Table 1 ROUTE MEDICATIONS INDICATIONS ORAL ACETAMINOPHEN • Mild pain • Fever ORAL ACETYLSALICYLIC ACID (ASA) • • • • ORAL IBUPROFEN • pain • inflammation • reduce fever ORAL OXYCODONE • moderate to severe pain TOPICAL FENTANYL PATCH TOPICAL CONTRAINDICATIONS SIDE EFFECTS • previous hypersensitivity • nausea • severe hepatic impairment/ • vomiting active liver disease • diarrhea • constipation • anxiety Mild pain • hypersensitivity to aspirin Fever • cross-sensitivity with other inflammatory disorders NSAIDs prophylaxis for heart attack • bleeding disorders • • • • • ADVERSE REACTIONS NURSING CONSIDERATION hepatotoxicity renal failure cardiac damage toxic epidermal necrosis rash • Many OTC and • Take drug exactly as prescriptions products directed and don’t exceed contain acetaminophen; be recommended amount. aware when calculating • consult doctor if fever lasts total daily dose >3days. • reduce total daily dose & • stop use and consult increase dosing intervals doctor if a rash occurs for patients with hepatic or renal impairment PATIENT TEACHINGS • • • • • nausea vomiting dyspepsia (indigestion) epigastric distress abdominal pain • GI Bleeding • Hypersensitivity reactions (anaphylaxis) • tinnitus • For inflammatory conditions, give scheduled doses. • monitor patient for hypersensitivity reactions • Monitor salicylate level; severe toxic effects levels >400mcg/mL • hypersensitivity • active GI bleeding or ulcer disease • severe HF • • • • nausea vomiting constipation abdominal discomfort • • • • • assess pain before and 1-2 • Take drug exactly as hr after administering directed and don’t exceed • assess for S/S GI bleeding recommended amount. • assess for skin rashes • May cause drowsiness; avoid driving • avoid drinking alcohol • hypersensitivity • respiratory depression • acute or severe bronchial asthma • • • • • nausea vomiting constipation confusion sedation • respiratory depression • orthostatic hypotension • blurred vision • Assess BP, pulse, & RR before and periodically during administration • assess risk for opioid addiction , abuse, or misuse before administration. • Instruct patient on how & when to ask for and take pain meds. • advise patient that this drug is know to abuse potential, protect from theft. • May cause drowsiness; avoid driving • moderate to severe chronic • hypersensitivity pain • acute, mild, intermittent, or post-op pain • respiratory depression • acute or severe bronchial asthma • • • • • nausea vomiting constipation confusion sedation • • • • • • assess BP, pulse, RR before and periodically during administration. • assess risk for opioid addictions use, or misuse prior to administration. • assess bowel function routinely • instruct how and when to ask for and take pain medication. • instruct correct method for application and disposal of patch. • avoid grapefruit juice LIDOCAINE PATCH • pain due to post-op neuralgia • hypersensitivity • third-degree heart block • Wolf-Parkinson-White syndrome • • • • nausea vomiting confusion drowsiness • seizure • cardiac arrest • monitor ECG continuously. BP & Respiratory status frequently during administration • monitor for pain intensity periodically during therapy • May cause drowsiness; avoid driving • explain purpose of lidocaine to patient • avoid contact with water since patch may not stick ORAL AMLODIPINE • hypertension • angina pectoris • vasospastic angina • hypersensitivity • systolic BP <90mmHg • • • • nausea dizziness fatigue flushing • • • • • monitor BP & pulse before therapy and periodically during therapy • monitor intake & output ratios and daily weight • monitor signs for heart failure • Take drug exactly as directed and don’t exceed recommended amount. • teach patient how to monitor pulse. • Contact healthcare professional if HR <50bpm. • May cause drowsiness; avoid driving ORAL HYDROCHLOROTHIAZIDE • mild to moderate hypertension • edema (heart failure, renal dysfunction) • hypersensitivity • intolerance to tartrazine • anuria • • • • nausea vomiting dizziness drowsiness • Stevens-Johnson syndrome (skin disorder) • hypotension • pancreatitis • monitor BP, intake/output, daily weight • assess for skin rash frequently during therapy • Take medication at the same time each day • motor weight biweekly; call doctor if significant changes • change positions slowly to minimize orthostatic hypotension ORAL LISINOPRIL • hypertension • heart failure • hypersensitivity • history of angioedema with previous use of ACE inhibitors • • • • nausea vomiting diarrhea cough • hypotension • impaired renal function • monitor BP & pulse periodically throughout therapy. • assess patient for signs of angioedema • Take medication at the same time each day even if felling well. • call doctor if rash, sore throat, fever occur • change positions slowly to reduce orthostatic hypotension ORAL LOSARTAN • hypertension • hypersensitivity • bilateral renal artery stenosis • • • • nausea diarrhea dizziness fatigue • • • • • assess patient for signs of angioedema • assess BP & pulse throughout therapy • call healthcare professional immediately if swelling of faces eyes, lips occur • May cause drowsiness; avoid driving • change positions slowly to reduce orthostatic hypotension ORAL METOPROLOL • hypertension • angina pectoralis (small chest pain) • HF • Pulmonary edema • bradycardia • • • • nausea vomiting diarrhea fatigue • HF • Pulmonary edema • bradycardia • monitor BP, ECG & pulse throughout therapy • monitor intake/output & daily weight • call healthcare professional if slow pulse, difficult breathing, wheezing, dizziness occurs EYE DROP TIMOLOL • hypertension • prevention of MI • prevent migraine headaches • • • • • • • • • nausea constipation fatigue weakness ED • • • • • • monitor intake/output ratios & daily weight. • assess patient routinely for evidence of fluid overload • Take drug as directed, at the same time each day, even if they’re feeling better. • Teach patient and family how to check pulse daily and BP biweekly. • Call healthcare professional immediately if slow pulse, difficulty breathing, wheezing. • May cause drowsiness; avoid driving Uncompensated HF pulmonary edema cardiogenic shock bradycardia or heart attack 1 HF MI stroke GI bleeding apnea respiratory depression bradycardia hypotension adrenal insufficiency peripheral edema angina bradycardia hypotension chest pain angioedema hypotension hypoglycemia Arrhythmias bradycardia HF pulmonary edema anaphylaxis • Take with food or glass of water to reduce GI reactions and sit upright for 15-30 minutes. • avoid use of alcohol • Consult doctor is tinnitus occurs • consult doctor if fever lasts >3days ROUTE MEDICATIONS INDICATIONS CONTRAINDICATIONS SIDE EFFECTS ADVERSE REACTIONS NURSING CONSIDERATION PATIENT TEACHINGS ORAL DEXTROMETHORPHAN • coughs caused by upper respiratory tract infections • chronic nonproductive coughs • hypersensitivity • chronic productive coughs • taking MAO inhibitors or SSRIs • nausea • vomiting • stomach pain • sedation • monitor cough type and frequency • Take drug exactly as directed and don’t exceed recommended amount. • instruct patient to cough effectively • avoid drinking alcohol • call doctor if cough lasts >1week ORAL GUAIFENESIN • coughs caused by upper respiratory tract infections • hypersensitivity • intolerance to alcohol • nausea • vomiting • diarrhea • urticaria • stomach pain • monitor cough type & frequency • instruct to cough effectively. • May cause drowsiness; avoid driving ORAL METFORMIN • type 2 diabetes • hypersensitivity • diabetic ketoacidosis • severe renal impairment • • • • • lactic acidosis • observe S/S of hypoglycemic reactions • patients with severe renal impairment are >risk for lactic acidosis • Take medication at the same time each day • drug helps control hyperglycemia and is usually long term therapy • follow prescribed diet and exercise SUBCUTANEOUS INSULIN • diabetes • hypersensitivity • hypoglycemia • swelling • pruritus (itching) • hypoglycemia • hypersensitivity reactions • assess periodically for symptoms of hypoglycemia and hyperglycemia • monitor body weight periodically • instruct on proper technique of administration • explain that this medication controls hyperglycemia and is long term therapy • emphasize the importance of compliance with nutritional guidelines and regular exercise as directed ORAL DIPHENHYDRAMINE • relief of allergic symptoms • mild nighttime sedation • prevents motion sickness • hypersensitivity • acute asthma attacks • known alcohol intolerance • nausea • drowsiness • dizziness • • • • • this drug has multiple uses. determine why it was ordered and assess symptoms • for anaphylaxis: assess urticaria and patient airway • for insomnia: assess sleep patterns • for motion sickness: assess nausea, vomiting, bowel sounds • Take drug exactly as directed and don’t exceed recommended amount. • May cause drowsiness; avoid driving • May cause dry mouth; frequent oral rinses • teach sleep hygiene techniques (dark-quiet room, limit daytime naps) ORAL LORATADINE • seasonal allergies • hives • hypersensitivity • drowsiness • confusion • dry mouth • blurred vision • GI upset • assess allergy symptoms • assess lung sounds & bronchial secretions • Take drug exactly as directed. • May cause drowsiness; avoid driving • avoid drinking alcohol ORAL PREDNISONE • inflammation • immunosuppression • endocrine disorder • active untreated infections • • • • • peptic ulceration • thromboembolism • hypertension • assess for signs of adrenal insufficiency before and periodically during therapy • monitor intake/output ratios & daily weights • observe for peripheral edema • Take medication as directed • Do not stop taking suddenly or adrenal insufficiency may occur • contact healthcare professional if severe abdominal pain or tarry stools occur TOPICAL HYDROCORTISONE CREAM • inflammation & pruritus • hypersensitivity (itching) from allergic/ • untreated bacterial or viral immunologic skin problems infections • dryness • irritation • burning • edema • adrenal suppression • secondary infection • assess affected skin before • Take drug exactly as and daily during therapy directed. • note degree of • instruct patient on correct inflammation & pruritus technique of medication administration • inform health care professional if symptoms return or worsen. SUBCUTANEOUS ENOXAPARIN • prevention of venous thromboembolism (VTE), DVT, and PE • • • • nausea vomiting dizziness headache • • • • • assess for signs of • instruct patient correct bleeding & hemorrhage technique for self-injection, • assess patient for evidence care, and disposal of additional or increase • advise patient to report any thrombosis symptoms of unusual • monitory patients bleeding or bruising, hypersensitivity reaction dizziness, itching, rash • advise patient not to take aspirin, naproxen, or ibuprofen without talking to doctor SUBCUTANEOUS HEPARIN • thromboembolic disorders • hypersensitivity (venous thromboembolism, • uncontrolled bleeding pulmonary emboli, Afib, • Hx heparin-induced etc) thrombocytopenia • open wounds • • • • fever anemia rash pain at injection site • bleeding • heparin-induced thrombocytopenia (HIT) • alopecia • osteoporosis • assess for signs of • advise patient to report any bleeding & hemorrhage symptoms of unusual • monitory for bleeding or bruising hypersensitivity reactions immediately • asess patient for additional • instruct patient not ro take or increased thrombosis medications containing aspirin or NSAIDs while on therapy • caution patient to avoid IM injections and activities leading to injury. • Use soft toothbrush & electric razor during therapy TOPICAL BACITRACIN • localized infections due to susceptible organisms • hypersensitivity • renal impairment • • • • nausea vomiting rash pain at injection site • pseudomembradnous colitis • renal failure • assess lesions prior to and periodically during therapy • Take drug exactly as directed. • caution to notify healthcare professional if fever and diarrhea occur, especially if it contains blood, pus, mucus. IV CEFTRIAXONE • infections • hypersensitivity • diarrhea • rash • seizures • C. Diff associated diarrhea • anaphylaxis • assess for infection at beginning & throughout therapy • obtain specimen for culture& sensitivity before therapy • report signs of superinfection and allergy • notify health care professional if fever and diarrhea develop especially if diarrhea contains blood, mucus, or pus. IV CIPROFLOXACIN • infections • hypersensitivity • Hx myasthenia gravis (muscle weakness) • nausea • diarrhea • rash • • • • • assess for infection at beginning & throughout therapy • obtain specimen for culture& sensitivity before therapy • take medication as directed, finish therapy even if feeling better • notify health care professional if fever and diarrhea develop especially if diarrhea contains blood, mucus, or pus. • hypersensitivity 2 nausea vomiting diarrhea bloating nausea vomiting acne depression tinnitus blurred vision hypotension dysuria bleeding anemia alopecia edema seizures C. Diff associated diarrhea anaphylaxis suicidal thoughts ROUTE MEDICATIONS INDICATIONS CONTRAINDICATIONS SIDE EFFECTS ADVERSE REACTIONS NURSING CONSIDERATION PATIENT TEACHINGS IV DOXYCYCLINE • infections • hypersensitivity • • • • nausea vomiting diarrhea rash • C. Diff associated diarrhea • pancreatitis • hepatotoxicity • assess for infection at • take medication as beginning & throughout directed, finish therapy therapy even if feeling better • obtain specimen for culture • notify health care & sensitivity before therapy professional if fever and • monitor bowel function diarrhea develop especially • assess for rash periodically if diarrhea contains blood, during therapy mucus, or pus. IV PIPERACILLIN/TAZOBACTAM • infections • hypersensitivity • • • • nausea vomiting diarrhea rash • seizures • C. Diff associated diarrhea • anaphylaxis • assess for infection at • report signs of beginning & throughout superinfection and allergy therapy • notify health care • obtain specimen for culture professional if fever and & sensitivity before therapy diarrhea develop especially • monitor bowel function if diarrhea contains blood, • assess for rash periodically mucus, or pus. during therapy IV VANCOMYCIN • infections • hypersensitivity • nausea • vomiting • rash • hypotension • anaphylaxis • nephrotoxicity • assess for infection at • report signs of beginning & throughout hypersensitivity, tinnitus, therapy vertigo, or hearing loss • obtain specimen for culture • notify health care & sensitivity before therapy professional if no • Monitor BP throughout IV improvement is seen in a infusion few days INHALER ALBUTEROL • asthma & COPD • prevention of exerciseinduced bronchospasm • hypersensitivity • • • • • nausea vomiting nervousness restlessness tremor • paradoxical bronchospasm • observe for (wheezing), (wheezing) withhold and notify • chest pain healthcare professional • palpitations immediately if it occurs • angina • assess lung sounds, pulse, • arrhythmias BP before and during peak of medications • monitor pulmonary function tests before initial therapy & periodically during therapy • Take drug exactly as directed and don’t exceed recommended amount. • Contact healthcare professional immediately if SOB is not relieved by medication • inform patient that it may cause unusual or bad taste • avoid smoking an other respiratory irritants INHALER FLUTICASONE PROPIONATE • chronic asthma • hypersensitivity • • • • • nausea vomiting diarrhea headache dizziness • • • • conjunctivitis epistaxis (nosebleed) pharyngitis laryngitis • observe patient carefully for evidence of systemic corticosteroid effects • monitor patient, especially post-op, during period of stress or severe asthma attack • Take drug exactly as directed and don’t exceed recommended amount. • Call doctor if medication doesn’t improve asthma episodes • Advise patient to report all adverse reactions INHALER IPRATROPIUM • reversible airway • hypersensitivity obstruction due to COPD & • avoid during acute asthma broncospasm • • • • • nausea cough rash headache dizziness • • • • • blurred vision hypotension palpitations epistaxis (nosebleed) allergic reactions • assess respiratory status before administering and peak of medication. • Instruct patient of proper use of inhaler and to take as directed. • advise parent to rinse mouth after using inhaler and have food oral hygiene • caution patient not to exceed 12 doses within 24hr. ORAL ALPRAZOLAM • generalized anxiety disorder (GAD) • panic disorder • anxiety associated w/ depression • hypersensitivity • cross-sensitivity with other benzodiazepines • pre-existing CNS depression • severe uncontrolled pain • • • • • nausea vomiting diarrhea constipation dizziness • • • • blurred vision tinnitus chest pain confusion • monitor patient also taking opioid for S/S of respiratory depression • give smallest effective dose to prevent ataxia • Take drug exactly as directed and don’t exceed recommended amount. • avoid drinking alcohol • May cause drowsiness; avoid driving • avoid drinking grapefruit juice during therapy ORAL ATORVASTATIN CALCIUM • management of high cholesterol • prevent coronary heart disease • hypersensitivity • active liver disease • • • • • nausea diarrhea constipation flatus heartburn • • • • • chest pain peripheral edema amnesia insomnia memory loss • obtain baseline lipid profile before treatment • obtain diet history and fat consumption • Take drug exactly as directed and don’t exceed recommended amount. • medication should be used along with diet restrictions • contact doctor if unexplained muscle pain/ tenderness/weakness occurs ORAL DOCUSATE SODIUM • constipation • prevention of opioid induced constipation • hypersensitivity • abdominal pain, nausea, vomiting associated with fever • • • • nausea vomiting diarrhea abdominal cramps • electrolyte imbalance • urinary discoloration • rash • before administering, determine if patient has adequate fluid intake, exercise & diet • laxative should be used for short-term therapy • use other forms of bowel regulation (>fluid intake) • for cardiac patients, avoid straining during BM ORAL FAMOTIDINE • heartburn, acid indigestion, • hypersensitivity sour stomach • phenylketonuria (birth • management of GERD defect; build up in body) • active duodenal ulcers • benign gastric ulcers • • • • nausea diarrhea drowsiness dizziness • arrhythmias • agranulocytosis (severe <WBC) • aplastic anemia (no RBC production) • assess patient for abdominal pain • look for blood in emesis, stool, gastric aspirate • Take drug exactly as directed and the full course even if they’re feeling better. • May cause drowsiness; avoid driving • avoid drinking alcohol ORAL FERROUS SULFATE • iron deficiency anemia • hypersensitivity • hemochromatosis (iron overload) • hemosiderosis (iron overload w/o tissue damage) • • • • nausea vomiting constipation dark stools • GI bleeding • syncope • GI upset may be related to dose • monitor Hb level, hematocrit, & reticulocyte count during therapy • explain purpose of iron therapy • advise patient that stools may be dark green/black • follow diet high in iron ORAL FUROSEMIDE • edema (heart failure, renal disease) • hypertension • hypersensitivity • cross-sensitivity with thiazides & sulfonamides • hepatic coma • • • • nausea vomiting diarrhea dehydration • Stevens-Johnson syndrome (skin disorder) • agranulocytosis • aplastic anemia (no RBC production) • monitor vital signs with long-term use • stop if oliguria (low urine) occurs • monitor glucose levels in diabetic patients • Take drug exactly as directed and don’t exceed recommended amount. • change positions to reduce orthostatic hypotension • call doctor if gained >3lbs in 1 day ORAL GABAPENTIN • partial seizures • posterepetic nerualgia • hypersensitivity • • • • dizziness drowsiness confusion depression • hypersensitivity reactions • suicidal thoughts • monitor patients taking or starting AEDs for changes in behavior (depression, suicidal thoughts) • If ordered to stop, gradually stop drug >1 week to minimize risk of seizures. • Take drug exactly as directed and don’t exceed recommended amount. • May cause drowsiness; avoid driving • call doctor if thoughts of suicide, depressions anxiety occur. 3 ROUTE MEDICATIONS INDICATIONS CONTRAINDICATIONS SIDE EFFECTS ADVERSE REACTIONS NURSING CONSIDERATION insomnia tachycardia arrhythmias angina pectoris • assess apical pulse & BP periodically throughout therapy • assess for tachyarrhythmias & chest pain • monitor thyroid function prior to and during therapy PATIENT TEACHINGS ORAL LEVOTHYROXINE • thyroid supplement of hypothyroidism • euthyroid goiters • hypersensitivity • MI • hyperthyroidism • • • • vomiting diarrhea sweating headache • • • • ORAL ONDANSETRON • prevent nausea & vomiting associated with chemo or radiation • hypersensitivity • use with apomorphine • • • • diarrhea constipation headache dizziness • Serontonin syndrome • monitor S/S for serotonin • Take medication as • stevens-johnson syndrome syndrome (mental status directed changes) • call healthcare professional • assess for rash periodically immediately if you have irregular heart beat, serotonin syndrome, involuntary eyes/face/limbs movement ORAL POTASSIUM CHLORIDE • potassium depletion • hyperkalemia • severe renal impairment • untreated Addison’s disease • • • • nausea vomiting diarrhea flatulance • arrhythmias • GI ulceration • paresthesia (pins & needles) • Assess S/S of hypokalemia • Take medication as directed • correct method of administration • encourage compliance with recommended diet TOPICAL NITROGLYCERIN PATCH • long-term prophylactic manamgent of angina pectoris • hypersensitivity • increase intracranial pressure • severe anemia • • • • nausea vomiting dizziness headache • hypotension • tachycardia • contact dermatitis • assess location, duration, intensity & precipitating factors of anginal pain. • monitor BP & pulse before & after administering • Take drug exactly as directed, even if feeling better. • change positions slowly to minimize orthostatic hypotension • avoid drinking alcohol • notify healthcare professional if dry mouth or blurred vision occurs IV PANTOPRAZOLE • GERD • hypersensitivity • diarrhea • headache • flatulence • C. Diff associated diarrhea • bone fracture • systemic lupus erythmetosis • assess routinely for epigastric or abdominal pain • take medication as directed, finish therapy even if feeling better • notify health care professional if fever and diarrhea develop IM CYANOCOBALAMIN • Vitamin B12 deficiency • pernicious anemia • hypersensitivity • • • • diarrhea headache itching swelling of the body • • • • anaphylaxis HF Pulmonary edema hypokalemia • assess patient for signs of vitamin B12 deficiency before and periodically during therapy • Foods high in Vitamin B12 (meat, seafood, eggs) • Encourage patient to comply with diet recommendations • emphasize importance of follow-up exams & evaluate progress EYE DROP LATANOPROST OPTHALMIC SOLUTION • Increased IOP with ocular HTN or open-angle glaucoma • hypersensitivity • intraocular inflammation • • • • dry eye itching rash lid discomfort • • • • angina blurred vision eye pain back pain • Don’t give drug while patient is wearing contact lenses • don’t exceed once-daily dosing • Inform patient that risk that iris color may change in treated eye • Inform patient that darkening of eyelid may • tell patient to remove contacts before instilling solution and wait 15 minutes before inserting them 4 • Take medication at the same time each day • explain that this is a lifelong therapy
