Drug Cards, Nursing – Flashcards

Classification: Nonsteriodal; Anti inflammatory; Nonopiod Analgesics Indication: Pain management Action: Inhibits prostaglandins; antipyretic and anti inflammatory properties Dosage: IV 15-30 mg every 6 hours IV administer undiluted: Rate: over 15 seconds; compatible with oxytocin Route: PO, IM, IV Contraindications: Hypersensitivity; use with other NSAIDS Nursing considerations: Not to be used longer than 5 days; use cautiously in GI bleeding, renal impairment, peds patient

Classification: analgesics, opioid combos [Schedule II] Indication:Pain Action: [oxycodone]-opiod agonist, inhibits ascending pain pathways; [acetaminophen]-nonopiate, nonsalicylate analgesic; may work peripherally to block pain impulse generation; acts on hypothalamus to produce antipyresis Dosage:1 tablet PO q4-6h PRN; max oxy60mg/aceta 4g qDAY. Contraindications: Alvimopan; hypersensitivity; suspected or known paralytic ileus; significant resp depression (bronchial asthma, hypercarbia, COPD) Nursing considerations:PREG (C); May cause hypotension, severe renal/hepatic impairment; individuals with hx of addiction; tolerance and physical dependence may occur;

Classification:NSAIDS Indication:Pain, fever, inflammatory disease, dysmenorrhea, osteoarthritis, RA, vascular headache, cystic fibrosis Action: inhibits synthesis of prostaglandins in body tissues by inhibiting at least 2 cyclooxygenase isoenzymes-(COX-1), (COX-2); may inhibit chemotaxis, may alter lymphocyte activity, decrease proinflammatory cytokine activity, and may inhibit neutrophil aggregation. These effects may contribute to its anti-inflammatory activity Dosage: 300-800mg PO q6h for pain; 100-200mg PO q4-6h PRN; not to exceed 3200mg/day Contraindications: ASA allergy; bleeding disorder, duodenal/gastric/peptic ulcer; stomatitis; SLE; ulcerative colitis; upper GI disease; late pregnancy (may cause premature closure of PDA) Nursing considerations:PREG (C); PREG (D) from 30wks onward may cause premature closure of PDA; NSAIDs increase risk of CV thrombotic events, MI and stroke;

• Classification: loop diuretic sulfonamide derivative • Indication:"x of pulmonary edema, ascites, edema in CHF; nephrotic syndrome; hepatic disease; HTN; UNLABELED USES: Hypercalcemia in malignancy; pulmonary edema or prevention of hemodynamic effect associated with blood product transfusion; hypertensive emergency/urgency • Action: inhibits re-absorption of NA and CL at proximal and distal tubule and in the loop of Henle • Dosage:PO: 20-80mg/day in AM; may give another dose in 6h up to 600mg/day. **Differ dose for HTN crisis, pulm edema** IV/IM: 20-40mg, incr by 20mg q2hr until desired response [IV route undil, thru y-tube or 3way stopcock; give 20mg or less/min; may be added to NS or D5W if lg doses req'd and given as IV inf, max 4mg/min; use inf pump o Admin: In AM to avoid interference with sleep if using product as a diuretic; Potassium replacemt if K <3mg/dl; PO with food if nausea occurs; absorption my be decreased slightly; tabs may be crushed; • Contraindications:breastfeeding; infants; hypersensitivity to sulfonamides, anuria, hypovolemia, electrolyte depletion • Side Effects: CNS: Headache, fatigue, weakness, vertigo, paresthesias o CV: orthostatic hypotension, chest pain, ECG changes o EENT: loss of hearing, ear pain, tinnitus, blurred vision o ELECT: hypokalemia, hypochloremic alkalosis, hypomagnesemia, hyperuricemia, hypocalcemia, hyponatremia, metabolic alkalosis o ENDO: hyperglycemia GI: nausea, diarrhea, dry mouth, vomiting anorexia, cramps, oral/gastric irritations, pancreatitis o GU: polyuria, glycosuria o INTEG: rash, pruritus, purpura, sweating, photosensitivity, urticaria o MS: cramps, stiffness ***CIRCULATORY COLLAPSE, RENAL FAILURE, THROMBOCYTOPENIA, AGRANULOCYTOSIS, LEUKOPENIA, NEUTROPENIA, ANEMIA, STEVEN-JOHNSON SYNDROME*" • Nursing considerations:**Assess: LABS** Signs of metabolic alkalosis: drowsiness, restlessness Signs of hypokalemia: postural hypotension, malaise, fatigue, tachycardia, leg cramps, weakness; Rashes, temp elevation q daily; Confusion, especially in geriatric pt; hearing, including tinnitus and hearing loss, when giving high doses for long periods; Weight, I&O q daily to determine fluid loss; effect of product may be decreased if used daily; Rate, rhythm, depth, of resps, effect of exertion, lung sounds; B/P lying, standing; postural hypotension may occur; Skin turgor, edema, condition of mucous membrance in mouth and nose *Allergies to sulfonamides, thiazides*** o Perform/Provide:Increased fluid intake 2-3L/day unless contraindicated o Labs: I&O; Urine glucose;CBC, Fe levels, albumin; VS electrolytes (K, Na, Cl); Calcium, Magnesium; BUN, creatinine; Blood glucose; ABGs; blood pH; uric acid; Renal function • DRUG INTERAXN: Lithium-toxicity; non-depolarizing skeletal muscle relaxants, digoxin; antiHTN(hypotensive axn) nitrates, aminoglycosides(ototoxicity), ciplantin, vancomycin, anticoag(+), salicylates, probenecid

• Classification: o Antihistamine, H1-receptor antagonist o Phenothiazine derivative • Indication:Motion sickness, rhinitis, allergy symptoms, sedation, nausea, preoperative and postop sedation • Action: acts on blood vessels, GI, respiratory system by competing with histamine for H1-receptor site; decreases allergic response by blocking histamine • Dosage:PO:/IM/IV/RECT: 12.5-25mg/q4-6h prn o Sedation(pre/post op): PO/IM/IV: 25-50mg. o IM in deep in large muscle, rotate site o IV route-Do not use if percip is present; rapid admin may cause transient decr in BP; after diluting each 25-50 mg/9mL of NaCl for inj, give 25mg or less/2min. • Side Effects:"BLACK BOX WARNING: IV USE, INFANTS, NEONATES, CHILDREN, INTRAARETRIAL ADMINISTRATION, SQ ADMIN o CNS: dizziness, drowsiness, poor coordination, fatigue, anxiety, euphoria, confusion, paresthesia, neuritis, EPS o CV: hypo/hypertension, palpitations, tachycardia o EENT: blurred vision, dlated pupils, tinnitus, nasal stuffiness, dry nose, throat, mouth, photosensitivity o GI: constipation, N&V, diarrhea o INTEG: rash, urticaria, o RESP: increased thick secretions, wheezing, chest tightness o NEUROLEPTIC MALIGNANT SYNDROME, THROBOCYTOPENIA, AGRANULOCYTOSIS, HEMOLYTIC ANEMIA, APNEA IN NEONATES, INFANTS, YOUNG CHILDREN • Contraindications:Hypersensitivity, breastfeeding, agranulocytosis, bone marrow suppression, coma, jaundice, Reye's syndrome • Nursing considerations: o Assess: I&O ratio: be alert for urinary retention, freq, dysuria: product should be discontinued;CBC (LT tx); Resp status, rate, rhythm,↑bronchial secretions, wheezing, chest tightness o Cardiac status: palpitations, ↑pulse, hypo/hypertension, VS o Avoid use with other CNS depressants o PO with meals for GI symptoms o For motion sickness, 30-1h before travel o Teach pt photosensitivity may occur, avoid prolonged sunlight o May reduce sweating, risk of hea stroke o May cause drowsiness, avoid hazardous activities • DRUG INTERAXN: barbituates, opiods, hypnotics, tricyclics, ETOH (CNS depression); MAOIs (+); heparin (oral anticoag effect)

• Classification: o antiHTN, antianginal, antidysrhythmic (classII); o Beta-adrenergic blocker • Indication: o chronic stable angina perctoris, HTN, supraventricular dysrhythmias, migraine prophylaxis, pheochromocytoma, cyanotic spells R/T to hypertrophic subaortic stenosis. o UNLABELED USES: anxiety, parkinson's tremor, prevention of variceal bleeding caused by portal HTN, akathisia induced by antipsychotics, acute MI, portal HTN, sclerodermal renal crisis, unstable angina, infantile capillary hemangioma • Action:nonselective B-blocker with negative inotropic, chronotropic, dromotropic properties • Dosage:PO: 10-30mg tid-qid[dysr]; 40mg bid or 80mg/day o Admin: do not break, crush, chew, or open cap (PO) o (ER) [HTN]; 80-320mg/div doses bid-qid [angina] do not us ER cap for essential tremor, MI cardiac dysrhythmias; ER caps should be taken daily. may mix oral sol with liquid or semi-solid food; rinse container to get entire dose. with 8oz water with food; food enhances bioavailability o IV BOL: 0.5-3mg, give 1 mg/min; may repeat in 2 min, may repeat q4hr thereafter o IV route-undiluted or diluted 10mL D5W for nj; give 1mg or less/min; may be diluted in 50mL NaCl and run 1mg over 10-15min • Contraindications:cardiogenic shock, AV heart block, brochospastic disease, sinus bradycardia; bronchospasm, asthma • Nursing considerations: o B/P, P, respiratons during beginning tx, notify prescriber if pulse <50bpm or systolic BP<90mmHg; wt daily, report gain of 5lb, I&O ratio, o CCr if kidney damage is dx, watch for fluid overload, fatique weight gain, jugular distention, dyspnea, periperal edema, crackles; o ECG cont, if using as antidysrhythimic, IV, PCWP, CVP o Hepatic enzymes: AST, ALT, bilirubin; Angina pain: duration, time started, activity being performed, character: tolerance(LT use); HA light-headedness, decr BP, may indicate need for decr dose o do not give aluminum containing antacid; may decr GI absorption o Teach not to d/c abruptly. monitor glucose, may mask hypoglycemia. • Side Effects: o depression, hallucinations, dizziness, fatigue, lethargy, paresthesias, bradycardia, hypotension, CHF, palpitations o AV block, PV insufficiency, pulm edema, dysrhythmias, laryngospasm, sore throat, decreased libido, agranulocytosis, thrombocytopenia, rash fever, facial swelling, wt change, joint pain, dyspnea, bronchospasm. • DRUG INTERAXN: phenothiazines-toxicity; propafenone, calcium channel blockers, NM blockers, disopyramide, cimetidine, quinidine, haloperidol, prazosin

• Classification: o antiHTN, antianginal; o B-blocker, B1, B2-blocker (high doses) • Indication: o mild to mod HTN, prophylaxis of angina pectoris; suspectued or known myocardial infarction (IV use); o UNLABELED USES: migraine prophylaxis, PSVT, unstable angina, ETOH WD • Action: o competitively blocks stimulations of B-adrenergic receptor within vascular smooth muscle; o produces negative chronotropic activity (decr rate of SA node discharge, incr recovery time), o slows conduction of AV node, decr HR, negative inotropic activity decr O2 consumption in myocardium; o also decr renin-aldosterone-angiotensin system at high doses, inhibits B2 receptors in bronchial system at higher doses • Dosage: o PO 25-50mh/day, incr q1-2wk to 100mg/day; may incr to 200mg/day for angina or up to 100mg for HTN; o Geriatric: PO 25mg/day initially o Admin PO before meals, hs, tab may be crushed or swallowed whole, reduced dosage in renal dysfxn o PO CCr15-35ml/min, max 50mg/day; CCr<15mL/min max dose 25mg/day; hemodialysis 25-50 mg ofter dialysis (renal disease) o IV-direct route-undiluted over 5min; o IV inf-diluted in 10-50mL of D5W, D5/NaCl, or NS and give as an inf at prescribed rate • Contraindications:preg D, hypersensitivity to B-blockers, cardiogenic shock, 2nd-or3rd degree heart block, sinus bradycardia, cardiac failure, Raynaud's diease, pulmonary edema. • Side Effects: o insomnia, fatigue, dizziness, mental changes, profound hypotension, bradycardia, CHF, o cold extremities,postural hypotension, sore throat, increased hypoglycemic response to insulin o mesenteric arterial thrombosis, ischemic colitis, impotence, decreased libido, agranulocytosis, thrombocytopenia purpura, rash, fever, alopecia, bronchospasm, dyspnea, wheezing, pulm edema • Nursing considerations: o Assess I&O, wt daily, watch for CHF(rales/crackles, JVD, wt gain, edema) BP P q4h, note rate, rhythm, quality; apical/radial pulse before admin; notify if <50bpm; o ECG; baselines in renal/hepatic studies before tx begins. o Teach not to d/c abruptly, taper over 2wk (angina), take at same time each day, not to use OTC products unless directed o report bradycardia, dizziness, confusion, depression, fever. o Carry emergency ID to identify product, allergies, and conditions Tx. • Drug INTERAXN: Mutual inhibition: sympathomimetics (cough, cold preparations), reserpine, hydralazine, methyldopa, prazosin, anticholinergics, digoxin, diltiazem, verapamil, cardiac glycosides, antiHTN, MAOIs

• Classification: o antiHTN, antianginal, o B1-blocker • Indication: o mild to moderate HTN, acute MI to reduce CV mortality, angina pectoris, NYHA class II, III heart failure; o UNLABELED USES: migraine prevention, HR control in a-fib/flutter without accessory pathway, essential tremor, unstable angina • Action: o lowers BP by B-blocking effects; o reduces elevated renin plasma levels; o blocks B2-adrenergic receptors in bronchial, vascular smooth muscle only at high doses o negative chronotropic effect • Dosage: o PO 50mg bid, or 100mg day; may give up to 200-450mg in div doses; Regular rel tabs after meals, hs; tab may be crushed or swallowed whole; take at same time each day. o EXT REL: 25-100mg/daily, titrate at weekly intervals; max 400mg/day. PO do not break crush or chew ext rel tabs. Teach to take immediatley after meals. o Geriatric: PO 25mg/day initially, incr weekly as needed. (HTN); o IV BOL: [early tx MI] 5mg q2minx3, thne 50mg PO 15min after last dose and q6h x 48h; (late tx) PO maintanence 100mg bid for >=3mo o IV route-undiluted, give over 1min, x3 doses at 2-5min intervals; start PO 15 min after last dose. • Contraindications:hypersensitivity to B-blockers, cardigenic shock, heart block (2nd-3rd degree), sinus bradycardia, pheochromocytoma, sick sinus syndrome • Side Effects: o insomnia, fatigue, dizziness, mental changes, profound hypotension, bradycardia, CHF o cold extremities, postural hypotension, sore throat, increased hypoglycemic response to insulin o mesenteric arterial thrombosis, ischemic colitis, impotence, decreased libido, agranulocytosis, thrombocytopenia purpura, rash, fever, alopecia, bronchospasm, dyspnea, wheezing, pulm edema • Nursing considerations: o Assess: ECG directly when giving IV during intial tx, I&O, wt daily, BP during initial tx; pulse q4h, note rate, rhythm, quality. apical/radial pulse before admin; notify if <50bpm; o ECG; baselines in renal/hepatic studies before tx begins. edema in feet, legs daily, skin turgor, dryness of mucous membranes for hydration status. o not to d/c abruptly; taper over 2wks, may cause precip angina, to report bradycardia, dizziness, confusion, depression, fever, sore throat, SOB, decr vision to prescriber. o To report symptoms of CHF. o to carry emergency ID on person. • Drug INTERAXN: Do not use MAOIs. reserpine, hydralazine, methyldopa, prazosin, amphetamines, epinephrine, H2-antagonit, Ca channel blockers, cimetidine,

• Classification: o antianginal, antiHTN, o calcium channel blocker; dihydropyridine • Indication: o chronic stable angina pectoris, HTN, variant angina (Prinzmetal's angina); may coadmin with other antiHTN, antianginals. o UNLABELED USES: HTN (pediatric pts) • Action: o inhibits Ca ion influx across cell membrane during cardiac depolarizations; o produces relaxation of coronary valcular smooth muscle and peripheral vascular smooth muscle; o dilates coronary vascular arteries; o incr myocardial o2 delivery in pt with vasospastic angina • Dosage: o PO 5-10mg/day (CAD); 2.5-5mg/day, may incr max 10mg/day (HTN); o Geriatric-2.5mg/day, may incr to 5mg/day max 10mg/day. o Admin: once a day, without regard to meals • Contraindications: hypersensitivity to this product, severe aortic stenosis, severe obstructive CAD • Side Effects: o HA, fatigue, dizziness, asthenia, peripheral edema, bradycardia, hypotension, palpitations, syncope, chest pain o dyspepsia, dysphagia, flatulence, anorezia, nocturia, polyuria, sexual difficulties, flushing, muscle cramps, cough, tinnitus, epistaxis • Nursing considerations: o Assess: Cardiac status: BP, P, RR, ECG, some pt have developed sever angina, acute MI after Ca channel blockers if obstructive CAD is severe. o I&O ratio, wt daily; CHF; peripheral edema, dyspnea, JVD, crackles; angina; intensity, location, duration of pain. o Teach to take product as prescribed, do not double or skip dose. o To avoid hazardous activities until stabilized on product, dizziness is no longer a problem. o Avoid OTC products, grapefruit juice unless directed by prescriber o Contact prescriber if pulse <50bpm • Drug INTERAXN: lithium-nuerotoxicity; antiHTN, nitrates, fentanyl, quinidine, diltiazem, NSAIDs,

• Classification: o cardiac glycoside, inotropic, o antidysrhthmic; digoxin preparation • Indication: o heart failure, A-fib, a-flutter, a-tach, cardiogenic shock, paroxysmal a-tach, rapid digitalization in these disorders; o UNLABELED USES: a-flutter, paroxysmal supraventricular tachycardia (PSVT) tx/prophylaxis • Action: o inhibits the Na-K ATPase, which make more Ca available for contractile porteins, resulting in increased cardiac output (positive inotropic effect); o increases force of contraction; o decreases HR (negative chronotropic effect); o decreases AV conduction speed • Dosage: o PO digitalizing dose: 0.75--1.25mg given as 50% of dose initially, additional fractions given at 4-8h intervals o maintenance 0.125-0.5mg/day (tabs) or 0.350-0.5mg/day (gel cap) o Do not break, crush, or chew caps (PO), PO with or without food; may crush tabs, only mix wth food/fluids o IV digitalizing dose: 0.6-1mg given as 50% of dose initially, additional fractions given at 4-8h intervals o IV route-undliuted or 1mL of product/4mL sterile H2O, D5 or NS; give >5min thru Y-tube or 3way stop; during digitalization close monitoring necessary • Contraindications:hypersensitivity to digoxin, V-fib, V-tach, carotid sinus syndrome, 2nd or 3rd degree heart block • Side Effects: o HA, drowsiness, apathy, confusion, disorientation, fatigue, depression, hallucinations, dysrhythmias o hypotension, bradycardia, AV block, yellow-green halos, abdominal pain, diplopia, blurred vision • Nursing considerations: o Assess: Apical P for 1min before giving product; if pulse <60 in adult, take again in 1hr; if <60 in adult, call prescriber; not rate, rhythm, cahracter; monitor ECG continuously during parenteral loading dose. o Electrolytes: K, Na, Cl, Mg, Ca; renal fxn studies; BUN, creatinine; blood studies: ALT, AST, bilirubin, o Hct, Hgb before initiating tx and periodically thereafter. I&O ratio, daily wts, monitor turgor, lung sounds, edema, monitor product levels (therapeutic level 0.5-2ng/mL) o cardiac status: apical pulse, character, rate rhythm. o K supplements if ordered for K levels <3, or foods high in K: bananas, orange juice o Teach not to stop product abruptly; o teach all aspects of product, to take exactly as ordered; o how to monitor HR; o avoid OTC med, herbal remedies since many adverse prod interaxn may occur; o do not take antacid at same time. • Drug INTERAXN: thiazides, parenteral calcium, diuretics, amphotericin B, carbenicillin, ticarcillin, corticosteroids, propantheline, quinidine, verapamil , amoidarone, anticholinergics, diltiazem, nifedipine, B-adrenergic blockers, antidysrhythmics, sympathomimetics, thyroid agents, cholestyramine, colestipol, metoclopramide

• Classification: o antiHTN, antianginal; o a/B-blocker • Indication: o mild to mod HTN, tx of severe HTn (IV) o UNLABELED USES: HTN in pt with pheochromocytoma, HTN in clonidine WD. • Action: o produces decr in BP without reflex tachycardia or significant reduction in HR thru mixture of a-blocking, B-blocking effects; o elevated plasma renins are reduced • Dosage: o PO 100mg bid; may be given with diuretic; may incr to 200mg bid after 2 days; may cont to incr q1-3days; may 2400mg/day in divided doses (HTN). o Admin: Po before meals, at bedtime, tab may be crushed or swallowed whole, give with meals to incr absorption. o reduced dosage in renal dysfxn. o IV INF: 200mg/160mL D5W, run at 2mg/min or 1.6mL/min; stop inf at desired response, repeat q6-8h as needed; o IV BOL 20-80mg over 2 min, may repeat 20-80mg q10min, not to exceed 300mg (HTN crisis) o IV route-undiluted or diluted in LR, D5W, D5 in 0.2%, 0.9%, 0.33% NaCl or Ringer's inj, give undiluted 20mg or less/2min; inf is titrated to pt response; 200mg of prod/160m: sol=1mg/mL; 300mg prod/240mL sol =1mg/mL; 200mg prod/250mL sol =2mg/3mL; use inf pump. Keep pt recumbent during and for 3hr after admin, mnitor VS q5-15min • Contraindications: hypersensitivity to B-blockers, cardiogenic shock, heart block(2nd or 3rd degree), sinus bradycardia, CHF, bronchial asthma • Side Effects: o dizziness, mental changes, drowsiness, fatigue, HA, catatonia, depression, anxiety, nightmares, paresthesias, lethargy o orthostatic hypotension, bradycardia, CHF, chest pain, ventricular dysrrhythmias, AV block o scalp tingling, tinnitus, visual changes, sore throat, dyspepsia, agranulocytosis, thrombocytosis, pupura, bronchospasm, dyspnea • Nursing considerations: o Assess: I&O, wt daily; fluid overload; wt gain, JVD, edema, crackles in lungs; o BP during beginning tx, P q4h; note rate, rhythm, quality; apical/radial pulse before admin; notify of significant changes. o baselines in renal, hepatic studies before therapy begins. edema in feet, legs daily, skin turgor, dryness of mucous membranes for hydration status o Teach not to d/c prodcut abruptly; taper over 2weeks; may cause precipitate angina. not to use OTC products containing alpha adrenergic stimulants unless directed o To report bradycardia, dizziness, confusion, depression, fever o To report symptoms of CHF, difficulty breathing, esp on exertion or when lying down, night cough, swelling of extremities. • Drug INTERAXN: Do not use within 2wk of MAOIs. ACONITE=DEATH, toxicity. hydantoins, general anesthetics, verapamil, diuretics, other HTNs, cimetidine, nitroglycerins, sympathomimetics, lidocaine, indomethacin, theophylline, B-blockers, bronchodilators, xanthines, glutethimide, NSAIDs, salicylates

• Classification: o potassium sparing diuretic; o aldosterone antagonist • Indication: o edema of CHF, HTN, diuretic induced hypokalemia, primary hyperaldosteronism (dx, St tx, LT tx), edema of nephrotic syndrom, cirrhosis of liver with ascites; o UNLABELED USES: CHF, hirsutism in women, bronchopulmonary dysplasia(BPD), PMS, PCOS, acne vulgaris, PMS • Action: o competes with aldosterone at receptor sites in distal tubule, resulting in excretion of NaCl, H2O, retention of K, phosphate • Dosage: o PO: 25-200mg/day in 1-2 div dose (edema/HTN); o 12.5-25mg.day; max 50mg daiy (CHF); o 25-100mg.day; if PO K supplemnts must not be used (hypoK) • Contraindications: • Side Effects: o HA, confusion, drowsiness, ataxia, hyperkalemia, hyperchloremic metabolic acidiosis, bleeding o hepatocellular toxicity, agranulocytosis, ammenorrhea, deepening voice • Nursing considerations: o Assess electrolytes: Na, Cl, K, BUN, serum creatinine, ABGs, CBC, signs of hyperkalemia, wt, o I&O daily to determine fluid loss. o EKG periodically, o If nausea occurs take med with food. o hydration, skin turgor, thrist dry mucous membranes. o Teach to avoid foods high in potassium content: bananas, dates, dried apricots. • Drug INTERAXN: ASA, NSAIDS, ARGININE=FATAL HYPOK,

• Classification: o AntiHTN, direct-acting peripheral vasodilator o Phtalazine • Indication: o Essential HTN, severe essential HTN o UNLABELED USES:CHF • Action: o Vasodilates arteriolar smooth muscle by direct relaxation o Reduction in BP with reflex incr in HR, SV, CO • Dosage: o PO: Adult: (HTN) 10mg qid 2-4 days, then 25mg rest of first wk, then 50mg qid indiv to desired response, max 300mg/day [CHILD DOSE DIFF] o PO: Adult (CHF) 10-25mg/tid, max 75mg tid o Admin: PO give with meals to enhance absorption o To recumbent pt, keep for 1 hr after admin o IV BOL: Adult (HTN CRISIS) 10-20mg q4-6hr, admin PO asap; iM 10-50mg q4-6hr [CHILD DOSE DIFF] o IV undiluted: give thru Y-tube or 3way stp, give ea 10mg over 1min or more. • Contraindications: hypersensitivity to hydralazines, mitral valvular rheumatic heart disease, dissecting aortic aneurysm • Side Effects: o HA, tremors, dizziness, anxiety, peripheral neuritis, depression, fever, chills o Palpitations, reflex tachycardia, angina, shock**, rebound HTN o N&V, paralytic ileus, urinary retention, leukopenia*, agranulocytosis*, anemia, thrombocytopenia*, lupuslike symptoms, flushing edema, dyspnea, edema • Nursing Considerations: o Assess: Cardiac status: BPq5minx2hr, then q1hrx2hr, then q4hr; P, JVD q4hr o Electrolytes: blood studies: K, Na, Cl, CO2, CBC, serum glucose o Weight daily, I&O o LE prep, ANA titer before starting tx and during tx; assess for fever, joint pain, rash, sore throat (lupuslike symptoms); notify prescriber o Edema in feet, legs daily o Skin turgor, dryness of mucous membranes for hydration status o Crackles, dyspnea, Orthopnea o Iv site for extravasation, rate o Mental status: affect, mood, behavior, anxiety; check for personality changes o Take with food to incr bioavailability (PO) o Avoid OTC preparations unless directed by prescriber o Notify prescriber if chest pain, severe fatigue, fever muscle or joint pain occurs o Rise slowly to prevent orthostatic hypotension • DRUG INTERAXNS: ACONITE=DEATH, MAOIs=severe hypotension, sympathomimetics=tachycardia, angina;

• Classification: o Nonsteroidal anti-inflammatory, antirheumatic o COX-2 inhibitor • Indication: o Acute, chronic RA, OA, familial adenomatous polyposis (FAP), acute pain, primary dysmenorrhea, ankylosing spondylitis, JRA o UNLABELED USES: colorectal adenoma prophylaxis • Action:inhibits prostaglandin synthesis by selectively inhibiting COX-2, an enzyme needed for biosynthesis • Dosage: DO NOT EXCEED REC DOSE=DEATH OCCUR o Adult (Acute Pain/Prim Dysmen) PO 400mg init, then 200mg if needed on 1st day, then 200mg bid prn on subsequent days; start with ½ dose in poor CYP2C9 metabolizers o Adult (OA) PO 200mg/day as single dose or 100mg bid; o Adult (RA) PO 200mg/day or in divided dose (bid) o Adult (FAP) PO 400 mg/bid; o Adult (colorectal) PO 400mg bid x6mo • Contraindication:Preg D 3rd trimester, hypersensitivity to salicylates, iodides,other NSAIDs, sulfonamides • Side Effects: o fatigue, anxiety, depression ,nervousness, paresthesia, dizziness, insomnia o stroke*, MI*, tachycardia*CHF*, angina, palpitations, dysrhythmias, HTN, fluid retention, tinnitus, hearing loss, blurred vision, N&V, dysuria, UTI, epistaxis, anemia, SOB, pneumonia • Nursing Considerations: o Assess for pain of RA, OA, check ROM, inflammation of joints, characteristics of pain o For cardiac disease that may be worse after taking product o FAP clients for decr number of polyps o Blood counts during tx, watch for decr platelets, if low tx may need d/c restarted after recovery o For blood dyscrasias (thrombocytopenia), bruising, fatigue, bleeding poor healing o GI toxicity: black, tarry stools, abdominal pain o Teach do not exceed recommended dose due to death risk o Check with prescriber prior to surgery o Report possible URI, SOB, coughing painful swallowing • DRUG INTERAXNS:bleeding risk-anticoag, SSRIs, antiplatelets, thrombolytics, salicylates, ETOH, NSAIDs, aspirin, glucocorticoids

• Classification: o antiHTN o angiotensin II receptor (type AT1) antagonist • Indication: HTN, alone or in combination, nephropathy in type2 diabetes, HTN with left ventricular hypertrophy • Action: o Blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II o Selectively blocks the binding of angiotensin II to the AT1, receptor found in tissues • Dosage: o Adult (HTN) PO: 50mg/day alone or 25mg/day when used in combo with diuretic; maintenance 25-100mg/day o Adult (Hep Dose) PO: 25mg/day as starting dose o Adult (HTN c LVH) PO: 50mg/day, add HCTZ 12.5mg/day and /or incr cozaar to 100mg/day, then incr HCTZ to 25mg/day o Adult (nephropathy in DM2) PO: 50mg/day, may incr to 100mg/day • Contraindication:hypersensitivity • Side Effects: o Dizziness, insomnia, anxiety, confusion, abnormal dreams, migraine, tremor, vertigo, HA, malaise o Angina pectoris, 2nd-degree AV block, CVA*, hypotension, MI* dysrhythmias, blurred vision, burning eyes, conjunctivitis o Diarrhea, dyspepsia, dry mouth, flatulence, gastritis, vomiting, impotence, nocturia, urinary freq, UTI, renal failure*, angioedema*, gout, URI, dyspnea • Nursing Considerations: o BP with position changes, pulse q4h note rate, rhythm, quality, o Electrolytes: K, Na, Cl o Baselines, in renal, hepatic studies before tx begins o Edema in feet, legs daily o Skin turgor, dryness of mucous membreanes for hydration status o Teach to avoid sunlight or use sunscreen o Comply with dose schedule o Avoid salt subs, ETOH, grapefruit juice • DRUG INTERAXNS: TOXICITY=LITHIUM, DEATH=ACONITE, fluconazole=antiHTN effect incr,

• Classification: o antiHTN o angiotensin II receptor antagonist (type AT1) • Indication: HTN, alone or in combination in pts>6yrs, CHF • Action: o Blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II o Selectively blocks the binding of angiotensin II to the AT1, receptor found in tissues • Dosage: o Adult PO (HTN): 80-160mg/day alone or n combinations with other antiHTN may incr to 320mg o Adult PO (CHF): 40mg bid, up to 160mg bid • Contraindication: o hypersensitivity, severe hepatic disease, bilateral renal artery stenosis o BBW-Pregnancy D, 2nd/3rd Trimester • Side Effects: o Dizziness, insomnia, drowsiness, vertigo, HA, fatigue o Angina pectoris, 2nd-degree AV block, CVA, hypotension, MI* dysrhythmias, conjunctivitis, diarrhea, abdominal pain, nausea, o hepatotoxicity*, impotence, nephrotoxicity, anemia, neutropenia, hyperkalemia, vasculitis, cramps, myalgia, pain, stiffness, cough • Nursing Considerations: o BP, P q4h, note rate, rhythm, quality, periodically o Blood studies: BUN, creatinine, LFTs before tx o Electrolytes: K, Na, Cl, total CO2 o Baselines in renal, hepatic studies before tx befins o Angioedema: facial swelling: SOB, edema in feet, legs daily o Skin turgor, dryness of nucous membranes for hydration status; correct volume depletion before initiating tx o Teach to comply with dosage schedule, even if feeling better o Notify prescriber of fever, swelling of hands or feet, irreg heartbeat, chest pain, dizziness • DRUG INTERAXNS:NSAIDs, salicylates-antiHTN effects, lithium(effects incr)

• Classification: o AntiHTN o Vasodilator, peripheral • Indication: o Severe HTN unresponsive to other tx (use with diuretic) o Topically to treat alopecia o UNLABELED USES: scleroderma renal crisis (SRC) to control HTN • Action: directly relaxes arteriolar smooth muscle, casuing vasodilation • Dosage: o Adult (severe HTN) PO: 25.5-5mg/day in 1-2 divided doses; max 100mg/day; usual range 10-40mg/day in single doses o Geriatric PO 2.5mg/day, may be incr gradually o Adult (alopecia) Topically: 1mL bid, rub into scalp daily, max 2mL/day 1mL no matter how much balding has occurred; incr dosage does not speed growth o Adult (SRC) PO: 5mg/day in 1-2 divided doses, incr after 3days by 10-20 mg/day to reach desired BP, max 100mg/day o Admin: with meals for better absorption, to decrease GI symptoms, o With B-blockers and/or diuretic for HTN • Contraindication:dissecting aortic aneurysm, hypersensitivity, pheochromocytoma o BBW: ACUTE MI: CAD, CHF, cardiac disease, cardiac tamponade, edema, hypotension, orthostatic hypotension, pericardial effusion • Side Effects:HA, fatigue, severe rebound HTN on WD in children, tachycardia, angina, incr T wave, CHF*, pulm edema*, pericardial effusion*, edema, sodium, water retention, N&V, breast tenderness, Hct, Hgb, erythrocyte count may decr initially, pruritus, Stevens-Johnson syndrome*, rash, hirsutism • Nursing Considerations: o Assess: Monitor closely, usually given with B-blocker to prevent tachycardia and incr myocardial workload, usually given with diuretic to prevent serious fluid accumulation, pt should be hospitalized dure beginning tx. o Nausea, edema in feet and legs daily o Skin turgor, dryness of mucous membranes for hydration status o Crackles, dyspnea, Orthopnea o Electrolytes: K, Na, Cl CO2 o Renal studies: catacholamines, BUN, creatinine o Hepatic studies: AST, ALT, alk phos o BP, Pulse, wt daily, I&O o Teach body hair will incr but reversible after d/c tx o Do not d/c abruptly o Report pitting edema, dizziness, wt gain>lb, SOB, bruising or bleeding, HR>20 beats/min over normal, severe indigestion, panting, new or aggravated symptoms of angina • DRUG INTERAXNS:AntiHTN-orthostatic hypotension, NSAIDs, salicylates-antiHTN effects

• Classification:analgesic-misc • Indication: o Mgmt of mod to severe pain, chronic pain o UNLABELED USES: restless leg syndrome (RLS), postop shivering • Action: o not completely understood ,binds to opioid receptors, inhibits reuptake or norepi, serotonin o Does not cause histamine release or affect heart rate • Dosage: o Adult (Mild to mod pain) PO 50-100mg prn q4-6hr; max 400mg/day o Geriatric >75y PO <300mg/day in divided doses o Adult (mod to severe chronic pain) PO-ER 100mg, titrate up q5days in 100mg increments, max 300mg/day o Adult (renal dose) PO CCr<30ml/min give q12hr, max 200mg/day, do use ER tab o Adult (hep impair) PO 50mg q12hr o Adult (RLS) PO 50-150mg/day x15-24 mo • Contraindication: hypersensitivity, acute intx with any CNS depressant • Side Effects: o Dizziness, CNS stimulation, somnolence, HA, anxiety, confusion, cuphoria, seizures* o Hallucinations, sedation, neuroleptic malignant syndrome-like rxns**, vasodilation, tachycardia, HTN, abnormal ECG, visual disturbances, GI bleeding, urinary retention/frequency, pruritus, rash, serotonin syndrome • Nursing Considerations: o Pain: location, type character, gie before pain becomes extreme o I&O ratio, check for decr output; may indicate urinary retention o Need for product: dependency o Bowel pattern; for constipation incre fluids, bulk in diet o CNS changes, dizziness, drowsiness, LOC, pupil rxns o Allergic rxns o Increased side effects in renal/hepatic disease o Teach report symptoms of CNS changes, allergic rxns • DRUG INTERAXNS:MAOIs, ETOH, sedatives, hypnotics, opiates, SSRIs,

• Classification: o Anticonvulsant o Gamma aminbutyric acid (GABA) analog • Indication: o neuropathic pain assoc with diabetic peripheral neuropathy, partial onset seizures, postherpetic neuralgia, fibromyalgia, o UNLABELED USES: generalized anxiety disorder, moderate pain, social anxiety disorder • Action: o binds to high voltage gated Ca channels in CNS tissues This may lead to anticonvulsant axn, similar to the inhibitory neurotransmitter GABA, anxiolytic, analgesics, and antiepileptic properties • Dosage: o Adult (DM peripheral neuropathic pain) PO 50mg bid, may incr to 30mg/day (max) within 1wk, adjust in renal disease o Adult (partial onset seizures) PO 75mg bid or 50mg tid; may incr to 600mg/day (max) o Adult (post herp neuralgia) PO 150mg/day divided in 2-3 doses, may incr to 300mg/day in 2-3 divded doses, if higher is req in 2-4wk may incr to 600mg/day in 2-3div doses o Adult (fibromyalgia) PO 75mg bid, may incr to 150mg bid within 1wk, and 225mg bid after 1wk • Contraindication: hypersensitivity, abrupt d/c • Side Effects: o dizziness, fatigue, confusion, euphoria, incoordination, nervousness, neuropathy, tremor, vertigo, somnolence, ataxia, amnesia, abnormal thinking o dry mouth, blurred vision, nystagmus, amblyopia, sinusitis, constipation, flatulence, weight gain, eccyhmosis, dyspnea, angioedema*suicidal ideation* • Nursing Considerations: o Assess: seizures: aura, location, durations, activity at onset o Pain location, duration, characteristics if using for diabetic neuropathy o Renal studies, UA, BUN, urine creatinine q3mo, creatinine kinase, if markedly incre, d/c o Mental status: mood, sensorium, affect, behavioral changes o Teach to carry emergency ID avoid driving drowsiness may occur o Taper over 1wk to d/c medication o Report muscle pain, tenderness, weakness, when accompanied by fever malaise • DRUG INTERAXNS:thiazolidinedione, avoid if poss (wt gain/fluid ret); anxiolytic, sedatives, hypnotics,

• Classification: o AntiHTN, o Central α-adrenergic agonist • Indication: o mild to mod HTN, used alone or in combo; severe pain in CA pt (epidural) o UNLABELED USES: opioid WD, prevention of vasc HA, tx of menopausal symptoms, dysmenorrhea, ADHD, autism, HTN er, tourette's syndrome • Action: o inhibits sympathetic vasomotor center in CNS, wheich reduces impulses in sympathetic nervous system o BP, HR, CO decr, prevents pain signal transmission in CNS by α-adrenergic receptor stimulation of the spinal cord • Dosage: o Adult (HTN) PO/Transdermal: 0.1mg bid, then increase by 0.1-0.2mg/day at weekly intervals, until desired response; range 0.2-0.6mg/dy individed doses o Geriatric PO 0.1mg HS, may incr gradually • Contraindication:hypersensitivity,(epidural) bleeding disorders, anticoagulants • Side Effects:drowsiness, sedation, HA, fatigue, nightmares, insomnia, mental changes, anxiety, depression, hallucination, delirium, CHF*palpitations, ECG abnormalities, hyperglycemia, taste change, parotid pain, alopecia, facila pallor, • Nursing Considerations: o Assess: blood studies: neutrophils, decr platelets o Renal studies: protein, BUN, creatinine, incre levels may indicate nephrotic syndrome o Baselines in renal, hepatic studies before beginning tx, K levels, although hyperkalemia rare o BP, pulse, if used for HTN, report significant changes o Pain, characteristics o Allergic rxns o Symptoms of CHF o Renal symptoms o Teach to avoid hazardous activities, notify all HCPs of med use o Not to d/c abruptly, comply with dose schedule • DRUG INTERAXNS: verapamil(AV block), tricyclics, B-blockers***(life threatening elevations of BP)

• Classification: o antiHTN, antianginal o b-adrenergic receptor blocker • Indication: chronic stable angina pectoris, mild to mod HTN • Action: o long-acting, nonselective B-adrenergic receptor blocking agent, blocks B1 in the heart and B2 in the lungs, uterus, and circ system o Mechanism is similar to that of propranolol • Dosage: o Adult PO 40mg/day, incr by 40-80mg q3-7days; maintenance 40-240mg/day for angina, 40-320mg/day for HTN o Geriatric PO 20mg/day, may incr by 20mg until desired dose • Contraindication:hypersensitivity to this product, cardiac failure, cardiogenic shock, 2nd-3rd heart block, bronhospastic disease, sinus Bradycardia, CHF, COPD • Side Effects: o Depression, dizziness, fatigue, lethargy, paresthesias, HA, weakness, insomnia, memory loss, nightmares o Bradycardia*, hypotension, CHF*, palpitations, AV block*, chest pain, peripheral ischemia, flushing, edema, vasodilation, conduction disturbances, hyperglycemia, hypoglycemia, N&V, diarrhea, colitis, constipation cramps, dyspnea, respiratory dysfxn, • Nursing Considerations: o BP, P, resp during beginning tx, orthstatic hypotension may occur, o Wt daily, report gain of 5lb o I&O ratio, CCr, if kidney damage is dx, crackles, JVD, fatigue, dyspnea o Pain: duration, time started, activity being performed,character o HA, light-headedness, decr BP, may indicate need for decr dosage o Take with 8ox H2O o Teach that prod may mask signs of hypoglycemia o Not to d/c abruptly, serious dysrhythmias may occur o How and when to check BP and P, to hold ose and contact prescriber if pulse <50bpm, systolic BP <90mmHg • DRUG INTERAXNS:Do not use with MAOIs (Bradycardia may occur); ergots(peripheral ischemia); digoxin (Bradycardia), DEATH-ACONITE