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  1. 1. Digoxin(di-jox-in)High Alert! Lanoxin, 1 full minute prior to administering. WithholdLanoxicaps dose and notify physician if pulse is <60Route/Dosage (Adult):Initial Dose-several (adult). Immediately report any significantdivided doses over a 12-24 hr period- IV 0.5-1 changes in HR, rhythm, or quality of pulse.mg, PO 0.75-1.5 mg, Maintenance Dose Evaluate serum electrolyte lvls (potassium,Tablets-0.125-0.5/day, Gelatin Capsules-0.35- magnesium, calcium). Observe serum lvl is <0.5 mg/day 0.5-2 ng/mL, evaluate s/s of toxicity (abdominalClassification: Therapeutic (antiarrhythmic, pain, anorexia, vomiting, visual disturbances,inotropics) Pharmacologic (digitalis glycosides) bradycardia)Indication: Heart Failure. Atrial fibrillation & Patient/Family Teaching: Instruct pt. to takeatrial flutter (slows ventricular rate) medications as directed at the same time eachAction: Increases the force of myocardial day. Do not d/c medication w/o consulting withcontraction. Increases cardiac output and a healthcare professional. Teach pt. to takeslows heart rate. pulse and contact healthcare professional priorSide Effects: fatigue, blurred/green/yellow to taking medication if pulse is <60>100.vision, ARRHYTHMIAS, bradycardia, Review s/s of toxicity and emphasizeincreased risk of falls (geriatric) theimportance of follow-up exams to determineNursing Implication: Monitor apical pulse for effectiveness and monitor toxicity.
  2. 2. Warfarin (war-fa-rin)Coumadin and other clotting factors frequently. MonitorRoute/Dosage (Adult): PO, IV 2-5 mg/day for hepatic function and CBC before and2-4 days; then adjust daily dose by results of periodically during treatment.INR (International Normalized Ratio- ability for Patient/Family Teaching: Inform Pt.blood anticoagulant effect may persist 2-5 days afterto clot). d/c of Warfarin. Avoid foods rich in Vitamin KClassification: anticoagulant; coumarins (brussel sprouts, leafy greens, spinach).Action: Prevention of thromboembolic events Instruct pt.to avoid injury, use soft toothbrush,Contraindications: Uncontrolled bleeding, do not floss, or use razors to shave. Advise pt.open wounds, active ulcer disease, recent to report any symptoms of unusual bleeding,injury/surgery, liver/kidney disease, bruising, or pain. Instruct pt. not to consumeuncontrolled hypertension. alcohol, take other Rx, OTC, or herbal productsSide Effects: Bleeding, dermal necrosis, especially those containing aspirin or NSAIDs.cramps, nausea. Emphasize the importance of frequent lab testsNursing Implication: Assess for signs of to monitor coagulation factors.bleeding and hemorrhage (gums, nose,unusual bruising, black stools, fall in hematocritor BP, nasogastric aspirate. Monitor PT, INR
  3. 3. Furosemide (fur-oh-se-mide)LasixRoute/Dosage (Adult): PO 20-80 mg/day (single imbalance, APLASTIC ANEMIA,dose initial), Hypertension 40 mg bid (decrease dose AGRANULOCYTOSIS, Nursing Implication:of other hypertensive 50%), congestive heart failure- Assess fluids, monitor daily weight, intake/output2.5 g/day, Hypercalcemia-120 mg/day (in 3 doses). ratio, amount/location of edema, lung sounds, skinIM/IV 20-40 mg may repeat in 1-2 hr and increase 20 turgor, and mucus membranes. Notify physician ifmg/ 1-2 hr until desired response is obtained. thirst, dry mouth, weakness, or hypotension occur.Continuous infusion-Bolus 0.1 mg/kg followed by 0.1 Monitor BP & pulse before and during medication.mg/kg/hr, double q 2 hr up to max 0.4 mg/kg/hr Assess pt. for tinnitus or hearing loss. MonitorClassification: diuretics; loop diuretics electrolytes, renal/heptic function, serum glucose,Action: Decrease BP, reduce edema, Inhibits the and uric acid lvls. May be taken with food/milk toreabsorbtion of sodium and chloride from the loop of minimize gastric irritation. Tablets may be crushed ifHenle and distal renal tubule. Increases renal pt. has trouble swallowing.excretion of water, sodium, chloride, magnesium, Patient/Family Teaching: Caution to changepotassium, & calcium. positions slowly, avoid standing long periods of time,Contraindications/Precautions: Hepatic coma or exercising in hot weather or use of alcohol toanuria, severe liver disease, Electrolyte depletion, minimize orthostatic hypotension. Teach to avoid dietDiabetes mellitus, pt. currently taking Digoxin high in potassium. Advise to contact healthcare(increased risk of toxicity of digoxin). professional if weight gain is > 3lbs in a day, muscleSide Effects: Blurred vision, dizziness, tinnitus, weakness, cramps, dizziness, tingling/numbness inhypotension, polyuria, dehydration, Electrolyte extremities. Caution pt. of increased photosensitivity.
  4. 4. Potassium ChlorideK-Dur Patient/Family Teaching: Do not chew onRoute/Dosage (Adult): PO, IV 40-80 mEq/day enteric-coated tablets, reduce excessive K inClassification: mineral & electrolyte diet. Avoid salt substitutes or low salt milk/foodreplacements/supplements unless approved by physician. Instruct pt. toAction: Maintain acid-base balance, isotonicity, report dark, tarry, or bloody stools, weakness,and electro physiologic balance of the cell. unusual fatigue, or tingling in extremities.Replacement/prevention of deficiency.Side Effects: Confusion, restlessness,ARRHYTHMIAS, abdominal pain, diarrhea,flatulence.Nursing Implication: Assess s/s ofhypokalemia (weakness, fatigue, U wave onECG, arrhythmias, polyuria, polydipsia). Monitorpulse, BP, and ECG periodically during IVtherapy. Monitor labs (serum potassium, renalfunction, serum bicarbonate, pH). Monitor for s/sof toxicity/overdose (hyperkalemia,confusion, abnormal ECG readings).
  5. 5. Amlodipine (am-loe-di-peen)Norvasc therapy. Monitor intake/output ratios,Route/Dosage (Adult): PO 5-10 mg/ daily weight, signs of CHFday, 2.5 mg/day (small pt., pt. already (peripheraledema, rails/crackles,receiving antihypertensive) up to 10 dyspnea, weight gain).mg/day. Patient/Family Teaching: AvoidClassification: antihypertensive; grapefruit juice, instruct pt. how to takeCalcium channel blocker pulse and BP contact health careAction: Systemicvasodilatation professional if HR < 50 BPM. Cautionresulting in decreased BP. Coronary pt. to move positions slowly,vasodilatation resulting indecreasing photosensitivity. Instruct pt.frequency and severity of angina. importance of good dental hygiene;Side Effects: headache,peripheral avoidalcohol use, OTC medicationsedema, bradycardia, hypotension (especially cold preparations).Nursing Implication: Monitor BP& Morphine SulfateMS Continpulse prior before treatment/during Route/Dosage (Adult): PO>50 kg= 30 mg q 3-dose titration/periodically during 4 hr; <50 mg= 0.3mg/kg q 3-4 hr.; IV, IM,
  6. 6. Subcut>50 kg=4-10 mg q 3-4 hr <50kg=0.05- Patient/Family Teaching: Instruct pt.0.2 mg/kg q 3-4hr max 15 mg/dose. how/when to ask for pain med. Instruct familyClassification:Opioid analgesics; opioid not to administer PCA dosesto sleeping pt.agonists (overmedication, sedation, respiratoryAction: For severe pain depression can result). Encourage bedfast pt. toSide Effects: Confusion, sedation, turn, cough, breathe deeply at least q 2hr.RESPIRATORY DEPRESSION, hypotension, Teach pt./family how/when to administerNursing Implication: Assess type, location, medication, infusion care, accurate measuringofintensity of pain prior to and following med. Emphasize importance of aggressivePO,subcut, IM (20 min (peak) following IV). prevention of constipation.Assess lvls of consciousness, BP,pulse, andrespirations before and periodically duringadministration. If respiratoryrate <10/min,assess lvl of sedation. Assess geriatric pt. often.Asses bowel function routinely. Explaintherapeutic value prior to administrationtoenhance its analgesic effect.
  7. 7. Famotidine (fa-moe-ti- Nursing Implication: Assess for epigastric/abdominal pain, blood in stool,deen)Pepcid emesis, or gastric aspirate. Monitor CBC w/Route/Dosage (Adult): PO 300-800 mg diff periodically. Administer w/ meals or(bid, hs, q 6hr).IM/IV- 300-600 mg q 6hr. immediately afterward/at bedtime to37.5 mg/hr. Not to exceed 2.4g/day (PO, prolong effect. Avoid antacids within 1 hr ofIM, IV) taking medClassification: antiulcer agents; histamine Patient/Family Teaching: NotifyH2 antagonists healthcare professional if difficultyAction: Short-term treatment of duodenal swallowing or abdominal pain occurs.ulcers. Management of gastric hyper Inform pt. smoking interferes with actionsecretory states, GERD.tx of heartburn, medication. Inform pt. increased fluid andacid indigestion, sour stomach. fiber intake helps min. constipation. AdviseSide Effects: Confusion, ARRHYTHMIAS, pt. to report onset of black, tarry stools,AGRANULOCYTOSIS, APLASTIC fever sore throat diarrhea, dizziness,ANEMIA, decrease sperm count,ED, drug- confusion, and hallucinations.induce hepatitis.
  8. 8. Cephalexin (sef-a-lex-in) use/reaction toKeflex penicillin/cephalosporins. ObtainRoute/Dosage (Adult): PO-250- specimens for culture/sensitivity500 mg, q 6hr before therapy. Observe for s/s ofClassification: anti-infective; 1st anaphylaxis. Monitor for bowelgen. cephalosporins function, diarrhea, bloody stools.Action:Treatment of infections Patient/Family Teaching: Takecaused by burn wounds, pneumonia, medication completely as directed,UTI, bone/joint infection, even if they feel better. Advise pt. toSepticemia. Otitis media report s/s of superinfection. InstructSide Effects:SEIZURES (high dose), pt. to report if they experience feverPSEUDOMEMBRANOUS COLITIS, S/J and diarrhea, especially if diarrheaSYNDROME, rash, hemolytic anemia, contains blood, mucus, pus. AdviseNursing Implication: assess for pt. notto treat diarrhea w/oinfection at beginning and during tx. speaking with healthcareObtain hx to determine previous professional.
  9. 9. Levothyroxine Sodium concentration (w/ brand change). AssessSynthroid for hyperthyroidism (tachycardia, chestRoute/Dosage (Adult): 50 mcg (initially), pain, nervousness, insomnia, diaphoresis,increase q 2-3 wks; maintenancedose- 75- tremors, weight loss). Administer in AM to125 mcg/day (1.5 mcg/kg/day) avoid insomnia.Classification: hormones; thyroid Patient/Family Teaching: Instructpreparations. changing brands may affectbioavailability;Action: Replacement in hypothyroidism to explain medication does not curerestore normal hormonal balance. hypothyroidism. Take with water to avoidSuppression of thyroid cancers. rapid tablet swell causing choking/troubleSide Effects: Nervousness,hypotension, swallowing.menstrual irregularities,Nursing Implication: assess apical pulse& BP prior and periodically during therapy.Assess for tachyarrhythmia& chest pain.Monitor labs (thyroid function, TSH
  10. 10. Promethazine SYNDROME, confusion, disorientation,HydrochloridePhenergan sedation, dry mouth, photosensitivity.Route/Dosage (Adult): antihistamine- PO 6.25- Nursing Implication: Monitor BP, pulse,12.5mg tid/ 25 mg hs (IV, IM, Rect- 25mg; may respirations often of pt. receiving IV dose.repeat q 2hr). antivertigo-PO-25 mg before Monitor pt. for extrapyramidal &departure (may repeat in8-12hr). Sedation-PO, pseudoparkinsonian side effects. Assess forRect, IM, IV-25-50 mg, may repeat q4hr. delirium, confusion, blurred vision. In IV- assessAntiemetic-PO, Rect, IM, IV- 12.5-25 mg q 4hr for burning and pain at IV site.(avoid IVPRN (initial PO dose=25 mg). administration if possible). May cause false +/-Classification:antiemetic, antihistamines, pregnancy results.sedative/hypnotics; phenothiazine Patient/Family Teaching: Advise frequentAction: tx of various allergic conditions and mouth rinses, good oral hygiene, and sugarlessmotion sickness. Tx/prevention of gum can decrease dry-mouth. Instruct pt. tonausea/vomiting. Adjunct to anesthesia & report sore throat, jaundice, fever, uncontrolledanalgesia movements. When taken for motion sickness,Side Effects: May cause severe injury to tissue advise pt. to take at least 30 min priorin IV.NEUROLEPTIC MALIGNANT (preferably1-2hr prior) to exposure to conditions that may cause motion sickness.
  11. 11. Monitor intake/output ratios and daily weight. AssessDiltiazen (dil-tye-a- signs of CHF (peripheral edema, rales/crackles,zem)Cardizem dyspnea, weight gain, jugular venous distention).Route/Dosage (Adult): PO-30-120 mg3-4 qd/ 60-120 Patient/Family Teaching: Avoid grapefruit juice.mg bid as SR caps/ 180-240 mg qd as CD/XR caps or Change position slowly. Instruct pt. of importance ofLA tabs (up to360 mg/day). IV-0.25/kg, may repeating dental hygiene and seeing dentist frequently for teeth15 min w/ dose of 0.35 mg/kg. May follow continuous cleaning to prevent tenderness, bleeding, guminfusion at 10 mg/hr (range 5-15 mg/hr) up to 24hr. enlargement. Advise pt. to report irregular HB,Classification: antianginals, antiarrhythmic (class 4), dyspnea, swelling of hands/feet, chest pain does notantihypertensives; Calcium Channel Blocker improve. Instruct pt./family in proper technique forAction: Systemic vasodilation resulting in decreased monitoring BP weekly and report sig. changesBP. Coronary vasodilation resulting in decreasedfrequency/severity of attacks of angina. Reduction ofventricular rate in atrial fibrillation or flutter.Side Effects: Abnormal dreams, anxiety, blurredvision, tinnitus, ARRYTHMIAS, CHE, peripheraledema, S/J SYNDROME,Nursing Implication: Monitor BP and pulse prior totherapy, during dose titration, and periodically duringtherapy. Monitor ECG continuously duringadministration; periodically during prolonged therapy.
  12. 12. Ibuprofen(eye-byoo-proe-fen) pain lvl, ROM. May cause prolonged bleeding.Motrin Ensure pt. well hydratedRoute/Dosage (Adult): POAnti-inflammitory- Patient/Family Teaching: Advise pt. to take w/400-800 mg 3-4/day (up to 3200 mg/day). full glass of water and remain in upright positionAnalgesic/antidysmenorrheal/antipyretic for 15-30 min. May cause drowsiness/dizziness.-200-400 mg q 4-6 hrs. (not to exceed 1200 Avoid concurrent use of alcohol (GI bleeding),mg/day). IVAnalgesic-400-800 mg q 6hr (not ASA, ACE. Do not take > 10 days for pain, >3exceed 3200 mg/day), Antipyretic-400 mg q 4- days for fever.6hr/ 100-200 q 4hr (not exceed 3200 mg/day)Classification: antipyretics, antirheumatics,nonopioid analgesics, nonsteroidal anti-inflammatory agents;Action: treatment of mild-moderate pain/fever.Reduces pain/inflammation/feverSide Effects: Headache, GI BLEEDING,HEPATITIS, ANAPHYLAXIS, DERMPROBLEMS, anemia Nursing Implication:Assess for rhinitis, asthma, urticaria, skin rash,
  13. 13. AspirinEcotrin headache, hyperventilation, agitation, mentalRoute/Dosage (Adult): Pain/fever- PO 325- confusion, Do not take antacids within 1-2 hr of1000mg q 4-6 hr (not exceed 4 g/day). taking enteric-coated tabsInflammation-2.4 g/day (initially), 3.6-5.4 g/day Patient/Family Teaching: Take with full glass(in divided doses) 7.8 g/day for acute rheumatic of water, remain upright 15-30 min. advise pt. tofever. Prevention of TIA-50-325 mg q.d. report tinnitus, unusual bleeding, brushing, blackPrevention of MI-80-325 mg q.d. stools, fever lasting > 3days. Caution pt. of GIClassification: antipyretic, nonopioid bleeding from alcohol, and avoid ACE oranalgesics; salicylates NSAIDs concurrently w/ aspirin. Teach pt.Action: Decrease incidence of TIA & MI; reduce Na in diet. Tabs w. vinegar-like smelldecrease platelet aggregation, reduce should be discarded. Aspirin may need to beinflammation/fever/pain. withheld prior to surgery. Advise pt. of reductionSide Effects: tinnitus, GI BLEEDING, epigastric of TIA/MI not to take > prescribed dose asdistress, anemia, increase dose not found to provide additionalNursing Implication: Assess pain & ROM, may benefit.cause prolonged bleeding, Prolong/high dose-monitor hepatic function, serum salicylates lvls,hematocrit. Monitor for onset of tinnitus,
  14. 14. EnoxaparinLovenox and inflammation. Monitor labs (CBC,Route/Dosage (Adult):Prophylaxis-30 q platelet count, blood in stools).12hr, 40 mg/day, 1 mg/kg q 12hr. Patient/Family Teaching: Advise. toClassification: anticoagulants; report any s/s of unusual bleeding,antithrombotic bruising, dizziness, itching, rash, fever,Action: Prevention of thrombus formation swelling, difficulty breathing. Instruct pt. notSide Effects: dizziness, BLEEDING, to take aspirin orNSAIDs.anemia, insomnia, and urinary retention.Nursing Implication: Assess for signs ofbleeding & hemorrhage. Assess forevidence of additional thrombosis. Monitorneurological impairment frequently (mayrequire urgent care). Monitor forhypersensitivity (chills, fever). Observeinjection sites for hematomas, ecchymosis,