MECHANISM OF INDICATION /

DRUG NAME ADVERSE EFFECT NURSING RESPONSIBILITIES

ACTION CONTRAINDICATION

GENERIC NAME: Interferes with fungal INDICATIONS: CNS: headache, dizziness Dx:
FLUCONAZOLE cytochrome  Oropharyngeal candidiasis  Obtain CBC, LFT; serum
P-450 activity, an enzyme  Esophageal candidiasis CV: QT interval potassium in critically ill pts.
BRAND NAME: necessary for  Candidal UTI prolongation, torsades  Receive full medication history
DIFLUCAN ergosterol formation  Systemic candidiasis de pointes and screen for interactions.
(principal sterol  Vaginal candidiasis  Assess areas of infection.
CLASSIFICATION: in fungal cell membrane).  Cryptococcal meningitis GI: nausea, vomiting,  Assess infected area.
 Pharmacologic  Suppression of cryptococcal diarrhea, dyspepsia,
Synthetic Azole  THERAPEUTIC meningitis in patients with abdominal discomfort Tx:
EFFECT: AIDS  Assess for hypersensitivity
 Therapeutic - Directly damages  To prevent candidiasis after Hematologic: reaction (chills, fever).
Systemic Antifungal fungal membrane, bone marrow transplantation leukopenia,  Monitor CBC, BMP, LFT.
altering its function. thrombocytopenia  Report rash, itching promptly.
DOSAGE: - Fungistatic. CONTRAINDICATIONS:  Monitor temperature at least
 Injection: 2 mg/ml in  Hypersensitivity to drug or Hepatic: hepatotoxicity daily.
100- or 200-ml bottles SOURCE: Kizior, R., its components  Monitor daily pattern of bowel
or containers Hodgson, B., Hodgson, K. Skin: rash, pruritus, activity, stool consistency.
 Powder for oral and Witmer, J., 2021. DRUG INTERACTIONS: exfoliative skin  Assess for dizziness; provide
suspension: 50 mg/5 ml Saunders nursing drug  Drug-to-Drug: disorders (including assistance as needed.
in 35-ml bottle, 200 handbook 2021. St. Louis,  Alfentanil, cyclosporine, Stevens-Johnson
mg/5 ml in 35-ml bottle Mo: Elsevier. phenytoin, rifabutin, syndrome) EDx:
 Tablets: 50 mg, 100 mg, tacrolimus, theophylline,  Report dark urine, pale stool,
150 mg, 200 mg zidovudine: increased blood Other: altered taste, jaundiced skin or sclera of eyes,
levels of these drugs, greater anaphylaxis rash, pruritus.
ROUTE: risk of toxicity  Pts with oropharyngeal
P.O.  Benzodiazepines, infections should maintain
IV buspirone, losartan, fastidious oral hygiene.
nisoldipine, tricyclic  Consult physician before taking
antidepressants, any other medication.
zolpidem: increased blood
levels and effects of these
drugs
 CYP3A4 inducers:
inhibited CYP3A4 enzyme
system, altered actions of
CYP3A4 inducers (with
fluconazole dosages above
200 mg/day)
 Glipizide, glyburide,
tolbutamide: increased
 hypoglycemic effect of these
drugs
 Rifampin: increased
rifampin blood level,
decreased fluconazole blood
level
 Thiazide diuretics:
increased fluconazole blood
level
 Warfarin: increased
warfarin activity

 Drug-to-Food:
 None known

MECHANISM OF INDICATION / NURSING

DRUG NAME ADVERSE EFFECT
ACTION CONTRAINDICATION RESPONSIBILITIES

GENERIC NAME: Directly increases INDICATIONS: CNS: confusion, dizziness, Dx:

VALPROIC ACID concentration of inhibitory  Complex partial seizures headache, sedation, ataxia,  Review history of seizure
neurotransmitter gamma-  Simple or complex absence paresthesia, asthenia, tremor, disorder (intensity,
BRAND NAME: aminobutyric acid (GABA). seizures drowsiness, emotional lability, frequency, duration, level
DEPAKOTE  Mania associated with abnormal thinking, amnesia, of consciousness).
 THERAPEUTIC bipolar disorder hyperammonemic  Initiate safety measures,
CLASSIFICATION: EFFECT:  To prevent migraine encephalopathy, suicidal quiet dark environment.
 Pharmacologic - Produces anticonvulsant behavior or ideation CBC should be
Carboxylic acid effect, stabilizes mood, CONTRAINDICATIONS: performed before and 2
derivative prevents migraine head  Hypersensitivity to drug or EENT: amblyopia, blurred wks after therapy begins,

 Therapeutic
Anticonvulsant, mood
stabilizer, antimigraine
agent
DOSAGE:
 Tablets, Delayed-Release
(Depakote): 125 mg, 250
mg, 500 mg.
 Tablets, Extended Release
(Depakote ER): 250 mg,
500 mg
ROUTE:
P.O.
ache. tartrazine (some products) vision, nystagmus, tinnitus, then 2 wks following
 Hepatic impairment pharyngitis maintenance dose.
SOURCE: Kizior, R.,  Urea cycle disorders  Obtain baseline hepatic
Hodgson, B., Hodgson, K. GI: nausea, vomiting, diarrhea, function tests.
and Witmer, J., 2021. DRUG INTERACTIONS: abdominal pain, dyspepsia,
Saunders nursing drug  Drug-to-Drug: anorexia, pancreatitis Tx:
handbook 2021. St. Louis,  Carbapenems (e.g.,  Monitor serum LFT,
Mo: Elsevier. meropenem), CYP3A4 Hematologic: leukopenia, ammonia, CBC.
inducers (e.g., thrombocytopenia  Observe frequently for
carbamazepine, recurrence of seizure
phenytoin) may decrease Hepatic: hepatotoxicity activity.
concentration/effects.  Monitor serum hepatic
 May alter effect of Metabolic: function tests, CBC.
warfarin. hyperammonemia  Assess skin for
 May increase concentration ecchymoses, petechiae.
of lamotrigine. Musculoskeletal: back pain  Monitor for clinical
 Topiramate may increase improvement (decrease in
risk of elevated serum Respiratory: dyspnea intensity/frequency of
ammonia levels. seizures).
Skin: rash, alopecia, bruising
 Drug-to-Food: EDx:
 None known Other: abnormal taste,  Do not abruptly
increased appetite, weight discontinue medication
gain, flulike symptoms, after long-term use (may
infection, infusion site pain precipitate seizures).
and  Strict maintenance of
reaction, multiorgan drug therapy is essential
hypersensitivity reaction for seizure control. 
 Avoid tasks that require
alertness, motor skills
until response to drug is
established.
 Drowsiness usually
disappears during
continued therapy.
 Avoid alcohol.
 Carry identification card,
bracelet that notes
anticonvulsant therapy.
 Report nausea, vomiting,
lethargy, altered mental
status, weakness, loss of
appetite, abdominal pain,
yellowing of skin,
 unusual
bruising/bleeding.
 Report if seizure control
worsens, suicidal ideation
(depression, unusual
changes in behavior,
suicidal thoughts) occurs.

MECHANISM OF INDICATION / NURSING

DRUG NAME ADVERSE EFFECT
ACTION CONTRAINDICATION RESPONSIBILITIES
GENERIC NAME: Inhibits cyclooxygenase 2, INDICATIONS: CNS: dizziness, drowsiness, Dx:
CELECOXIB the enzyme responsible for  Ankylosing spondylitis, headache,  Assess onset, type,
prostaglandin synthesis. Osteoarthritis insomnia, fatigue, stroke location, duration of
BRAND NAME:  Rheumatoid arthritis pain/inflammation.
CELEBREX  THERAPEUTIC  Adjunctive treatment in CV: angina, tachycardia,  Inspect appearance
EFFECT: familial adenomatous peripheral of affected joints for
CLASSIFICATION: - Reduces polyposis to decrease the edema, myocardial infarction immobility, deformity,
 Pharmacologic inflammation, number of adenomatous skin condition.
Nonsteroidal relieves pain. colorectal polyps EENT: ophthalmic effects,  Assess for allergy to sulfa,
cyclooxygenase-2  Acute pain or primary tinnitus, epistaxis, pharyngitis, aspirin, or NSAIDs
(COX-2) inhibitor, SOURCE: Kizior, R., dysmenorrhea rhinitis, sinusitis (contraindicated).
nonsteroidal anti- Hodgson, B., Hodgson, K.  Juvenile rheumatoid
inflammatory drug and Witmer, J., 2021. arthritis GI: nausea, diarrhea, Tx:
(NSAID) Saunders nursing drug constipation, abdominal pain,  Assess for therapeutic
 Therapeutic handbook 2021. St. Louis, CONTRAINDICATIONS: dyspepsia, flatulence, dry response: pain relief;
Antirheumatic Mo: Elsevier.  Hypersensitivity to drug, mouth, GI bleeding decreased stiffness,
sulfonamides, or other swelling; increased joint
DOSAGE: NSAIDs GU: menorrhagia, renal mobility; reduced joint
 Capsules: 50 mg, 100 mg,  Advanced renal disease failure tenderness; improved grip
200 mg, 400 mg  Severe hepatic impairment strength.
  Sensitivity precipitated by Hematologic: eosinophilia,  Observe for bleeding,
ROUTE: aspirin ecchymosis, bruising, weight gain.
P.O.  Third trimester of neutropenia, leukopenia,
pregnancy pancytopenia, EDx:
 Breastfeeding thrombocytopenia,  If GI upset occurs, take
agranulocytosis, with food.
granulocytopenia, aplastic  Avoid aspirin, alcohol
DRUG INTERACTIONS: anemia, bone marrow (increases risk of GI
 Drug-to-Drug: depression bleeding).
 Angiotensin converting Hepatic: hepatotoxicity  Immediately report chest
enzyme inhibitors, pain, jaw pain, sweating,
furosemide, thiazides: Metabolic: hyperchloremia, confusion, difficulty
reduced celecoxib efficacy hypophosphatemia speaking, one-sided
 Antacids containing weakness (may indicate
aluminum and Musculoskeletal: back pain, heart
magnesium: decreased leg cramps attack or stroke).
celecoxib blood level
 Aspirin (regular doses): Respiratory: upper
increased risk of GI respiratory tract infection
bleeding and GI ulcers
 Fluconazole, lithium: Skin: rash
increased blood levels of
these drugs Other: anaphylaxis
 Warfarin: increased risk
 of bleeding

 Drug-to-Food:
 None known

MECHANISM OF INDICATION /
DRUG NAME ADVERSE EFFECT NURSING RESPONSIBILITIES
ACTION CONTRAINDICATION
GENERIC NAME: Inhibits HMG-CoA INDICATIONS: CNS: amnesia, abnormal Dx:
ATORVASTATIN reductase, the enzyme  Adjunct to diet for dreams,  Obtain baseline cholesterol,
that catalyzes the early step controlling LDL, total emotional lability, triglycerides, LFT.
BRAND NAME: in cholesterol cholesterol, apo-lipoprotein headache, hyperactivity,  Question for possibility of
LIPITOR synthesis. Results in an B, and triglyceride levels and poor coordination, pregnancy before initiating
increase of expression to increase HDL levels in malaise, paresthesia, therapy.
CLASSIFICATION: in LDL receptors on patients with primary peripheral neuropathy,  Obtain dietary history.
 Pharmacologic hepatocyte membranes and hypercholesterolemia and drowsiness, syncope,
HMG-CoA reductase a stimulation of LDL mixed dyslipidemia; primary weakness Tx:
inhibitor catabolism. dysbetalipoproteinemia in  Monitor for headache.
patients unresponsive to diet CV: orthostatic  Assess for rash, pruritus,
 Therapeutic  THERAPEUTIC alone; adjunct to diet to hypotension, palpitations, malaise.
Lipid-lowering agent EFFECT: reduce elevated triglyceride phlebitis, vasodilation,  Monitor cholesterol,
- Decreases LDL and levels arrhythmias triglyceride lab values for
DOSAGE: VLDL, plasma  Adjunct to other lipid- therapeutic response.
 Tablets: 10 mg, 20 mg, triglyceride levels; lowering treatments in EENT: amblyopia, altered  Monitor LFTs, CPK.
40 mg, 80 mg increases HDL patients with homozygous refraction,
concentration. familial glaucoma, eye EDx:
ROUTE: hypercholesterolemia hemorrhage, dry eyes,  Follow special diet (important
P.O. SOURCE: Kizior, R.,  Adjunct to diet to decrease hearing loss, tinnitus, part of treatment).
Hodgson, B., Hodgson, K. total cholesterol, LDL, and epistaxis, sinusitis,  Periodic lab tests are essential
and Witmer, J., 2021. apo-lipoprotein B levels in pharyngitis part of therapy.
Saunders nursing drug boys and postmenarchal girls  Do not take other medications
handbook 2021. St. Louis, ages 10 to 17 with familial GI: nausea, vomiting, without consulting physician.
Mo: Elsevier. and nonfamilial diarrhea, constipation,  Do not chew, crush, dissolve, or
heterozygous abdominal cramps, divide tablets.
hypercholesterolemia abdominal or biliary pain,  Report dark urine, muscle
 Prevention of cardiovascular colitis, indigestion, fatigue, bone pain.
disease in patients without dyspepsia, flatulence,  Avoid excessive alcohol intake,
clinically evident coronary stomach ulcers, large quantities of grapefruit
heart disease (CHD) but with gastroenteritis, melena, products.
multiple CHD risk factors tenesmus, glossitis, mouth
 Prevention of stroke and sores, dry mouth,
myocardial infarction in dysphagia, esophagitis,
patients with type 2 diabetes pancreatitis, rectal
who have multiple risk hemorrhage
factors for CHD but without
clinically evident CHD GU: hematuria, nocturia,
CONTRAINDICATIONS: dysuria, urinary frequency
 Hypersensitivity to drug or or urgency, urinary
its components retention, cystitis,
 Active hepatic disease or nephritis, renal calculi,
unexplained, persistent abnormal ejaculation,
serum transaminase decreased libido, erectile
 elevations dysfunction,
 Pregnancy or breastfeeding epididymitis

DRUG INTERACTIONS: Hematologic: anemia,

 Drug-to-Drug: Thrombocytopenia
 Antacids, colestipol,
CYP450 3A4 (such as Hepatic: jaundice,
efavirenz, rifampin): hepatic failure,
decreased atorvastatin Hepatitis
blood level
 Azole antifungals, Metabolic:
colchicine, cyclosporine, hyperglycemia,
erythromycin, fibric acid Hypoglycemia
derivatives, HIV protease
inhibitors, lipid-modifying Musculoskeletal: bursitis,
doses of niacin, other joint pain, back pain, leg
HMG-CoA reductase cramps, gout, muscle
inhibitors, strong CYP3A4 pain or aches, myositis,
inhibitors (such as myasthenia
clarithromycin, gravis, neck rigidity,
itraconazole): protease torticollis,
inhibitors: increased risk of rhabdomyolysis
myopathy or rhabdomyolysis
 Digoxin: increased digoxin Respiratory: dyspnea,
level, pneumonia, bronchitis
greater risk of toxicity
 Hormonal contraceptives: Skin: alopecia, acne,
increased levels of these contact dermatitis,
drugs eczema, dry skin, pruritus,
rash, urticaria, skin ulcers,
 Drug-to-Food: seborrhea,
 Grapefruit juice: increased photosensitivity,
drug blood level, greater risk diaphoresis, toxic
of adverse effects epidermal necrolysis

Other: taste loss, gingival

bleeding,
fever, facial paralysis,
facial or generalized
edema, flulike symptoms,
infection,
appetite changes, weight
gain, allergic reaction,
Stevens-Johnson
 syndrome

MECHANISM OF INDICATION /
DRUG NAME ADVERSE EFFECT NURSING RESPONSIBILITIES
ACTION CONTRAINDICATION

GENERIC NAME: Inhibits calcium movement INDICATIONS: CNS: headache, dizziness, Dx:
AMLODIPINE across cardiac and vascular  Essential hypertension, drowsiness,  Assess baseline renal/hepatic
smooth muscle cell chronic stable angina light-headedness, fatigue, function tests, B/P, apical pulse.
BRAND NAME: membranes during pectoris, and vasospastic weakness,
NORVASC depolarization. angina (Prinzmetal’s angina) lethargy Tx:
 Assess B/P (if systolic B/P is
CLASSIFICATION:  THERAPEUTIC CONTRAINDICATIONS: CV: peripheral edema, less than 90 mm Hg, withhold
 Pharmacologic EFFECT:  Hypersensitivity to drug or angina, bradycardia, medication, contact physician).
Calcium channel - Dilates coronary its components hypotension, palpitations  Assess for peripheral edema
blocker arteries, peripheral behind medial malleolus (sacral
arteries/arterioles. DRUG INTERACTIONS: GI: nausea, abdominal area in bedridden pts).
 Therapeutic - Decreases total  Drug-to-Drug: discomfort  Assess skin for flushing.
Antihypertensive peripheral vascular  Beta-adrenergic blockers:  Question for headache,
resistance and B/P by increased risk of adverse Musculoskeletal: muscle asthenia.
DOSAGE: vasodilation. effects cramps, muscle pain or
 Tablets: 2.5 mg, 5 mg, 10  Fentanyl, nitrates, other inflammation EDx:
mg SOURCE: Kizior, R., antihypertensives,  Do not abruptly discontinue
Hodgson, B., Hodgson, K.  quinidine: additive Respiratory: shortness of medication.
ROUTE: and Witmer, J., 2021. hypotension breath, dyspnea,  Compliance with therapy
P.O. Saunders nursing drug Wheezing regimen is essential to control
handbook 2021. St. Louis,  Drug-to-Food: hypertension.
Mo: Elsevier.  Grapefruit products may Skin: rash, pruritus,  Avoid tasks that require
increase concentration, urticaria, flushing alertness, motor skills until
hypotensive effects. response to drug is established.
 Do not ingest grapefruit
products.