NURSING PROCESS PAPER 1
Medication Information
Drug Name(generic/trade name) / Drug Action/
Purpose / Normal Dose
Range / Major side
Effects / Nursing Considerations
omeprazole
Losec (CAN), Prilosec, Zegerid / Omeprazole interferes with gastric acid secretion by inhibiting the hydrogen-potassium-adenosine triphosphatase (H+K+-ATPase) enzyme system, or proton pump, in gastric parietal cells. Normally, the proton pump uses energy from the hydrolysis of adenosine triphos-phate to drive hydrogen (H+) and chloride (Cl-) out of parietal cells and into the stomach lumen in exchange for potassium (K+), which leaves the stomach lumen and enters the parietal cells. After this exchange, H+ and Cl-combine in the stomach to form hydrochloric acid (HCl), as shown below left. Omeprazole irreversibly blocks the exchange of intracellu-lar H+ and extracellular K+, as shown below right. By preventing H+ from entering the stomach lumen, omeprazole prevents additional HCl from forming. / * To treat GERD with erosive esophagitis
Delayed-release capsules, delayed-release tablets, oral suspension
Adults.
20 mg daily for 4 to 8 wk. / CNS:
Agitation, asthenia, dizziness, drowsiness, fatigue, headache, psychic disturbances, somnolence
CV:
Chest pain, hypertension, peripheral ed-dema
EENT:
Anterior ischemic optic neuropathy, optic atrophy or neuritis, stomatitis
ENDO:
Hypoglycemia
GI:
Abdominal pain, constipation, diarrhea, dyspepsia, elevated liver function test results, flatulence, hepatic dysfunction or failure, indigestion, nausea, pancreatitis, vomiting
GU:
Interstitial nephritis
HEME:
Agranulocytosis, anemia, hemolytic anemia, leukopenia, leukocytosis, neutrope-nia, pancytopenia, thrombocytopenia
MS:
Back pain
RESP:
Cough
SKIN:
Erythema multiforme, photosensitivity, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria
Other:
Anaphylaxis, angioedema, hypona-tremia / * Give omeprazole before meals, preferably in the morning for once-daily dosing. If neces-sary, also give an antacid, as prescribed.
* If needed, open capsule and sprinkle enteric-coated granules on applesauce or yogurt or mix with water or acidic fruit juice, such as apple or cranberry juice. Give immediately.
* To give drug via NG tube, mix granules in acidic juice because enteric coating dissolves in alkaline pH.
* Because drug can interfere with absorption of vitamin B12, monitor for macrocytic anemia.
* Be aware that long-term use of omeprazole may increase the risk of gastric carcinoma.
prednisone
Apo-Prednisone (CAN), Deltasone Liquid Pred, Meticorten, Orasone 1, Orasone 5, Orasone 10, Prednicen-M, Prednicot, Prednisone Intensol, Sterapred, Sterapred DS, Winpred (CAN) / Binds to intracellular glucocorticoid receptors and suppresses inflammatory and immune responses by:
inhibiting neutrophil and monocyte accumulation at inflammation site and suppressing their phagocytic and bactericidal activitystabilizing lysosomal membranessuppressing antigen response of macrophages and helper T cellsinhibiting synthesis of inflammatory response mediators, such as cytokines, interleukins, and prostaglandins. / * To treat adrenal insufficiency and acute and chronic inflammatory and immunosuppressive disorders
Oral solution, syrup,tablets
Adults and adolescents.
5 to 60 mg daily as a single dose or in divided doses. / CNS:
Euphoria, headache, insomnia, nervousness, psychosis, restlessness, seizures, vertigo
CV:
Edema, heart failure, hypertension
EENT:
Cataracts, exophthalmos, glaucoma, increased ocular pressure
ENDO:
Adrenal insufficiency, Cushing’s syndrome, growth suppression in children, hyperglycemia
GI:
Anorexia, GI bleeding and ulceration, increased appetite, indigestion, intestinal perforation, nausea, pancreatitis, vomiting
GU:
Menstrual irregularities
MS:
Avascular necrosis of joints, bone fractures, muscle atrophy or weakness, myalgia, osteoporosis
SKIN:
Acne; diaphoresis; ecchymosis; flushing; petechiae; striae; thin, fragile skin
Other:
Delayed wound healing, hypernatremia, hypokalemia, negative nitrogen balance / * Administer once-daily doses of prednisone in the morning to match the body’s normal cortisol secretion schedule.
* Because prednisone can produce many adverse reactions, assess regularly for signs and symptoms of such reactions as heart failure and hypertension. Also monitor fluid intake and output and daily weight.
* Monitor growth pattern in children because prednisone may retard bone growth.
* Be aware that prolonged use of prednisone may cause hypothalamic-pituitary-adrenal suppression.
* WARNING Withdraw prednisone gradually, as ordered, if therapy lasts longer than 2 weeks. Abrupt discontinuation may cause acute adrenal insufficiency and, possibly, death.
acetaminophen
Abenol (CAN), Acephen, Aceta Elixir, Aceta-minophen Uniserts, Aceta Tablets, Apacet Capsules, Apacet Elixir, Apacet Extra Strength Tablets, Apacet Regular Strength Tablets, Aspirin Free Pain Relief, Exdol (CAN), Feverall, Feverall Sprinkle Caps, Genapap Infants’ Drops, Genebs Extra Strength, Halenol Children's Junior Strength, Liquiprin Elixir, Liquiprin Infants’ Drops, Meda Cap, Neopap, Oraphen-PD, Panadol, Panadol Infants’ Drops, Pediaphen, Redutemp, Robigesic (CAN), St. Joseph Aspirin-Free Infant Drops, Tapanol Extra Strength, Tempra, Tempra Drops, Tylenol, Tylenol Caplets, Tylenol Children's Chewable Tablets, Tylenol Extra Strength, Tylenol Gel-caps, Tylenol Infants’ Drops / Inhibits the enzyme cyclooxygenase, blocking prostaglandin production and interfering with pain impulse generation in the peripheral nervous system. Acetamin-ophen also acts directly on temperature-regulating center in the hypothalamus by inhibiting synthesis of prostaglandin E2. / * To relieve mild to moderate pain associated with headache, muscle ache, backache, minor arthritis, common cold, toothache, and menstrual cramps; to reduce fever
Caplets, capsules, chewable tablets, elixir, e.r. caplets, gelcaps, liquid, solution, sprinkles, suspension, tablets
Adults.
325 to 650 mg every 4 to 6 hr, or 1,000 mg t.i.d. or q.i.d., or 2 E.R. caplets every 8 hr. Maximum: 4,000 mg daily. / GI:
Abdominal pain, hepatotoxicity, nausea, vomiting
HEME:
Hemolytic anemia (with long-term use), leukopenia, neutropenia, pancytopenia, thrombocytopenia
SKIN:
Jaundice, rash, urticaria
Other:
Angioedema, hypoglycemic coma / * Before and during long-term therapy, monitor liver function test results, including AST, ALT, bilirubin, and creatinine levels, as ordered.
* Monitor renal function in patient on long-term therapy. Keep in mind that blood or albumin in urine may indicate nephritis; decreased urine output, renal failure; and dark brown urine, presence of the metabolite phenacetin.
* Expect to reduce dosage for patients with renal dysfunction.
* Store suppositories under 80° F (26.6° C).
* WARNING Be aware that Pediaphen is a concentrated form of acetaminophen containing 80 mg/0.8 ml (standard liquid forms contain 32 mg/ml). Make sure to use correct concentration and correct dosage of liquid acetaminophen because serious adverse reactions can result from confusing concentrated form with regular liquid form.
Levsin
hyoscyamine sulfate, Anaspaz, A-Spas S/L, Cystospaz, Cystospaz-M, Donnamar, ED-SPAZ, Gastrosed, Levbid, Levsin/SL, Levsinex Timecaps, Symax SL, Symax SR / Competitively inhibits acetylcholine at autonomic postganglionic cholinergic receptors. Because the most sensitive receptors are in the salivary, bronchial, and sweat glands, hyoscyamine acts mainly to reduce salivary, bronchial, and sweat gland secretions. It also causes GI smooth muscle to contract and decreases gastric secretion and GI motility. In addition, hyoscyamine causes the bladder detrusor muscle to contract; reduces nasal and oropharyngeal secretions; and decreases airway resistance from relaxation of smooth muscle in the bronchi and bronchioles. / * To treat peptic ulcers and GI tract disorders caused by spasm
Elixir, oral solution
Adults and adolescents.
0.125 to 0.25 mg every 4 to 6 hr. / CNS:
Drowsiness, insomnia
EENT:
Blurred vision; dry mouth, nose, and throat; photophobia
ENDO:
Decreased lactation
GI:
Constipation
GU:
Impotence, urine retention
SKIN:
Decreased sweating
Other:
Heatstroke, injection site redness and urticaria / * Use hyoscyamine cautiously in patients who have arrhythmias, autonomic neuropathy, coronary artery disease, heart failure, hiatal hernia with reflux esophagitis, hypertension, hyperthyroidism, renal failure, or tachycardia.
* Give drug 30 to 60 minutes before meals and at bedtime. Give bedtime dose at least 2 hours after the day’s last meal.
* Anticipate that tablets may not disintegrate and may appear in stool.
* WARNING Anticipate an increased risk of drug-induced heatstroke in hot or humid weather because hyoscyamine decreases sweating.
* WARNING Be aware that lower doses may paradoxically decrease heart rate. Higher doses affect nicotinic receptors in autonomic ganglia, causing delirium, disorientation, hallucinations, and restlessness.
* Monitor urine output, and be alert for urine retention.
Maalox
magnesium hydroxide (milk of magnesia)/ aluminum hydroxide
(contains 135 mg elemental magnesium per tablet, 129 to 130 mg elemental magnesium per chewable tablet, and 164 to 328 mg elemental magnesium per 5 ml liquid, liquid concentrate, or oral solution)
Phillips’ Chewable Tablets, Phillips’ Magnesia Tablets (CAN), Phillips’ Milk of Magnesia, Phillips’ Milk of Magnesia Concentrate
AlternaGEL, Alu-Cap, Alugel (CAN), Alu-Tab, Amphojel, Dialume / Neutralizes or reduces gastric acidity, resulting in increased stomach and duodenal alkalinity. Protects stomach and duodenum lining by inhibiting pepsin's prote-olytic activity. Binds with phosphate ions in the intestine to form insoluble aluminum-phosphate compounds, which lower the blood phosphate level. / To treat hyperacidity associated with gastric hyperacidity, gastritis, hiatal hernia, peptic esophagitis, and peptic ulcers; to prevent phosphate renal calculus formation; to reduce hyperphosphatemia in chronic renal failure
Aluminum hydroxide capsules, suspension, or tablets
Adults.
500 to 1,500 mg as capsules or tablets in divided doses 3 to 6 times daily, taken between meals and at bedtime; 5 to 30 ml as suspension p.r.n., taken between meals and at bedtime. / CNS:
Encephalopathy
GI:
Constipation, intestinal obstruction, white-speckled stool
MS:
Osteomalacia, osteoporosis
Other:
Aluminum accumulation in serum, bone, and CNS; aluminum intoxication; electrolyte imbalances / * Don't administer aluminum hydroxide within 1 to 2 hours of other oral drugs.
* Be aware that two 0.6-g aluminum hydroxide tablets can neutralize 16 mEq of acid.
* Monitor patient's serum levels of sodium, phosphate, and other electrolytes, as appropriate.
Zoloft
sertraline hydrochloride / Inhibits reuptake of the neurotransmitter serotonin by CNS neurons, thereby increasing the amount of serotonin available in nerve synapses. An elevated serotonin level may result in elevated mood and reduced depression. This action may also relieve symptoms of other psychiatric conditions attributed to serotonin deficiency. / * To treat major depression
Oral concentrate,tablets
Adults.
Initial: 50 mg daily, increased after several wk in increments of 50 mg daily every wk, as needed. Maximum: 200 mg daily.
* To treat obsessive-compulsive disorder
Oral concentrate,tablets
Adults and adolescents.
Initial: 50 mg daily, increased after several wk in increments of 50 mg daily every wk, as needed. Maximum: 200 mg daily. / CNS:
Aggressiveness, agitation, anxiety, dizziness, drowsiness, fatigue, fever, headache, hyperkinesia, insomnia, nervousness, neuroleptic malignant syndrome–like reaction, paresthesia, serotonin syndrome, suicidal ideation, tremor, weakness, yawning
CV:
Palpitations
EENT:
Dry mouth, epistaxis, sinusitis, vision changes
ENDO:
Syndrome of inappropriate ADH secretion
GI:
Abdominal cramps, anorexia, constipation, diarrhea, flatulence, increased appetite, indigestion, nausea, vomiting
GU:
Anorgasmia, decreased libido, ejaculation disorders, impotence, urinary incontinence
SKIN:
Diaphoresis, flushing, purpura, rash
Other:
Weight loss / * Monitor liver function test results and BUN and serum creatinine levels, as appropriate, in patients with hepatic or renal dysfunction.
* WARNING Monitor patient closely for evidence of serotonin syndrome, such as agitation, hallucinations, coma, tachycardia, labile blood pressure, hyperthermia, hyperreflexia, incoordination, nausea, vomiting, and diarrhea. Serotonin syndrome in its most severe form can resemble neuroleptic malignant syndrome, which includes hyperthermia, muscle rigidity, autonomic instability, possibly rapid changes in vital signs, and mental status changes. Notify prescriber immediately because serotonin syndrome reactions that resemble neuroleptic malignant syndrome may be life-threatening. Be prepared to provide supportive care.
* Monitor patient for hypoosmolarity of serum and urine and for hyponatremia, which may indicate sertraline-induced syndrome of inappropriate ADH secretion.
* Be aware that effective antidepressant therapy can promote development of mania in predisposed people. If mania develops, notify prescriber immediately and expect to withhold sertraline.
* Watch closely for suicidal tendencies, especially when therapy starts and dosage changes and especially in children and adolescents.
* Monitor patient closely for evidence of GI bleeding, especially if patient takes a drug known to cause it, such as aspirin, an NSAID, a serotonin or norepinephrine reup-take inhibitor, or warfarin.
* When theray stops, expect to taper dosage to minimize adverse effects rather than stopping drug abruptly.
Coumadin
warfarin sodium / Interferes with the liver’s ability to synthesize vitamin K–dependent clotting factors, depleting clotting factors II (prothrombin), VII, IX, and X. This action, in turn, interferes with the clotting cascade. By depleting vitamin K-dependent clotting factors and interfering with the clotting cascade, warfarin prevents coagulation. / To prevent or treat pulmonary embolism; recurrent MI; thromboembolic complications from atrial fibrillation, heart valve replacement, or MI; and venous thrombosis (and its extension)
Tablets
Adults.
Initial: 2 to 5 mg daily / CNS:
Coma, intracranial hemorrhage, loss of consciousness, syncope, weakness
CV:
Angina, chest pain, hypotension
EENT:
Epistaxis, intraocular hemorrhage
GI:
Abdominal cramps and pain, diarrhea, hepatitis, nausea, vomiting
GU:
Hematuria, vaginal bleeding (abnormal)
HEME:
Anemia, potentially fatal hemorrhage (from any tissue or organ)
SKIN:
Alopecia, ecchymosis, jaundice, petechiae, pruritus, purple-toe syndrome, tissue necrosis
Other:
Anaphylaxis / * Reconstitute parenteral warfarin just before administration with 2.7 ml of sterile water for injection to yield 2 mg/ml. Then administer slowly over 1 to 2 minutes through peripheral I.V.
* Expect to administer another parenteral anticoagulant, such as heparin or enoxaparin, with oral warfarin for at least 3 days, or until desired response occurs, before giving warfarin only.
* Avoid I.M. injections during warfarin therapy, if possible, because they can result in bleeding, bruising, and hematoma.
* Monitor INR (daily in acute care setting) and assess for therapeutic effects, as prescribed. Therapeutic INR levels are 2.0 to 3.0 for bioprosthetic heart valve, nonvalvular atrial fibrillation, and venous thromboembolism, and 2.5 to 3.5 after MI and for mechanical heart valve.
* Expect treatment to last up to 12 weeks for bioprosthetic heart valve, 1 to 3 months for nonvalvular atrial fibrillation or venous thromboembolism, and for rest of life after MI and for mechanical heart valve replacement.
* WARNING Be aware of the increased risk for intracranial hemorrhage if patient has cerebral ischemia (such as recent transient ischemic attack or minor ischemic CVA) and INR of 3 to 4.5. As prescribed, withhold next warfarin dose and give vitamin K if INR exceeds 4 because of the risk of bleeding.
* Assess for occult bleeding if patient receives I.V. lipid emulsion or other medical product that contains soybean oil. Such products can decrease vitamin K absorption and increase warfarin’s anticoagulant effect.
ibuprofen
Actiprofen Caplets (CAN), Advil, Apo-Ibuprofen (CAN), Bayer Select Ibuprofen Pain Relief Formula Caplets, Children’s Advil, Children’s Motrin, Dolgesic, Excedrin IB, Genpril, Hal-tran, Ibifon 600 Caplets, Ibuprin, Ibuprohm Caplets, Ibu-Tab, Medipren, Midol IB, Motrin, Motrin-IB, Novo-Profen (CAN), Nu-Ibuprofen (CAN), Nuprin, Pamprin-IB, Q-Profen, Rufen, Trendar / Blocks the activity of cyclooxygenase, the enzyme needed to synthesize prostaglandins, which mediate the inflammatory response and cause local vasodilation, swelling, and pain. By inhibiting prostaglandins, this NSAID reduces inflammatory symptoms and relieves pain. Ibuprofen’s antipyretic action probably stems from its effect on the hypothalamus, which increases peripheral blood flow, causing vasodilation and encouraging heat dissipation. / * To relieve pain in rheumatoid arthritis and osteoarthritis
Capsules, chewable tablets, oral suspension, tablets
Adults.
300 mg q.i.d., or 400, 600, or 800 mg t.i.d. or q.i.d. Range: 1.2 to 3.2 g daily. / CNS:
Aseptic meningitis, dizziness, headache, nervousness, seizures, stroke
CV:
Fluid retention, heart failure, hypertension, MI, peripheral edema, tachycardia
EENT:
Amblyopia, epistaxis, stomatitis, tinnitus
GI:
Abdominal cramps, distention, or pain; anorexia; constipation; diarrhea; diverticulitis; dyspepsia; dysphagia; elevated liver function test results; epigastric discomfort; esophagitis; flatulence; gastritis; gastroenteritis; gastroesophageal reflux disease; GI bleeding, hemorrhage, perforation, or ulceration; heartburn; hemorrhoids; hepatic failure; hepatitis; hiatal hernia; indigestion; melena; nausea; stomatitis; vomiting
GU:
Cystitis, hematuria, renal failure (acute)
HEME:
Agranulocytosis, anemia, aplastic anemia, eosinophilia, hemolytic anemia, leukopenia, neutropenia, pancytopenia, prolonged bleeding time, thrombocytopenia
RESP:
Bronchospasm, dyspnea, wheezing
SKIN:
Blisters, erythema multiforme, photosensitivity, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria
Other:
Anaphylaxis, angioedema, flulike symptoms, weight gain / * Use ibuprofen with extreme caution in patients with a history of ulcer disease or GI bleeding because NSAIDs such as ibuprofen increase the risk of GI bleeding and ulceration. Expect to use ibuprofen for the shortest time possible in these patients.
* Be aware that serious GI tract ulceration, bleeding, and perforation may occur without warning symptoms. Elderly patients are at greater risk. To minimize risk, give drug with food. If GI distress occurs, withhold drug and notify prescriber immediately.
* Use ibuprofen cautiously in patients with hypertension, and monitor blood pressure closely throughout therapy. Drug may cause hypertension or worsen it.
* WARNING Monitor patient closely for thrombotic events, including MI and stroke, because NSAIDs increase the risk.
* Monitor patient—especially if he’s elderly or receiving long-term ibuprofen therapy—for less common but serious adverse GI reactions, including anorexia, constipation, diverticulitis, dysphagia, esophagitis, gastritis, gastroenteritis, gastroesophageal reflux disease, hemorrhoids, hiatal hernia, melena, stomatitis, and vomiting.
* Monitor liver function test results because, in rare cases, elevations may progress to severe hepatic reactions, including fatal hepatitis, liver necrosis, and hepatic failure.
* Monitor BUN and serum creatinine levels in elderly patients, patients taking diuretics or ACE inhibitors, and patients with heart failure, impaired renal function, or hepatic dysfunction; drug may cause renal failure.
* Monitor CBC for decreased hemoglobin and hematocrit. Drug may worsen anemia.
* WARNING If patient has bone marrow suppression or is receiving an antineoplastic drug, monitor laboratory results (including WBC count), and watch for evidence of infection because antiinflammatory and antipyretic actions of ibuprofen may mask signs and symptoms, such as fever and pain.
* Assess patient’s skin regularly for signs of rash or other hypersensitivity reaction because ibuprofen is an NSAID and may cause serious skin reactions without warning, even in patients with no history of NSAID sensivitity. At first sign of reaction, stop drug and notify prescriber.
* Although drug’s analgesic effect occurs at low doses, expect to give at least 400 mg four times daily for antiinflammatory effect.
* Expect higher doses for rheumatoid arthritis than for osteoarthritis.
* Be aware that ibuprofen oral suspension may contain sucrose, which may affect blood glucose level in patients with diabetes.
Source: Davis’s Drug Guide for Nurse 2011