Trade Name: Cipro

Classification: Broad-Spectrum Antiinfectives

Use(s): Infections caused by susceptible organisms E. Coli,
Proteus, staph.
Action: Interferes with conversion of DNA fragments into
higher molecular weight ones. DNA gyrase inhibitors.
Contraindications: Hypersensitivity to quinolones
Side Effects: Headache, dizziness, restlessness, N/V/D.
Nursing implications: Assess for CNS symptoms, I&O
ratio, allergic reactions.

FERROUS SULFATE
CLASSIFICATION: Antianemic, iron
ACTION: Normal daily intake males 12-20 mg; females 8-15 mg;
only 10% absorbed; Iron absorbed by from duodenum and upper
jejunum by active mechanism thru mucosal cells, combines with
transferring; iron stored as hemosiderin or aggregated ferritin cells
of liver, spleen, bone marrow; 2/3 of iron in circulating RBCs
INDICATIONS: Prophylaxis, treatment of iron deficiency and irondeficiency anemias; dietary supplement for iron
USUAL DOSAGE: Adults 300 mg/day
ADVERSE REACTIONS: Constipation, gastric irritation, nausea,
abdominal cramps, anorexia, diarrhea, dark-colored stools
NURSING CONSIDERATIONS: Substitution of one iron salt for
another without proper adjustment may result in serious over or

under dosing; Eggs, milk, coffee or tea may significantly inhibit iron
absorption.

AMOXICILLIN
CLASSIFICATION: Antibiotic, penicillin
ACTION: Synthetic broad-spectrum penicillin closely related to
ampicillin; Binds to bacterial cell wall (PBP-1 and PBP-3; penicillinbinding sites), causing cell death by inhibiting cell wall synthesis;
bactericidal action; spectrum is larger than penicillins
INDICATIONS: Ear, nose, and throat infections.
USUAL DOSAGE:
Over 40 kg: 500 mg q8hr or 500 mg q12hr; under 40 kg:
20mg/kg/day in divided doses q8hr
ADVERSE REACTIONS: Hypersensitivity, nausea & vomiting,
gastritis, stomatitis.

CONTRAINDICATIONS: Hypersensitivity to PCNs; PO use of PCNs

during acute stages of emphysema, bacteremia, pneumonia,
meningitis, pericarditis, and purulent or septic arthritis; lactation
NURSING CONSIDERATIONS: IV injections usually diluted with
IV solution; Assess for allergic reactions (if reaction occurs, stop drug
immediately); monitor vitals. assess for 20 min after administering
to check for allergies; should be prescribed cautiously to nursing
mothers; take full dosage; report unusual symptoms.

ACETAMINOPHEN
CLASSIFICATION: non-narcotic analgesic

ACTION: Decreases fever by 1) a hypothalamic effect leading to sweating

and vasodilation and 2) inhibits the effect of pyrogens on the
hypothalamic heat-regulating centers. May cause analgesia by inhibiting
CNS prostaglandin synthesis; however, due to minimal effects on
peripheral prostaglandin synthesis, acetaminophen has no antiinflammatory or uricosuric effects. Does not cause any anticoagulant
effect or ulceration of the GI tract. Antipyretic and analgesic effects are
comparable to those of aspirin.
INDICATIONS: 1) Control of pain 2) Reduces fever in bacterial or viral
infections
USUAL DOSAGE: Adults: 325-650 mg q4hr
ADVERSE REACTIONS: Few when taken in usual therapeutic doses; GI
upset in some; Chronic and even acute toxicity can develop after long
symptom-free usage
INTERACTIONS: Chronic EtOH toxicity of larger therapeutic doses;
barbiturates, carbamazepine, hydantoins, isoniazid, rifampin &
sulfinpyrazone: hepatotoxicity potential related to liver breakdown.

HYDROCHLOROTHIAZIDE
CLASSIFICATION: Antihypertensive, combination drug
ACTION: acts directly on the distal tubule to promote the excretion
of sodium, bicarbonate, chloride, and fluid; Increases urinary pH;
Hydrochlorothiazide promotes excretion of sodium and chloride and thus
water by distal renal tubule; Also increases excretion of potassium and
smaller amounts of bicarbonate; Antihypertensive effects due to direct
dilation of arterioles as well as fluid volume loss
INDICATIONS: Hypertension or edema in clients who manifest
hypokalemia on hydrochlorothiazide alone; in clients requiring a diuretic
and in whom hypokalemia cannot be risked; usually not first line of
therapy except when avoiding hypokalemia
ADVERSE REACTIONS: Nausea & vomiting, headache, anorexia, GI
upset, diarrhea, flatulence, dizziness, photosensitivity

NURSING CONSIDERATIONS: Assess for alcoholism, monitor vital

signs and tests (reduce dose with dysfunction; drug is taken to lower BP
and reduce swelling of extremities (take in AM with food to reduce GI
upset. rash, fever)
TAMULOSIN HYDROCHLORIDE
CLASSIFICATION: Alpha-adrenergic blocking drug
ACTION: Blockade of alpha1-receptors (probably alpha1a) in the
prostateresults in relaxation of smooth muscles in the bladder, neck and
prostate;thus, urine flow rate is improved and there is a decrease in
symptoms of BPH
INDICATIONS: Signs and symptoms of BPH; rule-out prostatic carcinoma
before using tamsulosin
ADVERSE REACTIONS: Headache, dizziness, pharyngitis/rhinitis,
shoulder/neck/back/extremity pain, asthenia, diarrhea, chest pain
NURSING CONSIDERATIONS: identify drugs prescribed to ensure none
of the drugs interact, especially cimetidine or Coumadin; monitor CBC,

I&O, VS, weight, urodynamic studies; note PSA levels, results of

digital rectal exam; take as directed, do not chew, crush, or open capsule.

Atenolol (Tenormin)
CLASSIFICATION: Beta-Blocker
ACTION: In therapeutic doses, atenolol selectively blocks beta1adrenergic receptors located chiefly in cardiac muscle.
INDICATIONS used to treat high blood pressure. It is also used to treat
angina and chest pain.
ADVERSE REACTIONS: Constipation, indigestion, dry mouth, dizziness
NURSING CONSIDERATIONS: Check apical pulse before giving oral
drug, especially in patients receiving digitalis (both drugs slow AV
conduction). If below 60 bpm (or other ordered parameter), withhold dose
and consult physician. Monitor apical pulse, BP, respirations, and

peripheral circulation throughout dosage adjustment period. Consult

physician for acceptable parameters.

ENALAPRIL MALEATE (Vasotec)

CLASSIFICATION: CARDIOVASCULAR AGENT; ANGIOTENSIN-CONVERTING
ENZYME (ACE) INHIBITOR; ANTIHYPERTENSIVE
ACTION: Angiotensin-converting enzyme (ACE) inhibitor. ACE catalyzes
the conversion of angiotensin I to angiotensin II, a vasoconstrictor
substance. Therefore, inhibition of ACE decreases angiotensin II levels,
which decreases vasopressor activity and aldosterone secretion.
INDICATIONS Management of mild to moderate hypertension.
ADVERSE REACTIONS:. Headache, dizziness, fatigue, Hypotension.

NURSING CONSIDERATIONS: Monitor BP for first several days of

therapy. If antihypertensive effect is diminished before 24 h, the total
dose may be given as 2 divided doses. Report transient hypotension with
lightheadedness. Older adults are particularly sensitive to drug-induced
hypotension. Supervise ambulation until BP has stabilized.
Lab tests: Monitor serum potassium and be alert to symptoms of
hyperkalemia (K+ >5.7 mEq/L).
PANTOPRAZOLE
CLASSIFICATION: GASTROINTESTINAL AGENT; PROTON PUMP INHIBITOR
ACTION Gastric acid pump inhibitor; belongs to a class of antisecretory
compounds. Gastric acid secretion is decreased by inhibiting the H+, K+ATPase enzyme system responsible for acid production.
INDICATIONS Short-term treatment of erosive esophagitis associated
with gastroesophageal reflux disease (GERD).
ADVERSE REACTIONS: Diarrhea, flatulence, abdominal pain.

NURSING CONSIDERATIONS: Monitor for and immediately report S&S of

angioedema or a severe skin reaction. Lab tests: Urea breath test 46 wk
after completion of therapy.

DICLOFENAC SODIUM
CLASSIFICATION: CENTRAL NERVOUS SYSTEM AGENT; ANALGESIC,
ANTIPYRETIC; NSAID
ACTION: Although its exact mechanism of action has not been fully
elucidated, it appears to be a potent inhibitor of cyclooxygenase, thereby
decreasing the synthesis of prostaglandins.
INDICATIONS Analgesic and antipyretic effects in symptomatic treatment
of rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. Also
acute gout.

ADVERSE REACTIONS:. Dizziness, headache, drowsiness, vomiting,

abdominal pain, cramps
NURSING CONSIDERATIONS: Monitor for therapeutic effectiveness. Up
to 3 wks may be needed for beneficial effects with rheumatoid arthritis or
osteoarthritis. Lab tests: Periodic liver function, serum uric acid
concentrations Hct, PT/INR, and blood glucose. Observe and report signs
of bleeding (e.g., petechiae, ecchymoses, bleeding gums, bloody or black
stools, cloudy or bloody urine). Monitor BP for hypertension and blood
sugar for hyperglycemia.

1. Acute pain related to: inflammation and infection of the urethra,

bladder and other urinary tract structures.
2. Hyperthermia related to: inflammatory reaction
3. Impaired Urinary Elimination related to: frequent urination, urgency and
hesitancy
4. Risk for Fluid Volume Deficit related to: excessive evaporation and
vomiting
5. Disturbed Sleep Pattern related to: pain and nocturia.
6. Knowledge Deficit: about condition, prognosis, and treatment needs
related to:
lack of sources of information.

1)

Monitor input and output characteristics of the urine.

Rational: provides information about renal function and presence of complications

2)

Determine the patient's voiding patterns

3)

Encourage increased fluid intake

Rationale: increased hydration will flush the bacteria.

4)

Review the full bladder complaints

Rational: urinary retention may occur causing tissue distension (bladder / kidney)

5)

Observations of changes in mental status:, behavior or level of consciousness

Rational: the accumulation of residual uremic and electrolyte imbalance can be toxic to the
central nervous system

6)

Unless contraindicated: reposition the patient every two hours

Rational: To prevent static urine

7)

Collaboration:
- Monitor laboratory tests: electrolytes, creatinine
Rational: control of renal dysfunction

HEPARIN
CLASSIFICATION: Heparin, Anticoagulant
ACTION: Does not dissolve previously formed clots, but forestalls enlargement and prevents new clots
from forming; Potentiates inhibitory action of antithrombin III; Occurs due to formation of a complex
with antithrombin III and causing a conformational change in antithrombin III molecule; Action of
thrombin in coagulation is inhibited; Also prevents formation of a stable fibrin clot by inhibiting the
activation of fibrin-stabilizing factor by thrombin
INDICATIONS: Pulmonary/peripheral arterial embolism; Prophylaxis and treatment of venous
thrombosis and extensions; Atrial fibrillation with embolization; Treatment and diagnosis of DIC; in low
doses to prevent DVT and PE in pregnant clients with thromboembolism history and others;
Prophylaxis of clotting in blood transfusions and others
ADVERSE REACTIONS: Hemorrhage ranging from minor local ecchymoses to major hemorrhagic
complications from any organ, chills, fever, urticaria, local irritation, erythema, mild pain, hematoma
INTERACTIONS:
Oralanticoagulants/dipyridamole/hydroxychloroquine/ibuprofen/indomethacin/NSAIDs/ticlopidine

additive prothrombin time; Antihistamines/digitalis/nicotine/nitroglycerin/tetracyclines - effect

of heparin
CONTRAINDICATIONS: Active bleeding, blood dyscrasias (or other bleedingdisorders as in
hemophilia), clients with frail or weakened blood vessels, purpura, thrombocytopenia, liver disease
with hypoprothrombinemia, open wounds, extensive denudation of skin, increased capillary
permeability; do not administer during surgery of eye, brain or spinal cord or during continuous tube
drainage of stomach or small intestine
NURSING CONSIDERATIONS: Do not administer IM; administer by deep subQ injection to minimize
local irritation, hematoma, and tissue sloughing and to prolong drug action; utilize Z-track method or
Bunch technique method; do not administer within 2in of umbilicus (decreased vascularity); do not
massage site, slight discoloration does not affect potency; perform test dose (1,000 units subQ) on
clients with allergies or asthma history
GENERIC NAME: METOPROLOL TARTRATE
CLASSIFICATION: Beta-adrenergic Blocking Agent
ACTION: Combines reversibly mainly with beta-adrenergic receptors to block the response to
sympathetic nerve impulses, circulating catecholamines, or adrenergic drugs; Blockage of betareceptors decreases heart rate, myocardial contractility, and cardiac output and slows AV conduction,
all of which decreases blood pressure

INDICATIONS: Hypertension; Acute MI in hemodynamically stable patients; Angina pectoris

ADVERSE REACTIONS: Fatigue, dizziness, depression, shortness of breath, bradycardia, diarrhea
CONTRAINDICATIONS: MI in clients with a heart rate of less than 45 bpm, in second- or third-degree
heartblock, or if SBP is less than 100 mm Hg; moderate to severe cardiac failure
NURSING CONSIDERATIONS: Do not confuse metoprolol with metoclopramide, metaproterenol, or
misoprostol; if transcient worsening of heart failure occurs, treat with increased doses of diuretics; may
need to lower dose of metoprolol or temporarily discontinue; for CHF, do not increase dose until
symptoms of worsening CHF have been stabilized; if CHF clients experience symptomatic bradycardia,
reduce dose; take dose each day at same time; do not stop suddenly
Vitamin D
INDICATIONS: management of hypocalcemia and resultant metabolic bone disease in patients
undergoing chronic renal dialysis; indicated in management of secondary hyperparathyroidism and
resultant metabolic bone disease in patients with mild/moderate/severe chronic renal failure not yet on
dialysis; management of hypocalcemia and clinical manifestations in patients with postsurgical
hypoparathyroidism, idiopathichypoparathyroidism, and pseudohypoparathyroidism

ADVERSE REACTIONS: Hypercalcemia syndrome or calcium intoxication; weakness, headache,

somnolence, N&V, dry mouth, constipation, muscle pain, bone pain, metallic taste, anorexia, stomach
pain, abdominal pain; polyuria, polydipsia, nocturia, calcific conjunctivitis, pancreatitis, photophobia,
rhinorrhea, pruritis, hyperthermia, decreased libido, elevated BUN, albuminuria, hypercholesterolemia,
elevated SGOT (AST) and SGPT (ALT) and MANY MORE
CONTRAINDICATIONS: Should not be taken to patients with hypercalcemia or evidence of Vit D
toxicity; use in patients with known hypersensitivity to Rocaltrol (or drugs of same class) or any of the
inactive ingredients is contraindicated
NURSING CONSIDERATIONS: Effectiveness is predicated on the assumption that each patient is
receiving an adequate daily intake of calcium; advise patients to have dietary intake minimum of 600
mg daily; patients should be advised of compliance with dosage instructions and adherence to
instructions about diet and calcium supplementation; advise avoidance of the use of unapproved
nonprescription drugs; carefully inform about S&S of hypercalcemia
GENERIC NAME: ASPIRIN (ACETYLSALICYCLIC ACID, ASA)
CLASSIFICATION: Nonsteroidal, anti-inflammatory drug, analgesic, antipyretic
ACTION: Exhibits antipyretic, anti-inflammatory, and analgesic effects; Antipyretic due to an action on
the hypothalamus, resulting in heat loss by vasodilation of peripheral blood vessels and promoting

sweating; Anti-inflammatory mediated through inhibition of cyclo-oxygenase, which results in a

decrease in prostaglandin synthesis and other mediators of pain response
INDICATIONS: Analgesic Pain from integumentary structures, myalgias, neuralgias,arthralgias,
headache, dysmenorrheal, and similar types of pain; gout; Antipyretic, Anti-inflammatory arthritis,
osteoarthritis, SLE, acute rheumatic fever, gout, and many other conditions
ADVERSE REACTIONS: Dyspepsia, nausea, epigastric, discomfort
CONTRAINDICATIONS: Hypersensitivity to salicylates; clients with asthma, hay fever, or nasal polyps
have higher incidence of hypersensitivity; severe anemia, history of blood coagulation defects, in
conjunction with anticoagulant therapy; vitamin K deficiency
NURSING CONSIDERATIONS
: Enteric-coated or buffered tablets better tolerated by some; take with full glass of water; use
epinephrine to counteract hypersensitivity; take temperature 1 hour after administering; note if
asthma, hay fever, ulcer disease or nasal polyps; take as directed; administer with meals and glass of
water

GENERIC NAME: METFORMIN HYDROCHLORIDE

CLASSIFICATION: Oral Antidiabetic, Biguanide

ACTION: Decreases hepatic glucose production, decreases intestinal absorption of glucose, increases
peripheral uptake and utilization of glucose; does not cause hypoglycemia in either diabetic or non
diabetic clients, and does not cause hyperinsulinemia; insulin secretion remains unchanged, while
fasting insulin levels and day-long plasma insulin response may decrease
INDICATIONS: As monotherapy, as adjunct to diet and exercise, to improve glycemic control in clients
with type 2 diabetes; Immediate-release tablets and PO solution can be used in clients 10 yrs and
older; Extended Release form used to treat type 2 diabetes as initial therapy or in conjunction with a
sulfonylurea or insulin in clients 17 y/o and older
ADVERSE REACTIONS: Lactic acidosis, hypoglycemia, diarrhea, nausea & vomiting, asthenia,
flatulence, headache, abdominal pain/discomfort
NURSING CONSIDERATIONS: Lactic acidosis is a rare, but serious, metabolic complication that can
occur due to metformin accumulation (50 % fatal); do not confuse Glucophage with Glucovance;
individualize dosage based on tolerance and effectiveness; give with meals and start at a low dose
with gradual escalation (will reduce GI side effects); may safely switch
from metformin to metformin extended-release; may cause a metallic taste (will subside)
GENERIC NAME: Candesartan

CLASSIFICATION: ARB
ACTION: Angiotensin II receptor (type AT1) antagonist. Angiotensin II is a potent vasoconstrictor and
primary vasoactive hormone of the reninangiotensinaldosterone system. Candesartan selectively
blocks binding of angiotensin II to the AT1 receptors found in many tissues (e.g., vascular smooth
muscle, adrenal glands).
INDICATIONS Treating high blood pressure alone or with other medicines. It is used in certain
patients to treat heart failure. It may also be used for other conditions as determined by your doctor.
Candesartan is an angiotensin II receptor blocker (ARB). It works by relaxing blood vessels. This helps
to lower blood pressure.
ADVERSE REACTIONS: upper respiratory tract infection, dizziness, back pain, pharyngitis, and rhinitis
NURSING CONSIDERATIONS: Monitor BP as therapeutic effectiveness is indicated by decreases in
systolic and diastolic BP within 2 wk with maximal effect at 46 wk. Monitor for transient hypotension
in volume/salt-depleted patients; if hypotension occurs, place in supine position and notify physician.
Monitor BP periodically; trough readings, just prior to the next scheduled dose, should be made when
possible. Lab tests: Periodically monitor BUN and creatinine, serum potassium, liver enzymes, and CBC
with differential.

GENERIC NAME: Candesartan

CLASSIFICATION: ARB
ACTION: Angiotensin II receptor (type AT1) antagonist. Angiotensin II is a potent vasoconstrictor and
primary vasoactive hormone of the reninangiotensinaldosterone system. Candesartan selectively
blocks binding of angiotensin II to the AT1 receptors found in many tissues (e.g., vascular smooth
muscle, adrenal glands).
INDICATIONS Treating high blood pressure alone or with other medicines. It is used in certain
patients to treat heart failure. It may also be used for other conditions as determined by your doctor.
Candesartan is an angiotensin II receptor blocker (ARB). It works by relaxing blood vessels. This helps
to lower blood pressure.
ADVERSE REACTIONS: upper respiratory tract infection, dizziness, back pain, pharyngitis, and rhinitis
NURSING CONSIDERATIONS: Monitor BP as therapeutic effectiveness is indicated by decreases in
systolic and diastolic BP within 2 wk with maximal effect at 46 wk. Monitor for transient hypotension
in volume/salt-depleted patients; if hypotension occurs, place in supine position and notify physician.
Monitor BP periodically; trough readings, just prior to the next scheduled dose, should be made when

possible. Lab tests: Periodically monitor BUN and creatinine, serum potassium, liver enzymes, and CBC
with differential.
Hypromellose Eye Drops
Hydromoor eye drops contain the active ingredient hypromellose, which is a type of medicine known
as an eye lubricant. (NB. Hypromellose eye drops are also available without a brand name, ie as the
generic medicine.)
Hypromellose is a synthetic polymer that forms a film on the surface of the eye (cornea). It produces a
transparent, lubricating and moistening film on the surface of the eye and is used as artificial tears.
Hypromellose eye drops provide soothing relief from the symptoms of dry eyes, such as soreness,
irritation or a gritty sensation. These may be caused by your eye not producing enough tears to keep
the eye moist, or by things such as certain medical conditions or treatments, prolonged use of
computer screens (where you tend to blink less and thus not lubricate the eyes sufficiently), or drying
atmospheric conditions such as air-conditioning, central heating or atmospheric pollution.

GENERIC NAME: OXYCODONE AND ACETOMINOPHEN

CLASSIFICATION: Analgesic
ACTION: Semi synthetic opiate that combines with specific receptors located in CNS to produce various
effects; mechanism is believed to involve decreased permeability of cell membrane to Na, which
results in diminished transmission of pain impulses and analgesia; causes mild sedation and no
antitussive effect; most effective in relieving acute pain; does not cause any anticoagulant effect or
ulceration of GI tract
INDICATIONS: Relief of moderate to moderately severe pain
ADVERSE REACTIONS: Dizziness, light-headedness, nausea & vomiting, sedation, sweating, itching, dry
mouth, constipation
NURSING CONSIDERATIONS: Combination drug; do not confuse Percocet and Percodan; do not confuse
oxycodone with OxyContin; assess for drug seeking behaviors; take only as directed; may take with

food to decrease GI upset; do not share drugs; keep in safe place; drug may cause dizziness and
drowsiness; may cause constipation, nausea& vomiting, rash/itching, and physical dependence; avoid
alcohol and any other CNS depressants without provider approval; tolerance may occur

ONDANSETRON HYDROCHLORIDE
CLASSIFICATION: Antiemetic
ACTION: Cytotoxic chemotherapy is thought to release serotonin from enterochromaffin cells of the
small intestine; the released serotonin may stimulate the vagal afferent nerves through the 5-HT3
receptors, thus stimulating the vomiting reflex; Ondansetron, a 5-HT3 antagonist, blocks this effect of
serotonin; whether the drug acts centrally and/or peripherally to antagonize the effect of serotonin is
not known
INDICATIONS: Prevent N&V resulting from initial and repeated courses of cancer chemotherapy,
including cisplatin, greater than 50 mg/m2; prevent N&V associated with initial and repeat courses of
moderately emetogenic cancer chemotherapy; Prevent N&V associated with radiotherapy in clients
receiving either total body irradiation, single high-dose fraction to the abdomen, or daily fractions to
the abdomen
ADVERSE REACTIONS: Diarrhea, headache, dizziness, malaise/fatigue, constipation, bradycardia,
hypotension, drowsiness/ sedation, anxiety/agitation, gynecological disorder, urinary retention,
hypoxia, pruritus, pyrexia, shivers

NURSING CONSIDERATIONS: Do not confuse Zofran with Zoloft, Zantac, or Zosyn; do not exceed 8 mg
PO or 8 mg IV daily with impaired hepatic function; 2 mg/mL Ondansetron injection requires no dilution
for administration for postop N&V; inspect visually for particulate matter and discoloration before
administering; drug is to prevent N&V; to be given exactly as prescribed; may cause drowsiness or
dizziness; do not perform activities that require mental alertness until drug effects realized; report any
rash, diarrhea, constipation, altered respirations (brochospasms), or loss of response

ALENDRONATE
CLASSIFICATION: BISPHOSPHONATE; REGULATOR, BONE METABOLISM
ACTION: Alendronate is a bisphosphonate that inhibits osteoclast-mediated bone resorption.
Antiresorption mechanism is not fully understood. It does, however, localize preferentially to resorption
sites of active bone turnover and has minimal to no interference with bone mineralization.
INDICATIONS: Prevention and treatment of osteoporosis in postmenopausal women, Paget's disease.
Treatment of glucocorticoid-induced osteoporosis.
ADVERSE REACTIONS Endocrine: Hypocalcemia, hypophosphatemia. GI: Esophageal irritation
and ulceration, nausea, vomiting, abdominal pain, dyspepsia, diarrhea, constipation,
flatulence. Other: Arthralgias, myalgias, headache, rash.
INTERACTIONS Drug: Ranitidine increases alendronate availability. Food: Calcium and food
(especially dairy products) reduce alendronate absorption.

CONTRAINDICATIONS: Hypersensitivity to alendronate or other bisphosphonates; severe renal

impairment (Clcr 35 mL/min); hypocalcemia; abnormalities; lactation, pregnancy (category C).
NURSING CONSIDERATIONS:
Lab tests: Monitor albumin-adjusted serum calcium, serum phosphate, serum alkaline phosphatase,
fasting and 24 h urinary calcium, and serum electrolytes. Periodically monitor renal and liver functions.
Diagnostic test: Bone density scan every 1218 mo.
Discontinue drug if the Clcr <35 mL/min.

GENERIC NAME: CALCIUM CARBONATE

CLASSIFICATION: Calcium salt
ACTION: Calcium is essential for maintaining normal function of nerves, muscles, the skeletal system,
and permeability of cell membranes and capillaries; normal serum calcium level is 9-10.4 mg.dL (4.55.2 mEq/L). Hypocalcemia is characterized by muscular fibrillation, twitching, skeletal muscle spasms,
leg cramps, titanic spasms, cardiac arrythmias, smooth muscle hyperexcitability, mental depression,
and anxiety states
INDICATIONS: Mild hypocalcemia; Antacid (including heartburn, sour stomach, and acid indigestion);
anithyperphosphatemic
USUAL DOSAGE: Hypocalcemia/Nutritional supplement 1.25-1.5 grams 1-3 times daily with or
without meals; antihyperphosphatemic 5-13 grams daily in divided doses with meals

ADVERSE REACTIONS: After PO use GI irritation, constipation, headache, mild hypercalcemia

(anorexia, N&V)
CONTRAINDICATIONS: Digitalized clients, sarcoidosis, renal or cardiac disease, ventricular
fibrillation, cancer clients with bone metastases; renal calculi, hypophosphatemia; hypercalcemia
NURSING CONSIDERATIONS: Perform thorough nursing history, noting clinical presentation,
indications for therapy, and any precipitating causes; list drugs prescribed, especially if receiving
digitalis products (may be contraindicated); monitor calcium levels and renal function; assess for renal
or parathyroid disease; note bone density findings; supplements need vitamin D to facilitate
absorption; report adverse side effects, lack of desired response, and keep all follow-up appointments
to evaluate drug response

CLOTRIMAZOLE
CLASSIFICATION: ANTIINFECTIVE; ANTIBIOTIC; ANTIFUNGAL
ACTION: Has broad-spectrum fungicidal activity. Acts by altering fungal cell membrane permeability,
permitting loss of phosphorous compounds, potassium, and other essential intracellular constituents
with consequent loss of ability to replicate.
INDICATIONS: Dermal infections including tinea pedis, tinea cruris, tinea corporis, tinea versicolor;
also vulvovaginal and oropharyngeal candidiasis.

ADVERSE REACTIONS GI: Abnormal liver function tests; occasional nausea and vomiting (with oral
troche). Skin: Stinging, erythema, edema, vesication, desquamation, pruritus, urticaria, skin
fissures. Urogenital: Mild burning sensation, lower abdominal cramps, bloating, cystitis, urethritis, mild
urinary frequency, vulval erythema and itching, pain and vaginal soreness during intercourse
INTERACTIONS Drug: Intravaginal preparations may inactivate SPERMICIDES.
CONTRAINDICATIONS: Ophthalmic uses; systemic mycoses. Safe use during pregnancy (category C
for oral troches, category B for topical preparations), lactation, and in children <3 y not established
NURSING CONSIDERATIONS:

Evaluate effectiveness of treatment. Report any signs of skin irritation with dermal
preparations.

Anticipate signs of clinical improvement within the first week of drug use.

GENERIC NAME: DOCUSATE SODIU

CLASSIFICATION: Laxative, Emollient

ACTION: Acts by lowering the surface tension of feces and promoting penetration by water and
fat (increases softness of fecal mass; not absorbed systematically, does not seem to interfere
with absorption of nutrients
INDICATIONS: Lessens strain of defecation in persons with hernia or CV diseases or other
diseases in which stool straining should be avoided; megacolon or bedridden patients;
Constipation associated with dry, hard stools
ROUTES OF ADMINISTRATION: Capsules, Soft-Gel Capsules, Oral Liquid, Syrup, Tablets
USUAL DOSAGE: Adults and persons above 12 y/o: 50-500 mg; Under 3y/o: 10-40mg; 3-6 y/o:
20-60 mg; 6-12 y/o: 40-120 mg
ADVERSE REACTIONS: Diarrhea, nausea & vomiting, perianal irritation, flatulence, cramps,
dehydration, electrolyte balance disturbance due to dehydration
INTERACTIONS: May absorption of mineral oil from GI tract;
CONTRAINDICATIONS: Nausea, vomiting, abdominal pain, intestinal obstruction; severe
abdominal pain due to appendicitis, enteritis, ulcerative colitis, diverticulitis, intestinal
obstruction, fecal impaction, undiagnosed abdominal pain
NURSING CONSIDERATIONS: Drink glass of water with each dose; may take oralsolutions with
milk or juice to help mask taste; may take 1-3 days to soften fecal matter due to minimally
absorbing docusate salts; assess activity levels, diet, water intake, exercise routines; have client
identify habits and BM activities; note length of time ittakes for laxative to take effect; with
abdominal pain and discomfort, note location, triggers, type of discomfort, rule out other
intestinal disorders/obstruction where laxatives should not be used

GENERIC NAME: POTASSIUM CHLORIDE

CLASSIFICATION: ELECTROLYTIC AND WATER BALANCE AGENT; REPLACEMENT SOLUTION
ACTION: Principal intracellular cation; essential for maintenance of intracellular isotonicity,
transmission of nerve impulses, contraction of cardiac, skeletal, and smooth muscles, maintenance of
normal kidney function, and for enzyme activity. Plays a prominent role in both formation and
correction of imbalances in acidbase metabolism.
INDICATIONS: To prevent and treat potassium deficit secondary to diuretic or corticosteroid therapy.
Also indicated when potassium is depleted by severe vomiting, diarrhea; intestinal drainage, fistulas,
or malabsorption; prolonged diuresis, diabetic acidosis. Effective in the treatment of hypokalemic
alkalosis (chloride, not the gluconate).
ADVERSE REACTIONS: GI: Nausea, vomiting, diarrhea, abdominal distension. Body as a
Whole: Pain, mental confusion, irritability, listlessness, paresthesias of extremities, muscle weakness
and heaviness of limbs, difficulty in swallowing, flaccid paralysis. Urogenital: Oliguria,
anuria. Hematologic: Hyperkalemia. Respiratory: Respiratory distress. CV: Hypotension,
bradycardia; cardiac depression, arrhythmias, or arrest; altered sensitivity to digitalis glycosides. ECG
changes in hyperkalemia:
INTERACTIONS Drug: POTASSIUM-SPARING DIURETICS, ANGIOTENSIN-CONVERTING
ENZYME (ACE) INHIBITORS may cause hyperkalemia.
CONTRAINDICATIONS: Severe renal impairment; severe hemolytic reactions; untreated Addison's
disease; crush syndrome; early postoperative oliguria (except during GI drainage); adynamic ileus;
acute dehydration; heat cramps, hyperkalemia, patients receiving potassium-sparing diuretics, digitalis
intoxication with AV conduction disturbance.
NURSING CONSIDERATIONS: Monitor I&O ratio and pattern in patients receiving the parenteral drug.
If oliguria occurs, stop infusion promptly and notify physician. Lab test: Frequent serum electrolytes are

warranted.Monitor for and report signs of GI ulceration (esophageal or epigastric pain or

hematemesis).Monitor patients receiving parenteral potassium closely with cardiac monitor. Irregular
heartbeat is usually the earliest clinical indication of hyperkalemia.Be alert for potassium intoxication
(hyperkalemia, see S&S, Appendix F); may result from any therapeutic dosage, and the patient may be
asymptomatic.