DRUG CLASSIFICATION ACTION INDICATION CONTRAINDICATIONS ADVERSE EFFECTS NURSING CONSIDERATIONS

TRAMADOL PHARMACOTHE Binds to mu- Moderate to Contraindications: Seizures reported in pts BASELINE ASSESSMENT
RAPEUTIC: opioid receptors Moderately Hypersensitivity to tramadol, receiving tramadol within Assess onset, type, location, duration of pain.
Centrally acting in CNS, Severe Pain opioids. Pediatric pts under 12 recommended dosage range. Assess drug history, esp. carbamazepine,
synthetic inhibiting yrs of age; post-op May have prolonged analgesics, CNS depressants, MAOIs. Review
opioid. ascending pain management in pts under 18 duration of action, past medical history, esp. epilepsy, seizures.
CLINICAL: pathway. yrs following tonsillectomy cumulative effect in pts with Assess renal function, LFT.
Analgesic. Inhibits and/or denoidectomy; severe hepatic/renal impairment, INTERVENTION/EVALUATION Monitor pulse,
reuptake of respiratory depression; acute serotonin syndrome B/P, renal/hepatic function. Assist with
norepinephrine, bronchial asthma in absence (agitation, hallucinations, ambulation if dizziness, vertigo occurs. Dry
serotonin, of appropriate monitoring; GI tachycardia, hyperreflexia). crackers, cola may relieve nausea. Palpate
inhibiting obstruction (paralytic ileus May cause suicidal ideation bladder for urinary retention. Monitor daily
descending pain [known or suspected]). and behavior pattern of bowel activity, stool consistency. Sips
pathways. Concomitant use with or of water may relieve dry mouth. Assess for
Therapeutic within 14 days following MAOI clinical improvement, record onset of relief of
Effect: Reduces therapy pain. Monitor closely for misuse or abuse.
pain PATIENT/FAMILY TEACHING
• May cause physical dependence.
• Pts with history of drug abuse is at increased
risk for misuse or abuse. Take medication only
as prescribed.
• Avoid alcohol, other narcotics, sedatives.
• May cause drowsiness, dizziness, blurred
vision.
• Avoid tasks requiring alertness, motor skills
until response to drug is established.
• Report severe constipation, difficulty
breathing, excessive sedation, seizures, muscle
weakness, tremors, chest pain, palpitations.
CEFTRIAXONE PHARMACOTHE Binds to Susceptible History of Antibiotic-associated colitis, BASELINE ASSESSMENT
RAPEUTIC: Third bacterial cell bacterial hypersensitivity/anaphylactic other super infections Obtain CBC, renal function tests. Question for
generation membranes, infections of the reaction to ceftriaxone, (abdominal cramps, severe history of allergies, particularly cephalosporins,
cephalosporin. inhibits cell wall lower cephalosporins. watery diarrhea, fever) may penicillins.
respiratory
CLINICAL: synthesis. Hyperbilirubinemia neonates, result from altered bacterial INTERVENTION/EVALUATION
tract, skin and
 Antibiotic. Therapeutic skin structure, esp. premature infants, should balance in GI tract. Assess oral cavity for white patches on mu cous
Effect: bone and joint, not be treated with Nephrotoxicity may occur, membranes, tongue (thrush). Monitor daily
Bactericidal. acute otitis ceftriaxone (can displace esp. in pts with preexisting pattern of bowel activity, stool consistency.
media, UTI’s bilirubin from its binding to renal disease. Pts with Mild GI effects may be tolerable (increasing
septicemia,
serum albumin, causing history of penicillin allergy is severity may indicate onset of antibiotic-
pelvic
inflammatory
bilirubin encephalopathy). Do at increased risk for associated colitis). Monitor I&O, renal function
disease, not administer with calcium- developing a severe tests for nephrotoxicity, CBC. Be alert for
intraabdominal, containing IV solutions, hypersensitivity reaction superinfection: fever, vomiting, diarrhea,
meningitis, including continuous calcium (severe pruritus, anal/genital pruritus, oral mucosal changes
surgical containing infusion such as angioedema, bronchospasm, (ulceration, pain, erythema).
prophylaxis parenteral nutrition (in anaphylaxis). PATIENT/FAMILY TEACHING
neonates) due to the risk of • Discomfort may occur with IM injection.
precipitation of ceftriaxone- • Doses should be evenly spaced.
calcium salt. Cautions: Hepatic • Continue antibiotic therapy for full length of
impairment, history of GI treatment
disease (esp. ulcerative colitis,
antibiotic-associated colitis).
History of penicillin allergy.
LACTULOSE PHARMACOTHE Inhibits diffusion Constipation, Hypersensitivity to lactulose. Severe diarrhea may cause BASELINE ASSESSMENT
RAPEUTIC: of NH3 into prevention of Pts requiring a low-galactose dehydration, electrolyte Question usual stool pattern, frequency,
Lactose blood by portal-systemic diet. Cautions: Diabetes, imbalance. Long-term use characteristics. Conduct neurological exam in
derivative. converting NH3 encephalopathy hepatic impairment, may result in laxative pts with elevated serum ammonia levels,
, treatment of
CLINICAL: to NH4 +; dehydration. dependence, chronic symptoms of encephalopathy. Assess hydration
portal-systemic
Hyperosmotic enhances encephalopathy
constipation, loss of normal status.
laxative, diffusion of NH3 , rectal bowel function INTERVENTION/EVALUATION
ammonia from blood to administration Encourage adequate fluid intake. Assess bowel
detoxicant gut, where it is (as retention sounds for peristalsis. Moni tor daily pattern of
converted to enema) bowel activity, stool consistency; record time of
NH4 +; produces evacuation. Assess for abdominal disturbances.
osmotic effect in Monitor serum electrolytes in pts with
colon, resulting prolonged, frequent, excessive use of
in colon medication. Monitor encephalopathic pts for
distention, symptom improvement (alertness, orientation,
promoting ability to follow commands).
 peristalsis. PATIENT/FAMILY TEACHING
Therapeutic • Evacuation occurs in 24–48 hrs of initial dose.
Effect: Promotes • Institute measures to promote defecation:
increased increase fluid intake, exercise, high-fiber diet.
peristalsis, • Drink plenty of fluids.
bowel • If therapy was started to treat high ammonia
evacuation; levels, notify physician if worsening of
decreases serum confusion, lethargy, weakness occurs
ammonia
concentration
PANTOPRAZOLE PHARMACOTHE Irreversibly Erosive Contraindications: Hyperglycemia occurs rarely. BASELINE ASSESSMENT
RAPEUTIC: binds to, inhibits Esophagitis Hypersensitivity to May increase risk of C. Question history of GI disease, ulcers, GERD.
Benzimidazole. hydrogen (Treatment), pantoprazole, other proton difficile–associated diarrhea INTERVENTION/EVALUATION
CLINICAL: potassium Maintenance pump inhibitors (e.g., Evaluate for therapeutic response (relief of GI
Proton pump adenosine of Healing of omeprazole). Cautions: May symptoms). Question if GI discomfort, nausea
inhibitor triphosphate, an Erosive increase risk of fractures, GI occur. Monitor for abdominal pain, diarrhea
enzyme on Esophagitis, infections. (with or without fever).
surface of Hypersecretor PATIENT/FAMILY TEACHING
gastric parietal y Conditions, • Report abdominal pain, diarrhea (with or
cells. Inhibits Prevention of without fever) that does not resolve; may
hydrogen ion Rebleeding in indicate colon infection.
transport into Peptic Ulcer • Avoid alcohol.
gastric lumen. Bleed • Swallow tablets whole; do not chew, crush,
Therapeutic (Unlabeled) dissolve, or divide.
Effect: Increases • Best if given before breakfast. May give
gastric pH, without regard to food.
reduces gastric
acid production.
METRONIDAZOLE PHARMACOTHE Diffuses into Amebiasis, Hypersensitivity to Oral therapy may result in BASELINE ASSESSMENT
RAPEUTIC: organism, Anaerobic metronidazole. Pregnancy furry tongue, glossitis, Obtain baseline CBC, LFT. Question for history
Nitroimidazole interacting with Infections, (first trimester with cystitis, dysuria, pancreatitis. of hypersensitivity to metronidazole, other
derivative. DNA causing a Intra- trichomoniasis), use of Peripheral neuropathy nitroimidazole derivatives (and parabens with
CLINICAL: loss of helical abdominal disulfiram within 2 wks, use of (manifested as numbness, topical). Obtain specimens for diagnostic tests,
Antibacterial, DNA structure Infections, alcohol during therapy or tingling of hands/feet) cultures before giving first dose (therapy may
 antiprotozoal, and strand Pseudomembr within 3 days of discontinuing usually is reversible if begin before results are known).
amebicide. breakage, anous Colitis, metronidazole. Cautions: treatment is stopped INTERVENTION/EVALUATION
inhibiting Bacterial Blood dyscrasias, severe immediately upon Monitor daily pattern of bowel activity, stool
protein Vaginosis, hepatic dysfunction, end stage appearance of neurologic consistency. Monitor I&O, assess for urinary
synthesis. Rosacea renal disease, seizure disorder, symptoms. Seizures occur problems. Be alert to neurologic symptoms
Therapeutic HF, other sodium-retaining occasionally (dizziness, paresthesia of extremities). Assess
Effect: Produces states, elderly. for rash, urticaria. Monitor for onset of
bactericidal, superinfection (ulceration/change of oral
antiprotozoal, mucosa, furry tongue, vaginal discharge,
amebicidal, genital/anal pruritus).
trichomonacidal PATIENT/FAMILY TEACHING
effects. • Urine may be red-brown or dark.
Produces anti- • Avoid alcohol, alcohol-containing preparations
inflammatory, (cough syrups, elixirs) for at least 48 hrs after
immunosuppres last dose.
sive effects • Avoid tasks that require alertness, motor skills
when applied until response to drug is established.
topically. • If taking metronidazole for trichomoniasis,
refrain from sexual intercourse until full
treatment is completed.
• For amebiasis, frequent stool specimen checks
will be necessary.
• Topical: Avoid contact with eyes.
• May apply cosmetics after application.
• Metronidazole acts on erythema, papules,
pustules but has no effect on rhinophyma
(hypertrophy of nose), telangiectasia, ocular
problems (conjunctivitis, keratitis, blepharitis).
• Other recommendations for rosacea include
avoidance of hot/spicy foods, alcohol, extremes
of hot/cold temperatures, excessive sunlight.
DIAZEPAM PHARMACOTHE Depresses all Anxiety, Hypersensitivity to diazepam. IV route may produce pain, BASELINE ASSESSMENT
RAPEUTIC: levels of CNS by Skeletal Acute narrow-angle glaucoma, swelling, thrombophlebitis, Assess B/P, pulse, respirations immediately
Benzodiazepine enhancing Muscle untreated open-angle carpal tunnel syndrome. before administration. Anxiety: Assess
 (Schedule IV). action of Relaxation, glaucoma, severe respiratory Abrupt or too-rapid autonomic response (cold, clammy hands;
CLINICAL: gamma- Alcohol depression, severe hepatic withdrawal may result in diaphoresis), motor response (agitation,
Antianxiety, aminobutyric Withdrawal, insufficiency, sleep apnea pronounced restlessness, trembling, tension). Musculoskeletal spasm:
skeletal muscle acid (GABA), a Status syndrome, myasthenia gravis. irritability, insomnia, hand Record onset, type, location, duration of pain.
relaxant, major inhibitory Epilepticus, Children younger than 6 mos tremor, abdominal/muscle Check for immobility, stiffness, swelling.
anticonvulsant. neurotransmitte Control of (oral). Cautions: Pts receiving cramps, diaphoresis, Seizures: Review history of seizure disorder
r in the brain. Increased other CNS depressants or vomiting, seizures. Abrupt (length, intensity, frequency, duration, LOC).
Therapeutic Seizure psychoactive agents, withdrawal in pts with Observe frequently for recurrence of seizure
Effect: Produces Activity depression, history of drug epilepsy may produce activity.
anxiolytic effect, (Breakthrough and alcohol abuse, increase in INTERVENTION/EVALUATION
elevates seizure Seizures) in Pts renal/hepatic impairment, frequency/severity of Monitor heart rate, respiratory rate, B/P,
threshold, with respiratory disease, impaired seizures. Overdose results in mental status. Assess children, elderly for
produces Refractory gag reflex, concurrent use of drowsiness, confusion, paradoxical reaction, particularly during early
skeletal muscle Epilepsy Who strong CYP3A4 inhibitors or diminished reflexes, CNS therapy. Evaluate for therapeutic response
relaxation. Are on Stable inducers. depression, coma. Antidote: (decrease in intensity/frequency of seizures;
Regimens of Flumazenil (see Appendix J calm facial expression, decreased restlessness;
Anticonvulsant for dosage.). decreased intensity of skeletal muscle pain).
s Therapeutic serum level: 0.5–2 mcg/mL; toxic
serum level: greater than 3 mcg/mL.
PATIENT/FAMILY TEACHING
• Avoid alcohol.
• Limit caffeine.
• May cause drowsiness; avoid tasks that
re quire alertness, motor skills until response
to drug is established.
• May be habit forming.
• Avoid abrupt discontinuation after prolonged
use.
TAMSULOSIN PHARMACOTHE Antagonist of Benign Contraindications: First-dose syncope BASELINE ASSESSMENT
RAPEUTIC: alpha receptors Prostatic Hypersensitivity to tamsulosin. (hypotension with sudden Assess history of prostatic hyperplasia (difficulty
Alpha1- in prostate. Hyperplasia Cautions: Concurrent use of loss of consciousness) may initiating urine stream, drib bling, sense of
adrenergic Therapeutic (BPH) phosphodiesterase (PDE5) oc cur within 30–90 min urgency, leaking). Question for sensitivity to
blocker. Effect: Relaxes inhibitors (e.g., sildenafil, after initial dose. May be tamsulosin, or use of other alpha-adrenergic
CLINICAL: smooth muscle tadalafil, vardenafil), pts with preceded by tachycardia blocking agents. Obtain vital signs.
 Benign prostatic in bladder neck orthostatic hypotension (pulse rate of 120–160 INTERVENTION/EVALUATION
hyperplasia and prostate; beats/min). Assist with ambulation if dizziness occurs.
agent improves Monitor renal function, I&O, weight changes,
urinary flow, peripheral edema, B/P. Monitor for first-dose
symptoms of syncope.
pros tatic PATIENT/FAMILY TEACHING
hyperplasia. • Take at same time each day, 30 min after the
same meal.
• Go from lying to standing slowly.
• Avoid tasks that re quire alertness, motor
skills until response to drug is established.
• Do not break, crush, open capsule.
• Avoid grapefruit products.
METOPROLOL PHARMACOTHE Selectively Hypertension, Hypersensitivity to Overdose may produce BASELINE ASSESSMENT
RAPEUTIC: blocks beta1- Angina metoprolol. Second- or third- profound bradycardia, Assess baseline renal function, LFT. Assess B/P,
Beta1- adrenergic Pectoris, HF, degree heart block. hypotension, bronchospasm. apical pulse immediately before drug
adrenergic receptors. Early Immediate-Release: MI: Abrupt withdrawal may administration (if pulse is 60/min or less or
blocker. Therapeutic Treatment of Severe sinus bradycardia (HR result in diaphoresis, systolic B/P is less than 90 mm Hg, withhold
CLINICAL: Effect: Slows MI less than 45 beats/min), palpitations, headache, medication, contact physician). Antianginal:
Antianginal, heart rate, systolic B/P less than 100 mm tremulousness, exacerbation Record onset, type (sharp, dull, squeezing),
antihypertensiv decreases Hg, moderate to severe HF, of angina, MI, ventricular radiation, location, intensity, duration of anginal
e, MI adjunct cardiac output, significant first-degree heart arrhythmias. May precipitate pain, precipitating factors (exertion, emotional
reduces B/P. block. Immediate Release: HF, MI in pts with heart stress).
Decreases HTN/Angina: Sinus disease, thyroid storm in INTERVENTION/EVALUATION
myocardial bradycardia, cardiogenic those with thyrotoxicosis, Measure B/P near end of dosing interval
ischemia shock, overt HF, sick sinus peripheral ischemia in those (determines whether B/P is controlled
severity. syndrome (except with with existing peripheral throughout day). Monitor B/P for hypotension,
pace maker), severe vascular disease. respiration for shortness of breath. Assess pulse
peripheral arterial disease. Hypoglycemia may occur in for quality, rate, rhythm. Assess for evidence of
Extended-Release: Severe pts with previously HF: dyspnea (esp. on exertion, lying down),
bradycardia, cardiogenic controlled diabetes (may night cough, peripheral edema, distended neck
shock, decompensated HF, mask signs of hypoglycemia). veins. Monitor I&O (increased weight,
sick sinus syndrome (except Antidote: Glucagon (see decreased urinary output may indicate HF).
with functioning pacemaker). Appendix J for dosage). Therapeutic response to hypertension noted in
 Cautions: Arterial obstruction, 1–2 wks.
bronchospastic disease, PATIENT/FAMILY TEACHING
hepatic impairment, • Do not abruptly discontinue medication.
peripheral vascular disease, • Compliance with therapy regimen is essential
hyperthyroidism, diabetes to control hypertension, arrhythmias.
mellitus, myasthenia gravis, • If dose is missed, take next scheduled dose
psychiatric disease, history of (do not double dose).
severe anaphylaxis to • Go from lying to standing slowly.
allergens. Extended-Release: • Report excessive fatigue, dizziness.
Compensated HF • Avoid tasks that require alertness, motor skills
until response to drug is established.
• Do not use nasal decongestants, OTC cold
preparations (stimulants) without physician
approval.
• Monitor B/P, pulse before taking medication.
• Restrict salt, alcohol intake.
ATORVASTATIN PHARMACOTHE Inhibits HMG- Dyslipidemias, Hypersensitivity to Potential for cataracts, BASELINE ASSESSMENT
RAPEUTIC: CoA reductase, Heterozygous atorvastatin. Active hepatic photosensitivity, myalgia, Obtain baseline cholesterol, triglycerides, LFT.
Hydroxymethylg the enzyme that Hypercholeste disease, breastfeeding, rhabdomyolysis. Question for possibility of pregnancy before
lutaryl CoA catalyzes the rolemia pregnancy or women who initiating therapy. Obtain dietary history.
(HMG-CoA) early step in may become pregnant, INTERVENTION/EVALUATION
reductase cholesterol unexplained elevated LFT Monitor for headache. Assess for rash, pruritus,
inhibitor. synthesis. results. Cautions: malaise. Monitor cholesterol, triglyceride lab
CLINICAL: Anti Results in an Anticoagulant therapy; history values for therapeutic response. Monitor LFTs,
hyperlipidemic increase of of hepatic disease; substantial CPK.
expression in alcohol consumption; pts with PATIENT/FAMILY TEACHING
LDL receptors on prior stroke/TIA; concomitant • Follow special diet (important part of
hepatocyte use of potent CYP3A4 treatment).
membranes and inhibitors; elderly • Periodic lab tests are essential part of therapy.
a stimulation of (predisposed to myopathy). • Do not take other medications without
LDL catabolism. consulting physician.
Therapeutic • Do not chew, crush, dissolve, or divide tablets.
Effect: • Report dark urine, muscle fatigue, bone pain.
Decreases LDL • Avoid excessive alcohol intake, large
 and VLDL, quantities of grapefruit products
plasma
triglyceride
levels; increases
HDL
concentration.
ALPRAZOLAM PHARMACOTHE Enhances the Anxiety Hypersensitivity to Abrupt or too-rapid BASELINE ASSESSMENT
RAPEUTIC: inhibitory Disorders, Alprazolam. Acute narrow withdrawal may result in Assess degree of anxiety; assess for drowsiness,
Benzodiazepine effects of the Anxiety with angle-closure glaucoma, restlessness, irritability, dizziness, light-headedness. Assess motor
(Schedule IV). neurotransmitte Depression, concurrent use with insomnia, hand tremors, responses (agitation, trembling, tension),
CLINICAL: r gamma- Panic Disorder ketoconazole or itraconazole abdominal/muscle cramps, autonomic responses (cold/clammy hands,
Antianxiety aminobutyric or other potent CYP3A4 diaphoresis, vomiting, diaphoresis). Initiate fall precautions.
acid in the brain. inhibitors. Cautions: seizures. Overdose results in INTERVENTION/EVALUATION
Therapeutic Renal/hepatic impairment, drowsiness, confusion. For pts on long-term therapy, perform
Effect: Produces predisposition to urate diminished reflexes, coma. hepatic/renal function tests, CBC periodically.
anxiolytic effect nephropathy, obese pts. Blood dyscrasias noted Assess for paradoxical reaction, particularly
due to CNS Concurrent use of CYP3A4 rarely. Antidote: Flumazenil during early therapy. Evaluate for therapeutic
depressant inhibitors/inducers and major (see Appendix J for dosage). response: calm facial expression, decreased
action. CYP3A4 substrates; debilitated restlessness, insomnia. Monitor respiratory and
pts, respiratory disease, cardiovascular status.
depression (esp. suicidal risk), PATIENT/FAMILY TEACHING
elderly (increased risk of • Drowsiness usually disappears during
severe toxicity). History of continued therapy.
substance abuse. • If dizziness occurs, change positions slowly
from recumbent to sitting position before
standing.
• Avoid tasks that require alertness, motor skills
until response to drug is established.
• Smoking reduces drug effectiveness.
• Sour hard candy, gum, sips of water may
relieve dry mouth.
• Do not abruptly withdraw medication after
long-term therapy.
• Avoid alcohol.
 • Do not take other medications without
consulting physician
POTASSIUM PHARMACOTHE Necessary for Treatment of Acetate: Severe renal Hyperkalemia (more BASELINE ASSESSMENT
CHLORIDE RAPEUTIC: multiple cellular Hypokalemia impairment, adrenal common in elderly, pts with Assess for hypokalemia (weakness, fatigue,
Electrolyte. metabolic insufficiency, hyperkalemia. renal impairment) polyuria, polydipsia). PO should be given with
CLINICAL: processes. Chloride: Renal failure, manifested as paresthesia, food or after meals with full glass of water, fruit
Potassium Primary action is hyperkalemia, conditions in motor weakness, cold skin, juice (minimizes GI irritation).
replenisher intracellular. which potassium retention is hypotension, confusion, INTERVENTION/EVALUATION
Therapeutic present. Solid oral dosage irritability, paralysis, cardiac Monitor serum potassium, calcium, phosphate.
Effect: Required form in pts in whom there is arrhythmias. Too-rapid If GI disturbance is noted, dilute preparation
for nerve structural, pathologic cause infusion may cause cardiac further or give with meals. Be alert to
impulse for delay in passage through arrhythmia, ventricular decreased urinary output (may be indication of
conduction, GI tract. Cautions: Cardiac fibrillation, cardiac arrest. renal insufficiency). Check IV site closely during
contraction of disease, acid-base disorders, infusion for evidence of phlebitis (heat, pain,
cardiac, skeletal, potassium-altering disorders, red streaking of skin over vein, hardening of
smooth muscle; digitalized pts, concomitant vein), extravasation (swelling, pain). Be alert to
maintains therapy that increases serum evidence of hyperkalemia (skin pallor/coldness,
normal renal potassium (e.g., ACE paresthesia, feeling of heaviness of lower
function, acid- inhibitors), renal impairment. extremities).
base balance Do not administer IV PATIENT/FAMILY TEACHING
undiluted. • Foods rich in potassium include beef, veal,
ham, chicken, turkey, fish, milk, bananas, dates,
prunes, raisins, avocados, watermelon,
cantaloupe, apricots, molasses, beans, yams,
broccoli, brus-
SPIRONOLACTONE PHARMACOTHE Interferes with Edema (For Hypersensitivity to Severe hyperkalemia may BASELINE ASSESSMENT
RAPEUTIC: sodium Cirrhosis), spironolactone. Hyperkalemia, produce arrhythmias, Weigh pt; initiate strict I&O. Evaluate hydration
Aldosterone reabsorption by Hypertension, Addison’s disease, bradycardia, ECG changes status by assessing mucous membranes, skin
receptor competitively Primary concomitant use with (tented T waves, widening turgor. Obtain baseline serum electrolytes,
antagonist. inhibiting action Aldosteronism eplerenone. Cautions: QRS complex, ST segment renal/hepatic function, urinalysis. Assess for
CLINICAL: of aldosterone ,HF. Dehydration, hyponatremia, depression). May proceed to edema; note location, extent. Check baseline
Potassium- in distal tubule, concurrent use of cardiac standstill, ventricular vital signs, note pulse rate/regularity.
sparing diuretic, promoting supplemental potassium, fibrillation. Cirrhosis pts at INTERVENTION/EVALUATION
antihypertensiv sodium and elderly pts, mild renal risk for hepatic Monitor serum electrolyte values, esp. for
 e water excretion, impairment declining renal decompensation if increased potassium, BUN, creatinine. Monitor
increasing function, ACE inhibitors or dehydration, hyponatremia B/P. Monitor for hyponatremia: mental
potassium angiotensin receptor blockers. occurs. Pts with primary confusion, thirst, cold/clammy skin, drowsiness,
retention. May aldosteronism may dry mouth. Monitor for hyperkalemia: colic,
decrease effect experience rapid weight loss, diarrhea, muscle twitching followed by
of aldosterone severe fatigue during high- weakness/paralysis, arrhythmias. Obtain daily
on arteriolar dose therapy weight. Note changes in edema, skin turgor.
smooth muscle. PATIENT/FAMILY TEACHING
Therapeutic • Expect increase in volume, frequency of
Effect: Produces urination.
diuresis, lowers • Therapeutic effect takes several days to begin
B/P and can last for several days when drug is
discontinued. This may not apply if pt is on a
potassium-losing drug concomitantly (diet, use
of supplements should be established by
physician).
• Report irregular or slow pulse, symptoms of
electrolyte imbalance (see previous
Intervention/ Evaluation).
• Avoid foods high in potassium, such as whole
grains (cereals), legumes, meat, bananas,
apricots, orange juice, potatoes (white, sweet),
raisins.
• Avoid alcohol.
• Avoid tasks that require alertness, motor skills
until response to drug is established (may cause
drowsiness).
TELMISARTAN PHARMACOTHE Blocks Hypertension, Hypersensitivity to Overdosage may manifest as BASELINE ASSESSMENT
RAPEUTIC: vasoconstrictor Cardiovascular telmisartan. Concurrent use hypotension, tachycardia; Obtain B/P, apical pulse immediately before
Angiotensin II and aldosterone Risk with aliskiren in pts with bradycardia occurs less each dose, in addition to regular monitoring (be
receptor secreting effects Reduction, diabetes. Cautions: often. alert to fluctuations). If excessive reduction in
antagonist. of angiotensin II, Hypovolemia, hyperkalemia, B/P occurs, place pt in supine position, feet
CLINICAL: inhibiting hepatic/ renal impairment, slightly elevated. Assess medication history
Antihypertensiv binding of renal artery stenosis (esp. diuretics). Question for history of hepatic/
 e angiotensin II to (unilateral, bilateral), biliary renal impairment, renal artery stenosis. Obtain
AT1 receptors. obstructive disease, significant serum BUN, creatinine, Hgb, Hct, vital signs
Therapeutic aortic/mitral stenosis. (particularly B/P, pulse rate).
Effect: Causes Concurrent use with ramipril INTERVENTION/EVALUATION
vasodilation, not recommended. Avoid Monitor B/P, pulse, serum electrolytes, renal
decreases potassium supplements function. Monitor for hypotension when
peripheral initiating therapy.
resistance, PATIENT/FAMILY TEACHING
decreases B/P. • Avoid tasks that require alertness, motor skills
until response to drug is established (possible
dizziness effect).
• Maintain proper hydration. • Avoid
pregnancy.
• Immediately report suspected pregnancy.
• Report any sign of infection (sore throat,
fever). • Avoid excessive exertion during hot
weather (risk of dehydration, hypotension)
PIPERACILLIN+TAZ PHARMACOTHE Piperacillin: treat Hypersensitivity to antibiotic-associated colitis, BASELINE ASSESSMENT
OBACTAM RAPEUTIC: Inhibits bacterial pneumonia piperacillin/tazobactam, any other superinfections Question for history of allergies, esp. to
Penicillin. cell wall and skin, penicillin. Cautions: History of (abdominal cramps, severe penicillins, cephalosporins. Obtain baseline CBC
CLINICAL: synthesis by gynecological, allergies (esp. cephalosporins, watery diarrhea, fever) may with differential, BMP, LFT; urinalysis; PT, aPTT
Antibiotic. binding to PCN- and abdominal beta-lactamase inhibitors), result from altered bacterial (if on anticoagulants or history of
binding (stomach renal impairment, preexisting balance in GI tract. coagulopathy).
proteins, which area) seizure disorder Overdose, more often with INTERVENTION/EVALUATION
inhibit the final infections renal impairment, may Monitor daily pattern of bowel activity, stool
step of caused by produce seizures, neurologic consistency; mild GI effects may be tolerable,
peptidoglycan bacteria reactions. Severe but increasing severity may indicate onset of
synthesis. hypersensitivity reactions, antibiotic-associated colitis. Be alert for
Therapeutic including anaphylaxis, occur superinfection: fever, vomiting, diarrhea,
Effect: rarely. anal/genital pruritus, oral mucosal changes
Bactericidal. (ulceration, pain, erythema). Monitor I&O,
Tazobactam: urinalysis. Monitor serum electrolytes, esp.
Inactivates potassium, renal function tests.
bacterial beta-
 lactamase.
Therapeutic
Effect: Protects
piperacillin from
enzymatic
degradation,
extends its
spectrum of
activity,
prevents
bacterial
overgrowth.
INSULIN PHARMACOTHE Acts via specific Type 1 Hypersensitivity to insulin, use Severe hypoglycemia (due to BASELINE ASSESSMENT
RAPEUTIC: receptor to Diabetes, Type during episodes of hyperinsulinism) may occur Obtain serum glucose level, Hgb A1c. Discuss
Exogenous regulate 2 Diabetes, hypoglycemia. Afrezza: with insulin overdose, lifestyle to determine extent of learning,
insulin. metabolism of Chronic lung disease. decrease/delay of food emotional needs. If given IV, obtain serum
CLINICAL: carbohydrates, Cautions: Pts at risk for intake, excessive exercise, chemistries (esp. serum potassium).
Antidiabetic. protein, and hypokalemia; renal/hepatic pts with brittle diabetes. INTERVENTION/EVALUATION
fats. Acts on impairment, elderly. Afrezza: Diabetic ketoacidosis may Assess for hypoglycemia (refer to
liver, skeletal Must be used with a long- result from stress, illness, pharmacokinetics table for peak times and
muscle, and acting insulin in type 1 omission of insulin dose, duration): cool, wet skin, tremors, dizziness,
adipose tissue. diabetes. Not recommended long term poor insulin headache, anxiety, tachycardia, numbness in
Liver: Stimulates for use in diabetic ketoacidosis control mouth, hunger, diplopia. Assess sleeping pt for
hepatic glycogen or in smokers. Pts with active restlessness, diaphoresis. Check for
synthesis, lung cancer, history of lung hyperglycemia: polyuria (excessive urine
synthesis of cancer, or at risk for lung output), polyphagia (excessive food intake),
fatty acids. cancer. polydipsia (excessive thirst), nausea/vomiting,
Muscle: dim vision, fatigue, deep and rapid breathing
Increases (Kussmaul respirations). Be alert to conditions
protein, altering glucose requirements: fever, trauma,
glycogen increased activity/stress, surgical procedure
synthesis. PATIENT/FAMILY TEACHING
Adipose tissue: • Instruct on proper technique for drug
Stimulates administration, testing of glucose, signs/
 lipoproteins to symptoms of hypoglycemia and hyperglycemia.
provide free • Diet and exercise are essential parts of
fatty acids, treatment; do not skip/delay meals.
triglyceride • Carry candy, sugar packets, other sugar
synthesis. supplements for immediate response to
Therapeutic hypoglycemia.
Effect: Controls • Wear or carry medical alert identification.
serum glucose • Check with physician when insulin demands
levels. are altered (e.g., fever, infection, trauma,
stress, heavy physical activity).
• Do not take other medication without
consulting physician.
• Weight control, exercise, hygiene (including
foot care), not smoking are integral parts of
therapy.
• Protect skin, limit sun exposure.
• Inform dentist, physician, surgeon of
medication before any treatment is given
SODIUM PHARMACOTHE Dissociates to Cardiac Arrest, Hypersensitivity to sodium Excessive, chronic use may BASELINE ASSESSMENT
BICARBONATE RAPEUTIC: provide Metabolic bicarbonate. Hypernatremia, produce metabolic alkalosis Assess for signs and symptoms of acidosis,
(NAHCO3) Alkalinizing bicarbonate ion. Acidosis (Mild alkalosis, unknown abdominal (irritability, twitching, alkalosis. Do not give PO medication within 1 hr
agent. Therapeutic to Moderate), pain, hypocalcemia, severe paresthesia, cyanosis, slow of antacids.
CLINICAL: Effect: Prevention of pulmonary edema. Cautions: or shallow respirations, INTERVENTION/EVALUATION
Antacid, Neutralizes Contrast- HF, edematous states, renal headache, thirst, nausea). Monitor serum, urinary pH, CO2 level, serum
electrolyte hydrogen ion Induced insufficiency, cirrhosis. Fluid overload results in electrolytes, plasma bicarbonate levels. Watch
supplement, concentration, Nephropathy, headache, weakness, blurred for signs of metabolic alkalosis, fluid overload.
urinary/systemi raises blood, Metabolic vision, behavioral changes, Assess for clinical improvement of metabolic
c alkalinizer. uri nary pH. Acidosis incoordination, muscle acidosis (relief from hyperventilation,
(Associated twitching, elevated B/P, weakness, disorientation). Monitor daily
with Chronic bradycardia, tachypnea, pattern of bowel activity, stool consistency.
Renal Failure), wheezing, coughing, Monitor serum phosphate, calcium, uric acid
Renal Tubular distended neck veins. levels. Assess for relief of gastric distress
Acidosis Extravasation may occur at
(Distal), Renal the IV site, resulting in tissue
Tubular necrosis, ulceration.
Acidosis
(Proximal),
Urine
Alkalinization,
Antacid,
Hyperkalemia