DRUG NAME MECHANISM OF INDICATION / SIDE EFFECTS/ NURSING RESPONSIBILITIES

ACTION CONTRAINDICATION ADVERSE EFFECT

GENERIC: Blocks angiotensin II from INDICATIONs: SIDE EFFECTS: BEFORE:

TELMISARTAN binding to receptor sites in  To manage Occasional (7%–3%): Dx.
many tissues, including hypertension, alone or Upper respiratory tract a) Assessed history of hypersensitivity to telmisartan
BRAND: vascular smooth muscle and with other infection, sinusitis, b) Assessed onset, type, location and duration of pain.
MICARDIS adrenal glands. This action antihypertensives back/leg pain, diarrhea. c) Obtain B/P, apical pulse immediately before each dose
inhibits the vasoconstrictive  To reduce risk of MI, Rare (1%): Dizziness, Tx.
CLASS: and aldosterone-secreting stroke, or death from headache, fatigue, nausea, a) Perform a thorough physical assessment to establish baseline
effects of angiotensin cardiovascular causes in heartburn, myalgia, cough, data before drug therapy begins, to determine the
THERAPEUTIC II, which reduces blood patients at high risk who peripheral edema. effectiveness of therapy, and to evaluate for the occurrence of
pressure. are unable to take ACE any adverse effects associated with drug therapy.
ANTIHYPERTENSIVE  Causes vasodilation, Inhibitors ADVERSE EFFECT b) Periodically assess dose.
decreases peripheral CNS: dizziness, headache, c) Monitor B/P, pulse, serum electrolytes, renal function.
PHARMACOLOGIC: resistance, decreases B/P. CONTRAINDICATION: fatigue
ANGIOTENSIN II Concurrent aliskiren therapy CV: chest pain, peripheral DURING:
RECEPTOR SOURCE: in patients with diabetes or edema, Dx:
ANTAGONIST Jones & Bartlett Learning., renal impairment (GFR less hypertension, intermittent a) Know that drug may be used alone or with other
& Jones & Bartlett than 60 ml/min.), claudication antihypertensives.
DOSAGE: Publishers. (2000). Nurse's hypersensitivity to EENT: sinusitis, b) Monitor mood changes.
80mg OD drug handbook. Sudbury, telmisartan or its components pharyngitis c) Monitor for hypotension when initiating therapy.
MA: Jones and Bartlett GI: nausea, vomiting,
ROUTE: Publishers. DRUG TO DRUG diarrhea, dyspepsia,
PO INTERACTION: abdominal pain Tx.
DRUG: NSAIDs (e.g., GU: urinary tract infection a) Don’t remove tablet from blister pack until just before giving.
ibuprofen, ketorolac, Musculoskeletal: myalgia, b) Administered medication.
naproxen) may decrease back and leg c) Notified physician of any significant changes.
antihypertensive effect. May pain Edx.
increase digoxin Respiratory: cough, upper a) Educate client on drug therapy to promote understanding and
concentration, risk of respiratory compliance.
toxicity. infection b) Instruct patient to verbalize feelings and concerns.
HERBAL: Ephedra, ginger, Skin: ulcer
 licorice, ginseng, yohimbe Other: pain, flu or flulike AFTER:
may worsen hypertension. symptoms, Dx.
Black cohosh, periwinkle hypersensitivity a) Observed patient for side effects.
may increase b) Assessed for therapeutic response: relief of pain, stiffness,
antihypertensive effect. swelling; increased joint mobility; reduced joint tenderness;
and improved grip strength.
DRUG TO FOOD c) Assessed for signs and symptoms of hypersensitivity.
INTERACTION:
None known. Tx.
a) In case of hypersensitivity, be sure that emergency equipment
is available.
b) Provide safety measures (e.g. adequate lighting, raised side
rails, etc.) to prevent injuries.
c) Provide comfort measures (e.g. voiding before dosing, taking
food with drug, etc.) to help patient tolerate drug effects.

Edx.
a. Instructed to avoid tasks that require alertness, and motor
skills until response to drug is established.
b. Instructed patient to increase water intake.
c. Emphasized to report any signs of itching, swelling in the
ankles, sore throat, easy bruising, etc.

DRUG NAME MECHANISM OF INDICATION / SIDE EFFECTS/ NURSING RESPONSIBILITIES

ACTION CONTRAINDICATION ADVERSE EFFECT

GENERIC: Blocks stimulation of beta1 INDICATIONs: SIDE EFFECTS BEFORE:

METROPOLOL (myocardial)  Hypertension Frequent: Diminished Dx.
adrenergic receptors, usually  Angina Pectoris sexual function, a) Checked BP for hypotension, pulse for bradycardia
BRAND: without affecting beta2  HF drowsiness, insomnia, immediately before giving medication.
TOPROL-XL (pulmonary, vascular, uterine)  Early Treatment of MI unusual fatigue/weakness. b) Checked history of hypersensitivity to metropolol.
CLASS: adrenergic receptor sites
CONTRAINDICATION:
THERAPEUTIC SOURCE:  Sinus bradycardia, heart
Jones & Bartlett Learning., block greater than first
ANTIHYPERTENSIVE, & Jones & Bartlett degree, cardiogenic
ANTIANGINAL Publishers. (2000). Nurse's shock, overt cardiac
drug handbook. Sudbury, failure (with Lopressor
PHARMACOLOGIC: MA: Jones and Bartlett used for hypertension or
BETA-ADRENERGIC Publishers. angina)
BLOCKER  Heart rate below 45
(SELECTIVE) beats/minute, second- or
third-degree heart block,
DOSAGE: significant first-degree
100mg OD heart block; systolic
pressure below 100 mm
ROUTE: Hg; or moderate-to-
PO severe cardiac failure
(when Lopressor is used
for MI)
 Hypersensitivity to drug
or its components
DRUG TO DRUG
INTERACTION:
Amphetamines, ephedrine,
epinephrine, norepinephrine,
phenylephrine,
pseudoephedrine: unopposed
alpha-adrenergic stimulation
(excessive hypertension,
bradycardia)
Antihypertensives, nitrates:
additive
hypotension
Digoxin: additive
Occasional: Anxiety,
diarrhea, constipation,
nausea, vomiting, nasal
congestion, abdominal
discomfort, dizziness,
difficulty breathing, cold
hands/feet.
Rare: Altered taste, dry
eyes, nightmares,
paresthesia, allergic
reaction (rash, pruritus).
ADVERSE EFFECT
CNS: fatigue, weakness,
anxiety,
depression, dizziness,
drowsiness,
insomnia, memory loss,
mental status
changes, nervousness,
nightmares
CV: orthostatic
hypotension, peripheral
vasoconstriction,
bradycardia,
heart failure, pulmonary
edema
EENT: blurred vision,
stuffy nose
GI: nausea, vomiting,
constipation,
diarrhea, flatulence, gastric
pain, heartburn,
dry mouth
GU: urinary frequency,
c) Questioned for history of allergies
Tx.
a) Perform a thorough physical assessment to establish baseline
data before drug therapy begins, to determine the
effectiveness of therapy, and to evaluate for the occurrence of
any adverse effects associated with drug therapy.
b) Perform culture and sensitivity tests at the site of infection to
ensure appropriate use of the drug.
c) Periodically assess dose.
Edx.
a) Educated client on drug therapy.
b) Ensured the patient takes drug as prescribed by physician.
c) Instructed to avoid, if possible, concurrent use of
neuromuscular blocking agents.
DURING:
Dx:
a) Assess for evidence of HF: dyspnea (esp. on exertion, lying
down), night cough, peripheral edema, distended neck veins.
b) Monitor I&O (increased weight, decreased urinary output
may indicate HF).
c) Monitor for adverse effects (e.g. sedation, dizziness,
respiratory dysfunctions, GU problems, etc)..
Tx.
a) Positioned client for proper administration.
b) Give metoprolol tartrate with or immediately after meals,
because food enhances its absorption.
c) Assist from lying to standing slowly.
Edx.
a) Caution patient to avoid driving and other hazardous
activities until drug effects are known.
b) Educate client on drug therapy to promote understanding and
compliance.
c) Instruct patient to verbalize feelings and concerns.
 bradycardia Dobutamine, erectile dysfunction, AFTER:
dopamine: reduced decreased libido Dx.
cardiovascular Hepatic: hepatitis a) Observed patient for side/adverse effects.
benefits of these drugs Metabolic: b) Assessed daily pattern of bowel activity, stool consistency
General anesthestics, hyperglycemia, c) Monitored daily pattern of bowel activity, stool consistency.
phenytoin (I.V.), hypoglycemia
verapamil: additive Respiratory: wheezing, Tx.
myocardial bronchospasm a) Provide safety measures (e.g. adequate lighting, raised side
depression Musculoskeletal: back rails, etc.) to prevent injuries.
Insulin, oral hypoglycemics: pain, joint pain b) Provide comfort measures (e.g. voiding before dosing, taking
altered efficacy Skin: rash food with drug, etc.) to help patient tolerate drug effects.
of these drugs Other: drug-induced lupus
MAO inhibitors: syndrome
hypertension
Edx.
DRUG TO FOOD a. Instructed to continue therapy for full length of treatment.
INTERACTION: b. Advise patient with heart failure to report signs or symptoms
Any food: enhanced drug of worsening condition, including weight gain and increasing
absorption shortness of breath.
c. When discontinuing drug, reduce dosage gradually over 1 to
2 weeks.

DRUG NAME MECHANISM OF INDICATION / SIDE EFFECTS/ NURSING RESPONSIBILITIES

ACTION CONTRAINDICATION ADVERSE EFFECT

GENERIC: Inhibits the enzyme DNA INDICATIONs: SIDE EFFECTS BEFORE:

LEVOFLOXACIN gyrase in susceptible gram- Treatment of susceptible Occasional (3%–1%): Dx.
negative and grampositive infections due to S. Diarrhea, nausea, a) Question for hypersensitivity to levoFLOXacin, other
BRAND: aerobic and anaerobic pneumoniae, S. aureus, E. abdominal pain, dizziness, fluoroquinolones.
IQUIX, bacteria, interfering with faecalis, drowsiness, headache. b) Receive full medication history, and screen for
LEVAQUIN, NOVO, bacterial DNA synthesis. H. influenzae, M. catarrhalis, Rare (less interactions, esp. medications that prolong QT interval.
LEVOFLOXACIN_, Serratia marcescens, K. than 1%): Flatulence; c) Obtain baseline EKG.
OFTAQUIX , QUIXIN, pneumoniae, E. coli, P. pain, inflammation,
TAVANIC SOURCE: mirabilis, P. aeruginosa, C.
Jones & Bartlett Learning., pneumoniae, Legionella
CLASS: & Jones & Bartlett pneumophila, Mycoplasma
Publishers. (2000). Nurse's pneumoniae, including acute
THERAPEUTIC drug handbook. Sudbury, bacterial exacerbation of
ANTI-INFECTIVE MA: Jones and Bartlett chronic bronchitis, acute
Publishers. bacterial sinusitis,
community-acquired
PHARMACOLOGIC: pneumonia, nosocomial
pneumonia, complicated and
FLUOROQUINOLONE uncomplicated UTI, acute
pyelonephritis, complicated
DOSAGE: and uncomplicated mild to
500 mg OD moderate skin/skin structure
infections, prostatitis.
ROUTE: Inhalation anthrax
PARENTERAL (postexposure); plague.
CONTRAINDICATION:
Hypersensitivity to
levofloxacin, other
fluoroquinolones, or their
components; myasthenia
gravis
DRUG TO DRUG
INTERACTION:
containing
antacids; didanosine; iron;
sucralfate; zinc: Reduced GI
absorption of levofloxacin
antineoplastics: Decreased
blood levofloxacin level
cimetidine: Increased blood
levofloxacin level
cyclosporine: Increased risk
swelling in calves, hands, Tx.
shoulder; a) Expect to obtain culture and sensitivity tests before
chest pain, difficulty levofloxacin treatment begins. Performed proper hand-
breathing, palpitations, washing and aseptic technique.
edema, tendon pain. b) Avoid giving drug within 2 hours of antacids.
c) Check vital signs, especially blood pressure. Too-rapid
ADVERSE EFFECT infusion can cause hypotension.
CNS: dizziness, headache,
insomnia, Edx.
seizures a) Instruct patient not to take with milk, yogurt,multivitamins
CV: chest pain, containing zinc or iron, or antacids containing aluminum
palpitations, or magnesium.
hypotension
EENT: photophobia, DURING:
sinusitis, Dx:
pharyngitis a) Monitor for muscle weakness, voice dystonia in pts with
GI: nausea, vomiting, myasthenia gravis; pain, swelling, bruising, popping of
diarrhea, constipation, tendons.
abdominal pain, dyspepsia, b) Check vital signs, especially blood pressure. Too-rapid
flatulence, infusion can cause hypotension.
pseudomembranous c) Closely monitor patients with renal insufficiency.
colitis Tx.
GU: vaginitis
Hematologic: a) Provide safety measures (e.g. adequate lighting, raised side
lymphocytopenia rails, etc.) to prevent injuries.
Metabolic: b) Give parenteral form over 60 to 90 minutes, depending on
hyperglycemia, dosage, because bolus or rapid I.V. delivery may cause
hypoglycemia hypotension.
c) Hydrate the patient
Edx.
a) It is essential to complete drug therapy despite symptom
improvement. Early discontinuation may result in
antibacterial resistance or increase risk of recurrent
infection.
b) Note the patient that severe allergic reactions, such as
of nephrotoxicity
NSAIDs: Possibly increased
CNS stimulation and risk of
seizures
oral anticoagulants:
Increased anticoagulant
effect and risk of bleeding
oral antidiabetic drugs:
Possibly hyperglycemia
or hypoglycemia
theophylline: Increased
blood theophylline level and
risk of toxicity
DRUG TO FOOD
INTERACTION:
_________________
hives, palpitations, rash, shortness of breath, tongue
swelling, may occur.
c) Instruct to immediately report nervous system problems
such as anxiety, confusion, dizziness, nervousness,
nightmares, thoughts of suicide, seizures, tremors, trouble
sleeping.
AFTER:
Dx.
a) Monitor daily pattern of bowel activity, stool consistency.
For those taking oral form, monitored daily pattern of
bowel activity and stool consistency
b) Be alert for superinfection: fever, vomiting, diarrhea,
anal/genital pruritus, oral mucosal changes (ulceration,
pain,erythema).
Tx.
a) Monitored daily pattern of bowel activity, stool
consistency.
b) Monitored input and output.
c) Monitored for presence of neurologic symptoms such as
dizziness; paresthesia of extremities.
Edx.
a. Tell pt. to promptly report hypersensitivity reaction: skin
rash, urticaria, pruritus, photosensitivity. Instruct to
complete full course of therapy
b) Educate that the drug may cause heart problems such as
low heart rate, palpitations; permanent nerve damage such
as burning, numbness, tingling, weakness.
 DRUG NAME MECHANISM OF INDICATION / SIDE EFFECTS/ NURSING RESPONSIBILITIES
ACTION CONTRAINDICATION ADVERSE EFFECT

GENERIC: Increases serum calcium level INDICATIONs: SIDE EFFECTS BEFORE:

CALCIUM through direct effects on bone,  Hypocalcemic Frequent: PO: Chalky Dx.
CARBONATE kidney, and GI tract. emergency taste. a) Assess B/P, EKG and cardiac rhythm, renal function, serum
Decreases osteoclastic  Hypocalcemic tetany Parenteral: Pain, rash, magnesium, phosphate, calcium, ionized calcium.
BRAND: osteolysis  Cardiac arrest redness, burning at b) Checked history of hypersensitivity to metropolol.
Apo-Cal (can), by reducing mineral release  Magnesium intoxication injection site; flushing, c) Questioned for history of allergies
Calci-Mix, Calsan and collagen breakdown in  Exchange transfusions nausea, vomiting, Tx.
(can), Liqui-Cal, Liquid bone.  Hyperphosphatemia in diaphoresis, hypotension. a) Store at room temperature, and protect from heat, moisture,
Cal-600, Titralac patients with end-stage Occasional: PO: Mild and direct light.
SOURCE: renal disease constipation, fecal b) Keep patient in a recumbent position for 30 minutes after
CLASS: Jones & Bartlett Learning.,  Dietary supplement impaction, peripheral parenteral administration to prevent dizziness from
& Jones & Bartlett edema, hypotension.
THERAPEUTIC Publishers. (2000). Nurse's CONTRAINDICATION: metabolic alkalosis Edx.
ANTACID, drug handbook. Sudbury,  Hypersensitivity to drug (muscle pain, restlessness, d) Educate to not take within 1–2 hrs of other oral medications,
ANTIHYPERMAGNES MA: Jones and Bartlett  Ventricular fibrillation slow respirations, altered fiber-containing foods.
EMIC, Publishers.  Hypercalcemia and taste). DURING:
ANTIHYPERPHOSPHA hypophosphatemia Calcium carbonate: Dx:
TEMIC,  Cancer Milk-alkali syndrome a) Regularly monitor serum calcium level and evaluate
ANTIHYPOCALCEMI  Renal calculi (headache, decreased therapeutic response by assessing for Chvostek’s and
C,  Pregnancy or appetite, Trousseau’s signs, which shouldn’t appear.
CALCIUM breastfeeding nausea, vomiting, unusual b) Shake bottle well before each use.
REPLACEMENT, fatigue). c) If calcium citrate effervescent tablets are prescribed, dissolve
CARDIOTONIC DRUG TO DRUG Rare: Urinary urgency, them in water and let the pt drink immediately
INTERACTION: painful urination. Tx.
PHARMACOLOGIC: Amphetamines, ephedrine, d) Positioned client for proper administration.
MINERAL epinephrine, norepinephrine, e) Administer P.O. doses 1 to 11⁄2 hours after meals.
phenylephrine,
DOSAGE: pseudoephedrine: unopposed ADVERSE EFFECT Edx.
500 mg TID alpha-adrenergic stimulation CNS: headache, weakness, a) Instruct patient to consume plenty of milk and dairy products
(excessive hypertension, dizziness, during therapy.
ROUTE: bradycardia) syncope, paresthesia b) Instruct patient to verbalize feelings and concerns.
PO Antihypertensives, nitrates: CV: mild blood pressure c) For chewable tablets, urge patient to chew thoroughly before
additive decrease, swallowing and to drink a glass of water afterward.
hypotension bradycardia,
Digoxin: additive arrhythmias, cardiac AFTER:
bradycardia Dobutamine, arrest (with rapid I.V. Dx.
dopamine: reduced injection) d) Observed patient for side/adverse effects.
cardiovascular GI: nausea, vomiting, e) Assessed daily pattern of bowel activity, stool consistency
benefits of these drugs diarrhea, constipation, f) Monitored daily pattern of bowel activity, stool consistency.
General anesthestics, epigastric pain or
phenytoin (I.V.), discomfort Tx.
verapamil: additive GU: urinary frequency, a) Store calcium at room temperature away from heat, moisture,
myocardial renal calculi and light. Warn against freezing suspension or syrup.
depression Metabolic: hypercalcemia b) Provide comfort measures (e.g. voiding before dosing, taking
Insulin, oral hypoglycemics: Musculoskeletal: joint food with drug, etc.) to help patient tolerate drug effects.
altered efficacy pain, back pain
of these drugs Respiratory: dyspnea Edx.
MAO inhibitors: Skin: rash a. Instructed to continue therapy for full length of treatment.
hypertension Other: altered or chalky b. Refer patient to dietitian for help in meal planning and
taste, excessive preparation.
DRUG TO FOOD thirst, allergic reactions c. As appropriate, review all other significant and life-
INTERACTION: (including threatening adverse reactions and interactions, especially
Any food: enhanced drug facial flushing, swelling, those related to the drugs, tests, and foods mentioned above.
absorption tingling, tenderness
in hands, and
anaphylaxis)

DRUG NAME MECHANISM OF INDICATION / SIDE EFFECTS/ NURSING RESPONSIBILITIES

ACTION CONTRAINDICATION ADVERSE EFFECT

GENERIC: Dissolves in acidic gastric INDICATIONs: SIDE EFFECTS BEFORE:

ALUMINUM secretions, releasing anions  Hyperacidity Frequent: PO: Chalky Dx.
HYDROXIDE that partially neutralize gastric taste. a) Don’t give within 1 to 2 hours of antibiotics, histamine2 (H2)
hydrochloric acid. Also CONTRAINDICATION: Parenteral: Pain, rash, blockers, iron preparations, corticosteroids, or enteric-coated
BRAND: elevates gastric pH, inhibiting a) Signs or symptoms of redness, burning at drugs.
ALTERNAGEL, the action of pepsin (an effect appendicitis or inflamed injection site; flushing, Tx.
ALU-CAP, ALUGEL important in peptic ulcer bowel nausea, vomiting, a) Provide care as appropriate if patient becomes constipated.
(CAN), disease). DRUG TO DRUG diaphoresis, hypotension. Edx.
ALU-TAB, AMPHOJEL, INTERACTION: Occasional: PO: Mild b) Educate to not take within 1–2 hrs of other oral medications,
DIALUME SOURCE: Amphetamines, ephedrine, constipation, fecal fiber-containing foods.
Jones & Bartlett Learning., epinephrine, norepinephrine, impaction, peripheral c) Inform patient that drug contains sodium, so he should
CLASS: & Jones & Bartlett phenylephrine, edema, discuss drug therapy with health care providers if he’s later
Publishers. (2000). Nurse's pseudoephedrine: unopposed metabolic alkalosis told to consume a low-sodium diet.
THERAPEUTIC drug handbook. Sudbury, alpha-adrenergic stimulation (muscle pain, restlessness, DURING:
ANTACID MA: Jones and Bartlett (excessive hypertension, slow respirations, altered Dx:
Publishers. bradycardia) taste). d) Use cautiously in gastric outlet obstruction, hypercalcemia,
PHARMACOLOGIC: Antihypertensives, nitrates: Calcium carbonate: hypophosphatemia, massive upper GI haemorrhage.
INORGANIC SALT additive Milk-alkali syndrome e) Monitor long-term use of high doses if patient is on sodium-
hypotension (headache, decreased restricted diet. (Drug contains sodium.)
DOSAGE: Digoxin: additive appetite, f) Monitor patient’s serum levels of sodium, phosphate, and
500 mg TID bradycardia Dobutamine, nausea, vomiting, unusual other electrolytes, as appropriate.
dopamine: reduced fatigue). Tx.
ROUTE: cardiovascular Rare: Urinary urgency, g) Administer with water or fruit juice.
PO benefits of these drugs painful urination. h) In reflux esophagitis, administer 20 to 40 minutes after meals
General anesthestics, and at bedtime.
phenytoin (I.V.), i) Give 1 hour after meals and at bedtime.
verapamil: additive
myocardial ADVERSE EFFECT
depression CNS: headache, weakness, Edx.
Insulin, oral hypoglycemics: dizziness, a) Tell patient to take drug 1 hour after meals and at bedtime.
altered efficacy syncope, paresthesia b) Caution patient not to take drug within 1 to 2 hours of anti-
of these drugs CV: mild blood pressure infectives, H2 blockers, iron, corticosteroids, or enteric-
MAO inhibitors: decrease, coated drugs.
hypertension bradycardia, c) Instruct patient to chew tablets thoroughly before swallowing
arrhythmias, cardiac and then to drink a full glass of water.
DRUG TO FOOD arrest (with rapid I.V.
INTERACTION: injection) AFTER:
Any food: enhanced drug GI: nausea, vomiting, Dx.
absorption diarrhea, constipation, a) Assess for GI bleeding.
epigastric pain or
discomfort
GU: urinary frequency,
renal calculi
Metabolic: hypercalcemia
Musculoskeletal: joint
pain, back pain Tx.
Respiratory: dyspnea
Skin: rash
Other: altered or chalky
taste, excessive
thirst, allergic reactions Edx.
(including
facial flushing, swelling,
tingling, tenderness
in hands, and
anaphylaxis)
b) Watch for constipation.
c) With long-term use, monitor blood phosphate level and
assess for signs and symptoms of hypophosphatemia
(anorexia, malaise,muscle weakness).
d) Also monitor bone density.
a) Assisted in consuming fiber and fluid intake and regular
physical activity to help ease constipation.
b) Assisted in periodic blood testing and bone mineral density
tests if he’s receiving long-term therapy.
a. Warn patient not to take maximum dosage for more than 2
weeks unless prescribed because doing so may cause stomach
to secrete excess hydrochloric acid.
b. If patient takes other prescription drugs, advise him to notify
prescriber about them before taking aluminum because of risk
of interactions.
c. Advise patient to notify prescriber if symptoms worsen or
don’t subside.