Drug Study

[generic name, Brand Name, classification, pregnancy category]

Example:
acetaminophen (all small letters), Tylenol (for brand name, first letter is capitalized; bold), non-
opioid analgesic
Prescribed dosage, 325 – 650 mg (dosage), q4h – q6h prn (frequency), PO/RECT (route)
frequency, and route of 650 mg q4h or 1000 mg q6h prn, IV
administration
Mechanism of Action
Indication
Contraindications
Adverse Effects per body system affected
Nursing Responsibilities

ceftriaxone, Rocephin, Third generation Cephalosporin, pregnancy category B

Prescribed dosage, Dosage

frequency, and route of
administration
ADULTS, ELDERLY: 1–2 g q12–24h, IM/IV CHILDREN: Mild to
moderate infection: 50–75 mg/kg/day in 1–2 divided doses.
Maximum: 2 g/day.
Severe infection: 80–100 mg/ kg/day divided q12–24h.
Maximum: 4 g/ day.
NEONATES: 25–50 mg/kg/dose, once daily, IM/IV

Mechanism of Action Binds to bacterial cell membranes, inhibits cell wall synthesis

Indication Susceptible bacterial infections of the lower respiratory

Contraindications
Adverse Effects
Nursing Responsibilities
tract, skin and skin structure, bone and joint, acute
otitis media, UTIs, septicemia, pelvic inflammatory disease
(PID), intraabdominal infections, meningitis, uncomplicated
gonorrhea.
History of hypersensitivity/anaphylactic reaction to
cefTRIAXone, cephalosporins. Hyperbilirubinemic neonates, esp.
premature infants, should not be treated with cefTRIAXone (can
displace bilirubin from its binding to serum albumin, causing
bilirubin encephalopathy). Do not administer with calcium-
containing IV solutions, including continuous calcium containing
infusion such as parenteral nutrition (in neonates) due to the
risk of precipitation of cefTRIAXone-calcium salt.
CNS: SEIZURES (HIGH DOSES). GI: PSEUDOMEMBRANOUS
COLITIS, diarrhea, cholelithiasis, sludging in the
gallbladder. Derm: rashes, urticaria. Hemat: bleeding,
eosinophilia, hemolytic anemia, leukopenia,
thrombocytosis. Local: pain at IM site, phlebitis at IV
site. Misc: ALLERGIC REACTIONS, INCLUDING
ANAPHYLAXIS, superinfection.
 Watch for seizures; notify physician
immediately if patient develops or increases
seizure activity.

Morphine sulfate, roxanol,  Opioid agonist, pregnancy category C
Prescribed dosage,
frequency, and route of
administration
Mechanism of Action
Indication
moderate to severe pain.2
 Monitor signs of pseudomembranous colitis,
including diarrhea, abdominal pain, fever, pus
or mucus in stools, and other severe or
prolonged GI problems (nausea, vomiting,
heartburn). Notify physician or nursing staff
immediately of these signs.
 Monitor signs of allergic reactions and
anaphylaxis, including pulmonary symptoms
(tightness in the throat and chest, wheezing,
cough dyspnea) or skin reactions (rash,
pruritus, urticaria). Notify physician or nursing
staff immediately if these reactions occur.
 Monitor signs of blood dyscrasias, including
eosinophilia (fatigue, weakness, myalgia),
hemolytic anemia (malaise, dizziness, jaundice,
abdominal pain), leukopenia (fever, sore throat,
mucosal lesions, signs of infection),
thrombocytopenia (bruising, nose bleeds,
bleeding gums, other unusual bleeding), or
thrombocytosis (headache, dizziness, chest
pain, fainting, visual disturbances, numbness or
tingling in the hands and feet). Report these
signs to the physician.
 Monitor injection site for pain, swelling, and
irritation. Report prolonged or excessive
injection site reactions to the physician.
Analgesia PO: (Immediate-Release): ADULTS, ELDERLY: 10–30
mg q4h as needed.
CHILDREN 6 MOS AND OLDER WEIGHING 50 KG OR MORE: 15–
20 mg q3–4h as needed. CHILDREN 6 MOS AND OLDER
WEIGHING LESS THAN 50 KG: 0.2–0.5 mg/kg q3–4h as needed.
CHILDREN YOUNGER THAN 6 MOS: (Oral Solution): 0.08–0.1
mg/kg q3–4h as needed.
Binds with opioid receptors within CNS, inhibiting ascending
pain pathways.
Morphine is used for the management of chronic,
 Opiods, including morphine, are effective for the short
term management of pain. Patients taking opioids
long term may need to be monitored for the
development of physical dependence, addiction
disorder, and drug abuse

Contraindications Hypersensitivity to morphine; respiratory insufficiency or

depression; severe CNS depression;attack of
bronchial asthma; heart failure secondary to chronic lung
disease;cardiac arrhythmias;increased intracranial or
cerebrospinal pressure;head injuries;brain tumor;
acute alcoholism; delirium tremens; convulsive disorders;
after biliary tract surgery; suspected surgical abdomen;
surgical anastomosis; concomitantly with MAO inhibitors or
within 14 days of such treatment.
Adverse Reactions Central Nervous System: Euphoria, dysphoria,
weakness, headache, insomnia, agitation,
disorientation, and visual disturbances.

Gastrointestinal: Dry mouth, anorexia, constipation,

and biliary tract spasm.

Cardiovascular: Flushing of the face, bradycardia,

palpitation, faintness and syncope.

Allergic: Pruritus, urticaria, other skin rashes, edema,
and, rarely hemorrhagic urticaria.

Nursing Responsibilities  Monitor blood pressure prior to administration. 

Hold if systolic BP < 100 mm Hg or 30 mm Hg
below baseline.
 Monitor patient's respiratory rate prior to
administration.
 Reassess pain after administration of
morphine.
 Monitor for respiratory depression and
hypotension frequently up to 24 hours after
administration of morphine.
 Place call light signal close to patient. 
Accompany patient if need to get out of bed to
minimize risk of falls.
 Drug interactions:  CNS depression potentiated
with other narcotics, alcohol, barbiturates, &
benzodiazepines.
 Drug interactions:  Anticholinergic effects
potentiated with antihistamines, tricyclic
antidepressants, and atropine–these can worsen
constipation and urinary retention.

Erythromicin, Macrolide antibiotics
Prescribed dosage,
frequency, and route of
administration
Mechanism of action
Indication
Contraindication
Adverse Reaction
 Drug interactions:  Hypotension can result if
combined with anti-hypertensive drugs or
vasodilators.
 Treatment for overdose includes ventilatory
support (manual ventilation with a bag-valve-
mask resuscitator) and administration of an
opiate antagonist (e.g., naloxone).
 Tolerance, a condition requiring larger doses to
achieve the same therapeutic effect, can result
from prolonged use.
 Physical dependence, resulting from prolonged
use, may create the risk of withdrawal symptoms
if drug is completely discontinued.
 Avoid alcohol and other CNS depressants
while under the influence of morphine.
 Avoid tasks requiring alertness like driving and
operating heavy machinery while under the
influence of morphine.
Usual Dosage Range PO: ADULTS, ELDERLY: (Base): 250–500 mg
q6–12h. Maximum: 4 g/day. CHILDREN: 30–50 mg/kg/day in 2–4
divided doses. Maximum: 2 g/day. (Ethylsuccinate): ADULTS,
ELDERLY: 400–800 mg q6–12h. Maximum: 4 g/day. CHILDREN:
30–50 mg/kg/day in divided doses. Maximum: 4 g/day.
NEONATES: 10 mg/kg/dose q8–12h. IV: ADULTS, ELDERLY: 15–
20 mg/kg/ day divided q6h. Maximum: 4 g/day. CHILDREN,
INFANTS: 15–20 mg/kg/day divided q6h. Maximum: 4 g/day.
NEONATES: 10 mg/kg/dose q8–12h.
Penetrates bacterial cell membranes, reversibly binds to
bacterial ribosomes, inhibiting RNA-dependent protein
synthesis.
Erythromycin is used to treat certain infections caused by
bacteria, such as infections of the respiratory tract, including
bronchitis, pneumonia, Legionnaires' disease (a type of lung
infection), and pertussis (whooping cough; a serious infection
that can cause severe coughing); diphtheria (a serious
infection in the throat); sexually transmitted diseases (STD),
including syphilis; and ear, intestine, gynecological, urinary
tract, and skin infections. It also is used to prevent recurrent
rheumatic fever. Erythromycin is in a class of medications
called macrolide antibiotics. It works by stopping the growth of
bacteria.
Hypersensitivity to erythromycin. Concomitant administration
with ergot derivatives, lovastatin, pimozide, simvastatin.
Adverse Reactions/Side Effects
CNS: seizures (rare). CV: QTC PROLONGATION (MAY
RESULT IN TORSADES DE POINTES), VENTRICULAR
 ARRHYTHMIAS. GI: PSEUDOMEMBRANOUS
COLITIS, nausea, vomiting, abdominal pain, cramping,
diarrhea, drug-induced hepatitis, infantile hypertrophic
pyloric stenosis, drug-induced pancreatitis
(rare). Derm: rashes. Misc: allergic reactions,
superinfection.
Nursing Resposibilities
BASELINE ASSESSMENT Question for history of allergies
(particularly erythromycins), hepatitis. Receive full medication
history and screen for interactions. INTERVENTION/EVALUATION
Monitor daily pattern of bowel activity, stool consistency. Assess
skin for rash. Assess for hepatotoxicity (malaise, fever,
abdominal pain, GI disturbances). Be alert for superinfection:
fever, vomiting, diarrhea, anal/ genital pruritus, oral mucosal
changes (ulceration, pain, erythema). Check for phlebitis (heat,
pain, red streaking over vein). Monitor for high-dose hearing
loss. PATIENT/FAMILY TEACHING • Continue therapy for full
length of treatment. • Doses should be evenly spaced. • Take
medication with 8 oz water 1 hr before or 2 hrs following food
or beverage. • Ophthalmic: Report burning, itching,
inflammation. • Topical: Report excessive skin dryness, itching,
burning. • Improvement of acne may not occur for 1–2 mos;
maximum benefit may take 3 mos; therapy may last mos or yrs.
• Use caution if using other topical acne preparations containing
peeling or abrasive agents, medicated or abrasive soaps,
cosmetics containing alcohol (e.g., astringents, aftershave
lotion).

Febuxostat, Uloric, xanthine oxidase inhibitors, pregnancy category c

Prescribed dosage, frequency, and route of Hyperuricemia
administration ADULTS, ELDERLY: Initially, 40 mg once daily,
PO
Mechanism of action Xanthine oxidase inhibitor; inhibits
conversion of hypoxanthine to
xanthine to uric acid; at therapeutic
dosages, decreases production of
uric acid without disrupting
synthesis of vital purines and
pyrimidines
Indications Febuxostat oral tablet is used to treat
hyperuricemia (constantly high levels of
uric acid) in adults who have gout. 
Contraindications febuxostat increases levels azathioprine,
didanosine, mercaptopurine,
theophylline by decreasing metabolism
Adverse reaction Adverse Reactions/Side Effects
GI: liver function abnormalities,
nausea. Derm: rash. MS: gout flare,
arthralgia.
Nursing Responsibilities  Assess baseline renal function, LFT;
concomitant use with azaTHIOprine,
mercaptopurine, theophylline
(contraindicated).
 Discontinue medication immediately if
rash appears.
 Encourage high fluid intake (3,000
mL/day). Monitor I&O (output should
be at least 2,000 mL/day).
 Monitor CBC, serum uric acid, renal
function, LFT.
 Assess urine for cloudiness, unusual
color, odor.
 Assess for therapeutic response
(reduced joint tenderness, swelling,
redness, limitation of motion).
 Monitor for symptoms of CVA, MI.

Doxycycline, acticlate, Tetracyclines, Pregnacy Category D

Prescribed dosage, frequency, and route of Usual Dosage
administration ADULTS, ELDERLY, CHILDREN OLDER THAN 8
YRS, WEIGHING MORE THAN 45 KG: 100–200
mg/day in 1–2 divided doses, PO.
100 mg q12h, IV
IV/PO: CHILDREN OLDER THAN 8 YRS,
WEIGHING 45 KG OR LESS: 2–4 mg/kg/day
(Maximum: 200 mg/day) in 1–2 divided doses.
Mechanism of Action Inhibits bacterial protein synthesis by binding
to ribosomes. May cause alterations in the
cytoplasmic membra
Indications Doxycycline is a prescription antibiotic
medication indicated for the treatment of
the following infections and
diseases: Rocky Mountain spotted
fever, typhus fever and the typhus
group, Q fever, rickettsialpox, and tick
fevers, respiratory tract infections, urinary
tract infections.
Contraindications Hypersensitivity to doxycycline, other
tetracyclines
Adverse Reaction Stomach and intestines- loss of
appetite,nausea,diarrhea,
inflammation and soreness of the tongue,
difficulty swallowing,
inflammation of the digestive tract,
inflammation of the pancreas,
inflammatory lesions on the anus and
genitals

Skin- sun sensitivity and severe rashes

Kidneys- kidney toxicity
 Immune system- allergic reaction,hives
fluid buildup,anaphylactic shock
pericarditis, or inflammation of the lining of
the heart
Blood- anemia
low count of white blood cells or platelets
disruption in immune cell counts
Other- high blood pressure in the skull
Nursing Responsibilities  Question for history of allergies, esp.
to tetracyclines, sulfites.
 Monitor daily pattern of bowel
activity, stool consistency. Assess skin
for rash.
 Monitor LOC due to potential for
increased intracranial pressure (ICP).
 Be alert for superinfection: fever,
vomiting, diarrhea, anal/genital
pruritus, oral mucosal changes
(ulceration, pain, erythema).


Dopamine, Intropin, Sympathomimetic (adrenergic agonist),pregnancy category C

Prescribed dosage, frequency, and route of Hemodynamic Support
administration IV infusion: ADULTS, ELDERLY, CHILDREN:
Range: 2–20 mcg/kg/min. Titrate to desired
response. May gradually increase by 5–10
mcg/kg/min increments. Maximum: 50
mcg/kg/min.
NEONATES: 2–20 mcg/kg/min. Titrate
gradually by 5–10 mcg/kg/min to desired
response.
Mechanism of Action Dopamine is a precursor to norepinephrine
in noradrenergic nerves and is also a
neurotransmitter in certain areas of the
central nervous system. Dopamine
produces positive chronotropic and
inotropic effects on the myocardium,
resulting in increased heart rate and
cardiac contractility. This is accomplished
directly by exerting an agonist action on
beta-adrenoceptors and indirectly by
causing release of norepinephrine from
storage sites in sympathetic nerve
endings. In the brain, dopamine actas as
an agonist to the five dopamine receptor
subtypes (D!, D2, D3, D4, D5).
Indications Dopamine is indicated for the correction
of hemodynamic imbalances present in
the shock syndrome due to myocardial
infarction, trauma, endotoxic septicemia,
open-heart surgery, renal failure, and
chronic cardiac decompensation as in
congestive failure.
Contraindications
Adverse Reaction Cardiovascular: Ventricular arrhythmia,
atrial fibrillation (at very high doses),
ectopic beats, tachycardia, anginal
pain, palpitation, cardiac conduction
abnormalities, widened QRS complex,
bradycardia, hypotension,
hypertension, vasoconstriction
Respiratory: Dyspnea
Gastrointestinal: Nausea, vomiting
Metabolic/nutritional: Azotemia
Central nervous system: Headache,
anxiety
Endocrine: Piloerection
Ocular: Increased intraocular pressure;
dilated pupils
Gangrene of extremities has occurred
when high doses were administered for
prolonged periods or in patients with
occlusive vascular disease receiving
low doses of dopamine hydrochloride

Nursing Responsibilities Examination and Evaluation

 Assess blood pressure (BP) and
compare to normal values
(See Appendix F). Report
whether drug therapy is
successful in normalizing BP in
patients with shock and other
cardiac conditions.

 Assess heart rate, ECG, and

heart sounds, especially during
exercise (See Appendices
G, H). Report any rhythm
disturbances or symptoms of
increased arrhythmias, including
palpitations, chest discomfort,
shortness of breath, fainting,
and fatigue/weakness.

 Monitor urine output whenever

possible, and report decreased
urine output, cloudy urine, or
sudden weight gain due to fluid
 retention.

 Monitor signs of peripheral

vasoconstriction, such as
extreme coldness in the hands
and feet, cyanosis, and muscle
cramping. Notify physician of
severe or prolonged signs of
vasoconstriction.

 Monitor IV injection site for pain,

swelling, and irritation. Report
prolonged or excessive
injection-site reactions to the
physician.

Interventions
 Because of an increased risk of
cardiac arrhythmias and
compromised cardiac output,
use caution during aerobic
exercise and endurance
conditioning. Terminate exercise
if patient exhibits untoward
symptoms (chest pain,
shortness of breath, etc.) or
displays other criteria for
exercise termination
(see Appendix L).

Patient/Client-Related Instruction
 Instruct patient or
family/caregivers to report other
troublesome side effects such
as severe or prolonged
headache, dilated pupils
(mydriasis), or GI problems
(nausea, vomiting).
Bisoprolol, Apo-Bisoprolol , Novo-Bisoprolol ), : Beta1 selective adrenergic blocker, pregnancy
category C
Prescribed dosage, Hypertension
frequency, and route PO: ADULTS, ELDERLY:
of administration Initially, 2.5–5 mg once daily. May increase to 10 mg, then to 20 mg
once daily. Usual dose: 5–10 mg once daily.
Dosage in Renal Impairment
CrCl less than 40 mL/min:
ADULTS, ELDERLY: Initially, give 2.5 mg.
Dosage in Hepatic Impairment Cirrhosis, hepatitis: Initially, 2.5 mg.
Mechanism of Action Though the mechanism of action of bisoprolol has not been
fully elucidated in hypertension, it is thought that
therapeutic effects are achieved through the antagonism of
β-1adrenoceptors to result in lower cardiac output.
Bisoprolol is a competitive, cardioselective β1-adrenergic
antagonist. When β1-receptors (located mainly in the
heart)14 are activated by adrenergic neurotransmitters such
as epinephrine, both the blood pressure and heart rate
increase, leading to greater cardiovascular work, increasing
the demand for oxygen. Bisoprolol reduces cardiac
workload by decreasing contractility and the need for
oxygen through competitive inhibition of β1-adrenergic
receptors.7,14
Bisoprolol is also thought to reduce the output of renin in
the kidneys, which normally increases blood pressure.
Additionally, some central nervous system effects of
bisoprolol may include diminishing sympathetic nervous
system output from the brain, decreasing blood pressure
and heart rate.

Indications Bisoprolol is used with or without other medications to treat high

blood pressure (hypertension). Lowering high blood pressure
helps prevent strokes, heart attacks, and kidney problems.
Contraindications Hypersensitivity to bisoprolol. Cardiogenic shock, marked sinus
bradycardia, overt HF, second- or third-degree heart block (except in
pts with pacemaker).
Adverse reactions Central nervous system: Drowsiness, insomnia

Endocrine & metabolic: Decreased sexual ability

1% to 10%:

Cardiovascular: Bradycardia, palpitations, edema, congestive heart

failure, reduced peripheral circulation

Central nervous system: Mental depression

Gastrointestinal: Diarrhea or constipation, nausea, vomiting, stomach

discomfort

Ocular: Mild ocular stinging and discomfort, tearing, photophobia,

 decreased corneal sensitivity, keratitis

Respiratory: Bronchospasm

Miscellaneous: Cold extremities

Nursing BASELINE ASSESSMENT

Responsibilities
Assess baseline renal/hepatic function tests. Assess B/P, apical
pulse immediately before drug is administered (if pulse is 60/min
or less or systolic B/P is less than 90 mm Hg, withhold
medication, contact physician).
INTERVENTION/EVALUATION Monitor B/P, pulse for
quality, irregular rate, bradycardia. Assist with ambulation if
dizziness occurs. Assess for peripheral edema. Monitor daily
pattern of bowel activity, stool consistency. Assess neurologic
status.

PATIENT/FAMILY TEACHING • Do not abruptly discontinue

medication. • Compliance with therapy regimen is essential to
control hypertension. • If dizziness occurs, sit or lie down
immediately. • Avoid tasks that require alertness, motor skills
until response to drug is established. • Take pulse properly before
each dose and report excessively slow pulse rate (less than 60
beats/min). Report numbness of extremities, dizziness. • Do not
use nasal decongestants, OTC cold preparations (stimulants)
without physician’s approval. • Restrict salt, alcohol intake.

Calcitonin, calcimar, : Synthetic hormone, pregnancy category c

Prescribed dosage, Paget’s Disease
frequency, and IM, SQ: ADULTS, ELDERLY: 100 units/day. Postmenopausal Osteoporosis
route of IM, SQ: ADULTS, ELDERLY: 100 units daily with adequate calcium and
administration vitamin D intake. Intranasal: ADULTS, ELDERLY: 200 units/ day as a single
spray in one nostril, alternating nostrils daily.
Hypercalcemia IM, SQ: ADULTS, ELDERLY: Initially, 4 units/kg q12h; may
increase to 8 units/kg q12h if no response in 2 days; may further
increase to 8 units/kg q6–12h.

Mechanism of Antagonizes effects of parathyroid hormone. Increases jejunal secretion

Action of water, sodium, potassium, chloride. Inhibits osteoclast bone
resorption. Promotes renal excretion of calcium, phosphate, sodium,
magnesium, potassium by decreasing tubular reabsorption.
Indications Calcitonin injection is used to treat Paget's disease of bone, or
high levels of calcium in the blood (hypercalcemia). Calcitonin
injection is also used to treat osteoporosis in postmenopausal
women.
Contraindications Hypersensitivity to calcitonin-salmon or any of the excipients. Less
than 5 years postmenopausal women with osteoporosis.
Adverse Reaction
Adverse effects
  Dermatologic: Flushing of face or hands, rash
 GI: Nausea, vomiting
 GU: Urinary frequency (calcitonin-human)
 Local: Local inflammatory reactions at injection
site (salmon), nasal irritation (nasal spray)

Nursing  Give skin test to patients with any history of

Responsibilities
allergies; salmon calcitonin is a protein, and risk
of allergy is significant. Observe after 15 min;
the presence of a wheal or more than
mild erythema indicates a positive response.
 Obtain baseline serum electrolyte levels.
 Ensure rotation of injection sites; check for inflammation.
 Assess vertebral bone mass (document
stabilization/improvement).
 Assess for allergic response: rash, urticaria, swelling, dyspnea,
tachycardia, hypotension.
 Monitor serum electrolytes, calcium, alkaline phosphatase

Celecoxib,celeBREX, nonsteroidal anti-inflammatory drugs (NSAIDs), celecoxib

pregnancy category
Prescribed dosage, Osteoarthritis PO: ADULTS, ELDERLY: 200 mg/day as a single dose or
frequency, and route of 100 mg twice daily. Rheumatoid Arthritis (RA) PO: ADULTS, ELDERLY:
administration 100–200 mg twice daily.
Juvenile Rheumatoid Arthritis (JRA) PO: CHILDREN 2 YRS AND
OLDER, WEIGHING MORE THAN 25 KG: 100 mg twice daily.
WEIGHING 10–25 KG: 50 mg twice daily.
Acute Pain, Primary Dysmenorrhea
PO: ADULTS, ELDERLY: Initially, 400 mg with additional 200 mg on
day 1, if needed. Maintenance: 200 mg twice daily as needed.
Ankylosing Spondylitis PO:
ADULTS, ELDERLY: 200 mg/day as a single dose or in 2 divided
doses. May increase to 400 mg/day if no effect is seen after 6 wks.
Mechanism of Action Celecoxib is a selective noncompetitive inhibitor of
cyclooxygenase-2 (COX-2) enzyme. COX-2 is expressed
heavily in inflamed tissues where it is induced by inflammatory
mediators.30 The inhibition of this enzyme reduces the
synthesis of metabolites that include prostaglandin E2 (PGE2),
prostacyclin (PGI2), thromboxane (TXA2), prostaglandin D2
(PGD2), and prostaglandin F2 (PGF2). Resultant inhibition of
these mediators leads to the alleviation of pain and
inflammation.
Indications Relief of signs/symptoms of osteoarthritis, rheumatoid arthritis (RA)
in adults. Treatment of acute pain, primary dysmenorrhea. Relief of
signs/symptoms associated with ankylosing spondylitis. Treatment
of juvenile rheumatoid arthritis (JRA) in pts 2 yrs and older and
weighing 10 kg or more.
Contraindications Hypersensitivity to celecoxib, sulfonamides, aspirin, other NSAIDs.
 Active GI bleeding. Pts experiencing asthma, urticaria, or allergic
reactions to aspirin, other NSAIDs. Treatment of perioperative pain
in coronary artery bypass graft (CABG) surgery.
Adverse Reaction
Adverse effects
 Abdominal pain, diarrhea, nausea, edema,
dizziness, headache, insomnia, upper
respiratory tract infections; rash.
 Potentially Fatal: Serious skin reactions such
as exfoliative dermatitis, Stevens-Johnson
syndrome, and toxic epidermal necrolysis.

Nursing Responsibilities Assess onset, type, location, duration of pain/inflammation. Inspect

appearance of affected joints for immobility, deformity, skin
condition. Assess for allergy to sulfa, aspirin, or NSAIDs
(contraindicated)
Assess for therapeutic response: pain relief; decreased stiffness,
swelling; increased joint mobility; reduced joint tenderness;
improved grip strength. Observe for bleeding, bruising, weight gain.
If GI upset occurs, take with food. • Avoid aspirin, alcohol (increases
risk of GI bleeding). • Immediately report chest pain, jaw pain,
sweating, confusion, difficulty speaking, one-sided weakness (may
indicate heart attack or stroke)
 Provide further comfort measures to reduce
pain (eg, positioning, environmental control)
and to reduce inflammation (eg, warmth,
positioning, and rest).

Cetirizine,  Zyrtec, antihistamine, pregnancy category B

Prescribed dosage, Upper Respiratory Allergies, Urticaria PO: ADULTS, CHILDREN OLDER
frequency, and route of THAN 5 YRS: Initially, 5–10 mg/day as single dose. Maximum: 10
administration mg/day. ELDERLY: 5 mg once daily. Maximum: 5 mg/day. CHILDREN
2–5 YRS: 2.5 mg/day. May increase up to 5 mg/day as a single dose
or in 2 divided doses.
CHILDREN 12–23 MOS: Initially, 2.5 mg/day. May increase up to 5
mg/day in 2 divided doses. CHILDREN 6–11 MOS: 2.5 mg once daily.
Dosage in Renal Impairment ADULT: GFR 50 mL/min or less: 5 mg
once daily. CHILDREN: GFR 10–29 mL/ min: reduce dose by 50 %.
GFR
Mechanism of Action Cetirizine, a metabolite of hydroxyzine, is an antihistamine
drug. Its main effects are achieved through selective inhibition
of peripheral H1 receptors. The antihistamine activity of
cetirizine has been shown in a variety of animal and human
models. In vivo and ex vivo animal models have shown
insignificant anticholinergic and antiserotonergic effects. In
clinical studies, however, dry mouth was found to be more
frequent with cetirizine than with a placebo. In vitro receptor
binding studies have demonstrated no detectable affinity of
 cetirizine for histamine receptors other than the H1 receptors.
Studies with radiolabeled cetirizine administration in the rat
have demonstrated insignificant penetration into the brain. Ex
vivo studies in the mouse have shown that systemically
administered cetirizine does not occupy cerebral H1 receptors
significantly
Indications Relief of symptoms (sneezing, rhinorrhea, postnasal discharge, nasal
pruritus, ocular pruritus, tearing) of upper respiratory allergies;
relieves itching due to urticaria.
Contraindications ZYRTEC is contraindicated in those patients with a known
hypersensitivity to it or any of its ingredients or hydroxyzine.
Adverse
Adverse effects
 CNS: Somnolence, sedation
 CV: Palpitation, edema
 GI: Nausea, diarrhea, abdominal pain,
constipation
 Respiratory: Bronchospasm, pharyngitis
 Other: Fever, photosensitivity,
rash, myalgia, arthralgia, angioedema

Nursing Responsibilities ssessment

 History: Allergy to any
antihistamines, hydroxyzine; narrow-angle
glaucoma, stenosing peptic ulcer,
symptomatic prostatic hypertrophy, asthmatic
attack, bladder neck
obstruction, pyloroduodenal obstruction;
lactation
 Physical: Skin color, lesions, texture;
orientation, reflexes, affect; vision examination;
R, adventitious sounds; prostate palpation;
renal function tests
Interventions
 Give without regard to meals.
 Provide syrup form or chewable tablets for
pediatric use if needed.
 Arrange for use of humidifier if thickening of
secretions, nasal dryness become bothersome;
encourage adequate intake of fluids.
 Provide skin care for urticaria.
Teaching points
 Take this drug without regard to meals.
 You may experience these side effects:
Dizziness, sedation, drowsiness (use caution if
driving or performing tasks that require
alertness); thickening of bronchial secretions,
dryness of nasal mucosa (humidifier may help).
 Report difficulty breathing, hallucinations,
tremors, loss of coordination, irregular
heartbeat.