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Classification: GASTROINTESTINAL AGENT; ANTISECRETORY (H2-RECEPTOR ANTAGONIST)

CONTRAINDICATIO NURSING
GENERIC NAME INDICATION AND DOSAGE ACTION SIDE EFFECTS
N CONSIDERATION
Ranitidine •Active Duodenal Ulcer •Completely •Contraindicated •CNS: headache, •Instruct patient on
HCL Adults: PO 150mg b.i.d. or 300 inhibits action of in patients malaise, vertigo proper use of OTC
mg at bedtime. Maintenance histamine on the hypersensitive to preparation as
dose is 150 mg at bedtime. H2 at receptor drug and those •EENT: Blurred vision, indicated.
IM/IV/Intermittent IV 50 mg every sites of parietal with porphyria
6 to 8 h. cells, decreasing •Assess patient for
•Hepatic: jaundice
gastric acid •Use cautiously in abdominal pain.
Children 1 mon -16 y/o: PO 2 to 4 secretions patients with Note presence of
mg/kg twice daily (max, 300 hepatic •Other: anaphylaxis, blood in emesis,
mg/day). dysfunction. Adjust angioedema, burning stool, or gastric
dose in patients ad itching at injection aspirate
•Maintenance therapy for with impaired renal site
Duodenal and Gastric Ulcers function •Ranitidine may be
Adults: 150mg P.O at bedtime added to total
parenteral nutrition
Children 1 mon -16 y/o: PO 2 to 4 solution
mg/kg daily up to 150mg daily
•Remind patient to
•Pathologic Hypersecretory take once daily
Conditions prescription drug at
Adults: PO 150 mg twice daily. bedtime for best
Individualize. results

•GERD and Erosive Esophagitis •Instruct patient to


Adults: PO 150mg b.i.d. take without regard
to meals because
Children 1 mon -16 y/o: PO 5 to absorption isn’t
10 mg/kg daily usually given in 2 affected by food
divided doses.
• Remind patient not
•Erosive Esophagitis: to confuse ranitidine
Maintenance dosage is 150mg with rimantadine:
P.O. q.i.d. don’t confuse Zantac
with Xanax or Zyrtec
•Heartburn
Adults and Children 1 mon -12
y/o and older: 75mg of Zantac 75
P.O. as symptoms occur, up to
150mg daily, not to exceed 2
weeks of continuous treatment.

Classification: Opioid Agonist-Antagonist


INDICATION AND
GENERIC NAME ACTION CONTRAINDICATION SIDE EFFECTS NURSING CONSIDERATION
DOSAGE
Nalbuphine •Management of •Binds with •Contraindicated in • CNS: Sedation, •Reassess patient’s level of
HCL moderate to severe pain opiate patients dizziness, vertigo, pain at least 15 and 30
receptors in hypersensitive to headache, agitation, minutes after parenteral
•preoperative and the CNS, drug confusion, crying, administration
postoperative analgesia altering depression, dysphoria,
perception of •Use cautiously in euphoria, faintness, •Nalbuphine acts as an
•supplement to and emotional patients with history floating feeling, opioid antagonist and may
balanced anesthesia response to of drug abuse and in hallucinations, heaviness cause withdrawal
pain. those with emotional feeling, hostility, syndrome. For patients who
•obstetrical analgesia instability, head nervousness, numbness, have received log-term
during labor and injury, increased ICP, opioids, give 25% of the
restlessness, seizures,
delivery impaired ventilation, tingling, unreality, usual dose initially. Watch
MI accompanied by unusual dreams for sings of withdrawal.
DOSAGE N/V, upcoming
Adults Subcutaneous / biliary surgery, and •Alert: Drug causes
IM / IV 10 mg per 70 kg •CV: Bradycardia,
hepatic or renal respiratory depression,
q 3 to 6 h as needed. hypertension,
disease which at 10mg is equal to
Individualize dosage. In hypotension, tachycardia
respiratory depression
nontolerant patients, do produced by 10 mg of
not exceed 20 mg/dose •EENT: Blurred vision, dry morphine
or 160 mg/day mouth
•Monitor circulatory and
•GI: Nausea, vomiting, respiratory status, bladder
biliary tract spasms, and bowel function. If
constipation cramps, respirations are shallow or
dyspepsia rate is below 12
breaths/minute, withhold
•GU: Urinary urgency dose and notify prescriber

•Constipation is often
•Respiratory: severe with maintenance
Respiratory depression, therapy. Make sure stool
asthma, dyspnea, softener or other laxative is
pulmonary edema ordered.

•Skin: Burning, •Psychological and physical


clamminess, diaphoresis, dependence may occur with
prolonged use.
pruritus, uticaria
• Remind patient not to
confuse Nubain with
Navane.

Classification: Dopamine Antagonist, GI stimulant


NURSING
GENERIC NAME INDICATION AND DOSAGE ACTION CONTRAINDICATION SIDE EFFECTS
CONSIDERATION
Metoclopramid •To prevent or reduce nausea and •Stimulates •Contraindicated in •CNS: •Monitoe bowel
e HCL vomiting from emetogeic cancer motility of upper patients Restlessness, sounds.
therapy. GI tract, hypersensitive to drowsiness,
increases lower drug and those with fatigue, lassitude, •Safety and
Adults: 1-2mg/kg I.V. 30 mins before esophageal pheochromocytoma insomnia, effectiveness of
chemotherapy; repet every 2 hours sphincter toe, or seizure disorders extrapyramidal drug haven’t been
for two doses, then every 3 hours for and blocks reactions, established for
3 doses dopamine • Contraindicated in parkinsonism-like therapy lasting
receptors at the patientsfor whom reactions, longer than 12
•To prevent or reduce postoperative chemoreceptor stimulation of GI akathisia, weeks.
nausea and vomiting. trigger zone motility might be dystonia,
Adults: 10-20mg I.M. near end of dangerous myoclonus, •ALERT: Use 24m
surgical procedure; repeat every 4-6 dizziness, anxiety diphenhydramine
hours, PRN •Use cautiously in I.V. to counteract
patients with history Extrapyramidal
•To facilitate small-bowel incubation, •CV: hypotention,
of depression, adverse effect
to aid in radiologic examinations Transient
Parkinson dse. Or from high doses
hypertension,
HPN
Adults and Children older than 14 bradycardia
y/o: 10mg or 2ml I.V. as a single
dose over 1-2 minutes. •GU: incontinence,
urinary frequency
Children ages 6-14 y/o: 2.5 -5mg or
0.5 to 1ml I.V. •GI: Nausea,
diarrhea, bowel
• Delayed gastric emptying
d/o
secondary to diabetic gastroparesis:
10 mg PO 30 min before each meal
for mild symptoms. Give slow I.V •Hematologic:
infusion over 12 minutes 30 minutes agranulocytosis,
before each meal ad at bedtime for
up to 10 days for severe symptoms;
then P.O. dose may be started and neutropenia
continue for 2-8 weeks
•skin: rash,
•gastroesophageal reflux dse: 10– urticaria
15 mg PO q.i.d, p.r.n., 30 min before
meals and at bedtime

•Emesis during pregnancy: Adults: 5-


10m P.O. or 5-20mg I.V. or I.M. t.i.d

Classification: Piperazine derivatine


NURSING
GENERIC NAME INDICATION AND DOSAGE ACTION CONTRAINDICATION SIDE EFFECTS
CONSIDERATION
Hydroxyzine •Anxiety/Tension •Suppresses •Contraindicated in •CNS: Transitory •Parenteral form
HCL Adults: PO / IM 50 to 100 mg 4 times activity in patients drowsiness; (hydroxyzine HCL) is
daily. certain essential hypersensitive to involuntary motor for I.M. use only,
Children older than 6 yr of age: PO regions of the drug, Early activity, including preferably by Z-tract
50 to 100 mg/day in divided doses. subcortical area pregnancy; tremor and injection. Never give
Children younger than 6 yr of age: of the CNS hypersensitivity to convulsions. drug I.V or
PO 50 mg/day in divided doses. hydroxyzine or subcutaneously
cetirizine and breast •GI: dry mouth
•Pruritus feeding women and constipation •Aspirate I.M
Adults: PO / IM 25 mg 3 or 4 times injection carefully to
daily. prevent inadvertent
•other: pain at
Children older than 6 yr of age: PO I.V injection. Inject
the injection site,
50 to 100 mg/day in divided doses. deeply into a large
hypersensitivity
Children younger than 6 yr of age: muscle.
reactions.
PO 50 mg/day in divided doses.
•If patient take CNS
•Psychiatric and Emotional drugs, observe for
Emergencies over sedation.
Adults: IM 50 to 100 mg stat and
every 4 to 6 h as needed. •Elderly patients
may be more
•Sedation sensitive to adverse
anti cholinergic
Adults: PO / IM 50 to 100 mg.
Children: PO / IM 0.6 mg/kg. effects, monitor
these patients for
dizziness, excessive
sedation, confusion,
hypotension, and
syncope.

•Remind patient not


to confuse
hydroxyzine with
hydroxyurea or
hydralazine

Classification: NSAID
CONTRAINDICATIO NURSING
GENERIC NAME INDICATION AND DOSAGE ACTION SIDE EFFECTS
N CONSIDERATION
• short term management of moderately •may inhibit •patients in whom • dizziness, • Check for
Ketorolac severe, acute pain prostaglandin ketorolac, aspirin, or sedation, doctor’s order
Tromethamine synthesis, to any NSAID have headache,
DOSAGE caused
produce anti- flatulence, •Perform ANST
hypersensitivity or
Single Dose inflammatory, nausea and prior to
allergic-type or
Adults: IM, IV Younger than 65 yr of age: 60 analgesic and reactions; active vomiting
admission
mg. Older than 65 yr of age, renal impairment, antipyretic peptic ulcer disease;
or weight less than 50 kg (110 lbs): 30 mg. IV effects. recent GI bleeding or •Should not be
Younger than 65 yr of age: 30 mg. Older than perforation;
65 yr of age, renal impairment, or weight less advanced renal given if positive
than 50 kg (110 lbs): 15 mg. impairment and in skin test
Children 2 to 16 yr of age: IM 1 mg/kg up to patients at risk for
30 mg max. IV 0.5 mg/kg up to 15 mg max. renal failure because •Slow IV push
of volume depletion;
Multiple Dose suspected or •Inform the
Adults: IM Younger than 65 yr of age: 30 mg confirmed
every 6 h. Do not exceed 120 mg/day. Older cerebrovascular patient about the
than 65 yr of age, renal impairment, or weight bleeding; possible side
less than 50 kg (110 lbs): 15 mg every 6 h. Do hemorrhagic effect of the drug
not exceed 60 mg/day. diathesis, incomplete
hemostasis, and •Advise patient
Transition from IV or IM to Oral those at high risk of
Adults: Younger than 65 yr of age: 20 mg as a bleeding; history of to report any
first oral dose for patients who received 60 mg peptic ulcer disease discomfort on the
IM single dose, 30 mg IV single dose, or 30 mg or GI bleeding; as IV insertion site
multiple dose IV/IM, followed by 10 mg every 4  prophylactic
to 6 h, not to exceed 40 mg per 24 h. Older analgesia before any
than 65 yr of age, renal impairment, or weight major surgery and
less than 50 kg (110 lbs): 10 mg as a first oral intraoperatively
dose for patients who received a 30 mg IM when hemostasis is
single dose, 15 mg IV single dose, or 15 mg critical; for
multiple dose IV/IM, followed by 10 mg every 4 intrathecal or
to 6 h, not to exceed 40 mg per 24 h. epidural
administration; labor
and delivery;
lactation;
concomitant use with
aspirin or other
NSAIDs; concomitant
use with
probenecid.en

Classification: first – generation Cephalosporin


CONTRAINDICATIO NURSING
GENERIC NAME INDICATION AND DOSAGE ACTION SIDE EFFECTS
N CONSIDERATION
Cefazolin •Treatment of infections of •First- generation •Containdicated in •Seizure, headache, •Before giving drug,
Sodium respiratory tract, urinary tract, cephalosporin patients confusion. ask patients if he is
skin and skin structures, biliary that inhibits cell- hypertensive to Thrombophlebitis with allergic to penicillin
tract, and bone and joint; wall synthesis, drug or other I.V. injection, diarrhea, or cephalosporins.
promoting cephalosporins. hypersensitivity
•Treatment of genital infections; osmotic reactions, abdominal •Obtain specimen
treatment of septicemia; instability, usually •Use cautiously in cramps for culture and
bactericidal patients sensitivity test
•Treatment of endocarditis hypertensive to before giving first
caused by susceptible strains of penicillin because dose. Therapy may
specific microorganisms; of the possibility of begin while awaiting
perioperative prophylaxis. cross-sensitivity results.
with other
DOSAGE betalactam •If creatinine
antibiotics. clearancefall below
Infection 55ml/miute, adjust
Adults: IM/IV Moderate to severe •Use cautiously I dosage.
infections: 500 mg to 1 g every 6 breast-feeding
to 8 h. Mild infections: 250 to 500 women and I •After reconstitution,
mg every 8 h. Severe, life- patients with a inject drugs I.M.
threatening infections: 1 to 1.5 g history of colitis or without further
every 6 h. real insufficiency. dilution. This drug
isn’t as painful as
Children older than 1 month other cephalosporin.
of age: IM/IV Mild to moderate Give injection deep
infections: 25 to 50 mg/kg (10 to into a large muscle,
20 mg/lb) daily divided into 3 or such as gluteus
4 equal doses. Severe infections: maximus or the side
100 mg/kg (45 mg/lb). of the thigh

Acute Uncomplicated UTIs •If large doses are


Adults: IM/IV 1 g every 12 h. given, therapy is
prolonged, or patient
Pneumococcal Pneumonia is at high risk,
Adults: IM/IV 500 mg every 12 h. monitor patients for
signs and symptoms
Perioperative Prophylaxis of super- infection.
Adults: IM/IV 1 g administered
½ to 1 h prior to start of surgery.
Operative procedures of 2 h or
more: 500 mg to 1 g during
surgery. Postoperatively: 500 mg
to 1 g every 6 to 8 h for 24 h.

Renal Function Impairment


Adults: IM/IV Ccr 55 mL/min or
greater: Administer full dose. Ccr
35 to 54 mL/min: Administer full
dose restricted to at least 8 h
intervals. Ccr 11 to 34 mL/min:
Administer 50% of usual dose
every 12 h. Ccr 10 mL/min or
less: Administer 50% of usual
dose every 18 to 24 h.

Children older than 1 month


of age: IM/IV Dosage
recommendations apply after an
initial loading dose. Ccr 70 to 40
mL/min: Administer 60% of
normal daily dose in equally
divided doses every 12 h. Ccr 40
to 20 mL/min: Administer 25% of
normal daily dose in equally
divided doses every 12 h. Ccr 20
to 5 mL/min: Administer 10% of
normal daily dose every 24 h.

Classification: antiinfective; aminoglycoside antibiotic


GENERIC NAME INDICATION AND DOSAGE ACTION CONTRAINDICATIO SIDE EFFECTS NURSING RESPONSIBILITY
N
Gentamicin Moderate to Severe •Broad- • History of •CNS: Assessment & Drug Effects
Infection spectrum hypersensitivity to neuromuscular
Adult: IV/IM 1.5–2 mg/kg aminoglycosid or toxic reaction blockade: skeletal • Lab tests: Perform C&S and
loading dose followed by 3– e antibiotic with any muscle weakness, renal function prior to first
5 mg/kg/d in 2–3 divided derived from aminoglycoside apnea, respiratory; dose and periodically during
doses Intrathecal 4–8 mg Micromonospo antibiotic. Safe use arachnoiditis therapy; therapy may begin
preservative free q.d. ra purpurea. during pregnancy pending test results.
Topical 1–2 drops of Action is (category C) or •CV: hypotension or Determine creatinine
solution in eye q4h up to 2 usually lactation is not clearance and serum drug
hypertension.
drops q1h or small amount bacteriocidal. established concentrations at frequent
intervals, particularly for
of ointment b.i.d. or t.i.d. •GI: Nausea, patients with impaired renal
Child: IV/IM 6–7.5 mg/kg/d vomiting, transient function, infants (renal
in 3–4 divided doses increase in AST, ALT, immaturity), older adults,
Intrathecal >3 mo, 1–2 and serum LDH and patients receiving high
mg preservative free q.d. bilirubin; doses or therapy beyond 10
Neonate: IV/IM 2.5 mg/kg hepatomegaly,
d, patients with fever or
q12–24h extensive burns, edema,
splenomegaly. obesity.
Acute Pelvic • Repeat C&S if improvement
Inflammatory Disease •Hematologic: does not occur in 3–5 d;
Adult: IV/IM 2 mg/kg Increased or reevaluate therapy.
followed by 1.5 mg/kg q8h decreased • Note: Dosages are generally
reticulocyte counts; adjusted to maintain peak
Prophylaxis of Bacterial granulocytopenia, serum gentamicin
thrombocytopenia, concentrations of 4– 10
Endocarditis g/mL, and trough
Adult: IV/IM 1.5 mg/kg 30 thrombocytopenic
purpura, anemia. concentrations of 1–2 g/mL.
min before procedure, may Peak concentrations above
repeat in 8 h 12 g/mL and trough
Child: IV/IM < 27 kg, 2 •Other: Local concentrations above 2 g/mL
mg/kg 30 min before irritation and pain are associated with toxicity.
procedure, may repeat in 8 following IM use;
h thrombophlebitis, • Draw blood specimens for
abscess, peak serum gentamicin
superinfections, concentration 30 min–1h
syndrome of after IM administration, and
hypocalcemia 30 min after completion of a
30–60 min IV infusion. Draw
blood specimens for trough
levels just before the next IM
or IV dose. Use
nonheparinized tubes to
collect blood.