1
NUR 201 DRUG CARD
Student: ________________________ Generic Name: Bupropion hydrobromide________ Trade Name(s): Wellbutrin, Aplenzin, Zyban_ Classification: Antidepressant – atypical (heterocyclic), Aminoketone_____________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: Mechanism of action is not known; the drug does not inhibit MAO, and it only weakly blocks neuronal uptake of epinephrine, serotonin, and dopamine. However, its action is believed to be mediated by noradrenergic and/or dopaminergic mechanisms. Exerts moderate anticholinergic and sedative effects, but only slight orthostatic hypotension. Indications: (1) Treatment of major depressive disorder (immediate-release and extended-release). (2) Major depressive episodes in those with a history of seasonal affective disorder (Wellbutrin XL only). (3) Aid to stop smoking (Zyban only); may be combined with a nicotine transdermal system. Contraindications: Hypersensitivity to bupropion or any ingredients. Seizure disorders; presence or history of bulimia or anorexia nervosa due to the higher incidence of seizures in such clients. Concomitant use of an MAOI. Use in clients undergoing abrupt discontinuation of alcohol and sedatives, including benzodiazepines. Use in clients who have shown an allergic response to bupropion or other components of the various products. Wellbutrin, Wellbutrin SR, Wellbutrin XL, and Zyban all contain bupropion; do not use together. Lactation. Interactions: Extreme caution with drugs that lower the seizure threshold (eg, other antidepressants, antipsychotics, theophylline, systemic steroids); use low initial doses and gradually titrate. Increased seizure risk with excessive alcohol or sedative use; opiate, cocaine, or stimulant addiction; use of OTC stimulants or anorectics, oral hypoglycemics, insulin. Minimize or avoid alcohol. IV: Y-Site Compatibilities (if appropriate): N/A IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) N/A Adverse Reactions/Side Effects: CNS: Agitation, dizziness, headache/migraine, tremor, sedation, insomnia, confusion, akinesia/bradykinesia, hostility, impaired sleep quality, sensory disturbance, anxiety, decreased/increased libido, disturbed concentration, akathisia, delusions, euphoria, pseudoparkinsonism, seizures, ataxia/incoordination, depression, dyskinesia, dystonia, hallucinations, mania/hypomania Tachycardia, cardiac arrhythmias, hypertension, palpitations, hypotension, syncope, chest pain, ECG abnormalities (premature beats, nonspecific ST-T changes) URT complaints, shortness of breath, dyspnea, bronchitis Dry mouth, constipation, weight loss/gain, N&V, anorexia, diarrhea, increased appetite, dyspepsia, increased salivation, stomatitis, bruxism, dysphagia, gum irritation, oral edema, thirst disturbance, toothache, liver damage, jaundice Excessive sweating, rashes (including nonspecific), pruritus, cutaneous temperature disturbance, alopecia, dry skin, photosensitivity. GU: Menstrual complaints, impotence, urinary frequency/retention, decreased sexual function, nocturia, painful erection, retarded ejaculation, testicular swelling, UTI, vaginal irritation, gynecomastia Arthritis, muscle spasms Blurred vision, mydriasis, visual disturbance

CV: RESP: GI:

DERM:

MSK: EENT:

Nursing Considerations/Implications: 1. 2. 3. 4. 5. List reasons for therapy, presenting behaviors, duration of symptoms, other agents/therapies trialed. Note history of seizures, recent MI, head trauma, CNS tumor, bulimia, anorexia nervosa; precludes therapy. Determine if client is of childbearing age or lactating. Assess mental stability and potential for compliance. Fewer side effects (no CV effects, drug interactions, sedation, and weight gain) with bupropion than other antidepressants. Take as directed for condition treated. Do not take Zyban with Wellbutrin, and do not break, crush, or chew sustained release products. If dose is missed, do not take extra dose to catch up: increases seizure risk.

Antidote (if appropriate): Treatment: Client should be hospitalized. Ensure an adequate airway, oxygenation, and ventilation. Monitor cardiac rhythm and vital signs. Monitor EEG for first 48 hr. Use general supportive and symptomatic measures. Do not induce emesis. Gastric lavage with a large-bore orogastric tube with appropriate airway protection, if needed, may be used if undertaken soon after ingestion or in symptomatic clients. Give activated charcoal. Seizures may be treated with IV benzodiazepines and other supportive procedures. Lab/Diagnostic Test (if appropriate): xxx.

2
NUR 201 DRUG CARD
Student: ________________________ Generic Name: Antidepressants - tricyclic ________ Trade Name(s): Norpramin, Sinequan, Tofranil, Aventyl Classification: Antidepressants ________________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: It is believed antidepressant drugs cause adaptive changes in the serotonin and norepinephrine receptor systems, resulting in changes in the sensitivities of both presynaptic and postsynaptic receptor sites. These effects may increase the sensitivity of postsynaptic alpha-1 adrenergic and serotonin receptors and decrease the sensitivity of presynaptic receptor sites. The overall effect is a reregulation of the abnormal receptor neurotransmitter relationship. The tricyclic antidepressants are chemically related to the phenothiazines; thus, they exhibit many of the same pharmacologic effects. Indications: (1) Endogenous and reactive depressions. (2) Drugs with significant sedative effects may be useful in depression associated with anxiety and sleep disturbances. The selective serotonin reuptake inhibitors are the most widely used antidepressants. See also individual drugs, as some are used for other purposes (e.g., enuresis, obsessivecompulsive disorder). Contraindications: Severely impaired liver function. Use during acute recovery phase from MI. Concomitant use with MAOIs (See Implementation/Administration/Storage). Generally, not recommended for those less than 12 years of age. Interactions: MANY. Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children, adolescents, and young adults with major depressive disorder and other psychiatric disorders. Anyone considering the use of antidepressants in a child, adolescent, or young adult must balance this risk with the clinical need. Clients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. IV: Y-Site Compatibilities (if appropriate): N/A IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) N/A Adverse Reactions/Side Effects: CNS: Agitation, akathisia, EEG pattern alterations, ataxia, anxiety, coma, confusion, disorientation, disturbed concentration, dizziness, drowsiness, dysarthria, exacerbation of psychosis, excitement, excessive appetite, extrapyramidal symptoms (including tardive dyskinesia), fatigue, hallucinations, delusions, headache, hyperthermia, hypomania, incoordination, insomnia, mania, nervousness CV: Arrhythmias, ECG changes, flushing, change in AV conduction, heart block, stroke, sudden death, hot flashes, hypertension, hypotension, orthostatic hypotension, palpitations, CHF, PVCs, syncope, tachycardia GI: N&V, abdominal pain or cramps, anorexia, aphthous stomatitis, constipation, diarrhea, epigastric distress, black tongue, dysphagia, increased pancreatic enzymes, flatulence, indigestion, GI disorder, parotid swelling, stomatitis, taste disturbance, peculiar taste, ulcerative stomatitis, hepatitis (rare), jaundice DERM: Skin rashes, urticaria, flushing, pruritus, petechiae, photosensitivity, edema HEMAT: Agranulocytosis, aplastic anemia, leukopenia, thrombocytopenia, purpura, eosinophilia Nursing Considerations/Implications: 1. 2. 3. 4. 5. In adolescents, the elderly, and outpatients, use lower initial dosage than in adults; gradually increase dose as needed. Individualize dose according to age, weight, physical, mental condition, and response to the therapy. Clients show the largest relative improvement during the first weeks of treatment. For maintenance therapy, a single daily dose may suffice. Dose usually administered at bedtime, so any anticholinergic and/or sedative effects will not impact ADL. To reduce incidence of sedation and anticholinergic effects, start with small doses and then gradually increase to desired dosage levels.

Antidote (if appropriate): Symptoms: CNS symptoms include agitation, confusion, hallucinations, hyperactive reflexes, choreoathetosis, seizures, coma. Anticholinergic symptoms include dilated pupils, dry mouth, flushing, and hyperpyrexia. CV toxicity includes depressed myocardial contractility, decreased HR, decreased coronary blood flow, tachycardia, intraventricular block, complete AV block, re-entry ventricular arrhythmias, PVCs, ventricular tachycardia or fibrillation, sudden cardiac arrest, hypotension, pulmonary edema. Treatment: Admit client to hospital and monitor ECG closely for 3 to 5 days.. Lab/Diagnostic Test (if appropriate): ↑ Alkaline phosphatase, transaminase, prolactin, bilirubin; ↑ or ↓ blood glucose. False ＋ or ↑ urinary catecholamines. Altered LFTs.

3

NUR 201 DRUG CARD
Student: ________________________ Generic Name: Donepezil HCl ________ Trade Name(s): Aricept, Aricept 23, Aricept ODT ___ Classification: Acetylcholinesterase inhibitor ________________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: Acetylcholinesterase inhibitor; may exert effect by increasing acetylcholine concentrations through reversible inhibition of its hydrolysis by acetylcholinesterase. Indications: Treatment of dementia of the Alzheimer's type. Contraindications: Hypersensitivity to piperidine derivatives. May cause weight loss, generalized convulsions, and bladder outflow obstruction. Caution with history of asthma or obstructive pulmonary disease. Use with caution with a history of asthma or obstructive pulmonary disease. Safety and efficacy not determined in children. Interactions: Anticholinergic drugs, Bethanechol, Carbamazepine, Dexamethasone, Ketoconazole, NSAIDs, Phenobarbital, Quinidine, Rifampin, Succinylcholine. IV: Y-Site Compatibilities (if appropriate): N/A IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) N/A Adverse Reactions/Side Effects: GEN: EENT: RESP: CNS: anorexia, diarrhea, fatigue, insomnia, muscle cramps, N&V, dizziness, headache, ecchymosis Cataract, eye irritation, blurred vision Dyspnea, sore throat, bronchitis, increased cough, pharyngitis, pneumonia insomnia, dizziness, depression, confusion, abnormal dreams, somnolence, abnormal crying, aggression/hostility, aphasia, ataxia, delusions, increased libido, irritability, nervousness, paresthesia, restlessness, tremor, ataxia, emotional lability, hallucinations, personality disorder, abnormal gait, anxiety, seizures CV: Hypertension, vasodilation, atrial fibrillation, hot flashes, hypotension, heart block, bradycardia, hemorrhage, syncope, ecchymosis, ECG abnormalities, heart failure GI: N&V, diarrhea, anorexia, fecal incontinence, GI bleeding (especially those at risk of developing ulcers), bloating, epigastric pain, abdominal pain, constipation, dyspepsia, gastroenteritis GU: Urinary incontinence, nocturia, frequent urination, cystitis, hematuria, UTI DERM: Diaphoresis, urticaria, pruritus, eczema, rash, skin ulcer HEMAT: anemia MSK: muscle cramps, arthritis, bone fracture Nursing Considerations/Implications: 1. Assess for hypersensitivity to the drug or piperadine derivatives, underlying cardiac conduction abnormalities, risks for developing ulcers, asthma, obstructive pulmonary disease, pregnancy/nursing status, and possible drug interactions. Monitor for vagotonic effects on SA and AV nodes, syncopal episodes, diarrhea, N/V, active/occult GI bleeding, weight loss, bladder outflow obstruction, generalized convulsions, and other possible adverse reactions. (Oral) Do not split, crush, or chew. (ODT) Allow to dissolve on the tongue and follow with water. Take in evening. Drug does not cure disease but helps alleviate symptoms or slow physical and mental progression of disease, especially when used with memantine. May take up to 3 weeks to notice any effects.

2. 3. 4.

Antidote (if appropriate): Symptoms: Cholinergic crisis characterized by severe N&V, salivation, sweating, bradycardia, hypotension, respiratory depression, collapse, convulsions, increased muscle weakness (may cause death if respiratory muscles are involved). Treatment: Atropine sulfate at an initial dose of 1–2 mg IV with subsequent doses based on the response. General supportive measures. Lab/Diagnostic Test (if appropriate): ↑ CPK, alkaline phosphatase, ALT, AST, LDH. Hyperlipemia, glycosuria.

4

NUR 201 DRUG CARD
Student: ________________________ Generic Name: alprazolam, clonazepam, diazepam, lorazepam _ Trade Name(s): Xanax, Klonopin, Valium, Ativan_ Classification: benzopiazepines ________________________________ Administration Routes: PO _√_ SQ ___ IM _√__ IV _√__ Transdermal ____ Ophth_____ Action: Benzodiazepines are a class of agents that work on the central nervous system, acting selectively on gammaaminobutyric acid-A (GABA-A) receptors in the brain. It enhances response to the inhibitory neurotransmitter GABA, by opening GABA-activated chloride channels and allowing chloride ions to enter the neuron, making the neuron negatively charged and resistant to excitation. Indications: Used as sedatives, hypnotics, anxiolytics, anticonvulsants and muscle relaxants. Also used to relieve nervousness and tension or improve sleep disturbances. It is also used to relieve symptoms of alcohol withdrawal such as tremors. Contraindications: Pts with acute narrow angle glaucoma, primary depressive disorders, psychosis. Should be avoided for the management of severe uncontrolled pain. Interactions: Selective serotonin reuptake inhibitors (SSRIs) may increase diazepam blood levels, and nefazadone (Serzone) may increase alprazolam levels through hepatic enzyme inhibition, leading to increased sedative-hypnotic effects or side effects. Interact synergistically with other central nervous system depressants, including other hypnotics, sedating antidepressants, neuroleptics, anticonvulsants, antihistamines and alcohol. IV: Y-Site Compatibilities (if appropriate): Refer to PI. IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) Refer to PI. Adverse Reactions/Side Effects: CNS: CV: MSK: GI: DERM: sedation, dizziness, weakness, unsteadiness, feeling of depression, loss of orientation, headache, sleep disturbance, dependence, aggitation, seizures palpatations, change in BP tremors, muscle cramping nausea, vomiting sweating

Nursing Considerations/Implications: 1. 2. 3. 4. When using IV administration, monitor respirations every 5-15 mins. Have airway and resuscitative equipment readily available. Assess for anxiety disorders/symptoms, acute alcohol withdrawal, skeletal muscle spasm, convulsive disorders, depression, and other conditions where treatment is contraindicated or cautioned. Assess for pregnancy/nursing status and possible drug interactions. Monitor for hypersensitivity reactions, rebound or withdrawal symptoms, seizures, psychiatric and paradoxical reactions, and respiratory depression.

Antidote (if appropriate): If overdose is suspected, flumazenil (Romazicon) can be administered to reverse CNS depressant effects. Lab/Diagnostic Test (if appropriate): Unknown.

5

NUR 201 DRUG CARD
Student: ________________________ Generic Name: Clonazepam________ Trade Name(s): Klonopin_____ Classification: Anticonvulsant, Benzodiazepine________________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: Benzodiazepine derivative that increases presynaptic inhibition and suppresses the spread of seizure activity. Indications: (1) Alone or as an adjunct to treat absence seizures (petit mal variant) including Lennox-Gastaut syndrome. (2) Alone or as an adjunct to treat akinetic and myoclonic seizures. (3) Some effectiveness in absence seizures resistant to succinimide therapy. (4) Panic disorder with or without agoraphobia, as defined by DSM-IV. Investigational: Parkinsonian (hypokinetic) dysarthria, acute manic episodes of bipolar affective disorder, leg movements (periodic) during sleep, adjunct in treating schizophrenia, neuralgias (deafferentation pain syndrome), multifocal tic disorders. Contraindications: Sensitivity to benzodiazepines. Severe liver disease, acute narrow-angle glaucoma. Pregnancy. Significant liver disease. Interactions: CNS depressants / Potentiation of clonazepam CNS depressant effect; Phenobarbital / ↓ Clonazepam effect R/T ↑ liver breakdown; Phenytoin / ↓ Clonazepam effect R/T ↑ liver breakdown; Valproic acid / ↑ Chance of absence seizures. IV: Y-Site Compatibilities (if appropriate): N/A IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) N/A Adverse Reactions/Side Effects: CNS: EENT: RESP: GI: GU: drowsiness, dizziness, fatigue, asthenia blurred vision upper resp. tract infections dry mouth, diarrhea, GI upset, constipation, changes in appetite difficulty urinating

Nursing Considerations/Implications: 1. 2. 3. 4. 5. Note reasons for therapy, onset/cause of S&S, other agents prescribed, outcome. With seizure disorder, note onset, frequency, characteristics of seizures, other agents trialed. Assess mental status and behavioral presentation. Monitor CBC, renal and LFTs, and response to therapy. Take with water and swallow whole. May take with food if GI upset occurs. Do not crush, chew, or break tablet. Give orally disintegrating tablet with water as follows: After opening the pouch, peel back foil on the blister. Do not push tablet through foil. Immediately upon opening the blister, using dry hands, remove tablet and place in the mouth. Tablet disintegration occurs rapidly in saliva, so it can be swallowed easily with or without water.

Antidote (if appropriate): If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Lab/Diagnostic Test (if appropriate): CBC, renal and LFTs, therapeutic drug level.

6

NUR 201 DRUG CARD
Student: ________________________ Generic Name: memantine hydrochloride________ Trade Name(s): Namenda, Namenda XR_____ Classification: anti-Alzheimers’s agents ________________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: It is believed that activation of N-methyl-D-aspartate (NMDA) receptors in the brain by glutamate, an excitatory amino acid, contributes to the symptomatology of Alzheimer's disease. Memantine is believed to have low to moderate affinity as an antagonist for open-channel NMDA receptors thus preventing activation by glutamate. The drug does not prevent or slow neurodegeneration in Alzheimer's disease. The drug also shows antagonistic effects at the 5HT3 receptor and for nicotinic acetylcholine receptors. Indications: Moderate-to-severe dementia of the Alzheimer's type. When combined with donepezil (Aricept), the decline of mental and physical function may be less. Investigational: Treatment of vascular dementia. Contraindications: Known hypersensitivity to memantine or any excipients in the formulation, including lactose monohydrate. Conditions that raise urine pH may decrease the urinary elimination of memantine, resulting in increased plasma levels. Severe renal impairment. Interactions: Carbonic anhydrase inhibitors, sodium bicarbonate (meds that increase urine pH. IV: Y-Site Compatibilities (if appropriate): N/A IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) N/A Adverse Reactions/Side Effects: CNS: Dizziness, headache, vertigo, ataxia, hypokinesia, confusion, somnolence, hallucinations, aggressive reaction. Infrequently, paresthesia, convulsions, extrapyramidal disorder, hypertonia, tremor, aphasia, hypoesthesia, abnormal coordination, hemiplegia, hyperkinesia, stupor, cerebral hemorrhage, neuralgia, neuropathy, delusions, personality disorder, emotional lability, nervousness, sleep disorder, increased libido, psychosis, amnesia, apathy, paranoid reaction, abnormal thinking, abnormal crying, paroniria, delirium, depersonalization, neurosis, suicide attempt Hypertension, TIA, syncope, CVA, cardiac failure. Infrequently, angina pectoris, bradycardia, MI, cardiac arrest, pulmonary embolism, thrombophlebitis, atrial fibrillation, hypotension, postural hypotension, pulmonary edema Coughing, difficulty breathing, dypsnea, pneumonia. Infrequently, apnea, asthma, hemoptysis Constipation, vomiting. Infrequently, gastroenteritis, diverticulitis, GI hemorrhage, melena, esophageal ulceration Frequent micturition. Infrequently, dysuria, hematuria, urinary retention Increased appetite, back pain, anemia, leukopenia (infrequent), decreased hearing, tinnitus, decreased weight Rash. Infrequently, skin ulceration, pruritus, cellulitis, eczema, dermatitis, erythematous rash, alopecia, urticaria

CV: RESP: GI: GU: MSIC: DERM:

Nursing Considerations/Implications: 1. 2. 3. 4. 5. 6. 7. 8. Note reasons for therapy, when diagnosed with Alzheimer's disease and when treatment began. Assess for other medical conditions that require careful monitoring, i.e., seizure disorder, liver or renal dysfunction. List all drugs prescribed to ensure none interact. Review MMSE score before therapy and then several months after to assess cognitive function and drug effectiveness. Monitor weight, VS, CBC, renal and LFTs. May take with or without food; with food if GI upset. Drug started at a low dose and gradually increased at 1 week intervals. Used in Alzheimer's disease to improve level of cognitive functioning; does not cure or alter disease but assists with symptoms. Improvement in cognitive functioning may take months before evident. The ER capsules should be swallowed whole. If unable to swallow, the capsules may be opened and sprinkled on applesauce and the entire contents consumed. Do not divide, chew, or crush capsules..

Antidote (if appropriate): Symptoms: See Side Effects. Treatment: Use general supportive measures; treat symptoms. Can enhance elimination by acidification of the urine. Lab/Diagnostic Test (if appropriate): Monitor CBC & platelets. May cause anemia. ↑ Alkaline phosphatase. Hyponatremia

7

NUR 201 DRUG CARD
Student: ________________________ Generic Name: gabapentin ________ Trade Name(s): Neurontin, Gabarone_____ Classification: anticonvulsants, analgesic adjuncts ________________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: Anticonvulsant and analgesic mechanisms are not known. Is related chemically to GABA but does not interact with GABA receptors. Indications: (1) Treatment of partial seizures with and without secondary generalization in clients 12 years and older. (2) Adjunct to treat partial seizures in children 3–12 years of age. (3) In adults, management of post-herpetic neuralgia or pain in the area affected by herpes zoster after treating the disease. Investigational: Neuropathic pain, bipolar disorder, prevent migraine, tremors associated with MS. With morphine to treat diabetic neuropathy or postherpetic neuralgia. Contraindications: Hypersensitivity. Interactions: Alcohol, antacids, CNS depressants (ETOH, antihistamines, opioids, and sedative/hypnotics) morphine. IV: Y-Site Compatibilities (if appropriate): N/A IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) N/A Adverse Reactions/Side Effects: CNS: Most common: Somnolence, ataxia, dizziness, and fatigue. Also, nystagmus, tremor, nervousness, dysarthria, amnesia, depression, abnormal thinking/coordination, twitching, headache, convulsions (including the possibility of precipitation of status epilepticus), confusion, insomnia, emotional lability, vertigo, hyperkinesia, paresthesia, decreased/increased/absent reflexes, anxiety, hostility, CNS tumors, syncope, abnormal dreaming, aphasia, hyperesthesia, intracranial hemorrhage, hypo-/dystonia, dysesthesia, paresis, hemiplegia, facial paralysis, stupor, cerebellar dysfunction, positive Babinski sign, decreased position sense, subdural hematoma, apathy, hallucinations, decreased or loss of libido, agitation, depersonalization, euphoria, ‘doped-up’ sensation, suicidal tendencies, sudden unexplained deaths, psychoses EENT: abnormal vision, nystagmus CV: Hyper-/hypotension, vasodilation, angina pectoris, peripheral vascular disorder, palpitation, tachycardia, migraine, murmur RESP: Rhinitis, pharyngitis, coughing, pneumonia, epistaxis, dyspnea, apnea GI: wt gain, anorexia, flatulence, gingivitis GU: Hematuria, dysuria, frequent urination, cystitis, urinary retention/incontinence, vaginal hemorrhage, amenorrhea, dysmenorrhea, menorrhagia, breast cancer, inability to climax, abnormal ejaculation, impotence MSK: arthralgia DERM: Pruritus, abrasion, rash, acne, alopecia, eczema, dry skin, increased sweating, urticaria, hirsutism, seborrhea, cyst, herpes simplex HEMAT: Leukopenia, decreased WBCs, purpura, anemia, thrombocytopenia, lymphadenopathy MISC: multi-organ hypersensitivity reactions, facial edema, ataxia, altered relexes, hyperkinesia, paresthesia Nursing Considerations/Implications: 1. 2. 3. 4. 5. 6. 7. Note reasons for therapy, onset, frequency, characteristics of seizures/symptoms, other agents prescribed, outcome. With chronic pain/neuralgia, rate pain level. List other drugs prescribed to ensure none interact. Monitor renal and LFTs; reduce dose in elderly and with impaired renal function. When drug therapy is discontinued or supplemental therapy added, do so gradually over at least 1 week. May be taken with or without food. Do not chew or crush; use half tablets within several days of breaking the scored tablet. May take first dose at bedtime to decrease sedative effects. Do not take antacids at any time while taking gabapentin or at least stagger 2 hr apart; decreases drug absorption. If having trouble swallowing, may open capsule and mix with applesauce or juice. Mix only one dose at a time just before taking it.

Antidote (if appropriate): Symptoms: Double vision, slurred speech, drowsiness, lethargy, diarrhea. Treatment: Hemodialysis. Lab/Diagnostic Test (if appropriate): xxx.

8

NUR 201 DRUG CARD
Student: ________________________ Generic Name: Fluoxetine hydrochloride ________Trade Name(s): Prozac, Prozac Pulvules, Prozac Weekly, Sarafem Classification: Antidepressant, selective serotonin reuptake inhibitor __________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: Antidepressant effect likely due to inhibition of CNS neuronal uptake of serotonin and, to a lesser extent, little to no anticholinergic, sedative, or orthostatic hypotensive effects. Indications: (1) Major depressive disorder in adults and children 8–18 years of age. (2) Obsessive-compulsive disorders (OCD) in adults and children 8–18 years of age. (3) Long-term treatment of binge-eating and vomiting behaviors in moderate to severe bulimia nervosa. (4) Short-term treatment of panic disorder in adults with or without agoraphobia. Contraindications: Use of thioridazine with fluoxetine or within a minimum of 5 weeks after fluoxetine has been discontinued. Interactions: MAO inhibitors, pimozide, thioridazine, meds that inhibits P450 enzyme system, alprazolam, linezolid, tramadol, triptans, ETOH, antihistamines, antidepressants, opioid analgesics, sedative/hypnotics, resperidone, phenothiazines, carbamazepine, clozapine, digoxin, haloperidol, phenytoin, lithium ,warfarin, buspirone, cyproheptadine, NSAIDs, aspirin, clopidogrel. IV: Y-Site Compatibilities (if appropriate): N/A IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) N/A Adverse Reactions/Side Effects: CNS: neuroleptic malignant syndrome, seizures, suicidal thoughts, anxiety, drowsiness, HA, insomnia nervousness, abnormal dreams, dizziness, fatigue, hypomania, mania, weakness EENT: mydriasis, stuffy nose, visual disturbances CV: chest pains, palpitations RESP: cough GI: abdominal pain, abnormal taste, anorexia, constipation, dry mouth, dyspepsia, N/V/D, wt loss MSK: arthralgia, back pain, myalgia GU: sexual dysfunction, urinary frequency DERM: increased sweating, pruritus, erythema nodusum, flushing, rashes LOCAL: tremor, dysmenorrheal, hyponatremia MISC: serotonin syndrome, allergic reactions, fever, flu-like syndrome, hot flashes, sensitivity reactions Nursing Considerations/Implications: 1. 2. 3. 4. 5. 6. 7. 8. Note reasons for therapy, onset, characteristics of S&S, any events/triggers and other agents trialed/outcome. Review drugs currently prescribed to ensure that none interact. Determine if pregnant or lactating. Obtain weight, renal and LFTs; reduce dose with elderly or debilitated, hepatic/renal dysfunction. Periodically reassess to determine need for continued therapy. Document mood, behaviors and clinical presentation. Take at the designated times; nervousness and insomnia may occur. May be taken with food to decrease chance of stomach upset. Use caution when driving or performing tasks that require mental alertness; may cause drowsiness/dizziness. Change positions slowly to avoid drop in BP.

Antidote (if appropriate): If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Lab/Diagnostic Test (if appropriate): Monitor CBC, proteinuria, and mild increase in AST, make cause electrolytes out of balance.

9

NUR 201 DRUG CARD
Student: ________________________ Generic Name: venlafaxine,duloxetine, desvenlafaxine ________ Trade Name(s): Effexor, Cymbalta,Pristiq _ Classification: SNRI’s(serotonin reuptake inhibitors) Antidepressant __________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: Potent inhibitor of neuronalserotonin and norepinephrine uptake, weak inhibitor of dopamine,nomuscarinic, histaminergic, or a-adrenergic receptors in vitro. Treats symptoms of depression, Venlafaxine is also used to treat generalized anxiety disorder, and panic disorder, social anxiety disorder, also effective in the treatment of hot flashes in premenstrual dysphoric disorder, and PTSD, Duloxetine is also used to treat diabetic peripheral neuropathic pain, fibromyalgia, and generalized anxiety disorder Indications: prevention/treatment of major depression at the end of life, long-term Contraindications: Hypersensitivity, Bipolar disorder, interstitial lung disease, seizure disorders, prostatic hypertrophy, and sever renal/hepatic/cardiac disease depending on the type of medication. Precaution: pregnancy cat C, breastfeeding, mania, recent MI, eosinophillic pneumonia, desvenlafaxine hypersensitivity, and antidepressants should be used cautiously in suicidal pts., severe depression, schizophrenia, hyperactivity, DM, pregnancy, and geriatric pts., Black Box warning: children-suicidal ideation. Interactions: Hyperthermia, rigidity, rapid fluctuations of vital signs, mental status changes, neuroleptic malignant syndrome:MAOIs, Increase-bleeding risk-salicylates, NSAIDs, platelet inhibitors, anticoagulants, Increased effectcimetidine, Increase CNS depression-alcohol, opioids, antihistamines, sedatives/hypnotics, Increased levels of clozapine, desipramine, haloperidol, warfarin, decrease- effect of indinavir. IV: Y-Site Compatibilities (if appropriate): N/A IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) N/A Adverse Reactions/Side Effects: CNS: seizures, emotional liability, vertigo, dizziness, weakness, apathy, euphoria, ataxia, CNS stimulation, hallucinations, hostility, increased libido, hypertonia psychosis, insomnia, anxiety EENT: Abnormal vision, taste, ear pain, cataract, conjunctivitis, corneal lesions, dry eyes, otitis media, photophobia CV: Migraine, angina pectoralis, HTN,, sustained HTN, change in QT-interval, increased pulse, increased cholesterol, extrasystoles, postural HoTN, syncope, thrombophlebitis RESP: Bronchitis, dyspnea, asthma, chest congestion, epistaxis, hyperventilation, laryngitis GI: Dysphagia, eructation, nausea, anorexia, dry mouth, colitis, gastritis, gingivitis, rectal hemorrhage, stomatitis, stomach and mouth ulceration GU: anorgasmia, abnormal ejaculation, dysuria, hematuria, metrorrhagia, vaginitis, urination, albuminuria, amenorrhea, kidney calculus, cystitis, nocturia, breast and bladder pain, polyuria, uterine hemorrhage vaginal hemorrhage, moniliasis MSK: arthritis, bone pain, bursitis, myasthenia, tenosynovitis, arthralgia HEMAT: agranulocytosis, aplastic anemia, neutropenia, pancytopenia, abnormal bleeding DERM: Rash, ecchymosis, acne, alopecia, britle nails, dry skin, photosensitivity, sweating, angioedema MISC: Systemic: malaise, neck pain, enlarged ABD, cyst, facial edema, hangover, hernia Nursing Considerations/Implications: 1. 2. Monitor mental status, mood, sensorium, affect, increase in psychiatric symptoms, depression, panic. Assess for suicidal ideation in children/adolescents.

Antidote (if appropriate): If overdose: EKG monitoring, lavage, activated charcoal, administer anticonvulsant, may require whole-bowel irrigation for extended release product.. Lab/Diagnostic Test (if appropriate): Monitor: CBC/diff, leukocytes, cardiac enzymes if pt. is receiving long term therapy, hepatic studies, AST, ALT, bilirubin, cholesterol.

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NUR 201 DRUG CARD
Student: ________________________ Generic Name: citalopram, escitalopram, fluoxetine Trade Name(s): Celexa, Lexapro, Prozac___ Classification: Selective serotonin reuptake inhibitor (SSRI)____________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: Antidepressant effect probably due to inhibition of CNS neuronal reuptake of serotonin and to a lesser extent to norepinephrine and dopamine neuronal reuptake. Not related chemically to tricyclic, tetracyclic, or other antidepressants. Slight to no anticholinergic, sedative, or orthostatic hypotensive effects. Indications: (1) Depression. (2) Obsessive-compulsive disorder. (3) Panic disorder. (4) Bulimia nervosa. (5) Generalized anxiety disorder. (6) Premenstrual dysphoric disorder. (7) Posttraumatic stress disorder. (8) Social anxiety disorder. Investigational: Enuresis. Contraindications: Hypersensitivity to any SSRI or any components of the products. Use in combination with a MAOI or within 14 days of stopping an MAOI. Lactation. Interactions: Other psychotropic drugs. IV: Y-Site Compatibilities (if appropriate): N/A IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) N/A Adverse Reactions/Side Effects: CNS: neuroleptic malignant syndrome, seizures, suicidal thoughts, anxiety, drowsiness, HA, insomnia nervousness, abnormal dreams, dizziness, fatigue, hypomania, mania, weakness EENT: mydriasis, stuffy nose, visual disturbances CV: chest pains, palpitations RESP: cough GI: abdominal pain, abnormal taste, anorexia, constipation, dry mouth, dyspepsia, N/V/D, wt loss MSK: arthralgia, back pain, myalgia GU: sexual dysfunction, urinary frequency DERM: increased sweating, pruritus, erythema nodusum, flushing, rashes LOCAL: tremor, dysmenorrheal, hyponatremia MISC: serotonin syndrome, allergic reactions, fever, flu-like syndrome, hot flashes, sensitivity reactions Nursing Considerations/Implications: 1. 2. 3. Administer in AM with or without food (as directed). Avoid other non-RX or OTC agents and alcohol during therapy. Note reasons for therapy, behavioral manifestations, symptom onset/characteristics, and contributing factors. List other drugs prescribed to ensure none interact; note agents trialed and outcome. Differentiate type of depression based on diagnostic features related to reactive, major depressive, or bipolar affective disorders. Assess for dysphoric mood, suicidal ideations, and excessive appetite/weight changes. Include behavioral health review. Note sleep disturbances, lethargy, apathy, impaired thought processes, or lack of response.

4.

Antidote (if appropriate): If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Lab/Diagnostic Test (if appropriate): Monitor CBC, proteinuria, and mild increase in AST, make cause electrolytes out of balance.

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NUR 201 DRUG CARD
Student: ________________________ Generic Name: topiramate ________ Trade Name(s): Topamax _____ Classification: Anticonvulsant/Miscellaneous ________________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: May prevent seizure spread as opposed to an elevation of seizure threshold, increases GABA activity. Indications: Partial seizures in adults and children 2-16y/o, tonic-clonic seizures, seisures with Lenox-Gastaut syndrome, migraine prophylaxis. Unlabeled uses: infantile spasms, bipolar disorder, alcohol dependence, absence seizures, neuropathic pain, cluster headaches, mania. Contraindications: hypersensitivity, metabolic acidosis, pregnancy cat D. Precautions: breastfeeding, children, renal/hepatic disease, acute myopia, secondary closed angle glaucoma, behaviorial disorders, COPD, dialysis, encephalopathy, status asthmaticus, status epilepticus, surgery, paresthesias, maculopathy. Interactions: Increase: renal stones-carbonic anhydrase inhibitors, increase- effect of amitriptyline, increase-CNS depression-alcohol, CNS depressants, increase- topiramate levels-metformin, HCTZ, lamotrigine, decrease- levels of oral contraceptives, estrogen, digoxin, valproic acid, lithium, risperidone. IV: Y-Site Compatibilities (if appropriate): N/A IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) N/A Adverse Reactions/Side Effects: CNS: EENT: RESP: GI: GU: MISC: Dizziness, fatigue, cognitive disorders, insomnia, anxiety, depression, paresthesia, memory loss, tremor, motor retardation, suicidal ideation Diplopia, vision abnormalities Upper respiratory tract infection, pharyngitis, sinusitis Diarrhea, anorexia, nausea, dyspepsia, ABD pain, constipation, dry mouth, pancreatitis Breast pain, dysmenorrhea, menstrual disorder weight loss, leukopenia, metabolic acidosis, increased body temp, unexplained death (epilepsy)

Nursing Considerations/Implications: 1. 2. 3. Assess seizures: type, duration, location, size, and aura. Bipolar: assess mood, behavior. Migraines: assess pain, location duration, alleviating factors.

Antidote (if appropriate): If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Lab/Diagnostic Test (if appropriate): Renal studies: UA, BUN, Urine creatinine Q3 months, s/s of renal colic. Hepatic studies: ALT, AST, bilirubin if pt. is receiving long term treatment. CBC during long term treatment (anemia), serum bicarbonate (metabolic acidosis).

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NUR 201 DRUG CARD
Student: ________________________ Generic Name: sertraline ________ Trade Name(s): Zoloft _____ Classification: Antidepressant ________________________________ Administration Routes: PO _√_ SQ ___ IM ___ IV ___ Transdermal ____ Ophth_____ Action: Inhibits serotonin reuptake in CNS, increases action of serotonin, doesn’t affect dopamine or epi. Indications: Major depressive disorder, OCD, PTSD, panic disorder, social anxiety disorder, premenstrual dysphoric disorder (PMMD). Unlabeled uses: Premature ejaculation, pruritis with cholestatic liver disease, hot flashes during menopause, breast cancer pts. taking tamoxifen, men with prostate cancer secondary to androgen-deprivation therapy. Contraindications: Hypersensitivity,to this product, or SSRI’s. Precautions: pregnancy cat C, breastfeeding, geriatric pts. renal/hepatic disease, epilepsy, recent MI, latex sensitivity (dropper of oral concentration) Interactions: Altered lithium levels: lithium, Disulfiram reaction: disulfiram and oral concentration due to alcohol content, FATAL reactions: MAOIs & pimozide, Increase: sertraline levels-cimetidine, warfarin, and other highly protein-bound products, effects of antidepressant(tricyclics), diazepam, tolbutamide, benzodiazapines, sumatrpitam, phenytoin, clozapine. Increased bleeding risk-anticoagulants,NSAIDs, thrombolytic, platelet inhibitors, salicylates. Increase: serotonin syndrome, neuroleptic malignant syndrome-SSRIs, SNRIs, serotonin receptor agonists, tricyclics,sibutramine, trazodone, buspirone, linezolid, tramadol. IV: Y-Site Compatibilities (if appropriate): N/A IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) N/A Adverse Reactions/Side Effects: CNS: Insomnia, agitation, fatigue somnolence, dizziness, headache, tremor, paresthesia, twitching, confusion, ataxia, gait abnormalities(geriatric), seizures, neuroleptic malignant=syndrome-like reaction, serotonin syndrome, suicidal ideations vision abnormalities, yawning palpitations, Chest pain N/V/D, constipation, dry mouth, dyspepsia, flatulence, weight loss/gain male sexual disfunction, micturition disorder Increased sweating, rash, hot flashes SIADH(geriatric pts), Hyponatremia

EENT: CV: GI: GU: DERM: ENDO:

Nursing Considerations/Implications: 1. 2. Assess mental status: mood, affect, suicidal tendencies, increase in psychiatric symptoms, depression, panic attacks, PTSD, OCD, social anxiety disorder. Monitor for orthostatic hypotension, and hold med, if b/p drops 20mm/hg..

Antidote (if appropriate): If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call their local poison control center at 1-800-222-1222. Lab/Diagnostic Test (if appropriate): LFTs at baseline and periodically.

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NUR 201 DRUG CARD
Student: ________________________ Generic Name: olanzapine ________ Trade Name(s): Zyprexa _____ Classification: Antipsychotic/neuroleptic ________________________________ Administration Routes: PO _√_ SQ ___ IM _√__ IV ___ Transdermal ____ Ophth_____ Action: May mediate antipsychotic activity by both dopamine, and serotonin type 2 (5-HT2) antagonists, may antagonize muscarinic receptors, histaminic (H1-and a-adrenergic receptors. Indications: Schizophrenia, acute manic episodes with bipolar disorder, acute agitation. Unlabeled use: acute psychosis Contraindications: Hypersensitivity, Precautions: pregnancy cat C, breastfeeding, geriatrics, HTN, cardiac/renal/hepatic disease, DM, agranulocytosis, abrupt discontinuation, Asian pts., closed-angle glaucoma, coma, leukopenia, QT prolongation, tardive dyskinesia, torsades de pointes. Black Box warning: increased mortality in elderly pts. with dementia,-related psychosis, post injection delirium/sedation syndrome. Interactions: SSRIs and SNRI’s-serotonin syndrome, neuroleptic malignant syndrome, increase sedation/HoTN-alcohol, antihypertensives, diazepam, barbituates, sedatives, hypnotics, antidepressants. IV: Y-Site Compatibilities (if appropriate): N/A IV: Rate of Administration (expressed in mL/hour, mg/min, or mcg/kg/min) N/A Adverse Reactions/Side Effects: CNS: EPS: (pseudoparkinsonism, alkathisia, dystonia, tardive dyskinesia), seizures, headaches, agitation, nervousness, hostility, dizziness, tremor, hypertonia, euphoria, confusion, drowsiness, fever, abnormal gait, fatigue,insomnia CV: Tachycardia, HoTN, chest pain heart failure, sudden death syndrome (geriatric) orthostatic HoTN, peripheral edema RESP: Cough, pharyngitis, fatal pneumonia (geriatrics) GI: Dry mouth, nausea, vomiting, ABD pain, appetite, dyspepsia, anorexia, constipation, weight gain, jaundice, hepatitis. MS: Joint pain, twitching GU: Urinary retention, urinary frequency, enuresis, impotence, amenorrhea, gynecomastia, breast enlargement, premenstrual syndrome. HEMAT: neutropenia DERM: rash ENDO: Increased prolactin levels, hypo/heperglycemia MISC: Peripheral edema, accidental injury, hypertonia, hyperlipidemia Nursing Considerations/Implications: 1. 2. 3. Assess mental status, mood, affect, behavior, presence of hallucinations and type before initial administration. Monitor orientation, LOC, reflexes, gait, orthostatic B/P. Supervise and assist when ambulating pt.

Antidote (if appropriate): If overdose: lavage if orally ingested, provide airway support, do not induce vomiting or use epinephrine. Lab/Diagnostic Test (if appropriate): Monitor bilirubin, CBC, UA.