As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs.

2. Contacts • Phone/E-Mail
Name
Ph:
e-mail:
Name
Ph:
e-mail:
Name
Ph:
e-mail:
Name
Ph:
e-mail:
Name
Ph:
e-mail:
Name
Ph:
e-mail:
Name
Ph:
e-mail:
Name
Ph:
e-mail:
Name
Ph:
e-mail:
Name
Ph:
e-mail:
Name
Ph:
e-mail:
Name
Ph:
e-mail:

3. MED
Notes
Nurse’s Pocket
Pharmacology Guide
Judith Hopfer Deglin
April Hazard Vallerand
Purchase additional copies of this book
at your health science bookstore or
directly from F A. Davis by shopping
.
online at www.fadavis.com or by calling
800-323-3555 (US) or 800-665-1148 (CAN)
A Davis’s Notes Book
F. A. Davis Company • Philadelphia

4. F A. Davis Company
.
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2004 by F A. Davis Company
.
All rights reserved. This book is protected by copyright. No part of it may
be reproduced, stored in a retrieval system, or transmitted in any form or
by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
Printed in China by Imago
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Publisher, Nursing: Robert G. Martone
Design Manager: Louis J. Forgione
Cover Designer: Paul Fry
As new scientific information becomes available through basic and clinical
research, recommended treatments and drug therapies undergo changes.
The author(s) and publisher have done everything possible to make this
book accurate, up to date, and in accord with accepted standards at the
time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the
book, and make no warranty, expressed or implied, in regard to the
contents of the book. Any practice described in this book should be applied
by the reader in accordance with professional standards of care used in
regard to the unique circumstances that may apply in each situation. The
reader is advised always to check product information (package inserts) for
changes and new information regarding dose and contraindications before
administering any drug. Caution is especially urged when using new or
infrequently ordered drugs.
Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F A. Davis Company
.
for users registered with the Copyright Clearance Center (CCC)
Transactional Reporting Service, provided that the fee of $.10 per copy is
paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those
organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the
Transactional Reporting Service is: 8036-1109-9/04 0 + $.10.

5. Place 2 78ϫ2 78
/
/
Sticky Notes
here
for a convenient and refillable note pad
Waterproof and Reusable
Wipe-Free Pages
Write directly onto any page of MedNotes with
a ballpoint pen. Wipe old entries off with an
alcohol pad and reuse.
BASICS
A–C
D–H
I–M
N–R
S–Z
TOOLS

6. Look for our other
Davis’s Notes titles
Available Now!
LPN Notes:
Nurse’s Clinical Pocket Guide
Ehren Myers, RN & Tracey Hopkins, RN, BSN
ISBN: 0-8036-1132-3
RNotes™:
Nurse’s Clinical Pocket Guide
Ehren Myers, RN
ISBN: 0-8036-1060-2
Coming soon!
NutriNotes:
Nutrition & Diet Therapy Pocket Guide
Carroll Lutz, MA, RN & Karen Przytulski, MS, RD
ISBN: 0-8036-1114-5
MedSurg Notes:
Nurse’s Clinical Pocket Guide
Tracey Hopkins, RN, BSN & Ehren Myers, RN
ISBN: 0-8036-1115-3
Also by Judith Hopfer Deglin
& April Hazard Vallerand
Davis’s Drug Guide for Nurses™

7. 1
High Alert Medications
High alert medications are those medications that have a high
risk of causing injury or death when improperly handled or
administered. Exercise extreme caution when administering
these medications:
I Adrenergic agonists (e.g., epinephrine, isoproterenol, norepinephrine)
I Cardioplegic solutions
I Chemotherapeutic agents
I Chloral hydrate (in pediatric patients)
I Colchicine injection
I High concentration dextrose (Ͼ10% dextrose)
I Hypoglycemic agents (oral)
I Hypertonic sodium chloride injection (Ͼ 0.9% concentration)
I Insulin
I IV adrenergic antagonists (propranolol, esmolol, metoprolol)
I IV calcium; IV magnesium sulfate
I IV digoxin
I IV potassium (phosphate and chloride)
I Lidocaine/ benzocaine other topical anesthetics
I Midazolam
I Neuromuscular blocking agents
I Opiates (opioids)
I Thrombolytics, heparin, warfarin
BASICS

8. BASICS
Safe Medication Administration
I Carefully read product packaging to note strength of solution,
dosage, and/or route of administration.
I Double-check with a pharmacist about dose range.
I Have a colleague double-check dosage calculations and infusion pump programming.
I Use the 5 Rights (right drug, right dose, right patient, right
route, right time) as a guide.
I Clarify any order that is incomplete, contains abbreviations, is
confusing or hard to read, or raises a question.
I Do not borrow medications from other patients or begin new
medications before order has been received in pharmacy: to
do so circumvents built-in checks that can detect a prescribing
error.
Standards for Patient Education
I All patients need clear written and verbal instruction for all
medications. Do not rush. Include family members.
I Present information in a format the patient can understand.
I Use an interpreter if provider and patient speak different
languages.
I Have the patient repeat the information you provide.
I Make sure to tell the patient:
The brand and generic names of the medication
The purpose of the medication
The strength and dose of the medication
When to take the medication
Possible side effects and what to do if they occur
How long to take the medication
What medications or foods to avoid and why they should be
avoided
How to store the medication
What to do if a dose is missed
What activities should be avoided while on the medication
Signs and symptoms of adverse drug reactions
2

9. 3
Abbreviations and Symbols Associated
with Medication Errors
Abbreviations and symbols are a source of medication errors.
Nurses should consult with the prescribing health care provider
on any orders that contain the following abbreviations.
Abbreviation/ Intended
Symbol
Meaning
AZT
CPZ
HCl
HCT
MgSO4
MS
MTX
Nitro drip
Norflox
PIT
/ (slash)
ϩ
Often
Mistaken For
Zidovudine
Compazine
Azathioprine
Thorazine
(chlorpromazine)
Hydrochloric
KCl (potassium
acid
chloride)
Hydrocortisone Hydrochlorothiazide
Magnesium
Morphine sulfate
sulfate
Morphine
Magnesium sulfate
sulfate
Methotrexate
Mitoxantrone
Nitroprusside
Nitroglycerin
Norfloxacin
Norflex
Pitocin
Pitressin
“per”
“1” (numeral
Plus sign
“one”)
“4” (numeral
“four”)
1 mg
10 mg
Recommendation
Use full drug name
Use full drug name
Use full drug name
Use full drug name
Use full drug name
Use full drug name
Use full drug name
Use full drug name
Use full drug name
Use full drug name
Spell out “per”
Spell out “and”
Zero after
a decimal
point
(e.g., 1.0 mg)
No zero
.1 mg
before a
decimal point
(e.g., .1 mg)
U
units
1 mg
ALWAYS USE zero
before a decimal
point
0 (zero), 4 (four) or
cc
HS
Hour of sleep
Spell out unit
Write out
medication
strength.
Half strength
DO NOT USE zero
after a decimal
point
Adapted from the Institute for Safe Medication Practices, 2003
http://www.ismp.org/msaarticles/specialissuetable.html.
BASICS

10. BASICS
IV Administration
Starting an IV
I Prepare the patient: Explain procedure, answer any questions, and reassure.
I Gather equipment: IV bag with primed tubing, sharps
container, catheter, tape, tourniquet, and antiseptic swabs.
I Organize supplies: Tear tape, have primed tubing and
sharps container within easy reach, and open 2ϫ2 dressing.
I Apply tourniquet proximal to intended insertion site, either
midforearm or above the elbow.
I Locate vein: Palpate with fingertips. To further enhance dilation, gently tap, apply heat or warm soak, and have patient
make a few fists or dangle arm below heart.
I Cleanse site: Using moderate friction, cleanse in a circular
motion, moving outward from intended site.
I Put on gloves while waiting for cleansed area to dry. Avoid
touching site once it has been prepared.
I Apply traction (in the direction opposite the catheter).
I Position needle, bevel side up, 15Њ–30Њ. NOTE: Hold the
needle with the thumb and pointer finger in a way that allows
for visualization of the flash chamber.
I Insert needle, and observe for “flash back” in flash chamber.
Lower catheter almost parallel to the skin, and insert the
needle 1–2 mm more to ensure that the catheter has also
entered the vein.
I Advance the catheter: Thread catheter into vein while
maintaining skin traction.
I Release the tourniquet, and apply digital pressure just
above the end of the catheter tip while gently stabilizing the
hub of the catheter.
I Remove needle, and discard into approved sharps container.
I Connect IV tubing, open clamp, and observe for free flow
of IV fluid.
I Secure catheter, and apply sterile dressing per hospital
policy and procedure.
I Clean up, and document per hospital policy and procedure.
4

11. 5
IV Insertion Guide
BASICS

12. BASICS
IV Piggyback (IVPB) Setup
I
I
I
I
I
The piggyback bag must be higher than the IV.
To do this, use an extension hook.
Use the most proximal access port on primary line.
Adjust piggyback stopcock to desired rate.
After infusion is complete, the primary IV bag will
begin to drip again. Ensure primary drip rate.
Location of Common Veins
Complications of Starting/Maintaining IVs
Infiltration
Phlebitis
Assessment: Classic sign is red
line along course of vein; other
signs include redness, heat,
swelling, and tenderness.
Assessment: Swelling;
tenderness; decreased or no
infusion rate; blanching of skin;
site is cool to touch.
Interventions: D/C IV, and restart
in a new site. Apply warm
compress to affected area.
Interventions: D/C IV, and restart
in a new site. Apply warm
compress to affected area.
6

13. 7
Flushing IV Catheters
Catheter Type
Solution
Strength
Frequency
Peripheral Catheters (Open Ended)
Peripheral IV catheter
Normal
saline
Midline catheter
(each lumen if multiple)
n/a
3 mL daily
and PRN
Heparin
10 units/
mL
5 mL daily
and PRN
Central Venous Catheters (CVC)
Valved-tip catheters
(Groshong PICC)
Normal
saline
n/a
5 mL per
lumen weekly
and PRN
Open-ended
PICC lines
Heparin
10 units/
mL
5 mL per
lumen daily
and PRN
Tunneled catheters
(Hickman, Broviac)
Heparin
100 units/
mL
5 mL per
lumen daily
and PRN
Implanted Port Catheters
Groshong Port-a-Cath
(when accessed)
Heparin
100 units/
mL
5 mL daily
and PRN
Solution Used to Flush a Catheter
Valved-tip catheters require only saline flushes; however, the use of heparin is
not contraindicated. All other central lines require heparin flushes to minimize
fibrin collection and clot formation.
Syringe Selection
The smaller the syringe size, the greater the pressure in PSI. Greater PSI
pressure increases potential for catheter damage. Therefore, a syringe size of
10 cc or greater is recommended for central-line flushes.
Positive-Pressure Flushing of Valved-Tip Catheters
Important: To reduce potential for blood backflow into the catheter tip, which
promotes clot formation and catheter occlusion, always remove needles or
needleless caps slowly while injecting the last 0.5 mL of saline.
“SAS” Technique Flush with Saline,
Administer Med, Flush with Saline
BASICS

14. BASICS
Intramuscular (IM) Injection Sites
8

15. 9
Z-Track Method for Giving IM Injections
BASICS

16. BASICS
Subcutaneous (SC) Injection Sites
Two inches away
from the umbilicus
Subcutaneous (SC) Heparin Injections
Site
Gauge
and Angle
Abdomen, posterior
upper arm, low back,
thigh, and upper back
25 g–26 g, 3/8′′
@ 90Њ (45Њ if on
a thin patient)
10
Aspirate
Massage
Site
No
No

17. 11
Intradermal (ID), Subcutaneous (SC), and Intramuscular (IM)
BASICS

18. BASICS
Mixing Insulins
1. Obtain appropriate-size insulin syringe, and draw up enough air
equal to combined volume of both insulins.
2. Inject the NPH vial with amount of air equal to amount of NPH
to be mixed without dipping needle into NPH solution.
→ This prevents the NPH (which is cloudy) from mixing with the
regular insulin (which is clear) and turning it cloudy.
3. Inject remaining air into regular insulin vial, and draw up the
regular insulin to be mixed.
→ Expel any air/bubbles. There should not be any air in the
syringe, because the NPH vial has already been pressurized.
4. Mix: Roll (do not shake) NPH vial between hands.
→ This prevents the formation of air bubbles, which can displace
the insulin and alter the dose.
5. Reinsert needle into pressurized NPH and withdraw desired
amount.
→ Remember to triple-check all medication orders, and have another nurse
present when you mix the insulin.
12

19. 13
Mixing Insulins
BASICS

20. A–C
ACYCLOVIR (ay-sye-kloe-veer) Avirax, Zovirax Antiviral
Pregnancy Category B (PO, IV) C (topical)
I INDICATIONS: Genital herpes, localized cutaneous herpes
zoster infections, shingles, chickenpox, varicella, herpes
simplex encephalitis, limited non–life-threatening herpes
simplex infections in immunocompromised patients (topical).
Therapeutic Effects: I Inhibition of viral replication,
decreased viral shedding, reduced lesion-healing time.
I DOSAGE: PO: Adults: 200–800 mg 3 to 5 times daily. Children:
20 mg/kg 4 times daily IV Adults and Children: 5–20 mg/kg
q8 h. Topical: Adults and Children: 1/2 inch ribbon for each 4
square inch area 6 times daily.
I ADMINISTRATION: PO: Can give with food or on an empty
stomach, with a full glass of water. IV: Do not reconstitute
with bacteriostatic water with benzyl alcohol or paraben.
Administer via infusion pump over at least 1 hour to minimize
renal tubular damage.
I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
dizziness, headache, diarrhea, nausea, vomiting, pain,
phlebitis, RENAL FAILURE, THROMBOTIC THROMBOCYTOPENIC PURPURA/ HEMOLYTIC UREMIC SYNDROME in high
doses in immunosuppressed patients.
I CONTRAINDICATIONS: Hypersensitivity to acyclovir or valacyclovir.
I CAUTIONS: Concurrent use of other nephrotoxic drugs
increases the risk of adverse renal effects.
14

21. 15
ALBUTEROL (al-byoo-ter-awl) AccuNeb, Proventil, Ventodisk,
Ventolin bronchodilator Pregnancy Category C
I INDICATIONS: Asthma or COPD-induced reversible airway
obstruction, acute bronchospasm, prevention of exerciseinduced bronchospasm, long-term control of chronic/persistent bronchospasm.
Therapeutic Effects: I Bronchodilation.
I DOSAGE: PO: Adults and Children Ն12: 2–4 mg 3–4 times
daily; 4–8 mg twice daily for extended-release tablets.
Children 6–12 yr: 2 mg 3–4 times daily. Children 2–6 yr: 0.1
mg/kg 3 times daily. Geriatrics: 2 mg 3–4 times daily.
Inhalation: Adults and Children 2–12 yr: Via nebulization or
IPPB: 1.25–2.5 mg 3–4 times daily. Adults and Children Ն4 yr:
Via Rotahaler inhalation device: 200 ␮g as Ventolin Rotacaps q
4–6 h up to 400 ␮g q 4–6 h. Adults and Children Ն4 yr: Via
metered-dose inhaler—2 inhalations q 4–6 h.
I ADMINISTRATION: PO: Administer oral medication with meals
to minimize gastric irritation. Inhalation: Allow at least 1
minute between inhalations of aerosol medication. For nebulization or IPPB, the 0.5–0.83-, 1-, and 2-mg/mL solutions do
not require dilution before administration. The 5 mg/mL solution must be diluted with 2.5 mL of 0.9% NaCl for inhalation.
I ADVERSE REACTIONS AND SIDE EFFECTS: Nervousness,
restlessness, tremor, chest pain, palpitations, angina, arrhythmias, hypertension, hypokalemia.
I CONTRAINDICATIONS: Hypersensitivity to adrenergic amines
or hypersensitivity to fluorocarbons inhaler.
I CAUTIONS: Excessive use may lead to tolerance and paradoxical bronchospasm. • Use with MAO inhibitors may lead
to hypertensive crisis. • Beta-blockers may negate therapeutic
effect.
Key:
underline = most common;
CAPS = life-threatening
A–C

22. A–C
ALENDRONATE (uh-len-dro-nate) Fosamax Bone resorption
inhibitor Pregnancy Category C
I INDICATIONS: Osteoporosis, Paget’s disease of the bone.
Therapeutic Effects: I Reversal of the progression of
osteoporosis with decreased fractures, decreased progression
of Paget’s disease.
I DOSAGE: PO: Adults: Treatment of osteoporosis: 5–10 mg
once daily or 70 mg once weekly. Prevention of osteoporosis:
5 mg once daily or 35 mg once weekly. Paget’s disease: 40 mg
once daily for 6 mo.
I ADMINISTRATION: Remain upright for 30 min following dose
to facilitate passage to stomach and minimize risk of
esophageal irritation. Do not drink coffee, tea, cola, mineral
water, or orange juice within 1/2 hour of taking alendronate.
I ADVERSE REACTIONS AND SIDE EFFECTS: Headache,
abdominal distention, abdominal pain, acid regurgitation,
constipation, diarrhea, dyspepsia, dysphagia, esophageal
ulcer, flatulence, gastritis, nausea, altered taste, vomiting,
erythema, photosensitivity, rash, musculoskeletal pain.
I CONTRAINDICATIONS: Renal insufficiency (CCr Ͻ35 mL/min),
pregnancy, lactation.
I CAUTIONS: Calcium supplements, antacids, other oral
medications and food significantly decrease the absorption of
alendronate. Caffeine coffee, tea, cola, mineral water, and
orange juice also decrease absorption. Wait 1 hour before
consuming.
16

23. 17
ALLOPURINOL (al-oh-pure-i-nawl) Apo-Allopurinol, Lopurin,
Zyloprim Anti-gout agent, antihyperuricemic Pregnancy Category
C
I INDICATIONS: Prevention of attack of gouty arthritis and
nephropathy. Treatment of secondary hyperuricemia that can
occur during treatment of tumors or leukemias. Treatment of
secondary hyperuricemia.
Therapeutic Effects: I Lowering of serum uric acid levels
by inhibiting the production of uric acid.
I DOSAGE: PO: Adults: 100 to 800 mg/d. Doses Ͼ300 mg/d
should be given in divided doses. Children 6–10 yr: 300 mg
daily. Children Ͻ6 yr: 150 mg daily. IV: Adults: 200–400
mg/m2/d (up to 600 mg/d) as a single daily dose or in divided
doses q 6–12 h. Children: 200 mg/m2 per day as a single daily
dose or in divided doses q 6–12 h.
I ADMINISTRATION: May be administered with milk or meals to
minimize gastric irritation. May be crushed.
I ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness,
diarrhea, hepatitis, nausea, vomiting, renal failure, rash,
urticaria, bone marrow depression, hypersensitivity reactions.
I CONTRAINDICATIONS: Hypersensitivity; pregnancy/lactation.
I CAUTIONS: Use with mercaptopurine and azathioprine
increases bone marrow depressant properties—dosages of these
drugs should be reduced. • Use with ampicillin or amoxicillin
increases the risk of rash. • Use with oral hypoglycemic agents
and warfarin increases the effects of these drugs. • Use with
thiazide diuretics or ACE inhibitors increases the risk of hypersensitivity reactions. • Discontinue allopurinol immediately if
rash occurs. • Therapy should be discontinued permanently if
reaction is severe. • Therapy may be reinstituted at a lower
dose (50 mg/d with very gradual titration) after a mild reaction
has subsided.
Key:
underline = most common;
CAPS = life-threatening
A–C

24. A–C
ALPRAZOLAM (al-pra-zoe-lam) Apo-Alpraz, Nu-Alpraz, Xanax
antianxiety agent (benzodiazepine) Pregnancy Category D
I INDICATIONS: Anxiety, panic attacks, premenstrual syndrome
(PMS) (unlabeled use).
Therapeutic Effects: I Relief of anxiety.
I DOSAGE: PO: Adults: 0.25–0.5 mg 2–3 times daily.
I ADMINISTRATION: May be administered with food if GI upset
occurs. Tablets may be crushed.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, lethargy, confusion, hangover, headache, mental
depression, paradoxical excitation, blurred vision, constipation, diarrhea, nausea, vomiting, rashes, physical dependence,
psychological dependence, and tolerance.
I CONTRAINDICATIONS: Hypersensitivity, narrow-angle glaucoma, cross-sensitivity with other benzodiazepines, preexisting CNS depression, severe, uncontrolled pain, pregnancy and lactation.
I CAUTIONS: Alcohol, antidepressants, other
benzodiazepines, antihistamines, opioid analgesics, kava,
valerian, skullcap, chamomile, or hops can increase CNS
depression. • Advise patient to avoid the use of alcohol or
other CNS depressants concurrently with alprazolam.
• Instruct patient to consult health care professional before
taking OTC medications concurrently with this medication.
18

25. 19
AMILORIDE (a-mill-oh-ride) Midamor diuretic (potassiumsparing diuretic) Pregnancy Category B
I INDICATIONS: Counteract potassium loss caused by other
diuretics; used with thiazides to treat edema or hypertension.
Therapeutic Effects: I Weak diuretic and antihypertensive
response when compared with other diuretics, conservation of
potassium.
I DOSAGE: PO: Adults: 5–10 mg/d (up to 20 mg).
I ADMINISTRATION: PO: Administer in morning to avoid interrupting sleep pattern. Administer with food or milk to minimize gastric irritation and to increase bioavailability.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
arrhythmias, constipation, GI irritation, impotence, hyperkalemia, hyponatremia, muscle cramps, allergic reactions.
I CONTRAINDICATIONS: Hypersensitivity, hyperkalemia.
I CAUTIONS: Additive hypotension with acute ingestion of
alcohol, other antihypertensives, or nitrates. • Use with ACE
inhibitors, indomethacin, potassium supplements, or
cyclosporine increases risk of hyperkalemia. • Decreases
lithium excretion. • Effectiveness may be decreased by
NSAIDs. • May cause dizziness. • Caution patient to avoid
driving or other activities requiring alertness until response to
medication is known.
Key:
underline = most common;
CAPS = life-threatening
A–C

26. A–C
AMIODARONE (a-mee-oh-da-rone) Cordarone, Pacerone antiarrhythmic Pregnancy Category D
I INDICATIONS: Ventricular arrhythmias. Unlabeled Uses:
Supraventricular tachyarrhythmias.
Therapeutic Effects: I Suppression of arrhythmias.
I DOSAGE: PO: Adults: Ventricular Arrhythmias–400–600 mg
daily in 1–2 doses. Supraventricular Tachycardia–200–400
mg/d. Children: Ventricular Arrhythmias: 2–5 mg/kg/d.
Supraventricular Tachycardia: 2.5 mg/kg/d. IV: Adults: 150 mg
over 10 min, followed by 360 mg over the next 6 hours and
then 540 mg over the next 18 h. Continue infusion at 0.5
mg/min until oral therapy is initiated.
I ADMINISTRATION: PO: Administer with meals if GI intolerance occurs. IV: Administer via volumetric pump using an inline filter.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, malaise, corneal microdeposits, ADULT RESPIRATORY
DISTRESS SYNDROME (ARDS), PULMONARY FIBROSIS, CHF
,
WORSENING OF ARRHYTHMIAS, bradycardia, hypotension,
LIVER FUNCTION ABNORMALITIES, anorexia, constipation,
nausea, vomiting, TOXIC EPIDERMAL NECROLYSIS, photosensitivity, hypothyroidism, ataxia, involuntary movement, paresthesia, peripheral neuropathy, poor coordination, tremor.
I CONTRAINDICATIONS: Severe sinus node dysfunction, 2nd
and 3rd AV block, bradycardia, pregnancy, and lactation.
I CAUTIONS: Increases digoxin levels (decrease digoxin by
50%) and activity of warfarin (decrease warfarin by 33%–50%).
• Increases blood levels and may lead to toxicity from quinidine, procainamide, mexiletine, lidocaine, flecainide, cyclosporine, dextromethorphan, methotrexate, phenytoin, and
theophylline. • Increased risk of bradyarrhythmias, sinus
arrest, or AV heart block with beta-blockers or calcium channel
blockers. • Do not confuse amiodarone with amrinone, now
called inamrinone.
20

27. 21
AMITRIPTYLINE (a-meh-trip-ti-leen) Elavil, Levate, Novotriptyn
antidepressant (tricyclic) Pregnancy Category D
I INDICATIONS: Depression, chronic pain syndromes (unlabeled
use).
Therapeutic Effects: I Improved mood.
I DOSAGE: PO: Adults: 75 to 150 mg/d in divided doses, or 50–100
mg at bedtime; may increase up to 150 mg. Hospitalized patients
dose may receive up to 300 mg/d. Geriatric Patients and
Adolescents: 10 mg three times daily and 20 mg at bedtime. Up
to 100 mg/d in a single bedtime dose or divided doses. IM:
Adults: 20–30 mg 4 times daily.
I ADMINISTRATION: PO: Administer with a meal to minimize
gastric upset. Tablet may be crushed. IM: For short-term IM
administration only. Do not administer IV.
I ADVERSE REACTIONS AND SIDE EFFECTS: Lethargy,
sedation, blurred vision, dry eyes, dry mouth, ARRHYTHMIAS,
hypotension, ECG changes, constipation, hepatitis, paralytic
ileus, urinary retention, blood dyscrasias, photosensitivity,
changes in blood glucose, gynecomastia, increased appetite and
weight gain.
I CONTRAINDICATIONS: Narrow-angle glaucoma, pregnancy and
lactation.
I CAUTIONS: May cause hypotension, tachycardia, and potentially fatal reactions when used with MAO inhibitors (discontinue MAO inhibitor 2 weeks before starting amitriptyline).
• May cause toxicity when used with SSRI antidepressants
(discontinue fluoxetine 5 weeks before starting amitriptyline).
• Concurrent use with clonidine may cause hypertensive crisis.
• Concurrent use with moxifloxacin or sparfloxacin increases risk
of adverse cardiovascular reactions. • Additive CNS depression
with other CNS depressants including alcohol, antihistamines,
clonidine, opioids, and sedative/hypnotics. • Phenothiazines or
oral contraceptives increase levels and may cause toxicity.
Key:
underline = most common; CAPS = life-threatening
A–C

28. A–C
AMLODIPINE (am-loe-di-peen) Norvasc antihypertensive
(calcium channel blocker) Pregnancy Category C
I INDICATIONS: Management of hypertension, angina pectoris,
and vasospastic (Prinzmetal) angina.
Therapeutic Effects: I Systemic vasodilation and
decreased blood pressure. Coronary vasodilation and decreased
frequency and severity of angina.
I DOSAGE: PO: Adults: 5–10 mg daily.
I ADMINISTRATION: May be administered without regard to
meals.
I ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizziness, fatigue, peripheral edema, angina, bradycardia,
hypotension, palpitations, gingival hyperplasia, nausea,
flushing.
I CONTRAINDICATIONS: Hypersensitivity to amlodipine or
blood pressure Ͻ90 mm Hg.
I CAUTIONS: Additive hypotension may occur when used
concurrently with fentanyl, other antihypertensives, nitrates,
acute ingestion of alcohol, or quinidine. • Blood levels and
effects are increased by concurrent ingestion of grapefruit
juice. • Do not confuse amlodipine with amiloride; do not
confuse Norvasc with Navane.
22

29. 23
AMOXICILLIN/CLAVULANATE (a-mox-i-sill-in klav-yoolan-ate) Augmentin ES, Augmentin XR, Clavulin anti-infective
Pregnancy Category B
I INDICATIONS: Skin and skin structure infections, otitis media,
sinusitis, respiratory tract infections, genitourinary tract infections, meningitis, septicemia.
Therapeutic Effects: I Bactericidal action against susceptible
bacteria.
I DOSAGE: PO: Adults and Children Ͼ40 kg: Tablets: 250–500
mg tablet q 8–12 h. Suspension: 500 mg q 12 h. Children
Ͻ2 yr: 20–40 mg/kg/d in divided doses q 8–12 h. Children
Ͼ3 mo: 200 mg/5 mL or 400 mg/5 mL suspension: 12.5 mg/kg
q 12 h or 6.6 mg/kg q 8 h (as 125 mg/5 mL or 250 mg/5 mL
suspension). Children Ͻ3 mo: 15 mg/kg q 12 h (125 mg/mL
suspension recommended).
I ADMINISTRATION: Administer around the clock. May be given
with meals to decrease GI side effects. Chewable tablets
should be crushed or chewed. Shake oral suspension before
administering. Do not administer 250 mg chewable tablets to
children Ͻ40 kg due to clavulanate content.
I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (high
doses), PSEUDOMEMBRANOUS COLITIS, diarrhea, hepatic
dysfunction, nausea, vomiting, rashes, urticaria, ANAPHYLAXIS and SERUM SICKNESS, superinfection.
I CONTRAINDICATIONS: Hypersensitivity to penicillins or clavulanate.
I CAUTIONS: May potentiate the effect of warfarin. • May
decrease the effectiveness of hormonal contraceptives.
• Instruct patient to notify health care professional immediately if diarrhea, abdominal cramping, fever, or bloody stools
occur and not to treat with antidiarrheals without consulting
health care professionals.
Key:
underline = most common;
CAPS = life-threatening
A–C

30. A–C
AMOXICILLIN (uh-mox-i-sil-in) Amoxil, Novamoxin, Trimox
anti-infective, anti-ulcer agent Pharm Class: Aminopenicillins
Pregnancy Category B
I INDICATIONS: Skin and skin structure infections, otitis media,
sinusitis, respiratory infections, genitourinary infections,
septicemia, endocarditis prophylaxis, ulcer disease due to
Helicobacter pylori. Unlabeled use: Lyme disease.
Therapeutic Effects: I Bactericidal action.
I DOSAGE: PO: Adults and Children Ͼ20 kg: 250–500 mg q 8 h
or 500–875 mg q 12 h. Children Ͼ3 mo: 20–40 mg/kg/d in
divided doses q 8 hour or 25–45 mg/kg/d in divided doses q
12 h. Infants Ͻ3 mo: up to 30 mg/kg/d in divided doses q 12 h.
I ADMINISTRATION: Administer around the clock. Administer
without regard to meals or with meals to decrease GI side
effects. Capsule contents may be emptied and swallowed with
liquids. Suspension may be given straight or mixed in
formula, milk, fruit juice, water, or ginger ale. Administer
immediately after mixing. Discard refrigerated reconstituted
suspension after 10 days.
I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (in
high doses), PSEUDOMEMBRANOUS COLITIS, diarrhea,
nausea, vomiting, rashes, urticaria, blood dyscrasias, allergic
reactions including ANAPHYLAXIS, SERUM SICKNESS, superinfection.
I CONTRAINDICATIONS: Hypersensitivity to penicillins.
I CAUTIONS: May potentiate the effect of warfarin. • May
decrease the effectiveness of oral contraceptives. • Infectious
mononucleosis (increased incidence of rash). • Observe for
signs and symptoms of anaphylaxis (rash, pruritus, laryngeal
edema, wheezing). • Monitor bowel function for signs or
symptoms of pseudomembranous colitis: diarrhea, abdominal
cramping, fever, and bloody stools.
24

31. 25
ATENOLOL (a-ten-oh-lole) Apo-Atenolol, Novo-Atenolol,
Tenormin antianginal, antihypertensive (selective beta-blocker)
Pregnancy Category D
I INDICATIONS: Hypertension, angina, reduce risk of second MI.
Therapeutic Effects: I Lower blood pressure and heart
rate, decreased frequency of angina.
I DOSAGE: PO: Adults: 25–100 mg once daily. IV: Adults:
Administer 5 mg over 5 min, followed by another 5mg 10 min
later.
I ADMINISTRATION: PO: Take apical pulse before administering
drug. If Ͻ50 bpm or if arrhythmia occurs, withhold medication
and notify physician or other health care professional.
IV: Administer each dose over 5 minutes.
I ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weakness, anxiety, depression, dizziness, insomnia, memory loss,
mental status changes, nervousness, nightmares, blurred
vision, stuffy nose, bronchospasm, wheezing, BRADYCARDIA,
CHF PULMONARY EDEMA, hypotension, peripheral vasocon,
striction, constipation, diarrhea, liver function abnormalities,
nausea, vomiting, impotence, decreased libido, urinary
frequency.
I CONTRAINDICATIONS: Uncompensated CHF pulmonary
,
edema, cardiogenic shock, bradycardia or heart block.
I CAUTIONS: Additive bradycardia may occur with digoxin.
• Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates. • May alter the
effectiveness of insulins or oral hypoglycemic agents (dosage
adjustments may be necessary). • May decrease effectiveness
of theophylline. • Monitor blood pressure, ECG, and pulse
frequently during dosage adjustment period and periodically
throughout therapy.
Key:
underline = most common;
CAPS = life-threatening
A–C

32. A–C
ATORVASTATIN (a-tore-va-sta-tin) Lipitor lipid-lowering agent
Pregnancy Category X
I INDICATIONS: Primary hypercholesterolemia and mixed
dyslipidemia.
Therapeutic Effects: I Lowering of total and LDL
cholesterol.
I DOSAGE: PO: Adults: 10 mg once daily initially; may be
increased q 2–4 wk up to 80 mg/d.
I ADMINISTRATION: Administer with the evening meal.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, insomnia, weakness, rhinitis, bronchitis, abdominal
cramps, constipation, diarrhea, flatus, heartburn, altered taste,
drug-induced hepatitis, dyspepsia, elevated liver enzymes,
nausea, pancreatitis, impotence, rashes, pruritus, RHABDOMYOLYSIS, arthralgia, arthritis, myalgia, myositis, hypersensitivity reactions.
I CONTRAINDICATIONS: Hypersensitivity, active liver disease,
pregnancy or lactation, concurrent use of gemfibrozil or azole
antifungals.
I CAUTIONS: Blood levels and the risk of myopathy are
increased by concurrent cyclosporine and gemfibrozil, clofibrate, erythromycin, large doses of niacin and azole antifungal agents. • Grapefruit juice may cause higher blood levels
and increased risk of toxicity. • Liver function tests, including
AST, should be monitored before, at 6–12 wk after initiation of
therapy or after dose elevation, and then every 6 mo. If AST
levels increase to 3 times normal, HMG-COA reductase
inhibitor therapy should be discontinued. • May cause
elevated alkaline phosphatase and bilirubin levels. • If patient
develops muscle tenderness during therapy, CPK levels
should be monitored. If CPK levels are markedly increased or
myopathy occurs, therapy should be discontinued.
26

33. 27
AZITHROMYCIN (aye-zith-row-my-sin) Zithromax agent for
atypical mycobacterium, anti-infectives (macrolide) Pregnancy
Category B
I INDICATIONS: Upper and lower respiratory tract infections, bronchitis, pneumonia, skin and skin structure infections, nongonococcal urethritis, cervicitis, gonorrhea, and chancroid, prevention
of disseminated Mycobacterium avium complex (MAC) infection
in patients with advanced HIV infection. Prevention of bacterial
endocarditis (unlabeled use).
Therapeutic Effects: I Bacteriostatic action against
susceptible bacteria.
I DOSAGE: PO: Adults: 500 mg 1st day, then 250 mg/d for duration
of therapy. May be given as 1 to 2 g single or weekly dose.
Children 2–15 yr: 10–12 mg/kg (not Ͼ500 mg/dose) on 1st day,
then 5 mg/kg (not Ͼ250 mg/dose.) IV: Adults: 500 mg IV q 24 h.
I ADMINISTRATION: PO: Administer 1 hour before or 2 hours after
meals. IV: Administer 1 mg/mL IV solution over 3 hours or 2
mg/mL solution over 1 hour. Do not administer as a bolus.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, fatigue, headache, ANGIOEDEMA, chest pain, palpitations, PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, nausea, cholestatic jaundice, dyspepsia, flatulence, melena,
nephritis, vaginitis, photosensitivity, rashes.
I CONTRAINDICATIONS: Hypersensitivity to azithromycin, erythromycin, or other macrolide anti-infectives.
I CAUTIONS: Observe for signs and symptoms of anaphylaxis.
• Monitor patient for signs and symptoms of pseudomembranous colitis: fever, diarrhea, and stool containing blood, pus, or
mucus. • Kaolin, magnesium and aluminum antacids will
decrease absorption of azithromycin. Separate dose times by at
least 2 hours. • Do not confuse azithromycin with erythromycin.
• Do not confuse Zithromax with Zinacef.
Key:
underline = most common;
CAPS = life-threatening
A–C

34. A–C
BACLOFEN (bak-loe-fen) Lioresal antispasticity agent, skeletal
muscle relaxant Pregnancy Category C
I INDICATIONS: Reversible spasticity associated with multiple
sclerosis or spinal cord lesions. Intrathecal: Severe spasticity
originating in the spinal cord.
Therapeutic Effects: I Decreased spasticity, improvement
of bowel and bladder function.
I DOSAGE: PO: Adults: 5 mg 3 times daily. May increase q 3
days by 5 mg/dose to maximum of up to 80 mg/d. Intrathecal:
Adults: 100–800 ␮g/d infusion. Children: 25–1200 ␮g/d infusion
(average 275 ␮g/d).
I ADMINISTRATION: PO: Administer with milk or food.
Intrathecal: Screening phase, dilute for a concentration of 50
␮g/mL with NaCl for injection. Test dose should be administered over at least 1 minute. If response is inadequate, 2 additional test doses, each 24 hours apart, 75 ␮g/1.5 mL and 100
␮g/2 mL respectively, may be administered.
I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES
(intrathecal), dizziness, drowsiness, fatigue, weakness, confusion, insomnia, hypotension, nausea, pruritus, ataxia.
I CONTRAINDICATIONS: Hypersensitivity.
I CAUTIONS: Additive effect with other CNS depressants
including alcohol, antihistamines, opioid analgesics, and
sedative/hypnotics. • Use with MAO inhibitors may lead to
increased CNS depression or hypotension. • Intrathecal:
Monitor patient closely during test dose and titration; resuscitative equipment should be immediately available for lifethreatening or intolerable side effects. • Caution patient to
avoid abrupt withdrawal of this medication because it may
precipitate an acute withdrawal reaction (hallucinations,
increased spasticity, seizures, mental changes, restlessness).
• Discontinue gradually over 2 weeks or more.
28

35. 29
BECLOMETHASONE (beh-kloe-meth-a-sone) Beclodisk,
Becloforte, Beclovent, Vanceril, antiasthmatic, anti-inflammatory
(inhalation corticosteroid) Pregnancy Category C
I INDICATIONS: Asthma.
Therapeutic Effects: I Decrease frequency and severity of
asthma attacks.
I DOSAGE: Inhalation: Adults and Children Ͼ12 yr: 42
␮g/inhalation: 2 inhalations 3–4 times daily or 4 inhalations
twice daily. 84 ␮g/inhalation: 2 inhalations twice daily or 4
inhalations twice daily. Children 6–12 yr: 42 ␮g/inhalation: 1–2
inhalations 3–4 times (not to exceed 10 inhalations/day) or 4
inhalations twice daily. 84 ␮g/inhalation: 2 inhalations twice
daily (not to exceed 5 inhalations/d).
I ADMINISTRATION: Allow at least 1 minute between inhalations of aerosol medication.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dysphonia,
hoarseness, oropharyngeal fungal infections, cataracts; bronchospasm, cough, wheezing, dry mouth, esophageal candidiasis, adrenal suppression, decreased growth (children),
CHURG-STRAUSS SYNDROME.
I CONTRAINDICATIONS: Acute attack of asthma/status asthmaticus.
I CAUTIONS: Advise patients also using bronchodilator to use
bronchodilator first and wait 5 minutes before taking beclomethasone. • Advise patient to use regular peak flow monitoring to determine respiratory status. • Advise patient to notify
physician if sore throat or sore mouth occurs. • Instruct patient
whose systemic corticosteroids have been recently reduced or
withdrawn to carry a warning card indicating the need for
supplemental systemic corticosteroids in the event of stress or
severe asthma attack unresponsive to bronchodilators. • Caution
patient to avoid smoking, known allergens, and other respiratory
irritants.
Key:
underline = most common;
CAPS = life-threatening
A–C

36. A–C
BENAZEPRIL (ben-aye-ze-pril) Lotensin antihypertensive (ACE
inhibitors) Pregnancy Category C (first trimester), D (second and
third trimesters)
I INDICATIONS: Hypertension.
Therapeutic Effects: I Lowering of blood pressure.
I DOSAGE: PO: Adults: 5–10 mg once daily, increased gradually
to maintenance dose of 20–40 mg/d as single dose or 2
divided doses (begin with 5 mg/d in patients receiving diuretics).
I ADMINISTRATION: Precipitous drop in blood pressure during
first 1–3 hours following first dose may occur, especially if
also taking diuretics. Monitor blood pressure closely.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, headache, insomnia, cough, hypotension, angina
pectoris, tachycardia, taste disturbances, anorexia, diarrhea,
nausea, proteinuria, impotence, renal failure, hyperkalemia,
AGRANULOCYTOSIS, ANGIOEDEMA.
I CONTRAINDICATIONS: Hypersensitivity, pregnancy,
angioedema (hereditary or idiopathic).
I CAUTIONS: Additive hypotension with other antihypertensives, nitrates, phenothiazines, acute ingestion of alcohol, and
during surgery or general anesthesia. • Hyperkalemia may
result from concurrent use of potassium supplements, potassium-sparing diuretics, indomethacin, salt substitutes, or
cyclosporine. • May increase the risk of lithium or digoxin
toxicity. Instruct patient to notify health care professional if
rash; mouth sores; sore throat; fever; swelling of hands or
feet; irregular heart beat; chest pain; dry cough; hoarseness;
swelling of face, eyes, lips, or tongue; difficulty swallowing or
breathing occur. • Persistent dry cough may occur and may
not subside until medication is discontinued.
30

37. 31
BENZTROPINE (benz-troe-peen) Apo-Benztropine, Cogentin
antiparkinson agent, anticholinergic Pregnancy Category C
I INDICATIONS: Parkinson’s disease, including drug-induced
extrapyramidal effects and acute dystonic reactions.
Therapeutic Effects: I Reduces rigidity and tremors.
I DOSAGE: PO: Adults: Parkinsonism: 1–2 mg/d in 1–2 divided
doses. Drug-induced extrapyramidal reactions: 1–4 mg given
once or twice daily. IM: Adults: Acute dystonic reactions:
1–2 mg.
I ADMINISTRATION: PO: Administer with food. May be crushed
and administered with food if difficulty swallowing.
I ADVERSE REACTIONS AND SIDE EFFECTS: Depression,
hallucinations, blurred vision, dry eyes, mydriasis, arrhythmias, hypotension, palpitations, tachycardia, constipation, dry
mouth, ileus, urinary retention, decreased sweating.
I CONTRAINDICATIONS: Hypersensitivity, children Ͻ3 yr,
narrow-angle glaucoma, tardive dyskinesia.
I CAUTIONS: Additive anticholinergic effects with antihistamines, phenothiazines, quinidine, disopyramide, and tricyclic
antidepressants. • Antacids and antidiarrheals may decrease
absorption. • Teach patient signs of urinary retention and
constipation/ileus. • Patients with mental illness are at risk of
developing exaggerated symptoms of their disorder during
early therapy. • Advise patient to avoid activities that require
alertness until response to the drug is known. • Caution
patient that this medication decreases perspiration.
• Overheating may occur during hot weather; patient should
notify health care professional if unable to remain indoors in
an air-conditioned environment during hot weather.
• IM: Monitor pulse and blood pressure closely and maintain
bedrest for 1 hour after administration.
Key:
underline = most common;
CAPS = life-threatening
A–C

38. A–C
BISOPROLOL (bis-oh-proe-lol) Zebeta antihypertensive (betablocker [selective]) Pregnancy Category C
I INDICATIONS: Hypertension
Therapeutic Effects: I Decreased blood pressure and
heart rate.
I DOSAGE: PO: Adults: 2.5–20 mg/d.
I ADMINISTRATION: Administer without regard to meals.
I ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue, weakness, anxiety, depression, dizziness, drowsiness, insomnia,
memory loss, mental status changes, nightmares, blurred
vision, bronchospasm, wheezing, BRADYCARDIA, CHF
,
PULMONARY EDEMA, hypotension, liver function abnormalities, nausea, impotence, decreased libido, urinary frequency,
rashes, hyperglycemia, hypoglycemia, arthralgia, back pain,
joint pain, drug-induced lupus syndrome.
I CONTRAINDICATIONS: Uncompensated CHF pulmonary
,
edema, cardiogenic shock, bradycardia or heart block.
I CAUTIONS: May alter the effectiveness of insulins or oral
hypoglycemic agents. • Additive bradycardia may occur with
digoxin. • Additive hypotension may occur with other antihypertensives, acute ingestion of alcohol, or nitrates. • Monitor
blood pressure, ECG, and pulse frequently during dosage
adjustment period. • Take apical pulse before administering:
If Ͻ50 or if arrhythmia occurs withhold medication and notify
physician or other health care professional.
32

39. 33
BUDESONIDE (byoo-dess-oh-nide) Pulmicort antiinflammatory (inhalation corticosteroid) Pregnancy Category B
I INDICATIONS: Asthma
Therapeutic Effects: I Decrease frequency and severity of
asthma attacks.
I DOSAGE: Inhalation: Adults: 1–2 inhalations once or twice
daily or 2–4 inhalations twice daily (maximum 8 inhalations
daily). Children Ն6 yr: 1–2 inhalations twice daily (maximum
4 inhalations daily). Children 12 mo–8 yr: 0.25 to 1 mg/d as a
single dose, or twice daily in divided doses. Individual titration is required.
I ADMINISTRATION: Allow at least 1 minute between inhalations of aerosol medication.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dysphonia,
hoarseness, oropharyngeal fungal infections, back pain,
headache, dyspepsia, gastroenteritis, cataracts, bronchospasm, cough, wheezing, dry mouth, esophageal candidiasis, adrenal suppression, decreased growth (children),
CHURG-STRAUSS SYNDROME.
I CONTRAINDICATIONS: Acute attack of asthma/status asthmaticus.
I CAUTIONS: Ketoconazole decreases metabolism and
increases levels of budesonide • Advise patients also using
bronchodilator to use bronchodilator first and wait 5 minutes
before taking beclomethasone. • Advise patient to use regular peak flow monitoring to determine respiratory status.
• Advise patient to notify physician if sore throat or sore
mouth occurs. • Instruct patient whose systemic corticosteroids have been recently reduced or withdrawn to carry a
warning card indicating the need for supplemental systemic
corticosteroids in the event of stress or severe asthma attack
unresponsive to bronchodilators. • Caution patient to avoid
smoking, known allergens, and other respiratory irritants.
A–C

40. A–C
BUMETANIDE (byoo-met-a-nide) Bumex diuretic (loop diuretic)
Pregnancy Category C
I INDICATIONS: Edema secondary to CHF hepatic or renal
,
disease.
Therapeutic Effects: I Diuresis and subsequent mobilization of excess fluid.
I DOSAGE: PO: Adults: 0.5–2 mg/d as a single dose. Up to 2
additional doses may be given during the day q 4–5 h (up to
10 mg/d). Alternate-day or q 2–3 day regimens may also be
used. IM, IV: Adults: 0.5–1 mg, may be repeated q 2–3 h as
needed (up to 10 mg/d).
I ADMINISTRATION: PO: Administer orally with food or milk to
minimize gastric irritation. IV: Direct IV: Rate: Administer
slowly over 2 minutes. Intermittent Infusion: Dilute in D5W,
0.9% NaCl, or LR, and administer through Y-tubing or 3-way
stopcock. Rate: May be administered over 12 hours for
patients with renal impairment.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, insomnia, nervousness, hearing loss, tinnitus,
hypotension, constipation, dry mouth, hyperglycemia, dehydration, hypochloremia, hypokalemia, hypomagnesemia,
hyponatremia, hypovolemia, metabolic alkalosis, hyperglycemia, arthralgia, muscle cramps, increased BUN.
I CONTRAINDICATIONS: Hypersensitivity (cross-sensitivity with
thiazides and sulfonamides may occur), pre-existing uncorrected electrolyte imbalance, hepatic coma, or anuria.
I CAUTIONS: Additive hypotension with antihypertensives,
nitrates. • Additive hypokalemia with other diuretics,
mezlocillin, piperacillin, amphotericin B, stimulant laxatives,
and corticosteroids. • Hypokalemia may increase digoxin
toxicity. • Increased risk of ototoxicity with aminoglycoside.
• May increase the effectiveness of warfarin, thrombolytic
agents, or anticoagulants.
34

41. 35
BUPROPION (byoo-proe-pee-on) Wellbutrin, Wellbutrin SR,
Zyban antidepressant, smoking deterrent Pregnancy Category B
I INDICATIONS: Depression, smoking cessation (Zyban).
Unlabeled Uses: ADHD (adults, SR only), diminished libido in
women.
Therapeutic Effects: I Improved mood, decreased craving
for cigarettes.
I DOSAGE: PO: Adults: Depression: 100 mg q 12 h; may be
increased to 450 mg/d in divided doses (no single dose to
exceed 150 mg). Smoking cessation (SR): 150 mg once daily
for 3 days, then 150 mg q 12 h for 7–12 wk.
I ADMINISTRATION: Administer doses in equally spaced time
increments throughout day to minimize the risk of seizures.
Sustained-release tablets should be swallowed whole; do not
break, crush, or chew. Insomnia may be decreased by avoiding bedtime doses. May be administered with food to lessen
GI irritation.
I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
agitation, headache, insomnia, mania, psychoses, dry mouth,
nausea, vomiting, weight gain, weight loss, photosensitivity,
hyperglycemia, hypoglycemia, syndrome of inappropriate
ADH secretion, tremor.
I CONTRAINDICATIONS: Hypersensitivity, history of seizures,
bulimia, and anorexia nervosa, concurrent MAO inhibitor
therapy.
I CAUTIONS: Increased risk of adverse reactions when used with
levodopa or MAO inhibitors. Increased risk of seizures with
phenothiazine, antidepressants, theophylline, corticosteroids,
OTC stimulants/anorectics, or cessation of alcohol or benzodiazepines. • Bupropion may impair judgment or motor and
cognitive skills; caution patient to avoid driving and other activities requiring alertness until response to medication is known.
Key:
underline = most common;
CAPS = life-threatening
A–C

42. A–C
CAPTOPRIL (kap-toe-pril) Capoten angiotensin-converting
enzyme (ACE) inhibitor Pregnancy Category C (first trimester),
D (second and third trimesters)
I INDICATIONS: Hypertension, CHF diabetic nephropathy.
,
Therapeutic Effects: I Lowered blood pressure, improvement in symptoms of CHF
.
I DOSAGE: PO: Adults: 12.5–25 mg 2–3 times daily, may be
increased at 1–2 wk intervals up to 150 mg 3 times daily.
I ADMINISTRATION: Administer 1 hour before or 2 hours after
meals.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, headache, insomnia, weakness, cough, hypotension,
angina pectoris, tachycardia, taste disturbances, anorexia,
diarrhea, nausea, proteinuria, impotence, renal failure, rashes,
hyperkalemia, AGRANULOCYTOSIS, NEUTROPENIA,
ANGIOEDEMA, fever.
I CONTRAINDICATIONS: Hypersensitivity, cross-sensitivity
among ACE inhibitors may occur, pregnancy, angioedema
(hereditary or idiopathic).
I CAUTIONS: Instruct patient to notify health care professional
if rash; mouth sores; sore throat; fever; swelling of hands or
feet; irregular heart beat; chest pain; dry cough; hoarseness;
swelling of face, eyes, lips, or tongue; difficulty swallowing or
breathing occur. • Additive hypotension with other antihypertensives, nitrates, phenothiazines, acute ingestion of alcohol,
and during surgery or general anesthesia. • Hyperkalemia
may result from concurrent use of potassium supplements,
potassium-sparing diuretics, indomethacin, salt substitutes,
or cyclosporine. • May increase the risk of lithium or digoxin
toxicity. • Persistent dry cough may occur and may not
subside until medication is discontinued.
36

43. 37
CARISOPRODOL (kar-i-sop-roe-dole) Soma, Vanadom skeletal
muscle relaxant Pregnancy Category UK
I INDICATIONS: Adjunct to rest and physical therapy in the
treatment of muscle spasm associated with acute painful
musculoskeletal conditions.
Therapeutic Effects: I Skeletal muscle relaxation.
I DOSAGE: PO: Adults: 350 mg 4 times daily. Children 5–12 yr:
6.25 mg/kg 4 times daily.
I ADMINISTRATION: Administer with food to minimize GI irritation. Provide safety measures; supervise ambulation and
transfer of patients.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, agitation, ataxia, depression, insomnia, syncope,
asthma attacks, hypotension, tachycardia, epigastric distress,
hiccups, nausea, vomiting, flushing, rashes, ANAPHYLACTIC
SHOCK, fever, psychological dependence, severe idiosyncratic
reaction.
I CONTRAINDICATIONS: Hypersensitivity to carisoprodol or to
meprobamate; porphyria or suspected porphyria.
I CAUTIONS: Instruct patient to notify health care professional
if signs of allergy (rash, hives, swelling of tongue or lips,
dyspnea) or idiosyncratic reaction occur. • Can cause additive
CNS depression with other CNS depressants including
alcohol, antihistamines, opioid analgesics, and
sedative/hypnotics. • Concomitant use of kava, valerian, or
chamomile can increase CNS depression. • Observe for idiosyncratic symptoms that may appear within minutes or hours
of administration of first dose: extreme weakness, quadriplegia, dizziness, ataxia, dysarthria, visual disturbances, agitation,
euphoria, confusion, and disorientation; symptoms usually
subside over several hours. • Advise patient to avoid driving
or other activities requiring alertness. Instruct patient to
change positions slowly to minimize orthostatic hypotension.
Key:
underline = most common;
CAPS = life-threatening
A–C

44. A–C
CARVEDILOL (kar-ve-dil-ole) Coreg antihypertensive (betablocker) Pregnancy Category C
I INDICATIONS: Hypertension, CHF
.
Therapeutic Effects: I Decreases heart rate and blood
pressure, slows the progression of CHF
.
I DOSAGE: PO: Adults: Hypertension: 6.25 mg twice daily, up to
25 mg twice daily; CHF: 3.125 mg twice daily; may be
increased to 6.25 mg twice daily. Dose may be doubled (not to
exceed 25 mg twice daily in patients Ͻ85 kg or 50 mg twice
daily in patients Ͼ85 kg).
I ADMINISTRATION: Administer without regard to food.
I ADVERSE REACTIONS AND SIDE EFFECTS: Weakness, anxiety, depression, insomnia, blurred vision, bronchospasm,
wheezing. BRADYCARDIA, CHF PULMONARY EDEMA, diar,
rhea, impotence, hyperglycemia, hypoglycemia.
I CONTRAINDICATIONS: Uncompensated CHF pulmonary
,
edema, cardiogenic shock, bradycardia or heart block, hepatic
impairment or bronchial asthma/bronchospasm.
I CAUTIONS: Teach patient to check pulse daily and blood
pressure biweekly and to report pulse Ͻ50 bpm or significant
change in blood pressure. • Abrupt withdrawal may precipitate life-threatening arrhythmias, hypertension, or myocardial
ischemia. • General anesthetics, IV phenytoin, diltiazem, and
verapamil may cause additive myocardial depression.
• Additive bradycardia may occur with digoxin. • Additive
hypotension may occur with other antihypertensives, or
nitrates. • Concurrent use with clonidine increases hypotension and bradycardia. • May alter the effectiveness of insulins
or oral hypoglycemic agents. • Use cautiously within 14 days
of MAO inhibitor therapy (may result in hypertension).
• Withhold medication if pulse is Ͻ50 bpm or if arrhythmia
occurs.
Key:
underline = most common;
CAPS = life-threatening
38

45. 39
CEFEPIME (seff-e-peem) Maxipime anti-infective third generation cephalosporin Pregnancy Category B
I INDICATIONS: Skin, bone, joint, urinary, gynecologic, respiratory tract, and intra-abdominal infections; septicemia.
Therapeutic Effects: I Bactericidal action against susceptible bacteria.
I DOSAGE: IM, IV: Adults: 0.5–1 g q 12 h. Children 2 mo–12 yr
and up to 40 kg: 50 mg/kg 12 h.
I ADMINISTRATION: IV: Monitor injection site frequently for
phlebitis. Rate: Administer over 30 minutes.
I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES (high
doses), PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea,
vomiting, rashes, urticaria, bleeding, phlebitis at IV site, allergic reactions including ANAPHYLAXIS and SERUM SICKNESS, superinfection.
I CONTRAINDICATIONS: Hypersensitivity to cephalosporins or
penicillins.
I CAUTIONS: Report fever and diarrhea, especially if stool
contains blood, pus, or mucus. • Advise patient not to treat
diarrhea without consulting health care professional.
• Observe patient for signs and symptoms of anaphylaxis
(rash, pruritus, laryngeal edema, wheezing). • Discontinue
drug and report signs and symptoms immediately.
• Concurrent use of large doses of cephalosporins and nonsteroidal anti-inflammatory agents (NSAIDs) may increase risk
of bleeding. • Concurrent use of loop diuretics or nephrotoxic
agents including aminoglycoside may increase the risk of
nephrotoxicity. • Determine previous use of and reactions to
penicillins or cephalosporins. • Persons with a negative
history of penicillin sensitivity may still have an allergic
response. • Obtain specimens for culture and sensitivity
before initiating therapy.
Key:
underline = most common;
CAPS = life-threatening
A–C

46. A–C
CELECOXIB (sel-e-kox-ib) Celebrex antirheumatic, nonsteroidal
anti-inflammatory (COX-2 inhibitor) Pregnancy Category C
I INDICATIONS: Osteoarthritis, rheumatoid arthritis, familial
adenomatous polyposis (FAP).
Therapeutic Effects: I Decreased arthritic pain and
inflammation, decreased number of colorectal polyps.
I DOSAGE: PO: Adults: Osteoarthritis: 200 mg/d as a single
dose or 100 mg twice daily. Rheumatoid arthritis: 100–200 mg
twice daily. Familial adenomatous polyosis: 400 mg twice
daily.
I ADMINISTRATION: May be administered without regard to
meals.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, insomnia, GI BLEEDING, abdominal pain, diarrhea,
dyspepsia, flatulence, nausea, rash.
I CONTRAINDICATIONS: Hypersensitivity, allergic reactions to
sulfonamides, asthma, urticaria, or allergic reactions to aspirin
or other NSAIDs, advanced renal disease, late pregnancy (may
cause premature closure of ductus arteriosus).
I CAUTIONS: Do not confuse with Celexa (citalopram) or
Cerebyx (fosphenytoin). • Advise patient to notify health care
professional promptly if signs or symptoms of GI toxicity
(abdominal pain, black stools), skin rash, unexplained weight
gain, or edema occur. • May decrease effectiveness of ACE
inhibitors, thiazide diuretics, and furosemide. • Use with
aspirin may increase risk of GI bleeding. • Use with warfarin
may increase risk of bleeding.
40

47. 41
CEPHALEXIN (sef-a-lex-in) Apo-Cephalex, Biocef, Keflex, NovoLexin anti-infective (first-generation cephalosporin) Pregnancy
Category B
I INDICATIONS: Skin and skin structure infections, pneumonia,
otitis media, urinary tract infections, bone and joint infections,
septicemia caused by susceptible organisms.
Therapeutic Effects: I Bactericidal action against susceptible bacteria.
I DOSAGE: PO: Adults: 250–500 mg q 6 h. Cystitis, skin and soft
tissue infections, streptococcal pharyngitis: 500 mg q 12 h.
Children: 6.25–25 mg/kg q 6 h. Skin and soft-tissue infections,
streptococcal pharyngitis: 12.5–50 mg/kg q 12 h.
I ADMINISTRATION: Administer around the clock on full or
empty stomach. Administer with food to minimize GI irritation.
Shake oral suspension well before administering.
I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
PSEUDOMEMBRANOUS COLITIS, diarrhea, nausea, vomiting,
cramps, rashes, urticaria, blood dyscrasias, hemolytic anemia,
ANAPHYLAXIS and serum sickness, superinfection.
I CONTRAINDICATIONS: Hypersensitivity to cephalosporins,
serious hypersensitivity to penicillins.
I CAUTIONS: Instruct patient to notify health care professional
if fever and diarrhea develop, especially if diarrhea contains
blood, mucus, or pus. Advise patient not to treat diarrhea
without consulting health care professional. • Concurrent use
of loop diuretics may increase the risk of renal toxicity.
• Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue drug and notify
physician or other health care professional immediately.
• Keep epinephrine and resuscitation equipment close by in
case of an anaphylactic reaction.
Key:
underline = most common;
CAPS = life-threatening
A–C

48. A–C
CETIRIZINE (se-ti-ra-zeen) Zyrtec allergy, cold and cough
remedy, antihistamine Pregnancy Category B
I INDICATIONS: Relief of allergic symptoms including seasonal
and perennial allergic rhinitis, chronic urticaria.
Therapeutic Effects: I Decreased symptoms of histamine
excess (sneezing, rhinorrhea, nasal and ocular pruritus, ocular
tearing and redness).
I DOSAGE: PO: Adults and children Ͼ6 yr: 5–10 mg once daily.
Children 6–11 yr: 5–10 mg daily. Children 2–5 yr: 2.5–5 mg
daily.
I ADMINISTRATION: Administer once daily without regard to
food.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness, drowsiness, fatigue, pharyngitis, dry mouth.
I CONTRAINDICATIONS: Hypersensitivity, acute attacks of
asthma, lactation.
I CAUTIONS: May cause dizziness and drowsiness; caution
patient to avoid driving or other activities requiring alertness
until response to medication is known. • Advise patient to
avoid taking alcohol or other CNS depressants concurrently
with this drug.
42

49. 43
CHLOROTHIAZIDE (klor-oh-thye-a-zide) Diuril antihypertensive
(thiazide diuretic) Pregnancy Category B
I INDICATIONS: Mild to moderate hypertension, edema.
Therapeutic Effects: I Lower blood pressure in hypertensive patients, diuresis with mobilization of edema.
I DOSAGE: PO: Adults: 250 mg–1 g/d as a single dose or in
divided doses. Children Ն6 mo: 10–20 mg/kg/d as a single
dose or in 2 divided doses. IV: Adults: Diuretic: 250 mg q 6–12
h. Antihypertensive: 500 mg–1 g/d as a single dose or 2
divided doses.
I ADMINISTRATION: Administer in the morning to prevent
disruption of sleep cycle.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, lethargy, weakness, hypotension, anorexia,
cramping, hepatitis, nausea, vomiting, photosensitivity,
rashes, hyperglycemia, hypokalemia, dehydration, hypercalcemia, hypochloremic alkalosis, hypomagnesemia, hyponatremia, hypophosphatemia, hypovolemia, blood dyscrasias,
hyperuricemia, elevated lipids, muscle cramps, pancreatitis.
I CONTRAINDICATIONS: Hypersensitivity, anuria, lactation.
I CAUTIONS: Additive hypotension with other antihypertensives, acute ingestion of alcohol, or nitrates. • Additive
hypokalemia with corticosteroids, amphotericin B,
mezlocillin, piperacillin, or ticarcillin. • Hypokalemia increases
risk of digoxin toxicity. • Decreases lithium excretion.
• Cholestyramine or colestipol decrease absorption. • Assess
patient, especially if taking digitalis glycosides, for anorexia,
nausea, vomiting, muscle cramps, paresthesia, and confusion;
notify health care professional if these signs of electrolyte
imbalance occur. • Instruct patient to monitor weight
biweekly and report weight gain or loss in excess of 2 pounds.
• Caution patient to change positions slowly to minimize
orthostatic hypotension.
Key:
underline = most common;
CAPS = life-threatening
A–C

50. A–C
CIMETIDINE (sye-meh-tih-deen) Novocimetine, Peptol,
Tagamet anti-ulcer agent (histamine h2 antagonist) Pregnancy
Category B
I INDICATIONS: Duodenal, benign and stress-induced gastric
ulcers, GERD, heartburn, acid indigestion, Zollinger-Ellison
syndrome.
Therapeutic Effects: I Healing and prevention of ulcers,
decreased gastroesophageal reflux, decreased secretion of
gastric acid.
I DOSAGE: PO: Adults: Ulcer treatment or prevention: 600–1200
mg/d in divided doses or 400–800 mg at bedtime. GERD:
800–1600 mg/d in divided doses. Zollinger-Ellison syndrome:
300–600 mg q 6 h (up to 2400 mg/d). Children: Active ulcers:
20–40 mg/kg/d in 4 divided doses. IM, IV: Adults: Active ulcers:
300 mg q 6 h. Continuous IV infusion: 900 mg infused over 24
h (37.5 mg/h). Prevention of upper GI bleeding in critically ill
patients: 50 mg/h. Children: Short-term treatment of active
ulcers: 5–10 mg/kg q 6–8 h.
I ADMINISTRATION: PO: Administer with meals and at bedtime.
Direct IV: Rate: Dilute and administer over at least 5 min to
prevent hypotension and arrhythmias. Intermittent Infusion:
Rate: Dilute and administer over 15–20 min.
I ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, dizziness, drowsiness, hallucinations, ARRHYTHMIAS, druginduced hepatitis, nausea, AGRANULOCYTOSIS, APLASTIC
ANEMIA.
I CONTRAINDICATIONS: Hypersensitivity.
I CAUTIONS: May increase blood levels of chlordiazepoxide,
diazepam, and midazolam, labetalol, metoprolol, propranolol,
caffeine, calcium channel blockers, carbamazepine, chloroquine, lidocaine, metronidazole, moricizine, pentoxifylline,
phenytoin, propafenone, quinidine, quinine, metformin,
sulfonylureas, tacrine theophylline, triamterene, tricyclic antidepressants, valproic acid, and warfarin.
44

51. 45
CIPROFLOXACIN (sip-roe-flox-a-sin) Cipro anti-infective (fluoroquinolone) Pregnancy Category C
I INDICATIONS: Urinary tract and gynecologic infections,
gonorrhea, prostatitis, respiratory tract infections, skin and
skin structure infections, bone and joint infections, infectious
diarrhea, intra-abdominal infections, febrile neutropenia, postexposure treatment of inhalational anthrax.
Therapeutic Effects: I Resolution of infection.
I DOSAGE: PO: Adults: 250–750 mg q 12 h. Gonorrhea 250 mg
single dose. IV: Adults: 200–400 mg q 12 h.
I ADMINISTRATION: PO: Do not give within 2 hours of administration of antacids, iron, zinc, or sucralfate. IV: Rate:
Administer over 60 min into a large vein to minimize venous
irritation.
I ADVERSE REACTIONS AND SIDE EFFECTS: SEIZURES,
dizziness, drowsiness, headache, acute psychoses, light-headedness, tremors, PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, nausea, photosensitivity, hyperglycemia,
hypoglycemia, phlebitis at IV site, tendinitis, tendon rupture,
hypersensitivity reactions including ANAPHYLAXIS,
STEVENS-JOHNSON SYNDROME.
I CONTRAINDICATIONS: Hypersensitivity, pregnancy, or children Ͻ18 yr.
I CAUTIONS: Instruct patient to notify health care professional
if fever and diarrhea develop, especially if stool contains
blood, pus, or mucus. Advise patient not to treat diarrhea
without consulting health care professional. • Instruct patient
to notify health care professional immediately if rash, tendon
pain, or inflammation occurs. • May increase the effects of
warfarin. Increases serum theophylline levels and may lead to
toxicity. • Concurrent use with foscarnet may increase risk of
seizures. • Concurrent use with corticosteroids may increase
risk of tendon rupture.
Key:
underline = most common;
CAPS = life-threatening
A–C

52. A–C
CITALOPRAM (si-tal-oh-pram) Celexa antidepressant (selective
serotonin reuptake inhibitor) Pregnancy Category C
I INDICATIONS: Depression
Therapeutic Effects: I Improved mood.
I DOSAGE: PO: Adults: 20–60 mg/d. Geriatric Patients: 20 mg/d,
up to 40 mg/d only in nonresponding patients.
I ADMINISTRATION: Administer as a single dose in the morning or evening without regard to food.
I ADVERSE REACTIONS AND SIDE EFFECTS: Apathy, confusion, drowsiness, insomnia, weakness, tremor, agitation,
amnesia, anxiety, decreased libido, dizziness, fatigue,
impaired concentration, increased depression, migraine
headache, suicide attempt, cough, postural hypotension,
tachycardia, abdominal pain, anorexia, diarrhea, dry mouth,
dyspepsia, flatulence, increased saliva, nausea, increased
appetite, vomiting, amenorrhea, ejaculatory delay, impotence,
polyuria, increased sweating, photosensitivity, pruritus, rash,
arthralgia, myalgia, paresthesia, fever, yawning.
I CONTRAINDICATIONS: Hypersensitivity, concurrent MAO
inhibitor therapy.
I CAUTIONS: Do not confuse with Celebrex (celecoxib) or
Cerebyx (fosphenytoin). • May cause serious, potentially fatal
reactions when used with MAO inhibitors; allow at least 14
days between citalopram and MAO inhibitors. • Serotonergic
effects may be potentiated by lithium (concurrent use should
be carefully monitored). • Concurrent use with 5-HT1 agonists
used for migraine headaches may increase the risk of adverse
reactions (weakness, hyperreflexia, incoordination).
• Increased risk of serotonergic side effects including serotonin syndrome with St. John’s wort and SAMe.
46

53. 47
CLINDAMYCIN (klin-da-mye-sin) Cleocin, Dalacin C, antiinfective Pregnancy Category B
I INDICATIONS: Skin, skin structure, respiratory tract, intraabdominal and gynecologic infections, septicemia,
osteomyelitis, endocarditis prophylaxis, severe acne.
Therapeutic Effects: I Bactericidal or bacteriostatic to
susceptible organisms.
I DOSAGE: PO: Adults: Most infections: 150–300 mg q 6 h.
P carinii pneumonia: 1200–1800 mg/d in divided doses with
.
15–30 mg primaquine/day. CNS toxoplasmosis: 1200–2400
mg/d in divided doses with pyrimethamine 50–100 mg/d.
Children Ͼ1 mo: 2–5 mg/kg q 6 h or 2.7–6.7 mg/kg q 8 h.
IM, IV: Adults: Most infections: 300–600 mg q 6–8 h or 900 mg
q 8 h. P carinii pneumonia: 2400–2700 mg/d in divided doses
.
with primaquine. Toxoplasmosis: 1200–4800 mg/d in divided
doses with pyrimethamine. Children Ͼ1 mo: 3.75–10 mg/kg q
6 h or 5–13.3 mg/kg q 8 h. Infants Ͻ1 mo: 3.75–5 mg/kg q 6 h
or 5–6.7 mg/kg q 8 h.
I ADMINISTRATION: PO: Administer with glass of water; may
be given with meals. IM: Do not administer Ͼ600 mg in a
single IM injection. Intermittent Infusion: Rate: Administer
each 300 mg over a minimum of 10 min.
I ADVERSE REACTIONS AND SIDE EFFECTS: Arrhythmias,
hypotension, PSEUDOMEMBRANOUS COLITIS, diarrhea,
bitter taste (IV only).
I CONTRAINDICATIONS: Hypersensitivity, history of
pseudomembranous colitis, severe liver impairment, diarrhea.
I CAUTIONS: Monitor GI status, diarrhea, abdominal cramping, fever, and bloody stools may be a sign of pseudomembranous colitis and should be reported immediately.
• Pseudomembranous colitis may begin up to several weeks
following the cessation of therapy. • Instruct patient to finish
the drug completely as directed, even if feeling better.
Key:
underline = most common;
CAPS = life-threatening
A–C

54. A–C
CLONAZEPAM (kloe-na-ze-pam) Klonopin, Rivotril, SynClonazepam anticonvulsant (benzodiazepine) Schedule IV
Pregnancy Category C
I INDICATIONS: Seizures, panic disorder. Unlabeled Uses:
Uncontrolled leg movements during sleep, neuralgias, sedation.
Therapeutic Effects: I Prevention of seizures, decreased
frequency of panic attacks.
I DOSAGE: PO: Adults: 1.5 mg 3 times daily, not to exceed 20
mg/d. Panic disorder: 0.125 mg twice daily. Children Ͻ10 yr or
30 kg: Initial daily dose 0.01–0.03 mg/kg/d (not to exceed 0.05
mg/kg/d) given in 2–3 equally divided doses; increase by no
more than 0.25–0.5 mg q 3rd day (not to exceed 0.2 mg/kg/d).
I ADMINISTRATION: Administer with food to minimize gastric
irritation.
I ADVERSE REACTIONS AND SIDE EFFECTS: Behavioral
changes, drowsiness, diplopia, nystagmus, increased secretions, palpitations, hepatitis, dysuria, nocturia, urinary retention, anemia, ataxia, hypotonia, fever, physical dependence,
psychological dependence.
I CONTRAINDICATIONS: Hypersensitivity to clonazepam or
other benzodiazepines, severe liver disease.
I CAUTIONS: Additive CNS depression with alcohol, antidepressants, antihistamines, other benzodiazepines, opioid
analgesics, kava, valerian, skullcap, chamomile, or hops.
• Cimetidine, hormonal contraceptives, disulfiram, fluoxetine,
isoniazid, ketoconazole, metoprolol, propoxyphene, propranolol, or valproic acid may decrease the metabolism of clonazepam, enhancing its actions. • May increase serum
phenytoin levels. • Phenytoin may decrease serum clonazepam levels. Instruct patient to notify health care professional of unusual tiredness, bleeding, sore throat, fever,
clay-colored stools, yellowing of skin, or behavioral changes.
• Do not discontinue abruptly.
48

55. 49
CLONIDINE (klon-i-deen) Catapres, Catapres-TTS, Duraclon
antihypertensive Pregnancy Category C
I INDICATIONS: Mild to moderate hypertension, management
of cancer pain unresponsive to opioids alone, opioid withdrawal (unlabeled use).
Therapeutic Effects: I Decreased blood pressure, decreased
pain.
I DOSAGE: PO: Adults: 200–600 ␮g (0.2–0.6 mg)/d in 2–3
divided doses (up to 2.4 mg/d). Opioid withdrawal: 300 ␮g (0.3
mg) –1.2 mg/d. Geriatric Patients: 100 ␮g (0.1 mg) at bedtime
initially, increased as needed. Children: 50–400 ␮g (0.05–0.4
mg) twice daily. Transdermal: Adults: Hypertension: 100–300
␮g (0.1–0.3 mg)/24 h every 7 days. Epidural: Adults: 30 ␮g/h.
Children: 0.5 ␮g/kg/h.
I ADMINISTRATION: PO: Administer last oral dose of the day at
bedtime. Transdermal: Absorption of transdermal system is
greater when placed on chest or upper arm than when placed
on thigh.
I ADVERSE REACTIONS AND SIDE EFFECTS: Drowsiness,
depression, dizziness, nervousness, nightmares, bradycardia,
hypotension, palpitations, dry mouth, constipation, nausea,
vomiting, impotence, rash, sweating, sodium retention,
weight gain, withdrawal phenomenon.
I CONTRAINDICATIONS: Hypersensitivity. Epidural: anticoagulant therapy, or bleeding problems.
I CAUTIONS: Additive hypotension with other antihypertensives and nitrates. • Additive bradycardia with myocardial
depressants. • Decreased antihypertensive effect with MAO
inhibitors, amphetamines, beta-blockers, prazosin, or tricyclic
antidepressants. • Withdrawal phenomenon may be
increased by discontinuation of beta-blockers. • Increased risk
of adverse cardiovascular reactions with verapamil. • All
routes of clonidine should be discontinued gradually over 2–4
days to prevent rebound hypertension.
Key:
underline = most common; CAPS = life-threatening
A–C

56. A–C
CLOPIDOGREL (kloh-pid-oh-grel) Plavix antiplatelet agent
(platelet aggregation inhibitor) Pregnancy Category B
I INDICATIONS: Reduction of atherosclerotic events (MI, stroke,
vascular death) in patients at risk for such events (recent MI,
stroke, or peripheral vascular disease).
Therapeutic Effects: I Decreased occurrence of atherosclerotic events in patients at risk.
I DOSAGE: PO: Adults: 75 mg once daily.
I ADMINISTRATION: Administer once daily without regard to
food.
I ADVERSE REACTIONS AND SIDE EFFECTS: Depression,
dizziness, fatigue, headache, epistaxis, cough, dyspnea, chest
pain, edema, hypertension, GI BLEEDING, abdominal pain,
diarrhea, dyspepsia, gastritis, pruritus, purpura, rash, BLEEDING, NEUTROPENIA, THROMBOTIC THROMBOCYTOPENIC
PURPURA, hypercholesterolemia, arthralgia, back pain,
Hypersensitivity reactions including ANGIOEDEMA, ANAPHYLACTOID REACTIONS, BRONCHOSPASM.
I CONTRAINDICATIONS: Hypersensitivity, pathologic bleeding
(peptic ulcer, intracranial hemorrhage), lactation.
I CAUTIONS: Monitor patient for signs of thrombotic thrombocytic purpura (thrombocytopenia, microangiopathic
hemolytic anemia, neurologic findings, renal dysfunction,
fever). • Advise patient to notify health care professional
promptly if fever, chills, sore throat, or unusual bleeding or
bruising occurs. • Concurrent abciximab, eptifibatide,
tirofiban, aspirin, NSAIDs, heparin, heparinoids, thrombolytic
agents, ticlopidine, or warfarin may increase the risk of bleeding. • May inhibit the metabolism and increase the effects of
phenytoin, tolbutamide, tamoxifen, torsemide, fluvastatin,
and many NSAIDs.
50

57. 51
COLCHICINE (kol-chi-seen) anti-gout agent Pregnancy
Category D
I INDICATIONS: Gouty arthritis.
Therapeutic Effects: I Decreased pain and inflammation
in acute attacks of gout, prevention of attacks.
I DOSAGE: PO: Adults: 0.5–1.2 mg, then 0.5–0.6 mg q 1–2 h until
a total cumulative dose of 4 mg is achieved. See following
dosage cautions. IV: Adults: 1–2 mg initially, then 0.5 mg q 6 h
or 1 mg q 6–12 h until a total cumulative dose of 4 mg is
achieved. See following dosage cautions.
I ADMINISTRATION: PO: Administer with food. IV: Avoid
extravasation; may cause necrosis.
I ADVERSE REACTIONS AND SIDE EFFECTS: Diarrhea,
nausea, vomiting, abdominal pain, anuria, hematuria, alopecia, AGRANULOCYTOSIS, APLASTIC ANEMIA, leukopenia,
thrombocytopenia.
I CONTRAINDICATIONS: Hypersensitivity, pregnancy, severe
renal, hepatic or biliary disease.
I CAUTIONS: HIGH ALERT MED: Therapeutic range is
narrow. Overdose can be fatal. Cumulative dose by any route
should not exceed 4 mg. Once dosing limit has been reached,
(4 mg) no more colchicine by any route should be given for at
least 7 days. Limit IV doses to a maximum of 1-2 mg in
patients who have recently received oral colchicine. Assess
patient for toxicity (weakness, abdominal discomfort, nausea,
vomiting, diarrhea, delirium, seizures, sense of suffocation,
dilated pupils, difficulty swallowing, ascending paralysis,
oliguria), withhold drug and report symptoms immediately.
• Cumulative dose should not exceed 2 mg in geriatric and
renal patients. After dosing limit has been reached, do not
give any additional colchicine by any route for 21 days.
Decrease dose by 50% for patients with renal impairment.
• Encourage fluids to promote urinary output of at least
2000 mL/d. Instruct patient not to increase doses during
an acute attack.
A–C

58. A–C
CORTISONE (kor-ti-sone) Cortone, Cortone Acetate, steroidal
anti-inflammatory (systemic corticosteroid) Pregnancy Category
UK
I INDICATIONS: Short-acting corticosteroid used to treat
adrenocortical insufficiency, and allergic and inflammatory
disorders.
Therapeutic Effects: I Suppression of inflammation;
modification of the normal immune response; replacement of
deficient adrenal corticoids.
I DOSAGE: PO: Adults: 25–300 mg/d as a single dose or in
divided doses. Children: Adrenocortical insufficiency—0.7
mg/kg (20–25 mg/m2)/d in divided doses. Other uses–2.5–10
mg/kg (75–300 mg/m2)/d as a single dose or in divided doses.
IM: Adults: 20–300 mg/d. Children: Adrenocortical insufficiency: 0.7 mg/kg (37.5 mg/m2) q 3 days or 0.23–0.35 mg/kg
(12.5 mg/m2)/d. Other uses–0.83–5 mg/kg (25–150 mg/m2) q
12–24 h.
I ADMINISTRATION: PO: Administer with meals to minimize GI
irritation.
I ADVERSE REACTIONS AND SIDE EFFECTS: Depression,
euphoria, psychoses, restlessness, cataracts, hypertension,
PEPTIC ULCERATION, anorexia, nausea, acne, decreased
wound healing, ecchymoses, fragility, hirsutism, petechiae,
adrenal suppression, hyperglycemia, hypokalemia, THROMBOEMBOLISM, thrombophlebitis, weight gain, weight loss,
muscle wasting, osteoporosis, cushingoid appearance,
increased susceptibility to infection.
I CONTRAINDICATIONS: Active untreated infections, lactation.
I CAUTIONS: Instruct patient to promptly report severe
abdominal pain or tarry stools occur. • May increase requirement for insulin or oral hypoglycemic agents. • Increased risk
of adverse GI effects with NSAIDs. • Advise patient to carry
identification describing medication regimen. • Instruct
patient to report swelling, weight gain, tiredness, bone pain,
bruising, nonhealing sores, or visual changes.
52

59. 53
DALTEPARIN (dal-te-pa-rin) Fragmin anticoagulant (low molecular weight heparin [LMWH]) (antithrombotic) Pregnancy
Category B
I INDICATIONS: Prevention of deep vein thrombosis, pulmonary
emboli, ischemic complications in patients with unstable
angina/non–Q-wave MI. LMWH has a more predictable anticoagulant response—special monitoring of clotting times is not
necessary.
Therapeutic Effects: I Prevention of thrombus formation.
I DOSAGE: SC: Adults: Presurgical prophylaxis of DVT: 2500 IU
1–2 h before surgery, then 2500–5000 IU once daily;
angina/non–Q-wave MI: 120 IU/kg every 12 h.
I ADMINISTRATION: SC: Administer deep into SC tissue. Do
not aspirate or massage. Rotate sites frequently.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
insomnia, edema, urinary retention, ecchymoses, pruritus,
rash, urticaria, BLEEDING, anemia, thrombocytopenia,
hematoma.
I CONTRAINDICATIONS: Hypersensitivity, uncontrolled bleeding, thrombocytopenia, regional anesthesia during treatment
for unstable angina/non–Q–wave MI.
I CAUTIONS: HIGH ALERT MED: Assess patient for signs of
bleeding and hemorrhage (bleeding gums; nosebleed;
unusual bruising; black, tarry stools; hematuria; fall in hematocrit or blood pressure; guaiac-positive stools); bleeding from
surgical site. Notify physician if these occur. • Risk of bleeding may be increased by warfarin, aspirin, NSAIDs, dipyridamole, some penicillins, clopidogrel, ticlopidine, abciximab,
eptifibatide, tirofiban, and dextran. • Increased bleeding risk
with anise, arnica, chamomile, clove, feverfew, garlic, ginger,
ginkgo, Panax ginseng, and others.
Key:
underline = most common;
CAPS = life-threatening
D–H

60. D–H
DEXAMETHASONE (dex-a-meth-a-sone) Decadron, Decaject,
Dexameth steroidal anti-inflammatory (systemic corticosteroid)
Pregnancy Category UK
I INDICATIONS: Inflammatory, allergic, hematologic, neoplastic,
autoimmune disorders, replacement therapy in adrenal insufficiency, cerebral edema. Diagnostic agent in adrenal disorders.
Therapeutic Effects: I Suppression of inflammation, modification of the normal immune response.
I DOSAGE: PO: Adults: 0.5–9 mg daily in single or divided
doses. IM, IV: Adults: Dexamethasone acetate (IM): 8–16 mg q
1–3 wk. Dexamethasone phosphate (IV): 0.5–24 mg/d. Cerebral
edema: Dexamethasone phosphate: 10 mg initially IV, 4 mg q
6 h, may be decreased to 2 mg q 8–12 h.
I ADMINISTRATION: PO: Administer with meals to minimize GI
irritation. Direct IV: May be given undiluted. Do not administer
suspension IV. Rate: Administer over 1 min.
I ADVERSE REACTIONS AND SIDE EFFECTS: Depression,
euphoria, psychoses, restlessness, cataracts, hypertension,
PEPTIC ULCERATION, anorexia, nausea, acne, decreased
wound healing, ecchymoses, fragility, hirsutism, petechiae,
adrenal suppression, hyperglycemia, hypokalemia, THROMBOEMBOLISM, thrombophlebitis, weight gain, muscle wasting, osteoporosis, cushingoid appearance, increased
susceptibility to infection.
I CONTRAINDICATIONS: Active untreated infections, lactation.
I CAUTIONS: Instruct patient to promptly report severe
abdominal pain or tarry stools occur. • May increase requirement for insulin or oral hypoglycemic agents. • Increased risk
of adverse GI effects with NSAIDs. • Advise patient to carry
identification describing medication regimen. Instruct patient
to report swelling, weight gain, tiredness, bone pain, bruising,
nonhealing sores, visual or behavioral changes.
54

61. 55
DIAZEPAM (dye-az-e-pam) Apo-Diazepam, Diastat, Dizac, DVal, Novodipam, Valium, Vivol antianxiety agent, anticonvulsant,
sedative/hypnotic, skeletal muscle relaxant (benzodiazepine)
Schedule IV Pregnancy Category D
I INDICATIONS: Anxiety, preoperative sedation, conscious sedation, status epilepticus/uncontrolled seizures, skeletal muscle
relaxant, alcohol withdrawal.
Therapeutic Effects: I Relief of anxiety, sedation, skeletal
muscle relaxation, decreased seizure activity.
I DOSAGE: PO: Adults: 2–10 mg 2–4 times daily or 15–30 mg of
extended-release form once daily. Children Ͼ6 mo: 1–2.5 mg
3–4 times daily may be increased. Geriatric or Debilitated
Patients: 2–2.5 mg 1–2 times daily initially. IV, IM: Adults: 5–10
mg every 10 to 15 min up to 30 mg, if needed. Children 1
mo–5 yr: 0.2–0.5 mg q 2–5 min to maximum of 5 mg. Children
Ն5 yr: 1 mg q 2–5 min up to 10 mg.
I ADMINISTRATION: PO: Tablets may be crushed. Do not crush,
break, or chew sustained-release capsules. IM: IM injections
are painful and erratically absorbed; inject deeply into deltoid
muscle for maximum absorption. IV: Do not dilute or mix IV
diazepam with any other drug. Administer into Y-site as close
to insertion site as possible—can precipitate in IV fluids and
be absorbed into infusion bags and tubing. Injection may
cause burning and venous irritation; avoid small veins. Rate:
Administer slowly at a rate of 5 mg over at least 1 min. Infants
and children should receive total dose over a minimum of 3–5
min. Rectal: Do not repeat Diastat rectal dose more than
5 times/mo or 1 episode every 5 days. Round dose up to next
available dose unit.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
drowsiness, lethargy, depression, hangover, headache, paradoxical excitation, blurred vision, respiratory depression,
hypotension (IV only), constipation, diarrhea, nausea, vomiting, rashes, pain (IM), phlebitis (IV), venous thrombosis, physical dependence, psychological dependence, tolerance.
(Continued)
D–H

62. D–H
DIAZEPAM (Continued)
I CONTRAINDICATIONS: Hypersensitivity, comatose patients,
pre-existing CNS depression, uncontrolled severe pain,
narrow-angle glaucoma, pregnancy or lactation.
I CAUTIONS: Have resuscitation equipment available when
administering IV; rapid injection may cause apnea, hypotension, bradycardia, or cardiac arrest. • Use cautiously in
hepatic dysfunction, severe renal impairment, history of
suicide attempt or drug dependence, geriatric or debilitated
patients and children. • Concurrent use alcohol, antidepressants, antihistamines, and opioid analgesics results in additive CNS depression. • Cimetidine, hormonal contraceptives,
disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol,
propoxyphene, propranolol, or valproic acid may decrease the
metabolism of diazepam, enhancing its actions. • May
decrease the efficacy of levodopa. • Rifampin or barbiturates
may increase the metabolism and decrease effectiveness of
diazepam. • Sedative effects may be decreased by theophylline. • Concomitant use of kava, valerian, skullcap,
chamomile, or hops can increase CNS depression.
• Medication may cause drowsiness, clumsiness, or unsteadiness; advise patient to avoid driving or other activities requiring alertness until response to medication is known.
• Caution patient to avoid taking alcohol or other CNS
depressants concurrently with this medication.
56

63. 57
DIGOXIN (di-jox-in) Digitek, Lanoxicaps, Lanoxin antiarrhythmic, inotropic Pregnancy Category C
I INDICATIONS: CHF tachyarrhythmias atrial fibrillation and
,
atrial flutter, paroxysmal atrial tachycardia.
Therapeutic Effects: I Increased cardiac output and slowing
of the heart rate.
I DOSAGE: PO: Maintenance dose: Adults: 0.125–0.25 mg daily.
Geriatrics: 0.0625–0.125 daily or every other day. Children Ͼ2
yr: 0.012 mg/kg, divided, q 12 h. Children 1–24 mo: 0.01–0.02
mg/kg, divided, q 12 hr. Loading dose: Adults: 0.5–1mg in
divided doses over 24 h. Children Ͼ2 yr: 0.02–0.04mg/kg,
divided, q 8 h over 24 h. Children 1–24 mo: 0.035–0.06 mg/kg,
divided, q 8 h over 24 h. IV: Loading dose: Adults: 0.5–1 mg.
Children Ͼ2 yr: 0.025–0.035 mg/kg. Children 1–24 mo:
0.03–0.05 mg/kg.
I ADMINISTRATION: PO: Administer without regard to meals.
Tablets can be crushed. IV: IV doses may be given undiluted
or each 1 mL may be diluted in 4 mL of sterile water, 0.9%
NaCl, D5W, or LR for injection. Less diluent will cause precipitation. Use diluted solution immediately. Rate: Administer
over a minimum of 5 min.
I ADVERSE REACTIONS AND SIDE EFFECTS: Fatigue,
headache, weakness, blurred vision, yellow vision, ARRHYTHMIAS, bradycardia, ECG changes, anorexia, nausea, vomiting,
diarrhea, gynecomastia, thrombocytopenia.
I CONTRAINDICATIONS: Hypersensitivity, uncontrolled ventricular arrhythmias, AV block, idiopathic hypertrophic subaortic
stenosis, constrictive pericarditis.
I CAUTIONS: HIGH ALERT MED: Narrow therapeutic range
(normal serum level: 0.5–2 ng/mL). Monitor digoxin levels and
assess for signs and symptoms of toxicity: abdominal pain,
anorexia, nausea, vomiting, visual disturbances, bradycardia,
and other arrhythmias. • Assess apical pulse for 1 min before
administering. If pulse rate is Ͻ60 bpm in an adult, Ͻ70 bpm
in a child, or Ͻ90 bpm in an infant, or if patient exhibits signs
(Continued)
D–H

64. D–H
DIGOXIN (Continued)
or symptoms of toxicity, withhold drug and notify physician or
health care professional immediately. • Monitor ECG throughout IV administration. • Treatment of life-threatening arrhythmias from digitalis toxicity may include administration of
digoxin immune Fab (Digibind), which binds to the digitalis
glycoside molecule in the blood and is excreted by the
kidneys. Temporary ventricular pacing may be useful in
advanced heart block. • Teach patient to take pulse and to
contact health care professional before taking medication if
pulse rate is Ͻ60 or Ͼ100. • Review signs and symptoms of
digitalis toxicity with patient and family. Advise patient to
notify health care professional immediately if these or symptoms of CHF occur. Inform patient that these symptoms may
be mistaken for those of colds or flu. • Use cautiously in electrolyte abnormalities (may predispose to toxicity), geriatric
patients (very sensitive to toxic effects), MI, renal impairment,
obese patients (dose should be based on ideal body weight),
pregnancy and lactation. • Thiazide and loop diuretics,
mezlocillin, piperacillin, ticarcillin, amphotericin B, and corticosteroids, which cause hypokalemia, may increase the risk of
toxicity. • Quinidine, quinine, cyclosporine, amiodarone, verapamil, diltiazem, propafenone, and diclofenac increase serum
levels and may lead to toxicity. • Spironolactone increases
half-life. • Additive bradycardia may occur with beta-blockers
and other antiarrhythmics (quinidine, disopyramide).
• St. John’s wort may decrease digoxin levels and effect.
58

65. 59
DILTIAZEM (dil-tye-a-zem) Apo-Diltiaz, Cardizem, Diltia XT, NuDiltiaz, Tiamate, antianginal, antiarrhythmic, antihypertensive
(calcium channel blocker) Pregnancy Category C
I INDICATIONS: Hypertension, angina, supraventricular tachyarrhythmias, atrial flutter/fibrillation with rapid ventricular
rate.
Therapeutic Effects: I Decreased blood pressure, decreased
frequency and severity of angina, suppression of arrhythmias.
I DOSAGE: PO: Adults: 120–360 mg daily in divided doses.
IV: Adults: 5–15 mg/h.
I ADMINISTRATION: PO: Give with meals if GI irritation is a
problem. IV: Rate: Administer bolus over 2 min.
I ADVERSE REACTIONS AND SIDE EFFECTS: Anxiety, confusion, weakness, blurred vision, paresthesia, tremor, disturbed
equilibrium, epistaxis, tinnitus, cough, dyspnea, ARRHYTHMIAS, CHF peripheral edema, bradycardia, chest pain, palpita,
tions, tachycardia, abnormal liver function studies, erythema
multiforme, photosensitivity, pruritus/urticaria, hyperglycemia,
blood dyscrasias, STEVENS-JOHNSON SYNDROME, gingival
hyperplasia.
I CONTRAINDICATIONS: Hypersensitivity, sick sinus syndrome,
2nd- or 3rd-degree AV block, blood pressure Ͻ90 mm Hg,
recent MI or pulmonary congestion.
I CAUTIONS: Monitor ECG during IV administration: Have
emergency equipment available. • Additive hypotension with
fentanyl, antihypertensives, nitrates, or quinidine. • Digoxin
levels may be increased. • Concurrent use with beta-blockers,
digoxin, disopyramide, or phenytoin may result in bradycardia, conduction defects, or CHF • Cimetidine, ranitidine
.
and grapefruit juice increase blood levels. • Instruct patient
to monitor pulse and contact health care professional if
Ͻ50 bpm. • Caution patient to change positions slowly.
Key:
underline = most common;
CAPS = life-threatening
D–H

66. D–H
DONEPEZIL (doe-nep-i-zill) Aricept anti-Alzheimer’s agent,
cholinergic Pregnancy Category C
I INDICATIONS: Mild to moderate dementia associated with
Alzheimer’s disease.
Therapeutic Effects: I May temporarily lessen some of the
dementia associated with Alzheimer’s disease.
I DOSAGE: PO: Adults: 5 mg once daily; after 4–6 wk may
increase to 10 mg once daily.
I ADMINISTRATION: Administer in the evening just before
going to bed. May be taken without regard to food.
I ADVERSE REACTIONS AND SIDE EFFECTS: Headache,
abnormal dreams, depression, dizziness, drowsiness, fatigue,
insomnia, syncope, atrial fibrillation, hypertension, hypotension, vasodilation, diarrhea, nausea, anorexia, vomiting,
frequent urination, ecchymoses, hot flashes, weight loss,
arthritis, muscle cramps.
I CONTRAINDICATIONS: Hypersensitivity to donepezil or piperidine derivatives.
I CAUTIONS: Exaggerates muscle relaxation from succinylcholine. • Interferes with the action of anticholinergics.
Increases the cholinergic effects of bethanechol. • May
increase the risk of GI bleeding from NSAIDs. Quinidine and
ketoconazole decrease the metabolism. Rifampin, carbamazepine, dexamethasone, phenobarbital, and phenytoin
induce the enzymes that metabolize donepezil and may
decrease its effects. • Monitor heart rate during therapy; may
cause bradycardia. • Caution patient and caregiver that
donepezil may cause dizziness. • Advise patient and caregiver
to notify health care professional if nausea, vomiting, diarrhea, or changes in color of stool occur or if new symptoms
occur, or previously noted symptoms increase in severity.
• Advise patient and caregiver to notify health care professional of medication regimen before treatment or surgery.
60

67. 61
DOXAZOSIN (dox-uh-zoe-sin) Cardura antihypertensive (antiadrenergic) Pregnancy Category C
I INDICATIONS: Hypertension, symptomatic management of
benign prostatic hyperplasia (BPH).
Therapeutic Effects: I Lowers blood pressure.
I DOSAGE: PO: Adults: Hypertension: 2–16 mg/d; incidence of
postural hypotension greatly increased at doses Ͼ4 mg/d.
BPH: 1 mg once daily, may be gradually increased to 8 mg/d.
I ADMINISTRATION: Administer daily dose at bedtime.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
headache, depression, drowsiness, fatigue, nervousness,
weakness, abnormal vision, blurred vision, conjunctivitis,
epistaxis, dyspnea, first-dose orthostatic hypotension, arrhythmias, chest pain, edema, palpitations, abdominal discomfort,
constipation, diarrhea, dry mouth, flatulence, nausea, vomiting, decreased libido, sexual dysfunction, flushing, rash,
arthralgia, arthritis, gout, myalgia.
I CONTRAINDICATIONS: Hypersensitivity.
I CAUTIONS: Additive hypotension with acute ingestion of
alcohol, other antihypertensives, or nitrates. • May decrease
antihypertensive effect of clonidine. • Monitor blood pressure
and pulse 2–6 h after first dose, with each increase in dose,
and periodically throughout course of therapy. • BPH: Assess
patient for symptoms of prostatic hyperplasia (urinary hesitancy, feeling of incomplete bladder emptying, bladder distention, interruption of urinary stream, impairment of size and
force of urinary stream, terminal urinary dribbling, straining to
start flow, dysuria, urgency) before and periodically throughout therapy. • Hypertension: May be administered concurrently with a diuretic or other antihypertensive. • Advise
patient to check blood pressure at least weekly and report
significant changes.
Key:
underline = most common;
CAPS = life-threatening
D–H

68. D–H
ENALAPRIL (e-nal-a-pril) Vasotec ENALAPRILAT (e-nal-a-pril-at)
Vasotec IV Pregnancy Category C (first trimester), D (second and
third trimesters)
I INDICATIONS: Hypertension, CHF
.
Therapeutic Effects: I Lowered blood pressure, improvement
in CHF symptoms.
I DOSAGE: PO (Enalapril): Adults: 5–40 mg/d in 1–2 divided
doses; initiate therapy at 2.5 mg/d in patients receiving diuretics. IV (Enalaprilat): Adults: 0.625–1.25 mg (0.625 mg if receiving diuretics) q 6 h.
I ADMINISTRATION: PO: Precipitous drop in blood pressure
during first 1–3 h following first dose may occur. Monitor
blood pressure closely. IV: Rate: Administer undiluted over at
least 5 min. May be given as intermittent infusion.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
fatigue, headache, insomnia, cough, hypotension, angina
pectoris, tachycardia, taste disturbances, diarrhea, nausea,
proteinuria, renal failure, rashes, and hyperkalemia, AGRANULOCYTOSIS, ANGIOEDEMA.
I CONTRAINDICATIONS: Hypersensitivity to enalapril or other
ACE inhibitors, pregnancy, history of angioedema.
I CAUTIONS: Additive hypotension with other antihypertensives, nitrates, phenothiazines, and general anesthesia.
• Hyperkalemia with concurrent use of potassium supplements, potassium-sparing diuretics, indomethacin, salt
substitutes, or cyclosporine. • May increase risk of lithium
or digoxin toxicity. Instruct patient to report rash; mouth
sores; sore throat; fever; swelling of hands or feet; irregular
heart beat; chest pain; dry cough; hoarseness; swelling of
face, eyes, lips, or tongue; difficulty swallowing or breathing
occur. • Persistent dry cough may occur and may not subside
until medication is discontinued.
62

69. 63
ENOXAPARIN (e-nox-a-pa-rin) Lovenox anticoagulant (low
molecular weight heparin [LMWH]) (antithrombotic) Pregnancy
Category B
I INDICATIONS: Prevention of deep vein thrombosis, pulmonary
emboli, ischemic complications in patients with unstable
angina/non–Q-wave MI. LMWH has a more predictable anticoagulant response than unfractionated heparin—special monitoring of clotting times is not necessary.
Therapeutic Effects: I Prevention of thrombus formation.
I DOSAGE: SC: Adults: Knee/hip surgery: 40 mg once daily
starting 9–15 h before hip surgery; abdominal surgery: 40 mg
once daily starting within 24 h postop; treatment of DVT/PE:
1 mg/kg q 12 h or 1.5 mg/kg q 24 h; angina/non–Q-wave MI:
1 mg/kg q 12 h.
I ADMINISTRATION: SC: Administer deep into SC tissue. Do not
aspirate or massage. Rotate sites frequently.
I ADVERSE REACTIONS AND SIDE EFFECTS: Dizziness,
insomnia, edema, urinary retention, ecchymoses, pruritus,
rash, urticaria, BLEEDING, anemia, thrombocytopenia,
hematoma.
I CONTRAINDICATIONS: Hypersensitivity to pork products,
uncontrolled bleeding, thrombocytopenia, patients with prosthetic heart valves.
I CAUTIONS: HIGH ALERT MED: Assess patient for signs of
bleeding and hemorrhage (bleeding gums, nosebleed;
unusual bruising; black, tarry stools, hematuria; fall in hematocrit or blood pressure; guaiac-positive stools), bleeding from
surgical site. Notify physician if these occur. • Risk of bleeding may be increased by warfarin, aspirin, NSAIDs, dipyridamole, some penicillins, clopidogrel, ticlopidine, abciximab,
eptifibatide, tirofiban, and dextran. Increased bleeding risk
with arnica, chamomile, feverfew, garlic, ginger, ginkgo, Panax
ginseng, and others.
Key:
underline = most common;
CAPS = life-threatening
D–H

70. D–H
ESTRADIOL (es-tra-dye-ole) Estrace, Gynodiol hormone (estrogen) Pregnancy Category X
I INDICATIONS: Vasomotor symptoms of menopause and of
various estrogen deficiency states, treatment and prevention
of postmenopausal osteoporosis, inoperable metastatic postmenopausal breast or prostate carcinoma.
Therapeutic Effects: I Restoration of hormonal balance in
various deficiency states, treatment of hormone-sensitive
tumors.
I DOSAGE: PO: Adults: 0.5–2 mg daily or in a cycle.
Postmenopausal breast carcinoma: 10 mg 3 times daily.
Prostate carcinoma: 1–2 mg 3 times daily.
I ADMINISTRATION: Administer with or immediately after food
to reduce nausea. Estradiol is also available in injectable,
transdermal, and vaginal tablet or ring formulations.
I ADVERSE REACTIONS AND SIDE EFFECTS: Headache, dizziness, lethargy, intolerance to contact lenses, MI, THROMBOEMBOLISM, edema, hypertension, nausea, weight changes,
jaundice, oily skin, acne, pigmentation, urticaria, gynecomastia (men), hyperglycemia, hypercalcemia, sodium and water
retention, leg cramps, breast tenderness, women—amenorrhea, dysmenorrhea, breakthrough bleeding, cervical
erosions, loss of libido, vaginal candidiasis, men—impotence,
testicular atrophy.
I CONTRAINDICATIONS: Thromboembolic disease, undiagnosed vaginal bleeding, pregnancy, lactation.
I CAUTIONS: May alter requirement for warfarin, oral hypoglycemic agents, or insulins. • Barbiturates or rifampin may
decrease effectiveness. • Smoking increases the risk of
adverse CV reactions.
64

71. 65
FENTANYL (TRANSDERMAL) (fen-ta-nil) Duragesic opioid
analgesic, opioid agonist Schedule II Pregnancy Category C
I INDICATIONS: Chronic pain requiring opioid analgesic therapy.
Therapeutic Effects: I Decreases severity of chronic pain.
I DOSAGE: Transdermal: Adults: 25 ␮g/h is the initial dose;
patients who have not been receiving opioids should receive
not more that 25 ␮g/h. See package insert for determining
equianalgesic dosages in patients already receiving opioid
analgesics. Transdermal patch lasts 72 hours in most patients.
Some patients require a new patch every 48 hours.
I ADMINISTRATION: Apply to flat, nonirritated, and nonirradiated site. If skin preparation is necessary, use clear water and
clip, do not shave, hair.
I ADVERSE REACTIONS AND SIDE EFFECTS: Confusion, sedation, APNEA, bronchoconstriction, laryngospasm, respiratory
depression, bradycardia, anorexia, constipation, dry mouth,
nausea, vomiting, sweating, erythema, application site reactions, skeletal and thoracic muscle rigidity.
I CONTRAINDICATIONS: Hypersensitivity to fentanyl or adhesives, known intolerance, acute pain.
I CAUTIONS: HIGH ALERT MED: Do not use in patients who
have received MAO inhibitors within the previous 14 days
(may cause unpredictable, potentially fatal reactions). Additive
CNS and respiratory depression with other CNS depressants,
alcohol, antihistamines, antidepressants, sedative/hypnotics,
and other opioids. • If respiratory rate is Ͻ10/min, assess
level of sedation. Dose may need to be decreased by 25% to
50%. • Naloxone (Narcan) is the antidote to reverse respiratory depression or coma.
Key:
underline = most common;
CAPS = life-threatening
D–H