gru NURSES RESPOSIBILITY | Instruct patient to take acamprosate exactlyas prescribed, even if a relapse occurs,and to seek help for a relapse.•Warn patient that acamprosate won’treduce symptoms of alcohol withdrawal ifrelapse occurs followed by cessation.• Urge caregivers to monitor patient for evidenceof depression (lack of appetite orinterest in life, fatigue, excessive sleeping,difficulty concentrating) or suicidal tendenciesbecause a small number ofpatients taking acamprosate have attemptedsuicide.• Advise patient to use caution when performinghazardous activities until adverseCNS effects of drug are known. | SIDE EFFECTS | Adverse ReactionsCNS: Abnormal thinking, amnesia, anxiety,asthenia, chills, depression, dizziness,headache, insomnia, paresthesia, somnolence,suicidal ideation, syncope, tremorCV: Chest pain, hypertension, palpitations,peripheral edema, vasodilationEENT: Abnormal vision, dry mouth,pharyngitis, rhinitis, taste perversionGI: Abdominal pain, anorexia, constipation,diarrhea, flatulence, increased appetite,indigestion, nausea, vomitingGU: Acute renal failure, decreased libido,impotenceHEME: Leukopenia, lymphocytosis, thrombocytopeniaMS: Arthralgia, back pain, myalgiaRESP: Bronchitis, cough, dyspneaSKIN: Diaphoresis, pruritus, rash | INDICATION | To maintain abstinence from alcohol foralcohol-dependent patients who areabstinent at the start of treatment CONTRAINDICATIONHypersensitivity to acamprosate or its com- ponents, severe hepatic (Child-Pugh classC) or renal impairment | ACTION | AntialcoholicChronic alcoholism may alter the balancebetween excitation and inhibition in neuronsin the brain; acamprosate restores it.When the neurotransmitter gammaaminobutyricacid (GABA) binds to itsreceptors in the CNS, it opens the chlo chlorideion channel and releases chloride(Cl-) into the cell (below left), therebyreducing neuronal excitability by inhibitingdepolarization. By interacting withGABA receptor sites, acamprosate preventsGABA from bindingWhen glutamate binds to its receptors, itcloses the chloride ion channel, increasingneuronal excitability by promotingdepolarization (below left). This imbalancefosters a craving for alcohol. Byinteracting with glutamate receptor sites,acamprosate prevents glutamate frombinding | FREQUENCY | TID | ROUTE | Oral | DOSE | Adults. 666 m | DRUG NAME | acamprosatecalcium |

NURSES RESPOSIBILITY | Check apical and radial pulses before givingacebutolol. Also, frequently monitorblood pressure and pulse rate, rhythm,and quality during treatment.• Give drug with food to prevent GI upset.• Acebutolol may elevate uric acid, potassium,triglyceride, lipoprotein, and antinuclearantibody levels; it also may interferewith accuracy of glucose tolerance tests.•Monitor diabetic patient’s blood glucoselevel to spot alterations.• Notify prescriber if you detect a heart ratebelow 50 beats/min or signs of heart failure,such as dyspnea, crackles, unexplainedweight gain, and jugular vein distention.•Monitor patient for peripheral edema, andevaluate fluid intake and output. | SIDE EFFECTS | CNS: Abnormal dreams, anxiety, confusion,depression, dizziness, fatigue, fever, headache,insomniaCV: Bradycardia, chest pain, edema, heartblock, heart failure, hypotensionEENT: Abnormal vision, conjunctivitis, dryeyes, eye pain, pharyngitis, rhinitisGI: Constipation, diarrhea, flatulence,hepatotoxicity, indigestion, nauseaGU: Dysuria, impotence, polyuriaMS: Arthralgia, myalgiaRESP: Bronchospasm, cough, dyspnea,wheezingSKIN: Rash | INDICATION | To treat hypertensionMechanism of ActionInhibits stimulation of beta1 receptors inthe heart, decreasing cardiac excitability,heart rate, cardiac output, and myocardialoxygen demand. Acebutolol also decreaseskidneys’ release of renin, which helpsreduce blood pressure. Drug suppresses SAnode automaticity and AV node conductivity,which suppresses atrial and ventricularectopy. By decreasing myocardial oxygendemand, acebutolol decreases myocardialischemia. At high doses, it inhibits stimula- tion of beta2 receptors in the lungs and maycause bronchoconstriction.CONTRAINDICATIONCardiogenic shock, heart failure unlessfrom tachyarrhythmia, hypersensitivity toacebutolol, overt heart failure, second- andthird-degree heart block, severe bradycardia | ACTION | Therapeutic class: Antihypertensive, class IIantiarrhythmic | FREQUENCY | BD | ROUTE | oral | DOSE | Initial: 200 mg b.i.d. Usual: 600 to1,200 mg daily | DRUG NAME | acebutololhydrochloride |

NURSES RESPOSIBILITY | Before and during long-term therapy,monitor liver function test results, includingAST, ALT, bilirubin, and creatinine levels,as ordered.•Monitor renal function in patient on longtermtherapy. Keep in mind that blood oralbumin in urine may indicate nephritis;decreased urine output may indicate renal failure; and dark brown urine may indicatepresence of the metabolitephenacetin.• Expect to reduce dosage for patients withrenal dysfunction.• Store suppositories under 80° F (26.6° C). | SIDE EFFECTS | GI: Abdominal pain, hepatotoxicity, nausea,vomitingHEME: Hemolytic anemia (with long-termuse), leukopenia, neutropenia, pancytopenia,thrombocytopeniaSKIN: Jaundice, rash, urticariaOther: Angioedema, hypoglycemic coma | INDICATION | To relieve mild to moderate pain fromheadache, muscle ache, backache, minorarthritis, common cold, toothache, ormenstrual cramps; to reduce feverContraindicationsHypersensitivity to acetaminophen or itscomponents | ACTION | Antipyretic, nonopioidAnalgesicMechanism of ActionInhibits the enzyme cyclooxygenase, blockingprostaglandin production and interferingwith pain impulse generation in theperipheral nervous system. Acetaminophenalso acts directly on temperature-regulatingcenter in the hypothalamus by inhibitingsynthesis of prostaglandin E2. | FREQUENCY | Every 4 to 6 hrs | ROUTE | orally | DOSE | 325 to 650 mg every 4 to 6 hr | DRUG NAME | Acetaminophen |

NURSES RESPOSIBILITY | Obtain culture and sensitivity test results,if possible, before starting therapy. Expectto start drug before results are available.• Expect to continue treatment for at least48 hours after symptoms resolve or culturedetects no signs of infection.WARNING Expect to give bacampicillin for10 days to treat infection caused by groupA beta-hemolytic streptococci to preventdevelopment of acute rheumatic fever oracute glomerulonephritis.• Assess patient for bacterial or fungalsuperinfection, which may occur with prolongedor repeated therapy. If it occurs,expect to administer another antibiotic orantifungal drug. | SIDE EFFECTS | CNS: Anxiety, confusion, depression,fatigue, fever, hallucinations, lethargy,malaise, neuromuscular irritability, seizures,stroke, syncopeCV: Hypotension, palpitations, periarteritisnodosa, pulmonary hypertension, tachycardia,vascular collapseEENT: Altered taste, black “hairy” tongue,blurred vision, glossitis, laryngospasm,mouth soreness, mucocutaneous candidiasis,stomatitis, taste disordersGI: Abdominal cramps or pain, anorexia,diarrhea, enterocolitis, epigastric distress,elevated liver function test results, gastritis,nausea, pseudomembranous colitis, vomitingGU: Elevated BUN and serum creatininelevels, hematuria, impotence, interstitialnephritis, neurogenic bladder, priapism,renal failure, vaginal candidiasisHEME: Agranulocytosis, anemia, bonemarrow depression, decreased hemoglobinlevel and hematocrit, eosinophilia, | INDICATION | To treat upper respiratory tract infections(including otitis media) caused bystreptococci, pneumococci, non–penicillinase-producing staphylococci, andHaemophilus influenzae; UTI causedby Escherichia coli, Proteus mirabilis,or Streptococcus faecalis; skin and softtissueinfections caused by streptococciand susceptible staphylococciTo treat lower respiratory tract infectionscaused by streptococci, pneumococci,non–penicillinase-producing staphylococci,and H. influenzaContraindicationsCholestatic jaundice and hepatic dysfunctionassociated with amoxicillin and clavulanatepotassium; hypersensitivity to penicillins,cephalosporins, imipenem and cilastatin,or beta-lactamase inhibitors, such aspiperacillin and tazobactam | ACTION | AntibioticInhibits bacterial cell wall synthesis in susceptible susceptiblebacteria. These bacteria assemblerigid, cross-linked cell walls in several steps.Bacampicillin, which undergoes hydrolysisto ampicillin, affects final stage of crosslinkingby binding with and inactivatingpenicillin-binding protein (enzyme responsiblefor linking cell wall strands). This actioninhibits bacterial cell wall synthesis andcauses cell lysis and death. | FREQUENCY | Every 12 hrs | ROUTE | oral | DOSE | 400 mg | DRUG NAME | bacampicillinhydrochloride |

NURSES RESPOSIBILITY | If patient also takes an oral corticosteroid,expect to taper dosage slowly (by decreasingdaily dosage or taking drug every otherday) about 1 week after beclomethasonetherapy begins. Expect dosage reductionsof more than 2.5 mg daily.WARNING When gradually switchingpatient from oral corticosteroid to inhaledbeclomethasone, watch for signs of lifethreateningadrenal insufficiency, such asfatigue, lassitude, weakness, nausea, vomiting,and hypotension, during transitionperiod and when exposed to trauma, surgery,infection, or other stressor. If signsoccur, notify prescriber immediately.• Expect to resume oral corticosteroid duringa stressful period or severe asthmaattack.• Because beclomethasone may be absorbedsystemically, watch for signs of adrenalinsufficiency during periods of stress. | SIDE EFFECTS | CNS: Depression, fatigue, fever, headache,insomnia, light-headednessCV: Chest pain, tachycardiaEENT: Cataracts, dry mouth, dysphonia,earache, epistaxis, glaucoma, hoarseness,lacrimation, nasal congestion, nose andthroat dryness and irritation, oral candidiasis,pharyngitis, rhinorrhea, sinusitis, sneezing,unpleasant smell and tasteENDO: Adrenal insufficiency, cushingoidsymptomsGI: Diarrhea, indigestion, nausea, rectalhemorrhageGU: Dysmenorrhea, UTIMS: Arthralgia, growth suppression in children(nasal aerosol)RESP: Bronchitis, bronchospasm, chestcongestion, cough, pulmonary infiltrates,upper respiratory tract infection, wheezingSKIN: Acne, eczema, pruritus, rash, skindiscoloration, urticariaOther: Angioedema, flulike symptoms,lymphadenopathy, weight gain | INDICATION | To control and prevent symptoms inpatients with chronic asthma and thosewho also require oral corticosteroidsContraindicationsHypersensitivity to beclomethasone’s ingrebeclomethasonedipropionate dients, infrequent oral corticosteroid treatment,primary treatment of status asthmaticusor other acute asthma attack, reliefof acute bronchospasm or of asthma controlledby bronchodilators or other nonsteroidaldrugs, treatment of nonasthmaticbronchitisB | ACTION | Antiasthmatic, Anti-inflammatoryINHALATION AEROSOLMechanism of ActionMay decrease number and activity of cellsinvolved in the inflammatory response ofasthma, allergies, and rhinitis, such as mastcells, eosinophils, basophils, lymphocytes,macrophages, and neutrophils. Also mayinhibit production or secretion of chemicalmediators, such as histamine, eicosanoids,leukotrienes, and cytokines. May producedirect smooth-muscle cell relaxation anddecrease airway hyperresponsiveness | FREQUENCY | B.D | ROUTE | iinhalation | DOSE | (84 MCG) | DRUG NAME | beclomethasonedipropionate |

NURSES RESPOSIBILITY | Before giving bosentan, obtain baselinehemoglobin level and liver function testresults, as ordered.WARNING Because bosentan use may causemajor birth defects, make sure femalepatient of childbearing age has had a negativepregnancy test before giving drug.WARNING Bosentan may cause risk of serioushepatic injury. Assess patient for evidenceof hepatic dysfunction, includingabdominal pain, fatigue, fever, jaundice,nausea, and vomiting.Monitor liver functiontest results every month, as ordered.• Expect dosage to be adjusted or drugstopped if liver function test resultsbecome elevated. Expect treatment to bestopped if bilirubin level increases to twicethe upper limit of normal (or higher) or ifclinical symptoms occur in conjunctionwith liver function test elevations.Bosentan probably won’t be prescribed forpatients with moderate to severe hepaticdysfunction or for those with liver function | SIDE EFFECTS | CNS: Fatigue, headacheCV: Edema, hypotension, palpitationsEENT: NasopharyngitisGI: Elevated liver function test results,hepatic injury, indigestion, liver failureGU: Decreased sperm countHEME: Decreased hemoglobin level andhematocrit, thrombocytopeniaSKIN: Flushing, pruritus, rashOther: Hypersensitivity | INDICATION | To treat pulmonary arterial hypertensionin patients with World HealthOrganization class III or IV symptoms,to improve exercise ability, and to slowworsening of clinical conditionContraindicationsHypersensitivity to bosentan or its components,concurrent use of cyclosporine orglyburide, pregnancy | ACTION | AntihypertensiveMechanism of ActionBosentan is an endothelin (ET) receptorantagonist that inhibits the effects of ET, apotent vasoconstrictor. ET, a neurohormoneproduced by endothelial cells thatline blood vessels, normally increases duringcardiovascular stress. Patients withpulmonary arterial hypertension have anabnormal increase in serum ET level.ET binds with its receptors, ETA andETB, which are located on endothelial andvascular smooth-muscle cells.When ETbinds with these receptors, it causes vasoconstriction,as shown below left, andsuch long-term effects as fibrosis andhypertrophy. By binding to ETA and ETBreceptors, as shown below right, bosentanblocks the vasoconstrictive effects of ET,causing pulmonary artery vasodilationand decreased pulmonary artery pressure.As a result, the patient experiencesincreased exercise tolerance and decreasedbreathlessness | FREQUENCY | b.i.d. | ROUTE | P.O | DOSE | Initial: 62.5 mg | DRUG NAME | bosentan |

NURSES RESPOSIBILITY | Use bromocriptine cautiously if patient hasa history of psychosis or cardiovascular disease,especially after MI with residualarrhythmia. In severe psychotic disorder,bromocriptine isn’t recommended becauseit may worsen the disorder or reduce theeffects of drugs used to treat it.• Expect to perform a pregnancy test every4 weeks during the amenorrheic period.Once menses resume, test whenever aperiod is missed, as ordered.• Plan to withhold bromocriptine if patientbecomes pregnant.• If rapidly expanding adenoma needs continuedtherapy, watch closely for hypertensivecrisis.• Bromocriptine shouldn’t be given postpartumif patient has a history of coronaryartery disease or other severe cardiovascularproblem unless risk of withdrawingdrug is greater than risk of use. If so, monitorclosely for signs and symptoms of CVdysfunction, such as chest pain.• Expect to give drug with levodopa if patientis being treated for Parkinson’s disease.• Assess for hypotension when bromocriptinetherapy starts and or bloodpressure often if patient takes other antihypertensives.• If patient has a history of peptic ulcer or | SIDE EFFECTS | CNS: Asthenia, confusion, dizziness,drowsiness, fatigue, hallucinations, headache,light-headedness, syncopeCV: Hypertension, hypotension, orthostatichypotension, pericarditis, pericardial effusion,Raynaud’s phenomenonEENT: Amblyopia, dry mouth, nasal congestion,rhinitis, sinusitisENDO: HypoglycemiaGI: Abdominal cramps, anorexia, constipation,diarrhea, GI bleeding, indigestion,nausea, vomitingRESP: Pleural effusion or thickening, | INDICATION | To treat amenorrhea, galactorrhea, malehypogonadism, and infertility fromhyperprolactinemiaTo treat prolactin-secreting adenoma | ACTION | Antidiabetic, antidyskinetic,antihyperprolactinemic, dopaminereceptoragonist, growth hormone suppressant,infertility therapy adjunctInhibits release of prolactin and growthhormone from the anterior pituitary gland,thus restoring testicular or ovarian functionand suppressing lactation. Bromocriptine | FREQUENCY | OD | ROUTE | P.O | DOSE | Initial: 1.25 to 2.5 mg | DRUG NAME | bromocriptinemesylate |

NURSES RESPOSIBILITY | Evaluate patient for therapeutic response,including decreased pain, cough, andfacial grimacing.• Take safety precautions, if needed.•Monitor respiratory depth, effort, andrate. Notify prescriber immediately if respiratoryrate drops below 10 breaths/min.• Assess urine output to detect retention.WARNING Assess patient for evidence ofphysical and psychological dependence.• Rotate sites for subcutaneous delivery.Repeated injection in same site may causetissue irritation, pain, and induration | SIDE EFFECTS | CNS: Coma, delirium, depression, disorientation,dizziness, drowsiness, euphoria,hallucinations, headache, lack of coordination,lethargy, light-headedness, mental andphysical impairment, mood changes, restlessness,sedation, seizures, tremorCV: Bradycardia, heart block, hypertension,orthostatic hypotension, palpitations,tachycardiaEENT: Altered taste, blurred vision, diplopia,dry mouth, laryngeal edema, laryngospasm,miosisGI: Abdominal cramps and pain, anorexia,constipation, flatulence, gastroesophagealreflux, ileus, indigestion, nausea, vomitingGU: Decreased libido, difficult ejaculation,dysuria, impotence, oliguria, ureteralspasm, urinary incontinence, urine retentionMS: Muscle rigidityRESP: Apnea, bronchoconstriction, | INDICATION | To treat mild to moderate painTo treat cough from chemical ormechanical irritation of respiratory systemContraindicationsHypersensitivity to codeine, other opioids,or their components; significant respiratorydepression | ACTION | Antitussive, opioid AnalgesicMechanism of ActionMay produce analgesia through partialmetabolism to morphine. Drug binds withmu, delta, and kappa receptors in the spinalcord and with mu1 and kappa3 receptorshigher in the CNS, decreasing intracellularcAMP, which inhibits adenylate cyclaseactivity and prevents release of pain neurotransmitters,such as substance P anddopamine, and altering perception of andemotional response to pain. | FREQUENCY | EVERY 4 HRS | ROUTE | ORAL SOLUTION, TABLETS, I.M. OR SUBCUTANEOUSINJECTION I.V. INJECTION | DOSE | 15 to 60 mg (usual, 30 mg | DRUG NAME | codeine phosphatecodeine sulfate |

NURSES RESPOSIBILITY | Mix colestipol granules with at least 90 mlof fluid before giving it to prevent accidentalinhalation or esophageal distress.• Because colestipol may interact with variousdrugs, give it on a separate schedulefrom other drugs when possible.•Make sure patient has adequate fluidintake, and obtain an order for a stool softeneror laxative to prevent constipation.To prevent impaction, expect to decreasedosage or discontinue drug if constipationoccurs or worsens.• Expect to discontinue drug if no responseoccurs after 3 months.•Monitor patient’s serum cholesterol levelas appropriate, usually at baseline, 4 to6 weeks after starting therapy, and thenevery 3 months. Expect to reduce monitoringfrequency to every 4 months | SIDE EFFECTS | CNS: HeadacheGI: Abdominal distention and pain, constipation,diarrhea, eructation, esophagealreaction, fecal impaction, heartburn, nausea,vomiting | INDICATION | To treat primary hypercholesterolemiaContraindicationsComplete biliary obstruction, hypersensitivityto colestipol or its components | ACTION | AntihyperlipidemicMechanism of ActionCombines with bile acids in the intestine,preventing their absorption and forming aninsoluble complex that’s excreted in feces.Loss of bile acids increases hepatic production of cholesterol to form new bile acidsand increases oxidation of cholesterol tobile acids. Depletion of cholesterol increaseshepatic LDL receptor activity, whichremoves LDLs from the blood | FREQUENCY | BID,QID | ROUTE | P.O | DOSE | 15 to 30 g daily in divided doses | DRUG NAME | colestipolhydrochloride |

NURSES RESPOSIBILITY | Nursing Considerations• Check patient’s creatinine clearance, asordered, before starting dalfampridine.• Use dalfampridine cautiously in patientswith mild renal failure (creatinine clearance51 to 80 ml/min/1.73 m2) becauseseizures may occur. If they do, expect drugto be discontinued.• Drug shouldn’t be taken with compounded4-AP, 4-aminopyridine, or fampridinebecause the risk of seizures may increase.•Monitor patient’s ability to walk to determinedrug’s effectiveness.PATIENT TEACHING• Tell patient to space dalfampridine dosesabout 12 hours apart.• Instruct patient, especially one with mildrenal impairment, to notify prescriber andstop dalfampridine if seizures occur.• Review signs and symptoms of UTI (painon urination, frequency or urgency withurination, cloudy appearance to urine)and tell patient to report any such effects | SIDE EFFECTS | CNS: Asthenia, balance disorder, confusion,dizziness, headache, insomnia, paresthesia,seizuresEENT: Nasopharyngitis, pharyngolaryngealpainGI: Constipation, dyspepsia, nauseaGU: UTIMS: Back pain, multiple sclerosis relapse | INDICATION | To improve walking in patients withmultiple sclerosisContraindicationsHistory of seizures, hypersensitivity to dalfampridineor its components, moderate orsevere renal impairment (creatinine clearanceof 50 ml/min/1.73 m2 or less) | ACTION | Potassium channel blockerMechanism of ActionMay improve walking in multiple sclerosispatients by blocking potassium channels.When potassium channels are blocked,there is increased conduction of actionpotentials in demyelinated axons resultingin improved muscle action. | FREQUENCY | BID | ROUTE | P.O | DOSE | 10 mg twice daily | DRUG NAME | dalfampridineAmpyra |

NURSES RESPOSIBILITY | Ensure that patients who are at risk forCAD undergo a satisfactory CV evaluationbefore you administer the first dose ofeletriptan and that they have a periodic reevaluationof their cardiac status duringintermittent long-term therapy.•Obtain an ECG immediately after firstdose of drug in patients who have CV riskfactors but who have had a satisfactory CVevaluation because of the drug’s potentialto cause coronary vasospasm.• Evaluate patient for CV signs and symptomsafter administration of eletriptanand notify prescriber if they occur. Expectdrug to be withheld, as ordered, whilepatient undergoes an extensive CVworkup, and discontinued if abnormalitiesare detected.•Monitor patient’s blood pressure duringtherapy because of drug’s potential toincrease blood pressure. | SIDE EFFECTS | CNS: Asthenia, dizziness, headache, paresthesia,somnolence, tiredness, weaknessCV: Chest tightness, pain, or pressure; coronaryartery vasospasm; hypertension, MI ormyocardial ischemia (transient); ventricularfibrillation or tachycardiaEENT: Dry mouth, throat tightnessGI: Abdominal pain, cramps, discomfort, orpressure; dysphagia; indigestion; nauseaSKIN: FlushingOther: Feeling of warmth, pain, or pressure | INDICATION | To relieve acute migraine attacks with orwithout auraContraindicationsBibasilar or hemiplegic migraine, cardiovasculardisease (significant), cerebrovascularsyndromes (stroke, transient ischemicattack), hepatic impairment (severe),hypersensitivity to eletriptan or components,ischemic bowel disease, ischemic orvasospastic coronary artery disease (CAD),peripheral vascular disease, uncontrolledhypertension, use within 24 hours ofanother serotonin 5-HT1–receptor agonistor ergot-type drug, use within 72 hours of apotent CYP3A4 inhibitor | ACTION | Antimigraine agentMechanism of ActionMay stimulate 5-HT1 receptors, causingselective vasoconstriction of inflamed anddilated cranial blood vessels in carotid circulation,which decreases carotid arterialblood flow and relieves acute migraines. | FREQUENCY | single dose.Repeated in 2 hr, | ROUTE | P.O | DOSE | 20 or 40 mg | DRUG NAME | eletriptanhydrobromideRelpax |

NURSES RESPOSIBILITY | As needed, open gabapentin capsules andmix contents with water, fruit juice, applesauce,or pudding before administration.• Administer initial dose at bedtime to minimizeadverse reactions, especially ataxia,dizziness, fatigue, and somnolence.• Give drug at least 2 hours after an antacid.• Don’t exceed 12 hours between doses on a3-times-a-day schedule.• Be aware that routine monitoring of bloodgabapentin level isn’t needed.WARNING To discontinue drug or switch toan a different anticonvulsant, expect tochange gradually over at least 1 week, asprescribed, to avoid loss of seizure control.•Monitor renal function test results, andexpect to adjust dosage, if needed.•Monitor patient closely for evidence ofsuicidal thinking or behavior, especiallywhen therapy starts or dosage changes | SIDE EFFECTS | CNS: Agitation, altered proprioception,amnesia, anxiety, apathy, aphasia, asthenia,ataxia, cerebellar dysfunction, chills, CNStumors, decreased or absent reflexes, delusions,depersonalization, depression, disappearanceof aura, dizziness, dream disturbances,dysesthesia, dystonia, emotionallability, euphoria, facial paralysis, fatigue,fever, hallucinations, headache, hemiplegia,hostility, hyperkinesia, hyperreflexia,hypoesthesia, hypotonia, intracranial hemorrhage,lack of coordination, malaise,migraine headache, nervousness, occipitalneuralgia, paranoia, paresis, paresthesia,positive Babinski’s sign, psychosis, sedation,seizures, somnolence, stupor, subduralhematoma, suicidal ideation, syncope,tremor, vertigoCV: Angina, hypertension, hypotension,murmur, palpitations, peripheral edema,peripheral vascular insufficiency, tachycardia,vasodilationEENT: Abnormal vision, amblyopia, blepharospasm,cataracts, conjunctivitis, diplopia,dry eyes and mouth, earache, epistaxis,eye hemorrhage, eye pain, gingivalbleeding, gingivitis, glossitis, hearing loss,hoarseness, increased salivation, inner earinfection, loss of taste, nystagmus, pharyngitis,photophobia, ptosis (bilateral or unilateral),rhinitis, sensation of fullness inears, stomatitis, taste perversion, tinnitus,tooth discoloration, visual field defectsGI: Abdominal pain, anorexia, constipation,diarrhea, fecal incontinence, flatulence, gastroenteritis,hemorrhoids, hepatitis,hepatomegaly, increased appetite, indigestion,melena, nausea, thirst, vomitingGU: Acute renal failure, decreased libido,impotenceHEME: Anemia, coagulation defect,decreased WBC count, leukopenia, thrombocytopeniaMS: Arthralgia, arthritis, back pain, bonefractures, dysarthria, joint stiffness or swelling,muscle twitching, myalgia, positiveRomberg test, tendinitisRESP: Apnea, cough, dyspnea, pneumonia,pseudocroupSKIN: Abrasion, acne, alopecia, cyst | INDICATION | To manage postherpetic neuralgiaContraindicationsHypersensitivity to gabapentin or its components | ACTION | AnticonvulsantAs adjunct to treat partial seizuresMechanism of ActionIs structurally like gamma-aminobutyricacid (GABA), the main inhibitory neurotransmitterin the brain. Although gabapentin’sexact mechanism of action isunknown, GABA inhibits the rapid firing ofneurons associated with seizures | FREQUENCY | BID | ROUTE | P.O | DOSE | 300 mg | DRUG NAME | gabapentinNeurontin |

NURSES RESPOSIBILITY | Don’t crush timed-release or controlledreleaseaspirin tablets unless directed.• Ask about tinnitus. This reaction usuallyoccurs when blood aspirin level reaches orexceeds maximum for therapeutic effect.PATIENT TEACHINGWARNING Advise parents not to give aspirinto a child or adolescent with chickenpoxor flu symptoms because of risk of Reye’ssyndrome (rare life-threatening reactioncharacterized by vomiting, lethargy, belligerence,delirium, and coma). Tell themto consult prescriber for alternative drugs.• Advise adult patient taking low-doseaspirin not to also take ibuprofen becauseit may reduce the cardioprotective andstroke preventive effects of aspirin.• Instruct patient to take aspirin with foodor after meals because it may cause GIupset if taken on an empty stomach.• Advise patient with tartrazine allergy notto take aspirin.• Tell patient to consult prescriber beforetaking aspirin with any prescription drugfor blood disorder, diabetes, gout, orarthritis.• Tell patient not to use aspirin if it has astrong vinegar-like odor. | SIDE EFFECTS | CNS: Confusion, CNS depressionEENT: Hearing loss, tinnitusGI: Diarrhea, GI bleeding, heartburn, hepatotoxicity,nausea, stomach pain, vomitingHEME: Decreased blood iron level,leukopenia, prolonged bleeding time, shortenedlife span of RBCs, thrombocytopeniaSKIN: Ecchymosis, rash, urticariaOther: Angioedema, Reye’s syndrome, salicylism(dizziness, tinnitus difficulty hearing hearing,vomiting, diarrhea, confusion, CNSdepression, diaphoresis, headache, hyperventilation,and lassitude) with regular useof large doses | INDICATION | To relieve mild pain or feverTo relieve mild to moderate pain frominflammation, as in rheumatoid arthritisand osteoarthritisTo treat juvenile rheumatoid arthritisTo treat acute rheumatic feverTo reduce the risk of recurrent transientischemic attacks or stroke in menTo reduce risk of MI in patients withprevious MI or unstable anginaTo reduce the severity of or preventacute MIContraindicationsAllergy to tartrazine dye, asthma, bleedingproblems (such as hemophilia), hypersensitivityto aspirin or its components, pepticulcer disease | ACTION | Anti-inflammatory,antiplatelet, antipyretic, nonopioid analgesicMechanism of ActionBlocks the activity of cyclooxygenase, theenzyme needed for prostaglandin synthesis.Prostaglandins, important mediators in theinflammatory response, cause local vasodilationwith swelling and pain.With blockingof cyclooxygenase and inhibition ofprostaglandins, inflammatory symptomssubside. Pain is also relieved becauseprostaglandins play a role in pain transmissionfrom the periphery to the spinal cord.aspirin A Aspirin inhibits platelet aggregation byinterfering with production of thromboxaneA2, a substance that stimulates plateletaggregation. Aspirin acts on the heatregulatingcenter in the hypothalamus andcauses peripheral vasodilation, diaphoresis,and heat loss. | FREQUENCY | P O | ROUTE | ORAL | DOSE | 325 mg daily. | DRUG NAME | aspirin(acetylsalicylic acid, |

NURSES RESPOSIBILITY | Use zolpidem cautiously in patients withadditional disorders because it isn’t knownif zolpidem therapy might aggravate theseconditions.• Administer zolpidem just before patient’sbedtime because drug has a rapid onset ofaction.• Expect patient to receive no more than a1-month supply of zolpidem for outpatienttherapy.WARNING If zolpidem is withdrawnabruptly (especially after prolonged therapy),monitor patient for withdrawal symptoms,such as abdominal cramps or discomfort,fatigue, flushing, inconsolablecrying, light-headedness, nausea, nervousness,panic attack, rebound insomnia, andvomiting.• Expect that zolpidem will produce anticonvulsantand muscle relaxant effects athigh doses.• If patient takes other CNS depressants,expect to reduce zolpidem dosage, as prescribed.WARNING Monitor patient closely forhypersensitivity reactions such as dyspnea,throat tightness, nausea, vomiting, andswelling. If present, discontinue zolpidemimmediately, notify prescriber, and prozolpidemtartrate 1105XYZ | SIDE EFFECTS | CNS: Amnesia, asthenia, ataxia, complexbehaviors (such as sleep driving), confusion,dizziness, drowsiness, euphoria, hallucinations,headache, insomnia, lethargy,paradoxical CNS stimulation (includingagitation, euphoria, hallucinations, hyperactivity,and nightmares), vertigoEENT: Diplopia, throat tightness, visualabnormalityGI: Constipation, diarrhea, hiccups, indigestion,nausea, vomitingGU: UTIMS: Arthralgia, myalgiaRESP: Dyspnea, upper respiratory infectionOther: Anaphylaxis, angioedema, withdrawalsymptoms | INDICATION | To provide short-term treatment ofInsomniaContraindicationsHypersensitivity to zolpidem or its components,ritonavir therapyInteractions | ACTION | 10 mg at bedtime for 7 to 10 days.Mechanism of ActionMay potentiate the effects of gammaaminobutyricacid (GABA) and otherinhibitory neurotransmitters. By binding tospecific benzodiazepine receptors in thelimbic and cortical areas of the CNS, zolpidemincreases GABA’s inhibitory effects,blocks cortical and limbic arousal, and preservesdeep sleep (stages 3 and 4). | FREQUENCY | od | ROUTE | po | DOSE | 10 mg | DRUG NAME | zolpidem tartrateAmbien, Ambien CR, Tovalt |

NURSES RESPOSIBILITY | Use rabeprazole cautiously in patientswith hepatic dysfunction.• Expect to monitor serum gastrin level inlong-term therapy to detect elevation.Closely monitor Japanese men receivingrabeprazole for adverse reactions becausethey’re more likely than other patients tohave increased blood drug levels | SIDE EFFECTS | CNS: Coma, delirium, disorientation, dizziness,headache, malaiseGI: Abdominal pain, diarrhea, jaundice,nausea, vomitingGU: Interstitial nephritisHEME: Agranulocytosis, hemolytic anemia,leukopenia, pancytopenia, thrombocytopeniaMS: RhabdomyolysisRESP: Interstitial pneumoniaSKIN: Erythema multiforme, rash, Stevens-Johnson syndrome, toxic epidermal necrolysisOther: Anaphylaxis, | INDICATION | To provide short-term treatment oferosive esophagitis or ulcerative gastroesophagealreflux disease (GERD)To promote healing of duodenal ulcer, asadjunct to treat Helicobacterpylori–positive duodenal ulcerTo provide maintenance treatment oferosive esophagitis or GERDContraindicationsHypersensitivity to rabeprazole, other substitutedbenzimidazoles (omeprazole, lansoprazole),or their components | ACTION | AntiulcerMechanism of ActionDecreases gastric acid secretion by suppressingits release at the secretory surfaceof gastric parietal cells. Rabeprazole alsoincreases gastric pH and decreases basalacid output, which helps to heal ulceratedareas. In gastric parietal cells, it’s transformedto an active sulfonamide, whichincreases the clearance rate of Helicobacterpylori. | FREQUENCY | BD | ROUTE | P.O | DOSE | 40 mg daily for4 to 8 wk.. | DRUG NAME | Rabeprazole sodium |