top 200 drug list 2016

Thyroid Replacement

• Administration
• • Hypothyroidism
• • Give orally to treat hypothyroidism and IV to treat myxedema coma.
• • Give daily on an empty stomach (at least 30 min before breakfast).
• • Monitor for cardiac excitability (angina, chest pain,palpitations, dysrhythmias).
• • Monitor T4 and TSH levels. (should have decrease TSH therapeutic)
• • Be aware that the various formulations of thyroxine are not interchangeable; instruct patients to notify the provider if a pharmacy dispenses a different levothyroxine product.
• • Expect lifelong replacement therapy.

• SE:
• • Hyperthyroidism (from excessive doses)

• Monitor for indications of hyperthyroidism (anxiety, tachycardia, palpitations, tremors, altered appetite, abdominal cramping, diarrhea, heat intolerance, fever, diaphoresis, weight loss,menstrual irregularities)

• • Thyrotoxicosis
• • Recent myocardial infarction
• • Cardiovascular disorders (hypertension, angina pectoris, ischemic heart disease)
• • Renal impairment
• • Diabetes mellitus
• • Older adults

• Cholestyramine (Questran), antacids, iron and calcium supplements, and sucralfate  (Carafate) reduce absorption, so patients should not take levothyroxine within 3 hr of these drugs.
• • Food reduces absorption.
• • Many antiseizure and antidepressant drugs, including carbamazepine (Tegretol), phenytoin (Dilantin), phenobarbital, and sertraline (Zoloft), decrease levels.
• • Anticoagulant effects of warfarin (Coumadin) increase.
• • Cardiac response to catecholamines (such as epinephrine) increases.

Pain Relief

Anti-Biotic

• Treats broad-spectrum infections caused by gram positive cocci and bacilli, such as ear and throat infections and urinary tract infections
• • Amoxicillin treats gonorrhea caused by nonpenicillinase producing bacteria.

• • Patient should not crush or chew extended-release form.
• • Chew chewable forms before swallowing.
• • For infants or young children,place drops directly on tongue or mix with a small amount of juice or formula; ensure that child takes full dose.
• • Give at the beginning of meals to decrease GI symptoms and increase absorption.
• • Give amoxicillin with probenecid, if prescribed, to increase therapeutic activity of amoxicillin.

• SE:
• • GI symptoms: diarrhea,nausea, vomiting
• • Rarely may cause pseudomembranous colitisdue to suprainfection (more frequent with other penicillinsthan amoxicillin)
• • Suprainfection with Candidaalbicans
• • Allergy to penicillin (rash,hives, wheezing and difficulty breathing)

• • Monitor for GI symptoms.
• • Monitor and report bloody stools or long-term watery diarrhea.
• • Monitor for and report Candida infections of mouth or vagina.
• • Expect to treat Candidainfections with an antifungal agent.
• • Ask patients if they are allergic prior to administering the first dose.
• • Monitor for allergy manifestations and notify provider.
• • For injectable penicillins (IM orIV), keep patient in facility for 30 min after administration and monitor for allergy.
• • Prepare to treat rash/hives with antihistamines; anaphylaxis with epinephrine and antihistamines.
• • Report watery or bloodydiarrhea to provider.
• • Take drug at the start of meals.
• • Report mouth pain or inability to eat.
• • Report vaginal burning, itching.and discharge.
• • Stop drug and notify provider for possible allergic reactions.
• • Call 911 for severe symptoms,such as difficulty breathing.

• Contra:
• • Allergy to penicillins
• • Infectious mononucleosis
• • Severe liver disease(amoxicillin/clavulanic acid)

• PreCa:
• • History of allergies, hay fever,or asthma
• • History of allergy to cephalosporins or carbapenemantibiotics
• • Colitis or diarrhea
• • Liver disease (amoxicillin)
• • Renal failure or dialysis(amoxicillin)
• • Diabetes mellitus

• Inter:
• • Probenecid increases penicillin blood levels.
• • Tetracyclines may decrease therapeutic effects

A.C.E. Inhibitor

G.E.R.D

Cholesterol

Cholesterol

Anti-Platelet

Asthma

Long-term treatment of chronic asthma• Prophylaxis for exercise-induced bronchospasm (EIB)• Management of allergic rhinitis• Schedule montelukast once daily in the evening.• Available as tablets, chewable tablets, and oral granules• Mix oral granules with applesauce, carrots, rice, or ice cream or place directly on the tongue.• To prevent EIB, take at least 2 hr before exercising and do not repeat the dose for 24 h

Side/Adverse EffectsInterventionsPatient Instructions• Leukotriene modifiers zileuton and zafirlukast can cause liver damage. Does not occur with montelukast• Monitor liver function with periodic testing.• Report abdominal tenderness, nausea, or anorexia.• Headache• Give mild analgesic for headache.• Use over-the-counter analgesics as needed

ContraindicationsPrecautionsInteractions• Liver dysfunction (zileuton and zafirlukast), not montelukast• Acute asthma exacerbations• Status asthmaticus• Severe asthma• Phenobarbital (Luminal) and phenytoin (Dilantin) may necessitate higher dosage

Cholesterol

Beta Blocker

Anti-Depressant

Anti-Biotic

Asthma Inhaler

• • Long-term management of asthma
• • Prevention of exercise-induced asthma
• • Treatment of ongoing asthma exacerbations

• • Follow manufacturer’s instructions for using delivery devices.
• • Use short-acting preparations for acute exacerbations.
• • Use long-acting preparations for long-term control.
• • Inhale beta2-adrenergic agonists before inhaling glucocorticoids.
• • Follow dosage limits and schedules.
• • Watch for signs and triggers of impending exacerbations of asthma.
• • Keep a log of the frequency and intensity of exacerbations.
• • Notify the provider of changes in patterns of exacerbations

• • Tachycardia, heart palpitations, and angina
•      • Monitor and report tachycardia, heart palpitations, and chest pain
•      • Report chest pain and heart palpitations.
•      • Report increase in pulse rate.
• • Avoid caffeine.
• • Tremors
•      • Monitor and report tremors.
•      • Notify provider if tremors interfere with ADLs

• cont
• • Allergy to albuterol or levalbuterol

• pre
• • Diabetes mellitus
• • Hyperthyroidism
• • Cardiovascular disease
• • Hypertension• Angina pectoris
• • Tachydysrhythmias
• • Tachycardia due to digitalis toxicity

• inter
• • Beta-adrenergic blockers reduce the effectiveness of beta2-adrenergic agonists.
• • Monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants increase the risks of hypertension, tachycardia, and angina.
• • Hypoglycemic (antidiabetes) drugs require increased dosing due to hyperglycemic effects.

Diuretic

Anti-Diabetic

Anti-Depressant

N.S.A.I.D

Insomnia

• Therapeutic Use:
• • Short term treatment ofinsomnia

• • Available orally for immediate or extended release, asublingual tablet (Intermezzo),and in a metered-dose oral spray (Zolpimist)
• • Administer just before bedtime;assure that patient has 8 hours available to sleep
• • Administer on an empty stomach for full effect

• • Daytime drowsiness, headache,anxiety, dizziness, diplopia,confusion in older adults
•      • Monitor patient carefully for adverse effects
•      • Take precautions to prevent falls, especially in older adults
•      • Teach patient to take zolpidem just before bedtime and assure that 8 hours are available for sleep; 4 hr upon waking in middle of night if using Intermezzo
•      • Teach patient to take as prescribed and not to take extra doses
•      • Instruct patient to report any dizziness or vision changes to provider
•      • Instruct patient not to take zolpidem with alcohol or other depressants
• • Amnesia, memory impairment,sleep driving, especially with larger doses
•      • Monitor for need to decrease dosage
•      • Advise patients that these effects can occur
•      • Instruct patient not to drive or perform activities that require alertness while sedation is present

• contra:
• • In patients with suicidal ideation
• • During labor/delivery

• preca:
• • Hepatic or renal dysfunction
• • Older adults
• • Depression or with those prone to substance abuse
• • Chronic respiratory disorders
• • Sleep apnea
• • Children younger than 18

• intera:
• • Decreased effect when taken with food
• • Increased sedative effect when taken with alcohol and other CNS depressants

Diuretic

G.E.R.D.

Anti-Depressant

A.2.R.B.

Pain Relief

Anti-Depressant

Blood Thinner

Calc. Chnl. Blkr.

Pain Relief

Anti-Psychotic

Anti-Histamine

Allergies

Anti-Anxiety

Anti-Anxiety

ACE Inhibitor

NSAID (Arthritis)

Anti-Depressant

Anti-Biotic

C.O.P.D.

Anti-Epileptic

Antipsychotic

Electrolyte

Muscle Relaxer

Corticosteroid

A.D.H.D.

• Therapeutic Use:
• • Attention-deficit/hyperactivity disorder
• • Narcolepsy

• • Give oral forms as directed depending on duration of action and type of preparation.
• • Sustained-release forms must never be crushed or chewed;swallow whole
• • Metadate CD and Ritalin LA capsules may be opened and sprinkled on food (e.g.,applesauce)
• • Apply transdermal patch(Daytrana) in a.m., leaving on for no more than 9 hr daily
• • Apply patch to a new area daily; do not apply over rash or inflamed skin

• • Insomnia, nervousness
•      • Give doses early in day to allow for nighttime sleep
•      • Instruct patients to avoid caffeine
•      • Instruct patients to take the drug as early in the day as possible (last dose no later than4 p.m.)
• • Anorexia, weight loss, possible growth suppression
•      • Monitor weight and height
•      • Drug “holidays” may help prevent growth suppression
•      • Instruct patient/family to report anorexia, weight loss to provider
•      • Arrange largest meals for times of day when appetite is greatest
• • Hypertension, tachycardia,heart palpitations
•      • Monitor vital signs
•      • Instruct patient to report cardiovascular symptoms
• • Tolerance, dependence andrisk for abuse
•      • Monitor use of this drug carefully
•      • Instruct patient to take only as directed and not to increase dosage
•      • Advise patient/family regarding abuse potential
• • Withdrawal – occurs whendrug is stopped abruptly(depression)
•      • Taper dose when discontinuing drug
•      • Monitor for signs of depression,fatigue when drug is stopped
•      • Instruct patient not to stop this drug abruptly, but to taper dose

• Contra:
• • Allergy to amphetamines
• • Cardiac arrhythmias
• • Structural cardiac defects
• • Psychosis, depression
• • History of drug abuse
• • Mania, agitation
• • Children under age 6
• • Use of MAOIs within 2 weeeks
• • Glaucoma
• • Motor tics
• • Tourette’s syndrome (or family history)

• Precat:
• • Hypertension
• • Hyperthyroidism

• Inter:
• • Use within 2 weeks of MAOI antidepressants can cause severe hypertension
• • Increased chance of cardiac effects when taken with other stimulants, digoxin,beta blockers or tricyclic antidepressants

Allergies

C.H.F.

Muscle Relaxer

C.H.F.

Alzheimers

• Therapeutic Use
• • Slows decrease in functioning for
• ◦Moderate/severe alzheimer’sdisease
• ◦Mild/moderate vasculardementia

• • Available orally in tablets or liquid solution
• • Give with or without food

• • CNS effects: dizziness,headache, increased confusion
•      • Monitor for these effects
•      • Keep patient safe if dizziness occurs
•      • Instruct patient/caregiver to report presence of CNS effectsto provider
• • Constipation
•      • Monitor for constipation
•      • Instruct patient/caregiver to increase fluids and fiber in diet
•      • Advise to report constipation to provider

• Contra:
• • Renal failure
• • Previous allergy to memantine

• Preca:
• • Liver disorders
• • Renal disorders (reduced dose may be necessary)
• • Seizure disorders
• • Older adults

• Interac:
• • Over-the-counter antacids(sodium bicarbonate) and other drugs that increase pH of urine cause increased levels of memantine and possible toxicity
• • Memantine with levodopa/carbidopa can enhance the adverse effects of levodopa/carbidopa
• • Other NMDA antagonists, such as amantadine (Symmetrel) or ketamine (Ketalar) may increase memantine levels

Beta Blocker

Anti-Anxiety

• Anxiety and anxiety disorders(alprazolam, diazepam)
• • Skeletal muscle spasm and spasticity (diazepam)
• • Seizure disorders—treats status epilepticus (diazepam)
• • Acute alcohol withdrawal symptoms (diazepam)
• • Induction of anesthesia(diazepam)

• • Give alprazolam orally.
• • Take oral benzodiazepines with food if gastrointestinal symptoms develop.
• • Give diazepam orally, rectally,IM, or IV.
• • Administer IV diazepam slowly and have emergency resuscitation equipment nearby.
• • Take care to avoid intra-arterial IV diazepam administration or extravasation into tissue.
• • Be aware that IV diazepam precipitates in solution with some diluents and drugs.
• • Do not give the emulsion form IM (IV only).
• • Avoid IM diazepam due to inconsistent absorption; if necessary, inject slowly into a large muscle.

• • Drowsiness, slurred speech
•      • Monitor patients to prevent falls and other injury following administration.
•      • Instruct patients to use care with ambulation and when driving or using hazardous equipment.
• • Impaired recall of events(anterograde amnesia),
•      • Assess patient’s memory following administration.
•      • Advise patients that amnesia may occur.
• • Paradoxical reaction(confusion, anxiety)
•      • Monitor patients, especially older adults, for a paradoxical reaction.
•      • Instruct patients to stop taking the drug and inform the provider if a paradoxical reaction occurs.
• • Hypotension, tachycardia,respiratory depression
•      • Monitor vital signs, especially with IV administration.
•      • Instruct patients to avoid increasing the prescribed dose.
•      • Instruct patients to change positions slowly to prevent falls.
• • Tolerance and physical dependence (especially with alprazolam)
•      • Monitor patients for signs of tolerance and dependence.
•      • Instruct patients that tolerance to benzodiazepines occurs withtime.
• • Withdrawal symptoms –Insomnia, anxiety, tremors,diaphoresis, dizziness, panic,hypertension, seizures
•      • Taper over 1 to 2 weeks to prevent or minimize withdrawal.
•      • Monitor for signs of withdrawal.
•      • Instruct patients to taper the drug slowly to prevent withdrawal symptoms.
• • Overdose/toxicity
• ◦Oral—sedation, confusion
• ◦Parenteral—possibly life threatening sedation,hypotension, respiratory depression, cardiac arrest
•      • Reverse sedation with IV flumazenil.
•      • Manage oral over dose with gastric lavage, activated charcoal, saline cathartics, and dialysis.
•      • Provide airway and blood pressure support as needed for parenteral overdose.
•      • Instruct patients to take the drug as prescribed and avoid the use of other depressants

• Contra:
• • Pregnancy Category D,lactation
• • Schedule IV controlled substances
• • Glaucoma
• • Coma, shock, neonates, labor/delivery (IV diazepam)

• Preca:
• • Older adults, children under 18 (alprazolam);
• • Renal or hepatic impairment
• • Mental health disorders,suicidal ideation, addiction risk
• • Chronic respiratory disorders
• • Neuromuscular disorders

• Inter:
• • The risk of severe sedation and respiratory depression increase when taken concurrently with other CNS depressants(alcohol, opioids, other benzodiazepines).
• • Cimetidine (Tagamet) increases benzodiazepine levels.
• • Smoking decreases the effects of benzodiazepines.
• • Kava kava and valerian increase the risk for sedation.
• • Disulfiram (Antabuse) and fluoxetine (Prozac) increase alprazolam levels.

Pain Relief

Osteoporosis

Supplement

A.2.R.B

Anti-Inflammatory

Anti-Biotic

Osteoporosis

• • Prevention and treatment of ◦Postmenopausal osteoporosis
• ◦Glucocorticoid -related osteoporosis
• ◦Age-related osteoporosis in men

• • Give drug 30 minutes before breakfast with a full glass of water.
• • Have patient sit or stand for 30 minutes after administration.
• • Avoid giving calcium-containing drugs/supplements within 30 minutes of administration

• • Esophagitis
• • Gastrointestinal disturbances (nausea and vomiting, abdominal pain)
•      • Give drug with full glass of water.
•      • For 30 minutes after taking drug have patients:
•    ◦Sit or stand up for 30 minutes.
•    ◦Avoid eating or drinking anything other than water.
•    ◦Avoid giving calcium supplement or antacid.
• .• Muscle and joint pain
•      • Give analgesic for muscle and joint pain.
•      • Advise patients to take analgesic for muscle and joint pain and report pain that persists.
• • Eye pain and vision changes
•      • Monitor patients for changes in vision.
•      • Instruct patients to report changes in vision to provider.

• Contra:
• • Esophageal strictures/disorders or difficulty swallowing
• • Patients unable to sit up for 30 minutes after administration
• • Renal insufficiency
• • Hypocalcemia

• Preca:
• • Upper gastrointestinal disorders
• • Infection
• • Liver disease
• • Heart failure

• Inter:
• • Calcium supplements and dairy products decrease absorption when given within 30 minutes of each other

G.E.R.D.

Freq. Urination

Diuretic Combo

Anti-Depressant

Opiate Addiction

A.C.E. Inhibitor

Cholesterol

Diabetes

Cholesterol

Anti-Depressant

• Major depression
• • Bipolar disorder
• • Panic disorder
• • Obsessive compulsive disorder(OCD)
• • Premenstrual dysphoric disorder
• • Bulimia nervosa

• • Give orally in tablets, capsules,solution, or sustained-release weekly capsules (fluoxetine).
• • Recognize that it may take 4 to 6 weeks to reach clinical effectiveness.
• • Administer with food if gastrointestinal upset occurs.
• • Give in the morning to prevent sleep disruption.

• • Insomnia, nervousness
•      • Monitor for these effects;decreased dosage may relieve symptoms.
•      • Report these effects.
•      • Take the drug in the morning to avoid interference with sleep.
• • Sexual dysfunction
•      • Monitor for this effect.
•      • Reducing dosage or changing antidepressant drugs may relieve this effect.
•      • Report impotence and decreased libido.
• • Headache
•      • Monitor for headache and worsening intensity.
•      • Report headache.
•      • Take over-the-counter analgesics as needed.
• • Weight gain
•      • Monitor weight weekly throughout therapy.
•      • Eat a healthful diet and increase exercise.
• • Hyponatremia (especially in older adults and those taking diuretics)
•      • Monitor serum sodium periodically.
•      • Observe for signs of hyponatremia, such as lethargy,abdominal cramps, diarrhea,and nausea
• • Report lethargy, abdominal cramps, diarrhea, and nausea.
•      • Increased risk for suicidal ideation (especially children,young adults)
•      • Monitor for increased depression/suicidal ideation.
•      • Understand that this is a risk.
•      • Report any worsening of depression or thoughts of suicide.
• • Serotonin syndrome
•      • Monitor for mental confusion,difficulty concentrating,fever, agitation, anxiety,hallucinations, incoordination,hyperreflexia, diaphoresis, and tremors.
•      • Discontinue the drug.
•      • Report increased anxiety, fever,excessive sweating, tremors,and hallucinations.
•      • Stop taking the drug.

• contra:
• • Allergy to any SSRI drug
• • Children younger than 7 to 8 years (fluoxetine).
• • Use with MAOIs

• preca:
• • Liver disease
• • Older adults
• • Peptic ulcer disease
• • Diabetes mellitus (may decrease glucose control)
• • Hyponatremia
• • Cardiac disease
• • Suicidal tendencies

• inter:
• • Taking an SSRI within 2 weeks of MAOIs or another SSRI increases the risk of serotonin syndrome.
• • Fluoxetine increases levels of tricyclic antidepressants and lithium.
• • NSAIDs increase the risk of gastrointestinal bleeding.

Long-Acting Insulin

Anti-Fungal

Anti-Biotic

Blood Thinner

N.S.A.I.D

Pain Relief

Allergies

Anti-Biotic

Anti-Convulsant

Rapid-Acting Insulin

Anti-Depressant

• Major depression
• • Social anxiety disorder
• • Generalized anxiety disorder (GAD)

• • Start with low doses and titrate upward every 4 days until optimal dosage is reached (venlafaxine).
• • Give with food to minimize gastrointestinal symptoms.
• • Make sure patients swallow sustained-release capsules whole.

• • Nausea, vomiting, anorexia
•      • Monitor for these common effects.
•      • Monitor for weight loss related to anorexia.
•      • Take the drug with food.
• • Headache
•      • Monitor for headache and worsening intensity.
•      • Report headache.
•      • Take over-the-counter analgesics as needed.
• • Hypertension
•      • Monitor blood pressure.
•      • Have blood pressure checked regularly.
• • Insomnia, nervousness
•      • Monitor for these effects; decreased dosage may relieve symptoms.
•      • Report these effects.
•      • Take the drug in the morning to avoid interference with sleep.
• • Withdrawal symptoms with abrupt discontinuation (anxiety, agitation, headache, tachycardia)
•      • Taper the drug over 2 to 4 weeks when discontinuing.
•      • Do not stop taking the drug abruptly.
• • Increased risk for suicide (especially children, young adults)
•      • Monitor for increased depression and suicidal ideation.
•      • Understand that this is a risk.
•      • Report any worsening of depression or thoughts of suicide

• contr:
• • Allergy to venlafaxine or other SNRIs
• • Suicidal ideation
• • Concurrent administration with MAOIs or within 14 days of last dose

• prec:
• • Liver and kidney disease
• • Glaucoma
• • Cardiac disorders, hypertension

• interac:
• • Taking SNRIs within 14 days of MAOIs increase the risk of serotonin syndrome.
• • Cimetidine (Tagamet), desipramine (Norpramin), and haloperidol (Haldol) increase blood levels of venlafaxine.
• • Trazodone (Desyrel), St. John’s wort, and sour date nut increase the risk of serotonin syndrome.

Anti-Anxiety

Cholesterol

Menopause

Anti-gout

Anti-Biotic

Diabetes

Anti-Depressant

• Treatment of major depression
• • Give orally at bedtime.
• • Monitor for therapeutic effects after 1 to 3 weeks.
• • Expect long-term use to control depression

• • Drowsiness, sedation
•      • Monitor for sedation and, if it occurs, take measures to prevent falls.
•      • Take at bedtime to prevent daytime drowsiness.
•      • Do not drive or perform hazardous activities if drowsy.
• • Orthostatic hypotension
•      • Monitor orthostatic vital signs.
•      • Do not drive or perform hazardous activities if drowsy.
•      • Move slowly from lying to sitting or standing.
• • Anticholinergic effects (dry mouth, constipation, urinary retention, blurred vision)
•      • Monitor for these effects.
•      • Urinate before taking the daily dose.
•      • Increase fiber and fluids to prevent constipation.
•      • Chew gum, suck on hard candy, or sip water to prevent dry mouth.
• • Increased risk for suicide (especially in children, adolescents)
•     • Monitor for increases in depression and suicidal ideation.
•     • Initiate suicide precautions when appropriate.
•      • Report any feelings of self-harm or worsening of depression.
• • Withdrawal symptoms with abrupt discontinuation (anxiety, headache, muscle pain, nausea)
•      • Taper the drug over 2 weeks to prevent or minimize withdrawal.
•      • Do not stop taking the drug abruptly.
• • High risk for overdose (life-threatening dysrhythmias, confusion, seizures)
•      • Assure that patients have no more than a 1-week supply of the drug.
•      • For overdose, prepare for gastric lavage and administer physostigmine to treat anticholinergic effects and lidocaine to treat ventricular dysrhythmias.
•      • Take the drug exactly as prescribed

• contr:
• • Allergy to TCAs
• • Children younger than 12 years
• • Recent acute myocardial infarction
• • Cardiac dysrhythmias
• • Seizure disorder history
• • Concurrent use with MAOIs

• prec:
• • Angle closure glaucoma
• • Prostatic hypertrophy
• • History of urinary retention
• • Liver or renal disorders
• • Suicidal ideation
• • History of electroconvulsive therapy
• • Schizophrenia
• • Hematologic or respiratory disorders
• • Diabetes mellitus
• • Alcohol use disorder

• inter:
• • CNS depressants increase sedation.
• • Levodopa/carbidopa and sympathomimetic drugs may cause increased effects of those drugs, such as hypertension.
• • Administration within 2 weeks of MAOIs may cause hypertensive crisis.
• • Cimetidine (Tagamet) and methylphenidate (Ritalin) increase amitriptyline levels.
• • Anticholinergic drugs (such as antihistamines) increase anticholinergic effects.
• • Ginkgo biloba increases the risk of seizures; St. John’s wort may cause serotonin syndrome.

Hypertension

Glaucoma

A.D.H.D.

Cholesterol

N.S.A.I.D.

G.E.R.D.

Diabetes

Anti-Psychotic

Incontinence

G.E.R.D

G.E.R.D.

Hypertension

Long-Acting Insulin

Thyroid Hormone

Antidepressant

• Treats depression
• • Prevents seasonal affective disorder (SAD)
• • Smoking cessation adjunct

• • Available in tablets, sustained release tablets and extended release tablets—assure that patient is taking prescribed form
• • Make sure patient swallows extended- and sustained release tablets whole
• • Give with food if GI symptoms occur

• • Nausea, vomiting, weight loss
•      • Give with food to minimize these effects
•      • Weigh patient weekly
•      • Instruct patient to notify provider for GI effects, including weight loss
• • Increased risk for seizures
•      • Assess patient for physical conditions, other drugs that could promote seizure activity
•      • Advise patient to take this drug exactly as prescribed; avoid overdose
• • CNS effects: insomnia,agitation, tremor, headache
•      • Monitor for these effects
•      • Instruct patient to report CNS symptoms to provider
• • Psychosis, hallucinations, and delusions
•      • Monitor for signs of psychosis,hallucinations, and delusions
•      • Notify the provider if any of these occur
•      • Advise patient/family to watch for signs of psychosis,hallucination, and delusions;notify provider if these occur and stay with patient until seen by provider
• • Increased risk for suicidal ideation(children and young adults)
•     • Monitor for increased depression/suicidal ideation
•      • Notify the provider if this occurs
•      • Advise patient/family thatthis is a risk; notify provider if depression increases and stay with patient until seen by provider

• contra:
• • Previous allergy to bupropion
• • History of an eating disorder
• • Seizure disorder
• • Suicidal ideation
• • Concurrent administration of MAOI antidepressant
• • Head trauma, tumor in CNS

• preca:
• • Liver or renal dysfunction
• • Cardiac disease
• • Schizophrenia or bipolar disorder
• • Diabetes mellitus
• • Alcohol use disorder
• • Children younger than 18 years

• interac:
• • Use with MAOI antidepressants may increase risk of bupropion toxicity
• • May decrease blood levels of cimetidine, phenytoin,Phenobarbital, and carbamazepine (increasing risk for seizures)

Allergies

• Management of:
• • Allergic rhinitis
• • Chronic idiopathic urticaria

• • May take with or without food.
• • Do not take with other over-the-counter antihistamines.
• • Expect dose to be lower in patients who have compromised renal or liver function.

• • Drowsiness and fatigue (less than first-generation sedating antihistamines, but still a possible effect)
•      • Monitor the patient when ambulating.
•      • Take once-daily dose at time desired.
•      • Avoid driving and activities that require mental alertness until the drug’s effects are known.
• • Anticholinergic effects - dry mouth, nose, and throat (less than first-generation sedating antihistamines, but still a possible effect)
•      • Provide water and encourage frequent sips.
•      • Provide hard candy to suck on.
•      • Take frequent sips of water.
•      • Suck on hard candy

• cont:
• • Infants under 6 months
• • Breastfeeding women'
• • Allergy to H1-receptor antihistamines or hydroxyzine

• prrec:
• • Impaired kidney or liver function

• inter:
• • Theophylline (Theo-24) can reduce clearance and lead to toxicity.
• • Atropine may cause anticholinergic effects

Antiepileptic

Herpes Mgmt.

Sleep Aid

Herpes Mgmt.

Antibiotic

Antibiotic

Gout

Cholesterol

Expectorant

Diabetes(II)

A.2.R.B.

G.E.R.D.

Hypertension

Antiemetic

Antibiotic

Supplement

Low T

Parkinson's

Antipsychotic

• • Treats both positive and negative symptoms of schizophrenia
• • Treats bipolar disorder
• • Manages irritability in patients with autism

• • Mix oral solution with juice,milk, water, or coffee; do not use tea or soft drinks
• • Remove rapidly-disintegrating form from packaging immediately before administration
• • Administer long-acting IM form (Risperdal Consta) every 2 weeks using large gluteal muscle and supplied needle
• • Continue giving oral risperidone for 3 weeks after Risperdal Consta therapy has started

• • Drowsiness, insomnia,dizziness and other CNS effects
•      • Monitor for these effects
•      • Instruct patient not to drive or operate hazardous equipment until CNS effects are known
• • Extrapyramidal effects(dystonia, akathisia, Parkinson like symptoms)—occur with higher doses of risperidone( but less often than with Conventional antipsychotics)
•      • Monitor for these effects• Prepare to treat acute dystonia with anticholinergic drug asprescribed
•      • Prepare to treat Parkinson symptoms with anti-Parkinsondrugs
•      • Some of these effects may require change to another antipsychotic drug
•      • Instruct patient to report symptoms of extra pyramidal effects to provider
• • Weight gain, onset of new diabetes or worsening of existing diabetes, increased cholesterol levels
•      • Monitor weight, blood glucose,and cholesterol/triglyceridelevels periodically
•      • Instruct patient to increase exercise, eat a diet low in sugar, fat, and calories
•      • Instruct patient to report polyuria, polydipsia (possible symptoms of diabetes)
•      • Instruct diabetic patients to monitor blood glucose more closely

• contr:
• • Previous allergy to risperidone
• • Severe CNS depression
• • Prolonged QT on ECG
• • Psychosis related to dementiain older adults (increase risk ofstroke)
• • Exposure to sunlight
• • Lactation
• • Children (<5 for autism; <10 forBPD; <13 for schizophrenia)

• precu:
• • Older adults
• • Parkinson’s disease
• • Liver or renal disorders
• • Heart failure, cardiacdysrhythmias, or MI
• • Hypotension
• • Seizure disorders
• • Fluid or electrolyte disturbances
• • Diabetes mellitus
• • CNS depression

• intrer:
• • May decrease effects of antiParkinson drugs
• • May increase effects of antihypertensive drugs
• • Clozapine increasesrisperidone levels
• • Phenytoin, carbamazepine,phenobarbital and rifampindecrease risperidone levels

Antihistamine

Antibacterial

ADHD

Anti-coagulant

Narcotic Analgesic

• • Available in multiple forms for surgical premedication,including IV and stick lozenges
• • Place a stick lozenge between cheek and gum of child or adult;patient should suck (not chew)on lozenge longer than 15 min

• • Sedation
•      • Monitor level of consciousnessduring use
•      • Advise patient that drowsinessis expected
• • Nausea
•      • Monitor for nausea
•      • Instruct patient to report nausea
• • Respiratory and/or circulatorydepression
•      • Monitor vital signs carefully• Have resuscitation equipmentat hand
•      • Have the opioid antagonist,naloxone (Narcan) available
•      • Advise patient that frequent monitoring will occur before,during, and after procedure

• Contra:
• • Substance abuse
• • Obstetric delivery
• • Myasthenia gravis

• Preca:
• • Patients with increased intracranial pressure
• • Older adults or young children
• • Debilitated patients
• • Cardiac or respiratory disorders
• • Liver or kidney disorders

• Intra:
• • MAOI antidepressants given within 2 weeks of fentanyl can cause hypertensive crisis
• • CNS depressants increase risk for sedation, respiratory depression

I.B.S.

Beta Blocker

A.D.H.D.

Hypertension

Sleep Aid

Weight Loss

ACE Inhibitor

Impotence

Antiemetic

Antiviral (Flu)

Rheum. arthritis

• Decrease joint inflammation and subsequently joint damage.

• • Give methotrexate once a week via route prescribed (oral, subcutaneous or intramuscular).
• • Folic acid supplement may be prescribed to decrease risk of toxicity

• • Bone marrow suppression (decreased platelets, red and white blood cells)
•      • Monitor for decreased platelets, red and white blood cell counts.
•      • Report abnormal bleeding, bruising, or petechiae (pinpoint areas of blood under the skin).Report ulcerations of the mouth or tongue.
• • Increased risk of infection
•      • Monitor for signs and symptoms of infection.
•      • Report signs and symptoms of infection immediately.
• • Liver damage
•      • Monitor liver function tests and observe for jaundice.
•      • Avoid ingesting alcohol.
•      • Report yellowing of the skin and eyes immediately.
• • Gastrointestinal ulceration
•      • Monitor for gastrointestinal bleeding (with methotrexate).
•      • Report blood in vomitus or stools.
• • Pulmonary fibrosis
•      • Monitor for respiratory distress and decreased oxygenation
•      • Report difficulty breathing or shortness of breath
•      • Drink 8 to 12 8-ounce glasses of water daily to ensure excretion of drug
•      • Use contraception and do not take within 6 months of pregnancy or during breastfeeding

• contr:
• • Pregnancy Category X (methotrexate)
• • Liver insufficiency or hepatitis
• • Renal insufficiency

• prec:
• • Peptic ulcer or ulcerative colitis
• • Active bacterial or viral infections
• • Concurrent use of methotrexate and digoxin may reduce digoxin level

• inter:
• • Concurrent use of methotrexate and NSAIDs, salicylates, and sulfonamides may cause toxicity
• • Alcohol use may increase risk of hepatotoxicity

Anticoagulant

Ulcerative colitis

Freq. Urination

• Treats hypertension
• • Treats benign prostatic hypertrophy (BPH)

• • Available in oral form only
• • Give at bedtime – especially first dose; subsequent doses individualized based on orthostatic blood pressure changes

• • Orthostatic hypotension —especially with first dose and with dose increases
• • Reflex tachycardia may also occur
•      • Monitor orthostatic blood pressure and pulse 2 to 6 hours after 1st dose or after dose increases
•      • Report significant drop of >20 mm Hg systolic between lying/standing to provider; report tachycardia to provider
•      • Report dizziness, syncope rapid heartbeat or palpitations to provider
•      • Take this drug at bedtime
•      • Rise slowly from lying to sitting or standing to prevent injury
•      • Do not perform hazardous activities, such as driving for at least 12 hours following first dose and subsequent dosage increases
• • Headache
•      • Monitor for and report frequent headaches
•      • Report increase in frequency of headache to provide

• cont
• • Allergy to doxazosin or other alpha1 adrenergic blockers
• • Hypotension; history of syncope
• • Children

• pre
• • Renal or hepatic disease

• inter
• • Sildenafil (Viagra) and other phosphodiesterase inhibitors may increase risk for hypotension

Anti-depressant

Rapid-Acting Insulin

Antibiotic

Anti-anxiety

Short-term treatment of certain anxiety disorders, such as generalized anxiety disorder(GAD)

• • Give orally on a regular basis(not PRN) for anxiety.
• • Begin buspirone 2 to 4 weeks before tapering benzodiazepines due to delayed therapeutic effect of buspirone.

• • Paradoxical effects (insomnia,anxiety, restlessness)
•      • Monitor for paradoxical effects.
•      • Report paradoxical effects.
• • Nausea and other gastrointestinal effects
•      • Monitor for these effects.
•      • Take with food if the drug causes nausea.
• • Dizziness, light headedness,headache
•      • Monitor the occurrence and severity of these symptoms.
•      • Institute fall precautions,especially for older adults.
•      • Report paradoxical effects.
•      • Rise slowly from a reclining or sitting position.
•      • Report dizziness.
•      • Do not engage in dangerous activities if dizziness occurs or tends to recur.
•      • Report headache.
•      • Take over-the-counter analgesics for headache.

• Contr:
• • History of hypersensitivity to  buspirone

• Prec:
• • Liver or kidney insufficiency

• Inter:
• • Grapefruit juice, erythromycin, and ketoconazole increase blood levels.
• • MAOI antidepressants within 2 weeks can cause severe hypertension.

B.P.H.

Antifungal

Overactive Bladder

Anti-addictive

Antibiotic

U.T.I.

Diuretic

• Treats hypertension
• • Treats symptoms of heart failure following MI

• • Available for oral use only
• • Give alone or combined with other antihypertensive drugs
• • Maximum effect of eplerenone may take up to 4 weeks
• • Reduce dose for patients taking CYP3A4 inhibitor

• • Hyperkalemia
•      • Monitor for signs of hyperkalemia (see patient instructions)
•      • Monitor periodic potassium levels, BUN and creatinine in patients at risk for hyperkalemia
•      • Assure that patient is not taking potassium-sparing diuretics or other drugs that raise potassium levels (see interactions)
•      • Do not take potassium supplements, use potassium-containing salt substitutes or drugs which raise potassium levels unless prescribed by the provider
•      • Report palpitations, muscle twitching, weakness, or paresthesias in extremities to provide

• cont
• • Serum potassium above normal levels (>5.0 mEq/L)
• • Type 2 diabetes with microalbuminuria
• • Increased serum creatinine or decreased creatinine clearance
• • Lactation

• prec
• • Children
• • Liver failure or disease
• • Concurrent use of prescribed drugs which raise potassium levels

• inter
• • Drugs which inhibit CYP3A4, such as ketoconazole, erythromycin, verapamil, and others may greatly increase risk for toxicity and hyperkalemia
• • Drugs which raise potassium levels, such as ACE inhibitors and potassium-sparing diuretics increase risk for hyperkalemia
• • May cause lithium toxicit

Impotence

Corticosteroid

Antitussive

Antiepileptic

B.P.H.

Gout

Antiepileptic

Antidepressant

C.O.P.D.

G.E.R.D.

Anti-Arthritis

• DMARDs are drugs that decrease joint inflammation, and subsequently, joint damage
• • DMARD II drugs are tumor necrosis factor antagonists - drugs that bind with naturally occurring tumor necrosis factor, preventing it from attaching to cells on the surface of synovial tissue in the joints.

• • Give by subcutaneous injection.
• • Give twice weekly.
• • Monitor site for redness, pain, and swelling after administration

•      • Assess for infection prior to each injection.
•      • Monitor for signs and symptoms of infection during therapy.
•      • Report signs and symptoms of infection immediately.
•      • Avoid immunizations, especially those that contain live vaccines.
• • Severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema multiforme
•      • Monitor for skin reactions.
•      • Report skin rashes immediately.
• • Local injection site reaction
•      • Monitor for redness, warmth, and itching at injection site.
•      • Advise patients to report reactions that do not subside within a few days.
• • Heart failure
•      • Monitor patients for signs and symptoms of heart failure (cough, shortness of breath, elevated blood pressure and heart rate, pink sputum).
•      • Report signs and symptoms of heart failure (cough, shortness of breath, elevated blood pressure and heart rate, pink sputum) immediately.
• • Reactivation of latent tuberculosis (TB)
•      • Administer TB test prior to starting therapy.
•      • Report shortness of breath or new production of sputum.

• cont:
• • Active infection
• • Hematologic disease
• • Malignancy

• pre:
• • Autoimmune diseases
• • Live vaccines
• • Heart failure

• inter:
• • Administration with chemotherapeutic drugs may cause bone marrow suppression.
• • Should not be given with anakinra (Kineret) due to increased risk of infections.

Beta Blocker

N.S.A.I.D

Calc. Chan. Blocker

Antibiotic

Angina

Incontinence

Impotence

Corticosteroid

Anti-Dimentia

G.E.R.D.

AntibioticD

Muscle Relaxer

Ocular Hypertension

Antipsychotic

B.P.H.

Migraine

• Relieve symptoms of existing migraine or cluster headache

• • Give orally, SC, or by nasal spray
• • Use nasal spray by spraying once into a single nostril; may repeat after 2 hr
•    ◦Single dose ranges from 5 to 20 mg
•    ◦Maximum dose is 40 mg in 24hr
• • Give one SC injection repeat once after 1 hr if no relief; no more than 2 doses in 24 hr
• • Give one oral tablet; repeat once after 2 hr if no relief
•    ◦Single dose ranges from 25mg to 100 mg
•    ◦Maximum dose is 200 mg in 24 hr

• • Chest pressure or “heaviness”; may progress to angina pain caused by coronary vasospasm
•      • Monitor for this effect
•      • Monitor vital signs closely after first dose
•      • Instruct patient to notify provider at once for chest pressure or tightness/heavinessin back, jaw, throat that does not spontaneously resolve
• • CNS effects: tingling sensation,vertigo
•      • Monitor for this effect  
•      • Instruct patient to report CNS symptoms to provider at next visit

• contra:
• • Coronary artery disease,angina, previous MI, severe hypertension
• • Peripheral vascular disease (PVD)
• • Older adults
• • Stroke
• • Use of MAOI within last 2weeks
• • Use of another triptan within last 24 hr

• precat:
• • Liver or kidney insufficiency
• • Coronary artery disease risk factors
• • Seizure disorder
• • Blood pressure elevation
• • Serotonin syndrome
• • Chest, jaw, or neck tightness
• • Fertility impairment

• intera:
• • MAO inhibitors taken within 2weeks can cause sumatriptan toxicity
• • Ergotamine or another triptan patients use within 24 hr of sumatriptan increases chance of angina
• • Serotonin agonists with sumatriptan can cause serotonin syndrome
• • Herbal St. John’s wort can cause toxicity

Osteoporosis

• Postmenopausal osteoporosis- Prevention and treatment
• • Reduces risk of estrogen receptor-positive breast cancer

• • Give orally daily.
• • May give with or without food

• • Increased risk of deep vein thrombosis (DVT) and pulmonary emboli
•      • Observe for signs and symptoms of thromboemboli.
•      • Contact provider if experiences pain in calf or difficulty breathing.
•      • Do not take estrogen replacement therapy during treatment.
• • Hot flashes
•      • Use lightweight covers over patients.
•      • Warn patients that hot flashes may occur.
•      • Monitor bone density.
•      • Encourage patients to consume adequate amount of calcium and vitamin D
•      • Encourage patients to perform weight-bearing exercises (walking) daily.
•      • If pre-menopausal and using raloxifene to prevent breast cancer, use contraception and do not breastfeed during treatment.
•      • Do not take estrogen replacement therapy during treatmen

• contr:
• • Pregnancy Category X
• • Lactation
• • Current and past history of deep-vein thrombosis

• prec:
• • Estrogen therapy
• • Hyperlipidemia

• inter:
• • Concurrent administration with estrogen is not recommended

Antidepressant

Anti-inflammatory

Parkinson's

Muscle Relaxer

Hypertension

Antibacterial

Hypertension

Smoking addiction

Calc. Chan. Blocker

Antifungal

Anticonvulsant

• Therapeutic Use 
• • Tonic-clonic seizures
• • Partial seizures

• Administration:
• Give with meals to prevent GI symptoms
• • Inject IV form slowly, using correct dilution
• • Monitor vital signs during IV administration to prevent cardiac dysrhythmias and hypotension
• • Due to narrow therapeutic range, carefully monitor plasma levels, which should remain between 10 and 20 mcg/mL. Levels greater than 30 mcg/mL can be toxic.

•      • Monitor patient for these side effects
•      • Instruct patient not to drive or perform other hazardous activities if experiencing CNS side effects
•      • Instruct patient to notify provider if CNS effects occur
• • Gingival hyperplasia (abnormal growth of tissue around gums)
•      • Refer patients for dental care and teaching about oral hygiene techniques
•      • Instruct patient to obtain regular  dental checkups
•      • Instruct, as needed, in brushing with soft-bristled toothbrush, gum massage and flossing.
• • Skin rash (epidermal necrolysis, Stevens-Johnson syndrome)
•      • Monitor for rash; phenytoin should be discontinued if rash  occurs
•      • Instruct patient to notify provider if rash occurs.
• • Withdrawal symptoms following long-term use (seizures)
•      • Reduce phenytoin dosage gradually
•      • Instruct patient not to stop taking phenytoin abruptly

• Contra:
• • Pregnancy Risk Category: D
• • Skin rash
• • Bradycardia or heart block
• • Previous allergy to hydantoins
• • Seizures caused by low blood sugar

• Preca:
• • Liver or kidney disease
• • Cardiac dysfunction
• • Diabetes mellitus
• • Older adults
• • Debilitated patients
• • Alcohol use disorder
• • Respiratory dysfunction

• Intra:
• • IV phenytoin incompatible in solution with many other drugs and with dextrose solution
• • Diazepam, isoniazid,cimetidine, and valproic acid increase levels of phenytoin
• • Alcohol use may either increase or decrease phenytoin levels
• • CNS depressants increase sedative effects
• • Phenobarbital and carbamazepine can decrease phenytoin levels
• • Use can decrease efficacy of oral contraceptives.

Parkinson's

• • Relieves symptoms of Parkinson’s disease (PD)
• • Restless leg syndrome

• • Give 3 hr before bedtime for restless leg syndrome
• • When increasing dosage, allow 4 to 7 days between each increase

• SE:
• • Nausea and other GI symptoms
•     • Inform patient that nausea can lessen over time
•     • Instruct patient to take drug with food if nausea occurs
• • Drowsiness, “sleep attacks”
•     • Instruct patient to avoid driving or       performing activities that require mental alertness ifdrowsiness occurs
•     • Advise patient to avoid alcohol and other CNS depressants which increase risk for drowsiness
•     • If taking once daily, make sure patient is taking before bedtime
• • Muscle weakness
•     • Monitor blood CPK levels if weakness occurs
•     • Instruct patient to report muscle weakness to provider
• • Orthostatic hypotension
•     • Monitor cardiac status
•     • Instruct patients to move slowly to a sitting/standing position if orthostatic hypotension occurs
• • Dyskinesias (abnormal muscle movements)
•     • Advise patient to notify provider if these effects occur

• contra:
• • Allergy to pramipexole or ropinirole

• Preca:
• • Renal dysfunction
• • Existing compulsive behaviors
• • Children

• Intra:
• • Cimetidine increases levels of pramipexole
• • Metoclopramide and phenothiazine antipsychotics decrease therapeutic effect
• • Alcohol and other CNS depressants increases risk for adverse effects

Anti-Diabetic

Heart Disease

NSAID Gel

Anti-Diabetic

Cholesterol

Muscle Relaxer

ADHD / Narcolepsy

Shingles Vaccine

Cholesterol Combo