Med Cards for Geriatrics – Flashcards

acetaminophen Acephen, Feverall Chemical class: Nonsalicylate, para-aminophenol derivative Therapeutic class: Antipyretic, nonopioid analgesic Indications- To relieve mild to moderate pain from headache, muscle ache, backache, minor arthritis, common cold, toothache, or menstrual cramps; to reduce fever Adverse Reactions- Abdominal pain, hepatotoxicity (possibly severe), nausea, vomiting,Hemolytic anemia (with long-term use), rash, urticaria, Anaphylaxis, angioedema, hypoglycemic coma Contraindications-Hypersensitivity to acetaminophen or its components, severe hepatic impairment, severe active liver disease Nursing Considerations- Use acetaminophen cautiously in patients with hepatic impairment or active hepatic disease, alcoholism, chronic malnutrition, severe hypovolemia, or severe renal impairment. Before and during long-term therapy, monitor liver function test results, including AST, ALT, bilirubin, and creatinine levels, as ordered.Store suppositories under 80? F (26.6? C). Interaction DRUGS- anticholinergics: Decreased onset of acetaminophen actionbarbiturates, carbamazepine, hydantoins, isoniazid, rifampin, sulfinpyrazone: Decreased therapeutic effects and increased hepatotoxic effects of acetaminophenlamotrigine, loop diuretics. Decreased effectiveness of acetaminophenprobenecid: Dosage-SUPPOSITORIES Adults and adolescents. 650 mg every 4 to 6 hr, as needed. Maximum: 3,000 mg in 24 hr. EVAL Teach patient to recognize signs of hepatotoxicity, such as bleeding, easy bruising, and malaise, which commonly occurs with chronic overdose

albuterol albuterol sulfate - Proventil, AccuNeb, Ventolin Class and Category- Chemical class: Selective beta Therapeutic class: Bronchodilator Indications- To treat bronchospasm in patients with reversible obstructive airway disease or acute bronchospastic attack Adverse Reactions- Anxiety, dizziness, drowsiness, headache, hyperkinesia, insomnia, irritability, nervousness, tremor, vertigo, weakness Angina; chest pain; cough, dyspnea, pulmonary edema, Diaphoresis, flushing, pallor, pruritus, rash, urticaria, Angioedema, hypokalemia, infection, metabolic acidosis Contraindications- Hypersensitivity to albuterol or its components Nursing Considerations- Administer pressurized inhalations of albuterol during second half of inspiration, when airways are open wider and aerosol distribution is more effective.Monitor serum potassium level because albuterol may cause transient hypokalemia.Be aware that drug tolerance can develop with prolonged use. Interaction/DRUGS- beta blockers:Inhibited effects of albuterolbronchodilators (sympathomimetics), Dose- INHALATION SOLUTION Adults and children age 12 and over. 2.5 mg t.i.d. or q.i.d. by nebulization over 5 to 15 min PATIENT TEACHING Teach patient to use inhaler. Tell him to shake canister before use and to check that a new canister is working by spraying it the appropriate number of times (once to four times based on manufacturer instructions) into the air while looking for a fine mist. Instruct patient to wash mouthpiece with water once a week and let it air-dry.Advise patient to wait at least 1 minute between inhalations.

buspirone hydrochloride BuSpar, BuSpar DIVIDOSE, Bustab (CAN) Class Chemical class: Azaspirodecanedione Therapeutic class: Antianxiety Indications-To manage anxiety Nursing Considerations- Use buspirone cautiously in patients with hepatic or renal impairment. Institute safety precautions because of possible adverse CNS reactions. Follow closely if patient is being withdrawn from long-term therapy with benzodiazepines or other sedative-hypnotic drugs while starting buspirone therapy because buspirone won't prevent withdrawal symptoms. Contraindications- Hypersensitivity to buspirone or its components, severe hepatic or renal impairment Interactions- Drugs-diltiazem, erythromycin, itraconazole, nefazodone, nordiazepam, verapamil: Foods- food: Possibly decreased clearance of buspirone, grapefruit juice: Increased blood buspirone level Dosages- Tablets Adults- Initial: 5 mg t.i.d. or 7.5 mg b.i.d. increased by 5 mg daily at 2- to 3-day intervals until desired response occurs.Maintenance: 20 to 30 mg daily (usual therapeutic range).Maximum: 60 mg daily. Patient Teaching- Advise patient to take buspirone consistently, either always with or always without food. Caution patient to avoid drinking large amounts of grapefruit juice. Inform patient that 1 to 2 weeks of therapy may be needed before she notices drug's antianxiety effect. Stress the importance of not taking more buspirone than prescribed. Advise patient to avoid potentially hazardous activities until drug's CNS effects are known.

lorazepam Apo-Lorazepam (CAN), Ativan, Lorazepam Intensol, Novo-Lorazem (CAN), Nu-Loraz (CAN) Class and Schedule Chemical class: Benzodiazepine Therapeutic class: Amnestic, antianxiety, anticonvulsant, sedative Controlled substance schedule: IV Indications- To treat anxiety,To treat insomnia caused by anxiety Adverse Reactions- Amnesia, anxiety, ataxia, coma, confusion, delusions, depression, dizziness, drowsiness, headache, hypokinesia, seizures, slurred speech, suicidal ideation, Chest pain, palpitations, tachycardia, Blurred vision, diplopia, dry mouth, increased salivation, photophobia, abdominal pain, constipation, diarrhea, increased liver enzyme levels, jaundice, nausea, vomiting, Libido changes, Agranulocytosis, pancytopenia, thrombocytopenia, Apnea, respiratory depression, Nursing Considerations- Before starting lorazepam therapy in a patient with depression, make sure he already takes an antidepressant because of the increased risk of suicide in patients with untreated depression. Use extreme caution when giving lorazepam to elderly patients, especially those with compromised respiratory function Dosages- Oral concentrate, tablets. Adults and adolescents. 1 to 3 mg b.i.d. or t.i.d. Maximum: 10 mg daily. Patient Teaching- Instruct patient to take lorazepam exactly as prescribed and not to stop drug without consulting prescriber because of the risk of withdrawal symptoms. Advise patient to avoid potentially hazardous activities until drug's CNS effects are known. Urge patient to avoid alcohol while taking lorazepam because it increases drug's CNS depressant effects. Instruct patient to report excessive drowsiness and nausea. Inform pregnant patient that lorazepam therapy will need to be discontinued early in the third trimester to avoid possible withdrawal symptoms in the newborn.

magnesium hydroxide (milk of magnesia) Milk of Magnesia, Pedia-Lax® Indications- short-term basis to treat constipation. Before taking magnesium hydroxide, tell your doctor and pharmacist if you are allergic to magnesium hydroxide or any other drugs. Tell your doctor and pharmacist what prescription and nonprescription medications you are taking, including vitamins. Tell your doctor if you have or have ever had kidney disease. Side Effects- stomach cramps, upset stomach, vomiting, diarrhea Storage- Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication. Dosage-13 to 18 years: 30 to 60 mL orally once a day or in divided doses.

Aspirin (ASA), Bayer Class-Chemical class: Salicylate Therapeutic class: Anti-inflammatory, antiplatelet, antipyretic, nonopioid analgesic Indications- To relieve mild pain or fever Contraindications- Allergy to tartrazine dye, asthma, bleeding problems (such as hemophilia), hypersensitivity to aspirin or its components, peptic ulcer disease Nursing Considerations- Don't crush timed-release or controlled-release aspirin tablets unless directed. Ask about tinnitus. This reaction usually occurs when blood aspirin level reaches or exceeds maximum for therapeutic effect. Interaction-DRUGS-ACE inhibitors: Decreased aspirin absorptionantacids, urine alkalinizers:Increased risk of bleeding; prolonged bleeding time carbonic anhydrase inhibitors, Salicylism corticosteroids: Increased excretion and decreased blood level of aspirin heparin: Increased risk of bleeding ibuprofen: Possibly reduced cardioprotective and stroke preventive effects of aspirin methotrexate,Increased risk of ulcers Dosage- CHEWABLE TABLETS- Adults 325 to 650 mg every 4 hr, p.r.n.; or 500 mg every 3 hr, p.r.n.; or 1,000 mg every 6 hr, p.r.n. PATIENT TEACHING- Advise adult patient taking low-dose aspirin not to also take ibuprofen because it may reduce the cardio-protective and stroke preventive effects of aspirin. Instruct patient to take aspirin with food or after meals because it may cause GI upset if taken on an empty stomach.Instruct patient to stop taking aspirin and notify prescriber if any symptoms of stomach or intestinal bleeding occur such as passage of black, bloody, or tarry stools or if patient is coughing up blood or vomit that looks like coffee grounds. Advise patient with tartrazine allergy not to take aspirin.

Polyvinyl alcohol is used as a lubricant for the relief of symptoms of dry eye and for artificial eyes. Contrainindications- Allergy (hypersensitivity) to any of the ingredients WARNINGS -Polyvinyl alcohol should be used with caution in: Wearers of contact lenses (these should be removed before use and can be re-inserted after 15 minutes) It should not be used in Allergy (hypersensitivity) to any of the ingredients Dosage- instill 1 to 2 drops in the affected eye(s) as needed STORAGE- Store polyvinyl alcohol eye drops below 25°C. Do not refrigerate or freeze.

benzocaine, Benz-O-Sthetic Indications-Treating pain from mouth and gum irritations (eg, canker sores). Contraindications- Do NOT use benzocaine gel if you are allergic to any ingredient in benzocaine gel or to other local anesthetics (eg, butacaine, procaine) Adverse Effects - Headache, high fever, nausea, vomiting, worsening of pain, redness, swelling, or irritation in or around the mouth Nursing Considerations -Benzocaine topical is considered contraindicated in patients with congenital or idiopathic methemoglobinemia. Benzocaine topical is for external use only, and is not intended to be used in or near the eyes. Benzocaine crystals may appear as a white precipitate following topical application.Do not apply in large quantities or over large, raw, or blistered areas, Benzocaine topical is not intended for use on deep or puncture wounds, or serious burns. Instruct patients to avoid eating for approximately 1 hour following topical application to oral mucosa. Dosage- Greater than or equal to 2 years to 18 years:Benzocaine topical 10% mucous membrane gel:Toothache, sore gums, canker sores: Apply topically to affected area(s) up to 4 times daily. A cotton swab may be helpful when applying to young children.

carvedilol, Coreg, Coreg CR Chemical class: Nonselective beta-adrenergic blocker with alpha1-adrenergic blocking activity Therapeutic class: Antihypertensive, heart failure treatment adjunct Indications - To control hypertension Adverse Reactions- Asthenia, depression, dizziness, fatigue, fever, headache, hypesthesia, hypotonia, insomnia, light-headedness, stroke, syncope, Angina, AV block, bradycardia, edema, heart failure, hypertension, orthostatic hypotension, palpitations, Hyperglycemia, hypoglycemia, Abdominal pain, diarrhea, elevated liver function test results, melena, nausea, vomiting, hematuria, elevated BUN and creatinine levels, impotence, renal insufficiency, UTI, Aplastic anemia, decreased PT, thrombocytopenia, unusual bleeding or bruising, Arthralgia, arthritis, back pain, muscle cramps, Dyspnea, increased cough, Jaundice, pruritus, purpura, Anaphylaxis, fluid overload, gout, hyperkalemia, hyperuricemia, hyponatremia, hypovolemia, viral infection, weight gain or loss Contraindications- Asthma or related bronchospastic conditions; cardiogenic shock; decompensated heart failure that requires I.V. inotropics; hypersensitivity to carvedilol or its components; and second- or third-degree AV block, severe bradycardia or hepatic impairment, or sick sinus syndrome unless pacemaker is in place Nursing Considerations- Use carvedilol cautiously in patients with peripheral vascular disease because it may aggravate symptoms of arterial insufficiency; in patients with diabetes mellitus it may mask signs of hypoglycemia, such as tachycardia, and may delay recovery. Monitor patient's blood glucose level, as ordered, throughout carvedilol therapy because drug may alter blood glucose level. WARNING Avoid stopping drug abruptly in patients with hyperthyroidism because thyroid storm may occur and in patients with angina because it may worsen or MI may occur. If patient has heart failure, expect to also give digoxin, a diuretic, and an ACE inhibitor. Dosage- Tablets- Adults. 3.125 mg b.i.d. for 2 wk, then increased to 6.25, 12.5, and 25 mg b.i.d. at successive 2-wk intervals, as tolerated. Maximum (for patients with mild to moderate heart failure): 50 mg b.i.d. if patient weighs more than 85 kg (187 lb). Patient Teaching- Instruct patient prescribed extended-release capsules to swallow them whole. If swallowing capsules is difficult, tell patient he may open capsule and sprinkle beads on a spoonful of cold applesauce and then eat the applesauce immediately without chewing. Warn patient that drug may cause orthostatic hypotension, light-headedness, and dizziness; advise him to take safety precautions. Tell patient with heart failure to notify prescriber if he gains 5 lb or more in 2 days or if shortness of breath increases. These changes may signal worsening heart failure. Alert patient with diabetes to monitor his glycemic control closely because drug may increase blood glucose level or mask symptoms of hypoglycemia.

docusate sodium (dioctyl sodium sulfosuccinate), Colace Chemical class: Anionic surfactant Therapeutic class: Laxative, stool softener Indications -To treat constipation Adverse Reactions- Dizziness, syncope, Palpitations, Abdominal cramps and distention, diarrhea, nausea, perianal irritation, vomiting, Muscle weakness Contraindications- Fecal impaction; hypersensitivity to docusate salts or their components; intestinal obstruction; nausea, vomiting, or other symptoms of appendicitis; undiagnosed abdominal pain Nursing Considerations- WARNING Expect long-term or excessive use of docusate to cause dependence on laxatives for bowel movements, electrolyte imbalances, osteomalacia, steatorrhea, and vitamin and mineral deficiencies. Assess for laxative abuse syndrome, especially in women with depression, personality disorders, or anorexia nervosa. Dosage- Capsules, Liquid, Syrup, Tablets (Docusate Sodium) Adults and adolescents. 50 to 500 mg at bedtime. Patient Teaching- Tell patient not to use docusate when she's has abdominal pain, nausea, or vomiting. Advise patient to take docusate with a full glass of water or milk. To help prevent constipation, encourage patient to increase her fiber intake, exercise regularly, and drink 6 to 8 glasses (240 ml/ glass) of water daily. Instruct patient to notify prescriber about rectal bleeding; symptoms of electrolyte imbalances, such as dizziness, light-headedness, muscle cramping, and weakness; and unrelieved constipation.

furosemide, Lasix, Chemical class: Sulfonamide Therapeutic class: Antihypertensive, diuretic Indications - To reduce edema caused by cirrhosis, heart failure, and renal disease, including nephrotic syndrome Incompatibilities- Don't mix furosemide (a milky, buffered alkaline solution) with highly acidic solutions. Contraindications- Anuria unresponsive to furosemide; hypersensitivity to furosemide, sulfonamides, or their components Adverse Reactions- Dizziness, fever, headache, paresthesia, restlessness, vertigo, weakness, Orthostatic hypotension, shock, thromboembolism, Hyperglycemia Nursing Considerations-WARNING Use furosemide cautiously in patients with advanced hepatic cirrhosis, a history of electrolyte imbalance or hepatic encephalopathy; Obtain patient's weight before and periodically during furosemide therapy to monitor fluid loss. For once-a-day dosing, give drug in the morning so patient's sleep won't be interrupted by increased need to urinate. Expect patient to have periodic hearing tests during prolonged or high-dose I.V. therapy. Monitor BUN, blood glucose, and serum creatinine, electrolyte, and uric acid levels, as appropriate. Be aware that elderly patients are more susceptible to hypotensive and electrolyte-altering effects and thus are at greater risk for shock and thromboembolism. If patient is at high risk for hypokalemia, give potassium supplements along with furosemide, as prescribed. Expect to discontinue furosemide at maximum dosage if oliguria persists for more than 24 hours. Be aware that furosemide may worsen left ventricular hypertrophy and adversely affect glucose tolerance and lipid metabolism. Notify prescriber if patient experiences hearing loss, vertigo, or ringing, buzzing, or sense of fullness in her ears. Drug may need to be discontinued. Oral tablets - Adults- Initial: 40 mg b.i.d., adjusted until desired response occurs. Maximum: 600 mg daily Patient Teaching- Instruct patient to take furosemide at the same time each day to maintain therapeutic effects. Urge her to take it as prescribed, even if she feels well. Instruct patient to take the last dose of furosemide several hours before bedtime to avoid sleep interruption from diuresis. Advise patient to change position slowly to minimize effects of orthostatic hypotension and to take furosemide with food or milk to reduce GI distress. Caution patient about drinking alcoholic beverages, standing for prolonged periods, and exercising in hot weather because these actions increase the hypotensive effect of furosemide.

levothyroxine sodium (L-thyroxine sodium, T4, thyroxine sodium) Synthroid, Unithroid Chemical class: Synthetic thyroxine (T4) Therapeutic class: Thyroid hormone replacement Indications- To treat mild hypothyroidism Adverse Reactions -Fatigue, headache, insomnia, somnolence Hyperthyroidism (with overdose), Dysphagia, Muscle weakness, myalgia, slipped capital femoral epiphysis, Alopecia (transient), rash, urticaria, Weight gain Contraindications- Acute MI (unless caused or complicated by hyperthyroidism), hypersensitivity to levo-thyroxine or its components, uncorrected adrenal insufficiency, untreated thyrotoxicosis Nursing Considerations-Administer levothyroxine tablets as a single daily dose 30 to 60 minutes before breakfast. If patient has difficulty swallowing, crush tablet and suspend in a small amount of water or food. To prevent decreased drug absorption, administer oral levothyroxine at least 4 hours before or after aluminum- or magnesium-containing antacids, bile acid sequestrants, calcium carbonate, cation exchange resins, cholestyramine, colestipol, ferrous sulfate, kayexalate, or sucralfate. Expect to give drug I.V. or I.M. if patient can't take tablets. Be aware that drug shouldn't be given subcutaneously. For I.V. use, reconstitute drug by adding 5 ml of normal saline solution. Monitor PT of patient who is receiving anticoagulants; she may require a dosage adjustment. Monitor blood glucose level of diabetic patient. Prescriber may reduce antidiabetic drug dosage as thyroid hormone level enters therapeutic range. Expect patient to undergo thyroid function tests regularly during levothyroxine therapy. Interactions- Drugs- adrenocorticoids: Possibly adrenocorticoid dosage adjustments as thyroid status changes,aluminum- and magnesium-containing antacids, bile acid sequestrants, calcium carbonate, cation exchange resins, cholestyramine, colestipol, ferrous sulfate, kayexalate, orlistat, sucralfate: Possibly reduced effects of levothyroxine,amiodarone, iodide: Possibly hyperthyroidism, beta blockers: Possibly impaired action of beta blockers and decreased conversion of T to triiodothyronine (T) cholestyramine, colestipol: Delayed or inhibited levothyroxine absorption, digoxin: Reduced therapeutic effects of digoxin estrogen, phenylbutazone, phenytoin: Reduced binding of levothyroxine to protein, possibly requiring increased levothyroxine dosage,insulin, oral antidiabetic drugs: Possibly uncontrolled diabetes mellitus, requiring increased dosage of insulin or oral antidiabetic drug, ketamine: Foods- dietary fiber, soybean flour (infant formula), walnuts: Possibly decreased absorption of levothyroxine from GI tract Dosage-Tablets-Adults.- Initial: 50 mcg daily, increased by 25 to 50 mcg every 2 to 3 wk until desired response occurs or therapeutic blood level is reached. Maintenance: 75 to 125 mcg daily. Patient Teaching- Inform patient that levothyroxine replaces a hormone that is normally produced by the thyroid gland and that she'll probably need to take drug for life. Instruct patient to take drug at least 30 minutes before breakfast because drug absorption is increased on an empty stomach and evening doses may cause insomnia. Stress the need to take levothyroxine with a full glass of water to avoid choking, gagging, having tablet stick in throat, and developing heartburn afterward. Instruct patient to separate iron and calcium supplements and antacids by at least 4 hours from levothyroxine doses. Inform patient that drug may require a few weeks to take effect.

lisinopril, Prinivil, Zestril Chemical class: Lysine ester of enalaprilat Therapeutic class: Antihypertensive, vasodilator Indications- To manage uncomplicated essential hypertension Adverse Reactions- Ataxia, confusion, dizziness, fatigue, headache, stroke, syncope, transient ischemic attack, vertigo, Arrhythmias, chest pain, hypotension, MI, orthostatic hypotension, palpitations, peripheral edema, vasculitis, Hyperglycemia, Abdominal pain, anorexia, cholestatic jaundice, diarrhea, elevated liver enzyme levels, fulminant hepatic necrosis, gastritis, hepatitis, indigestion, nausea, pancreatitis, vomiting, Contraindications- Hypersensitivity to lisinopril, other ACE inhibitors, or their components; history of angioedema related to previous treatment with an ACE inhibitor; hereditary or idiopathic angioedema Nursing Considerations- Use lisinopril cautiously in patients with fluid volume deficit, heart failure, impaired renal function, or sodium depletion. To prepare pediatric suspension, add 10 ml of purified water to a polyethylene tereph-thalate (PET) bottle containing ten 20-mg tablets and shake for at least 1 minute. Add 30 ml of Bicitra diluent and 160 ml of Ora-Sweet SF to the concentrate in the PET bottle, and shake gently for several seconds. Store in refrigerator for up to 4 weeks. Shake the suspension before each use. Monitor blood pressure often, especially early in treatment. If excessive hypotension develops, expect to withhold drug for several days. WARNING- If angioedema affects face, glottis, larynx, limbs, lips, mucous membranes, or tongue, notify prescriber immediately and expect to stop lisinopril and start appropriate therapy at once. If airway obstruction threatens, promptly give 0.3 to 0.5 ml of epinephrine 1:1, 000 solution subcutaneously, as prescribed. Monitor patient for anaphylaxis, especially patient being dialyzed with high-flux membranes and treated concurrently with an ACE inhibitor such as lisinopril. If anaphylaxis occurs, stop dialysis immediately and treat aggressively (antihistamines are ineffective in this situation), as ordered. Anaphylaxis has also occurred with some patients undergoing low-density lipoprotein apheresis with dextran sulfate absorption. Notify prescriber if patient has persistent, nonproductive cough, a common adverse effect of ACE inhibitors such as lisinopril. Monitor for dehydration, which can lead to hypotension. Be aware that diarrhea and vomiting can cause dehydration. Monitor patient for hepatic dysfunction because lisinopril, an ACE inhibitor, may rarely cause a syndrome that starts with cholestatic jaundice or hepatitis and progresses to fulminant hepatic necrosis. Interactions- Drugs- allopurinol, bone marrow depressants (such as methotrexate), procainamide, systemic corticosteroids: Increased risk of potentially fatal neutropenia or agranulocytosis cyclosporine, potassium-sparing diuretics, potassium supplements: Increased risk of hyperkalemia diuretics, other antihypertensives: Increased hypotensive effect insulin, oral antidiabetics: Increased risk of hypoglycemia lithium: Increased blood lithium level and risk of lithium toxicity NSAIDs: Foods- high-potassium diet, potassium-containing salt substitutes: Increased risk of hyperkalemia Activities- alcohol use: Possibly increased hypotensive effect Dosage- Tablets- Adults- Initial: 5 mg daily. Maintenance: 5 to 20 mg daily. Maximum: 80 mg daily. Patient Teaching- Explain to patient that lisinopril helps to control but doesn't cure hypertension and that she may need lifelong therapy. Advise patient to take lisinopril at the same time every day. Emphasize need to take drug as ordered, even if patient feels well; caution her not to stop drug without consulting prescriber. Instruct patient to report dizziness, especially during the first few days of therapy. Inform patient that a persistent, nonproductive cough may develop during lisinopril therapy. Urge her to notify prescriber immediately if cough becomes difficult to tolerate. Advise patient to drink adequate fluid and avoid excessive sweating, which can lead to dehydration and hypotension. Make sure she understands that diarrhea and vomiting also can cause hypotension. Caution patient not to use salt substitutes that contain potassium. Instruct patient to report signs of infection, such as fever and sore throat, which may indicate neutropenia.

memantine hydrochloride, Namenda Chemical class: N-methyl-D-aspartate (NMDA) receptor antagonist Therapeutic class: Antidementia agent Indications- To treat moderate-to-severe dementia of the Alzheimer's type Adverse Reactions- Abnormal gait, agitation, akathisia, anxiety, confusion, delirium, delusions, depression, dizziness, drowsiness, dyskinesia, fatigue, hallucinations, headache, tardive dyskinesia AV block, chest pain, hypertension, peripheral edema, prolonged QT interval, supraventricular tachycardia, tachycardia, Hypoglycemia, Acute pancreatitis, anorexia, Acute renal failure, impotence, urinary incontinence, UTI, Bronchitis, cough, dyspnea, upper respiratory tract infection, Stevens-Johnson syndrome, Generalized pain, flulike symptoms Contraindications- Hypersensitivity to memantine, amantadine, or their components Nursing Considerations- Use memantine cautionly in patients with renal tubular acidosis or severe UTI because these conditions cause urine to become alkaline, thereby reducing memantine excretion and increasing the risk of adverse reactions. Use cautiously in patients with severe hepatic impairment because drug undergoes partial hepatic metabolism which may increase risk of adverse reactions. Monitor patient's response to memantine, and notify prescriber if serious or bothersome adverse reactions occur. Interactions- Drugs- amantadine, dextromethorphan, ketamine: Possibly additive effects, carbonic anhydrase inhibitors, sodium bicarbonate: Decreased memantine clearance, leading to increased blood drug levels and risk of adverse effects, cimetidine, hydrochlorothiazide, metformin, nicotinic acid, quinidine, ranitidine, triamterene: Possibly increased blood levels of both agents Dosages- Tablets- Adults- Initial: 5 mg daily P.O., increased by 5 mg/wk, as needed, to 10 mg daily in two divided doses; then 15 mg daily with one 5-mg and one 10-mg dose daily; then 20 mg daily in two divided doses. Maintenance: 20 mg daily. Patient Teaching- Advise patient to avoid a diet excessively high in fruits and vegetables because these foods contribute to alkaline urine, which can alter memantine clearance and increase adverse reactions. Caution patient to avoid hazardous activities until drug's CNS effects are known.

acetaminophen- Tylenol Extra Strength Chemical class: Nonsalicylate, para-aminophenol derivative Therapeutic class: Antipyretic, nonopioid analgesic Adverse Reactions- Abdominal pain, hepatotoxicity (possibly severe), nausea, vomiting, Hemolytic anemia (with long-term use), leukopenia, neutropenia, pancytopenia, thrombocytopenia, Jaundice, pruritus, rash, urticaria, Anaphylaxis, angioedema, hypersensitivity reaction, hypoglycemic coma Contraindications- Hypersensitivity to acetaminophen or its components, severe hepatic impairment, severe active liver disease Nursing Considerations- Use acetaminophen cautiously in patients with hepatic impairment or active hepatic disease, alcoholism, chronic malnutrition, severe hypovolemia, or severe renal impairment. Before and during long-term therapy, monitor liver function test results, including AST, ALT, bilirubin, and creatinine levels, as ordered. Monitor renal function in patient on long-term therapy. Keep in mind that blood or albumin in urine may indicate nephritis; decreased urine output may indicate renal failure; and dark brown urine may indicate presence of the metabolite phenacetin. Expect to reduce dosage for patients with renal dysfunction. Interaction- anticholinergics :Decreased onset of acetaminophen action, arbiturates, carbamazepine, hydantoins, isoniazid, rifampin, sulfinpyrazon, Decreased therapeutic effects and increased hepatotoxic effects of acetaminophen lamotrigine, loop diuretics, Possibly decreased therapeutic effects of these drugs, oral contraceptives, Decreased effectiveness of acetaminophen, probenecid, Possibly increased therapeutic effects of acetaminophen, propranolol, alcohol use: Increased risk of hepatotoxicity Dosages - EXTRA-STRENGTH (500 MG): CAPLETS, RAPID-RELEASE GELCAPS, EZ TABS Adults and children age 12 and over- 500 mg (2 caplets, gelcaps, tabs) q 6 hr, as needed. Maximum: 3,000 mg (3 doses) in 24 hr. PATIENT TEACHING- Tell patient that tablets may be crushed or swallowed whole. Concentrated infant drops are being phased out and are no longer manufactured, but may still be available. Instruct patient to read manufacturer's label and follow dosage guidelines precisely. Explain that infants' and children's acetaminophen liquid aren't equal in drug concentration and aren't interchangeable. Until concentrated infant drops are completely phased out, parents should use extra caution to ensure the correct dose is given with strength being used. Tell them to use only the measuring device that comes with the bottle to help ensure accurate dosage.

citalopram hydrobromide, Celexa Chemical class: Racemic, bicyclic phthalate derivative Therapeutic class: Antidepressant Indications- To treat depression Adverse Reactions- Agitation, akathisia, anxiety, asthenia, delirium, dizziness, drowsiness, dyskinesia, fatigue, fever, insomnia, myoclonus, neuroleptic malignant syndrome, seizures, serotonin syndrome, suicidal ideation, tremor- Chest pain, prolonged QT interval, thrombosis, ventricular arrhythmias Blurred vision, dry mouth, rhinitis, sinusitis, Acute renal failure, anorgasmia, decreased libido, dysmenorrhea, ejaculation disorders, impotence, priapism, Abnormal bleeding, decreased PT, hemolytic anemia, thrombocytopenia, Upper respiratory tract infection, Diaphoresis, ecchymosis, erythema multiforme Anaphylaxis, angioedema, hyponatremia, weight gain or loss Contraindications - Hypersensitivity to citalopram or its components, use within 14 days of MAO inhibitor therapy Nursing Considerations- WARNING Whenever citalopram dosage is increased, monitor patient for possible serotonin syndrome, characterized by agitation, chills, confusion, diaphoresis, diarrhea, fever, hyperactive reflexes, poor coordination, restlessness, shaking, talking or acting with uncontrolled excitement, tremor, and twitching. Be aware that effective antidepressant therapy may convert depression into mania in predisposed people. If patient develops symptoms of mania, notify prescriber immediately and expect to discontinue citalopram. Monitor patient with hepatic disease for increased adverse reactions because drug is extensively metabolized in the liver. Assess elderly patients and those taking diuretics for signs suggesting syndrome of inappropriate secretion of antidiuretic hormone, including hyponatremia and increased serum and urine osmolarity.

CARD 2 citalopram hydrobromide, Celexa Interactions- Drugs- amitriptyline, bromocriptine, buspirone, clomipramine, dextromethorphan, fluoxetine, fluvoxamine, furazolidone, imipramine, levodopa, lithium, meperidine, naratriptan, nefazodone, paroxetine, pentazocine, phenelzine, procarbazine, selegiline, sertraline, sibutramine, sumatriptan, tramadol, tranylcypromine, trazodone, venlafaxine, zolmitriptan: Possibly enhanced serotonergic effects of citalopram, resulting in agitation, chills, confusion, diaphoresis, diarrhea, fever, hyperreflexia, hypomania, incoordination, myoclonus, or tremor aspirin, NSAIDs, warfarin: Increased risk of bleeding ranging from ecchymoses to life-threatening hemorrhage, carbamazepine: Possibly increased clearance of citalopram, cimetidine: Possibly increased blood citalopram level, desipramine, metoprolol: Increased blood levels of these drugs, furazolidone, procarbazine, selegiline: Possibly hyperthermia, rigidity, myoclonus, and extreme agitation progressing to delirium and coma, itraconazole, ketoconazole, macrolide antibiotics, omeprazole: Possibly decreased clearance of citalopram, MAO inhibitors: Increased risk of life-threatening serotonin syndrome or neuroleptic malignant syndrome, warfarin: Possibly increased PT Dosages- Oral solution, tablets- Adults. Initial: 20 mg daily. Increased by 20 mg at weekly intervals, as prescribed. Usual: 40 mg daily. Maximum: 60 mg daily. Patient Teaching- Inform patient that citalopram's full effects may take up to 4 weeks to occur. Advise patient not to self-medicate for coughs, colds, or allergies without consulting prescriber because these preparations can increase the risk of adverse reactions. Caution patient not to stop citalopram abruptly because doing so may lead to serious adverse reactions. If patient (especially a child or adolescent) takes citalopram for depression, urge care-givers to monitor him closely for suicidal tendencies, especially when therapy starts or dosage changes. Caution against taking OTC NSAIDs, aspirin, or other remedies (including herbal products, such as St. John's wort) while taking citalopram because they may increase the risk of bleeding.

esomeprazole magnesium, Nexium, Nexium I.V. Chemical class: Substituted benzimidazole Therapeutic class: Antiulcerative Indications- To treat gastroesophageal reflux disease (GERD) Adverse Reactions- Agitation, aggression, depression, dizziness, headache, hallucinations, hepatic encephalopathy, Blurred vision, dry mouth, mucosal discoloration, sinusitis, stomatitis, taste disturbance, Gynecomastia, Abdominal pain; Barrett's esophagus; benign polyps or nodules; candidiasis; constipation; diarrhea; duodenitis; dyspepsia; esophagitis; esophageal stricture, ulceration, or varices; flatulence; gastric ulcer; gastritis; hepatic failure; hepatitis; jaundice; nausea; pancreatitis, Interstitial nephritis Agranulocytosis, pancytopenia, Muscle weakness, myalgia, RESP: Bronchospasm, respiratory tract infection, Alopecia, diaphoresis, erythema multiforme, photosensitivity, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis, Anaphylaxis, infusion site redness or pruritus Nursing Considerations - Give oral esomeprazole at least 1 hour before meals because food decreases bioavail-ability. WARNING If patient takes drug with amoxicillin or clarithromycin for H. pylori-related ulcer, severe diarrhea may indicate pseudo-membranous colitis. Obtain stool cultures, as ordered. Patient Teaching- If patient has trouble swallowing esomeprazole capsules, tell him to open capsule and sprinkle pellets into a tablespoon of cool applesauce. Tell him not to chew pellets and to discard any unused pellets. Urge patient to tell prescriber if he takes antacids. Interactions- Drugs antimicrobials: Increased blood esomeprazole levels atazanavir: Decreased blood atazanavir level diazepam: Possibly increased diazepam level digoxin, iron salts, ketoconazole: Possibly decreased absorption of these drugs, voriconazole: Increased esomeprazole exposure and risk of adverse effects, warfarin: Possibly increased INR and PT, leading to abnormal bleeding Foods- all foods: Decreased bioavailability of esomeprazole Delayed-release capsules- Adults. 40 mg daily with amoxicillin 1,000 mg b.i.d. and clarithromycin 500 mg b.i.d. for 10 days. To reduce the risk of gastric ulcer formation in patients who are receiving continuous NSAID therapy and who either are over age 60 or have a history of gastric ulcer Patient Teaching- If patient has trouble swallowing esomeprazole capsules, tell him to open capsule and sprinkle pellets into a tablespoon of cool applesauce. Tell him not to chew pellets and to discard any unused pellets. Urge patient to tell prescriber if he takes antacids.

simvastatin, Zocor Chemical class: Synthetically derived fermentation product of Aspergillus terreus Therapeutic class: Antihyperlipidemic Indications To treat hyperlipidemia Adverse Reactions- Asthenia, dizziness, fatigue, headache Chest pain, Cataracts, rhinitis, Abdominal pain, constipation, diarrhea, elevated liver function test results, flatulence, heartburn, hepatic failure, indigestion, nausea, pancreatitis, vomiting Myalgia, myopathy, rhabdomyolysis, Upper respiratory tract infection, Eczema, pruritus, rash Interactions- Drugs-amiodarone, antiretroviral protease inhibitors (amprenavir, indinavir, nelfinavir, ritonavir, saquinavir), clarithromycin, cyclosporine, danazol, gemfibrozil and other fibrates, itraconazole, ketoconazole, erythromycin, nefazodone, niacin (1 g daily or more), telithromycin, verapamil: Increased risk of myopathy or rhabdomyolysis, azole antifungals, cyclosporine, gemfibrozil, immunosuppressants, macrolide antibiotics (including erythromycin), niacin, verapamil: Increased risk of acute renal failure, bile acid sequestrants, cholestyramine, colestipol: Decreased simvastatin bioavailability, digoxin: Possibly slight elevation in blood digoxin level diltiazem, verapamil: Possibly increased blood simvastatin level, increased risk of myopathy, oral anticoagulants: Increased bleeding or prolonged PT Foods- grapefruit juice (1 or more quarts daily): Possibly increased blood simvastatin level Nursing Considerations- Use simvastatin cautiously in elderly patients and those with renal or hepatic impairment. Give drug 1 hour before or 4 hours after giving bile acid sequestrant, cholestyramine, or colestipol. Expect to monitor liver function test results every 3 to 6 months for abnormal elevations. Monitor serum lipoprotein level, as ordered, to evaluate response to therapy. Contraindications- Active hepatic disease; breast-feeding; concurrent use with clarithromycin, erythromycin, more than 1 quart of grapefruit juice daily, HIV protease inhibitors, itraconazole, ketoconazole, nefazodone, or telithromycin; hypersensitivity to simvastatin or its components Dosages- Tablets-Adults. Initial: 20 to 40 mg daily in the evening. Dosage adjusted at 4-wk intervals, as needed, to achieve target LDL-cholesterol level. Maintenance: 5 to 80 mg daily. Maximum: 80 mg daily. To treat homozygous familial hypercholesterolemia Patient Teaching Urge patient to take drug in the evening. Encourage patient to follow a lowfat, cholesterol-lowering diet. Urge patient to notify prescriber immediately about muscle pain, tenderness, or weakness and other symptoms of myopathy. Inform female patient of childbearing age of need to use reliable contraceptive method while taking drug. Instruct her to notify prescriber at once if she suspects pregnancy. Advise patient to avoid grapefruit juice to decrease risk of drug toxicity.

tamulosin, Flomax Class- alpha-1A blocker. Indications- treatment for men who are having difficutly urinating due to benign prostatic hyperplagia (BPH) Adverse Reactions- Abnormal ejaculation, postural hypotension, dizziness, rhinitis, cough, somnolence, sinusitis, amblyopia, decreased libido, insomnia, syncope; rare: priapism. Considerations- Take with food, Rule out prostate cancer. Sulfa allergy. Syncope. End-stage renal disease. Cataract surgery (intraoperative floppy iris syndrome possible). Interactions: Do not use with other α-blockers. Caution with cimetidine (esp. with tamsulosin >0.4mg/day), warfarin Dosage- Swallow whole. Take ½ hr after same meal of each day. Initially 0.4mg once daily; may increase to 0.8mg once daily after 2-4 weeks if response is inadequate. If therapy is interrupted, resume at 0.4mg once daily and retitrate.

budesonide, Pulmicort Respules Chemical class: Glucocorticoid (Steroid) Therapeutic class: Anti-asthmatic, anti-inflammatory Indications- To manage symptoms of seasonal or perennial allergic rhinitis Adverse Reactions:Pulmicort Flexhaler: nasal congestion, allergic rhinitis, viral upper respiratory tract infection, oral candidiasis, viral gastroenteritis, nausea, bronchospasm (rare). Pulmicort Respules: Respiratory or other infection, GI upset, moniliasis, fatigue, cough, dysphonia, rash, epistaxis, hypersensitivity reactions (discontinue if occurs). Contraindications: Not for primary treatment of acute attack. Warnings/Precautions: Maintain regular regimen. Infections. If exposed to chickenpox or measles, consider antiinfective prophylactic therapy. Adrenal insufficiency may occur when transferring patients from systemic corticosteroids to inhaled corticosteroids: see literature. Monitor for growth suppression in children. Post-op or during stress: monitor adrenal response. Monitor for hypercorticism and HPA axis suppression (if occur discontinue gradually). Transferring from oral corticosteroids: see literature. Pregnancy (Cat.B). Interactions: Caution with CYP3A4 inhibitors (eg, ketoconazole) Adult Dose for PULMICORT RESPULES: Use Flexhaler.

formoterol fumarate, PERFOROMIST Pharmacological Class: Long-acting beta-2 agonist. Indications: Long-term maintenance treatment of COPD-associated bronchoconstriction. Adverse Reactions: GI upset, nasopharyngitis, dry mouth, dizziness, insomnia; ECG changes or cardiovascular effects (eg, increased BP, tachycardia; consider discontinuing if occur); hypokalemia, hyperglycemia, metabolic acidosis; hypersensitivity reactions; rarely: paradoxical bronchospasm, increased risk of asthma-related death. Contraindications: In patients with asthma without use of a long-term asthma control medication. Warnings/Precautions: Increased risk of asthma-related death. Do not initiate in acutely deteriorating COPD. Not for the treatment of asthma. Not for relief of acute symptoms. Prescribe a short-acting, inhaled β2-agonist for acute symptoms; monitor for increased need. Not for use with other long-acting β2-agonists. Do not exceed recommended dose. Cardiovascular disease (esp. hypertension, coronary insufficiency, arrhythmias). Convulsive disorders. Thyrotoxicosis. Hyperresponsiveness to sympathomimetics. Diabetes. Ketoacidosis. Hypokalemia. Interactions: Caution with MAOIs, tricyclics, others that prolong QTc interval (may cause ventricular arrhythmias). Antagonized by β-blockers. K+-depleting diuretics, xanthines, steroids may potentiate hypokalemia. Sympathetic effects potentiated by additional adrenergics (caution). How Supplied: Single-use vials (2mL)—60 Adult Dose for PERFOROMIST: 20micrograms (1 vial) by nebulizer twice daily (AM & PM). Use standard jet nebulizer (eg, PARI-LC Plus [with face-mask or mouthpiece]) and air compressor (eg, Proneb Ultra compressor). Does not need to be diluted before nebulization. Do not mix with other drugs.

Tiotropium (as bromide monohydrate) SPIRIVA HANDIHALER Rx Pharmacological Class: Long-acting anticholinergic. Indications for SPIRIVA HANDIHALER: Long-term maintenance treatment of bronchospasm due to COPD, including chronic bronchitis and emphysema. To reduce exacerbations of COPD. Interactions: Avoid other anticholinergics. Adverse Reactions: Upper respiratory tract infection, dry mouth, sinusitis, pharyngitis, non-specific chest pain, urinary tract infection, dyspepsia, rhinitis, other anticholinergic effects (eg, urinary retention/difficulty, constipation, increased heart rate, blurred vision, glaucoma), GI upset, epistaxis, rash, arthritis, cough, flu-like symptoms, paradoxical bronchospasm, angioedema. Warnings/Precautions: Discontinue if immediate hypersensitivity reactions (eg, angioedema) or paradoxical bronchospasm occurs; consider alternative therapy. Avoid getting powder into eyes. Monitor for signs/symptoms of worsening narrow-angle glaucoma; or worsening GI or GU obstruction. Renal impairment (CrCl ≤50mL/min); monitor for anticholinergic effects. Allergy to milk proteins. Contraindications: Allergy to atropine or its derivatives (eg, ipratropium). Not for primary treatment of acute attack. Adult Dose for SPIRIVA HANDIHALER: 2 inh of one capsule contents (18mcg) once daily, using HandiHaler inhalation device. Do not swallow caps.

albuterol sulfate, Ipratropium bromide + Albuterol sulfate Rx Pharmacological Class: Anticholinergic + beta-2 agonist. Indications: COPD when a second aerosol bronchodilator is needed. Adverse Reactions: Lung disorders, pharyngitis, chest pain, GI disturbances, bronchitis, UTI, leg cramps, pain, voice changes, anticholinergic effects, nervousness, headache, dizziness, insomnia, tachycardia, hypokalemia, paradoxical bronchospasm. Interactions: Avoid MAOIs, tricyclics within 14 days (increased cardiovascular effects). Caution with other anticholinergics, sympathomimetics, drugs that lower potassium. Monitor digoxin. Antagonized by β-blockers. Warnings/Precautions: Not for primary treatment of acute attack. Avoid excessive use. Discontinue if paradoxical bronchospasm or cardiovascular effects occur. Cardiovascular disease (eg, coronary insufficiency, arrhythmias, hypertension). Hyperthyroidism. Diabetes. Seizure disorders. Narrow angle glaucoma. GI or GU obstruction. Hepatic or renal disease. Avoid eyes. Pregnancy (Cat.C). Labor & delivery. Nursing mothers: not recommended Contraindications: Atropine allergy. Note: Formerly known under the brand name DuoNeb Adult Dose: ≥18yrs: 1 vial by nebulizer 4-6 times daily.

acetaminophen, TYLENOL OTC Pharmacological Class: Analgesic/antipyretic. Indications: Minor aches and pain. Fever Adverse Reactions: Hepatotoxicity (overdosage) Interactions: Hepatotoxicity risk increased by chronic, heavy alcohol use. Warnings/Precautions: Hepatic dysfunction How Supplied: Tabs 325mg—100; Adult Dose: 650mg every 4-6 hours; max 4g/day.

aluminum magnesium hydroxide, MYLANTA OTC Pharmacological Class: Antacid. Indications for MYLANTA: Acid indigestion, sour stomach, heartburn, upset stomach. Interactions: Reduces absorption of tetracyclines, possibly other drugs Warnings/Precautions: Hypoparathyroidism. How Supplied: Liq—12oz, 24oz; Adult Dose for MYLANTA: 10-20mL between meals and at bedtime or as needed

Atrovent, Ipratropium bromide Pharmacological Class: Anticholinergic. Indications: Rhinorrhea associated with allergic and nonallergic perennial rhinitis. Adverse Reactions: Epistaxis, pharyngitis, nasal dryness or irritation, other nasal symptoms, nausea. Warnings/Precautions: Avoid eyes. Narrow-angle glaucoma. GI or GU obstruction. How Supplied: Nasal spray—30mL (345 sprays) Adult: ≥6yrs: 2 sprays in each nostril 2-3 times daily.

nitroglycerin, Nitrostat Pharmacological Class: Nitrate. Indications: Acute relief of angina attack. Prophylaxis of angina pectoris Adverse Reactions: Headache, vertigo, weakness, palpitation, orthostatic hypotension, tachycardia, syncope, flushing, rash, exfoliative dermatitis. Interactions: See Contraindications. Hypotension potentiated by sildenafil, calcium channel blockers, alcohol, vasodilators, antihypertensives, β-blockers, phenothiazines, aspirin. May antagonize alteplase, heparin. Drugs that cause dry mouth (e.g., tricyclics, anticholinergics) may interfere with sublingual dissolution. Avoid ergotamine and related drugs. Tolerance to other forms of nitrates may blunt effects. May interfere with cholesterol tests. Warnings/Precautions: Acute MI, heart failure: monitor. Hypotensive or volume depleted. Hypertrophic cardiomyopathy. Avoid abrupt cessation. Discontinue if blurred vision or dry mouth occur. Elderly. Contraindications: Early MI. Severe anemia. Increased intracranial pressure. Concomitant sildenafil. Adult Dose: Treatment: 1 tab sublingually or in buccal pouch at onset, may repeat in 5 minutes; max 3 tabs in 15 minutes. Prophylaxis: 5-10 minutes before activity. How Supplied: Tabs 0.4mg—4 x 25, 100; 0.3mg, 0.6mg—100

Azelastine, ASTELIN .Pharmacological Class: Antihistamine. Indications: Seasonal allergic rhinitis. Vasomotor rhinitis Adverse Reactions: Bitter taste, headache, so nolence, dysesthesia, nasal burning, pharyngitis, dry mouth, paroxysmal sneezing, nausea, rhinitis, fatigue, dizziness, epistaxis, weight increase, myalgia. Children: also conjunctivitis, cough, asthma. Interactions: Potentiates CNS depression with alcohol, other CNS depressants. Caution with other antihistamines Warnings/Precautions: Avoid eyes. How Supplied: Ready-Spray—30mL (200 sprays) Adult Dose: 2 sprays in each nostril twice daily.

hydrocodone apap, NORCO Pharmacological Class: Opioid + analgesic Indications: Moderate to moderately severe pain Adverse Reactions: Lightheadedness, CNS/respiratory depression, nausea, vomiting, constipation, urinary retention, rash, abuse potential; hepatotoxicity (overdosage) Interactions: Potentiation with alcohol, other CNS depressants, MAOIs, tricyclic antidepressants, antihistamines, anticholinergics, antipsychotics, antianxiety agents (reduce dose of either or both drugs if used together). Acetaminophen may cause false (+) urinary 5-hydroxyindoleacetic acid test Warnings/Precautions: Head injury. Increased intracranial pressure. Acute abdomen. Impaired renal, hepatic, thyroid, pulmonary, or adrenocortical function. GI or GU obstruction. Asthma. Drug abusers. Elderly. Debilitated. How Supplied: Tabs 5/325, 7.5/325—100; 10/325—100, 500 Adult Dose: 5mg/325mg: 1-2 tabs every 4-6 hrs as needed

lorazpam, ATIVAN Pharmacological Class: Benzodiazepine. Adverse Reactions: CNS depression (esp. sedation), dizziness, weakness, unsteadiness, transient memory impairment, disorientation, nausea, headache, sleep disturbances, agitation, abuse potential. Interactions: Potentiation of CNS depression with alcohol, other CNS depressants. May be potentiated by probenecid or valproate (reduce lorazepam dose by 50%). Warnings/Precautions: Therapy for >4 months. Avoid abrupt cessation. Change dose gradually. Discontinue if paradoxical reactions occurs. Drug or alcohol abuse. Depression. Suicidal tendencies. Renal, hepatic, or pulmonary dysfunction. Seizure disorder. Reevaluate periodically. Monitor blood counts, liver function with long-term use. Elderly. Debilitated. Psychosis, pregnancy, nursing mothers: not recommended. Contraindications: Acute narrow-angle glaucoma How Supplied: 0.5mg, 2mg—100; 1mg—100, 1000 Adult Dose for ATIVAN: Give in 2 or 3 divided doses, with largest dose taken at bedtime. Initially 2-3mg daily; range: 1-10mg daily. Elderly or debilitated: initially 1-2mg daily; adjust gradually if needed

polyethylene glycol, GLYCOLAX Pharmacological Class: Osmotic. Indications: Constipation. Adverse Reactions: Nausea, abdominal bloating, cramping, flatulence, diarrhea Warnings/Precautions: Nausea, vomiting, abdominal pain or distention: exclude bowel obstruction. Elderly (increased incidence of diarrhea). Avoid prolonged, frequent, or excessive use. Adult Dose: Dissolve 17g in 8oz water and drink once daily for up to two weeks. May need 2-4 days for results. How Supplied: Powder—255g, 527g (both w. dosing cup)

polyvinyl alcohol, REFRESH CLASSIC Pharmacological Class: Ocular lubricant Indications: Dry eye. Warnings/Precautions: Reevaluate if irritation, eye pain, or visual changes persist beyond 72 hours or worsen. How Supplied: Single-use vials—50 Adults: 1-2 drops in affected eye(s) as needed

soidum chloride, OCEAN Indications for OCEAN: Nasal moisturizer. Adults: 1-2 sprays or drops in each nostril How Supplied: Soln—45mL, pt Dose: 1 spray in each nare TID PRN for allergic rhinitis

baclofen, Baclofen Pharmacological Class: Muscle relaxant (central). Indications: Spasticity associated with MS and spinal cord injury or disease. Adverse Reactions: Transient drowsiness, confusion, dizziness, weakness, fatigue, headache, hypotension, nausea, increased urinary frequency; seizures and hallucinations on abrupt withdrawal. Interactions: Alcohol and other CNS depressants potentiated. Warnings/Precautions: Impaired renal function. Beneficial spasticity. Stroke. Epilepsy. Avoid abrupt cessation. Adult Dose: 5mg 3 times daily. Increase in increments of 5mg 3 times daily every 3 days if needed; max 80mg daily. Use lowest dose possible. How Supplied: Tabs—contact supplier

atorvastatin, LIPITOR Pharmacological Class: HMG-CoA reductase inhibitor Indications: Adjunct to diet in primary hypercholesterolemia (heterozygous familial and nonfamilial) and mixed dyslipidemia (Types IIa and IIb) to reduce total-C, LDL-C, apo B and TG, and to increase HDL-C. Adverse Reactions: GI upset, headache, myalgia, arthralgia, rash, elevated serum transaminases, myopathy, rhabdomyolysis with renal dysfunction; increased HbA1c and fasting serum glucose, cognitive impairment; rare: immune-mediated necrotizing myopathy. Warnings/Precautions: Discontinue if myopathy, elevated CPK levels occur; suspend if a predisposition to development of renal failure secondary to rhabdomyolysis develops. Monitor liver function before starting therapy and repeat as clinically indicated. History of liver disease. Substantial alcohol ingestion. Hemorrhagic stroke. Elderly. Interactions: See Adult dose. Avoid with concomitant cyclosporine, gemfibrozil, tipranavir + ritonavir, telaprevir. Potentiated by strong CYP3A4 inhibitors, grapefruit juice (>1.2L/day). Caution with lopinavir + ritonavir, other fibrates, niacin (≥1g/day), colchicine; consider dose reduction of atorvastatin. May increase serum levels of digoxin, oral contraceptives (norethindrone, ethinyl estradiol); monitor digoxin. Caution with drugs that decrease levels or activity of steroid hormones (eg, ketoconazole, spironolactone, cimetidine). Adult Dose: ≥17yrs: Heterozygous and Types IIa and IIb: initially 10 or 20mg once daily; if more than a 45% reduction in LDL-C is needed, may start at 40mg once daily; range 10-80mg once dail How Supplied: Tabs 10mg, 20mg—90, 5000; 40mg, 80mg—90, 500, 2500

magnesium gluconate, CITRACAL PLUS w. MAGNESIUM Indications: Calcium supplement. Adverse Reactions: Hypercalcemia, hypercalciuria. Warnings/Precautions: Hypoparathyroidism. Interactions: May antagonize tetracycline, bisphosphonates (separate by 2hrs), phenytoin, other drugs. May be antagonized by phenytoin, iron supplements.

omeprazole, OMECLAMOX-PAK Pharmacological Class:Proton pump inhibitor + antibiotics (macrolide + penicillin). Indications: Treatment of patients with H. pylori infection and duodenal ulcer disease (active or one-year history) to eradicate H. pylori. Warnings/Precautions: Hepatic impairment, Asian patients: avoid. Myasthenia gravis (monitor). Mononucleosis. Renal impairment. Interactions: See Contraindications. Clarithromycin: cardiac arrhythmias possible with concomitant pimozide. Vasospasm and ischemia with ergots. Colchicine toxicity (esp. in elderly). Torsades de pointes with quinidine, disopyramide. Potentiates digoxin, theophylline, carbamazepine, sildenafil, statins (lovastatin, simvastatin). Monitor QT prolongation with concomitant antiarrhythmics. May potentiate oral anticoagulants. CNS effects with triazolobenziodidiazepines (eg, triazolam, alprazolam) and benzodiazepines (eg, midazolam). Omeprazole: Increased INR and PT with concomitant warfarin. Antagonizes atazanavir, nelfinavir: not recommended. Consider dose reduction of concomitant saquinavir, cilostazol. Potentiates tacrolimus; monitor. May interfere with absorption of drugs for which gastric pH is important (eg, ketoconazole, ampicillin esters, iron salts). Amoxicillin: Potentiated by probenecid. May interfere with testing for glucose in urine using Clinitest, Benedict's or Fehling's Solution. Contraindications: Concomitant ergots, pimozide. How Supplied: Daily administration card—1, 10 Adult Dose: Swallow whole. Take on an empty stomach. Omeprazole 20mg + clarithromycin 500mg + amoxicillin 1g, all twice daily (AM + PM) for 10 days.

prednisone, Prednisone Pharmacological Class: Glucocorticoid. Indications: Corticosteroid-responsive disorders. Adverse Reactions: HPA axis suppression, increased susceptibility to infection, glaucoma, cataracts, secondary infections, hypokalemia, hypocalcemia, hypernatremia, hypertension, CHF, psychic disorders, myopathy, osteoporosis, peptic ulcer, dermal atrophy, increased intracranial pressure, carbohydrate intolerance.

captopril, CAPOTEN Pharmacological Class: ACE inhibitor. Indication: Heart failure inadequately controlled by digitalis and diuretics. To reduce mortality in stable post-MI patients with left ventricular dysfunction (ejection fraction ≤40%). Adverse Reactions: Headache, dysgeusia, rash, pruritus, dizziness, fatigue, cough, proteinuria, nephritis, GI upset, hyperkalemia, hyponatremia, tachycardia, excessive hypotension, dry mouth, jaundice, somnolence, impotence, angioedema. Interactions: Dual inhibition of the renin-angiotensin system with ARBs, ACEIs, or aliskiren may increase risk of hypotension, hyperkalemia, renal function changes; monitor closely. Concomitant aliskiren in diabetics or renal impairment (CrCl <60mL/min): not recommended. Caution with K+-sparing diuretics, K+-containing supplements and K+-containing salt substitutes. May be antagonized by, and renal toxicity potentiated by NSAIDs (including COX-2 inhibitors); monitor renal function in elderly and/or volume depleted. Potentiated by diuretics, β-blockers, adrenergic antagonists. Discontinue nitroglycerin, other nitrates, or other vasodilators before starting therapy; if resumed, reduce dose and give cautiously. May increase lithium levels. May produce false (+) urinary acetone. Nitroid reactions with injectable gold (sodium aurothiomalate). Warnings/Precautions: Fetal toxicity may develop: discontinue if pregnancy is detected. Renal impairment. Salt/volume depletion. Dialysis (esp. high-flux membrane). CHF. Aortic stenosis. Monitor WBCs and renal function in renal and collagen vascular disease. Monitor for hyperkalemia in diabetics, blood pressure and renal insufficiency. Surgery. Discontinue if neutropenia, agranulocytosis, angioedema or laryngeal edema occurs. Neonates. Pregnancy (Cat.D); monitor. Nursing mothers: not recommended. Contraindications: History of ACEI-associated or other angioedema. Adult Dose for CAPOTEN: Take 1 hr before meals. Heart failure: Initially 25mg 3 times daily (generally with diuretic and digitalis regimen). Increase, if needed, to 50mg 3 times daily. After 2 wks, may increase; max 450mg/day. Salt/volume depleted, or if systolic BP <100mmHg: Initially 6.25mg-12.5mg 3 times daily. Titrate to usual dose after several days. Post-MI: First dose 6.25mg 3 days post-MI, then increase to 12.5mg 3 times daily. Increase to 25mg 3 times daily over several days; maintenance 50mg 3 times daily. Renal impairment: see literature. Elimination: Renal. How Supplied: Tabs 25mg, 50mg—100, 1000; 12.5mg, 100mg—100

cetirizine, ZYRTEC Pharmacological Class: Antihistamine. Indications: Allergic rhinitis. Adverse Reactions: Drowsiness, somnolence, fatigue, dry mouth, pharyngitis. Children: headache, pharyngitis, GI upset/pain, cough, somnolence, diarrhea, epistaxis, bronchospasm, fatigue, irritability, insomnia. Interactions: Potentiates CNS depression with alcohol, other CNS depressants. Warnings/Precautions: Hives Relief: not used for prevention or as a substitute for epinephrine. Hepatic or renal dysfunction. Pregnancy. Nursing mothers: not recommended. Contraindications: Hydroxyzine sensitivity. Adults: Chew tabs: may take with or without water. For doses <5mg: use syrup. <2yrs: not recommended. 2-6yrs: initially 2.5mg once daily; max 5mg once daily or 2.5mg every 12hrs. ≥6yrs: initially 5-10mg once daily. ≥65yrs: use chew tabs or syrup: 5mg once daily. Hepatic or renal impairment: individualize. Adults: Chew tabs: may take with or without water. For doses <5mg: use syrup. <2yrs: not recommended. 2-6yrs: initially 2.5mg once daily; max 5mg once daily or 2.5mg every 12hrs. ≥6yrs: initially 5-10mg once daily. ≥65yrs: use chew tabs or syrup: 5mg once daily. Hepatic or renal impairment: individualize.

finasteride,PROSCAR Pharmacological Class: Type II 5 alpha-reductase inhibitor. Indications for PROSCAR: BPH, to improve symptoms and reduce risks of acute urinary retention and need for prostate surgery. To reduce risk of symptomatic progression of BPH, with doxazosin. Limitations of use: not for the prevention of prostate cancer. Adverse Reactions: Impotence, decreased libido or ejaculate volume, breast enlargement or tenderness, rash. Warnings/Precautions: Increased risk of high-grade prostate cancer. Monitor prostate specific antigen (PSA) values; double PSA levels for comparison with normal ranges. Rule out prostate cancer and other urological disorders prior to treatment. Monitor for obstructive uropathy. Hepatic dysfunction. Contraindications: Not for use in children or women. Pregnant women (Cat.X) and those of childbearing potential should avoid handling crushed or broken tabs. Adult Dose for PROSCAR: 5mg once daily. Reevaluate at 6 months, then periodically

nebivolol, BYSTOLIC Pharmacological Class: Cardioselective beta-blocker. Indications: Hypertension. Adverse Reactions: Headache, fatigue, dizziness, GI upset. Interactions: Caution with phenylalkylamine and benzothiazepine calcium channel blockers (eg, verapamil, diltiazem), antiarrhythmics (eg, disopyramide), digoxin, reserpine, guanethidine; monitor. May be potentiated by CYP2D6 inhibitors (eg, quinidine, propafenone, paroxetine, fluoxetine); may need to reduce dose. If on both nebivolol and clonidine, discontinue nebivolol before tapering clonidine. May block epinephrine. Warnings/Precautions: CHF. Angina. Recent MI. Bronchospastic disease. Diabetes. Hyperthyroidism. Severe renal impairment. Moderate hepatic impairment. Avoid abrupt cessation (taper over 1-2 weeks). Surgery. Peripheral vascular disease. Pheochromocytoma. Contraindications: Severe hepatic impairment (Child-Pugh >B). Severe bradycardia. 2nd- or 3rd-degree AV block. Cardiogenic shock. Overt heart failure. Sick sinus syndrome (unless paced). Adult Dose: ≥18yrs: initially 5mg once daily. Individualize; may increase at 2-week intervals; max 40mg/day. Severe renal or moderate hepatic impairment: initially 2.5mg once daily.

furosemide, LASIX Pharmacological Class: Loop Diuretic Indications: Edema. Adverse Reactions: Excessive diuresis, fluid or electrolyte imbalance, GI upset, dizziness, vertigo, paresthesias, orthostatic hypotension, hyperglycemia, jaundice, hyperuricemia, rash, photosensitivity, tinnitus, hearing loss, blood dyscrasias, renal calcification, persistence of patent ductus arteriosus in premature infants. Interactions: Concomitant chloral hydrate: not recommended. Concomitant acetylsalicylic acid may reduce creatinine clearance. Digitalis, lithium toxicity. Alcohol, CNS depressants may increase orthostatic hypotension. Antagonized by indomethacin, phenytoin. May alter excretion of salicylates, lithium. Hypokalemia with corticosteroids, ACTH, large amounts of licorice, prolonged laxatives. Increased risk of cephalosporin-induced nephrotoxicity and radiocontrast nephropathy. Increased risk of gouty arthritis with cyclosporine. Antagonizes tubocurarine, norepinephrine. Potentiates antihypertensives, succinylcholine, ganglionic or peripheral adrenergic blocking drugs. Ototoxicity with aminoglycosides, ethacrynic acid. Ototoxicity, nephrotoxicity with cisplatin (give lower doses of furosemide with positive fluid balance). Separate sucralfate dosing by at least two hours. Antagonized by, and potentiates, methotrexate. Warnings/Precautions: Hepatic cirrhosis: do not initiate during hepatic coma or electrolyte depletion. Discontinue if increasing azotemia and oliguria occur during treatment of severe progressive renal disease. Renal or hepatic dysfunction. Diabetes. Gout. SLE. Sulfonamide sensitivity. Bladder emptying disorders. Prostatic hyperplasia. Urethral narrowing. Hypoproteinemia. Monitor BP, electrolytes, fluids, blood, BUN. Potassium supplementation may be needed. Elderly Contraindications: Anuria. Adult Dose: Initially 20-80mg daily. May repeat or increase after 6-8 hours; max 600mg/day. Maintenance: intermittent dosing optimal.

guaifenesin (Mucinex) Pharmacological Class: Expectorant + decongestant. Indications: Chest and nasal congestion. Sinus pressure. Adverse Reactions: GI upset, drowsiness, headache, rash, dizziness, nervousness, insomnia. Interactions: Hypertensive crisis with MAOIs (see Contraindications). Warnings/Precautions: Asthma. Lower respiratory disorders. Cardiovascular disease. Hyperthyroidism. Hypertension. Diabetes. GI or GU obstruction. Contraindications: During or within 14 days of MAOIs Adult Dose: Swallow whole. 2 tabs every 12 hours. Max: 4 tabs/day.

Nitroglycerin, NITRO-DUR Pharmacological Class: Nitrate. Indications: Prophylaxis of angina. Not for acute attacks. Adverse Reactions: Headache, increased angina, dizziness, flushing, orthostatic hypotension, tachycardia, nausea, rash. Interactions: See Contraindications. Severe hypotension with sildenafil. Hypotension potentiated with alcohol, other vasodilators, calcium channel blockers. Warnings/Precautions: Acute or recent MI. Volume depletion. Hypotension. Heart failure. Hypertrophic cardiomyopathy. Reduce dose if hypotension occurs. Remove before defibrillation or cardioversion. Elderly. Contraindications: Concomitant sildenafil Adult Dose : Initially one 0.2-0.4mg/hr patch for 12-14hr/day. Remove patch for 10-12hrs/day.

potassium chloride, Potassium Chloride Sust-Rel Tabs Therapeutic Use: Electrolyte disturbances Indications for Potassium Chloride Sust-Rel Tabs: Hypokalemia, including that caused by diuretics. Digitalis intoxication without AV block. Adverse Reactions: Hyperkalemia, GI discomfort and irritation, diarrhea, rash (rare). Esophageal and GI ulceration, bleeding, obstruction, perforation. Interactions: Hyperkalemia with ACE inhibitors, spironolactone, triamterene, amiloride, and potassium-containing salt substitutes. Anticholinergics, other agents that decrease GI motility increase risk of serious GI reactions with tablets. Warnings/Precautions: Discontinue if GI bleed, ulceration, or other disturbances occur. Renal or cardiac disease. Monitor potassium level, clinical status, acid-base balance, and ECG. Elderly Contraindications: Hyperkalemia. Chronic renal disease. Acute dehydration. Heat cramps. Severe tissue destruction. Adrenal insufficiency. Familial periodic paralysis. Acidosis (potassium chloride products). Alkalosis (potassium bicarbonate products). Esophageal compression due to enlarged left atrium. Decreased GI motility. Adult Dose: Do not crush or chew. Take with meals and fluid. Prophylaxis: 20mEq daily. Treatment: 40-100mEq daily in divided doses. Note: Formerly known under the brand name Klotrix.

olopatadine, PATANOL Therapeutic Use: Ocular allergy/inflammation Pharmacological Class: Antihistamine/mast cell stabilizer. Indications: Treatment of signs and symptoms of allergic conjunctivitis. Adverse Reactions: Headache, ocular effects (eg, blurred vision, burning/stinging, dry eye, foreign body sensation, hyperemia, keratitis, lid edema, pruritus), asthenia, cold syndrome, pharyngitis, rhinitis, sinusitis, taste perversion. Warnings/Precautions: Contact lenses (remove; may reinsert 10 minutes after administration, if eye is not red). Adults: <3yrs: not recommended. ≥3yrs: 1 drop in affected eye(s) twice daily (6-8 hours apart)

ranolazine, RANEXA Therapeutic Use: Angina Pharmacological Class: Antianginal. Indications: Chronic angina; may be used with beta-blockers, nitrates, calcium channel blockers, ACE inhibitors, angiotensin receptor blockers, anti-platelet and lipid-lowering therapies. Adverse Reactions: Dizziness, headache, constipation, nausea; QT prolongation Interactions: See Contraindications. Potentiates metformin; monitor glucose levels. May potentiate drugs metabolized by CYP3A (eg, simvastatin, lovastatin, cyclosporine, tacrolimus, sirolimus), P-gp transporters (eg, digoxin), CYP2D6 (eg, antipsychotics, tricyclic antidepressants); adjust doses of these drugs. May be potentiated by P-gp inhibitors (eg, cyclosporine). Caution with drugs that cause QT prolongation (eg, Class IA, Class III antiarrhythmics, thioridazine, ziprasidone). Warnings/Precautions: Not for acute angina episodes or for treating diabetes. History of or congenital long QT syndrome. Monitor renal function after initiation and periodically in moderate-to-severe renal impairment. Discontinue if acute renal failure develops. Elderly. Pregnancy (Cat.C). Nursing mothers: not recommended. Contraindications: Severe hepatic impairment. Concomitant strong CYP3A inhibitors (eg, ketoconazole, itraconazole, clarithromycin, nefazodone, nelfinavir, ritonavir, indinavir, saquinavir) or CYP3A inducers (eg, rifampin, rifabutin, rifapentine, phenobarbital, phenytoin, carbamazepine, St. John's wort). Adult Dose for RANEXA: Swallow whole. Initially 500mg twice daily, may increase to max 1g twice daily. Concomitant moderate CYP3A inhibitors (eg, diltiazem, verapamil, erythromycin, fluconazole, grapefruit-containing products): max 500mg twice daily. Concomitant P-gp inhibitors (eg, cyclosporine): titrate ranolazine dose based on response. Concomitant simvastatin: limit simvastatin to 20mg once daily. Concomitant metformin: give max metformin 1.7g/day if taking ranolazine 1g twice daily.

rivaroxaban (Xarelto) Therapeutic Use: Thromboembolic disorders Pharmacological Class: Factor Xa inhibitor. Indications: To reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. Treatment of deep vein thrombosis (DVT), pulmonary embolism (PE). To reduce the risk of recurrence of DVT, PE following 6 months treatment for DVT, PE. Prophylaxis of DVT, which may lead to pulmonary embolism in patients undergoing knee or hip replacement surgery. Adverse Reactions: Bleeding events (may be serious or fatal), wound secretion, pain in extremity, muscle spasm, syncope, pruritus, blister; hypersensitivity reactions. Interactions: Increased risk of bleeding with concomitant aspirin, P2Y12 platelet inhibitors, other antithrombotic agents, fibrinolytic therapy, NSAIDs, clopidogrel; avoid. Avoid with concomitant combined P-gp and strong CYP3A4 inhibitors (eg, ketoconazole, itraconazole, lopinavir/ritonavir, ritonavir, indinavir/ritonavir, conivaptan). Avoid with concomitant combined P-gp and strong CYP3A4 inducers (eg, carbamazepine, phenytoin, rifampin, St. John's wort). May be potentiated with concomitant renal impairment and combined P-gp and weak or moderate CYP3A4 inhibitors Warnings/Precautions: Premature discontinuation increases risk of thrombotic events; if discontinued for reason other than bleeding or therapy completion, consider coverage with another anticoagulant. Increased risk of spinal/epidural hematoma in anticoagulated patients receiving neuraxial anesthesia or undergoing spinal puncture; monitor for signs/symptoms of neurological impairment. Increased risk of bleeding; monitor for signs/symptoms of blood loss; discontinue if active pathological hemorrhage occurs. Patients with prosthetic heart valves: not recommended. Moderate or severe hepatic impairment, hepatic disease associated with coagulopathy: avoid. Discontinue 24hrs before surgery. Elderly. Labor & delivery. Pregnancy (Cat. C); use with caution, risk of pregnancy-related hemorrhage. Nursing mothers: not recommended. Contraindications: Active pathological bleeding. Adult Dose: 15mg and 20mg tablets: take with food. Unable to swallow whole tablets: may crush 15mg or 20mg tabs and mix with applesauce immediately prior to use, then follow with food; may also give by NG or gastric tube (see full labeling). Nonvalvular atrial fibrillation: CrCl >50mL/min: 20mg once daily with the evening meal; CrCl 15-50mL/min: 15mg once daily with the evening meal; CrCl <15mL/min: avoid. Treatment of DVT, PE: 15mg twice daily for first 21 days, then 20mg once daily for remaining treatment. Reduction in risk of recurrence of DVT, PE: 20mg once daily. DVT, PE treatment, risk reduction: avoid use if CrCl<30mL/min. Prophylaxis of DVT: take 6-10 hours after surgery once hemostasis established. 10mg once daily; severe renal impairment (CrCl<30mL/min): avoid; moderate renal impairment (CrCl 30-50mL/min); monitor closely for blood loss; discontinue if acute renal failure develops. Hip: treat for 35 days. Knee: treat for 12 days. Switching from or to warfarin, or other anticoagulants: see full labeling.