Drug Study Name of drug Nimodipine 30mg 2tabs q 6 Action Inhibits the transport of calcium into vascular smoothmuscle

cells, resulting in inhibition of excitationcontraction coupling and subsequent contraction. Potent peripheral vasodilator. Therapeutic Effects: Prevention of vascular spasmafter subarachnoid hemorrhage, resulting in decreased neurologic impairment. Indication Management of subarachnoid hemorrhage. Contraindication Contraindicated in: Hypersensitivity; Sick sinus syndrome; 2nd- or 3rddegree AV block Side effects CNS: abnormal dreams, anxiety, confusion, dizziness, drowsiness, headache, nervousness, psychiatric disturbances, weakness. EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus. Resp: cough, dyspnea. CV: ARRHYTHMIAS, CHF, bradycardia, chest pain, hypotension, palpitations, peripheral edema, syncope, tachycardia. GI: abnormal liver function studies, anorexia, constipation, diarrhea, drymouth, dysgeusia, dyspepsia, nausea, vomiting. GU: dysuria, nocturia, polyuria, sexual dysfunction, urinary frequency. Derm: dermatitis, erythema Nursing consideration Assess patients neurologic status (level of consciousness, movement) prior to and periodically following administration. Monitor blood pressure and pulse prior to therapy and periodically throughout therapy. Monitor intake and output ratios and daily weight. Assess for signs of CHF (peripheral edema, rales/crackles, dyspnea, weight gain, jugular venous

multiforme, flushing, increased sweating, photosensitivity, pruritus/urticaria, rash. Endo: gynecomastia, hyperglycemia. Hemat: anemia, leukopenia, thrombocytopenia.Meta b: weight gain.MS: joint stiffness, muscle cramps. Neuro: paresthesia, tremor. Misc: STEVENSJOHNSON SYNDROME, gingival hyperplasia.

distention). Lab Test Considerations: Total serum calcium on centrations are not affected by calcium channel blockers. Monitor renal and hepatic functions periodically. Several days of therapy may cause increase in hepatic enzymes, which return to normal upon discontinuation of therapy. Assess for allergy to atropine and belladonna alkaloids; patients with these allergies may also be

Combivent q6 / Ipatropium neb now then q 12

Inhaln: Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased concentrations of cyclic

Inhaln: Maintenance therapy of reversible air way obstruction due to COPD, including chronic bronchitis and

Contraindicated in: Hypersensitivity to ipratropium, atropine, belladonna alkaloids, or bromide. Avoid use during acute broncho spasm;

CNS: dizziness, headache, nervousness. EENT: blurred vision, sore throat; nasal only epistaxis, nasal dryness/irritation. Resp:

guanosinemonophos phate (cGMP). Decreased levels of cGMP produce local bronchodilation.

emphysema.

bronchospasm, cough. CV: hypotension, palpitations. GI: GI irritation, nausea. Derm: rash. Misc: allergic reactions.

sensitive to ipratropium. Atrovent HFA MDI does not contain CFC or soy and may be used safely in soy or CFCallergic patients. However, CombiventMDI should be avoided in soyor peanutallergic patients. Inhaln: Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration and at peak of medication. Consult physician or other health care professional about alternative

medication if severe broncho spasm is present; onset of actions is too slow for patients in acute distress. If paradoxical broncho spasm (wheezing) occurs, withhold medication and notify physician or other health care professional immediately. Nasal Spray: Assess patient for rhinorrhea. Assess patient for abdominal distention, presence of bowel sounds, and normal pattern of bowel function. Assess color,

Lactulose 30cc q HS

Increases water content and softens the stool. Lowers the pH of the colon, which inhibits the diffusion of ammonia from the colon into the blood, thereby reducing

Treatment of chronic constipation in adults and geriatric patients. Adjunct in the management of portal-systemic (hepatic) encephalopathy

Contraindicated in: Patients on low-galactose diets. Use Cautiously in: Diabetes mellitus; Excessive or prolonged use (may lead to dependence); OB, Lactation, Pedi:

GI: belching, cramps, distention, flatulence, diarrhea. Endo: hyperglycemia (diabetic patients).

blood ammonia levels. Therapeutic Effects: Relief of constipation. Decreased blood ammonia levels with improved mental status in PSE.

(PSE).

Pregnancy, lactation, or children (safety not established).

consistency, and amount of stool produced. PSE: Assess mental status (orientation, level of consciousness) before and periodically throughout course of therapy. Lab Test Considerations: Decreases blood ammonia concentrations by 2550%. May cause increased blood glucose levels in diabetic patients. Obtain a dietary history, especially with regard to fat consumption. Lab Test Considerations:

Simvastatin 40mg tab OD HS

Inhibit an enzyme, 3-hydroxy-3methylglutarylcoenzyme A (HMGCoA) reductase, which is responsible for catalyzing an early step in the

Simvastatin: Secondary prevention of cardiovascular events (_ risk of MI, coronary revascularization,

Contraindicated in: Hypersensitivity; Active liver disease or unexplained persistent_in AST or ALT; OB, Lactation: Pregnancy or lactation (potential for fetal

CNS: dizziness, headache, insomnia, weakness. CV: chest pain, peripheral edema. EENT: rhinitis; lovastatin blurred vision. Resp: bronchitis.

synthesis of cholesterol. Therapeutic Effects: Lowers total and LDL cholesterol and triglycerides. Slightly increase HDL. Slows of the progression of coronary atherosclerosis with resultant decrease in CHD-related events (all agents except rosuvastatin have indication for_ events).

stroke, and cardiovascularmort ality) in patients with clinically evident CHD or those at high-risk for CHD (history of diabetes, peripheral arterial disease, or stroke).

anomalies); Concurrent use of gemfibrozil or azole antifungals; Concurrent use of nelfinavir or ritonavir (with lovastastin or simvastatin).

GI: abdominal cramps, constipation, diarrhea, flatus, heartburn, altered taste, druginduced hepatitis, dyspepsia, elevated liver enzymes, nausea, pancreatitis. GU: erectile dysfunction. Derm: rashes, pruritus. MS: RHABDOMYOLYSIS, arthralgia, arthritis, myalgia,myositis. Misc: hypersensitivity reactions.

Evaluate serum cholesterol and triglyceride levels before initiating, after 46 wk of therapy, and periodically thereafter. Monitor liver function tests, including before, at 12 wk after initiation of therapy after dose elevation, and then q 6mo. levels_to 3 times normal, HMG-CoA tase inhibitor therapy should be reduced herdiscontinued. May also cause_alkaline phosphatase and bilirubin levels. Assess patient routinely for epigastric or

Omeprazole 40mg tab OD

Binds to an enzyme on gastric parietal cells in the presence

Long term use of medication; GERD/maintenanc

Contraindicated in: Hypersensitivity; Metabolic alkalosis and

CNS: dizziness, drowsiness, fatigue, headache, weakness.

of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen.

e of healing in hypocalcemia (Zegerid erosive esophagitis. only). Duodenal ulcers (with or without anti-infectives for Helicobacter pylori). Short-term treatment of active benign gastric ulcer. Pathologic hypersecretory conditions, including Zollinger-Ellison syndrome. Reduction of risk of GI bleeding in critically ill patients.

CV: chest pain. GI: abdominal pain, acid regurgitation, constipation, diarrhea, flatulence, nausea, vomiting. Derm: itching, rash. Misc: allergic reactions.

abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate. Lab Test Considerations: Monitor CBC with differential periodically during therapy. May cause_AST, ALT, alkaline phosphatase, and bilirubin. May cause serum gastrin concentrations to during first 12 wk of therapy. Levels return to normal after discontinuation of omeprazole. Somazine must not be

Citicoline 150 mg 1 tab BID

Citicoline is an interneuronal

CVD in acute & recovery phase,

Parasympathetic hypertonia

Common side effects are trouble sleeping

communication enhancer. It increases the neurotransmission levels because it favors the synthesis and production speed of dopamine in the striatum, acting then as a dopaminergic agonist thru the inhibition of tyrosinehydroxylase.

symptoms & signs of cerebral insufficiency (dizziness, memory loss, poor concentration, disorientation, recent cranial trauma & their sequelae.)

(insomnia), headache, di arrhea, low or high blood pressure, nausea, blurred vision, chest pains, and others.

administered along with medicaments containing meclophenoxate

Celecoxib 40mg OD & Etoricoxib 120mg tab if with severe headache

Inhibits the enzyme COX-2. This enzyme is required for the synthesis of prostaglandins. Has ulanalgesic, anti-inflammatory, and antipyretic properties.

Relief of signs and symptoms of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and juvenile rheumatoid arthritis. Reduction of the number of adenomatous colorectal polyps in familial adenomatous

Contraindicated in: Hypersensitivity; Crosssensitivity may exist with other NSAIDs, including aspirin; History of allergic-type reactions to sulfonamides; History of asthma, urticaria, or allergic-type reactions to aspirin or other NSAIDs, including the aspirin triad (asthma, nasal polyps, and severe hypersensitivity reactions to aspirin); Advanced renal disease; Peri-opera-

CNS: dizziness, headache, insomnia. CV: edema. GI: GI BLEEDING, abdominal pain, diarrhea, dyspepsia, flatulence, nausea. Derm: EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rash.

Assess range of motion, degree of swelling, and pain in affected joints before and periodically throughout therapy. Assess patient for allergy to sulfonamides, aspirin, or NSAIDs. Patients with these allergies

polyposis (FAP), as an adjunct to usual care (endoscopic surveillance, surgery). Management of acute pain including primary dysmenorrheal.

Furosemide 40mg TIV now then q 12

Inhibits the reabsorption of sodiumand chloride from the loop of Henle and distal renal tubule. Increases renal excretion of water, sodium, chloride,magnesium, potassium, and calcium. Effectiveness persists in impaired renal function.

Edema due to heart failure, hepatic impairment or renal disease. Hypertension.

tive pain fromcoronary artery bypass graft (CABG) surgery; OB: Should not be used in late pregnancy (may cause premature closure of the ductus arteriosus). Lactation: Potential for serious neonatal adverse effects. Discontinue drug or bottle feed. Contraindicated in: Hypersensitivity; Cross sensitivity with thiazides and sulfonamidesmay occur; Hepatic coma or anuria; Some liquid products may contain alcohol, avoid in patients with alcohol intolerance.

should not receive celecoxib.

Lab Test Considerations: May cause AST and ALT levels.

CNS: blurred vision, dizziness, headache, vertigo. EENT: hearing loss, tinnitus. CV: hypotension. GI: anorexia, constipation, diarrhea, dry mouth, dyspepsia, nausea, pancreatitis, vomiting. GU: excessive urination. Derm: photosensitivity, pruritis, rash. Endo: hyperglycemia, hyperuricemia. F and E: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia,

Assess fluid status. Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Notify physician or other health care professional if thirst, dry mouth, lethargy, weakness, hypotension, or

hypovolemia, metabolic alkalosis. Hemat: APLASTIC ANEMIA, AGRANULOCYTOSIS , hemolytic anemia, leukopenia, thrombocytopenia.MS: muscle cramps. Neuro: paresthesia.Misc: fever, increased BUN, nephrocalcinosis.

oliguria occurs. Monitor blood pressure and pulse before and during administration. Monitor frequency of prescription refills to determine compliance in patients treated for hypertension. Geri: Diuretic use is associated with increased risk for falls in older adults. Assess falls risk and implement fall prevention Assess patient for tinnitus and hearing loss Lab Test Considerations: Monitor

Sodium Chloride tab Sodium is a major BID 3 days cation in extracellular fluid and helps maintain water distribution, fluid and electrolyte balance, acid-base equilibrium, and osmotic pressure. Chloride is the major

Prevention of or management of volume depletion due to salt restriction or heat prostration when excessive sweating occurs during exposures to high temperatures.

Contraindicated in: IV solution: Hypertonic (3%, 5%) solutions should not be used in patients with elevated, slightly decreased, or normal serum sodium, Fluid retention or hypernatremia.

CV: CHF, PULMONARY EDEMA, edema. F and E: hypernatremia, hypervolemia, hypokalemia.

electrolytes, renal and hepatic function, serum glucose, and uric acid levels before and periodically throughout therapy. Commonly decrease serum potassium. May cause decrease serum sodium, calcium, and magnesium concentrations. May also cause increase BUN, serum glucose, creatinine, and uric acid levels. Assess fluid balance (intake and output, daily weight, edema, lung sounds) throughout therapy. Assess patient

anion extracellular fluid and is involved in maintaining acidbase balance. Solutions of NaCl resemble extracellular fluid. Reduces corneal edema by an osmotic effect.

for symptoms of hyponatremia(h eadache, tachycardia, lassitude, dry mucous membranes, nausea, vomiting, muscle cramps) or hypernatremia (edema, weight gain, hypertension, tachycardia, fever, flushed skin, mental irritability) throughout therapy. Sodium is measured in relation to its concentration to fluid in the body, and symptoms may change based on patients hydration status. Lab Test Considerations:

Monitor serum sodium, potassium, bicarbonate, and chloride concentrations and acid-base balance periodically for patients receiving prolonged therapy with sodium chloride. Dexamethasone 5mg TIV q 8 Have negligible mineralocorticoid activity. Management of cerebral edema: Diagnostic agent in adrenal disorders. Contraindicated in: Active untreated infections (may be used in patients being treated for some forms of meningitis); Lactation (avoid chronic use); Known alcohol, bisulfite, or tartrazine hypersensitivity or intolerance (some products contain these and should be avoided in susceptible patients); Administration of live virus vaccines. CNS: depression, euphoria, headache, increased intracranial pressure (children only), personality changes, psychoses, restlessness. EENT: cataracts, increased intraocular pressure. CV: hypertension. GI: PEPTIC ULCERATION, anorexia, nausea, vomiting. Derm: acne, decreased wound healing, ecchymoses, fragility, These drugs are indicated form any conditions. Assess involved systems before and periodically during therapy Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting,

hirsutism, petechiae. Endo: adrenal suppression, hyperglycemia. F and E: fluid retention (longterm high doses), hypokalemia, hypokalemic alkalosis. Hemat: THROMBOEMBOLIS M, hrombophlebitis. Metab: weight gain. MS: muscle wasting, osteoporosis, aseptic necrosis of joints, muscle pain. Misc: cushing appearance (moon face, buffalo hump), increased susceptibility to infection.

anorexia, lethargy, confusion, restlessness) before and periodically during therapy. Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional if these occur. Children should have periodic evaluations of growth. Lab Test Considerations: Monitor serum electrolytes and glucose. May

Tramadol 100mg initially then 50 mg TIV q 6 x 4 doses

Binds to mu-opioid Moderate to receptors. Inhibits moderately severe reuptake of serotonin pain and norepinephrine in the CNS.

Contraindicated in: Hypersensitivity; Cross sensitivity with opioids may occur; Patients who are acutely intoxicated with alcohol, sedative/hypnotics, centrally acting analgesics, opioid analgesics, or psychotropic agents; Patients who are physically dependent on opioid analgesics (may precipitate withdrawal

CNS:SEIZURES, dizziness, headache, somnolence, anxiety, CNS stimulation, confusion, coordination disturbance, euphoria, malaise, nervousness, sleep disorder, weakness. EENT: visual disturbances. CV: vasodilation. GI: constipation, nausea, abdominal pain, anorexia, diarrhea, dry mouth, dyspepsia, flatulence, vomiting.

cause hyperglycemia, especially in persons with diabetes. May cause hypokalemia. Patients on prolonged therapy should routinely have CBC, serum electrolytes, and serum and urine glucose evaluated. Assess type, location, and intensity of pain before and 23 hr (peak) after administration. Assess blood pressure and respiratory rate before and periodically during administration. Respiratory depression has not occurred

GU: menopausal symptoms, urinary retention/frequency. Derm: pruritus, sweating. Neuro: hypertonia. Misc: physical dependence, psychological dependence, tolerance.

with recommended doses. Assess bowel function routinely. Prevention of constipation should be instituted with increased intake of fluids and bulk and with laxatives to minimize constipating effects. Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria. Pain: Assess pain (note type,

Ketorolac 30mg TIV q 8 x 6 doses

Inhibits prostaglandin synthesis, producing peripherally analgesia. Also has antipyretic and anti inflammatory properties.

Post operative pain medication of the patient; Short-term management of pain (not to exceed 5 days total for all routes combined).

Contraindicated in: Hypersensitivity; Cross sensitivity with other NSAIDs may exist

CNS: drowsiness, abnormal thinking, dizziness, euphoria, headache. Resp: asthma, dyspnea. CV: edema, pallor, vasodilation. GI: GI BLEEDING, abnormal taste, diarrhea, drymouth, dyspepsia, GI pain, nausea. GU: oliguria, renal toxicity, urinary frequency. Derm: EXFOLIATIVE

DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, pruritus, purpura, sweating, urticaria. Hemat: prolonged bleeding time. Local: injection site pain. Neuro: paresthesia. Misc: allergic reactions including, anaphylaxis.

location, and intensity) prior to and 12 hr following administration. Lab Test Considerations: Evaluate liver function tests, especially AST and ALT, periodically in patients receiving prolonged therapy. May cause increased levels. Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning and during therapy. Before initiating therapy, obtain a history to determine previous use of

Cefazolin 1g TIV q 8

Bind to bacterial cell wall membrane, causing cell death. Therapeutic Effects: Bactericidal action against susceptible bacteria.

Meningitis, gynecologic infections, and Lyme disease.

Contraindicated in: Hypersensitivity to cephalosporins; Serious hypersensitivity to penicillins.

CNS: SEIZURES (high doses). GI: PSEUDOMEMBRANO US COLITIS, diarrhea, cramps, nausea, vomiting. Derm: rashes, urticaria. Hemat: agranulocytosis, bleeding (_with cefotetan and cefoxitin), eosinophilia, hemolytic anemia, neutropenia, thrombocytopenia.

Local: pain at IM site, phlebitis AT IV SITE. Misc: allergic reactions including ANAPHYLAXIS and SERUM SICKNESS, superinfection.

and reactions to penicillins or cephalosporins. Persons with a negative history of penicillin sensitivity may still have an allergic response. Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify physician or other health care professional immediately if these symptoms occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event

Paracetamol 110 mg IV q 4 37.8

Inhibits the synthesis Mild pain. Fever. of prostaglandins thatmay serve asmediators of pain and fever, primarily in the CNS. Has no significant antiinflammatory properties or GI toxicity. Therapeutic Effects: Analgesia. Antipyresis.

Contraindicated in: Previous hypersensitivity; Products containing alcohol, aspartame, saccharin, sugar, or tartrazine (FDC yellow dye #5) should be avoided in patients who have hypersensitivity or intolerance to these compounds. Use Cautiously in: Hepatic disease/renal disease (lower chronic doses recommended); Chronic alcohol use/abuse; Malnutrition.

GI: HEPATIC FAILURE, HEPATOTOXICITY (overdose). GU: renal failure (high doses/chronic use). Hemat: neutropenia, pancytopenia, leukopenia. Derm: rash, urticaria.

of an anaphylactic reaction. Assess overall health status and alcohol usage before administering acetaminophen. Patients who are malnourished or chronically abuse alcohol are at higher risk of developing hepatotoxicity with chronic use of usual doses of this drug. Fever: Assess fever; note presence of associated signs (diaphoresis, tachycardia, and malaise). Lab Test Considerations: Evaluate hepatic, hematologic, and renal

function periodically during prolonged, high-dose therapy.