level of consciousness
frequently for 3–4 hr after administration.
• If used to treat postoperative respiratory depres-
sion, assess effectiveness, but also remember that
these medications reverse the effects of analgesia.
• Assess pain using a pain scale.
• Assess client for signs and symptoms of opioid or
alcohol withdrawal. Symptoms may occur from
within a few minutes to 2 hr.
• Excessive dose in postoperative patients may
cause excitement, pain, hypotension, HTN,
pulmonary edema, ventricular tachycardia and
fibrillation, and seizures.

Route/Dosage: Naloxone: IV/0.02–2 mg q 2–3 min, or as a continuous infusion, until desired response obtained, Naltrexone: PO/50 mg daily after a
Uploaded
negative naloxone challenge and 7–10 days of opioid bymg/mo;
abstinence; IM/380 MEDBOOKSVN.ORG
alcohol dependence: PO/50 mg daily, Nalmefene: IV/0.25–1 mcg/kg
1882_Tab06_109-160 11/10/12 2:39 PM Page 114

Central Nervous System Drugs General Anesthetic 114

Propofol
(proe-poe-fol)

Diprivan
1882_Tab06_109-160 11/10/12 2:39 PM Page 114
Central Nervous System Drugs General Anesthetic
Therapeutic/Pharmacologic Class
General anesthetic
Indications
Induction of general anesthesia in children older than
3 yr and adults. Maintenance of balanced anesthesia
when used with other agents in children older than
2 mo and adults. Initiation and maintenance of mon-
itored anesthesia care (MAC). Sedation of intubated,
mechanically ventilated clients in intensive care units.
Action
Short- and rapid-acting (40 sec) sedative-hypnotic.
Mechanism of action is unknown, but because it
is highly lipophilic, it has affinity for CNS tissue.
Produces amnesia, but has no analgesic properties.
Adverse Reactions/Side Effects
CNS: dizziness, headache. Resp: apnea, cough.
CV: bradycardia, hypotension, hypertension. GI:
abdominal cramping, hiccups, nausea, vomiting.
Derm: flushing. Local: burning, pain, stinging,
coldness, numbness, tingling at IV site. MS:
involuntary muscle movements, perioperative
myoclonia. GU: discoloration of urine (green).
Misc: fever.
Route/Dosage: IV/2–2.5 mg/kg for induction; Uploaded
100–200 mcg/kg/min
114
Keep in Mind
Teach client:
• This medication decreases or eliminates mental
recall of the procedure.
• May cause drowsiness or dizziness. Ability to be alert
may be affected for 24 hr following administration.
• Avoid alcohol or other CNS depressants for 24 hr
following administration.
• The medication will sting and burn when administered.
Make the Connection
• Assess respiratory status, pulse, and
BP continuously throughout therapy. Frequently
causes apnea. Maintain patent airway, apply
nasal cannula, and maintain adequate ventilation.
Endotracheal intubation tray and resuscitation
equipment should be readily available.
• Be certain client has maintained NPO status prior
to the procedure.
• May be administered as an intermittent or
continuous infusion for clients on mechanical
ventilation.
by
MEDBOOKSVN.ORG
for maintenance
1882_Tab06_109-160 11/10/12 2:39 PM Page 115

Central Nervous System Drugs Barbiturates 115

Pentobarbital Secobarbital
(pen-toe-bar-bi-tal) (see-koe-bar-bi-tal)

Nembutal Seconal
Novopentobarb Novosecobarb

Phenobarbital
(fee-noe-bar-bi-tal)

Luminal, Solfoton
Ancalixir
1882_Tab06_109-160 11/10/12 2:39 PM Page 115

Central Nervous System Drugs Barbiturates 115

Therapeutic/Pharmacologic Class Derm: rashes, urticaria. Local: phlebitis at
Anticonvulsant; sedative-hypnotic/barbiturates IV site. MS: arthralgia, myalgia, neuralgia.
Indications Misc: hypersensitivity reactions including
Treatment of insomnia (short term). Preoperative angioedema and serum sickness, physical
sedation and induction of coma in clients with dependence, psychological dependence.
cerebral ischemia and ICP. Treatment of seizures.
Keep in Mind
Action Teach client:
Depresses the CNS, probably by potentiating • Do not discontinue medication abruptly.
GABA, an inhibitory neurotransmitter. Produces all • This medication may cause daytime
levels of CNS depression, including the sensory cor- drowsiness.
tex and motor activity, as well as altered cerebellar • Avoid taking alcohol or other CNS depressants
function. Anticonvulsant effect due to decreased concurrently with this medication.
synaptic transmission and increased seizure threshold.
May decrease cerebral blood flow, cerebral edema,
and intracranial pressure (IV only). Make the Connection
Adverse Reactions/Side Effects • Monitor respiratory status, pulse, and
CNS: drowsiness, hangover, lethargy, delirium, BP frequently.
excitation, mental depression, vertigo. Resp: • Monitor CBC with differential, and LFT and RFT
respiratory depression; IV—laryngospasm, if on long-term therapy.
bronchospasm. CV: IV—hypotension. GI: • May increase need for adjustment of dosage for
constipation, diarrhea, nausea, vomiting. other meds (↑ liver enzymes).

Route/Dosage: Pentobarbital: PO/20 mg 3–4 times daily for sedation; IM/150–200 mg as hypnotic/preoperative sedative; IV/100–500 mg as an
anticonvulsant; IV/5–7 mg/kg for induction of coma, Secobarbital: PO/100–300 mg for sedation or sleep; Phenobarbital: IV/15–18 mg/kg for status
Uploaded by MEDBOOKSVN.ORG
epilepticus; IV, PO/1–3 mg/kg/day for maintenance
1882_Tab06_109-160 11/10/12 2:39 PM Page 116

Central Nervous System Drugs Benzodiazepine 116

Midazolam
(mid-ay-zoe-lam)

Versed
1882_Tab06_109-160 11/10/12 2:39 PM Page 116
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Antianxiety agent; sedative-hypnotic/benzodiazepines
Indications
Promotion of presurgical sedation and anxiolysis in
pediatric clients (oral). Promotion of presurgical
sedation/anxiolysis/amnesia in adult clients (IM or IV).
Commonly used for conscious sedation. Aids in the
induction of anesthesia and as part of balanced anes-
thesia. Provision of sedation of mechanically ventilated
clients in a critical care setting (continuous infusion).
Action
Acts at many levels of the CNS to produce general-
ized CNS depression. Effects may be mediated by
GABA, an inhibitory neurotransmitter.
Adverse Reactions/Side Effects
CNS: agitation, drowsiness, excess sedation,
headache. EENT: blurred vision. Resp: apnea,
laryngospasm, respiratory depression, bron-
chospasm, coughing. CV: cardiac arrest, arrhyth-
mias. GI: hiccups, nausea, vomiting. Derm:
rashes. Local: phlebitis at IV site, pain at IM site.
Uploaded
Route/Dosage: IM/5 mg prior to surgery; IV/1–2.5
mg initially, increased as needed up to 5 mg, for conscious sedation
Benzodiazepine 116
Keep in Mind
Teach client:
• This medication decreases mental recall of the
procedure.
• Drowsiness or dizziness may be experienced for
24 hr after administration.
• Arrange for someone to provide transportation
home from the procedure.
• Avoid alcohol or other CNS depressants for 24 hr
following administration.
Make the Connection
• Assess level of sedation and level of
consciousness throughout and for 2–6 hr following
administration.
• Monitor BP, pulse, respiration, and arterial blood
gas continuously during IV administration. Oxygen
should be given by nasal cannula. Resuscitative
equipment should be immediately available. Two
practitioners should check dose calculations.
• The antidote is flumazenil (Romazicon).
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:39 PM Page 117

Central Nervous System Drugs Hypnotics 117

Zolpidem
(zole-pi-dem)

Ambien, Ambien CR, Edluar,

Zolpimist, Intermezzo

Eszopiclone
(es-zop-i-klone)

Lunesta
1882_Tab06_109-160 11/10/12 2:40 PM Page 117

Central Nervous System Drugs Hypnotics 117

Therapeutic/Pharmacologic Class • Avoid concurrent use of alcohol or other CNS
Hypnotic/cyclopyrrolones (eszopiclone only) depressants.
Indications • A bitter taste sensation that may or may not be
Treatment of insomnia. transient may be experienced.
Action • Report any episodes of sleepwalking while on this
medication immediately to the HCP.
Produces CNS depression by binding to GABA
receptors. Possesses no analgesic properties.
Adverse Reactions/Side Effects Make the Connection
CNS: amnesia, daytime drowsiness, dizziness, • Prolonged use of up to 7–10 days may
“drugged” feeling. GI: diarrhea, nausea, vomit- lead to physical and psychological dependence.
ing. Misc: hypersensitivity reactions, physical • Older clients require half the regular dose.
dependence, psychological dependence, tolerance. • Sleepwalking, sleep-eating, and sleep-driving
have been reported under the influence of this
Keep in Mind medication.
Teach client: • Discuss a therapeutic sleep regimen with
• Take as directed. client. Discuss how to protect client from
• Go to bed immediately after taking the medica- injury. Remember: GABA is an inhibitory
tion, as it has a rapid onset. neurotransmitter.
• May cause daytime drowsiness or dizziness. • Tablets should be swallowed whole.

Route/Dosage: Zolpidem: PO, SL/10 mg at bedtime, 12.5 mg ER tab; SL/1.75 mg (women) or 3.5 mg (men) within 4 hr of middle-of-the-night awaken-
Uploaded
ing (Intermezzo), Eszopiclone: PO/2–3 mg immediately by MEDBOOKSVN.ORG
before bedtime
1882_Tab06_109-160 11/10/12 2:40 PM Page 118

Central Nervous System Drugs Melatonin Receptor Agonist 118

Ramelteon
(ram-ell-tee-on)

Rozerem
1882_Tab06_109-160 11/10/12 2:40 PM Page 118

Central Nervous System Drugs Melatonin Receptor Agonist 118

Therapeutic/Pharmacologic Class
Sedative-hypnotic/melatonin receptor agonists Make the Connection
Indications • Monitor sleep patterns and occurrence
Treatment of insomnia. of somnolence.
Action • Maintain a safe care environment. Place the client
in a monitored room, make certain the side rails
Binds to melatonin 1 and 2 receptors in suprachias- are up (top), keep call light in reach, and keep
matic nucleus, promoting sleep. the room clear of obstructions.
Adverse Reactions/Side Effects • Monitor serum testosterone and prolactin levels.
CNS: somnolence, fatigue. Endo: decreased • Administer medication at least 2 hr after the last
testosterone and cortisol levels, increased pro- evening meal.
lactin levels. Misc: anaphylaxis, angioedema. • Discuss natural sleep patterns, exercise, diet, and
sleep hygiene with the client.
Keep in Mind
Teach client:
• Sleepwalking must be reported immediately.
• Fatigue or dizziness may be experienced; avoid
activities that require alertness.
• Report unexplained amenorrhea, decreased
libido, or fertility issues.
• Avoid becoming pregnant.
• Avoid breastfeeding.
• Follow a sleep hygiene regimen.
Uploaded
Route/Dosage: PO/8 mg within 30 min of going to bed by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 119

Central Nervous System Drugs Pyrrolidines 119

Levetiracetam
(le-ve-teer-a-se-tam)

Keppra, Keppra XR
1882_Tab06_109-160 11/10/12 2:40 PM Page 119
Central Nervous System Drugs Pyrrolidines
Therapeutic/Pharmacologic Class
Anticonvulsant/Pyrrolidines
Indications
Treatment of partial-onset seizures (adjunct).
Action
Appears to inhibit burst firing without affecting
normal neuronal excitability and may selectively
prevent hypersynchronization of epileptiform burst
firing and propagation of seizure activity. In many
sources, the exact action of these medications is
unknown.
Adverse Reactions/Side Effects
CNS: dizziness, fatigue/somnolence, weakness,
behavioral abnormalities, depression. Neuro:
coordination difficulties (adults only). GI:
nausea. Resp: rhinitis. Derm: photosensitivity.
Keep in Mind
Teach client:
• Take medication as directed.
• Follow instructions for proper use of a calibrated
measuring device for accurate child dosing.
Route/Dosage: PO, IV/500–1000 mg bid; ER, Uploaded
1000 mg/day
119
• Do not discontinue abruptly.
• May cause dizziness and somnolence.
• Avoid driving until physician gives clearance
based on control of seizure disorder.
• Notify HCP if pregnancy is planned or suspected.
• Wear a Medic-Alert bracelet.
Make the Connection
• Assess and record location, duration,
and characteristics of seizure activity.
• Assess client for CNS adverse effects throughout
therapy.
• Monitor CBC with differential and LFT for
abnormalities.
• Place on seizure precautions.
• Give information on the ketogenic diet, which
seems to have a positive effect on seizure control.
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 120

Central Nervous System Drugs Anticonvulsants 120

Gabapentin Tiagabine
(ga-ba-pen-tin) (tye-a-ga-been)

Gralise, Neurontin Gabitril

Topiramate Pregabalin
(tope-ear-a-mate) (pre-gab-a-lin)

Topamax Lyrica
1882_Tab06_109-160 11/10/12 2:40 PM Page 120
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Anticonvulsants
Indications
Adjunctive treatment of partial seizures. Some are used
for mood stabilization and adjunctive analgesia (diabetic
neuropathy, postherpetic neuralgia, and fibromyalgia).
Action
Involved in enhancing the activity of GABA, an
inhibitory neurotransmitter. May cause blockage of
Na channels in neurons. Most drugs in this class
have unknown actions.
Adverse Reactions/Side Effects
CNS: dizziness, drowsiness, nervousness, weak-
ness, cognitive impairment, confusion, difficulty
concentrating (especially in children), hallucina-
tions, headache, mental depression, personality
disorder. EENT: abnormal vision, tinnitus. Resp:
dyspnea, epistaxis. CV: chest pain, edema,
HTN, palpitations, syncope, tachycardia. GI:
abdominal pain, gingivitis, nausea, stomatitis,
weight changes. Derm: alopecia, dry skin, rash,
sweating. MS: arthralgia, neck pain. Neuro:
Route/Dosage: Gabapentin: PO/900–1800 mg/day in 3 divided doses, Tiagabine: PO/4–8 mg/day, up to 56 mg/day in 2–4 divided doses,
Uploaded
Topiramate: PO/50–400 mg/day in divided doses,
Pregabalin: PO/50–150 mg bid
Anticonvulsants 120
ataxia, tremors. Misc: allergic reactions, chills,
lymphadenopathy.
Keep in Mind
Teach client:
• Take medication as directed.
• Do not discontinue abruptly (↑ seizure activity).
• Notify HCP immediately if frequency of seizures
increases.
• May cause dizziness. Do not resume driving until
physician gives clearance based on control of
seizure disorder.
• Wear a Medic-Alert bracelet.
Make the Connection
• Assess and record location, duration,
and characteristics of seizure activity.
• Assess mental status.
• Therapeutic serum levels have not been determined.
• Administer with food if nausea occurs.
• Always discontinue anticonvulsants gradually to
avoid recurrence or worsening of seizure activity.
• Give information on ketogenic diet.
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 121

Central Nervous System Drugs Anticonvulsants 121

Carbamazepine
(kar-ba-maz-e-peen)

Tegretol, Tegretol XR, Teril,

Epitol, Carbatrol
Apo-Carbamazepine

Oxcarbazepine
(carbamazepine analogue)
(ox-kar-baz-e-peen)

Trileptal
1882_Tab06_109-160 11/10/12 2:40 PM Page 121
Central Nervous System Drugs Anticonvulsants
Therapeutic/Pharmacologic Class
Anticonvulsant
Indications
Monotherapy or adjunctive therapy of tonic-clonic,
mixed, and complex partial seizures in adults with
epilepsy. Adjunctive therapy of partial seizures in
clients 4–16 yr old with epilepsy.
Action
Blocks sodium channels in neural membranes,
stabilizing hyperexcitable states, inhibiting repetitive
neuronal firing, and decreasing propagation of
synaptic impulses.
Adverse Reactions/Side Effects
CNS: dizziness/vertigo, drowsiness/fatigue,
headache, cognitive symptoms. EENT: abnormal
vision, diplopia, nystagmus. GI: abdominal pain,
dyspepsia, nausea, vomiting, thirst. CV: heart
failure. Derm: acne, rash, urticaria. F and E:
hyponatremia. Neuro: ataxia, gait disturbances,
tremor. Misc: allergic reactions; hypersensitivity
reactions, including Stevens-Johnson syndrome
and multiorgan reactions; lymphadenopathy.
Uploaded
Route/Dosage: Carbamazepine: PO/600–1200/day
in divided doses, MEDBOOKSVN.ORG
121
Keep in Mind
Teach client:
• Take as directed. Do not discontinue abruptly.
• May cause dizziness, drowsiness, or CNS changes.
Do not resume driving until physician gives clear-
ance based on control of seizure disorder.
• Do not take alcohol or other CNS depressants
concurrently with this medication.
• Wear a Medic-Alert bracelet.
• Report dyspnea, bruising, edema in dependent
areas, or frequent infections.
Make the Connection
• Assess and record frequency, location,
duration, and characteristics of seizure activity.
• Monitor client for CNS changes.
• Monitor ECG and serum electrolytes before and peri-
odically during therapy. May cause hyponatremia.
• Auscultate lungs for crackles and assess for
dependent edema (CHF).
• Implement seizure precautions as indicated.
• Give client information about ketogenic diet.
byOxcarbazepine:
PO/300–1200 mg/day
1882_Tab06_109-160 11/10/12 2:40 PM Page 122

Central Nervous System Drugs Hydantoins 122

Phenytoin
(fen-i-toyn)

Dilantin, Phenytek

Fosphenytoin
(fos-fen-i-toyn)

Cerebyx
1882_Tab06_109-160 11/10/12 2:40 PM Page 122
Central Nervous System Drugs Hydantoins
Therapeutic/Pharmacologic Class
Anticonvulsant/hydantoin
Indications
Treatment and prevention of tonic-clonic seizures
and complex partial seizures.
Action
Limits seizure propagation by altering ion transport.
May also decrease synaptic transmission. Fosphenytoin
is rapidly converted to phenytoin in the body.
Adverse Reactions/Side Effects
CNS: ataxia, agitation, cerebral edema, coma,
dizziness, drowsiness, dysarthria, dyskinesia,
extrapyramidal syndrome, headache, nervousness,
weakness. EENT: diplopia, nystagmus, tinnitus.
CV: hypotension, tachycardia, vasodilation.
GI: gingival hyperplasia, nausea, altered taste,
anorexia, constipation, drug-induced hepatitis,
dry mouth, vomiting, weight loss. GU: pink,
red, reddish-brown coloration of urine. Derm:
hirsutism, exfoliative dermatitis, pruritus. F and E:
hypocalcemia. Hemat: BMS. MS: allergic
Route/Dosage: Phenytoin: PO/200–1200 mg/day; IV/15–20 mg/kg for status epilepticus, Fosphenytoin: (phenytoin sodium equivalents [PE])
IV/15–20 mg PE/kg Uploaded by MEDBOOKSVN.ORG
122
reactions, including Stevens-Johnson syndrome;
fever; lymphadenopathy.
Keep in Mind
Teach client:
• Take as directed; may cause drowsiness.
• Do not drive until physician has given clearance
based on seizure control; wear a Medic-Alert
bracelet.
• Avoid alcohol or other CNS depressants.
• Side effects such as urine discoloration and
unwanted hair growth may occur.
• Flossing and brushing carefully are recommended.
• Maintain a well-balanced diet.
Make the Connection
• Monitor ECG, CBC with differential,
serum drug level (10–20 mcg/mL), and LFT.
• Assess for skin rash, which may progress to
severe exfoliative dermatitis.
• Assess for hypersensitivity syndrome.
1882_Tab06_109-160 11/10/12 2:40 PM Page 123

Central Nervous System Drugs Anticonvulsants 123

Primidone
(pri-mi-done)

Mysoline
Apo-Primidone
1882_Tab06_109-160 11/10/12 2:40 PM Page 123
Central Nervous System Drugs Anticonvulsants
Therapeutic/Pharmacologic Class
Anticonvulsant
Indications
Management of tonic-clonic, complex partial, and
focal seizures.
Action
Decreases neuronal excitability. Increases the threshold
of electric stimulation of the motor cortex.
Adverse Reactions/Side Effects
CNS: ataxia, drowsiness, vertigo, excitement
(increased in children). EENT: visual changes.
Resp: dyspnea. CV: edema, orthostatic hypoten-
sion. GI: anorexia, drug-induced hepatitis,
nausea, vomiting. Derm: alopecia, rash. Hemat:
blood dyscrasias, megaloblastic anemia. Misc:
folic acid deficiency.
Keep in Mind
Teach client:
• Take the medication at the same time each day
exactly as directed. Abrupt withdrawal may lead
to status epilepticus.
Route/Dosage: PO/250 mg 3–4 times/day Uploaded by MEDBOOKSVN.ORG
123
• May cause drowsiness or dizziness. Do not
resume driving until physician gives medical
clearance based on control of seizure disorder.
• Avoid taking alcohol or other CNS depressants
concurrently with this medication.
• Avoid sudden changes in position to decrease
dizziness.
• Wear a Medic-Alert bracelet.
• Notify HCP if skin rash, unsteady gait, joint pain,
fever, changes in vision, dyspnea, pregnancy, or
paradoxical excitement occurs.
• Routine examinations and laboratory tests will be
required.
• Eat green, leafy vegetables to ensure the diet
contains adequate folic acid.
Make the Connection
• Assess and record location, duration,
frequency, and characteristics of seizure activity.
Institute and document seizure precautions.
• Assess client for signs of folic acid deficiency.
• Monitor CBC with differential and blood
chemistries.
1882_Tab06_109-160 11/10/12 2:40 PM Page 124

Central Nervous System Drugs Anticonvulsants 124

Ethosuximide
(eth-oh-sux-i-mide)

Zarontin
1882_Tab06_109-160 11/10/12 2:40 PM Page 124

Central Nervous System Drugs Anticonvulsants 124

Therapeutic/Pharmacologic Class Keep in Mind
Anticonvulsant Teach client:
Indications • Take the medication exactly as directed. Sudden
Treatment of absence seizures (petit mal). withdrawal may precipitate seizures.
Action • Avoid activities requiring alertness.
Elevates the seizure threshold. Suppresses abnormal • Notify HCP if skin rash, joint pain, sore throat,
wave and spike activity associated with absence fever, unusual bleeding or bruising, swollen
(petit mal) seizures. glands, pink/brown urine, or pregnancy occurs.
Adverse Reactions/Side Effects • Wear a Medic-Alert bracelet.
CNS: increased frequency of tonic-clonic • Laboratory tests and follow-up examinations will
be required.
seizures, ataxia, dizziness, drowsiness,
euphoria, fatigue, headache, hyperactivity,
irritability, psychiatric disturbances. EENT: Make the Connection
myopia. GI: abdominal pain, anorexia,
cramping, diarrhea, nausea, vomiting, weight
• Assess and record location, duration,
frequency, and characteristics of seizure activity.
loss, hiccups. GU: pink/brown discoloration
of urine, vaginal bleeding. Derm: Stevens-
• Monitor CBC with differential, hepatic function
tests, and urinalysis routinely, and drug levels
Johnson syndrome, hirsutism, rashes, urticaria. throughout the course of prolonged therapy.
Hemat: BMS. Neuro: ataxia. Misc: systemic
lupus erythematosus.
• Measure liquid preparations with calibrated
measuring device to ensure accurate dosage.
• Administer with food or milk to minimize GI
irritation.
• This drug is one of two drugs of choice for
Uploaded
Route/Dosage: PO/20–40 mg/kg/day in 2 divided doses absence seizures.
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 125

Central Nervous System Drugs Anticonvulsants 125

Lamotrigine
(la-moe-tri-jeen)

Lamictal, Lamictal XR

Lacosamide
(la-kose-a-mide)

Vimpat
1882_Tab06_109-160 11/10/12 2:40 PM Page 125
Central Nervous System Drugs Anticonvulsants
Therapeutic/Pharmacologic Class
Anticonvulsants
Indications
Adjunct treatment of partial seizures in adults
and children with epilepsy; treatment of Lennox-
Gastaut syndrome; adjunct treatment of primary
generalized tonic-clonic seizures in adults and
children.
Action
Stabilizes neuronal membranes by inhibiting Na
transport. Lacosamide may also bind to collapsin-
response mediator protein-2 (CRMP-2), which is
involved in neural differentiation and growth.
Adverse/Side Effects
CNS: Aseptic meningitis, suicidal thoughts,
ataxia, dizziness, headache, behavior changes,
depression, drowsiness, insomnia, tremor. EENT:
blurred vision, double vision, rhinitis. GI: nausea,
vomiting. GU: vaginitis. Derm: photosensitivity,
rash (higher incidence in children, patients taking
valproic acid, high initial doses, or rapid dose
increases). MS: arthralgia. Misc: Stevens-Johnson
syndrome.
Uploaded
Route/Dosage: PO/300–500 mg/day in 2 divided doses by MEDBOOKSVN.ORG
125
Keep in Mind
Teach client:
• Take medication as ordered, regularly. Do not
discontinue the medication abruptly, as this may
cause increased seizure activity.
• Notify HCP immediately if a skin rash, fever, or
swollen lymph glands occur, or if seizure incidence
increases.
• Wear sunscreen and protective clothing to prevent
photosensitivity reactions.
• Wear a Medic-Alert bracelet.
• Report any signs of depression, suicidal
thoughts, being angry or violent, trouble
sleeping, somnolence, or anxiety.
Make the Connection
• Monitor for suicidal ideation.
• Assess for skin rash frequently, especially in the
initial 2–8 wk of therapy.
• Monitor for therapeutic plasma range (proposed
to be 1–5 mcg/mL).
1882_Tab06_109-160 11/10/12 2:40 PM Page 126

Central Nervous System Drugs Anticonvulsants 126

Divalproex Valproic Acid

(dye-val-proe-ex) (val-proe-ik as-id)

Depakote, Depakene, Stavzor

Depakote ER Apo-Valproic
Epival

Valproate Sodium
(val-proe-ate soe-dee-um)

Depacon
1882_Tab06_109-160 11/10/12 2:40 PM Page 126
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Anticonvulsant
Indications
Treatment of simple and complex absence seizures
and partial seizures with complex symptomatology,
treatment of manic episodes associated with bipolar
disorder, and treatment of migraine headache.
Action
Increase levels of GABA, an inhibitory neurotrans-
mitter for the CNS.
Adverse Reactions/Side Effects
CNS: confusion, dizziness, headache, sedation.
EENT: visual disturbances. GI: hepatotoxicity,
indigestion, diarrhea, hypersalivation, increased
appetite, pancreatitis. Derm: rashes. Hemat:
BMS. Metab: increase in serum ammonia levels.
Neuro: ataxia, paresthesia.
Route/Dosage: Divalproex: PO/10–60 mg/kg/day, Valproic acid: PO/10–60 mg/kg/day (valproic acid ER [Stavzor]: 15–60 mg/kg/day), Valproate
sodium: IV/10–60 mg/kg/day Uploaded by MEDBOOKSVN.ORG
Anticonvulsants 126
Keep in Mind
Teach client:
• Take the medication at the same time each day
exactly as directed. Abrupt withdrawal may lead
to status epilepticus.
• May cause drowsiness or dizziness. Do not
resume driving until physician gives medical clear-
ance based on control of seizure disorder.
• Avoid taking alcohol or other CNS depressants
concurrently with this medication.
• Wear a Medic-Alert bracelet.
Make the Connection
• Assess and record location, duration,
frequency, and characteristics of seizure activity.
Institute and document seizure precautions.
• Monitor CBC with differential; LFT; and amylase,
lipase, and serum drug levels.
• May be administered with food to minimize GI
effects.
1882_Tab06_109-160 11/10/12 2:40 PM Page 127

Central Nervous System Drugs Monoamine Oxidase Type B Inhibitors 127

Selegiline Selegiline
(se-le-ji-leen)
Transdermal
(se-le-ji-leen tranz-derm-al)
Eldepryl, Carbex
Apo-Selegiline
Emsam

Rasagiline
(ra-za-ji-leen)

Azilect
1882_Tab06_109-160 11/10/12 2:40 PM Page 127
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Anti-Parkinson agents/monoamine oxidase (MAO)
type B inhibitors
Indications
Management of Parkinson’s disease (with levodopa
or levodopa/carbidopa) in clients who fail to
respond to levodopa/carbidopa alone.
Action
Following conversion by MAO to its active form,
this drug inactivates MAO by irreversibly binding to
it at type B (brain) sites. Inactivation of MAO leads
to increased amounts of dopamine, serotonin, and
norepinephrine available in the CNS. Rasagiline
differs from selegiline by its nonamphetamine
characteristics. Selegiline transdermal is used for
major depression.
Adverse Reactions/Side Effects
CNS: confusion, dizziness, fainting, hallucina-
tions, insomnia, vivid dreams. GI: nausea,
abdominal pain, dry mouth.
Uploaded
Route/Dosage: Selegiline: PO/5 mg bid, 1.25–2.5
mg daily (oral disintegrating tab); transdermal 6–12 mg/24 hr, Rasagiline: PO/0.5–1 mg/day
Monoamine Oxidase Type B Inhibitors 127
Keep in Mind
Teach client:
• Take medication as directed with food.
• Notify HCP immediately if severe headache occurs.
• Change positions slowly to ↓ dizziness.
• Report increased body temperature, sweating, men-
tal status change, muscle twitching, or confusion.
• Increase fluids or use sugarless gum, candy, or ice
to minimize dry mouth symptoms.
Make the Connection
• Concurrent use with meperidine or
other opioid analgesics may result in a poten-
tially fatal reaction. Serotonin syndrome may
occur with concurrent use of SSRIs, SRNIs, or
TCAs.
• Monitor sleep pattern changes and presence of
nightmares. Keep room free of obstacles.
• Monitor LFT and RFT.
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 128

Central Nervous System Drugs Dopamine Agonists Agents 128

Ropinirole
(rope-in-er-ole)

Requip, Requip XL

Pramipexole
(pram-i-pex-ole)

Mirapex
1882_Tab06_109-160 11/10/12 2:40 PM Page 128
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Anti-Parkinson agent/dopamine agonist
Indications
Management of mild Parkinson’s disease as
monotherapy and as adjunctive therapy with
levodopa/carbidopa in more advanced cases.
Treatment of restless leg syndrome (rapid-release
form only).
Action
Act as dopamine agonists, directly stimulating
postsynaptic dopaminergic receptors in the CNS.
Some actions are unknown.
Adverse Reactions/Side Effects
CNS: sleep attacks, drowsiness, dyskinesia, hal-
lucinations, confusion, insomnia. EENT: rhinitis.
Resp: dyspnea. CV: orthostatic hypotension,
arrhythmias (atrial premature contractions,
sinus tachycardia), HTN, palpitations. GI: con-
stipation, nausea, abdominal pain, diarrhea, dry
mouth, dyspepsia. Neuro: compulsive behaviors.
Uploaded
Route/Dosage: Ropinirole: PO/up to 9 mg/day
(ER form, up to 24
Dopamine Agonists Agents 128
Keep in Mind
Teach client:
• Take medication as directed.
• May cause drowsiness and unexpected episodes
of falling asleep. Notify HCP if episodes of
falling asleep occur.
• Change positions slowly to ↓ dizziness.
• Use good oral hygiene and sugarless gum or
candy to minimize dry mouth.
• If uncontrollable urges occur, such as the urge to
gamble, report this immediately to the HCP.
Make the Connection
• Assess for decrease in signs and symptoms
of Parkinson’s disease.
• Assess for confusion or hallucinations. Notify
physician or other HCP if these occur.
• Assess client for drowsiness and sleep attacks.
• Monitor ECG and BP frequently.
• Administer with meals to minimize nausea.
• Monitor LFT, RFT, and behavioral changes.
by
MEDBOOKSVN.ORG
mg/day), Pramipexole: PO/1.5–4.5 mg/day in 3 divided doses
1882_Tab06_109-160 11/10/12 2:40 PM Page 129

Central Nervous System Drugs Anti-Parkinson Agents 129

Amantadine
(a-man-ta-deen)

Symmetrel
1882_Tab06_109-160 11/10/12 2:40 PM Page 129
Central Nervous System Drugs Anti-Parkinson Agents
Therapeutic/Pharmacologic Class
Anti-Parkinson agent; antiviral
Indications
Symptomatic initial and adjunctive treatment of
Parkinson’s disease. Treatment of viral illness.
Action
Potentiates the action of dopamine in the CNS.
Adverse Reactions/Side Effects
CNS: ataxia, dizziness, insomnia, anxiety, confu-
sion, depression, drowsiness, psychosis, seizures.
GI: nausea, vomiting, anorexia, constipation.
EENT: blurred vision, dry mouth. Resp: dyspnea.
CV: hypotension, CHF, edema. GU: urinary
retention. Derm: mottling, rashes. Hemat:
leukopenia, neutropenia.
Keep in Mind
Teach client:
• Take medication around the clock as directed.
• May cause dizziness or blurred vision. Change
position slowly to avoid dizziness.
Route/Dosage: PO/100 mg 1–2 times daily Uploaded by MEDBOOKSVN.ORG
129
• Dry mouth can be relieved with good oral hygiene
and use of sugarless gum or candy.
• Notify HCP if confusion, mood changes, difficulty
with urination, edema, SOB, or worsening of
Parkinson’s symptoms occur.
• Full effect for Parkinson’s disease relief may take
up to 2 wk of therapy.
• Wean from the drug gradually.
Make the Connection
• Monitor BP periodically.
• Monitor VS and mental status periodically during
first few days of treatment.
• Assess for CHF, especially in clients on chronic
therapy or with a history of CHF.
• Assess client for the appearance of a diffuse red
mottling of the skin (livedo reticularis), especially
in the lower extremities or on exposure to cold.
• Monitor I&O closely in geriatric clients. May
cause urinary retention.
• Symptoms of toxicity include CNS stimulation.
Physostigmine has been used to reverse CNS
effects.
1882_Tab06_109-160 11/10/12 2:40 PM Page 130

Central Nervous System Drugs Dopamine Agonists 130

Bromocriptine
(broe-moe-krip-teen)

Parlodel, Cycloset
Apo-Bromocriptine
1882_Tab06_109-160 11/10/12 2:40 PM Page 130
Central Nervous System Drugs Dopamine Agonists
Therapeutic/Pharmacologic Class
Anti-Parkinson agent; antidiabetic/dopamine agonists
Indications
Adjunct to levodopa in the treatment of parkin-
sonism. Parlodel is used only for treatment of
hyperprolactinemia (female infertility), prolactin-
secreting adenomas, and acromegaly. Cycloset is
used for treatment of type 2 DM.
Action
Activates dopamine receptors in the CNS.
Decreases prolactin and growth hormone secre-
tion. Decreases blood glucose by action on
growth hormone.
Adverse Reactions/Side Effects
CNS: dizziness, confusion, drowsiness, halluci-
nations, headache, insomnia, nightmares.
EENT: burning eyes, nasal stuffiness, visual
disturbances. Resp: effusions, pulmonary
infiltrates. CV: MI, hypotension. GI: nausea,
abdominal pain, anorexia, dry mouth, metallic
taste, vomiting. Derm: urticaria. MS: leg cramps.
Misc: digital vasospasm (acromegaly only).
Route/Dosage: PO/2.5–100 mg/day in dividedUploaded
doses
130
Keep in Mind
Teach client:
• Take medication as directed.
• May cause drowsiness and dizziness.
• Avoid concurrent use of alcohol.
• Watch for signs of MI and notify HCP immediately
if any occur.
• Women should consult with HCP regarding a
nonhormonal method of birth control.
• Maintain appointments for regular follow-up.
Make the Connection
• Assess client for allergy to ergot derivatives.
• Monitor BP; severe hypotension may occur.
• Assess for symptom relief before and throughout
therapy.
• Monitor LFT; RFT; and CPK, alkaline phosphatase,
and uric acid levels.
• Auscultate the lungs every shift for crackles.
• This medication is often given concurrently with
levodopa or a levodopa/carbidopa combination
in the treatment of Parkinson’s disease.
• Administer with food or milk to minimize GI distress.
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 131

Central Nervous System Drugs Catechol-O-Methyltransferase Inhibitors 131

Tolcapone
(toll-ca-pone)

Tasmar

Entacapone
(en-tah-ca-pone)

Comtan
1882_Tab06_109-160 11/10/12 2:40 PM Page 131

Central Nervous System Drugs Catechol-O-Methyltransferase Inhibitors 131

Therapeutic/Pharmacologic Class
Anti-Parkinson agent/Catechol-O-methyltransferase
(COMT) inhibitor
Indications
Treatment of Parkinson’s disease as an adjunct to
levodopa/carbidopa therapy to decrease fluctuation
of dopamine (off periods).
Action
Inhibits the enzyme that breaks down levodopa,
greatly increasing its availability to the CNS.
Prolongs duration of response to levodopa without
end-of-dose motor fluctuations.
Adverse Reactions/Side Effects
CNS: hallucination, somnolence, vivid dreams,
confusion, headache, syncope, agitation. CV:
orthostatic hypotension, angina. EENT: tinnitus.
GI: severe diarrhea, nausea, hepatotoxicity.
GU: erectile dysfunction, urinary tract infection.
MS: myalgia. Derm: rash. Misc: anaphylaxis,
hypertensive crisis with concurrent use of MAOI
type A or B, SSRIs, or TCAs.
Keep in Mind
Teach client:
• Take as directed.
• Watch for signs of liver dysfunction.
• Report severe diarrhea.
• This drug may cause drowsiness.
• Report insomnia, hallucinations, or vivid dreams.
• Report severe headache or visual changes.
• Report suspected pregnancy to HCP immediately.
• Change position slowly to ↓dizziness.
Make the Connection
• Assess LFT periodically. This drug can
cause serious liver problems quickly.
• Do not give concurrently with MAOI type A or
B drugs, SSRIs, SNRIs, or TCAs.
• Give with levodopa/carbidopa.

Uploaded
Route/Dosage: Tolcapone: PO/200 mg tid, Entacapone: PO/200 by
mg up MEDBOOKSVN.ORG
to 8 times daily
1882_Tab06_109-160 11/10/12 2:40 PM Page 132

Central Nervous System Drugs Dopamine Agonists 132

Carbidopa/Levodopa
(kar-bi-doe-pa/lee-voe-doe-pa)

Parcopa, Sinemet, Sinemet CR

1882_Tab06_109-160 11/10/12 2:40 PM Page 132
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Anti-Parkinson agent/dopamine agonist
Indications
Treatment of Parkinson’s disease. These drugs are
not useful for drug-induced extrapyramidal reactions.
Action
Levodopa is converted to dopamine in the CNS,
where it serves as a neurotransmitter. Carbidopa, a
decarboxylase inhibitor, prevents peripheral destruc-
tion of levodopa. Consequently, more levodopa is
delivered to the CNS using a smaller dose when
used with carbidopa.
Adverse Reactions/Side Effects
CNS: involuntary movements, anxiety, dizziness,
hallucinations, memory loss, psychiatric prob-
lems. EENT: blurred vision, mydriasis. GI: nausea,
vomiting, anorexia, dry mouth, hepatotoxicity.
Derm: melanoma. Hemat: hemolytic anemia,
leukopenia. Misc: darkening of urine or sweat.
Keep in Mind
Teach client:
• Take this drug as directed.
Uploaded
Route/Dosage: PO/25 mg carbidopa with levodopa
100 mg tid (up
Dopamine Agonists 132
• GI irritation may be decreased by eating food
shortly after taking medications, but high-protein
meals may impair the drug’s effects.
• May cause drowsiness or dizziness.
• Change positions slowly to ↓ dizziness.
• Dry mouth can be relieved by using good oral
hygiene and sugarless gum or candy.
• Avoid multivitamins. Pyridoxine (vitamin B6) and
iron may decrease effectiveness.
• Harmless darkening of urine or sweat may occur.
• Notify HCP if palpitations, urinary retention,
involuntary movements, behavioral changes, severe
nausea and vomiting, or new skin lesions occur.
Make the Connection
• Assess BP and pulse frequently during
period of dose adjustment.
• Monitor hepatic and renal function tests and
CBC with differential.
• Assess for signs of toxicity (involuntary muscle twitch-
ing, facial grimacing, spasmodic eye winking, exagger-
ated protrusion of tongue, behavioral changes).
byto 8MEDBOOKSVN.ORG
tablets daily); ER/carbidopa 50 mg with levodopa 200 mg bid
1882_Tab06_109-160 11/10/12 2:40 PM Page 133

Central Nervous System Drugs Anticholinergics 133

Benztropine
(benz-troe-peen)

Cogentin
Apo-Benztropine

Trihexyphenidyl
(trye-hex-ee-fen-i-dill)

Artane, Artane Sequels (ER)

Apo-Trihex
1882_Tab06_109-160 11/10/12 2:40 PM Page 133
Central Nervous System Drugs Anticholinergics
Therapeutic/Pharmacologic Class
Anti-Parkinson agent/anticholinergic
Indications
Adjunctive treatment of all forms of Parkinson’s
disease, including drug-induced extrapyramidal
effects and acute dystonic reactions.
Action
Blocks cholinergic activity in the CNS, which is par-
tially responsible for the symptoms of Parkinson’s
disease. Restores the natural balance of neurotrans-
mitters in the CNS.
Adverse Reactions/Side Effects
CNS: confusion, depression, dizziness, halluci-
nations, headache, sedation, weakness. EENT:
blurred vision, dry eyes, mydriasis. CV: arrhythmias,
hypotension, palpitations, tachycardia. GI: con-
stipation, dry mouth, ileus, nausea. GU: hesitancy,
urinary retention. Misc: decreased sweating.
Route/Dosage: Benztropine: PO/1–2 mg/day; PO, IM, IV/1–4 mg/day for dystonia or EPS, Trihexyphenidyl: PO/6–10 mg/day in 3 divided doses,
ER-PO/5 mg q 12 hr Uploaded by MEDBOOKSVN.ORG
133
Keep in Mind
Teach client:
• Take as directed.
• May cause drowsiness or dizziness.
• Dry mouth may be relieved by use of sugarless
gum or candy and frequent good oral hygiene.
• Change positions slowly to ↓ dizziness.
• Avoid taking antacids or antidiarrheals within
1–2 hr of administration.
Make the Connection
• Assess parkinsonian and EPS before and
throughout therapy.
• Assess bowel function daily.
• Monitor I&O.
• Remember, anticholinergics cause side effects of
“hot as a hare, dry as a bone, red as a beet,
mad as a hatter, blind as a bat.”
• If administering the drug IV (for acute dystonic
reactions), monitor pulse, ECG, and BP closely
and maintain bed rest for 1 hr after administration.
1882_Tab06_109-160 11/10/12 2:40 PM Page 134

Central Nervous System Drugs Cholinergics (Cholinesterase Inhibitors) 134

Donepezil Galantamine
(doe-nep-i-zill) (ga-lant-a-meen)

Aricept, Aricept Razadyne,

Oral Disintegrating Razadyne ER
Tablets (ODT)

Rivastigmine Tacrine
(rye-va-stig-meen) (tak-rin)

Exelon, Exelon Cognex

Transdermal Patch
1882_Tab06_109-160 11/10/12 2:40 PM Page 134
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Anti-Alzheimer agent/cholinergic; cholinesterase
inhibitor
Indications
Treatment of mild-to-moderate dementia associated
with Alzheimer’s disease.
Action
Improves cholinergic function, which is lacking in
clients with Alzheimer’s disease, by inhibiting
acetylcholinesterase, thus prolonging the effect
of acetylcholine (the neurotransmitter of the
cholinergic system).
Adverse Reactions/Side Effects
CNS: headache, abnormal dreams, depression,
dizziness, drowsiness, fatigue, insomnia, syncope.
CV: atrial fibrillation, HTN, hypotension, vasodi-
lation. GI: diarrhea, nausea, anorexia, vomiting,
peptic ulcers. GU: frequent urination. Derm:
ecchymoses. Metab: hot flashes, weight loss.
MS: arthritis, muscle cramps.
Route/Dosage: Donepezil: PO/5–10 mg daily, Galantamine: PO/4–12 mg bid; PO (ER)/8–16 mg once daily, Rivastigmine: PO/1.5–3 mg bid;
Uploaded
transdermal/4.6–9.5 mg/24 hr, Tacrine: PO/10–20
mg qid (maximum
Cholinergics (Cholinesterase Inhibitors) 134
Keep in Mind
Teach client:
• Take the medication daily, as directed.
• May cause dizziness.
• Notify HCP if abdominal pain, coffee ground
emesis, nausea, diarrhea, or changes in color of
stool occur, or if new symptoms occur or previously
noted symptoms increase in severity.
• Follow-up will be scheduled to monitor progress.
• These medications slow the progress of the
disease but do not provide a cure.
Make the Connection
• Assess cognitive function (memory, attention,
reasoning, language, ability to perform simple
tasks) periodically during therapy.
• Remember SLUDGE—salivation, lacrimation,
urination, diarrhea, GI distress, emesis—are
cholinergic side effects.
• Administer in the evening just before going to bed.
• Give the family information on local Alzheimer’s
day-care and respite-care facilities.
by160MEDBOOKSVN.ORG
mg daily)
1882_Tab06_109-160 11/10/12 2:40 PM Page 135

Central Nervous System Drugs Benzodiazepines 135

Alprazolam Diazepam
(al-pray-zoe-lam) (dye-az-e-pam)

Xanax, Xanax Valium, Diastat

XR, Niravam Apo-Diazepam
Apo-Alpraz,
Novo-Alprazol

Clonazepam Lorazepam
(kloe-na-ze-pam) (lor-az-e-pam)

Klonopin Ativan
Syn-Clonazepam Apo-Lorazepam
1882_Tab06_109-160 11/10/12 2:40 PM Page 135
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Antianxiety agent; sedative-hypnotic agent/
benzodiazepine
Indications
Treatment of anxiety; also a centrally acting muscle
relaxer and adjunctive analgesic. Diazepam is used
for treatment of stiff-man syndrome and in con-
scious sedation.
Action
Acts at many levels in the CNS to produce anxiolytic
effect. May produce CNS depression. Effects may be
mediated by GABA, an inhibitory neurotransmitter.
Adverse Reactions/Side Effects
CNS: dizziness, drowsiness, lethargy, confusion,
hangover, headache, mental depression, para-
doxical excitation. EENT: blurred vision. GI:
constipation, diarrhea, nausea, vomiting. Derm:
rashes. Misc: physical dependence, psychological
dependence, tolerance.
Route/Dosage: Alprazolam: PO/0.25–0.5 mg 2–3 times daily; PO (panic attack)/0.5–1 mg tid; PO (ER)/3–6 mg/day, Diazepam: PO/2–10 mg
2–4 times daily; IM, IV/2–10 mg q 3–4 hr, Clonazepam: PO/0.5 mg daily; PO (panic attack)/1 mg daily, Lorazepam: PO/1–3 mg 2–3 times daily;
SL/2–3 mg in divided doses Uploaded by MEDBOOKSVN.ORG
Benzodiazepines 135
Keep in Mind
Teach client:
• Take medication exactly as directed.
• May cause drowsiness or dizziness.
• Older clients may have an increased “hangover effect”
in the morning and are at increased risk for falls.
• Avoid drinking grapefruit juice during therapy.
• Avoid the use of alcohol or other CNS depressants
concurrently with these drugs.
Make the Connection
• Kava, valerian, and chamomile can ↑
CNS depression.
• Assess degree and manifestations of anxiety during
therapy.
• Monitor CBC with differential, and liver and renal
function.
• Plan to give more of your time to the anxious client;
remain nonjudgmental. Offer yourself (“I will stay”).
1882_Tab06_109-160 11/10/12 2:40 PM Page 136

Central Nervous System Drugs Antianxiety Agent 136

Buspirone
(byoo-spye-rone)

BuSpar
1882_Tab06_109-160 11/10/12 2:40 PM Page 136
Central Nervous System Drugs Antianxiety Agent
Therapeutic/Pharmacologic Class
Antianxiety agent
Indications
Management of generalized anxiety disorder.
Action
Binds to serotonin and dopamine receptors in the brain.
Increases norepinephrine metabolism in the brain.
Adverse Reactions/Side Effects
CNS: dizziness, drowsiness, excitement, fatigue,
headache, insomnia, nervousness, weakness,
personality changes. EENT: blurred vision, nasal
congestion, sore throat, tinnitus, altered taste or
smell, conjunctivitis. Resp: chest congestion,
hyperventilation, SOB. CV: chest pain, palpita-
tions, tachycardia, HTN, hypotension, syncope.
GI: nausea, abdominal pain, constipation,
diarrhea, dry mouth, vomiting. GU: changes in
libido, dysuria, urinary frequency, urinary hesi-
tancy. Derm: rashes, alopecia, blisters, dry skin,
easy bruising, edema, flushing, pruritus. Endo:
irregular menses. MS: myalgia. Neuro: incoordi-
nation, numbness, paresthesia, tremor. Misc:
clamminess, sweating, fever.
Route/Dosage: PO/20–30 mg day in 2 dividedUploaded
doses
by MEDBOOKSVN.ORG
136
Keep in Mind
Teach client:
• Take exactly as directed.
• May cause dizziness or drowsiness.
• Avoid concurrent use of alcohol or other CNS
depressants.
• Consult HCP before taking OTC medications or
herbal products with this drug.
• Notify HCP if any chronic abnormal muscle
movements occur or if pregnancy is suspected.
• Maintain appointments for follow-up
examinations.
• Report palpitations, chest discomfort, or
faintness immediately.
Make the Connection
• Concomitant use of kava, valerian, or
chamomile can ↑ CNS depression. Grapefruit
juice will ↑ serum levels.
• Concomitant use of MAOIs will cause HTN.
• Assess degree and manifestations of anxiety
before and periodically during therapy.
• Monitor LFT and RFT.
• Monitor ECG and assess for chest discomfort.
1882_Tab06_109-160 11/10/12 2:40 PM Page 137

Central Nervous System Drugs Selective Serotonin Reuptake Inhibitors 137

Fluoxetine Citalopram
(floo-ox-uh-teen) (si-tal-oh-pram)

Prozac, Prozac Celexa

Weekly, Sarafem

Fluvoxamine Paroxetine
(floo-voks-a-meen) (par-ox-e-teen)

Luvox, Luvox CR Paxil, Paxil ER, Pexeva

Escitalopram
(ess-sit-al-o-pram)

Lexapro
1882_Tab06_109-160 11/10/12 2:40 PM Page 137
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Antidepressant/selective serotonin reuptake inhibitor
(SSRI)
Indications
Treatment of various forms of depression, OCD,
social phobias, bulimia and anorexia nervosa, and
panic disorder. Sarafem: Management of premen-
strual dysphoric disorder (PMDD).
Action
Selectively inhibits the reuptake of serotonin from
the neural synapse.
Adverse Reactions/Side Effects
CNS: seizures, anxiety, drowsiness, headache,
insomnia, nervousness, abnormal dreams,
dizziness, fatigue, hypomania, mania, weakness.
EENT: stuffy nose, visual disturbances. Resp:
cough. CV: chest pain, palpitations. GI: diarrhea,
abdominal pain, abnormal taste, anorexia,
constipation, dry mouth, dyspepsia, nausea,
vomiting, weight loss. GU: sexual dysfunction,
urinary frequency. Derm: excessive sweating,
Route/Dosage: Fluoxetine: PO/20 mg daily; PO (ER)/90 mg weekly, Citalopram: PO/20–40 mg daily, Fluvoxamine: PO/50–100 mg at bedtime; PO
Uploaded
(CR)/100–300 mg at bedtime, Paroxetine: PO/20–50
mg daily; PO (CR)/25–62.5 mg daily, Escitalopram: PO/10–20 mg once daily
Selective Serotonin Reuptake Inhibitors 137
pruritus, erythema nodosum, flushing, rashes.
Endo: dysmenorrhea. MS: arthralgia, back pain,
myalgia. Neuro: tremor. Misc: allergic reactions,
fever, flu-like syndrome, hot flashes, sensitivity
reaction.
Keep in Mind
Teach client:
• Take the medication exactly as directed.
• May cause drowsiness, dizziness, impaired
judgment, blurred vision, and dry mouth.
• Avoid alcohol, CNS depressant drugs, and herbal
products such as SAMe and St. John’s wort.
• The medication may cause decreased libido.
• Report chest discomfort, palpitations, or suicidal
thoughts immediately.
Make the Connection
• Assess for suicidal tendencies, especially
in the first 2–4 wk.
• Monitor appetite and nutrition intake.
• Monitor CBC, LFT, and RFT.
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 138

Central Nervous System Drugs Mood Stabilizer 138

Lithium
(lith-ee-um)

Lithobid
Carbolith
1882_Tab06_109-160 11/10/12 2:40 PM Page 138
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Mood stabilizer
Indications
Treatment of bipolar affective disorders (treatment
of acute manic episodes and prophylaxis against
recurrence).
Action
Alters cation transport in nerve and muscle.
Influences reuptake of neurotransmitters.
Adverse Reactions/Side Effects
CNS: seizures, fatigue, headache, impaired
memory, ataxia, confusion, dizziness, drowsiness,
psychomotor retardation, restlessness, stupor.
EENT: aphasia, blurred vision, dysarthria, tinnitus.
CV: arrhythmias, ECG changes, edema,
hypotension. GI: abdominal pain, anorexia,
bloating, diarrhea, nausea, dry mouth, metallic
taste. GU: polyuria, glycosuria, nephrogenic
diabetes insipidus, renal toxicity. Derm: acne,
folliculitis, alopecia, diminished sensation,
pruritus. Endo: hypothyroidism, goiter,
Uploaded
Route/Dosage: PO/300 mg 3–4 times daily; PO (ER)/300 mg tid
Mood Stabilizer 138
hyperglycemia, hyperthyroidism. F and E:
hyponatremia. Hemat: leukocytosis. Metab:
weight gain. MS: muscle weakness, hyperirri-
tability, rigidity. Neuro: tremors.
Keep in Mind
Teach client:
• Report palpitations or SOB to HCP immediately.
• May cause dizziness or drowsiness.
• Do not limit sodium intake. Take as directed.
• Unwanted weight gain and acne may occur.
• Do not drink coffee, tea, or cola in large amounts.
• Notify HCP if fever, vomiting, or diarrhea occurs.
Make the Connection
• Assess for suicidal ideation and react
swiftly.
• Monitor I&O; electrolytes; and CBC, LFT, and RFT.
• Monitor serum drug levels (0.5–1.5 mEq/L).
The client with toxicity looks like a person who
is inebriated, with ataxia, slurred speech, and
drowsiness.
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 139

Central Nervous System Drugs Aminoketones 139

Bupropion
(byoo-proe-pee-on)

Wellbutrin, Wellbutrin SR,

Budeprion XL, Zyban, Aplenzin
1882_Tab06_109-160 11/10/12 2:40 PM Page 139
Central Nervous System Drugs Aminoketones
Therapeutic/Pharmacologic Class
Antidepressant; smoking deterrent/aminoketone
Indications
Treatment of major depression, often in conjunction
with psychotherapy.
Action
Alters the effects of serotonin in the CNS.
Adverse Reactions/Side Effects
CNS: lower seizure threshold, drowsiness,
confusion, dizziness, fatigue, hallucinations,
headache, insomnia, nightmares, slurred speech,
syncope, weakness. EENT: blurred vision, tinnitus.
CV: hypotension, arrhythmias, chest pain, HTN,
palpitations, tachycardia. GI: dry mouth, altered
taste, constipation, diarrhea, excess salivation,
flatulence, nausea, vomiting. GU: hematuria,
impotence, priapism, urinary frequency. Derm:
rashes. Hemat: anemia, leukopenia. MS: myalgia.
Neuro: tremor.
Uploaded
Route/Dosage: PO/100–450 mg daily in divided
doses; PO (XR, XL)/150 mg daily
139
Keep in Mind
Teach client:
• Take medication exactly as directed.
• May cause drowsiness and blurred vision.
• Avoid concurrent use of alcohol or other CNS
depressant drugs.
• Expect follow-up examinations.
• Report any suicidal ideation immediately to
the HCP.
Make the Connection
• Concomitant use of herbal products
such as kava, valerian, or chamomile can ↑ CNS
depression.
• The risk of serotonin syndrome increases when
medication is taken with St. John’s wort or SAMe.
• Monitor BP, pulse, and ECG as baseline, then
periodically.
• Assess mental status and mood changes.
• There are fewer problems with sexual side effects
than with SSRIs.
• Monitor CBC, LFT, and RFT.
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 140

Central Nervous System Drugs Serotonin and Norepinephrine Reuptake

Inhibitors 140

Venlafaxine Duloxetine
(ven-la-fax-een) (do-lox-e-teen)

Effexor, Effexor XR Cymbalta

Desvenlafaxine
(des-ven-la-faz-een)

Pristiq
1882_Tab06_109-160 11/10/12 2:40 PM Page 140
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Antidepressant; antianxiety agent/Serotonin and
norepinephrine reuptake inhibitor (SNRI)
Indications
Treatment of major depressive illness or relapse, often
in conjunction with psychotherapy. Treatment of gen-
eralized anxiety disorder and social anxiety disorder.
Action
Inhibits serotonin and norepinephrine reuptake in
the CNS.
Adverse Reactions/Side Effects
CNS: seizures, abnormal dreams, anxiety, dizzi-
ness, headache, insomnia, nervousness, weakness,
abnormal thinking, agitation, confusion, deper-
sonalization, drowsiness, emotional lability,
worsening depression. EENT: rhinitis, visual
disturbances, tinnitus. CV: chest pain, HTN,
palpitations, tachycardia. GI: abdominal pain,
altered taste, anorexia, constipation, diarrhea,
dry mouth, dyspepsia, nausea, vomiting, weight
Route/Dosage: Venlafaxine: PO/75–225 mg daily in divided doses; PO (XL)/75–225 mg daily, Duloxetine: PO/60–120 mg once daily,
Desvenlafaxine: PO/50 mg once daily Uploaded by MEDBOOKSVN.ORG
Serotonin and Norepinephrine Reuptake
Inhibitors 140
loss. GU: sexual dysfunction, urinary frequency,
urinary retention. Derm: ecchymoses, itching,
photosensitivity, skin rash. Neuro: paresthesia,
twitching. Misc: chills, yawning.
Keep in Mind
Teach client:
• Take the medication exactly as directed.
• The medication may cause drowsiness or dizziness.
• Avoid using alcohol or other CNS depressant drugs.
• Report suicidal thoughts immediately.
Make the Connection
• The risk of serotonin syndrome increases
with use of MAOIs, St. John’s wort, or SAMe.
• Assess suicidal tendencies, especially in early
therapy.
• Monitor CBC, LFT, RFT, and electrolyte levels.
1882_Tab06_109-160 11/10/12 2:40 PM Page 141

Central Nervous System Drugs Tricyclic Antidepressants 141

Desipramine Nortriptyline
(dess-ip-pra-meen) (nor-trip-ti-leen)

Norpramin Aventyl, Pamelor

Pertofrane

Imipramine Clomipramine
(im-ip-pra-meen) (cloe-mip-pra-meen)

Tofranil, Tofranil PM, Anafranil

Norfranil, Tipramine
Apo-imipramine,
Novopramine
1882_Tab06_109-160 11/10/12 2:40 PM Page 141

Central Nervous System Drugs Tricyclic Antidepressants 141

Therapeutic/Pharmacologic Class
Antidepressant/tricyclic antidepressant (TCA)
Indications
Treatment of depression, often in conjunction with
psychotherapy. Treatment of OCD (clomipramine).
Action
Potentiates the effect of serotonin and norepinephrine in
the CNS. Produces significant anticholinergic side effects.
Adverse Reactions/Side Effects
CNS: lethargy, sedation. EENT: blurred vision,
dry eyes, dry mouth. CV: arrhythmias, hypoten-
sion, ECG changes. GI: constipation, hepatitis,
paralytic ileus. GU: urinary retention. Derm:
photosensitivity. Endo: changes in blood glucose,
gynecomastia. Hemat: blood dyscrasias. Misc:
increased appetite, weight gain.
Keep in Mind
Teach client:
• Take the medication exactly as directed. It is best
taken at bedtime because of the sedating effects.
Route/Dosage: Desipramine: PO/100–200 mg once daily, or 300 mg in divided doses, Nortriptyline: PO/25 mg 3–4 times daily, up to 150 mg daily,
Imipramine: PO/25–50 mg 3–4 times daily, up to 300 mg daily; IM/100 mg daily in divided doses, Clomipramine: PO/25 mg tid, up to 250–350 mg
in divided doses Uploaded by MEDBOOKSVN.ORG
• This medication may cause drowsiness.
• Dizziness on standing, sedation, and confusion
are common side effects.
• Avoid alcohol or other CNS depressant drugs.
• Use sunscreen and protective clothing.
• An increase in appetite may occur.
• Notify HCP immediately if having any suicidal
thoughts.
Make the Connection
• Appears on Beers Criteria list as a drug
that is inappropriate for older clients. Increases
the risk for falls.
• May ↑ risk of suicide attempt/ideation, especially
during early treatment.
• Serotonin syndrome may occur when medication
is combined with SAMe or St. John’s wort.
• Anticholinergic effects are “hot as a hare, dry as
a bone, red as a beet, mad as a hatter, and
blind as a bat.”
• Monitor CBC, LFT, RFT, serum glucose, and
serum alkaline phosphatase.
1882_Tab06_109-160 11/10/12 2:40 PM Page 142

Central Nervous System Drugs Monoamine Oxidase Inhibitors 142

Phenelzine Tranylcypromine
(fen-el-zeen) (tran-ill-sip-roe-meen)

Nardil Parnate

Isocarboxazid
(eye-soe-car-box-a-zid)

Marplan
1882_Tab06_109-160 11/10/12 2:40 PM Page 142
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Antidepressant/monoamine oxidase inhibitor (MAOI)
Indications
Treatment of neurotic or atypical depression
(usually reserved for clients who do not tolerate or
respond to other modes of therapy [eg, TCAs,
SSRIs, SNRIs, electroconvulsive therapy]).
Action
Inhibits the enzyme MAO, resulting in an accumula-
tion of various neurotransmitters (dopamine, epineph-
rine, norepinephrine, serotonin) in the neural synapse.
Adverse Reactions/Side Effects
CNS: seizures, dizziness, drowsiness, fatigue,
headache, hyperreflexia, insomnia, tremor, twitch-
ing, weakness, euphoria, paresthesia, restlessness.
EENT: blurred vision, glaucoma, nystagmus.
CV: hypertensive crisis, edema, orthostatic
hypotension. GI: constipation, dry mouth, abdom-
inal pain, ↑ LFT, nausea, vomiting. GU: sexual
dysfunction, urinary retention. Derm: pruritus,
rashes. F and E: hypernatremia. Endo: weight gain.
Route/Dosage: Phenelzine: PO/60–90 mg daily in divided doses, Tranylcypromine: PO/30–60 mg bid, Isocarboxazid: PO/10–60 mg daily in
2–4 divided doses Uploaded by MEDBOOKSVN.ORG
Monoamine Oxidase Inhibitors 142
Keep in Mind
Teach client:
• Take the medication as directed.
• Avoid alcohol, CNS depressants, OTC deconges-
tant drugs, excessive caffeine intake, and foods or
beverages containing tyramine (give client a list).
• This medication may cause dizziness or drowsiness.
• Wear a Medic-Alert bracelet.
• Ophth testing will also be done periodically.
Make the Connection
• Serious, potentially fatal adverse reactions
(serotonin syndrome) may occur with concur-
rent use of other antidepressants. Avoid using
within 2–5 wk of each other.
• This medication may cause severe HTN and
seizures when combined with opioids, trypto-
phan, tyrosine, phenylalamine, tyramine, or high
caffeine intake.
• Assess for suicidal tendencies, especially during
early therapy.
• Monitor LFT.
1882_Tab06_109-160 11/10/12 2:40 PM Page 143

Central Nervous System Drugs Butyrophenones 143

Haloperidol
(ha-loe-per-i-dole)

Haldol, Haldol Decanoate

PMS-Haloperidol

Droperidol
(droe-per-i-dole)

Inapsine
1882_Tab06_109-160 11/10/12 2:40 PM Page 143
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Antipsychotic agent/butyrophenones
Indications
Treatment of acute and chronic psychotic disorders,
including schizophrenia, manic states, and drug-
induced psychoses. Also useful in the management
of aggressive or agitated clients. Treatment of
Tourette’s syndrome.
Action
Alters the effects of dopamine in the CNS. Also
has anticholinergic and alpha-adrenergic blocking
activity.
Adverse Reactions/Side Effects
CNS: seizures, extrapyramidal reactions, confu-
sion, drowsiness, restlessness, tardive dyskinesia.
EENT: blurred vision, dry eyes. Resp: respiratory
depression. CV: hypotension, tachycardia.
GI: constipation, dry mouth, anorexia, drug-
induced hepatitis, ileus. GU: urinary retention.
Derm: diaphoresis, photosensitivity, rashes.
Endo: galactorrhea. Hemat: anemia, leukopenia.
Route/Dosage: Haloperidol: PO, IV, IM/0.5–5 mg daily in divided doses; IM/(haloperidol decanoate) 100–300 mg monthly, Droperidol:
IV/0.5–1.25 mg q 4 hr (antiemetic) Uploaded by MEDBOOKSVN.ORG
Butyrophenones 143
Metab: hyperpyrexia. Misc: neuroleptic
malignant syndrome, hypersensitivity reactions.
Keep in Mind
Teach client:
• Take the medication as directed. Do not discon-
tinue abruptly.
• Report abnormal muscle movements or twitches.
• This medication may cause drowsiness.
• Avoid using alcohol or other CNS depressants.
• Extremes of temperature should also be avoided.
Make the Connection
• Assess mental status.
• Monitor BP for orthostatic hypotension.
• May cause QT interval changes on ECG.
• Refer immediately to movement disorders
specialist if EPS occur.
• Monitor for development of neuroleptic
malignant syndrome.
• Monitor CBC and LFT.
1882_Tab06_109-160 11/10/12 2:40 PM Page 144

Central Nervous System Drugs Phenothiazines 144

Chlorpromazine Fluphenazine
(klor-proe-ma-zeen) (floo-fen-a-zeen)

Thorazine Prolixin, Prolixin

Novo- Decanoate
Chlorpromazine Apo-Fluphenazine

Perphenazine
(per-fen-a-zeen)

Trilafon
Apo-Perphenazine
1882_Tab06_109-160 11/10/12 2:40 PM Page 144
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Antipsychotic agent/phenothiazine (older antipsy-
chotic agent)
Indications
Treatment of acute and chronic psychoses, particu-
larly when accompanied by increased psychomotor
activity. Treatment of nausea and vomiting.
Treatment of intractable hiccups.
Action
Alters the effects of dopamine in the CNS. Has sig-
nificant anticholinergic/alpha-adrenergic blocking
activity.
Adverse Reactions/Side Effects
CNS: neuroleptic malignant syndrome, sedation,
extrapyramidal reactions, tardive dyskinesia.
EENT: blurred vision, dry eyes, lens opacities.
CV: hypotension (increased with IM, IV), tachycar-
dia. GI: constipation, dry mouth, anorexia, hepatitis,
ileus. GU: urinary retention. Derm: photosensitivity,
Route/Dosage: Chlorpromazine: PO/200 mg daily in divided doses; IM/25–50 mg initially, repeated in an hr (up to 1 g daily) for severe psychosis,
Fluphenazine: PO/0.5–10 mg daily in divided doses q 6–8 hr; IM/(fluphenazine decanoate) 12.5–25 mg q 3 wk, up to 100 mg daily,
Uploaded
Perphenazine: PO/2–16 mg daily in divided doses;
IM/15–30 mg daily;
Phenothiazines 144
pigment changes, rashes. Endo: galactorrhea.
Hemat: agranulocytosis, leukopenia. Metab:
hyperthermia. Misc: allergic reactions.
Keep in Mind
Teach client:
• Take the medication exactly as directed.
• Report abnormal muscle movement or twitches
immediately to HCP.
• This medication may cause drowsiness.
• Avoid using alcohol or other CNS depressants.
• Extremes of temperature should be avoided.
Make the Connection
• Assess client’s mental status prior to and
periodically throughout therapy.
• Refer to a movement disorder specialist if EPS occur.
• Monitor for orthostatic hypotension.
• Monitor for development of neuroleptic malignant
syndrome.
• Monitor CBC, LFT, and ocular acuity.
byIV/1–5
MEDBOOKSVN.ORG
mg, or 0.5 mg/min as infusion, for nausea or intractable hiccups
1882_Tab06_109-160 11/10/12 2:40 PM Page 145

Central Nervous System Drugs Thioxanthines 145

Thiothixene
(thye-oh-thix-een)

Navane
1882_Tab06_109-160 11/10/12 2:40 PM Page 145
Central Nervous System Drugs Thioxanthines
Therapeutic/Pharmacologic Class
Antipsychotic agent/thioxanthene
Indications
Management of psychotic disorders.
Action
Alters the effect of dopamine in the CNS.
Adverse Reactions/Side Effects
CNS: neuroleptic malignant syndrome,
extrapyramidal reactions, sedation, tardive
dyskinesia, seizures. EENT: blurred vision, dry
eyes, lens opacities. CV: hypotension, tachycardia,
nonspecific ECG changes. GI: constipation, dry
mouth, anorexia, ileus, nausea. GU: urinary
retention. Derm: photosensitivity, pigment
changes, rashes. Endo: breast enlargement,
galactorrhea. Hemat: leukocytosis, leukopenia.
Metab: hyperpyrexia. Misc: allergic reactions.
Keep in Mind
Teach client:
• Take the medication exactly as directed.
Route/Dosage: PO/2 mg tid (mild), 5 mg bid Uploaded
(severe), up to 20–30
145
• Report symptoms such as abnormal muscle
movement or twitches immediately.
• This medication may cause drowsiness.
• Avoid using alcohol or other CNS depressants.
• Extremes of temperature should be avoided.
• This medication may cause breast enlargement.
• Routine follow-up examinations and continued
participation in psychotherapy are needed.
Make the Connection
• Assess client’s mental status prior to and
periodically throughout therapy.
• Monitor for orthostatic hypotension.
• Refer to a movement disorder specialist if EPS
occur.
• Monitor for development of neuroleptic malig-
nant syndrome.
• Monitor CBC, LFT, and ocular acuity.
• Avoid contact with all forms of solution because
it may cause dermatitis.
by
MEDBOOKSVN.ORG
mg daily
1882_Tab06_109-160 11/10/12 2:40 PM Page 146

Central Nervous System Drugs Dihydrocarbostyril 146

Aripiprazole
(a-ri-pip-ra-zole)

Abilify
1882_Tab06_109-160 11/10/12 2:40 PM Page 146
Central Nervous System Drugs Dihydrocarbostyril
Therapeutic/Pharmacologic Class
Antipsychotic agent; mood stabilizer/dihydrocarbostyril
Indications
Treatment of schizophrenia. Acute and maintenance
therapy of manic and mixed episodes associated
with bipolar disorder (as monotherapy or with lithium
or valproate); adjunctive treatment of depression in
adults; and treatment of agitation associated with
schizophrenia or bipolar disorder and irritability
associated with autistic disorder in children.
Action
Psychotropic activity may be due to agonist activity
at dopamine D2 and serotonin 5-HT1A receptors
and antagonist activity at the 5-HT2A receptor. Also
has alpha1-adrenergic blocking activity.
Adverse Reactions/Side Effects
CNS: neuroleptic malignant syndrome, suicidal
thoughts, seizures, drowsiness, sedation, tardive
dyskinesia, nervousness, lightheadedness, insom-
nia, confusion, manic reactions, akathisia, EPS,
impaired cognitive function, abnormal gait,
tremor. EENT: visual disturbances, conjunctivitis,
ear pain. CV: chest pain, orthostatic hypotension,
Route/Dosage: PO/10–30 mg daily Uploaded by MEDBOOKSVN.ORG
146
tachycardia, HTN. GI: constipation, anorexia,
dry mouth, increased salivation, nausea, vomit-
ing, weight loss. GU: incontinence. Derm:
sweating, dry skin, ecchymosis, skin ulcer. MS:
muscle cramps, neck pain. Endo: hyperglycemia.
Hemat: bone marrow changes including ane-
mia, leukopenia, and neutropenia.
Keep in Mind
Teach client:
• Report abnormal muscle movements or seizures
to HCP immediately.
• May cause drowsiness; avoid concurrent use of
alcohol or other CNS depressants.
Make the Connection
• Monitor client’s mental status, BP, CBC,
LFT, HgA1c and serum glucose.
• Refer to a movement disorder specialist if EPS
occur.
• Monitor for development of neuroleptic
malignant syndrome.
1882_Tab06_109-160 11/10/12 2:40 PM Page 147

Central Nervous System Drugs Benzisoxizoles 147

Risperidone
(ris-pear-i-doen)

Risperdal, Risperdal M-TAB,

Risperdal Consta
1882_Tab06_109-160 11/10/12 2:40 PM Page 147
Central Nervous System Drugs Benzisoxizoles
Therapeutic/Pharmacologic Class
Antipsychotics; mood stabilizers/benzisoxizoles
Indications
Treatment of schizophrenia, bipolar disorder, and
irritability in autistic children.
Action
May act by antagonizing dopamine and serotonin
in the CNS.
Adverse Reactions/Side Effects
CNS: neuroleptic malignant syndrome, suicidal
thoughts, aggressive behavior, dizziness,
extrapyramidal reactions, headache, ↑ dreams,
↑ sleep duration, insomnia, sedation, fatigue,
impaired temperature regulation, nervousness,
tardive dyskinesia. EENT: pharyngitis, rhinitis,
visual disturbances. Resp: cough, dyspnea. CV:
arrhythmias, orthostatic hypotension, tachycar-
dia. GI: constipation, diarrhea, dry mouth,
nausea, abdominal pain, anorexia, dyspepsia, ↑
salivation, vomiting, weight gain, weight loss, poly-
dipsia. GU: ↓ libido, dysmenorrhea/menorrhagia,
difficulty urinating, polyuria. Derm: itching/
skin rash, dry skin, ↑ pigmentation, sweating,
Route/Dosage: PO/1 mg bid; IM/25–50 mg qUploaded
2 wk by MEDBOOKSVN.ORG
147
photosensitivity, seborrhea. Endo: galactorrhea,
hyperglycemia. Hemat: agranulocytosis, leukopenia,
neutropenia. MS: arthralgia, back pain.
Keep in Mind
Teach client:
• Take the medication exactly as directed.
• Watch for abnormal muscle movements or
twitches and report these symptoms immediately.
• This medication may cause seizures and drowsiness.
• Avoid concurrent use of alcohol and other CNS
depressants.
Make the Connection
• Monitor client’s mental status before and
periodically during therapy.
• Monitor for orthostatic hypotension.
• Monitor ECG for cardiac abnormalities.
• Refer to a movement disorder specialist if EPS occur.
• Monitor for development of neuroleptic malignant
syndrome.
• Monitor CBC and LFT.
1882_Tab06_109-160 11/10/12 2:40 PM Page 148

Central Nervous System Drugs Thienobenzodiazepines 148

Olanzapine
(oe-lanz-a-peen)

Zyprexa, Zyprexa Relprevv, Zyprexa

Intramuscular, Zyprexa Zydis
1882_Tab06_109-160 11/10/12 2:40 PM Page 148
Central Nervous System Drugs Thienobenzodiazepines
Therapeutic/Pharmacologic Class
Antipsychotic; mood stabilizer/Thienobenzodiazepines
Indications
Acute therapy of manic or mixed episodes associated
with bipolar I disorder (as monotherapy or with lithi-
um or valproate) and maintenance therapy of bipolar
I disorder. Treatment of acute agitation due to schizo-
phrenia or bipolar I mania (IM), depressive episodes
associated with bipolar I disorder (when used with
fluoxetine), and treatment-resistant depression (when
used with fluoxetine). Unlabeled uses: Anorexia
nervosa and emesis associated with chemotherapy.
Action
Antagonizes dopamine and serotonin type 2 in the
CNS and has anticholinergic, antihistaminic, and
anti–alpha1-adrenergic effects.
Adverse Reactions/Side Effects
CNS: neuroleptic malignant syndrome, seizures,
suicidal thoughts, agitation, delirium, dizziness,
headache, restlessness, sedation, weakness,
dystonia, insomnia, mood changes, personality
disorder, speech impairment, tardive dyskinesia.
Route/Dosage: PO/10 mg daily; IM/300 mg qUploaded
2 wk by MEDBOOKSVN.ORG
148
EENT: amblyopia, rhinitis, ↑ salivation, pharyngitis.
Resp: cough, dyspnea. CV: bradycardia, chest pain,
orthostatic hypotension, tachycardia. GI: constipa-
tion, dry mouth, ↑ liver enzymes, weight loss or
gain, abdominal pain, ↑ appetite, nausea, ↑ thirst.
GU: impotence, ↓ libido, urinary incontinence.
Hemat: agranulocytosis, leukopenia, neutropenia.
Keep in Mind
Teach client:
• Take the medication exactly as directed.
• Report abnormal muscle movements or seizure to
HCP immediately.
• May cause drowsiness so avoid concurrent use of
alcohol and other CNS depressants.
Make the Connection
• Monitor client’s mental status, BP, ECG,
CBC, and LFT.
• Refer to a movement disorder specialist if EPS occur.
• Monitor for development of neuroleptic malig-
nant syndrome.
1882_Tab06_109-160 11/10/12 2:40 PM Page 149

Central Nervous System Drugs Piperizine Derivative 149

Ziprasidone
(zye-pras-i-doen)

Geodon
1882_Tab06_109-160 11/10/12 2:40 PM Page 149
Central Nervous System Drugs Piperizine Derivative
Therapeutic/Pharmacologic Class
Antipsychotic; mood stabilizer/piperizine derivatives
Indications
Treatment of schizophrenia. IM form is reserved for
control of acutely agitated patients and treatment
of bipolar mania (acute manic and manic/mixed
episodes).
Action
Effects probably mediated by antagonism of
dopamine type 2 (D2) and serotonin type 2 (5-HT2).
Adverse Reactions/Side Effects
CNS: neuroleptic malignant syndrome,
seizures, dizziness, drowsiness, restlessness,
EPS, syncope, tardive dyskinesia. Resp:
cough/runny nose. CV: prolonged QT interval,
orthostatic hypotension. GI: constipation,
diarrhea, nausea, dysphagia. GU: amenorrhea,
impotence. Hemat: agranulocytosis, leukopenia,
neutropenia. Endo: galactorrhea. Derm: rash,
urticaria.
Route/Dosage: PO/20 mg daily initially (up toUploaded
40–80 mg bid); IM/40 daily in divided doses
149
Keep in Mind
Teach client:
• Take the medication exactly as directed.
• Watch for abnormal muscle movements or
twitches and report these symptoms immediately.
• This medication may cause seizures and drowsiness.
• Avoid concurrent use of alcohol and other CNS
depressants.
Make the Connection
• Monitor client’s mental status before and
periodically during therapy.
• Monitor for orthostatic hypotension.
• Monitor ECG for cardiac abnormalities.
• Refer to a movement disorder specialist if EPS
occur.
• Monitor for development of neuroleptic
malignant syndrome.
• Monitor CBC and LFT.
bymgMEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 150

Central Nervous System Drugs Ergot Alkaloids 150

Ergotamine
(er-got-a-meen)

Ergomar, Ergostat
Gynergen

Dihydroergotamine
(dye-hye-droe-er-got-a-meen)

D.H.E. 45, Migranal

Dihydroergotamine-Sandoz
1882_Tab06_109-160 11/10/12 2:40 PM Page 150

Central Nervous System Drugs Ergot Alkaloids 150

Therapeutic/Pharmacologic Class
Vascular headache suppressant/ergot alkaloid
Indications
Treatment of vascular, cluster, and migraine headache.
Methylergonovine is an oxytocic that contracts the
uterus to prevent postpartum hemorrhage.
Action
Vasoconstriction of dilated blood vessels by stimu-
lating alpha-adrenergic and serotonergic (5-HT)
receptors. Larger doses may produce alpha-
adrenergic blockade and vasodilation.
Adverse Reactions/Side Effects
CNS: dizziness. CV: MI, HTN, angina pectoris,
arterial spasm, intermittent claudication. GI:
abdominal pain, nausea, vomiting, diarrhea, poly-
dipsia. MS: extremity stiffness, muscle pain, stiff
neck, stiff shoulders. Neuro: leg weakness, numb-
ness or tingling in fingers or toes. Misc: fatigue.
Keep in Mind
Teach client:
• Use pain scale as instructed to objectively rate
severity of migraine symptoms.
• Report palpitations or chest pain immediately.
• Do not take this medication if you have uncon-
trolled HTN, PVD, or ischemic heart disease.
• Laboratory tests will be scheduled periodically.
Make the Connection
• Monitor pain level using a scale, and
report relief of migraine headache.
• Monitor ECG and ask client to report palpitations.
• Monitor LFT and RFT periodically.
• Assess for signs of ergotism (cold, numb fingers
and toes; nausea; vomiting; headache; muscle
pain; weakness)
• Medicate at the first sign of migraine pain to
possibly abort the migraine headache.

Route/Dosage: Ergotamine: PO, SL/1–2 mg initially, then 1–2 mg q 30 min, until attack subsides or a total of 6 mg has been given; PO/(cluster
headache) 1–2 mg at bedtime for 10–14 days, Dihydroergotamine: IM, SC/1 mg, may repeat in 1 hr, not to exceed 3 mg; IV/0.5 mg, may repeat in
Uploaded
1 hr, not to exceed 2 mg daily; nasal spray/1 spray by
each nostril, may MEDBOOKSVN.ORG
repeat in 15 min (Migranal)
1882_Tab06_109-160 11/10/12 2:40 PM Page 151

Central Nervous System Drugs Appetite Suppressant 151

Sibutramine
(si-byoo-tra-meen)

Meridia
1882_Tab06_109-160 11/10/12 2:40 PM Page 151
Central Nervous System Drugs Appetite Suppressant
Therapeutic/Pharmacologic Class
Weight control agent/appetite suppressant
Indications
Treatment of obesity in clients with body mass
index >30 kg/m2 (or >27 kg/m2 in clients with
diabetes, HTN, or other risk factors) in conjunction
with other interventions (dietary restriction, exercise);
used to produce and maintain weight loss.
Action
Acts as an inhibitor of the reuptake of serotonin,
norepinephrine, and dopamine; increases the
satiety-producing effects of serotonin.
Adverse Reactions/Side Effects
CNS: seizures, headache, insomnia, CNS stimu-
lation, dizziness, drowsiness, emotional lability,
nervousness. EENT: laryngitis/pharyngitis, rhinitis,
sinusitis. CV: HTN, palpitations, tachycardia,
vasodilation. GI: anorexia, constipation, dry
mouth, altered taste, dyspepsia, increased
appetite, nausea. GU: dysmenorrhea. Derm:
increased sweating, rash.
Route/Dosage: PO/10–15 mg once daily Uploaded by MEDBOOKSVN.ORG
151
Keep in Mind
Teach client:
• Take medication as directed.
• Avoid using other CNS depressants or excessive
amounts of alcohol with this medication.
• Take weight at the same time, using the same
scale, with the same clothing weekly.
Make the Connection
• Concurrent use of other centrally acting
appetite suppressants, MAOIs, SSRIs, 5-HT1
agonists, dihydroergotamine, dextromethorphan,
meperidine, pentazocine, fentanyl, lithium, or
tryptophan may result in potentially fatal “sero-
tonin syndrome.”
• Monitor clients for weight loss and adjust concur-
rent medications as needed.
• Monitor BP and heart rate regularly during
therapy. Increases in BP or heart rate, especially
during early therapy, may require decrease in
dose or discontinuation of this drug.
1882_Tab06_109-160 11/10/12 2:40 PM Page 152

Central Nervous System Drugs Central Nervous System Stimulants 152

Methylphenidate
(meth-ill-fen-i-date)

Concerta, Metadate CD, Metadate ER,

Methylin, Ritalin, Ritalin LA, Ritalin-SR
PMS-Methylphenidate
Daytrana Transdermal Patch

Dexmethylphenidate
(dex-meth-ill-fen-i-date)

Focalin, Focalin XR
1882_Tab06_109-160 11/10/12 2:40 PM Page 152

Central Nervous System Drugs Central Nervous System Stimulants 152

Therapeutic/Pharmacologic Class Keep in Mind
Central nervous system (CNS) stimulant Teach client:
Indications • Take medication as directed before 6 PM.
Treatment of attention deficit/hyperactivity disorder • Weight will be assessed 2–3 times weekly.
(ADHD). Symptomatic treatment of narcolepsy. • Avoid using caffeine-containing beverages.
Unlabeled uses: Management of some forms of • Report palpitations or insomnia.
refractory depression. • Parents are to notify school nurse of medication
regimen (ADHD).
Action
Produce CNS and respiratory stimulation with weak
sympathomimetic activity. Make the Connection
Adverse Reactions/Side Effects • Using with MAOIs or vasopressors may
CNS: hyperactivity, insomnia, restlessness, result in hypertensive crisis.
tremor, dizziness, headache, irritability. EENT: • Monitor BP, pulse, and respiration.
blurred vision. CV: HTN, palpitations, tachycardia, • Medication has a high dependence and abuse
hypotension. GI: anorexia, constipation, cramps, potential.
diarrhea, dry mouth, metallic taste, nausea, • Assess effectiveness when used for ADHD or
vomiting. Derm: rashes. Neuro: akathisia, narcolepsy.
dyskinesia. Misc: fever, hypersensitivity reactions, • Monitor CBC.
physical dependence, psychological dependence,
suppression of weight gain (children), tolerance.

Route/Dosage: Methylphenidate: transdermal/(children) 10–30 mg over a wk, gradually increased; PO/5–20 mg 2–3 times a day (ER varies as to
formulation), Dexmethylphenidate: PO/2.5–10Uploaded
mg bid; 10 mg bidby
(ER) MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 153

Central Nervous System Drugs Central Nervous System Stimulants 153

Amphetamine
(am-fet-a-meen)

Amphetamine Salt, Adderall,

Adderall XR
1882_Tab06_109-160 11/10/12 2:40 PM Page 153

Central Nervous System Drugs Central Nervous System Stimulants 153

Therapeutic/Pharmacologic Class Keep in Mind
Central nervous system (CNS) stimulant Teach client:
Indications • Take the medication at least 6 hr before bedtime.
Treatment of narcolepsy. Adjunct in the management • Report insomnia or palpitations.
of ADHD. • Weight will be assessed frequently.
Action
Causes release of norepinephrine from nerve endings. Make the Connection
Adverse Reactions/Side Effects • Using with MAOIs or meperidine can
CNS: hyperactivity, insomnia, irritability, rest- result in hypertensive crisis.
lessness, tremor, dizziness, headache, cardiomy- • Monitor BP, pulse, and respiration.
opathy (increased with prolonged use, high • Medication may produce a false sense of euphoria
doses). CV: palpitations, tachycardia, HTN, and well-being.
hypotension. GI: anorexia, constipation, cramps, • Medication has high dependence and abuse
diarrhea, dry mouth, metallic taste, nausea, potential.
vomiting. GU: erectile dysfunction, increased • Monitor weight biweekly.
libido. Derm: urticaria. Endo: growth inhibition • Assess effectiveness in treatment of ADHD or
(with long-term use in children). Misc: psycho- narcolepsy.
logical dependence.

Uploaded
Route/Dosage: PO/(narcolepsy) 10–60 mg daily in divided doses; by MEDBOOKSVN.ORG
PO/(ADHD) 20 mg ER formulation once daily
1882_Tab06_109-160 11/10/12 2:40 PM Page 154

Central Nervous System Drugs Selective Norepinephrine Reuptake Inhibitor 154

Atomoxetine
(a-to-mox-e-teen)

Strattera
1882_Tab06_109-160 11/10/12 2:40 PM Page 154

Central Nervous System Drugs Selective Norepinephrine Reuptake Inhibitor 154

Therapeutic/Pharmacologic Class
Attention deficit disorder agent/selective norepi-
nephrine reuptake inhibitor
Indications
Treatment of ADHD.
Action
Selectively inhibits the presynaptic transporter of
norepinephrine.
Adverse Reactions/Side Effects
CNS: dizziness, fatigue, mood swings, insomnia
(adults). CV: HTN, orthostatic hypotension,
tachycardia. GI: dyspepsia, severe liver injury
(rare), nausea, vomiting; dry mouth, constipa-
tion. Derm: rash, urticaria. GU: dysmenorrhea,
ejaculatory problems, ↓ libido, erectile dysfunc-
tion, urinary hesitation, urinary retention.
Metab: decreased appetite, weight/growth loss.
Misc: allergic reactions including angioneurotic
edema.
Keep in Mind
Teach client:
• Take medication as directed.
• Avoid pregnancy or breastfeeding.
• Notify school nurse of ADHD medication regimen.
Make the Connection
• Contraindicated if used concurrently
with or within 2 wk of MAOIs.
• Contraindicated in clients with narrow-angle
glaucoma or CV history.
• This medication may ↑ risk of suicide attempt/
ideation.
• Concurrent albuterol or vasopressor use
increases risk of adverse CV reactions.
• Assess effectiveness for treatment of ADHD.
• Monitor BP, pulse, and LFT.

Route/Dosage: PO/40–100 mg daily in dividedUploaded byearlyMEDBOOKSVN.ORG

doses in the AM and PM
1882_Tab06_109-160 11/10/12 2:40 PM Page 155

Central Nervous System Drugs Central Nervous System Stimulant 155

Modafinil
(mo-daf-i-nil)

Provigil
1882_Tab06_109-160 11/10/12 2:40 PM Page 155

Central Nervous System Drugs Central Nervous System Stimulant 155

Therapeutic/Pharmacologic Class disorder, neck pain. Neuro: ataxia, dyskinesia,
Central nervous system (CNS) stimulant hypertonia, paresthesia, tremor. Misc: infection.
Indications Keep in Mind
Improvement of wakefulness in clients with excessive Teach client:
daytime drowsiness due to narcolepsy, obstructive
sleep apnea, or shift work sleep disorder. • Take the medication as directed.
Action
• This medication may impair judgment.
• Avoid pregnancy or breastfeeding.
Produces CNS stimulation through several pathways
(weak dopaminergic activity, alpha1-adrenergic ago-
• Notify HCP immediately if rash, hives, or other
allergic reactions occur.
nism, and decrease in GABA transmission).
Adverse Reactions/Side Effects
CNS: headache, amnesia, anxiety, cataplexy,
Make the Connection
confusion, depression, dizziness, insomnia, ner- • Contraindicated in patients with CV
problems.
vousness. EENT: rhinitis, abnormal vision, ambly-
opia, epistaxis, pharyngitis. Resp: dyspnea, lung • May cause elevated liver enzymes, so monitor
LFT periodically.
disorder. CV: arrhythmias, chest pain, HTN,
hypotension, syncope, vasodilation. GI: nausea, • Administer as a single dose in the morning or 1 hr
before the start of work shift for clients with shift
abnormal liver function, anorexia, diarrhea,
work sleep disorder.
gingivitis, mouth ulcers, thirst, vomiting. GU:
abnormal ejaculation, albuminuria, urinary
retention. Derm: dry skin, herpes simplex. Endo:
hyperglycemia. Hemat: eosinophilia. MS: joint

Uploaded
Route/Dosage: PO/200 mg daily as a single dose by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 156

Central Nervous System Drugs 5-HT1 Agonists 156

Almotriptan Sumatriptan
(al-moe-trip-tan) (su-ma-trip-tan)

Axert Imitrex, Imitrex

STATdose, Sumavel
DosePro

Rizatriptan Naratriptan
(ri-za-trip-tan) (nar-a-trip-tan)

Maxalt, Maxalt-MLT Amerge

1882_Tab06_109-160 11/10/12 2:40 PM Page 156

Central Nervous System Drugs 5-HT1 Agonists 156

Therapeutic/Pharmacologic Class • Lying down in a darkened room following drug
Vascular headache suppressant/5-HT1 agonist administration may further help relieve headache.
Indications • Avoid pregnancy or breastfeeding.
Treatment of acute migraine headache. • Notify HCP prior to next dose of the drug if
there is pain or tightness in the chest or if pain
Action is severe or does not subside.
Acts as an agonist at specific 5-HT1 receptor sites in
intracranial blood vessels and sensory trigeminal nerves. • May cause dizziness or drowsiness.
• Avoid alcohol, which aggravates headache.
Adverse Reactions/Side Effects • Follow instructions for proper method of SC
CNS: drowsiness, headache. CV: coronary artery self-injection of medication.
vasospasm, MI, myocardial ischemia, VFib, VT.
GI: dry mouth, nausea. Neuro: paresthesia.
Make the Connection
Keep in Mind • Medication is contraindicated in basilar
Teach client: or hemiplegic migraine.
• Medication should be used only during a • Concurrent use with MAOI inhibitors, SSRIs, or
migraine attack. other 5-HT1 agonists is contraindicated.
• Medication should be used as soon as symptoms • Tablets should be swallowed whole with liquid.
of a migraine attack appear. • SC-administered medications may abort a vascular
• Do not take medication within 24 hr of another headache within several minutes.
vascular headache suppressant. • Monitor ECG.
Route/Dosage: Almotriptan: PO/6.25 mg initially. May repeat in 2 hr (2 dose maximum), Sumatriptan: PO/25–50 mg initially, may repeat in 2 hr
(300 mg/day maximum); SC/6 mg, may repeat in 1 hr (12 mg daily maximum); intranasal/5, 10, or 20 mg spray in one nostril, may repeat in
2 hr (40 mg daily maximum), Rizatriptan: PO/5–10 mg, may repeat in 2 hr (3 doses/24 hr maximum), Naratriptan: PO/1 or 2.5 mg, may repeat
in 4 hr (5 mg/24 hr maximum) Uploaded by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 157

Central Nervous System Drugs Adrenergics 157

Epinephrine
(e-pi-nef-rin)

Adrenalin, AsthmaNefrin,
EpiPen, S-2 (racepinephrine)
1882_Tab06_109-160 11/10/12 2:40 PM Page 157
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Antiasthmatic agent; bronchodilator; vasopressor/
adrenergic agent
Indications
Management of cardiac arrest. Increase of contrac-
tility, heart rate, and urinary output in shock.
Action
Results in the accumulation of cAMP at beta-
adrenergic receptors. Affects both beta1-adrenergic
(cardiac) receptors and beta2-adrenergic (pulmonary)
receptor sites. Produces bronchodilation. Also has
alpha-adrenergic agonist properties, which result in
vasoconstriction. Inhibits the release of mediators
of immediate hypersensitivity reactions from mast cells.
Adverse Reactions/Side Effects
CNS: nervousness, restlessness, tremor,
headache, insomnia. Resp: paradoxical bron-
chospasm (excessive use of inhalers). CV: angina,
arrhythmias, HTN, tachycardia. GI: nausea,
vomiting. Endo: hyperglycemia.
Route/Dosage: SC, IM/0.1–0.5 mg, may repeat q 10–15 min for anaphylaxis; IV/0.1–0.25 mg q 5–15 min for severe anaphylaxis; Inhaln/MDI
Uploaded
delivering 160–250 mcg in one puff, may repeat
once after 1 min, then MEDBOOKSVN.ORG
Adrenergics 157
Keep in Mind
Teach client:
• Take medication exactly as directed.
• Contact HCP immediately if SOB is not relieved
by medication or is accompanied by diaphoresis,
dizziness, palpitations, or chest pain.
• Follow instructions for proper use of MDIs.
Make the Connection
• Contraindicated in hypersensitivity to
adrenergic amines and in cardiac arrhythmias.
• Assess lung sounds, respiratory pattern, pulse,
BP, and ECG.
• Observe for paradoxical bronchospasm
(wheezing).
• Assess for hypersensitivity reaction (rash;
urticaria; swelling of the face, lips, or eyelids).
• May cause an increase in blood glucose and
serum lactic acid concentrations.
• Client harm or fatalities have occurred from
medication errors with this drug. Have second
practitioner check dose calculations (IV).
byq 3–4
hr
1882_Tab06_109-160 11/10/12 2:40 PM Page 158

Central Nervous System Drugs Adrenergics 158

Terbutaline
(ter-byoo-ta-leen)
1882_Tab06_109-160 11/10/12 2:40 PM Page 158
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Bronchodilator/adrenergic agent
Indications
Management of reversible airway disease due to
asthma or COPD; Inhaln and SC agents used for
short-term control and oral agent for long-term
control.
Action
Results in the accumulation of cAMP at beta-
adrenergic receptors. Relaxes smooth muscle in
the airways, vessels, and uterus.
Adverse Reactions/Side Effects
CNS: nervousness, restlessness, tremor, headache,
insomnia. Resp: paradoxical bronchospasm
(excessive use of inhalers). CV: angina, arrhyth-
mias, HTN, tachycardia. GI: nausea, vomiting.
Endo: hyperglycemia.
Uploaded
Route/Dosage: PO/2.5–5 mg tid; SC/250 mcg,
may repeat in 15–30
Adrenergics 158
Keep in Mind
Teach client:
• Take the medication exactly as directed.
• Contact HCP immediately if SOB is not relieved
or if chest pain occurs.
• Consult HCP before taking any OTC medications
or consuming alcoholic beverages.
• Avoid smoking and other respiratory irritants.
Make the Connection
• Assess lung sounds, respiratory pattern,
ECG, pulse, and BP before administration and
during peak of medication.
• Observe for paradoxical bronchospasm
(wheezing).
• Symptoms of overdose include persistent agitation,
chest pain or discomfort, decreased BP, dizziness,
hyperglycemia, hypokalemia, seizures, tachyarrhyth-
mias, persistent trembling, and vomiting.
byminMEDBOOKSVN.ORG
(500 mcg in 4 hr maximum); IV/2.5–10 mcg/min infusion for tocolysis
1882_Tab06_109-160 11/10/12 2:40 PM Page 159

Central Nervous System Drugs Opioid Agonist Antagonist 159

Butorphanol
(byoo-tor-fa-nole)

Stadol, Stadol NS
1882_Tab06_109-160 11/10/12 2:40 PM Page 159
Central Nervous System Drugs
Therapeutic/Pharmacologic Class
Opioid analgesic/opioid agonist antagonist
Indications
Management of moderate-to-severe pain.
Treatment of labor pain. Sedation prior to surgery
and supplement in balanced anesthesia.
Action
Binds to opiate receptors in the CNS. Alters the
perception of and response to painful stimuli while
producing generalized CNS depression. Has partial
antagonist properties that may result in opioid
withdrawal in physically dependent patients.
Adverse Reactions/Side Effects
CNS: confusion, dysphoria, hallucinations,
sedation, euphoria, floating feeling, headache,
unusual dreams. EENT: blurred vision, diplopia,
miosis (high doses). Resp: respiratory depres-
sion. CV: HTN, hypotension, palpitations. GI:
nausea, constipation, dry mouth, ileus, vomiting.
GU: urinary retention. Derm: sweating, clammy
feeling. Misc: physical dependence, psychological
dependence, tolerance.
Route/Dosage: IM/1–4 mg q 3–4 hr; IV/0.5–2Uploaded
mg q 3–4 hr; intranasal/1–2 mg (1–2 sprays) q 3–4 hr
Opioid Agonist Antagonist 159
Keep in Mind
Teach client:
• Request pain medication prior to the pain becoming
severe.
• Medication may cause drowsiness or dizziness. Call
for assistance when ambulating. Change positions
slowly to minimize orthostatic hypotension.
• Turn, cough, and deep-breathe or use incentive
spirometer q 2 hr to prevent atelectasis.
Make the Connection
• Assess pain level using a scale or client
behavior.
• Monitor VS regularly, especially respiratory rate
and pulse oximetry.
• Assess previous analgesic history. Administering
this medication to a client who is opioid-dependent
may cause immediate withdrawal symptoms.
• Monitor for ↑ serum amylase and lipase.
• Antidote is naloxone.
by MEDBOOKSVN.ORG
1882_Tab06_109-160 11/10/12 2:40 PM Page 160

Central Nervous System Drugs Antidepressants 160

St. John’s Wort

(Hypericum perforatum)
(saynt jonz wort)

Amber, Demon chaser,

Goatweed, Hardhay, Klamath
weed, Rosin rose, Tipton weed
1882_Tab06_109-160 11/10/12 2:40 PM Page 160
Central Nervous System Drugs Antidepressants
Therapeutic/Pharmacologic Class
Antidepressants
Indications
Treatment of mild depressive symptoms.
Action
Derived from Hypericum perforatum; the active com-
ponent is hypericin. PO: Antidepressant action may
be due to ability to inhibit reuptake of serotonin and
other neurotransmitters. Topical: Anti-inflammatory,
antifungal, antiviral, and antibacterial properties.
Adverse Reactions/Side Effects
CNS: dizziness, restlessness, sleep disturbances.
CV: HTN. Endo: hypoglycemia. GI: abdominal
pain, bloating, diarrhea, dry mouth, feeling of full-
ness, flatulence, nausea, vomiting. Neuro: neuropa-
thy. Derm: allergic skin reactions (hives, itching, skin
rash), phototoxicity. Misc: serotonin syndrome.
Keep in Mind
Teach client:
• Depression should be evaluated by HCP.
Standard therapy may be of greater benefit
for moderate-to-severe depression. St. John’s
Route/Dosage: PO/300 mg tid Uploaded by MEDBOOKSVN.ORG
160
wort should be taken for 4–6 wk. If no improve-
ment, see HCP.
• Tell HCP if herbals are being used. Buy herbals
from reputable supplier.
• Avoid sun exposure and use protective sunscreen
to reduce the risk of photosensitivity reactions.
• Do not use alcohol while taking St. John’s wort.
• St. John’s wort may reduce the therapeutic effec-
tiveness of several drugs and may potentiate
effect of sedatives and side effects of other antide-
pressants. Do not take within 2 wk of MAOIs,
SSRIs, TCAs, or SNRIs.
Make the Connection
• Use with MAOIs, tramadol, and selective
serotonin agonists could result in serotonin
syndrome.
• May ↓ effectiveness of oral contraceptives, pheny-
toin, and phenobarbital.
• Assess client for improvement of depressive symp-
toms or improvement of skin lesions (topical).
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 13
CARDIOVASCULAR
Protamine Sulfate, 161
Heparin, 162
Tinzaparin, 162
Dalteparin, 163
Enoxaparin, 163
Warfarin, 164
Ticlopidine, 165
Clopidogrel, 165
Cilostazol, 165
Aminocaproic Acid, 166
Alteplase, 167
Tenecteplase, 167
Streptokinase, 167
Reteplase, 167
Phytonadione, 168
Digoxin, 169
Milrinone, 170
Inamrinone, 170
Nesiritide, 171
Dopamine, 172
Metoprolol, 173
Carvedilol, 173
Atenolol, 173
Labetalol, 173
Amlodipine, 174
Verapamil, 174
Nifedipine, 174
Diltiazem, 174
Enalapril, Enalaprilat, 175
Lisinopril, 175
Ramipril, 175
Captopril, 175
Losartan, 176
Candesartan, 176
Valsartan, 176
Irbesartan, 176
Clonidine, 177
Procainamide, 178
Lidocaine
(parenteral), 178
Amiodarone, 178
Quinidine, 178
Isosorbide
Mononitrate, 179
Nitroglycerin, 179
Isosorbide Dinitrate, 179
Gemfibrozil, 180
Fenofibrate, 180
Atorvastatin, 181
Rosuvastatin, 181
Simvastatin, 181
Continued
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 14

CARDIOVASCULAR

Lovastatin, 181 Omega-3-Acid Ethyl Atropine, 188

Ezetimibe, 182 Esters, 184 Dabigatran, 189
Colestipol, 183 Folic Acid, 185 Desirudin, 189
Cholestyramine Aliskiren, 186 Oprelvekin, 190
Resin, 183 Pegfilgrastim, 187 Fondaparinux, 191
Colesevelam, 183 Filgrastim, 187 Rivaroxaban, 191

Uploaded by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 161

Cardiovascular System Drugs Antiheparin 161

Protamine Sulfate
(proe-ta-meen soll-fate)

Protamine Sulfate (Injection)

1882_Tab07_161-191 11/10/12 2:41 PM Page 161
Cardiovascular System Drugs Antiheparin
Therapeutic/Pharmacologic Class
Antidote/antiheparin agent
Indications
Acute management of severe heparin overdosage.
Neutralization of heparin received during dialysis,
cardiopulmonary bypass, and other procedures.
Unlabeled uses: Management of overdose of
heparin-like compounds.
Action
A strong base that forms a complex with heparin
(an acid).
Adverse Reactions/Side Effects
Resp: dyspnea. CV: bradycardia, HTN, hypoten-
sion, pulmonary hypertension. GI: nausea,
vomiting. Derm: flushing, warmth. Hemat:
bleeding. MS: back pain. Misc: hypersensitivity
reactions, including anaphylaxis, angioedema,
and pulmonary edema.
Uploaded
Route/Dosage: IV/0.5–1.5 mg/100 units heparin
(based on time frame MEDBOOKSVN.ORG
161
Keep in Mind
Teach client:
• Report recurrent bleeding immediately.
• Avoid activities that may result in bleeding.
Make the Connection
• Assess for bleeding and hemorrhage
throughout therapy.
• Assess for allergy to fish (salmon) or previous
reaction to or use of insulins containing this
drug or to the drug itself. Observe client for
signs and symptoms of hypersensitivity reaction.
• Vasectomized and infertile men also have higher
risk for hypersensitivity reaction because of the
presence of antibodies to the drug found in
their serum.
• Monitor clotting factors.
• In severe cases, fresh frozen plasma or whole
blood may be required to control bleeding.
• Dosage varies with type of heparin, route of
heparin therapy, and amount of time elapsed
since discontinuation of heparin.
• May be given as a direct, undiluted IV infusion.
by and
route)
1882_Tab07_161-191 11/10/12 2:41 PM Page 162

Cardiovascular System Drugs Antithrombotics 162

Heparin
(hep-a-rin)

Hep-Lock, Hep-Lock U/P

Hepalean

Tinzaparin
(Tin-za-par-in)

Innohep
1882_Tab07_161-191 11/10/12 2:41 PM Page 162
Cardiovascular System Drugs
Therapeutic/Pharmacologic Class
Anticoagulant/antithrombotic agent
Indications
Prophylaxis and treatment of various thromboem-
bolic disorders, including venous and arterial
thrombosis, embolism, pulmonary emboli, coagu-
lopathies, and atrial fibrillation with embolization.
Action
Potentiates the inhibitory effect of antithrombin on
factor Xa and thrombin. In low doses, prevents the
conversion of prothrombin to thrombin by its effects
on factor Xa. In higher doses, neutralizes thrombin,
preventing the conversion of fibrinogen to fibrin.
Adverse Reactions/Side Effects
GI: drug-induced hepatitis. Derm: alopecia
(long-term use), rash, urticaria. Hemat: bleed-
ing, anemia, thrombocytopenia. Local: pain at
the injection site. MS: osteoporosis (long-term
use). Misc: fever, hypersensitivity.
Route/Dosage: Heparin: SC/5000 units q 8–12 hr; IV/35–70 units/kg continuous infusion (weight-based dosage changes with partial thromboplastin time
Uploaded
(PTT) level/weight calculation), Tinzaparin: SC/175 IU/kg daily by MEDBOOKSVN.ORG
Antithrombotics 162
Keep in Mind
Teach client:
• Report any symptoms of unusual bleeding or
bruising to the HCP immediately.
• Do not take antiplatelet agents.
• Use a soft toothbrush and an electric razor.
• Wear a Medic-Alert bracelet at all times.
Make the Connection
• Assess client for signs of bleeding and
hemorrhage.
• Monitor for hypersensitivity reactions.
• Assess LFT, K+, CBC, aPTT, and D-dimer studies.
• Two practitioners should independently check the
order, calculate the dose (especially in weight-
based applications), and set the infusion pump.
The two practitioners then cosign the MAR.
• Antidote is protamine sulfate.
1882_Tab07_161-191 11/10/12 2:41 PM Page 163

Cardiovascular System Drugs Antithrombotics (Low Molecular Weight

Heparins) 163

Dalteparin
(dal-te-pa-rin)

Fragmin

Enoxaparin
(e-nox-a-pa-rin)

Lovenox
1882_Tab07_161-191 11/10/12 2:41 PM Page 163
Cardiovascular System Drugs Antithrombotics (Low Molecular Weight
Heparins)
Therapeutic/Pharmacologic Class
Anticoagulant/antithrombotic agent; low molecular
weight heparins
Indications
Prevention of DVT and PE after abdominal surgery
or knee/hip surgery or replacement.
Action
Potentiates the inhibitory effect of antithrombin on
factor Xa and thrombin.
Adverse Reactions/Side Effects
CNS: dizziness, headache, insomnia. CV: edema.
GI: constipation, nausea, reversible increase in
liver enzymes, vomiting. Derm: ecchymosis,
pruritus, rash, urticaria. Hemat: bleeding, anemia,
thrombocytopenia. Local: pain at the injection
site, hematoma. Misc: fever, hypersensitivity.
Neuro: epidural or spinal hematoma with use of
these anticoagulants during spinal procedures.
Uploaded
Route/Dosage: Dalteparin: SC/2500 IU 2 hr before
surgery, Enoxaparin: SC/30–40 mg daily
163
Keep in Mind
Teach client:
• Report any symptoms of unusual bleeding or
bruising to the HCP immediately.
• Do not concurrently take antiplatelet agents.
• Use a soft toothbrush and an electric razor.
• Wear a Medic-Alert bracelet at all times.
• Follow instructions for proper method of inject-
ing the drug.
Make the Connection
• Assess client for signs of bleeding and
hemorrhage.
• Monitor for hypersensitivity reactions.
• Monitor CBC with platelets and D-dimer studies.
• Monitor LFT.
• Antidote is protamine sulfate.
• Injection systems have special instructions
(Lovenox is given in the “love handles”).
by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 164

Cardiovascular System Drugs Coumarins 164

Warfarin
(war-fa-rin)

Coumadin, Jantoven
Warfilone
1882_Tab07_161-191 11/10/12 2:41 PM Page 164
Cardiovascular System Drugs Coumarins
Therapeutic/Pharmacologic Class
Anticoagulant/coumarin
Indications
Prophylaxis and treatment of venous thrombosis,
PE, and atrial fibrillation with embolization.
Management of MI. Decrease of risk for death
and subsequent MI and PE. Prevention of thrombus
formation and embolization after prosthetic valve
placement.
Action
Interferes with hepatic synthesis of vitamin
K-dependent clotting factors (II, VII, IX, X).
Adverse Reactions/Side Effects
GI: cramps, nausea. Derm: dermal necrosis.
Hemat: bleeding. Misc: fever.
Keep in Mind
Teach client:
• Take medication exactly as directed.
• Do not eat excessive amounts of foods containing
vitamin K (give client a list).
Route/Dosage: PO, IV/2–5 mg daily, adjustedUploaded
by INR
164
• Use a soft toothbrush, floss gently, and shave
with an electric razor during therapy.
• Report any symptoms of unusual bleeding or
bruising.
• Do not drink alcohol or take antiplatelet
medications.
• Frequent laboratory tests will be done.
• Wear a Medic-Alert bracelet at all times.
• Inform all involved health-care personnel of
anticoagulant therapy before laboratory tests,
treatment, or surgery.
Make the Connection
• Assess client for signs of bleeding and
hemorrhage.
• Monitor PT, INR, and CBC.
• Assess stool and urine occult blood before and
periodically throughout therapy.
• The antidote is vitamin K.
• This medication requires 3–5 days to reach
effective levels.
by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 165

Cardiovascular System Drugs Platelet Aggregation Inhibitors 165

Ticlopidine Cilostazol
(tye-cloe-pi-deen) (sil-os-tah-zol)

Pletal

Clopidogrel
(kloh-pid-oh-grel)

Plavix
1882_Tab07_161-191 11/10/12 2:41 PM Page 165

Cardiovascular System Drugs Platelet Aggregation Inhibitors 165

Therapeutic/Pharmacologic Class
Antiplatelet agent/platelet aggregation inhibitor
Indications
Reduction of atherosclerotic events in clients at risk
for such events, including those with recent MI,
acute coronary syndrome (unstable angina/
non–Q-wave MI), stroke, or PVD/PAD.
Action
Decreases blood viscosity by inhibiting platelet
aggregation and decreasing fibrinogen. Inhibits
platelet aggregation by irreversibly inhibiting the
binding of ATP to platelet receptors.
Adverse Reactions/Side Effects
CNS: depression, dizziness, fatigue, headache.
EENT: epistaxis. Resp: cough, dyspnea.
CV: chest pain, edema, HTN. GI: GI bleeding,
abdominal pain, diarrhea, dyspepsia, gastritis.
Derm: pruritus, purpura, rash. Hemat: bleed-
ing, neutropenia, thrombotic thrombocy-
topenic purpura. Metab: hypercholesterolemia.
MS: arthralgia, back pain. Misc: fever, hypersen-
sitivity reactions.
Keep in Mind
Teach client:
• Take the medication exactly as directed.
• Notify HCP promptly if fever, chills, sore throat,
or unusual bleeding or bruising occurs.
• Avoid taking OTC medications containing aspirin
or NSAIDs without consulting HCP.
Make the Connection
• Assess client for symptoms of stroke,
peripheral vascular disease, and MI periodically
during therapy.
• Monitor client for signs of thrombotic thrombo-
cytic purpura.
• Prolonged bleeding time is expected. Monitor
CBC with differential and platelet count periodi-
cally during therapy.
• Monitor LFT, lipid panel, and uric acid level.
• Contraindicated in idiopathic thrombocytopenic
purpura.

Uploaded
Route/Dosage: Ticlopidine: PO/250 mg bid with food, Cilostazol:by MEDBOOKSVN.ORG
PO/100 mg bid, Clopidogrel: PO/75 mg/day
1882_Tab07_161-191 11/10/12 2:41 PM Page 166

Cardiovascular System Drugs Fibrinolysis Inhibitors 166

Aminocaproic Acid
(a-mee-noe-ka-pro-ik as-id)

Amicar, epsilon
aminocaproic acid
1882_Tab07_161-191 11/10/12 2:41 PM Page 166
Cardiovascular System Drugs Fibrinolysis Inhibitors
Therapeutic/Pharmacologic Class
Hemostatic agent/fibrinolysis inhibitor
Indications
Management of acute, life-threatening hemorrhage
due to systemic hyperfibrinolysis or urinary fibri-
nolysis. Prevention of recurrent subarachnoid
hemorrhage. Prevention of bleeding following oral
surgery in hemophiliacs. Management of severe
hemorrhage caused by thrombolytic agents.
Action
Inhibits activation of plasminogen. Plasminogen is a
serum protease that can be activated to form clots.
Adverse Reactions/Side Effects
CNS: dizziness, malaise. EENT: nasal stuffiness,
tinnitus. CV: arrhythmias, hypotension (IV only).
GI: anorexia, bloating, cramping, diarrhea, nau-
sea. GU: diuresis, renal failure. MS: myopathy.
Keep in Mind
Teach client:
• Notify the nurse immediately if bleeding recurs or
if thromboembolic symptoms develop.
Route/Dosage: PO, IV/6 mg/day Uploaded by MEDBOOKSVN.ORG
166
• When medication is given IV, make position
changes slowly to avoid orthostatic hypotension.
Make the Connection
• Contraindicated in active intravascular
clotting.
• Concurrent use with conjugated estrogens may
result in a hypercoagulable state and resultant
thrombus formation.
• Monitor BP, pulse, and respiratory status as
indicated by severity of bleeding.
• Monitor for overt bleeding every 15–30 min.
• Monitor neurologic status in clients with sub-
arachnoid hemorrhage.
• Monitor I&O frequently.
• Notify physician of positive Homans’ sign, leg
pain and edema, hemoptysis, dyspnea, or chest
pain.
• Monitor platelet count and clotting factors.
• Monitor for increased CPK, AST, and serum
aldolase, which may indicate myopathy.
• May elevate serum potassium, so assess
electrolytes frequently.
1882_Tab07_161-191 11/10/12 2:41 PM Page 167

Cardiovascular System Drugs Plasminogen Activators 167

Alteplase Streptokinase
(al-te-plase) (strep-toe-kye-nase)

Cathflo Activase, tissue Kabbikinase,

plasminogen activator, Streptase
t-PA, Activase
Activase rt-PA

Tenecteplase Reteplase
(te-nek-te-plase) (re-te-plase)

TNKase Retavase
1882_Tab07_161-191 11/10/12 2:41 PM Page 167
Cardiovascular System Drugs
Therapeutic/Pharmacologic Class
Thrombolytic agent/plasminogen activator
Indications
Treatment of acute MI. Treatment of acute ischemic
stroke. Treatment of PE. Clearance of occluded
central venous access devices. Treatment of DVT.
Treatment of acute peripheral arterial thrombosis.
Action
Directly converts plasminogen to plasmin, which
then degrades clot-bound fibrin.
Adverse Reactions/Side Effects
CNS: intracranial hemorrhage. EENT: epistaxis,
gingival bleeding. Resp: bronchospasm, hemop-
tysis. CV: reperfusion arrhythmias, hypotension,
recurrent ischemia/thromboembolism. GI: GI
bleeding, nausea, retroperitoneal bleeding,
vomiting. GU: GU tract bleeding. Derm: ecchy-
moses, flushing, urticaria. Hemat: bleeding.
Route/Dosage: Alteplase: IV/15 mg bolus, then 0.75 mg/kg over 30 min, and 0.5 mg/kg over next hr, Streptokinase: IV/1.5 million units over 60 min,
Uploaded
Tenecteplase: IV/30–50 mg (weight-based), Reteplase: IV/10 unitsby
Plasminogen Activators 167
Local: hemorrhage at injection site, phlebitis
at injection site. MS: MS pain. Misc: allergic
reactions including anaphylaxis, fever.
Keep in Mind
Teach client:
• Maintain bed rest and move carefully to prevent injuries.
Make the Connection
• Contraindicated in clients with active
internal bleeding, history of CVA or recent (within
2 mo) history of arteriovenous or CNS structural
abnormalities, severe HTN, or bleeding tendencies.
• Assess client for hypersensitivity reaction,
neurologic status, and bleeding.
• For MI, must be given within 6 hr of onset of
symptoms. Remember, time is muscle!
• For CVA, must be given within 2–3 hr of onset of
symptoms. Remember, time is brain!
• Monitor CBC, D-dimer, fibrinogen, PT, aPTT,
and thrombin time.
• Antidote is aminocaproic acid (Amicar).
MEDBOOKSVN.ORG
(repeat in 30 min)
1882_Tab07_161-191 11/10/12 2:41 PM Page 168

Cardiovascular System Drugs Fat-Soluble Vitamin 168

Phytonadione
(fye-toe-na-dye-one)

Mephyton, vitamin K
1882_Tab07_161-191 11/10/12 2:41 PM Page 168
Cardiovascular System Drugs Fat-Soluble Vitamin
Therapeutic/Pharmacologic Class
Antidote, vitamin/fat-soluble vitamin
Indications
Prevention and treatment of hypoprothrombine-
mia, which may be associated with excessive
doses of oral anticoagulants, salicylates, certain
anti-infective agents, nutrition deficiencies, and
prolonged TPN. Prevention of hemorrhagic disease
of the newborn.
Action
Required for hepatic synthesis of blood coagulation
factors II (prothrombin), VII, IX, and X.
Adverse Reactions/Side Effects
GI: gastric upset, unusual taste. Derm: flushing,
rash, urticaria. Hemat: hemolytic anemia. Local:
erythema, pain at injection site, swelling. Misc:
allergic reactions, hyperbilirubinemia (large
doses in very premature infants), kernicterus.
Keep in Mind
Teach client:
• Take this medication as ordered.
Uploaded
Route/Dosage: SC, IV/10 mg; PO/2.5–25 mg/day by MEDBOOKSVN.ORG
168
• The diet should remain consistent, with no
drastic changes, while taking this drug.
• Be aware of the rationale for this drug therapy.
• Watch for and report any symptoms of unusual
bleeding or bruising.
• While on this drug, consult with the HCP about
taking OTC medications.
• Wear a Medic-Alert bracelet.
• Frequent laboratory tests will be required to
monitor coagulation factors.
Make the Connection
• Monitor for frank and occult bleeding.
• Monitor pulse and BP frequently.
• PT and INR should be monitored.
• The parenteral route is preferred for this drug.
Because of severe, potentially fatal hypersensitivity
reactions, the IV route is not recommended.
• This drug is the antidote for warfarin overdose.
• Hint: “K” is for “Koagulation” (German form of
the word “coagulation”).
1882_Tab07_161-191 11/10/12 2:41 PM Page 169

Cardiovascular System Drugs Digitalis Glycosides 169

Digoxin
(di-jox-in)

Lanoxicaps, Lanoxin
1882_Tab07_161-191 11/10/12 2:41 PM Page 169
Cardiovascular System Drugs
Therapeutic/Pharmacologic Class
Antiarrhythmic agent; inotropic agent/digitalis
glycoside
Indications
Treatment of CHF, tachyarrhythmias, atrial fibrilla-
tion, atrial flutter, and paroxysmal atrial tachycardia.
Action
Slows and strengthens the force of myocardial con-
traction by prolonging the refractory period of the
atrioventricular (AV) node and decreasing conduc-
tion through the SA and AV nodes.
Adverse Reactions/Side Effects
CNS: fatigue, headache, weakness. EENT:
blurred vision, yellow or green vision. CV:
arrhythmias, bradycardia, ECG changes, AV
block, SA block. GI: anorexia, nausea, vomiting,
diarrhea. Endo: gynecomastia. Hemat: throm-
bocytopenia. Metab: hyperkalemia with acute
toxicity.
Uploaded
Route/Dosage: IV/0.5–1 mg (50% of dose), followed
by 25% of total doseMEDBOOKSVN.ORG
Digitalis Glycosides 169
Keep in Mind
Teach client:
• Take medication as directed. Report nausea,
vomiting, or anorexia.
• Wear a Medic-Alert bracelet, and inform other
HCPs of this drug regimen.
• Routine follow-up examinations will be scheduled.
Make the Connection
• Contraindicated in hypersensitivity,
uncontrolled ventricular arrhythmias, and AV blocks.
• Electrolyte abnormalities, especially of K+ (low),
predisposes to toxicity. Monitor electrolytes, LFT,
and RFT.
• Monitor apical pulse for 1 full min before admin-
istering the drug.
• Monitor I&O and daily weight. Assess for peripheral
edema, and auscultate lungs for rales/crackles
throughout therapy.
• Therapeutic serum digoxin levels range from
0.5 to 2 ng/mL.
• Digoxin immune Fab (Digibind) is the antidote.
• Monitor BNP levels.
by
at 6- to 12-hr intervals; PO/0.125–5 mg daily
1882_Tab07_161-191 11/10/12 2:41 PM Page 170

Cardiovascular System Drugs Bipyridines 170

Milrinone
(mill-ri-none)

Primacor

Inamrinone
(in-am-ri-none)

Inocor
1882_Tab07_161-191 11/10/12 2:41 PM Page 170
Cardiovascular System Drugs Bipyridines
Therapeutic/Pharmacologic Class
Inotropic agent, vasodilator/bipyridines
Indications
Short-term treatment of CHF unresponsive to con-
ventional therapy with digoxin, diuretics, and
vasodilators.
Action
Increases myocardial contractility. Decreases pre-
load (amount of blood returning to the heart) and
afterload (pressure in the aorta that the heart must
overcome to push blood out of the heart) by a
direct dilating effect on vascular smooth muscle.
Adverse Reactions/Side Effects
CNS: headache, tremor. CV: ventricular
arrhythmias, angina pectoris, chest pain,
hypotension, supraventricular arrhythmias.
CV: skin rash. GI: liver function abnormalities.
F and E: hypokalemia. Hemat: thrombocytopenia.
Route/Dosage: Milrinone: IV/0.5 mcg/kg/min,Uploaded
Inamrinone: IV/5–10
170
Keep in Mind
Teach client:
• Be aware of the reasons for administration and
the desired effect.
• ECG will be monitored.
• A decrease in SOB and edema should be
experienced.
• This drug will not cure CHF, but its use is a
temporary measure to control the symptoms.
Make the Connection
• Monitor pulse and BP. Slow or stop the
infusion if the BP drops significantly, because
this is a sign of overdose.
• Monitor I&O and daily weight.
• Monitor ECG continuously during infusion.
Arrhythmias are common and may be life
threatening.
• Monitor platelet count, electrolytes, and renal
function frequently during administration.
• Have second practitioner check dose calculations.
• Monitor peripheral IV site carefully.
• Monitor BNP levels.
bymcg/kg/min
MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 171

Cardiovascular System Drugs Vasodilators (Human B-type Natriuretic

Peptide) 171

Nesiritide
(ne-sir-i-tide)

Natrecor
1882_Tab07_161-191 11/10/12 2:41 PM Page 171

Cardiovascular System Drugs Vasodilators (Human B-Type Natriuretic

Peptide) 171
Therapeutic/Pharmacologic Class reactions. MS: back pain, leg cramps. Neuro:
Vasodilators; human B-type natriuretic peptide paresthesia, tremor. Misc: fever.
Indications Keep in Mind
Treatment of acutely decompensated CHF in hospi-
Teach client:
talized clients who have dyspnea at rest or with
minimal activity. • ECG will be monitored.
Action
• This drug will not cure CHF, but it will control the
symptoms.
Binds to guanylyl cyclase receptors in vascular
smooth muscle and endothelial cells, producing
increased intracellular guanosine 3´5´-cyclic Make the Connection
monophosphate (cGMP) and smooth muscle cell • Monitor BP, pulse, ECG, respiratory ease,
relaxation. cGMP acts as a “second messenger” to CVP (hypotension can be severe). Remember
dilate veins and arteries. BP low—down the head goes; BP high—head to
Adverse Reactions/Side Effects the sky.
CNS: anxiety, confusion, dizziness, headache, • Monitor I&O, daily weight, and RFT.
hypotension (dose related), insomnia, drowsi- • Monitor BNP levels.
ness. EENT: amblyopia. Resp: apnea, cough, • Have second practitioner independently check
hemoptysis. CV: HTN, arrhythmias, bradycar- dose calculations.
dia. GI: abdominal pain, nausea, vomiting. GU:
↑ creatinine, renal failure. Derm: itching, rash,
sweating. Hemat: anemia. Local: injection site

Route/Dosage: IV/0.01–0.03 mcg/kg/min Uploaded by MEDBOOKSVN.ORG

1882_Tab07_161-191 11/10/12 2:41 PM Page 172

Cardiovascular System Drugs Adrenergic 172

Dopamine
(dope-a-meen)

Intropin
Revimine
1882_Tab07_161-191 11/10/12 2:41 PM Page 172
Cardiovascular System Drugs
Therapeutic/Pharmacologic Class
Inotropic agent, vasopressor/adrenergic
Indications
Adjunct to standard measures to improve blood
pressure, cardiac output, and urinary output
in treatment of shock unresponsive to fluid
replacement.
Action
Small doses (0.5–3 mcg/kg/min) stimulate dopamin-
ergic receptors, producing renal vasodilation. Larger
doses (2–10 mcg/kg/min) stimulate dopaminergic
and beta1-adrenergic receptors, producing cardiac
stimulation and renal vasodilation. Doses greater
than 10 mcg/kg/min stimulate alpha-adrenergic
receptors and may cause renal vasoconstriction.
Adverse Reactions/Side Effects
CNS: headache. EENT: mydriasis (high dose).
Resp: dyspnea. CV: arrhythmias, hypotension,
angina, ECG change, palpitations, vasocon-
striction. GI: nausea, vomiting. Derm: piloerec-
tion. Local: irritation at IV site.
Route/Dosage: IV/1–15 mcg/kg/min (may be Uploaded
increased based on by
Adrenergic 172
Keep in Mind
Teach client:
• Inform the nurse immediately if chest pain,
dyspnea, numbness, tingling, or burning of
extremities occurs.
• Inform nurse immediately of pain or discomfort
at the site of administration.
Make the Connection
• Contraindicated in tachyarrhythmias,
pheochromocytoma, or hypersensitivity to
bisulfites.
• Do not administer with MAOI, ergot alkaloids
(ergotamine), or some antidepressants because
the combination can result in severe HTN.
• Using with IV phenytoin may cause hypotension
and bradycardia.
• Monitor BP, heart rate, PCWP, CO, CVP, ECG, and
urinary output continuously during administration.
• If hypotension occurs, administration rate should
be increased; if HTN occurs, rate is decreased.
• Have second practitioner independently check
dose calculations.
MEDBOOKSVN.ORG
condition; renal perfusion at lower end of dosage)
1882_Tab07_161-191 11/10/12 2:41 PM Page 173

Cardiovascular System Drugs Beta-Adrenergic Blockers 173

Metoprolol Atenolol
(me-toe-proe-lole) (a-ten-oh-lole)

Lopressor, Toprol-XL Tenormin

Betaloc-ZOK, Apo-Atenolol
Lopresor

Carvedilol Labetalol
(kar-ve-dil-ole) (la-bet-a-lole)

Coreg, Coreg CR Trandate

1882_Tab07_161-191 11/10/12 2:41 PM Page 173

Cardiovascular System Drugs Beta-Adrenergic Blockers 173

Therapeutic/Pharmacologic Class drug-induced hepatitis, nausea, vomiting. GU:
Antianginals; antihypertensives; antiarrhythmics/ erectile dysfunction, decreased libido, urinary
beta-adrenergic receptor blocker (beta blocker) frequency. Derm: rash. Endo: hyperglycemia,
Indications hypoglycemia. MS: arthralgia. Misc: drug-
Treatment of HTN. Prevention of MI and decrease induced lupus syndrome.
of mortality in clients with recent MI. Management
Keep in Mind
of stable, symptomatic CHF.
Teach client:
Action • Notify HCP if slow pulse or dyspnea occurs.
Blocks stimulation of beta1-adrenergic receptors.
Do not usually affect beta2-adrenergic receptor sites
if cardioselective. Make the Connection
Adverse Reactions/Side Effects • Assess the pulse and BP prior to
CNS: fatigue, weakness, anxiety, depression, administering.
dizziness, drowsiness, insomnia, memory loss, • Monitor LFT, RFT, electrolytes, ANA, I&O, and
mental status changes, nervousness, nightmares. daily weight.
EENT: blurred vision, stuffy nose. Resp: bron- • Notice the endings olol, ilol, or alol in the generic
chospasm, wheezing. CV: bradycardia, CHF, names.
pulmonary edema, hypotension, peripheral
vasoconstriction. GI: constipation, diarrhea,

Route/Dosage: Metoprolol: IV/5 mg q 2 min 3 times; PO/25–100 mg/day, Atenolol: PO/50–100 mg/day, Carvedilol: PO/6.25 mg bid; XR/20 mg/day,
Uploaded
Labetalol: PO/400–800 mg/day in 2—3 divided doses; by MEDBOOKSVN.ORG
IV/2 mg/min infusion
1882_Tab07_161-191 11/10/12 2:41 PM Page 174

Cardiovascular System Drugs Calcium Channel Blockers 174

Amlodipine Nifedipine
(am-loe-di-peen) (nye-fed-i-peen)

Norvasc Procardia, Procardia XL,

Adalat CC
Apo-Nifed,
Novo-Nifedin

Verapamil Diltiazem
(ver-ap-a-mil) (dil-tye-a-zem)

Calan, Calan SR, Cardizem, Cardizem LA,

Covera-HS, Isoptin, CartiaXT, Dilacor XR,
Isoptin SR Diltia XT, Tiazac
Novo-Veramil, Apo-Diltiaz,
Nu-Verap Novo-Diltazem
1882_Tab07_161-191 11/10/12 2:41 PM Page 174

Cardiovascular System Drugs Calcium Channel Blockers 174

Therapeutic/Pharmacologic Class
Antianginal agent; antiarrhythmic agent (class IV);
antihypertensive agent/calcium channel blocker
Indications
Treatment of hypertension, angina pectoris and
Prinzmetal’s angina, and arrhythmias.
Action
Inhibits transport of calcium into myocardial and
vascular smooth muscle cells, resulting in inhibition
of excitation of muscle.
Adverse Reactions/Side Effects
CNS: abnormal dreams, anxiety, confusion,
dizziness, drowsiness, headache, nervousness,
psychiatric disturbances, weakness. EENT:
blurred vision, disturbed equilibrium, epistaxis,
tinnitus. Resp: cough, dyspnea. CV: arrhyth-
mias, CHF, peripheral edema, bradycardia,
chest pain, hypotension, palpitations, syncope,
tachycardia. GI: abnormal LFT, anorexia,
constipation, diarrhea. GU: dysuria, nocturia,
polyuria, sexual dysfunction, urinary frequency.
Derm: dermatitis, flushing, increased sweating,
photosensitivity, rash. Endo: gynecomastia,
hyperglycemia. Hemat: anemia, leukopenia,
thrombocytopenia. Metab: weight gain.
MS: joint stiffness, muscle cramps. Neuro:
paresthesia, tremor. Misc: Stevens-Johnson
syndrome, gingival hyperplasia.
Keep in Mind
Teach client:
• Report unrelieved chest pain or SOB immediately.
Make the Connection
• Take BP and pulse prior to administration.
• Monitor ECG, I&O, and daily weight.
• Monitor LFT, RFT, CBC, serum glucose level,
and K+.
• Notice the “Ca” in most brand names.

Route/Dosage: Amlodipine: PO/5–10 mg/day, Nifedipine: PO/10–30 mg tid; XL/30–90 mg daily, Verapamil: PO/80–120 mg tid; XL/80–240 mg/day;
IV/5–10 mg/kg, Diltiazem: PO/30–120 mg 3–4Uploaded by LA/up
times/day; SR/180–240; MEDBOOKSVN.ORG
to 360 mg/day
1882_Tab07_161-191 11/10/12 2:41 PM Page 175

Cardiovascular System Drugs ACE Inhibitors 175

Enalapril, Ramipril
(ra-mi-pril)
Enalaprilat
(e-nal-a-pril, e-nal-a-pril-at)
Altace
Vasotec,
Vasotec IV

Lisinopril Captopril
(lyse-sin-oh-pril) (kap-toe-pril)

Prinivil, Zestril Capoten

1882_Tab07_161-191 11/10/12 2:41 PM Page 175
Cardiovascular System Drugs
Therapeutic/Pharmacologic Class
Antihypertensive agent/angiotensin-converting
enzyme (ACE) inhibitor
Indications
Used alone or with other agents in the management
of HTN. Reduction of death or development of
CHF after MI. Slowed progression of left ventricular
dysfunction.
Action
ACE inhibitors block the conversion of angiotensin I
to angiotensin II, a potent vasoconstrictor. They also
inhibit the renin-angiotensin-aldosterone system,
reducing the amount of aldosterone (the body’s
salt) in the bloodstream.
Adverse Reactions/Side Effects
CNS: dizziness, fatigue, headache, insomnia,
weakness. Resp: cough, eosinophilic pneu-
monitis. CV: hypotension, angina pectoris,
tachycardia. GI: taste disturbances, anorexia,
diarrhea, hepatotoxicity (rare), nausea.
Route/Dosage: Enalapril: PO/2.5–5 mg/day; IV/0.625–1.25 mg q 6 hr, Ramipril: PO/2.5–20 mg/day in divided doses, Lisinopril: PO/10–40 mg/day,
Captopril: PO/12.5–25 mg 2–3 times/day Uploaded by MEDBOOKSVN.ORG
ACE Inhibitors 175
GU: proteinuria, erectile dysfunction, renal
failure. Derm: rash. F and E: hyperkalemia.
Hemat: BMS. Misc: angioedema, fever.
Keep in Mind
Teach client:
• Take this medication exactly as directed.
• Report to the HCP immediately if chest pain;
palpitations; or swelling of the lips, face, or
tongue occurs.
• This medication may cause drowsiness.
Make the Connection
• Always take the BP prior to administration.
• Monitor I&O and daily weight.
• Monitor for signs of angioedema.
• Assess for signs of CHF.
• Monitor LFT, RFT, CBC, serum glucose, and
K+(↑).
• Notice the ending “pril” in the generic names.
1882_Tab07_161-191 11/10/12 2:41 PM Page 176

Cardiovascular System Drugs Angiotensin II Receptor Antagonists 176

Losartan Valsartan
(loe-sar-tan) (val-sar-tan)

Cozaar Diovan

Candesartan Irbesartan
(can-de-sar-tan) (ir-be-sar-tan)

Atacand Avapro
1882_Tab07_161-191 11/10/12 2:41 PM Page 176

Cardiovascular System Drugs Angiotensin II Receptor Antagonists 176

Therapeutic/Pharmacologic Class • Report to the HCP immediately if a rash; mouth
Antihypertensive agent/angiotensin II receptor sores; sore throat; fever; swelling of the hands or
antagonists feet; irregular heartbeat; chest pain; dry cough;
Indications hoarseness; swelling of the face, lips, or tongue;
Management of HTN. Treatment of CHF in clients difficulty swallowing; or breathing occurs.
who cannot tolerate ACE inhibitors. Reduction of • Report nausea, vomiting, diarrhea, or a metallic
stroke risk in clients with CHF and left ventricular taste that produces anorexia.
hypertrophy. • Do not use salt substitutes.
Action • Follow instructions for correct method of assess-
ing BP.
Block receptors for angiotensin II, disabling the
renin-angiotensin-aldosterone system. • Women of childbearing age should use
contraception.
Adverse Reactions/Side Effects • This medication may cause drowsiness.
CNS: dizziness, fatigue, headache. CV: hypoten-
sion. GI: diarrhea, drug-induced hepatitis.
GU: renal failure. F and E: hyperkalemia. Make the Connection
• Always take the BP prior to administration.
Keep in Mind • Monitor ECG periodically during prolonged
Teach client: therapy. May cause prolonged PR interval.
• Take this medication exactly as directed. • Monitor I&O and daily weight.
• Assess for signs of CHF and angioedema.
• Monitor LFT, RFT, CBC, and K+ level.
• Notice the ending “sartan” in the generic names.
Route/Dosage: Losartan: PO/25–100 mg/day, Valsartan: PO/80–160 mg/day, Candesartan: PO/16–32 mg/day (divided doses),
Irbesartan: PO/150–300 mg/day Uploaded by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 177

Cardiovascular System Drugs Central Alpha-Adrenergic Agonists 177

Clonidine
(klon-i-deen)

Catapres, Catapres-TTS
Dixarit
1882_Tab07_161-191 11/10/12 2:41 PM Page 177

Cardiovascular System Drugs Central Alpha-Adrenergic Agonists 177

Therapeutic/Pharmacologic Class
Antihypertensive agent/alpha-adrenergic stimulant
(centrally acting)
Indications
Management of mild-to-moderate HTN. Epidural:
Management of cancer pain unresponsive to
opioids alone. Unlabeled Uses: Management of
opioid withdrawal.
Action
Stimulates alpha-adrenergic receptors in the brainstem,
which decreases sympathetic outflow inhibiting car-
dioacceleration and vasoconstriction centers. Prevents
pain signal transmission to the CNS by stimulation of
alpha-adrenergic receptors in the spinal cord.
Adverse Reactions/Side Effects
CNS: drowsiness, depression, dizziness, nervous-
ness, nightmares. CV: bradycardia, hypotension
(increased with epidural), palpitations. GI: dry
mouth, constipation, nausea, vomiting. GU:
impotence. Derm: rash, sweating. F and E: Na
retention. Metab: weight gain. Misc: withdrawal
phenomenon.
Keep in Mind
Teach client:
• Take the drug at the same time each day.
• Notify HCP if itching or redness of skin (with
transdermal patch), mental depression, swelling
of feet and lower legs, or vivid dreams or night-
mares occur.
• Self-monitor BP.
• Follow instructions for proper application of
transdermal system. Change every 7 days.
Make the Connection
• Monitor I&O and daily weight, and assess
for edema daily.
• Monitor BP and pulse prior to administering this
medication.

Uploaded
Route/Dosage: PO/0.1–0.2 mg/day; transdermal/0.1–0.3 mg/24 by
hr q 7 MEDBOOKSVN.ORG
days
1882_Tab07_161-191 11/10/12 2:41 PM Page 178

Cardiovascular System Drugs Antiarrhythmics 178

Procainamide Amiodarone
(proe-kane-ah-mide) (am-ee-oh-da-rone)

Cordarone, Pacerone,
Nexterone

Lidocaine Quinidine
(kwin-i-deen)
(parenteral)
(lye-doe-kane)
Apo-quinidine
LidoPen, Xylocaine,
Lidoderm
Xylocard
1882_Tab07_161-191 11/10/12 2:41 PM Page 178

Cardiovascular System Drugs Antiarrhythmics 178

Therapeutic/Pharmacologic Class Keep in Mind
Antiarrhythmic agents Teach client:
Indications • Take medication as directed.
Treatment of a wide variety of ventricular and atrial • Notify HCP immediately if fever, chills, joint
arrhythmias. pain or swelling, pain with breathing, skin rash,
or unusual bleeding or bruising occurs.
Action
Decreases myocardial excitability.
Adverse Reactions/Side Effects Make the Connection
CNS: seizures, confusion, dizziness. CV: asys- • CBC with differential should be monitored
tole, heart block, ventricular arrhythmias, every 2 wk during the first 3 mo of therapy for
CHF, hypotension. GI: diarrhea, anorexia, signs of BMS.
bitter taste, nausea, vomiting. Derm: rash. • Monitor ANA, LFT, chemistries, and hematology
Hemat: BMS. Misc: chills, drug-induced tests during prolonged therapy.
systemic lupus syndrome, fever. • Monitor serum drug levels to prevent toxicity.
• When using antiarrhythmic agents, it is important
to remember that by interfering with the elec-
trolytes responsible for cardiac conduction, new
arrhythmias can occur or the heart rate may slow
and cause CHF.

Route/Dosage: Procainamide: IM/50 mg/kg/day in divided doses q 3–6 hr; IV/100 mg q 5 min until arrhythmia is resolved, then 1–4 mg/min infusion,
Amiodarone: PO/400 mg/day; IV/0.5 mg/min,Uploaded by MEDBOOKSVN.ORG
Lidocaine: IV/1–4 mg/min, Quinidine: PO/200–400 mg q 4–6 hr
1882_Tab07_161-191 11/10/12 2:41 PM Page 179

Cardiovascular System Drugs Nitrates 179

Isosorbide Isosorbide
Mononitrate Dinitrate
(eye-soe-sor-bide (eye-soe-sor-bide
mo-noe-nye-trate) dye-nye-trate)

IMDUR, ISMO, Dilatrate SR, Isordil,

Monoket Isotrate
Apo-ISMN Apo-ISDN
Nitroglycerin
(nye-tro-gli-ser-in)

Nitro-Time, Nitro-Bid IV, Tridil, Nitrolingual,

Nitro-Bid, Nitrostat, NitroQuick, Minitran,
Nitrek, Nitro-Dur
Nitrogard SR
1882_Tab07_161-191 11/10/12 2:41 PM Page 179
Cardiovascular System Drugs Nitrates
Therapeutic/Pharmacologic Class
Antianginal agent/nitrate
Indications
Acute (translingual and SL) and long-term prophylac-
tic (oral, buccal, transdermal) management of angina
pectoris. Adjunctive treatment of chronic CHF.
Action
Increases coronary blood flow by dilating coronary
arteries and improving collateral flow to ischemic
regions. Produces vasodilation (venous greater than
arterial). Decreases preload. Reduces myocardial
oxygen consumption.
Adverse Reactions/Side Effects
CNS: dizziness, headache, apprehension,
restlessness, weakness. EENT: blurred vision.
CV: hypotension, tachycardia, syncope. GI:
abdominal pain, nausea, vomiting. Derm:
contact dermatitis (transdermal or ointment).
Misc: cross-tolerance, flushing, tolerance.
Route/Dosage: Isosorbide mononitrate: PO/5–20 mg bid (ISMO/Monoket), 30–60 mg/day (IMDUR), Isosorbide dinitrate: SL/2.5–5 mg repeated
q 5–10 min for 3 doses; PO/5–20 mg 3–4 times/day, Nitroglycerin: SL/0.3–0.6 mg (repeat up to 3 times); transdermal/ointment, 1–2 inches q 6–8 hr;
Uploaded
patch/0.4–0.8 mg/hr, on 12 hr and off 12 hr; IV/5–20 mcg/min
179
Keep in Mind
Teach client:
• Take medication exactly as directed.
• Avoid concurrent use of alcohol with this medication.
• Headache is a common side effect.
• Acute anginal attacks: Sit down and use medica-
tion. If pain does not subside, repeat dose and
call EMS.
• Store tablets in dark glass container away from
(body) heat. Replace 6 mo after opening.
Make the Connection
• Use of nitrates in any form with sildenafil,
tadalafil, and vardenafil increases the risk of
serious and potentially fatal hypotension.
• Always assess the BP prior to administration.
• Clients receiving IV nitrates require continuous
ECG and BP monitoring.
by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 180

Cardiovascular System Drugs Fibric Acid Derivatives 180

Gemfibrozil
(gem-fye-broe-zil)

Lopid

Fenofibrate
(fen-o-fi-brate)

Antara, Lofibra, Tricor, Triglide

Lipidil Micro
1882_Tab07_161-191 11/10/12 2:41 PM Page 180
Cardiovascular System Drugs Fibric Acid Derivatives
Therapeutic/Pharmacologic Class
Lipid-lowering agent/fibric acid derivative
Indications
Management of type IIb hyperlipidemia (decreased
HDL, increased LDL, increased triglycerides) in
clients who do not yet have clinical coronary artery
disease and have failed therapy with diet, exercise,
weight loss, or other agents (niacin, bile acid
sequestrants).
Action
Inhibits peripheral lipolysis. Decreases triglyceride
production by the liver. Decreases production of
the triglyceride carrier protein. Increases HDL.
Adverse Reactions/Side Effects
CNS: dizziness, headache. EENT: blurred vision.
GI: abdominal pain, diarrhea, epigastric pain,
flatulence, gallstones, heartburn, nausea, vomit-
ing. Derm: alopecia, rash, urticaria. Hemat:
anemia, leukopenia. MS: myositis.
Uploaded
Route/Dosage: Gemfibrozil: PO/600 mg bid 30
min before breakfast dinner, Fenofibrate: PO/145 mg/day (Tricor)
180
Keep in Mind
Teach client:
• Take the medication exactly as directed.
• This medication should be used in conjunction
with dietary restrictions, exercise, and cessation
of smoking.
• Notify HCP promptly if any of the following
symptoms occur: severe stomach pains with
nausea and vomiting, fever, chills, sore throat,
rash, diarrhea, muscle cramping, general
abdominal discomfort, or persistent flatulence.
Make the Connection
• Assess lipid panel, LFT, CBC, and
electrolytes at baseline and periodically while on
medication.
• Administration of these drugs with HMG-CoA
reductase inhibitors increases the risk for rhab-
domyolysis that can result in renal failure.
byandMEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 181

Cardiovascular System Drugs HMG-CoA Reductase Inhibitors 181

Atorvastatin Simvastatin
(a-tore-va-stat-in) (sim-va-sta-tin)

Lipitor Zocor

Rosuvastatin Lovastatin
(roe-soo-va-sta-tin) (loe-va-sta-tin)

Crestor Mevacor, Altoprev

1882_Tab07_161-191 11/10/12 2:41 PM Page 181
Cardiovascular System Drugs HMG-CoA Reductase Inhibitors
Therapeutic/Pharmacologic Class
Lipid-lowering agent/HMG-CoA reductase inhibitor
Indications
Adjunctive management of primary hypercholes-
terolemia and mixed dyslipidemia. Primary preven-
tion of coronary heart disease (MI, stroke, angina,
and coronary revascularization) in asymptomatic
clients with increased total and LDL cholesterol and
decreased HDL cholesterol.
Action
Inhibits HMG-CoA reductase, an enzyme responsi-
ble for catalyzing an early step in the synthesis of
cholesterol.
Adverse Reactions/Side Effects
CNS: dizziness, headache, insomnia, weakness.
EENT: rhinitis. Resp: bronchitis. CV: chest pain,
peripheral edema. GI: abdominal cramps, con-
stipation, diarrhea, flatus, heartburn, altered
taste, drug-induced hepatitis, dyspepsia,
elevated liver enzymes, nausea, pancreatitis.
GU: impotence. Derm: rash, pruritus. MS:
Uploaded
Route/Dosage: Atorvastatin: PO/10–80 mg/day,
Simvastatin: PO/5–80 MEDBOOKSVN.ORG
181
rhabdomyolysis, arthralgia, arthritis, myalgia,
myositis. Misc: hypersensitivity reactions,
including angioneurotic edema.
Keep in Mind
Teach client:
• Take this medication exactly as directed.
• Avoid drinking more than 1 quart of grapefruit
juice per day during therapy.
• Notify HCP if unexplained muscle pain,
tenderness, or weakness occurs, especially
if accompanied by fever or malaise.
• Avoid pregnancy or breastfeeding.
Make the Connection
• Evaluate serum cholesterol and triglyceride
levels before initiating medication, after 2–4 wk of
therapy, and periodically thereafter.
• Monitor LFT prior to beginning medication, at
12 wk, and then every 6 mo.
• If muscle tenderness develops during therapy
with CPK ↑, this is indicative of rhabdomyolysis.
by mg/day,
Rosuvastatin: PO/5–40 mg/day, Lovastatin: PO/20–80 mg/day
1882_Tab07_161-191 11/10/12 2:41 PM Page 182

Cardiovascular System Drugs Cholesterol-Absorption Inhibitors 182

Ezetimibe
(e-zet-i-mibe)

Zetia
Ezetrol
1882_Tab07_161-191 11/10/12 2:41 PM Page 182
Cardiovascular System Drugs Cholesterol-Absorption Inhibitors
Therapeutic/Pharmacologic Class
Lipid-lowering agent/cholesterol-absorption inhibitor
Indications
Used alone or with other agents (HMG-CoA reduc-
tase inhibitors) in the management of dyslipidemias,
including primary hypercholesterolemia and geneti-
cally induced hypercholesterolemia.
Action
Inhibits the absorption of cholesterol in the small
intestine.
Adverse Reactions/Side Effects
GI: cholecystitis, cholelithiasis, ↑ hepatic
transaminases (with HMG-CoA reductase
inhibitors), nausea, pancreatitis. Derm: rash.
Misc: angioedema.
Keep in Mind
Teach client:
• Take this medication as directed, at the same
time each day, even if feeling well.
• Be aware that medication helps control, but does
not cure, elevated serum cholesterol levels.
Route/Dosage: PO/10 mg/day Uploaded by MEDBOOKSVN.ORG
182
• This medication should be used in conjunction
with diet restrictions, exercise, and cessation of
smoking.
• Notify HCP if unexplained muscle pain, tender-
ness, or weakness occurs. Risk of symptoms may
increase when used with HMG-CoA reductase
inhibitors.
• Notify HCP immediately if breathing or swallow-
ing becomes difficult.
• Follow-up examinations will be scheduled.
Make the Connection
• Obtain a diet history, especially with
regard to fat consumption.
• Evaluate serum cholesterol and triglyceride levels
before initiating medication, after 2–4 wk of
therapy, and periodically thereafter.
• Administer without regard to meals. May be
taken at the same time as HMG-CoA reductase
inhibitor (medication is frequently combined with
simvastatin [Vytorin]).
• Monitor for angioedema.
1882_Tab07_161-191 11/10/12 2:41 PM Page 183

Cardiovascular System Drugs Bile Acid Sequestrants 183

Colestipol Colesevelam
(koe-les-ti-pole) (koe-less-sev-i-lam)

Colestid Welchol

Cholestyramine Resin
(koe-less-tear-a-meen re-zin)

LoCHOLEST, LoCHOLEST Light,

Prevalite, Questran, Questran Light
1882_Tab07_161-191 11/10/12 2:41 PM Page 183
Cardiovascular System Drugs
Therapeutic/Pharmacologic Class
Lipid-lowering agent/bile acid sequestrant
Indications
Management of primary hypercholesterolemia.
Treatment of pruritus associated with elevated
levels of bile acids.
Action
Binds bile acids in the GI tract, forming an insolu-
ble complex. The liver must use more cholesterol to
make more bile acids. Result is increased clearance
of cholesterol.
Adverse Reactions/Side Effects
EENT: irritation of the tongue. GI: abdominal
discomfort, constipation, nausea, fecal
impaction, flatulence, hemorrhoids, perianal
irritation, steatorrhea, vomiting. Derm: irrita-
tion, rash. F and E: hyperchloremic acidosis.
Metab: vitamin A, D, and K deficiency.
Route/Dosage: Colestipol: PO/granules, 5 g 1–2 times/day; tablets, 2–16 g 1–2 times/day, Colesevelam: PO/3 tabs tid or suspension, 3.75 pack/day,
Uploaded
Cholestyramine resin: PO/4–24 g/day in divided doses
Bile Acid Sequestrants 183
Keep in Mind
Teach client:
• Take medication before meals. May be mixed
with cool foods.
• Constipation may occur.
• Notify HCP if unusual bleeding or bruising;
petechiae; or black, tarry stools occur. Treatment
with vitamin K may be necessary.
Make the Connection
• Obtain a diet history, especially with
regard to fat consumption.
• Assess for constipation and presence of bowel
sounds.
• Serum cholesterol and triglyceride levels should
be evaluated before and frequently during the
first few months of therapy.
• Administer before meals and spaced 1–2 hr apart
from other drugs (may bind with them).
• Monitor LFT, electrolytes, and PT.
by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 184

Cardiovascular System Drugs Fatty Acid 184

Omega-3-Acid
Ethyl Esters
(oh-me-ga three as-id eth-il es-ters)

Lovaza
1882_Tab07_161-191 11/10/12 2:41 PM Page 184
Cardiovascular System Drugs Fatty Acid
Therapeutic/Pharmacologic Class
Lipid-lowering agent/fatty acid
Indications
Treatment of hypertriglyceridemia in adults; used
with specific diet.
Action
Inhibits synthesis of triglycerides.
Adverse Reactions/Side Effects
GI: altered taste, eructation. Derm: rash.
Keep in Mind
Teach client:
• Take this medication as directed.
• Be aware that medication helps control, but
does not cure, elevated serum triglyceride levels.
• This medication should be used in conjunction
with diet restrictions (fat, cholesterol, carbohy-
drates, alcohol), exercise, weight loss in over-
weight clients, and control of medical problems
Route/Dosage: PO/2 g bid or 4 g/day Uploaded by MEDBOOKSVN.ORG
184
(e.g., diabetes mellitus, hypothyroidism) that may
contribute to hypertriglyceridemia.
• Follow-up examinations and laboratory tests will
be scheduled to determine effectiveness.
Make the Connection
• Use with caution in clients with
hypersensitivity to fish.
• Obtain a diet history, especially with regard to
fat consumption.
• Monitor serum triglyceride levels and serum LDL
levels (may increase) prior to and periodically
during therapy, and LFT periodically during
therapy.
1882_Tab07_161-191 11/10/12 2:41 PM Page 185

Cardiovascular System Drugs Water-Soluble Vitamin 185

Folic Acid
(foe-lik as-id)

Folate, Folvite, vitamin B

Apo-Folic
1882_Tab07_161-191 11/10/12 2:41 PM Page 185
Cardiovascular System Drugs Water-Soluble Vitamin
Therapeutic/Pharmacologic Class
Antianemic agent; vitamin/water-soluble vitamin
Indications
Prevention and treatment of megaloblastic and
macrocytic anemias. Given during pregnancy to
promote normal fetal development.
Action
Required for protein synthesis and red blood cell
function. Stimulates the production of red RBCs,
WBCs, and platelets. Necessary for normal fetal
development.
Adverse Reactions/Side Effects
Derm: rash. CNS: irritability, difficulty sleeping,
malaise, confusion. Misc: fever.
Keep in Mind
Teach client:
• Comply with diet recommendations of HCP. The
best source of vitamins is a well-balanced diet.
• Foods high in this nutrient include vegetables
(green leafy), fruits, and organ meats.
Route/Dosage: PO, SC, IM, IV/0.5–1 mg/day Uploaded
185
• The effectiveness of megadoses of this nutrient
for treatment of various medical conditions is
unproven and may cause side effects.
• This nutrient may make urine more intensely
yellow.
• Notify HCP if rash occurs, which may indicate
hypersensitivity.
• Follow-up examinations and laboratory tests will
be scheduled.
Make the Connection
• Monitor plasma vitamin levels and Hbg,
Hct, and reticulocyte counts before and periodi-
cally during therapy.
• Because of infrequency of solitary vitamin
deficiencies, combinations are commonly
administered.
• May be given SC, deep IM, or IV when PO route
is not feasible.
• Antacids should be given at least 2 hr after the
medication.
• The medication should be given 2 hr before or
4–6 hr after cholestyramine.
by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 186

Cardiovascular System Drugs Renin Inhibitor 186

Aliskiren
(a-lis-ki-ren)

Tekturna
1882_Tab07_161-191 11/10/12 2:41 PM Page 186
Cardiovascular System Drugs Renin Inhibitor
Therapeutic/Pharmacologic Class
Antihypertensives/renin inhibitor
Indications
Treatment of HTN (alone or with other agents).
Action
Inhibition of renin results in decreased formation
of angiotensin II, a powerful vasoconstrictor.
Adverse Reactions/Side Effects
Resp: cough. GI: abdominal pain, diarrhea
(↑ in females and elderly), dyspepsia, reflux.
Misc: angioedema.
Keep in Mind
Teach client:
• May cause dizziness. Caution patient to lie down
and notify HCP. Avoid driving and other activities
requiring alertness until response to the drug is
known.
• Report signs and symptoms of angioedema
(swelling of face, extremities, eyes, lips, or
tongue, or difficulty swallowing or breathing)
to HCP immediately.
Route/Dosage: PO/150–300 mg/day Uploaded by MEDBOOKSVN.ORG
186
• Apprise HCP of all Rx or OTC medications, vita-
mins, or herbal products being taken, especially
methadone and other antiretrovirals.
• Advise female patients to notify HCP if pregnancy
is planned or suspected, or if breastfeeding.
Make the Connection
• Monitor BP and pulse frequently during
initial dose adjustment and periodically during
therapy. If an excessive fall in BP occurs, place
patient in a supine position and administer IV
0.9% NaCl, if necessary. Remember: BP low—
down the head goes; BP high—head to the sky!
• May cause minor ↑ in BUN, serum creatinine, K+,
uric acid, and creatine kinase; may cause a small
↓ in hemoglobin and hematocrit.
• Monitor for angioedema.
1882_Tab07_161-191 11/10/12 2:41 PM Page 187

Cardiovascular System Drugs Colony-Stimulating Factors 187

Pegfilgrastim
(peg-fil-gra-stim)

Neulasta

Filgrastim
(fil-gra-stim)

Neupogen, G-CSF,
Granulocyte-Stimulating Factor
1882_Tab07_161-191 11/10/12 2:41 PM Page 187
Cardiovascular System Drugs Colony-Stimulating Factors
Therapeutic/Pharmacologic Class
Colony-stimulating factors
Indications
To decrease the incidence of infection (febrile neu-
tropenia) in patients with nonmyeloid malignancies
receiving myelosuppressive antineoplastics associated
with a high risk of febrile neutropenia.
Action
These drugs are glycoproteins. They bind to and
stimulate neutrophils to divide and differentiate.
They also activate mature neutrophils. Binding to a
polyethylene glycol molecule prolongs its effects.
Adverse Reactions/Side Effects
Resp: ARDS. GI: splenic rupture. Hemat: sickle
cell crisis, leukocytosis. MS: medullary bone pain.
Misc: allergic reaction including anaphylaxis.
Keep in Mind
Teach client:
• Notify HCP immediately if signs of allergic reac-
tion (shortness of breath, hives, rash, pruritus,
Uploaded
Route/Dosage: Pegfilgrastim: SC/6 mg for each
chemotherapy cycle, MEDBOOKSVN.ORG
187
laryngeal edema) or signs of splenic rupture
(left upper abdominal or shoulder tip pain)
occur.
• Compliance with therapy and regular monitoring
of blood counts is essential.
Make the Connection
• Assess for bone pain throughout therapy.
Pain is usually mild to moderate and controllable
with nonopioid analgesics, but may require opioid
analgesics.
• Assess patient periodically for signs of ARDS
(fever, lung infiltration, respiratory distress).
• Obtain CBC and platelet count before chemother-
apy. Monitor hematocrit and platelet count
regularly. May cause elevated LDH, alkaline
phosphatase, and uric acid levels.
• Monitor for acute allergic reaction or signs of
splenic rupture.
byFilgrastim:
SC, IV/5 mcg/kg/day
1882_Tab07_161-191 11/10/12 2:41 PM Page 188

Cardiovascular System Drugs Anticholinergic (Antimuscarinic) 188

Atropine
(at-ro-peen)

AtroPen
1882_Tab07_161-191 11/10/12 2:41 PM Page 188
Cardiovascular System Drugs
Therapeutic/Pharmacologic Class
Antiarrhythmic/anticholinergic; antimuscarinic
Indications
Given preoperatively to decrease oral and respiratory
secretions (IM). Treatment of sinus bradycardia,
heart block, reversal of adverse muscarinic effects
of anticholinesterase agents or anticholinesterase
poisoning (IM, IV). Used in Inhaln form to treat
exercise-induced bronchospasm.
Action
Inhibits the action of acetylcholine at postganglion-
ic sites located in smooth muscle, secretory glands,
and the CNS (antimuscarinic activity).
Adverse Reactions/Side Effects
CNS: drowsiness, confusion, hyperpyrexia.
EENT: blurred vision, cycloplegia, photophobia,
dry eyes, mydriasis. CV: tachycardia, palpita-
tions, arrhythmias. GI: dry mouth, constipation,
impaired GI motility. GU: urinary hesitancy,
retention, erectile dysfunction. Resp: tachypnea,
pulmonary edema. Misc: flushing, decreased
sweating.
Route/Dosage: IM, IV, SC, PO/0.4–0.6 mg 30–60 min preoperatively; IV/0.5–1 mg, may repeat as needed q 5 min, not to exceed a total of 2 mg, for
bradycardia; Inhaln/0.025–0.05 mg/kg/dose qUploaded
4–6 hr as needed (maximum
Anticholinergic (Antimuscarinic) 188
Keep in Mind
Teach client:
• May cause drowsiness and visual changes.
• Frequent oral hygiene may help relieve dry mouth.
• Atropine impairs heat regulation. Strenuous activ-
ity in a hot environment may cause heat stroke.
• Males with BPH should report changes in urinary
stream to HCP.
Make the Connection
• Side effects are “hot as a hare, dry as a
bone, red as a beet, mad as a hatter, and blind
as a bat.”
• Assess VS and ECG tracings during IV drug
therapy.
• Monitor I&O and bowel sounds.
• If overdose occurs, physostigmine is the antidote.
by MEDBOOKSVN.ORG
2.5 mg/dose).
1882_Tab07_161-191 11/10/12 2:41 PM Page 189

Cardiovascular System Drugs Direct Thrombin Inhibitors 189

Dabigatran
(da-bye-gat-ran)

Pradaxa

Desirudin
(des-i-rude-in)

Iprivask
1882_Tab07_161-191 11/10/12 2:41 PM Page 189
Cardiovascular System Drugs Direct Thrombin Inhibitors
Therapeutic/Pharmacologic Class
Anticoagulant/direct thrombin inhibitor
Indications
To ↓ risk of stroke/systemic embolization associated
with nonvalvular atrial fibrillation.
Action
Act as a direct inhibitor of thrombin.
Adverse Reactions/Side Effects
GI: abdominal pain, diarrhea, dyspepsia,
gastritis, nausea. Hemat: bleeding. Misc:
anaphylaxis.
Keep in Mind
Teach client:
• May bleed more easily or longer than usual.
Notify HCP if bleeding or vomiting of blood
occurs.
Uploaded
Route/Dosage: Dabigatran: PO/150 mg bid, Desirudin: SC/15 mgby
189
• Tell HCP about all Rx or OTC medications,
vitamins, or herbal products being taken. Do not
discontinue this drug without notifying HCP.
• Advise female patient to notify HCP if pregnancy
is planned or suspected, or if breastfeeding.
Make the Connection
• Assess patient for symptoms of stroke or
peripheral vascular disease periodically during
therapy.
• Assess for anaphylaxis.
• Assess for uncontrolled bleeding from any
orifice.
• Assess vital signs at each visit.
q 12 MEDBOOKSVN.ORG
hr
1882_Tab07_161-191 11/10/12 2:41 PM Page 190

Cardiovascular System Drugs Interleukin (Thrombopoetic Growth Factor) 190

Oprelvekin
(o-prell-ve-kin)

Neumega
1882_Tab07_161-191 11/10/12 2:41 PM Page 190
Cardiovascular System Drugs Interleukin (Thrombopoetic Growth Factor)
Therapeutic/Pharmacologic Class
Colony-stimulating factors/interleukins; throm-
bopoetic growth factors
Indications
Prevention of severe thrombocytopenia and
reduction of the need for platelet transfusions
following myelosuppressive chemotherapy in
patients with nonmyeloid malignancies at risk
for thrombocytopenia.
Action
Stimulates production of megakaryocytes and
platelets.
Adverse Reactions/Side Effects
CNS: dizziness, headache, insomnia, nervous-
ness, weakness. EENT: conjunctival hemorrhage,
blurred vision, changes in visual acuity, blind-
ness, papilledema, pharyngitis, rhinitis. Resp:
cough, dyspnea, pleural effusions. CV: ventricu-
lar arrhythmias, atrial fibrillation, edema, pal-
pitations, syncope, tachycardia, vasodilation.
GI: anorexia, constipation, diarrhea, dyspepsia,
mucositis, nausea, oral moniliasis, vomiting,
Uploaded
Route/Dosage: SC/50 mcg/kg once daily for 10–21 days
190
abdominal pain. Derm: alopecia, ecchymoses,
rash. F and E: sodium and water retention.
Local: injection site reactions. MS: bone pain,
myalgia. Misc: chills, fever, infection, pain.
Keep in Mind
Teach client:
• May cause transient blurred vision or dizziness.
• Notify HCP if pregnancy is planned or suspected.
• Notify HCP if chest pain, SOB, fatigue, blurred
vision, or irregular heartbeat persists.
Make the Connection
• Assess for signs of fluid retention.
• Monitor CBC and platelet count prior to and peri-
odically during therapy. Hgb and Hct will decrease
due to dilutional anemia (3–5 days after therapy is
begun), then diminish. Monitor platelet count until
postnadir count greater than 50,000 cells/mL.
• Monitor electrolyte concentrations in patients
receiving chronic diuretic therapy. Hypokalemia
may be fatal. Remember: Normal K+ level is
3.5–5. May cause ↑ in plasma fibrinogen.
by MEDBOOKSVN.ORG
1882_Tab07_161-191 11/10/12 2:41 PM Page 191

Cardiovascular System Drugs Active Factor X (Xa) Inhibitors 191

Fondaparinux
(fond-a-par-i-nux)

Arixtra

Rivaroxaban
(ri-va-rox-a-ban)

Xarelto
1882_Tab07_161-191 11/10/12 2:41 PM Page 191
Cardiovascular System Drugs
Therapeutic/Pharmacologic Class
Anticoagulant/active factor X inhibitor
Indications
Prevention and treatment of DVT and PE.
Action
Bind selectively to antithrombin III (AT III). This
binding potentiates the neutralization (inactivation)
of active factor X (Xa).
Adverse Reactions/Side Effects
CNS: confusion, dizziness, headache, insomnia.
CV: edema, hypotension. GI: constipation,
diarrhea, dyspepsia, ↑ liver enzymes, nausea,
vomiting. GU: urinary retention. Derm: bullous
eruption, hematoma, purpura, rash. Hemat:
bleeding, thrombocytopenia. F and E:
hypokalemia. Misc: fever, ↑ wound drainage.
Keep in Mind
Teach client:
• Report any symptoms of unusual bleeding or
bruising, dizziness, itching, rash, fever, swelling,
or difficulty breathing to HCP immediately.
Route/Dosage: Fondaparinux: SC/2.5–10 mg Uploaded
once daily (based onby
Active Factor X (Xa) Inhibitors 191
• Do not to take aspirin or NSAIDs without con-
sulting HCP during therapy.
Make the Connection
• Assess for signs of bleeding and hemorrhage
from any orifice.
• Assess for evidence of additional or increased
thrombosis. Symptoms will depend on area of
involvement.
• Monitor neurologic status frequently for signs of
impairment, especially in patients with indwelling
epidural catheters.
• Monitor platelet count closely (may cause throm-
bocytopenia). PT and aPTT are not adequate indi-
cators of this drug’s action. INR level desired is 2–3.
• Monitor CBC, serum creatinine levels, and stool
(for occult blood) during therapy.
• May cause asymptomatic ↑ in AST and ALT.
Elevations are fully reversible.
MEDBOOKSVN.ORG
weight range), Rivaroxaban: PO/10 mg/day
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 15
RESPIRATORY
Aminophylline, 192
Theophylline, 192
Ipratropium, 193
Albuterol, 194
Salmeterol, 194
Metaproterenol, 194
Formoterol, 194
Levalbuteral, 194
Isoproterenol, 195 Budesonide, 199
Acetylcysteine, 196 Triamcinolone, 199
Guaifenesin, 197 Cromolyn, 200
Fexofenadine, 198 Montelukast, 201
Diphenhydramine, 198 Zyleuton, 201
Loratadine, 198 Zafirlukast, 201
Beclomethasone, 199 Roflumilast, 202
Fluticasone, 199
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 16

Uploaded by MEDBOOKSVN.ORG
1882_Tab08_192-202 10/10/12 12:51 PM Page 192

Respiratory System Drugs Xanthines 192

Aminophylline
(am-in-off-i-lin)

Phyllocontin

Theophylline
(thee-off-i-lin)

Theo-24, Elixophyllin,
Quibron-T
Apo-Theo LA,
Novo-Theophyl SR
1882_Tab08_192-202 10/10/12 12:51 PM Page 192
Respiratory System Drugs Xanthines
Therapeutic/Pharmacologic Class
Bronchodilator/xanthine
Indications
Long-term control of reversible airway obstruction
caused by asthma or COPD. Increases diaphragmatic
contractility. Used to treat apnea of prematurity.
Action
Inhibits phosphodiesterase, producing increased
tissue concentrations of cAMP. Increased levels of
cAMP result in bronchodilation, CNS stimulation,
positive inotropic and chronotropic effects, diuresis,
and gastric acid secretion.
Adverse Reactions/Side Effects
CNS: seizures, anxiety, headache, insomnia.
CV: arrhythmias, angina, tachycardia, palpita-
tions. GI: nausea, vomiting, anorexia, cramps.
Neuro: tremor.
Route/Dosage: Aminophylline: IV/loading dose 6 mg/kg over 30 min, followed by 0.7 mg/kg/hr continued infusion, Theophylline: PO/5 mg/kg,
Uploaded
followed by 10 mg/kg/day in divided doses q 8–12 hr
192
Keep in Mind
Teach client:
• PO doses need to be taken at the prescribed time.
• Increase fluid intake to a minimum of eight 8-oz
glasses of fluid daily. Avoid caffeine.
• Do not eat charbroiled meats, use large amounts
of pepper, or consume large amounts of crucifer-
ous vegetables because they interfere with the
action of the drug.
• Supplement vitamin B6 to overcome depletion
caused by this drug.
• Avoid alcohol consumption while on this
medication.
• Blood will be drawn for routine laboratory tests.
Make the Connection
• Serum drug levels range from 10 to
15 mcg/mL. Low levels will precipitate bron-
chospasm. High levels will result in toxicity.
• Monitor I&O, CXR, respiratory ease, pulse oximetry,
and K+ and Mg+ levels.
by MEDBOOKSVN.ORG
1882_Tab08_192-202 10/10/12 12:51 PM Page 193

Respiratory System Drugs Anticholinergic 193

Ipratropium
(i-pra-troe-pee-um)

Atrovent, Atrovent HFA

1882_Tab08_192-202 10/10/12 12:51 PM Page 193
Respiratory System Drugs Anticholinergic
Therapeutic/Pharmacologic Class
Allergy, cold, cough remedy; bronchodilator/
anticholinergic agent
Indications
Inhaln: Maintenance therapy of reversible airway
obstruction due to COPD and bronchospasm due
to asthma. Intranasal: Treatment of rhinorrhea.
Action
Given by inhalation, the drug inhibits cholinergic
receptors in bronchial smooth muscle tissue, result-
ing in decreased concentrations of cGMP. Decreased
cGMP produces local bronchodilation. Given
intranasally, application inhibits secretions from
glands lining the nasal mucosa (local effects).
Adverse Reactions/Side Effects
CNS: dizziness, headache, nervousness. EENT:
blurred vision, sore throat; epistaxis, nasal
dryness/irritation (intranasal only). Resp:
bronchospasm, cough. CV: hypotension,
palpitations. GI: GI irritation, nausea. Derm:
rash. Misc: allergic reactions.
Uploaded
Route/Dosage: Inhaln/MDI, 2 puffs qid; intranasal/2
sprays each nostril MEDBOOKSVN.ORG
193
Keep in Mind
Teach client:
• Follow instructions for proper use of inhaler or
nasal spray, and take as directed.
• Pulmonary function tests will be scheduled.
Make the Connection
• When multiple inhalation medications
are given, use beta2-adrenergic agonists (adrener-
gics) first, then this class, and inhaled steroids
last. Remember: 1 min between inhalations of
the same medications and 5 min between each
different medication.
• Assess respiratory status breath sounds, pulse
oximetry and CXR (if available) carefully prior to
and after inhalation of medication.
• Anticholinergic inhalers promote plugging of
mucus in clients with tracheostomy. Have suction
catheters and normal saline at the bedside.
by 2–3
times/day
1882_Tab08_192-202 10/10/12 12:51 PM Page 194

Respiratory System Drugs Beta2-Agonists 194

Albuterol Metaproterenol
(al-byoo-ter-ole) (met-a-proe-ter-e-nole)

Proventil Alupent
Hydrofluoroakane
(HFA), Ventolin HFA, Formoterol
VoSpire ER, AccuNeb, (for-mo-te-role)
ProAir HFA
Novo-Salmol Foradil, Perforomist

Salmeterol Levalbuteral
(sal-me-te-role) (leev-al-byoo-ter-ole)

Serevent Xopenex, Xopenex HFA,

Xopenex Concentrate
1882_Tab08_192-202 10/10/12 12:51 PM Page 194

Respiratory System Drugs Beta2-Agonists 194

Therapeutic/Pharmacologic Class
Bronchodilator/adrenergic agent; beta2-agonist
Indications
Used as a bronchodilator for control and preven-
tion of reversible airway obstruction caused by
asthma or COPD.
Action
Binds to beta2-adrenergic receptors in airway
smooth muscle, increases levels of cAMP. Selective
for beta2 receptors in lungs. cAMP decreases action
of myosin and CA+, resulting in relaxation of airway
smooth muscle.
Adverse Reactions/Side Effects
CNS: nervousness, restlessness, tremor, headache,
insomnia, hyperactivity in children. CV: chest
pain, palpitations, angina, arrhythmias, HTN.
GI: nausea, vomiting. Endo: hyperglycemia.
F and E: hypokalemia. Neuro: tremor.
Keep in Mind
Teach client:
• Take this medication as directed. A spacer assists
in dose delivery.
• Contact the HCP immediately if SOB is not
relieved by medication.
• Adrenergic inhalers are used before anticholiner-
gic or steroid inhalers. To repeat inhaled doses of
the same drug, wait 1 min; for repeat doses of a
different drug, wait 5 min; rinse mouth.
Make the Connection
• Using medication with MAOIs may lead
to HTN crisis.
• Observe for paradoxical bronchospasm (wheezing).
• Monitor for palpitations/arrhythmias.

Route/Dosage: Albuterol: PO/2–4 mg 3 to 4 times daily, 4–8 mg of ER tabs twice daily; Inhaln/(metered dose inhaler) 2 puffs q 4–6 hr or 2 puffs 15
min before exercise, Metaproterenol: PO/20 mg 3 to 4 times/day; Inhaln/0.2–0.3 mL of 5% solution, Salmeterol: Inhaln/a 50-mcg inhalation q 12 hr,
Uploaded
Formoterol: Inhaln/1 cap (12 mcg) q 12 hr, Levalbuteral: Inhaln/2by
puffs MEDBOOKSVN.ORG
q 4–6 hr
1882_Tab08_192-202 10/10/12 12:51 PM Page 195

Respiratory System Drugs Beta2-Agonists 195

Isoproterenol
(eye-soe-proe-ter-e-nole)

Isuprel, Medihaler-Iso
1882_Tab08_192-202 10/10/12 12:51 PM Page 195
Respiratory System Drugs Beta2-Agonists
Therapeutic/Pharmacologic Class
Bronchodilator; antiarrhythmic agent/beta2-agonist
Indications
Management of bronchospasm during anesthesia.
Treatment of asthma or COPD. Management of
bradycardia (IV only).
Action
Results in the accumulation of cAMP at beta-
adrenergic receptors. Produces bronchodilation.
Inhibits the release of mediators of immediate
hypersensitivity reactions from mast cells. Has
additional significant beta (cardiac)-adrenergic
action, which results in positive inotropic and
chronotropic effects.
Adverse Reactions/Side Effects
CNS: nervousness, restlessness, tremor,
headache, insomnia. CV: arrhythmias, angina,
HTN, tachycardia. GI: nausea, vomiting, xero-
stomia. Endo: hyperglycemia. Misc: pink/red
discoloration of saliva.
Uploaded
Route/Dosage: IV/0.02–0.06 mg may be followed
by 5-mcg/min infusion; MEDBOOKSVN.ORG
195
Keep in Mind
Teach client:
• Avoid smoking and other respiratory irritants.
• Contact HCP immediately if SOB is not relieved
by medication or is accompanied by diaphoresis,
dizziness, palpitations, or chest pain.
Make the Connection
• Assess lung sounds, respiratory pattern,
pulse, and BP before administration and during
peak of medication effect.
• Note amount, color, and character of sputum
produced.
• Monitor pulmonary function tests.
• Symptoms of overdose include persistent agita-
tion, chest pain or discomfort, decreased BP,
dizziness, hyperglycemia, hypokalemia, seizures,
tachyarrhythmias, persistent trembling, and
vomiting. Treatment includes discontinuing
beta-adrenergic agonists and instituting symp-
tomatic, supportive therapy.
by bronchospasm,
0.01–0.02 mg; IM, SC/0.2 mg; Inhaln/1–2 puffs
1882_Tab08_192-202 10/10/12 12:51 PM Page 196

Respiratory System Drugs Mucolytics 196

Acetylcysteine
(a-se-teel-sis-teen)

Acetadote
Mucomyst, Parvolex
1882_Tab08_192-202 10/10/12 12:51 PM Page 196
Respiratory System Drugs Mucolytics
Therapeutic/Pharmacologic Class
Mucolytic, antidote for acetaminophen
Indications
IV use: Antidote for the management of potentially
hepatotoxic overdosage of acetaminophen (should
be administered within 8–24 hours of ingestion
depending on overdosage amount). Inhaln use:
Reduction of mucous viscosity associated with
thick secretions.
Action
Decreases the buildup of a hepatotoxic metabolite
in acetaminophen overdosage. Degrades mucus,
allowing easier mobilization and expectoration.
Adverse Reactions/Side Effects
CNS: drowsiness. CV: vasodilation. EENT:
rhinorrhea. Resp: bronchospasm, bronchial/
tracheal irritation, chest tightness, increased
secretions. GI: nausea, vomiting, stomatitis.
Derm: pruritus, rash, urticaria, clamminess.
Misc: allergic reactions (primarily with IV),
including anaphylaxis, angioedema, chills, fever.
Uploaded
Route/Dosage: PO/140 mg/kg initially, followed by 70 mg/kg q 4 by
hr; IV/loading dose, 150 mg/kg over 60 min
196
Keep in Mind
Teach client:
• Clear airway by coughing deeply before taking
aerosol inhalation treatment.
• There is an unpleasant odor to this drug.
• The face may feel sticky after using the mask
nebulizer, and the residue can be easily cleaned.
• Suctioning may be necessary after mucolytic
therapy.
Make the Connection
• Keep suction available; as mucus thins, it
may be too copious for the client to expectorate.
• When used as antidote in acetaminophen over-
dose, assess plasma acetaminophen levels.
• Monitor LFT, RFT, ECG, glucose, and electrolytes.
• Notify HCP if nausea, vomiting, or urticaria
occurs.
MEDBOOKSVN.ORG
1882_Tab08_192-202 10/10/12 12:51 PM Page 197

Respiratory System Drugs Expectorants 197

Guaifenesin
(gwye-fen-e-sin)

Robitussin, Hytuss,
Guiatuss, Mucinex
Benylin-E
1882_Tab08_192-202 10/10/12 12:51 PM Page 197
Respiratory System Drugs Expectorants
Therapeutic/Pharmacologic Class
Allergy, cold, and cough remedy; expectorant
Indications
Treatment of coughs associated with viral upper
respiratory tract infections. Treatment of chronic
lung conditions.
Action
Reduces viscosity of tenacious secretions by increas-
ing respiratory tract fluid.
Adverse Reactions/Side Effects
CNS: dizziness, headache. GI: nausea, diarrhea,
stomach pain, vomiting. Derm: rash, urticaria.
Keep in Mind
Teach client:
• Cough effectively. Sit upright, take three deep
breaths, and cough deeply with the hand placed
loosely in front of the mouth (positive airway
pressure). Do this several times.
• This drug may cause dizziness, so avoid activities
that require alertness until the effect of the drug
is known.
Route/Dosage: PO/600–1200 mg q 12 hr Uploaded by MEDBOOKSVN.ORG
197
• Limit talking, stop smoking, and maintain mois-
ture in the environment. Cool mist is best.
• Sugarless gum and candy may be used to assist in
keeping the mouth moist.
• If cough causes gagging, persists for longer than
1 wk, or is accompanied by a fever, rash, or sore
throat; contact HCP.
Make the Connection
• Assess lung sounds and frequency and
type of cough during therapy.
• Assess color and amount of secretions. Clients
may swallow secretions, so do not assume that
the cough is nonproductive because of this. If on
auscultation rhonchi occur, move, and disappear
with coughing, this is a finding that indicates a
productive cough.
• Give with a full glass of water.
• ER tabs should be swallowed whole; not
crushed, chewed, or broken.
1882_Tab08_192-202 10/10/12 12:51 PM Page 198

Respiratory System Drugs Antihistamines 198

Fexofenadine Loratadine
(fex-oh-fen-a-deen) (lor-a-ta-deen)

Allegra Alavert, Claritin, Claritin

24–Hour Allergy, Claritin Hives
Relief, Children’s Loratadine,
Claritin Reditabs, Clear-Atadine,
Dimetapp Children’s ND
Non-Drowsy Allergy
Diphenhydramine
(dye-fen-hye-dra-meen)

Benadryl, Sominex, Unisom Nightime Sleep Aid,

Benadryl Allergy
Allerdryl
1882_Tab08_192-202 10/10/12 12:51 PM Page 198
Respiratory System Drugs Antihistamines
Therapeutic/Pharmacologic Class
Allergy, cold, and cough remedy/antihistamine
Indications
Relief of symptoms of seasonal allergic rhinitis.
Management of chronic idiopathic urticaria. May be
used, depending on product, as a sedative/hypnotic.
Action
Antagonizes the effects of histamine at peripheral
histamine1 (H1) receptors. Inhibition of these recep-
tors can be used for histamine-related inflammation,
like pruritus and urticaria. Medications also have a
drying effect on the nasal mucosa.
Adverse Reactions/Side Effects
CNS: drowsiness, fatigue. GI: dyspepsia. Endo:
dysmenorrhea.
Keep in Mind
Teach client:
• Take the medication as directed.
Route/Dosage: Fexofenadine: PO/60 mg bid, Uploaded
Loratadine: PO/10 mg/day, Diphenhydramine: PO/25–50 mg q 4–6 hr; IM, IV/25–50 mg q 4 hr
198
• This drug may cause drowsiness, so avoid driving
or other activities requiring alertness until response
to drug is known.
• Contact the HCP if symptoms persist.
Make the Connection
• Assess allergy symptoms (rhinitis,
conjunctivitis, hives) before and periodically
during therapy.
• Assess lung sounds and character of bronchial
secretions.
• Maintain fluid intake of 1500–2000 mL/day to
decrease viscosity of secretions.
• Medication causes false-negative reactions on
allergy skin tests; discontinue 3 days before such
testing.
• Administer with food or milk to decrease GI
irritation. Caps and tabs should be taken with
water or milk, not juice.
• If the drug is taken for sleep, assess quality of
sleep and sleep patterns.
by MEDBOOKSVN.ORG
1882_Tab08_192-202 10/10/12 12:51 PM Page 199

Respiratory System Drugs Corticosteroids 199

Beclomethasone Budesonide
(be-kloe-meth-a-sone) (byoo-des-oh-nide)

Qvar Pulmicort Respules,

Pulmicort Flexhaler

Fluticasone Triamcinolone
(floo-ti-ka-sone) (trye-am-sin-oh-lone)

Flovent HFA, Flovent AllerNaze,

Diskus Nasacort AQ
1882_Tab08_192-202 10/10/12 12:51 PM Page 199

Respiratory System Drugs Corticosteroids 199

Therapeutic/Pharmacologic Class
Anti-inflammatory agent (steroidal)/corticosteroid
agent
Indications
Maintenance treatment of asthma as prophylactic
therapy. Possible decrease in requirement for or
elimination of systemic corticosteroid use in clients
with asthma.
Action
Potent, locally acting anti-inflammatory and
immune modifier.
Adverse Reactions/Side Effects
CNS: headache. EENT: cataracts, dysphonia,
oropharyngeal fungal infections, pharyngitis,
rhinitis, sinusitis. Resp: bronchospasm, cough,
wheezing. Endo: adrenal suppression (increased
dose, long-term therapy only), decreased growth
(children). MS: back pain.
Keep in Mind
Teach client:
• When using inhalation corticosteroids and
bronchodilator, use bronchodilator first and
allow 5 min to elapse before administering
the corticosteroid, unless otherwise directed
by HCP.
• Do not use this drug for rescue.
• Rinse the mouth after using.
Make the Connection
• Monitor respiratory status and lung
sounds.
• Assess clients changing from systemic to inhalation
corticosteroids for signs of adrenal insufficiency.
• Periodic adrenal function tests may be ordered.
• May cause increased serum and urine glucose
concentrations if significant absorption occurs.

Route/Dosage: Beclomethasone: Inhaln/40–160 mcg bid, Budesonide: Inhaln/180–360 mcg bid, Fluticasone: Inhaln/88–440 mcg bid; Inhaln
(powder)/100–1000 mcg bid, Triamcinolone: Uploaded by MEDBOOKSVN.ORG
Inhaln/55 mcg per metered spray
1882_Tab08_192-202 10/10/12 12:51 PM Page 200

Respiratory System Drugs Mast Cell Stabilizers 200

Cromolyn
(kroe-moe-lin)

Gastrocrom, NasalCrom
Apo-Cromolyn
1882_Tab08_192-202 10/10/12 12:51 PM Page 200

Respiratory System Drugs Mast Cell Stabilizers 200

Therapeutic/Pharmacologic Class • Prime the canister with 3 puffs before the first use
Antiasthmatic agent; antiallergy agent/mast cell and if the canister remains unused for more than
stabilizer 7 days to ensure adequate and accurate dosing.
Indications • Notify HCP if asthmatic symptoms do not
Management of mild to moderate asthma or allergy- improve within 4 wk, worsen, or recur.
induced asthmatic reactions. • This medication is not for rescue during acute
episodes of respiratory distress. Use bron-
Action chodilators for rescue.
Prevents the release of histamine and slow-reacting
substance of anaphylaxis (SRS-A) from sensitized
mast cells. Make the Connection
Adverse Reactions/Side Effects • Evaluate pulmonary function testing.
CNS: dizziness, fatigue, headache. EENT: • Assess lung sounds and respiratory function
pharyngitis, rhinitis. CV: chest pain. Resp: bron- before and periodically during therapy.
chospasm, cough, dyspnea. GI: unpleasant • Reduction in dose of other asthma medications
taste, diarrhea, dyspepsia, nausea, vomiting. may be possible after 2–4 wk of therapy.
Derm: rash. Misc: fever. • Pretreatment with a bronchodilator may be
required to increase delivery of inhalation
Keep in Mind product.
Teach client:
• Medication must be used as directed.
• Follow instructions for proper use of the metered-
dose inhaler.

Route/Dosage: Inhaln/1 ampule (20 mg) of theUploaded

nebulizer solution 4 by MEDBOOKSVN.ORG
times daily; intranasal/1 spray each nostril 3 to 4 times daily; PO/400 mg qid
1882_Tab08_192-202 10/10/12 12:51 PM Page 201

Respiratory System Drugs Leukotriene Receptor Antagonists 201

Montelukast Zafirlukast
(mon-te-loo-kast) (za-feer-loo-kast)

Singulair Accolate

Zyleuton
(zye-loo-ton)

Zyflo CR
1882_Tab08_192-202 10/10/12 12:51 PM Page 201
Respiratory System Drugs Leukotriene Receptor Antagonists
Therapeutic/Pharmacologic Class
Allergy, cold, and cough remedy; bronchodilator/
leukotriene receptor antagonist
Indications
Prevention and chronic treatment of asthma.
Management of seasonal allergic rhinitis.
Action
Antagonizes the effects of leukotrienes, which
are mediators of the inflammatory response.
Decrease airway edema and smooth muscle
constriction. Asthma and allergy are caused by
chronic inflammation.
Adverse Reactions/Side Effects
CNS: headache, dizziness, weakness.
GI: abdominal pain, diarrhea, drug-induced
hepatitis (women), dyspepsia, nausea,
vomiting. MS: arthralgia, back pain, myalgia.
Misc: Churg-Strauss syndrome (angiitis;
vasculitis), fever, infection (geriatric clients),
pain.
Route/Dosage: Montelukast: PO/10 mg daily,Uploaded
Zafirlukast: PO/20by
mg bid, Zyleuton: PO/1200 mg bid
201
Keep in Mind
Teach client:
• These drugs are not for rescue. In the case of
bronchospasm, use the prescribed inhaler.
• Take as recommended for prophylaxis.
Make the Connection
• Remember the part played by leukotrienes
in the inflammatory process (inflammation is the
root of many problems, thus it should be given
your complete attention). Look for clues in the
generic name that would connect them with
leukotrienes (luk)!
• Assess for effectiveness.
• Long-term therapy requires periodic assessment
of liver and renal function.
• Remember: Only beta2-agonists should be used
for bronchospasm.
MEDBOOKSVN.ORG
1882_Tab08_192-202 10/10/12 12:51 PM Page 202

Respiratory System Drugs Phosphodiesterase Inhibitor 202

Roflumilast
(row-floo-mi-last)

Daliresp
1882_Tab08_192-202 10/10/12 12:51 PM Page 202
Respiratory System Drugs Phosphodiesterase Inhibitor
Therapeutic/Pharmacologic Class
Chronic obstructive pulmonary disease (COPD)
agents/phosphodiesterase inhibitor
Indications
To ↓ the risk of exacerbations in patients with
severe COPD and a history of chronic bronchitis
with exacerbations.
Action
Roflumilast and one active metabolite (roflumilast
N-oxide) act as selective inhibitors of phosphodi-
esterase 4 (PDE4), responsible for breaking down
cAMP. The result is decreased inflammation and
reduction of neutrophils, eosinophils, and total
inflammatory cells in sputum.
Adverse Reactions/Side Effects
CNS: Suicidal thoughts, anxiety, depression,
dizziness, headache, insomnia. GI: diarrhea,
abdominal pain, ↓ appetite, dyspepsia, gastritis,
nausea, vomiting. Metabolic: weight loss.
MS: muscle spasms. Neuro: tremor.
Route/Dosage: PO/500 mcg daily Uploaded by MEDBOOKSVN.ORG
202
Keep in Mind
Teach client:
• This drug is not a bronchodilator and should not
be used for treating bronchospasm.
• Monitor weight regularly. If weight loss is noted,
the drug may be discontinued.
• Notify HCP if thoughts about suicide or dying,
trouble sleeping, depression, anxiety, acting on
dangerous impulses, or other unusual changes
in behavior or mood occur. Teach family
members to watch for these behaviors also.
• Notify HCP of any Rx or OTC medications,
vitamins, or herbal products being taken.
Make the Connection
• Assess respiratory status and number of
exacerbations periodically.
• Monitor weight regularly.
• Assess mental status for suicidal ideation.
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 17

SENSORY

Acetazolamide, 203 Dipivefrin, 205 Ranibizumab, 207

Brinzolamide, 203
Dorzolamide, 203
Carbachol, 204
Acetylcholine, 204
Pilocarpine, 204
Brimonidine, 205 Verteporfin, 208
Apraclonidine, 205 Pegaptanib, 209
Latanoprost, 206 Lutein, 210
Bimatoprost, 206 Zeaxanthin, 210
Travoprost, 206
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 18

Uploaded by MEDBOOKSVN.ORG
1882_Tab09_203-210 10/10/12 12:52 PM Page 203

Sensory System Drugs Carbonic Anhydrase Inhibitors 203

Acetazolamide Dorzolamide
(a-set-a-zole-a-mide) (door-zole-a-mide)

Diamox, Trusopt
Diamox Sequels
Apo-Acetazolamide

Brinzolamide
(brin-zole-a-mide)

Azopt
1882_Tab09_203-210 10/10/12 12:52 PM Page 203

Sensory System Drugs Carbonic Anhydrase Inhibitors 203

Therapeutic/Pharmacologic Class syndrome, rash. Endo: hyperglycemia. F and E:
Antiglaucoma agent; diuretic; ocular hypotensive agent; hyperchloremic acidosis, hypokalemia, growth
anticonvulsant agent/carbonic anhydrase inhibitor retardation (in children receiving chronic therapy).
Indications Hemat: aplastic anemia, hemolytic anemia,
Lowering of intraocular pressure in the treatment of leukopenia. Metab: weight loss, hyperuricemia.
glaucoma. Neuro: paresthesias. Misc: allergic reactions
including anaphylaxsis.
Action
Inhibition of carbonic anhydrase in the eye results in Keep in Mind
decreased secretion of aqueous humor. Inhibition Teach client:
of renal carbonic anhydrase results in self-limiting • Take the medication as directed.
urinary excretion of Na, K+, bicarbonate, and water. • Take PO form with food.
CNS inhibition of carbonic anhydrase and resultant • Report any rash immediately.
diuresis may ↓ abnormal neuronal firing. Alkaline
diuresis prevents precipitation of uric acid or cystine
in the urinary tract. Make the Connection
Adverse Reactions/Side Effects • Assess for hypersensitivity or cross-sensitivity
CNS: depression, tiredness, weakness, drowsiness. with sulfonamides.
EENT: transient nearsightedness. GI: anorexia, • Assess tonometry readings when used for glaucoma.
metallic taste, nausea, vomiting, melena. GU: Normal IOP is 10–21 mm Hg.
crystalluria, renal calculi. Derm: Stevens-Johnson • Monitor serum electrolytes, CBC, glucose levels,
and LFT.
• Assess ABG for metabolic acidosis.
Route/Dosage: Acetazolamide: PO/250–1000 mg/daily; IV/250–500 mg (maximum, 1 g)/daily, rate less than 500 mg/min, Dorzolamide: Ophth/
1 drop of 2% soln tid, Brinzolamide: Ophth/1 Uploaded
drop of 1% soln tid by MEDBOOKSVN.ORG
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Sensory System Drugs Cholinergics (Direct-Acting) 204

Carbachol Pilocarpine
(carb-a-kol) (pie-loe-car-peen)

Carboptic, Isopto Isopto Carpine,

Carbachol Ocusert Pilo

Acetylcholine
(a-ceet-till-choe-leen)

Miochol-E
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Sensory System Drugs Cholinergics (Direct-Acting) 204

Therapeutic/Pharmacologic Class Keep in Mind
Intraocular pressure-reducing agent/cholinergic Teach client:
(direct-acting) • Use this medication as directed by HCP.
Indications • This medication may sting when administered.
Management of open-angle glaucoma not • Drop into conjunctival pocket, not directly onto
controlled with short-acting miotics. Also used the eyeball.
to facilitate miosis after ophthalmic surgery or to • Hold the lacrimal duct for 1 min following
reverse mydriatics. administration to prevent systemic absorption.
Action • Report immediately any unexpected changes in vision.
Cholinergic nerve fibers are stimulated directly in • Do not drive or operate machinery at night because
pupils will be constricted and vision impaired.
the eye, promoting miosis. This increases outflow
of aqueous humor, decreasing intraocular pressure. • Periodic examinations will be scheduled.
Adverse Reactions/Side Effects
CNS: headache and eye pain. CV: hypotension, Make the Connection
syncope, cardiac arrhythmias, flushing (large • Reverse this drug with atropine, an
systemic absorption). EENT: change in eye anticholinergic.
accommodation, stinging and burning, iritis, • Use cautiously in clients with chronic lung
salivation. GI: cramps, vomiting, diarrhea, conditions, such as asthma (large systemic
epigastric distress. GU: bladder spasm. absorption can cause bronchospasm).
Resp: bronchospasm. Misc: sweating. • Normal IOP is 10–21 mm Hg.
Route/Dosage: Carbachol: Ophth/1–2 drops of 0.01%–3% soln 1 to 3 times daily, Pilocarpine: Ophth/1–2 drops of 0.5%–4% soln up to 6 times
daily; gel, 1/2 -inch strip of 4% gel at bedtime; counteracting sympathomimetic mydriatics, 1 drop of 1% soln, Acetylcholine: Ophth/0.5–2 mL into
anterior chamber (surgical) Uploaded by MEDBOOKSVN.ORG
1882_Tab09_203-210 10/10/12 12:52 PM Page 205

Sensory System Drugs Sympathomimetics 205

Dipivefrin Apraclonidine
(di-pi-ve-frin) (a-pra-clon-i-deen)

Propine Iopidine

Brimonidine
(bri-mon-i-deen)

Alphagan P
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Sensory System Drugs Sympathomimetics 205

Therapeutic/Pharmacologic Class • Avoid activities that require good visual acuity.
Antiglaucoma agent/sympathomimetic agent Mydriasis causes visual disturbances and sensitivity
Indications to light.
Management of glaucoma. • Report palpitations to the HCP.
Action • Periodic examinations for intraocular pressure
and visual acuity will be scheduled.
Lowers intraocular pressure by decreasing forma-
tion of aqueous humor.
Adverse Reactions/Side Effects Make the Connection
CNS: headache, nervousness, drowsiness. CV: • Monitor BP, pulse, and rhythm when
palpitations, arrhythmias, HTN (large systemic the client first begins to self-administer the
absorption). EENT: stinging, burning eye pain, medication.
sensitivity to light. • Monitor tonometry readings. Normal IOP is
10–21 mm Hg.
Keep in Mind • Avoid concurrent use of MAOI agents.
Teach client:
• Follow instructions for proper method of instilla-
tion. Place in conjunctival pocket and not directly
on eyeball.
• Hold lacrimal duct for 1 min after instillation to
prevent systemic absorption.

Uploaded
Route/Dosage: Dipivefrin: Ophth/1 drop of 0.1% by MEDBOOKSVN.ORG
soln q 12 hr, Apraclonidine: Ophth/1–2 drops of 0.5% soln tid, Brimonidine: Ophth/1 drop q 8 hr
1882_Tab09_203-210 10/10/12 12:52 PM Page 206

Sensory System Drugs Prostaglandin Agonists 206

Latanoprost Travoprost
(lat-an-oe-prost) (trav-oe-prost)

Xalatan Travatan

Bimatoprost
(bye-mat-toe-prost)

Lumigan
1882_Tab09_203-210 10/10/12 12:52 PM Page 206

Sensory System Drugs Prostaglandin Agonists 206

Therapeutic/Pharmacologic Class • Hold lacrimal duct for 1 min after instillation to
Antiglaucoma agent/prostaglandin agonist prevent systemic absorption.
Indications • Eye color may change to brown; local irritation
Management of glaucoma. and eyelash growth may occur.
Action • Periodic examinations for intraocular pressure
and visual acuity will be scheduled.
Anti-inflammatory action reduces obstruction to
aqueous humor outflow, lowering intraocular
pressure. Make the Connection
Adverse Reactions/Side Effects • Do not administer when contact lenses
EENT: local irritation, stinging, foreign body are in the eye.
sensation, increased eyelash growth, increased • Monitor tonometry readings. Normal IOP is
brown eye pigment (may change eye color to 10–21 mm Hg.
brown). CV: palpitations (excessive systemic
absorption).

Keep in Mind
Teach client:
• Follow instructions for proper method of instilla-
tion. Place in conjunctival pocket, not directly on
eyeball.

Route/Dosage: Latanoprost: Ophth/1 drop of 0.005% soln once daily, Travoprost: Ophth/1 drop of 0.004% soln once daily (PM),
Uploaded
Bimatoprost: Ophth/1 drop of 0.03% soln once daily (PM) by MEDBOOKSVN.ORG
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Sensory System Drugs Monoclonal Antibody 207

Ranibizumab
(ran-i-bi-zoo-mab)

Lucentis
1882_Tab09_203-210 10/10/12 12:52 PM Page 207
Sensory System Drugs Monoclonal Antibody
Therapeutic/Pharmacologic Class
Ocular agents/monoclonal antibodies
Indications
Treatment of neovascular (wet) macular
degeneration.
Action
Binds to vascular endothelial growth factor A
(VEGF-A) receptor sites, preventing the binding
of endogenous VEGF-A, resulting in decreased
endothelial proliferation, vascular leakage, and new
vessel formation. Arrests visual damage related to
the genesis of leaky endothelial vessel formation.
Adverse Reactions/Side Effects
EENT: conjunctival hemorrhage, eye pain,
↑ intraocular pressure, intraocular inflamma-
tion, vitreal floaters, endophthalmitis, retinal
detachment. CV: arterial thromboembolic
events.
Route/Dosage: Intravitreal/0.5 mg monthly forUploaded
4 mo, then q 1–3 mo
207
Keep in Mind
Teach client:
• Notify ophthalmologist immediately if eye
becomes red, sensitive to light, or painful, or
develops a change in vision, as this indicates
acute glaucoma.
• Signs and symptoms of ocular infection.
Make the Connection
• Contraindicated in hypersensitivity or in
the presence of ocular or periocular infections.
• Caution if needed during pregnancy or lactation
(maternal benefit outweighs risk to fetus).
• Assess eye for signs of infection frequently during
week following injection.
• Check perfusion of optic nerve head immediately
after injection, use tonometry to measure intraoc-
ular pressure within 30 min following the injec-
tion (normal pressure is 10–21 mm Hg), and use
biomicroscopy between 2 and 7 days following
injection. Increases in intraocular pressure have
been seen within 30 min of injection.
by
MEDBOOKSVN.ORG
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Sensory System Drugs Photodynamic Agent 208

Verteporfin
(ver-te-por-fin)

Visudyne
1882_Tab09_203-210 10/10/12 12:52 PM Page 208
Sensory System Drugs Photodynamic Agent
Therapeutic/Pharmacologic Class
Photodynamic agent
Indications
Treatment of age-related macular degeneration in
patients with predominantly classic subfoveal
choroidal neovascularization.
Action
Vertoporfin is activated by nonthermal red light
in the presence of oxygen to form reactive oxygen
radicals. The resultant compound produces local
damage to neovascular epithelium and subse-
quent vessel occlusion.
Adverse Reactions/Side Effects
CNS: headache, weakness. EENT: visual
disturbances, cataracts, conjunctivitis/
conjunctival injection, dry eyes, ocular itching,
severe vision loss, subconjunctival/subretinal/
vitreous hemorrhage. Derm: photosensitivity.
Local: injection site reactions including
extravasation and rashes. MS: back pain
(during infusion). Misc: fever, flu-like syndrome.
Uploaded
Route/Dosage: IV/6 mg/m2 infused over 10 min, followed by laserby
208
Keep in Mind
Teach client:
• Avoid exposure of skin or eyes to direct sunlight
or bright indoor light for 5 days due to photo-
sensitivity. If the client must go outdoors, dark
glasses and sunscreen must be used.
• Exposure to indoor ambient light is helpful and
causes the expected reaction in the eye and skin.
• Appointments for follow-up evaluations every
3 mo must be kept.
Make the Connection
• Contraindicated in hypersensitivity and
porphyria.
• The largest arm vein, preferably the antecubital,
should be used for injection.
• If extravasation occurs, stop infusion immedi-
ately and apply cold compresses. The area of
extravasation must be protected from light until
swelling and discoloration have faded, to pre-
vent a potentially severe local burn.
• Monitor CBC for anemia and for ↓ or ↑ WBC;
monitor for ↑ LFT, ↑ creatinine, and albuminuria.
MEDBOOKSVN.ORG
treatment
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Sensory System Drugs Vascular Endothelial Growth Factor Antagonists 209

Pegaptanib
(peg-apt-i-nib)

Macugen
1882_Tab09_203-210 10/10/12 12:52 PM Page 209
Sensory System Drugs Vascular Endothelial Growth Factor Antagonists
Therapeutic/Pharmacologic Class
Ocular agents/vascular endothelial growth factor
antagonist
Indications
Neovascular (wet) age-related macular degeneration.
Action
Acts as an antagonist of vascular endothelial
growth factor (VEGF). VEGF may be responsible for
the formation of incompetent, leaky blood vessels
associated with macular degeneration. Inhibition of
vessel growth decreases the loss of visual acuity.
Adverse Reactions/Side Effects
EENT: cataract, blurred vision, conjunctival
bleeding, irritation/pain, ↑ IOP, ocular inflam-
mation, infection (rare), retinal detachment
(rare), traumatic cataract formation (rare).
Misc: anaphylaxis, angioedema.
Keep in Mind
Teach client:
• Contact ophthalmologist immediately if eye
becomes red, sensitive to light, or painful, or a
Route/Dosage: Intravitreal/0.3 mg every 6 wk Uploaded
209
change in vision that can indicate acute glaucoma
develops.
• Signs and symptoms of infection of the eye.
Make the Connection
• Must not be administered if an ocular or
periocular infection is present. Assess the eye
frequently for signs of infection for 1 week follow-
ing injection.
• Check perfusion of optic nerve head immediately
after injection.
• Use tonometry to measure intraocular pressure
within 30 min following the injection, and use
biomicroscopy between 2 and 7 days following
injection (normal pressure is 10–21 mm Hg).
Increases in intraocular pressure have been seen
within 30 min of injection.
• Monitor for anaphylaxis or angioedema.
by MEDBOOKSVN.ORG
1882_Tab09_203-210 10/10/12 12:52 PM Page 210

Sensory System Drugs Xanthophyll Carotenoids 210

Lutein
(loo-teen)

Zeaxanthin
(zee-a-zan-thin)
1882_Tab09_203-210 10/10/12 12:52 PM Page 210
Sensory System Drugs Xanthophyll Carotenoids
Therapeutic/Pharmacologic Class
Phytochemicals/Xanthophyll carotenoids
Indications
Prevention of central blindness or age-related
macular degeneration.
Action
Lutein and zeaxanthin are yellow pigments found
concentrated in the macula and are thought to
protect the macula from oxidative stress and high-
energy photons of blue light. Supplementation
of lutein and zeaxanthin increases this yellow
pigment.
Adverse Reactions/Side Effects
Unknown at common supplemental dosages.
Keep in Mind
Teach client:
• Lifestyle choices are important, also. Do not
smoke, or take steps to discontinue smoking.
Avoid prolonged exposure to sunlight without
protection, including effective sunglasses.
Uploaded
Route/Dosage: Lutein: PO/6–20 mg/day, Zeaxanthin: by
PO/2 mg/day
210
• Consuming a healthy diet with whole grains,
fruits, and vegetables can supply lutein and
zeaxanthin in therapeutic doses.
• Vision examinations should be a normal part of a
healthy life—at least yearly.
Make the Connection
• Lutein and zeaxanthin are contained in
many ocular supplements, but they may be con-
sumed as part of a healthy diet. Food sources
include spinach, corn, broccoli, and eggs.
• Monitor clients for visual deficits when
doing initial assessments, and refer to an
ophthalmologist.
• Understand risk factors for age-related macular
degeneration, and assess lifestyle factors that may
contribute to disease.
MEDBOOKSVN.ORG
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INDEX
1882_Leek_Divider Tab 02/11/12 2:19 PM Page 20

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211

Index Aleve, 68
Alfuzosin, 57
Aminocaproic acid, 166
Aminophylline, 192
Apo-Amoxi, 79
Apo-ASA, 69
Note: Proprietary names are in
italic. Aliskiren, 186 Amiodarone, 178 Apo-Atenolol, 173
Allegra, 198 Amlodipine, 174 Apo-Benztropine, 133
A Allerdryl, 198 Amoxicillin, 79 Apo-Bromocriptine, 130
Abacavir, 91 AllerNase, 199 Amoxicillin/clavulanate, 79 Apo-Cal, 1
Abatecept, 108 Alloprim, 107 Amoxil, 79 Apo-carbamazepine, 121
Abilify, 146 Allopurinol, 107 Amphetamine, 153 Apo-Cephalex, 82
Acarbose, 37 Almotriptan, 156 Amphetamine Salt, 153 Apo-Cimetidine, 6
Accolate, 201 Alosetron, 13 Amphotec, 87 Apo-Cromolyn, 200
AccuNeb, 194 Aloxi, 25 Amphotericin B, 87 Apo-Diazepam, 135
Acetadote, 196 Alpha-Tamoxifen, 101 Ampicillin/sulbactam, 79 Apo-Diltiaz, 174
Acetazolamide, 203 Alphagan P, 205 Amrix, 97 Apo-Doxy, 81
Actonel/Atelvia, 100 Alprazolam, 135 Anafranil, 141 Apo-Erythro-EC, 74
Acetylcholine, 204 Altace, 175 Anaprox, 68 Apo-Fluphenazine, 144
Acetylcysteine, 196 Alteplase, 167 Anaspaz, 11 Apo-Folic, 185
Aciphex, 7 Altoprev, 181 Ancalixir, 115 Apo-Furosemide, 54
Activase/ Activase rt-PA, 167 Alupent, 194 Anexsia, 111 Apo-Glyburide, 38
Actos, 39 Amantadine, 129 Antara, 180 Apo-Hydro, 55
Acyclovir, 89 Amaryl, 38 Antivert, 22 Apo-imipramine, 141
Adalat CC, 174 Amber, 160 Anzemet, 25 Apo-Indomethacin, 68
Adcirca, 56 Ambien/Ambien CR, 117 Aricept/Aricept Oral Disintegrating Apo-ISDN, 179
Adderall/Adderall XR, 153 AmBisome, 87 Tablets (ODT), 134 Apo-ISMN, 179
Adrenalin, 157 Amerge, 156 Apidra, 28 Apo-K, 2
Alavert, 198 Amicar, 166 Aplenzin, 139 Apo-Lorazepam, 135
Albuterol, 194 Amikacin, 76 Apo-Acetazolamide, 203 Apo-Metoclop, 24
Aldactone, 53 Amikacin, 76 Apo-Allopurinol, 107 Apo-Napro-Na, 68
Alendronate, 100 Amiloride, 53 Apo-Alpraz, 135 Apo-Nifed, 174
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212
Apo-Perphenazine, 144 Avandia, 39 Biaxin/Biaxin XL, 74 Calan/Calan SR, 174
Apo-Primidone, 123 Avapro, 176 Bicitra, 3 Calcijex, 61
Apo-quinidine, 178 Avelox, 78 Bimatoprost, 206 Calcipotriene, 73
Apo-Selegiline, 127 Aventyl, 141 Binostro, 100 Calcitonin (salmon), 102
Apo-Sulfatrim DS, 86 Avinza, 112 Bisaco-Lax, 17 Calcitriol, 61
Apo-Tetra, 81 Avirax, 89 Bisacodyl, 17 Calcium acetate, 1, 59
Apo-Theo LA, 192 Avodart, 58 Bismatrol, 10 Calcium carbonate, 1
Apo-Trihex, 133 Axert, 156 Bismuth subsalicylate, 10 Calcium citrate, 1
Apo-Valproic, 126 Axid, 6 Bonamine, 22 Calcium gluconate, 1
Apo-Zidovudine, 91 Azilect, 127 Bonine, 22 Calphron, 1, 59
Apraclonidine, 205 Azithromycin, 74 Boniva, 100 Canasa, 27
Aripiprazole, 146 Azopt, 203 Brimonidine, 205 Cancidas, 88
Arixtra, 191 AZT, 91 Brinzolamide, 203 Candesartan, 176
Armour Thyroid, 41 Azulfadine, 27 Bromocriptine, 130 Capoten, 175
Artane/Artane Sequels (ER), 133 Budeprion XL, 139 Captopril, 175
Asacol/Asacol-HD, 27 B Budesonide, 199 Carafate, 9
Aspirin, 69 Baclofen, 97 Bumetanide, 54 Carbachol, 204
AsthmaNefrin, 157 Bactrim/Bactrim DS, 86 Bumex, 54 Carbamazepine, 121
Astramorph, 112 Baking soda, 3 Bupropion, 139 Carbatrol, 121
Atacand, 176 Bayer Aspirin, 69 Burinex, 54 Carbex, 127
Atenolol, 173 Beclomethasone, 199 BuSpar, 136 Carbidopa/levodopa, 132
Ativan, 135 Bell-Ans, 3 Buspirone, 136 Carbolith, 138
Atomoxetine, 154 Benadryl/Benadryl Allergy, 198 Butorphanol, 159 Carboptic, 204
Atorvastatin, 181 Benylin-E, 197 Bydureon, 33 Cardizem/Cardizem LA, 174
AtroPen, 188 Benztropine, 133 Byetta, 33 Cardura/Cardura XL, 57
Atropine, 188 Besifloxacin, 78 Carisoprodol, 97
Atrovent/Atrovent HFA, 193 Besivance, 78 C CartiaXT, 174
Augmentin/Augmentin Betaloc-ZOK, 173 Cabbage palm, 65 Carvedilol, 173
ES/Augmentin XR, 79 Bethanechol, 52 Cal-Citrate 250, 1 Caspofungin, 88

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213
Catapres/Catapres-TTS, 177 Claritin/Claritin 24-Hour Allergy/ Coumadin, 164 Denosumab, 103
Cathflo Activase, 167 Claritin Hives Relief/Claritin Covera-HS, 174 Depacon, 126
Cefepime, 82 Reditabs, 198 Cozaar, 176 Depakene, 126
Ceftazidime, 82 Clavulin, 79 Crestor, 181 Depakote/Depakote ER, 126
Ceftriaxone, 82 Clear-Atadine, 198 Cromolyn, 200 Desipramine, 141
Celebrex, 105 Cleocin/Cleocin T, 75 Cyclobenzaprine, 97 Desirudin, 189
Celecoxib, 105 Clindamycin, 75 Cycloset, 130 Desmopressin, 46
Celexa, 137 Clomipramine, 141 Cyclosporine, 66 Desvenlafaxine, 140
Cephalexin, 82 Clonazepam, 135 Cymbalta, 140 Detoconazole (systemic), 87
Cephulac, 18 Clonidine, 177 Cytomel, 41 Detrol/Detrol LA, 51, 64
Cerebyx, 122 Clopidogrel, 165 Cytotec, 8 DexFerrum, 63
Cesamet, 26 Cogentin, 133 Dexmethylphenidate, 152
Children’s Loratadine, 198 Cognex, 134 D D.H.E. 45, 150
Chlorothiazide, 55 Colace, 19 Dabigatran, 189 DiaBeta, 38
Chlorpromazine, 144 Colchicine, 106 Dalacin C, 75 Diamox/Diamox Sequels, 203
Cholestyramine resin, 183 Colcrys, 106 Daliresp, 202 Diastat, 135
Chronulac, 18 Colesevelam, 183 Dalteparin, 163 Diazepam, 135
Cialis, 56 Colestid, 183 Dantrium, 98 Didanosine, 91
Cidomycin, 76 Colestipol, 183 Dantrolene, 98 Dideoxyinosine, 91
Cilostazol, 165 Colyte, 15 Darifenacin, 51 Didronel, 100
Cimetidine, 6 Compazine, 23 Darunavir, 92 Diflucan, 87
Cipro/Cipro XR, 78 Comtan, 131 Daytrana Transdermal Patch, 152 Digoxin, 169
Ciprofloxacin, 78 Concerta, 152 DC Softgels, 19 Dihydroergotamine-Sandoz,
Citalopram, 137 Cordarone, 178 DDAVP/DDAVP Rhinal Tube/ 150
Citrate of magnesia, 20 Coreg/Coreg CR, 173 DDAVP Rhinyl Drops, 46 Dilacor XR, 174
Citrical/Citracal Liquitab, 1 Cortef, 43 ddI, 91 Dilantin, 122
Citrocarbonate, 3 Cortifoam, 43 Delavirdine, 93 Dilatrate SR, 179
Citrucel, 14 Cortisone, 43 Demerol, 112 Dilaudid/Dilaudid-HP, 112
Clarithromycin, 74 Cortone, 43 Demon chaser, 160 Diltia XT, 174
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214
Diltiazem, 174 Ducolax Magnesia Tablets, 20 Enoxaparin, 163 Evista, 101
Dimetapp Children’s ND Ducosate calcium, 19 Entacapone, 131 Ex-Lax, 17
Non-Drowsy Allergy, 198 Duloxetine, 140 Epimorph, 112 Exalgo, 112
Diovan, 176 Duragesic, 110 Epinephrine, 157 Exelon/Exelon Transdermal
Dipentum, 27 Duramorph, 112 EpiPen, 157 Patch, 134
Diphenhydramine, 198 Dutasteride, 58 Epitol, 121 Exenatide/exenatide ER
Diphenoxylate/atropine, 12 Duvoid, 52 Epival, 126 suspension, 33
Dipivefrin, 205 Dynabac, 74 Epivir/Epivir HBV, 91 Ezetimibe, 182
Diprivan, 114 Dyrenium, 53 EPO, 62 Ezetrol, 182
Dirithromycin, 74 Epoetin, 62
Ditropan/Ditropan XL, 51 E Epogen, 62 F
Diuril, 55 E-Mycin, 74 Eprex, 62 Famciclovir, 89
Divalproex, 126 Ecotrin, 69 Epsilon, 166 Famivir, 89
Dixarit, 177 Edluar, 117 Ergomar, 150 Famotidine, 6
Docusate sodium, 19 Edrophonium, 99 Ergostat, 150 Fareston, 101
Dolasetron, 25 Eduant, 93 Ergotamine, 150 Fenofibrate, 180
Donepezil, 134 E.E.S., 74 Ertapenem, 83 Fentanyl (transdermal), 110
Dopamine, 172 Efavirenz, 93 EryGel, 74 Fesoterodine, 64
Doribax, 83 Effexor/Effexor XR, 140 EryPed, 74 Fexofenadine, 198
Doripenem, 83 Eldepryl, 127 Erythromycin, 74 Filgrastim (granulocyte
Doryx, 81 Elidel, 67 Escitalopram, 137 colony-stimulating factor
Dorzolamide, 203 Elixophyllin, 192 Esomeprazole, 7 [G-CSF]), 72, 187
Dovonex, 73 Enablex, 51 Eszopiclone, 117 Finasteride, 58
Doxazosin, 57 Enalapril, 175 Etanercept, 71 Fletcher’s Castoria, 17
Doxycycline, 81 Enalaprilat, 175 Ethambutol, 85 Flexeril, 97
Dramamine II, 22 Enbrel, 71 Ethosuximide, 124 Flomax, 57
Dronabinol, 26 Endocet, 111 Etibi, 85 Florinef, 44
Droperidol, 143 Enfuvirtide, 94 Etidronate, 100 Flovent HFA/Flovent Diskus, 199
Ducolax, 17 Enlon, 99 Etravirine, 93 Fluconazole, 87

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Fludrocortisone, 44 Garamycin, 76 Granulocyte/macrophage Hypericum perforatum
Fluoxetine, 137 Gas-X, 16 colony-stimulating factor, (St. John’s Wort), 160
Fluphenazine, 144 Gastrocrom, 200 recombinant human (rHu Hytinic, 63
Fluticasone, 199 Gelnique, 51 GM-CSF), 72 Hytrin, 57
Fluvoxamine, 137 Gemfibrozil, 180 Guaifenesin, 197 Hytuss, 197
Focalin/Focalin XR, 152 Genfraf, 66 Guiatuss, 197
Folate, 185 Gentamicin, 76 Gynergen, 150 I
Folic acid, 185 Geodon, 149 Ibandronate, 100
Folvite, 185 Ginger, 4 H Ibudone, 111
Fondaparinux, 191 Glimepiride, 38 Haldol/Haldol Decanoate, 143 Ibuprofen, oral, 68
Foradil, 194 Glipizide, 38 Haloperidol, 143 IMDUR, 179
Formoterol, 194 GlucaGen, 40 Hardhay, 160 Imipenem/cilastatin, 83
Fortamet, 34 Glucagon, 40 Hep-Lock/Hep-Lock U/P, 162 Imipramine, 141
Fortaz, 82 Gluconorm, 36 Hepalean, 162 Imitrex/Imitrex STATdose, 156
Forteo, 104 Glucophage/Glucophage XR, 34 Heparin, 162 Imodium/Imodium AD, 12
Fortical, 102 Glucotrol/Glucotrol XL, 38 Humalog, 28 Inamrinone, 170
Fosamax, 100 Glyburide, 38 Humatrope, 47 Inapsine, 143
Fosphenytoin, 122 Glynase PresTab, 38 Humulin N, 30 Indocin, 68
Fragmin, 163 Glyset, 37 Humulin R, 29 Indomethacin, 68
Fungizone, 87 GM-CSF (granulocyte/ Hydrochlorothiazide, 55 InFeD, 63
Furosemide, 54 macrophage colony- Hydrocodone/acetaminophen, Infliximab, 71
Fuzeon, 94 stimulating factor), 72 111 INH, 85
Goatweed, 160 Hydrocodone/ibuprofen, Innohep, 162
G GoLYTELY, 15 111 Inocor, 170
G-CSF (granulocyte colony- Gralise, 120 Hydrocortisone, 43 Insulin, regular, 29
stimulating factor), 72, 187 Granisetron, 25 Hydrofluoroakane (HFA), 194 Insulin aspart rDNA
Gabapentin, 120 Granulocyte colony- Hydromorphone, 112 origin, 28
Gabitril, 120 stimulating factor Hydrostat IR, 112 Insulin detemir, 31
Galantamine, 134 (G-CSF), 72, 187 Hyoscyamine, 11 Insulin glargine, 31
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Insulin glulisine (rDNA Isosorbide dinitrate, 179 Klonopin, 135 Levothyroxine, 41
origin) injection, 28 Isosorbide mononitrate, 179 Klor-Con, 2 Levoxyl, 41
Insulin (isophane insulin Isotrate, 179 Kristalose, 18 Levsin, 11
suspension) intermediate Isuprel, 195 Kytril, 25 Lexapro, 137
type, 30 Lialda, 27
J
Insulin lispro rDNA origin, 28 L Lidocaine (parenteral), 178
Jantoven, 164
Insulin-Toronto, 29 Labetalol, 173 Lidoderm, 178
Januvia, 35
Intelence, 93 Lacosamide, 125 LidoPen, 178
Jenamicin, 76
Intermezzo, 117 Lactulax, 18 Linagliptin, 35
Ju-Zhong, 65
Intropin, 172 Lactulose, 18 Lioresal, 97
Invanz, 83 K Lamictal/Lamictal XR, 125 Liothyronine, 41
Invirase, 92 K-Dur, 2 Lamivudine, 91 Lipidil Micro, 180
Iopidine, 205 K-Exit, 5 Lamotrigine, 125 Lipitor, 181
Ipratropium, 193 K-Long, 2 Lanoxicaps, 169 Lisinopril, 175
Iprivask, 189 K-Lor, 2 Lanoxin, 169 Lithium, 138
Irbesartan, 176 Kabbikinase, 167 Lanreotide, 48 Lithobid, 138
Iron dextran, 63 Kadian, 112 Lansoprazole, 7 LoCHOLEST/LoCHOLEST
Iron polysaccharide, 63 Kalcinate, 1 Lantus, 31 Light, 183
Iron sucrose, 63 Kanamycin, 76 Lasix, 54 Lofibra, 180
Isentress, 96 Kantrex, 76 Latanoprost, 206 Logen, 12
ISMO, 179 Kaopectate, 10 Laxit, 17 Lomotil, 12
Isocarboxazid, 142 Kaopectolin, 10 Leukine, 72 Lonox, 12
Isoniazid, 85 Karacil, 14 Levalbuteral, 194 Loperamide, 12
Isoproterenol, 195 Kayexalate, 5 Levaquin, 78 Lopid, 180
Isoptin/Isoptin SR, 174 Keflex, 82 Levemir, 31 Lopresor, 173
Isopto Carbachol, 204 Keppra/Keppra XR, 119 Levetiracetam, 119 Lopressor, 173
Isopto Carpine, 204 Ketorolac, 68 Levitra, 56 Lopurin, 107
Isopto Hyoscine, 21 Klamath weed, 160 Levofloxacin, 78 Loratadine, 198
Isordil, 179 Klean-Prep, 15 Levothroid, 41 Lorazepam, 135

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Lorcet, 111 Medihaler-Iso, 195 Micronase, 38 Naloxone, 113
Lortab, 111 Medrol, 43 Microzide, 55 Naltrexone, 113
Losartan, 176 Megace, 49 Midamor, 53 Naprosyn, 68
Losec, 7 Megestrol, 49 Midazolam, 116 Naproxen, 68
Lotronex, 13 Meperidine, 112 Miglitol, 37 Naratriptan, 156
Lovastatin, 181 Mephyton, 168 Migranal, 150 Narcan, 113
Lovaza, 184 Meridia, 151 Milrinone, 170 Nardil, 142
Lovenox, 163 Meropenem, 83 Minitran, 179 Nasacort AQ, 199
Lucentis, 207 Merrem, 83 Miochol-E, 204 NasalCrom, 200
Lumigan, 206 Mesalamine, 27 Mirapex, 128 Nateglinide, 36
Luminal, 115 Mestinon/Mestinon Timespan/ Misoprostol, 8 Natrecor, 171
Lunesta, 117 Mestinon SR, 99 Modafinil, 155 Navane, 145
Lutein, 210 Metadate CD/Metadate ER, 152 MOM (milk of magnesia), 20 Nebcin, 76
Luvox/Luvox CR, 137 Metamucil, 14 Monoket, 179 Nembutal, 115
Lyrica, 120 Metaproterenol, 194 Montelukast, 201 Nelfinavir, 92
Metaxolone, 97 Morphine, 112 Neo-Diaral, 12
M Metformin, 34 Morphine H.P., 112 Neoral, 66
Macugen, 209 Methimazole, 42 Moxifloxacin, 78 Neostigmine, 99
Mag-Ox 400, 20 Methotrexate, 70 MS Contin, 112 Nephro-Calci, 1
Magnacet, 111 Methylcellulose, 14 Mucinex, 197 Nephrocaps, 60
Magnesium citrate, 20 Methylin, 152 Mucomyst, 196 Nesiritide, 171
Magnesium hydroxide, 20 Methylphenidate, 152 Myambutol, 85 Neut, 3
Magnesium oxide, 20 Methylprednisolone, 43 Mycamine, 88 Neulasta, 72, 187
Maraviroc, 95 Metoclopramide, 24 Mylicon, 16 Neumega, 190
Marinol, 26 Metoprolol, 173 Mysoline, 123 Neupogen, 72, 187
Marplan, 142 Mevacor, 181 Neural protamine Hagedorn
Maxalt/Maxalt-MLT, 156 Miacalcin, 102 N (NPH), 30
Maxipime, 82 Micafungin, 88 Nabilone, 26 Neurontin, 120
Meclizine, 22 Micro-K/ Micro-K ExtenCaps, 2 Nalmefene, 113 Nevirapine, 93
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Nexium, 7 Novo-Tamoxifen, 101 Oracit, 3 Pegvisomant, 50
Nexterone, 178 Novo-Theophyl, 192 Orencia, 108 Pentasa, 27
Nifedipine, 174 Novo-Veramil, 174 Oretic, 55 Pentobarbital, 115
Niferex, 63 Novolin ge NPH, 30 Os-Cal, 1 Pepcid, 6
Niravam, 135 Novolog, 28 Oseltamivir, 90 Pepto-Bismol, 10
Nitrek, 179 Novopentobarb, 115 Ovol/ Ovol-40, 16 Percocet, 111
Nitro-Bid/Nitro-Bid IV, 179 Novopramine, 141 Oxcarbazepine Perforomist, 194
Nitro-Dur, 179 Novosecobarb, 115 (carbamazepine analog), Periostat, 81
Nitro-Time, 179 Novospiroton, 53 121 Perphenazine, 144
Nitrogard SR, 179 Novulin R, 29 Oxybutynin, 51 Pertofrane, 141
Nitroglycerin, 179 NPH (neural protamine Oxycodone/acetaminophen, Pexeva, 137
Nitrolingual, 179 Hagedorn), 30 111 Phazyme, 16
NitroQuik, 179 Nu-Iron, 63 Oxytocin, 45 Phenelzine, 142
Nitrostat, 179 Nu-Verap, 174 Oxytrol, 51 Phenobarbital, 115
Nizatidine, 6 Nucynta, 112 Phenytek, 122
Nizoral, 87 NuLytely, 15 P Phenytoin, 122
Norfranil, 141 Pacerone, 178 Phillips Magnesia Tablets, 20
Norpramin, 141 O Palonosetron, 25 Phillips Milk of Magnesia, 20
Nortriptyline, 141 Octreotide, 48 Pamelor, 141 Phos-Lo, 1
Norvasc, 174 Ocusert Pilo, 204 Pantoprazole, 7 PhosLo, 59
Norvir, 92 Olanzapine, 148 Parcopa, 132 Phyllocontin, 192
Nova-Theophyl SR, 192 Olsalazine, 27 Pariet, 7 Phytonadione, 168
Novo-Alprazol, 135 Omega-3-acid ethyl esters, Parlodel, 130 Pilocarpine, 204
Novo-Chlorpromazine, 144 184 Parnate, 142 Pimecrolimus, 67
Novo-Diltazem, 174 Omeprazole, 7 Paroxetine, 137 Pioglitazone, 39
Novo-Metformin, 34 Ondansetron, 25 Parvolex, 196 Piperacillin/tazobactam, 80
Novo-Nifedin, 174 Onglyza, 35 Paxil/Paxil ER, 137 Pitocin, 45
Novo-Rythro, 74 Oprelvekin, 190 Pegaptanib, 209 Pitressin, 46
Novo-Salmol, 194 Oracea, 81 Pegfilgrastim (G-CSF), 72, 187 Plavix, 165

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Pletal, 165 Prinivil, 175 Q Renal Caps, 60
PMS-Dicitrate, 3 Pristiq, 140 Questran/Questran Light, 183 Renvela, 59
PMS-Haloperidol, 143 ProAir HFA, 194 Quibron-T, 192 Repaglinide, 36
PMS Hydromorphone, 112 Procainamide, 178 Quinidine, 178 Reprexain, 111
PMS-Isoniazid, 85 Procardia/Procardia XL, 174 Quinupristin/dalfopristin, 84 Requip/Requip XL, 128
PMS-Levothyroxine Prochlorperazine, 23 Qvar, 199 Rescriptor, 93
sodium, 41 Procrit, 62 Restasis, 66
PMS-Methylphenidate, 152 Prolia, 103 R Retavase, 167
PMS Pyrazinamide, 85 Prolixin/Prolixin Decanoate, Rabeprazole, 7 Reteplase, 167
PMS-Sulfasalazine, 27 144 Ralivia, 109 Retrovir, 91
Polyethylene glycol/ Propecia, 58 Raloxifene, 101 Revatio, 56
electrolyte, 15 Propine, 205 Raltegravir, 96 Revex, 113
Potassium chloride, 2 Propofol, 114 Ramelteon, 118 ReVia (oral), 113
Pradaxa, 189 Propyl-Thyracil, 42 Ramipril, 175 Revimine, 172
Pramipexole, 128 Propylthiouracil, 42 Ranibizumab, 207 Rheumatrex, 70
Pramlintide, 32 Proscar, 58 Ranitidine, 6 Rifadin, 85
Prandin, 36 Prostigmin, 99 Rasagiline, 127 Rifampin, 85
Precose, 37 Protamine sulfate (injection), Razadyne/Razadyne ER, 134 Rilpivirine, 93
Prednisone, 43 161 Reclast, 100 Risedronate, 100
PredPak, 43 Protonix/Protonix IV, 7 Recombinant human Risperdal/Risperdal M-TAB/
Pregabalin, 120 Proventil, 194 granulocyte/macrophage Risperdal Consta, 147
Pressyn, 46 Provigil, 155 colony-stimulating factor Risperidone, 147
Prevacid/Prevacid 24 hr, 7 Prozac/Prozac Weekly, 137 (rHu GM-CSF), 72 Ritalin/Ritalin LA/Ritalin-SR,
Prevalite, 183 Psyllium, 14 Reglan/Reglan ODT, 24 152
Prezista, 92 PTU, 42 Regonol, 99 Ritonavir, 92
Prilosec/Prilosec OTC, 7 Pulmicort Respules/Pulmicort Regulex, 19 Rivaroxaban, 191
Primacor, 170 Flexhaler, 199 Relenza, 90 Rivastigmine, 134
Primaxin, 83 Pyrazinamide, 85 Remicade, 71 Rizatriptan, 156
Primidone, 123 Pyridostigmine, 99 Renagel, 59 Robitussin, 197
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Rocaltrol, 61 Saw palmetto, 65 Sodium citrate/citric acid, 3 Sumavel DosePro, 156
Rocephin, 82 Saw palmetto Sodium polystyrene Sumycin, 81
Rofact, 85 berry, 65 sulfonate, 5 Surfak, 19
Roflumilast, 202 Saxagliptin, 35 Solfoton, 115 Sustiva, 93
Ropinirole, 128 Scopolamine, 21 Solifenacin, 51 Symlin, 32
Rosiglitazone, 39 Secobarbital, 115 Solu-Cortef, 43 Symmetrel, 129
Rosin rose, 160 Seconal, 115 Solu-Medrol (IV), 43 Syn-Clonazepam, 135
Rosuvastatin, 181 Selegiline/selegiline Soma, 97 Synercid, 84
Rowasa, 27 transdermal, 127 Somatropin, 47 Synthroid, 41
Roxycet, 111 Selzentry, 95 Somatuline Depot, 48 Syntocinon, 45
Rozerem, 118 Sennosides, 17 Somavert, 50
Ryzolt, 109 Senokot, 17 Sominex, 198 T
Septra, 86 Spironolactone, 53 T3, 41
S Serenoa repens, 65 Sprix, 68 T4, 41
S-2 (racepinephrine), 157 Serevent, 194 St. John’s Wort (Hypericum t-PA, 167
Sabal, 65 Serostim, 47 perforatum), 160 Tacrine, 134
Salmeterol, 194 Sevelamer, 59 Starlix, 36 Tadalafil, 56
Salofalk, 27 Sibutramine, 151 Stavzor, 126 Tagamet, 6
Sanctura/Sanctura XL, 64 Sildenafil, 56 Stemetil, 23 Tamiflu, 90
Sandimmune, 66 Simethicone, 16 Sterapred, 43 Tamoxifen, 101
Sandostatin/Sandostatin LAR, 48 Simvastatin, 181 Stimate, 46 Tamsulosin, 57
Sans-Acne, 74 Sinemet/Sinemet CR, 132 Stradol/Stradol NS, 159 Tapazole, 42
Saquinavir, 92 Singulair, 201 Strattera, 154 Tapentadol, 112
Sarafem, 137 Sitagliptin, 35 Streptase, 167 Tasmar, 131
Sargramostim (recombinant Skelaxin, 97 Streptokinase, 167 Tazicef, 82
human granulocyte/ Slow-K, 2 Sucralfate, 9 Tegretol/Tegretol XR, 121
macrophage colony- SMZ/TMP, 86 Sulcrate, 9 Tekturna, 186
stimulating factor [rHu Soda Mint, 3 Sulfasalazine, 27 Tenecteplase, 167
GM-CSF]), 72 Sodium bicarbonate, 3 Sumatriptan, 156 Tenormin, 173

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Tensilon, 99 Topiramate, 120 U VESIcare, 51
Terazosin, 57 Toprol-XL, 173 Ultram/Ultram ER, 109 VFEND, 87
Terbutaline, 158 Toradol, Toradol 68 Unasyn, 79 Viagra, 56
Teril, 121 Toremefine, 101 Unisom Nightime Sleep Vibramycin, 81
Teriparitide, 104 Toviaz, 64 Aid, 198 Vicodin, 111
Tetracycline, 81 Tramadol, 109 Urabeth, 52 Vicoprofen, 111
THC, 26 Trandate, 173 Urecholine, 52 Videx/Videx EC, 91
Theo-24, 192 Transderm-Scop, 21 Uroxatral, 57 Vimpat, 125
Theophylline, 192 Transderm-V, 21 Viracept, 92
Thiothixene, 145 Tranylcypromine, 142 V Viramune, 93
Thorazine, 144 Travatan, 206 Valacyclovir, 89 Visudyne, 208
3TC, 91 Travoprost, 206 Valium, 135 Vitamin B, 185
Thyrar, 41 Trexall, 70 Valproate sodium, 126 Vitamin B with vitamin C,
Thyroid, 41 Triamcinolone, 199 Valproic acid, 126 60
Tiagabine, 120 Triamterene, 53 Valsartan, 176 Vitamin K, 168
Tiazac, 174 Tricor, 180 Valtrex, 89 Vivitrol (injection), 113
Ticlopidine, 165 Tridil, 179 Vanadom, 97 Voriconazole, 87
Tinzaparin, 162 Triglide, 180 Vancocin, 77 VoSpire ER, 194
Tipramine, 141 Trihexyphenidyl, 133 Vancomycin, 77
W
Tipton weed, 160 Trilafon, 144 Vardenafil, 56
Warfarin, 164
Tissue plasminogen activator Trileptal, 121 Vasopressin, 46
Warfilone, 164
(t-PA), 167 Trimethoprim/ Vasotec/Vasotec IV, 175
Welchol, 183
TNKase, 167 sulfamethoxazole, 86 Velosulin R, 29
Wellbutrin/Wellbutrin SR, 139
TOBI, 76 Trimox, 79 Venlafaxine, 140
Westhroid, 41
Tobramycin, 76 Triostat, 41 Venofer, 63
Tofranil/Tofranil PM, 141 Trospium, 64 Ventolin HFA, 194 X
Tolcapone, 131 Trusopt, 203 Verapamil, 174 Xalatan, 206
Tolterodine, 51, 64 Tums/Tums E-X, 1 Versed, 116 Xanax/Xanax XR, 135
Topamax, 120 Tylox, 111 Verteporfin, 208 Xarelto, 191
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Xopenex/Xopenex HFA/Xopenex Zarontin, 124 Zocar, 181 Zyflo CR, 201
Concentrate, 194 Zeaxanthin, 210 Zofran, 25 Zyleuton, 201
Xylocaine, 178 Zestril, 175 Zoledronic acid, 100 Zyloprim, 107
Xylocard, 178 Zetia, 182 Zolpidem, 117 Zyprexa/Zyprexa Relprevv/Zyprexa
Ziagen, 91 Zolpimist, 117 Intramuscular/Zyprexa Zydis,
Z Zidovudine, 91 Zometa, 100 148
Zafirlukast, 201 Ziprasidone, 149 Zosyn, 80
Zantac/ Zantac-C, 6 Zithromax, 74 Zovirax, 89
Zanamivir, 90 Zmax, 74 Zyban, 139

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