1. MEDICATION MOA RT LABS TO SIDE EFFECTS NURSING REVIEW RESPONSIBILITIESMisoprostol Action PO BUN, Frequent Baseline assessment Replaces protective Hematocrit, Abdominal pain Question for possibility of(Cytotec) prostaglandins consumed CBC Diarrhea pregnancy before initiating with prostaglandin- ALT, AST, Occasional therapy (Pregnancy Category X) inhibiting therapies (e.g., Hgb, Nausea,Stage 3 NSAIDs). Creatinine Flatulence(Also used in Therapeutic Effect: Dyspepsiafirst trimester to Reduces acid secretion Headacheterminate from gastric parietal cells,pregnancy) stimulates bicarbonate production from gastric/duodenal mucosa. Uses Prevention of NSAID- induced gastric ulcers and in pts at high risk for developing gastric ulcer/gastric ulcer complications Chemical termination of pregnancy (in conjunction with mifepristone)Bicitra Action PO sodium levels Nausea, During pregnancy, this This medication is used to pH (acidity) vomiting, medication should be used only (Cytra-2, make the urine less acidic. of your urine diarrhea, and when clearly needed. ThisLiqui-DualCitra, This medication can also blood stomach pain medication may worsen highOracit) prevent and treat certain electrolyte blood pressure during pregnancyGI System metabolic problems bicarbonate (toxemia of pregnancy).(electrolyte (acidosis) caused by kidney levelsmodifier) disease. Citric acid and citrate saltsStage 1 (which(prior to contain potassium andepidural) sodium)Methergine Action PO calcium Nausea, uterine Baseline assessment Stimulates alpha- levels cramping, Determine baseline serum(Methylergonovine) adrenergic, serotonin vomiting calcium level, B/P, pulse. AssessStage 2 receptors, producing for any evidence of bleeding(, given after arterial vasoconstriction before administration.delivery, Causes vasospasm of Intervention/evaluation rdshortens 3 coronary arteries Monitor uterine tone, bleeding,stage of labor) Directly stimulates uterine B/P, pulse q15min until stable muscle. (about 1–2 hrs) Assess extremities for color, warmth, movement, pain. Report chest pain promptly Provide support with ambulation if dizziness occurs.
2. Magnesium Action IV Mg, Common Baseline assessment Essential for enzyme IM electrolytes Assess if pt is sensitive toSulfate Muscle activity, nerve conduction, PO magnesium.(Epsom Salt) muscle contraction Weakness Antacid: Assess GI pain (duration,Stage 1 Maintains and restores Lack of Energy location, quality, time of magnesium levels. Blurry Vision occurrence, relief with food, Anticonvulsant: Slurred Speech causative/excacerbative factors). Blocks neuromuscular Headache Laxative: Assess for weight loss, transmission, amount of Nausea and nausea, vomiting, and history of acetylcholine released at Vomiting recent abdominal surgery. motor end plate. Flushing Systemic: Assess renal function, Produces seizure control serum magnesium. Uses Intervention/evaluation Treatment/prevention of Antacid: Assess for relief of hypomagnesemia gastric distress. Monitor renal Prevention and treatment function (esp. if dosing is long of seizures in eclampsia; term or frequent). Torsade de pointes Laxative: Monitor daily pattern of (atypical ventricular bowel activity, stool consistency. tachycardia); Maintain adequate fluid intake. Treatment of arrhythmias Systemic: Monitor renal function, due to hypomagnesemia magnesium levels, EKG for (ventricular cardiac function. tachycardia/ventricular Test patellar reflexes (knee jerk fibrillation) reflexes) before giving repeat parenteral doses (used as indication of CNS depression; suppressed reflexes may be sign of impending respiratory arrest). Patellar reflex must be present, respiratory rate should be 16/min or over before each parenteral dose. Initiate seizure precautions.Oxytocin Uses IV electrolytes Occasional: Baseline assessment Assess Induction of labor at term, Tachycardia, baselines for vital signs, B/P, fetal(Pitocin, control of post-partum premature heart rate. Determine frequency,Syntocinon) bleeding. Adjunct in ventricular duration, strength ofEndocrine management of abortion. contractions, contractions.system hypotension, Intervention/evaluation(pituitary drug) nausea, Monitor B/P, pulse, respirations, vomiting. Rare: fetal heart rate, intrauterine(Stage 1 & 3) Nasal: pressure, contractions (duration, Lacrimation/tea strength, frequency) q15min. ring, nasal Notify physician of contractions irritation, that last longer than 1 min, occur rhinorrhea, more frequently than every 2 unexpected min, or stop. Maintain careful uterine I&O; be alert to potential water bleeding/contra intoxication. Check for blood loss. ctions.
3. Terbutaline Action IV Frequent (38%– Baseline assessment(Brethine) Stimulates beta2- PO 23%): Bronchospasm: Offer emotional(Bricanyl) adrenergic receptors, Tremor, anxiety support (high incidence of resulting in relaxation of Occasional anxiety due to difficulty in uterine, bronchial smooth (11%–10%): breathing, Sympathomimetics(CNS system. muscle Drowsiness, response to drug). Preterm labor:Stimulant) Therapeutic Effect: headache, Assess baseline maternal pulse, Inhibits uterine nausea, B/P, frequency and duration of(Stage 2) contractions heartburn, contractions, fetal heart rate. Relieves bronchospasm, dizziness Intervention/evaluation reduces airway resistance. Bronchospasm: Monitor rate, Uses depth, rhythm, type of Symptomatic relief of respiration; quality, rate of pulse. reversible bronchospasm Assess lung sounds for rhonchi, due to bronchial asthma, wheezing, and rales. Monitor bronchitis, emphysema ABGs. Observe lips, fingernails for Delays premature labor in cyanosis (blue or dusky color in pregnancies between 20 light-skinned pts; gray in dark- and 34 wks skinned pts). Observe for clavicular retractions, hand tremor. Evaluate for clinical improvement (quieter, slower respirations, relaxed facial expression, and cessation of clavicular retractions). Preterm labor: Monitor for frequency, duration, strength of contractions. Diligently monitor fetal heart rate.Penicillin Action IM CBC, Occasional: Baseline assessment Inhibits bacterial cell wall urinalysis, Lethargy, fever, Question for history of allergies,G benzathine synthesis by binding to one renal dizziness, rash, particularly penicillins, or more of the penicillin- function pain at injection cephalosporins.(Stage 2) binding proteins of tests. site. Rare: bacteria. Therapeutic Seizures, Effect: interstitial Bactericidal. Uses nephritis. Treatment of mild to moderate severe infections caused by organisms susceptible to low concentrations of penicillin including streptococcal (Group A) upper respiratory infections, syphilis, yaws. Prophylaxis of infections caused by susceptible organisms (e.g., rheumatic fever prophylaxis).
4. Penicillin G Action IV CBC, Occasional: Baseline assessment Inhibits bacterial cell wall urinalysis, Lethargy, fever, Question for history of allergies,potassium synthesis by binding to one renal dizziness, rash, particularly penicillins, or more of the penicillin- function pain at injection cephalosporins.(Stage 2) binding proteins of tests. site. Rare: bacteria. Seizures, Therapeutic Effect: interstitial Bactericidal. nephritis. Uses Treatment of susceptible infections due to gram- positive organisms, gram- negative organisms, actinomycosis, clostridium, diphtheria, Listeria, N. meningitidis, pasteurella including anthrax, endocarditis, respiratory tract infections, meningitis, neurosyphilis, skin/skin structure infections.Penicillin V Action PO Hgb levels Frequent: Baseline assessment Inhibits cell wall synthesis Mild Question for history of allergies,potassium by binding to bacterial cell hypersensitivity particularly penicillins, membranes. reaction (chills, cephalosporins.(Stage 3) Therapeutic Effect: fever, rash), Intervention/evaluation Bactericidal. nausea, Hold medication, promptly report Uses vomiting, rash (hypersensitivity), diarrhea Treatment of mild to diarrhea. (with fever, abdominal pain, moderate infections of Rare: mucus or blood in stool may respiratory tract, skin/skin Bleeding, indicate antibiotic-associated structure, otitis media, allergic colitis). Monitor I&O, urinalysis, necrotizing ulcerative reaction. renal function tests for gingivitis; prophylaxis for nephrotoxicity. Be alert for rheumatic fever, dental superinfection: fever, vomiting, procedures. diarrhea, anal/genital pruritus, oral mucosal change (ulceration, pain, and erythema). Review Hgb levels; check for bleeding (overt bleeding, ecchymosis, swelling of tissue).
5. Betamethasone Action: IM Calcium Frequent: Baseline assessment Controls rate of protein PO levels, Systemic: Question for hypersensitivity to(Celestone, synthesis, depresses TOPICAL Hematocrit, Increased any corticosteroid, sulfite.Celestone migration of Hgb, RBC, PT, appetite, Obtain baseline values for height,Phosphate, polymorphonuclear PTT abdominal weight, B/P, serum glucose, leukocytes/fibroblasts, distention, electrolytes.Celestone reverses capillary nervousness, Obtain baseline results of initialSoluspan) permeability, prevents or insomnia, false tests (tuberculosis [TB] skin test,(Stage 3) controls inflammation. sense of well- X-rays, EKG). Therapeutic Effect: being. Intervention/evaluation Decreases tissue response Topical: Monitor B/P, blood glucose, to inflammatory process. Burning, electrolytes. Uses stinging, Apply topical preparation Systemic: pruritus. sparingly. Do not use on broken Anti-inflammatory, skin or in areas of infection. immunosuppressant, Do not apply to wet skin, face, corticosteroid replacement and inguinal areas. therapy. Topical: Relief of inflammatory and pruritic dermatoses. Foam: Relief of inflammation, itching associated with dermatosis.Ropivacaine Action Nerve Hypotension, Baseline assessment Most local anesthetics fall block bradycardia, Pt should be in recumbent(Naropin, into one of two groups: headache, position before drug isNaropin esters or amides. Both pruritus, administered by parenteralPolyamp, provide anesthesia and nausea, route. Assess onset, type,Naropin SDV, analgesia by reversibly vomiting, location, duration of pain. Obtain binding to and blocking dizziness, vital signs before givingNaropin sodium (Na) channels. This anxiety, medication. If respirations areNovaplus) slows the rate of tinnitus, 12/min or less (20/min or less in depolarization of the nerve dyspnea, children), withhold medication, action potential; thus, cardiac arrest, contact physician. Effect of propagation of the arrhythmias, medication is reduced if full pain electrical impulses needed seizures, recurs before next dose. for nerve conduction is syncope, chills Intervention/evaluation prevented. Monitor vital signs 15–30 min Uses after subcutaneous/IM dose, 5– Local anesthetics suppress 10 min after IV dose (monitor for pain by blocking impulses hypotension, change in along axons. Suppression rate/quality of pulse). Monitor of pain does not cause pain level, sedation response. generalized depression of Monitor daily pattern of bowel the entire nervous system. activity, stool consistency; avoid Local anesthetics may be constipation. Check for adequate given topically and by voiding. Initiate deep breathing, injection (local infiltration, coughing exercises, particularly in peripheral nerve block pts with pulmonary impairment. [axillary], IV regional [Bier Therapeutic serum level: 100–550 block], epidural, and spinal). ng/ml; toxic serum level: greater than 1,000 ng/ml.
6. Demerol Action IV plasma Frequent: Baseline assessment Binds to opioid receptors IM amylase & Sedation, Pt should be in recumbent(meperidine) within CNS. Therapeutic PO lipase hypotension position before drug is(Isonipecaine) Effect: Alters pain concentration (including administered by parenteral(Pethidine) perception, emotional orthostatic route. Assess onset, type,(Neperdine) response to pain. hypotension), location, duration of pain. Obtain Uses diaphoresis, vital signs before givingAnalgesic Relief of moderate to facial flushing, medication. If respirations are severe pain. dizziness, 12/min or less (20/min or less inNARCAN nausea, children), withhold medication,is vomiting, contact physician. Effect ofantidote constipation. medication is reduced if full pain recurs before next dose. Intervention/evaluation Monitor vital signs 15–30 min after subcutaneous/IM dose, 5– 10 min after IV dose (monitor for hypotension, change in rate/quality of pulse). Monitor pain level, sedation response. Monitor daily pattern of bowel activity, stool consistency; avoid constipation. Check for adequate voiding. Initiate deep breathing, coughing exercises, particularly in pts with pulmonary impairment. Therapeutic serum level: 100– 550 ng/ml; toxic serum level: greater than 1,000 ng/ml.Morphine Action IV plasma Ambulatory pts, Baseline assessment Binds with opioid amylase & that not in Pt should be in recumbentsulfate receptors within CNS lipase severe pain position before drug is given by(Avinza, Kadian, Therapeutic Effect: concentration may experience parenteral route. Assess onset,Morphine IR, MS Alters pain perception, nausea, type, location, duration of pain.Contin, MSIR, emotional response to vomiting more Obtain vital signs before giving pain frequently than medication. If respirations areOramorph SR, Uses those in supine 12/min or less (20/min or less inRoxanol) Relief of moderate to position or who children), withhold medication,NARCAN severe, acute, or chronic have severe contact physician. Effect ofis pain; analgesia during pain. medication is reduced if full painantidote labor Frequent: recurs before next dose. Drug of choice for pain due Sedation, Intervention/evaluation to MI, dyspnea from decreased B/P Monitor vital signs 5–10 min after pulmonary edema not (including IV administration, 15–30 min resulting from chemical orthostatic after subcutaneous, IM. Be alert respiratory irritant hypotension), for decreased respirations, B/P. DepoDur: Epidural diaphoresis, Check for adequate voiding. (lumbar) single dose facial flushing, Monitor daily pattern of bowel management of surgical constipation, activity and stool consistency. pain. Infumorph: Use in dizziness, devices for managing drowsiness, intractable chronic pain nausea, vomiting..
7. ketorolac Action IV Frequent (17%– Baseline assessment Inhibits prostaglandin IM BUN, serum 12%): Assess onset, type, location,(Toradol) synthesis, reduces PO creatine, CBC Headache, duration of pain. Obtain baseline prostaglandin levels in with diff, nausea, renal/hepatic function tests.Immune system aqueous humor. electrolytes, abdominal Intervention/evaluationdrug, Anti- Therapeutic Effect: bleeding cramps/pain, Monitor renal/hepatic functioninflammatory & Reduces intensity of pain time, & liver dyspepsia tests, urinary output. MonitorDisease- stimulus, reduces function (heartburn, daily pattern of bowel activity,modulating intraocular inflammation. tests indigestion, stool consistency. Observe forAgent Uses epigastric pain). occult blood loss. Assess for PO, injection: Short-term therapeutic response: relief of (5 days or less) relief of pain, stiffness, swelling; mild to moderate pain. increased joint mobility, reduced Ophthalmic: Relief of joint tenderness, improved grip ocular itching due to strength. Be alert to signs of seasonal allergic bleeding (may also occur with conjunctivitis. Treatment ophthalmic route due to systemic postop for inflammation absorption). following cataract extraction, pain following incisional refractive surgery.Hydralazine Action PO None Frequent: Baseline assessment Competes with histamine IM significant Drowsiness, dry Anxiety: Offer emotional support(Apresoline) for receptor sites in GI mouth, marked to anxious pt. Assess motor tract, blood vessels, discomfort with responses (agitation, trembling, respiratory tract IM injection. tension), autonomic responses Diminishes vestibular Occasional: (cold/clammy hands, stimulation, depresses Dizziness, diaphoresis). Antiemetic: Assess labyrinthine function. ataxia, asthenia for dehydration (poor skin turgor, Therapeutic Effect: (loss of dry mucous membranes, and Produces anxiolytic, strength, longitudinal furrows in tongue). anticholinergic, energy), slurred Intervention/evaluation antihistaminic, analgesic speech, For those on long-term therapy, effects; relaxes skeletal headache, hepatic/renal function tests, muscle; controls nausea, agitation, blood counts should be vomiting. increased performed periodically. Monitor Uses anxiety. lung sounds for signs of Treatment of anxiety, hypersensitivity reaction. preop sedation, antipruitic Monitor serum electrolytes in pts with severe vomiting. Assess for paradoxical reaction, particularly during early therapy. Assist with ambulation if drowsiness, light- headedness occur.
8. Nubain Action IV plasma Frequent Baseline assessment Binds with opioid IM amylase & Sedation. Obtain vital signs before giving(Nalbuphine ) receptors within CNS. May lipase Occasional medication. If respirations areShort acting displace opioid agonists, concentration Diaphoresis, 12/min or less (20/min or less in competitively inhibiting cold/clammy children), withhold medication, their action; may skin, nausea, contact physician. Assess onset, precipitate withdrawal vomiting, type, location, duration of pain. symptoms. Therapeutic dizziness, Effect of medication is reduced if Effect: Alters pain vertigo, dry full pain recurs before next dose. perception, emotional mouth, Low abuse potential. response to pain. headache. Intervention/evaluation Uses Monitor for change in Relief of moderate to respirations, B/P, rate/quality of severe pain, preop pulse. Monitor daily pattern of analgesia, obstetric bowel activity and stool analgesia, adjunct to consistency. Initiate deep anesthesia. OFF-LABEL: breathing, coughing exercises, Opioid-induced pruritus. particularly in pts with pulmonary impairment. Assess for clinical improvement, record onset of relief of pain. Consult physician if pain relief is not adequate.Ritodrine Action PO Frequent: Baseline assessment Inhibits HIV-1 and HIV-2 GI disturbances Pts beginning combination proteases, rendering these (abdominal therapy with ritonavir and enzymes incapable of pain, anorexia, nucleosides may promote GIused to stop processing polypeptide diarrhea, tolerance by beginning ritonavirpremature labor precursors leading to nausea, alone and subsequently adding production of vomiting), nucleosides before completing 2 noninfectious, immature circumoral and wks of ritonavir monotherapy. HIV particles. Therapeutic peripheral Obtain baseline laboratory Effect: Slows HIV paresthesias, testing, esp. serum hepatic replication, reducing altered taste, function tests, triglycerides progression of HIV headache, before beginning ritonavir infection. dizziness, therapy and at periodic intervals Uses Treatment of HIV fatigue, during therapy. Offer emotional infection in combination asthenia (loss support to pt/family. with other antiretroviral of strength, Intervention/evaluation agents. energy). Closely monitor for evidence of GI disturbances, neurologic abnormalities (particularly paresthesias). Monitor serum hepatic function tests, serum glucose, CD4 cell count, plasma levels of HIV RNA.
9. Calcium Action: IV electrolytes, Frequent: Baseline assessment Assess Essential for function, serum Mg, PO: Chalky B/P, EKG and cardiac rhythm,Gluconate integrity of nervous, Ph, & K taste. renal function, serum(Tums) muscular, skeletal systems. concentratio Parenteral: magnesium, phosphate, Plays an important role in ns Pain, rash, potassium concentrations.GI Drug, normal cardiac/renal redness, Intervention/evaluationelectrolyte function, respiration, burning at Monitor B/P, EKG, cardiacmodifier blood coagulation, cell injection site, rhythm, serum magnesium, membrane and capillary flushing, feeling phosphate, potassium, renal permeability. Assists in of warmth, function. Monitor serum, urine Therapeutic regulating release/storage nausea, calcium concentrations. Monitor Effect: of vomiting, for signs of hypercalcemia.Replaces calcium neurotransmitters/hormo diaphoresis,in deficiency nes. Neutralizes/reduces hypotensionstates; controls gastric acid (increases pH).hyperphosphate Calcium acetate: Combinesmia in end-stage with dietary phosphate,renal disease, forming insoluble calciumrelieves phosphate.heartburn, Uses:indigestion. Parenteral: Acute hypocalcemia (e.g., neonatal hypocalcemia tetany, alkalosis), electrolyte depletion, cardiac arrest (strengthens myocardial contractions), hyperkalemia (reverses cardiac depression), Hypermagnesemia (aids in reversing CNS depression).Stadol Action IV plasma Frequent: Baseline assessment Binds to opiate receptor Nasal amylase & Parenteral: Obtain vital signs before giving(Butorphanol) sites in CNS. Reduces Spray lipase Drowsiness, medication. If respirations areShort acting intensity of pain stimuli (Stadol concentration dizziness. 12/min or less (20/min or less in incoming from sensory NS): Nasal: children), withhold medication, nerve endings. Therapeutic 10 mg/ml. Nasal contact physician. Assess onset, Effect: Alters pain congestion type, location, duration of pain. perception, emotional . Effect of medication is reduced if response to pain full pain recurs before next dose. Uses Protect from falls. During labor, Management of pain assess fetal heart tones, uterine (including postop pain). contractions. Nasal: Management of Intervention/evaluation moderate to severe pain, Monitor for change in including migraine respirations, B/P, rate/quality of headache pain. Parenteral: pulse. Initiate deep breathing, Preop, preanesthetic coughing exercises, particularly in medication, supplement those with pulmonary balanced anesthesia, relief impairment. Change pt’s position of pain during labor. q2–4h. Assess for clinical improvement, record onset of relief of pain.
10. Phytonadione Action IM PT Occasional: Intervention/evaluation Promotes hepatic IV IR Pain, soreness, Monitor PT, internationalAqua formation of coagulation PO swelling at IM normalized ratio (INR) routinely(Vitamin K 1) factors II, VII, IX, X. injection site, in those taking anticoagulants.stage 2 Therapeutic Effect: pruritic Assess skin for ecchymoses,First hour after Essential for normal erythema (with petechiae. Assess gums for clotting of blood. repeated gingival bleeding, erythema.birth Uses injections), Assess urine for hematuria. Prevention, treatment of facial flushing, Assess Hct, platelet count,Cardiovascular hemorrhagic states in altered taste. urine/stool culture for occultDrug, Affecting neonates; antidote for blood. Assess for decrease in B/P,coagulation hemorrhage induced by increase in pulse rate, complaint oral anticoagulants, of abdominal/back pain, severeAntidote hypoprothrombinemic headache (may be evidence offor states due to vitamin K hemorrhage). Question forWARFARIN deficiency. Will not increase in amount of discharge counteract anticoagulation during menses. Assess peripheral effect of heparin. pulses. Check for excessive bleeding from minor cuts, scratches.PNV Prenatal vitamins are used PO None Upset stomach; Avoid taking any other to provide the additional significant headache; or multivitamin product within 2 vitamins needed Unusual or hours before or after you take during pregnancy. unpleasant your prenatal vitamins. Taking Minerals may also be taste in your similar vitamin products together contained in prenatal mouth. at the same time can result in a multivitamins. vitamin overdose or serious side effects. Avoid the regular use of salt substitutes in your diet if your multivitamin contains potassium. If you are on a low-salt diet, ask your doctor before taking a vitamin or mineral supplement. Do not take this medication with milk, other dairy products, calcium supplements, or antacids that contain calcium. Calcium may make it harder for your body to absorb certain ingredients of the prenatal vitamin.
11. Iron Sulfate Uses PO Serum iron, Constipation Although symptoms of iron Ferrous sulfate provides total iron- Stomach Upset deficiency usually improve within(ferrous sulfate) the iron needed by the binding a few days, you may have to take body to produce red blood capacity, ferrous sulfate for 6 months if cells. reticulocyte you have severe iron deficiency. count, Hgb, This medication should be taken It is used to treat or ferritin. on an empty stomach, at least 1 prevent iron-deficiency hour before or 2 hours after anemia, a condition that eating. occurs when the body has Ferrous sulfate drops come with too few red blood cells a special dropper for measuring because of pregnancy, the dose. Ask your pharmacist to poor diet, excess bleeding, show you how to use it. The or other medical problems. drops may be placed directly in the mouth or mixed with water or fruit juice (not with milk).Ducolax Action PO electrolytes Frequent: Some Intervention/evaluation Direct effect on colonic degree of Encourage adequate fluid intake. smooth musculature by abdominal Assess bowel sounds for stimulating intramural discomfort, peristalsis. Monitor daily patternGI system, nerve plexi. Therapeutic nausea, mild of bowel activity and stoolLaxative/ bowel Effect: Promotes fluid and cramps, consistency; record time ofpreps/ ion accumulation in colon faintness. evacuation. Assess for abdominalAnitflatulents increasing peristalsis, Occasional: disturbances. Monitor serum producing laxative effect. Rectal electrolytes in those exposed to Uses administration: prolonged, frequent, or excessive Treatment of constipation, burning of use of medication. colonic evacuation before rectal mucosa, examinations or mild proctitis. procedures.(Reglan Action IV ◀ ALERT ▶ Baseline assessment(Metoclopramide) Stimulates motility of upper GI PO Doses of 2 Antiemetic: Assess for tractRoutes mg/kg or dehydration (poor skin turgor, Decreases reflux into esophagus. Raises threshold greater, or dry mucous membranes, and activity in chemoreceptor increased longitudinal furrows in tongue). trigger zone length of Assess for nausea, vomiting, Therapeutic Effect: therapy, may abdominal distention, and bowel Accelerates intestinal transit, sounds. result in a gastric emptying. Relieves nausea, vomiting. greater Intervention/evaluation Uses incidence of Monitor for anxiety, restlessness, Facilitates placement of enteral side effects. extrapyramidal symptoms (EPS) feeding tubes; stimulates Frequent (10%): during IV administration. Monitor gastric emptying, intestinal Drowsiness, daily pattern of bowel activity transit in conjunction with restlessness, and stool consistency. Assess skin radiography; treatment of gastroparesis, fatigue, for rash. Evaluate for therapeutic gastroesophogeal reflux lethargy response from gastroparesis disease (GERD); prevents or (nausea, vomiting, bloating). treats cancer chemotherapy- Monitor renal function, B/P, induced nausea, vomiting; heart rate. prevents or treats postop nausea, vomiting. Orally- Disintegrating Tablets: Treatment of gastroparesis, GERD.
12. Methyldopa Lowers blood pressure by ORAL slow heart rate; You should not take decreasing the levels of pale or this medication if you are allergic(Aldomet) certain chemicals in your yellowed skin, to methyldopa, or if you have blood. This allows your fever, confusion liver disease (especially cirrhosis), blood vessels (veins and or weakness; or a history of liver problems arteries) to relax (widen) nausea, upper caused by taking methyldopa. Do and your heart to beat stomach pain, not use methyldopa if you have more slowly and easily. itching, loss of used an MAO inhibitor such as appetite, dark furazolidone (Furoxone), Methyldopa is used to urine, clay- isocarboxazid (Marplan), treat hypertension (high colored stools, phenelzine (Nardil), rasagiline blood pressure). jaundice (Azilect), selegiline (Eldepryl, (yellowing of Emsam, Zelapar), or the skin tranylcypromine (Parnate) in the or eyes); last 14 days. A dangerous drug skin rash, interaction could occur, leading bruising, severe to serious side effects. tingling, numbness, pain, muscle weakness; feeling short of breath, even with mild exertion; swelling in your hands, ankles, or feet; easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin; or Muscle movements you cannot control.
13. Procardia Action PO LFT, RFT, Frequent Baseline assessment Inhibits calcium ion SUB CBC, serum Peripheral Concurrent therapy of sublingual(Nifedipine) movement across cell LINGUAL glucose, K edema, nitroglycerin may be used forCardiovascular membranes, depressing headache, relief of anginal painsystem, contraction of cardiac, flushed skin, Record onset, type (sharp, dull,Affecting vascular smooth muscle dizziness. squeezing), radiation, location,contractility/ Therapeutic Effect: Occasional intensity, duration of anginalrhythm/ Increases heart rate, Nausea, pain; precipitating factorscirculating cardiac output shakiness, (exertion, emotional stress)blood volume Decreases systemic muscle Check B/P for hypotension vascular resistance, B/P cramps/pain, immediately before giving Uses drowsiness, medication. Treatment of angina due palpitations, Intervention/evaluation to coronary artery spasm nasal Assist with ambulation if light- (Prinzmetal’s variant congestion, headedness, dizziness occurs angina), chronic stable cough, Assess for peripheral edema. angina (effort-associated dyspnea, Assess skin for flushing. Monitor angina) wheezing. serum hepatic enzymes, Extended-release signs/symptoms of CHF. Treatment of essential hypertensionBupivacaine Inducing spinal anesthesia Nerve Mild dizziness Baseline assessment(Marcaine HCl, for certain medical or block or drowsiness. Pt should be in recumbentMarcaine Spinal, surgical procedures. position before drug isSensorcaine, administered by parenteralSensorcaine- Bupivacaine Solution is an route. Assess onset, type,MPF, anesthetic. It works by location, duration of pain. ObtainSensorcaine- blocking the generation vital signs before givingMPF Spinal) and conduction of nerve medication. If respirations are impulses. 12/min or less (20/min or less in children), withhold medication, contact physician. Effect of medication is reduced if full pain recurs before next dose. Intervention/evaluation Monitor vital signs 15–30 min after subcutaneous/IM dose, 5– 10 min after IV dose (monitor for hypotension, change in rate/quality of pulse). Monitor pain level, sedation response. Monitor daily pattern of bowel activity, stool consistency; avoid constipation. Check for adequate voiding. Initiate deep breathing, coughing exercises, particularly in pts with pulmonary impairment. Therapeutic serum level: 100– 550 ng/ml; toxic serum level: greater than 1,000 ng/ml.
14. Action IV plasma amylase Frequent: Baseline assessment ResuscitativeFentanyl Binds to opioid receptors in CNS, IM BUCAL & lipase IV: Postop equipment, opiate antagonist (naloxone( Fentora, reducing stimuli from sensory drowsiness, nausea, 0.5 mcg/kg) must be available. Establish nerve endings, inhibits ascending vomiting. baseline B/P, respirations. Assess type,Onsolis) pain pathways. Therapeutic Transdermal (10%– location, intensity, duration of pain.CNS, Analgesics Effect: Alters pain reception, 3%): Headache, Intervention/evaluation increases pain threshold. pruritus, nausea, Assist with ambulation. Encourage post-NARCAN is antidote Uses vomiting, op pt to turn, cough, deep breathe q2h. For sedation, pain relief, preop diaphoresis, Monitor respiratory rate, B/P, heart rate, medication; adjunct to general or dyspnea, confusion, oxygen saturation. Assess for relief of regional anesthesia. Duragesic: dizziness, pain. Management of chronic pain drowsiness, (transdermal). Actiq: Treatment diarrhea, of breakthrough pain in chronic constipation, cancer or AIDS-related pain. decreased appetite. Fentora: Breakthrough pain in pts Occasional: IV: on chronic opioids. Onsolis: Postop confusion, Breakthrough pain in pts with blurred vision, cancer currently receiving opioids chills, orthostatic and tolerant to opioid therapy. hypotension, constipation, difficulty urinating. Transdermal (3%– 1%): Chest pain, arrhythmias, erythema, pruritus, syncope, agitation, skin irritations. Action PO Serum Expected: Baseline assessmentPhenergan Antihistamine: Inhibits histamine IV electrolytes, Drowsiness, Assess allergy symptoms. Assess B/P,(Promethazine) at histamine receptor sites. serum bilirubin, disorientation; pulse for bradycardia, tachycardia if pt isGI System, Antiemetic: AST, ALT hypotension, given parenteral form. If used asAntiemetics/ Diminishes vestibular stimulation confusion, syncope antiemetic, assess for dehydration (poorAntihistamine Depresses labyrinthine function in elderly skin turgor, dry mucous membranes, and Acts on chemoreceptor trigger Frequent: longitudinal furrows in tongue). zone Dry mouth, nose, Intervention/evaluation Sedative-hypnotic: throat; urinary Monitor serum electrolytes in pts with Produces CNS depression by retention; severe vomiting. Assist with ambulation if decreasing stimulation to brain thickening of drowsiness, light-headedness occurs. stem reticular formation bronchial secretions Monitor for relief of nausea, vomiting, Therapeutic Effect: allergic symptoms Prevents allergic responses mediated by histamine (urticaria, pruritus). Prevents, relieves nausea/vomiting Produces mild sedative effect Uses Treatment of allergic conditions, Motion sickness, Nausea Vomiting May be used as mild sedative
15. RhoGAM Action IV CNS: dizziness, Assessment Prevent production of anti-Rh(D) IM headache. IV: Assess vital signs periodically during antibodies in Rh(D)-negative CV: hypertension, therapy in patients receiving IV Rh(D) patients who were exposed to hypotension. immune globulin .ITP: Monitor patient for Rh(D)-positive blood. Increase Derm: rash. signs and symptoms of intravascular(RHo (D) platelet counts in patients with GI: diarrhea, hemolysis (IVH) (back pain, shaking chills,immune ITP. Therapeutic Effects: nausea, vomiting. fever, hemoglobinuria), anemia, and renalglobulin) Prevention of antibody response Hemat: ITP: insufficiency. If transfusions are required, and hemolytic disease of the anemia, use Rh(D) negative packed red blood cells newborn (erythroblastosis fetalis) intravascular to prevent exacerbation of IVH. in future pregnancies of women hemolysis. Lab Test Considerations: Pregnancy: Type who have conceived a Rh (D)- MS: arthralgia, and crossmatch of mother and newborns positive fetus. Prevention of myalgia. Local: pain cord blood must be performed to Rh(D) sensitization following at injection site. determine need for medication. Mother transfusion accident. Decreased Misc: fever. must be Rh (D)-negative and Du-negative. bleeding in patients with ITP. Infant must be Rh(D)-positive. If there is doubt regarding infants blood type or if father is Rh(D)-positive, medication should be given. An infant born to a woman treated with Rh(D) immune globulin antepartum may have a weakly positive direct Coombs test result on cord or infant blood.ITP: Monitor platelet counts, RBC counts, hemoglobin, and reticulocyte levels to determine effectiveness of therapy .Zofran Action IV Serum Frequent Baseline assessment(Ondansetron) Blocks serotonin, both PO electrolytes, (13%–5%): Assess degree of nausea, peripherally on vagal nerve serum Anxiety, vomiting. Assess for dehydration terminals and centrally in bilirubin, dizziness, if excessive vomiting occurs (poorGI System, chemoreceptor trigger AST, ALT drowsiness, skin turgor, dry mucousAntiemetics/ zone headache, membranes, and longitudinalAntihistamine Therapeutic Effect: fatigue, furrows in tongue). Provide Prevents nausea/vomiting constipation, emotional support. Uses diarrhea, Intervention/evaluation Prevention/treatment of hypoxia, urinary Monitor pt in environment. nausea/vomiting due to retention. Assess bowel sounds for cancer chemotherapy Occasional peristalsis. Provide supportive (including high-dose (4%–2%): measures. Assess mental status. cisplatin) Abdominal Monitor daily pattern of bowel Prevention of postop pain, activity and stool consistency. nausea, vomiting. xerostomia, Record time of evacuation Prevention of radiation- fever, feeling of induced nausea, vomiting. cold, Treatment of postop redness/pain at nausea, vomiting. injection site, OFF-LABEL: paresthesia, Postanesthetic shivering, asthenia (lack vomiting due to viral of strength, illness energy) Treatment of early-onset Rare (1%): alcoholism, Hyperemesis Hypersensitivity gravidarum reaction (rash, pruritus), blurred vision
16. Motrin Action PO Serum, Occasional: Baseline assessment(Diphenhydramine Inhibits prostaglandin plasma, Nausea with or Assess onset, type, location,Ibuprofen ) synthesis. Produces URINE without duration of pain, inflammation. vasodilation acting on vomiting, Inspect appearance of affected heat-regulating center of dyspepsia, joints for immobility, deformities, hypothalamus. dizziness, rash. skin condition. Assess Therapeutic Effect: Rare (less than temperature. Produces analgesic, anti- 3%): Diarrhea Intervention/evaluation inflammation effects, or constipation, Monitor for evidence of nausea, decreases fever. flatulence, dyspepsia. Monitor CBC, Uses abdominal hepatic/renal function tests, Treatment of fever, cramps or pain, occult blood loss. Monitor daily juvenile rheumatoid pruritus. pattern of bowel activity and arthritis (JRA), stool consistency. Assess skin for osteoarthritis, minor pain, rash. Observe for bleeding, mild to moderate pain, bruising. Evaluate for therapeutic primary dysmenorrheal. response: relief of pain, stiffness, NeoProfen: Closes swelling; increased joint mobility; clinically significant patent reduced joint tenderness; ductus arteriosus (PDA) in improved grip strength. Monitor premature infants temperature for fever. weighing between 500 and 1,500 g who are no more than 32 wks gestational age when usual medical management is ineffective.Zantac Action PO serum AST, Occasional Baseline assessment Inhibits histamine action at IM ALT levels, (2%): Diarrhea. Obtain history of(ranitidine) histamine 2 receptors of IV creatinine, Rare (1%): epigastric/abdominal pain. gastric parietal cells. BUN Constipation, Obtain baseline hepatic/renal Therapeutic Effect: Inhibits headache (may function tests. gastric acid secretion (fasting, nocturnal, when stimulated be severe). Intervention/evaluation by food, caffeine, insulin). Monitor. Assess mental status in Reduces volume, hydrogen . elderly. Question present ion concentration of gastric abdominal pain, GI distress juice. Uses Short-term treatment of active duodenal ulcer. Prevention of duodenal ulcer recurrence. Treatment of active benign gastric ulcer, pathologic GI hypersecretory conditions, acute gastroesophageal reflux disease (GERD), includes erosive esophagitis. Maintenance of healed erosive esophagitis. Part of regimen for H. pylori eradication to reduce risk of duodenal ulcer recurrence. OTC: Relieve heartburn, acid indigestion, sour stomach.
17. Pepcid Action PO Occasional Baseline assessment Inhibits histamine action IM (5%): Assess epigastric/abdominal pain. H2 receptors of parietal IV Headache. Intervention/evaluation (Famotidine, cells. Therapeutic Effect: Monitor daily pattern of bowelcalcium, and Inhibits gastric acid activity and stool consistency.magnesium) secretion (fasting, Monitor for diarrhea, nocturnal, or stimulated by constipation, and headache. food, caffeine, insulin). Assess confusion in elderly. Uses Short-term treatment of active duodenal ulcer. Prevention, maintenance of duodenal ulcer recurrence. Treatment of active benign gastric ulcer, pathologic GI hypersecretory conditions. Short-term treatment of gastroesophageal reflux disease (GERD), including erosive esophagitis. OTC formulation for relief of heartburn, acid indigestion, sour stomach.Beractant Action Intra Frequent: Baseline assessment Lowers alveolar surface tracheal Transient Drug must be administered in(Survanta) tension during respiration, bradycardia, highly supervised setting. stabilizing alveoli. oxygen (O2) Clinicians caring for neonate Therapeutic Effect: desaturation, must be experienced with Improves lung compliance, increased intubation, ventilator respiratory gas exchange. carbon dioxide management. Offer emotional Uses (CO2) support to parents. Prevention and treatment retention. Intervention/evaluation (rescue therapy) of Monitor infant with arterial or respiratory distress Occasional: transcutaneous measurement of syndrome (RDS—hyaline Endotracheal systemic O2, CO2. Assess for membrane disease) in tube reflux. adventitious breath sounds premature infants. (rales, rhonchi). Prevention: Body weight less than 1,250 g in infants at risk for developing or with evidence of surfactant deficiency (give within 15 min of birth). Rescue Therapy: Treatment of infants with RDS confirmed by X-ray, requiring mechanical ventilation (give within 8 hrs of birth).
18. Erythromycin 1% Action PO Frequent: Baseline assessment Penetrates bacterial cell TOPICAL IV: Abdominal Question for history of allergiesstage 2 membranes, reversibly cramping/disco (particularly erythromycins),First hour after binds to bacterial mfort, hepatitis.birth ribosomes, inhibiting phlebitis/throm Intervention/evaluation protein synthesis. bophlebitis. Monitor daily pattern of bowel Therapeutic Effect: Topical: Dry activity and stool consistency. Bacteriostatic. skin (50%). Assess skin for rash. Assess for Uses Occasional: hepatotoxicity (malaise, fever, Treatment of susceptible Nausea, abdominal pain, GI disturbances). infections due to S. vomiting, Be alert for superinfection: fever, pyogenes, S. pneumoniae, diarrhea, rash, vomiting, diarrhea, anal/genital S. aureus, M. pneumoniae, urticaria. pruritus, oral mucosal changes Legionella, diphtheria, Rare: (ulceration, pain, erythema). pertussis, chancroid, Ophthalmic: Check for phlebitis (heat, pain, Chlamydia, N. gonorrheae, Sensitivity red streaking over vein). Monitor E. histolytica, syphilis, reaction with for high-dose hearing loss. nongonococcal urethritis, increased Campylobacter irritation, . gastroenteritis. Topical: burning, Treatment of acne itching, vulgaris. Ophthalmic: inflammation. Prevention of gonococcal Topical: ophthalmia neonatorum, Urticaria. superficial ocular infections. OFF-LABEL: Systemic: Treatment of acne vulgaris, chancroid, Campylobacter enteritis, gastroparesis, Lyme disease, preoperative gut sterilization. Topical: Treatment of minor bacterial skin infections. Ophthalmic: Treatment of blepharitis, conjunctivitis, keratitis, chlamydial trachoma.Narcan Action IV None known; Baseline assessment Displaces opioids at opioid- IM little or no Maintain clear airway. Obtain weight(Naloxone) occupied receptor sites in pharmacologic of children to calculate drug dosage.CNS Drug, CNS. Therapeutic Effect: effect in absence Intervention/evaluation Reverses opioid-induced of narcotics. Monitor vital signs, esp. rate, depth,Opioid Reversal sleep/sedation, increases rhythm of respiration, during andAgent respiratory rate, raises B/P to frequently following administration. normal range. Carefully observe pt after satisfactory Uses response (duration of opiate may Complete or partial reversal of exceed duration of naloxone, opioid depression including resulting in recurrence of respiratory respiratory depression. Diagnosis depression). Assess for increased of suspected opioid tolerance or acute opioid overdose. Neonatal pain with reversal of opiate. opiate depression. Coma of unknown origin
19. Benadryl Action IV Frequent: Baseline assessment Competitively blocks IM Drowsiness, If pt is having acute allergic(Diphenhydramine) effects of histamine at PO dizziness, reaction, obtain history ofRespiratory peripheral H1 receptor muscle recently ingested foods, drugs,System, Anti- sites. Therapeutic Effect: weakness, environmental exposure, andallergy/ Anti- Produces anticholinergic, hypotension, emotional stress. Monitor B/Pinflammatory antipruritic, antitussive, urinary rate, depth, rhythm, type ofAgent antiemetic, antidyskinetic, retention, respiration; quality, rate of pulse. sedative effects. thickening of Assess lung sounds for rhonchi, Uses bronchial wheezing, and rales. Treatment of allergic secretions, dry Intervention/evaluation reactions, parkinsonism; mouth, nose, Monitor B/P, esp. in elderly prevention/treatment of throat, lips; in (increased risk of hypotension). nausea, vomiting, vertigo elderly: Monitor children closely for due to motion sickness; sedation, paradoxical reaction. antitussive; short-term dizziness, management of insomnia. hypotension. Topical form used for relief Occasional: of pruritus, insect bites, Epigastric skin irritations. distress, flushing, visual/hearing disturbances, paresthesia, diaphoresis, chills.Percocet Action PO May increase ◀ ALERT ▶ Baseline assessment Binds with opioid serum Effects are Assess onset, type, location, receptors within CNS. amylase, dependent on duration of pain. Effect of(Acetaminophen/ Therapeutic Effect: Alters lipase. dosage amount. medication is reduced if full painOxycodone) perception of and Ambulatory pts, recurs before next dose. Obtain emotional response to those not in vital signs before giving pain. severe pains medication. If respirations are may experience 12/min or less (20/min or less in Uses dizziness, children), withhold medication, Relief of mild to nausea, contact physician. moderately severe pain. vomiting, and Intervention/evaluation hypotension Palpate bladder for urinary more retention. Monitor daily pattern frequently than of bowel activity and stool those in supine consistency. Initiate deep position or breathing, coughing exercises, having severe esp. in pts with pulmonary pain. Frequent: impairment. Monitor pain relief, Drowsiness, respiratory rate, mental status, dizziness, B/P. hypotension (including orthostatic hypotension), anorexia.