10 Drug Study

Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur
College of Health Sciences

PASAWA, DIANA L. BSN 3E NCM 112-RLE
DRUG STUDY
DRUG NAME DOSAGE MECHANISM OF INDICATIONS CONTRAINDICATION ADVERSE EFFECTS NURSING
ACTION S CONSIDERATIONS
Mannitol Route: IV In large doses, To promote diuresis in Anuria; marked CNS: Headache, -Take care to avoid
Dosage: increases rate of prevention and pulmonary congestion tremor, convulsions, extravasation.
CLASSIFICATION: ADULTS, ELDERLY: electrolyte excretion treatment of oliguric or edema; severe dizziness, transient Observe injection site
0.25–1 g/kg/dose. by the kidney, phase of acute kidney CHF; metabolic muscle rigidity. for signs of
Pharmacotherapeutic:  May repeat q6–8h particularly sodium, failure following edema; organic CNS CV: Edema, CHF, inflammation or
Polyol (sugar alcohol). as needed to chloride, and cardiovascular disease, intracranial angina-like pain, edema.
maintain serum potassium. surgery, severe bleeding; shock, hypotension, -Lab tests: Monitor
Clinical: Osmotic osmolality ˂300-
traumatic injury, severe dehydration, hypertension, closely serum and
diuretic 325 mOsm/kg
surgery in presence of history of allergy; thrombophlebitis. urine electrolytes and
CHILDREN: 0.25–1 severe jaundice, pregnancy (category Eye: Blurred vision. kidney function during
g/kg/dose; repeat to hemolytic transfusion C), lactation; GI: Dry mouth, therapy.
maintain serum reaction. Also used to concomitantly with nausea, vomiting. -Measure I&O
osmolality reduce elevated blood. Urogenital: Marked accurately and record
intraocular (IOP) and diuresis, urinary to achieve proper fluid
IOP REDUCTION intracranial pressure retention, nephrosis, balance.
Route: IV (ICP), to measure uricosuria. Metabolic: -Monitor vital signs
Dosage: glomerular filtration Fluid and electrolyte closely. Report
ADULTS, ELDERLY: rate (GFR), to promote imbalance, especially significant changes in
1.5–2 g/kg over 30–60 excretion of toxic hyponatremia; BP and signs of CHF.
min 1–1.5 hrs prior to substances, to relieve dehydration, acidosis. -Monitor for possible
surgery.
symptoms of Other: With indications of fluid and
CHILDREN: 1–2 g/kg pulmonary edema, extravasation (local electrolyte imbalance
over 30–60 min 1–1.5 and as irrigating edema, skin necrosis; (e.g., thirst, muscle
hrs prior to surgery. solution in chills, fever, allergic cramps or weakness,
transurethral prostatic reactions). paresthesias, and
reaction to minimize signs of CHF).
hemolytic effects of -Be alert to the
water. Commercially possibility that a
available in rebound increase in

combination with ICP sometimes occurs
sorbitol for urogenital about 12 h after drug
irrigation. administration. Patient
may complain of
headache or
confusion.
-Take accurate daily
weight.
Bisacodyl (Dulcolax) Adult: Expands intestinal Temporary relief of Acute surgical Systemic effects not Assessment & Drug
Route: PO fluid volume by acute constipation and abdomen, nausea, reported. Mild Effects
CLASSIFICATIONS: Dosage: increasing epithelial for evacuation of colon vomiting, abdominal cramping, nausea, -Evaluate periodically
5–15 mg prn (max: 30 permeability. before surgery, cramps, intestinal diarrhea, fluid and patient's need for
Gastrointestinal Agent; mg for special proctoscopic, obstruction, fecal electrolyte continued use of drug;
Stimulant Laxative procedures) PR 10 mg sigmoidoscopic, and impaction; use of disturbances bisacodyl usually
prn
radiologic rectal suppository in (especially potassium produces 1 or 2 soft
Pregnancy Category:
examinations. Also presence of anal or and calcium). formed stools daily.
C Child:
Route: PO used to cleanse colon rectal fissures, -Monitor patients
Dosage: before delivery and to ulcerated receiving concomitant
6 y, 5–10 mg prn PR relieve constipation in hemorrhoids, proctitis. anticoagulants.
patients with spinal Indiscriminate use of
2 y, 10 mg; <2 y, 5 mg cord damage. laxatives results in
decreased absorption
of vitamin K.
Patient & Family

Education
-Add high-fiber foods
slowly to regular diet
to avoid gas and
diarrhea. Adequate
fluid intake includes at
least 6–8 glasses/d.
-Do not breast feed
while taking this drug
without consulting

physician.
Amiodarone Route: PO: Structurally related to -Prophylaxis and Hypersensitivity to CNS: Peripheral -Monitor BP carefully
Dosage: thyroxine. Class III treatment of life- amiodarone, or benzyl neuropathy (muscle during infusion and
CLASSIFICATION:  ADULTS, antiarrhythmic; also threatening ventricular alcohol; cardiogenic weakness, wasting slow the infusion if
ELDERLY: Initially, has antianginal and arrhythmias and shock, severe sinus numbness, tingling), significant hypotension
Pharmacotherapeutic: 400 mg q8–12h for antiadrenergic supraventricular bradycardia, advanced fatigue, abnormal gait, occurs;
Cardiac agent. 1–2 wks, then properties. Totally arrhythmias, AV block unless a dyskinesias, dizziness, -Monitor for S&S of:
decrease to 200– unrelated to other particularly with atrial pacemaker is paresthesia, Adverse effects.
Clinical: 400 mg once daily.
antiarrhythmics. Acts fibrillation. available, severe headache. CV: -Lab tests: Baseline
Antiarrhythmic. Class Maintenance: 200–
directly on all cardiac -Treatment of sinus-node Bradycardia, and periodic
III 400 mg/day.
tissues. Prolongs nonexertional angina, dysfunction or sick hypotension (IV), sinus assessments should
Route: IV infusion duration of action conversion of atrial sinus syndrome, arrest, cardiogenic be made of liver, lung,
Dosage: potential and fibrillation to normal bradycardia, shock, CHF, thyroid, neurologic,
 ADULTS, refractory period sinus rhythm, congenital or acquired arrhythmias; AV block. and GI function.
ELDERLY: without significantly paroxysmal QR prolongation Special Senses: -Monitor for elevations
Initially, 150 mg affecting resting supraventricular syndromes, or history Corneal of AST and ALT.
over 10 min, then membrane potential. tachycardia, of torsade de pointes; microdeposits, blurred -Auscultate chest
1 mg/min over 6 ventricular rate control severe liver disease, vision, optic neuritis, periodically or when
hrs; then 0.5 due to accessory children. Safety during optic neuropathy, patient complains of
mg/min. pathway conduction in pregnancy (category permanent blindness, respiratory symptoms.
 Continue this rate pre-excited atrial D) or lactation is not corneal degeneration, -Anticipate possible
over at least 18 arrhythmia, after established. macular degeneration, CNS symptoms within
hrs or until
defibrillation and photosensitivity. GI: a week after
complete
epinephrine in cardiac Anorexia, nausea, amiodarone therapy
transition or oral.
arrest. vomiting, constipation, begins.
 Breakthrough
stable VT: 150 hepatotoxicity.
mg in 100 mL Metabolic:
D5W or NS over Hyperthyroidism or
10 min. 1–6 hypothyroidism; may
mg/mL. cause neonatal hypo-
or hyperthyroidism if
RENAL taken during
IMPAIRMENT: pregnancy.
No Dose Adjustment Respiratory:

(Pulmonary toxicity)
HEPATIC Alveolitis, pneumonitis
IMPAIRMENT: (fever, dry cough,
No Dose Adjustment dyspnea), interstitial
pulmonary fibrosis,
fatal gasping
syndrome with IV in
children. Skin: Slate-
blue pigmentation,
photosensitivity, rash.
Other: With chronic
use, angioedema.
Omeprazole Gastroesophageal An antisecretory -Duodenal and gastric Long-term use for CNS: Headache, Assessment & Drug
Reflux, Erosive compound that is a ulcer. gastroesophageal dizziness, fatigue. GI: Effects
CLASSIFICATION Esophagitis, Duodenal gastric acid pump Gastroesophageal reflux disease Diarrhea, abdominal -Lab tests: Monitor
Ulcer inhibitor. Suppresses reflux disease (GERD), duodenal pain, nausea, mild urinalysis for
Pharmacotherapeutic: Adult: PO 20 mg gastric acid secretion including severe ulcers; proton pump transient increases in hematuria and
BenziMidazole. once/d for 4–8 wk by inhibiting the H+, erosive esophagitis (4 inhibitors (PPIs), liver function tests. proteinuria. Periodic
K+-ATPase enzyme to 8 wk treatment). hypersensitivity; Urogenital: Hematuria, liver function tests with
Clinical: Proton Pump
Gastric Ulcer system [the acid Long-term treatment of children <2 y; use of proteinuria. Skin: prolonged use.
Inhibitor
Adult: PO 20 mg b.i.d. (proton H+) pump] in pathologic OTC formulation in Rash.
for 4–8 wk the parietal cells. hypersecretory children <18 y or GI Patient & Family
conditions such as bleeding; pregnancy Education
Hypersecretory Zollinger-Ellison (category C); use of -Report any changes
Disease syndrome, multiple Zegerid in metabolic in urinary elimination
Adult: PO 60 mg endocrine adenomas, alkalosis, such as pain or
once/d up to 120 mg and systemic hypocalcemia, discomfort associated
t.i.d. mastocytosis. In vomiting, GI bleeding. with urination, or blood
combination with in urine.
Duodenal Ulcer clarithromycin to treat -Report severe
Associated with H. duodenal ulcers diarrhea; drug may
pylori associated with need to be
Adult: PO 40 mg Helicobacter pylori. discontinued.
once/d for 14 d, then -Healing or prevention -Do not breast feed

20 mg/d for 14 d, in of NSAID-related while taking this drug.
combination with ulcers.
clarithromycin 500 mg
t.i.d. for 14 d
Aspirin 80 mg Mild to Moderate Pain, Major actions appear To relieve pain of low History of Body as a Whole: -Monitor for loss of
Fever to be associated to moderate intensity. hypersensitivity to Hypersensitivity tolerance to aspirin.
CLASSIFICATION Adult: PO/PR 350–650 primarily with inhibiting Also for various salicylates including (urticaria, -Lab tests: frequent PT
Pharmacotherapeutic: mg q4h (max: 4 g/d) the formation of inflammatory methyl salicylate (oil of bronchospasm, and IRN with
Non-Steroidal Anti- Child: PO/PR 10–15 prostaglandins conditions, such as wintergreen); anaphylactic shock concurrent
Inflammatory Drug mg/kg in 4–6 h (max: involved in the acute rheumatic fever, sensitivity to other (laryngeal edema). anticoagulant therapy;
(Nsaid).
3.6 g/d) production of Systemic Lupus, NSAIDs; patients with CNS: Dizziness, more frequent fasting
inflammation, pain, rheumatoid arthritis, "aspirin triad" (aspirin confusion, drowsiness. blood glucose levels
Clinical: Anti-
InflammatoRy, Arthritic Conditions and fever. osteoarthritis, bursitis, sensitivity, nasal Special Senses: with diabetes.
Antipyretic, Analgesic, Adult: PO 3.6–5.4 g/d and calcific tendonitis, polyps, asthma); Tinnitus, hearing loss. -Monitor the diabetic
Anti-Platelet. in 4–6 divided doses and to reduce fever in chronic rhinitis; chronic GI: Nausea, vomiting, child carefully for need
Child: PO 80–100 selected febrile urticaria; history of GI diarrhea, anorexia, to adjust insulin dose.
mg/kg/d in 4–6 divided conditions. Used to ulceration, bleeding, or heartburn, stomach -Monitor for salicylate
doses; max 130 reduce recurrence of other problems; pains, ulceration, toxicity.
mg/kg/d TIA due to fibrin hypoprothrombinemia, occult bleeding, GI -Note: Potential for
platelet emboli and vitamin K deficiency, bleeding. Hematologic: toxicity is high in older
Thromboembolic risk of stroke in men; hemophilia, or other Thrombocytopenia, adults and patients
Disorders to prevent recurrence bleeding disorders; hemolytic anemia, with asthma, nasal
Adult: PO 81–325 mg of MI; as prophylaxis CHF. Do not use prolonged bleeding polyps, perennial
qd against MI in men with aspirin during time. Skin: Petechiae, vasomotor rhinitis, hay
unstable angina. pregnancy (category easy bruising, rash. fever, or chronic
TIA Prophylaxis D), especially in third Urogenital: Impaired urticaria.
Adult: PO 650 mg trimester; lactation; or renal function. Other:
b.i.d. in prematures, Prolonged pregnancy
neonates, or children and labor with
MI Prophylaxis under 2 y, except increased bleeding.
Adult: PO 80–325 under advice and
mg/d supervision of
physician. Do not use
in children or
teenagers with

chickenpox or
influenza-like illnesses
because of possible
association with
Reye's syndrome.
Insulin Diabetes Mellitus Short-acting, clear, Emergency treatment Hypersensitivity to Body as a Whole: -Note: Frequency of
Adult: SC 5–10 U 15– colorless solution of of diabetic insulin animal protein. Most adverse effects blood glucose
CLASSIFICATION 30 min a.c. and h.s. exogenous unmodified ketoacidosis or coma, are related to monitoring is
PHARMACOTHERAP (dose adjustments insulin extracted from to initiate therapy in hypoglycemia; determined by the type
EUTIC: Exogenous based on blood beta cells in pork patient with insulin- anaphylaxis (rare), of insulin regimen and
insulin. CLINICAL: glucose pancreas or dependent diabetes hyperinsulinemia health status of the
Antidiabet determinations) synthesized by mellitus, and in [Profuse sweating, patient.
Child: SC 2–4 U 15– recombinant DNA combination with hunger, headache, -Lab tests: Periodic
30 min a.c. and h.s. technology (human). intermediate-acting or nausea, postprandial blood
(dose adjustments Enhances long-acting insulin to tremulousness, glucose, and HbA1C.
based on blood transmembrane provide better control tremors, palpitation, -Notify physician
glucose passage of glucose of blood glucose tachycardia, promptly for presence
determinations) across cell concentrations in the weakness, fatigue, of acetone with sugar
membranes of most diabetic patient. Used nystagmus, circumoral in the urine; may
Ketoacidosis body cells and by IV to stimulate growth pallor; numb mouth, indicate onset of
Adult: IV 2.4–7.2 U unknown mechanism hormone secretion tongue, and other ketoacidosis.
loading dose, followed may itself enter the (glucose counter paresthesias; visual -Monitor for
by 2.4–7.2 U/h cell to activate regulatory hormone) to disturbances (diplopia, hypoglycemia
continuous infusion selected intermediary evaluate pituitary blurred vision, -Check BP, I&O ratio,
Child: IV 0.1 U/kg metabolic processes. growth hormone mydriasis), staring and blood glucose and
loading dose, followed Promotes conversion reserve in patient with expression, confusion, ketones every hour
by 0.1 U/h continuous of glucose to known or suspected personality changes, during treatment for
infusion glycogen. growth hormone ataxia, incoherent ketoacidosis with IV
deficiency. Other uses speech, apprehension, insulin.
include promotion of irritability, inability to -Give patients with
intracellular shift of concentrate, severe hypoglycemia
potassium in treatment personality changes, glucagon, epinephrine,
of hyperkalemia (IV) uncontrolled yawning, or IV glucose 10–50%.
and induction of loss of consciousness,
hypoglycemic shock delirium, hypothermia,

as therapy in convulsions, Babinski
psychiatry.. reflex, coma. (Urine
glucose tests will be
negatives). CNS: With
overdose, psychic
disturbances (i.e.,
aphasia, personality
changes, maniacal
behavior). Metabolic:
Posthypoglycemia or
rebound
hyperglycemia
(Somogyi effect),
lipoatrophy and
lipohypertrophy of
injection sites; insulin
resistance. Skin:
Localized allergic
reactions at injection
site; generalized
urticaria or bullae,
lymphadenopathy.
HUMAN ALBULIN Emergency Volume Obtained by To restore plasma Severe anemia; Body as a Whole: -Monitor BP, pulse and
Replacement fractionating pooled volume and maintain cardiac failure, Fever, chills, flushing, respiration, and IV
Adult: IV 25 g, may venous and placental cardiac output in patients with normal or increased salivation, albumin flow rate.
repeat in 15–30 min if human plasma, which hypovolemic shock; for increased headache, back pain. -Lab tests: Monitor
necessary (max: 250 is then sterilized by prevention and intravascular volume. Skin: Urticaria, rash. dosage of albumin
g) filtration and heat to treatment of cerebral Safety during CV: Circulatory using plasma albumin
minimize possibility of edema; as adjunct in pregnancy (category overload, pulmonary (normal): 3.5–5 g/dL;
Colloidal Volume transmitting hepatitis B exchange transfusion C) or lactation is not edema (with rapid total serum protein
Replacement virus or HIV. Risk of for hyperbilirubinemia established. infusion); hypotension, (normal): 6–8.4 g/dL;
(Nonemergency) sensitization is and erythroblastosis hypertension, Hgb; Hct; and serum
Child: IV 12.5 g, may reduced because it fetalis; to increase dyspnea, tachycardia. electrolytes.
repeat in 15–30 min if lacks cellular elements plasma protein level in GI: Nausea, vomiting. -Observe closely for
necessary and contains no treatment of S&S of circulatory

coagulation factors, hypoproteinemia; and overload and
Hyperbilirubinemia, Rh factor, or blood to promote diuresis in pulmonary edema.
Erythroblastosis group antibodies. refractory edema. Also -Observe for bleeding
Fetalis used for blood dilution points that did not
Child: IV 1 g/kg of 25% prior to or during bleed at lower BP with
solution 1–2 h before cardiopulmonary injuries or surgery and
transfusion bypass procedures. as BP rises.
Has been used as -Monitor I&O ratio and
Hypoproteinemia adjunct in treatment of pattern.
Prophylaxis in adult respiratory -Withhold fluids
Neonates distress syndrome completely during
Child: IV 1.4–1.8 (ARDS). succeeding 8 h, when
mL/kg of 25% solution albumin is given to
patients with cerebral
edema.
-Report chills, nausea,
headache, or back
pain to physician
immediately.
-Do not breast feed
while taking this drug
without consulting
physician.
Nicardipine Hypertension, Angina Calcium entry blocker Either alone or with Hypersensitivity to CNS: Dizziness or -Establish baseline
Adult: PO 20–40 mg that inhibits the beta blockers for nicardipine; advanced headache, fatigue, data before treatment
CLASSIFICATION t.i.d. or 30–60 mg SR transmembrane influx chronic, stable (effort- aortic stenosis; anxiety, depression, is started including BP,
PHARMACOTHERAP b.i.d. IV Initiation of of calcium ions into associated) angina; lactation. parerethesias, pulse, and lab values
EUTIC: Calcium therapy in a drug-free cardiac muscle and either alone or with insomnia, of liver and kidney
channel blocker. patient: 5 mg/h initially, smooth muscle, thus other somnolence, function.
Dihydropyridine. increase dose by 2.5 affecting contractility. antihypertensives for nervousness. CV: -Monitor BP during
CLINICAL: mg/h q15min (or More selectively essential Pedal edema, initiation and titration
Antianginal, faster) (max: 15 mg/h); affects vascular hypertension. CHF, hypotension, flushing, of dosage carefully.
antihypertensive for severe smooth muscle than cerebral ischemia, palpitations, -Avoid too rapid

hypertension: 4–7.5 cardiac muscle; migraine. tachycardia, increased reduction in either
mg/h; for postop relaxes coronary angina. GI: Anorexia, systolic or diastolic
hypertension: 10–15 vascular smooth nausea, vomiting, dry pressure during
mg/h initially, then 1–3 muscle with little or no mouth, constipation, parenteral
mg/h negative inotropic dyspepsia. Skin: Rash, administration.
Child: IV 1–3 effect. pruritus. Body as a -Discontinue IV
mcg/kg/min has been Whole: Arthralgia or infusion if hypotension
used in children 9 arthritis. or tachycardia
days old to 10 y develop.
-Observe for large
Substitute for Oral peak and trough
Nicardipine differences in BP.
Adult: IV 20 mg q8h
PO = 0.5 mg/h; 30 mg
q8h PO = 1.2 mg/h; 40
mg q8h PO = 2.2 mg/h
Digoxin Digitalizing Dose Widely used cardiac Rapid digitalization Digitalis CNS: Fatigue, muscle -Take apical pulse for
Adult: PO 10–15 glycoside of Digitalis and for maintenance hypersensitivity, weakness, headache, 1 full min, noting rate,
CLASSIFICATION mcg/kg (1 mg) in lanata. Acts by therapy in CHF, atrial ventricular fibrillation, facial neuralgia, rhythm, and quality
PHARMACOTHERAP divided doses over increasing the force fibrillation, atrial flutter, ventricular tachycardia mental depression, before administering
EUTIC: Cardiac 24–48 h IV 10–15 and velocity of paroxysmal atrial unless due to CHF. paresthesias, drug.
glycoside. CLINICAL: mcg/kg (1 mg) in myocardial systolic tachycardia. Full digitalizing dose hallucinations, -Be familiar with
Antiarrhythmic. divided doses over 24 contraction (positive not given if patient has confusion, drowsiness, patient's baseline data.
h inotropic effect). It also received digoxin agitation, dizziness. -Lab tests: Baseline
Child: PO/IV <2 y, 40– decreases conduction during previous week CV: Arrhythmias, and periodic serum
60 mcg/kg; 2–10 y, velocity through the or if slowly excreted hypotension, AV block. digoxin, potassium,
20–40 mcg/kg; >10 y, atrioventricular node. cardiotonic glycoside Special Senses: Visual magnesium, and
10–15 mcg/kg (1.5–2 Action is more prompt has been given during disturbances. GI: calcium.
mg) and less prolonged previous 2 wk. Anorexia, nausea, -Monitor for S&S of
Neonate: PO/IV 30–50 than that of digitalis vomiting, diarrhea. drug toxicity
mcg/kg and digitoxin. Other: Diaphoresis, -Monitor I&O ratio
Premature neonate: recurrent malaise, during digitalization,
PO/IV 20 mcg/kg dysphagia. particularly in patients
with impaired renal
Maintenance Dose function.

Adult: PO/IV 0.1– -Monitor serum digoxin
0.375 mg/d levels closely during
Child: PO/IV <2 y, 7.5– concurrent antibiotic–
9 mcg/kg/d; 2–10 y, 6– digoxin therapy.
7.5 mcg/kg/d; >10 y, -Observe patients
0.125–0.25 mg/d closely when being
Neonate: 6–7.5 transferred from one
mcg/kg/d preparation (tablet,
Premature neonate: elixir, or parenteral) to
3.75 mcg/kg/d another.
Atropine SO4 Preanesthesia Acts by selectively Adjunct in Hypersensitivity to CNS: Headache, -Monitor vital signs.
Adult: IV/IM/SC 0.2–1 blocking all muscarinic symptomatic treatment belladonna alkaloids; ataxia, dizziness, -Note: Frequent and
Classification: mg 30–60 min before responses to of GI disorders (e.g., synechiae; angle- excitement, irritability, continued use of eye
Antiarrhythmias surgery acetylcholine (ACh), peptic ulcer, closure glaucoma; convulsions, preparations, as well
Child: IV/IM/SC <5 kg, whether excitatory or pylorospasm, GI parotitis; obstructive drowsiness, fatigue, as overdosage, can
0.02 mg/kg; >5 kg, inhibitory. Selective hypermotility, irritable uropathy, e.g., bladder weakness; mental have systemic effects.
0.01–0.02 mg/kg 30– depression of CNS bowel syndrome) and neck obstruction depression, confusion, -Monitor I&O,
60 min before surgery relieves rigidity and spastic disorders of caused by prostatic disorientation, especially in older
tremor of Parkinson's biliary tract. Relaxes hypertrophy; intestinal hallucinations. CV: adults and patients
Arrhythmias syndrome. upper GI tract and atony, paralytic ileus, Hypertension or who have had surgery.
Adult: IV/IM 0.5–1 mg Antisecretory action colon during hypotonic obstructive diseases of hypotension, -Monitor CNS status.
q1–2h prn (max: 2 mg) (vagolytic effect) radiography. GI tract, severe ventricular -Monitor infants, small
Child: IV/IM 0.01–0.03 suppresses sweating, Oral inhalation for ulcerative colitis, toxic tachycardia, children, and older
mg/kg for 1–2 doses lacrimation, salivation, short-term treatment megacolon; palpitation, adults for "atropine
and secretions from and prevention of tachycardia secondary paradoxical fever".
Organophosphate nose, mouth, pharynx, bronchospasms to cardiac insufficiency bradycardia, AV -Patients receiving
Antidote and bronchi. Blocks associated with or thyrotoxicosis; dissociation, atrial or atropine via inhalation
Adult: IV/IM 1–2 mg vagal impulses to asthma, bronchitis, acute hemorrhage; ventricular fibrillation. sometimes manifest
q5–60min until heart with resulting and COPD and as myasthenia gravis. GI: Dry mouth with mild CNS stimulation
muscarinic signs and decrease in AV drying agent in upper Safety during thirst, dysphagia, loss with doses in excess
symptoms subside conduction time, respiratory infection. pregnancy (category of taste; nausea, of 5 mg and mental
(may need up to 50 increase in heart rate Adjunctive therapy for C) or lactation is not vomiting, constipation, depression and other
mg) and cardiac output, hypermotility of GI established. delayed gastric mental disturbances
Child: IV/IM 0.05 and shortened PR tract. emptying, antral with larger doses.
mg/kg q10–30 min interval. stasis, paralytic ileus.

until muscarinic signs Urogenital: Urinary
and symptoms hesitancy and
subside retention, dysuria,
impotence. Skin:
COPD Flushed, dry skin;
Adult: Inhalation 0.025 anhidrosis, rash,
mg/kg diluted with 3–5 urticaria, contact
mL saline, via dermatitis, allergic
nebulizer 3–4 times conjunctivitis, fixed-
daily (max: 2.5 mg/d) drug eruption. Special
Child: Inhalation 0.03– Senses: Mydriasis,
0.05 mg/kg diluted blurred vision,
with 3–5 mL saline, via photophobia,
nebulizer 3–4 times increased intraocular
daily pressure, cycloplegia,
eye dryness, local
Uveitis redness.
Adult/Child:
Ophthalmic 1–2 drops
of solution or small
amount of ointment in
eye up to t.i.d.
Cycloplegia
Adult: Ophthalmic 1
drop of solution or
small amount of
ointment in eye 1 h
before the procedure
Child: Ophthalmic 1–2
drops in eye b.i.d. for
1–3 d prior to
procedure or a small
amount of ointment in
conjunctival sac t.i.d.

for 1–3 d prior to
procedure with last
dose applied several
hours before the
procedure
Drug Name Mechanism of Indications/ Routes/ Contraindications Adverse Effects Nursing Considerations
Action Dosage
Mannitol  Increases ELEVATED  Hypersensitivit  Fluid electrolyte Baseline Assessment
osmotic INTRACRANIAL y to mannitol. imbalance may occur  Obtain serum osmolality,
CLASSIFICATION: pressure of PRESSURE  Severe due to rapid sodium.

glomerubular Route: IV dehydration, administration of large  Obtain baseline B/P,
Pharmacotherapeutic: filtrate, inhibiting Dosage: active doses or inadequate pulse.
Polyol (sugar alcohol). tubular ADULTS, ELDERLY: intracranial urine output resulting  Assess skin turgor,
reabsorption of 0.25–1 g/kg/dose. bleeding in overexpansion of mucous membranes,
Clinical: Osmotic diuretic water and  May repeat q6–8h (except during extracellular fluid. mental status, muscle
electrolytes, as needed to craniotomy)  Circulatory overload strength.
resulting in maintain serum  Severe may produce  Obtain baseline weight.
increased urine osmolality ˂300-325 pulmonary pulmonary edema,  Assess hydration status.
output. mOsm/kg edema HF.
 Reduces  Congestion  Excessive diuresis Intervention/Evaluation
intracranial CHILDREN: 0.25–1  Severe renal may produce  Monitor urinary output to
pressure by g/kg/dose; repeat to disease hypokalemia. ascertain therapeutic
decreasing maintain serum (anuria)  Fluid loss in excess of response.
blood viscosity, osmolality  Progressive electrolyte excretion  Monitor serum
thereby HF. may produce electrolytes, serum
increasing IOP REDUCTION hypernatremia, osmolality, ICP, renal
cerebral blood Route: IV hyperkalemia. function, LFT.
flow/oxygen Dosage:  Assess vital signs, skin
transport. ADULTS, ELDERLY: turgor, mucous
1.5–2 g/kg over 30–60 membranes. Weigh daily.
min 1–1.5 hrs prior to
 Monitor for signs of
surgery.
hypernatremia (confusion,
drowsiness, thirst, dry
CHILDREN: 1–2 g/kg
mouth, cold/clammy skin);
over 30–60 min 1–1.5
signs of hypokalemia
hrs prior to surgery.
(changes in muscle
strength, tremors, muscle
cramps, altered mental
status, cardiac
arrhythmias). Signs of
hyperkalemia include
colic, diarrhea, muscle
twitching followed by
weakness, paralysis,

arrhythmias.
Bisacodyl (Dulcolax) Expands intestinal ACUTE  Hypersensitivit  Persistent Assessment & Drug Effects
fluid volume by CONSTIPATION
y nausea/vomiting/diarrh
CLASSIFICATIONS: increasing epithelial  Evaluate periodically
permeability. unable  Obstruction or ea patient's need for
Gastrointestinal Agent; to be reabsorbed. Adult: severe  Muscle continued use of drug;
Stimulant Laxative Route: PO bisacodyl usually
impaction cramps/weakness
Dosage: produces 1 or 2 soft
Pregnancy Category: C 5–15 mg prn (max: 30  Symptoms  Irregular heartbeat formed stools daily.
mg for special of appendicitis  Dizziness  Monitor patients receiving
procedures) PR 10 mg  Fainting concomitant
or acute
prn anticoagulants.
surgical  Decreased urination Indiscriminate use of
Child: abdomen  Mental/mood changes laxatives results in
Route: PO  Vomiting (such as confusion) decreased absorption of
Dosage: vitamin K.
6 y, 5–10 mg prn PR  Rectal bleeding
2 y, 10 mg; <2 y, 5 mg Patient & Family Education
 Add high-fiber foods

slowly to regular diet to
avoid gas and diarrhea.
 Adequate fluid intake
includes at least 6–8
glasses/d.
 Do not breast feed while
taking this drug without
consulting physician.
Amiodarone  Inhibits VENTRICULAR  Hypersensitivity  Serious, potentially fatal Baseline Assessment
adrenergic ARRHYTHMIAS to amiodarone, pulmonary toxicity  Obtain baseline serum ALT,
CLASSIFICATION: stimulation; Route: PO: iodine. (alveolitis, pulmonary AST, alkaline phosphatase,
affects Na, K, Dosage:  Bradycardia- fibrosis ECG; pulmonary function
Pharmacotherapeutic: Ca channels;  ADULTS, induced  Pneumonitis, acute tests, CXR in pts with

Cardiac agent. prolongs action ELDERLY: Initially, syncope respiratory distress pulmonary disease.
potential and 400 mg q8–12h for (except in the syndrome) may begin  Assess B/P, apical pulse
Clinical: Antiarrhythmic. refractory period 1–2 wks, then presence of a with progressive immediately before drug is
Class III in myocardial decrease to 200– pacemaker), dyspnea and cough administered (if pulse is
tissue. 400 mg once daily.  Second- and with crackles, 60/min or less or systolic
 Decreases AV Maintenance: 200– third-degree AV decreased breath B/P is less than 90 mm Hg,
conduction and 400 mg/day. block (except in sounds, pleurisy, HF, or withhold medication,
sinus node presence of a hepatotoxicity. May contact physician).
function. Route: IV infusion pacemaker); worsen existing
Dosage:  severe sinus arrhythmias or produce Intervention/Evaluation
 ADULTS, node new arrhythmias.  Monitor for symptoms of
ELDERLY: dysfunction, pulmonary toxicity
Initially, 150 mg causing (progressively worsening
over 10 min, then marked sinus dyspnea, cough).
1 mg/min over 6 bradycardia;  Dosage should be
hrs; then 0.5 cardiogenic discontinued or reduced if
mg/min. shock toxicity occurs.
 Continue this rate  Assess pulse for quality,
over at least 18 rhythm, bradycardia.
hrs or until  Monitor ECG for cardiac
complete changes (e.g., widening of
transition or oral. QRS, prolongation of PR
 Breakthrough and QT intervals).
stable VT: 150 mg  Notify physician of any
in 100 mL D5W or significant interval changes.
NS over 10 min.  Assess for nausea, fatigue,
1–6 mg/mL. paresthesia, tremor.
 Monitor for signs of
RENAL IMPAIRMENT: hypothyroidism (periorbital
No Dose Adjustment edema, lethargy, pudgy
hands/feet, cool/pale skin,
HEPATIC vertigo, night cramps) and
IMPAIRMENT: hyperthyroidism (hot/ dry
No Dose Adjustment skin, bulging eyes

[exophthalmos], frequent
urination, eyelid edema,
weight loss, difficulty
breathing).
 Monitor serum ALT, AST,
alkaline phosphatase for
evidence of hepatic toxicity.
 Assess skin, cornea for
bluish discoloration in pts
who have been on drug
therapy longer than 2 mos.
 Monitor thyroid function test
results. If elevated hepatic
enzymes occur, dosage
reduction or discontinuation
is necessary.
 Monitor for therapeutic
serum level (0.5–2.5
mcg/mL). Toxic serum level
not established.
Patient/Family Teaching
 Protect against
photosensitivity reaction on
skin exposed to sunlight.
 Bluish skin discoloration
gradually disappears when
drug is discontinued.
 Report shortness of breath,
cough.
 Outpatients should monitor
pulse before taking
medication.

 Do not abruptly discontinue
medication.
 Compliance with therapy
regimen is essential to
control arrhythmias.
 Restrict salt, alcohol intake.
 Avoid grapefruit products.
 Recommend ophthalmic
exams q6mos.
 Report any vision changes,
signs/symptoms of cardiac
arrhythmias.
Omeprazole Inhibits hydrogen- ACTIVE DUODENAL  Hypersensitivity  Pancreatitis Intervention/Evaluation
potassium ULCER to omeprazole,  Hepatotoxicity  Evaluate for therapeutic
CLASSIFICATION adenosine Route: PO other proton  Interstitial nephritis response (relief of GI
triphosphatase Dosage: pump inhibitors. occur rarely. May symptoms). Question if GI
Pharmacotherapeutic: (H+/K+ ATP pump), ADULTS, ELDERLY:  Concomitant increase risk of C. discomfort, nausea,
BenziMidazole. an enzyme on the 20–40 mg once daily use with difficile infection diarrhea occurs.
surface of gastric for 4 wks. products
Clinical: Proton Pump parietal cells. containing Patient/Family Teaching
Inhibitor SYMPTOMATIC rilpivirine  Report headache, onset of
Therapeutic Effect: GERD black, tarry stools,
Increases gastric Route: PO: diarrhea, abdominal pain.
pH, reduces gastric Dosage:  Avoid alcohol.
acid production. ADULTS, ELDERLY,  Swallow capsules whole;
CHILDREN do not chew, crush,
WEIGHING 20 KG OR dissolve, or divide. • Take
MORE: 10 mg once before eating.
daily.
 May increase to
20 mg once daily
after 4–8 wks if
necessary.
 Discontinue once

asymptomatic for
8 wks.
10–19 KG: 10 mg/day

for up to 4 wks.
5–9 KG: 5 mg/day for

up to 4 wks.
EROSIVE
ESOPHAGITIS
Route: PO
Dosage:
ADULTS, ELDERLY,
CHILDREN
WEIGHING 20 KG OR
MORE: Treatment: 20–
40 mg once daily.
 Once symptoms
are controlled,
continue for at
least 8 wks.
CHILDREN underlined
– top prescribed drug
876 ondansetron O
1–16 YRS WEIGHING

10–19 KG: 10 mg/day.
WEIGHING5–9 KG: 5
mg/day.
CHILDREN 1–11 MOS


WEIGHING 10 KG OR
MORE: 10 mg/ day.
WEIGHING 5–9 KG: 5

mg/day. WEIGHING 3–
4 KG: 2.5 mg/day.
MAINTENANCE:
ADULTS, ELDERLY,
CHILDREN
WEIGHING 20 KG OR
MORE: 20 mg/day for
up to 12 mos (including
treatment period).
ASIAN PTS,
CHILDREN
WEIGHING 10–19 KG:
10 mg/day.
WEIGHING 5–9 KG: 5

mg/day. Pathologic
HYPERSECRETORY
CONDITIONS
Note: Doses more than
80 mg in divided
doses.
Route: PO
Dosage:
ADULTS, ELDERLY:
Initially, 40 mg twice
daily. May titrate up to

180 mg/day.
H. PYLORI
DUODENAL Ulcer
Route: PO
Dosage:
ADULTS, ELDERLY:
20 mg or 40 mg twice
daily as part of an
appropriate
combination regimen
with antibiotics (dose
depends on the
selected regimen).
GASTRIC ULCER
Route: PO:
Dosage:
ADULTS, ELDERLY:
20–40 mg once daily
for 8 wks.
OTC Use (Frequent

Heartburn)
Route: PO
Dosage:
ADULTS, ELDERLY:
20 mg/day for 14 days.
May repeat after 4 mos
if needed.
Dosage in
Renal/Hepatic

Impairment:
No dose adjustment.
Aspirin 80 mg Irreversibly inhibits ANALGESIA, FEVER  Hypersensitivity  High doses of aspirin Baseline Assessment
cyclo-oxygenase Route: PO: to NSAIDs. may produce GI  Do not give to children or
CLASSIFICATION enzyme, resulting in Dosage: ADULTS,  Pts with bleeding and/or gastric teenagers who have or
Pharmacotherapeutic: Non- a decreased ELDERLY, CHILDREN asthma rhinitis, mucosal lesions. have recently had viral
Steroidal Anti-Inflammatory formation of 12 YRS AND OLDER nasal polyps;  Dehydrated, febrile infections (increases risk
Drug (Nsaid). prostaglandin AND WEIGHING 50  Inherited or children may of Reye’s syndrome).
precursors. KG OR MORE: 325– acquired experience aspirin  Do not use if vinegar-like
Clinical: Anti-InflammatoRy, Irreversibly inhibits 650 mg q4–6h or 975 bleeding toxicity quickly. odor is noted (indicates
Antipyretic, Analgesic, Anti- formation of mg q6h prn or 500– disorders;  Reye’s syndrome, chemical breakdown).
Platelet. thromboxane, 1,000 mg q4–6h prn.  Use in children characterized by  Assess history of GI bleed,
resulting in inhibiting Maximum: 4 g/day. (younger than persistent vomiting, peptic ulcer disease, OTC
platelet aggregation. 16 yrs) for viral signs of brain use of products that may
Route: RECTAL: infections with dysfunction, may occur contain aspirin.
Therapeutic Effect: Dosage: 300– 600 mg or without fever in children taking  Assess type, location,
Reduces q4h prn. aspirin with recent viral duration of pain,
inflammatory infection (chickenpox, inflammation. Inspect
response, intensity INFANTS, CHILDREN common cold, or flu). appearance of affected
of pain; decreases WEIGHING LESS  Low-grade aspirin joints for immobility,
fever; inhibits THAN 50 KG: 10–15 toxicity characterized deformities, skin condition.
platelet aggregation. mg/ kg/dose q4–6h. by tinnitus, generalized  Therapeutic serum level
Maximum: 4 g/day or pruritus (may be for antiarthritic effect: 20–
90 mg/kg/day. severe), headache, 30 mg/ dL (toxicity occurs
dizziness, flushing, if level is greater than 30
REVASCULARIZATIO tachycardia, mg/dL).
N hyperventilation,
Route: PO diaphoresis, thirst. Intervention/Evaluation
Dosage:  Marked toxicity  Monitor urinary pH
ADULTS, ELDERLY: characterized by (sudden acidification, pH
80–325 mg/day. hyperthermia, from 6.5 to 5.5, may
restlessness, seizures, result in toxicity).
KAWASAKI’S abnormal breathing  Assess skin for evidence
DISEASE patterns, respiratory of ecchymosis. If given

Route:PO: failure, as antipyretic, assess
 Dosage: temperature directly
CHILDREN: 80–100 before and 1 hr after
mg/kg/day in giving medication.
divided doses q6h  Evaluate for therapeutic
up to 14 days (until response: relief of pain,
fever resolves for at stiffness, swelling;
least 48 hrs). increased joint mobility; A
 After fever resolves, underlined – top
1–5 mg/kg once prescribed drug 86
daily for at least 6–8 atazanavir reduced joint
wks. tenderness; improved
grip strength.
MI, STROKE (RISK Patient/Family Teaching
REDUCTION)  Do not, chew, crush,
Route: PO: dissolve, or divide
Dosage:ADULTS, enteric-coated tablets.
ELDERLY:(Durlaza):  Avoid alcohol, OTC
162.5 mg once daily. pain/cold products that
may contain aspirin.
DOSAGE IN  Report ringing of the ears
RENAL/HEPATIC or persistent abdominal
IMPAIRMENT GI pain, bleeding.
Avoid use in severe  Therapeutic anti-
impairment. inflammatory effect noted
in 1–3 wks. • Behavoral
changes, persistent
vomiting may be early
signs of Reye’s
syndrome; contact
physician.
Insulin  Acts via specific Note: Insulin Hypersensitivity to Severe hypoglycemia (due Baseline Assessment
receptor to requirements vary insulin, use during to hyperinsulinism) may  Obtain serum glucose

CLASSIFICATION regulate dramatically among episodes of occur with insulin level, Hgb A1c.
PHARMACOTHERAPEUTI metabolism of pts, requiring dosage hypoglycemia. overdose, decrease/delay  Discuss lifestyle to
C: Exogenous insulin. carbohydrates, adjustment. Afrezza: Chronic of food intake, excessive determine extent of
CLINICAL: Antidiabet protein, and lung disease. C exercise, pts with brittle learning, emotional needs.
fats. TYPE 1 DIABETES diabetes. Diabetic  If given IV, obtain serum
 Acts on liver, ketoacidosis may result chemistries (esp. serum
skeletal muscle,  Multiple daily from stress, illness, potassium).
and adipose injections, guided omission of insulin dose,
tissue. by glucose longterm poor insulin Intervention/Evaluation
 Liver: monitoring or control.  Assess for hypoglycemia
Stimulates continuous SQ (refer to pharmacokinetics
hepatic insulin infusions, is table for peak times and
glycogen standard of care. duration): cool, wet skin,
synthesis,  Usual initial dose: tremors, dizziness,
synthesis of 0.4–0.5 unit/kg/ day headache, anxiety,
fatty acids. in divided doses. tachycardia, numbness in
 Muscle:  Usual maintenance: mouth, hunger, diplopia.
Increases 0.4–1 units/kg/day  Assess sleeping pt for
protein, in divided doses. restlessness, diaphoresis.
glycogen Check for hyperglycemia:
synthesis. TYPE 2 DIABETES polyuria (excessive urine
 Adipose tissue: output), polyphagia
Stimulates  Initially, 4–6 units or (excessive food intake),
lipoproteins to 0.1–0.2 units/ kg polydipsia (excessive
provide free given before largest thirst), nausea/vomiting,
fatty acids, meal of day. dim vision, fatigue, deep
triglyceride  Adjust dose by 2 and rapid breathing
synthesis. units q3days to (Kussmaul respirations).
reach fasting  Be alert to conditions
Therapeutic Effect: glucose target altering glucose
Controls serum (while avoiding requirements: fever,
glucose levels hypoglycemia). trauma, increased
 General goal is to activity/stress, surgical
achieve Hgb A1c procedure.

less than 7% using
safe medication PATIENT/FAMILY
titration. TEACHING
 Dual therapy  Instruct on proper
(metformin and a technique for drug
second administration, testing of
antihyperglycemic glucose, signs/ symptoms
agent) is of hypoglycemia and
recommended in hyperglycemia.
pts who fail to  Diet and exercise are
achieve glycemic essential parts of
goals after 3 mos treatment; do not
with lifestyle skip/delay meals.
interventions and  Carry candy, sugar
metformin packets, other sugar
monotherapy. supplements for
immediate response to
 (Afrezza): Dosage hypoglycemia.
based on metabolic  Wear or carry medical
needs, blood alert identification.
glucose results,  Check with physician
glycemic goal when insulin demands
control. are altered (e.g., fever,
infection, trauma, stress,
heavy physical activity).
 Do not take other
medication without
consulting physician.
 Weight control, exercise,
hygiene (including foot
care), not smoking are
integral parts of therapy.
 Protect skin, limit sun
exposure.

 Inform dentist, physician,
surgeon of medication
before any treatment is
given.
Human Albumin
Nicardipine Inhibits calcium ion CHRONIC STABLE Hypersensitivity to Overdose produces Baseline Assessment
movement across ANGINA niCARdipine. confusion, slurred speech,  Concurrent therapy with
CLASSIFICATION cell membranes of Route: PO Advanced aortic drowsiness, marked sublingual nitroglycerin
PHARMACOTHERAPEUTI cardiac, vascular Dosage: stenosis hypotension, bradycardia. may be used for relief of
C: Calcium channel blocker. smooth muscle. ADULTS, ELDERLY: anginal pain.
Dihydropyridine. CLINICAL: Initially, 20 mg 3  Record onset, type (sharp,
Antianginal, Therapeutic Effect: times/day. dull, squeezing), radiation,
antihypertensive Relaxes coronary Range: 20–40 mg 3 location, intensity,
vascular smooth times/ day (allow at duration of anginal pain,
muscle. Causes least 3 days between precipitating factors
coronary dosage increases). (exertion, emotional
vasodilation, stress).
increasing HYPERTENSION Intervention/Evaluation
myocardial oxygen Route: PO  Monitor B/P, heart rate
delivery in angina. Dosage: during and following IV
ADULTS, ELDERLY: infusion.
Initially, 20 mg 3  Assess for peripheral
times/day. edema.
Range: 20–40 mg 3  Assess skin for facial
times/ day (allow at flushing, dermatitis,
least 3 days between rash.
dosage increases).  Question for asthenia,
headache.
ACUTE
 Monitor LFT results.
HYPERTENSION
 Assess ECG, pulse for
Route: IV
tachycardia.
Dosage:
ADULTS, ELDERLY  PATIENT/FAMILY
(GRADUAL B/P TEACHING • May take

DECREASE): without regard to food.
 Initially, 5 mg/hr. • Sustained-release
May increase by 2.5 capsule taken whole;
mg/hr q5–15min. do not break, chew,
 Maximum: 15 crush, or open. • Avoid
mg/hr. alcohol, grapefruit
 After B/P goal is products; limit
achieved, adjust caffeine. • Report if
dose to maintain anginal pain not
desired BP. relieved or if
palpitations, shortness
DOSAGE IN RENAL of breath, swelling,
IMPAIRMENT dizziness,
ADULTS, ELDERLY: constipation, nausea,
Route: PO hypotension occurs. •
Dosage: Avoid tasks requiring
Initially, give 20 mg motor skills, alertness
q8h (30 mg twice daily until response to drug
[sustained-release is established.
capsules]), then titrate.
Route: IV
No dose adjustment.
DOSAGE IN
HEPATIC
IMPAIRMENT
ADULTS, ELDERLY:
Route: PO
Dosage:
Initially, give 20 mg
twice daily, then titrate.
Route: IV
No dose adjustment.
Digoxin  HF: Inhibits LOADING DOSE Hypersensitivity to The most common early BASELINE ASSESSMENT

sodium/potassiu Route: PO: digoxin. manifestations of digoxin Assess apical pulse. If pulse
CLASSIFICATION m ATPase pump Dosage: Ventricular toxicity are GI is 60 or less/min (70 or
PHARMACOTHERAPEUTI in myocardial ADULTS, ELDERLY: fibrillation. disturbances (anorexia, less/min for children),
C: Cardiac glycoside. cells. 0.75–1.5 mg. Cautions: Renal nausea, vomiting), withhold drug, contact
CLINICAL: Antiarrhythmic.  Promotes impairment, sinus neurologic abnormalities physician. Blood samples are
calcium influx. CHILDREN 10 YRS nodal disease, (fatigue, headache, best taken 6–8 hrs after dose
 Supraventricular AND OLDER: 10–15 acute MI (within 6 depression, weakness, or just before next dose.
arrhythmias: mcg/kg. mos), second- or drowsiness, confusion, INTERVENTION/EVALUATIO
Suppresses AV CHILDREN 5–9 YRS: third-degree heart nightmares). Facial pain, N Monitor pulse for
node conduction. 20–35 mcg/ kg. block (unless personality change, ocular bradycardia, ECG for
functioning disturbances arrhythmias for 1–2 hrs after
Therapeutic Effect: CHILDREN 2–4 YRS: pacemaker), (photophobia, light flashes, administration (excessive
 HF: Increases 30–40 mcg/kg. concurrent use of halos around bright slowing of pulse may be first
contractility. strong inducers or objects, yellow or green clinical sign of toxicity).
 Supraventricula CHILDREN 1–23 inhibitors of P- color perception) may Assess for GI disturbances,
r arrhythmias: MOS: 35–60 mcg/kg. glycoprotein (e.g., occur. Sinus bradycardia, neurologic abnormalities
Increases cyclosporine), AV block, ventricular (signs of toxicity) q2–4h
effective NEONATES, FULL- hyperthyroidism, arrhythmias noted. during loading dose (daily
refractory TERM: 25–35 mcg/kg. hypothyroidism, Antidote: Digoxin immune during maintenance). Monitor
period/decrease hypokalemia, FAB (see Appendix J for serum potassium,
s conduction NEONATES, hypocalcemia dosage) magnesium, calcium, renal
velocity, PREMATURE: 20–30 function. Therapeutic serum
decreases mcg/kg. level: 0.8–2 ng/mL; toxic
ventricular heart Route: IV serum level: greater than 2
rate of fast atrial Dosage: ng/mL. PATIENT/FAMILY
arrhythmias. ADULTS, ELDERLY: TEACHING • Follow-up visits,
0.5–1 mg. blood tests are an important
CHILDREN 10 YRS part of therapy. • Follow
AND OLDER: 8–12 guidelines to take apical pulse
mcg/kg. and report pulse of 60 or
less/min (or as indicated by
CHILDREN 5–9 YRS: physician). • Wear/carry
15–30 mcg/kg. identification of digoxin
therapy and inform dentist,

CHILDREN 2–4 YRS: other physician of taking
25–35 mcg/kg. digoxin. • Do not increase or
skip doses. • Do not take
CHILDREN 1–23 OTC medications without
MOS: 30–50 mcg/kg. consulting physician. • Report
decreased appetite,
NEONATES, FULL- nausea/vomiting, diarrhea,
TERM: 20–30 mcg/kg. visual changes
NEONATES,
PREMATURE: 15–25
mcg/kg.
MAINTENANCE
DOSAGE
Route: PO IV/IM
Dosage:
Preterm infant: 5–7.5
mcg/kg 4–6 mcg/kg
Full-term infant: 8–10

mcg/kg 5–8 mcg/kg
1 mo–2 yrs: 10–15

mcg/kg 9–15 mcg/kg
2–5 yrs: 8–10 mcg/kg

6–9 mcg/kg
5–10 yrs: 5–10 mcg/kg

4–8 mcg/kg
Note: Avoid doses

greater than 0.125

mg/day in elderly due
to decreased renal
clearance.
HEART FAILURE
Route: PO
Dosage: ADULTS,
ELDERLY: 0.125–0.25
mg once daily.
ATRIAL
FIBRILLATION
Dosage:
ADULTS, ELDERLY:
Digitalizing dose (IV):
 Initially, 0.25–0.5
mg over several
minutes. May
repeat doses of
0.25 mg q6 hrs up
to a maximum of
1.5 mg over 24 hrs.
 Maintenance dose
(PO): 0.125–0.25
mg once daily.
Underlined – top
prescribed drug
338
dihydroergotamine
D
DOSAGE IN RENAL

IMPAIRMENT
Dosage adjustment is
based on creatinine
clearance.
Loading dose:
Decrease by 50% in
end-stage renal
disease.
Maintenance Dose
eGFR
Dosage 10–50 mL/min
25%–75% of usual
dose or q36h (0.0625
mg q24–36hrs)
Less than 10 mL/min
(HD, PD, CRRT) 10%–
25% of usual dose or
q48h (0.0625 mg q48h)
Atropine SO4
Classification:
Antiarrhythmias

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Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

College of Health Sciences

College of Health Sciences

Patient & Family

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2 y, 10 mg; <2 y, 5 mg Patient & Family Education

 Add high-fiber foods

College of Health Sciences

College of Health Sciences

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College of Health Sciences

10–19 KG: 10 mg/day

5–9 KG: 5 mg/day for

1–16 YRS WEIGHING

CHILDREN 1–11 MOS

College of Health Sciences

WEIGHING 5–9 KG: 5

WEIGHING 5–9 KG: 5

College of Health Sciences

OTC Use (Frequent

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Full-term infant: 8–10

1 mo–2 yrs: 10–15

2–5 yrs: 8–10 mcg/kg

5–10 yrs: 5–10 mcg/kg

Note: Avoid doses

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