HELLO NURSES! 30.

FENTANYL
A few days ago I posted a draft of an empty FLASH CARD 31. KETAMINE
that can hep you MEMORIZE some of our 32. NALOXONE
basic/protoype drugs. Now, to help you have a clearer 33. DANTRIUM
path on which drugs should you write on those cards, i AUTNOMIC NERVOUS SYSTEM
made a SHORT LIST of drugs belonging to different 34. EPINEPHRINE
pharmacologic classifications (one drug per class). 35. ALBUTEROL
Below are the drugs that I RECOMMEND you to write on 36. PRAZOSIN
those empty flash cards. I believe that having 37. BETHANECHOL
knowledge on these drugs below can make you be 38. PHYSOSTIGMINE
prepared for MEDICAL SURGICAL NURSING. 39. ATROPINE SULFATE
NOTE; FLASH CARDS ARE JUST FOR MEMORIZATION OF ANITHYPERLIPIDEMICS
THE DRUGS. Understanding and Analysis is a different 40. ATORVASTATIN
thing, and that's what I mean when I say "knowledge". 41. CHOLESTYRAMINE
But this can be a good start for you to have that 42. GEMFIBROZIL
knowledge. 🙂 CARDIO DRUGS
here's the SHORT LIST: 43. ENALAPRIL
ANTIMICROBIALS 44. LOSARTAN
1. PENICILLIN G 45. NICARDIPINE
2. CEFOTAXIME 46. PROPRANOLOL
3. MEROPENEM 47. CLONIDINE
4. FOSFOMYCIN 48. HYDRALAZINE
5. GENTAMICIN 49. DIGOXIN
6. AMIKACIN 50. NITROGYCERIN
7. AZITHROMYCIN 51. DILTIAZEM
8. CIPROFLOXACIN 52. RETEPLASE
9. AMPOTHERECIN B 53. NOREPINEPHRINE
10. FLUCONAZOLE 54. DOPAMINE
11. CHLOROQUINE DIURETICS
12. METRONIDAZOLE 55. FUROSEMIDE
13. MEBENDAZOLE 56. HYDROCHLOROTHIAZIDE
14. ACYCLOVIR 57. MANNITOL
BODY DEFENSES / PAIN 58. SPIRONOLACTONE
15. ACETYLSALICYLIC ACID ENDOCRINE
16. IBUPROFEN 59. SOMATROPIN
17. CELECOXIB 60. DESMOPRESSIN
18. DICOFENAC 61. LEVOTHYROXINE
19. PIROXICAM 62. PROPYLTHIOURACIL
20. ACETAMINOPHEN 63. HYDROCORTISONE
21. INTERFERON ALFA 2B 64. HUMAN REGULAR INSULIN
22. CYCLOSPORINE 65. GLARGINE INSULIN
23. HEPATITIS B VACCINE 66. INSULIN ASPART
24. MORPHINE 67. HUMAN ISOPHANE INSULIN
25. PENTAZOCINE 68. METFORMIN
ANESTHESIA 69. GLICLAZIDE
26. LIDOCAINE 70. EMPAGLIFLOZIN
27. SEVOFLURANE 71. ALENDRONATE
28. PROPOFOL 72. OXYTOCIN
29. MIDAZOLAM 73. ISOXILAN
RESPI
74. ACETYLCISTEINE
75. DEXTROMETORPHAN
76. MONTELUKAST
77. AMINOPHYLLINE
78. OXYMETHAZOLINE
79. CETIRIZINE
GASTRO
80. METOCLOPRAMIDE
81. ONDANSETRON
82. LOPERAMIDE
83. RANITIDINE
84. OMEPRAZOLE
85. SUCRALFATE
86. MISOPROSTOL
87. CASTOR OIL
88. IPECAC
end of shortlist.
PS. Nurses are known to be RESOURCEFUL.
No printer? write them.
No clean paper? utilize used ones.
No book? use the net.
No internet? use the book.
No book and internet? ask a friend.
No time? that's an excuse. If you think its good for you,
you'll find time.
1 drug will just take 15 mins. 🙂
ANTIMICROBIALS
Generic Name: Penicillin G Benzathine/ Penicillin G
Procaine
Trade Name: Bicillin C-R
Pharmacologic Class: Antibiotic; penicillins
Therapeutic Class: Anti-infectives
Action: Bind to bacterial cell wall, resulting in cell death.
Reasons Given (Disease States):
Treatment of a wide variety of infections including:
Pneumococcal pneumonia, Streptococcal pharyngitis,
Syphilis, Gonorrhea strains. Treatment of enterococcal
infections (requires the addition of an aminoglycoside).
Prevention of rheumatic fever
Nursing Process
Pre-Administration Assessment:
● Assess for infection (vital signs; appearance of wound,
sputum, urine, and stool; WBC) at beginning of and
during therapy.
● Obtain a history to determine previous use of and
reactions to penicillins, cephalosporins, or other beta-
lactam antibiotics. Persons with a negative history of
penicillin sensitivity may still have an allergic response.
● Obtain specimens for culture and sensitivity before
initiating therapy. First dose may be given before
receiving results.
● Observe patient for signs and symptoms of
anaphylaxis (rash, pruritus, laryngeal edema, wheezing).
Discontinue drug and notify physician or other health
care professional immediately if these symptoms occur.
Keep epinephrine, an antihistamine, and resuscitation
equipment close by in case of an anaphylactic reaction.
● Lab Test Considerations: May cause positive direct
Coombs’ test results.
● Hyperkalemia may develop after large doses of
penicillin G potassium.
● Monitor serum sodium concentrations in patient with
hypertension or HF. Hypernatremia may develop after
large doses of penicillin sodium.
● May cause AST, ALT, LDH, and serum alkaline
phosphatase concentrations.
● May cause leukopenia and neutropenia, especially
with prolonged therapy or hepatic impairment.
Post-Administration Assessment:
Resolution of signs and symptoms of infection. Length
of time for complete resolution depends on the
organism and site of infection.
Nursing Considerations:
●Instruct patient to take medication around the clock
and to finish drug completely as directed, even if feeling
better. Advise patient that sharing this medication may
be dangerous.
● Advise patient to report signs of superinfection (black,
furry overgrowth on tongue; vaginal itching or
discharge; loose or foul-smelling stools) and allergy.
● Instruct patient to notify health care professional if
fever and diarrhea develop, especially if stool contains
blood, pus, or mucus. Advise patient not to treat
diarrhea without consulting health care professional.
● Instruct patient to notify health care professional if
symptoms do not improve.
● Advise patient taking oral contraceptives to use an
additional nonhormonal method of contraception
during therapy with penicillin and until next menstrual
period.
● Patient with an allergy to penicillin should be
instructed to always carry an identification card with
this information.
https://www.medicinenet.com/
penicillin_benzathine_procaine_injection/article.htm
https://www.drugbank.ca/drugs/
DB01053#:~:text=Penicillin%20G%20is%20a
%20penicillin,antibiotics%20derived%20from%20the
%20penicillins.
https://davisplus.fadavis.com/3976/meddeck/pdf/
penicilling.pdf
https://nursing.unboundmedicine.com/nursingcentral/
view/Davis-Drug-Guide/109318/all/penicillin_G?
q=g+penicillin#13
Generic Name: Cefotaxime
Trade Name: Claforan
Pharmacologic Class: third-generation cephalosporin
Therapeutic Class: antibiotic
Action: Cefotaxime is primarily bactericidal; it also may
be bacteriostatic. Activity depends on the organism,
tissue penetration, dosage, and rate of organism
multiplication. It acts by adhering to bacterial penicillin-
binding proteins, thereby inhibiting cell wall synthesis.
Reasons Given (Disease States):
Indicated for the treatment of patients with serious
infections caused by susceptible strains of the
designated microorganisms in the diseases.
● Lab Test Considerations:May cause positive results for
Coombs’ test.
● May causeqserum AST, ALT, alkaline phosphatase,
bilirubin, LDH, BUN, and creatinine.
● May rarely cause leukopenia, neutropenia,
agranulocytosis, thrombocytopenia,
and eosinophilia.
● May cause leukopenia and neutropenia, especially
with prolonged therapy or hepatic impairment.
Post-Administration Assessment:
●Resolution of the signs and symptoms of infection.
Length of time for complete resolution depends on the
organism and site of infection.
● Decreased incidence of infection when used for
prophylaxis.

Nursing Process Nursing Considerations:

Pre-Administration Assessment: ●Advise patient to report signs of superinfection (furry

overgrowth on the tongue, vaginal itching or discharge,
●Assess patient for infection (vital signs; appearance of loose or foul-smelling stools) and allergy.
wound, sputum, urine, and ● Instruct patient to notify health care professional if
stool; WBC) at beginning of and throughout therapy. fever and diarrhea develop, especially if stool contains
● Before initiating therapy, obtain a history to blood, pus, or mucus. Advise patient not to treat
determine previous use of and reactions to penicillins or diarrhea without consulting health care professional.
cephalosporins. Persons with a negative history of
penicillin https://davisplus.fadavis.com/3976/meddeck/pdf/
sensitivity may still have an allergic response. cefotaxime.pdf
● Obtain specimens for culture and sensitivity before
initiating therapy. First dose https://www.glowm.com/resources/glowm/cd/pages/
may be given before receiving results. drugs/c029.html
● Observe patient for signs and symptoms of
anaphylaxis (rash, pruritus, https://www.rxlist.com/claforan-drug.htm#indications
laryngeal edema, wheezing). Discontinue the drug and
notify health
care professional immediately if these symptoms occur.
Keep epinephrine, an antihistamine, and resuscitation
equipment close by in the event
of an anaphylactic reaction.
● Monitor bowel function. Diarrhea, abdominal
cramping, fever, and
bloody stools should be reported to health care
professional promptly
as a sign of pseudomembranous colitis. May begin up to
several weeks
following cessation of therapy.
Generic Name: Meropenem
Trade Name: Merrem I.V.
Pharmacologic Class: carbapenem derivative
Therapeutic Class: antibiotic/anti-infectives
Action: Binds to bacterial cell wall, resulting in cell
death. Meropenem resists the actions of many enzymes
that degrade most other penicillins and penicillin-like
anti-infectives
Reasons Given (Disease States):
To reduce the development of drug-resistant bacteria
and maintain the effectiveness of MERREM IV and other
antibacterial drugs, MERREM IV should only be used to
treat or prevent infections that are proven or strongly
suspected to be caused by susceptible bacteria. When
culture and susceptibility information are available, they
should be considered in selecting or modifying
antibacterial therapy. In the absence of such data, local
epidemiology and susceptibility patterns may contribute
to the empiric selection of therapy.
Nursing Process
Pre-Administration Assessment:
● Assess for infection (vital signs; appearance of wound,
sputum, urine, and stool;
WBC) at beginning of and throughout therapy.
● Obtain a history before initiating therapy to
determine previous use of and reactions to penicillins.
Persons with a negative history of penicillin sensitivity
may still
have an allergic response.
● Obtain specimens for culture and sensitivity prior to
initiating therapy. First dose
may be given before receiving results.
● Observe for signs and symptoms of anaphylaxis (rash,
pruritus, laryngeal edema, wheezing). Discontinue the
drug and notify physician immediately if these
symptoms occur. Have epinephrine, an antihistamine,
and resuscitative equipment close by in the event of an
anaphylactic reaction.
● Assess injection site for phlebitis, pain, and swelling
periodically during administration.
● Lab Test Considerations: Monitor hematologic,
hepatic, and renal functions
periodically during therapy.
● BUN, AST, ALT, LDH, serum alkaline phosphatase,
bilirubin, and creatinine may
be transientlyq.
● Hemoglobin and hematocrit concentrations may bep.
● May cause positive direct or indirect Coombs’ test.
Post-Administration Assessment:
● Resolution of the signs and symptoms of infection.
Length of time for complete resolution depends on the
organism and site of infection.
Nursing Considerations:
● Advise patient to report the signs of superinfection
(black, furry overgrowth on the
tongue; vaginal itching or discharge; loose or foul-
smelling stools) and allergy.
● May cause dizziness. Caution patient to avoid driving
or other activities requiring
alertness until response to drug is known.
● Caution patient to notify health care professional if
fever and diarrhea
occur, especially if stool contains blood, pus, or mucus.
Advise patient
not to treat diarrhea without consulting health care
professional. May
occur up to several weeks after discontinuation of
medication.
● Advise patient to notify health care professional of all
Rx or OTC medications, vitamins, or herbal products
being taken and to consult with health care professional
before taking other medications.
https://davisplus.fadavis.com/3976/meddeck/pdf/
meropenem.pdf
https://www.glowm.com/resources/glowm/cd/pages/
drugs/m022.html
https://www.rxlist.com/merrem-iv-
drug.htm#indications
Generic Name: Fosfomycin https://www.rxlist.com/monurol-drug.htm#indications
https://www.accessdata.fda.gov/drugsatfda_docs/label
Trade Name: Monurol
/2008/050717s005lbl.pdf
https://www.glowm.com/resources/glowm/cd/pages/
drugs/f044.html
Pharmacologic Class: phosphonic acid derivative

Therapeutic Class: antibiotic/anti-infectives https://reference.medscape.com/drug/monurol-

fosfomycin-342560

Action: Inactivates an enzyme crucial for bacterial cell

wall synthesis. Decreases adherence of bacteria to
uroepithelial cells

Reasons Given (Disease States):

MONUROL is indicated only for the treatment of

uncomplicated urinary tract infections (acute cystitis) in
women due to susceptible strains of Escherichia coli and
Enterococcus faecalis. MONUROL is not indicated for
the treatment of pyelonephritis or perinephric abscess.

Nursing Process

Pre-Administration Assessment:

● Assess patient for signs and symptoms of cystitis

(frequency, urgency, painful urination).
● Obtain urine specimen for culture and sensitivity
before administration.
● Monitor bowel function. Diarrhea, abdominal
cramping, fever, and bloody stools should be reported
to health care professional promptly as a sign of
pseudomembranous colitis. May begin up to several
weeks following cessation of therapy.

Post-Administration Assessment:

● Improvement in symptoms of acute cystitis within 2–

3 days.

Nursing Considerations:

● Instruct patient on correct preparation of sachet.

● Instruct patient to notify health care professional
immediately if diarrhea, abdominal cramping, fever, or
bloody stools occur and not to treat with antidiarrheals
without consulting health care professionals.
● Advise patient to notify health care professional if
symptoms have not improved or
persist more than 2– 3 days after treatment.

https://davisplus.fadavis.com/3976/meddeck/pdf/
fosfomycin.pdf
Generic Name: Gentamicin/gentamicin sulfate ● Lab Test Considerations: Monitor renal function by
urinalysis, specific gravity, BUN, creatinine, and CCr
Trade Name: Garamycin
before and throughout therapy.
● May causeqBUN, AST, ALT, serum alkaline
phosphatase, bilirubin, creatinine,
Pharmacologic Class: aminoglycosides and LDH concentrations.
Therapeutic Class: anti-infectives ● Toxicity and Overdose: Monitor blood levels
periodically during therapy.
Timing of blood levels is important in interpreting
Action: Inhibits protein synthesis in bacteria at level of results. Draw blood for peak
30S ribosome levels 1 hr after IM injection and 30 min after a 30-min
IV infusion is completed.
Reasons Given (Disease States): Trough levels should be drawn just before next dose.
Peak level range 4– 12 mcg/
Treatment of serious gram-negative bacterial infections
mL; trough level range 0.5– 2 mcg/mL. Once daily peaks
and infections caused by staphylococci when penicillins
are 2– 3 times greater
or other less toxic drugs are contraindicated. In
than multiple dosing.
combination with other agents in the management of
serious enterococcal infections.
Post-Administration Assessment:
Prevention of infective endocarditis. Topical, Ophth:
● Resolution of the signs and symptoms of infection. If
Treatment of localized infections due to susceptible
no response is seen within 3–5 days, new cultures
organisms.
should be taken.
Nursing Process
● Prevention of infective endocarditis.
Pre-Administration Assessment:
Nursing Considerations:
● Assess for infection (vital signs, wound appearance,
● Instruct patient to report signs of hypersensitivity,
sputum, urine, stool, WBC) at
tinnitus, vertigo, hearing loss,
beginning of and throughout therapy.
rash, dizziness, or difficulty urinating.
● Obtain specimens for culture and sensitivity before
● Advise patient of the importance of drinking plenty of
initiating therapy. First dose
liquids.
may be given before receiving results.
● Teach patients with a history of rheumatic heart
● Evaluate eighth cranial nerve function by audiometry
disease or valve replacement the
before and throughout therapy. Hearing loss is usually
importance of using antimicrobial prophylaxis before
in the high-frequency range. Prompt recognition and
invasive medical or dental
intervention are essential in preventing permanent
procedures.
damage. Also monitor for vestibular dysfunction
● Topical: Instruct patient to wash affected skin gently
(vertigo, ataxia, nausea, vomiting). Eighth cranial nerve
and pat dry. Apply a thin film
dysfunction is associated with persistently elevated
of ointment. Apply occlusive dressing only if ordered by
peak aminoglycoside levels. Aminoglycosides should be
health care professional.
discontinued if tinnitus or subjective hearing loss
Patient should assess skin and inform health care
occurs.
professional if skin irritation develops or infection
● Monitor intake and output and daily weight to assess
worsens
hydration status and renal
function.
https://davisplus.fadavis.com/3976/meddeck/pdf/
● Assess for signs of superinfection (fever, upper
gentamicin.pdf
respiratory infection, vaginal itching or discharge,
https://www.rnpedia.com/nursing-notes/
increasing malaise, diarrhea).
pharmacology-drug-study-notes/gentamicin-sulfate/
https://www.rxlist.com/consumer_gentamicin/drugs-
condition.htm
Generic Name: Amikacin/amikacin sulfate
Trade Name: Amikin
Pharmacologic Class: aminoglycosides
Therapeutic Class: antibiotic/anti-infectives
Action:

Inhibits protein synthesis in bacteria at the level of
the 30S ribosome. Resists the action of enzymes
known to inactivate other aminoglycosides
 Semisynthetic derivative of kanamycin with broad
range of antimicrobial activity that includes many
strains resistant to other aminoglycosides.
 Pharmacologic properties are essentially the same
as those of gentamicin.
 Appears to inhibit protein synthesis in bacterial cell
and is usually bactericidal.
Reasons Given (Disease States):
IM, IV: Treatment of serious infections for which
treatment with less toxic anti-infectives is
contraindicated or known to be ineffective. Unlabeled
Use: Part of combination treatment of Mycobacterium
avium complex infections. IT: With parenteralamikacin
in the management of CNS infections. Inhaln: By aerosol
nebulization for the prevention of serious pneumonia in
high-risk populations.
Nursing Process
Pre-Administration Assessment:
● Assess for infection (vital signs; wound appearance;
sputum, urine, and stool; WBCs at beginning and
throughout therapy.
● Obtain specimens for culture and sensitivity before
initiating therapy. First dose may be given before
receiving results.
● Evaluate eighth cranial nerve function by audiometry
before and throughout therapy. Hearing loss is usually
in the high-frequency range. Prompt recognition and
intervention are essential in preventing permanent
damage. Also monitor for vestibular dysfunction
(vertigo, ataxia, nausea, vomiting). Eighth cranial nerve
dysfunction is associated with persistently elevated
peak amikacin levels. Amikacin should be discontinued
if tinnitus or subjective hearing loss occurs.
● Monitor intake and output and daily weight to assess
hydration status and renal function.
● Assess for signs of superinfection (fever, upper
respiratory infection, vaginal itching or discharge,
increasing malaise, diarrhea).
● Lab Test Considerations: Monitor renal function by
urinalysis, specific gravity, BUN, creatinine, and CCr
before and during therapy.
● May causeqBUN and creatinine concentrations.
● Toxicity and Overdose: Monitor therapeutic blood
levels periodically during
therapy. Timing of blood levels is important in
interpreting results. Draw blood for
peak levels 1 hr after IM injection and 30 min after a 30-
min IV infusion is completed. Trough levels should be
drawn just before next dose. Peak level range 20–
30 mcg/mL; trough level 10 mcg/mL.
● Unlabeled q 24 h dosing—trough level 1 mcg/mL.
Post-Administration Assessment:
● Resolution of the signs and symptoms of infection. If
no response is seen within 3–5 days, new cultures
should be obtained.
Nursing Considerations:
 Instruct patient to report signs of hypersensitivity,
tinnitus, vertigo, muscle weakness/twitching,
feeling of fullness in the head, or hearing loss.
 Report immediately any changes in hearing or
unexplained ringing/roaring noises or dizziness, and
problems with balance or coordination.
 Do not breast feed while taking this drug without
consulting physician.
https://davisplus.fadavis.com/3976/meddeck/pdf/
amikacin.pdf
https://www.rxlist.com/amikin-drug.htm#indications
https://www.glowm.com/resources/glowm/cd/pages/
drugs/a027.html
Generic Name: Azithromycin

Trade Name: Zithromax, Zmax  Treatment of pharyngitis and tonsillitis in children >
2 yr who cannot use first-line therapy

Pharmacologic Class: macrolides/ azalide macrolide  Prevention and treatment of disseminated

Therapeutic Class: agents for atypical mycobacterium, Mycobacterium avium complex (MAC) in patients
anti-infectives with advanced AIDS

 Treatment of patients with mild to moderate acute

Action: bacterial sinusitis caused by H. influenzae,
Moracellis catarrhalis, S. pneumoniae (Zmax)

 Inhibits protein synthesis at the level of the 50S

 Treatment of mild to moderate community
bacterial ribosome.
acquired pneumonia caused by Chlamydophila

 Azithromycin blocks transpeptidation by binding to

pneumoniae, H. influenzae,
pneumoniae, S. pneumoniae (Zmax)
Mycoplasma

50s ribosomal subunit of susceptible organisms and

disrupting RNA-dependent protein synthesis at the
chain elongation step.
 Unlabeled uses: Uncomplicated gonococcal
infections caused by N. gonorrhoeae; gonococcal
Reasons Given (Disease States): pharyngitis caused by N. gonorrhoeae; chlamydial
infections caused by C. trachomatis; prophylaxis

 Treatment of lower respiratory infections: Acute

after sexual attack

bacterial exacerbations of COPD due to Nursing Process

Haemophilus influenzae, Moraxella catarrhalis,
Streptococcus pneumoniae; community-acquired
pneumonia due to S. pneumoniae, H. influenzae
Pre-Administration Assessment:
● Assess patient for infection (vital signs; appearance of
wound, sputum, urine, and

 Treatment of lower respiratory infections:

Streptococcal pharyngitis and tonsillitis due to
Streptococcus pyogenes in those who cannot take
penicillins
 Treatment of uncomplicated skin infections due to
Staphylococcus aureus, S. pyogenes, Streptococcus
agalactiae
stool; WBC) at beginning of and throughout therapy.
● Obtain specimens for culture and sensitivity before
initiating therapy. First dose may be given before
receiving results.
● Observe for signs and symptoms of anaphylaxis (rash,
pruritus, laryngeal edema, wheezing). Notify health care
professional immediately if
these occur.
● Assess patient for skin rash frequently during therapy.
Discontinue azithromycin at first sign of rash; may be

 Treatment of nongonococcal urethritis and cervicitis

life-threatening. Stevens-Johnson syndrome or toxic
epidermal necrolysis may develop. Treat
due to Chlamydia trachomatis; treatment of PID symptomatically; may recur once treatment is stopped.


● Lab Test Considerations: May causeqserum bilirubin,
Treatment of acute sinusitis AST, ALT, LDH, and alkaline phosphatase
concentrations.

 Treatment of otitis media caused by H. influenzae,

● May cause creatine phosphokinase, potassium,
prothrombin time, BUN, serum
M. catarrhalis, S. pneumoniae in children > 6 mo creatinine, and blood glucose concentrations
● May occasionally cause WBC and platelet count. https://www.rnpedia.com/nursing-notes/
pharmacology-drug-study-notes/azithromycin/
Post-Administration Assessment:
https://www.rxlist.com/zithromax-drug.htm
● Resolution of the signs and symptoms of infection.
Length of time for complete resolution depends on the
https://www.glowm.com/resources/glowm/cd/pages/
organism and site of infection.
drugs/a072.html
Nursing Considerations:

● Instruct patients to take medication as directed and

to finish the drug completely,
even if they are feeling better. Take missed doses as
soon as possible unless almost
time for next dose; do not double doses. Advise patients
that sharing of this medication may be dangerous.
● Instruct patient not to take azithromycin with food or
antacids.
● May cause drowsiness and dizziness. Caution patient
to avoid driving or other activities requiring alertness
until response to medication is known.
● Advise patient to use sunscreen and protective
clothing to prevent photosensitivity
reactions.
● Advise patient to report symptoms of chest pain,
palpitations, yellowing
of skin or eyes, or signs of superinfection (black, furry
overgrowth on
the tongue; vaginal itching or discharge; loose or foul-
smelling stools)
or rash.
● Instruct patient to notify health care professional if
fever and diarrhea
develop, especially if stool contains blood, pus, or
mucus. Advise patient
not to treat diarrhea without advice of health care
professional.
● Advise patients being treated for nongonococcal
urethritis or cervicitis that sexual
partners should also be treated.
● Instruct parents, caregivers, or patient to notify health
care professional if symptoms do not improve.
● Pedi: Tell parents or caregivers that medication is
generally well tolerated in children. Most common side
effects in children are mild diarrhea and rash. Tell
parents to notify health care practitioner if these occur.

https://davisplus.fadavis.com/3976/meddeck/pdf/
azithromycin.pdf
Generic Name: Ciprofloxacin
Trade Name: Ciloxan, Cipro, Cipro HC Otic, Cipro I.V.,
Cipro XR, Co Ciprofloxacin (CAN), Proquin XR
Pharmacologic Class: fluoroquinolones
Therapeutic Class: antibacterial/anti-infectives/
antibiotic
Action: Inhibits bacterial DNA synthesis by inhibiting
DNA gyrase enzyme
Ciprofloxacin promotes breakage of double-stranded
DNA in susceptible organisms and inhibits DNA gyrase,
which is essential in reproduction of bacterial DNA.
Reasons Given (Disease States):
PO, IV: Treatment of the following bacterial infections:
Urinary tract and gynecologic infections, including
cystitis, and prostatitis, Respiratory tract infections
including acute sinusitis, acute exacerbations of chronic
bronchitis, and pneumonia, Skin and skin structure
infection , Bone and joint infections , Infectious diarrhea
, Complicated intra-abdominal infections (with
metronidazole), Typhoid fever. Post-exposure
prophylaxis of inhalational anthrax. Cutaneous anthrax.
Unlabeled Use: Febrile neutropenia. Acute pulmonary
exacerbations in cystic fibrosis
Nursing Process
Pre-Administration Assessment:
● Assess for infection (vital signs; appearance of wound,
sputum, urine, and stool;
WBC; urinalysis; frequency and urgency of urination;
cloudy or foul-smelling
urine) at beginning of and throughout therapy.
● Obtain specimens for culture and sensitivity before
initiating therapy. First dose
may be given before receiving results.
● Observe for signs and symptoms of anaphylaxis (rash,
pruritus, laryngeal edema, wheezing). Discontinue drug
and notify health care professional immediately if these
problems occur. Keep epinephrine, an antihistamine,
and resuscitation equipment close by in case of an
anaphylactic reaction.
● Monitor bowel function. Diarrhea, abdominal
cramping, fever, and
bloody stools should be reported to health care
professional promptly
as a sign of pseudomembranous colitis. May begin up to
several weeks
following cessation of therapy.
● Lab Test Considerations:May causeqserum AST, ALT,
LDH, bilirubin, and alkaline phosphatase. May also
cause or serum glucose.
● History: Allergy to ciprofloxacin, norfloxacin or other
quinolones; renal dysfunction; seizures; lactation
● Physical: Skin color, lesions; T; orientation, reflexes,
affect; mucous membranes, bowel sounds; LFTs, renal
function tests
Post-Administration Assessment:
● Resolution of the signs and symptoms of bacterial
infection. Time for complete resolution depends on
organism and site of infection.
● Post-exposure treatment of inhalational anthrax or
cutaneous anthrax
Nursing Considerations:
● Instruct patient to take medication as directed at
evenly spaced times and to finish drug completely, even
if feeling better. Take missed doses as soon as possible,
unless almost time for next dose. Do not double doses.
Advise patient that sharing of
this medication may be dangerous.
● Advise patients to notify health care professional
immediately if they are taking theophylline.
● Encourage patient to maintain a fluid intake of at
least 1500– 2000 mL/day to prevent crystalluria.
● Advise patient that antacids or medications
containing calcium, magnesium, aluminum, iron, or zinc
will decrease absorption and should not be taken within
4 hr
before and 2 hr after taking this medication.
● May cause dizziness and drowsiness. Caution patient
to avoid driving or other activities requiring alertness
until response to medication is known.
● Caution patient to use sunscreen and protective
clothing to prevent phototoxicity reactions during and
for 5 days after therapy. Notify health care professional
if a sunburn-like reaction or skin eruption occurs.
● Instruct patients being treated for gonorrhea that
partners also must be treated.
● Instruct patient to notify health care professional of
all Rx or OTC medications, vitamins, or herbal products
being taken and to consult health care professional
before taking any other Rx, OTC, or herbal products.
● Advise patient to report signs of superinfection (furry
overgrowth on the tongue, vaginal itching or discharge,
loose or foul-smelling stools).
● Instruct patient to notify health care professional if
fever and diarrhea develop, especially if stool contains
blood, pus, or mucus. Advise patient not to treat
diarrhea without consulting health care professional.
● Instruct patient to notify health care professional
immediately if signs and symptoms of hepatotoxicity
(anorexia, jaundice, dark urine, pruritus, or tender
abdomen), rash, signs of hypersensitivity, or tendon
(shoulder, hand, Achilles, and other) pain, swelling, or
inflammation occur. If tendon symptoms occur, avoid
exercise and use of the affected area. Increased risk in
65 yrs old, kidney, heart and lung transplant recipients,
and patients taking corticosteroids concurrently.
Therapy should be discontinued.

https://davisplus.fadavis.com/3976/meddeck/pdf/
ciprofloxacin.pdf

https://wps.prenhall.com/wps/media/objects/
2943/3014230/nursproc/Chapter22NPFforCW.pdf

https://www.rxlist.com/cipro-drug.htm

https://www.rnpedia.com/nursing-notes/
pharmacology-drug-study-notes/ciprofloxacin/

https://www.glowm.com/resources/glowm/cd/pages/
drugs/c060.html
Generic Name: Ampotherecin B
Trade Name: Ambisome/Amphocin/Fungizone
Pharmacologic Class: polyene antibiotic
Therapeutic Class: antifungal
Action:
Binds to fungal cell membrane, allowing leakage of
cellular contents. Toxicity (especially acute infusion
reactions and nephrotoxicity) is less with lipid
formulations.
Reasons Given (Disease States):
IV: Treatment of progressive, potentially fatal fungal
infections. The cholesteryl sulfate, lipid complex, and
liposome formulations should be considered for
patients who are intolerant (e.g., renal dysfunction) or
refractory to amphotericin B dexycholate. Amphotericin
B liposome: Management of suspected fungal infections
in febrile neutropenic patients: Treatment of visceral
leishmaniasis, Treatment of cryptococcal meningitis in
HIV patients
Nursing Process
Pre-Administration Assessment:
● Obtain complete health history including
allergies, drug history, and possible drug
interactions.
● Obtain a culture and sensitivity of suspected area
of infection to determine need for therapy.
● Obtain baseline vital signs, especially pulse and
blood pressure.
● Obtain renal function including blood tests
(CBC, chemistry panel, BUN, and creatinine).
● Monitor patient closely during test dose and the first
1– 2 hr of each dose for fever, chills, headache,
anorexia, nausea, or vomiting. Premedicating with
antipyretics,
corticosteroids, antihistamines, meperidine, and
antiemetics may decrease these reactions. Febrile
reaction usually subsides within 4 hr after the infusion is
completed.
● Assess injection site frequently for thrombophlebitis
or leakage. Drug is very irritating to tissues.
● Monitor vital signs every 15 min during test dose and
every 30 min for 2– 4 hr after administration.
Meperidine and dantrolene have been used to
prevent and treat rigors. Assess respiratory status (lung
sounds, dyspnea) daily. If respiratory distress occurs,
discontinue infusion immediately; anaphylaxis may
occur. Equipment for cardiopulmonary resuscitation
should be readily available.
● Monitor intake and output and weigh daily. Adequate
hydration (2000– 3000 mL/ day) and maintaining
sodium balance may minimize nephrotoxicity.
● Lab Test Considerations: Monitor CBC, BUN and
serum creatinine, and potassium and magnesium levels
daily. If BUN and serum creatinine significantly, may
need to discontinue or consider switching to cholesteryl
sulfate, lipid complex, or liposomal formulation.
Post-Administration Assessment:
● Resolution of signs and symptoms of infection.
Several weeks to months of therapy may be required to
prevent relapse.
Nursing Considerations:
● Explain need for long duration of IV or topical
therapy.
● IV: Inform patient of potential side effects and
discomfort at IV site. Advise patient to notify health
care professional if side effects occur.
● Home Care Issue: Instruct family or caregiver on
dilution, rate, and administration of drug and proper
care of IV equipment.
https://davisplus.fadavis.com/3976/meddeck/pdf/
amphotericinb.pdf
https://www.rxlist.com/ambisome-
drug.htm#indications
https://wps.prenhall.com/wps/media/objects/
2943/3014230/nursproc/Chapter23NPFforCW.pdf
https://www.glowm.com/resources/glowm/cd/pages/
drugs/a040.html
Generic Name: Fluconazole
Trade Name: DiFlucan, Canesoral, Monicure
Pharmacologic Class: bis-triazole derivative
Therapeutic Class: antifungals
Action:
Inhibits synthesis of fungal sterols, a necessary
component of the cell membrane.
Reasons Given (Disease States):
PO, IV: Fungal infections caused by susceptible
organisms, including: Oropharyngeal or esophageal
candidiasis , Serious systemic candidal infections,
Urinary tract infections, Peritonitis, Cryptococcal
meningitis. Prevention of candidiasis in patients who
have undergone bone marrow transplantation. PO
Single-dose oral treatment of vaginal candidiasis.
Unlabeled Use: Prevention of recurrent vaginal yeast
infections.
Nursing Process
Pre-Administration Assessment:
● History: Hypersensitivity to fluconazole, renal
impairment, lactation, pregnancy
● Physical: Skin color, lesions; T; injection site;
orientation, reflexes, affect; bowel sounds; LFTs, renal
function tests; CBC and differential; culture of area
involved
● Assess infected area and monitor CSF cultures before
and periodically during therapy.
● Specimens for culture should be taken before
instituting therapy. Therapy may be started before
results are obtained.
● Assess patient for rash (mild to moderate rash usually
occurs in the 2nd wk of therapy and resolves within 1– 2
wk of continued therapy). If rash is severe (extensive
erythematous or maculopapular rash with moist
desquamation or angioedema) or accompanied by
systemic symptoms (serum sickness-like reaction,
Stevens-Johnson syndrome, toxic epidermal necrolysis),
therapy must be discontinued immediately.
● Lab Test Considerations: Monitor BUN and serum
creatinine before and periodically during therapy;
patients with renal dysfunction will require dose
adjustment.
● Monitor liver function tests before and periodically
during therapy. May cause AST, ALT, serum alkaline
phosphate, and bilirubin concentrations.
Post-Administration Assessment:
● Resolution of clinical and laboratory indications of
fungal infections. Full course of therapy may require
weeks or months of treatment after resolution of
symptoms.
● Prevention of candidiasis in patients who have
undergone bone marrow transplantation.
● Decrease in skin irritation and vaginal discomfort in
patients with vaginal candidiasis. Diagnosis should be
reconfirmed with smears or cultures before a second
course of therapy to rule out other pathogens
associated with vulvovaginitis. Recurrent vaginal
infections may be a sign of systemic illness.
Nursing Considerations:
● Instruct patient to take medication as directed, even if
feeling better. Doses should be taken at the same time
each day. Take missed doses as soon as remembered,
but not if almost time for next dose. Do not double
doses.
● Instruct patient to notify health care professional if
skin rash, abdominal pain, fever, or diarrhea becomes
pronounced, if signs and symptoms of liver dysfunction
(unusual fatigue, anorexia, nausea, vomiting, jaundice,
dark urine, or pale stools) occur, if unusual bruising or
bleeding occur, or if no improvement is seen within a
few days of therapy.
https://davisplus.fadavis.com/3976/meddeck/pdf/
fluconazole.pdf
https://www.rnpedia.com/nursing-notes/
pharmacology-drug-study-notes/fluconazole/
https://www.rxlist.com/diflucan-drug.htm#indications
https://www.glowm.com/resources/glowm/cd/pages/
drugs/f018.html
Generic Name: Chloroquine
Trade Name: Aralen
Pharmacologic Class: 4-aminoquinoline
Therapeutic Class: antimalarial, amebicide, anti-
inflammatory, antirheumatics (DMARDs)
Action:
Inhibits protein synthesis in susceptible organisms by
inhibiting DNA and RNA polymerase
Reasons Given (Disease States):
Prophylaxis and treatment of acute attacks of malaria.
Treatment of extraintestinal amebiasis. Unlabeled Use:
Treatment of severe rheumatoid arthritis. Treatment of
systemic lupus erythematosus.
Nursing Process
Pre-Administration Assessment:
● Determine baseline for future reference that includes
current symptoms of disease prior to administration.
● Assess deep tendon reflexes periodically to determine
muscle weakness. If weakness occurs, discontinue
therapy.
● Discontinue therapy immediately if hearing
impairment develops.
● Perform ophthalmologic exam initially and
periodically during therapy; discontinue therapy
immediately if visual disturbances develop.
● Observe for development of rash. Discontinue
chloroquine at the first sign of skin reactions. Serious
adverse reactions such as Stevens-Johnson syndrome or
toxic epidermal necrolysis preclude further use.
● Malaria: Assess patient for improvement in signs and
symptoms of condition daily throughout therapy.
● Rheumatoid Arthritis/Systemic Lupus Erythematosus:
Assess degree of joint pain and limitation of motion
monthly.
● Lab Test Considerations: Monitor CBC periodically
throughout therapy. May cause decreased WBC and
platelet counts.
● Monitor liver function tests periodically during
therapy.
Post-Administration Assessment:
● Prevention of or improvement in signs and symptoms
of malaria.
● Regression of extraintestinal amebic disease.
● Decrease in the symptoms and progression of
rheumatoid arthritis and systemic lupus erythematosus.
Nursing Considerations:
● Instruct patient to take medication exactly as directed
and continue full course of therapy, even if feeling
better. Missed doses should be taken as soon as
remembered, except with regimens requiring doses
more than once a day, for which missed doses should
be taken within 1 hr or omitted. Do not double doses.
● Review methods of minimizing exposure to
mosquitoes with patients receiving chloroquine
prophylactically (use insect repellent, wear long-sleeved
shirt and long trousers, use screen or netting).
● Advise patients to avoid use of alcohol while taking
chloroquine.
● Caution patient to keep chloroquine out of the reach
of children; fatalities have occurred with ingestion of 3
or 4 tablets.
● Explain need for periodic ophthalmic exams for
patients on prolonged high-dose therapy. Advise patient
that the risk of ocular damage may be decreased by the
use of dark glasses in bright light. Protective clothing
and sunscreen should also be used to reduce risk of
dermatoses.
● Advise patient to notify health care professional
promptly if sore throat, fever, unusual bleeding or
bruising, blurred vision, difficulty reading, visual
changes, ringing in the ears, difficulty hearing, mental
changes, or muscle weakness occurs or if diarrhea,
anorexia, nausea, stomach pain, vomiting, or rash
becomes pronounced or bothersome. Most adverse
reactions are dose related.
● Advise female patient to notify health care
professional of pregnancy is planned or suspected, or if
breast feeding.
● Rheumatoid Arthritis/Systemic Lupus Erythematosus:
Instruct patient to contact health care professional if no
improvement is noticed within a few days. Treatment
may require up to 6 mo for full benefit.
https://davisplus.fadavis.com/3976/meddeck/pdf/
chloroquine.pdf
https://www.glowm.com/resources/glowm/cd/pages/
drugs/c048.html
Generic Name: Metronidazole
Trade Name: Flagyl, Flagyl ER, MetroCream, MetroGel,
MetroGel-Vaginal, MetroLotion, Metro IV, Nidagel,
Noritate, Novonidazol, Trikacide, Vandazole
Pharmacologic Class: nitroimidazole
Therapeutic Class: Antibiotic, Antibacterial, Amebicide,
Antiprotozoal
Action:
Disrupts DNA and protein synthesis in susceptible
organisms.
Metronidazole is converted to reduction products that
interact with DNA to cause destruction of helical DNA
structure and strand leading to a protein synthesis
inhibition and cell death in susceptible organisms. It is
effective against a wide range of organisms including E.
histolytica, T. vaginalis, Giardia, anaerobes e.g.
Bacterioides sp, Fusobacterium sp, Clostridium sp,
Peptococcus sp and Peptostreptococcus sp, and
moderately active against Gardnerella sp and
Campylobacter sp.
Reasons Given (Disease States):
PO, IV: Treatment of the following anaerobic infections:
Intra-abdominal infections (may be used with a
cephalosporin), Gynecologic infections, Skin and skin
structure infections, Lower respiratory tract infections,
Bone and joint infections, CNS infections, Septicemia,
Endocarditis. IV Perioperative prophylactic agent in
colorectal surgery. PO: Amebicide in the management
of amebic dysentery, amebic liver abscess, and
trichomoniasis: Treatment of peptic ulcer disease
caused by Helicobacter pylori. Topical Treatment of
acne rosacea. Vag: Management of bacterial vaginosis.
Unlabeled Use: Treatment of giardiasis. Treatment of
anti-infective associated pseudomembranous colitis.
Nursing Process
Pre-Administration Assessment:
● History: CNS or hepatic disease; candidiasis
(moniliasis); blood dyscrasias; pregnancy; lactation
● Physical: Reflexes, affect; skin lesions, color (with
topical application); abdominal examination, liver
palpation; urinalysis, CBC, LFTs
● Assess for infection (vital signs; appearance of wound,
sputum, urine, and stool; WBC) at beginning of and
throughout therapy.
● Obtain specimens for culture and sensitivity before
initiating therapy. First dose may be given before
receiving results.
● Monitor neurologic status during and after IV
infusions. Inform health care professional if numbness,
paresthesia, weakness, ataxia, or seizures occur.
● Monitor intake and output and daily weight,
especially for patients on sodium restriction. Each 500
mg of premixed injection for dilution contains 14 mEq
of sodium.
● Assess for rash periodically during therapy. May cause
Stevens-Johnson syndrome. Discontinue therapy if
severe or if accompanied with fever, general malaise,
fatigue, muscle or joint aches, blisters, oral lesions,
conjunctivitis, hepatitis and/or eosinophilia.
● Giardiasis:Monitor three stool samples taken several
days apart, beginning 3– 4 wk after treatment.
● Lab Test Considerations:May alter results of serum
AST, ALT, and LDH tests
Post-Administration Assessment:
● Resolution of the signs and symptoms of infection.
Length of time for complete resolution depends on
organism and site of infection.
● Significant results should be seen within 3 wk of
application of topical gel. Application may be continued
for 9 wk.
Nursing Considerations:
● Instruct patient to take medication as directed with
evenly spaced times between doses, even if feeling
better. Do not skip doses or double up on missed doses.
Take missed doses as soon as remembered if not almost
time for next dose.
● Advise patients treated for trichomoniasis that sexual
partners may be asymptomatic sources of reinfection
and should be treated concurrently. Patient should also
refrain from intercourse or use a condom to prevent
reinfection.
● Caution patient to avoid intake of alcoholic beverages
or preparations containing alcohol during and for at
least 3 days after treatment with metronidazole,
including vaginal gel. May cause a disulfiram-like
reaction (flushing, nausea, vomiting, headache,
abdominal cramps).

● May cause dizziness or light-headedness. Caution

patient to avoid driving or other activities requiring
alertness until response to medication is known.

● Instruct patient to notify health care professional

promptly if rash occurs.

● Inform patient that medication may cause an

unpleasant metallic taste.

● Advise patient to notify health care professional of all

Rx or OTC medications, vitamins, or herbal products
being taken and to consult with health care professional
before taking other medications.

● Advise patient that frequent mouth rinses, good oral

hygiene, and sugarless gum or candy may minimize dry
mouth. Notify health care professional if dry mouth
persists for more than 2 wk.

● Inform patient that medication may cause urine to

turn dark.

● Advise patient to consult health care professional if

no improvement in a few days or if signs and symptoms
of superinfection (black, furry overgrowth on tongue;
vaginal itching or discharge; loose or foul-smelling
stools) develop.

● Advise patient to inform health care professional if

pregnancy is suspected before taking this medication or
if breast feeding.

● Vag: Instruct patient in correct technique for

intravaginal instillation. Advise patient to avoid
intercourse during treatment with vaginal gel.

● Topical: Instruct patient on correct technique for

application of topical gel. Cosmetics may be used after
application of gel.

https://davisplus.fadavis.com/3976/meddeck/pdf/
metronidazole.pdf

https://www.rnpedia.com/nursing-notes/
pharmacology-drug-study-notes/metronidazole/
Generic Name: Mebendazole

Trade Name: Vermox

Pharmacologic Class: benzimidazole

Therapeutic Class: anthelmintic

Action:

Mebendazole inhibits uptake of glucose and other low-

molecular-weight nutrients in susceptible helminths,
depleting the glycogen stores they need for survival and
reproduction. It has a broad spectrum and may be
useful in mixed infections. It’s considered a drug of
choice in the treatment of ascariasis, capillariasis,
enterobiasis, trichuriasis, and uncinariasis; it has been
used investigationally to treat echinococciasis,
onchocerciasis, and trichinosis.

Reasons Given (Disease States):

Treatment of patients two years of age and older with

gastrointestinal infections caused by Ancylostoma
duodenale (hookworm), Ascaris lumbricoides
(roundworm), Enterobius vermicularis (pinworm),
Necator americanus (hookworm), and Trichuris trichiura
(whipworm).

Nursing Process

Pre-Administration Assessment:

• Obtain complete health history

including allergies, drug history and
possible drug interactions.
• Obtain a stool specimen for
verification of parasite & determine
need for therapy
• Obtain complete blood count
• Assess the patient’s living situation
including number of individuals in
close contact with the patient.

Post-Administration Assessment:

• Report healing of parasitic infection

• Demonstrate an understanding of the drug’s action by

accurately describing drug side
effects and precautions.

• Immediately report effects such as itching, hives,

diarrhea and fever

Nursing Considerations:

*Instruct patient to bring stool sample to lab

for testing
*Instruct patients to report transient
abdominal pain, diarrhea, and fever to health
care provider.
*Instruct patient to notify health care
practitioner of any bleeding or signs of
infection.
*Instruct patient to use effective birth control during
drug therapy notify health care practitioner of any signs
of pregnancy.
*Instruct patient that tablets can be chewed,
swallowed or crushed and mixed with food,
especially fatty foods such as cheese or ice
cream.
*Instruct patient that all family members may be
treated at the same time to prevent reinfestation
* to wash all fruits and vegetables; cook meat
thoroughly
* to carefully wash hands with soap and water
before and after eating and toileting
* to wash toilet eats with disinfectants
* to keep nails clean and out of mouth
* to wear tight underwear and change daily
* to sleep alone and wash bedding
* that it is extremely important to complete
the entire course of drug therapy
https://www.rxlist.com/vermox-drug.htm#indications

https://wps.prenhall.com/wps/media/objects/
3775/3866436/npf_charts/ch35/Mebendazole.pdf

https://www.glowm.com/resources/glowm/cd/pages/
drugs/m008.html
Generic Name: Acyclovir
Trade Name: Valtrex
Pharmacologic Class: synthetic purine nucleoside
Therapeutic Class: antivirals
Action:
Rapidly converted to acyclovir. Acyclovir interferes with
viral DNA synthesis.
Reasons Given (Disease States):
Treatment of herpes zoster (shingles).
Treatment/suppression of genital herpes. Reduction of
transmission of genital herpes. Treatment of
chickenpox. Treatment of herpes labialis (cold sores).
Nursing Process
Pre-Administration Assessment:
● Assess lesions before and daily during therapy.
● Monitor patient for signs of thrombotic thrombocytic
purpura/hemolytic uremic syndrome
(thrombocytopenia, microangiopathic hemolytic
anemia, neurologic findings, renal dysfunction, fever).
Requires prompt treatment; may be fatal.
●History: Allergy to acyclovir, seizures, CHF, renal
disease, lactation, pregnancy
●Physical: Skin color, lesions; orientation; BP, P,
auscultation, perfusion, edema; R, adventitious sounds;
urinary output; BUN, creatinine clearance
Post-Administration Assessment:
● Decrease in time to full crusting, loss of vesicles, loss
of ulcers, and development of crusts in patients with
acute herpes zoster (shingles).
● Decrease in time to full crusting, loss of vesicles, loss
of ulcers, and development of crusts in patients with
genital herpes.
● Decrease in frequency of outbreaks in patients with
genital herpes.
● Decrease in time to full crusting, loss of vesicles, loss
of ulcers, and development of crusts in patients with
herpes labialis. Decrease in transmission of genital
herpes.
● Treatment of chicken pox.
Nursing Considerations:
● Instruct patient to take valacyclovir exactly as
directed for the full course of therapy. Take missed
doses as soon as remembered if not just before next
dose; do not double doses. Advise patient to read the
Patient Information before starting therapy.
● Advise patient to maintain adequate hydration during
therapy.
● Advise patient to notify health care professional
promptly if nervous system symptoms (aggressive
behavior, unsteady movement, shaky movements,
confusion, speech problems, hallucinations, seizures,
coma) occur.
● Instruct patient to notify health care professional of
all Rx or OTC medications, vitamins, or herbal products
being taken and consult health care professional before
taking any new medications.
● Instruct female patients to notify health care
professional if pregnancy is planned or suspected, or if
breast feeding.
● Herpes Zoster: Inform patient that valacyclovir does
not prevent the spread of infection to others.
Precautions should be taken around others who have
not had chickenpox or varicella vaccine, or are
immunosuppressed, until all lesions have crusted.
● Genital Herpes and Herpes Labialis: Inform patient
that valacyclovir does not prevent the spread of herpes
labialis to others. Advise patient to avoid contact with
lesions while lesions or symptoms are present.
Valacyclovir reduces transmission of genital herpes to
others. Advise patient to practice safe sex (avoid sexual
intercourse when lesions are present and wear a
condom made of latex or polyurethane during sexual
contact).
https://davisplus.fadavis.com/3976/meddeck/pdf/
valacyclovir.pdf
https://www.rnpedia.com/nursing-notes/
pharmacology-drug-study-notes/acyclovir/
https://www.glowm.com/resources/glowm/cd/pages/
drugs/a009.html
BODY DEFENSES/PAIN
Generic Name: Aspirin
Trade Name: Acetylsalicylic acid, Acuprin, ASA,
Asaphen, Aspergum, Aspir-Low, Aspirtab, Bayer Aspirin,
Bayer Timed-Release Arthritic Pain Formula, Easprin,
Ecotrin, 8-
Hour Bayer Timed-Release, Empirin, Entrophen,
Halfprin, Healthprin, Lowprin, Norwich Aspirin,
Novasen, Rivasa, Sloprin, St. Joseph Adult Chewable
Aspirin, Therapy Bayer, ZORprin
Pharmacologic Class: salicylate
Therapeutic Class: nonnarcotic analgesic, antipyretic,
anti-inflammatory, antiplatelet
Action:
Produce analgesia and reduce inflammation and fever
by inhibiting the production of prostaglandins.
Decreases platelet aggregation.
Reasons Given (Disease States):
Inflammatory disorders including: Rheumatoid arthritis,
Osteoarthritis. Mild tomoderate pain. Fever. Prophylaxis
of transient ischemic attacks and MI. Unlabeled Use:
Adjunctive treatment of Kawasaki disease.
Nursing Process
Pre-Administration Assessment:
 Assess for contraindications or cautions (e.g., history
of allergy to salicylate and tartrazine, renal disease,
bleeding disorders, pregnancy and lactation, etc.) to
avoid adverse effects.
 Establish baseline physical assessment to monitor
for any potential adverse effects.

Assess for presence of skin lesions to monitor for
dermatological effects.
 Monitor temperature to evaluate drug’s
effectiveness in lowering temperature.
 Evaluate CNS status to assess CNS effects of the
drug.

Monitor pulse, blood pressure, and perfusion to
assess for bleeding effects or cardiovascular effects
of the drug.
 Evaluate respirations and adventitious sounds to
detect hypersensitivity reactions.
 Perform a liver evaluation and monitor bowel
sounds to detect hypersensitivity reactions,
bleeding, and GI effects of the drug.
 Monitor laboratory tests for CBC, liver and renal
functions tests, urinalysis, stool guaiac, and clotting
times to detect bleeding or other adverse effects of
the drug and changes in function that could interfere
with drug metabolism and excretion.
Post-Administration Assessment:
 Monitor patient response to therapy (improvement
in condition being treated, relief of signs and
symptoms of inflammation).
 Monitor for adverse effects (e.g., GI upset, CNS
changes, bleeding).
 Evaluate patient understanding on drug therapy by
asking patient to name the drug, its indication, and
adverse effects to watch for.
 Monitor patient compliance to drug therapy.
Nursing Considerations:
● Instruct patient to take salicylates with a full glass of
water and to remain in an upright position for 15– 30
min after administration.
● Advise patient to report tinnitus; unusual bleeding of
gums; bruising; black, tarry
stools; or fever lasting longer than 3 days.
Name /bks_53161_deglins_md_disk/aspirin 03/06/2014 concurrently with acetaminophen or NSAIDs for more
08:09AM Plate # 0-Composite pg 3 # 3 than a few days,
Canadian drug name. Genetic Implication. CAPITALS unless directed by health care professional to prevent
indicate life-threatening, underlines indicate most analgesic nephropathy.
frequent. ● Teach patients on a sodium-restricted diet to avoid
● Caution patient to avoid concurrent use of alcohol effervescent tablets or buffered-aspirin preparations.
with this medication ● Tablets with an acetic (vinegar-like) odor should be
to minimize possible gastric irritation; 3 or more glasses discarded.
of alcohol per ● Advise patients on long-term therapy to inform health
day may increase risk of GI bleeding. Caution patient to care professional of medication regimen before surgery.
avoid taking Aspirin may need to be withheld for 1 wk before
surgery.
● Pedi: Centers for Disease Control and Prevention
warns against giving aspirin to children or adolescents
with varicella (chickenpox) or influenza-like or viral
illnesses because of a possible association with Reye’s
syndrome.
● Transient Ischemic Attacks or MI: Advise patients
receiving aspirin prophylactically to take only prescribed
dose. Increasing dose has not been found to provide
additional benefits.
https://davisplus.fadavis.com/3976/meddeck/pdf/
aspirin.pdf
https://nurseslabs.com/salicylates/
https://www.glowm.com/resources/glowm/cd/pages/
drugs/a061.html
Generic Name: Ibuprofen
Trade Name: Advil, Advil Migraine Liqui-Gels, Children’s
Advil, Children’s Motrin, Excedrin IB, Junior Strength
Advil, Medipren, Midol Maximum Strength Cramp
Formula, Motrin, Motrin Drops, Motrin IB, Motrin
Junior Strength, Motrin Migraine Pain, Nuprin,
PediaCare Children’s Fever
Pharmacologic Class: NSAID
Therapeutic Class: nonnarcotic analgesic, antipyretic,
anti-inflammatory
Action:
Inhibits prostaglandin synthesis. Ibuprofen exhibits anti-
inflammatory, analgesic and antipyretic activities. Its
analgesic effect is independent of anti-inflammatory
activity and has both central and peripheral effects. It
potently inhibits the enzyme cyclooxygenase resulting
in the blockage of prostaglandin synthesis. It also
prevents formation of thromboxane A2 by platelet
aggregation.
Reasons Given (Disease States):
 Relief of signs and symptoms of rheumatoid arthritis
and osteoarthritis

Relief of mild to moderate pain
 Treatment of primary dysmenorrhea
 Fever reduction
 Unlabeled uses: Prophylactic for migraine; abortive
treatment for migraine
Nursing Process
Pre-Administration Assessment:
● History: Allergy to ibuprofen, salicylates or other
NSAIDs; CV dysfunction, hypertension; peptic
ulceration, GI bleeding; impaired hepatic or renal
function; pregnancy; lactation
●Physical: Skin color, lesions; T; orientation, reflexes,
ophthalmologic evaluation, audiometric evaluation,
peripheral sensation; P, BP, edema; R, adventitious
sounds; liver evaluation, bowel sounds; CBC, clotting
times, urinalysis, LFTs, renal function tests, serum
electrolytes, stool guaiac
● Patients who have asthma, aspirin-induced allergy,
and nasal polyps are at increased risk for developing
hypersensitivity reactions. Assess for rhinitis, asthma,
and urticaria.
● Assess for signs and symptoms of GI bleeding (tarry
stools, lightheadedness, hypotension), renal dysfunction
(elevated BUN and creatinine levels, decreased urine
output), and hepatic impairment (elevated liver
enzymes, jaundice). Geri:Higher risk for poor outcomes
or death from GI bleeding. Age-related renal
impairment
increases risk of hepatic and renal toxicity.
● Assess patient for skin rash frequently during therapy.
Discontinue ibuprofen at first sign of rash; may be life-
threatening. Stevens-Johnson syndrome or toxic
epidermal necrolysis may develop. Treat
symptomatically; may recur once treatment is stopped.
● Pain: Assess pain (note type, location, and intensity)
prior to and 1– 2 hr following administration.
● Arthritis: Assess pain and range of motion prior to and
1– 2 hr following administration.
● Fever:Monitor temperature; note signs associated
with fever (diaphoresis, tachycardia, malaise).
● PDA Closure: Monitor preterm neonates for signs of
bleeding, infection and decreased urine output.
Monitor IV site for signs of extravasation.
● Lab Test Considerations: BUN, serum creatinine, CBC,
and liver function tests
should be evaluated periodically in patients receiving
prolonged therapy.
● Serum potassium, BUN, serum creatinine, alkaline
phosphatase, LDH, AST, and
ALT may showqlevels. Blood glucose, hemoglobin, and
hematocrit concentrations, leukocyte and platelet
counts, and CCr may bep.
● May cause prolonged bleeding time; may persist for 1
day following discontinuation.
Post-Administration Assessment:
● Decrease in severity of pain.
● Improved joint mobility. Partial arthritic relief is
usually seen within 7 days, but
maximum effectiveness may require 1– 2 wk of https://www.glowm.com/resources/glowm/cd/pages/
continuous therapy. Patients who drugs/ij000.html
do not respond to one NSAID may respond to another.
● Reduction in fever.

Nursing Considerations:

● Advise patients to take ibuprofen with a full glass of

water and to remain in an upright position for 15– 30
min after administration.
● Instruct patient to take medication as directed. Take
missed doses as soon as remembered but not if almost
time for next dose. Do not double doses. Pedi: Teach
parents and caregivers to calculate and measure doses
accurately and to use measuring device supplied with
product.
● May cause drowsiness or dizziness. Advise patient to
avoid driving or other activities requiring alertness until
response to medication is known.
● Caution patient to avoid the concurrent use of
alcohol, aspirin, acetaminophen, and other OTC or
herbal products without consulting health care
professional.
● Advise patient to inform health care professional of
medication regimen prior to treatment or surgery.
● Instruct patients not to take OTC ibuprofen
preparations for more than 10 days for pain or more
than 3 days for fever, and to consult health care
professional if symptoms persist or worsen. Many OTC
products contain ibuprofen; avoid duplication.
● Caution patient that use of ibuprofen with 3 or more
glasses of alcohol per day may increase the risk of GI
bleeding.
● Advise patient to consult health care professional if
rash, itching, visual disturbances, tinnitus, weight gain,
edema, epigastric pain, dyspepsia, black stools,
hematemasis, persistent headache, or influenza-like
syndrome (chills, fever, muscle aches, pain) occurs.
● Pedi: Advise parents or caregivers not to administer
ibuprofen to children who may be dehydrated (can
occur with vomiting, diarrhea, or poor fluid intake);
dehydration increases risk of renal dysfuntion.
● Advise female patients to notify health care
professional if pregnancy is planned or
suspected.
https://davisplus.fadavis.com/3976/meddeck/pdf/
ibuprofen.pdf
https://www.rnpedia.com/nursing-notes/
pharmacology-drug-study-notes/ibuprofen/
Generic Name: Celecoxib

Trade Name: Celebrex

Pharmacologic Class: cyclooxygenase-2 (COX-2)

inhibitor

Therapeutic Class: anti-inflammatory

Action:

Inhibits the enzyme COX-2. This enzyme is required for

the synthesis of prostaglandins. Has analgesic, anti-
inflammatory, and antipyretic properties

Reasons Given (Disease States):

Relief of signs and symptoms of osteoarthritis,

rheumatoid arthritis, ankylosing spondylitis and juvenile
rheumatoid arthritis. Management of acute pain
including primary dysmenorrhea.

Nursing Process

Pre-Administration Assessment:

● History: Renal impairment, impaired hearing,

allergies, hepatic and CV conditions, lactation,
pregnancy
●Physical: Skin color and lesions; orientation, reflexes,
ophthalmologic and audiometric evaluation, peripheral
sensation; P, edema; R, adventitious sounds; liver
evaluation; CBC, LFTs, renal function tests; serum
electrolytes
● Assess range of motion, degree of swelling, and pain
in affected joints before and periodically throughout
therapy.

● Assess patient for allergy to sulfonamides, aspirin, or

NSAIDs. Patients with these allergies should not receive
celecoxib.

● Assess patient for skin rash frequently during therapy.

Discontinue at first sign of rash; may be life-threatening.
Stevens-Johnson syndrome may develop. Treat
symptomatically; may recur once treatment is stopped.

● Lab Test Considerations: May cause AST and ALT

levels.

● May cause hypophosphatemia and BUN.

Post-Administration Assessment:
● Reduction in joint pain in patients with osteoarthritis.
● Reduction in joint tenderness, pain, and joint swelling
in patients with rheumatoid
arthritis and juvenile rheumatoid arthritis.
● Decreased pain with dysmenorrhea.

Nursing Considerations:

● Instruct patient to take celecoxib exactly as directed.

Do not take more than prescribed dose. Increasing
doses does not appear to increase effectiveness. Use
lowest effective dose for shortest period of time.
● Advise patient to notify health care professional
promptly if sign or symptom of GI toxicity (abdominal
pain, black stools), skin rash, unexplained weight gain,
edema, or chest pain occurs. Patients should
discontinue celecoxib and notify health care
professional if signs and symptoms of hepatotoxicity
(nausea, fatigue, lethargy, pruritus, jaundice, upper
right quadrant tenderness, flu-like symptoms) occur.
● Advise patient to notify health care professional if
pregnancy is planned or suspected.
https://davisplus.fadavis.com/3976/meddeck/pdf/
celecoxib.pdf
https://www.rnpedia.com/nursing-notes/
pharmacology-drug-study-notes/celecoxib/
https://www.glowm.com/resources/glowm/cd/pages/
drugs/c038.html
Generic Name: Diclofenac
Trade Name:
diclofenac potassium
Cataflam
diclofenac sodium
Voltaren, Voltaren-XR
Pharmacologic Class: NSAID
Therapeutic Class: antarthritic, anti-inflammatory
Action:
Inhibits prostaglandin synthesis.
Reasons Given (Disease States):
PO: Management of inflammatory disorders including:
Rheumatoid arthritis, Osteoarthritis, Ankylosing
spondylitis. Primary dysmenorrhea. Relief of mild to
moderate pain. Acute treatment of migraines (powder
for oral solution). Topical Management of: Actinic
keratoses (Solaraze), Osteoarthritis (Voltaren Gel,
Pennsaid [for knees]). Transdermal Acute pain due to
minor strains, sprains, and contusions.
Nursing Process
Pre-Administration Assessment:
● History: Renal impairment; impaired hearing;
allergies; hepatic, CV, and GI conditions; lactation,
pregnancy
● Physical: Skin color and lesions; orientation, reflexes,
ophthalmologic and audiometric evaluation, peripheral
sensation; P, edema; R, adventitious sounds; liver
evaluation; CBC, clotting times, renal function tests,
LFTs, serum electrolytes, stool guaiac
● Patients who have asthma, aspirin-induced allergy,
and nasal polyps are at risk for developing
hypersensitivity reactions.
● Monitor BP closely during initiation of treatment and
periodically during therapy in patients with
hypertension.
● Assess patient for skin rash frequently during therapy.
Discontinue at first sign of rash; may be life-threatening.
Stevens-Johnson syndrome may develop. Treat
symptomatically; may recur once treatment is stopped.
● Pain: Assess pain and limitation of movement; note
type, location, and intensity before and 30– 60 min
after administration.
● Arthritis: Assess arthritic pain (note type, location,
intensity) and limitation of movement before and
periodically during therapy.
● Actinic Keratosis: Assess lesions prior to and
periodically during therapy.
● Lab Test Considerations: Diclofenac has minimal
effect on bleeding time and platelet aggregation.
● May causepin hemoglobin and hematocrit.
● Monitor CBC and liver function tests within 4– 8 wk of
initiating diclofenac and periodically during therapy.
May causeqserum alkaline phosphatase, LDH, AST, and
ALT concentrations.
Post-Administration Assessment:
● Decrease in severity of mild-to-moderate pain.
● Increased ease of joint movement. Patients who do
not respond to one NSAID may respond to another.
May require 2 wk or more for maximum effects.
● Decrease in or healing of lesions in actinic keratosis.
Optimal effect may not be seen until 30 days after
discontinuation of therapy. Lesions that do not heal
should be re-evaluated.
Nursing Considerations:
● Caution patient to avoid concurrent use of alcohol,
aspirin, acetaminophen, other NSAIDs, or other OTC
medications without consulting health care
professional.
● Instruct patient to notify health care professional of
medication regimen before treatment or surgery.
● May cause serious side effects: CV (MI or stroke), GI
(ulcers, bleeding), skin (exfoliative dermatitis, Stevens-
Johnson Syndrome, toxic epidermal necrolysis) and
hypersensitivity (anaphylaxis). May occur without
warning symptoms. Advise patient to stop medication
and notify health care professional immediately if
symptoms of CV side effects (chest pain, shortness of
breath, weakness, slurring of speech), GI side effects
(epigastric pain, dyspepsia, melana, hematemesis), skin
side effects (skin rash, blisters, fever, itching) or
hypersensitivity reactions (difficulty breathing or
swelling of face or throat) occur. Inform patient that risk
for heart attack or stroke that can lead to death
increases with longer use of NSAID medications and in
people who have heart disease and that risk of ulcer occurs. Fold used patches so adhesive sticks to itself and
increases with concurrent use of corticosteroids and discard where children and pets cannot get them.
anticoagulants, longer use, smoking, drinking alcohol, Encourage patient to read the NSAID Medication Guide
older age, and having poor health. that accompanies the prescription.
● Advise patient to notify health care professional ● Instruct patients if patch begins to peel off to tape the
promptly if unexplained weight gain, swelling of arms edges. Do not wear patch during bathing or showering.
and legs or hands and feet, nausea, fatigue, lethargy, Bathing should take place between scheduled patch
rash, pruritis, yellowing of skin or eyes, itching, stomach removal and application.
pain, vomiting blood, bloody or tarry stools, or flu-like ● Advise patient referred for MRI test to discuss patch
symptoms occur. with referring health care professional and MRI facility
● Instruct patient to notify health care professional of to determine if removal of patch is necessary prior to
all Rx or OTC medications, vitamins, or herbal products test
being taken and to consult with health care professional and for directions for replacing patch.
before taking other medications. https://davisplus.fadavis.com/3976/meddeck/pdf/
● Instruct female patients to inform health care diclofenac.pdf
professional if they plan or suspect pregnancy. Caution https://www.rnpedia.com/nursing-notes/
female patient to avoid use of diclofenac in last pharmacology-drug-study-notes/diclofenac/
trimester of pregnancy and to notify health care https://www.glowm.com/resources/glowm/cd/pages/
professional if breast feeding. drugs/d031.html
● PO: Instruct patient to take diclofenac with a full glass
of water and to remain in an upright position for 15– 30
min after administration. Take missed doses as soon
as possible within 1– 2 hr if taking once or twice a day
or unless almost time for next dose if taking more than
twice a day. Do not double doses.
● May cause drowsiness or dizziness. Caution patient to
avoid driving or other activities requiring alertness until
response to medication is known.
● Caution patient to wear sunscreen and protective
clothing to prevent photosensitivity reactions.
● Topical: Advise patient to minimize use of concurrent
NSAIDs during topical therapy. Instruct patient to read
Medication Guide before starting therapy and with
each Rx refill in case changes have been made.
● Pennsaid: Instruct patient to avoid touching treated
knee and allowing another person to touch knee until
completely dry. Cover knee with clothing until
completely dry. Avoid covering lesion with occlusive
dressing or tight clothing, and avoid applying sunscreen,
insect repellent, lotion, moisturizer, cosmetics to the
affected area. Do not use heating pads, sunlamps and
tanning beds. Protect treated knee from sunlight; wear
protective clothes when in sunlight. Avoid showers or
baths for at least 30 minutes after application.
● Solarze: Advise patient that it may take up to 1 mo for
complete healing of the lesion to occur.
● Transdermal: Instruct patient on correct application
procedure for patch. Apply patch to most painful area.
Change patch every 12 hr. Remove patch if irritation
Generic Name: Piroxicam
Trade Name: Feldene
Pharmacologic Class: NSAID
Therapeutic Class: nonnarcotic analgesic, antipyretic,
anti-inflammatory
Action:
Inhibits prostaglandin synthesis.
Reasons Given (Disease States):
Management of inflammatory disorders, including:
Rheumatoid arthritis, Osteoarthritis. Unlabeled Use:
Dysmenorrhea.
Nursing Process
Pre-Administration Assessment:
● Patients who have asthma, aspirin-induced allergy,
and nasal polyps are at increased risk for developing
hypersensitivity reactions. Monitor for rhinitis, asthma,
and urticaria.
● Assess for rash periodically during therapy. May cause
Stevens-Johnson syndrome. Discontinue therapy if
severe or if accompanied with fever, general malaise,
fatigue, muscle or joint aches, blisters, oral lesions,
conjunctivitis, hepatitis and/or eosinophilia.
● Arthritis: Assess pain and range of motion prior to and
1– 2 hr following administration.
● Lab Test Considerations: Bleeding time may be
prolonged for up to 2 wk following discontinuation of
therapy.
● May cause hemoglobin, hematocrit, leukocyte, and
platelet counts.
● Monitor liver function tests periodically during
therapy. May cause serum alkaline phosphatase, LDH,
AST, and ALT concentrations.
● Monitor BUN, serum creatinine, and electrolytes
periodically during therapy. May cause BUN, serum
creatinine, and electrolyte concentrations and purine
electrolyte concentrations.
Post-Administration Assessment:
● Decreased pain and improved joint mobility. Partial
arthritic relief is usually seen within 2 wk, but maximum
effectiveness may require up to 12 wk of continuous
therapy. Patients who do not respond to one NSAID
may respond to another.
Nursing Considerations:
● Advise patient to take this medication with a full glass
of water and to remain in an upright position for 15– 30
min after administration.
● Instruct patient to take medication as directed. Take
missed doses as soon as remembered but not if almost
time for the next dose. Do not double doses.
● May cause drowsiness or dizziness. Advise patient to
avoid driving or other activities requiring alertness until
response to the medication is known.
● Caution patient to avoid the concurrent use of
alcohol, aspirin, acetaminophen, or other OTC or herbal
products without consulting health care professional.
● Advise patient to inform health care professional of
medication regimen prior to treatment or surgery.
● Caution patient to use sunscreen and protective
clothing to prevent photosensitivity reaction (rare).
● Advise patient to consult health care professional if
rash, itching, visual disturbances, tinnitus, weight gain,
edema, black stools, persistent headache, or influenza-
like syndrome (chills, fever, muscle aches, pain)
occurs.
https://davisplus.fadavis.com/3976/meddeck/pdf/
piroxicam.pdf
https://www.glowm.com/resources/glowm/cd/pages/
drugs/p042.html
Generic Name: Acetaminophen
Trade Name: Acephen, Anacin Aspirin Free, Feverall,
Neopap, Panadol, Tempra, Tylenol
Pharmacologic Class: para-aminophenol derivative
Therapeutic Class: nonnarcotic analgesic, antipyretic
Action:
Inhibits the synthesis of prostaglandins that may serve
as mediators of pain and fever, primarily in the CNS. Has
no significant anti-inflammatory properties or GI
toxicity.
Reasons Given (Disease States):

Analgesic-antipyretic in patients with aspirin allergy,
hemostatic disturbances, bleeding diatheses, upper
GI disease, gouty arthritis
 Arthritis and rheumatic disorders involving
musculoskeletal pain (but lacks clinically significant
antirheumatic and anti-inflammatory effects)
 Common cold, flu, other viral and bacterial infections
with pain and fever
 Unlabeled use: Prophylactic for children receiving
DPT vaccination to reduce incidence of fever and
pain
Nursing Process
Pre-Administration Assessment:
● Assess overall health status and alcohol usage before
administering acetaminophen. Patients who are
malnourished or chronically abuse alcohol are at higher
risk of developing hepatotoxicity with chronic use of
usual doses of this drug.
● Assess amount, frequency, and type of drugs taken in
patients self-medicating, especially with OTC drugs.
Prolonged use of acetaminophen increases the risk of
adverse renal effects. For short-term use, combined
doses of acetaminophen and salicylates should not
exceed the recommended dose of either drug given
alone. Do not exceed maximum daily dose of
acetaminophen when considering all routes of
administration and all combination products containing
acetaminophen.
● Pain: Assess type, location, and intensity prior to and
30– 60 min following administration.
● Fever: Assess fever; note presence of associated signs
(diaphoresis, tachycardia, and malaise).
● Lab Test Considerations: Evaluate hepatic,
hematologic, and renal function periodically during
prolonged, high-dose therapy.
● May alter results of blood glucose monitoring. May
cause falsely values when measured with glucose
oxidase/peroxidase method, but probably not with
hexokinase/G6PD method. May also cause falsely
values with certain instruments; see manufacturer’s
instruction manual.
● Increased serum bilirubin, LDH, AST, ALT, and
prothrombin time may indicate hepatotoxicity.
● Toxicity and Overdose: If overdose occurs,
acetylcysteine (Acetadote) is the antidote.
Post-Administration Assessment:
● Relief of mild to moderate pain.
● Reduction of fever
Nursing Considerations:
● Advise patient to take medication exactly as directed
and not to take more than the recommended amount.
Chronic excessive use of 4 g/day (2 g in chronic
alcoholics) may lead to hepatotoxicity, renal or cardiac
damage. Adults should not take acetaminophen longer
than 10 days and children not longer than 5 days unless
directed by health care professional. Short-term doses
of acetaminophen with salicylates or NSAIDs should not
exceed the recommended daily dose of either drug
alone.
● Advise patient to avoid alcohol (3 or more glasses per
day increase the risk of liver damage) if taking more
than an occasional 1– 2 doses and to avoid taking
concurrently with salicylates or NSAIDs for more than a
few days, unless directed by health care professional.
● Advise patient to discontinue acetaminophen and
notify health care professional if rash occurs.
● Inform patients with diabetes that acetaminophen
may alter results of blood glucose monitoring. Advise
patient to notify health care professional if changes are
noted.
● Caution patient to check labels on all OTC products.
Advise patients to avoid taking more than one product
containing acetaminophen at a time
to prevent toxicity.
● Advise patient to consult health care professional if
discomfort or fever is not relieved by routine doses of
this drug or if fever is greater than 39.5C (103F) or
lasts longer than 3 days.
● Pedi: Advise parents or caregivers to check
concentrations of liquid preparations. All OTC single
ingredient acetaminophen liquid products now come in
a single concentration of 160 mg/5 mL. Errors have
resulted in serious liver damage. Have parents or
caregivers determine the correct formulation and dose
for their child (based on the child’s age/ weight), and
demonstrate how to measure it using an appropriate
measuring device.
https://davisplus.fadavis.com/3976/meddeck/pdf/
acetaminophen.pdf
https://www.rnpedia.com/nursing-notes/
pharmacology-drug-study-notes/acetaminophen-n-
acetyl-p-aminophenol/
https://www.glowm.com/resources/glowm/cd/pages/
drugs/a004.html
Generic Name: Inteferon alfa 2b
Trade Name: Intron A
Pharmacologic Class: Interferon, biologic response
modifier
Therapeutic Class: Immunostimulant
Action:
Interferons are proteins capable of modifying the
immune response and have antiproliferative action
against tumor cells. Interferons also have antiviral
activity
Reasons Given (Disease States):
Interferon alfa-2b is a biologic response modifier
prepared by recombinant DNA technology that is
approved to treat cancers (hairy cell leukemia,
malignant melanoma, non-Hodgkin’s lymphoma, AIDS-
related Kaposi’s sarcoma) as well as viral infections
(human papilloma virus, chronic hepatitis virus B and C).
Nursing Process
Pre-Administration Assessment:
● Assess for signs of neuropsychiatric disorders
(irritability, anxiety, depression, suicidal ideation,
aggressive behavior). May require discontinuation of
therapy.
● Monitor for signs of infection (vital signs, WBC) during
therapy. Discontinue drug therapy in cases of severe
infection, and antibiotic therapy instituted.
● Assess for cardiovascular disorders (pulse, BP, chest
pain). An ECG should be performed before and
periodically during the course of therapy in patients
with a history of cardiovascular disease.
● Assess for signs of colitis (abdominal pain, bloody
diarrhea, fever) and pancreatitis (nausea, vomiting,
abdominal pain) during therapy. Discontinue therapy if
these occur; may be fatal. Colitis usually resolves within
1–3 wk of discontinuation.
● Assess for development of flu-like syndrome (fever,
chills, myalgia, headache).
Symptoms often appear suddenly 3– 6 hr after therapy.
Symptoms tend to decrease, even with continued
therapy. Acetaminophen may be used for control of
these symptoms.
● Monitor for bone marrow depression. Assess for
bleeding (bleeding gums; bruising; petechiae; guaiac
stools, urine, and emesis) and avoid IM injections and
rectal temperatures if platelet count is low. Apply
pressure to venipuncture sites for 10 min. Assess for
signs of infection during neutropenia. Anemia may
occur. Monitor for increased fatigue, dyspnea, and
orthostatic hypotension.
● May cause nausea and vomiting. Antiemetics may be
used prophylactically. Monitor intake and output, daily
weight, and appetite. Adjust diet as tolerated for
anorexia. Encourage fluid intake of at least 2 liters/day.
● Assess pulmonary status (lung sounds, respirations)
periodically during therapy.
● Perform a baseline eye exam in all patients prior to
initiation of therapy. Eye exams should be performed
periodically during therapy in patients with pre-existing
diabetic or hypertensive retinopathy. Discontinue
therapy if patients develop new or worsening eye
disorders.
● Assess for signs of thyroid dysfunction, as
hypothyroidism or hyperthyroidism may occur.
Discontinue therapy if the patient’s thyroid function
cannot be controlled with medications (e.g., thyroid
hormone supplementation, antithyroid medications).
● Kaposi’s Sarcoma: Monitor number, size, and
character of lesions prior to and throughout therapy.
● Lab Test Considerations: Systemic: Monitor for CBC
and differential prior to and periodically during therapy.
May cause leukopenia, neutropenia, thrombocytopenia,
decreased hemoglobin and hematocrit, and hemolytic
anemia. The nadirs of leukopenia and
thrombocytopenia occur in 3–5 days, with recovery 3– 5
days after withdrawal of interferon alpha-2b For
malignant melanoma, if granulocyte count 250/mm3
but 500/mm3, discontinue interferon alpha-2b until
platelet or granulocyte counts return to normal or
baseline levels, then reinstitute at 50% of dose. If
granulocyte count 250/mm3 with interferon alpha-2b,
discontinue permanently. For follicular non-Hodgkin’s
lymphoma, if granulocyte count 1000/mm3 or platelet
count 50,000/mm3, discontinue interferon alpha-2b.
● Monitor TSH at baseline and if patients develop
symptoms consistent with hypothyroidism or
hyperthyroidism.
● Hairy Cell Leukemia: Monitor number of peripheral
blood hairy cells and bone marrow hairy cells prior to
and during therapy.
Post-Administration Assessment: patient to avoid crowds and persons with known
infections. Instruct patient to use soft toothbrush
● Normalized blood parameters (hemoglobin,
and electric razor and to avoid falls. Caution patient not
neutrophils, platelets, monocytes, and bone marrow
to drink alcoholic beverages or take medication
and peripheral hairy cells) in hairy cell leukemia.
containing aspirin or NSAIDs; may precipitate gastric
Response may not be seen for 6 mo with interferon
bleeding.
alpha-2b.
● Inform patient of the potential for depression and
● Decrease in the size and number of lesions in Kaposi’s
advise patient to notify health care professional if
sarcoma. Therapy may be required for 6 mo before full
depression occurs.
response is seen. Therapy is continued until disease
● Discuss with patient the possibility of hair loss.
progresses or a maximum response has been achieved
Explore coping strategies.
after 4 mo of therapy.
● Explain to patient that fertility may be impaired and
● Increase in time to relapse and overall survival in
that contraception is needed during treatment to
patients with malignant melanoma.
prevent potential harm to the fetus.
● Disappearance of or decrease in size and number of
● Instruct patient not to receive any vaccinations
genital warts. Condylomata acuminata usually respond
without advice of health care professional.
in 4– 8 wk. A second course of therapy may be required
● Emphasize need for periodic lab tests to monitor for
if genital warts persist and laboratory values remain in
side effects.
acceptable limits.
https://davisplus.fadavis.com/3976/meddeck/pdf/
● Decrease in symptoms and improvement in liver
interferonalpha2b.pdf
function tests and progression of hepatic damage in
https://www.glowm.com/resources/glowm/cd/pages/
patients with hepatitis B or hepatitis C infection.
drugs/ij017.html
Pharmacology for Nurses, A Pathophysiological
Nursing Considerations: Approach, 4th Edition- Michael Adams ( PDFDrive.com )

● Advise patient to take medication as directed. If a

dose is missed, omit dose and return to the regular
schedule. Notify health care professional if more than 1
dose is missed.
● Home Care Issues: Instruct patient and family on
preparation and correct technique for administration of
injection and care and disposal of equipment. Advise
patient to read Medication Guide prior to
administration and with each prescription refill to check
for changes. Explain to patient that brands should not
be switched without consulting health care
professional; may result in a change of dose.
● Discuss possibility of flu-like reaction 3– 6 hr after
dose. Acetaminophen may be taken prior to injection
and every 3– 4 hr afterward as needed to control
symptoms.
● Review side effects with patient. Interferon may be
temporarily discontinued or dose decreased by 50% if
serious side effects occur.
● Instruct patient to notify health care professional
promptly if fever; chills; cough; hoarseness; sore throat;
signs of infection; lower back or side pain; painful or
difficult urination; bleeding gums; bruising; petechiae;
blood in stools, urine, or emesis; increased fatigue;
dyspnea; or orthostatic hypotension occurs. Caution
Generic Name: Cyclosporine
Trade Name: Gengraf, Neoral, Sandimmune
Pharmacologic Class: Calcineurin inhibitor
Therapeutic Class: Immunosuppressant
Action:
Inhibits normal immune responses (cellular and
humoral) by inhibiting interleukin2, a factor necessary
for initiation of T-cell activity
Reasons Given (Disease States):
Cyclosporine is a complex chemical obtained from a soil
fungus that inhibits helper T cells. Compared to some of
the other immunosuppressants, cyclosporine is less
toxic to bone marrow cells. When prescribed for
transplant recipients, it is often used in combination
with high doses of a corticosteroid such as prednisone.
Nursing Process
Pre-Administration Assessment:
● Monitor serum creatinine level, intake and output
ratios, daily weight, and BP during therapy. Report
significant changes.
● Assess for any new signs or symptoms that may be
suggestive of progressive multifocal
leukoencephalopathy (PML), an opportunistic infection
of the brain caused by the Jakob Cruzfeldt (JC) virus,
that may be fatal; withhold dose and notify health care
professional promptly. PML symptoms may begin
gradually (hemiparesis, apathy, confusion, cognitive
deficiencies and ataxia) and may include deteriorating
renal function and renal graft loss.
● Monitor for signs and symptoms of posterior
reversible encephalopathy syndrome (PRES) (impaired
consciousness, convulsions, visual disturbances
including blindness, loss of motor function, movement
disorders
and psychiatric disturbances, papilloedema, visual
impairment). Usually reversible with discontinuation of
cyclosporine. Occurs more often in patients with liver
transplant than kidney transplant.
● Prevention of Transplant Rejection: Assess for
symptoms of organ rejection throughout therapy.
● IV: Monitor patient for signs and symptoms of
hypersensitivity (wheezing, dyspnea, flushing of face or
neck) continuously during at least the first 30 min of
each treatment and frequently thereafter. Oxygen,
epinephrine, and equipment for treatment of
anaphylaxis should be available with each IV dose.
● Arthritis: Assess pain and limitation of movement
prior to and during administration.
● Prior to initiating therapy, perform a physical exam
including BP on 2 occasions to determine baseline.
Monitor BP every 2 wk during initial 3 mo, then monthly
if stable. If hypertension occurs, dose should be
reduced.
● Psoriasis: Assess skin lesions prior to and during
therapy.
● Lab Test Considerations: Measure serum creatinine,
BUN, CBC, magnesium, potassium, uric acid, and lipids
at baseline, every 2 wk during initial therapy, and then
monthly if stable. Nephrotoxicity may occur; report
significant increases.
● May cause hepatotoxicity; monitor for AST, ALT,
alkaline phosphatase, amylase, and bilirubin.
● May cause serum potassium and uric acid levels and
serum magnesium levels.
● Serum lipid levels may beq.
● Toxicity and Overdose: Evaluate serum cyclosporine
levels periodically during therapy. Dose may be
adjusted daily, in response to levels, during initiation of
therapy. Guidelines for desired serum levels will vary
among institutions
Post-Administration Assessment:
● Prevention of rejection of transplanted tissues.
● Decrease in severity of pain.
● Increased ease of joint movement.
● Decrease in progression of psoriasis.
Nursing Considerations:
● Instruct patient to take medication at the same time
each day with meals, as directed. Do not skip doses or
double up on missed doses. Take missed doses as
soon as remembered within 12 hr. Do not discontinue
medication without advice of health care professional.
● Reinforce the need for lifelong therapy to prevent
transplant rejection. Review symptoms of rejection for
transplanted organ, and stress need to notify health
care professional immediately if they occur.
● Instruct patients and/or parents to notify health care
professional if diarrhea develops; decreases absorption
of cyclosporine and can result in rejection.
● Instruct patient to avoid grapefruit and grapefruit
juice to prevent interaction with
cyclosporine.
● Advise patient of common side effects
(nephrotoxicity, increased BP, hand tremors, increased
facial and body hair, gingival hyperplasia). Advise
patients that if
hair growth is excessive, depilatories, or waxing, can be
used.
● Teach patient the correct method for monitoring BP.
Instruct patient to notify health care professional of
significant changes in BP or if hematuria, increased
frequency, cloudy urine, decreased urine output, fever,
sore throat, tiredness, or unusual bruising occurs.
● Instruct patient on proper oral hygiene. Meticulous
oral hygiene and dental examinations for teeth cleaning
and plaque control every 3 mo will help decrease
gingival inflammation and hyperplasia.
● Instruct patient to notify health care professional of
all Rx or OTC medications, vitamins, or herbal products
being taken and consult health care professional before
taking other Rx, OTC, or herbal products or receiving
any vaccinations while taking this medication.
● Advise patient to notify health care professional if
pregnancy is planned or suspected, or if breast feeding.
● Emphasize the importance of follow-up exams and lab
tests
● Advise patient to inform health care professional of
medication regimen prior to treatment or surgery.
● Caution patient to use sunscreen and protective
clothing to prevent photosensitivity reaction (rare).
● Advise patient to consult health care professional if
rash, itching, visual disturbances, tinnitus, weight gain,
edema, black stools, persistent headache, or influenza-
like syndrome (chills, fever, muscle aches, pain)
occurs.
https://davisplus.fadavis.com/3976/meddeck/pdf/
cyclosporine.pdf
https://www.glowm.com/resources/glowm/cd/pages/
drugs/c095.html
Pharmacology for Nurses, A Pathophysiological
Approach, 4th Edition- Michael Adams ( PDFDrive.com )
Generic Name: Hepatitis B Vaccine https://davisplus.fadavis.com/3976/meddeck/pdf/
hepatitisbimmuneglobulin.pdf
Trade Name: Engerix-B, Recombivax HB
Pharmacology for Nurses, A Pathophysiological
Approach, 4th Edition- Michael Adams ( PDFDrive.com )
Pharmacologic Class: Vaccine

Therapeutic Class: Vaccine

Action:

An immune gamma-globulin fraction containing high

titers of antibodies to the hepatitis B surface antigen.
Confers passive immunity to hepatitis B infection

Reasons Given (Disease States):

Hepatitis B vaccine is used to provide active immunity in

individuals who are at risk for exposure to hepatitis B
virus (HBV). It is indicated for infants born to mothers
who are HBV-positive, and those at high risk for
exposure to HBV infected blood, including nurses,
health care providers, dentists, dental hygienists,
morticians, and paramedics.

Nursing Process

Pre-Administration Assessment:

● For passive immunity, determine the date of exposure

to infection. Hepatitis B immune globulin should be
administered preferably within 24 hr but not later than
7 days after exposure to hepatitis B.

● Assess patient for signs of anaphylaxis (hypotension,

flushing, chest tightness, wheezing, fever, dizziness,
nausea, vomiting, diaphoresis) after administration.
Epinephrine and antihistamines should be available for
treatment of anaphylactic reactions.

Post-Administration Assessment:

● Prevention of hepatitis B infection in exposed patients

by providing passive immunity.

Nursing Considerations:

●Explain to patient the use and purpose of hepatitis B

immune globulin therapy. Discuss methods of
transmission and vaccination for prophylaxis.
● Advise patient to report symptoms of anaphylaxis
immediately.
● Inform patient that pain, tenderness, swelling, and
erythema at the injection site may occur after IM
injections
Generic Name: Morphine
Trade Name: Astramorph PF, AVINza, Doloral,
Duramorph PF, Embeda, Epimorph, Infumorph, Kadian,
M-Eslon, Morphine H.P, M.O.S, M.O.S.-S.R, MS Contin,
Statex
Pharmacologic Class: opioid agonists
Therapeutic Class: opioid analgesics
Action:
Binds to opiate receptors in the CNS. Alters the
perception of and response to painful stimuli while
producing generalized CNS depression
Reasons Given (Disease States):
Severe pain (the 20 mg/mL oral solution concentration
should only be used in opioid-tolerant patients).
Management of moderate to severe chronic pain in
patients requiring use of a continuous around-the-clock
opioid analgesic for an extended period of time
(extended/sustained-release). Pulmonary edema. Pain
associated with MI.
Nursing Process
Pre-Administration Assessment:
● Assess type, location, and intensity of pain prior to
and 1 hr following PO, subcut, IM, and 20 min (peak)
following IV administration. When titrating opioid
doses, increases of 25– 50% should be administered
until there is either a 50% reduction in the patient’s
pain rating on a numerical or visual analogue scale or
the patient reports satisfactory pain relief. When
titrating doses of short-acting morphine, a repeat dose
can be safely administered at the time of the peak if
previous dose is ineffective and side effects are minimal.
● Patients on a continuous infusion should have
additional bolus doses provided every 15– 30 min, as
needed, for breakthrough pain. The bolus dose is
usually set to the amount of drug infused each hour by
continuous infusion.
● Patients taking sustained-release morphine may
require additional short-acting opioid doses for
breakthrough pain. Doses of short-acting opioids should
be equivalent to 10– 20% of 24 hr total and given every
2 hr as needed.
● An equianalgesic chart (see Appendix B) should be
used when changing routes or when changing from one
opioid to another.
● High Alert: Assess level of consciousness, BP, pulse,
and respirations before and periodically during
administration. If respiratory rate is 10/min, assess level
of sedation. Physical stimulation may be sufficient to
prevent significant hypoventilation. Subsequent doses
may need to be decreased by 25– 50%. Initial
drowsiness will diminish with continued use.Geri:
Assess geriatric patients frequently; older adults are
more sensitive to the effects of opioid analgesics and
may experience side effects and respiratory
complications more frequently. Pedi: Assess pediatric
patient frequently; children are more sensitive to the
effects of opioid analgesics and may experience
respiratory complications, excitability and restlessness
more frequently.
● Prolonged use may lead to physical and psychological
dependence and tolerance. This should not prevent
patient from receiving adequate analgesia. Most
patients who receive morphine for pain do not develop
psychological dependence. Progressively higher doses
may be required to relieve pain with long-term therapy.
● Assess bowel function routinely. Institute prevention
of constipation with increased intake of fluids and bulk
and with laxatives to minimize constipating effects.
Administer stimulant laxatives routinely if opioid use
exceeds 2– 3 days, unless contraindicated.
● Lab Test Considerations: May plasma amylase and
lipase levels.
● Toxicity and Overdose: If an opioid antagonist is
required to reverse respiratory depression or coma,
naloxone is the antidote. Dilute the 0.4-mg ampule of
naloxone in 10 mL of 0.9% NaCl and administer 0.5 mL
(0.02 mg) by direct IV push every 2 min. For children
and adults weighing 40 kg, dilute 0.1 mg of naloxone in
10 mL of 0.9% NaCl for a concentration of 10 mcg/mL
and administer 0.5 mcg/kg every 2 min. Titrate dose to
avoid withdrawal, seizures, and severe pain.
Post-Administration Assessment:
● Decrease in severity of pain without a significant
alteration in level of consciousness or respiratory status.
● Decrease in symptoms of pulmonary edema.
Nursing Considerations:

● Instruct patient how and when to ask for pain

medication.
● May cause drowsiness or dizziness. Caution patient to
call for assistance when ambulating or smoking and to
avoid driving or other activities requiring alertness until
response to medication is known.
● Advise patient to change positions slowly to minimize
orthostatic hypotension.
● Caution patient to avoid concurrent use of alcohol or
other CNS depressants with this medication.
● Encourage patients who are immobilized or on
prolonged bedrest to turn, cough, and breathe deeply
every 2 hr to prevent atelectasis.
● Home Care Issues: High Alert: Explain to patient and
family how and when to administer morphine and how
to care for infusion equipment properly. Pedi: Teach
parents or caregivers how to accurately measure liquid
medication and to use only the measuring device
dispensed with the medication.
● Emphasize the importance of aggressive prevention
of constipation with the use of morphine.
https://davisplus.fadavis.com/3976/meddeck/pdf/
morphine.pdf
Generic Name: Pentazocine
Trade Name: Talwin
Pharmacologic Class: opioid agonists/antagonists
Therapeutic Class: analgesic, adjunct to anesthesia
Action:
Binds to opiate receptors in the CNS. Alters perception
of and response to painful stimuli, while producing
generalized CNS depression. Has partial antagonist
properties, which may result in opioid withdrawal in
physically dependent patients.
Reasons Given (Disease States):
Moderate to severe pain. Also used for: Analgesia
during labor, Sedation prior to surgery,
Supplementation in balanced anesthesia.
Nursing Process
Pre-Administration Assessment:
● Assess type, location, and intensity of pain prior to
and 1 hr following PO, subcut, or IM and 15– 30 min
(peak) following IV administration. When titrating
opioid doses, increases of 25– 50% should be
administered until there is either a 50% reduction in the
patient’s pain rating on a numeric or visual analogue
scale or the patient reports satisfactory pain relief. A
repeat dose can be safely administered at the time of
the peak if previous dose is ineffective and side effects
are minimal. Patients requiring doses higher than 100
mg should be converted to an opioid agonist.
Pentazocine is not recommended for prolonged use or
as first-line therapy for acute or cancer pain.
● An equianalgesic chart (see Appendix B) should be
used when changing routes or when changing from one
opioid to another.
● Assess BP, pulse, and respirations before and
periodically during administration. If respiratory rate is
10/min, assess level of sedation. Physical stimulation
may be sufficient to prevent significant hypoventilation.
Dose may need to be decreased by 25– 50%.
Pentazocine produces respiratory depression, but this
does not markedly increase with increased doses.
● Assess prior analgesic history. Antagonistic properties
may induce withdrawal symptoms (vomiting,
restlessness, abdominal cramps, and increased BP and
temperature) in patients physically dependent on
opioids.
● Although this drug has a low potential for
dependence, prolonged use may lead to physical and
psychological dependence and tolerance. This should
not prevent patient from receiving adequate analgesia.
Most patients receiving pentazocine for pain do not
develop psychological dependence. If tolerance
develops, changing to an opioid agonist may be
required to relieve pain.
● Geri: Assess falls risk and implement prevention
strategies. Assess for adverse CNS effects.
● Lab Test Considerations: May cause serum amylase
and lipase levels.
● Toxicity and Overdose: If an opioid antagonist is
required to reverse respiratory depression or coma,
naloxone (Narcan) is the antidote. Dilute the 0.4-mg
ampule of naloxone in 10 mL of 0.9% NaCl and
administer 0.5 mL (0.02 mg) by direct IV push every 2
min. For patients weighing 40 kg, dilute 0.1 mg of
naloxone in 10 mL of 0.9% NaCl for a concentration of
10 mcg/mL and administer 0.5 mcg/kg every 2 min.
Titrate dose to avoid withdrawal, seizures, and severe
pain.
Post-Administration Assessment:
● Decrease in severity of pain without a significant
alteration in level of consciousness or respiratory status.
Nursing Considerations:
● Instruct patient on how and when to ask for pain
medication.
● Medication may cause drowsiness, dizziness, or
hallucinations, particularly in geriatric patients. Advise
patient to call for assistance when ambulating and to
avoid driving or other activities requiring alertness until
response to medication is known. Institute fall
prevention strategies and teach patient or family how
to prevent falls at home.
● Caution patient to change positions slowly to
minimize orthostatic hypotension.
● Advise patient to avoid concurrent use of alcohol and
other CNS depressants.
● Encourage patient to turn, cough, and breathe deeply
every 2 hr to prevent atelectasis.
● Advise patient that frequent mouth rinses, good oral
hygiene, and sugarless gum or candy may decrease dry
mouth.
https://davisplus.fadavis.com/3976/meddeck/pdf/
pentazocine.pdf
ANESTHESIA
Generic Name: Lidocaine
Trade Name:
lidocaine (lignocaine)
Xylocaine
lidocaine hydrochloride
Anestacon, Dilocaine, L-Caine, Lidoderm Patch, Lidoject,
LidoPen Auto-Injector, Nervocaine, Xylocaine, Xylocaine
Viscous, Zilactin-L
Pharmacologic Class: amide derivative
Therapeutic Class: anesthetics (topical/local),
antiarrhythmics (class IB)
Action:
IV, IM: Suppresses automaticity and spontaneous
depolarization of the ventricles during diastole by
altering the flux of sodium ions across cell membranes
with little or no effect on heart rate. Local: Produces
local anesthesia by inhibiting transport of ions across
neuronal membranes, thereby preventing initiation and
conduction of normal nerve impulses
Reasons Given (Disease States):
IV: Ventricular arrhythmias. IM: Self-injected or when IV
unavailable (during transport to hospital facilities).
Local: Infiltration/mucosal/topical anesthetic. Patch:
Pain due to post-herpetic neuralgia.
Nursing Process:
Pre-Administration Assessment:
• Obtain complete health history including
allergies, drug history and possible drug
interactions.
• Assess for presence/history of the following
disorders: Stokes-Adams syndrome, severe
cardiac problems, and/or decreased liver
function. This medication is contraindicated
for those with this disorder. Assess for
allergies to amide-type local anesthetics
• Check for the presence of broken skin,
infection, burns and wounds where
medication is to be used.
• Assess for character, duration, location, and
intensity of pain where medication is to be
used
Post-Administration Assessment:
● Decrease in ventricular arrhythmias.
● Local anesthesia.
Nursing Considerations:
● May cause drowsiness and dizziness. Advise patient to
call for assistance during ambulation and transfer.
● IM: Available in LidoPen Auto-Injector for use outside
the hospital setting. Advise patient to telephone health
care professional immediately if symptoms of a heart
attack occur. Do not administer unless instructed by
health care professional. To administer, remove safety
cap and place back end on thickest part of thigh or
deltoid muscle. Press hard until needle prick is felt. Hold
in place for 10 sec, then massage area for 10 sec. Do not
drive after administration unless absolutely necessary.
● Topical: Apply Lidoderm Patch to intact skin to cover
the most painful area. Patch may be cut to smaller sizes
with scissors before removing release liner.
Clothing may be worn over patch. If irritation or burning
sensation occurs during application, remove patch until
irritation subsides. Wash hands after application; avoid
contact with eyes. Dispose of used patch to avoid access
by children or pets.
● Caution women to consult health care professional
before using a topical anesthetic for a mammogram or
other procedures. If recommended, use lowest drug
concentration, and apply it sparingly. Do not apply to
broken or irritated skin, do not wrap skin, and do not
apply heat to area (heating pad/electric blanket), to
decrease chance that drug may be absorbed into the
body. May result in seizures, cardiac arrhythmias,
respiratory failure, coma, and death.
● Advise patient referred for MRI test to discuss patch
with referring health care professional and MRI facility
to determine if removal of patch is necessary prior to
test
and for directions for replacing patch.
https://davisplus.fadavis.com/3976/meddeck/pdf/
lidocaine.pdf
https://wps.prenhall.com/wps/media/objects/
2943/3014230/nursproc/Chapter13NPFforCW.pdf
https://www.glowm.com/resources/glowm/cd/pages/
drugs/kl025.html
Generic Name: Sevoflurane

Trade Name: Ultane

Pharmacologic Class: General anesthetics, inhalation

 Monitor laboratory test results (e.g. liver and

renal function tests) to determine possible need for

Therapeutic Class: a reduction in dose and evaluate for toxicity.

Post-Administration Assessment:
Action:

Ultane (sevoflurane) Volatile Liquid For Inhalation is an

anesthetic drug used to induce and maintain general
anesthesia in adult and pediatric patients during surgery
 Monitor patient response to therapy (analgesia,

loss of consciousness).
Reasons Given (Disease States):

Sevoflurane is indicated for induction and maintenance

of general anesthesia in adult and pediatric patients for
inpatient and outpatient surgery.
 Monitor for adverse effects (e.g. respiratory

depression, hypotension, bronchospasm, skin

Sevoflurane should be administered only by persons
breakdown, etc).
trained in the administration of general anesthesia.


Facilities for maintenance of a patent airway, artificial
ventilation, oxygen enrichment, and circulatory
resuscitation must be immediately available. Since level Evaluate patient understanding on drug therapy
of anesthesia may be altered rapidly, only vaporizers
producing predictable concentrations of sevoflurane by asking patient to name the drug, its indication,
should be used. and adverse effects to watch for.

Nursing Process:
Pre-Administration Assessment:  Monitor patient compliance to drug therapy.

 Assess for the mentioned cautions

contraindications (e.g. drug allergies, hepatic and

and
Nursing Considerations

renal impairment, etc.) to prevent any untoward https://nurseslabs.com/general-local-anesthetic-

complications. agents/
https://www.rxlist.com/ultane-drug.htm#precautions

 Perform a thorough physical assessment (e.g.

weight, neurological status, vital signs, heart sounds,

skin color and lesions, bowel sounds, etc.) to
establish baseline data before drug therapy begins,
to determine effectiveness of therapy, and to
evaluate for occurrence of any adverse effects
associated with drug therapy.
Generic Name: Propofol
Trade Name: Diprivan
Pharmacologic Class: phenol derivative
Therapeutic Class: anesthetics
Action:
Short-acting hypnotic. Mechanism of action is unknown.
Produces amnesia. Has no analgesic properties
● Toxicity and Overdose: If overdose occurs, monitor
pulse, respiration, and BP continuously. Maintain patent
airway and assist ventilation as needed. If hypotension
occurs, treatment includes IV fluids, repositioning, and
vasopressors.
Post-Administration Assessment:
● Induction and maintenance of anesthesia.
● Amnesia.
● Sedation in mechanically ventilated patients in an
intensive care setting

Reasons Given (Disease States): Nursing Considerations:

● Inform patient that this medication will decrease
Induction of general anesthesia in children 3 yr and mental recall of the procedure.
adults. Maintenance of balanced anesthesia when used ● May cause drowsiness or dizziness. Advise patient to
with other agents in children 2 mo and adults. Initiation request assistance prior to ambulation and transfer and
and maintenance of monitored anesthesia care (MAC). to avoid driving or other activities requiring alertness
Sedation of intubated, mechanically ventilated patients for 24 hr following administration.
in intensive care units (ICUs). ● Advise patient to avoid alcohol or other CNS
depressants without the advice of a health care
Nursing Process: professional for 24 hr following administration.
Pre-Administration Assessment:
● Assess respiratory status, pulse, and BP continuously https://davisplus.fadavis.com/3976/meddeck/pdf/
throughout propofol therapy. Frequently causes apnea propofol.pdf
lasting 60 sec. Maintain patent airway and adequate https://www.glowm.com/resources/glowm/cd/pages/
ventilation. Propofol should be used only by individuals drugs/p067.html
experienced in endotracheal intubation, and equipment
for this procedure should be readily available.
● Assess level of sedation and level of consciousness
throughout and following administration. When using
for ICU sedation, wake-up and assessment of CNS
function should be done daily during maintenance to
determine minimum dose required for sedation.
Maintain a light level of sedation during these
assessments; do not discontinue. Abrupt
discontinuation may cause rapid awakening with
anxiety, agitation, and resistance to mechanical
ventilation.
● Monitor for propofol infusion syndrome (severe
metabolic acidosis, hyperkalemia, lipemia,
rhabdomyolysis, hepatomegaly, cardiac and renal
failure). Most frequent with prolonged, high-dose
infusions (5 mg/kg/ hr for 48 hr) but has also been
reported following large-dose, shortterm infusions
during surgical anesthesia. If prolonged sedation or
increasing dose is required, or metabolic acidosis
occurs, consider alternative means of sedation.
Generic Name: Midazolam Nursing Considerations:
● Inform patient that this medication will decrease
Trade Name: Versed
mental recall of the procedure.
● May cause drowsiness or dizziness. Advise patient to
Pharmacologic Class: benzodiazepine
request assistance prior to ambulation and transfer and
Therapeutic Class: preoperative sedative, agent for to avoid driving or other activities requiring alertness
conscious sedation, adjunct for induction of general for 24 hr following administration.
anesthesia, amnesic agent ● Instruct patient to inform health care professional
prior to administration if pregnancy is suspected.
● Advise patient to avoid alcohol or other CNS
Action: depressants for 24 hr following administration of
midazolam.
Acts at many levels of the CNS to produce generalized
CNS depression. Effects may be mediated by GABA, an https://davisplus.fadavis.com/3976/meddeck/pdf/
inhibitory neurotransmitter midazolam.pdf
Reasons Given (Disease States): https://www.glowm.com/resources/glowm/cd/pages/
drugs/m047.html
PO: Preprocedural sedation and anxiolysis in pediatric
patients. IM, IV: Preoperative
sedation/anxiolysis/amnesia. IV: Provides
sedation/anxiolysis/amnesia during therapeutic,
diagnostic, or radiographic procedures (conscious
sedation): Aids in the induction of anesthesia and as
part of balanced anesthesia, As a continuous infusion,
provides sedation of mechanically ventilated patients
during anesthesia or in a critical care setting, Status
epilepticus.

Nursing Process:
Pre-Administration Assessment:
● Assess level of sedation and level of consciousness
throughout and for 2– 6 hr following administration.
● Monitor BP, pulse, and respiration continuously
during IV administration. Oxygen and resuscitative
equipment should be immediately available.
● Toxicity and Overdose: If overdose occurs, monitor
pulse, respiration, and BP continuously. Maintain patent
airway and assist ventilation as needed. If hypotension
occurs, treatment includes IV fluids, repositioning, and
vasopressors.
● The effects of midazolam can be reversed with
flumazenil (Romazicon).

Post-Administration Assessment:
● Sedation during and amnesia following surgical,
diagnostic, and radiologic procedures.
● Sedation and amnesia for mechanically ventilated
patients in a critical care setting
Generic Name: Fentanyl citrate
Trade Name: Sublimaze
Pharmacologic Class: opioid agonist
Therapeutic Class: analgesic, adjunct to anesthesia,
anesthetic
Action:
Fentanyl is a strong synthetic opioid, which is similar to
morphine but produces analgesia to a greater extent.
Reasons Given (Disease States):
Fentanyl is similar to other opioid drugs. Fentanyl
molecules target a subclass of opioid receptor systems
in the body, many of which are localized in the brain
within specialized neuroanatomical structures,
particularly regarded as the control of emotions, pain,
and speaking to the point of its infamous addictive
properties, reward.
Nursing Process:
Pre-Administration Assessment:
Dosage should be individualised according to age,
bodyweight, physical status, underlying pathological
condition, use of other drugs, type of anesthesia to be
used and the surgical procedure involved. Fentanyl
injection contains no antimicrobial agent. It should be
used only once and any residue discarded.
Post-Administration Assessment:
Nursing Considerations:
• Fentanyl may cause bradycardia. Pretreatment with
an anticholinergic (such as atropine or glycopyrrolate)
may minimize this effect.
• High doses can produce muscle rigidity. This effect can
be reversed by naloxone.
• Many anesthesiologists use epidural and intrathecal
fentanyl as a potent adjunct to epidural anesthesia.
Transmucosal form
• The fentanyl Oralet is used as an adjunct to
anesthesia; Actiq is used for breakthrough cancer pain.
ALERT Amount of drug in lozenges can be fatal to a
child.
Transdermal form
ALERT Transdermal fentanyl isn’t recommended for
postoperative pain.
• Dosage adjustments in patients using the transdermal
system should be made gradually. Reaching steady state
levels of a new dose may take up to 6 days; delay dose
adjustment until after at least two applications.
• Most patients experience good control of pain for 3
days while wearing the transdermal system, although a
few may need a new application after 48 hours.
Because serum fentanyl level increases for the first 24
hours after application, analgesic effect can’t be
evaluated for the first day.
• When reducing opiate therapy or switching to a
different analgesic, withdraw the transdermal system
gradually. Because the serum level of fentanyl
decreases very gradually after removal, give half of the
equianalgesic dose of the new analgesic 12 to 18 hours
after removal.
• Observe patient for delayed onset of respiratory
depression.
• Monitor patient for at least 12 hours for adverse
reactions to transdermal system. Serum fentanyl levels
decrease very gradually and may take as long as 17
hours to decline by 50%.
Pregnant patients
• Drug is contraindicated during pregnancy unless
benefits outweigh risks to fetus.
Breast-feeding patients
• Drug appears in breast milk; don’t administer to
breast-feeding women.
Pediatric patients
• Safe use in children younger than age 2 hasn’t been
established for parenteral or transmucosal (buccal) use.
• Safe use in children younger than age 12 hasn’t been
established for transdermal system.
• Don’t use transdermal system in children younger
than age 18 who weigh less than 50 kg (110 lb).
• Don’t use buccal form in any child who weighs less
than 15 kg (33 lb).
Geriatric patients
• Use cautiously in elderly patients.
http://www.guildlink.com.au/gc/ws/astra/pi.cfm?
product=appfenta20818
https://www.glowm.com/resources/glowm/cd/pages/
drugs/f008.html
Generic Name: Ketamine https://davisplus.fadavis.com/3976/meddeck/pdf/
ketamine.pdf
Trade Name: Ketalar
https://www.glowm.com/resources/glowm/cd/pages/
drugs/kl000.html
Pharmacologic Class: dissociative anesthetic

Therapeutic Class: anesthetics

Action:

Blocks afferent impulses of pain perception. Suppresses

spinal cord activity. Affects CNS transmitter systems

Reasons Given (Disease States):

Anesthesia for short-term diagnostic and surgical

procedures. As induction before the use of other
anesthetics. As a supplement to other anesthetics.
Unlabeled Use: Provides sedation and analgesia.

Nursing Process:
Pre-Administration Assessment:
● Assess level of consciousness frequently throughout
therapy. Ketamine produces a dissociative state. The
patient does not appear to be asleep and experiences a
feeling of dissociation from the environment.
● Monitor BP, ECG, and respiratory status frequently
throughout therapy. May cause
hypertension and tachycardia. May cause increased CSF
pressure and increased intraocular pressure.
● Toxicity and Overdose: Respiratory depression or
apnea may be treated with mechanical ventilation or
analeptics.

Post-Administration Assessment:
● Sense of dissociation and general anesthesia without
muscle relaxation

Nursing Considerations:
● Psychomotor impairment may last for 24 hr after
anesthesia. Caution patient to avoid driving or other
activities requiring alertness until response to
medication is
known.
● Advise patient to avoid alcohol or other CNS
depressants for 24 hr after anesthesia. Transdermal
form
ALERT Transdermal fentanyl isn’t recommended for
postoperative pain.
Generic Name: Naloxone
Trade Name: Narcan
Pharmacologic Class: narcotic (opioid) antagonist
Therapeutic Class: narcotic antagonist
Action:
Competitively blocks the effects of opioids, including
CNS and respiratory depression, without producing any
agonist (opioid-like) effects.
Reasons Given (Disease States):
Post-Administration Assessment:
● Adequate ventilation.
● Alertness without significant pain or withdrawal
symptoms.
Nursing Considerations:
● As medication becomes effective, explain purpose
and effects of naloxone to patient.
https://davisplus.fadavis.com/3976/meddeck/pdf/
naloxone.pdf
https://www.glowm.com/resources/glowm/cd/pages/
drugs/n005.html

Reversal of CNS depression and respiratory depression

because of suspected opioid overdose. Unlabeled Use:
Opioid-induced pruritus (low dose IV infusion).
Management of refractory circulatory shock.

Nursing Process:
Pre-Administration Assessment:
● Monitor respiratory rate, rhythm, and depth; pulse,
ECG, BP; and level of consciousness frequently for 3– 4
hr after the expected peak of blood concentrations.
After a moderate overdose of a short half-life opioid,
physical
stimulation may be enough to prevent significant
hypoventilation. The effects of some opioids may last
longer than the effects of naloxone, and repeat doses
may be necessary.
● Patients who have been receiving opioids for 1 wk are
extremely sensitive to the effects of naloxone. Dilute
and administer carefully.
● Assess patient for level of pain after administration
when used to treat postoperative respiratory
depression. Naloxone decreases respiratory depression
but also reverses analgesia.
● Assess patient for signs and symptoms of opioid
withdrawal (vomiting, restlessness, abdominal cramps,
increased BP, and temperature). Symptoms may occur
within a few minutes to 2 hr. Severity depends on dose
of naloxone, the opioid involved, and degree of physical
dependence.
● Lack of significant improvement indicates that
symptoms are caused by a disease process or other
non-opioid CNS depressants not affected by naloxone.
● Toxicity and Overdose: Naloxone is a pure antagonist
with no agonist properties and minimal toxicity.
Generic Name: Dantrolene sodium
Trade Name: Dantrium
Pharmacologic Class: hydantoin derivative
Therapeutic Class: skeletal muscle relaxant
Action:
Acts directly on skeletal muscle, causing relaxation by
decreasing calcium release from sarcoplasmic reticulum
in muscle cells. Prevents intense catabolic process
associated with malignant hyperthermia.
Reasons Given (Disease States):
PO: Treatment of spasticity associated with: Spinal cord
injury, Stroke, Cerebral palsy, Multiple sclerosis.
Prophylaxis of malignant hyperthermia. IV Emergency
treatment of malignant hyperthermia. Unlabeled Use:
Management of neuroleptic malignant syndrome.
Nursing Process:
Pre-Administration Assessment:
● Assess bowel function periodically. Persistent
diarrhea may warrant discontinuation of therapy.
● Muscle Spasticity: Assess neuromuscular status and
muscle spasticity before initiating and periodically
during therapy to determine response.
● Malignant Hyperthermia: Assess previous anesthesia
history of all surgical patients. Also assess for family
history of reactions to anesthesia (malignant
hyperthermia or perioperative death).
● Monitor ECG, vital signs, electrolytes, and urine
output continuously when administering IV for
malignant hyperthermia.
● Monitor patient for difficulty swallowing and choking
during meals on the day of administration.
● Lab Test Considerations: Monitor liver function
frequently duringtherapy. Liver function abnormalities
(qAST, ALT, alkaline phosphatase, bilirubin, GGTP) may
require discontinuation of therapy.
● Evaluate renal function and CBC before and
periodically during therapy in patients
receiving prolonged therapy.
Post-Administration Assessment:
● Relief of muscle spasm in musculoskeletal conditions.
One wk or more may be required to see improvement;
if there is no observed improvement in 45 days, the
medication is usually discontinued.
● Prevention of or decrease in temperature and skeletal
rigidity in malignant hyperthermia.
Nursing Considerations:
● Advise patient not to take more medication than the
amount prescribed, to minimize risk of hepatotoxicity
and other side effects. If a dose is missed, do not take
unless remembered within 1 hr. Do not double doses.
● May cause dizziness, drowsiness, visual disturbances,
and muscle weakness. Advise patient to avoid driving
and other activities requiring alertness until response
to drug is known. After IV dose for surgery, patients
may experience decreased grip strength, leg weakness,
light-headedness, and difficulty swallowing for up to 48
hr. Caution patients to avoid activities requiring
alertness and to use caution when walking down stairs
and eating during this period.
● Advise patient to avoid taking alcohol or other CNS
depressants concurrently with this medication.
● Instruct patient to notify health care professional if
rash; itching; yellow eyes or skin; dark urine; or clay-
colored, bloody, or black, tarry stools occur or if nausea,
weakness, malaise, fatigue, or diarrhea persists. May
require discontinuation of therapy.
● Advise patient to wear sunscreen and protective
clothing to prevent photosensitivity reactions.
● Emphasize the importance of follow-up exams to
check progress in long-term therapy and blood tests to
monitor for side effects.
● Malignant Hyperthermia: Patients with malignant
hyperthemia should carry identification describing
disease process at all times.
https://davisplus.fadavis.com/3976/meddeck/pdf/
dantrolene.pdf
https://www.glowm.com/resources/glowm/cd/pages/
drugs/d006.html
AUTONOMIC NERVOUS
SYSTEM
Generic Name: Sevoflurane  Monitor for adverse effects (e.g. respiratory
depression, hypotension, bronchospasm, skin
Trade Name: Ultane
breakdown, etc).
 Evaluate patient understanding on drug therapy by
Pharmacologic Class: General anesthetics, inhalation
asking patient to name the drug, its indication, and
Therapeutic Class: adverse effects to watch for.
 Monitor patient compliance to drug therapy.

Action: Nursing Considerations

Ultane (sevoflurane) Volatile Liquid For Inhalation is an

anesthetic drug used to induce and maintain general
anesthesia in adult and pediatric patients during surgery

Reasons Given (Disease States):

Sevoflurane is indicated for induction and maintenance

of general anesthesia in adult and pediatric patients for
inpatient and outpatient surgery.
Sevoflurane should be administered only by persons
trained in the administration of general anesthesia.
Facilities for maintenance of a patent airway, artificial
ventilation, oxygen enrichment, and circulatory
resuscitation must be immediately available. Since level
of anesthesia may be altered rapidly, only vaporizers
producing predictable concentrations of sevoflurane
should be used.

Nursing Process:
Pre-Administration Assessment:
 Assess for the mentioned cautions and
contraindications (e.g. drug allergies, hepatic and
renal impairment, etc.) to prevent any untoward
complications.
 Perform a thorough physical assessment (e.g.
weight, neurological status, vital signs, heart sounds,
skin color and lesions, bowel sounds, etc.) to
establish baseline data before drug therapy begins,
to determine effectiveness of therapy, and to
evaluate for occurrence of any adverse effects
associated with drug therapy.
 Monitor laboratory test results (e.g. liver and renal
function tests) to determine possible need for a
reduction in dose and evaluate for toxicity.

Post-Administration Assessment:
 Monitor patient response to therapy (analgesia, loss
of consciousness).