PATIENT MEDICATIONS

Medication (Trade & Action and Uses for Dosage

Generic) Classification Your Patient (Usual) Side Effects (5) Nursing Implementation
(own terminology) and Ordered

Acetaminophen Reduces pain and Usual dose: 650 Risk of severe liver Before and during long term therapy, monitor liver
fever through COX1 & mg every 4 to 6 injury if combined with function: AST, ALT, bilirubin, creatinine.
COX2 inhibition hr PRN excessive alcohol use.

Ordered dose: Skin reactions, Ensure that the daily dose from all sources does not
325 mg tablet, 2 Stevens-Johnson exceed maximum daily limits.
tablets PO syndrome, toxic
every 4 hr PRN epidermal necrolysis

Antipyretic, analgesic Abdominal pain, Monitor for signs of hepatotoxicity such as bleeding,
nausea, vomiting easy bruising, malaise

Hemolytic anemia Monitor renal function in patient on long term therapy.

Dosage not to Antidote:

exceed 3gm/24 Acetylcysteine
hrs (Mucomyst)

Aspirin (Acetylsalicylic COX inhibitor. Usual dose: 75 - Gastric ulceration Ask for tinnitus. This usually occurs when blood
acid, ASA) 81 mg/day aspirin levels exceed maximum dosage for
therapeutic effects.

Anti-inflammatory, anti- To reduce risk of MI Ordered dose; Renal impairment Take with food or after meals to minimize GI upset.
platelet, antipyretic, and stroke in patients 81 mg
analgesic with chronic coronary 1 tablet PO at
artery disease bedtime

NSAID Prolonged bleeding Monitor for GI bleeding (bloody or tarry stool, coffee
time ground emesis)

Salicylism (tinnitus,
sweating, headache,
dizzy)

Aleve (Naproxen sodium) COX inhibitor Usual dose: 220 GI bleeding and Monitor for GI bleeding. Give with food to minimize
mg every 8 to ulceration risk
12 hr
Analgesic, anti-inflammatory, To relieve mild to Ordered dose: Renal impairment Monitor BUN and serum creatinine
antipyretic moderate 220 mg
musculoskeletal 2 tablets PO
inflammation or pain twice a day

NSAID Heart failure, Monitor blood pressure, and watch for eater retention
Hypertension, fluid due to naproxen’s sodium content
retention

Hemolytic anemia Monitor CBC for decreased hemoglobin and

hematocrit

Skin reactions Assess skin regularly for signs of hypersensitivity

Aricept (Donepezil HCl)
Cholinesterase inhibitor Usual dose: GI: Nausea, vomiting For patient with history of gastric irritation, Aricept
- reduces/prevents 10 mg at dyspepsia, diarrhea may aggravate condition. Monitor for gastric bleeding
acetylcholine bedtime (black, tarry stools)
breakdown in brain
tissue, thereby
increasing availability
at cholinergic
synapses.

Antidementia To treat mild to Ordered dose: Bradycardia, fainting, Monitor heart rate, rhythm for bradycardia. Take
moderate Alzheimer’s 10 mg falls, dizziness safety precautions for dizziness
disease 1 tablet at
bedtime

Headache
Namenda (Memantine HCl) NMDA receptor Usual dose: 10 Hepatic failure, Monitor patients with severe hepatic impairment
antagonist – modulates mg daily in two hepatitis because drug may increase risk of adverse reactions,
the effects of glutamate divided doses monitor LFTs.
at NMDA receptors.
The NMDA receptor
regulates Calcium entry
into neurons. Binding of
glutamate to the
receptor promotes
calcium influx. The brief
period of Ca entry
constitutes a “signal” in
the learning and
memory process.

Antidementia Indicated for moderate Ordered dose: Headache Monitor blood pressure.
or severe Alzheimer’s 10 mg
Disease 1 tablet PO in
the morning

Slows functional Confusion Caution to stand up slowly and change position

decline. slowly.

Constipation

Dizziness

Vitamin C (Ascorbic Acid) Participates in multiple Usual dose: 25 Nausea Monitor patient for GI disturbances
biochemical reactions to 1000 mg
(synthesis of adrenal
steroids, conversion of
folic acid, regulation of
respiratory cycle in
mitochondria,
production of collagen,
antioxidant, absorption
of dietary iron)

Ordered dose: Abdominal cramps

500 mg tablet
1 tablet PO in
the morning
 Indication is deficiency Diarrhea

Flushing

Headache

Buspirone HCl MOA not established. Usual dose: Dizziness Institute safety precautions because of possible CNS
Thought to bind with 5, 10, 15 and 30 reactions (position changes, fall risk)
high affinity to mg.
receptors for serotonin Maximum of 60
and with lower affinity mg/day
to receptors for
dopamine.

Anxiolytic To manage anxiety Ordered dose; Nausea Monitor BP

10 mg tablet
1 tablet PO at
bedtime

Headache

CNS: Nervousness,
sedation,
lightheadedness,
excitement

Cipro (Ciprofloxacin HCl) MOA: inhibits two Usual dose: GI: nausea, vomiting, Obtain culture & sensitivity test results as ordered,
bacterial enzymes; 500 mg diarrhea, abdominal before giving ciprofloxacin.
DNA gyrase and pain
topoisomerase IV,
which are needed for
DNA replication and
cell division.

Antibiotic Active against broad Ordered dose: CNS: dizziness, Assess hematologic, hepatic and renal functions
spectrum of bacteria. 500 mg tablet headache, periodically, as ordered.
1 tablet PO restlessness,
twice a day confusion
(Fluoroquinolone) To treat UTI caused by Geriatric: Assess for signs of rash or other hypersensitivity
susceptible organism. Risk of confusion,
somnolence,
psychosis, visual
disturbance

Tendon injury Monitor closely for changes in mood or behavior that

may be caused by ciprofloxacin-induced depression
or worsening psychotic reactions.

phototoxicity Caution to avoid excessive exposure to sunlight

Co-Enzyme Q10 Antioxidant that serves Usual dose: GI: gastritis, reduced Mild interaction with Pravastatin
vital role in cellular 50 – 200 mg appetite, nausea,
energy production. daily diarrhea
With age CoQ-10
levels decrease.

Antioxidant Used to treat heart Ordered dose; Hypotension Monitor LFTs

failure, muscle injury Capsule 200 mg
caused by HMG-CoA 1 capsule PO
reductase inhibitors once a day
(statins)

Skin reactions Monitor BP

Elevated LFTs Assess for skin reactions

Dulcolax Suppository Stimulates peristalsis Usual dose: Rectal burning Mild interaction with Potassium chloride
(Bisacodyl) and softens feces by 10 mg sensation
increasing secretion of suppository
water and electrolytes once daily
into the intestine and
decreasing water and
electrolyte absorption

Stimulant laxative To treat constipation Ordered dose: Prolonged use may Monitor for fluid imbalance and increase fluid intake
1 suppository cause proctitis
rectally PRN (at
bedtime)
If no result from
Milk of
Magnesia
 Electrolyte and fluid Monitor for electrolyte imbalances, potassium.
imbalance

Abdominal cramping

Nausea

Melatonin Melatonin is a hormone Usual dose: Hangover Monitor for change in mood and behavior.
that helps regulate
circadian rhythm
(melatonin receptors on
the suprachiasmatic
nucleus, the anatomic
site of the circadian
cock, mediate clock
resetting by exogenous
melatonin)

Hormone Used for insomnia, by Ordered dose: Headache Monitor temperature

promoting sleep 5 mg tablet
(labelled as dietary 2 tablets PO at
supplement, not FDA bedtime (10 mg
regulated total)

Nightmares

Hypothermia

Transient depression

Milk Thistle One of the active GI: nausea, diarrhea, Monitor LFTs
ingredients in milk indigestion, intestinal
thistle is silymarin, gas, bloating, fullness
which is extracted from or pain, and loss of
the plant's seeds. appetite
Silymarin is a flavonoid
believed to have
antioxidant properties.

(not FDA regulated) Labelled as dietary Ordered dose: Pruritus

supplement to treat 140 mg PO in
loss of appetite, the morning
dyspepsia and liver
conditions.
 Headache

Estrogenic effects

Anaphylaxis

Milk of Magnesia Osmotic action retains Usual dose: Loss of fluids Increase fluid intake to avoid dehydration
Suspension (Magnesium water and thereby 15 – 30 mL
hydroxide) softens the feces; fecal daily, increased
swelling promotes to 60 mL if
peristalsis. needed

Osmotic laxative To treat constipation Ordered dose: CNS: confusion, Before giving as laxative, shake oral solution well and
30 mL PO every decreased reflexes give with a large amount of water
72hr PRN
If no bowel
movement for 3
days

CV: arrythmias, Observe for and report early evidence of

hypotension hypermagnesemia: bradycardia, depressed deep
tendon reflexes, diplopia, dyspnea, flushing,
hypotension, nausea, slurred speech, vomiting and
weakness

GI: flatulence,
vomiting

Muscle cramps
Remeron (Mirtazapine) Benefits derive from Usual dose: Somnolence May lower serum sodium in elderly patients – monitor
increased release of 5- 15 – 45 mg/day serum sodium.
HT and NE. The
mechanism is blockade
of presynaptic alpha2-
adrenergic receptors
that serve to inhibit
release.
Mirtazapine is a
powerful blocker of two
serotonin receptor
subtypes: 5-HT2 and 5-
HT3
Blocks histamine
receptors and thus
promotes sedation and
weight gain.

Antidepressant To treat major Ordered dose: Weight gain, Monitor for signs and symptoms of serotonin
depression 7.5 mg tablet increased appetite, syndrome – alteration in vital signs, GI symptoms,
1 tablet PO at elevated cholesterol mental status changes, neuromuscular abnormalities
bedtime

Neutropenia Monitor for infection (fever, pharyngitis, stomatitis)

which may be linked to a low WBC

Accommodation May cause mild pupillary dilation, which may lead to

disturbances an episode of acute closure glaucoma (Eye exam)

Hypotension Change position slowly to minimize the effects of

orthostatic hypotension

Potassium chloride ER Acts as a major cation Usual dose: CNS: confusion, Administer with or immediately after meals.
in intracellular fluid, 6.7 – 20 mEq paresthesia,
activating many three times a weakness
enzymatic reactions, day
essential for
physiologic processes,
including nerve impulse
transmission and
cardiac and skeletal
muscle contraction.
Electrolyte To treat hypokalemia Ordered dose: CV: arrythmias Monitor serum potassium level before and during
10 mEq tablet administration
1 tablet PO in
the morning

GI: abdominal pain, Regularly assess for signs of hypokalemia

bloody stools, GI (arrhythmias, fatigue, weakness) and for signs of
bleeding, nausea, hyperkalemia (arrhythmias, confusion, dyspnea,
vomiting paresthesia)

Dyspnea Monitor serum creatinine and urine output

Hyperkalemia

Pravastatin sodium HMG-CoA Reductase Usual dose: Memory loss Obtain laboratory values for total cholesterol, LDL
Inhibitor, the rate 40 – 80 mg at cholesterol, HDL cholesterol and TGs (VLDLs)
limiting enzyme in bedtime
cholesterol
biosynthesis

Antihyperlipidemic To prevent Ordered dose: hyperglycemia Obtain baseline LFTs and CK level
cardiovascular and 80 mg
coronary events in 1 tablet PO in
patients at risk, to treat the morning
hyperlipidemia

Myopathy/rhabdomyol Identify atherosclerotic cardiovascular disease

ysis (ASCVD) risk – advancing age , history of ASCVD
and hypertension.

hepatotoxicity Diet modification for elevated LDL cholesterol (limit

consumption to below 200 mg/day and saturated fat
to below 7% of caloric intake.

Report muscle aches or weakness

Protonix Delayed Release Proton pump inhibitor – Usual dose: GI: Diarrhea, If treatment lasts more than 3 years, patient may not
(Pantoprazole sodium) interferes with gastric 40 mg/day headache, dizziness, be able to absorb vitamin B12 because of achlorhydria
acid secretion by hypomagnesemia or hypochlorhydria. Treatment for cyanocobalamin
inhibiting the hydrogen- deficiency may be needed.
potassium-adenosine
triphosphate (H+-K+-
ATPase) enzyme
system in gastric
parietal cells.
Antiulcer, gastric acid proton To treat GERD and Ordered dose: GU: Elevated serum Monitor urine output and signs of blood in urine
pump inhibitor hypersecretory states 40 mg creatinine, interstitial because pantoprazole may cause acute interstitial
1 tablet PO nephritis nephritis
once daily

MS: arthralgia, Monitor for diarrhea from C. difficile which can occur
myalgia with or without antibiotics in patients taking
pantoprazole

Vitamin B12 Monitor for hypomagnesemia, serum Mg levels

deficiency weight
changes

Osteoporosis, Monitor for bone fractures

fractures
Note that cutaneous and systemic lupus
erythematosus have occurred within days to years
after proton pump therapy. Most common symptoms
presented were arthralgia, cytopenia and rash.

Risperidone Risperidone binds to Usual dose: Agranulocytosis, Warning: Be aware that risperidone should not be
multiple receptors. It is Initial: 0.5 mg anemia, leukopenia, used to treat elderly patients with dementia
a powerful 5-HT2 twice daily for neutropenia, related psychosis because it increases risk of
receptor antagonist and elderly patients, thrombocytopenia death in these patients
a less powerful D2 increased by 0.5
receptor antagonist. mg twice daily
Antagonism at both every wk as
sites underlies needed.
therapeutic effects.
Maximum: 3 mg
daily

Antipsychotic Relieves positive and Ordered dose: Hyperglycemia Monitor for orthostatic hypotension especially in
negative symptoms of 0.5 mg patients with cardiac or cerebrovascular disease
schizophrenia and 1 tablet PO
improves cognitive twice a day
function.

Dyslipidemia Monitor blood glucose and lipid levels

Agitation, dizziness, Monitor patients CBC

somnolence, Sedation

Orthostatic
hypotension
Senna Plus (Sennosides – Surfactant action Usual dose: Diarrhea, discolored Monitor for fluid imbalance and increase fluid intake
Docusate sodium) softens the stool by 2 tablets once urine, nausea,
facilitating penetration daily – 4 tablets vomiting, stomach
Docusate sodium 50 mg of water. twice daily cramps, throat
Sennosides 8.6 mg Stimulant laxatives irritation
stimulate peristalsis
and soften feces by
increasing secretion of
water into the intestine.

Stimulant laxative Relieves occasional Ordered dose: Allergic reactions (skin Increase fiber intake
constipation generally 2 tablets PO rash, itching, hives,
produces bowel twice a day swelling of the face,
movement in 6-12 lips, or tongue)
hours

Surfactant laxative muscle weakness Monitor for electrolyte imbalance

Trospium chloride Antagonizes the effects Usual dose: Dry mouth, blurred Administer 1 hr before meals or on empty stomach,
of acetylcholine on 20 mg twice vision as food delays absorption
muscarinic receptors in daily
the bladder. Trospium’s
parasympatholytic
action reduces the
tonus of smooth
muscle in the bladder.

Bladder antispasmodic To treat an overactive Ordered dose: GI: Stomach upset, May decrease GI motility; assess for constipation
bladder with symptoms 20 mg tablet constipation
of urge urinary 1 tablet PO
incontinence, urgency every morning
and urinary frequency and at bedtime

CNS: confusion, Monitor elderly patients closely for adverse reactions

dizziness, fatigue, as the elderly have an increased risk of trospium-
headache induced adverse reactions

anaphylaxis Monitor for anticholinergic CNS adverse effects such

as dizziness, confusion, hallucinations, somnolence
 GU: urine retention Monitor for urine retention

Vitamin B12 ER Vitamin B12 is essential Usual dose: Hypokalemia (muscle Monitor CBC
(Cyanocobalamin ER) for the synthesis of 1000 – 10,000 weakness,
DNA, and so is mcg/day arrhythmia)
required for the growth
and division of virtually
all cells.
Vitamin B12 helps
catalyze the conversion
of folic acid to its active
form. Active folic acid
then participates in
several reactions
essential for DNA
synthesis.

To treat Vitamin B12 Ordered dose: Increased erythrocyte Monitor plasma levels of Vitamin B12
deficiency. 1000 mcg ER production
tablet
1 tablet PO in
the morning

Because stomach acid A Schilling test may be ordered to assess Vitamin B12
is required to release absorption.
Vitamin B12 from foods,
the vitamin cannot be
absorbed if acid
secretion is significantly
reduced, as often
happens for older
adults taking acid-
suppressing drugs.

Monitor serum potassium levels and observe for

signs of potassium insufficiency
Vitamin D3 Vitamin D is essential Usual dose; Hypercalcemia: Monitor for signs of hypercalcemia
(Cholecalciferol) for bone health, owing Up to 10,000
to its effects on calcium IU/day
utilization. An important
regulator of calcium
and phosphorus
homeostasis.

To treat Vitamin D Ordered dose: Hypervitaminosis D: In severe hypercalcemia, monitor for polyuria,
deficiency Capsule 5000 Early symptoms – nocturia, proteinuria, seizures, confusion, ataxia
UNIT weakness, fatigue,
1 capsule PO in nausea, vomiting,
the morning anorexia, abdominal
cramping and
constipation

Nephrolithiasis

Osteoporosis (very
large doses)

Zyrtec (Cetirizine HCl) Second generation H1 Headache Administer with food to minimize GI upset
antagonist.
Antagonizes the effects
of histamine at H1-
receptor sites; does not
bind to or inactivate
histamine.
Anticholinergic effects
are minimal, and
sedation is dose-
related.

Antihistamine To treat mild allergies Ordered dose: Fatigue Assess lung sounds and character of bronchial
10 mg tablet secretions.
1 tablet PO in
the morning

Dry mouth Maintain fluid intake of 1500-2000 mL/day to

decrease viscosity of secretions.

Stomach pain Assess allergy symptoms before and during therapy.

 drowsiness

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