Saturday, May 13, 2006


Generic name Allopurinol

Classification Gout Preparations

Primary uncomplicated hyperurecemia; mild gout; severe tophaceous gout; uric acid nephropathy; uric acid nephrolithiasis; and in the prevention of renal Calcium oxalate stones.

reduces uric acid production by inhibiting biochemical reactions preceding its formation.

Adverse reactions
allergic skin reactions, GI disturbances, diarrhea, and joint pains

Nursing considerations

  • monitor serum uric acid levels to evaluate drug’s effectiveness
  • monitor fluid intake and output; daily urine output of at least 2 liters and maintenance of neutral or slightly alkaline urine are desirable
  • periodically monitor CBC and hepatic and renal function, especially at start of therapy, as ordered
  • If renal insufficiency occurs at any time during treatment, be prepared to reduce dosage, as ordered.
  • Optimal benefits may require 2-6 weeks of therapy. Because acute gouty attacks occur during this time, concurrent use of colchicines may be prescribed prophylactically.
  • To minimize GI disturbance, tell patient to take with or immediately after meals.
  • Encourage the patient to drink plenty of fluids while taking this drug unless otherwise contraindicated.
  • Drug may cause drowsiness, tell patient not to drive or perform hazardous tasks requiring mental alertness until CNS effects of the drug are known.
  • If the patient is taking allopurinol for treatment of recurrent calcium oxalate stones, advise him to also reduce his dietary intake of animal protein, sodium, refined sugars, oxalate-rich foods, and calcium.
  • Tell patient to discontinue at first sign of rash, which may precede severe hypersensitivity or other adverse reaction. Rash is more common in patient taking diuretics and in those with renal disorders. Tell the patient to report all adverse reactions.


Classification Vitamins

Hypoprothrombinemia secondary to vitamin K malabsorption, drug therapy, or excessive vitamin A dosage; hypoprothrombinemia secondary to effect of oral anticoagulants; prevention of hemorrhagic disease of newborn

prevention of hypoprothrombonemia related to vitamin K deficiency for long-term parenteral nutrition; prevention of hypoprothrombinemia in infants receiving less than 0.1 mg/liter vitamin K in breast milk or milk substitute.

An antihemorrhagic actor that promotes hepatic formation of active prothrombin.

Adverse Reactions
dizziness, transient hypotension after IV administration, rapid and weak pulse, diaphoresis, flushing, erythema, pain, swelling and hematoma at injection site.

Nursing Considerations

  • IV use: Dilute with 0.9% sodium chloride for injection, D5W, or D5W in 0.9% sodium chloride for injection. Give IV by slow infusion over 2 to 3 hours. Rate shouldn’t exceed 1 mg/minute in adults or 3 mg/m2/minute in children.
  • Effects of IV injection are more rapid but shorter-lived than SC or IM injections.
  • Protect parenteral products from light. Wrap infusion container with aluminum foil.
  • For IM administration in adults and older children, administer in upper outer quadrant of buttocks; for infants, administer in the anterolateral aspect of thigh or deltoid region.
  • Anticipate order of weekly addition of 5 to 10 mg of phytonadione to total parenteral nutrition solutions.
  • Monitor PT to determine dosage effectiveness as ordered.
  • If severe bleeding occurs, don’t delay other measures, such as fresh frozen plasma or whole blood.
  • Alert: watch for signs of flushing, weakness, tachycardia and hypotension; may progress to shock.
  • Be aware that phytonodione therapy for hemorrhagic disease in infants causes fewer adverse reactions than do other vitamin K analogues.
  • Failure to respond to vitamin K may indicate coagulation defects.


Generic name Atorvastatin

Classification Antihyperlipedemic Agents

reduction of elevated total and LDL cholesterol, apolipoprotein B and triglycerides in patient with primary hypercholesterolemia, mixed hyperlipidemia, heterozygous and homozygous familial hypercholesterolemia.

Inhibits 3-hydroxy-3-methylglutaryl-coenzyme A reductase, as early (and rate-limit) step in cholesterol biosynthesis.

Adverse Reactions
GI disturbances, headache, myalgia, asthenia, insomnia, angioneurotic edema, muscle cramps, myositis, myopathy, cholestatic jaundice, peripheral neuropathy, pruritus.

Nursing Considerations

  • use cautiously in patient with liver disease or heavy alcohol use.
  • know that drugs should be withheld or discontinued in patients with serious, acute conditions that suggest myopathy or those at risk for renal failure; major surgery; sever metabolic, endocrine, and electrolyte disorders; severe acute infection; hypotension; or uncontrolled seizures
  • know that drug may be given as a single dose at any time of day, with or without food.
  • watch for signs of myositis.
  • teach patient about proper dietary management, weight control, and exercise. explain their importance in controlling elevated serum lipid levels.
  • warn patient to avoid alcohol.
  • tell patient o inform the doctor of adverse reactions, such as muscle pain, malaise, and fever.


Generic name Levocarnitine

Classification Cardiac Drug

Chronic myocardial ischemia, cardiac failure, angina pectoris, arrhythmia, acute myocardial ischemia
action facilitates transport of fatty acids into cellular mitochondria. the fatty acids are then used to produce energy

Adverse reactions
nausea, vomiting, cramps, diarrhea, body odor

Nursing considerations
• give enteral liquid alone or dissolved in drinks or liquid food.
• space doses evenly every 3-4 hours and give drug with or after meals, if possible.
• use entire or partial contents of containers of liquid immediately after opening; discard any unused contents.
• do not refrigerate solution.
• monitor patient’s tolerance during 1st week of therapy and after increasing dosage, as ordered.
• monitor blood chemistry results and plasma carnitine concentrations periodically, as ordered, as well as vital signs and patient’s overall clinical condition.
• tell patient to consume oral liquid slowly to minimize GI distress. if GI intolerance persists, dosage e may have to be reduced.
• caution patient not to share drug with others. some people have used it to improve athletic performance.
• warn patient about possible body odor.


Generic name Piperacillin sodium and Tazobactam sodium

Classification Penicillin

Treatment of systemic and/or local bacterial infections caused by sensitive organisms; UTI, lower respiratory tract, intra-abdominal; skin and skin structure infections; bacterial septicemia; polymicrobic infections

Piperacillin is an extended-spectrum penicillin that inhibits cell-wall synthesis during microorganism multiplication’ tazobactam increase piperacillin’s effectiveness by inactivating beta lactamases, which destroy penicillins.

Adverse Reactions
diarrhea, constipation, nausea, headache, insomnia, rash, erythema, pruritus, vomiting, allergic reactions, urticaria and superinfection.

Nursing Considerations

  • use cautiously in patients with other drug allergies, especially to cephalosporins (possible cross-sensitivity), or in those with bleeding tendencies, uremia, and hypokalemia.
  • obtain specimen for culture and sensitivity test before first doe. therapy may begin pending results.
  • IV use: Reconstitute each gram of piperacillin with 5ml of diluents, such as sterile or bacteriostatic water for injection, bacteriostatic 0.9% sodium chloride for injection, D5W, dextrose 5% in 0.9% sodium chloride for injection, or dextran 6% in 0.9% sodium chloride for injection. don’t use lactated Ringer’s injection. don’t use lactated Ringer’s injection. shake until dissolved. further dilute to a final volume of 50 ml before infusion.
  • infuse over at least 30 minutes. discontinue any primary infusion during administration if possible. don’t mix with other drugs.
  • use drug immediately after reconstitution. discard unused drug after 24 hours if stored at room temperature; 48 hours if refrigerated. once diluted, drug is stable in IV bags for 24 hours at room temperature or 1 week if refrigerated.
  • change IV site every 48 hours.
  • because hemodialysis removes 6% of the piperacillin dose and 21% of the tazobactam dose, be aware that supplemental doses may be needed after hemodialysis.
  • observe closely. with large doses and prolonged therapy, bacterial and fungal superinfection may occur, especially in elderly, debilitated, or immunocompromised.
  • tell patient to report adverse reactions promptly.
  • instruct patient to alert nurse if discomfort occurs at IV site.


Classification Electrolytes and Replacement Solutions


Replaces and maintains potassium level.

Adverse Reactions
nausea, vomiting, abdominal pain, post infusion phlebitis, paresthesia of the extremities, mental confusion, weakness or heaviness of limbs, flaccid paralysis, ECG changes, hypotension, arrhythmias, heart block, possible cardiac arrest, respiratory paralysis.

Nursing Considerations

  • use cautiously in patients with cardiac disease and in those with renal impairment
  • Alert: IV use: Give by infusion only; never give IV push or IM. give slowly as dilute solution; potentially fatal hyperkalemia may result from too-rapid infusion
  • Give oral potassium supplements with extreme caution because different forms deliver varying amounts of potassium. Never switch products without a doctor’s order.
  • Give oral potassium supplements with extreme caution because different forms deliver varying amounts of potassium. Never switch products without doctor’s order.
  • make sure powders are completely dissolved before administering
  • Know that enteric-coated tablets are not recommended because of increased potential for GI bleeding and small bowel ulcerations.
  • Know that drug is often used orally with potassium-wasting diuretics to maintain potassium levels.
  • Be aware that sugar free liquid is available; use if tablet or capsule passage is likely to be delayed, such as GI obstruction. Have patients sip slowly to minimize GI irritation.


Generic name Nitroglycerin

Congestive Heart Failure, angina pectoris, prevention of phlebitis and extravasations.

A nitrate that reduces cardiac oxygen demand by decreasing left ventricular end-diastolic pressure (preload) and, to a lesser extent, systemic vascular resistance (afterload). also increases blood flow through the collateral coronary vessels.

Adverse Reaction
Frequently: headache
Occasionally: application site reactions
Rarely: dizziness, reflex tachycardia, facial flushing, postural hypotension, nausea, vomiting.

Nursing Considerations

  • use cautiously in patients with hypotension or volume depletion.
  • closely monitor vital sings. be particularly aware of blood pressure, especially in a patient with an MI. excessive hypotension may worsen the MI.
  • remove transdermal patch before defibrillation. because of its aluminum backing, the electric current may cause arcing that can result in damage to paddles and burns to the patient.
  • when stopping transdermal treatment of angina, gradually reduce the dose and frequency of application over 4-6 weeks, as ordered.
  • monitor blood pressure and intensity and duration of drug response.
  • caution the patient to take nitroglycerin regularly, as prescribed, and to have it accessible at all times.
  • alert: advise patient that abrupt discontinuation of drug causes coronary vasospasms.
  • instruct the patient to use with caution when wearing transdermal patch near microwave oven. leaking radiation may heat patch’s metallic backing and cause burns.
  • advice patient o avoid alcohol.
  • to minimize orthostatic hypotension, tell the patient to change upright position slowly. advise him to go up and down stairs carefully and to lie down at the first sign of dizziness.


Generic Name Amiodarone

Classification Cardiac drugs

Cardiac arrhythmias: supraventricular arrhythmias, junctional arrhythmias, ventricular arrhythmias: paroxysmal tachycardia, extrasystoles, ventricular flutter and fibrillation.

unknown. though to prolong the refractory period and action potential duration.

Adverse Reactions
reversible corneal microdeposits, colored halos; hyper or hypothyroidism. rarely: photosensitization and pigmentation, reversible diffuse interstitial pneumopathy or peripheral neuropathy.

Nursing Considerations

  • use with extreme caution in those receiving other anti arrhythmics.
  • use cautiously in patient with pulmonary or thyroid disease.
  • be aware that although amiodarone is often effective for treatment of arrhythmias resistant to other drug therapy, the high incidence of adverse reactions limits its use
  • obtain baseline pulmonary, liver, and thyroid function tests.
  • administer loading doses in a hospital setting and with continuous ECG monitoring because of the slow onset on antiarrhythmic effect and risk of life-threatening arrhythmias.
  • divide oral loading dose into three equal doses and give with meals to decrease GI intolerance. maintenance dosage may be given once daily, but may be divided into two doses taken with meals of GI intolerance occurs.
  • IV use: know that amiodorone may be given IV where facilitates for close monitoring of cardiac function and resuscitation are available. initial dosage of 150 mg should be mixed with 100 ml of dextrose 5% solution. repeat doses should be administered through a central venous catheter.
  • continuously monitor cardiac status of patient receiving drug IV.
  • monitor BP and heart rate and rhythm frequently. perform continuous ECG monitoring during initiation and alteration of dosage. Notify doctor of significant change.


Generic name Pantoprazole Sodium

Classification antacids and antiulcerants

Symptomatic treatment of mild reflux esophagitis; long term management and prevention of relapse of reflux esophagitis; duodenal and gastric ulcers, reflux esophagitis; eradication of H. pylori.

nhibits proton pump activity by binding to hydrogen-potassium adenosine triphosphatase, located at secretory surface of gastric parietal cells, to suppress gastric acid secretion.

Adverse reactions
Frequently: headache, diarrhea
Rarely: nausea, upper abdominal pain, flatulence, skin rash, pruritus or dizziness.

Nursing Considerations

  • alert: don’t confuse with protonix tablet, prisolec, prozac, or prevacid
  • drug can be given without regard to meals
  • drug shouldn’t be used for maintenance therapy beyond 16 weeks.
  • symptomatic response to therapy doent preclude the presence of gastric malignancy.


Classification Alkalinizers

Cardiac arrest; Metabolic acidosis; systemic or urinary alkalinization

Restores body’s buffering capacity of the boy and neutralizes excess acid.

Adverse Reactions
gastric distention, belching, flatulence. with overdose – metabolic alkalosis, hypernatremia, hyperosmolarity; local pain and irritation at injection site.

Nursing Considerations

  • use with extreme caution in patients with CHF or other edematous or sodium-retaining conditions or renal insufficiency
  • to avoid risk of alkalosis, obtain blood pH, Pao2, PaCO2, and serum electrolytes. keep the doctor informed of serum laboratory results.
  • tell the patient not to take with milk. may cause hypercalcemia, alkalosis and possibly renal calculi.


Classification Anti-anxiety


Unknown. A piperazine antihistamine whose action may be due to a suppression of activity in certain key regions of the subcortical area of the Central Nervous System.


Anxiety, Preoperative and postoperative adjunctive therapy, Pruritus due to anxiety, Psychiatric and emotional emergency, nausea and vomiting

Adverse reactions

Common: Drowsines, dry mouth

Uncommon:Involuntary motor activity, Hypersensitivity reactions

Nursing considerations

· Parenteral form for IM administration only, never administer IV, the Z-tract injection is preferred

· Aspirate IM injection carefully to prevent inadvertent IV injection. Inject deeply into a large muscle mass

· If the patient is taking other CNS drugs for over sedation


Classification Amebicides and Antiprotozoals


A direct-acting trichomonacide and amebecide that works at both intestinal and extraintestinal sites. It is thought to enter the cells of microorganisms that certain nitroreductase. Unstable compounds are then formed that bind to DNA and inhibit synthesis, causing cell death.


Amebic hepatic abscess, Intestinal amebiasis, Trichomoniasis, Refractory trichomoniasis, Bacterial infections caused by anaerobic microorganisms, Giardiasis

Adverse reactions
Candida infection

Uncommon: Headache, dizziness, confusion, irritability, depression, weakness, insomnia, abdominal cramping, nausea and vomiting, anorexia, diarrhea, constipation, polyuria or dysuria, vaginal Candiasis, flushing, rash

Nursing considerations

· Give oral form with meals

· Use cautiously in patients with history of blood dyscrasia, or CNS disorders, and in patients with retinal or visual field changes

· Don’t refrigerate the neutralized diluted solution

· Observe for edema, especially in patients receiving steroids.


Classification Non-Steroidal Anti-inflammatory Drug


Unknown. Produces anti-inflammatory, analgesic, and antipyretic effects, possibly by inhibiting prostaglandin synthesis.


Rheumatoid arthritis, osteoarthritis, arthritis; mild to moderate pain, dysmenorrheal; fever; external treatment of joint pain; swelling of tissues adjacent to joints; juvenile arthritis

Adverse reactions

Common: Headache, dizziness, peripheral edema, tinnitus, epigastric distress, nausea, occult blood loss, peptic ulceration, acute renal failure, rash

Nervousness, aseptic meningitis, fluid retention, edema, diarrhea, constipation, dyspepsia, flatulence, heartburn, decreased appetite, hematuria, prolonged bleeding time, anemia, prutitus, urticaria, neutropenia, leukopenia

Nursing considerations

  • Use cautiously in patients with GI disorders, history of peptic ulcer disease, hepatic or renal disease, cardiac decompensation, hypertension, known intrinsic coagulation defects
  • Be aware that the drug’s anti-pyretic and anti-inflammatory actions may mask the signs and symptoms of infection.


Classification Penicillins


A penicillinase – resistant penicillin that inhibits cell-wall synthesis during microorganism multiplication; bacteria resists penicillins by producing penicilllinase – enzymes that convert penicillins to inactivate penecillic acids. Oxacillin resists these enzymes.


Systemic infections caused by penicillinase-producing staphylococci

Adverse reactions

Common: Thrombophebitis
: Neuropathy, neuromuscular irritability, lethargy, hallucination, anxiety, confusion, agitation, depression, dizziness, fatigue, oral lesions, nausea, vomiting, diarrhea, enterocolitis, interstitial nephritis, nephropathy, thrombocytopenia, hemolytic anemia, anemia, hypersensitivity reactions

Nursing considerations

  • Use cautiously in patients with other drug allergy, especially to cephalosporins.
  • Obtain specimen for culture and sensitivity tests before first dose.
  • To prevent vein irritation, avoid continuous infusions. Change site every 48 hours.
  • Give 1-2 hours before or 2-3 hours after meals to prevent gastric irritation.


Classification Nonnarcotic analgesic and antipyretic


Unknown. Thought to produce analgesia by blocking generation of pain impulses. Probably by inhibiting prostaglandin synthesis in the CNS or the synthesis or action of other substances that sensitize pain receptors to mechanical or chemical stimulation. It is thought to relieve fever by central action in the hypothalamic heat-regulating center


Mild pain or fever

Adverse reactions

Hemolytic anemia, Neutropenia, Leucopenia, jaundice, rash, urticaria

Nursing considerations

  • Use cautiously in patients with history of chronic alcohol use because hepatotoxicity has occurred after therapeutic doses
  • Many OTC products contain acetaminophen
  • Liquid form is recommended for children and for patients who have difficulty swallowing
  • Know that acetaminophen may produce false-positive decreases in blood glucose levels in home monitoring systems.


Generic Name Fluconazole

Classification Antifungal


Inhibits fungal cytochrome P-450 (responsible for fungal sterol synthesis) and weakens fungal cell walls.


Oropharyngeal candidiasis; esophageal candidiasis; systemic candidiasis, cryptococcal meningitis; prevention of candidiasis in bone marrow transplant; suppression of relapse of cryptococcal meningitis in patients with AIDS

Adverse Reactions

Common: nausea
Uncommon: headache, vomiting, abdominal pain, diarrhea, elevated liver enzymes, rash

Life-threatening: hepatotoxicity, Stevens-Johnson Syndrome (rare)

Nursing Considerations
  • use cautiously in patients with hypersensitivity to other antifungal azole compounds; no information exists regarding cross-sensitivity
  • Do not remove protective overwrap from IV bags until just before use, to ensure product sterility. The plastic container may show some opacity from moisture absorbed during sterilization. This is normal, doesn’t affect the drug, and diminishes over time.
  • IV use: Administer by continuous infusion at a rate not to exceed 200 mg/hour. Use an infusion pump. To prevent air embolism, do not connect in series with other infusions. Do not add any other drugs to the solution.
  • Periodically monitor liver function during prolonged therapy, as ordered. Although adverse effects are rare, they can be serious.
  • If the patient develops mild rash, monitor closely. Discontinue drug if lesions progress and notify doctor.
  • Be aware that the incidence of adverse reactions appears to be greater in HIV-infected patients.


Generic Name Azithromycin

Classification Macrolide anti-infective


Binds to the 50S subunit of bacterial ribosomes, blocking protein synthesis; bacteriostatic or bactericidal, depending on concentration.


Acute bacterial exacerbations of COPD caused by Haemophilus influenzae, Moraxella (Branhamella) catarrhalis, or Streptococcus pneumoniae; mild community-acquired pneumonia caused by H. influenzae or S. pneumoniae; uncomplicated skin and skin-structure infections caused by Staphylococcus aureus, streptococcus pyogens, or S. agalactiae; second-line therapy of pharyngitis or tonsillitis caused by S. pyogens.; Nongonococcal urethritis or cervicitis caused by Chlamydia trachomatis; prevention of disseminated Mycobacterium avium complex (MAC) disease in patients with advanced HIV infection; urethritis and cervicitis due to Neisseria gonorrhoeae; genital ulcer disease in men due to Haemophilus ducreyi (chancroid)

Adverse Reactions

Common: nausea, vomiting, diarrhea, abdominal pain

Uncommon: dizziness, vertigo, headache, fatigue, somnolence, palpitations, chest pain, dyspepsia, flatulence, melena, cholestatic jaundice, psuedomembranous colitis, candidiasis, vaginitis, nephritis, rash, photosensitivity, angioedema

Nursing Considerations

  • Use cautiously in patients with impaired hepatic function
  • Obtain specimen for culture and sensitivity test before first dose. therapy may begin pending results
  • Administer capsules 1 hour before or 2 hours after meals; do not administer with antacids. Oral suspension can be taken with or without food.
  • Monitor for superinfection. May cause overgrowth of nonsusceptible bacteria or fungi.


Generic Name Esomeprazole Magnesium

Classification antiulcer drug


Inhibits the activity of the acid (proton) pump, and binds to hydrogen-potassium adenosine triphosphatase, located at the secretory surface of the gastric parietal cells to block the formation of gastric acid.


Severe erosive esophagitis; poorly responsive gastroesophageal reflux disease (GERD); maintenance of healing erosive esophagitis; pathologic hypersecretory conditions; duodenal ulcer; treatment of H. pylori infection or ulcers caused by H. pylori; short-term treatment of active benign gastric ulcer.

Adverse reactions

Headache, dizziness, asthenia, diarrhea, abdominal pain, nausea, vomiting, constipation, flatulence, cough, upper respiratory infection, rash , back pain

Nursing Interventions

  • know that dosage adjustments aren’t needed for renal or hepatic impairment
  • Know that esomeprazole increases its own bioavailability with repeated dosages. Drug is labile in gastric acid; fewer drugs are lost to hydrolysis because the drug increases gastric pH.


Generic name Lactulose

Classification Laxative


Produces an osmotic effect in the colon. Resulting distention promotes peristalsis. Also decreases blood ammonia, probably as a result of bacterial degradation, which decreases the pH of colon contents.


Constipation; to prevent and treat hepatic encephalopathy, including hepatic encephalopathy, including hepatic precoma and coma in patients with severe hepatic disease.

Adverse Reactions

Common: abdominal cramps, belching, diarrhea, gaseous distension, flatulencE

Uncommon: nausea, vomiting

Nursing Considerations

  • use cautiously in patients with diabetes mellitus
  • to minimize sweet taste, dilute with water or fruit juice or give with food
  • Monitor serum sodium level for possible hypernatremia, especially when giving in higher doses to treat hepatic encephalopathy.
  • be prepared to replace fluid loss
  • Store at room temperature, preferably below 86˚F (30˚C). Don’t freeze.


Generic Name Isophane Insulin

Classification Antidiabetic drugs


Increase glucose transport across muscle and fat cell membranes to reduce blood glucose level. Promotes conversion of glucose to its storage form, glycogen; triggers amino acid uptake and conversion to protein in muscle cells and inhibits protein degradation; stimulates triglyceride formation and inhibits r3elease of free fatty acids from adipose tissue; and stimulates lipoprotein lipase activity, which converts circulating lipoproteins to fatty acids.


Diabetic ketoacidosis, Type I diabetes, adjunct to type II diabetes inadequately controlled by diet and oral antidiabetic agents.

Adverse Reactions

Common: lipoatrophy, lipohypertrophy

Uncommon: urticaria, pruritus, swelling, redness, stinging, warmth at injection site, hypersensitivity reactions

Life-threatening: anaphylaxis, hypoglycemia

Nursing Considerations

  • Dosage is always expressed in USP units. remember to use only the syringes calibrated for the particular concentration of insulin administered
  • Be aware that some patients may develop insulin resistance and require large insulin doses to control symptoms of diabetes.
  • To mix insulin suspension, swirl vial gently or rotate between palms or between palm and thigh. don’t shake vigorously: this causes bubbling and air in syringe
  • Know that lente, semilente, and ultralente insulins may be mixed in any proportion. Regular insulin may be mixed with NPH or lente insulins in any proportion. When mixing regular insulin with intermediate or long acting insulin, always draw up regular insulin into syringe first.
  • Note that switching from separate injections to a prepared mixture may alter patient response. Whenever NPH or lente in mixed with regular insulin in the same syringe, give it immediately to avoid loss of potency.
  • don’t use insulin that changes color or becomes clumped or granular in appearance
  • check expiration date on vial before using contents
  • Know that usual administration route is SC. for proper SC administration, remember to pinch a fold of skin with the fingers at least 3 inches apart, and insert at a 45- to 90-degree angle, depending on the type of syringe.
  • Press but do not rub site after injection. Rotate injection sites and chart to avoid overuse of one area. Know that diabetic patients may achieve better control if injection site is rotated within same anatomic region.
  • Store insulin in cool area. Refrigeration is desirable but not essential, except with regular insulin concentrated.


Classification Fluoroquinolones


Mild to moderate urinary tract infection caused by E. coli, K. pneunomiae, E. cloacae, serratia marcesens, P. mirabilis, Providencia rettgeri, M. morganii, C. diversus, C. freundii, P. aeruginosa, S. epidermidis, and Enterococcus faecalis.

Severe or complicated bone or joint infections; severe respiratory tract infections; severe skin and skin-structure infections.

Adverse reactions

Common: Diarrhea, rash, nausea

Uncommon:headache, restlessness, tremor, dizziness, fatigue, drowsiness, insomnia, depression, light-headedness, confusion, hallucination, paresthesia, vomiting, abdominal pain or discomfort, oral candidiasis, flatulence, constipation, arthralgia, joint or back pain, joint stiffness, neck or chest pain, photosensitivity

Nursing considerations

  • Use cautiously in patients with CNS disorders, such as severe cerebral arteriosclerosis or seizure disorders, and in those at risk for seizures
  • Obtain specimen for culture and sensitivity
  • Administer oral form 2 hours after a meal
  • Know that long-term therapy may result in overgrowth of organisms resistant to ciprofloxacin


Classification Hematinics


Provides elemental iron component in the formation of hemoglobin.


Iron deficiency

Adverse reaction

Common: nausea, constipation, black stools

Uncommon: epigastric pain, vomiting, diarrhea, anorexia; liquid forms may temporarily stain teeth

Nursing considerations

  • Use cautiously on long-term basis
  • Keep in mind that GI upset may be related to dose. Between-meal doses are preferable, but can be given with some foods, although absorption may be decreased. Enteric-coated products reduce GI upset but also reduce amount of iron absorbed
  • Be aware that oral iron may turn stools black. Although this unabsorbed iron is harmless, it could mask melenas.
  • Monitor hemoglobin and hematocrit levels and reticulocyte count during therapy, as ordered


Classification Vitamins and minerals


Stimulates collagen formation and tissue repair; involved in oxidation-reduction reactions.


Frank and subclinical scurvy; extensive burns, delayed fracture or wound healing, postoperative wound healing, severe febrile or chronic disease states. Prevention of Vitamin C deficiency in patients with poor nutritional habits or increased requirements. Potentiation of methenamine in urine acidification

Adverse reactions

Diarrhea, acid urine, oxaluria, renal calculi, discomfort at injection site

Nursing considerations

  • When giving for urine acidification, check urine pH to ensure efficacy
  • Stress proper nutritional habits to prevent recurrence of deficiency



Benzodiazepines are the largest and most frequently prescribed group of antianxiety agents. Exact mechanism unknown; may increase the inhibiting effect of gamma-aminobutyric acid (GABA) (inhibiting nerve impulse transmission) as well as other inhibitory transmitters by binding to specific benzodiazepine receptors in various areas of the CNS.


Treatment of anxiety. additionally, some benzodiazepines are used as hypnotics, anticonvulsants to prevent delirium tremors during alcohol withdrawal and as a djunctive therapy for relaxation of skeletal muscle spasms. Midazolam, a short-acting injectable form, is ued for preop sedation, relieving anxiety for short diagnostic, endoscopic procedures


CNS depressants (e.g. alcohol, barbiturates, narcotics) may increase CNS effects of benzodiazepines (e.g. sedation)

Side Effects

Drowsiness is the most common side effect, usually disappears with continued use. Dizziness, hypotension occur frequently.

Toxic Effects/Adverse Reactions

Incidence of toxicity is very low when antianxiety drugs are taken alone. Confusion, hypersensitivity reactions, headache, stupor, paradoxical excitement, nausea, vomiting, lood dyscrasias, jaundice (hepatic dysfunction) are rare effects. these vary according to individual drug IV administration may cuse respiratory depression, apnea.

Nursing Implication

  • Provide restful environment and measures for comfort
  • comply with federal narcotic laws regarding Schedule IV drugs
  • consider potential for abuse/dependence
  • For IV administration, have respiratory equipment available; keep patient recumbent
  • most antianxiety drugs should not be mixed with other drugs in a syringe
  • Monitor BP
  • Assess for therapeutic response (according to reason for use, e.g. seizure activity, anxiety, alcohol withdrawal) or paradoxical reactions
  • take safety precautions for drowsiness, dizziness

Patient Teaching

  • Avoid smoking; may interfere with drug action
  • do not drive or perform tasks requiring mental acuity until response to medication is controlled
  • consult physician before taking other medications
  • Do not take alcohol
  • Medication must not be stopped abruptly
  • Inform other physicians, dentist of drug therapy









Panic Disorder

PO; 0.75-4





Alcohol withdrawal


PO; 15-100




PO; 1.5-20




Alcohol withdrawal


PO; 15-60




Alcohol withdrawal


Muscle relaxant

PO; 4-40





PO; 2-4




PO; 30-120



Seizures consist of abnormal and excessive discharges from the brain. Anticonvulsants can prevent or reduce excessive discharge or neurons with seizure foci or decrease the spread of excitation from the seizure foci to normal neurons


Anticonvulsants are generally effective in the treatment of absence (petit ma) seizures (brief, abrupt loss of consciousness, some clonic motor acitivity rnaging from eyelid blinking to jerkin gof entire body), tonic clonic (grand mal) seizures (major convulsions, usually beginning with spasms of all body musculature, then clonis jerking, followed by depression of all central function), and complex partial seizures (confused behavior, impaired consciousness, bizarre generalized EEG activity). other types of seizures generally respond poorly to anticonvulsant therapy.


Drug interactions are extensive; any other medication administered should be carefully checked for interaction with anticonvulsants. teach patients never to take medication without consulting physician. effects are increased by CNS depressants, decreased with tricyclic antidepressants, phenothizine antipsychotics, anatacids.

Side effects

Drowsiness, sedation, mild dizziness, gingival hyperplasia, anorexia, nausea, vomiting, hyperglycemia, and glycosuria.

Toxic Effects/Adverse Effects

Visual disturbances, unusual excitement, confusion, skin disorders. Steven-Johnson syndrome (headache, skin lesiona with other symptoms), liver damage, hirsutism, blood dyscrasias, endlarge lymph glnads in the neck and under arms.

Nursing Implications

  • Status epilepticus is a life-threatening emergency that requires immediate IV medication (diazepam is the drug of choice)
  • Never mix parenteral solutions with other drugs or IV fluids – should be administered via slow IV push
  • when discontinued, gradual reduction is recommended.
  • provide protection against injury
  • Monitor BP, pulse, respirations, serum drug levels
  • assess neurologic status
  • Identify characteristics of seizures if they occu
Patient Teaching
  • Therapy is usually several years to life.
  • take with food or fluids to minimize GI irritation
  • Important to take as directed
  • Do not drive or engage in activities requiring mental acuity until physician approves (seizures and response to drug are controlled)
  • carry identification card/bracelet indicating anticonvulsant therapy









Complex partial, tonic-clonic, mixed, trigeminal neuralgia

Adults: 800-1200 mg/day

Children: 400-800 mg/day




Petit mal, akinetic, myoclonic, absence

Adults: 1.5-20 mg/day

Children: 0.01-0.2 mg/day




Partial Seizures

Adults: 7.5-9.0 mg/day

Children: 7.5-60 mg/day




Adjunctive therapy status epilepticus

Adults: PO; 4-40 mg/day

IV/IM: 5-30 mg

Children: PO: 3-10 mg/day

IV/IM 1-10 mg




Absence seizures

Children: 20 mg/kg/day




Partial seizures, Lennox-Gustaut syndrome

Adults: 1200-3600 mg/day

Children 14 yrs: 1200-3600 mg/day




Partial seizures

Adults: 900-1800 mg/day

Children >12 yrs: 900-1800 mg/day




Tonic-clonic, partial, status epilepticus

Adults: PO: 100-300 mg/day

IM/IV: 200-600 mg

Children: PO 3-5 mg/kg/day

IM/IV: 100-400 mg




Tonic-clonic, complex partial, autonomic seizures, status epilepticus

Adults: PO: 300-600 mg/day

IV: 150-250 mg

Status epilepticus: 15-18 mg/kg

Children: PO: 4-8 mg/kg/day

Status epilepticus: 10-15 mg/kg




Complex partial, akinetic, tonic-clonic

Adults: 0.75-2 Gm/day

Children: 10-25 mg/kg/day

Valproic acid




Absence, multiple seizure types

15-60 mg/kg/day