140 Must Know NCLEX Meds

Alteplase (t-PA)

class: thrombolytics

Indication: MI, acute ischemic stroke, occluded central lines

Action: converts plasminogen to plasmin which degrades the fibrin found

Nursing Considerations:

- contraindicated in active bleeding

-monitor for anaphylaxis

- use caution with uncontrolled hypertension

Atorvastatin (Lipitor)

class: lipid-lowering agent

Indication: management of high cholesterol (hypercholesterolemia), primary prevention of cardiovascular disease

Action: lowers total cholesterol as well as LDL while slightly increasing HDL. Inhibits HMG-CoA reductase which plays a role in the liver in cholesterol formation

Nursing Considerations

- contraindicated in active liver disease

- may cause rhabdomyolysis

- monitor serum cholesterol

- monitor liver function tests, renal function

Acetaminophen (Tylenol)

class: antipyretic, non-opioid analgesic

Indication: pain, fever

Action: inhibit the synthesis of prostaglandins which play a role in transmission of pain signals and fever response

Nursing Considerations:

- do not exceed 4g of acetaminophen per day

- overdose will lead to hepatotoxicity

- *Acetadote*is the antidote for overdose

- may increase risk for bleed with warfarin therapy

Acyclovir (Zovirax)

class: antiviral, purine analogues

Indication:genital herpes, herpes zoster, chicken pox

Action: interferes with viral DNA synthesis

Nursing Considerations:

- may cause seizures, renal failure, Stevens-Johnson syndrome, thrombotic thrombocytopenic purpura syndrome, diarrhea, dizziness, nausea

- monitor renal function

- assess lesions

- instruct patient to use proper protection during sexual intercourse

Albuterol (Proventil)

class: bronchodilator ,adrenergic

Indication:bronchodilator used to prevent airway obstruction in asthma and COPD

Action: binds to Beta2 adrenergic receptors in the airway leading to relaxation of the smooth muscles in the airways

Nursing Considerations:

- may decrease the effectiveness of Beta Blockers

-use caution with: heart disease, diabetes, glaucoma, seizure disorder

- overuse of inhalers can lead to bronchospasm

- monitor for chest pain and palpitations

- can decrease digoxin levels

Alendronate (Fosamax)

class: bone resorption inhibitor, biphosphnates

Indication: osteoporosis (aging, menopause, corticosteroid induced)

Action: inhibits osteoclast activity leading to inhibition of resorption of bone

Nursing Considerations:

- take first thing in the morning with full glass of water 30 min prior to eating

- assess serum calcium and vitamin D

- may lead to muscle pain

Alprazolam (Xanax)

class: benzodiazepine, anti-anxiety agent

Indication:anxiety, panic disorder, manage symptoms of PMS, insomnia, mania, psychosis

Action: works in CNS to produce anxiolytic effect causing CNS depression.

Nursing Considerations:

- may cause CNS depression, drowsiness, lethargy

- may lead to physical dependence

- assess anxiety and mental status

- Flumazenil is the antidote for overdose

- Grapefruit juice may increase blood levels

Amiodarone (Cordarone)

class: Antiarrhythmic class III, Potassium channel blocker

Indication: ventricular arrhythmias, SVT, ACLS protocol for v-fib and vTACH

Action: prolongs action potential, inhibits adrenergic stimulation, slows rate, decreases peripheral vascular resistance causing vasodilation

Nursing Considerations:

- may lead to ARDS, pulmonary toxicity, CHF, bradycardia, hypotension

- increases risk for QT prolongation

- increases digoxin levels

- increases activity of warfarin

- monitor EKG

- assess for signs and symptoms of ARDS

- monitor liver function test

- check dosage with another RN

- avoid drinking grapefruit juice

Amitryptiline (Elavil)

class: tricyclic antidepressant

Indication: depression, anxiety, insomnia

Action: increases effect of serotonin and norepinephrine in the CNS, exhibits anticholinergic effects

Nursing Considerations:

- contraindicated in MI, heart failure, QT prolongation, glaucoma

- may increase risk for suicidal ideation

- may cause arrhythmias, hypotension, EKG changes

- may cause alterations in blood glucose levels

- may lead to general sedation and lethargy

- do not use within 2 weeks of MAOIs

- monitor for orthostatic hypotension

- may lead to photosensitivity, instruct patient to use sunscreen

- may turn urine blue/green color

Amlodipine (Norvasc)

class: Ca channel blocker, antihypertensive

Indication: hypertension, angina

Action: blocks transport of calcium into muscle cells inhibiting excitation and contraction

Nursing Considerations:

- may cause gingival hyperplasia

- grapefruit juice may increase drug level

- monitor blood pressure and pulse

- monitor intake and output

- assess for signs of CHF

- assess characteristics of angina

- instruct patient of interventions for hypertension and how to take BP

Amoxicillin (Moxatag)

class: anti-infectives, antiulcer agent, aminopenicillins

Indication: skin infections, respiratory infections, sinusitis, endocarditis prophylaxis, lime disease

Action: Inhibits synthesis of bacterial cell wall leading to cell death.

Nursing Considerations:

- Contraindicated with penicillin allergy

- may cause seizures

- assess for rash, anaphylaxis

- excreted by kidneys - monitor renal labs

- monitor patient for diarrhea - bloody stool should be reported immediately

Ampicillin (Principen)

class: aminopenicillin, anti-infective

Indication: skin infections, soft tissue infections, otitis media, sinusitis, respiratory infections, GU infections, meningitis, septicemia

Action: bactericidal, broader spectrum than penicillin, binds to cell wall leading to bacterial cell death

Nursing Considerations:

- contraindicated in penicillin allergy, use caution in renal insufficiency

- may lead to seizures, diarrhea, anaphylaxes, super infection

- monitor liver function tests

- instruct patient on signs of super infection: fury over growth on tongue, vaginal itching, loose and foul smelling stool

- pt should not use with oral contraceptive use.

Aspirin (Bayer Aspirin)

class: antipyretics, non-opioid, analgesics

Indication: rheumatoid arthritis, osteoarthritis, ischemic stroke and MI prophylaxis

Action: inhibits the production of prostaglandins which leads to a reduction of fever and inflammation, decreases platelet aggregation leading to a decrease in ischemic diseases

Nursing Considerations:

- use caution in bleeding disorders, chronic alcohol use

- may lead to Stevens-Johnson syndrome, laryngeal edema, and anaphylaxis

- increases risk for bleeding with warfarin, heparin, and clopidogrel

- increased risk for GI bleeding with NSAID use

- monitor liver function tests

- concurrent use with alcohol may increase risk for GI bleeding

Atenolol (Tenormin)

class: beta blocker,

antianginal, antihypertensive

Indication: hypertension, angina, prevention of MI

Action: blocks the stimulation of beta1 receptors in the SNS with minimal effect on beta2 receptors

Nursing Considerations:

- Contraindicated in CHF, pulmonary edema, cardiogenic shock, bradycardia, heart block

- monitor hemodynamic parameters (HR, BP)

- May cause bradycardia, CHF, pulmonary edema

- Masks symptoms associated with diabetes mellitus

- advise to change positions slowly to prevent orthostatic hypotension

- instruct patient on how to take blood pressure

atropine (Atro-pen)

class: antiarrhythmic, anticholinergic, antimuscarinic

Indication: decreases oral and respiratory secretions, treats sinus bradycardia and heart block, treatment of bronchospasm

Action: Atropine is an anticholinergic which means that it inhibits the effects of the parasympathetic nervous system, specifically acetylcholine. This inhibition causes increase in HR, bronchodilation, decreased GI and respiratory secretions.

Nursing Considerations:

- Avoid in acute hemorrhage, tachycardia, and angle closure glaucoma

- monitor patient for tachycardia and palpitations

- may cause urinary retention in elderly patients

- patients may experience constipation due to slowed GI motility

azithromycin (Zithromax)

class: agents for atypical mycobacterium, anti-infectives

Indication: URI, chronic bronchitis, lower respiratory infections, otitis media, skin infections, various STIs, prevention of bacterial endocarditis, treatment of cystic fibrosis

Action: inhibits bacterial protein synthesis

Nursing Considerations:

-may lead to pseudomembranous colitis, pain, diarrhea, nausea, Stevens-Johnson syndrome, angioedema

- may increase risks for warfarin toxicity

- monitor patient for signs of anaphylaxis

- instruct patient to notify physician for diarrhea, or blood or pus in stool

- instruct patient to take medication exactly as prescribed

Benzotropine (Cogentin)

class: Anticholinergic, Antiparkinson agent

Indication: anticholinergic properties in the CNS to reduce rigidity and tremors

Action: treatment for Parkinson's disease,

Nursing Considerations:

- may lead to arrhythmias, hypotension, palpitations, and tachycardia

- anticholinergic effects like constipation, dry mouth

- assess for extrapyramidal symptoms

- instruct patient to take as directed

- instruct patient to maintain good oral hygiene

biscodyl (Ducolax)

class: stimulant laxatives

Indication: treatment of constipation, bowel regimen

Action: stimulates peristalsis leads to fluid accumulation in the colon

Nursing Considerations:

-may lead to hypokalemia

- may cause abdominal pain and cramps

- use caution with milk

- assess for abdominal distention and bowel function

- instruct patient to drink 1500-2000 mL/day during therapy

- monitor fluid and electrolyte levels

- instruct patient to take as ordered

Bismuth Subsalicylate (Kaopectate, Pepto-Bismol)

class: antidiarrheal, antiulcer

Indication: diarrhea, heartburn, indigestion, H. pylori associated ulcer

Action: Stimulates the absorption of fluids and electrolytes in the intestinal wall, reduction in hypermotility of the stomach, and binds to toxins

Nursing Considerations:

-contraindicated in aspirin hypersensitivity

- increase risk for impaction with geriatric and pediatric patients

- monitor liver profile

- bismuth may interfere with radiologic exams

bupropion (Wellbutrin)

class: Antidepressants, smoking deterrents

Indication: depression, smoking cessation, treat ADHD in adults

Action:

Nursing Considerations:

- may lead to seizures, suicidal thoughts

- do not administer if patient is taking MAOI

- use caution with renal and liver impairment

- assess mental status

- instruct patient to avoid alcohol while taking bupropion

Buspirone (BuSpar)

class: Antidepressants, smoking deterrents

Indication:management of anxiety

Action: relieves anxiety by binding to dopamine and serotonin receptors

Nursing Considerations:

- do not administer concurrently with MOAI or grapefruit juice

- may lead to dizziness, drowsiness, fatigue, and weakness

- patient may experience chest pain, palpitations, tachycardia

- instruct patient to take as directed

- instruct patient to avoid alcohol and other CNS depressants

Butorphanol (Stadol)

class: Opioid Analgesic

Indication: moderate to severe pain, labor pain, sedation

Action: alters perception and response to pain by biding to opiate receptors in CNS

Nursing Considerations:

-use caution with concurrent use of MAOIs

- may cause confusion, hallucinations, sedation

- monitor for CNS depression

- assess blood pressure pulse and respirations during administration

- administer slowly through IV line

Calcium acetate (PhosLo)

class: antacids

Indication: treatment of hypocalcemia, prevention of post menopausal osteoporosis, treatment of hypokalemia and hypomagnesaemia, adjunct in cardiac arrest, control of hyperphosphatemia with ESRD

Action: calcium is essential for nervous muscular and skeletal systems, helps maintain cell membranes, aids in transmission of nerve impulses and muscle contraction, aids in blood formation and coagulation

Nursing Considerations:

- may cause cardiac arrest and arrhythmias

- phlebitis at site of insertion

- monitor hemodynamics

- may causes hypotension, bradycardia, and arrhythmias

- hypercalcemia can increase risk for digoxin toxicity

- administer slowly

- instruct pt on foods that contain Vitamin D and encourage adequate intake.

- monitor parathyroid hormone

Calcium carbonate (Tums / Rolaids)

class: antacids

Indication: treatment of hypocalcemia, prevention of post menopausal osteoporosis, treatment of hypokalemia and hypomagnesaemia, adjunct in cardiac arrest, used as antacid

Action: calcium is essential for nervous muscular and skeletal systems, helps maintain cell membranes, aids in transmission of nerve impulses and muscle contraction, aids in blood formation and coagulation

Nursing Considerations:

- may cause cardiac arrest and arrhythmias

- monitor hemodynamics

- may causes hypotension, bradycardia, and arrhythmias

- hypercalcemia can increase risk for digoxin toxicity

- instruct pt on foods that contain Vitamin D and encourage adequate intake.

- monitor parathyroid hormone

captopril (Capoten)

class: ACE Inhibitor, antihypertensives

Indication: hypertension, management of CHF, decrease progression of DM neuropathy

Action: block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation

Nursing Considerations:

- can cause neutropenia - check WBCs regularly

- use cautiously with potassium supplements and potassium sparing diuretics.

- use cautiously with diuretic therapy

- administer 1 hour before meals

- monitor blood pressure often

- monitor weight and fluid status

- monitor renal profile

- monitor CBC frequently

- May lead to Rhabdomyolysis

- Dry cough

carbamazepine (Tegretol)

class: Anticonvulsant

Indication: seizures, DM neuropathy, pain associated with trigeminal neuralgia

Action: affects Na channels in neurons leading to decreased synaptic transmission

Nursing Considerations:

- interferes with oral contraceptives

- do not use with MAOIs

- may cause suicidal thoughts

- may cause Stevens-Johnson syndrome, agranulocytosis, aplastic anemia, thrombocytopenia

- do not consume grapefruit juice while taking this medication

- monitor CBC and platelet count

- monitor serum blood levels of medication often

carbidopa/levodopa (Sinemet)

class: Antiparkinson agent, Dopamine Agonist

Indication: Parkinson's disease

Action: levodopa is converted to dopamine and works as a neurotransmitter and carbidopa prevents the destruction of levodopa

Nursing Considerations:

- may cause orthostatic hypotension

- may cause dark urine

- weeks to months to take effect

- do not use with MAOIs

- don't use with glaucoma, melanoma

- assess for parkinsonian symptoms

- instruct patient to take as directed

cefaclor (Ceclor)

class: Cephalosporin 2nd generations

Indication: treatment of respiratory tract infections, skin infections, otitis media

Action: bacteriacidal, binds to bacterial cell wall causing cell death

Nursing Considerations:

contraindicated in cephalosporin and possibly penicillin allergies

- may need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis

- Assess infection and allergies

- obtain cultures prior to therapy

- monitor bowel function

- may lead to super infection

cefdinir (Omnicef)

class: Cephalosporin 2nd generations

Indication: treatment of skin infections, otitis media

Action: bactericidal, binds to bacterial cell wall causing cell death

Nursing Considerations:

- contraindicated in cephalosporin and possibly penicillin allergies

- may need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis

- Assess infection and allergies

- obtain cultures prior to therapy

- monitor bowel function

- monitor for bleeding

- may lead to super infection

celecoxib (Celebrex)

class: antirrheumatics/NSAID

Indication: osteoarthritis, rheumatoid arthritis, acute pain

Action: decreases pain and inflammation by inhibiting synthesis of prostaglandins

Nursing Considerations:

- use caution with cardiovascular disease

- increases risk for MI, CVA, thrombosis

- may cause GI bleeding, Stevens-Johnson syndrome, dermatitis

- notify provider for new-onset abdominal pain or black stool

cephalexin (Keflex)

class: Cephalosporin 1st generations

Indication: skin infections, pneumonia, UTI, otitis media

Action: bactericidal: binds to bacterial cell wall leading to cell death

Nursing Considerations:

- contraindicated with cephalosporin and serious penicillin allergies.

- may need lead to seizures, pseudomembranous colitis, diarrhea, phlebitis at IV site, anaphylaxis

- Assess infection and allergies

- obtain cultures prior to therapy

- monitor bowel function

- may lead to super infection

- may cause elevated liver enzymes

chlorpromazine (Thorazine)

class: Antipsychotic, antiemetic

Indication:second line treatment of schizophrenia and psychosis, nausea/vomiting, pre-op sedation, acute intermittent porphyria, headache, bipolar

Action: exhibits anticholinergic activity, alters effects of dopamine in CNS

Nursing Considerations:

- may cause neuroliptic malignant syndrome, sedation, tardive dyskineisa, hypotenstion, agranulocytosis

- assess mental status prior to and during treatment

- monitor blood pressure

- ensure patient is taking medication

- monitor CBC and liver function tests

- instruct patient not to skip doses or double dose

cimetidine (Tagamet)

class: Histamine H2 antagonist, antiulcer agent

Indication: treatment of duodenal ulcers, GERD, heartburn, Zollinger Ellison syndrome, prevention of GI bleeding in critical patients.

Action: inhibits action of histamine leading to inhibition of gastric acid secretion

Nursing Considerations:

- increases serum level of warfarin

- can lead to respiratory infection (green sputum)

- monitor for arryhtmias

- may cause agranulocytosis, aplastic anemia

- monitor CBC during therapy

- take medication as directed

- instruct patient to increase fluid and fiber intake to decrease constipation

ciprofloxacin (Cipro)

class: Fluoroquinolone, anti-infectives

Indication: urinary tract infections, gonorrhea, respiratory tract infections, bronchitis, pneumonia, skin and bone infections, infectious diarrhea, abdominal infections

Action: inhibits bacterial DNA synthesis

Nursing Considerations:

- contraindicated in allergies

- may cause QT prolongation, avoid use with other drugs that can cause QT prolongation

- can cause seizures, arrythmias, pseudomembranous colitis, anaphalaxis, Stevens Johnson

syndrome

- may decreased of phenytoin

- monitor renal panel

- assess for infection, obtain cultures prior to therapy

- monitor liver function tests

clindamycin (Cleocin)

class: Anti-infectives

Indication: skin infections, respiratory tract infections, septicemia, intra-abdominal infections, osteomyelitis

Action: inhibits protein synthesis

Nursing Considerations:

- arrythmias, pseudomembranous colitis, diarrhea, phlebitis

- monitor bowel function

- assess for infection, obtain cultures prior to therapy

- monitor liver function tests.

- monitor CBC

clopidogrel (Plavix)

class: Antiplatelet agent

Indication: atherosclerotic events, MI, CVA, PVD, acute coronary syndrome

Action:

Nursing Considerations:

- may cause GI bleeding, neutropenia, hypercholesterolemia

- may increase risk for bleeding in warfarin, aspirin, heparin

- can increase risk for bleeding with garlic, ginkgo, ginger

- monitor for signs of bleeding

- monitor bleeding times

- monitor CBS and platelet count

- discontinue use 5-7 days before surgery

codeine (Paveral)

class: opioid agonist

Indication: management of pain, diarrhea, cough suppressant

Action: Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS. This depression also causes a decrease in the cough reflex and GI motility.

Nursing Considerations:

- may cause alterations in mentation, hypotension, constipation, nausea, vomiting

- assess BP, pulse, and respiratory rate prior to administration and frequently during

administration

- use caution if patient is receiving MAO Inhibitors

- Narcan (naloxone) is the antidote for opioid agonists

cortisone (Cortone)

class: antiasthmatics, corticosteroids

Indication: management of adrenocortical insufficiency (Addison's Disease).

Action: Replace cortisol in states of deficiency, suppress inflammation and normal immune response.

Nursing Considerations:

- Excreted by the liver - monitor liver profile

- Avoid in active untreated infections

- may cause CNS alterations

- may cause peptic ulcers

- may cause Cushingoid appearance (buffalo hump, moon face)

- Weight gain

- Osteoporosis

- Decrease wound healing

- May elevate blood sugars

- May increase cholesterol and lipid values

cyclosporine (Sandimmune)

class: immunosuppresants, antirheumatics (DMARD)

Indication: prevention of rejection in transplantation, treatment of severe RA, management of ulcerative colitis

Action: inhibits normal immune response

Nursing Considerations:

-may cause seizures, tremors, hypertension, hepatotoxicity, diarrhea, N/V, gingival hyperplasia

- increases immune suppression with corticosteroids

- avoid grapefruit juice while taking this medications

- assess for signs of organ rejection

- monitor renal panel, liver enzymes

- take medication as directed

- lifelong therapy required for transplant patients

- instruct pt on how to take blood pressure

dexamethasone (Decadron)

class: antiasthmatics, corticosteroids

Indication:Manage cerebral edema, assess for Cushing's Disease

Action: Suppress inflammation and normal immune response. Used in inflammatory states to decrease inflammation.

Nursing Considerations:

-Excreted by the liver

- monitor liver profile

- Avoid in active untreated infections

- may cause CNS alterations

- may cause peptic ulcers

- may cause Cushingoid appearance (buffalo hump, moon face)

- Weight gain

- Osteoporosis

- Decrease wound healing

- May elevate blood sugars

- May increase cholesterol and lipid values

diazepam (Valium)

class: Benzodiazepine

Indication: anxiety, pre-op sedation, conscious sedation, treatment of seizures, insomnia, management of alcohol withdrawal

Action: depresses the CNS

Nursing Considerations:

- contraindicated in hepatic dysfunction

- use caution with renal impairment

- can cause dizziness, drowsiness, lethargy, hypotension, physical dependence, tolerance

- instruct patient to take as directed

- caution to avoid alcohol use

- Romazicon is the reversal agent

digoxin (Lanoxin)

class: antiarrhythmic, inotropics

Indication: CHF, A-fib, A-flutter

Action: Positive inotropic effect (increases force of myocardial contraction), prolongs refractory period, ↓ conduction through SA and AV nodes. Essentially digoxin is given to increase cardiac output and slow the rate.

Nursing Considerations:

- Excreted by kidneys

- Assess patient for hypersensitivity

- Contraindicated with uncontrolled ventricular arryhtmias

- Hypokalemia increase risk for toxcicity

- Hypercalcemia ↑ risk for toxicity

- Use caution with diuretic use as they may cause electrolyte abnormalities that can lead to

toxicity

- Assess patient for cardiac arrythmias including bradycardia

- Signs of toxicity include vision changes (blurred vision, yellow, green vision disturbances)

- Monitor pulse rate for 1 full minute prior to dosing patient (hold for pulse <60)

diltiazem (Cardizem)

class: Ca Channel Blocker (Bezothiazepine), antianginals, antiarrhythmics, antihypertensive

Indication: hypertension, angina, SVT, a-fib, aflutter

Action: inhibits calcium transport resulting in inhibition of excitation and contraction, leads to depression of AV and SA node leading to decreased HR, leads to vasodilatation and decreased blood pressure.

Nursing Considerations:

- contraindicated in 2nd and 3rd AV block

- may cause arrhythmias, CHF, bradycardia, peripheral edema, gingival hyperplasia

- increases digoxin levels

- don't drink grapefruit juice

- assess for signs of CHF

- monitor EKG continuously

- tell patient to change positions slowly

- monitor serum potassium

- instruct pt on how to take blood pressure

diphenhydramine (Benadryl)

class: antihistamine, antitussive

Indication: allergy, anaphylaxis, sedation, motion sickness, antitussive

Action: antagonizes effects of histamine, CNS depression

Nursing Considerations:

-may cause drowsiness, anorexia, dry mouth, nausea, chest tightness, thick secretions, hypotension, blurred vision, headache

- anticholinergic effects

- assess purpose of medication prior to giving it

- assess allergies, sleep patterns, cough and lung sounds

- patient should avoid other over-the-counter cough and cold remedies

diphenoxylate/atropine (Lomotil)

class: anticholinergic, antidiarrheal

Indication: Treatment for diarrhea

Action: Inhibits GI motility via anticholinergic effects

Nursing Considerations:

- Contraindicated with angle-closure glaucoma, dehydration

- Structurally related to opioids so use caution with patients that have allergies to opioids

- Side effects: constipation, tachycardia, dizziness, ileus

- Monitor liver function as medication is excreted by the liver

- Insure that client is taking medication as prescribed and not double dosing

divalproex (Depakote)

class: Anticonvulsant, vascular headache suppressants

Indication: seizures, manic episodes, prevention of headache

Action: increases the level of GABA in CNS

Nursing Considerations:

- may cause suicidal thoughts, agitation, dizziness, insomnia, hepatotoxicity, pancreatitis

- increases risk for bleeding with Warfarin

- use caution with MAOIs

- monitor liver function tests

dobutamine (Dobutrex)

class: beta-adrenergic agonist, inotropic

Indication: short term management of heart failure

Action: Dobutamine has a positive inotropic effect (increases cardiac output) with very little effect on heart rate. Stimulates Beta1 receptors in the heart.

Nursing Considerations:

- Monitor hemodynamics: hypertension, ↑HR, PVCs

- Skin reactions may occur with hypersensitivity

- Beta blockers may negate therapeutic effects of dobutamine

- Monitor cardiac output

- Monitor peripheral pulses before, during, and after therapy

- DO NOT confuse dobutamine with dopamine

dopamine (Intropin)

class: inotropic, vasopressor, adrenergic

Indication: used to improve blood pressure, cardiac output, and urine output

Action:

-Smaller doses result in renal vasodilation

-Doses 2-10mcg/kg/min result in cardiac stimulation by acting on beta1 receptors

-Doses >10mcg/kg/min stimulate alpha receptors leading to vasoconstriction (↑SVR)

Nursing Considerations:

-Monitor hemodynamics closely: BP, HR, EKG, CVP, and PAOP if available

- Obtain parameters for hemodynamic values

- Titrate to obtain appropriate BP (more potent vasoconstrictors may be required)

- Irritation may occur at IV site

- Beta blockers may counteract therapeutic effects

enalapril (Vasotec)

class: ACE Inhibitor, antihypertensives

Indication: hypertension, management of CHF

Action: block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation

Nursing Considerations:

- can cause neutropenia - check WBCs regularly

- use cautiously with potassium supplements and potassium sparing diuretics.

- use cautiously with diuretic therapy

- administer 1 hour before meals

- monitor blood pressure often

- monitor weight and fluid status

- monitor renal profile

- monitor CBC frequently

- dry cough

enoxaparin (Lovenox)

class: antithrombotic

Indication: prevention of VTE, DVT, and PE

Action: prevents thrombus formation by potentiating the inhibitory effect of antithrombin on factor Xa and thrombin

Nursing Considerations:

- contraindicated in pork hypersensitivity

- monitor for signs of bleeding

- administer in subcutaneous tissue

- DO NOT eject air bubble prior to injection

- DO NOT aspirate or massage site

epinephrine (Adrenalin, EpiPen)

class: adrenergic agonist, antiasthmatic, bronchodilator, vasopressor

Indication: Asthma and COPD exacerbations, allergic reactions, cardiac arrest, anesthesia adjunct

Action: Affects both beta1 and beta2 also has alpha agonist properties. Results in bronchodilation, increases in HR and BP

Nursing Considerations:

- Side effects include: angina, tachycardia, hypertension, restlessness, nervousness, hyperglycemia

- Use with MAOI may lead to hypertensive crisis

- Patients should not use stimulants (caffeine, guarana, etc)

- Excessive use may cause bronchospasm

- Assess lung sounds, pulse, BP, and other hemodynamic parameters

- Monitor for chest pain

- Instruct patient to use as directed

- Patient should insure adequate fluid intake to liquefy secretions

- Mouth should be rinsed after inhalation

- Beta blocker may negate effects

- May increase blood glucose levels

epoetin (Epogen)

class: antianemics, hormones

Indication anemia

Action: stimulates erythropoesis

Nursing Considerations:

- contraindicated in albumin hypersensitivity

- may cause seizures, CHF, MI, CVA, HTN

- monitor blood pressure during therapy

- monitor for signs of anemia

- assess dialysis shunts

- monitor bleeding times

- initiate seizure precautions

- do not shake vial

erythromycin (E-Mycin)

class: macrolide, anti-infective

Indication useful in place of penicillin when patient cannot take penicillin, upper and lower respiratory tract infections, otitis media, skin infections, pertussis, syphilis, rheumatic fever

Action: suppresses bacterial protein synthesis, bacteriostatic

Nursing Considerations:

- Causes QT prolongation, ventricular arrhythmias

- diarrhea

- asses infection

- monitor liver function tests

- instruct patient to finish medication dosage even if they are feeling better

- medication should not be shared

escitalopram (Lexapro)

class: SSRI, antidepressant

Indication major depressive disorder, anxiety disorder, PCD, PTSD, social phobia

Action: selectively inhibits reuptake of serotonin

Nursing Considerations:

-contraindicated with MAOI

- may cause suicidal thoughts, insomnia, drowsiness, diarrhea, nausea, serotonin syndrome

- may cause QT prolongation with certain medications

- assess for sexual dysfunction

- may take 4-6 weeks for full affect to take place

famotidine (Pepcid)

class: Histamine H2 antagonist

Indication short term treatment of active ulcer, GERD, treatment of heartburn, indigestion, management of Zollinger Ellison syndrome, prevention of GI bleeding in critically ill patients, management of symptoms associated with overuse of NSAIDs

Action: blocks action of histamine located in gastric parietal cells, inhibits gastric acid secretion

Nursing Considerations:

- may cause arrythmias, agranulocytosis, aplastic anemias

- assess for abdominal pain and occult blood

- monitor CBC

- instruct pt to increase fluid and fiber intake to prevent constipation

fentanyl (Sublimaze)

class: Opioid Analgesic

Indication supplement to general anesthesia, continuous IV infusion for purpose of analgesia

Action: binds to opiate receptors in CNS altering perception of pain, producing CNS depression

Nursing Considerations:

- use caution with increased ICP, head trauma, adrenal insufficiency

- avoid use with MAOIs

- may cause apnea, laryngospasm, decreased respirations, bradycardia, hypotension

- do not consume grapefruit while taking this medication

- monitor hemodynamics during administration

- assess patient pain scale frequently

ferrous sulfate (Feosol)

class: iron supplements

Indication prevention and treatment of iron-deficiency anemia

Action: Iron is essential for hemoglobin, myoglobin and enzymes, it is transported to organs where it becomes part of iron stores

Nursing Considerations:

- may cause seizures, hypotension, constipation, epigastric pain, diarrhea, skin staining, anaphylaxis

- assess nutritional status, bowel function

- monitor hemoglobin, hematocrit, iron levels

- may cause elevated liver enzymes

- take on an empty stomach to increase absorption/vitamin c helps with absorption

- use z-track for IM injections

fluoxetine (Prozac)

class: SSRI, antidepressant

Indication depressive disorder, OCD, bulimia, panic disorder, bipolar, anorexia, ADHD, DM neuropathy, obesity

Action: inhibits reuptake of serotonin

Nursing Considerations:

- do not use while taking MAOIs

- may cause suicidal thoughts, drowsiness, anxiety, sexual dysfunction, insomnia, palpitations

- monitor closely for serotonin syndrome

- concurrent use with certain medications may lead to QT prolongation

- monitor mood changes and assess for suicidal ideation

- monitor nutrition status

- may cause elevated liver enzymes

- instruct pt to maintain good oral hygiene

Fluticasone (Flovent)

class: corticosteroids, anti-asthmatics, anti-inflammatory (steroid)

Indication prophylactic asthma treatment

Action: locally acting anti-inflammatory

Nursing Considerations:

- use cautiously with untreated infections and suppressed immune function

- may cause headache, insomnia, bronchospasm, nasal congestion, adrenal suppression

- monitor patient's respiratory status

- may lead to decreased bone density

- instruct patients using corticosteroids and bronchodilators that they need to use

bronchodilators first.

- instruct patient to stop smoking

Furosemide (Lasix)

class: loop diuretics

Indication edema, hypertension

Action: prevents reabsorption of sodium and chloride in the kidneys, increase excretion of water, sodium, chloride, magnesium, potassium.

Nursing Considerations:

- use caution with liver disease

- may cause hypotension, dry mouth, excessive urination, dehydration, electrolyte abnormalities,

metabolic alkalosis

- hypokalemia may lead to increase risk of digoxin toxicity

- monitor renal panel

- use caution with other anithypertensives

- causes arthritic symptoms/do not administer with aminoglycosides due to ototoxicity

gabapentine (Neurontin)

class: analgesic adjuncts, therapeutic, anticonvulsants, mood stabilizers

Indication seizures, peripheral neuropathy, neuropathic pain, prevention of migraines

Action: exact method of action unknown

Nursing Considerations:

- may cause suicidal thoughts, confusion, depression, drowsiness, ataxia, facial edema, hypertension

- monitor pt closely for changes in behavior and depression

- assess seizure activity

- assess pain level

- patient should take medications exactly as prescribed

gentamicin (cidomycin)

class: Aminoglycoside, anti-infectants

Indication Treatment of gram negative infections when penicillin is ineffective

Action: Inhibits bacterial protein synthesis

Nursing Considerations:

- causes tinnitus-hearing loss/do not administer with penicillin

- use caution in renal impairment

- assess for infection

- obtain cultures prior to therapy

- monitor liver function tests

- monitor blood levels of drug

glipizide (Glucotrol)

class: sulfonylureas, anti-diabetic

Indication type 2 diabetes mellitus

Action: stimulates release and sensitivity to insulin to lower blood glucose

Nursing Considerations:

- may cause aplastic anemias, hypoglycemia, photosensitivity, dizziness, drowsiness, headache, diarrhea

- monitor CBC, assess for allergy to sulfonamides

- beta blockers may create signs of hypoglycemia

- instruct patient on how to check blood sugars and

- instruct patient on importance of carrying source of sugar in case of hypoglycemia

glucagon (GlucaGen)

class: pancreatics

Indication Severe hypoglycemia, antidote for Beta Blockers and calcium channel blockers

Action: Stimulates production of glucose, relaxes Gi tract,

Nursing Considerations:

- may cause anaphylaxis

- may cause hypotension

- assess for signs of hypoglycemia, neuro status

- monitor serum glucose levels

- teach patient signs of hypoglycemia

Guaifenesin (Robitussin)

class: allergy, cold and cough remedies, expectorant

Indication Cough suppression, expectorant

Action: Decreases viscosity of and mobilizes secretions

Nursing Considerations:

- patient should avoid over the counter cold medications

- assess lung sounds

- maintain adequate fluid intake

haloperidol (Haldol)

class: Atypical Antipsychotic

Indication Schizophrenia, mania, aggressive and agitated patient

Action: Alters the effect of dopamine

Nursing Considerations:

- *extrapyramidal symptoms*

- use caution in QT prolongation

- may cause seizures, constipation, dry mouth, agranulosytosis

- assess for hallucinations

- monitor hemodynamics

- monitor for neuroleptic malignant syndrome

- monitor CBC with differential

heparin (Hep-Lock)

class: antithrombotic

Indication Venous thromboembolism prophylaxis and treatment, low dose used to ensure patency of IV catheters

Action: increases the inhibitory effect of antithrombin on factor Xa

Nursing Considerations:

- monitor for signs of bleeding

- monitor platelet count

- may cause hyperkalemia

- have patient report any signs of bleeding

hydralazine (Apresoline)

class: vasodilator, anti-hypertensive

Indication hypertension

Action: arterial vasodilator

Nursing Considerations:

- may cause tachycardia, sodium retention, arrhythmias, angina

- use caution with MAOIs

- monitor blood pressure

- instruct patient on how to take blood pressure

hydrochlorothiazide (HydroDiuril)

class: antihypertensives, diuretics

Indication Hypertension, CHF, renal dysfunction, cirrhosis, glucocorticoid therapy

Action: Increases sodium and water excretion produces arterial dilation

Nursing Considerations:

-May cause dizziness, hypokalemia, hyponatremia, hypophosphatemia, hypomagnesemia, dehydration

- Hypokalemia can increase risk for digoxin toxicity

- Monitor blood pressure and intake and output

- Monitor electrolyte levels

- Patient should take medication at the same time each day even if feeling better

- Instruct patient on how to take blood pressure

hydrocodone/acetaminophen (Norco)

class: opioid agonists, nonopioid analgesic combinations

Indication management of moderate to severe pain

Action: alters the perception and reaction to pain by binding to opiate receptors in the CNS, also suppresses the cough reflex

Nursing Considerations:

-use caution with concurrent use of MAOI - avoid use within 14 days of each other

- hypotension - monitor hemodynamics and respirations after administering

- may increase ICP use caution with head trauma

- Narcan is the antidote for overdose

- do not exceed 4g of acetaminophen per day

hydromorphone (Dilaudid)

class: opioid agonist

Indication moderate to severe pain

Action: alters the perception and reaction to pain by binding to opiate receptors in the CNS, also suppresses the cough reflex

Nursing Considerations:

-Assess BP, respirations, and pulse before and during administration - medication causes general CNS depression

- Narcan is the antidote for overdose

- use caution with concurrent use of MAOI - avoid use within 14 days of each other

- may be used as an antitussive

- advised to dilute with NS prior to administration and to administer slowly to decrease CNS

depression

ibuprofen (Advil / Motrin)

class: antipyretics, antirheumatics, nonopioid analgesics, nonsteroidal anti-inflammatory agents (NSAIDS)

Indication Mild to moderate pain, inflammatory states

Action: Decreases pain and inflammation by inhibiting prostaglandins

Nursing Considerations:

-may cause GI bleeding, hepatitis, Stevens-Johnson Syndrome

- may cause anaphylaxis

- monitor for headache, nausea, vomiting, constipation

- therapy should be discontinued after first sign of rash

- monitor renal and liver labs

- patient should avoid using alcohol

indomethacin (Indocin)

class: antirheumatics, ductus arteriosus patency adjuncts (IV only), nonsteroidal anti-inflammatory agents

Indication Inflammatory disorders when patients do not respond to other medications

Action: Decreases pain and inflammation by inhibiting prostaglandin synthesis

Nursing Considerations:

-Monitor for hepatitis and GI bleeding

- Monitor for dizziness, drowsiness, and headache

- Assess for anaphylactic reaction

- Aspirin may decrease effectiveness

- Monitor renal labs

- Shake suspension before administration

- Patient should wear sunscreen and protective clothing to protect against photosensitivity

regular insulin (Humulin R/Novolin R)

class: antidiabetics, hormones

Indication hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis

Action: stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (short acting)

Nursing Considerations:

-assess for symptoms of hypoglycemia or hyperglycemia

- monitor body weight over time

- may cause decreased inorganic phosphates, potassium, and magnesium

- monitor blood sugars every 6 hours, monitor A1C every 3-6 months

NPH insulin (Humulin N, Novolin N)

class: antidiabetics, hormones

Indication hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis

Action: stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (intermediate acting)

Nursing Considerations:

-assess for symptoms of hypoglycemia or hyperglycemia

- monitor body weight over time

- may cause decreased inorganic phosphates, potassium, and magnesium

- monitor blood sugars every 6 hours, monitor A1C every 3-6 months

insulin detemir, insulin glargine

(Levemir, Lantus)

class: antidiabetics, hormones

Indication hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis

Action: stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (long acting)

Nursing Considerations:

-assess for symptoms of hypoglycemia or hyperglycemia

- monitor body weight over time

- may cause decreased inorganic phosphates, potassium, and magnesium

- monitor blood sugars every 6 hours, monitor A1C every 3-6 months

insulin aspart (novolog)

insulin lispro (humalog)

insulin glulisine (apidra)

class: antidiabetics, hormones

Indication hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis

Action: stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (rapid acting)

Nursing Considerations:

-assess for symptoms of hypoglycemia or hyperglycemia

- monitor body weight over time

- may cause decreased inorganic phosphates, potassium, and magnesium

- monitor blood sugars every 6 hours, monitor A1C every 3-6 months

Lispro mixture, Aspart mixture, NPH/regular

(Humalog Mix, NovoLog Mix, Humulin 70/30, Novolin 70/30)

class: antidiabetics, hormones

Indication hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis

Action: stimulates uptake of glucose into muscle and fat cells, inhibits production of glucose in the liver, prevents breakdown of fat and protein (insulin mixtures)

Nursing Considerations:

-assess for symptoms of hypoglycemia or hyperglycemia

- monitor body weight over time

- may cause decreased inorganic phosphates, potassium, and magnesium

- monitor blood sugars every 6 hours, monitor A1C every 3-6 months

radioactive iodine

class: Antithyroid Agent

Indication: thyroidectomy pretreatment, thyrotoxic crisis, radiation exposure

Action: inhibits the release of thyroid hormones

Nursing Considerations:

-may cause GI bleeding, diarrhea, hypothyroidism, goiter

- monitor for hypersensitivity

isoniazide (INH)

class: Antitubercular

Indication tuberculosis

Action: Inhibits synthesis of mycobacterial cell wall

Nursing Considerations:

-can cause jaundice

- may cause peripheral neuropathy, seizures, hepatitis

- patient should avoid high amounts of tyramine (pickled meats, aged/smoked meats, alcohol, exotic/aged cheese)

- monitor liver function tests

- complete full course of therapy (6-12 months)

- often used in combination with Rifampin

ketorolac (Toradol)

class: nonsteroidal anti-inflammatory agents, nonopioid analgesics

Indication pain

Action: Pain relief due to prostaglandin inhibition

Nursing Considerations:

-may cause GI bleeding, Stevens-Johnson Syndrome, anaphylaxis, drowsiness

- should not exceed 5 days of therapy

- bleeding risk increased with garlic, ginger, and ginkgo

- may decrease effectiveness of hypertensive medications and diuretics

lactulose (Kristalose)

class: laxative

Indication Constipation, portal-systemic encephalopathy

Action: Draws water into the stool and softens stool, inhibits ammonia passing into the colon

Nursing Considerations:

-use caution with DM

- may cause cramps, abdominal distention, hyperglycemia

- assess mental status, ammonia levels, abdominal distention

- patient should average 2-3 bowel movements per day

lamotrigine (Lamictal)

class: anticonvulsant

Indication Seizures r/t epilepsy, bipolar

Action: Inhibits sodium transport in neurons

Nursing Considerations:

- May cause suicidal thoughts, dizziness, behavior changes, nausea, vomiting, photosensitivity, rash, Stevens-Johnson Syndrome

- Use caution with oral contraceptive use

- Assess mental status

- Assess for seizures

- Do not discontinue use abruptly

levetiracetam (Keppra)

class: anticonvulsants

Indication Seizures

Action: Decreases severity and incidence of seizures

Nursing Considerations:

-May cause suicidal thoughts, dizziness, weakness

- May alter RBC, WBC, and liver function

- May cause somnolence

- Should be infused over 15 minutes

levofloxacin (Levaquin)

class: fluoroquinolone, Anti-infective

Indication urinary tract infections, gonorrhea, respiratory tract infections, bronchitis, pneumonia, skin and bone infections

Action: Inhibits DNA synthesis in bacteria

Nursing Considerations:

-contraindicated in allergies

- may cause QT prolongation, avoid use with other drugs that can cause QT prolongation

- can cause seizures, arrythmias, pseudomembranous colitis, anaphylaxis, Stevens Johnson

syndrome

- may decreased of phenytoin

- monitor renal panel

- assess for infection, obtain cultures prior to therapy

- monitor liver function tests

levothyroxine (Levothroid)

class: hormone

Indication thyroid hormone replacement in hypothyroidism

Action:

replaces thyroid hormone increasing metabolism, promotes gluconeogenesis, stimulates protein synthesis, restores normal hormone balance and suppresses thyroid cancer

Nursing Considerations:

-assess pulse and monitor for tachyarrythmias and chest pain

- monitor TSH levels

- overdose is presented as hyperthyroidism

- start with low doses and increase as indicated

- therapy is lifelong

- take directly after breast feeding

- increases the effects of warfarin

lisinopril (Prinivil)

class: ACE Inhibitor, anti-hypertensive

Indication hypertension, management of CHF

Action: block conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation

Nursing Considerations:

-Dry cough

- 1st dose hypotension

- use cautiously with potassium supplements and potassium sparing diuretics.

- use cautiously with diuretic therapy

- administer 1 hour before meals

- monitor blood pressure often

- monitor weight and fluid status

- monitor renal profile

- monitor liver function tests

lithium (Lithizine)

class: Mood Stabilizer

Indication: mania

Action: alters cation transport and neurotransmitter reuptake

Nursing Considerations:

- do not administer with NSAIDs

- monitor drug blood levels frequently

- may cause seizures, arrhythmias, fatigue, confusion, nausea, anorexia, hypothyroidism, tremors

- Ace Inhibitors may increase serum levels

- instruct patient to maintain adequate fluid intake

- therapeutic level: 0.5-1.5 mEq/L

loperamide (Imodium)

class: antidiarrheal

Indication acute diarrhea, decrease drainage post ileostomy

Action: inhibits peristalsis, reduces the volume of feces while increasing the bulk and viscosity

Nursing Considerations:

-may lead to constipation - insure proper use

- assess bowel function

- assess fluid and electrolyte levels

lorazepam (Ativan)

class: Benzodiazepine

Indication: anxiety, sedation, seizures

Action: general CNS depression

Nursing Considerations:

- use caution with COPD and sleep apnea

- avoid alcohol use

- antidote is Flumazenil (Romazicon)

- may cause apnea, cardiac arrest, bradycardia, hypotension

- use caution with other CNS depressants

- administer slowly and dilute to decrease complications

Losartan (Cozaar)

class: angiotensin II receptor antagonist, antihypertensives

Indication hypertension, DM neuropathy, CHF

Action: inhibits vasoconstrictive properties of angiotensin II

Nursing Considerations:

-may cause hypotension, tacycardia, angiodema, hyperkalemia

- may increase digoxin levels

- assess blood pressure and heart rate

- assess fluid levels

- monitor daily weights with CHF

- monitor renal and liver

- instruct patient on how to take blood pressure

magnesium sulfate (MgSO4)

class: minerals/electrolytes

Indication: treatment of hypomagnesaemia, hypertension, preterm labor, torsade de pointes, asthma, anticonvulsant with eclampsia

Action: magnesium plays a role in muscle excitability

Nursing Considerations:

-use caution with renal insufficiency

- may cause decreased respiratory rate, arrythmias, hypotension, muscle weakness

- monitor EKG and respiratory status

- monitor Mg levels

- ensure dosage with secondary practitioner

- Calcium gluconate is the antidote

-Magnesium toxicity results in respiratory depress and loss of deep tendon reflexes

mannitol (Osmitrol)

class: osmotic diuretic

Indication increased ICP, oliguric renal failure, edema, intraocular pressure

Action: inhibits reabsorption of water and electrolytes by increasing osmotic pressure, excreted by kidneys

Nursing Considerations:

- may cause phlebitis at IV site

- may cause dehydration, fluid and electrolyte imbalances

- monitor neuro status

- administer via a filter

meperidine (Demerol)

class: Opioid Analgesic

Indication moderate to severe pain, sedation

Action: Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS.

Nursing Considerations:

-may cause alterations in mentation, hypotension, constipation, nausea, vomiting

- assess BP, pulse, and respiratory rate prior to administration and frequently during

administration

- use caution if patient is receiving MAOIs

- Narcan (naloxone) is the antidote for opioid agonists

- can cause seizure

- may increase pancreatic enzyme levels

- assess bowel function

metformin (Glucophage)

class: Anti-diabetic

Indication: management of Type II DM, PCOS

Action: decreases glucose production in the liver, decreases absorption, increases cellular insulin sensitivity.

Nursing Considerations:

- do not use with renal dysfunction, metabolic acidosis

- may cause diarrhea, nausea, vomiting, lactic acidosis

- monitor patient closely for ketoacidosis and lactic acidosis, discontinue medication immediately

if acidotic

- may cause metallic taste

- instruct patient that medication does not cure diabetes

methadone (Mathadose)

class: opioid analgesic

Indication withdrawal symptoms, pain

Action:

Binds to opiate receptors in the CNS and alters perception of pain while producing a general depression of the CNS. Suppresses withdrawal symptoms. This depression also causes a decrease in the cough reflex and GI motility.

Nursing Considerations:

-use caution if patient is receiving MAO Inhibitors

- may cause QT prolongation, hypotension, respiratory depression, dependence, confusion, sedation

- assess pain, vital signs, bowel function

- may increase pancreatic enzyme levels

- assess withdrawal symptoms

methylergonovine (Methergine)

class: oxytocic

Indication treatment of post-partum hemorrhage

Action: stimulates uterine muscles causing uterine contraction

Nursing Considerations:

-can cause hypertension, cramps, nausea, vomiting, dyspnea

- monitor BP, heart rate, uterine response

- assess calcium levels - effectiveness ↓ with hypocalcemia

- monitor uterine bleeding and notify physician of any changes

methylphenidate (Ritalin)

class: central nervous system stimulant

Indication: ADHD, narcolepsy

Action: improves attention span in ADHD by producing CNS stimulation

Nursing Considerations:

-can cause sudden death, hypertension, palpitations, anorexia, hyperactivity, insomnia

- may decrease effects of Warfarin and Phenytoin

- do not use with MAOIs

- monitor cardiovascular system

- monitor for behavioral changes

- monitor for dependence

- do not consume caffeinated beverages

-"Drug Holiday" used to assess dependence and status

methylprednisone (Solu-medrol)

class:

Indication: Inflammation, allergy, autoimmune disorders, prevent organ rejection

Action:

Nursing Considerations:

metoclopramide (Reglan)

class: antiemetic

Indication: prevention of nausea, vomiting, hiccups, migraines, gastric stasis

Action: accelerates gastric emptying by stimulating motility

Nursing Considerations:

- don't use with GI obstruction

- may cause extrapyramidal reaction, neurolyptic malignant syndrome, tardive dyskinesia,

arrhythmias, blood pressure alterations, hematologic alterations, facial movements, sedation

- can decrease effects of levodopa

- assess nausea/vomiting

- monitor liver function tests