Peds meds

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Emilybillet
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Peds meds
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2014-11-28 14:50:07
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peds nursing meds
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  1. Acetaminophen (Tylenol
    • Class: antipyretics/ non-opioid analgesics 
    • Indication: treatment of moderate pain, fever
    • Action: inhibits prostaglandins that may serve as mediators of pain and fever
    • Assessments: assess for malnutrition, pain assessment and fever assessment 
    • Side effects: may causes increased agitation, hepatotoxicity, and constipation 
    • Teaching: ensure that parents are able to correctly dose liquid preparations and have them return demonstrate. do not take with aspirin or NSAIDS
  2. Activated Charcoal (Acta-Char)
    • Class: antidote, adsorbents 
    • Indication: acute management of many oral poisenings following emesis/lavage 
    • Side effects: Black stools, constipation
  3. Adderall Amphetamine (Adderal)
    • Class: CNS stimulant
    • Indication: ADHD 
    • Ation: Causes release of norepinephrine from verve endings; increase attention spand and ADHD
    • Side effects: Growth inhibition, anorexia, palpitations, sudden death and hyperactivity
    • Assessments: Monitor BP, pulse, and respiration before and during therapy, obtain a H & P. monitor height periodically
    • Teaching: Children should be given a drug free day to reassess symptoms, if reduce appetite and weight loos are a problem advice parents to provide high calories meal at breakfast or bed time, and advice patient to limit caffeine
  4. Albuterol
    • Class: Bronchodilator 
    • Indication: To control and prevent reversible air way obstruction cause by asthma.
    • Action: Causes bronchodilation,  
    • Side effects: Insomnia, Hyperactivity, restlessness
    • Assessments: Lung sound, pulse and BP before and during pick; assess mucus, use spacer for children under 8 years, rinse mouth after each use; notify HCP if there is no response to the usual dose, caution adolescences and parents about the overuse of inhalers can cause heart damage and arethmias
    • Teaching:
  5. Amoxicillin
    • Class: Antiinfective 
    • Action: Treatment of skin, respiratory and GU infections, sinusitis and OM; Lyme disease in children under 8
    • Side effects: seizures, PSEUDOMEMBRANOUS COLITIS, anaphylaxis, rash 
    • Assessments: allergy hx; Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Notify health care professional immediately if these occur, keep epi and resus. equipment near by; Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly;
    • Teaching: take medication around the clock and to finish the drug completely as directed, even if feeling better; Teach parents or caregivers to calculate and measure doses accurately. Reinforce importance of using measuring device supplied by pharmacy or with product, not household items; Advise patient to report the signs of superinfection; Instruct patient to notify health care professional immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals; Instruct female patients taking oral contraceptives to use an alternate or additional nonhormonal method of contraception during therapy
  6. Ampicillin
    • Class: Anti-infective
    • Indication: Skin, Soft-tissue, OM, Sinusitis, Resp, GU infections, Meningitis, Septicemia.
    • Action: Binds to bacterial cell wall, resulting in cell death.
    • Side effects: seizures, PSEUDOMEMBRANOUS COLITIS, dnv, rash, anaphylaxis 
    • Assessments: allergy hx; assess infection, Observe patient for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Discontinue the drug and notify health care professional immediately if these occur. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction. Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly
    • Teaching: Take full course, report signs of superinfection, Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional, use mechanical contraceptives while on therapy
  7. Atropine
    • Class: Anti-arrythmic/anti-cholinergic
    • Indications: Given preoperatively to decrease oral and respiratory secretions; Treatment of sinus bradycardia; 
    • Action: Inhibits the action of acetylcholine at postganglionic sites located in Smooth muscle, Secretory glands, CNS (antimuscarinic activity).
    • Side effects: drowsiness, blurred version, tachycardia, urinary retention 
    • Assessments: Assess vital signs and ECG tracings frequently; monitor I&O, Assess patients routinely for abdominal distention and auscultate for bowel sounds. If constipation becomes a problem, increasing fluids and adding bulk to the diet may help 
    • Teaching:  physostigmine is the antidote; Instruct patient that oral rinses, sugarless gum or candy, and frequent oral hygiene may help relieve dry mouth; Strenuous activity in a hot environment may cause heat stroke;  Instruct parents or caregivers that medication may cause fever and to notify health care professional before administering to a febrile child
  8. Ipratropium (Atrovent)
    • Class: Bronchodilator
    • Indication: Rhinorrhea associated with allergic and nonallergic perennial rhinitis or the common cold; may be used for asthma as adjunct
    • Action:  Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased concentrations of cyclic guanosine monophosphate (cGMP). Decreased levels of cGMP produce local bronchodilation; also acts on glands lining nasal mucosa 
    • Side effects: dizziness, Headache, blurred vision, nose bleed, bronchospasm, hypotension
    • assessment:  Assess for allergy to atropine and belladonna alkaloids; assess resp status before and at peak, Consult health care professional about alternative medication if severe bronchospasm is present; onset of action is too slow for patients in acute distress
    • Teaching:  Take missed doses as soon as remembered unless almost time for the next dose; space remaining doses evenly during day. Do not double doses; Caution patient not to exceed 12 doses within 24 hr. Patient should notify health care professional if symptoms do not improve within 30 min after administration of medication or if condition worsens.; Instruct patient in proper use of nasal spray. Clear nasal passages gently before administration. Do not inhale during administration, so medication remains in nasal passages.
  9. amoxicillin/clavulanate (aumentin)
    • class: anti-infective
    • indication: skin, resp, gu, infections, OM, sinusitis
    • Action: Binds to bacterial cell wall, causing cell deat
    • Side effect: siezures, pseudomem., anaphylaxis, dnv, rash, superinfection
    • Assessment: infection, bowels, allergies, Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing), symptoms of superinfection 
    • Teaching: take full dose, Teach parents or caregivers to calculate and measure doses accurately. Reinforce importance of using measuring device supplied by pharmacy or with product, not household items, Instruct patient to notify health care professional immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care ,
  10. bacitracin
    • Class: anti-infective
    • indication: Treatment of infants with pneumonia and empyema caused by susceptible Staphylococci, Treatment of localized infections due to Staphylococci, Streptococci.
    • Action: Inhibits bacterial cell wall synthesis by preventing transfer of mucopeptides into growing cell wall; bacterialcidal
    • Side effects: pseudomem, renal failure, n/v
    • assessment: assess infection, monitor bowels 
    • teaching: complete and follow therapy; Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional; dvise patient to only for use on minor cuts or burns. Do not use on animal bites, puncture wounds, serious burns, or deep cuts.
  11. baclofen
    • class: antispasicity
    • indication:Treatment of reversible spasticity due to multiple sclerosis or spinal cord lesions; Treatment of severe spasticity of cerebral or spinal origin
    • Action: Inhibits reflexes at the spinal level.
    • side effects: SEIZURES, dizziness, drowsiness,  fatigue, weakness, confusion, depression, rash, weight gain, ataxia, headache, insomnia
    • assessment: Assess muscle spasticity before and periodically during therapy; Monitor patient closely during test dose and titration. Resuscitative equipment should be immediately available for life-threatening or intolerable side effects.
    • Teaching: Take a missed dose within 1 hr; do not double doses. Caution patient to avoid abrupt withdrawal of this medication because it may precipitate an acute withdrawal reaction; Advise patient to report signs and symptoms of hypersensitivity; Caution patient and caregiver not to discontinue IT therapy abruptly. May result in fever, mental status changes, exaggerated rebound spasticity, and muscle rigidity.
  12. bactroban
    • Class: anti-infective
    • Indication: impetigo
    • Action: Inhibits bacterial protein synthesis.
    • Side effect: headache, rash, itching, burning, stinging, pain, 
    • assessment: Assess lesions before and daily during therapy.
    • Teaching: Advise patient to apply medication exactly as directed for the full course of therapy, If a dose is missed, apply as soon as possible unless almost time for next dose. Avoid contact with eyes, Teach patient and family appropriate hygienic measures to prevent spread of impetigo.
  13. Caffeine
    • Class: CNS stimulant
    • Indication: Short-term treatment of idiopathic apnea of prematurity in infants between 28 and <33 wk gestational age.
    • Action: Increases levels of cyclic AMP by inhibiting phosphodiesterase.Acts as a bronchial smooth muscle relaxant.
    • Side effect: NECROTIZING ENTEROCOLITIS, feeding intolerance, gastritis, GI bleeding, irritability, tachycardia, dry skin, muscle tremors
    • Assessment:  Assess respiratory status frequently throughout therapy.Monitor patient for signs of necrotizing enterocolitis (abdominal distension, vomiting, bloody stools, lethargy). May be fatal; 
    • Teaching: Instruct parent on correct technique for administration. Measure oral dose accurately with a 1-mL syringe. If apnea events continue, consult health care professional; do not increase dose.Advise parent to consult health care professional immediately if signs of necrotizing enterocolitis occur.
  14. Captopril (Capoten) Ac
    • Class: ACE inhibitor/ Anti-HTN
    • Indication: Management of heart failure.Reduction of risk of death, heart failure-related hospitalizations, and development of overt heart failure following myocardial infarction.
    • Action: (ACE) inhibitors block the conversion of angiotensin I to the vasoconstrictor angiotensin II. ACE inhibitors also prevent the degradation of bradykinin and other vasodilatory prostaglandins. ACE inhibitors also ↑ plasma renin levels and ↓ aldosterone levels. Net result is systemic vasodilation.
    • Side effect: angioedema, agranlocytosis, dry cough, hypotension
    • Assessment: Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy; Assess patient for signs of angioedema (dyspnea, facial swelling);  Monitor weight and assess patient routinely for resolution of fluid overload 
    • Teaching: Instruct patient to take captopril as directed at the same time each day, even if feeling well. Take missed doses as soon as remembered but not if almost time for next dose. Do not double doses. Warn patient not to discontinue ACE inhibitor therapy unless directed by health care professional;  avoid salt substitutes containing potassium or foods containing high levels of potassium or sodium; Instruct patient to notify health care professional if rash; mouth sores; sore throat; fever; swelling of hands or feet; irregular heart beat; chest pain; dry cough; hoarseness; swelling of face, eyes, lips, or tongue; difficulty swallowing or breathing occurs; or if taste impairment or skin rash persists. Persistent dry cough may occur and may not subside until medication is discontinued. use other form od=f contraceptives
  15. Carbamazepine
    • Class: anti-convlsant
    • Indication: Treatment of tonic-clonic, mixed, and complex-partial seizures
    • Action: Decreases synaptic transmission in the CNS by affecting sodium channels in neurons.
    • Side effect: SUICIDAL THOUGHTS, ataxia, drowsiness, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLY, photosensitivity, AGRANULOCYTOSIS, APLASTIC ANEMIA, THROMBOCYTOPENIA, 
    • Assessment: Monitor for changes in skin condition in early therapy. Stevens-Johnson syndrome and toxic epidermal necrolysis are significantly more common in patients with a particular human leukocyte antigen (HLA) allele, HLA-B*1502 
    • Teaching: Take missed doses as soon as possible but not just before next dose; do not double doses; Instruct patients that behavioral changes, skin rash, fever, sore throat, mouth ulcers, easy bruising, petechiae, unusual bleeding, abdominal pain, chills, rash, pale stools, dark urine, or jaundice should be reported to health care professional immediately. Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse
  16. Cefuroxime
    • Class: anti-infective 2nd class cephalo
    • Indication: Resp, Skin, Bone and joint , Utis, Gyn infections, Septicemia (IV),OM (PO),Meningitis (IV), Lyme disease (PO).
    • Action: Binds to bacterial cell wall membrane, causing cell death.
    • Side effect: seizures, pseudomemb. dnv, itchy, bleeding, pain at site
    • Assessment: infection, allerg Hx, Observe patient for signs and symptoms of anaphylaxis, keep epi on hand, Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis
    • teaching: take full dose of medicine,  Missed doses should be taken as soon as possible unless almost time for next dose; do not double doses, learn correct dosage; Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional; notify if signs of superinfection
  17. Cefazolin
    • Class: anti-infectiv 1st gen cephalosporin
    • Indication: Skin and skin structure infections (including burn wounds), Pneumonia, Urinary tract, Biliary tract, Genital, Bone and joint, Septicemia, Bacterial endocarditis prophylaxis for dental and upper resp procedures.
    • Action: Binds to bacterial cell wall membrane, causing cell death.
    • Side effect: seizures, pseudomemb. dnv, itchy, pain at site, steven johnson's
    • Assessment: infection, allergy Hx, Observe patient for signs and symptoms of anaphylaxis, keep epi on hand, Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis
    • teaching: take full dose of medicine,  Missed doses should be taken as soon as possible unless almost time for next dose; do not double doses, learn correct dosage; Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional; notify if signs of superinfection
  18. ciproflozacin (cipro)
    • Class: fluroquinolones 
    • indication: Urinary tract and gynecologic infections, including cystitis, and prostatitis, Respiratory tract infections including acute sinusitis, acute exacerbations of chronic bronchitis, and pneumonia, Skin and skin structure infections, Bone and joint infections, Infectious diarrhea, Complicated intra-abdominal infections (with metronidazole), Typhoid fever.
    • action: Inhibits bacterial DNA synthesis by inhibiting DNA gyrase enzyme.
    • Side Effect:  ELEVATED INTRACRANIAL PRESSURE, seizures, HEPATOTOXICITY, PSEUDOMEMBRANOUS COLITIS, abdominal pain, diarrhea, photo sensitivity, tendon rupture/ tendonitis; anaphylaxis
    • Assessment: assess infection bowel, for symptoms of supernfection; monitor for anaphylaxis
    • Teaching: Instruct patient to take medication as directed at evenly spaced times and to finish drug completely, even if feeling better; Advise patient that antacids or medications containing calcium, magnesium, aluminum, iron, or zinc will decrease absorption and should not be taken within 4 hr before and 2 hr after taking this medication; Caution patient to use sunscreen and protective clothing to prevent phototoxicity reactions during and for 5 days after therapy;  Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. nstruct patient to notify health care professional immediately if signs and symptoms of hepatotoxicity (anorexia, jaundice, dark urine, pruritus, or tender abdomen), rash, signs of hypersensitivity, or tendon (shoulder, hand, Achilles, and other) pain, swelling, or inflammation occur. If tendon symptoms occur, avoid exercise and use of the affected area. Increased risk in >65 yrs old, kidney, heart and lung transplant recipients, and patients taking corticosteroids concurrently. Therapy should be discontinued.
  19. clindamycin
    • Class: anti-infective 
    • Indication:  Treatment of Skin and skin structure infections, Respiratory tract infections, Septicemia, Intra-abdominal infections, Gynecologic infections, Osteomyelitis, Endocarditis prophylaxis. Topical-Severe acne.
    • Action: Inhibits protein synthesis in susceptible bacteria at the level of the 50S ribosome.
    • Side effects: pseudo, dnv, dizziness, 
    • assessment: asses infection, assess bowel, assess for sensitivity reaction
    • Teaching: complete therapy, ake missed doses as soon as possible unless almost time for next dose. Do not double doses. Advise patient that sharing of this medication may be dangerous. Instruct patient to notify health care professional immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals; report signs of superinfection, Caution patient applying topical clindamycin that solution is flammable (vehicle is isopropyl alcohol). Avoid application while smoking or near heat or flame.
  20. Clotrimazole (Lotrimin)
    • Class: antifungal 
    • Indication: Treatment or prevention of oropharyngeal candidiasis
    • Action: Affects the permeability of the fungal cell wall, allowing leakage of cellular contents
    • Side effect: abnormal mouth sensations, ↑ liver function tests, nausea, vomiting, itching 
    • Assessments: Assess oropharnyngeal mucosa prior to and periodically during therapy.
    • Teaching: Instruct patient to take clotrimazole as directed. Allow each troche to slowly dissolve in mouth
  21. methylphenidate (Concerta)
    • Class: CNS stimulant 
    • Indication: Treatment of ADHD (adjunct)
    • Action: Produces CNS and respiratory stimulation with weak sympathomimetic activity and increases attention span in ADHD
    • Side effects: hyperactivity, insomnia, restlessness, tremor, sudden death, hypertension, palpitations, tachycardia, anorexia, dnv, anaphylaxis, angioedema,  
    • Assesment: Monitor BP, pulse, and respiration before administering and periodically during therapy. Obtain a history (including assessment of family history of sudden death or ventricular arrhythmia), physical exam to assess for cardiac disease, and further evaluation; If exertional chest pain, unexplained syncope, or other cardiac symptoms occur, evaluate promptly; Monitor growth, both height and weight, in children on long-term therapy; Assess children for attention span, impulse control, and interactions with others. Therapy may be interrupted at intervals to determine whether symptoms are sufficient to continue therapy; 
    • Teaching: take as directed; do not double doses, avoid caffeine, Advise parents to notify school nurse of medication regimen; hcp may order days w/o therapy to assess progress
  22. cyclophosphamide (Cytoxan) *high risk*
    • Class: antineoplastic; alkylating agent 
    • Indication: management of Hodgkin's disease, Malignant lymphomas, Multiple myeloma, Leukemias, Mycosis fungoides, Neuroblastoma,
    • Action: Interferes with DNA replication and RNA transcription, ultimately disrupting protein synthesis; death of rapidly growing cells
    • Side effects: pulmonary fibrosis, myocardial fibrosis, anorexia, n/v, hemorragic cystitis, hematuria, alopecia, leukopenia, thrombocytopenia, 
    • Assessment: Monitor urinary output frequently during therapy. To reduce the risk of hemorrhagic cystitis, fluid intake should be at least 1000-2000mL/day; Monitor for bone marrow depression. Assess for bleeding (bleeding gums, bruising, petechiae, guaiac stools, urine, and emesis) and avoid IM injections and taking rectal temperatures if platelet count is low. Apply pressure to venipuncture sites for 10 min. Assess for signs of infection during neutropenia. Anemia may occur. Monitor for increased fatigue, dyspnea, and orthostatic hypotension; Antiemetics may be given 30 min before administration of medication to minimize GI effects; Assess cardiac and respiratory status for dyspnea, rales/crackles, cough, weight gain, edema. Pulmonary toxicity may occur after prolonged therapy. Cardiotoxicity may occur early in therapy and is characterized by symptoms of HF.
    • Teaching:Instruct patient to take dose in early morning. Emphasize need for adequate fluid intake for 72 hr after therapy; Instruct patient to notify health care professional promptly if fever; sore throat; signs of infection; lower back or side pain; difficult or painful urination; sores in the mouth or on the lips; yellow discoloration of skin or eyes; bleeding gums; bruising; petechiae; blood in urine, stool, or emesis; unusual swelling of ankles or legs; joint pain; shortness of breath; cough, palpitations, weight gain of more than 5 lb in 24 hr, dizziness, loss of consciousness or confusion occurs; Caution patient to avoid crowds and persons with known infections. Instruct patient to use soft toothbrush and electric razor and to avoid falls. Patient should also be cautioned not to drink alcoholic beverages or to take products containing aspirin or NSAIDs; may precipitate GI hemorrhage.
  23. desmopressin (DDAVP)
    • Class: hormone/ anti-diuretic 
    • Indication:  Treatment of central diabetes insipidus caused by a deficiency of vasopressin.
    • Action: An analogue of naturally occurring vasopressin; Primary action is enhanced reabsorption of water in the kidneys.
    • Side effects: seizures, water intoxication, nasal congestion, flushing
    • Assessment: Monitor urine and plasma osmolality and urine volume frequently. Assess patient for symptoms of dehydration (excessive thirst, dry skin and mucous membranes, tachycardia, poor skin turgor). Weigh patient daily and assess for edema; Signs and symptoms of water intoxication include confusion, drowsiness, headache, weight gain, difficulty urinating, seizures, and coma, if this occurs decrease dose; and possible lasix
    • Teaching:  Instruct patient on intranasal administration. Medication is supplied with a flexible calibrated catheter (rhinyle). Draw solution into rhinyle. Insert one end of tube into nostril, blow on the other end to deposit solution deep into nasal cavity. An air-filled syringe may be attached to the plastic catheter for children, infants, or obtunded patients. Tube should be rinsed under water after each use; do not double dose; Patients with diabetes insipidus should carry identification at all times describing disease process and medication regimen.
  24. Deferoxamine (Desferal)
    • Class: Antidote; heavy metal antagonist 
    • Indication: Acute toxic iron ingestion. 
    • Action: Chelates unbound iron, forming a water-soluble complex in plasma that is easily excreted by the kidneys.
    • Side effects: blurred vision, red urine, pain at site, erythema, abdominal pain, ototoxicity 
    • Assessment: n acute poisoning, assess time, amount, and type of iron preparation ingested; early acute (abdominal pain, bloody diarrhea, emesis), late acute (decreased level of consciousness, shock, metabolic acidosis); Report hypotension, erythema, urticaria, or signs of allergic reaction. Keep epinephrine, an antihistamine, and resuscitation equipment close by in the event of an anaphylactic reaction; report decreased visual or hearing acuity; Monitor intake and output and urine color.
    • Teaching: reinforce safety education to parents; red urine is expected; advise pt to not take vitamin C; eye and hearing exams should be monitored q 3 moths
  25. Dexamethasone (decadron)
    • Class: anti-inflammatory/ steroid
    • indication: management of Inflammatory, Allergic, Hematologic, Endocrine, Neoplastic, Dermatologic, Autoimmune disorders, Management of cerebral edema, Diagnostic agent in adrenal disorders
    • Action: In pharmacologic doses, suppresses inflammation and the normal immune response.
    • Side effects: depression, euphoria, increased ICP in kids, HTN, peptic ulcer, anorexia, acne, decreased wound healing; ecchymoses, hirsutism,petechiae, moon face, buffalo hump), ↑ susceptibility to infection; muscle wasting, thromboembolism 
    • Assessments: Assess involved systems before and periodically during therapy; Assess for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy; Assess for changes in level of consciousness and headache throughout therapy; Assess for changes in level of consciousness and headache throughout therapy; monitor I&O and daily weights
    • Teaching: Instruct patient on correct technique of medication administration. Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately; may cause immunosupression and mask symptoms of infection, avoid large crowds and those with contagious illness, nal.Review side effects with patient. Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occur. Patient should also report unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances;
  26. digoxin (lanoxin) *high alert*
    • Class: digitalis glycoside
    • Indication: HF, A-Fib, Atrial flutter
    • Action: Increases the force of myocardial contraction .Prolongs refractory period of the AV node. Decreases conduction through the SA and AV nodes.
    • Side effects: fatigue, ARRHYTHMIAS, bradycardia
    • Assessment: Monitor apical pulse for 1 full min before administering. Withhold dose and notify health care professional if pulse rate is <70 bpm;Monitor ECG throughout IV administration and 6 hr after each dose. Notify health care professional if bradycardia or new arrhythmias occur; monitor I&O; Assess for peripheral edema, and auscultate lungs for rales/crackles throughout therapy.
    • Teaching:Teach parents or caregivers that changes in heart rate, especially bradycardia, are among the first signs of digoxin toxicity in infants and children. Instruct parents or caregivers in apical heart rate assessment and ask them to notify health care professional if heart rate is outside of range set by health care professional before administering the next scheduled dose; carry I card, do not double doses
  27. Diphenhydramine HCL (Benadryl)
    • Class: allergy, cold and cough remedies antihistamines antitussives
    • Indication: Relief of allergic symptoms caused by histamine release including; antitussitive(syrup) 
    • Action: Antagonizes the effects of histamine at H1-receptor sites; does not bind to or inactivate histamine.
    • Side effects: drowsiness, dry mouth, anorexia
    • Assessment: assess for effectiveness 
    • Teaching: Instruct patient to take medication as directed; do not exceed recommended amount. Caution patient not to use oral OTC diphenhydramine products with any other product containing diphenhydramine, including products used topically; Can cause excitation in children. Caution parents or caregivers about proper dose calculation; overdose, especially in infants and children, can cause hallucinations, seizures, or death. Caution parents to avoid OTC cough and cold products while breast feeding or to children <4 yr.
  28. edetate calcium disodium (EDTA)
    • Class: antidote/chelating therapy
    • Indication: Management of acute and chronic lead poisoning, including encephalopathy and nephropathyAction: Removes toxic amounts of lead or other divalent or trivalent cations by their displacement of calcium in edetate calcium disodium. Result is a soluble complex that is excreted by the kidneys.
    • Side Effects: headache; pain at IM site; nephrotoxicity
    • Assessment: Assess patient and family members for evidence of lead poisoning prior to and periodically throughout therapy. Acute lead poisoning is characterized by a metallic taste, colicky abdominal pain, vomiting, diarrhea, oliguria, and coma;
    • Teaching: Discuss need for follow-up appointments to monitor lead levels. Additional treatments may be necessary.
  29. Lidocaine (EMLA)
    • Class: anesthesia
    • Indication: Produces local anesthesia prior to minor painful procedures including (circumcision, IM injections) 
    • Action: Produces local anesthesia by inhibiting transport of ions across neuronal membranes, thereby preventing initiation and conduction of normal nerve impulses
    • Side effects: blanching, redness, anaphylaxis
    • Assessment: Assess application site for open wounds. Apply only to intact skin.Assess application site for anesthesia following removal of system and prior to procedure.
    • Teaching: Instruct patient or parent in proper application. Provide a diagram of location for application; explain purpose
  30. pimecrolimus (Elidel)
    • Class: immunosuppressants
    • Indication: Short-term and intermittent long-term management of mild to moderate atopic dermatitis 
    • Action: Inhibits T-cell and mast cell activation by interfering with production of inflammatory cytokines
    • Side effects: burning 
    • Assessments: Assess skin lesions prior to and periodically during therapy. Discontinue therapy after signs and symptoms of atopic dermatitis have resolved. Resume treatment at the first signs and symptoms of recurrence.
    • Teaching: Instruct patient on correct technique for application. Apply only as directed to external areas. Wash hands following application, unless hands are areas of application; Caution patient to avoid exposure to natural or artificial sunlight, including tanning beds, while using cream.Advise patient that pimecrolimus may cause skin burning. This occurs most commonly during first few days of application, is of mild to moderate severity, and improves within 5 days or as atopic dermatitis resolves.
  31. permethrin (Elimite)
    • Class: pediculocides
    • Indication: Eradication of Pediculus humanus capitis (head lice and their eggs); Prevention of infestation of head lice during epidemics. 5% cream-Eradication of Sarcoptes scabiei (scabies).
    • Action: Causes repolarization and paralysis in lice by disrupting sodium transport in normal nerve cells
    • Side effects: burning, itching, rash, redness, stinging, swelling
    • Assessments: Assess scalp for presence of lice and their ova (nits) prior to and 1 wk after application of permethrin. Scabies-Assess skin for scabies prior to and following therapy.
    • Teaching: Instruct patient to notify health care professional if scalp itching, numbness, redness, or rash occurs; avoid getting in eyes; others in house should be checked/treated; Instruct patient to wash hair with regular shampoo, rinse, and towel dry. Each container holds enough medication for one treatment. Shake the container well. Thoroughly wet scalp and hair with the lotion. The patient should use as much of the solution as needed to coat entire head of hair, then discard remainder of solution. Allow lotion to remain on hair for 10 min, then thoroughly rinse hair and towel dry with a clean towel. Comb hair with a fine-toothed comb to remove dead lice and eggs;Explain to patient that permethrin will protect from reinfestation for 2 wk. These effects continue even when the patient resumes regular shampooing; Scabies- Instruct patient to massage thoroughly into the skin from head to soles of feet. Treat infants on the hairline, neck, scalp, temple, and forehead. Remove the cream by washing after 8–14 hr. One application is sufficient
  32. Epinephrine (adrenalin, Epipen) *High alert*
    • Class: antiasthmatics, bronchodilators, vasopressors
    • Indication:Management of reversible airway disease due to asthma or COPD, Management of severe allergic reactions, croup; cardiac arrest
    • Action: Bronchodilation, Maintenance of heart rate and BP.
    • Side effects: nervousness, restlessness, tremor, angina, arrhythmias, hypertension, tachycardia, PARADOXICAL BRONCHOSPASM 
    • Assessments: Assess lung sounds, respiratory pattern, pulse, and BP before administration and during peak of medication. Note amount, color, and character of sputum produced, and notify health care professional of abnormal findings, Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold medication and notify health care professional immediately. Assess for hypersensitivity reaction (rash; urticaria; swelling of the face, lips, or eyelids). If condition occurs, withhold medication; Monitor BP, pulse, ECG, and respiratory rate frequently during IV administration. Continuous ECG, hemodynamic parameters, and urine output should be monitored continuously during IV administration; monitor for chest pain, arrhythmias, heart rate >110 bpm, and hypertension. Consult physician for parameters of pulse, BP, and ECG changes
    • Teaching: Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain; Advise patients to use bronchodilator first if using other inhalation medications, and allow 5 min to elapse before administering other inhalant medications, unless otherwise directed.Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth.Advise patient to maintain adequate fluid intake (2000–3000 mL/day) to help liquefy tenacious secretions
  33. Erythromycin (Pediazole)
    • Class: anti-infective; macrolide antibiotic 
    • Indiction: Upper and lower respiratory tract infections, Otitis media (with sulfonamides), Skin and skin structure infections, Pertussis, Diphtheria,
    • Action: Suppresses protein synthesis at the level of the 50S bacterial ribosome.
    • Side effects: TORSADE DE POINTES, VENTRICULAR ARRHYTHMIAS, QT interval prolongation; PseudoMC, phlebitis at IV site, rash, infantile hypertrophic pyloric stenosis, 
    • Assessments: assess infection, Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
    • Teaching: take as directed, finish regimen, notify health care professional if these effects persist or if severe abdominal pain, yellow discoloration of the skin or eyes, darkened urine, pale stools, or unusual tiredness develops. May cause infantile hypertrophic pyloric stenosis in infants; notify health care professional if vomiting and irritability occur. Caution patient to notify health care professional if fever and diarrhea occur, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication.Advise patient to report signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools).
  34. Ferrous Sulfate, ferrous
    gluconate, or ferrous fumarate
    • Class:iron supp/ antianemic
    • Indication:Treatment & prevention iron deficiency anemia.
    • Action: Enters the bloodstream and is transported to the organs of the reticuloendothelial system (liver, spleen, bone marrow) where it becomes part of iron stores
    • Side effects: teeth staining, nausea, constipation, dark stools, epigastric pain, GI bleeding, vomiting
    • Assessments: Assess nutritional status and dietary history to determine possible cause of anemia and need for patient teaching.Assess bowel function for constipation or diarrhea. Notify physician or other health care professional and use appropriate nursing measures should these occur.
    • Teaching: Encourage patient to comply with medication regimen. Take missed doses as soon as remembered within 12 hr; otherwise, return to regular dosing schedule. Do not double doses; Advise patient that stools may become dark green or black.Instruct patient to follow a diet high in iron; Discuss with parents the risk of a child overdosing on iron. Medication should be stored in the original childproof container and kept out of reach of children. Do not refer to vitamins as candy. In the event of a suspected overdose, parents should contact poison control center
  35. Filgrastim (Neupogen)
    • class: colony-stimulating factors
    • indication:Reduction of time for neutrophil recovery and duration of fever in patients undergoing induction and consolidation chemotherapy for acute myelogenous leukemia.
    • Action: A glycoprotein, filgrastim binds to and stimulates immature neutrophils to divide and differentiate. Also activates mature neutrophils.
    • Side effects: SPLENIC RUPTURE, splenomegaly; ACUTE RESPIRATORY DISTRESS SYNDROME; allergic reaction; bone pain; thrombocytopenia 
    • Assessments: Monitor heart rate, BP, and respiratory status before and periodically during therapy.Assess bone pain throughout therapy. Pain is usually mild to moderate and controllable with nonopioid analgesics; Monitor for signs and symptoms of allergic reactions, usually occur 30 min after admin; Assess for signs and symptoms of acute respiratory distress syndrome (fever, lung infiltrates, or respiratory distress). If symptoms occur, withhold filgrastim until symptoms resolve
    • Teaching: explain purpose; Instruct patient on correct technique and proper disposal for home administration. Caution patient not to reuse needle, vial, or syringe. Provide patient with a puncture-proof container for needle and syringe disposal.
  36. Furosemide (lasix)
    • Class: loop diuretic
    • Indication: Edema due to heart failure, hepatic impairment or renal disease. Hypertension.
    • Action: nhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule
    • Side effects: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia,hyponatremia, hypovolemia, metabolic alkalosis, ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS; APLASTIC ANEMIA, AGRANULOCYTOSIS
    • Assessments:Assess fluid status. Monitor daily weight, intake and output ratios, amount and location of edema, lung sounds, skin turgor, and mucous membranes. Notify health care professional if thirst, dry mouth, lethargy, weakness, hypotension, or oliguria occurs; Monitor BP and pulse before and during administration; Assess patient for tinnitus and hearing loss; assess allergy to sulfas; Assess patient for skin rash frequently during therapy. Discontinue furosemide at first sign of rash; may be life-threatening
    • Teaching: Caution patient to change positions slowly to minimize orthostatic hypotension; Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions.Advise patient to contact health care professional immediately if rash, muscle weakness, cramps, nausea, dizziness, numbness, or tingling of extremities occurs.
  37. Gamma Globulin (immune globulin)
    • Class: vaccines/immunizing agents
    • Indication: Provides passive immunity to a variety of infections including-Hepatitis A, Measles (rubeola) when immune sera are unavailable or when there is insufficient time for active immunization to take place; prevention of bacterial infections in kids with hiv; treatment of kawasaki
    • Action: A human serum fraction containing gamma globulin antibodies (IgG). 
    • Side effect:  THROMBOEMBOLIC EVENTS, chest pain, vascular occlusion, renal failure, : muscle stiffness, pain, tenderness at site; anaphylaxsis
    • Assessments: For passive immunity, determine the date of exposure to infection. Immune globulin should be administered within 2 wk of exposure to hepatitis A and within 6 days after exposure to measles; Monitor vital signs continuously during infusion of immune globulin IV and assess patient for signs of anaphylaxis (hypotension, flushing, chest tightness, wheezing, fever, dizziness, nausea, vomiting, diaphoresis) for 1 hr following initiation of infusion.
    •  Teaching: Explain the use and purpose of immune globulin therapy to the patient. Instruct patient and parents administering subcut immune globulin at home the correct technique for administration and care of equipment.Advise patient to report symptoms of anaphylaxis immediately. Inform patients that pain, tenderness, and muscle stiffness at the injection site may occur following IM injections of immune globulin; Instruct patient to notify health care professional immediately if decreased urine output, sudden weight gain, edema, or shortness of breath occur.
  38. somatropin (Growth Hormone)
    • Class: growth hormone 
    • Indication: Growth failure in children due to inadequate secretion of growth hormone.
    • Action: Produce growth (skeletal and cellular).
    • Side effect: edema of the hands and feet; pain at injection site
    • Assessment: Monitor bone age annually and growth rate determinations, height, and weight every 3–6 mo during therapy.
    • Teaching:Instruct patient and parents on correct procedure for reconstituting medication, site selection, technique for subcut injection, and disposal of needles and syringes. Review dosage schedule. Parents should report persistent pain or edema at injection site; xplain rationale for prohibition of use for increasing athletic performance. Administration to persons without growth hormone deficiency or after epiphyseal closure may result in acromegaly; GH is synthetic; dicuss need for follow up
  39. Gentamicin
    • Class: aminoglycoside, anti-infective
    • Indication: Treatment of serious gram-negative bacterial infections and infections caused by staphylococci when penicillins or other less toxic drugs are contraindicated.
    • Action: Inhibits protein synthesis in bacteria at level of 30S ribosome.
    • Side effects: ataxia, vertigo, ototoxicity, nephrotoxicity 
    • Assessment: assess infection, Evaluate eighth cranial nerve function by audiometry before and throughout therapy. Hearing loss is usually in the high-frequency range. Prompt recognition and intervention are essential in preventing permanent damage. Also monitor for vestibular dysfunction; Monitor intake and output and daily weight to assess hydration status and renal function.Assess for signs of superinfection.
    • Teaching: Instruct patient to report signs of hypersensitivity, tinnitus, vertigo, hearing loss, rash, dizziness, or difficulty urinating.Advise patient of the importance of drinking plenty of liquids. Instruct patient to wash affected skin gently and pat dry. Apply a thin film of ointment. Apply occlusive dressing only if ordered by health care professional. Patient should assess skin and inform health care professional if skin irritation develops or infection worsens.
  40. Hydrocortisone
    • class: anti-inflammatory; steroidal
    • Indication:Management of adrenocortical insufficiency; chronic use in other situations is limited because of mineralocorticoid activity; Used systemically and locally in a wide variety of disorders including; Inflammatory, Allergic, Hematologic, Neoplastic, Autoimmune disorders, Septic shock.
    • Action: In pharmacologic doses, suppresses inflammation and the normal immune response.
    • Side effects: depression, euphoria, headache, ↑ intracranial pressure (children only),hypertension, PEPTIC ULCERATION, anorexia, nausea,  acne, ↓ wound healing, ecchymoses, fragility, hirsutism, petechiae,  adrenal suppression, THROMBOEMBOLISM, muscle wasting, anaphylaxsis, moon face, buffalo hump), ↑ susceptibility to infection
    • assessment: Assess involved systems prior to and periodically during therapy.Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) prior to and periodically during therapy.Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional should these occur.Children should have periodic evaluations of growth. assess for ulcerative colitis
    • Teaching: Take missed doses as soon as remembered unless almost time for next dose. Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life-threatening; Corticosteroids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections immediately.Caution patient to avoid vaccinations without first consulting health care professional.Review side effects with patient. Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occur. Patient should also report unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or behavior changes.
  41. Ibuprofen (advil, motrin)
    • Class: NSAID, antipyretic, non-opioid analgesic
    • Indication: Treatment of:Mild to moderate pain,Fever.
    • Action: Inhibits prostaglandin synthesis.
    • Side Effects: headache, GI bleeding, constipation, dyspepsia, nausea, hepatitis, EXFOLIATIVE DERMATITIS, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, anaphylaxis
    • Assessments: Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions. Assess for rhinitis, asthma, and urticaria.Assess for signs and symptoms of GI bleeding (tarry stools, lightheadedness, hypotension), renal dysfunction (elevated BUN and creatinine levels, decreased urine output), and hepatic impairment (elevated liver enzymes, jaundice) Assess patient for skin rash frequently during therapy. Discontinue ibuprofen at first sign of rash, assess pain, monitor temp, PDA Closure- Monitor preterm neonates for signs of bleeding, infection and decreased urine output. Monitor IV site for signs of extravasation.
    • Teaching: Advise patients to take ibuprofen with a full glass of water and to remain in an upright position for 15–30 min after administration; avoid the concurrent use of alcohol, aspirin, acetaminophen, and other OTC or herbal products without consulting health care professional; Advise parents or caregivers not to administer ibuprofen to children who may be dehydrated (can occur with vomiting, diarrhea, or poor fluid intake); dehydration increases risk of renal dysfuntion.
  42. Indocin (Indomethacin)
    • class: antirheumaticsductus arteriosus patency adjuncts (IV only)nonsteroidal anti inflammatory agents
    • Indication: Alternative to surgery in the management of patent ductus arteriosus (PDA) in premature neonates.
    • Action: Inhibits prostaglandin synthesis. In the treatment of PDA, decreased prostaglandin production allows the ductus to close. 
    • Side effects: dizziness, drowsiness, headache, psychic disturbances, DRUG-INDUCED HEPATITIS, GI BLEEDING, constipation, dyspepsia, nausea, vomiting, anaphylaxis
    • Assessments: Patients who have asthma, aspirin-induced allergy, and nasal polyps are at increased risk for developing hypersensitivity reactions; Monitor respiratory status, heart rate, BP, echocardiogram, and heart sounds routinely throughout therapy.
    • Teaching:  Explain to parents the purpose of medication and the need for frequent monitoring.
  43. Levothyroxine (Synthroid)
    • Class: Hormone/ thyroid prep
    • Indication: Thyroid supplementation in hypothyroidism. Treatment or suppression of euthyroid goiters.
    • Action: Replacement of or supplementation to endogenous thyroid hormones.Principal effect is increasing metabolic rate of body tissues
    • Side effect: headache, insomnia, irritability, angina pectoris, arrhythmias, tachycardia, heat intolerance weight loss, accelerated bone maturation in children
    • Assessment: Assess apical pulse and BP prior to and periodically during therapy. Assess for tachyarrhythmias and chest pain; Monitor height, weight, and psychomotor development.
    • Teaching: Instruct patient to take medication as directed at the same time each day. Take missed doses as soon as remembered unless almost time for next dose. If more than 2–3 doses are missed, notify health care professional. Do not discontinue without consulting health care professional, Explain to patient that medication does not cure hypothyroidism; it provides a thyroid hormone supplement. Therapy is lifelong; stress importance of follow up; Discuss with parents the need for routine follow-up studies to ensure correct development. Inform patient that partial hair loss may be experienced by children on thyroid therapy. This is usually temporary.
  44. Methylphenidate (Ritalin)
    • Class: CNS stimulant
    • Indication: Treatment of ADHD
    • Action: Produces CNS and respiratory stimulation with weak sympathomimetic activity.
    • Side effects: hyperactivity, insomnia, restlessness, tremor;SUDDEN DEATH, hypertension, palpitations, tachycardia, growth suppression,angioedema, anaphylaxis
    • Assessments:  Monitor BP, pulse, and respiration before administering and periodically during therapy. Obtain a history (including assessment of family history of sudden death or ventricular arrhythmia), physical exam to assess for cardiac disease, and further evaluation;  Monitor growth, both height and weight, in children on long-term therapy. Assess children for attention span, impulse control, and interactions with others. Therapy may be interrupted at intervals to determine whether symptoms are sufficient to continue therapy.
    • Teaching: Instruct patient to take medication as directed. If an oral dose is missed, take the remaining doses for that day at regularly spaced intervals; do not double doses. Take the last dose before 6 pm to minimize the risk of insomnia. Instruct patient not to alter dose without consulting health care professional. Abrupt cessation of high doses may cause extreme fatigue and mental depression; Advise patient to check weight 2–3 times weekly and report weight loss to health care professional. Avoid caffeine; notify school nurse of regimen; parents should be aware that HCP may schedule days w/o regimen to note progress/effectiveness
  45. Metoclopramide (Reglan)
    • Class: antiemetic 
    • Indication: Prevention of chemotherapy-induced emesis.Treatment of postsurgical and diabetic gastric stasis; management of GER
    • Action: Blocks dopamine receptors in chemoreceptor trigger zone of the CNS
    • Side effect: drowsiness, extrapyramidal reactions, restlessness, NEUROLEPTIC MALIGNANT SYNDROME,
    • Assessment: Assess for nausea, vomiting, abdominal distention, and bowel sounds before and after administration; Monitor for neuroleptic malignant syndrome (hyperthermia, muscle rigidity, altered consciousness, irregular pulse or BP, tachycardia, and diaphoresis).Assess for signs of depression periodically throughout therapy.
    • Teaching: Instruct patient to take metoclopramide as directed. Take missed doses as soon as remembered if not almost time for next dose; Unintentional overdose has been reported in infants and children with the use of metoclopramide oral solution. Teach parents how to accurately read labels and administer medication; Inform patient of risk of extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome. Advise patient to notify health care professional immediately if involuntary or repetitive movements of eyes, face, or limbs occur.
  46. Morphine *High Alert*
    • Class: Opioid Anlagesic
    • Indication: Severe pain
    • Action: Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression.
    • Side Effect: confusion, sedation, dizziness, dysphoria, euphoria, RESP depression, constipation, hypotension
    • Assessment: Pain assessment/effectiveness of medication; monitor bowel function, increase fluids, fiber, and laxatives may be used; Assess pediatric patient frequently; children are more sensitive to the effects of opioid analgesics and may experience respiratory complications, excitability and restlessness more frequently; Assess level of consciousness, BP, pulse, and respirations before and periodically during administration. If respiratory rate is <10/min, assess level of sedation. Physical stimulation may be sufficient to prevent significant hypoventilation
    • Teaching: Advise patient to change positions slowly to minimize orthostatic hypotension; : Teach parents or caregivers how to accurately measure liquid medication and to use only the measuring device dispensed with the medication; emphasize importance of prevention of constipation
  47. Naloxone (Narcan)
    • Class: antidote/ opioid antagonist 
    • Indication: Reversal of CNS depression and respiratory depression because of suspected opioid overdose
    • Action: Reversal of CNS depression and respiratory depression because of suspected opioid overdose
    • Side effects: ventricular arrhythmias, HTN, Nausea and vomiting
    • Assessments: Monitor respiratory rate, rhythm, and depth; pulse, ECG, BP; and level of consciousness frequently for 3–4 hr after the expected peak of blood concentrations; Assess patient for level of pain after administration when used to treat postoperative respiratory depression. Naloxone decreases respiratory depression but also reverses analgesia.
    • Teaching: explain purpose and effects of naloxone to patient.
  48. Prednisolone (Orapred/Pediapred/Prelone)
    • Class: anti-inflammatories (steroidal) (intermediate-acting)
    • Indication: Used systemically and locally including- Inflammatory, Allergy 
    • Action: In pharmacologic doses, suppresses inflammation and the normal immune response.
    • Side Effect: depression, euphoria, headache, ↑ intracranial pressure (children only), HTN, peptic ulceration, anorexia, adrenal suppression,  acne, ↓ wound healing, ecchymoses, fragility, hirsutism, petechiae, thromboembolism, muscle wasting, osteoporosis, avascular necrosis of joints, muscle pain, cushingoid appearance (moon face, buffalo hump), ↑ susceptibility to infection
    • Assessment: Assess patient for signs of adrenal insufficiency; monitor I&O and daily weights, Children should have periodic evaluations of growth; watch for signs of infection
    • Teaching: Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency; ause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections immediately
  49. Oxybutynin (Ditropan)
    • Class: urinary tract antispasmodics/ anticholinergic
    • Indication: Urinary symptoms that may be associated with neurogenic bladder including- Frequent urination, Urgency, Nocturia, Urge incontinence.
    • Action: Inhibits the action of acetylcholine at postganglionic receptors.
    • Side effects: dizziness, drowsiness, agitation, confusion, constipation, dry mouth, nausea, abdominal pain, decreased sweating, angioedema, anaphylaxis
    • Assessments: Monitor voiding pattern and intake and output ratios, and assess abdomen for bladder distention prior to and periodically during therapy. Catheterization may be used to assess post void residual;
    • Teaching: Instruct patient that frequent rinsing of mouth, good oral hygiene, and sugarless gum or candy may decrease dry mouth; Advise patient to stop taking oxybutinin and notify health care professional immediately if signs of angioedema and/or anaphylaxis; Inform patient that oxybutynin decreases the body's ability to perspire. Avoid strenuous activity in a warm environment because overheating may occur.
  50. Pancrelipase
    • Class: digestive agent/pancreatic enzyme
    • Indication: Chronic pancreatitis, Pancreatectomy, Cystic fibrosis
    • Action: Contains lipolytic, amylolytic, and proteolytic activity, used to digest fat, carbs and protein
    • Side Effects: fibrosing colonpathy, abdominal pain (high doses only), diarrhea, nausea, stomach cramps, allergic reactions
    • Assessments: Assess patient's nutritional status (height, weight, skin-fold thickness, arm muscle circumference, and lab values) prior to and periodically throughout therapy, Monitor stools for high fat content (steatorrhea). Stools will be foul-smelling and frothy, assess for allergy to pork; 
    • Teaching: Encourage patients to comply with diet recommendations of health care professional (generally high-calorie, high-protein, low-fat); Instruct patient not to chew tablets and to swallow them quickly with plenty of liquid to prevent mouth and throat irritation; Eating immediately after taking medication helps further ensure that the medication is swallowed and does not remain in contact with mouth and esophagus for a prolonged period; Advise patients and caregivers notify health care professional if symptoms of fibrosing colonopathy (abdominal pain, distention, vomiting, constipation) occur
  51. Penicillin
    • Class: Anti-infective
    • Indication: Pneumococcal pneumonia, Streptococcal pharyngitis
    • Action: Bind to bacterial cell wall, resulting in cell death.
    • Side Effect: seizures, anaphylaxis, serum sickness, diarrhea, epigastric distress, nausea, vomiting, pseudomembranous colitis, rash, pain at site
    • Assessment: Assess infection, ask about allergies to penicillin, observe for signs of anaphylaxis
    • Teaching: instruct patient to finish regimen, notify HCP if signs of superinfection or anaphylaxis occur
  52. Phenobarbital
    • Class: anticonvulsants/sedative/hypnotics
    • Indication: Anticonvulsant in tonic-clonic (grand mal), partial, and febrile seizures in children. Preoperative sedative and in other situations in which sedation may be required. Hypnotic (short-term).
    • Action: Produces all levels of CNS depression. Depresses the sensory cortex, decreases motor activity, and alters cerebellar function. Inhibits transmission in the nervous system and raises the seizure threshold.
    • Side Effect: hangover, resp depression, lethargy drowsiness, laryngospasm, angioedema, serum sickness
    • Assessment: Monitor respiratory status, pulse, and BP and signs and symptoms of angioedema (swelling of lips, face, throat, dyspnea) frequently in patients receiving phenobarbital IV. Equipment for resuscitation and artificial ventilation should be readily available; Assess location, duration, and characteristics of seizure activity; may cause dependence. 
    • Teaching: Take as directed, Abrupt withdrawal may precipitate seizures or status epilepticus; Advise patient to notify health care professional if signs and symptoms of angioedema, fever, sore throat, mouth sores, unusual bleeding or bruising, nosebleeds, or petechiae occur; Advise parents or caregivers that child may experience irritability, hyperactivity, and/or sleep disturbances, which may diminish in a few days to a few weeks or may persist until drug is stopped. An alternative medication can be considered. Instruct parents to monitor for skin rash occurring 7–20 days after treatment begins and to contact a health care provider if rash occurs. Teach family about symptoms of toxicity (staggering, drowsiness, slurred speech).
  53. Phenytoin (Dilantin)
    • Class: antiarrhythmics (group IB) anticonvulsants
    • Indication: Treatment/prevention of tonic-clonic (grand mal) seizures and complex partial seizures.
    • Action: Limits seizure propagation by altering ion transport. May also decrease synaptic transmission. Antiarrhythmic properties as a result of shortening the action potential and decreasing automaticity.
    • Side effects: suicidal thoughts, ataxia, diplopia, nystagmus, hypotension, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, hypertrichosis, rash, agranulocytosis, aplastic anemia
    • Assessments: Assess patient for phenytoin hypersensitivity syndrome (fever, skin rash, lymphadenopathy). Rash usually occurs within the first 2 wk of therapy. Hypersensitivity syndrome usually occurs at 3–8 wk but may occur up to 12 wk after initiation of therapy. May lead to renal failure, rhabdomyolysis, or hepatic necrosis; may be fatal; Discontinue phenytoin at the first sign of skin reactions; Discontinue phenytoin at the first sign of skin reactions; assess location, duration, frequency, and characteristics of seizure activity; monitor ECG frequently 
    • Teaching: take as directed, maintain good dental hygiene, Instruct patients that behavioral changes, skin rash, fever, sore throat, mouth ulcers, easy bruising, petechiae, unusual bleeding, abdominal pain, chills, pale stools, dark urine, jaundice, severe nausea or vomiting, drowsiness, slurred speech, unsteady gait. swollen glands,or persistent headache should be reported to health care professional immediately; in older kids assess behavior and moods;
  54. Prednisone
    • Class: anti-inflammatories (steroidal)
    • Indication: Used systemically and locally including- Inflammatory, Allergy 
    • Action: In pharmacologic doses, suppresses inflammation and the normal immune response.
    • Side Effect: depression, euphoria, headache, ↑ intracranial pressure (children only), HTN, peptic ulceration, anorexia, adrenal suppression,  acne, ↓ wound healing, ecchymoses, fragility, hirsutism, petechiae, thromboembolism, muscle wasting, osteoporosis, avascular necrosis of joints, muscle pain, cushingoid appearance (moon face, buffalo hump), ↑ susceptibility to infection
    • Assessment: Assess patient for signs of adrenal insufficiency; monitor I&O and daily weights, Children should have periodic evaluations of growth; watch for signs of infection
    • Teaching: Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency; ause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious illnesses and to report possible infections immediately
  55. Prostaglandin E
    • Class: PDA adjunct, prostaglandin 
    • Indication: Temporary maintenance of patent ductus arteriosus in neonates who depend on patency until surgery can be performed.
    • Action: Directly relaxes smooth muscle of the ductus arteriosus.
    • Side Effects: seizures, hypotension, apnea, irritability, bradycardia, HF, flushing, DIC, fever, thrombocytopenia
    • Assessment:  Monitor temperature, respiratory rate, pulse, BP, and ECG continuously during therapy. In neonates with aortic arch anomalies, monitor pulmonary artery and descending aorta pressures, and urinary output. Palpate femoral pulse frequently to assess circulation to lower extremities. Assess respiratory status (lung sounds, arterial blood gases) and heart sounds frequently. Monitor neurologic status closely. Observe for seizure activity. Monitor for the development of HF. Neonates <2 kg are at higher risk of developing respiratory (apnea, wheezing), cardiovascular (bradycardia, hypotension), and neurologic effects. 
    • Teaching: Explain to the parents the purpose of alprostadil and the need for continuous monitoring.
  56. Ranitidine (zantac)
    • Class: histamine h2 antagonists/antiulcer
    • Indication: Treatment of gastroesophageal reflux disease (GERD).
    • Action: Inhibits the action of histamine at the H2-receptor site located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion
    • Side effects: confusion, arrythmias, agranulocytosis, aplastic anemia
    • Assessment: Assess patient for epigastric or abdominal pain and frank or occult blood in the stool, emesis, or gastric aspirate.
    • Teaching: Take as directed, avoid products containing aspirin or NSAIDs, excessive amounts of caffeine, and foods that may cause an increase in GI irritation, inform patient that increased fluid and fiber intake and exercise may minimize constipation; Advise patient to report onset of black, tarry stools; fever; sore throat; diarrhea; dizziness; rash; confusion
  57. Ribavirin (Virazole)
    • Class: Antiviral
    • Indication: Treatment of severe lower respiratory tract infections caused by the respiratory syncytial virus (RSV) in infants and young children.
    • Action: Inhibits viral DNA and RNA synthesis and subsequent replication.
    • Side Effects: Dizziness, fainting, cardiac arrest,anorexia (↑ in children), vomiting, fever, Steven Johnson's,  emotional lability
    • Assessment: assess patient for infection; Assess respiratory (lung sounds, quality and rate of respirations) and fluid status prior to and frequently throughout therapy; Assess for signs of colitis (abdominal pain, bloody diarrhea, fever) and pancreatitis; Assess pulmonary status; Monitor for hypersensitivity reactions; 
    • Teaching:  Explain the purpose and route of treatment to the patient and parents.Inform patient and parents that ribavirin may cause blurred vision and photosensitivity; Advise patient to stop taking ribavirin and notify health care professional immediately if rash with fever; blisters or sores in mouth, nose, or eyes; or conjunctivitis occurs and to notify health care professional if trouble breathing, hives or swelling, chest pain, severe stomach pain or low back pain, bloody diarrhea or bloody or black stools, bruising or unusual bleeding, change in vision, fever >100.5°F,
  58. Rifampin
    • Class: antituberculars
    • Indication: Active tuberculosis (with other agents). Elimination of meningococcal carriers.
    • Action: Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms.
    • Side Effects: red discoloration of tears and urine, abdominal pain, diarrhea, flatulence, heartburn, nausea, vomiting, ↑ liver enzymes, red discoloration of saliva
    • Assessment: Perform mycobacterial studies and susceptibility tests prior to and periodically during therapy to detect possible resistance. Assess lung sounds and character and amount of sputum periodically during therapy.
    • Teaching: Strict adhereance to regimen is essential, stress importance of follow up visits, instruct that tears, saliva, and urine may turn red; Advise patient to notify health care professional promptly if signs and symptoms of hepatitis (yellow eyes and skin, nausea, vomiting, anorexia, unusual tiredness, weakness) or of thrombocytopenia (unusual bleeding or bruising) occur.
  59. Guaifenesin (Robitussin DM) 
    • Class: allergy, cold and cough remediesexpectorant
    • Indication: Coughs associated with viral upper respiratory tract infections.
    • Action: Reduces viscosity of tenacious secretions by increasing respiratory tract fluid.
    • Side Effects:  dizziness, headache, nausea, diarrhea, stomach pain, vomiting, rash 
    • Assessment: Assess lung sounds, frequency and type of cough, and character of bronchial secretions periodically during therapy. Maintain fluid intake of 1500–2000 mL/day to decrease viscosity of secretions.
    • Teaching: Instruct patient to cough effectively. avoid OTC cough and cold products while breast feeding or administering to children <4 yrs. 
  60. trimethoprim/sulfamethoxazole (Septra)
    • Class: anti-infectives/ antiprotozoals
    • Indication: Treatment of-Bronchitis, Shigella enteritis, Otitis media, Pneumocystis jirovecii pneumonia (PCP), Urinary tract infections, Traveler's diarrhea
    • Action:inhibits the metabolism of folic acid in bacteria at two different points.
    • Side effects: kernicterus in neonates, PSEUDOMEMBRANOUS COLITIS, HEPATIC NECROSIS, nausea, vomiting, ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rash, photosensitivity, AGRANULOCYTOSIS, APLASTIC ANEMIA, phlebitis at site 
    • Assessments: Assess infection, assess patient allergy hx for sulfas, inspect IV site frequently, monitor bowel's and I&O (increase fluids). Assess for rash 
    • Teaching: Take full regimen, Instruct patient to notify health care professional if rash, or fever and diarrhea develop, especially if diarrhea contains blood, mucus, or pus. Advise patient not to treat diarrhea without consulting health care professional, use sunscreen, Instruct family or caregiver on dilution, rate, and administration of drug and proper care of IV equipment.
  61. methylprednisolone (Solu medrol)
    • Class: anti-inflammatories (steroidal) immunosuppressants; corticosteroid 
    • Indication: used for allergy/ inflammation
    • Action: Suppresses inflammation and the normal immune response.
    • Side effects: depression, euphoria, headache, ↑ intracranial pressure (children only), HTN, peptic ulceration, anorexia, adrenal suppression,  acne, ↓ wound healing, ecchymoses, fragility, hirsutism, petechiae, thromboembolism, muscle wasting, osteoporosis, avascular necrosis of joints, muscle pain, cushingoid appearance (moon face, buffalo hump), ↑ susceptibility to infection
    • Assessment: Assess patient for signs of adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, restlessness) before and periodically during therapy. Monitor intake and output ratios and daily weights. Observe patient for peripheral edema, steady weight gain, rales/crackles, or dyspnea. Notify health care professional if these occur. Children should have periodic evaluations of growth.
    • Teaching: Instruct patient on correct technique of medication administration. Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be life-threatening. avoid people with known contagious illnesses and to report possible infections immediately. nform health care professional promptly if severe abdominal pain or tarry stools occur. Patient should also report unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or behavior changes
  62. Syrup of Ipecac **Off Market Drug**
    • Class: Emetic
    • Indication: Induces vomiting in the early management of overdose/poisoning from noncaustic substances (in conscious patients).
    • Action: Stimulates the chemoreceptor trigger zone in the CNS and irritates the gastric mucosa. Action is due to two major alkaloids: emetine and cephaeline
    • Side effects: myocarditis, aspiration, arrythmias
    • Assessment: A history is essential in determining treatment and antidotes for accidental poisoning. Do not induce vomiting if patient has ingested petroleum distillates, volatile oils, or caustic substances. Assess level of consciousness prior to administration. Do not administer ipecac if patient is unconscious, semiconscious, or convulsing.
    • Teaching: The American Academy of Pediatrics no longer recommends ipecac syrup for home management of poisonings and overdoses. Parents should be advised to dispose of ipecac syrup. In the event of a poisoning, parents should contact a poison control center 
  63. Theophylline
    • Class: bronchodilators/xanthine
    • Indication: Long-term control of reversible airway obstruction caused by asthma 
    • Action: Inhibit phosphodiesterase, producing increased tissue concentrations of cyclic adenosine monophosphate (cAMP)
    • Assessment: Assess BP, pulse, respiratory status (rate, lung sounds, use of accessory muscles) before and throughout therapy. Ensure that oxygen therapy is correctly instituted during acute asthma attacks; monitor I&O 
    • Teaching: Emphasize the importance of taking only the prescribed dose at the prescribed time intervals. Take missed doses as soon as possible or omit if close to next dose; increase fluids and avoid colas, coffee, chocolate
  64. Valproic acid (Depakene),
    • Class: anticonvulsants
    • Indication: Monotherapy and adjunctive therapy for simple and complex absence seizures. Monotherapy and adjunctive therapy for complex partial seizures. Adjunctive therapy for patients with multiple seizure types, including absence seizures.
    • Action: Increase levels of GABA, an inhibitory neurotransmitter in the CNS.
    • Side effects:  suicidal thoughts, agitation, dizziness, headache, insomnia, sedation, confusion, depression, hepatotoxicty, abdominal pain, anorexia, diarrhea, indigestion, nausea,vomiting, pancreatitis, hyperammonemia, hypothermia and tremor 
    • Assessment:  Assess location, duration, and characteristics of seizure activity. Institute seizure precautions. Assess for suicidal tendencies, especially during early therapy. Restrict amount of drug available to patient. Risk may be increased in children, adolescents, and adults ≤24 yr.
    • Teaching: take as directed; Advise patient and family to notify health care professional if thoughts about suicide or dying, attempts to commit suicide; new or worse depression; new or worse anxiety; feeling very agitated or restless; panic attacks; trouble sleeping; new or worse irritability; acting aggressive; being angry or violent; acting on dangerous impulses; an extreme increase in activity and talking, other unusual changes in behavior or mood occur; Advise patient to notify health care professional if anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, unusual bleeding or bruising, pregnancy, or loss of seizure control occurs. Children <2 yr of age are especially at risk for fatal hepatotoxicity.
  65. Vancomycin
    • Class: anti-infectives
    • Indications: (IV) Treatment of potentially life-threatening infections when less toxic anti-infectives are contraindicated(penicillin) Treatment of staphylococcal enterocolitis or diarrhea due to Clostridium difficile.
    • Action: Binds to bacterial cell wall, resulting in cell death
    • Side effects: Nephrotoxicity; ototoxicity, hypotension, phlebitis, rash, anaphylaxis, superinfection
    • Assessments: assess infection, monitor IV site, Evaluate 8th cranial nerve by audiometry and serum vancomycin levels prior to and throughout therapy in patients with borderline renal function; Monitor I&O and daily weight. Cloudy or pink urine may be a sign of nephrotoxicity; Assess patient for signs of superinfection; monitor for anaphylaxis reaction; 
    • Teaching: Advise patients on oral vancomycin to take as directed. Take missed doses as soon as remembered unless almost time for next dose; do not double dose. Instruct patient to report signs of hypersensitivity, tinnitus, vertigo, or hearing loss.
  66. levalbuterol (Xopenex)
    • Class: Bronchodilator/ adrenergic 
    • Indication: Bronchospasm due to reversible airway disease (short-term control agent).
    • Action:  Binds to beta-2 adrenergic receptors in airway smooth muscle leading to activation of adenylcyclase and increased levels of cyclic-3', 5'-adenosine monophosphate (cAMP). Increases in cAMP activate kinases, which inhibit the phosphorylation of myosin and decrease intracellular calcium. Decreased intracellular calcium relaxes bronchial smooth muscle.
    • Side Effects: anxiety, dizziness, headache, nervousness, hypokalemia; paradoxical bronchospasm
    • Assessments: Assess lung sounds, pulse, and BP before administration and during peak of medication. Note amount, color, and character of sputum produced. Closely monitor patients on higher dose for adverse effects; Monitor pulmonary function tests before initiating therapy and periodically during course to determine effectiveness of medication. Observe for paradoxical bronchospasm (wheezing, dyspnea, tightness in chest). If condition occurs, withhold medication and notify health care provider immediately.
    • Teaching: Instruct patient in the proper use of metered-dose inhaler and nebulizer; Advise patients to use levalbuterol first if using other inhalation medications, and allow 5 min to elapse before administering other inhalant medications unless otherwise directed.Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth.Instruct patient to notify health care professional if no response to the usual dose;
  67. azithromycin (Zithromax)
    • Class: agents for atypical mycobacterium/anti-infectives/ macrolides 
    • Indication: Upper respiratory tract infections, including streptococcal pharyngitis, acute bacterial exacerbations of chronic bronchitis and tonsillitis;Skin and skin structure infections;  Acute otitis media (unlabeled- Treatment of cystic fibrosis lung disease)
    • Action: Inhibits protein synthesis at the level of the 50S bacterial ribosome.
    • Side Effects: dizziness, seizures, drowsiness, fatigue, headache, Torsade de pointes, QT interval prolongation, hepatoxicity, Pseudomem Colitis, abdominal pain, nephritis, steven johnsons, otoxicity, toxic epidermal necrolysis, photosensitvity, angioedema
    • Assessments: assess infection, Observe for signs and symptoms of anaphylaxis (rash, pruritus, laryngeal edema, wheezing). Notify health care professional immediately if these occur. Assess patient for skin rash frequently during therapy. Discontinue azithromycin at first sign of rash; may be life-threatening. Stevens-Johnson syndrome or toxic epidermal necrolysis may develop. 
    • Teaching: Take as directed, complete regimen; Instruct patient not to take azithromycin with food or antacids. Advise patient to report symptoms of chest pain, palpitations, yellowing of skin or eyes, or signs of superinfection (black, furry overgrowth on the tongue; vaginal itching or discharge; loose or foul-smelling stools) or rash. Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without advice of health care professional. Tell parents or caregivers that medication is generally well tolerated in children. Most common side effects in children are mild diarrhea and rash. Tell parents to notify health care practitioner if these occur.
  68. Acyclovir (Zovirax)
    • Class: Antiviral
    • Indication:  Localized cutaneous herpes zoster infections (shingles) and chickenpox (varicella).
    • Action: Interferes with viral DNA synthesis.
    • Side effects: Seizures, dizziness, headache, rash, renal failure, Steven Johnson's, pain, phlebitis, joint pain
    • Assessments: Assess lesions before and daily during therapy.
    • Teaching: Instruct patient to take medication as directed for the full course of therapy; Inform patient that acyclovir is not a cure. The virus lies dormant in the ganglia, and acyclovir will not prevent the spread of infection to others; wear loose fitting clothing to help avoid irritation.

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