Generic Name: Phenobarbital  Confusion

 paradoxical CNS reactions (hyperactivity, anxiety

Brand Name: Luminal
in children; excitement, restlessness in elderly,
Drug Class: Barbiturate (Schedule IV). generally noted during first 2 wks of therapy,
particularly in presence of uncontrolled pain).
Therapeutic Class: Anticonvulsant, hypnotic A/E:
Dosage/Route/Timing:  Agranulocytosis
Status Epilepticus  Stevens–Johnson syndrome
IV: ADULTS, ELDERLY, CHILDREN: 20 mg/kg. May repeat  Angioedema
once in 10 min with a dose of 5–10 mg/kg.  Laryngospasm
CHILDREN: 20 mg/kg (Maximum: 1,000 mg) over 10  respiratory depression
min; may repeat after 15 min (Maximum dose: 40  CNS depression
mg/kg.  Coma
 Death
Seizure Control (Maintenance)
Note: Maintenance dose usually starts 12 hrs after Nursing Responsibilities:
loading dose.
PO, IV: ADULTS, ELDERLY, CHILDREN OLDER THAN 12  Monitor CNS status, seizure activity,
YRS: 1–3 mg/kg/day. hepatic/renal function, respiratory rate, heart
CHILDREN 5–12 YRS: 4–6 mg/kg/day in divided doses. rate, B/P.
CHILDREN 1–5 YRS: 6–8 mg/kg/day in divided doses.  Monitor for therapeutic serum level
CHILDREN YOUNGER THAN 1 YR: 5–8 mg/kg/day in 1–2 Therapeutic serum level: 10–40 mcg/mL; toxic
divided doses. serum level: greater than 40 mcg/mL.
NEONATES: 3–4 mg/kg/day given once daily.
Patient Teaching:

Doctor’s order:  Avoid alcohol, limit caffeine.

90 mg 1 tab q 12 PO  May be habit-forming.
 Do not discontinue abruptly.
MOA: Depresses sensory cortex, decreases motor  May cause dizziness/drowsiness; avoid tasks
activity, alters cerebellar function. that require alertness, motor skills until
response to drug is established.
Indications:

 Status Epilepticus
 Seizure Control (Maintenance)

Contraindications:

 Hypersensitivity to PHENobarbital, other

barbiturates
 porphyria
 dyspnea or airway obstruction
 use in nephritic pts (large doses)
 severe hepatic impairment
 history of sedative/hypnotic addiction
 Intra- arterial or subcutaneous administration

S/E:

 Drowsiness
Generic Name: Azithromycin Nursing Responsibilities:

Brand Name: (Zithromax, Zmax)  Question for history of hepatitis, allergies to

azithromycin, erythromycins.
Drug Class: Macrolide
 Assess for infection (WBC count, appearance of
Therapeutic Class: Antibiotic wound, evidence of fever).
 Check for GI discomfort, nausea, vomiting.
Dosage/Route/Timing:  Monitor daily pattern of bowel activity and stool
PO; 500 mg for one dose, then 250 mg/day for 4 days consistency.
 Monitor LFT, CBC.
Doctor’s order: 500mg IV OD, WSJ  Assess for hepatotoxicity: malaise, fever,
abdominal pain, GI disturbances.
MOA: Binds to ribosomal receptor sites of susceptible  Be alert for superinfection: fever, vomiting,
organisms, inhibiting RNA-dependent protein synthesis. diarrhea, anal/genital pruritus, oral mucosal
changes (ulceration, pain, erythema).
Indications:

 Mild to Moderate Respiratory Tract, Skin, Soft Patient Teaching:

Tissue Infections  Continue therapy for full length of treatment.
 MAC Prevention  Avoid concurrent administration of aluminum-
 MAC Treatment or magnesium-containing antacids.
 Otitis Media  conjunctivitis: Do not wear contact lenses.
 Pharyngitis
 Tonsillitis
 Pneumonia, Community-Acquired
 Bacterial Conjunctivitis

Contraindications:

 Hypersensitivity to azithromycin or other

macrolide antibiotics
 History of cholestatic jaundice/hepatic
impairment associated with prior azithromycin
therapy

S/E:

 Nausea & vomiting

 Diarrhea
 abdominal cramping
 dry skin orburning (topical route)

A/E:

 anaphylaxis
 ototoxicity
 pseudomembranous colitis
 hepatotoxicity
 superinfections
 dysrhythmias
 anemia
Generic Name: Tramadol A/E:

Brand Name: Ultram  Seizures

 May have prolonged duration of action,
Drug Class: Centrally acting synthetic opioid
cumulative effect in pts with hepatic/renal
Therapeutic Class: Analgesic impairment, serotonin syndrome (agitation,
hallucinations, tachycardia, hyperreflexia)
Dosage/Route/Timing:  May cause suicidal ideation and behavior
PO; 50–100 mg every 4–6 h prn (max: 400 mg/day);
may start with 25 mg/day, and increase by 25 mg every Nursing Responsibilities:
3 days up to 200 mg/day
 Assess onset, type, location, duration of pain
Doctor’s order: 5O mg IV q8 hr as needed to pain  Assess drug history, esp. carbaazepine,
analgesics, CNS depressants, MAOIs.
MOA: Binds to mu-opioid receptors, inhibits reuptake of  Review past medical history, esp. epilepsy,
norepinephrine, serotonin, inhibiting ascending and seizures.
descending pain pathways.  Assess renal function, LFT.
 Monitor pulse, B/P, renal/hepatic function.
Indications: Assist with ambulation if dizziness, vertigo
occurs.
 Moderate to Moderately Severe Pain  Dry crackers, cola may relieve nausea. Palpate
Contraindications: bladder for urinary retention.
 Monitor daily pattern of bowel activity, stool
 hypersensitivity to tramadol, opioids consistency.
 acute alcohol intoxication  Sips of water may relieve dry mouth.
 concurrent use of centrally acting analgesics  Assess for clinical improvement, record onset of
 hypnotics relief of pain.
 opioids
 psychotropic drugs Patient Teaching:

S/E:  May cause dependence.

 Avoid alcohol, OTC medications (analgesics,
 dizziness sedatives).
 vertigo  May cause drowsiness, dizziness, blurred vision.
 nausea  Avoid tasks requiring alertness, motor skills until
 constipation response to drug is established.
 headache  Report severe constipation, difficulty breathing,
 drowsiness excessive sedation, seizures, muscle weakness,
 vomiting tremors, chest pain, palpitations.
 pruritus
 CNS stimulation (e.g., nervousness, anxiety,
agitation, tremor, euphoria, mood swings,
hallucinations)
 asthenia
 diaphoresis
 dyspepsia,
 dry mouth
 diarrhea
Generic Name: Phenytoin

Brand Name: Dilantin A/E:

Drug Class: Hydantoin  blood dyscrasias

 lymphadenopathy
Therapeutic Class: Anticonvulsant, antiarrhythmic
 osteomalacia (due to interference of vitamin D
Dosage/Route/Timing: metabolism) may occur
Status Epilepticus  Toxic phenytoin blood concentration (25
IV: ADULTS, ELDERLY, ADOLESCENTS: Loading dose: 20 mcg/mL or more) may produce ataxia,
mg/kg at maximum rate of 50 mg/min. May repeat in 10 nystagmus, diplopia.
min after loading dose with dose of 5–10 mg/kg.  As level increases, extreme lethargy to
INFANTS, CHILDREN: Loading dose: 20 mg/kg at comatose state occurs.
maximum rate of 1 mg/kg/min. May give additional
Nursing Responsibilities:
dose of 5–10 mg/kg after loading dose.
 Initiate seizure precautions.
Seizure Control (Maintenance)  LFT, CBC should be performed before beginning
PO: ADULTS, ELDERLY: Usual dose: 100 mg 3–4 therapy and periodically during therapy.
times/day up to 200 mg 3 times/day (may consider 300  Observe frequently for recurrence of seizure
mg once daily in pts established on 100 mg 3 activity.
times/day). Maximum: 300 mg/day.  Monitor ECG for cardiac arrhythmia.
 Assess for clinical improvement (decrease in
PO; 15–18 mg/kg or 1-g initial dose; then 300 mg/day in intensity/frequency of seizures).
one to three divided doses; may be gradually increased  Monitor for signs/symptoms of depression,
to 100 mg/week suicidal tendencies, unusual behavior. Monitor
CBC with differential, renal function, LFT, B/P
Doctor’s order: 100 mg IV q80 (with IV use).
 Assist with ambulation if drowsiness, lethargy
MOA: Stabilizes neuronal membranes in motor cortex. occurs.
Decreases influx of sodium during generation of nerve  Monitor for therapeutic serum level (10–20
impulses. mcg/mL).

Indications: Patient Teaching:

 Status Epilepticus  Pain may occur with IV injection.

 Seizure Control (Maintenance)  To prevent gingival hyperplasia (bleeding,
tenderness, swelling of gums), maintain good
Contraindications: oral hygiene, gum massage, regular dental visits.
 Serum levels should be performed every mo for
 hypersensitivity to hydantoin products
1 yr after maintenance dose is established and
 rash, seizures due to hypoglycemia
q3mos thereafter.
 sinus bradycardia
 Report sore throat, fever, glandular swelling,
 heart block
skin reaction (hematologic toxicity).
 Drowsiness usually diminishes with continued
S/E:
therapy. Avoid tasks that require alertness,
 somnolence motor skills until response to drug is
 drowsiness established.
 dizziness  Do not abruptly withdraw medication after
 nystagmus long-term use (may precipitate seizures).
 gingival hyperplasia
 Strict maintenance of drug therapy is essential
for seizure control, arrhythmias.
 Avoid alcohol.
 Report any unusual changes in behavior.
Generic Name: Enalapril Nursing Responsibilities:

Brand Name: Vasotec  Obtain BUN, serum creatinine, CrCL.

 Receive full medication history, esp. potassium-
Drug Class: Angiotensin-converting enzyme (ACE)
sparing diuretics.
inhibitor
 Obtain B/P immediately before each dose (be
Therapeutic Class: Antihypertensive, vasodilator alert to fluctuations).
 In pts with renal impairment, autoimmune
Dosage/Route/Timing: disease, or taking drugs that affect
PO; 5–40 mg in one dose or two divided doses (max: 40 leukocytes/immune response, CBC should be
mg/day) performed before beginning therapy, q2wks for
3 mos, then periodically thereafter.
Doctor’s order: 5g/tab 1/8 tab OD  Assist with ambulation if dizziness occurs.
Monitor CBC, serum BUN, potassium,
MOA: creatinine, B/P.
Suppresses renin-angiotensin-aldosterone system  Monitor daily pattern of bowel activity, stool
(prevents conversion of angiotensin I to angiotensin II, a consistency.
potent vasoconstrictor; may inhibit angiotensin II at
local vascular, renal sites). Decreases plasma angiotensin Patient Teaching:
II, increases plasma renin activity, decreases aldosterone
secretion.  To reduce hypotensive effect, go from lying to
standing slowly.
 Several wks may be needed for full therapeutic
Indications: effect of B/P reduction.
 Skipping doses or voluntarily discontinuing drug
 Hypertension may produce severe rebound hypertension.
 Adjunctive Therapy for HF  Limit alcohol intake.
 Asymptomatic Left Ventricular Dysfunction  Report vomiting, diarrhea, diaphoresis,
persistent cough, difficulty in breathing; swelling
Contraindications: of face, lips, tongue.
 Hypersensitivity to enalapril
 History of angioedema from previous treatment
with ACE inhibitors
 Idiopathic/hereditary angioedema
 Concomitant use of aliskiren in pts with
diabetes

S/E:

 headache
 dizziness
 orthostatic hypotension
 rash
 cough

A/E:

 Angioedema
 acute renal failure
 first-dose phenomenon
Generic Name: dapagliflozin  pyelonephritis
 trigonitis
Brand Name: Farxiga
 urethritis
Drug Class: Sodium-glucose co-transporter 2 (SGLT2)  uTI
inhibitor Nursing Responsibilities:

Therapeutic Class: Antidiabetic agent  Monitor capillary blood glucose, Hgb A1c, renal
function tests.
Dosage/Route/Timing:  Assess for hypoglycemia, hyperglycemia,
PO:ADULTS/ELDERLY: Initially, 5 mg once daily in the mycotic infections.
morning. May increase to 10 mg once daily  Screen for glucose-altering conditions: fever,
increased activity or stress, trauma, surgery.
Doctor’s order:  Obtain dietary consult for nutritional education.
10g/tab 7 tab OD  Encourage PO intake.
 Monitor for hypotension.
MOA: Increases excretion of urinary glucose by  Monitor for hypersensitivity reaction such as
inhibiting reabsorption of glucose in kidneys by dyspnea, urticaria, angioedema, dizziness.
inhibiting SGLT2 in proximal renal tubule
Patient Teaching:
Indications:
 Diabetes mellitus requires lifelong control.
 type 2 Diabetes Mellitus  Diet and exercise are principal parts of
Contraindications: treatment; do not skip or delay meals.
 Test blood sugar regularly.
 hypersensitivity to dapagliflozin, other SGLT2  When taking combination drug therapy or when
inhibitors glucose demands are altered (fever, infection,
 severe renal impairment trauma, stress), have low blood sugar treatment
 dialysis available (glucagon, oral dextrose).
 end-stage renal disease  Monitor daily calorie intake.
S/E:  Report suspected pregnancy. Do not breastfeed.
 nasopharyngitis  Genital itching or discharge may indicate yeast
 back pain infection.
 increased urination  Therapy may increase risk for dehydration/low
 nausea blood pressure, esp. in pts who are elderly, on
 constipation low-salt diet, have low blood pressure, or take
 extremity pain water pills (diuretics) Drink plenty of fluids.
 discomfort with urination  Report any decrease in urine output, dark-
A/E: colored urine, painful urination, or flank pain
 Therapy may increase risk of bladder cancer;
 orthostatic hypotension report any blood in urine or painful urination.
 postural dizziness  May rarely cause allergic reaction; report
 symptomatic hypotension itching, hives, difficulty breathing, wheezing.
 syncope
 genital mycotic (yeast) infections
 hypersensitivity reactions including anaphylaxis,
angioedema (tongue/lip swelling), erythema,
rash, pruritus, urticaria
 cystitis
 kidney infection
 prostatitis
Generic Name: diazepam Nursing Responsibilities:

Brand Name: Valium  Monitor heart rate, respiratory rate, B/P, mental
status.
Drug Class: Benzodiazepine
 Assess children, elderly for paradoxical reaction,
Therapeutic Class: Antianxiety, skeletal muscle relaxant, particularly during early therapy.
anticonvulsant  Evaluate for therapeutic response (decrease in
intensity/frequency of seizures; calm facial
Dosage/Route/Timing: expression, decreased restlessness; decreased
IM/IV; 5–10 mg (repeat as needed at 10–15 min intensity of skeletal muscle pain).
intervals up to 30 mg; repeat again as needed every 2–4  Therapeutic serum level: 0.5–2 mcg/mL; toxic
h) serum level: greater than 3 mcg/mL.
IV push; administer emulsion at 5 mg/min
Patient Teaching:
Doctor’s order: 10 mg slow IVTT q6h for frank seizure
 Avoid alcohol.
MOA:  Limit caffeine.
Depresses all levels of CNS by enhancing action of  May cause drowsiness; avoid tasks that require
gamma-aminobutyric acid (GABA), a major inhibitory alertness, motor skills until response to drug is
neurotransmitter in the brain. established.
 May be habit forming.
Indications:  Avoid abrupt discontinuation after prolonged
use.
 anxiety
 skeletal Muscle Relaxation
 alcohol Withdrawal
 status epilepticus

Contraindications:

 hypersensitivity to diazepam
 acute narrow-angle glaucoma
 untreated open-angle glaucoma
 severe respiratory depression
 severe hepatic insufficiency
 sleep apnea syndrome
 myasthenia gravis
 children younger than 6 mos (oral)

S/E:

 drowsiness
 sedation
 ataxia

A/E:

 Laryngospasm
 respiratory depression
 cardiovascular collapse
 coma
Generic Name:

Brand Name:

Drug Class:

Therapeutic Class:

Dosage/Route/Timing:
Doctor’s order:

MOA:

Indications:

Contraindications:

S/E:

A/E:

Nursing Responsibilities:

Patient Teaching: