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

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