Care Plan Addendum: Black Box Warnings
Procedure: Check off all medications ordered and watch for symptoms listed, notify the physician when clinically significant
Medication
Black Box Warning (see PDR)
Watch for:
Actigall (ursodiol)
Actiq (fentanyl transmucosal)
Amphetamines
Amiodarone
Aminoglycosides
Antiarrhythmics
Antidepressants
Antiretrovirals
Antipsychotics
Avandia\Actos (piogli\rosili-tazone)
Beta-blockers, including ophthalmics
Cellcept (mycophenolate)
Cleocin (clindamycin)
Clozaril (clozapine)
Coumadin (warfarin)
Cylert (pemoline)
Danocrine (danazol)
Dantrium (dantrolene)
Darvon/Darvocet (propoxyphene)
Depakote / Depakene (valproic)
Diuretic-loop: Lasix,Bumex,Demadex
Diuretics – potassium sparing
Elidel (pimecrolimus)
Ergotamine w/macrolides
Erythropoetic agents
Estrogens / progesterone
Eulexin (flutamide)
Felbatol (felbamate)
Flagyl (metronidazole)
Fluoroquinolone Avelox Cipro Factive Floxin
Levaquin, Maxaquin, Noroxin, Penetrex
Glucophage/Avandamet (metformin)
Guanethidine
Hydrea (hydroxyurea)
Imuran (azathioprine)
Interferon
INH (isoniazid)
LABAs- Advair,Brovana Foradil, Performist,
Serevent, Symbicort
Lamictal (lamotrigine)
Lithium (2)
Loniten (minoxidil)
Mellaril (thioridazine)
Methotrexate
Narcotics – long-acting
Neoral, Sandimmune (cyclosporin)
Nizoral (ketoconazole)
Nolvadex (tamoxifen)
NSAIDs, Celebrex (1+)
Oxandrin (oxandrolone)
Plaquenil (hydroxychloroquine)
Proamatine (midodrine)
Procan (procainamide)
Prograf (tacrolimus)
Remicade (infliximab)
Ritalin (methyphenidate)
Sporanox (itraconazole)
Rapamune (sirolimus)
Talwin (pentazocine)
Tasmar (tolcapone)
Tegretol (carbamazepine)
Thyroid, Synthroid (l-thyroxine)
Ticlid (ticlopidine)
Vitamin K
Zaroxolyn, Diulo (metolazone)
Resident:
High rate of gallstone recurrence
Not narcotic naïve
Dependence, sudden death
Pulmonary and hepatic toxicities
Renal and oto-toxicities
Pro-arrhythmic, cardiac arrest
Increased suicide risk for persons <25 years of age
Hematologic toxicities
Increased risk of death w/.dementia dx
Increased risk of negative cardiac events
Induced arrhythmia during abrupt cessation->taper
Susceptibility to infection, lymphoma
Severe colitis
Agranulocytosis
Major or fatal risk of bleeding
Hepatotoxicity
Peliosis hepatis, hepatic adenoma
Hepatotoxicity, monitor AST / ALT
Fatalities with overdose
Hepatic toxicity
Water and electrolyte depletion
hyperkalemia
Malignancies reported,
Peripheral ischemia w/cyp3a4 drugs
Increased MI, CVA, thrombosis, CA-head-neck risks
Endometrial cancer
Hepatic injury
Aplastic anemia, hepatic failure
Carcinogenic in rats
Abd pain, nausea
Respiratory depression
Increased requests for med
Sob, nausea, abd pain
Nausea, hearing loss
Dizziness, falls, angina
Suicide acts or verbalization
Weakness, fever, infection
TIA symptoms, chest pain
Chest pain, weakness
Chest pain, dizziness
Fever, infection, malaise
Diarrhea, abd pain
Weakness, fever, infection
Signs or symptoms bleeding
GI pain, nausea, vomiting
Jaundice, hepatomegally
GI pain, nausea, vomiting
respiratory depression
GI pain, nausea, vomiting
Weakness, arrhythmia, confusion
Weakness, arrhythmia, malaise
Pain, lumps, weakness
Neuropathies, cold extremities
Chest pain, weakness,
Pain, malaise, abd pain
Pain, jaundice, abd pain
Fever, pain, jaundice, abd pain
Rats taking chemotherapy
Risk of tendonitis and tendon rupture
Ambulation issues, pain
Lactic acidosis
Orthostatic hypotension
Carcinogenic
Immunosupression -> carcinogenic
Aggravate neuropsychiatric, autoimmune, ischemic
Hepatitis
Abd distress, malaise, myopathy
Dizziness, fainting
Pain, weakness, malaise
Pain, weakness, malaise
Confusion, malaise
jaundice, abd pain, nausea
Asthma related deaths
Sob, dyspnea
Life threatening rash
Rash
Monitor levels
Lithium levels, if ordered
Pericardial effusion, angina
Angina, weakness
QTc interval prolongation
Angina, weakness, dizziness
pulm, bone marrow, diarrhea, ulcerative stomatitis
Diarrhea, fever, stomatitis,
Not narcotic naïve, chronic pain only, no PRN use
Resp depression
Physician experienced only
jaundice, abd pain, nausea
Hepatic toxicity
jaundice, abd pain, nausea
CVA, PE, uterine malignancies
Confusion, chest pain, sob
GI, bleeding + renal toxicities
Fainting, weakness,
Peliosis hepatis, lipid changes
Jaundice, hepatomegally
Physician must be ware of all of PI
Visual disturbances
Use only in severe impairment
Hypertension, headache
Development of positive ANA
Bradycardia, dizziness
Increased infection + lymphoma risk
Fever, weakness, infection
Opportunistic infections, TB
Fever, weakness, infection
Dependence, psychotic episodes
Increased request for med
Contraindicated in heart failure, serious drug interac
Nausea, weakness
Increased infection + lymphoma risk
Fever, weakness, infection
Oral use only
Resp depression
Liver failure
jaundice, abd pain, nausea
Aplastic anemia, agranulocytosis
Fever, weakness, infection
Not used for weight loss
tachycardia, perspiration
Neutropenia, TTP,
Fever, weakness, infection
Avoid IV use
Avoid IV use
Mykrox + Zaroxolyn not equivalent
Weakness, arrhythmia, confusion
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