Allopurinol

Brand names: Aloprim, Alloprin (Canda), Lopurin, Zyloprim

Drug Classification:

Pharmacologic: Xanthine oxidase inhibitors

Therapeutic: Antigout agents, antihyperuricemics

Use: Allopurinol is used to treat gout. It is used to treat high uric acid levels in the blood or urine caused by certain types of cancer chemotherapy. It is also used to treat certain patients with a certain type of kidney stones and high amounts of uric acid in the urine.

Dosage: Management of Gout: 100mg/day increase at weekly intervals based on serum uric acid.

Management of Secondary Hyperuricemia: 600-800mg/day in 2-3 divided doses started 1-2 days before chemotherapy.

Adverse effects:Diarrhea, nausea, rash, itching and drowsiness. The most frequent side effect to allopurinol is skin rash. Allopurinol should be discontinued immediately at the first appearance of rash, painful urination, blood in the urine, eye irritation, or swelling of the mouth or lips, because these can be a signs of an impending severe allergic reaction that can be fatal. Allopurinol should be avoided by patients with a prior severe reaction to the drug. Allopurinol can cause a flare-up of gouty arthritis during initial therapy.Rarely, allopurinol can cause nerve, kidney, and bone marrow damage. Allopurinol can cause a serious allergic liver toxicity that can be fatal. Appetite loss and itching can be signs of liver toxicity. The risk of this reaction increases in patients with kidney impairment. Patients with kidney impairment should receive lower doses of allopurinol. 

Nursing Considerations: Assessment: History: Allergy to allopurinol, blood dyscrasias, liver disease, renal failure, lactation

Physical: Skin lesions, color, orientation, reflexes; liver evaluation, normal urinary output; normal output; CBC, LETs, renal function test.

Interventions: Administer drug following meals. Encourage pt. to drink 2.5 to 3L/day to decrease the risk of renal stone development. Check urine alkalinity. WARNING: DISCONTINUE DRUG AT FIRST SIGHT OF SKIN RASH; SEVERE TO FATAL SKIN REACTIONS HAVE OCCURRED.

Arrange for regular medical follow-up and blood tests.

Patient Education:

-Take the drug after meals.

-Avoid OTC medications. Many of these preparations contain vitamin C or other agents that might increase the likelihood of kidney stone formation.

- You may experience these side effects: Exacerbation of gouty attack or renal stones (Drink 2.5-3 liters of fluids per day while on this drug.), nausea, vomiting, loss of appetite, drowsiness (use caution while driving or performing hazardous tasks.)

- Report unusual bleeding or bruising; fever, chills; gout attack; numbness or tingling; flank pain, skin rash.

Page Number 121 in Davis Drug Guide

Celexa

Generic name: Citalopram

Drug Classification:

Pharmacologic: Selective serotonin reuptake inhibitor

Therapeutic: Antidepressant

Use:Celexa is used to treat depression.

Dosage:

Oral solution: 10mg/5mL 

Tablets: 10mg, 20mg, 40mg

Initially, 20mg P.O. daily; may increase by 20mg/day at weekly intervals, up to 60mg/day. Usual dosage is 40mg/day.

Adverse effects:  Apathy, confusion, drowsiness, insomnia, migraine, weakness, agitation, amnesia, anxiety, dizziness, fatigue, poor concentration, tremor, paresthesia, deepening of depression, suicide attempt. Orthostatic hypotension, tachycardia. Abnormal visual accommodation. Nausea, vomiting, diarrhea, abdominal pain, dyspepsia, flatulence, increased saliva, dry mouth, increased appetite, anorexia.  Polyuria, amenorrhea, dysmenorrhea, ejaculatory delay, erectile dysfunction, decreased libido. Joint pain, myalgia. Cough.  Rash, pruritus, diaphoresis,photosensitivity, Altered taste, fever, yawning, weight changes.

Nursing Considerations:

-If the patient is receiving lithium concurrently, watch closely for potentiation of serotonergic effects.

-Assess for evidence of drug efficacy.

Patient Education:

- Instruct patient to take drug with full glass of water at the same time every day.

- Advise patient to immediately report suicidal thoughts or extreme depression.

- Instruct patient to move slowly when sitting up or standing, to avoid dizziness or lightheadedness caused by sudden blood pressure decrease.

- Tell patient several weeks may pass before he/she starts to feel better.

- Advise patient to avoid alcohol during therapy.

- Tell male patient he may experience inadequate filling of penile erectile tissue. Advise him to consult prescriber if he experiences adverse sexual effects.

-As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and herbs.

Davis Drug Guide Page 319

Colchicine

Brand Name: Colcrys

Drug Classification:

Pharmacologic: Colchicum alkaloid

Therapeutic: Antigout drug

Use: Colchicine is used to treat gout attacks.

Dosage:

Tablets: 0.5mg, 0.6mg

Patients with acute gouty arthritis, 0.6 to 1.2mg P.O.; then 0.6 to 1.2mg P.O. every 1-2 hours ir until relief occurs, adverse GI reactions occur, or patient has received a total cumulative dosage of 8mg.

Prophylaxis for recurrent gouty arthritis: In patients who have one yearly attack or less, 0.6mg P.O. daily 3 days per week. In patients who have more than one yearly attack, 0.6mg P.O. daily; in severe cases, 1 to 1.8mg P.O. daily.

Side effects:Nausea, vomiting, diarrhea,abdominal pain. Colchicine also may cause hair loss, weakness, and nerve irritation. One of the most worrisome side effects of colchicine is that it can damage the bone marrow causing severe anemia, low white blood counts, and low platelets. Reduced white blood cell counts may increase the risk of infections. May cause muscle pain (myopathy) or severe muscle breakdown (rhabdomyolysis). 

Nursing Considerations:

-Monitor patient for signs and symptoms of toxicity (nausea, vomiting, abdominal pain, bloody diarrhea, burning sensation, muscle weakness, oliguria, hematuria, ascending paralysis, delirium, and seizures). Discontinue drug if these occur.

-Monitor CBC and renal function test results regularly.

-Be aware that patient may need opioids to control drug-induced diarrhea (especially if he's receiving maximum colchicine dosage).

Patient Education:

-Instruct patient to report rash, sore throat, fever, tiredness, weakness, numbness, or tingling.

-Tell patient to immediately report muscle tremors, weakness, fatigue, bruising, bleeding, yellowing of eyes or skin, pale stools, dark urine, severe vomiting, watery or bloody diarrhea, or abdominal pain.

-Advise patient to increase fluid intake to prevent renal calculi (unless prescriber wants him/her to restrict fluids).

-Instruct patient to advoid alcohol, herbal teas, and caffeine during therapy.

 Davis Drug Guide Page 342

Ethambutol

Generic Name: Ethambutol

Brand Name: Myambutol

Drug Classification:

Pharmacological: Synthetic antitubercular

Therapeutic: Antitubercular, antileprotic

Use: Ethambutol is used to treat tuberculosis (TB)

Dosage: Tablets 100mg, 400mg

In patients who haven't received previous antitubercular therapy, 15mg/kg P.O. daily. In patients who haven't received previous antitubercular, 25mg/kg P.O. daily, decreased after 60 days to 15mg/kg daily.

Adverse effects:Confusion, disorientation, malaise, dizziness, hallucinations, headache, peripheral neuritis. Optic neuritis, blurred vision, decreased visual acuity, red-green color blindness, eye pain. Nausea, vomiting, abdominal pain, GI upset, anorexia. Joint pain, gouty arthritis. Bloody sputum, pulmonary infiltrates. Rash, pruritus, toxic epidermal necrolysis. Fever, anaphylactoid reactions

Nursing Considerations:

-Watch for serious adverse reactions, such as thrombocytopenia, respiratory problems, and anaphylactoid reactions.

-Monitor liver function test, CBC, and blood urea nitrogen, creatinine glucose, and serum uric acid levels.

-Give analgesics for drug-induced pain, as prescribed.

-Observe for signs and symptoms of gout.

Patient Education:

-Instruct patient to take with 8oz of water. If stomach upset occurs, advise him/her to take with food.

-If patient must take antacids, advise him/her to take only aluminum-free antacids.

-Tell patient to immediately report easy bruising or bleeding, respiratory problems, or signs and symptoms of hypersensitivity reactions.

-Advise patient to report vision changes and to have annual eye exams. Reassure him/her that visual disturbances will subside within several weeks to months after drug is discontinued.

Davis Drug Guide Page 548

Hydrochlorothiazide

Generic Name: Hydrochlorothiazide

Brand Names: Aquazide H, HydroDIURIL, Microzide 

Drug Classification:

Pharmacologic: Thiazide diuretic

Therapeutic: Diuretic, antihypertensive

Use: Hydrochlorothiazide is used to treat fluid retention (edema) in people with congestive heart failure, cirrhosis of the liver, or kidney disorders, or edema caused by taking steroids or estrogen. This medication is also used to treat high blood pressure (hypertension). 

Dosage:

Capsules: 12.5mg

Oral solution: 10mg/mL, 100mg/mL

Tablets: 12.5mg, 25mg, 50mg, 100mg

Edema caused by heart failure, renal dysfunction, cirrhosis, corticosteroid therapy, or estrogen therapy, 25 to 100mg P.O. daily as single dose or in divided doses. Maximum disage is 200mg/day.

Mild to moderate hypertension initially, 12.5mg daily P.O.; then, based on blood pressure response, may give 12.5 to 50mg/day P.O. Higher dosages may be given in refractory cases.

Adverse effects: Dizziness, drowsiness, lethargy, headache, insomnia, nervousness, vertigo, asthenia, asterixis, paresthesias, confusion, fatigue, encephalopathy. Chest pain, orthostatic hypotension, ECG changes, thrombophlebitis, arrhythmias. Nystagmus. Nausea, vomiting, epigastic distress, anorexia, pancreatitis. Polyuria, nocturia, erectile dysfunction, loss of libido, renal failure.Muscle cramps. Photosensitivity, urticaria, rash, dermatitis, purpura, alopecia, flushing. Fever, weight loss, anaphylaxis.

Nursing Considerations:

-Monitor blood pressure, fluid intake and output, and daily weight.

-Assess electrolyte levels, especially potassium. Monitor for signs and symptoms of hypokalemia.

-Monitor blood urea nitrogen and creatinine levels.

-Check blood glucose level in diabetic patients.

-Assess for signs and symptoms of gout attacks in patients with gouty arthritis.

Patient Education:

-Advise patient to take food or milk if GI upset occurs.

-Tell patient to take early in day to avoid night time urination.

-Instruct patient to track intermittent doses on calendar.

-Tell patient to weigh himself daily, at the same time on same scale and wearing same clothes.

-Instruct patient to report decreased urination, swelling, unusual bleeding or bruising, dizziness, fatigue, numbness, and muscle weakness or cramping.

-Instruct patient to move slowly when sitting up or standing, to avoid dizziness from sudden blood pressure decrease.

-Caution patient to avoid driving and other hazardous activities until he/she knows how drug affects concentration and alertness.

Davis Drug Guide Page 449

Ibuprofen

Generic Name: Ibuprofen

Brand Name: Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever etc.

Drug Classification:

Pharmacologic: Nonsteroidal anti-inflammatory drug (NSAID)

Therapeutic: Analgesic, antipyretic, anti-inflammatory

Use: Ibuprofen is used for pain relief, fever reduction, and swelling. 

Dosage:

Capsules (liquigels): 200mg 

Oral suspension: 100mg/5mL

Tablets: 100mg, 200mg, 400mg, 600mg, 800mg

Tablets (Chewable): 50mg, 100mg

Adults with Rheumatoid arthritis; osteoarthritis: 1.2 to 3.2g/day P.O. in three to four divided doses.

Adults with mild to moderate pain: 400mg P.O. every 4 to 6 hours as needed.

Adults with Primary dysmenorrhea: 400mg P.O. every 4 hours as needed.

Adverse effects:Headache, dizziness, drowsiness, nervousness, aseptic meningitis. Arrhythmias. Amblyopia, blurred vision, tinnitus. Nausea, vomiting, constipation, dyspepsia, abdominal discomfort, GI bleeding.Cystitis, hematuria, azotemia, renal failure Bronchospasm. Rash, prurtus, urticaria, Steven-Johnson sydrome.Edma, allergic reactions including anaphylaxis.

Nursing Considerations:

-Monitor for desired effect.

-Watch for GI upset, adverse CNS effects (such as headache and drowsiness), and hypersensitivity reaction.

-Stay alert for GI bleeding and ulcers, especially in long-term therapy.

-In long-term therapy, assess renal and hepatic function regularly.

Patient Education:

-Tell patient to take with full glass of water, with food, or after meals to minimize GI upset.

-To help prevent esophageal irritation, instruct patient to avoid lying down for 30-60 mins after taking dose.

-Instruct patient to immediately report irregular heartbeats, black tarry stools, vision changes, unusual tiredness, yellowing of skin or eyes, change in urination pattern, difficulty breathing, finger or ankle swelling, weight gain, itching, rash, fever, or sore throat.

-Caution patient to avoid driving and other hazardous activities until he/she knows how drug affects concentration, alertness, and balance.

Davis Drug Guide Page 678

Lispro Insulin

Generic name: Lispro Insulin

Brand name: Humalog, Humalog Pen

Drug Classification: 

Pharmacologic: Pancreatic hormone

Therapeutic: antidiabetics

Use: Used to control hyperglycemia in patients with type 1 or type 2 diabetes mellitus.

Dosage: In newly diagnosed diabetes, total of 0.5 to 1 unit/kg/day subcutaneously as part of multidose regimen of short-and long-acting insulin. Dosage individualized based on patient's glucose level, adjusted to premeal and bedtime glucose levels. Reserve concentrated insulin (500 units/mL) for patients requiring more than 200 units/day.

Adverse effects: Hypokalemia, sodium retention, hypoglycemia, rebound hyperglycemia (Somogyi effect). Urticaria, rash, pruritus. Edema, lipodystrophy, lipohypertrophy, erythema, stinging or warmth at injection site; allergic reactions including anaphylaxis.

Nursing Considerations:

-Monitor glucose level frequently to assess drug efficacy and appropriateness of dosage.

-Watch blood glucose level closely if patient is converting from one insulin type to another or is under unusual stress (as from surgery or trauma).

-Monitor for signs and symptoms of hypoglycemia. Keep glucose source at hand in case hypoglycemia occurs.

-Asses for signs and symptoms of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (as shown by blood and urinary ketones, metabolic acidosis, extremely elevated blood glucose level).

-Monitor for glycosuria

-Closely evaluate kidney and liver function test results in patients with renal or hepatic impairment.

Patient Education:

-Teach patient how to administer insulin subcutaneously as appropriate.

-Advise patient to draw up regular insulin into syringe first when mixing two types of insulin. Caution him/her not to change order of mixing insulins.

-Instruct patient to rotate subcutaneous injection sites and keep a record of sites used, to prevent fatty tissue breakdown.

-Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him/her to carry a glucose source at all times.

-Instruct patient to store insulin in refrigerator (not freezer).

-Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.

-Tell patient that dietary changes, activity, and stress can alter blood glucose level and insulin requirements.

-Instruct patient to wear medical identification stating that he/she is diabetic and takes insulin.

-Advise patient to have regular medical, vision, and dental exams.

Davis Drug Guide Page  712

Lipitor

Generic Name: Atorvastatin Calcium

Drug Classification:

Pharmacologic: HMG-CoA reductase inhibitor

Therapeutic: Lipid-lowering agent

Use: Lipitor is used to treat high cholesterol, and to lower the risk of stroke, heart attack, or other heart complications in people with type 2 diabetes, coronary heart disease, or other risk factors.

Dosage:

Tablets: 10mg, 20mg, 40mg, 80mg

Adults: Initially, 10mg P.O. daily; increase to 80mg P.O. daily if needed. Adjust dosage according to patient's cholesterol level.

Adverse effects: Amnesia, abnormal dreams, emotional lability, headache, hyperactivity, poor coordination, malaise, paresthesia, peripheral, neuropathy, drowsiness, syncope, weakness. Orthostatic hypotension, palpitations, phlebitis, vasodilation, arrhythmias. Amblyopia, altered refraction, glaucoma, eye hemorrhage, dry eyes, hearing loss, tinnitus, epistaxis, sinusitis, pharyngitis.Nausea, vomiting, diarrhea, constipation, abdominal cramps, abdominal or biliary pain, colitis, indigestion, dyspepsia, flatulence, stomach ulcers, gastroenteritis, melena, tenesmus, glossitis, mouth sores, dry mouth, dysphagia, esophagitis, pancreatitis, rectal hemorrhage.Hematuria, nocturia, dysuria, urinary frequency or urgency, urinary retention, cystitis, nephritis, renal calculi, abnormal ejaculation, decreased libido, erectile dysfunction, epididymitis. Bursitis, joint pain, back pain, leg cramps, gout, muscle pain or aches, myositis, myasthenia gravis, neck rigidity, torticollis, rhabdomyolysis. Dyspnea, pneumonia, bronchitis.  Alopecia, acne, contact dermatitis, eczema, dry skin, pruritus, rash, urticaria, skin ulcers, seborrhea, photosensitivity, diaphoresis, toxic epidermal necrolysis. taste loss, gingival bleeding, fever, facial paralysis, facial or generalized edema, flulike symptoms, infection, appetite changes, weight gain, allergic reaction, Stevens-Johnson syndrome.

Nursing considerations:

-Monitor patient for signs and symptoms of allergic response.

-Evaluate for muscle weakness (a symptom of myositis and possibly rhabdomyolysis).

-Be aware that reduction in dosage and periodic monitoring of creatine kinase level may be considered for patients taking drugs that may increase atorvastatin level.

-Monitor liver function test results and blood lipid levels.

Patient Education:

-Tell patient he/she may take drug with or without food.

-Advise patient to immediately report allergic response, irregular heart beats, unusual tiredness, yellowing of skin or eyes, or muscle weakness.

-Caution patient to avoid driving and other hazardous activities until he/she knows how drug affects concentration, alertness, and vision.

-Inform patient taking hormonal contraceptives that drug increases estrogen levels. Instruct her to tell all prescribers she's taking drug.

-Tell men that drug may cause erectile dysfunction and abnormal ejaculation. Encourage them to discuss these issues with prescriber.

-Tell patient he/she will undergo regular blood testing during therapy.

Davis Drug Guide Page 654

Lantus

Generic Name: Insulin Glargine (rDNA origin)

Drug Classification:

Pharmacologic: Pancreatic homormone

Therapeutic: Hypoglycemic

Use:Lantus is used to treat type 1 or type 2 diabetes.

Dosage:

Injection: 100 units/mL in 10mL vials and 3mL cartridges. Subcutaneous injection daily at same time each day, with dosage based on blood glucose level.

Adverse effects:Rebound hyperglycemia (Somogyi effect), hypoglycemia. Urticaria, rash, pruritus, redness, stinging, or warnth at injection site. Edma, lipodystrophy, lipohypertrophy, allergic reactions including anaphylaxis.

Nursing Considerations:

-Monitor blood glucose level frequently to assess drug efficacy and appropriateness of dosage.

-Watch blood glucose level closely if patient is converting from on insulin type to another or is under unusual stress (as from surgery or trauma).

-Check for signs and symptoms of hypoglycemia (such as CNS changes). Keep glucose source at hand.

-Monitor for signs and symptoms of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (blood and urine ketones, metabolic acidosis, extremely elevated glucose level, hypovolemia).

-Monitor for glycosuria.

-Closely monitor kidney and liver function test results in patients with renal or hepatic impairment.

Patient Education:

-Instruct patient how to administer insulin subcutaneously.

-Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him/her to always carry glucose source.

-Advise patient to rotate subcutaneous injection sites and keep a record of sites used.

-Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.

-Inform patient that changes in diet, activity, and stress level can affect blood glucose level and insulin requirements.

-Advise patient to wear medical identification stating that he/she is diabetic and takes insulin.

Davis Drug Guide Page 709

K-DUR

Generic Name: Potassium Chloride                                                          Brand Name: K-DUR

Drug Classification:

Pharmacologic: Mineral, electrolyte

Therapeutic: Electrolyte replacement, nutritional supplement

Use: Potassium chloride is used to prevent or to treat low blood levels of potassium (hypokalemia).

Dosage:Tablets and capsules: 8, 10, 20 mEq. Liquid: 20, 40 mEq/15 ml. Powder: 20, 25 mEq/packet. Injection: 10, 20, 30, 40, 60, 90 mEq and 2 mEq/ml.

The usual adult recommendation for treatment of hypokalemia is 40-100 mEq daily. The dose for prevention is 16-24 mEq daily. Oral potassium is usually taken with meals and fluids to prevent intestinal problems. Liquid should be diluted in water or juice, and controlled release tablets should be swallowed whole.

Adverse effects: Common reactions to potassium are primarily gastrointestinal and include nausea, vomiting, diarrhea, flatulence and abdominal discomfort. Irritation and damage to the stomach, for example, ulceration, can be reduced by taking potassium supplements with meals, reducing the dose, or diluting liquid preparations with juice. More important side effects include high blood potassium levels, bleeding or perforation of the stomach or small intestine from ulcers, and narrowing (stricture) of the small intestine from healed ulcers. 

Nursing Considerations:

-Monitor renal function, fluid intake and output, and potassium, creatinine, and blood urea nitrogen levels.

-Assess vital signs and ECG. Stay alert for arrhythmias.

-Monitor neurologic status. Watch for neurologic complications.

-Monitor I.V. site for irritation.

-Know that potassium is contraindicated in patients with severe renal impairment and must be used with extreme caution (if at all) in patients with any degree of renal impairment, because of risk of life threatening hyperkalemia.

Patient Education:

-Instruct patient to mix and dissolve powder completely in 3 to 8 oz water or juice.

-Tell patient to swallow extended-release capsules whole without crushing or chewing them.

-Instruct patient to take oral form with or just after a meal, with a glass of water or fruit juice.

-Tell patient to sip diluted liquid form over 5 to 10 minutes.

-Advise patient to report nausea, vomiting, confusion, numbness, and tingling, unusual fatigue or weakness, or heavy feeling in legs.

-Tell patient to minimize GI upset by eating frequent, small servings of food and drinking plenty of fluids.

-Inform patient that although wax matrix form may appear in stool, drug has already been absorbed.

-Advise patient not to use salt substitutes.

Davis Drug Guide Page 1037

Lopressor

GENERIC NAME: metoprolol

BRAND NAMES: Lopressor, Toprol XL

Drug Classification:

Pharmacologic: Beta-adrenergic blocker (selective)

Therapeutic: Antihypertensive, antianginal

Use: Used for treating high blood pressure, heart pain, abnormal rhythms of the heart, and some neurologic conditions

Dosage:

Tablets: 25, 50, and 100 mg.

Tablets (extended release): 25, 50, 100, and 200 mg.

Injection: 1 mg/mL

The dose for treating hypertension is 100-450 mg daily in single or divided doses. Angina is treated with 100-400 mg daily in two divided doses. Acute myocardial infarction is treated with three 5 mg injections administered 2 minutes apart followed by treatment with 50 mg oral metoprolol every 6 hours for 48 hours. After 48 hours, patients should receive 100 mg orally twice daily for at least 3 months.

Adverse effects: Abdominal cramps, diarrhea, constipation, fatigue, insomnia, nausea, depression, dreaming, memory loss, fever, impotence, lightheadedness, slow heart rate, low blood pressure, cold extremities, sore thoart and shortness of breath or wheezing. Metoprolol can aggravate breathing difficulties in patients with asthma, chronic bronchitis, or emphysema.

Nursing Considerations:

-Measure blood pressure closely when starting therapy and titrating dosage. Once patient stabilizes, measure blood pressure every 3 to 6 months.

-Monitor blood pressure and pulse before I.V. administration. If patient is hypotensive or has bradycardia, consult prescriber before giving dose.

-Watch for orthostatic hypotension in at risk patients, particularly the elderly.

-Assess glucose levels in diabetic patient. Be aware that drug may mask signs and symptoms of hypoglycemia.

-Monitor for signs and symtoms of hyperthyroidism. Know that drug may mask these. Reduce dosage gradually in hyperthyroid patients.

-When discontinuing drug, reduce dosage gradually over 1 to 2 weeks.

Patient Education:

-Advise patient to take with food IMMEDIATELY after meals.

-Tell patient that extended release tablets are scored and can be divided, but that he/she should swallow tablets or half tablets whole and not crush or chew them.

-Advise patient with heart failure to report signs and symptoms of worsening condition, including weight gain and increasing shortness of breath.

-Caution patient to avoid driving and other hazardous activities until drug effects are known.

-Instruct patient to notify health care providers (including dentists) that he/she is taking drug before having surgery.

Davis Drug Guide Page 853

Isoniazid 

Generic Name: Isoniazid

Brand Name: Nydrazid

Drug Classifications:

Pharmacologic:Isonicotinic acid hydrazide

Therapeutic:Antiitubercular

Use: Isoniazid is used to prevent active tuberculosis in persons who have an abnormal skin test for tuberculosis (latent tuberculosis) or in combination with other drugs for the treatment of active tuberculosis.

Dosage: 

Tablets: 100 or 300 mg.

Syrup: 50 mg per teaspoonful.

Injection: 100 mg/ml.

The recommended dose for latent tuberculosis 300 mg daily for 9 months. Active tuberculosis is treated with 5 mg/kg up to 300 mg daily or 15 mg/kg up to 900 mg 1-3 times weekly.

Adverse effect: Clumsiness or unsteadiness, Dark urine, Loss of appetite, Nausea or vomiting, Numbness, tingling, burning, or pain in hands and feet, Unusual tiredness or weakness, Yellow eyes or skin.

Nursing Considerations:

-Assess hepatic enzyme levels.

-Watch for adverse reactions, such as peripheral neuropathy.

Patient Education:

-Advise patient to take medication as directed. Take missed doses as soon as possible unless almost time for next dose; do not double up on missed doses. Emphasize the importance of continuing therapy even after symptoms have subsided.

-Advise patient to notify health care professional promptly if signs and symptoms of hepatitis (yellow eyes and skin, nausea, vomiting, anorexia, dark urine, unusual tiredness, or weakness) or peripheral neuritis (numbness, tingling, paresthesia) occur. Pyridoxine may be used concurrently to prevent neuropathy. Any changes in visual acuity, eye pain, or blurred vision should also be reported immediately.

-Caution patient to avoid the use of alcohol during this therapy, as this may increase the risk of hepatotoxicity. Ingestion of Swiss or Cheshire cheeses, fish (tuna, skipjack, and sardinella), and possibly
tyramine-containing foods should also be avoided, as they may result in redness or itching of the skin; hot feeling; rapid or
pounding heartbeat; sweating; chills; cold, clammy feeling; headache; or light-headedness.

-Emphasize the importance of regular follow-up physical and ophthalmologic exams to monitor progress and to check for side effects.

Davis Drug Guide Page 733

Glipizide

Generic Name:Glipizide

Brand Name:Glucotrol

Drug Classifications:

Pharmacologic class: Sulfonylurea

Therapeutic class: Hypoglycemic

Use: Used to control high blood sugar in people with type 2 diabetes (non-insulin-dependent diabetes). It may also be used with other diabetes medications. 

Dosage:

Tables: 5mg, 10mg

Tables (extended release): 5mg, 10mg

5mg/day by mouth initially, increased as needed after several days (range is 2.5 to 40mg/day). Give extended release tablet once daily; maximum dosage is 20mg/day. Give daily dosage above 15mg in two divided doses.

Adverse effects:Easy bruising or bleeding (nosebleeds, bleeding gums), feeling tired or short of breath, rapid heart rate, nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes), pale skin,fever, confusion; or throbbing headache, severe nausea and vomiting, fast or pounding heartbeats, sweating or thirst, feeling like you might pass out

Nursing Consideration:

-Monitor blood glucose level, especially during periods of increased stress.

-Evaluate CBC and renal function test.

-If patient is ill or has abnormal laboratory values, monitor electrolyte, ketone, glucose, pH, lactate dehyrogenase, and pyruvate levels.

-Monitor cardiovascular status.

Patient Education:

-Advise patient to take daily dose of extended release tablets with breakfast or immediate release tablet 30 mins. before breakfast (and second dose, if prescribed, before dinner).

-Advise patient to monitor blood glucose level as instructed by prescriber.

-Tell patient he/she may need supplemental insulin during times of stress or when he/she can't maintain adequate oral intake.

-Teach patient how to recognize signs and symptoms of hypoglycemia and hyperglycemia.

-Stress importance of diet and exercise to help control diabetes.

-Instruct patient to wear or carry medical I.D. describing his condition.

-Advise patient to keep sugar source at hand at all times in case of hypoglycemia.

-Tell patient he/she will under go regular blood testing during therapy.

Davis Drug Guide Page 639

Haldol

Generic Name: Haloperidol

Brand Name: Haldol

Drug Classification:

Pharmacologic: butyrophenones

Therapeutic: antipsychotics

Use:Used to treat schizophrenia. It is also used to control motor and speech tics in people with Tourette's syndrome.

Dosage:

Injection: 50mg/mL 100mj/mL

Oral concentrate: 2mg/mL

Tablets: 0.5mg, 1mg, 2mg, 5mg, 10mg, 20mg

Adults: 0.5–5 mg 2 –3 times daily. Patients
with severe symptoms may require up to 100 mg/
day.

Geriatric Patients or Debilitated Patients: 0.5–2 mg twice daily initially; may be gradually increased as needed.

IM (Adults): 2 –5 mg q 1 –8 hr (not to exceed 100
mg/day).

Adverse effects: Seizures, extrapyramidal reactions, confusion,drowsiness, restlessness, tardive dyskinesia.
blurred vision, dry eyes. respiratory depression. hypotension, tachycardia, ECG changes (QT prolongation, torsade de pointes), ventricular arrhythmias. constipation, dry mouth, anorexia,
drug-induced hepatitis, ileus, weight gain. impotence, urinary retention. diaphoresis,photosensitivity, rashes. amenorrhea, galactorrhea, gynecomastia. HAGRANULOCYTOSIS,anemia, leukopenia, neutropenia. hyperpyrexia. NEUROLEPTIC MALIGNANT SYNDROME, hypersensitivity reactions.

Nursing Considerations:

-Assess mental status (orientation, mood, behavor) prior to and periodically during therapy.
-Assess positive (hallucination, delusions) and negative (social isolation) symptoms of schizophrenia.
-Monitor BP (sitting, standing, lying) and pulse prior to and frequently during the period of dose adjustment. May cause QT interval changes on ECG.
-Observe patient carefully when administering medication, to ensure that medication is actually taken and not hoarded.

-Monitor intake and output ratios and daily weight. Assess patient for signs and symptoms of dehydration (decreased thirst, lethargy, hemoconcentration), especially in geriatric patients.

-Assess fluid intake and bowel function. Increased bulk and fluids in the diet help minimize constipating effects.

-Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Report symptoms immediately. May also cause leukocytosis,elevated liver function tests, elevated CPK.

Patient Education:

-Advise patient to take medication as directed.Take missed doses as soon as remembered, with remaining doses evenly spaced throughout the day. May require several weeks to obtain desired
effects. Do not increase dose or discontinue medication without consulting health care professional. Abrupt withdrawal may cause dizziness;nausea; vomiting; GI upset; trembling; or uncontrolled movements of mouth, tongue, or jaw.
-Inform patient of possibility of extrapyramidal symptoms, tardive dyskinesia, and neuroleptic malignant syndrome. Caution patient to report symptoms immediately.
-Advise patient to change positions slowly to minimize orthostatic hypotension.
-May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
-Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.
-Advise patient to use sunscreen and protective clothing when exposed to the sun to prevent photosensitivity reactions. Extremes of temperature should also be avoided; drug impairs body tem-
perature regulation. Instruct patient to use frequent mouth rinses,
good oral hygiene, and sugarless gum or candy to minimize dry mouth.
-Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
-Instruct patient to notify health care professional promptly if weakness, tremors, visual disturbances, dark-colored urine or clay-colored stools, sore throat, fever, menstrual abnormalities, galactorrhea or sexual dysfunction occur.
-Emphasize the importance of routine follow-up exams to monitor response to medication and detect side effects.

Davis Drug Guide Page 641

Heparin

Generic Name: Heparin

Brand Name: Hepalean, Hep-Lock, Hep-Lock U/P

Drug Classification:

Pharmacologic: Antithrombotics

Therapeutic: Anticoagulants

Use:Used to treat and prevent blood clots in the veins, arteries, or lung. Heparin is also used before surgery to reduce the risk of blood clots.

Dosage: IV (Adults): Intermittent bolus 10,000 units,followed by 5000–10,000 units q 4–6 hr. Continuious infusion 5000 units (35–70 units/kg), followed by 20,000–40,000 units infused over 24 hr
(approx. 1000 units/hr or 15–18 units/kg/hr).

Subcut (Adults): 5000 units IV, followed by initial subcut dose of 10,000–20,000 units, then 8000–10,000 units q 8 hr or 15,000–20,000 units every 12 hrs.

Adverse effects:drug-induced hepatitis. Alopecia (long-term use), rashes, urticaria.BLEEDING, HEPARIN-INDUCED THROMBOCYTOPENIA (HIT) (WITH OR WITHOUT THROMBOSIS), anemia. Pain at injection site.Osteoporosis (long-term use),fever, hypersensitivity.

Nursing Considerations:

-Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising;black, tarry stools; hematuria; fall in hematocrit or BP; guaiac-positive stools). Notify health care
professional if these occur.
-Assess patient for evidence of additional or increased thrombosis. Symptoms will depend on area of involvement.
-Monitor patient for hypersensitivity reactions(chills, fever, urticaria).
-Subcut: Observe injection sites for hematomas,ecchymosis, or inflammation.

Patient Education:

-Advise patient to report any symptoms of unusual
bleeding or bruising to health care professional immediately.
-Instruct patient not to take medications containing aspirin or NSAIDs while on heparin therapy.Caution patient to avoid IM injections and activities leading to injury and to use a soft toothbrush and electric razor during heparin therapy.
-Advise patient to inform health care professional
of medication regimen prior to treatment or surgery.
-Patients on anticoagulant therapy should carry an
identification card with this information at all
times.

Davis Drug Guide Page 641