The first document discusses the use of digoxin including indications, dosages, side effects and nursing implications such as monitoring pulse and electrolyte levels. The second document covers the anticoagulant warfarin including contraindications, side effects and teaching patients to avoid foods and activities that could increase bleeding risk. The third document provides information on the loop diuretic furosemide including classifications, side effects, and nursing implications like assessing for dehydration and electrolyte imbalances.

1. Digoxin(di-jox-in)High Alert! Lanoxin, 1 full minute prior to administering. Withhold
Lanoxicaps dose and notify physician if pulse is <60
Route/Dosage (Adult):Initial Dose-several (adult). Immediately report any significant
divided 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 (abdominal
Classification: Therapeutic (antiarrhythmic, pain, anorexia, vomiting, visual disturbances,
inotropics) Pharmacologic (digitalis glycosides) bradycardia)
Indication: Heart Failure. Atrial fibrillation & Patient/Family Teaching: Instruct pt. to take
atrial flutter (slows ventricular rate) medications as directed at the same time each
Action: Increases the force of myocardial day. Do not d/c medication w/o consulting with
contraction. Increases cardiac output and a healthcare professional. Teach pt. to take
slows heart rate. pulse and contact healthcare professional prior
Side Effects: fatigue, blurred/green/yellow to taking medication if pulse is <60>100.
vision, ARRHYTHMIAS, bradycardia, Review s/s of toxicity and emphasize
increased risk of falls (geriatric) theimportance of follow-up exams to determine
Nursing Implication: Monitor apical pulse for effectiveness and monitor toxicity.

2. Warfarin (war-fa-rin)Coumadin and other clotting factors frequently. Monitor
Route/Dosage (Adult): PO, IV 2-5 mg/day for hepatic function and CBC before and
2-4 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 after
to clot). d/c of Warfarin. Avoid foods rich in Vitamin K
Classification: 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 consume
uncontrolled hypertension. alcohol, take other Rx, OTC, or herbal products
Side Effects: Bleeding, dermal necrosis, especially those containing aspirin or NSAIDs.
cramps, nausea. Emphasize the importance of frequent lab tests
Nursing Implication: Assess for signs of to monitor coagulation factors.
bleeding and hemorrhage (gums, nose,
unusual bruising, black stools, fall in hematocrit
or BP, nasogastric aspirate. Monitor PT, INR

3. Furosemide (fur-oh-se-mide)Lasix
Route/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/output
2.5 g/day, Hypercalcemia-120 mg/day (in 3 doses). ratio, amount/location of edema, lung sounds, skin
IM/IV 20-40 mg may repeat in 1-2 hr and increase 20 turgor, and mucus membranes. Notify physician if
mg/ 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. Monitor
Classification: 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 to
reabsorbtion of sodium and chloride from the loop of minimize gastric irritation. Tablets may be crushed if
Henle and distal renal tubule. Increases renal pt. has trouble swallowing.
excretion of water, sodium, chloride, magnesium, Patient/Family Teaching: Caution to change
potassium, & calcium. positions slowly, avoid standing long periods of time,
Contraindications/Precautions: Hepatic coma or exercising in hot weather or use of alcohol to
anuria, severe liver disease, Electrolyte depletion, minimize orthostatic hypotension. Teach to avoid diet
Diabetes 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, muscle
Side Effects: Blurred vision, dizziness, tinnitus, weakness, cramps, dizziness, tingling/numbness in
hypotension, polyuria, dehydration, Electrolyte extremities. Caution pt. of increased photosensitivity.

4. Potassium ChlorideK-Dur Patient/Family Teaching: Do not chew on
Route/Dosage (Adult): PO, IV 40-80 mEq/day enteric-coated tablets, reduce excessive K in
Classification: mineral & electrolyte diet. Avoid salt substitutes or low salt milk/food
replacements/supplements unless approved by physician. Instruct pt. to
Action: 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 of
hypokalemia (weakness, fatigue, U wave on
ECG, arrhythmias, polyuria, polydipsia). Monitor
pulse, BP, and ECG periodically during IV
therapy. Monitor labs (serum potassium, renal
function, serum bicarbonate, pH). Monitor for s/s
of toxicity/overdose (hyperkalemia,
confusion, abnormal ECG readings).

5. Amlodipine (am-loe-di-peen)Norvasc therapy. Monitor intake/output ratios,
Route/Dosage (Adult): PO 5-10 mg/ daily weight, signs of CHF
day, 2.5 mg/day (small pt., pt. already (peripheraledema, rails/crackles,
receiving antihypertensive) up to 10 dyspnea, weight gain).
mg/day. Patient/Family Teaching: Avoid
Classification: antihypertensive; grapefruit juice, instruct pt. how to take
Calcium channel blocker pulse and BP contact health care
Action: Systemicvasodilatation professional if HR < 50 BPM. Caution
resulting 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 medications
edema, bradycardia, hypotension (especially cold preparations).
Nursing Implication: Monitor BP& Morphine SulfateMS Contin
pulse 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. 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 family
Classification:Opioid analgesics; opioid not to administer PCA dosesto sleeping pt.
agonists (overmedication, sedation, respiratory
Action: For severe pain depression can result). Encourage bedfast pt. to
Side Effects: Confusion, sedation, turn, cough, breathe deeply at least q 2hr.
RESPIRATORY DEPRESSION, hypotension, Teach pt./family how/when to administer
Nursing Implication: Assess type, location, medication, infusion care, accurate measuringof
intensity of pain prior to and following med. Emphasize importance of aggressive
PO,subcut, IM (20 min (peak) following IV). prevention of constipation.
Assess lvls of consciousness, BP,pulse, and
respirations before and periodically during
administration. If respiratoryrate <10/min,
assess lvl of sedation. Assess geriatric pt. often.
Asses bowel function routinely. Explain
therapeutic value prior to administration
toenhance its analgesic effect.

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 to
37.5 mg/hr. Not to exceed 2.4g/day (PO,
prolong effect. Avoid antacids within 1 hr of
IM, IV)
taking med
Classification: antiulcer agents; histamine
Patient/Family Teaching: Notify
H2 antagonists
healthcare professional if difficulty
Action: Short-term treatment of duodenal
swallowing or abdominal pain occurs.
ulcers. Management of gastric hyper
Inform pt. smoking interferes with action
secretory states, GERD.tx of heartburn,
medication. Inform pt. increased fluid and
acid indigestion, sour stomach.
fiber intake helps min. constipation. Advise
Side 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. Cephalexin (sef-a-lex-in) use/reaction to
Keflex penicillin/cephalosporins. Obtain
Route/Dosage (Adult): PO-250- specimens for culture/sensitivity
500 mg, q 6hr before therapy. Observe for s/s of
Classification: anti-infective; 1st anaphylaxis. Monitor for bowel
gen. cephalosporins function, diarrhea, bloody stools.
Action:Treatment of infections Patient/Family Teaching: Take
caused by burn wounds, pneumonia, medication completely as directed,
UTI, bone/joint infection, even if they feel better. Advise pt. to
Septicemia. Otitis media report s/s of superinfection. Instruct
Side Effects:SEIZURES (high dose), pt. to report if they experience fever
PSEUDOMEMBRANOUS COLITIS, S/J and diarrhea, especially if diarrhea
SYNDROME, rash, hemolytic anemia, contains blood, mucus, pus. Advise
Nursing Implication: assess for pt. notto treat diarrhea w/o
infection at beginning and during tx. speaking with healthcare
Obtain hx to determine previous professional.

9. Levothyroxine Sodium concentration (w/ brand change). Assess
Synthroid for hyperthyroidism (tachycardia, chest
Route/Dosage (Adult): 50 mcg (initially), pain, nervousness, insomnia, diaphoresis,
increase q 2-3 wks; maintenancedose- 75- tremors, weight loss). Administer in AM to
125 mcg/day (1.5 mcg/kg/day) avoid insomnia.
Classification: hormones; thyroid Patient/Family Teaching: Instruct
preparations. changing brands may affectbioavailability;
Action: Replacement in hypothyroidism to explain medication does not cure
restore normal hormonal balance. hypothyroidism. Take with water to avoid
Suppression of thyroid cancers. rapid tablet swell causing choking/trouble
Side 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. 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 for
Rect, IM, IV-25-50 mg, may repeat q4hr. delirium, confusion, blurred vision. In IV- assess
Antiemetic-PO, Rect, IM, IV- 12.5-25 mg q 4hr for burning and pain at IV site.(avoid IV
PRN (initial PO dose=25 mg). administration if possible). May cause false +/-
Classification:antiemetic, antihistamines, pregnancy results.
sedative/hypnotics; phenothiazine Patient/Family Teaching: Advise frequent
Action: tx of various allergic conditions and mouth rinses, good oral hygiene, and sugarless
motion sickness. Tx/prevention of gum can decrease dry-mouth. Instruct pt. to
nausea/vomiting. Adjunct to anesthesia & report sore throat, jaundice, fever, uncontrolled
analgesia movements. When taken for motion sickness,
Side Effects: May cause severe injury to tissue advise pt. to take at least 30 min prior
in IV.NEUROLEPTIC MALIGNANT (preferably1-2hr prior) to exposure to conditions
that may cause motion sickness.

11. Monitor intake/output ratios and daily weight. Assess
Diltiazen (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 of
LA tabs (up to360 mg/day). IV-0.25/kg, may repeating dental hygiene and seeing dentist frequently for teeth
15 min w/ dose of 0.35 mg/kg. May follow continuous cleaning to prevent tenderness, bleeding, gum
infusion 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 not
antihypertensives; Calcium Channel Blocker improve. Instruct pt./family in proper technique for
Action: Systemic vasodilation resulting in decreased monitoring BP weekly and report sig. changes
BP. Coronary vasodilation resulting in decreased
frequency/severity of attacks of angina. Reduction of
ventricular rate in atrial fibrillation or flutter.
Side Effects: Abnormal dreams, anxiety, blurred
vision, tinnitus, ARRYTHMIAS, CHE, peripheral
edema, S/J SYNDROME,
Nursing Implication: Monitor BP and pulse prior to
therapy, during dose titration, and periodically during
therapy. Monitor ECG continuously during
administration; periodically during prolonged therapy.

12. Ibuprofen(eye-byoo-proe-fen) pain lvl, ROM. May cause prolonged bleeding.
Motrin Ensure pt. well hydrated
Route/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 position
Analgesic/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, >3
exceed 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/fever
Side Effects: Headache, GI BLEEDING,
HEPATITIS, ANAPHYLAXIS, DERM
PROBLEMS, anemia Nursing Implication:
Assess for rhinitis, asthma, urticaria, skin rash,

13. AspirinEcotrin headache, hyperventilation, agitation, mental
Route/Dosage (Adult): Pain/fever- PO 325- confusion, Do not take antacids within 1-2 hr of
1000mg q 4-6 hr (not exceed 4 g/day). taking enteric-coated tabs
Inflammation-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. to
fever. Prevention of TIA-50-325 mg q.d. report tinnitus, unusual bleeding, brushing, black
Prevention of MI-80-325 mg q.d. stools, fever lasting > 3days. Caution pt. of GI
Classification: antipyretic, nonopioid bleeding from alcohol, and avoid ACE or
analgesics; salicylates NSAIDs concurrently w/ aspirin. Teach pt.
Action: Decrease incidence of TIA & MI; reduce Na in diet. Tabs w. vinegar-like smell
decrease platelet aggregation, reduce should be discarded. Aspirin may need to be
inflammation/fever/pain. withheld prior to surgery. Advise pt. of reduction
Side Effects: tinnitus, GI BLEEDING, epigastric of TIA/MI not to take > prescribed dose as
distress, anemia, increase dose not found to provide additional
Nursing 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. 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. to
Classification: anticoagulants; report any s/s of unusual bleeding,
antithrombotic bruising, dizziness, itching, rash, fever,
Action: Prevention of thrombus formation swelling, difficulty breathing. Instruct pt. not
Side Effects: dizziness, BLEEDING, to take aspirin orNSAIDs.
anemia, insomnia, and urinary retention.
Nursing Implication: Assess for signs of
bleeding & hemorrhage. Assess for
evidence of additional thrombosis. Monitor
neurological impairment frequently (may
require urgent care). Monitor for
hypersensitivity (chills, fever). Observe
injection sites for hematomas, ecchymosis,