DRUGS

ANTICOAGULANTS
HEPARIN

 Prevent Clotting, prophylaxis against postoperative venous thrombosis, Given IV or

subcutaneous
Side effect
 “Hemorrhage -Monitor vital signs, observe for increased heart rate,
decreased blood pressure, bruising, petechiae, hematomas, black tarry
stools, Monitor activated partial thromboplastin time (aPTT). Keep
value at 1.5 to 2 times the baseline, bleeding precautions”
 “Thrombocytopenia – Monitor platelet count periodically throughout
treatment, especially in the first month. Stop heparin if platelet
count is less than 100,000/mm3.”
 Hypersensitivity reactions (chills, fever, urticaria)- Administer a small test dose first
Antidote

 Protamine sulphate
 Durinf toxicity slow protamine IV
 CONTRAINDICATION
 “clients who have low platelet counts (thrombocytopenia) uncontrollable
bleeding, hemophilia,dissecting aneurysm,
 peptic ulcer disease, severe hypertension, hepatic or renal disease, or threatened abortion.
Should not be used during or following surgeries of the eye(s), brain, or spinal cord;
lumbar puncture; or regional anesthesia (Neurologic damage may happen from if
hematoma is formed during spinal or epidural anesthesia.”
ENOXAPARIN/FONDAPARINAUX INJ

 Do not expel the air bubble from the prefilled syringe, Do not aspirate. Do not
rub the site for 1 to 2 min after the injection. Rotate and record injection sites.

 Heparin mEd Effectiveness

Client aPTT levels of 60 to 80 seconds, No Blood cclot
WARFARIN

 Work against vitamin K, prevent synthesis of clotting factor,

anticoagulant
 SIDE EFFECT
 “Hemorrhage -Monitor vital signs, observe for increased heart
rate, decreased blood pressure, bruising, petechiae, hematomas,
black tarry stools, Monitor PT/INR, bleeding precautions”
 Hepatotoxic – Monitor liver enzymes. Assess for jaundice
ANTIDOTE-VIT K

 CONTRAINDICATION-
 Pregnancy, clients who have low platelet counts (thrombocytopenia)
uncontrollable bleeding, vitamin K deficiencies, liver disorders, and alcohol use disorder
due to the additive risk of bleeding, hemophilia,dissecting aneurysm, peptic ulcer disease,
severe hypertension, hepatic or renal disease, or threatened abortion. Should not be used
during or following surgeries of the eye(s), brain, or spinal cord; lumbar puncture; or
regional anesthesia (Neurologic damage may happen from if hematoma is formed during
spinal or epidural anesthesia.
WARF WITH OTHER MED

 Concurrent use of phenobarbital, carbamazepine , phenytoin, oral

contraceptives, and vitamin K decreases anticoagulant effects.

 WAR AND FOOD

 “Foods high in vitamin K, such as dark green leafy vegetables
(lettuce, cooked spinach), cabbage, broccoli, Brussels sprouts,
mayonnaise, canola, and soybean oil, may decrease anticoagulant
effects with excessive intake. Instruct clients to maintain a
consistent intake of vitamin K to avoid sudden fluctuations that
could affect the action of warfarin.”
Teaching

 Bleeding precautions, full therapeutic effect may not be achieved for 3 to 5

days. Avoid alcohol and over-the-counter meds, PT/INR montoring, use soft-bristle
toothbrush,use electric razor for shaving

 INR
 INR of 2 to 3 for treatment of acute myocardial infarction, atrial fibrillation,
pulmonary embolism, venous thrombosis, and/or tissue heart valves. Mechanical heart
valve need INR above 3
DABIGATRAN

 inhibiting thrombin, preventing a thrombus from developing

 SIDE EFFECT
 Bleeding (GI, GU, cranial and other sites) : Teach clients to
report manifestations of bleeding to provider, no antidote to
dabigatran is available
 GI discomfort, nausea, vomiting, esophageal reflux,ulcer formation
: Take dabigatran with food, antacids
RIVAROXABAN

 “Anticoagulation, Prevents DVT and pulmonary embolism in clients

who are undergoing total hip or knee arthroplasty surgery”
 ADVERSE EFFECT
 Bleeding (GI, GU, cranial retinal, epidural following removal of
epidural catheter) : Wait at least 18 hr following last dose to
remove an epidural catheter
 Elevated liver enzymes, Bleeding risk is increased when taking erythromycin,
diltiazem, verapamil, quinidine, amiodarone. Monitor hemoglobin, hematocrit, and liver
and kidney function periodically during treatment.
RIVAROXABAN therapeutic effect affected by

 Rifampin, carbamazepine, phenytoin, and St. John’s wort may decrease rivaroxaban levels
 ANTIPLATELETS COMMOM MED
 Aspirin (Acetyle Salicylic Acid), Abciximab, Eptifibatide, Tirofiban, Clopidogrel, Ticlopidine,
For imtermittent claudication (Pentoxifylline, Dipyridamole, Cilostazol)
 ASPIRIN SIDE EFFECT
 GI effects : Use enteric-coated tablets, take aspirin with food.
 Hemorrhagic stroke, bleeding, thrombocytopenia : Bbserve for weakness, dizziness, and
headache (?Stroke), Monitor bleeding time. Monitor for gastric bleed, bruising, petechiae, and
bleeding gums
 Tinnitus, hearing loss
ABCIXIMAB

 Hypotension and bradycardia, bleeding : Monitor vitals, bleeding precautions,

Apply pressure to cardiac catheter access site
 CLOPIDROGEL SIDE EFFECTS
 Bleeding, GI effects – diarrhea, dyspepsia, pain
 PENTOXIFYLLINE SIDE
 Dyspepsia, nausea, vomiting : Take with food.Do not crush or chew
medication. Monitor hydration if GI upset occurs
THROMBOLYTIC OVERVIEW

 Alteplase (tPA), Tenecteplase, Reteplase. Dissolve clots, Given IV

 NURSING CARE
 Giving within 3 hr is best, continuous hemodynamic monitoring, Obtain
baseline vital signs, platelet counts, hemoglobin (Hgb), hematocrit (Hct), aPTT, PT, INR,
and fibrinogen level. Do not mix any medications in IV with thrombolytic agents.
Minimize bruising or bleeding by limiting venipunctures and subcutaneous/intramuscular
injections. Hold direct pressure to injection site or ABG site for up to 30 min until any
oozing stops.
 DIURETICS

 FUROSEMIDE/BUMETAMIDE/TORSEMIDE
 LOOP S/E
 Dehydration, hyponatremia, hypochloremia, hyperuricemia : Assess/monitor clients for signs of
dehydration: dry mouth, increased thirst, minimal urine output, and weight loss. Monitor electrolytes/gout.
If signs of headache and/or chest, calf, or pelvic pain- notify doctor (may be signs of thrombosis or
embolism)
 Hypotension : Instruct clients about signs of postural hypotension (lightheadedness). Avoid sudden changes
of position and arise slowly from lying down or sitting
 Ototoxicity : notify the provider of tinnitus, Avoid use with other ototoxic medications, such as gentamicin
 Hypokalemia : Monitor clients’ cardiac status and potassium levels. Teach clients to consume high-
potassium foods (e.g., bananas, potatoes, dried fruits, nuts, spinach, and citrus fruit).
LOOP- MED INTERACTION

 Digoxin toxicity (ventricular dysrhythmias) can occur in the presence of hypokalemia : Monitor the
client’s cardiac status and potassium client’s cardiac status and potassium, Administer potassium
supplements
 Lithium carbonate serum levels can increase, which may lead to toxicity,
 NSG CONSIDERATION
 Monitor the client’s blood pressure and I&O. Avoid administering the
medication late in the day to prevent nocturia. Instruct clients with
diabetes to monitor for elevated blood glucose levels as hyperglycemia
can occur with loop diuretics. Instruct clients to observe for signs of
low magnesium levels (e.g., weakness, muscle twitching, and tremors as
hypomagnesimea can occur.
THIAZIDE

 Hydrochlorothiazide, Chlorothiazide, Methyclothiazide, Indapamide,

Chlorthalidone, Metolazone
 ADVERSE EFFECT
 Dehydration, hyponatremia, hypochloremia : Assess/monitor clients for signs
of dehydration: dry mouth, increased thirst, minimal urine output, and weight
loss. Monitor electrolytes. If signs of headache and/or chest, calf, or
pelvic pain- notify doctor (may be signs of thrombosis or embolism)
 Hypokalemia : Monitor clients’ cardiac status and potassium levels. Teach
clients to consume high-potassium foods (e.g., bananas, potatoes, dried
fruits, nuts, spinach, and citrus fruit).
 Hyperglycemia :Monitor clients for an increase in blood glucose levels.
K SPARING

 Spironolactone, Triamterene, Amiloride :block the action of

aldosterone (sodium and water retention), which results in
potassium retention and the secretion of sodium and water.
 S/E
 Hyperkalemia :Monitor potassium level. Initiate cardiac
monitoring, restrict potassium in diet, insulin injections if
needed, Avoid use of ACE inhibitors/angiotensin receptor blockers
– as they increase potassium levels.
 Endocrine effects (impotence in male clients; irregularities of menstrual cycle in female
clients)
OSMOTIC - MANNITOL

 Reduce intracranial pressure and intraocular pressure by drawing

fluid back into the vascular and extravascular space
 ADVERSE EFFECT
 Heart failure, pulmonary edema, Kidney failure, Fluid and
electrolyte imbalances
ANTIHYPERTENSIVES

 ACE INHIBITORS
 “Pril” meds : Captopril, Enalapril, Fosinopril, Lisinopril, Ramipril
 S/E
 First-dose orthostatic hypotension : Start treatment with a low dosage of the
medication, stop other diuretics for 2-3 days if needed
 Cough : The medication should be discontinued
 Hyperkalemia, kidney failure: Monitor potassium levels. Avoid the use of salt
substitutes containing potassium,
 Angioedema -swelling of the tongue and oral pharynx : Stop med. Treat severe
effects with subcutaneous injection of epinephrine
 Captopril S/E-Rash, dysgeusia (change in taste), Neutropenia
ACE & FOOD

 Captopril and moexipril should be taken at least 1 hr before meal.

Other ACE inhibitors can be taken with or without food

 ANGIOTENSIN II RECEPTOR BLOCKER(ARBs)

 “Sartan” drugs: Losartan, Valsartan, Olmesartan
 S/E-Angioedema -swelling of the tongue and oral pharynx : Stop
med. Treat severe effects with subcutaneous injection of
epinephrine
ALDOSTERONE ANTAGONIST:
EPLERENONE, SPIRONOLACTONE

 Reduce blood volume by blocking aldosterone receptors in the kidney,

promoting excretion of sodium and water
 ALDOSTERONE ANTAGONIST S/E
 Hyperkalemia, hyponatremia, Flulike manifestations, Dizziness
 CONTRAINDICATION
 Clients who have high potassium levels, kidney impairment, liver
impairemnet, and type 2 diabetes mellitus with albuminuria.
DIRECT RENIN INHIBITORS

Aliskiren – inhibit production of angiotensin

S/E
Allergic reaction: angioedema, Hyperkalemia, Diarrhea
FOOD INTERACTION- High-fat meals interfere with absorption
CA CHANNEL BLOCKERS-
VASODILATATION
 Nifedipine, Verapamil, Diltiazem, Amlodipine, Felodipine, Nicardipine
 Reflex tachycardia, Peripheral edema, Acute toxicity
 Verapamil, Diltiazem S/E
Orthostatic hypotension, Peripheral edema, Constipation, bradycardia,
heart failure, Dysrhythmias, Acute toxicity
Nifedipine CONTRAINDICATION
Acute MI, unstable angina, aortic stenosis, shock, and intestinal
obstruction
Verapamil CONTRAINDICATION
Heart block, digoxin toxicity, severe heart failure, and during
lactation
CA CHANNAL BLOCKERS- FOOD
No grapefruit juice
ALPHA ADRENERGIC BLOCKERS

 prazosin, doxazosin, terazosin : Venous and arterial dilation,

Smooth muscle relaxation
 prazosin and terazosin
 used to decrease manifestations of benign prostatic hyperplasia
(BPH),
 S/E
 First-dose orthostatic hypotension : Start treatment with a low
dosage of the medication, give at night, fall precautions
CLONIDINE

 CNS Action – reduces blood pressure

 OTHER USES THAN THAN HTN
 Severe cancer pain, Migraine headache, Flushing from menopause,
Management of ADHD and Tourette syndrome, Management of withdrawal
symptoms from alcohol, tobacco, and opioids
 S/E
 Drowsiness and sedation, Dry mouth, Rebound hypertension
 NSG NOTES
 Avoid use during lactation, Dont give with other CNS depressants, ake larger dose at bedtime
to decrease the occurrence of daytime sleepiness, Transdermal patches are applied every seven days
BETA ADRENERGIC BLOCKERS

 “LOL” medications: Metoprolol, Atenolol, Esmolol, Propranolol,

Nadolol, Carvedilol, Labetalol
 : Metoprolol & Propranolol S/E
 Bradycardia :Monitor the client’s pulse. If below 60/min, hold medication and notify the
provider. It can mask tachycardia, an early sign of hypoglycemia, so careful use in DM clients
 Decreased cardiac output, AV block :Start with low dose and titrated
to the desired level, observe for signs of worsening heart failure,
Obtain a baseline ECG and monitor
 Orthostatic hypotension: Sit or lie down if experiencing dizziness or faintness, avoid
sudden changes of position and rise slowly.
Propranolol SPECIFIC S/E

 Bronchoconstriction: Avoid in clients who have asthma

 BETA BLOCKERS CONTRAINDICATION
 Dont use for clients who have AV block and sinus bradycardia, clients who have asthma,
bronchospasm,
 HYPERTENSIVE CRISIS MEDICATIONS
 Nitroglycerin, Nitroprusside, Nicardipine
 Nitroprusside s/e- Cyanide poisoning, Thiocyanate toxicity: Headache, and drowsiness, and
may lead to cardiac arrest: Slower infusion, thiosulfate administration, hepatotoxicity
 Nitroprusside nsg administration
 Should not be administered in the same infusion as any other medication. Protect IV
container and tubing from light. Solution may be light brown in color. Discrad if any
other color, Discard medication after 24 hr, Vitals and ECG monitoring
CARDIAC DRUGS- DIGOXIN

 Increases force of myocardial contraction, decreases heart rate

 S/E
 HAD DNV : Halo (visual disturbances), Anorexia, Dizziness, Diarhea,
Nausea, Vomiting
 ADVERSE REACTION
 Dysrhythmias, Cardiac Toxicity: Monitor pulse rate, Therapeutic serum
levels 0.5 to 2.0 ng/mL, Avoid hypokalemia,
 NSG NOTES
 Check pulse rate and rhythm before administration of digoxin and record. Hold if less than 60/min
in an adult, less than 70/min in children, and less than 90/min in infants. Observe for manifestations of
hypokalemia, such as muscle weakness,
DIGOXIN TOXICITY INTERVENTION

 Stop Digoxin and potassium-sparing medication,Maintain normal K level, Treat

Dysrhythmia with lidocaine, Treat bradycardia with atropine.For excessive
overdose, activated charcoal, cholestyramine, or Digibind to bind and prevent
further absorption
 ADRENERGIC AGONIST FOR CHF
 Epinephrine, Dopamine, Dobutamine, Terbutaline : Vasoconstriction and increases
BP, HR, Bronchodialtion and makes breathing easier
 S/E
 hypertensive crisis, dysrhythmias
 NSG NOTES
 administered IV by continuous infusion (IV pump), Dosage is titrated based on
blood pressure, Dopamine Extravasation can lead to necrosis,
NITROGLYCERINE

 Dilates veins and decreases venous return, decreases cardiac oxygen demand,
reduces coronary artery spasm
 ADVERSE REACTION
 Headache, Orthostatic hypotension, Reflex tachycardia, Tolerance
 NSG NOTES
 Vital signs, Ask about use of sildenafil [Viagra], tadalafil [Cialis], vardenafil (might result in severe
hypotension), S/L and spray- rapid-acting give at the first sign of chest pain,
 Take first tab at onset of pain, if pain not relived in 5 mts, call
emergency and take second tab, if pain persists after 5 more minutes, take 3rd
tab. Dont take more than 3. Place the tablet under the tongue and allow it to
dissolve, Tablets should be stored in original bottles, and in a cool, dark
place.
TRANSDERMAL NTG PATCH

 Take first tab at onset of pain, if pain not relived in 5 mts, call emergency and
take second tab, if pain persists after 5 more minutes, take 3rd tab. Dont take more than 3.
Place the tablet under the tongue and allow it to dissolve, Tablets should be stored in
original bottles, and in a cool, dark place.
 NTG OINTMENT
 Slow onset, Remove the prior dose before a new dose is applied,
Apply to a clean, hairless area of the body, and cover with clear
plastic wrap, Avoid touching ointment with the hands
RANOLAZINE-ANTIANGINAL

 Lowers cardiac oxygen demand, improves exercise tolerance and

decreases pain
 ADVERSE EFFECT
 QT prolongation,Elevated blood pressure. Contraindicated in clients who have
liver dysfunction
ANTIDYSARHYTHMIA MEDICATION

 Sodium channel blockers (Procainamide, Lidocaine, Propafenone) , Potassium channel blockers

(Amiodarone), Calcium channel blockers (Verapamil), Beta-adrenergic blockers (Propranolol),
Adenosine, Digoxin
 ADENOSINE
 Decrease electrical conduction through AV node
 PROCAINAMIDE S/E
 Hypotension, Systemic lupus syndrome (fever, painful and swollen joints,
butterfly-shaped rash on face), Neutropenia and thrombocytopenia,
Cardiotoxicity (Widened QRS, increased QT, PR)
 THERAPEUTIC PROCAINBAMIDE LEVEL
 4-8MCG/ML
LIDOCAINE ADVERSE EFFECT

 CNS effects (drowsiness, altered mental status, paresthesias, seizures),

Respiratory arrest
 PROPAFENONE ADVERSE EFFECT
 Bradycardia, heart failure, dizziness
 Hypotension, bradycardia, heart failure, fatigue
 Amiodarone adverse effect
 Pulmonary toxicity (adverse effects may continue even after stopping med,
Obtain baseline chest x-ray and pulmonary function tests), Sinus bradycardia
and AV block (Monitor blood pressure, ECG, S/S of Heart failure) , Visual
disturbances (photophobia, blurred vision, may lead to blindness), liver and
thyroid dysfunction; GI disturbances, CNS effects. Phlebitis with IV
administration
VERAMPAMIL ADVERSE EFFECT

 Bradycardia, hypotension, heart failure (report s/s) ,constipation,

orthostatic hypotension (change positions slowly)
 ADENOSINE S/E
 hypotension, dyspnea, bradycardia, flushing of face
 NOTES
 Very short half-life (Give fast IV, flushed with saline after, give
through central line-close to heart if possible)
 LIDOCAINE NOTES
 IV start with a loading dose, maintenance dose of 1 to 4 mg/min, dont use for no more than
24 hr
CHOLESTROL LOWERING MED

 “Statin”: Atorvastatin, Simvastatin, Lovastatin, Pravastatin,

Rosuvastatin, Fluvastatin :
 ADVERSE EFFECT
 Hepatotoxicity (Monitor liver function tests),
Myopathy/Rhabdomyolysis (Monitor CK levels)
 NURSE NOTES
 Notify Muscle aches, pain, and tenderness, observe for indications
of liver dysfunction (anorexia, vomiting, nausea, jaundice). Teach
to take in the evening, avoid grapefruit juice
EZETIMIDE

 Inhibits absorption of cholesterol

 S/E
 Hepatiis and Myopathy
 COLESEVELAM & COLESTIPOL
 Bile Acid Sequestrants – decrease in LDL cholesterol
 Bile Acid Sequestrants S/E
 Constipation (increase the intake of high-fiber food and oral fluids),
Reduced absorption of other meds (take other medications 4 hr before)
 COLESTIPOL & FOOD
 Colestipol – Give 30 min before a meal. If powder form – use an adequate amount
of fluid to dissolve to avoid impaction of the esophagus
NIACIN/NICOTINIC ACID

 decrease in LDL cholesterol and triglyceride levels

 S/E
 GI distress, Facial flushing, Hyperglycemia, Hepatotoxicity,
Hyperuricemia
 GEMFIBROZIL/FENOFIBRATE
 Decrease in triglyceride levels, Increase in HDL levels
 S/E
 GI distress (take medication 30 min prior to breakfast and dinner)
Gallstones (watch for RUQ pain, fat intolerance, bloating), Myopathy
(Monitor for muscle aches, pain, and tenderness,CK level), Hepatotoxicity
PSYCHIATRY MED

 BENZODIAZEPINE SEDATIVE HYPNOTIC ANXIOLYTICS

 Diazepam, Alprazolam, Chlordiazepoxide, Clorazepate, Oxazepam,
Clonazepam
 OTHER USES
 Seizure disorders, Insomnia, Muscle spasm, Alcohol withdrawal, Induction of
anesthesia
 S/E
 CNS depression (avoid hazardous activities), Anterograde amnesia
(difficulty recalling events that occur after dosing), Acute
toxicity, paradoxical respnse, risk for dependence/withdrawal
BENZODIAZEPINE ORAL TAB TOXICITY

 CONFUSION ,LETHARGY DROWSINESS

 ACTION DURING TOXICITY
 Gastric lavage, administration of activated charcoal or saline
 BENZODIAZEPINE IV (RESP DEPRESSION,SEVERE HYPOTENSION,OR
CARDIAC ARREST)TOXICITY ACTION
 Administer flumazenil, Monitor the client’s vital signs, maintain
patent airway, Fluids, resuscitation equipment
DIAZEPAM CONTRAINDICATION

 clients who have sleep apnea, respiratory depression and/or glaucoma. Careful with
client who have liver disease and/or a history of mental illness or a substance use
disorder.
 BUSPIRONE
 Nonbarbiturate Anxiolytic, Dependency is much less likely. No sedation, Might take upto
3 to 6 weeks for the full benefit, not recommended for women who are breastfeeding
 BUSPIRONE CONTRAINDICATION
 contraindicated for concurrent use with MAOI antidepressants or for 14 days after MAOIs
are discontinued – Hypertensive crisis may result
 BUSPIRONE & FOOD
 Avoid the use of antimicrobial agents Erythromycin, ketoconazole, Herbal St. John’s
wort and grapefruit juice – increases the effect on Buspirone
Selective serotonin reuptake inhibitors

 Sertraline , Paroxetine, Escitalopram, Citalopram, Fluoxetine, Fluvoxamine

(SPEC FF)
 SSRI & SNERI
Venlafaxine
SSRI – Early adverse effects (first few days/week)
Nausea, diaphoresis, tremor, fatigue, drowsiness : Instruct clients to take
the medication as prescribed, Advise clients that these effects should soon
subside.
SSRI Later adverse effects (after 5 to 6 weeks of therapy)
sexual dysfunction, weight gain, GI bleeding, Hyponatremia, Bruxism (grinding
and clenching of teeth, usually during sleep)
Serotonin Syndrome

 Group of symptoms which can appear from 2 to 72 hours after

starting SSRI treatment – serious/Lethal. MAOIs, TCAs, and St.
John’s wort increase risk of serotonin syndrome
 Serotonin Syndrome Symptoms
 HATRED FACT: Hallucinations, Agitation, Tremors, Reflex – hyper,
Easily distracted, Diaphoresis, Fever, Anxiety, Confusion,
Tachycardia
 SSRI and pregnancy
 Fluoxetine and paroxetine increase the risk of birth defects. SSRI not
recommended in later trimester of pregnancy (pulmonary HTN in newborn)
Tricyclic Antidepressants

 Tricyclic Antidepressants Side Effects

 Orthostatic hypotension, Anticholinergic effects (Dry mouth,
Blurred vision, Photophobia, Urinary hesitancy or retention,
Constipation, Tachycardia) ; Sedation, Excessive sweating
 Tricyclic Antidepressants – Client Teaching to minimize
anticholinergic effects
Chewing sugarless gum, Sipping on water, Wearing sunglasses
when outdoors, Eating foods high in fiber, Participating in regular
exercise, Increasing fluid intake to at least 2 to 3 L a day from
beverages, Voiding just before taking medication
Monoamine Oxidase Inhibitors
(MAOIs) – Antidepressent

 Phenelzine, Isocarboxazid, Tranylcypromine, Selegiline

 MAOIs Side effect
 CNS stimulation (anxiety, agitation, mania), Orthostatic hypotension,
Hypertensive crisis (with tyramine rich food),
 MAOI precautions -Hypertensive crisis (tyramine food), Dont give to
clients on SSRI, Use cautiously in clients who have diabetes and seizure
disorders or those taking TCAs, Transdermal selegiline is contraindicated
for clients taking carbamazepine (increases blood level of MAOI)
 Tyramine-rich foods to Avoid With MAOIs -aged cheese, pepperoni, salami,
avocados, figs, bananas, smoked fish, protein dietary supplements, soups,
soy sauce, beers, wine
MAOI Nurse Notes

 Full therapeutic effects may take 2 to 3 months, Suicide watch –

Antidepressant medications can increase the client’s risk for suicide, Avoid
Tyramine rich food
 Lithium Carbonate
 Mood Stabilizer, Also used for Alcohol use disorder, Bulimia nervosa,
Psychotic disorders
 Lithium Less than 1.5 mEq/L -Diarrhea, nausea, vomiting,thirst, polyuria,
muscle weakness, fine hand tremor,slurred speech : Advise clients to withhold
medication and notify
 Lithium Level : 1.5 to 2.0 mEq/L -Ongoing gastrointestinal distress,
including nausea, vomiting, and diarrhea; mental confusion; poor
coordination;coarse tremors : withhold medication and notify
Lithium Severe toxicity : 2.0 to
2.5 mEq/L

 Extreme polyuria of dilute urine, tinnitus, blurred vision,

ataxia, seizures, severe hypotension leading to coma and possibly
death from respiratory complications
 Lithium Level Greater than 2.5 mEq/L -coma and death
 Lithium Nurse Notes
Monitor plasma lithium levels – Maintenance level range is
between 0.4 to 1.0 mEq/L. Maintain adequate fluid and sodium intake –
Hyponatremia and dehydration increases toxic levels
Carbamazepine, Valproic acid,
Lamotrigine (mood stabilizing
antiepileptic drugs)
 Treatment of bipolar disorder
 Carbamazepine Side effect
 1 -CNS effects (nystagmus, double vision, vertigo staggering gait,
headache) – Start with low dose, Administer dose at bedtime.
 2. Blood dyscrasias (leukopenia, anemia, thrombocytopenia) – Have
client’s baseline CBC and platelets, ongoing monitoring, bruising and
bleeding gum?, sore throat, fatigue, or other indications of infection?
 3. Teratogenesis (dont use in pregnancy), Increases ADH – leading to
fluid overload (watch for signs of hypervolumea, monitor sodium), Skin
disorders (dermatitis, rash,Stevens-Johnson syndrome) – wear sunscreen
Valporic Acid Side Effect

 Hepatotoxicity, Pancreatitis, Thrombocytopenia

 Conventional/ First Generation – Antipsychotic medications
 Control mainly the positive symptoms (hallucinations, delusions, and
bizarre behavior of psychotic disorders)
 Second-generation (atypical) antipsychotic agents -Relief of both
the positive and negative symptoms of the disease, Decreasee
depression, anxiety and suicidal behaviors. Improve memory, Less
extrapyramidal and anticholinergic side effects
 Conventional/ First Generation – Antipsychotic example
 Chlorpromazine, Haloperidol, Fluphenazine, Thiothixene, Perphenazine
Conventional/ First Generation –
Antipsychotic Adverse Effects

 Extrapyramidal side effects (Acute dystonia, Parkinsonism, Akathisia,

Tardive dyskinesia) , Neuroleptic malignant syndrome, Anticholinergic
effects, Neuroendocrine effects (gynecomastia, galactorrhea, menustral
abnormalities), Seizures, Skin (photosensitivity, dermatitis),
orthostatic hypotension, sedation, sexual dysfunction, agranulocytosis,
Severe dysrhythmias
 Extrapyramidal side effects
 Acute dystonia (severe spasms of tongue,neck, face, or back)
Parkinsonism (bradykinesia, rigidity, shuffling gait,
drooling,tremor) , Akathisia (unable to stand or sit still) , Tardive
dyskinesia (involuntary movements of the arms, legs, trunk or tongue
and face like lip-smacking)
Neuroleptic malignant syndrome S/S

 high-grade fever, blood pressure fluctuations, dysrhythmias,

muscle rigidity, and change in level of consciousness developing
into coma.
 Stop antipsychotic medication, vitals, cooling blanket,
antipyretics, increase fluids, diazepam to control anxiety,
dantrolene to induce muscle relaxation
 Second-generation (atypical) antipsychotic agents
 Risperidone, Olanzapine, Quetiapine, Aripiprazole, Ziprasidone,
Clozapine, Lurasidone,Paliperidone,Iloperidone
Second-generation (atypical)
antipsychotic agents Adverse
Effect
 New onset of diabetes mellitus, Weight gain, CV disorder (HTN,
high cholestrol, orthostatic), Anticholinergic effects, CNS
(agitation, dizziness, sedation, sleep problem), Mild EPS (tremor)
 Quetiapine specific side effect -cataracts – baseline and regular
eye exam
 Ziprasidone specifc side effect -ECG changes and QT prolongation
may lead to torsades de pointes
 Clozapine specific side effect -Agranulocytosis – Obtain baseline
WBC and monitor weekly, Monitor for indications of infection
(fever, sore throat, lesions in mouth), and notify
Disulfiram – Alcohol withdrawal –
Abstinence Maintenance

 Disulfiram used concurrently with alcohol will cause acetaldehyde

syndrome to occur (nausea, vomiting, weakness, sweating,
palpitations, and hypotension). Acetaldehyde syndrome can progress
to respiratory depression, cardiovascular suppression, seizures,
and death.
 Disulfiram Nurse Notes
 Advise clients to avoid any products that contain alcohol (cough
syrups, mouthwash,aftershave lotion), monitor LFT, wear a medical
alert bracelet, participate in a 12-step self-help program
Nicotine patch

 apply a nicotine patch to an area of clean, dry skin each day,

Remove the patch prior to MRI scan, and replace when the scan is
completed
 Varenicline -Reduces cravings for nicotine
 Varenicline Nurse Notes -Take medication after a meal, Monitor BP
and blood sugar, notify the provider if nausea, vomiting,
insomnia, new-onset depression or suicidal thoughts occur
Neuro Med

 Anticholinesterase (neostigmine, Pyridostigmine) -To treat

myasthenia gravis, Alzheimer’s disease, and Parkinson’s disease
 Anticholinesterase Adverse Effect - Increased gastrointestinal
motility, increased GI secretions, bradycardia, and urinary
urgency, Cholinergic crisis
 Med for neostigmine toxicity -Atropine
 Levodopa /carbidopa (Parkinson’s disease) Adverse Effects -GI
(N/V), Dyskinesias (head bobbing, tics, tremor), Orthostatic
hypotension, Cardiovascular effects (tachycardia, palpitations,
irregular heartbeat), Psychosis, Discoloration of sweat/urine,
Levodopa /carbidopa Nurse Notes

 Avoid administering with foods high in protein/pyridoxine, Monitor

the client’s vital signs, ECG
 Antiepileptic Medicine-
Phenobarbital,Primidone,Phenytoin,Carbamazepine,Valproic
Acid,Lamotrigine,Levetiracetam,Topiramate,
Oxcarbazepine,Pregabalin,Gabapentin
 Barbiturates: phenobarbital, primidone Adverse Effect -CNS effects
: drowsiness,sedation, depression, confusion and anxiety. In
children, irritability and hyperactivity. Avoid hazardous
activities/alcohol
Barburates Toxicity

 Signs : nystagmus, ataxia, respiratory depression, coma, pinpoint pupils,

hypotension, death : Stop medication, take vitals, give oxygen/emergency
care
 Phenobarbital, primidone, phenytoin special points -They decreases
effectiveness of warfarin (check PT/INR). They decreases effectiveness of
oral contraceptives (use another form of contraception)
 Phenytoin Adverse Effects -CNS effects (nystagmus, sedation, ataxia,double
vision, cognitive impairment). Gingival hyperplasia (softening and
overgrowth of gum tissue, tenderness, and bleeding gums), Skin rash (Stop
medication if rash develops), Teratogenic, Cardiovascular effects
(dysrhythmias, hypotension), Endocrine and other effects (coarsening of
facial features, hirsutism, and interference with vitamin D metabolism)
Carbamazepine Adverse Effects
(also discussed in Psych med)

 CNS effects (nystagmus, double vision, vertigo, staggering gait, headache) , Associated with birth defects, Blood dyscrasias
(leukopenia, anemia, thrombocytopenia), promotes secretion of ADH, Skin disorders (dermatitis, rash, Stevens‑Johnson
syndrome), decrease in the effects of oral contraceptives and warfarin
 Lamotrigine Adverse Effect
 1 CNS effects (dizziness, somnolence, aphasia, double or blurred vision, headache, nausea or
vomiting, depression), Teratogenic effects
 2. Skin: Stevens-Johnson syndrome and toxic epidermal necrolysis: Discontinue medication if
there is a severe reaction.
 Lamotrigine CNS Effect Nurse Notes -Monitor for manifestations of aseptic meningitis
((headache, fever, stiff neck, nausea, vomiting, rash,sensitivity to light), Monitor for
suicidal ideation.
 Topiramate Adverse Effects-CNS effects (dizziness, somnolence, ataxia, nervousness, diplopia,
confusion, impaired cognitive function), Teratogenic effects, Metabolic acidosis (monitor Serum
bicarbonate, Report hyperventilation, fatigue, anorexia). Angle-closure glaucoma (eye exam)
Hematology/Oncology

 Erythropoietin
 Erythropoietin Complications -Hypertension due to to elevations in
hematocrit, Risk for a thrombotic event (MI/Stroke/PE/DVT)
 Erythropoietin Nurse Notes -Monitor Hgb levels and blood pressure,
Donot give for high Hb, Do not agitate the vial of medication (single
dose), Ensure a normal iron level
 Leukopoietic growth factors -Filgrastim, Pegfilgrastim – stimulate the
bone marrow to increase production of neutrophils.
 Leukopoietic growth factors adverse effect -Bone pain, Leukocytosis
(Monitor CBC), Splenomegaly and rupture (Evaluate reports of left upper
quadrant abdominal pain or shoulder tip pain)
Oprelvekin

 Increases the production of platelets. Decreases thrombocytopenia and the need for
platelet transfusions.
 Oprelvekin Adverse Effects -Fluid retention (peripheral edema, dyspnea on exertion),
Cardiac dysrhythmias, eye problems
 Oprelvekin expected outcome -platelet count greater than 50,000/mm3.
 Methotrexate -Kill cancer cells
 Methotrexate side effect - Bone marrow suppression, GI discomfort, Mucositis,
Reproductive toxicity, Renal damage (hyperuricemia)
 Methotrexate side effect Management -Monitor WBC, absolute neutrophil count,
platelet count, Hgb, and Hct, bleeding, frequent oral hygiene using soft
toothbrushes and avoid alcohol mouthwashes, Monitor kidney function, BUN,
creatinine, and I&O, adequate fluid intake, Administer allopurinol if uric acid
level is elevated.
Cytarabine
 Inhibit cancer cell growth
 Cytarabine Side Effect -Bone marrow suppression,Liver disease (Monitor liver
enzymes. Monitor for indications of jaundice), May reduce digoxin level
(Monitor digoxin level and ECG), Neurotoxicity (nystagmus), Pulmonary edema,
Arachnoiditis (nausea, headache,fever – spinal cord membraine inflamation)
 Mercaptopurine- Chemo
 Bone marrow suppression,Liver disease (Monitor liver enzymes. Monitor for indications of
jaundice), Mucositis, Reproductive toxicity,
 Methotrexate special note
 Administer with leucovorin rescue to reduce toxicity to healthy cells. Take
the medication on an empty stomach. Protect the skin from sunlight. Female
clients to use birth control during and for 6 months after completing
treatment. Salicylates, other NSAIDs, sulfonamides,penicillin, and
tetracyclines may cause methotrexate toxicity. Avoid folic acid supplements
or vitamins containing folic acid (decreases absorption)
Doxorubicin (Chemo med) Side
Effect

 Bone marrow suppression, GI manifestations, extravasations, Alopecia,

Acute cardiac toxicity, Cardiomyopathy, heart failure (Monitor ECG and
echocardiogram) Red coloration to urine and sweat (not harmful)
 Vincristine -Used in combination with other chemo drugs
 Vincristine Adverse Effects -Peripheral neuropathy (weakness,
paresthesia), extravasations of vesicants (Use a central line for
infusion), Alopecia, Vincristine may reduce effects of digoxin and
phenytoin.
 Paclitaxel -Chemo drug – stop cell division
 Paclitaxel Side Effect -Bone marrow suppression, Cardiac (Bradycardia,
heart block, MI), Alopecia
Cyclophosphamide

 Chemo drug – Kills rapid growing cells

 Cyclophosphamide Adverse effects -Bone marrow suppression, GI
discomfort, Acute hemorrhagic cystitis, Alopecia
 Acute hemorrhagic cystitis Nurse Notes -Increase fluids (3 L
daily), Monitor for blood in urine, Mesna -uroprotectant agent-may
be given
 Carmustine -Chemo drug
 Carmustine Adverse Effect -Pulmonary fibrosis (monitor lung
function) , Bone marrow suppression, GI discomfort, Liver and
kidney toxicity
Cisplatin-Chemo drug

 Cisplatin Adverse Effects -Bone marrow suppression, GI discomfort, Renal

toxicity, Hearing loss (Monitor for tinnitus)
 Asparaginase -Kills cancer – leukemia
 Asparaginase Adverse Effects -Hypersensitivity reaction (Test dose,
Premedicate, Monitor for wheezing and/or rash), CNS effects, Liver and pancreas
toxicity, Renal Toxicity, GI discomfort, Decreased effect of antidiabetic
medication
 Hydroxyurea -Chemo drug – Bone marrow depression
 Tamoxifen -Breast cancer treatment
 Tamoxifen Adverse Effect -Endometrial cancer (Monitor for abnormal bleeding,
gynecological exam and PAP smear), Hypercalcemia, Nausea and vomiting,
Pulmonary embolus, Hot flushes, Vaginal discharge or bleeding
Anastrozole

 Stops growth of breast cancer

 Anastrozole Side Effect -Muscle and joint pain,
headache,Nausea,Vaginal bleeding,Increased risk for osteoporosis
(Advise clients to take calcium and vitamin D supplements and
perform weight-bearing exercises), Hot flushes
 Trastuzumab -Targets breast cancer cells
 Trastuzumab Adverse Effects -Cardiac toxicity, tachycardia,heart
failure (Obtain baseline ECG and monitor for heart failure),
Hypersensitivity reaction (Have resuscitation equipment), Nausea
and vomiting
Interferon alfa-2b

 Increases immune response and decreases production of cancer

cells.
 Interferon Adverse Effect -Flulike symptoms, Bone marrow
suppression, alopecia, cardiotoxicity, and neurotoxicity (with
prolonged therapy), Depression, anxiety, insomnia,altered mental
states
 Interferon Nurse Note -Store the medication in the refrigerator
and do not freeze. Administer at room temperature. Do not shake
vial. Monitor for flu symptoms, give acetaminophen. Advise clients
to practice good oral hygiene. Monitor CBC, platelets, and
electrolytes, fluid status
Cetuximab, Rituximab, Bevacizumab,
Imatinib

 Antibody that stops cancer cell growth and increases cell death
 Cetuximab Side Effect -Infusion reaction, rash,hypotension, wheezing
(premedicate), PE, Skin toxicity, rash (use sun screen)
 Imatinib Side Effect -GI discomfort (antiemetic, with food), Flulike
symptoms,Edema,Hypokalemia,Neutropenia, anemia
 Rituximab Side Effect -Infusion reaction, rash, hypotension, wheezing,
Flulike symptoms, Tumor lysis syndrome
 Bevacizumab Side Effect -Thromboembolism, Alopecia, Hemorrhage (GI,
vaginal, nasal, intracranial, or pulmonary), Gastric perforation,
Hypertension. Contraindicated in clients who have a low WBC, nephrotic
syndrome, recent surgery or dental work, or hypertensive crisis.
Antibiotics

 Penicillin -Antibiotic
 Penicillin Adverse Effects -Allergies/anaphylaxis (Check allergy,
Observe clients for 30 min following IV), Nephrotoxic,
Hyperkalemia/dysrhythmias, Hypernatremia
 Penicilin Contraindication -Penicillins are contraindicated for
clients who have a severe history of allergies to
penicillin,cephalosporin, and/or imipenem
 Cephalosporins -1st generation (cephalexin,cefazolin), 2nd
generation (cefaclor, cefotetan), 3rd generation (ceftriaxone,
cefotaxime), 4th generation (cefepime)
Cephalosporins Adverse Effect

 Allergic/hypersensitivity/, Bleeding tendencies, Thrombophlebitis with IV, Antibiotic-

associated colitis
 Vancomycin Adverse Effect -Ototoxicity (assess for
tinnitus/hearing issues, monitor vanco levels- peak and trough),
Infusion reactions (Red man syndrome – rashes, flushing,
tachycardia, hypotension- administer slowly) , Renal toxicity
 Vancomycin Contraindication -For clients who have allergy to
corn/corn products or previous allergy to vancomycin
Tetracycline

 doxycycline
 Tetracycline Adverse Effects -GI discomfort, Yellow/brown tooth
discoloration (Avoid administration to children less than 8 years
of age and pregnant women), Hepatotoxicity (lethargy, jaundice),
Photosensitivity (sun precaution), antibiotic‑associated colitis
 Tetracycline and food -Tetracycline should be taken on an empty
stomach with a full glass of water. It may be taken with food if
gastric distress occur. Minocycline may be taken with food.Taking
any of the tetracyclines just before lying down increases the
chance of esophageal ulceration.
Macrolides- Antibiotics

 Erythromycin, Azithromycin
 Macrolides Complications -GI discomfort, cardiac (Prolonged QT
interval/dysrhythmia), Ototoxicity (Monitor for hearing loss, vertigo, and ringing
in ear.)
 Aminoglycosides – Antibiotics
 Genatmicin, Amikacin, Tobramycin, Neomycin, Streptomycin
 Aminoglycosides Adverse Effects
 1. Ototoxicity- cochlear damage (hearing loss) and vestibular damage (loss of
balance): Monitor clients for tinnitus (ringing in the ears),headache, hearing loss,
nausea, dizziness, and vertigo
 2. Nephrotoxicity: proteinuria, casts in the urine, dilute urine, elevated BUN,
creatinine levels- Monitor I&O, BUN, and creatinine levels. Report hematuria and/or
cloudy urine.
 3. respiratory depression or muscle weakness, Hypersensitivity (rash, pruritus,
paresthesia of hands and feet, and urticaria)
Streptomyycin (Specific side
effect)

 Neurologic disorder (peripheral neuritis, optic nerve dysfunction,

tingling/numbness, of the hands and feet)
 Sulfonamides and trimethoprim – Antibiotics
 to treat urinary tract infections, otitis media, bronchitis,
shigellosis, and Pneumocystis jiroveci pneumonia
 Sulfonamides and trimethoprim side effect -Hypersensitivity,
including Stevens‑Johnson syndrome, Blood dyscrasias (hemolytic
anemia, agranulocytosis, leukopenia,thrombocytopenia, aplastic
anemia), Crystalluria ( cryslas irritation and obstruction leading
to kidney failure), Kernicterus (jaundice causing neurotoxicity),
Photosensitivity
Sulfonamides and trimethoprim
precaution

 Do not administer to client who has allergies to sulfa, Thiazide

diuretics, Loop diuretics and Sulfonylurea-type oral hypoglycemics
– Allergic reaction
 Sulfonamides and trimethoprim Nurse Notes -Baseline CBC (blood
dyscrasia) . Avoid med for pregnant and breasfeeding or infnats
(neurotoxic). Monitor for kidney failure (crystalluria). Better to
take on an empty stomach with a full glass of water.
Nitrofurantoin

 UTI antibiotic, Donot use with impaired renal clearance,

 Nitrofurantoin adverse effects -Gastrointestinal (GI) discomfort
(with milk or meals), pulmonary hypersensitivity- dyspnea, cough,
chest pain, fever ( stop medication and call provider), Blood
dyscrasias (blood test, bleeding precautions), Peripheral
neuropathy, Headache, drowsiness, dizziness
 Nitrofurantoin Special Notes -Avoid crushing tablets because of
the possibility of tooth staining. A brownish discoloration of
urine is expected. Avoid nitrofurantoin while pregnant (can cause
infant birth defects)
Fluoroquinolones

 Ciprofloxacin, ofloxacin, moxifloxacin, levofloxacin, Norfloxacin

 Fluoroquinolones Adverse effect - GI discomfort, Achilles tendon
rupture (pain, swelling, and redness at Achilles tendon site-
report), › Suprainfection (thrush, vaginal yeast infection ,cottage
cheese/curd-like lesions on the mouth/genital area- report),
Phototoxicity (severe sunburn)
 Phenazopyridine -local anesthetic on the mucosa of the urinary
tract- for burning on urination, pain, frequency and urgency
 Phenazopyridine adverse effect -Changes urine to an orange/red
color. Urine may stain clothes. Administer with or after meals to
prevent mild GI discomfort. Contraindicated in kidney disease
Metronidazole

 Treatment of protozoal infection,H. pylori, surgical prophylaxis

 Metronidazole adverse effect -GI discomfort (nausea, vomiting, dry
mouth, and metallic taste), Darkening of urine (harmless), CNS
symptoms (numbness of extremities, ataxia, and seizures – stop med
and notify dr.
Antifungal meds

 Amphotericin B, Ketoconazole, Flucytosine, Nystatin, Miconazole,

Clotrimazole, Terbinafine, Fluconazole, Griseofulvin
 Use of Antifungal -Treatment of choice for systemic fungal infection
(Candidiasis, Aspergillosis Cryptococcosis, Mucormycosis) and
nonopportunistic mycoses, (Blastomycosis, Histoplasmosis,Coccidioidomycosis),
Skin infection ((tinea pedis,, tinea cruris ,candida infections, fungal
infections of the nails (Onychomycosis).
 Amphotericin B: Adverse Effects -Cardiac dysrhythmias,Neurotoxicity;
tinnitus; visual disturbances; hand or feet numbness, tingling, or pain;
convulsions, Pulmonary infiltrates, Renal toxicity, potassium loss,
hypomagnesemia,Fever, chills, headache, nausea, occasional hypotension,
gastrointestinal (GI) upset, anemia
Amphotericin B: Adverse Effects
Prevention

 Premedicate with antiemetics, antihistamines, antipyretics, and

corticosteroids. Infuse slow (2-6 hrs), IV infusion pumps, dilute,
and the most distal veins possible.Infuse 1 L saline on the day of
amphotericin B infusion, watch for hypokalemia and bone marrow
depression
 Ketoconazole Side Effect - Nephrotoxic, Hepatotoxicity (anorexia,
nausea, vomiting, jaundice, dark urine, clay stool – LFT), Effects
on sex hormones (gynecomastia, decreased libido, erectile
dysfunction in male, mentrual irregularities in female )

Resp Med

 Beta2-adrenergic agonists :albuterol,

Formoterol,Salmeterol,Terbutaline -activating the beta2-receptors
in the bronchial smooth muscle, resulting in bronchodilation
 Albuterol -Inhaled (short acting), Oral (long acting). Used for
prevention of exercise induced asthma
 Albuterol side effect -tachycardia, tremors
 DPI (Dry powder Inhaler) use – Correct technique
 Don’t shake before use,Dont tilt the disc. Inspiration should be
deep and rapid ,No spacer needed- no need for coordinating with
inhalation as its rapid dispersion,Rinse mouth afterwards
Bronchodilator and glucocorticoid
inhaler?

 Take bronchodialator first, wait for 5 minutes, take sterod second,

rinse mouth after.
 Salmeterol -Long acting (not a rescure inhaler)
 Theophylline -Causes relaxation of bronchial smooth muscle,
resulting in bronchodilation
 Theophylline Toxicity -Mild (GI distress), Severe – dysrhythmias
and seizures- Advice client to report nausea, diarrhea, or
restlessness.
 Therapeutic range Theophylline -5 to 15 mcg/mL
 Theophylline and food -Caffeine can increase theophylline levels.
Inhaled Anticholinergics

 Ipratropium (atrovent) and Tiotropium (spiriva)

 Inhaled Anticholinergics side effects -Local anticholinergic effects
(dry mouth hoarseness) – Advise clients to sip fluids and suck on
sugar-free hard candies to control dry mouth
 Inhaled Anticholinergics and interaction -Contraindicated in clients
who have an allergy to peanuts (med has soy lecithin). Caution for
narrow-angle glaucoma and benign prostatic hyperplasia
(anticholinergic effect makes these conditions worse)
 Inhaled Anticholinergics notes -Rinse the mouth after inhalation to
decrease unpleasant taste. Wait at least 5 min between two
medications.
Glucocorticoids

 Beclomethasone, Prednisone
 Beclomethasone Side Effect -Difficulty speaking, hoarseness, and
candidiasis : rinse mouth or gargle with water or salt water after
use, monitor for redness, sores, or white patches and to report
 Prednisone when used for 10 days or more (Adverse effect) -
Suppression of adrenal gland function (monitor blood glucose,
taper dose). Bone loss ( perform weight-bearing exercises, diet
rich in calcium and vit D), Hyperglycemia and glucosuria,
Myopathy, Peptic ulcer disease ( report black, tarry stools),
Infection, hypokalemia
Glucocorticoids interaction

 Contraindicated in clients who have received a live virus vaccine

and those with systemic fungal infections.
 Glucocorticoids Respi notes -Use glucocorticoid inhalers on a
regular, fixed schedule for long-term therapy, not to be used to
treat an acute episode.
 Montelukast, Zileuton and zafirlukast - Prevent the effects of
leukotrienes, thereby suppressing
inflammation,bronchoconstriction, airway edema, and mucus
production.
Dextromethorphan- Antitussive

 suppresses cough. Can cause high fever when used within 2 weeks of MAOI
antidepressants
 Guaifenesin – Expectorant
 Decrease chest congestion by coughing out secretions. Advise to increase fluid
intake when taking guaifenesin
 Guaifenesin side effect and management -GI upset (take with food), › Drowsiness,
dizziness, Allergic reaction (rash)
 Mucolytic –
 Acetylcysteine : enhance the flow of secretions in the respiratory passages
 Mucolytic side effect -Aspiration and bronchospasm. Not be used in clients at
risk for GI hemorrhage. Use cautiously in clients who have peptic ulcer disease,
esophageal varices, and severe liver disease.
Phenylephrine – decongestant –
side effect

 Rebound congestion with long use (use only for short-term therapy
3- 5 days), CNS stimulation (agitation, nervousness, uneasiness),
Vasoconstriction
Musculo & Sleep

 Succinylcholine -Neuromuscular blocking agents block

acetylcholine- resulting in muscle relaxation and hypotension
 Succinylcholine adverse effect -Respiratory arrest, Hypotension,
malignant hyperthermia, Hyperkalemia
 Centrally acting muscle relaxants -Diazepam, Baclofen,
Cyclobenzaprine, Tizanidine
 Peripherally acting muscle relaxants -Dantrolene
 Diazepam, cyclobenzaprine, tizanidine side effect -CNS depression,
Hepatic toxicity, dependence
 Baclofen side effect -CNS depression, Nausea, constipation, urinary
retention (increase intake of high-fiber foods, I/O)
 Dantrolene side effect -Hepatic toxicity, Muscle weakness
 Oxybutynin -Prevents contractions of the bladder and the urge to
void
 Oxybutynin side effect -Anticholinergic effects (constipation, dry
mouth, blurred vision,photophobia, dry eyes) – increase dietary
fiber, consume 2 to 3 L/day of fluid from beverage and food sources,
sip fluids, and avoid , sip fluids, and avoid hazardous activities
if vision is impaired) › CNS effects (hallucinations confusion,
insomnia, nervousness)
Oxybutynin interaction

 Contraindicated in clients who have glaucoma, myasthenia gravis,

paralytic ileus, GI or GU obstruction, or urinary retention.
 Zolpidem, Zaleplon, Eszopiclone, Trazodone -Sleep medication –
management of insomnia- Daytime sleepiness and lightheadedness may
occur – take med at bedtime
 Ramelteon -Melatonin Agonist – activate melatonin- help with sleep
 Ramelteon Side Effect - Sleepiness, dizziness, fatigue, Hormonal
effects (amenorrhea, decreased libido, infertility, galactorrhea)
 Ramelteon and food -High-fat meals and grapefruit juice increase
absorption. Take medication on an empty stomach.
Gold salts: auranofin

 For rheumatic disease -slow joint degeneration and progression of rheumatoid arthritis.

 Gold salts Adverse effect -Toxicity (severe pruritus, rashes

stomatitis), Renal toxicity, Blood dyscrasias (thrombocytopenia,
leukopenia, agranulocytosis, aplastic anemia), Hepatitis, GI
discomfort
 hydroxychloroquine -For rheumatic disease -slow joint degeneration
and progression of rheumatoid arthritis (also has anti malarial
property)
 hydroxychloroquine side effect -Retinal damage (blindness). Advice
regular eye exam
Alendronate

 inhibits bone resorption

 alendronate adverse effect -Esophagitis, esophageal ulceration
(Instruct client to take tablets with at least 8 oz water, sit
upright or ambulate for 30 min after taking this medication
orally), GI disturbances, Musculoskeletal pain,Visual
disturbances, Take the medication first thing in the morning after
getting out of bed. Avoid all calcium-containing foods and liquids
or any medications within 30 min of taking alendronate. Avoid
chewing or sucking on the tablet
Endocrine

 Rapid-acting Insulin -Lispro insulin, Humalog, Insulin aspart,

NovoLog, Insulin glulisine, Apidra
 Rapid-acting Insulin Onset -15 to 30 min
 Short-acting Insulin -Regular insulin, Humulin R, Novolin R
 Short-acting Insulin Onset -0.5 to 1 hr
 Intermediate-acting -NPH insulin, Humulin N – Onset 1 to 2 hr
 Long-acting -Insulin glargine, Lantus – Onset 70 min, No peak
Complication of Insulin

 Risk for hypoglycemia, Lipohypertrophy (rotate injection sites )

 Mixing Insulin -Regular first, then NPH. Do not mix lantus
 Sulfonylureas – Help with insulin release from the pancreas
 chlorpropamide, glipizide, tolzamide, glyburide, glimepiride
 Biguanides -Reduces the production of glucose within the liver ,
Increases muscles’ glucose uptake and use -Metformin HCl
 Thiazolidinediones – decrease insulin resistance -Pioglitazone
 Alpha glucosidase inhibitors -Slows carbohydrate absorption and
digestion -Acarbose
Metformin HCl- other use

 To treat polycystic ovary syndrome

 Metformin Side Effect -Gastrointestinal effects (anorexia,nausea,
vomiting, weight loss), decreases absorption of Vitamin B12 and
folic acid leading to deficiency, Lactic acidosis (monitor and
report hyperventilation, myalgia, sluggishness, somnolence)
 Pioglitazone side Effect -Fluid retention, High LDL,
Hepatotoxicity
 Acarbose side effect -Intestinal effects (abdominal distention and
cramping, hyperactive bowel sounds, diarrhea, excessive gas),
Anemia due to decreased iron absorption, Hepatotoxicity
Metformin Interaction

 Metformin HCl is contraindicated for clients who have severe

infection, shock and hypoxic condition
 Acarbose Interaction -Acarbose is contraindicated for clients who
have gastrointestinal disorders, such as inflammatory disease,
ulceration, or obstruction
 Oral atidiabetics and timings 1 -Glipizide – Best taken 30 min
prior to meal. Acarbose – Instruct clients to take with the first
bite of food, three times per day.
 Oral atidiabetics and timings 2 -Repaglinide – Instruct clients to
eat within 30 min of taking a dose of the medication, 3 times/day
 Exenatide – to promote release of insulin
 Prefilled injector pens, given SQ, Give injection within 60 min
before the morning and evening meal. Never administer after a
meal. Keep the injection pen in the refrigerator and to discard
after 30 days.
 Exenatide Side effects -GI effects (nausea, vomiting, diarrhea),
Pancreatitis.
 Glucagon Injection – Emergency management of hypoglycemic
reactions -Increases blood glucose levels by increasing the
breakdown of glycogen into glucose
Thyroid hormone – Levothyroxin

 Take daily on an empty stomachObtain the client’s baseline vital signs,

weight, and height, T3,T4,TSH and monitor periodically, Monitor and
report signs of cardiac excitability (angina, chest pain, palpitations,
dysrhythmias)
 Antithyroid medication -Propylthiouracil (PTU), Methimazole
 Antithyroid medication Side Effect -Agranulocytosis (watch for
infection), › Liver injury, hepatitis, Overmedication leading to
hypothyroidm
 Antithyroid medication Nurse Notes -Therapeutic effects may take 1 to 2
weeks, Monitor vital signs, weight, and I&O at baseline and periodically.
Monitor for signs of hypothyroidism. Monitor CBC for leukopenia or
thrombocytopenia
Radioactive iodine

 High dose of thyroid-radioactive iodine destroys thyroid cells.

 Radioactive iodine Adverse Effect -Radiation sickness
(hematemesis, epistaxis, intense nausea, vomiting). Bone marrow
depression,Hypothyroidism
 Radioactive iodine- Radioactivity precautions -Void frequently to
avoid irradiation of gonads. Limit contact with clients to 30
min/day/person. Encourage clients to increase fluid intake,
usually 2 to 3 L/day. Instruct clients to dispose of body wastes
per protocol. Avoid coughing and expectoration (source of
radioactive iodine).
 Strong iodine solution (Lugol’s solution) – nonradioactive iodine
 Thyroid-nonradioactive iodine creates high levels of iodide that
will reduce iodine uptake by thyroid gland, inhibit thyroid
hormone production, and block the release of thyroid hormones
 Strong iodine solution (Lugol’s solution) – side effect
 Iodism due to corrosive property (metallic taste, stomatitis, sore
teeth and gums, frontal headache, skin rash). Can progress to
overdose (severe GI distress and swelling of the glottis)
 Antidot for Lugol’s -Sodium thiosulfate
Thyroid-nonradioactive iodine
nurse notes

 Obtain the client’s baseline vital signs, weight, and I&O, and monitor periodically,
dilute strong iodine solution (Lugol’s solution) with juice to improve taste, increase
fluid intake
 Corticosteroids – Anti-inflammatory -Methylprednisolone, betamethasone, hydrocortisone,
fluticasone
 Corticosteroids – side effect -Immunosuppression (watch for infection),Cataracts – Need
yearly eye exam. Hyperglycemia  (caution in DM), Fluid retention and Weight gain (Watch
for HTN, Heart failure), osteoporosis and muscle weakness, Gastric irritation : Take
with food.
 Steroids Important Notes -Do not discontinue abruptly. Report any signs and symptoms of
infection to the HCP immediately (sore throat, fever, redness and swelling, discharge,
pain). No live vaccines (varicella-zoster, MMR, rotavirus, yellow fever, nasal flu
vaccine). TB skin test – positive if induration is more than 5 mm (usually 10 mm). GI
bleed – report dark tarry stool, orthostatic vitals, Hb level
Gastro& Vitamins

 Histamine2-receptor antagonists- suppress the secretion of gastric

acid -Ranitidine, Cimetidine, Famotidine, Nizatidine
 Cimetidine side effect -block androgen receptors-decreased libido
and impotence. CNS effects (lethargy, depression, confusion). It
can increase the levels of warfarin, phenytoin, theophylline, and
lidocaine.
 Proton pump inhibitors (PPI) – reduce gastric acid secretion -
Omeprazole, Pantoprazole, Lansoprazole, Rabeprazole, Esomeprazole
 PPI long term use effect -Long-term use of proton pump inhibitors
increases the risk of osteoporosis
PPI nurse note

 Do not crush, chew, or break sustained-release capsules,Do not open

capsule and sprinkle contents over food, omeprazole once a day prior
to eating in the morning
 Sucralfate -Mucosal protectant
 Sucralfate side effect -constipation (increase fiber)
 Antacids- neutralize gastric acid - Aluminum carbonate, Aluminium
Hydroxide, Magnesium hydroxide (milk of magnesia), Sodium
bicarbonate, Calcium carbonate (Tums)
 Antacid Side Effect -Aluminum and calcium compounds cause
constipation. Magnesium compounds cause diarrhea, renal toxic.
Aluminum hydroxide – hypophosphatemia and hypomagnesemia.
Antacid Nurse note

 Do not mix with other meds. Give 1 hour before or 3 hours after meals.
 Dopamine antagonists- Antiemetic -Prochlorperazine, metoclopramide
(Reglan), promethazine (Phenergan)
 Ondansetron -Antiemetic
 Ondansetron side effect -Headache, diarrhea,dizziness
 Prochlorperazine side effect -Extrapyramidal symptoms (monitor for
restlessness, anxiety, spasms of face and neck; Administer an
anticholinergic medication to treat), Hypotension, Sedation,
Anticholinergic effects
 Scopolamine -Anticholinergic effects, sedation, antinausea, treat motion
sickness
Laxatives

 -Psyllium (Metamucil), Docusate sodium (Colace), Bisacodyl

(Dulcolax) Magnesium hydroxide (Milk of Magnesia), senna
(Senokot), lactulose (Cephulac)
 Laxative contraindication- Contraindicated in clients who have
fecal impaction, bowel obstruction, and acute surgical abdomen to
prevent perforation. Contraindicated in clients who have nausea,
cramping, and abdominal pain
 Laxative teaching- Chronic laxative use can lead to fluid and
electrolyte imbalances. Increase high-fiber foods in daily diet
such as bran, fresh fruits and vegetables. Increase fluid intake
(2 to 3 L/day). Maintain a regular exercise regimen
Loperamide (Antidiarrheals)
Teaching

 Drink small amounts of clear liquids/oral electrolyte solution. Avoid

caffeine (increase peristalsis and worsen diarrhea).
 Metoclopramide ( controls nausea and vomiting) Adverse Effect- Extrapyramidal
symptoms (report restlessness, anxiety, and spasms of face and neck),
Sedation (fall precaution, avoid activities that require alertness, such as
driving), Diarrhea (monitor for dehydration)
 Metoclopramide Contraindication- Contraindicated in clients who have GI
perforation, GI bleeding, bowel obstruction, and hemorrhage.
 Sulfasalazine- Decrease inflammation in IBS, Crohn’s disease, ulcerative
colitis
 sulfasalazine side effects- Blood disorders (agranulocytosis,hemolytic and
macrocytic anemia), Nausea, cramps, rash, arthralgia
sulfasalazine Nurse note

 contraindicated in clients who have sensitivity to sulfonamides,

salicylates
 Ferrous sulfate Side effect- GI distress – nausea, constipation(take
with orange juice), Teeth staining (Teach clients to dilute liquid
iron with water or juice, drink with a straw, and rinse mouth after
swallowing),
 Ferrous sulfate notes- Better to take empty stomach, Taking with
Vitamin C increases absorption, Z-track technique for IM, increase
water and fiber intake to prevent constipation.
 Foods high in Iron- liver, egg yolks, muscle meats, yeast, grains,
green leafy vegetables
Genito Urinary

 Medroxyprogesterone- To regulate ovulation and menustration, treat

endometriosis and cancer of uterus
 Medroxyprogesterone adverse effect- Breast cancer (perform regular
breast self-examinations and get mammograms), Thromboembolic events -
MI, pulmonary embolism, thrombophlebitis, stroke (Discourage clients
from smoking, Monitor for pain, swelling, warmth, or erythema of lower
legs, notifychest pain or shortness of breath), Breakthrough bleeding,
Edema, Jaundice (monitor LFT), Migraine headaches
 Medroxyprogesterone nurse note- Anticipate withdrawal bleeding 3 to 7
days after stopping the medication. Stop taking the medication
immediately if pregnancy is suspected. Conception should be delayed for
3 months following use.
Oral contraceptives

 stop conception by preventing ovulation

 Oral contraceptives adverse effect- Thromboembolic events (MI, pulmonary
embolism, thrombophlebitis, stroke), Hypertension, breakthrough bleeding,
Breast cancer
 Oral contraceptives contraindication- Smokers and over the age of 35, Have a
history of thrombophlebitis and cardiovascular events, Have a family history
or risk factors for breast cancer, Are experiencing abnormal vaginal bleeding.
 Oral contraceptives drug interaction- Oral contraceptive effectiveness
decreases with use of carbamazepine (Tegretol); phenobarbital; antibiotics,
especially penicillins and cephalosporins; phenytoin (Dilantin); and rifampin.
Oral contraceptives decrease the effects of warfarin and oral hypoglycemics.
Oral contraceptives Nurse Note

 Instruct clients to take pills at the same time each day. Instruct clients to take
medication for 21 days followed by 7 days of no medication (or inert pill). For the
traditional 28-day cycle OCs, begin the sequence on the fifth day after the onset of
menses. For one missed dose, instruct clients to take two together at the next scheduled
dose. Encourage clients who smoke to quit.Advise client to report swelling or redness in
legs, shortness of breath or severe headache (?? thromoelbolic events)
 Finasteride- Reduction of the prostate size, increases sclap
hair growith (help with male baldness)
 Finasteride Side Effect- Decreased libido, Gynecomastia,
Orthostatic hypotension
Finasteride nurse note

 Therapeutic effects may take 6 months or longer. Pregnant women should not handle crushed or broken medication.
Advise clients not to donate blood unless medication has been discontinued for at least 1 month.
 Tamsulosin- decrease mechanical obstruction of the urethra by relaxing smooth muscles,
decreased blood pressure
 Tamsulosin side effect- Hypotension, dizziness, nasal congestion, sexual dysfunction. Take
30 min after a meal at the same time each day. Monitor BP
 sildenafil, tadalafil, vardenafil (-fil meds)- for erectile dysfunction in male
 Adverse effects of “-fil” meds (sildenafil, tadalafil, vardenafil )- MI, sudden death,
Priapism (erection lasts more than 4 hr), Fatal hypotension when taken with nitroglycerin
 Nurse notes for “-fil” meds (sildenafil, tadalafil, vardenafil )- Ask about use of -fil
med before giving nitro. Do not give nitro within 4-6 hours of taking -fil meds.
Grapefruit juice, and some meds (ketoconazole, erythromycin, cimetidine increase plasma
concentrations of med leading to toxicity)
Maternity Med

 Oxytocin- Uterine stimulants increase the strength, frequency, and

length of uterine contractions
 oxytocin uses- Induction of labor (postterm pregnancy, premature
rupture of membranes, pre-eclampsia), Delivery of placenta
(postpartum, miscarriage), Management of postpartum hemorrhage,
contraction stress test
 Dinoprostone- prostaglandin used to promote cervical ripening and to
stimulate uterine contractions
 Methylergonovine- Used for emergency intervention for serious
postpartum hemorrhage.
 oxytocin adverse effect- Uterine rupture
 methylergonovine note- Use only after, and not during labor.
Monitor for manifestations of hypertensive crisis (headache,
nausea, vomiting,increased blood pressure). Should not be given to
clients who have hypertension, organ failure (cardiovascular,
kidney, liver). Mothers should not breast feed until 12 hr after
their last dose of methergine
 Contraindications of oxytocin- Maternal factors (sepsis, an unripe
cervix, genital herpes, history of multiple births,uterine
surgery). Fetal factors (immature lungs, cephalopelvic
disproportion, fetal malpresentation prolapsed umbilical cord,
fetal distress, and threatened spontaneous abortion)
oxytocin administration

 Use an infusion pump, monitor blood pressure and pulse rate, uterine contractions
(frequency and duration), fetal distress
 oxytocin goal of treatment- The goal is contractions that last 1 min or less every
2 to 3 min. Monitor for uterine hyperstimulation (contractions lasting longer than
60 seconds, occurring more frequently than every 2 to 3 min, resting uterine
pressure greater than 15 mm Hg). Stop infusion and notify the provider immediately.
 terbutaline sulfate, nifedipine, indomethacin- Tocolytics- uterine smooth muscle
relaxation
 Tocolytics adverse effects- Tachycardia, palpitations, chest pain, Tremors,
anxiety, headache
 Tocolytics Contraindication- Greater than 34 weeks gestation,Acute fetal distress,
Severe gestational hypertension or eclampsia, Vaginal bleeding, Cervical dilation
greater than 6 cm
Turbutalin administration

 Terbutaline is administered subcutaneously. Oral pill dose will

not reach desired site of action
 Tocolytic notes- Monitor FHR, uterine contractions, pulse, blood
pressure, respiratory rate, lung sounds, and daily weights.
Withhold/discontinue the medication and contact the provider for
reports of chest pain, maternal heart rate greater than 120/min,
or presence of cardiac arrhythmias. Limit fluid intake to 1,500 to
2,400 mL/24 hr.Notify the provider if contractions persist or
increase in frequency or duration.
 Butorphanol, nalbuphine- Pain meds. Give at the peak of
contraction