Drug Name
Drug Class
Admin.
Side Effects
Notes (action, uses, fun
facts, cautions, extra info)
Assessment
Fatigue, headache,
prolonged QT with
high doses
PO, IM,
Drowsiness,
INTRANASA dysgeusia(intranas
L, IV
a), extrapyramidal
reactions,
restlessness
PO, IM, IV
Confusion,
disorientation,
sedation
Decreased incidence and
severity of nausea and
vomiting
Stimulates gastric emptying,
suppresses vomiting best in
cancer patients
Assess from N/V, Abd distention, and
bowel sounds prior to and after. May cause
Stevens Johnson syndrome
Tx of allergic conditions
and motion sickness. Preop
sedation, Tx and prevention
of N/V
PO, Rect. IM,
IV
Extrapyramidal
reactions, blurred
vision, dry eyes,
constipation, dry
mouth
Management of N/V,
treatment of psychoses and
anxiety.
PO, IM, IV
Dizziness,
drowsiness,
lethargy, Apnea,
cardiac arrest
Produces muscle relaxation,
has antianxiety, anti-emetic,
and anticonvulsant.
Properties
If administered IV, assess site for burning
and pain. May cause severe tissue injury.
Avoid IV administration, if possible. If pain
occurs, discontinue administration
immediately.
LABS: May cause false- positive or false
negative HCG test. May cause increase
serum glucose.
Monitor BP (sitting, standing, lying down),
ECG, HR, and resp rate before and
frequently during the period of dosage
adjustment. May cause Q-wave and T-wave
changes in ECG.
LABS: CBC and LFT may cause dyscrasias
(hematologic disorder) and hepatotoxicity
LABS: routine eval. renal, hepatic, and
hematologic function
Anti-Emetics
Zofran
(Ondansetron)
Antiemetics
Reglan
(Metocloprami
de HCL)
Anti-emetic;
peristaltic stimulant
Phenergan
(Promethazine
)
HIGH Alert
Antiemetics,
antihistamines,
sedative/hypnotics
Anti-emetic,
Compazine
(Prochlorperaz antipsychotics
ine)
Ativan
(Lorazepam)
Analgesic adjuncts,
antianxiety agents,
sedative/hypnotics
PO, IM, IV
LABS: May alter hepatic function test
results. May cause increase serum prolactin
and aldosterone concentrations.
Analgesics (Pain Medicine) HIGH ALERT
Opioid analgesic
Dilaudid
(Hydromorpho
ne)
HIGH Alert
PO- IR, POER,
SUBCUT,
IM, IV,
RECT.
Opioid agonists
(Allergy, cold and
cough remedies)
Opioid agonist
Monitor VS closely (BP,
O2, RR)
Opioid analgesic
PO, IV, IM,
transdermal,
PCA
Opioid agonist
Respiratory
Depression
Severe pain, pulmonary
edema, pain associated with
MI.
Morphine
(Morphine
sulfate)
Assess BP, pulse, and resp before and
periodically during administration. If RR is
<10/min, assess level of sedation. Dose may
need to be
LABS: May increase plasma amylase and
lipase concentration
ANTIDOTE: NARCAN (naloxone)
Assess LOC, BP, pulse, and resp before and
periodically. If Resp is <10/min, assess
level of sedation.
HIGH Alert
Hypotension,
constipation,
confusion,
sedation
Sedation,
respiratory
depression,
constipation
Confusion,
dizziness,
sedation,
hypotension,
constipation,
dyspepsia, nausea
Respiratory
depression,
confusion,
sedation,
constipation.
Respiratory
depression,
nausea, vomiting,
itching
ANTIDOTE: NARCAN (naloxone)
Fentanyl
(Fentanyl
Citrate)
HIGH ALERT
Norco/Vicodin
(Hydrocodone)
HIGH Alert
Opioid analgesic
IM, IV
Decrease pain, supplement
in anesthesia
Opioid analgesic
PO, PO-ER
Roxicodone
(Oxycodone)
HIGH Alert
Opioid analgesic
PO, PO-ER
Percocet
(Oxycodone)
HIGH Alert
Opioid analgesic
PO, PO-ER
Tylenol-3
(Tylenol with
Codeine)
HIGH Alert
Opioid analgesics
PO
Hypotension,
nausea, vomiting,
confusion,
sedation
Opioid combined with
acetaminophen
antipyretics,
Tylenol
(Acetaminophe nonopioid
analgesics
n/APAP)
PO, IV, rectal
Nausea, tiredness,
vomiting, paleness
Mild pain, fever
NSAID
Ibuprofen
(Advil, Motrin)
PO, IV
H/A, constipation,
dyspepsia, N/V
Take with food to prevent
GI upset.
Pain and anti-inflammatory,
fever
Opioid combined with
acetaminophen (Tylenol)
Monitor RR and BP may cause sleep related
breathing disorders.
s/s of toxicity- resp depression,
hypotension, arrythmias, bradycardia.
ANTIDOTE: NARCAN (naloxone)
Assess BP, pulse, and resp before and
periodically during administration. If RR is
<10/min, assess level of sedation.
LABS: May increase plasma amylase and
lipase concentration
ANTIDOTE: NARCAN (naloxone)
Decrease moderate to severe Assess BP, pulse, and resp before and
periodically during administration. If RR is
pain
Decrease moderate to severe
pain
<10/min, assess level of sedation.
LABS: May increase plasma amylase and
lipase concentration
ANTIDOTE: NARCAN (naloxone)
Assess BP, pulse, and resp before and
periodically during administration. If RR is
<10/min, assess level of sedation.
LABS: May increase plasma amylase and
lipase concentration
ANTIDOTE: NARCAN (naloxone)
Assess BP, pulse, and resp before and
periodically during administration. If RR is
<10/min, assess level of sedation.
LABS: May increase plasma amylase and
lipase concentration
ANTIDOTE: NARCAN (naloxone)
LABS: Increased serum bilirubin, LDH,
AST, ALT, and PT may indicate
hepatotoxicity.
Toxicity Overdose: acetylcysteine
(Acetadote)
LABS: BUN, Serum CREA, CBC,
Gabapentin
(Neurontin)
Analgesic adjuncts,
therapeutic,
anticonvulsants,
mood stabilizers
PO- IR, POSR
Dizziness,
Partial seizures, postherpetic
vasodilation,
neuralgia, RLS.
tremors, dry mouth
Ketamine
General anesthetics
IV, IM
Emergence
reactions, HTN,
tachycardia
ONLY TO BE GIVEN BY
MD
Lidocaine
Analgesic/local
anesthetic
IV, IM, Local
Confusion,
drowsiness
Control of ventricular
arrhythmias, local
anesthesia
Narcan
Opioid Antagonist
IV, IM,
Subcut,
Intranasal
Reverses opioid
drug affects,
increase pain
Reversal of signs of opioid
excess
Toradol
(Ketorolac
tromethamine)
Nonopioid
analgesics
PO, IM, IV,
IN
Drowsiness
May increase GI bleeding
(avoid with these patients)
Works amazing for kidney
stone pain
PO, IV
Constipation,
dizziness,
difficulty sleeping,
headache,
diarrhea.
PO, PO-ER,
IV, topical,
vaginal
Dizziness, H/A,
stomach upset,
N/V, loss of
appetite, diarrhea.
Used for sinusitis, PNA,
anthrax, UTI
Broad spectrum for Gram () and Gram (+) as well as
atypical respiratory
infections
PO: Tx of anaerobic
infections
IV: perioperative
prophylactic agent in
colorectal surgery
Vag: management of
bacterial vaginosis
Monitor closely for notable changes in
behavior that could indicate the emergence
or worsening of suicidal thoughts or
behavior or depression.
LABS: False- positive readings when
testing urine protein.
May cause liver dysfunction with recurrent
use.
TOXICITY: Respiratory depression or
apnea may be treated with mechanical
ventilation or analeptics.
Monitor ECG continuously and BP and
Respiratory
LABS: Serum electrolyte levels, IM
adminis. May cause increase CK levels
Monitor respiratory rate, rhythm, and depth;
pulse, ECG, BP; and level of consciousness
frequently for 3–4 hr after the expected
peak of blood concentrations.
Minimal toxicity
Evaluate liver function tests, especially
AST and ALT. May cause ↑ levels. May
cause prolonged bleeding time that may
persist for 24–48 hr following
discontinuation of therapy. May cause ↑
BUN, serum creatinine, or potassium
concentrations
Antibiotics
Levaquin
(Levofloxacin)
Fluoroquinolone
Antibiotic
Anti-infectives,
Flagyl
(Metronidazole antiprotozoals,
antiulcer agents
)
LABS:
May cause ↑ serum AST, ALT, LDH,
bilirubin, and alkaline phosphatase. May
also cause ↑ or ↓ serum glucose.
LABS:
May alter results of serum AST, ALT, and
LDH tests
Nausea, diarrhea,
vomiting,
dyspepsia, tendon
rupture
Pain at IM site,
Phlebitis at IV site
Inhibits bacterial DNA
synthesis by inhibiting DNA
gyrase enzyme.
LABS:
May cause ↑ serum AST, ALT, LDH,
bilirubin, and alkaline phosphatase.
May also cause ↑ or ↓ serum glucose.
Bactericidal action against
susceptible bacteria
PO
Diarrhea, N/V or
upset stomach
Anti- infectives
IV, PO
Nephrotoxicity,
phlebitis
Used in respiratory, GI, GU.
Breaks down Gram (-)
bacteria; breaks down cell
wall
Bactericidal action against
susceptible organisms
Tetracyclines
Tetracycline
Antibiotic
PO
Diarrhea, N/V,
photosensitivity
Bacteriostatic action against
suspectable bacteria
Doxycycline
(Vibramycin –
Doxy calcium)
Anti-infectives
PO, IV
Diarrhea, N/V,
photosensitivity
Augmentin
(Amoxicillinclavulanate
potassium)
Anti-infectives
PO
Diarrhea, rash
Used in PNA, STD, malaria,
anthrax, periodontitis.
Gram (+) and (-)
Encourage taking with meal
to decrease GI sx
Bactericidal action against
susceptible bacteria.
Streptococci, Pneumococci,
Enterococci,
Haemophilus influenzae,
Escherichia coli, Proteus
mirabilis, Neisseria
meningitidis,N.
gonorrhoeae,
LABS:
May cause positive results for Coombs' test.
May cause increased AST, ALT, alkaline
phosphatase, bilirubin, LDH, BUN, and
serum creatinine.
LABS:
May cause positive results for Coombs' test.
May cause increased AST, ALT, alkaline
phosphatase, bilirubin, LDH, BUN, and
serum creatinine.
LABS:
Monitor for casts, albumin, or cells in the
urine or decreased specific gravity, CBC,
and renal function periodically during
therapy. May cause increased BUN levels.
TOXICITY:
Trough concentration should not exceed
10mcg/mL or 15-20mcg/mL
May cause ↑ AST, ALT, serum alkaline
phosphatase, bilirubin, and amylase
concentrations. Tetracyclines, except
doxycycline, may cause elevated serum
BUN. May cause false ↑ in urinary
catecholamine levels.
Monitor renal and hepatic functions and
CBC periodically during long-term therapy.
May cause ↑ AST, ALT, serum alkaline
phosphatase, bilirubin, and amylase
concentrations. May cause false ↑ in urinary
catecholamine levels.
LABS:
May cause ↑ serum alkaline phosphatase,
LDH, AST, and ALT concentrations.
Elderly men and patients receiving
prolonged treatment are at ↑ risk for hepatic
dysfunction.
May cause false-positive direct Coombs'
test result.
Ciprofloxacin
Anti-infectives
PO, PO-ER,
IV
Rocephin
(Ceftriaxone)
Cephalosporin
Antibiotic
IM, IV
Keflex
Anti-infectives
Vancomycin
Bactrim
(Sulfamethoxa
zoletrimethoprim)
Sulfonamide-folate
antagonist
Antibiotic
PO, IV
Penicillin V
Anti- infectives
PO, IV, IM
Zosyn
(Piperacillin)
Anti-infectives
IV
agents for atypical
Zithromax
(Azithromycin) mycobacterium,
anti-infectives
IV, PO
Staphylococcus aureus,
Klebsiella pneumoniae,
Shigella, Salmonella,
Moraxella catarrhalis.
Phlebitis at IV site, Active against many strains
loss of appetite,
of gram-positive aerobic
N/V, dizziness
pathogens including:
Streptococcus pneumoniae,
Staphylococcus aureus,
Group A beta-hemolytic
streptococci, Nocardia,
Enterococcus.
Diarrhea, rash,
Active against:
epigastric distress, Most gram-positive
N/V
organisms, including many
streptococci and Bacillus
anthracis,
Some gram-negative
organisms, such
as Neisseria
meningitidis and N.
gonorrhoeae
Some anaerobic bacteria
and spirochetes
including Borellia
burgdorferi.
GI upset, oral or
Appendicitis and peritonitis.
vaginal
Skin and skin structure
candidiasis, rash,
infections.
anaphylaxis
Gynecologic infections.
Community-acquired and
nosocomial pneumonia.
Abd. Pain
Treatment
Diarrhea, nausea
Upper respiratory tract
infections (streptococcal
pharyngitis, acute bacterial
exacerbations of chronic
bronchitis and tonsillitis)
LABS:
Monitor CBC and urinalysis periodically
during therapy.
May produce ↑ serum bilirubin, ↑
potassium, creatinine, and alkaline
phosphatase. May cause hypoglycemia.
May cause positive direct Coombs' test
results.
May cause ↑ AST, ALT, LDH, and serum
alkaline phosphatase concentrations.
May cause leukopenia and neutropenia,
especially with prolonged therapy or
hepatic impairment.
Evaluate renal and hepatic function, CBC,
serum potassium, and bleeding times prior
to and routinely during therapy.
LABS:
May cause increase serum bili, AST , ALT,
LDH, and alkaline phosphatase
concentration
Lower respiratory tract
infections (bronchitis and
pneumonia)
Acute otitis media, Skin and
skin structure infections,
Nongonococcal urethritis,
cervicitis, gonorrhea, and
chancroid.
Prevention of
disseminated Mycobacteriu
m avium complex (MAC)
infection in patients with
advanced HIV infection.
Treatment of serious gramnegative bacterial infection.
And infection caused by.
Staphylococcus when
penicillin or other less toxic
drugs are contraindicated.
Gentamicin
Aminoglycoside
Antibiotic
IM, IV
Kidney failure,
ototoxicity,
itching, swelling,
rash
Ancef
(Cefazolin)
anti- infectives
IV, IM
Diarrhea, N/V,
rash, pain at IM
site, Phlebitis at IV
site
Used in presurgical, Sepsis,
GU tract infections, trauma
Used frequently in open
fractures
Anti- inflammatory
IV, PO
HTN, acne,
decrease wound
healing,
ecchymoses,
hirsutism,
petechiae, adrenal
suppression,
anorexia nausea,
muscle wasting,
osteoporosis,
depression,
euphoria
Used systemically and
locally in a wide variety of
chronic diseases including:
Inflammatory, Allergic,
Hematologic, Endocrine,
Neoplastic, Dermatologic,
Autoimmune disorders,
Management of cerebral
edema, Diagnostic agent in
adrenal disorders.
LABS:
Monitor. Renal function by urinalysis,
specific gravity, BUN, serum creatinine,
and CCR. May cause increase in BUN,
AST, alt, serum alkaline Phosphatase,
bilirubin, serum creatinine, and LDH
concentration.
TOXICITY: Trough levels >2mcg/mL
May cause increase serum ALT, AST,
alkaline phosphatase, bilirubin, LDH, BUN,
and serum creatinine.
Steroids
Decadron
(Dexamethaso
ne)
Monitor serum electrolytes and glucose.
May cause hyperglycemia, especially in
patients with diabetes. Monitor hematologic
values, serum electrolytes, and serum and
urine glucose in patients on prolonged
therapy. May cause ↓ WBC counts. May
cause ↓ serum potassium and calcium and ↑
serum sodium concentrations
HTN, acne,
decrease wound
healing,
ecchymoses,
fragility hirsutism,
petechiae, adrenal
suppression,
anorexia nausea,
muscle wasting,
osteoporosis,
depression,
euphoria
Peptic ulcers, GI
bleed,
hyperglycemia,
delayed wound
healing, Cushing’s
syndrome
Suppresses inflammatory
and immune system by
inhibiting synthesis of
mediators
Reduces inflammation,
redness, warmth, pain
Push IV slowly: will cause
projectile vomiting
Monitor serum electrolytes and glucose.
May cause hyperglycemia, especially in
persons with diabetes. May cause
hypokalemia. Patients on prolonged therapy
should routinely have hematologic values,
serum electrolytes, and serum and urine
glucose evaluated. May ↓ WBC counts.
May ↓ serum potassium and calcium and
increase serum sodium concentrations
Suppression of
inflammation and
modification of the normal
immune response
Monitor serum electrolytes and glucose.
May cause hyperglycemia, especially in
persons with diabetes. May cause
hypokalemia. Patients on prolonged courses
of therapy should routinely have
hematologic values, serum electrolytes, and
serum and urine glucose evaluated. May
decrease WBC counts. May ↓ serum
potassium and calcium and ↑ serum sodium
concentrations
IV, PO
Peptic ulceration,
thromboembolism
anorexia, nausea,
depression,
Suppression of
inflammation and
modification of the normal
immune response.
Replacement therapy in
adrenal insufficiency.
Monitor serum electrolytes and glucose.
May cause hyperglycemia, especially in
persons with diabetes. May cause
hypokalemia. Patients on prolonged courses
of therapy should routinely have
hematologic values, serum electrolytes, and
serum electrolytes evaluated. May decrease
WBC counts. May decrease serum
potassium and calcium and increase serum
sodium concentrations.
PO,
PO-CD,LA,
XT
IV
Arrhythmias, HF,
Stevens- Johnson
syndrome,
peripheral edema
Decreases
contractility/conductivity,
demand for O2
Systemic vasodilation
resulting in decreased BP.
Coronary vasodilation
resulting in decreased
Monitor BP, HR, ECG (may cause
prolonged PR interval)
Monitor intake and output/ daily weight
Assess for signs of HF (peripheral edema,
rales/crackles, dyspnea, weight gain, jugular
venous distention).
LABS:
Solu-Medrol
methylprednis
olone
Corticosteroid
PO, IM, IV
Prednisone
Antiinflammatories,
Immune modifiers
PO
Cortisone
Antiinflammatories
Anti-arrhythmic
Diltiazem
Calcium Channel
Blocker
frequency and severity of
attacks of angina.
Reduction of ventricular
rate in atrial fibrillation or
flutter.
Amiodarone
HIGH ALERT
Antiarrhythmics
PO, IV
HF, worsening of
arrhythmias, QT
intervals
prolonged.
Bradycardia,
hypotension,
nausea, vomiting,
photosensitivity,
dizziness, fatigue.
Suppression of arrhythmias
Rythmol
(Propafenone
hydrochloride)
Antiarrhythmics
PO
Heart failure,
bradycardia,
arrythmias, blurry
vision, GI upset
Suppression of ventricular
arrhythmias
Lidocaine
HIGH Alert
Anesthetics
(topical/local)
Antiarrhythmics
IV, IM, Local
Seizures,
confusion,
drowsiness,
cardiac arrest,
stinging
IV to be used only with
patient on tele monitor.
Blocks sodium channel and
slows conduction; reduces
automaticity in ventricles,
accelerates repolarization
Total serum calcium concentrations are not
affected by calcium channel blockers.
Monitor serum potassium periodically.
Hypokalemia ↑ the risk of arrhythmias and
should be corrected.
Monitor renal and hepatic functions
periodically during long-term therapy. May
cause ↑ in hepatic enzymes after several
days of therapy, which return to normal on
discontinuation of therapy.
Monitor ECG, HR and rhythm throughout
therapy; PR prolongation, slight QRS
widening, and T-wave amplitude reduction
with T-wave widening and bifurcation may
occur. QT prolongation may be associated
with worsening of arrhythmias; monitor
closely during IV therapy. Report
bradycardia or increase in arrhythmias
promptly; patients receiving IV therapy
may require slowing rate, discontinuing
infusion, or inserting a temporary
pacemaker.
LABS: Monitor Liver and thyroid functions
Monitor ECG (may cause PR and QT
prolongation), BP, HR, intake, and output.
Assess for signs of HF.
LABS: May cause ↑ ANA titer, which is
usually asymptomatic and reversible.
Monitor prothrombin level in patients
taking warfarin; may ↑ effects of warfarin.
Toxicity Overdose: Signs of toxicity
include hypotension, excessive drowsiness,
and decreased or abnormal heart rate.
Notify health care professional if these
signs occur.
Monitor ECG continuously and BP and
respiratory status frequently during
administration.
Lab Test Considerations: Serum electrolyte
levels should be monitored periodically
during prolonged therapy.
IM administration may cause ↑ CK levels.
Toxicity: Serum lidocaine therapeutic range
1.5- 5mcg/mL
S/S: confusion, excitation, blurred or double
vision, nausea, vomiting, ringing in ears,
Atropine
Anticholinergic /
Antidysrthymic
IM, subcut,
IV
Tachycardia,
blurred vision, dry
mouth, urinary
hesitancy,
drowsiness
Digoxin
HIGH ALERT
Cardiac glycoside
Inotrope
PO, IM, IV
Fatigue,
bradycardia,
anorexia, nausea,
vomiting
Arrhythmias
Nitroglycerin
Vasodilator
Antianginals
SL/Translingu Dizziness, h/a,
al, PO-ER,
hypotension,
Oint, Patch,
tachycardia
IV
Adenosine
(Adenocard)
Antiarrhythmics
IV
Increased heart rate.
Decreased GI and
respiratory secretions.
Reversal of muscarinic
effects.
May have a spasmolytic
action on the biliary and
genitourinary tracts.
Increased cardiac output
(positive inotropic effect)
and slowing of the heart rate
(negative chronotropic
effect)
Relief or prevention of
anginal attacks.
Increased cardiac output.
Reduction of BP
Arrythmias, facial Restoration of normal sinus
flushing, SOB, MI, rhythm
Ventricular
tremors, twitching, seizures, difficulty
breathing, severe dizziness or fainting, and
unusually slow heart rate.
Assess ECG, BP, HR, Monitor intake and
output.
Antidote: physostigmine
Monitor apical pulse for 1 full min before
administering. Withhold dose and notify
health care professional if pulse rate is <60
bpm in an adult, <70 bpm in a child, or <90
bpm in an infant. Monitor ECG during IV
administration and 6 hr. after each dose.
Notify health care professional if
bradycardia or new arrhythmias occur.
LABS: Therapeutic serum digoxin levels
range from 0.5–2 ng/mL, may be drawn 68hrs after a dose
Toxicity: s/s Abd pain, anorexia, nausea,
vomiting, visual disturbances, bradycardia,
and other arrhythmias
Tx of life-threatening arrhythmias=
digoxin immune Fab
Assess location, duration, intensity, and
precipitating factors of patient's anginal
pain. Monitor BP and pulse before and after
administration. Patients receiving IV
nitroglycerin require continuous ECG and
BP monitoring. Additional hemodynamic
parameters may be monitored.
LABS: May cause ↑ urine catecholamine
and urine vanillylmandelic acid
concentrations.
Excessive doses may cause ↑
methemoglobin concentrations.
May cause falsely ↑ serum cholesterol
levels.
Monitor heart rate frequently (every 15–30
sec) and ECG continuously during therapy.
A short, transient period of 1st-, 2nd-, or
3rd-degree heart block or asystole may
occur following injection; usually resolves
quickly due to short duration of adenosine.
Once conversion to normal sinus rhythm is
achieved, transient arrhythmias (premature
ventricular contractions, atrial premature
contractions, sinus tachycardia, sinus
bradycardia, skipped beats, AV nodal
block) may occur, but generally last a few
sec.
Tachycardia,
seizures, Stroke
Hypertensive/Hypotensive/Rate Control
Decreased BP and HR.
Decreased frequency of
attacks of angina pectoris.
Decreased rate of
cardiovascular mortality and
hospitalization in pt with
HR.
Systemic vasodilation
resulting in decreased BP.
Coronary vasodilation
resulting in decreased
frequency and severity of
attacks of angina
Monitor BP, ECG, and HR periodically.
Monitor intake and output ratios and daily
weights.
LABS: may cause increase in BUN, Serum
lipoprotein, potassium, triglyceride, uric
acid, ANA titers, blood sugar levels, serum
AKP, LDH, AST, and ALT levels
Tachycardia, drug
induced lupus
syndrome.
Used in HTN, HF by
lowering BP in HTN PTs
and decreased afterload in
PTs with HF.
Monitor BP and HR,
LABS: Monitor BP, ECG, and HR
periodically. Monitor intake and output
ratios and daily weights.
Hypotension,
cough, dizziness
Decreases peripheral
vascular resistance with
OUT increasing CO, rate, or
contractility
Lowering of BP in
hypertensive patients.
Increased survival and
decreased symptoms in
patients with heart failure.
Assess patient for signs of angioedema
(swelling of face, extremities, eyes, lips,
tongue, difficulty in swallowing or
breathing); may occur at any time during
therapy. Discontinue medication and
provide supportive care. Monitor BP and
HR
LABS: Monitor BUN, creatinine, and
electrolyte levels periodically. Serum
potassium, BUN and creatinine may be ↑,
whereas sodium levels may be ↓. If ↑ BUN
or serum creatinine concentrations occur,
Metoprolol
(Lopressor)
HIGH Alert
Beta Blocker
Antihypertensive
PO, PO-ER,
IV
Fatigue, weakness,
erectile
dysfunction,
bradycardia, HF,
Pulmonary Edema
Cardene
(Nicardipine)
Calcium Channel
Blocker
Antihypertensives,
antianginals
PO, IV
Peripheral edema,
Arrhythmias,
stevens Johnson
syndrome, HF
Hydralazine
(Apresoline)
Antihypertensives
Vasodilator
PO, IM, IV
Lisinopril
Ace Inhibitor
Antihypertensives
PO
Monitor BP, ECG, and HR periodically.
Monitor intake and output ratios and daily
weights. May cause Stevens-Johnson
Syndrome.
LABS: monitor serum K+, hypokalemia
increase risk of arrhythmias. Monitor renal
and hepatic functions.
Increased survival after
myocardial infarction.
Coreg
(Carvedilol)
Beta Blocker
Antihypertensives
PO, PO-CR
Stroke, AV block,
bradycardia,
hypotension, lung
edema
Decreased heart rate and
BP. Improved cardiac
output, slowing of the
progression of HF and
decreased risk of death.
Decrease BP and HR.
Decreased frequency of
attacks of anginal pectoris
and prevention of MI
Atenolol
Beta Blocker
Antianginals,
antihypertensives
PO
Fatigue, weakness,
ED, Bradycardia,
HF, Pulmonary
Edema
Lotensin
(benazepril
HCL)
ACE inhibitor
Antihypertensives
PO
Headache,
hypotension,
cough
Lowering BP in PTs with
HTN
Propranolol
(Inderal)
HIGH ALERT
Beta Blocker
Antianginals
Antiarrhythmics
Antihypertensives
Vascular headache
suppressants
PO, PO-ER,
IV
Fatigue, weakness,
ER. Arrhythmias,
bradycardia, HF,
pulmonary edema,
ERYTHEMA
MULTIFORME, E
XFOLIATIVE
DERMATITIS, ST
EVENSJOHNSON
SYNDROME, TO
Beta 1 & 2 adrenergic
antagonist
Decreases HR, force of
contraction, rate of AV
conduction
Used for angina,
hypertension, dysrhythmias
dose reduction or withdrawal may be
required.
May cause hyperkalemia.
Monitor CBC periodically during therapy in
patients with collagen vascular disease
and/or renal disease. May rarely cause
slight ↓ in hemoglobin and hematocrit and
agranulocytosis.
May cause ↑ AST, ALT, alkaline
phosphatase, and serum bilirubin.
Monitor BP and HR if HR is below 505
adjust dose. Monitor intake and output.
LABS: may cause increased BUN, serum
lipoprotein, potassium, triglyceride, uric
acid levels, ANA titers and Blood sugars.
Monitor BP and HR if HR is below 505
adjust dose. Monitor intake and output.
LABS: may cause increased BUN, serum
lipoprotein, potassium, triglyceride, uric
acid levels, ANA titers and Blood sugars.
Monitor BP and HR if HR is below 505
adjust dose. Monitor intake and output. S/s
of angioedema (swelling of face,
extremities, eyes, lips, tongue, difficulty in
swallowing or breathing)
LABS: Monitor Renal function. May cause
increased BUN, serum creatinine. Monitor
CBC may cause decrease hemoglobin,
leukopenia, and eosinophilia. May cause
increase AST, AKP and ALT, serum BILI,
uric acid, and glucose
Monitor BP and HR. propranolol IV must
have continuous ECG monitoring. Monitor
intake and output.
LABS: May cause ↑ BUN, serum
lipoprotein, potassium, triglyceride, and
uric acid levels. May cause ↑ ANA titers.
May cause ↓ or ↑ in blood glucose levels. In
labile diabetic patients, hypoglycemia may
be accompanied by precipitous ↑ of BP.
Captopril
Ace inhibitors
Antihypertensives
PO
XIC EPIDERMAL
NECROLYSIS
Dizziness,
orthostatic
hypotension, GI
upset, COUGH,
headache,
Lower BP, reduced
symptoms in PTs with HF.
Decreased progression of
diabetic nephropathy with
decreased need for
transplantation or dialysis
ANGIOEDEMA
Losartan
(Cozaar)
ARB
Anti-hypertensive
PO
diarrhea, blurred
vision, difficulty
breathing, dizzy,
faintness., fast or
irregular heartbeat,
nausea or
vomiting.
Lowering of BP in HTN
patients. Decrease
progression of diabetic.
Nephropathy. Decrease
incidence of stroke in
patients with hypertension
and left ventricular
Hypertrophy.
Valsartan
(Diovan)
Antihypertensives
PO
Hypotension,
dizziness, GI
issues
Amlodipine
Antihypertensives
(Calcium channel
blockers)
PO, IV
Peripheral edema,
hypotension,
bradycardia
Lowers blood pressure.
Decreases risk of heart
failure related
hospitalizations in patients
with heart failure. Decreases
risk of death from
cardiovascular causes in
patients with left ventricular
systolic dysfunction
following myocardial
infarction.
Reduction in BP. Decreased
frequency and severity of
attacks of angina. Reduction
in risk of hospitalizations
for angina or coronary
revascularization in patients
with recent documented
coronary artery disease.
Monitor blood pressure and pulse
frequently during. Therapy. Assess patient
for signs of angioedema.
LABS: monitor renal function. May cause
increased B UN and creatinine. May cause
hyperkalemia. May cause increased AST,
ALT, alkaline phosphatase, and. Bilirubin.
Monitor CBC. Every two weeks for the first
three months.
Assess BP and HR frequently during initial
dose. Assess patient for signs of
angioedema.
LABS: Monitor renal function. May
increase BUN and creatinine. May cause
increase AST, ALT, and bilirubin. May
cause hyperkalemia. May cause slight
decrease in hemoglobin and hematocrit.
Assess BP and HR frequently during initial
dose. Assess patient for signs of
angioedema.
LABS: monitor renal function. Just going
to come in the next day may cause increase
be UN and. Serum creatinine. May cause
hyperkalemia. May cause increased AST
and ALT. May cause slight decrease in
hemoglobin and hematocrit or neutropenia.
Monitor BP and pulse before therapy,
during dose titration, and periodically
during therapy. Monitor ECG periodically
during prolonged therapy.
Monitor intake and output.
LABS: Total serum calcium concentration
are not affected by calcium channel
blockers.
Nifedipine
Antianginals,
antihypertensives
(Calcium channel
blockers)
Po, PO-ER
Hypotension,
bradycardia, AV
block, headache,
GI upset,
peripheral edema
Systemic vasodilation,
resulting in decreased BP.
Coronary vasodilation,
resulting in decrease
frequency and severity of
attacks of angina
Verapamil
Antianginals,
antiarrhythmics,
antihypertensives,
vascular headache
suppressants
(Calcium channel
blockers)
Antihypertensives,
diuretics
PO, PO-ER,
IV
Dizziness, SOB,
CP, cough
Arrhythmias, HF,
Stevens-Johnson
Syndrome.
Decreases
contractility/conductivity,
demand for O2
PO, IV, IM
Hypokalemia,
dizziness, h/a,
weakness, ER
Lowering of BP in HTN Pts
and diuresis with
mobilization of edema
PO
Supine HTN,
urinary
urge/retention/freq
uency, dysuria,
piloerection,
pruritus,
paresthesia
Increase in vascular tone
and BP
Hydrochloroth
iazide
(Thiazide diuretics)
Midodrine
(Proamatine)
Alpha-adrenergic
agonist
Monitor BP, HR, ECG during prolonged
therapy. Monitor intake/output. Assess for
signs of HF be monitor for toxicity. (pts
receiving digoxin concurrently with
nifedipine should have routine tests of
serum digoxin levels) May cause StevensJohnson syndrome-assess for rash.
LABS: monitor serum potassium
periodically. Monitor serum K+,
hypokalemia increases risk of arrhythmias.
Monitor renal and hepatic functions. May
cause increase hepatic enzymes. May cause
positive ANA and direct Coombs’ Test
results
Monitor BP, HR, ECG (verapamil may
cause prolonged PR interval)
Monitor intake and output. Assess for signs
of HF. Assess for rash periodically during
therapy.
Monitor BP, intake, output, and daily wt
and assess feet, legs, and sacral area for
edema daily. Monitor BP.
LABS: Monitor electrolytes (especially
potassium), blood glucose, BUN, serum
creatinine, and uric acid levels before and
periodically during therapy.
May cause ↑ serum and urine glucose in
diabetic patients.
May cause ↑ serum bilirubin, calcium,
creatinine, and uric acid, and ↓ serum
magnesium, potassium, sodium, and urinary
calcium concentrations.
May cause ↑ serum cholesterol, low-density
lipoprotein, and triglyceride concentrations.
Monitor supine and sitting BP prior to and
during therapy.
Assess pattern of urinary output prior to and
during treatment for incontinence.
LABS: Monitor renal and hepatic function
prior to and periodically during therapy.
Atropine
Clonidine
(Catapres)
Antiarrhythmics
IV, IM subcut
Tachycardia,
blurred vision, dry
mouth, urinary
hesitancy,
drowsiness
Acts on smooth muscle of
heart and increase cardiac
rate by inhibiting
acetylcholine
Assess vital signs and ECG tracings
frequently during IV drug therapy. Monitor
intake/output.
Toxicity: Physostigmine is the antidote.
Centrally acting
alpha agonist
Anti-hypertensive
PO,
transdermal,
epidural
Dry mouth,
drowsiness,
withdrawal
phenomenon
Deceased BP and pain.
Improvement in ADHD
symptoms
HTN: monitor BP, HR and Intake/ output.
Monitor pain. Monitor for opioid
withdrawal. Assess for ADHD.
LABS: May cause transient ↑ in blood
glucose levels.
May cause ↓ urinary catecholamine and
vanillylmandelic acid (VMA)
concentrations; these may ↑ on abrupt
withdrawal.
May cause weakly positive Coombs' test
result
HMG-CoA
Reductase Inhibitor
PO
Rash, abd.
Cramps,
constipation,
diarrhea, flatus,
heartburn.
Rhabdomyolysis,
hypersensitivity
reactions.
Lowers total LDL and
triglycerides. Slight increase
HDL.
Reducing the risk of
myocardial infarction and
stroke. Slows progression of
coronary atherosclerosis.
PO, PO-ER
Rash, abd.
Cramps,
constipation,
diarrhea, flatus,
heartburn.
Rhabdomyolysis,
Lowering total LDL and
triglycerides. Slight increase
HDL.
Reducing the risk of
myocardial infarction and
stroke. Slows progression of
coronary atherosclerosis.
Obtain a diet hx.
LABS: monitor liver function f symptoms
of serious liver injury, hyperbilirubinemia,
or jaundice occurs
discontinue atorvastatin and do not restart.
May also cause ↑ alkaline phosphatase and
bilirubin levels.
If patient develops muscle tenderness
during therapy, monitor CPK levels. If CPK
levels are >10 times the upper limit of
normal or myopathy occurs, therapy should
be discontinued.
Obtain a diet hx.
LABS: monitor liver function f symptoms
of serious liver injury, hyperbilirubinemia,
or jaundice occurs
discontinue atorvastatin and do not restart.
May also cause ↑ alkaline phosphatase and
bilirubin levels.
If patient develops muscle tenderness
during therapy, monitor CPK levels. If CPK
levels are >10 times the upper limit of
normal or myopathy occurs, therapy should
be discontinued.
Statins
Atorvastatin
(Lipitor)
Lipid lowering
agent
Lovastatin
(Mevacor)
HMG-CoA
Reductase Inhibitor
Lipid lowering
agent
Pravastatin
(Pravachol)
HMG-CoA
Reductase Inhibitor
Lipid lowering
agent
PO
Hard on liver
Rhabdomyolysis.
Abd cramps,
constipation,
diarrhea, flatus,
heartburn
Lowering total LDL and
triglycerides. Slight increase
HDL.
Reducing the risk of
myocardial infarction and
stroke. Slows progression of
coronary atherosclerosis.
Simvastatin
(Zocor)
HMG-CoA
Reductase Inhibitor
Lipid lowering
agent
PO
Hard on liver
Rhabdomyolysis.
Abd cramps,
constipation,
diarrhea, flatus,
heartburn
Used for
hypercholesterolemia,
prevention of
primary/secondary cardiac
events
Get LFT regularly checked
Give medication in evening
Obtain a diet hx.
LABS: monitor liver function f symptoms
of serious liver injury, hyperbilirubinemia,
or jaundice occurs
discontinue atorvastatin and do not restart.
May also cause ↑ alkaline phosphatase and
bilirubin levels.
If patient develops muscle tenderness
during therapy, monitor CPK levels. If CPK
levels are >10 times the upper limit of
normal or myopathy occurs, therapy should
be discontinued.
Obtain a diet hx.
LABS: monitor liver function f symptoms
of serious liver injury, hyperbilirubinemia,
or jaundice occurs
discontinue atorvastatin and do not restart.
May also cause ↑ alkaline phosphatase and
bilirubin levels.
If patient develops muscle tenderness
during therapy, monitor CPK levels. If CPK
levels are >10 times the upper limit of
normal or myopathy occurs, therapy should
be discontinued.
Diuretics
Spironolactone
(Aldactone)
Potassium-sparing
Diuretic
PO
Hyperkalemia,
drowsiness,
dizziness,
lightheadedness,
stomach upset,
diarrhea, nausea,
vomiting, or HA
Used for CHF, cirrhosis,
renal disease, hypertension
with edema
Monitor BP, intake, and output, assess pt
for development of hyperkalemia. Assess
for skin rash
LABS: Evaluate K+, monitor BUN, serum
creatinine, and electrolytes. May cause
increase serum magnesium, uric acid, BUN,
creatinine, potassium, plasma renin, and
urinary calcium excretion. May cause
lowering sodium levels. Discontinue
potassium-sparing diuretics 3 days prior to a
glucose tolerance test because of risk of
severe hyperkalemia.
May cause false ↑ of plasma cortisol
concentrations. Spironolactone should be
withdrawn 4–7 days before test
Lasix
(Furosemide)
Diuretics, loop
diuretics
PO, IV, IM
Dehydration,
hypocalcemia,
hypochloremia,
Used for CHF, cirrhosis,
renal disease, hypertension
with edema
Monitor BP, intake, and output, assess pt
for development of hyperkalemia. Assess
for skin rash
hypokalemia,
hypomagnesemia,
hyponatremia,
hypovolemia,
metabolic alkalosis
Torsemide
(Demadex)
Antihypertensives
Loop diuretic
Bumex
(Bumetanide)
Loop diuretic
PO
Dehydration,
Used for CHF, cirrhosis,
hypochloremia,
renal disease, hypertension
hypokalemia,
Monitor I/O’s
hypomagnesemia,
hyponatremia,
hypovolemia,
metabolic alkalosis
Electrolyte
changes,
hypotension,
weight change,
I&O imbalance,
dehydration,
hyperglycemia
Used for edema due to heart
failure, hepatic disease, or
renal impairment.
LABS: Monitor electrolytes, renal and
hepatic function, serum glucose, and uric
acid levels before and periodically
throughout therapy. Commonly ↓ serum
potassium. May cause ↓ serum sodium,
calcium, and magnesium concentrations.
May also cause ↑ BUN, serum glucose,
serum creatinine, and uric acid levels.
Monitor BP, intake, and output, assess pt
for development of hyperkalemia. Assess
for skin rash
LABS: Monitor electrolytes, renal and
hepatic function, serum glucose, and uric
acid levels before and periodically
throughout therapy. Commonly ↓ serum
potassium. May cause ↓ serum sodium,
calcium, and magnesium concentrations.
May also cause ↑ BUN, serum glucose,
serum creatinine, and uric acid levels.
Monitor BP, intake, and output, assess pt
for development of hyperkalemia. Assess
for skin rash
LABS: Monitor electrolytes, renal and
hepatic function, serum glucose, and uric
acid levels before and periodically
throughout therapy. Commonly ↓ serum
potassium. May cause ↓ serum sodium,
calcium, and magnesium concentrations.
May also cause ↑ BUN, serum glucose,
serum creatinine, and uric acid levels.
Vasopressors HIGH ALERT
Levophed
(Norepinephri
ne)
Alpha/beta agonist
Vasopressor
IV
Pain, burning,
irritation,
discoloration, or
skin changes,
sudden numbness,
weakness, slow or
uneven HR.
Increased BP increased
cardiac output.
Monitor BP Q2-3min until stabilized and
Q5min thereafter. Systolic BP is usually
maintained at 80-100 mmHg or 30-40 mm
Hg below the previously existing systolic
pressure in previously hypertensive pts.
ECG should be monitored continuously.
CVP, intra-arterial pressure, pulmonary
artery diastolic pressure, pulmonary
capillary wedge pressure (PCWP), and
cardiac output may also be monitored.
Monitor urine output and notify health care
professional if it decreases to <30 mL/hr.
Toxicity: If overdose occurs, discontinue
norepinephrine, and administer fluid and
Dopamine
Inotropic,
vasopressors,
adrenergics
IV
Arrhythmias,
hypotension
Causes vasodilation,
increases contractility, SV,
and CO
High doses: peripheral
resistance, increased BP,
renal vasoconstriction
Best if used through
central line***
Dobutamine
HIGH alert
Inotropic,
adrenergics
IV
HTN, increase HR, Increased cardiac output
premature
without significantly
ventricular
increased heart rate.
contractions
Vasopressin
Post pituitary
hormone
Antidiuretic
hormone
IM, Subcut.
IV
HF, myocardial
ischemia, limb
ischemia
Decreased urine output and
increased urine osmolarity
in diabetes insipidus,
increased BP.
electrolyte replacement therapy. An alphaadrenergic blocking agent may be
administered intravenously to treat
hypertension.
Monitor BP, HR, pulse pressure, ECG,
pulmonary capillary wedge pressure,
cardiac output, CVP, and urinary output
continuously during administration.
Monitor urine output frequently throughout
administration. Report decreases in urine
output promptly.
Palpate peripheral pulses and assess
appearance of extremities routinely
during dopamine administration.
If hypotension occurs, administration rate
should be increased. If hypotension
continues, more potent vasoconstrictors
(norepinephrine) may be administered.
Toxicity Overdose: If excessive
hypertension occurs, rate of infusion should
be decreased or temporarily discontinued
until BP is decreased.
Monitor BP, heart rate, ECG, pulmonary
capillary wedge pressure, cardiac output,
CVP, and urinary output continuously
during the administration.
Palpate peripheral pulses and assess
appearance of extremities routinely
during dobutamine administration. Notify
health care professional if quality of pulse
deteriorates or if extremities become cold or
mottled.
LABS: Monitor potassium concentrations
during therapy; may cause hypokalemia.
Monitor electrolytes, BUN, creatinine, and
prothrombin time weekly during prolonged
therapy.
Toxicity Overdose: If overdose occurs,
reduction or discontinuation of therapy is
the only treatment necessary because of the
short duration of dobutamine.
Monitor BP, HR, and ECG periodically
throughout therapy and continuously
throughout cardiopulmonary resuscitation.
Diabetes Insipidus: Monitor urine
osmolality and urine volume frequently to
Epinephrine
(Adrenalin)
Antiasthmatics,
bronchodilators,
vasopressors,
adrenergics
Inhaln.
Subcut. IM.
IV
Angina,
arrhythmias,
hypertension,
tachycardia,
nervousness,
restlessness,
tremor
Causes vasoconstriction,
increases HR,
bronchodilation
PO, IV
Joint pain,
dizziness, h/a ,
N/V, gas, diarrhea
Diminished accumulation of
acid in the gastric lumen,
with lessened acid reflux.
Healing of duodenal ulcer
and esophagitis. Decrease
acid secretion in
hypersecretory conditions.
determine effects of medication. Assess
patient for symptoms of dehydration Weigh
patient daily, monitor intake and output, and
assess for edema.
LABS:
Monitor urine specific gravity throughout
therapy.
Monitor serum electrolyte concentrations
periodically during therapy.
Toxicity Overdose:
Signs and symptoms of water intoxication
include confusion, drowsiness, headache,
weight gain, difficulty urinating, seizures,
and coma.
Treatment of overdose includes water
restriction and temporary
LABS: May cause transient ↓ in serum
potassium concentrations with nebulization
or at higher than recommended doses.
May cause an ↑ in blood glucose and serum
lactic acid concentrations.
Toxicity Overdose: Symptoms of overdose
include persistent agitation, chest pain or
discomfort, decreased BP, dizziness,
hyperglycemia, hypokalemia, seizures,
tachyarrhythmias, persistent trembling, and
vomiting.
Treatment includes discontinuing
adrenergic bronchodilator and other betaadrenergic agonists and symptomatic,
supportive therapy. Cardio selective beta
blockers are used cautiously because they
may induce bronchospasm.
Gastrointestinal
Protonix
(Pantoprazole)
Proton Pump
Inhibitor
Assess patient routinely for epigastric or
abdominal pain and for frank or occult
blood in stool, emesis, or gastric aspirate.
LABS: May cause abnormal liver function
tests, including ↑ AST, ALT, alkaline
phosphatase, and bilirubin. May cause
hypomagnesemia. Monitor serum
magnesium prior to and periodically during
therapy.
Carafate
(sucralfate)
Antiulcer agents.
GI protectants
PO
Constipation
ORAL
GI Cocktail
(lidocaine/bent
yl/Maalox)
Protection of ulcers, with
subsequent healing.
Used as a mixture to numb
upper GI tract and decrease
acid production while
coating the stomach
Might be called Green
Lizard
Decreased GI motility
Bentyl
(dicyclomine
hydrochloride)
Anticholinergics
PO, IM
Palpitations,
constipation, urine
retention,
decreased
sweating
Maalox
(aluminummagnesium
hydroxide)
Antiulcer agents,
antacids
PO
Constipation,
diarrhea
Used for heartburn, GI
upset, acid indigestion
Octreotide
(Sandostatin)
Somatostatin
analogue, growth
hormone
Subcut, IV,
IM, PO
Edema, increased
sweating, sinusitis,
hyperglycemia,
abdominal pain,
cholelithiasis,
diarrhea, nausea,
Used for GI bleeds, severe
diarrhea, acromegaly,
dumping syndrome
Assess patient routinely for abdominal pain
and frank or occult blood in the stool.
Assess for symptoms of irritable bowel
syndrome (abdominal cramping, alternating
constipation and diarrhea, mucus in stools
Assess patient routinely for abdominal
distention and auscultate for bowel sounds.
If constipation becomes a problem,
increasing fluids and adding bulk to the diet
may help alleviate the constipating effects
of the drug.
Monitor intake and output ratios; may cause
urinary retention.
LABS: Antagonizes effects of pentagastrin
and histamine during the gastric acid
secretion test. Avoid administration for 24
hr preceding the test.
Toxicity Overdose: severe anticholinergic
symptoms may be reversed with
physostigmine or neostigmine.
Antacid: Assess for heartburn and
indigestion as well as location, duration,
character, and precipitating factors of
gastric pain.
LABS: Monitor serum phosphate,
potassium, and calcium levels periodically
during chronic use. May cause ↑ serum
calcium and ↓ serum phosphate
concentrations.
Pepcid
(famotidine)
Antiulcer agents,
histamine h2
antagonists
PO, IV
vomiting,
arthralgia, h/a.
Confusion,
arrhythmias,
agranulocytosis,
aplastic anemia
Healing and preventions of
ulcers. Decreased symptoms
of gastroesophageal reflux.
Decrease secretion of
gastric acid.
Assess for epigastric or abdominal pain and
frank or occult blood in the stool, emesis, or
gastric aspirate
LABS:
Monitor CBC with differential periodically
during therapy.
May cause false-negative results in skin
tests using allergenic extracts. Histamine
antagonists should be discontinued 24 hr
prior to the test.
May cause an ↑ in serum transaminases and
serum creatinine.
May cause false-positive results for urine
protein; test with sulfosalicylic acid.
Psychiatric
Ativan
(Lorazepam)
Anti-anxiety/
Anti-emetic
Benzodiazepine
PO, Po-XR,
IM, IV
Dizziness,
drowsiness,
lethargy, apnea,
cardiac arrest
Sedation, decreased anxiety,
decreased seizures
Valium
(Diazepam)
Antianxiety agents,
anticonvulsants,
sedative/hypnotics,
skeletal muscle
relaxants
PO, IV, IM
Dizziness,
drowsiness,
lethargy,
respiratory
depression
Relief of anxiety. Sedation.
Amnesia. Skeletal muscle
relaxation. Decreased
seizure activity.
Assess risk for addiction, abuse, or misuse
prior to administration and periodically
during therapy.
LABS: Patients on high-dose therapy
should receive routine evaluation of renal,
hepatic, and hematologic function.
Toxicity Overdose: If overdose occurs,
flumazenil (Romazicon) is the antidote. Do
not use with patients with seizure disorder.
May induce seizures.
Assess risk for addiction, abuse, or misuse
prior to administration and periodically
during therapy.
LABS: Evaluate hepatic and renal function
and CBC periodically during prolonged
therapy. May cause ↑ transaminases and
alkaline phosphatase.
Toxicity Overdose:
Flumazenil is an adjunct in the management
of toxicity or overdose. (Flumazenil may
induce seizures in patients with a history of
seizures disorder or who are on tricyclic
antidepressants.)
Celexa
(citalopram)
SSRI
Anti-depressant
PO
Lexapro
(escitalopram
oxalate)
SSRI
Antidepressants
PO
antidepressants,
Wellbutrin
smoking.
(bupropion
hydrobromide) DETERRENTS.
Aminoketone's
PO
Geodon
(ziprasidone)
Antipsychotic,
mood stabilizers,
piperazine
derivatives
PO, IM
Latuda
(lurasidone
hydrochloride)
Dopamineserotonin receptor
agonist
Anti-psychotic
PO
Sweating,
Antidepressant action.
abdominal pain,
anorexia, diarrhea,
dry mouth,
dyspepsia,
flatulence, increase
saliva, nausea,
confusion,
drowsiness,
insomnia, tremor
Diarrhea, nausea,
Used for depression,
insomnia
anxiety, hot flashes
Inhibits neuronal reuptake
of serotonin
Assess for suicidal tendencies. Assess for
serotonin syndrome. (Mental changes.,
agitation, hallucinations, coma, anatomic
instability. Tachycardia labile BP.
LABS: Monitor electrolytes (potassium and
magnesium). In patients at risk for
electrolyte imbalances prior to and
periodically during therapy.
Increased suicidal diminish depression.
thoughts,
Decrease cravings for
dizziness,
cigarettes.
arrythmia, weight
changes, decreased
libido
Assess mental status and mood changes in
all patients.
LABS: Monitor, hepatic and renal function
closely in patients with kidney or liver
impairment. To prevent increased serum
and tissue, bupropion on concentration.
Make calls false positive urine test for
amphetamines
Nausea.,
drowsiness,
parkinsonism,
akathisia
Assess for suicidal tendencies. Assess for
serotonin syndrome. (Mental changes
[agitation, hallucinations, coma], anatomic
instability [Tachycardia, labile BP]
Diminished schizophrenic
behavior. Reduces
symptoms of mania
Monitor serum potassium and magnesium
prior to and periodically during therapy.
Obtain fasting blood glucose and
cholesterol levels initially and periodically
during therapy.
Monitor CBC frequently during initial. May
cause leukopenia, neutropenia, or
agranulocytosis. Discontinue therapy if this
occurs.
Monitor serum prolactin prior to and
periodically during therapy. May cause ↑
serum prolactin levels
Decreases schizophrenic
behavior. Decrease
depressive episode and
bipolar. One disorder.
Monitor mood changes assess for suicidal
tendencies.
LABS: May cause increased serum
prolactin levels. May cause increase CPK.
Obtain fasting blood glucose and
cholesterol levels initially and periodically
during therapy. Monitor CBC frequently
during initial therapy.
Assess degree of anxiety.
LABS: Monitor CBC. And liver and renal
function periodically during long term
therapy period may cause decrease Hematic
crit and neutropenia.
Toxicity: Flumazenil Is the antidote for
alprazolam toxicity or overdose.
Monitor closely for notable changes in
behavior that could indicate the emergence
or worsening of suicidal thoughts.
LABS: Patients on prolonged therapy
should have CBC and liver function tests.
May cause an increase in serum bilirubin,
AST, and ALT. May cause decrease
thyroidal uptake of 123 I, and 131 I.
Toxicity: Therapeutic serum concentrations
are 20- 80 mg/ml. Flumazenil Antagonist,
clonazepam toxicity or overdose.
Xanax
(Alprazolam)
anti-anxiety agents., PO
benzodiazepine,
Dizziness,
drowsiness,
lethargy.
Used in anxiety, panic
disorders
Potentiates effects of GABA
to depress the CNS
Klonopin
(clonazepam)
Anticonvulsants,
benzodiazepines
PO
Amnesia,
confusion,
palpitations,
cough, hair loss
Prevention of seizures.
Decrease manifestation of
panic disorder.
PO, IV, IM
Dizziness,
drowsiness, lightheadedness,
anorexia, GI upset,
nausea
Used for skeletal muscle
relaxation
Assess patient for pain, muscles stiffness,
and range of motion. Monitor HR and BP.
LABS: Monitor renal function periodically
during prolonged parenteral therapy (>3
days), because polyethylene glycol 300
vehicle is nephrotoxic.
May cause falsely increased urinary 5hydroxyindoleacetic acid (5-HIAA) and
vanillylmandelic acid (VMA)
determinations.
PO, Extended
release
Dizziness,
sleepiness,
confusion, dry
mouth, palpitations
Dizziness,
drowsiness,
lethargy,
respiratory
depression
Reduction in muscle spasm
and hyperactivity without
loss of function
Assess patient for pain, muscle stiffness,
and range of motion before and periodically
throughout therapy.
Assess for serotonin syndrome
Relief of anxiety. Sedation.
Amnesia. Skeletal muscle
relaxation. Decreased
seizure activity.
Assess risk for addiction, abuse, or misuse
prior to administration and periodically
during therapy.
LABS: Evaluate hepatic and renal function
and CBC periodically during prolonged
therapy. May cause ↑ transaminases and
alkaline phosphatase.
Toxicity Overdose:
Muscle Relaxers
Robaxin
(Methocarbam
ol)
Skeletal muscle
relaxants
Skeletal muscle
Flexeril
(Cyclobenzapri relaxants
ne)
Valium
(Diazepam)
Benzodiazepine
PO, IM, IV
Ativan
(Lorazepam)
Anti-anxiety/
Anti-emetic
Benzodiazepine
PO, Po-XR,
IM, IV
Dizziness,
drowsiness,
lethargy, apnea,
cardiac arrest
Produces muscle relaxation,
has antianxiety, anti-emetic,
and anticonvulsant.
properties
Soma
Skeletal muscle
relaxants
PO
Dizziness,
drowsiness
Skeletal muscle relaxation
Flumazenil is an adjunct in the management
of toxicity or overdose. (Flumazenil may
induce seizures in patients with a history of
seizures disorder or who are on tricyclic
antidepressants.)
Assess risk for addiction, abuse, or misuse
prior to administration and periodically
during therapy.
LABS: Patients on high-dose therapy
should receive routine evaluation of renal,
hepatic, and hematologic function.
Toxicity Overdose: If overdose occurs,
flumazenil (Romazicon) is the antidote. Do
not use with patients with seizure disorder.
May induce seizures.
Assess patient for pain, muscle stiffness,
and range of motion before and periodically
during therapy.
Observe for idiosyncratic symptoms
(extreme weakness, quadriplegia, dizziness,
ataxia, dysarthria, visual disturbances,
agitation, euphoria, confusion,
disorientation); may appear within minutes
or hours of first dose. Usually subsides over
several hours.
Blood Thinner/Anti-platelet
Heparin
Anti-coagulant
Lovenox
(Enoxaparin)
HIGH Alert
antithrombotic
low molecular
weight heparins
Subcut, IV
BLEEDING, HEP
ARIN-INDUCED
THROMBOCYTO
PENIA (HIT)
(WITH OR
WITHOUT
THROMBOSIS), a
nemia
Prevention of thrombus
formation. Prevention of
extension of existing
thrombi.
Bruising, bleeding, Prevention of thrombus
thrombocytopenia, formation
angioedema
Assess for signs of bleeding and
hemorrhage (bleeding gums; nosebleed;
unusual bruising; black, tarry stools;
hematuria; fall in hematocrit or BP; guaiacpositive stools). Notify health care
professional if these occur.
Monitor activated partial thromboplastin
time (aPTT) and hematocrit
Toxicity Overdose: Protamine sulfate is
the antidote. Due to short half-life, overdose
can often be treated by withdrawing the
drug.
Assess for signs of bleeding and
hemorrhage (bleeding gums; nosebleed;
unusual bruising; black, tarry stools;
hematuria; fall in hematocrit or BP; guaiacpositive stools). Notify health care
professional if these occur.
Monitor CBC, platelet count, and stools for
occult blood periodically during therapy. If
thrombocytopenia occurs, monitor closely.
If hematocrit decreases unexpectedly,
assess patient for potential bleeding sites.
Toxicity Overdose:
For overdose, protamine sulfate 1 mg for
each mg of enoxaparin should be
administered by slow IV injection.
Aspirin
(acetylsalicylic
acid, ASA)
Antiplatelet agents
Antipyretics
Nonopioid
analgesics
PO
Dyspepsia,
epigastric distress,
nausea, GI
bleeding
Pain, fever, angina, stroke,
CABG.
Warfarin
(Coumadin)
HIGH Alert
Anti-coagulant
PO
Calciphylaxis,
bleeding
Prevention of
thromboembolic events
Eliquis
(Apixaban)
Anti-coagulant,
Factor Xa inhibitor
PO
Bleeding,
anaphylaxis
Prevents thrombin
generation.
Patients who have asthma, allergies, and
nasal polyps or who are allergic to
tartrazine are at an increased risk for
developing hypersensitivity reactions.
Monitor for signs and symptoms of DRESS
(fever, rash, lymphadenopathy, facial
swelling) periodically during therapy.
Discontinue therapy if symptoms occur
Toxicity Overdose:
Monitor for the onset of tinnitus, headache,
hyperventilation, agitation, mental
confusion, lethargy, diarrhea, and sweating.
If these symptoms appear, withhold
medication and notify health care
professional immediately.
Assess for signs of bleeding and
hemorrhage (bleeding gums; nosebleed;
unusual bruising; tarry, black stools;
hematuria; fall in hematocrit or BP; guaiacpositive stools, urine, or nasogastric
aspirate).
LABS: Monitor PT, INR
Toxicity Overdose:
Withholding 1 or more doses of warfarin is
usually sufficient if INR is excessively
elevated or if minor bleeding occurs. If
overdose occurs or anticoagulation needs to
be immediately reversed, the antidote is
vitamin K (phytonadione, Aquamephyton).
Administration of whole blood or plasma
also may be required in severe bleeding
because of the delayed onset of vitamin K.
Assess patient for symptoms of stroke,
DVT, PE, bleeding, or peripheral vascular
disease periodically during therapy.
Toxicity Overdose:
To prevent stroke with a.fib,
DVT prevention postsurgery
Plavix
(Clopidogrel)
Antiplatelet agents
Platelet aggregation
inhibitors
PO
GI bleeding, bleeding,
neutropenia,
thrombotic
thrombocytopenic
purpura,
ACUTE
GENERALIZED
EXANTHEMATOUS
PUSTULOSIS, DRU
G RASH WITH
EOSINOPHILIA
AND SYSTEMIC
SYMPTOMS, STEVE
NS-JOHNSON
SYNDROME, TOXIC
EPIDERMAL
NECROLYSIS
Reduction in risk of MI and
stroke
Arixtra
(fondaparinux
sodium)
Anticoagulants,
active factor x
inhibitors
Subcut
Bleeding,
increased liver
levels
Interruption of the
coagulation cascade
resulting in inhibition of
thrombus formation.
Prevention of thrombus
formation decreases the risk
of pulmonary emboli
Antidote is andexanet alfa. Effects persist
for at least 24 hrs after last dose. Oral
activated charcoal decreases apixaban
absorption, lowering plasma concentrations.
Other agents and hemodialysis do not have
a significant effect.
Assess patient for symptoms of stroke,
peripheral vascular disease, or MI
periodically during therapy.
Monitor patient for signs of thrombotic
thrombocytopenic purpura
LABS:
Monitor bleeding time during therapy.
Prolonged bleeding time, which is time- and
dose-dependent, is expected.
Monitor CBC with differential and platelet
count periodically during therapy.
Neutropenia and thrombocytopenia may
rarely occur.
May cause ↑ serum bilirubin, hepatic
enzymes, total cholesterol, nonprotein
nitrogen, and uric acid concentrations
Assess for signs of bleeding and
hemorrhage.
Monitor platelet count closely; may cause
thrombocytopenia. If platelet count is
<100,000/mm3 , discontinue fondaparinux.
Fondaparinux is not accurately measured by
prothrombin time (PT), activated
thromboplastin time (aPTT), or
international standards of heparin or lowmolecular-weight heparins. If unexpected
changes in coagulation parameters or major
bleeding occurs, discontinue fondaparinux.
Monitor CBC, serum creatinine levels, and
stool occult blood tests routinely during
therapy.
May cause asymptomatic ↑ in AST and
ALT. Elevations are fully reversible and not
associated with ↑ in bilirubin.
May cause ↑ aPTT temporally associated
with bleeding with or without concomitant
administration of other anticoagulants and
thrombocytopenia with thrombosis similar
to heparin-induced thrombocytopenia, with
or without exposure to heparin or lowmolecular-weight heparins.
Assess for symptoms of stroke or peripheral
vascular disease periodically during
therapy.
Assess for symptoms of bleeding and blood
loss; may be fatal. If reversal of
anticoagulant effect is required, may use
idarucizumab.
LABS: Use aPTT or ecarin clotting time
(ECT), not INR, to assess anticoagulant
activity, if needed.
Monitor renal function prior to and
periodically during therapy. Patients with
renal impairment may require dose
reduction or discontinuation.
Assess for bleeding
Lab Test Considerations:
May cause ↑ serum AST, ALT, total
bilirubin, and GGT levels.
Monitor renal function periodically during
therapy.
Toxicity Overdose:
Antidote is andexanet alfa; effects persist
for at least 24 hr after last dose. Other
agents and hemodialysis do not have a
significant effect. Consider using
prothrombin complex concentrate (PCC) or
Factor VIIa.
Pradaxa
(dabigatran)
Anticoagulants
PO
Thrombi inhibitions
Bleeding, abd pain
Reduced risk of thrombotic
sequelae (stroke and
systemic embolism) in
nonvalvular AF.
Reduced risk of recurrent
PE and DVT.
Resolution of DVT and PE.
Xarelto
(Rivaroxaban)
Anticoagulants
Antithrombotics
Factor xa inhibitors
PO
Bleeding
Used to prevent DVT, PE,
emboli from a.fib.
PO, IV
Torsades de
pointes, stevensjohnson syndrome,
hepatotoxicity
Prevention of fungal
infection
Lab Test Considerations:
Monitor BUN and serum creatinine before
and periodically during therapy; patients
with renal dysfunction will require dose
adjustment.
Monitor liver function tests before and
periodically during therapy. May cause ↑
AST, ALT, serum alkaline phosphate, and
bilirubin concentrations.
Diarrhea, nausea
stomach pain
Binds to fungal cell wall
altering permeability.
Inspect oral mucous membranes before and
frequently during therapy. Increased
irritation of mucous membranes may
indicate need to discontinue medication
Anti-fungal
Diflucan
(Fluconazole)
Antifungal
Nystatin
Anti-fungal
PO
Used for intestinal
candidiasis, thrush, mycotic
infections
Thyroid
Thyroid hormone
Synthroid
(Levothyroxine
)
PO, IV
Weight gain/loss,
h/a, vomiting,
diarrhea, fever
Replacement in
hypothyroidism to restore
normal hormonal balance.
Suppression of thyroid
cancer.
Assess apical pulse and BP prior to and
periodically during therapy. Assess for
tachyarrhythmias and chest pain
Lab Test Considerations:
Monitor thyroid function studies prior to
and during therapy. Monitor thyroidstimulating hormone (TSH) serum levels
after start.
Monitor blood and urine glucose in diabetic
patients. Insulin or oral hypoglycemic dose
may need to be increased.
Toxicity Overdose:
Overdose is manifested as hyperthyroidism
(tachycardia, chest pain, nervousness,
insomnia, diaphoresis, tremors, weight
loss). Usual treatment is to withhold dose
for 2–6 days then resume at a lower dose.
Acute overdose is treated by induction of
emesis or gastric lavage, followed by
activated charcoal. Sympathetic
overstimulation may be controlled by
antiadrenergic drugs (beta blockers), such
as propranolol. Oxygen and supportive
measures to control symptoms are also
used.
Cardiac arrest,
phlebitis at IV site,
suicidal thoughts,
apnea,
laryngospasm,
respiratory
depression
Short-term sedation.
Postoperative amnesia.
Termination of seizure
activity.
Assess level of sedation and level of
consciousness throughout and for 2–6 hr
following administration.
Monitor BP, pulse, and respiration
continuously during administration,
especially if co-administering opioid
analgesics. Oxygen and resuscitative
equipment should be immediately available
during IV administration.
Assess risk for addiction, abuse, or misuse
before starting and periodically during
therapy.
Toxicity Overdose:
Anti-Convulsant
Versed
(Midazolam)
Benzodiazepine
IN, IM, IV
Keppra
(levetiracetam)
Anticonvulsants
IV, PO
Ativan
(Lorazepam)
Anti-anxiety/
Anti-emetic
Benzodiazepine
PO, IV, IM
Dilantin
(Phenytoin)
Antiarrhythmics,
anticonvulsants
PO, PO-ER,
IV
Aggression,
agitation, anger,
anxiety, apathy,
depersonalization,
depression,
dizziness,
drowsiness,
fatigue, hostility,
irritability,
personality
disorder,
psychosis,
weakness
Dizziness,
drowsiness,
lethargy, apnea,
cardiac arrest
Inhibits simultaneous
neuronal firing.
Used epilepsy, tonic-clonic
seizures
Gingival
hyperplasia
Bradycardia
GI upset,
headache,
insomnia
Diminished seizures
activity. Termination of
ventricular arrhythmias.
Calms and sedates by
causing muscle relaxation
If overdose occurs, monitor pulse,
respiration, and BP continuously. Maintain
patent airway and assist ventilation as
needed. If hypotension occurs, treatment
includes IV fluids, repositioning, and
vasopressors.
The effects of midazolam can be reversed
with flumazenil (Romazicon).
Monitor mood changes. Assess for suicidal
tendencies, especially during early therapy.
Restrict amount of drug available to patient.
Assess for rash periodically during therapy.
May cause Stevens-Johnson syndrome.
Discontinue therapy if severe or if
accompanied with fever, general malaise,
fatigue, muscle or joint aches, blisters, oral
lesions, conjunctivitis, hepatitis, and/or
eosinophilia.
LABS:
May cause ↓ RBC and WBC and abnormal
liver function tests.
Assess risk for addiction, abuse, or misuse
prior to administration and periodically
during therapy.
LABS: Patients on high-dose therapy
should receive routine evaluation of renal,
hepatic, and hematologic function.
Toxicity Overdose: If overdose occurs,
flumazenil (Romazicon) is the antidote. Do
not use with patients with seizure disorder.
May induce seizures.
Monitor closely for notable changes in
behavior that could indicate the emergence
or worsening of suicidal thoughts or
behavior or depression.
LABS: Monitor CBC, serum calcium,
albumin, and hepatic function tests prior to
and monthly for the first several mo, then
periodically during therapy.
May cause ↑ serum alkaline phosphatase,
GGT, and glucose levels.
Monitor serum folate concentrations
periodically during prolonged therapy.
Toxicity Overdose:
Tegretol
(Carbamazepi
ne)
Anticonvulsant,
mood stabilizers
Antiepileptic
Valproic Acid
(Depakene/Dep
akote)
Monitor serum phenytoin levels routinely.
Therapeutic blood levels are 10–20 mcg/mL
(8–15 mcg/mL in neonates) in patients with
normal serum albumin and renal function.
In patients with altered protein binding
(neonates, patients with renal failure,
hypoalbuminemia, acute trauma), free
phenytoin serum concentrations should be
monitored. Therapeutic serum free
phenytoin levels are 1–2 mcg/mL.
Progressive signs and symptoms of
phenytoin toxicity include nystagmus,
ataxia, confusion, nausea, slurred speech,
and dizziness.
Monitor closely for changes in behavior that
could indicate the emergence or worsening
of suicidal thoughts or behavior or
depression
LABS:
Monitor CBC, including platelet count,
reticulocyte count, and serum iron, at
baseline, weekly during the first 2 mo, and
yearly thereafter for evidence of potentially
fatal blood cell abnormalities. Discontinue
therapy if bone marrow depression occurs.
PO, PO-ER
Ataxia,
drowsiness,
hepatotoxicity,
pancreatitis
Used for tonic-clonic and
partial seizures.
Reduces synaptic reaction.
Frequent level checks
PO, IV
Hepatotoxicity,
pancreatitis,
suicidal thoughts
Prevention of seizures.
Relief of pain in trigeminal
neuralgia, Decreased mania.
Monitor closely for changes in behavior that
could indicate the emergence or worsening
of suicidal thoughts or behavior or
depression
LABS: Monitor CBC, including platelet
count, reticulocyte count, and serum iron, at
baseline, weekly during the first 2 mo, and
yearly thereafter for evidence of potentially
fatal blood cell abnormalities. Discontinue
therapy if bone marrow depression occurs.
Toxicity: Serum blood levels should be
routinely monitored during therapy.
Therapeutic levels range from 4–12
mcg/mL.
Arrhythmias,
hypocalcemia,
weakened/absent
Treatment/prevention of
hypomagnesemia.
Prevention and treatment of
Hypomagnesemia/Anticonvulsant: Monitor
pulse, BP, respirations, and ECG frequently
during administration of
Electrolyte Replacement
Magnesium
(Magnesium
sulfate)
Minerals
electrolytes
IV, PO
deep tendon
reflexes
High Alert
seizures associated with
severe eclampsia or preeclampsia.
Potassium
(Potassium
chloride)
Electrolyte
replacement
PO
Arrhythmias,
abdominal pain,
diarrhea,
flatulence, nausea,
vomiting.
Treatment of hypokalemia
Do NOT crush PO
Hang IV with fluids to
decrease burning
Calcium
(Calcium
gluconate,
chloride)
Mineral and
electrolyte
replacements/
supplements
IV, PO
Arrhythmias,
cardiac arrest,
constipation,
phlebitis
Replacement of calcium in
deficiency states.
parenteral magnesium sulfate. Respirations
should be at least 16/min before each dose.
LABS:
Monitor serum magnesium levels and renal
function periodically during administration
of parenteral magnesium sulfate.
Assess for signs and symptoms of
hypokalemia (weakness, fatigue, U wave on
ECG, arrhythmias, polyuria, polydipsia)
and hyperkalemia
LABS:
K+, monitor renal function, serum
bicarbonate, and pH
Toxicity: Symptoms of toxicity are those of
hyperkalemia (slow, irregular heartbeat;
fatigue; muscle weakness; paresthesia;
confusion; dyspnea; peaked T waves;
depressed ST segments; prolonged QT
segments; widened QRS complexes; loss of
P waves; and cardiac arrhythmias)
Treatment includes discontinuation of
potassium, administration of sodium
bicarbonate to correct acidosis, dextrose and
insulin to facilitate passage of potassium
into cells, calcium salts to reverse ECG
effects (in patients who are not receiving
digoxin), sodium polystyrene used as an
exchange resin, and/or dialysis for patient
with impaired renal function.
Observe patient closely for symptoms of
hypocalcemia (paresthesia, muscle
twitching, laryngospasm, colic, cardiac
arrhythmias, Chvostek's or Trousseau's
sign). Monitor BP, pulse, and ECG
frequently during parenteral therapy. May
cause vasodilation with resulting
hypotension, bradycardia, arrhythmias, and
cardiac arrest. Transient increases in BP
may occur during IV administration,
especially in geriatric patients or in patients
with hypertension.
LABS: Monitor serum calcium or
ionized calcium, chloride, sodium,
potassium, magnesium, albumin, and
parathyroid hormone (PTH) concentrations
before and periodically during therapy for
treatment of hypocalcemia
Toxicity:
Assess patient for nausea, vomiting,
anorexia, thirst, severe constipation,
paralytic ileus, and bradycardia. Contact
health care professional immediately if
these signs of hypercalcemia occur
Allergic Reaction
Antihistamine
Benadryl
(diphenhydra
mine)
PO, IM, IV
Anorexia, dry
mouth, drowsiness
Epinephrine
bronchodilators,
vasopressors,
adrenergics
IV, IM
Angina,
arrhythmias, HTN,
tachycardia,
nervousness,
restlessness,
tremor
Pepcid
(famotidine)
Histamine h2
antagonists
PO, IV
Constipation,
confusion,
diarrhea,
dizziness/HA,
Arrhythmias
Decreased symptoms of
histamine excess (sneezing,
rhinorrhea, nasal and ocular
pruritus, ocular tearing and
redness, urticaria). Relief of
acute dystonic reactions.
Prevention of motion
sickness. Suppression of
cough.
Used for anaphylaxis,
hypotension r/t septic shock,
cardiac resuscitation,
asthma
Healing and prevention of
ulcers. Decreased symptoms
of gastroesophageal reflux.
Decreased secretion of
gastric acid.
LABS:
May ↓ skin response to allergy tests.
Discontinue 4 days before skin testing
LABS:
May cause transient ↓ in serum potassium
concentrations with nebulization or at
higher than recommended doses.
May cause an ↑ in blood glucose and serum
lactic acid concentrations.
Toxicity:
Symptoms of overdose include persistent
agitation, chest pain or discomfort,
decreased BP, dizziness, hyperglycemia,
hypokalemia, seizures, tachyarrhythmias,
persistent trembling, and vomiting.
Treatment includes discontinuing
adrenergic bronchodilator and other betaadrenergic agonists and symptomatic,
supportive therapy. Cardio selective beta
blockers are used cautiously because they
may induce bronchospasm.
Assess for epigastric or abdominal pain and
frank or occult blood in the stool, emesis, or
gastric aspirate.
LABS:
Monitor CBC with differential periodically
during therapy.
Insulins/Blood Sugar Control
Rapid Acting
Insulin
(Humalog,
Novolog)
Insulin
Short Acting
Insulin
(Humulin R)
Insulin
Intermediate
Acting Insulin
(NPH,
Detemir)
Insulin
SC, IV
Hypoglycemia
SC, IV
Control of hyperglycemia in
diabetic patients.
Assess for symptoms of hypoglycemia
(anxiety; restlessness; tingling in hands,
feet, lips, or tongue; chills; cold sweats;
confusion; cool, pale skin; difficulty in
concentration; drowsiness; nightmares or
trouble sleeping; excessive hunger;
headache; irritability; nausea; nervousness;
tachycardia; tremor; weakness; unsteady
gait)and hyperglycemia (confusion,
drowsiness; flushed, dry skin; fruit-like
breath odor; rapid, deep breathing, polyuria;
loss of appetite; unusual thirst) periodically
during therapy.
Control of hyperglycemia in
diabetic patients.
Lab Test Considerations:
Monitor blood glucose every 6 hr during
therapy, more frequently in ketoacidosis
and times of stress. A1C may be monitored
every 3–6 mo to determine effectiveness.
Monitor serum potassium in patients at risk
for hypokalemia (those using potassiumlowering agents, those receiving IV insulin)
periodically during therapy.
Control of hyperglycemia in
diabetic patients.
Toxicity Overdose:
Overdose is manifested by symptoms of
hypoglycemia. Mild hypoglycemia may be
treated by ingestion of oral glucose. Severe
hypoglycemia is a life-threatening
emergency; treatment consists of IV
glucose, glucagon, or epinephrine
Control of hyperglycemia in
diabetic patients.
“same”
Maintenance of blood
glucose
When combined with oral sulfonylureas,
observe for signs and symptoms of
hypoglycemic reactions (abdominal pain,
sweating, hunger, weakness, dizziness,
headache, tremor, tachycardia, anxiety).
Hypoglycemia
SC, IV
Hypoglycemia
Hypoglycemia
Long-Acting
Insulin
(Lantus)
Insulin
Metformin
Biguanide
Antidiabetics
SC, IV
Hypoglycemia
PO
Lactic acidosis,
abd bloating,
diarrhea, nausea,
vomiting
Patients who have been well controlled
on metformin who develop illness or
laboratory abnormalities should be assessed
for ketoacidosis or lactic acidosis.
Assess serum electrolytes, ketones, glucose,
and, if indicated, blood pH, lactate,
pyruvate, and metformin levels. If either
form of acidosis is present,
discontinue metformin immediately and
treat acidosis. Patients with severe renal
impairment are at greatest risk for lactic
acidosis.
Glipizide
Sulfonylureas
PO
D50
Dextrose and water
IV
Glucagon
Hormone
pancreatic
IV, SC, IM
Hypoglycemia
Lowering of blood sugar in
diabetic patients.
“Observe for signs and symptoms of
hypoglycemic reactions (sweating, hunger,
weakness, dizziness, tremor, tachycardia,
anxiety). Patients on concurrent betablocker therapy may have very subtle signs
and symptoms of hypoglycemia.
Assess patient for allergy to sulfonamides.
Lab Test Considerations:
Monitor serum glucose and glycosylated
hemoglobin (HbA1C ) periodically during
therapy to evaluate effectiveness of
treatment.
Monitor CBC periodically during therapy.
Report ↓ in blood counts promptly.
May cause an ↑ in AST, LDH, BUN, and
serum creatinine.
Toxicity Overdose:
Overdose is manifested by symptoms of
hypoglycemia. Mild hypoglycemia may be
treated with administration of oral glucose.
Treat severe hypoglycemia with IV D50W
followed by continuous IV infusion of more
dilute dextrose solution at a rate sufficient
to keep serum glucose at approximately 100
mg/dL.
“same”
Epistaxis, eye
redness, itchy
eyes, itchy throat,
Increase in blood glucose.
Assess for signs of hypoglycemia
(sweating, hunger, weakness, headache,
dizziness, tremor, irritability, tachycardia,
nasal congestion,
nasal discomfort,
nasal itching,
nausea, vomiting.
Relaxation of GI
musculature, facilitating
radiographic examination.
anxiety) prior to and periodically during
therapy.