Drugs Used To Treat Digestive Problems: Classification: Antidiarrheals

DRUGS USED TO TREAT DIGESTIVE PROBLEMS
Classification: Antidiarrheals
DRUG
ACTION
Difenoxin (Motofen)
MECHANISM OF ACTION:
Decrease the effects of the
Diphenoxylate (Lomotil)
mesenteric plexus of the
- Dosage: tablet 2 mg;
intestines
capsule 2 mg; liquid 1
Inhibit peristalsis by direct
mg/5 mL or 1 mg/mL
- Frequency: PRN for
central action on the brain
every unformed stool
Decrease propulsive
- Route: oral
contractions
Loperamide (Imodium)
Enhance sphincter tone
- Dosage: tablet 2 mg
Enhances ileocecal valve
- Frequency: PRN for
tone
every unformed stool; 16 cap/day
ADVERSE EFFECTS:
- Route: oral
Anorexia and nausea (in
Bismuth subsaliculate
early stage)
(Pepto bismol)
Abdominal distention
Cholestyramine resin
Auscultation of high pitched
(Questran)
sounds over the abdomen
Attapulgite (Diatabs)
Eventually, a silent
Activated charcoal
abdomen absent of bowel
Kaolin & Pectin (Kaopectate)
sounds
Possible percussion of air or
fluid over distended
abdomen
Absence of flatus
Absence of bowel
movements
Loperamide (Imodium)
INDICATION/CONTRAINDICATION
INDICATION:
Decrease peristalsis in the
intestines by depressing the
circular and longitudinal
muscles of the small
intestine
Decrease propulsive
contractions throughout the
entire colon
Diphenoxylate may provide
antisecretory effect but
little analgesic
Loperamide produces less
severe CNS effects than
difenoxin o diphenoxylate
Kaolin and Pectine are locally

acting antidiarrheal that are
not absorbed; also act as
adsorbents
CONTRAINDICATION:
Use cautiously with hepatic

dysfunction, acute
ulcerative colitis, pregnancy
and lactation
Contraindicated with allergy
to any components or to
aspirin or other salicylates
NURSING RESPONSIBILITY
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
5. Right time and manner
6. Right client education
7. Right documentation
8. Right to refuse medications
9. Right assessment
10.Right evaluation
Obtain an order for

antiemetic if patient vomits
Identify the use of drugs
that may interact with
opium
Assess bowel pattern
Watch for signs of
hypoperistalsis (withhold
the next dose of the drug)
Record I & O
Possible vomiting with

resultant fluid and
electrolyte imbalance
DRUG INTERACTIONS:
Can enhance the
depressant effects of
alcohol, barbiturates,
tranquilizers and other CNS
Has additive effects when
used together with
anticholinergics
Classification: Laxatives (Hyperosmolar laxatives)

DRUG
ACTION
Glycerin
- Dosage: Adults 15-30
mL/day; Children (7-14)
15 mL/day; (1-6) 5-10
mL/day; Infant 5 mL/day
- Frequency: OD
- Route: oral or rectal or
ophthalmic
Lactulose (Duphalac)
- Dosage: Oral 1-2 g/kg;
ophthalmic 1 or 2 drops
- Frequency: OD
- Route: oral or rectal
Magnesium salts
Sodium biphosphate
Glycerin acts by osmotic
fluid pressure shifts; helpful
in bowel retraining;
introduced into the large
intestines and not absorbed
systemically
Lactulose (Duphalac) site
of action is the colon; the
unabsorbed lactulose is
metabolized by intestinal
microflora into lactate
(decrease ph)
Magnesium salts produce
watery stools; evacuation
within 1-3 hours
Sodium biphosphate
causes hypertonicity within
the lumen producing
osmotic effect
INDICATION:
Episiotomy
Hemorrhoids/anorectal
fissures
Cardiovascular diseases
Geriatrics
Adjunct to anthemintics
therapy
Presurgery
Diagnostic exams
Removal of poison
Preventing fecal impaction
Correcting constipation for
bedridden patients
CONTRAINDICATION:
Contraindicated with allergy to
lactulose, low-galactose diet
Use cautiously with diabetes,
pregnancy and lactation
10 Rights
1. Right
2. Right
3. Right
4. Right
5. Right
6. Right
7. Right
8. Right
9. Right
10.Right
ADVERSE EFFECTS:
High sodium level causes

tachycardia, hypotension,
dehydration
High magnesium level
muscle weakness, decrease
reflexes, paralysis,
tachycardia
Low calcium level
neuromuscular irritability,
cardiac arrhythmias
Hypovolemic shock
medication
dosage
patient
route
time and manner
client education
documentation
to refuse medications
assessment
evaluation
Do not freeze laxative form.

Extremely dark or cloudy
syrup may be unsafe, do not
use
Give laxative syrup orally with
fruit juice, water or milk to
increase palatability
Administer retention enema
using a rectal balloon catheter.
Do not use cleansing enemas
containing soapsuds or other
alkaline agents that
counteract the effects of
lactulose
Do not administer other
laxatives while using lactulose
Monitor serum ammonia levels
Monitor with long-term
therapy for potential
electrolyte and acid-base
imbalances
Carefully monitor blood
glucose levels in diabetic
patients
Classification: Laxatives (Bulk forming laxatives)

DRUG
Methylcellulose (Matsuprex)
Polycarbophil (Fibercon)
- Dosage: Adults 6 g/day;
children
3 g/day
- Frequency: OD or QID
- Route: oral
Psyllium Hydrophilic
Mucilloid (Metamucil)
- Dosage: 1 tsp or packet
in cool water or juice
- Frequency: Children:
OD or TID
- Route: oral
ACTION
Resembles dietrary fiber
Contain natural and
semisynthetic
polysaccharide and
cellulose
Increase fecal bulk and
water content thereby
promoting peristalsis and
elimination
Ingested but not absorbed
Act in the small intestines
and colon
Fecal softening occurs in 13 days
INDICATION:
Short-term relief of
constipation
To prevent straining
To evacuate the bowel for
diagnostic procedure
To remove ingested poisons
from the lower GI tract
Adjunct in anthelmintic
therapy
CONTRAINDICATION:
In cases of allergy to these
drugs
Third trimester of
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
Should be taken with water

Monitor for fecal obstruction
Good with irritable bowel
syndrome
ADVERSE EFFECTS:
Excessive bowel activity
Perianal irritation
Abdominal cramps
Weakness
Dizziness
Cathartic dependence
pregnancy
Acute abdominal pain
Ensure that patient has

sufficient water to
completely swallow dose
Swallow tablets whole
Do not take this drug within
1 hr of any other drugs
Report sweating, flushing,
muscle cramps, excessive
thirst
Classification: Laxatives (Emollient laxatives or surfactant laxatives)

DRUG
Docusate calcium
Docusate potassium
Docusate sodium
Polyxamer 188
ACTION
Decreases surface tension

of interfacing liquid bowel
contents
Promote fluid accumulation
in the bowel and softening
the stools
Easy defecation by
emulsifying the fats and
water components of feces
in the small and large
intestines
INDICATION:
constipation
therapy
CONTRAINDICATION:
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
This detergent allows water

and lipids to penetrate fecal
material producing net
accumulation
Stimulate electrolyte and
fluid secretion from the
intestinal mucosal cells

drugs
Third trimester of
pregnancy

thirst
Emollients can also be given

before rectal cathartics to
treat fecal impaction
ADVERSE EFFECTS:
Perianal irritation
Abdominal cramps
Weakness
Dizziness
Classification: Laxatives (Stimulant laxatives)

DRUG
Bisacodyl (Dulcolax)
- Dosage: Oral 10-15 mg;
Rectal 2.5 g in water via
enema
- Frequency:
Phenophthalein (Ex Lax)
ACTION
Also known as irritant

cathartics
Irritate the intestinal
mucosa or activate the
intramural nerve plexus of
the intestinal smooth
INDICATION:
Constipation produced by
medications
Neurologic disorders
Irritable bowel
Prolonged hospitalization
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
Cascara Sagrada
- Dosage: 325-650 mg PO
- Frequency:
- Route: oral
Senna (Senokot)
- Dosage: syrup 10-25mL
- Frequency: 1-8 tab per
day at bedtime
muscles (increases
intestinal motility)
Alter fluid and electrolyte
Stimulate peristalsis and
induce defecation by
irritating the intestinal
mucosa or stimulating
nerve endings of the
intestines
ADVERSE EFFECT:
Perianal irritation
Abdominal cramps
Weakness
Dizziness
Used before surgeries

(sigmoidoscopy, proctoscopic
procedure)
constipation
therapy
CONTRAINDICATION:
drugs
Third trimester of
pregnancy
7. Right
8. Right
9. Right
10.Right
documentation
assessment
evaluation

thirst
Not used in lactating mothers
Phenopthalein can cause
reddish urine
Classification: Laxative (Lubricant laxatives)
DRUG
Mineral oil
Dosage: 5-45 mL PO
Frequency: 1-8 tab per
day at bedtime
Route: oral or rectal
ACTION
Increases water retention in
the stool by creating a
barrier between the colon
wall and feces
Prevents colonic reabcorption
INDICATION:
constipation
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
of fecal water
ADVERSE EFFECT:
Perianal irritation
Abdominal cramps
Weakness
Dizziness

therapy
CONTRAINDICATION:
drugs
Third trimester of
pregnancy
7. Right
8. Right
9. Right
10.Right
documentation
assessment
evaluation

thirst
Advise patient that it may
cause nausea, vomiting and
abdominal cramping
Inspect anal area for irritation
Classification: Anti-peptic ulcer drugs [Histamine (H2) receptor antagonists]

DRUG
Cimetidine (Tagamet)
- Dosage: tablets 100,
200, 300, 400, 800 mg;
liquid 300 mg/5 mL;
injection 150 mg/mL,
300 mg/ 2 mL
ACTION
Specifically block the H2
receptors that control the
basal and stimulated
secretion of hydrochloric
acid by the parietal cells
INDICATION:
Short-term treatment of active
duodenal ulcer
Short-term treatment of
benign gastric ulcer
Treatment of pathologic
hypersecretory conditions
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
Frequency: Oral HS,

QID, BID; IV or IM 6-8
hours
- Route: oral, IM, IV
Ranitidine (Zantac)
Famotidine (Pepcid)
Ranitidine Bismuth Citrate
(Tritec)
Nizatidine (Axid)
- Dosage: capsules 150,
300 mg; OTC tablets 75
mg
- Frequency: BID or daily
- Route: oral
Inhibits the action of histamine

at the histamine H2 receptor of
the parietal cells of the
stomach, inhibiting basal gastric
acid secretion and gastric acid
secretion that is stimulated by
food, caffeine, insulin,
histamine, cholinergic agonists,
gastrin and pentagastrin. Total
pepsin output also is reduced
ADVERSE EFFECTS:
CNS effects include: mental
confusion, disorientation,
agitation and hallucinations
Cimetidine, when given
over prolonged period of
time may have an
antiandrogen (feminizing)
effect on men producing
gynecomastia, impotence
and loss of libido; these
effects are not
characterisitics of other H2
antagonists
(Zollinger-Ellison syndrome)
Prophylaxis of stress-induced
ulcers and acute upper GI
bleeding in critical patients
Treatment of erosive GERD
OTC use: relief of symptoms of
heartburn, acid indigestion,
sour stomach
CONTRAINDICATION:
these drugs
Use cautiously with impaired
renal or hepatic function,
lactation
DRUG INTERACTION:
They alter absorption of
other drugs such as
Ketoconazole and
Itraconazole (should be
taken 2 hours apart)
Classification: Anti-peptic ulcer drugs [Proton (acid) pump inhibitors]
7. Right
8. Right
9. Right
10.Right
documentation
assessment
evaluation
Give drug with meals and hs

Decrease doses in patients
with renal and liver
dysfunction
Administer IM dose undiluted
deep into large muscle group
Arrange for regular follow-up,
including blood tests to
evaluate effects
DRUG
Esomeprazole (Nexium)
- Dosage: delayedrelease capsules 20, 40
mg
- Frequency: daily for
maintenance of healing
of erosive esophagitis
- Route: oral
Lansoprazole (Prevacid)
- Dosage: DR capsules
15, 30 mg; DR granules
for oral suspension 15,
30 mg; injection 30
mg/vial
- Frequency: daily for
maintenance of healing
of erosive esophagitis
- Route: oral or IV
Omeprazole (Prisolec,
Losec)
- Dosage: DR capsules
10, 20, 40 mg; DR
tablets 20 mg (OTC);
powder for oral
suspension 20
mg/packet
- Frequency: daily for 48 wk for active duodenal
ulcer
- Route: oral
ACTION
Drugs that block the action of

this pump can block acid
secretion by the parietal cells
Block the enzyme that pumps
hydrogen ions (or proton) into
the luminal (or secretory) side
of the parietal cells of the
stomach
This enzyme blockade is more
effective than histaminereceptor blockade at reducing
stomach acid production
Often preferred over H2
antagonists
More potent than H2
antagonists but are used for the
same indications
PPIs change the ph of the
stomach
ADVERSE EFFECTS:
For short term therapy:

headache, nausea and vomiting
For long term therapy;
hypergastrinemia (over
production of gastrin)
DRUG INTERACTION:
Increased serum levels and
potential eincrease in
toxicity of benzodiazepines
when taken concurrently
May interfere with
INDICATION:
Treating severe erosive

esophagitis that has not
responded to therapy with
H2 antagonists
Used in the short term
treatment of acute peptic
ulcer disease (especially
when combined with
antimicrobial to eradicate
Helicobacter Pylori
Onset of action within an
hour; duration of action is
longer and varied from 24
to 72 hours
CONTRAINDICATION:
Contraindicated with
hypersensitivity to omeprazole
, esomeprazole or other proton
pump inhibitor
Use cautiously with hepatic
dysfunction, pregnancy,
lactation
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
If administering antacids, they

may be administered
concomitantly with
esomeprazole
Ensure that the patient
swallows capsule whole, do
not crush or chew
Patients who have difficulty
swallowing may open capsule
and sprinkle in applesauce or
disperse in tap water, orange
or apple juice, or yogurt
Obtain baseline liver function
tests and monitor periodically
during therapy
Provide additional comfort
measure to alleviate
discomfort from GI effects and
headache
Establish safety precautions if
dizziness or other CNS effects
occur (use side rails,
accompany patient)
Pantoprazole )Protonix)
Rabeprazole (AcipHex)
absorption of drugs
depende upon presence of
acidic environment (eg.
Ketoconazole, iron salts,
digoxin)
Classification: Antacids
DRUG
Aluminum
500, 600 mg
- Frequency: 3-6 times
per day
- Route: oral
Calcium salts
500, 650, 975 mg
- Frequency: PRN
- Route: oral
Magaldrate
- Dosage: suspension 540
mg/5 mL; liquid 540mg/5
mL
- Frequency: PO
between meals
- Route: oral
Magnesium salts
Sodium bicarbonate
ACTION
INDICATION:
Esophageal reflux
Neutralizes or reduces
Acid indigestion
gastric acidity, resulting in
Heartburn
an increase in the pH of the
stomach and duodenal bulb
Dyspepsia
and inhibiting the
Symptomatic relief of upset
proteolytic activity of pepsin
stomach associated with
The combination of
hyperacidity
magnesium (causes
Hyperacidity associated
diarrhea when administered
with peptic ulcer, gastritis,
alone) and aluminum
peptic esophagitis, gastric
(constipating when
hyperacidity and hiatal
administered alone) salts
hernia
usually minimizes adverse
GI effects
CONTRAINDICATION:
ADVERSE EFFECTS:
Aluminum:
Constipation which can lead to
fecal impaction and obstruction

magnesium or aluminum
products
Use cautiously with renal
insufficiency, gastric outlet
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
Avoid administering calcium

carbonate for long term therapy
of peptic ulcer disease because
gastric hypersecretion and acid
rebound may occur
Shake suspensions well
Have the patient thoroughly
chew any chewable tablets
before swallowing and take
Dosage: tablets 325,

520, 650 mg
- Frequency: QID
- Route: oral
Antagon (ganirelix acetate)
- Dosage: 250 mcg
- Frequency: once daily
starting on day 2 or 3 of
the cycle
- Route: Subcutaneous
injection
When used in patients with

renal failure may produce
hyperaluminemia, in which
aluminum accumulates in
bones, lungs and nerve tissues
Osteomalacia and dementia
may occur
Hypophosphatemia may occur
with prolonged use of
aluminum-containing antacids
Magnesium:
Laxation/diarrhea
Alkalosis may occur with
systemic products
Calcium Carbonate/Sodium
Bicarbonate:
Constipation is frequent than
laxation
May cause rebound hyperacidity
and milk-alkali syndrome
characterized by
hypercalcemia, metabolic
alkalosis and renal impairment
DRUG INTERACTION:
Within the GIT, they combine

chemically with some drugs,
notably tetracycline forming
complexes that resist digestion
and pass unchanged out of the
system
When administered with enteric
coated drugs, they may
obstruction (aluminum salt

may inhibit gastric emptying),
pregnancy, lactation
water
Separate the administration of
antacids and other entericcoated drugs by 1 hour because
antacids may cause premature
release of enteric-coated drugs
into the stomach
Dont give any other oral
medications with 1-2 hrs of
antacid administration because
antacids impair the absorption
of other drugs
Reassure the patient that stools
may appear speckled or whitish
Advise patients on sodium
restricted diet to avoid antacids
because sodium and fluid
retention may occur or increase.
Stress the importance of taking
antacids exactly as prescribed
for maximum effect
disintegrate the coating,

releasing these drugs
prematurely in the stomach
Elevation of ph also alter
membrane transport of alkaline
and acidic compounds,
promoting passive diffusion of
acidic chemicals and lipid
membrane transport of alkaline
chemicals. It can alter both
absorption and excretion of
many systemic drugs
Calcium directly augments the
ionic stimulation of cardiac
contractility thereby mimicking
the action of digitalis
Magnesium may also potentiate
digitalis by depleting potassium
store causing hypokalemia
secondary to diarrhea
Classification: Antiemetic (Serotonin receptor antagonists)

DRUG
Dolasetron (Anzemet)
- Dosage: tablets 50, 100
mg; injection 20 mg/mL
ACTION
Selectively binds to
serotonin receptors in the
INDICATION:
Prevents nausea and

vomiting after radiation
10 Rights
1. Right medication
2. Right dosage
3. Right patient
Frequency: PO within 1
CTZ. Blocking the nausea
hr before chemotherapy
and vomiting cause by the
or within 2 hr before
release of serotonin by
surgery
mucosal cells during
- Route: oral or IV
chemotherapy,
Granisetron (Kytril)
radiotherapy or surgical
invasion (an action that
- Dosage: tablets 1 mg;
stimulates the CTZ and
injection 1 mg/mL; oral
causes nausea and
solution 1 mg/5mL
vomiting)
- Frequency: IV over 5
min starting within 30
ADVERSE EFFECTS:
min chemotherapy, only
Headache
on days of
chemotherapy; oral PO
Constipation
bid or 2 mg/day,
Diarrhea
beginning up to 1 hr
Arrhythmia
before chemotherapy
Bronchospasms
and second dose 12 hr
after chemotherapy, only
DRUG INTERACTION:
on days of
Possible cardiac
chemotherapy
arrhythmias with drugs that
- Route: Oral or IV
cause ECG interval
Ondansetron (Zofran)
prolongation
- Dosage: tablets 4, 8, 24
Potential for severe toxic

mg
reaction with high-does
- Frequency: TID
anthracycline therapy
- Route: oral
Decreased levels if
combined with rifampin
therapy for cancer or bone

marrow transplantation
The antineoplastic drugs that

are destructive to cells release
serotonin from the
enterochromaffin cells in the
GIT, which causes severe
emetic response
CONTRAINDICATION:
dolasetron or any of its
components or these drugs;
markedly prolong QTc interval,
second-or third-degree AV
block
Use cautiously in any patient
at risk of developing
prolongation of cardiac
conduction intervals,
especially QT interval
(congenital QT syndrome,
hypokalemia,
hypomagnesemia), pregnancy,
lactation
4. Right
5. Right
6. Right
7. Right
8. Right
9. Right
10.Right
route
time and manner
client education
documentation
assessment
evaluation
Check for hypersensitivity;

may cause anaphylactic
reaction
If patient is unable to
swallow tablets, dilute
injection in apple or applegrape juice; dosage remains
the same; solution is stable
for 2 hr at room
temperature
Provide mouth care,
sugarless lozenges to suck
to help alleviate nausea
Obtain baseline ECG and
periodically monitor ECG in
any patient at risk for QTc
prolongation
Provide appropriate
analgesics for headache
Classification: Antiemetic (Dompamine receptor antagonists)
DRUG
Chlorpromazine (Thorazine)
- Dosage: tablets 10, 25, 50,
100, 200 mg; concentrate
100 mg/mL; suppository 100
mg; injection 25mg/mL
- Frequency: oral q 4-6 hr;
rectal q 6-8 h; IM if no
hypotension q 3-4 hr
- Route: oral, rectal, IM
Perphenazine (trilafon)
- Dosage: tablets 2, 4, 8, 16
mg; concentrate 16mg/5
mL; injection 5 mg/mL
- Frequency: PO daily; give
IV when needed to control
severe vomiting
- Route: oral or IV
Prochlorperazine (Compazine)
- Dosage: tablets 5, 10, 25
mg; SR capsules 1-, 15 mg;
syrup 5 mg/5 mL; injection 5
mg/mL; suppositories 2.5, 5,
25 mg
- Frequency: oral TID or QID;
IM initially, repeated q 3-4 hr
ACTION
Mechanism is not fully
understood; antipsychotic
drugs block postsynaptic
dopamine receptors in the
braine; depress those parts
of the brain involved with
wakefulness and emesis;
anticholinergic.
Antihistaminic (H1), and
alpha-adrenergic blocking
ADVERSE EFFECTS:
Extrapyramidal reactions
(pseudoparkinsonism,
dystonia, akathisia, and
tardive dyskinesia)
Hypotension Sedation
INDICATION:
DRUG INTERACTION:
Precipitate or discoloration
may occur when mixed with
Suppress nausea and

vomiting by blocking
CTZ
They also produce blockade
of acetylcholine
(muscarinic), histamine,
and norepinephrine
receptors
They are often used as
antipsychotic drugs
Effective in reducing
vomiting from
antineoplastic and radiation
therapy of cancer
Control post operative
vomiting
They do not prevent motion
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
Do not change brand names of

oral dosage forms or rectal
suppositories; bioavailability
differs
Dilute the oral concentrate
just before administration in
60 mL or more of tomato or
fruit juice, milk, simple syrup,
orange syrup, carbonate
beverage, coffee, tea, water or
in semisolid foods (soup,
puddings)
Protect oral concentrate from
up to 40 mg/day
Route: oral or IV
morphine, meperidine,
cresols
Decreased hypotension
effect with guanethidine
sickness
Major drug interaction is a
synergistic depression with
drugs depressing the CNS
particularly, when
respiratory depression is
involved
Chlorpromazine (Thorazine)
CONTRAINDICATION:
chlorpromazine, comatose or
severely depressed states,
bone marrow depression,
circulatory collapse,
subcortical brain damage,
Parkinsons disease, liver
damage, cerebral or coronary
arteriosclerosis, severe
hypotension or hypertension
Use cautiously with respiratory
disorders; glaucoma; epilepsy
or history of epilepsy; peptic
ulcer or history of peptic ulcer;
decreased renal function;
protate hypertrophy; breast
cancer; thyrotoxicosis;
myelography within 24 hr or
scheduled within 48 hr,
lactation; exporsure to heat,
phosphorous insecticides;
children with chicken pox, CNS
infections
light
Do not give by subcutaneous
injection
Keep patient recumbent for 30
min after injection to avoid
orthostatic hypotension
Avoid skin contact with oral
concentrates and parenteral
drug solutions due to possible
contact dermatitis
Patient or the patients
guardian should be advised
about the possibility of tardive
dyskinesias
Classification: Antiemetic (Cannabinoids)

DRUG
Dronabinol (Marinol)
- Dosage: capsules 2.5,
5, 10 mg
- Frequency: 4-6 doses a
day
- Route: oral
ACTION
The mechanism by which
cannabinoids supress
nausea and vomiting is
unknown
INDICATION:
Treatment of nausea and
vomiting associated with
cancer chemotherapy in
patients who have failed to
respond adequately to
conventional antiemetic
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
Nabilone (Cesamet)
They inhibit the emesis

center in the brainstem by
an action at the CB1 or
cannabinoid receptor
Used for nausea and
vomiting associated with
antineoplastic therapy
(especially Cisplatin)
ADVERSE EFFECTS:
Euphoria or dysphoria
Detachment or
depersonalization
Tachycardia and
hypotension
DRUG INTERACTION:
Do not give with ritonavir,
alcohol, sedatives,
hypnotics, other
psychotomimetic
substances
Increased tachycardia,
hypertension, drowsiness
with anticholinergivs,
antihistamines, TCAs
Use caution if combined
with dofetilide
treatment
Treatment of anorexia
associated with weight loss in
patients with AIDS
CONTRAINDICATION:
Contraindicated to patients
with psychiatric disorders

these drugs or sesame oil
vehicle in capsules, nausea
and vomiting arising from any
cause other than cancer
chemotherapy, lactation
Use cautiously with
hypertension; heart disease,
manic, depressive,
schizophrenic patients;
pregnancy
7. Right
8. Right
9. Right
10.Right
documentation
assessment
evaluation
Store capsules in
refrigerator
Limit prescriptions to the
minimum necessary for a
single cycle of
chemotherapy because
abuse potential
Warn patient about drugs
profound effects on mental
status and abuse potential
before giving drug; patient
needs full information
regarding the use of this
drug
Warn patient about drugs
potential effects on mood
and behavior to prevent
panic incase these occur
Patient should be
supervised by a responsible
adult while taking drug;
monitor during the first
cycle of chemotherapy in
which dronabinol is used to

determine how long patient
will need supervision
Classification: Antiemetic (Muscarinic receptor antagonists)

DRUG
Scopolamine (pamine,
Transderm Scop)
- Route: transdermal
ACTION
Scopolamine is a reversible
inhibitor of the actions of
acetylcholine at muscarinic
receptors
Prevents the actions of
acetylcholine in the vestibular
system
Causes additive effects when
used with other anticholinergic
drugs (antiparkinsons drugs,
phenothiazines, tricyclic
antidepressants and some
antihistamines)
Readily absorbed and crosses
blood brain barrier
ADVERSE EFFECTS:
This medication patch may be

harmful if chewed or swallowed.
If overdose or swallowing is
suspected, remove the patch if
possible
DRUG INTERACTION:
Causes additive effects when
INDICATION:
Considered the most

effective drug available for
prophylaxis and treatment
of motion sickness and
vertigo
With some antiemetic
action for patients with post
operative emesis
Also administered as a
preanesthetic agent to
depress respiratory
secretions and salivation
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
CONTRAINDICATION:
Do not share this

medication with others
Contraindicated to those
who are allergic to this drug
Use cautiously during
pregnancy or lactation
Avoid activities that may
For motion sickness,

transdermal patch is preferred
to decrease adverse effects;
patch is applied 4 hrs in
advance of travel and delivers
scopolamine over 3 days
Patch is not advisable for
children
Store at room temperature
When the weather is hot,

drink plenty of fluids and
dress lightly. If you become
overheated, promptly seek
cooler shelter and stop
used with other anticholinergic

drugs (antiparkinsons drugs,
phenothiazines, tricyclic
antidepressants and some
antihistamines)
cause you to overheat (such

as doing strenuous
work/exercise in hot
weather, using hot tubs)
exercising Keep all
medications away from children

and pets
Do not flush medications down
the toilet or pour them into a
drain unless instructed to do so
Properly discard this product

when it is expired or no longer
needed
Classification: Antiemetic (Histamine receptor antagonists)

DRUG
Dimenhydrinate
(Dramamine, Gravol)
Diphenhydramine
(Benadryl)
Hydroxyzine (Vistaril, Iterax,
Atarax)
Meclizine (Bonamine)
Promethazine (Phenergan)
- Dosage: tablets 12.5,
25, 50 mg; syrup 6.25,
25 mg/mL; suppositories
12.5, 25, 50 mg;
injection 25, 50 mg/mL
- Frequency: oral PRN;
rectal q 4-6 hr, IM or IV,
not to be repeated
frequently than q 4-6 hr
ACTION
Help prevent motion
sickness and vertigo
although the action is
unknown
Suppression of the
stimulation of receptors in
the labyrinth of the ear from
which signals governing the
sense of equilibrium arise
Not all antihistamines are
effective as antiemetics and
there is no correlation
between their ability to
prevent motion sickness
and their potency as
INDICATION:
Antihistamines treat motion

sickness and vertigo; 30
minutes before travel and
4-6 hrs after as needed
Dimenhydrinate and
Hydroxyzine are for motion
sickness and vertigo; can be
given orally, IM, IV, rectally
Promethazine is the most
effective drug for motion
sickness but with sedating
effects
Hydroxyzine if given IM
reduces post surgical
nausea and vomiting
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
Do not give tablets or rectal

suppositories to children <
2 yr
Give IM injections deep into
muscle
Do not administer
Route: oral, rectal, IM

or IV
antihistamines or
anticholinergics
ADVERSE EFFECTS:
Drowsiness and dry mouth
Headache and jitters
DRUG INTERACTION:
Causes additive depression
with the use of CNS
depressants (opioids,
alcohol, antidepressants,
sedative-hypnotics)
Meclizine treats nausea of

vestibular disorders such as
Menieres disease and
Labyrinthitis
Diphenhydramine treat
dystonic reactions caused by
antipsychotic drugs
CONTRAINDICATION:
Contraindicated in patients
with narrow angle
glaucoma; and premature
babies
Used cautiously in patients
with pyloric obstruction,
cardiovascular diseases,
prostatic hypertrophy,
hyperthyroidism
subcutaneously; tissue
necrosis may occur
Avoid using alcohol avoid
prolonged exposure to sun,
or use a sunscreen or
covering garments
Maintain fluid intake, and
use precautions against
heat stroke in hot weather
Classification: Antiemetic (Miscellaneous drugs)

DRUG
Benzquinamide (emete-con)
given IM because of the
risk of arrhythmia
Diphenidol (Vontrol) given
oral
Metoclopramide (PMS
ACTION
Benzquinamide acts by
depressing the CTZ in the brain
stem
Diphenidol acts on the aural
vestibular apparatus to inhibit
function and at the CTZ to
INDICATION:
Relief symptoms of acute and
recurrent diabetic
gastroparesis
Short-term therapy (4-12 wk)
for adults with symptomatic
gastroesophageal reflux who
fail to respond to conventional
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
metoclopramide, Reglan)
well absorbed if given IM or
rectally
- Dosage: tablets 5, 10
mg; syrup 5 mg/5 mL;
concentrated solution 10
mg/mL; injection; 5
mg/mL
- Frequency: oral TID; IM
or IV for up to 10 days
until symptoms subside
- Route: oral, IM or IV
inhibit nausea and vomiting

Metoclopramide blocks
dopaminergic (specifically D2)
receptors at the CTZ to reduce
afferent input; blocks
serotonergic receptors
It enhances GI motility of
smooth muscles from the
esophagus to the bowel and
accelerates gastric emptying
which counteracts the loss of
tone in vomiting
Distributed to body tissues and
fluids and crosses blood brain
and placental barrier
ADVERSE EFFECTS:
Drowsiness, dizziness,
fatigue
Transient hypertension
Nausea
Diarrhea
Parkinsonism-like reaction
therapy
Porphylaxis of postoperative
nausea and vomiting when
nasogastric suction is
undesirable
CONTRAINDICATION:
Contraindicated with allergy

to metoclopramide and
these drugs; GI
hemorrhage, mechanical
obstruction or perforation,;
pheochromocytoma (may
cause hypertensive crisis);
epilepsy
Use cautiously with
previously detected breast
cancer 9one third of such
tumors are prolactin
dependent); pregnancy,
lactation
DRUG INTERACTION:
Decreased absorption of digoxin

from stomach
Increased toxic and
immunosuppressive effects of
cyclosporine
DRUGS TO TREAT RESPIRATORY PROBLEMS

9. Right assessment
10.Right evaluation
Monitor BP carefulliy during IV

administration
Monitor for extrapyramidal
reactions and consult
physician if they occur
Monitor diabetic patients,
arrange for alternation in
insulin dose or timing if
diabetic control is
compromised by alterations in
timing of food absorption
Classification: Expectorant
DRUG
Guaifensin (Robitussin)
Atropine
Potassium Iodide (SSKI)
Terpin hydrate
Ammonium chloride
- Dosage: tablets 10 mg
- Frequency: PO (Per
Orem)
- Route: oral
ACTION
Enhances the output of
respiratory tract fluid by
reducing adhesives and
surface tension, facilitating the
removal of viscous mucus
ADVERSE EFFECTS:
CNS: Headache, dizziness

Dermatologic: Rash,
urticarial
GI: Nausea, vomiting, GI
Discomfort
DRUG INTERACTIONS:
Drug lab test Color
interference and false results
of 5-HIAA and VMA urinary
determinations
Classification: Mucolytics
INDICATION:
Symptomatic relief of
respiratory conditions
characterized by dry, nonproductive cough and when
there is mucus in the
respiratory tract
CONTRAINDICATION:
guaifenesin
Use cautiously with
pregnancy, lactation, and
persistent coughs
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
History: Allergy to guaifensin,

persistent cough due to
smoking, asthma or
emphysema, very productive
cough; pregnancy
Physical: Skin lesions, color,
orientation, adventitious
sounds
Interventions
Warning: Monitor reaction to
drug; persistent cough for
longer than 1wk fever rash, or
persistent headache may
indicate a more serious
condition.
DRUG
Acetylcysteine
Hypertonic Saline
- Dosage: 1-10 mL of
20% solution by
nebulization or 2-20 mL
of 10% solution q2-6h
PRN; Acetamainophen
toxicity: initially 140
mg/kg orally, then 70
mg/kg orally q4h for 17
doses (total)
- Frequency: q 2-6h PRN;
q 4h for 17 doses (total)
-
ACTION
Reduction of viscosityof mucus
in acute and chronic
bronchopulmonary
disease,traccheostomy care,
atelectasis due to pulmonary
to mucus
ADVERSE EFFECTS:
Route: oral or inhalation
Mucolytic use
- GI: Nausea, stomatitis
- Hypersensitivity:
Urticaria
- Respiratory:
Bronchospasm,
especially in patients
with asthma
- Other: Rhinorrhea
Antidotal use
- Dermatologic: Rash
- GI: Nausea, vomiting,
other GI Problems
INDICATION:
To prevent or lessen hepatic
injury that may occur after
ingestion of potentially
hepatotoxic dose of
acetaminophen; treatment
must start as soon as possible;
most effective if administered
within 8 hours of ingestion,
but can be given within 24
hour or longer after ingestion;
IV use approved for this
indication
CONTRAINDICATION:
Mucoytic use
- Contraindicated with
hypersensitivity to
acetylceisteine, use
caution and discontinue
immediately if
bronchospasm occur.
Antidotal use
-
Classification: Antitussives
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
No contraindications; use
caution with esophageal
varices, peptic ulcers
Patients with asthma, older

adults, severe hepatic
disease, esophageal
varices, peptic ulcer disease
Patient/family teaching:the
patient should be advised to
report difficulty with clearing
the airway or any other
respiratory distress
DRUG
Benzonate (Tessalon)
Codeine
Dextromethorphan
Hydrobromide (Robitussin DM)
Diphenhydramine Hch
(Bendaryl
Lidocaine HCl (Xylocaine)
ACTION
Opioid Antitussives:
Used frequently for cough

suppression
Act in the CNS to elevate
cough threshhold
Decrease frequency and
intensity of cough
Less risk for physical
dependence
May suppress respiration
Dosage: 10-20, Doses
are low, 1/10 of those

needed to relieve pain,:
100 mg
Frequency: 10-20 mg 4- Non Opioid Antitussives:
6X a day, 100 mg TID
Enhance analgesic effects
Route: oral
of opioids (double the
analgesic response to 30
mg morphine by adding 30
mg of dextromethorphan)
Suppress cough by
decreasing the sensitivity of
the respiratory tract stretch
Codeine sulfate
receptors (components of
the cough-reflex pathway)
INDICATION:
Control of non-productive
cough (nonopioid antitussive)
CONTRAINDICATION:
hypersensitivity to any
component (check label of
products for flavorings,
vehicles), sensitivity to
bromides, cough that
persists for more than
1week, tends to recur, is
accompanied by excessive
secretions high fever
Use cautiously with
lactation, pregnancy
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
ADVERSE EFFECTS:
Sedation
Dizziness
constipation
DRUG INTERACTIONS:
Concomitant MAOI use may
Monitor for signs of respiratory

depression
Avoid concomitant use with
MAO inhibitors
Increase fluid intake
Prolong use of codeine may
cause physical dependence
Capsules must be
swallowed intact, since
chewing will anesthetize the
mouth and larynx
Drug is not given to infants
because anesthesia of the
mouth may impair
swallowing
In the event of overdose:
give Naloxone (opioid
antagonist)
cause hypotension, fever,

nausea, myoclonic jerks,
and coma avoid this
combination
Classification: Decongestants
DRUG
ACTION
Ephedrine Sulfate
Dosage: 25 mg
capsules, 50 mg/mL
injections
Frequency: PO
Route: oral, IM, slow IV or

subcutaneously
Phenylpropanolamine
(Disudrin)
Reduce nasal congestion
Stimulating alpha adrenergic
receptors on nasal blood vessels
Causes vasoconstriction
Causes shrinkage of swollen
membranes followed by nasal
drainage
Relieve stuffiness
Do not reduce rhinorrhea, sneezing
or itching
Reduce congestion associated with
sinusitis and cold
ADVERSE EFFECTS:
Restlessness
Irritability
Anxiety
Insomnia
Cause widespread
vasoconstriction
DRUG INTERACTIONS:
Severe hypertension with
MAOIs, TCAs, furazolidone,
Additive effects and increased
risk of toxicity with urinary
alkalinizers
Decreases hypotensive acon of
guanethidine with ephedrine
Classification: Xanthines and Xanthine derivatives
INDICATION:
Treatment of hypotensive
rate especially those

associated with spinal
anestheia, strokes-Adams
syndrome with complete
heart block syndrome with
complete heart block, CNS
stimulation narcolepsy and
depressive states acute
bronchospasm.
Treatment of allergic disorders

such as bronchial asthma, and
local treatment of nasal
congestion in acute coryza,
vasomotor rhinitis, acute
sinusitis, hay fever
CONTRAINDICATION:
ephedrine, angle closure
glaucoma,anesthesia with
cyclopropane or halothane,
thyrotoxicosis diabetes,
hypertension, CV disorders,
women in labor whose P is
lower than 130/80 mmHg
Use cautiously with angina,
arrhythmias, prostatic
hypertrophy, unstable
vasomotor syndrome,
lactation
10 Rights
1. Right
2. Right
3. Right
4. Right
5. Right
6. Right
7. Right
8. Right
9. Right
10.Right
medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
Not given together with other

sympathomimetics, CNS
stimulation may occur
Not given before bedtime,
may interfere with sleep
Limit the use of

decongestants for 3-5 days
Must not be given to
patients with chronic rhinitis
DRUG
Anhydrous -Theophylline
(Theo-Dur)
Aminophylline (Aminophylline)
Oxtriphylline
Dyphylline
Dosage: adult: 4.7

mg/kg; child (1-9 years)
6.2 mg/kg; child (9-16
years) 4.7 mg/kg
Frequency: adult q 8;
child q 6
Route: oral
ACTION
inhibits phosphodiesterase, an
enzyme responsible for
breaking down cyclic AMP
produces bronchodilation
reduces airway resistance
reduces pulmonary
hypertension and alveolar CO2
tension
Inhibit mass cell degranulation
Inhibit the release of histamine
and other mediators
Impedes enzymatic actions
ADVERSE EFFECTS:
Nausea
Vomiting
Diarrhea
Rectal irritation
Reactivation of peptic ulcer
Irritability especially in children
Restlessness
Lightheadedness
Muscle toxicity
Proteinuria
DRUG INTERACTIONS:
Accolate (zafirlukast) AccuNeb
(albuterol) acebutolol
acetaminophen / butalbital
acetaminophen / caffeine
acetaminophen / codeine
acetaminophen / tramadol
Acetocot (triamcinolone)
INDICATION:
This medication is a
bronchodilator, prescribed for
asthma, bronchitis, and
emphysema. It relaxes
muscles in lungs, decreases
the sensitivity of lungs to
allergens and increases the
contractions of diaphragm.
CONTRAINDICATION:
Patients with peptic ulcer,
gastritis and
hypersensitivity to the drug
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
Monitor ABGs and

theophylline levels
Monitor vital signs
Avoid caffeine derivatives
(chocolates, coffee, tea or
cola)
Monitor heart rate and
blood pressure
Evaluate the occurrence of
tremors
Increase fluid intake
Avoid smoking
Classification: Ipratropium
DRUG
Atrovent
- Dosage: nasal inhaler
0.03 or 0.06%; oral
inhaler (aerosol) 0.021
mg/spray
- Frequency: BID or TID
- Route: inhalation
Combivent
ACTION
Ipratropium bromide is an
anticholinergic
(parasympatholytic) agent.
Anticholinergics prevent the
increases in intracellular
concentration of Ca++
which is caused by
interaction of acetylcholine
with the muscarinic
receptors on bronchial
smooth muscle
ADVERSE EFFECTS:
Dry mouth
Irritation to the pharynx
May raise IOP to patients
with glaucoma
DRUG INTERACTIONS:
Hemangeol (propranolol)
Hydrochlorothiazide /
propranolol
AK-Beta (levobunolol
ophthalmic)
Use with other
anticholinergic drugs (for

example, atropine) may
increase the occurrence of
side effects.
INDICATION:
Allergen-induced asthma
Exercise-induced
bronchospsms
Bronchospasms associated
with COPD; use alsoin
asthma
CONTRAINDICATION:
Combivent Inhalation Aerosol
is contraindicated in patients
with history of hypersensitivity
to soya lecithin or related food
products such as soybean and
peanut. Combivent Inhalation
Aerosol is also contraindicated
in patients hypersensitive to
any other components of the
drug product or to atropine or
its derivatives
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
Ensure adequate hydration,

control environmental
temperature to prevent
hyperpyrexia.
Have patient void before
taking medication to avoid
urinary retention
Check for allergies
Teach patient proper use of

inhalator
Classification: Prophylactic asthmatic drugs
DRUG
Cromolyn Sodium
Nedocromil
- Dosage: nebulization
solution 20 mg; metered
dose inhaler: 2 puffs
- Frequency: nebulization
solution QID; metered dose
inhaler QID
- Route: inhalation
ACTION
Cromolyn sodium
INDICATION:
Nasalcrom (cromolyn sodium)
Nasal Spray is used to prevent
and relieve nasal symptoms of
hay fever and other nasal
allergies
Runny/itchy nose
Sneezing
inhibits
the
degranulation
of
sensitized mast cells which
occurs after exposure to
specific antigens. Cromolyn
sodium inhibits the release
of histamine and SRS-A (the
slow-acting substance of CONTRAINDICATION:
anaphylaxis)
Patients who have shown
ADVERSE EFFECTS:
Headache
Ocular burning, irritation
and stinging
Nasal congestion
Asthma
Conjunctivitis
Eye redness
Photophobia
Rhinitis
hypersensitivity to any of the

ingredients
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
Instruct patient not to share

this medication with others.
Doing so may cause the
spread of germs. Avoid
allergens that may be the
cause of your allergies
Classification: Corticostreroids
DRUG
Beclomethasone
-Dipropionate (Baclovent)
Dexamethasone Sodium
-Phosphate (Decadron
Phosphate
- Dosage: adult 40 mcg/inh
or 80 mcg/inh
- Frequency: BID
- Route: inhalation
Beclomethasone-Dipropionate
(Becotide)
ACTION
Corticosteroids enhance the
beta-adrenergic response to
relieve the muscle spasm. They
also act by reversing the
mucosal edema, decreasing
vascular permeability by
vasoconstriction, and inhibiting
the release of LTC4 and LTD4.
Corticosteroids reduce the
mucus secretion by inhibiting
the release of secretagogue
from macrophages.
Corticosteroids inhibit the late
phase reaction by inhibiting the
inflammatory response and
interfering with chemotaxis.
This action may be due to the
inhibition of LTB4 release
ADVERSE EFFECTS:
Adrenal suppression
Osteoporosis
Hyperglycemia
Suppression of growth
PUD
Bone loss (osteoporosis and
stunted growth)
Adrenal suppression
DRUG INTERACTIONS:
Anticonvulsants
INDICATION:
Control of bronchial asthma

that requires corticosteroids
along with Intranasal Relief
of symptoms of seasonal or
perennial rhinitis that
respond poorly to other
treatments; prevention of
recurrence of nasal polyps
following surgical removal
CONTRAINDICATION:
Hypersensitivity to any of the
ingredients of this preparation
contraindicates its use
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
Check for allergies

Teach patient proper use
Anticoagulants
Anti-diabetes
DRUGS TO TREAT ENDOCRINE SYSTEM

Classification: Anti-diabetic agents
DRUG
ACTION
Regular (Natural) Insulin
Lispro Insulin (Humalog)
Unmodified crystalline
insulin
Rapid onset
Short duration
Clear solution
Only form that can be
administered IV
Forms aggregates if given
SC
Given 30-60 minutes AC
Insulin Aspart (Novolog)
Neutral Protamine Hagedorn

(NPH) Insulin
Lente Insulin and Ultralente
Insulin less allergenic than
Acts faster than Natural

Insulin
Shorter duration: 3-6 hours
Rapid acting: 15-30 minutes
Can be given AC and even
PC
Dispense by prescription
Because of its short
duration, must be given with
Intermediate or Long Acting
Insulin
Analog of human insulin
Short duration: 3-5 hours
Rapid Onset: 10-20 minutes
Available in 10 ml vials
Given SC eat within 5-10
minutes immediately after
administration
In combination with
Immediate or Long Acting
Insulin to provide basal
glycemic control between
meals and at night
INDICATION:
Type 1 DM
Diabetic Ketoacidosis to
allow cells to take up K and

lower K level in the blood
Treat hyperkalemia
CONTRAINDICATION:
Blood glucose of <50 mg/dl
Increased insulin than
needed
10 Rights
11.Right
12.Right
13.Right
14.Right
15.Right
16.Right
17.Right
18.Right
19.Right
20.Right
medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
Check for allergies to drugs

Monitor blood glucose level
before administering
Monitor vital signs
Observe for convulsions and
tachycardia
NPH
Semilente Insulin
Most rapid
Amorphous; noncrystalline
Small particles of small size
Ultralente Insulin
Large crystals
Dissoleve slowly
Long duration of action
Lente Insulin
70% ultralente
30% semilente
Intermediate duration of
action
Insulin Glargine (Lantus)
Classification: Sulfonylureas
Can be mixed with NPH

mixing is done just before
administration
Dispense by prescription
Protamine the solubility of
NPH; retards absorption
Delayed Onset
Extended duration
Intermediate acting
Protamine is a foreign body
watch for allergic reactions
DRUG INTERACTIONS:
Hypoglycemic Agents can
intensify hypoglycemia caused
by insulin
Hyperglycemic Agents drugs
that increase blood sugar level
Beta Blockers- delay awareness
of insulin-induced hypoglycemia
by masking signs
associatedwith SNS stimulation.
It impairs glycogenolysis a
way for our body to counteract
glucose level
DRUG
Tolbutamide
Acetohexamide
Tolazamide
Chlorpropamide
- Dosage: 250 mg
- Frequency: OD
- Route: oral
Glipizide
Glyburide
Glimepiride (Amaryl)
-
Dosage: 1-4 mg
Frequency: OD
Route: oral
ACTION
Stimulate the release of
insulin from the pancreas

If pancreas is unable to
synthesize insulin
Tolbutamide if ineffective
Not effective in Type 1 DM;
with prolonged use may
increase cellular sensitivity
to insulin
ADVERSE EFFECTS:
Hypoglycemia may be
severe and require dextrose

infusion
Teratogenic in pregnancy
Cardiovascular toxicity
INDICATION:
indicated only for Type 2 DM
used only when diet and
exercise failed to produce

glycemic control
CONTRAINDICATION:
Type 1 DM
10 Rights
11.Right medication
12.Right dosage
13.Right patient
14.Right route
15.Right time and manner
16.Right client education
17.Right documentation
18.Right to refuse medications
19.Right assessment
20.Right evaluation
Classification: Meglitinides
Check vital signs

Monitor glucose levels
Assess patients history well
before administering the
drug
Check for allergies to the
drug
Monitor drug toxicity
DRUG
Repaglinide (NovoNorm)
- Dosage: 0.5, 1-2 mg
- Frequency: OD
- Route: oral
ACTION
Same as sulfonylureas
Stimulates release of
pancreatic enzymes
ADVERSE EFFECTS:
Hypoglycemia patients
should not eat later than 30

minutes
INDICATION:
indicated only for Type 2 DM
used only when diet and
exercise failed to produce

glycemic control
CONTRAINDICATION:
Type 1 DM
10 Rights
11.Right medication
12.Right dosage
13.Right patient
14.Right route
18.Right to refuse medications
19.Right assessment
20.Right evaluation
Classification: Biguanides
Check vital signs

Assess patients history well
before administering the
drug
drug
DRUG
Metformin (Glucophage)
- Dosage: 500 mg or
850 mg
- Frequency: 500 mg
BID; 850 mg OD
- Route: oral
ACTION
Decrease production of
glucose by the liver
Suppression of
gluconeogenesis
Enhances glucose uptake
and utilization by the
muscles
Do not promote insulin
release by the pancreas
Do not cause hypoglycemia
Given PO absorbed slowly
by the small intestines
Excreted in the kidneys
unchanged decrease
kidney function result to
toxicity
ADVERSE EFFECTS:
Decrease appetite
Nausea and vomiting
absorption of vitamin B12
and folic acid
Weight loss
Lactic acidosis medical
emergency
Myalgia
Hyperventilation
DRUG INTERACTIONS:
INDICATION:
Glucophage (metformin
hydrochloride) Tablets is
indicated as an adjunct to diet
and exercise to improve
glycemic control in adults and
children with type 2 diabetes
mellitus.
Glucophage XR (metformin
hydrochloride) ExtendedRelease Tablets is indicated as
an adjunct to diet and exercise
to improve glycemic control in
adults with type 2
diabetes mellitus.
CONTRAINDICATION:
Renal disease or
renal dysfunction (e.g., as
suggested
by serumcreatinine levels 1.5
mg/dL [males], 1.4 mg/dL
[females]
or abnormalcreatinine
clearance) which may also
result from conditions such
ascardiovascular collapse
10 Rights
11.Right medication
12.Right dosage
13.Right patient
14.Right route
18.Right to refuse
medications
19.Right assessment
20.Right evaluation
Check vital signs

Assess patients history
well before
administering the drug
drug
Severe hypertension with MAOIs,

TCAs, furazolidone, additive
effects and increased risk of
toxicity with urinary alkalinizers
Decreases hypotensive action of
guanethidine with ephedrine
(shock), acute myocardial

infarction,
andsepticemia (see WARNINGS
and PRECAUTIONS).
Known hypersensitivity to
metformin hydrochloride.
Acute or chronic metabolic acid
osis, including diabetic
ketoacidosis, with or
without coma.
Diabetic ketoacidosis should be
treated with insulin
DRUGS USED TO TREAT HYPERTHYROIDISM

DRUG
ACTION
Propylthiouracil (PTU)
Methimazole (Tapazole)
Radioactive Iodine
Iodine 131 (Iodotope)
Nonradioactive Iodine
Propranolol (Inderal)
- Dosage: determined by
the thyroid size; 4-10
mCi
- Route: Radiation (Xrays); oral
High concentrations
produce paradoxical
suppressant effect on the
thyroid
Decrease iodine uptake by
the thyroid
Inhibit thyroid hormone
synthesis
Decrease circulating T3 and
T4
Destroy malignant thyroid
cells
But all forms of thyroid
cancer do not accumulate
iodine
INDICATION:
4 Applications in
Hyperthyroidism:
PTU can be used alone for
Graves disease
As an adjunct to radiation
therapy - to control
hyperthyroidism until the
effects of radiation appear
Suppress thyroid hormone
synthesis in preparation for
thyroid surgery
For thyrotoxicosis
CONTRAINDICATION:
No contraindication is
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medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
Monitor iodine levels

Monitor Vital Signs
Check for tachyphylaxis
Must give large doses
shown
ADVERSE EFFECTS:
Agranulocytosis
develops during the 1st 2
months
sorethroat and fever
earliest signs
PTU must be discontinued
Hypothyroidism
Neonatal hypothyroidism
and goiter dosage must
be kept low
DRUGS RELATED TO HYPOTHALAMIC AND PITUITARY FUNCTION

DRUG
ACTION
Octreotide (Sandostatin)
- Dosage: 100 g
- Frequency: TID
- Route: subcutaneous
Analog of somatostatin
Suppress GH release
Mimic suppressant action of
somatostatin in the pituitary
Primary therapy for
acromegaly or adjunct to
radiation and surgery
ADVERSE EFFECTS:
GI upset but may subside of

1-2 weeks
develop cholesterol
Gallstones
Hyperglycemia
Hypothyroidism
Antibodies to GH
INDICATION:
For patients with growth

deficiency and excess
For children whose growth
has been retarded by
growth hormone deficiency
Efficacy of treatment
declines as patient grows
older and lost at age 20-24
Short children with normal
GH level are inappropriate
for GH therapy
Not very effective for
children with normal GH
level (average increase in
height is 2 in)
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medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
Check for skin allergies to

the drugs
Check the expiration date of
the drug
Monitor Vital Signs
CONTRAINDICATION:
No contraindication is shown
DRUGS USED TO TREAT MALIGNANT NEOPLASMS

Classification: Alkylating agents
DRUG
ACTION
Altretamine (Hexalen)
Bendamustine (Treanda)
- Dosage: 100 mg/m2
- Frequency over 30 min
on days
1 and 2 of a 28-d cycle
up to
6 cycles
- Route: IV
Busulfan (Busulfex,
Myleran)
Carboplatin (Paraplatin)
- Dosage: 360 mg/m2
- Frequency: on day 1
every 4 wk; reduce dose
as needed based on
blood counts and with
renal impairment
- Route: IV
Carmustine (BiCNU, Gliadel)
Chlorambucil (Leukeran)
Cisplatin (Platinol-AQ)
Frequency: once every 3
wk used in combination
with
other antineoplastic agents
Dosage: 2050 mg/m2/d
Route: IV
Cyclophosphamide
(Cytoxan, Neosar)
Dacarbazine (DTIC-Dome)
Ifosfamide (Ifex)
Antineoplastic drugs alter
human cells in a variety of
ways. Their action is
intended to target the
abnormal cells that
compose the neoplasm or
cancer, having a greater
impact on them than on
normal cells.
ADVERSE EFFECTS:
bone marrow suppression
with leukopenia,
thrombocytopenia
anemi
pancytopenia
secondary to the effects of
the drugs
on the rapidly multiplying
cells of the bone marrow
nausea
vomiting
anorexia
diarrhea
and mucous membrane
deterioration,
Alopecia
All drugs that cause cell
death
can cause a potentially
toxic increase in uric acid
INDICATION:
Treatment of
myelodysplastic syndrome
Treatment of chronic
lymphocytic leukemia
Treatment of chronic
myelogenous leukemia; not
effective in blastic phase or
without the Philadelphia
chromosome
Palliative or initial treatment
of returning ovarian cancer
after prior chemotherapy;
initial treatment of ovarian
cancer with other
chemotherapy; may be
useful in several other
cancers
Treatment of brain tumors,
Hodgkin disease, and
multiple myelomas;
available in implantable
wafer form for treatment of
glioblastoma
Palliative treatment of
lymphomas and leukemias
including Hodgkin disease;
being considered for the
treatment of rheumatoid
arthritis and other
conditions
Combination therapy as a
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medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
The patient should report

any signs of infection, like
fever, sore throat and
malaise
The patients should report
any signs of anemia such as
fatigue, headache,
faintness, irritability and
shortness of breath
any abnormal bleeding
The patient should avoid
using razors
Patients should be warned
of the potential for hair loss
with certain antineoplastics
Dosage: 1.2 g/m2/d

Frequency: 5
consecutive days; repeat
every 3 wk
- Route: IV
lomustine (CeeNU)
Mechlorethamine
(Mustargen)
- Dosage: 0.4 mg/kg
- Frequency: for each
course; usually repeated
every 36 wk
- Route: IV
Melphalan (Alkeran)
Oxaliplatin (Eloxatin)
Procarbazine (Matulane)
Streptozocin (Zanosar)
Temozolomide (Temodar)
Thiotepa (Thioplex).
levels.
DRUG INTERACTIONS:
Alkylating agents that are
known to cause hepatic or
renal toxicity should be
used cautiously with any
other drugs that have
similar effects. In addition,
drugs that are toxic to the
liver may adversely affect
drugs that are metabolized
in the liver or that act in the
liver (e.g., oral
anticoagulants). Always
check for specific drugdrug
interactions for each agent
in a nursing drug guide.
third-line agent in treating

germ cell testicular cancers;
being tested for treatment
of other cancers
Palliative combination
therapy for Hodgkin disease
and primary and metastatic
brain tumors
Used in combination
therapy for treatment of
stages III and IV of Hodgkin
disease
Treatment of metastatic
islet cell carcinoma of the
pancreas
Treatment of refractory
astrocytoma or
glioblastoma in patients
refractory to other
treatments
Treatment of
adenocarcinoma of the
breast and uterus and
papillary carcinoma of the
bladder; available
intrathecally to treat
effusion
CONTRAINDICATION:
Alkylating agents are

contraindicated during
pregnancy
Lactation
Allergy to any of them;
with bone marrow
suppression, which
is often the index for
redosing and dosing levels;
or with
suppressed renal or hepatic
function,
Classification: Antibiotic antineoplasms

DRUG
Bleomycin (Blenoxane)
- Dosage: 0.250.5
units/kg
- Frequency: once or
twice weekly
- Route: IV, IM, SUBCU
Dactinomycin
(Cosmegen)
Daunorubicin
(DaunoXome)
Doxorubicin (Adriamycin,
Doxil)
- Dosage: 6075 mg/m2
as a single
- Frequency: repeat
every 21 d
- Route: IV
Epirubicin (Ellence)
ACTION
Antineoplastic antibiotics
although selective for
bacterial cells, are also toxic
to human cells. Because
these drugs tend to be more
toxic to cells that are
multiplying rapidly, they are
more useful in the treatment
of certain cancers
ADVERSE EFFECTS:
leukopenia
thrombocytopenia
anemia
Nausea
Vomiting
Anorexia
Diarrhea
Alopecia may also occur
Idarubicin (Idamycin)
- Dosage: 12 mg/m2/d
DRUG INTERACTIONS:
- Frequency: for 3 days
Antimetabolites that are known
with cytarabine
to cause hepatic or renal
- Route: IV
toxicity should be used with
Mitomycin (Mutamycin)
care with any other drugs
known to have the same effect.
- Dosage: 20 mg/m2
Drugs that result in toxicity to
- Frequency: as a single
the heart or lungs should be
dose at 68-wk intervals
used with caution with any
- Route: IV
other drugs that produce that
Mitoxantrone(Novantrone)
particular Toxicity. Check for
INDICATION:
Palliative treatment of
squamous cell carcinomas,
testicular cancers, and
lymphomas; used to treat
malignant pleural effusion
Part of combination drug
regimen in the treatment of
a variety of sarcomas and
carcinomas; potentiates the
effects of radiation therapy
Treatment of a number of
leukemias and cancers;
used to induce regression;
available in a liposomal
form for treatment of AIDSassociated Kaposi sarcoma
Treatment of disseminated
adenocarcinoma of the
stomach and pancreas
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
CONTRAINDICATION:
Pregnancy
lactation
suppressed renal
or hepatic function,
GI ulcerations or ulcerative

malaise
fatigue, headache,
shortness of breath
using razors
Valrubicin (Valstar)
specific drugdrug interactions

for each agent in a nursing drug
guide.
Classification: Antimetabolites
DRUG
ACTION
Capecitabine (Xeloda)
Cladribine (Leustatin)
Clofarabine (Clolar)
Cytarabine (DepoCyt,Tarabine
PFS)
Floxuridine (FUDR)
Floudarabine (Fludara)
- Dosage: 25 mg/m2/d
- Frequency: for 5 d; repeat
every 28
- Route: IV
Fluorouracil (Adrucil,Carac,
Efudex,
Fluoroplex)
- Dosage: 12 mg/kg/d
- Frequency: days 14
- Route: IV
Gemcitabine (Gemzar)
Mercaptopurine (Purinethol)
Methotrexate (Rheumatrex,
Trexall)
Pemetrexed (Alimta)
- Dosage: 500 mg/m2
- Frequency: over 10 min on
day 1
with 75 mg/m2
cisplatin
- Route: IV
Pentostatin (Nipent)
Pralatrexate (Folotyn)
Thioguanine (Tabloid)
Antimetabolites inhibit DNA
production in cells that
depend on certain natural
metabolites to produce
their DNA
They replace these needed
metabolites and thereby
prevent normal cellular
function. Many of these
agents inhibit thymidylate
synthetase, DNA
polymerase, or folic acid
reductase, all of which are
needed for DNA synthesis
ADVERSE EFFECTS:
cause hepatic
or renal toxicity
should be used with care
with any other drugs known
to have the same effect.
INDICATION:
Treatment of metastatic
breast cancer with
resistance
to paclitaxel or
anthracyclines; treatment
of metastatic colorectal
cancer as fi rst-line therapy
treatment of breast ancer
with docetaxel in patients
with metastatic disease;
postsurgery Dukes C colon
cancer
Treatment of active hairy
cell leukemia
adenocarcinoma metastatic
to the liver in patients who
are not candidates for
surgery
CONTRAINDICATION:
Pregnancy
lactation
known allergy to any of
them to prevent
hypersensitivity reactions;
with bone marrow
suppression,
GI ulcerations
or ulcerative diseases that
might be exacerbated
10 Rights
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10.Right
medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation

malaise
fatigue, headache,
shortness of breath
using razors
DRUGS USED TO TREAT PSYCHOGENIC DISORDERS
Classification: Sedatives and Hypnotics

DRUG
Amobarbital
(Amytal)
- Dosage:
adults for
insomnia 65
200 mg; adults
sedation 30
50 mg; children
26
mg/kg/dose
- Frequency:
PO; bedtime;
BID or TID
- Route: adults
IM or IV;
children IM
Butabarbital
Chloral hydrate
Dexmedetomidine
Estazolam
Lorazepam
Flurazepam
Mephobarbital
Zaleplon
Quazepam
ACTION
INDICATION/CONTRAINDICATIO
N
A barbiturate with hypnotic and
sedative properties (but not
antianxiety). Adverse effects
are mainly a consequence of
dose-related CNS depression
and the risk of dependence
with continued use is high
INDICATION:
This medication is a
barbiturate derivative,
prescribed for anxiety,
insomnia and induction of
preanesthetic sedation. It
alters cerebellar function
and produces drowsiness,
sedation and hypnosis
ADVERSE EFFECTS:
Slow heart rate
low blood pressure
Drowsiness
Agitation
Confusion
Headache
mental disturbances
hallucinations
Nausea
Vomiting
Constipation
Liver damage
DRUG INTERACTIONS
Amobarbital has been known to
decrease the effects of
hormonal birth control,
sometimes to the point of
uselessness.[citation needed]
Being chemically related to
phenobarbital, it might also do
CONTRAINDICATION:
Contraindicated in
patients with history of
acute or chronic pain,
respiratory disease,
severe liver impairment,
porphyria and
hypersensitivity.
NURSING RESPONSIBILITIES
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medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
It comes as a solution for

injection to be administered by
a healthcare provider into the
vein or large muscle
Caution should be exercised in
patients with history of liver or
kidney disease, any allergy,
who are taking other
medications, elderly, children,
during pregnancy and
breastfeeding
Avoid long-term use of this
medication; otherwise patient
may get addicted to this drug
Avoid rapid administration;
otherwise it may lead to
breathing problem
Avoid alcohol consumption
the same thing to digitoxin, a

cardiac glycoside
Classification: Antidepressant
DRUG
ACTION
N
Citalopram
Duloxetine
Escitalopram
Bupropion
(Aplenzin)
- Dosage: 300
mg
- Frequency: PO
- Route: ora
Fluoxetine
Fluvoxamine
Mirtazapine
Sertraline
Phenelzine
Trazodone
Venlafaxine
Nefaxozodone
An antidepressant medication
that affects chemicals within
the brain that nerves use to
send messages to each other
Works by inhibiting the
reuptake of dopamine,
serotonin, and norepinephrine;
an action that results in more
dopamine, serotonin, and
norepinephrine to transmit
messages to other nerves
ADVERSE EFFECTS:
Anxiety
dry mouth
hyperventilation
irregular heartbeats
irritability
restlessness
shaking
shortness of breath
trouble sleeping
DRUG INTERACTION:
should be used cautiously in
patients receiving drugs that
reduce the threshold for
seizures
Such drugs include
prochlorperazine (Compazine),
chlorpromazine (Thorazine},
and other antipsychotic
medications of the
phenothiazine class
Classification: Antimanic Agents
INDIC ATION:
Treating Psychiatric
Disorders.
Use in Smoking Cessation
Treatment
Major Depressive
Disorder, Seasonal
Affective Disorder
CONTRAINDICATION:
Bupropion hydrochloride
extended-release tablet
(XL) is contraindicated in
patients with a seizure
disorder
Bupropion is
contraindicated in
patients with a current or
prior diagnosis of bulimia
or anorexia nervosa
because of a higher
incidence of seizures
noted in patients treated
for bulimia with the
immediate-release
formulation of Bupropion
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medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
Caution in severe hepatic cirrhosis

(do not exceed 150 mg every
other day), mild-moderate hepatic
impairment, head trauma and
prior seizure history, CNS tumor,
concomitant meds lowering
seizure threshold
Observe patients for
neuropsychiatric symptoms, such
as changes in behavior, hostility,
agitation, depressed mood, and
suicide-related events
Seizure disorder or condition that
increases risk of seizure (see
Contraindications)
Discontinue permanently in
patients who experience seizures
False-positive urine immunoassay
screening tests for amphetamines
have been reported; confirmatory
test (eg, gas chromatography,
mass spectrometry) will
distinguish bupropion from
amphetamines
DRUG
Lithium (Lithane)
- Dosage: 600
mg
- Frequency:
TID
- Route: oral
ACTION
The lithium ion behaves in the
body much like the sodium ion;
but its exact mechanism of
action is unclear
At the synapse, it accelerates
catecholamine destruction,
inhibits the release of
neurotransmitters and
decreases sensitivity of
postsynaptic receptors
ADVERSE EFFECTS:
psychomotor retardation
Arrhythmias
Hypotension
ECG changes
Impaired vision
Hypothyroidism
Nausea
Vomiting
anorexia
DRUG INTERACTION:
Anticholinergics: May increase
anticholinergic effect and
glaucoma. Azole antifungals,
buspirone, macrolides:May
increase haloperidol level.
Carbamazepine:May increase
haloperidol level. CNS
depressants:May increase CNS
depression.L ithium: May cause
INDICATION/CONTRAINDICAT
ION
INDICATION:
Control and prophylaxis of

acute mania and the acute
manic phase of mixed
bipolar disorder.
CONTRAINDICATION:
Significant cardiovascular or
kidney disease, brain
damage, severe debilitation,
dehydration or sodium
depletion; patients on lowsalt diet or receiving
diuretics; pregnancy,
especially first trimester
(category D), lactation,
children <12 hypnosis
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10.
medication
dosage
patient
route
time and manner
client education
documentation
assessment
Right evaluation
Give with meals.

Ensure that sustained
release tablets are not
chewed or crushed; must
be swallowed whole.
Protect from light and
moisture.
Monitor response to drug.
Usual lag of 12 wk
precedes response to
lithium therapy. Keep
physician informed of
progress.
Monitor lithium level
Weigh patient daily; check
ankles, tibiae, and wrists
for edema. Report changes
lethargy and confusion after high

doses.M ethyldopa:May cause
dementia.R if ampin: May
decrease haloperidol level.
in I&O ratio, sudden weight

gain, or edema.
Monitor thyroid function
periodically. Be alert to and
report symptoms of
hypothyroidism.
Classification: Antianxiety Agents

DRUG
ACTION
ION
Amoxapine
Buspirone
Clorazepate
Doxepin
Alprazolam
(Niravam)
- Dosage:
0.25-0.5 mg
- Frequency:
TID
- Route: oral
Diazepam
Chlorpromazine
(Largactil)
An anti-anxiety medication
in the benzodiazepine
family, the same family
that includes diazepam
Other benzodiazepines act
by enhancing the effects of
gamma-aminobutyric acid
(GABA) in the brain
ADVERSE EFFECTS:
Apathy
fatigue
Bradycardia
palpitations, edema
Pruritus
Constipation
Diarrhea
Vomiting
Elevations of blood
enzymes
DRUG INTERACTION:
Increased CNS depression
with alcohol, other CNS
depressants, propoxyphene
Increased effect with
cimetidine, disulfiram,
omeprazole, isoniazid,
hormonal contraceptives,
valproic acid
Decreased effect with
INDICATION:
Management of anxiety
disorders, short-term relief
of symptoms of anxiety;
anxiety associated with
depression.
Treatment of panic attacks
with or without agoraphobia
Unlabeled uses: Social
phobia, premenstrual
syndrome, depression
CONTRAINDICATION:
hypersensitivity to
benzodiazepines, psychoses,
acute narrow-angle
glaucoma, shock, coma,
acute alcoholic intoxication
with depression of vital
signs, pregnancy (crosses
the placenta; risk of
congenital malformations,
neonatal withdrawal
syndrome), labor and
delivery (floppy infant
syndrome), lactation
(secreted in breast milk;
infants become lethargic
and lose weight).
Use cautiously with impaired
liver or kidney function,
debilitation.
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10. Right evaluation
Arrange to taper dosage

gradually after long-term
therapy, especially in epileptic
patients
Taper drug slowly; decrease by
no more than 0.5 mg every 3
days
Take this drug exactly as
prescribed; take extendedrelease form once a day in the
morning; place rapidly
disintegrating tablet on top of
tongue, where it will
disintegrate and can be
swallowed with saliva.
Do not drink grapefruit juice
while on this drug
Do not stop taking drug (in
long-term therapy) without
consulting health care provider;
drug should not be stopped
suddenly
Avoid alcohol, sleep-inducing,
or over-the-counter drugs
Report severe dizziness,
carbamazepine, rifampin,
theophylline
Possible increased risk of
digitalis toxicity with
digoxin
Decreased antiparkinson
effectiveness of levodopa
with benzodiazepines
ketoconazole, itraconazole;
serious toxicity can occur
weakness, drowsiness that

persists, rash or skin lesions,
difficulty voiding, palpitations,
swelling in the extremities
Classification: Antipsychotic Agents

DRUG
Clozapine
Haloperidol
Molindone
Chlorpromazine
(Thorazine)
ACTION
Chlorpromazine blocks
brain; also alter dopamine
release and turnover
Dosage: 1025 mg
ADVERSE EFFECTS:
- Frequency:
neuroleptic malignant
2-4 times daily
syndrome
- Route: oral
tardive dyskinesia
Loxapine
hypotension
Olanzapine
blurred vision
Fluphenazine
dry eyesconstipation
Pimozide
dry mouth
Thiothixene
urinary retention
Risperidone
leukopenia
photosensitivity
rashes
DRUG INTERACTIONl
Potentiation of
anticholinergic effects of
antiparkinson agents and
TCAs may lead to
ananticholinergic crisis.
Additive orthostatic
hypotensive effect in
combination withMAOIs.
ION
INDICATION:
Acute and chronic
psychoses, particularly
when accompanied by
increased psychomotor
activity. Nausea and
vomiting.
Also used in the treatment
of intractable hiccups.
CONTRAINDICATION:
Hypersensitivity.
Cross-sensitivity may exist
among phenothiazines.
Should not be used in
narrow-angle glaucoma.
Should not be used in
patients who have CNS
depression.
Coma
bone-marrow suppression
phaeochromocytoma
lactation
10 Rights
1. Right
2. Right
3. Right
4. Right
5. Right
6. Right
7. Right
8. Right
9. Right
10. Right
medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
Assess mental status prior to and

periodically during therapy
Monitor BP and pulse prior to and
frequently during the period of
dosage adjustment. May cause
QT interval changes on ECG
Observe patient carefully when
administering medication, to
ensure that medication is
actually taken and not hoarded
Monitor I&O ratios and daily
eight. Assess patient for signs
and symptoms of dehydration
Monitor for development of
neuroleptic malignant syndrome
Report symptoms immediately.
May also cause leukocytosis,
elevated liver function tests,
elevated CPK
Advise patient to take medication
as directed. Take missed doses
as soon as remembered, witih
DRUG USED TO TREAT ALLERGIE
Classification: Antihistamine
DRUG
remaining doses evenly spaced

throughout the day.
Reverses antihypertensive
effect of
guanethidine,methyldopa
and clonidine.
Additive depressant effect
with sedatives, hypnotics,
antihistamines
ACTION
N
Clemastine
(tavist)
- Dosage:1.34
mg tablet
- Frequency:
PO q12hr
- Route: oral
Cetirizine
(Zyrtec)
Palgic(carbinoxa
mine)
Xyzal(levocetirizi
ne)
Allegra(fexofenad
ine)
Benadryl(dipheny
dramine)
Desloratadine
(Clarinex)
- Frequency:
OD
- Dosage: 5mg
- Route: oral
Dimetane
Claritin(loratadin
e)
ChlorrTrimeton(chlorph
eniramine)
Clemastine is a selective
histamine H1 antagonist. It
binds to the histamine H1
receptor, thus blocking the
action
of endogenoushistamine,
which leads to temporary
relief of the negative
symptoms caused by
histamine.
ADVERSE EFFECTS:
Pharyngitis
Dry mouth
Nausea
Dizziness
Somnolence
Fatigue
Myalgia
Diarrhea
Insomnia
DRUG INTERACTIONS
Desloratadine is very
similar to loratadine. Do
not use medications
containing loratadine while
using desloratadine
INDICATION:
This medication is an
antihistamine and
anticholinergic agent,
prescribed for allergic
rhinitis. It is also used for
uricaria and angioedema.
This medication inhibits
the effect of histamines in
the body.
CONTRAINDICATION:
During pregnancy, this
medication should be
used only when clearly
needed.
Before using this
medication, tell your
doctor or pharmacist your
medical history, especially
of: kidney
disease, liver disease
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medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
Give cautiously to older adults

who are taking other
medications
Monitor for side effects
Encourage a fluid intake of 2,
500-3, 000 mL/day unless
contraindicated
Give Benadryl before
transfusion or diagnostic tests
that use contrast media as
ordered
Take only one antihistamine at
a time
Don not drink alcohol
Use hard candy, gum, ice chips
or mouth rinses to relieve
dryness
Stop the drug and notify the
physician if excessive sedation,
dizziness, palpitations or
urinary retention occurs
Classification: Estrogens
DRUG
DRUGS USED TO TREAT REPRODUCTIVE PROBLEMS

ACTION
Conjugated
INDICATION:
Mimic the effects of estrogen in
Hormone Replacement
Estrogens
estrogen-sensitive
tissues
Therapy used along with
(Premarin)
Bind
to
cytoplasmic
receptors
progestin
Dienestrol (Ortho
As birth control pills;
Dienestrol)
combined with progestin
ADVERSE
EFFECTS:
Esterified Estrogens
Treat adverse reactions from

Breast tenderness
(Estratab, Menest)
loss of estrogen (hot
Increase risk of endometrial
Estradiol (Estrace)
flashes)
cancer stimulates
Estrone (Estrone)
For vaginal atrophy (vaginal

endometrial proliferation
Estropipate (Ogen)
creams)
May promote estrogen Replacement therapy during
Mestranol
sensitive tumors
puberty
- Dosage: low
Hypertension
In metastatic cancer or
Risk of thromboses
doses for
advanced prostatic carcinoma
Depression
replacement
atherosclerosis
therapy; high
CONTRAINDICATION:
doses for oral
Are pregnant.
DRUG INTERACTIONS
contraceptive
Have unexplained vaginal
and breast
bleeding.
Some products that may
cancer
Have active liver disease or
- Route: oral,
interact with this drug
chronic impaired liver
transdermal,
include: aromatase
function
parenteral,
inhibitors (such as
Have a personal history
vaginal, IV
anastrozole,
of breast cancer, ovarian
exemestane, letrozole),
cancer, or endometrial
fulvestrant, ospemifene,
cancer.
raloxifene, tamoxifen,
Are a smoker.
toremifene
Have a history of blood
This medication may
clots.
Have had a stroke
interfere with certain
laboratory tests
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medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
Ask aeg if he/she has/have a

family history of breast
cancer, ovarian
cancer, stroke, blood clots, or
endometrial cancer
Classification: Estrogens antagonist

DRUG
ACTION
Clomiphene
(Clomid, Milophene,
Serophene)
Raloxiphene (Evista,
Ratoxiphene)
- Dosage: 50 mg
- Frequency:
daily
- Route: oral or IV
Tamoxifen
(Nolvadex)
Toremifene
(Fareston)
Binds to receptors of
estrogen but produces no
significant estrogenic action
Competes with estradiol for
estrogen-binding sites in the
hypothalamus
Increases release of
GnRHrelease of FSH and LH
Stimulates ovulation
Given orally
Biotransformed in the liver
ADVERSE EFFECTS:
Hot flashes antiestrogenic
properties
Abdominal bloating
Breast tenderness
Nausea & vomiting
Visual disturbances
INDICATION:
Treat ovulatory failure
(polycystic ovary
syndrome)
Menstrual disorder
Persistent lactation
Oligospermia
Fibrocystic breast disease
Male infertility
CONTRAINDICATION:
Hypersensitivity or allergy
to clomiphene citrate or to
any of its ingredients
Pregnant women are
contraindicated, as CLOMID
does not offer benefit in
this population
Patients with liver disease
or a history of liver
dysfunction
Abnormal uterine bleeding
of undetermined origin
Ovarian cysts or
enlargement not due to
polycystic ovarian
syndrome
Uncontrolled thyroid or
adrenal dysfunction or in
the presence of an organic
intracranial lesion such as
pituitary tumor
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medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
Not given to patients with

persistent ovarian
enlargement or with
ovarian cysts
Patients with polycystic
ovary syndrome are
unusually sensitive to
clomiphene d/c the drug
C/I to patients with uterine
bleeding, pituitary tumors
Risk of multiple gestation
Not given together with
ovarian stimulators
Classification: Progestins
DRUG
ACTION
Desogestrel
Produce the action of
Ethynodiol
naturally-occurring
Hydroxyprogesterone
progestins
Norgestrel
Actions arise as
- Dosage: One 1.5
progestin interacts with
mg tablet
steroid receptors inside
- Frequency:
target cells to alter gene
possible within
expression
72 hours of
MAGESTROL
unprotected
antianorectic/anticacheti
intercourse
c drug
- Route: oral
Levonergestrel
ADVERSE EFFECTS:
Medroxyprogesterone
Breakthrough menstrual
(depo provera)
bleeding
Megestrol
Amenorrhea
Progesterone
Edema; Breast
tenderness
Depression; mood
changes
Weight gain
Delayed return of
fertility
INDICATION:
For proliferation of uterus
Contraceptive agent with
estrogen
High doses: suppresses
bleeding of endometrium
Withdrawal: sloughing of
tissue (for secondary
amenorrhea)
For dysfunctional uterine
bleeding (DUB)
Induces menstruation
Treat endometriosis
CONTRAINDICATION:
Thrombophlebitis or
thromboembolic disorders
A past history of deep vein
thrombophlebitis or
thromboembolic disorders
Cerebral vascular or
coronary artery disease
Known or suspected
carcinoma of the breast
Carcinoma of the
endometrium or other
known or suspected
estrogen-dependent
10 Rights
1. Right medication
2. Right dosage
3. Right patient
4. Right route
9. Right assessment
10.Right evaluation
Should be avoided during

pregnancy causes
androgenic effect of female
fetuses
Causes excessive hair
growth or loss
Risk of thromboses
neoplasia
Undiagnosed abnormal
genital bleeding
Cholestatic jaundice of
pregnancy or jaundice with
prior pill use
Classification: Progestin antagonist

DRUG
ACTION
MIFEPRISTONE (RU
486, Mifeprex)
- Dosage: adult
600 mg
- Frequency: 49
days
- Route: oral
10 Rights
INDICATION:
1. Right medication
Prevents the action of
Reversible means of
2. Right dosage
progesterone (progestin) in
preventing pregnancy
3. Right patient
target tissues such as
Postcoital contraception
4. Right route
endometrium
Treat acne
Terminate intrauterine
Treat
endometriosis
pregnancy within the first
Normalization
of
irregular
49 days
menses
Reversible means of
9. Right assessment
preventing pregnancy
10.Right evaluation
Postcoital contraception CONTRAINDICATION:
Patients with confirmed or
PROGESTIN alone alter
Given with Misoprostol
suspected fertilized egg
cervical mucus and
has implanted outside the
endometrium but dont
uterus
always suppress
Chronic adrenal failure
ovulation
Concurrent
long-term
Progestin alone is less
corticosteroid
therapy
effective
History
of
allergy
to
mifepristone
ADVERSE EFFECTS:
Misoprostol
or
other
Bleeding (may require
prostaglandin
blood transfusions)
Bleeding disorders
Abdominal pain
Liver or kidney impairment
Uterine cramping
Pregnancy and lactation
Fatigue
IUD in place
Nausea and vomiting
Undiagnosed uterus mass.
May come from either
estrogen or progestin
alone
Nausea & vomiting
Bloating
Breast tenderness
Edema
Hypertension
Cervical discharges
Classification: Uterine motility agent

DRUG
ACTION
OXYTOCIN
(Sintocinon, Pitocin)
Dosage: 0.5 to 1
milliunits
Frequency: per
hour
Route: IV
INDICATION:
Binds
the
oxytocin
Induction of labor
receptor which leads to
an
increase
in CONTRAINDICATION:
intracellular
calcium CPD
levels
Fetal distress
Induces contraction of Placenta previa
Abnormal fetal presentation

myometrium
ADVERSE EFFECTS:
Vomiting
Blood loss
Water intoxication
Uterine rupture and
hematoma
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2. Right
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6. Right
7. Right
8. Right
9. Right
10.Right
medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
Check for allergies
DRUG INTERACTION:
Vasoconstriction drugs
Classification: Prostaglandins
DRUG
ACTION
Alprostadil
Bimatoprost
Carboprost
(Hemabate)
Dinoprostone
Epopostenol
Misoprostol
Travopost
Suppresses the immune

response of Rh-negative
individuals to Rh-positive
red blood cells
ADVERSE EFFECTS:
Fever
Chills
GI upset
Diarrhea
Convulsion
Chest pain
Hypertension
Bronchospasm
Bronchoconstriction
Nausea and vomiting
Cardiorespiratory failure
DRUG INTERACTION:
Oxytocin
Teratogens
10 Rights
INDICATION:
1. Right medication
Induces labor during the 2nd

2. Right dosage
trimester when the uterus is
3. Right patient
resistant to oxytocin
4. Right route
Cervical ripening in pregnant

women at or near term with
need for labor induction
CONTRAINDICATION:
Anemia
Pregnancy
Diabetes
Hypersensitivity
Placenta previa
Ruptured membranes
Acute
pelvic
inflammatory
disease
Unexplained vaginal bleeding

during current pregnancy
Active cardiac, pulmonary,

renal, or hepatic disease

9. Right assessment
10.Right evaluation
Check for allergies
Classification: Rhogam
DRUG
ACTION
RhoGAM (rhod
immune globulin
human)
MICRhoGAM (rhod
immune globulin
human)
Rho(D) Immune
Globulin (Human)
INDICATION:
Suppresses the immune

Pregnancy
Obstetrical Conditions in
response of Rh-negative
Rh-Negative Women,
individuals to Rh-positive
Unless the Father or Baby
are Conclusively Rh
red blood cells
Negative
ADVERSE EFFECTS:
Redness
Swelling
Induration
CONTRAINDICATION:
Hypersensitivity
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Mild pain at the site of

injection
medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
Check for allergies

Observe patient for at least
20 minutes after
administration
Classification: Uterine relaxant tocolytics

DRUG
ACTION
Ritodrine (Yutopar)
Terbutaline
(bricanyl, Brethine)
INDICATION:
Causes uterine relaxation

Stop spontaneous labor
Stimulates beta 2 receptor

during the 20th 36th
sites
week of gestation
(associated with
ADVERSE EFFECTS:
irreversible fetal problems)
Anxiety
Palpitation
CONTRAINDICATION:
Tachycardia
Hypersensitivity
Hypokalemia
Increase FHR
Hyperglycemia
Increase maternal cardiac

workload
DRUG INTERACTION:
Beta blockers
10 Rights
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7. Right
8. Right
9. Right
10.Right
medication
dosage
patient
route
time and manner
client education
documentation
assessment
evaluation
Check for allergies

Drugs Used To Treat Digestive Problems: Classification: Antidiarrheals

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DRUGS USED TO TREAT DIGESTIVE PROBLEMS

Kaolin and Pectine are locally

Use cautiously with hepatic

Obtain an order for

Possible vomiting with

Classification: Laxatives (Hyperosmolar laxatives)

High sodium level causes

Do not freeze laxative form.

Classification: Laxatives (Bulk forming laxatives)

Should be taken with water

Ensure that patient has

Classification: Laxatives (Emollient laxatives or surfactant laxatives)

Decreases surface tension

Swallow tablets whole

This detergent allows water

In cases of allergy to these

Do not take this drug within

Emollients can also be given

Classification: Laxatives (Stimulant laxatives)

Also known as irritant

Used before surgeries

Swallow tablets whole

Acute abdominal pain

Classification: Laxative (Lubricant laxatives)

Prevents colonic reabcorption

To remove ingested poisons

Acute abdominal pain

Swallow tablets whole

Classification: Anti-peptic ulcer drugs [Histamine (H2) receptor antagonists]

Frequency: Oral HS,

Inhibits the action of histamine

Classification: Anti-peptic ulcer drugs [Proton (acid) pump inhibitors]

Give drug with meals and hs

Drugs that block the action of

For short term therapy:

Treating severe erosive

If administering antacids, they

Contraindicated with allergy to

Avoid administering calcium

Dosage: tablets 325,

When used in patients with

Within the GIT, they combine

obstruction (aluminum salt

disintegrate the coating,

Classification: Antiemetic (Serotonin receptor antagonists)

Prevents nausea and

Potential for severe toxic

therapy for cancer or bone

The antineoplastic drugs that

Check for hypersensitivity;

Classification: Antiemetic (Dompamine receptor antagonists)

Suppress nausea and

Do not change brand names of

Classification: Antiemetic (Cannabinoids)

They inhibit the emesis

Contraindicated with allergy to

which dronabinol is used to

Classification: Antiemetic (Muscarinic receptor antagonists)

This medication patch may be

Causes additive effects when

Considered the most

Do not share this

For motion sickness,