Name of drug: METHYLDOPA (ALDOMET) Classification: Antihypertensive Action: Lower blood pressure Indication for use: treatment of hypertension as sole agent /in combination with thiazide diuretic Dosage: Adult PO initial dose 250 mg 2-3 times/d for 2 d. Maintenance dose 500 mg-2 g in 2-4 doses/d. IV 250 -500 mg q6h prn (do not exceed 1 g q6h) Pediatric PO 10 mg/kg/d in 2-4 doses IV 20-40 mg/kg/d divided q6h Maximum dose 65 mg/kg or 3 g/d, whichever less Side effects: CNS sedation, headache, dizziness, symptoms of cerebrovascular insufficiency, Parkinson’s disease, Bell’s palsy, psychic disturbances CV bradycardia, edema, orthostatic hypotension, exacerbation of angina, prolonged carotid sinus hypersensitivity GI N&V, colitis, diarrhea, dry mouth, pancreatitis, sore/black tongue HEM hemolytic anemia, leucopenia, thrombocytopenia HEP jaundice, hepatitis, elevated serum AST, ALT Other rash, weight gain, breast enlargement, nasal congestion, impotence Toxic effects: toxic epidermal necrolysis, lithium toxicity when combine with lithium, Drug interaction: MAO inhibitor – antagonize antihypertensive effect. Do not use together. Levodopa, TCAs, Phenothiazides – can produce additive hypotensive effects Lithium – can produce lithium toxicity Antihypertensive, Diuretics – increase hypotensive effects. Decrease Aldomet dose is needed. Nursing considerations: 1. before administration – assess BP, F/E level, CBC, with longer use assess: hepatic, CV, renal, hemopoietic status; 2. contraindications – hypersensitivity, active hepatic disease associated with previouse therapy; use cautiously in pts with renal and liver impairment, 3. client/family teaching – report signs of infection (sore throat, fever), report any side effects, dizziness or drowsiness may occur, use caution in potentially dangerous activities, check your BP regularly, may darken urine, avoid using with alcohol, avoid high Na+ foods (canned soups, cheese), may produce decreased libido; 4. do not d/c drug without contact your MD, notify any physician/dentist of use before any treatment; Resources: Mosby’s 2004 Nursing Drug Cards. Springhouse Nurse’s Drug Guide 2005. Name of drug: METAPROTERENOL SULFATE (ALUPENT INHALER) Classification: Bronchodilator Action: Improves breathing. Relaxes bronchial smooth muscles by acting on beta2-adrenergic receptors. Indication for use: treatment of bronchial asthma; reversible bronchospasm associated with bronchitis, emphysema; Dosage: Adult/ Pediatric Inhaler: single dose 2-3 inhalations q 3-4 h Bulb nebulizer: 10 inhalations 5% solution: 0.3ml with IPPB Side effects: CNS headache, nervousness, tremors, drowsiness; CV trachycardia, hypertension, cardiac arrest, palpitations, changes in ECG GI N&V Other muscle cramps, paradoxical bronchoconstriction, Toxic effects: may increase cardiac toxicity while administrated with Theophylline or Aminophylline, monitor ECG and VS closely. Drug interactions: Propranolol and other beta-blockers – block Alupent bronchodilating effect, monitor patient; MAO-I – require supervision Other Sympathomimetics – avoid administrating at the same time due to risk of toxicity Nursing considerations: 1. before administration – assess patient condition, VS (esp BP, heart rate), D/C if >120 beats/m; 2. contraindications – hypersensitivity, cardiac arrhythmia associated with tachycardia; 3. client/family teaching – give pt instruction how to use metered-dose inhaler (shake well; clear nasal passages and throat; breathe out, expelling as much air as possible; place mouthpiece well into mouth and inhale deeply as you release dose from inhaler; hold breath for several seconds; remove mouthpiece and exhale slowly; allow 2 minutes between inhalations); take as order by physician; report immediately of rapid HR, chest pain, tremors; 4. take pulse before administration and report if >120 bpm; if paradoxical bronchospasm occur stop taking drug immediately and notify physician; Resources: Mosby’s 2004 Nursing Drug Cards. Springhouse Nurse’s Drug Guide 2005. Name of drug: DOXYCYCLINE (VIBRAMYCIN) Classification: tetracycline Action: Bacteriostatic effect due to inhibition of ribosomal protein growth Indication for use: drug of choice for Chlamydia, Mycoplasma, Rickettsial infection; in patient allergic to penicillin: Gonorrhea, Primary and Secondary Syphilis; prevention of Malaria; acne control; Lyme disease; pleural effusion related to cancer; Dosage: Adult/Children (>8 years) >45 kg 100mg PO q12h then maintenance dosage of 50-100 mg q8-12h; or IV 200mg first day in 1-2 infusions then maintenance dosage of 100- 200mg IV daily Adult/Children <45 kg 4.4MG/KG PO or IV daily q12h on first day then maintenance dosage of 2.2-4.4 mg/ kg daily Side effects: CNS Intracranial hypertension CV Pericarditis, thrombophlebitis GI anorexia, N&V, diarrhea, enterocolitis GU increase BUN level HEM neutropenia, thrombocytopenia Other bone growth retardation in children under age 8, discoloration of teeth, phlebitis at infusion site, maculopapular rash, anaphylaxis, superinfection Toxic effect: avoid using with Methoxyflurane, may cause nephrotoxicity; Drug interactions: Antacids, Carbamazepine, Ferrous sulfate, Methoxyflurante, dairy products- avoid using together, decrease Doxycycline absorption; Hormonal contraceptive – decreases contraceptive effectivness and increases risk of breakthrough bleeding, recommended nonhormonal form of birth control; PO anticoagulant – may increase anticoagulant effect, monitor PT and INR and adjust Dosage; Penicilline – avoid using together, interfere with action of Penicilline; Nursing considerations: 1. before administration – assess pt’ s infection; C&S test; assess renal and hepatic status; assess VS, BUN and AST level; 2. contraindications – do not administrate to pregnant women, neonates, children under age 8 (damage to bone and teeth); hypersensitivity to drug or other tetracyclines; 3. client/family teaching – complete full course (10 days) of therapy even if symptoms subside; take with glass of water 1h before or 2 hours after meal ; avoid dairy products; report any severe side effects; discard product after use; avoid prolonged exposure to sunlight and UV light (photosensitivity); provide frequent mouth care; ice chips or sugarless candy to suck if stomayitis and sore mouth problem occur; drink a lot of fluids and maintain nutrition; 4. administration precautions – cautiously in pts with renal and hepatic impairment; avoid using in breast-feeding mothers; monitor VS (esp temperature), BUN, AST, creatinine; monitor for signs of Superinfection (diarrhea, itching, coated tongue); Resources: +Mosby’s 2004 Nursing Drug Cards. +Karch, A. “Focusing on Nursing Pharmacology”. +Springhouse Nurse’s Drug Guide 2005. Name of drug: WARFARIN SODIUM (COUMADIN) Classification: coumarin derivative, anticoagulant Action: reduce ability of blood to clot Indication for use: adjunct in coronary occlusion; treatment of thromboembolic complications associated with atrial fibrillation and cardiac valve replacement; prevention, in treatment of venous thrombosis and pulmonary embolism; Dosage: Adult initially 2-5mg d PO or IV for 2-4 days; PT and INR determine maintenance dosage, usually 2-10mg/ d Side effects: CNS headache, fever, dizziness GI anorexia, N&V, diarrhea, cramps, mouth ulceration, sore mouth, melena GU hematuria, hemorrhage HEM agranulocytosis, anemia, leucopenia HEP hepatitis, jaundice Other rash, alopecia, dermatitis, prolonged and painful erection Toxic effects: avoid administration with Anticonvulsant – may increase levels of phenytoin and phenobarbiral that can lead to toxicity Drug interaction: Acetaminophen – may increase bleeding, monitor pt carefully; NSAIDs and Salicylates – increase PT and ulcerogenic effects, do not use together Oral antidiabetics (Sulfonylureas) – increase hypoglycemic response, monitor pt glucose Level; Has documented drug-drug interactions with lots of other drugs. It is important to consult physician to adjust dosage or discontinue any of drugs; Nursing considerations: 1. before therapy – assess baseline status and any potential side effects; VS; hepatic and renal function tests; CBC; clotting studies; hypersensitivity to drug; pregnancy; hemorrhagic disorders; 2. contraindications – in pt with bleeding or hemorrhage disorders; GI ulcerations; severe hepatic or renal dysfunctions; vitamin K deficiency; in pt who had recent eye, brain, or spinal cord surgery; pregnant women; 3. client/family teaching – take at same time q day; stop taking drug and contact your physician immediately if fever, bleeding, and rash occur; make sure to keep up regular follow-ups; avoid OTC containing aspirin or other salicylates, or drug that may interact with warfarin; establish safety precaution to prevent bleeding (use electric razors, soft toothbrush, avoid contact sports); maintain consistent daily intake of leafy green vegetables (may decrease anticoagulation); identify physician/ dentist of anticoagulant use before any treatment; 4. administration precaution – schedule for PT and INR to evaluate the effectiveness of drug; maintain vitamin K on stand by as antidote; elderly pts and pts with hepatic or renal impairment are especially sensitive to warfarin effects (monitor for adverse effects closely); regular CBC to monitor drug effectivness; Resources: +Mosby’s 2004 Nursing Drug Cards. +Karch, A. “Focusing on Nursing Pharmacology”. +Springhouse Nurse’s Drug Guide 2005. Name of drug: FERROUS SULFATE (FEOSOL) Classification: oral iron supplement Action: relieves iron deficiency Indication for use: iron deficiency anemia Dosage: adult 300 mg PO bid to qid, or 1 extended-release cap (160-525mg) PO daily to bid Peds age 2 and older 3mg/kg PO daily to tid or qid Side effects: GI nausea, epigastric pain, vomiting, constipation, diarrhea, black stool, anorexia Other suspention and drops may temporary stain teeth Toxic effect: as few as three tab may cause poisoning in children; Hemolytic anemia that may increase serum iron level and toxicity CNS toxicity causing coma and death Drug interactions: Antacids, Penicillamine, Tetracycline, vitamin E, Cimetidine – decrease iron absorption, separate doses by 2-4 hours; Fluoroquinolone (Ciprofloxacin, Norfloxacin, Ofloxacin) – decrease their absorption if taken with Feosol, separate doses by 2 hours; Levodopa, Methyldopa – decrease absorption when given with Feosol, give 2 hours apart; Chloramphenicol – increase iron response, watch pt carefully for iron toxicity; L-Thyroxine – decrease it absorption, separate doses by 2 hours, monitor thyroid function; vitamin C – increase iron absorption, suggest to take it with drug; Food interaction: cereals, cheese, coffee, eggs, milk, tea, yogurt, whole-grain breads – impair oral iron absorption, do not use together; Nursing consideration: 1. before therapy – assess pt iron level; levels of: Hgb, Hct, retic count; allergy; 2. contraindication – in pt with primary hemochromatosis, hemosiderosis, hemolytic anemia, peptic ulcer disease, regional enteritis, ulcerative colitis, in those receiving repeted blood transfusion; 3. pt teaching – take tab with juice or water not with milk or antacids; do not crush or chew extended-release forms; to avoid staining drink susp. or elix. with straw and place drops at back of throat; GI upset may be reduced by taking drugs with some foods (food-drug interaction!); teach dietary measures for preventing constipation; 4. administration precaution – be alert of adverse reactions and drug interactions; use cautiously in children; monitor elderly pt for constipation; oral iron may cause melanoma, have stool tested for blood in it; Resources: +Karch, A. “Focusing on Nursing Pharmacology”. +Springhouse Nurse’s Drug Guide 2005. Name: CIMETIDINE (TAGAMET) Classification: histamine-2 receptors antagonist, antiulcer agent Action: block histamine-2 receptor sites, leads to decrease in gastric acid and pepsin secretion; Indication use for: short-term treatment for duodenal ulcers or benign gastric ulceration; prevention of stressed- induced ulcers and active upper GI bleeding; heartburn; gastroesophageal reflux disease; pathologic hypersecretory conditions: Zollinger_Ellison yndrome, mastocytosis); Dosage: adult 300 mg PO qid with meals and h.s., or 800 mg PO h.s. 300 mg IV or IM q6-8h Not use for children <16 y old Side effects: CNS dizziness, headache, somnolence, confusion CV bradycardia, hypotention GI diarrhea or constipation HEM agranulocytosis, neutropenia, thrombocytopenia, aplastic anemia Other gyneomastia, impotence, rash, urticaria Toxic effects: look at drug-drug interaction Drug interactions: can slow metabolism of following drugs, leading to increase serum level and possible toxicity: Warfarin, Phenytoin, beta-adrenergic blockers (metoprolol, timolol, propranolol), alcohol, quinidine, lidocaine, chloroquine, carbamazepine, tricyclic antidepressant, procainamide; monitor level of these drugs Nursing considerations: 1. before therapy – allergy, hepatic or renal function tests, pregnancy or lactation, GI disorders, VS, EKG, skin condition, assess in decrease dosage in pt with renal or hepatic dysfunction; 2. contraindications – allergy, in pregnancy with caution, not in lactating women; hepatic and renal impairment, 3. pt teaching – take drug with meals and h.s.; IM administration may be painful; report stat: melena, diarrhea, confusion, muscle or joint pain, rash; avoid drinking or dangerous activities; use of OTC drug and any others consult with your physician (drug interaction!) ; avoid smoking because it increase gastric juices secretion and worsen disease; regular follow-up; comfort and safety measures; 4. administration precaution – monitor for side effects and toxicity; monitor pt’s CV status during IV administration because drug can cause bradycardia and other cardiotoxic effects if given too rapidly; Resources: +Karch, A. “Focusing on Nursing Pharmacology”. +Springhouse Nurse’s Drug Guide 2005. Name: HYDROCHLOROHIAZIDE (HYDRODIURIL) Classification: thiazide diuretic, Action: decrease Na and H2O excretion by inhibiting Na and Cl reabsorption in DCT, lower BP Indication use for: edema of CHF or liver/renal disease, hypertention, Dosage: adult 25-100 mgd PO Peds <6 mo 3.3 mg/kg PO bid Peds 6mo-2y 12.5-37.5 mg d PO bid Peds 2-12y 37.6-100 mg PO d bid Side effects: hypokalemia – weakness, muscle cramp, arrhythmia; Hypercalcemia, hyperuricemia leads to goat, hyperglycemia, CV ortostatic hypotention GI pancreatitis, anorexia, nausea GU nocturia, polyuria, renal impairment HEM anemia, thrombocytopenia, leucopenia Toxic effects: Lithium – monitor level, Digoxin – monitor potassium and digoxin level, Drug interaction: Antidiabetic – decrease effectiveness of hypoglycemic, adjust dosage, monitor glucose level; Antihypertensive – use together cautiously, monitor BP; NSAIDs – increase risk of NSAID-induced renal impairment, monitor pt closely; Furosemide – cause excessive diuretic responses, monitor pt closely; Cholestyramine, Colestipol – decrease absorption of drug, separate dosage 2 h; Nursing considerations: 1. before therapy – assess pt edema and BP; monitor BP, I&O; electrolytes level; BUN, creatinine, and uric acid levels; 2. contraindications – in pt with anuria, allergic to thiazides; pregnancy and lactation; 3. pt teaching – take drug early daytime to prevent nocturia; prevent GI upset give with food; avoid sudden postural changes and rise slowly to avoid orthostatic hypotension; avoid alcohol (increase orto. hypotension); use sunblockers to prevent photosensitive reactions; 4. administration precaution – in pt with renal and hepatic dysfunction; may be used with potassium-sparing diuretics to prevent potassium loss; monitor Digoxin, Lithium, and K levels; Resources: +Karch, A. “Focusing on Nursing Pharmacology”. +Springhouse Nurse’s Drug Guide 2005.