ROQUE, ABIE JEWEL JOY R.

NOVEMBER 5, 2018

BSN 301|GROUP 2 PROF. LAURO

DRUG STUDY

Name of Drug Indication Contraindication Adverse Effects

Mechanism of Action Side Effects Nursing Responsibilities
Generic Name: Long-acting agonist that Prevention of and Contraindicated with Hoarseness, throat CNS: Assess
Salmeterol binds to beta2receptors in maintenance therapy for hypersensitivity to irritation, headache, rapid Headache, tremor allergy to salmeterol;
the lungs, causing bronchospasm in select salmeterol, acute asthma heartbeat, nervousness, pregnancy, acute asthma
Band Name: bronchodilation ; also patients with asthma, attack, worsening or cough, dry mouth/throat, CV: attack, worsening
Serevent Diskus inhibits the release of chronic obstructive deteriorating asthma or upset stomach may Tachycardia, palpitations, asthma, lactation
inflammatory mediators pulmonary disease, and (life-threatening), acute occur. hypertension
Classification: in the lung, blocking exercise-induced asthma. airway obstruction. Ensure that drug is not
Beta2- swelling and Respiratory: used to treat acute asthma
selectiveadrenergic inflammation Use cautiously with Worsening of asthma, or with worsening or
agonistAntasthmatic pregnancy ,lactation. difficulty breathing, deteriorating asthma (risk
bronchospasm of death).
Dosage:
Instruct in the proper use
of diskus.

Monitor use of inhaler;

use of more than
4puffs/day may worsen
asthma; obtain evaluation
by physician.

Have patients who

experience exercise-
induced asthma use it
30–60 min before
activity.

Arrange for periodic

evaluation of respiratory
condition.
 Name of Drug Indication Contraindication Adverse Effects
Mechanism of Action Side Effects Nursing Responsibilities
Generic Name: Selectively and Prophylaxis and chronic Contraindicated with Dizziness, fatigue, fever; CNS: Headache,  History:
Montelukast competitively blocks the treatment of asthma in hypersensitivity to rash; abdominal pain, dizziness Hypersensitivity
receptor that inhibits adults and children montelukast or any of its dyspepsia, dental pain, to montelukast or
Band Name: leukotriene formation, >12mo components; acute gastroenteritis; increased GI: Nausea, diarrhea, any of its
Singulair thus blocking many of asthma attacks; status AST; weakness; cough, abdominal pain, components;
the signs and symptoms Relief of symptoms of asthmaticus. nasal congestion. dental pain acute asthma
Classification: of asthma—neutrophil seasonal allergic rhinitis attacks; status
Leukotriene receptor and eosinophil migration, in adults and children >2 Use cautiously with Respiratory: Influenza, asthmaticus,
antagonist neutrophil and monocyte yr pregnancy and lactation. cold, nasal congestion pregnancy and
aggregation, leukocyte lactation
Dosage: adhesion, increased Inlabeled uses: Chronic Other: Generalized pain, Interventions
10mg/PO capillary permeability, urticaria, atopic fever, rash, fatigue  Administer in the
and smooth muscle dermatitis evening without
contraction. These regard to food.
actions contribute to  Ensure that drug
inflammation, edema, is taken
mucus secretion, and continually for
bronchoconstriction optimal effect.
associated with the signs  Do not administer
and symptomsof asthma. for acute asthma
attack or acute
bronchospasm.
 Avoid the use of
aspirin or
NSAIDs in
patients with
known
sensitivities while
they are using this
drug.
 Ensure that
patient has a
readily available
rescue medication
 for acute asthma
attacks or
situations when a
short-acting
inhaled agent is
needed.
Teaching points
 Take this drug
regularly as
prescribed; do not
stop taking this
drug during
symptom-free
periods; do not
stop taking this
drug without
consulting your
health care
provider.
Continue taking
any other
antiasthma drugs
that have been
prescribed for
you. Notify your
health care
provider if your
asthma becomes
worse.
 Do not take this
drug for an acute
asthma attack or
acute
bronchospasm;
this drug is not a
bronchodilator,
and routine
emergency
 procedures should
be followed
during acute
attacks.
 Avoid the use of
aspirin or
NSAIDs if you
have a known
sensitivity to
these drugs.
Montelukast will
not prevent
reactions.
 These side effects
may occur:
Dizziness (use
caution when
driving or
performing
activities that
require alertness
if these effects
occur); nausea,
vomiting (eat
frequent small
meals, take drug
with food);
headache
(analgesics may
be available).
 Report fever,
acute asthma
attacks, flulike
symptoms,
lethargy.
 Name of Drug Indication Contraindication Adverse Effects
Mechanism of Action Side Effects Nursing Responsibilities
Generic Name: Synthetic To relieve Contraindicated Heart feels like it is Body Whole: Assessment & Drug Effects
Albuterol sympathomimetic amine bronchospasm w/hypersensitivity to pounding or racing Hypersensitivity
and moderately selective associated with acute or albuterol; tachy- (palpitations), chest reaction.  Monitor therapeutic
Band Name: beta2-adrenergic agonist chronic asthma, arrhythmias, tachycardia pain, fast heart rate, effectiveness which is
Accuneb with comparatively long bronchitis, or other caused by digitalis shakiness, nervousness, CNS: Tremor, anxiety, indicated by significant
action. Acts more reversible obstructive intoxication; general headache, dizziness, nervousness, subjective
Classification: prominently on beta2 airway diseases. Also anesthesia w/halogenated sore throat restlessness , improvement in
autonomic nervous receptors (particularly used to prevent hydrocarbons/cyclo- and runny nose. convulsions , weakness , pulmonary function
system agent; beta- smooth muscles of exercise-induced propane(sensitize the headache, within 60–90 min after
adrenergic agonist bronchi, uterus, and bronchospasm. myocardium to hallucinations. drug administration.
(sympathomimetic); vascular supply to catecholamines);unstable  Monitor for: S&S of
bronchodilator skeletal muscles) than vasomotor system CV: Palpitation, fine tremor in fingers,
(respiratory smooth on beta1 (heart) disorders; HPN; coronary hypertension, which may interfere
muscle relaxant) receptors. Minimal or no insufficiency, CAD; Hx hypotension, with precision
effect on alpha- of CVA; COPD ptsw/ bradycardia, reflex handwork; CNS
Dosage: adrenergic receptors. DHD. tachycardia. stimulation, particularly
adult: PO 2–4 mg 3–4 Inhibits histamine in children 2–6 y,
times/d, 4–8 mg release by mast cells. Spec Senses:Blurred (hyperactivity,
sustained release 2 Produces vision, dilated pupils. excitement,
times/d Inhaled 1–2 bronchodilation, nervousness,
inhalations q4–6h regardless of GI: Nausea, vomiting. insomnia), tachycardia,
administration route, by other: Muscle cramps, GI symptoms. Report
child: PO 2–6 y, 0.1– relaxing smooth muscles hoarseness. promptly to physician.
0.2 mg/kg t.i.d. (max: 4 of bronchial tree. This  Lab tests: Periodic
mg/dose); 6–12 y, 2 mg decreases airway ABGs, pulmonary
3–4 times/d; Inhaled6– resistance, facilitates functions, and pulse
12 y, 1–2 inhalations mucus drainage, and oximetry.
q4–6h increases vital capacity.  Consult physician
about giving last
albuterol dose several
hours before bedtime, if
drug-induced insomnia
 is a problem.

Patient & Family Education

 Review directions for

correct use of
medication and inhaler
(see ADMINISTRATI
ON).
 Avoid contact of
inhalation drug with
eyes.
 Do not increase number
or frequency of
inhalations without
advice of physician.
 Notify physician if
albuterol fails to
provide relief because
this can signify
worsening of
pulmonary function and
a reevaluation of
condition/therapy may
be indicated.
 Note: Albuterol can
cause dizziness or
vertigo; take necessary
precautions.
 Do not use OTC drugs
without physician
approval. Many
medications (e.g., cold
remedies) contain drugs
that may intensify
albuterol action.
 Do not breast feed
while taking this drug
without consulting

Name of Drug
Generic Name:
Ipratroprium
Band Name:
Atrovent
Classification:
AUTONOMIC NERVOUS
SYSTEM AGENT;
ANTICHOLINERGIC
(PARASYMPATHOLYTIC); on intracellular calcium,
ANTIMUSCARINIC;
BRONCHODILATOR
Dosage:
COPD
Adult: Inhalation 2
inhalations of MDI q.i.d. at
no less than 4 h intervals
(max: 12 inhalations in 24 h)
Nebulizer 500 mcg (1 unit
dose vial) q6–8h
Child: Inhalation 3–12 y, 1–2
inhalations t.i.d. (max: 6/d)
Nebulizer 125–250 mcg t.i.d.
Rhinitis
Adult: Intranasal 5 y, 2 sprays
of 0.03% each nostril b.i.d. or
physician.
Nursing
Indication Contraindication Adverse Effects
Mechanism of Action Side Effects Responsibilities
It blocks muscarinic Management of Hypersensitivity to Dizziness, nausea, Special Senses: Blurred Assessment & Drug
cholinergic receptors, reversible bronchospasm ipratropium, atropine stomach upset, dry vision (especially if Effects
without specificity for associated with (and its derivatives), or mouth, or constipation. sprayed into eye),
subtypes, resulting in a obstructive airway any component of the difficulty in  Monitor
decrease in the diseases (eg, formulation. accommodation, acute respiratory status;
formation of cyclic bronchialasthma).For eye pain, worsening of auscultate lungs
guanosine patients with chronic Use cautiously with narrow-angle glaucoma. before and after
monophosphate obstructive pulmonary narrow-angle glaucoma, inhalation.
(cGMP). Most likely disease(COPD) on a prostatic hypertrophy, GI: Bitter taste, dry  Report treatment
due to actions of cGMP regular inhaled bladder neck oropharyngeal failure
bronchodilator who obstruction, pregnancy, membranes. With higher (exacerbation of
this results in decreased continue to have lactation. doses: nausea, respiratory
contractility of smooth evidence of constipation. symptoms) to
muscle. bronchospasm and who physician.
require a second Respiratory: Cough,
bronchodilator. hoarseness, exacerbation Patient & Family
of symptoms, drying of Education
bronchial secretions,
mucosal ulcers,  Note: This
epistaxis, nasal dryness. medication is not
an emergency
Skin: Rash, hives. agent because of
its delayed onset
Urogenital: Urinary and the time
retention. required to reach
peak
CNS: Headache. bronchodilation.
 Review patient
information sheet
on proper use of
t.i.d. nasal spray.
 Allow 30–60 sec
Common Cold between puffs for
Adult: Intranasal 2 sprays of optimum results.
0.06% each nostril t.i.d. or Do not let
q.i.d. up to 4 d medication
contact your
eyes.
 Wait 5 min
between this and
other inhaled
medications.
Check with
physician about
sequence of
administration.
 Take medication
only as directed,
noting some
leniency in
number of puffs
within 24 h.
Supervise child's
administration
until certain all of
dose is being
administered.
 Rinse mouth after
medication puffs
to reduce bitter
taste.
 Discuss changes
in normal urinary
pattern with the
physician (more
common in older
adults).
 Call physician if
you note changes
 in sputum color
or amount, ankle
edema, or
significant
weight gain.
 Do not breast
feed while taking
this drug without
consulting
physician.

Name of Drug Mechanism of Indication Contraindication Side Effects Adverse Effects

Action Nursing Responsibilities
Generic Name: Xanthine Prophylaxis and Contraindicated Nausea/vomiting, CNS: Stimulation (Irritability, restlessness, Assessment & Drug Effects
Theophylline derivative that symptomatic with stomach/abdominal insomnia, dizziness, headache, tremor,
relaxes smooth relief of bronchial hypersensitivity to pain, headache, hyperexcitability, muscle twitching, drug-  Monitor vital signs.
Band Name: muscle by direct asthma, as well as any xanthines, trouble sleeping, induced seizures). Improvement in respiratory
Theo-dur action, bronchospasm peptic ulcer, active diarrhea, irritability, status is the expected
particularly of associated with gastritis, pregnancy restlessness, CV: Palpitation, tachycardia, extrasystoles, outcome.
Classification: bronchi and chronic bronchitis (neonatal nervousness, flushing, marked hypotension, circulatory  Observe and report early
BRONCHODILATOR pulmonary and emphysema. tachycardia, shaking, or increased failure. signs of possible toxicity:
(RESPIRATORY vessels, and Also used for jitteriness, and urination may occur. Anorexia, nausea,
SMOOTH MUSCLE stimulates emergency withdrawal apnea), GI: Nausea, vomiting, anorexia, epigastric vomiting, dizziness,
RELAXANT); medullary treatment of underlying seizure or abdominal pain, diarrhea, activation of shakiness, restlessness,
XANTHINE respiratory paroxysmal disorders (unless peptic ulcer. abdominal discomfort,
center with cardiac dyspnea receiving irritability, palpitation,
Dosage: resulting and edema of appropriate Urogenital: Transient urinary frequency, tachycardia, marked
Adult/Child: PO/IV increase in vital CHF. anticonvulsant albuminuria, kidney irritation. hypotension, cardiac
Loading Dose 5 mg/kg capacity. Also medication). arrhythmias, seizures.
Adult: PO/IV relaxes smooth Respiratory: Tachypnea, respiratory  Monitor for tachycardia,
Maintenance muscles of arrest. which may be worse in
Dose* Nonsmoker, 0.4 biliary and GI patients with severe cardiac
mg/kg/h [*IV by tracts. Stimulates Body as a Whole: Fever, dehydration. disease. Conversely,
continuous infusion, myocardium, theophylline toxicity may
PO divided q6h thereby be masked in patients with
(immediate release) or increasing force tachycardia.
q8–12h (sustained of contractions  Lab tests: Monitor plasma
release)]; Smoker, 0.6 and cardiac level of theophylline. Be
mg/kg/h; with CHF or output, and aware that therapeutic
cirrhosis, 0.2 mg/kg/h stimulates all plasma level ranges from
Child: PO/IV levels of CNS, 10–20 mcg/mL (a narrow
Maintenance Dose* 1– but to a lesser therapeutic range). Levels
9 y, 0.8 mg/kg/h; 10–12 degree than exceeding 20 mcg/mL are
y, 0.6 mg/kg/h caffeine. associated with toxicity.
 Monitor drug levels closely
Infant: PO/IV in heavy smokers. Cigarette
Maintenance Dose* 2– smoking induces hepatic
6 mo, 0.4 mg/kg/h; 6– microsomal enzyme
11 mo, 0.7 mg/kg/h activity, decreasing serum
half-life and increasing
Neonate: PO/IV body clearance of
Maintenance theophylline. An increase
Dose* 0.13 mg/kg/h of dosage from 50–100% is
usual in heavy smokers.
 Monitor plasma drug level
closely in patients with
heart failure, kidney or
liver dysfunction,
alcoholism, high fever.
Plasma clearance of
xanthines may be reduced.
 Take necessary safety
precautions and forewarn
older adult patients of
possible dizziness during
early therapy.
 Monitor patients on
sustained release
preparations for S&S of
overdosage. Continued
slow absorption leads to
high plasma concentrations
for a prolonged period.
 Note: Neonates of mothers
 using this drug have
exhibited slight
tachycardia, jitteriness, and
apnea.
 Monitor CLOSELY for
adverse effects in infants
<6 mo and prematures;
theophylline metabolism is
prolonged as is the half-life
in this age group.

Patient & Family Education

 Take medication at the

same time every day.
 Avoid charcoal-broiled
foods (high in polycyclic
carbon content); may
increase theophylline
elimination and reduce the
half-life as much as 50%.
 Limit caffeine intake
because it may increase
incidence of adverse
effects.
 Cigarette smoking may
significantly lower
theophylline plasma
concentration.
 Be aware that a low-
carbohydrate, high-protein
diet increases theophylline
elimination, and a high-
carbohydrate, low-protein
diet decreases it.
 Drink fluids liberally
(2000–3000 mL/d) if not
contraindicated to decrease
viscosity of airway
 secretions.
 Avoid self-dosing with
OTC medications,
especially cough
suppressants, which may
cause retention of
secretions and CNS
depression.
 Do not breast feed while
taking this drug without
consulting physician. Since
theophylline is distributed
into breast milk, it may be
advisable to nurse the
infant just before taking the
drug.

Nursing
Name of Drug Indication Contraindication Adverse Effects
Mechanism of Action Side Effects Responsibilities
Generic Name: Binds to the Fluticasone propionate, a Hypersensitivity (Flonase Headache, dysphonia, CNS: headache Assessment
Fluticasone glucocorticoid receptor. medium-potency contains alcohol). hoarseness,
Unbound corticosteroids synthetic corticosteroid, oropharyngeal fungal EENT: epistaxis, nasal Monitor degree of
Band Name: cross the membranes of is used topically to Use Cautiously in: infections, Budesonide: burning, nasal irritation, nasal stuffiness, amount
Flovent cells such as mast cells relieve inflammatory and flu-like syndrome nasopharyngeal fungal and color of nasal
and eosinophils, binding pruritic symptoms of Active untreated infection, pharyngitis discharge, and frequency
Classification: with high affinity to dermatoses and psoriasis, infections of sneezing.
SKIN AND MUCOUS glucocorticoid receptors intranasally to manage Diabetes or glaucoma GI: nausea, vomiting Patients on long-
MEMBRANE AGENT; (GR). The results include symptoms of allergic and Underlying term therapy should have
ANTIINFLAMMATORY; alteration of transcription non-allergic rhinitis, and immunosuppression (due Endo: adrenal periodic otolaryngologic
CORTICOSTEROID and protein synthesis, a orally for the to disease or concurrent suppression (↑ dose, examinations to monitor
decreased release of maintenance treatment of therapy) long-term therapy only), nasal mucosa and
Dosage: leukocytic acid asthma as prophylactic Systemic ↓ growth (children) passages for infection or
Intranasal: (Children ≥4 hydrolases, reduction in therapy and for patients corticosteroid therapy ulceration.
yr): Flonase –1 spray in fibroblast proliferation, requiring oral (should not be abruptly Derm: rash, urticaria Monitor growth rate
each nostril once daily prevention of corticosteroid therapy for discontinued when in children receiving
(not to exceed 2 sprays in macrophage asthma. intranasal therapy is Resp: cough chronic therapy; use
each nostril/day).
Intranasal: (Children 2–
11 yrs): Veramyst –1
spray in each nostril daily;
may ↑ to 2 sprays if no
response; once symptoms
controlled, attempt to ↓
dose to 1 spray/day.
accumulation at inflamed started) lowest possible dose.
sites, reduction of Concurrent use of Misc: ANAPHYLAXIS, Monitor for signs and
collagen deposition, ritonavir ANGIOEDEMA symptoms of
interference with Recent nasal trauma, hypersensitivity reactions
leukocyte adhesion to the septal ulcers, or surgery (rash, pruritis, swelling
capillary wall, reduction (wound healing may be of face and neck,
of capillary membrane impaired by nasal dyspnea) periodically
permeability and corticosteroids) during therapy.
subsequent edema, OB: Lactation: Pedi:
reduction of complement Pregnancy, lactation, or Patient/Family
components, inhibition children <4 yr (for Teaching
of histamine and kinin Flonase) or <2 yr (for
release, and interference Veramyst) (safety not Advise patient to take
with the formation of established; prolonged or medication exactly as
scar tissue. In the high-dose therapy may directed. Take missed
management of asthma, lead to complications). doses as soon as
the glucocorticoid remembered unless
receptor complexes almost time for next
down-regulates dose.
proinflammatory Instruct patient in
mediators such as correct technique for
interleukin-(IL)-1, 3, and administering nasal spray
5, and up-regulates anti- (see medication
inflammatory mediators administration
such as IkappaB techniques). Shake well
[inhibitory molecule for before use. Before first-
nuclear factor kappaB1], time use, prime unit by
IL-10, and IL-12. The spraying 6 times. If not
antiinflammatory actions used for at least 7 days or
of corticosteroids are if cap left off for more
also thought to involve than 5 days, reprime unit.
inhibition of cytosolic Warn patient that
phospholipase A2 temporary nasal stinging
(through activation of may occur.
lipocortin-1 (annexin)) Instruct patient to stop
which controls the fluticasone and notify
biosynthesis of potent health care professional
mediators of immediately if signs of
inflammation such as anaphylaxis (rash, hives,
prostaglandins and difficulty breathing,
leukotrienes. swollen lips or throat)
occur.
Instruct patient to
notify health care
professional of all Rx or
OTC medications,
vitamins, or herbal
products being taken and
consult health care
professional before
taking other Rx, OTC, or
herbal products.
Advise female patients
to notify health care
professional if pregnancy
is planned or suspected
or if breastfeeding.
Instruct patient to
notify health care
professional if symptoms
do not improve within 1
mo or if symptoms
worsen.
 Nursing
Name of Drug Indication Contraindication Adverse Effects
Mechanism of Action Side Effects Responsibilities
Generic Name: When an environmental This drug is an anti-IgE Hypersensitivity to Hives, rash; anxiety Body as Whole: Assessment & Drug
Omalizumab allergen first enters the antibody indicated for: omalizumab; severe or fear, feeling like Anaphylaxis/anaphylactoid Effects
body, is taken up by infections, including you might pass out; reactions, injection site reactions
Band Name: antigen-presenting cells 1. Moderate to chicken pox and other flushing (warmth, (bruising, erythema, warmth,  Monitor for
Xolair (APCs). It is then severe persistent viral infections; acute redness, or tingly burning, stinging, pruritus, hive injection site
processed, and presented asthma in bronchospasm, status feeling); formation, pain, induration, reactions
to T and B immune patients 6 years asthmaticus; chest tightness, inflammation), fatigue, generalized including
Classification: cells. This is followed of age and older malignancies; children wheezing, feeling pain. bruising,
BIOLOGIC RESPONSE by the activation of B- with a positive <12 y. short of breath, redness,
MODIFIER; lymphocyte and skin test or in difficult breathing; CNS: Headache, dizziness. warmth,
MONOCLONAL production of allergen- vitro reactivity fast or weak burning,
ANTIBODY; specific IgE. This IgE is to a perennial heartbeats; or GI: Nausea, vomiting, diarrhea, stinging,
RESPIRATORY then released by plasma aeroallergen and swelling of your abdominal pain. itching, hive
ANTIINFLAMMATORY cells (converted B symptoms that face, lips, tongue, or formation, pain,
AGENT lymphocytes) and is are inadequately throat. Hematologic: Epistaxis, indurations,
therefore available to controlled with menorrhagia, hematoma, anemia. mass, and
Dosage: bind to IgE receptors on inhaled inflammation.
Adult/Adolescent: SC several other cells. corticosteroids Musculoskeletal: Arthralgia.  Lab test:
150–375 mg q2–4wk. 2. Chronic Platelet counts
Dose is based on baseline IgE binds to high- idiopathic Respiratory: Upper respiratory if signs of
IgE serum levels. affinity (Fc€RI) and urticaria in tract infections, sinusitis, increased
low-affinity (Fc€RII) adults and pharyngitis. tendency to
receptors on multiple adolescents 12 bleed appear.
cells of the immune years of age and Skin: Rash, pruritus, urticaria,
system. Following older who dermatitis. Patient & Family
subsequent antigen remain Education
exposure, cross-linking symptomatic Special Senses: Earache.
of the antigen occurs by despite H1  Do not use this
several Fc€RI-bound antihistamine drug for relief of
IgE molecules on the treatment. acute
surface of both basophils bronchospasm
and mast cells. This or status
leads to the activation of asthmaticus.
mast cells and histamine  Promptly report
release, producing a any of the
wheal and other following:
symptoms of urticaria . bleeding or
unusual
The following are bruising,
explanations of the difficulty
mechanism of action for breathing or
both indications of this shortness of
drug: breath, skin rash
or hives.
Asthma  Do not accept a
live virus
Omalizumab inhibits the vaccine without
binding of IgE to the consulting
high-affinity IgE physician.
receptor (FcεRI) on the  Do not breast
surface of both mast feed while
cells and basophils. The taking this drug
reduction in surface- without
bound IgE on FcεRI- consulting
bearing cells limits the physician.
degree of release of
mediators of the typical
allergic response.
Treatment with
omalizumab also
reduces the number of
FcεRI receptors on
basophils in atopic
patients.

Omalizumab binds to
free IgE with a higher
affinity than IgE itself
binds to the high-affinity
Fc€RI receptors found
on basophils. Therefore,
it decreases the
availability of free IgE
for binding.
Omalizumab by itself
does not bind to the
Fc€RI receptors, nor
does the drug bind to
receptor-bound IgE.
These binding
characteristics allow
omalizumab to
neutralize the typical
IgE-mediated responses
without causing the
degranulation of
basophils or cross-
linking with basophil-
bound IgE.

Chronic Idiopathic
Urticaria Omalizumab
binds to IgE and
decreases free IgE
levels. Subsequently,
IgE receptors (FcεRI) on
cells are down-
regulated. The
mechanism by which
these effects of
omalizumab result in an
improvement of CIU
symptoms is unclear.
 Contraindi- Nursing
Name of Drug Indication Adverse Effects
Mechanism of Action cation Side Effects Responsibilities
Generic Name: Pilocarpine is a Contraindicated with Sweating, nausea, CNS: Oral (asthenia, Assessment & Drug
Pilocarpine Hcl cholinergic For the treatment of Secondary glaucoma, runny nose, chills, headaches, dizziness, chills). Effects
parasympathomimetic radiation-induced dry acute iritis, acute flushing, frequent
Band Name: agent. It increase mouth (xerostomia) inflammatory disease urge to urinate, Special Senses: Ciliary  Be aware that
Salagen secretion by the and symptoms of dry of anterior segment of dizziness, weakness, spasm with brow ache, hourly
exocrine glands, and mouth in patients with eye; pregnancy diarrhea, and blurred twitching of eyelids, eye pain tonometric tests
Classification: produces contraction of Sjögrens syndrome. (category C), lactation. vision may occur. with change in eye focus, may be done
EYE PREPARATION; MIOTIC the iris sphincter muscle miosis, diminished vision in during early
(ANTIGLAUCOMA AGENT); and ciliary muscle poorly illuminated treatment
AUTONOMIC NERVOUS (when given topically to areas, blurred vision, because drug
SYSTEM AGENT; DIRECT- the eyes) by mainly reduced visual acuity, may cause an
ACTING CHOLINERGIC stimulating muscarinic sensitivity, contact allergy, initial transitory
(PARASYMPATHOMIMETIC) receptors. lacrimation, follicular increase in IOP.
conjunctivitis, conjunctival  Monitor changes
Dosage: irritation, cataract, retinal in visual acuity.
Acute Glaucoma detachment.  Monitor for
Adult/Child: Ophthalmic 1 adverse effects.
drop of 1–2% solution in GI: Nausea, vomiting, Brow pain and
affected eye q5–10min for 3–6 abdominal cramps, diarrhea, myopia tend to
doses, then 1 drop q1–3h until epigastric be more
IOP is reduced distress, salivation. prominent in
younger patients
Chronic Glaucoma Respiratory: Bronchospasm, and generally
Adult/Child: Ophthalmic 1 rhinitis. disappear with
drop of 0.5–4% solution in continued use of
affected eye q4–12h or 1 ocular CV: Tachycardia. drug.
system (Ocusert) q7d
Body as a Whole: Patient & Family
Miotic Tremors, increased Education
Adult/Child: Ophthalmic 1 sweating, urinary frequency.
drop of 1% solution in affected  Understand that
eye therapy for
glaucoma is
Xerostomia prolonged and
Adult: PO 5 mg t.i.d., may that adherence to
increase up to 10 mg t.i.d. established
regimen is
crucial to prevent
blindness.
 Do not drive or
engage in
potentially
hazardous
activities until
vision clears.
Drug causes
blurred vision
and difficulty in
focusing.
 Discontinue
medication if
symptoms of
irritation or
sensitization
persist and report
to physician.
 Do not breast
feed while taking
this drug without
consulting
physician.

Name of Drug
Mechanism of Action
Generic Name: Muscarinic agonists For the treatment of
Cevimeline Hydrochloride
such as cevimeline bind symptoms of dry mouth
and activate the in patients with
Band Name: muscarinic M1 and M3 Sjögren's Syndrome.
Evoxac receptors. The M1
receptors are common
Classification: in secretory glands
AUTONOMIC NERVOUS (exocrine glands such
SYSTEM AGENT; as salivary and sweat
CHOLINERGIC glands), and their
(PARASYMPATHOMIMETIC) activation results in an
increase in secretion
Dosage: from the secretory
glands. The M3
Dry Mouth receptors are found on
Adult: PO 30 mg t.i.d. smooth muscles and in
many glands which
help to stimulate
secretion in salivary
glands, and their
activation generally
results in smooth
muscle contraction and
increased glandular
secretions. Therefore,
as saliva excretion is
increased, the
symptoms of dry mouth
are relieved.
Nursing
Indication Contraindication Adverse Effects
Side Effects Responsibilities
Hypersensitivity to Sweating, nausea, Body as a Assessment & Drug
cevimeline; uncontrolled runny nose, flushing, Whole: Excessive Effects
asthma; acute iritis; frequent urge to sweating,
narrow-angle glaucoma; urinate, dizziness, headache, back pain,  Monitor for S&S
lactation. weakness, diarrhea, and dizziness, fatigue, pain, of increased
blurred vision may hot flushes, rigors, airway
occur. tremor, hypertonia, resistance,
myalgia, fever, eye pain, especially in
ear ache, flu-like patient with
symptoms. asthma,
bronchitis,
CNS: Insomnia, anxiety, emphysema, or
vertigo, depression, COPD.
hyporeflexia.  Monitor cardiac
status, especially
CV: Peripheral edema, in those with
chest pain. known cardiac
disease or
GI: Nausea, dysfunction.
diarrhea, excessive  Monitor fluid
salivation, dyspepsia, status, especially
abdominal pain, in those at risk
coughing, vomiting, for dehydration.
constipation, anorexia,  Lab tests:
dry mouth, hiccup. Routine blood
chemistry during
Respiratory: Rhinitis, long-term
sinusitis, upper therapy.
respiratory tract  Report S&S of
infection, pharyngitis, excess
bronchitis. cholinergic
Skin: Rash, activity (e.g.,
conjunctivitis, pruritus. diaphoresis,
frequent urge to
Special Senses: urinate, nausea
Abnormal vision.
Urogenital: Urinary and/or diarrhea).
tract infection.
Patient & Family
Education

 Do not drive or
engage in
potentially
hazardous
activities until
response to drug
is known.
 Consult
physician if
confusion,
dizziness, or
faintness occur.
 Report
diminished night
vision or depth
perception.
 Drink fluids
liberally (2000–
3000 mL/d) in
the event of
excessive
sweating when it
occurs.
 Do not breast
feed while taking
this drug.
 Name of Drug Indication Contraindication Adverse Effects
Mechanism of Action Side Effects Nursing Responsibilities
Generic Name: Blocks release of Moderate to moderately Contraindicated with Stomach pain, dry mouth, CNS: confusion,  In prolonged use,
Hydrocodone- inhibitory severe pain. patient with tiredness, headache, back drowsiness, sedation, monitor for
Acetaminophen neurotransmitters, hypersensitivity of the pain, muscle tightening dysphoria, euphoria, psychological and
altering perception of and Short-term pain due to an drugs and its contents. difficult, frequent, or floating feeling, physical dependence.
Band Name: emotional response to injury, surgery, or dental painful urination, ringing hallucinations, headache,  Watch closely for
Vicodin pain. procedure. Occasionally, in the ears, difficulty anxiety, depression, withdrawal symptoms
Hydrocodone/ibuprofen it is used to treat chronic falling asleep or staying fatigue, insomnia, when drug is
Classification: combination raises pain pain, migraines, or other asleep, foot, leg, or ankle lethargy, nervousness, discontinued.
Narcotic Analgesic threshold by non types of recurring, long- swelling, and slurred speech, tremor,  Assess elderly patients
selectively inhibiting term conditions that uncontrollable shaking of asthenia, unusual dreams carefully for adverse
Dosage: cyclooxygenase; cause pain. a part of the body. CV: orthostatic reactions.
prostaglandin synthesis hypotension, bradycardia,  Monitor for signs and
The usual dose for adults then decreases and anti- peripheral edema, symptoms of drug
is 1 to 2 tablets or inflammatory and palpitations, arrhythmias overdose, including
capsules (hydrocodone analgesic effects occur. EENT: blurred vision, nausea, vomiting,
2.5 to 10 mg; vision changes, diplopia, blurred vision, cool and
acetaminophen 300 to miosis, tinnitus, clammy skin, dizziness,
750 mg) every 4 to 6 pharyngitis, rhinitis, confusion, dyspnea,
hours or 15 mL of liquid sinusitis respiratory depression,
every 4 to 6 hours as GI: nausea, vomiting, bradycardia, hearing
needed. constipation, dysphagia, loss, tinnitus, headache,
esophagitis, dyspepsia, and mood or behavior
flatulence, gastritis, changes.
gastroenteritis, mouth  Patient teaching
ulcers, dry mouth,  Tell patient drug may
anorexia cause drowsiness.
GU: urinary retention or Caution him to avoid
frequency, erectile driving and other
dysfunction hazardous activities
Respiratory: respiratory until CNS effects are
depression, bronchitis, known.
dyspnea
 Inform patient that
Skin: pruritus, urticaria, prolonged use may lead
diaphoresis, flushing to physical or
Other: physical or psychological
psychological drug dependence.
dependence, drug

Name of Drug
Mechanism of Action
Generic Name: Gastric acid-pump
Omeprazole inhibitor: Suppresses
gastric acid secretion by
Band Name: specific inhibition of the
Losec,Prilosec hydrogen-potassium
ATPase enzyme system
Classification: at the secretory surface of
GASTROINTESTINAL the gastric parietal cells;
AGENT; PROTON blocks the final step of
PUMP INHIBITOR acid production.
Dosage:
tolerance  Caution patient to avoid
alcohol during therapy.
 Instruct patient to move
slowly when sitting up
or standing, to avoid
dizziness from sudden
blood pressure decrease.
As appropriate, review
all other significant and
life-threatening adverse
reactions and
interactions, especially
those related to the drugs,
tests, herbs, and
behaviors mentioned
above.
Indication Contraindication Adverse Effects
Side Effects Nursing Responsibilities
Short-term treatment of Contraindicated with Headache, stomach pain, CNS: Headache, Assessment & Drug
active duodena lulcer; hypersensitivity to nausea, diarrhea and dizziness, fatigue. Effects
First-line therapy in omeprazole or its vomiting.
treatment of heartburn or components; Use GI: Diarrhea, abdominal  Lab tests:
symptoms of gastro cautiously with pain, nausea, mild Monitor
esophageal reflux pregnancy, lactation. transient increases in urinalysis for
disease(GERD); liver function tests. hematuria and
Short-term treatment of proteinuria.
active benign gastric Urogenital: Hematuria, Periodic liver
ulcer; proteinuria. function tests
GERD, with prolonged
severerosiveesophagitis, Skin: Rash.
Gastroesophageal poorly responsive use.
Reflux, Erosive symptomatic GERD;
Esophagitis, Duodenal Long-term therapy: Patient & Family
Ulcer Treatment of pathologic Education
Adult: PO 20 mg once/d hyper secretory
for 4–8 wk conditions (Zollinger  Report any
Ellison syndrome, changes in
Gastric Ulcer multiple adenomas, urinary
Adult: PO 20 mg b.i.d. systemic mastocytosis); elimination such
for 4–8 wk Eradication ofH. Pyloric as pain or
With amoxicillin or discomfort
Hypersecretory Disease metronidazole. associated with
Adult: PO 60 mg once/d urination, or
up to 120 mg t.i.d. blood in urine.
 Report severe
Duodenal Ulcer diarrhea; drug
Associated with H. may need to be
pylori discontinued.
Adult: PO 40 mg once/d  Do not breast feed
for 14 d, then 20 mg/d for while taking this
14 d, in combination with drug.
clarithromycin 500 mg
t.i.d. for 14 d

Nursing
Name of Drug Indication Contraindication Adverse Effects
Mechanism of Action Side Effects Responsibilities
Generic Name: Dopamine is a precursor For the correction of Contraindicated in Irregular heartbeats, CV: Hypotension, ectopic Assessment & Drug
Dopamine Hcl to norepinephrine in hemodynamic Pheochromocytoma; Nausea, Vomiting, beats, tachycardia, anginal Effects
noradrenergic nerves and imbalances present in the tachyarrhythmias or Anxiety, Headache, pain, palpitation,
Band Name: is also a neurotransmitter shock syndrome due to ventricular fibrillation. Chills vasoconstriction  Monitor blood
Intropin in certain areas of the myocardial infarction, Safe use during Goosebumps and (indicated by pressure, pulse,
central nervous system. trauma, endotoxic pregnancy (category C), Shortness of breath. disproportionate rise in peripheral pulses,
Classification: Dopamine produces septicemia, open-heart lactation, or children is diastolic pressure), cold and urinary
AUTONOMIC positive chronotropic and surgery, renal failure, not established. extremities; less output at intervals
NERVOUS SYSTEM inotropic effects on the and chronic cardiac frequent: aberrant prescribed by
AGENT; ALPHA- AND myocardium, resulting in decompensation as in conduction, bradycardia, physician. Precise
BETA-ADRENERGIC increased heart rate and congestive failure widening of QRS measurements are
AGONIST cardiac contractility. This complex, elevated blood essential for
(SYMPATHOMIMETIC) is accomplished directly pressure. accurate titration
by exerting an agonist of dosage.
Dosage: action on beta- GI: Nausea, vomiting.  Report the
Shock adrenoceptors and following
Adult/Child: IV 2–5 indirectly by causing CNS: Headache. indicators
mcg/kg/min increased release of norepinephrine promptly to
gradually up to 20–50 from storage sites in Skin:Necrosis, tissue physician for use
mcg/kg/min if necessary sympathetic nerve sloughing with in decreasing or
endings. In the brain, extravasation, gangrene, temporarily
Renal Failure dopamine actas as an piloerection. suspending dose:
Adult: IV 2–5 agonist to the five Reduced urine
mcg/kg/min dopamine receptor Other: Azotemia, flow rate in
subtypes (D!, D2, D3, dyspnea, dilated pupils absence of
D4, D5). (high doses). hypotension;
ascending
tachycardia;
dysrhythmias;
disproportionate
rise in diastolic
pressure (marked
decrease in pulse
pressure); signs
of peripheral
ischemia (pallor,
cyanosis,
mottling,
coldness,
complaints of
tenderness, pain,
numbness, or
burning
sensation).
 Monitor
therapeutic
effectiveness. In
addition to
improvement in
vital signs and
urine flow, other
indices of
adequate dosage
and perfusion of
vital organs
include loss of
pallor, increase in
toe temperature,
adequacy of nail
bed capillary
filling, and
reversal of
confusion or
comatose state.

Name of Drug
Generic Name:
Trospium chloride
Band Name:
Sanctura
Classification:
AUTONOMIC NERVOUS
SYSTEM AGENT;
ANTISPASMODIC;
ANTICHOLINERGIC
(PARASYMPATHOLYTIC)
AGENT;
ANTIMUSCARINIC
AGENT
Dosage:
Overactive Bladder
Adult: PO 20 mg twice daily
on empty stomach
Geriatric: PO 20 mg twice
daily on empty stomach,
may decrease to 20 mg once
daily at bedtime if
anticholinergic adverse
effects are intolerable
Renal Impairment
Clcr < 30 mL/min: reduce
dose to 20 mg once daily at
bedtime.
Nursing
Indication Contraindication Adverse Effects
Mechanism of Action Side Effects Responsibilities
Trospium antagonizes For the treatment of Hypersensitivity to Dry mouth, Body as a Whole: Assessment & Drug
the effect of overactive bladder with trospium; patients with constipation, stomach Fatigue. Effects
acetylcholine on symptoms of urge or at risk for urinary upset, headache, dry
muscarinic receptors in urinary incontinence, retention; uncontrolled eyes, dizziness, blurred CNS : Headache.  Monitor bowel
cholinergically urgency, and urinary narrow-angle glaucoma; vision, or drowsiness and bladder
innervated organs. Its frequency, detrusor gastric tension, GI may occur. GI : Dry mouth, function. Report
parasympatholytic action instability and frequency obstruction, ileus, constipation , abdominal urinary hesitancy
reduces the tonus of of micturition. pyloric stenosis, toxic pain, dyspepsia, or significant
smooth muscle in the megacolon, severe flatulence. constipation.
bladder. ulcerative colitis;  Withhold drug
pregnancy (category C). Special Senses: Dry and notify
Safety and effectiveness eyes. physician if
in children have not been urinary retention
established. Urogenital : Urinary develops.
retention.  Monitor for and
report worsening
of GI symptoms
in those with
GERD.
 Frequent
monitoring of
IOP is required in
those with
controlled
narrow-angle
glaucoma.
Patient & Family
Education
 Report promptly
any of the
following: signs
of an allergic
reaction, (e.g.,
itching or hives),
 blurred vision or
difficulty
focusing,
confusion,
dizziness,
difficulty passing
urine.
 Moderate intake
of tea, coffee,
caffeinated sodas,
and alcohol to
minimize side
effects of this
drug.
 Avoid situations
in which
overheating is
likely, as drug
may impair
sweating, which
is a normal
cooling
mechanism.
 Do not engage in
hazardous
activities until
response to the
drug is known.
 Do not breast
feed while taking
this drug without
consulting
physician.
 Name of Drug
Generic Name:
Metronidazole
Band Name:
Flagyl
Classification:
ANTIINFECTIVE;
ANTITRICHOMONAL;
AMEBICIDE;
ANTIBIOTIC
Dosage:
Trichomoniasis,
Giardiasis, Gardnerella
Adult: PO 2 g once or
250 mg t.i.d.; 375 mg
b.i.d. or 500 mg b.i.d. for
7 d Vaginal Apply once
or twice daily times 5 d
Child: PO 15 mg/kg/d in
3 divided doses for 7–10
d proctitis.
Infant: PO 10–30
mg/kg/d for 5–8 d
Amebiasis
Adult: PO 500–750 mg
t.i.d.
Child: PO 35–50
mg/kg/d in 3 divided
doses
Anaerobic Infections
Adult: PO 7.5 mg/kg q6h
(max: 4 g/d) IV Loading
Dose 15 mg/kg IV
Indication Contraindication Adverse Effects
Mechanism of Action Side Effects Nursing Responsibilities
Metronidazole is a For the treatment of Contraindicated with Headache, dizziness, Body as a Whole: Assessment & Drug
prodrug. Unionized anaerobic infections and hypersensitivity to ataxia, vertigo, Hypersensitivity (rash, Effects
metronidazole is mixed infections, surgical metronidazole; incoordination, insomnia, urticaria, pruritus,
selective for anaerobic prophylaxis requiring pregnancy (do not use for seizures, peripheral flushing), fever, fleeting  Discontinue
bacteria due to their anaerobic coverage, trichomoniasis in first neuropathy, fatigue joint pains, overgrowth therapy
ability to intracellularly Clostridium difficile- trimester). of Candida. immediately if
reduce metronidazole to associated diarrhea and Unpleasant metallic taste, symptoms of
its active form. This colitis, Helicobacter Use cautiously with CNS anorexia, nausea, CNS: Vertigo, headache, CNS toxicity (see
reduced metronidazole pylori infection and diseases, hepatic disease, vomiting, diarrhea, GI ataxia, confusion, Appendix F)
then covalently binds to duodenal ulcer disease, candidiasis (moniliasis), upset, cramps irritability, depression, develop. Monitor
DNA, disrupt its helical bacterial vaginosis, blood dyscrasias, restlessness, weakness, especially for
structure, inhibiting Giardia lamblia gastro- lactation. Dysuria, incontinence, fatigue, drowsiness, seizures and
bacterial nucleic acid enteritis, amebiasis darkening of the urine insomnia, paresthesias, peripheral
synthesis and resulting in caused by Entamoeba sensory neuropathy neuropathy (e.g.,
bacterial cell death. histolytica, acne rosacea (rare). numbness and
(topical treatment), and paresthesia of
Trichomonas infections. GI: Nausea, vomiting, extremities).
anorexia, epigastric  Lab tests: Obtain
distress, abdominal total and
cramps, diarrhea, differential WBC
constipation, dry mouth, counts before,
metallic or bitter taste, during, and after
therapy,
especially if a
Urogenital: Polyuria, second course is
dysuria, pyuria, necessary.
incontinence, cystitis,  Monitor for S&S
decreased libido, of sodium
dyspareunia, dryness of retention,
vagina and vulva, sense especially in
of pelvic pressure. patients on
corticosteroid
Special Senses: Nasal therapy or with a
congestion. history of CHF.
 Monitor patients
CV: ECG changes on lithium for
(flattening of T wave). elevated lithium
Maintenance Dose 7.5 levels.
mg/kg q6h (max: 4 g/d)  Report
Child: PO/IV 30 appearance of
mg/kg/d divided q6h candidiasis or its
(max: 4 g/d) becoming more
Neonate: PO/IV 7.5–15 prominent with
mg/kg/d divided q12–48h therapy to
physician
promptly.
 Repeat feces
examinations,
usually up to 3
mo, to ensure that
amebae have been
eliminated.

Patient & Family

Education

 Adhere closely to
the established
regimen without
schedule
interruption or
changing the
dose.
 Refrain from
intercourse during
therapy for
trichomoniasis
unless male
partner wears a
condom to
prevent
reinfection.
 Have sexual
partners receive
concurrent
treatment.
 Asymptomatic
trichomoniasis in
the male is a
frequent source of
reinfection of the
female.
 Do not drink
alcohol during
therapy; may
induce a
disulfiram-type
reaction (see
Appendix F).
Avoid alcohol or
alcohol-
containing
medications for at
least 48 h after
treatment is
completed.
 Urine may appear
dark or reddish
brown (especially
with higher than
recommended
doses). This
appears to have
no clinical
significance.
 Report symptoms
of candidal
overgrowth: Furry
tongue, color
changes of
tongue, glossitis,
stomatitis;
vaginitis, curd-
like, milky
vaginal discharge;
 proctitis.
Treatment with a
candidacidal
agent may be
indicated.
 Do not breast feed
while taking this
drug.

Name of Drug Mechanism of Indication Contraindication Side Effects Adverse Effects

Action Nursing Responsibilities
Generic Name: Azithromycin binds Treatment of lower respiratory Contraindicated with Diarrhea or loose stools, CNS: Headache, Assessment & Drug
Azithromycin to the 50S subunit of infections: Acute bacterial hypersensitivity to nausea, abdominal pain, dizziness. Effects
the 70S bacterial exacerbations of COPD due to azithromycin, stomach upset, vomiting,
Band Name: ribosomes, and Haemophilus influenzae, erythromycin, or constipation, dizziness, GI: Nausea, vomiting,  Monitor for and
Zmax therefore inhibits Moraxellacatarrhalis,Streptococ anymacrolideantibiotic. tiredness, headache, diarrhea, abdominal report loose stools
RNA-dependent cuspneumoniae; community- vaginal itching or pain; hepatotoxicity, mild or diarrhea, since
Classification: protein synthesis in acquiredpneumonia due to Use cautiously with discharge, nervousness, elevations in liver pseudomembrano
ANTIINFECTIVE; bacterial cells. S.pneumoniae, H.influenzae gonorrhea or syphilis, sleep problems function tests. us colitis (see
MACROLIDE pseudomembranous (insomnia), Appendix F) must
ANTIBIOTIC Treatment of lower respiratory colitis, hepatic or renal skin rash or itching, be ruled out.
infections: impairment, lactation. ringing in the ears,  Monitor PT and
Dosage: Streptococcalpharyngitis and hearing problems, INR closely with
Bacterial Infections tonsillitis due to or decreased sense of concurrent
Adult: PO 500 mg on Streptococcuspyogenes in those taste or smell. warfarin use.
day 1, then 250 mg who cannot take penicillins.
q24h for 4 more Patient & Family
d IV 500 mg q.d. for at Treatment of uncomplicated Education
least 2 d, administer 1 skin infections due to
mg/mL over 3 h or 2 Staphylococcus aureus, S.  Direct sunlight
mg/mL over 1 h pyogenes, S (UV) exposure
Child: PO 6 mo, 10 treptococcusagalactiae should be
mg/kg on day 1, then 5 minimized during
mg/kg for 4 more d Treatment of nongonococcal therapy with drug.
(max: 250 mg/d) urethritis and cervicitis due to  Take aluminum or
Chlamydia magnesium
Acute Bacterial trachomatis;treatment of PID antacids 2 h
Sinusitis before or after
Adult: PO 500 mg Treatment of acute sinusitis drug.
once daily x 3  Report onset of
d. Zmax: single one- loose stools or
time dose of 2 g. diarrhea.
Child: PO 6 mo, 10  Do not breast feed
mg/kg once daily x 3 d while taking this
drug without
Otitis Media consulting
Child: PO >6 mo, 30 physician.
mg/kg as a single dose
or 10 mg/kg once daily
(not to exceed 500
mg/d) for 3 d or 10
mg/kg as a single dose
on day 1 followed by 5
mg/kg/d on days 2–5

Gonorrhea
Adult: PO 2 g as a
single dose

Chancroid
Adult: PO 1 g as a
single dose
Child: PO 20 mg/kg as
single dose (max: 1 g)