University of Evansville
Page _____ of ______
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Date_________________ Client’s Initials ________
Student ____________________________
Allergies:
Priority Nursing Diagnosis:
Long and Short term goals (must be measurable):
Interventions:
MEDICATION WITH
INDIVIDUAL DESIRED
NURSING IMPLICATIONS/
EVALUATION OF DESIRED
PRESCRIBED DOSEAGE
EFFECT OF DRUG FOR
CONSIDERATIONS FOR
EFFECT FOR THE PATIENT.
CLASSIFICATION OF THE
THIS PATIENT
THIS PATIENT
INCLUDING ASSESSMENT,
DRUG
LAB RESULTS AND
USUAL DOSE/SAFE DOSE
PROCEDURES
AND ADMINISTRATION
Vincristine
Drug Interactions:
Effects on Lab Test Results:
Pharmacological Class: vinca
Arrests mitosis in metaphase,
Asparaginase, Azole
may increase uric acid level,
alkaloid
blocking cell division. Inhibits antifungals, calcium channel
may decrease sodium and
Therapeutic Class:
replication of certain cancer
blockers, digoxin, mitomycin,
hemoglobin levels and
antineoplastic
cells
phenytoin, quinolone
hematocrit. May decrease
antibiotics
WBC and platelet counts.
Route: IV
Considerations: After giving
Adverse Reactions:
Available forms:
CNS: acute uric acid
drug monitor for life
Injection: 1 mg/ml in 1,2,5 ml
neuropathy, ataxia, coma,
threatening acute
multiple dose vials
cranial nerve palsies, fever,
brochospasm…reaction is most
1 mg/ml in 1, 2 ml preservative
headache, hoarseness, jaw pain, likely to occur if pt also is
free vials
loss of deep tendon reflexes,
taking mitomycin. Monitor for
paresthesia, peripheral
hyperuricemia. Check for
neuropathy, permanent
depression of Achilles tendon
neurotoxicity, seizures, sensory reflex, numbness, tingling,
loss, wrist drop and foot drop,
footdrop or wrist drop,
vocal cord paralysis.
difficulty walking, ataxia, and
CV: hypertension, hypotension, slapping gait. Check ability to
phlebitis
walk on heels. Monitor bowel
EENT: diplopia, optic and
function. Constipation may be
extraocular neuropathy, ptosis, early signs of neurotoxicity.
visual disturbances
Give antiemetic before drug.
GI: anorexia, constipation,
Fatal if taken intrarectally.
cramps, diarrhea, dysphagia,
Don’t give drug more than once
1/2009
N478 Drug Sheet
University of Evansville
Page _____ of ______
Department of Nursing and Health Sciences
Drug Dispensing Sheet
ileus that mimics surgical
a week. Maintain good
abdomen, intestinal necrosis,
hydration and give allopurinol
nausea, stomatitis, vomiting
to prevent uric acid
GU: dysuria, polyuria, urine
nephropathy. If SIADH occurs
retention
restrict fluids. Give stool
Hematologic: anemia,
softener, laxative, or water
leucopenia, thrombocytopenia
prior to each dose to prevent
Metabolic: hyperuricemia,
constipation.
hyponatremia, weight loss
Patient Education: instruct pt
Musculoskeletal: muscle
on infection control and
weakness and cramps
bleeding precautions. Warn
Respiratory: acute
about alopecia. Encourage fluid
bronchospasm
intake. Advise not to become
Skin: cellulitis at injection site, pregnant.
rash, reversible alopecia, severe
local reaction with
extravasation
Other: SIADH
Darbepoetin alfa (Aranesp)
Pharmacological Class:
hematopoietic
Therapeutic class: antianemic
Route: IV 21 hour duration
subq peak at 34 hr lasts 49 hrs
Available form:
Injection (in albumin or
polycarbonate solutions):
25mcg/0.42ml, 40mcg/0.4ml,
60mcg/0.3ml, 100mcg/0.5ml,
150mcg/0.3ml, 200mcg/0.4ml,
300mcg/0.6ml, 500mcg/ml in
1/2009
N478 Drug Sheet
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
single dose syringes or auto
injections
25mcg/ml, 40mcg/ml,
60mcg/ml, 100mcg/ml,
150mcg/0.75ml, 200mcg/ml,
300mcg/ml, 500mcg/ml in
single dose vials.
Furosemide 20 mg PO HS; 40
mg PO daily
Pharmacolgical Class: loop
diuretic
Therapeutic Class: diuretic,
antihypertensive
Route: PO, IV, IM
Dose: Injection: 10 mg/ml
Oral Solution: 40 mg/5 ml; 10
mg/ml
Tablets: 20 mg, 40 mg, 80mg,
500mg
1/2009
N478 Drug Sheet
Promotes water and sodium
excretion
Specific to Patient:
Monitor glucose levels as they
can be increased by this
medication, this is especially
important since he is also
taking Metformin (an
antidiabetic) which is a drug
interaction; since uric acid
levels can be increased on this
drug the Allopurinol level may
need to be adjusted
accordingly; since he is taking
a potassium supplement it is
important that his potassium
levels are monitored as this
drug can decrease potassium
especially if the Furosemide is
discontinued; warn patient of
possible nocturia with the HS
dose even though it is small
Page _____ of ______
Drug interactions:
Aminoglycoside antibiotics,
cisplatin: May potentiate
ototoxicity. Use together
cautiously.
Amphoterin B, corticosteroids,
corticotrophin: May increase
risk of hypokalemia. Monitor
potassium level closely.
Antidiabetics: May decrease
hypoglycemic effects. Monitor
glucose levels.
Antihypertesives: May increase
risk of hypotension. Use
together cautiously.
Chlorothiazide, chlorthalidone,
hydrochlorothiazide,
indapamide, metolazone: May
cause excessive diuretic
response, resulting in serious
electrolyte abnormalities or
dehydration. Adjust doses
carefully while monitoring
patient closely.
Digoxin, neuromuscular
blockers: May increase toxicity
from furosemide-induced
hypokalemia. Monitor
Effects on Lab results:
May increase glucose,
cholesterol, and uric acid
levels. May decrease
potassium, sodium, calcium,
magnesium, and hemoglobin
levels, and hematocrit; May
decrease granulocyte, WBC,
and platelets
Considerations:
Monitor weight, peripheral
edema, breath sounds, blood
pressure, fluid intake and
output, and electrolyte, glucose,
BUN, and carbon dioxide
levels; Monitor uric acid level,
especially if patient has a
history of gout;
Patient Education:
Take PO and IM dose in
morning to decrease risk of
nocturia and then a second dose
in early afternoon; advise
patient to stand slowly to
prevent dizziness, not to drink
alcohol, and to minimize
strenuous exercise in hot
weather
University of Evansville
Page _____ of ______
Department of Nursing and Health Sciences
Drug Dispensing Sheet
potassium level closely.
Ethacrynic acid: May increase
risk of ototoxicity. Do not use
together.
Lithium: May decrease lithium
excretion, resulting in lithium
toxicity. Monitor lithium level.
NSAIDs: May inhibit diuretic
response. Use together
cautiously
Salicylates: May cause
salicylate toxicity. Use together
cautiously.
Adverse Reactions:
Dizziness, fever, headache,
parethesia, restlessness, vertigo,
weakness, orthostatic
hypotension, thrombophlebitis
with IV use, volume depletion,
dehydration, blurred or yellow
vision, transient deafness,
abdominal discomfort,
anorexia, constipation,
diarrhea, nausea, pancreatitis,
vomiting, azotemia, frequent
urination, nocturia, oliguria,
polyuria, agranulocytosis,
anemia, aplastic anemia,
leucopenia, thrombocytopenia,
hepatic dysfunction,
asymptomatic, hyperuricemia,
fluid and electrolyte
imbalances, including diltional
hypotnaturemia, hypocalcemia,
and hypomagnesemia, glucose
1/2009
N478 Drug Sheet
Cyanocobalamin (Vitamin
B12)
Pharmacological: water soluble
vitamin
Therapeutic class: vitamin,
nutrition supplement
Available:
Cyanocobalamin
Injection: 100, 1000 mcg/ml
Intranasal: 500mcg/0.1ml
Tablets: 25, 50, 100, 250, 500,
1000 mcg
hydroxocobalamin
Injection: 1000 mcg/ml,
cyanokit 2 g vial, two vials per
kit
1/2009
N478 Drug Sheet
University of Evansville
Page _____ of ______
Department of Nursing and Health Sciences
Drug Dispensing Sheet
intolerance, hyperglycemia,
hypochloremic alkalosis,
hypokalemia, muscle spasm,
dermatitis, photosensitivity,
purpura, gout, transient pain at
IM injection site
Acts as a coenzyme that
Adverse Effects:
Effects on lab test results:
stimulates metabolic functions. CV: heart failure, peripheral
May decrease potassium level.
Needed for cell replication,
vascular thrombosis
May cause false positive results
hematopoiesis, and
GI: transient diarrhea
for intrinsic factor antibody
nucleoprotein and myelin
Respiratory: Pulmonary Edema test.
synthesis. As antidote, binds to Skin: itching, transitory
Hydroxocobalamin: may
cyanide ions forming
exanthema, urticaria.
increase blood creatinine,
cyanocobalamin which is
Other: anaphylactoid reactions, triglyceride, cholesterol, total
excreted in urine. Increases
anaphylaxis, burning, pain
protein, glucose, albumin,
vitamin b12 level. Removes
alkaline phosphatase, and
Drug Interactions:
cyanide from body.
Aminoglycosides,
bilirubin levels. Urine glucose,
chloramphenicol, colchicines,
protein, ketones, bilirubin,
para-aminosalicylic acid and
urobilinogen, and nitrate levels,
Specific to this patient: This
salts.
and HGB levels. May decrease
patient is on this drug to
Alcohol use: may cause
ALT and amylase levels. May
prevent anemia.
malabsorption of vitamin B 12. increase urine pH and RBC,
Sun exposure: may lead to
WBC and basophil counts. May
photosensitivity
increase or decrease aPTT, PT
and phosphate, uric acid, AST,
CK, creatine kinase MB, and
LDH levels.
Considerations: Assess
deficiency before therapy.
Determine reticulocyte count,
hct, and B12, iron, and folate
levels before therapy. Infection,
tumors, renal, hepatic, or other
debilitating diseases may
reduce therapeutic response.
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Promethazine hydrochloride
(Phenergan)
Pharmacologic class:
phenothiazine derivative
Therapeutic class: antiemetic,
antihistamine, sedative
For nausea and vomiting:
adults receive 12.5 to 25 mg
PO, IM, or PR every 4 hours,
prn; Children older than age 2
receive 0.5 mg/kg
1/2009
N478 Drug Sheet
Prevents motion sickness and
relieves nausea, nasal
congestion, and allergy
symptoms. Also promotes
calmness
Page _____ of ______
Closely monitor potassium
level for first 48 hours. Don’t
mix with other drugs. Don’t
give oral doses. Give potassium
supplement if needed. Give
spray to one nostril weekly one
1 hr before or after hot foods or
liquids. Monitor bp during and
after IV infusion. Oxalate
crystals may occur in urine.
Patient Education: Avoid
direct sunlight while skin is
discolore. Pernicious anemia
pts must return for monthly
injections. Have a wellbalanced diet. Store oral tablets
in a tightly closed container at
room temp.
Assess patient’s condition
May increase glucose and
before starting therapy and
hemoglobin levels and
regularly thereafter to
hematocrit
monitor drug’s
May decrease WBC,
effectiveness
platelet, and granulocyte
Pronounced sedative effect
counts
limits use in many
May have false-positive or
ambulatory patients
false-negative results with
Give drug with food or milk
urine pregnancy tests
to reduce GI distress
May interfere with blood
Check patient for sulfite
typing of ABO group
allergy before giving
Effects on Children:
Phenergan IM
Contraindicated in
Inject IM deep into large
neonates, breast feeding
muscle mass, rotate
women, premature
injection sites
neonates, and acutely ill or
Do not give Sub Q
dehydrated children. Don’t
University of Evansville
Page _____ of ______
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Drug may be safely mixed
use in children for nausea
with Demerol in the same
and vomiting when the
syringe
cause of vomiting is
In children it is especially
unknown. Younger than
important to monitor
age 2, contraindicated. Ue
respiratory depressant
with caution when 2 or
effects and avoiding
older, use lowest effective
combining the drug with
dose, and watch for
other drugs known to have
respiratory depression.
respiratory depressive
effects
Warn patient about
photosensitivity and
precautions to avoid it
Drug & Class
1/2009
N478 Drug Sheet
Pharmacologic
Action
Therapeutic Use
Adverse Effects
Drug Interactions
Precautions &
Contraindications
Duragesic
(Fentanyl)
Class: Opioid
Analgesic
Dosages:
10, 20, 30, 40 cm
systems deliver 25,
50, 75, or 100 mg/hr
to the systemic
circulation,
representing
approximately 0.6,
1.2, 1.8, or 2.4
mg/day. The 50, 75,
and 100 mg/hour
doses are to be used
only in opioidtolerent patients.
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
It works by binding to The Duragesic patch
*weak, shallow
receptors in the brain is used to manae
breathing.
and nervous system
chronic pain in
*severe weakness,
used by the body’s
patients who need
feeling light-headed
natural pain relievers. continous narcotic
or fainting.
pain relief and whose *cold, clammy skin
pain cannot be
*pale skin, easily
managed by less
bruising or bleeding.
powerful pain
*nausea, vomiting,
medicines
stomach pains,
constipation, gas.
*dizziness,
drowsiness, anxiety,
sleep problems
(insomnia).
*muscle stiffness,
back pain.
*itching, blistering,
redness, or swelling
where the patch was
worn.
*increased sweating,
urinating less than
usual.
*THIS IS NOT A
COMPLETE
LIST!!!
Page _____ of ______
*Carbamazepine
(Tegretol, Carbatrol)
*Phenytoin (Dilantin)
*Diltiazem (Cartia,
Dilacor, Tiazac)
*St John’s wort
*Rifampin (Rifamate,
Rifater, Rimactane)
*Antibotic (ie.
Clarithromycin(Biaxin),
Erythromycin(E-Mycin
Ery-Tab, E.E.S)
Itraconazole (Sporax),
Ketoconaol (Nizoral),
or Troleandomycin
(Tao)
*HIV medications (i.e.
amprenavir
(Agenerase), tipranavie
(Aptivus), indinavir
(Crixivan), saquinavir
(Invirase),
lopinavir/ritonavir
(Kaletra),
fosamprenavir
(Lexiva), ritonavir
(Norvir), atazanavir
(Reyataz) nelfinavir
(Viracept)
*THIS IS NOT A
COMPLETE LIST!!!
Nursing Actions related to the Modalities
Direct Care
1/2009
N478 Drug Sheet
Drug or Drug Class:
Teaching/Counseling
Social Support
*In elderly, cachectic
or debilitated patients
may have altered
pharmacokinetics due
to poor fat stores,
muscle wasting or
altered clearance. So
the clearance of
fentanyl may be
reduced, and the
terminal half life
prolonged.
*Should not be used
in management of
postoperative pain.
*Patients with known
hypersensitivity to
fentanyl.
*Patients with head
injuries an increased
intracranial pressure.
*Patients with cardiac
disease, Hepatic or
renal disease, chronic
pulmonary disease.
*category C in
pregnancy.
*monitor patients for signs of
respiratory distress and apply oxygen
or control respiration as needed.
*monitor patients who are running a
fever/ or using external heat, because it
can increase the amount of medication
absorbed.
*patients should be monitored until
stable.
*monitor patients with heart rhythm
disorders, liver disease, kidney disease
closely.
1/2009
N478 Drug Sheet
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
*Avoid drinking alcohol, or using other
medications that make you sleepy. (i.e.
cold medication, other pain medications,
muscle relaxers, or medications for
depression or anxiety)
*Do not use patch if it has been cut or
damaged.
*Do not use soaps, oils, lotions, alcohol,
or other chemicals on the skin where you
apply the patch. Because they could
increase the amount of Fentanyl that
your skin absorbs.
*Apply the patch to flat, dry, hairless
area of the chest, back, or outer side of
upper arms. To remove any hair from
these areas clip the hair short do not
shave.
*Do not wear more than one patch at a
time.
*May wear the patch for up to 72 hours.
* Do not use the same skin area twice in a
row.
*After removing patch fold it in half,
sticky side in and flush the patch down
the toilet.
*Store at room temperature. Keep each
patch in its foil package until ready to
use it.
Page _____ of ______
*Do not expose the skin patch to heat
while you are wearing it. This includes a
hot tub, heating pad, heated water bed.
*Avoid touching the sticky side of a
patch with your fingers.
*KEEP OUT OF REACH OF
CHILDREN AND PETS. COULD BE
FATAL TO THEM IF THEY CHEW
OR SUCK ON THE PATCH!!
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Drug & Class
Folic Acid
Vitamin
Tablets:
0.4, 0.8, 1 mg
IM, IV, subQ:
5 mg/ml solution
Note: injections are
reserved for those
patients with
severely impaired
GI absorption.
4 mg/day for a
woman who has
already had a neural
tube defect
Supplementation
should begin 1
month before
conception
Green leafy veggies
are good sources
1/2009
N478 Drug Sheet
Pharmacologic
Action
Absorption:
Undergo hydrolysis
in GI tract before
being completely
absorbed.
Distribution:
Distributed rapidly
to all body tissues.
Metabolism:
metabolized and
stored in the liver.
Exertion: in urine
and feces, some in
breast milk.
Required for
nucleoprotein
synthesis and
maintainence of
eryothopoeisis
Therapeutic Use
To treat
megaloblastic
anemia caused by
folic acid
deficiency.
Folic acid
deficiency in
pregnancy can
cause neural tube
defects in the fetus.
Adverse Effects
Allergic reaction,
itching, nausea,
irritability, and
allergic
bronchospasm
Page _____ of ______
Drug Interactions
May increase
metabolism or
counteract effects of
anticonvulsants,
causing
subtherapeutic
phenytoin level and
increasing the risk
of seizures. Aspirin,
hormonal
contraceptives,
methotrexate,
triamterene,
pentamidine,
trimethoprim, and
sulfasalazine may
decrease folic
levels.
Precautions &
Contraindications
Folic acid
contraindicated in
patients with
pernicious anemia
and other
megaloblastic
anemias caused by
B12 deficiency.
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
Nursing Actions related to the Modalities
Drug or Drug Class:
Direct Care
Teaching/Counseling
It is common for patients that have a folic
Be cautious when taking folic acid when on
acid deficiency to also have a vitamin B12 any type of anticonvulsant and have blood
deficiency. Folic acid supplements can
levels checked regularly.
mask a vitamin B12 deficiency while not
correcting the problem, which could lead
It is important for women that or pregnant
to neurological problems. Patients’
or planning to become pregnant to take folic
receiving folic acid should also be checked acid supplements in order to avoid a
for vitamin B12 deficiency.
deficiency that could be potentially harmful
to the developing fetus.
Clinical Experiences with Drugs of This Class:
Drug (Generic & Trade
Dose & Route
Name)
1/2009
N478 Drug Sheet
Page _____ of ______
Why this Client was Receiving the
Drug
Social Support
Comments or Notes
University of Evansville
Department of Nursing and Health Sciences
Drug Dispensing Sheet
1/2009
N478 Drug Sheet
Page _____ of ______