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Pharm Phlash!
Pharmacology Flash Cards
Valerie I. Leek, MSN, RNC-NIC, CMSRN
Assistant Professor of Nursing
Cumberland County College
Vineland, New Jersey
F. A. DAVIS COMPANY • Philadelphia

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F. A. Davis Company As new scientific information becomes available through basic and clinical
1915 Arch Street research, recommended treatments and drug therapies undergo changes.
The author(s) and publisher have done everything possible to make this
Philadelphia, PA 19103 book accurate, up to date, and in accord with accepted standards at the
www.fadavis.com time of publication. The author(s), editors, and publisher are not responsi-
ble for errors or omissions or for consequences from application of the
book, and make no warranty, expressed or implied, in regard to the con-
Copyright © 2009 by F. A. Davis Company tents of the book. Any practice described in this book should be applied by
the reader in accordance with professional standards of care used in regard
Copyright © 2009 by F. A. Davis Company. All rights reserved. to the unique circumstances that may apply in each situation. The reader is
This book is protected by copyright. No part of it may be repro- advised always to check product information (package inserts) for changes
and new information regarding dose and contraindications before adminis-
duced, stored in a retrieval system, or transmitted in any form or tering any drug. Caution is especially urged when using new or infrequently
by any means, electronic, mechanical, photocopying, recording, ordered drugs.
or otherwise, without written permission from the publisher.
Authorization to photocopy items for internal or personal use, or the inter-
nal or personal use of specific clients, is granted by F. A. Davis Company
Printed in the United States of America for users registered with the Copyright Clearance Center (CCC)
Transactional Reporting Service, provided that the fee of $.10 per copy is
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those
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Dedication
To my husband, David, whose love, faith, and wonderful dinners made hard work so bearable.
To my son Zachary, whose vision and hope are larger than life.
To my son Jeffrey, whose love and gentle patience calm me.
To my granddaughter Cadence, who I hope will be proud of her Noni.
To my parents Pauline and Harry Fallows, whose love and support are limitless.
To my colleagues, Joy Wood, Priscilla Meyers, and Deirdre Conroy, who supported me in
the development and application of this project.
Acknowledgments
I would like to thank all the hard-working nursing students who used my Pharm Phlash!,
survived it, and learned. You are the amazing, transformed persons who sustain me in my
practice as an instructor.
I'd also like to thank all the wonderful people I've worked with at F.A. Davis Company,
including Tom, Nora, and Julie. You've made this journey a pleasant one.
Valerie I. Leek

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Reviewers
Deborah S. Bridgewater, RN, MSN
Professor, Coordinator of Academic Support
St. Mary’s School of Nursing
Huntington, WV
Sally K. Davis, RN, MSN

Nursing Instructor
Western Wisconsin Technical College
LaCrosse, WI
Penny Fairman, MSN, EdD

Healthcare Education Consultant
Fairman and Associates
Show Low, AZ
Linda C. McIntosh, PhD, RN, LPC

Assistant Professor
North Carolina A&T State University
School of Nursing
Greensboro, NC

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List of Icons
Gastrointestinal System Drugs Central Nervous System Drugs
Endocrine System Drugs Cardiovascular System Drugs
Urologic System Drugs Respiratory System Drugs
Immune System Drugs Sensory System Affecting the Eye
Musculoskeletal System Drugs

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Abbreviations Used on Cards

ABGs arterial blood gases CHF congestive heart failure DMARD disease modulating anti-
ac before meals CNS central nervous system rheumatic drug
ACE angiotensin-converting CO cardiac output DNA deoxyribonucleic acid
enzyme COPD chronic obstructive DVT deep vein thrombosis
ADH antidiuretic hormone pulmonary disease ECG electrocardiogram
ADHD attention-deficit/ CPK creatine phosphokinase EEG electroencephalogram
hyperactivity disorder CR controlled release EENT eye, ear, nose, and throat
AFB acid-fast bacillus CSF colony-stimulating factor; EMS Emergency Medical
ALT alanine aminotransferase cerebrospinal fluid Services
ANA antinuclear antibodies CT computerized tomography Endo endocrine
APAP acetaminophen CV cardiovascular EPS extrapyramidal symptoms
aPTT activated partial throm- CVA cerebrovascular accident ER extended-release
boplastin time CVC central venous catheter ESRD end-stage renal disease
ASA acetylsalicylic acid CVP central venous pressure F and E fluid and electrolyte
AST aspartate aminotrans- CXR chest x-ray G, g, gm gram
ferase D5/0.9%NaCl 5% dextrose and normal GABA gamma-aminobutyric
bid two times a day saline solution (0.9% acid
BMS bone marrow suppression NaCl) GERD gastroesophageal reflux
BNP brain natriuretic peptide D5/1⁄2 NS 5% dextrose and half disease
BP blood pressure normal saline solution GFR glomerular filtration
bpm beats per minute (0.45% NaCl) rate
BUN blood urea nitrogen D5W 5% dextrose in water GI gastrointestinal
Ca+ serum calcium Derm dermatology GTT glucose tolerance test
cap capsule DKA diabetic ketoacidosis GU genitourinary
CBC complete blood count dL deciliter HCP health-care professional

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HDL high-density lipoproteins mcg microgram(s) OCD obsessive-compulsive

Hemat hematologic MDI metered dose inhaler disorder
Hgb A1c hemoglobin A1c glycos- mEq milliequivalent Oint ointment
lated hemoglobin Metab metabolic Ophth ophthalmic
hr hour(s) mg milligram OTC over-the-counter
HRT hormone replacement Mg+ serum magnesium oz ounce(s)
therapy MI myocardial infarction pc after meals
HTN hypertension min minute(s) PCA patient-controlled
IM intramuscular Misc miscellaneous analgesia
Inhaln inhalation mL milliliter PCWP pulmonary capillary
INR international normalized mo month(s) wedge pressure
ratio MRI magnetic resonance PE pulmonary embolus
I&O intake and output imaging PO by mouth, orally
IT intrathecal MS musculoskeletal Prn as needed
IV intravenous Na sodium PT prothrombin time
K+ potassium NaCl sodium chloride PVC premature ventricular
KCl potassium chloride 0.9% NaCl 0.9% NaCl solution/ contractions
kg kilogram normal saline q every
L liter Neuro neurologic qid four times a day
LA long-acting NG nasogastric RA rheumatoid arthritis
LDH lactic dehydrogenase NMDA N-methyl-D-aspartate RBC red blood cell
LDL low-density lipoproteins NPO nothing by mouth RDA recommended daily
LFT liver function tests NRTI nucleoside reverse allowance
LR lactated Ringer’s solution transcriptase inhibitor Rect rectum
MAO monoamine oxidase NS(S) normal saline (solution) REM rapid-eye movement
MAOI monoamine oxidase NSAIDs non-steroidal anti- Resp respiratory
inhibitor inflammatory drugs RFT renal function tests

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RNA ribonucleic acid supp suppository VT ventricular tachycardia

Rx prescription tab tablet WBC white blood cell
SA sinoatrial TB tuberculosis wk week(s)
SAMe S-adenosyl-L-methionine tbs tablespoon(s) yr year(s)
subcut (sc) subcutaneously tid three times a day
sec(s) second(s) TNF tumor necrosis factor
↑ increased or high
SL sublingual Top topically or topical ↓ decreased or low

SOB shortness of breath tsp teaspoon
SR sustained release VFib ventricular fibrillation
SSRIs selective serotonin VLDL very low-density
reuptake inhibitor(s) lipoproteins
stat immediately VS vital sounds

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Contents
Gastrointestinal System Drugs, Cards 1–27 Urologic System Drugs, Cards 51–63
Electrolyte Modifiers, Cards 1–5 Affecting Urination, Cards 51–52
Gastric Mucosa Protectors, Cards 6–10 Diuretics, Cards 53–55
Antidiarrheals, Cards 11–13 Men’s Health, Cards 56–58
Irritable Bowel Syndrome, Card 14 Dialysis/Renal Failure, Cards 59–63
Laxatives/Bowel Preps/Antiflatulents, Cards 15–21
Antiemetics, Cards 22-26 Immune System Drugs, Cards 64–94
Appetite Stimulants, Card 27 Anti-Inflammatory and Disease-
Modulating Agents, Cards 64–76
Endocrine System Drugs, Cards 28–50 Anti-Infectives, Cards 77–94
Insulin—Very Rapid-Acting, Card 28
Insulin—Rapid-Acting, Card 29 Musculoskeletal System Drugs, Cards 95–99
Insulin—Slow-Acting, Card 30 Muscle Relaxants, Cards 95–96
Insulin—Basal Agents, Card 31 Myasthenia Gravis, Card 97
Antidiabetic Agents, Cards 32–39 Osteoporosis, Cards 98–99
Pancreatics, Card 40
Thyroid, Cards 41–43 Central Nervous System Drugs, Cards 100–151
Adrenal, Cards 44–45 Analgesics, Cards 100–106
Pituitary Drugs, Cards 46–49 Opioid Reversal Agents, Card 107
Gonadal, Card 50 Anesthetics and Sleep Inducers, Cards 108–115

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Anticonvulsants, Cards 116–122 Respiratory System Drugs, Cards 177–185

Anti-Parkinson’s and Anti-Alzheimer’s Bronchodilating Agents, Cards 177–180
Agents, Cards 123–130 Mucolytic/Expectorant Agents, Cards 181–182
Affecting Mental Health, Cards 131–142 Anti-Allergy/Anti-Inflammatory
Stimulants, Cards 143–151 Agents, Cards 183–185
Cardiovascular System Drugs, Cards 152–176 Sensory System Drugs, Cards 186–189
Affecting Coagulation, Cards 152–159 Ophthalmic Agents, Cards 186–189
Affecting Contractility/Rhythm/Circulating
Blood Volume, Cards 160–169
Anti-Anginal, Card 170
Lipid-Lowering Agents, Cards 171–175
Blood-Forming Agents, Card 176

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Introduction
Teaching and learning pharmacology is a large written 8 quizzes and 2 tests that can be accessed
undertaking. Memorization of drugs as single enti- on the DavisPlus website.
ties is almost impossible, even for those of us with Medications are grouped in systems, and then
wonderful recall. After years of trial and error, I into pharmacologic groups with similar action.
decided that grouping the drugs in classes would There is a table of contents for general access and
be the best method of instruction to promote a full index alphabetized that will direct you by
student recall. Pharm Phlash! is the happy result of generic, brand name, and Canadian brand names
this type of instruction. ( ). The cards are designed with the drug names
Pharm Phlash! is a tried and true method of on the front with their body system and basic use.
pharmacology instruction. Students learn to
take clues from both the generic and trade On the back of the cards you will find
names. When I ask students “What kind of drug 1. Therapeutic/Pharmacologic class (these
ends with ‘olol,’ ‘ilol,’ or ‘alol,’ they can tell me are always listed in this order)
quickly that these are beta-adrenergic blockers.
2. Indications for use of the drug
As a pharmacology instructor, this is music to
my ears. I hope you will experience the same 3. Action of the drug
results. 4. Adverse Reactions/Side Effects detailing
I recommend that students practice their all reactions but important information
knowledge by reinforcing quizzes and tests. I have will appear in bold, red type
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5. Keep in Mind section that includes client This learning system is not meant to replace
teaching a complete drug reference book or pharmaco-
6. Make the Connection area where informa- logy text. It is meant as a tool to mentally group
tion crucial to safe medication information and learn common drugs. Students who employ
is listed. Again extremely important infor- this system will “make the connection” and
mation is in bold, red type. Laboratory and learn their medications, laboratory values that
vital sign parameters are listed here, along are important for safe administration, and vital
with nursing implications and evaluative sign parameters. Best of luck to all.
data.
Valerie I. Leek, MSN, RNC-NIC, CMSRN
7. Possible nursing diagnoses are listed to help
Assistant Professor of Nursing
with care planning activities.
Cumberland County College
8. Other applications for the drugs are listed
as a cross-referencing tool.

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GASTROINTESTINAL

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Gastrointestinal System Drugs Electrolyte Modifiers 1
Calcium Carbonate
(kal-see-um kar-bo-nate)
Os-Cal, Tums, Tums E-X,

Nephro-Calci
Apo-Cal
Calcium Gluconate
(kal-see-um gloo-koh-nate)
Kalcinate
Therapeutic/Pharmacologic Class • Vitamin D must be taken in adequate amounts.

Mineral and electrolyte replacement/supplement; • Watch for signs of deficiency (paresthesias,
acid buffer/Electrolyte Chvostek’s sign, tremors).
Indications • Excessive use (PO form) may result in arrhythmias.
Antacid treatment of gastritis. Treatment of electrolyte • Avoid high-oxalate foods.
imbalance. • Report any kidney discomfort or passage of
Action sediment or stones.
Acts as an activator in the transmission of nerve
impulses and contraction of cardiac, skeletal, and Make the Connection
smooth muscle. Essential for bone formation and
blood coagulation. Buffers acidity.
• Serum levels must be assessed prior to
and after administration (9–10.5 mg/dL).
Adverse Reactions/Side Effects • Assess effectiveness if used for gastritis.
CNS: syncope (IV only), tingling. CV: cardiac arrest • Concurrent administration may render other
(IV only), arrhythmias, bradycardia. GI: constipa- medications useless. Give separately.
tion, nausea, vomiting, rebound acidity. GU: calculi, • Monitor blood pressure, pulse, and ECG fre-
hypercalciuria. Local: phlebitis (IV only). quently throughout parenteral therapy. May
cause vasodilation with resulting hypotension,
Keep in Mind bradycardia, arrhythmias, and cardiac arrest.
Teach client:
• May cause constipation and rebound stomach acidity.
Nursing Dx: Risk for injury (cardiovascular, neurological); Also Used for: Central nervous system applications (used as a
Risk for imbalanced nutrition (less or more than body reversal agent for magnesium sulfate toxicity).
requirements). Universal Free E-Book Store
Potassium Chloride
(po-tas-e-um clor-ide)
K-Dur, K-Lor, Klor-Con, Micro-K

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

Therapeutic/Pharmacologic Class Keep in Mind

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

Sodium Bicarbonate
(soe-dee-um bye-kar-boe-nate)
Baking Soda, Bell-Ans, Citrocarbonate,

Neut, Soda Mint
Sodium Citrate and

Citric Acid
(soe-dee-um sye-trate and sit-rik as-id)
Bicitra, Oracit
PMS-Dicitrate

Antiulcer agent, antiurolithic, mineral replacement/ Teach client:
Alkalinizing agent • Take medication as directed.
Indications • Clients on chronic therapy should watch for symp-
PO, IV: Management of metabolic acidosis. PO, IV: toms of electrolyte imbalance and notify a health
Alkalinization of urine and promotion of excretion of care professional if these symptoms occur.
certain drugs in overdosage situations (phenobarbital, • Taking milk products concurrently with this med-
aspirin). PO: Antacid. Prevention of aspiration pneu- ication can result in renal calculi or hypercalcemia
monitis during surgical procedures. Management of (milk-alkali syndrome).
chronic metabolic acidosis associated with chronic • Dyspepsia that persists >2 wk should be evaluated
renal insufficiency or renal tubular acidosis. by a health care professional.
Action • Clients on sodium-restricted diet should avoid use of
baking soda as a home remedy for indigestion and
Acts as an alkalinizing agent by releasing bicarbonate high-sodium foods (canned, processed, pickled).
ions. Following oral administration, releases bicar-
bonate, which is capable of neutralizing gastric acid.
Therapeutic Effects: Alkalinization of body fluids. Make the Connection
Neutralization of gastric acid. Increase of blood pH. • Monitor serum electrolyte level. This elec-
Adverse Reactions/Side Effects trolyte must be in the 135–145-mEq/L range.
CV: edema. GI: (PO) flatulence, gastric distention, • Daily weights are the most reliable measure of fluid
diarrhea. F and E: metabolic alkalosis, hyperna- overload. Other assessments include intake and out-
tremia, hypocalcemia, hypokalemia, sodium and put, lung sounds, and presence of pitting edema.
water retention, fluid overload. Local: irritation at
IV site. Neuro: tetany. Also Used for: Urological system applications (to prevent certain
Nursing Dx: Fluid volume excess. types of renal calculi) Universal Free E-Book Store
0.9% NaCl Solution (Isotonic); 5% Dextrose in

Water (Isotonic)
0.45% NaCl Solution (dex-tros)
(Hypotonic)
(soe-dee-um klor-ide soe-loo-shun)
Dextrose 5% and 0.9%

NaCl (Hypertonic)
Lactated
Ringer’s Dextrose 5% and
Solution (Isotonic) 0.45% NaCl
(lak-tate-ed ring-ers soe-loo-shun)
(Hypertonic)
Therapeutic/Pharmacologic Class • Remind staff if site has not been changed in 96 hr.
Intravenous solution • Compare circumference of the arms. If arm with
Indications the IV site is larger, inform staff.
Increasing of blood pressure, hydration of intersti-
tium and cells, pulling of fluid from the tissues and
cells to the blood stream. Make the Connection
Action • Hypertonic solutions pull fluid into the
vascular space.
Isotonic solution: increases circulating blood volume.
Hypertonic solution: pulls fluid from interstitium and
• Hypotonic solutions hydrate the interstitial space
and cells.
cells to the vascular space. Hypotonic solution:
hydrates the interstitium and cells.
• Isotonic solutions increase the circulating blood
volume.
Adverse Reactions/Side Effects • Solution types are chosen for specific reasons; check
CV: increase in blood pressure, bounding pulse. the orders to confirm that the correct solution is
Resp: hemoptysis. GI: abdominal distention, discom- hanging and it is at the ordered rate of infusion.
fort. F and E: fluid overload, decrease in serum elec- • Assess the infusion site every 2 hr.
trolyte levels. Local: injection site infiltration, phlebitis. • These solutions are not for long-term nourishment.
Keep in Mind
• Monitor serum electrolyte levels and complete
blood count daily.
Teach client: • Daily weights might be taken. Lung sounds and
• Report any pain or coolness at the injection site. intake and output must be assessed every shift.
• Watch for signs of fluid overload.
Nursing Dx: Fluid volume deficit; Fluid volume excess; Risk
for infection. Universal Free E-Book Store
Sodium Polystyrene
Sulfonate
(soe-dee-um po-lee-stye-reen sul-fon-ate)
Kayexalate
K-Exit

Therapeutic/Pharmacologic Class • A low-sodium diet will be ordered.

Hypokalemic, electrolyte modifier/Cationic exchange • Foods with high-potassium level should be avoided
resin (melons, bananas, orange juice, potatoes).
Indications • Report constipation.
Treatment of mild to moderate hyperkalemia. If
severe, glucose/insulin infusion may be used.
Make the Connection
Action
Exchanges sodium ions for potassium ions in the
• Assess ECG changes for hyperkalemia
and hypokalemia.
intestine (each 1 g is exchanged for 1 mEq potas-
sium). Therapeutic Effects: Reduction of serum
• Monitor intake and output and daily weight. Assess
for symptoms of fluid overload (dyspnea, rales/
potassium levels. crackles, jugular venous distention, peripheral
Adverse Reactions/Side Effects edema).
GI: constipation, fecal impaction, anorexia, • Remember to keep potassium levels in the range
gastric irritation, nausea, and vomiting. F and of 3.5–5 mEq/L. As potassium levels fall, digoxin
E: hypocalcemia, hypokalemia, sodium reten- toxicity can occur.
tion, hypomagnesemia. • Assess abdomen, bowel sounds, and frequency of
stools.
Keep in Mind • Monitor all electrolyte levels.
Teach client:
• Report signs of hypokalemia, such as muscle
weakness and fatigue.
Nursing Dx: Risk for injury (cardiovascular); Constipation.

Gastrointestinal System Drugs Gastric Mucosa Protectors 6
Famotidine Cimetidine
(fa-moe-ti-deen) (sye-me-ti-deen)
Pepcid Tagamet
Apo-Cimetidine
Ranitidine Nizatidine
(ra-ni-ti-deen) (ni-za-ti-deen)
Zantac Axid
Zantac-C


Antiulcer agent/Histamine H2 receptor antagonist Teach client:
Indications • Take medication as directed for the full course of
Treatment of active duodenal ulcers and gastroesoph- therapy.
ageal reflux disease (GERD). Management of gastric • Notify a health care professional if difficulty swal-
hypersecretory states (Zollinger-Ellison syndrome). lowing occurs or abdominal pain persists.
IV: Prevention and treatment of upper GI bleed. • Smoking interferes with the action of histamine
receptor antagonists.
Action
Inhibit the action of histamine at the H2-receptor • Avoid alcohol, products containing aspirin or
NSAIDs, excessive amounts of caffeine, and foods
site located primarily in gastric parietal cells, result- that may cause an increase in GI irritation.
ing in inhibition of gastric acid secretion.
• Report immediately signs of bone marrow suppres-
Adverse Reactions/Side Effects sion, such as bleeding, purpura, and sore throat.
CNS: confusion, dizziness, drowsiness, halluci- • Report confusion or hallucinations immediately.
nations, headache. CV: arrhythmias. GI: con-
stipation, diarrhea, drug-induced hepatitis,
nausea. GU: decreased sperm count, impotence. Make the Connection
Endo: gynecomastia. Hemat: agranulocytosis, • Monitor the CBC and differential counts
aplastic anemia. Misc: hypersensitivity daily.
reactions. • Other medications may be less effective because
of increased stomach pH.
• Direct IV doses are given over specific time
frames. Look it up.
Nursing Dx: Risk for infection; Risk for constipation. Also Used for: Integumentary system applications (urticaria)
Esomeprazole Omeprazole
(es-o-mep-ra-zole) (o-mep-ra-zole)
Nexium Prilosec; Prilosec OTC

Losec
Pantoprazole Lanzoprazole
(pan-toe-pra-zole) (lan-soe-pra-zole)
Protonix; Protonix I.V. Prevacid

Therapeutic/Pharmacologic Class • Take drugs for duration ordered by health care

Antiulcer agent/Proton (gastric) pump inhibitor provider.
Indications • Report abdominal pain; diarrhea; or black, tarry
Treatment of GERD with or without esophageal stools to health care provider immediately.
erosion, duodenal ulcers (Helicobacter pylori), upper
GI bleeds, and hypersecretory conditions.
Make the Connection
Action
Decrease gastric acid by binding to an enzyme on gas-
• Monitor liver enzymes.
tric parietal cells. Prevents proton pump from releasing
• Best if given on an empty stomach 1 hr prior to
other drugs or food.
acid into the gastric lumen, raising gastric pH.
• Monitor for improvement in symptoms.
Adverse Reactions/Side Effects • Lansoprazole IV must be given through a special
CNS: headache. Endo: changes in blood glucose filter. Pantoprazole IV is given direct IV, undiluted,
levels. GI: abdominal pain, flatulence, diarrhea. over 2 min.
Derm: rash. • Some capsules can be opened and sprinkled on
applesauce, followed by water.
Keep in Mind • Remember, clients can get too much of a good
Teach client: thing. We need stomach acid. Watch for digestive
• Avoid alcohol, ASA, NSAIDS, smoking, caffeine, problems with foods and medications.
and foods that cause gastric distress.
Nursing Dx: Readiness for enhanced comfort level.

Misoprostol
(mye-soe-prost-ole)
Cytotec

Therapeutic/Pharmacologic Class • Misoprostol will cause spontaneous abortion.

Antiulcer agent, cytoprotective agent/Prostaglandin Contraception must be used throughout therapy.
Indications • Report diarrhea persisting for more than 1 wk; the
Prevention of gastric mucosal injury from NSAIDs, onset of black, tarry stools; or severe abdominal pain.
including aspirin, in high-risk clients (elderly clients, • Avoid alcohol, tobacco, and foods that may
debilitated clients, or those with a history of ulcers). cause an increase in GI irritation.
With mifepristone for termination of pregnancy.
Unlabelled uses: Treatment of duodenal ulcers.
Make the Connection
Action
Acts as a prostaglandin analog, decreasing gastric
• Assess client routinely for epigastric or
abdominal pain and for frank or occult blood in
acid secretion and increases the production of pro- the stool, emesis, or gastric aspirate.
tective mucus. Causes uterine contractions.
• Assess women of childbearing age for pregnancy.
Adverse Reactions/Side Effects Misoprostol is usually begun on 2nd or 3rd day of
CNS: headache. GI: abdominal pain, diarrhea, menstrual period following a negative pregnancy
constipation, dyspepsia, flatulence, nausea, and test result.
vomiting. GU: miscarriage, menstrual disorders.
Keep in Mind
Teach client:
• Take medication as directed for the full course of
therapy when first starting NSAID therapy.
Nursing Dx: Diarrhea; Readiness for enhanced comfort Also Used for: Reproductive system applications (induction of
level; Risk for injury (reproductive). labor/abortion) Universal Free E-Book Store
Sucralfate
(soo-kral-fate)
Carafate
Sulcrate

Therapeutic/Pharmacologic Class • Take medication for entire course.

Antiulcer agent/GI protectant • Take 1 hr prior to meals on an empty stomach.
Indications • May decrease effectiveness (absorption) of some
Management of peptic ulcers. Suspension used for medications. Check with health care provider.
mucositis/stomatitis/oral ulcers.
Activated by stomach acid to form a thick, protec-
tive paste.
• Assess for effectiveness of medication.
• Monitor drug levels, such as phenytoin, to assess
Adverse Reactions/Side Effects bioavailability.
CNS: dizziness and drowsiness. GI: constipa- • Tablets may begin to dissolve in the esophagus if
tion, diarrhea, indigestion, nausea. Derm: rash, client cannot swallow effectively, causing a chok-
pruritus. ing risk. Tablet will go easily into suspension.
Administer in this way with extra fluid.
Keep in Mind
Teach client:
• Report changes in bowel habit.
• Exercise, fiber, and fluids can stave off constipation.
Nursing Dx: Altered bowel elimination; Risk for injury

(Pharmacologic). Universal Free E-Book Store
Lansoprazole/Amoxicillin/
Clarithromycin
(lan-soe-pra-zole/a-mox-i-sil-in/kla-rith-roe-mye-sin)
(Prevacid/Amoxil/Biaxin)
PREVPAC
Bismuth Subsalicylate/
Metronidazole/Tetracycline
(biz-muth sub-sa-lis-i-late/me-troe-ni-da-zole/te-tra-sye-kleen)
Pepto-Bismol/Flagyl/Achromycin
HELIDAC Universal Free E-Book Store

Antiulcer agent/Anti-infective/Gastric pump inhibitor Teach client:
Indications • Take full course of therapy.
Treatment of peptic ulcers related to H. pylori • Bismuth pack is taken with an H2 histamine
infection. receptor blocker.
Action • Report any signs of bone marrow suppression or
hypersensitivity reaction immediately.
Decrease gastric acidity. Eliminate H. pylori infection
to cure gastric ulcers.
Adverse Reactions/Side Effects Make the Connection
GI: diarrhea, hepatic impairment. Hemat: Bone • Monitor effectiveness.
marrow suppression (anti-infective). Reyes syn- • Monitor CBC with differential count during therapy.
drome in age-susceptible children with associ- • Assess for rash.
ated viral infection (bismuth). GU: Renal • Monitor drug levels because these medications may
impairment, moniliasis. cause elevations in commonly used drugs like digoxin.
• Salicylates can cause Reye’s syndrome in suscepti-
ble persons.
Nursing Dx: Readiness for enhanced comfort level; Risk

for infection. Universal Free E-Book Store
Gastrointestinal System Drugs Antidiarrheals 11
Bismuth Subsalicylate
(biz-muth sub-sa-lis-i-late)
Pepto-Bismol
PMS-Bismuth Subsalicylate
Attapulgite
(at-a-pull-gite)
Kaopectate
Kaopectate
Therapeutic/Pharmacologic Class • Rest the gut; slowly introduce clear liquids (not
Antidiarrheal/Adsorbent apple juice).
Indications • Use OTC electrolyte solutions for pediatric clients
To decrease water content of stool. to prevent dehydration.
Action • If symptoms are not controlled within 24 hours,
Promote intestinal absorption of fluid and elec- or if symptoms of dehydration (decreased urina-
trolytes. Absorbent. tion, change in level of consciousness, weakness)
occur, report immediately to health care provider.
Adverse Reactions/Side Effects
GI: hepatic impairment, constipation, change in
stool color. Immune: risk for Reyes syndrome Make the Connection
(bismuth). •Salicylates cause Reyes syndrome in pedi-
atric clients.
Keep in Mind • Monitor frequency and character of stools.
Teach client:
• Use pediatric preparations to prevent
complications.
Nursing Dx: Diarrhea; Altered bowel elimination. Also Used for: Gastrointestinal system applications (ulcers, Crohn’s
disease, ulcerative colitis) Universal Free E-Book Store
Atropine
(at-ro-peen)
Atro-Pen
Hyoscyamine
(hi-oh-si-a-meen)
Anaspaz, Levsin

Therapeutic/Pharmacologic Class Derm: decreased sweating, urticaria. Misc: aller-

Antispasmodic/Anticholinergic gic reactions including anaphylaxis, fever (espe-
Indications cially in children), suppression of lactation.
Treatment of spastic bladder and bowel; including Keep in Mind
diverticulitis, infant colic, and biliary and renal colic; Teach client:
peptic ulcer disease; irritable bowel syndrome; and
neurogenic bowel disturbances. • Take exactly as directed.
• May cause drowsiness; avoid activities requiring
Action alertness.
Inhibit the muscarinic effect of acetylcholine in • Oral rinses, sugarless gum or candy, and frequent
smooth muscle, secretory glands, and the CNS. oral hygiene may help relieve dry mouth.
Adverse Reactions/Side Effects • Report change in urinary stream in males with
CNS: confusion/excitement (especially in geri- BPH.
atric clients), dizziness, flushing, headache,
insomnia, lightheadedness (IM, IV, SC), nerv-
ousness. EENT: blurred vision, cycloplegia,
Make the Connection
increased intraocular pressure, mydriasis, photo- •Anticholinergic medications cause symp-
toms that are categorized with the saying “hot as a
phobia. CV: palpitations, tachycardia. GI: dry
hare, dry as a bone, red as a beet, mad as a hatter,
mouth, altered taste perception, bloated feeling,
and blind as a bat.”
constipation, nausea, paralytic ileus, vomiting.
GU: impotence, urinary hesitancy/retention.
Nursing Dx: Risk for impaired urinary elimination; Also Used for: Cardiovascular system applications (bradycardia),
Readiness for enhanced bowel elimination pattern. sensory system applications (glaucoma), neurological system appli-
cations (Parkinsonian tremor) Universal Free E-Book Store
Diphenoxylate/ Loperamide
Atropine (loe-per-a-mide)
(dye-fen-ox-i-late/a-troe-peen)
Imodium
Lomotil
Codeine
(koe-deen)
Codeine

Therapeutic/Pharmacologic Class • Take with plenty of fluids.

Antidiarrheal • May cause drowsiness and dizziness.
Indications • Use hard candy or sugarless gum to moisten mouth.
Adjunctive therapy of acute diarrhea. Treatment of • Report any increased abdominal discomfort or
chronic diarrhea associated with inflammatory bowel urinary difficulties.
disease. Decreases the volume of ileostomy drainage.
Inhibit excess GI motility. Inhibit peristalsis and
prolong transit time by a direct effect on nerves in
• These drugs contain mild opioid agonists
but have no analgesic effects. Combining mild
the intestinal muscle wall. Reduce fecal volume, opioids with atropine or other drugs decreases the
increase fecal viscosity and bulk while diminishing likelihood of abuse.
loss of fluid and electrolytes.
• Drugs cause anticholinergic effects.
Adverse Reactions/Side Effects • Monitor intake and output, and character and
CNS: drowsiness, dizziness, nervousness. number of stools.
GI: constipation, abdominal pain/distention/ • Check bowel sounds. An area of increased bowel
discomfort, dry mouth, nausea, vomiting, ileus. sounds may indicate ileus, especially if additional
Misc: allergic reactions. clinical signs such as nausea and abdominal dis-
tention are present.
Keep in Mind • Monitor liver function studies and serum amylase
Teach client: levels if on long-term therapy.
• When atropine is added, expect anticholinergic
effects.
Nursing Dx: Constipation; Fluid volume deficit.

Gastrointestinal System Drugs Irritable Bowel Syndrome 14
Alosetron
(a-low-se-tron)
Lotronex

Gastrointestinal System Drugs Irritable Bowel Syndrome 14
Therapeutic/Pharmacologic Class one’s life. This is especially important for those

Anti-irritable bowel syndrome agent/5-HT3 receptor with IBS characterized by diarrhea because of the
inhibitor risk of acute ischemic colitis.
Indications • Be aware of and watch for signs of acute ischemic
Treatment of irritable bowel syndrome (IBS) charac- colitis.
terized by diarrhea. • Report worsening abdominal pain or rectal
bleeding.
Action
5-HT3 receptor site antagonism results in slowing of
colonic transit time in IBS characterized by diarrhea. Make the Connection
Adverse Reactions/Side Effects • IBS can be characterized by either
CNS: headache. GI: acute ischemic colitis, diarrhea or constipation.
constipation, abdominal discomfort, abdominal • Monitor therapy and watch for signs of abdominal
distention, flatulence, nausea, GI viral infections, distress.
hemorrhoids, regurgitation or reflux. • Monitor bowel sounds.
• Note character, amount, and ease of stooling.
Keep in Mind
Teach client:
• Take exactly as directed.
• Be aware of the risks and benefits of pharma-
cotherapy and the impact of IBS symptoms on
Nursing Dx: Readiness for enhanced bowel elimination

pattern; Risk for injury (colonic). Universal Free E-Book Store
Gastrointestinal System Drugs Laxatives/Bowel Preps/Antiflatulents 15
Psyllium
(sill-i-yum)
Metamucil,
Karacil
Methylcellulose
(meth-il-sell-you-lose)
Citrucel

Therapeutic/Pharmacologic Class • Follow mixture with another 8 oz of fluid.

Laxative/Bulk-forming agent • Become aware of natural bowel patterns, and do
Indications not force a bowel movement.
Management of simple or chronic constipation, • Do not take laxatives when abdominal pain,
particularly if associated with a low-fiber diet. cramping, or fever is present.
Useful in situations in which straining should be
avoided (after myocardial infarction, rectal surgery,
prolonged bed rest). Used in the management of Make the Connection
chronic watery diarrhea. • Bulk-forming agents are used for both
constipation and diarrhea.
Action
Combine with water in the intestines to form an
• It is better to allow the natural processes of the
body time to work to produce a bowel movement.
emollient gel or viscous solution that promotes Dietary choices, increasing fluid intake, and
peristalsis and reduces transit time. adding moderate exercise can promote regularity.
Adverse Reactions/Side Effects • Never allow the client, especially the elderly or those
Resp: bronchospasm. GI: cramps, intestinal or with risk of choking, to drink a gelled mixture.
esophageal obstruction, nausea, and vomiting.
Keep in Mind
Teach client:
• Do not let the mixture gel prior to drinking as this
may cause a choking risk.

pattern; Knowledge deficit.
Polyethylene Glycol/Electrolyte
(po-lee-eth-e-leen glye-kole/e-lek-troe-lite)
GoLYTELY, NuLytely, MIRALAX

Klean-Prep
Sodium Chloride/Sodium
Bicarbonate/Potassium
Chloride with Bisacodyl Slow
Release Tablets
Halflytely
Therapeutic/Pharmacologic Class drinking each 240-mL portion is preferred over

Laxative/Osmotic, intestinal stimulant drinking small amounts continuously.
Indications
Bowel cleansing in preparation for GI examination. Make the Connection
Unlabelled uses: Treatment of acute iron overdose
in children.
• May be administered on the morning of
the examination as long as time is allotted to drink
Action solution (3 hr) and evacuate bowel (1 additional hr).
Polyethylene glycol (PEG) in solution acts as an osmotic For barium enema, administer solution early in the
agent, drawing water into the lumen of the GI tract. evening (6 PM) prior to exam to allow proper
Adverse Reactions/Side Effects mucosal coating by barium.
GI: abdominal fullness, diarrhea, bloating, cramps, • PO: Solution may be reconstituted with tap
nausea, vomiting. Misc: allergic reactions (rare). water. Shake vigorously until powder is dissolved.
May be administered via NG tube at a rate of
Keep in Mind 20–30 mL/min.
Teach client: • When used as a laxative, may be mixed in 8 oz
• If using for bowel prep, fast for 3–4 hr prior to water and taken once daily up to 2 wk, then every
administration and never have solid food within 2 hr 2–4 days as needed.
of administration. • It is better to stool naturally. Clients should be
• Clear liquids only are allowed after administration. counseled on dietary choices, activity, and fiber
• If using the liquid prep, the client will drink 240 mL intake.
every 10 min until 4 L have been consumed or fecal • Monitor electrolytes, stool character, and subjec-
discharge is clear and free of solid matter. Rapidly tive data from client.
Nursing Dx: Imbalanced nutrition, less than body require-
ments; Fluid volume deficit; Knowledge deficit. Universal Free E-Book Store
Simethicone
(si-meth-i-kone)
Gas-X, Mylicon, Phazyme

Ovol

Therapeutic/Pharmacologic Class • Eat, chew, and swallow slowly to prevent excess

Antiflatulent/Surfactant gas formation.
Indications • Avoid carbonated beverages.
Relief of painful symptoms of excess gas in the GI tract
that may occur postoperatively or as a consequence of
air swallowing, dyspepsia, peptic ulcer, or diverticulitis. Make the Connection
Action • Assess client for abdominal pain, disten-
tion, and bowel sounds prior to and periodically
Causes the coalescence of gas bubbles. Does not throughout course of therapy. Frequency of belching
prevent the formation of gas. and passage of flatus should also be assessed.
Adverse Reactions/Side Effects • Administer after meals and at bedtime for best
None results. Shake liquid preparations well prior to
administration.
Keep in Mind • Chewable tablets should be chewed thoroughly
Teach client: before swallowing, for faster and more complete
• Diet and exercise are important in the prevention results. Give the chewable tablets after other
of gas. This medication does not prevent the for- medications.
mation of gas. • Drops can be mixed with 30 mL of cool water,
• Notify health care professional if symptoms are infant formula, or other liquid as directed. Shake
persistent. well before administering.
• Lie in fetal position with legs drawn to chest to
relieve gas discomfort, especially after laparo-
scopic procedures.
pattern; Pain. Universal Free E-Book Store
Sennoside Bisacodyl
(sen-oh-side) (bis-a-koe-dill)
Ex-Lax, Fletcher’s Dulcolax

Castoria, Senokot Bisaco-Lax
Casanthranol & Docusate

Sodium
(ka-san-thran-ole & dok-you-sate so-dee-um)
Peri-Colace

Therapeutic/Pharmacologic Class • Clients with cardiac disease should avoid straining

Laxative/Stimulant laxative during bowel movements (Valsalva maneuver).
Indications • Do not use laxatives when abdominal pain, nausea,
Treatment of constipation, particularly when vomiting, or fever is present.
associated with slow transit time, constipating
drugs, and irritable or spastic bowel syndrome.
Make the Connection
Action
Active components alter water and electrolyte
• Assess client for abdominal distention,
presence of bowel sounds, and usual pattern of
transport in the large intestine, resulting in bowel function.
accumulation of water and increased peristalsis.
• Assess color, consistency, and amount of stool
Adverse Reactions/Side Effects produced.
Neuro: dizziness, asthenia. CV: edema. Resp: • Abnormal bowel habits can cause dependence on
shortness of breath. GI: cramping, diarrhea, nau- laxatives (impaired peristalsis), diverticula devel-
sea. GU: discoloration of urine. F and E: elec- opment, and hemorrhoids. Natural is better.
trolyte abnormalities. Misc: laxative dependence. • These laxatives can be added to OTC “diet” aids.
Keep in Mind
• May be used as the initial part of bowel prep.
Teach client:
• Take for short-term therapy only.
• This medication can cause urine to appear pink,
red, violet, yellow, or brown.
Nursing Dx: Constipation; Diarrhea; Readiness for

enhanced bowel elimination pattern. Universal Free E-Book Store
Lactulose
(lak-tyoo-lose)
Cephulac, Kristalose, Chronulac

Lactulax

Therapeutic/Pharmacologic Class • Medication may cause belching, flatulence, or

Laxative/Osmotic abdominal cramping. Notify health care profes-
Indications sional if this becomes bothersome or if diarrhea
Treatment of chronic constipation in adults and occurs.
geriatric clients. Used in diabetic clients with gas-
troparesis. Adjunct in the management of portal- Make the Connection
systemic (hepatic) encephalopathy (PSE). • Assess client for presence of bowel
Action sounds.
Increases water content and softens the stool. • PSE: Assess mental status before and periodically
Lowers the pH of the colon, which inhibits the dif- throughout course of therapy.
fusion of ammonia from the colon into the blood, • Monitor serum ammonia levels (↓25%–50%) and
thereby reducing blood ammonia levels. serum glucose levels if diabetic.
Adverse Reactions/Side Effects • Monitor serum electrolytes periodically. May
GI: belching, cramps, distention, flatulence, cause diarrhea with resulting hypokalemia and
diarrhea. Endo: hyperglycemia (diabetic clients). hypernatremia. Metabolic acidosis can occur.
Loss of GI fluid from above the waist (vomiting
Keep in Mind or NGT suction)=metabolic alkalosis, from below
Teach client: the waist (diarrhea) causes loss of base=metabolic
• Increasing bulk in the diet, fluid intake, and mobility acidosis.
are other effective forms of bowel regulation. • To administer enema, use rectal balloon catheter.
Becoming aware of natural elimination patterns Mix 300 mL of lactulose with 700 mL of water or
is important. 0.9% NaCl. Retain 30–60 min.
Nursing Dx: Constipation; Altered bowel elimination. Universal Free E-Book Store
Docusate Calcium
(dok-yoo-sate kal-see-um)
Surfak; DC Softgels
Docusate Sodium
(dok-yoo-sate soe-dee-um)
Colace
Regulex

Therapeutic/Pharmacologic Class • Choose foods to enhance elimination.

Laxative, stool softener/Adsorbent • Cardiac and surgical clients (rectal/ocular)
Indications should not strain.
Prevention of constipation and straining at stool • Never use when abdominal pain, nausea, vomiting,
(cardiac clients, recent rectal surgery). Can be used or fever exists.
rectally to soften fecal impaction.
Adsorbent: pull water into stool. Increase elec-
trolyte and water secretion into colon.
• This is not a stimulant laxative.
• Give with increased amounts of clear fluid.
Adverse Reactions/Side Effects • Do not give within 2 hr of other laxatives, espe-
GI: mild cramps. EENT: throat irritation. cially mineral oil.
Derm: rashes. • Oral liquid is more palatable if diluted or mixed
with juice.
Keep in Mind
Teach client:
• Should be used for short-term use only and may
take time to work.
• Follow instructions for natural promotion of
bowel movement.
Nursing Dx: Constipation; Readiness for enhanced bowel

elimination pattern. Universal Free E-Book Store
Magnesium Magnesium
Oxide Sulfate (IV)
(mag-nee-zhum ox-ide) (mag-nee-zhum sul-fate)
Mag-Ox 400 Magnesium Sulfate Inj
Magnesium Hydroxide
(mag-nee-zhum hye-drox-ide)
Dulcolax Magnesia Tablets,

Phillips Magnesia Tablets,
Phillips Milk of Magnesia, MOM
Therapeutic/Pharmacologic Class • As an antacid: Report signs of GI bleeding (black,

Mineral and electrolyte replacement, supplement, tarry stools; coffee-ground emesis).
laxative/Saline • Laxatives should be used only for short-term
Indications therapy; long-term therapy may cause electrolyte
Treatment/prevention of hypomagnesemia. As a imbalance and dependence.
laxative/bowel evacuant. PO liquid is also used as • Notify health care professional if unrelieved
an antacid. constipation, rectal bleeding, or symptoms of
Action electrolyte imbalance (muscle cramps or pain,
Essential for the activity of many enzymes. Play an weakness, dizziness) occur.
important role in neurotransmission and muscular
excitability. Are osmotically active in GI tract, drawing Make the Connection
water into the lumen and causing peristalsis.
• Monitor electrolytes carefully.
Adverse Reactions/Side Effects • If IV form of magnesium is used, deep tendon
GI: diarrhea, bloating, cramping. Derm: flushing, reflexes must be reactive.
sweating. F and E: electrolyte imbalance. • Watch blood pressure.
Keep in Mind
Teach client:
• Do not take this medication within 2 hr of taking
other medications, especially fluoroquinolones,
nitrofurantoin, and tetracyclines.
Nursing Dx: Constipation; Risk for fluid volume deficit. Also Used for: Reproductive system (IV) applications (preterm labor,
preeclampsia), respiratory system (IV) applications (bronchodilation in
asthma), cardiovascular system (IV)Universal
applicationsFree
(Torsade de pointes).
E-Book Store
Gastrointestinal System Drugs Antiemetics 22
Scopolamine
(scoe-pol-a-meen)
Isopto Hyoscine, Transderm-Scop,

Transderm-V


Antiemetic/Anticholinergic Teach client:
Indications • Medication may cause drowsiness or blurred
Transdermal: Prevention of motion sickness. vision. Avoid driving or other activities requiring
Management of nausea and vomiting associated alertness until response to medication is known.
with opioid analgesia or general anesthesia/recovery • Use caution when exercising and in hot weather;
from anesthesia. Reduction of secretions in the dying overheating may result in heatstroke.
client in hospice care. IM, IV, Subcut: Preoperatively • Avoid concurrent use of alcohol and other CNS
for the production of amnesia and the reduction of depressants with this medication. Frequent
salivation and excessive respiratory secretions. mouth rinses, good oral hygiene, and sugarless
gum or candy may minimize dry mouth.
Action
Inhibits the muscarinic activity of acetylcholine. • Transdermal: Apply at least 4 hr (US product) before
exposure to travel to prevent motion sickness. Apply
Corrects the imbalance of acetylcholine and norepi- to hairless site. May bathe with patch in place.
nephrine in the CNS, which may be responsible for Remove if eye pain or excessive side effects occur.
motion sickness.
CNS: drowsiness, confusion. EENT: blurred Make the Connection
vision, mydriasis, photophobia. CV: tachycardia, • When using an anticholinergic, remember
palpitations. GI: dry mouth, constipation. the saying “hot as a hare, dry as a bone, red as a
GU: urinary hesitancy, urinary retention. beet, mad as a hatter, and blind as a bat” to help
Derm: decreased sweating. identify side effects.
• Assess client for nausea and vomiting periodically
during therapy.
Nursing Dx: Hyperthermia; Disturbed sensory perception. • Assess level of consciousness after surgical procedure.
Meclizine
(mek-li-zeen)
Antivert, Bonine, Dramamine II

Bonamine

Therapeutic/Pharmacologic Class • Frequent mouth rinses, good oral hygiene, and

Antiemetic/Antihistamine sugarless gum or candy may decrease dryness of
Indications mouth.
Management/prevention of motion sickness and • Avoid concurrent use of alcohol and other CNS
vertigo. depressants with this medication.
Action • When using as prophylaxis for motion sickness,
Has central anticholinergic, CNS depressant, and take medication at least 1 hr before exposure to
antihistaminic properties. Decreases excitability of conditions that may cause motion sickness.
the middle ear labyrinth and depresses conduction
in middle ear vestibular-cerebellar pathways. Make the Connection
Adverse Reactions/Side Effects • Assess client for level of sedation after
CNS: drowsiness, fatigue. EENT: blurred vision. administration.
GI: dry mouth. • Assess client for nausea and vomiting before and
60 min after administration.
Keep in Mind • Assess degree of vertigo periodically in clients
Teach client: receiving this medication for labyrinthitis.
• Take medication exactly as directed. If a dose is • May cause false-negative results in skin tests using
missed, take as soon as possible unless almost allergen extracts. Discontinue this medication 72 hr
time for next dose. Do not double doses. before testing.
• May cause drowsiness. Avoid driving or other • Administer oral doses with food, water, or milk to
activities requiring alertness until response to the minimize GI irritation. Chewable tablet may be
medication is known. chewed or swallowed whole.
Nursing Dx: Risk for injury; Altered oral mucous membrane; Also Used for: Sensory system applications (labyrinthitis)
Nausea. Universal Free E-Book Store
Prochlorperazine
(proe-klor-pair-a-zeen)
Compazine
Stemetil


Antiemetic, antipsychotic/phenothiazine Teach client:
Indications • Report uncontrolled tremor or muscle contraction
Management of nausea and vomiting. immediately.
Action • Change positions slowly to minimize orthostatic
hypotension.
Alters the effects of dopamine in the CNS. Possesses
significant anticholinergic and alpha-adrenergic • May cause drowsiness.
blocking activity. Depresses the chemoreceptor trigger • Avoid taking alcohol or other CNS depressants
concurrently with this medication.
zone (C TZ) in the CNS.
• Use sunscreen and protective clothing to prevent
Adverse Reactions/Side Effects photosensitivity reactions.
CNS: neuroleptic malignant syndrome, • Use good oral hygiene and sugarless gum or
extrapyramidal reactions, sedation. EENT: blurred candy for dry mouth.
vision, dry eyes, lens opacities. CV: ECG changes, • Urine may turn pink to reddish-brown.
hypotension, tachycardia. GI: constipation, dry
mouth, anorexia, drug-induced hepatitis, ileus.
GU: pink or reddish-brown discoloration of Make the Connection
urine, urinary retention. Derm: photosensitivity, • Side effects are serious. Never give to
pigment changes, rashes. Endo: galactorrhea. clients under age 16.
Hemat: agranulocytosis, leukopenia. • Assess for extrapyramidal symptoms.
Metab: hyperthermia. Misc: allergic reactions, • Assess for relief of nausea and vomiting.
Reyes syndrome in children under 16 years • Monitor chemistry panel and CBC with differential.
of age.
Nursing Dx: Risk for injury; Nausea; Impaired physical Also Used for: CNS mental health applications (antianxiety and
mobility. antipsychotic agent) Universal Free E-Book Store
Metoclopramide
(met-oh-kloe-pra-mide)
Reglan
Apo-Metoclop


Antiemetic/gastric stimulant Teach client:
Indications • May cause drowsiness.
Prevention of emesis related to chemotherapy and • Report any tremor or uncontrollable muscle
surgery. Reduction of GERD. Prevention of contraction immediately.
microaspiration in clients with enteral feedings. • Maintain hydration and protect from extremes of
Unlabeled use: treatment of hiccups. temperature.
Action • Avoid CNS depressants.
Blocks dopamine receptors in the chemoreceptor
trigger zone (CTZ) of the CNS. Stimulates motility of Make the Connection
the upper GI tract and accelerates gastric emptying. • Assess for nausea, abdominal distention,
Adverse Reactions/Side Effects and bowel sounds before giving.
CNS: drowsiness, extrapyramidal reactions, • Assess for extrapyramidal effects.
neuroleptic malignant syndrome, anxiety, • Observe for depression.
depression. CV: arrhythmias, hypertension, • Monitor hepatic panel and serum prolactin and
hypotension. GI: constipation, diarrhea, dry aldosterone (increases).
mouth, nausea. Endo: gynecomastia. • Have client rate nausea severity on a 0–10 scale.
Hemat: methemoglobinemia, bone marrow
suppression.
Nursing Dx: Nausea; Constipation; Risk for injury Also Used for: Cardiovascular system applications (adjunctive
(neurological). management of migraines) Universal Free E-Book Store
Ondansetron
(on-dan-se-tron)
Zofran
Granisetron
(gra-nees-e-tron)
Kytril


Antiemetic/5-HT3 receptor antagonist Teach client:
Indications • Take as directed.
Prevention of nausea and vomiting associated with • Notify health care professional immediately if invol-
chemotherapy and radiation therapy. IM, IV: Prevention untary movement of eyes, face, or limbs occurs.
and treatment of postoperative nausea and vomiting.
Block the effects of serotonin at receptor sites • Assess for extrapyramidal symptoms.
(selective antagonist) located in vagal nerve terminals • Assess effectiveness of antiemetic on a 0–10 scale
and in the chemoreceptor trigger zone in the CNS. of nausea severity.
Adverse Reactions/Side Effects • Monitor for nausea, bowel sounds, and gastric
CNS: headache, dizziness, drowsiness, fatigue, distention.
weakness. GI: constipation, diarrhea, abdominal • May cause transient ↑ in serum bilirubin, AST,
pain, dry mouth, increased liver enzymes. and ALT levels.
Neuro: extrapyramidal reactions. • If giving direct IV, look up time frame for infusion.
Nursing Dx: Nausea; Risk for injury (neurological). Universal Free E-Book Store
Gastrointestinal System Drugs Appetite Stimulants 27
Dronabinol
(droe-nab-i-nol)
THC, Marinol
Nabilone
(na-bi-lone)
Cesamet

Gastrointestinal System Drugs Appetite Stimulants 27

Antiemetic, Appetite stimulant/Cannabinoid Teach client:
Indications • Take exactly as directed.
Treatment of nausea and vomiting due to • Signs of overdose (mood changes, confusion, hallu-
chemotherapy that has not responded to other cinations, depression, nervousness, fast or pounding
conventional antiemetics. Stimulation of appetite in heartbeat) may occur with increased doses.
the cachexic client. • May cause dizziness, orthostatic hypotension,
drowsiness, and impaired judgment and
Action coordination.
Active ingredient in marijuana, with a wide variety
of CNS effects, including inhibition of the vomiting • Avoid taking alcohol or other CNS depressants
concurrently.
control mechanism in the medulla oblongata.
CNS: anxiety, concentration difficulty, confusion, Make the Connection
dizziness, drowsiness, mood change, abnormal • Monitor client closely for altered mental
thinking, depression, disorientation, hallucinations, status.
headache, impaired judgment, memory lapse, • Monitor vital signs periodically during therapy.
paranoia. EENT: dry mouth. CV: palpitations, • May cause anemia; monitor CBC.
syncope, tachycardia. GI: abdominal pain, • Appetite stimulation: Institute intake and output,
nausea, vomiting. Derm: facial flushing. daily weights, as well as calorie counts.
Neuro: ataxia, paresthesia. Misc: physical
dependence, psychological dependence (high
doses or prolonged therapy).
Nursing Dx: Nausea; Risk for unbalanced nutrition: less
than body requirements; Risk for injury. Universal Free E-Book Store
ENDOCRINE

Endocrine System Drugs Insulin—Very Rapid-Acting 28
Insulin Aspart, Insulin Lispro,

rDNA Origin rDNA Origin
(in-su-lin) (in-su-lin)
Novolog Humalog
Insulin Glulisine (rDNA

Origin) Injection
(in-su-lin)
Apidra

Endocrine System Drugs Insulin—Very Rapid-Acting 28

Antidiabetic agent, hormone/Pancreatic agent Teach client:
Indications • Use U-100 syringes with solutions containing
Treatment of diabetes mellitus. These antidiabetic 100 units/mL.
agents are described as very rapid-acting (onset • Sick days require more monitoring.
5–15 min, with peak 30–60 min). • Carry a source of glucose.
Action • Wear a Medic-Alert bracelet.
Lower blood glucose by stimulating glucose uptake • Watch for signs and symptoms of hypoglycemia and
hyperglycemia, and know what to do if they occur.
in skeletal muscle and fat, inhibiting hepatic glucose
production. Other actions are inhibition of lipolysis
and proteolysis. Make the Connection
Adverse Reactions/Side Effects • Because of the high error rate, 2 nurses
Derm: urticaria. Endo: hypoglycemia, rebound must check the insulin type and dose.
hyperglycemia (Somogyi effect). Local: • Very rapid-acting agents are called “dose and
lipodystrophy (lipoatrophy, lipohypertrophy), eat” for a reason. Onset 5–15 min!
itching, redness, swelling. Misc: allergic • Memorize the peak time of these medications!
reactions, including anaphylaxis. Look for hypoglycemia (normal 70–120 mg/dL).
• Hypoglycemia looks like an anxiety attack with
cold, clammy skin.
Nursing Dx: Readiness for enhanced nutrition metabolic

pattern. Universal Free E-Book Store
Endocrine System Drugs Insulin—Rapid-Acting 29
Regular Insulin
(in-su-lin)
Humulin R, Novulin R, Velosulin

Insulin-Toronto

Endocrine System Drugs Insulin—Rapid-Acting 29
Therapeutic/Pharmacologic Class • Recognize signs and symptoms of hyperglycemia

Antidiabetic agent, hormone/Pancreatic agent and hypoglycemia, and be aware of self-treat-
Indications ment measures if these occur.
Treatment of diabetes mellitus; can be used to treat • Hypoglycemia occurs during the peak time of this
diabetic ketoacidosis (DKA). drug (2–4 hr after injection).
Action • Consult with health care professional if feeling ill.
Lowers blood glucose by stimulating glucose uptake
in skeletal muscle and fat, inhibiting hepatic glucose Make the Connection
production. Also inhibits lipolysis and proteolysis,
enhancing protein synthesis.
• Two nurses should check the insulin
type, dosage, and expiration date.
Adverse Reactions/Side Effects • Rotate injection sites. May be injected SC into
Derm: urticaria. Endo: hypoglycemia, rebound abdominal wall, thigh, or upper arm.
hyperglycemia (Somogyi effect). Local: lipodys- • This is the only insulin type that can be given IV
trophy (lipatrophy, lipohypertrophy), itching, as a direct dose or continuous infusion.
redness, swelling. Misc: allergic reactions, • Monitor for hypoglycemia. This looks like a person
including anaphylaxis. having an anxiety attack with clammy skin.
Keep in Mind
• Remember the classic 3 “Ps” of diabetes
(polyuria, polyphagia, and polydipsia).
Teach client: • Long-term effects of poor glycemic control include
• Follow instructions for proper administration. neuropathy, nephropathy, and retinopathy.
• Administer the insulin at the correct time. Its
onset is 30 min.
Nursing Dx: Powerlessness; Readiness for enhanced
individual coping. Universal Free E-Book Store
Endocrine System Drugs Insulin—Slow-Acting 30
Insulin Zinc Suspension, Extended

(Ultralente Insulin)
Humulin U Ultralente
Novolin de Ultralente
Neutral Protamine Hagedorn (NPH)

Insulin (Isophane Insulin Suspension)
Intermediate Type
Humulin N
Novolin ge NPH
Endocrine System Drugs Insulin—Slow-Acting 30

Indications • Proper use of syringes and vials is important, as is
Treatment of diabetes mellitus. Because of the the proper storage of the insulin.
delayed and prolonged duration, cannot be used • Testing of serum glucose and ketones is important,
in the acute treatment of diabetic ketoacidosis. especially for sick day care.
Intermediate suspensions have onset of 1–2 hr • Carry a glucose source and wear a Medic-Alert
and peak of 4–12 hr. Extended suspensions bracelet!
(Ultra Lente) have onset of 4–6 hr, with peak at • Carbohydrate counting is a useful method for
18–24 hr. diet planning to control blood glucose.
Action • Know signs of hypoglycemia and hyperglycemia
and actions to take.
Lowering of blood glucose levels by stimulating
glucose uptake in skeletal muscle and fat, inhibiting • Notify health care professional if pregnancy is
planned or suspected.
hepatic glucose production. Other actions include
inhibition of lipolysis and proteolysis.
Derm: urticaria. Endo: hypoglycemia, rebound • Due to high error rate, 2 licensed nurses
hyperglycemia (Somogyi effect). Local: lipodys- must confirm solution and dose.
trophy (lipoatrophy, lipohypertrophy), itching, • Memorize peak times. Hypoglycemia will happen
redness, swelling. Misc: allergic reactions, during these times.
including anaphylaxis. • Hypoglycemia looks like an anxiety attack with
cold, clammy skin.
Nursing Dx: Readiness for enhanced nutritional metabolic
Endocrine System Drugs Insulin—Basal Agents 31
Insulin Detemir
(in-su-lin)
Levemir
Insulin Glargine
(in-su-lin)
Lantus

Endocrine System Drugs Insulin—Basal Agents 31

Indications • Follow instructions for proper administration
Treatment of diabetes mellitus. Because of its techniques.
delayed onset (1-2 hr) and prolonged duration, • Make sure that U-100 syringes are used with
medication cannot be used in the acute treatment 100-unit/mL insulin.
of diabetic ketoacidosis (DKA). • The onset is from 1–2 hr.
Action • Recognize signs and symptoms of hyperglycemia
and hypoglycemia, and be aware of self-
Lower blood glucose by stimulating glucose uptake treatment measures if these occur.
in skeletal muscle and fat; inhibit hepatic glucose
production. Other actions include inhibition of • Carry a simple sugar or glucose tablets in case of
hypoglycemia.
lipolysis and proteolysis, and enhanced protein
synthesis. • Consult with health care professional if feeling ill.
• Follow instructions for testing blood glucose.
Derm: urticaria. Endo: hypoglycemia, rebound
hyperglycemia (Somogyi effect). Local: lipodys- Make the Connection
trophy (lipatrophy, lipohypertrophy), itching, • Two nurses should check the insulin
redness, swelling. Misc: allergic reactions, type, dosage, and expiration date. Insulin-related
including anaphylaxis. medication errors have resulted in client harm and
death.
• Rotate injection sites.
• Monitor for hypoglycemia. This looks like a person
Nursing Dx: Powerlessness; Readiness for enhanced having an anxiety attack with cool, clammy skin.
individual coping. • Basal insulins cannot be mixed.
Endocrine System Drugs Antidiabetic Agents 32
Pramlintide
(pram-lin-tide)
Symlin


Antidiabetic agent/Synthetic analogue of human Teach client:
amylin. • Take the drug exactly as prescribed, at mealtimes.
Indications • Do not mix this drug in the same syringe with
Treatment of type 1 and type 2 diabetes in conjunction insulin.
with other antidiabetic agents. • Refrain from activities requiring alertness until the
effect on blood glucose is determined.
Action
Slows the rate of gastric emptying, reducing the • Do not drink alcohol, as this may result in
severe hypoglycemia.
amount of glucose absorbed postprandially.
Decreases the level of glucagon and reduces appetite. • Watch for signs and symptoms of hypoglycemia,
and know what to do in case they occur.
CNS: anxiety, blurred vision, seizures, coma,
headache, nightmares, dizziness, depression, Make the Connection
confusion. Derm: cool, pale skin. Resp: cough, • Review baseline Hgb A 1c level and recent
pharyngitis, shortness of breath, wheezing. blood glucose tests to plan care based on patterns
GI: difficulty swallowing, vomiting, weight loss, of glycemic control. Postprandial levels are the best
increased hunger. MS: muscle pain or stiffness, indicator of control.
pain in joints. CV: fast heartbeat, tightness in • A U-100 syringe is used to give this drug.
chest. Misc: hives; itching; puffiness or swelling • Rotate injection sites.
of the eyelids or around the eyes, face, lips, or • Watch for hypoglycemia within the first 3 hr
tongue; skin rash; and other allergic reactions, following injection.
including anaphylaxis. • Monitor for severe nausea and vomiting.
Nursing Dx: Readiness for enhanced metabolic patterns;
Risk for injury (pharmacologic). Universal Free E-Book Store
Exenatide
(ex-en-a-tide)
Byetta

Therapeutic/Pharmacologic Class • Follow instructions for SC administration with

Antidiabetic agent/Incretin mimetic agent prefilled pens.
Indications • Follow prescribed diet, medication, and exercise
Treatment of type 2 diabetes uncontrolled by regimen to remain euglycemic.
metformin and/or a sulfonylurea. Control of post- • Watch for signs of hypoglycemia and
prandial glucose levels. hyperglycemia.
Action • Stomach emptying is delayed with this medication,
Mimics the action of incretin, which promotes which may interfere with other medications. Take
insulin secretion from pancreas, decreases absorp- medications 1 hr prior to this drug.
tion of glucose from the gut, decreases the action • Wear a Medic-Alert bracelet.
of glucagon, and decreases appetite.
CV: dizziness, headache, jitteriness, weakness. • Monitor serum glucose, liver function
GI: diarrhea, nausea, vomiting, dyspepsia, tests, and weight.
gastrointestinal reflux. Derm: hyperhidrosis. • Remember, this drug is given by an invasive route.
Metab: ↓ appetite, weight loss. • An incretin mimetic acts like GLP-1, a hormone
that helps to decrease appetite and regulate
Keep in Mind glucose levels, especially postprandial levels
Teach client: (after meals).
• Administer 60 min before a meal. Do not take
after a meal.

pattern; Knowledge deficit. Universal Free E-Book Store
Metformin
(met-for-min)
Fortamet, Glucophage,
Glucophage XR
Novo-Metformin

Therapeutic/Pharmacologic Class • Inform health care professional of medication

Antidiabetic agent/Biguanide regimen before diagnostics or surgery.
Indications
Management of type 2 diabetes mellitus; may be used
with diet, insulin, or sulfonylurea oral hypoglycemics. Make the Connection
Action • Remember, this drug works differently
from an insulin secretagogue, so it is used in com-
Decreases hepatic glucose production. Decreases bination with other antidiabetic agents.
intestinal glucose absorption. Increases sensitivity
of the cell receptors to insulin.
• Lactic acidosis occurs more frequently in persons
with renal insufficiency.
Adverse Reactions/Side Effects • Assess renal function before initiating and at least
GI: abdominal bloating, diarrhea, nausea, vomiting, annually during therapy.
unpleasant metallic taste. Endo: hypoglycemia. • Monitor liver function tests, creatinine level,
F and E: lactic acidosis. Misc: decreased vitamin B12 serum folic acid, and vitamin B12.
levels. • This drug, when combined with iodinated contrast
dye, can cause kidney damage. The drug should be
Keep in Mind held on the day of the imaging procedure and for
Teach client: 48 hr after.
• Follow prescribed diet, medication, and exercise • XR tablets must be swallowed whole; do not
regimen to remain euglycemic. crush or chew.
• Symptoms of lactic acidosis should be reported
to the health care professional immediately.
Nursing Dx: Risk for injury; Knowledge deficit. Universal Free E-Book Store
Sitagliptin
(sit-a-glip-tin)
Januvia


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

pattern; Knowledge deficit. Universal Free E-Book Store
Repaglinide
(re-pag-gli-nide)
Gluconorm, Prandin
Nateglinide
(na-teg-li-nide)
Starlix

Therapeutic/Pharmacologic Class • Watch for signs of hypoglycemia and hyper-

Antidiabetic agent/Meglitinide glycemia, and take appropriate action.
Indications • Test blood glucose levels before meals and before
Treatment of type 2 diabetes mellitus, with diet and bed.
exercise; may be used with metformin, rosiglitazone, • Wear Medic-Alert bracelet.
or pioglitazone. • Not recommended during pregnancy; insulin is
Action safer.
Stimulate the release of insulin from pancreatic beta • Concurrent use of chromium and coenzyme Q 10
cells by closing potassium channels, which results in can cause an increase in hypoglycemia.
the opening of calcium channels in beta cells. This is • Blood glucose levels may rise with emotional or
followed by release of insulin. This is a secretagogue. physiological stress.
CV: angina, chest pain. Endo: hypoglycemia, Make the Connection
hyperglycemia. • Know the normal serum glucose level
and Hgb A1c. The nurse must act appropriately if
Keep in Mind these levels are abnormal.
Teach client: • Do not give this medication if the blood glucose
• Take 30 min before each meal, exactly as directed. level is low or if the client is NPO.
• Follow prescribed diet, medication, and exercise • Notice the clue in the brand name indicating that
regimen to remain euglycemic. these drugs reduce postprandial glucose levels.
Nursing Dx: Risk for injury; Readiness for enhanced

nutritional metabolic pattern. Universal Free E-Book Store
Acarbose
(aye-kar-bose)
Precose
Miglitol
(mi-gli-tole)
Glyset

Therapeutic/Pharmacologic Class • Carry an oral form of glucose for hypoglycemia.

Antidiabetic agent/alpha-glucosidase inhibitors Remember that sucrose is not digested.
Indications • Wear a Medic-Alert bracelet.
Management of diabetes in conjunction with • Monitor blood glucose levels. Do not take the
dietary therapy; may be used with insulin or other medication if glucose level is low.
hypoglycemic agents. • High sucrose intake causes increased GI side
Action effects.
Lowers blood glucose by inhibiting the enzyme
alpha-glucosidase in the GI tract. Sucrose is not Make the Connection
digested and passes through the GI tract
unchanged.
• It is very important to remember that
this drug stops sucrose from being digested and
Adverse Reactions/Side Effects used to increase the blood glucose level; so the old
GI: abdominal pain, diarrhea, flatulence, ↑ in remedy of candy, table sugar, or cake icing will not
transaminases. work.
Keep in Mind
• Memorize serum glucose (65–110 mg/dL range)
and Hgb A1c (below 7) levels.
Teach client: • Monitor transaminases after baseline obtained.
• Watch for signs of hypoglycemia and hyperglycemia, • This medication alone does not cause
and take appropriate actions. hypoglycemia, but it is often used with other
• Follow prescribed diet, medication, and exercise antidiabetics and potentiates their effect.
regimen to remain euglycemic. • Administer with first bite of each meal 3 times/day.
Nursing Dx: Altered bowel elimination; Readiness for
enhanced nutritional metabolic pattern. Universal Free E-Book Store
Glipizide Glimepiride
(glip-i-zide) (glye-me-pi-ride)
Glucotrol, Glucotrol XL Amaryl
Glyburide
(glye-byoo-ride)
DiaBeta, Micronase, Glynase PresTab

Apo-Glyburide


Antidiabetic agent/Sulfonylurea Teach client:
Indications • Watch for signs of hypoglycemia and take appro-
PO: Treatment of type 2 diabetes mellitus, as an priate actions.
adjunct to diet therapy or in cases of insulin resistance. • Follow prescribed diet.
Action • Monitor glucose levels before meals and at
bedtime.
Lower blood sugar by stimulating the release of
insulin from the pancreas (secretagogue) and • May occasionally cause dizziness or drowsiness.
Avoid activities requiring alertness.
increasing the sensitivity to insulin at receptor sites.
May also decrease hepatic glucose production. • Do not use alcohol (disulfram effect).
• Use sunscreen to prevent rash and burns.
Adverse Reactions/Side Effects • Wear a Medic-Alert bracelet.
CNS: dizziness, drowsiness, headache, weakness. • Report sore throat, unusual bruising, shortness of
GI: constipation, cramps, diarrhea, drug-induced breath, rash, or hives immediately.
hepatitis, dyspepsia, increased appetite, nausea,
vomiting. Derm: photosensitivity, rashes.
Endo: hypoglycemia. F and E: hyponatremia. Make the Connection
Hemat: aplastic anemia, agranulocytosis, • Monitor glucose and Hgb A 1c levels, post-
leukopenia, pancytopenia, thrombocytopenia. prandial glucose levels, complete blood count (CBC)
with differential count, liver and renal studies.
• Assess client for allergy to sulfonamides.
Remember that cross-sensitivity can occur.

Rosiglitazone
(roe-zi-glit-a-zone)
Avandia
Pioglitazone
(pi-o-glit-a-zone)
Actos

Therapeutic/Pharmacologic Class • If taken with other antidiabetic agents, monitor

Antidiabetic agent/Thiazolidinedione for signs and symptoms of hypoglycemia and
Indications take appropriate action.
Treatment of type 2 diabetes mellitus, as an adjunct • Laboratory studies will be necessary to assess
to diet and exercise. May be used alone or with glycemic control, liver function, lipid profile, and
other diabetic agents. renal function.
Action • Report edema, sudden weight gain, or shortness
In insulin resistance, improves receptor affinity of of breath immediately.
cells for glucose.
CV: CHF, edema. Derm: urticaria. Hemat: anemia. • Not for use in pregnant or lactating
Metab: Increased cholesterol, LDL, and HDL; women.
weight gain. Misc: angioedema rare). • Weigh the client and assess lungs for crackles
(CHF).
Keep in Mind • Monitor lab chemistries, CBC, and brain natri-
Teach client: uretic peptide (BNP) (especially in those clients
• Does not cause hypoglycemia and can be taken with a history of CHF).
without regard to food.

Endocrine System Drugs Pancreatics 40
Glucagon
(gloo-ka-gon)
GlucaGen

Endocrine System Drugs Pancreatics 40
Therapeutic/Pharmacologic Class • Follow instructions for administering the injection.

Hormone/Pancreatic agent Teach family members how to give the injection in
Indications case of emergency.
Acute management of severe hypoglycemia. • Oral glucose and a protein should be consumed
Action after the severe hypoglycemic episode is corrected.
Stimulates hepatic production of glucose from • If hypoglycemia causes unconsciousness, position
glycogen stores. Relaxes the musculature of the the family member on their side.
GI tract, temporarily inhibiting movement. Has a • Wear a Medic-Alert bracelet.
positive inotropic and chronotropic effect on the
heart. Make the Connection
Adverse Reactions/Side Effects • Know the signs of hypoglycemia.
CV: transient increase in heart rate and blood • Hypoglycemia will occur at antidiabetic agents’
pressure. GI: nausea, vomiting. Misc: hypersen- peak times.
sitivity reactions, including anaphylaxis. • Monitor glucose levels for 3–4 hr after
administration.
Keep in Mind • May be given IV.
Teach client:
• Used for hypoglycemia. It looks like an anxiety
attack with cold, clammy skin.
Nursing Dx: Risk for injury; Nausea. Also Used for: Gastrointestinal applications (relaxation of smooth
muscle of the gut during radiographs when barium
Universal FreeisE-Book
used) Store
Endocrine System Drugs Thyroid 41
Levothyroxine Liothyronine
(lee-voe-thye-rox-een) (lye-oh-thye-roe-neen)
Levothroid, Levoxyl, Cytomel, Triostat

Synthroid
PMS-Levothyroxine
Sodium
Liotrix Thyroid
(lye-oh-trix) (thye-royd)
Thyrolar Armour Thyroid


Hormone/Thyroid preparation Teach client:
Indications • Take medication in the morning.
Replacement therapy in clients without thyroid hor- • Report chest pain, palpitations, or dizziness
mone, or pharmacologic doses to enhance diminished immediately.
thyroid function. Replacement or pharmacologic • Full effects may not be felt for several weeks.
doses in neonates to correct inborn errors of metabo- • Report excessive weight loss.
lism (prevents developmental delay).
Metabolism of all nutrients is increased, promoting • The previously sluggish heart will beat
cell growth and increased protein synthesis. faster, increasing myocardial O2 needs. This may
lead to angina or even MI.
CNS: insomnia, irritability, nervousness, • Monitor T3, T4, and thyroid-stimulating hormone
(TSH) levels (TSH is high when thyroid function
headache. CV: cardiovascular collapse, arrhyth- is low).
mias, tachycardia, angina pectoris, blood
pressure changes, increased cardiac output. • Monitor glucose, weight, and increasing physical
and mental energy.
GI: cramps, diarrhea, vomiting. Derm: hair loss
in children, diaphoresis. Endo: hyperthyroidism,
menstrual irregularities. Metab: weight loss, heat
intolerance. MS: accelerated bone maturation in
children.
Nursing Dx: Fatigue; Ineffective tissue perfusion; Activity

intolerance. Universal Free E-Book Store
Calcitonin (Salmon)
(kal-si-toe-nin)
Calcimar, Miacalcin,
Osteocalcin, Salmonine
Calcitonin (rDNA)
Fortical


Hypocalcemic agent/Hormone Teach client:
Indications • Take medication exactly as directed.
Treatment of Paget’s disease of bone. Adjunctive • Report allergy to salmon or other seafood.
therapy for hypercalcemia. Management of post- • Flushing and warmth may occur (1 hr).
menopausal osteoporosis. Treatment of hypercal- • Diet should be high in calcium and vitamin D.
cemia related to bone cancer. • Alternate nares daily when using nasal spray, to
avoid nose bleeds.
Action
Decrease serum calcium by a direct effect on bone, • Weight-bearing exercise is beneficial for treatment
of osteoporosis.
kidney, and GI tract. Promote renal excretion of
calcium. Routes include intranasally, IM, and SC.
CNS: headaches. EENT: intranasal only—epistaxis, • Observe client for signs of hypersensitivity.
nasal irritation, rhinitis. GI: nausea, vomiting, • Assess for tetany, monitor the ECG, and check
altered taste, diarrhea. GU: urinary frequency. for Chvostek’s and Trousseau’s signs.
Derm: rashes. Local: injection site reactions. • Monitor serum calcium levels (8–11 mg/dL). The
MS: arthralgia, back pain. Misc: allergic reactions, drug name rhymes with “cali-bone-in.”
including anaphylaxis, facial flushing; swelling, • Ask the client to report nasal irritation.
tingling, and tenderness in the hands.
Nursing Dx: Readiness for enhanced activity-exercise

pattern; Risk for injury. Universal Free E-Book Store
Methimazole
(meth-im-a-zole)
Tapazole
Propylthiouracil
(proe-pill-thye-oh-yoor-a-sill)
PTU
Propyl-Thyracil

Therapeutic/Pharmacologic Class • Report sore throat, unusual bleeding, bruising,

Antithyroid agent pallor, shortness of breath, or extreme fatigue
Indications immediately.
Palliative treatment of hyperthyroidism. An adjunct • Wear a Medic-Alert bracelet.
to control hyperthyroidism in preparation for • Lab tests will be done frequently to assess effec-
thyroidectomy or radioactive iodine therapy. tiveness of the drug.
Action
Inhibit the synthesis of thyroid hormones. Make the Connection
Adverse Reactions/Side Effects • Watch for thyroid storm (thyrotoxicosis).
CNS: drowsiness, headache, vertigo. GI: diarrhea, characterized by tachycardia, palpitations, nervous-
drug-induced hepatitis, loss of taste, nausea, ness, insomnia, fever, diaphoresis, heat intolerance,
parotitis, vomiting. Derm: rash, skin discoloration, tremors, and weight loss.
urticaria. Hemat: agranulocytosis, anemia, • Conversely watch for signs of hypothyroidism.
leukopenia, thrombocytopenia. MS: arthralgia. • Assess client for skin rash or swelling of cervical
Misc: fever, lymphadenopathy. lymph nodes. Treatment may be discontinued if
this occurs.
Keep in Mind • Monitor thyroid function studies at baseline and
Teach client: when treatment is initiated.
• Monitor weight 2–3 times/wk. Notify health care • Monitor for bone marrow suppression.
professional of significant changes. • Monitor liver function tests.
• May cause drowsiness.
Nursing Dx: Risk for injury; Risk for imbalanced body
temperature; Risk for infection. Universal Free E-Book Store
Endocrine System Drugs Adrenal 44
Cortisone Hydrocortisone
(kor-ti-sone) (hye-droe-kor-ti-sone)
Cortone Cortef, Cortifoam,

Solu-Cortef
Methylprednisolone Prednisone
(meth-ill-pred-niss-oh-lone) (pred-ni-sone)
Medrol, Solu-Medrol Deltasone, Liquid

(IV), PredPak Pred, Meticorten

Therapeutic/Pharmacologic Class aseptic necrosis of joints, muscle pain. Misc: cushin-

Anti-inflammatory (steroidal) agent, immunosup- goid appearance, increased susceptibility to infection.
pressant/Glucocorticosteroid
Keep in Mind
Indications Teach client:
Systemic and local treatment of a wide variety of
inflammatory diseases and conditions. Replacement • Do not stop the medication suddenly.
therapy in adrenal insufficiency. • Avoid grapefruit juice and limit caffeine when
taking oral forms.
Action
Suppresses inflammation and the normal immune
response. Make the Connection
Adverse Reactions/Side Effects • Monitor intake and output, daily weights,
edema, lung sounds, serum electrolytes, CBC, and
CNS: depression, euphoria, headache, increased
glucose level.
intracranial pressure (children only), personality
changes, psychoses, restlessness. EENT: cataracts, • Give with food in the AM to decrease gastric
upset and mimic natural cortisol.
increased intraocular pressure. CV: hypertension.
GI: peptic ulceration. Derm: acne, decreased wound
healing, ecchymoses, fragility, hirsutism, petechiae.
Endo: adrenal suppression, hyperglycemia. F and Also Used for: Neurologic applications (acute spinal cord injury);
E: fluid retention, hypokalemia. Hemat: throm- respiratory applications (PO and inhalant forms to decrease airway
inflammation); integumentary applications (PO and topical for
boembolism, thrombophlebitis. Metab: weight gain, dermatitis); immune system applications (PO/IV to reduce auto-
hyperglycemia. MS: muscle wasting, osteoporosis, immune reactions); renal applications (PO to reduce inflammation
in the nephron); cancer treatment applications (palliative to reduce
inflammation at tumor sites); GI applications (PO/IV to reduce
Nursing Dx: Risk for infection; Hyperglycemia. inflammation of Crohn’s disease and ulcerative colitis).
Fludrocortisone
(floo-droe-kor-ti-sone)
Florinef


Hormone/Corticosteroid (mineralocorticoid) Teach client:
Indications • Take medication as directed. Abrupt discontinuation
Treatment of sodium loss and hypotension associated may lead to addisonian crisis.
with adrenocortical insufficiency (given with hydrocor- • Follow dietary modification prescribed by health
tisone or cortisone). Management of sodium loss due care professional.
to congenital adrenogenital syndrome (congenital • Wear a Medic-Alert bracelet.
adrenal hyperplasia). Unlabelled uses: Treatment of • Watch for signs and symptoms of addisonian crisis.
idiopathic orthostatic hypotension (with increased
sodium intake). Make the Connection
Action • Monitor blood pressure periodically during
Causes sodium reabsorption, hydrogen and potas- therapy.
sium excretion, and water retention by its effects on • Monitor for fluid retention (weigh daily, assess for
the distal renal tubule. edema, and auscultate lungs for rales/crackles).
Adverse Reactions/Side Effects • Monitor clients with Addison’s disease closely and
CNS: dizziness, headache. CV: CHF, arrhythmias, stop treatment if a significant increase in weight
edema, hypertension. GI: anorexia, nausea. or blood pressure, edema, or cardiac enlargement
Endo: adrenal suppression, weight gain. occurs. Clients with Addison’s disease are more
F and E: hypokalemia, hypokalemic alkalosis. sensitive to the action of this drug and may have
MS: arthralgia, muscular weakness, tendon an exaggerated response.
contractures. Neuro: ascending paralysis. • Monitor serum electrolytes periodically during
Misc: hypersensitivity reactions. therapy. This drug causes ↓ in serum potassium
levels.
Nursing Dx: Risk for fluid volume excess; Knowledge deficit. Universal Free E-Book Store
Endocrine System Drugs Pituitary Drugs 46
Oxytocin
(ox-i-toe-sin)
Pitocin, Syntocinon

Therapeutic/Pharmacologic Class F and E: maternal—hypochloremia, hyponatremia,

Hormone/Oxytocic agent water intoxication. Misc: maternal—increased
Indications uterine motility, painful contractions, abruptio
IV: Induction or augmentation of labor at term. placentae, decreased uterine blood flow, hyper-
Can be used as an abortive agent. Postpartum sensitivity.
control of bleeding after expulsion of the placenta. Keep in Mind
Intranasal: Promotion of milk let-down in lactating Teach client:
women. Unlabelled uses: Evaluation of fetal com-
petence (fetal stress test). • Expect contractions to become more severe and
last longer.
Action • Nasal spray: Administer nasal spray 2–3 min prior
Stimulates uterine smooth muscle, producing to planned breast-feeding to initiate let-down
uterine contractions similar to those in spontaneous reflex. Cramps are to be expected.
labor. Contracts the uterus to squeeze closed the
attachment sites of the placenta, so it stops excess
postpartum bleeding. Stimulates mammary gland Make the Connection
smooth muscle, facilitating lactation. Has vasopressor • Assess character, frequency, and duration
and antidiuretic effects. of uterine contractions; resting uterine tone; and fetal
heart rate frequently throughout administration.
CNS: maternal—coma, seizures; fetal—intracra- • This drug occasionally causes water intoxication.
nial hemorrhage. Resp: fetal—asphyxia, hypoxia. • Make sure there is a physician in-house at all
times when the client is on a continuous drip.
CV: maternal—hypotension; fetal—arrhythmias.
Nursing Dx: Acute pain; Powerlessness; Readiness for

enhanced home maintenance management (breast-feeding). Universal Free E-Book Store
Desmopressin
(des-moe-press-in)
DDAVP, DDAVP Rhinal Tube,

DDAVP Rhinyle Drops,
Octostim, Stimate
Vasopressin
(vay-soe-press-in)
Pitressin
Pressyn

Hormone/Antidiuretic hormone Teach client:
Indications • Notify health care professional if bleeding is not
Management of primary nocturnal enuresis unre- controlled or if headache, dyspnea, heartburn,
sponsive to other treatment modalities. Treatment nausea, abdominal cramps, vulval pain, or severe
of diabetes insipidus caused by a deficiency. nasal congestion or irritation occurs.
Action • Avoid use of alcohol with this medication.
Analogs or derivatives of naturally occurring antidi- • If increased urine output occurs, contact health
care professional for dosage adjustment.
uretic hormone. The primary action is enhanced
reabsorption of water in the kidneys. • Wear a Medic-Alert bracelet.
CNS: drowsiness, headache, listlessness. Make the Connection
EENT: intranasal—nasal congestion, rhinitis. • Assess client for symptoms of dehydration.
Resp: dyspnea. CV: hypertension, hypotension, • Weigh client daily and assess for edema.
tachycardia. GI: mild abdominal cramps, • Assess for signs of bleeding. Monitor clotting
nausea. GU: vulval pain. Derm: flushing. factors.
F and E: water intoxication/hyponatremia. • Monitor blood pressure and serum sodium level.
• Monitor for signs and symptoms of water
intoxication.
Nursing Dx: Risk for imbalanced fluid volume; Knowledge Also Used for: Hematology applications (desmopressin controls
deficit. bleeding in certain types of hemophilia and in von Willebrand’s
disease); gastrointestinal applications (desmopressin shortens
bleeding time in clients with liver Universal
disease) Free E-Book Store
Somatropin
(soe-ma-troe-pin)
Humatrope, Serostim


Hormone/Growth hormone Teach client:
Indications • Follow instructions for IM or SC injections and
Treatment of short stature in children with open proper disposal of syringes.
epiphyses. • Follow up with endocrinologist as recommended.
Action • Report any joint pain (fingers, legs, hips), as this
could be an epiphyseal abnormality.
Produces skeletal and cellular growth.
CV: edema of the hands and feet. Endo: hyper- Make the Connection
glycemia, hypothyroidism, insulin resistance. • Epiphyses must be open in order for
Local: pain at injection site. MS: arthralgia, medication to have an effect.
carpal tunnel syndrome. • Observe for epiphyseal abnormalities, such as
limping, pain, or joint disfigurement.
• Measure growth and reassure child that the
medication is working.
• Watch the glucose levels and monitor thyroid
function.
Nursing Dx: Risk for altered growth; Readiness for Also Used for: Musculoskeletal application (growth hormone
enhanced self-concept. deficiency in adults) and gastrointestinal applications (AIDS
wasting or cachexia, and short-bowel syndrome.)
Octreotide
(ok-tree-oh-tide)
Sandostatin, Sandostatin LAR

Therapeutic/Pharmacologic Class nausea, vomiting. Derm: flushing. Endo: hyper-

Antidiarrheal/Hormone glycemia, hypoglycemia. Local: injection-site
Indications pain.
Treatment of severe diarrhea and flushing episodes Keep in Mind
in clients with GI endocrine tumors, including Teach client:
metastatic carcinoid tumors and vasoactive intestinal
peptide (VIP) tumors (VIPomas). Relief of symptoms • May cause dizziness, drowsiness, or visual distur-
bances.
and suppressed tumor growth in clients with pituitary
tumors associated with acromegaly. Management • Change positions slowly to minimize orthostatic
hypotension.
of diarrhea in AIDS clients or clients with fistulas.
• Keep record of number and characteristics of
Action bowel movements.
Suppresses secretion of serotonin and gastroentero-
hepatic peptides. Increases absorption of fluid and
electrolytes from the GI tract and increases transit Make the Connection
time. Suppresses secretion of growth hormone, • Assess frequency and consistency of
insulin, and glucagon. stools and bowel sounds throughout therapy.
Adverse Reactions/Side Effects • Monitor pulse and blood pressure.
CNS: dizziness, drowsiness, fatigue, headache, • Assess client’s fluid and electrolyte balance.
weakness. EENT: visual disturbances. CV: edema, • Monitor diabetic clients for signs of hypo-
glycemia.
orthostatic hypotension, palpitations. GI: abdominal
pain, cholelithiasis, diarrhea, fat malabsorption, • Assess for gallbladder disease.
pattern; Risk for altered growth. Universal Free E-Book Store
Endocrine System Drugs Gonadal 50
Megestrol
(me-jess-trole)
Megace

Endocrine System Drugs Gonadal 50
Therapeutic/Pharmacologic Class • Report to health care professional any unusual

Antineoplastic, hormone/Progestin vaginal bleeding or signs of deep vein throm-
Indications bophlebitis.
Palliative treatment of endometrial and breast car- • This medication may have teratogenic effects.
cinoma, either alone or with surgery or radiation Contraception should be used during therapy
(tablets only). and for at least 4 months after therapy is
Action completed.
Antineoplastic effect may result from inhibition of • There is a possibility of hair loss.
pituitary function.
CV: thromboembolism, edema. GI: GI irritation. • Assess client for swelling (usually uni-
Derm: alopecia. Endo: asymptomatic adrenal laterally), pain, or tenderness in legs or armpit.
suppression (chronic therapy). Hemat: throm- Measure circumference and report these signs of
bophlebitis. MS: carpal tunnel syndrome. deep vein thrombophlebitis.
Keep in Mind
• May be administered with meals if GI irritation
becomes a problem.
Teach client: • Any ovarian hormone may pose a risk for throm-
• Take medication exactly as directed; do not skip bophlebitis and embolus formation.
or double up on missed doses. • Smoking increases the risk for thrombotic embolus
formation.
Nursing Dx: Risk for injury (cardiovascular); Impaired Also Used for: Gastrointestinal applications (appetite stimulant in
body image. cachexic clients) Universal Free E-Book Store
UROLOGIC

Urologic System Drugs Affecting Urination 51
Tolterodine Solifenacin
(tol-ter-oh-deen) (so-li-fen-a-sin)
Detrol, Detrol LA VESIcare
Oxybutynin (Oral)
(ox-i-byoo-ti-nin)
Ditropan, Ditropan XL
Oxybutynin (Transdermal)
Oxytrol
Therapeutic/Pharmacologic Class • May cause dizziness and blurred vision. Avoid

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

pattern; Impaired urinary elimination. Universal Free E-Book Store
Bethanechol
(be-than-e-kole)
Urecholine


Urinary tract stimulant/Cholinergic Teach client:
Indications • Change positions slowly to minimize orthostatic
Treatment of postpartum and postoperative nonob- hypotension.
structive urinary retention or urinary retention caused • Report abdominal discomfort, salivation, sweating,
by neurogenic bladder. or flushing to health care professional.
Action
Stimulates cholinergic receptors. Effects include con- Make the Connection
traction of the urinary bladder, decreased bladder • Monitor blood pressure, pulse, and
capacity, increased frequency of ureteral peristaltic respirations before administering.
waves, increased tone and peristalsis in the GI tract, • Monitor intake and output.
increased pressure in the lower esophageal sphincter, • Palpate abdomen for bladder distention.
and increased gastric secretions. • Catheterization may be ordered to assess post-
Adverse Reactions/Side Effects void residual.
CNS: headache, malaise. EENT: lacrimation, • Monitor liver and pancreatic enzymes.
miosis. Resp: bronchospasm. CV: heart block, • Notice the “chol” in both the generic and brand.
syncope/cardiac arrest, bradycardia, hypoten- That is a clue to its actions!
sion. GI: abdominal discomfort, diarrhea, • Remember the acronym SLUDGE: salivation,
nausea, salivation, vomiting. GU: urgency. lacrimation, urination, defecation, GI distress,
Misc: flushing, sweating, hypothermia. and emesis.
Nursing Dx: Readiness for enhanced urinary elimination

pattern; Pain (digestive). Universal Free E-Book Store
Urologic System Drugs Diuretics 53
Spironolactone Triamterene
(speer-oh-no-lak-tone) (trye-am-ter-een)
Aldactone Dyrenium
Novospiroton
Amiloride
(a-mill-oh-ride)
Midamor

Therapeutic/Pharmacologic Class growth (in women). F and E: hyperkalemia,

Diuretic, potassium-sparing diuretic/Na reabsorption hyponatremia, hyperchloremic metabolic acido-
inhibitor. sis. Hemat: agranulocytosis. MS: muscle
Indications cramps. Misc: allergic reactions.
Management of primary hyperaldosteronism. Keep in Mind
Management of edema associated with congestive Teach client:
heart failure, cirrhosis, and nephrotic syndrome.
Management of essential hypertension. Treatment • Avoid salt substitutes and high-potassium foods.
of hypokalemia (counteracts potassium loss caused • May cause dizziness.
by other diuretics). • Blood pressure and lab work will be monitored.
• Wear a Medic-Alert bracelet.
Action • Notify health-care professional if muscle weakness
Cause loss of sodium bicarbonate and calcium while or cramps; fatigue; or severe nausea, vomiting,
saving potassium and hydrogen ions by antagonizing palpitations, or diarrhea occur.
aldosterone. Blocks reabsorption of sodium in the
distal convoluted tubules and collecting ducts of the
nephrons, while conserving potassium. Make the Connection
Adverse Reactions/Side Effects •Monitor intake and output and daily
weight (the best indicator) during therapy.
CNS: dizziness, clumsiness, headache. CV:
arrhythmias. GI: GI irritation. GU: impotence, • Always assess potassium level (3.5–5 mEq/L) and
BP before administering.
dysuria. Endo: gynecomastia (in men), breast
tenderness, deepening of voice, increased hair • Monitor ECG for signs of hyperkalemia (tented T
waves).
Nursing Dx: Fluid volume excess (or deficit); Knowledge
deficit. Universal Free E-Book Store
Furosemide
(fur-oh-se-mide)
Lasix
Apo-Furosemide
Bumetanide
(byoo-met-a-nide)
Bumex

Therapeutic/Pharmacologic Class MS: arthralgia, muscle cramps, myalgia.

Diuretic/Loop diuretic Misc: increased BUN.
Indications Keep in Mind
Treatment of edema due to CHF, hepatic or renal Teach client:
disease, and hypertension.
• Change position slowly to minimize effects of
Action orthostatic hypotension.
Inhibit reabsorption of sodium and chloride from the • Consume high-potassium foods or prescribed
loop of Henle and distal renal tubule. Increase water, potassium supplements (as directed).
sodium, chloride, magnesium, hydrogen, calcium, and • Use sunscreen.
potassium. May have peripheral vasodilatory effects. • Report any unusual bleeding, bruising, sore
Adverse Reactions/Side Effects throat, or shortness of breath.
CNS: dizziness, encephalopathy, headache, • Report, prior to starting therapy, any allergic
insomnia, nervousness. EENT: hearing loss, tinni- reaction to sulfonamides.
tus. CV: hypotension. GI: constipation, diarrhea,
dry mouth, dyspepsia, nausea, vomiting. GU:
excessive urination. Derm: photosensitivity, rashes.
Make the Connection
Endo: hyperglycemia. F and E: dehydration, • Always check potassium level (3.5–5 mEq/L)
and BP prior to giving.
hypochloremia, hypokalemia, hypomagnesemia,
hyponatremia, hypovolemia, metabolic alkalosis • Watch the ECG for arrhythmias.
due to loss of hydrogen ion. Hemat: blood • Bone marrow suppression can occur.
dyscrasias. Metab: hyperglycemia, hyperuricemia. • Photosensitivity may be severe.
• Low potassium causes digoxin toxicity.
Nursing Dx: Fluid volume excess (or deficit); Risk for injury. Also Used for: Immune system applications (hypercalcemia of
malignancy) Universal Free E-Book Store
Chlorothiazide
(klor-oh-thye-a-zide)
Diuril
Hydrochlorothiazide
(hye-droe-klor-oh-thye-a-zide)
Esidrex, HCTZ
Apo-Hydro


Antihypertensive, diuretic/Thiazide diuretic Teach client:
Indications • Change position slowly to minimize effects of
Management of mild-to-moderate hypertension. orthostatic hypotension.
Treatment of edema associated with congestive • Consume high-potassium foods.
heart failure (CHF), renal dysfunction, cirrhosis, • Use sunscreen.
corticosteroid therapy, and estrogen therapy. • Report any unusual bleeding, bruising, sore
throat, or shortness of breath.
Action
Increase excretion of sodium and water by inhibiting • Report, prior to starting therapy, any allergic
reaction to sulfonamides.
sodium reabsorption in the distal tubule. Promote
excretion of chloride, potassium, magnesium, and • Report severe abdominal pain or yellow
coloration of skin or whites of eyes.
bicarbonate. May produce arteriolar dilation.
CNS: dizziness, drowsiness, lethargy, weakness. Make the Connection
CV: hypotension. GI: anorexia, cramping, hepatitis, • Always check potassium level (3.5–5 mEq/L)
nausea, vomiting. Derm: photosensitivity, rashes. and BP prior to giving.
Endo: hyperglycemia. F and E: hypokalemia, • Watch the ECG for arrhythmias.
dehydration, hypercalcemia, hypochloremic • Bone marrow suppression can occur so monitor
alkalosis, hypomagnesemia, hyponatremia, the CBC.
hypophosphatemia, hypovolemia. Hemat: blood • Photosensitivity may be severe.
dyscrasias. Metab: hyperuricemia, elevated lipids. • Low potassium causes digoxin toxicity.
MS: muscle cramps. Misc: pancreatitis. • Monitor liver function tests, amylase and lipase
Nursing Dx: Fluid volume excess (or deficit); Risk for injury. levels.
Urologic System Drugs Men’s Health 56
Sildenaf il Tadalafil
(sil-den-a-fil) (ta-da-la-fil)
Revatio, Viagra Cialis
Vardenaf il
(var-den-a-fil)
Levitra


Anti-impotence agent/Phosphodiesterase type Teach client:
5 inhibitor • Take as prescribed before sexual activity.
Indications • Do not take with other drugs, unless directed to
Treatment of erectile dysfunction. do so by health care provider.
Action • Erections lasting longer than 4 hr (priapism) or
sudden, decreased vision loss in one or both eyes
Enhance effects of nitric oxide released during sexual must be reported immediately.
stimulation. Nitric oxide activates guanylate cyclase,
which produces increased levels of cyclic guanosine
monophosphate (cGMP). cGMP produces smooth Make the Connection
muscle relaxation of the corpus cavernosum, which •This medication causes vasodilation in
promotes increased blood flow and subsequent the penis and in other areas of the body, so it
erection. should not be given with any other vasodilating
Adverse Reactions/Side Effects agent.
CNS: headache, dizziness, insomnia. • Assess effectiveness through interview.
EENT: abnormal vision (color tinge to vision,
increased sensitivity to light, blurred vision), epis-
taxis, nasal congestion. CV: MI, sudden death,
cardiovascular collapse. GI: dyspepsia, diarrhea.
GU: priapism, urinary tract infection. Derm: flush-
ing, rash. MS: mylagia. Neuro: paresthesias.
Nursing Dx: Readiness for enhanced sexuality patterns; Also Used for: Respiratory system applications (pulmonary hyper-
Risk for injury. tension) Universal Free E-Book Store
Doxazosin
(dox-ay-zoe-sin)
Cardura
Tamsulosin
(tam-soo-loe-sin)
Flomax

Therapeutic/Pharmacologic Class ejaculation. Derm: flushing, rash, urticaria.

Antihypertensive, prostatic urethra relaxant/ MS: arthralgia, arthritis, gout, myalgia.
Peripherally acting antiadrenergic
Keep in Mind
Treatment of symptomatic benign prostatic hyper-
plasia (BPH). Management of outflow obstruction • Take this medication exactly as prescribed.
in male patients with BPH. • Avoid driving or other activities requiring alertness
until response to medication is known.
Action • Change positions slowly to decrease orthostatic
Decrease contractions in smooth muscle of the hypotension.
prostatic capsule by preferentially binding to • Maintaining appointments for follow-up visits is
alpha1-adrenergic receptors. important to determine effectiveness of therapy.
Adverse Reactions/Side Effects • Avoid drinking alcohol, as this may cause worsening
CNS: dizziness, headache, depression, drowsi- orthostatic hypotension.
ness, fatigue, nervousness, weakness.
EENT: abnormal vision, blurred vision, conjunc-
tivitis, epistaxis. Resp: dyspnea. CV: first-dose
Make the Connection
orthostatic hypotension, arrhythmias, chest • Monitor blood pressure and pulse 2–6 hr
after first dose, with each increase in dose, and peri-
pain, edema, palpitations. GI: abdominal
odically during therapy. Report significant changes.
discomfort, constipation, diarrhea, dry mouth,
flatulence, nausea, vomiting. GU: decreased • Monitor intake and output, weight, and edema.
libido, sexual dysfunction, retrograde/diminished • Assess client for symptoms of prostatic hyperplasia
prior to and periodically during therapy.
Nursing Dx: Risk for falls; Readiness for enhanced urinary Also Used for: Cardiovascular system applications (hypertension)
Finasteride
(fi-nas-teer-ide)
Propecia, Proscar
Dutasteride
(doo-tas-te-ride)
Avodart

Therapeutic/Pharmacologic Class • Women who are pregnant or may become preg-

Benign prostatic hyperplasia (BPH) agent/Androgen nant should avoid exposure to semen of a partner
inhibitor taking this medication and should not handle
Indications crushed finasteride because of the potential for
Management of the symptoms of BPH in men with absorption. Absorption may cause birth defects if
an enlarged prostate gland. the woman is pregnant.
Action • Follow-up examinations and laboratory work
Inhibit the enzyme 5-alpha-reductase, which is should be expected.
responsible for converting testosterone to its potent
metabolite 5-alpha-dihydrotestosterone in prostate, Make the Connection
liver, and skin. 5-alpha-dihydrotestosterone is partially
responsible for prostatic hyperplasia and hair loss.
• Assess prostate-specific antigen (PSA)
levels at baseline and during treatment.
Adverse Reactions/Side Effects • Assess urinary stream.
GU: decreased libido, decreased volume of • Assess nocturia, hesitation, and urgency.
ejaculate, impotence. • Remember, this is a testosterone inhibitor.
Significant birth defects could occur in the case
Keep in Mind of women who come into contact with the med-
Teach client: ication (through sperm or the tablet itself) who
• Volume of ejaculate may be decreased during are pregnant and carrying a male fetus (testos-
therapy, but this will not interfere with normal terone inhibition).
sexual function. Sexual dysfunction side effects
will diminish over time.
Nursing Dx: Readiness for enhanced urinary elimination Also Used for: Integumentary system applications (male pattern
patterns. baldness in men only) Universal Free E-Book Store
Urologic System Drugs Dialysis/Renal Failure 59
Sevelamer
(se-vel-a-mer)
Renagel
Calcium Acetate
(kal-see-um ass-e-tate)
Calphron, PhosLo

Therapeutic/Pharmacologic Class • If GI effects are severe or prolonged, notify health

Electrolyte modifier/Phosphate binder care professional.
Indications • Report palpitations or tingling if the calcium
Reduction of serum phosphate levels in clients with form is used.
hyperphosphatemia associated with end-stage renal
disease.
Make the Connection
Action
Polymers that bind phosphate in the GI tract, pre-
• Assess client for GI side effects periodi-
cally during therapy.
venting its absorption or exchange of phosphate for
calcium in excretory system.
• Monitor serum phosphorus, calcium, bicarbonate,
and chloride levels periodically during therapy.
Adverse Reactions/Side Effects • Doses of concurrent medications, especially
GI: diarrhea, dyspepsia, vomiting, constipation, antiarrhythmics, should be spaced at least 1 hr
flatulence, nausea. CNS: tingling. CV: arrhyth- before or 3 hr after these medications.
mias, bradycardia, vomiting. GU: calculi, • Administer with meals. Tablets should not be
hypercalciuria. broken, chewed, or crushed.
Keep in Mind
Teach client:
• Do not break, crush, or chew tablets.
• Space concurrent medications at least 1 hr before
or 3 hr after these medications.
Nursing Dx: Knowledge deficit; Risk for injury (pathologic

fracture). Universal Free E-Book Store
Vitamin B with
Vitamin C
(vye-ta-min B with C)
Renal Caps, Nephrocaps


Vitamin/Water-soluble vitamin Teach client:
Indications • Comply with diet recommendations of health-care
Treatment and prevention of vitamin deficiencies in professional.
dialyzed clients. • Consume a well-balanced diet.
Action • Watch for signs and symptoms of vitamin B and
C deficiency.
Contains most or all of the B-complex vitamins (B1,
B2, B3, B5, B6, B12) and vitamin C, a diverse group of
compounds necessary for normal growth and devel- Make the Connection
opment that act as coenzymes or catalysts in • Remember, dialysis flushes water-soluble
numerous metabolic processes. vitamins out of the body.
Adverse Reactions/Side Effects • Monitor client for anaphylaxis (wheezing,
GU: bright-yellow urine. Misc: anaphylaxis urticaria, edema); contains thiamine.
(vitamin B1-thiamine), allergic reactions to • Monitor laboratory values for hematology and
preservatives. B vitamins.
• Monitor ability to heal and occurrence of gingivitis.
• B vitamins are vital to “b”lood and “b”rain health.
Nursing Dx: Risk for imbalanced nutrition: less than body

requirements. Universal Free E-Book Store
Calcitriol
(kal-si-trye-ole)
Rocaltrol

Therapeutic/Pharmacologic Class E: hypercalcemia. Local: pain at injection site.

Vitamin/Fat-soluble vitamin Metab: hyperthermia. MS: bone pain, metastatic
Indications calcification, muscle pain. Misc: allergic reactions
Management of hypocalcemia in clients undergoing (pruritus, rash, urticaria).
chronic renal dialysis (IV and PO). Treatment of Keep in Mind
hypocalcemia in clients with hypoparathyroidism or Teach client:
pseudohypoparathyroidism (PO only). Management
of secondary hyperparathyroidism (PO only). • Consume foods high in calcium and vitamin D.
• Avoid concurrent use of antacids containing
Action magnesium.
Promotes the absorption of calcium and decreases
parathyroid hormone concentrations.
CNS: headache, somnolence, weakness. • Observe client carefully for hypocalcemia.
EENT: conjunctivitis, photophobia, rhinorrhea. • Serum calcium, phosphorus, magnesium, alkaline
phosphatase, and intact parathyroid hormone
CV: arrhythmias, hypertension. GI: abdominal
concentrations will be monitored at least monthly.
pain, anorexia, constipation, dry mouth, liver
function test elevation, metallic taste, nausea,
pancreatitis, polydipsia, vomiting, weight loss.
GU: albuminuria, azotemia, decreased libido,
nocturia, polyuria. Derm: pruritus. F and
Nursing Dx: Risk for injury (pathologic fracture); Risk for Also Used for: Musculoskeletal system applications (promotion of
imbalanced nutrition: less than body requirements. calcium absorption in osteoporosis); integumentary system
applications (psoriasis) Universal Free E-Book Store
Epoetin
(e-poe-e-tin)
Epogen, Procrit
Eprex

Therapeutic/Pharmacologic Class Make the Connection

Antianemic/Hormone • Institute seizure precautions in clients who
Indications experience greater than a 4-point increase in
Treatment of anemia associated with chronic renal hematocrit in a 2-wk period or exhibit change in
failure. mental status.
Action • Do not shake the vial. It will turn into unusable
suds, and the medication is expensive.
Stimulates erythropoiesis (red blood cell production).
• Monitor CBC.
• May need more heparin during hemodialysis.
CNS: seizures, headache. CV: hypertension,
thrombotic events. Derm: transient rashes.
• Monitor blood pressure for increases that may
need treatment.
Endo: restored fertility, resumption of menses. • Monitor thrill and bruit in arteriovascular grafts.
Keep in Mind • Monitor serum ferritin, transferrin, and iron levels.
Teach client:
• Menses and fertility may return in women of
childbearing age.
• Learn how to sense and protect oneself from
seizures (teach family members, also)
• Consume foods high in iron, like meat and eggs,
or take an iron supplement.
Nursing Dx: Activity intolerance; Ineffective tissue perfusion; Also Used for: Immune system applications (anemia associated
Risk for injury (seizures). with chemotherapy [nonmyeloid cancers]); cardiovascular system
applications (reduction of need forUniversal
transfusionFree
after E-Book
surgery) Store
Iron Dextran Iron

(eye-ern dex-tran)
Polysaccharide
(eye-ern poll-ee-sak-a-ride)
DexFerrum, InFeD
Niferex
Iron Sucrose
(eye-ern su-krose)
Venofer

Therapeutic/Pharmacologic Class • A balanced diet is important.

Antianemic/Supplement • Watch for symptoms of CHF (rare), like activity
Indications intolerance, edema, lethargy, and palpitations.
Prevention/treatment of anemia in clients undergoing
hemodialysis who are concurrently receiving epoetin.
Make the Connection
Action
An essential mineral found in hemoglobin, myoglo-
• Monitor serum levels.
bin, and many enzymes, essential for red blood cell
• Monitor CBC, especially reticulocyte, hemoglobin,
and hematocrit levels.
formation.
• Monitor for allergic reactions.
Adverse Reactions/Side Effects • If giving PO, use a straw to avoid staining teeth.
CNS: IM, IV–seizures, dizziness, headache, • If giving IM, give by Z-track to avoid staining
syncope. CV: IM, IV–hypotension, tachycardia, the skin.
hemochromatosis, heart failure. GI: nausea, • Monitor for stomach pain, which is one of the
constipation, dark stools, diarrhea, epigastric first signs of toxicity.
pain, GI bleeding, taste disorder. Derm: IM, IV– • Assess weight, activity tolerance, and lung sounds
flushing, urticaria. Local: pain at injection site, to rule out CHF.
skin staining. MS: arthralgia, myalgia. • Avoid giving coffee, tea, dairy, eggs, and whole
Misc: staining of teeth, allergic reactions. grain breads for 1 hr after PO dose.
Keep in Mind • Orange juice (PO form) aids in absorption.
Teach client:
• Stools may become very dark. They should have a
dark-green halo when water is mixed, not red.
Also Used for: Cardiovascular system applications (iron-deficiency
Nursing Dx: Activity intolerance; Ineffective tissue perfusion. anemia)
IMMUNE

Immune System Drugs Anti-Inflammatory and Disease-Modulating Agents 64
Allopurinol
(al-oh-pure-i-nole)
Zyloprim, Alloprim
Apo-Allopurinol

Therapeutic/Pharmacologic Class • Report skin rash or influenza symptoms to the

Antigout and antihyperuricemic agent/xanthine oxi- HCP immediately; this may indicate
dase inhibitor hypersensitivity.
Indications • Take with food to minimize gastric distress.
Prevention of attacks of gouty arthritis and nephropa- • Increase daily fluid intake as directed.
thy. Treatment of secondary hyperuricemia, which
may occur during treatment of tumors or leukemias.
Make the Connection
Action
Inhibits the production of uric acid by inhibiting the
• Minimum fluid intake for persons being
treated for gout is 2500–3000 mL/day.
action of xanthine oxidase.
• Monitor for clinical signs of toxicity or hypersensi-
Adverse Reactions/Side Effects tivity (vomiting, diarrhea, or rash).
CNS: drowsiness. GI: diarrhea, hepatitis, nausea, • Monitor the CBC with differential, RFTs, LFTs,
vomiting. GU: renal failure. Derm: rash, urticaria. and blood glucose.
Hemat: bone marrow suppression. Misc: hyper- • Recent studies have shown that this medication
sensitivity reactions. combined with colchicine may be more effective
at preventing gouty flare-ups.
Keep in Mind
Teach client:
• Dietary changes must be made (alkaline ash diet).
Alcohol must be avoided to avoid gouty attacks.
Nursing Dx: Risk for infection; Acute pain; Knowledge Also Used for: Musculoskeletal system applications (gouty arthritis)
Cyclosporine
(sye-kloe-spor-een)
Sandimmune, Restasis

Therapeutic/Pharmacologic Class Hemat: bone marrow suppression. Metab:

Immunosuppressant, disease-modulating hyperlipidemia, hyperuricemia. Neuro: hyperes-
antirheumatic drug (DMARD)/Polypeptide (cyclic) thesia, paresthesia. Misc: gingival hyperplasia,
Indications hypersensitivity reactions, infections.
Prevention and treatment of organ rejection. Keep in Mind
Prevention and treatment of graft vs. host disease Teach client:
in bone marrow transplant clients. Treatment of
autoimmune diseases. Treatment of inflammatory • For most indications, this drug will be needed for life.
dry eye. • Report sore throat or feelings of ill health.
• Cosmetic changes (hirsutism, acne) may occur.
Action
Inhibits normal immune responses by inhibiting
interleukin-2, a factor necessary for initiation of Make the Connection
T-cell activity. • Monitor CBC with differential, RFTs,
chemistries, serum drug levels, and LFTs.
CNS: seizures, tremor, confusion, flushing, head- • Monitor I&O, daily weight, and BP.
ache, psychiatric problems. CV: hypertension. • Assess for symptoms of organ rejection.
GI: diarrhea, hepatotoxicity, nausea, vomiting, • When administering IV, monitor client for signs and
symptoms of hypersensitivity.
abdominal discomfort, anorexia, pancreatitis.
GU: nephrotoxicity. Derm: hirsutism, acne.
F and E: hyperkalemia, hypomagnesemia.
Nursing Dx: Risk for infection; Risk for injury; Excess fluid Also Used for: Sensory system applications (dry eye); musculoskeletal
volume. system applications (RA); integumentary system Free
Universal applications
E-Book(psoriasis)
Store
Colchicine
(kol-chi-seen)
Colchicine

Therapeutic/Pharmacologic Class • Report nausea, vomiting, abdominal pain,

Antigout agent/Anti-inflammatory agent diarrhea, unusual bleeding, bruising, sore throat,
Indications fatigue, malaise, or rash promptly.
Treatment and prevention of acute attacks of gouty • Increase daily fluid intake as directed.
arthritis.
Interferes with the functions of WBCs in initiating
and perpetuating the inflammatory response to
• Assess client for toxicity.
monosodium urate crystals.
• An overdose can be fatal. Cumulative dose by
any route should not exceed 4 mg.
Adverse Reactions/Side Effects • During initiation of therapy, monitor for drug
GI: diarrhea, nausea, vomiting, abdominal response (pain relief in affected area) every 1–2 hr.
pain. GU: anuria, hematuria, renal damage. • Monitor intake and output.
Derm: alopecia. Hemat: bone marrow sup- • Monitor LFT, RFT, chemistries, and CBC with
pression. Local: phlebitis at IV site. Neuro: differential.
peripheral neuritis. • Administer oral doses with food to minimize
gastric irritation.
Keep in Mind • Monitor IV site carefully to avoid extravasation.
Teach client:
• Take the medication as directed.
• Do not consume alcohol and maintain dietary
restrictions.
Nursing Dx: Acute pain; Knowledge deficit; Risk for Also Used for: Musculoskeletal system applications (gouty arthri-
infection. tis); gastrointestinal system applications (cirrhotic
Universal Freehepatitis)
E-Book Store
Celecoxib
(sel-e-kox-ib)
Celebrex


Antirheumatic, nonsteroidal anti-inflammatory Teach client:
drug (NSAID)/Cyclo-oxygenase-2 (COX-2) inhibitor • Do not take this drug if a history of high blood
Indications pressure or heart failure exists.
Relief of signs and symptoms of osteoarthritis, • Do not take this drug if a history of stomach
rheumatoid arthritis (RA), and ankylosing spondylitis. ulcers and GI bleeding exists.
Reduction of the number of adenomatous colorectal • Report a rash immediately.
polyps in familial adenomatous polyposis (FAP), as • Report nausea, fatigue, lethargy, itching, jaun-
an adjunct to usual care (endoscopic surveillance, dice, upper right quadrant tenderness, flu-like
surgery). Management of acute pain, including symptoms, or edema.
primary dysmenorrhea. • Watch for signs of GI bleeding (stomach pain,
black-red tarry odorous stools).
Action
Inhibits the enzyme COX-2. This enzyme is required • If an allergy to sulfonamides, aspirin, or other
NSAIDs exists, do not take this drug.
for the synthesis of prostaglandins. Has analgesic,
anti-inflammatory, and antipyretic properties.
CNS: dizziness, headache, insomnia. • Monitor blood pressure and for signs of
CV: myocardial infarction (MI), cerebrovascular heart failure. This drug has been implicated in the
accident (CVA), edema. GI: GI bleeding, abdomi- development of MI and CVA.
nal pain, diarrhea, dyspepsia, flatulence, nausea. • Respond to development of a rash immediately.
Derm: exfoliative dermatitis, Stevens-Johnson • Assess for effectiveness. Monitor liver and renal
syndrome, toxic epidermal necrolysis, rash. function labs.
Nursing Dx: Acute pain; Risk for injury; Excess fluid volume. Also Used for: Central nervous system applications (analgesics)
Mesalamine
(me-sal-a-meen)
Asacol, Canasa, Rowasa

Salofalk
Olsalazine
(ole-sal-a-zeen)
Dipentum


Gastrointestinal anti-inflammatory/Cyclo-oxygenase Teach client:
1 and 2 inhibitor • May cause dizziness.
Indications • Notify health-care professional if skin rash, sore
Treatment of inflammatory bowel diseases, including throat, fever, mouth sores, unusual bleeding or
ulcerative colitis. bruising, wheezing, fever, or hives occur.
Action • May take 1–2 months for full effect.
Locally acting anti-inflammatory action in the • If cramping, acute abdominal pain, bloody diar-
rhea, fever, headache, or rash occur, discontinue
colon, where activity is probably due to inhibition therapy and notify health-care professional
of prostaglandin synthesis. immediately.
Adverse Reactions/Side Effects • Increase oral intake of fluids to prevent renal lith.
CNS: headache, dizziness, malaise, weakness.
EENT: pharyngitis, rhinitis. CV: pericarditis.
GI: diarrhea, eructation, flatulence, nausea, Make the Connection
vomiting. GU: interstitial nephritis, pancreatitis, • Assess client for allergy to sulfon-
renal failure. Derm: hair loss, rash. Local: anal amides and salicylates.
irritation (enema, suppository). MS: back pain. • Fluid intake should be 1500–2000 mL/day.
Misc: anaphylaxis, acute intolerance syndrome, Monitor daily weight and intake/output.
fever. • Monitor blood chemistries for liver and renal
function and CBC with differential.
• Monitor amylase and lipase levels (pancreatitis).
Nursing Dx: Diarrhea; Readiness for enhanced bowel
Montelukast
(mon-te-loo-kast)
Singulair
Zafirlukast
(za-feer-loo-kast)
Accolate


Allergy, cold, and cough remedy, bronchodilator/ Teach client:
Leukotriene antagonist • These drugs are not for rescue. In the case of
Indications bronchospasm, use the prescribed inhaler.
Prevention and chronic treatment of asthma. • Take as recommended for prophylaxis.
Management of seasonal allergic rhinitis.
Antagonize the effects of leukotrienes. Leukotrienes • Remember the part played by
are mediators of the inflammatory response. leukotrienes in the inflammatory process (inflam-
Decrease airway edema and smooth muscle con- mation is the root of many problems, so it should
striction. Asthma and allergy are caused by chronic be given your complete attention). Look for clues in
inflammation. the generic name that would connect them with
Adverse Reactions/Side Effects leukotrienes (lūk)!
CNS: headache, dizziness, weakness. • Assess for effectiveness.
GI: abdominal pain, diarrhea, drug-induced • Long-term therapy indicates a need to assess liver
hepatitis (women), dyspepsia, nausea, vomiting. and renal function periodically.
MS: arthralgia, back pain, myalgia. Misc: Churg- • Remember: Only beta2-agonists should be used
Strauss syndrome (angiitis; vaculitis), fever, for bronchospasm.
infection (geriatric clients), pain.
Nursing Dx: Ineffective airway clearance; Risk for altered

respiratory function. Universal Free E-Book Store
Pimecrolimus
(pye-mi-krol-i-mus)
Elidel 1% Cream


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

Indomethacin Ibuprofen,
(in-doe-meth-a-sin)
Oral
(eye-byoo-proe-fen)
Indocin
Apo-Indomethacin
Motrin, Advil
Apo-Ibuprofen
Naproxen Ketorolac
(na-prox-en) (kee-toe-role-ak)
Aleve, Anaprox, Toradol

Naprosyn
Apo-Napro-Na

Antirheumatic, analgesic/Nonsteroidal anti- Teach client:
inflammatory agent. COX-1 inhibitor • Take with food or milk and remain upright for
Indications 30 min to decrease irritation of the lower
Treatment of mild-to- moderate pain or dysmenor- esophagus. Alchohol increases the potential for
rhea. Treatment of inflammatory disorders. stomach irritation.
Treatment of fever and pain in adults and children. • May cause drowsiness or dizziness.
Action • Report abdominal/stomach pain or black-red
odorous stools.
Inhibit prostaglandin synthesis.
• Wear sunscreen and protective clothing.
Adverse Reactions/Side Effects • Report rash or sore throat immediately.
CNS: headache, dizziness, drowsiness, psychic
disturbances. EENT: amblyopia, blurred vision,
tinnitus. CV: arrhythmias, edema, MI, CVA. GI: GI Make the Connection
bleeding, hepatitis, constipation, dyspepsia, nau- • Assess for rhinitis, asthma, and urticaria
sea, vomiting, abdominal discomfort. GU: cystitis, (hypersensitivity).
hematuria, renal failure. Derm: exfoliative dermati- • Monitor vital signs and pain level.
tis, Stevens-Johnson syndrome, toxic epidermal • Monitor BUN, serum creatinine, CBC with differ-
necrolysis, rashes. Hemat: blood dyscrasias, pro- ential, electrolytes, bleeding time, and liver func-
longed bleeding time. Misc: allergic reactions, tion tests periodically.
including anaphylaxis.
Also Used for: Cardiovascular system applications (IV for ductus
Nursing Dx: Pain; Readiness for enhanced activity-exercise arteriosus patency); sensory system applications (eye inflammation);
pattern. respiratory system applications (lung disease in cystic fibrosis);
musculoskeletal system applications (analgesia/arthritis)
Aspirin
(as-pir-in)
Bayer Aspirin, Ecotrin

Apo-ASA

Therapeutic/Pharmacologic Class • If the tablets smell like vinegar, they are no longer
Antipyretic, nonopioid analgesic/Salicylate effective.
Indications • Contraindicated for children <16 y/o (Reye’s
Treatment of inflammatory disorders syndrome).
Action • A 325 mg dose of ASA should be taken if unre-
Inhibits the production of prostaglandins. Also lieved chest pain occurs.
decreases platelet aggregation.
EENT: hearing loss, tinnitus. GI: GI bleeding, • Monitor liver and renal function, elec-
dyspepsia, epigastric distress, heartburn, nausea, trolytes, bleeding time, CBC, and serum drug levels
abdominal pain, anorexia, hepatotoxicity, vomit- if on long-term therapy.
ing. Hemat: anemia, hemolysis, increased bleeding • Tinnitus is a sign of toxicity.
time. Misc: allergic reactions (anaphylaxis, laryn- • Monitor for drug effectiveness.
geal edema), noncardiogenic pulmonary edema. • Part of “MONA” for myocardial infarction—
morphine sulfate, oxygen, nitroglycerin, aspirin.
Keep in Mind • 81 mg daily dosage helps to prevent clot forma-
Teach client: tion and may reduce cholesterol accumulation.
• Take with food or milk.
• Report tinnitus (toxicity level reached).
• Avoid taking with other NSAIDs.
Nursing Dx: Pain; Disturbed sensory perception (auditory); Also Used for: Cardiovascular system applications (decrease in platelet
Risk for injury. aggregation); musculoskeletal system applications (analgesia/arthritis)
Methotrexate
(meth-o-trex-ate)
Folex, Folex PFS,

Rheumatrex, Trexall

Therapeutic/Pharmacologic Class marrow suppression. Metab: hyperuricemia. MS:

Antineoplastic, disease-modulating antirheumatic osteonecrosis, stress fracture. Misc: nephropathy,
drug (DMARD), immunosuppressant/Antimetabolite chills, fever, soft tissue necrosis.
Alone or with other treatment modalities in the Teach client:
treatment of carcinoma/leukemia/mycosis fun-
goides. Treatment of severe psoriasis and rheuma- • Report shortness of breath, bruising, or sore
throat.
toid arthritis unresponsive to conventional therapy.
• Avoid alcohol to prevent GI irritation.
Action • Avoid vaccinations without advice of HCP.
Interferes with folic acid metabolism. Result is inhi-
bition of DNA synthesis and cell reproduction. Also
has immunosuppressive activity. Make the Connection
Adverse Reactions/Side Effects • Auscultate lungs and monitor character
of respirations and presence of cough (pulmonary
CNS: dizziness, drowsiness, headaches, malaise.
fibrosis).
EENT: blurred vision, dysarthria, transient blind-
ness. Resp: pulmonary fibrosis, intestinal • Monitor CBC with differential, liver and renal
function, and uric acid levels prior to and
pneumonitis. GI: anorexia, hepatotoxicity, nausea,
frequently during therapy.
stomatitis, vomiting. GU: infertility. Derm: alopecia,
painful plaque erosions, photosensitivity, pruritus,
rashes, skin ulceration, urticaria. Hemat: bone
Nursing Dx: Risk for injury; Impaired gas exchange; Also Used for: Musculoskeletal system applications (rheumatoid
Potential for infection. arthritis); hematologic system applications (chemotherapeutic agent)
Infliximab
(in-flix-i-mab)
Remicade
Etanercept
(e-tan-er-sept)
Enbrel


Disease-modulating antirheumatic drug (DMARD), Teach client:
gastrointestinal anti-inflammatory/Anti-tumor • Do not receive live vaccines during therapy and
necrosis factor (TNF) agent. avoid exposure to ill people.
Indications • Notify HCP if upper respiratory or other infec-
To decrease progression, signs, and symptoms of tions occur.
rheumatoid arthritis, juvenile arthritis, ankylosing
spondylitis, and psoriatic arthritis or plaque psoriasis Make the Connection
when response has been inadequate to other disease-
modifying agents. May be used with other agents. • Monitor clients who develop a new
infection. Do not initiate therapy in clients with
Action active infections.
Bind to TNF, making it inactive. TNF is a mediator • Assess for latent tuberculosis with a tuberculin
of inflammatory response. skin test prior to initiation of therapy.
Adverse Reactions/Side Effects • Monitor for allergic reaction (IV).
CNS: headache, dizziness, weakness. EENT: rhinitis, • Monitor CBC with differential and anti-nuclear
pharyngitis, sinusitis. Resp: upper respiratory antibody (ANA).
tract infection, cough, respiratory disorder. • Monitor for improvement in treated autoimmune
GI: abdominal pain, dyspepsia. Derm: rash. disease.
Hemat: bone marrow suppression. Local: injec-
tion site reactions. Misc: infections, ↑ risk of
malignancies.
Nursing Dx: Risk for infection; Readiness for enhanced Also Used for: Gastrointestinal system applications (ulcerative colitis);
activity-exercise pattern. integumentary system applications (psoriasis); musculoskeletal system
applications (ankylosing spondylitis)
Filgrastim
(fil-gra-stim)
Neupogen, G-CSF (Granulocyte

Colony-Stimulating Factor)
Sargramostim
(sar-gram-oh-stim)
Leukine, rHu GM-CSF (Recombinant Human

Granulocyte/Macrophage Colony-Stimulating Factor)
Therapeutic/Pharmacologic Class Make the Connection

Colony-stimulating factor/Biologic response modifier • Monitor heart rate, ECG, blood pres-
Indications sure, and respiratory status before and periodically
Acceleration of bone marrow recovery after during therapy.
chemotherapy or ablative bone marrow transplant. • Assess bone pain throughout therapy. Pain is
Management of severe chronic leukopenia. usually mild-to-moderate and is an indication of
renewed WBCs.
Action
Glycoproteins that bind to and stimulate immature • Monitor CBC with differential, uric acid and alka-
line phosphatase concentrations, serum albumin
WBCs to divide and differentiate. Also activate
(circulating protein), RFTs, and LFTs.
mature WBCs.
• Refrigerate. Do not shake (causes foaming).
CNS: headache, malaise, weakness. Resp: dyspnea.
• Assess for peripheral edema daily throughout thera-
py. Capillary leak syndrome (swelling of feet or
CV: pericardial effusion, peripheral edema, tran- lower legs, sudden weight gain, dyspnea) and pleu-
sient supraventricular tachycardia. GI: diarrhea. ral or pericardial effusion may occur.
Derm: itching, rash. MS: arthralgia, bone pain,
myalgia. Misc: chills, fever, first-dose reaction.
• May cause flushing with first dose.
Keep in Mind
Teach client:
• Notify health care professional if dyspnea or
palpitations occur.
• Follow instructions for home administration.
Nursing Dx: Risk for infection.
Calcipotriene
(kal-si-poe-try-een)
Dovonex

Therapeutic/Pharmacologic Class • Report any signs of local adverse reactions, per-

Antipsoriatic/Synthetic vitamin D3 analog sistent irritation, or facial rash to health-care
Indications professional. May cause irritation of lesions and
Management of moderate plaque psoriasis. surrounding skin. Discontinuation of the drug
Action may be required.
Modulates skin cell development and production by • Regular lab tests will be done to monitor calcium
acting as a synthetic form of vitamin D. concentrations.
Adverse Reactions/Side Effects • Expect improvement in 2–8 weeks.
Derm: burning, itching, skin irritation, dry skin,
erythema, peeling, rash, worsening/spreading of Make the Connection
psoriatic lesions. F and E: hypercalcemia. • Monitor serum calcium concentrations
before and periodically during therapy. May cause
Keep in Mind transient, rapidly reversible hypercalcemia. If hyper-
Teach client: calcemia occurs, discontinue and monitor calcium
• This drug is for external use only; contact with levels weekly until normal serum calcium levels are
face or eyes should be avoided. Wash hands after restored.
application. • Excessive use may cause hypercalcemia.
• Apply a thin layer to affected skin twice daily and • If ultraviolet B treatment is concurrent, use the
rub in completely; do not cover. cream after the light therapy.
• Do not use for any disorder other than that for • Remember, sunlight is the natural enemy of psoriasis.
which it was prescribed. • Vitamin D increases the absorption of calcium, so
even topical application can cause hypercalcemia.
Nursing Dx: Impaired skin integrity; Readiness for
enhanced social interaction. Universal Free E-Book Store
Immune System Drugs Anti-Infectives 77
Azithromycin Clarithromycin
(aye-zith-row-mye-sin) (kla-rith-roe-mye-sin)
Zithromax, Zmax Biaxin, Biaxin XL
Erythromycin
(eh-rith-roe-mye-sin)
E-Mycin, E.E.S., EryPed, Ilosone, E/Gel

Apo-Erythro-EC,
Novo-Rythro,
Sans-Acne
Therapeutic/Pharmacologic Class melena, oral candidiasis. GU: nephritis, vaginitis.

Agent for atypical mycobacterium, anti-infective/ Hemat: anemia, leukopenia, thrombocytopenia.
Macrolide Derm: photosensitivity, Stevens-Johnson syn-
Indications drome, rashes. EENT: ototoxicity. F and E: hyper-
Treatment of the following infections due to sus- kalemia. Misc: angioedema.
ceptible organisms: upper respiratory tract infec- Keep in Mind
tions, lower respiratory tract infections; acute otitis Teach client:
media; skin and skin structure infections; genitouri-
nary infections. Prevention of disseminated • Take the entire prescription as directed with food.
Mycobacterium avium complex (MAC) infection in • Report blood in stool.
clients with advanced HIV infection.
Inhibit protein synthesis at the level of the 50S bacterial • Culture and sensitivity tests should be
ribosome. Effective against many gram-positive and performed prior to starting therapy.
gram-negative bacteria, as well as mycobacteria. • Observe for signs and symptoms of anaphylaxis.
Adverse Reactions/Side Effects • Monitor CBC with differential.
CNS: dizziness, seizures, drowsiness, fatigue,
headache. CV: chest pain, hypotension, palpita-
tions, arrhythmias (rare). GI: pseudomembranous
Also Used for: Ophthalmic applications (infection and prophylaxis
colitis, abdominal pain, diarrhea, nausea, cholestatic against Chlamydia/gonorrheal infection in the eye); gastrointestinal
jaundice, elevated liver enzymes, dyspepsia, system applications (Helicobacter pylori infections [peptic ulcers]);
cardiovascular system applications (prevention of endocarditis);
respiratory system applications (treatment of infections in cystic
Nursing Dx: Risk for Infection; Diarrhea. fibrotic lung disease)
Clindamycin
(klin-da-mye-sin)
Cleocin, Cleocin T
Dalacin C


Anti-Infective Teach client:
Indications • Take the drug as directed until finished.
Treatment of skin and skin structure infections, respi- • Notify health-care professional immediately if
ratory tract infections, septicemia, intra-abdominal diarrhea, abdominal cramping, fever, or bloody
infections, gynecologic infections, and osteomyelitis. stool occurs.
Prevention of endocarditis. Unlabelled uses: • Be aware of risk of Candida (yeast) infection.
Treatment of opportunistic disease in HIV+ clients. • Refrain from vaginal intercourse if intravaginal
preparation is used.
Action
Inhibits protein synthesis in susceptible bacteria at • If a rash occurs, discontinue medication and
notify health care professional immediately.
the level of the 50S bacterial ribosome. Effective
against most gram-positive aerobic cocci. Also
effective against anaerobic bacteria of reproductive Make the Connection
tract. • Culture and sensitivity tests should be
Adverse Reactions/Side Effects performed before therapy is begun.
CNS: dizziness, headache, vertigo. CV: arrhyth- • Monitor CBC with differential (“good” cells can
mias, hypotension. GI: pseudomembranous also be affected), and liver and renal labs.
colitis, diarrhea, bitter taste (IV), nausea, vomiting. • Monitor for improvement in condition clinically
Derm: rashes. Local: phlebitis at IV site. and by lab work.
Nursing Dx: Risk for infection; Diarrhea. Also Used for: Reproductive system applications (intravaginal
application for bacterial vaginitis)
Gentamicin Amikacin
(jen-ta-mye-sin) (am-i-kay-sin)
Garamycin Amikin
Cidomycin
Kanamycin Tobramycin
(kan-a-mye-sin) (toe-bra-mye-sin)
Kantrex Nebcin, TOBI


Anti-infective/Aminoglycoside Teach client:
Indications • Report tinnitus, vertigo, hearing loss, rash,
Treatment of serious gram-negative bacterial infec- dizziness, or difficulty urinating.
tions and infections caused by staphylococci when • Drink plenty of liquids.
penicillins or other less toxic drugs are contraindi- • Topical application if applicable. Assess skin and
cated. In combination with other agents in the inform HCP if skin irritation develops or infection
management of serious enterococcal infections. worsens.
Prevention of infective endocarditis. Prophylactic
IV treatment in the neonate. Make the Connection
Action • Culture and sensitivity test should be
Inhibit protein synthesis in bacteria at level of the 30S performed before initiating therapy.
bacterial ribosome. • Monitor for hearing loss or ataxia.
Adverse Reactions/Side Effects • Monitor intake and output and daily weight.
CNS: ataxia, vertigo. EENT: ototoxicity • Monitor CBC with differential, LFT and RFT.
(vestibular and cochlear). GU: nephrotoxicity. • Monitor peak and trough serum blood levels.
MS: muscle paralysis (high parenteral doses). • Neonates should be assessed by audiometric
studies prior to discharge.
Misc: hypersensitivity reactions.
• Monitor for fungal infections.
Nursing Dx: Risk for infection; Risk for injury. Also Used for: Sensory system applications (ophthalmic/otic
infections); respiratory system applications (first-line treatment
with other drugs of tuberculosis)
Vancomycin
(van-koe-mye-sin)
Vancocin


Anti-infective Teach client:
Indications • Oral forms are to be taken exactly as directed.
IV: Treatment of potentially life-threatening infec- • Report tinnitus, rash, vertigo, or hearing loss.
tions when less toxic anti-infectives are contraindi- • Report flushing of the skin, or dizziness.
cated. Particularly useful in methicillin-resistant
staphylococcal infections. PO: Treatment of Make the Connection
staphylococcal enterocolitis or pseudomembranous
colitis due to Clostridium difficile. • Culture and sensitivity tests are per-
formed prior to initiating therapy.
Action • Monitor IV site closely to avoid extravasation.
Binds to bacterial cell wall, resulting in cell death • Monitor blood pressure and presence of skin
(bacteriocidal). Effective against gram-positive flushing throughout IV infusion.
pathogens. • Monitor intake and output and daily weight. Cloudy
Adverse Reactions/Side Effects or pink urine may be a sign of nephrotoxicity.
EENT: ototoxicity. CV: hypotension, massive • Assess bowel status.
histamine release called “red-man syndrome” • Monitor CBC with differential, and liver and renal
with rapid IV infusion. GI: nausea, vomiting. function. Monitor peak and trough drug levels.
GU: nephrotoxicity. Derm: rashes. Hemat: Report subtherapeutic or toxic levels immediately.
eosinophilia, leukopenia. Local: phlebitis. • IV: Administer over at least 60–90 min to prevent
MS: back and neck pain. Misc: anaphylaxis, “red-man syndrome” (massive histamine release).
superinfection. • Look for Candida infections.
Nursing Dx: Risk for infection; Diarrhea.

Ciprofloxacin
(sip-roe-flox-a-sin)
Cipro, Cipro XR
Levofloxacin
(le-voe-flox-a-sin)
Levaquin

Therapeutic/Pharmacologic Class hypoglycemia. Hemat: eosinophilia. Local:

Anti-infective/Fluoroquinolone phlebitis at IV site. MS: tendonitis, tendon
Indications rupture. Neuro: peripheral neuropathy.
PO, IV: Treatment of the following bacterial infections: Misc: anaphylaxis.
Urinary tract and gynecologic infections; respiratory Keep in Mind
tract infections; skin and skin structure infections; Teach client:
bone and joint infections; infectious diarrhea; compli-
cated intra-abdominal infections; and typhoid fever. • Take medication as directed.
Postexposure prophylaxis of inhalational anthrax. • Drink plenty of fluids daily to prevent crystalluria.
Treatment of cutaneous anthrax. Unlabelled uses: • Do not take with antacids.
Treatment of febrile neutropenia. • May cause dizziness and drowsiness.
• Use sunscreen and protective clothing.
Action • Report rash, tendon pain, or blood in stool.
Inhibit bacterial DNA synthesis by inhibiting DNA
gyrase enzyme (bacteriocidal). Effective against
gram-positive and gram-negative bacteria. Make the Connection
Adverse Reactions/Side Effects • Culture and sensitivity tests should be
performed before initiating therapy.
CNS: seizures, dizziness, drowsiness, headache,
insomnia/agitation, confusion. GI: pseudomem- • Monitor for anaphylactic reaction.
branous colitis, abdominal pain, diarrhea, • Monitor CBC with differential, liver and renal
studies, and blood glucose.
abnormal liver enzymes, nausea. GU: vaginitis.
Derm: photosensitivity, rash. Endo: hyperglycemia, • Monitor for signs of Candida infection.
• Best if given on an empty stomach.
Nursing Dx: Risk for infection; Knowledge deficit.
Amoxicillin Ampicillin/
(a-mox-i-sill-in)
Sulbactam
(am-pi-sill-in/sul-bak -tam)
Amoxil, Trimox
Apo-Amoxi
Unasyn
Amoxicillin/ Piperacillin/
Clavulanate Tazobactam
(a-mox-i-sill-in/klav-yoo-lan-ate) (pi-per-a-sill-in/tay-zoe-bak-tam)
Augmentin, Augmentin Zosyn

ES, Augmentin XR
Clavulin Universal Free E-Book Store

Anti-infective/Aminopenicillin/beta lactamase Teach client:
inhibitor with clavulanate or sulbactam/extended • Take as directed.
spectrum with tazobactam. • Women taking oral contraceptives should use a
Indications barrier method while on this medication.
Treatment of skin and skin structure infections, • Be aware that yeast infections may occur.
otitis media, sinusitis, respiratory infections, and • Notify health care professional immediately if
genitourinary infections. Prevention of endocarditis. diarrhea, abdominal cramping, fever, or bloody
Postexposure inhalational anthrax prophylaxis. stools occur.
Treatment of infections with resistant organisms. • Calculate and measure doses accurately if admin-
Unlabelled uses: Lyme disease in children <8 years. istering to pediatric client, using proper measuring
device.
Action
Bind to bacterial cell wall, causing cell death (bac-
teriocidal). Depending on agent, drugs have broad Make the Connection
spectrum and can kill resistant organisms. • Observe for signs and symptoms of
Adverse Reactions/Side Effects anaphylaxis (rash, pruritus, laryngeal edema,
CNS: seizures (high doses). GI: pseudomembra- wheezing).
nous colitis, diarrhea, nausea, vomiting, elevated • Obtain specimens for culture and sensitivity testing
liver enzymes. Derm: rashes, urticaria. Hemat: prior to therapy.
bone marrow suppression. Misc: anaphylaxis, • Monitor bowel function.
serum sickness, superinfection. • Monitor CBC with differential and liver enzymes.
Nursing Dx: Risk for infection; Knowledge deficit; Also Used for: Gastrointestinal system applications (treatment of
Diarrhea. peptic ulcers due to H. pylori [POUniversal
only]). Free E-Book Store
Doxycycline
(dox-i-sye-kleen)
Doryx, Vibramycin
Apo-Doxy
Tetracycline
(te-tra-sye-kleen)
Achromycin
Apo-Tetra
Therapeutic/Pharmacologic Class Derm: photosensitivity, rashes. Hemat: bone

Anti-infective/Tetracycline marrow suppression. Local: phlebitis at IV site.
Indications Misc: hypersensitivity reactions, superinfection.
Treatment of various infections caused by unusual Keep in Mind
organisms, including Mycoplasma, Chlamydia, Teach client:
Rickettsia, and Borrelia burgdorferi. Treatment of
inhalational anthrax (postexposure) and cutaneous • Take as directed. Report rash (allergic reaction).
anthrax. Treatment of gonorrhea and syphilis in • Avoid taking antacids and dairy products.
penicillin-allergic clients. Prevention of exacerba- • Women should use a nonhormonal method of
contraception (barrier method).
tions of chronic bronchitis. Treatment of acne.
• Use sunscreen and protective clothing.
Action • Watch for signs of yeast infection.
Inhibit bacterial protein synthesis at the level of the
30S bacterial ribosome (bacteriostatic). Low-dose
products used in the management of periodontitis Make the Connection
inhibit collagenase. Effective against some gram- • Culture and sensitivity testing are done
positive and gram-negative bacteria, as well as before initiating therapy.
Mycoplasma and Rickettsia. • Monitor renal and liver functions, amylase and
lipase levels, and CBC with differential.
CNS: benign intracranial hypertension (higher • Pregnant women and children under 8 yr of age
should not take these preparations, as they affect
in children). GI: diarrhea, nausea, vomiting,
teeth (brown, speckled stain) and bones.
esophagitis, hepatotoxicity, pancreatitis.
Nursing Dx: Risk for infection; Risk for injury.

Ceftriaxone Cephalexin
(3rd Generation) (1st Generation)
(sef-try-ax-one) (sef-a-lex-in)
Rocephin Keflex
Apo-Cephalex
Ceftazidime Cefepime
(3rd Generation) (4th Generation)
(sef-taz-i-deem) (sef-e-peem)
Fortaz, Tazicef Maxipime


Anti-infective/Cephalosporin Teach client:
Indications • Take as directed.
Treatment of skin and skin structure infections; • Notify health-care professional if fever and diar-
bone and joint infections; complicated and uncom- rhea develop, especially if stool contains blood,
plicated urinary tract infections; uncomplicated pus, or mucus.
gynecologic infections, including gonorrhea; lower • These medications are related to penicillins, so
respiratory tract infections; intra-abdominal infec- report pre-existing allergy.
tions; septicemia; meningitis; otitis media; and • Women should use a barrier method of birth
perioperative prophylaxis. control.
Action • Report rash or signs of yeast infection.
Bind to the bacterial cell wall membrane, causing
cell death (bacteriocidal). Spectrum varies depend- Make the Connection
ing on drug generation. Third generation is more • Before initiating therapy, obtain a history
effective against more organisms. to determine previous use of and reactions to peni-
Adverse Reactions/Side Effects cillins or other beta-lactam medications.
CNS: Seizures (high doses). GI: pseudomembra- • Obtain specimens for culture and sensitivity test-
nous colitis, diarrhea, cholelithiasis, sludging in ing before initiating therapy.
the gallbladder. Derm: rashes, urticaria. Hemat: • Observe client for signs and symptoms of
bone marrow suppression. Local: pain at IM anaphylaxis.
site, phlebitis at IV site. Misc: allergic reactions • Monitor CBC with differential.
including anaphylaxis, superinfection. • Discuss alternative forms of birth control with
female clients.
Nursing Dx: Risk for infection; Knowledge deficit; Diarrhea. Universal Free E-Book Store
Imipenem/Cilastatin
(i-me-pen-em/sye-la-stat-in)
Primaxin


Anti-infective/Carbapenem Teach client:
Indications • Watch for signs and symptoms of yeast infection.
Treatment of lower respiratory tract infections, uri- • Notify health-care professional if fever and diar-
nary tract infections, abdominal infections, gyneco- rhea occur, especially if stool contains blood, pus,
logic infections, skin and skin structure infections, or mucus. Symptoms may occur up to several
bone and joint infections, bacteremia, endocarditis, weeks after discontinuation of medication.
polymicrobic infections, and infections with resist-
ant organisms. Make the Connection
Action • Obtain a history before initiating therapy
Binds to the bacterial cell wall, resulting in cell death to determine previous use of and reactions to beta-
(bacteriocidal). Combination of drugs prevents renal lactam drugs.
inactivation. Many enzymes that degrade most other • Obtain specimens for culture and sensitivity test-
beta-lactam drugs do not affect this drug. Broad ing before initiating therapy.
spectrum against gram-positive and gram-negative • Observe client for signs and symptoms of
aerobes and anaerobes. anaphylaxis.
Adverse Reactions/Side Effects • Monitor CBC with differential to assess
CNS: seizures, dizziness, somnolence. CV: hypoten- effectiveness.
sion. GI: pseudomembranous colitis, diarrhea, • Monitor liver function and renal function tests.
nausea, vomiting. Derm: rash, pruritus, sweating, This drug has very high renal concentrations.
urticaria. Hemat: eosinophilia. Local: phlebitis at IV • Do not administer direct IV. Drug must be diluted.
site. Misc: anaphylaxis, fever, superinfection.
Nursing Dx: Risk for infection; Risk for injury; Diarrhea.
Isoniazid Ethambutol
(eye-soe-nye-a-zid) (e-tham-byoo-tole)
INH Myambutol
PMS Isoniazid Etibi
Pyrazinamide Rifampin
(peer-a-zin-a-mide) (rif-am-pin)
PMS Pyrazinamide Rifadin

Rofact


Antitubercular/Bacteriostatic, bacteriocidal Teach client:
Indications • Take medication exactly as directed. Therapy may
First-line therapy of active tuberculosis, in combina- be continued for 6 mo–2 yr.
tion with other agents. Multi-drug regimen prevents • Report numbness of extremities or decrease in
resistance. Preventive treatment (exposed to active vision. Take pyridoxine (B6) to ↓ neuropathy.
TB) may be accomplished with monotherapy. • Avoid the use of alcohol.
Action • Avoid tyramine-containing foods.
Inhibit mycobacterial cell wall synthesis and inter- • Maintain appointments for regular follow-up.
fere with metabolism; one first-line drug interferes • Be aware that urine may change color (“r” drug =
red).
with RNA transcription. Bactericidal/bacteriostatic
action.
CNS: psychosis, seizures, optic neuritis. • Monitor CBC with differential, liver func-
EENT: visual disturbances. GI: drug-induced tion tests, and uric acid levels.
hepatitis, nausea, vomiting. Derm: rashes. • Teach the client carefully about the regimen,
Endo: gynecomastia. Hemat: bone marrow public health concerns, and possible side effects.
changes. Neuro: peripheral neuropathy. • Monitor vision and for nerve pain/paresthesias.
Misc: fever, drug that begins with “r” causes • Therapy will continue until 2 sputum samples for
urine to be discolored red (r = red!). acid-fast bacillus (AFB) are negative.
Nursing Dx: Noncompliance; Risk for infection; Pain.

Trimethoprim/
Sulfamethoxazole
(trye-meth-oh-prim/sul-fa-meth-ox-a-zole)
Bactrim, Bactrim DS, SMZ/TMP, Septra

Apo-Sulfatrim DS


Anti-infective, antiprotozoal/Folate antagonist, Teach client:
sulfonamide • Take medication as directed.
Indications • Use sunscreen and protective clothing.
Treatment of bronchitis, Shigella enteritis, otitis • Notify health-care professional if skin rash, sore
media, Pneumocystis carinii pneumonia (PCP), urinary throat, fever, mouth sores, or unusual bleeding or
tract infections, and traveler’s diarrhea. Prevention bruising occurs.
of PCP in HIV-positive clients. • Maintain appointments for regular follow-up.
Action • Increase fluid intake to decrease the risk of renal
crystals.
Combination inhibits the metabolism of folic acid
in bacteria at two different points (bacteriocidal).
Effective against gram-negative and gram-positive Make the Connection
bacteria. • Obtain specimens for culture and sen-
Adverse Reactions/Side Effects sitivity testing before initiating therapy.
CNS: fatigue, hallucinations, headache, insomnia, • Inspect IV site frequently. Phlebitis is common.
mental depression. GI: hepatic necrosis, nausea, • Assess client for allergy to sulfonamides.
vomiting, diarrhea, stomatitis, hepatitis, cholestatic • Monitor intake and output. Promote adequate
jaundice. GU: crystalluria. Derm: severe exfolia- fluid intake.
tive rashes, photosensitivity. Hemat: bone mar- • Monitor CBC with differential and liver and renal
row suppression. Local: phlebitis at IV site. labs.
Misc: allergic reactions, fever.
Nursing Dx: Risk for infection. Also Used for: Sensory system applications (ophthalmic prepara-
tion for keratitis); integumentary system applications (bacterial
infections of the skin) Universal Free E-Book Store
Fluconazole Amphotericin B
(floo-kon-a-zole)
Deoxycholate
(am-foe-ter-i-sin)
Diflucan
Fungizone, Amphotec
Terbinafine Ketoconazole
(ter-bi-na-feen)
(Systemic)
(kee-toe-koe-na-zole)
Lamisil
Nizoral


Antifungal (systemic) Teach client:
Indications • Take medication as directed.
PO, IV: Treatment of fungal infections caused by • Notify health-care professional if skin rash, abdomi-
susceptible organisms. nal pain, fever, diarrhea, unusual fatigue, anorexia,
nausea, vomiting, jaundice, unusual bruising, bleed-
Action ing, palpitations, dark urine, or pale stools occur.
Inhibit synthesis of fungal sterols, a necessary com-
ponent of the cell membrane (fungistatic). Destroys • Report development of a rash immediately.
fungi at higher doses (fungicidal).
CNS: headache, dizziness, tremor, seizures. • Specimens for culture should be taken
GI: hepatotoxicity, abdominal discomfort, diarrhea, before instituting therapy.
nausea, vomiting. Derm: exfoliative skin disorders. • Monitor liver and renal function tests and CBC
Endo: hypokalemia, hypocalcemia, hypomagne- with differential.
semia, hypertriglyceridemia. Misc: allergic reactions, • Monitor vital signs every 15–30 min during
including anaphylaxis; acute infusion reactions. test dose and every 30 min for 2–4 hr after
Resp: dyspnea, hypoxia, wheezing with certain administration of amphotericin. May need to
drugs. CV: hypotension, arrhythmias with ampho- premedicate with meperidine, dantrolene, and
tericin. GU: nephrotoxicity, hematuria with ampho- diphenhydramine.
tericin. MS: arthralgia, myalgia with amphotericin. • Assess respiratory status daily after administra-
Neuro: peripheral neuropathy with amphotericin. tion of amphotericin.
Nursing Dx: Risk for infection; Risk for impaired skin Also Used for: Integumentary system applications (topical prepara-
integrity; Risk for injury; Pain. tions for tinea) Universal Free E-Book Store
Acyclovir Famciclovir
(ay-sye-kloe-veer) (fam-sye-kloe-veer)
Zovirax Famvir
Avirax
Valacyclovir
(val-ay-sye-kloe-veer)
Valtrex

Therapeutic/Pharmacologic Class clients). Local: pain, phlebitis, local irritation.

Antiviral MS: joint pain. Misc: polydipsia.
PO, IV: Treatment of recurrent genital herpes infec- Teach client:
tions. Treatment of localized cutaneous herpes zoster
infections (shingles) and chickenpox (varicella). • Take medication as directed.
Treatment of herpes simplex encephalitis in immuno- • Condoms should always be used during sexual
contact.
compromised clients. Topical: Treatment of recurrent
herpes labialis (cold sores). • Women with genital herpes should have yearly
Papanicolaou smears.
Action • Follow instructions for proper application of
Interfere with viral DNA synthesis. topical creams or ointments.
Adverse Reactions/Side Effects • Wash hands after touching affected areas to avoid
CNS: seizures, dizziness, headache, hallucina- spreading the viral infection to other areas of the
tions, trembling. GI: diarrhea, nausea, vomiting, body. Avoid drug contact in or around the eyes.
elevated liver enzymes, hyperbilirubinemia,
abdominal pain, anorexia. GU: renal failure, crys-
talluria, hematuria. Derm: acne, hives, skin rashes,
Make the Connection
unusual sweating, Stevens-Johnson syndrome. •
Monitor BUN, serum creatinine, and
creatinine clearance rate (CCr) before and during
Endo: changes in menstrual cycle. Hemat: throm-
therapy. ↑ BUN and serum creatinine levels or ↓
botic thrombocytopenic purpura/hemolytic ure-
CCr may indicate renal failure.
mic syndrome (high doses in immunosuppressed
Nursing Dx: Risk for infection; Readiness for enhanced Also Used for: Sensory system applications (ophthalmologic prepa-
comfort level. rations for viral eye infections) Universal Free E-Book Store
Zanamivir
(za-na-mi-veer)
Relenza
Oseltamivir
(owe-sell-tam-i-veer)
Tamiflu

Therapeutic/Pharmacologic Class • This medication is not a substitute for a flu shot.

Antiviral/Neuraminidase inhibitor • Persons with a history of asthma should have a
Indications fast-acting inhaled bronchodilator available in
Treatment of uncomplicated acute illness caused by case of bronchospasm. If using bronchodilator
influenza virus in adults and children >7 yr who have and the medication concurrently, administer
been symptomatic no more than 2 days. bronchodilator first.
Action
Inhibits the enzyme neuraminidase, which may alter Make the Connection
virus particle aggregation and release.
• Assess client for signs and symptoms of
Adverse Reactions/Side Effects influenza (fever, headache, myalgia, cough, sore
Resp: bronchospasm. throat) before administration. Determine duration
of symptoms. Indicated for clients who have been
Keep in Mind symptomatic for up to 2 days.
Teach client:
• Take exactly as directed and finish entire 5-day
course, even if feeling better. Follow instructions
for the use of the DISKHALER. Client education
pamphlet accompanies the inhaler.
Nursing Dx: Readiness for enhanced comfort level; Risk

for infection; Impaired spontaneous ventilation. Universal Free E-Book Store
Abacavir Didanosine
(ah-back-ah-veer) (dye-dan-oh-seen)
Ziagen ddI, Dideoxyinosine,

Videx, Videx EC
Lamivudine Zidovudine
(la-mi-vyoo-deen) (zye-doe-vyoo-deen)
Epivir, Epivir HBV, 3TC AZT, Retrovir

Apo-Zidovudine

Therapeutic/Pharmacologic Class • Always use a condom, and avoid sharing needles

Antiretroviral/Nucleoside reverse transcriptase or donating blood.
inhibitor (NRTI) • Report any signs of allergic reaction.
Indications • Maintain appointments for regular follow-up
Management of HIV infection (AIDS) in combination exams and blood counts.
with other antiretrovirals. Combining anti-retrovirals • CD4 and viral load counts and their significance.
prevents the development of resistant strains. See
special combination regimens in drug guide.
Make the Connection
Action
Inhibit the activity of HIV-1 reverse transcriptase,
• Assess client for change in severity of HIV
symptoms and for symptoms of opportunistic
interfering with the order of transcription, which in infections throughout therapy.
turn terminates viral DNA growth.
• Assess for signs of hypersensitivity reactions.
Adverse Reactions/Side Effects • Monitor liver function tests, serum glucose, lipid
CNS: headache, insomnia. GI: hepatotoxicity, panel, and serum lactate levels.
diarrhea, nausea, vomiting, anorexia. Derm: rashes. • Monitor viral load and CD4 cell count regularly
F and E: lactic acidosis. Misc: hypersensitivity during therapy. Chart on a graph to show progress
reactions. (encourages compliance).
Keep in Mind • Monotherapy with zidovudine is used during
Teach client: pregnancy.
• Take medications as directed. • Initial combination therapy usually includes two
NRTIs and one protease inhibitor.
• These medications do not cure HIV/AIDS, but
control disease progression.
Nursing Dx: Risk for infection. Universal Free E-Book Store
Ritonavir Saquinavir
(ri-toe-na-veer) (sa-kwin-a-veer)
Norvir Invirase
Nelfinavir Amprenavir
(nell-finn-a-veer) (am-pren-a-veer)
Viracept Agenerase

Therapeutic/Pharmacologic Class MS: increased creatine phosphokinase, myalgia.

Antiretroviral/Protease inhibitor Neuro: circumoral paresthesia, peripheral
Indications paresthesia. Misc: hypersensitivity reactions,
Treatment of HIV infection (with other antiretrovirals). including Stevens-Johnson syndrome and
anaphylaxis; fat redistribution; fever.
Action
Inhibit the action of HIV protease, which acts like Keep in Mind
scissors that cut DNA chain to appropriate length. Teach client:
Without the HIV protease, the chain is sensed as • Take exactly as directed.
abnormal and terminated. • Use condoms, do not share needles or donate
Adverse Reactions/Side Effects blood.
CNS: seizures, abnormal thinking, weakness, • Sex with another HIV+ person may result in
dizziness, headache, malaise, somnolence, spread of different strains of HIV.
syncope. EENT: pharyngitis, throat irritation. • Smoking may interfere with the drug.
Resp: angioedema, bronchospasm. CV: ortho- • Redistribution of body fat may occur.
static hypotension, vasodilation. GI: abdominal
pain, altered taste, anorexia, diarrhea, nausea,
vomiting, constipation, dyspepsia, flatulence.
Make the Connection
GU: renal insufficiency. Derm: rash, skin erup- • Monitor viral load and CD4 counts.
tions, sweating, urticaria. Endo: hyperglycemia. • Monitor liver function tests, CPK, lipid panel,
serum uric acid, and serum glucose levels.
F and E: dehydration. Metab: hyperlipidemia.
Nursing Dx: Risk for infection; Risk for loneliness; Risk for
injury. Universal Free E-Book Store
Efavirenz Delavirdine
(e-fav-i-renz) (de-la-veer-deen)
Sustiva Rescriptor
Nevirapine
(ne-veer-a-peen)
Viramune


Antiretroviral/Nonnucleoside reverse transcriptase Teach client:
inhibitor (NNRTI) • Take exactly as directed. Must always be used in
Indications combination with other antiretroviral drugs.
Treatment of HIV infection (in combination with • May cause dizziness, impaired concentration, or
one or more other antiretroviral agents to prevent drowsiness. Avoid activities requiring alertness.
resistance to the medication). • These medications do not cure HIV/AIDS.
Action • Use a condom, do not share needles, and do not
donate blood.
Inhibit HIV reverse transcriptase, which results in
disruption of DNA synthesis. The chain is seen as • Notify health care professional immediately if
rash occurs.
corrupt and is terminated.
• Maintain appointments for regular follow-up.
CNS: abnormal dreams, depression, dizziness,
drowsiness, fatigue, headache, impaired concen- Make the Connection
tration, insomnia, nervousness, psychiatric symp- • Assess for rash, especially during first
tomatology. GI: nausea, abdominal pain, anorexia, month of therapy.
diarrhea, dyspepsia, flatulence. GU: hematuria, • Assess client for CNS and psychiatric symptoms.
renal calculi. Derm: rash, increased sweating, • Monitor liver function tests, lipid panel, viral load,
pruritus. Neuro: hypoesthesia. and CD4 cell count regularly during therapy.
• May cause false-positive urine cannabinoid results.
Nursing Dx: Risk for infection; Knowledge deficit.

Lopinavir/Ritonavir Lamivudine/Zidovudine
(loe-pin-a-veer/ri-toe-na-veer ) (la-mi-vyoo-deen/zye-doe-vyoo-deen)
Kaletra Combivir
Abacavir
(ah-back-ah-veer)
Lamivudine
(la-mi-vyoo-deen)
Zidovudine
(zye-doe-vyoo-deen)
Trizivir Universal Free E-Book Store

Therapeutic/Pharmacologic Class Misc: hypersensitivity reactions, including

Antiretroviral/Nucleoside reverse transcriptase inhibitor Stevens-Johnson syndrome and anaphylaxis; fat
(NRTI), protease inhibitor combination drug redistribution; fever.
Treatment of HIV infection. Teach client:
Action • Take exactly as directed. These drugs are com-
Inhibit reverse transcriptase and protease, resulting bined essential antiretroviral agents.
in a corrupt DNA chain, causing termination. • May cause dizziness, impaired concentration, or
Adverse Reactions/Side Effects drowsiness. Avoid activities requiring alertness.
CNS: seizures, abnormal thinking, weakness, • These medications do not cure HIV/AIDS.
dizziness, headache, malaise, somnolence, • Use a condom, do not share needles, and do not
syncope. EENT: pharyngitis, throat irritation. donate blood.
Resp: angioedema, bronchospasm. CV: ortho- • Report a rash immediately.
static hypotension, vasodilation. GI: abdominal • Maintain appointments for regular follow-up.
pain, altered taste, anorexia, diarrhea, nausea,
vomiting, constipation, dyspepsia, flatulence.
GU: renal insufficiency. Derm: rash, skin erup-
Make the Connection
tions, sweating, urticaria. Endo: hyperglycemia. • Monitor viral load and CD4 counts.
F and E: dehydration, lactic acidosis. • Monitor liver function tests, CPK, lipid panel,
serum uric acid, and serum glucose levels.
Metab: hyperlipidemia. MS: increased creatine
phosphokinase, myalgia. Neuro: circumoral • Assess for signs of hypersensitivity reactions.
paresthesia, peripheral paresthesia. • Initial combination therapy usually includes two
NRTIs and one protease inhibitor.
Nursing Dx: Risk for infection; Social isolation.
MUSCULOSKELETAL

Musculoskeletal System Drugs Muscle Relaxants 95
Cyclobenzaprine Baclofen
(sye-kloe-ben-za-preen) (bak-loe-fen)
Flexeril Kemstro, Lioresal
Metaxolone
(met-ax-a-loan)
Skelaxin


Therapeutic: skeletal muscle relaxants (centrally acting) Teach client:
Management of acute, painful musculoskeletal condi- • Medication may cause drowsiness, dizziness, and
tions associated with muscle spasm. Unlabelled uses: blurred vision. Avoid activities requiring alertness.
Management of fibromyalgia. One in this class may • Do not use alcohol or other CNS depressants
also be used for treatment of reversible spasticity due with this medication.
to multiple sclerosis or spinal cord lesions (intrathecally) • Take with food to decrease stomach irritation.
and orally to treat pain in trigeminal neuralgia. • Increase fluid intake and bulk in diet to decrease
likelihood of constipation.
Action
Reduce tonic somatic muscle activity at the level of • Report symptoms of urinary retention.
the brainstem. Structurally similar to tricyclic anti- • Use good oral hygiene and sugarless gum or
candy for dry mouth.
depressants. One in this class inhibits reflexes at the
spinal level. • Do not discontinue therapy abruptly.
CNS: dizziness, drowsiness, confusion, fatigue, Make the Connection
headache, nervousness. EENT: dry mouth, blurred • It is important to remember the CNS
vision. CV: arrhythmias. GI: constipation, dyspepsia, depression associated with these drugs.
nausea, unpleasant taste. GU: urinary retention. • Assess client for improvement in pain or spasticity.
Neuro: ataxia (intrathecal administration-seizures). • Almost all drugs used for musculoskeletal illness
Metab: hyperglycemia, weight gain. Misc: Hyper- are gastric irritants.
sensitivity reactions, sweating.
Nursing Dx: Risk for activity intolerance; Readiness for
self-care activities. Universal Free E-Book Store
Dantrolene
(dan-troe-leen)
Dantrium

Therapeutic/Pharmacologic Class GU: crystalluria, dysuria, frequency, impotence,

Skeletal muscle relaxant (direct acting)/Hydantoin incontinence, nocturia. Derm: pruritus, sweating,
derivative urticaria. Hemat: eosinophilia. Local: irritation
Indications at IV site, phlebitis. MS: myalgia. Misc: chills,
PO: Treatment of spasticity associated with spinal drooling, fever.
cord injury, stroke, cerebral palsy, and multiple Keep in Mind
sclerosis. Prophylaxis of malignant hyperthermia. Teach client:
IV: Emergency treatment of malignant hyperthermia.
• May cause dizziness, drowsiness, visual distur-
Action bances, and muscle weakness.
Acts directly on skeletal muscle, causing relaxation • Avoid taking alcohol or other CNS depressants
by decreasing calcium release from sarcoplasmic concurrently with this medication.
reticulum in muscle cells. Prevents intense catabolic • Wear sunscreen.
process associated with malignant hyperthermia.
CNS: drowsiness, muscle weakness, confusion,
Make the Connection
dizziness, headache, insomnia, malaise, nervousness. • Assess bowel function for diarrhea.
EENT: excessive lacrimation, visual disturbances. • Assess neuromuscular status to establish a base-
line before initiating therapy.
Resp: pleural effusions. CV: changes in BP, tachy-
cardia. GI: hepatotoxicity, diarrhea, anorexia, • On the day of administration, assess gag reflex
and have client “dry swallow” to see the rise of
cramps, dysphagia, GI bleeding, vomiting.
the larynx prior to giving food.
Nursing Dx: Risk for injury. Also Used for: CNS applications (Parkinsonian crisis and neuroleptic
malignant syndrome [associated with anti-psychotic
Universal Freemedications])
E-Book Store
Musculoskeletal System Drugs Myasthenia Gravis 97
Edrophonium Neostigmine
(e-droh-fone-ee-yum) (nee-oh-stig-meen)
Enlon, Tensilon Prostigmin
Pyridostigmine
(peer-id-oh-stig-meen)
Mestinon
Mestinon SR

Musculoskeletal System Drugs Myasthenia Gravis 97
Therapeutic/Pharmacologic Class nausea. GU: incontinence, urinary frequency.

Antimyasthenic/Anticholinesterase, cholinergic Derm: sweating, rashes. MS: fasciculation.
Diagnosis of myasthenia gravis. Assessment of adequacy Teach client:
of anticholinesterase therapy in myasthenia gravis.
Differentiating myasthenic from cholinergic crisis. • Wear a Medic-Alert bracelet describing disease
and medication regimen at all times.
Reversal of muscle paralysis from nondepolarizing
neuromuscular blocking agents. Other agents in • Take medication exactly as directed. Take the
medication on time.
this class increase muscle strength in symptomatic
treatment of myasthenia gravis and prevent and • Lifelong treatment with these medications will be
required.
treat postoperative bladder distention/urinary
retention or ileus. • Space activities to avoid fatigue.
Action
Inhibit the breakdown of acetylcholine by acetyl- Make the Connection
cholinesterase in the neural synapse, resulting in a • To differentiate myasthenic from cholin-
prolonged effect. Cause muscular contraction. ergic crisis, assess for increased cholinergic symp-
toms (SLUDGE—Salivation, Lacrimation, Urination,
Diarrhea, GI distress, Emesis) after administration
CNS: seizures, dizziness, dysphasia, dysphonia,
of these medications (cholinergic crisis). If strength
weakness. EENT: diplopia, lacrimation, miosis.
improves after administration of these medications,
Resp: bronchospasm, excess secretions. CV: brady-
client is in myasthenic crisis.
cardia, hypotension. GI: abdominal cramps,
diarrhea, dysphagia, excess salivation, vomiting, • Give exactly when ordered.
• Atropine, an anticholinergic, may be used for
Nursing Dx: Risk for activity intolerance; Fatigue.
treatment of cholinergic symptoms.
Musculoskeletal System Drugs Osteoporosis 98
Alendronate Etidronate
(a-len-drone-ate) (eh-tih-drone-ate)
Fosamax Didronel
Ibandronate Risedronate
(i-ban-dro-nate) (riss-ed-roe-nate)
Boniva Actonel


Bone resorption inhibitor/Bi- and diphosphonate Teach client:
Indications • Take the medication first thing in the morning,
Treatment and prevention of postmenopausal 30 min before other medications, beverages, or
osteoporosis and osteoporosis in men. Treatment food (decreases absorption), and remain upright
of Paget’s disease of the bone. Treatment of so acid reflux is decreased.
corticosteroid-induced osteoporosis in clients • Eat a balanced diet and consult health care profes-
(men and women) who are receiving 7.5 mg of sional about the need for calcium and vitamin D
prednisone/day (or equivalent) with evidence of supplements.
decreased bone mineral density. • Engage in weight-bearing exercise.
Action • Be aware that smoking and excessive alcohol con-
sumption increase osteoporosis risk.
Inhibit resorption of bone by inhibiting osteoclast
activity. • Use sunscreen and protective clothing.
CNS: headache. EENT: blurred vision, conjunc- Make the Connection
tivitis, eye pain/inflammation. GI: abdominal • Assess bone density studies.
distention, abdominal pain, acid reflux and • Assess dietary regimen and lifestyle to teach
esophageal ulceration, constipation, diarrhea, effectively.
gastritis, dysphagia, flatulence, nausea, taste • Assess serum calcium and phosphate levels for
perversion, vomiting. Derm: erythema, photo- baseline and during therapy.
sensitivity, rash. MS: musculoskeletal pain. • Make a notation on the medication administra-
tion record (MAR) of special administration
Nursing Dx: Risk for injury; Pain; Readiness for enhanced instructions.
home maintenance management. Universal Free E-Book Store
Raloxifene
(ra-lox-i-feen)
Evista
Tamoxifen
(ta-mox-i-fen)
Nolvadex
Alpha-Tamoxifen,
Novo-Tamoxifen
Therapeutic/Pharmacologic Class Hemat: leukopenia, thrombocytopenia.

Bone resorption inhibitor, antineoplastic/Selective Metab: hot flashes. Misc: tumor flare.
estrogen receptor modulator (SERM)
Keep in Mind
Treatment and prevention of osteoporosis in post-
menopausal women and adjuvant therapy of breast • Take as directed; bone pain should be reported.
cancer after surgery and radiation (delays recurrence). • Engage in regular weight-bearing exercise.
Palliative or adjunctive treatment of advanced breast • Report leg pain (DVT).
cancer. Prevention of breast cancer in high-risk clients. • May cause hot flashes or induce ovulation.
• Monitor weight weekly. Report weight gain.
Action
Bind to estrogen receptors, producing estrogen-like
effects on bone, resulting in reduced resorption of Make the Connection
bone and decreased bone turnover. Compete for • Assess client for bone mineral density.
estrogen-binding sites in the breast, reducing estro- • Monitor lipid panel; hormone panel; and serum
gen response. calcium, phosphate, total protein, and albumin.
Adverse Reactions/Side Effects • Monitor CBC for a decrease in platelet count.
MS: leg cramps, bone pain. CNS: confusion, • Discuss the STAR clinical trial, which compares
these SERMs for effectiveness in prevention and
depression, headache, weakness. EENT: blurred
postsurgical treatment of breast cancer.
vision. CV: pulmonary embolism, stroke, edema.
GI: nausea, vomiting. GU: uterine malignancies,
vaginal bleeding. F and E: hypercalcemia.
Nursing Dx: Risk for injury; Impaired gas exchange; Pain. Also Used for: Reproductive applications (breast cancer prevention
and recurrence)
CENTRAL NERVOUS SYSTEM

Central Nervous System Drugs Analgesics 100
Acetaminophen
(a-seet-a-min-oh-fen)
Tylenol, Panadol, APAP

Apo-Acetaminophen

Therapeutic/Pharmacologic Class • Follow directions for use of pediatric liquid

Antipyretic/Nonopioid analgesic measuring device and accurate dosing.
Indications • Be aware that many over-the-counter (OTC)
Alleviation of mild pain. Reduction of fever. preparations contain this drug and taking an
Action excessive amount may cause liver failure.
Inhibits the synthesis of prostaglandins that may serve • Ask for dose or take the medication at home
as mediators of pain and fever, primarily in the CNS. before pain is severe, to abort excessive pain.
Controversial as to its anti-inflammatory effects.
GI: hepatic failure, hepatotoxicity (overdose • Assess health status and alcohol usage
or use with alcohol). GU: renal failure (high before administering.
doses/chronic use). Hemat: neutropenia, pancy- • Complete a thorough drug inventory with the
topenia, leukopenia. Derm: rash, urticaria. client, especially use of OTC drugs, to prevent
excessive dosing and reduce risk for liver failure.
Keep in Mind • In the case of long-term therapy, periodically
Teach client: monitor CBC with differential, and liver and renal
• Take medication exactly as directed and do not function tests, including prothrombin time, to
take more than the recommended amount. Avoid assess for toxicity.
alcohol. • Use a pain scale to objectively assess pain.
• Check concentrations of liquid preparations. • Assess remittance of febrile symptoms.
Errors have resulted in serious liver damage. • Acetylcysteine (Acetadote) is the antidote.
The drug is dosed by weight according to age,
and the dose must be exact.
Nursing Dx: Pain; Risk for injury; Risk for activity intolerance. Also Used for: Musculoskeletal applications
Universal (arthritis)
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Tramadol
(tra-ma-dol)
Ultram


Analgesic/Centrally acting weak mu-receptor agonist Teach client:
Indications • Ask for pain medication before the pain becomes
Treatment of moderate to moderately severe pain. severe.
Action • This drug may cause dizziness and drowsiness.
Binds to mu-opioid receptors, but has low affinity. • Change position slowly from lying to sitting or
standing.
Inhibits reuptake of serotonin and norepinephrine in
the CNS, which decreases stimulation of nociceptors. • Avoid concurrent use of alcohol or other CNS
depressants with this medication.
CNS: seizures, dizziness, headache, somnolence,
anxiety, CNS stimulation, confusion, coordina- Make the Connection
tion disturbance, euphoria, malaise, nervousness, • Assess pain relief objectively.
sleep disorder, weakness. EENT: visual distur- • Assess blood pressure and respiratory rate before
bances. CV: vasodilation. GI: constipation, and periodically during administration.
nausea, abdominal pain, anorexia, diarrhea, dry • Assess bowel function routinely (constipation).
mouth, dyspepsia, flatulence, vomiting. • Monitor patient for seizures. Risk is increased
GU: menopausal symptoms, urinary retention/ with higher doses and in patients taking antide-
frequency. Derm: pruritus, sweating. pressants, opioid analgesics, or other drugs that
Neuro: hypertonia. Misc: physical dependence, decrease the seizure threshold.
psychological dependence, tolerance. • Monitor liver and renal function tests, CBC for
hemoglobin level, and urinalysis for proteinuria.
Nursing Dx: Pain; Readiness for enhanced activity-exercise

Fentanyl (Transdermal)
(fen-ta-nil)
Duragesic


Opioid analgesic, analgesic adjunct/Opioid receptor Teach client:
agonist • Fatalities have occurred from children having
Indications access to improperly discarded patches.
Treatment of moderate-to-severe chronic pain • May be worn while bathing, showering, or swimming.
requiring continuous opioid analgesic therapy for • May cause drowsiness or dizziness.
an extended time. This transdermal analgesic is not • Change positions slowly to minimize dizziness.
recommended for the control of postoperative, • Avoid concurrent use of alcohol or other CNS
mild, or intermittent pain, nor should it be used for depressants with this medication.
short-term pain relief. • Good oral hygiene and use of sugarless gum or
candy may decrease dry mouth.
Action
Binds to opiate receptors in the CNS, altering the
response to and perception of pain. Make the Connection
Adverse Reactions/Side Effects • Objectively assess pain and record client
CNS: confusion, sedation, weakness, dizziness, response.
restlessness. Resp: apnea, bronchoconstriction, • Assess bowel function routinely for constipation.
laryngospasm, respiratory depression. CV: brady- • Monitor plasma amylase and lipase levels.
cardia. GI: anorexia, constipation, dry mouth, • Naloxone (Narcan) is the antidote.
nausea, vomiting. Derm: sweating, erythema. • Discontinue gradually.
Local: application site reactions. MS: skeletal and • Apply to nonhairy areas. Change after 72 hours.
thoracic muscle rigidity. Misc: physical dependence, • Full effectiveness takes several hours as system
psychological dependence. begins to release the medication.
Nursing Dx: Acute pain; Readiness for enhanced comfort Also Used for: Central nervous system anesthetic applications
level. (balanced anesthesia, induction ofUniversal
anesthesia)Free E-Book Store
Oxycodone/ Hydrocodone/
Acetaminophen Acetaminophen
(ox-i-koe-done/ (hye-droe-koe-done/
a-seet-a-min-oh-fen) a-seet-a-min-oh-fen)
Percocet, Tylox Lorcet, Lortab,

Endocet, Vicodin, Hydrocet
Oxycocet
Hydrocodone/Ibuprofen
(hye-droe-koe-done/eye-byoo-proe-fin)
Vicoprofen Universal Free E-Book Store


Opioid analgesic (in combination with nonopioid Teach client:
analgesic)/Opioid receptor agonist • Take as directed.
Indications • Addition of acetaminophen increases the risk for
Management of moderate-to-severe pain. liver and renal damage.
Action • Ask for analgesic before pain becomes severe, to
abort excessive discomfort.
Bind to opiate receptors in the CNS. Alter the
perception of and response to painful stimuli, while • The medication may cause drowsiness or dizziness.
producing generalized CNS depression. • Change positions slowly to minimize dizziness.
• Avoid concurrent use of alcohol or other CNS
Adverse Reactions/Side Effects depressants with this medication.
CNS: confusion, sedation, dysphoria, euphoria, • Use good oral hygiene and sugarless gum or
floating feeling, hallucinations, headache, unusual candy to decrease dry mouth.
dreams. EENT: blurred vision, diplopia, miosis. • Report constipation.
Resp: respiratory depression. CV: hypotension,
bradycardia. GI: constipation, nausea, vomiting.
GU: urinary retention. Derm: sweating. Make the Connection
Misc: physical dependence, psychological • Pain level should be assessed objectively.
dependence, tolerance. • Monitor plasma amylase and lipase concentrations.
• Naloxone (Narcan) is the antidote.
• Discontinue gradually after long-term use.
• Administer with food or milk to minimize GI
irritation.
Nursing Dx: Acute pain; Readiness for enhanced comfort Also Used for: Respiratory system applications (antitussive effect)
level. Universal Free E-Book Store
Meperidine
(me-per-i-deen)
Demerol


Opioid analgesic/Opioid receptor agonist Teach client:
Indications • Take as directed. Medication is more effective if
Treatment of moderate or severe pain (alone or taken before the pain is severe.
with nonopioid agents). • May cause drowsiness or dizziness.
Action • Change positions slowly to minimize dizziness.
Binds to opiate receptors in the CNS. Alters the • Avoid concurrent use of alcohol or other CNS depres-
sants to minimize risk for respiratory depression.
perception of and response to painful stimuli, while
producing generalized CNS depression. • Report constipation.
CNS: seizures, confusion, sedation, dysphoria, Make the Connection
euphoria, floating feeling, hallucinations, • Use a pain scale to objectively assess pain.
headache, unusual dreams. EENT: blurred vision, • This drug is used instead of morphine in clients
diplopia, miosis. Resp: respiratory depression. with biliary spasm (acute cholecystitis).
CV: hypotension, bradycardia. GI: constipation, • Monitor plasma amylase and lipase concentrations.
nausea, vomiting. GU: urinary retention. • Naloxone (Narcan) is the antidote.
Derm: flushing, sweating. Misc: physical depend- • Discontinue gradually after long-term use to
ence, psychological dependence, tolerance. prevent withdrawal symptoms.
• For direct IV administration, always dilute and
administer over 5 min after checking dose with
second practitioner.
Nursing Dx: Acute pain. Also Used for: Central nervous system anesthetic applications
(preoperative sedation and induction of anesthesia)
Morphine
(mor-feen)
Morphine Sulfate, Roxanol,

MS Contin, Duramorph
Morphine H.P., Epimorph

Therapeutic/Pharmacologic Class • This medication may cause drowsiness or dizziness.

Opioid analgesic/Opioid receptor agonist • Report constipation.
Indications • Report inability to urinate.
Treatment of severe pain associated with many etiologies.
Binds to opiate receptors in the CNS. Alters the
perception of and response to painful stimuli, while
• Use a pain scale to assess pain.
producing generalized CNS depression.
• Assess respirations.
• Assess bowel and bladder function.
Adverse Reactions/Side Effects • Naloxone (Narcan) is the antidote.
CNS: confusion, sedation, dizziness, dysphoria, • When administering direct IV, always dilute in
euphoria, floating feeling, hallucinations, 5–10 mL NaCl and give over 4–5 min after
headache, unusual dreams. EENT: blurred vision, checked by second practitioner.
diplopia, miosis. Resp: respiratory depression. • After epidural administration, nonopioid analge-
CV: hypotension, bradycardia. GI: constipation, sia will be administered for breakthrough pain for
nausea, vomiting. GU: urinary retention. Derm: 24 hr. If itching occurs, Benadryl or Nubain may
flushing, itching, sweating. Misc: physical depend- be ordered for relief.
ence, psychological dependence, tolerance.
Keep in Mind
Teach client:
• Pain control is better when the medication is Also Used for: Respiratory system applications (air hunger in the
taken before the pain is severe. dying patient, pulmonary edema), cardiovascular system applications
(pain control and reduction of oxygen consumption by the heart
Nursing Dx: Acute pain; Risk for injury (respiratory). during a myocardial infarction).
Propoxyphene Napsylate/
Acetaminophen
(proe-pox-i-feen nap-si-late/
a-seet-a-min-oh-fen)
Darvocet-N 50, Darvocet-N 100

Therapeutic/Pharmacologic Class • This medication contains acetaminophen.

Opioid analgesic/Opioid agonist and nonopioid Overdosage can cause liver and kidney damage.
analgesic combinations • Pain control will be better if dose is taken before
Indications the pain is severe.
Treatment of mild-to-moderate pain with or with- • This medication may cause drowsiness or dizziness.
out fever. • Change positions slowly to minimize dizziness.
Action • Avoid concurrent use of alcohol or other CNS
Binds to opiate receptors in the CNS. Alters the depressants with this medication.
perception of and response to painful stimuli, while • Use good oral hygiene and sugarless gum or
producing generalized CNS depression. candy to decrease dry mouth.
CNS: disorientation, dizziness, weakness, dysphoria, Make the Connection
euphoria, headache, insomnia, paradoxical excite- • Use a pain scale to assess pain.
ment, sedation. EENT: blurred vision. CV: hypoten- • Initial drowsiness will diminish with continued use.
sion. GI: nausea, abdominal pain, constipation, • Assess bowel function routinely for constipation.
vomiting. Derm: rash. Misc: physical dependence, • Monitor liver function tests and serum amylase
psychological dependence, tolerance. and lipase levels.
Keep in Mind
• Naloxone (Narcan) is the antidote for the opioid
portion of the drug. Acetylcysteine is the antidote
Teach client: for acetaminophen.
• Take medication as directed, and do not take • Doses may be administered with food or milk to
more than the recommended amount. minimize GI irritation.
Nursing Dx: Pain; Readiness for enhanced comfort level. Universal Free E-Book Store
Central Nervous System Drugs Opioid Reversal Agents 107
Naloxone
(nal-ox-one)
Narcan
Naltrexone
(nal-treks-one)
Vivitrol

Central Nervous System Drugs Opioid Reversal Agents 107
Therapeutic/Pharmacologic Class
Antidote (for opioids)/Opioid receptor antagonists Make the Connection
Indications • Monitor respiratory rate, rhythm, and
Reversal of CNS depression and respiratory depres- depth; pulse; ECG; blood pressure; and level of
sion because of suspected opioid overdosage and consciousness frequently for 3–4 hr after
alcohol abuse. Unlabelled Uses: Narcotic-induced administration.
pruritus (low-dose IV infusion). • If used to treat postoperative respiratory depres-
sion, assess effectiveness—but also remember that
Action these medications reverse the effects of analgesia.
Competitively block the effects of opioids, including • Assess pain using a pain scale.
CNS and respiratory depression, without producing • Assess client for signs and symptoms of opioid or
any agonist (opioid-like) effects. alcohol withdrawal. Symptoms may occur from
Adverse Reactions/Side Effects within a few minutes to 2 hr.
CV: hypertension, hypotension, ventricular fibrilla- • Excessive dose in postoperative patients may
tion, ventricular tachycardia. GI: nausea, vomiting. cause excitement, pain, hypotension, hyperten-
sion, pulmonary edema, ventricular tachycardia
Keep in Mind and fibrillation, and seizures.
Teach client:
• As medication becomes effective, explain purpose
and effects of naloxone to patient.
• Wear a Medic-Alert bracelet if receiving opioids
for chronic pain.
Nursing Dx: Risk for injury (pharmacologic). Also Used for: Cardiovascular system applications (management of
refractory circulatory shock), mental health (alcoholism)
Central Nervous System Drugs Anesthetics and Sleep Inducers 108
Propofol
(proe-poe-fol)
Diprivan, Disoprofol


General anesthetic/Nonopioid sedative-hypnotic Teach client:
Indications • This medication decreases or eliminates mental
Induction of general anesthesia in children >3 yr recall of the procedure.
and adults. Maintenance of balanced anesthesia • May cause drowsiness or dizziness. Ability to be alert
when used with other agents in children >2 months may be affected for 24 hr following administration.
and adults. Initiation and maintenance of monitored • Avoid alcohol or other CNS depressants for 24 hr
anesthesia care (MAC). Sedation of intubated, following administration.
mechanically ventilated clients in intensive care units. • The medication will sting and burn when
administered.
Action
Short- and rapid-acting (40 sec) sedative-hypnotic.
Mechanism of action is unknown, but because it is Make the Connection
highly lipophilic, it has affinity for CNS tissue. • Assess respiratory status, pulse, and
Produces amnesia, but has no analgesic properties. blood pressure continuously throughout therapy.
Adverse Reactions/Side Effects Frequently causes apnea. Maintain patent airway,
CNS: dizziness, headache. Resp: apnea, cough. apply nasal cannula, and maintain adequate venti-
CV: bradycardia, hypotension, hypertension. lation. Endotracheal intubation tray and resuscita-
GI: abdominal cramping, hiccups, nausea, vom- tion equipment should be readily available.
iting. Derm: flushing. Local: burning, pain, • Be certain client has maintained NPO status prior
stinging, coldness, numbness, tingling at IV site. to the procedure.
MS: involuntary muscle movements, periopera- • May be administered as an intermittent or contin-
tive myoclonia. GU: discoloration of urine uous infusion for clients on mechanical ventilation.
(green). Misc: fever.
Nursing Dx: Impaired gas exchange; Impaired memory. Universal Free E-Book Store
Ketamine
(ket-a-meen)
Ketalar


General anesthetic, dissociative anesthetic/NMDA Teach client:
receptor and thalamus to cortex transmission blocker. • Coordination impairment may last for 24 hr after
Indications anesthesia. Do not drive during this time.
Along with other agents, anesthesia of clients • Avoid alcohol or other CNS depressants for 24 hr.
undergoing short-term diagnostic and surgical • Dreams may be vivid or disconcerting.
procedures.
Blocks afferent impulses of pain perception. Suppresses •
Assess level of consciousness frequently
spinal cord activity. Affects CNS transmitter systems. throughout therapy. This medication causes a
Adverse Reactions/Side Effects dissociative state.
CNS: emergence reactions, elevated intracranial • Monitor blood pressure, ECG, and respiratory
pressure. EENT: diplopia, increased intraocular status frequently throughout therapy.
pressure, nystagmus. Resp: laryngospasm, respira- • May cause increased CSF pressure and increased
tory depression, apnea (rapid IV administration intraocular pressure.
of large doses). CV: hypertension, tachycardia, • Tonic-clonic movements during anesthesia do not
arrhythmias, bradycardia, hypotension. GI: exces- indicate the need for more medication.
sive salivation, nausea, vomiting. Derm: erythema,
rash. Local: pain at injection site. MS: increased
skeletal muscle tone.
Nursing Dx: Anxiety; Acute confusion; Disturbed thought Also Used for: Central nervous system applications (antidepressant);
process. respiratory system applications (bronchodilation in status asthmaticus);
musculoskeletal system applications (restless legs
Universal Freesyndrome)
E-Book Store
Pentobarbital Secobarbital
(pen-toe-bar-bi-tal) (see-koe-bar-bi-tal)
Nembutal Seconal
Novopentobarb Novosecobarb
Phenobarbital
(fee-noe-bar-bi-tal)
Luminal, Solfoton
Ancalixir

Therapeutic/Pharmacologic Class urticaria. Local: phlebitis at IV site. MS: arthral-

Anticonvulsant, sedative-hypnotic/Barbiturate gia, myalgia, neuralgia. Misc: hypersensitivity
Indications reactions including angioedema and serum sick-
Treatment of insomnia (short-term). Preoperative ness, physical dependence, psychological
sedation and induction of coma in clients with dependence.
cerebral ischemia and intracranial pressure (ICP). Keep in Mind
Treatment of seizures. Teach client:
Action • Take medication exactly as directed.
Depress the CNS, probably by potentiating gamma- • Do not discontinue medication abruptly.
aminobutyric acid (GABA), an inhibitory neurotrans- • This medication may cause daytime drowsiness.
mitter. Produce all levels of CNS depression, including • Avoid taking alcohol or other CNS depressants
the sensory cortex, and motor activity, as well as concurrently with this medication.
altered cerebellar function. Anticonvulsant effect due
to decreased synaptic transmission and increased
seizure threshold. May decrease cerebral blood flow, Make the Connection
cerebral edema, and intracranial pressure (IV only). •
Monitor respiratory status, pulse, and
blood pressure frequently.
CNS: drowsiness, hangover, lethargy, delirium, • Monitor CBC with differential, and liver and renal
function tests if on long-term therapy.
excitation, mental depression, vertigo. Resp: res-
piratory depression; IV – laryngospasm, bron- • May increase need for dosage adjustment of
other meds (↑ liver enzymes).
chospasm. CV: IV – hypotension. GI: constipation,
diarrhea, nausea, vomiting. Derm: rashes,
Nursing Dx: Risk for disturbed sleep pattern; Ineffective Also Used for: Central nervous system applications (anticonvulsant)
breathing pattern. Universal Free E-Book Store
Succinylcholine
(sux-sin-il-koe-leen)
Anectine, Quelicin
Pancuronium
(pan-cure-oh-nee-yum)
Pavulon


Skeletal muscle paralyzer/Neuromuscular blocking Teach client:
agent (depolarizing and nondepolarizing) • Muscle soreness may be experienced after the
Indications procedure depending on which agent is used.
In combination with other agents during surgical • Report any family history of malignant
procedures for the production of balanced anesthe- hyperthermia.
sia with skeletal muscle paralysis and facilitation of
intubation after induction of anesthesia. Facilitation Make the Connection
of client compliance during mechanical ventilation.
• Nurse anesthetist or anesthesiologist
Action must be present when these drugs are in use.
Prevent neuromuscular transmission by blocking Keep endotracheal intubation and resuscitative
the effect of acetylcholine at the myoneural junc- equipment immediately available.
tion. Cause the release of histamine. Have no • Monitor ECG, heart rate, and blood pressure
analgesic or anxiolytic effects. continuously.
Adverse Reactions/Side Effects • Assess client for history of malignant hyperther-
Resp: apnea, bronchospasm. CV: arrhythmias, mia before administration.
heart rate changes, hypotension. F and E: hyper- • Monitor arterial blood gas, blood chemistries,
kalemia. MS: rhabdomyolysis, muscle fascicula- and ECG.
tion. Misc: malignant hyperthermia, myoglo- • In the event of overdosage, maintain airway
binemia (increased in children), myoglobinuria patency and ventilation, and administer fluids
(increased in children), anaphylaxis. Resp: bron- and vasopressors, to maintain oxygenation and
chospasm. GI: excessive salivation. Derm: rash. circulatory function.
• If eyes remain open, protect corneas with artifi-
Nursing Dx: Risk for injury; Ineffective breathing pattern. cial tears and tape closed.
Bupivacaine
(byoo-pi-vi-kane)
Marcaine, Sensorcaine
Procaine
(pro-kane)
Novocaine


Anesthetic (topical/local)/Amino ester anesthetic Teach client:
Indications • Notify health-care professional if any signs of
Local or regional anesthesia or analgesia of clients systemic toxicity occur (palpitations, faintness,
undergoing surgical, obstetric, dental, or diagnostic blurred vision, tinnitus, metallic taste, tremors,
procedures. circumoral tingling and numbness).
Action • Request assistance during ambulation until resid-
ual motor deficits are ruled out when spinal or
Local anesthetics inhibit initiation and conduction epidural procedures have been performed.
of sensory nerve impulses by altering the influx of
sodium and efflux of potassium in neurons, slowing
or stopping pain transmission. May also vasocon- Make the Connection
strict blood vessels to prevent excessive bleeding in • Assess for systemic toxicity (circumoral
local uses. tingling and numbness, ringing in ears, metallic
Adverse Reactions/Side Effects taste, dizziness, blurred vision, tremors, slow speech,
CNS: seizures, anxiety, dizziness, headache, irri- irritability, twitching, seizures, cardiac dysrhyth-
tability. EENT: blurred vision, tinnitus. CV: car- mias). Report such symptoms to anesthesiologist
diovascular collapse, arrhythmias, bradycardia, immediately.
hypotension. GI: nausea, vomiting. GU: urinary • Monitor BP, heart rate, and respiratory rate con-
retention. Derm: pruritus. F and E: metabolic tinuously while client is receiving this medication.
acidosis. Neuro: circumoral tingling/numbness, • Monitor for return of sensation after procedure.
tremor. Misc: allergic reactions, fever.
Nursing Dx: Risk for injury; Risk for falls. Universal Free E-Book Store
Midazolam
(mid-ay-zoe-lam)
Versed


Antianxiety agent, sedative/hypnotic/Benzodiazepine Teach client:
Indications • This medication decreases mental recall of the
Promotion of presurgical sedation and anxiolysis in procedure.
pediatric clients (oral). Promotion of presurgical • Drowsiness or dizziness may be experienced for
sedation/anxiolysis/amnesia in adult clients (IM or 24 hr after administration.
IV). Commonly used for conscious sedation. Aids in • Arrange for a person to provide transportation
the induction of anesthesia and as part of balanced home from the procedure.
anesthesia. Provision of sedation of mechanically • Avoid alcohol or other CNS depressants for 24 hr
ventilated clients in a critical care setting (continu- following administration.
ous infusion).
Acts at many levels of the CNS to produce general- •Assess level of sedation and level of con-
ized CNS depression. Effects may be mediated by sciousness throughout and for 2–6 hr following
GABA, an inhibitory neurotransmitter. administration.
Adverse Reactions/Side Effects • Monitor blood pressure, pulse, respiration, and
CNS: agitation, drowsiness, excess sedation, arterial blood gas continuously during IV adminis-
headache. EENT: blurred vision. Resp: apnea, tration. Oxygen should be given by nasal cannula.
laryngospasm, respiratory depression, bron- Resuscitative equipment should be immediately
chospasm, coughing. CV: cardiac arrest, arrhyth- available. Two practitioners should check dose.
mias. GI: hiccups, nausea, vomiting. Derm: rashes. • The antidote is flumazenil (Romazicon).
Local: phlebitis at IV site, pain at IM site.
Nursing Dx: Risk for injury; Ineffective breathing patterns. Also Used for: Central nervous system applications
Universal Free(status epilepticus)
E-Book Store
Zolpidem
(zole-pi-dem)
Ambien, Ambien CR
Pyrrolopyrazine
(pie-role-oe-py-ra-seen)
Lunesta

Therapeutic/Pharmacologic Class • A bitter taste sensation that may or may not be

Sedative-hypnotic/GABA receptor modulator transient may be experienced.
Indications • Report any episodes of sleepwalking while on this
Treatment of insomnia. medication immediately to the health-care
Action professional.
Produce CNS depression by binding to GABA
receptors. Possess no analgesic properties. Make the Connection
Adverse Reactions/Side Effects • Prolonged use of >7–10 days may lead
CNS: amnesia, daytime drowsiness, dizziness, to physical and psychological dependence.
“drugged” feeling. GI: diarrhea, nausea, vomiting. • Older clients require half the regular dose.
Misc: hypersensitivity reactions, physical depend- • Sleepwalking, sleep-eating, and sleep-driving
ence, psychological dependence, tolerance. have been reported under the influence of this
medication.
Keep in Mind • Discuss a therapeutic sleep regimen with client.
Teach client: • Protect client from injury.
• Take as directed. • Tablets should be swallowed whole.
• Go to bed immediately after taking the medication,
as it has a rapid onset.
• May cause daytime drowsiness or dizziness.
• Avoid concurrent use of alcohol or other CNS
depressants.
Nursing Dx: Sleep pattern disturbance; Readiness for

enhanced sleep. Universal Free E-Book Store
Ramelteon
(ram-ell-tee-on)
Rozerem

Therapeutic/Pharmacologic Class • Avoid becoming pregnant.

Hypnotic/Melatonin 1 and 2 agonist • Avoid breast-feeding.
Indications • Follow a sleep hygiene regimen.
Treatment of insomnia.
Binds to melatonin 1 and 2 receptors in suprachias-
matic nucleus, promoting sleep.
• Monitor sleep patterns and occurrence
of somnolence.
Adverse Reactions/Side Effects • Maintain a safe care environment. Place the client
CNS: somnolence, fatigue. Endo: decreased in a monitored room, make certain the side rails
testosterone and cortisol levels, increased are up (top), keep call light in reach, and keep
prolactin levels. Misc: anaphylaxis, angioedema. the room clear of obstructions.
Keep in Mind
• Monitor serum testosterone and prolactin levels.
Teach client:
• Administer medication at least 2 hr after the last
evening meal.
• Sleepwalking must be reported immediately. • Discuss natural sleep patterns, exercise, diet, and
• Fatigue or dizziness may be experienced; avoid sleep hygiene with the client.
activities that require alertness.
• Report unexplained amenorrhea, decreased
libido, or fertility issues.
Nursing Dx: Risk for injury; Sleep pattern disturbance. Universal Free E-Book Store
Central Nervous System Drugs Anticonvulsants 116
Levetiracetam
(le-ve-teer-a-se-tam)
Keppra
Lamotrigine
(la-mo-tri-geen)
Lamictal

Therapeutic/Pharmacologic Class • Do not discontinue abruptly.

Anticonvulsant/Miscellaneous • May cause dizziness and somnolence.
Indications • Avoid driving until physician gives clearance
Treatment of partial-onset seizures (adjunct). based on control of seizure disorder.
Action • Notify health-care professional if pregnancy is
Appear to inhibit burst firing without affecting nor- planned or suspected.
mal neuronal excitability and may selectively prevent • Wear a Medic-Alert bracelet.
hypersynchronization of epileptiform burst firing
and propagation of seizure activity. In many sources, Make the Connection
the exact action of these medications is unknown. • Assess and record location, duration,
Adverse Reactions/Side Effects and characteristics of seizure activity.
CNS: dizziness, fatigue/somnolence, weakness, • Assess client for CNS adverse effects throughout
behavioral abnormalities, depression. Neuro: coor- therapy.
dination difficulties (adults only). GI: nausea. • Monitor CBC with differential and liver function
Resp: rhinitis. Derm: photosensitivity. tests for abnormalities.
• Place on seizure precautions.
Keep in Mind • Give information on the ketogenic diet, which
Teach client: seems to have a positive effect on seizure control.
• Take medication as directed.
• Follow instructions for proper use of a calibrated
measuring device for accurate child dosing.
Nursing Dx: Risk for injury; Risk for falls. Also Used for: Central nervous system applications (migraine
prevention, mood disorder, neurogenic pain, trigeminal
Universal neuralgia)
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Gabapentin Tiagabine
(ga-ba-pen-tin) (tye-a-ga-been)
Gabarone, Gabitril
Neurontin
Topiramate Pregabalin
(tope-ear-a-mate) (pre-gab-a-lin)
Topamax Lyrica


Anticonvulsant/Miscellaneous Teach client:
Adjunctive treatment of partial seizures. • Do not discontinue abruptly (↑ seizure activity).
Action • Notify health-care professional immediately if fre-
quency of seizures increases.
Involved in enhancing the activity of GABA, an
inhibitory neurotransmitter. Most drugs in this class • May cause dizziness. Do not resume driving until
physician gives clearance based on control of
have unknown actions. seizure disorder.
Adverse Reactions/Side Effects • Wear a Medic-Alert bracelet.
CNS: dizziness, drowsiness, nervousness, weak-
ness, cognitive impairment, confusion, difficulty
concentrating (especially in children), hallucina- Make the Connection
tions, headache, mental depression, personality • Assess and record location, duration,
disorder. EENT: abnormal vision, tinnitus. and characteristics of seizure activity.
Resp: dyspnea, epistaxis. CV: chest pain, • Assess mental status.
edema, hypertension, palpitations, syncope, • Therapeutic serum levels have not been determined.
tachycardia. GI: abdominal pain, gingivitis, • Administer with food if nausea occurs.
nausea, stomatitis, weight changes. Derm: • Always discontinue anticonvulsants gradually, to
alopecia, dry skin, rash, sweating. MS: arthral- avoid recurrence or worsening of seizure activity.
gia, neck pain. Neuro: ataxia, tremors. • Give information on ketogenic diet.
Misc: allergic reactions, chills, lymphadenopathy.
Nursing Dx: Risk for injury; Pain. Also Used for: Central nervous system applications (neurogenic
pain, mood disorders, and fibromyalgia)
Carbamazepine
(kar-ba-maz-e-peen)
Tegretol, Tegretol Extended Release (XR)

Apo-Carbamazepine
Oxcarbazepine
(ox-kar-baz-e-peen)
Trileptal


Anticonvulsant/Iminostilbene Teach client:
Indications • Take as directed. Do not discontinue abruptly.
Monotherapy or adjunctive therapy of tonic-clonic, • May cause dizziness, drowsiness, or CNS changes.
mixed, and complex partial seizures in adults with Do not resume driving until physician gives clear-
epilepsy. Adjunctive therapy of partial seizures in ance based on control of seizure disorder.
clients 4–16 yr of age with epilepsy. • Do not take alcohol or other CNS depressants
concurrently with this medication.
Action
Block sodium channels in neural membranes, • Wear a Medic-Alert bracelet.
stabilizing hyperexcitable states, inhibiting repeti- • Report dyspnea, bruising, edema in dependent
areas, or frequent infections.
tive neuronal firing, and decreasing propagation
of synaptic impulses.
CNS: dizziness/vertigo, drowsiness/fatigue, • Assess and record frequency, location,
headache, cognitive symptoms. EENT: abnormal duration, and characteristics of seizure activity.
vision, diplopia, nystagmus. GI: abdominal pain, • Monitor client for CNS changes.
dyspepsia, nausea, vomiting, thirst. CV: heart fail- • Monitor ECG and serum electrolytes before and peri-
ure. Derm: acne, rash, urticaria. F and E: hypona- odically during therapy. May cause hyponatremia.
tremia. Neuro: ataxia, gait disturbances, tremor. • Auscultate lungs for crackles and assess for
Misc: allergic reactions; hypersensitivity reactions, dependent edema (CHF).
including Stevens-Johnson syndrome and multi- • Implement seizure precautions as indicated.
organ reactions; lymphadenopathy. • Give client information about ketogenic diet.
Nursing Dx: Risk for injury. Also Used for: CNS applications (trigeminal neuralgia, mood
disorders) Universal Free E-Book Store
Phenytoin
(fen-i-toyn)
Dilantin
Fosphenytoin
(fos-fen-i-toyn)
Cerebyx

Therapeutic/Pharmacologic Class including Stevens-Johnson syndrome; fever;

Anticonvulsant/Hydantoin lymphadenopathy.
Treatment and prevention of tonic-clonic seizures Teach client:
and complex partial seizures.
• Take as directed; may cause drowsiness.
Action • Do not drive until physician has given clearance based
Limit seizure propagation by altering ion transport. on seizure control; wear a Medic-Alert bracelet.
May also decrease synaptic transmission. • Avoid alcohol or other CNS depressants.
Adverse Reactions/Side Effects • Side effects like urine discoloration and unwanted
CNS: ataxia, agitation, cerebral edema, coma, hair growth may occur.
dizziness, drowsiness, dysarthria, dyskinesia, • Flossing and brushing carefully are recommended.
extrapyramidal syndrome, headache, nervous- • Maintain a well-balanced diet.
ness, weakness. EENT: diplopia, nystagmus,
tinnitus. CV: hypotension, tachycardia, vasodi-
lation. GI: gingival hyperplasia, nausea, altered
Make the Connection
taste, anorexia, constipation, drug-induced • Monitor ECG; CBC with differential;
serum drug level (10–20 mcg/mL); and LFT.
hepatitis, dry mouth, vomiting, weight loss.
GU: pink, red, reddish-brown coloration of • Assess for skin rash, which may progress to
severe exfoliative dermatitis.
urine. Derm: hirsutism, exfoliative dermatitis,
pruritus. F and E: hypocalcemia. Hemat: bone • Assess for hypersensitivity syndrome.
marrow suppression. MS: allergic reactions,
Also Used for: Central nervous system applications (neurogenic
pain, mood disorder), cardiovascular system applications (antiar-
Nursing Dx: Risk for injury. rhythmic Class 1B) Universal Free E-Book Store
Primidone
(pri-mi-done)
Mysoline
Apo-Primidone

Therapeutic/Pharmacologic Class • May cause drowsiness or dizziness. Do not resume

Anticonvulsant/Barbiturate driving until physician gives medical clearance based
Indications on control of seizure disorder.
Management of tonic-clonic, complex partial, and • Avoid taking alcohol or other CNS depressants
focal seizures. concurrently with this medication.
Action • Avoid sudden changes in position to decrease dizziness.
Decreases neuronal excitability. Increases the thresh- • Wear a Medic-Alert bracelet.
old of electric stimulation of the motor cortex. • Notify health-care professional if skin rash, unsteady
gait, joint pain, fever, changes in vision, dyspnea,
Adverse Reactions/Side Effects pregnancy, or paradoxical excitement occurs.
CNS: ataxia, drowsiness, vertigo, excitement
(increased in children). EENT: visual changes.
• Routine exams and lab tests will be required.
Resp: dyspnea. CV: edema, orthostatic
• Eat green, leafy vegetables to ensure the diet con-
tains adequate folic acid.
hypotension. GI: anorexia, drug-induced hepati-
tis, nausea, vomiting. Derm: alopecia, rash.
Hemat: blood dyscrasias, megaloblastic ane- Make the Connection
mia. Misc: folic acid deficiency. • Assess and record location, duration,
frequency, and characteristics of seizure activity.
Keep in Mind Institute and document seizure precautions.
Teach client: • Assess client for signs of folic acid deficiency.
• Take the medication at the same time each day • Monitor CBC with differential and blood chemistries.
exactly as directed. Abrupt withdrawal may lead • May be administered with food to minimize GI effects.
to status epilepticus. • For liquid administration, use a calibrated mea-
suring device to ensure accurate dosage.
Nursing Dx: Risk for injury; Knowledge deficit. Also Used for: Central nervous system applications
Universal Free(mood disorders)
E-Book Store
Ethosuximide
(eth-oh-sux-i-mide)
Zarontin


Anticonvulsant/Succinimide Teach client:
Indications • Take the medication exactly as directed. Sudden
Treatment of absence seizures (petit mal). withdrawal may precipitate seizures.
Action • Avoid activities requiring alertness.
Elevates the seizure threshold. Suppresses abnormal • Notify health-care professional if skin rash, joint pain,
sore throat, fever, unusual bleeding or bruising, swollen
wave and spike activity associated with absence glands, pink/brown urine, or pregnancy occurs.
(petit mal) seizures.
• Wear a Medic-Alert bracelet.
Adverse Reactions/Side Effects • Lab tests and follow-up exams will be required.
CNS: increased frequency of tonic-clonic
seizures, ataxia, dizziness, drowsiness, euphoria,
fatigue, headache, hyperactivity, irritability, Make the Connection
psychiatric disturbances. EENT: myopia. • Assess and record location, duration,
GI: abdominal pain, anorexia, cramping, diar- frequency, and characteristics of seizure activity.
rhea, nausea, vomiting, weight loss, hiccups. • Monitor CBC with differential, hepatic function
GU: pink/brown discoloration of urine, vaginal tests, and urinalysis routinely and drug levels
bleeding. Derm: Stevens-Johnson syndrome, throughout the course of prolonged therapy.
hirsutism, rashes, urticaria. Hemat: bone mar- • Measure liquid preparations with calibrated
row suppression. Neuro: ataxia. Misc: systemic measuring device to ensure accurate dosage.
lupus erythematosus. • Administer with food or milk to minimize GI irritation.
• This drug is one of two drugs of choice for
absence seizures.
Nursing Dx: Risk for injury; Knowledge deficit. Also Used for: Central nervous system applications (chemotherapy-
induced neuropathy) Universal Free E-Book Store
Divalproex
(dye-val-proe-ex)
Depakote, Depakote Extended Release (ER)

Epival
Valproic Acid
(val-proe-ik as-id)
Depakene

Therapeutic/Pharmacologic Class • May cause drowsiness or dizziness. Do not

Anticonvulsant/Miscellaneous resume driving until physician gives medical clear-
Indications ance based on control of seizure disorder.
Treatment of simple and complex absence seizures • Avoid taking alcohol or other CNS depressants
and partial seizures with complex symptomatology. concurrently with this medication.
Action • Wear a Medic-Alert bracelet.
Increase levels of GABA, an inhibitory neurotrans-
mitter for the CNS. Make the Connection
Adverse Reactions/Side Effects • Assess and record location, duration,
CNS: confusion, dizziness, headache, sedation. frequency, and characteristics of seizure activity.
EENT: visual disturbances. GI: hepatotoxicity, Institute and document seizure precautions.
indigestion, diarrhea, hypersalivation, increased • Monitor CBC with differential, LFT, amylase and
appetite, pancreatitis. Derm: rashes. Hemat: bone lipase levels and serum drug levels.
marrow suppression. Metab: increase in serum • May be administered with food to minimize GI effects.
ammonia levels. Neuro: ataxia, paresthesia.
Keep in Mind
Teach client:
• Take the medication at the same time each day
exactly as directed. Abrupt withdrawal may lead
to status epilepticus.
Nursing Dx: Risk for injury; Knowledge deficit. Also Used for: Central nervous system applications (mood disorders,
migraine prevention)
Central Nervous System Drugs Anti-Parkinson’s and Anti-Alzheimer’s Agents 123
Selegiline
(se-le-ji-leen)
Eldepryl, Carbex,
ENSAM Transdermal
Apo-Selegiline


Anti-Parkinson’s agent/Monoamine oxidase type B Teach client:
inhibitor • Take medication as directed with food.
Indications • There is less risk with tyramine-containing foods
Management of Parkinson’s disease (with levodopa if the transdermal system is used.
or levodopa/carbidopa) in clients who fail to • Notify health-care professional immediately if
respond to levodopa/carbidopa alone. severe headache occurs.
Action • Change positions slowly to ↓ dizziness.
Following conversion by monoamine oxidase • Report increased body temperature, sweating, men-
tal status change, muscle twitching or confusion.
(MAO) to its active form, this drug inactivates
MAO by irreversibly binding to it at type B (brain) • Increase fluids or use sugarless gum, candy, or ice
to minimize dry mouth symptoms.
sites. Inactivation of MAO leads to increased
amounts of dopamine, serotonin, and norepineph-
rine available in the CNS. Make the Connection
Adverse Reactions/Side Effects • Concurrent use with meperidine or other
CNS: confusion, dizziness, fainting, hallucina- opioid analgesics may possibly result in a potentially
tions, insomnia, vivid dreams. GI: nausea, fatal reaction. Serotonin syndrome may occur with
abdominal pain, dry mouth. concurrent use of selective serotonin reuptake
inhibitor (SSRI) and tricyclic antidepressants.
• Monitor sleep pattern changes and presence of
nightmares. Keep room free of obstacles.
• Monitor liver function and renal function tests.
Nursing Dx: Risk for injury (pharmacologic); Readiness Also Used for: Central nervous system applications (major depres-
for enhanced self-care activities. sion, borderline personality disorder)
Ropinirole
(rope-in-er-ole)
Requip
Pramipexole
(pram-i-pex-ole)
Mirapex

Therapeutic/Pharmacologic Class • May cause drowsiness and unexpected episodes

Anti-Parkinson’s agent/Dopamine agonist of falling asleep. Notify health-care professional
Indications if episodes of falling asleep occur.
Management of mild Parkinson’s disease as • Change positions slowly to ↓ dizziness.
monotherapy and as adjunctive therapy with • Use good oral hygiene, and sugarless gum or
levodopa/carbidopa in more advanced cases. candy to minimize dry mouth.
Action • If uncontrollable urges occur, such as the urge to
Act as dopamine agonists, directly stimulating post- gamble, report this immediately to the health-
synaptic dopaminergic receptors in the CNS. Some care professional.
actions are unknown.
CNS: sleep attacks, drowsiness, dyskinesia, hallu- •Assess for decrease in signs and symp-
cinations, confusion, insomnia. EENT: rhinitis. toms of Parkinson’s disease.
Resp: dyspnea. CV: orthostatic hypotension, • Assess for confusion or hallucinations. Notify
arrhythmias (atrial premature contractions, sinus physician or other health-care professional if
tachycardia), hypertension, palpitations. GI: con- these occur.
stipation, nausea, abdominal pain, diarrhea, dry • Assess client for drowsiness and sleep attacks.
mouth, dyspepsia. Neuro: compulsive behaviors. • Monitor ECG and blood pressure frequently.
Keep in Mind
• Administer with meals to minimize nausea.
Teach client:
• Monitor liver function tests, renal function tests,
and behavioral changes.
Nursing Dx: Risk for injury; Readiness for enhanced self- Also Used for: Musculoskeletal system applications (restless legs
care activities. syndrome) Universal Free E-Book Store
Amantadine
(a-man-ta-deen)
Symmetrel

Therapeutic/Pharmacologic Class • Dry mouth can be relieved with good oral hygiene
Anti-Parkinson’s agent, antiviral/Indirect dopamine and use of sugarless gum or candy.
releaser and dopamine receptor agonist • Notify health-care professional if confusion, mood
Indications changes, difficulty with urination, edema, shortness of
Symptomatic initial and adjunctive treatment of breath or worsening of Parkinson’s symptoms occurs.
Parkinson’s disease. • Full effect for Parkinson’s disease relief may take
Action up to 2 wk of therapy.
Potentiates the action of dopamine in the CNS. • Wean from the drug gradually.
CNS: ataxia, dizziness, insomnia, anxiety, confu- Make the Connection
sion, depression, drowsiness, psychosis, seizures. • Monitor blood pressure periodically.
GI: nausea, vomiting, anorexia, constipation. • Monitor vital signs and mental status periodically
EENT: blurred vision, dry mouth. Resp: dyspnea. during first few days of treatment.
CV: hypotension, CHF, edema. GU: urinary • Assess for CHF especially in clients on chronic
retention. Derm: mottling, rashes. Hemat: therapy or with a history of CHF.
leukopenia, neutropenia. • Assess client for the appearance of a diffuse red
mottling of the skin (livedo reticularis), especially
Keep in Mind in the lower extremities or on exposure to cold.
Teach client: • Monitor intake and output closely in geriatric
• Take medication around the clock as directed. clients. May cause urinary retention.
• May cause dizziness or blurred vision. Change • Symptoms of toxicity include CNS stimulation. Phy-
position slowly to avoid dizziness. siostigmine has been used to reverse CNS effects.
Nursing Dx: Risk for injury (pharmacologic); Impaired Also Used for: Immune system applications (antiviral prophylaxis
physical mobility. against influenza type A [Asian flu])
Bromocriptine
(broe-moe-krip-teen)
Parlodel
Apo-Bromocriptine

Therapeutic/Pharmacologic Class • Avoid concurrent use of alcohol.

Anti-Parkinson’s agent/Dopamine agonist • Watch for signs of MI and notify health-care
Indications professional immediately if any occur.
Adjunct to levodopa in the treatment of parkinsonism. • Women should consult with health-care professional
Action regarding a nonhormonal method of birth control.
Activates dopamine receptors in the CNS. Decreases • Maintain appointments for regular follow-up.
prolactin secretion.
CNS: dizziness, confusion, drowsiness, halluci- • Assess client for allergy to ergot derivatives.
nations, headache, insomnia, nightmares. • Monitor blood pressure; severe hypotension may
EENT: burning eyes, nasal stuffiness, visual dis- occur.
turbances. Resp: effusions, pulmonary infiltrates. • Assess for symptom relief before and throughout
CV: MI, hypotension. GI: nausea, abdominal therapy.
pain, anorexia, dry mouth, metallic taste, vomiting. • Monitor liver function tests; renal function test; and
Derm: urticaria. MS: leg cramps. Misc: digital CPK, alkaline phosphatase, and uric acid levels.
vasospasm (acromegaly only). • Auscultate the lungs every shift for crackles.
Keep in Mind
• This medication is often given concurrently with
levodopa or a levodopa-carbidopa combination
Teach client: in the treatment of Parkinson’s disease.
• Take medication as directed. • Administer with food or milk to minimize gastric
• May cause drowsiness and dizziness. distress.
Nursing Dx: Impaired physical mobility; Risk for injury Also Used for: Central nervous system applications (prolactinoma,
(pharmacologic). pituitary tumors, acromegaly, neuroleptic malignant syndrome); repro-
ductive system applications (infertility related to Free
Universal hyperprolactinemia)
E-Book Store
Tolcapone
(toll-ca-pone)
Tasmar
Entacapone
(en-tah-ca-pone)
Comtan


Anti-Parkinson’s agent/Catechol-O-methyltransferase Teach client:
(COMT) inhibitor • Take as directed.
Indications • Watch for signs of liver dysfunction.
Treatment of Parkinson’s disease as an adjunct to • Report severe diarrhea.
levodopa/carbidopa therapy to decrease fluctua- • This drug may cause drowsiness.
tion of dopamine (off-periods). • Report insomnia, hallucinations, or vivid dreams.
Action • Report severe headache or visual changes.
Prolong and stabilize the effects of levodopa/ • Report suspected pregnancy to health care pro-
fessional immediately.
carbodopa. Also prolong monoamine oxidase cata-
bolic effects. • Change position slowly to ↓ dizziness.
CNS: hallucination, somnolence, vivid dreams, Make the Connection
confusion, headache, syncope, agitation. CV: ortho- • Assess liver function tests periodically.
static hypotension, angina. EENT: tinnitus. This drug can cause serious liver problems quickly.
GI: severe diarrhea, nausea, hepatotoxicity. • Do not give concurrently with MAOI A or B drugs,
GU: erectile dysfunction, urinary tract infection. SSRIs, or tricyclic antidepressants.
MS: Myalgia. Derm: Rash. Misc: anaphylaxis, • Give with levodopa/carbidopa.
hypertensive crisis with concurrent use of MAOI
type A or B, SSRI, or tricyclic antidepressants.
Nursing Dx: Risk for injury (pharmacologic); Impaired Also Used for: Musculoskeletal system applications (restless legs
mobility. syndrome) Universal Free E-Book Store
Levodopa
(lee-voe-doe-pa)
Dopar, Larodopa, L-dopa
Carbidopa/Levodopa
(kar-bi-doe-pa/lee-voe-doe-pa)
Parcopa, Sinemet,
Sinemet Continuous Release (CR)


Anti-Parkinson’s agent/Dopamine agonist Teach client:
Indications • Take this drug as directed.
Treatment of Parkinson’s disease. These drugs are not • Gastric irritation may be decreased by eating
useful for drug-induced extrapyramidal reactions. food shortly after taking medications, but high-
protein meals may impair the drug’s effects.
Action
Levodopa is converted to dopamine in the CNS, • May cause drowsiness or dizziness.
where it serves as a neurotransmitter. Carbidopa, a • Change positions slowly to ↓ dizziness.
decarboxylase inhibitor, prevents peripheral • Dry mouth can be relieved by good oral hygiene
and sugarless gum or candy.
destruction of levodopa. Consequently, more
levodopa is delivered to the CNS using a smaller • Avoid multivitamins.
dose when used with carbidopa. • Harmless darkening of urine or sweat may occur.
• Notify health-care professional if palpitations, urinary
Adverse Reactions/Side Effects retention, involuntary movements, behavioral changes,
CNS: involuntary movements, anxiety, dizziness, severe nausea and vomiting, or new skin lesions occur.
hallucinations, memory loss, psychiatric problems.
EENT: blurred vision, mydriasis. GI: nausea,
vomiting, anorexia, dry mouth, hepatotoxicity. Make the Connection
Derm: melanoma. Hemat: hemolytic anemia, • Assess blood pressure and pulse fre-
leukopenia. Misc: darkening of urine or sweat. quently during period of dose adjustment.
• Monitor hepatic and renal function tests and
CBC with differential.
• Assess for signs of toxicity (involuntary muscle twitch-
Nursing Dx: Risk for falls; Impaired mobility; Readiness ing, facial grimacing, spasmodic eye winking, exagger-
for enhanced self-care activities. ated protrusion of tongue, behavioral changes).
Benztropine
(benz-troe-peen)
Cogentin
Apo-Benztropine
Trihexyphenidyl
(trye-hex-ee-fen-i-dill)
Artane
Apo-Trihex
Therapeutic/Pharmacologic Class • May cause drowsiness or dizziness.

Anti-Parkinson’s agent/Anticholinergic • Dry mouth may be relieved by use of sugarless
Indications gum or candy.
Adjunctive treatment of all forms of Parkinson’s • Change positions slowly to ↓ dizziness.
disease, including drug-induced extrapyramidal • Avoid taking antacids or antidiarrheals within
effects and acute dystonic reactions. 1–2 hr of this medication.
Action
Block cholinergic activity in the CNS, which is par- Make the Connection
tially responsible for the symptoms of Parkinson’s
disease. Restore the natural balance of neurotrans-
• Assess parkinsonian and extrapyramidal
symptoms before and throughout therapy.
mitters in the CNS.
• Assess bowel function daily.
Adverse Reactions/Side Effects • Monitor intake and output.
CNS: confusion, depression, dizziness, hallucina- • Remember, anticholinergics cause side effects of
tions, headache, sedation, weakness. EENT: blurred “hot as a hare, dry as a bone, red as a beet, mad
vision, dry eyes, mydriasis. CV: arrhythmias, as a hatter, blind as a bat.”
hypotension, palpitations, tachycardia. GI: consti- • If administering the drug IV (for acute dystonic
pation, dry mouth, ileus, nausea. GU: hesitancy, reactions), monitor pulse, ECG, and blood pres-
urinary retention. Misc: decreased sweating. sure closely and maintain bedrest for 1 hr after
administration.
Keep in Mind
Teach client:
• Take as directed.
Nursing Dx: Impaired mobility; Readiness for enhanced
self-care activities; Constipation; Urinary retention. Universal Free E-Book Store
Donepezil Galantamine
(doe-nep-i-zill) (ga-lant-a-meen)
Aricept, Aricept Razadyne,

Oral Disintegrating Razadyne ER,
Tablets (ODT) Reminyl
Rivastigmine Tacrine
(rye-va-stig-meen) (tak-rin)
Exelon Cognex


Anti-Alzheimer’s agent/Cholinergic (acetyl- Teach client:
cholinesterase inhibitor) • Take the medication daily, as directed.
Indications • May cause dizziness.
Treatment of mild-to-moderate dementia associated • Notify health-care professional if abdominal pain,
with Alzheimer’s disease. coffee ground emesis, nausea, diarrhea, or changes
in color of stool occur, or if new symptoms occur
Action or previously noted symptoms increase in severity.
Improve cholinergic function, which is lacking in
clients with Alzheimer’s disease, by inhibiting acetyl- • Follow-up will be scheduled to monitor progress.
cholinesterase, thus prolonging the effect of acetyl- • These medications slow the progress of the dis-
ease but do not provide a cure.
choline (the neurotransmitter of the cholinergic
system).
CNS: headache, abnormal dreams, depression, • Assess cognitive function (memory,
dizziness, drowsiness, fatigue, insomnia, attention, reasoning, language, ability to perform
syncope. CV: atrial fibrillation, hypertension, simple tasks) periodically during therapy.
hypotension, vasodilation. GI: diarrhea, nausea, • Remember SLUDGE—Salivation, Lacrimation,
anorexia, vomiting, peptic ulcers. GU: frequent Urination, Diarrhea, GI distress, Emesis are
urination. Derm: ecchymoses. Metab: hot cholinergic side effects. Administer in the evening
flashes, weight loss. MS: arthritis, muscle just before going to bed.
cramps. • Give the family information on local Alzheimer’s
day care and respite care facilities.
Nursing Dx: Ineffective family coping; Risk for disturbed
thought process; Risk for falls. Universal Free E-Book Store
Central Nervous System Drugs Affecting Mental Health 131
Alprazolam Diazepam
(al-pray-zoe-lam) (dye-az-e-pam)
Xanax, Valium
Xanax Extended Apo-Diazepam
Release (XR)
Apo-Alpraz,
Novo-Alprazol
Clonazepam Lorazepam
(kloe-na-ze-pam) (lor-az-e-pam)
Klonopin Ativan
Syn-Clonazepam Apo-Lorazepam
Therapeutic/Pharmacologic Class • May cause drowsiness or dizziness.

Antianxiety agent, sedative-hypnotic • Older clients may have an increased “hangover
agent/Benzodiazepine effect” in the morning and are at increased risk
Indications for falls.
Treatment of anxiety. • Avoid drinking grapefruit juice during therapy.
Action • Avoid the use of alcohol or other CNS depres-
Act at many levels in the CNS to produce anxiolytic sants concurrently with these drugs.
effect. May produce CNS depression. Effects may be
mediated by GABA, an inhibitory neurotransmitter. Make the Connection
Adverse Reactions/Side Effects • Kava, valerian, and chamomile can ↑
CNS: dizziness, drowsiness, lethargy, confusion, CNS depression.
hangover, headache, mental depression, para- • Concurrent ingestion of grapefruit juice will ↑
doxical excitation. EENT: blurred vision. blood levels.
GI: constipation, diarrhea, nausea, vomiting. • Assess degree and manifestations of anxiety
Derm: rashes. Misc: physical dependence, during therapy.
psychological dependence, tolerance. • Monitor CBC with differential, and liver and renal
function.
Keep in Mind • Plan to give more of your time to the anxious
Teach client: client; remain nonjudgmental.
• Take medication exactly as directed.
Nursing Dx: Anxiety; Risk for falls; Readiness for enhanced Also Used for: Reproductive system applications (premenstrual
comfort level. syndrome); musculoskeletal system applications (muscle relaxants);
central nervous system applications (anticonvulsants)
Buspirone
(byoo-spye-rone)
BuSpar


Antianxiety agent/Azaspirodecanedione Teach client:
Indications • Take exactly as directed.
Management of generalized anxiety disorder. • May cause dizziness or drowsiness.
Action • Avoid concurrent use of alcohol or other CNS
depressants.
Binds to serotonin and dopamine receptors in the brain.
Increases norepinephrine metabolism in the brain. • Consult health-care professional before taking OTC
medications or herbal products with this drug.
Adverse Reactions/Side Effects • Notify health-care professional if any chronic abnormal
CNS: dizziness, drowsiness, excitement, fatigue, muscle movements occur or if pregnancy is suspected.
headache, insomnia, nervousness, weakness, • Maintaining appointments for follow-up exams.
personality changes. EENT: blurred vision, nasal • Report palpitations, chest discomfort, or faint-
congestion, sore throat, tinnitus, altered taste or ness immediately.
smell, conjunctivitis. Resp: chest congestion,
hyperventilation, shortness of breath. CV: chest
pain, palpitations, tachycardia, hypertension, Make the Connection
hypotension, syncope. GI: nausea, abdominal •Concomitant use of kava, valerian, or
pain, constipation, diarrhea, dry mouth, vomiting. chamomile can ↑ CNS depression.
GU: changes in libido, dysuria, urinary frequency, • Grapefruit juice will ↑ serum levels.
urinary hesitancy. Derm: rashes, alopecia, blis- • Assess degree and manifestations of anxiety
ters, dry skin, easy bruising, edema, flushing, before and periodically during therapy.
pruritus. Endo: irregular menses. MS: myalgia. • Monitor liver and renal function tests.
Neuro: incoordination, numbness, paresthesia, • Monitor ECG and assess for chest discomfort.
tremor. Misc: clamminess, sweating, fever.
Nursing Dx: Anxiety; Knowledge deficit. Universal Free E-Book Store
Fluoxetine Citalopram
(floo-ox-uh-teen) (si-tal-oh-pram)
Prozac, Celexa
Prozac Weekly,
Sarafem
Fluvoxamine Paroxetine
(floo-voks-a-meen) (par-ox-e-teen)
Luvox Paxil

Therapeutic/Pharmacologic Class erythema nodosum, flushing, rashes. Endo: dys-

Antidepressant/Selective serotonin reuptake inhibitor menorrhea. MS: arthralgia, back pain, myalgia.
(SSRI) Neuro: tremor. Misc: allergic reactions, fever, flu-
Indications like syndrome, hot flashes, sensitivity reaction.
Treatment of various forms of depression, OCD, Keep in Mind
social phobias, bulimia and anorexia nervosa, and Teach client:
panic disorder. Sarafem: Management of premen-
strual dysphoric disorder (PMDD). • Take the medication exactly as directed.
• May cause drowsiness, dizziness, impaired judg-
Action ment, blurred vision and dry mouth.
Selectively inhibit the reuptake of serotonin from • Avoid alcohol, CNS depressant drugs, and herbal
the neural synapse. products like SAMe and St. John’s wort.
Adverse Reactions/Side Effects • The medication may cause decreased libido.
CNS: seizures, anxiety, drowsiness, headache, • Report chest discomfort, palpitations, or suici-
insomnia, nervousness, abnormal dreams, dizzi- dal thoughts immediately.
ness, fatigue, hypomania, mania, weakness.
EENT: stuffy nose, visual disturbances. Resp:
cough. CV: chest pain, palpitations. GI: diarrhea,
Make the Connection
abdominal pain, abnormal taste, anorexia, con- • Assess for suicidal tendencies, espe-
cially in the first 2–4 wks.
stipation, dry mouth, dyspepsia, nausea, vomit-
ing, weight loss. GU: sexual dysfunction, urinary • Monitor appetite and nutrition intake.
frequency. Derm: excessive sweating, pruritus, • Monitor CBC, LF T, and RFT.
Also Used for: Metabolic system applications (obesity); muscu-
loskeletal system applications (fibromyalgia); cardiovascular system
Nursing Dx: Risk for disturbed thought processes; Chronic applications (Raynaud’s phenomenon); CNS applications (attention
sorrow; Anxiety. deficit and hyperactivity disorder;Universal Free E-Book Store
diabetic neuropathy)
Lithium
(lith-ee-um)
Eskalith, Lithobid, Lithotabs

Carbolith

Therapeutic/Pharmacologic Class hyponatremia. Hemat: leukocytosis. Metab: weight

Antimanic agent/Neurotransmitter reuptake gain. MS: muscle weakness, hyperirritability, rigidity.
inhibitor Neuro: tremors.
Treatment of bipolar affective disorders (treatment Teach client:
of acute manic episodes and prophylaxis against
recurrence). • Take the medication as directed.
• May cause dizziness or drowsiness.
Action • Do not limit sodium intake.
Alters cation transport in nerve and muscle. • Unwanted weight gain and acne may occur.
Influences reuptake of neurotransmitters. • Do not drink coffee, tea, or cola in large amounts.
Adverse Reactions/Side Effects • Notify HCP if fever, vomiting, or diarrhea occurs.
CNS: seizures, fatigue, headache, impaired
memory, ataxia, confusion, dizziness, drowsiness,
psychomotor retardation, restlessness, stupor.
Make the Connection
EENT: aphasia, blurred vision, dysarthria, tinnitus. •Assess for suicidal ideation and react
swiftly.
CV: arrhythmias, ECG changes, edema, hypoten-
sion. GI: abdominal pain, anorexia, bloating, diar- • Monitor I&O; electrolytes; and CBC, LFT, RFT.
rhea, nausea, dry mouth, metallic taste. GU: polyuria, • Monitor serum drug levels (0.5–1.5 mEq/L).
The client with toxicity looks like a person who
glycosuria, nephrogenic diabetes insipidus, renal
is inebriated, with ataxia, slurred speech, and
toxicity. Derm: acne, folliculitis, alopecia, dimin-
drowsiness.
ished sensation, pruritus. Endo: hypothyroidism,
goiter, hyperglycemia, hyperthyroidism. F and E:
Nursing Dx: Disturbed thought processes; Suicidal Also Used for: Central nervous system applications (migraine and
thoughts; Risk for situational low self-esteem. cluster headache) Universal Free E-Book Store
Trazodone
(traz-oh-done)
Desyrel, Trialodine, Trazon
Bupropion
(byoo-proe-pee-on)
Wellbutrin,
Wellbutrin Sustained Release (SR),
Wellbutrin Extra Long-Acting (XL),
Zyban

Antidepressant/Nontricyclic, nonselective seroto- Teach client:
nin reuptake inhibitor (SSRI) (2nd-generation • Take medication exactly as directed.
antidepressant) • May cause drowsiness and blurred vision.
Indications • Avoid concurrent use of alcohol or other CNS
Treatment of major depression, often in conjunc- depressant drugs.
tion with psychotherapy. • Expect follow-up exams.
Action • Report any suicidal ideation immediately to the
health-care professional.
Alter the effects of serotonin in the CNS.
CNS: lower seizure threshold (bupropion), Make the Connection
drowsiness, confusion, dizziness, fatigue, halluci- • Concomitant use of herbal products like
nations, headache, insomnia, nightmares, slurred kava, valerian, or chamomile can ↑ CNS depression.
speech, syncope, weakness. EENT: blurred • The risk for serotonin syndrome increases when med-
vision, tinnitus. CV: hypotension, arrhythmias, ication is taken with St. John’s wort or SAMe.
chest pain, hypertension, palpitations, tachycardia. • Monitor BP, pulse, and ECG as baseline, then
GI: dry mouth, altered taste, constipation, diar- periodically.
rhea, excess salivation, flatulence, nausea, vomiting. • Assess mental status and mood changes.
GU: hematuria, impotence, priapism, urinary • There are fewer problems with sexual side effects
frequency. Derm: rashes. Hemat: anemia, than with SSRIs.
leukopenia. MS: myalgia. Neuro: tremor. • Monitor CBC, LFT, and RFT.
Nursing Dx: Disturbed thought processes. Also Used for: Respiratory system applications (smoking cessation);
central nervous system applications Universal
(diabetic neuropathy and insomnia)
Free E-Book Store
Venlafaxine Mirtazapine
(ven-la-fax-een) (meer-taz-a-peen)
Effexor, Remeron,
Effexor XR Remeron Soltabs
Nefazodone Duloxetine
(neff-a-zoe-done) (do-lox-e-teen)
Serzone Cymbalta

Therapeutic/Pharmacologic Class dry mouth, dyspepsia, nausea, vomiting, weight

Antidepressant, antianxiety agent/Serotonin and loss. GU: sexual dysfunction, urinary frequency,
norepinephrine reuptake inhibitor (SSNRI) urinary retention. Derm: ecchymoses, itching,
(3rd-generation antidepressant). photosensitivity, skin rash. Neuro: paresthesia,
Indications twitching. Misc: chills, yawning.
Treatment of major depressive illness or relapse, Keep in Mind
often in conjunction with psychotherapy. Treatment Teach client:
of generalized anxiety disorder and social anxiety
disorder. • Take the medication exactly as directed.
• The medication may cause drowsiness or dizziness.
Action • Avoid using alcohol or other CNS-depressants.
Inhibit serotonin and norepinephrine reuptake in • Report suicidal thoughts immediately.
the CNS.
CNS: seizures, abnormal dreams, anxiety, dizzi-
Make the Connection
ness, headache, insomnia, nervousness, weakness, • The risk for serotonin syndrome increases
with use of St. John’s wort or SAMe.
abnormal thinking, agitation, confusion, deper-
sonalization, drowsiness, emotional lability, • Assess suicidal tendencies, especially in early
therapy.
worsening depression. EENT: rhinitis, visual dis-
turbances, tinnitus. CV: chest pain, hypertension, • Monitor CBC, LFT, RFT, and electrolytes.
palpitations, tachycardia. GI: abdominal pain,
altered taste, anorexia, constipation, diarrhea,
Nursing Dx: Disturbed thought processes; Anxiety; Also Used for: Reproductive system applications (premenstrual
Suicidal thoughts. syndrome) Universal Free E-Book Store
Amitriptyline Nortriptyline
(a-mee-trip-ti-leen) (nor-trip-ti-leen)
Elavil, Endep Aventyl, Pamelor

Apo-Amitriptyline
Imipramine Clomipramine
(im-ip-pra-meen) (cloe-mip-pra-meen)
Tofranil Anafranil

Therapeutic/Pharmacologic Class • This medication may cause drowsiness.

Antidepressant/Tricyclic antidepressant • Dizziness on standing, sedation, and confusion
Indications are common side effects.
Treatment of depression, often in conjunction with • Avoid alcohol or other CNS depressant drugs.
psychotherapy. • Use sunscreen and protective clothing.
Action • An increase in appetite may occur.
Potentiate the effect of serotonin and norepineph- • Notify HCP immediately if having any suicidal
rine in the CNS. Produce significant anticholinergic thoughts.
side effects.
CNS: lethargy, sedation. EENT: blurred vision, • Appears on Beers list as a drug that is inap-
dry eyes, dry mouth. CV: arrhythmias, hypoten- propriate for older clients. Increases the risk for falls.
sion, ECG changes. GI: constipation, hepatitis, • May ↑ risk of suicide attempt/ideation, especially
paralytic ileus. GU: urinary retention. Derm: pho- during early treatment.
tosensitivity. Endo: changes in blood glucose, • Serotonin syndrome may occur when medication
gynecomastia. Hemat: blood dyscrasias. is combined with SAMe or St. John’s wort.
Misc: increased appetite, weight gain. • Anticholinergic effects are “hot as a hare, dry as
a bone, red as a beet, mad as a hatter, and blind
Keep in Mind as a bat.”
Teach client: • Monitor CBC, LFT, RFT, serum glucose, and
• Take the medication exactly as directed. It is best serum alkaline phosphatase.
taken at bedtime because of the sedating effects.
Nursing Dx: Disturbed thought processes; Suicidal Also Used for: Central nervous system applications (neurogenic
thoughts; Risk for injury (falls). pain) Universal Free E-Book Store
Phenelzine Tranylcypromine
(fen-el-zeen) (tran-ill-sip-roe-meen)
Nardil Parnate
Isocarboxazid
(eye-soe-car-box-a-zid)
Marplan

Therapeutic/Pharmacologic Class urinary retention. Derm: pruritus, rashes. F and

Antidepressant/Monoamine oxidase inhibitor (MAOI) E: hypernatremia. Endo: weight gain.
Treatment of neurotic or atypical depression (usually Teach client:
reserved for clients who do not tolerate or respond
to other modes of therapy [e.g., tricyclic antidepres- • Take the medication as directed.
sants, SSRIs, SSNRIs, electroconvulsive therapy]). • Avoid alcohol, CNS depressants, OTC deconges-
tant drugs, excessive caffeine intake, and foods or
Action beverages containing tyramine (give client a list).
Inhibit the enzyme monoamine oxidase, resulting in • This medication may cause dizziness or drowsiness.
an accumulation of various neurotransmitters • Wear a Medic-Alert bracelet.
(dopamine, epinephrine, norepinephrine, serotonin) • Ophthalmologic testing will also be done periodically.
in the neural synapse.
CNS: seizures, dizziness, drowsiness, fatigue,
Make the Connection
headache, hyperreflexia, insomnia, tremor, • Serious, potentially fatal adverse reac-
tions may occur with concurrent use of other antide-
twitching, weakness, euphoria, paresthesia, rest-
pressants. Avoid using within 2–5 wk of each other.
lessness. EENT: blurred vision, glaucoma, nys-
tagmus. CV: hypertensive crisis, edema, ortho- • This medication may cause severe HTN and seizures
when combined with opioids, tryptophan, tyrosine,
static hypotension. GI: constipation, dry mouth,
phenylalamine, tyramine, or high caffeine intake.
abdominal pain, liver function test elevation,
nausea, vomiting. GU: sexual dysfunction, • Assess for suicidal tendencies, especially during
early therapy.
Nursing Dx: Disturbed thought processes; Suicidal
• Monitor LFT.
thoughts; Risk for injury (pharmacologic). Universal Free E-Book Store
Haloperidol
(ha-loe-per-i-dole)
Haldol,
Haldol Long Acting (LA)
Apo-Haloperidol

Therapeutic/Pharmacologic Class Metab: hyperpyrexia. Misc: neuroleptic malig-

Antipsychotic agent/Butyrophenone nant syndrome, hypersensitivity reactions.
Treatment of acute and chronic psychotic disor- Teach client:
ders, including shizophrenia, manic states, and
drug-induced psychoses. Also useful in the manage- • Take the medication as directed. Do not discon-
tinue abruptly.
ment of aggressive or agitated clients. Treatment of
Tourette’s syndrome. • Report abnormal muscle movements or twitches.
• This medication may cause drowsiness.
Action • Avoid taking alcohol or other CNS depressants.
Alters the effects of dopamine in the CNS. Also has • Extremes of temperature should also be avoided.
anticholinergic and alpha-adrenergic blocking activity.
CNS: seizures, extrapyramidal reactions, confu-
Make the Connection
sion, drowsiness, restlessness, tardive dyskinesia. • Assess mental status.
EENT: blurred vision, dry eyes. Resp: respiratory • Monitor BP for orthostatic hypotension.
depression. CV: hypotension, tachycardia. • May cause QT interval changes on ECG.
GI: constipation, dry mouth, anorexia, drug- • Refer immediately to movement disorders specialist
if EPS occurs.
induced hepatitis, ileus. GU: urinary retention.
Derm: diaphoresis, photosensitivity, rashes. • Monitor for development of neuroleptic malig-
nant syndrome.
Endo: galactorrhea. Hemat: anemia, leukopenia.
• Monitor CBC and LFT.
Nursing Dx: Disturbed thought processes; Acute confu- Also Used for: Gastrointestinal system applications (nausea)
sion; Disturbed sensory perception. Universal Free E-Book Store
Chlorpromazine Fluphenazine
(klor-proe-ma-zeen) (floo-fen-a-zeen)
Thorazine Permitil, Prolixin

Novo-
Chlorpromazine
Perphenazine Trifluoperazine
(per-fen-a-zeen) (try-floo-oe-pear-a-zeen)
Trilafon Stelazine


Antipsychotic agent/Phenothiazine (older antipsy- Teach client:
chotic agent) • Take the medication exactly as directed.
Indications • Report abnormal muscle movement or twitches
Treatment of acute and chronic psychoses, particularly immediately to health-care professional.
when accompanied by increased psychomotor activity. • This medication may cause drowsiness.
Treatment of nausea and vomiting. Treatment of • Avoid using alcohol or other CNS depressants.
intractable hiccups. • Extremes of temperature should be avoided.
Action
Alter the effects of dopamine in the CNS. Have signifi- Make the Connection
cant anticholinergic/alpha-adrenergic blocking activity. •Assess client’s mental status prior to and
Adverse Reactions/Side Effects periodically throughout therapy.
CNS: neuroleptic malignant syndrome, sedation, • Refer to a movement disorder specialist if EPS
extrapyramidal reactions, tardive dyskinesia. occurs.
EENT: blurred vision, dry eyes, lens opacities. CV: • Monitor for orthostatic hypotension.
hypotension (increased with IM, IV), tachycardia. • Monitor for development of neuroleptic malig-
GI: constipation, dry mouth, anorexia, hepatitis, nant syndrome.
ileus. GU: urinary retention. Derm: photosensitiv- • Monitor CBC, LFT, and ocular acuity.
ity, pigment changes, rashes. Endo: galactorrhea.
Hemat: agranulocytosis, leukopenia. Metab:
hyperthermia. Misc: allergic reactions.
Also Used for: Cardiovascular system applications (vascular
Nursing Dx: Disturbed thought processes; Disturbed sen- headache); gastrointestinal system applications (nausea); central
sory perception. nervous system applications (preoperative
Universalsedation)
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Thiothixene
(thye-oh-thix-een)
Navane

Therapeutic/Pharmacologic Class • Report symptoms such as abnormal muscle

Antipsychotic agent/thioxanthene movement or twitches immediately.
Indications • This medication may cause drowsiness.
Management of psychotic disorders. • Avoid using alcohol or other CNS depressants.
Action • Extremes of temperature should be avoided.
Alters the effect of dopamine in the CNS. • This medication may cause breast enlargement.
Adverse Reactions/Side Effects • Routine follow-up exams and continued partici-
pation in psychotherapy are needed.
CNS: neuroleptic malignant syndrome,
extrapyramidal reactions, sedation, tardive dys-
kinesia, seizures. EENT: blurred vision, dry eyes, Make the Connection
lens opacities. CV: hypotension, tachycardia, • Assess client’s mental status prior to and
non-specific ECG changes. GI: constipation, dry periodically throughout therapy.
mouth, anorexia, ileus, nausea. GU: urinary • Monitor for orthostatic hypotension.
retention. Derm: photosensitivity, pigment • Refer to a movement disorder specialist if EPS
changes, rashes. Endo: breast enlargement, occurs.
galactorrhea. Hemat: leukocytosis, leukopenia. • Monitor for development of neuroleptic malig-
Metab: hyperpyrexia. Misc: allergic reactions. nant syndrome.
Keep in Mind
• Monitor CBC, LFT, and ocular acuity.
Teach client:
• Avoid contact with all forms of solution because
it may cause dermatitis.
• Take the medication exactly as directed.
Nursing Dx: Disturbed thought processes; Disturbed sen-
sory perception. Universal Free E-Book Store
Aripiprazole Risperidone
(a-ri-pip-ra-zole) (ris-pear-i-doen)
Abilify Risperdal
Olanzapine Ziprasidone
(oe-lanz-a-peen) (zye-pras-i-doen)
Zyprexa, Geodon
Zyprexa Zydis


Antipsychotic agent/Dopamine and serotonin Teach client:
receptor blocker (atypical, newer antipsychotic • Take the medication exactly as directed.
agent) • Watch for abnormal muscle movements or
Indications twitches and report these symptoms immediately.
Treatment of schizophrenia. • This medication may cause seizures and drowsiness.
Action • Avoid concurrent use of alcohol and other CNS
depressants.
Bind to dopamine and serotonin receptors in the
CNS. Produce fewer extrapyramidal reactions and
less tardive dyskinesia than standard antipsychotics. Make the Connection
Adverse Reactions/Side Effects • Monitor client’s mental status before
CNS: neuroleptic malignant syndrome, and periodically during therapy.
seizures, dizziness, sedation. EENT: visual dis- • Monitor for orthostatic hypotension.
turbances, conjunctivitis, ear pain. CV: chest • Monitor ECG for cardiac abnormalities.
pain, hypotension, tachycardia, ECG changes, • Refer to a movement disorder specialist if EPS
hypertension. GI: constipation, abdominal occurs.
discomfort, dry mouth, increased salivation, • Monitor for development of neuroleptic malig-
nausea, vomiting. Derm: sweating. Endo: hyper- nant syndrome.
glycemia. Hemat: bone marrow changes. • Monitor CBC and LFT.
Neuro: extrapyramidal reactions. Resp: Dyspnea.
Misc: weight loss.
Nursing Dx: Disturbed thought processes; Disturbed sen- Also Used for: Central nervous system applications (bipolar
sory perception. disorder/mania) Universal Free E-Book Store
Central Nervous System Drugs Stimulants 143
Caffeine Ergotamine,
(kaff-een)
Caffeine
(err-got-a-mine, kaff-een)
Cafcit
Cafergot
Butalbital, Acetaminophen,
Caffeine
(bute-al-bit-al, a-seet-a-min-oe-fen, kaff-een)
Fioricet


Analgesic, stimulant/Xanthine derivative alone or in Teach client:
combination with butalbital (barbiturate), ergota- • Use pain scale as instructed to objectively rate
mine (intercranial vessel constrictor), and/or aceta- severity of migraine symptoms.
minophen (nonsteroidal analgesic) • Report palpitations or chest pain immediately.
Indications • Do not take this medication if you have
Treatment of migraine headache. Used as a respira- glaucoma or BPH.
tory stimulant in neonates (noncombination drug). • Laboratory tests will be scheduled periodically.
Action • Suppositories may be available instead of PO form
if nausea and vomiting accompany migraine
Vasoconstriction of dilated blood vessels implicated symptoms.
in recurrent painful migraine headache. Produces
bronchodilation.
GI: constipation, dry mouth. MS: myalgia, tin- •Monitor pain scale and report relief of
gling of fingers and toes. CV: Palpitations, fast migraine headache.
heart rate, angina pectoris, Neuro: dizziness, • Monitor ECG and ask client to report palpitations.
nervousness, insomnia. GU: worsening of benign • Monitor liver and renal function tests periodically.
prostatic hyperplasia (BPH), painful urination. • Place on monitor; take vital signs and pulse
Sensory: Worsening of glaucoma. oximeter reading immediately if client reports
chest pain.
• Medicate at the first sign of migraine pain to pos-
sibly abort the migraine headache.
Nursing Dx: Pain; Readiness for enhanced comfort level. Also Used for: Respiratory system applications (bronchodilation
and prevention of apnea in the neonate [noncombined
Universal stimulant])
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Sibutramine
(si-byoo-tra-meen)
Meridia


Weight control agent/Appetite suppressant Teach client:
Treatment of obesity in clients with body mass • Avoid using other CNS depressants or excessive
index ≥30 kg/m2 (or ≥27 kg/m2 in clients with dia- amounts of alcohol with this medication.
betes, hypertension, or other risk factors) in con- • Take weight at the same time, using the same
junction with other interventions (dietary restriction, scale, with the same clothing weekly.
exercise); used to produce and maintain weight loss.
Acts as an inhibitor of the reuptake of serotonin, • Concurrent use of other centrally acting
norepinephrine, and dopamine; increases the satiety- appetite suppressants, MAOI, SSRIs, naratriptan,
producing effects of serotonin. frovatriptan, rizatriptan, zolmitriptan, sumatriptan,
Adverse Reactions/Side Effects dihydroergotamine, dextromethorphan, meperidine,
CNS: seizures, headache, insomnia, CNS stimu- pentazocine, fentanyl, lithium, or tryptophan may
lation, dizziness, drowsiness, emotional lability, result in potentially fatal “serotonin syndrome.”
nervousness. EENT: laryngitis/pharyngitis, • Monitor clients for weight loss and adjust con-
rhinitis, sinusitis. CV: hypertension, palpitations, current medications as needed.
tachycardia, vasodilation. GI: anorexia, consti- • Monitor blood pressure and heart rate regularly
pation, dry mouth, altered taste, dyspepsia, during therapy. Increases in blood pressure or
increased appetite, nausea. GU: dysmenorrhea. heart rate, especially during early therapy, may
Derm: increased sweating, rash. require decrease in dose or discontinuation of
this drug.
Nursing Dx: Therapeutic regimen: individual, effective
management; Risk for imbalanced nutrition: more than Also Used for: Central nervous system applications (antidepres-
body requirements. sant) Universal Free E-Book Store
Methylphenidate
(meth-ill-fen-i-date)
Concerta, Metadate Continuous Dosage (CD),

Metadate Extended Release (ER), Methylin,
Methylin Sustained Release (SR), Ritalin,
Ritalin Long-Acting (LA), Ritalin-SR
PMS-Methylphenidate
Dexmethylphenidate
(dex-meth-ill-fen-i-date)
Focalin, Focalin Extended Release (XR)

Therapeutic/Pharmacologic Class psychological dependence, suppression of

Attention span–enhancing agent/Central nervous weight gain (children), tolerance.
system stimulant.
Keep in Mind
Treatment of attention deficit/hyperactivity disorder
(ADHD). Symptomatic treatment of narcolepsy. • Take medication as directed before 6 PM.
Unlabelled Uses: Management of some forms of • Weight will be assessed 2–3 times weekly.
refractory depression. • Avoid using caffeine-containing beverages.
• Report palpitations or insomnia.
Action • Parents are to notify school nurse of medication
Produce CNS and respiratory stimulation with weak regimen (ADHD).
sympathomimetic activity.
CNS: hyperactivity, insomnia, restlessness,
Make the Connection
tremor, dizziness, headache, irritability. • Using with MAOI or vasopressors may
result in hypertensive crisis.
EENT: blurred vision. CV: hypertension, palpita-
tions, tachycardia, hypotension. GI: anorexia, • Monitor blood pressure, pulse, and respiration.
constipation, cramps, diarrhea, dry mouth, • Medication has a high dependence and abuse
potential.
metallic taste, nausea, vomiting. Derm: rashes.
Neuro: akathisia, dyskinesia. Misc: fever, hyper- • Assess effectiveness when used for ADHD or
narcolepsy.
sensitivity reactions, physical dependence,
• Monitor CBC.
Nursing Dx: Risk for imbalanced nutrition: less than body
requirements; Readiness for enhanced self-perception. Universal Free E-Book Store
Amphetamine
(am-fet-a-meen)
Amphetamine Salt, Adderall,

Adderall Extended Release (XR)


Attention span–enhancing agent/Central nervous Teach client:
system stimulant • Take the medication at least 6 hr before bedtime.
Indications • Report insomnia or palpitations.
Treatment of narcolepsy. Adjunct in the management • Weight will be assessed frequently.
of attention-deficit/hyperactivity disorder (ADHD).
Causes release of norepinephrine from nerve endings. • Using with MAOI or meperidine can
Adverse Reactions/Side Effects result in hypertensive crisis.
CNS: hyperactivity, insomnia, irritability, rest- • Monitor blood pressure, pulse, and respiration.
lessness, tremor, dizziness, headache, cardiomy- • Medication may produce a false sense of eupho-
opathy (increased with prolonged use, high ria and well-being.
doses). CV: palpitations, tachycardia, hyperten- • Medication has high dependence and abuse
sion, hypotension. GI: anorexia, constipation, potential.
cramps, diarrhea, dry mouth, metallic taste, • Monitor weight biweekly.
nausea, vomiting. GU: erectile dysfunction, • Assess effectiveness in treatment of ADHD or
increased libido. Derm: urticaria. Endo: growth narcolepsy.
inhibition (with long-term use in children).
Misc: psychological dependence.
Nursing Dx: Readiness for enhanced social interaction; Risk

for imbalanced nutrition: less than body requirements. Universal Free E-Book Store
Atomoxetine
(a-to-mox-e-teen)
Strattera


Attention deficit disorder agent/Selective norepi- Teach client:
nephrine reuptake inhibitor • Take medication as directed.
Indications • Avoid pregnancy or breast-feeding.
Treatment of attention-deficit/hyperactivity disorder • Notify school nurse of ADHD regimen.
(ADHD).
Selectively inhibits the presynaptic transporter of •Contraindicated if used concurrently or
norepinephrine. within 2 wk of MAOI.
Adverse Reactions/Side Effects • Contraindicated in clients with narrow angle
CNS: dizziness, fatigue, mood swings, insomnia glaucoma with cardiovascular history.
(adults). CV: hypertension, orthostatic hypoten- • This medication may ↑ risk for suicide attempt/
sion, tachycardia. GI: dyspepsia, severe liver ideation.
injury (rare), nausea, vomiting; dry mouth, con- • Concurrent albuterol or vasopressor use increases
stipation. Derm: rash, urticaria. GU: dysmenor- risk of adverse cardiovascular reactions.
rhea, ejaculatory problems, ↓ libido, erectile • Assess effectiveness for treatment of ADHD.
dysfunction, urinary hesitation, urinary retention. • Monitor BP, pulse, and LFT.
Metab: decreased appetite, weight/growth loss.
Misc: allergic reactions including angioneurotic
edema.
Nursing Dx: Risk for imbalanced nutrition: less than body Also Used for: Central nervous system applications (adjunctive
requirements; Suicidal thoughts. treatment for certain types of depression)
Modafinil
(mo-daf-i-nil)
Provigil

Therapeutic/Pharmacologic Class Endo: hyperglycemia. Hemat: eosinophilia.

Wakefulness enhancement agent/Central nervous MS: joint disorder, neck pain. Neuro: ataxia,
system stimulant dyskinesia, hypertonia, paresthesia, tremor.
Indications Misc: infection.
Improvement of wakefulness in clients with exces- Keep in Mind
sive daytime drowsiness due to narcolepsy, obstruc- Teach client:
tive sleep apnea, or shift work sleep disorder.
• Take the medication as directed.
Action • This medication may impair judgment.
Produces CNS stimulation through several path- • Avoid pregnancy or breast-feeding.
ways (weak dopaminergic activity, alpha1-adrenergic • Notify health-care professional immediately if
agonism, and decrease in GABA transmission). rash, hives, or other allergic reactions occur.
CNS: headache, amnesia, anxiety, cataplexy,
confusion, depression, dizziness, insomnia, nerv-
Make the Connection
ousness. EENT: rhinitis, abnormal vision, ambly- • Contraindicated in patients with cardio-
vascular problems.
opia, epistaxis, pharyngitis. Resp: dyspnea, lung
disorder. CV: arrhythmias, chest pain, hyper- • May cause elevated liver enzymes, so monitor
LFT periodically.
tension, hypotension, syncope, vasodilation.
GI: nausea, abnormal liver function, anorexia, • Administer as a single dose in the morning or
1 hr before the start of work shift for clients with
diarrhea, gingivitis, mouth ulcers, thirst, vomiting.
shift work sleep disorder.
GU: abnormal ejaculation, albuminuria, urinary
retention. Derm: dry skin, herpes simplex.
Nursing Dx: Sleep pattern disturbance. Universal Free E-Book Store

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

Therapeutic/Pharmacologic Class • Lying down in a darkened room following drug

Vascular headache suppressant/5-HT1 agonist administration may further help relieve headache.
Indications • Avoid pregnancy or breast-feeding.
Treatment of acute migraine headache. • Notify HCP prior to next dose of the drug if
Action there is pain or tightness in the chest or if pain
Act as an agonist at specific 5-HT1 receptor sites in is severe or does not subside.
intracranial blood vessels and sensory trigeminal • May cause dizziness or drowsiness.
nerves. • Avoid alcohol, which aggravates headache.
Adverse Reactions/Side Effects • Follow instructions for proper method of self-
subcutaneous medication administration.
CNS: drowsiness, headache. CV: coronary
artery vasospasm, MI, myocardial ischemia,
ventricular fibrillation, ventricular tachycardia. Make the Connection
GI: dry mouth, nausea. Neuro: paresthesia. •Medication is contraindicated in basilar
or hemiplegic migraine.
Keep in Mind • Concurrent use with MAO-A inhibitors, SSRIs,
Teach client: or other 5-HT1 agonists is contraindicated.
• Medication should be used only during a • Tablets should be swallowed whole with liquid.
migraine attack. • Subcutaneously administered medications may
• Medication should be used as soon as symptoms abort a vascular headache within several minutes.
of a migraine attack appear.
• Do not take medication within 24 hr of another
vascular headache suppressant.
Nursing Dx: Risk for pain; Risk for injury (pharmacologic). Universal Free E-Book Store
Epinephrine
(e-pi-nef-rin)
Adrenalin, Ana-Guard,
AsthmaHaler Mist,
AsthmaNefrin (Racepinephrine),
EpiPen, MicroNefrin, Nephron,
Primatene, Sus-Phrine, S-2


Antiasthmatic agent, bronchodilator, vasopressor/ Teach client:
Adrenergic agent • Take medication exactly as directed.
Indications • Contact HCP immediately if shortness of breath is
Management of cardiac arrest. Increase of contrac- not relieved by medication or is accompanied by
tility, heart rate, and urinary output in shock. diaphoresis, dizziness, palpitations, or chest pain.
Action • Follow instructions for proper use of metered
dose inhalers.
Results in the accumulation of cyclic adenosine
monophosphate (cAMP) at beta-adrenergic recep-
tors. Affects both beta1 (cardiac)-adrenergic recep- Make the Connection
tors and beta2 (pulmonary)-adrenergic receptor • Contraindicated in hypersensitivity to
sites. Produces bronchodilation. Also has alpha- adrenergic amines and in cardiac arrhythmias.
adrenergic agonist properties, which result in • Assess lung sounds, respiratory pattern, pulse,
vasoconstriction. Inhibits the release of mediators and blood pressure.
of immediate hypersensitivity reactions from mast • Observe for paradoxical bronchospasm (wheezing).
cells. • Assess for hypersensitivity reaction (rash;
Adverse Reactions/Side Effects urticaria; swelling of the face, lips, or eyelids).
CNS: nervousness, restlessness, tremor, • May cause an increase in blood glucose and
headache, insomnia. Resp: paradoxical bron- serum lactic acid concentrations.
chospasm (excessive use of inhalers). CV: angina, • Client harm or fatalities have occurred from
arrhythmias, hypertension, tachycardia. GI: nausea, medication errors with this drug. Have second
vomiting. Endo: hyperglycemia. practitioner check dose (IV).
Nursing Dx: Risk for injury (pharmacologic). Universal Free E-Book Store
Terbutaline
(ter-byoo-ta-leen)
Brethaire, Bricanyl


Bronchodilator, tocolytic agent/Adrenergic agent Teach client:
Indications • Take the medication exactly as directed.
Management of reversible airway disease due to • Contact health-care professional immediately if
asthma or chronic obstructive pulmonary disease; shortness of breath is not relieved or if chest
inhalation and subcutaneous agents used for short- pain occurs.
term control and oral agent for long-term control. • Consult HCP before taking any OTC medications
Treatment for preterm labor. or alcoholic beverages.
Action • Avoid smoking and other respiratory irritants.
monophosphate (cAMP) at beta-adrenergic recep- Make the Connection
tors. Relaxes smooth muscle in the airways, vessels, • Assess lung sounds, respiratory pattern,
and uterus. pulse, and blood pressure before administration
Adverse Reactions/Side Effects and during peak of medication.
CNS: nervousness, restlessness, tremor, • Observe for paradoxical bronchospasm (wheezing).
headache, insomnia. Resp: paradoxical bron- • Symptoms of overdose include persistent agitation,
chospasm (excessive use of inhalers). CV: angina, chest pain or discomfort, decreased blood pressure,
arrhythmias, hypertension, tachycardia. GI: nausea, dizziness, hyperglycemia, hypokalemia, seizures, tach-
vomiting. Endo: hyperglycemia. yarrhythmias, persistent trembling, and vomiting.
Nursing Dx: Risk for injury (pharmacologic). Also Used for: Reproductive system applications (tocolytic therapy
for preterm labor).
CARDIOVASCULAR

Cardiovascular System Drugs Affecting Coagulation 152
Protamine Sulfate
(proe-ta-meen soll-fate)
Protamine Sulfate (Injection)


Antidote/Antiheparin agent Teach client:
Indications • Report recurrent bleeding immediately.
Acute management of severe heparin overdosage. • Avoid activities that may result in bleeding.
Neutralization of heparin received during dialysis,
cardiopulmonary bypass, and other procedures. Make the Connection
Unlabelled Uses: Management of overdose of
heparin-like compounds. • Assess for bleeding and hemorrhage
throughout therapy.
Action • Assess for allergy to fish (salmon) or previous
A strong base that forms a complex with heparin reaction to or use of insulins containing this drug
(an acid). or to the drug itself. Vasectomized and infertile
Adverse Reactions/Side Effects men also have higher risk for hypersensitivity
Resp: dyspnea. CV: bradycardia, hypertension, reaction because of the presence of antibodies to
hypotension, pulmonary hypertension. GI: nau- the drug found in their serum.
sea, vomiting. Derm: flushing, warmth. Hemat: • Observe client for signs and symptoms of hyper-
bleeding. MS: back pain. Misc: hypersensitivity sensitivity reaction.
reactions, including anaphylaxis, angioedema, • Monitor clotting factors.
and pulmonary edema. • In severe cases, fresh frozen plasma or whole
blood may also be required to control bleeding.
• Dosage varies with type of heparin, route of
heparin therapy, and amount of time elapsed
since discontinuation of heparin.
• May be given by direct IV infusion undiluted.
Heparin
(hep-a-rin)
Hep-Lock, Hep-Lock U/P

Hepalean


Anticoagulant/Antithrombotic agent Teach client:
Indications • Report any symptoms of unusual bleeding or bruis-
Prophylaxis and treatment of various thromboem- ing to the health-care professional immediately.
bolic disorders, including venous and arterial • Do not take antiplatelet agents.
thrombosis, embolism, pulmonary emboli, • Use a soft toothbrush and an electric razor.
coagulopathies, and atrial fibrillation with • Wear a Medic-Alert bracelet at all times.
embolization.
Potentiates the inhibitory effect of antithrombin on • Assess client for signs of bleeding and
factor Xa and thrombin. In low doses, prevents the hemorrhage.
conversion of prothrombin to thrombin by its • Monitor for hypersensitivity reactions.
effects on factor Xa. Higher doses neutralize throm- • Assess LFT, K+, CBC, aPTT, and D-dimer studies.
bin, preventing the conversion of fibrinogen to • Two practitioners should independently check the
fibrin. order, calculate the dose (especially in weight-
Adverse Reactions/Side Effects based applications), and set the infusion pump.
GI: drug-induced hepatitis. Derm: alopecia The two practitioners then cosign the MAR.
(long-term use), rash, urticaria. Hemat: bleed- • Antidote is protamine sulfate.
ing, anemia, thrombocytopenia. Local: pain at
the injection site. MS: osteoporosis (long-term
use). Misc: fever, hypersensitivity.
Dalteparin Enoxaparin
(dal-te-pa-rin) (e-nox-a-pa-rin)
Fragmin Lovenox
Fondaparinux Tinzaparin
(fon-da-par-i-nux) (tin-za-pa-rin)
Arixtra Innohep


Anticoagulant/Antithrombotic agent Teach client:
Indications • Report any symptoms of unusual bleeding or bruis-
Prevention of deep vein thrombosis (DVT) and ing to the HCP immediately.
pulmonary embolus (PE) after abdominal surgery • Do not concurrently take antiplatelet agents.
or knee/hip surgery or replacement. • Use a soft toothbrush and an electric razor.
Action • Wear a Medic-Alert bracelet at all times.
Potentiate the inhibitory effect of antithrombin on • Follow instructions for proper method of inject-
ing the drug.
factor Xa and thrombin.
CNS: dizziness, headache, insomnia. CV: edema. Make the Connection
GI: constipation, nausea, reversible increase in • Assess client for signs of bleeding and
liver enzymes, vomiting. Derm: ecchymosis, hemorrhage.
pruritus, rash, urticaria. Hemat: bleeding, anemia, • Monitor for hypersensitivity reactions.
thrombocytopenia. Local: pain at the injection • Monitor CBC with platelets and D-dimer studies.
site, hematoma. Misc: fever, hypersensitivity. • Monitor liver function studies.
Neuro: epidural or spinal hematoma with use of • Antidote is protamine sulfate.
these anticoagulants during spinal procedures. • Injection systems have special instructions.
“Love” nox – given in the “love handles.” Arixtra
must be given with the thumb on the plunger,
leaving the air bubble intact.
Warfarin
(war-fa-rin)
Coumadin
Warfilone

Therapeutic/Pharmacologic Class • Use a soft toothbrush, do not floss, and shave

Anticoagulant/Coumarin with an electric razor during therapy.
Indications • Report any symptoms of unusual bleeding or
Prophylaxis and treatment of venous thrombosis, pul- bruising.
monary embolus (PE), atrial fibrillation with emboliza- • Do not drink alcohol or take anti-platelet
tion. Management of MI. Decrease of risk for death and medications.
subsequent MI and PE. Prevention of thrombus forma- • Frequent lab tests will be done.
tion and embolization after prosthetic valve placement. • Wear a Medic-Alert bracelet at all times.
Action • Inform all involved health-care personnel of anticoag-
Interferes with hepatic synthesis of vitamin ulant therapy before lab tests, treatment, or surgery.
K-dependent clotting factors (II, VII, IX, X).
GI: cramps, nausea. Derm: dermal necrosis. • Assess client for signs of bleeding and
Hemat: bleeding. Misc: fever. hemorrhage.
Keep in Mind
• Monitor PT, INR, and CBC.
Teach client:
• Assess stool and urine occult blood before and
periodically throughout therapy.
• Take medication exactly as directed. • The antidote is vitamin K.
• Do not eat excessive amounts of foods containing • This medication requires 3–5 days to reach
vitamin K; Give client a list. effective levels.
Nursing Dx: Risk for injury (pharmacologic); Knowledge

Ticlopidine
(tye-cloe-pi-deen)
Ticlid
Clopidogrel
(kloh-pid-oh-grel)
Plavix


Antiplatelet agent/Platelet aggregation inhibitor Teach client:
Indications • Take the medication exactly as directed.
Reduction of atherosclerotic events (MI, stroke, • Notify health-care professional promptly if
vascular death) in clients at risk for such events, fever, chills, sore throat, or unusual bleeding or
including those with recent MI, acute coronary syn- bruising occurs.
drome (unstable angina/non–Q-wave MI), stroke, • Avoid taking OTC medications containing aspirin or
or peripheral vascular disease. NSAIDs without consulting health-care professional.
Action
Decrease blood viscosity by inhibiting platelet Make the Connection
aggregation and decreasing fibrinogen. Inhibit • Assess client for symptoms of stroke,
platelet aggregation by irreversibly inhibiting the peripheral vascular disease, and MI periodically
binding of ATP to platelet receptors. during therapy.
Adverse Reactions/Side Effects • Monitor client for signs of thrombotic thrombo-
CNS: depression, dizziness, fatigue, headache. cytic purpura.
EENT: epistaxis. Resp: cough, dyspnea. CV: chest • Monitor bleeding time during therapy. Prolonged
pain, edema, hypertension. GI: GI bleeding, bleeding time, which is time and dose dependent,
abdominal pain, diarrhea, dyspepsia, gastritis. is expected. Monitor CBC with differential and
Derm: pruritus, purpura, rash. Hemat: bleeding, platelet count periodically during therapy.
neutropenia, thrombotic thrombocytopenic pur- • Monitor liver function studies, lipid panel, and
pura. Metab: hypercholesterolemia. MS: arthralgia, uric acid concentrations.
back pain. Misc: fever, hypersensitivity reactions. • Contraindicated in idiopathic thrombocytopenic
Nursing Dx: Risk for injury (pharmacologic); Readiness purpura.
for enhanced home maintenance management. Universal Free E-Book Store
Aminocaproic Acid
(a-mee-noe-ka-pro-ik)
Amicar

Therapeutic/Pharmacologic Class • When medication is given IV, make position

Hemostatic agent/Fibrinolysis inhibitor changes slowly to avoid orthostatic hypotension.
Indications
Management of acute, life-threatening hemorrhage
due to systemic hyperfibrinolysis or urinary Make the Connection
fibrinolysis. Prevention of recurrent subarachnoid • Contraindicated in active intravascular
hemorrhage. Prevention of bleeding following oral clotting.
surgery in hemophiliacs. Management of severe • Concurrent use with conjugated estrogens may
hemorrhage caused by thrombolytic agents. result in a hypercoagulable state and resultant
thrombus formation.
Action
Inhibits activation of plasminogen. Plasminogen is a
• Monitor blood pressure, pulse, and respiratory
status as indicated by severity of bleeding.
serum protease that can be activated to form clots.
• Monitor for overt bleeding every 15–30 min.
Adverse Reactions/Side Effects • Monitor neurologic status in clients with sub-
CNS: dizziness, malaise. EENT: nasal stuffiness, arachnoid hemorrhage.
tinnitus. CV: arrhythmias, hypotension (IV only). • Monitor intake and output (I&O) frequently.
GI: anorexia, bloating, cramping, diarrhea, nau- • Notify physician of positive Homans’ sign, leg pain
sea. GU: diuresis, renal failure. MS: myopathy. and edema, hemoptysis, dyspnea, or chest pain.
Keep in Mind
• Monitor platelet count and clotting factors.
Teach client:
• Monitor for increased CPK, AST, and serum
aldolase, which may indicate myopathy.
• Notify the nurse immediately if bleeding recurs or • May elevate serum potassium, so assess elec-
if thromboembolic symptoms develop. trolytes frequently.
Nursing Dx: Risk for injury (hypovolemia); Deficient fluid
volume; Knowledge deficit. Universal Free E-Book Store
Alteplase
(al-te-plase)
Cathflo Activase,
Tissue Plasminogen Activator (t-PA),
Activase
Activase rt-PA
Streptokinase
(strep-toe-kye-nase)
Kabikinase, Streptase

Thrombolytic agent/Plasminogen activator Teach client:
Indications • Be aware of the need for bedrest and minimal
Treatment of acute MI. Treatment of acute ischemic handling during therapy to avoid injury.
stroke. Treatment of PE. Clearance of occluded
central venous access devices. Treatment of DVT. Make the Connection
Treatment of acute peripheral arterial thrombosis.
• Contraindicated in clients with active
Action internal bleeding, history of CVA or recent (within 2
Directly convert plasminogen to plasmin, which mo) history of arterial or venous or CNS structural
then degrades clot-bound fibrin. abnormalities, severe HTN, or bleeding tendencies.
Adverse Reactions/Side Effects • Assess client carefully for bleeding.
CNS: intracranial hemorrhage. EENT: epistaxis, • Assess client for hypersensitivity reaction.
gingival bleeding. Resp: bronchospasm, hemop- • Assess neurologic status throughout therapy.
tysis. CV: reperfusion arrhythmias, hypotension, • For MI, must be given within 6 hrs of onset of
recurrent ischemia/thromboembolism. GI: GI symptoms.
bleeding, nausea, retroperitoneal bleeding, • For CVA, must be given within 2–3 hr of onset of
vomiting. GU: GU tract bleeding. Derm: ecchy- symptoms.
moses, flushing, urticaria. Hemat: bleeding. • For PE, monitor VS and breath sounds.
Local: hemorrhage at injection site, phlebitis at • Monitor CBC, D-dimer, fibrinogen, PT, aPTT, and
injection site. MS: musculoskeletal pain. Misc: thrombin time.
allergic reactions including anaphylaxis, fever. • Antidote is aminocaproic acid (Amicar).
Nursing Dx: Risk for injury (hemorrhage); Knowledge
Phytonadione
(fye-toe-na-dye-one)
AquaMEPHYTON,
Mephyton, Vitamin K

Therapeutic/Pharmacologic Class • The diet should remain consistent, with no dras-

Antidote, vitamin/Fat-soluble vitamin tic changes, while taking this drug.
Indications • Be aware of the rationale for this drug therapy.
Prevention and treatment of hypoprothrombine- • Watch for and report any symptoms of unusual
mia, which may be associated with excessive doses bleeding or bruising.
of oral anticoagulants, salicylates, certain anti- • While on this drug, consult with the health-care
infective agents, nutrition deficiencies, and pro- professional about taking OTC medications.
longed total parenteral nutrition (TPN). Prevention • Wear a Medic-Alert bracelet.
of hemorrhagic disease of the newborn. • Frequent lab tests will be required to monitor
Action coagulation factors.
Required for hepatic synthesis of blood coagulation
factors II (prothrombin), VII, IX, and X. Make the Connection
Adverse Reactions/Side Effects • Monitor for frank and occult bleeding.
GI: gastric upset, unusual taste. Derm: flushing, • Monitor pulse and blood pressure frequently.
rash, urticaria. Hemat: hemolytic anemia. • PT and INR should be monitored.
Local: erythema, pain at injection site, swelling. • The parenteral route is preferred for this
Misc: allergic reactions, hyperbilirubinemia drug. Because of severe, potentially fatal
(large doses in very premature infants), kernicterus. hypersensitivity reactions, the IV route is not
recommended.
Keep in Mind • This drug is the antidote for warfarin overdose.
Teach client: • Hint: “K” is for “Koagulation” (German form of
• Take this medication as ordered. the word coagulation).
Nursing Dx: Risk for injury (pharmacologic and physiologic). Universal Free E-Book Store
Cardiovascular System Drugs Affecting Contractility/Rhythm/Circulating

Blood Volume 160
Digoxin
(di-jox-in)
Digitek, Lanoxicaps,
Lanoxin


160
Blood Volume
Therapeutic/Pharmacologic Class • Wear a Medic-Alert bracelet, and inform other
Antiarrhythmic agent, inotropic agent/Cardiac glycoside health-care providers of this drug regimen.
Indications • Routine follow-up exams will be scheduled.
Treatment of CHF, tachyarrhythmias, atrial fibrilla-
tion, atrial flutter, and paroxysmal atrial tachycardia.
Make the Connection
Action
Slows and strengthens the force of myocardial
• Contraindicated in hypersensitivity,
uncontrolled ventricular arrhythmias, and AV blocks.
contraction by prolonging the refractory period of
the atrioventricular (AV) node and decreasing con-
• Electrolyte abnormalities, especially of potassium
(low), predisposes to toxicity. Monitor electro-
duction through the sinoatrial (SA) and AV nodes. lytes, LFTs, and RFTs.
Adverse Reactions/Side Effects • Monitor apical pulse for 1 full min before administering
CNS: fatigue, headache, weakness. EENT: blurred • Monitor intake, output, and daily weight. Assess
vision, yellow or green vision. CV: arrhythmias, for peripheral edema, and auscultate lungs for
bradycardia, ECG changes, AV block, SA block. rales/crackles throughout therapy.
GI: anorexia, nausea, vomiting, diarrhea. • Therapeutic serum digoxin levels range from
Endo: gynecomastia. Hemat: thrombocytopenia. 0.5–2 ng/mL.
Metab: hyperkalemia with acute toxicity. • Digoxin immune fab (Digibind) is the antidote.
Keep in Mind
• Monitor the brain natriuretic peptide (BNP).
Teach client:
• Take medication as directed. Report nausea,
vomiting, or anorexia.
Nursing Dx: Decreased cardiac output; Excess fluid volume.


161
Blood Volume
Milrinone
(mill-ri-none)
Primacor


161
Blood Volume
Inotropic agent, vasodilator/Phosphodiesterase Teach client:
isozyme-III inhibitor • Be aware of the reasons for administration and
Indications the desired effect.
Short-term treatment of CHF unresponsive to • ECG will be monitored.
conventional therapy with digoxin, diuretics, and • A decrease in shortness of breath and edema
vasodilators. should be experienced.
Action • This drug will not cure CHF, but its use is a tem-
porary measure to control the symptoms.
Increases myocardial contractility. Decreases pre-
load (amount of blood returning to the heart) and
afterload (pressure in the aorta that the heart must Make the Connection
overcome to push blood out of the heart) by a • Monitor pulse and blood pressure. Slow
direct dilating effect on vascular smooth muscle. or stop the infusion if the blood pressure drops
Adverse Reactions/Side Effects significantly, because this is a sign of overdose.
CNS: headache, tremor. CV: ventricular • Monitor intake, output, and daily weight.
arrhythmias, angina pectoris, chest pain, • Monitor ECG continuously during infusion.
hypotension, supraventricular arrhythmias. Arrhythmias are common and may be life
CV: skin rash. GI: liver function abnormalities. threatening.
F and E: hypokalemia. Hemat: thrombocytopenia. • Monitor platelet count, electrolytes, and renal
function frequently during administration.
• Have second practitioner check dose.
• Monitor peripheral IV site carefully.
Nursing Dx: Decreased cardiac output; Excess fluid • Monitor the brain natriuretic peptide (BNP).
volume. Universal Free E-Book Store

162
Blood Volume
Nesiritide
(ne-sir-i-tide)
Natrecor


162
Blood Volume
Therapeutic/Pharmacologic Class Hemat: anemia. Local: injection site reactions.
Vasodilator/Human B-type natriuretic peptide MS: back pain, leg cramps. Neuro: paresthesia,
Indications tremor. Misc: fever.
Treatment of acutely decompensated CHF in Keep in Mind
hospitalized clients who have dyspnea at rest or Teach client:
with minimal activity.
• ECG will be monitored.
Action • This drug will not cure CHF but control the
Binds to guanyl cyclase receptors in vascular smooth symptoms.
muscle and endothelial cells, producing increased
intracellular guanosine 3′5′-cyclic monophosphate
(cGMP) and smooth muscle cell relaxation. cGMP Make the Connection
acts as a “second messenger” to dilate veins and • Monitor BP, pulse, ECG, respiratory
arteries. ease, CVP (hypotension can be severe). Remember
blood pressure low—down you go [head], blood
pressure high—head to the sky [head up]).
CNS: anxiety, confusion, dizziness, headache,
hypotension (dose related), insomnia, drowsiness. • Monitor I&O, daily weight, and RFT.
EENT: amblyopia. Resp: apnea, cough, hemoptysis. • Monitor BNP.
CV: hypotension, arrhythmias, bradycardia. GI: • Have second practitioner independently check
dose calculations.
abdominal pain, nausea, vomiting. GU: ↑ creati-
nine, renal failure. Derm: itching, rash, sweating.
Nursing Dx: Decreased cardiac output; Excess fluid volume. Universal Free E-Book Store

163
Blood Volume
Dopamine
(dope-a-meen)
Intropin
Revimine


163
Blood Volume
Inotropic agent, vasopressor/Adrenergic agent Teach client:
Indications • Inform the nurse immediately if chest pain, dyspnea,
Adjunct to standard measures to improve blood numbness, tingling, or burning of extremities occurs.
pressure, cardiac output, and urinary output in • Inform nurse immediately of pain or discomfort
treatment of shock unresponsive to fluid replacement. at the site of administration.
Action
Small doses (0.5–3 mcg/kg/min) stimulate dopamin- Make the Connection
ergic receptors, producing renal vasodilation. Larger • Contraindicated in tachyarrhythmias,
doses (2–10 mcg/kg/min) stimulate dopaminergic pheochromocytoma, or hypersensitivity to bisulfites.
and beta1-adrenergic receptors, producing cardiac • Do not administer with MAOI, ergot alkaloids
stimulation and renal vasodilation. Doses greater (ergotamine), or some antidepressants, because
than 10 mcg/kg/min stimulate alpha-adrenergic the combination can result in severe HTN.
receptors and may cause renal vasoconstriction. • Using with IV phenytoin may cause hypotension
Adverse Reactions/Side Effects and bradycardia.
CNS: headache. EENT: mydriasis (high dose). • Monitor BP, heart rate, PCWP, CO, CVP, ECG,
Resp: dyspnea. CV: arrhythmias, hypotension, and urinary output continuously during adminis-
angina, ECG change, palpitations, vasocon- tration.
striction. GI: nausea, vomiting. Derm: piloerec- • If hypotension occurs, administration rate should
tion. Local: irritation at IV site. be increased; HTN, rate is decreased.
• Have second practitioner independently check
dose.
Nursing Dx: Ineffective tissue perfusion (renal, cerebral,
cardiopulmonary, peripheral). Universal Free E-Book Store

164
Blood Volume
Metoprolol Atenolol
(me-toe-proe-lole) (a-ten-oh-lole)
Lopressor, Toprol-XL Tenormin

Betaloc, Apo-Atenolol
Lopressor
Carvedilol Labetalol
(kar-ve-dil-ole) (la-bet-a-lole)
Coreg Normodyne, Trandate


164
Blood Volume
Therapeutic/Pharmacologic Class hypotension, peripheral vasoconstriction. GI: con-
Antihypertensive agent/Beta-adrenergic receptor stipation, diarrhea, drug-induced hepatitis, nausea,
blocker (beta blocker) vomiting. GU: erectile dysfunction, decreased
Indications libido, urinary frequency. Derm: rash. Endo: hyper-
Treatment of hypertension. Prevention of MI and glycemia, hypoglycemia. MS: arthralgia. Misc:
decrease of mortality in clients with recent MI. drug-induced lupus syndrome.
Management of stable, symptomatic CHF. Keep in Mind
Action Teach client:
Block stimulation of beta1 adrenergic receptors. Do • Notify HCP if slow pulse or dyspnea occurs.
not usually affect beta2 adrenergic receptor sites if
cardioselective.
CNS: fatigue, weakness, anxiety, depression, • Assess the pulse and BP prior to admin-
istering.
dizziness, drowsiness, insomnia, memory loss,
mental status changes, nervousness, nightmares. • Monitor LFT, RFT, electrolytes, ANA, I&O and daily
weight.
EENT: blurred vision, stuffy nose. Resp: bron-
chospasm, wheezing. CV: bradycardia, congestive • Notice the olol, ilol, or alol ending in the generic
names.
heart failure (CHF), pulmonary edema,
Nursing Dx: Ineffective tissue perfusion (renal, cerebral, Also Used for: Cardiovascular system applications (angina
cardiopulmonary, peripheral). pectoris); central nervous system applications (migraine headache,
aggressive behavior); sensory system applications (glaucoma)

Blood Volume 165
Amlodipine Nifedipine
(am-loe-di-peen) (nye-fed-i-peen)
Norvasc Procardia, Procardia XL

Adalat, Adalat CC,
Apo-Nifed,
Novo-Nifedin
Verapamil Diltiazem
(ver-ap-a-mil) (dil-tye-a-zem)
Calan, Calan SR, Cardizem, Cardizem LA,

Covera-HS, Isoptin, CartiaXT, Dilacor XR,
Isoptin SR Diltia XT, Tiazac
Novo-Veramil, Apo-Diltiaz,
Apo-Verap Novo-Diltazem

165
Blood Volume
Therapeutic/Pharmacologic Class frequency. Derm: dermatitis, flushing, increased
Antianginal agent, antiarrhythmic agent (class IV), sweating, photosensitivity, rash. Endo: gyneco-
antihypertensive agent/Calcium channel blocker mastia, hyperglycemia. Hemat: anemia, leukope-
Indications nia, thrombocytopenia. Metab: weight gain.
Treatment of hypertension, angina pectoris and MS: joint stiffness, muscle cramps. Neuro:
Prinzmetal’s angina, and arrhythmias. paresthesia, tremor. Misc: Stevens-Johnson
syndrome, gingival hyperplasia.
Action
Inhibit transport of calcium into myocardial and Keep in Mind
vascular smooth muscle cells, resulting in inhibition Teach client:
of excitation of muscle. • Report unrelieved chest pain or SOB immediately.
CNS: abnormal dreams, anxiety, confusion,
dizziness, drowsiness, headache, nervousness,
Make the Connection
psychiatric disturbances, weakness. EENT: • Take BP and pulse prior to administration.
blurred vision, disturbed equilibrium, epistaxis, • Monitor ECG, I&O, and daily weight.
tinnitus. Resp: cough, dyspnea. CV: arrhyth- • Monitor LFT, RFT, CBC, serum glucose level, and K . +
mias, CHF, peripheral edema, bradycardia, • Notice the “Ca” in most brand names.
chest pain, hypotension, palpitations, syncope,
tachycardia. GI: abnormal liver function studies,
anorexia, constipation, diarrhea. GU: dysuria,
nocturia, polyuria, sexual dysfunction, urinary
Nursing Dx: Pain; Activity intolerance; Ineffective tissue Also Used for: Cardiovascular system applications (Raynaud’s phenom-
perfusion (renal, cerebral, cardiopulmonary, peripheral). enon); central nervous system applications (mood stabilizer [Calan])

166
Blood Volume
Enalapril Ramipril
(e-nal-a-pril) (ra-mi-pril)
Vasotec, Altace
Vasotec IV
Lisinopril Captopril
(lyse-sin-oh-pril) (kap-toe-pril)
Prinivil, Zestril Capoten


Blood Volume 166
Therapeutic/Pharmacologic Class F and E: hyperkalemia. Hemat: bone marrow

Antihypertensive agent/Angiotensin converting suppression. Misc: angioedema, fever.
enzyme (ACE) inhibitor
Keep in Mind
Used alone or with other agents in the management
of hypertension. Reduction of death or develop- • Take this medication exactly as directed.
ment of CHF after MI. Slowed progression of left • Report to the HCP immediately if chest pain, palpita-
tions, or swelling of the lips, face, or tongue occurs.
ventricular dysfunction.
Action
ACE inhibitors block the conversion of angiotensin I
to angiotensin II, a potent vasoconstrictor. They Make the Connection
also inhibit the renin-angiotensin-aldosterone sys- •
Always take the blood pressure prior to
tem, reducing the amount of aldosterone (the administration.
body’s salt) in the bloodstream. • Monitor I&O and daily weight.
Adverse Reactions/Side Effects • Monitor for signs of angioedema.
CNS: dizziness, fatigue, headache, insomnia, • Assess for signs of CHF.
weakness. Resp: cough, eosinophilic pneumoni- • Monitor LFT, RFT, CBC, serum glucose, and K+(↑).
tis. CV: hypotension, angina pectoris, tachycar- • Notice the “pril” ending in the generic names.
dia. GI: taste disturbances, anorexia, diarrhea,
hepatotoxicity (rare), nausea. GU: proteinuria,
erectile dysfunction, renal failure. Derm: rash.
Also Used for: Central nervous system applications (migraine
Nursing Dx: Ineffective tissue perfusion (renal, cerebral, headache); urological system applications (diabetic nephropathy
cardiopulmonary, peripheral). prophylaxis) Universal Free E-Book Store

Blood Volume 167
Losartan Valsartan
(loe-sar-tan) (val-sar-tan)
Cozaar Diovan
Candesartan Irbesartan
(can-de-sar-tan) (ir-be-sar-tan)
Atacand Avapro


Blood Volume 167
Therapeutic/Pharmacologic Class of the hands or feet, irregular heartbeat, chest pain,

Antihypertensive agent/Angiotensin II receptor dry cough, hoarseness, swelling of the face, lips, or
antagonist tongue, difficulty swallowing, or breathing occurs.
Indications • Report nausea, vomiting, diarrhea, or a metallic
Management of hypertension. Treatment of CHF in taste that produces anorexia.
clients who cannot tolerate ACE inhibitors. Reduction • Do not use salt substitutes.
of stroke risk in clients with CHF and left ventricular • Follow instructions for correct method of assessing
hypertrophy. blood pressure.
Action
• Women of childbearing age should use contraception.
Block receptors for angiotensin II, disabling the
renin-angiotensin-aldosterone system.
CNS: dizziness, fatigue, headache. CV: hypoten- •
Always take the blood pressure prior to
sion. GI: diarrhea, drug-induced hepatitis. GU: administration.
renal failure. F and E: hyperkalemia. • Monitor ECG periodically during prolonged ther-
apy. May cause prolonged PR interval.
Keep in Mind • Monitor intake, output, and daily weight.
Teach client: • Assess for signs of CHF. +
• Take this medication exactly as directed. • Monitor LFT, RFT, CBC, and K level.
• Report to the health-care professional immediately • Notice the “sartan” ending in the generic names.
if a rash, mouth sores, sore throat, fever, swelling
Nursing Dx: Tissue perfusion (renal, cerebral, cardiopul- Also Used for: Urological system applications (diabetic nephropathy
monary, peripheral). prophylaxis) Universal Free E-Book Store

Blood Volume 168
Clonidine
(klon-i-deen)
Catapres, Catapres-TTS
Dixarit


Blood Volume 168
Therapeutic/Pharmacologic Class mouth, constipation, nausea, vomiting. GU: impo-

Antihypertensive agent/Alpha-adrenergic stimulant tence. Derm: rash, sweating. F and E: sodium
(centrally acting) retention. Metab: weight gain. Misc: withdrawal
Indications phenomenon.
Management of mild to moderate hypertension. Keep in Mind
Epidural: Management of cancer pain unresponsive Teach client:
to opioids alone. Unlabelled Uses: Management of
opioid withdrawal. • Take the drug at the same time each day.
• Notify HCP if itching or redness of skin (with trans-
Action dermal patch), mental depression, swelling of feet
Stimulates alpha-adrenergic receptors in the brain- and lower legs, or vivid dreams or nightmares occur.
stem, which decreases sympathetic outflow inhibit- • Self-monitor BP.
ing cardioacceleration and vasoconstriction centers. • Follow instructions for proper application of
Prevents pain signal transmission to the CNS by transdermal system. Change every 7 days.
stimulation of alpha-adrenergic receptors in the
spinal cord.
CNS: drowsiness, depression, dizziness, nervous- •
Monitor I&O, daily weight, and assess
for edema daily.
ness, nightmares. CV: bradycardia, hypotension
(increased with epidural), palpitations. GI: dry • Monitor BP and pulse prior to administering this
medication.
Nursing Dx: Ineffective tissue perfusion (renal, cerebral, Also Used for: Central nervous system applications (epidural
cardiopulmonary, peripheral). administration for cancer pain adjunct; mood stabilizer; impulse
control in adolescence; opioid withdrawal)

Blood Volume 169
Procainamide Amiodarone
(proe-kane-ah-mide) (am-ee-oh-da-rone)
Procanbid, Promine, Cordarone, Pacerone

Pronestyl,
Pronestyl-SR
Lidocaine Quinidine
(kwin-i-deen)
(Parenteral)
(lye-doe-kane)
Quiniglute
LidoPen, Xylocaine,
Xylocard

Blood Volume 169
Therapeutic/Pharmacologic Class fever, chills, joint pain or swelling, pain with

Antiarrhythmic agent/Electrolyte channel blocking agent breathing, skin rash, or unusual bleeding or
Indications bruising occur.
Treatment of a wide variety of ventricular and atrial
arrhythmias. Make the Connection
Action •
CBC with differential should be moni-
Decrease myocardial excitability. tored every 2 wk during the first 3 mo of therapy
Adverse Reactions/Side Effects for signs of bone marrow suppression.
CNS: seizures, confusion, dizziness. CV: asystole, • Monitor ANA, LFTs, chemistries, and hematology
heart block, ventricular arrhythmias, congestive tests during prolonged therapy.
heart failure, hypotension. GI: diarrhea, anorexia, • Monitor serum drug levels to prevent toxicity.
bitter taste, nausea, vomiting. Derm: rash. • When using antiarrhythmic agents, it is important to
Hemat: bone marrow suppression. Misc: chills, remember that by interfering with the electrolytes
drug-induced systemic lupus syndrome, fever. responsible for cardiac conduction, new arrhythmias
can occur or the heart rate may slow and cause CHF.
Keep in Mind
Teach client:
• Notify health-care professional immediately if
Nursing Dx: Decreased cardiac output. Also Used for: Dermatologic system applications (infiltration for
suturing [lidocaine]); central nervous system applications (transdermal
system and topical preparations for pain control [lidocaine])
Cardiovascular System Drugs Anti-Anginal 170
Isosorbide Isosorbide
Mononitrate Dinitrate
(eye-soe-sor-bide mo-noe-nye-trate ) (eye-soe-sor-bide dye-nye-trate )
Imdur, Ismo, Isonate, Isorbid,

Isotrate ER, Isordil, Isotrate
Monoket Apo-ISDN,
Novosorbide, Sorbitrate
Nitroglycerin
(nye-tro-gli-ser-in)
EXTENDED-RELEASE CAPSULES Nitrocot, NitroglynE-R, Nitro-par, Nitro-Time EXTENDED-RELEASE TABLETS Nitrong
EXTENDED-RELEASE BUCCAL TABLETS Nitrogard Nitrogard SR INTRAVENOUS Nitro-Bid IV, Tridil TRANSLIN-
GUAL SPRAY Nitrolingual OINTMENT Nitro-Bid, Nitrol SUBLINGUAL Nitrostat, NitroQuick TRANSDERMAL SYSTEM
Deponit, Minitran, Nitrek, Nitrodisc, Nitro-Dur, Transderm-Nitro

Cardiovascular System Drugs Anti-Anginal 170

Anti-anginal agent/Nitrate Teach client:
Acute (translingual and SL) and long-term prophylatic • Avoid concurrent use of alcohol with this medication.
(oral, buccal, transdermal) management of angina • Headache is a common side effect.
pectoris. Adjunctive treatment of chronic CHF. • Acute anginal attacks: Sit down and use med-
ication. If pain does not subside, repeat dose
Action and call EMS.
Increase coronary blood flow by dilating coronary
arteries and improving collateral flow to ischemic • Store tablets in dark glass container away from
(body) heat. Replace in 6 mo.
regions. Produce vasodilation (venous greater than
arterial). Decreases preload. Reduce myocardial
oxygen consumption. Make the Connection
Adverse Reactions/Side Effects • Use of nitrates in any form with sil-
CNS: dizziness, headache, apprehension, rest- denafil, tadalafil, and vardenafil increases the risk
lessness, weakness. EENT: blurred vision. for serious and potentially fatal hypotension.
CV: hypotension, tachycardia, syncope. • Always assess the blood pressure prior to admin-
GI: abdominal pain, nausea, vomiting. istration.
Derm: contact dermatitis (transdermal or • Clients receiving IV nitrates require continuous
ointment). Misc: cross-tolerance, flushing, ECG and blood pressure monitoring.
tolerance.
Nursing Dx: Acute pain; Ineffective tissue perfusion

(cardiac). Universal Free E-Book Store
Cardiovascular System Drugs Lipid-Lowering Agents 171
Gemfibrozil
(gem-fye-broe-zil)
Lopid
Fenofibrate
(fen-o-fi-brate)
Antara, Lofibra, Tricor, Triglide

Therapeutic/Pharmacologic Class • This medication should be used in conjunction with

Lipid-lowering agent/Fibric acid derivative dietary restrictions, exercise, and cessation of smoking.
Indications • Notify health-care professional promptly if any of
Management of type IIb hyperlipidemia (decreased the following symptoms occurs: severe stomach
HDLs, increased LDLs, increased triglycerides) in clients pains with nausea and vomiting, fever, chills, sore
who do not yet have clinical coronary artery disease throat, rash, diarrhea, muscle cramping, general
and have failed therapy with diet, exercise, weight loss, abdominal discomfort, or persistent flatulence.
or other agents (niacin, bile acid sequestrants).
Inhibit peripheral lipolysis. Decrease triglyceride
production by the liver. Decrease production of the
• Serum triglyceride and cholesterol levels
should be monitored before and periodically
triglyceride carrier protein. Increase HDL. throughout therapy. LDL and VLDL levels should be
Adverse Reactions/Side Effects assessed before and periodically throughout therapy.
CNS: dizziness, headache. EENT: blurred vision. Medication should be discontinued if paradoxical
GI: abdominal pain, diarrhea, epigastric pain, increase in lipid levels occurs.
flatulence, gallstones, heartburn, nausea, • Liver function tests should be assessed before and
vomiting. Derm: alopecia, rash, urticaria. periodically throughout therapy.
Hemat: anemia, leukopenia. MS: myositis. • CBC and electrolytes should be evaluated.
Keep in Mind
• Administration of these drugs with HMG Co-A
reductase inhibitors increases the risk for rhabdomy-
Teach client: olysis (breakdown of skeletal muscle fibers that
• Take the medication exactly as directed. form microemboli that flow through the kidney,
Nursing Dx: Ineffective tissue perfusion (cardiac); Risk for clogging nephrons and resulting in renal failure).
injury (renal). Universal Free E-Book Store
Atorvastatin Simvastatin
(a-tore-va-stat-in) (sim-va-sta-tin)
Lipitor Zocor
Rosuvastatin Lovastatin
(roe-soo-va-sta-tin) (loe-va-sta-tin)
Crestor Mevacor

Therapeutic/Pharmacologic Class pruritus. MS: rhabdomyolysis, arthralgia, arthritis,

Lipid-lowering agent/HMG-CoA reductase inhibitor myalgia, myositis. Misc: hypersensitivity reactions,
Indications including angioneurotic edema.
Adjunctive management of primary hypercholes- Keep in Mind
terolemia and mixed dyslipidemia. Primary preven- Teach client:
tion of coronary heart disease (MI, stroke, angina,
and coronary revascularization) in asymptomatic • Take this medication exactly as directed.
clients with increased total and low-density lipopro- • Avoid drinking more than 1 quart of grapefruit
juice per day during therapy.
tein (LDL) cholesterol and decreased high-density
lipoprotein (HDL) cholesterol. • Notify HCP if unexplained muscle pain, tender-
ness, or weakness occurs, especially if accompa-
Action nied by fever or malaise.
Inhibit 3-hydroxy-3-methylglutaryl-coenzyme A • Avoid pregnancy or breast-feeding.
(HMG-CoA) reductase, an enzyme responsible for
catalyzing an early step in the synthesis of cholesterol.
CNS: dizziness, headache, insomnia, weakness. • Evaluate serum cholesterol and trigly-
ceride levels before initiating medication, after
EENT: rhinitis. Resp: bronchitis. CV: chest pain,
2–4 wk of therapy, and periodically thereafter.
peripheral edema. GI: abdominal cramps, constipa-
tion, diarrhea, flatus, heartburn, altered taste, drug- • Monitor LFT prior to and then every 6 mo.
induced hepatitis, dyspepsia, elevated liver enzymes, • If muscle tenderness develops during therapy
with CPK ↑, this is indicative of rhabdomyolysis.
nausea, pancreatitis. GU: impotence. Derm: rash,
Nursing Dx: Ineffective tissue perfusion (cardiac); Risk for

injury (renal). Universal Free E-Book Store
Ezetimibe
(e-zet-i-mibe)
Zetia

Therapeutic/Pharmacologic Class • This medication should be used in conjunction

Lipid-lowering agent/Cholesterol absorption with diet restrictions, exercise, and cessation of
inhibitor smoking.
Indications • Notify health-care professional if unexplained
Used alone or with other agents (HMG-CoA reduc- muscle pain, tenderness, or weakness occurs.
tase inhibitors) in the management of dyslipidemias, Risk of symptoms may increase when used with
including primary hypercholesterolemia and geneti- HMG-CoA reductase inhibitors.
cally induced hypercholesterolemia. • Notify health-care professional immediately if
Action breathing or swallowing becomes difficult.
Inhibits the absorption of cholesterol in the small • Follow-up exams will be scheduled.
intestine.
GI: cholecystitis, cholelithiasis, ↑ hepatic •Obtain a diet history, especially with
transaminases (with HMG-CoA reductase regard to fat consumption.
inhibitors), nausea, pancreatitis. Derm: rash. • Evaluate serum cholesterol and triglyceride levels
Misc: angioedema. before initiating medication, after 2–4 wk of ther-
apy, and periodically thereafter.
Keep in Mind
Teach client: • Administer without regard to meals. May be
taken at the same time as HMG-CoA reductase
• Take this medication as directed, at the same inhibitor (medication is frequently combined with
time each day, even if feeling well.
simvastatin [Vytorin]).
• Be aware that medication helps control, but does
not cure, elevated serum cholesterol levels.
Nursing Dx: Ineffective tissue perfusion (cardiac). Universal Free E-Book Store
Colestipol Colesevelam
(koe-les-ti-pole) (koe-less-sev-i-lam)
Colestid Welchol
Cholestyramine Resin
(koe-less-tear-a-meen re-zin)
LoCHOLEST, LoCHOLEST Light,

Prevalite, Questran, Questran Light

Therapeutic/Pharmacologic Class • Take medication before meals. May be mixed

Lipid-lowering agent/Bile acid sequestrant with cool foods.
Indications • Constipation may occur.
Management of primary hypercholesterolemia. • Notify health-care professional if unusual bleeding
Treatment of pruritus associated with elevated or bruising; petechiae; or black, tarry stools occur.
levels of bile acids. Treatment with vitamin K may be necessary.
Action
Bind bile acids in the GI tract, forming an insoluble Make the Connection
complex. The liver must use more cholesterol to
make more bile acids. Result is increased clearance
•Obtain a diet history, especially with
regard to fat consumption.
of cholesterol.
• Assess frequency, amount, and consistency of
Adverse Reactions/Side Effects stools and presence of bowel sounds.
EENT: irritation of the tongue. GI: abdominal • Serum cholesterol and triglyceride levels should
discomfort, constipation, nausea, fecal be evaluated before and frequently during the
impaction, flatulence, hemorrhoids, perianal irri- first few months of therapy.
tation, steatorrhea, vomiting. Derm: irritation, • Administer before meals 1-2 hr apart from other
rash. F and E: hyperchloremic acidosis. drugs (may bind with them).
Metab: vitamin A, D, and K deficiency. • Monitor LFT, electrolytes, and PT.
Keep in Mind
Teach client:
• Take this medication exactly as directed. Also Used for: Dermatologic system applications (pruritus due to
Nursing Dx: Ineffective tissue perfusion (cardiac); excess bile acid accumulation); gastrointestinal system applications
Readiness for enhanced comfort level. (diarrhea) Universal Free E-Book Store
Omega-3-Acid
Ethyl Esters
(oh-me-ga three as-id eth-il es-ters)
Lovasa

Therapeutic/Pharmacologic Class clients, and control of medical problems (e.g.,

Lipid-lowering agent/Fatty acid diabetes mellitus, hypothyroidism) that may
Indications contribute to hypertriglyceridemia.
Treatment of hypertriglyceridemia in adults; used • Follow-up exams and lab tests will be scheduled
with specific diet. to determine effectiveness.
Action
Inhibits synthesis of triglycerides. Make the Connection
Adverse Reactions/Side Effects • Use with caution in clients with hyper-
GI: altered taste, eructation. Derm: rash. sensitivity to fish.
• Obtain a diet history, especially with regard to fat
Keep in Mind consumption.
Teach client: • Monitor serum triglyceride levels and serum LDL
• Take this medication as directed. levels (may increase) prior to and periodically
• Be aware that medication helps control, but does during therapy, and liver function studies periodi-
not cure, elevated serum triglyceride levels. cally during therapy.
• This medication should be used in conjunction • May be taken as a single 4-g dose or as 2 g twice
with diet restrictions (fat, cholesterol, carbohy- daily. May be administered with meals.
drates, alcohol), exercise, weight loss in overweight
Cardiovascular System Drugs Blood-Forming Agents 176
Folic Acid
(foe-lik a-sid)
Folate, Folvite, Vitamin B

Apo-Folic

Cardiovascular System Drugs Blood-Forming Agents 176
Therapeutic/Pharmacologic Class • The effectiveness of megadoses of this nutrient

Antianemic agent, vitamin/Water-soluble vitamin for treatment of various medical conditions is
Indications unproven and may cause side effects.
Prevention and treatment of megaloblastic and • This nutrient may make urine more intensely
macrocytic anemias. Given during pregnancy to yellow.
promote normal fetal development. • Notify health-care professional if rash occurs,
Action which may indicate hypersensitivity.
Required for protein synthesis and red blood cell • Follow-up exams and lab tests will be scheduled.
function. Stimulates the production of red blood
cells, white blood cells, and platelets. Necessary for Make the Connection
normal fetal development.
•Monitor plasma vitamin levels and
Adverse Reactions/Side Effects hemoglobin, hematocrit, and reticulocyte counts
Derm: rash. CNS: irritability, difficulty sleeping, before and periodically during therapy.
malaise, confusion. Misc: fever. • Because of infrequency of solitary vitamin deficien-
cies, combinations are commonly administered.
Keep in Mind • May be given SC, deep IM, or IV when PO route
Teach client: is not feasible.
• Comply with diet recommendations of health- • Antacids should be given at least 2 hr after the
care professional. The best source of vitamins is a medication.
well-balanced diet. • The medication should be given 2 hr before or
• Foods high in this nutrient include vegetables 4–6 hr after cholestyramine.
(green leafy), fruits, and organ meats.
Also Used for: Reproductive system applications (prevention of neural
tube defects in the fetus [400 mcg in prenatal vitamins daily]); central
Nursing Dx: Fatigue; Risk for activity intolerance. nervous system applications (alcoholUniversal
abuse [withFree
other E-Book
B vitamins])
Store
RESPIRATORY

Respiratory System Drugs Bronchodilating Agents 177
Aminophylline IV
(am-in-off-i-lin)
Phyllocontin, Truphylline
(A Salt of Theophylline)
Theophylline
(thee-off-i-lin)
Accurbron, Sustaire, Theobid, Theo-Dur, Theovent,

Theospan, Bronkodyl, Elixophyllin, Quibron-T,
Slo-Bid, Slo-Phyllin
Apo-Theo LA Universal Free E-Book Store

Bronchodilator/Xanthine Teach client:
Indications • PO doses need to be taken at the prescribed time.
Long-term control of reversible airway obstruction • Increase fluid intake to a minimum of eight 8-oz
caused by asthma or chronic obstructive pulmonary glasses of fluid daily. Avoid caffeine.
disease (COPD). Increases diaphragmatic contrac- • Do not eat charbroiled meats, use large amounts
tility. Used to treat apnea of prematurity. of pepper, or consume large amounts of crucifer-
ous vegetables, because they interfere with the
Action action of the drug.
Inhibit phosphodiesterase, producing increased tis-
sue concentrations of cyclic adenosine monophos- • Supplement vitamin B6 to overcome depletion
caused by this drug.
phate (cAMP). Increased levels of cAMP result in
bronchodilation, CNS stimulation, positive inotropic • Avoid alcohol consumption while on this medication.
and chronotropic effects, diuresis, and gastric acid • Routine labs will be drawn.
secretion.
CNS: seizures, anxiety, headache, insomnia. • Serum drug levels range from 10–15
CV: arrhythmias, angina, tachycardia, palpita- mcg/mL. Low levels will precipitate broncho-
tions. GI: nausea, vomiting, anorexia, cramps. spasm. High levels will result in toxicity.
Neuro: tremor. • Monitor I&O, CXR, respiratory ease, pulse oxime-
try, K+ and Mg+ levels.
Nursing Dx: Impaired gas exchange; Risk for altered

respiratory pattern. Universal Free E-Book Store
Ipratropium
(i-pra-troe-pee-um)
Atrovent

Therapeutic/Pharmacologic Class palpitations. GI: GI irritation, nausea. Derm: rash.

Allergy, cold, cough remedy; bronchodilator/ Misc: allergic reactions.
Anticholinergic agent
Keep in Mind
Inhalation: Maintenance therapy of reversible airway
obstruction due to COPD and bronchospasm due • Follow instructions for proper use of inhaler or
nasal spray, and take as directed.
to asthma. Intranasal: Treatment of rhinorrhea asso-
ciated with allergic and nonallergic perennial rhinitis • Pulmonary function tests will be scheduled.
or the common cold.
Given by inhalation, the drug inhibits cholinergic • When multiple inhalation medications are
receptors in bronchial smooth muscle tissue, result- given, use beta2-adrenergic agonists (adrenergics) first,
ing in decreased concentrations of cyclic guanosine then this class, and inhaled steroids last. Remember,
monophosphate (cGMP). Decreased cGMP produces 1 min between inhalations of the same medications,
local bronchodilation. Given intranasallly, applica- and 5 min between each different medication.
tion inhibits secretions from glands lining the nasal • Assess respiratory status carefully prior to and
mucosa (local effects). after inhalation of medication. Breath sounds
should always be assessed prior to inhalation ther-
apy; it is the best tool. Also assess pulse oximetry,
CNS: dizziness, headache, nervousness.
ease of respiratory effort, and chest radiograph.
EENT: blurred vision, sore throat; epistaxis,
nasal dryness/irritation (intranasal only). • Be aware that anticholinergic inhalers promote
mucus plugging in clients with tracheostomy (drying
Resp: bronchospasm, cough. CV: hypotension,
effect). Have suction, normal saline, and catheters
Nursing Dx: Ineffective airway clearance; Impaired gas
exchange.
of varying size in the room to prevent damage.
Albuterol Metaproterenol
(al-byoo-ter-ole) (met-a-proe-ter-e-nole)
Proventil, Proventil Alupent

Hydrofluoroakane
(HFA), Vento-Disk,
Ventolin, Ventolin
HFA, Volmax, VoSpira
ER, AccuNeb, Airet
Novo-Salmol
Salmeterol Formoterol
(sal-me-te-role) (for-mo-te-role)
Serevent Foradil (Powder Inhaler)

Therapeutic/Pharmacologic Class hypertension. GI: nausea, vomiting. Endo: hyper-

Bronchodilator/Adrenergic agent glycemia. F and E: hypokalemia. Neuro: tremor.
Used as a bronchodilator for control and prevention of Teach client:
reversible airway obstruction caused by asthma or
COPD. When inhaled, the medication is used for quick • Take this medication exactly as directed.
relief ofbronchospasm (rescue) and for prevention of • Contact the HCP immediately if SOB is not
relieved by medication.
exercise-induced bronchospasm. Used PO for long-
term control of chronic/persistent bronchospasm. • A “spacer” may be used to assist in dose delivery.
• Adrenergic inhalers are used before anti-cholinergic or
Action steroid inhalers. Inhalations of the same medications
Bind to beta2-adrenergic receptors in airway smooth should be 1 min apart, and inhalations of different
muscle, leading to activation of adenylcyclase and medications should be 5 min apart; rinse mouth.
increased levels of cyclic adenosine monophosphate
(cAMP). Relatively selective for beta2 (pulmonary)
receptors. cAMP decreases action of myosin and CA+ Make the Connection
resulting in relaxation of airway smooth muscle. • Using medication with MAOIs may lead
to hypertensive crisis.
CNS: nervousness, restlessness, tremor, headache, • Observe for paradoxical bronchospasm
(wheezing).
insomnia (occurs more frequently in young
children than in adults); hyperactivity in children. • Assess for effectiveness of medication.
CV: chest pain, palpitations, angina, arrhythmias,
Nursing Dx: Ineffective airway clearance; Impaired gas

exchange. Universal Free E-Book Store
Isoproterenol
(eye-soe-proe-ter-e-nole)
Isuprel, Medihaler-Iso


Bronchodilator, antiarrhythmic agent/Adrenergic agent Teach client:
Indications • Avoid smoking and other respiratory irritants.
Management of bronchospasm during anesthesia. • Contact health-care professional immediately if
Treatment of asthma or COPD. shortness of breath is not relieved by medication
or is accompanied by diaphoresis, dizziness,
Action palpitations, or chest pain.
monophosphate (cAMP) at beta-adrenergic recep-
tors. Produces bronchodilation. Inhibits the release Make the Connection
of mediators of immediate hypersensitivity reactions •Assess lung sounds, respiratory pattern,
from mast cells. Has additional significant beta pulse, and blood pressure before administration
(cardiac)-adrenergic action, which results in positive and during peak of medication.
inotropic and chronotropic effects. • Note amount, color, and character of sputum
Adverse Reactions/Side Effects produced.
CNS: nervousness, restlessness, tremor, headache, • Monitor pulmonary function tests.
insomnia. CV: arrhythmias, angina, hyperten- • Symptoms of overdose include persistent agita-
sion, tachycardia . GI: nausea, vomiting, xerosto- tion, chest pain or discomfort, decreased blood
mia. Endo: hyperglycemia. Misc: pink/red pressure, dizziness, hyperglycemia, hypokalemia,
discoloration of saliva. seizures, tachyarrhythmias, persistent trembling,
and vomiting. Treatment includes discontinuing
beta-adrenergic agonists and instituting symp-
tomatic, supportive therapy.
Nursing Dx: Impaired gas exchange; Decreased cardiac Also Used for: Cardiovascular system applications (bradycardia
output. [IV only]) Universal Free E-Book Store
Respiratory System Drugs Mucolytic/Expectorant Agents 181
Acetylcysteine
(a-se-teel-sis-teen)
Acetadote, Mucomyst, Mucosil

Therapeutic/Pharmacologic Class (primarily with IV), including anaphylaxis,

Mucolytic, antidote for acetaminophen/Viscosity- angioedema, chills, fever.
reduction agent, antioxidant
Keep in Mind
IV use: Antidote for the management of potentially
hepatotoxic overdosage of acetaminophen (should be • Clear airway by coughing deeply before taking
aerosol inhalation treatment.
administered within 8–24 hours of ingestion depend-
ing on overdosage amount). Inhaled use: Reduction • There is an unpleasant odor to this drug.
of mucus viscosity associated with thick secretions. • The face may feel sticky after using the mask
nebulizer, and the residue can be easily cleaned.
Action • Suctioning may be necessary after mucolytic therapy.
Decreases the buildup of a hepatotoxic metabolite
in acetaminophen overdosage. Degrades mucus,
allowing easier mobilization and expectoration. Make the Connection
Adverse Reactions/Side Effects • Keep suction available; as mucus thins,
it may be too copious for the client to expectorate.
CNS: drowsiness. CV: vasodilation. EENT: rhin-
orrhea. Resp: bronchospasm, bronchial/tracheal • When used as antidote in acetaminophen overdose,
assess plasma acetaminophen levels.
irritation, chest tightness, increased secretions.
GI: nausea, vomiting, stomatitis. Derm: pruritus, • Monitor LFT, RFT, ECG, glucose, and electrolytes.
rash, urticaria, clamminess. Misc: allergic reactions • Notify HCP if nausea, vomiting, or urticaria
occurs.
Nursing Dx: Ineffective airway clearance; Risk for injury Also Used for: Urological system applications (prevention of
(pharmacologic). radiocontrast-induced renal dysfunction; gastrointestinal system
applications (dissolution of gall stones)
Guaifenesin
(gwye-fen-e-sin)
Robitussin, Hytuss, Guiatuss,

Mucinex, Humibid
Benylin-E

Therapeutic/Pharmacologic Class that require alertness until the effect of the drug
Allergy, cold, and cough remedy, expectorant/Mucus is known.
humectant • Limit talking, stop smoking, and maintain mois-
Indications ture in the environment. Cool mist is best.
Treatment of coughs associated with viral upper • Sugarless gum and candy may be used to assist in
respiratory tract infections. Treatment of chronic keeping the mouth moist.
lung conditions. • If cough causes gagging; persists for greater than
1 wk; or is accompanied by a fever, rash, or sore
Action throat; contact health-care professional.
Reduces viscosity of tenacious secretions by increas-
ing respiratory tract fluid.
CNS: dizziness, headache. GI: nausea, diarrhea, • Assess lung sounds, and frequency and
stomach pain, vomiting. Derm: rash, urticaria. type of cough during therapy.
• Assess color and amount of secretions. Clients may
Keep in Mind swallow secretions, so do not assume that the cough
Teach client: is nonproductive because of this. If on auscultation,
• Cough effectively. Sit upright, take three deep rhonchi occur, move, and disappear with coughing,
breaths, and cough deeply with the hand placed this is a finding that indicates a productive cough.
loosely in front of the mouth (positive airway • Give with a full glass of water.
pressure). Do this several times. • Extended-release tablets should be swallowed
• This drug may cause dizziness, so avoid activities whole; not crushed, chewed, or broken.
Nursing Dx: Ineffective airway clearance; Ineffective Also Used for: Reproductive system applications (thinning of cervical
breathing pattern. mucus [infertility]) Universal Free E-Book Store
Respiratory System Drugs Antiallergy/Anti-inflammatory Agents 183
Fexofenadine Hydroxyzine
(fex-oh-fen-a-deen) (hye-drox-i-zeen)
Allegra Atarax, Vistaril

Apo-Hydroxyzine
Loratadine Diphenhydramine
(lor-a-ta-deen) (dye-fen-hye-dra-meen)
Alavert, Claritin, Claritin Benadryl, Sominex,

24–Hour Allergy, Claritin Hives Unisom Nightime
Relief, Children’s Loratadine, Sleep Aid, Benadryl Allergy
Claritin Reditabs, Clear-Atadine, Allerdryl
Dimetapp Children’s ND Non-
Drowsy Allergy, Non-Drowsy
Allergy Relief for Kids, Tavist ND
Therapeutic/Pharmacologic Class • This drug may cause drowsiness, so avoid driving

Allergy, cold, and cough remedy/Antihistamine, or other activities requiring alertness until
sleep-inducer response to drug is known.
Indications • Contact the health-care professional if symptoms
Relief of symptoms of seasonal allergic rhinitis. persist.
Management of chronic idiopathic urticaria.
May be used, depending on product, as a
sedative/hypnotic. Make the Connection
Action • Assess allergy symptoms (rhinitis, con-
junctivitis, hives) before and periodically during
Antagonize the effects of histamine at peripheral therapy.
histamine1 (H1) receptors. Inhibition of these recep-
tors can be used for histamine-related inflammation,
• Assess lung sounds and character of bronchial
secretions.
like pruritus and urticaria. Medications also have a
drying effect on the nasal mucosa.
• Maintain fluid intake of 1500–2000 mL/day to
decrease viscosity of secretions.
Adverse Reactions/Side Effects • Medication causes false-negative reactions on
CNS: drowsiness, fatigue. GI: dyspepsia. allergy skin tests; discontinue 3 days before such
Endo: dysmenorrhea. testing.
Keep in Mind
• Administer with food or milk to decrease GI irri-
tation. Capsules and tablets should be taken with
Teach client: water or milk, not juice.
• Take the medication as directed. • If the drug is taken for sleep, assess quality of
sleep and sleep patterns.
Nursing Dx: Ineffective breathing patterns. Also Used for: Central nervous system applications (IM injection
for anxiety [hydroxyzine]). Universal Free E-Book Store
Beclomethasone Fluticasone
(be-kloe-meth-a-sone) (floo-ti-ka-sone)
Qvar, Vanceril Flovent, Flovent Diskus
Triamcinolone
(trye-am-sin-oh-lone)
Azmacort, Nasacort


Anti-inflammatory agent (steroidal)/Corticosteroid agent Teach client:
Indications • When using inhalation corticosteroids and bron-
Maintenance treatment of asthma as prophylactic ther- chodilator, use bronchodilator first and allow 5 min
apy. Possible decrease in requirement for or elimination to elapse before administering the corticosteroid,
of systemic corticosteroid use in clients with asthma. unless otherwise directed by HCP.
Action • Do not use this drug for rescue.
Potent, locally acting anti-inflammatory and • Rinse the mouth after using.
immune modifier.
CNS: headache. EENT: cataracts, dysphonia, • Monitor respiratory status and lung sounds.
oropharyngeal fungal infections, pharyngitis, • Assess clients changing from systemic to inhalation
rhinitis, sinusitis. Resp: bronchospasm, cough, corticosteroids for signs of adrenal insufficiency.
wheezing. Endo: adrenal suppression (increased • Periodic adrenal function tests may be ordered.
dose, long-term therapy only), decreased growth • May cause increased serum and urine glucose
(children). MS: back pain. concentrations if significant absorption occurs.
Nursing Dx: Impaired gas exchange; Readiness for Also Used for: Respiratory system applications (asthma prophylaxis
enhanced breathing pattern. [steroid and beta adrenergic combinations]); dermatologic system
applications (topical application for dermatitis)
Nedocromil
(ne-doe-kroe-mil)
Tilade
Cromolyn
(kroe-moe-lin)
Intal, NasalCrom
Apo-Cromolyn

Therapeutic/Pharmacologic Class • Prime the canister with three puffs before the first
Antiasthmatic agent, antiallergy agent/Mast cell use, and if the canister remains unused for more
stabilizer than 7 days, to ensure adequate and accurate
Indications dosing.
Management of mild to moderate asthma or • Notify health-care professional if asthmatic symp-
allergy-induced asthmatic reactions. toms do not improve within 4 wk, worsen, or recur.
Action • This medication is not for rescue during acute
Prevent the release of histamine and slow-reacting episodes of respiratory distress. Use bron-
substance of anaphylaxis (SRS-A) from sensitized chodilators for rescue.
mast cells.
CNS: dizziness, fatigue, headache. EENT: • Evaluate pulmonary function testing.
pharyngitis, rhinitis. CV: chest pain. Resp: broncho- • Assess lung sounds and respiratory function
spasm, cough, dyspnea. GI: unpleasant taste, before and periodically during therapy.
diarrhea, dyspepsia, nausea, vomiting. Derm: • Reduction in dose of other asthma medications
rash. Misc: fever. may be possible after 2–4 wk of therapy.
Keep in Mind
• Pretreatment with a bronchodilator may be
required to increase delivery of inhalation product.
Teach client:
• Medication must be used as directed.
• Follow instructions for proper use of the metered-
dose inhaler.
Nursing Dx: Ineffective breathing pattern; Impaired gas Also Used for: Sensory system applications (allergic sensitivity [eye
exchange. drops]) Universal Free E-Book Store
EYE

Sensory System Drugs Ophthalmic Agents 186
Acetazolamide
(a-set-a-zole-a-mide)
Diamox, Diamox Sequels,

Storzolamide
Apo-Acetazolamide

Therapeutic/Pharmacologic Class growth retardation (in children receiving chronic

Antiglaucoma agent, diuretic, ocular hypotensive agent, therapy). Hemat: aplastic anemia, hemolytic
anticonvulsant agent/Carbonic anhydrase inhibitor anemia, leukopenia. Metab: weight loss, hyper-
Indications uricemia. Neuro: paresthesias. Misc: allergic
Lowering of intraocular pressure in the treatment of reactions including anaphylaxsis.
glaucoma. Keep in Mind
Action Teach client:
Inhibition of carbonic anhydrase in the eye results in • Take the medication as directed.
decreased secretion of aqueous humor. Inhibition of • Take PO form with food.
renal carbonic anhydrase results in self-limiting uri-
nary excretion of sodium, potassium, bicarbonate,
and water. Make the Connection
Adverse Reactions/Side Effects • Assess for hypersensitivity or cross-
sensitivity with sulfonamides.
CNS: depression, tiredness, weakness, drowsi-
ness. EENT: transient nearsightedness. GI: • Assess tonometry readings.
anorexia, metallic taste, nausea, vomiting, melena. • Monitor serum electrolytes, CBC, glucose levels,
and LFT.
GU: crystalluria, renal calculi. Derm: Stevens-
Johnson syndrome, rash. Endo: hyperglycemia. • Assess arterial blood gas for metabolic acidosis.
F and E: hyperchloremic acidosis, hypokalemia,
Nursing Dx: Risk for injury (pharmacologic); Disturbed Also Used for: Central nervous system applications
sensory perception (visual). (seizures/hydrocephalus); urologic system applications
(diuretic/uric acid and cystine lith reduction agent); respiratory
system applications (altitude sickness).
Carbachol Pilocarpine
(carb-a-kol) (pie-loe-car-peen)
Carboptic, Isopto Adsorbocarpine,

Carbachol Isopto Carpine
Ocusert Pilo,
Pilopine, Pilostat
Miocarpine
Demecarium Acetylcholine
(de-me-car-ee-um) (a-ceet-till-choe-leen)
Humorsol Miochol-E

Intraocular pressure–reducing agent/Cholinergic Teach client:
Indications • Use this medication as directed by health-care
Management of open-angle glaucoma not controlled professional.
with short-acting miotics. Also used to facilitate miosis • This medication may sting when administered.
after ophthalmic surgery or to counteract mydriatics • Follow instructions for proper method of instilla-
(after exam). tion. Drop into conjunctival pocket, not directly
onto the eyeball.
Action
Cholinergic nerve fibers are stimulated directly in • Hold the lacrimal duct for 1 min following
administration to prevent systemic absorption.
the eye, promoting miosis. This increases outflow of
aqueous humor, decreasing intraocular pressure. • Report immediately any changes in vision that are
unexpected.
Adverse Reactions/Side Effects • Do not drive or operate machinery at night after
CNS: headache and eye pain. CV: hypotension, use of this medication, because pupils will be
syncope, cardiac arrhythmias, flushing (large constricted and vision impaired.
systemic absorption). EENT: change in eye • Periodic exams will be scheduled.
accommodation, stinging and burning, iritis,
salivation. GI: cramps, vomiting, diarrhea,
epigastric distress. GU: bladder spasm. Make the Connection
Resp: bronchospasm. Misc: sweating. • Reverse this drug with atropine, an
anticholinergic.
• Use cautiously in clients with chronic lung condi-
tions, like asthma (large systemic absorption can
Nursing Dx: Risk for injury (pharmacologic); Disturbed cause bronchospasm).
sensory perception (visual). • Assess tonometry readings.
Dipivefrin Apraclonidine
(di-pi-ve-frin) (a-pra-clon-i-deen)
(Propine) Iopidine
Brimonidine Epinephrine
(bri-mon-i-deen) (e-pin-eff-rin)
Alphagan Epifrin, Glaucon

Therapeutic/Pharmacologic Class • Avoid activities that require good visual acuity.

Antiglaucoma agent/Sympathomimetic agent Mydriasis causes visual disturbances and sensitivity
Indications to light.
Management of glaucoma. • Report palpitations to the health-care provider.
Action • Periodic exams for intraocular pressure and visual
Lower intraocular pressure by decreasing formation acuity will be scheduled.
of aqueous humor.
CNS: headache, nervousness, drowsiness. •
Monitor blood pressure, pulse, and
CV: palpitations, arrhythmias, hypertension rhythm when the client first begins to self-administer
(large systemic absorption). EENT: stinging, the medication.
burning eye pain, sensitivity to light. • Monitor tonometry readings.
Keep in Mind
• Avoid concurrent use of MAOI agents.
Teach client:
• Follow instructions for proper method of instilla-
tion. Place in conjunctival pocket and not directly
on eyeball.
• Hold lacrimal duct for 1 min after instillation to
prevent systemic absorption.
Nursing Dx: Disturbed sensory perception (visual); Risk

for injury (pharmacologic). Universal Free E-Book Store
Latanoprost
(lat-an-oe-prost)
Xalatan
Travoprost
(trav-oe-prost)
Travatan

Therapeutic/Pharmacologic Class • Hold lacrimal duct for 1 min after instillation to

Antiglaucoma agent/Prostaglandin agonist prevent systemic absorption.
Indications • Avoid activities that require good visual acuity.
Management of glaucoma. Mydriasis causes visual disturbances and sensitivity
Action to light.
Anti-inflammatory action reduces obstruction to • Report palpitations to the health-care provider.
aqueous humor outflow, lowering intraocular • Eye color may change to brown.
pressure. • Periodic exams for intraocular pressure and visual
acuity will be scheduled.
EENT: local irritation, stinging, foreign body
sensation, increased eyelash growth, increased Make the Connection
brown eye pigment (may change eye color to •Monitor blood pressure, pulse, and
brown). CV: palpitations (excessive systemic rhythm when the client first begins to self-administer
absorption). the medication.
Keep in Mind
• Do not administer when contact lenses are in
the eye.
Teach client: • Monitor tonometry readings.
• Follow instructions for proper method of instilla-
tion. Place in conjunctival pocket and not directly
on eyeball.
Nursing Dx: Disturbed sensory perception (visual); Risk

for injury (pharmacologic). Universal Free E-Book Store
INDEX

Leek_Index_i-xi.qxd 5/26/08 5:38 PM Page I-i
I-i
Index Adrenalin, 150

Adsorbocarpine, 187
amiloride, 53
aminocaproic acid, 157
Apo-Amitriptyline, 137
Apo-Amoxicillin, 82
Note: Generic drug names are
bolded. Trade drug names begin Advil, 71 aminophylline IV, 177 Apo-ASA, 72
with a capital letter. Card num- Agenerase, 92 amiodarone, 169 Apo-Atenolol, 164
bers follow the drug name. Airet, 179 amitriptyline, 137 Apo-Benztropine, 129
Alavert, 183 amlodipine, 165 Apo-Bromocriptine, 126
A albuterol, 179 amoxicillin, 82 Apo-Cal, 1
abacavir, 91, 94 Aldactone, 53 amoxicillin/clavulanate, 82 Apo-Carbamazepine, 118
Abilify, 142 alendronate, 98 Amoxil, 82 Apo-Cephalex, 84
acarbose, 37 Aleve, 71 amphetamine, 146 Apo-Cimetidine, 6
Accolate, 69 Allegra, 183 Amphetamine Salt, 146 Apo-Cromolyn, 185
AccuNeb, 179 Allerdryl, 183 Amphotec, 88 Apo-Diazepam, 131
Accurbron, 177 Alloprim, 64 amphotericin B Apo-Diltiaz, 165
Acetadote, 181 allopurinol, 64 deocycholate, 88 Apo-Doxy, 83
acetaminophen, 100 almotriptan, 149 ampicillin/sulbactam, 82 Apo-Erythro-EC, 77
acetazolamide, 186 alosetron, 14 amprenavir, 92 Apo-Folic, 176
acetylcholine, 187 Alphagan, 188 Anafranil, 137 Apo-Furosemide, 54
acetylcysteine, 181 Alpha-Tamoxifen, 99 Ana-Guard, 150 Apo-Glyburide, 38
Achromycin, 83 alprazolam, 131 Anaspaz, 12 Apo-Haloperidol, 139
Activase, 158 Altace, 166 Ancalixir, 110 Apo-Hydro, 55
Activase rt-PA, 158 alteplase, 158 Anectine, 111 Apo-Hydroxyzine, 183
Actonel, 98 Alupent, 179 Antara, 171 Apo-Ibuprofen, 71
Actos, 39 amantadine, 125 Antivert, 23 Apo-Indomethacin, 71
acyclovir, 89 Amaryl, 38 APAP, 100 Apo-ISDN, 170
Adalat, 165 Ambien, 114 Apidra, 28 Apo-K, 2
Adalat CC, 165 Ambien CR, 114 Apo-Acetaminophen, 100 Apo-Lorazepam, 131
Adderall, 146 Amicar, 157 Apo-Acetazolamide, 186 Apo-Metoclop, 25
Adderall Extended Release amikacin, 79 Apo-Allopurinol, 64 Apo-Napro-Na, 71
(XR), 146 Amikin, 79 Apo-Alpraz, 131 Apo-Nifed, 165
Leek_Index_i-xi.qxd 5/26/08 5:38 PM Page I-ii
I-ii
Apo-Nifeden, 165 Atro-Pen, 12 Betaloc, 164 C
Apo-Primidone, 120 atropine, 12 bethanechol, 52 Cafcit, 143
Apo-Selegiline, 123 Atrovent, 178 Biaxin, 77 Cafergot, 143
Apo-Sulfatrim DS, 87 attapulgite, 11 Biaxin XL, 77 caffeine, 143
Apo-Tetra, 83 Augmentin, 82 Bicitra, 2, 3 Calan, 165
Apo-Theo LA, 177 Augmentin ES, 82 bisacodyl, 18 Calan SR, 165
Apo-Trihex, 129 Augmentin XR, 82 Bisaco-Lax, 18 Calcimar, 42
Apo-Verap, 165 Avandia, 39 bismuth subsalicylate, calcipotriene, 76
Apo-Zidovudine, 91 Avapro, 167 11 calcitonin (rDNA), 42
apraclonidine, 188 Aventyl, 137 bismuth subsalicylate/ calcitonin (salmon), 42
Aqua-MEPHYTON, 159 Avirax, 89 metronidazole/tetracycline, calcitriol, 61
Aricept, 130 Avodart, 58 10 calcium acetate, 59
Aricept Oral Axert, 149 Bonamine, 23 calcium carbonate, 1
Disintegrating Axid, 6 Bonine, 23 calcium gluconate, 1
Tablets (ODT), 130 azithromycin, 77 Boniva, 98 Calphron, 59
aripiprazole, 142 Azmacort, 184 Brethaire, 151 Canasa, 68
Arixtra, 154 AZT, 91 Bricanyl, 151 candesartan, 167
Armour Thyroid, 41 brimonidine, 188 Capoten, 166
Artane, 129 B bromocriptine, 126 captopril, 166
Asacol, 68 baclofen, 95 Bronkidyl, 177 Carafate, 9
aspirin, 72 Bactrim, 87 bumetanide, 54 carbachol, 187
AsthmaHaler Mist, 150 Bactrim DS, 87 Bumex, 54 carbamazepine, 118
AsthmaNefrin Baking Soda, 3 bupivacaine, 112 Carbex, 123
(Racepinephrine), 150 Bayer Aspirin, 72 bupropion, 135 carbidopa/levodopa, 128
Atacand, 167 beclomethasone, 184 BuSpar, 132 Carbolith, 134
Atarax, 183 Bell-Ans, 3 buspirone, 132 Carboptic, 187
atenolol, 164 Benedryl, 183 butalbital, Cardizem, 165
Ativan, 131 Benedryl Allergy, 183 acetaminophen, Cardizem LA, 165
atomoxetine, 147 Benylin-E, 182 caffeine, 143 Cardura, 57
atorvastatin, 172 benztropine, 129 Byetta, 33 CartiaXT, 165

Leek_Index_i-xi.qxd 5/26/08 5:38 PM Page I-iii
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carvedilol, 164 ciprofloxacin, 81 Concerta, 145 delavirdine, 93
casanthranol & docusate citalopram, 133 Cordarone, 169 Deltasone, 44
sodium, 18 Citrocarbonate, 3 Coreg, 164 demecarium, 187
Catapres, 168 Citrucel, 15 Cortef, 44 Demerol, 104
Catapres-TTS, 168 clarithromycin, 77 Cortifoam, 44 Depakene, 122
Cathflo Activase, 158 Claritin, 183 cortisone, 44 Depakote, 122
cefepime (4th generation), Claritin Hives Relief, 183 Cortone, 44 Depakote Extended Release
84 Claritin Reditabs, 183 Coumadin, 155 (ER), 122
ceftazidime (3rd generation), Claritin 24-Hour Allergy, 183 Coverta-HS, 165 Deponit, 170
84 Clavulin, 82 Cozaar, 167 desmopressin, 47
ceftriaxone (3rd generation), Clear-Atadine, 183 Crestor, 172 Desyrel, 135
84 Cleocin, 78 cromolyn, 185 Detrol, 51
Celebrex, 67 Cleocin T, 78 cyclobenzaprine, 95 Detrol LA, 51
celecoxib, 67 clindamycin, 78 cyclosporine, 65 DexFerrum, 63
Celexa, 132 clomipramine, 137 Cymbalta, 136 dexmethylphenidate, 145
cephalexin (1st generation), clonazepam, 131 Cytomel, 41 dextrose 5% and 0.9% NaCl
84 clonidine, 168 Cytotec, 8 (hypotonic), 4
Cephulac, 19 clopidogrel, 156 dextrose 5% and 0.45%
Cerebyx, 119 codeine, 13 D NaCl (isotonic), 4
Cesamet, 27 Cogentin, 129 Dalacin C, 78 dextrose 5% in water
Children’s Loratadine, 183 Cognex, 130 dalteparin, 154 (isotonic), 4
chlorothiazide, 55 Colace, 20 Dantrium, 96 DiaBeta, 38
chlorpromazine, 140 Colchicine, 66 dantrolene, 96 diazepam, 131
cholestyramine resin, 174 colchicine, 66 Darvocet-N 50, 106 didanosine, 91
Chronulac, 19 colesevelam, 174 Darvocet-N 100, 106 Dideoxyinosine, 91
Cialis, 56 Colestid, 174 DC Softgels, 20 Didronel, 98
Cidomycin, 79 colestipol, 174 DDAVP, 47 Diflucan, 88
cimetidine, 6 Combivir, 94 DDAVP Rhinal Tube, 47 Digitek, 160
Cipro, 81 Compazine, 24 DDAVP Rhinyl Drops, 47 digoxin, 160
Cipro XR, 81 Comtan, 127 ddl, 91 Dilacor XR, 165

Leek_Index_i-xi.qxd 5/26/08 5:38 PM Page I-iv
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Dilantin, 119 Dulcolax, 18 epinephrine, 150, 188 fenofibrate, 171
Dilatia XT, 165 Dulcolax Magnesia Tablets, 21 EpiPen, 150 fentanyl (transdermal), 102
diltiazem, 165 duloxetine, 136 Epival, 122 fexofenadine, 183
Dimetapp Children’s ND Duragesic, 102 Epivir, 91 filgrastim, 75
Non-Drowsy Allergy, 183 Duramorph, 105 Epivir HBV, 91 finasteride, 58
Dimox, 186 dutasteride, 58 epoetin, 62 Fioricet, 143
Dimox Sequels, 186 Dyrenium, 53 Epogen, 62 Fletcher’s Castoria, 18
Diovan, 167 Eprex, 62 Flexeril, 95
Dipentum, 68 E ergotamine, caffeine, 143 Flomax, 57
diphenhydramine, 183 Ecotrin, 72 EryPed, 77 Florinef, 45
diphenoxylate/atropine, 13 edrophonium, 97 erythromycin, 77 Flovent, 184
dipivefrin, 188 E.E.S., 77 Esidrex, 55 Flovent Diskus, 184
Diprivan, 108 efavirenz, 93 Eskalith, 134 fluconazole, 88
Disoprofol, 108 Effexor, 136 esomeprazole, 7 fludrocortisone, 45
Ditropan, 51 Effexor XR, 136 etanercept, 74 fluoxetine, 133
Ditropan XL, 51 E/Gel, 77 ethambutol, 86 fluphenazine, 140
Diuril, 55 Eldepryl, 123 ethosuximide, 121 fluticasone, 184
divalproex, 122 Elevil, 137 Etibi, 86 fluvoxamine, 133
Dixarit, 168 Elidel 1% Cream, 70 etidronate, 98 Focalin, 145
docusate calcium, 20 Elixophyllin, 177 Evista, 99 Focalin Extended Release
docusate sodium, 20 E-Mycin, 77 Exelon, 130 (XR), 145
donepezil, 130 enalapril, 166 exenatide, 33 Folate, 176
dopamine, 163 Enbrel, 74 Ex-Lax, 18 Folex, 73
Dopar, 128 Endocet, 103 ExtenCaps, 2 Folex PFS, 73
Doryx, 83 Enlon, 97 ezetimibe, 173 folic acid, 176
Dovonex, 76 enoxaparin, 154 Folvite, 176
doxazosin, 57 ENSAM Transdermal, 123 F fondaparinux, 154
doxycycline, 83 entacapone, 127 famciclovir, 89 Foradil (Powder Inhaler), 179
Dramamine II, 23 Epifrin, 188 famotidine, 6 formoterol, 179
dronabinol, 27 Epimorph, 105 Famvir, 89 Fortamet, 34

Leek_Index_i-xi.qxd 5/26/08 5:38 PM Page I-v
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Fortaz, 84 Glucotrol XL, 38 hydrocodone/acetaminophen, insulin glulisine (rDNA
Fortical, 42 glyburide, 38 103 origin) injection, 28
Fosamax, 98 Glynase PresTab, 38 hydrocodone/ibuprofen, insulin lispro, rDNA
fosphenytoin, 119 Glyset, 37 103 origin, 28
Fragmin, 154 GoLYTELY, 16 hydrocortisone, 44 Insulin-Toronto, 29
Fungizone, 88 granisetron, 26 hydroxyzine, 183 insulin zinc suspension,
furosemide, 54 guaifenesin, 182 hyoscyamine, 12 extended (ultralente
Guiatuss, 182 Hyrocet, 103 insulin), 30
G Hytuss, 182 Intal, 185
gabapentin, 117 H Intropin, 163
Gabarone, 117 Haldol, 139 I Invirase, 92
Gabitril, 117 Haldol Long Acting (LA), ibandronate, 98 Iopidine, 188
galantamine, 130 139 ibuprofen, 71 ipratropium, 178
Garamycin, 79 Halflytely, 16 Ilosone, 77 irbesartan, 167
Gas-X, 17 haloperidol, 139 Imdur, 170 iron dextran, 63
G-CSF (granulocyte HCTZ, 55 imipenem/cilastatin, 85 iron polysaccharide, 63
colony-stimulating factor), HELIDAC, 10 imipramine, 137 iron sucrose, 63
75 Hepalean, 153 Imitrex, 149 Ismo, 170
gemfibrozil, 171 heparin, 153 Imodium, 13 isocarboxazid, 138
gentamicin, 79 Hep-Lock, 153 Indocin, 71 Isonate, 170
Geodon, 142 Hep-Lock U/P, 153 indomethacin, 71 isoniazid, 86
Glaucon, 188 horazine, 140 InFeD, 63 isoproterenol, 180
glimepiride, 38 Humalog, 28 infliximab, 74 Isoptin, 165
glipizide, 38 Humatrope, 48 INH, 86 Isoptin SR, 165
GlucaGen, 40 Humibid, 182 Innohep, 154 Isopto Carbachol, 187
glucagon, 40 Humorsol, 187 insulin, regular, 29 Isopto Carpine, 187
Gluconorm, 36 Humulin N, 30 insulin aspart, rDNA origin, Isopto Hyoscine, 22
Glucophage, 34 Humulin R, 29 28 Isorbid, 170
Glucophage XR, 34 Humulin U Ultralente, 30 insulin detemir, 31 Isordil, 170
Glucotrol, 38 hydrochlorothiazide, 55 insulin glargine, 31 isosorbide dinitrate, 170

Leek_Index_i-xi.qxd 5/26/08 5:38 PM Page I-vi
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isosorbide mononitrate, 170 Klor-Con, 2 Levitra, 56 losartan, 167
Isotrate, 170 Kristalose, 19 levodopa, 128 Losec, 7
Isotrate ER, 170 Kytril, 26 levofloxacin, 81 Lotronex, 14
Isuprel, 180 Levothroid, 41 Lovasa, 175
L levothyroxine, 41 lovastatin, 172
J labetalol, 164 Levoxyl, 41 Lovenox, 154
Junuvia, 35 lactated Ringer’s solution, 4 Levsin, 12 Luminal, 110
lactated Ringer’s solution lidocaine (parenteral), 169 Lunesta, 114
K (isotonic), 4 LidoPen, 169 Luvox, 133
Kabikinase, 158 Lactulax, 19 Lioresal, 95 Lyrica, 117
Kalcinate, 1 lactulose, 19 liothyronine, 41
Kaletra, 94 Lamictal, 116 liotrix, 41 M
Kantrex, 79 Lamisil, 88 Lipitor, 172 magnesium hydroxide, 21
Kaopectate, 11 lamivudine, 91, 94 Liquid Pred, 44 magnesium oxide, 21
Karacil, 15 lamivudine/zidovudine, 94 lisinopril, 166 Magnesium Sulfate Inj, 21
katamycin, 79 lamotrigine, 116 lithium, 134 magnesium sulfate (IV), 21
Kayexalate, 5 Lanoxicaps, 160 Lithobid, 134 Mag-Ox 400, 21
K-Dur, 2 Lanoxin, 160 Lithotabs, 134 Marcaine, 112
Keflex, 84 lansoprazole/amoxicillin/ LoCHOLEST, 174 Marinol, 27
Kemstro, 95 clarithromycin, 10 LoCHOLEST Light, 174 Marplan, 138
Keppra, 116 Lantus, 31 Lofibra, 171 Maxipime, 84
Ketalar, 109 lanzoprazole, 7 Lomotil, 13 meclizine, 23
ketamine, 109 Larodopa, 128 loperamide, 13 Medihaler-ISO, 180
ketoconazole (systemic), 88 Lasix, 54 Lopid, 171 Medrol, 44
ketorolac, 71 latanoprost, 189 lopinavir/ritonavir, 94 Megace, 50
K-Exit, 5 L-dopa, 128 Lopressor, 164 megestrol, 50
Klean-Prep, 16 Leutrine, 75 loratadine, 183 meperidine, 104
K-Long, 2 Levaquin, 81 lorazepam, 131 Mephyton, 159
Klonopin, 131 Levemir, 31 Lorcet, 103 Meridia, 144
K-Lor, 2 levetiracetam, 116 Lortab, 103 mesalamine, 68

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Mestinon, 97 Minitran, 170 Nardil, 138 Nitrodisc, 170
Mestinon SR, 97 Miocarpine, 187 Nasacort, 184 Nitro-Dur, 170
Metadate Continuous Miochol-E, 187 NasalCrom, 185 Nitrogard, 170
Dosage (CD), 145 MIRALAX, 16 nateglinide, 36 Nitrogard SR, 170
Metadate Extended Release Mirapex, 124 Natrecor, 162 nitroglycerin, 170
(ER), 145 mirtazapine, 136 Navane, 141 NitroglynE-R, 170
Metamucil, 15 misoprostol, 8 Nebcin, 79 Nitrolingual, 170
metaproterenol, 179 modafinil, 148 nedocromil, 185 Nitrong, 170
metaxolone, 95 MOM, 21 nefazodone, 136 Nitro-par, 170
metformin, 34 Monoket, 170 nelfinavir, 92 NitroQuick, 170
methimazole, 43 montelukast, 69 Nembutal, 110 Nitrostat, 170
methotrexate, 73 morphine, 105 neostigmine, 97 Nitro-Time, 170
methylcellulose, 15 Morphine H.P., 105 Nephro-calci, 1 nizatidine, 6
Methylin, 145 Morphine Sulfate, 105 Nephrocaps, 60 Nizoral, 88
Methylin Sustained Release Motrin, 71 Nephron, 150 Nolvadex, 99
(SR), 145 MS Contin, 105 nesiritide, 162 Non-Drowsy Allergy Relief for
methylphenidate, 145 Mucinex, 182 Neupogen, 75 Kids, 183
methylprednisolone, 44 Mucomyst, 181 Neurontin, 117 Normodyne, 164
Meticorten, 44 Mucosil, 181 Neut, 3 nortriptyline, 137
metoclopramide, 25 Myambutol, 86 neutral protamine Hagedorn Norvasc, 165
metoprolol, 164 Mylicon, 17 (NPH) insulin (isophane Norvir, 92
Mevacor, 172 Mysoline, 120 insulin suspension) Novo-Alprazol, 131
Miacalcin, 42 intermediate type, 30 Novocaine, 112
Micro-K, 2 N nevirapine, 93 Novo-Chlorpromazine, 140
Micronase, 38 nabilone, 27 Nexium, 7 Novo-Diltazem, 165
MicroNefrin, 150 naloxone, 107 nifedipine, 165 Novolin de Ultralente, 30
Midamor, 53 naltrexone, 107 Niferex, 63 Novolin ge NPH, 30
midazolam, 113 Naprosyn, 71 Nitrek, 170 Novolog, 28
miglitol, 37 naproxen, 71 Nitro-Bid IV, 170 Novo-Metformin, 34
milrinone, 161 Narcan, 107 Nitrocot, 170 Novopentobarb, 110

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Novo-Rythro, 77 oxycodone/acetaminophen, Phillips Magnesia Tablets, 21 pregabalin, 117
Novo-Salmol, 179 103 Phillips Milk of Magnesia, 21 Pressyn, 47
Novosecobarb, 110 oxytocin, 46 PhosLo, 59 Prevacid, 7
Novosorbide, 170 Oxytrol, 51 Phyllocontin, 177 Prevacid/Amoxil/Biaxin, 10
Novospiroton, 53 phytonadione, 159 Prevalite, 174
Novo-Tamoxifen, 99 P pilocarpine, 187 PREVPAC, 10
Novo-Veramil, 165 Pacerone, 169 Pilopine, 187 Prilosec, 7
Novulin R, 29 Pamelor, 137 Pilostat, 187 Prilosec OTC, 7
NuLytely, 16 Panadol, 100 pimecrolimus, 70 Primacor, 161
pancuronium, 111 pioglitazone, 39 Primatene, 150
O pantoprazole, 7 piperacillin/tazobactam, 82 Primaxin, 85
Octostim, 47 Parcopa, 128 Pitocin, 46 primidone, 120
octreotide, 49 Parlodel, 126 Pitressin, 47 Prinivil, 166
Ocusert Pilo, 187 Parnate, 138 Plavix, 156 procainamide, 169
olanzapine, 142 paroxetine, 133 PMS-Bismuth Subsalicylate, 11 procaine, 112
olsalazine, 68 Pavulon, 111 PMS-Dicitrate, 2 Procanbid, 169
omega-3-acid ethyl esters, Paxil, 133 PMS Isoniazid, 86 Procardia, 165
175 pentobarbital, 110 PMS-Levothyroxine Sodium, Procardia XL, 165
omeprazole, 7 Pepcid, 6 41 prochlorperazine, 24
ondansetron, 26 Pepto-Bismol, 11 PMS-Methylphenidate, 145 Procrit, 62
Oracit, 3 Pepto-Bismol/Flagyl/ PMS Pyrazinamide, 86 Prolixin, 140
Os-Cal, 1 Achromycin, 10 polyethylene glycol/ Promine, 169
oseltamivir, 90 Percocet, 103 electrolyte, 16 Pronestyl, 169
Osteocalcin, 42 Peri-Colace, 18 potassium chloride, 2 Pronestyl-SR, 169
Ovol, 17 Permitil, 140 pramipexole, 124 Propecia, 58
oxcarbazepine, 118 perphenazine, 140 pramlintide, 32 Propine, 188
oxybutynin (oral), 51 Phazyme, 17 Prandin, 36 propofol, 108
oxybutynin (transdermal), phenelzine, 138 Precose, 37 propoxyphene
51 phenobarbital, 110 prednisone, 44 napsylate/acetaminophen,
Oxycocet, 103 phenytoin, 119 PredPak, 44 106

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propylthiouracil, 43 R risedronate, 98 scopoloamine, 22
Propyl-Thyracil, 43 raloxifene, 99 Risperdal, 142 secobarbital, 110
Proscar, 58 ramelteon, 115 risperidone, 142 Seconal, 110
Prostigmin, 97 ramipril, 166 Ritalin, 145 selegiline, 123
protamine sulfate, 152 ranitidine, 6 Ritalin Long-Acting (LA), 145 sennoside, 18
Protamine Sulfate (Injection), Razadyne, 130 Ritalin (SR), 145 Senokot, 18
152 Razadyne ER, 130 ritonavir, 92 Sensorcaine, 112
Protonix, 7 Reglan, 25 rivastigmine, 130 Septra, 87
Protonix I.V., 7 Regulex, 20 Robitussin, 182 Serevent, 179
Proventil, 179 Relenza, 90 Rocaltrol, 61 Serostim, 48
Proventil Remeron, 136 Rocephin, 84 Serzone, 136
Hydrofluoroakane Remeron Soltabs, 136 Rofact, 86 sevelamer, 59
(HFA), 179 Remicade, 74 ropinirole, 124 sibutramine, 144
Provigil, 148 Reminyl, 130 rosiglitazone, 39 sildenafil, 56
Prozac, 133 Renagel, 59 rosuvastatin, 172 simethicone, 17
Prozac Weekly, 133 Renal Caps, 60 Rowasa, 68 simvastatin, 172
psyllium, 15 repaglinide, 36 Roxanol, 105 Sinemet, 128
PTU, 43 Requip, 124 Rozerem, 115 Sinemet Continuous Release
pyrazinamide, 86 Rescriptor, 93 (CR), 128
pyridostigmine, 97 Restasis, 65 S Singulair, 69
pyrrolopyrazine, 114 Retrovir, 91 salmeterol, 179 sitagliptin, 35
Revatio, 56 Salmonine, 42 Skelaxin, 95
Q Revimine, 163 Salofalk, 68 Slo-Bid, 177
Quelicin, 111 Rheumatrex, 73 Sandimmune, 65 Slo-Phyllin, 177
Questran, 174 rHu GM-CSF (recombinant Sandostatin, 49 Slow-K, 2
Questran Light, 174 human granulocyte/ Sandostatin LAR, 49 SMZ/TMP, 87
Quibron-T, 177 macrophage colony- Sans-Acne, 77 Soda Mint, 3
quinidine, 169 stimulating factor), 75 saquinavir, 92 sodium bicarbonate, 3
Quiniglute, 169 Rifadin, 86 Sarafem, 133 sodium chloride 0.45%
Qvar, 184 rifampin, 86 sargramostim, 75 solution (hypotonic), 4

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sodium chloride 0.9% sumatriptan, 149 Theo-Dur, 177 tranylcypromine, 138
solution (isotonic), 4 Surfak, 20 Theospan, 177 Travatan, 189
sodium chloride/sodium Sus-Phrine, 150 Theovent, 177 travoprost, 189
bicarbonate/potassium Sustiva, 93 thiophylline IV, 177 trazodone, 135
chloride with bisacodyl Symlin, 32 thiothixene, 141 Trazon, 135
slow release tablets, 16 Symmetrel, 125 3TC, 91 Trexall, 73
sodium citrate and citric Syn-Clonazepam, 131 thyroid, 41 Trialodine, 135
acid, 3 Syntocinon, 46 Thyrolar, 41 triamcinolone, 184
sodium polystyrene tiagabine, 117 triamterene, 53
sulfonate, 5 T Tiazac, 165 Tricor, 171
Solfoton, 110 tacrine, 130 Ticlid, 156 Tridil, 170
solifenacin, 51 tadalafil, 56 ticlopidine, 156 trifluoperazine, 140
Solu-Cortef, 44 Tagamet, 6 Tilade, 185 Triglide, 171
Solu-Medrol (IV), 44 Tamiflu, 90 tinzaparin, 154 trihexyphenidyl, 129
somatropin, 48 tamoxifen, 99 Tissue Plasminogen Trilafon, 140
Sominex, 183 tamsulosin, 57 Activator (t-PA), 158 Trileptal, 118
Sorbitrate, 170 Tapazole, 43 TOBI, 79 trimethoprim/
spironolactone, 53 Tasmar, 127 tobramycin, 79 sulfamethoxazole,
Starlix, 36 Tavist ND, 183 Tofranil, 137 87
Stelazine, 140 Tazicef, 84 tolcapone, 127 Triostat, 41
Stemetil, 24 Tegretol, 118 tolterodine, 51 Trizivir, 94
Stimate, 47 Tegretol Extended Release Topamax, 117 Truphylline, 177
Storzolamide, 186 (XR), 118 topiramate, 117 Tums, 1
Strattera, 147 Tenormin, 164 Toprol-XL, 164 Tums E-X, 1
Streptase, 158 Tensilon, 97 Toradol, 71 Tylenol, 100
streptokinase, 158 terbinafine, 88 tramadol, 101 Tylox, 103
S-2, 150 terbutaline, 151 Trandate, 164
succinylcholine, 111 tetracycline, 83 Transderm-Nitro, 170 U
sucralfate, 9 THC, 27 Transderm-Scop, 22 Ultram, 101
Sulcrate, 9 Theobid, 177 Transderm-V, 22 Unasyn, 82

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Unisom Nightime Sleep Aid, verapamil, 165 Welchol, 174 Ziagen, 91
183 Versed, 113 Wellbutrin, 135 zidovudine, 91, 94
Urecholine, 52 VESIcare, 51 Wellbutrin Extra Long-Acting ziprasidone, 142
Viagra, 56 (XL), 135 Zithromax, 77
V Vibramycin, 83 Wellbutrin Sustained Release Zmax, 77
valacyclovir, 89 Vicodin, 103 (SR), 135 Zocor, 172
Valium, 131 Vicoprofen, 103 Zofran, 26
valproic acid, 122 Videx, 91 X zolpidem, 114
valsartan, 167 Videx EC, 91 Xalatan, 189 Zosyn, 82
Valtrex, 89 Viracept, 92 Xanax, 131 Zovirax, 89
Vanceril, 184 Viramune, 93 Xanax Extended Release (XR), Zyban, 135
Vancocin, 80 Vistaril, 183 131 Zyloprim, 64
vancomycin, 80 vitamin B, 176 Xylocaine, 169 Zyprexa Zydis, 142
vardenafil, 56 vitamin B with vitamin C, Xylocard, 169
vasopressin, 47 60
Vasotec, 166 vitamin K, 159 Z
Vasotec IV, 166 Vivitrol, 107 zafirlukast, 69
Velosulin, 29 Volmax, 179 zanamivir, 90
venlafaxine, 136 VoSpira ER, 179 Zantac, 6
Venofer, 63 Zantac C, 6
Ventolin, 179 W Zarontin, 121
Ventolin HFA, 179 warfarin, 155 Zestril, 166
Ventro-Disk, 179 Warfilone, 155 Zetia, 173

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F. A. DAVIS COMPANY • Philadelphia

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Sally K. Davis, RN, MSN

Penny Fairman, MSN, EdD

Linda C. McIntosh, PhD, RN, LPC

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Gastrointestinal System Drugs Central Nervous System Drugs

Endocrine System Drugs Cardiovascular System Drugs

Urologic System Drugs Respiratory System Drugs

Immune System Drugs Sensory System Affecting the Eye

Musculoskeletal System Drugs

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Abbreviations Used on Cards

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HDL high-density lipoproteins mcg microgram(s) OCD obsessive-compulsive

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RNA ribonucleic acid supp suppository VT ventricular tachycardia

SL sublingual Top topically or topical ↓ decreased or low

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Anticonvulsants, Cards 116–122 Respiratory System Drugs, Cards 177–185

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Gastrointestinal System Drugs Electrolyte Modifiers 1

Os-Cal, Tums, Tums E-X,

Gastrointestinal System Drugs Electrolyte Modifiers 1

Therapeutic/Pharmacologic Class • Vitamin D must be taken in adequate amounts.

Gastrointestinal System Drugs Electrolyte Modifiers 2

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

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Gastrointestinal System Drugs Electrolyte Modifiers 2

Therapeutic/Pharmacologic Class Keep in Mind

Nursing Dx: Risk for injury (cardiovascular).

Gastrointestinal System Drugs Electrolyte Modifiers 3

Baking Soda, Bell-Ans, Citrocarbonate,

Sodium Citrate and

Gastrointestinal System Drugs Electrolyte Modifiers 3

Therapeutic/Pharmacologic Class Keep in Mind

Gastrointestinal System Drugs Electrolyte Modifiers 4

0.9% NaCl Solution (Isotonic); 5% Dextrose in

Dextrose 5% and 0.9%

Gastrointestinal System Drugs Electrolyte Modifiers 4

Gastrointestinal System Drugs Electrolyte Modifiers 5

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Gastrointestinal System Drugs Electrolyte Modifiers 5

Therapeutic/Pharmacologic Class • A low-sodium diet will be ordered.

Nursing Dx: Risk for injury (cardiovascular); Constipation.

Gastrointestinal System Drugs Gastric Mucosa Protectors 6

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Gastrointestinal System Drugs Gastric Mucosa Protectors 6

Therapeutic/Pharmacologic Class Keep in Mind

Gastrointestinal System Drugs Gastric Mucosa Protectors 7

Nexium Prilosec; Prilosec OTC

Protonix; Protonix I.V. Prevacid

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Gastrointestinal System Drugs Gastric Mucosa Protectors 7