MEDICATION CLASS MECHANISM OF DOSAGE RANGE SIDE EFFECTS NURSING

ACTION IMPLICATIONS/
TEACHING
PO (Adults): 5-10 mg Assessment
GENERIC NAME Inhibits the transport once daily; CNS: headache, Monitor blood pressure
Therapeutic: of calcium into antihypertensive in dizziness, fatigue. and pulse before therapy,
amlodipine myocardial and fragile or small CV: peripheral edema, during dose titration, and
antihypertensives
vascular smooth patients or patients angina, bradycardia, periodically during therapy.
TRADE NAME (S) muscle cells, resulting already receiving hypotension, palpitations. Monitor ECG periodically
Norvasc in inhibition of other during prolonged therapy.
excitation-contraction antihypertensives-- GI: gingival hyperplasia, Monitor intake and output
coupling and initiate at 2.5 mg/day, nausea. ratios and daily weight.
THERAPEUTIC subsequent increase as Derm: flushing. Assess for signs of CHF
EFFECT contraction. required/tolerated (up (peripheral edema,
to 10 mg/day) as an rales/crackles, dyspnea,
Drug/Drug:
antihypertensive weight gain, jugular venous
Systemic vasodilation Additive hypotension
therapy with 2.5 distention). .
resulting in decreased Condition For mg/day in patients may occur when used Angina: Assess location,
blood pressure. concurrently with
Which Med Is with hepatic duration, intensity, and
Coronary vasodilation fentanyl, other
Ordered For This insufficiency. precipitating factors of
resulting in decreased antihypertensives,
PO (Geriatric patient's anginal pain.
frequency and severity Patient. nitrates, acute ingestion
Patients):
of attacks of angina. Hypertension of alcohol, or quinidine.
Antihypertensive-- Advise patient to take
Initiate therapy at 2.5 Antihypertensive medication as directed,
mg/day, increase as effects may be ↓ by even if feeling well. Take
required/tolerated (up concurrent use of missed doses as soon as
to 10 mg/day); nonsteroidal anti- possible unless almost time
antianginal--initiate inflammatory agents. for next dose; do not double
therapy at 5 mg/day, May ↑ risk of doses. May need to be
increase as neurotoxicity with lithium. discontinued gradually.
required/tolerated (up Advise patient to avoid
to 10 mg/day). Drug-Food: large amounts (6-8 glasses
Grapefruit juice ↑ of grapefruit juice/day)
serum levels and effect. during therapy.
Instruct patient on correct
technique for monitoring
pulse. Instruct patient to
contact health care
professional if heart rate is
<50 bpm.
Caution patient to
change positions slowly to
minimize orthostatic
hypotension.
May cause drowsiness or
dizziness. Advise patient to
avoid driving or other
activities requiring alertness
until response to the
medication is known.
Instruct patient on
importance of maintaining
good dental hygiene and
seeing dentist frequently for
teeth cleaning to prevent
tenderness, bleeding, and
gingival hyperplasia (gum
enlargement).
Instruct patient to avoid
concurrent use of alcohol or
OTC medications,
especially cold
preparations, without
consulting health care
professional.
Advise patient to notify
health care professional if
irregular heartbeats,
dyspnea, swelling of hands
and feet, pronounced
dizziness, nausea,
constipation, or
hypotension occurs or if
headache is severe or
persistent.
Caution patient to wear
protective clothing and use
sunscreen to prevent
photosensitivity reactions.
Advise patient to inform
health care professional of
medication regimen before
treatment or surgery. .
Angina: Instruct patient
on concurrent nitrate or
beta-blocker therapy to
continue taking both
medications as directed
and to use SL nitroglycerin
as needed for anginal
attacks.
Advise patient to contact
health care professional if
chest pain does not
improve or worsens after
therapy, if it occurs with
diaphoresis, if shortness of
breath occurs, or if severe,
persistent headache
occurs.
Caution patient to
discuss exercise
restrictions with health care
professional before
exertion. .
Hypertension:
Encourage patient to
comply with other
interventions for
hypertension (weight
reduction, low-sodium diet,
smoking cessation,
moderation of alcohol
consumption, regular
exercise, and stress
management). Medication
controls but does not cure
hypertension.
 Instruct patient and
family in proper technique
for monitoring blood
pressure. Advise patient to
take blood pressure weekly
and to report significant
changes to health care
professional.
 MEDICATION
GENERIC NAME
Therapeutic: anti-
donepezil
Alzheimer's agents
TRADE NAME (S)
Aricept, Aricept
ODT
THERAPEUTIC
EFFECT
May temporarily
lessen some of the
dementia associated
with Alzheimer's
disease. Enhances
cognition. Does not
cure the disease.
CLASS MECHANISM OF DOSAGE RANGE SIDE EFFECTS
ACTION
Mild to Moderate
Inhibits Alzheiner's Disease CNS: headache,
acetylcholinesterase PO (Adults): 5 mg abnormal dreams,
thus improving once daily; after 4-6 depression, dizziness,
cholinergic function by wk may increase to 10 drowsiness, fatigue,
making more mg once daily (dose insomnia, syncope,
acetylcholine available. should not exceed 5 sedation (unusual).
mg/day in frail, elderly CV: atrial fibrillation,
females). hypertension,
hypotension, vasodilation.
Condition For Severe Alzheimer's
Which Med Is Disease GI: diarrhea, nausea,
Ordered For This PO (Adults): 10 mg anorexia, vomiting,
once daily (dose weight gain (unusual).
Patient. should not exceed 10 GU: frequent urination.
Alzheimer’s Disease mg/day). Derm: ecchymoses.
Metab: hot flashes,
weight loss.
MS: arthritis, muscle
cramps.
Drug/Drug:
Exaggerates muscle
relaxation from
succinylcholine.
Interferes with the
action of
anticholinergics.
↑ cholinergic effects of
bethanechol.
May ↑ risk of GI
bleeding from NSAIDs.
Quinidine and
ketoconazole ↓
NURSING
IMPLICATIONS/
TEACHING
Assess cognitive function
(memory, attention,
reasoning, language, ability
to perform simple tasks)
periodically during therapy.
Administer Mini-Mental
Status Exam (MMSE)
initially and periodically as a
screening tool to rate
cognitive functioning.
Administer Clock
Drawing Test initially and
periodically as a screening
tool to measure severity of
dementia.
Monitor heart rate
periodically during therapy.
May cause bradycardia.
Emphasize the
importance of taking
donepezil daily, as directed.
Missed doses should be
skipped and regular
schedule returned to the
following day. Do not take
more than prescribed;
higher doses do not
increase effects but may
increase side effects.
Inform patient/family that
it may take weeks before
improvement in baseline
behavior is observed.
Caution patient and
metabolism of donepezil. caregiver that donepezil
Rifampin, may cause dizziness.
carbamazepine, Advise patient and
dexamethasone, caregiver to notify health
phenobarbital, and care professional if nausea,
phenytoin induce the vomiting, diarrhea, or
enzymes that metabolize changes in color of stool
donepezil and may ↓ its occur or if new symptoms
effects. occur or previously noted
Drug-Natural: Jimson symptoms increase in
weed and scopolia may severity.
antagonize cholinergic Advise patient and
effects. caregiver to notify health
care professional of
medication regimen before
treatment or surgery.
Emphasize the
importance of follow-up
exams to monitor progress;
atypical antipsychotics may
be used as an adjunct to
improve behavior.
 MEDICATION CLASS MECHANISM OF DOSAGE RANGE
ACTION
Binds to an enzyme PO (Adults):
GENERIC NAME on gastric parietal cells GERD/erosive
Therapeutic: in the presence of esophagitis--20 mg
Omeprazole acidic gastric pH, once daily.Duodenal
antiulcer agents
preventing the final ulcers associated with
TRADE NAME (S) transport of hydrogen H. pylori--40 mg daily
ions into the gastric in the morning with
Losec, Prilosec, lumen. clarithromycin for 2
Prilosec OTC, wk, then 20 mg once
daily for 2 wk or 20 mg
Zegerid
twice daily with
Condition For clarithromycin 500 mg
THERAPEUTIC Which Med Is twice daily and
EFFECT Ordered For This amoxicillin 1000 mg
twice daily for 10 days
Patient.
(if ulcer is present at
Diminished GERD
beginning of therapy,
accumulation of acid in
continue omeprazole
the gastric lumen with
20 mg daily for 18
lessened
more days); has also
gastroesophageal
been used with
reflux. Healing of
clarithromycin and
duodenal ulcers.
metronidazole. Gastric
ulcer--40 mg once
daily for 4-6 wk.
Reduction of the risk
of GI bleeding in
critically ill patients--40
mg initially, then
another 40 mg 6-8 hr
later, followed by 40
mg once daily for up to
14 days.Gastric
hypersecretory
conditions--60 mg
SIDE EFFECTS NURSING
IMPLICATIONS/
TEACHING
Assessment
CNS: dizziness, Assess patient routinely
drowsiness, fatigue, for epigastric or abdominal
headache, weakness. pain and frank or occult
CV: chest pain. blood in the stool, emesis,
GI: abdominal pain, acid or gastric aspirate.
regurgitation, Lab Test
constipation, diarrhea, Considerations: Monitor
flatulence, nausea, CBC with differential
vomiting. periodically during therapy.
Derm: itching, rash. May cause ↑ AST, ALT,
Misc: allergic reactions. alkaline phosphatase, and
bilirubin.
May cause serum gastrin
Drug/Drug:
concentrations to ↑ during
Omeprazole is
first 1-2 wk of therapy.
metabolized by the
Levels return to normal
CYP450 enzyme system
after discontinuation of
and may compete with
omeprazole.
other agents metabolized
Monitor INR and
by this system.
prothrombin time in patients
↓ metabolism and may
taking warfarin.
↑ effects of Rx antifungal
agents,atazanavirdiazep
Instruct patient to take
am, digoxin,
medication as directed for
flurazepam, triazolam,
the full course of therapy,
cyclosporine,
even if feeling better. Take
disulfiram, phenytoin,
missed doses as soon as
tacroilimus, and
remembered but not if
warfarin.
almost time for next dose.
May interfere with
Do not double doses.
absorption of drugs
May cause occasional
requiring acidic gastric
drowsiness or dizziness.
pH, including esters of
Caution patient to avoid
ampicillin, iron salts,
driving or other activities
once daily initially; digoxin, requiring alertness until
may be increased up cyanocobalamine, and response to medication is
to 120 mg 3 times ketoconazole. known.
daily (doses >80 Has been used safely Advise patient to consult
mg/day should be with antacids. health care professional
given in divided May ↑ risk of bleeding before taking any Rx, OTC,
doses); OTC-- 20 mg with warfarin (monitor or herbal products with
once daily for up to 14 INR/PT). omeprazole.
days. Advise patient to avoid
PO (Children >2 yr alcohol, products containing
and <20 kg): 10 mg aspirin or NSAIDs, and
once daily. foods that may cause an
PO (Children >2 yr increase in GI irritation.
and ≥20 kg): 20 mg Advise patient to report
once daily. onset of black, tarry stools;
PO (Children): diarrhea; abdominal pain;
Alternative dosing--1 or persistent headache to
mg/kg/day given once health care professional
or divided twice daily promptly.
(range of doses in the
literature: 0.2-3.5
mg/kg/day);
Adjunctive therapy of
duodenal ulcers
associated with H.
pylori--15-30 kg: 10
mg BID; >30 kg: 20
mg BID.
 MEDICATION CLASS MECHANISM OF DOSAGE RANGE SIDE EFFECTS NURSING
ACTION IMPLICATIONS/
TEACHING
Inhibits platelet Recent MI, Stroke, or Assessment
GENERIC NAME aggregation by Peripheral Vascular Incidence of adverse Assess patient for
Therapeutic: irreversibly inhibiting Disease reactions similar to that of symptoms of stroke,
Clopidogrel the binding of ATP to PO (Adults): 75 mg aspirin peripheral vascular
antiplatelet agents
platelet receptors. once daily. CNS: depression, disease, or MI periodically
TRADE NAME (S) dizziness, fatigue, during therapy.
Condition For Acute Coronary headache. Monitor patient for signs
Plavix Syndrome EENT: epistaxis. of thrombotic thrombocytic
Which Med Is PO (Adults): 300 mg Resp: cough, dyspnea. purpura (thrombocytopenia,
Ordered For This initially, then 75 mg CV: chest pain, edema, microangiopathic hemolytic
THERAPEUTIC once daily; aspirin 75- hypertension. anemia, neurologic
Patient.
EFFECT 325 mg once daily GI: GI BLEEDING, findings, renal dysfunction,
PVD (Peripheral should be given abdominal pain, diarrhea, fever). May rarely occur,
Vascular Disease) concurrently. dyspepsia, gastritis. even after short exposure
Decreased occurrence
of atherosclerotic Derm: pruritus, purpura, (<2 wk). Requires prompt
events in patients at rash. treatment.
risk. Hemat: BLEEDING, Lab Test
NEUTROPENIA, Considerations: Monitor
THROMBOTIC bleeding time during
THROMBOCYTOPENIC therapy. Prolonged
PURPURA. Metab: bleeding time, which is
hypercholesterolemia. time- and dose-dependent,
MS: arthralgia, back pain. is expected.
Monitor CBC with
Misc: fever, differential and platelet
hypersensitivity reactions. count periodically during
therapy. Neutropenia and
thrombocytopenia may
Drug/Drug:
rarely occur.
Concurrent
May cause ↑ serum
abciximab, eptifibatide,
bilirubin, hepatic enzymes,
tirofiban, aspirin,
total cholesterol, nonprotein
NSAIDs, heparin,
nitrogen (NPN), and uric
heparanoids,
acid concentrations.
thrombolytic agents,
Instruct patient to take
ticlopidine, or warfarin medication exactly as
may ↑ risk of bleeding. directed. Take missed
May ↓ metabolism and doses as soon as possible
↑ effects of phenytoin, unless almost time for next
tolbutamide, tamoxifen, dose; do not double doses.
torsemide, fluvastatin, Advise patient to notify
and many NSAIDs. health care professional
Drug-Natural: ↑ promptly if fever, chills, sore
bleeding risk with anise, throat, or unusual bleeding
arnica, chamomile, or bruising occurs.
clove, fenugreek, Advise patient to notify
feverfew, garlic, ginger, health care professional of
ginkgo, Panax ginseng, medication regimen prior to
and others. treatment or surgery.
Instruct patient to avoid
taking OTC medications
containing aspirin or
NSAIDs without consulting
health care professional.
 MEDICATION CLASS MECHANISM OF DOSAGE RANGE SIDE EFFECTS NURSING
ACTION IMPLICATIONS/
TEACHING
Children ≤12 yr should Assessment
GENERIC NAME Therapeutic: Inhibits the not receive >5 GI: HEPATIC FAILURE, Assess overall health
antipyretics, doses/24 hr without HEPATOTOXICITY(OVE status and alcohol usage
Acetaminophen synthesis of
nonopioid analgesics notifying physician or RDOSE). before administering
prostaglandins that
other health care GU: renal failure (high acetaminophen. Patients
may serve as
TRADE NAME (S) professional. doses/chronic use). who are malnourished or
mediators of pain
Hemat: neutropenia, chronically abuse alcohol
and fever, primarily
Tylenol PO (Adults and pancytopenia, are at higher risk of
in the CNS.
Children > 12 yr): leukopenia. Derm: rash, developing hepatotoxicity
Has no significant
325-650 mg q 4-6 hr urticaria. with chronic use of usual
THERAPEUTIC anti-inflammatory or 1 g 3-4 times daily doses of this drug.
EFFECT properties or GI or 1300 mg q 8 hr (not Assess amount,
toxicity. Drug/Drug:
to exceed 4 g or 2.5 frequency, and type of
Chronic high-dose
Analgesia. Antipyresis g/24 hr in patients with drugs taken in patients self-
acetaminophen (>2
hepatic/renal medicating, especially with
g/day) may ↑ risk of
impairment). OTC drugs. Prolonged use
bleeding with warfarin
Condition For PO (Children 1-12 of acetaminophen
(PT should be monitored
yr): 10-15 mg/kg/dose increases the risk of
Which Med Is regularly and INR should
q 4-6 hr as needed adverse renal effects. For
not exceed 4).
Ordered For This (not to exceed 5 short-term use, combined
Hepatotoxicity is
doses/24 hr). doses of acetaminophen
Patient. additive with other
PO (Infants): 10-15 and salicylates should not
Pain, as needed. hepatotoxic
mg/kg/dose q 4-6 hr exceed the recommended
substances, including
as needed (not to dose of either drug given
alcohol.
exceed 5 doses/24 alone. .
Concurrent use of
hr). Pain: Assess type,
sulfinpyrazone,
PO (Neonates): 10-15 location, and intensity prior
isoniazid, rifampin,
mg/kg/dose q 6-8 hr to and 30-60 min following
rifabutin, phenytoin,
as needed. administration.
barbiturates, and
Rect (Adults and Fever: Assess fever;
carbamazepine may ↑
Children > 12 yr): note presence of
the risk of
325-650 mg q 4-6 hr associated signs
acetaminophen-induced
as needed or 1 g 3-4 (diaphoresis, tachycardia,
liver damage (limit self-
times/day (not to and malaise).
medication); these agents
exceed 4 g/24 hr). Lab Test
Rect (Children 1-12 will also ↓ therapeutic Considerations: Evaluate
yr): 10-20 mg/kg/dose effects of acetaminophen. hepatic, hematologic, and
q 4-6 hr as needed. renal function periodically
Rect (Infants): 10-20 Concurrent NSAIDs ↑ during prolonged, high-
mg/kg/dose q 4-6 hr the risk of adverse renal dose therapy.
as needed. effects (avoid chronic May alter results of blood
Rect (Neonates): 10- concurrent use). glucose monitoring. May
15 mg/kg/dose q 6-8 Propranolol ↓ cause falsely ↓ values when
hr as needed. metabolism and may ↑ measured with glucose
effects. oxidase/peroxidase
May ↓ effects of method, but probably not
lamotrigine and with hexokinase/G6PD
zidovudine. method. May also cause
falsely ↑ values with certain
instruments; see
manufacturer's instruction
manual.
Increased serum
bilirubin, LDH, AST, ALT,
and prothrombin time may
indicate hepatotoxicity. .
Toxicity and Overdose:
If overdose occurs,
acetylcysteine (Acetadote)
is the antidote.

Advise patient to take

medication exactly as
directed and not to take
more than the
recommended amount.
Chronic excessive use of >
4 g/day (2 g in chronic
alcoholics) may lead to
hepatotoxicity, renal or
cardiac damage. Adults
should not take
acetaminophen longer than
10 days and children not
longer than 5 days unless
directed by health care
professional. Short-term
doses of acetaminophen
with salicylates or NSAIDs
should not exceed the
recommended daily dose of
either drug alone.
Advise patient to avoid
alcohol (3 or more glasses
per day increase the risk of
liver damage) if taking more
than an occasional 1-2
doses and to avoid taking
concurrently with salicylates
or NSAIDs for more than a
few days, unless directed
by health care professional.

Pedi: Advise parents or

caregivers to check
concentrations of liquid
preparations. Errors have
resulted in serious liver
damage. Have parents or
caregivers determine the
correct formulation and
dose for their child (based
on the child's age/weight),
and demonstrate how to
measure it using an
appropriate measuring
device.
Inform patients with
diabetes that
acetaminophen may alter
results of blood glucose
monitoring. Advise patient
to notify health care
professional if changes are
noted.
 Caution patient to check
labels on all OTC products.
Advise patients to avoid
taking more than one
product containing
acetaminophen at a time to
prevent toxicity.
Advise patient to consult
health care professional if
discomfort or fever is not
relieved by routine doses of
this drug or if fever is
greater than 39.5°C (103°F)
or lasts longer than 3 days.