ADVERSE

DATE DOSE AND MODE OF REACTIONS

DRUG CLASSIFICATION INDICATION NURSING CONSIDERATIONS
ORDERED FREQUENCY ACTION / SIDE
EFFECTS
01/24/2019 Levetiracetem 500 mg/tab Q12 Anti-convulsants Partial onset Appears to CNS:  Assess location, duration, and
seizures inhibit burst SUICIDAL characteristics of seizure activity.
(adjunct). firing without THOUGHTS,  Assess patient for CNS adverse
Primary affecting aggression, effects throughout therapy. These
generalized normal agitation, adverse effects are categorized as
tonic-clonic neuronal anger, somnolence and fatigue (asthenia),
seizures excitability and anxiety, coordination difficulties (ataxia,
(adjunct) may selectively apathy, abnormal gait, or incoordination), and
(immediate- prevent depersonaliza behavioral abnormalities (agitation,
release and hypersynchroni tion, hostility, anxiety, apathy, emotional
injection only). zation of depression, lability, depersonalization, depression)
Myoclonic epileptiform dizziness, and usually occur during the first 4 wk
seizures in burst firing and hostility, of therapy.
patients with propagation of irritability,  Monitor mood changes. Assess for
juvenile seizure activity. personality suicidal tendencies, especially during
myoclonic disorder, early therapy. Restrict amount of drug
epilepsy weakness, available to patient.
(adjunct) drowsiness,  Assess for rash periodically during
(immediate- dyskinesia, therapy. May cause Stevens-Johnson
release and fatigue. syndrome. Discontinue therapy if
injection only). Neuro: severe or if accompanied with fever,
coordination general malaise, fatigue, muscle or
difficulties joint ac
(adults only).
Derm:
STEVENS-
JOHNSON
SYNDROME,
TOXIC
EPIDERMAL
NECROLYSIS
.
01/24/2019 Lactulose 30CC ODHS Laxative / Ammonia Treatment of Increases belching,  Assess patient for abdominal
reduction agent chronic water content cramps, distention, presence of bowel sounds,
constipation. and softens distention, and normal pattern of bowel function.
Adjunct in the the stool. flatulence,  Assess color, consistency, and
management of Lowers the pH diarrhea. amount of stool produced.
portal-systemic of the colon, Endo:  PSE: Assess mental status
 (hepatic) which inhibits hyperglycemi (orientation, level of consciousness)
encephalopathy the diffusion of a (diabetic before and periodically throughout
(PSE). ammonia from patients) course of therapy.
the colon into
the blood,
thereby
reducing blood
ammonia
levels.
01/26/2019 Mannitol 100CC/IV Q6 Diuretics The promotion of Increases the confusion,  Monitor vital signs, urine output, CVP,
diuresis, in the osmotic headache,blur and pulmonary artery pressures
prevention pressure of the red vision, (PAP) before and hourly throughout
and/or treatment glomerular rhinitis. CV: administration.
of the oliguric filtrate, thereby transient  Assess patient for signs and
phase of acute inhibiting volume symptoms of dehydration (decreased
renal failure reabsorption of expansion, skin turgor, fever, dry skin and
before water and chest pain, mucous membranes, thirst) or signs
irreversible renal electrolytes. HF, of fluid overload (increased CVP,
failure becomes Causes pulmonary dyspnea, rales/crackles, edema).
established; The excretion of: edema,  Assess patient for anorexia, muscle
reduction of Water, tachycardia.G weakness, numbness, tingling,
intracranial Sodium, I: nausea, paresthesia, confusion, and
pressure and Potassium, thirst, excessive thirst. Report signs of
treatment of Chloride, vomiting. GU: electrolyte imbalance.
cerebral edema Calcium, renal failure,  Increased Intracranial Pressure:
by reducing Phosphorus, urinary Monitor neurologic status and
brain mass; The Magnesium, retention. F intracranial pressure readings in
reduction of Urea, Uric and E: patients receiving this medication to
elevated acid. dehydration, decrease cerebral edema.
intraocular hyperkalemia,  Increased Intraocular Pressure:
pressure when hypernatremi Monitor for persistent or increased
the pressure a, eye pain or decreased visual acuity.
cannot be hypokalemia,
lowered by other hyponatremia.
means, and Local:
Promoting the phlebitis at IV
urinary excretion site.
of toxic
substances.
01/26/2019 Tramadol 50mg/IV if persistent Analgesics Moderate to Binds to mu- CNS:  Assess BP and respiratory rate
headache Q8 PRN moderately opioid SEIZURES, before and periodically during
severe pain receptors. dizziness, administration. Respiratory
(extended- Inhibits headache, depression has not occurred with
release reuptake of somnolence, recommended doses.
formulations serotonin and anxiety, CNS  Assess bowel function routinely.
indicated for norepinephrine stimulation, Prevention of constipation should be
patients who in the CNS confusion, instituted with increased intake of
require around- coordination fluids and bulk and with laxatives to
the-clock pain disturbance, minimize constipating effects.
management). euphoria,  Monitor patient for seizures. May
malaise, occur within recommended dose
nervousness, range. Risk is increased with higher
sleep doses and in patients taking
disorder, antidepressants (SSRIs, SNRIs,
weakness. tricyclics, or MAO inhibitors), opioid
EENT: visual analgesics, or other drugs that
disturbances. decrease the seizure threshold.
CV:  Monitor for serotonin syndrome
vasodilation. (mental-status changes), autonomic
GI: instability, neuromuscular aberrations
constipation, and/or gastrointestinal symptoms in
nausea, patients taking these drugs
abdominal concurrently
pain,
anorexia,
diarrhea, dry
mouth,
dyspepsia,
flatulence,
vomiting.GU:
menopausal
symptoms,
urinary
retention/freq
uency. Derm:
pruritus,
sweating.
Neuro:
hypertonia.Mi
sc:
SEROTONIN
 SYNDROME,
physical
dependence,
psychological
dependence,
tolerance
01/27/2019 KCL 1 tab QID Potassium To treat or Maintain acid- Paresthesia  Assess for signs and symptoms of
Supplements prevent base balance, of the limbs, hypokalemia (weakness, fatigue, U
hypokalemia isotonicity, and Confusion, wave on ECG, arrhythmias, polyuria,
electrophysiolo Weakness or polydipsia) and hyperkalemia
gic balance of  Emphasize correct method of
heaviness of
the cell. administration. GI irritation or
Activator in limbs, ulcerationmay result from chewing
many ECG enteric-coated tablets or insufficient
enzymatic changes, dilution of liquid or powder forms.
reactions; Hypotension,  Instruct patient to avoid salt
essential to Nausea and substitutes or low-salt milk or food
transmission of vomiting unless approved by health care
nerve professional
impulses;  Instruct patient to report dark, tarry, or
contraction of bloody stools; weakness; unusual
cardiac, fatigue; or tingling of extremities.
skeletal, and Notify health care professional if
smooth nausea, vomiting, diarrhea, or
muscle; gastric stomach discomfort persists. Dosage
secretion; may require adjustment.
renal function;
tissue
synthesis; and
carbohydrate
metabolism.
01/27/2019 Nimodipine 30 mg/tab 2 tabs for subarachnoid Management of Inhibits the CNS:  Assess patient’s neurologic status
21 days Q4 hemorrhage subarachnoid transport of abnormal (level of consciousness, movement)
therapy agents hemorrhage. calcium into dreams, prior to and periodically following
vascular anxiety, administration.
smooth muscle confusion,  Monitor BP and pulse prior to therapy
cells, resulting dizziness, and periodically during therapy.
in inhibition of drowsiness,  Monitor intake and output ratios and
excitation- headache, daily weight. Assess for signs of HF
contraction nervousness, (peripheral edema, rales/crackles,
coupling and psychiatric dyspnea, weight gain,jugular venous
subsequent disturbances, distention).
 contraction. weakness.  Assess for rash periodically during
Potent EENT: blurred therapy. May cause Stevens-Johnson
peripheral vision, syndrome. Discontinue therapy if
vasodilator. disturbed severe or if accompanied with fever,
equilibrium, general malaise, fatigue, muscle or
epistaxis, joint aches, blisters, oral lesions,
tinnitus conjunctivitis, hepatitis and/or
eosinophilia.

01/27/2018 Clonidine 75 mcg/tab 1 tab SL Anti-hypertensives Mild to moderate Stimulates drowsiness,  Monitor intake and output ratios and
for BP >180/100 PRN hypertension alpha- depression, daily weight, and assess for edema
adrenergic dizziness, daily, especially at beginning of
receptors in hallucinations, therapy.
the CNS, nervousness,  Monitor BP and pulse prior to starting,
which results nightmares frequently during initial dose
in decreased adjustment and dose increases and
sympathetic periodically throughout therapy.
outflow Titrate slowly in patients with cardiac
inhibiting conditions or those taking other
cardioaccelerat sympatholytic drugs. Report
ion and significant changes.
vasoconstrictio  Monitor for fever as potential sign of
n centers. catheter infection.
Prevents pain  Administer last dose of the day at
signal bedtime. May be taken without regard
transmission to for food.
the CNS by  Swallow extended-release tablets
stimulating whole; do not crush, break, or chew
alpha-
adrenergic
receptors in
the spinal cord.
01/28/2018 Paracetamol 500mg/tab Q6 Analgesics Treatment of Inhibits the CNS:  Assess overall health status and
mild pain, fever. synthesis of agitation (in alcohol usage before administering
prostaglandins children) (IV), acetaminophen. Patients who are
that may serve Anxiety (IV), malnourished or chronically abuse
as mediators Headache alcohol are at higher risk of
of pain and (IV), Fatigue developing hepatotoxicity with chronic
fever, primarily (IV), Insomnia use of usual doses of this drug.
in the CNS. (IV).  Assess amount, frequency, and type
 Has no Resp: of drugs taken in patients self-
significant anti- Atelectasis (in medicating, especially with OTC
inflammatory children) (IV), drugs. Prolonged use of
properties or Dyspnea (IV). acetaminophen increases the risk of
GI toxicity CV: adverse renal effects. For short-term
Hypertension use, combined doses of
(IV), acetaminophen and salicylates
Hypotension should not exceed the recommended
(IV). dose of either drug given alone. Do
GI: not exceed maximum daily dose of
HEPATOTOXI acetaminophen when considering all
CITY routes of administration and all
(DOSES), combination products containing
Constipation acetaminophen.
(in children)  Pain: Assess type, location, and
(IV), intensity prior to and 30– 60 min
Liver following administration.
enzymes,  Fever: Assess fever; note presence of
Nausea (IV), associated signs (diaphoresis,
Vomiting (IV). tachycardia, and malaise).
F and E:  Lab Test Considerations: Evaluate
Hypokalemia hepatic, hematologic, and renal
(IV). function periodically during
GU: prolonged, high-dose therapy.
Renal failure  May alter results of blood glucose
(high monitoring. May cause falsely values
doses/chronic when measured with glucose
use). oxidase/peroxidase method, but
Hemat: probably not with hexokinase/G6PD
Neutropenia, method. May also cause falsely
Pancytopenia. values with certain instruments; see
MS: manufacturer’s instruction manual.
Muscle  Increased serum bilirubin, LDH, AST,
spasms (IV), ALT, and prothrombin time may
Trismus (IV). indicate hepatotoxicity.
Derm:  Toxicity and Overdose: If overdose
ACUTE occurs, acetylcysteine (Acetadote) is
GENERALIZE the antidote.
D
EXANTHEMA
TOUS
PUSTULOSIS
 ,
STEVENS-
JOHNSON
SYNDROME,
TOXIC
EPIDERMAL
NECROLYSIS
, Rash,
Urticaria.

01/29/2019 Celocoxib 200mg/Cap BID PRN Anti-rheumatics, Relief of signs Inhibits the CNS:  Assess range of motion, degree
nonsteroidal anti- and symptoms enzyme COX- dizziness, of swelling, and pain in affected
inflammatory of osteoarthritis, 2. This enzyme headache, joints before and periodically
agents rheumatoid is required for insomnia. CV: throughout therapy.
arthritis, the synthesis MYOCARDIA  Assess patient for allergy to
ankylosing of L sulfonamides, aspirin, or NSAIDs.
spondylitis and prostaglandins. INFARCTION, Patients with these allergies
juvenile Has analgesic, STROKE, should not receive celecoxib.
rheumatoid anti- THROMBOSI  Assess patient for skin rash
arthritis. inflammatory, S, edema. GI: frequently during therapy.
Management of and antipyretic GI Discontinue at first sign of rash;
acute pain properties. BLEEDING, may be life-threatening. Stevens-
including primary abdominal Johnson syndrome may develop.
dysmenorrhea. pain, Treat symptomatically; may recur
diarrhea, once treatment is stopped
dyspepsia,
flatulence,
nausea
01/30/2019 Telmisartan 80mg/tab OD Anti-hypertensive Alone or with Blocks the CNS:  Assess BP (lying, sitting,
other agents in vasoconstrictor dizziness, standing) and pulse frequently
the management and fatigue, during initial dose adjustment and
of hypertension. aldosterone- headache. periodically during therapy. Notify
Reduction of risk secreting CV: health care professional of
of myocardial effects of hypotension. significant changes.
infarction, angiotensin II EENT:  Monitor frequency of prescription
stroke, or at various sinusitis. F refills to determine compliance.
cardiovascular receptor sites, and E:  Assess patients for signs of
death in patients including hyperkalemia. angioedema (dyspnea, facial
= 55 yr who are vascular GI: abdominal swelling).
at high risk for smooth muscle pain,  Encourage patient to comply with
cardiovascular and the diarrhea, additional interventions for
events and are adrenal glands dyspepsia. hypertension. Medication controls
unable to take GU: impaired but does not cure hypertension.
ACE inhibitors. renal function.  Instruct patient and family on
MS: back proper technique for monitoring
pain, BP. Advise them to check BP at
myalgia.Misc: least weekly and to report
ANGIOEDEM significant changes
A