The
Drug Notebook
NCLEX Review and Remediation Project (NRR Project)
The purpose of this Drug Notebook is to ensure that
the nurse is able to provide safe care related to the
administration and monitoring of clients taking
commonly prescribed medications.
Table of Contents
Template
5
Alpha1 Adrenergic Blockers
6
Angiotensin Converting Enzyme Inhibitors (ACEIs)
7
Angiotensin Receptor Blockers (ARBs)
9
Anti-Alzheimer/Dementia Agents
10
Antianginals - Nitrates
12
Antibiotics - Aminoglycosides
13
Antibiotics - Cephalosporins
14
Antibiotics- Fluoroquinolones
15
Antibiotics - Macrolides
16
Antibiotics - Penicillins
18
Antibiotics - Sulfonamides
19
Antibiotics - Tetracyclines
20
Anticoagulants
21
Anticonvulsants / Anti Seizure Agents
22
Antidepressants - Selective Serotonin Reuptake Inhibitors
(SSRIs)
24
Antidepressants - Tricyclic Antidepressants (TCAs)
25
Antidiabetics - Insulin
26
Antidiabetics - Sulfonylureas
28
Antidiabetics - Other Antidiabetic Agents
29
Antidiarrheals
31
Antiemetics
32
Antifungals
34
Antihistamines
35
Antineoplastics
37
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Antiparkinsonism Agents
38
Antiplatelets Agents
39
Antipsychotics
40
Antitubercular Agents (Tuberculosis Drugs)
42
Antiulcer (Acid controlling drugs)
43
Antivirals
44
Anxiolytic (Anti-Anxiety) - Benzodiazepines
46
Atropine Sulfate (Anticholinergic)
47
Beta-Adrenergic Blockers
48
Bisphosphonates - Bone reabsorption inhibitors
50
Bronchodilators - Non anti-inflammatory
51
Bronchodilators - Anti-Inflammatory
53
Calcium Channel Blockers
54
Central Nervous System (CNS) Stimulants
55
Corticosteroids
57
Diuretics - Loop (Potassium-Wasting)
58
Diuretics - Osmotic
59
Diuretics - Potassium-Sparing
60
Electrolyte Replacement - Potassium
61
Electrolyte Replacement - Magnesium
62
Electrolyte Replacement - Calcium
63
Erectile Dysfunction Drugs
64
Hematopoietic Agents - Erythropoietin Alfa
65
Hematopoietic Agents - Filgrastim
66
Immunosuppressants - T & C Cell Suppressors
67
Laxatives
68
Lipid-Lowering Agents - HMG- CoA Reductase Inhibitors
69
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Lipid-Lowering Agents - Bile Acid Sequestrants
70
Migraine-Specific Drugs (Triptans)
71
Non-Opioid Analgesics
72
Opioid Analgesics
74
Sedatives - Hypnotics
75
Skeletal Muscle Relaxants
76
Thyroid Hormone (T4) Replacement
78
Urate-lowering Drugs (antigout)
79
Urinary Antispasmodic
80
Pediatric Considerations
81
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Template
The Drug Notebook
Class: ______________
Medications
(Generic Name)
Therapeutic Uses
Mechanism of action
Contraindications
Major Adverse Effects (common)
Nursing Considerations
(consider nursing assessments and interventions specific to drug therapy; known drug
interactions; routes of administration)
Additional Notes
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The Drug Notebook
Alpha1 Adrenergic Blockers
Medications
Therapeutic Uses
doxazosin
prazosin
terazosin
tamsulosin
Control blood pressure or treat the symptoms
associated with benign prostatic hyperplasia
(BPH).
Mechanism of action
Alpha1 blockers work by inhibiting the alpha1 receptor sites, which causes decreased vascular
muscle tone and vasodilation. This leads to a decreased blood pressure and relaxation of the
prostate and bladder neck in (BHP) clients. Alpha 1 blockers are metabolized in the liver and
excreted in the feces, bile or urine.
Contraindications
Major Adverse Effects (common)
It is unknown if these medications cross the
placenta, but they could cross into breast milk
and cause adverse effects for the newborn.
The side effects are associated with the
sympathetic nervous system. All alpha 1 blockers
share similar side effects such as hypotension,
dizziness, loss of muscle strength and energy
(asthenia), headache and edema.
Doxazosin should be used with caution in
client's suffering from constipation,
gastrointestinal obstruction, ileus or liver
impairment.
Terazosin, prazosin and tamsulosin are
contraindicated for clients that have undergone
cataract or glaucoma surgery and should be
used with caution in clients that have a history
of angina or orthostatic hypotension.
Nursing Considerations
● Prior to the first dose, obtain baseline data. Important baseline data includes blood
pressure, pulse, fluid volume status and weight. Important laboratory results include BUN
and creatinine.
● Administer the first dose of the medication at bedtime to prevent a syncopal episode,
which is a risk with Alpha 1 blockers. The client should be considered at an increased risk
for falls.
● Monitor the client's blood pressure, pulse, fluid volume status, weight, gastrointestinal
function, muscle strength and liver function.
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● Teach the client (or reinforce teaching) to change positions slowly to prevent orthostatic
hypotension, how to monitor and record blood pressure and pulse, when to notify the
health care provider, and to consult the HCP prior to discontinuing the medication.
● If appropriate, instruct and encourage the client to make lifestyle changes to decrease
blood pressure and increase effectiveness of the medication. Important lifestyle changes
include managing weight, increasing activity level and changing unhealthy dietary
practices (low sodium).
The Drug Notebook
Angiotensin Converting
Enzyme Inhibitors (ACEIs)
Medications
Therapeutic Uses
captopril
enalapril
lisinopril
ramipril
Control blood pressure, treat heart failure and
prevent cerebrovascular accidents (CVA;
stroke). They are also used as a kidney
protectant for clients with diabetic nephropathy.
Mechanism of action
ACE inhibitors work in the lungs to prevent the angiotensin converting enzyme (ACE) from
converting angiotensin I to angiotensin II, a potent vasoconstrictor. This results in a lowered blood
pressure and a decrease in aldosterone secretion. These medications are metabolized in the liver
and excreted in the urine and feces.
Contraindications
Major Adverse Effects (common)
ACE inhibitors should be used with caution in
clients that have impaired renal function or
renal artery stenosis.
Side effects of ACE inhibitors are related to
the vasodilatory effects, blood flow alterations
and a decrease in aldosterone secretion.
Common side effects include chest pain,
persistent cough, hypotension, rash,
hyperkalemia and loss of taste. While rare,
angioedema, hepatotoxicity, pancreatitis,
pancytopenia and renal damage can occur
with ACE inhibitor use.
These medications are known to cross the
placenta and cause severe fetal abnormalities
and death.
ACE Inhibitors are contraindicated for clients
with a history of ACE Inhibitor-induced
angioedema.
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Nursing Considerations
● Prior to the first dose, verify that the client does not have a history of ACE
inhibitor-induced angioedema. This is a rare complication that causes swelling of the face
or tongue and may rapidly lead to cardiac arrest. If angioedema is noted, it is a medical
emergency and the health care provider should be notified immediately.
● Obtain important baseline data prior to administering. Important baseline data include
blood pressure, pulse rate and rhythm and fluid volume status. Important laboratory
assessments include BUN, creatinine, sodium and potassium. For women of childbearing
age, a negative pregnancy test should be confirmed.
● Monitor the client's vital signs, electrolytes and fluid volume status when these
medications are being used. First-dose hypotension has been associated with ACE
Inhibitor use, especially in clients suffering from heart failure, hyponatremia or volume
depletion.
● Teach the client (or reinforce teaching) to change position slowly to prevent hypotension,
to avoid potassium supplements and to consult the health care provider prior to
discontinuing the medication. Women of childbearing age should use barrier
contraceptives to prevent pregnancy. Additionally, if the client becomes pregnant, ACE
inhibitors should be discontinued. Clients should not breastfeed while using ACE
inhibitors.
● When clients experience a persistent cough, they often discontinue their use of ACE
Inhibitors. Remind the client to consult with their HCP before they discontinue this
medication and that many over-the-counter cough, cold and allergy medications may
exacerbate hypertension.
● If appropriate, instruct and encourage the client to make lifestyle changes to decrease
blood pressure and increase effectiveness of the medication. Important lifestyle changes
include managing weight, increasing activity level and changing unhealthy dietary habits.
Drug-Specific Considerations
Captopril
● The client should take medication on an empty stomach one hour before meals or two
hours after meals.
● Tablets may be crushed to aid in swallowing.
● Let the client know that they may experience a loss of taste for 2-3 months. The nurse
should monitor nutritional intake.
Enalapril
● Cardiovascular adverse reactions may occur, especially when given parenterally.
● When given parenterally, monitor blood pressure before and after administration, and the
medication should be administered over 5 minutes.
Lisinopril
● The client can take lisinopril without regard to food.
● Tablets may be crushed to aid in swallowing.
Ramipril
● The client can take ramipril without regard to food.
● The contents of the capsule can be mixed with water, juice or applesauce to aid in
swallowing.
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The Drug Notebook Angiotensin Receptor Blockers
(ARBs)
Medications
Therapeutic Uses
valsartan hydrochlorothiazide
valsartan
losartan
candesartan
irbesartan
Control blood pressure and treat heart failure.
They are used with clients who cannot tolerate
ACE inhibitors and to reduce mortality in
high-risk clients following myocardial infarctions
(MIs).
Mechanism of action
ARBs prevent the powerful vasoconstrictor, angiotensin II, from binding to the angiotensin II
receptors on the vascular smooth muscles and adrenal cortex. As a result, blood vessels dilate
and blood pressure is lowered. ARBs are metabolized in the liver and secreted in feces and urine.
Contraindications
Major Adverse Effects (common)
ARBs are known to cross the placenta and
cause severe fetal abnormalities and death.
Side effects associated with ARBs are related
to the decrease in blood pressure. Common
side effects of all ARBs are headache,
dizziness, syncope and weakness. Other side
effects include abdominal discomfort, back
pain, tooth pain and symptoms commonly
associated with an upper respiratory
infection.
Dry mouth, dry skin
Nursing Considerations
●
●
●
●
Obtain important baseline data prior to administering the first dose. Important data
include blood pressure, pulse, weight, respiratory status, and gastrointestinal
function.
Before the first dose, verify baseline laboratory values for liver function and kidney
function. Important laboratory data includes liver function tests and BUN and
creatinine levels.
For women of childbearing age, a negative pregnancy test should be confirmed.
Instruct the client to take measures to prevent pregnancy while taking ARBs. If the
client becomes pregnant, she should discontinue using ARBs. The client should not
breastfeed while using ARBs.
Monitor the client's vital signs, respiratory status, and gastrointestinal function during
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●
continued ARB use.
If appropriate, instruct and encourage the client to make lifestyle changes to decrease
blood pressure and increase effectiveness of the medication. Important lifestyle
changes include weight management, increasing activity level and dietary changes
(low sodium).
The Drug Notebook
Anti-Alzheimer’s Dementia
Agents
Medications
Therapeutic Uses
Cholinesterase inhibitors
donepezil
galantamine
rivastigmine
NMDA (N-Methyl-D-aspartate) receptor
antagonists
memantine hydrochloride
Slow the progression of Alzheimer's disease.
Alzheimer's disease is a degenerative
condition of the cerebral cortex that results in
a decrease in the number of
acetylcholine-producing cells and cholinergic
receptors. These changes lead to progressive
dementia, resulting in decreased cognitive
functioning (memory, attention and
reasoning). These medications are often
prescribed based on the severity of dementia.
Mechanism of action
Cholinesterase inhibitors work by affecting the chemical neurotransmitter, acetylcholine.
Acetylcholine is broken down by the enzyme, acetylcholinesterase (cholinesterase). These
agents prevent the breakdown of acetylcholine by blocking the activity of
acetylcholinesterase. Cholinesterase inhibitors are metabolized by the liver eliminated in the
urine and feces.
NMDA receptor antagonists work by decreasing the effects of glutamine, the principal
excitatory neurotransmitter in the brain, which is involved in the processing, storage and
retrieval of information. Memantine hydrochloride undergoes minimal metabolism and is
excreted in the urine unchanged.
Contraindications
Major Adverse Effects (common)
Cholinesterase inhibitors should be used with
caution in clients that have a history of
asthma, COPD, bradycardia, bladder
The side effects of Anti-Alzheimer's Agents
are associated with the nervous system and
include headache, insomnia, generalized pain,
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obstruction and ulcer disease. It is unknown
if these drugs cross into breastmilk.
Galantamine, rivastigmine, and memantine
hydrochloride should not be used in clients
diagnosed with severe renal impairment.
Galantamine and rivastigmine should not be
used in clients with low body weight, due to
the side effect of anorexia.
dizziness, anorexia and diarrhea/increased
frequency of bowel movements, nausea,
vomiting, anorexia. NMDA receptor
antagonists have an additional common side
effect including hypertension and cough.
Excessive accumulation of ACh result in a
cholinergic crisis. This is usually manifested
by severe nausea, diaphoresis, bradycardia,
hypotension, increased salivation, muscle
weakness, seizures, respiratory depression
and cardiac arrest. The antidote for an
anticholinergic inhibitor overdose is atropine
sulfate given IV.
Nursing Considerations
●
●
●
●
●
●
Prior to the first dose, obtain baseline data. Important baseline data include
assessment of cognitive function, vital signs, and a medical history that would indicate
that anticholinesterase inhibitors are contraindicated such as an allergy or and severe
renal disease.
The first dosage of cholinesterase inhibitors should be the lowest possible dose. The
dosage should be gradually increased to minimize cholinergic side effects. Donepezil
can be given without regard to food and is best taken at bedtime. However,
galantamine and rivastigmine should be given with meals.
Monitor the client's cognitive function, intake and output, renal function, and weight.
Continual monitoring should also include assessing for signs and symptoms of a
cholinergic reaction or crisis (increased salivation, diaphoresis, bradycardia,
hypotension).
Teach the client and caregivers (or reinforce teaching) on the signs and symptoms of
an overdose. Assure that the client and caregivers understand that these medications
are not a cure for Alzheimer's disease, but slow the progression. Clients and
caregivers may benefit from a referral to a local Alzheimer's chapter as a supportive
resource.
Monitor for GI distress and bleeding
Monitor serum transaminase (ALT)levels
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The Drug Notebook
Antianginals
Nitrates
Medications
Therapeutic Uses
isosorbide mononitrate
nitroglycerin
Prevent and treat angina pectoris.
Mechanism of action
Nitrates work by relaxing and dilating blood vessels, which decreases venous return and
arterial blood pressure. These actions in turn reduce the cardiac workload. The result is an
increase in the supply of oxygen-rich blood to the myocardium and a decrease in the
myocardial oxygen demand. Nitrates are metabolized by the liver and excreted in the urine.
They cross the placenta and enter breast milk.
Contraindications
Major Adverse Effects (common)
Nitrates are contraindicated for clients that
are taking sildenafil (erectile dysfunction)
especially within 24-36 hours of taking a
nitrate as could cause severe hypotension.
Additional contraindications for nitrate use
include severe anemia, cerebral trauma or
cerebral hemorrhage. Caution should be
used in clients that have hepatic or renal
impairment, hypotension or hypovolemia.
The common side effects associated with
nitrate use are due to the mechanism of
action and resulting vasodilation. Common
side effects occur in the central nervous
system (headache, dizziness, syncope),
gastrointestinal system (nausea and
vomiting) and the cardiovascular system
(hypotension, reflex tachycardia, and
increased angina).
Nursing Considerations
●
●
●
Prior to the first dose, obtain important baseline data including: blood pressure, heart
rate, history of taking sildenafil.
Monitor clients for signs and symptoms of worsening or unrelieved angina,
hypotension, reflex tachycardia, loss of consciousness or cardiac dysrhythmia. The
client may suffer from a headache related to this medication and can take common
pain relievers to treat the headache.
Teach the client (or reinforce teaching) to change position slowly to prevent postural
hypotension.
Additional Notes
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Essential information for the client to know while carrying sublingual nitroglycerin
after discharge includes:
●
●
●
Potency is lost approximately three months after opening the bottle.
Keep a fresh supply of nitroglycerin on hand and store tablets in an airtight, dark
glass bottle with a metal cap.
If three sublingual tablets taken over a 15-minute period do not alleviate the chest
pain, this may indicate a myocardial infarction and the client should call 911
immediately.
Antibiotics
The Drug Notebook
Aminoglycosides
Medications
Therapeutic Uses
amikacin
gentamycin
tobramycin
Aminoglycosides are bactericidal,
anti-infective agents used to treat severe
infections.
Mechanism of action
Aminoglycosides are powerful bactericidal agents that treat gram-negatives. They inhibit
protein synthesis in bacteria and compromise the structure of the bacterial cell wall, leading
to cell death. Aminoglycosides are poorly absorbed in the GI tract, but rapidly absorbed after
injection. They are excreted unchanged in the urine, cross the placenta and enter breast
milk.
Contraindications
Major Adverse Effects (common)
Aminoglycosides are contraindicated for
clients with renal or hepatic disease due to
the increased risk of toxicity, preexisting
hearing loss, herpes infection, myasthenia
gravis, Parkinson's or breastfeeding. If these
medications are used in pregnancy, they
may result in congenital deafness.
Aminoglycosides contain a Black Box Warning
concerning nephrotoxicity and irreversible
ototoxicity.
Other common side effects include anorexia,
nausea, vomiting, diarrhea and pain at the
injection site.
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Nursing Considerations
●
●
●
●
Prior to the first dose, obtain baseline data, including: auditory, renal, and hepatic
function.
Aminoglycosides are fairly toxic, so they are given for the shortest period of time.
Therapeutic serum levels may be drawn to ensure adequate dosing. These serum labs
include a peak and trough.
Monitor the client for signs and symptoms of worsening infection, tinnitus and vertigo.
Fungal superinfections may occur due to the decrease in resident bacteria.
Teach the client (or reinforce teaching) to report any changes in bowel patterns or
discomfort, tinnitus, or perceived changes in hearing to their HC
Antibiotics
The Drug Notebook
Cephalosporins
Medications
Therapeutic Uses
cephalexin (first generation)
cefuroxime (second generation)
cefdinir (third generation)
cefepime (fourth generation)
The generations of cephalosporin vary in
spectrum. The first generation is considered a
narrow spectrum and the fourth generation
includes broad-spectrum antibiotics that are
effective against many respiratory tract
infections, skin and soft-tissue infections, and
urinary tract infections.
Mechanism of action
Cephalosporins are bactericidal agents that inhibit bacterial cell wall synthesis. These
medications are excreted in the urine.
Contraindications
Major Adverse Effects (common)
Cephalosporins are contraindicated for
clients that have an anaphylactic reaction to
penicillin. Caution should be used when
administering to clients with renal
impairment, history of a GI ulcerative
disease or history of a penicillin allergy.
Common side effects of cephalosporins
include oral or vaginal candidiasis, diarrhea,
and abdominal cramping. Occasionally, a
serum sickness-like reaction may occur,
which manifests as fever and arthralgia. Due
to the imbalance of resident bacteria,
antibiotic-associated colitis and other
superinfections may occur.
Nursing Considerations
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●
●
●
Prior to administration of antibiotics, the nurse should ensure a culture and sensitivity
has been obtained. Additionally, baseline data before administration should include
renal function, respiratory status, vital signs and a baseline skin assessment to
determine if a hypersensitivity reaction has occurred.
Monitor the client for candidiasis within the oral cavity and genitals, or any changes in
bowel patterns.
Teach the client (or reinforce teaching) to complete the full regimen and report
candidiasis or persistent diarrhea.
The Drug Notebook
Antibiotics
Fluoroquinolones
Medications
Therapeutic Uses
ciprofloxacin
levofloxacin
moxifloxacin
Treat gram-negative and gram-positive
bacteria that infect primarily the lower
respiratory system, skin and soft tissues,
urinary tract and sexually transmitted
diseases. Levofloxacin has been found to be
effective against inhalation anthrax infections.
Mechanism of action
Fluoroquinolones are bactericidal and act by directly inhibiting DNA replication and repair in
bacteria. These medications are metabolized in the liver and excreted unchanged in the
urine.
Contraindications
Major Adverse Effects (common)
Fluoroquinolones are contraindicated for
clients that have a history of a
hypersensitivity reaction to the specific
fluoroquinolone medication, or any
quinolones. Ciprofloxacin is contraindicated
in children under 18 years of age due to the
risk of tendonitis and tendon rupture.
Caution should be used when administering
these agents to clients with diabetes, renal
impairment, rheumatoid arthritis, prolonged
Common side effects of fluoroquinolone use
include GI distress, confusion and crystalluria.
Colitis and photosensitivity have been
reported with fluoroquinolone use. For
ophthalmic use, burning of the eyes and a
crusty discharge may occur. Fluoroquinolones
contain a Black Box Warning due to the
increased likelihood of tendonitis and tendon
rupture.
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QT intervals and myasthenia gravis.
Nursing Considerations
●
●
●
●
●
●
Superinfections, colitis, diarrhea
Prior to the first dose, obtain baseline data including obtaining a culture and
sensitivity test, reviewing for a history of hypersensitivity reactions, impaired renal
function or liver function, and an EKG to rule out prolonged QT intervals.
During and after the first dose, monitor the clients for hypersensitivity reactions
including rash, pruritus and flushing. Oral ciprofloxacin and levofloxacin should be
administered with a glass of water one hour before or two hours after meals, antacids
or iron supplements.
During fluoroquinolone use, monitor for muscle weakness or tendon swelling, serum
glucose, gastric upset and photosensitivity.
Teach the client (or reinforce teaching) to maintain hydration and report diarrhea,
bloody stools, muscle weakness or tendon swelling to their HCP, and to complete the
full course of antibiotics regardless of symptom improvement
Avoid with milk, antacids
The Drug Notebook
Antibiotics
Macrolides
Medications
azithromycin
clarithromycin
erythromycin
Therapeutic Uses
Treat primarily gram-positive bacterium, but
are effective against certain gram-negative
cocci. These medications are used in various
systemic and local infections of the
respiratory tract and soft tissues such as the
skin, and sexually transmitted diseases.
Azithromycin and clarithromycin are used as
prophylaxis for endocarditis before dental
procedures. Azithromycin is also used as
prophylaxis for pulmonary exacerbations in
clients with cystic fibrosis. Clarithromycin is
used for prophylaxis in pertussis and Lyme
disease.
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Mechanism of action
Macrolides are bacteriostatic agents that inhibit bacterial growth and reproduction by
interfering with the bacteria's ability to make proteins. These medications are metabolized in
the liver and excreted in the urine.
Contraindications
Major Adverse Effects (common)
Macrolides are contraindicated in clients with
a history of hepatic impairment related to
azithromycin use. Macrolides are also
contraindicated for clients using ergot
alkaloid derivatives such as lovastatin,
simvastatin and ergotamine due to the risk
of lingual ischemia. Caution should be used
in clients that have hepatic or renal
impairment, liver disease, myasthenia gravis
or prolonged QT intervals. Common
aluminum or magnesium antacids can
decrease absorption.
Common side effects of macrolides include
nausea, vomiting and diarrhea. In topical use,
dry skin is often reported. For macrolides
given intravenously, a side effect is pain and
redness at the injection site. Clarithromycin
has additional side effects of headaches and
altered taste.
Older clients who take calcium channel
blockers (CCB) or other medications that
prolong QT waves are at risk for hypotension
or shock if they take erythromycin or
clarithromycin.
Nursing Considerations
●
●
●
●
Prior to the first dose, obtain baseline data. Important baseline data include obtaining
a culture and sensitivity test, and reviewing for history of hypersensitivity reactions,
impaired renal function or liver function, and an EKG to rule out prolonged QT
intervals.
During and after the first dose, monitor the client for hypersensitivity reactions
including rash, pruritus, and flushing. Azithromycin and clarithromycin can be
administered without regard to food.
During macrolide use, monitor the client for GI upset and bowel patterns, liver
function, and pruritus.
Teach the client (or reinforce teaching) to report diarrhea, avoid aluminum and
magnesium antacids, and to complete the full dose of macrolide agents even if
symptoms improve.
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The Drug Notebook
Antibiotics
Penicillins
Medications
Therapeutic Uses
amoxicillin
ampicillin
penicillin
Broad spectrum antibiotics that are commonly
used to prevent or treat bacterial infections
including streptococcal infections, syphilis and
Lyme disease.
Mechanism of action
Penicillin are a large group of bactericidal agents that work by inhibiting bacterial cell wall
production. Penicillins are metabolized in the liver and excreted in the urine.
Contraindications
Major Adverse Effects (common)
Penicillins are contraindicated for clients that
have cephalosporin-related anaphylaxis.
Caution should be used when administering
penicillin to clients with a history of renal or
hepatic impairment, a seizure disorder,
asthma, or hypersensitivity reaction to
cephalosporins.
All penicillins have similar side effects that
include allergic reactions, renal, hepatic and
hematologic abnormalities, nausea, vomiting
and diarrhea, lethargy and electrolyte
imbalances.
Nursing Considerations
●
●
●
Prior to the first dose of penicillin, obtain important baseline data including serum
electrolytes, integumentary assessment and liver/kidney function tests. The nurse
should verify that a client does not have a pre-existing penicillin or cephalosporin
allergy.
Monitor the client's serum electrolytes, intake and output, renal function, and signs
and symptoms of a hypersensitivity reaction or antibiotic-associated colitis.
Teach the client (or reinforce teaching) to report diarrhea, topical rash or ecchymosis,
and the importance of completing the full medication regimen even if symptoms
improve.
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Antibiotics
The Drug Notebook
Medications
Sulfonamides
Therapeutic Uses
sulfamethoxazole- trimethoprim
Treat urinary tract infections, ulcerative
colitis, Crohn's disease, some types of
bacterial pneumonia and shigellosis. They are
also effective in treating some protozoal
infections, otitis media and toxoplasmosis.
Mechanism of action
Sulfonamide antibiotics work by disrupting the production of dihydrofolic acid, a form of folic acid
that bacteria and human cells use for producing proteins.
Contraindications
Major Adverse Effects (common)
Sulfonamides are a common allergy affecting
about 3% of the population. Clients with a
history of allergic reactions to sulfonamides,
sulfamethoxazole, or trimethoprim should
not take these medications. Other
contraindications are during pregnancy and
in newborns less than 2 months old due to
the risk of kernicterus. Caution should be
used with clients of advanced age due to the
increased risk of photosensitivity, and with
clients who have a history of renal
dysfunction, hepatic impairment or asthma.
Side effects may include hypersensitivity
reactions, which are often delayed 7-14 days
after the initiation of sulfonamides; these
include rash, urticaria, purpura and shortness
of breath. Common side effects include
anorexia, nausea and vomiting.
Nursing Considerations
●
●
●
Prior to the first dose, obtain important baseline data including any history of asthma
or a hypersensitivity reaction to trimethoprim, sulfonamide, or sulfites. Additionally,
the nurse should ensure a culture and sensitivity has been obtained.
After the initiation of sulfonamides, the nurse should monitor for signs and symptoms
of a hypersensitivity reaction, or changes in bowel patterns, integumentary, renal
function, hepatic function and hematological function.
Teach clients (or reinforce teaching) to maintain hydration, report any new signs and
symptoms that could indicate a hypersensitivity reaction, avoid prolonged sun
exposure, and complete the full medication regimen even if symptoms improve.
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Antibiotics
The Drug Notebook
Tetracyclines
Medications
Therapeutic Uses
doxycycline
minocycline HCL
Treat respiratory tract infections, skin
infections, genital infections (e.g. syphilis,
chlamydia) and urinary tract infections. They
are also used as prophylaxis for malaria.
Mechanism of action
Tetracyclines are bacteriostatic agents that exert their effect by inhibiting protein synthesis.
Tetracyclines are metabolized in the liver and eliminated in the bile and urine.
Contraindications
Major Adverse Effects (common)
Tetracyclines are contraindicated in clients
with a history of a tetracycline or
sulfite-related hypersensitivity reaction,
pregnant women, or if they are children less
than 8 years old. Tetracycline use during
pregnancy and in childhood have been
associated with permanent discoloration of
teeth. Caution should be used in clients with
a predisposition to candidiasis and renal,
hepatic or hematologic impairment.
Common side effects of tetracyclines include
photosensitivity, anorexia, GI upset, diarrhea,
and renal, hepatic and hematologic
abnormalities. Tetracyclines have also been
associated with an increase in intracranial
pressure (ICP).
Nursing Considerations
●
●
●
●
●
Prior to the first dose, obtain important baseline data including obtaining a culture and
sensitivity test and verifying that no tetracycline or sulfite hypersensitivity reactions
have occurred in the past.
The nurse should also perform a central nervous system assessment, verification of
pregnancy status and evaluate renal and hepatic function.
Monitor the client's renal function and bowel patterns. Assess the client for any signs
of a hypersensitivity reaction, increased ICP, or a superinfection (oral or genital).
Teach the client (or reinforce teaching) about the use of barrier contraceptives due to
the decreased effectiveness of oral contraceptives.
Encourage clients to wear protective clothing while in direct sunlight, to avoid taking
tetracyclines with antacids or iron products and to complete the full course of
tetracyclines even if symptoms improve.
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The Drug Notebook
Anticoagulants
Medications
Uses
Heparin
Prevent arterial and venous thrombi associated
with stroke, heart valve disease, coronary artery
disease, heart failure, dysrhythmia, atrial
fibrillation, and deep vein thrombosis.
Enoxaparin (low-molecular weight heparin
(LMWH))
Warfarin
Mechanism of action
Anticoagulant medications inhibit clotting factor synthesis
Contraindications
Major Adverse Effects (common)
If a client has an underlying coagulation
disorder, peptic ulcer disease, malignancy,
recent surgery or active bleeding, they should
not be taking an anticoagulant.
Side effects of these medications are related to
their therapeutic use, including bleeding and
fever.
If a client is pregnant or lactating, she should
not receive warfarin.
Heparin and heparin-like agents should be
used cautiously in clients receiving epidural
analgesia.
The nurse should monitor for bleeding and
anemia in clients receiving these medications.
Since heparin and enoxaparin are injections,
pain and bruising at the injection site is
common.
Heparin has an added concern of
heparin-induced thrombocytopenia.
Nursing Considerations
● Treatment is considered effective when there are no signs of thrombosis, embolism, stroke,
or myocardial infarction (MI), ultimately preventing death in at-risk clients.
● The nurse will monitor clients taking anticoagulant medications for bruising or bleeding; tarry
stools; hematuria; decrease in serum platelet and hematocrit levels or blood pressure.
● For clients taking anticoagulants, discharge instructions should include: information on
obtaining and wearing a medical alert bracelet, using a soft toothbrush, using an electric
razor and reporting to the provider if the client experiences bleeding gums, excessive
bruising, epistaxis (nose bleeds) and/or tarry stools. Clients taking warfarin should
consistently consume foods high in Vitamin K such as green, leafy vegetables, fish, liver,
meat and eggs.
● Herbs that can interact with anticoagulant medications include garlic, ginger, ginkgo,
ginseng, alfalfa, and chamomile. Vitamin C may prolong the prothrombin time (PT) used to
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●
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●
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monitor warfarin therapy and vitamin E can increase warfarin's anticoagulation effects.
Clients who are on anticoagulants and scheduled for a spinal or epidural procedure must
check with their health care provider (HCP) about how many hours or days before the
procedure the anticoagulant should be stopped. The time frame will depend on the
prescribed anticoagulant and its half-life.
The antidote for heparin is protamine sulfate.
The antidote for warfarin is Vitamin K or fresh frozen plasma (FFP).
Therapeutic effectiveness: Serum PTT lab test for Heparin; serum PT/INR for Warfarin
The Drug Notebook
Anticonvulsants
(Antiseizure Agents)
Medications
Therapeutic Uses
Hydantoins
Phenytoin
Control epileptic seizures and treat the
neuropathic pain associated with diabetes,
shingles, and fibromyalgia. Regarding
seizures, the seizure class and type of seizure
generally determine the appropriate
medication. They can also be used to treat
migraine headaches and bipolar disorder.
Barbiturates and Barbiturate-like Drugs
Phenobarbital
Benzodiazepines
clonazepam
Diazepam
Succinimides
Ethosuximide
Gamma butyric acid (GABA) Inhibitors
valproic acid
Drugs that Treat Partial Seizures
carbamazepine
gabapentin
Generalized seizures involve both
hemispheres of the brain and a loss of
consciousness. Seizures within this category
are febrile, status epilepticus, myoclonic,
atonic, absence and tonic-clonic.
Partial seizures involve one hemisphere of the
brain with no loss of consciousness and
include simple or complex seizures.
Mechanism of action
Hydantoins, barbiturates and benzodiazepines work by stabilizing the nerve membranes
throughout the central nervous system (CNS), which decreases excitability related to
stimulation. These medications are metabolized in the liver and excreted in the urine.
Valproic acid is a medication used to treat absence seizures by increasing the inhibitory
effects of gamma butyric acid (GABA).
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Contraindications
Major Adverse Effects (common)
Most anticonvulsants (hydantoins,
barbiturate and barbiturate-like medications,
benzos) are associated with significant birth
defects and should not be used during
pregnancy or lactation. Caution should be
used when giving these medications to
clients with cardiac dysrhythmias, liver
impairment or renal impairment.
Hydantoins/Barbiturate and Barbiturate-like
drugs: CNS depression (dizziness,
drowsiness, fatigue; unsteadiness; attention
difficult, blurred/double vision), depression,
confusion, constipation, loss of libido, ataxia,
urinary retention, dry mouth, severe liver
toxicity or bone marrow suppression.
Succinimides have fewer incidences of side
effects when compared to other
anticonvulsant agents.
Additional, drug-specific side effects include:
●
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●
●
Hydantoins: severe liver toxicity,
nystagmus and diplopia, rash, gingival
hyperplasia, and or hirsutism.
Barbiturate and barbiturate-like drugs:
dependence and respiratory
depression.
Valproic acid: severe liver toxicity,
pancreatitis and teratogenicity.
Benzodiazepines: dependence.
Carbamazepine: myelosuppression,
fluid overload, diplopia, or rash.
Nursing Considerations
●
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Prior to administering the first dose of medication, determine important baseline data
including a neurological assessment, history of hypersensitivity reactions,
pregnancy/lactation status and, liver and renal function tests.
Monitor clients for hypersensitivity reactions, therapeutic plasma levels for the
medication, liver function and level of consciousness; monitor WBC (leukopenia)
Teach the client (or reinforce important teaching) to speak to their HCP before
discontinuing any anticonvulsant therapy, to avoid alcohol or other CNS depressants
to reduce the risks of severe CNS depression, to use barrier contraceptives to prevent
pregnancy and to avoid activity that requires alertness.
Clients diagnosed with seizures could benefit from information about community
resources and support groups. The client should also wear a medication alert bracelet.
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The Drug Notebook
Antidepressants
Selective Serotonin Reuptake
Inhibitors (SSRIs)
Medications
Therapeutic Uses
citalopram
escitalopram
fluoxetine
paroxetine
sertraline
Treat moderate-to-severe depression and
chronic fatigue syndrome. They also treat
premenstrual dysphoric disorder (PMDD),
obsessive-compulsive disorder (OCD), panic
disorder, post-traumatic stress disorder
(PTSD) and generalized anxiety disorder
(GAD).
Mechanism of action
Selective serotonin reuptake inhibitors (SSRIs) block the reabsorption (reuptake) of
serotonin (5HT).
Contraindications
Major Adverse Effects (common)
Clients who have an allergy to SSRIs should
not take this medication. Clients who are
taking any type of MAOI should not take this
medication.
Most antidepressant medications, including
SSRIs, can cause weight gain of 10 pounds
(or more) in one out of four people.
Additionally, many SSRIs are associated with
sodium level changes, loss of libido and
sexual dysfunction.
Black Box Warning! All antidepressants have
warnings about increased risk of suicidal
ideation or attempts in children and
adolescents.
Nursing Considerations
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Monitor clients for hypersensitivity reactions, hyponatremia and weight changes.
Teach the client (or reinforce teaching) to report any suicidal or homicidal ideations.
Let clients know that therapeutic effects may take up to 4 weeks of use, and that they
should avoid alcohol.
Due to its short half-life and few drug interactions, sertraline is the drug of choice for
treating depression in the elderly. Conversely, due to its long half-life, fluoxetine is a
better choice for children.
Citalopram, escitalopram, fluoxetine, and sertraline can increase the effects of
digoxin, warfarin, and diazepam.
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The Drug Notebook
Antidepressants
Tricyclic Antidepressants(TCAs)
Medications
Therapeutic Uses
These mediations relieve depression and help
treat obsessive compulsive disorder (OCD)
and enuresis. Off-label uses include panic
disorder, bulimia and chronic pain, including
migraine, diabetic neuropathy and
post-herpetic neuralgia.
Also treat anxiety.
amitriptyline
doxepin
imipramine
nortriptyline
Mechanism of action
Tricyclic medications inhibit the presynaptic reuptake serotonin (5HT) and norepinephrine
(NE), resulting in increased levels of these neurotransmitters in the brain. They also block
the action of acetylcholine and histamine (causing many of the side effects of these
medications). They are metabolized in the liver and excreted in the urine.
Contraindications
Major Adverse Effects (common)
TCAs are contraindicated in clients with a
history of recent myocardial infarction or
current MAOI use. Pregnancy and lactation
are contraindicated for TCA use due to fetal
abnormalities. TCAs should be used with
caution in clients with a history of glaucoma,
enlarged prostate, cardiovascular problems,
history of seizures, liver impairment or renal
impairment.
Common side effects of TCAs include
sedation/drowsiness, hallucinations, difficulty
concentrating, and ataxia. Anticholinergic
effects may be evident in the gastrointestinal,
genitourinary, and cardiovascular systems.
These side effects include dry mouth,
constipation, nausea and urinary retention.
Other common side effects include sexual
dysfunction, loss of libido and orthostatic
hypotension.
QT prolongation
TCAs have a black box warning of increased
suicidal ideation, especially in children and
adolescents.
TCAs should be avoided for 24 hours after
myelography due to the drug-to-drug
interaction with the dyes used in these
exams.
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Nursing Considerations
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Prior to the first dose, obtain important baseline data including any history of
hypersensitivity reactions associated with TCAs, blood pressure, pulse, orientation,
affect, and bowel movement patterns.
Monitor clients for adverse effects, suicidal ideation, hypersensitivity reaction or other
side effects related to TCAs.
Teach clients (or reinforce important teaching) to report any suicidal ideation, avoid
alcohol or other CNS depressants, take at night to reduce complications associated
with drowsiness and that continued use is needed to ensure effectiveness (which
could take 4 to 8 weeks).
Antidiabetics
The Drug Notebook
Insulins
Medications
Therapeutic Uses
insulin aspart
insulin glargine
insulin lispro
regular insulin
insulin-isophane suspension
Insulin is used in clients suffering from
diabetes to reduce blood sugar levels by
assisting glucose into the cells to be used as
energy.
Mechanism of action
Insulin is a hormone produced by the beta cells in the islets of Langerhans. Insulin occurs
naturally in the body of clients with properly functioning beta cells. Insulin secretion
increases in response to blood sugar increases, and to incretins (peptides secreted in
response to food). Natural and synthetic insulin works by attaching to receptor sites that
allow glucose to enter the cell and to be used for energy. Insulin is used in the treatment of
type 1 diabetes mellitus (autoimmune destruction of the beta cells in the pancreas) and may
be used to treat type 2 diabetes mellitus (insulin inadequacy or cellular resistance to insulin).
Contraindications
Major Adverse Effects (common)
Insulin is a naturally occurring hormone in
the body. If hypersensitivity reactions occur,
it may be from animal derived insulins,
which are rarely used. It is contraindicated
to give insulin to clients who are suffering
from hypoglycemia, due to the therapeutic
intention of lowering blood sugar.
Insulin is available in a variety of
preparations, which all vary based on onset,
peak, and duration of effectiveness. Due to
the multiple forms, side effects and the
timing of these side effects should be noted.
The side effects of insulin are generally
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related to the route of administration
(injection site discomfort) and the intended
therapeutic effect (lowering blood sugar).
Hypoglycemia is a concern when
administering insulin.
Nursing Considerations
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Before administering a dose of insulin, obtain important baseline information
including: previous reaction to insulin, blood glucose level and the ability of the client
to eat.
Insulin is a high-risk medication and two nurses should independently verify the
insulin to be administered to reduce medication errors.
The nurse should rotate injection sites to decrease the chances of local reactions at
the injection site.
The nurse should be aware of the onset, peak, and duration of the insulin preparation
administered. The side effects and therapeutic effect may be delayed in long-acting
insulin.
Monitor the client for side effects of insulin including hypoglycemia.
Teach the client or caregiver (or reinforce teaching) about blood sugar management
and monitoring, proper injection technique, rotating injection sites, proper
administration of insulin, insulin regimen, dietary changes, carrying a sugar-rich food
source in the case of hypoglycemia, and signs and symptoms of hypoglycemia.
Clients who are taking diabetic medication should wear a medication alert band.
The client could benefit from attending community support groups focusing on
managing diabetes.
Long-acting insulin should never be mixed with other insulins in the same syringe.
Additional Notes
Onset
Peak
Duration
Insulin aspart
(Novolog)
10 to 20 minutes
1 to 3 hours
3 to 5 hours
Insulin lispro
(Humalog)
< 15 minutes
30 to 90 minutes
3 to 5 hours
Insulin regular
30 to 60 minutes
2 to 4 hours
6 to 12 hours
Insulin isophane
(NPH)
1 to 15 hours
4 to 12 hours
18 to 24 hours
Insulin glargine
(Lantus)
60 to 70 minutes
None
24 hours
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Antidiabetics
The Drug Notebook
Sulfonylureas
Medications
Therapeutic Uses
First-Generation
Chlorpropamide
Second-Generation
Glimepiride
Glipizide
Glyburide
To improve insulin availability and binding to
receptor sites for clients with type 2 diabetes.
This decreases blood sugar levels.
Mechanism of action
Sulfonylureas stimulate insulin production by the beta cells and increase binding to the
insulin receptor sites. These medications are metabolized in the liver and excreted in the
urine and bile.
Contraindications
Major Adverse Effects (common)
These medications are contraindicated in
clients that have a history of a
hypersensitivity reaction to any
sulfonylureas. These medications are also
contraindicated in clients with a severe
infection, pregnancy, lactation, or severe
renal or liver impairment. These drugs
should not be used in clients with type I
diabetes, as they do not have functioning
beta cells.
The most common side effect of sulfonylureas
is hypoglycemia related to the intended
therapeutic action. Other common side
effects include gastrointestinal upset,
headache, dizziness, nausea, vomiting, and
diarrhea.
Nursing Considerations
●
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Prior to the first dose of sulfonylureas, a baseline assessment should be conducted of
blood sugar, symptoms of nausea, vomiting, and anorexia (there is an increased risk
of hypoglycemia if the client is not consuming or digesting food).
Monitor blood glucose levels and for signs and symptoms of hypersensitivity reactions.
Teach the client (and reinforce teaching) about healthy dietary habits, exercise,
carrying a quick source of glucose for hypoglycemia emergencies, monitoring blood
glucose levels and avoiding alcohol.
Although these medications will help reduce blood sugar levels, they should be used in
conjunction with diet and exercise.
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The Drug Notebook
Antidiabetics
Other Antidiabetic Agents
Medications
Therapeutic Uses
Alpha-glucosidase Inhibitors: acarbose
Used in the treatment of type 2 diabetes
mellitus.
Biguanide: metformin
Thiazolidinediones: pioglitazone
Dipeptidyl Peptidase-4 Inhibitors (DPP-4
Inhibitors): sitagliptin
Mechanism of action
Biguanides work by improving the insulin's ability to move glucose into cells, especially
muscle cells. Thiazolidinediones enhance insulin effectiveness in both muscle and adipose
tissue.
Additionally, oral agents block enzymes that help digest starches, slowing the rise in blood
sugar (alpha-glucosidase inhibitors) and block an enzyme that deactivates a protein (GLP-1),
which will keep insulin circulating in the blood (DPP-4 inhibitors).
Contraindications
Major Adverse Effects (common)
These medications are contraindicated in
clients that have a history of a
hypersensitivity reaction to medications
within the same subcategory. Additionally,
these medications are all contraindicated
during pregnancy, lactation, renal
impairment, or for those with a history of
pancreatic disease.
Acarbose
Side effects include abdominal pain, diarrhea,
flatulence and rash.
If the client has a history of sulfonamide
allergy, acarbose should not be used due to
the risk of cross-sensitivity.
Metformin
Side effects include headache, weakness,
dizziness, drowsiness, agitation, nausea,
vomiting, diarrhea, lactic acidosis and
flatulence.
Pioglitazone
Side effects include cold symptoms,
headache, sinusitis, respiratory infection,
muscle pain and tooth disorder.
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Sitagliptin
Side effects include pancreatitis, kidney
problems, upper respiratory infection,
headache, rhinitis and sore throat.
Nursing Considerations
●
●
●
Prior to administering the first dose, important baseline information should be
obtained. This information should include a baseline blood sugar level, activity level
and adherence to prescribed diet.
Continual monitoring should be done regarding adherence to the prescribed diet,
nausea, vomiting, anorexia, and signs and symptoms of liver or renal impairment.
Teach the client (or reinforce teaching) to use these medications in conjunction with
diet and exercise, monitoring blood glucose levels, recognizing the signs and
symptoms of hypoglycemia, responding to hypoglycemia with a quick source of sugar
and wearing a medical alert band.
Additional Notes
Medication specific considerations include:
●
●
●
metformin
○ Metformin is typically taken twice per day with food to decrease GI symptoms.
The tablets can be crushed as long as they are not extended release tablets. Be
aware of signs of lactic acidosis (hyperventilation, fatigue, chills and
sleepiness).
pioglitazone
○ Clients should take the medication at the same time every day. Teach clients
that they will need to have their liver enzymes checked and have regular eye
exams for macular edema.
○ Pioglitazone may increase the risk of bone fractures and can exacerbate heart
failure. In 2011, the FDA issued an alert that clients who have been on the
medication for over a year have an elevated risk of bladder cancer.
sitagliptin
○ Clients should take the medication immediately prior to meals and contact their
HCP if they experience symptoms of pancreatitis, such as persistent abdominal
pain, with or without vomiting.
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The Drug Notebook
Antidiarrheals
Medications
Therapeutic Uses
bismuth subsalicylate
loperamide
diphenoxylate(narcotic)-atropine
Reduce the number and frequency of bowel
movements. Other uses include prevention
and treatment of traveler's diarrhea and to
decrease volume of stool contents from
ileostomies. Diphenoxylate-atropine is used to
treat severe or intractable diarrhea.
Mechanism of action (also consider protein binding
Antidiarrheals slow the passage of stool through the intestines; loperamide and bismuth
subsalicylate decrease the secretion of fluid into the intestine and inhibit the activity of
bacteria. Diphenoxylate-atropine, a controlled substance, works by slowing intestinal
motility. Bismuth subsalicylate and loperamide and absorbed from the GI tact, metabolized
by the liver and excreted in the urine. Loperamide is also excreted in the feces.
Contraindications
Major Adverse Effects (common)
Clients should consult with their health care
provider if they experience signs or
symptoms of a bowel obstruction (ileus,
megacolon or abdominal distention). Clients
with phenylketonuria (PKU) should consult
with their provider as well. Caution should
be used when administering these
medications to someone with hepatic
impairment or who is pregnant or lactating.
A common temporary side effect of bismuth
subsalicylate is a dark tint of the tongue or
stool. Do not confuse this with black and tarry
stools, which are a sign of bleeding in the
intestinal tract.
Nursing Considerations
●
●
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Prior to administering the first dose, important baseline data should be obtained
including a history of allergy to these drugs, an abdominal assessment and a history
of bowel movement patterns.
Monitor for slowing or decrease in bowel movements and signs and symptoms of
constipation or gastrointestinal discomfort.
Teach the client (or reinforce teaching) to continue a clear liquid diet or bland diet
until diarrhea is resolved and to report any abdominal distension (bloating), fever, or
bloody stool immediately.
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●
●
Subsalicylate can cause a serious and sometimes fatal condition called Reye's
syndrome in children. Do not give bismuth subsalicylate to children or teens.
The use of OTC antidiarrheals could mask a more serious condition.
The Drug Notebook
Antiemetics
Medications
Therapeutic Uses
meclizine
metoclopramide HCL
prochlorperazine
promethazine
ondansetron
These medications are used to manage
nausea and vomiting.
Mechanism of action
Antiemetics act on the central nervous system by either depressing the chemoreceptor
trigger zone (CTZ) in the medulla or blocking other receptor sites that are associated with
nausea and vomiting.
Contraindications
Major Adverse Effects (common)
Most antiemetics should not be used during
pregnancy or lactation due to the risk of
adverse effects on the fetus or neonate. The
only approved antiemetic for women who are
pregnant is a combination drug, which
includes doxylamine succinate
(antihistamine) and pyridoxine (B vitamin).
Caution should be used in clients with
impaired renal or liver function.
Common side effects of all antiemetics are
related to the action on the CNS. These side
effects include drowsiness, dizziness, and
sleep disturbances.
Antiemetics are contraindicated in heart
clients receiving chemotherapy. Injectable
dolasetron should no longer be used to
prevent chemotherapy-related nausea and
vomiting in cancer clients of all ages.
However, since differing antiemetics work on
differing receptor sites in the CNS, additional
common side effects include:
Metoclopramide HCL: restlessness, lassitude,
headache, sleeplessness, dry mouth, and
anxiety
Prochlorperazine: orthostatic hypotension,
blurred vision, dry eyes, dry mouth,
constipation, and photosensitivity
Promethazine: constipation, urinary retention,
dry mouth and hyperglycemia
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Nursing Considerations
●
●
●
Prior to administering the first dose of antiemetics, important baseline data should be
assessed including a previous hypersensitivity reaction to medications within the same
class.
Monitor for hypersensitivity reactions and side effects such as headaches, dizziness
and drowsiness.
Teach the client (or reinforce teaching) to refrain from activities that require mental
alertness while on these medications, to avoid alcohol or other CNS depressants while
using antiemetics, to change position slowly to decrease dizziness, and to monitor
bowel patterns in order to prevent constipation
Odansetron leads to prolonged OT interval and VT
Additional Notes
Since medications act on differing receptor sites, additional considerations for
these medications include:
●
●
●
metoclopramide HCL
○ This medication can be used with tube feedings to decrease residual volume
and reduce the risk of aspiration.
○ If the client is taking the medication by mouth (PO), they should take the drug
30-60 minutes before meals or medical procedures.
○ IV administration should be injected slowly over 1-2 minutes or infused over 15
minutes. The nurse should monitor for tardive dyskinesia.
prochlorperazine
○ The nurse will monitor for the development of neuroleptic malignant syndrome
(which may cause symptoms such as fever, respiratory distress, tachycardia,
convulsions, sweating and hypertension). When used long-term, the client's
erythrocyte and liver functions should be tested. There is a risk of developing
tardive dyskinesia and an increased risk of mortality in elderly clients with
dementia.
○ Inject this medication slowly, deep into the gluteal muscle. After injection, the
client should remain lying down for 30 minutes. If the medication is taken PO,
the client will take it with food.
○ Teach the client (or reinforce teaching) that extended release tablets may not
be crushed, and to wear sunscreen or protective clothing to prevent
photosensitivity reactions.
promethazine
○ This medication can also cause severe chemical irritation and damage to the
tissue. It can also lower seizure thresholds. Furthermore, clients may receive a
false-positive reading on a pregnancy test.
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The Drug Notebook
Medications
(Generic Name)
Antifungals
Therapeutic Uses
Systemic Antifungal Azole Agents
clotrimazole
Local Antifungal Azole agents
fluconazole
Other antifungals
amphotericin B
These medications are used to treat systemic,
localized, or topical fungal infections
(including yeast infections).
Mechanism of action
Systemic and local antifungal azole agents work by binding to sterols on the fungus or by
interfering with cellular replication. This leads to both a fungicidal (fungal cell death) and
fungistatic (inhibiting growth) effect. These effects are generally determined by the
concentration of the agent used. Antifungal medications are metabolized by the liver and
excreted in either the urine or feces.
Contraindications
Major Adverse Effects (common)
Contraindications with severe liver
impairment. Caution should be used when
administering these medications to clients
who are pregnant. Systemic antifungals are
not typically given to children.
Common side effects of all antifungals are
gastrointestinal upset, headache and
abdominal pain. Most antifungals have an
increased risk of hepatoxicity and should not
be used with other agents that carry the
same risk.
amphotericin B
Side effects can include blood, kidney,
●
heart and liver abnormalities. GI upset,
hypokalemia, CNS disturbances, skin irritation
and phlebitis around the injection site have
also been reported.
Additional side effects include fever,
●
malaise, hypotension and headache
fluconazole
Side effects include nausea, headache,
●
abdominal pain, diarrhea and taste distortion.
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Nursing Considerations
●
●
●
Prior to the first dose of antifungal medication, a culture and sensitivity test should be
obtained. Antifungal medications (specifically systemic antifungals) can be toxic to the
host. By obtaining a culture and sensitivity test, the nurse helps ensure an antifungal
medication is used that the fungus is susceptible to. The nurse should also obtain
important baseline data, including any history of hypersensitivity reactions related to
antifungal use.
Monitor for signs and symptoms of hepatotoxicity or signs of liver damage.
Teach the client (or reinforce teaching) on important educational concepts including:
○ Fungal spores can survive for long periods of time, and the medications may
need to be taken for long periods of time to achieve the therapeutic effect.
○ Do not combine azole antifungals or amphotericin B with other medications that
are linked to hepatotoxic effects, including alcohol. If abdominal distension,
anorexia, or jaundice is noted, the client should contact their HCP.
Additional Notes
●
●
Fluconazole may affect warfarin levels and increase prothrombin time. It has also
been linked to a reduced metabolism of tolbutamide, glyburide and glipizide. Glucose
levels should be monitored in clients with a history of diabetes or hyperglycemia.
When administering the potent antifungal, amphotericin B, the nurse should monitor
for any change in liver or renal function. The nurse should also monitor for
hypokalemia and take meticulous care of the injection site, noting any signs of
phlebitis or thrombophlebitis.
The Drug Notebook
Antihistamines
Medications
Therapeutic Uses
First Generation
hydroxyzine
diphenhydramine
Provide relief of symptoms associated with
allergic reactions and the resulting histamine
release. These medications prevent the
symptoms associated with histamine release
including rhinitis, urticaria and angioedema.
They are also used as adjunctive therapy in
anaphylactic reactions. Other uses take
advantage of antihistamine side effects. These
uses include treatment of insomnia, nausea,
vomiting, motion sickness and Parkinson-like
reactions.
Second Generation (non-sedating)
cetirizine HCL
fexofenadine
loratadine
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Mechanism of action
Antihistamines compete with histamine at histamine-1 receptor sites. Histamine is released
during inflammatory actions and acts by increasing capillary permeability and vasodilation,
which increases secretions and narrows airways. Antihistamines are metabolized by the liver
and excreted in the urine or feces. These drugs cross the placenta and enter the breast milk.
Contraindications
Major Adverse Effects (common)
Contraindications in clients who are pregnant
or lactating. The benefit of the antihistamine
must be weighed against the risk to the
neonate. Caution should be taken while
administering these medications to clients
with a history of liver or renal impairment, or
cardiac dysrhythmias.
First generation antihistamines are associated
with drowsiness and sedation. However, for
some clients, even second-generation
antihistamines will have sedating effects.
Geriatric clients are at increased risk for
orthostatic hypotension with many
antihistamines and should be advised to
change positions slowly.
Many clients will complain of dry mucous
membranes when taking antihistamines. This
is related to the mechanism of action for
these agents.
Nursing Considerations
●
●
●
●
●
●
Prior to giving the first dose of antihistamines, important baseline data should be
obtained. Since antihistamines are used for various reasons, the intended therapeutic
action should be understood. Additionally, liver and renal function should be assessed.
Monitor to ensure that the intended therapeutic action is achieved and for side effects
such as dizziness, drowsiness and dry mucous membranes.
Teach the client (or reinforce teaching) to avoid substances related to allergies (if
possible) and appropriate antihistamine use. Since antihistamines are sold over the
counter, these medications are often misused to treat infections.
Regardless of the generation of antihistamine use, clients should avoid activities that
require mental alertness until they understand the effect of that particular
antihistamine.
Antihistamines act as a CNS depressant and should not be taken with other CNS
depressants, such as alcohol.
Clients should maintain adequate hydration to decrease the discomfort associated
with dry mucous membranes. Clients may also benefit from hard candy (if
appropriate) to alleviate dry mouth.
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The Drug Notebook
Medications
(Generic Name)
Antineoplastics
Therapeutic Uses
Treat various solid tumors, lymphomas and
leukemias, with the goal of limiting growth by
decreasing numbers or size in order to allow
the natural immune system to respond. They
are also prescribed for some autoimmune
disorders, such as rheumatoid arthritis.
methotrexate
tamoxifen
Mechanism of action
Antineoplastic medications inhibit or prevent the development, maturation or spread of
neoplastic cells by various mechanisms of action. They can cause damage to the DNA of
cancer cells, interfere with the cancer cell's metabolism or affect cell division.
Contraindications
Major Adverse Effects (common)
Pregnancy and lactation. Severe effects on the
fetus and neonate. Bone marrow suppression.
Index of redosing and dosing levels. Renal and
hepatic dysfunction. Interfere with drug
metabolism and excretion. Known GI
ulceration or ulcerative diseases. Can be
exacerbated by the effects of the drug.
Side effects of antineoplastic agents are a
result of the toxicity to normal cells. Common
side effects include nausea, vomiting and
diarrhea, altered taste, alopecia and
ulcerative stomatitis. Other effects include
bone marrow suppression, which often is the
indication used for redosing. Effects of bone
marrow suppression include leukopenia,
anemia and thrombocytopenia. Uric acid
levels may also increase with the use of these
medications.
Tamoxifen has been linked to irreversible
visual changes and temporary vaginal
bleeding.
Nursing Considerations
●
Prior to giving the first dose of these medications, the nurse should assess for a
history of a hypersensitivity reaction, severe bone marrow suppression, renal or liver
impairment, and pregnancy and lactation status. Methotrexate will terminate
pregnancy and stimulate abortions. Pregnancy tests should be performed on clients
that are ordered to receive this medication.
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●
●
●
Monitor for signs and symptoms of side effects of antineoplastic including intractable
nausea, vomiting, bone marrow suppression, weight loss, respiratory status and
ulcers.
Health care workers should limit their exposure to these medications. All personnel
who handle antineoplastic drugs must receive information and training about the
health hazards.
Teach the client (or reinforce teaching) to avoid people with contagious infections
(due to their own impaired immune system) and avoid medication that could thin
their blood.
Additional Notes
●
●
Methotrexate has been linked to pulmonary toxicity, which may manifest early as a
dry, nonproductive cough.
Tamoxifen has been linked to irreversible vision changes. Instruct the client to contact
their HCP if they notice a change in their visual acuity. Reassure the client that any
vaginal bleeding, pruritus, or hot flashes that occur are reversible after the medication
is discontinued.
The Drug Notebook
Antiparkinsonism Agents
Medications
Therapeutic Uses
carbidopa and levodopa
levodopa
rasagiline
These medications relieve the clinical
manifestations of Parkinson's disease,
including tremor or trembling in the hands,
arms, legs, jaw and face; stiffness or rigidity
of the arms, legs and trunk; bradykinesia;
and ataxia.
Mechanism of action
Dopaminergic agents work at the dopamine receptor sites to increase the effects of the
neurotransmitter, dopamine. They also mimic the role of dopamine or block the effects of
other chemicals that cause problems in the brain when dopamine levels decrease.
Dopaminergic agents are metabolized by the liver and excreted in the urine.
Contraindications
Major Adverse Effects (common)
Dopaminergic are contraindicated in clients
with angle closure glaucoma. Additionally,
these medications have been linked to
Common side effects of Dopaminergic agents
are associated with the intended action,
stimulation of the dopamine receptors. These
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melanoma in clients with a history of
suspicious skin lesions. Caution should be
used when administering these agents to
clients that have a history of cardiac
conditions, asthma and psychiatric disorders.
side effects include agitation, dry mouth,
urinary retention, cardiac dysrhythmias,
abnormal breathing patterns, headache,
malaise, confusion and ataxia.
Involuntary movements (dyskinesia),
impulsive & compulsive behaviours;
hypotension; fast/irregular heart rate; loss of
appetite; dizziness; hallucinations
Nursing Considerations
● Prior to administering the first dose of Dopaminergic agents, the nurse should assess
important baseline data including the client's blood pressure, heart rate/rhythm, and ask
whether they have a history of suspicious skin lesions, glaucoma or a hypersensitivity
reaction to dopaminergic agents. Assess Parkinson’s-related symptoms (ie. rigidity,
tremors)
● Monitor hepatic and renal function and CBC periodically in clients on long-term therapy.
These drugs can cause an increase in aspartate aminotransferase (AST), alanine
aminotransferase (ALT), bilirubin, alkaline phosphatase, lactate dehydrogenase (LDH) and
serum protein-bound iodine concentrations.
● Clients and caregivers should understand that Parkinson's is a progressive illness and
these medications will not be effective when neural deterioration has progressed to a
certain point. However, some adjunctive Antiparkinsonism agents exist to inhibit these
"wearing off effects."
● If appropriate, clients and caregivers could benefit from information regarding local
Parkinson's resources or support groups.
● Educate client to take on an empty stomach (at least 30 min before a meal or 60 mins
after a meal)
The Drug Notebook
Antiplatelet Agents
Medications
Therapeutic Uses
aspirin
clopidogrel
dipyridamole
These medications treat and prevent
thromboembolic events, such as stroke, MI or
peripheral vascular disease. They are also
prescribed after devices are placed inside the
heart or blood vessels, such as stents and
artificial heart valves.
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Mechanism of action
Antiplatelets block the formation of platelet adhesion and aggregation by blocking receptor
sites on the platelet membrane. These medications are metabolized by the liver and excreted
in the urine. They do cross into breast milk.
Contraindications
Major Adverse Effects (common)
Caution should be used in clients that have a
history of bleeding disorder, active bleeding,
recent surgery, history of stroke or with
concurrent use of another medication that
affects blood clotting.
The most common side effects experienced
with this drug are related to their therapeutic
use. These side effects include bleeding and
bruising. Other common side effects include
headaches, weakness, gastrointestinal upset
and skin rash.
Nursing Considerations
●
●
●
Prior to administering the first dose, important baseline assessments should include
inquiring about a history of a hypersensitivity reaction related to these medications,
blood pressure, history of strokes and pregnancy status.
Monitor the client for common side effects including headache, weakness, skin rash
and gastrointestinal upset.
Teach the client (or reinforce teaching) to monitor for signs and symptoms of bleeding
and to use caution if dizziness occurs while ambulating. The client should tell all
health care providers about the use of these medications, especially prior to any
procedure or surgery.
The Drug Notebook
Medications
(Generic Name)
1st Generation
haloperidol
chlorpromazine
2nd Generation
clozapine
risperidone
ziprasidone HCL
Antipsychotics
Therapeutic Uses
Antipsychotics are used to treat acute and
chronic psychosis, especially when
accompanied by increased psychomotor
activity.
Off-label uses include Tourette's syndrome,
substance abuse, stuttering, OCD, PTSD,
depression, bipolar disorder, and personality
disorders.
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Mechanism of action
Antipsychotic medications block dopamine receptors and depress the RAS system, which limits
stimulation coming into the brain. The newer second-generation class of medications not only
block dopamine receptors, but also serotonin receptors. The second-generation of medications
has a decreased incidence of the neurological effects associated with the first-generation class.
Antipsychotic medications are metabolized in the liver and secreted in the bile and urine. These
medications cross the placenta and enter breast milk.
Contraindications
Major Adverse Effects (common)
These medications are contraindicated in
clients that have a history of central nervous
system depression, cardiac dysrhythmia, blood
dyscrasia or Parkinson's disease, and for
elderly clients with dementia.
Caution should be used due to the
anticholinergic effects of these medications
that could exacerbate certain conditions such
as benign prostate enlargement, glaucoma,
peptic ulcer disease and bowel obstruction.
These medications also lower the seizure
threshold, and should be used with caution in
clients that have a history of seizures.
Common side effects of antipsychotics are
related to a therapeutic mechanism of action
that blocks dopamine receptors. These
medications usually cause drowsiness,
sedation, vertigo, headache and visual
disturbances. Haloperidol, ziprasidone, and
risperidone have been linked to tardive
dyskinesia. Pseudoparkinson's effects may be
exhibited and include cog-wheel rigidity,
drooling and a shuffling gait. Other effects
include dystonia, akathisia and muscle
rigidity.
These medications should not be given within
24 to 48 hours of myelography procedures due
to neuron interaction with the dye.
Black Box Warning! Conventional antipsychotic
drugs can increase the risk of death for elderly
people with dementia-related psychosis.
Neuroleptic malignant syndrome (NMS) is a
rare but life-threatening side effect of
antipsychotics and clinical manifestations of
this condition are muscle rigidity, altered
mental condition and decreased level of
consciousness.
Nursing Considerations
●
●
●
Before administering the first dose of the medication, the nurse should assess
appropriate baseline data including blood pressure. Other assessments should include
neurological status, history of hypersensitivity reaction, cardiac dysrhythmia,
respiratory status, seizure disorder, glaucoma, or recent myelography procedure.
Monitor the client for pseudo parkinson's symptoms and other adverse effects
including excessive central nervous system depression, hypotension and
hyperglycemia.
Teach the client (or reinforce teaching) to avoid the use of alcohol and other CNS
depressants, protect themselves from sun exposure and change positions slowly.
Encourage them to speak to their HCP before using over-the-counter medications.
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The Drug Notebook
Antitubercular Agents
Medications
Therapeutic Uses
Isoniazid
rifampin
pyrazinamide
Used to treat mycobacterium tuberculosis
(TB). It is also used as prophylaxis for people
who live with someone who was recently
diagnosed with TB.
Mechanism of action
Antitubercular agents work by acting on the DNA and/or RNA of the mycobacterium, which
leads to a lack of growth, replication and eventually bacterial death. These agents are often
used in combination with other agents in this class to increase effectiveness and reduce the
risk of the emergence of resistant strains. These agents are metabolized in the liver and
excreted in the urine.
Contraindications
Major Adverse Effects (common)
Clients should not take medications if they
have severely impaired renal or liver function.
Central nervous system (CNS) and
gastrointestinal (GI) side effects are common
with antitubercular agents. CNS effects
include dizziness, headache, drowsiness and
hallucinations, and peripheral neuropathy,
while GI effects are often anorexia, nausea,
vomiting and abdominal pain. The client
should be warned that body secretions may
become orange and could stain their clothes
or contact lens. This orange-tint to body
fluids is not an indication to stop treatment.
Nursing Considerations
●
●
●
●
Prior to the first dose, the nurse should assess for a history of hypersensitivity
reaction and the results of baseline liver and kidney function tests.
Monitor for signs and symptoms of a hypersensitivity reaction or liver impairment
when taking these medications. Clients cannot drink alcohol with this medication and
must have monthly liver tests.
Teach the client (or reinforce teaching) about signs and symptoms of liver impairment
including yellow eyes and skin, nausea, vomiting, anorexia, dark urine and unusual
tiredness or weakness.
Resistant strains of TB exist, if the client cannot tolerate the medications or the
infection is not responding to these first-line drugs, a second-line antitubercular agent
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may be used.
The Drug Notebook
Antiulcer Agents
Acid controlling Agents
Medications
Therapeutic Uses
Proton Pump Inhibitors (PPIs)
lansoprazole
omeprazole
Antiulcer agents are used to treat and prevent
peptic ulcers and gastric hypersecretory
conditions and to manage the symptoms of
gastroesophageal reflux disease (GERD). They
also treat recurrent gastric and duodenal
ulcers caused by Helicobacter pylori infections
by being used in conjunction with an antibiotic
and gastric acid suppression therapy.
Histamine-2 Antagonists (H-2 Receptor
Blockers)
cimetidine
famotidine
Antacids
sodium bicarbonate
Gastrointestinal Protectant
Sucralfate
Mechanism of action
These medications block the secretion of gastric acid by the gastric parietal cells (PPIs). They
also stop the action of histamine on the gastric parietal cells, which inhibits the secretion of
hydrochloric acid (H-2 receptor blockers). Antacids work by neutralizing stomach acids. These
medications are usually metabolized in the liver and excreted in the urine.
Contraindications
Major Adverse Effects (common)
Caution should be used when administering
these medications during pregnancy,
lactation, or with hepatic or renal
impairment.
Common side effects of antiulcer medication
include headache and gastrointestinal
disturbances (nausea, vomiting, diarrhea,
constipation, flatulence). Cimetidine may lead to
confusion in clients of advanced age and has
been associated with cardiac dysrhythmias due
to the H-2 receptor sites also being found in the
heart. Since antiulcer medication is often
associated with impaired absorption and slowed
metabolism of other medications, the timing of
administration in relation to other medications
Antacids are contraindicated in the presence
of any condition that could be exacerbated
by electrolyte or acid base imbalance
Women who are pregnant or lactating and
clients with hypersensitivity, electrolyte
disorders, GI obstruction or kidney disease
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cannot take antiulcer drugs.
and food is important.
With the use of antacids, acid rebound is a
concern; this is an attempt by the body to
overcome the antacid's effect and return the
stomach to an acidic environment by producing
more acid.
Nursing Considerations
●
●
●
●
●
●
Prior to the first dose, baseline assessment data includes electrolytes, bowel sound
assessment, renal function tests, and liver function tests. The client should be
questioned about any history of a hypersensitivity reaction.
For clients with severe liver impairment, nizatidine is often used since it is not
metabolized by the liver.
Teach the client (or reinforce teaching) to report any signs and symptoms of
hypersensitivity, gastrointestinal upset and dizziness, to change position slowly, and
to maintain adequate hydration.
These medications are often sold over the counter, continued and prolonged use of
these medications may mask a serious underlying condition.
A common etiology of ulcers is increased NSAID use. Reinforce teaching of proper
NSAID use.
Long-term use of PPIs interferes with calcium absorption which can lead to or worsen
osteoporosis.
The Drug Notebook
Antivirals
Medications
Therapeutic Uses
acyclovir
oseltamivir phosphate
valacyclovir HCL
Prevent, manage and/or treat viral infections,
such as HIV, herpes simplex and
cytomegalovirus, viral pneumonia, measles,
mumps and influenza.
Mechanism of action
Antiviral medications are designed to work by either inhibiting the ability of viruses to multiply or
mimicking the virus attachment protein, which disrupts the DNA replication process.
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Contraindications
Major Adverse Effects (common)
Caution should be used in clients with impaired Common side effects associated with all
antivirals are headache, dizziness,
renal impairment related to the altered
nausea and vomiting.
excretion of the medication.
Oseltamivir should not be used during
pregnancy or lactation.
Zanamivir is not recommended for clients with
asthma or COPD due to the risk of serious and
fatal bronchospasm. Clients who are allergic to
milk proteins or lactose should not use this
drug.
acyclovir
Side effects include peripheral neuropathy,
thrombocytopenia purpura and liver damage.
oseltamivir phosphate
Additional side effects include fatigue and
cough. These medications have also been
associated with orthostatic hypotension,
insomnia and urinary retention.
valacyclovir HCL
Side effects include diarrhea, abdominal
cramps, rash and fatigue.
Nursing Considerations
●
●
●
●
●
Antiviral drugs work best when started within two days after the client becomes sick.
They reduce the severity of symptoms and shorten the length of illness but they will
not cure the disease.
Prior to the first dose, baseline data should be obtained including any history of a
hypersensitivity reaction to these medications, pregnancy status and renal function.
Monitor for adverse reactions associated with antiviral agent use including headache,
worsening infection, superinfections, and dizziness.
Teach the client (or reinforce teaching) to report signs and symptoms of a
superinfection, change positions slowly related to dizziness and possible hypotension,
and to increase fluid intake.
Clients being treated for sexually transmittable viruses should be instructed to avoid
sexual contact while lesions are visible.
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Anxiolytic Agents
The Drug Notebook
Benzodiazepines
Medications
Therapeutic Uses
alprazolam
chlordiazepoxide
diazepam
lorazepam
Treat anxiety disorder, panic disorder,
preoperative anxiety, and alcohol withdrawal.
Mechanism of action
Benzodiazepine medications act at many levels in the central nervous system (CNS) including
the limbic and reticular activating system (RAS) by making gamma-aminobutyric acid (GABA)
(an inhibitory neurotransmitter) more effective. This leads to an anxiolytic effect in low
doses. In higher doses, sedation and hypnosis is achieved. Benzodiazepines are metabolized
in the liver and excreted in the urine. They do cross into the placenta and also enter breast
milk.
Contraindications
Major Adverse Effects (common)
They are also contraindicated during
pregnancy due to the risk of fetal abnormalities
(cleft palate, cardiac defects, microcephaly).
Neonates born after maternal use of
benzodiazepines will suffer from neonatal
abstinence syndrome. Other contraindications
include psychosis, narrow-angle glaucoma,
coma, acute alcohol intoxication and shock.
These conditions could be exacerbated by the
CNS depressant effects of benzodiazepines.
Common side effects of benzodiazepines are
related to the effects on the CNS and include
drowsiness, light-headedness, lethargy and
hypotension. Other side effects include
gastrointestinal upset, dry mouth,
constipation, hypotension, respiratory
depression, dysrhythmia, palpitations, cardiac
arrest and confusion.
Caution should be used when giving
benzodiazepines to clients of advanced age
due to the unpredictable reactions. Also,
caution should be used when administering
these medications to clients with impaired liver
or renal function. If benzodiazepines are
warranted in these clients, the lowest dose
possible should be administered.
Abruptly discontinuing use of these
medications will cause withdrawal syndrome
which is associated with nausea, headache
and night terrors.
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Nursing Considerations
● Prior to administering the first dose of medication, the nurse should assess if the client has
a history of a hypersensitivity reaction, adequate liver and renal function, whether the
client is pregnant, and baseline vital signs should be obtained.
● Elderly clients have increased sensitivity to benzodiazepines, which is associated with an
increased risk of falls.
● Benzodiazepines are better for intermittent or short-term use in the management of
anxiety.
● Clients can develop tolerance and these medications have addictive potential. Be aware
that for some clients, symptoms of depression or suicidal behavior may worsen.
● During benzodiazepine use, the nurse should monitor vital signs, respiratory and cardiac
status, level of consciousness and orientation.
● Reinforce important educational topics, such as safety risks of falls and avoiding activity
that requires mental alertness. If taken at home, these medications should be kept in a
safe place away from children and adolescents.
Atropine Sulfate
The Drug Notebook
Anticholinergic
Medications
Therapeutic Uses
Atropine sulfate
Atropine is used to treat bradyasystolic
cardiac arrest and to correct bradycardia.
Atropine is also used when treating
life-threatening exposure to nerve agents or
insecticides. When used in small doses,
atropine decreases salivary and bronchial
secretions by acting on exocrine glands. This
drug is also commonly used as a
preanesthetic medication and to treat
disorders of the eye or intestine.
Mechanism of action
These medications inhibit acetylcholine's muscarinic action in the smooth muscles, cardiac
muscles, SA and AV nodes, and the urinary bladder. This blocks the effects of the
parasympathetic nervous system.
Contraindications
Major Adverse Effects (common)
Atropine is contraindicated in the presence
Common side effects associated with this
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of a hypersensitivity reaction to atropine or
other muscarinic antagonists. It is also
contraindicated in clients that suffer from
glaucoma, asthma and gastrointestinal or
genitourinary obstruction. High doses of
atropine should be used with caution as they
can cause hallucinations, coma and death.
medication include agitation, diplopia, dry
mouth, dizziness, altered taste, urinary
retention, tachycardia, altered taste, muscle
twitching, photophobia, mydriasis, increase in
intraocular pressure and shallow breathing.
Clients taking this medication will also have a
decrease in sweating ability.
If life-threatening exposure to nerve agents
or insecticides is being treated, there are no
contraindications.
Nursing Considerations
●
●
●
●
Prior to administering the first dose, obtain baseline assessment data including any
history of hypersensitivity reactions to atropine, heart rate, blood pressure, and any
history of urinary retention, prostate enlargement or cardiac dysfunction.
Monitor heart rate, intake and output, and breathing patterns.
Reinforce important educational concepts, including appropriate use of these
medications, and to notify the HCP if abdominal pain, urinary retention, blurred vision,
or heart palpitation occur.
The client should avoid strenuous activity and overheating as the sweating ability of
the exocrine glands will be decreased.
The Drug Notebook
Beta-Adrenergic Blockers
Medications
Therapeutic Uses
Beta1-Selective Adrenergic
Blocking Agents (Beta Blockers)
atenolol
metoprolol succinate
metoprolol tartrate
Nonselective Beta-Adrenergic
Blocking Agents (Beta Blockers)
propranolol HCL
Beta blockers are used for long-term
treatment of hypertension, dysrhythmia, and
angina. They can also treat glaucoma,
prevent reinfarction after a myocardial
infarction (cardioprotective) and prevent
migraine headaches.
Mechanism of action
Beta blockers act on the sympathetic nervous system to block norepinephrine and epinephrine
from binding to the beta receptors on nerves. By blocking the effects of these neurotransmitters
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and dilating blood vessels, they reduce heart rate and blood pressure. Nonselective
Beta-Adrenergic Blocking Agents act by blocking the beta receptors of the heart and kidney. This
action prevents the release of renin, which decreases blood pressure, cardiac workload and
cardiac excitability. These medications are metabolized in the liver and excreted in the urine.
Contraindications
Major Adverse Effects (common)
Contraindications include bradycardia,
pregnancy and breastfeeding, diabetes or
thyroid disease. Caution should be used
when giving any of these medications to
clients with a history of a chronic respiratory
illness, as high doses of Beta1 Adrenergic
Blocking agents may affect the Beta2
receptors. Caution should be used in clients
that suffer from respiratory illnesses and
who are taking high doses of these
medications. Caution should also be used for
clients with heart failure as these
medications will decrease the cardiac output
and signs and symptoms could worsen.
metoprolol succinate/metoprolol tartrate
Side effects include bradycardia, hypotension,
rebound hypertension when abruptly stopped,
constipation, palpitations, nausea, vomiting,
diarrhea, heart failure, depression, insomnia,
dizziness and confusion.
propranolol HCL
Side effects include headache, weakness,
hypotension, bronchospasm, bradycardia,
insomnia and depression
Hypoglycemia - impaired ability for the liver
to convert glycogen to glucose
Nursing Considerations
●
●
●
●
●
Prior to administering these medications, essential baseline information should be
obtained including, any history of hypersensitivity reactions to these medications, an
apical pulse, and a respiratory assessment.
Monitor heart rate, blood pressure, dizziness, and signs of heart failure in clients
taking this medication. In diabetic clients, nurses should be alert to signs and
symptoms of hypoglycemia.
Teach the client (or reinforce teaching) important educational concepts including:
○ To contact their physician before they discontinue their medication. Abrupt
withdrawal can cause severe exacerbation of angina, heart attacks or sudden
death.
○ How to accurately assess and monitor their heart rate using the radial pulse. If
their radial pulse is below 50, they should not take the medication and contact
their HCP.
The spelling of the generic names of beta blockers ends with "lol."
Side note: Beta blockers are also used to calm the brain. They decrease palpitations
during panic attacks, decrease essential tremors and decrease situational anxiety.
They may also decrease migraine headaches in some people.
Additional Notes
metoprolol succinate/metoprolol tartrate
● The nurse will check the client's apical pulse; if it is less than 60 beats per minute, the
nurse will hold the medication and notify the HCP.
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● Metoprolol succinate may worsen heart failure and hypoglycemia in diabetics.
● Clients should not use OTC unless directed by provider and should report dyspnea to the
provider.
propranolol HCL
● The nurse will check the client's apical pulse; if it is less than 60 beats per minute, the
nurse will hold the medication and notify the HCP. This medication can cause cardiac
failure, hypoglycemia in diabetics or mask hyperthyroidism.
● Clients will take the medication with a full glass of water at the same time each day. The
medication should not be opened, chewed or crushed. Clients should not concurrently use
an antacid that contains aluminum; it may decrease the medication's absorption.
The Drug Notebook
Bisphosphonates
Bone reabsorption inhibitors
Medications
Therapeutic Uses
alendronate
Bisphosphonates are used to treat
osteoporosis and increase bone mass.
Mechanism of action
The mechanism of action of bisphosphonates is poorly understood. However, it is thought
that these medications reduce bone remodeling and thus bone resorption. This leads to a
gradual increase in bone mass. These medications do not undergo metabolism and are
excreted in the urine.
Contraindications
Major Adverse Effects (common)
Bisphosphonates are contraindicated
hypocalcemia, or the inability to sit upright
for 30 minutes after taking the medication.
This medication is also contraindicated in
clients that have esophageal emptying
difficulties such as strictures. These
medications can cause esophageal irritation
and preliminary studies show a possible link
to esophageal cancer. Caution should be
used in clients with renal impairment.
Common side effects associated with
bisphosphonates are headache, vertigo, new
or worsening bone pain and diarrhea.
Esophageal irritation and erosion may occur
with these medications.
Nursing Considerations
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● Baseline assessment information should include serum calcium levels, the ability to sit
upright, and any history of a hypersensitivity reaction to these medications.
● These medications should not be given with food, antacids, calcium or iron as there will be
a decrease in absorption.
● Monitor for signs and symptoms of side effects, renal impairment and hypocalcemia.
● Teach the client (or reinforce teaching) to take the medication in the morning with water, to
sit upright or to stand for 30 minutes after taking the medication, and to also take a
calcium and vitamin D supplement.
The Drug Notebook
Bronchodilators
(Non-Anti-inflammatory)
Medications
Therapeutic Uses
Anticholinergics:
ipratropium
Bronchodilators are medications used to dilate
airways for relief of the narrowed airways and
difficulty breathing associated with asthma
and chronic obstructive pulmonary disease
(COPD).
Sympathomimetics/Beta2 adrenergic
agonists:
Albuterol (Ventolin/Salbutamol)
Methylxanthines:
theophylline
Mechanism of action
The mechanism of action of these medications is determined by the subcategory.
Beta2 adrenergic agonists work by targeting beta2 receptors in the bronchial smooth muscle,
which causes bronchodilation (relieves cough, wheezing & SOB by ↑ air flow through bronchial
tubes)
Anticholinergic medications act by blocking the stimulation of the vagus nerve and thus causing
bronchodilation. Xanthine agents stimulate CNS & relax act smooth muscles in the bronchi and
the blood vessels causing bronchodilation and vasodilation. In general, bronchodilator
medications relax bronchial smooth muscle, making the airways larger and allowing air to pass
through the lungs. Encourage mucus drainage
Contraindications
Caution should be used in clients that have
heart disease, hypertension, hypothyroidism
or a seizure disorder.
Major Adverse Effects (common)
Beta2 adrenergic agonists/albuterol
CNS side effects include nervousness,
restlessness, tremor, headache and insomnia.
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Anticholinergic use is contraindicated in
clients that have conditions that would be
exacerbated by the anticholinergic effects of
the drug, such as narrow-angle glaucoma
and urinary obstruction. These medications
should also not be used in clients that have
an allergy to soy or peanuts due to the
methods used to prepare the drugs.
Hyperactivity in children is common.
Additional side effects include nausea,
vomiting, hyperglycemia, hypokalemia and
tremors. Tremors usually resolve with
continued use.
Anticholinergic/ipratropium
Anticholinergic side effects are related to the
therapeutic method of action of these drugs.
Anticholinergic effects include dry mouth,
dizziness, headache, fatigue, palpitations and
urinary retention.
Xanthine/theophylline (*Infrequently
prescribed due to their narrow safety
margin)
Side effects include restlessness, palpitations,
sinus tachycardia, dizziness, anorexia,
vomiting, headache and insomnia. Adverse
effects are more likely to occur at
theophylline serum levels greater than 20
mcg/ml. The client may begin to exhibit
headache, gastrointestinal upset. At levels
higher than 30 mcg/ml dysrhythmias,
seizures, or death may occur.
Nursing Considerations
When clients use both an inhaled steroid and inhaled bronchodilator, they should use the
bronchodilator first to open up airways, then wait a few minutes and use the steroid so it
can penetrate the lungs more effectively. "Rinse and spit" after using the inhalers.
INFO: Correct use of inhalers
Additional Notes
● albuterol
○ The nurse will assess lung sounds, pulse and blood pressure before administration
and during peak of the medication. The nurse will note the amount, color and
consistency of sputum produced. Monitor pulmonary function tests before initiating
therapy and periodically during therapy.
○ The nurse will observe for paradoxical bronchospasm (wheezing), which can occur
with excessive use of the medication. If this condition occurs, withhold the
medication and notify the HCP immediately.
○ Teach the client (or reinforce teaching) how to monitor their heart rate, to avoid
caffeine, and proper inhaler use.
● theophylline
○ Alcohol, caffeine and smoking are prohibited with this medication.
○ Clients should check with their provider when using an OTC medication and contact
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the provider if they experience symptoms of toxicity = nausea, vomiting, anxiety,
insomnia or convulsions.
○ Lab testing is required because of narrow safety margins. The dose of theophylline
must be individualized on the basis of peak serum theophylline concentration
measurements. Draw peak serum theophylline levels 15-30 minutes after an
administering IV loading dose. Ensure that diazepam is readily available to treat
seizures.
Bronchodilators
(Anti-inflammatory)
The Drug Notebook
Medications
Therapeutic Uses
Inhaled Steroids
budesonide
Inhaled steroids and leukotriene receptor
antagonists work to dilate airways and to treat or
prevent the inflammatory process that leads to
the narrowing of airways. These are common
medications for clients suffering from bronchial
asthma or COPD.
Leukotriene Receptor Antagonists
zafirlukast
montelukast
Mechanism of action
Inhaled steroids decrease the inflammatory process in the airway by decreasing the effects of
the inflammatory cells.
Leukotriene Receptor Antagonists block receptors that increase the production of
leukotrienes. This action blocks the inflammatory process associated with asthma.
Contraindications
Major Adverse Effects (common)
Neither of these medications are to be used for The common side effects of inhaled steroids
are usually related to the method or route of
treatment of acute asthma attack or status
administration and include sore throat and
asthmaticus.
dry mouth.
Inhaled steroids should be used cautiously
when clients have an active infection of the
respiratory tract. By inhibiting the normal
inflammatory process, the infection can
worsen.
Leukotriene Receptor Antagonists should be
used cautiously in clients with hepatic or renal
impairment. These medications are new and
long-term effects have not been established.
Inhaled steroids/Montelukast
Side effects include dizziness, headache,
upper respiratory infection (URI), fever,
pharyngitis, cough, GI upset, otitis media,
runny nose and sinusitis.
Leukotriene Receptor Antagonists
Common side effects that have been reported
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with these medications include dizziness,
headache, nausea, diarrhea, fever, infection
and myalgia.
Nursing Considerations
● Assess important baseline data prior to administering the first dose including respiratory
status, renal and liver function and history of hypersensitivity reaction associated with the
use of these medications.
● Monitor the client for signs and symptoms of infection or headaches, dizziness, or
generalized pain.
● Teach the client (or reinforce teaching) to report any signs and symptoms associated with
a respiratory infection, that these medications are not used for acute attacks, and that
therapeutic effects may take weeks to achieve.
Additional Notes
Montelukast may increase the risk of neuropsychiatric events including hallucination,
aggression, anxiousness, suicidal behavior and tremors. The client will notify the provider if
they experience these symptoms as well as any wheezing or respiratory distress.
The Drug Notebook
Calcium Channel Blockers
(CCBs)
Medications
Therapeutic Uses
amlodipine
diltiazem
felodipine
verapamil
Treat hypertension, decrease cardiac
workload, angina and abnormal heart rhythms
(e.g. atrial fibrillation, paroxysmal
supraventricular tachycardia). They are also
used to treat post-myocardial infarction
clients who cannot tolerate beta-blockers.
Mechanism of action
These medications slow the rate at which calcium passes into the vessel walls. This relaxes the
vessels and allows blood to flow more easily through them, thus lowering blood pressure.
Verapamil and diltiazem also work by blocking the calcium channels in the myocardium; this
affects the pacemakers of the heart (SA and AV node) and results in a reduction of heart rate and
contraction force. These medications are available in immediate or sustained release
preparations.
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Contraindications
Major Adverse Effects (common)
These medications can have a toxic effect on
the liver, therefore clients with liver
impairment should not take these
medications. Due to the effects of these
medications, they are contraindicated in
clients that have hypotension or are having
an acute MI. Clients with symptomatic heart
failure and heart block should not use these
medications as decreasing the cardiac output
will worsen these conditions.
The side effects of these medications are
related to the intended therapeutic action of
decreasing the cardiac output and the action
on smooth muscle. Common central nervous
system effects include headache, dizziness
and fatigue. Often, clients will complain of
gastrointestinal (r/t liver) and skin effects
such as nausea, vomiting, flushing, rash,
constipation and abdominal pain. Other side
effects include hypotension and bradycardia,
peripheral edema.
Nursing Considerations
●
●
●
Prior to administering these medications, obtain important baseline data including any
history of hypersensitivity reactions, blood pressure, heart rate and liver function.
Monitoring of the client's blood pressure and heart rate are essential when giving
these medications. The client should also be assessed for signs and symptoms of
heart failure and liver failure.
Teach the client (or reinforce teaching) these important concepts:
○ Do not consume any form of grapefruit when taking these medications. The
combination causes a higher bioavailability of the drug and can be toxic.
○ Change positions slowly to decrease dizziness and possible syncope.
○ Discuss any OTC medications with their HCP before taking them.
○ The importance of monitoring their heart rate while on this medication
The Drug Notebook
Central Nervous System
(CNS) Stimulants
Medications
Therapeutic Uses
lisdexamfetamine
methylphenidate
Improve concentration and focus for those
with attention-deficit disorder (ADD). They
can also be used to decrease appetite and
promote weight loss. Some clients may take
CNS stimulants to alleviate sleep disorders,
including narcolepsy, shift work sleep disorder
and jet lag.
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Mechanism of action
These medications increase physical activity (energy), mental alertness and attention span
by acting on the reticular activating system (RAS) and stimulating catecholamines. This has a
contradictory effect of calming hyperactivity that is thought to be related to an immature
RAS. However, the exact mechanism of action is not known. These medications are
metabolized in the liver and excreted in the urine.
Contraindications
Major Adverse Effects (common)
Contraindications of CNS stimulants include
heart defects or cardiac problems. CNS
stimulants should not be prescribed to clients
with anxiety, tension and glaucoma; these
effects can be exacerbated by the CNS effects
of these medications.
Common side effects include headache,
respiratory infections, hyperhidrosis,
decreased appetite, visual disturbances,
abdominal pain, cough, nausea, insomnia and
restlessness.
Caution should be used when administering
these medications to clients with a history of
seizures (as they may lower the seizure
threshold), to those with a history of substance
dependence, or to clients with hypertension.
Nursing Considerations
●
●
●
Prior to administering the first dose, obtain important baseline data including if a
history of a hypersensitivity reaction exists, history of seizures, cardiac disease
including congenital heart defects, and pregnancy or lactation status.
Monitor for side effects included weight loss, respiratory infections, anorexia, cough
and insomnia.
Teach the client (or reinforce teaching) to monitor their weight, take these
medications in the morning, report any side effects, and how to ensure safekeeping of
these controlled substances. These medications can be habit-forming and the dose
must be tapered off to avoid withdrawal syndrome.
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The Drug Notebook
Corticosteroids
Medications
Therapeutic Uses
Glucocorticoids
methylprednisolone
prednisolone
dexamethasone
betamethasone
Oral forms are used to treat inflammation and
pain associated with arthritis and autoimmune
diseases. Inhaled medications treat asthma
and allergies. Topical application helps heal
skin conditions. The injected forms treat the
pain and inflammation of arthritis, gout and
other inflammatory diseases (inflammatory
bowel disease - IBD).
Mineralocorticoids
cortisone
fludrocortisone
hydrocortisone
Mechanism of action
Corticosteroid medications mimic the effect of hormones produced naturally by the adrenal
glands. When the dose exceeds the body's usual hormone levels, they will suppress inflammation
and the immune system. They are also used for their antineoplastic activity.
Contraindications
These medications should not be used in
clients who have an infection or who are at
high risk for infection due to the intended
therapeutic use of immunosuppression.
These medications should be used with
caution in clients that have diabetes as they
are associated with hyperglycemia.
Major Adverse Effects (common)
Prednisone and mineralocorticoids affect
potassium, sodium, and fluid levels within the
body.
Other common side effects of corticosteroid
use are headache, vertigo, impaired wound
healing and increased appetite. Clients may
complain of weight gain due to sodium and
fluid retention and increased appetite.
In long-term use of corticosteroids, iatrogenic
Cushing's syndrome is common and results in
truncal weight gain, a moon shaped face,
poor wound healing, hypertension, thinning
skin and extremities and a fat deposit on the
nape of the neck.
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Fluticasone propionate salmeterol
(inhaled)
Side effects include, dysphonia, hoarseness,
throat irritation, cough, oropharyngeal fungal
infections, muscle and bone pain, viral
respiratory infections and bronchitis.
Nursing Considerations
●
●
●
●
Before administering the first dose of the medication, important baseline data should
be obtained including any history of hypersensitivity reaction, a generalized
assessment to verify that no active infections are present, electrolyte levels, and liver/
renal functioning.
The nurse should monitor sodium and potassium levels, as well as for any signs of
infection. Clients with diabetes may need increases in their insulin dosages due to the
effects of these medications.
Due to immunosuppression, clients taking corticosteroids should not receive a "live"
vaccine. They should call their primary care practitioner if they are exposed to
chickenpox or measles, since these conditions can be fatal in people who are using a
steroid.
Teach the client (or reinforce teaching) to take the prescribed dose in the morning,
maintain a low sodium, higher potassium diet and to avoid grapefruit
Diuretics - Loop
The Drug Notebook
(Potassium-Wasting)
Medications
(Generic Name)
bumetanide
furosemide
Therapeutic Uses
Loop diuretics treat edema including acute
pulmonary edema, heart failure, liver disease,
or renal disease. They are also used to treat
hypertension.
Ensure you understand the role of potassium
(K) in the body
Mechanism of action
These medications work in the ascending loop of Henle. Disrupted reabsorption causes increased
urine production, which lowers blood volume and results in lowered blood pressure. They also
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cause the veins to dilate, which lowers blood pressure mechanically. These medications result in
copious amounts of sodium-rich urine.
Contraindications
Major Adverse Effects (common)
These medications are contraindicated in
clients who are suffering from electrolyte
depletion and anuria.
The most common side effect of loop diuretics
is hypotension, hypovolemia, photophobia
and hypokalemia.
Ototoxicity and even deafness have been
reported with these medications, especially
when giving large doses intravenously too
quickly.
Clients should not use loop diuretics during
pregnancy or if they have severe liver or
kidney disease, an irregular heartbeat, or
suffer from gout. Clients with a history of
diabetes should expect an increase in their
blood sugar as a result of these medications.
Nursing Considerations
●
●
●
Prior to administering the first dose of loop diuretic, the nurse should assess
important baseline data including blood pressure, history of any hypersensitivity
reactions, liver and renal function levels and electrolyte levels.
Monitor the client for dizziness, hypotension, hypovolemia, weight, intake and output,
and hypokalemia.
Teach the client (or reinforce teaching) to eat a potassium-rich diet and take any
potassium supplements as prescribed, to weigh each morning and to use sun
protection.
Diuretics
The Drug Notebook
Osmotic
Medications
Therapeutic Uses
mannitol
Osmotic diuretics are used to treat increased
intracranial pressure or increased intraocular
pressure.
Mechanism of action
Osmotic diuretics are low-molecular-weight substances that produce a rapid loss of sodium and
water by inhibiting their reabsorption in the kidney tubules and the loop of Henle, thus increasing
plasma osmolality. This increases the diffusion of water from the intraocular, intracranial and
cerebrospinal fluids.
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Contraindications
Major Adverse Effects (common)
This medication should not be given if the
client active intracranial bleeding, liver
failure, anuria, pulmonary edema or severe
dehydration. Caution should be used when
administering this medication to clients who
have renal impairment.
Common side effects of mannitol use include
fluid and electrolyte imbalance,
hypernatremia, hypovolemia, nausea,
vomiting, and hypotension. Shock may occur
with the use of mannitol.
Extravasation (leakage) of mannitol can
cause edema and skin necrosis.
Nursing Considerations
●
●
●
●
Prior to administering the first dose of mannitol, the nurse should obtain important
baseline data including any history of a hypersensitivity reaction, electrolytes,
obtaining a baseline weight, and ensuring adequate kidney function.
Monitor blood pressure, intake and output, and electrolyte levels.
Mannitol may crystallize; use a filter needle to withdraw mannitol from the vial, and
an in-line filter with continuous IV infusion.
Teach the client (or reinforce teaching) to report any chest pain, breathing difficulty,
or pain at the IV site to the nurse. The client should also change position slowly to
decrease dizziness.
Diuretics
The Drug Notebook
Potassium-Sparing
Medications
Therapeutic Uses
spironolactone
Treat clients with heart failure, since they do
not significantly lower blood pressure. They
are the preferred diuretic for clients that are
also taking digitalis or for clients with cardiac
dysrhythmias. Spironolactone is also used to
treat hyperaldosteronism.
Mechanism of action
Spironolactone works by blocking aldosterone in the distal tube, which increases sodium and
water excretion and increases potassium reabsorption.
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Contraindications
Major Adverse Effects (common)
Contraindicated in clients with acute renal
insufficiency, Addison's disease,
hyperkalemia or pregnancy.
Common side effects of potassium sparing
diuretics include dizziness, headache, tinnitus
and abdominal pain. Spironolactone acts like
progesterone in the body, causing side effects
like impotence, gynecomastia, irregular
menses, amenorrhea, hirsutism and
deepening of the voice.
Nursing Considerations
●
●
●
●
Prior to administering the first dose of potassium-sparing diuretic, obtain important
baseline data including serum potassium level, blood pressure and edema status.
Monitor the client for serum potassium levels, cardiac dysrhythmias, blood pressure
and edema status.
Teach clients (or reinforce teaching) to take this medication with food or milk, monitor
their blood pressure, and to change position slowly to prevent dizziness.
Potassium-sparing diuretics have weak diuretic and antihypertensive properties, when
compared to other diuretics.
The Drug Notebook
Electrolyte Replacement
Potassium
Medications
Therapeutic Uses
Potassium chloride
Prevent or treat hypokalemia in clients that
do not ingest enough potassium in their diet
or who are losing potassium rapidly due to
conditions such as cirrhosis of the liver,
vomiting or the use of potassium-wasting
diuretics.
Mechanism of action
Potassium is the main intracellular cation and is needed to activate many physiological processes
including the transmission of nerve impulses in the cardiac and skeletal muscle system.
Contraindications
These medications are
contraindicated in clients that
Major Adverse Effects (common)
Common side effects of potassium supplementation
include abdominal discomfort, dysrhythmias,
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have hyperkalemia, suffer from
renal impairment or use
potassium sparing diuretics.
paresthesia and hyperkalemia.
For oral supplements, various forms exist including
tablets, effervescent tablets and a liquid form. These
medications can be mixed with water and/or juice to aid
in swallowing.
Injectable potassium supplements often cause irritation
to the veins. These medications should be administered
slowly after proper dilution. If injected without dilution,
potassium supplementation can be fatal.
Nursing Considerations
●
●
●
Prior to administering the first dose of potassium, the nurse should verify the serum
potassium level of the client and that the client has adequate renal function.
Monitor serum potassium level and any signs and symptoms of cardiac effects. If the
medication is given intravenously, frequent checks of the IV site and vein should be
performed.
Teach clients (and reinforce teaching) to report any signs and symptoms of cardiac
effect (heart rate changes or palpitations) or gastrointestinal bleeding (red, dark, or
tarry stools).
The Drug Notebook
Electrolyte Replacement
Magnesium
Medications
Therapeutic
magnesium oxide
magnesium sulfate
Ccorrect hypomagnesemia, which could be
caused by malnutrition, alcoholism or
magnesium-depleting medications.
Magnesium supplementation (in various forms
of the cation) is used for various other
reasons including as an antiarrhythmic,
laxative, antacid and anticonvulsant.
Mechanism of action
Magnesium is an essential cation that is required for all adenosine triphosphate (ATP)
functions including in the sodium-potassium pump of muscle cells.
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Contraindications
Major Adverse Effects (common)
These medications should be used cautiously
in clients that have a history of heart disease
or renal impairment.
Common side effects of magnesium
supplementation include decreased reflexes,
flatulence, dysrhythmias and dizziness.
Nursing Considerations
●
●
●
●
Assess important baseline information, including a history of a reaction to magnesium
supplementation, serum magnesium level, cardiac history, heart rate and blood
pressure.
Continued monitoring of serum magnesium levels is needed as well as cardiac
assessments including heart rate, rhythm, deep tendon reflexes and blood pressure.
Teach clients (or reinforce teaching) to recognize the signs and symptoms of
hypermagnesemia, including bradycardia, decreased reflexes, double vision, trouble
breathing and excessive diarrhea.
Note: Calcium gluconate is used to treat magnesium intoxication.
The Drug Notebook
Electrolyte Replacement
Calcium
Medications
Therapeutic Uses
calcium chloride
calcium citrate
calcium gluconate
Calcium supplementation is used to treat
hypocalcemia, hypermagnesemia, and as a
part of cardiac resuscitation.
Mechanism of action
Calcium supplements increase the levels of intra and extracellular calcium in the body, which
are needed to maintain homeostasis in the nervous, renal, respiratory and musculoskeletal
system.
Contraindications
Major Adverse Effects (common)
Calcium supplementation is contraindicated
in clients that have a hypersensitivity to
calcium salts or calcium-containing
medications. They are also contraindicated in
Side effects associated with calcium
supplementation include changes in the
nervous system such as dizziness and
hypotension. Other signs and symptoms that
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clients with hypercalcemia.
are indicative of hypercalcemia include
weakness, lethargy, depressed reflexes,
anorexia, nephrolithiasis and ↑BP.
Nursing Considerations
●
●
●
Prior to administering the first dose of calcium, assess for any history of a
hypersensitive reaction. Serum calcium levels, heart rate and blood pressure should
also be assessed prior to administration, especially if giving parentally.
Monitor serum calcium levels and for the absence of reflexes associated with
hypercalcemia (Chvostek and Trousseau's sign). If calcium is given intravenously,
frequent checks of the IV site are warranted as calcium has been linked to necrosis.
Teach the client (or reinforce teaching) to report any paresthesia or abnormal
reflexes.
Erectile Dysfunction
Drugs
The Drug Notebook
Medications
Therapeutic Uses
sildenafil
Sildenafil is used to treat erectile dysfunction
and pulmonary artery hypertension.
Mechanism of action
This medication works by increasing the effects of nitric oxide, which increases blood flow to
the penis and produces an erection.
When used to treat pulmonary hypertension, this medication works to cause smooth muscle
relaxation and subsequently vasodilation of the pulmonary artery.
Contraindications
Major Adverse Effects (common)
These medications are contraindicated with the use of
nitrates, such as nitroglycerin, due to the risk of severe
hypotension. These medications should be used with
caution in clients that have a history of diabetes,
myocardial infarction or stroke, hepatic or renal
impairment, or who suffer from hypotension.
Common side effects of these
medications include dizziness,
hypotension and diplopia.
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Nursing Considerations
●
●
●
●
Assess for important baseline data including blood pressure, heart rate, history of
hypersensitivity reaction, myocardial infarction or stroke.
Monitor for signs and symptoms of hypotension or a hypersensitivity reaction.
In clients suffering from an acute myocardial infarction, medication protocols change
if the client reports use of this medication. The client should not receive nitroglycerin.
Teach the client (or reinforce teaching) about these important concepts:
○ Disclose the use of this medication to all health care providers; if nitrates are
used with these medications, severe hypotension and death may occur.
○ Notify the HCP for an erection lasting longer than 4 hours.
○ Diabetic clients should monitor their blood sugar closely while taking this
medication.
The Drug Notebook
Hematopoietic Agents
Erythropoietin Alfa
Medications
Therapeutic Uses
Erythropoietin alfa
Hematopoietic agents are used to treat anemias
associated with renal failure and chemotherapy.
These medications may also be used to reduce
the need for blood transfusions in clients with
planned surgeries.
Mechanism of action
Erythropoietin is a naturally occurring substance in the body that is excreted by the kidneys
in response to hypoxia. Erythropoietin acts on the bone marrow to stimulate the release of
reticulocytes into the bloodstream.
Contraindications
Major Adverse Effects (common)
These medications are contraindicated in
clients that have a history of a hypersensitivity
reaction to human albumin. These medications
are also contraindicated for clients with
uncontrolled hypertension.
Common side effects related to erythropoietin
are arthralgia and muscle weakness. The client
may complain of flu-like symptoms and injection
site reactions. Dizziness, tachycardia, nausea
and vomiting have also been reported.
These medications have also been linked to
seizures, strokes, thromboembolic events, and
heart failure.
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Nursing Considerations
●
●
●
Prior to administering the first dose of this medication, the nurse should evaluate the
client's iron level, blood pressure and hemoglobin level.
Monitor for side effects including dizziness, tachycardia and pain.
Reinforce important educational concepts including working with the HCP to have
hemoglobin levels assessed regularly. If the client will inject these medications at
home, they (or their caregiver) must be taught the method used for injection.
The Drug Notebook
Hematopoietic Agents
Filgrastim
Medications
Therapeutic Uses
filgrastim
Filgrastim is used to prevent or treat low
leukocyte levels associated with cancer
treatment, congenital or idiopathic
neutropenia.
Mechanism of action
Filgrastim stimulates the formation of neutrophil progenitor cells by binding to granulocyte
receptors, which then divide and differentiate to provide protection against infection.
Contraindications
Major Adverse Effects (common)
These medications are contraindicated in
clients that report a history of a
hypersensitivity reaction to this medication
or other granulocyte colony-stimulating
factors.
Common side effects of this medication
include arthralgia and myalgia, headache and
rash. The client may also complain of
injection site pain. Thrombocytopenia,
splenomegaly, and splenic rupture has also
been reported to the use of this medication.
Nursing Considerations
●
●
●
Prior to administering the first dose of filgrastim, the nurse should obtain important
baseline data including CBC, hematocrit, platelet levels, and any history of a
hypersensitivity reaction.
Monitor the client's response to the medication, including leukocyte, hematocrit and
platelet levels. The nurse should assess for ecchymosis and spleen enlargement.
Teach the client (or reinforce teaching) methods used for self-injection, prevention of
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infection while leukocyte counts are low, and to report pain in the left upper quadrant.
The Drug Notebook
Immunosuppressants
T and B Cell Suppressors
Medications
Therapeutic Uses
cyclosporine
tacrolimus
These medications are used to suppress the
immune system. Common indications include
preventing transplant rejection and in
autoimmune diseases; Crohn's disease; IBD.
Mechanism of action
These agents block antibody production in B cells and inhibit helper T cells and suppressor T
cells. These actions suppress the immune system.
Contraindications
Major Adverse Effects (common)
These medications are contraindicated
pregnancy or when the client is
breastfeeding. Caution should be used with
clients that have severe renal impairment or
that have neoplasms.
Common side effects of these medications
include headache, gum hyperplasia, tremors,
hypertension, kidney dysfunction, secondary
infections and bone marrow suppression.
Nursing Considerations
●
●
●
Prior to giving these medications, the nurse should assess for baseline information
including any history of a hypersensitivity reaction, blood pressure, pregnancy status
and history of neoplasm. The nurse should verify renal function.
Monitor renal function, for signs of infection and blood pressure.
Teach the client (or reinforce teaching) about infection prevention, blood pressure
monitoring, and signs and symptoms of renal dysfunction.
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The Drug Notebook
Laxatives
Medications
Therapeutic Uses
Softener/Surfactant
Docusate
Laxatives treat or prevent constipation. After
rectal surgery, laxatives may be used to aid in
defecation and to prevent damage to the
surgical site.
Chemical Stimulant
cascara
senna
Bisacodyl
Bulk Stimulant
lactulose
magnesium citrate
polyethylene glycol
Psyllium
Lubricant
Mineral oil
Mechanism of action
Laxative medications are typically classified as either chemical stimulant, bulk stimulant or
lubricants. Chemical stimulates act by stimulating the nerves of the intestine, which
intensifies intestinal movement. Bulk stimulants work quickly by causing fecal matter in the
intestines to increase in volume while simultaneously increasing fluid in the gastrointestinal
(GI) tract and motility. Lubricants do not stimulate the digestive tract, but ease fecal
movement/defecation by decreasing straining.
Contraindications
Major Adverse Effects (common)
Use this medication with caution if the client
is a diabetic. Do not use it on clients with
acute bowel illnesses or diarrhea. Laxatives
should be used with caution in clients with a
history of cardiovascular disease and with
clients who are pregnant.
Common side effects of laxatives include
nausea, vomiting, abdominal cramping and
fecal incontinence. Additionally, due to the
increased motility, absorption of key
nutrients, fluid, and electrolytes may be
diminished.
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Nursing Considerations
●
●
●
Prior to the first dose, important baseline data should be obtained. This data should
include bowel movement patterns and an abdominal assessment.
Monitor for signs and symptoms of defecation, abdominal pain, dizziness, weakness,
or perianal irritation.
Teach the client (or reinforce teaching) that the laxative should not be used as a
weight loss plan. Cathartic dependence has been associated with routine use of
laxatives.
The Drug Notebook
Lipid-Lowering Agents
HMG- CoA Reductase Inhibitors
Medications
Therapeutic Uses
atorvastatin
rosuvastatin
simvastatin
To reduce blood lipids in an effort to reduce
the morbidity and mortality of atherosclerotic
cardiovascular disease. These medications
should be used in conjunction with diet and
exercise.
Mechanism of action
HMG- CoA Reductase Inhibitor agents reduce low density lipoprotein (LDL) cholesterol by
inhibiting the HMG-CoA reductase enzyme in the liver that is responsible for the synthesis of
cholesterol. This reduces LDL levels and slightly increases the cardioprotective high density
lipoprotein (HDL) levels. This drug may cause atheroma formations to shrink.
Contraindications
Major Adverse Effects (common)
Contraindications include pregnancy and
breastfeeding, or active liver disease.
Caution should be used when administering
these medications to diabetics due to the
increase in blood glucose levels.
Common side effects of HMG-CoA Reductase
Inhibitor agents include constipation,
decreased absorption of fat-soluble vitamins,
abdominal pain, and arthralgia. Other side
effects include rhabdomyolysis and upper
respiratory tract infections.
Simvastatin has been linked to cataracts.
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Nursing Considerations
●
●
●
Assess for important baseline data prior to administering these medications, including
liver function tests, renal function tests, any history of hypersensitivity, and bowel
patterns including the last bowel movement.
Monitor the client for liver dysfunction, muscle pain and renal function.
Teach clients (or reinforce teaching) to use this medication in conjunction with diet
and exercise and to notify their HCP for muscle pain, decreased urination, or signs of
a respiratory infection.
The Drug Notebook
Lipids-Lowering Agents
Bile Acid-Sequestrants
Medications
Therapeutic Uses
cholestyramine
Bile acid sequestrants are used in conjunction
with diet and exercise to reduce serum
cholesterol levels (Low density lipoproteins,
LDLs; triglycerides). Cholestyramine is also
used to treat pruritus associated with partial
biliary obstruction.
Mechanism of action
Bile acid sequestrants work by increasing the amount of bile acid excreted in the feces. This
increases the liver's cholesterol use to make more bile acids, resulting in a decreased serum
cholesterol level. These medications are not absorbed and are excreted in the intestines.
Contraindications
Major Adverse Effects (common)
Contraindicated in clients with total biliary
obstruction or impaired intestinal function.
Caution should be used if this medication is
warranted during pregnancy due to the
decreased absorption of fat-soluble vitamins.
Common side effects of these medications
include headache, fatigue, drowsiness and
gastrointestinal irritation. Constipation
associated with the use may progress to fecal
impaction.
Nursing Considerations
●
Prior to administering the first dose of bile acid sequestrants, important baseline data
should be obtained including bowel patterns, a history of a hypersensitivity reaction to
these medications, biliary patency and pregnancy status. An abdominal assessment
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●
●
should be performed, including documenting the last bowel movement.
Monitor for signs and symptoms of biliary obstruction, hypersensitivity reactions or GI
distress.
Teach the client (or reinforce teaching) on how to prevent constipation, to report any
right upper quadrant pain, and the importance of using this medication in conjunction
with dietary changes and exercise.
The Drug Notebook
Migraine-Specific Drugs
(Triptans)
Medications
Therapeutic Uses
sumatriptan
Triptans are used to treat acute migraine
attacks.
Mechanism of action
Triptans are medications that work as selective serotonin receptor agonists; they cause
vasoconstriction in cranial nerves that has been associated with migraine and cluster
headache pain relief. These medications are not used for prevention of migraine headaches.
These medications are primarily metabolized in the liver and excreted in the urine. They
cross the placenta and have shown toxic effects to the fetus in clinical animal studies. They
also enter breast milk.
Contraindications
Major Adverse Effects (common)
These medications are contraindicated
pregnancy. Clients that have had an acute
myocardial infarction or who have been
diagnosed with coronary artery disease
should not take these medications as these
conditions will be exacerbated by the
intended therapeutic effects of these
medications. Use caution in giving these to
clients of advanced age and those that have
renal or liver impairment.
The common side effects of these medications
are associated with the intended therapeutic
action of constricting blood vessels. Common
side effects include paresthesia, burning
sensation, weakness, muscle pain and
vertigo. Cardiovascular effects include blood
pressure changes and angina.
Nursing Considerations
●
Prior to administering the first dose of triptans, important baseline data should be
obtained including any history of hypersensitivity reactions to these medications,
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●
●
●
blood pressure, cardiac history, and renal and liver function.
Monitor the client for angina, blood pressure changes and renal or liver impairment.
Teach clients (or reinforce teaching) to take these medications at the first sign of a
migraine and to report any chest tightness or tingling of extremities to their HCP.
These medications are not associated with the vascular and gastrointestinal effects of
ergot derivatives that are also used as antimigraine therapy.
The Drug Notebook
Non-Opioid Analgesics
Medications
Therapeutic Uses
First generation NSAIDs
aspirin
ibuprofen
Ketorolac
Control inflammation, mild-to-moderate pain,
and fever. Aspirin is also used to inhibit
platelet aggregation, which may help protect
against myocardial infarctions and stroke.
Second generation NSAIDs (COX-2
Inhibitor)
celecoxib
Acetaminophen
Mechanism of action
There are multiple non-opioid analgesic medications. They target and block the chemical
substances released by the brain (particularly prostaglandin) in response to injury.
NSAIDs work by blocking the cyclooxygenase enzymes (COX-1; COX-2), which block the
inflammatory process.
As an antipyretic, acetaminophen acts in the hypothalamus to inhibit the synthesis of
prostaglandin E, which causes the release of heat through vasodilation and sweating. The
analgesic mechanism of acetaminophen is not understood, but it is theorized that it works
similarly to NSAIDs by blocking the COX enzymes.
Second generation NSAIDS/celecoxib, which are commonly used to treat arthritis, work by
inhibiting the COX-2 enzyme. This enzyme is responsible for converting arachidonic acid to
prostaglandins, which produces an inflammatory response.
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Contraindications
Major Adverse Effects (common)
Adequate kidney and liver function is needed
to metabolize and excrete these
medications. They are also contraindicated
for clients with peptic ulcer disease and
should be used with caution in clients that
have a Helicobacter pylori infection.
Due to blocking the COX-1 enzyme, NSAIDs
block protective mucous production in the
gastrointestinal tract. A common complaint
associated with these medications is
gastrointestinal upset (abdominal pain and
nausea). In prolonged use, this may lead to
bleeding ulcers. An allergic reaction can cause
a skin reaction with a rash or blisters;
bleeding, dizziness and headache have also
been reported.
Ketorolac is contraindicated in clients that
have a history of severe kidney disease.
Second generation NSAIDs should be used
with caution in clients that have
cardiovascular disease, as these medications
may increase the risk of myocardial
infarction and strokes. These medications
are also contraindicated for clients that have
an allergy to drugs containing sulfa.
NSAIDs have also been associated with eight
cranial nerve stimulation including tinnitus.
Acetaminophen use is generally well tolerated
when used appropriately. However, some side
effects include headache, hemolytic anemia
and liver or renal dysfunction.
Nursing Considerations
● Important baseline data should be obtained before administering the first dose of these
medications including pain level or temperature reading before medicating, a history of a
hypersensitivity reaction, and liver and renal functioning.
● Monitor the client to ensure the intended effect has been achieved such as reduction of
fever or pain level. The nurse should also continually monitor the amount of medication
clients are being administered per day.
● Acetylcysteine is used as an antidote to an acetaminophen overdose.
● Teach the client (or reinforce teaching) about:
● Appropriate use of these medications (continued long term use of NSAIDs may lead to
gastric ulcers).
● These medications may mask the signs and symptoms of treatable illnesses, infections, or
injuries.
● Aspirin toxicity (salicylism) may progress from ringing in the ears and fever to coma and
respiratory depression. Acetaminophen can be extremely toxic to the liver. Clients should
understand adequate dosing and to limit the amount of acetaminophen to less than 4,000
mg/day in adults from all sources.
● Parents should read the drug label or consult with their pediatrician to find an adequate
dose for children. This medication is also used in many combination drugs.
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The Drug Notebook
Opioid Analgesics
Medications
Therapeutic Uses
codeine
hydrocodone
hydromorphone
meperidine
morphine
oxycodone
Opioid analgesics are used to manage
moderate-to-severe pain.
Mechanism of action
Opioid medications interact with opioid mu receptors in the central nervous system, acting as
agonists of endogenous opioid peptides (enkephalins and endorphins). This action produces
analgesia and euphoria.
They can be categorized as long-acting, short-acting or rapid-onset agents.
All opioids are schedule II drugs.
Contraindications
Major Adverse Effects (common)
Contraindications include respiratory
depression, paralytic ileus, and upper airway
obstruction. These medications should be
used cautiously in clients who also take CNS
depressants such as alcohol. Caution should
also be exercised with clients of advanced
age and those that suffer from chronic
respiratory conditions. If these medications
are used during pregnancy, neonates may
suffer from neonatal abstinence syndrome.
Common side effects are associated with CNS
depression, respiratory depression, and
decreased gastrointestinal motility. These
side effects include nausea, vomiting,
respiratory distress, orthostatic hypotension,
bradycardia, and impaired cognitive
capabilities. Prolonged use of these
medications is associated with dependence.
Nursing Considerations
●
Prior to administering the first dose of opioid analgesic, the nurse should assess
baseline data including the indication for these medications, any hypersensitivity
related to these medications, respiratory status, level of consciousness, blood
pressure and heart rate. The nurse should obtain a baseline pain level prior to
administering the first dose. These medications should not be administered if
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●
●
●
●
respiratory rates are lower than 12 breaths per minute.
Monitor respiratory status and breathing patterns, blood pressure, heart rate and pain
level.
Withdrawal symptoms of these medications may occur and include nausea, vomiting,
irritability, fever and dizziness.
Teach the client (or reinforce teaching) to take the medication appropriately and keep
the medication is a safe place, to never combine other CNS depressants with these
medications, and to work closely with the HCP when it is necessary to discontinue
use.
The antidote for opioids is an opioid antagonist called naloxone. Repeated doses may
be needed to rapidly reverse opioid medications.
Sedative
The Drug Notebook
Hypnotics
Medications
Therapeutic Uses
zolpidem
zaleplon
eszopiclone
These medications are used for the
short-term treatment of insomnia.
Mechanism of action
Sedative-hypnotics work by binding to benzodiazepine receptors in the central nervous
system and increasing the inhibitory effect of gamma-aminobutyric acid (GABA).
Contraindications
Major Adverse Effects (common)
They are also contraindicated if taking these
medications before bedtime prevent the
client from getting 6-8 hours of sleep. These
should be used with caution if other CNS
depressants are being taken, if the liver and
kidneys are impaired, or in the presence of
respiratory disorders. These medications
should be used in caution in clients of
advanced age or those suffering from
depression.
Common side effects of these medications
include drowsiness, amnesia, behavioral
changes, blurred vision and constipation.
After beginning these medications, a
worsening of depression, hallucinations or
suicidal ideations have occurred.
These medications have been associated with
withdrawal symptoms.
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Nursing Considerations
●
●
●
Prior to administering these medications, important baseline data includes any history
of a hypersensitivity reaction to these medications, liver and kidney function, and
bowel patterns.
Monitor the client for dizziness, daytime drowsiness, worsening depression, or liver
and kidney impairment.
Teach the client (or reinforce teaching) to avoid using alcohol or other CNS
depressants during usage and to take these medications when 6-8 hours of sleep is
possible (just prior to bedtime).
The Drug Notebook
Skeletal Muscle Relaxants
Medications
Therapeutic Uses
cyclobenzaprine
baclofen
Muscle relaxants are used to treat spasticity
associated with spinal cord diseases (such as
cerebral palsy, multiple sclerosis) or lesions.
They also relieve symptoms of acute painful
musculoskeletal conditions. These
medications should be used in conjunction
with other modalities to reduce muscle
spasms and pain, including rest, heat, or
physical therapy.
Mechanism of action
Muscle relaxant medications act centrally on the brain stem to inhibit neuronal transmission. They
are typically classified by their pharmacologic properties as either anti-spasticity or antispasmodic
agents. Most skeletal muscle relaxants are metabolized in the liver and all are excreted in the
urine. Baclofen is not metabolized by the body.
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Contraindications
Major Adverse Effects (common)
These medications are contraindicated in
clients who are in the acute recovery phase
of a myocardial infarction, dysrhythmias or
heart failure. Use with caution in clients of
advanced age, those with renal disease or
cardiac dysfunction, and those with a history
of seizures.
Common side effects of these medications
(associated with CNS depression) include
headache, dizziness, drowsiness, confusion
and insomnia.
cyclobenzaprine
Side effects include drowsiness, dizziness,
fatigue, dry mouth, constipation and
headache.
baclofen
Additional side effects include increased
urinary frequency and seizures
Nursing Considerations
●
●
●
Prior to administering the first dose, important baseline information should be
obtained including a history of a hypersensitivity reaction to these medications,
neurological assessment, cardiac assessment and renal function.
Monitor clients for cardiac dysrhythmias, excessive CNS depression and confusion.
Teach the client (or reinforce teaching) to avoid using other CNS depressants such as
alcohol while on this medication., The client should avoid activities that require mental
alertness until the reaction to these medications is known. Clients should also be
urged to ask for assistance with walking, due to the dizziness and weakness
associated with these medications.
Additional Notes
●
●
Clients taking cyclobenzaprine may experience anticholinergic effects such as dry
mouth and urinary retention. While taking this medication, antidepressants should be
used with caution due to the increased risk of serotonin syndrome, excessive CNS
depression, and hyperpyretic crisis.
Clients taking baclofen should be instructed to take it with food and that discontinuing
the use of baclofen abruptly can cause severe adverse reactions.
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The Drug Notebook
Thyroid Hormone (T4)
Replacement
Medications
Therapeutic Uses
levothyroxine
desiccated thyroid
Used to treat low levels or absent levels of
thyroid hormones, myxedema coma, for
thyroid stimulating hormone (TSH)
suppression, and in thyroid cancer treatment.
Mechanism of action
Thyroid replacement hormones act as endogenous thyroid hormone would and
increase the metabolic activity of body tissues. These agents are metabolized by
the liver and eliminated in the bile. These medications do not cross into the
placenta, and seemingly have no effect on the developing fetus.
Contraindications
Major Adverse Effects (common)
Contraindications during acute
thyrotoxicosis, or during acute myocardial
infarction.
The common side effects of thyroid
replacement hormones are related to the
intended therapeutic action. These effects
include cardiac stimulation (palpitations,
dysrhythmias) and CNS stimulation (tremors,
anxiety, insomnia). However, effects are rare
when the therapeutic levels of these
medications are monitored through routine
thyroid function tests.
Caution should be used when administering
these medications to breastfeeding mothers
and clients that suffer from Addison's
disease. These medications should not be
stopped during pregnancy; the dosages are
often increased during pregnancy. These
drugs are not approved for weight loss.
Nursing Considerations
●
●
●
Prior to administering the first dose of medication, the nurse should assess important
baseline information including any history of hypersensitivity reactions to these
agents, myocardial infarction or untreated thyrotoxicosis, or a history of Addison's
disease. Baseline cardiac and neurological function should be assessed.
Monitor the client for any side effects associated with thyroid replacement use
including tremors, anxiety, sleeplessness, palpitations and dysrhythmias.
Teach clients (or reinforce teaching) to take the medication 30 minutes before
breakfast to increase absorption and prevent insomnia, and not to abruptly stop the
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medication without discussing this with their HCP.
The Drug Notebook
Urate-Lowering Drugs
(Antigout Agents)
Medications
Therapeutic Uses
allopurinol
Used to treat primary gout and
hyperuricemia. They can also be used to treat
secondary hyperuricemia related to cancer
and recurrent calcium oxalate calculi.
Mechanism of action
These medications work by inhibiting uric acid production and xanthine oxidase. The enzyme
Xanthine oxidase converts hypoxanthine and xanthine to uric acid. In gouty arthritis, urate
crystals accumulate in joints causing pain.
Contraindications
Major Adverse Effects (common)
Caution should be used when administering
these mediations to clients with a history of
renal or liver impairment.
Common side effects of urate-lowering agents
are drowsiness, chills, peripheral neuropathy,
nausea and vomiting.
Nursing Considerations
●
●
●
Prior to administering the first dose of medication, obtain CBC and uric acid levels to
establish a baseline. Review renal and liver function tests prior to administration.
Monitor the client for hypersensitivity reactions including fever, rash, and decreased
liver/kidney function.
Teach the client (or reinforce teaching) to:
○ Take the medication after meals and drink enough water to produce 2 liters of
urine a day.
○ Adhere to a low purine diet to prevent uric acid.
○ Report any abnormal bleeding and bruising.
○ During the first months of use, an increase in gout "flare ups" may occur. The
client should contact their HCP for recommendations to treat this pain, but
should not discontinue use.
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The Drug Notebook
Urinary Antispasmodic
Medications
Therapeutic Uses
oxybutynin
tolterodine
Treat bladder hyperactivity including
symptoms of urgency, frequency, nocturia
and incontinence.
Mechanism of action
These medications have an anticholinergic effect and block acetylcholine on smooth muscles,
including the smooth muscle of the bladder.
Contraindications
Major Adverse Effects (common)
These medications are contraindicated in the
presence of a hypersensitivity reaction to
these medications or other muscarinic
antagonists. These medications are
contraindicated with other medications that
have an anticholinergic action, such as
antihistamines.
Common side effects of these medications are
related to the effect of blocking acetylcholine,
which includes dry mouth, drowsiness and
constipation. Occasionally, clients may have
side effects that include urinary retention,
blurred vision, nausea and vomiting. Clients
taking this medication will also have a
decrease in sweating abilities.
Nursing Considerations
●
●
●
Prior to administering the first dose, the nurse should assess important baseline data
including any history of hypersensitivity reactions to muscarinic antagonists and the
client's urinary frequency.
Monitor intake and output, for clinical manifestations of urinary retention, and monitor
the client's bowel activity.
Teach the client (or reinforce teaching) to avoid alcohol while taking these
medications, avoid activities that require alertness until the side effects of these
medications are known, and to treat dry mouth with sugarless candy and adequate
hydration. The client should avoid strenuous activity and overheating as the sweating
abilities of the exocrine glands will be decreased.
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Pediatric Considerations
Important nursing considerations when administering medications to pediatric
clients include:
1. Medications in pediatrics should be administered cautiously. As children have
immature systems, medications may be more toxic to children than adults.
Newborn and premature infants have the greatest risk for physical harm with
medications due to an immature liver.
2. Pediatric medications are often calculated by body weight.
3. The following medications are considered high-alert medications and many
facilities recommend using two nurses to check these medications:
○ Amiodarone
○ Digoxin
○ Dopamine
○ Epinephrine
○ Fentanyl
○ Gentamicin
○ Heparin
○ Insulin
○ Morphine
○ Norepinephrine
○ Phenytoin
○ Potassium
○ Propofol
○ Tacrolimus
4. Aspirin has been linked to Reye's syndrome.
Reye's syndrome is a rare illness that can affect the blood, liver and brain of someone
who has recently had a viral infection. It always follows another illness. Although it
mostly affects children and teens, anyone can get it. It can develop quickly and without
warning. It is most common during flu season. Symptoms include: nausea and vomiting,
listlessness, personality change - such as irritability, combativeness or confusion,
delirium, convulsions and loss of consciousness. Reye's syndrome can lead to a coma
and brain death, so quick diagnosis and treatment are critical. The cause of Reye's
syndrome is unknown. Studies have shown that taking aspirin increases the risk of
getting it. Because of that, aspirin is no longer recommended for routine use in children
and should be avoided unless the child has been diagnosed with Rheumatic fever or
Kawasaki disease.
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