Common Drugs & Nursing Responsibilities

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Activated Charcoal
- antiflatulent/
antidote
- inactivates toxins and binds until excreted
- adverse Effects:
- N/V, black stool, constipation & diarrhea
- contraindicated to semiconsciousness, cyanide
poisoning, gag reflex depression, & ethanol
intoxication
- Nursing Considerations:
- assess LOC
- give after inducing vomiting unless vomiting is
contraindicated
- use laxative to promote elimination
- give through NGT if pt is unable to swallow
 Albuterol
bronchodilator, used in a nebulizer for asthma
patients
Typically a drop (0.5 mg) of albuterol is
suspended in saline and nebulized with oxygen.
 Aspirin
 NSAID
 Common AE: tinnitus, hearing loss, Nausea, GI bleeding,
leukopenia, thrombocytopenia, rashes & Reye’s syndrome
 Effect: may increase liver function test, decrease WBC &
platelet count
 Nursing considerations:
 don’t give w/ chicken pox or flu-like symptoms – increases the
risk of Reye’s syndrome
 If unable to swallow – give it by rectum (watch out for rectal
mucosal irritation or bleeding
 Stop aspirin 5-7 days prior to surgery
 Don’t give to patient who is allergic to tartazine dye
 Take w/ meals to reduce GI unpleasant reaction (best time 1 hr
after lunch or 1 hr pc)
 Don’t crush or chew
Atenolol
beta-blocker similar to metoprolol
Atropine
It is used for several purposes, including inducing the
heart to beat faster as well as an antidote
anticholinesterase insecticide poisoning like
organophosphate .
 It is sometimes used as a drug for patients with
severe asthma.
It can also be dripped into the eyes to produce dilation
of the pupil (although this is a different formulation).
Can also be used to dry up respiratory secretions
during procedures.
Nursing considerations:
 Watch for tachycardia – may lead to ventricular
fibrillation
 Use sunglasses – potential sensitivity to the sun
Budesonide
Anti-asthma
Stock: respule
AE: oral candidiasis, stomatitis, pharyngitis,
rhinnitis, repiratory tract infection
Nursing considerations:
○ If bronchospasm results after using shift to
bronchodilator
○ Use inhaler for those who have no effect on acute
asthma
○ Rinse mouth after using inhaler & spit out the water
to prevent developing oral candidiasis
 Captopril
Antihypertensive
Adverse Effect: Leukopenia, agranulocytosis,
pancytopenia, anemia & thrombocytopenia
Nursing Considerations:
○ Check WBC & differental count before treatment
every 2 wks for 3 months of therapy
○ Check BP at least ≥ 90/60 mmHg
○ Take 1 hr a.c. – GI tract may reduce absorption
○ Rise slowly – to prevent orthostatic hypotension
○ Report swelling of face – sign of Angioedema
Clopidogrel (Plavix)
Thrombolytic agent
AE: GI hemorrhage
Effect: decreases platelet count
Nursing consideration
○ Avoid activities that can cause trauma or bleeding
○ Taken with or without meals
Diazepam (Valium)
is a benzodiazepine that is used both as a
powerful sedative and as an anticonvulsant for
patients with seizures
use for alcohol withdrawal, cocaine toxicity, and
status epilepticus (i.e. uncontrolled seizures)
may produce respiratory depression.
Nursing consideration:
○ Do not drink alcohol or take other medications that
can make you tired or drowsy while you are taking
Valium.
○ Avoid taking Valium with meals, because food may
decrease the effect of Valium and delay the time it
takes to work in your body.
Digoxin
(a derivative of the Foxglove plant) is a cardiac drug –
Cardiac Glycoside
use to slow conduction through the heart, especially in
cases of atrial-fibrillation
As a side effect it can produce various dysrhythmias
including ventricular fibrillation and aystole, nausea &
vomiting, visual disturbances (yellow green halos
around light, blurred vision, light flashes, photophobia
& diplopia)
Need normal K+ serum levels to prevent toxicity (K+
binds to the same receptor of Digoxin)
Therapeutic level: 1-0.8 to 2ng/ml – should be
obtained at least 6-8 hrs after use
Antidote: Digibind
Nursing Checks:
○ Apical rate prior to administration
○ Hold for <60 beats/minute
○ Hold for change in rhythm

What to teach:
○ signs of toxicity
○ monitor for rate and rhythm
○ monitor for signs of hypokalemia – increase K
intake
○ Avoid using herbal meds:
 plantain & st. john’s wort – may decrease effectiveness of digoxin
 siberian ginseng - may increase toxicity
Diltiazem(Cardizem)
calcium channel blocker , antianginal
use to slow the heart down in patients with certain
types of tachycardias such as atrial fibrillation
Adverse Effect:
 Headache, fatigue, drwosiness, edema, N/V,
photosensitivity, rhinitis, dyspnea
Treatment for overdose: atropine for AV block &
vasopressor for hypoBP
Nursing Considerations:
 Assess fluid volume status
 Assess BP. PR, RR, ECG
 Monitor liver function tests; AST, ALT, bilirubin
 give with meals
 Dopamine
is a mild vasopressor agent,
Symphatomimetic drug
is administered IV to produce vasoconstriction
and raise a patient’s blood pressure, renal &
mesenteric vasodilation
Indication: treatment for heart failure & Increase
renal perfusion
Adverse Effects:
○ Headache, tachycardia, hypertension, angina, N/V,
diarrhea, extravasation, dyspnea
 Nursing Considerations:
○ Monitor ECG for dyspnea, ischemia during treatment
○ Monitor BP & PR
○ Check extravasation - change site q48hrs
○ Treatment for overdose: short acting A-blockers like
Phentolamine (dilates peripheral blood vessels &
lowering peripheral resistance)
• Epinephrine
– is a natural substance produced by the adrenal gland
(a.k.a. adrenaline)
– is used in emergencies to stimulate the heart or to
dilate the bronchial tree
– Other indication: Mydriatic during eye surgery to
control bleeding; and relief of Nasal & nasophrayngeal
decongestion
– It is also mixed with lidocaine to prolong lidocaine’s
effect and to control bleeding.
– Nursing considerations:
• Don’t exceed 5 days for topical nasal solution – rebound
congestion may occur after vasoconstriction subsides
• May administer through ET route
Furosemide (Lasix)
– is a loop diuretic, which is given IV or PO
– produce more urine, thus decreasing the BP.
– given to reduce the fluid overload in patients with
congestive heart failure (a.k.a. CHF) or hypertension.
– Common AE: increase urination, drowsiness,
sensitivity to sunlight, & increase thirst
– Nursing checks:
• BP ≥90/60 mmHG
• Urine output at least 30cc/hr
– Nursing considerations:
• Administer with foods to prevent GI upset
• Give in early day so that increased urinary will not disturb
sleep.
• measure fluid and weight to monitor fluid changes
• Increase K intake
• Heparin
– anticoagulant used to prevent blood from clotting
– It is used in patients suspected of having a myocardial
infarction and to prep the syringe for an arterial-blood-
gas for the same reason.
– Antidote: Protamine SO4
– Nursing Checks:
• Signs of bleeding
– Nursing Considerations:
• Use heparin lock needles to avoid repeated injections
• Give SC injection, avoid IM & massaging the site– may
cause hematoma formation
• Apply pressure
• Avoid contact sports or other activities that can cause
injury
Ketorolac (Toradol)
– a powerful NSAID, nonopioid analgesic
– Uses: severe headaches, musculo-skeletal pain,
kidney stones and inflammation
– Adverse Effects:
– Drowsiness, tinnitus, hearing loss, N/V, GI bleeding, taste
change, blood dyscrasia, Hematoria, cramps, dry mouth &
constipation
– Nursing Considerations:
– Monitor blood count during therapy
– Assess for GI bleeeding: sputum, emesis, stool
– Give 30 mins AC or 2 hrs PC
– Caution when driving
– Caution pt when using soft contact lenses, the drug may
cause eye burning sensation
Lactulose
Laxative, use for chronic constipation & portal-
systemic encephalopathy with heaptic disease
 Disaccharides that are not absorbed from the digestive tract. They are
thought to improve the generation of ammonia by bacteria, render the
ammonia inabsorbable by converting it to ammonium (NH4), and increase
transit of bowel content through the gut.
Adverse effects:
 N/V, anorexia, diarrhea, flatulence, distention belching, abdominal cramps

Nursing Considerations:
 Assess abdominal cramping , rectal bleeding, N/V – if these will
occur the drug may be discontinued by the prescriber
 Monitor blood ammonia level: 30-70 mg/100ml, monitor LOC
(increased LOC is the expected outcome for pt with hepatic
disease)
 Avoid for long-term use bowel tone may be lost
 If diarrhea occurs it indicates overdosage
 Lidocaine
2 uses:
- local anesthetic when injected subcutaneously (and it
can be used for a nerve block)
- antidysrhythmic drug when injected IV (used to treat
cardiac dysrhythmias).
Anesthetic preparations come in 2 forms: with
and without epinephrine.
The epinephrine is added to reduce absorption
and prolong the effect.
toxic dose when used as a local anesthetic:
- 5mg/kg for lidocaine without epi, and 7mg/kg with epi.
Lorazepam
Sedative
AE: drowsiness, sedation & decreases BP
Effect: Increases Liver function test
Nursing considerations:
○ Avoid alcohol & hazardous activities that requires
alertness
○ Instruct patient to avoid standing after taking the
drug
• Magnesium Sulfate
– Antiepiliptic, electrolyte, laxative
– Laxative – attract water and retains water in
the intestinal lumen and distend the bowel
to promote mass movement & relieve
constipation
– Usually given for eclamptic pt.
– Antidote: Ca Gluconate
– Nursing checks:
• Knee jerk reflex
• BP≥ 90/60mmHG
• RR≥ 16CPM
• Take ECG
• Serum K determination
Mannitol
– Osmotic diuretic
– Decreases intracranial pressure, thus
decreasing the pt’s BP
– Common AE: increased urination, GI upset, dry
mouth, headache, blurred vision
– Nursing considerations:
• Don’t’ expose solution to low temperature – crystallization may
occur
– If crystals are seen – arm the bottle in a hot water bath, then cool the
body temperature before adminstration

• Take BP before adminstration, withhold if BP ˂90/60mmhg

• Check urine output at least 30cc/hr
• Assess for difficulty of breathing, chest pain, and pain in the IV
site
Metoprolol
 Antihypertensive & antianginal
 beta-blocker
 use to slow down the heart and lower blood-pressure
 Common AE:
 Fluid retention and worsening heart failure, Fatigue, Hypotension,
Bradycardia or heart block , drowsiness
 Nursing Alert: are not typically used in asthmatics, as they
can induce bronchoconstriction
 Treatment for overdose: atropine – bradycardia, theophylline
– bronchospasm, glucose for hyperglycemia
 Nursing Considerations:
 Give with food to prevent GI upset
 Teach signs & symptoms of CHF
 Check BP & PR
 Hold if PR ˂ 60bpm, BP ˂90/60 mmHg
Metronidazole (Flagyl)
is an antibiotic used against anaerobic bacteria and
certain parasite ( Amebecide & Antiinfective)
Given to patient with hepoencephalopathy: the
rationale of their use was the fact that ammonia and other waste
products are generated and converted by intestinal bacteria, and killing of
these bacteria would reduce the generation of these waste products.
Adverse Effects:
 Sore throat, metallic taste, stomatitis, N/V, anorexia,
pseudomembranous colitis, darkened urine, nephrotoxicity, decreased
libido, bone marrow depression, leukopenia, vaginal drynes
Nursing considerations:
 Assess signs of infections
 Asses urine output – check for increased BUN & creatinine
 Instruct pt of metallic taste andt urine may turn dark
 Avoid alcohol when taking this drug because it makes their
stommach violently ill, may experience disulfiran (antabuse)
reactions
 Midazolam (Versed)
a very powerful short acting benzodiazepine type
of sedative
is used to sedate patients for painful procedures
(preoperative, endoscopic, intubation)
Adverse effect:
 Retrograde amnesia, hypotension, cardiac arrest,
N/V, respiratory depression, blurrred vision & loss of
balance
Nursing Considerations:
 Excessive dosing may produce respiration depression (when given i.v.)
or coma.
 Grapefruit foods can increase midazolam effect
 Monitor BP, PR, RR during IV – medical equipment should be nearby
 Don’t give rapid bolus for IV route
Morphine Sulfate
– a powerful opiate (derived from opium and similar
to heroin) that is used as a pain killer (i.e.
analgesic)
– Adverse Effects:
– drowsiness, confusion, euphoria, papitation,
bradycardia, cardiac arrest, hypoBP, blurred vision,
miosis, N/V, urinary retention, respiratory
depression and constipation
– Antidote: Naloxone (Narcan)
– Nursing Considerations:
• Check BP at least not less than 90/60 mmhg
• Check RR not > 12 CPM
• Check Urine output >30 cc/hr – Monitor I&O
• Monitor LOC
• Increase bulk & fluids in diet
• May be given by PCA pump in terminal illness
Naloxone (Narcan)
antidote to opioids such as heroin or morphine
It is very rapidly acting and competes with the
opioid at the opioid receptor.
Adverse effect:
Drowsiness, nervousness, ventricular
tachycardia, increase sytolic BP (high doses),
N/V, hyperpnea
Nursing considerations:
○ Assess cardiac status: tachycardia, hyperBP, ECG
○ Monitor LOC
○ Assess for signs of Opioids withdrawal: cramping,
hypertension, vomiting – these may occur 2 hrs
after administration
N-Acetylcysteine (Mucomyst)
Mucomyst is given in cases of acetaminophen
toxicity (e.g. Tylenol).
Adverse effects:
○ Drowsiness, hypotension, rhinorrhea, hepatotoxicity,
bronchospasm, chest tightness, stomatitis
Nursing Considerations:
○ Assess cough
○ Assess cardiac status
○ Frequent rinsing of mouth for dryness of oral cavity
 Nitroglycerin
Antianginal drug
Treats Hypertension, acute heart failure, & anginal
pain
Nursing Considerations:
 Abrupt stopping may cause sapsm of the artery
 Administer 1 tab SL q 5 mins. Maximum of 3 tablets
can be taken by the pt having anginal pain
 Tingling sensation w/ SL drug, hold tablet in cheek
 30mins-2hrs p.c. – swallow tablet don’t chew
 Rise slowly – prevent orthostatic hypotension
 Place in a Light protected – cool & dark container,
close tightly and remove cotton because it absorbs
the drug
If transdermal patch (Deponit) is used:
○ Remove the patch before defibrillation
because aluminum backing may damage the
puddle and cause burns
○ Apply in rotation & hairless site
Prednisone
is a corticosteroid that is given for asthma and
as an anti-inflammatory
A side effect of prolonged use is Cushing’s
syndrome and often you may see tremors.
Adverse Effects:
○ Depression, flushing, sweating, hypertension,
circulatory collapse, fungal infections, increased
IOP, nausea, thrombocytopenia, poor wound
healing, hyperglycemia, ecchymosis, osteoporosis
Nursing Considerations:
○ Monitor serum K, blood glucose, urine glucose –
may cause hypokalemia & hyperglycemia
○ Monitor weight daily: notify physicain wt gain ˃5 lbs
○ Monitor I&O: report for decreasing urinary output &
increasing edema
○ Monitor Bp: refer for chest pain
○ Monitor plasma cortisol level (138-635 mmol/L
measured at 8am
○ Assess adrenal functions – may suppress
hypothalamic, pituitary & adrenal
○ Assess infection, the drug masks inections
symptoms
○ May be given w/ food or milk to reduce GI
symptoms
○ Use emergency ID as steroid user
○ Don’t discontinue abruptly may cause adrenal crisis
Pilocarpine
is dripped into the eyes to produce constriction of
the pupil in patients with glaucoma
Phenobarbital
is a barbiturate
used either as a sedative and/or anticonvulsant
medication.
Adverse Effects:
○ Drowsiness, hangover headache, coma, N/V,
stevens-johnson syndrome & thrombophebitis
Nursing Considerations:
○ Assess mental status
○ Assess respiratory dysfunctions – hold drug if
RR˂10/min or pupils are dilated
○ Assess signs of drug toxicity:
 Hypotension, pulmonary constriction, cold & clammy skin,
cyanosis, coma, CNS depression
○ May crush or mix with food if difficulty of
swallong
○ Drug should be tapered before discontinuing
○ Bruising & bleeding indicates blood dyscrasias
○ Avoid driving & other activities that require
alertness
○ Overdose: Activated Charcoal
 Pentobarbital
Similar to phenobarbital but much faster
acting and with a duration of effect.
It is used as an anticonvulsant medication
and to treat severe alcohol withdrawal.
 Sodium Bicarbonate
The drug is given to correct Hyperkalemia,
metabolic acidosis with bicarbonate loss, hypoxic
lactic acidosis, as an antacid (symptomatic relief
of GI upset)
Nursing considerations:
○ Check serum K levels – risk of metabolic acidosis in
increase state of hypokalemia
○ Hook pt to cardiac monitor while administering the
drug
○ Chew oral tablet follow with water
○ don’t take 1-2 hrs in any drug may decrease the
effect
• Valproic Acid (Depakene)
– is used as an anticonvulsant medication
– It is not typically used in the emergency treatment
of seizures, but toxicity can often be seen with
seizure patients who have taken too much.
– Effect: may cause positive result of ketones
– Nursing considerations:
• Avoid withdrawing the drug immediately to prevent
worsening of seizure
• Take with foods
• Don’t not chew tablet form – may cause irritation of
the throat and mouth
• Don’t mix with carbonated beverages
Phenytoin (Dilantin)
is an anticonvulsant, antidysrhythmic
when administered too fast, it can induce
hypotension
Antidote: Acetylceisteine
Adverse Effects:
○ Drowsiness, confusion, suicidal tendencies,
hypotension, blurred vision, hepatitis, gingival
hyperplasia, anemia, stevens-Johnson syndrome

Nursing considerations:
○ Assess drug level: wait ≥1wk to determine the level
 Therapeutic level 7.5-20mcg/ml
 Toxic level 30-50 mcg/ml
 Assess mental status
 Assess beginning rash may lead to SJS
 Assess for blood dyscrasia: fever, sore, throat, bruising, rash,
jaundice, epistaxis
 Monitor for toxicity: bone marrow depression, N/V, CV collapse,
slurred speech & confusion
 Monitor liver function test: ALT & AST, Bilirubin
 Give with meals
 Tablet: can be crushed or chewed
 Don’t take antidiarrheal or antacid within 2-3 hrs of taking the
drug
 Avoid driving or other activities that require mental alertness
 Taper off dosage over several week
 Proper oral hygiene or visit dentist toutinly – gingival hyperplasia
Ranitidine
Antiulcer
Nursing considerations:
○ Assess abdominal pain, acute presence of blood in
emesis, stool or gastric aspirate
○ Take at bedtime for best effect
○ May be taken with or without meals
○ Avoid smoking – increase gastric acid secretions
Sucralfate
Antiulcer
AE: constipation, nausea, dry mouth and
indegistion
Nursing considerations:
○ Take 1 hr ac or empty stomach & at bedtime
○ Avoid smoking
○ Antacid my be used while taking sucralfate by 30
mins apart
Topiramate (Topamax)
Anticonvulsant
It is also indicated to prevent migraine headache
Effect: Sleepiness or concentration problems
Nursing considerations:
○ Caution in hot weather – may cause oligohydrosis
or hyperthermia
○ Increase oral fluid to prevent of forming kidney
stones
○ Don’t break or crush – casue bitter taste, swallow
immediately without chewing
 Vancomycin
antibiotic, used for highly resistant bacteria
It is fairly toxic to the patient, and often is a drug
of choice to a septic, shocky patient.
Adverse Effects:
○ Cardiac Arrest, ototoxicity, permanent deafness,
tinnitus, nephrotoxicity, increased BUN & creatinine,
wheezing & dyspnea, leukopenia, neutropenia,
anaphylaxis
Nursing Considerations:
○ Report hematuria
○ Report compromise renal system – drug is slowly
excreted in the renal system
○ if pt experience ringing or roaring ear, the drug
should be discontued
○ Have adrenalin, suction, tracheostomy set,
endotracheal intubation equipment – anaphylaxis
may occur
50% Dextrose sol.
 Alternative: Glucagon
 Classification: Antihypoglycemic
 Indication:
To treat hypoglycemia that results either from
fasting or insulin use in a patient with diabetes
mellitus.
 The End!!!
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