NURS 1566 Clinical Form 3: Clinical Medications Worksheets(You will need to make additional copies of these forms)

Generic NameDuloxetine

Trade NameCymbalta

ClassificationSelective serotonin and norepinephrine reuptake inhibitors

Dose90 mg

RoutePO

Time/frequencyQHS

Peak6 hours

OnsetUnknown

Duration12 hours

Normal dosage range20-30 mg per day for depression or 60 mg per day for neuropathic pain

Why is your patient getting this medicationBipolar Disorder, DMII

For IV meds, compatibility with IV drips and/or solutionsN/A

Mechanism of action and indications(Why med ordered)Inhibits serotonin and norepinephrine reuptake in the CNS. Indicated for Major depressive disorder, in conjunction with psychotherapy. Management of diabetic neuropathic pain

Nursing Implications (what to focus on) Contraindications/warnings/interactionsHypersensitivity and concurrent MAOI therapy. Uncontrolled narrow angle glaucoma, end stage renal failure, Chronic hepatic impairment or substantial alcohol use. Use cautiously if there is history of suicide attempt or mania as it may activate mania/hypomania, diabatic patients or those with renal failure.

Common side effectsFatigue, drowsiness, insomnia, decreased apetite, constipation, dry mouth, nausea, dysuria, increased sweating.

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)Risk of hepatotoxicity with chronic alcohol abuse

Lab value alterations caused by medicineMay cause in increased ALT,AST, bilirubin, CPK, and alkaline phosphataseBe sure to teach the patient the following about this medicationTake as directed at the same time each day, don’t stop abruptly. Be alert for anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, mania, worsening depression and suicidal ideation. May cause drowsiness. Notify provider of signs of liver damage. Avoid taking alcohol.

Nursing Process- Assessment(Pre-administration assessment)Monitor BP, appetite, Depression, pain

AssessmentWhy would you hold or not give this med?You wouldn’t, needs to be gradually decreased

EvaluationCheck after givingIncreased sense of well being and decreased neuropathic pain