14389435-commondrugsinnclexrn1

8/3/2019 14389435-commondrugsinnclexrn1

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Name of the Drug

Brand Names

Classification and Action

Indications

Side Effects

Adverse Effects

Nursing Implication

Alendronate Sodium

Fosamax

A bisphosphonate ;

acts as a specific inhibitor of

osteoclast-mediated bone

resorption.; A bone resorption

inhibitor

INDICATIONS

Treatment and

prevention of osteoporosis in

post menopausal women Treatment of osteoporosis in

men

Treatment of Page ts

disease

Treatment of corticosteroid-

induced osteoporosis

nausea stomach pain

constipation

diarrhea

gas

bloating or fullness in the

stomach

change in ability to taste

food

bone, muscle, or joint

pain

headache

dizziness

flu-like symptoms erythema,

photosensitivity, rash

ADVERSE

Esophageal adverse

experiences, such as

esophagitis, esophageal ulcers

and esophageal erosions,

occasionally with bleeding and

rarely followed by esophageal

stricture or perforation, new or

worsening heartburn,difficulty

swallowing,pain onswallowing ,chest pain ,bloody

vomit or vomit that looks like

coffee grounds, black, tarry, or

bloody stools,fever, blisters or

peeling skin ,rash (may be

Administer 1st thing in the morning with 6 to 8 oz plain water 30minutes before other medications, beverages, or foods.

Instruct to remain upright for 30 minutes following dose to facilitate

passage to the stomach and minimize the risk for esophageal

irritation

Food decreases absorption; caffeine (coffee, tea, cola), mineral water

and orange juice also decreases absorption

Calcium supplements, antacids and other drugs decrease absorption

Advise to eat a balanced diet and consult health care provider about

the need for supplemental calcium and vitamin D

Encourage to participate in regular exercise and to modify

behaviors that increase the risk of osteoporosis

Use sunscreen and protective clothing to prevent photosensitivity

reactions If you have chest pain, new or worsening heartburn, or have trouble

or pain when swallowing, stop taking the drug and call MD


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made worse by sunlight)

,itching,hives ,swelling of

eyes, face, lips, tongue, or

throat , difficulty

breathing,hoarseness, painful

or swollen gums, loosening of

the teeth, numbness or heavy

feeling in the jaw , poor

healing of the jaw , eye pain

Amlodipine

Norvasc

Antihypertensive

Calcium Channel Blocker

Inhibits transport of calcium

into myocardial and vascular

smooth muscle cells.

Therapeutic effect is

systemic vasodilation

resulting in decreased BP

Coronary vasodilationreducing the frequency and

severity of attacks of angina

INDICATIONS

Management of hypertension,

angina pectoris and

vasospastic (Prinzmetal)

angina

CNS: headache,

dizziness, fatigue

CV: Peripheral edema,

angina, bradycardia,

hypotension, palpitations

GI: ginigval hyperplasia,

nausea

Integumentary: flushing

ADVERSE

Irregular heartbeat, dyspnea,

swelling of hands and feet,

pronounced dizziness, severe

and persistent headache,

hypotension

Instruct on correct technique for monitoring pulse; Instruct to

contact health care provider if heart rate is below 50 bpm

Instruct on proper way of monitoring blood pressure

Monitor intake and output and daily weight; Assess for S/Sx of

CHF

Caution to change position slowly to minimize orthostatic

hypotension

Advise to avoid driving or other activities requiring alertness until

response to the drug is known.

Maintain good dental hygiene to prevent tenderness, bleeding and

gingival hyperplasia.

Wear protective clothing and use sunscreen to prevent

photosensitivity reactions.

Additive hypotension may occur when used concurrently with

fentanyl, nitrates, other antihypertensives, acute ingestion of

alcohol or quinidine

Antihypertensive effect may be decreased when used concurrently

with NSAIDs

May increase risk of neurotoxicity with lithium.

Blood level s and effects may be increased when combined with

grapefruit juice.

Amoxicillin

Amoxil, Trimox, Wymox,Novamoxin

Pharm. Class: Aminopenicillins

Therapeutic class: Anti-

infectives, antiulcer agents

GI: diarrhea, nausea,

vomiting Derma: rashes, urticaria

Hema: Blood dyscracias

Administer around the clock; may be given without or with meals to

decrease GI effects. Capsule contents may be emptied andswallowed with liquids. Chewable tablets should be cru shed or

chewed before swallowing with liquids

Shake oral suspension before administration. Suspension may be

given straight or may be mixed in formula, milk, fruit juice, water or

ginger ale; Administer immediately after mixing. Discard


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Binds to bacterial cell wall,

causing cell death. Bactericidal

action spectrum is broader than

penicillins

INDICATIONS

Treatment of the following

infections: Skin infections,Otitis media, sinusitis,

respiratory infections,

genitourinary infections,

septicemia, endocarditis,

prophylaxis, management of

H.Pylori infection.

ADVERSE

CNS: Seizures (high

doses)

GI: Pseudomembranouscolitis

Anaphylaxis or allergic

reactions

Serum sickness and

superinfection

refrigerated suspension after 10 days

Take medication around the clock and finish the drug completely as

directed, even if feeling better

May decrease the effectiveness of oral contraceptives teach to use

an alternate or additional nonhormonal method of contraception

during therapy with amoxicillin and until next menstrual period

Advise to report signs of superinfection (furry overgrowth on the

tongue, vaginal itching, or discharge, loose or foul-smelling stools)

and allergy Instruct to report to MD immediately if diarrhea, abdominal

cramping, fever or bloody stools occur and not to treat with

antidiarrheals without consulting MD Pseudomembranous colitis

may begin up to several weeks following cessation of therapy

Teach patients with a history of rheumatic heart disease or valve

replacement the importance of using antimicrobial prophylaxis

before invasive medical or dental procedures

Drug-Drug interactions: Probenecid decreases renal excretion and

increases blood levels of amoxicillin; may potentiate the effect of

warfarin; may decrease the effectiveness of oral contraceptives

May cause in creased AST and ALT, increased serum alkaline

phosphatase, LDH and may cause a positive-false Direct Coombs

test result;

Ampicillin

Ampicin, Marcillin, Omnipen,

Principen, Totacillin, Penbritin,

Polycillin

Pharm. Class: Aminopenicillins

Therapeutic class: Anti-

infectives

Binds to bacterial cell wall,

resulting in cell death; Ba

ctericidal action

INDICATIONS

Same as Amoxicillin

Same as amoxicillin Reserve IM or IV route for moderately severe or severe infections or

patients unable to take the medication per orem.

PO: Administer around the clock and finish the whole course of

treatment. Administer on an empty stomach at least 1 hour before or

2 hours after meals with a full glass of water. Capsules may be

opened or mixed with water. Reconstituted oral suspensions retain

potency for 7 days at room temperature and 14 days if refrigerated.

Observe for signs and symptoms of anaphylaxis: rash, pruritus,

laryngeal edema, wheezing) Discontinue the drug and notify MD

immediately if these occur.

Assess skin for ampicillin rash, a non-allergic, dull-red macular or

maculopapular mildly pruritic rash Report signs of superinfection pseudomembranous colitis (same as

for amoxicillin)

Use other alternatives or methods of contraception for those people

who are on oral contraceptives

Drug-Drug interactions: Probenecid decreases renal excretion and


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increases blood levels ; may decrease the effectiveness of oral

contraceptives

May cause in creased AST and ALT, increased serum alkaline

phosphatase, LDH and may cause a positive-false Direct Coombs

test result;

Ma y cause transient decreases in estradiol, estriol or conjugated

estrone in pregnant women

Incidence of rash increases with concurrent allopurinol therapy;

increases risk of bleeding with warfarin

Buspirone

Buspar

Anti anxiety agent;

anxiol,ytic agent; binds to

serotonin and dopamine

receptors in the brain;

increases norepinephrine

metabolism in the brain;

Relief of anxiety

INDICATIONS

Management of anxiety

CNS: dizziness,

drowsiness, excitement,

fatigue, headache,

insomnia, nervousness,

weakness and personality

changes

EENT: Blurred

vision, nasal congestion,

sore throat, tinnitus, al

tered tas te or smell,

conjunctivitis Respiratory: chest

congestion,

hyperventilation,

shortness of breath

CV:chest pain,

palpitations, tachycardia,

hypertension,

hypotension, syncope

GI: nausea,

abdominal pain,

constipation, dry mouth,

vomiting

Derm: Rashes,

alopecia, blisters, dry

skin, easy bruising,

edema, flushing, pruritus

MS: Myalgia

Endo: irregular

Buspirone will not prevent withdrawal symptoms; so patients

changing from other anti anxiety agents must receive gradually

decreasing doses

Ma y be administered with food to minimize gastric irritation

Caution to avoid driving and other activities requiring mental

alertness

Avoid concurrent use of alcohol or other CNS depressants with this

drug

Advise to consult health care professionals before taking OTC

medications

Instruct to notify health care professional if any chronic abnormalmovements occur

DRUG-DRUG interaction: with MAOIs may result in

hypertension; may in crease hepatic effects from t razodone;

concurrent use with itraconazole or erythromycin increases blood

levels

Concomittant use of kava, valerian, skullcap, chamomile, or hops

can increase CNS depression

Grape fruit juice increases serum level s and effects


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menses

Neuro:

Incoordination,

numbness, paresthesia,

tremor

Misc: clumsiness,

sweating, fever

ADVERSE

Chronic, abnormal movements

dystonia, motor restlessness,

involuntary movements of

facial or cervical muscles

Calcitonin

Calcimar, Miacalcin,

Osteocalcin, Salmonine

Hypocalcemic; hormone

Decreases serum calcium

by a direct effect on bone,

kidney, and GIT.; promotes

renal excretion of calcium;

Therapeutic effects:

Decreased rate of bone

turnover; Lowering of

serum calcium

INDICATIONS

Treatment of Pagets disease ;

adjunctive therapy for

hypercalcemia; management of

postmenopausal osteoporosis

CNS: headaches

EENT (nasal only)

epistaxis, nasal irritation,

rhinitis

GI: IM, SC nausea,

vomiting, altered taste,

diarrhea

GU: IM, SC urinary

frequency

Derm: rashes

Local: injection site

reactions

MS: nasal arthralgia,

back pain

ADVERSE

Allergic reactions,

anaphylaxis, skin rash, fever,

Observe for signs of hypersensitivity. Keep epinephrine,

antihistamines, and oxygen nearby in the event of a reaction

Assess for signs of hypocalcemic tetany (nervousness, irritability,

paresthesia, muscle twitching, tetanic spasms, convulsions) duringthe first several doses of calcitonin. Parenteral calcium, such as

Calcium gluconate should be available in case of this event

Monitor serum calcium and alkaline phosphatase periodically

throughout therapy. These levels should normalize within a few

months of initiation of therapy

Monitor Hydroxyproline (24 hour) periodically in patients with

Pagets disease

Store solution in refrigerator

IM, SC: Inspect injection site for the appearance of redness, swelling

and pain. Rotate injection sites. SC is the preferred route; Use

multiple sites to minimize inflammatory reactions

Do not administer if the solution is discolored or contains particulate

matter

Advise to report signs of hypercalcemic relapse (deep bone or flank

pain, renal calculi, anorexia, nausea, vomiting, thirst, lethargy) or

allergic response promptly

Flushing and warmth following injection are transient and usually

last about 1 hour


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serum sickness, facial

flushing, swelling,

tenderness, and tingling in the

hands

Nausea following injection tends to decrease even with continued

therapy

Observe for signs of hypersensitivity. Keep epinephrine,

antihistamines, and oxygen nearby in the event of a reaction

Assess for signs of hypocalcemic tetany (nervousness, irritability,

paresthesia, muscle twitching, tetanic spasms, convulsions) during

the first several doses of calcitonin. Parenteral calcium, such as

Calcium gluconate should be available in case of this event

Monitor serum calcium and alkaline phosphatase periodicallythroughout therapy. These levels should normalize within a few

months of initiation of therapy

Monitor Hydroxyproline (24 hour) periodically in patients with

Pagets disease

Store solution in refrigerator

IM, SC: Inspect injection site for the appearance of redness, swelling

and pain. Rotate injection sites. SC is the preferred route; Use

multiple sites to minimize inflammatory reactions

Do not administer if the solution is discolored or contains particulate

matter

Advise to report signs of hypercalcemic relapse (deep bone or flank

pain, renal calculi, anorexia, nausea, vomiting, thirst, lethargy) or

allergic response promptly

Flushing and warmth following injection are transient and usually

last about 1 hour

Nausea following injection tends to decrease even with continued

therapy

Follow low calcium diet if recommended. Women with

postmenopausal osteoporosis should adhere to a diet high in

calcium and vitamin D

For patients receiving calcitonin for the treatment of osteoporosis,

exercise has been found to arrest and reverse bone loss.

Intranasal administration: Instruct on correct use of nasal spray.

Before first use, activate pump by holding upright and depressing

white side arms down toward bottle 6 times until a fine spray is

emitted. Follow activation, place nozzle firmly in nostril with head

in an upright position and depress the pump toward the bottle

Notify health care professional if significant nasal irritation occurs

Drug-Drug interaction: Previous biphosphanate therapy, including

alendronate, risedronate, etidronate, or pamidronate may decrease

response to calcitonin

Follow low calcium diet if recommended. Women with


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postmenopausal osteoporosis should adhere to a diet high in

calcium and vitamin D

For patients receiving calcitonin for the treatment of osteoporosis,

exercise has been found to arrest and reverse bone loss.

Intranasal administration: Instruct on correct use of nasal spray.

Before first use, activate pump by holding upright and depressing

white side arms down toward bottle 6 times until a fine spray is

emitted. Follow activation, place nozzle firmly in nostril with head

in an upright position and depress the pump toward the bottle Notify health care professional if significant nasal irritation occurs

Drug-Drug interaction: Previous biphosphanate therapy, including

alendronate, risedronate, etidronate, or pamidronate may decrease

response to calcitonin

Captopril

Capoten

Therapeutic class:

Antihypertensives

Phar. Class: ACE inhibitor

Blocks the con version of

Angiotensin I to the

vasoconstrictor Angiotensin II. Inactivates the vasodilator

bradykinin and other

vasodilatory prostaglandins

Increases plasma renin

levels and reduces

aldosterone levels

Therapeutic effects:

Lowering of BP in

hypertensive patients;

decreased afterload in

patients with CHF;

decreased progression of

diabetic nepropathy ;

decreased development ofovert heart failure

INDICATIONS

Management of CHF,

CNS: dizziness, fatigue,

headache, insomnia,

weakness

Respiratory: cough,

eosinophilic pneumonitis

CV: Hypotension, angina

pectoris, tachycardia

GI: taste disturbances,anorexia, diarrhea, nausea,

GU: proteinuria,

impotence, renal failure

Derm: rashes

F and E: hyperkalemia

Hema:

AGRANULOCYTOSIS,

NEUTROPENIA

Misc: ANGIOEDEMA;

fever

ADVERSE

Extreme decrease of blood

presure;

AGRANULOCYTOSIS,

Assess BP and pulse frequently during initial dosage adjustment and

periodically throughout the therapy

Monitor weight and assess routinely for resolution of fluid overload

in clients with CHF

Monitor BUN, creatinine and electrolyte levels periodically. Serum

BUN, creatinine and serum potassium may be increased and serum

sodium levels may be decreased.

Monitor CBC periodically. May rarely cause slight decrease in

hemoglobin and Hematocrit

May cause elevated AST, ALT, alkaline phosphatase, serum

bilirubin, uric acid and glucose

May cause positive ANA titer; May cause false-positive test result

for urine acetone

Assess urine protein prior to and periodically during therapy for up

to 1 year in patients with renal impairment or those receiving more

than 150 mg/day of captopril. If excessive or increasing proteinuria

occurs, reevaluate ACE inhibitor therapy

WBC with differential should be monitored prior to initiation of

therapy, monthly for the first 3 to 6 months, and periodically

thereafter for up to 1 year in patients at risk for neutropenia

(patients with renal impairment, collagen-vascular disease, orthose receiving high doses) or at first sign of infection;

Discontinue therapy if neutrophil count is


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reduction of risk of death

or development of CHF

following MI; Decreased

progression of diabetic

nephropathy

NEUTROPENIA,

angioedema

mg tablet and dissolving it in 25/100mL of water. Shake for at least

5 minutes and administer within 30 minutes

Precipitous drop in BP during first 1 to 3 hour following first dose

may require volume expansion with normal saline but is not

normally considered an indication for stopping therapy.

Discontinuing diuretic therapy or increasing salt intake 1 week

prior to initiation may decrease risk of hypotension. Monitor

closely for at least 1 hour after BP has stabilized. Resume diuretics

if BP is not controlled Do not discontinue unless directed by health care professional

Caution to avoid salt substitutes or foods containing high levels of

pot potassium or sodium

Change positions slowly

Advise that exercising in hot weather may increase hypotensive

effects

Caution to avoid driving or other activities requiring mental alertness

Inform health care professional of medication regimen prior to

treatment or surgery

Advise that medication may cause impairment of taste that generally

resolves within 8 to 12 weeks, even with continued therapy

Instruct to notify health care professional if rash; mouth sores,

sore throat; fever; swelling of hands/feet; irregular heartbeat;

chest pain; dry cough; hoarseness; swelling of face eyes, lips,or tongue; difficulty swallowing or breathing occur or if taste

impairment or skin rash persist

Encourage patient to comply with additional interventions for

hypertension. Medication controls but does not cure hypertension

Drug-drug interaction: excessive hypotension with concurrent use

of diuretics; additive hypotension with other antihypertensives,

nitrates, phenothiazines, acute ingestion of alcohol, and during

surgery or general anesthesia; hyperkalemia from concurrent use of

potassium supplements, potassium-sparing diuretics, indomethacin,

salt substitutes, , or cyclosporine; Antihypertensive response may

be blunted by NSAIDs; Antacids decrease absorptin; Increased

levels may increase the risk of lithium or digoxin toxicity;

Probenecid decreases elimination and increases levels of captopril;

Risk of hypersensitivity reactions increased by concurrent

allopurinol

Cimetidine CNS: confusion, Avoid administration of antacids within 30 minutes to 1 hour


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Tagamet, Tagamet HB

Ther. Class: Antiulcer agents

Pharm. Class: Histamine H2

Antagonists

Inhibits the action of histamine

at the H2 receptor site, resulting

in inhibition of gastric acid

secretion.

INDICATIONS

Short term treatment of

active duodenal ulcers and

benign gastric ulcers;

prophylaxis of duodenal

ulcers; management of

GERD

Treatment and prevention

of heartburn, acid

indigestion, and sour

stomach

Management of gastric

hypersecretory states(Zollinger-Ellison

syndrome)

Prevention and treatment of

stress-induced upper GI

bleeding in critically ill patients

dizziness, drowsiness,

hallucinations, headache

CV: ARRHYTHMIAS

GI: diarrhea, drug-

induced hepatitis, nausea

Endo: gynecomastia,

GU: impotence, decreased

sperm count, decreasedlibido

Hema:

AGRANULOCYTOSIS,

APLASTIC ANEMIA,

anemia, neutropenia,

thrombocytopenia

Local: pain at IM site

Misc: hypersensitivity

reactions, transient rash,

hepatic abnormalities,

hirsutism

ADVERSE

Arrhythmias, hypotension,

agranulocytosis, aplastic

anemia, liver impairment

drug-induced hepatitis

of H 2 antagonist and take sucralfate 2 hours after histamine

H2 antagonist may decrease the absorption of histamine

blocker

Monitor hepatic enzymes and blood counts

Administer with meals or immediately afterward and at bedtime to

reduce acid secretion

Cimetidine tablets have a characteristic odors

Inhibits drug metabolizing enzymes in the liver and may lead to

increased blood levels and toxicity with the following: somebenzodiazpines (chlordiazepoxide, diazepam and midazolam),

some beta-blockers (labetalol, metoprolol, propranolol), caffeine,

calcium channel blockers, carbamazepine, chloroquine, lidocaine,

metronidazole, moricizine, pentoxyfylline; phenytoin,

propafenone, quinidine, quinine, metformin, sulfonylureas, tacrine,

theophylline, triamterene, TCA, valproic acid and warfarin.

Increases the effects of succinylcholine, flecainide, procainamide,

carmustine and fluorouracil; decreases the absorption of

Ketoconazole

Food reduces the rate of absorption

May cause mental confusion, agitation, psychosis, anxiety and

disorientation

Reduce dosage in clients with renal impairment

By the IV route, a 300 mg dose can be diluted in a total volume

of 20 mL and injected slowly over not less than 2 minutes, or it

may be diluted over 15 to 20 minutes; IV administration can

cause hypotension and dysrhthmias

If administered with warfarin sodium (Coumadin), phenytoin

(Dilantin), theophylline or lidocaine, the dosages of these

medications should be reduced

Smoking interferes with action of histamine antagonists

Caution to avoid driving or other activities requiring mental alertness

Ciprofloxacin

Cipro

Fluoroquinolones

Anti-infectives

Inhibit bacterial DNA

synthesis by inhibiting

DNA gyrase.

Death of susceptible bacteria

CN S: dizziness,

drowsiness, headache,

insomnia, acute

psychosis, agitation,

confusion, hallucination,increased ICP, light

headedness, tremors

Abdominal pain, diarrhea,

nausea, altered taste

GU: Crystalluria,

Ciprofloxacin is a vesicant; irritating to the veins

May be administered with food if gastric irritation occurs, but

food slows and might slightly decrease absorption

Do not give with milk and yogurt alone but may be taken with

other dietary calcium decrease absorption Administer IV infusion over 60 minutes (into a large vein)

highly irritating

Monitor liver, renal and blood counts

Notify MD immediately if taking theophylline it increases


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INDICATIONS

Treatment of UTI and

gynecologic infections,

Prostatitis, Gonorrhea;

Respiratory tract infections

incuding sinusitis

Skin and skin structure

infections Bone and joint infections

Infectious diarrhea

Intra abdominal infections

Febrile neutropenia

Post-exposure treatment of

inhalation Anthrax

elevated BUN and

creatinine

Local: Phlebitis at IV site

Endo: hyperglycemia,

hypoglycemia

Misc: photophobia

ADVERSE

Superinfections

Arrhythimias

Renal and hepatic impairment

seizures

theophylline levels and leads to toxicity

Impaired absorption if administered with: antacids, iron salts,

bismuth subsalicylate, sucralfate and zinc salts. These should

not be taken within 2 hours before Cipro

Maintain a fluid intake of at least 1500 200 ml/day to prevent

crystalluria

Avoid driving or other activities requiring mental alertness

Use sunscreen and protective clothing to prevent phototoxic

reactions and for 5 days after therapy Report signs of superinfection (furry overgrowth on the tongue,

vaginal itching or discharge, loose or foul-smelling stools)

Drug-Drug interaction: Increases serum theophylline levels; may

increase effect of warfarin, Cimetidine may interfere with

elimination; Antineoplastic may decrease serul levels of

fluoroquinolones; Nitrofurantoin may antagonize beneficial effects

of Cipro ; Probenecid decreases renal elimination, Increases risk of

nephrotoxicity from cyclosporine,

Concurrent use with Foscarnet in creases the risk of seizure

and concurrent therapy with corticosteroids may increase the risk

of tendon rupture

Citalopram

Celexa

Therapeutic Class:

Antidepressants

Pharm. Class: SSRI

Selectively inhibits the

reuptake of serotonin in the

CNS.

Therapeutic Effects:

Antidepressant action

INDICATIONS

Treatment of depression, often

in conjunction with

psychotherapy

CNS: apathy , confusion ,

drowsiness , insomnia ,

weakness , agitation, amnesia,

anxiety, decreased libido,

dizziness, fatigue, impaired

concentration, increased

depression, migraine

headache, suicide attempt.

EENT: abnormal

accommodation.

Resp: cough.

CV: postural hypotension,

tachycardia.

GI: abdominal pain ,

anorexia , diarrhea , dry mouth

, dyspepsia , flatulence ,

increased saliva , nausea ,altered taste, increased

appetite, vomiting.

GU: amenorrhea,

dysmenorrhea, ejaculatory

Monitor mood changes throughout therapy.o Assess for suicidal tendencies, especially during

early therapy. Restrict amount of drug available to patient.

o PO: Administer as a single dose in the morning or

evening without regard to food.

May cause drowsiness, dizziness, impaired concentration, and

blurred vision. Caution patient to avoid driving and other activities

requiring alertness until response to the drug is known.

Advise to avoid alcohol or other CNS depressant drugs during

therapy and to consult health care professional before taking other

medications with citalopram.

Caution to change positions slowly to minimize dizziness.

Advise to use sunscreen and wear protective clothing to prevent

photosensitivity reactions.

Frequent mouth rinses, good oral hygiene, and sugarless gum orcandy may minimize dry mouth. If dry mouth persists for more than

2 wk, consult health care professional regarding use of saliva

substitute.

Instruct female patients to inform health care professional if


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delay, impotence, polyuria.

Derm: increased sweating ,

photosensitivity, pruritus, rash.

Metab: decreased weight,

increased weight.

MS: arthralgia, myalgia.

Neuro: tremor , paresthesia.

Misc: fever, yawning.

ADVERSE

Dizziness, sweating, nausea,

vomiting, somnolence, and

sinus tachycardia.

rare cases, include amnesia,

confusion, coma, convulsions,

hyperventilation, cyanosis,

rhabdomyolysis, and ECG

changes (including nodal

rhythm, ventricular

arrhythmia)

pregnancy is planned or suspected, or if they plan to breastfeed an

infant.

Caution patients that citalopram should not be used for at least 14

days after discontinuing MAO inhibitors, and at least 14 days

should be allowed after stopping citalopram before starting an

MAO inhibitor.

May require 14 wk of therapy to obtain antidepressant

effects.

DrugDrug:

May cause serious, potentially fatal reactions when used with

MAO inhibitors ; allow at least 14 days between citalopram

andMAO inhibitors

Use cautiously with othercentrally acting drugs (including

alcohol , antihistamines , opioid analgesics , and

sedative/hypnotics ; concurrent use with alcohol is not

recommended)

Cimetidine increases blood levels of citalopram

Serotonergic effects may be potentiated by lithium

(concurrent use should be carefully monitored)

Ketoconazole , itraconazole , erythromycin , and

omeprazole may increase blood levels

Carbamazepine may decrease blood levels

May increase blood levels ofmetoprolol

Concurrent use with tricyclicantidepressants should be

undertaken with caution because of altered pharmacokinetics

Concurrent use with 5-HT 1 agonists used for migraine

headaches may increase the risk of adverse reactions

(weakness, hyperreflexia, incoordination).

DrugNatural:

Increased risk of serotinergic side effects including serotonin syndrome

with St. Johns wort and SAMe .

Cromolyn Sodium

Intal

INDICATIONS

sore throat bad taste in the mouth

stomach pain

cough

stuffy nose

comes as powder-filled capsules, a solution, and an aerosol toinhale by mouth. It is usually inhaled three or four times a day to

prevent asthma attacks or within an hourbefore activities to

prevent breathing difficulties caused by exercise.

It may take up to 4 weeks for cromolyn to work.


12/21

Used to prevent the

wheezing, shortness of

breath, and troubled

breathing caused by asthma.

To prevent breathing

difficulties (bronchospasm)

during exercise. It works by

preventing the release ofsubstances that cause

inflammation (swelling) in

the air passages of the lungs.

itching or burning nasal

passages

sneezing

headache

ADVERSE

wheezing

increased difficulty breathing

swelling of the tongue or

throat

severe bronchospasm

laryngeal and pharyngeal

edema

pulmonary infiltrates witheosinophilia

Do not swallow the capsules. Do not remove a capsule from its foil

until you are ready to use it, and handle it as little as possible.

Moisture from your hands will soften it

To use the inhaler, follow these steps:

Shake the inhaler well.

Remove the protective cap.

Exhale (breathe out) as completely as possible

through your nose while keeping your mouth shut.

Open Mouth Technique: Open your mouth wide,and place the open end of the mouthpiece about 1 or 2 inches

from your mouth.Closed Mouth Technique: Place the open

end of the mouthpiece well into your mouth, past your front

teeth. Close your lips tightly around the mouthpiece.

Take a slow, deep breath through the mouthpiece

and, at the same time, press down on the container to spray

the medication into your mouth. Be sure that the mist goes

into your throat and is not blocked by your teeth or tongue.

Adults giving the treatment to young children may hold the

child's nose closed to be sure that the medication goes into

the child's throat.

Hold your breath for 510 seconds, remove the

inhaler, and exhale slowly through your nose or mouth. If

you take two puffs, wait 2 minutes and shake the inhaler wellbefore taking the second puff.

Replace the protective cap on the inhaler.

If you have difficulty getting the medication into

your lungs, a spacer (a special device that attaches to the

inhaler) may help

Do not use cromolyn to relieve an asthma attack that has alreadystarted; continue to use the medication prescribed for your acute

attacks.

Nasal spray: first blow your nose, and clear it as much as possible.

Insert the applicator into a nostril. Sniff as you squeeze the sprayer

once. To prevent mucous from entering the sprayer, do not release

your grip until after you remove the sprayer from your nose. Repeat

this process for your other nostril. To relieve dry mouth or throat irritation caused by cromolyn

inhalation, rinse your mouth with water, chew gum, or suck

sugarless hard candy after each treatment.

Inhalation devices require regular cleaning. Once a week, remove

the drug container from the plastic mouthpiece, wash the


13/21

mouthpiece with warm tap water, and dry it thoroughly.

Dicyclomine

Bentyl , Bentylol , Formulex,

Spasmoban

Therapeutic: antispasmodicsPharmacologic:

anticholinergics

May have a direct and local

effect on GI smooth muscle,

reducing motility and tone.


Decreased GI motility

INDICATIONS

Management of irritable bowel

syndrome in patients who do

not respond to usual

interventions (sedation/change

in diet).

CNS: confusion (increased in

geriatric patients), drowsiness,

light-headedness (IM only).

EENT: blurred vision,

increased intraocular pressure.

CV: palpitations, tachycardia.

GI:, constipation , heartburn ,

decreased salivation, dry

mouth, nausea, vomiting.

GU: impotence, urinary

hesitancy, urinary retention.

Derm: decreased sweating.

Endo: decreased lactation.

Local: pain/redness at IM site.

ADVERSE

PARALYTIC ILEUSallergic reactions including

ANAPHYLAXIS

ASSESSMENT

Assess patient for symptoms of irritable bowel syndrome

(abdominal cramping, alternating constipation and diarrhea,

mucus in stools) before and periodically during therapy.

Assess patient routinely for abdominal distention andauscultate for bowel sounds. If constipation becomes a

problem, increasing fluids and adding bulk to the diet may

help alleviate the constipating effects of the drug.

Monitor intake and output ratios; may cause urinary retention.

Lab Test Considerations:Antagonizes effects of pentagastrin

and histamine during the gastric acid secretion test. Avoid

administration for 24 hr preceding the test.

Toxicity and Overdose: Severe anticholinergic symptoms

may be reversed with physostigmine or neostigmine.

IMPLEMENTATION

PO: Administer dicyclomine 30 min1 hr before meals.

IM: Monitor patient after administration; may cause light-

headedness and irritation at injection site.

PATIENT/FAMILY TEACHING

SE: drowsiness and blurred vision - avoid driving or other

activities requiring alertness until response to the medication is

known.

Frequent oral rinses, sugarless gum or candy, and good oral

hygiene to relieve dry mouth. Consult health care professional

regarding use of saliva substitute if dry mouth persists for more

than 2 wk.

Make position changes slowly to minimize the effects of

drug-induced orthostatic hypotension. Avoid extremes of temperature. This medication decreases

the ability to sweat and may increase the risk of heat stroke.

Consult health care professional before taking any OTC


14/21

medications concurrently with this therapy.

Notify health care professional immediatelyif eye pain or

increased sensitivity to light occurs. Emphasize the importance

ofroutine eye exams throughout therapy.

Disulfiram

Antabuse

Alcohol-Abuse DeterrentEnzyme Inhibitors

Disulfiram blocks the oxidation of

alcohol at the acetaldehyde stageduring alcohol metabolism

following disulfiram intake causing

an accumulation of acetaldehyde in

the blood producing highly

unpleasant symptoms. Disulfiram

blocks the oxidation of alcoholthrough its irreversible inactivation

of aldehyde dehydrogenase, whichacts in the second step of ethanol

utilization. In addition, disulfiram

competitively binds and inhibits the

peripheral benzodiazepine receptor,which may indicate some value in

the treatment of the symptoms ofalcohol withdrawal

More common

Drowsiness

Less common or rare

Decreased sexual ability in

males; headache; metallic or

garlic-like taste in mouth;

skin rash; unusual tiredness

ADVERSE

tenderness or any change in

vision; mood or mental

changes; numbness, tingling,pain, or weakness in hands orfeet

Darkening of urine; light

gray-colored stools; severe

stomach pain; yellow eyes or

skin

Hepatic failure;hepatitis

OPTIC NEURITIS,

PERIPHERAL NEURITIS,

POLYNEURITIS, AND

PERIPHERAL

NEUROPATHY

Psychotic reactions, attributable

in most cases to high dosage,

combined toxicity (with

Before you take the first dose of this medicine, make sure you have nottaken any alcoholic beverage or alcohol-containing product ormedicine (for example, tonics, elixirs, and cough syrups) during the

past 12 hours

Do not drink any alcohol, even small amounts, while you are takingthis medicine and for 14 days after you stop taking it, because thealcohol may make you very sick. In addition to beverages, alcohol is

found in many other products. Reading the list of ingredients on foods

and other products before using them will help you to avoid alcohol.

You can also avoid alcohol if you:

Do not use alcohol-containing foods, products, or medicines, such as

elixirs, tonics, sauces, vinegars, cough syrups, mouth washes, or

gargles.

Do not come in contact with or breathe in the fumes of chemicals

that may contain alcohol, acetaldehyde, paraldehyde, or other

related chemicals , such as paint thinner, paint, varnish, or shellac. Use caution when using alcohol-containing products that are

applied to the skin , such as some transdermal (stick-on patch)

medicines or rubbing alcohol, back rubs, after-shave lotions,colognes, perfumes, toilet waters, or after-bath preparations. Using

such products while you are taking disulfiram may cause headache,nausea, or local redness or itching because the alcohol in these

products may be absorbed into your body. Before using alcohol-

containing products on your skin, first test the product by applying

some to a small area of your skin. Allow the product to remain on

your skin for 1 or 2 hours. If no redness, itching, or other unwanted

effects occur, you should be able to use the product.

Do not use any alcohol-containing products on raw skin or open

wounds .

Baseline and follow-up liver function tests (10-14 days) are

suggested to detect any hepatic dysfunction that may result with

disulfiram therapy. In addition, a complete blood count and serum

chemistries, including liver function tests, should be monitored.

DISULFIRAM SHOULD BE USED WITH CAUTION IN THOSE

PATIENTS RECEIVING PHENYTOIN AND ITS CONGENERS, SINCE


15/21

metronidazole or isoniazid),

Eye pain or

The Disulfiram-Alcohol

Reaction: Disulfiram plus

alcohol, even small amounts,produceflushing, throbbing

in head and neck, throbbing

headache, respiratory

difficulty, nausea, copious

vomiting, sweating, thirst,

chest pain, palpitation,

dyspnea, hyperventilation,tachycardia, hypotension,

syncope, marked uneasiness,

weakness, vertigo, blurred

vision, and confusion. In

severe reactions there may be

respiratory depression,

cardiovascular collapse,

arrhythmias, myocardial

infarction, acute congestiveheart failure,

unconsciousness,

convulsions, and death.

THE CONCOMITANT ADMINISTRATION OF THESE TWO DRUGS

CAN LEAD TO PHENYTOIN INTOXICATION. PRIOR TOADMINISTERING DISULFIRAM TO A PATIENT ON PHENYTOIN

THERAPY, A BASELINE PHENYTOIN SERUM LEVEL SHOULD BE

OBTAINED. SUBSEQUENT TO INITIATION OF DISULFIRAM

THERAPY, SERUM LEVELS OF PHENYTOIN SHOULD BE

DETERMINED ON DIFFERENT DAYS FOR EVIDENCE OF AN

INCREASE OR FOR A CONTINUING RISE IN LEVELS. INCREASEDPHENYTOIN LEVELS SHOULD BE TREATED WITH APPROPRIATE

DOSAGE ADJUSTMENT.

It may be necessary to adjust the dosage of oral anticoagulants uponbeginning or stopping disulfiram, since disulfiram may prolong prothrombin

time.

Patients taking isoniazid when disulfiram is given should be

observed for the appearance of unsteady gait or marked changes in mental

status, the disulfiram should be discontinued if such signs appear.

Ethotoin (e.g., Peganone) or

Mephenytoin (e.g., Mesantoin) or

Phenytoin (e.g., Dilantin)Taking these medicines with disulfiram

may change the amount of anticonvulsant medicine you need to take

Isoniazid (e.g., INH, Nydrazid)Disulfiram may increase central

nervous system (CNS) effects, such as dizziness, clumsiness,

irritability, or trouble in sleeping

Metronidazole (e.g., Flagyl) or

Paraldehyde (e.g., Paral)These medicines should not be taken with

or within several days of disulfiram because serious side effects may

occur

Ethylene dibromide or organic solvents (such as chemicals which

may contain alcohol, acetaldehyde, paraldehyde, or other related

chemicals used in factories and in hobbies [e.g., paint thinner])

Make sure you tell your doctor if you will come in contact with or

breathe the fumes of ethylene dibromide or organic solvents whileyou are taking disulfiram.

A transient mild drowsiness, fatigability, impotence, headache,

acneform eruptions, allergic dermatitis, or a metallic or garlic-like aftertaste

may be experienced during the first two weeks of therapy. These complaintsusually disappear spontaneously with the continuation of therapy, or with

reduced dosage

Disulfiram will add to the effects of other CNS depressants Some


16/21

examples of CNS depressants are antihistamines or medicine for hay fever,

other allergies, or colds; sedatives, tranquilizers, or sleeping medicine;

prescription pain medicine or narcotics; barbiturates; medicine for seizures;

muscle relaxants; or anesthetics, including some dental anesthetics.Checkwith your doctor before taking any of the above while you are using this

medicine

Docusate SodiumColace , Correctol Stool Softener

Soft Gels , Diocto , Docu , DOS

Softgels , DOSS , DSS , ex-lax

Stool Softener , Genasoft , Modane

Soft , Silace , Stool Softener ,Therevac SB

Therapeutic: laxativesPharmacologic: stool softeners

Promotes incorporation of

water into stool, resulting in

softer fecal mass

May also promote

EENT: throat irritation.

GI: mild cramps.

Derm: rashes.

IMPLEMENTATION

General: This medication does not stimulate intestinal peristalsis.

PO: Administer with a full glass of water or juice. May be

administered on an empty stomach for more rapid results.

o Oral solution may be diluted in milk or fruit juice to decrease

bitter taste.

o Do not administer within 2 hr of other laxatives, especially

mineral oil. May cause increased absorption.


Laxatives should be used only for short-term therapy. Long-


17/21

electrolyte and water

secretion into the colon.


o Softening and passage of

stool.

INDICATIONS

PO: Prevention of

constipation (in patients who

should avoid straining, such as

after MI or rectal surgery)

Rect: Used as enema to soften

fecal impaction

term therapy may cause electrolyte imbalance and

dependence.

Encourage to use other forms of bowel regulation, such as

increasing bulk in the diet, increasing fluid intake (68 full

glasses/day), and increasing mobility. Normal bowel habits

are variable and may vary from 3 times/day to 3 times/wk.

Instruct patients with cardiac disease to avoid straining during

bowel movements (Valsalva maneuver). Advise patient not to use laxatives when abdominal pain,

nausea, vomiting, or fever is present.

Advise patient not to take docusate within 2 hr of other

laxatives.

Effectiveness of therapy can be demonstrated by:

A soft, formed bowel movement, usually within 2448 hr.

Therapy may take 35 days for results. Rectal dosage forms

produce results within 215 min.

doxorubicin hydrochloride

Adriamycin PFS , Adriamycin

RDF , Rubex

Therapeutic: antineoplastics Pharmacologic: anthracyclines

Inhibits DNA and RNA

synthesis by forming a

complex with DNA; action

is cell-cycle S-phase

specific

Also hasimmunosuppressive

properties.

Therapeutic Effects:o Death of rapidly replicating

GI: diarrhea , esophagitis ,

nausea , stomatitis , vomiting .

GU: red urine .

Derm: alopecia ,

photosensitivity.

Endo: sterility, prepubertal

growth failure with temporary

gonadal impairment (children

only).

Metab: hyperuricemia.

ADVERSE

CV:CARDIOMYOPATHY ,

ECG changes.

Resp: recall pneumonitis.

hypersensitivity reactions

Hema: anemia , leukopenia ,

thrombocytopenia

Local: phlebitis at IV site ,

tissue necrosis

ASSESSMENT

General: Monitor blood pressure, pulse, respiratory rate, and

temperature frequently during administration. Report significant

changes.

Monitor for bone marrow depression. Assess for bleeding

(bleeding gums, bruising, petechiae, guaiac 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 intake and output ratios, and report occurrence of

significant discrepancies. Encourage fluid intake of 20003000

ml/day. Allopurinol and alkalinization of the urine may be usedto decrease serum uric acid levels and to help prevent urate stone

formation.

Severe and protracted nausea and vomiting may occur as early

as 1 hr after therapy and may last 24 hr. Administer parenteral

antiemetics 3045 min prior to therapy and routinely around the


18/21

cells, particularly malignant

ones.

INDICATIONS

Alone or with other modalities

in the treatment of various

solid tumors including:

o Breast

o Ovarian

o Bladder

o Bronchogenic carcinoma

o Malignant lymphomas and

leukemias

clock for the next 24 hr as indicated. Monitor amount of emesis

and notify physician or other health care professional if emesis

exceeds guidelines to prevent dehydration.

Monitor for development of signs of cardiac toxicity, which

may be either acute and transient (ST segment depression,

flattened T wave, sinus tachycardia, and extrasystoles) or late

onset (usually occurs 16 mo after initiation of therapy) and

characterized by intractable CHF (peripheral edema, dyspnea,

rales/crackles, weight gain). Chest x-ray, echocardiography,

ECGs, and radionuclide angiography may be ordered prior to and

periodically during therapy. Cardiotoxicity is more prevalent in

children younger than 2 yr and geriatric patients. Dexrazoxane

may be used to prevent cardiotoxicity in patients receiving

cumulative doses of >300 mg/m 2 .

Assess injection site frequently for redness, irritation, or

inflammation. Doxorubicin is a vesicant but may infiltrate

painlessly even if blood returns on aspiration of infusion needle.

Severe tissue damage may occur if doxorubicin extravasates. If

extravasation occurs, stop infusion immediately, restart, and

complete dose in another vein. Local infiltration of antidote is

not recommended. Apply ice packs and elevate and rest

extremity for 2448 hr to reduce swelling, then resume normal

activity as tolerated. If swelling, redness, and/or pain persists

beyond 48 hr, immediate consultation for possible debridement is

indicated.

Assess oral mucosa frequently for development of stomatitis.

Increased dosing interval and/or decreased dosing is

recommended if lesions are painful or interfere with nutrition.

Lab Test Considerations:Monitor CBC and differential prior

to and periodically during therapy. The WBC nadir occurs 1014

days after administration, and recovery usually occurs by the 21st

day. Thrombocytopenia and anemia may also occur. Increased

dosing interval and/or decreased dose is recommended if ANC is

3

mg/dl.

o May cause serum and urine uric acid

concentrations.


19/21

IMPLEMENTATION

High Alert: Fatalities have occurred with incorrect

administration of chemotherapeutic agents. Before administering,

clarify all ambiguous orders; double check single, daily, and

course-of-therapy dose limits; have second practitioner

independently double check original order, calculations and

infusion pump settings. Do not confuse doxorubicinhydrochloride (Adriamycin, Rubex) with doxorubicin

hydrochloride liposome (Doxil) or with daunorubicin

hydrochloride (Cerubidine) or daunorubicin citrate liposome

(DaunoXome) or with idarubicin.. Do not confuse adriamycin

with idamycin. Clarify orders that do not include generic and

brand names.

General: Solution should be prepared in a biologic cabinet. Wear

gloves, gown, and mask while handling medication. Discard IV

equipment in specially designated containers

o Aluminum needles may be used to administer doxorubicin but

should not be used during storage, because prolonged contact

results in discoloration of solution and formation of a dark

precipitate. Solution is red.

Direct IV: Dilute each 10 mg with 5 ml of 0.9% NaCl(nonbacteriostatic) for injection. Shake to dissolve completely. Do

not add to IV solution. Reconstituted medication is stable for 24 hr

at room temperature and 48 hr if refrigerated. Protect from sunlight.

Rate:Administer each dose over 35 minutes through Y-site of a

free-flowing infusion of 0.9% NaCl or D5W. Facial flushing and

erythema along involved vein frequently occur when administration

is too rapid.


Notify health care professional promptly if fever; sore throat; signs

of infection; bleeding gums; bruising; petechiae; blood in stools,

urine, or emesis; increased fatigue; dyspnea; or orthostatic

hypotension occurs. Caution patient to avoid crowds and personswith known infections. Instruct patient to use soft toothbrush and

electric razor and to avoid falls. Caution patient not to drink

alcoholic beverages or take medication containing aspirin or

NSAIDs, because these may precipitate gastric bleeding.


20/21

Instruct to report pain at injection site immediately.

Instruct to inspect oral mucosa for erythema and ulceration. If

ulceration occurs, advise patient to use sponge brush, rinse mouth

with water after eating and drinking, and confer with health care

professional if mouth pain interferes with eating. Pain may require

treatment with opioid analgesics. The risk of developing stomatitis

is greatest 510 days after a dose; the usual duration is 37 days.

Advise that this medication may have teratogenic effects.

Contraception should be used during and for at least 4 mo aftertherapy is concluded. Inform patient before initiating therapy that

this medication may cause irreversible gonadal suppression.

Instruct to notify health care professional immediately if irregular

heartbeat, shortness of breath, swelling of lower extremities, or skin

irritation (swelling, pain, or redness of feet or hands) occurs.

Discuss the possibility of hair loss with patient. Explore methods of

coping. Regrowth usually occurs 23 mo after discontinuation of

therapy.

Instruct patient not to receive any vaccinations without advice of

health care professional.

Inform patient that medication may cause urine to appear red for 1

2 days.

Instruct patient to notify health care professional if skin irritation

occurs at site of previous radiation therapy. Advise family and/or caregivers to take precautions (i.e., latex

gloves) in handling body fluids for at least 5 days posttreatment.

Emphasize the need for periodic lab tests to monitor for side

effects.

DrugDrug:

bone marrow depression with otherantineoplastics orradiation

therapy

Pediatric patients who have received concurrent doxorubicin and

dactinomycin have an risk of recall pneumonitis at variable

times following local radiation therapy

May skin reactions at previous radiation therapy sites

Ifpaclitaxel is administered first, clearance of doxorubicin is and

the incidence and severity of neutropenia and stomatitis are

(problem is diminished if doxorubicin is administered first)

Hematologic toxicity is and prolonged by concurrent use of

cyclosporine ; risk of coma and seizures is also


21/21

Incidence and severity of neutropenia and thrombocytopenia are

by concurrent progesterone

Phenobarbital may clearance and decrease effects of

doxorubicin

Doxorubicin may metabolism and effects ofphenytoin

Streptozocin may the half-life of doxorubicin (dosage of

doxorubicin recommended)

May risk of hemorrhagic cystitis from cyclophosphamide or

hepatitis from mercaptopurine Cardiac toxici ty may be by radiation therapy or

cyclophosphamide

May antibody response to live-virus vaccines and risk of

adverse reactions.

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