DRUG STUDY

DRUG STUDY
MEDICATION MECHANISM INDICATION SIDE EFFECTS DRUG TO DRUG ADVERSE NURSING CONSIDERATION/
OF ACTION INTERACTION/CONTRAINDICATION EFFECTS Patient Teaching

GENERIC NAME: INHIBITS SODIUM • ACUTE • HEADACHES Drug-drug. Aminoglycoside antibiotics, such CNS: vertigo, headache, dizziness, NURSING CONSIDERATION
FUROSEMIDE CHLORIDE AND PULMONARY • DIZZINESS cisplatin: May increase ototoxicity. Use paresthesia, weakness, restlessness, fever. If oliguria or azotemia develops or increases, drug may need
BRAND NAME: LASIX, REABSORPTION EDEMA • NAUSEA together cautiously CV: orthostatic hypotension, to be stopped.
LASIX SPECIAL AT THE • EDEMA • VOMITING Amphotericin B, corticosteroids, thrombophlebitis with IV f administration. Monitor fluid intake and output and electrolyte, BUN, and
DRUG CLASS: PROXIMAL AND • HTN • PANCREATITIS corticotropin, metolazone: May increase risk EENT: blurred or yellowed vision, transient carbon dioxide levels frequently. Watch for signs of
LOOP DIURETICS DISTAL TUBULES of hypokalemia. Monitor potassium level deafness, tinnitus. GI: abdominal hypokalemia, such as muscle weakness and cramps.
DOSAGE AND THE closely. Antidiabetics: May decrease discomfort and pain, diarrhea, anorexia, Consult prescriber and dietitian about a high-potassium diet
For acute pulmonary ASCENDING LOOP hypoglycemic nausea, vomiting, constipation, or potassium supplements.
edema OF HENLE. effects. Monitor glucose level. pancreatitis. GU: azotemia, nocturia, Monitor glucose level in diabetic patients. Drug may not be
Adults: 40 mg IV Antihypertensives: May increase the risk of polyuria, frequent urination, oliguria. well absorbed orally in patient with severe HF Drug may need
injected slowly over 1 to hypotension. Use together cautiously. Hematologic agranulocytosis, aplastic to be given IV even if patient is taking other oral drugs.
2 minutes; then 80 mg Decrease antihypertensive dose if needed. anemia, leukopenia, thrombocytopenia, Monitor uric acid level, especially in parents with a history of
IV over 1 to 2 minutes Cardiac glycosides, and neuromuscular anemia. Hepatic dysfunction, jaundice, gout.
after 1 hour if needed. blockers: May increase toxicity of these drugs increased liver enzyme levels. Metabolic Monitor elderly patients, who are especially susceptible to
FREQUENCY from furosemide-induced hypokalemia. volume depletion and dehydration, excessive diuresis, because circulatory collapse and
, may repeat in 1–2 hr Monitor potassium level. Chlorothiazide, asymptomatic hyperuricemia, impaired thromboembolic complications are possible.
and ↑ by 20 mg every chlorthalidone, hydrochlorothiazide, glucose tolerance, hypokalemia, Monitor patients with severe symptoms of urine retention
1–2 hr until response is indapamide, metolazone: May cause hypochloremic alkalosis, hyperglycemia, due to bladder emptying disorders, prostate enlargement, or
obtained excessive diuretic response, causing serious dilutional hyponatremia, hypocalcemia, urethral narrowing or worsening of symptoms, especially
ROUTE electrolyte abnormalities or dehydration. hypomagnesemia. Musculoskeletal: during initial treatment. Drug may increase fetal birth weight.
IV Adjust doses carefully, and monitor patient muscle spasm. Skin: dermatitis, purpura, Monitor fetal growth during pregnancy.
If discolored yellow, closely for signs and symptoms of excessive photosensitivity reactions, transient pain Nephrocalcinosis and nephrolithiasis have occurred in
don't use. diuretic response. Ethacrynic acid: This may at IM injection site, toxic epidermal premature infants and in children younger than age 4 on long-
For direct injection, give increase the risk of ototoxicity. Avoid using necrolysis, SJS, erythema multiforme. term furosemide therapy Monitor renal function and renal
over 1 to 2 minutes. together. Other: gout ultrasounds Look alike-sound alike: Don't confuse Furosemide
Alert: For high-dose, Lithium: This may decrease lithium excretion, with torsemide: Don't confuse Lasix with Lonox, Lidex, or
intermittent infusion in resulting in lithium toxicity. Monitor lithium Luvox.
adults, dilute with D, W, level. PATIENT TEACHING
NSS, or lactated Ringer NSAIDs: This may inhibit the diuretic Advise patient to take drug in morning to prevent need to
solution. To avoid response. Use together cautiously. Phenytoin: urinate at night. If a second dose is needed, tell patient to take
ototoxicity, infuse at a May decrease the diuretic effects of it in early afternoon, 6 to 8 hours after morning dose. Inform
rate no greater than 4 furosemide. Use together cautiously. patient of possible need for potassium or magnesium
mg/minute. Use Propranolol: May increase propranolol level. supplements. Instruct patient to stand slowly to prevent
prepared infusion Monitor the patient closely. dizziness and to limit alcohol intake and strenuous exercise in
solution within Salicylates: May cause together cautiously. hot weather to avoid worsening dizziness upon standing
24 hours. Sucralfate: May reduce diuretic and quickly. Advise patient to report all adverse reactions and to
Incompatibilities: Acidic antihypertensive effects. Separate doses by 2 immediately report ringing in ears, severe ab
solutions, rinone, hours dominal pain, or sore throat and fever, these symptoms may
ciprofloxacin, milrinone, Drug-herb. Aloe: May increase drug effect. indicate toxicity. Tell patient to consult prescriber or
and various others. Discourage use together. Bayberry, blue pharmacist before taking OTC drugs. Teach patient to avoid
Consult a drug cohosh, cayenne, ephedra, ginger, ginseng
 incompatibility
reference for more
information.
GENERIC NAME: INHIBITS CELL-
AMOXICILLIN WALL SYNTHESIS
BRAND NAME:
AMOXIL, APO-AMOXI, BACTERIAL
AURO-AMOXICILLIN, MULTIPLICATION.
NOVAMOXIN
DRUG CLASS:
AMINOPENICILLINS
DOSAGE
For Acute otitis media
Children aged 6 and
older with mild to
moderate infection: 80
to 90 mg/kg PO daily in
two divided doses for 5
to 7 days.
FREQUENCY
80 to 90 mg/kg PO daily
in two divided doses for
5 to 7 days.
ROUTE
PO
Before giving, ask
patient about allergic
reactions to penicillin. A
negative history of
penicillin allergy is no
guarantee against al-
lergic reaction.
Obtain specimen for
culture and sensitivity
tests before giving first
dose. Begin therapy
while awaiting results.
Give drug with or
without food.
(American), kola, and licorice: May worsen direct sunlight and to use protective clothing and sunblock
HTN. Discourage use together. because of risk of photosensitivity reactions.
Licorice: This may cause unexpected rapid
potassium loss. Discourage use together.
Drug-food. Any food: May decrease
furosemide serum level. Don't give with food.
• Contraindicated in patients hypersensitive
to drug and in those with anuria.
• Use cautiously in patients with hepatic
cirrhosis and in those allergic to sulfonamides.
• Drug may exacerbate or activate SLE.
• Premature infants may be at increased risk
for persistent patent ductus arteriosus with
furosemide treatment during first weeks of
life.
• MILD TO • NAUSEA INTERACTIONS CNS: seizures, anxiety, confusion, NURSING CONSIDERATION
MODERATE • VOMITING Drug-drug. Hormonal contraceptives: May agitation, dizziness, reversible If large doses are given or if therapy is pro- longed, bacterial
DURING INFECTIONS OF • DIARRHEA decrease contraceptive effectiveness. Advise hyperactivity, anxiety, insomnia, or fungal superinfection may occur, especially in elderly,
THE EAR, NOSE, • SKIN RASHES use of additional form of contraception during behavioral changes. Gl: diarrhea, nausea, debilitated, or immunosuppressed patients.
AND THROAT; • HEADACHE penicillin therapy. pseudomembranous colitis, vomiting. GU: CDAD, ranging from mild diarrhea to fatal colitis, has been
SKIN AND SKIN • TASTE AND Live-virus vaccines: May decrease effective- interstitial nephritis, nephropathy. reported with nearly all antibacterial agents, including
STRUCTURE; OR SMELL ness of live-virus vaccines. Concurrent use Hematologic: agranulocytosis, leukopenia, amoxicillin. Evaluate patient if diarrhea occurs. Amoxicillin
GU TRACT. CHANGES recommended. thrombocytopenia, thrombocytopenic usually causes fewer cases of diarrhea than ampicillin. Look
• MILD TO SEVERE • ALLERGIC Methotrexate: May increase methotrexate purpura, anemia, eosinophilia, hemolytic alike-sound alike: Don't confuse amoxicillin with amoxapine.
INFECTIONS OF REACTIONS serum concentration. Monitor patient closely anemia. Other anaphylaxis, PATIENT TEACHING
THE LOWER for toxicity. hypersensitivity reactions, overgrowth of Tell patient to take entire quantity of drug exactly as
RESPIRATORY Probenecid: May increase levels of amoxicillin non-susceptible organisms. prescribed, even after feeling better. Instruct patient to take
TRACT AND and other penicillins. Probenecid may be used drug with or without food. Tell patient to notify prescriber if
SEVERE for this purpose. rash, fever, or chills develop. A rash is the most common
INFECTIONS OF Tetracyclines: May reduce therapeutic action allergic reaction, especially if allopurinol is also being taken.
THE EAR, NOSE, of penicillins. Avoid administering together. Tell parent to place drops directly on child's tongue for
AND THROAT; Warfarin: May enhance anticoagulant effect. swallowing or add to formula, milk, fruit juice, water, ginger
SKIN AND SKIN Use together cautiously. ale, or other cold drink for immediate and complete
STRUCTURE; OR Drug-herb. Khat: May decrease antimicrobial consumption.
GU TRACT. effect. Discourage khat chewing, or tell
• PHARYNGITIS, patient to take drug 2 hours after khat
TONSILITIS, OR chewing.
BOTH CONTRAINDICATIONS & CAUTIONS
SECONDARY TO *Contraindicated in patients hypersensitive to
STREPTOCOCCUS drug or other penicillins.
PYOGENES Use cautiously in patients with other drug
INFECTION. allergies (especially to cephalosporins) be-
• ACUTE OTTITIS cause of possible cross-sensitivity.
MEDIA Use cautiously in those with mononucleosis
because of high risk of maculopapular rash,
Dialyzable drug: Yes.
 For a child, place drops
directly on child's
tongue for swallowing
or add to formula, milk,
fruit juice, water, ginger
ale, or other cold drink
for immediate and
complete consumption.
Store reconstituted oral
suspension in
refrigerator, if possible.
Be sure to check
individual product
labels for storage
information.
GENERIC NAME: Thought to • MILD PAIN OR INTERACTIONS NS: agitation (IV), anxiety, fatigue, NURSING CONSIDERATIONS
ACETAMINOPHEN produce analgesia FEVER • red, peeling Drug-drug. Barbiturates, carbamazepine headache, insomnia, pyrexia CV HTN, hy Black Box Warning Many OTC and prescription products
BRAND NAME: by inhibiting • MILD-MODERATE or blistering hydantoins, rifampin: High doses or long- potension, peripheral edema, periorbital contain acetaminophen; be aware of this when calculating
ACEPHEN, ACET, prostaglandin and PAIN; MILD- skin. term use of these drugs may reduce edema, tachycardia (IV) Gli nausea, total daily dose. Black Box Warning Use caution when pre-
ATHRITIS PAIN RELIEF, other substances MODERATE PAIN therapeutic effects and enhance hepatotoxic vomiting, abdominal pain, diarrhea, scribing, preparing, and administering IV acetaminophen to
• rash.
FORTOLIN, OFIRMEV, that sensitize pain WITH effects of acetaminophen. Avoid using constipation (IV), GU: oliguria (IV). avoid dosing errors leading to accidental overdose and death.
PEDIATRIX, RAPID receptors. Drug ADJUNCTIVE • hives. together. Busulfan: May increase busulfan Hematologic hemolytic anemia, Be careful not to confuse dose in milligrams and dose in
ACTION, TAMINOL, may relieve fever OPIOID • itching. level, Monitor patient closely. leukopenia, neutropenia, milliliters. Be sure to base dose on weight for patients
TRIAMINIC FEVER central action in ANALGESTICS; Cholestyramine resin: May decrease weighing less than 50 kg, to properly program infusion pump,
• swelling of
REDUCER, TYLENOL the hypothalamic FEVER acetaminophen absorption. Give at least 1 pancytopenia, anemia. Hepatic: jaundice. and to ensure that total daily dose of acetaminophen from all
the face,
DRUG CLASS: heat-regulating hour after acetaminophen or consider Metabolic: hypoalbuminemia (IV), sources doesn't exceed maximum daily limit. Consider
throat,
PARA-AMINOPHENOL center. therapy change. Dasatinib: May enhance hypoglycemia, hypokalemia, reducing total daily dose and increasing dosing intervals in
tongue, lips,
DERIVATIVES hepatotoxic effects of dasatinib and increase hypervolemia, hypomagnesemia, patients with hepatic or renal impairment.
eyes,
DOSAGE acetaminophen level. Avoid use together. hypophosphatemia (IV). Musculoskeletal: PATIENT TEACHING
FOR MILD PAIN OR
hands, feet, Imatinib, mipomersen: May increase hepato- muscle spasms, extremity pain (IV). Tell parents to consult prescriber before giving drug to
FEVER ankles, or toxic effects of these drugs. Monitor patient Respiratory: abnormal breath sounds, children younger than age 2. •Advise parents that drug is only
Adults: 325 to 650 mg lower legs. closely. dyspnea, hypoxia, atelectasis, pleural for short- term use; urge them to consult prescriber if giving
PO every 4 to 6 hours. O • hoarseness. Isoniazid: May increase risk of acetaminophen effusion, pulmonary edema, stridor, to infants for longer than 3 days, 5 children for longer than 5
two extended-release • difficulty adverse effects. Monitor patient closely. wheezing (IV) Skin: rash, urticaria, days, or adults for longer than 10 days. Black Box Warning
caplets PO every 8 breathing or Lamotrigine: Prolonged acetaminophen use infusion-site pain (IV), pruritus. Advise patient or care-giver that many OTC products contain
hours Maximum, 3,250 swallowing. may decrease lamotrigine level. Monitor acetaminophen and should be counted when calculating total
mg daily unless under patient for therapeutic effects; adjust daily dose. Tell patient to consult prescriber for fever lasting
health care provider lamotrigine dosage as needed. longer than 3 days or recurrent fever. Alert: Warn patient that
supervision, when 4 g Lomitapide: May increase lomitapide level. high doses or unsupervised long-term use can cause liver
daily (immediate- Limit maximum adult dose of acetaminophen damage. Excessive alcohol use may increase the risk of liver
release) may be used. to 4 g or less daily for 3 or fewer days per damage. Caution long-term alcoholics to limit drug to 2 g/day
For long-term therapy, week or consider therapy change. or less.
don't exceed 2.5 g daily Metyrapone, probenecid: May increase acet-
unless prescribed and aminophen level and risk of hepatotoxicity.
monitored closely by Avoid use together.
the health care Warfarin: May increase
provider. hypoprothrombinemic effects with long-term
FREQUENCY use with high doses of acetaminophen.
2 OR 3 A DAY (4 TO 6 Monitor INR closely.
HOURS) Drug-lifestyle. Alcohol use: May increase risk
ROUTE of hepatic damage. Discourage use together.
 PO CONTRAINDICATIONS
Use liquid form for .Contraindicated in patients hypersensitive to
children and drug. IV form is contraindicated in patients
patientswho have a with severe hepatic impairment or severe
headache who have active liver disease.
difficulty swallowing. Use cautiously in patients with any type of
Give drug without liver disease, G6PD deficiency, chronic
regard for food. malnutrition, severe hypovolemia
Dispersible tablet (dehydration, blood loss), or severe renal
should be allowed to impairment (CrCl of 30 mL/minute or less).
dissolve in the mouth. Use cautiously in patients with long-term
Shake liquid alcohol use because therapeutic doses cause
formulations well hepatotoxicity in these patients. Chronic
before using. alcoholics shouldn't take more than 2 g of
Give extended-release acetaminophen every 24 hours. Dialyzable
forms whole, don’t drug: Unknown.
crush, dissolve, or allow
patient to chew
extended-release forms.