Week 3 - Anti Infectives
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Cefazolin
Generic Name - Cefazolin Sodium
Brand Name - Kefzol, Ancef
Classification ○ Therapeutic Class - Antibiotic
○ Pharmacological Class - Cephalosporins, 1st generation.
Indication ○ Perioperative prevention in contaminated surgery.
○ Infections of respiratory, biliary, and GU tracts; skin, soft-tissue, bone, and joint infections;
septicemia; endocarditis.
Action/MOA - Inhibits cell wall synthesis, promotic osmotic instability; usually bactericidal. Stops
replication and breaks it down.
Route - IV or IM
Dosage ○ 250 to 500 mg IM or IV every 8 hours for mild infections
○ 500 mg to 1.5 g IM or IV every 6 to 8 hours for moderate to severe or life-threatening infections.
○ Maximum, 12 g/day in life-threatening situations.
Contraindications ○ patients with hypersensitivity to drug or other cephalosporins
○ use cautiously with patients hypersensitive to penicillin because it can cause cross sensitivity.
○ Prolonged use could cause fungal or bacterial superinfection.
Side Effects - anorexia, chills, diarrhea, dizziness, dyspepsia, fever, headache, paresthesia, pruritus,
urticaria.
Nursing Considerations ○ If CrCl falls below 55 mL/minute in adults or 70 mL/minute in children, adjust dosage.
○ If large doses are given, therapy is prolonged or the patient is at high risk.
○ Monitoring patients for signs and symptoms of superinfection.
○ Monitor patients for diarrhea and treat appropriately.
Adverse Effects ○ CV: phlebitis, thrombophlebitis with IV injection.
○ GI: diarrhea, pseudomembranous colitis, anorexia, glossitis, dyspepsia, abdominal cramps, anal
pruritus, oral candidiasis.
○ GU: genital pruritus, candidiasis, vaginitis.
○ Hematologic: neutropenia, leukopenia, thrombocytopenia, eosinophilia.
○ Skin: maculopapular and erythematous rashes, urticaria, pruritus, pain, induration, sterile
abscesses, tissue sloughing at injection site, SJS.
○ Other: anaphylaxis, hypersensitivity reactions, drug fever.
Ceftriaxone
Generic Name - Ceftriaxone Sodium
Brand Name - Rocephin
Classification ○ Therapeutic - Antibiotic
○ Pharmacological - 3rd Generation cephalosporins.
Indication ○ Uncomplicated gonococcal vulvovaginitis
○ UTI; lower respiratory tract, gynecologic, bone or joint, intra abdominal, skin or skin structure
infection; septicemia.
○ Meningitis
○ Perioperative prophylaxis
○ Acute bacterial otitis media
○ Acute otitis media
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Action - Inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal.
Route - IV or IM
Dosage Range ○ 250 mg IM as a single dose, plus azithromycin 1 g PO as a single dose or doxycycline 100 mg PO
b.i.d. for 7 days.
○ 1 to 2 g IM or IV daily or in equally divided doses every 12 hours. Total daily dose shouldn’t
exceed 4 g. Treat for 4 to 14 days. Complicated infections may require longer treatment.
Contraindications ○ Contraindicated in patients hypersensitive to drug or other cephalosporins.
○ Use cautiously in patients hypersensitive to penicillin because of the possibility of crosssensitivity with other beta-lactam antibiotics.
○ May cause superinfection and mild to fatal CDAD. If suspected, manage appropriately;
discontinue drug if needed.
○ May cause hemolytic anemia, which can be fatal. If anemia develops during therapy, stop the drug
until the cause is determined.
○ Use cautiously in patients with a history of colitis, renal insufficiency, or GI or gallbladder
disease.
Side Effects - diarrhea
Nursing Considerations ○ If large doses are given, therapy is prolonged, or patient is at high risk.
○ Monitoring the patient for signs and symptoms of superinfection.
○ Monitor PT and INR in patients with impaired vitamin K synthesis or low vitamin K stores.
Vitamin K therapy may be needed.
○ Monitor patients for superinfection, diarrhea, and anemia and treat appropriately.
Adverse Effects ○ GI: pseudomembranous colitis, diarrhea.
○ Hematologic: eosinophilia, thrombocytosis, leukopenia.
○ Skin: pain, induration, tenderness at injection site, rash.
○ Other: hypersensitivity reactions, serum sickness, anaphylaxis.
Amoxicillin
Generic Name - Amoxicillin
Trade Name - Amoxil
Classification ○ Therapeutic - Antibiotics
○ Pharmacologic - Aminopenicillins
Indication ○ Mild to moderate infections of the ENT; skin and skin structure; or GU tract.
○ Mild to severe infections of the lower respiratory tract and severe infections of the ENT; skin and
skin structure or GU tract.
○ Pharyngitis, tonsillitis
○ Helicobacter pylori eradication to reduce risk of duodenal ulcer recurrence.
○ Acute otitis Media.
Action - Inhibits cell-wall synthesis during bacterial multiplication.
Route - PO (orally)
Dosage Range ○ 500 mg PO every 12 hours or 250 mg PO every 8 hours.
○ 875 mg PO every 12 hours or 500 mg PO every 8 hours.
○ 875 mg every 12 hours or 500 mg every 8 hours for at least 10 days.
Contraindications ○ Contraindicated in patients hypersensitive to drug or other penicillins.
○ Use cautiously in patients with other drug allergies (especially to cephalosporins) because of
possible cross-sensitivity.
○ Use cautiously in those with mononucleosis because of high risk of maculopapular rash.
Side Effects - agitation, anxiety, chills, confusion, diarrhea, dizziness, fever, insomnia, nausea, purpura,
vomiting.
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Nursing Considerations ○ If large doses are given or if therapy is prolonged, bacterial or fungal superinfection may occur,
especially in elderly, debilitated, or immunosuppressed patients.
○ CDAD, ranging from mild diarrhea to fatal colitis, has been reported with nearly all antibacterial
agents, including amoxicillin. Evaluate patients if diarrhea occurs.
○ Amoxicillin usually causes fewer cases of diarrhea than ampicillin.
Adverse Effects ○ CNS: seizures, anxiety, confusion, agitation, dizziness, reversible hyperactivity, anxiety, insomnia,
behavioral changes.
○ GI: diarrhea, nausea, pseudomembranous colitis, vomiting.
○ GU: interstitial nephritis, nephropathy.
○ Hematologic: agranulocytosis, leukopenia, thrombocytopenia, thrombocytopenic purpura, anemia,
eosinophilia, hemolytic anemia.
○ Other: anaphylaxis, hypersensitivity reactions, overgrowth of nonsusceptible organisms.
Piperacillin/Tazobactam
Generic Name - Piperacillin Sodium & Tazobactam Sodium
Trade Name - Zosyn
Classification ○ Therapeutic - Antibiotic
○ Pharmacologic Class - extended-spectrum penicillins-beta-lactamase inhibitors.
Indication ○ Moderate to severe infections.
○ Appendicitis, peritonitis.
○ Moderate to severe nosocomial pneumonia.
Action - Inhibits cell-wall synthesis during bacterial multiplication.
Route - IV (vein)
Dosage Range ○ .375g (3g piperacillin/0.375g tazobactam) every 6 hours by IV infusion for 7-10 days.
Contraindications ○ Contraindicated in patients hypersensitive to drug, other penicillins, cephalosporins, or betalactamase inhibitors.
○ Drug can cause CDAD. Consider possibility of CDAD in all patients who present with diarrhea
after antibiotic use.
○ Use cautiously in patients with bleeding tendencies, uremia, hypokalemia, and allergies to other
drugs.
Side Effects - abdominal pain, agitation, anxiety, chest pain, constipation, diarrhea, dizziness, dyspepsia,
dyspnea, fever, headache, insomnia, nausea, pruritus, tachycardia, vomiting.
Nursing Considerations ○ Contraindicated in patients hypersensitive to drug, other penicillins, cephalosporins, or betalactamase inhibitors.
○ Drug can cause CDAD. Consider possibility of CDAD in all patients who present with diarrhea
after antibiotic use.
○ Use cautiously in patients with bleeding tendencies, uremia, hypokalemia, and allergies to other
drugs.
Adverse Effects ○ CNS: headache, insomnia, fever, seizures, agitation, anxiety, dizziness, pain.
○ CV: arrhythmia, chest pain, edema, HTN, tachycardia.
○ EENT: rhinitis.
○ GI: diarrhea, constipation, nausea, pseudomembranous colitis, abdominal pain, dyspepsia, stool
changes, vomiting, oral candidiasis.
○ GU: candidiasis, interstitial nephritis.
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Hematologic: leukopenia, neutropenia, thrombocytopenia, anemia, eosinophilia.
Respiratory: dyspnea.
Skin: pruritus, rash.
Other: anaphylaxis, hypersensitivity reactions, inflammation, phlebitis at IV site.
Vancomycin
Generic Name - Vancomycin Hydrochloride
Brand Name - Vancocin, Firvanq
Classification ○ Therapeutic - Antibiotics
○ Pharmacologic Class - Glycopeptides
Indication ○ Serious or severe infections when other antibiotics are ineffective or contraindicated.
○ CDAD
○ Staphylococcal enterocolitis.
Action - Hinders bacterial cell-wall synthesis, damaging the bacterial plasma membrane and making the
cell more vulnerable to osmotic pressure. Also interferes with RNA synthesis.
Route - IV or PO
Dosage Range ○ 500 mg IV every 6 hours or 1 g IV every 12 hours.
○ 125 mg PO every 6 hours for 10 days.
○ 500 mg to 2 g PO in three or four divided doses daily for 7 to 10 days.
Contraindications ○ Contraindicated in patients hypersensitive to drug or its components.
○ Use cautiously in patients receiving other neurotoxic, nephrotoxic, or ototoxic drugs; in patients
older than age 60; and in those with impaired hepatic or renal function, hearing loss, or allergies to
other antibiotics.
Side Effects - abdominal pain, chills, diarrhea, dyspnea, erythema, fatigue, fever, flatulence, headache,
hearing loss, nausea, oliguria, pruritus, tinnitus, urticaria, vomiting, wheezing.
Nursing Considerations ○ Obtain hearing evaluation before and during prolonged therapy.
○ Monitor patient’s fluid balance and watch for oliguria and cloudy urine.
○ Monitor patient carefully for red-man syndrome, which can occur if drug is infused too rapidly.
Signs and symptoms include maculopapular rash on face, neck, trunk, and limbs and pruritus and
hypotension caused by histamine release. If wheezing, urticaria, or pain and muscle spasm of the
chest and back occur, stop infusion and notify prescriber.
○ Don’t give drug IM.
○ Assess renal function (BUN, creatinine level and CrCl, urinalysis, and urine output) before and
during therapy.
○ Carefully monitor serum concentrations of vancomycin to adjust IV dosage requirements.
○ Monitor patient for signs and symptoms of superinfection. CDAD can occur up to 2 months after
therapy ends.
Adverse Effects ○ CNS: fever, pain, headache, fatigue.
○ CV: hypotension, thrombophlebitis at injection site.
○ EENT: ototoxicity, tinnitus.
○ GI: pseudomembranous colitis, nausea, abdominal pain, vomiting, diarrhea, flatulence.
○ GU: nephrotoxicity.
○ Hematologic: leukopenia, neutropenia, eosinophilia.
○ Metabolic: hypokalemia (PO).
○ Respiratory: dyspnea, wheezing.
○ Skin: red-man syndrome (with rapid IV infusion).
○ Other: anaphylaxis, chills, superinfection.
Cefepime
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Generic Name - Cefepime Hydrochloride
Brand Name - Maxipime
Classification ○ Therapeutic - Antibiotics
○ Pharmacologic - 4th Generation Cephalosporins
Indication
○ UTI
○ Pneumonia
○ Skin infection
○ Complicated intra abdominal infection
Action - Inhibits bacterial cell-wall synthesis, promotes osmotic instability, and destroys bacteria.
Route - IV or IM
Dosage Range
○ 0.5 to 1 g IM or IV over 30 minutes every 12 hours for 7 to 10 days. Use IM only for E. coli
infection when IM route is considered more appropriate route of administration.
○ 2 g IV over 30 minutes every 12 hours for 10 days.
Contraindications ○ Contraindicated in patients hypersensitive to drug, cephalosporins, beta-lactam antibiotics, or
penicillins.
○ Drug may increase risk of nonconvulsive status epilepticus (altered mental status, confusion,
decreased responsiveness), especially in patients with renal impairment. To decrease risk, follow
dosage adjustment guidelines for patients with CrCl of 60 mL/minute or less. Discontinue drug in
patients with seizures associated with drug.
○ Use cautiously in patients with history of colitis or renal insufficiency.
Side Effects - Chills, confusion, diarrhea, fever, headache, myoclonus, nausea, pruritus, vomiting
Nursing Considerations ○ Monitor patient for superinfection, including CDAD and pseudomembranous colitis, which can
occur more than 2 months after final dose. Drug may cause overgrowth of nonsusceptible bacteria
or fungi.
○ Drug may alter PT and increase bleeding risk. Patients at risk include those with renal or hepatic
impairment or poor nutrition and those receiving prolonged therapy. Monitor PT and INR in these
patients. Give vitamin K, as indicated.
Adverse Effects
○ CNS: fever, headache.
○ CV: phlebitis.
○ GI: diarrhea, nausea, vomiting.
○ Skin: rash, pruritus.
○ Other: anaphylaxis, pain, inflammation, hypersensitivity reactions.
WEEK 4 - Anti Anginal
Nitrate - Isosorbide Mononitrate
● Generic Name - Isosorbide Mononitrate
● Brand Name - Imdur
● Classification ○ Therapeutic - Antianginals
○ Pharmacologic - Nitrates
● Indication ○ Treatment and prevention of angina pectoris
● Action - Thought to reduce cardiac oxygen demand by decreasing preload and afterload. Drug also may
increase blood flow through the collateral coronary vessels.
● Route - PO (regular or XR)
● Dosage Range ○ For immediate release, 5 to 20 mg PO b.i.d., with the two doses given 7 hours apart.
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○ For extended-release, 30 to 60 mg PO daily; titrate every 3 days to 120 mg PO daily.
○ Rarely, 240 mg may be required.
Contraindications ○ Contraindicated in patients with hypersensitivity or idiosyncrasy to nitrates and in those with
severe hypotension, increased ICP, shock, or acute MI with low left ventricular filling pressure.
○ Methemoglobinemia can occur with drug use.
○ Use cautiously in patients with blood volume depletion (such as from diuretic therapy), mild
hypotension, or suspected right ventricular infarction.
Side Effects - bradycardia, confusion, diaphoresis, diarrhea, dizziness, dyspnea, fever, headache, nausea,
orthostatic hypotension, palpitations, paralysis, syncope, tachycardia, vertigo, vomiting.
Nursing Considerations ○ To prevent tolerance, a nitrate-free interval of 10 to 14 hours per day is recommended. The
regimen for isosorbide mononitrate (1 tablet on awakening with the second dose in 7 hours, or 1
extended-release tablet daily) is intended to minimize nitrate tolerance by providing a substantial
nitrate-free interval.
○ Monitor BP, HR, and intensity and duration of drug response.
○ Drug may cause headaches, especially at beginning of therapy. Dosage may be reduced
temporarily, but tolerance usually develops. Treat headache with aspirin or acetaminophen.
○ Monitor patient for methemoglobinemia, which has occurred with nitrate use. Signs and
symptoms are those of impaired oxygen delivery despite adequate cardiac output and adequate
arterial partial pressure of oxygen.
Adverse Effects ○ CNS: headache, dizziness, weakness.
○ CV: orthostatic hypotension, tachycardia, palpitations, ankle edema, flushing, fainting.
○ EENT: sublingual burning.
○ GI: nausea, vomiting.
○ Skin: cutaneous vasodilation, rash.
Beta Adrenergic Blockers - Metoprolol Tartrate
● Generic Name - Metoprolol Tartrate
● Brand Name - Lopressor
● Classification ○ Therapeutic - Antihypertensive
○ Pharmacologic - Selective beta-adrenergic blockers
● Indication ○ Hypertension
○ Early intervention in acute MI
○ Angina pectoris
● Action - A selective beta blocker that selectively blocks beta 1 receptors; decreases cardiac output,
peripheral resistance, and cardiac oxygen consumption; it depresses renin secretion.
● Route - PO, PO XR, IV
● Dosage Range ○ HTN - Initially, 50 mg PO b.i.d. or 100 mg PO once daily; then up to 100 to 400 mg daily in two
or three divided doses. Or, 25 to 100 mg extended-release tablets (tartrate equivalent) PO once
daily. Adjust dosage as needed and tolerated at intervals of not less than 1 week to maximum of
400 mg (extended-release) daily or 450 mg (immediate-release) daily.
● Contraindications ○ Contraindicated in patients hypersensitive to drug or other beta blockers.
○ Contraindicated in patients with sinus bradycardia, greater than first-degree heart block,
cardiogenic shock, sick sinus syndrome (unless a permanent pacemaker is in place), or overt
cardiac failure when used to treat HTN or angina. When used to treat MI, drug is contraindicated
in patients with HR less than 45 beats/minute, greater than first-degree heart block, PR interval of
0.24 second or longer with first-degree heart block, systolic BP less than 100 mm Hg, or moderate
to severe cardiac failure.
○ Use cautiously in patients with HF, diabetes, or respiratory or hepatic disease.
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Avoid initiating high-dose, extended-release drug in patients undergoing noncardiac surgery
because drug has been associated with bradycardia, hypotension, stroke, and death.
○ Don’t routinely withdraw long-term beta-blocker therapy before surgery.
Side Effects - bradycardia, confusion, constipation, depression, diarrhea, dizziness, dyspnea, erectile
dysfunction, fatigue, flatulence, headache, insomnia, nausea, palpitations, pruritus, tachycardia, tinnitus,
vertigo, vomiting, wheezing.
Nursing Considerations ○ Always check patient’s apical pulse rate before giving drug. If it’s slower than 60 beats/minute,
withhold drug and contact prescriber immediately to verify dose.
○ In diabetic patients, monitor glucose level closely because drug masks common signs and
symptoms of hypoglycemia.
○ Monitor BP frequently; drug masks common signs and symptoms of shock.
○ Beta blockers may mask tachycardia caused by hyperthyroidism. In patients with suspected
thyrotoxicosis, taper off beta blocker to avoid thyroid storm.
Adverse Effects ○ CNS: fatigue, dizziness, depression, headache, insomnia, mental confusion, nightmares, shortterm memory loss, hallucinations, vertigo.
○ CV: hypotension, bradycardia, HF, edema, palpitations, stroke.
○ EENT: blurred vision, tinnitus, rhinitis.
○ GI: nausea, diarrhea, constipation, heartburn, dry mouth, flatulence, gastric pain, vomiting.
○ GU: decreased libido, erectile dysfunction.
○ Musculoskeletal: pain.
○ Respiratory: dyspnea, wheezing, bronchospasm.
○ Skin: rash, pruritus.
Calcium Channel Blockers - Amlodipine
● Generic Name - Amlodipine Besylate
● Brand Name - Norvasc
● Classification ○ Therapeutic - Antihypertensive
○ Pharmacologic - Calcium Channel Blockers
● Indication ○ Hypertension
○ Chronic stable angina, vasospastic angina.
● Action - Inhibits calcium ion influx across cardiac and smooth muscle cells, dilates coronary arteries and
arterioles, and decreased BP and myocardial oxygen demand.
● Route - PO
● Dosage Range ○ Initially, 5 mg PO daily. Dosage adjusted according to patient response and tolerance. Titration
should occur over 7 to 14 days. Maximum daily dose is 10 mg.
○ Initially, 5 to 10 mg PO daily. Most patients need 10 mg daily.
● Contraindications ○ Contraindicated in patients hypersensitive to drug.
○ Use cautiously in patients receiving other peripheral vasodilators, especially those with severe
aortic stenosis or hypertrophic cardiomyopathy with outflow tract obstruction, and in patients with
HF with reduced LVEF. Because drug is metabolized by the liver, use cautiously and in reduced
dosage in patients with severe hepatic disease.
● Side Effects - abdominal pain, chest pain, dizziness, dyspnea, fatigue, headache, nausea, palpitations,
pruritus, tachycardia.
● Nursing Considerations ○ Monitor patient carefully. Some patients, especially those with severe obstructive CAD, have
developed increased frequency, duration, or severity of angina or acute MI after initiation of
calcium channel blocker therapy or at time of dosage increase.
○ Monitor BP frequently during initiation of therapy. Because drug-induced vasodilation has a
gradual onset, acute hypotension is rare.
○ Notify prescriber if signs of HF occur, such as swelling of hands and feet or shortness of breath.
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Adverse Effects ○ CNS: headache, somnolence, fatigue, dizziness.
○ CV: edema, flushing, palpitations.
○ GI: nausea, abdominal pain.
○ Respiratory: pulmonary edema, dyspnea.
○ Skin: pruritus, rash.
Calcium Channel Blockers - Diltiazem Hydrochloride
● Generic Name - Diltiazem Hydrochloride
● Brand Name - Cardizem
● Classification ○ Therapeutic - Antihypertensive
○ Pharmacologic - Calcium Channel Blockers
● Indication ○ To manage prinzmetal or variant angina or chronic stable angina pectoris
○ Hypertension - alone or as combination therapy.
● Action - Inhibits calcium ion influx across cardiac and smooth-muscle cells, decreasing myocardial
contractility and oxygen demand. Drug also dilates coronary arteries and arterioles.
● Route - PO or IV
● Dosage Range ○ Initially 180 to 240 mg extended-release capsules PO once daily. Adjust dosage based on patient
response to a maximum dose of 480 mg/day (Cardizem CD, Cartia XT). Or, 120 to 240 mg
extended-release capsules PO once daily. Adjust dosage based on patient response to a maximum
dose of 540 mg/day (Tiazac, Taztia XT). Or, 180 to 240 mg extended-release tablet PO once daily.
Dosage can be adjusted approximately every 14 days to a maximum of 540 mg daily.
● Contraindications ○ Contraindicated in patients hypersensitive to drug and in those with sick sinus syndrome or
second- or third-degree AV block in the absence of an artificial pacemaker, hypotension (systolic
less than 90 mm Hg), acute MI, and pulmonary congestion.
○ Additional contraindications for IV form include patients who have atrial fibrillation or flutter
with an accessory bypass tract, as in Wolff-Parkinson-White syndrome or short PR interval
syndrome, cardiogenic shock, and ventricular tachycardia, and within a few hours of IV betablocker therapy.
○ Use cautiously in elderly patients and in those with HF, hypertrophic obstructive cardiomyopathy,
or impaired hepatic or renal function.
● Side Effects - bradycardia, constipation, depression, dizziness, headache, nausea, tachycardia.
● Nursing Considerations ○ Patients controlled on drug alone or with other drugs may be switched to Cardizem LA tablets
once a day at the nearest equivalent total daily dose.
○ Monitor BP and HR when starting therapy and during dosage adjustments.
○ Maximal antihypertensive effect may not be seen for 14 days.
○ If systolic BP is below 90 mm Hg or HR is below 60 beats/minute, withhold dose and notify
prescriber.
● Adverse Effects ○ CNS: headache, dizziness, asthenia, somnolence.
○ CV: edema, arrhythmias, AV block, bradycardia, HF, flushing, hypotension, conduction
abnormalities, abnormal ECG.
○ GI: nausea, constipation, abdominal discomfort.
○ Hepatic: acute hepatic injury.
○ Skin: rash.
Week 5 - Antihypertensives
Alpha Adrenergic Blocker - Minipress
● Generic Name - Minipress Hydrochloride
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Brand Name - Prazosin
Classification ○ Therapeutic - Antihypertensives
○ Pharmacologic - Alpha Blockers
Indication ○ Mild to moderate hypertension.
Action - Unknown. Thought to act by blocking alpha-adrenergic receptors.
Route - PO
Dosage Range
○ Initially, 1 mg PO b.i.d. or t.i.d. Dosage may be increased slowly. Maximum daily dose is 20 mg.
Maintenance dosage is 6 to 15 mg daily in divided doses. Some patients need larger dosages (up to
40 mg daily in divided doses).
○ If other antihypertensives or diuretics are added to therapy, decrease prazosin dosage to 1 to 2 mg
t.i.d. and retitrate to maintenance dosage.
Contraindications ○ Contraindicated in patients hypersensitive to drug or its components, quinazolines, or other alpha
blockers.
○ Use cautiously in patients receiving other antihypertensives.
○ Not approved for use in children.
Side Effects - constipation, depression, diarrhea, dizziness, dyspnea, epistaxis, headache, nausea,
orthostatic hypotension, palpitations, paresthesia, priapism, syncope, urinary frequency, vertigo, vomiting.
Nursing Considerations ○ Monitor patient’s BP and pulse rate frequently.
○ Elderly patients may be more sensitive to drug’s hypotensive effects.
○ Adherence might be improved with twice-daily dosing. Discuss dosing change with prescriber if
compliance problems are suspected.
Adverse Effects ○ CNS: dizziness, first-dose syncope, headache, drowsiness, nervousness, paresthesia, weakness,
depression, vertigo, lack of energy.
○ CV: orthostatic hypotension, palpitations, edema.
○ EENT: blurred vision, conjunctivitis, epistaxis, nasal congestion.
○ GI: vomiting, diarrhea, abdominal cramps, nausea, constipation.
○ GU: urinary frequency.
○ Musculoskeletal: arthralgia, myalgia.
○ Respiratory: dyspnea.
○ Skin: rash.
Angiotensin Converting Enzyme Inhibitors - Lisinopril
● Generic Name - Lisinopril
● Brand Name - Zestril
● Classification ○ Therapeutic - Antihypertensive
○ Pharmacologic - ACE Inhibitors
● Indication ○ Hypertension
○ Adjunctive treatment for HF
○ Hemodynamically stable patients within 24 hours of acute MI to improve survival.
● Action - Causes decreased production of angiotensin II and suppression of the RAAS.
● Route - PO
● Dosage Range
○ Initially, 10 mg PO daily for patients not taking a diuretic. Most patients are well controlled on 20
to 40 mg daily as a single dose. For patients taking a diuretic, initially, 5 mg PO daily.
● Contraindications ○ Contraindicated in patients hypersensitive to ACE inhibitors and in those with a history of
angioedema related to previous treatment with ACE inhibitor.
○ Use cautiously in patients with impaired renal function; adjust dosage.
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Use cautiously in patients at risk for hyperkalemia or hypotension and in those with aortic stenosis
or hypertrophic cardiomyopathy. The safety and effectiveness of lisinopril on BP control in
children younger than age 6 or in children with GFR less than 30 mL/minute hasn’t been
established.
Side Effects - abdominal pain, alopecia, chest pain, constipation, diarrhea, dizziness, dyspepsia, dyspnea,
fatigue, fever, flatulence, headache, nausea, orthostatic hypotension, paresthesia, pruritus, syncope,
urticaria, vertigo.
Nursing Considerations ○ When using drug in acute MI, give patient the appropriate and standard recommended treatment,
such as thrombolytics, aspirin, and beta blockers.
○ Although ACE inhibitors reduce BP in all races, BP reduction is less in Blacks taking an ACE
inhibitor alone. Black patients should take drug with a thiazide diuretic for a more favorable
response.
○ Monitor BP frequently. If drug doesn’t adequately control BP, diuretics may be added.
○ Monitor WBC with differential counts before therapy, every 2 weeks for first 3 months of therapy,
and periodically thereafter.
○ Monitor serum potassium level periodically.
Adverse Effects ○ CNS: dizziness, headache, fatigue, paresthesia, syncope, vertigo.
○ CV: orthostatic hypotension, hypotension, chest pain.
○ EENT: nasal congestion.
○ GI: diarrhea, constipation, flatulence, nausea, dyspepsia.
○ GU: impaired renal function, impotence.
○ Metabolic: hyperkalemia.
○ Respiratory: dyspnea; dry, persistent, tickling, nonproductive cough.
○ Skin: rash, alopecia, pruritus, photosensitivity, SJS, urticaria.
○ Other: angioedema.
Beta Adrenergic Blockers - Atenolol
● Generic Name - Atenolol
● Brand Name - Tenormin
● Classification ○ Therapeutic - Antihypertensives
○ Pharmacologic - Beta Blockers
● Indication ○ Hypertension
○ Angina Pectoris
○ Acute MI
● Action - Selectively blocks beta1-adrenergic receptors, decreases cardiac output and cardiac oxygen
consumption, and depresses renin secretion.
● Route - PO
● Dosage Range ○ Initially, 50 mg PO daily alone or in combination with a diuretic as a single dose, increased to 100
mg once daily after 7 to 14 days. Dosages of more than 100 mg daily are unlikely to produce
further benefit.
● Contraindications ○ Contraindicated in patients hypersensitive to drug or its components.
○ Contraindicated in patients with sinus bradycardia, heart block greater than first degree, overt
cardiac failure, untreated pheochromocytoma, and cardiogenic shock.
○ Contraindicated in patients with acute MI and HF who don’t promptly respond to IV furosemide
or equivalent therapy.
○ Use cautiously in patients at risk for HF and in those with diabetes, hyperthyroidism, and impaired
renal or hepatic function.
○ Beta blockers shouldn’t be routinely used in patients with bronchospastic disease. Atenolol may
be used cautiously in patients who don’t respond to or can’t tolerate other antihypertensive
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treatment. Use lowest possible dosage and have bronchodilator available. Consider divided doses
if atenolol dosage must be increased.
○ Safe use in children hasn’t been established.
Side Effects - Bradycardia, depression, diarrhea, dizziness, dyspnea, fatigue, fever, intermittent
claudication, nausea, orthostatic hypotension, tachycardia, vertigo, wheezing.
Nursing Considerations ○ Monitor BP, preferably just before next dose, to evaluate effectiveness.
○ Monitor hemodialysis patients closely because of hypotension risk.
○ Beta blockers may mask tachycardia caused by hyperthyroidism. In patients with suspected
thyrotoxicosis, withdraw beta blocker gradually to avoid thyroid storm.
○ Drug may mask signs and symptoms of hypoglycemia in diabetic patients.
○ Drug may cause changes in exercise tolerance and ECG.
○ Monitor patient for cardiac failure. Discontinue drug in patients who develop cardiac failure that
doesn’t respond to standard treatment.
Adverse Effects ○ CNS: depression, dizziness, fatigue, lethargy, vertigo, drowsiness, fever, light-headedness.
○ CV: orthostatic hypotension, bradycardia, HF, heart block, intermittent claudication, atrial
fibrillation, supraventricular tachycardia, cardiac arrest, ventricular tachycardia.
○ GI: nausea, diarrhea.
○ Musculoskeletal: limb pain.
○ Respiratory: bronchospasm, dyspnea, PE, wheezing.
○ Skin: rash.
Angiotensin II Receptor Blockers - Losartan Potassium
● Generic Name - Losartan Potassium
● Brand Name - Cozaar
● Classification ○ Therapeutic - Antihypertensives
○ Pharmacologic - ARB’s
● Indication ○ Hypertension
○ Nephropathy in patients with type 2 diabetes.
○ To reduce risk of stroke in patients with HTN and left ventricular hypertophy.
● Action - Inhibits vasoconstrictive and aldosterone-secreting action of angiotensin II by blocking
angiotensin II receptor on the surface of vascular smooth muscle and other tissue cells.
● Route - PO
● Dosage Range ○ Initially, 50 mg PO daily. Maximum daily dose is 100 mg.
● Contraindications ○ Contraindicated in patients hypersensitive to drug.
○ Use cautiously in patients with impaired renal or hepatic function.
● Side Effects - Abdominal pain, back pain, bradycardia, chest pain, diarrhea, dizziness, dyspepsia, fatigue,
fever, headache, insomnia, leg pain, muscle weakness, nausea, orthostatic hypotension, tachycardia.
● Nursing Considerations ○ Drug can be used alone or with other antihypertensives.
○ Monitor patient’s BP closely to evaluate effectiveness of therapy. When used alone, drug has less
of an effect on BP in black patients than in patients of other races.
○ Monitor patients who are also taking diuretics for symptomatic hypotension.
○ Regularly assess patient’s renal function (via creatinine and BUN levels).
○ Patients with severe HF whose renal function depends on the angiotensin-aldosterone system may
develop acute renal failure during therapy. Closely monitor patient’s BP, renal function, and
potassium levels, especially during first few weeks of therapy and after dosage adjustments.
● Adverse Effects ○ CNS: dizziness, asthenia, fatigue, headache, insomnia.
○ CV: edema, chest pain.
○ EENT: nasal congestion, sinusitis, pharyngitis, sinus disorder.
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GI: abdominal pain, nausea, diarrhea, dyspepsia.
Musculoskeletal: muscle cramps, myalgia, back or leg pain.
Respiratory: cough, URI.
Other: angioedema.
Calcium Channel Blockers - Clonidine HCL
● Generic Name - Clonidine Hydrochloride
● Brand Name - Catapres
● Classification ○ Therapeutic - Antihypertensives
○ Pharmacologic - Centrally Acting Alpha Agonists
● Indication ○ Essential and rental hypertension
○ Severe cancer pain that is unresponsive to epidural or spinal opiate.
○ ADHD as monotherapy or as adjunctive therapy to stimulants.
● Action - Unknown. Thought to stimulate alpha2 receptors and inhibit the central vasomotor centers,
decreasing sympathetic outflow to the heart, kidneys, and peripheral vasculature and lowering peripheral
vascular resistance, BP, and HR.
● Route - PO, Transdermal, Epidural
● Dosage Range ○ Initially, 0.1 mg PO b.i.d.; then increased by 0.1 mg daily on a weekly basis. Usual range is 0.2 to
0.6 mg daily in divided doses; infrequently, dosages as high as 2.4 mg daily are used.
○ Or, apply transdermal patch once every 7 days, starting with 0.1-mg system and adjusted with
another 0.1-mg or larger system after 1 or 2 weeks if desired BP reduction isn’t achieved. Don’t
exceed concurrent use of two clonidine 0.3-mg transdermal systems.
● Contraindications ○ Contraindicated in patients hypersensitive to drug.
○ Transdermal form is contraindicated in patients hypersensitive to any component of the adhesive
layer of transdermal system.
○ Epidural form is contraindicated in patients receiving anticoagulant therapy, in those with bleeding
diathesis, in those with an injection-site infection, and in those who are hemodynamically unstable
or have severe CV disease.
○ Use cautiously in patients with severe coronary insufficiency, conduction disturbances, recent MI,
cerebrovascular disease, chronic renal failure, or impaired liver function.
○ Safety and effectiveness in children for essential and renal HTN haven’t been established in
adequate and well-controlled trials.
● Side Effects - agitation, analgesia, anorexia, apnea, bradycardia, constipation, depression, dizziness, erectile
dysfunction, fatigue, headache, miosis, nausea, orthostatic hypotension, pruritus, vomiting.
● Nursing Considerations ○ Drug may be given to lower BP rapidly in some hypertensive emergencies.
○ Monitor BP and pulse rate frequently. Dosage is usually adjusted to patient’s BP and tolerance.
○ Elderly patients may be more sensitive than younger ones to drug’s hypotensive effects.
○ Observe patient for tolerance to drug’s therapeutic effects, which may require increased dosage.
○ Noticeable antihypertensive effects of transdermal clonidine may take 2 to 3 days. Oral
antihypertensive therapy may have to be continued in the interim; wean patient from oral dose in
the 2 to 3 days after first patch is applied.
○ Remove transdermal patch before defibrillation or cardioversion to prevent arcing.
○ Stop drug gradually by reducing dosage over 2 to 4 days to avoid rapid rebound in BP, agitation,
headache, and tremor. When stopping therapy in patients receiving both clonidine and a beta
blocker, gradually withdraw the beta blocker several days before gradually stopping clonidine to
minimize adverse reactions.
○ Don’t stop drug before surgery.
○ When drug is given epidurally, carefully monitor infusion pump, and inspect catheter tubing for
obstruction or dislodgment.
● Adverse Effects ○ CNS: drowsiness, dizziness, sedation, weakness, fatigue, malaise, agitation, depression.
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CV: bradycardia, severe rebound HTN, orthostatic hypotension.
GI: constipation, dry mouth, nausea, vomiting, anorexia.
GU: urine retention, erectile dysfunction.
Metabolic: weight gain.
Skin: pruritus, dermatitis with transdermal patch, rash.
Other: loss of libido.
Vasodilators - Hydralazine
● Generic Name - Hydralazine Hydrochloride
● Brand Name - Apresoline
● Classification ○ Therapeutic - Antihypertensive
○ Pharmacologic - Peripheral Vasodilators
● Indication ○ Hypertension
○ Hypertensive Emergency
○ HF with reduced affection fraction
● Action - Not fully understood. A direct-acting peripheral vasodilator that relaxes arteriolar smooth muscle.
● Route - PO, IV, IM
● Dosage Range ○ Initially, 10 mg PO q.i.d. for first 2 to 4 days, then 25 mg q.i.d. for balance of first week; 50 mg
q.i.d. from second week on, based on patient tolerance and response. Maximum dose, 300 mg/day.
● Contraindications ○ Contraindicated in patients hypersensitive to drug.
○ Drug may contain tartrazine and cause allergic reactions, especially in patients hypersensitive to
aspirin.
○ Drug may produce a clinical picture consistent with SLE.
○ Contraindicated in those with CAD or mitral valvular rheumatic heart disease.
○ Use cautiously in patients with suspected cardiac disease, stroke, or severe renal impairment and
in those taking other antihypertensives.
○ May cause blood dyscrasias. Discontinue drug if they occur.
● Side Effects - Anorexia, anxiety, chest pain, chills, constipation, depression, diaphoresis, diarrhea,
dizziness, dyspnea, fever, headache, nausea, orthostatic hypotension, palpitations, pruritus, purpura,
tachycardia, urticaria, vomiting.
● Nursing Considerations ○ Monitor patient’s BP standing and sitting/supine, HR, and body weight frequently. Drug may be
given with diuretics and beta blockers to decrease sodium retention and tachycardia and to prevent
angina attacks.
○ Elderly patients may be more sensitive to drug’s hypotensive effects.
○ Obtain CBC, lupus erythematosus cell preparation, and ANA titer determination before therapy
and periodically during long-term therapy.
● Adverse Effects ○ CNS: anxiety, headache, depression, dizziness, peripheral neuritis, increased ICP, psychosis.
○ CV: angina pectoris, palpitations, tachycardia, orthostatic hypotension, edema, flushing, shock.
○ EENT: conjunctivitis, nasal congestion.
○ GI: nausea, vomiting, diarrhea, anorexia, constipation, paralytic ileus.
○ GU: difficult urination.
○ Hematologic: anemia, neutropenia, leukopenia, agranulocytosis, eosinophilia, thrombocytopenia
with or without purpura.
○ Musculoskeletal: muscle cramps, arthralgia.
○ Respiratory: dyspnea.
○ Skin: diaphoresis, pruritus, urticaria, rash.
○ Other: hypersensitivity reactions, chills.
Week 6 - Laxatives
Magnesium Hydroxide
● Generic Name - Magnesium Hydroxide
● Brand Name - Milk of Mag
● Classification ○ Therapeutic - Laxatives
○ Pharmacologic - Magnesium Salts
● Indication ○ Constipation; to evacuate bowels before surgery
● Action - Saline laxative that produces an osmotic effect in the small intestine by drawing water into the
intestinal lumen.
● Route - PO
● Dosage Range ○ 8.75 to 25 g or 6.5 to 10 oz magnesium citrate PO daily as a single or divided dose (patient should
drink 8 oz of liquid with each dose). Or, 2.4 to 4.8 g or 30 to 60 mL magnesium hydroxide PO (2
to 4 tablespoons at bedtime or upon arising, followed by 8 oz of liquid) daily as a single dose or
divided. Or, 10 to 30 g (2 to 6 level tsp) magnesium sulfate PO daily as a single or divided dose.
● Contraindications ○ Contraindicated in patients with myocardial damage, heart block, fecal impaction, rectal fissures,
intestinal obstruction or perforation, renal disease, or signs and symptoms of appendicitis or acute
surgical abdomen, such as abdominal pain, nausea, or vomiting.
○ Use cautiously in patients with rectal bleeding.
● Side Effects - Abdominal pain, bradycardia, constipation, diarrhea, dizziness, dyspnea, nausea, syncope,
vomiting.
● Nursing Considerations ○ Before giving drug for constipation, determine whether patient has adequate fluid intake, exercise,
and diet.
○ Monitor electrolyte levels during prolonged use. Magnesium may accumulate if patient has renal
insufficiency.
○ Use cautiously in patients with sodium restrictions because drug contains sodium.
○ Drug is recommended for short-term use only.
○ Magnesium sulfate is more potent than other saline laxatives.
● Adverse Effects ○ GI: abdominal cramping, diarrhea, nausea.
○ Metabolic: fluid and electrolyte disturbances with daily use.
○ Other: laxative dependence with long-term or excessive use.
Bisacodyl
● Generic Name - Bisacodyl
● Brand Name - Dulcolax
● Classification ○ Therapeutic - Laxatives
○ Pharmacologic - Diphenylmethane Derivatives
● Indication ○ Constipation, prepping for surgery or rectal/bowel exam.
● Action - Stimulant laxative that increases peristalsis, probably by direct effect on smooth muscle of the
intestine, by irritating the muscle or stimulating the colonic intramural plexus. Drug also promotes fluid
accumulation in colon and small intestine.
● Route - PO/PR
● Dosage Range ○ 5 to 15 mg PO in evening or before breakfast. Or, 10 mg PR for evacuation before exam or
surgery. Enema may be given as a single daily dose.
● Contraindications -
○
●
●
●
Contraindicated in patients hypersensitive to drug or its components and in those with rectal
bleeding, gastroenteritis, intestinal obstruction, abdominal pain, nausea, vomiting, or other
symptoms of appendicitis or acute surgical abdomen.
Side Effects - abdominal pain, constipation, diarrhea, dizziness, dyspepsia, muscle weakness, nausea,
vomiting.
Nursing Considerations ○ Give drug at times that don’t interfere with scheduled activities or sleep. Soft, formed stools are
usually produced 15 to 60 minutes after rectal use or 6 to 12 hours after oral use.
○ Before giving for constipation, determine whether patient has adequate fluid intake, exercise, and
diet.
○ May use tablets and suppositories together to clean the colon before and after surgery and before
barium enema.
Adverse Effects ○ CNS: dizziness, faintness, muscle weakness with excessive use.
○ GI: abdominal cramps, burning sensation in rectum with suppositories, nausea, vomiting, diarrhea
with high doses, laxative dependence with long-term or excessive use, protein-losing enteropathy
with excessive use.
○ Metabolic: alkalosis, fluid and electrolyte imbalance, hypokalemia.
○ Musculoskeletal: tetany.
Week 8 - Anti-Anxiety
Alprazolam
● Generic Name - Alprazolam
● Brand Name - Xanax
● Classification ○ Therapeutic - Anxiolytics
○ Pharmacologic - Benzodiazepines
● Indication ○ Anxiety
○ Panic Disorders
● Action - Unknown. Probably potentiates the effects of GABA, depresses the CNS, and suppresses the
spread of seizure activity.
● Route - PO/PO XR
● Dosage Range ○ Usual first dose, 0.25 to 0.5 mg (immediate-release) PO t.i.d. Maximum, 4 mg daily in divided
doses.
○ 0.5 mg PO t.i.d., increased at intervals of 3 to 4 days in increments of no more than 1 mg/day.
Maximum, 10 mg daily in divided doses. For extended-release tablets, start with 0.5 to 1 mg PO
once daily. Increase by no more than 1 mg/day every 3 to 4 days. Maximum daily dose, 10 mg.
● Contraindications
○ Contraindicated in patients hypersensitive to drug or other benzodiazepines and in those with
acute angle-closure glaucoma.
○ Opioids should only be prescribed with benzodiazepines or other CNS depressants to patients for
whom alternative treatment options are inadequate.
○ Use cautiously in patients with hepatic, renal, or pulmonary disease or history of substance abuse.
○ Use cautiously in elderly patients.
● Side Effects - abdominal pain, agitation, anorexia, anxiety, ataxia, back pain, chest pain, confusion,
constipation, depression, diarrhea, dizziness, dysmenorrhea, dyspepsia, dyspnea, fatigue, headache,
insomnia, leg pain, nausea, palpitations, paresthesia, pruritus, syncope, tinnitus, vertigo, vomiting.
● Nursing Considerations ○ Contraindicated in patients hypersensitive to drug or other benzodiazepines and in those with
acute angle-closure glaucoma.
○
●
Opioids should only be prescribed with benzodiazepines or other CNS depressants to patients for
whom alternative treatment options are inadequate.
○ Use cautiously in patients with hepatic, renal, or pulmonary disease or history of substance abuse.
○ Use cautiously in elderly patients.
○ Monitor hepatic, renal, and hematopoietic function periodically in patients receiving repeated or
prolonged therapy.
○ Closely monitor addiction-prone patients.
○ Consider giving same total daily dose of immediate-release formulation in divided doses more
frequently in patients being treated for panic disorder who experience early-morning anxiety or
anxiety symptoms between doses.
Adverse Effects ○ CNS: insomnia, irritability, dizziness, headache, anxiety, confusion, drowsiness, light-headedness,
sedation, somnolence, difficulty speaking, impaired coordination, memory impairment, fatigue,
depression, suicide, mental impairment, ataxia, paresthesia, dyskinesia, hypoesthesia, lethargy,
vertigo, malaise, tremor, nervousness, restlessness, agitation, nightmare, syncope, akathisia,
mania.
○ CV: palpitations, chest pain, hypotension.
○ EENT: blurred vision, tinnitus, allergic rhinitis, nasal congestion.
○ GI: diarrhea, dry mouth, constipation, nausea, increased or decreased appetite, anorexia, vomiting,
dyspepsia, abdominal pain, increased or decreased salivation.
○ GU: dysmenorrhea, sexual dysfunction, premenstrual syndrome, difficulty urinating.
○ Metabolic: increased or decreased weight.
○ Musculoskeletal: arthralgia, myalgia, arm or leg pain, back pain, muscle rigidity, muscle cramps,
muscle twitch.
○ Respiratory: URI, dyspnea, hyperventilation.
○ Skin: pruritus, increased sweating, dermatitis.
○ Other: influenza, injury, emergence of anxiety between doses, dependence, feeling warm,
increased or decreased libido.
Diazepam
● Generic Name - Diazepam
● Brand Name - Valium
● Classification ○ Therapeutic - Anxiolytics
○ Pharmacologic - Benzodiazepines
● Indication ○ Anxiety
○ Acute alcohol withdrawal
○ Preoperative sedation
● Action - Potentiates the effects of GABA, depresses the CNS, and suppresses the spread of seizure activity.
● Route - PO, IV, IM, PR
● Dosage Range ○ Depending on severity, 2 to 10 mg PO b.i.d. to q.i.d. Or, 2 to 10 mg IM or IV. May repeat in 3 to 4
hours if needed.
○ 10 mg PO t.i.d. or q.i.d. during first 24 hours; reduce to 5 mg PO t.i.d. or q.i.d., p.r.n. Or, 10 mg IV
or IM initially; then 5 to 10 mg IV or IM again in 3 to 4 hours if needed.
○ 10 mg IM or IV before surgery.
● Contraindications ○ Opioids should only be prescribed with benzodiazepines or other CNS depressants to patients for
whom alternative treatment options are inadequate.
○ Contraindicated in patients hypersensitive to drug and in infants younger than age 6 months (oral
form).
○ Diazepam (oral form) is contraindicated in patients with myasthenia gravis, severe respiratory
insufficiency, severe hepatic insufficiency, or sleep apnea syndrome.
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Diazepam is contraindicated in patients with acute angle-closure glaucoma.
Use cautiously in patients experiencing shock, coma, or acute alcohol intoxication (parenteral
form).
○ Use cautiously in elderly and debilitated patients and in patients with hepatic or renal impairment,
depression, history of substance abuse, impaired gag reflex, or chronic open-angle glaucoma (who
are receiving appropriate therapy) and in those at risk for falls.
○ Some injectable forms may contain propylene glycol; large amounts are potentially toxic and have
been associated with hyperosmolarity, lactic acidosis, seizures, and respiratory depression.
Side Effects - amnesia, anxiety, apnea, ataxia, bradycardia, confusion, constipation, depression, diarrhea,
diplopia, dizziness, dysarthria, fatigue, headache, hiccups, insomnia, jaundice, nausea, nystagmus, vertigo
Nursing Considerations ○ Periodically monitor LFTs, CBC, and renal function in patients receiving repeated or prolonged
therapy.
○ Monitor HR, BP, and mental status changes. Patients are at an increased risk for falls.
○ Use of drug may lead to abuse and addiction. Don’t withdraw drug abruptly after long-term use
because withdrawal symptoms may occur; taper gradually.
Adverse Effects ○ CNS: drowsiness, dysarthria, slurred speech, tremor, transient amnesia, fatigue, ataxia, headache,
insomnia, paradoxical anxiety, hallucinations, minor changes in EEG patterns, pain, vertigo,
confusion, depression.
○ CV: CV collapse, bradycardia, hypotension.
○ EENT: diplopia, blurred vision, nystagmus.
○ GI: nausea, constipation, diarrhea with rectal form, dry mouth.
○ GU: incontinence, urine retention.
○ Hematologic: neutropenia.
○ Hepatic: jaundice.
○ Respiratory: respiratory depression, apnea, hiccups.
○ Skin: rash, phlebitis at injection site.
○ Other: altered libido, physical or psychological dependence.
Lorazepam
● Generic Name - Lorazepam
● Brand Name - Ativan
● Classification ○ Therapeutic - Anxiolytics
○ Pharmacologic - Benzodiazepines
● Indication ○ Anxiety
○ Preoperative Sedation
● Action - Potentiates the effects of GABA, depresses the CNS, and suppresses the spread of seizure activity.
● Route - PO, IV, IM
● Dosage Range ○ 2 to 6 mg PO daily in divided doses, with the largest dose taken before bedtime. Maximum, 10 mg
daily.
● Contraindications ○ Contraindicated in patients hypersensitive to drug, other benzodiazepines, or the vehicle
(including polyethylene glycol, propylene glycol, benzyl alcohol) used in parenteral dosage form,
and in patients with acute angle-closure glaucoma. IV administration is contraindicated in patients
with sleep apnea and in patients with severe respiratory insufficiency, except those who are
mechanically ventilated.
○ Contraindicated for intra-arterial administration.
○ Opioid class warning: Opioids should only be prescribed with benzodiazepines or other CNS
depressants to patients for whom alternative treatment options are inadequate.
○ Repeated or lengthy use of general anesthetic and sedation drugs during surgeries or procedures in
children younger than age 3 or in pregnant women during the third trimester may affect brain
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development in children. Weigh benefits of appropriate anesthesia in young children and pregnant
women against risks.
○ Use cautiously in patients with pulmonary, renal, or hepatic impairment, or history of substance
abuse.
○ Use cautiously in elderly, acutely ill, or debilitated patients.
Side Effects - agitation, amnesia, anxiety, apnea, ataxia, confusion, delirium, depression, dizziness,
headache, insomnia, nausea.
Nursing Considerations ○ Monitor hepatic, renal, and hematopoietic function periodically in patients receiving repeated or
prolonged therapy.
○ Use of this drug may lead to abuse and addiction. Don’t stop drug abruptly after long-term use
because withdrawal symptoms may occur.
Adverse Effects ○ CNS: drowsiness, sedation, amnesia, insomnia, agitation, dizziness, weakness, unsteadiness,
disorientation, depression, headache, somnolence.
○ CV: hypotension.
○ EENT: visual disturbances, nasal congestion.
○ GI: abdominal discomfort, nausea, change in appetite.
○ Respiratory: respiratory failure, respiratory depression.
○ Other: pain at injection site.
Week 9 - Opioid Analgesics
Tramadol
● Generic Name - Tramadol Hydrochloride
● Brand Name - Ultram
● Classification ○ Therapeutic - Analgesics
○ Pharmacologic - Synthetic Centrally Active Analgesics
● Indication ○ Moderate to moderately severe chronic pain.
● Action - Unknown. Thought to bind to opioid receptors and inhibit reuptake of norepinephrine
and serotonin.
●
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Route - PO, PO XR
Dosage Range ○ Initially, 25 mg (immediate-release) PO in the morning. Adjust by 25 mg every 3 days
to 100 mg/day (25 mg q.i.d.). Thereafter, adjust by 50 mg every 3 days to reach 200
mg/day (50 mg q.i.d.). Thereafter, give 50 to 100 mg PO every 4 to 6 hours p.r.n.
Maximum, 400 mg daily.
●
Contraindications -
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Contraindicated in patients hypersensitive to drug or opioids, in patients with severe
renal or hepatic impairment, suicidal patients, and in those with acute intoxication
from alcohol, hypnotics, centrally acting analgesics, opioids, or psychotropic drugs.
Contraindicated in patients with GI obstruction, including paralytic ileus.
Contraindicated with concomitant use or within 14 days of MAO inhibitor therapy.
Contraindicated in patients with significant respiratory depression or acute or severe
bronchial asthma or hypercapnia in unmonitored settings or where resuscitative
equipment isn’t available.
Contraindicated for use to treat pain in children younger than age 12 and to treat pain
in children younger than age 18 after surgery to remove tonsils or adenoids.
May cause fatal respiratory depression, especially during initiation or dosage
increase.
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The effects of concomitant use or discontinuation of CYP3A4 inducers or inhibitors,
or CYP2D6 inhibitors with tramadol are complex and require careful consideration of
the effects on parent drug, tramadol, and the active metabolite, M1.
Opioids should only be prescribed with benzodiazepines or other CNS depressants
to patients for whom alternative treatment options are inadequate.
Side Effects - abdominal pain, agitation, amenorrhea, anorexia, apnea, bradycardia, chills, confusion,
constipation, depression, diaphoresis, diarrhea, dizziness, dyspepsia, erectile dysfunction, fatigue, fever,
flatulence, headache, insomnia, miosis, muscle flaccidity, mydriasis, nausea, neck pain, paresthesia,
pruritus, rhinorrhea, urinary frequency, vertigo, vomiting.
Nursing Considerations -
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Caution patient or caregiver of patient taking an opioid with a benzodiazepine, CNS
depressant, or alcohol to seek immediate medical attention for dizziness, lightheadedness, extreme sleepiness, slowed or difficult breathing, or unresponsiveness.
Tramadol exposes patients to the risk of addiction, abuse, and misuse, which can
lead to overdose and death. Assess each patient’s risk before prescribing; monitor
patient regularly for development of abnormal behaviors.
Reassess patient’s level of pain at least 30 minutes after administration.
Monitor CV and respiratory status, especially within first 24 to 72 hours of therapy
initiation and after dosage increases; adjust dosage accordingly. Withhold dose and
notify prescriber if respirations are shallow or rate is below 12 breaths/minute.
Carefully monitor vital signs, pain level, respiratory status, and sedation level in all
patients receiving opioids, especially those receiving IV drugs, even those given
postoperatively.
Monitor bowel and bladder function. Anticipate need for stimulant laxative.
For better analgesic effect, give drug before onset of intense pain.
Monitor patients at risk for seizures. Drug may reduce seizure threshold.
In the case of an overdose, naloxone may also increase risk of seizures.
Monitor patient for drug dependence. Drug can produce dependence similar to that
of codeine and thus has potential for abuse.
Don’t stop drug abruptly; withdraw slowly and individualize the gradual tapering plan
to prevent signs and symptoms of withdrawal, worsening pain, and psychological
distress in physically dependent patients. Refer to manufacturer’s label for specific
tapering instructions.
When tapering opioids, monitor patient closely for signs and symptoms of opioid
withdrawal (restlessness, lacrimation, rhinorrhea, yawning, perspiration, chills,
myalgia, mydriasis, irritability, anxiety, insomnia, backache, joint pain, weakness,
abdominal cramps, anorexia, nausea, vomiting, diarrhea, increased BP or HR,
increased respiratory rate). Such signs and symptoms may indicate a need to taper
more slowly. Also monitor patient for suicidal thoughts, use of other substances, and
mood changes.
If patient is taking opioids with serotonergic drugs, watch for signs and symptoms of
serotonin syndrome (agitation, hallucinations, rapid HR, fever, excessive sweating,
shivering or shaking, muscle twitching or stiffness, trouble with coordination, nausea,
vomiting, diarrhea), especially when starting treatment or increasing dosages. Signs
and symptoms may occur within several hours of coadministration but may also
occur later, especially after dosage increase. Discontinue the opioid, serotonergic
drug, or both if serotonin syndrome is suspected.
Monitor patient for signs and symptoms of adrenal insufficiency (nausea, vomiting,
loss of appetite, fatigue, weakness, dizziness, low BP). Perform diagnostic testing if
adrenal insufficiency is suspected. If adrenal insufficiency is confirmed, treat with
corticosteroids and wean patient off opioids if appropriate. Discontinue
corticosteroids when clinically appropriate.
○
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Monitor patient for signs and symptoms of decreased sex hormone levels (low libido,
erectile dysfunction, amenorrhea, infertility). If signs and symptoms occur, evaluate
patient and obtain lab testing.
Adverse Effects ○ CNS: dizziness, headache, somnolence, vertigo, seizures, anxiety, asthenia, CNS
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stimulation, confusion, coordination disturbance, euphoria, malaise, nervousness,
sleep disorder, fever, paresthesia, tremor, depression, agitation, apathy.
CV: vasodilation, HTN, peripheral edema.
EENT: visual disturbances, nasopharyngitis, pharyngitis, rhinitis, sinusitis.
GI: constipation, nausea, vomiting, abdominal pain, anorexia, diarrhea, dry mouth,
dyspepsia, flatulence.
GU: menopausal symptoms, proteinuria, urinary frequency, urine retention, pelvic
pain, UTI, prostate disorder.
Metabolic: weight loss.
Musculoskeletal: hypertonia, arthralgia, neck pain, myalgia.
Respiratory: bronchitis, respiratory depression.
Skin: diaphoresis, pruritus, rash.
Other: chills, withdrawal syndrome, accidental injury.
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Generic Name
Brand Name
Classification
Indication
Action
Route
Dosage Range
Contraindications
Side Effects
Nursing Considerations
Adverse Effects
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Generic Name
Brand Name
Classification
Indication
Action
Route
Dosage Range
Contraindications
Side Effects
Nursing Considerations
Adverse Effects
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Generic Name
Brand Name
Classification
Indication
Action
Route
Dosage Range
Contraindications
Side Effects
Nursing Considerations
Adverse Effects
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Generic Name
Brand Name
Classification
Indication
Action
Route
Dosage Range
Contraindications
Side Effects
Nursing Considerations
Adverse Effects
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Generic Name
Brand Name
Classification
Indication
Action
Route
Dosage Range
Contraindications
Side Effects
Nursing Considerations
Adverse Effects
●
●
●
●
●
●
●
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Generic Name
Brand Name
Classification
Indication
Action
Route
Dosage Range
Contraindications
Side Effects
Nursing Considerations
Adverse Effects