I.

Look for the drug-drug interaction of the following drugs given and give nursing considerations
as you give the drugs together:

1. Celecoxib with ACE inhibitors

CELECOXIB WITH ACE INHIBITORS

DRUG-DRUG INTERACTION
● May decrease antihypertensive effect

NURSING CONSIDERATIONS
● Watch for signs and symptoms of overt and occult bleeding and rush
● Immediately evaluate signs and symptoms of heart attack or stroke
● Patients with HTN, edema, or heart failure should be closely monitored because these
drugs can cause fluid retention.
● Drugs may impair response of antihypertensives. Monitor BP.
● Assess patient for cardiovascular risk factors before therapy
● Keep an eye out for signs and symptoms of liver toxicity, as this medication may be
hepatotoxic.
● Before starting drug therapy, rehydrate patient who is dehydrated
● Monitor patient’s renal function; renal insufficiency is possible in patients with pre-existing
renal disease. Long-term administration may cause renal papillary necrosis and other renal
injury.
● Examine the patient for sulfonamide, aspirin, or NSAID allergies. Celecoxib
should not be given to patients who have these allergies.

2. amitriptyline hydrochloride with barbiturates

AMITRIPTYLINE HYDROCHLORIDE WITH BARBITURATES

DRUG-DRUG INTERACTION
● May increase amitriptyline metabolism. Consider therapy modification.

NURSING CONSIDERATIONS
● Restriction of drug availability for patients who are depressed or suicidal.
● Reduce dosage if signs or symptoms of psychosis occur or increase
● Record mood changes and monitor patient for suicidal tendencies and allow only minimum
supply of drug
● Stop using TCAs gradually a few days prior to surgery since individuals who use these may
get hypertensive episodes and arrhythmias.
● Monitor glucose level
● Watch for nausea, headache, and malaise after abrupt withdrawal of long-term therapy
3. acetylcysteine with activated charcoal

ACETYLCYSTEINE WITH ACTIVATED CHARCOAL

DRUG-DRUG INTERACTION
● May limit acetylcysteine’s effectiveness. Avoid using activated charcoal before or with oral
acetylcysteine

NURSING CONSIDERATIONS
● Monitor patient for bronchospasm, especially if patient has asthma
● Monitor patients receiving IV form for anaphylactoid reactions. Reactions involving more
than simple skin flushing or erythema should be treated as anaphylactic reactions. If
anaphylactoid reaction occurs, stop infusion and treat reaction with antihistamines and
epinephrine if needed. Once anaphylaxis treatment starts, carefully restart infusion. If
anaphylactoid symptoms return, stop the drug.
● When acetaminophen level is below toxic level according to nomogram, stop therapy.

4. budesonide inhalation with ketoconazole

BUDESONIDE INHALATION WITH KETOCONAZOLE

DRUG-DRUG INTERACTION
● May inhibit metabolism and increase the level of budesonide. Monitor patients for adverse
reactions and adjust dosage as needed.

NURSING CONSIDERATIONS
● When transferring from systemic corticosteroid to inhalation drug, use caution and
gradually decrease corticosteroid dose to prevent adrenal insufficiency
● If bronchospasm occurs after inhalation use, stop therapy and treat with a bronchodilator
● Watch for Candida infections of the mouth or pharynx
● Inhaled corticosteroids have been linked to increased IOP and cataract development. Stop
drugs if local irritation occurs.
● Monitor bone mineral density in patients at risk for decreased bone mineral content.
● Monitor children for reduction in growth velocity. Use the lowest effective dose.
● Monitor patient for hypercorticism and adrenal suppression and if they occur, reduce
dosage slowly
● Monitor patients for eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac
symptoms, and neuropathy.

5. clobazam with hormonal contraceptives

CLOBAZAM WITH HORMONAL CONTRACEPTIVES

DRUG-DRUG INTERACTION
● Clobazam may increase the metabolism of hormonal contraceptives, such as birth control
pills, which can reduce their effectiveness.

NURSING CONSIDERATIONS
● Monitor patients for signs of breakthrough bleeding or unintended pregnancy, especially if
they are using hormonal contraceptives while taking clobazam.
6. esmolol hydrochloride with antidiabetic agents

ESMOLOL HYDROCHLORIDE WITH ANTIDIABETIC AGENTS

DRUG-DRUG INTERACTION
● May increase blood glucose-lowering of antidiabetic. Closely monitor blood glucose
concentration.

NURSING CONSIDERATIONS
● Monitor ECG and BP continuously during infusion. Nearly half of patients will develop
hypotension. Diaphoresis and dizziness may accompany hypotension. Monitor patient
closely, especially if the patient had low BP before treatment.
● If a local reaction develops at the infusion site, change to another site.
● Monitor serum electrolyte levels, as hyperkalemia can occur, especially in patients with
renal impairments.
● Monitor patient for thyrotoxicosis when withdrawing drug.

7. indomethacin with aminoglycosides

INDOMETHACIN WITH AMINOGLYCOSIDES

DRUG-DRUG INTERACTION
● Avoid using together because it may enhance toxicity

NURSING CONSIDERATIONS
● Watch for and immediately evaluate signs and symptoms of heart attack or stroke
● Watch for bleeding in patients receiving anticoagulants, patients with coagulation defects,
and neonates
● Because NSAIDs impair synthesis of renal prostaglandins, they can decrease renal blood
flow and lead to reversible renal impairment, especially in patients with renal failure, heart
failure, or hepatic dysfunction; in older adults; and in patients taking diuretics. Monitor
these patients closely.
● Watch for weight gain (especially in older adults) and increased BP in patients with HTN as
these drugs can cause sodium retention
● Monitor patient for rash and respiratory distress, which may indicate hypersensitivity
reaction
● Monitor patient on long-term oral therapy for toxicity by conducting regular eye exams,
hearing tests, CBCs, and kidney function tests.

8. isoniazid with acetaminophen

ISONIAZID WITH ACETAMINOPHEN

DRUG-DRUG INTERACTION
● May inhibit acetaminophen metabolism. Monitor patient closely for hepatotoxicity.

NURSING CONSIDERATIONS
● Monitor and interview patients monthly. For those patients older than 35, aso measure
hepatic enzyme level before and periodically throughout treatment. Elevated liver function
test (LFT) results occur in about 15% of patients; most abnormalities are mild and
 transient, but some may persist throughout treatment, and progressive liver dysfunction
may occur. If liver function test (LFT) values exceed 3-5 x upper limit of normal (ULN),
strongly consider discontinuing treatment

9. mesalamine with warfarin

MESALAMINE WITH WARFARIN

DRUG-DRUG INTERACTION
● May lead to an increased risk of bleeding when taken together

NURSING CONSIDERATIONS
● Evaluate the patient's current INR (International Normalized Ratio) levels, if applicable, as
this will provide a baseline for warfarin therapy.
● Monitor the patient's vital signs regularly, paying attention to blood pressure and heart rate,
as well as any signs of bleeding or clotting such as unexplained bruising, petechiae, or
hematuria.
● Keep a close eye on the patient's stool for any signs of gastrointestinal bleeding, which can
be a side effect of mesalamine.
● If the patient has a history of bleeding episodes or a high risk of bleeding, work with the
healthcare provider to establish a schedule for more frequent INR monitoring.

10. rifampicin with probenecid

RIFAMPICIN WITH PROBENECID

DRUG-DRUG INTERACTION
● May increase rifampin levels. Use together cautiously.

NURSING CONSIDERATIONS
● In patients with existing impaired hepatic function, monitor liver function test (LFT) values,
especially aspartate transaminase (AST) and alanine transaminase (ALT), before therapy,
then every 2-4 weeks during therapy
● Watch for and report signs and symptoms of hepatic impairment
● Monitor hepatic function, hematopoietic studies, and uric acid level.

II. Give the adverse reactions of the following drugs on the systems indicated:
1. cimetidine – GI

CIMETIDINE GASTROINTESTINAL

ADVERSE EFFECT: Cimetidine: Nausea and Vomiting, diarrhea, abdominal pain,

flatulence, dry mouth, altered taste, mucosal changes
2. esterified estrogen – CNS

ESTERIFIED ESTROGEN CENTRAL NERVOUS SYSTEM

ADVERSE EFFECT: Headache, dizziness, chorea, depression, nervousness, mood

disturbance, irritability, exacerbation of epilepsy, dementia, stroke,
seizures

3. gentamicin sulfate – respiratory

GENTAMICIN SULFATE RESPIRATORY

ADVERSE EFFECT: Apnea

4. iloperidone – EENT

ILOPERIDONE EYE, EAR, NOSE, & THROAT

ADVERSE EFFECT: Blurred vision, conjunctivitis, dry mouth, nasal congestion,

nasopharyngitis

5. meropenem – CNS

MEROPENEM CENTRAL NERVOUS SYSTEM

ADVERSE EFFECT: Headache

6. simvastatin – respiratory

SIMVASTATIN RESPIRATORY

ADVERSE EFFECT: URI, Bronchitis

7. trospium chloride – EENT

TROSPIUM CHLORIDE EYE, EAR, NOSE, & THROAT

ADVERSE EFFECT: Dry eyes, mouth and nose; nasopharyngitis

8. desmopressin acetate – GI

DESMOPRESSIN GASTROINTESTINAL
ACETATE

ADVERSE EFFECT: Nausea, abdominal cramps

9. ethambutol hydrochloride – musculoskeletal

ETHAMBUTOL MUSCULOSKELETAL
HYDROCHLORIDE

ADVERSE EFFECT: Joint pain

10. promethazine hydrochloride - metabolic

PROMETHAZINE METABOLIC
HYDROCHLORIDE

ADVERSE EFFECT: Hyperglycemia