Medication Brand/Generic Lactulose, Kristalose

Mechanism of Action Synthetic disaccharide used for constipation. Bacteria in the colon degrade lactulose into lactic acid and formic acid which causes increase in osmotic pressure which in turn, softens the stool by promoting stool water content. Draws liquid into the colon and thus softening the stool.

Indications Constipation. Hepatic encephalopathy: treatment and prophylaxis

Assessment Improves GI motility so monitor the bowel movements. Monitor serum electrolytes (K, Cl, and CO2)

Contraindications Low-glucose diet requirement

Side Effects GI: bloating, diarrhea, epigastric pain, flatulence, nausea, vomiting Muscle: Cramps Endrocrine: Hypernatremia, Hypokalemaia

Colace Docusate

Constipation Care

Decrease abd discomfort and pain Bowel movement 12-72 hours Reassess if rectal bleeding or no bowel movement after laxative

Hypersensitivity to docusate products. Concomitant use of mineral oil. Intestinal obstruction Acute abd pain with N/V Hypersensitivity to any component such as polyethylene glycol Bowel obstruction

Abnormal taste in the mouth (Bitter) Nausea Muscle cramps

Polyethylene Glycol 3350 Miralax

Is an osmotic agent that causes retention of water in the stool which increases bowel movements. It appears to have no effect on active absorption or secretion of glucose or electrolytes Semisynthetic beta-lactam antibiotic. Clavulanic acid, a beta-lactamase inhibitor, protects amoxicillin against degradation and extends the antibiotic spectrum compared to amoxicillin alone.

Constipation

Decrease abd pain and discomfort Bowel movement 2 to 4 days Check electrolyte imbalance after prolonged use.

Diarrhea, Flatulence, nausea, stomach cramps, swollen abd

Amoxicillin/ clavulanate Augmentin

Acute otitis Pneumonia Lower resp tract infections UTI Sinusitis

CBC to monitor pts response Culture treatment to ensure bacteria are sensitive to PCNs Hepatic function, in these patients check at regular intervals

PCN allergies Hemodialysis pts Severe renal impairment

Skin: diaper rash GI: diarrhea, loose stool, N/V Reproductive: Mycosis vaginitis Other: Candidiasis

Medication Brand/Generic Trimethoprimsulfamethoxazole Bactrim

Mechanism of Action Sulfamethoxalzole is an antibacterial sulfonamide that prevents the formation of dihydrofolic acid, blocking bacterial synthesis. It interferes with the production of folic acid. Acts as an anti-inflammatory as a human glucocorticoid receptor agonist

Indications Acute infective exacerbation of COPD HIV Pneumocystis pneumonia Travelers diarrhea UTI Shigellosis Allergic rhinitis, Asthma, Atopic dermatitis, Disorder of skin, corticosteroidresponsive dermatoses, and non-allergic rhinitis (off label nasal polyp and vitiligo)

Assessment Watch for fever and check the CBC counts. Monitor Renal function Serum K, especially in elderly, HIV pts, and is also known to cause hyperkalemia

Contraindications Allergies to sulfonamides Infants less than 2 months Hepatic damage Pregnant or nursing mothers Renal dysfunction Hypersensitivity to the drug or to milk proteins, and primary treatment of status asthmaticus or other forms of asthma requiring and inhaler.

Side Effects Skin: Rash, Uticaria. GI:N/V Dermatologic: Erythema multiforme (SStevensJohnson syndrome Hepatic: Hepatic necrosis

Flonase/Fluticasone Propionate

-Resp: Lung sounds, pulmonary function tests during and several months after change from systemic to inhalation corticosteroids -Withdrawal symptoms from oral corticosteroids: depression, pain in joints, fatigue -Safety Alert! Adrenal Insufficiency: nausea, weakness, fatigue, hypotension, hypoglycemia, anorexia; may occur when changing from systemic to inhalation; may be life threatening; adrenal function tests periodically: hypothalamic-pituitary-adrenal axis suppression in long-term treatment -growth rate in children -Allergy: itchy, runny, watery eyes; congested nose; before and during treatment -I&O: be alert for urinary retention, frequency, dysuria, esp. geriatric pts; product should be discontinued if these occur, serum creatinine/BUN baseline and periodically during treatment -Resp: rate, rhythm, increase in bronchial secretions, wheezing, chest tightness

Candidiasis of mouth and esophagus, headache, bronchitis, cough, epistaxis, inflammatory disorder of upper respiratory tract, sinusitis, throat irritation, and upper respiratory infection are the most common. Serious side effects include secondary hypocortisolism, anaphylaxis, immune hypersensitivity reaction, glaucoma, and pneumonia

Allegra/ Fexofenadine Hydrochloride

Inhibits release of histamine from mast cells and selectively antagonizes peripheral histaminereceptor activity.

Chronic idiopathic urticarial and seasonal allergic rhinitis. (Offlabel: hymenoptera immunotherapy pretreatment and perennial allergic rhinitis)

Hypersensitivity

Indigestion, dizziness, headache, somnolence, otitis media, dysmenorrhea, upper respiratory infection, fatigue, viral disease, cold, and flu

Medication Brand/Generic Zyrtec/ Cetirizine Hydrochloride

Mechanism of Action An antihistamine that selectively inhibits the effect of peripheral H1-receptors; a human metabolite of hydroxyzine

Indications Perennial and seasonal allergic rhinitis, and chronic urticaria (offlabel: adjunct asthma, atopic dermatitis, and acute urticaria)

Assessment -Allergy symptoms: pruritus, urticaria, watering eyes, baseline and during treatment -Resp: rate, rhythm, increase in bronchial secretions, wheezing, chest tightness -Blood studies: LFTs, BUN, creatinine baseline, periodically -Be alert for urinary retention, frequency, dysuria; product should be discontinued -CBC during long-term therapy; blood dyscrasias may occur -Resp: rate, rhythm, increase in bronchial secretions, wheezing, chest tightness

Contraindications Hypersensitivity to cetirizine, levocetirizine, or hydroxyzine

Side Effects Xerostomia, headache, somnolence, and fatigue.

Benadryl/ Diphenhydramine Hydrochloride

Acts as an antihistamine by competing with histamine for receptor cites on effector cells

Allergic rhinitis, anaphylaxis, common cold, insomnia, motion sickness, Parkinsons, and pruritus of skin (off-label: chemotherapy, extrapyramidal disease, hyperemesis gravidarum, local anesthesia) Moderate to severe chronic pain that cannot be managed by other means in a patient who is opioid tolerant. (Off-label: moderate to severe osteoarthritis with an inadequate response with a weak opioid analgesic therapy)

Hypersensitivity, newborn/premature infants, and nursing mothers

Xerostomia, dizziness, dyskinesia, sedative effects, somnolence, dry nasal mucosa, pharyngeal dryness, thick sputum, and anaphylaxis

Fentanyl

Systemically produces effects via agonist actions at the mu receptor. May cause respiratory depression. Increases tone and decreases contractions of smooth muscle of GI tract. Transdermally acts with opiod mu-receptors in CNS causing analgesia, mood alterations, euphoria, dysphoria, and drowsiness. Constricts the pupils. Alters perception of and emotional response to pain.

-VS after parenteral route; note muscle rigidity, drug history, hepatic and renal function tests -CNS: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil reaction -Allergic reaction: rash, urticaria -Resp: respiratory depression, character, rate, rhythm; notify prescriber if respirations < 10/min

MAY CAUSE RESPIRATORY DEPRESSION. Acute or postoperative pain, risk of lifethreatening hypoventilation, acute or severe bronchial asthma. Hypersensitivity. Mild or intermittent pain management. Opioid non-tolerant patients. Suspected or known paralytic ileus. Should not be used on children.

Potential for abuse due to opioid-like effects. Application site reactions, pruritus, sweating, abdominal pain, constipation, diarrhea, indigestion, nausea, vomiting, xerostomia, asthenia, confusion, dizziness, nervousness, headache, insomnia, somnolence, anxiety, depression, euphoria, hallucinations, urinary retention, upper respiratory infection, and fatigue. Serious side effects include bradyarrhythmia, cardiac dysrhythmia, chest pain, apnea, dyspnea, respiratory depression.

Medication Brand/Generic Solu Medrol/ Methylprednisolone

Mechanism of Action Anti-Inflammatory

Indications Rheumatoid Arhritis Psoriatic Arthritis Ulcerative Colitis Crohns Disease Serum Sickness Transfusion Rxn Stevens-Johnson syndrome Acute Asthma

Assessment Monitor: Electrolyte Balance BP Weight Urinalysis Chest X-rays needed if treatment > 6wks Give at smallest dose possible

Contraindications Osteoporosis or risk of Systemic fungal infection

Side Effects Fluid retention Wight Gain High BP Hirutism Headache Weakness Photosensitivity Ulcers Convulsions Euphoria Insomnia Nervousness Tremors Headache Palpitations High BP Dizziness Nausea Nervousness Tremors Headache Palpitations High BP Dizziness Nausea Headache Sore Throat Sinus Inflammation N/V Bronchitis Dizziness

Albuterol

Bronchodilator

Asthma Exercise induced asthma Chronic Bronchitis Emphysema

None Recommended

PT Hypersensitive to drug class Ischemic Heart Disease Hypertension Arrhythmias Hyperthyroidism Epilepsy PT Hypersensitive to drug class PT on Monoamine oxidase inhibitor medication

Xopenex/ Levalbuterol

Bronchodilator

Asthma Exercise induced asthma COPD

None Recommended

Advair/ Combination of Flucticasone and Salmerol

Bronchodilator

Asthma Maintenance COPD

Bone Density if Osteoporotic Oral Cavity Inspection Monitor for Vision Changes, child development

PT Hypersensitive to Atropine Narrow Angle Glaucoma Prostatic Hypertrophy Allergies to Milk Proteins

Medication Brand/Generic Atrovent/ Ipratropium

Mechanism of Action Bronchodilator Prophylactic

Indications COPD Chronic Bronchitis Emphysema

Assessment None Recommended

Contraindications PT Hypersensitive to Atropine Narrow Angle Glaucoma Prostatic Hypertrophy Urinary system obstruction Pregnancy (D) 3rd trimester, breastfeeding, children <12 yrs, Allergy to NSAIDs, history of stomach or intestinal bleeding, vit. K deficiency,acute bronchospasm, agranulocytosis, increased intracranial pressure, bleeding disorder such as hemophilia, increased risk of stomach bleeding with alcohol or warfarin consumption.

Side Effects Dizziness Nausea Heartburn Constipation Dry mouth Back pain Difficulty urinating Pain when urinating frequency Seizures, coma, Gi bleeding, hepatitis, thrombocytopenia, agranulocytosis, leukopenia, neutropenia, hemolytic anemia, Reyes Syndrome (children), anaphylaxis, laryngeal edema. Nausea, vomiting, rash,Tinnitus, stomach bleeding, GI ulcers, esophagitis, gastritis, dyspepsia, nausea, vomiting, constipation, diarrhea and abdominal pain.

Aspirin

Blocks pain impulses in CNS, reduces inflammation by inhibition of prostaglandin synthesis; antipyretic action results from vasodilation of peripheral vessels; decreases platelet aggregation

Mild to moderate pain or fever including RA, osteoarthritis, TIA, thromboembolic disorders, rheumatic fever, post MI, prophylaxis of MI, ischemic stroke, angina, acute MI,

Pain: character, location, intensity; ROM-before and 1 hr after administration. Fever: temperature before and 1 hr after administration. Hepatic studies: AST, ALT, bilirubin, creatinine if pt is on long-term therapy. Renal Studies: BUN, urine creatinine; I&O ratio; decreasing output may indicate renal failure. Blood studies: CBC, Hct, Hgb, PT if patient is on long-term therapy. Allergic RXN: rash, urticaria,. Ototoxicity: tinnitus, ringing, roaring in ears. Edema in feet, ankles, legs.

Medication Brand/Generic Coumadin

Mechanism of Action Inhibits the Vitamin K dependent synthesis of clotting factors II, VII, IX, and X and protein C, S, and Z, which results in antithrombotic effects.

Indications Venous thrombosis and pulmonary embolism, thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement. Reduces the risk of death, recurrent myocardial infarction, stroke.

Assessment Fever, skin rash, urticaria. Black Box: Bleeding gums, petechiae, ecchymosis, black tarry stools, hematuria, fatal hemorrhage. Blood studies: Hct, PT, platelets, occult blood in stools. INR: in hospital daily after 2nd or 3rd dose; once in therapeutic range for 2 consecutive days, monitor 23x wk for 1-2 wk, then less frequently. Outpatient-monitor every few days until stable does, then periodically thereafter depending on stability of INR results.

Contraindications Hypersensitivity to warfarin; pregnancy (X); bleeding tendencies associated with active ulceration or overt bleeding of: 1)GI, GU, or respiratory tracts; 2) cerebrovascular hemorrhage; 3) cerebral aneurysms; 4) pericarditis and pericardial effusions; 5) bacterial endocarditis. Malignant hypertension, preeclampsia, eclampsia, severe hepatic disease. Severe thrombocytopenia, hypersensitivity to Heparin, hemophilia, leukemia with bleeding, peptic ulcer disease, severe renal/hepatic disease, blood dyscrasias, severe hypertension, subacute bacterial endocarditis, acute nephritis.

Side Effects Hematuria, hepatitis, hemorrhage, agranulocytosis, leukopenia, eosinophilia, anaphylaxis, exfoliative dermatitis, purple toe syndrome. Rash, diarrhea, fever, swelling of the face, throat, mouth, legs, feet or hands, Bruising that comes about without an injury, chest pain or pressure, nausea or vomiting, joint or muscle aches, difficulty moving, numbness of tingling in any part of the body. Risk for hemorrhage and in severe cases, necrosis.

Heparin

Prevents conversion of fibrinogen to fibrin and prothrombin to thrombin by enhancing inhibitory effects of antithrombin III.

Prevents deep-vein thrombosis, pulmonary embolism, MI, open heart surgery, disseminated intravascular clotting syndrome, atrial fibrillation with embolization, as an anticoagulant in transfusion and dialysis procedures, maintains patency of indwelling venipuncture devices; diagnosis and treatment of disseminated intravascular coagulation

Bleeding: gums, petechiae, ecchymosis, black tarry stools, hematuria, epistaxis, decrease in Hct, BP. Blood studies: Hct, occult blood in stools. Partial prothrombin time, which should be 1.2-2.5 X control; for continuous IV infusion, check aPTT baseline 6 hr after initiation and 6 hr after any dose change; aPTT for dosing adjustments; once 2 therapeutic aPTT has be measured, check aPTT daily. Platelet count q2-3 days; thrombocytopenia may occur on 4th day of treatment. Hypersensitivity: rash, chills, fever, itching.

Hematuria, hemorrhage, thrombocytopenia, anemia, anaphylaxis. Fever, rash, Hyperkalemia, is the result of heparininduced aldosterone suppression (hypoaldosteronism) The hyperkalemia can appear within a few days after the onset of heparin therapy.

Medication Brand/Generic Lovenox

Mechanism of Action Prevents conversion of prothrombin to thrombin and prevents fibrin from further converting to thrombin.

Indications Prevention of DVT, PE (inpatient) in hip and knee replacement, abdominal surgery at risk for thrombosis; unstable angina/non Q wave MI.

Assessment Blood studies: Hct, Hgb, CBC, coagulation, platelets, occult blood ins tools, anti-factor Xa. Renal studies: BUN/creatinine baseline and periodically. Bleeding: gums, petechiae, ecchymosis, black tarry stools, hematuria Neuro symptoms in patients who have received spinal anesthesia.

Contraindications Active major bleeding; thrombocytopenia with a positive in vitro test for antiplatelet antibody in the presence of enoxaparin sodium; known hypersensitivity to enoxaparin sodium, heparin, pork products, or benzyl alcohol (multi-dose formulation only)

Side Effects Hemorrhage, hypochromic anemia, thrombocytopenia, bleeding. Fever confusion, nausea, ecchymosis, hyperkalemia in renal failure, edema, peripheral edema; allergic reaction: hives; difficulty breathing; swelling of face, lips, tongue, or throat. Bleeding that wont stop; pale skin, easy bruising, unusual weakness; swelling, bruising or swelling in one or both legs. Heart Failure, hepatic failure, proteinuria, hematuria, pancytopenia, leukocytosis, pneumonia, angioedema, exfoliative dermatitis, StevensJohnsons Syndrome, toxic epidermal necrolysis. Headache, dizziness, asthenia, diarrhea, abdominal pain, vomiting, nausea, constipation, flatulence, acid regurgitation, rash, back apin, upper respiratory infections, cough. Tinnitus, taste perversion, chest pain, palpitations, tachycardia, bradycardia, peripheral edema, abdominal swelling, anorexia, irritable colon, dry mouth, UTI, urinary

Prilosec

Gastric acid pump inhibitorSuppresses gastric acid (H+ ion) secretion by blocking the hydrogen/potassium ATP ase pump (proton pump) of the gastric parietal cells which secrete H+ directly into the gastric lumen.

Duodenal ulcer, gastric ulcer, gastroesophageal reflux disease (GERD); maintain healing of erosive esophagitis; long-term treatment of pathological hypersecretory conditions in adults.

GI system: bowel sounds q8hr, abdomen for pain, swelling, anorexia, blood in stools. Hepatic enzymes: AST, ALT, alkaline phosphatase during treatment; blood studies: CBC, differential during treatment, blood dyscrasias may occur. Seious skin rxns: toxic epidermal necrolysis, Stevens-Johnson syndrome, angioedema, exfoliative dermatitis; fever, sore throat, fatigue, thin ulcers, lesions in mouth, lips.

Known hypersensitivity. Pregnancy (C), breastfeeding, children.

Medication Brand/Generic

Mechanism of Action

Indications

Assessment

Contraindications

Side Effects frequency, dry skin, urticaria, pruitis, alopecia, hypoglycemia, weight gain, fever, fatigue, malaise.

Prilosec cont.

Synthroid/Levothyroxine Sodium

Thyroid replacement hormone; mechanism not established. Suspected that principal effects are exerted through control of DNA transcription and protein synthesis.

Plavix/Clopidogrel Bisulfate

Platelet activation and aggregation inhibitor; irreversibly and selectively inhibits the binding of ADP to its platelet P2Y12 receptor and subsequent ADPmediated activation of the glycoprotein GPIIb/IIIa complex.

Replacement or supplemental therapy in congenital or acquired hypothyroidism during recovery phase of subacute thyroiditis. Treatment or prevention of various types of euthyroid goiters, including thyroid nodules, subacute or chronic lymphocytic thyroiditis, multinodular goiter and as an adjunct to surgery and radioiodine therapy for thyrotropin-dependent well-differentiated thyroid cancer. To decrease the rate of combined endpoint of CV death, MI, stroke, or refractory ischemia in pts w/ non-ST-segment elevation ACS, including those who are managed medically and those w/ coronary revascularization. To reduce rate of death from any cause and the rate of combined endpoint of death, reinfarction, or stroke in

Assess for untreated subclinical or overt thyrotoxicosis, acute MI, uncorrected adrenal insufficiency, age, CAD, CV disorders, nontoxic diffuse goiter, nodular thyroid disease, DM, hypersensitivity, pregnancy/nursing status, and for possible drug interactions. In patients w/ secondary or tertiary hypothyroidism, assess for additional hypothalamic/pituitary hormone deficiencies. Assess for weight and TSH levels. In infants with congenital hypothyroidism, assess for congenital anomalies.

Untreated subclinical (suppressed serum TSH level with normal T3 level and T4 levels) or overt thyrotoxicosis of any etiology, acute MI, and uncorrected adrenal insufficiency.

Fatigue, increase appetite, weight loss, heat intolerance, headache, hyperactivity, irritability, insomnia, palpitations, arrhythmias, dyspnea, hair loss, menstrual irregularities, pseudotumor cerebri (children), slipped capital femoral epiphysis (children).

Assess for presence of active pathological bleeding, previous hypersensitivity to the drug, reduced CYP2C19 function, pregnancy/nursing status, and possible drug interactions. Assess use in pts at risk for increase bleeding (eg, undergoing surgery).

Active pathological bleeding (eg, peptic ulcer, intracranial hemorrhage).

TTP, bleeding, epistaxis, hematuria, bruising, hematoma, pruritus.

Medication Brand/Generic Plavix/Clopidogrel Bisulfate Cont.

Mechanism of Action

Indications patients with ST_elevation MI. To reduce rate of combined endpoint of new ischemic stroke or MI, and other vascular deaths in pts with hx of recent MI or stroke, or established PAD.

Assessment

Contraindications

Side Effects

Vancomycin/Vancomycin HCl

Tricyclic glycopeptide antibiotic; inhibits cell-wall biosynthesis, alters bacterial cell membrane permeability and RNA synthesis.

Treatment of serious or severe infections caused by susceptible strains of methicillinresistant staphylococci. Indicated for PCNallergic pts who cannot receive or have failed to respond to other drugs, and for infections caused by vancomycin-susceptible organisms that are resistant to other antimicrobials. Treatment of uncomplicated/complic ated UTI including pyelonephritis, uncomplicated skin and skin structure, complicated intraabdominal infections, and pneumonia caused by susceptible strains of microorganisms. Empiric therapy for febrile neutropenia.

Assess for renal function, underlying hearing loss, pregnancy/nursing status and possible drug interactions. Perform culture and susceptibility testing.

Contraindicated for pts with known hypersensitivity to this product, renal, and auditory susceptibility/insuffi ciency.

Infusion-related events, hypotension, wheezing, pruritus, chest and back muscle spasm or pain, dyspnea, urticaria, nephrotoxicity, pseudomembranous colitis, ototoxicity, neutropenia, phlebitis.

Maxipime/Cefepime HCl

4th generation cephalosporin; bactericidal agent that acts by inhibiting cell wall synthesis.

Assess for PCN allergy, pregnancy/nursing status, history of GI disease, renal/hepatic impairment, nutritional status, and possible drug interactions. Document indications for therapy with culture and susceptibility testing. (Generic): Assess for allergy to corn or corn products.

Hypersensitivity to penicillins or other beta-lactam antibiotics.

Local reactions (eg, phlebitis), rash, diarrhea, (+) Coombs test (without hemolysis).

Medication Brand/Generic Zyvox/Linezolid

Mechanism of Action Oxazolidinone antibacterial; inhibits bacterial protein synthesis; bids to a site on the bacteria 23S ribosomal RNA of the 50S subunit and prevents formation of functional 70S initiation complex, which is an essential component of the bacterial translation process.

Indications Treatment of vancomycin-resistant Enterococcus faecium (VRE) infections including cases with concurrent bacteremia, nosocomial pneumonia, complicated skin and skin structure infections (SSSI) including diabetic food infections without concomitant osteomyelitis, uncomplicated SSSI, community-acquired pneumonia (CAP) including concurrent bacteremia caused by susceptible strains of designated microorganisms.

Assessment Assess for pre-existing myelosuppression (including anemia, leukopenia, pancytopenia, thrombocytopenia), concomitant drugs that produce myelosuppression, presence of chronic infections, previous or concomitant antibiotic therapy, catheter-related bloodstream infections or catheter-site infections, pregnancy/nursing status, uncontrolled HTN, carcinoid syndrome, pheochromocytoma, untreated hyperthyroidism, phenylketonuria, renal/hepatic impairment, and possible drug interactions.

Contraindications MAOIs A or B (eg phenelzine, isocarboxazid) or within two weeks after taking such drugs; uncontrolled HTN, pheochromocytoma , thyrotoxicosis, and/or taking directly and indirectly acting sympathomimetic agents, vasopressive agents, dopaminergic agents; carcinoid syndrome and/or taking SSRIs, TCAs, serotonin 5-HT1 receptor agonists, meperidine or buspirone. Family hx of angioedema. Pt hx of angioedema w/ previous ACE inhibitors. Hypersensitivity. Pregnancy Category C (1st trimester), Category D (2nd/3rd trimesters). Breastfeeding (appears in breast milk). Use caution: Pts w/ renal impairment, hypovolemia,

Side Effects Diarrhea, headache, N/V, fever, sepsis, anemia, thrombocytopenia, upper respiratory infection, trauma.

Lisinopril

Angiotensin-converting enzyme (ACE) inhibitor. Blocks conversion of angiotensin I to vasoconstrictor angiotensin II. Prevents degradation of bradykinin and other vasodilatory prostaglandins. Incr plasma renin levels and decr aldosterone levels. Net result = systemic vasodilation.

Hypertension, heart failure, reduce risk of dealth or heart failure after MI. Lowers BP.

Monitor BP and pulse frequently, esp during initial dose adjustment. Monitor freq of Rx refills to determine compliance. Assess for signs of angioedema (dyspnea, facial swelling). To prevent heart failure, monitor weight and assess pt routinely for resolution of fluid overload (peripheral edema, rales/crackles, dyspnea, wt gain, jugular venous distention). Monitor renal function. May cause incr in BUN & serum creatinine. May cause hyperkalemia. Monitor CBC for pts w/ collagen vascular dx &/or renal dx. May cause elevated AST,

Angioedema. CNS: dizziness, fatigue, HA, weakness. Resp: cough. CV: hypotension, chest pain. GI: abdominal pain, N/V, diarrhea. GU: erectile dysfunction, impaired renal function. Derm: rashes. F&E hyperkalemia.

Medication Brand/Generic

Mechanism of Action

Indications

Assessment ALT, alkaline phosphatase & serum bilirubin.

Contraindications hyponatremia, concurrent diuretic therapy. Incr risk of angioedema in black pts & monotherapy less effective in black pts (may require addl therapy). Surgery/anesthesia (hypotension may be exaggerated). Safety not established-children < 6yr. Geriatric: initial dosage reduction recommended.

Side Effects

Lisinopril cont.

Metoprolol (Lopressor)

Beta-Blocker Beta-adrenergic antagonistblock SNS catecholamines..reduced renin & aldosterone release & fluid balance..vasodilation of arterioles to decr pulmonary vascular resistance and blood pressure.

Antihypertensive ACE inhibitor. Hypertension, antianginal in long term tx of angina. Dysrhythmias (to suppress sinus and atrial tachydysrhythmias) Beta1 (cardioselective) metopropol (Lopressor, Toprol XL) used for angina and hypertension

VS assess BP before & after initial dose. Monitor closely if given w/ a Calcium channel blocker. Report any weakness, dizziness, fainting, edema or difficulty breathing. If SBP is below 90mm/Hg or for bradycardia, notify HC provider. Pts w/ DM: tachycardia (a symp of hypoglycemia) is often masked due to beta1 blockade.

Atrioventricula (AV) block, bradydysrhythmias. Bradycardia, hypotension. May interact w/ hypoglycemic agents- use caution in pt w/ DM.

Orthostatic hypotension, bradycardia, drowsiness, decreased libido.

Medication Brand/Generic

Mechanism of Action

Indications

Assessment

Contraindications GI obstruction or perforation, GI hemorrhage. Dont use concurrently w/ meds that cause extrapyramidal reactions (motor deficits, loss of postural reflexes, bradykinesia, tremor, rigidity, various involuntary movements.

Side Effects

Metoclopramide Hydrochloride (Reglan)

Suppresses emesis by blocking dopamine receptors in the chemoreceptor trigger aone. Increases tone and accelerates intestinal transit & gastric emptying by enhancing action of ACh.

Peristaltic stimulant, antiemetic

Monitor renal function, BP and heart rate. Assess hydration. Monitor for anxiety restlessness, extrapyramidal symptoms. Monitor bowel response and therapeutic response. To prevent nausea, admin 30 pre chemotherapy. Also 30 min before meals and at bedtime for gastroparesis.

Drowsiness, restlessness, fatigue, lethargy, dizziness, HA, insomnia, dry mouth, extrapyramidal symptoms (toxic).

Promethazine (Phenergan)

Blocks histamine receptors in neuronal pathway, from vestibular apparatus to vomiting center in the medulla.

Antiemetic, antihistamine.

Evaluate pt respiratory status, teach pt to avoid tasks requiring mental alertness and to report tremors or abnormal body movements. Long-term therapycheck CBC. Watch for drowsiness, restlessness, hypotension, confusion, urinary retention.

Severe CNS depression, acute asthma, glaucoma, GI or GU obstruction, pregnancy, seizures.

Sedation, drowsiness, disorientation, syncope in geriatrics, hypotension, dry mouth, urinary retention, flushing, epigastric distress, visual and hearing disturbances.

Medication Brand/Generic

Mechanism of Action

Indications

Assessment

Contraindications Orally disintegrating tablets contain aspartame and should not be given to pts w phenylketonuria. Concurrent use of apomorphine. Hypersensitivity. Use cautiously in: hepatic impairment (daily dose must be < 8mg), abdominal surgery (may mask ileus), Pregnancy (category B), lactation, or children 3 or younger (PO) or < 1 mo (parenternal) (safety not established).

Side Effects

Ondansetron (Zofran) Blocks effects of serotonin at 5-HT3 receptor sites (selective antagonist) located in vagal nerve terminals & the chemoreceptor trigger zone in the CNS. Antiemetic. Prevent N/V associated w emetogenic chemotherapy or radiation therapy. Prevent and treat postoperative N/V.

(do not confuse with Zosyn!)

Assess for N/V, abdominal distention & bowel sounds prior to and following administration. Assess for extrapyramidal effects (involuntary movements, facial grimacing, rigidity, shuffling walk, trembling hands). Lab tests: may cause incr in serum bilirubin, AST & ALT levels.

CNS: HA, dizziness, drowsiness, fatigue, weakness. GI: constipation, diarrhea, abdominal pain, dry mouth, incr liver enzymes. Neuro: extrapyramidal reactions.

Monitor hepatic, blood studies Anxiety, panic disorders with or without agoraphobia, anxiety with depressive symptoms Pregnancy Monitor BP lying, standing; pulse, if systolic pressure drops 20 mm Hg, hold product, notify prescriber Monitor mental status: anxiety, mood, drowsiness, dizziness, sleeping pattern, orientation and sensorium, especially in geriatric patients prior to and during treatment Monitor physical dependency, withdrawal symptoms, agitation, Breastfeeding Hypersensitivity to benzodiazepines Closed- angle glaucoma Psychosis Addiction

Skin: Rash, dermatitis, itching GI: Constipation, dry mouth, nausea, vomiting anorexia, diarrhea, weight gain/ loss, increased appetite EENT: Blurred vision, tinnitus, mydriasis CV: Orthostatic hypotension, ECG changes,

Niravam, Xanax Alprazolam

Depresses subcortical levels of CNS, including limbic system, reticular formation

Medication Brand/Generic

Mechanism of Action

Indications

Assessment seizures, muscle pain, weakness, headache, panic attacks, nausea, vomiting

Contraindications

Side Effects tachycardia, hypotension CNS: Dizziness, drowsiness, confusion, headache, anxiety, tremors, fatigue, depression, insomnia, hallucinations, memory impairment, poor coordination

Niravam, Xanax Alprazolam cont.

Pregnancy Monitor respiratory depression: rate, depth, character Monitor blood dyscrasias: fever, sore throat, bruising, rash, jaundice Monitor mental status: mood, sensorium, memory (long, short), suicidal thoughts/ behaviors Monitor purple glove syndrome with IV use Monitor skin disorders: rash that may lead to Stevens- Johnson syndrome or toxic epidermal necrolysis; phenytoin should not be used again Monitor temperature, lymphadenopathy; may cause hepatotoxicity, renal failure, rhabdomyolysis Hypersensitivity

Psychiatric condition

CNS: Drowsiness, dizziness, insomnia, depression, suicidal tendencies, paresthesias, aggression, headache, confusion, slurred speech, peripheral neuropathy CV: Hypotension, ventricular fibrillation

Dilantin Phenytoin Inhibits spread of seizure activity in motor cortex by altering ion transport; increases AV conduction

Generalized tonicclonic seizures; status epilepticus; nonepileptic seizures associated with Reyes syndrome or after head trauma; Bells palsy, complex partial seizures

Bradycardia

EENT: Nystagmus, diplopia, blurred vision ENDO: Diabetes insipidus GI: Nausea, vomiting, constipation, anorexia, weight loss, hepatitis, jaundice, gingival hyperplasia GU: Nephritis, urine discoloration Skin: Rash, hirsutism, toxic

AV and SA block

Stokes- Adams syndrome

Hepatic failure

Medication Brand/Generic

Mechanism of Action

Indications

Assessment

Contraindications Acute intermittent porphyria

Side Effects epidermal necrolysis, lupus erythematosus, StevensJohnson syndrome SYST: Hypocalcemia, purple glove syndrome (IV) HEMA: Agranulocytosis, leucopenia, aplastic anemia, megaloblastic anemia thrombocytopenia,

Dilantin Phenytoin cont.

Monitor renal and hepatic studies Monitor CBC during long- term therapy (anemia), metabolic acidosis Seizures- location, type, duration Partial seizures in adults and children 216 yr old; tonic- clonic seizures; seizures in Lennox- Gastaut syndrome, migraine prophylaxis Migraines- pain location, duration, alleviating factor Bipolar disorder: mood, behavior Mental status: behavioral changes, suicidal thoughts/ behaviors, sensorium, body weight, evidence of cognitive disorder Hypersensitivity Metabolic acidosis

CNS: Dizziness, fatigue, cognitive disorder, insomnia, anxiety, depression, paresthesia, memory loss, tremor, motor retardation, suicidal ideation EENT: Diplopia, vision abnormality GI: Diarrhea, anorexia, nausea, dyspepsia, abdominal pain, constipation, dry mouth, pancreatitis Skin: Rash GU: Breast pain, dysmenorrheal, menstrual disorder RESP: Upper respiratory tract infection, pharyngitis,

Topamax Topiramate

May prevent seizure spread as opposed to an elevation of seizure threshold

Medication Brand/Generic Topamax Topiramate cont.

Mechanism of Action

Indications

Assessment

Contraindications

Side Effects sinusitis Misc: Weight loss, leukopenia, metabolic acidosis, increased body temperature, unexplained death (epilepsy)

Monitor seizure activity including type, location, duration; provide seizure precaution Monitor mental status: mood, memory (long, short), suicidal thoughts/ behaviors Inhibits spread of seizure activity in motor cortex by altering ion transport; increases AV conduction, prodrug of phenytoin Generalized tonicclonic seizures status epilepticus, partial seizures Toxicity: bone marrow depression, nausea, vomiting, ataxia, diplopia, cardiovascular collapse, slurred speech, confusion Respiratory depression: rate, depth, character of respirations Blood dyscrasias: fever, sore throat, bruising, rash, jaundice Monitor BP and ECG

Pregnancy

Hypersensitivity

CNS: Drowsiness, dizziness, insomnia, paresthesias, depression, suicidal tendencies, aggression, headache, confusion CV: Hypo/ hypertension, ventricular fibrillation, shock EENT: Nystagmus, diplopia, blurred vision GI: Nausea, vomiting, diarrhea, constipation, anorexia, weight loss, hepatitis, jaundice, gingival hyperplasia HEMA: Agranulocytosis, leukopenia, aplastic anemia,

Psychiatric conditions

Cerebyx, Prodilantin Fosphenytoin

Bradycardia

SA and AV block

Stokes- Adams syndrome

Medication Brand/Generic

Mechanism of Action

Indications

Assessment

Contraindications

Side Effects thrombocytopenia, megaloblastic anemia

Absence seizures Cerebyx, Prodilantin Fosphenytoin cont. Skin: Rash, lupus erythematosus, StevensJohnson syndrome, hirsutism, hypersensitivity, pruritus SYST: Hyperglycemia, hypokalemia CNS: Headache, flushing, dizziness

Nitro- Time, Nitro- Bid, Nitro- Stat, Nitro- Mist, Minitran, Nitro-Dur

Nitroglycerine

Decreases preload, afterload, which is responsible for decreasing left ventricular end diastolic pressure, systemic vascular resistance; dilates coronary arteries, improves blood flow through coronary vasculature, dilates arterial, venous beds systemically

Chronic stable angina pectoris, prophylaxis of angina pain, CHF acute MI, controlled hypotension in surgical procedures

Monitor pain: duration, time started, activity being performed, character Orthostatic BP, pulse prior to and after administration Headache, light- headedness, decreased BP; may indicate a need for decreased dosage Tolerance if taken over long period

Hypersensitivity to this product or nitrites, severe anemia, increased intracranial pressure, cerebral hemorrhage, closedangle glaucoma, cardiac temponade, cardiomyopathy, constrictive pericarditis

CV: Postural hypotension, tachycardia, collapse, syncope, palpitations

GI: Nausea, vomiting

Skin: Pallor, sweating, rash

Medication Brand/Generic

Mechanism of Action

Indications

Assessment

Contraindications

Side Effects CNS - drowsiness, dizziness, confusion, H/A, sedation, euphoria, insomnia, seizures CV palpitations, bradycardia, change in B/P, shock, cardiac arrest, chest pain, edema, hypo/hypertension, tachycardia EENT tinnitus, blurred vision, miosis, diplopia GI - N/V, anorexia, constipation, cramps, biliary tract pressure GU - Urinary retention HEMA thrombocytopenia INTEG rash, urticaria, bruising, flushing, diaphoresis, pruritus RESP - respiratory depression, respiratory arrest, apnea

Morphine Brands: Astramorph PF, Avinza, Depo Dur, Infumorph PF, Kadian, M.O.S., MS Contin, MSIR, Oramorph SR, PMSMorphine Sulfate, ratioMorphine, ratioMorphine SR

Depresses pain impulse transmission at the spinal cord level by interacting with opioid receptors

Moderate to severe pain

Pain: Location, type, character give before too severe Bowel function - constipation I&O - may cause urinary retention B/P, Pulse, Resp - character, depth, rate CNS dizziness, drowsiness, hallucinations, euphoria, LOC, pupil rxn Allergic Rxn - rash, urticaria Respiratory dysfunction depression, character, rate, rhythm, notify prescriber if resp<12/min

Hypersensitivity, addiction (opioid), hemorrhage, bronchial asthma, increased intracranial pressure BLACK BOX: resp depression

Medication Brand/Generic

Mechanism of Action

Indications

Assessment

Contraindications

Side Effects CNS- drowsiness, dizziness, confusion, H/A, sedation, euphoria, mood changes, seizures CV-Palpitations, bradycardia, change in B/P, hypotension, tachycardia, peripheral vasodilation EENT-Tinnitus, blurred vision, miosis, diplopia GIN/V, anorexia, constipation, cramps, dry mouth, paralytic ileus GUIncreased urinary output, dysuria, urinary retention HEMA-thrombocytopenia INTEG- rash, urticaria, bruising, flushing, diaphoresis, pruritus RESPrespiratory depression, dyspnea

Hydromorphone Brands: Dilaudid, Dilaudid HP, Exalgo, Hydromorph contin, PMS-Hydromorphone

Inhibits ascending pain pathways in CNS, increases pain threshold, alters pain perception

Moderate to severe pain, nonproductive cough

Respiratory dysfunction depression, character, rate, rhythm, notify prescriber if resp <10/min I&O may cause urinary retention CNS dizzy, drowsy, hallucinations, euphoria, LOC, pupil rxn Bowel function - Constipation Allergic Rxn rash, urticaria Need for pain medication, physical dependence Pain control, sedation by scoring on 0-10 scale, ATC dosing is best for pain control

Hypersensitivity BLACK BOX: respiratory depression

Medication Brand/Generic

Mechanism of Action

Indications

Assessment

Contraindications

Side Effects

Hydrocodone / Acetaminophen Brands: Anexsia, CoGesic, Hycet, Liquicet, Lorcet, Lorcet Plus, Lortab, Margesic H, Maxidone, Norco, Polygesic, Stagesic, Vanacet, Vicodin, Vicodin ES, Vicodin HP, Xodol, Zamicet, Zolvit, Zydone

Acts directly on cough center in medulla to suppress cough; binds to opiate receptors in CNS to reduce pain

Hyperactive and nonproductive cough, mild to moderate pain

Pain: intensity, type, location, and other characteristics before and 1 hr after giving product, titrate upward by 25% until pain is reduced by 1/2 CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil rxn B/P, Pulse, Resp:before and periodically, if resp < 10/min, dose may need to be reduced, oversedation may occur Bond Status: constipation, provide fluids, fiber in diet, may need stimulative laxative Allergic Rxn: rash, urticaria Cough and Resp. dysfunction:respiratory depression, character, rate, rhythm Need for pain medication, physical dependence, opioid is more effective before pain is severe

Ance rosacea/vulgaris, Cushing's, measles, perioral dermatitis, varicella, abrupt discontinuation, hypersensitivity to this product or benzyl hypersensitivity

CNS: drowsiness, dizziness, light-headedness, confusion, H/A, sedation, euphoria, dysphoria, weakness, hallucinations, disorientation, mood changes, dependence, seizures CV: palpitations, tachycardia, bradycardia, change in B/P, circulatory depression, syncope; cardiac arrest (children) EENT: tinnitus, blurred vision, miosis, diplopia GI: nausea, vomiting, anorexia, constipation, cramps, dry mouth, ulcers GU: Increased urinary output, dysuria, urinary retention INTEG: rash, urticaria, flushing, pruritus RESP: resp depression; pulmonary edema, bronchopneumonia, resp arrest (children)

Medication Brand/Generic

Mechanism of Action

Indications

Assessment

Contraindications

Side Effects CNS: drowsiness, dizziness, light-headedness, confusion, H/A, sedation, euphoria, dysphoria, weakness, hallucinations, disorientation, mood changes, dependence, seizures CV: palpitations, tachycardia, bradycardia, change in B/P, circulatory depression, syncope; cardiac arrest (children) EENT: tinnitus, blurred vision, miosis, diplopia GI: nausea, vomiting, anorexia, constipation, cramps, dry mouth, ulcers GU: Increased urinary output, dysuria, urinary retention INTEG: rash, urticaria, flushing, pruritus RESP: resp depression; pulmonary edema, bronchopneumonia, resp arrest (children)

Hydrocodone Brands: Hycodan, Tussigon

Acts directly on cough center in medulla to suppress cough; binds to opiate receptors in CNS to reduce pain

Hyperactive and nonproductive cough, mild to moderate pain

Pain: intensity, type, location, and other characteristics before and 1 hr after giving product, titrate upward by 25% until pain is reduced by 1/2 CNS changes: dizziness, drowsiness, hallucinations, euphoria, LOC, pupil rxn B/P, Pulse, Resp:before and periodically, if resp < 10/min, dose may need to be reduced, oversedation may occur Bond Status: constipation, provide fluids, fiber in diet, may need stimulative laxative Allergic Rxn: rash, urticaria Cough and Resp. dysfunction:respiratory depression, character, rate, rhythm Need for pain medication, physical dependence, opioid is more effective before pain is severe

Ance rosacea/vulgaris, Cushing's, measles, perioral dermatitis, varicella, abrupt discontinuation, hypersensitivity to this product or benzyl hypersensitivity

Medication Brand/Generic

Mechanism of Action

Indications

Assessment 1. Potassium, blood glucose, urine glucose while on long-term therapy; hypokalemia and hyperglycemia; potassium depletion: paresthesias, fatigue, nausea, vomiting, depression, polyuria, dysrhythmias, weakness 2. B/P every 4hr, pulse; notify prescriber if chest pain 3. I&O be alert for decreasing urinary output, increasing edema, weight daily, notify prescriber of weekly gain >5 lbs 4.Adrenal insufficiency (Cushingoid symptoms): nausea, anorexia, SOB, moon face, fatigue, dizziness, weakness, joint pain before and during treatment 5. Plasma cortisol levels during long term therapy (normal level:138-635 nmol/L SI units when drawn at 8 am) 6.Infection: increase temp, WBC, even after withdrawal of medication; product masks infection 7. Mental status: affect mood, behavioral changes, aggression

Contraindications

Side Effects

Hydrocortisone Brands: Cortef

decreases inflammation by suppression of migration of polymorphonus clear leukocytes, fibroblasts, reversal of increased capillary permeability, and lysosomal stabilization

Severe inflammation, septic shock, adrenal insufficiency, ulcerative colitis, collagen disorders

Children < 2yrs, psychosis, hypersensitivity, idiopathic thrombocytopenia(I M), acute glomerulonephritis, amebiasis, fungal infections, nonasthmatic bronchial disease, AIDS, TB, recent MI (associated with left ventricular rupture)

CNS: depression, flushing, sweating, H/A, mood changes CV: hypertension, circulatory collapse, thrombophlebitis, embolism, tachycardia, edema EENT: fungal infections, increased intraocular pressure, blurred vision GI: diarrhea, nausea, abdominal distention, GI hemorrhage, increased appetite, pancreatitis HEMA: thrombocytopenia INTEG: acne, poor wound healing, ecchymosis, petechiae MS: fractures, osteoporosis, weakness

Medication Brand/Generic

Mechanism of Action

Indications

Assessment Assess for an increase in bone or tumor pain. Confer with health care professional regarding analgesics. This transient pain usually resolves despite continued therapy Lab Test Considerations Monitor CBC, platelets, and calcium levels before and during therapy. May cause transient hypercalcemia in patients with metastases to the bone. An estrogen receptor assay should be assessed before initiation of therapy Monitor serum cholesterol and triglyceride concentrations in patients with pre-existing hyperlipidemia. May cause concentrations Monitor hepatic function tests and thyroxine (T4) periodically during therapy. May cause serum hepatic enzyme and thyroxine concentrations Gynecologic examinations should be performed regularly; may cause variations in Papanicolaou and vaginal smears Top Assess for infusion-related symptoms (chills, fever, nausea, vomiting, pain [in some cases at tumor sites], headache, dizziness, dyspnea, hypotension, rash, and asthenia) following initial infusion. Severe reactions (bronchospasm, anaphylaxis, angioedema, hypoxia, severe hypotension) may occur during or immediately following

Contraindications

Side Effects

Tamoxifen Citrate/Nolvadex

Competes with estrogen for binding sites in breast and other tissues Reduces DNA synthesis and estrogen response

Breast Caner in postmenoposal women, adjunctively with surgery in the treatment of breast carcinoma with positive lymph nodes

Anticoagulant therapy including coumadin; preexisting endometrial hyperplasia; IM if platelets < 50,000/mm. Pregnancy category D

Whole Body :Increased bone pain, and transient local disease flair; loss of hair, weight gain, shortness of breath, photosensitivity, hot flashes CNS: Depression, lightheadedness, dizziness, mental confusion, sleepiness CV: Thrombosis, pulmonary embolism. GI: NV, distaste for food, annorexia. Hematologic: Leukopenia, thrombocytopenia. Metabolic: Hyperkalcemia. Skin: Skin rash or dryness. Senses: Retinopathy, blurred vision. Urogenital: Changes in menstrual period, milk production and leaking from breasts, vaginal discharge and bleeding

A monoclonal antibody that binds to HER2 sites in breast cancer tissue and inhibits proliferation of cells that overexpress HER2 protein

Metastatic breast cancer in those whose tumors overexpress the HER2 protien.

Concurrent admin. Of anthracycline or raditation. Pregnancy Category D

CNS: dizziness, headache, insomnia, weakness, depression, . Resp: INTERSTITIAL PNEUMONITIS, PULMONARY EDEMA, PULMONARY FIBROSIS, dyspnea, increased cough, pharyngitis, rhinitis, sinusitis.CV:

Medication Brand/Generic

Mechanism of Action

Indications

Assessment the initial infusion. May be treated with epinephrine, corticosteroids, diphenhydramine, bronchodilators, and oxygen. Discontinue if dyspnea or severe hypotension occurs and discontinue permanently if severe reaction occurs Assess for signs and symptoms of HF (dyspnea, increased cough, paroxysmal nocturnal dyspnea, peripheral edema, S3 gallop, reduced ejection fraction) prior to and frequently during therapy. Baseline cardiac assessment of history, physical exam, and left ventricular ejection fraction (LVEF) with ECG . CHF with trastuzumab may be severe, resulting in cardiac failure, death, and stroke. Trastuzumab should be discontinued upon the development of significant CHF Monitor patient for signs of pulmonary hypersensitivity reactions (dyspnea, pulmonary infiltrates, pleural effusion, noncardiogenic pulmonary edema, pulmonary insufficiency, hypoxia, acute respiratory distress syndrome). Patients with symptomatic pulmonary disease or extensive lung tumor involvement are at increased risk. Infusion should be discontinued if severe symptoms occur Lab Test Considerations CBC with differential, platelet count, Hgb and HCT

Contraindications

Side Effects ARRHYTHMIAS, HF, hypertension, tachycardia. GI: abdominal pain, anorexia, diarrhea, nausea, vomiting. Derm: rash, acne, herpes simplex.F and E: edema.Neuro: neuropathy, paresthesia, peripheral neuritis.MS: back pain, arthralgia, bone pain. Hemat: anemia, leukopenia.

Herceptin/Trastuzumab

Medication Brand/Generic

Mechanism of Action

Indications

Assessment Monitor vital signs frequently during administration. Report significant changes Monitor intake and output and specific gravity frequently during therapy. Report discrepancies immediately. To reduce the risk of nephrotoxicity, maintain a urinary output of at least 100 mL/hr for 4 hr before initiating and for at least 24 hr after administration Encourage patient to drink 2000 3000 mL/day to promote excretion of uric acid. Allopurinol and alkalinization of the urine may be used to help prevent uric acid nephropathy Assess patency of IV site frequently during therapy. Cisplatin may cause severe irritation and necrosis of tissue if extravasation occurs. If a large amount of highly concentrated cisplatin solution extravasates, mix 4 mL of 10% sodium thiosulfate with 6 mL of sterile water or 1.6 mL of 25% sodium thiosulfate with 8.4 mL of sterile water and inject 14 mL (1 mL for each mL extravasated) through existing line or cannula. Inject subcut if needle has been removed. Sodium thiosulfate inactivates cisplatin Severe and protracted nausea and vomiting usually occur 14 hr after a dose; vomiting may last for 24 hr. Administer parenteral antiemetic agents 3045 min before therapy and routinely around the clock for the next 24 hr. Monitor amount of emesis and

Contraindications

Side Effects

Platinol/Cisplatin

Inhibits DNA synthesis by producing cross-linking of parent DNA strands (cellcycle phasenonspecific)

Combination therapy (vinblastine, bleomycin) for pts. With metastatic testicular tumors and with doxorubicin for metastic ovarian tumors following surgery or raditation

Hypersensitivity Pregnancy or lactation Use Cautiously in: Hearing loss Renal impairment (dosage recommended) CHF Electrolyte abnormalities Active infections Bone marrow depression Geriatric patients ( risk of nephrotoxicity, peripheral neuropathy) Chronic debilitating illnesses Patients with childbearing potential

CNS: SEIZURES, malaise, weakness. EENT: ototoxicity, tinnitus. GI: severe nausea, vomiting, diarrhea, hepatotoxicity. GU: nephrotoxicity, sterility. Derm: alopecia. F and E: hypocalcemia, hypokalemia, hypomagnesemia. Hemat : LEUKOPENIA, THROMBOCYTOPENIA, anemia. Local: phlebitis at IV site. Metabolic: hyperuricemia. Neuro: peripheral neuropathy. Misc: anaphylactoid reactions.

Medication Brand/Generic

Mechanism of Action

Indications

Assessment notify health care professional if emesis exceeds guidelines to prevent dehydration. Nausea and anorexia may persist for up to 1 wk Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, stools, urine, and emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for increased fatigue, dyspnea, and orthostatic hypotension Monitor for signs of anaphylaxis (facial edema, wheezing, dizziness, fainting, tachycardia, hypotension). Discontinue medication immediately and report symptoms. Epinephrine and resuscitation equipment should be readily available Medication may cause ototoxicity and neurotoxicity. Assess patient frequently for dizziness, tinnitus, hearing loss, loss of coordination, loss of taste, or numbness and tingling of extremities; may be irreversible. Notify health care professional promptly if these occur. Audiometry should be performed before initiation of therapy and before subsequent doses. Hearing loss is more frequent with children and usually occurs first with high frequencies and may be unilateral

Contraindications

Side Effects

Platinol/Cisplatin cont.

Medication Brand/Generic

Mechanism of Action

Indications

Assessment or bilateral Monitor for inadvertent cisplatin overdose. Doses >100 mg/m2/cycle once every 34 wk are rarely used. Differentiate daily doses from total dose/cycle. Symptoms of high cumulative doses include muscle cramps (localized, painful involuntary skeletal muscle contractions of sudden onset and short duration) and are usually associated with advanced stages of peripheral neuropathy Lab Test Considerations Monitor CBC with differential and platelet count before and routinely throughout therapy. The nadir of leukopenia, thrombocytopenia, and anemia occurs within 1823 days and recovery 39 days after a dose. Withhold further doses until WBC is >4000/mm3 and platelet count is >100,000/mm3 Monitor BUN, serum creatinine, and CCr before initiation of therapy and before each course of cisplatin to detect nephrotoxicity. May cause BUN and creatinine and calcium, magnesium, phosphate, sodium, and potassium levels that usually occur the 2nd wk after a dose. Do not administer additional doses until BUN is <25 mg/100 mL and serum creatinine is <1.5 mg/100 mL. May cause uric acid level, which usually peaks 35 days after a dose May cause transiently serum bilirubin and AST concentrations

Contraindications

Side Effects

Platinol/Cisplatin cont.

Medication Brand/Generic Platinol/Cisplatin cont.

Mechanism of Action

Indications

Assessment May cause positive Coombs' test result

Contraindications

Side Effects

Methotrexate/MTX

Interferes with folic acid metabolism. Result is inhibition of DNA synthesis and cell reproduction (cellcycle S-phasespecific Also has immunosuppressive activity

Severe psoriasis, severe active rheumatoid arthritis, breast cancer, lung cancer, certain cancers of the head and neck, certain types of lymphoma, and leukemia

Monitor CBC and differential prior to and frequently during therapy. The nadir of leukopenia and thrombocytopenia occurs in 714 days. Leukocyte and thrombocyte counts usually recover 7 days after the nadirs. Notify health care professional of any sudden drop in values Monitor renal (BUN and creatinine) and hepatic function (AST, ALT, bilirubin, and LDH) prior to and routinely during therapy. Urine pH should be monitored prior to high-dose methotrexate therapy and every 6 hr during leucovorin rescue. Urine pH should be kept above 7.0 to prevent renal damage May cause serum uric acid concentrations, especially during initial treatment of leukemia and lymphoma

Hypersensitivity OB: Lactation: Pregnancy or lactation Pedi: Products containing benzyl alcohol should not be used in neonates Use Cautiously in: Renal impairment (CCr must be B60 mL/min prior to therapy) Patients with childbearing potential Active infections bone marrow reserve Geri: May be more sensitive to toxicity and adverse events

CNS: arachnoiditis (IT use only), dizziness, drowsiness, headache, malaise. EENT: blurred vision, dysarthria transient blindness. Resp: PULMONARY FIBROSIS, intestinal pneumonitis. GI: anorexia, hepatotoxicity, nausea, stomatitis, vomiting. GU: infertility. Derm: alopecia, painful plaque erosions (during psoriasis treatment), photosensitivity, pruritus, rashes, skin ulceration, urticaria. Hemat: APLASTIC ANEMIA, anemia, leukopenia, thrombocytopenia. Metabolic: hyperuricemia. MS: osteonecrosis, stress fracture. Misc: nephropathy, chills, fever, soft tissue necrosis.

Medication Brand/Generic

Mechanism of Action

Indications

Assessment Monitor blood pressure, pulse, and respiratory rate during therapy. Report significant changes Monitor neurologic status. Assess for paresthesia (numbness, tingling, pain), loss of deep tendon reflexes (Achilles reflex is usually first involved), weakness (wrist drop or footdrop, gait disturbances), cranial nerve palsies (jaw pain, hoarseness, ptosis, visual changes), autonomic dysfunction (ileus, difficulty voiding, orthostatic hypotension, impaired sweating), and CNS dysfunction (decreased level of consciousness, agitation, hallucinations). Notify physician if these symptoms develop, as they may persist for months Monitor intake and output ratios and daily weight; report significant discrepancies. Decreased urine output with concurrent hyponatremia may indicate SIADH, which usually responds to fluid restriction Assess infusion site frequently for redness, irritation, or inflammation. If extravasation occurs, infusion must be stopped and restarted elsewhere to avoid damage to subcut tissue. Cellulitis and discomfort may be minimized by infiltration with hyaluronidase and application of moderate heat or by application of cold compresses Assess nutritional status. An antiemetic may be used to

Contraindications

Side Effects

Vincristine

Binds to proteins of mitotic spindle, causing metaphase arrest Cell replication is stopped as a result (cell cyclespecific for M phase) Has little or no effect on bone marrow

Hodgkin's disease, Leukemias, Neuroblastoma, Malignant lymphomas, Rhabdomyosarcoma,Wi lms' tumor, Other tumors

Hypersensitivity OB: Lactation: Pregnancy or lactation Use Cautiously in: Infection bone marrow reserve Hepatic impairment (50% dose recommended if serum bilirubin >3 mg/dL) OB: Instruct women of childbearing potential to avoid pregnancy during treatment

CNS: agitation, insomnia, mental depression, mental status changes. EENT: cortical blindness, diplopia. Resp: bronchospasm. GI: nausea, vomiting, abdominal cramps, anorexia, constipation, ileus, stomatitis. GU: gonadal suppression, nocturia, oliguria, urinary retention. Derm: alopecia. Endo: syndrome of inappropriate antidiuretic hormone (SIADH). Hemat: anemia, leukopenia, thrombocytopenia (mild and brief). Local: phlebitis at IV site, tissue necrosis (from extravasation). Metabolic: hyperuricemia. Neuro: ascending peripheral neuropathy.

Medication Brand/Generic

Mechanism of Action

Indications

Assessment minimize nausea and vomiting Monitor for symptoms of gout (increased uric acid, joint pain, edema). Encourage patient to drink at least 2 liters of fluid per day. Allopurinol or alkalinization of urine may be used to decrease uric acid levels Lab Test Considerations Monitor CBC prior to and periodically throughout therapy. May cause slight leukopenia 4 days after therapy, which resolves within 7 days. Platelet count may or Monitor liver function studies (AST, ALT, LDH, bilirubin) and renal function studies (BUN, creatinine) prior to and periodically throughout therapy May cause uric acid. Monitor periodically during therapy

Contraindications

Side Effects

Vincristine cont.

Medication Brand/Generic

Mechanism of Action

Indications

Assessment

Contraindications

Side Effects Dizziness, weakness, drowsiness, headache, depression, confusion, seizures (IV, IM use); Postural hypertension, bradycardia; Diploma, temporary vision loss, photophobia, syncope, nasal congestion; Nausea, vomiting, hiccups, anorexia, metallic taste, jaundice; Brown, black, green urine; Hemolysis, increased hemoglobin; leukopenia (IV only); Rash, pruritis, fever, urticaria, phlebitis; Anaphylaxis, angioneurotic edema (IM, IV).

Robaxin (Methocarbamol)

Depresses multisynaptic pathways in the spinal cord, causing skeletal muscle relaxation.

Adjunct for relief of spasm and pain in musculoskeletal conditions, tetanus.

Pain, spasm: ROM; Blood dyscrasias: CBC, WBC, differential; EEG in epileptic patients; Allergic rxns: rash, fever, respiratory distress; Severe weakness, numbness in extremities; Tolerance: increased need for medication; CNS depression: dizziness, drowsiness.

Hypersensitivity to this product; hypersensitivity to PEG 300 (inj); children <12yr; intermittent porphyria; renal disease (IM/IV).

Medication Brand/Generic

Mechanism of Action

Indications

Assessment

Contraindications

Side Effects Depression, flushing, sweating, headache, mood changes, euphoria, psychosis, seizures; Hypertension, circulatory collapse, thrombophlebitis, embolism; tachycardia, edema, cardiomyopathy; Increased intraocular pressure, blurred vision; HPA suppression, hyperglycemia, sodium/fluid retention; Diarrhea, nausea, abdominal distention, GI hemorrhage, increased appetite, pancreatitis; Thrombocytopenia, transient leukocytosis; Poor wound healing, ecchymosis, petechiae; Hypokalemia; Bone fractures, osteoporosis, myopathy. Dizziness, weakness, drowsiness, headache, tremor, depression, insomnia, confusion, paresthesia, nervousness; Postural hypertension, tachycardia, dysrhythmias; Diploma, temporary loss of vision; Nausea, vomiting, hiccups, dry mouth, constipation, hepatitis; urinary retention, frequency, change in libido.

Decadron (Dexamethasone)

Decreases inflammation by suppression of migration of polymorphonuclear leukocytes, fibroblasts, reversal of increased capillary permeability and lysosomal stabilization.

Inflammation, allergies, neoplasms, cerebral edema, septic shock, collagen disorders.

Potassium, blood, urine glucose while on long-term therapy; hypokalemia and hyperglycemia; weight daily: notify MD if weekly gain>5lb; B/P q4hr, pulse; notify MD of chest pain; I&O ratio: be alert for decreasing urinary output, increasing edema; plasma cortisol levels during long-term therapy; infection: fever, WBC after withdrawal of medicine; potassium depletion; edema, hypertension, cardiac symptoms; mental status.

Children<2 yr, psychosis, hypersensitivity to corticosteroids or benyl alcohol; idiopathic thrombocytopenia, acute glomerulonephritis, amebiasis, fungal infections, nonasthmatic bronchial disease, AIDS, TB, ocular infection, glaucoma.

Flexeril (Cyclobenzaprine)

Reduction of tonic muscle activity at the brain stem; may be related to antidepressant effect.

Adjunct for relief of muscle spasm and pain in musculoskeletal conditions.

Pain: location, duration, mobility, stiffness, baseline; Allergic reactions: rash, fever, respiratory distress; Severe weakness, numbness in extremities.

Children<12yr; acute recovery phase of MI, dysrhythmias, heart block, CHF, hypersensitivity, intermittent porphyria, thyroid disease.

Medication Brand/Generic

Mechanism of Action

Indications

Assessment B/P (lying+standing): if systolic drops 20mmHg hold product; Pulse; Respiratory rate: respirations q5-15min if given IV; Blood studies: CBC during longterm therapy, blood dyscrasias; Hepatic studies: AST, ALT, bilirubin, creatinine, LDH, alk phos; Degree of anxiety; Pain relief; IV site for thrombosis or phlebitis; Mental status: mood, sensorium, affect, suicidal tendencies; Physical dependency; Withdrawal symptoms: headache, nausea, vomiting, muscle pain.

Contraindications

Side Effects

Valium (Diazepam)

Potentiates the actions of GABA, especially in limbic system, reticular formation; enhances presympathetic inhibition, inhibits spinal polysynaptic afferent paths.

Anxiety, acute alcohol withdrawal, adjunct in seizure disorders; preoperatively as a relaxant, skeletal muscle relaxation; rectally for acute repetitive seizures.

Pregnancy (D), hypersensitivity to benzodiazepines, closed-angle glaucoma, coma, myasthenia gravis, ethanol intoxication, hepatic disease, sleep apnea.

Dizziness, drowsiness, confusion, headache, anxiety, tremors, depression, insomnia, hallucinations, fatigue; Orthostatic hypotension, ECG changes, tachycardia, hypotension; Blurred vision, tinnitus, mydriasis; constipation, dry mouth, NV, diarrhea; Neutropenia; Rash, dermatitis, itching; Respiratory depression.

Ancef

(Cefazolin)

Inhibits bacterial cell wall synthesis, rendering cell wall osmotically unstable, leading to cell death; lysis mediated by cell wall autolytic enzymes.

Gram-negative bacilli: Haemophilus influenzae, Escherichia coli, Proteus mirabilis, Klebsiella; Grampositive organisms: Staphylococcus aureus; Upper and lower respiratory tract, urinary tract, skin infections, bone, joint, biliary, genital infections, endocarditis, surgical prophylaxis, septicemia.

Sensitivity to penicillin and other cephalosporins; Nephrotoxicity: increased BUN, creatinine; I&O daily; Blood studues:AST, ALT, CBC, Hct, bilirubin, LDH, alk phos; Electrolytes: K, Na, Cl; Bowel pattern daily: Urine output; Anaphylaxis; Bleeding: ecchymosis, bleeding gums, hematuria, stool guaiac daily; Overgrowth of infection:perineal itching, malaise, redness, pain, swelling, diarrhea, change in cough, sputum.

Hypersensitivity to cephalosporins; infants <1 month.

Headache, dizziness, paresthesia, fever, chills, seizures (high doses); N/V, diarrhea, anorexia, GI bleeding, increased AST & ALT, pseudomembranous colitis; Proteinuria, vaginitis, increased BUN, nephrotoxicity, renal failure; Leukopenia, thrombocytopenia, agranulocytosis, anemia, neutropenia, lymphocytosis, eosinophilia, pancytopenia, hemolytic anemia; Dyspnea; Anaphylaxis, serum sickness, superinfection, Stevens-Johnson syndrome.

N3515 Medications Bold and Red life-threatening Italics - common ATC Anatomical Therapeutic Chemical (ATC) Classification System B/P blood pressure H/A headache LOC loss of consciousness N/V nausea & vomiting Rxn - reaction Resp respiratory/respirations SOB- Shortness of Breath Abbreviations: N/V: nausea/vomiting. HA: headache. Pt: patient. Mo: month. Incr: increase. Decr: decrease. MI: myocardial infarction. Hx: history. Dx: disease. w/ : with. Wt: weight. F&E: fluid & electrolytes.

aPTT=activated partial thromboplastin time AST=aspartate aminotransferase ALT=alanine aminotransferase BUN=Blood Urea Nitrogen CBC=Complete Blood Count Hct=Hematocrit Hgb=Hemoglobin PT=Prothrombin Time RA=Rheumatoid Arthritis TIA=transient ischemic attack MI=Myocardial Infarction LFT = Liver Function Test HYPERSENSITIVITY REACTIONS, chills, fever, infection, pain, allergic reactions, flu-like syndrome.