NURS 2516 Clinical Medications Worksheets

(You will need to make additional copies of these forms)

Generic Name Trade Name Classification Dose Route Time/frequency

Duloxetine Cymbalta Antidepressants 20mg PO 0900 daily
(SSNRIs)
Peak Onset Duration For IV meds, compatibility with IV drips and /or solutions
6 hr unknown 12 hr N/A

Mechanism of action and indications Nursing Implications (what to focus on)

(Why med ordered) Contraindications/warnings/interactions
Inhibits serotonin and norepinephrine reuptake in the Hypersensitivity. Use cautiously in: History of suicide
CNS. Both antidepressant and pain inhibition are attempt or ideation; History of mania (may activate
centrally mediated. mania/hypermania); Concurrent use of other centrally-acting
Depression, pain. drugs (increased risk of adverse reactions); History of seizure
disorder. Pedi: May increase risk of suicide attempt/ideation
especially during dose early treatment or dose adjustment;
risk may be greater in children and adolescents (safe use in
children and adolescents not established). Increased risk of
hepatotoxicity with alcohol use.
Common side effects
SEIZURES, fatigue, drowsiness, insomnia, decreased
appetite, constipation, dry mouth, nausea, dysuria,
increased sweating
Interactions with other patient drugs, OTC or herbal
medicines (ask patient specifically)
none
Lab value alterations caused by medicine
May increase ALT, AST, bilirubin, CPK, and alkaline
phosphatase.
Be sure to teach the patient the following about this
medication
Instruct pt. to take as directed at the same time each day.
Take missed doses as soon as possible unless time for next
dose. Do not stop abruptly; must be decreased gradually.
Encourage pt. and family to be alert for emergence of
anxiety, agitation, panic attacks, insomnia, irritability,
hostility, impulsivity, akathisia, hypomania, mania,
worsening of depression and suicidal idealation, especially
during early antidepressant therapy. If these symptoms,
notify health care professional. May cause drowsiness.
Caution pt. to avoid driving or other activities requiring
alertness until response to medication is known. Advise pt to
consult health care professional prior to taking any Rx, OTC,
or herbal products. Instruct p. to notify healthcare
professional if signs of liver damage (pruritus, dark uring,
jaundice, right upper quadrant tenderness, unexplained “flu-
like symptoms) occur. Advise pt. to avoid taking alcohol
during duloxetine therapy. Instruct pt. to notify health care
professional if pregnancy is suspected.

Nursing Process- Assessment Assessment Evaluation

(Pre-administration assessment)
Monitor blood pressure before and
periodically during therapy. Monitor appetite
and nutritional intake. Assess mental status
and mood. Assess suicidal tendencies.
Assesspain intensity, quality, and location.
Why would you hold or not give this
med?
Sustained hypertention, occurrence of
severe side effects.
Check after giving
Increased sense of well-being,
renewed interest in
surroundings. Need for
therapy should be periodically
reassessed. Pts. May notice
improvement within -4 wks,
but should be advised to
continue therapy as directed.
Therapy is usually continued
for several months.

Dose Range: no pediatric range available because safe use in children/adolescents is not
established. Adult dose range for antidepressant use is 20-30 mg twice daily and for
neuropathic pain is 60 mg once daily.