INDICATION AND DRUG ADVERSE CONTRAINDICAT NURSING

DRUG ACTION
DOSAGE INTERACTION REACTION ION CONSIDERATION
DIAZEPAM ➢ Anxiety. Adults: Chemical Drug-drug. CNS: pain, > Contraindicated >Obtain history of
Depending on severity, 2
➢ > Apo- to 10 mg P.O. b.i.d. Or 2
Effects: Crinetidine: May drowsiness, in patients patient’s underlying
diazep to 10 mg I.M. or I.V. q 3 May depress increase sedation. lethargy, hangover, hypertensive to condition before
am to 4 hours, if needed. CNS at limbic Monitor patients ataxia, fainting, drug or any of its therapy, and
Elderly Patients: 2 to 2.5 mg P.O
➢ > once or twice daily; increase and subcortical carefully. depression, components and in reassess regularly
Diastal gradually, as needed and levels of brain; CNS Depressants: anterograde, those with angle- thereafter.
➢ > tolerated. suppresses May increase CNS amnesia, psychosis, closure glaucoma,
➢ Acute alcohol
Diaze withdrawal. Adults: 10
spread of depression. Avoid slurred speech, shock, coma, or >Periodically
muls mg P.O. t.i.d or q.i.d., seizure activity using together. tremors, headache, acute alcohol monitor liver, kidney
➢ > p.r.n. Or, initially, 10 mg produced by Diltiazem: May insomnia. intoxication and hepatopoetic
I.M. or I.V.; then 5 to 10
Novo- mg I.M or I.V. in 3 to 4 epiloleptogenis increase CNS CV: transient (parenteral form). function studies in
Dipam hours, if needed. foci in cortex, depression and may hypotension, > Use cautiously in patient receiving
➢ Before endoscopic thalamus, and prolong effects of bradycardia, CV patients with repeated or
Pharmacologic procedures. Adults:
Titrate I.V. dose to limbic system. diazepam. Use collapse. hepatic or renal prolonged therapy.
class:
benzodiazepine desired sedative Therapeutic lower dose of EENT: diplopia, impairment,
response (up to 20 mg). Effects: diazepam. blurred vision, depression or >Look for adverse
➢ Or 5 to 10 mg I.M. 30
minutes before Relieves Fluconazole, nystagmus,. chronic open angle reactions and drug
procedure. anxiety, ketoconazole, GI: nausea, glaucoma. interactions.
➢ Muscle spasm: Adults: muscle itraconazole, vomiting, abdominal
2 to 10 mg P.O. b.i.d to
q.i.d daily. Or 5 to 10 mg spasm, miconazole: May discomfort, >Assess patient’s
I.M. or I.V. initially; then seizures increase and constipation. and family’s
5 to 10 I.M. or I.V in 3 to
4 hours p.r.n. For
(parenteral prolong diazepam Respiratory: knowledge of drug
tetanus, larger doses form); level, CNS respiratory therapy.
may be required. promotes depression, depression
Elderly patients: 2 to 2.5 mg I.M.
or I.V. once or twice daily; calmness and psychomotor Skin: rash, uticaria,
increase p.r.n. sleep. impairment. Don’t desquamation
Children age 5 and older: 5 to 10 use together. Other: physical or
mg I.M. or I.V .q 3 to 4 hours,
p.r.n. Digoxin: May psychological
Infants older than age 30 days increase level of dependence, acute
and younger than age 5 : 1 to 2
mg I.M. or I.V. slowly repeated q 3
digoxin, increasing withdrawal
to 4 hours, p.r.n. toxicity. Monitor syndrome after
➢ Preoperative dogoxin level. sudden
Sedation: Adults: 10 Phenobarbital: May discontinuation in
mg I.M. (preferred) or I.V.
before surgery. increase effects of physically
 ➢ Cardioversion: Adults: both drugs. Use dependent people,
5 to 15 mg I.V. 5 to 10
minutes before
together cautiously. phlebitis at injection
procedure. Phenytion: May site.
➢ Adjunct in seizure increase level of
disorders: Adults: 2 to
10 mg P.O. b.i.d to q.i.d.
phenytion. Monitor
Elderly Patients: 2 to 2.5 P.O. once patient for toxicity.
or twice daily; increase p.r.n. Ranitidine: May
Children and infants age 6
months and older: 1 to 2.5 mg
increase absorption.
P.O. t.i.d or q.i.d initially; increase Monitor patient for
as tolerated and needed. decreased effect.
➢ Status epilepticus: Drug-herb. Kava,
Adults: 5 to 10 mg I.V.
(preferred) or I.M. sassafras, valerian:
initially. Repeat q 10 to Sedative effects
15 minutes, p.r.n., to
maximum, 30 mg. may be enhanced.
Repeat in 2 to 4 hours Discourage using
p.r.n. together.
Children age 5 and older: 1 mg
I.V. q 2 to 5 minutes maximum,
10 mg. Repeat in 2 to 4 hours
p.r.n.
Infants older than age 30 days
and younger than age 5 : 0.2 to
0.5 mg I.V. slowly q 2 to 5
minutes t o maximum, 5 mg.
Repeat in 2 to 4 hours p.r.n.
➢ To control acute
repetitive seizure
activity in patients
already taking
anticonvulsants.
Adults and Children age 12 and
older: 0.2 mg/kg P.R. using
applicator. A second dose may be
given 4 to 12 hours after the first
dose, if needed.
Children age 6 to 11: 0.3 mg/kg
P.R. using applicator. A second
dose may be given 4 to 12 hours
after the first dose, if needed.
Children ages 2 to 5: 0.5 mg/kg
P.R. using applicator. A second
dose may be given 4 to 12 hours
after the first dose, if needed.
 INDICATION AND DRUG ADVERSE CONTRAINDICAT NURSING
DRUG ACTION
DOSAGE INTERACTION REACTION ION CONSIDERATION
GLIPEREMIDE >Type 2 (non insulin >Chemical effect: >Drug-drug. Beta >CNS: Dizzines, >Contraindicated in >Monitor fasting
dependent) diabetes blockers:May mask
mellitus who’s Stimulates release asthenia, headache. patients glucose periodically
>Amaryl symptoms of
hyperglycemia can’t of insulin from EENT: changes in hypersensitive to to determine
be managed by diet pancreatic beta hypoglycemia. accommodation. the drug or any of therapeutic
Pharmacologic and exercise alone. Monitor glucose levels
Adults: Initially. 1 to 2 cells; increase GI: nausea. its components, in response. Also
class: sulfonylurea carefully.
mg P.O. once daily with sensitivity of >Hematologic : those with diabetic monitor
first meal of day. Usual
maintenance dosage to peripheral tissues to Drugs that may leucopenia, ketoacidosis, and in glycosylated
4 mg. P.O. once daily. insulin. produce hemolytic anemia, those with allergies hemoglobin level,
After reaching 2 mg. > Therapeutic hyperglycemia, other agranulocytosis, to sulfonamides or usually every 3 to 6
increase dosage in diuretics: May lead to
increments not effect: Lowers thrombocytopeni thiazide diuretics. months, to more
loss of glucose
exceeding 2 mg q 1 to glucose levels. a, apastic >Use cautiously in precisely assess
2weeks, based on control. May require
patients response. anemia, debilitated or long-term glycemic
dosage adjustment.
Maximum, 8 mg daily. pancytopenia. malnourished control.
>Adjustment to Insulin: May increase patients and in >Assess patient’s
insulin therapy in
potential for Hepatic:
patients with type 2 those with adrenal, and family’s
hypoglycemia. cholestatic jaundice.
( non-insulin pituitary, hepatic, or knowledge of drug
dependent) diabetes Monitor glucose level >Metabolic:
mellitus whose renal insufficiency. therapy.
closely. hypoglycemia.
hyperglycemia can’t
be managed by diet NSAIDs: , other highly
and exercise with oral
Skin: allergic skin
hypoglycemic. protien –bound drugs: reactions ( pruritis,
Adults: 8 mg P.O. once May increase erythema, urticaria
daily with first main hypoglycemic action
meal of the day, low- and morbilliform or
of sulfonylureas, such
dose insulin. Adjust maculopapular
insulin upward weekly as glimeperide.
p.r.n., based on patient’s Monitor patient eruptions).
response carefully.
>Adjust to metformin
therapy in patients >Drug herb. Aloe,
with type 2 ( non-
insulin-dependent) bitter melon, bilberry
diabetes mellitus leaf, burdock,
whose hyperglycemia dandelion, fenugreek,
can’t be managed by garlic, ginseng: May
diet exercise, and
gliperemide or improve glucose
metformin alone. control, which may
Adults: 8 mg P.O. once allow reduction of oral
daily with first meal of
the day, in combination hypoglycemic. Tell
with metformin. Adjust patient to discuss
dosages based on herbs with prescriber
patient’s blood glucose
before use.
response to determine
minimum effective
>Drug
dosage of each drug.
lifestyle.Alcohol use:
May alter glycemic
control, most
commonly
hypoglycemia. May
cause disulfiram like
reaction. Discouraging
using together.
Sex Exposure: May
cause photosensitivity.
Discourage prolonged
or unprotected
exposure to the sun.
 INDICATION AND ADVERSE CONTRAINDICAT NURSING
DRUG ACTION DRUG INTERACTION
DOSAGE REACTION ION CONSIDERATION
HYDROCORTISON >Severe >Chemical effect: >Drug-drug: Aspirin, Most adverse >Contraindicated in >Assess patients
E Inflammation, Not clearly defined; indomethacin, other reactions are dose or patients condition before
adrenal NSAIDs: May increase risk duration dependent.
decreases hypertensive to starting therapy and
>Cortel insufficiency: Adults: of GI distress and bleeding.
20 to 240 mg
inflammation, >CNS: euphoria, drug or any of its regularly thereafter.
>Cortenema Give together cautiously.
hydrocortisone or mainly by stabilizing insomnia, psychotic components, and in >Monitor patient’s
>Hydrocortone
crypionate P.O. daily. Or leukocyte lysosomal Barbiturates,phyenytoin,rif behavior, those with systemic weight, blood
5 to 75 mg acetate membranes; ampin: May decrease pseudomotor cerebri, fungal infections. pressure, and
Pharmacologic injected into joints to corticosteroid effect; may seizures.
suppresses immune Hydrocortisone electrolyte levels.
class: soft tissue. Give once q require increased dosage.
response; >CV: heart failure, sodium succinateis >Monitor patient for
2 to 3 weeks, although
Adrenocortical stimulates bone Live-attenuated virus hypertension, edema, contraindicated in stress. Fever,
some conditions may
steroids require weekly marrow; and vaccines, other toxoids arythmias, premature infants. trauma, surgery,
injections. Dosage influences nutrient and vaccines: May thromboembolism. >Use cautiously in and emotional
varies with degree of metabolism. decrease antibody patients with recent problems may
>EENT: cataracts,
inflammation and size >Therapeutic response and increase risk MI and in those with increase adrenal
and location of the joint glaucoma.
effect: Reduces of neurologic GI ulcer, renal insufficiency.
of soft tissues. Or 15 to complications. Avoid using >GI: peptic
inflammation, disease, >Periodically
240 mg phosphate I.V., all together.
suppresses immune ulceration, GI hypertension, measure growth and
or I.M. , or S.C. daily,
function and raises irritation, increased osteoporosis, development during
divided into 12- hour Oral anticoagulants: May
appetite,
 intervals. Or, initially, adrenocorticoid alter dosage requirements. pancreatitis. diabetes mellitus, high dose and
100 to 500 mg hormonal levels. Monitor PT and INR closely. hypothyroidism, prolonged therapy
succinate I.V. or I.M. ; >Metabolic:
Potassium depleting drugs hypokalemia, cirrhosis, in child.
may repeat q 2 to 6
hours p.r.n. (such as thiazide hyerglycemia, diverticulitis, >Be alert for
diuretics): May enhance carbohydrate nonspecific adverse reactions
>Adjuct for potassium-wasting effects intolerance. ulcerative colitis, and drug
ulcerative colitis and of hydrocortisone. Monitor recent instability, interactions.
proctitis. Adults: >Musculoskeletal:
potassium level. and psychotic >Assess patient’s
muscle weakness,
1 enema (100 mg)
Skin-test antigens :May growth suppression in tendencies and family’s
hydrocortisone or knowledge of drug
decrease skin response. children, osteoporosis.
acetate P.R. nightly for therapy.
Defer testing until therapy
21 days. >Skin: hirsutism,
is completed.
delayed wound
>Shock. Adults:
Initially, 50 mg/kg >Drug lifestyle: Alcohol healing, acne, various
succinate I.V. repeated use: May increase risk of skin eruptions, easy
in 4 hours or q 24 GI effects. Discourages brusing.
hours, p.r.n. using together.
>Other: susceptibility
Children: 0.16 to 1 to infections,acute
mg/kg or 6 to 30 adrenal
mg/m2 phosphate I.M. insufficiencywith
or succinate I.M. or I.V. increased stress
daily or b.i.d. (infection, surgery,
or trauma) or
abrupt withdrawal
after long-term
therapy.

INDICATION AND DRUG ADVERSE CONTRAINDICAT NURSING

DRUG ACTION
DOSAGE INTERACTION REACTION ION CONSIDERATION
LEVOFLOXACIN >Acute Maxillary >Chemical effect: >Drug-drug. >CNS: headache, >Contraindicated in >Obtain specimen
Sinusitis caused by
>Levaquin Inhibits bacterial Aluminum, hydroxide, insomnia, dizziness, patients for culture and
susceptible strains of
Stertococcus DNA gyrase and calcium carbonate, encephalopathy, hypersensitive to sensitivity tests
 penumoniae, Monraxella prevents DNA magnesium paresthesia, pain, the drug or any of before starting
catarrhalis, or
Pharmacologic class: replication, hydroxide: May seizures. its components, or therapy and as
Haemophilus Influenzae.
fluorinated Adults: 500 mg P.O. or daily transcription, repair, decrease effects of other needed to detect
carboxyquinolone for 10-14 days. levofloxacin. Give >CV: Chest pain,
and recombination fluoroquinolones. bacterial resistance.
antacid at least 6 palpitations,
>Acute bacterial in susceptible vasodilation, Therapy may begin
exascerbation of chronic hours before or 2
bacteria. abnormal ECG. pending results.
bronchitis caused by hours after
Streptococcus aureus, S. >Therapeutic levofloxacin. >Obtain history of
pnenumoniae, M. effect: Kills >GI: nausea, seizure disorders or
catarrhalis, or H.
susceptible Antidiabetics: May diarrhea, other CNS diseases,
influenza, or
bacteria. alter glucose levels. constipation, such as cerebral
parainfluenzae.Adults:
Monitor them closely. vomiting, abdominal
500 mg P.O. or I.V. daily for arteriosclerosis,
7 days. pain, dyspepsia, before starting
Iron salts: May
flatulence.
>Community –acquired decrease absorption therapy.
pneumonia caused by S.
of levofloxacin Pseudomembrano >Monitor glucose
pnenumoniae resistant
to two or more of the reducing anti us colitis. level and renal,
following antibiotics: -infective response. hepatic, and
penicillin, second- Give at least 2 hours >GU: vaginitis
generation hematopoetic blood
apart.
cephalos[orins, >Hematologic : studies.
macrolides,
NSAIDs: May increase eosinophilia, >Assess patient’s
tetracyclines,
trimethoprim, and CNS stimulation. hemolytic anemia, and family’s
sulfamethoxazole; or by Monitor patient for lymphocytopenia. knowledge of drug
S. aureus, M. seizures.
catarrhalis, H. influenza,
therapy.
>Metabolic:
H. parainfluenzae, Sucralfate, products
Klebsiella pnuemoniae,
Hypoglycemia
containing zinc: May
Chlamydia pneumoniae,
Legionella interfere with GI Muscoskeletal:
pneumophilia, absorption of back pain, tendon
Mycoplasma levofloxacin. Give at rupture.
pnuemoniae, or S.
least 2 hours apart.
pnuemoniae. Adults: 500
Respiratory:
mg P.O. or I.V. daily for 7 to
14 days. Or, 750 mg P.O. or
Theophyline: May allergic pneumonitis.
I.V. once daily for 5 days decrease theophyline
( not for multidrug-resistant clearance with some Skin: Rash,
S. pneumoniae). fluoroquinolones. photosensitivity
>Mild moderate skin and Monitor theophylline reactions, pruritis,
skin –structure
levels. erythema
infections caused by S.
aureus or Stretococcus multiforme,
Wafarin: May enhance
pyogenes. Adults: 500 mg Stevens-johnson
P.O. or I.V. daily for 7 to 10 anticoagulant effects.
syndrome.
days.
Monitor PT and INR
>Mild to moderate closely. Other:
uncomplicated UTI causd hypersensitivity
by Escherichia coli, K. >Drug-lifestyle. Sun reactions,
Pneumoniae or
exposure: May cause anaphylaxis,
Straphylococcus
saprophyticus. Adults: photosensitivity multisystem organ
250 mg. P.O. daily for 3 reactions. Urge failure.
days. patient to avoid
>Mild and Moderate UTI unprotected or
caused by Enterococcus prolonged exposure to
faecalis, Enterobacter sunlight.
cloacae, E. coli, K.
Pneumoniae, or
Pseudomonas
aeruginosa. Adults: 250
mg P.O or I.V. daily for 10
days.

>Mild moderate acute

pyelonephritis caused by
E coli. Adults: 250 mg. P.O.
or I.V. daily for 10 days.

> Complicated skin to

skin structure infections
causedby methicillin-
sensitive S aureus, E.
faecalis, S. pyogenes, P.
mirabilis; nosocomial
pneumonia caused by
methicillin susceptible S.
aureus , P. aeuginosa,
Serratia marcescens, E.
coli, K. Pneumoniae, H.
influenza, or S.
 pneumoniae. Adults: 750
mg P.O. or I.V. infusion over
90 minutes daily for 7 to 14
days.

>Chronic bacterial
prostatitis caused by E.
coli, E. faecalis, or
Straphylococcus
epidermidis. Adullts: 500
mg P.O. or I.V. daily for 28
days.

INDICATION AND DRUG ADVERSE CONTRAINDICAT NURSING

DRUG ACTION
DOSAGE INTERACTION REACTION ION CONSIDERATION
FERROUS >Iron deficiency. >Chemical effect: >Drug-drug. >GI: nausea, >Contraindicated in >Obatin baseline
SULFATE Adults: 50 to 100 provides elemental Antacids, epigastric pain, patients with assessment of
cholestyramine resin,
mg ferrous fumerate iron, an essential vomiting, primary patient’s iron
>ferosol fluoroquinolones,
elementa iron P.O. component in levodopa,
constipation, hemochromatosis, deficiency before
t.i.d. Or 325 mg formation of penicillamine, diarrhea, black hemosiderosis, starting therapy.
ferrous gluconate hemoglobin. tetracycline, vitamin stools, anorexia. hemolytic anemia >Evaluate
Pharmacologic P.O. q.i.d.; increase >Therapeutic E.: May decrease iron >Other: (unless iron hemoglobin,
class: oral and iron absorption. Separate
supplement to 650 mg q.i.d. if effect: Relives iron doses by 2 to 4 hours. suspension and deficiency anemia is hematocrit, and
needed and deficiency. Chloramphenicol: May
drops may also present), peptic reticulocyte count
tolerated. Or 300 increase iron response. temporarily stain ulcer disease, during therapy.
mg ferrous sulfate Watch patient carefully. teeth. regional enteritis, or >Be alert for
P.O. b.i.d to q.i.d.; Or ulcerative colitis, adverse reactions
Flouroquinolones,
I extended- penivillamine,
and in those and drug
releasecapsule tetracyclines: May receiving repeated interactions.
( 160 to 525mg ) decrease GI absortion, blood transfusions. >Assess patient’s
ferrous sulfate P.O. possibly decreasing >Use cautiously on and family’s
daily to b.i.d. levels and long term basis. knowledge of drug
Children: 4 to 6 effectiveness. Separate therapy.
doses by 2 to 4 hours.
mg/kg ferrous
fumerate P.O. daily, L-Thyroxine: May
divided into three decrease L- thyroxine
doses. absortion. Separate
doses by at least 2
Children age 2 and
hours. Monitor thyroid
older: 3 mg/kg function.
ferrous gluconate
P.O. daily in three to Levodopa, methyldopa:
May decrease
four divided doses.
absorption and
Or 3 mg/kg ferrous effectiveness of
sulfate daily in three levodopa and
or for divided doses. methyldopa. Monitor
patient for decreased
effects of these drugs.

Vitamin C: May
increase iron
absorption. Suggest
patient take vitamin C
with drug.

>Drug-food: Cereals
,cheese coffee, eggs,
,milk, tea, whole-grain
breads, yogurt. May
impair oral iron
absorption. Advise
against using together.