GENERIC NAME:  digoxin immune Fab  TRADE NAME: Digibind, DigiFab   NURSING CONSIDERATION: assess: hypokalemia: ST depression, flat T
CLASSIFICATION:  antidote – digoxin specific
USES:  life-threatening digoxin toxicity
DOSAGE & ROUTE: 1 (38-mg) vial binds 0.5 mg digoxin Digoxin toxity
(known amount) (tabs, oral sol, IM) – Adult & child: IV dose (mg) – dose
ingested (mg) x 0.8/1000 x 38; if ingested amount is unknown, give 760 mg IV;
Toxicity (known amount) (cap, IV) – Adult & child: IV dose = dose ingested
(mg)/0.5 x 38; Toxicity (known amount) by serum digoxin concentration
(SDCs) – adult & child: IV SDC (ng/ml) x kg of weight/100 x 38; Digoxin  gtt of sol on skin and make a scratch through the drop with a sterile needle; read
toxicity (unknown amount) – adult & child: >20 kg: IV 228mg (6 vials), infant
& child: <20 kg: IV 38mg (1 vial); Acute ingestion – adult: IV 380 mg (10
vials) Life-threatening ingestion – adult: IV760mg (20 vials); Skin test –
adult: ID 9.5 mcg
SIDE EFFECTS:  CV: CHF, ventricular rate increase, atrial fibrillation, low
cardiac output, hypotension.  INTEG: hypersensitivity, allergic reactions, facial
swelling, redness, phlebitis.  META: hypokalemia. MISC: anaphylaxis (rare).
RESP: impaired respiratory function, rapid respiratory rate.
GENERIC NAME:  digoxin              TRADE NAME:  lanoxicaps, lanoxin  
CLASSIFICATION:  cardiac glycoside, inotropic, antidysrhythmic
USES:  heart failure, atrial fibrillation, atrial flutter, atrial tachycardia,
cardiogenic shock, paroxysmal atrial tachycardia, rapid digitalization in these
disorders
DOSAGE & ROUTES:  adult: IV digitalizing dose 0.6-1 mg given as 50% of
the dose initially, additional fractions given at 4-8 hr intervals; PO digitalizing
dose 0.75-1.25mg given as 50% of the dose initially, additional fractions given at
4-8 hr intervals; maintenance 0.125-0.5 mg/day (tabs), or 0.25-0.5 mg/day
(gelatin cap) child >10 yr: IV digitalizing dose 8-12 mcg/kg given as 50% of the
dose initially, additional fractions given 4-8 hr intervals; PO digitalizing dose
0.01-0.015 mg/kg given 50% of the dose initially, additional fractions given at 6-
8 hr intervals; maintenance 25%-35% of the loading dose daily as a single dose.
Child 5-10yr:IV digitalizing dose 0.015-0.03 mg/kg given as 50% of the dose
initially, additional fractions given at 4-8 hr intervals. PO digitalizing dose 0.02-
0.025 mg/kg given as 50% of the dose initially, additional fractions given at 6-8
hr intervals;
waves, presence of U wave, ventricular dysrhythmia; potassium levels may
decrease rapidly.  CHF: dyspnea, crackles, peripheral edema, B/P, volume
overload.  Administer: test doses have proven to be ineffective in the general
population; only use test dose in those with known allergies or those previously
treated with digoxin immune FAB.  For test dose dilute 0.1 ml or reconstituted
product (9.5 mg/ml) in 9.9 ml sterile isotonic saline, inj 0.1 ml (1:100 dislution)
ID and observe for wheal with erythema; read in 20 min.  for scratch test place 1
in 20 min.  after diluting 38 mg/4ml of sterile H2O for inj 10 mg/ml mix; may be
further diluted with normal saline, sol should be clear, colorless.  By bolus if
cardiac arrest is imminent or IV over 30 min using a 0.22-µm filter. 
Perform/provide: storage of reconstituted sol for up to 4 hr in refrigerator.  Do
not freeze DigiFag.  Evaluate:  therapeutic response: correction of digoxin
toxicity; check digoxin levels 0.5-2 ng/ml; digitoxin level 9-25ng/ml.  teach
patient/family:  the purpose of medication; to report delayed hypersensitivity;
fever, chills, itching, swelling, dyspnea
maintenance 25%-35% Of the loading dose daily in 2 divided doses. Child 2-
5yr: IV digitalizing dose 0.025-035 mg/kg given 50% of the dose initially,
additional fractions given at 4-8 hr intervals. PO digitalizing dose 0.03-0.04
mg/kg given 50% of the dose initially,additional fractions given at 6-8 hr
intervals; maintenance 25%-35% of the loading dose daily in 2 divided doses.
Child 1-2yr: IV digitalizing dose 0.03-0.05 mg/kg given as 50% of the dose
initially, additional fractions given at 4-8 hr intervals; PO digitalizing dose
0.035-0.06 mg/kg given as 50% of the dose initially, additional fractions given at
4-8 hr intervals; maintenance 25%-35% of the loading dose daily in 2 divided
doses. Infant: IV digitalizing dose 0.02-0.03 mg/kg given as 50% of the dose
initially, additional fractions given at 4-8 hr intervals; PO digitalizing dose
0.025-0.035 mg/kg given as 50% of the dose initially, additional fractions given
at 4-8 hr intervals; maintenance 25%-35% of the loading dose daily in 2 divided
doses. Infant, premature: IV digitalizing dose 0.015-0.025 mg/kg given as 50%
of the dose initially, additional fractions given at 4-8 hr intervals; PO digitalizing
dose 0.02-0.03 mg/kg given as 50% of the dose initially, additional fractions
given at 4-8 hr intervals; maintenance 20%-30% of the loading
dose daily in 2 Divided doses.  Available forms: caps 0.05, 0.1, 0.2 mg; elix 0.05   monitoring is necessary.  Perform/provide: storage protected from light.
mg/ml; tabs 0.125, 0.25, 0.5 mg; inj 0.5, 0.25 mg/ml; pediatric inj 0.1 mg/ml
NURSING CONSIDERATIONS: assess: apical pulse for 1 min before giving
product; if pulse <60 in adult or <90 in an infant, take again in 1 hr; if <60 in
adult, call prescriber; note rate, rhythm, character; monitor ECG continuously
during parenteral,loading dose.  Electrolytes: K, Na, Cl, Mg, Ca; renal function
studies: BUN creatinine; blood studies: ALT, AST, bilirubin, Hct, Hgb before
initiating treatment and periodically thereafter.  I&O ratio, daily weights; monitor
turgor, lung sounds, edema.  Monitor product levels (therapeutic level 0.5-2
ng/ml).  cardiac status; apical pulse, character, rate rhythm.  Administer: PO
route: do not break, crush, or chew caps.  PO with or without food; may crush
tabs, only mix with food/fluids.  Potassium supplements if ordered for potassium
levels <3, or foods high in potassium: bananas, orange juice.  IV therapeutic
response: decreased weight, edema, pulse, respiration, route: undiluted or 1 ml of
product/4 ml sterile H2O, D5 or NS; give >5 min through Y-tube or 3-way
stopcock; during digitalization close
GENERIC NAME: procainamide    TRADE NAME:  promine, pronestyl  
CLASSIFICATION:  antidysrhythnic (class IA)
USES:  life-threatening ventricular dysrhythmias
DOSAGE & ROUTE:  atrial fibrillation/PAT: adult: PO 1-1.25g; may give another
750mg if needed; if no response, 500mg-1g q2hr until desired response; maintenance
50mg/kg in divided doses q6hr. ventricular tachycardia – adult: PO 1g; maintenance
50mg/kg/day given in 3-hr intervals. Other dysrhythmias – adult: IV BOL 100mg
q5min, given 25-50mg/min, max 500mg; or 17 mg/kg total then IV INF 2-6 mg/min.
renal dose – adult: IV CCr 10-50 ml/min give q6-12hr; CCr < 10 ml/min give q8-24hr.  paresthesias, seizures, product should be discontinued. Administer: IM route – IM inj in
available forms: caps 250, 375, 500 mg; tabs 250, 500 mg; inj 100, 500 mg/ml
SIDE EFFECTS:  CNS: headache, dizziness, confusion, psychosis, restlessness,
irritability, weakness, depression. CV: hypotension, heart block, cardiovascular collapse,
arrest. GI: nausea, vomiting, anorexia, diarrhea, hepatomegaly, pain, bitter taste. HEMA:
SLE syndrome, agranulocytosis, thrombocytopenia, neutropenia, hemolytic anemia.
INTEG: rash, urticaria, Edema, swelling (rare), pruritus, flushing, angioedema. SYST:
SLE.
NURSING CONSIDERATIONS:  assess: ECG continuously if using IV to determine
increased PR or QRS segments; discontinue immediately, watch for increased
 
Evaluate: crackles; increased urine output; serum digoxin level (0.5-2 ng/ml). 
teach patient/family: not to stop product abruptly; teac all aspects of product, to
take exactly as ordered; how to monitor heart rate.  To avoid OTC medications,
herbal remedies since many adverse product interactions may occur; do not take
antacid at same time. To notify prescriber of loss of appetite, lower stomach pain,
diarrhea, weakness, drowsiness, headache, blurred or yellow vision, rash,
depression, toxicity.  The toxic symptoms of this product and when to notify
prescriber.  To maintain a sodium-restricted diet as ordered. To report shortness
of breath, difficulty breathing, weight gain, edema, persistent cough.
SIDE EFFECTS:  CNS: headache, drowsiness, apathy, confusion, disorientation,
fatigue, depression, hallucinations. CV: dysrhythmias, hypotension, bradycardia,
AV block. EENT: blurred vision, yellow-green halos, photophobia, diplopia. GI:
nausea, vomiting, anorexia, abdominal pain, diarrhea
 
ventricular ectopic beats, maximum need to rebolus. Blood levels, 3-10 mcg.ml or NAPA
levels 10-20 mcg/ml.  CBC q2wk x 3 mo; leukocyte, neutrophil, platelet counts may be
decreased, treatment may need to be discontinued. I&O ratio; electrolytes (K, Na, Cl),
weigh weekly, report gain >2. Toxicity: confusion, drowsiness, nausea, vomiting,
tachydysrhythmias, oliguria.  ANA titer, during long-term treatment, watch for lupuslike
syndromes.  Cardiac rate, rhythm, character, B/P continuously for fluctuations.  
Respiratory status: rate, rhythm, character, lung fields; bilateral crackles may occur in CF
patient; watch for respiratory depression.  CNS effects: dizziness, confusion, psychosis,
deltoid; aspirate to avoid intravascular administration. IV route – after diluting 100
mg/ml of D5W or sterile H2O for inj; give 20 mg or less/1 min; may dilute 1 g/250-500
ml D5W, run at 2-6 mg/min. evaluate: therapeutic response: decreased  dysrhythmias
.teach patient/family that wax matrix may appear in stools.  Not to discontinue without
health care provider’s advice.  To notify prescriber immediately if lupuslike symptoms
appear, (joint pain, butterfly rash, fever, chills, dyspnea).  To notify prescriber of
leucopenia (sore mouth, gums, throat) or thrombocytopenia (bleeding, bruising).  How to
take pulse and when to report to prescriber.  To avoid driving, other hazardous activities
until effect is known.
GENERIC NAME: adenosine    TRADE NAME:  adenocard, adeno-jec, adenoscan  
CLASSIFICATION:  antidysrhythmic
USES:  SVT, as a diagnostic aid to assess myocardial perfusion defects in CAD, Wolff-
Parkinson-White (WPW) syndrome
DOSAGE & ROUTE:  antidysrhythmic- adult & child >50kg: IV BOL 6 mg; if
conversion to normal sinus rhythm does not occur within 1-2 min, give 12 mg by rapid
IV BOL; may repeat 12 mg dose again in 1-2 min. infant & child <50kg; IV BOL 0.05
mg/kg; if not effective, increase dose by 0.05 mg/kg q2min to a max of 0.3 mg/kg/dose or
12 mg. diagnostic use – adult: IV INF 140 mcg/kg/min x 6 min. Wolff-Parkinson-
White (WPW) syndrome – adult/adolescent/child ≥ 50 kg; rapid IV BOL 6 MG, follow
with saline flush; then IV BOL 12 mg if needed.  Wide-complex tachycardia diagnosis
(unlabeled) – adult/adolescent/child ≥ 50kg: rapid IV BOL 12 mg if needed.
SIDE EFFECTS:  CNS: light-headedness, dizziness, arm tingling, numbness,
apprehension, blurred vision, headache. CV: chest pain, pressure, atrial
tachydysrhythmias, sweating, palpatations, hypotension, facial flushing. GI: nausea,
metallic taste, throat tightness, groin pressure. RESP: dyspnea, chest pressure,
hyperventilation, bronchospasm (asthmatics)
GENERIC NAME: lidocaine    TRADE NAME:lidopen auto-injector, xylocaine,  
xylocard  mg/min.  blood levels (therapeutic level: 1.5-5 mcg/ml).  I&O ratio, electrolytes (K, Na,
CLASSIFICATION:  antidysrhythmic (class 1b)
USES:  ventricular tachycardia, ventricular dysrhythmias during cardiac surgery,
myocardial infarction, digoxin toxicity, cardiac catheterization
DOSAGE & ROUTE:  adult: IV BOL 50-100mg (1 mg/kg) over 2-3 min, repeat q3-5
min, not to exceed 300 mg in 1 hr; begin IV INF; IV INF 20-50 mcg/kg/min; IM 200-
300 mg (4.3 mg/kg) in deltoid muscle, may repeat in 1-1 ½ hr if needed. Child: ID
(zingo) 0.5 mg applied 1-3 min prior to needle insertion. CHF, reduced hepatic
function – geriatric: IV BOL give ½ adult dose. Child: IV BOL 1 mg/kg, then IV INF
30 mcg/kg/min.
SIDE EFFECTS:  CNS: headache, dizziness, involuntary movement, confusion, tremor,
drowsiness, euphoria, seizures. CT: hypotension, bradycardia, heart block, CV collapse,
arrest. EENT: tinnitus, blurred vision. GI: nausea, vomiting, anorexia. HEMA:
methemoglobinemia. INTEG: rash, urticaria, edema, swelling. MISC: febrile response,
phlebitis at inj site. RESP: dyspnea, respiratory depression.
NURSING CONSIDERATIONS:  assess: ECG continuously to determine increased PR
or QRS segments; if these develop, discontinue or reduce rate; watch for increased
NURSING CONSIDERATIONS:  assess: I&O ratio, electrolytes (K, Na, Cl). 
Cardiopulmonary status: B/P, pulse, respiration, ECG intervals (PR, QRS, QT); check for
transient dysrhythmias (PVCs, PACs, sinus tachycardia, AV block). Respiratory status:
rate, rhythm, lung fields for crackles, watch for respiratory depression; bilateral crackles
may occur in CHF patient; increased respiration, increased pulse, product should be
discontinued.  CNS effects: dizziness, confusion, psychosis, paresthesias, seizures;
product should be discontinued.  Administer: IV direct route – undiluted; give 6 mg or
less by rapid inj over 1-2 sec; if using an IV line; use port near insertion site, flush with
NS (50 ml). CONT IV INF route – give 30 ml vial, undiluted, by peripheral vein. 
Perform/provide: storage at room temperature; sol should be clear, discard unused
product.  Evaluate: therapeutic response: normal sinus rhythm or diagnosis of perfusion
defect. Teach patient/family: to report facial flushing, dizziness, sweating palpitations,
chest pain.  To rise from sitting or standing slowly to prevent orthostatic hypotension.
ventricular extopic beats; may have to rebolus, B/P.  IV inf rate using inf pump; run at <4
Cl).  Malignant hyperthermia: tachypnea, tachycardia, changes in B/P, increased temp. 
respiratory status: rate, rhythm, lung fields for crackles, watch for respiratory depression;
lung fields, bilateral crackles may occur in CHF patient; increased repiration, increased
pulse; product should be discontinued.  CNS effects: dizziness, confusion, psychosis,
paresthesias, convulsions; product should be discontinued. Administer: IM in in deltoid;
aspirate to avoid intravascular administration; shcek site daily for infiltration or
extravasation. IV route – bolus undiluted (1%, 2% only) give 50 mg or less over 1 min or
dilute 1 g/250-500 ml of D5W; titrate to patient response; use of inf pump; pediatric inf is
120 mg of lidocaine/100 ml D5W; 1-2.5 ml/kg/hr = 20-50 mcg/kg/min; use only 1%, 2%
sol for IV bol. Evaluate: therapeutic response: decreased dysrhythmias. Teach
patient/family: the use of automatic lidocaine injection device if ordered for personal use.
GENERIC NAME: prazosin    TRADE NAME: minipress, prazosin   Acid if on long-term therapy. Weight daily, I&O; edema in feet, legs daily. Skin turgor,
CLASSIFICATION: antihypertensive dryness of mucous membranes for hydration status. Crackles, dyspnea, orthopnes
USES:  hypertension, refractory CHF, Raynaud’s vasopasm q30min. administer: 1st dose at bedtime to avoid fainting. Evaluate: therapeutic response
DOSAGE & ROUTE:  hypertension – adult:  PO 1 mg bid or tid, increasing to 20 decreased B/P. teach patient/family: that fainting occasionally occurs after 1st dose; take
mg/day in divided doses if requires; usual rang 6-15 mg/day,  not to exceed 1 mg 1st dose at bedtime or do not drive or operate machinery for 4 hr after 1st dose; that full
initially; max 20-40 mg/day. Child: PO 5 mcg/kg q6hr; max 400 mcg/kg/day. Benign effect may take 4-6 wk. to change positions slowly, to prevent orthostatic hypotension.
prostatic hyperplasia (unlabeled) - adult: PO 2 mg bid. Raynaud’s phenomenon To avoid OTC medications unless approved by prescriber.
(unlabeled) – adult: PO 0.5-3 mg bid. CHF(unlabeled) – adult: PO 1 mg bid-tid. May
gradually increase to max 20 mg/day. Child: PO 5 mcg/kg q6hr, may gradually increase
to 25 mcg/kg q6hr. hypertensive urgency (unlabeled) – adult: PO 10-20mg, may repeat
in 30 min.
SIDE EFFECTS:  CNS: dizziness, headache, drowsiness, anxiety, depression, vertigo,
weakness, fatigue. CV: palpitations, orthostatic hypotension, tachycardia, edema, rebound
hypertension. EENT: blurred vision, epistaxis, tinnitus, dry mouth, red sclera. GI: nausea,
vomiting, diarrhea, constipation, abdominal pain. GU: urinary frequency, incontinence,
impotence, priapism, H2O, sodium retention.
NURSING CONSIDERATIONS:  assess: B/P (sitting, standing) during initial treatment,
periodically thereafter, pulse, jugular venous distention q4hr.  BUN, uric
     
GENERIC NAME: nitroprusside    TRADE NAME:  nitropress, sodium nitroprusside   Legs daily; skin turgor, dryness of mucous membranes for hydration status.  Crackles,
CLASSIFICATION:  antihypertensive, vasodilator dyspnea, orthopnea q30min.  for decrease in bicarbonate, PCO2 blood pH, acidosis.
USES:  hypertensive crisis, to decrease bleeding by creating hypotension during surgery; Administer: antidote is sodium thiosulfate. IV route – depending on B/P reading
acute CHF q15min.  IV after diluting 50 mg/2-3 of D5W, further dilute in 250 ml of D5W; use an
DOSAGE & ROUTE: adult/child: IV INF 0.3-8 mcg/kg/min; max 10 mcg/kg/min infusion pump only; wrap bottle with aluminum foil to protect from light; observe for
SIDE EFFECTS:  CNS: dizziness, headache, agitation, twitching, decreased reflexes, color change in the inf; discard if highly discolored (blue, green, dark red); titrate to
restlessness. CV: bradycardia, ECG changes, tachycardia, hypotension. GI: nausea, patient response.  Evaluate: therapeutic response: decreased B/P, absence of bleeding. 
vomiting, abdominal pain.  INTEG: pain, irritation at inj, sweating. MISC: cyanide, Teach patient/family: to report headache, dizziness, loss of hearing, blurred vision,
thiocyanate toxicity, flushing, hypothyroidism dyspnea, faintness.  The reason for giving product and expected results.
NURSING CONSIDERATIONS:  assess: electrolytes: K, Na, Cl, CO2, CBC, serum
glucose, serum methemoglobin if pulmonary O2 levels are decreased; use IV 1-2 mg/kg
methylene blue given over several min for methemoglobinemia.  Renal studies:
catecholamines, BUN, creatinine. Hepatic studies: AST, ALT, alk phos. B/P by direct
means if possible; check ECG continuously; pulse, jugular vein distention; PSWP;
rebound hypertension may occur after nitroprusside is discontinued.  Weight daily, I&O.
thiocyanate, lactate, cyanide levels daily in inf >3 mcg/kg/min; thiocyanate level should
be ≤1 mmol/L; thiocyanate toxicity includes confusion, weakness, seizures,
hyperreflexia, psychosis, tinnitus, coma.  Nausea, vomiting, diarrhea.  Edema in feet,
GENERIC NAME:  furosemide   TRADE NAME:  lasix  
CLASSIFICATION:  loop diuretic
USES:  pulmonary edema; edema in CHF, hepatic disease, nephritic syndrome, ascites,
hypertension
DOSAGE & ROUTE:  edema – adult: Initially, 20–80 mg/day PO as a single dose. If needed, a
second dose may be given in 6–8 hr. If response is unsatisfactory, dose may be increased in 20- to
40-mg increments at 6- to 8-hr intervals. Up to 600 mg/day may be given. Intermittent dosage
schedule (2–4 consecutive days/wk) is preferred for maintenance, or 20–40 mg IM or IV (slow IV
injection over 1–2 min). May increase dose in increments of 20 mg in 2 hr. High-dose therapy
should be given as infusion at rate not exceeding 4mg/min.  Acute pulmonary edema: 40 mg IV
over 1–2 min. May be increased to 80 mg IV given over 1–2 min if response is unsatisfactory after
1 hr.· Hypertension: 40 mg bid PO. If needed, additional antihypertensive agents may be sadded at
50% usual dosage.
SIDE EFFECTS:  CNS: Dizziness, vertigo, paresthesias, xanthopsia, weakness, headache,
drowsiness, fatigue, blurred vision, tinnitus, irreversible hearing loss· CV: Orthostatic hypotension,
volume depletion, cardiac arrhythmias, thrombophlebitis Dermatologic: Photosensitivity, rash,
pruritus, urticaria, purpura, exfoliative dermatitis, erythema multiforme GI: Nausea, anorexia,
vomiting, oral and gastric irritation, constipation, diarrhea, acute pancreatitis, jaundice GU:
Polyuria, nocturia, glycosuria, urinary bladder spasm Hematologic: Leukopenia, anemia,
thrombocytopenia, fluid and electrolyte imbalancess Other: Muscle cramps and muscle spasms
GENERIC NAME: diltiazem TRADE NAME:    SIDE EFFECTS: CNS: Dizziness, light-headedness, headache, asthenia, fatigue CV:
CLASSIFICATION:  Calcium channel blocker, Antianginal, Antihypertensive
USES:  Angina pectoris due to coronary artery spasm (Prinzmetal's variant angina).
Effort-associated angina; chronic stable angina in patients not controlled by beta-
adrenergic blockers, nitrates. Sustained- and extended-release forms: Essential
hypertension. Parenteral: Paroxysmal supraventricular tachycardia, atrial fibrillation,
atrial flutter
DOSAGE & ROUTE:  ADULTS
Initially, 30 mg PO qid before meals and hs; gradually increase dosage at 1- to 2-day
intervals to 180–360 mg PO in three to four divided doses. Sustained and extended
release Cardizem SR: Initially, 60–120 mg PO bid; adjust dosage when maximum
antihypertensive effect is achieved (around 14 days); optimum range is 240–360 mg/day.
Cardizem CD and Cartia XT: 180–240 mg daily PO for hypertension; 120–180 mg daily
PO for angina. Dilacor XR and Diltia XT: 180–240 mg daily PO as needed; up to 480 mg
has been used. Tiazac: 120–240 mg daily PO for hypertension—once daily dose; 120–
180 mg PO once daily for angina. IV Direct IV bolus: 0.25 mg/kg (20 mg for the average
patient); second bolus of 0.35 mg/kg. Continuous IV infusion: 5–10 mg/hr with increases
up to 15 mg/hr; may be continued for up to 24 hr.
NURSING CONSIDERATIONS:  Assess:· History: Allergy to furosemide, sulfonamides, tartrazine; electrolyte
depletion anuria, severe renal failure; hepatic coma; SLE; gout; diabetes mellitus; lactation, pregnancy·
Physical: Skin color, lesions, edema; orientation, reflexes, hearing; pulses, baseline ECG, BP, orthostatic BP,
perfusion; R, pattern, adventitious sounds; liver evaluation, bowel sounds; urinary output patterns; CBC, serum
electrolytes (including calcium), blood sugar, liver and renal function tests, uric acid, urinalysis Interventions:·
Administer with food or milk to prevent GI upset. Reduce dosage if given with other antihypertensives; readjust
dosage gradually as BP responds.· Give early in the day so that increased urination will not disturb sleep.·
Avoid IV use if oral use is at all possible.· Do not mix parenteral solution with highly acidic solutions with pH
below 3.5.· Do not expose to light, may discolor tablets or solution; do not use discolored drug or solutions.·
Discard diluted solution after 24 hr.· Refrigerate oral solution.· Measure and record weight to monitor fluid
changes.· Arrange to monitor serum electrolytes, hydration, liver function.· Arrange for potassium-rich diet or
supplemental potassium as needed.  Teaching points: · Record intermittent therapy on a calendar or dated
envelopes. When possible, take the drug early so increased urination will not disturb sleep. Take with food or
meals to prevent GI upset.· Weigh yourself on a regular basis, at the same time and in the same clothing, and
record the weight on your calendar.· These side effects may occur: increased volume and frequency of
urination; dizziness, feeling faint on arising, drowsiness (avoid rapid position changes; hazardous activities, like
driving; and consumption of alcohol); sensitivity to sunlight (use sunglasses, wear protective clothing, or use a
sunscreen); increased thirst (suck on sugarless lozenges; use frequent mouth care); loss of body potassium (a
potassiumrich diet or potassium supplement will be necessary).· Report loss or gain of more than 3 lb in 1 day,
swelling in your ankles or fingers, unusual bleeding or bruising, dizziness, trembling, numbness, fatigue, muscle
weakness or cramps.
Peripheral edema, hypotension, arrhythmias, bradycardia, AV block, asystole
Dermatologic: Flushing, rash GI: Nausea, hepatic injury, reflux
NURSING CONSIDERATIONS: Assess: History: Allergy to diltiazem, impaired hepatic
or renal function, sick sinus syndrome, heart block, lactation, pregnancy. Physical: Skin
lesions, color, edema; P, BP, baseline ECG, peripheral perfusion, auscultation; R,
adventitious sounds; liver evaluation, normal output; liver and renal function tests,
urinalysis. Interventions: •Monitor patient carefully (BP, cardiac rhythm, and output)
while drug is being titrated to therapeutic dose; dosage may be increased more rapidly in
hospitalized patients under close supervision. Monitor BP carefully if patient is on
concurrent doses of nitrates. Monitor cardiac rhythm regularly during stabilization of
dosage and periodically during long-term therapy. Ensure patient swallows ER and SR
preparations whole; do not cut, crush, or chew. Teaching points: Swallow SR, ER, and
LA preparations whole; do not cut, crush, or chew; do not drink grapefruit juice while
using this drug. These side effects may occur: Nausea, vomiting (eat frequent small
meals); headache (regulate light, noise, and temperature; medicate if severe). Report
irregular heart beat, shortness of breath, swelling of the hands or feet, pronounced
dizziness, constipation.
GENERIC NAME: potassium acetate TRADE NAME:  k-electrolyte  
CLASSIFICATION:  electrolyte, mineral replacement
USES:  prevention and treatment of hypokalemia
DOSAGE & ROUTE:  potassium acetate – hypokalemia: adult/child: PO 40-100
mEq/day in divided doses 2-4 days
SIDE EFFECTS:  CNS: confusion. CV: bradycardia, cardiac depression, dysrhythmias,
arrest, peaking T waves, lowered R and depressed RST, prolonged P-R interval, widened
QRS, complex. GI: nausea, vomiting, cramps, pain, diarrhea, ulceration of small bowel.
GU: oliguria. INTEG: cold extremities, rash.
NURSING CONSIDERATIONS:  assess: ECG for peaking T waves, lowered R,
depressed RST, prolonged P-R interval, widening QRS complex, hyperalemia; product
should be reduced or discontinued. Potassium level during treatment (3.5-5 mg/dl is
normal level). I&O ratio; watch for decreased urinary output; notify prescriber
imeediately. Cardiac status: rate, rhythm, CVP, PWP, PAWP, ikf being monitored
directly. Administer: PO ROUTE: do not break, crush, or chew ext rel tabs/caps or
enteric products. With or after meals; dissolve effervescent tabs, powder in 8 oz cold
water or juice; do not give IM, SUBCUT. Caps with full glass of liquid. IV ROUTE:
through large-bore needle to decrease vein inflammation; check for extravasation. In large vein,
avoiding scalp vein in child (IV). IV after diluting in large volume if IV sol
GENERIC NAME: albumin    TRADE NAME:  albuminar 5%, albutein 5%  
CLASSIFICATION:  blood derivative
USES:  restores plasma volume in burns, hyperbilirubinemia, shock,
hyperproteinemia, prevention of cerebral edema, cardiopulmonary bypass
procedures, ARDS, nephritic syndrome
DOSAGE & ROUTE:  BURNS: adult: IV dose to maintain plasma albumin at
30-50 g/L, use 5% sol initially, then 25% sol after 24 hr. SHOCK adult: IV 500
ml of 5% sol q30min, as needed. Child:IV 0.5-1 g/kg/dose.
HYPOPROTEINEMIA: adult: IV 1000-2000 ml of 5% sol/day, max 5-10
ml/min or 25-100 g of 25% sol/day, max 3 ml/min, titrated to patient response.
HYPERBILIRUBINEMIA/ERYTHROBLASTOSIS FETALIS: infant IV 1 g of
25% sol/kg -2 hr before transfusion
SIDE EFFECTS:  CNS: fever, chills, flushing, headache. CV: fluid overload,
hypotension, erratic pulse, tachycardia. GI: nausea, vomiting, increased
salivation. RESP: altered respirations, pulmonary edema. INTEG: rash, urticaria.
and five as an inf, slowly by IV inf to prevent toxicity; never give IV bolus or IM.
Perform/provide: storage at room temperature. Evaluate: therapeutic response: absence
of fatigue, muscle weakness; decreased thirst and urinary output; cardiac changes. Teach
patient/family: to add potassium-rich foods to diet: bananas, orange juice, avocados;
whole grains, broccoli, carrots, prunes, coca after this medication is discontinued. To
avoid OTC products: antacids, salt substitutes, analgesics, vitamin preparations, unless
specifically directed by prescriber; avoid licorice in large amounts, may cause
hypokalemia, sodium retention. To report hyperkalemia symptoms (lethargy, confusion,
diarrhea, nausea, vomiting, fainting, decreased output) or continued hypokalemia
symptoms (factigue, wakness, polyuria, polydipsia, cardiac changes). To dissolve
powder or tablet completely in at least 120 ml water or juice. Importance or regular
follow-up visits. That potassium levels will need to be monitored periodically.
NURSING CONSIDERATIONS:  assess: blood studies Hct, Hgb; if serum
protein declines, dyspnea, hypoxemia can result. Decreased B/P, erratic pulse,
respiration. I&O ration: urinary output may decrease. CVP, pulmonary wedge
pressure will increase if overload occurs. Allergy: fever, rash, itching, chills,
flushing, urticaria, nausea, vomiting Hypotension, requires discontinuation of
infusion, use of new lot if therapy reinstituted; premedicate with
diphenhydrAMINE. CVP reading: distended neck veins indicate circulatory
overload; shortness of breath, anxiety, insomnia, expiratory crackles, frothy
blood-tinged cough, cyanosis indicate pulmonary overload. Administer: IV
ROUTE: slowly, to prevent fluid overload; dilute with NS for injection or D5W;
5% may be given undiluted; 25% may be given diluted, give over 4 hr, use
infusion pump. Perform/provide: adequate hydration before, during
administration. Check type of albumin; some stored t room temperature, some
need to be refrigerated. Evaluate: therapeutic response: increased B/P, decreased
edema, increased serum albumin levels, increased plasma protein.
GENERIC NAME: dipyridamole    TRADE NAME:  Persantine  
CLASSIFICATION:  coronary vasodilator, antiplatelet agent
USES:  Dipyridamole keeps blood flowing smoothly by preventing blood cells from clumping
together (coagulating). It is used after heart valve replacement. It is taken in combination with a
"blood thinner" such as warfarin.
DOSAGE & ROUTE:  75 – 100 mg four times daily as adjunct to warfarin therapy
SIDE EFFECTS:  Loss of appetite, nausea, diarrhea, headache or dizziness may occur at first as
your body adjusts to the medication. If these effects persist or become bothersome, inform your
doctor. Notify your doctor promptly if the following occur: unusual bleeding or bruising, fainting,
skin rash, yellowing eyes/skin. Seek immediate medical attention if the following occur: trouble
breathing. If you notice other effects not listed above, contact your doctor or pharmacist.
NURSING CONSIDERATIONS:  Monitor vital signs, EKG, chem. tests; document mental status,
skin color, cardiopulmonary findings; helps prevent clots by inhibiting platelet stickiness; avoid
alcohol and tobacco usage due to hypotensive vasoconstrictive effects; avoid use of unprescribed
drugs without approval; avoid quick movements due to ↓ BP; try small meals frequently if nausea
or gastric distress experiencedMonitor vital signs, EKG, chem. tests; document mental status, skin
color, cardiopulmonary findings; helps prevent clots by inhibiting platelet stickiness; avoid alcohol
and tobacco usage due to hypotensive vasoconstrictive effects; avoid use of unprescribed drugs
without approval; avoid quick movements due to ↓ BP; try small meals frequently if nausea or
gastric distress experienced
GENERIC NAME: ezetimibe TRADE NAME: Zetia  
CLASSIFICATION: Antihyperlipidemic
USES: Primary hypercholesterolemia, either as monotherapy or combination therapy
with HMG-CoA reductase inhibitors; with atorvastatin or simvastatin for homozygous
familial hypercholesterolemia; as adjunct therapy to diet for homozygous sitosterolemia
DOSAGE & ROUTE: 10 mg once daily with or without food
SIDE EFFECTS:  Back pain, diarrhea, arthralgia, sinusitis, abdominal pain
NURSING CONSIDERATIONS: Place client on a standard cholesterol-lowering diet
before therapy and for duration of treatment; give at least 2 hr prior or 4 hr after giving a
bile acid sequestrant; store from 15-30°C (59-86°F) protected from moisture; monitor
CBC, lipid panel, renal and LFTs; schedule LFTs at the beginning of therapy; list all
medications preascribed to ensure none interact unfavorably; identify cardiac risk factors;
take daily as directed with or without food; avoid taking with antacids (reduces drug
effect); low-cholesterol diet must be followed during drug therapy; report any S&S of
infection
GENERIC NAME: warfarin sodium TRADE NAME: Coumadin
CLASSIFICATION: Anticoagulant, coumarin derivative
USES: Prophylaxis and treatment of venous thrombosis and its extension; Prophylaxis
and treatment of atrial fibrillation with embolization; Prophylaxis and treatment of
pulmonary embolism; Prophylaxis and treatment of thromboembolic complications
associated with atrial fibrillation
DOSAGE & ROUTES: Init: 5-10 mg/day for 2-4 days; then adjust dose on prothrombin
or INR determinations (lower in geriatric or debilitated patients): Maintenance: 2-10
mg/day based on prothrombin or INR
SIDE EFFECTS: Bleeding/hemorrhage is main side effect; may occur from any organ or
tissue
NURSING CONSIDERATIONS: Take oral warfarin as prescribed and at same time each
day; must be compliant with drug therapy; do not change brands (may alter response);
does not dissolve clots but decreases clotting ability of blood and helps to prevent
formation of blood clots in vessels and heart valves; avoid IM shots, activities that may
cause injury or cuts and bruises; protect from light (store at controlled room temperature);
dispense in tight light-resistant container; vial not for multiple uses; discard unused
solution; note any bleeding tendencies; determine if pregnant (may cause fetal malformations and
neonatal hemorrhage)
GENERIC NAME: levothyroxine TRADE NAME: Synthroid, Levoxyl, Levothroid,
others
CLASSIFICATION: Synthetic Thyroid Preparation
USES: preferred drug for treatment of hypothyroidism because its hormonal content is
standardized and its effect is predictable. Also used to treat goiters, as replacement
therapy in patients who have had thyroidectomys
DOSAGE & ROUTE: 25-300 mcg/day (25-200 mcg/day most common) IM/IV: 50% of
oral dose; IV 200-500 mcg in a single dose; repeat next day 100-300 mcg if necessary.
Pediatric 0-12 yr, PO: 25-150 mcg/day
SIDE EFFECTS: usually a result of overdose. Cardiac dysrhythmia with the risk for life-
threatening or fatal irregularities, tachycardia, palpitations, angina, hypertension, cardiac
arrest, insomnia, tremors, headache, anxiety, nausea, diarrhea, increased or decreased
appetite, cramps, menstrual irregularities, weight loss, sweating, heat intolerance, fever.
NURSING CONSIDERATIONS: Half life long enough that it only needs to be
administered once a day. Pregnancy category A. Switching between courses of
treatments should be minimized. Thyroid function tests should be monitored
GENERIC NAME: glyburide TRADE NAME: Diaßeta, Glynase, PresTab, Micronase  
CLASSIFICATION: Antidiabetic, oral; second generation sulfonylurea
USES: Diabetes mellitus; may be used with metformin when diet and glyburide or diet and
metformin alone do not provide adequate control
DOSAGE & ROUTE: Initial for adults (Nonmicronized) – 2.5 – 5 mg/day given with breakfast (or
first main meal), then increase by 2.5 mg at weekly intervals to achieve the desired response;
maintenance – 1.25 – 20 mg/day; clients sensitive to sulfonylureas should start with 1.25 mg/day;
initial for adults (Micronized) – 1.5 – 3 mg/day given with breakfast (or first main meal); those
sensitive to sulfonylureas should start with 0.75 mg/day; increase by no more than 1.5 mg at
weekly intervals to achieve the desired response
SIDE EFFECTS:  Hypoglycemia, nausea, epigastric distress, heartburn, allergic skin reactions,
blurred visions
NURSING CONSIDERATIONS: Do not confuse glyburide with glipizide or Glucatrol; administer
30 minutes prior to meals; do not exceed 20 mg/day of nonmicrozized and 12 mg/day of
micronized products; note reasons for therapy; explain that it works by causing pancreas to release
more insulin into the blood stream, helps insulin get into cells to lower blood sugar and help restore
the way you use food to make energy; take as directed with food; record finger sticks at various
times (fasting, 1 – 2 hr after meals, before bedtime), continue regular daily exercise, lifestyle
changes, BP control, weight loss, and dietary restrictions to control cholesterol and glucose; avoid
alcohol, OTC agents without approval; practice reliable contraception
GENERIC NAME: guaifenesin TRADE NAME: Naldecon, Senior EX, Robitussin,  
Scot-Tussin Expectorant, Siltussin SA, Alterussin, Guiatuss, Humabid Maximum
Strength, Mucinex
CLASSIFICATION: Diabetic Tussin, Organidin NR
USES: Dry, nonproductive cough due to colds and minor upper respiratory tract
infections where there is mucus in respiratory tract; to loosen phlegm and thin bronchial
secretions
DOSAGE & ROUTE: Expectorant: Over 12 y/o 200-400 mg q 4 hr, not exceeding 2,400
mg/day; 6-11 y/o 100-200 mg q 4 hr not exceeding 1,200 mg/day, 2-5 y/o 50-100 mg q 4
hr not exceeding 600 mg/day, 6 mos-2 yrs 25-50 mg q 4 hr not exceeding 300 mg/day
SIDE EFFECTS:  Nausea & vomiting; GI discomfort
NURSING CONSIDERATIONS: Assess for tobacco use, fever/chills, loss of appetite, or
increased fatigue; if symptoms persist for more than one week, recur, or are accompanied
by a persistent headache, fever or rash, notify provider; do not perform activities that
require mental alertness (drug may cause drowsiness); report any evidence of increased
bruising/bleeding, fever, change in secretions, or lack of response
GENERIC NAME: metformin TRADE NAME: Fortamet, Glucophage, Glucophage
XR, Glumetza, Riomet
CLASSIFICATION: Oral Antidiabetic, Biguanide
USES: As monotherapy, as adjunct to diet and exercise, to improve glycemic control in
clients with type 2 diabetes; Immediate-release tablets and PO solution can be used in
clients 10 yrs and older; Extended Release form used to treat type 2 diabetes as initial
therapy or in conjunction with a sulfonylurea or insulin in clients 17 y/o and older
USUAL DOSAGE: Oral Solution: Adult up to 2,550 mg/day; child up to 2,000 mg/day
Tablets: Start dose 500 mg twice daily with food; dosage increases may be made in 500
mg every week, divided doses, up to maximum of 2,500 mg; If 2,500 mg needed, may be
tolerable in 3 equal doses daily
SIDE EFFECTS:  Lactic acidosis, hypoglycemia, diarrhea, nausea & vomiting, asthenia,
flatulence, headache, abdominal pain/discomfort
NURSING CONSIDERATIONS: Lactic acidosis is a rare, but serious, metabolic
complication that can occur due to metformin accumulation (50 % fatal); do not confuse
Glucophage with Glucovance; individualize dosage based on tolerance and effectiveness;
give with meals and start at a low dose with gradual escalation (will reduce GI side
effects); may safely switch from metformin to metformin extended-release; may cause a metallic
taste (will subside): 
GENERIC NAME: streptokinase    TRADE NAME:  streptase
CLASSIFICATION:  thrombolytic enzyme
USES:  deep vein thrombosis, PE, arterial thrombosis, arterial embolism, lysis of coronary artery thrombi after
acute MI, acute evolving transmural MI
DOSAGE & ROUTE:  lysis of coronary artery thrombi – adult: IC 20,000 international units, then 2000
international units/min over 1 hr as IV INF. Thrombosis/embolism/deep vain thrombosis/pulmonary
embolism – adult:IV INF 250,000 international units over ½ hr, then 100,000 international unites/hr, then
100,000 international units/hr for 72 hr for deep vein thrombosis; 100,000 international units/hr x 24-72 hr for
arterial thrombsis or embolism. Acute evolving transmural MI - adult: IV INF 1,500,000 international units
diluted to a volume of 45 ml; give within 1 hr via inf pump; intracoronary INF 20k000 international units by
BOL, then 2000 international units/min x 1 hr, total dose 140,000 international units. Arterovenous cannula
occlusion (unlabeled) – adult: IV INF 10,000 international units/3 ml sol into occluded limb of cannula; clamp
for 1 hr distally; apirate contents; flush wit NaCl sol and reconnect (serious reactions have been reported).
SIDE EFFECTS:  CNS: headache, fever, Guillan-Barre syndrome. CV: dysrhythmias, hypotension,
noncardiogenic pulmonary edema, PE. EENT: periorbital edema. GI: Nausea. HEMA: decreased Hct, bleeding,
anemia. INTEG: rash, urticaria, phlebitis at IV inf site, itching, flushing. MS: low back pain, arthralgia,
myalgia. RESP: altered respirations, shortness of breath, bronchospasm, pulmonary bleeding. SYST: GI, GU
intracranial, retroperitoneal bleeding, surface bleeding, anaphylaxis. NURSING CONSIDERATIONS: assess:
allergy: fever, rash, itching, chills; mild reaction may be treated with antihistamines. For bleeding during 1st hr
of treatment; hematuria, hematemesis, bleeding from mucous membranes, epistaxis, ecchymosis; may require
transfusion (rare), continue to assess for bleeding for 24 hr.
blood studies (Hct, platelets, PTT, PT, TT, aPTT) before starting therapy; PT or aPTT must be less than 2X  
control before starting therapy; PTT or PT q3-4hr during treatment. For hypersentsitive reactions: fever, rash,
dyspnea, facial swelling; product should be discontinued; for streptokinase reactions previously; notify
prescriber immediately, stop product, keep resuscitative equipment nearby. VS, B/P, pulse, respirations,
neurologic signs, temp at least q4hr; temp >104o F (40oC) indicates internal bleeding; systolic pressure increase
> 25 mm Hg should be reported to prescriber; assess neurologic status, neurologic change may indicate
intracranial bleeding. For neurologic changes that may indicate intracranial bleeding. Retroperitoneal bleeding:
back pain, leg weakness, diminished pulses. For Guillain-Barre syndrome that may occur after treatment with
this product. ECG continuously, cardiac enzymes, radionuclide myocardial scanning/coronary angiography.
For respiratory depression. Administer: IV ROUTE: as soon as thrombi identified; not useful for thrombi over
1 wk old. Cryoprecipitate or fresh frozen plasma if bleeding occurs. Loading dose at beginning of therapy;
may require increased loading doses. Heparin after fibrinogen level >100 mg/dl; heparin infusion to increase
PTT to 1.5-2 x baseline for 3-7 days; IV heparin discontinuing streptokinase to prevent redevelopment of
thrombi. After reconstituting with 5 ml NS or D5W; do not shake; further dilute to total volume of 45 ml; may
be diluted to 500 ml in 45 ml increments; may dilute vial in 15 ml NS, further dilute 750,000 international
units/50 ml NS or D5W; further dilute 1,500,000 international units dose/100 ml or more. About 10% patients
have high streptococcal antibody titers requiring increased loading doses. IV therapy using 0.8 µm filter.
Perform/provide: storage of reconstituted sol in refrigerator; discard after 24 hr. bed rest during entire course of
treatment. Avoid venous or arterial puncture, inj, rectal temp; any invasive treatment. Treatment of fever with
acetaminophen or aspirin. Pressure for 30 sec to minor bleeding sites; inform prescriber if this does not attain
hemostatis; apply pressure dressing. Evaluate: therapeutic response: resolution of thrombosis, embolism. Teach
patient/family: reason for medication and expected results.
NURSING CONSIDERATIONS:  assess: hepatic studies: AST, ALT, bilirubin, uric  
acid, alk phos; blood glucose before and ruing treatment. Cardiac status: rate, rhythm,
quality; postural hypotension, dysrhythmias. Nutritional status; liver, yeast, legumes,
organ meat, lean poultry; fat in diet. Hepatic dysfunction: clay-colored stools, itching,
dark urine, jaundice. CNS symptoms: headache, paresthesias, blurred vision. For
symptoms of niacin deficiency: nausea, vomiting, anemia, poor memory, confusion,
dermatitis. For lip, triglyceride, cholesterol level, if using for hyperlipidemia.
Administer: do not break, crush, or chew ext rel tabs, caps. With meals for GI symptoms,
And 81-325 mg aspirin or NSAIDs ½ hr before dose to decrease flushing.
Evaluate: therapeutic response: decreased lipids, warm extremities, absence of
numbness in extremities. Teach patient/family: that flushing and increase in
feelings of warmth will occur several hr after taking product (PO); after 2 wk of
therapy, these side effects diminish. To remain recumbent if postural
hypotension occurs; to rise slowly to prevent orthostatic hypotension. To abstain
from alcohol if product is prescribed for hyperlipidemia. To avoid sunlight if
skin lesions are present. To report clay-colored stools, anorexia, jaundiced
sclera, skin; dark urine, hepatotoxicity may occur.
GENERIC NAME: nicotinic acid (niacin)   TRADE NAME:  slo-niacin
CLASSIFICATION:  vitamin B3, antihyperlipidemic
USES:  pellagra, hyperlipidemias (types 4, 5), peripheral vascular disease that presents a
risk for pancreatitis.
DOSAGE & ROUTE:  niacin deficiency – adult: PO 100-500 mg/day in divided doses;
IM/SUBCUT 5-100 mg 5 or more x/day; IV 25-100 mg bid or tid. Child: PO up to 300
mg/day in divided doses. Adjunct in hyperlipidemia – adult: PO 250 mg after evening
meal; may increase dose at 1-4 wk intervals to 1-2 g tid, max 6 g/day; EXT REL 500 mg
at bedtime for wk 5-8; do not increase by more than 500 mg q4wk, max 2000 mg/day.
Pellagra – adult: PO 300-5000 mg/day in divided doses. Child: PO 100-300 mg/day in
divided doses. Peripheral vascular disease – adult: PO 250-800 mg/day in divided
doses.
SIDE EFFECTS:  CNS; paresthesias, headache, dizziness, anxiety. CV: postural
hypotension, vasovagal attacks, dysrhythmias, vasodilation. EENT: blurred vision, ptosis.
GI: nausea, vomiting, anorexia, jaundice, hepatotoxicity, diarrhea, peptic ulcer,
dyspepsia. GU: hyperuricemia, glycosuria, hypoalbuminemia. INTEG: flushing, dry skin,
rash, pruritus, itching, tingling.
GENERIC NAME: corticotropin    TRADE NAME:  acthar gel
CLASSIFICATION:  pituitary hormone
USES:  testing adrenocortical function, treatment of adrenal insufficiency caused by
administratioin of corticosteroids (long term), MS, infantile spasms
DOSAGE & ROUTE:  acute exacerbations of multiple sclerosis - adult: IM 80-120
units/day x 14-21 days. Infantile spasms – infant: IM GEL 20 units/day x 2 wk, increase
if needed.
SIDE EFFECTS:  CNS: convulsions, dizziness, euphoria, incomnia, headache,
depression, psychosis. END: diabetes. GI: nausea, vomiting, peptic ulcer perforatin,
pancreatitis. GU: water and sodium retention, hypokalemia. MUSCULOSKELETAL:
hypocalcemia with possible pathologic bone fractures. OCULAR: cataracts. OTHER:
sweating, acne, hyperpigmentation, weakness, muscle atrophy, myalgia, arthralgia.
NURSING CONSIDERATIONS:  Assessment: Assess for disorders for which
hypothalamic and pituitary hormones are given: For children with impaired growth,
assess height and weight (actual and compared with growth charts) and diagnostic x-ray
reports of bone age. For clients with diabetes insipidus, assess baseline blood pressure,
weight, ratio of fluid intake to urine output, urine specific gravity, and laboratory reports
GENERIC NAME: vasopressin    TRADE NAME:  pitressin  
CLASSIFICATION:  pituitary hormone
USES:  diabetes insipidus (nonnephrogenic/nonpsychogenic), abdominal distention
postoperatively, bleeding esophageal varices
DOSAGE & ROUTE:  diabetes insipidus - adult: IM/SUBCUT 5-10 units bid-qid as needed;
IM/SUBCUT 2.5-5 units q2-3 days (Pitressin Tannate) for chronic therapy; CONT IV INF 0.0005
units/kg/hr (0.05 milliunit/kg/hr), double dose 130min as needed. Child: IM/SUBCUT 2.5-10 units
bid-qid asneeded; IM/SUBCUT 1.25-2.5 units q2-3 days (pitressin Tannate) for chronic therapy.
Abdominal distention – adult: IM 5 units, then q3-4hr, increasing to 10 units if needed (aqueous).
SIDE EFFECTS:  CNS: drowsiness, headache, lethargy, flushing, vertigo. CV: increased B/P,
dysrhythmias. EENT: nasal irritation, congestion, rhinitis. GI: nausea, heartburn, cramps, vomiting,
flatus. GU: vulval pain, uterine cramping. MISC: tremor, sweating, vertigo, urticaria, bronchial
constriction.
NURSING CONSIDERATIONS:  ASSESS: nasal mucosa if given by intranasal spray; for
irritation. Pulse, B/P, when giving product IV or IM. I&O ration, weight daily, fluid/electrolyte
balance; check for edema in extremities; if water retention is severe, diuretic may be prescribed.
H2O intoxication: lethargy, behavioral changes, disorientatin, neuromuscular excitability.
Evaluate: therapeutic response: absence of Severe thirst, decreased urine output, osmolality. Teach
patient/family: to measure and record I&O. to avoid alcohol, all OTC medications unless approved
by prescriber.
GENERIC NAME: desmopressin    TRADE NAME:  minirin, octostim  
CLASSIFICATION:  pituitary hormone
USES:  hemophilia A, von Willebrand’s disease type 1, nonnephrogenic diabetes
insipidus, symptoms of polyuria/polydipsia caused by pituitary dysfunction, nocturnal
enuresis
DOSAGE & ROUTE:  adult: Diabetes insipidus, intranasally; 0.1–0.4 mL/d, usually in
two divided doses; Hemophilia A, von Willebrand’s; disease, IV 0.3 mcg/kg in 50 mL
sterile saline, infused over 15–30 min. child: 3 mo–2 y: Diabetes insipidus, intranasally
0.05–0.3 mL/d in 1–2 doses Weight >10 kg: Hemophilia A, von Willebrand’s disease,
same as adult dosage Weight ≤10 kg: Hemophilia A, von Willebrand’s disease, IV 0.3
mcg/kg in 10 mL of sterile saline.
SIDE EFFECTS:  CNS: drowsiness, headache, lethargy, flushing. CV: increased B/P,
palpitations, tachycardia. EENT: nasal irritation, congestion, rhinitis. GI: nausea,
heartburn, cramps. GU: vulval pain. META: hyponatremia, hyponatremia-induced
seizures. Syst: ANAPHYLAXIS (IV)
NURSING CONSIDERATIONS:  ASSESS: pulse, B/P when giving IV or SUBCUT.
I&O ration, weight daily; check for edema in extremities; if water retention is severe,
diuretic may be prescribed. Water intoxication: lethargy, behavioral changes,
of serum electrolytes. For clients with diarrhea, assess number and consistency of stools
per day as well as hydration status. Nursing Diagnoses: Deficient Knowledge: Drug
administration and effects Altered Growth and Development Anxiety related to multiple
injections Risk for Injury: Adverse drug effects Planning/Goals: The client will:
Experience relief of symptoms without serious adverse effects Take or receive the drug
accurately Comply with procedures for monitoring and follow-up Interventions: For
children receiving growth hormone, assist the family to set reasonable goals for increased
height and weight and to comply with accurate drug administration and follow-up
procedures (periodic x-rays to determine bone growth and progress toward epiphyseal
closure, recording height and weight at least weekly). For clients with diabetes insipidus,
assist them to develop a daily routine to monitor their response to drug therapy (eg, weigh
themselves, monitor fluid intake and urine output for approximately equal amounts, or
check urine specific gravity [should be at least 1.015] and replace fluids accordingly).
Evaluation: Interview and observe for compliance with instructions for taking the
drug(s). Observe for relief of symptoms for which pituitary hormones were prescribed.
disorientation, neuromuscular excitability. Intranasal use: nausea, congestion, cramps,
headache; usually decreased with decreased dose; for nasal mucosa changes: congestion,
edema, discharge, scaring (nasal route). For severe allergic reaction including
anaphylaxis (IV route). Urine vol/osmolality and plasma osmolality (diabetes insipidus)
Factor VIII coagulant activity before using for hemostasis. Nocturnal enuresis: frequency
of enuresis before and during treatment. Administer: undiluted over 1 min in diabetes
insipidus. Diluted, one single dose/50 ml of 0.9% NaCl (adult and child >10 kg), a single
dose/10 ml as an IV inf over 15-30 min in von Willebrand’s disease or hemophilia A.
perform/provide: storage in refrigerator or cool environment. Evaluate: therapeutic
response: absence of severe thirst, decreased urine output, decreased osmolality. Teach
patient/family: the proper technique for nasal instillation: to insert tube into nostril to
instill product. To avoid OTC products: cough, hay fever products, since these
preparations may contain epinephrine, decrease product response; do not use with
alcohol, adverse reactions may occur. To wear emergency ID specifying therapy. That if
dose is missed, take when remembered up to 1 hr before next dose; do not double dose.
To report to prescriber upper respiratory infection, nasal congestion.
GENERIC NAME: levothyroxine    TRADE NAME:  Synthroid, Levothroid  
CLASSIFICATION:  thyroid hormone
USES:  hypothyroidism, myxedema coma, thyroid hormone replacement, thyrotoxicosis, congenital
hypothyroidism, some types of thyroid cancer, pituitary TSH suppression.
DOSAGE & ROUTE:  adult: PO 0.05 mg/d initially, increased by 0.025 mg every 2–3 wk until desired
response obtained; usual maintenance dose, 0.1–0.2 mg/d (100–200 mcg/d) Myxedema coma, IV 0.4 mg in a
single dose; then 0.1–0.2 mg daily Thyroid-stimulating hormone (TSH) suppression in thyroid cancer, nodules,
and euthyroid goiters,
PO 2.6 mcg/kg/d for 7–10 days Older adults, clients with cardiac disorders, and clients with hypothyroidism of
long duration: PO 0.0125–0.025 mg/d for 6 wk, then dose is doubled every 6–8 wk until the desired response is
obtained Myxedema coma, same as adult dosage Child: Congenital hypothyroidism, PO as follows: Birth–6
mo: 25–50 mcg/d (or 8–10 mcg/kg/d) 6–12 mo: 50–75 mcg/d (or 6–8 mcg/kg/d) 1–5 y: 75–100 mcg/d (or 5–6
mcg/kg/d) 6–12 y: 100–150 mcg/d (or 4–5 mcg/kg/d) >12 y: >150 mcg/d (or 2–3 mcg/kg/d)
SIDE EFFECTS:  CNS: anxiety, insomnia, tremors, headache, thyroid storm, excitability. CV: tachycardia,
palpitations, angina, dysrhythmias, hypertension, cardiac arrest. GI: nausea, diarrhea, increased or decreased
bone mineral density.
NURSING CONSIDERATIONS: assess: B/P, pulse periodically during treatment. Weight daily in same
clothing, using same scale, at same time of day. Height, growth rate of a child. T3, T4, FTIs, which are
decreased; radioimmunoassay of TSH, which is increased; radio uptake, which is increased if patient is on too
low a dose of medication. PT may require decreased anticoagulant; check for bleeding, bruising.
GENERIC NAME:  Propylthiouracil   TRADE NAME:  PIV, PTU  
CLASSIFICATION:  thyroid hormone antagonist (antithyroid)
USES:  preparation for thyroidectomy, thyrotoxic crisis, hyperthyroidism, thyroid storm
DOSAGE & ROUTE:  adult: PO 300–400 mg/d in divided doses q8h, until the
client is euthyroid; then 100–150 mg/d in three divided doses, for maintenance. Child:
>10 y: PO 150–300 mg/d in divided doses q8h; usual maintenance dose, 100–300 mg/d
in two divided doses, q12h 6–10 y: 50–150 mg/d in divided doses q8h
SIDE EFFECTS:  CNS: drowsiness, headache, vertigo, fever, paresthesias, neuritis. GI:
nausea, diarrhea, vomiting, jaundice, hepatitis, loss of taste. GU: nephritis. HEMA:
agranulocytosis, leucopenia, thrombocytopenia, hypotherombinemia, lymphadenopathy,
bleeding, vasculitis, periarteritis. INTEG: rash, uritcaria, pruritus, alopecia,
hyperpigmentation, lupuslike syndrome. MS: myalgia, arthralgia, nocturnal muscle
cramps, osteoporosis.
NURSING CONSIDERATIONS:  assess: pulse, B/P, temp. I&O ratio; check for edema:
puffy hands, feet, periorbits; indicates hypothyroidism. Weight daily; same clothing,
scale, time of day. T3, T4, which are increased; serum TSH, which is decreased; free
thyroxine index, which is increased if dosage is too low; discontinue product 3-4 wk
before RAIU. Blood studies: CBC for blood dyscrasias: leucopenia, thrombocytopenia,
agranulocytosis; LFTs. Overdose: peripheral edema, heat intolerance, diaphoresis,
Increased nervousness, excitability, irritability, which may indicate too high dose of medication, usually after 1-
3 wk of treatment. Cardiac status: angina, palpitation, chest pain, change in VS. administer: PO route-in AM if
possible as a single dose to decrease sleeplessness; at same time each day to maintain product level; take on
empty stomach. Only for hormone imbalances; not to be used for obesity, male infertility, menstrual conditions,
lethargy. Lowest dose that relieves symptoms; lower dose to the geriatric patient and in cardiac diseases.
Crushed and mixed with water; nonsoy formula, or breast milk for infants/children. Separate antacids, iron,
calcium products by 4 hr. IV direct route- IV after diluting with provided diluent 0.5 mg/5 ml; shake; give
through Y-tube or 3-way stopcock; give 0.1 mg or less over 1 min; do not add to IV inf; 0.1 mg = 1 ml.
considered to be incompatible in syringe with all other products. Perform/provide: storage in tight, light-
resistant container; sol should be discarded if not used immediately. Withdrawal of medication 4 wk before
RAIU test. Evaluate: therapeutic response: absence of depression; increased weight loss, diuresis, pulse,
appetite; absence of constipation, peripheral edema, cold intolerance; pale, cool, dry skin; brittle nails, alopecia,
coarse hair, menorrhhagia, night blindness, paresthesias, syncope, stupor, coma, rosy cheeks. Teach
patient/family: that hair loss will occur in child, is temporary. To report excitability, irritability, anxiety, which
indicate overdose. Not to switch brands unless approved by prescriber. That product may be discontinued after
giving birth, thyroid panel evaluated after 1-2 mo. That hypothyroid child will show almost immediate
behavior/personality change. That product is not to be taken to reduce weight. To avoid OTC preparations with
iodine; read labels; separate antacids, iron, calcium products by 4 hr. to avoid iodine food, iodized salt,
soybeans, tofu, turnips, high-iodine seafood, some bread. That product is not a cure but controls symptoms and
treatment is lifelong.
palpitations, dysrhythmias, severe tachycardia, increased temp, delirium, CNS
irritability.Hypersensitivity: rash, enlarged cervical lymph nodes; product may have to be
discontinued. Hypoprothrombinemia: bleeding, petechiae, ecchymosis. Clinical
response: after 3 wk shoulc include increased weight, pulse; decreased T4. bone marrow
depression: sore throat, fever, fatigue. Administer: with meals to decrease GI upset. At
same time each day to maintain product level. Lowest dose that relieves symptoms.
Perform/provide: storage in light-resistant container. Fluids to 3-4 L/day, unless
contraindicated. Evaluate: therapeutic response: weight gain, decreased pulse, decreased
T4, decreased B/P. teach patient/family: to abstain from breastfeeding after delivery. To
take pulse daily. To report redness, swelling, sore throat, mouth lesions, which indicate
blood dyscrasias. To keep graph of weight, pulse, mood. To avoid OTC products that
contain iodine. That seafood, other iodine products may be restricted. Not to discontinue
this medication abruptly; thyroid crisis may occur; stress response. That response may
take several months if thyroid is large. The symptoms/signs of overdose: periorbital
edema, cold intolerance, metal depression. The symptoms of inadequate does:
tachycardia, diarrhea, fever, irritability. To take medication as prescribed; not to skip or
double dose; missed doses should be taken when remembered up to 1 hr before next dose.
to carry emergency ID listing condition, medication.
GENERIC NAME: insulin lispro    TRADE NAME:  humalog  
CLASSIFICATION:  antidiabetic, pancreatic hormone
USES:  type 1 diabetes mellitus, type 2 diabetes mellitus, gestational diabetes, insulin lispro may be
used in combination with sulfonylureas in children >3 yr.
DOSAGE & ROUTE:  adult: SUBCUT 15 min before meals
SIDE EFFECTS:  EENT: blurred vision, dry mouth. INTEG: flushing, rash, urticaria, warmth,
lipodystrophy, lipohypertrophy, swelling, redness. META: hypoglycemia, rebound hyperglycemia
(somogyi effect 12-72 hr or longer). SYST: anaphylaxis.
NURSING CONSIDERATIONS:  assess: fasting vlood glucose, 2 hr PP (80-150 mg/dl, normal
fasting level; 70-130 mg/dl, noral 2 hr level); also A1c may be drawn to identify treatment
effectiveness q3mo. Urine ketones during illness; insulin requirements may increase during stress,
illness, surgery. For hypoglycemic reaction that can occur during peak time (seating, weakness,
dizziness, chills, confusion, headache, nausea, reapid weak pulse, fatigue, tachycardia, memory
lapses, slurred speech, staggering gait, anxiety, tremors, hunger). For hyperglycemia: acetone
breath; polyuria; fatigue; polydipsia; flushed, dry skin; lethargy. Administer: SUBCUT ROUTE –
after warming to room temperature by rotating in palms to prevent injecting cold insulin; use only
insulin syringes with markings or syringe matching units/ml; rotate inj sites within one area:
Abdomen, upper back, thighs, upper arm, buttocks; keep record of sites. Increased dosages if
tolerance occurs. Premixed insulins and NPH are cloudy suspensions. Regular human insulin,
rapid-acting analogs, and long-acting analogs are clear; do not use if cloudy, thick, or discolored.
GENERIC NAME:  glipizide   TRADE NAME:  glucotrol  
CLASSIFICATION:  antidiabetic
USES:  type 2 diabetes mellitus
DOSAGE & ROUTE:  PO, initially 5 mg daily in a single dose, 30 min before breakfast.
Maximum dose, 40 mg daily.
SIDE EFFECTS:  CNS: headache, weakness, dizziness, drowsiness, tinnitus, fatigue,
vertigo. ENDO: hypoglycemia. GI: hepatotoxicity, cholestatic jaundice, nausea,
vomiting, diarrhea, heartburn. HEMA: leucopenia, thrombocytopenia, agranulocytosis,
aplastic anemia; increased AST, ALT, alk phos; pancytopenia, hemolytic anemia.
INTEG: rash, allergic reactions, pruritus, urticaria, eczema, photosensitivity, erythema.
NURSING CONSIDERATIONS:  assess: hypo/hyperglycemic reaction that can occur
soon after meals; for severe hypoglycemia give IV D5W, then IV dextrose solution.
Blood, A1c levels during treatment to determine diabetes control. CBC baseline and
throughout treatment. Administer: do not break, crush, or chew ext rel tabs; may crush
tabs and mix with fluids if unable to swallow whole. Product 30 min before meals; if
patient is NPO, may need to hold dose to prevent hypoglycemia. Perform/provide:
storage in tight, light-resistant container at room temperature. Evaluate: therapeutic
response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of
CONT SUBCUT ROUTE (INSULIN INFUSION CSII) – do not mix with other insulins when using a pump.
Insulin lispro 3 ml cartridges are to be used in Disetronic H-TROM plus V100 pump using Disetronic rapid inf
sets; the inf set and the cartridge adapter should be changed q48hr; replace 3 ml cartridge q7 days. IV ROUTE
(INSULIN GLULISINE ONLY) – dilute to 1 international unit/ml in inf systems with 0.9% NaCl using PVC
viaflex if bags and PVC tubing; use dedicated line; do not admix. IV ROUTE (REGULAR ONLY) 0 when
regular insulin is administered IV, monitor glucose, potassium often to prevent fatal hypoglycemia,
hypokalemia. IV direct undiluted via vein, Y-site, 3-way stopcock; give at 50 units/min or less. By cont inf
after diluting with IV sol and run at prescribed rate; use IV inf pump for correct dosing; give reduced dose at
serum glucose level of 250 mg/100 ml. perform/provide: store at room temperature for <1 mo (some insulins);
keep away from heat and sunlight; refrigerate all other supply; NPH, premixed insulins are cloudy; regular,
rapid-acting analogs, long-acting analogs are clear; do not freeze – IV route, regular only. Evaluate: therapeutic
response: decrease in polyuria, polydipsia, polyphagia; clear sensorium; absence of dizziness; stable gain.
Teach patient/family: that blurred vision occurs; not to change corrective lens until vision is stabilized 1-2 mo.
To keep insulin, equipment available at all times; carry a glucagons kit, candy, or lump of sugar to treat
hypoglycemia. That product does not cure diabetes but controls symptoms. To carry emergency ID as diabetic.
To recognized hypoglycemia reaction: headache, tremors, fatigue, weakness. To recognize hyperglycemia
reaction: frequent urination, thirst, fatigue, hunger. The dosage, route, mixing instructions, if any diet
restrictions, disease process. The symptoms of ketoacidosis: nausea; thirst; polyuria; dry mouth; decreased B/P;
dry, flushed skin; acetone breath; drowsiness; Kussmaul respirations. That a plan is necessary for diet, exercise;
all food on diet should be eaten; exercise routine should not vary. About blood glucose testing; make sure
patient is able to determine glucose level. To avoid OTC products unless directed by prescriber.
Dizziness; stable gait; improved serum glucose A1c. teach patient/family: not to drink;
explain disulfiram reaction (nausea, headache, cramps, flushing, hypoglycemia). To
check for symptoms of cholestatic jaundice: dark urine, pruritus, yellow sclera; prescriber
should be notified. The symptoms of hypo/hyperglycemia, what to do about each; to
have glucagons emergency kit available, carry sugar packets. That product must be
continued on dialy basis; explain consequences of discontinuing product abruptly. To
take product in morning to prevent hypoglycemic reactions at night. To use sunscreen or
stay out of the sun to prevent photosensitivity. To avoid OTC medications unless ordered
by prescriber. That diabetes is a lifelong illness; product will not cure disease. That all
food in diet plan must be eaten to prevent hypoglycemia. To carry emergency ID with
prescriber and medications. To test using blood glucose meter while on this product. To
continue weight control, dietary restrictions, exercise, hygiene. Ext rel tab may appear in
stool.
GENERIC NAME: prednisone    TRADE NAME:  orasone  
CLASSIFICATION:  corticosteroid
USES:  severe inflammation, immunosuppression, neoplasms, multiple sclerosis,
collagen disorders, dermatologic disorders.
DOSAGE & ROUTE:  adult: PO 20–60 mg/d. child: PO 2 mg/kg/d initially.
SIDE EFFECTS:  CNS: depression, flushing, sweating, headache, mood changes. CV:
hypertension, circulatory collapse, thrombophlebitis, embolism, tachycardia. 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. META:
hyperglycemia. MS: fractures, osteoporosis, weakness.
NURSING CONSIDERATIONS:  assess: adrenal insufficiency: nausea, vomiting,
anorexia, confusion, hypotension. Potassium, blood glucose, urine glucose while on
long-term therapy; hypokalemia and hyperglycemia. Weight daily; notify prescriber of
weekly gain > 5 lb. B/P q4hr, pulse; notify prescriber of chest pain; monitor for crackles,
dyspnea if edema is present. I&O ration; be alert for decreasing urinary output,
increasing edema. Plasma cortisol (long-tem therapy) (normal: 138-635 nmol/L SI units
drawn at 8 am). Infection: increased temp, WBC, even after withdrawal of medication;
GENERIC NAME: estrogen, conjugated    TRADE NAME:  premarin, premphase  
CLASSIFICATION:  estrogen, hormone
USES:  vasomotor symptoms (menopause), inoperable breast cancer, prostatic cancer, abnormal
uterine bleeding, hypogonadism, primary ovarian failure, prevention of osteoporosis
DOSAGE & ROUTE:  menopausal: PO 0.3–1.25 mg daily for 21 d followed by 7 d without the
drug. Hypogonadism: PO 2.5–7.5 mg daily in divided doses, cyclically, 20 d on, 10 d off the drug.
Osteoporosis: PO 0.625 mg daily for 21 d, then 7 d without the drug
SIDE EFFECTS:  CNS: dizziness, headache, migraine, depression, seizures, mood disturbances.
CV: hypotension, thrombophlebitis, edema, thromboembolism, stroke, pulmonary embolism,
myocardial infarction. EENT: contact lens intolerance, increased myopia, astigmatism. GI:
nausea, vomiting, diarrhea, anorexia, pancreatitis, cramps, constipation, increased appetite,
cholestatic jaundice, hepatic adenoma, weight gain/loss. GU: amenorrhea, cervical erosion,
breakthrough bleeding, dysmenorrheal, vaginal candidiasis, breast changes, gynecomastia,
testicular atrophy, impotence, increased risk of breast cancer, endometrial cancer, libido changes.
INTEG: rash, urticaria, acne, hirsutism, alopecia, oily skin, seborrhea, purpura, melasma. META:
folic acid deficiency, Hypercalcemia, hyperglycemia.
NURSING CONSIDERATIONS: assess: blood glucose if diabetic patient, hyperglycemia may
occur. Weight daily; notify prescriber of weekly weight gain >5 lb; if increase, diuretic may be
ordered. B/P q4hr; watch for increase caused by H2O and Na retention. I&O ration; be alert for
decreasing urinary output, increasing edema. Hepatic studies: AST, ALT, bilirubin, alk phos.
product masks infection. Potassium depletion: paresthesias, fatigue, nausea, vomiting
Depression, polyuria, dysrhythmias, weakness. Edema, hypertension, cardiac symptoms.
Mental status: affect, mood, behavioral changes, aggression. Administer: for long-term
use, alternate-day therapy is recommended to decrease adverse reactions. Titrated dose;
use lowest effective dose. With food or milk to decrease GI symptoms.
Perform/provide: assistance with ambulation to patient with bone tissue disease to
prevent fractures. Evaluate: therapeutic response: ease of respirations, decreased
inflammation. Teach patient/family: that emergency ID as steroid user should be carried;
information on product being taken and condition. To notify prescriber if therapeutic
response decreases; dosage adjustment may be needed. To avoid vaccinations. Not to
discontinue abruptly, or adrenal crisis can result. To avoid OTC products; salicylates,
cough products with alcohol, cold preparations unless directed by prescriber. About
cushingoid symptoms: moon face, weight gain. That product causes immunosuppression;
to report any symptoms of infection (fever, sore throat, cough). The symptoms of adrenal
insufficiency: nausea, anorexia, fatigue, dizziness, dyspnea, weakness, joint pain.
Hypertension, cardiac symptoms, jaundice, hypercalcemia. Mental status: affect, mood, behavioral
changes, aggression. Female patient for intact uterus; if so, progesterone should be added to
estrogen therapy to decrease risk of endometrial cancer; abnormal uterine bleeding, breast exam.
Administer: titrated dose, use lowest effective dose. IM ROUTE- IM reconstitute after withdrawing
>5 ml of air from container and inject sterile diluent on vial side, rotate to dissolve; give inj deep in
large muscle mass. With food or milk to decrease GI symptoms (PO). VAGINAL ROUTE – use
applicator provider. IV, DIRECT ROUTE – IV, after reconstituting as for IM, inject into distal port
of running IV line of D5W, 0.9% NaCl, LR at 5 mg/min or less. Evaluate: therapeutic response:
absence of breast engorgement, reversal of menopause symptoms, or decrease in tumor size in
prostate cancer. Teach patient/family: to avoid breastfeeding, since product is excreted in breast
milk. To weigh weekly, report gain >5 lb. to report breast lumps, vaginal bleeding, edema,
jaundice, dark urine, clay-colored stools, dyspnea, headache, blurred vision, abdominal pain, leg
pain and redness, numbness or stiffness in legs, chest pain; male to report impotence or
gynecomastia. To avoid sunlight or wear sunscreen; burns may occur. To notify prescriber if
pregnancy is suspected. That vasomotor symptoms improve in 2 wk, max relief in 8 wk.to report
breast lumps, vaginal bleeding, edema, jaundice, dark urine, clay-colored stools, dyspnea,
headache, blurred vision, abdominal pain, leg pain and redness, numbness or stiffness in legs, chest
pain; male to report impotence or gynecomastia. To avoid sunlight or wear sunscreen; burns may
occur. To notify prescriber if pregnancy is suspected. That vasomotor symptoms improve in 2 wk,
max relief in 8 wk.
GENERIC NAME: clomiphene    TRADE NAME:  clomid, serophen   Prescriber immediately if low abdominal pain occurs; may indicate ovarian cyst, cyst
CLASSIFICATION:  ovulation stimulant rupture. To notify prescriber of photophobia, blurred vision, diplopia, abnormal bleeding,
USES:  female infertility (ovulatory failure) hot flashes, nausea, vomiting, headache. That if dose is missed, to double it nest time; if
DOSAGE & ROUTE:  adult: PO 50-100 mg/day x 5 days or 50-100 mg/day beginning more than one dose is missed, to call prescriber. That response usually occurs 4-10 days
on day 5 of cycle; may be repeated until conception occurs or 3 cycles of therapy have after last day of treatment. The method for taking, recording basal body temp to
been completed determine whether ovulation has occurred. If ovulation can be determined (there is a
SIDE EFFECTS:  CNS: headache, depression, restlessness, anxiety, nervousness, fatigue, slight decrease in temp, then a sharp increase for ovulation), to attempt coitus 3 days
insomnia, dizziness, glushing. CV: vasomotor flushing, phlebitis, deep-vein thrombosis. before and every other day until after ovulation. If pregnancy is suspected, to notify
EENT: blurred vision, diplopia, photophobia. GI: nausea, vomiting, constipation, prescriber immediately.
abdominal pain, bloating. GU: polyuria, urinary frequency, birth defects, spontaneous
abortions, multiple ovulation, breast pain, oliguria, abnormal uterine, bleeding, ovarian
cyst, hypertrophy of ovary. INTEG: rash, dermatitis, urticaria, alopecia.
NURSING CONSIDERATIONS:  assess: for LFTs before therapy: AST, ALT, alk phos.
Serum progesterone, urinary excretion of pregnanediol to identify occurrence of
ovulation. Ovarian size, cervical condition by pelvic examination. For endometrial
carcinoma in women over 35 by endometrial biopsy. Administer: after discontinuing
estrogen therapy. At same time daily to maintain product level. Evaluate: therapeutic
response: fertility. Teach patient/family: that multiple births are common. To notify
     
GENERIC NAME: raloxifene    TRADE NAME:  evista   72 hr before prolonged bed rest; advise to avoid one position for long periods. To take
CLASSIFICATION:  hormone modifier, selective estrogen receptor modulator 9SERM) calcium supplements, vit D if intake is inadequate. To increase exercise using weights.
USES:  prevention, treatment of osteoporosis in postmenopausal women; breast cancer To stop smoking and to Decrease alcohol consumption. That this product does not help
prophylaxis control hot flashes. To report fever, acute migraine, insomnia, emotional distress; urinary
DOSAGE & ROUTE:  adult: PO 60 mg/day, max 60 mg/day tract infection, or vaginal burning/itching; swelling, warmth, or pain calves.
SIDE EFFECTS:  CNS: insomnia, CVA. CV: hot flashes. EENT: retinal vein occlusion
(rare). GI: nausea, vomiting, diarrhea, dyspepsia. GU: vaginitis, leucorrhea, cystitis, hot
flashes. INTEG: rash, sweating. META: weight gain, peripheral edema. MS: arthralgia,
myalgia, leg cramps, arthritis. RESP: sinusitis, pharyngitis, increased cough, pneumonia,
laryngitis, bronchitis, pulmonary embolism, flulike symptoms.
NURSING CONSIDERATIONS:  assess: weight daily, notify prescriber of weekly
weight gain > 5 lb. B/P, watch for increase caused by H2O and sodium retention. I&O
ratio; decreasing urinary output, increasing edema. Hepatic studies, including AST,
ALT, bilirubin, alk phos. Bone density test baseline and throughout treatment, bone-
specific alk phos. Administer: without regard to meals, vit D. add calcium supplement if
inadequate. Evaluate: therapeutic response: prevention, treatment of osteoporosis. Teach
patient/family: to weigh weekly, report gain >5 lb. To discontinue
GENERIC NAME: norethindrone    TRADE NAME:  ortho micronor, errin  
CLASSIFICATION:  progestogen
USES:  uterine bleeding (abnormal), amenorrhea, endometriosis, contraception
DOSAGE & ROUTE:  amenorrhea, abnormal uterine bleeding (aygestin) – adult: PO
2.5-10 mg/day on days 5-25 of menstrual cycle. Endometriosis (aygestin) – adult: PO 5
mg/day x 2 wk, then increased by 2.5 mg/day x 2 wk, up to 15 mg/day. Contraception –
adult: PO 0.35 mg on 1st day of menses, then 0.35 mg/day.
SIDE EFFECTS:  CNS: dizziness, headache, migraines, depression, fatigue. CV:
hypotension, thrombophlebitis, edema, thromboembolism, CVA, stroke, PE, MI. EENT:
diplopia. GI: nausea, vomiting, anorexia, cramps, increased weight, cholestatic jaundice.
GU: amenorrhea, cervical erosion, break through bleeding, dysmenorrheal, vaginal
candidiasis, breast changes, (gynecomastia, testicular atrophy, impotence), endometriosis,
spontaneous abortion, breast tenderness. INTEG; rash, urticaria, acne, hirsutism,
alopecia, oily skin, seborrhea, purpura, melasma. META: hyperglycemia.
NURSING CONSIDERATIONS:  assess: weight daily: notify prescriber of weekly
weight gain >5 lb. B/P at beginning of treatment and periodically. I&O ratio; be alert for
decreasing urinary
GENERIC NAME: alendronate    TRADE NAME:  fosamax  
CLASSIFICATION:  bone-resorption inhibitor
USES:  treatment and prevention of osteoporosis in postmenopausal women, treatment of
osteoporosis in men, Paget’s disease, treatment of corticosteroid-induced osteoporosis in
postmenopausal women not receiving estrogen and men who are on continuing
corticosteroid treatment with low bone mass.
DOSAGE & ROUTE:  Osteoporosis: Postmenopausal women: Prevention, PO 5 mg once
daily or 35 mg once weekly; treatment, PO 10 mg once daily or 70 mg once weekly Men,
10 mg once daily; Glucocorticoid-induced, 5 mg once daily Paget’s disease, PO 40 mg
daily for 6 mo; repeated if necessary
SIDE EFFECTS:  CNS: headache. GI: abdominal pain, constipation, nausea, vomiting,
esophageal ulceration, acid reflux, dyspepsia, esophageal perforation, diarrhea. META:
hypophosphatemia, hypocalcemia. MS: bone pain, osteonecrosis of the jaw. SYST:
angioedema, Stevens-Jonshon syndrome, toxic epidermal necrolysis.
NURSING CONSIDERATIONS:  assess: serious actions: angioedema, Stevens-Johnson
syndrome, toxic epidermal necrolysis. Hormonal status if a woman, prior to treatment.
For osteoporosis: bone density test before and ruing treatment. For Paget’s disease:
increased skull size, bone pain, headache; decreased vision, hearing. Electrolytes; renal
output, increasing edema. Hepatic studies: ALT, AST, bilirubin, periodically during
long-term therapy. Edema, hypertension, cardiac symptoms, jaundice,
thromboembolism. Mental status: affect, mood, behavioral changes, depression.
Hypercalcemia. Administer: titrate does; use lowest effective dose. In one Dose in AM.
With food or milk to decrease GI symptoms. At same time of day; do not interrupt
between pill packs. Perform/provide: storage in dark area. Evaluate: therapeutic
response: decreased abnormal uterine bleeding, absence of amenorrhea. Teach
patient/family: about cushingoid symptoms. To report breast lumps, vaginal bleeding,
amenorrhea, edema, jaundice, dark urine, clay-colored stools, dyspnea, headache, blurred
vision, abdominal pain, numbness or stiffness in legs, check pain; men to report
impotence or gynecomastia. To take at same time of day; do not interrupt between pill
packs. To report suspected pregnancy immediately, to wait ≥3 mo after stopping
medication to become pregnant. To avoid smoking; CV reactions may occur. Product
does not protect against HIV, STDs. That product may mask onset of menopause.
Function studies,; Ca, P, Mg, K. for hypercalcemia: paresthesias, twitching,
laryngospasm, Chvostek’s, Trousseau’s signs. Alk phos levels, baseline and periodically,
2 x upper limit of normal is indicative of Paget’s disease. Dental status: regular dental
exams should be done. Administer: for 6 months to be effective in Paget’s disease; take
with8 ox of water 30 min before 1st food, beverage, or medication of the day.
Perform/provide: storage in cool environment, out of direct sunlight. Evaluate:
therapeutic response: increased bone mass, absence of fractures. Teach patient/family: to
remain upright for 30 min after dose to prevent esophageal irritation, if dose is missed,
skip dose, do not double doses or take later in day. To take in AM before food, other
meds, take with 6-8 oz of water only (no mineral water). To take calcium, vit D if
instructed by health care provider. To use weight-bearing exercise to increase bone
density. To let health care provider know if pregnant or if pregnancy is planned or if
breastfeeding.
GENERIC NAME: medroxyprogesterone    TRADE NAME:  depo-provera  
CLASSIFICATION:  antineoplastic, hormone, contraceptive
USES:  hot flashes, symptoms of menopause; paraphilia (men), hot flashes (men), in
prostate cancer
DOSAGE & ROUTE:  Dysfunctional uterine: bleeding: PO 5–10 mg daily for 5–10 d
beginning on 16th or 21st d of cycle. IM 400–1000 mg weekly until improvement, then
400 mg monthly
SIDE EFFECTS:  CNS: dizziness, migraines, fatigue, depression, headache. CV:
hypotension, thrombophlebitis, edema, thromboembolism, stroke, PE, MI. EENT:
diplopia. GU: amenorrhea, cervical erosion, break-through bleeding, dysmenorrheal,
vaginal candidiasis, breast changes, gynecomastia, testicular atrophy, impotence,
endometriosis, spontaneous abortion. GI: nausea, vomiting, anorexia, cramps, increased
weight, cholestatic jaundice, abdominal pain. INTEG: rash, urticaria, acne, hirsutism,
alopecia, oily skin, seborrhea, purpura, melasma, photosentivity. META: hyperglycemia.
MS: decreased bone density. SYST: angioedema, anaphylaxis
NURSING CONSIDERATIONS:  assess: symptoms indicating severe allergic reaction,
angioedema, have epinephrine and rescusitative equipment available. Weight daily;
notify prescriber of weekly weight gain >5 lb; bone mineral density. B/P at beginning
GENERIC NAME: Choriogonadotropin alfa    TRADE NAME:  Ovidrel  
CLASSIFICATION:  ovulation stimulant.
USES:  female infertility in selected patients
DOSAGE & ROUTE:  adult: To induce ovulation, IM 5000–10,000 units in one dose, 1
d after treatment with menotropins. Child: To induce ovulation, IM 5000–10,000 units in
one dose, 1 d after treatment with menotropins
SIDE EFFECTS:  CARDIOVASCULAR: tachycardia, phlebitis, deep vein thrombosis,
hypovolemia. CNS: dizziness, headache, flushing, depression, restlessness, anxiety,
nervousness, fatigue. GI: nausea, bloating, constipation, abdominal pain, vomiting,
anorexia. MISC: urticaria, ovarian hyperstimulation, multiple pregnancies, blurred
vision, diplopia, photophobia, breast pain, fever.
NURSING CONSIDERATIONS: Assess: Assess for disorders for which hypothalamic
and pituitary hormones are given: For children with impaired growth, assess height and
weight (actual and compared with growth charts) and diagnostic x-ray reports of bone
age. For clients with diabetes insipidus, assess baseline blood pressure, weight, ratio of
fluid intake to urine output, urine specific gravity, and laboratory reports of serum
electrolytes. For clients with diarrhea, assess number and consistencyof stools per day as
well as hydration status.
Of treatment and periodically. I&O ratio; be alert for decreasing urinary output,
increasing edema. Hepatic studies: ALT, AST, bilirubin, periodically during long-term
therapy. Edema, hypertension, cardiac symptoms, jaundice. Mental status: affect, mood,
behavioral changes, depression. Administer: titrated dose; use lowest effective dose. Oil
solution deep in large muscle mass (IM); rotate sites. With food or milk to decrease GI
symptoms (PO). Perform/provide: storage in dark area. Evaluate: therapeutic response:
decreased abnormal uterine bleeding, absence of amenorrhea. Teach patient/family: to
avoid sunlight or use sunscreen; photosensitivity can occur. Cushingoid symptoms:
weight gain, moon face, buffalo hump, acne. To report breast lumps, vaginal bleeding,
edema, jaundice, dark urine, clay-colored stools, dyspnea, headache, blurred vision,
abdominal pain, sudden change in speech/coordination, numbness or stiffness in legs,
chest pain; male to report impotence or gynecomastia. To report suspected pregnancy;
fertility returns in 6-12 months after discontinuing. Long-term use decreases bone
density; exercise and calcium supplements can help lessen this.
Nursing Diagnoses: Deficient Knowledge: Drug administration and effects
Altered Growth and Development Anxiety related to multiple injections Risk for
Injury: Adverse drug effects. Planning/Goals: The client will: Experience relief
of symptoms without serious adverse effects Take or receive the drug accurately
Comply with procedures for monitoring and follow-up. Interventions: For
children receiving growth hormone, assist the family to set reasonable goals for
increased height and weight and to comply with accurate drug administration and
follow-up procedures (periodic x-rays to determine bone growth and progress
toward epiphyseal closure, recording height and weight at least weekly). For
clients with diabetes insipidus, assist them to develop a daily routine to monitor
their response to drug therapy (eg, weigh themselves, monitor fluid intake and
urine output for approximately equal amounts, or check urine specific gravity
[should be at least 1.015] and replace fluids accordingly). Evaluation: Interview
and observe for compliance with instructions for taking the drug(s). Observe for
relief of symptoms for which pituitary hormones were prescribed.
GENERIC NAME: fluoxymesterone    TRADE NAME:  androxy  
CLASSIFICATION:  hormone-androgen
USES:  inoperable female breast cancer, male hypogonadism, delayed male puberty
DOSAGE & ROUTE:  androgen replacement in male hypogonadism – adult: PO 5
mg 1-4 x/day, may increase dose, max 40 mg/day. Delayed male puberty – adult and
adolescent: PO 2.5-10 mg/day x 4-6 mo, max 20 mg/day. Inoperable female breast
cancer – adult: PO 10-40 mg/day in divided doses, continue for ≥2-3 mo
SIDE EFFECTS:  CNS: heart failure. GI: hepatitis. GU: amenorrhea, feminization,
virilization, prostatic hypertrophy, priapism, oligospermia, oligomenorrhea,
gynecomastia. HEMA: coagulation disorders (clotting factors II, V, VII, X). INTEG:
alopecia, acne, hirsutism, seborrhea. MISC: edema, hypercalcemia.
NURSING CONSIDERATIONS:  assess: weight daily; notify prescriber if weekly
weight gain is >5 lb. I&O ratio; be alert for decreasing urinary output, increasing edema.
Growth rate in children; growth rate may be uneven (linear/bone growth) with extended
use. Electrolytes: K, Na, Cl, Ca; cholesterol. Hepatic studies: ALT, AST, bilirubin.
Edema, hypertension, cardiac symptoms. Signs of masculinization in female: in creased
libido, deepening of voice, decreased breast tissue, enlarged clitoris, menstrual
GENERIC NAME: dextromethorphan    TRADE NAME:  robitussin pediatric, sucret  
cough control, vicks formula 44 cough relief
CLASSIFICATION:  antitussive, nonopioid
USES:  nonproductive cough
DOSAGE & ROUTE:  adult/child ≥12 yr: PO 10-20 mg q4hr, or 30 mg q6-8hr, not to
exceed 120 mg/day; SUS-REL LIQ 60 mg q12hr, not to exceed 120 mg/day. Child 6-
12yr: PO 5-10 mg q4hr; SUS-REL LIQ 30 mg bid, LOZ 5-10 mg q1-4hr; max 60
mg/day. Child 2-6yr: PO 2.5-5 mg q4hr, or 7.5 mg q6-8hr, max 30 mg/day; SUS REL
LIQ 15 ml bid.
SIDE EFFECTS:  CNS: dizziness, sedation, confusion, ataxia, fatigue. GI: nausea.
NURSING CONSIDERATIONS:  assess: cough: type, frequency, character, including
sputum. Administer: decreased dose to geriatric patients; metabolism may be slowed.
Perform/provide: increased fluids to liquefy secretions. Humidification of patient’s
room. Evaluate: therapeutic response: absence of cough. Teach patient/family: to avoid
driving, other hazardous activities until patient is stabilized on this medication. To avoid
smoking, smoke-filled rooms, perfumes, dust, environmental pollutants, cleaners that
increase cough. To avoid alcohol, CNS depressants. To notify prescriber if cough
persists over a few days.
irregularities; male: gynecomastia, impotence, testicular atrophy. Hypercalcemia:
lethargy, polyuria, polydipsia, nausea, vomiting, constipation; product may have to be
Decreased. Hypoglycemia in diabetics; oral antidiabetic action is increased. Administer:
as a single dose or up to 4x/day. Perform/provide: storage at controlled room temperature
(68o – 77oF). Evaluate: therapeutic response: decreased advance of inoperable female
breast cancer, male puberty. Teach patient/family: to notify prescriber if therapeutic
response decreases; if edema occurs. About changes in sex characteristics. That women
should report menstrual irregularities, voice changes, acne, facial hair growth. To notify
prescriber if pregnancy is planned or suspected; use contraception while taking product.
That 2-3 mo course is necessary to determine objective treatment in breast cancer. To
report signs/symptoms of hepatic disorder.
GENERIC NAME: sildenafil    TRADE NAME:  revatio, viagra
CLASSIFICATION:  erectile agent, antihypertensive, peripheral vasodilator
USES:  treatment of erectile dysfunction, pulmonary hypertension
DOSAGE & ROUTE:  PO 25-100 mg 1 h before sexual activity, no more than once
daily.
SIDE EFFECTS:  CNS: headache, flushing, dizziness, transient global amnesia. CV: MI,
sudden death, CV collapse. MISC: dyspepsia, nasal congestion, UTI, abnormal vision,
diarrhea, rash, nonarteritic ischemic optic neuropathy, hearing loss, priapism
NURSING CONSIDERATIONS:  assess: for any severe loss of vision while taking this
or any similar products; these products should not be used. Use of organic nitrates that
should not be used with this product. Cardiac status in pulmonary hypertension: B/P,
pulse. ADMINISTER: approximately 1 hr before sexual activity; do not use more than
once a day. Evaluate: therapeutic response: decreasing pulmonary hypertension; ability
to perform sexually (male). Teach patient/family: that product does not protect against
sexually transmitted disease, including HIV. That product absorption is reduced with a
high-fat meal. That product should not be used with nitrates in any form. That abs may
be split. To notify prescriber immediately and stop taking product if vision loss occurs,
or erections >4 hr.
GENERIC NAME: aminophylline    TRADE NAME:  phyllocontin, truphylline  
CLASSIFICATION:  bronchodilator, spasmolytic
USES:  bronchial astma, bronchospasm associated with chronic bronchitis, emphysema,
bradycardia, apnea in iinfancy for respiratory/myocardial stimulation
DOSAGE & ROUTE:  Adults and children up to 16 years of age, loading dose: Equivalent of 5-6
mg of anhydrous theophylline/kg. Bronchodilator, acute attacks, in clients currently receiving
theophylline. Adults and children up to 16 years of age: If possible, a serum theophylline level
should be obtained first. Then, base loading dose on the premise that each 0.5 mg theophylline/kg
lean body weight will result in a 0.5-1.6-mcg/mL increase in serum theophylline levels. If
immediate therapy is needed and a serum level cannot be obtained, a single dose of the equivalent
of 2.5 mg/kg of anhydrous theophylline can be given. Maintenance in acute attack, based on
equivalent of anhydrous theophylline. Young adult smokers: 4 mg/kg q 6 hr; healthy,
nonsmoking adults: 3 mg/kg q 8 hr; geriatric clients or clients with cor pulmonale: 2 mg/kg q 8 hr;
clients with CHF or liver failure: 2 mg/kg q 8-12 hr. Pediatric, 12-16 years: 3 mg/kg q 6 hr; 9-12
years: 4 mg/kg q 6 hr; 1-9 years: 5 mg/kg q 6 hr; 6-12 months: Use the formula: dose (mg/kg q 8
hr) = (0.05) (age in weeks) + 1.25; up to 6 months: Use the formula: dose (mg/kg q 8 hr) = (0.07)
(age in weeks) + 1.7. Chronic therapy, based on equivalent of anhydrous theophylline. Adults,
initial: 6-8 mg/kg up to a maximum of 400 mg/day in three to four divided doses at 6-8-hr intervals;
then, dose can be increased in 25% increments at 2-3 day intervals up to a maximum of 13 mg/kg
or 900 mg/day, whichever is less.
Bronchodilator, acute attack, for clients currently on theophylline. Adults and children up to   patients. Monitory I&O; diuresis occurs; dehydration may occur in geriatric patients or children.
16 years, loading dose based on anhydrous theophylline: If possible, a serum theophylline level
should be obtained first. Then, base loading dose on the premise that each 0.5 mg theophylline/kg
lean body weight will result in a 0.5-1.6 mcg/mL increase in serum theophylline levels. If
immediate therapy is needed and a serum level cannot be obtained, a single dose of the equivalent
of 2.5 mg/kg of anhydrous theophylline can be given. Maintenance for acute attacks, based on
equivalent of anhydrous theophylline. Young adult smokers: 0.7 mg/kg/hr; nonsmoking, healthy
adults: 0.43 mg/kg/hr; geriatric clients or clients with cor pulmonale: 0.26 mg/kg/hr; clients with
CHF or liver failure: 0.2 mg/kg/hr. Pediatric, 12-16 years, nonsmokers: 0.5 mg/kg/hr; 9-12 years,
0.7 mg/kg/hr; 1-9 years, 0.8 mg/kg/hr; up to 1 year, Based on the following formula: dose
(mg/kg/hr) = (0.008) (age in weeks) + 0.21.
SIDE EFFECTS:  CNS: anxiety, restlessness, insomnia, dizziness, seizures, headache, light-
headedness, muscle twitching, tremors. CV: palpitations, sinus tachycardia, hypotension, flushing,
dysrhythmias, edema. GI: nausea, vomiting, diarrhea, dyspepsia, anal irritation (suppositories),
epigastric pain, reflux, anorexia. GU: urinary frequency, SIADH. INTEG: flushing, urticaria.
MISC: hyperglycemia. RESP: tachypnea, increased respiratory rate.
2 L/day to decrease secretion viscosity. To avoid smoking; decreases blood levels and terminal
half-life.
NURSING CONSIDERATIONS:  assess: theophylline blood levels (therapeutic level is 10-20
mcg/ml); toxicity may occur with small increase above 20 mcg/ml, especially in geriatric
Pediatric, initial: 16 mg/kg up to a maximum of 400 mg/day in three to four divided doses at 6-8 hr
intervals; then, dose may be increased in 25% increments at 2-3 day intervals up to the following
maximum doses (without measuring serum theophylline): 16 years and older: 13 mg/kg or 900
mg/day, whichever is less; 12-16 years: 18 mg/kg/day; 9-12 years: 20 mg/kg/day; 1-9 years: 24
mg/kg/day; up to 12 months, Use the following formula: dose (mg/kg/day) = (0.3) (age in weeks) +
8.0. •Enteric-Coated Tablets Bronchodilator, chronic therapy, based on equivalent of
anhydrous theophylline. Adults, initial: 6-8 mg/kg up to a maximum of 400 mg/day in three to
four divided doses at 6-8-hr intervals; then, dose may be increased, if needed and tolerated, by
increments of 25% at 2-3 day intervals up to a maximum of 13 mg/kg/day or 900 mg/day,
whichever is less, without measuring serum theophylline. Pediatric, over 12 years of age, initial: 4
mg/kg q 8-12 hr; then, dose may be increased by 2-3 mg/kg/day at 3- day intervals up to the
following maximum doses (without measuring serum levels): 16 years and older: 13 mg/kg/day or
900 mg/day, whichever is less; 12-16 years: 18 mg/kg/day. Enema For use as a bronchodilator for
loading doses and for maintenance in acute attacks, see doses for oral solution and tablets. •IV
Infusion Bronchodilator, acute attacks, for clients not currently on theophylline. Adults and
children up to 16 years, loading dose based on anhydrous theophylline: 5 mg/kg given over a
period of 20 min
Whether theophylline was given recently (24hr). respiratory rate, rhythm, depth; auscultate lung
fields bilaterally; notify prescriber of abnormalities. Allergic reactions: rash, urticaria; if these
occur, product should be discontinued. Administer: avoid IM inj; pain and tissue damage may
occur. PO ROUTE – do not break, crush, or chew enteric-coated or cont rel tabs. Avoid giving
with food. RECTAL ROUTE: if patient is unable to take PO, retain rectal dose for ½ hr. remain in
bed 15-20 min after rect supp is inserted to avoid removal. IV ROUTE: only clear sol; flush IV line
before dose. May be diluted for IV INF in 100-200 ml in D5W, D10W, D20W, 0.9% NaCl, 0.45%
NaCl, LR. Give loading dose over ½ hr; max rate of inf 25 mg/min, use infusion pump; after
loading dose give by cont inf. Perform/provide: storage of dilutd solution for 24 hr if refrigerated.
Evaluate: therapeutic response: decreased dyspnea, respiratory stimulation in infancy, clear lung
fields bilaterally. Teach patient/family: to take doses as prescribed, not to skip dose, not to double
dose. To check OTC medications, current prescription medications for ephedrine; will increase
CNS stimulation; not to drink alcohol or caffeine products (tea, coffee, chocolate, colas). To avoid
hazardous activities; dizziness may occur. If GI upset occurs, to take product with 8 oz water;
avoid food, since absorption may be decreased. To notify prescriber of toxicity: insomnia, anxiety,
nausea, vomiting, rapid pulse, seizures, flushing, headache, diarrhea; notify prescriber immediately.
To notify prescriber of change in smoking habit; a change in dose may be required. To increase
fluids to
GENERIC NAME: theophylline    TRADE NAME:  theo-dur, accurbron  
CLASSIFICATION:  brondhodilator
USES:  bronchial asthma, bronchospasm of COPD, chronic bronchitis, emphysema
DOSAGE & ROUTE:  hepatic dose – adult: PO 6 mg/kg loading dose, then 2 mg/kg
q8hr x 2 doses, then 1-2 mg/kg q12hr; IV 4.7 mg/kg, then 0.39 mg/kg/hr for 12 hr, then
0.08-0.16 mg/kg/hr maintenance. Bronchospasm, bronchial asthma – adult: PO 100-
200 mg q6hr; dosage must be individualized; max 800 mg/day. Child: PO 50-100 mg
q6hr, max 12 mg/kg/24 hr. COPD, chronic bronchitis – adult: PO 300-800 mg q6-8hr
after meals. Child 1-9yr: PO 5 mg/kg loading dose, then 4 mg/kg q6hr. child 9-16yr: PO
5 mg/kg loading dose, then 4 mg/kg q6hr. apnea of prematurity – neonate: 2-10
mg/kg/day divided q8-12hr (usual loading dose is 4 mg/kg PO).
SIDE EFFECTS:  CNS: anxiety, restlessness, insomnia, dizziness, seizures, headache,
light-headednes, muscle twitching, remors. CV: palpitations, sinus tachycardia,
hypotension, dysrhythmias, fluid retention with tachycardia. ENDO: hyperglycemia. GI:
nausea, vomiting, anorexia, diarrhea, bitter taste, dyspepsia, gastric distress. INTEG:
flushing, urticaria. MISC: SIADH, urinary frequency. RESP: increased rate, tachypnea.
NURSING CONSIDERATIONS: assess: theophylline blood levels (therapeutic level is
5-15 mcg/ml); toxicity may occur with small increase above 10 mcg/ml. monitor I&O;
GENERIC NAME: zileuton    TRADE NAME:  zyflo  
CLASSIFICATION:  antileukotriene
USES:  oral prophylaxis and long-term treatment of asthma.
DOSAGE & ROUTE:  adult/child ≥12: PO 600 mg qid
SIDE EFFECTS:  The side effects mentioned here, if arise should be informed to your
prescriber or health care professional as soon as it occurs: chest pain, difficulty breathing,
wheezing, flu-like symptoms (chills, fatigue, fever, muscle aches), nausea, pruritus, skin
rash or itching, unusual weakness or tiredness, yellowing of the skin. The side effects that
usually do not require medical attention include: back pain, dizziness, drowsiness,
dyspepsia, headache, insomnia, numbness or tingling in the hands or feet, stomach pain
and weakness.
NURSING CONSIDERATIONS:  Assessment: History: Hypersensitivity to zileuton;
impaired hepatic function; lactation; pregnancy; acute asthma or bronchospasm. Physical:
T; orientation, reflexes; R, adventitious sounds; GI evaluation; liver function tests
Interventions: Obtain baseline hepatic function tests before beginning therapy; monitor
liver enzymes on a regular basis during therapy; discontinue drug and consult prescriber
if enzymes rise more than three times normal. Administer without regard to food. Ensure
Diuresis occurs; geriatric patients or children may be dehydrated. Signs of toxicity:
irritability, insomnia, restlessness, tremors, nausea, vomiting. Respiratory rate, rhythm,
depth; auscultate lung fields bilaterally; notify prescriber of abnormalities. Allergic
reactions: rash, urticaria; product should be discontinued. Administer: do not break,
crush, chew, or dissolve time-release products. PO wit 8 oz of water for GI symptoms;
avoid food; absorption may be affected; take dose consistently; do not take Theo-24 with
meals. Contents of bead-filled capsule sprinkled over food for children’s use. Check
OTC medications, current prescriptions for ephedrine, which will increase stimulation.
IV ROUTE: loading dose over 20-30 min, max 20-25 mg/min; do not give by rapid IV,
use only cont inf. Evaluate: therapeutic response: ability to breathe more easily. Teach
patient/family: to check OTC medications, current prescription medications for
ephedrine, which will increase stimulation; to avoid alcohol, caffeine. To avoid hazardous
activities; dizziness may occur. That if GI upset occurs, to take product with 8 oz of
H2O; avoid food; take at same time of day; absorption may be decreased. To notify
prescriber of toxicity: nausea, vomiting, anxiety, insomnia, seizures. To notify prescriber
of change in smoking habit; dosage may have to be changed.
that drug is taken continually for optimal effect. Do not administer for acute asthma
attack or acute bronchospasm. Teaching points: Take this drug regularly as prescribed; do
not stop taking this drug during symptom-free periods; do not stop taking this drug
without consulting your health care provider. Continue taking any other antasthmatics
that have been prescribed for you. Do not take this drug for an acute asthma attack or
acute bronchospasm; this drug is not a bronchodilator; routine emergency procedures
should be followed during acute attacks. Avoid the use of over-the-counter drugs while
you are using this medication; many of them contain products that can interfere with or
cause serious side effects when used with this drug. If you feel that you need one of these
products, consult your nurse or physician. These side effects may occur: Dizziness (use
caution when driving or performing activities that require alertness); nausea, vomiting
(eat frequent small meals; take drug with food); headache (analgesics may be helpful).
Report fever, acute asthma attacks, flulike symptoms, lethargy, pruritus, changes in color
of urine or stool.